Download NEET PG 2013 Question Paper with Answers

Download NEET PG (The National Eligibility cum Entrance Test Postgraduate) 2013 Question Paper with Answers

1.Firstcarpalbonetoappearis?
a)Trapezium
b)Capitate
c)Pisiform
d)Lunate
CorrectAnswer-B
Ans.is'B'i.e.,Capitate[RefReddy'sEssentials26th/ep.63]
Theossificationcentresincarpalbonesappearasfollows:
nCapitate
1year
nHamate
2years
nTriquitrum
3years nLunate
4years
nScaphoidandtrapezoid 5years nTrapezium 6years
nPisiform
11years

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2.Pharyngealmusclesarederivedfrom
whichpharyngealarch?
a)1st
b)2nd
c)3rd
d)5th
CorrectAnswer-C
3rd

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3.Spinalcorddevelopsfrom?
a)Neuraltube
b)Mesencephalon
c)Rhombencephalon
d)Prosencephalon
CorrectAnswer-A
Ans.is'a'i.e.,Neuraltube
Nervoussystemdevelopsfromectoderm(neuroectoderm).Nervous
systemdevelopsfromneuraltubewhichinturndevelopsbyprocess
ofneurulation,i.e.formationofneuralplateanditsinfoldinginto
neuraltube.Structuresformedfromneuraltubeare:?
1.Fromcranialpart(enlargedcephalicpart)
Givesrisetobrain.Developmentalpartsare:
Forebrain(prosencephalon)
Telencephalon:Cerebralhemisphereandlateralventricle.
Diencephalon:Opticcupandstalk(givesrisetoretina),pituitary,
thalamus,hypothalamus,epithalamus,pinealgland,andthird
ventricle.
Midbrain(mesencephalon)
Cerebralaqueduct.
Hindbrain(rhombencephalon)
Metencephalon:Cerebellum,pons
Myelencephalon:Medullaoblongata
2.Fromcaudalpart
Givesrisetospinalcord.

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4.

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Collectingpartofkidneydevelopsfrom?
a)Pronephrons
b)Mesonephros
c)Metanephros
d)Uretericbud
CorrectAnswer-D
Ans.is'd'i.e.,Uretericbud
Developmentofkidney
Kidneysdevelopfromtwosources:
Metanephros(metanephricmesodermorblastema):Itisthelowest
partofnephrogeniccordwhichisderivedfromintermediate
mesoderm.Itformstheexcretoryunitofkidneyi.e.glomeruls,
proximalconvolutedtubule,loopofhenleanddistalconvoluted
tubule.
Uretericbud:Itarisesfromlowerpartofmesonephricduct.Itforms
collectingpartofkidney(pelvis,majorcalyes,minorcalyces,
collectingtubules)andureter.

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5.whichlevelthesomitesinitiallyform?
a)Thoraciclevel
b)Cervicallevel
c)Lumbarlevel
d)Sacrallevel
CorrectAnswer-B
Ans.is'b'i.e.,Cervicallevel
Thefirstpairofsomitesdevelopashortdistanceposteriortothe
cranialendofthenotochord,andtherestofthesomitesfrom
caudally.
"Bythe20"day,thefirstpairofsomiteshaveformedinneckregion."
Textbookofembryology
Paraxialmesodermdifferentiatesintosomites.Bytheendof20th
day,thefirstpairofsomiteshaveformedinneckregion.Afterthis,
about3pairsofsomitesareformedperdayandbytheendof5"
weekabout42-44somitepairsareformed(4-occipital,8-cervical,
12-thoracic,5-lumbar,5-sacraland8-10cooccygeal).Somitesare
furtherdifferentiatedinto:-
Dermatomyotome:-Giverisetoskeletalmusclesanddermis.
Sclerotomes:-Giverisetovertebralcolumn.

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6.Doubleinferiorvenacavaisformeddue
to?
a)Persistenceofsacrocardinalveins
b)Persistanceofsupracardinalveins
c)Persistanceofsubcardinalveins
d)Persistanceofbothsupracardinalandsubcardinalveins
CorrectAnswer-D
Ans.is'd'i.e.,Persistanceofbothsupracardinalandsubcardinal
veins
Developmentalanomaliesofveins
A.AnomaliesofSVC
Leftsuperiorvenacavaisformedwhenleftanteriorcardinaland
commoncardinalveinspersistandtherightonesobliterate.Left
SVCopensintorightatriumthroughthecoronarysinus.
Doublesuperiorvenacavaoccursduetopersistenceofleftanterior
cardinalvein.TherightSVCopensdirectlyintorightatriumwhileleft
oneopensthroughcoronarysinus.
B.AnomaliesofIVC
Absenceofinferiorvenacavaaboverenalveinsoccurswhenthe
anastomoticchannelbetweenrightsubcardinalveinandright
lepatocardinalchannelfailstodevelop.
Doubleinferiorvenacavaisformedbelowrenalveinsdueto
persistenceofboththesubcardinalandsupracardinalveinsbelow
thekidney.
Leftinferiorvenacava,i.e.infrarenalpartofIVCisformedonleft
sideinsteadofright.
PreuretericIVCisformedwheninfrarenalpartofIVCdevelopsfrom
subcardinalvein(whichliesanteriortoureter)insteadof

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supracardinalvein(whichliesposteriortoureter).

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7.Jellyformedaroundthehearttubeduring
earlydevelopment,contributestothe
formationof:
a)Pericardium
b)Mesocardium
c)Myocardium
d)Endocardium
CorrectAnswer-C
Ci.e.Myocardium
Dorsalmesocardiumformstransversepericardialsinus;
somatopleuricmesodermformsparietalpericardium;
splanchnopluricmesodermformsmyocardium&conductionsystem
ofhearts(i.e.Purkinjefibers);neuralcreastcellsform
subpulmonaryinfundibulum.
Cardiacjellyformsendocardialcushionandmyocardium

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8.Theretinaisanoutgrowthofthe?
a)Mesencephalon
b)Diencephalon
c)Telencephalon
d)Pons
CorrectAnswer-B
Ans.is'b'i.e.,Diencephalon
Diancephalonforms-opticcupandstalk,pituitary,thalmus,
hypothalmus,epithalmus,pinealgland(orepiphysis),and3rd
ventricle(mostpart).
Retinadevelopsfromwallsofopticcup.Theouterthinnerlayer
becomesretinalpigmentedepitheliumandinnerthickerlayerforms
neurallayerofretina.
Forebrain(prosencephalon)consistsoftelencephalon(anterioror
rostralpart)anddiencephalon(posteriororcaudalpart).

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9.ArchofAortadevelopsfromwhichaortic
archartery?
a)RightPt
b)Right3rd
c)Left4th
d)Left3rd
CorrectAnswer-C
Ans.is'c'i.e.,Left4th

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10.Muscleofthirdarch?
a)Tensortympani
b)Stylopharyngeus
c)Cricothyroid
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Stylopharyngeus
Stylopharyngeusisthemuscleof3rdpharyngealarch.

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11.Sinusvenosusreceivesbloodfromall
except?
a)Vitellinevein
b)Umbilicalvein
c)Commoncardinalvein
d)Subcardinalvein
CorrectAnswer-D
Ans.is'd'i.e.,Subcardinalvein
Sinusvenosus:Itisthecaudalmostpartoftubularheart.Atits
lowerenditpresentsrightandlefthorns.Eachhornreceives
bloodfromfollowingthreeveins:
1. Vitellineveinfromyolksac.Rightvitellineveinformsterminalpartof
interiorvenacava.
2. Umbilicalveinfromplacenta.
3. Commoncardinalveinfrombodywall.Rightcommoncardinalvein
formssuperiorvenacava.

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12.Mastoidprocessiswhichtypeof
epiphysis
a)Pressure
b)Aberrant
c)Atavistic
d)Traction
CorrectAnswer-D
Ans.is'd'i.e.,Traction
Typesofepiphysis
Theepiphysisareoffollowingfourtypes:?
1. Pressureepiphysis:Itiscoveredbyanarticularcartilageandtakes
partinthetransmissionofbodyweight,e.g.headoffemur,headof
humerus,condylesoftibia,lowerendofradiusetc.
2. Tractionepiphysis:Itisnon-articularanddoesnottakepartin
weighttransmission.Itisproducedbyapullofthemuscle.
Examplesaregreaterandlessertrochantersoffemur,greaterand
lessertuberclesofhumerusandmastoidprocess.
3. Atavisticepiphysis:Itisanindependentboneinlowermammals,
whichinmangetsfusedtothenearestbonetoreceivenutritionfrom
thehostbone.Examplesarecoracoidprocessofscapula,posterior
tubercleoftalus(ostrigonum),etc.
4. Aberrantepiphysis:Itisanepiphysiswhichappearsatunusualend
ofashortlongbone,e.g.headofPtmetacarpalandbaseofother
metacarpals.

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13.Collagenfoundinhyalinecartilageis?
a)TypeI
b)TypeII
c)TypeIV
d)Typev
CorrectAnswer-B
Ans.is'b'i.e.,TypeII

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14.

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Billorth'scordarepresentinwhichpartof
spleen?
a)Whitepulp
b)Redpulp
c)Both
d)Capsule
CorrectAnswer-B
Ans.is`b'i.e.,Redpulp
Histologyofspleen
Spleenhasacapsulewhichismainlycomposedofcollagenwith
someelastin.Trabeculaeareseptaepassinwardsfromthecapsule.
Spleenismainlycomposedoftwoparts:
1. Whitepulp:ThewhitepulpofthespleenisformedofmassofTand
Blymphocytessurroundingcentralartery,arrangedaslymphoid
nodule.EachnoduleisalsocalledMalpigianbodies.Marginalzone
surroundsthewhitepulpandcontainsantigenpresentingcellsas
macrophages.
2. Redpulp:Redpulpismadeupofameshofleakysinusoids
(vascularsinuses)throughwhichtheredcellsaresqueezed.
Adjacentbloodspacescontainbloodcellsandarrangedincords
calledspleniccordsofbillorth.

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15.

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B-cellsaredispersedinwhichpartofspleen?
a)Whitepulp
b)Redpulp
c)Capsule
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Whitepulp

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16.

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Folliclesarepresentinwhichpartoflymph
nodes?
a)Redpulp
b)Whitepulp
c)Cortex
d)Medulla
CorrectAnswer-C
Ans.is'c'i.e.,Cortex

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17.Hyoidliesatthelevelof?
a)C3
b)C,
c)C7
d)T2
CorrectAnswer-A
Ans.is'a'i.e.,C3
Surfaceanatomyoflarynxare:
C,Levelofbodyofhyoidanditsgreatercornu.
C3-C,JunctionLevelofupperborderofthyroidcartilageand
bifurcationofcommoncarotidartery.C4-C,JunctionLevelofthyroid
cartilage.
C6Levelofcricoidcartilage.

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18.Pubicsymphysisiswhichtypeofjoint?
a)Gomphosis
b)Fibrousjoint
c)Primarycartilaginous
d)Secondarycartilaginous
CorrectAnswer-D
Ans.is'd'i.e.,Secondarycartilaginous
Pubicsymphysisisasecondarycartilaginousjoint(symphsesor
fibrocartilaginousjoint).

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19.Epithelialliningofurinarybladder?
a)Squamous
b)Transitional
c)Cuboidal
d)Columnar
CorrectAnswer-B
Ans.is'b'i.e.,Transitional
Urothelium(transitionalepithelium)isfoundinrenalpelvis,calyces,
ureter,urinarybladder,proximalpartofurethra.

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20.Trueaboutcardiacmuscleis?
a)Spindleshaped
b)Largecentralnucleus
c)Nogapjunctions
d)Arrangedinsheets
CorrectAnswer-B
Ans.is'b'i.e.,Largecentralnucleus

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21.Clavipectoralfasciaisderivedfromwhich
ligament?
a)Coracoacromial
b)Coracoclavicular
c)Costoclavicular
d)Costocoracoid
CorrectAnswer-D
Ans.is'd'i.e.,Costocoracoid

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22.Allareinfraclavicularbranchesofbrachial
plexusexcept?
a)Ulnarnerve
b)Longthoracicnerve
c)Axillarynerve
d)Thoracodorsalnerve
CorrectAnswer-B
Ans.is`b'i.e.,Longthoracicnerve

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23.Rootvalueofthoracodorsalnerve?
a)C5,C6,C7
b)C8,T1
c)C6,C7,C8
d)TiT2
CorrectAnswer-C
Ans.is'c'i.e.,C6C7C8
Branchesofbrachialplexus
Branchesofbrachialplexusarisesfromdifferentanatomical
segments:-
1.Branchesoftheroots
Nervetoserratusanterior(longthoracicnerve)(C5,C6,C7).
Nervetorhomboideus(dorsalscapularnerve)(C5).
2.Branchesofthetrunks
Theseariseonlyfromtheuppertrunkwhichgivestwobranches.I.
Suprascapularnerve(C5,C6)
Nervetosubclavius(C5,C6)
3.Branchesofthecords
1.Branchesoflateralcord
Lateralpectoral(C5-C7)
Musculocutaneous(C5-C7)
Lateralrootofmedian(C5-C7)
2.Branchesofmedialcord
Medialpectoral(C8,T1)
Medialcutaneousnerveofarm(C8,TO
Medialcutaneousnerveofforearm(C8,Ti).

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Ulnar(C7,C8,Ti).C7fibresreachbyacommunicatingbranchfrom
lateralrootofmediannerve.
Medialrootofmedian(C8,T1).
3.Branchesofposteriorcord
Uppersubscapular(C5,C6)
Nervetolatissimusdorsi(thoracodorsal)(C6,C7,CO
Lowersubscapular(C5,C6)
Axillary(circumflex)(C5,C6)
Radial(C5-C8,T1)

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24.Largestbranchofbrachialplexusis
a)Ulnar
b)Medial
c)Radial
d)Axillary
CorrectAnswer-C
Ans.is'c'i.e.,Radial
Radialnerveisthelargestbranchofbrachialplexusandisthe
continuationofposteriorcord(rootvalueC5_8T1).

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25.Apersonhadinjurytorightupperlimbhe
isnotabletoextendfingersbutableto
extendwristandelbow.Nerveinjuredis?
a)Radial
b)Median
c)Ulnar
d)Posteriorinterosseus
CorrectAnswer-D
Ans.is'd'i.e.,Posteriorinterosseus
Inposteriorinterosseusnerveinjury,wristextensionispreserved
duetosparedECRL,hencethereisnowristdrop.
Thereislossofextensionofmetacarpophalangealjoints,hence
thumbandfingerdropoccurs.oInradialnerveinjury,thereiswrist
drop.
Clinicalfeaturesofradialnervepalsy
Clinicalfeaturesdependuponthesiteoflesion.
1.Iflesionishigh
Wristdrop,thumbdropandfingerdrop.
Inabilitytoextendelbow,wrist,thumb&fingers(MPjoint)
Patientcanextendinterphalangealjointsduetoactionoflumbricals
andinterossei.
Sensorylossoverposteriorsurfaceofarm&forearmandlower
lateralhalfofforearm.
2.Iflesionislow
TypeI
Wristdrop,thumbdropandfingerdrop.
Elbowextensionispreserved.

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Sensorylossoverthedorsumoffirstwebspace.
TypeH
Thumbdropandfingerdrop
Elbowandwristextensionispreserved
Sensorylossoverthedorsumoffirstwebspace
Clinicalfeaturesofposteriorinterosseusnerve
Itispronetobeinjuredininjury&operationsofradialhead-neck.
Thereisnosensorydeficitasitisapuremotornerve.
Wristextensionispreserved(i.e.nowristdrop)duetospared
extensorcarpiradialislongus.
Presentswithlossofextensionofmetacarpophalangeal(MP)joints
i.e.,thumb&fingerdrop.

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26.Whichmusclewillbeparalyzedwhen
radialnerveisinjuredinjustbelowbe
spiralgroove?
a)Lateralheadoftriceps
b)Medialheadoftriceps
c)Longheadoftriceps
d)ECRL
CorrectAnswer-D
Ans.is'd'i.e.,ECRL
Radialnerveinjury
Radialnerveinjurymaybehighorlow.
1.Highradialnervepalsy
Injuryisbeforethespiralgroove
Allmusclessuppliedbyradialnerveareparalysed.
2.Lowradialnervepalsy
Injuryisafterthespiralgroove.
Lowradialnervepalsymaybeoftwotypes.
Injuryoccursbetweenthespiralgrooveandelbowjoint.
Musclesinvolvementis:?
Elbowextensors(Triceps,anconeus)arespared.
Wrist,elbowandfingerextensorsareparalysed.
Sensorylossinfirstwebspace(ondorsalside)
Injuryoccursbelowtheelbowjoint.
Elbowextensors(triceps,anconeus)andwristextensors(ECRL)are
spared.
Fingerextensors(extensordigitorum,extensordigitiminimi,
extensorindicis)andthumbextensors(extensorpollicislongus&

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brevis)areparalysed.
Sensorylossinfirstwebspace(ondorsalside).

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27.Inarmulnarnervegivesmuscularbranch
towhichmuscle?
a)FCU
b)FDP
c)Both
d)None
CorrectAnswer-C
Ans.is'C'i.e.,both
ReferenceBDC4theditionvolume1,pg157.

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28.Distalendofhumerousdevelopsfrom
howmanycentres?
a)2
b)5
c)3
d)4
CorrectAnswer-D
Ans.is'd'i.e.,4
PartofhumerusOssification
ShaftOneprimarycenter
UpperendThreesecondarycenters?
1. Oneforhead(appearsin1"year).
2. Oneforgreatertubercle(appearsin2n?year).
3. Oneforlessertubercle(appearsin5thyear).
Thisthreecentersfusestogetherduring6thyearandfinallywith
shaftduring20thyear.
LowerendFoursecondarycenters
1. Oneforcapitulum&lateralflangeoftrochlea(19tyear).
2. Oneformedialflangeoftrachlea(9thyear).
3. Oneforlateralepicondyle(12thyear).
4. Thesethreefuseduring14thyeartoformoneepiphysiswhichfuses
withshaftat16years.
5. Oneformedialepicondyle(4-6years),whichseparatelyfuseswith
shaftduring20thyear.

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29.Radialbursaisthesynovialsheath
coveringthetendonof?
a)FDS
b)FDP
c)FPL
d)FCR
CorrectAnswer-C
Ans.is'c'i.e.,FPL

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30.Allaretrueregardingaxillarylymph
nodesexcept?
a)Posteriorgroupliesalongsubscapularvessels
b)Lateralgroupliesalonglateralthoracicvessels
c)Apicalgroupliesalongaxillaryvessels
d)Apicalgroupisterminallymphnodes
CorrectAnswer-B
Ans.is'b'i.e.,Lateralgroupliesalonglateralthoracicvessels
Axillarylymphnodes
Theaxillarylymphnodesaredividedinto5groups:?
1. Anterior(pectoral)group:-Liealonglateralthoracicvessels,i.e.
alongthelateralborderofpectoralisminor.Theyreceivelymphfrom
upperhalfoftheanteriorwalloftrunkandfrommajorpartofbreast.
2. Posterior(scapular)group:-LiealongtheSubscapularvessels.
Theyreceivelymphfromtheupperhalfoftheposteriorwalloftrunk
andaxillarytail.
3. Lateralgroup:-Liealongtheupperpartofthehumerus,medialto
theaxillaryvein.Theyreceivelymphfromupperlimb.
1. Centralgroup:-Lieinthefatoftheupperaxilla.Thereceivelymph
fromtheprecedinggroupsanddrainintoapicalgroup.The
intercostobrachialnerveiscloselyrelatedtothem.
2. Apical(infraclavicular)group:-Liedeeptotheclavipectoralfascia
alongtheaxillaryvessels.Theyreceivelymphfromcentralgroup,
upperpartofbreastandthethumbanditsweb.Thesearecalled
terminalgroupoflymphnodes,astheyreceivelymphaticsfrom
othernodesofbreast.

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31.Allaretrueaboutmammarygland,except
?
a)Isamodifiedsweatgland
b)Extendsfrom2ndto6thribvertically
c)Suppliedbyinternalmammaryartery
d)Nippleissuppliedby6thintercostalnerve
CorrectAnswer-D
Ans.is'd'i.e.,Nippleissuppliedby6thintercostalnerve
Mammarygland
Breast(mammarygland)isamodifiedsweatglandpresentinthe
superficialfasciaofpectoralregion.
Verticallyitextendfrom2ndto6thribsatmidclavicularlineand
horizonalextentisfromsternalmargintomidaxillarylineatthelevel
of4thrib
Arterialsupplyofbreastincludes?
PerforatingbranchesofinternalmammaryarteryinII,III,
IVintercostalspaces.
Thoracoacromial,lateralthoracicandsuperiorthoracicbranchesof
axillary.
Mammarybranches,from2nd,3rdand4thposteriorintercostal
arteries.
VenousDrainage
Thereisananastomoticcircleofveinsaroundthebaseofnipple-the
circulusvenosusofHaller.
Veinsfromthisandfromtheglandulartissueradiatetothe
circumferenceoftheglandanddrainintoaxillary,internalmammary
andposteriorintercostalveins.

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Nervesupply
Sensoryandsympatheticinnervationisviaanteriorandlateral
cutaneousbranchesof4th,5thand6thintercostalnerves.
Nippleismainlyinnervatedbythe4thintercostalnerve.

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32.Thenervesupplyofnailbedofindex
fingeris?
a)Superficialbrofradialnerve
b)Deepbrofradialnerve
c)Mediannerve
d)Ulnarnerve
CorrectAnswer-C
Ans.is'c'i.e.,Mediannerve

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33.Bounderiesofanatomicalsnuffboxareall
except
a)APL
b)EPL
c)EPB
d)ECU
CorrectAnswer-D
Ans.is'd'i.e.,ECU
AnatomicalSnuffbox
Triangulardepressiononthedorsalandradialaspectofthehand
becomevisiblewhenthumbisfullyextended.Boundaries
Medial/PosteriorTendonoftheextensorpollicislongus.
Lateral/AnteriorTendonoftheextensorpollicisbrevisand
abductorpollicislongus.
RoofSkinandfasciawithbeginningofcephalicveinand
crossedbysuperficialbranchoftheradialnerve.
FloorStyloidprocessofradius,trapezium,scaphoidandbaseof
1stmetacarpal.
ContentsTheradialartery.

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34.Whichofthefollowingmuscleisnotin
thepectoralregion?
a)Pectoralismajor
b)Infraspinatus
c)Pectoralisminor
d)Subclavius
CorrectAnswer-B
Ans.is'b'i.e.,Infraspinatus

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35.Whichmuscleoriginatesfromtendonof
othermuscle
a)Palmarislongus
b)FCR
c)Lumbricals
d)Adductorpollicis
CorrectAnswer-C
Ans.is'c'i.e.,Lumbricals

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36.Nerverunningalongwithprofundabrachii
artery,inspiralgroove?
a)Ulnar
b)Median
c)Radial
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Radial
Profundabrachiiisabranchofbrachialartery.
Itaccompaniesradialnerveinspiralgroove.
Branchesofprofundabrachiiarteryare:?
1. Deltoidbranch(ascendingbranch):-Itanastomoseswiththe
descendingbranchofposteriorcircumflexhumeralartery.
2. Nutrientarterytohumerus:
3. Muscularbranches
4. Posteriordescending(middlecollateral):-Itanastomoseswith
interosseousrecurrentbranchofulnarartery.
5. Anteriordescending(radialcollateral):Itanastomoseswithradial
recurrentbranchofradialarteryinfrontoflateralepicondyle.

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37.Allofthefollowingmuscleshavedual
nervesupplyexcept?
a)Subscapularis
b)Pectoralismajor
c)Pronatorteres
d)Flexordigitorumprofundus
CorrectAnswer-C
Ans.is'c'i.e.,Pronatorteres

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38.Whichofthefollowingisnotthemuscles
ofsuperficalanteriorcompartmentof
forearm?
a)FDS
b)FPL
c)FCR
d)Palmarislongus
CorrectAnswer-B
Ans.B.FPL
Musclesofsuperficialanteriorcompartmentofforearm:ECR,FDS,
FCU,Pronatorteres,palmarislongus
Musclesofdeepanteriorcompartmentofforearm:FDP,FPL,
Pronatorquadrantus.

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39.Contentsofmidpalmarspaceareall
except
a)2ndlumbrical
b)FDPof3rdfinger
c)1stlumbrical
d)FDPof4thfinger
CorrectAnswer-C
Ans.is'c'i.e.,1stlumbrical
Boundariesofmidpalmarspaceare:
Anterior-Flexortendonsof3rd,4th,and5thfingers
2nd,3rdand4thlumbricals
Palmaraponeurosis
Posterior-Fasciacoveringinterosseiandmetacarpals
Lateral-Intermediatepalmarseptum
Medial-Medialpalmarseptum
1stlumbricalispresentinthethenarspace

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40.Axillarynerveisaccompaniedbywhich
artery?
a)Axillary
b)Subscapular
c)Anteriorcircumflexhumeral
d)Posteriorcircumflexhumeral
CorrectAnswer-D
Ans.is'd'i.e.,Posteriorcircumflexhumeral
Axillarynerve
Axillarynerveisabranchoftheposteriorcordofbrachialplexus
withrootvalueC5andC6.Itleavestheposteriorwallofaxillaalong
withtheposteriorcircumflexhumeralvesselsthrouththe
quadrangularspace.Whilepassingthroughthequadrangularspace
itgivesitsfirstbranch,anarticulartwigtotheshoulderjoint.Thenit
dividesinto?
1. Anteriordivision:-Windsaroundthesurgicalneckofhumerusto
supplydeltoid.
2. Posteriordivision:-Itgivesof
3. Branchestoposteriorpartofdeltoid.
4. Nervetoteresminorwhichshowsapseudoganglion.
5. Upperlateralcutaneousnerveofarmsupplyingtheskincovering
lowerpartofdeltoid(regimentalbadgeregion).

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41.Nervesupplytothemusclesofflexor
compartmentofarm?
a)Radialnerve
b)Mediannerve
c)Musculocutaneousnerve
d)Ulnarnerve
CorrectAnswer-C
Ans.is'c'i.e.,Musculocutaneousnerve

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42.Musclecausingsupinationofforearm?
a)Bicepsbrachii
b)Brachioradialis
c)FDS
d)Anconeus
CorrectAnswer-A
Ans.is'a'i.e.,Bicepsbrachii
MovementMusclescausingmovement
PronationPronatorquadratus(strongpronator),Pronatorteres
(Rapidpronator).
SupinationSupinator(whenelbowisextended),Biceps(when
elbowisflexed

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43.3rdextensorcompartmentofwrist
containstendonof?
a)ECRL
b)ECRB
c)EPL
d)EPB
CorrectAnswer-C
Ans.C)EPL
Thethirdcompartmentcontainstheextensorpollicis
longustendon,whichoriginatesatthemid-ulnaandinsertsatthe
baseofthefirstdistalphalanx.
IncombinationwiththeEPBtendon,itextendsthethumbatthefirst
carpometacarpalandfirstinterphalangealjoints.

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

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45.Interosseousmembraneofforearmis
pierecedby?
a)Brachialartery
b)Anteriorinterosseousartery
c)Posteriorinterosseousartery
d)Ulnarrecurrentartery
CorrectAnswer-B
Ans.is'b'i.e.,Anteriorinterosseousartery
Theanteriorinterosseousarteryisthedeepestarteryonthefrontof
forearm.
Itisoneoftheterminalbranchofcommoninterosseousartery,
whichinturnisabranchofulnarartery.
Itisaccompoinedbyanteriorinterosseousnerve,abranchof
mediannerve.
Itdescendsonthesurfaceoftheinterosseousmembranebetween
theFDPandFPL.
Itpiercestheinterosseousmembraneattheupperborderofthe
pronatorquadratustoentertheextensor(dorsal)compartment.
Branchesofanteriorinterosseousarteryare:?
1. Muscularbranches:Fordeepmusclesoffrontofforearm.
2. Nutrientarterytoradiusandulna.
3. Medianartery.

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46.Truestatementaboutgreatsphenous
vein
a)Itbeginsatlateralendofdorsalvenousarch
b)Itrunsanteriortomedialmalleolus
c)Itisaccomponiedbysuralnerve
d)Terminatesintopoplitealvein
CorrectAnswer-B
Ansis'b'i.e.,Itrunsanteirortomedialmalleolus

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47.Neurovascularbundleofanterior
compartmentoflegpassesbetweenthe
tendonsof?
a)EHLandEDL
b)EDLandperoneustertius
c)TibialisanteriorandEHL
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,EHLandEDL

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48.Structurepassingdeeptoflexor
retinaculumis?
a)Posttibialartery
b)Longsaphenousvein
c)Tibialisant.tendon
d)Peroneustertius
CorrectAnswer-A
Ans.is'a'i.e.,Posttibialartery

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49.Whichmusclesisknownas'Triceps
surae'
a)Gastro-soleus
b)Popliteus
c)EHL
d)EDL
CorrectAnswer-A
Ans.is'a'i.e.,Gastro-soleus
Gastrocnemiusandsoleustogether(gastro-soleus)areknownas
tricepssurae.
Soleusisknownasperipheralhearthelpinginvenousreturnfrom
lowerlimb

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50.Thebloodsupplytofemoralheadis
mostlyby?
a)Lateralepiphysealartery
b)Medialepiphysealartery
c)Ligamentousteresartery
d)Profundafemoris
CorrectAnswer-D
Ans.is'd'i.e.,Profundafemoris
Arterialsupplyoffemoralhead?
1. Medialcircumflexfemoralartery(majorsupply).
2. Lateralcircumflexfemoralartery.
3. Obturatorarterythrougharteryofligamentumteres.
4. Intramedullaryvesselsinthefemoralneck.
Medialandlateralcircumflexfemoralarteriesarebranchesof
profandafemorisarterywhichinturnisabranch-offemoralartery.

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51.Mainbloodsupplytotheheadandneckof
femurcomesfrom
a)LateralcircumflexfemoralArtery
b)MedialcircumflexfemoralArtery
c)ArteryofLigamentumTeres
d)PoplitealArtery
CorrectAnswer-B
Ans.is'b'i.e.,MedialcircumflexfemoralArtery
Themedialcircumflexfemoralarteryalongwithitsretinacularand
epiphysealbranchessuppliesmostofthebloodsupplytothehead
andneckoffemur.
Arterialsupplyoffemoralheadhasbeenexplainedindetailsin
previoussessions.

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52.Trueaboutlineaaspera?
a)Formslateralborderoffemur
b)Formsmedialborderoffemur
c)Continuesasglutealtuberostiy
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Continuesasglutealtuberostiy

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53.Muscleattachedtolateralsurfaceof
greatertrochanter-
a)Gluteusmaximus
b)Gluteusmedius
c)Gluteusminimus
d)Piriformis
CorrectAnswer-B
Ans.is'b'i.e.,Gluteusmedius
Attachmentsofgreatertrochanter(GT)
Allareinsertions
PartofGT
Muscleinserted
Apex(tip)ofGT
Piriformis
Anteriorsurface(lateralpart) Gluteusminimus
Lateralsurface
Gluteusmedius
Medialsurface
Obturatorinternus&twogemelli
Trochantericfossa
Obturatorexternus

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54.Sacrotuberousligamentispiercedby
a)Perforatingcutaneousnerve
b)Posteriorfemoralcutaneous
c)Superiorglutealnerve
d)Sciaticnerve
CorrectAnswer-A
Ans:APerforatingcutaneousnerve
Sacrotuberousligament(STL)-
Stabiliserofsacro-iliacjoint.
Connectsbonypelvistovertebralcolumn.
StructurepiercingviaSTL-Perforatingcutaneousnerve.
Perforatingcutaneousnerve:
Cutaneousnervethatarisesfromthe52and53nerverootsofthe
sacralplexus.
Supplieslowermedialpartofbuttock.

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55.Thesuperficialexternalpudendalarteryis
abranchof?
a)Femoralartery
b)Externaliliacartery
c)Internaliliacartery
d)Aorta
CorrectAnswer-A
Ans.is'a'i.e.,Femoralartery
Femoralartery
Itisthemainarteryofthelowerlimb.Itbeginsasacontinuationof
externaliliacarterybelowtheinguinalligamentatmidinguinalpoint
midwaybetweenpubicsymphysisandanteriorsuperioriliacspine.It
descendsthroughfemoraltriangleandthenthroughadductorcanal.
Afterthatitendsbypassingthroughadductorhiatusintheadductor
magnusmuscletocontinueaspoplitealartery.
Branchesoffemoralarteryare:?
A.Infemoraltriangle
1. Superficialbranches:-(i)Superficialexternalpudendal,(ii)
Superficialepigastric,(iii)Superficialcircumflexiliac.
2. Deepbranches:-(i)Profundafemoris,(ii)Deepexternalpudendal,
(iii)Muscularbranches.
B.Inadductorcanal
Descendinggenicularartery.
Profundafemorisarteryisthelargestbranchoffemoralarteryand
suppliesallthreecompartmentsofthigh(anterior,medialand
posterior).Itarisesfromthelateralsideoffemoralarteryabout4cm
belowtheinguinalligament.Theprofundafemorisgivesofffollowing
branches:

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1. Medialcircumflexfemoral:-Majorsupplytotheheadoffemur.
2. Lateralcircumflexfemoral.
3. Fourperforatingarteries:-2"dperforatingarterygivesnutrientartery
tofemur.

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56.Linefrommidinguinalpointtoadductor
tuberclerepresent?
a)Inferiorepigastricartery
b)Femoralartery
c)Superiorepigastricartery
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Femoralartery
Femoralarteryentersthethighbehindtheinguinalligamentatthe
mid-inguinalpoint./tisrepresentedbytheuppertwo-thirdofaline
joiningthemid-inguinalpointtoadductortubercle.
Femoralveinhassamemarkingsasfemoralarteryexceptthatthe
upperpointistaken1cmmedialtomid-inguinalpointandlower
point1cmlateraltoadductortubercle.
Inferiorepigastricvesselsisrepresentedbytheuppertwo-thirdofa
linejoiningthemid-inguinalpointtoumblicus.

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57.Skinandfasciaofgreattoedrainsinto?
a)Superficialinguinallymphnodes
b)Externaliliacnodes
c)Internaliliacnodes
d)Deepinguinalnodes
CorrectAnswer-A
Ans.is'a'i.e.,Superficialinguinallymphnodes

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58.Lowerendoffemurisossifiedfromhow
manyossificationcenters:?
a)1
b)2
c)3
d)4
CorrectAnswer-A
Ans.is'a'i.e.,1
Therearethreeossificationcentersintheproximalfemoralend
locatedinitshead,greaterandlessertrochanters,whereasthere
existsonlyoneossificationcenterinthedistalfemoralend.

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59.Musclecausingflexionofhip?
a)Bicepsfemoris
b)Psoasmajor
c)Gluteusmaximus
d)TFL
CorrectAnswer-B
Ans.is'b'i.e.,Psoasmajor

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60.Sacralpromontoryisthelandmarkfor
a)Originofsuperiormesentericartery
b)Terminationofpresacaralnerve
c)Originofinferiormesentericartery
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Terminationofpresacaralnerve
Atthesacralpromontorylevelorjustcaudaltoit,thepresacral
nervesterminateandgiverisetorightandlefthypogastricnerves,
whichwilljointtheinferiorhypogastricplexusatthelevelofS2-S3-
S4.

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61.Esophagusispresentinallexcept?
a)Superiormediastinum
b)Middlemediastinum
c)Anteriormediastinum
d)Posteriormediastinum
CorrectAnswer-C
Ans.is'c'i.e.,Anteriormediastinum
Esophagusmainlydescendsinsuperiorandposteriormediastinum.
Esophagusisusuallynotacontentofmiddlemediastinum,butit
formsposteriorboundryofmiddlemediastinum(BDCVol.-1,6`"/ep.
246).
Esophagushasnorelationtoanteriormediastinum.Thus,among
thegivenoptions,bestanswerisanteriormediastinum.

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62.Esophagusispresentinwhich
mediastinum?
a)Anterior
b)Posterior
c)Middle
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Posterior

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63.

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Whichofthefollowingisrelatedto
mediastinalpartofrightlung?
a)Archofaorta
b)SVC
c)Pulmonarytrunk
d)Leftventricle
CorrectAnswer-B
Ans.is"b.''i.e.,SVC

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64.Posteriorsurfaceofheartisformedby-
a)RA
b)LA
c)LV
d)RV
CorrectAnswer-B
Ans.is'b>a'i.e.,LA>RA
Surfacesoftheheart
1. Anterior(sternocostal)surface:-Formedmostlybyrightventricle
(major)andrightauricleandpartlybyleftventricleandleftauricle.
2. Inferior(diaphragmatic)surface:-Itisformedbyleftventricle(left
2/3)andrightventricle(right1/3).Itistraversedbyposterior
interventriculargroove(PIV)containingPIVbranchofRCA.
3. Base(posteriorsurface):-Formedmainlybyleftatriumandpartly
byrightatrium.ItisseparatedfromT5toT,vertebraeby
pericardium,obliquepericardialsinus,esophagusanddescending
thoracicaorta.
4. Rightsurface:-Mainlybyrightatrium.
5. Leftsurface:-Mainlybyleftventricleandpartlybyleftauricle.

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65.

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Anterosuperiorsternalpartofheartismade
upof?
a)Rightatriumandauricle
b)Leftatrium.
c)Leftventricle
d)Rightventricle
CorrectAnswer-D
Ans.is'd'i.e.,Rightventricle

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66.Posteriortosternumis?
a)Leftatrium
b)Leftventricle
c)Rightatrium
d)Rightventricle
CorrectAnswer-D
Ans.is'd'i.e.,Rightventricle
Normally,mostoftheanteriorportionofrightventricleisincontact
withsternum.
Itisforthisreasonthatsternalandparasternalinjurycommonly
resultsinrightvantricularinjury.

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67.Nottrueaboutrightbronchus
a)Shorter
b)Wider
c)Morehorizontal
d)Inthelineoftrachea
CorrectAnswer-C
Ans.is'c'i.e.,Morehorizontal
TracheabifurcatesatCarina(atlowerborderofT4vertebraatT4-T,
discspace)intorightandleftprincipal(primary)bronchi.
Rightprincipalbronchusiswider,shorter(2.5cmlong),andmore
verticalinthelineoftrachea(25?withmedianplane.
Thereforeaforeignbodyismostlikelytolodgeintherightbronchus.
Rightbronchusdividesintoepiarterialandhyparterialbronchi,
passingrespectivelyaboveandbelowthepulmonaryartery,before
enteringthehilum.
Leftprincipalbronchusisnarrower,longer(5cmlong)andmore
horizontal(45?withmedianplane).
Leftbronchuscrossesinfrontoftheesophagusproducingaslight
constriction.
Insidethelungitdividesinto2lobarbronchi:upperandlower.

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68.Thoracicductdoesnotdrains?
a)Rightupperpartofbody
b)Leftupperpartofbody
c)Rightlowerpartofbody
d)Leftlowerpartofbody
CorrectAnswer-A
Ans.is'a'i.e.,Rightupperpartofbody
Thoracicduct
ThoracicductisalsocalledasPecquetduct.
Itisthelargestlymphaticductinbody,about45cm(18inches)long.
Ithasabeadedappearancebecauseofthepresenceofmany
valvesinitslumen.
Thoracicductbeginsasacontinuationoftheupperendofthe
cisternachylinearthelowerborderofT12vertebraandentersthe
thoraxthroughtheaorticopeningofdiaphragm(atT12).
ItthenascendsthroughtheposteriormediastinumandatT5level
crossesfromrightsidetotheleftsideandascendsalongleftmargin
ofoesophagustoentertheneck.
AtthelevelofC7vertebrae,archestowardsleftsidetoopenintoleft
brachiocephalicveinattheangleofunionofleftsubclavianandleft
internaljugularveins.
Thoracicductreceiveslymphfrombothhalvesofthebodybelowthe
diaphragmandthelefthalfabovethediaphragm.
Itstributariesare:-
1. Rightandleftlumbartrunk.
2. Inthorax:-Posteriormediastinalnodes,smallintercostallymph
nodes.
3. InNeck:-Leftjugulartrunk,leftsubclaviantrunkandleft

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bronchomediastinaltrunk.

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69.Uppertwoposteriorintercostalarteries
arisefrom?
a)Aorta
b)Superiorintercostalartery
c)Internalmammaryartery
d)Bronchialartery
CorrectAnswer-B
Ans.B)Superiorintercostalartery
The1stand2ndposteriorintercostalarteriesarisefromthe
supremeintercostalartery,abranchofthecostocervicaltrunkof
thesubclavianartery.
Thelowerninearteriesaretheaorticintercostals,socalled
becausetheyarisefromthebackofthethoracicaorta.

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70.Trueaboutanteriorintercostalartery?
a)Presentin1stto11thintercostalspace
b)Eachintercostalspacehastwoanteriorintercostalarteries
c)Branchofinternalthoracicartery
d)Branchofaorta
CorrectAnswer-C
Ans.is'c'i.e.,Branchofinternalthoracicartery
Eachofuppernineintercostalspaces(1to9)haveoneposterior
andtwoanteriorintercostalarteries.The10"and11"spaceshave
oneposteriorintercostalartery(noanteriorintercostalartery)
Posteriorintercostalarteryisthemainarteryofintercostalspace
andrunsinthecostalgroovealongtheupperborderofan
intercostalspace,lyingbetweenposteriorintercostalveinand
intercostalnerve(relationshipfromabovedownwardVAN).1"and2'
posteriorintercostalarteriesarebranchesofsuperiorintercostal
artery(abranchofcostocervicaltrunkfrom2"dpartofsubclavian
artery*05)).Lowernine(3rdto11`")posteriorintercostalarteriesare
branchesofdescendingthoracicaorta.Rightposteriorintercostal
arteriesarelongerthantheleft.
Anteriorintercostalarteriesforuppersixspaces(twoineachspace)
arisefrominternalthoracicorinternalmammaryartery.For7thto9th
spaces,thesearebranchesofmusculophrenicartery(terminal
branchofinternalthoracicartery).

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71.Carinaissituatedatwhichlevel?
a)T3
b)T4
c)T6
d)T9
CorrectAnswer-A
Ans.is'13'i.e.,T4
Tracheabifurcatesatcarina,attheleveloflowerborderofT4or
T4-Tsdiscspace.
StructureCervicothoraciclevel
TrachealbifurcationT4-T5
ArchofaortaBeginsandendsatT4
XiphoidprocessT9
SplenicaxisAlong10thrib
Carotidbifurcation,HyoidboneC3
UpperborderofthyroidcartilageC4
LevelofcricoidscartilageC6
Lumbarlevel
CeliactrunkT12-LI
SuperiormesentericarteryLl
TranspyloricplaneLowerborderofLl

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72.Whichlymphnodesdrainuppervagina&
cervix?
a)Paraaortic
b)Externaliliac
c)Superioringuinal
d)Deepinguinal
CorrectAnswer-B
Ans.is'b'i.e.,Externaliliac
Thelymphaticsfromthecervixdrainintotheexternaliliac,internal
iliacandsacralnodes.
LymphaticDrainageofuterus:
Fundusandupperbody-aorticnodesandsuperficialinguinalnodes
Lowerbody-externaliliacnodes
Cervix-externaliliac,internaliliacandsacralnodes.
LymphaticdrainageofVagina:
Upper1/3-externaliliacnodes
Middle1/3-internaliliacnodes
Lower1/3-superficialinguinalnodes

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73.

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Asurgeonremovesapartoflivertoleftof
falciparumligament,whichsegmentofliver
isremoved?
a)1&4
b)2&3
c)1&4
d)1&3
CorrectAnswer-B
Ans.is'b'i.e.,2&3

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74.Caudatelobeofliveris?
a)I
b)III
c)IV
d)VI
CorrectAnswer-A
Ans.is'a'i.e.,I
Thecaudatelobe(posteriorhepaticsegmentI,Spigelianlobe)is
situateduponthepostero-superiorsurfaceoftheliverontheright
lobeoftheliver,oppositethetenthandelevenththoracicvertebrae.

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75.Locationoftestisishigheron?
a)Rightside
b)Leftside
c)Maybeonrightorleftside
d)Samelevelonbothsides
CorrectAnswer-A
Ans.A
Right
Righttestisislocatedatahigherpositionthanleft.

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76.Supportofprostateis?
a)Pubococcygeus
b)Ischiococcygeus
c)Ilioccygeus
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Pubococcygeus
Levatoranimuscleisdivisibleintofollowingparts:1)Puboccygeus
part
Anteriorfibersofthispartcloselysurroundtheprostate,inmales,to
form,levatorprostatae.Inthefemalethesefibressurroundthe
vaginaandformsphinctervaginae.Inbothcasestheseanterior
fibresareinsertedintotheperinealbody.
Middlefibersconstitutethepuborectalis.Theypartlyformaloopor
slingaroundtheanorectaljunction;andarepartlycontinuouswith
longitudinalmusclecoatoftherectum.
Posteriorfibersareattachedtoanococcygealligamentandtipof
coccyx.
Iliococcygeuspart
Thisisinsertedtoanococcygealligamentandlasttwopiecesof
coccyx.
Ischiococcygeuspart(orcoccygeus)
Itformsposteriorpartofpelvicfloor.

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77.Incaseofaberrantobturatorartery,it
arisesmostcommonlyfrom?
a)Commoniliacartery
b)Femoralartery
c)Profundafemorisartery
d)Inferiorepigastricartery
CorrectAnswer-D
Ans.D.Inferiorepigastricartery

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78.Internalspermaticfasciaisderivedfrom?
a)Externalobliquemuscle
b)Internalobliquemuscle
c)Fasciatransversalis
d)Colle'sfascia
CorrectAnswer-C
Ans.is'c'i.e.,Fasciatransversalis
Layersofthescrotum
Thescrotumismadeupofthefollowinglayersfromoutsideinwards.
1. Skin,continuationofabdominalskin.
2. Dartosmusclewhichreplacesthesuperficialfascia.Thedartos
muscleisprolongedintoamedianverticalseptumbetweenthetwo
halvesofthescrotum.
3. Theexternalspermaticfasciafromexternalobliquemuscle.
4. Thecremastericmuscleandfasciafrominternalobliquemuscle.
5. Theinternalspermaticfasciafromfasciatransversalis

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79.Portalveinsupplies?
a)Spleen
b)Liver
c)Pancreas
d)Colon
CorrectAnswer-B
Ans.is'b'i.e.,Liver
Portalveinisavein,stillitsupplybloodtoliver(usuallyaveindrains
bloodfromanorganortissue).
Theliverhasdualbloodsupply:-
20%ofbloodsupplyisthroughthehepaticartery.
80%ofbloodsupplyisthroughtheportalvein.

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80.Ratioofconnectivetissue:smooth
muscleincervixis?
a)2:1
b)5:1
c)8:1
d)None
CorrectAnswer-C
Ans.is'c'i.e.,8:1

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81.Helicinearteryarebranchof?
a)Deeparteryofpenis
b)Femoralartery
c)Externalpudendalartery
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Deeparteryofpenis
Helicinearteriesofpenisarefivebranchesofcavernosalartery
(deeparteryofpenis)thatfillsinusoidalspaceofcorporacovernosa.
Helicinearteriesofuterusareextremelytortuousterminalbranches
ofuterinearterysupplyinguterinemuscle.

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82.

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Mostdependentpartofabdomeninstanding
positionis?
a)Vesicouterinepouch
b)Pouchofdouglas
c)Rectouterinepouch
d)b&c
CorrectAnswer-D
Ans.is'd'i.e.,b&c
Inmales,rectovesiclepouchofperitoneumintervenesbetween
rectumandurinarybladder.
ObliteratedpartofrectovesicalpouchiscalledfasciaofDenonviller's
whichseparatesposteriorsurfaceofprostatefromrectum.
Infemalesrectouterinepouch(pouchofDouglas)liesbetween
rectum(posteriorly)anduterusandposteriorfornixofvagina
(anteiorly).
Infemalesvesicouterinepouchliesbetweenurinarybladder
(anteriorly)anduterusposteriorly.
Therectovesicalpouch(inmales)andrectouterinepouch(in
females)arethemostdependentportionsofperitonealcavityin
erectposture

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83.Pelvicpainismediatedby?
a)Pudendalnerve
b)Sciaticnerve
c)Autonomicnerves
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Autonomicnerves
Visceralafferentfibersofpelvistravelwithautonomicnervefibers.
Visceralafferentfibersconductingreflexivesensations(information
thatdoesnotreachconsciousness)travelwithparasympathetic
fiberstospinalsensorygangliaofS2-S4.
Theroutetakenbyvisceralafferentfibersconductingpainsensation
differsinrelationtoanimaginaryline,thepelvicpainline,that
correspondstotheinferiorlimitofperitoneum,exceptincaseof
largeintestine,wherepainlineoccursmidwayalonglengthof
sigmoidcolon.
Visceralafferentfibersthattransmitpainsensationsfromtheviscera
inferiortopelvicpainlinetravelinparasympatheticfibersofthe
spinalgangliaS,-S4(viapelvicsplanchnicnerveornerve
erigentes).
Visceralafferentfiberconductingpainfromtheviscerasuperiorto
pelvicpainlinefollowthesympatheitcfibersreterogradelytoinferior
thoracicandsuperiorlumbar(Ti-Li0,2)spinalganglia.

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84.Cochleateuterusis?
a)Largeuterus
b)Acuteanteflexion
c)Acuteretroflexion
d)Largecervix
CorrectAnswer-B
Ans.is'b'i.e.,Acuteanteflexion
Cochleateuterusisacutelyanteflexeduteruswithpinholeos.
Itisasmalladultuteruswithaconicalcervixandabodythatis
small,globularandacutelyflexed.
Itcancauseprimarydysmenorrhea.

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85.Lengthofanalcanal
a)10-15mm
b)15-20mm
c)25-30mm
d)35-40mm
CorrectAnswer-D
Ans.is'd'i.e.,35-40mm
Theanalcanalistheterminalpartofthealimentarycanal.
Itbeginsatano-rectaljunctionwhichissituated2-3cminfrontand
slightlybelowthetipofcoccyx.Fromano-rectaljunctionanalcanal
passesdownwardsandbackwardsthroughthepelvicdiaphragm
andopensatanaloriface(anus)whichissituatedinthecleft
betweenthebuttocksabout4cmbelowandinfrontofthetipof
coccyx.
Sacculationsandtaeniaeareabsentinanalcanal.Thelengthof
analcanalis3.8cm.

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86.Mostcommoncongenitalanomalyof
kidney
a)Ectopickidney
b)Renalduplication
c)Horseshoekidney
d)Renalagenesis
CorrectAnswer-C
Ans.is'c'i.e.,Horseshoekidney
Horseshoekidneyisthemostcommoncongenitalrenalanomaly,
withanincidenceof1in400livebirths.
Fusiontypicallyoccursatlowerpoles,withsubsequentarrestof
ascendofkidney,duetorestrictionattheinferiormesentericartery.
Asaresult,kidneysarelowerinabdomen.

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87.Superiorwallofmiddleearisformedby?
a)Tympanicmembrane
b)Jugularbulb
c)Tegmentympani
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Tegmentympani
Roof(superiorwall)ofmiddleearisformedbytegmentympani.

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88.Nervesupplyoflarynxabovelevelof
vocalcord
a)Superiorlaryngeal
b)Recurrentlaryngeal
c)Glossopharyngeal
d)Externallaryngeal
CorrectAnswer-A
Ans.is'a'i.e.,Superiorlaryngeal
Nervesupplyoflarynx
Themaincranialnerveinnervatingthelarynxisthevagusnervevia
itsbranches;superiorlaryngealnerve(SLN)andrecurrentlaryngeal
nerve(RLN).
Sensorysupplyoflarynx
Abovethelevelofvocalcords,larynxissuppliedbyinternal
laryngealnerve,abranchofsuperiorlaryngealnerve.
Belowthevocalcord,larynxissuppliedbyrecurrentlaryngeal
nerve.
Motorsupplyoflarynx
Alltheintrinsicmusclesoflarynxaresuppliedbyrecurrentlaryngeal
nerveexceptforcricothyroidmuscle.
Cricothyroidissuppliedbyexternallaryngealnerve,abranchof
superiorlaryngealnerve.

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89.Whichmuscleoflarynxisnotsuppliedby
recurrentlaryngealnerve?
a)Vocalis
b)Thyroarytenoid
c)Cricothyroid
d)Interarytenoid
CorrectAnswer-C
Ans.is'c'i.e.,Cricothyroid
Allintrinsicmusclesaresuppliedbythereccurrentlaryngealnerve
exceptcricothyroidwhichissuppliedbytheexternallaryngealnerve

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90.Whichmuscleplaysaroleinwinking
a)Levatorlabisuperioris
b)Orbicularisoculi
c)Corrugatorsupercilli
d)Levatorpalpebrae
CorrectAnswer-B
Ans.is'b'i.e.,Orbicularisoculi

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91.Galen'sanastomosisisbetween?
a)Recurrentlaryngealnerveandexternallaryngealnerve
b)Recurrentlaryngealnerveandinternallaryngealnerve
c)Internallaryngealnerveandexternallaryngealnerve
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Recurrentlaryngealnerveandinternallaryngeal
nerve
Therearetwotypesofimportantanastmosisbetweenlaryngeal
branchesofvagus:?
1.Galenanastomosis(RamusanastomoticusorAnsaofGalen)
Thisisananastomosisbetweentherecurrentlaryngealnerveand
internallaryngealnerve(internalbranchofsuperiorlaryngealnerve).
Generally,posteriorbranchofrecurrentlaryngealnervecontributes
totheanastomosis;however,anteriorbranchcanalsocontribute.
2.Humancommunicatingnerve
Itisananastomosisbetweenrecurrentlaryngealnerve(distalpart)
andexternallaryngealnerve(externalbranchofsuperiorlaryngeal
nerve).

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92.Allpassthroughjugularforamenexcept
a)Emissaryvein
b)Vagusnerve
c)Mandibularnerve
d)Internaljugularvein
CorrectAnswer-C
Ans.is'c'i.e.,Mandibularnerve

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93.Allarecontentsofoccipitaltriangle
except?
a)Greatauricularnerve
b)Suprascapularnerve
c)Lesseroccipitalnerve
d)Occipitalartery
CorrectAnswer-B
Ans.is'b'i.e.,Suprascapularnerve

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94.Theroofoftheolfactoryregionisformed
by?
a)Nasalbone
b)Cribriformplateofethmoid
c)Sphenoid
d)Temporalbone
CorrectAnswer-B
Ans.is'b'i.e.,Cribriformplateofethmoid
Theolfactorymucosalinestheupperone-thirdofnasalcavity
includingtheroofformedbycribriformplateandthemedialand
lateralwallsuptothelevelofsuperiorconcha(turbinate).

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95.

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Chordatympaniisapartof?
a)Middleear
b)Innerear
c)Externalauditorycanal
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Middleear
Contentsofmiddleear
Contentsofmiddleear(tympaniccavity)are:?
1. EarossiclesMalleus,incus,stapes
2. MusclesTensortympani,stapedius
3. Chordatympani
4. Tympanicplexus

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96.Stapediusnerveisabranchof?
a)Trigeminalnerve
b)Facialnerve
c)Vagusnerve
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Facialnerve
Branchesoffacialnerve
1. Infallopian(facialcanal):-Greaterpetrosal(greatersuperficial
petrosal)nerve,nervetostapedius,chordatympani.
2. Atitsexitfromstylomastoidforamen:-Posteriorauricular,digastric
nerve,stylohyoidnerve.
3. Terminalbranches:-Temporal,zygomatic,buccal,marginal
mandibular,andcervical.

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97.Deepinjuryofneckalwaysinvolves
a)Platysma
b)Tropezius
c)Sternocleidomastoid
d)Longuscolli
CorrectAnswer-A
Ans.is'a'i.e.,Platysma
Theneckisinvestedbytwomajorfasciallayers:?
1. Superficialfascia:Platysmaanditsinvestingfascia.
2. Deepfasica:Investsthedeppermuscles,thethoracicduct,blood
vessels,nerves,glands,tracheaandoesophagus.
Significantinjurytodeepstrucutresoftheneckisunlikelywithout
penetrationoftheplatysma.
Therefore,astabwoundthatdoesnotpenetratetheplatysmaneeds
nofurtherevaluation.

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98.Lacrimalpunctumofupperandlower
eyelidsare?
a)Theyareopposed
b)Norelation
c)Upperpunctumismedial
d)Upperpunctumislateral
CorrectAnswer-A
Ans.is'a'i.e.,Theyareopposed

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99.Protrusionoftonguenotpossiblein
damageof?
a)Styloglossus
b)Hyoglossus
c)Palatoglossus
d)Genioglossus
CorrectAnswer-D
Ans.is'di.e.,Genioglossus

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100.Terminalbranchesofinternalcarotid
arteryareallexcept?
a)Anteriorcerebralartery
b)Middlecerebralartery
c)Posteriorcommunicatingartery
d)Cavernousartery
CorrectAnswer-D
Ans.is'd>c'i.e.,Cavernousartery>Posteriorcommunicating
artery
Thisquestionhasnotbeenframedproperly.
Internalcarotidarteryhastwoterminalbranches,i.e.ICAendsby
dividinginto:?
1. Anteriorcerebralartery
2. Middlecerebralartery(largerterminalbranch)
Ithink,examinerwantstoknowthebranchesofterminal/cerebral
partofICA(notterminalbranches).Inthatcaseanswerisoption'd',
ascavernousbrancharisesfromcavernouspart.
Internalcarotidartery
Itisthemainarterysupplyingstructuresinsidethecranialcavityand
orbit.Itisdividedinto4parts:?
1. Cervicalpart:-Itextendsfromupperborderofthyroidcartilageto
thebaseofskull.Thispartgivesnobranch.
2. Petrouspart:-Itliesinbonycarotidcanalinthepetroustemporal
bone.Itgivestwobranches(i)Caroticotympanic,and(ii)pterygoid.
3. Cavernouspart:-Itrunsthroughthemedialwallofcavernoussinus.
Itgivesthreebranches:(i)Meningealbranch,(ii)hypophyseal
branchand(iii)cavernousbranch.
4. Cerebralpart:-Itisrelatedtoinferiorsurfaceofcerebrum.Itgives

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followingbranches:(i)Ophthalmicartery,(ii)posterior
communicatingartery,(iii)anteriorchoroidalartery,(iv)anterior
cerebralarteryand(v)middlecerebralartery.

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101.Numberofmusclesinmiddleear-
a)1
b)2
c)3
d)4
CorrectAnswer-B
Ans.is'b'i.e.,2
TensortympaniandStapediusarethetwomusclesinmiddleear.
Theybothworktodampentheintensityofhighpitchedsoundwaves
andthusprotectinnerear.

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102.Nottrueaboutfacialveinis?
a)DrainsinEJV
b)Largestveinofface
c)Formedfromangularvein
d)Hasnovalves
CorrectAnswer-A
Ans.is'a'i.e.,DrainsinEJV
Thefacialveinisthelargestveinofthefacewithnovalves.
Itbeginsastheangularveinatthemedialangleoftheeye.
Angularveinisformedbytheunionofsupraorbitaland
supratrochlearveins.
Theangularveincontinuesasfacialveins.
Whichjoinstheanteriordivisionofretromandubularvein(i.e.deep
facialvein)belowtheangleofthemandibletoformcommonfacial
vein.
Commonfacialveindrainsintotheinternaljugularvein.

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103.Structurepassingthroughsuperior
orbitalfissure?
a)Oculomotornerve
b)Trochlearnerve
c)Superiorophthalmicvein
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Structurespassingthroughsuperiororbitalfissureare:-
1. Middlepart(withinthering)Upperandlowerdivisionofoculomotor
nerve,nasociliarynerve,abducentnerve.
2. Lateralpart(abovethering):-Trochlearnerve,frontalnerveand
lacrimalnerve,superiorophthalmicvein,recurrentmenigealbranch
oflacrimalartery,orbitalbranchofmiddlemeningealarteryand
sometimesmeningealbranchofophthalmicartery.
3. Medialpart(belowthering):-Inferiorophthalmicvein,sympathetic
nervesaroundICA.

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104.Chiefarteryoflateralsurfaceofcerebral
hemisphere?
a)Anteriorcerebralartery
b)Posteriorcerebralartery
c)Middlecerebralartery
d)Posteriorinferiorcerebellarartery
CorrectAnswer-C
Ans.C.Middlecerebralartery

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105.Vertebralarteriesofbothsidesuniteto
form
a)Anteriorspinalartery
b)Posteriorspinalartery
c)Medullaryartery
d)Basilarartery
CorrectAnswer-D
Ans.is'd'i.e.,Basilarartery
VertebralArtery
Itarisesfrom1stpartofsubclavianartery
FirstPart:OrigintotheforamentransversariumofC6vertebra.It
liesinthescalenovertebral/vertebraltriangle(triangleofvertebral
artery)betweenscalemusanteriorandlonguscollimuscles.
SecondPart:Thispartpassesthroughforaminatransversariaof
upper6cervicalvertebrae(C6toC1).
ThirdPart:ItextendsfromforamentransversariumofCitoforamen
magnum,lyinginagrooveontheuppersurfaceofposteriorarchof
atlas.Thispartofthearteryliesinthesuboccipitaltriangle.Itthen
entersthevertebralcanalbypassingdeeptothelowerarched
marginofposterioratlanto-occipitalmembrance.
FourthPart:Itliesintheposteriorcranialfossaextendingfromthe
foramenmagnumtothelowerborderofpons.
Inthevertebralcanal,itpiercestheduraandarachnidandascends
infrontofhypoglossalnerveroots.Atthelowerborderofponsboth
vertebralarteriesunitetoformthebasilarartery.
Cervicalbranches
1. Spinalbranches:Entervertebralcanalthroughintervertebral

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foraminaandsupplycervicalsegmentsofspinalcord,meninges,
andvertebrae.
2. Muscularbranches:Supplysuboccipitalmuscles.
CranialBranches:
1. Meningeal:Supplymeningesofposteriorcranialfossa
2. Posteriorspinal
3. Anteriorspinal
4. Medullary
5. Posteriorinferiorcerebellar
Basilarartery:Asinglemedianvesselformedbytheunionofthe
twovertebralarteriesatthelowerborderofpons,runsupwardin
frontofthepons,embeddedinthegroove,tobifurcateintotwo
posteriorcerebralarteriesattheupperborderofpons.Itsbranches
are:
1. Labyrinthine
2. anteriorinferiorcerebellar
3. Pontine
4. Superiorcerebellar
5. Posteriorcerebral

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106.Tributariesofcavernoussinusareall
except?
a)Inferiorcerebralvein
b)Centralveinofretina
c)Sphenoparietalsinus
d)Superiorcerebralvein
CorrectAnswer-D
Ans.is'd'i.e.,Superiorcerebralvein
Tributaries(incomingchannels)ofcavernoussinus
1. Superiorophthalmicvein
2. Abranchofinferiorophthalmicveinorsometimesveinitself
3. Centralveinofretina(itmayalsodrainintosuperiorophthalmic
vein)
4. Superficialmiddlecerebralvein
5. Inferiorcerebralvein
6. Sphenoparietalsinus
7. Frontaltrunkofmiddlemeningealvein(itmayalsodraininto
pterygoidplexusorintosphenoparietalsinus)
Drainingchannels(communications)ofcavernoussinus
1. Intotransversesinusthroughsuperiorpetrosalsinus
2. Intointernaljugularveinthroughinferiorpetrosalsinusandthrough
aplexusaroundtheICA
3. Intopterygoidplexusofveinsthroughemissaryveins
4. Intofacialveinthroughsuperiorophthalmicvein
5. Rightandleftcavernoussinuscommunicateswitheachotherby
anteriorandposteriorintercavernoussinusesandthroughbasilar
plexusofveins

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107.Pinealglandforms?
a)Floorofthirdventricle
b)Anteriorwallofthirdventricle
c)Posteriorwallofthirdventricle
d)Roofofthirdventricle
CorrectAnswer-C
Ans.is'c'i.e.,Posteriorwallofthirdventricle
Boundriesofthirdventricleare:-
1. Anteriorwall:Laminaterminal,anteriorcommissure,anterior
columnsoffornix.
2. Posteriorwall:Pinealbody,posteriorcommissure,cerebral
aqueduct.
3. Roof:Ependymaliningofundersurfaceoftelachoroideaof
ventricle.Thechoroidplexusofthirdventricleprojectsdownwards
fromroof.
4. Floor:Opticchiasma,tubercinereum,infundibulum(pituitarystalk),
mammillarybody,posteriorperforatedsubstanceandtegmentumof
midbrain.Opticrecessisseenatthejunctionoffloorwithanterior
wall.
5. Lateralwall:Medialsurfaceofthalamus,hypothalamusand
hypothalamicnuclei.Interventricularforamen(ofMonroe)isseenat
thejunctionofroofwithanteriorandlateralwall.

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108.Whichthalamicnucleiconnectswith
neocortex?
a)Palvinar
b)Intralaminar
c)Anterior
d)All
CorrectAnswer-D
Ans.is'd'i.e.,All

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109.Medullaoblongataarisesfrom?
a)Prosencephalon
b)Rhombencephalon
c)Mesencephalon
d)None
CorrectAnswer-B
Ans.'B'i.e.,Rhombencephalon
Medullaoblongatadevelopsfromcaudalmyelenphalonpart
oftherhombencephalicvesicle.
Neuroblastsfromthealarplateoftheneuraltubeatthislevelwill
producethesensorynucleiofthemedulla.
Thebasalplateneuroblastswillgiverisetomotornuclei.

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110.Glomuscellsarefoundin-
a)Bladder
b)Brain
c)Chemoreceptors
d)Kidney
CorrectAnswer-C
Ans.is'c'i.e.,Chemoreceptors
Arterialchemoreceptorsconsistofglobularaggregationsof
chemoreceptivecells(glomuscells),andsupportivecells,separated
fromoneanotherbyfibroustissuesepta.
Inthesesetpaandbetweenglomuscells,numerouscapillariesand
nervefibersareseen.
Theglomuscellshavethestructureofendocrineaminehormone
secretingcells.

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111.Guardianangelagainstobesityname
givento?
a)Adiponectin
b)Fibronectin
c)HDL
d)Insulin
CorrectAnswer-A
Ans.A.Adiponectin
Adiponectin,whichhasbeencalleda"fatburningmolecule"andthe
guardianangelagainstobesity,directsfattyacidstomusclefortheir
oxidation".

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112.Whatistheminimumfluidurineoutput
forneutralsolutebalance?
a)300ml
b)400ml
c)500ml
d)750ml
CorrectAnswer-C
Ans.C.500ml
Normally,180Loffluidisfilteredthroughtheglomeruli,whilethe
averagedailyurinevolumeisabout1Lwithaurineconcentrationof
290mOsm/L.
Thesameloadofsolutecanbeexcretedperdayinaurinevolume
of500mlwhentheurineismaximallyconcentratedi.e,1400
mOsm/L;orinavolumeof23.3Lwhentheurineismaximallydilute,
i.e,,30-50mOsm/L.

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113.FeverincreasewaterlossesbymUday
perdegreeCelsius
a)100
b)200
c)400
d)800
CorrectAnswer-B
Ans.is`b'i.e.,200ml/dayperdegreeCelsius

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114.Type3respiratoryfailureoccursdueto?
a)Post-operativeatelectasis
b)Kyphoscoliosis
c)Flailchest
d)Pulmonaryfibrosis
CorrectAnswer-A
Ans.is'a'i.e.,Post-operativeatelectasis

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115.Trueaboutobesity
a)Seenmostlyinfemales
b)Prevalencedecreaseupto40yearsofage
c)Nogeneticpredisposition
d)Smokingisariskfactor
CorrectAnswer-D
Ans.is'd'i.e.,Smokingisariskfactor
Cessationofsmoking
Weightgainisverycommonwhenpeoplestopsmoking.
Thisisthoughttobemediatedatleastinpartbynicotinewithdrawal,
whichisassociatedwithincreasedfoodintakeandreducedenergy
expenditure.
Weightgainof1to2kginthefirsttwoweeksisoftenfollowedbyan
additional2to3kgweightgainoverthenextfourtofivemonths.
Theaverageweightgainis4to5kgbutcanbemuchgreater.
Obesityiscommoninbothmenandwomen(morecommonin
women).
EtiologicClassificationofObesity
latrogeniccauses
Drugsthatcauseweightgain
Hypothalamicsurgery
Dietaryobesity
Infantfeedingpractices
Progressivehyperplasticobesity
Frequencyofeating
Highfatdiets
Overeating
Neuroendocrineobesities

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Hypothalamicobesity
Seasonalaffectivedisorder
Cushing'ssyndrome
Polycysticovarysyndrome
Hypogonadism
Growthhormonedeficiency
Pseudohypoparathyroidism
Socialandbehavioralfactors
Socioeconomicstatus
Ethnicity
Psychologicalfactors
Restrainedeaters
Nighteatingsyndrome
Binge-eating
Sedentarylifestyle
Enforcedinactivity(post-operative)
Aging
Genetic(dysmorphic)obesities
Autosomalrecessivetraits
Autosomaldominanttraits
X-linkedtraits
Chromosomalabnormalities
Other
Lowbirthweight

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116.Trueaboutbreathingareallexcept?
a)Normalbreathingoccurswhentranspulmonarypressureis8-5
cmH,0
b)Compliancedependsonlyonsurfactant
c)Expirationduringquitebreathingispassive
d)Inspirationisanactiveprocess
CorrectAnswer-B
Ans.B.Compliancedependsonlyonsurfactant
Complianceoflungsdependson:-
1. Elasticforcesoflungtissue(one-third).
2. Elasticforcescausedbyalveolarsurfacetension.
TheretwoforcesoPPosedistensibilityoflungandtherefore
decreaselungcompliance.
Surfactant,bydecreasingthealveolarsurfacetensionincreases
lungcompliance.

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117.Normalvitalcapacityinanadultis-
a)1200ml
b)2500ml
c)3000ml
d)4700ml
CorrectAnswer-D
Ans.D.4700ml

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118.Boyle'sLawstatesthat?
a)P/T=constant
b)PV=constant
c)PV=nRT
d)V/T=constant
CorrectAnswer-B
Ans.B.PV=constant
Boyle'slaw
Ataconstanttemperature,thepressure(P)ofagivenmassis
inverselyproportionatetoitsvolume(pdirectlyproportionalto1/v),
i.e.,PVconstant.

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119.Airremaininginlungafternormal
expiration?
a)TV
b)RV
c)FRC
d)VC
CorrectAnswer-C
Ans,C.FRC
Functionalresidualcapacity(FRC)istheamountofairremainingin
thelungsafteranormaltidalexpiration.

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120.Maximumvoluntaryventilationis-
a)25L/min
b)50L/min
c)100L/min
d)150L/min
CorrectAnswer-D
Ans.D.150L/min

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121.Physiologicaldeadspaceiscalculated
by?
a)Boyle'slaw
b)Dalton'slaw
c)Bohrequation
d)Charle'slaw
CorrectAnswer-C
Ans.C.Bohrequation
Anatomicaldeadspace->measuredbysingle-breathN,method.
Physiological(total)deadspace>measuredbyBohrequation.

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122.CentralChemoreceptorsaremost
sensitivetofollowingchangesinblood:
a)TPCO2
b)IPCO2
c)TH+
d)TPO2
CorrectAnswer-A
TPCO2

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123.Hypoxicpulmonaryvasoconstrictiondue
to-
a)Irreversiblepulmonaryvasocontrictionhypoxia
b)Reversiblepulmonaryvasoconstrictionduetohypoxia
c)Directbloodtopoorlyventilatedareas
d)Occurshoursafterpulmonaryvasoconstriction
CorrectAnswer-B
Answer-b.Reversiblepulmonaryvasoconstrictiondueto
hypoxia
Hypoxicpulmonaryvasoconstriction(HPV)isanadaptivevasomotor
responsetoalveolarhypoxiawhichredistributesbloodtooptimally
ventilatidlungsegmentsbyanactiveprocessof'vasoconstriction,
particularlyinvolvingthesmallmuscularresistancepulmonary
arteries(PA).

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124.Depressorreflex,Bezold-Jarischreflex,producedbythefollowingstimulus:
a)Atrialoverload
b)Myocardialinfarction
c)Ventriculardistension
d)Isotonicexercise
CorrectAnswer-C
VentriculardistensioncanproduceapowerfuldepressorreflexcalledtheBezold-Jarisch
reflex;vagalafferentsofthiscardiopulmonaryreflexarealsoactivatedbychemical
stimulation(eg,prostanoids,cytokines,serotonin,andclassically,Veratrumalkaloids).The
centralconnectionsforthisreflexareinthenucleustractussolitarii,whichhasboth
sympatheticandparasympatheticsynapses.
Ref:HoitB.D.,WalshR.A.(2011).Chapter5.NormalPhysiologyoftheCardiovascular
System.InV.Fuster,R.A.Walsh,R.A.Harrington(Eds),Hurst'sTheHeart,13e.

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125.HormoneresponsibleforBPregulation
afterafallduetobloodloss.
a)ADH
b)ANP
c)Epinephrine
d)Aldosterone
CorrectAnswer-A
Ans.is'a'i.e.,ADH
(principlesofmedicalphysiologyp.573)
Bloodpressureisregulatedbyfollowingmechanisms.
Shorttermregulation
Thesemechanismsactimmediatelyandcorrectthebloodpressure
quickly.
Theseare:-
1. Baroreceptorreflex:WorksduringBprange70-150mmHg
2. Chemoreceptorreflex-WorkswhenBpbelow80mmHg.
3. CNSischemicresponse:ThistheonlyhopeofsurvivalwhenBPis
below40mmHg.
Hormonalrelease:Theseare-
1. Antidiuretichormone(ADH):Increaseswaterreabsorptionin
kidney.
2. AngiotensinII:Causesvasoconstriction.

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126.BPislessthan40mmHg.Which
mechanismofregulationisworking?
a)Chemoreceptorreflex
b)Baroreceptorreflex
c)CNSischemicreflex
d)Noneoftheabove
CorrectAnswer-C
Ans,C,CNSischemicreflex
ChemoreceptorreflexisusefulinregulationofBPwhenitfallsto
levelbetween40-70mmHg.
ButifBPisbelow40mmHg,thelastrayofhopeforsurvivalisthe
CentralNervousSystem(CNS)Ischemicresponse.
CNSischemicresponseisevokedbyischemiaofCNS.

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127.Capacitancevesselshaveintheirwall?
a)Moreelastictissueandlessmuscle
b)Lesselastictissueandmoremuscle
c)Moreelastictissueandmoremuscle
d)Lesselastictissueandlessmuscle
CorrectAnswer-D
Ans.is'd'i.e.,Lesselastictissueandlessmuscle
Veinsarecapacitancevessels.Theyhavelesssmoothmuscleand
lesselastictissueintheirwall.
Structureofvessels
A)Structureofartery
Itismadeupthreelayers-
1.TunicaIntima
Theinnermostlayer(towardslumen)ofarteryisintima.
Itconsistsofendothelialcellswhichrestonbasmentmembrane.
Thereissomesubendothelialconnectivetissue.
Intimaisseparatedfrommediabyinternalelasticlamina.
2.TunicaMedia
Itismainlycontainssmoothmusclesandlaminaeofelastictissue
Mediaisseparatedfromadventitiabyexternalelasticlamina.
3.TunicaAdventitia
Itistheoutermostlayer.
Containscollegenandelasticfibers.
B)Structureofcapillaries
Capillariesarethinwalledvesselsmadeupofsinglelayerof
endothelialcellswithitsbasementmembrane.oCapillariesareof
threetypes-
1.Continouscapillaries-
Thesecapillarieshascontinuousliningofendothelialcellswithno

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Thesecapillarieshascontinuousliningofendothelialcellswithno
fenestration.
Basementmembraneisalsocontinuous.
2.Fenesteratedcapillaries
Therearefenestrationbetweentheendothelialcells.
Basmentmembraneiscontinuous.
3.Sinusoidalcapillaries
Bothendothelialcellsandbasementmembranehavefenestration.
Inrestingtissues,mostofthecapillariesarecollapsedandblood
flowsthroughthethroughfarevesselsfromthearteriolestothe
venules.
C)Structureofveins
Structureofveinissmiliartoarteryexceptthat-
1.Wallisthinner
2.Threetunicaearelesswelldemarcated.
3.Elastictissueisscantyandnotclearlyorganizedintodistinct
internalandexternalelasticlamina.
4.Havevalves(exceptvenaecavaeandcommoniliacvein).

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128.Deoxygenatedbloodisnotseenin?
a)Pulmonaryartery
b)Pulmonaryvein
c)Rightatrium
d)Umbilicalartery
CorrectAnswer-C
Ans,C.Rightatrium
Pulmonaryveinscarryoxygenatedbloodfromthelungstotheleft
sideofheart(leftatrium).
Pulmonaryarterycarriesdeoxygenatedbloodfromrightsideof
heart(rightventricle)tothelung
Rightsideofheart(rightatriumandrightventricle)contains
deoxygenatedblood.
Umbilicalarteriessupplydeoxygenatedbloodfromthefetusto
placenta,intheumbilicalcord.

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129.Cardiacoutputincreasesby?
a)Standingfromlyingdownposition
b)Expiration
c)Increasedcardiaccontractility
d)Parasympatheticstimulation
CorrectAnswer-C
Ans.is'c'i.e.,Increasedcardiaccontractility
Cardiacoutputistheproductofstrokevolumeandheartrate.Hence
anyfactorwhichaffectseitherthestrokevolumeortheheartrateor
bothaffectsthecardiacoutput.
A)Factorsaffectingstrokevolume
Strokevolume,whichistheamountofbloodpumpedbytheheart
duringonestroke,dependsmainlyonthreefactors:?
Preload(Degreeofventricularfillingduringdiastole):-Cardiac
preloadisrepresentedbyvolumeofvenousbloodthatdistendsthe
ventricle,i.e.,venousreturndeterminesthepreload.Anincreasein
preload,i.e.,increaseinvenousreturnresultsinahigherend-
diastolicvolume(Preload).Thisresultsinstretchingofmyocardial
fiberandthisincreaseinlengthofmyofibrilincreasesthestrengthof
cardiaccontractioninaccordancewiththeFrank-Starlinglawor
Starling'slawoftheheart.AccordingtoStarling'slaw,greaterthe
initiallengthofmusclefiber,greateristheforceofcontraction.The
initiallengthofmusclefiber(lengthoffiberattheinitiationof
contraction/systole)referstolengthofthefiberattheendofthe
diastole,i.e.,end-diastolicfiberlength.Thus,thefactorswhich
improvevenousreturnincreasethecardiacoutputbyincreasing
end-diastolicventricularvolumeandlength,i.e.,preload.Oppositeis
trueforfactorswhichdecreasevenousreturn.

---

---

130.Coronarybloodflowismaximumduring
whichphaseofcardiaccycle:
a)Isovolumicrelaxationphase
b)Isovolumiccontractionphase
c)Ejectionphase
d)Isovolumiccontractionphase
CorrectAnswer-A
Ans.A:Isovolumicrelaxationphase
Maximumcoronarybloodflowoccursduringthephaseof
isovolumetricventricularrelaxationphase
Isovolumetric/isometricrelaxationtime/IVRT
Anintervalinthecardiaccycle,fromtheaorticcomponentofthe
secondheartsound,thatis,closureoftheaorticvalve,toonsetof
fillingbyopeningofthemitralvalve.
Ventricularpressuredecreasestozerorapidlywhileaorticpressure
decreasesonlyto80mmHgi.e.itremainsfairlyhigh.
Therefore,intramyocardialcompressionofbloodvesselsisminimal
andperfusionpressureismaintainedfairlyhigh.
Socoronarybloodflowrisessharply
Maximumcoronarybloodflowoccursduringthisphase
Itcanbeusedasanindicatorofdiastolicdysfunction.
ProlongedIVRTindicatespoormyocardialrelaxation.
AnormalIVRTisabout70?12ms,andapproximately10mslonger
inpeopleoverfortyyears.
Inabnormalrelaxation,IVRTisusuallyinexcessof110ms.
Withrestrictiveventricularfilling,itisusuallyunder60ms

---

131.Slowestbloodflowisseenin?
a)Arteriole
b)Veins
c)Capillaries
d)Venules
CorrectAnswer-C
Ans,C.Capillaries

---

132.DirectFickmethodofmeasuringcardiacoutputrequiresestimationof:
a)O2contentofarterialblood
b)O2consumptionperunittime
c)ArteriovenousO2difference
d)Alloftheabove
CorrectAnswer-D
DirectFickmethodandtheindicatordilutionmethodareusedformeasuringcardiac
output.
TheFickprinciplestatesthattheamountofasubstancetakenupbyanorgan(orbythe
wholebody)perunitoftimeisequaltothearteriallevelofthesubstanceminusthevenous
level(A-Vdifference)timesthebloodflow.Botharterialandmixedvenous(whichisequal
topulmonaryartery)bloodmustbesampledinthismethod.
TheprinciplecanbeusedtodeterminecardiacoutputbymeasuringtheamountofO2
consumedbythebodyinagivenperiodanddividingthisvaluebytheA-Vdifference
acrossthelungs.
Ref:BarrettK.E.,BarmanS.M.,BoitanoS.,BrooksH.L.(2012).Chapter30.TheHeartasa
Pump.InK.E.Barrett,S.M.Barman,S.Boitano,H.L.Brooks(Eds),Ganong'sReviewof
MedicalPhysiology,24e.

---

133.QRScomplexisdueto:
September2008
a)Ventricularrepolarization
b)Atrialdepolarization
c)ConductionthroughAVnode
d)Ventriculardepolarization
CorrectAnswer-D
Ans.D:Ventriculardepolarization
QRScomplexisduetoventriculardepolarizationandatrial
repolarization.Normaldurationis0.08sec.

---

134.Pwaveisdueto:
a)Atrialdepolarization
b)Atrialrepolarization
c)Ventriculardepolarization
d)Ventricularrepolarization
CorrectAnswer-A
AnswerisA(AtrialDepolarization)
Pwaveisproducedduetoatrialdepolarization.
Intervals
EventsintheHeartDuringInterval
Pwave
Atrialdepolarization
Atrialdepolarizationandconductionthrough
PRinterval
AVnode
Ventriculardepolarizationandatrial
QRSduration
repolarization
Ventriculardepolarizationplusventricular
QTinterval
repolarization
STinterval(QT
Ventricularrepolarization
minusQRS)

---

135.Inhealthyperson,arterialbaroreceptor
activityisseenatwhatstagofcardiac
systole?
a)Systole
b)Diastole
c)Both
d)None
CorrectAnswer-A
Ans.A.Systole
Baroreceptorsrespondnotonlytopressuremagnitudebutalsoto
rateofchangeofpressure.
Atrest,arterialbaroreceptorsarestimulatedduringthesystolic
upstrokeofthepressurepukewove

---

136.SIunitofpressureis?
a)mmHg
b)cmHg
c)Pascal
d)Torr
CorrectAnswer-C
Ans.C.Pascal
Bloodpressureisthelateralpressureexertedbythecolumnof
bloodonthewallsofthearteries,
MostcommonlyusedunitofBPismmHg.
ButrecentlythereisatrendtowardsadoptingIhesystem
International'd'units(SIunits).
InSIunits,thebasicunitforpressureisnewtonpersquaremeter,
andiscalledpascal(Pa).

---

137.Healthyadultcardiacreserveis?
a)50-100%
b)100-200%
c)200-250%
d)300-400%
CorrectAnswer-D
Ans,D.300-400%
Cardiacreserve
Themaximumpercentagethatthecardiacoutputcanincrease
abovenormaliscalledisthecardiacreserve.
Thus,inthehealthyadultthecardiacreserveis300-400%percent.

---

138.Criticalclosingpressureis?
a)Arterialpressureminusvenouspressure
b)Capillarypressureminusvenouspressure
c)Pressurebelowwhichcapillariesclose
d)Noneoftheabove
CorrectAnswer-C
Ans.C.Pressurebelowwhichcapillariesclose
Thecriticalpressurebelowwhichthecapillariescloseiscalledthe
criticalclosingpressure.

---

139.Allaretrueaboutbaroreceptors,expect
?
a)StimulatedwhenBPdecreases
b)Afferentsarethroughsino-aorticnerves
c)Stimulationcausesincreasedvagaldischarge
d)Stimulatenucleusambiguous
CorrectAnswer-A
Ans.A.StimulatedwhenBPdecreases
BaroreceptorsarehighlysensitivetoanychangeinmeanBp.
WhenBPrises,baroreceptorsarestimulatedandtheiraferent
(throughsinoaorticnerves)stimulatenucleusoftractussolitarus
(MIS)whichinhibitsthepressorareaofvasomotercenteri.e.RVLM.
Thisresultsindecreasedsympatheticoutflowand,asaresult
vasodilatation.
Bpcomesdown.

---

140.Normalvelocityofbloodis?
a)40-50cm/sec
b)100-150cm/sec
c)200-250cm/sec
d)250-300cm/sec
CorrectAnswer-A
Ans.A.40-50cm/sec
Meanbloodvelocityinaortais40cm/sec.

---

141.Durationofmaximumcontraction
dependsupon?
a)Absoluterefractiveperiod
b)Relativerefractiveperiod
c)Both
d)Noneofthetwo
CorrectAnswer-B
Ans.B.Relativerefractiveperiod
Duringthisperiod,excitabilitygraduallyrecoversandanewaction
potentialcanbeelicitedsoonerwithastrongerstimulus.
Actionpotentialsgeneratedveryearlyintherelativerefractiveperiod
donotriseassharplyasnormalactionpotentials,andhavealower
amplitudeandshorterduration.
Thusdurationofactionpotential(andthuscontraction)depends
uponrelativerefractiveperiod.
IfAPisgeneratedearlyinrelativerefractiveperiod,ithasshorter
duration.
AndifAPisgeneratedaftercompletionofrelativerefractiveperiod,
ithaslonger(normal)durationofactionpotential.

---

142.Temperaturecentreis?
a)Supraopticnucleusofhypothalamus
b)Paraventricularnucleusofhypothalamus
c)Preopticnucleusofhypothalamus
d)Suprachiasmaticnucleusofhypothalamus
CorrectAnswer-C
Ans.is'c'i.e.,Preopticnucleusofhypothalamus[Ry'Ganong
23'd/ep.275)

---

143.Stretchimpulseiscarriedby?
a)Ia
b)lb
c)B
d)C
CorrectAnswer-A
Ans.A.Ia
A-alpha,(TypeIa)fibersareprimaryafferentforstretchreflex.

---

144.Lessmitochondriaareseenin-
a)Redfibers
b)TypeIfibers
c)Whitefibers
d)Slowfibers
CorrectAnswer-C
Ans.C.Whitefibers
TypeIIfibersarewhitebecausetheylackmyoglobinandhaveafew
mitochondria.Theirmetabolismisglycolytic.
TypeIIfibersarefasttwitchfiberswithshortdurationoftwitch.

---

145.Allaretrueaboutredmusclefibers
except?
a)Moremitochondria
b)Glycolyticmetabolism
c)Moremyoglobin
d)Moreoxidativecapacity
CorrectAnswer-B
Ans.B.Glycolyticmetabolism

---

146.Integrationcenteroftoniclabyrinthine
reflexis?
a)Spinalcord
b)Medulla
c)Midbrain
d)Cerebralcortex
CorrectAnswer-B
Ans.B.Medulla

---

147.Highercenterforrightingreflex?
a)Pons
b)Spinalcord
c)Cortex
d)Midbrain
CorrectAnswer-D
Ans.D.Midbrain

---

148.Rightingreflexisa?
a)Cochlearreflex
b)Spinalreflex
c)Vestibularreflex
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Vestibularreflex
[RefUnderstandingofmedicalphysiologyp.662]
Vestibularreflexes
Theinformationcollectedbyvestibularapparatusleadsmainlyto
reflexadjustmentinpostureandeyemovements.
Vestibularreflexesare-
Toniclabyrinthinereflex
Rightingreflex(labyrinthinerightingreflex)
Visualreflexvestibulo-ocularreFlex)

---

149.Rightingreflexisa?
a)Strechreflex
b)Posturalreflex
c)Spinalreflex
d)Ocularreflex
CorrectAnswer-B
Ans.B.Posturalreflex
Posturereferstothestaticpositionofanypartofthebody.
MovementsarethetransitionfromonePosturetotheanother.

---

150.ThenucleusinvolvedinPapezcircuitis:
a)Pulvinar
b)Intralaminar
c)VPLnucleus
d)AnteriornucleusofThalamus
CorrectAnswer-D
NucleusinvolvedinPapezcircuitisanteriornucleusofthalamus.
Ref:ReviewofMedicalPhysiologybyWilliamganong,22ndEdition,Page256

---

151.Jointposition&vibrationsenseis
carriedby?
a)Act
b)A(3)
c)AY
d)B
CorrectAnswer-A
Ans,A.Act

---

152.Tonicneckreflexdisappearsatwhatage
?
a)1month
b)2months
c)3months
d)6months
CorrectAnswer-D
Ans.D.6months

---

153.Significanceofabsenceoflossof
assymmetrictonicneckreflexin9
months?
a)Decreasedmuscletone
b)Increasedmuscletone
c)Normalphenomenon
d)Noneoftheabove
CorrectAnswer-B
Ans.B.Increasedmuscletone
Asymmetrictonicneckreflexisprominantbetween2ndand4th
months.
Persistenceofthisreflexbeyondtheageof5-9monthsora
constanttonicneckpostureareabnormalandusuallyindicate
spasticcerebralpalsy.
Inspasticcerebralpalsy,thereisincreasedmuscletonewithhyper-
reflexia.

---

154.Cerebellardamagecausesallexcept?
a)Dysmetria
b)Hypertonia
c)Ataxia
d)Past-pointing
CorrectAnswer-B
Ans.B.Hypertonia
Damagetothecerebellumleadstoseveralcharacteristic
abnormalities,including:
Ataxia
Hypotonia
Dysmetria
Reboundphenomenon
Decompositionofmovement

---

155.Whichreceptorgetstimulatedin
moderatecold?
a)CMR-1
b)VR1
c)VRL-1
d)VR2
CorrectAnswer-A
Ans.A.CMR-1
Oneisreceptorformoderatecold-+CMR-1(coldandmethanol
sensitivereceptor-l)
Twotypesofvanilloidreceptorsfornoxiousheat(painfulheat):-
I4R-landVRL-L.

---

156.Post-ganglionicparasympatheticfibers
are-
a)Aa
b)A(3
c)A7
d)C
CorrectAnswer-D
Ans.D.C
Post-ganglionicautonomicfibers(bothsympatheticand
parasympathetic)are'C'typeoffibers.

---

157.GroupBnervefibersare?
a)Sympatheticpreganglionic
b)Sympatheticpostganglionic
c)Parasympatheticpreganglionic
d)Parasympatheticpostganglionic
CorrectAnswer-A
Ans.A.Sympatheticpreganglionic
"Inboththesympatheticandparasympatheticdivisions,
preganglionicfibersaremyelinatedtypeBfibers".

---

158.Painreceptorsare?
a)Meissnerscorpuscle
b)Paciniancorpuscle
c)Freenerveendings
d)Merkeldisc
CorrectAnswer-C
Ans.C.Freenerveendings
Painreceptorsarefreenerveendings,i.e.theyarenotenclosedina
capsule.

---

159.Ruffiniendorganisassociatedwithsensationof:
a)SustainedPressure
b)Heat
c)Touch
d)Noneoftheabove
CorrectAnswer-A
Meissner'scorpusclesaredendritesencapsulatedinconnectivetissueandrespondto
changesintextureandslowvibrations.Merkelcellsareexpandeddendriticendings,and
theyrespondtosustainedpressureandtouch.Ruffinicorpusclesareenlargeddendritic
endingswithelongatedcapsules,andtheyrespondtosustainedpressure.Pacinian
corpusclesconsistofunmyelinateddendriticendingsofasensorynervefiber,2min
diameter,encapsulatedbyconcentriclamellaeofconnectivetissuethatgivetheorganthe
appearanceofacocktailonion.Thesesreceptorsrespondtodeeppressureandfast
vibration.
Ref:BarrettK.E.,BarmanS.M.,BoitanoS.,BrooksH.L.(2012).Chapter8.Somatosensory
Neurotransmission:Touch,Pain,andTemperature.InK.E.Barrett,S.M.Barman,S.
Boitano,H.L.Brooks(Eds),Ganong'sReviewofMedicalPhysiology,24e.

---

160.Spinalpathwaymainlyregulatingfine
motoractivity?
a)Anteriorcorticospinaltract
b)Rubrospinaltract
c)Vestibulospinaltract
d)Reticulospinaltract
CorrectAnswer-B
Ans.B.Rubrospinaltract

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161.Normalcerebralbloodflowinml/min?
a)55
b)150
c)750
d)1000
CorrectAnswer-C
Ans.is'c'i.e.,750
Thecerebralbloodflow(CBF)isabout750ml/min(15%oftotal
cardiacoutput),or54m1/100gmbraintissueperminute

---

162.Whatisseeninwithdrawalreflex?
a)Extension
b)Flexion
c)Extensionfollowedbyflexion
d)Noneoftheabove
CorrectAnswer-B
Ans.B.Flexion

---

163.Whichofthefollowinghassame
concentrationinCSFandplasma?
a)Ca"
b)HCO3
c)Glucose
d)Cl?
CorrectAnswer-B
Ans.B.HCO3

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164.Sweatingismediatedby?
a)Norepinephrine
b)Epinephrine
c)Acetylcholine
d)Histamine
CorrectAnswer-C
Ans.C.Acetylcholine
Nervesupplyofsweatglandisuniqueinthatitksympatheticbut
cholinergic(mostothersympatheticsitesarenoradrenergic)

---

165.Whichthalamicnucleicanproducebasal
gangliasymptoms?
a)Lateraldorsal
b)Pulvinar
c)Ventralanterior
d)Intralaminar
CorrectAnswer-C
Ans.C.Ventralanterior
Motornuclei(ventralanteriorandventrallateral)ofthalamusrelay
andprocessmessagesfrombasalganglia(especiallyglobus
pallidus)andcerebellumtomotorandpremotorcortex

---

166.Whichofthefollowingisacerebellar
nucleus?
a)Caudatenucleus
b)Subthalamicnucleus
c)Fastigialnucleus
d)Pautamen
CorrectAnswer-C
Ans.C.Fastigialnucleus
Cerebellumisdividedinto-
1. CerebellarCortex(external):-Containsfivecellspurkinjecells,
granulecells,basketcells,stellatecellsandgolgicell.
2. Deepcerebellarnuclei(external):-Therearefourntcleidmtate,
fastigial,globose,andemboliform

---

167.Salivationofdogwhenfoodisgiven
alongwithbellis?
a)Conditionedreflex
b)Reinforcement
c)Habituation
d)Innatereflex
CorrectAnswer-A
Ans,A.Conditionedreflex

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168.Precentralgyrus&corticospinaltractare
essentialfor?
a)Vision
b)Olfaction
c)Auditory
d)Voluntarymovement
CorrectAnswer-D
Ans.D.Voluntarymovement
Precentralgyrusistheprimarymotorcortex(Brodmann'sArea4)
wheretheimpulseforvoluntaryactivityoriginates.

---

169.NumberofconesinRetina?
a)3-5millions
b)10-20millions
c)25-50millions
d)50-100millions
CorrectAnswer-A
Ans.A.3-5millions
NumberofConesinretinais3-4.5millionswhereasnumberofRods
are90-100millions.

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170.Cellbodiesoforexigenicneuronsare
presentin?
a)Dorsalraphae
b)Locuscoerulus
c)Lateralhypothalamicarea
d)Hippocampus
CorrectAnswer-C
Ans.C.Lateralhypothalamicarea
ARCneuronsalsoprojecttootherhypothalamicnuclei,includingthe
orexigenicorexincontainingneuronsinlateralhypothalamicarea,to
stimulateapPetite.

---

171.Cushingreflexisassociatedwithall
except?
a)Hypotension
b)Increasedintracranialpressure
c)Bradycardia
d)Tachyponea
CorrectAnswer-A
Ans.is'a'i.e.,Hypotension
AriseinintracranialpressurecausesimpairedbloodsupplytoVMC
(RVLM)neuronsandthelocalhypoxiaandhypercapniaincrease
theirdischargetothesystemicresistancevessels,i.e.,cushing
reflex.TheresultantriseinBPtendstorestorecerebralbloodflow
andoveraconsiderablerange,theBPriseisproportionaltothe
increaseinintracranialpressure.TheincreaseinBPcausesreflex
bradycardiathrougharterialbaroreceptors.Thatiswhybradycardia
ratherthantachycardiaischaracteristicallyseeninpatientswith
increase(ICP).
Cushingreflexconsistsofhypertension(increasedBP),bradycardia
andtachyponea.

---

172.Whichofthefollowingdoesnothave
sympatheticnoradrenergicfibers?
a)Bloodvessels
b)Sweatgland
c)Heart
d)Eye
CorrectAnswer-B
Ans.B.Sweatgland

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173.Allshouldbefeaturesofasubstanceto
measureGFR,except?
a)Freelyreabsorbed
b)Freelyfelteredacrossglomerulusmembrane
c)Notsecretedbykidney
d)None
CorrectAnswer-A
Ans.A.Freelyreabsorbed
TomeasureGFR,thesubstanceshouldhavefollowing
features:-
1. Passfreelyacrosstheglomerularmembrane.
2. Neitherreabsorbednorsecretedbykidney.

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174.Renalbloodflowis?
a)1-1.5L/min
b)1.5-2L/min
c)2-2-5L/min
d)2.5-3L/min
CorrectAnswer-A
Ans.A.1-1.5L/min
Thetotalrenalbloodflow(RBF)isapproximately1.1-1.3Lt/min.
i.e.,22-25%ofcardiacoutput.
Thekidneyshaveahighbloodflow
Inresting,healthy,youngadultmen,renalbloodflowaverages
about1.2L/min.
Thisisabout25%ofthecardiacoutput(5to6L/min).
Bothkidneystogetherweighabout300g,sobloodflowpergram
oftissueaveragesabout4mL/min.
Thisrateofperfusionexceedsthatofallotherorgansinthebody,
excepttheneurohypophysisandcarotidbodies.
Thehighbloodflowtothekidneysisnecessaryforahigh
GFRandisnotduetoexcessivemetabolicdemands.

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175.Theprimaryactivestepforsodiumreabsorptionintheproximaltubule
involves:
a)Sodium-glucosecotransportacrosstheluminalmembrane
b)Sodium/hydrogenioncountertransportacrosstheluminal
membrane
c)SodiumtransportviatheNa+-K+-ATPaseatthebasolateral
membrane
d)Sodium-aminoacidcotransportacrosstheluminalmembrane
CorrectAnswer-C
SodiumtransportviatheNa-K-ATPaseatthebasolateralmembrane.Thisistheonly
transportstepforsodiumintheproximaltubulethatinvolvesthedirectinputofenergyto
movesodiumagainstitselectrochemicalgradient(inthiscasefromtheinsideofthecellto
theoutside).

---

176.BestmeasureforGFR?
a)Serumcreatinine
b)Urineoutput
c)BUN
d)PAN
CorrectAnswer-A
Ans.A.Serumcreatinine
InulinismoreaccuratemeasureofGFR,butisinconvenient
becauseithastobeinjectedintravascular.
Creatinineisnotasaccurateasinulin,butcreatinineisalready
presentinthebloodinsteady-state,sotheendogenouscreatinine
clearancecanbeusedwithoutthenecessityofhavingtoinfuse
inulin.

---

177.AngiotensinIIcausesallofthefollowing,EXCEPT:
a)Stimulationofthirst
b)Aldosteronesecretion
c)IncreasedADHsecretion
d)Vasodilation
CorrectAnswer-D
"AngiotensinIIisoneofthemostpotentvasoconstrictorsknown,beingfourtoeight
timesasactiveasnorepinephrineonaweightbasisinnormalindividuals".Itproduces
arteriolarconstrictionandariseinsystolicanddiastolicbloodpressure.-Ganong
Italsoactsontheadrenalcortextoincreasesecretionofaldosterone.
Itfacilitatesthereleaseofnorepinephrinebyadirectactiononpostganglionicsympathetic
neurons,contractionofmesangialcellswitharesultantdecreaseinGFRandadirecteffect
ontherenaltubulestoincreaseNa+reabsorption.
Itactsonthebraintoincreasewaterintake(throughsubfornicialorgan)andincreasethe
secretionofvasopressinandACTH.

---

178.Normalrenalthresholdforglucoseisat
plasmaglucoselevel?
a)100mg/dl
b)200mg/dl
c)300mg/dl
d)400mg/dl
CorrectAnswer-B
Ans.B.200mg/dl
Thetransportmaximumforglucoseis375mg/minwhereasthe
filteredloadofglucoseisonly125mg/min.
Theoveralltransportmaximumforthekidneys,whichisnormally
about375mg/min,isreachedwhenallnephronshavereachedtheir
maximalcapacitytoreabsorbglucose.
Thus,Renalthresholdforglucose
1. Atplasmalevels?200mg/dl
2. Atfilteredload25Omg/min

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179.Hyperosmolarityofrenalmedullaisdue
to?
a)K
b)Na
c)glucose
d)Cl
CorrectAnswer-A:B:D
Ans.(B)Na(A)K(D)Cl
ThethickascendinglimbofloopofHenleisimpermeabletowater
butitactivelyreabsorbsNaCl.
ThethindescendinglimbofloopofHenleisrelativelyimpermeable
tosolutesbuthighlypermeabletowater.
Themostimportantcauseofthehighmedullaryosmolarityisactive
transportofsodiumandco-transportofpotassium,chlorideand
otherionsoutofthethickascendinglimbofloopofHenleintothe
medullaryinterstitium.
MostimportantamongalltheseisNaCl,formaintenanceofhigh
medullaryinterstitium.

---

180.Mostimportantextracellularbuffer?
a)Phosphate
b)Plasmaproteins
c)Ammonia
d)Bicarbonates
CorrectAnswer-D
Ans.D.Bicarbonates
Bicarbonates-Bicarbonatesarethemostimportantbuffersin
blood.
Thisisbecausethecomponentsofthisbuffersystemcanbe
adjustedbythebody.
TheHCO3-concentrationiscontrolledbythekidneywhilethePCO,
iscontrolledthroughpulmonarycirculation.

---

181."Deltacells"ofstomachsecrete?
a)Cholecystokinin
b)Gastrin-releasingpeptide
c)Somatostatin
d)Secretin
CorrectAnswer-C
Ans.C.Somatostatin

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182.Sugarsareprimarilyabsorbedin?
a)Duodenum
b)Jejunum
c)Ileus
d)Ascendingcolon
CorrectAnswer-B
Ans.B.Jejunum
Absorptionofglucose,galactoseandfructoseoccursmainlyinsmall
intestine,especiallyintheproximalpartofjejunum.

---

183.Trypsinogenisconvertedtotrypsinby?
a)Combinationof2moleculesoftrypsinogen
b)Phosphorylation
c)Removaloffewaminoacidsfromtrypsinogen
d)Additionofalkylgroup
CorrectAnswer-C
Ans.C.Removaloffewaminoacidsfromtrypsinogen
Severalenzymesaresynthesizedininactiveforms,called
proenzymes(zymogens).
Activatedwhenasmalllengthoftheproteiniscleavedofffromone
endthroughtheactionofspecificprotease.
Thiscausesanirreversiblerearrangementofthetertiarystructureto
yieldtheactiveformoftheprotein.
Enterokinasecleavestrypsinogentoyieldactivetrypsin.The
enzymecleavesproteinsatsitesofneutralaminoacids,witha
preferenceforaromaticorlargealiphaticsidechains.

---

184.Whichofthefollowingplantcomponents
isnotfermentedbygastrointestinal
microorganisms?
a)Lignin
b)Cellulose
c)Hemicellulose
d)Pectin
CorrectAnswer-A
Ans.A.Lignin
Lignin,anon-carbohydratetypeofdietaryfiberisneitherdigested
(byendogenoushumanenzymes)norfermentedbygastrointestinal
microorganisms.

---

185.Detergentactionofbilesaltsisdueto:
a)Hydropathic
b)Actsasazwitterion
c)Amphipathic
d)All
CorrectAnswer-C
Ans.C.Amphipathic

---

186.
LowestpHisseeninwhichofthe
gastrointestinalsecretion?
a)Gastricjuice
b)Bilejuice
c)Saliva
d)Pancreaticjuice
CorrectAnswer-A
Ans.A.Gastricjuice

---

187.Dailysalivarysecretionis
a)250-500ml
b)1000-1500ml
c)2000-2500ml
d)3000ml
CorrectAnswer-B
Ans.B.1000-1500ml

---

188.Pancreaticjuicerichinwaterand
electrolytespoorinenzymesissecreted
inresponseto:
a)Pancreatozymin
b)Cholecystokinin
c)Secretin
d)Proteins
CorrectAnswer-C
Ci.e.Secretin

---

189.Whichcellsarereferredas"Pacemakercells"with
relationto'BER'?
a)SAnode
b)AVnode
c)InterstitialcellsofCajal.
d)Pyramidalcells
CorrectAnswer-C
InterstitialcellsofCajal
BasicElectricalRhythm(BER):
Smoothmusclecellsofthegastrointestinaltracthavespontaneous
rhythmicfluctuationsinmembranepotentialbetweenabout-65and
-45mV.
BERinitiatedbyPacemakercellscalled"InterstitialcellsofCajal".
Pacemakercells-
InterstitialcellsofCajal.
Stellatemesenchymalcellswithsmoothmuscle-likefeatures.
Location:
Areabsentinesophagus&proximalstomach.
Indistalstomach&smallintestine-Locatedinoutercircularmuscle
layernearmyentericplexus.
Incolon-Locatedatthesubmucosalborderofcircularmusclelayer.
Frequency:
InStomach&smallintestine-
Pacemakerfrequencyisindescendinggradient.
Pacemakerwiththehighestfrequencyusuallydominates(Eg.,In
Heart).

---

190.Inhibitionofmyentericplexusresultsin
a)Hyperacidity
b)Diarrhea
c)Decreasedgutmotility
d)Increasedsecretions
CorrectAnswer-C
Ans.C.Decreasedgutmotility
MyentericplexusorAuerbach'splexus:-Itisanouterplexuslying
betweenthelongitudinalandcircularmusclelayer.
Themyentericplexuscontrolsmainlygastrointestinalmotility
therefore,perisalsisrequiresanactivemyentericplexus

---

191.Gastrinisproducedby:
a)Pancreas
b)Gastricantralcells
c)Pituitary
d)All
CorrectAnswer-D
Di.e.All

---

192.Primaryhormoneforsecretionofmilk?
a)Oxytocin
b)Prolactin
c)Glucocorticoids
d)Relaxin
CorrectAnswer-B
Ans.B.Prolactin
Lactogenesisisthesynthesisandsecretionofmilkfrombreast
alveoli.
Thisrequiresprimarilyprolactin

---

193.Glucagonstimulates
a)Gluconeogenesis
b)Glycogenesis
c)Fattyacidsynthesis
d)Glycolysis
CorrectAnswer-A
Ans.'A'Gluconeogenesis.
GlucagonisapolypeptidehormonethatissecretedbytheAcellsof
theisletsofLangerhansofthepancreas.ItactsbyincreasingcAMP.
1)Glucagonstimulatesglycogenolysisintheliverbutnotinmuscle.
Breakdownofglycogenyieldsglucose.
2)Glucagonstimulatestheproductionofglucosefromaminoacids
(gluconeogenesis).Bothglycogenolysisandgluconeogenesistend
toraiseplasmaglucoselevels.
3)Glucagonstimulateslipolysis.Breakdownoflipidsyieldsfreefatty
acids,whichmaybeoxidizedcompletelytocarbondioxide,or
incompletelytoformketonebodies.

---

194.Whichofthefollowingisnotstoredin
cell
a)Insulin
b)Cortisol
c)Thyroxin
d)Renin
CorrectAnswer-B
Ans.B.Cortisol
Peptidesandaminehormonesarestoredincellswithinsecretory
vesicles.
Incontrast,steroidhormonesarenotstoredinsecretoryvesicle
beforetheirsecretion.

---

195.Bloodtissuebarrierintestisisformed
by?
a)Basallamina&interstitialcells
b)Adjacentsertolicellswithbasallamina
c)Basallamina&spermatogonia
d)Basallamina&leydigcells
CorrectAnswer-B
Ans.B.Adjacentsertolicellswithbasallamina
Junctionbetweenadjacentsertolicellsformblood-testisbarrier.

---

196.LHsurgeisassociatedwith?
a)Increasedestrogen&decreasedprogesterone
b)Increasedestrogen&increasedprogesterone
c)Decreasedestrogen&increasedprogesterone
d)Decreasedestrogen&increasedprogesterone
CorrectAnswer-A
Ans.A.Increasedestrogen&decreasedprogesterone
Atthetimeofovulation(LHsurge)estrogenlevelishighwhile
progesteronelevelislow.

---

197.TheintervalbetweenovulationandLH
surgeis?
a)12-24hours
b)24-48hours
c)48-72hours
d)72-96hours
CorrectAnswer-B
Ans.B.24-48hours
At36to48hbeforeovulation,theestrogenfeedbackeffect
becomespositive,andthisinitiatestheburstofLHsecretion(LH
surge)thatproducesovulation.

---

198.Whichhormoneincreaseswithage?
a)GH
b)Prolactin
c)Parathormone
d)Insulin
CorrectAnswer-C
Ans,C.Parathormone
Parathyroidhormonelevelsrisewithage,whichmaycontributeto
osteoporosis,
Increasingageaffectsthehormonalsecretionofbody.

---

199.Thefollowingistheunitforprolactin
levelof20inblood?
a)mg/ml
b)ng/ml
c)mg/L
d)ng/L
CorrectAnswer-B
Ans.B.ng/ml
Thenormalprolactinlevelis<20nglml.

---

200.Humanspermremainsfertileforhow
manyhoursinafemalegenitaltract?
a)6-8hrs
b)12-24hrs
c)24-48hrs
d)72-96hrs
CorrectAnswer-C
Ans.C.24-48hrs
Ahumanspermatozoonremainsfertileforatotalof24-48hrs.inthe
femalegenitaltract"--Textbookofreproductivesystem
Ovumremainsfertilefor72hours.

---

201.Deficiencyofenzymearomataseleadsto
deficiencyofwhichhormone?
a)Cortisol
b)Estrogen
c)Testosteron
d)Mineralcorticoids
CorrectAnswer-B
Ans.B.Estrogen
Aromataseistheenzymethatcatalyzestheconversionof
androgensintoestrogens.

---

202.Afterfirstmeioticdivision,theprimary
oocyteremainsarrestedin?
a)Diplotenestage
b)Pachytenestage
c)Metaphase
d)Telophase
CorrectAnswer-A
Ans.A.Diplotenestage

---

203.Allareandrogensexcept?
a)Testosterone
b)Dihydrotestosterone
c)Androstenedione
d)17a-hydroxprogesterone
CorrectAnswer-D
Ans.D.17a-hydroxprogesterone
Androgensaresubstanceswhichcausedevelopmentofsecondary
sexcharactersincastratedmalc.
Androgensinmaleare-
1. Testosterons
2. Dihydrotestosterone(mostpotent)
3. Dehydroepiandrosterone
4. Androstenedione

---

204.Chronicatrophyofadrenalglandwill
resultinwhichhormonedeficiency?
a)CRH
b)ACTH
c)Cortisol
d)MSH
CorrectAnswer-C
Ans.C.Cortisol
Cortisol(themajorglucocorticoid)isreleasedbyadrenalcortex.
CRHissecretedbyhypothalamus,andACTHandMSHare
secretedbypituitary.

---

205.Trueaboutthyroidhormonereceptoris?
a)DirectlybindstoTSH
b)DirectlybindstoTRH
c)Aresurfacereceptors
d)CausesnucleartranscriptionafterbindingwithT4
CorrectAnswer-D
Ans.D.CausesnucleartranscriptionafterbindingwithT4
TRHandTSHbindtocellmembranerecePtors(surfacereceptors)'
Thyroidhormone(thyroxine)receptorsareintranuclearreceptors
whichinducesynthesisofspecificProteins(transcriptionofproteins)
byincreasingexpressionofspecificgene.

---

206.Afterinjectingtestosteroneina
hypoandrogenicmale,whichofthe
followingoccurs?
a)DecreasedFSHsecretion
b)DecreasedLHsecretion
c)Increasedspermatogenesis
d)Noneoftheabove
CorrectAnswer-B
Ans.B.DecreasedLHsecretion
Systemicallyadministeredtestosteronedoesnotraisethe
testosteronelevelinthetestistoagreatdegree(asitis
administeredsystemically),anditinhibitsLHsecretion(testosterone
inhibitsLHsecretionbyinhibitionatbothhypothalamusandpituitary
levels).
So,endogenoustestosteronesecretionisdecreased(LHis
necessaryforendogenoustestosteronesecretion).
Thus,testisdoesnothavesufficienttestosteronethatisnecessary
fornormalspermatogenesis.
Therefore,prolongedadministrationofsystemictestosteronecan
causeoligospermiaorazoospermia.

---

207.Conversionofchondrocyteinto
osteogeniccellsiscausedby?
a)Insulin
b)IGF-1
c)Growthhormone
d)Thyroxine
CorrectAnswer-B:C
Ans.(C)Growthhormone(B)IGF-1
AspecificeffectofGrowthHormone(GH)onskeletalgrowthisto
convertchondrocytesintoosteogeniccells,thus,causingspecific
depositionofnewbone.
Thiseffectonbonegrowthismediatedbyinsulinlikegrowthfactor-l
(IGF-I).
Thus,conversionofchondrocytesintoosteogeniccells:-
Causedby-+growthhormone
Whichismediatedby-IGF-1

---

208.Inbreastlactiferousductsareformed
undertheinfluenceofwhichhormone?
a)Eestrogen
b)Progesterone
c)LH
d)FSH
CorrectAnswer-A
Ans.A.Eestrogen
Estrogenstimulatesproliferationofthelactiferousductswhile
progesteroneisresponsibleforthedevelopmentofmammary
Iobules.

---

209.Implantationoccursafterhowmanydays
offertilization?
a)3-5days
b)5-7days
c)7-9days
d)>14days
CorrectAnswer-B
Ans.B.5-7days
About6-7daysafterfertilizationtheblastocystattachestothe
endometrium,aprocesscalledasimplantationorembedding.
Normalsiteofimplantationisposteriorwallofuteruscloseto
fundus.

---

210.Spermiogenesisrefersto?
a)Formationofspermatazoafromspermatogonia
b)Formationofspermatazoafromspermatids
c)Formationofspermatidsfromspermatocytes
d)Formationofsecondaryspermatocytesfromprimary
spermatocytes
CorrectAnswer-B
Ans.B.Formationofspermatazoafromspermatids
SpermatogenesisFormationofspermatozoafrom
spermatogonia,
Spermiogenesis-Formationofspermatozoafromspermatids.
Thus,spermiogenesisisthelaststepofspermatogenesis.

---

211.Spermatogenesistakesplacein?
a)Epididymis
b)Seminiferoustubule
c)Ductusdeferens
d)Prostate
CorrectAnswer-B
Ans.B.Seminiferoustubule
Spermatogenesisreferstotheprocessofformationofspermatozoa
(sperm)fromprimitivegermcells(spetmatogonia).
SPermatogenesisbeginsatpubertyandcontinuesthroughoutadult
lifetodeclineinoldage.
Inhumans,ittakesanaverageof74daystoformamaturespem
fromprimitivegermcells.
Spermatogenesisoccursinseminiferoustubules.

---

212.WhichofthefollowingactionofGHis
mediatedbyIGF-1
a)Lipolysis
b)decreasesinsulin
c)Antilipolysis
d)Na*retention
CorrectAnswer-C
Ans.(C)Antilipolysis
Theactionsofgrowthhormone-mediatedviaIGF-1(somatomedin-
C)aretheindirecteffectsofgrowthhormone.
Theseinclude
-antilipolyticactivity
-insulin-likeactivity
-proteinsynthesis
-epiphysealgrowth.

---

213.AllofthefollowingstimulateGH
release,except-
a)Fasting
b)Exercise
c)Freefattyacids
d)Stress
CorrectAnswer-C
Ans.C.Freefattyacids
StimulithatincreasesecretionofGHarehypoglycemia,exercise,
fasting,proteinmeals,aminoacids(likearginine),stress,glucagon,
Pyrogen,lysinvasopressin,apomorphins,L-dopa&alpha-
adrenergics,estrogen,androgensand2-deoryflucose.
StimulithatdecreasesecretionofGHareR"EMsleep,glucose,
Somatostatin,cortisol,FFA,GHitseif,IGF-1,and
medroxyprogesteron.

---

214.HalflifeofT3?
a)10hours
b)1day
c)6days
d)10days
CorrectAnswer-B
Ans.B.1day

---

215.Notincreasedinstress?
a)ADH
b)thyroxine
c)GH
d)None
CorrectAnswer-D
Ans.D.None.
Allthegivenhormonesareincreasedduringstress.

---

216.Plasmavolumeismeasuredby?
a)Inulin
b)Evansblue
c)Mannitol
d)D20
CorrectAnswer-B
Ans.B.Evansblue

---

217.Mostcommontypeofcalciumchannels
ofskeletalmusclesare?
a)Ttype
b)Ltype
c)Rtype
d)Ntype
CorrectAnswer-B
Ans.B.Ltype
lnskeletalmuscle,thereisaveryhighconcentrationofL-type
calciumchannels,situatedinT-tubules.

---

218.Whatistheeffectofmoderateexercise
oncerebralbloodflow
a)Doesnotchange
b)Increases
c)Decreases
d)Initiallydecreasesthenincreases
CorrectAnswer-A
Ans.A.Doesnotchange
Cerebralbloodflowismaintainedduetoautoregulation(between
60-160mmHg)inresponsetomoderateexercise.
Duringexercise
1. Bloodflowdecreasedin;-Inactiveskeletalmuscles,kidney'liver'
GIT.
2. Bloodflowisunalteredinthebrain(duetoautoregulation).
3. Bloodflowisincreasedinexercisingskeletalmuscles,heart
(coronarycirculation),lung.
4. Initially,itdecreasedduetotheredistributionofbloodtowards
musclebutlaterincreasedduetoanincreaseintemperatureof
Skin.

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219.'Patch-clamp'isusedfor?
a)Torecordfacilitateddiffusion
b)Torecordflowinvoltagegatedchannel
c)Torecordosmoticpressurearoundsemipermeablemembrane
d)TorecordRMP
CorrectAnswer-B
Ans.B.Torecordflowinvoltagegatedchannel
Patch-clampisusedtorecordcurrentflowthroughasinglevoltage-
gatedproteinchannel.

---

220.Gapjunctions?
a)Areabsentincardiacmuscles
b)Areabsentinsmoothmuscles
c)Arepresentincardiacmusclestotransmitimpulsefromoneto
anothermyocyte
d)Arepresentincardiacmusclesbutnorole
CorrectAnswer-C
Ans.C.Arepresentincardiacmusclestotransmitimpulse
fromonetoanothermyocyte
Gapjunctions
Theyareintercellularconnectionscalledhemichannelsor
connexons.
Theyaremadeupofproteinsubunits"Connexins".
Thesecontinuouschannel(connexons)permitssubstances(ions
andother)topassfromonecelltootherwithouthavingtopass
throughthecellmembrane.
Gapjunctionistypicallyseenincardiacandsmoothmuscles.
Becauseofgapjunctionscardiacmusclebehavesasafunctional
syncytiumasthesegapjunctionsprovidelow-resistanceBridgefor
spreadofexcitationfromonefibertoother-

---

221.Carbonicanhydraseactivityfoundinall
except?
a)Brain
b)Kidney
c)RBC
d)Plasma
CorrectAnswer-D
Ans.D.Plasma
Carbonicanhydrase(CAse)isanenzymewhichcatalyzesthe
reversiblereactionofformationofbicarbonateions,
Theenzymeispresentinrenaltubularcells(especiallyPT),gastric
mucosa,exocrinepancreas,ciliarybodyofeye,brainandRBC.

---

222.Halflifeofalbuminis:
a)5days
b)10days
c)20days
d)40days
CorrectAnswer-C
Ans.C:20days
Albuminhasaserumhalf-lifeofapproximately20days.Ithasa
molecularmassof67kDa.
Albuminissynthesizedintheliveraspreproalbuminwhichhasan
N-terminalpeptidethatisremovedbeforethenascentproteinis
releasedfromtheroughendoplasmicreticulum.
Theproduct,proalbumin,isinturncleavedintheGolgivesiclesto
producethesecretedalbumin.
Humanserumalbuministhemostabundantproteininhumanblood
plasma.
Itisproducedintheliver.
Albumincomprisesabouthalfofthebloodserumprotein.Itis
solubleandmonomeric.

---

223.HalflifeofPrealbuminis?
a)2days
b)10days
c)20days
d)40days
CorrectAnswer-A
Ans.A.2days

---

224.Calmodulinactivates?
a)Musclephosphorylase
b)Proteinkinase
c)2,3DPG
d)Glucokinase
CorrectAnswer-A
Ans.A.Musclephosphorylase
Calcium-calmodulincomplexactivatesmyosinlightkinase(myosin
kinase)whichisaphosphorylaseandphosphorylatemyosinhead.

---

225.Duringstarvation,whichlevelincreases
?
a)Leptin
b)MSH
c)Grhelin
d)Insulin
CorrectAnswer-C
Ans.C.Grhelin

---

226.Bloodsupplyofliver[m1/100g/min]
a)1500-2000
b)1000-1500
c)50-60
d)250-300
CorrectAnswer-C
Ans.is'c'i.e.,50-60
[Ref:Ganong23'd/ep.570]
Bloodflowthroughvariousorgansareasfollow:-
TotalBloodFlow(bloodflowtowholeorganinml/min)rLiver(1500)
>kidney(1260)>skeletalmuscle(540)>Brain(750)>Skin(,162)
>Heart(250).

---

227.Centroacinarcellsarepresentin?
a)Pancreas
b)Parotidgland
c)Prostate
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Pancreas
Pancreas
Itisamixedexocrineandendocrinegland.
A.Exocrinepart
Theexocrineportionisacompoundacinargland,consistsof
pancreaticacini.
Theaciniofpancreasconsistofagroupofpyramid-shapedacinar
cells'(pancreaticparenchymalcells)arrangedaroundasmalllumen.
Thecentroacinar-cellsareseenatthecentreofaciniwheretheduct
systembegins.Thesecellsareanextensionoftheintercalatedduct
cellsintotheacinus.Theyaddbicarbonateionstopancreaticjuce.
Individualaciniaredrainedbyintercalatedducts(interalobular
ducts),whichdrainintolargerinterlobularducts,foundinconnective
tissuesepta.
B.Endocrinepart
IsletsofLangerhansconstitutetheendocrinepartandarescattered
throughouttheexocrinepart,mostabundandlyintailregion.

---

228.TrueaboutGproteincoupledreceptors
is:
a)Gproteinsbindtohormonesonthecellsurface
b)Allthethreesubunitsalpha,betaandgammashouldbindto
eachotherforGproteintoact
c)Gproteinsactasinhibitoryandexcitatorybecauseofdifference
inalphasubunit
d)GproteinisboundtoGTPinrestingstate
CorrectAnswer-C
Gproteinsactasinhibitoryandexcitatorybecauseofdifferencein
alphasubunit[Ref:Harper26/ep458;LippincottBiochem3/ep93;
Ganong22/ep41]
G-proteincoupledreceptors(GPCR)arethelargestsuperfamilyof
cellsurfacereceptors.
Theytypicallyhavesevenhelicesthattraversethemembrane.
Thesereceptorsareintegralmembraneproteinscharacterizedby
anextracellularligand-bindingregion,seventransmembrane
helices,andanintracellulardomainthatinteractswithG-proteins.
ThefunctionofGPCRistotransducesignalsthatinduceacellular
responsetotheenvironment.
Mechanism:
Theligandbindstoasiteontheextracellularportionofthereceptor.
Bindingoftheligandtothereceptor
*activatesaGproteinassociatedwiththecytoplasmicC-terminal.
Thisinitiatestheproductionofa"secondmessenger".Themost
commonoftheseare
*cyclicAMP,(cAMP)whichisproducedbyadenylylcyclasefrom
ATPand
*inositol1,4,5-trisphosphate(IP3)

---

*inositol1,4,5-trisphosphate(IP3)
Thesecondmessenger,inturn,initiatesaseriesofintracellular
eventssuchas
*phosphorylationandactivationofenzymes
*releaseofCa2+intothecytosolfromstoreswithintheendoplasmic
reticulum
Gproteins
Gproteinsareso-calledbecausetheybindtheguaninenucleotides
GDPandGTP.Theyareheterotrimers(i.e.,madeofthreedifferent
subunits)
Thethreesubunitsare:
*Ga,whichcarriesthebindingsiteforthenucleotide.Atleast21
differentkindsofGamoleculesarefoundinmammaliancells.
*GP
*Gy
HowTheyWork
IntheinactivestateGproteinhasGDPboundtoitsGa.subunit.
WhenahormoneorotherligandbindstotheassociatedGPCRthe
GDPisexchangedforGTP
GTPactivatesGacausingittodissociatefromGI3Gy(whichremain
linkedasadimer).
ActivatedGainturnactivatesaneffectormolecule(adenylyl
cyclase-anenzymeintheinner.sfaceoftheplasmamembrane
whichcatalyzestheconversionofATPintothe"secondmessenger"
cyclicAMP).
Thebetaandgammasubunitdonotseparatefromeachother,and
Gi3Gydimeralsoactivatesavarietyofeffectors.
TheactionsoftheGa-GTPcomplexareshortlivedbecausetheG-
proteinhasaninherentGTPaseactivity,resultingintherapid
hydrolysisofGTPtoGDP.ThisleadstoreassociationoftheGaunit
withtheGI3Gydimer.ThisinactivatestheGprotein.
Theabilityofaligandtostimulateorinhibitthesecondmessenger
dependsonthetypeofG-proteinthatislinkedtothereceptor.One
familyofG-proteins,designatedGs,isspecificforstimulationof
adenylylcyclase;anotherfamily,designatedGi,causesinhibitionof
theenzyme.ThesedifferentactionsofGproteinsareattributedto
differentalphasubunits.Gscontainsa,andGicontains
SomeTypesofGaSubunits

---

SomeTypesofGaSubunits
Gas_Thistypestimulates(s="stimulatory")adenylylcyclase.Gasis
thetargetofthetoxinliberatedbyVibriocholerae,thebacteriumthat
causescholera.BindingofcholeratoxintoGaskeepsitturned"on".
TheresultingcontinuoushighlevelsofcAMPcausesamassiveloss
ofsaltsfromthecellsoftheintestinalepithelium.Massiveamounts
ofwaterfollowbyosmosiscausingadiarrheathatcanbefatalifthe
saltsandwaterarenotquicklyreplaced.
Ga;-Thisinhibits(i="inhibitory")adenylylcyclaseloweringthelevel
ofcAMPinthecell.
Gag_ThisactivatesphospholipaseC(PLC)whichgeneratesthe
secondmessengers:
*inositoltrisphosphate(IP3)
*diacylglycerol(DAG)
Gat_The"t"isfortransducin,themoleculeresponsiblefor
generatingasignalintherodsoftheretinainresponsetolight.

---

229.WhichofthefollowingactthroughG
proteincoupledreceptors?
a)AchMuscarinicreceptors
b)Insulinreceptors
c)AchNicotinicreceptors
d)GABA-Areceptors
CorrectAnswer-A
Ans:A.AchMuscarinicreceptors
Ref:Lippincott,6't'ed.,Pg.27-28
Ml,M2,M3,M4andM5areAchMuscarinicreceptors.
TheyareGproteincoupledreceptors

---

230.Mechanismofactionofcholecystokinin
?
a)Activationofadenylylcyclase
b)Openingofionchannels
c)ThroughIP3-DAGsystem
d)Transcriptionfacters
CorrectAnswer-C
Ans.C.ThroughIP3-DAGsystem

---

231.WhichhormoneactsonJAK-STAT
kinasereceptor?
a)TSH
b)Thyroxine
c)GH
d)FSH
CorrectAnswer-C
Ans.C.GH

---

232.Thyroidhormonebindstowhich
receptor?
a)Membrane
b)Cytoplasmic
c)Nuclear
d)None
CorrectAnswer-C
Ans.C.Nuclear

---

233.Normalrangeofserumosmolalityis
(mOsm/Kg)?
a)280-300
b)250-270
c)300-320
d)210-230
CorrectAnswer-A
Ans.A.280-300
Normalosmolalconcentration(osmolalityofplasmais290
mOsm/Kg.

---

234.Thefollowingistheactionofmelatonin?
a)FacilitatesACTHsecretion
b)Preventssleepinduction
c)Regulatesthecircadiandaynightrhythm
d)ReleaseofTSH
CorrectAnswer-C
Ans.C.Regulatesthecircadiandaynightrhythm
Theprincipalsecretoryproductofthepinealglandismelatonin.
Melatoninsecretionshowsacircadianrhythm,thelevelbeinghigher
atnightandloweratday.
Thisdiurnalvariationisbroughtaboutbynorepinephrinesecretedby
postganglionicsympatheticnervesthatinnervatethepinealgland.
Inthedarknorepinephrine,secretionisincreasedwhichactson-
receptorstoincreaseintracellularcAMPandcAMP,inturn,
producesamarkedincreaseinN-Acetyltransferaseactivity,an
enzymeinvolvedinmelatoninsynthesisfromserotonin.

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235.Na+-K+-C1-cotransportercontains?
a)5transmembranespanningdomain
b)7transmembranespanningdomain
c)9transmembranespanningdomain
d)12transmembranespanningdomain
CorrectAnswer-D
Ans.D.12transmembranespanningdomain
Na+-K+-Cl-cotransporter(cation-chloridecotransporter)has12-
transmembranespanningdomainswithglycosylationsiteson
extracellularloopbetweenmembranespans7and8.

---

236.Vonwilebrandfactorissynthesizedby
allexcept?
a)Endothelialcells
b)Megakaryoctyes
c)Hepatocytes
d)None
CorrectAnswer-C
AnsC.Hepatocytes
Mostclottingfactorsaresynthesizedinliverexcepta
componentoffactorVIII.FactorVIIIhastwocomponents:-
1. FactorVIIIc(coagulantfactorVIII):-Synthesizedinliver(main
source)andkidney.
2. VonWillebrandfactor(vWF):-Synthesizedinendothelium(main
source)andmegakaryocytes.

---

237.FemaleshavelowRBCcountcompared
tomalesdueto?
a)Lowerythropoietin
b)Mensturalbloodloss
c)Highestrogen
d)Lowstemcells
CorrectAnswer-B
Ans.B.Mensturalbloodloss
Differencesinbloodvaluesbetweenmenandwomenresult
becauseofseveralfactors:-
1. MenhavehigherandrogenslevelsandandrogensstimulateRBC
production.
2. Womenofreproductiveagelosebloodthroughmenstruation,which
lowerbloodcells.
3. Womentypicallyhavemorefatthanmen,andthehigherthebody
fatcontent,thelowerthehematocritlevel.

---

238.ATPaseactivityispresentin
a)Actin
b)Myosin
c)Troponin
d)None
CorrectAnswer-B
Ans.B.Myosin
Myosinistheproteinthatconstitutesthethickfilaments.
Myosinofskeletalmuscleismyosin-II
Myosinparticipatesinthecontractilemechanismandalsofunctions
asanATPase.

---

239.Normalferritinlevelinadultmale?
a)5-10ng/ml
b)100-200ng/ml
c)500-700ng/ml
d)800-900ng/ml
CorrectAnswer-B
Ans.B.100-200ng/ml
Normalserumferritin
Males-30-400ng/ml
Females-30-200ng/ml

---

240.Dailywaterlossinsweatduringnormal
activities?
a)50-100ml
b)200-400ml
c)500-700ml
d)1000-1200ml
CorrectAnswer-A
Ans.A.50-100ml
Fluidlossinsweat:Thisishighlyvariable,anddependsonphysical
activityandenvironmentaltemperature.
Thevolumeofsweatnormallyisabout100ml/day.

---

241.Ionicreceptorsareallexcept?
a)NMDA
b)Kainate
c)mGluR
d)AMPA
CorrectAnswer-C
Ans.C.mGluR
Inotropicreceptors
Inotropicreceptorsaretransmembraneionchannelswhichallow
differentkindsofiontotravelinandoutofthecell.
Bindingofneurotransmitter(ligand)eitheropenorclosetheion
channel.
Therefore,inotropicreceptorsare"Ligandgatedtransmembraneion
channels,"
Examplesofinotropicreceptorsare:-
1. Forglutamate-AMPA,Kainate,NMDA
2. ForGABA:GABA(a)recePtors
3. Foracetylcholine:Nicotinic(Nm,Nn)
4. Forserotonin-5HT3

---

242.Majorsiteofproteinglycosylationis?
a)ERandgolgibody
b)Ribosomeandgolgibody
c)ERandribosome
d)Ribosomeandcytoplasm
CorrectAnswer-A
Ans.is'a'i.e.,ERandgolgibody[RefHarper28aVep.514,515;
Lippincotts5thlep.167,168]
N-GlycosylationoccursinERandO-glycosylationoccursingolgi
apparatus.

---

243.Intypelamaplesyrupurinedisease,
genemutationseenis?
a)Ela
b)Elb
c)E2
d)E3
CorrectAnswer-A
Ans.is'a'i.e.,Ela[RefHarper27"/ech.29;Nelson18th/ech.
85.6;Medicalbiochemistrybysheriff1"/ep.513]
Metabolicdisordersofbranched-chainaminoacidcatabolism
Asthenameimplies,theodorofurineinmaplesyrupurinedisease
(branched-chainketonuria)suggestsmaplesyruporburntsugar.
Decarboxylationofleucine,isoleucine,andvalineisaccomplished
byacomplexenzymesystem(branched-chaina-ketoacid
dehydrogenase)usingthiaminepyrophosphate(vitamin81)asa
conzyme.
Thismitochondrialenzymeconsistsoffoursubunits:Ha,El(3,E2,
andE3.DeficiencyofthisenzymesystemcausesMSUD.Basedon
clinicalfindingsandresponsetothiamineadministration,five
phenotypesMSUDhavebeenidentifiedclassical,intermediate,
intermittent,thiamineresponsiveandE3deficiency.Allformsof
MSUDareinheritedasanautosomalrecessivetrait.

---

244.Sirtuinsareassociatedwith?
a)Memory
b)Metabolism
c)Vision
d)Olfaction
CorrectAnswer-B
Ans.is'b'i.e.,Metabolism
SirtuinsareafamilyofhighlyconservedNAD+dependent
deacetylase5thatactascellularsensorstodetectenergy
availabilityandmodulatemetabolicprocess.
Twomammaliansirtuinsareinvolvedincontrolingmetabolic
process:SIRT-1(innucleus)andSIRT-2(inmitochondria).
TheyareactivatedbyhighNAD?levels(lowcellularenergystatus).
They,then,deacetylateavarietyofproteinscausinginductionof
catabolicprocessesandinhibitionofanabolicprocesses.
SIRT-1andSIRT-3coordinatelyincreasecellularenergystoresand
ultimatelymaintaincellularenergyhomeostasis.
GeneticvariantinSIRT-1geneisassociatedlowerriskof
cardiovascularmortalityandwithbettercognitivefunctioning.
SIRT-1variantsareassociatedwithdecreasedbasalenergy
expenditureandalowerlipidperoxidationrate.Therefore,ithas
beenproposedthatgeneticvariationinSIRT-1maydeterminethe
responseratesofindividualesundergoingcaloricrestrictionand
increasedphysicalactivity.
GeneticvariantsofSIRT-3maybeassociatedwithincreased
longevity(increasedlifespan),butthereisnoevidenceofsuchan
association.

---

245.Whichelementisrequiredby
phosphofructokinase?
a)Magnesium
b)Inorganicphosphate
c)Manganese
d)Copper
CorrectAnswer-A
Phosphofructokinase(PFK)is--300aminoacidsinlength,and
structuralstudiesofthebacterialenzymehaveshownitcomprises
twosimilar(alpha/beta)lobes:oneinvolvedinATPbindingandthe
otherhousingboththesubstrate-bindingsiteandtheallostericsite
(aregulatorybindingsitedistinctfromtheactivesite,butthataffects
enzymeactivity).Theidenticaltetramersubunitsadopt2different
conformations:ina'closed'state,theboundmagnesiumionbridges
thephosphorylgroupsoftheenzymeproducts(ADPandfructose-
1,6-bisphosphate);andinan'open'state,themagnesiumionbinds
onlytheADP,asthe2productsarenowfurtherapart

---

246.Carboxypeptidasecontainswhich
mineral?
a)Copper
b)Zinc
c)Iron
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Zinc
Zinccontainingenzymesarecarboxypeptidase,carbonicanhydrase,
alkalinephosphatase,lactatedehydrogenase,alcohol
dehydrogenase,glutamatedehydrogenase,RNApolymeraseand
superoxidedismutase.

---

247.Enzymespecificityisgivenby?
a)Km
b)Vrm,,
c)Both
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Km.
TheKmofanenzymeistheconcentrationofthesubstratethat
enablestheenzymetofunctionathalfmaximumactivityandis
thereforeameasureofthespecificityofasubstrate.forthe
enzyme"Clinicalbiochemistry
ActuallyenzymespecificityisnotmeasuredbyKmalone.
ItismeasuredbytheratioKcat/Kmwhichisasecondorderrate
constantforthereactionbetweensubstrateandfreeenzyme.
Thisratioisimportant,foritprovidesadirectmeasureofenzyme
efficiencyandspecificity.
Note:Kcatisturnovernumberandmeasurestherateofthecatalytic
process.

---

248.Kcat/kmisameasureof-
a)Enzymeefficiency
b)Speedofenzymaticreaction
c)Concentrationofsubstrate
d)Enzymeturnover
CorrectAnswer-D
Answer-D.Enzymeefficiency
"TheKmofanenzymeistheconcentrationofthesubstrate
thatenablestheenzymeto
Functionathalfmaximumactivityandisthereforeameasureof
thespecificityofasubstratefortheenzyme".
Actuallyenzymespecificityisnotmeasuredbyalone.
ItismeasuredbytheratioKcat/Kmwhichisasecondorder
rateconstantforthereactionbetweensubstrateandfree
enzyme.
Thisratioisimportant,foritprovidesadirectmeasureof
enzymeeficiencyandspecificity.
Note:Km,isturnovernumberandmeasurestJrerateofthe
catalyticprocess

---

249.Q10inenzymematcheswith?
a)2
b)4
c)8
d)10
CorrectAnswer-A
Ans.is'a'i.e.,2
Mostenzymeshowa50-300%(average200%)increaseinreaction
ratewhenthetemperatureisincreasedby10?,andtheratioofrate
constantattwotemperatures10?apartisusuallybetween1.5to4
(average2)formostenzymes.
ThisvalueistermedasQ10.
"Therateofenzymaticreactiondoubleswithevery10?risein
temperature."

---

250.Whichofthefollowingisalyase?
a)Decarboxylase
b)Synthetase
c)Kinase
d)Oxygenase
CorrectAnswer-A
Ans.is'a'i.e.,Decarboxylase
Enzymeclass Importantenzymes
Oxidases,Dehydrogenases,Hydroperoxidases,
Oxidoreductase (catalase,peroxidase),oxygenases
Aminotransferaseortransaminase,e.g.,SGOT
(AST)andSGPT(ALT),kinases(Hexokinaseo
Transferase
glucokinase,pyruvatekinaseetc),Transketolases,
transaldolases,transcarboxylase
Alldigestiveenzymes(Pepsin,trypsin,lipases,
Hydrolases
esterases),lysosomalenzymes,urease,and
phosphatase
DecarboxylasesQ,aldolases,hydratases,enolase,
Lyases
fumaraseQ,Arginosuccinase
Racemases,epimerases,cis-trans-isomerases,
lsomerases
mutases
Ligases
SynthatasesQ,Carboxylases,DNAligase

---

251.Hexokinaseis?
a)Ligase
b)Transferase
c)Oxidoreductase
d)Reductase
CorrectAnswer-B
Ans.is`b'i.e.,Transferase

---

252.Whichispredominantinnormal
healthyhuman?
a)LDH1
b)LDH2
c)LDH3
d)LDH4
CorrectAnswer-B
Ans.is'b'i.e.,LDH2
Submit
Percentagein
Isoenzyme
Issue
composition
serrum
LDHI
HHHH
Myocardium,RBC 30
LDH2
HHHM
Myocardium,RBC 35
LDH3
HHMM
Brain,Kidney
20
Skeletalmuscle,
LDH4
HMMM
10
Liver
Skeletalmuscle,
LDH5
MMMM
5
Liver

---

253.AccordingtoIUBsystem,hydrolases
belongtowhichclass?
a)EC-1
b)EC-2
c)EC-3
d)EC-4
CorrectAnswer-C
Ans.is'c'i.e.,EC-3
IUBclassification
Enzymecodenumber(ECnumber) Enzyme
EC-1
Oxidoreductase
EC-2
Transferase
EC-3
Hydrolases
EC-4
Lyases
EC-5
Isomerases
EC-6
Ligases

---

254.Whichofthefollowingisserineprotease
?
a)Pepsin
b)Trypsin
c)Carboxypeptidase
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Trypsin

---

255.Fastestactingenzyme?
a)LDH
b)Trypsin
c)Catalase
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Catalase
Measurementofenzymeactivity
Theactivityofenzymeismeasuredintermsofthefollowing:
Unitofenzymeactivity:-Byinternationalagreement,oneunit
enzymeactivityisdefinedastheamountcausingtransformationof
1.0micromoleofsubstrateperminuteat25?C.Itisusually
expressedasmoleofsubstratedisappearedormoleofproduct
formedperminute.
Specificactivity:-Itreferstothenumberofenzymeunitsper
milligramofprotein.Itisameasureofenzymepurity;higherthe
enzymepurity,moreisthespecificactivity.
Turnovernumber:-Thisreferstothenumberofsubstrate
moleculestransformedperunittimebyasingleenzymemolecule
(orbyasinglecatalyticsite),whentheenzymeconcentrationalone
israte-limitingfactor.Catalasehasthehighestturnovernumberand
henceisthefastestactiveenzyme.Carbonicanydrasehasthe2"
fastestturnovernumber;therefore,itis2ndfastestactiveenzyme
(aftercatalase).Lysozymehasthelowestturnovernumberand
thereforeisslowestacting.

---

256.Whichofthefollowingishighenergy
compound?
a)ADP
b)Glucose-6-phosphate
c)Creatinephosphate
d)Fructose-6-phosphate
CorrectAnswer-C
Ans.is'c'i.e.,Creatinephosphate
Highenergycompounds
Theenergyreleasedduringoxidationofmonosaccharides,fatty
acidsandaminoacidsmaynotberequiredimmediately.Therefore,
theremustbesomewayofstoringenergy.Theenergyreleased
duringcatabolismiscapturedintheformofagroupofcompounds
knownas"high-energyphosphates".Themostimportantmemberof
thisgroupisATP.
Acompoundthatliberates7Kcal/molormoreonhydrolysisiscalled
highenergycompound,oracompoundthatonhydrolysis
undergoesalarge(7kcal/mol)decreaseinfreeenergy(AG)under
standardconditioniscalledhighenergycompound,i.e.,AG?-7
Kcal/mol.Forexample,ATPliberates7.3Kcal/molonhydrolysis.
Highenergycompoundsare:?
Phosphatecompounds:Nucleotides(ATPQ,GTP,UTP,UDP-
glucose),Creatininephosphate,argininephosphate,1,3-
bisphosphoglycerate,Phosphoenolpyruvate,inorganic
pyrophosphate,Carbamoylphosphatee,aminoacyladenylate(amino
acylAMP).
Sulfurcompounds:-CoAderivatives(acetylCoAe,SuccinylCoA,

---

fattyacylCoA,HMGCoA),S-adenosylmethionine(SAM),
adenosinephosphosulfate.
Acompoundwhichliberates<7Kcal/molonhydrolysisiscalledlow
energycompound,i.e.,adecreaseinfreeenergyis<7Kcal/mol,
i.e.,AG<-7Kcal/mol.Lowenergycompoundsareglucose-1-
phosphate,fructose-6phosphate,glucose-6-phosphate,glycerol-3-
phosphate,AMP,ADPQ.

---

257.Whichenergymoleculegives10.5kcal/
molecule?
a)ATP
b)GTP
c)Creatinephosphate
d)Glucose-6-phosphate
CorrectAnswer-C
Ans.is'c'i.e.,Creatinephosphate
Acompoundthatliberates7Kcal/molormoreonhydrolysisiscalled
highenergycompound,oracompoundthatonhydrolysis
undergoesalarge(7kcal/mol)decreaseinfreeenergy(AG)under
standardconditioniscalledhighenergycompound,i.e.,
AG7Kcal/mol.
Forexample,ATPliberates7.3Kcal/molonhydrolysis
Metabolite
AG LiberatedenergyinKcallmole
Phosphoenolpyruvate
-14.8 14.8
Carbamoylphosphate
-12.3 12.3
1,3-Bisphosphoglycerate -11-8 11.8
Acidphosphate
-112 112
Creatinephosphate
-10.3 10.3
Argininephosphate
-7.6 7.6
ATPtoADP+Pi
-7.3 7.3
ATPtoAMP+PPi
-7-7 7.7
Glucose-1-phosphate
-5.0 5.0
Glucose-6-phosphate
-3.3 3.3
Glycerol-l-phosphate
-2.2 2.2

---

258.AllaretrueaboutVitaminB12,except?
a)Activeformismethylcobalamine
b)Requiresforconversionofhomocysteinetomethionine
c)RequiresinmetabolismofmethylmalonylCoA
d)Requiresforconversionofpyruvatetolactate
CorrectAnswer-D
Ans.is'd'i.e.,Requiresforconversionofpyruvatetolactate

---

259.ATPisgeneratedinETCby?
a)Na'ATPase
b)Cl-ATPase
c)FoF,ATPase
d)ADPKinase
CorrectAnswer-C
Ans.is`c'i.e.,FoFiATPase

---

260.Atractilosideactas?
a)Uncoupler
b)Inhibitorofoxidativephosphorylation
c)InhibitorofcomplexIofETC
d)InhibitorofcomplexIIIofETC
CorrectAnswer-B
Ans.is'b'i.e.,Inhibitorofoxidativephosphorylation
Inhibitorsofelectrontransportchain?
Inhibitorsofrespiratorychainmaybedividedintothreegroups:?
1.Inhibitorsofelectrontransportchainproper
Theseinhibitorsinhibittheflowofelectronsthroughtherespiratory
chain.Thisoccursatfollowingsites.
ComplexI(NADHtoCoQ)isinhibitedby:-Barbiturates
(amobarbital),PiericidinA(anantibiotic),rotenone(aninsectiside),
chlorpromazine(atranquilizer),andguanethidine(an
ntihypertensive).Theseinhibitorsblockthetransferofreducing
equivalentsfromFeSproteintoCoQ.
ComplexIIisinhibitedby:-CarboxinandTTFAinhibittransferof
electonfromFADH2toCoQ,whereasmalanatecompetitivelyinhibit
fromsuccinatetocomplexII.ComplexIII(Cytochromebto
cytochromeCI)isinhibitedby:-Dimercaprol,antimycinA,BAL
(Britishantilewisite),Naphthyloquinone.Theseinhibitorsblockthe
transferofelectronsfromcytochromebtocytochrome
ComplexIV(cytochromeCoxidase)isinhibitedby:-Carbon
monoxide,CN-,H2Sandazide(N3-).Theseinhibitorsblockthe
transferofelectronsfromcytochromeaa3tomolecularoxygenand
thereforecantotallyarrestcellularrespiration.
2.Inhibitorsofoxidativephosphorylation

---

ThesecompoundsdirectlyinhibitphosphorylationofADPtoATP.
OligomycininhibitsFocomponentofF0F,ATPase.Atractiloside
inhibitstranslocase,atransportproteinthattransportsADPinto
mitochondriaforphosphorylationintoATP.
3.Uncouples
Asthenamesuggests,thesecompondsblockthecoupelingof
oxidationwithphosphorylation.Thesecompoundsallowthetransfer
ofreducingequivalentsinrespiratorychainbutpreventthe
phosphorylationofADPtoATPbyuncouplingthelinkagebetween
ETCandphosphorylation.Thustheenergyinsteadofbeingtrapped
byphosphorylationisdissipatedasheat.Uncouplersmaybe:-
1. Natural:-Thermogenin,thyroxine
2. Synthetic:-2,4-dinitrophenol(2,4-DNP),2,4-dinitrocresol(2,4-
DNC),andCCCP(chlorocarbonylcyanidephenylhydrazone).

---

261.Naturaluncoupleris?
a)Thermogonin
b)2,4nitrophenol
c)2,4Dinitrophenol
d)Oligomycin
CorrectAnswer-A
Ans.is'a'i.e.,Thermogenin
Amongstthegivenoptions,a,bandcareuncouplers.
However,onlythermogenin,amongthesethreeisanatural
(physiological)uncoupler.
Uncouples
Asthenamesuggests,thesecompondsblockthecoupelingof
oxidationwithphosphorylation.Thesecompoundsallowthetransfer
ofreducingequivalentsinrespiratorychainbutpreventthe
phosphorylationofADPtoATP?byuncouplingthelinkagebetween
ETCandphosphorylation.Thustheenergyinsteadofbeingtrapped
byphosphorylationisdissipatedasheat.Uncouplersmaybe:-
Natural:-Thermogenin,thyroxine
Synthetic:-2,4-dinitrophenol(2,4-DNP),2,4-dinitrocresol(2,4-
DNC),andCCCP(chlorocarbonylcyanidephenylhydrazone).

---

262.Physiologicaluncoupleris?
a)Thyroxine
b)Freefattyacids
c)Thermogenin
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove

---

263.Reducingequivalantsproducedin
glycolysisaretransportedfromcytosol
tomitochondriaby?
a)Carnitine
b)Creatine
c)Malateshuttle
d)Glutamateshuttle
CorrectAnswer-C
Ans.is'c'i.e.,Malateshuttle
MostoftheNADHandFADH2,enteringthemitochondrialelectron
transportchainarisefromcitricacidcycleand13-oxidationoffatty
acids,locatedinthemitochondriaitself.
However,NADHisalsoproducedinthecytosolduringglycolysis.
Togetoxidized,NADHhastobetransportedintothemitochondria
asrespiratorychain(ETC)islocatedinsidethemitochondria.
Since,theinnermitochondrialmembraneisnotpermeableto
cytoplasmicNADH,therearespecialshuttlesystemswhichcarry
reducingequivalentsfromcytosolicNADH(ratherthanNADHitself)
intothemitochondriabyanindirectroute.
Twosuchshuttlesystemsthatcanleadtotransportofreducing
equivalentfromthecytoplasmintomitochondriaare:-
1. Malateshuttle(malate-aspartateshuttlesystem).
2. Glycerophosphateshuttle.

---

264.WhichofthefollowingisAldosugar?
a)Fructose
b)Erythrulose
c)Glucose
d)None
CorrectAnswer-C
Ans.is`c'i.e.,Glucose
Numberof Aldoses
Sugar
Ketoses(ketosugars)
carbonatoms (Aldosugars)
Trioses
2 Glyceraldehyde Dihydroxyacetone
Tetroses
4 Erythrose
Erythrulose
Pentoses
5 Ribose,Xylose
Ribulose,xylulose
Glucose,
Hexoses
6 galactase,
Fructose
mannose
Heptoses
7 Glucoheptose
Sedoheptulose

---

265.PFK-Iinhibitor?
a)AMP
b)Citrate
c)Glucose6phosphate
d)Insulin
CorrectAnswer-B
Ans.is'b'i.e.,Citrate

---

266.Phosphofructokinase-1occupiesakeypositioninregulatingglycolysisand
isalsosubjectedtofeedbackcontrol.Whichamongthefollowingisthe
allostericactivatorsofphosphofructokinase-1?
a)Fructose2,3bisphosphate
b)Fructose2,6bisphosphate
c)Glucokinase
d)PEP
CorrectAnswer-B
Themostpotentpositiveallostericactivatorofphosphofructokinase-1andinhibitor
offructose1,6-bisphosphataseintheliverisfructose2,6-bisphosphate.
Itrelievesinhibitionofphosphofructokinase-1byATPandincreases
theaffinityforfructose6-phosphate.
Itinhibitsfructose1,6-bisphosphatasebyincreasingtheKmforfructose1,6-bisphosphate.
Itsconcentrationisunderbothsubstrate(allosteric)andhormonalcontrol(covalent
modification).
Phosphofructokinase-1isinhibitedbycitrateandbynormalintracellular
concentrationsofATPandisactivatedby5'AMP.

Ref:BenderD.A.,MayesP.A.(2011).Chapter20.Gluconeogenesis&theControlofBlood
Glucose.InD.A.Bender,K.M.Botham,P.A.Weil,P.J.Kennelly,R.K.Murray,V.W.
Rodwell(Eds),Harper'sIllustratedBiochemistry,29e.

---

267.Hexokinaseisinhibitedby?
a)Glucose-6-phosphate
b)Glucagon
c)Glucose
d)Insulin
CorrectAnswer-A
Ans.is'a'i.e.,Glucose-6-phosphate[Ref:Harper29"/ep.171,
190]

---

268.Allofthefollowingareinhibitedduring
fasting/starvation,except?
a)Hexokinase
b)Glucokinase
c)PDH
d)Pyruvatekinase
CorrectAnswer-A
Ans.is'a'i.e.,Hexokinase[RefHarper29th/ep.190]
Hexokinase(incontrasttoglycokinase)isnotaffectedby
feeding/insulinorstarvation.
Otherthreeenzymesactivityisdecreasedinstarvation.

---

269.Allareusedingluconeogenesisexcept?
a)Oleate
b)Succinate
c)Glutamate
d)Aspartate
CorrectAnswer-A
Ans.is'a'i.e.,Oleate
Substrateofgluconeogenesisare:
Lactate(lacticacid)
Pyruvate
Allaminoacids(exceptleucineandlysine)
Propionate
Intermediatesofcitricacidcycle
Fattyacidsarenotsubstratesforgluconeogenesis.
Comingtothequestion
Fattyacids(oleateinthequestion)isnotasubstratefor
gluconeogenesis.
SuccinateisanintermediateofTCAcycle,andisasubstratefor
gluconeogenesis.
Allaminoacids(inthequestionglutamateandaspartate),except
leucineandlysinearesubstratesforgluconeogenesis.

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270.Whichofthefollowingvitaminsdoesnot
participateinoxidativedecarboxylation
ofpyruvatetoacetylCoA?
a)Thiamine
b)Niacine
c)Riboflavin
d)Biotin
CorrectAnswer-D
Ans.is`d'i.e.,Biotin

---

271.Gluconeogenesisoccursinallexcept?
a)Liver
b)Kidney
c)Gut
d)Muscle
CorrectAnswer-D
Ans.is'd'i.e.,Muscle
Gluconeogenesisoccursmainlyintheliverandtoalesserextentin
renalcortex.
Somegluconeogenesiscanalsooccurinsmallintestine,butitisnot
significant.
Someofthereactionsofgluconeogenesisoccursinthe
mitochondriabutmostoccurincytosol.
Gluconeogenesiscannotoccurinmuscles.
Glucose-6-phosphataseisabsentinmusclestherefore,glucose-6-
phosphatecannotbedegradedtofreeglucoseinmuscles.
Moreover,glucose-6-phosphatecannotdiffuseoutofthemuscles.
Therefore,musclecannotprovideglucosetomaintainbloodglucose
level.Rather,muscleglycogenactsasasourceofenergy;the
glucose-6phosphateenterstheglycolysistoproduceenergy.

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272.Trueaboutgluconeogenesis?
a)Occursmainlyinmuscle
b)Itisreverseofglycolysis
c)Alanine&lactatebothcanserveassubstrate
d)Glycerolisnotasubstrate
CorrectAnswer-C
Ans.is'c'i.e.,Alanine&lactatebothcanserveassubstrate
Synthesisofglucosefromnoncarbohydrateprecursorsiscalled
gluconeogenesisi.e.,synthesisofnewglucose.
Themajornoncarbohydrateprecursors(substrate)for
gluconeogenesisarelactate,pyruvate,glycerol,glucogenicamino
acids,propionateandintermediatesofthecitricacidcycle.
Allaminoacids,exceptforleucineandlysine,aresubstratefor
gluconeogenesis.
Alanineisthemostimportantgluconeogenicaminoacid.
Gluconeogenesisoccursmainlyintheliverandtoalesserextentin
renalcortex.
Somegluconeogenesiscanalsooccurinsmallintestine,butitisnot
significant.
Someofthereactionsofgluconeogenesisoccursinthe
mitochondriabutmostoccurincytosol.
Gluconeogenesisinvolvesglycolysis,thecitricacidcycleplussome
specialreactions.
Glycolysisandgluconeogenesissharethesamepathwaybutin
oppositedirection.
Sevenreactionsofglycolysisarereversibleandthereforeareused
withsameenzymeinthesynthesisofglucosebygluconeogenesis.
However,threeofthereactionsofglycolysisareirreversibleand

---

mustbecircumventedbyfourspecialreactionswhichareuniqueto
gluconeogenesisandcatalyzedby:(1)Pyruvatecarboxylase,(ii)
Phosphoenolpyruvatecarboxykinase,(iii)Fructose-1,6-
bisphosphatase,(iv)Glucose-6-phosphatase.
Thesefourenzymesarethekeyenzymesofgluconeogenesis(or
gluconeogenesisenzymes).
Amongthesefour,pyruvatecarboxylaseisamitocondrialenzyme
andotherthreearecytoplasmicenzymes.

---

273. Gluconeogenesisfromlactateneedsall
except?
a)Transportoflactatefrommuscletoliver
b)Conversionoflactatetopyruvate
c)Transaminationofpyruvatetoalanine
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Transaminationofpyruvatetoalanine

---

274.

---

Whichoftheenzymeofglycolysisisapart
ofgluconeogenesis?
a)Pyruvatekinase
b)PFK
c)Hexokinase
d)Phosphoglyceratekinase
CorrectAnswer-D
Ans.is'd'i.e.,Phosphoglyceratekinase
Sevenofthereactionsofglycolysisarereversibleandareusedin
thesynthesisofglucosebygluconeogenesis.Thus,sevenenzymes
arecommontobothglycolysisandgluconeogenesis:(i)
Phosphohexoseisomerase;(ii)Aldolase;(iii)Phosphotriose
isomerase,(iv)Glyceraldehyde3-phosphatedehydrogenase;(v)
Phosphoglyceratekinase;(vi)Phosphoglyceratemutase;(vii)
Enolase.
Threereactionsofglycolysisareirreversiblewhicharecircumvented
ingluconeogenesisbyfourreactions.So,enzymesatthesesteps
aredifferentinglycolysisandgluconeogenesis.
ReactionsEnzymeinglycolysisEnzyme
ingluconeogenesis
Glucose?Glucose-6-PHexokinase/glucokinase
Glucose-6-phosphatase
Fructose-6-P?Fructose-I,6-BPPhosphofructokinase
Fructose-1-6-bisphosphatase
Phosphoenolpyruvate?PyruvatePyruvatekinase
PyruvatecarboxylasePEPcarboxykinase

---

275.Trueaboutglycolysisareallexcept?
a)Providenutritiontocancercells
b)Substratelevelphosphorylationatpyruvatekinase
c)Twocarbonendproductisformed
d)NADPHisformedbyglyceraldhyde-3-phosphate
dehydrogenase
CorrectAnswer-C
Ans.is'c'i.e.,Twocarbonendproductisformed
Importantfactsaboutglycolysis
Animportantbiochemicalsignificanceistheabilityofglycolysisto
provideATPintheabsenceofoxygen(anerobicglycolysis)and
allowstissuestosurviveanoxicepisodes.
Itoccursincytosol
3Carbonatomsendproduct(pyruvateorlactate)isproduced.
Irreversiblestepsarecatalyzedby:-Glucokinase/Hexokinase,
phosphofructohnase-I,andpyruvatekinase.
Reversiblestepsarecatalyzedby:-Phosphohexoseisomerase,
aldolase,phosphotrioseisomerase,glyceraldehyde3-phosphate
dehydrogenase,Phosphoglyceratekinase,Phosphoglycerate
mutase,Enolase.
Energy(ATP)usingstepsarecatalyzeeby:-
Hexokinase/glucokinase,phosphofurctokinase.
Energy(ATP)productionatsubstratelevelarecatalyzedby:
Phosphoglyceratekinase,Pyruvatekinase.
Reducingequivalent(NADH)productioniscatalyzedby:
Glyceraldehyde3-phosphatedehydrogenase.
Cancercellsderivenutritionfromglycolysisastheyhavelackof02
supplybecauseoflackofcapillarynetwork.Glycolysis(anaerobic

---

glycolysis)istheonlymetabolicpathwayinthebodywhichcan
provideenergybyglucosemetabolisminanerobicconditions.

---

276.Anaerobicglycolysisoccursinallplaces
except
a)Muscles
b)RBCs
c)Brain
d)Kidney
CorrectAnswer-C
Ans.is'c'i.e.,Brain
Therearetwotypesofglycolysis:-
1. Aerobicglycolysis:-Itoccurswhenoxygenisplentifulandthefinal
productispyruvate,i.e.,finalstepiscatalyzedbypyruvatekinase
(seethecycleabove).WhichislaterconvertedtoacetylCoAby
oxidativedecarboxylation.Thereisnetgainof7ATPs.AcetylCoA
entersTCAcycle.
2. Anaerobicglycolysis:-Itoccursintheabsenceofoxygen.The
pyruvateisfermented(reduced)tolactateinsinglestage.The
reoxidationofNADH(formedintheglyceraldehyde-3-phosphate
dehydrogenasestep)byrespiratorychainispreventedassame
NADHisutilizedatlactatedehydrogenasestep.So,thereisnonet
productionofNADH.Thus,thereisnetgainof2ATPonly.Unlike
pyruvatewhichisconvertedtoacetylCoAtoenterintokrebscycle,
lactatecannotbefurtherutilizedbyfurthermetabolicpathways.
Thus,lactatecanberegarededasdeadendinglycolysis.Anaerobic
glycolysisoccursinexercisingskeletalmuscle,RBCs,lens,some
regionofretina,renalmedulla,testisandleucocytes.

---

277.ThenumberofATPsgeneratedinkrebs
cycleare?
a)12
b)24
c)15
d)30
CorrectAnswer-B
Ans.is'b'>b'i.e.,24
OneturnoftheTCAcycle,startingwithacetylCoAproduces10
ATPs.Whenthestartingmoleculeispyruvate,theoxidative
decarboxylationofpyruvate,theoxidativedecarboxylationof
pyruvateyields2.5ATPsandtherefore,12.5ATPsareproduced
whenstartingcompoundispyruvate.Since,twomoleculesof
pyruvateentertheTCAcyclewhenglucoseismetabolized
(glycolysisproduces2moleculesofpyruvate),thenumberofATPs
isdoubled.Therefore,25ATPmolecules,perglucosemolecule,are
producedwhenpyruvateenterstheTCAcycle.
Note:PreviouslycalculationsweremadeassumingthatNADH
produces3ATPsandFADHgenerates2ATPs.Thiswillamounta
netgenerationof30ATPmoleculesinTCApermoleculeglucose
andtotal38moleculesfromstarting.Recentexperimentsshowthat
thesevaluesareoverestimatesandNADHproduces2.5ATPsand
FADHproduces1.5ATPs.Therefore,netgenerationduringTCAis
25ATPsandcompleteoxidationofglucosethroughglycolysisplus
citricacidcycleyieldanet32ATPs.
Energyyield(numberofATPgenerated)permoleculeofglucose
whenitiscompletelyoxidizedthroughglycolysispluscitricacid
cycle,underaerobicconditions,isasfollows:-

---

Noof
Methodof NoofATPs ATPs
Pathway Step Enzyme
Source gained
ATP
perglucose
Asperold
formation
(new
calculation
calculation)
Glycolysis 1
Hexokinase
Minus
Minus1
Do
3
Phosphofructokinase
Minus
Minus1
NADH
Glyceraldehyde-3-p
2.5x2=
Do
5
Respiratory
3x2=6
DH
5
chain
Substrate 1x2--
Do
6
1,3-BPGkinaseATP
1x2=2
level
2
ATP 1x2
Do
9
Pyruvatekinase
Substrate
1x2=2
=2
level
NADH
Pyruvate
2.5x2=
Pyruvate
Respiratory
3x2=6
to
5
?
chain
Acetyl
Dehydrogenase
CoA
NADH 2.5x2=
TCA
IsocitrateDH
Respiratory
3x2=6
5
cycle
3
chain
NADH
Alphaketoglutarate
2.5x2=
Do
4
Respiratory
3x2=6
DH
5
chain
GTP 1x2=
Do
5
Succinatethiokinase Substrate
1x2=2
2
level
Succicinate
Respiratory 1.5x2=
Do
6
2x2=4
DHFADH2
chain
3
Do
8
MalateDH
NADH 2.5x2= 3x2=6
Respiratory 5
chain
Netgenerationinglycolyticpathway9minus2=710

---

minus2=8
Generationinpyruvatedehydrogenasereaction5?6
Generationincitricacidcycle20?24
NetgenerationofATPfromoneglucosemole32?
38

---

278.OneKrebscyclegenerateshowmany
ATP?
a)6
b)12
c)24
d)36
CorrectAnswer-B
Ans.is'b'i.e.,12
Thisquestionisslightlydifferentfrompreviousone.Herethe
examinerisaskingaboutthegeneraionofATPsperTCAcycle.
InasingleTCAcycle10moleculesofATPareproduced(12
moleculesaccordingtooldercalculations).

---

279.VitaminnotrequiredinTCAcycle?
a)Niacin
b)Riboflavin
c)Thiamine
d)Folicacid
CorrectAnswer-D
Ans.is'd'i.e.,Folicacid
FouroftheBvitaminsareessentialinthecitricacidcycle:
1. Riboflavin,intheformofflavinadeninedinucleotide(FAD),a
cofactorforsuccinatedehydrogenase.
2. Niacin,intheformofnicotinamideadeninedinucleotide(NAD)the
electronacceptorforisocitratedehydrogenase,a-ketoglutarate
dehydrogenase,andmalatedehydrogenase.
3. Thiamine(vitaminB1),asthiaminediphosphate,thecoenzymefor
decarboxylationina-ketoglutaratedehydrogenasereaction.
4. Pantothenicacid,aspartofcoenzymeA,thecofactorattachedto
"active"carboxylicacidresiduessuchasacetyl-CoAandsuccinyl
CoA.

---

280.Theenergyforglycogenesisisprovided
by-
a)GTP
b)GDP
c)UTP
d)AMP
CorrectAnswer-C
Ans.is'c'i.e.,UTP

---

281.Branchingenzymeisfoundin?
a)Glycogenesis
b)Glucogenesis
c)Glycogenolysis
d)Glycolysis
CorrectAnswer-A
Ans.is'a'i.e.,Glycogenesis

---

282.HMPshuntoccursinallorgansexcept?
a)Liver
b)Adiposetissue
c)RBC
d)Brain
CorrectAnswer-D
Ans.is'd'i.e.,Brain
HMPisanalternativeroutefortheoxidationofglucose(beside
glycolysis).
Itisalsocalledas"pentosephosphatepathway","Dickens-
Horeckerpathway","Shuntpathway"or"phosphogluconate
oxidativepathway".
HMPshuntisrequiredforprovisionofreducedNADPHandfiver-
carbonsugars(Pentosephosphates)fornucleicacidsynthesis.
Normally,90%ofglucoseisoxidizedbyglycolysisand10%is
oxidizedbyHMPshunt.
However,inliverandRBCsHMPshuntaccountsforoxidationof
30%glucose.
HMPshuntoccursinthecytosol.
Itishighlyactiveinliver,adiposetissue,adrenalcortex,lens,
cornea,lactating(butnotthenonlactating)mammaggland,Gonads
(testis,ovary)anderythrocytes.
Activityofthispathwayisminimalinmuscleandbrain,wherealmost
alloftheglucoseisdegradedbyglycolysis.

---

283.Reducingsugarinurinecanbedetected
by-
a)a)Benedictstest
b)b)Fehlingsolution
c)c)Glucose-oxidasetest
d)d)Alloftheabove
CorrectAnswer-D
Explanation-Reducingsugarcanbedetectedby-benedict'stest,
fehling'stest,gluco-oxidasetest.

---

284.Corisdiseaseisduetodefectin
a)Branchingenzyme
b)Debranchingenzyme
c)Myophosphorylase
d)Hepaticphosphorylase
CorrectAnswer-B
Ans.is'b'i.e.,Debranchingenzyme
Organ(s)

Type
Enzymedeficiency affected
Glucose6-
I
vonGierke'sdisease
Liver,kidney
phosphatase
a(1?44)
II
Pompe'sdisease
Allorgans
Glucosidase
(acidmaltase)
Cori's
Debranching
disease/Forbe's
Muscle,liver
enzyme
III
disease
Liver,
IV
Andersen'sdisease Branchingenzyme
myocardium
V
McArdle'sdisease
Phosphorylase
Muscle
VI
Hers'disease
Phosphorylase
Liver
VII
Tarui'sdisease
Phosphofructokinase Muscle,RBCs
Phosphorylase
Liver
VIII
kinase
ThereisalsoonX-linkedformofphosphorylasekinasedeficiency.
Thisissoleexceptionasallotherglycogenstoragediseasesare
inheritedasautosomalrecessivetrait.

---

---

285.Fructoseintoleranceisduetodeficiency
of?
a)AldolaseB
b)Fructokinas
c)Triokinas
d)AldolaseA
CorrectAnswer-A
Ans.is'a'i.e.,AldolaseB
DiseaseDificientenzymes
EssentialfructosuriaFructokinase
HereditaryfructoseintoleranceAldolase-B
GalactosemiaGalactose-l-phosphateuridyl
transferase(mostcommon),GalactokinaseUDP-galactose-4-
epimerase
LactoseintoleranceLactase((3-galactosidase)
EssentialpentosuriaL-xylulosedehydrogenase
(xylulosereductase)

---

286.Glucoseistransportedinpancreas
throughwhichreceptor?
a)GLUT1
b)GLUT2
c)GLUT3
d)GLUT4
CorrectAnswer-B
Ans.is'b'i.e.,GLUT2
GlucoseenterstheBcellsofpancreaticisletsviaGLUT2transporter
andthisstimulatethereleaseofinsulin.

---

287.GLUT2receptors?
a)Insulindependent
b)Insulinindependent
c)Foundincardiacmuscle
d)Foundinbrain
CorrectAnswer-B
Ans.is'b'i.e.,Insulinindependent
GLUT-2isinsulinindependent(insulindependentGLUTisGLUT-
4).
ItisfoundinB-cellsofisletsofpancreas,liver,epithelialcellsof
smallintestineandkidney.
Alsoseeexplanation-4ofsession-2.

---

288.Inhibitionofglycolysisbyincreased
supplyof02iscalled?
a)Crabtreeeffect
b)Pasteureffect
c)Lewiseffect
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Pasteureffect
Pasteureffect
Ithasbeenobservedthatunderanaerobicconditionatissueor
microorganismutilizesmoreglucosethanitdoesunderaerobic
conditions.
Itreflectsinhibitionofglycolysisbyoxygenandiscalledpasteure
effect.
ThePasteureffectisduetoinhibitionoftheenzyme
phosphofructokinasebecauseofinhibitoryeffectcausedbycitrate
andATP,thecompoundsproducedinpresenceofoxygendueto
operationofTCAcycle.Crabtreeeffect
ThisisoppositeofPasteureffect,whichrepresentsdecreased
respirationofcellularsystemscausedbyhighconcentrationof
glucose.
Whenoxygensupplyiskeptconstantandglucoseconcentrationis
increased,theoxygenconsumptionbycellsfalls,i.e.,relative
anaerobiosisisproducedwhenglucoseconcentrationisincreased
inconstantsupplyofoxygen.
Itisseenincellsthathaveahighrateofaerobicglycolysis.
Insuchcellstheglycolyticsequenceconsumesmuchofthe
availablePiandNAD+,whichlimitstheiravailabilityforoxidative

---

phosphorylation.
Asaresult,rateofoxidativephosphorylationdecreases,andoxygen
consumptionalsoshowsacorrespondingfall.

---

289.Whichofthefollowingisnota
phospholipid?
a)Lecithine
b)Plasmalogen
c)Cardiolipin
d)Ganglioside
CorrectAnswer-D
Ans.is'd'i.e.,Ganglioside
Phospholipidsare:
1. Glycerophospholipids(glycerolcontaining):-Phosphatidylcholine
(lecithin),phosphatidylethanolamine(cephaline),phosphatidylserine,
phosphatidylinositol,plasmalogens,lysophospholipids,cardiolipin.
2. Sphingophospholipids(sphingosinecontaining):-Sphingomyeline

---

290.Allaretrueaboutketonebodiesexcept?
a)Acetoacetateisprimaryketonebody
b)Synthesizedinmitochondria
c)Synthesizedinliver
d)HMGCoAreductaseistherate-limitingenzyme
CorrectAnswer-D
Ans.is'd'i.e.,HMGCoAreductaseistherate-limitingenzyme

---

291.Ketonebodiesarenotusedby?
a)Muscle
b)Brain
c)RBC
d)Renalcortex
CorrectAnswer-C
Ans.is'c'i.e.,RBC
OnlyglucoseisthesolefuelforRBCs.
AsRBCshavenomitochondria,theyoxidizeglucoseanaerobically
tolactate.
Liveralsocannotuseketonebodiesbecauseoflackofsuccinyl-
CoA-acetoacetate-CoAtransferase,whichisrequiredforactivation
ofketonebodies.

---

292.Ketonebodyformationwithout
glycosuriaisseenin?
a)Diabetesmellitus
b)Diabetesinsipidus
c)Starvation
d)Obesity
CorrectAnswer-C
Ans.is'c'i.e.,Starvation
Amongstthegivenoptions,DMandstarvationarethecauses
ofketosis
1. Diabetes:-Ketosiswithhyperglycemiaandglycosuria
2. Prolongedstarvation:-Ketosiswithlowornormalglucoseand
withoutglycosuria.
IndiabeticKetoacidosis:-(i)PositiveRothera'stest(duetoketone
bodies)(ii)PositiveBenedict'stest(duetopresenceofreducing
sugarinurine)
InStarvationketosis:-(i)PostiveRothera'stest(duetoketone
bodies),(ii)NegativeBenedict'stest(nosugarinurine)

---

293.Whatisessentialfortransferoffattyacid
acrossmitochondrialmembrane-
a)Creatine
b)Creatinine
c)Carnitine
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Carnitine

---

294.Krabbesdiseaseisduetodeficiencyof?
a)Sphingomyelinase
b)Betagalactocerebrosidase
c)Hexosaminidase
d)Arylsulfatase
CorrectAnswer-B
Ans.is'b'i.e.,Betagalactocerebrosidase

---

295.Whichisanabnormallipoprotein?
a)VLDL
b)Chylomicron
c)Lp(a)
d)LDL
CorrectAnswer-C
Ans.is'c'i.e.,Lp(a)
SomepeoplehaveaspecialtypeofabnormalLDLcalledlipoprotein
(a)orLp(a),containinganadditionalprotein,apoprotein-a.
ElevatedLPalevelsareassociatedwithanincreasedriskofCHD.

---

296.AllaretrueaboutLDLexcept?
a)Moredensethanchylomicron
b)SmallerthanVLDL
c)Transportsmaximumamountoflipid
d)Containsmaximumcholesterol
CorrectAnswer-C
Ans.is'c'i.e.,Transportsmaximumamountoflipid

---

297.Majorapolipoproteinofchylomicrons?
a)B-100
b)D
c)B-48
d)None
CorrectAnswer-C
Ans.is'c'i.e.,B-48

---

298.Concentrationofwhichisinversely
relatedtotheriskofcoronaryheart
disease?
a)VLDL
b)LDL
c)HDL
d)None
CorrectAnswer-C
Ans.is'c'i.e.,HDL
ThelevelofHDLinserumisinverselyrelatedtotheincidenceofMI.
Asitis"antiatherogenic"or"protective"innature,HDLisknownas
"goodcholesterol".
HDLhasitsbeneficialeffectbyreversecholesteroltransport.

---

299.Maximumcholesterolisseenin?
a)VLDL
b)LDL
c)HDL
d)Chylomicrons
CorrectAnswer-B
Ans.is'b'i.e.,LDL
MaximumtriglyceridecontentChylomicrons
MaximumexogenoustriglycerideChylomicrons
MaximumendogenoustriglycerideVLDL
MaximumcholesterolcontentLDL

---

300.Lipidwithhighestmobilityis?
a)HDL
b)LDL
c)VLDL
d)Chylomicrons
CorrectAnswer-A
Ans.is`a'i.e.,HDL
HDL:-Hasmaximumelectrophoreticmobility,hasmaximum
density,hasminimumlipidcontent,hasmaximumprotein
(apoprotein)content,aresmallestinsize,hasmaximum
phospholipid,hasminimumtriglycerides.
Chylomicrons:-Havenoelectrophoreticmobility,haveminimum
density,havemaximumlipidcontent,haveminimumproteincontent,
arelargestinsize,haveminimumphospholipids,havemaximum
triglycerides.

---

301.ApolipoproteinEisrichin?
a)Lysine
b)Arginine
c)Histidine
d)Methionine
CorrectAnswer-B
Ans.is'b'i.e.,Arginine
Argininerichapo-EisisolatedfromVLDL.
Itcontainsargininetotheextentof10percentofthetotalamino
acidsandaccountsfor5to10percentoftotalVLDLapoproteinsin
normalsubjects.

---

302.Primaryhypercholesterolemiais?
a)TypeI
b)TypeHa
c)TypeIIb
d)TypeIII
CorrectAnswer-B
Ans.is'b'i.e.,TypeHa

---

303.Interactioninvolvedinprimarystructure
ofprotein?
a)Hydrogenbond
b)Disulfidebond
c)Peptidebond
d)Electrostaticbond
CorrectAnswer-C
Ans.is`c'i.e.,Peptidebond

---

304.Aminoacidwithdoublechiralis?
a)Phenyalanine
b)Threonine
c)Tryptophane
d)Tyrosine
CorrectAnswer-B
Ans.is'b'i.e.,Threonine

---

305.Neutralaminoacidis?
a)Aspartate
b)Arginine
c)Glycine
d)Histidine
CorrectAnswer-C
Ans.is'c'i.e.,Glycine
Neutralaminoacids
AlanineAsparging
CysteineGlycineGlutamineIsoleucine
LeucineMethionine
ProlinePhenylalanine
Serine
Threonine
TyrosineTryptophan
Valine

---

306.Polaraminoacidsareallexcept?
a)Glutamicacid
b)Histidine
c)Glutamine
d)Methionine
CorrectAnswer-D
Ans.is'd'i.e.,Methionine

---

307.Aminoacidwithaliphaticsidechainis?
a)Serine
b)Leucine
c)Threonine
d)Aspartate
CorrectAnswer-B
Ans.'B'Leucine
Basedonthechemicalstructureofsidechain,aminoacidsare
classifiedinto?
Aliphaticaminoacids:-Alanine,glycine,isoleucine,leucine,valine.
Hydroxyaminoacids:-serine,threonine,tyrosine.
Sulfur-containingaminoacids:-Cysteine,methionine.
Dicarboxylicaminoacids:-Asparticacid(aspartate),glutamicacid
(glutamate).
Amidecontainingaminoacids:-Glutamine,aspargine(theseare
amidesofdicarboxylicaminoacids.Glutamineisanamideof
glutamicacidandaspargineisanamideofasparticacid).
Aromaticaminoacids:-Phenylalanine,tyrosine,tryptophan.
Iminoacidsorheterocyclicaminoacids:-Oneofthe20aminoacids,
prolineisanimino(-NH)acidnotanamino(-NH)acid,asareother
19.

---

308.Serotoninisderivedfrom-
a)Tyrosine
b)Tryptophan
c)Phenylalanine
d)Methionine
CorrectAnswer-B
Ans.is'b'i.e.,Tryptophan
[RefHarper29'/ep.300]
Tryptophanisaprecursorforsynthesisofniacin(nicotinicacid),
serotoninandmelatonin.

---

309.Catecholaminesaresynthesizedfrom?
a)Tryptophan
b)Tyrosine
c)Methionine
d)Histidine
CorrectAnswer-B
Ans.is'b'i.e.,Tyrosine
Catecholamines(epinephrine,norepinephrineanddopamine)are
synthesizedfromtyrosin.
Hasbeenexplainedinpreviousseesions.

---

310.Creatineismadeupofall,except?
a)Glycine
b)Alanine
c)Methionine
d)Arginine
CorrectAnswer-B
Ans.is'b'i.e.,Alanine

---

311.Ninhydrintestisusedfor?
a)Bilesalts
b)Aminoacids
c)Nucleicacid
d)Lipids
CorrectAnswer-B
Ans.is'b'i.e.,Aminoacids
Importantchemicalreactionsofaminoacids
Followingaresomeimportantchemicalreactions.
A.Reactionusedtodetermineaminoacidsequenceinpolypeptide
chain:-Generally,aminoterminal(N-terminal)ofaminoacidis
taggedwithsomereagent.Itissplitoffbyhydrolysisandtagged
aminoacidisidentified.Thereactionis,then,repeatedwithnewN-
terminalofsubsequentaminoacidandsoon.Thetworeactionsare
usedforidentificationofaminoacidsequence:?
Sanger'sreaction:-UsesSanger'sreagent(1-fluoro-2,4-
dinitrobenzene)totagaminoterminal.
Edman'sreaction:-UsesEdman'sreagent(phenylisothiocyanate)
totagaminoterminal.
B.Reactionusedtoidentificationofindividualorgroupofamino
acids:-Thesereactionsarefrequentlyusedforqualitativedetection
andquantitativemeasurementofvariousaminoacids.
Ninhydrintese:-Alla-aminoacids.
Xanthophoreticreaction:-Aromaticaminoacidse(Tyrosine,
tryptophan,phenylalanine).
Millan'steste(Millon-Nassereaction):-Tyrosine?(phenolgroupof
tyrosine).Thereforemillon'stestispositiveintyrosinosis?.
Aldehydetest:-Tryptophan(indolering)

---

Hopkins-tolereaction:-Tryptophan(indolering)
Sakaguch'sreaction:-Arginine(guanidiniumgroupofarginine).
Sulphurtest:-Cysteine(sulphydrylgroup)
Nitroprussidetest:-Cysteine(sulphydrylgroup)
Pauly'stest:-Histidine(imidazolegroup)
Biuretreaction:-Peptidebond
DiazoreactionQ(Pauli's):-Histidineortyrosine.

---

312.Oxidativedeaminationiscatalyzedby?
a)Glutaminase
b)Glutaminesynthase
c)Glutamatedehydrogenase
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Glutamatedehydrogenase

---

313.TransminationofAspartateforms?
a)Pyruvate
b)Acetly-CoA
c)Oxaloacetate
d)Alanine
CorrectAnswer-C
Ans.is'c'i.e.,Oxaloacetate
Transamination
Transaminationinvolvesthereversibletransferofa-aminogroupof
a-aminoacidtoana-ketoacid('toformanewaminoacidandanew
ketoacid.Theenzymecatalyzethereactioniscalled
aminotransferase(transaminase).Mosttransaminasesusea-
ketoglutarate(a-ketoacid)asacommonacceptorofa-aminogroup
ofa-aminoacids.Alltransaminasesrequirepyridoxalphosphate
(VitaminB6)asacoenzymneQ.Someofthemostimportant
transaminasesare:-
Alaninetransaminase(ALT)alsocalledglutamatepyruvate
transaminase(GPT):-Itcatalyzesthetransferofaminogroupof
alaninetoa-ketoglutarateresultinginformationofpyruvateandL-
glutamateQ.
ALT
L-AlanineQ+a-ketoglutarateQ_____PyruvateQ+L-glutamateQPLP
Aspartatetransaminase(AST)alsocalledglutamateoxaloacetate
transaminase(GOT):Itcatalyzesthetransferofaminogroupof
aspartatetoa-ketoglutarateresultinginformationofoxaloacetate
andL-glutamate.
AST
L-Aspartate+a-ketoglutarateOxaloacetate+L-glutamatePLP

---

Mostaminoacidsundergotransaminationreactionexceptlysine,
threonine,prolineandhydroxyproline.
Alltheaminogroupsfromaminoacidsthatundergotransamination
arecollectedintoonecommonaminoacid,i.e.,glutamate.Thisis
importantbecauseL-glutamateistheonlyaminoacidthat
undergoesoxidativedeaminationatanappreciableratein
mammaliantissue.Thus,formationofammoniafromaminoacids
occursmainlyviathea-aminonitrogenofglutamate.Transamination
isnotrestrictedtoa-aminogroups.The6-aminogroupofornithine
(butnottheE-aminogroupoflysine)undergoestransmination.

---

314.InureacyclewhichdefectisanX
linkeddisease?
a)Ornithinetranscarbamylase
b)Aspartatetranscarbamylase
c)Arginase
d)Argininosuccinatesynthase
CorrectAnswer-A
Ans.is'a'i.e.,Ornithinetranscarbamylase

---

315.Sourceofammoniainurine?
a)Glutaminase
b)Urease
c)Glutamatedehydrogenase
d)Arginase
CorrectAnswer-A
Ans.is'a'i.e.,Glutaminase
Inmanytissueslikeliver,kidneyandbrain,ammoniacombineswith
glutamatetoyieldglutamine,bytheactionofglutaminesynthase.
Thebrainisarichsourceofglutaminesynthaseandit
predominantlydetoxifiesammoniabythisroute.
ATPADP+Pi
Glutamate+NH,4Glutamine
Glutaminesynthetase
Glutamineisanontoxicmajortransportformofammonia.The
glutamineistransportedbybloodtoliverwheredeamination
(removalofaminogroup)ofglutaminetakesplace.Glutaminase
cleavesglutaminetoyieldglutamateandfreeammonia(ammonium
ion).Theammoniaisconvertedbylivertourea.
0H2
Glutamine________________________Glutamate+NH,
Glutaminase
Formationandsecretionammoniabyrenaltubularcellsmaintain
acidbasebalance.Ammoniaisformedfromglutamineby
glutaminase.Excretionofammoniaincreasesinmetabolicacidosis
anddecreasesinmetabolicalkalosis.

---

316.Whichofthefollowingaccumulatesin
maplesyrupurinedisease
a)Leucine
b)Valine
c)Isoleucine
d)All
CorrectAnswer-D
Ans.is`d'i.e.,All
Maplesyrupurinedisease(MSUD)orbranched-chain
ketoaciduria
*Itisaninbornerrorofmetabolismofbranched-chainamino
acidsvaline,leucineandisoleucine.
*Itisduetodeficiencyofanenzymethatcatalyzesthesecond
reactionintheseaminoacidsmetabolismi.e.branchedchain-a
ketoaciddehydrogenasewhichcatalyzesthedecarboxylationof
branched-chainaminoacids.
*Asaresult,thebranched-chainaminoacids,leucine,isoleucine
andvaline,andtheira-ketoacidsaccumulateintheblood,urine,
andCSF.
*Thereisacharacteristicmaplesyrupodourtotheurine.
*Inmaplesyrupurinediseasethereistheexcretionofbranched-
chainaminoacids(isoleucine,leucine,valine)andtheirketoacids
(-keto-methylvalerate,-ketoisocaproate,-ketoisovalerate)in
theurine.

---

317.Keratinisa?
a)Globularprotein
b)Cylindricalprotein
c)Fibrousprotein
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Fibrousprotein
Basedontheirthree-dimensionalshape(i.e.,conformation),the
proteinsaredividedintotwoclasses:
1. Fibrousproteins:-Thepolypeptidechainsextendalonga
longitudinalaxiswithoutshowinganysharpbends,givingthemrod
orneedlelikeelongatedshape.Mostofthestructuralproteinsare
fibrousproteins,e.g.,collagen,elastin,andkeratin.Fibrousproteins
centrifugemorerapidlybecauseoftheirrodlikeshape.
2. Globularproteins:-Thepolypeptidechainsaretightlyfoldedand
packedintocompactstructuregivingsphericalorovalshape.Most
enzymes,tranportproteins(albumin,globulins),hemoglobin,
myoglobin,antibodiesandhormonesareglobularproteins.

---

318.Keratincontains?
a)Arginine
b)Histidine
c)Lysine
d)All
CorrectAnswer-D
Ans.is'd'i.e.,All
Aminoacidsrequiredforspecializedproducts
CreatineGlycine+Arginine+Methionine
GlutathioneGlycine+Cysteine+Glutamate
CystineCysteine+Cysteine
PurineGlycine+Aspartate+Glutamate+Serine
PyrinidineAsparatate+Glutamine
Carnosine13-Alanine+histidine
CholineFormedwiththehelpofmethionine,glycine,
serine,B6
NitricoxideArginine
HemeGlycinc,SuccinylCoA
CarnitineMethionine+lysine
KeratinHistidine;arginine;lysine(1:12:4)
GlutamateGamma-aminobutyricacid(GABA)

---

319.TrueaboutGlutathioneexcept?
a)Tripeptide
b)Formedfromglutamicacid,glycine,cysteine
c)Actasantioxidantinreducedstate
d)Alloftheabove
CorrectAnswer-D
Ans.is`d'i.e.,Alloftheabove
Glutathione
Glutathioneisatripeptideofglutamieacid,cysteine,andglycine.
Themoleculehasasulfhydryl(-SH)orthiolgrouponthecysteine,
whichaccountsforitsstrongelectron-donatingcharacter.
Itexistsintwoforms:reducedglutathioneorGSH.Inthereduced
state,thethiolgroupofcysteineisabletodonateareducing
equivalent(H+e-)tootherunstablemolecules,suchasreactive
oxygenspecies.Indonatinganelectron,glutathioneitselfbecomes
reactive,butreadilyreactswithanotherreactiveglutathionetoform
glutathionedisulfide(GSSG)oroxidizedglutathione.GSHcanbe
regeneratedfromGSSGbytheenzymeglutathionereductase.
Whileallcellsinthehumanbodyarecapableofsynthesizing
glutathione,liverglutathionesynthesishasbeenshowntobe
essential.TheliveristhelargestGSHreservoir.
Becauseofitsreducingproperty,reducedglutathionehaspotent
antioxidantaction.
Functions:
GSHisanextremelyimportantcellprotectant.Itdirectlyreduces
reactivehydroxylfreeradicals,otheroxygencenteredfreeradicals,
andradicalcentersonDNAandotherbiomolecules.
GSHistheessentialcofactorformanyenzymeswhichrequirethiol-

---

reducingequivalents,andhelpskeepredox-sensitiveactivesiteson
enzymesinthenecessaryreducedstate.GSHisusedasacofactor
by?
Multipleperoxidaseenzymes,todetoxifyperoxidesgeneratedfrom
oxygenradicalattackonbiologicalmolecules;
Transhydrogenases,toreduceoxidizedcentersonDNA,proteins,
andotherbiomolecules;and
GlutathioneS-transferases(GST)toconjugateGSHwith
endogenoussubstances(e.g.,estrogens)andtoexogenous
electrophiles(e.g.,areneoxides,unsaturatedcarbonyls,organic
halides),anddiversexenobiotics.
GSHisaprimaryprotectantofskin,lens,cornea,andretinaagainst
radiationdamage,andthebiochemicalfoundationofP450
detoxicationintheliver,kidneys,lungs,intestinalepithelia,andother
organs.
GSHactsasacarrierintransportofcertainaminoacidsacross
membranesinthekidney.
Glutathione(GSH)participatesinleukotrienesynthesis.

---

320.Sweatyfeetodorinurineisseenin?
a)Phenylketonuria
b)Maplesyrupurine
c)Isovalericacidemia
d)Alkaptonuria
CorrectAnswer-C
Ans.is'c'i.e.,Isovalericacidemia
"SweatyFeet"odourisseeninisovalericacidemia&glutaric
aciduria
"MousyorMustyOdour"ofskin,hairandurineisseeninPKU.
BurntsugarlikeodourisseeninMSUdisease(Branchedchain
ketonuria).
Boiledcabbagelikeurinaryodourisseenin-Tyrosinemia&
hypermethioninemia.
Swimmingpoolurineodourisseenin-Hawkinsinuria

---

321.Salvagepurinesynthesisrefersto?
a)Synthesisofpurinefromribose-5-phosphate
b)Synthesisofpurinefrompyrimidine
c)Synthesisofpurinenucleotidesfrompurinebases
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Synthesisofpurinenucleotidesfrompurinebases
Twoimportantpurinenucleotidesaresynthesized:(i)adenosine
monophosphate(AMP)and(ii)guanosinemonophosphate(GMP).
ThenAMPandGMPareconvertedtootherpurinenucleotideslike
ADP,ATP,GDP,GTPetc.Purinenucleotidescanbesynthesized
bytwopathways-(1)Denovosynthesisand(2)Salvagepathway.
Denovopathway(Denovosynthesis)
Indenovopathway,thepurinenucleotidesaresynthesizedfrom
amphibolicintermediates.Amphibolicintermediatesarethe
intermediarymetabolitesofamphibolicpathways(eg.citricacid
cycle)whichhavedualpurposes,ie.theyserveincatabolismas
wellasinanabolism.
Indenovosynthesis,purineringisformedfromvarietyofprecursors
isassembledonribose-5-phosphate.Precursorsfordenovo
synthesisare?
1. GlycineprovidesCa,C5andN7
2. AspartateprovidesN,
3. GlutamineprovidesN3andN9
4. TetrahydrofolatederivativesfurnishC2andC8
5. CarbondioxideprovidesCo
Salvagepathwayofpurinenucleotidesynthesis
Freepurinebases(adenine,guanineandhypoxanthine)andpurine

---

nucleosidesareformedincellsduringthemetabolicdegradationof
nucleicacidsandnucleotides.
Thesefreepurinebasesandpurinenucleosidesarereusedinthe
formationofpurinenucleotides.
Thisiscalledsalvagepathway(salvagemeanspropertysavedfrom
loss).
Salvagesynthesisrequiresfarlessenergythandenovosynthesis.

---

322.Salvagepathwayofpurinenucleotide
synthesisareusedbyallexcept?
a)Brain
b)Liver
c)RBC
d)Leukocytes
CorrectAnswer-B
Ans.is'b'i.e.,Liver
Purinenucleotidesynthesisoccursbytwopathways:
Denovosynthesis
Salvagepathway
Liveristhemajorsiteofpurinenucleotidebiosynthesis(denovo).
Certaintissuescannotsynthesizepurinenucleotidesbydenovo
patyway,eg.brain,erythrocytesandpolymorphonuclearleukocytes.
Thesearedependentonsalvagepathwayforsynthesisofpurine
nucleotidesbyusingexogenouspurines,whichareformedby
degradationofpurinenucleotidessynthesizedinliver.

---

323.Inhumans,endproductofpurine
metabolism
a)Allantoin
b)Uricacid
c)CO2
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Uricacid

---

324.Ratelimitingstepinpyrimidine
synthesis?
a)Dihydro-orotase
b)Ornithinetranscarbomoylase
c)Aspartatetranscarbomoylase
d)Carbamoylphosphatesynthase-I
CorrectAnswer-C
Ans.is'c'i.e.,Aspartatetranscarbomoylase

---

325.AtphysiologicalpHDNAis?
a)Acidic
b)Negativelycharged
c)Amphipathic
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
DNAisamphipathic
Amphipathicmoleculeisonewhichcontainsbothpolar(hydrophilic)
andnonpolar(hydrophobic)regionsinitsstructure,i.e.thepartof
moleculeiswatersolubleandpartiswaterinsoluble.
InDNAhelix
Hydrophilic(polar)deoxyribose-phosphateofeachchainison
outsideofmolecule.
Hydrophobic(nonpolar)basesarestackedin.
ThusDNAisregardedasamphipathicinnature.
DNAisnegativelychargedandacidic
PhosphategroupliesonoutsideofmoleculeofDNA.
EachphosphategrouphasanegativechargeatphysiologicalpH,
makingDNAanegativelycharge(anion)atphysilogicalpH.
"Histonesarestronglycationicandcanbindnon-specificallyto
stronglyaniomicDNA"Harper"AtphysiologicalpHDNAis
negativelycharged,andisassociatedwithpositivelycharged(basic)
histones"RonaldHofmann.oAnionicmoleculesareacidicinnature.

---

326.NotpresentinDNA?
a)Uracil
b)Thymine
c)Cytosine
d)Adenine
CorrectAnswer-A
Ans.is'a'i.e.,Uracil
Twotypesofbasesarefoundinnucleotides:(i)purinesand(ii)
pyrimidines.
1. Purines:TwomajorpurinebasesfoundbothinDNAsaswellas
RNAsare(i)adenine(A)and(ii)guanine(G).
2. Pyrimidines:Threemajorpyrimidinebasesare(i)cytosine(C),(ii)
Uracil(U)and(iii)Thymine(T).Cytosineanduracilarefoundin
RNAsandcytosineandthyminearefoundinDNAs.Uracilisnot
foundinDNAseandthymineisnotfoundinRNAs.
Differentmajorbaseswiththeircorrespondingnucleosidesand
nucleotides
Base
Ribonucleoside
Ribonucleotide
Adenine
Adenosinemonophosphate
Adenosine
(A)
(AMP)
Guanine
Guanosinemonophosphate
Guanosine
(G)
(GMP)
Uracil(U) Uridine
Uridinemonophosphate(UMP)
Cytosine
Cytidine
Cytidine(Monophosphate)(CMP)
(C)
Base
Deoxyribonucleoside Deoxyribonucleotide
Deoxyadenosinemonophosphate
Deoxyadenosine

---

Deoxyadenosine
Adenine
(dAMP)
Deoxyguanosinemonphosphate
Guanine
Deoxyguanosine
(dGMP)
Deoxycytidinemonophosphate
Cytosine Deoxycytidine
(dCMP)
Deoxythymidinemonophosphate
Thymine
Deoxythymidine
(dCMP)

---

327.HereditaryoroticaciduriaType-Iisdue
todeficiencyof?
a)Orotatephosphoribosyltransferase
b)Oroticaciddecarboxylase
c)UMPsynthase
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove[RefPankajNaikp.310]
Oroticaciduriaisahereditarydisorderwhichcanresultfroma
defectiveenzymeinpyrimidinesynthesis.
ThereisadefectinthemultifunctionalenzymeUMPsynthase
whichhastwoactivities:?
1. Orotatephosphoribosyltransferase
2. Oroticaciddecarboxylase(orotidylatedecarboxylase)
UMPsynthaseconvertsoroticacidtoUMP.Thus,indefectofUMP
synthaseoroticacidcannotbeconvertedtoUMPandisexcretedin
urineoroticaciduria.
Therearetwotypesoforoticaciduria.
1. TypeI:-ThereisdeficiencyofboththecomponentsofUMP
synthase,i.e.orotatephosphoribosyltransferaseandoritidylate
decarboxylase.
2. TypeII:-Thereisdeficiencyofonlyorotidylatedecarboxylase/

---

328.Molecularinteraction,foundinthe
structureofDNA-
a)Hydrogenbond
b)Glycosidicbond
c)Covalentinteractions
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove

---

329.TATAboxisseenin?
a)Promoterregion
b)Palindromicregion
c)Enhancerregion
d)Silencerregion
CorrectAnswer-A
Ans.is'a'i.e.,Promoterregion

---

330.Okazakifragmentsareformedduring?
a)Transcription
b)Translation
c)DNAreplication
d)None
CorrectAnswer-C
Ans.is'c'i.e.,DNAreplication

---

331.Whichenzymepolymerisesokazaki
fragments?
a)DNApolymeraseI
b)DNApolymeraseII
c)DNApolymeraseIII
d)RNApolymerase
CorrectAnswer-C
Ans.is'c'i.e.,DNApolymeraseIII
TwoDNApolymerasesactonOkazakifragments:?
DNApolymerase:-Causespolymerizationofokazakifragments,
i.e.synthesisofDNAonlaggingstrand.Italsocausessynthesisof
leadingstrand.
DNApolymeraseI:-Itfillsthegapbetweenokazakifragmentswhen
theirpolymerizationiscompleted,i.e.whenthesynthesisonlagging
strandiscompleted,DNApolymeraseIfillsthegapbetweenfully
polymerizedokazakifragments.
Thus,DNApolymeraseIIIisinvolvedduring'elongation'
(polymerizationofokazakifragments)andDNApolymeraseIis
involvedduring'termination'(fillingthegapsbetweenokazaki
fragments).

---

332.ReplicationofmitochondrialDNAis
causedbywhichtypeofDNA
polymerase?
a)a
b)p
c)S
d)y
CorrectAnswer-D
Ans.is'd'i.e.,y[RefPankajNaikp.314]
DNApolymerasea:-Ithasprimaseactivity(i.e.synthesizesRNA
primer),andinitiatesDNAsynthes
DNApolymerase:-ItisaDNArepairenzyme?
DNApolymerasey:-ReplicatesmitochondrialDNA
DNApolymerase6:-HelpsDNAsynthesisonlaggingstrand,i.e.
elongationofokazakifragmentsonlaggingstrand.Italsohas5'3'
exonucleaseactivityforproofreading.
DNApolymerasec:-HelpsinDNAsynthesisonleadingstrand.It
alsohas5'->3'exonucleaseactivityforproofreading.

---

333.RNAwhichcontainscodonforspeicific
aminoacid?
a)tRNA
b)rRNA
c)mRNA
d)None
CorrectAnswer-C
Ans.is'c'i.e.,mRNA
ThemRNAcarriesgeneticinformationintheformofcodons.
Codonsareagroupofthreeadjacentnucleotidesthatcodeforthe
aminoacidsofprotein.
EachmRNAmoleculeisatranscriptofantisenseortemplatestrand
ofaparticulargene.
Itsnucleotidesequenceiscomplementarytothatofantisenseor
templatestrandofthegene,i.e.adenineforthyamine,guaninefor
cytosine,uracilforadenine(asRNAdoesnotcontainthymine)and
cytosineforguanine.
Forexample,ifantisensestrandofDNAhasagenewithsequence
5'-TTACGTAC-3',itscomplementaryRNAtranscriptwillbe5'-
GUACGUAA-3'.

---

334.Pseudouridinefoundin?
a)DNA
b)rRNA
c)mRNA
d)tRNA
CorrectAnswer-D
Ans.is'd'i.e.,tRNA
ModifiedbasesfoundintRNAare-
1. Dihydrouridine(D)inwhichoneofthedoublebondsofthebaseis
reduced.
2. Ribothymidine(T)inwhichmethylgroupisaddedtouraciltoform
thymine.Thus,tRNAistheonlyRNAthatcancontainthymine
thoughonlysometimes.
3. Pseudouridine(yr)inwhichuracilisattachedtoribosebyacarbon-
carbonbondratherthananitrogenbond.

---

335.RNAispresentin?
a)Cytoplasm
b)Nucleus
c)Ribosome
d)Alloftheabove
CorrectAnswer-D
Ans.is`d'i.e.,Alloftheabove
mRNAissynthesizedfromDNAbytheprocessoftranscriptionin
thenucleus.
AfterformationmRNAtransportoutofthenucleusintocytoplasm.
t-RNAisalsosynthesizedinnucleusandistransportedto
cytoplasm.
Proteinsynthesis(translation)occursinribosomes,andrequires
bothmRNAandtRNA.
rRNAispresentinribosomes.
rRNAissynthesizedinnucleolus
Thus,RNAcanbefoundin-
1. Nucleus
2. Cytoplasm
3. Ribosome
4. Nucleolus

---

336.Allarecharacteristicsofgeneticcode?
a)Overlapping
b)Nonambiguous
c)Universal
d)Degeneracy
CorrectAnswer-A
Ans.is'a'i.e.,Overlapping
Characteristicofgeneticcodes
Geneticcodeshavefollowingcharacteristics?
1.Universal:-Eachcodonspecificallycodesforsameaminoacidin
allspecies,e.g.UCAcodesforserineandCCAcodesforprolinein
allorganisms.Thatmeansspecificityofcodonhasbeenconserved
fromveryearlystagesofevolution.Exceptiontotheuniversalityof
geneticcoderarefoundinhumanmitochondria,wherethecode:-
UGAcodesfortryptophaninsteadofservingasastopcodon.
AUAcodesformethionineinsteadofisoleucine?
CUAcodesforthreonineinsteadofleucine.
AGAandAGGserveasstopcodoninsteadofcodingforarginine.
2.Unambiguous/Specific:-Aparticularcodonalwayscodesforthe
sameaminoacid.ForexampleCCUalwayscodesforprolineand
UGGalwayscodesfortryptophan.
3.Degeneracy/Redundancy:-Agivenaminoacidmayhavemore
thanonecodon.Forexample,CCU,CCC,CCAandCCGallfour
codonscodeforproline.Therefore,thereare61codonsfor20
aminoacids.
4.Stoporterminationornonsensecodons:-Threeofthe64
possiblenucleotidetripletsUAA(amber),UAG(Ochre)andUGA
(opal)donotcodeforanyaminoacid.Theyarecallednonsense

---

codonsthatnormallysignalterminationofpolypeptidechains.Thus,
thoughthereare64possibletripletcodons,only61codesfor20
aminoacids(asremainingthreearenon-sensecodons).
5.Nonoverlappingandnonpuntate(Commaless):-During
translation,thecodeisreadsequentially,withoutspacerbases,from
afixedstartingpoint,asacontinuoussequenceofbases,taken3at
atime,e.g.AUGCUAGACUUUisreadasAUG/CUA/GAC/UUU
without"ponctation"(coma)betweencodons.

---

337.Whichofthefollowingisanexampleof
Trinucleotiderepeatmutation?
a)Huntington'schorea
b)Fragile-X-syndrome
c)Friedreichataxia
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Trinucleotiderepeatmutation
Inthistypeofmutationacodon(i.e.trinucleotidesequence)
undergoesamplificationandthesamecodonisrepeated
continuouslysomanytimesinthechain.
Diseasesassociatedwithtrinucleotiderepeatmutationare
Huntington'sdisease(CAGrepeat),Spinocerebellarataxia(CAG
repeat),friedreichataxia(GAArepeat),fragile-X-syndrome(GGGor
GCCrepeat),dystrophiamyotonica(CTG/CUGrepeat),X-linked
spinobulbarmuscularatrophy(CAGrepeat)anddentorubral
pallidolusianatrophy(CAGrepeat).

---

338.Frameshiftmutationdoesnoteffect
completeaminoacidsequenceifit
occursinmultipleof?
a)I
b)2
c)3
d)None
CorrectAnswer-C
Ans.is'c'i.e.,3
Frame-shiftmutation
FrameshiftmutationsQoccurduetoinsertionordeletionQofoneor
twobaseswhichcauseschangeinthereadingframedistaltothe
mutation.
IfIor2basepairchange,wholereadingframeischangeddistalto
themutation,resultingintoentirelydifferentproteinmolecule.
If3basepairschange,singleaminoacidisincorporatedordeleted.
Therestofaminoacidsequenceissame.
Thisisbecausethegeneticcodeisreadinformoftripletsof
nucleotides(i.e.codons).
Ifoneortwobasepairsfromthecodeareremovedorinserted,the
geneticcodewillbemisreadfromthatchangeonwardsbecause
geneticcodeisnotpunctate.Thereforetheaminoacidsequence
translatedfromthechangeonwardswillbecompletelychanged.
Howeveriftheremoval/insertionhappensinmultipleofthree,restof
thereadingfromdoesnotchangeandhencetheaminoacid
sequencewillnotchange.

---

339.Chemicalprocessinvolvedinconversion
ofprogesteronetoglucocorticoidsis
a)Methylation
b)Hydroxylation
c)Carboxylation
d)None
CorrectAnswer-B
Ans.is`b'i.e.,Hydroxylation

---

340.Whichsteroidisformedfromcholesterol
withouthydroxylation?
a)Progesterone
b)Glucocorticoid
c)Mineralocorticoid
d)Estradiol
CorrectAnswer-A
Ans.is'a'i.e.,Progesterone
Progesteroneisformedbeforehydroxylationstep.

---

341.Membraneproteinsaresynthesizedin?
a)Freeribosome
b)Boundribosome
c)Nucleolus
d)Mitochondria
CorrectAnswer-B
Ans.is'b'i.e.,Boundribosome
Ribosomes
RibosomesaretheactualsitesofproteinsynthesisQ.Theribosomes
aresmallgranulesofRNAs.Ribosomesareusuallyoccurinclusters
calledpolyribosomesattachedtoonemRNAmolecule,an
arrangementthatincreasestherateofpolypeptidesynthesis.There
aretwotypesofpolyribosomes:-
1. Free(cytosolic):-Presentfreeincytosol.
2. Boundpolyribosome:-PresentonroughER.
Bothtypescansynthesizeprotein:?
Proteinssynthesizedbypolyribosomes
Cytosolic(free)
Bound(roughER)Polyribosomes
Polyribosomes
Cytosolicproteins,e.g.,
Synthesizeallmembraneproteins
Hemoglobin
Cytoskeletalproteins
Mitochondria]membrane
Mitochondrialproteins
ERmembrane
GolgiapparatusmembraneuPlasma
Nuclearproteins
membrane
Peroxisomalprotein
Secretoryproteins
Lysosomalenzym

---

---

342.Whichvitaminisrequiredfortransferof
1-carbonunit?
a)VitaminA
b)Folicacid
c)VitaminB12
d)Niacin
CorrectAnswer-B
Folicacid[RefHarper29m/ep.537-539,Vasudevanelep.400-
402]
Goups,containingasinglecarbonatomarecalledonecarbon
groups.Onecarbongroupsareformedfromfollowingaminoacids
duringtheirmetabolism:-Serine,glycine,histidineandtryptophan.
Onecarbongroupsformedduringmetabolismare:methyl(C113),
methylene(CH,),methenyl(CH),formyl(CHO)andformimino
(CH=NH)
Theseonecarbongroupsaretransferredbywayof
tetrahydrofolate(THF),whichisderivativeoffolicacid?.One
carbongroupscarriedbyTHFareattachedeithertonitrogenN5or
Mc'ortobothN5andN").DifferentonecorbonderivativesofTHF
are-N5-methylTHF,N5,N'?-methyleneTHF,N5,N"-methenyl
THF,N5-formylTHFandN5-formiminoTHEThesederivativesare
interconvertable.

---

343.Majorformoffolicacidtotransferone
carbonis?
a)MethyleneTHF
b)FormylTHF
c)MethylTHF
d)All
CorrectAnswer-A
Ans.is'a'i.e.,MethyleneTHF
Folicacid
Theactiveformoffolicacid(pteroylglutamate)istetrahydrofolate
(THF).
THFservesasacarrierofone-carbon(C1)unit0duringseveral
biosyntheticreactionslikenucleicacidQandaminoacidmetabolism.
Twoothercofactorsarealsoknowntobeinvolvedintheadditionof
onecarbon(C1)unittoametabolicprecursor,biotinincarboxylation
reactionandS-adenosylmethionine(SAM)asmethylatingagent.
However,folicacidismoreversatilethaneitherofthesetwo
becauseitcantransfertheC,unitsinseveraloxidationstates.
THFactsasacarrierofonecarbonunit0.
Theonecarbonunitscanbe:Methyl(C.113),methylene(CH2),
methenyl(CH),formyl(CHO),orformimino(CH=NH).
OnecarbonunitbindstoTHFthroughN5orN1?orbothN5,N'?
position.
Forexample,ifformylunitisattachedtoN-5,itiscalledN5-formyl
THF;ifmethyleneunitisattachedtobothN5and1\l'?,itiscalledN5,
N'?methyleneTHF.
CarbonunitsattachedtoN5areformyl,formimino,ormethyl;

---

attachedtoN'?isformyl;andattachedtobothN5-N10aremethylene
ormethenyl.
So,variouspossibleTHFare:-N5-FormylTHF,N5-formiminoTHF,
N5-methylTHF,N1?-formylTHF,N5-N10methyleneTHFandN5-N'?-
methenylTHF.
THFreceivestheC,unitsfromvariousdonormoleculesduring
catabolicreactionsandcantransfersthemtospecificacceptorsfor
thesynthesisofvariouscompounds.
Themajorpointofentryforone-carbonunitintosubstitutedfolates
ismethyleneTHF,whichisformedbythereactionofglycine,serine
andcholine.Serineisthemostimportantsourceofsubstituted
folatesforbiosyntheticreactions,andactivityofserine
hydroxymethyltransferaseisregulatedbythestateoffolate
substitutionandavailabilityoffolate.

---

344.Riboflavindeficiencyisassessedby?
a)Transketolase
b)Glutathionereductase
c)PDH
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Glutathionereductase
Riboflavin(VitaminB2)
RiboflavinisalsocalledWarburgyellowenzyme.
Riboflavinprovidesthereactivemoietiesofthecoenzymesflavin
mononucleotide(FMN)andflavinadeninedinucleotide(FAD).
Flavincoenzymesareinvolvedinoxidoreductionreactionsas
electroncarriers.
Thesereactionsincludethemitochondrialrespiratorychain,key
enzymesinfattyacidandaminoacidoxidationandthecitricacid
cycle.
Flavindependent(flavoprotein)enzymesare:
FMNdependent:L-aminoacidoxidase,NADHdehydrogenase.
FADdependent:ComplexIIofrespiratorychain,microsomal
hydroxylasesystem,D-aminoacidoxidase,xanthineoxidase,
succinatedehydrogenase,acyl-CoAdehydrogenase,glycerol-3-
phosphatedehydrognenase,pyruvatedehydrognenase,a-
ketoglutaratedehydrogenase.
Deficiencyofriboflavinischarcterizedbycheilosis,desquamation
andinflammationoftongue,andaseborrheicdermatitis.
Riboflavinnutritionalstatusisassessedbymeasurementof
activationofglutathionereductasebyFADaddedinvitro.

---

345.Riboflavinisaconstituentof?
a)FMN
b)NAD
c)PLP
d)THF
CorrectAnswer-A
Ans.is'a'i.e.,FMN
RiboflavinisalsocalledWarburgyellowenzyme.
Riboflavinprovidesthereactivemoietiesofthecoenzymesflavin
mononucleotide(FMN)andflavinadeninedinucleotide(FAD).
Flavincoenzymesareinvolvedinoxidoreductionreactionsas
electroncarriers.
Thesereactionsincludethemitochondrialrespiratorychain,key
enzymesinfattyacidandaminoacidoxidationandthecitricacid
cycle.

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346.ThemainfunctionofVitaminCinthe
bodyis
a)Coenzymeforenergymetabolism
b)Regulationoflipidsynthesis
c)Involvementasantioxidant
d)Inhibitionofcellgrowth
CorrectAnswer-C
Ans.is'c'i.e.,Involvementasantioxidant
VitaminC(Ascorbicacid)
Ascorbicacid(VitaminC)isalsocalledantiscorbuticfactor.Itisvery
heatlabile,especiallyinbasicmedium.
Ascorbicaciditselfisanactiveform.MaximumamountofvitaminC
isfoundinadrenalcortex.
Ascorbicacidfunctionsasareducingagentandscavangeroffree
radicals(antioxidant).Itsmajorfunctionsare:-
Incollagensynthesis:-VitaminCisrequiredforpost-translational
modificationbyhydroxylationofprolineandlysineresidues
convertingthemintohydroxyprolineandhydroxylysine.Thusvitamin
Cisessentialfortheconversionofprocollagentocollagen,whichis
richinhydroxyprolineandhydroxylysine.Throughcollagen
synthesis,itplaysaroleinformationofmatrixofbone,cartilage,
dentineandconnectivetissue.
1. Synthesisofnorepinephrinefromdopaminebydopamine-(3-
monoxygenase(dopamine-f3-hydroxylase)requiresVitaminC.
2. Carnitinesynthesis
3. Bileacidsynthesis:-7-ct-hydroxylaserequiresvitaminC.
4. Absorptionofironisstimulatedbyascorbicacidbyconversionof
ferrictoferrousions.

---

5. Duringadrenalsteroidsynthesis,ascorbicacidisrequiredduring
hydroxylationreactions.
6. Tyrosinemetabolism:-OxidationofP-hydroxy-phenylpyruvateto
homogentisate.
7. Folatemetabolism:-Folicacidisconvertedtoitsactiveform
tetrahydrofolatebyhelpofVitaminC.

---

347.Whichofthefollowingtraceelementhas
vitaminElikeaction:
a)Selenium
b)Cheomycin
c)Copper
d)Zinc
CorrectAnswer-A
Selenium

---

348.Glutathionerequireswhichvitamintoact
asantioxidant?
a)VitaminE
b)Niacin
c)VitaminC
d)VitaminA
CorrectAnswer-B
Ans.is'b'i.e.,Niacin

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349.AllaretrueaboutvitaminEexcept?
a)Actasantioxidant
b)Preventlipidperoxidationofcellmembrane
c)Watersolublevitamin
d)Chemicallytocopheral
CorrectAnswer-C
Ans.is'c'i.e.,Watersolublevitamin
VitaminEisafatsolublevitamin(notwatersoluble).
Allotheroptionsarecorrect.

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350.ThemineralhavingactionlikevitaminE
?
a)Calcium
b)Iron
c)Selenium
d)Magnesium
CorrectAnswer-C
Ans.is'c'i.e.,Selenium
SeleniumfunctionsasanantioxidantalongwithvitaminE.
Seleniumisaconstituentofglutathioneperoxidase,anantioxidant
enzymewhichpreventsagainstoxidativedamage.
Seleniumalsoisaconstituentofiodothyroninedeiodinase,the
enzymethatconvertsthyroxinetriiodothyronine.

---

351.Bloodformoffolicacidis-
a)Folinicacid
b)Pteroglutamate
c)MethylTHE
d)None
CorrectAnswer-C
Ans.is'c'i.e.,MethylTHE
Folicacidisabsorbedinthejejunum.
Followingabsorption,folicacidistransportedinbloodbytwo(3-
globulins.
Themajorcirculatingformismethyltetrahydrofolateandthenormal
concentrationrangeis5-15ng/ml.
Onceitarrivesintheliver,themethylderivatesaretakenupby
hepatocyteswherevariouscoenzymeareproduced.oFolicacidis
notstoredinthebody.
Remembers
Majorcirculatingformoffolicacid--0methylTHE
Majorpointofenteryfor1carbontransferbysubstituedfolate-4
methyleneTHE

---

352.Notobtainedfromplantsource?
a)Cobalamine
b)Riboflavin
c)Thiamine
d)VitaminA
CorrectAnswer-A
Ans.is'a'i.e.,Cobalamine
VitaminB12(cobalaminorcynocobalmin)ispresentonlyinfoodof
animalorigin.
Otherthreevitaminscanbetakenfromplantsource.

---

353.ThefunctionofvitaminKlargely
dependsonwhichmineral?
a)Selenium
b)Calcium
c)Iron
d)Magnesium
CorrectAnswer-B
Ans.is'b'i.e.,Calcium
VitaminKplaysanimportantroleinbloodcoagulationforitis
requiredforthepost-translationalprocessingofseveralclotting
factors(factorII,VII,IXandX).
Maturationoftheseclottingfactorsrequirestheconversionof
glutamylresiduesofprecursorproteinsinto'ycarboxyglutamate
(Gla)residuesbyadditionofcarboxylategroup.Thiscarboxylation
ofglutamylresdiueisvitaminKdependent.
They-carboxyglutamate(Gla)residuessoformedserveasbinding
siteforcalciumions.EachGlacontainstwonegativechargeswhich
chelatethepositivecalciumion.
AfterbindingtoGlaresidueonactivatedclottingfactor,calcium
bindswithnegativelychargedphospholipidspresentontheplatelet
cellmembrane.
Inthisway,bridgingofthephospholipidstheGlaresidueof
prothrominoccursviacalciumion.

---

354.WhichVitaminisinvolvedinRedox
reactions
a)Pyridoxin
b)Biotin
c)Folicacid
d)Riboflavin
CorrectAnswer-D
Ans.is'd'i.e.,Riboflavin
Riboflavinandniacinareinvolvedinredox(reductionandoxidation)
reactions.

---

355.Whichisnotadietaryfiber?
a)Lignin
b)Lactulose
c)Pectin
d)Cellulose
CorrectAnswer-B
Ans.is'b'i.e.,Lactulose
Dietaryfibres(Review)
Dietaryfibreconsistsofunabsorbablecellwallandother
consititutentsofvegetablefoodlikecelluloseQ,lignin,
hemicellulosee,gums,pectins?,aliginatesandother
polysaccharides.
Inherbivorousanimals,intestinalmicrooganismbreakdownthese
polysaccharidesintoacetate,propionateandbutyrate.
Thesepolysaccharidescontain13-glycosidiclinkages.
Therefore,theycannotbedigestedbya-amylasepresentinhuman
salivaandpancreaticjuicebecausea-amylasebreaksa-glycosidic
bond(especially1-4alinkage).
So,dietaryfibersarenotdigestedorhydrolyzedbutarefermented
bycolonicbacteriaexceptforlignin,whichisneitherdigestednor
fermentedbyintestinalmicroorganisms?.
Dietaryfibreabsorbeswaterintheintestine,swells,increasebulkof
stoolbyincreasingwatercontentoffaecesandsoftenit,decreases
transittimebyfacilitatingcolonictansit.
"Thepresenceoffibreshortensthetransittimeseandincreasesthe
stoolbulk".
Dietaryfibreisoftwotypes:-
1. Solublefibree:-Thesearepectin,aliginates,andgums.These

---

absorbupto15timesitsweightinwaterasitmovesthroughGIT,
producingsofterstools.Itsgoodsourcesareoat,flaxseeds,peas,
beans,apple,citrusfruits,carrots,bareleyandpsyllium.
2. Insolublefibre?:-Thesearecellulose,hemicelluloseandlignin.
Thesepromotemovementofmaterialthroughdigestivesystemand
increasesstoolbulk.Itsgoodsourcesarewheatflour,wheatbran,
nutsandvegetables.

---

356.Immediatesourceofenergyis?
a)Cori'scycle
b)HMP
c)ATP
d)TCAcycle
CorrectAnswer-C
Ans.is'c'i.e.,ATP
Therearethreeenergysystemstoprovideenergyformuscular
activities.
Immediateenergysystem:EnergyisprovidedbystoredATPand
creatinephosphate.
Anaerobicglycolyticsystem(lacticacidsystem):Energyis
generatedbyutilizationofglucoseorglycogenbyanaerobic
glycolysis.Thisenergyisalsogeneratedearly.
Aerobicoroxidativesystem:Energyisgeneratedbyutilizationof
glucose/glycogen,andfattyacidsthroughoxidativepathways,e.g.
TCAcycle.
Thesethreeenergysystemsoperateasacontinuum;eachsystem
isalwaysfunctioning,evenatrest.oWhatvariesistherelative
contributioneachsystemmakestototalATPproductionatanygiven
time.
Oxidative(aerobic)
Immediate
Anerobic
system
energysystem
glycolyticsystem Glucoseor
ATP,creatine
Glucoseor
glycogen,fatty
phosphate
glycogen
Substrates
acids
EnergyproductionVery
Fast
Slow
fast
Peakat
0-30sec.
20-180sec.
>3min

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Peakat
0-30sec.
20-180sec.
>3min
Limiting
DepletionofCrP, Lacticacidas_. Glycogendepletion
factor
ATP
vitiation
Activity
Powerlifting&
Longersprints
Enduranceevents
example
weight
lifting,short
Middledistance
Teamsports
sprints
teamsports
Jumping,
Ballgames
Ballgames(Soccer,
throwing
(Soccer,rugby)
fieldhockey)

---

357.Instantenergytomuscleisprovidedby
whichpathway?
a)HMPshunt
b)Embdenmayerhoffpathway
c)Coricycle
d)TCAcycle
CorrectAnswer-B
Ans.is'b'i.e.,Embdenmayerhoffpathway
ATPandcreatinephosphateprovideimmediateenergy..
Anaerobicglycolysis(EMP)providesearlyenergy.

---

358.Duringstarvation,muscleuses?
a)Fattyacids
b)Ketonebodies
c)Glucose
d)Proteins
CorrectAnswer-A
Ans.is'a'i.e.,Fattyacids

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359.Fattyacidsusedbyallexcept?
a)Liver
b)Muscle
c)Brain
d)Kidney
CorrectAnswer-C
Ans.is`c'i.e.,Brain
Thereisnostoredfuelinbrain,butitutilized60%oftotalenergy
underrestingconditions.
Glucoseisvirtuallythesolefuelforthebrain,exceptinprolonged
starvingwhenketonebodiesarethemajorsource.
Fattyacidsdonotserveasfuelforthebrain,becausetheyare
boundtoalbumininplasma;hencecannotcrossblood-brainbarrier.

---

360.Metabolicchangeseeninstarvationare
allexcept?
a)Increasedgluconeogenesis
b)Increasedglycolysis
c)Ketogenesis
d)Protiendegradation
CorrectAnswer-B
Ans.is'b'i.e.,Increasedglycolysis

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361.Actionofmetalloproteinase?
a)Degradationofcollagen
b)Polymerizationofcollagen
c)Oxidationofcollagen
d)Stimulationofcollagen
CorrectAnswer-A
Ans.is'a'i.e.,Degradationofcollagen
DegradationofcollagenandotherECM(extracellularmatrix)
proteinsisachievedbymatrixmetalloproteinases(MMPs).
MMPsisafamilyofenzymesthathaveincommona180-residue
zincproteasedomain.
Matrixmetalloproteinasesinclude:-
Interstitialcollagenase(MMP-1,2,and3):Cleavethefibrillar
collagentypesI,IIandIII.
Gelatinases(MMP-2and9):Degradeamorphouscollagenand
fibronectin.
Stromelysins(MMP-3,10and11):Actonproteoglycans,laminin,
fibronectinandamorphouscollagen.
Membrane-boundMMPs(ADAMs):Cleavemembrane-bound
precursorformsofTNFandTGF-a,releasingtheactivemolecule.

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362.Proteincatabolismisincreasedin?
a)Starvation
b)Burns
c)Surgery
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Conditionscausingincreasedproteincatabolism
Multipletrauma
Infectionandsepsis
Burns
Fever
Surgery
Longbonefracture
Prolongedstarvation
Prolongedcorticosteroidtherapy

---

363.Hemeiswhichporphyrin?
a)TypeI
b)TypeII
c)TypeIII
d)TypeIV
CorrectAnswer-C
Ans.is'c'i.e.,TypeIII

---

364.Hypercalcemiainsarcoidosisallaretrue
except?
a)Parathormonelevelisincreased
b)PTHrPlevelisincreased
c)Calcitriollevelisincreased
d)Oralsteroidsareuseful
CorrectAnswer-A
Answer-A.Parathormonelevelisincreased
Extrarenalsynthesisofcalcitriol[1,25(OH)2D3]iscentraltothe
pathogenesisofabnormalcalciummetabolisminsarcoidosis.
Sarcoidosiscausesanincreaseinl,25-dihydroxyvitaminD,the
activemetaboliteofvitaminD,whichisusuallyhydrorylatedwithin
thekidney,butinsarcoidosispatientshydroxylationofvitaminDcan
occuroutsidethekidneys,mainlyinsidetheimmunecellsfoundin
thegranulomasandproduces1alpha,25(OH)2D3,whichisthe
maincauseforhypercalcemiainsarcoidosis.
PTHreleaseisinhibitedbyhypercalcaemiaandhighlevelsof
calcitriol,soPTHlevelissuppressedinsarcoidosis.

---

365.Hay'ssulphertestisusedtodetect
whichofthefollowing?
a)Bilesaltsinurine
b)Reducingsugarinurine
c)Ketonebodiesinurine
d)Urobilinogeninurine
CorrectAnswer-A
Ans.is'a'i.e.,Bilesaltsinurine
Tests
Usedfor
Rothera'stest
Ketonebodiesinurine:-acetoneand
(nitroprussidetest)
acetocetate
Gerhardt'stest(ferric
Ketonebodiesinurine:-acetoacetate.
chloridetest)
Benedict'stest
Reducingsugarsinurine
Fehling'stest
Reducingsugarsinurine
Hay'ssulphertest
Bilesaltsinurine
Fouchet's(boriumsulphate Bilepigment:bilirubin
test)
Gmelin's(nitricacid)test
Bilepigment:bilirubin
VandenBerghtest
Bilepigment:bilirubin
Bilinogens(stercobilinogen,
Ehrlich'stest
urobilinogen)
Schlesinger'stest
Bilins(stercobilin,urobilin).
Porphobilinogenandurobilinogenin
Ehrlich'saldehydetest
urine

---

366.Truestatementabouthemoglobinis?
a)Eachhemoglobinmoleculeismadeof4polypeptidesofeach
subunit
b)Twoalphaandtwobetasubunitshavinga02attachedtoeach
subunit
c)Eachhemoglobinmoleculebindstoonlyone02molecule
d)Eachhemoglobinhasonehememolecule
CorrectAnswer-A
Ans.is'a'i.e.,Eachhemoglobinmoleculeismadeof4
polypeptidesofeachsubunit

---

367.Allaretrueaboutchaperonesexcept?
a)Causefoldingofproteins
b)Arelipidinnature
c)MayhaveATPaseactivity
d)Includeheatshockproteins
CorrectAnswer-B
Ans.is'b'i.e.,Arelipidinnature
Chaperonesareproteins(notlipid).
Chaperones
Certainproteinsplayaroleintheassemblyorproperfoldingofother
proteinswithoutthemselvesbeingcomponentsofthelatter.
Suchproteinsarecalledmolecularchaperones.
MostchaperonesexhibitATPaseactivityandbindADPandATP.
Thisactivityisimportantfortheireffectonfolding.
SomePropertiesofChaperoneProteins
Presentinawiderangeofspeciesfrombacteriatohumans
Manyareso-calledheatshockproteins(Hsp)
Someareinduciblebyconditionsthatcauseunfoldingofnewly
synthesizedproteins(eg,elevatedtemperatureandvarious
chemicals)
Theyblindtopredominantlyhydrophobicregionsofinfoldedproteins
andpreventtheiraggregation
Theyactinpartasaqualitycontroloreditingmechanismfor
detectingmisfoldedorotherwisedefectiveproteins
MostchapersonesshowassociatedATPaseactivity,withATPor
ADPbeinginvolvedintheprotein-chaperoneinteraction
Foundinvariouscellularcompartmentssuchascytosol,
mitochondria,andthelumenoftheendoplasmicreticulum

---

---

368.Whichofthefollowingisthemajor
proteoglycanofsynovialfluid?
a)Chondroitinsulfate
b)Dermatansulfate
c)Heparansulfate
d)Hyaluronicacid
CorrectAnswer-D
Ans.is'd'i.e.,Hyaluronicacid
Distribution
Hyaluronic
Synovialfluid(providesviscosity),vitreoushumor,
acid
looseconnectivetissue)
Chondroitin
Cartilage,bone,tendon,ligament,cornea
sulfate
Dermatan
Pliabilityofskin,andheartvalves,widedistribution
sulfate
Keratan
Hornystructureslikehair,nails,claws,horn,hoofs
sulfate
Alsopresentincornea
Heparin
Mastcells
Heparan
sulfate
Skinfibroblast,aorticwall

---

369.Themechanismbywhichmercury
causesdamage?
a)Bindsto-SHgroupofenzyme
b)Directlytoxic
c)InhibitsETC
d)Inhibitsproteinsynthesis
CorrectAnswer-A
Ans.is'a'i.e.,Bindsto-SHgroupofenzyme
Heavymetaltoxicityiscausedbytightbindingofametalsuchas
mercury(Hg),lead(Pb),aluminium(Al),oriron(Fe)toafunctional
groupofenzyme.
Mercury,forexample,bindstoreactivesulfhydrylgroups(-SH)in
theactivesiteofsomanyenzymes,thatithasbeendifficultto
determinewhichoftheinhibitedenzymeisresponsibleformercury
toxicity.
Leadalsohashighaffinityforsulfhydrylgroup.

---

370.Trueregardingcollagensynthesisisall
except?
a)Synthesizedinribosomesaspreprocollagen
b)HydroxylationofprolineoccursinGolgiapparatus
c)HydroxylationoflysineoccursinER
d)TriplehelixassemblyoccursinER
CorrectAnswer-B
Ans.is'b'i.e.,HydroxylationofprolineoccursinGolgiapparatus

---

371.TypeofcollagenfoundinspaceofDisse
inliveris-
a)CollagenI&II
b)CollagenIII&IV
c)CollagenII&
d)CollagenII&V
CorrectAnswer-B
Ans.is'b'i.e.,CollagenIII&IV

---

372.Albuminbindswithallexcept?
a)Steroid
b)Calcium
c)FFA
d)Thyroxine
CorrectAnswer-D
Ans.is'd'i.e.,Thyroxine
Albuminisinvolvedintransportofseveralsubstancesbecauseofits
predominantlypolarnature.
Nearly40%ofplasmacalciumisbound-upwithalbumin.
OthersubstanceswhichareBound-upand/ortranportedbyalbumin
are:?
1. Freefattyacids
2. Bilirubin
3. Steroids
4. Manynonpolardrugs
Comingbacktoquestion
Thyroxinealsobindstoalbumin,butitisnotthemajortransport
proteinforthyroxin.Mostofthethyroxineistransportedbyglobulin.
Thyroxinebindingplasmaproteinsare:-
1. ThyroxinebindingglobulinMajorthyroidhormonebindingprotein
2. Thyroxinebindingalbumin
3. Thyroxinebindingpre-albumin
Thus,amongthegivenoptions,thyroxineisthebestanswer.

---

373.Whichcollagenproducessheets?
a)I
b)II
c)IV
d)VI
CorrectAnswer-C
Ans.is'c'i.e.,IV
Variousstructureproducedbycollagens
Fibrils
Sheets
Beadedfilaments Anchoringfibrils
CollagenI CollagenIV CollagenVI
CollagenVII
CollagenII CollagenVIII
CollagenIII CollagenX
CollagenV
CollagenXI

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374.Mainenzymeforglycogenmetabolism?
a)Glucose-6-phosphatase
b)Glycogensynthase
c)PFK-1
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Glycogensynthase

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375.Whichofthefollowingisseeninyoung's
syndrome?
a)Azoospermia
b)Bronchiectasis
c)Infertility
d)Alloftheabove
CorrectAnswer-D
Answer-D.Alloftheabove
Young'ssyndromeischaracterizedby:
1. Bronchiectasis
2. Azoospernia&infertility
3. Sinusitis
4. Nasalpolypi

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376.Amyloidosisoccursinallexcept
a)Tuberculosis
b)Chronicbronchitis
c)Osteomyelitis
d)Bronchiectasis
CorrectAnswer-B
Answer-B.Chronicbronchitis
Secondoryamyloidosis
Itoccurssecondarytoanassociatedinflammatoryconditionslike
1. Rheumatoidarthritis(mostcommon)
2. TB&Leprosy
3. Ankylosingspondylitis
4. Chronicosteomyelitis
5. IBD(crohndisease,ulcerativecolitis)
6. Bronchiectasis
Itmayalsooccurinsometumors
1. Renalcellcarcinoma(Hypernephroma)
2. Hodgkinlymphoma

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377.MostcommoncauseofdeathinSLEin
children
a)Lupusnephritis
b)Lupuscerebrits
c)Libmansacksendocarditis
d)Anemiaandinfections
CorrectAnswer-A
Answer-A.Lupusnephritis
MajorcausesofdeathinpediatricSLEinclude:
1. Renaldisease(lupusnephritis)
2. Severediseaseflare
3. Infections

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378.Smallposteriorfossaseenin?
a)Arnoldchiarimalformation
b)Dandywalker
c)Medulloblastoma
d)Schizencephaly
CorrectAnswer-A
Answer-A.Arnoldchiarimalformation
Smallposteriorfossaarnoldchiarimalformation.
Largeposteriorfossadondywalkermolformation

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379.Whichofthefollowingisa
Channelopathy
a)AtaxiaTelangiectasia
b)FrederichAtaxia
c)Spinocerebellarataxia
d)AndersonTawilSyndrome
CorrectAnswer-D
Ans.is'd'i.e.,AndersonTawilSyndrome
Andersonsyndrome(Anderson-Tawisyndrome)isapotassium
channelchannelopathy.

---

380.IncorrectaboutHIVassociated
nephropathy?
a)Proteinuria
b)Shrunkenkidneys
c)15%casesshowmesengialproliferation
d)DevelopswhenCD4<200
CorrectAnswer-B
Answer-B.Shrunkenkidneys
Mostcommon(80%)kidneylesioninAIDSisFSGS(especially
collapsingvarianti.e.collapsingglomerulopathy).ItistermedasHIV
associatednephropathy(HIVAN).
Mesangioproliferative(mesangialproliferation)GNis2ndmost
kidneylesion
OtherkidneylesionsarediffuseproliferativeGN,MPGN,IgA
nephropathy,membranousGNandminimalchangedisease.

---

381.Thesignofreversibleinjuryinacaseof
alcoholicliverdisease-
a)Lossofcellmembrane
b)Nuclearkaryolysis
c)Cytoplasmicvacuole
d)Pyknosis
CorrectAnswer-C
Ans.is'c'i.e.,Cytoplasmicvacuole
oFattychangesoccurinalcoholicsteatosis(fattyliver).Itis
manifestedbyappearenceoflipidvacuoleinthecytoplasm,whichis
asignofreversibleinjury.
oOtherthreeoptions(lossofcellmembrane,nuclearkaryolysisand
pyknosis)aresignsofirreversibleinjury

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382.OrganellewhereH202isproducedand
destroyedis?
a)Peroxisome
b)Lysosome
c)Golgibody
d)Ribosome
CorrectAnswer-A
Ans.is'a'i.e.,Peroxisome
Peroxisomeisamembraneboundorganellelfoundinalleukaryotic
cells.
"Peroxisomescontainagroupofenzymesthatoxidizeavarietyof
substratesandtherebyformhydrogenperoxide.TheH202thus
formedisefficientlydecomposedwithintheorganellebycatalase
whichispresentinhighconcentration".
LysosomescanonlyformH,02-TheycannotdegradeH202.
Remember
H202isproducedaswellasdestroyedinmitochondriaandcytosol.
ItisproducedfromsuperoxidebyenzymeSOD.
Itisdestroyedbyglutathioneperoxidase.

---

383.Eosinophiliainnecrosedtissueisdueto
a)Coagulationofproteins
b)Denaturationofenzymes
c)Denaturationofprotein
d)Mitochondrialdamage
CorrectAnswer-C
Ans.is'c'i.e.,Denaturationofprotein
Necroticcellsshowincreasedeosinophiliainhematoxylinandeosin
(H&E)stains.
Itisdueto-
1. LossofcytoplasmicRNA(orribonucleoprotein/RNP)whichbinds
thebluedye,hematoxylin.
2. Denaturedcytoplasmicproteinswhichbindthereddye,eosin.

---

384.Gaseousnecrosisisseenin-
a)CMVinfection
b)Staphylococcalinfection
c)Treponemalinfection
d)HSVinfection
CorrectAnswer-C
Ans.is'c'i.e.,Treponemalinfection[RefRobbin's9`"/ep.43;
Anderson's10thiep.375]
Caseousnecrosisisafeatureofsyphiliswhichiscausedby
tremonemalinfection.
Gaseousnecrosis
Itisavariantofcoagulativenecrosis.Itismostcommonly
encounteredwhencelldeathisattributabletoertainorganisms
e.g.,mycobacteriumtuberculosis(TB),syphilisandfungi
(Histoplasma,Coccidioidomycosis).

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385.Typeofnecrosisinpancreatitis?
a)Fibrinoid
b)Coagulative
c)Fat
d)Caseous
CorrectAnswer-C
Ans.is'c'i.e.,Fat
Fatnecrosisisseenmostfrequentlyinacutepancreatitisdueto
leakageoflipase.
Fatnecrosis
Fatnecrosismaybeoftwotypes:?
1.Enzymaticfatnecrosis
Thisisduetoactionoflipaseonadiposetissue.
Itoccursmostfrequentlyinacutepancreatitisduetoleakageof
lipase.
Dependingontheseverityofacutepancreatitis,fatnecrosismay
occurin:-aAdiposetissuecontiguoustopancrease,
retroperitonealfat.
Adiposetissueinanteriormediastinum.
Bonemarrow
Omentalandabdominalfat
2.NonenzymaticorTraumaticfatnecrosis
Occursduetotrauma
Isseeninsubcutaneoustissueofbreast,thigh,andabdomen.

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386.ExampleofApoptosisis?
a)CouncilmanBodies
b)GammaGandyBody
c)Russellbodies
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Councilmanbodies
Apoptoticbody
Oneofthemurphologicalhallmarkofapoptosisistheapoptoticbody
whichiseosinophilicandmaycontainsomekarryorhecticnuclear
bebris.
Itisaresultofshrinkageofcytoplasmandnucleardisruption.
Firstthereissurfaceblebbingandmarginationofchromatinwhichis
followedbycellshrinkageandbreakupintosmallerapoptotic
bodies.
Theseapoptoticbodiesaretakenupbysurroundingcellsand
digested.
Sincetheprocesswasseenforalongtimebeforethemechanism
wasunderstood,apoptoticbodiesinparticularsituationsattracted
specificnames:
1. Civattebodiesorcolloidbodiesinlichenplanus.
2. Kaminobodiesinmelanocyticlesions
3. Councilmanbodiesinacuteviralhepatitis
4. Tingiblebodies(foundsinmacrophages)inlymphoma
5. Sunburncells
6. Satellitedyskeratoticcells
7. Eosinophilicglobules

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387.Dystrophiccalcificationisseenin?
a)Milkalkalisyndrome
b)Atheromatousplaque
c)Hyperparathyroidism
d)VitaminAintoxication
CorrectAnswer-B
Ans.is'b'i.e.,Atheromatousplaque
Dystrophiccalcification
*Whenpathologicalcalcificationtakesplaceindead,dyingor
degeneratedtissue,itiscalleddystrophiccalcification.oCalcium
metabolismisnotalteredandserumcalciumlevelisnormal.
Dystrophiccalcificationin
Dystrophiccalcificationin
deadtissues
degeneratedtissues
1.Incaseousnecrosisof
1. Atheromatousplague
tuberculosis
2. Monkeberg'ssclerosis
(mostcommonwhichmaybe
3. Psommamabodies
inlymphnodes)
4. Densoldscars
2.Chronicabscessin
5. Seniledegenratedchangessuch
liquifactivenecrosis
asincostalcartilage,tracheal,
3.Fungalgranuloma
bronchialrings,Pinealglandin
4.Infarct
brain.
5.Thrombi
6. Heartvalvesdamagedby
6.Haematomas
rheumaticfever.
7.Deadparasites-
Cystecercosis/Toxoplasma
Hydatid/Schistosoma
8.Infatnecrosisofbreast&
othertissues

---

Howdoescalcificationoccursinthesesitewithnormalserum
calcium?
*Calcificationofdeadanddyingcellsandtissuesisacommon
findinginhumanpathologicconditions.
*Denaturedproteinsindeadorirreversibledamagedtissues
preferentiallybindphosphateions.
*Phosphateionsreactwithcalciumionstoformaprecipitateor
calciumphosphate.
*Thus,necrotictissueservesasacalciumsink.

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388.Whichofthefollowingislabilecell?
a)Cardiaccell
b)Liverparenchymalcell
c)Vascularendothelialcells
d)Surfaceepithelium
CorrectAnswer-D
Ans.is'd'i.e.,Surfaceepithelium
Whenacellproliferates,itpassthroughacellcycle.
Cellcyclehasaseriesofphases:
GphaseRestphase(Presyntheticphase)
SphaseSyntheticphaseinwhichsynthesisofDNAtakes
place.
G2phaseRestingphase(Postsyntheticorpostmitotic
phase).
MphaseMitoticphaseinwhichmitosistakesplace.
GophaseWhencellisnotproliferating,itremainsin
quiescentphase(Go).Basedontheirproliferativecapacity,cellsare
dividedintoSGoG,
1.Labilecells(Continouslydividingcells)orintermitoticcells.
Havecapacitytoproliferateandregenerate.
HaveveryshortGoandalmostalwaysremainincellcycle.Example
are:-
Surfaceepithelium(stratifiedsquamous)ofskin,oralcavity,vagina
andcervix.
Liningmucosaofallexcretoryductsofglands(Salivarygland,
pancreas,biliaryduct).
ColuminarepitheliumofGITanduterus.
Transitionalepitheliumoftheurinarytract.

---

Bonemarrowcellsandhematopoieticcells.
Basalcellsofepithelia.
2.Stableorquiescentorreversiblepostimitoticcells.
Havelimitedcapacitytoproliferateandregenerate.
RamaininGophaseofcellcyclebutcanenterinGIphasewhen
stimulatedi.e.,theyusuallyremainquiescent,butproliferatein
responsetostimuli.Exampleare-
Parenchymalcellsofliver,kidneyandpancreas.
Mesenchymalcells,e.g.,fibroblastandsmoothmuscles.
Vascularendothelium
Osteoblast,chondroblast
Restinglymphocytesandotherleukocytes.
3.Permanentornondividingorirreversiblepostmitoticcells.
Cannotdivideandregenerate.
Thesecellsarenondividingandhaveleftthecellcycle,i.e.,theydo
notbelongtoanyphaseofcellcycle.Exampleare-
LiNeurons
Cardiacmuscle
Skeletalmuscle

---

389.Changesseeninatheroscleroticplaque
atthetimeofruptureareallexcept-
a)Thinfibrosiscap
b)Multiplefoamcap
c)Smoothmusclecellhypertrophy
d)Celldebris
CorrectAnswer-C
Ans.is'c'i.e.,Smoothmusclecellhypertrophy
Ruptureoccursinadvancedatheroscleroticlesion.
Inadvancedatheroma,smoothmusclecellsundergoapoptosisand
advancedatheromatousplaqueoftenhavemostlyfibrouscharacter
withlackofsmoothmusclecellsthatareseeninlessadvanced
lesion.

---

390.Whichofthefollowingisanon-
modifiableriskfactorforCHD-
a)Diabetes
b)Smoking
c)Hypertension
d)Oldage
CorrectAnswer-D
Ans.is'd'i.e.,Oldage
1. Oldageisanon-modifiableriskfactorforatherosclerosisand
coronaryheartdisease(CHD).
2. Otherthree(giveninquestion)aremodifiableriskfactors.

---

391.Heartfailurecellsare?
a)Lipofuscingranulesincardiaccells
b)Pigmentedalveolarmacrophages
c)Pigmentedpancreaticacinarcells
d)Pigmentcellsseeninliver
CorrectAnswer-B
Ans.is`B'i.e.,Pigmentedalveolarmacrophages
Heartfailurecells(siderophages)arehemosiderincontaining
macrophagesinalveolithatareseeninleftventricularfailureand
denotepreviousepisodesofpulmonaryedema.
Leftsidedheartfailure
ThemajormorphologicalandclinicaleffectsofLVFaredue
increasedbackpressureinpulmonarycirculationandthe
consequencesofdiminishedperipheralbloodpressureandflow.
Theextracardiacorgansinvolvedcommonlyare?
1. Lung(mostcommon)
2. Kidney
3. Brain
Lung
Pressureinthepulmonaryveinsincreasesandtransmitted
retrogradelytocapillariesandarteries.
Thisresultsinpulmonarycongestionandpulmonary-edemaWet
lung.
Thereisperivascularandinterstitialtransdate,particularlyinthe
interlobularseptaresponsibleforkerley's`B'linesonX-rays.
Edematousfluidaccumulatesinalveoli.
Ironcontainingproteinsandhemoglobinleakoutfromthe
capillaries,andarephagocytosedbymacrophagesandconvertedto

---

hemosiderin.
Hemosiderin-containingmacrophagesinthealveoli(called
siderophages,orheartfailurecells)denotepreviousepisodesof
pulmonaryedema.
TheclinicalmanifestationsofLVFareprimarilyduetothese
changesinlungsDysnea,orthopnea,paroxysomalnocturnal
dysnea.
Kidney
Decreasedcardiacoutputcausesareductioninrenalperfusion.
Ifitissevereenoughtoimpairetheexcretionofnitrogenousproduct
(BUN,Creatinine),PrerenalARF(Prerenalazotemia)maybe
precipitated.
Brain
Reducedperfusiontobrainmaycausehypoxic/ischemic
encephalopathy.

---

392.Irreversibleinjuryinmyocardiumoccurs
at?
a)2minutes
b)30minutes
c)2hours
d)5hours
CorrectAnswer-B
Ans.is'b'i.e.,30minutes
Themetabolicrateoftheheartishigh,anditsstoresofsubstrate
arelow.
So,heartiscriticallydependentonacontinuoussupplyofoxygen
andnutrients.
Ischemiaofmyocardiuminducesprofoundfunctional,biochemical
andmorphologicalconsequences.
Myocardialfunctionismoresensitivetoisc_hemia(lossof
contractilityoccurswithin60seconds)thanmyocardialstructure
(irreversibleinjuryoccursin20-40minutes,thusmyocardialnecrosis
beginsatapproximately30minutesaftercoronaryocclusion.
Keyeventsinischemiccardiacmyocytes
Feature
Time
OnsetofATPdepletion Seconds
Lossofcontractility
<2minutes
ATPreducedto50%
10minutes
ATPreducedto10%
40minutes
Irrversibleinjury
2040min
Microvascularinjury
>1hr

---

---

393.Hyperplasticarteriolitiswithnerotizing
arteriolitisisseenin?
a)Buerger'sdisease
b)Benignhypertension
c)Malignanthypertension
d)Diabetes
CorrectAnswer-C
Ans.is'c'i.e.,Malignanthypertension
Hyperplasticarteriosclerosisischaracteristicallypathologicchange
seeninvesselsofthepatientsufferingfrommalignanthypertension.
Arteriolesofalltheorgansinthebodycanaffectedbutfavoured
sitesare
1.Kidney2.SmallIntestine3.Gallbladder4.Peripancreaticfat
5.Periadrenalfat.

---

394.EarliesthistologicalchangeinMI-
a)Macrophageinfiltration
b)Neutrophilicinfiltration
c)Wavinessoffibers
d)Coagulativenecrosis
CorrectAnswer-C
Ans.is'c'i.e.,Wavinessoffibers
Variablewavinessoffibresatborderistheearliesthistological
finding(seetablesofpreviousexplanation).

---

395.Syphiliticaneurysmmostlyinvolve?
a)Archofaorta
b)Descendingaorta
c)Abdominalaortaabovetherenalarteries
d)Abdominalaortabelowtherenalarteries
CorrectAnswer-A
Ans.A.Archofaorta
Theascendingaortaisthesegmentmostcommonlyaffected(50%),
followedbythearch(35%)andthedescendingaorta(15%)

---

396.

---

Classificationofaorticdissectiondepends
upon?
a)Causeofdissection
b)Levelofaortaaffected
c)Percentageofaortaaffected
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Levelofaortaaffected
ClassificationofAorticdissection
Theriskandnatureofseriouscomplicationsofdissectiondepend
stronglyonthelevelofaortaaffected,withthemostserious
complicationsoccuringfromtheaorticvalvetothearch.
Thusaorticdissectionsaregenerallyclassifiedintotwotypes?
Proximallesion(TypeA)
Morecommonandmoredangerous.
Involveeithertheascendingportiononlyorbothascendingandthe
descendingportionofaorta.
Distallesion(TypeB)
Involveonlydiscendingpartdistaltosubclavianartery.

---

397.CreatininekinaseiselevatedinMIafter-
a)2-4hrs.
b)4-8hrs.
c)12-24hrs
d)>24hrs.
CorrectAnswer-A
Ans.is'a'i.e.,2-4hrs
Initiationof
Returnto
Enzyme
Peak
rise
baseline
24
CK-MB
2-4hours
48-72hours
hours
TroponinTandI(TnT
48
2-4hours
7-10days
Tnl)
hours
48
AST/SGOT
In12hours
4-5days
hours
3-6
LDH
24hours
2weeks
days

---

398.WhichisnotseeninAschoffbodies-
a)Giantcells
b)Aschoffcells
c)Fibroblasts
d)Polymorphonuclearcells
CorrectAnswer-D
Ans.isdi.e.,Polymorphonuclearcells
Aschoffbodies:
*Aschoffbodiesarefocalinflammatorylesionsseenduringacute
rheumaticfever
*Theyconsistoffociofswolleneosinophilliccollagensurroundedby
Lymphocytes(primarilyTcells)
Occasionalplasmacells
Aschoffgiantcells(macrophagesofrheumaticfever)
Antitschkowcells
(Antischkowcellsaremodifiedmacrophageswithabundant
cytoplasmandcentralroundtoovoidnucleiinwhichthechromatin
isdisposedinthecentral,slenderwavyribbonlikepattern-caterpillar
cells)
Histiocytes
Fibroblasts

---

399.Allaretrueaboutnon-bacterial
thromboticendocarditis,except?
a)Causeemboli
b)Vegetation>5mm
c)Noinflammatoryreaction
d)Locallynondestructive
CorrectAnswer-B
Ans.is'b'i.e.,Vegetation>5mm
Nonbacterialthromboticendocarditis(NBTE)
NBTEischaracterizedbythedepositionofsmallsterilethrombion
theleafletsofthecardiacvalves.
Thelesionsaresmall,rangingfrom1mmto5mm.
Theyoccursinglyormultiplyalongthelinesofclosureofleafletor
cusps.
Theyarecomposedofblandthrombithatarelooselyattachedtothe
underlyingvalve.
Thevegetationsarenotinvasiveanddonotelicitanyinflammatory
reaction.Thus,thelocaleffectofvegetationsisusuallyunimportant
buttheymaybethesourceofsystemicemboli.
NBTEisoftenencounteredindebilitatedpatients.Itisseenin
hypercoagulablestates,e.g.cancer,promyelocyticleukemia,
mutinousadinocarcinomasandincreasedestrogenicstate.

---

400.Concentrichypertrophyofleftventricle
isseenin?
a)Mitralstenosis
b)Hypertension
c)Aorticregurgitation
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Hypertension
Concentrichypertrophy-->Inpressureoverload,e.g.hypertension
andaorticstenosis.oEccentrichypertrophyInvolumeoverload,
e.g.inaorticregurgitation.
Adaptationsinheart
Thecardiacmyocyteisterminallydifferentiatedcellthatisnotable
todivide.
Myocardiumcannotundergohyperplasia,i.e.increaseinthenumber
ofmyocyte.
So,myocardiumcanadaptbyincreasingthesize(i.e.hypertrophy)
ofthemyocyteinresponsetostress.
Therearetwotypesofstressestoheart
1.Pressureoverload
Occurinhypertensionoraorticstenosis.
Pressureoverloadedventriclesdevelopconcentrichypertrophyof
theleftventricle,withincreasedinwallthicknessHeartsizemay
increase.
Theincreaseinwallthicknessmayreducethecavitydiameter-->
ratioofcavitysizetowallthicknessdecreases.
Thereisincreaseinthetransversediameter(width)ofmyocytes,but
celllengthremainsthesame.

---

2.Volumeoverload
Asoccursinaorticregurgitation
Thereisdilatationofventricularchamberalongwithincreased
thicknessofventricularwallEccentrichypertrophy.
Thereisincreasebothinthetransversediameter(width)andthe
lengthofmyocytes.
Itisduetodepositionofthesarcomeres(functionalintracellular
contractileunitofcardiacmuscles)inparalleltothelongaxisof
cells.

---

401.Fibrinoidnecorsiswithneutrophilic
infiltrationisseenin?
a)PAN
b)Giantcellarteritis
c)Takayasuarteritis
d)Wegener'sgranulomatosis
CorrectAnswer-A
Ans.is'a'i.e.,PAN
Amongthegivenoptions,PANispredominantlynecrotizing
vasculitis,characterizedbyfibrinoidnecrosis.
DuringacutephaseofPAN,thereistransmuralinflammationwith
mixedinfiltrateofneutrophils,eosinophilsandmononuclearcells
withaccompaniedfibrinoidnecrosis.
Otherthreeoptionsarepredominantlygranulomatousvasculitis.

---

402.Thromboangitisobliteransisassociated
with?
a)HLAB27
b)HLA-DR4
c)HLA-B5
d)HLA-DR2
CorrectAnswer-C
Ans.is'c'i.e.,HLA-B5
Thromboangitisobliterans(Bergerdisease)
Thrombangitisobliteransisadistinctivediseasethatischaracterized
bysegmental,thrombosingacuteandchronicinflammationof
mediumsizedandsmallsizedarteries,andsometimessecondarily
extendingtoveinsandnerves.
Thromboangitisobliteransoccursalmostexclusivelyamongheavy-
cigarrete-smokingpersons.
Itismorecommoninmenbutincidenceisincreasinginwomen
becauseofincreasingsmokinghabitinwomen.oBuergerdiseaseis
associatedwithHLAB-5andHLA-A9.
Inthrombongitisobliteransthereisacuteandchronicsegmental
inflammationofvesselswithaccompaniedthrombosisinthelumen.
Typically,thethrombuscontainsmicroabscesseswithacentral
focusofneutrophilssurroundedbygranulomatousinflammation.
Later,theinflammatoryprocessextendsintocontiguousveinsand
nervesandintimeallthreestructures(arteries,veinsandnerves)
becomeencasedinfibroustissue,acharactersticthatisveryrare
withotherformofvasculitis.
Clinicalmanifestations
Thrombangitisobliteransaffectsvesselsofupperandlower

---

extremities.
Symptomsareduetovascularinsufficiency,i.e.Ischemiaoftoes,
feetandfingersthatcanleadtoulcerandfrankgangrene.
Duetoneuralinvolvement,theremaybeseverepain,evenatrest.

---

403.Trueregardingfibromusculardysplasia
areallexcept-
a)Mediumsizevessels
b)OCPspredispose
c)Aneurysmmayoccur
d)Irregularhyperplasia
CorrectAnswer-B
Ans.is'b'i.e.,OCPspredispose
Fibromusculardysplasia
Itisfocalirregularthickeningofthewallsofmediumandlarge
musculararteries,includingrenal,carotid,splanchnic,andvertebral
vessels.
Segmentsofvesselwallarefocallythickenedbyacombinationof
irregularmedialandintimalhyperplasiaandfibrosis,causingluminal
stenosis.Inrenalvessels,itmaycauserenovascularhypertension.
Aneurysmmaydevelopinthevesselsegmentwithattenuated
media,andcanruptureinsomecases.
Thereisnoassociationwithuseoforalcontraceptivesorsex
hormoneabnormalities.

---

404.Sequenceofeventsinacute
inflammation?
a)VasodilatationStasisTransientvasoconstriction
Increasedpermeability
b)TransientvasoconstrictionStasisVasodilatation
Increasedpermeability
c)TransientvasoconstrictionVasodilatationStasis
Increasedpermeability
d)TransientvasoconstrictionVasodilatationIncreased
permeabilityStasis
CorrectAnswer-D
Ans.is'd'i.e.,TransientvasoconstrictionVasodilatation
IncreasedpermeabilityStasis
1)Changesinvascularcaliber(vasodilatation)
Vasodilatationisoneoftheearliestmanifestationsofacute
inflammation.
Sometimes,itfollowsatransientconstrictionofarterioles,
(vasoconstrictions)lastingforafewseconds-
>Thoughvasodilatationistheearliestmanifestationofacute
inflammation,itfollowsatransientperiodofvasoconstriction.
2)Changeinvascularpermeability
Vasodilatationisquicklyfollowedbyincreasedvascular
permeability.
Increasedvascularpermeabilyisthehallmarkofacuteinflammation.
Thisleadstoescapeofproteinrichfluid(exudate)andleukocytes
intoextravascularspace
3)Changeinvascularflow(Stasis)
Thelossoffluidresultsinconcentrationofredcellsandincreased

---

viscosityofblood-Slowerbloodflow-Stasis.

---

405.Increasedpermeabilityinacute
inflammationisdueto-
a)Histamine
b)IL-2
c)TGF-P
d)FGF
CorrectAnswer-A
Ans.is'a'i.e.,Histamine
*Formationofendothelialgapsinvenules,i.e.immediatetransient
responseisthemostcommonmechanismcausingincreased
vascularpermeabilityinacuteinflammation.
*Mediatorsinvolvedinthismechanismare:-
i)Immediate(moreimportant):Histamine,bradykinin,leukotrienes,
neuropeptidesubstanceP.Somewhatdelayed:IL-1,TNF,IFN-y

---

406.Duringangiogenesisrecruitmentof
pericytesandperiendothelialcellsisdue
to
a)VEGF&PDGF
b)Angiopoietins,TGF&PDGF
c)TGF,VEFG&PDGF
d)VEGF,IL-6
CorrectAnswer-B
Ans.is'b'i.e.,Angiopoietins,TGF&PDGF
Angiogenesis
Bloodvesselsformationinadultsisknownasangiogenesisor
neovascularization.Itcanoccurbytwoways:?
1.Angiogenesisfrompre-existingbloodvessels
Themajorstepsinthisprocessare:?
VasodilatationbyNO,andVEGF-inducedincreasedpermeabilityof
thepre-existingvessel.
Preoteolyticdegradationofbasementmembraneby
metalloproteinases(MMPs)anddisruptionofcellto-cellcontact
betweenendothelialcellsbyplasminogenactivator.
Migrationofendothelialcellstowardsangiogenicstimulus.
Proliferationofendothelialcells,justbehindtheleadingfrontof
migratingcells.
Maturationofendothelialcells.
Recruitmentofperiendothelialcells(pericytesandvascularsmooth
musclecells)toformthematurecells.
2.Angiogenesisfromendothelialprecursorcells(EPCs)
EPCscanberecruitedfromthebonemarrowintotissuestoinitiate

---

angiogenesis.
Growthfactorsinvolvedintheprocessofangiogenesis
VEGFisthemostimportantgrowthfactorinadulttissues
undergoingangiogenesis.
ThemostimportantreceptorforVEGFisVEGFR-2,atyrosine
kinasereceptor.
VEGFinducesthemigrationofEPCsinthebonemarrow,and
enhancestheproliferationanddifferentiationofthesecellsatsitesof
angiogenesis.
FGF2canalsostimulateendothelialcellproliferation,differentiation
andmigration.
Newlyformedvesselsarefragileandneedtobecomestabilized,
whichrequirestherecruitmentofpericytesandsmoothmusclecells
(periendothelialcells).Angiopoietin1and2(Ang1&2),PDGFand
TGF-/3participateinstabilizationprocess.
Remember
VEGFtranscriptionisregulatedbythetranscriptionfactorHIF,which
isinducedbyhypoxia.

---

407.Increasedpermeabilityinacute
inflammationisdueto?
a)Histamine
b)IL-2
c)TGF-(3
d)FGF
CorrectAnswer-A
Ans.is'a'i.e.,Histamine
Formationofendothelialgapsinvenules,i.e.immediatetransient
responseisthemostcommonmechanismcausingincreased
vascularpermeabilityinacuteinflammation.
Mediatorsinvolvedinthismechanismare:-
Immediate(moreimportant):Histamine,bradykinin,leukotrienes,
neuropeptidesubstanceP.
Somewhatdelayed:IL-1,TNF,IFN-y

---

408.Macrophagesareconvertedtoepitheloid
cellsbywhichcytokine?
a)IL-2
b)IFN-y
c)TNF-a
d)TGF-(3
CorrectAnswer-B
Ans.is'b'i.e.,IFN-y
Agranulomaisafocusofchronicinflammationconsistingofa
microscopicaggregationofmacrophagesthataretransformedinto
epitheliumlikecells(epithelioidcells)surroundedbyaCollorof
mononuclearleukocytes,principallylymphocytesandoccasionally
plasmacells.
Frequently,theseepitheloidcellsfusetoformgiantcellsinthe
peripheryorsometimesinthecenterofgranuloma.
Pathogenesisofgranuloma
Immunegranuloma(mostcommontypeofgranuloma)isatypeIV
hypersensitivitythatinvolvedCD-4helperTcell.
On-exposuretoparticulateantigenmacrophagesprocessand
presentthisantigentoHelperTcellsandalsosecretesIL-2.
T-cellsareactivatedoncontactwiththisantigenandbyIL-2.
ActivatedT-cells(helper)produceIFN-y,themajorcytokineof
granulomatousinflammation.
IFN-yhasthefollowingeffects
Itisthemostimportantactivatorofmacrophages.
Itinducegranulomaformationbyconversionofactivated
macrophagesintoepitheliodcellsandformationofgiantcell.
AugmentthedifferentiationofT-cells.

---

FinallythereisformationofgranulomainducedbyIFN-y.
Remember
Foreignbody(Nonimmune)granulomaconsistalmostentirelyof
epitheloidcellsandmultinucleatedgiantcellsbutnolymphocytes.
Granulomasinducedbyparasitescontainalargecomponentof
eosinophils.
InlymphogranulomavenerumandCatscratchdiseasegranulomas
haveacharacteristiccentralneutrophilicabscesssurroundedby
macrophagesandothermononuclearcells.

---

409.Resolutionofinflammationcausedby?
a)TNFAlfa,IL-1andCRP
b)TNFbeta,IL-6andCRP
c)TNFAlfa,IL10andIL1receptorantagonist
d)TNFgamma
CorrectAnswer-C
Ans.is'c'i.e.,TNFAlfa,IL-10andIL1receptorantagonist
Actuallynooptionisabsolutelycorrect:
IL-10isananti-inflammatorycytokineCauseresolutionof
inflammation
IL-1isapro-inflammatorycytokineIL-1receptorantagonismwill
causeresolutionofinflammation
TNF-aisanpro-inflammatorycytokinecausesinflammation
So,inoptionC,twomediatorsarecorrectandoneisincorrect
regardingresolutionofinflammation.However,amongthegiven
optionsonlyoptionCistheclosestone.
Proinflammatorycytokines
Major:-IL-1,TNF-alpha,IL-6
Other:-IL-2,IL-4,IL-5,IL-6,IL-8,IL-11,IL-12,IL-15,IL-21,IL-23,
ITN-gamma,GM-CSF
Anti-inflammatorycytokines
IL-4,IL-10,IL-13
Here,youcanconsiderIL-4aspro-inflammatorycytokine(asmore
thanoneoptionscanbecorrectinPGIchandigarh).

---

410.Cytokinecausingfever-
a)IL-6
b)IFN-y
c)IL-18
d)IL-4
CorrectAnswer-A
Ans.is'a'i.e.,IL-6
Pvrogenes
Pyrogenesaresubstancesthatcausefever.
Pyrogensmaybeexogenousorendogenous
ExogenousBacterialtoxins
EndogenousIL-1,TNF-a,IL-6,Interferons,Ciliory'sneurotropic
factor
ThesepyrogenesincreasethelevelofPGE2inthehypothalamus
thatelevatesthethermoregulatorysetpointandcausesfever.

---

411.Falseaboutwoundhealing?
a)Inhibitedbyinfection
b)InhibitedbyDM
c)Inhibitedbyhematoma
d)Inhibitedbyforeignbody
CorrectAnswer-C
Ans.is'c'i.e.,Inhibitedbyhematoma
Factorscausingimpairmentofwoundhealing
A.Systemicfactors
Poornutrition(proteindeficiency,vitaminCdeficiency).
Metabolicabnormalities(Diabetesmellitus).
Poorcirculatorystatus(Inadequatebloodsupply).
Hormones,e.g.glucocorticoids.
B.Localfactors
Infectionisthesinglemostimportantfactor.
Mechanicalfactors,e.g.earlymobilization.
Foreignbodies(unnecessarysutures,fragmentsofsteelorglass).
Woundinpoorlyvacularizedarea,e.g.foot.

---

412.Bandtestisdonein?
a)RA
b)SLE
c)Scleroderma
d)PAN
CorrectAnswer-B
Ans.is'b'i.e.,SLE
Bandtest(Lupusbandtest)
Lupusbandtestisdoneuponskinbiopsy,withdirect
immunofluorescencestaining,inwhich,ifpositive,IgGand
complementdepositionsarefoundatthedermoepidermaljunction.
Thistestcanbehelpfulindistinguishingsystemiclupus
erythematosus(SLE)fromcutaneouslupus,becauseinSLEthe
lupusbandtestwillbepositiveinbothinvolvedanduninvolvedskin,
whereaswithcutaneouslupusonlytheinvolvedskinwillbepositive.
Theminimumcriteriaforpositivityare:
Insun-exposedskin:PresenceofabandofdepositsofIgMalong
theepidermalbasementmembranein50%ofthebiopsy,
intermediate(2+)intensityormore.
Insunprotectedskin:Presenceofinterrupted(i.e.lessthan50%)
depositsofIgMalongtheepidermalbasementmembrane,
intermediate(2+)intensityormore.
Thepresenceofotherimmunoglobulins(especiallyIgA)and/or
complementproteins(especiallyC4)increasesthespecificityofa
positivetest.

---

413.Theprofessionalantigenpresenting
cells?
a)Bcells
b)Dendriticcells
c)Tcells
d)NKcells
CorrectAnswer-B
Ans.is'b'i.e.,Dendriticcells
Dendriticcellsarethemostpotentandeffectiveantigenpresenting
cellsinthebody-Harrison2024MatureB-cellsandT-cellsbefore
antigenicexposurearecallednaive-BandTcellsrespectively.
SequenceofeventsinactivationofnaiveTcells.
Immaturedendriticcellsintheepidermisarecalledlangerhanscell.
Theseimmaturedendriticcells(langerhanscells)capturethe
antigenintheepidermis.
Aftercapturingtheantigenthesecellssecretecytokines.
Thesecytokinescauselossofadhesivenessoflangerhanscells.
Langerhanscellsseparatefromeachotherandmigrateinto
lymphaticvessels.
Inlymphaticvessel,maturationoflangerhanscellstakesplace.
ThenthesematurelangerhansdendriticcellsreachtonaiveTcells
inthelymphnodesandpresentantigentothesecellsandactivate
them.

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414.Whichcytokineactivatemacrophages?
a)IL-8
b)IFN-y
c)PAF
d)LeukotrieneB4
CorrectAnswer-B
Ans.is'b'i.e.,IFN-'y
Activatedmacrophages
Recentstudiesshowthattherearetwotypesofactivated
macrophages:?
1.Classicallyactivatedmacrophages(M1)
TheseareactivatedbymicrobialproductsandcytokineslikeIFN-y.
Thesecellsreleaselysosomalenzymes,NO,IL-1,andIL-12.
Thesecellsareinvolvedinmicrobicidalactivitiesandpathogenic
inflammation.
2.Alternativelyactivatedmacrophages(M2).
Thesecellsareactivatedbymicrobialproductsandcytokineslike
IL-4,IL-5.
ThesecellsreleaseIL-10,TGF-I3.
Thesecellsareinvolvedinanti-inflamatoryactionsandwound
repair.

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415.Allaretrueregardingtransforming
growthfactor?pexcept-
a)Proliferationforfibroblast
b)Proliferationofendothelialcells
c)Chemotaxisoffibroblasts
d)Activationofmacrophages
CorrectAnswer-D
Ans.is`d'i.e.,Activationofmacrophages
Alsoseeaboveexplanation.
Growthfactorsandcytokinesinvolvedinregenerationandwound
healing
GrowthfactorEpidermalgrowtha
Transforminggrowthfactora
Heparin-bindingEGF
Hepatocytegrowthfactor/scatterfactor
Vascularendothelialcellgrowthfactor(isoformsA,B,C,D)
Platelet-derivedgrowthfactor(isoformsA,B,C,D)
Fibroblastgrowthfactor1(acidic),2(basic),andfamily
Transforminggrowthfactor13(isoforms1,2,3);othermembersof
thefamilyareBMPsandactivin
Functions
Mitogenickeratinocytesandfibroblasts;stimulateskeratinocyte
migrationandgranulationtissueformation
SimilartoEGF;stimulatesreplicationofhepatocytesandmost
epithelialcells
Keratinocytereplication
Enhancesproliferationofhepatocytes,epithelialcells,and
endothelialcells;increasescellmotility,keratinocytereplication
Increasesvascularpermeability;mitogenicforendothelialcells;

---

Increasesvascularpermeability;mitogenicforendothelialcells;
angiogenesis
ChemotacticforPMNs,macrophages,fibroblasts,andsmooth
musclecells;activatesPMNs,macrophagesandfibroblasts;
mitogenicforfibroblasts,endothelialcells,andsmoothmusclecells;
stimulatesproductionofMMPs,fibronectin,andHA;stimulates
angiogenesisandwoundcontraction
Chemotacticforfibroblasts;mitogenicforfibroblastsand
keratinocytes;stimulateskeratinocytemigration,angiogenesis,
woundcontractionandmatrixdeposition
ChemotacticforPMNs,macrophages,lymphocytesfibroblastsand
smoothmusclecells;stimulatesTIMPsynthesis,angiogenesisand
fibroplasia;inhibitsproductionofMMPsandkeratinocyte
proliferation
KeratinocytegrowthKa
FibroblastsStimulateskeratinocyte
migration,proliferation
factor(also
called
anddifferentiation
FGF-7)
TumornecrosisfactorTNFMacrophagesmast
cells,Activatesmacrophages;regulatesother
Tlymphocytescytokines,multiplefunctions

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416.HLAislocatedon?
a)Shortarmofchr-6
b)Longarmofchr-6
c)Shortarmofchr-3
d)Longarmofchr-3
CorrectAnswer-A
Ans.is'a'i.e.,Shortarmofchr-6
HLAcomplex(MHC)geneislocatedontheshortarmof
chromosome6.
Thehistocompatibilityantigens(humanleukocyteantigens-HLA)
arecellsurfaceantigensthatinduceanimmuneresponseleadingto
rejectionofallografts.
Theprincipalphysiologicfunctionofthecellsurface
histocompatibilitymoleculesistobindpeptidefragmentsofforeign
proteinsforpresentationtoantigenspecificTcells.
Thehistocompatibilityantigensareencodedbyacloselylinked
multiallelicclusterofgenesMajorhistocompatibilitycomplex
(MHC)orHumanleukocyteantigenscomplex(HLAcomplex).
HLAcomplexofgenesislocatedontheshortarmofchromosome6.

---

417.Druginducedlupusantibodiesarefound
in?
a)Anti-Rho
b)Ds-DNA
c)Anti-Sm
d)Anti-histoneantibody
CorrectAnswer-D
Ans.is'd'i.e.,AntiHistoneantibody
Druginducedlupuserythematosus
Alupuslikesyndromemaydevelopinpatientsreceivingavarietyof
drugs.
Procainamideandhydralazinearemostcommonoffenders.
Mostpatientsdonothavesymptomsoflupuserythematosus.
AntidsDNAantibodyisrare
Thereisanextremelyhighfrequencyofantihistoneantibodies.
AlthoughmultipleorgansmaybeaffectedrenalandCNS
involvement,usuallydoesnotoccur.

---

418.WhichantibodiesinmotherwithSLEis
responsibleforcongenitalheartdisease
inchild?
a)Anti-histone
b)Anti-Ro&Anti-LA
c)AntidsDNA
d)Anti-centromere
CorrectAnswer-B
Ans.is'b'i.e.,Anti-Ro&Anti-LA
MostsensitiveAntinuclearantibody(ANA)
MostspecificAntidoublestrandedanitbodyandthe
antibodyagainstsmith(Sm)
AssocitedwithneonatalAntiRo,AntiLAantibody
lupusandcongenital
heartblock
AssociatedwithlupusAntiPantibody
psychosis

---

419.Xerostomiaisseeninallexcept?
a)Sjogrensyndrome
b)RA
c)Sarcoidosis
d)Midlinegranuloma
CorrectAnswer-D
Ans.is'd'i.e.,Midlinegranuloma
Sjogrensyndrome
Sjogrensyndromeisachronicdiseasecharacterizedbydryeyes
(keratoconjuctivitissicca)anddrymouth(xerostomia)resultingfrom
immunologicalmediateddestructionofthelacrimalandsalivary
glands.oItoccursintwoforms?
Primaryform(SICCASYNDROME)Occursasanisolated
disorder.
SecondryformWhenitoccursinassociationwithotherautoimmune
disorder.Itismorecommon.
oAutoimmunediseasesassociatedwithsjogrensyndrome
Rheumatoidarthritis
Primarybiliarycirrhosis
Thyroiditis
SLE
Mixedconnectivetissuedisease
Sarcoidosis
Polymyositis
Vasculitis
Scleroderma
ChronicactivehepatitisAmongstthese,Sjogrensyndromeis
associatedmostcommonlywithRA.

---

---

420.MajorfibrilproteininPrimary
Amyloidosisis-
a)AL
b)AA
c)Transthyretin
d)Procalcitonin
CorrectAnswer-A
Ans.is'a'i.e.,AL
Classificationofamyloidosis
oTheamyloidcanbeclassifiedintofollowingtwobroadgroups?
1.Systemic(generalised)amyloidosis
Whenamyloidosisaffectsmorethanonebodyorganor
system.
Onclinicalgrounds,thesystemic(generalised)amyloidosisis
subclassifiedinto?
A.Primary
Primaryamyloidosisoccurswhenaspecializedcellinthebone
marrow(plasmacell)spontaneouslyproduceaparticularportion,
(i.e.lightchain)ofantibodyAL(amyloidlightchain).
Itisthemostcommontypeofamyloidosis.
B.Secondary(Reactive)
Whenamyloidosisoccursasaresultofunderlyingchronic
inflammatoryprocess,i.e.AAtype.
Othersystemicamyloidosesdonotfallineitherofthesecategories.

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421.Whichoneofthefollowingstainsis
specificforAmyloid?
a)PeriodicAcidschif(PAS)
b)Alzerianred
c)Congored
d)Von-Kossa
CorrectAnswer-C
Ans.is'c'i.e.,CongoRed
"Todifferentiateamyloidfromotherhyalinedeposits(eg.Collagen
andfibrin),avarietyofhistochemicaltechniquesareused,ofwhich
themostwidelyusedisCongoRed"-Robbins7'/ep.259
StainingforAmyloid
Congored:Itisthemostwidelyusedspecificstainforamyloid.
Iodinestaining:Itisusedforunfixedspecimenorhistological
section.Amyloidstainsmahoganybrownandifsulfuricacidis
added,itturnsviolet.
Thioflavin'T'and`S'givesecondaryimmunoflurescencewith
ultravioletlight.ThioflavinTismoreusefulfordemonstrating
juxtalomerularapparatusofthekidney.
Metachromaticstainslikecrystalvioletandmethylvioletgiverose
pinkappearance.
AmyloidisPASpositive.

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422.GenesilencingRNA?
a)rRNA
b)tRNA
c)miRNA
d)None
CorrectAnswer-C
Ans.is'c'i.e.,miRNA
Accordingtorecentsudiesaverylargenumberofgenesdonot
encodeproteins.Instead,theirproductsplayimportantregulatory
functions.
Themostrecentlydiscoveredamongthisclassofgenesarethat
encodeforgene-silencingRNAs,i.e.RNAsthatdonotencode
proteinsbutinsteadinhibitgeneexpression(unlikeclassicalRNAs
whichencodeforproteins)
Twogene-silencingRNAsare:
1. MicroRNAs(miRNAs)
2. SmallinterferingRNAs(siRNAs)
1.MicroRNA(miRNAs)
Becauseoftheirprofoundinfluenceongeneregulation,miRNAsare
assumingcentralimportanceinunderstandingnormal
developmentalpathways,aswellaspathologicconditions,suchas
cancer.oBycurrentestimatesthereareapproximately1000genes
inhumonsthatencodesmiRNAs.
TranscriptionofmiRNAgeneproducesprimarymiRNAtranscripts,
whichisprocessedwithinthenucleustoformanotherstructure,
calledpre-miRNA.
Pre-miRNAistransportedtocytoplasmbyatransportor(Export)
protein.

---

Dicer(anenzyme)doestheadditionalcuttingofthispre-miRNAthat
areabout21-30nucleotideinlength(hencecalled"micro").
AtthisstagemRNAisstilldoublestranded.
Next,themiRNAunwinds,andsinglestrandsofthisduplexare
incorporatedintoamultiproteincomplexcalledRNA-induced
silencingcomplex(RISC).
Base-pairingbetweenthemiRNAstrandandittargetmRNA
(messengerRNA)directsRISCtoeithercausemRNAcleavageor
repressitstranslation.
Inthisway,thegenefromwhichthetargetwasderivedissilenced
(atapost-transcriptionlevel).
AsinglemiRNAcansilencemanytargetgenes.
2.SmallinterferingRNAs(siRNAs)
siRNAsworkinsimilarmannerasmiRNA
UnlikemiRNA,siRNAprecursorsareintroducedbyinvestigatorsinto
cells.
siRNAarebecomingpowerfultoolsforstudyinggenefunctionand
mayinthefuturebeusedtherapeuticallytosilencespecificgenes,
suchasoncogenes,whoseproductsareinvolvedinneoplastic
transformation.

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423.Chanceofhavingcysticfibrosisifonly
oneparentisaffectedandotheris
normal-
a)25%
b)50%
c)70%
d)80%
CorrectAnswer-B
Ans.is'b'i.e.,50%
Cysticfibrosisisanautosomalrecessivedisorder.Thus,inthegiven
scenorio(question)therearetwopossibilities:-1)Oneparent
affectedandtheotherisgenotypicallynormal.Inthiscondition,no
childwillbeaffectedandallwillbecarrier.
2)Oneparentaffectedandtheotherisgenotypicallycarrier(normal
phenotypically).Inthiscondition,50%ofchildwillbeaffected

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424.Angelmansyndromeisdueto-
a)Digenicinheritence
b)Inversion
c)Uniparentaldisomy
d)Mitochondrialdisorder
CorrectAnswer-C
Ans.is'c'i.e.,Uniparentaldisomy
PraderWillisyndrome
Anglemansyndrome
Paternaldeletion(Paternal
Maternaldeletion(maternal
genomicimprinting)
genomicimprinting)
Maternaluniparentaldisomy
Paternaluniparentaldisomy

---

425.Normalfemale,whosefatherwascolor
blindmarriedanormalman.Whatarethe
chancesofcolorblindnessinson-
a)25%
b)50%
c)75%
d)Nochance
CorrectAnswer-B
Ans.is'b'i.e.,50%
*Fatherofthefemalewascolorblind;thatmeansshehasreceived
mutatedX-chromosomefromherfatherandsheiscarrierforcolour
blindness.
Ifthisfemalegivesbirthtoamalechildthereis50%chancethathe
willgetthediseasebecausethecarrierfemaleiscarryingone
normalX-chromosomeandonemutatedX-chromosome.
Note?
*HereIwouldliketomentiononeimportantfactthatthisquestion
hasbeenaskedspecificallyforthechancesofdiseaseinason.The
questioncanbeframedinfollowingdifferentways.
i)Howmanychildrenwillhavethedisease.
ii)Whatarethechancesofsongettingthedisease.
iii)Whatarethechancesofdaughtergettingthedisease.
iv)Howmanysonwillhavethedisease.
*Thus:?
i)25%ofchildrenwillhavedisease.
ii)50%ofson(1outof2)willhavedisease.
iii)Nodaughterwillhavedisease.

---

iv)Chancesthatsonwillhavediseaseis50%(1outof2male
childcangetthedisease).

---

426.AllaretrueaboutFragileXsyndrome
except?
a)Largehead
b)Largenose
c)Largeear
d)Largetestis
CorrectAnswer-B
Ans.is'b'i.e.,Largenose
Fragile-Xsyndrome
Fragile-Xsyndromeistheprototypeofdiseasesinwhichthe
mutationischaracterizedbyalongrepeatingsequenceofthree
nucleotides.
InfragileXsyndrome,trinucleotidcrepeatmutationinvolveCGGon
noncodingregion.
Clinicalfeaturesoffragile-Xsyndrome
MentalretardationqLongfacewithlargemandibleq
HyperexntesiblejointqMitralvalveprolapse
LargeevertedearsqLargetestis(macro-orchidism)
Higharchedpalate
FragileXsyndromeisthesecondmostcommoncauseofmental
retardation,afterDownssyndrome.

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427.Chromosome22deletionsyndromeis?
a)Downsyndrome
b)DiGeorgesyndrome
c)Turnersyndrome
d)Klinefeltersyndrome
CorrectAnswer-B
Ans.is'b'i.e.,DiGeorgesyndrome
Chromosome22q11.2deletionsyndrome
Thissyndromeencompassesaspectrumofdisordersthatresult
fromasmalldeletionofbandq11.2onlongarmofchromosome22.
Clinicalfeaturesareconsideredtorepresenttwodifferentdisorders
:?
1DiGeorgesyndrome
ThesepatientshavethymichypoplasiawithresultantT-cell
immunodeficiency.
Otherfeaturesincludeparathyroidhypoplasia(causing
hypocalcemia),cardiacmalformations&facialanomalies.
TBX-1gene(aT-boxtranscriptionfactor)ismostcloselyassociated
withthissyndrome.ThetargetofTBX-1includePAX9,agenethat
controlsthedevelopmentofthepalate,parathyroidandthymus.
2Velocardiofacialsndrome
Thissyndromeischaracterizedbyfacialdysmorphism(prominant
nose,retrognathia),cleftpalate,cardiovascularanomalies,and
learningdisabilities.

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428.Hamartomais-
a)Malignanttumor
b)Metastatictissue
c)Developmentmalformation
d)Hemorrhageinvessel
CorrectAnswer-C
Ans.is'c'i.e.,Developmentmalformation
Hamartoma
Ahamartomaisabenign(noncancerous)tumor-likegrowth
consistingofadisorganizedmixtureofcellsandtissues
normallyfoundintheareaofbodywherethegrowthoccurs.
*Forexample,hamartomaoflungcontainscartilage,bloodvessels,
bronchialtypeofstructuresandlymphoid
tissues.
*Itisafocaldevelopmentmalformationthatresemblesaneoplasm
inthetissueoforigin.
*But,itisnotaneoplasmbecauseitgrowsatthesamerateasthe
surroundingtissuesunlikeneoplasmwhose
growthexceedsthegrowthofsurroundingtissue.
Choristoma
*Choristomaistheectopicrestofnormaltissue,i.e.,thenormal
tissueispresentatadifferentanatomicalsiteofthe
body.
*Forexample,presenceofpancreatictissueinmucosaofsmall
intestine.
*Normallyarrangedtissueatadifferentanatomicalsite(ectopic
site)-->Choristoma.
*Abnormallyarrangedtissuepresentatnormal

---

site-Hamartoma

---

429.Allaregrowthpromotingoncogenes
except?
a)FGF
b)TGF-a
c)TGF-p
d)PDGF
CorrectAnswer-C
Ans.is'c'i.e.TGF-p
Growthfactorgenes:SIS,HST-1,INT-2,TGFa,FGF.

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430.Tumorsuppressorgeneisnotinvolved
in?
a)Breastcancers
b)Neurofibromatosis
c)Multipleendocrineneoplasia
d)Retinoblastoma
CorrectAnswer-C
oMultipleendocrineneoplasiainvolvesRETprotooncogene(not
tumorsuppressorgene).

---

431.Allareobstructivelungdiseaseexcept-
a)Emphysema
b)Interstitialfibrosis
c)Asthma
d)Bronchitis
CorrectAnswer-B
Ans.is'b'i.e.,Interstitialfibrosis
Diffusepulmonarydiseasesaredividedintotwocategories-
Obstructivedisease(airwaydisease)
Obstructivediseaseischaracterizedbyanincreaseinresistanceto
airflowowingtopartialorcompleteobstructionatanylevel,fromthe
tracheatotherespiratorybronchioles.
Examplesarechronicobstructivelungdisease(COPD-
Emphysema,bronchitis),bronchiectasis,andasthma.
Restrictivedisease
Restrictivediseaseischaracterizedbyreducedexpansionoflung
parenchyma,withdecreasedtotallungcapacity.oItmayoccurdue
totwotypesofdisorders-
ChestwalldisordersinthepresenceofNormallungs
Neuromusculardisorders,e.g.polio,severeobesity,pleuraldisease,
kyphoscoliosis.
InterstitialandinfiltrativediseasesoflungPneumoconiosis,
interstitialfibrosis.

---

432.Curshmann'scrystalsareseenin?
a)Bronchialasthma
b)Bronchiectasis
c)Chronicbronchitis
d)Wegnersgranulomatosis
CorrectAnswer-A
Ans.is'a'i.e.,Bronchialasthma
PathologyofAsthma
Gross?
*Lungsareoverdistendedbecauseofoverinflationandtheremay
besmallareaofatelactasis.
*Themoststrikingmacroscopicfindingisocclusionofbronchiand
bronchiolesbythicktenaciousmucusplugs.
Histology?
*Characterizedbypresenceofnumerouseosinophilsand
neutrophils.
Curschntanspiral-Whorlsofshedepitheliuminmucusplugs.
Charcot-leydencrystals-Collectionofcrystalloidsmadeupof
eosinophilicmembraneprotein.
TheothercharacteristichistologicalfindingofAsthmaiscollectively
calledAirwayremodelling,itincludes?
*Thickeningofthebasementmembraneofthebronchial
epithelium.
*Edemaandaninflammatoryinfiltrateinthebronchialwallswitha
prominenceofeosinophilsandmastcells.
*Anincreaseinthesizeofsubmucosalglands.
*Hypertrophyofbronchialwallmuscle.
The"airwayremodelling"contributestoairflowobstruction.

---

---

433.Terminalstageofpneumoniais
a)Congestion
b)Redhepatization
c)Grayhepatization
d)Resolution
CorrectAnswer-D
Ans.is'd'i.e.,Resolution
Intheusualcourseofpneumonia,finalstageisresolution.
However,insomeneglectedcasesfollowingcomplicationsmay
develop-
AbscessformationPleuraleffusion,pleuritis
EmpyemaBecteremicdisseminationBrainabscess,
endocarditis,meningitis,
Organizationsupurrativearthritis.
Pathologicalchangesofbacterialpneumonia
A.Lobarpneumonia
Largeconfluentareaofthelungorentirelobesareconsolidated.
Thelowerlobesareaffectedmostcommonly.
Therearefourstagesoftheinflammatoryresponse(Laennec's
stages)?
1.Stageofcongestion(initialphase)
Theaffectedlobeisenlarged,heavy,darkredandcongested.
Cutsurfaceexudesblood-stainedfrothyfluid.
Thereisdilatationandcongestionofalveolarcapillaries.
Therearefewneutrophilsandnumerousbacteriainthealveolar
fluid.
2.Stageofredhepatization(earlyconsolidation)
Thetermhepatizationreferstoliver-likeconsistencyoftheaffected

---

lobeoncutsection.
Theaffectedlobeisredandfirm.
Theedemafluidofprecedingstageisreplacedbystrandsoffibrin.
Thereismarkedcellularexudateofneutrophilswithextravasationof
redcells.
3.Stageofgrayhepatizatioa(lateconsolidation)
Theaffectedlobeisgrayishbrown,firmanddry.
Thefibrinstrandaredenseandmorenumerous.
Thereisprogressivedisintigrationofredcellsandneutrophils.
Themacrophagesbegintoappearintheexudate.
Theorganismsarelessnumerousandappearasdegenerated
forms.
4.Resolution
Thepreviouslysolidandfibrinousconstituentisliquefiedby
enzymaticaction.
Granularandfragmentedstrandsoffibrininthealveolarspacesare
seenduetoprogressiveenzymaticdigestion.
Thereisprogressiveremovaloffluidcontentaswellascellular
exudatefromtheairspaces,resultinginrestorationofnormallung
parenchymawithareation.
B.Bronchopneumonia
Patchyareasofredorgreyconsolidation,moreoftenmultilobarand
frequentlybilateralandbasal(lowerzones)becauseoftendencyof
secretionstogravitateintolowerlobes..
Thereissuppurativeexudate,consistingchieflyneutrophils,filling
bronchi,bronchiolesandadjacentalveolarspaces.
Alveolarseptathickenduetocongestedcapillariesandleucocytic
infiltration.

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434.Primarypleuraltumoris
a)Mesothelioma
b)Myxoma
c)Lipoma
d)All
CorrectAnswer-A
Ans.is'a'i.e.,Mesothelioma
Pleuraltumors
*Thepleuramaybeinvolvedbyprimaryorsecondarytumors.
Primarytumors
*Benign-->Solitaryfibroustumor(benignfibrous
mesotheliomaorbenignmesotheliomaorpleuralfibroma).
*Malignant-->Malignantmesothelioma.
Secondarytumors
*Morecommonthanprimarytumors.
*Mostcommonprimarysitesarelungandbreast.

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435.Renalcellcarcinomaisrelatedtogene
locatedonchromosome-
a)3
b)X
c)22
d)20
CorrectAnswer-A
Ans.is'a'i.e.,3
oClearcellcarcinomaisthemostcommonrenalcellcarcinoma
andisassociatedwith3pdeletion.

---

436.Thepathogenesisofacuteproliferative
glomerulonephritis-
a)CytotoxicT-cellmediated
b)Immunecomplexmediated
c)Antibodymediated
d)Cell-mediated(TyperIV)
CorrectAnswer-B
Ans.is'b'i.e.,Immunecomplexmediated
*Postinfectiousacuteproliferativeglomerulonephritisisdueto
immune-complexmediated(TypeIII)hypersensitivity.

---

437.AccordingtoWHO,membranous
glomerulonephritisseeninSLE,is-
a)ClassII
b)ClassIII
c)ClassIV
d)ClassV
CorrectAnswer-D
Ans.is'd'i.e.,ClassV
ThereareseveralversionsofWHOclassificationoflupusnephritis?
1)Minimalornodetectableabnormalities(class1)
2)Mesangiallupusglomerulonephritis(classII)
3)Focalproliferativeglomerulonephritis(classIII)
4)Diffuseproliferativeglomerulonephritis(classIV)
5)Membranousglomerulonephritis(classV)

---

438.Allarefeaturesofhaemolyticuremic
syndrome,except-
a)Hyperkalemia
b)Anaemia
c)Renalmicrothrombi
d)Neuropsychiatricdisturbances
CorrectAnswer-D
Ans.is'd'i.e.,neuropsychiatricmanifestations
Hyperkalemiaisseeninhemolyticurenicsyndromeasaresultof
renalfailure.
ABOUTNEUROPSYCHIATRICMANIFESTATIONS
*Neurologicalmanifestationsareusedtodistinguishbetween
HemolyticuremicsyndromeandThromboticThrombocytopenic
Purpura.
*H.U.S.isdistinguishedfromT.T.Pbytheabsenceofneurological
symptomsandtheprominenceofacuterenalfailure.
*Recentstudies,howeverhavetendedtoblurrtheseclinical
distinctions.Manyadultpatientswith"T.T.P.lackoneormoreofthe
fivecriteriaandpatientswith"HUS"havefeverandneurological
dysfunction.

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439.Trueaboutlightmicroscopyinminimal
changediseaseis:
a)Lossoffootprocessseen
b)AntiGBMAbsseen
c)IgAdepositsseen
d)Nochangeseen
CorrectAnswer-D
AnswerisD(Nochangeseen)
Noabnormalityisevidentonlightmicroscopyinacaseofminimal
changedisease.
Investigation
LightmicroscopyQ
ElectronmicroscopyQ
ImmunofluorescenceQ
Observation
Noabnormalityhencethetermminimalchange
Fusionoffootprocesses
Absenceofimmunoglobulinorcomplement

---

440.Inglomerulussubendothelialdeposits
areseenin?
a)Goodpasturesyndrome
b)IgAnephropathy
c)MPGNtypeI
d)MPGNtypeII
CorrectAnswer-C
Ans.is'c'i.e.,MPGNtypeI
Subendothelial-MPGN(Type-1),SLE,AcuteON

---

441.NottrueaboutAlport'ssyndrome?
a)X-linked
b)Autosomaldominant
c)Nervedeafness
d)Glomerulonephritis
CorrectAnswer-B
Ans.is'b'i.e.,Autosomaldominant
Autosomaldominantformalsoexist,butitisveryrare.Thus,among
thegivenoptions,itisthebestanswer.
OtherthreeoptionsareclassicalfeaturesofAlport'ssyndrome.
Alport'ssyndrome
Alport'ssyndromeisatypeofhereditarynephritischaracterizedby-
Glomerulonephritisprogressingtochronicrenalfailure.
Nervedeafness
Eyedefectslenticonus,lensdislocation,posteriorcataract,corneal
dystrophy.
MostcommonlyitisinheritedasX-linkedform.
Rareautosomal-recessiveandautosomal-dominantpedigreesalso
exist.
Pathogenesis
ThereisdefectiveGBMsynthesisbecauseofproductionof
abnormalcollagentypeIVunderliestherenallesions.
Thedefectiscausedbymutationinthegeneencodingac-chainof
collagentypeIV.

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442.MichaelisGutmannbodiesareseenin
a)>Xanthogranulomatous
b)>pyelonephritis
c)>Malakoplakia
d)Nailpatellasyndrome
CorrectAnswer-C
Malakoplakia[Ref.Robbins7th/ep1027-1028]
Malakoplakiaisavariantofcystitis,itisrelatedtochronicbacterial
infectionmostlybyE.colioroccasionallybyproteusspecies.
Itischaracterizedbyunusualappearingmacrophagesandgiant
phagosomes.
Itpointstodefectinphagocyticordegradativefunctionof
macrophage.
Itisapeculiarpatternofvesicalinflammatoryreactioncharacterized
microscopicallybysoft,yellow,slightlyraisedmucosalplaques3-4
cmindiameter.
Histologicallyitischaracterizedbyinfiltrationwithlargefoamy
macrophageswithoccasionalmultinucleategiantcellsand
interspersedlymphocytes."
Themacrophageshaveanabundantgranularcytoplasmandthe
granularityisPASpositive.
Inadditiontothesehistologicalchanges,malakoplokiaisalso
characterizedbyMichaelisGuttmanbodies.-MichaliesGuttman
bodiesareLaminatedmineralizedconcretionsresultingfrom
depositionofcalciuminenlargedlysosomes.
-Theyaretypicallypresentbothwithinthemacrophagesand
betweencells.
-TheydemonstratepositiveresultsusingPASstainandare
diastaseresistance.

---

diastaseresistance.
-TheystainwithKossa,stainforcalciumandperlsPrussianblue
stainforiron.
-Immunchistochemicalstudiesdemonstratespositiveresultsfor
CD68antibodies.
Malakoplakiaoccurswithincreasedfrequencyin
itnmunosuppressedtransplantrecipients.

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443.Notacarcinogenforbladdercancer?
a)Benzidine
b)Isopropylalcohol
c)Acrolein
d)Phenacetin
CorrectAnswer-B
Ans.is'b'i.e.,Isopropylalcohol
Riskfactorsfortransitionalcellcarcinoma(TCC)ofbladder?
Smoking-4Majoretiologicalfactor.
OccupationalexposuretochemicalsNephthylaminebenzidine,
anilinedyes,acrolein.
Schistosomahaematobium(Bilharziasis)Itisariskfactorforboth
TCC&SCC.
Drugs-->Phenacetin
Cyclophosphamidetherapy
Pelvicirradiations

---

444.AllaretrueaboutPolycythemiavera
except
a)IncreasedvitB12
b)DecreaseLAPscore
c)Leucocytosis
d)Increasedplatelets
CorrectAnswer-B
Ans.is'b'i.e.,DecreaseLAPscore
Polycythemiavera
Polycythemiaveraisaneoplasmarisinginamultipotentmyeloid
stermcellthatischaracterizedbyincreasedmarrowproductionof
erythroid,granulocyticandmegakaryocyticelements.
Thisleadstoerythrocytosis(polycythemia),granulocytosis,and
thrombocytosisintheperipheralblood.
Polycythemiaisresponsibleformostoftheclinicalsymptomsof
polycythemiavera.
Polycythemiaveraprogenitorcellshavemarkedlydecreased
requirementsforerythropoietinandotherhematopoieticgrowth
factors.Accordinglyserumerythropoietinlevelsinpolvuthemiavera
areverylow,whereasalmostallotherformsofabsolute
polycythemiaarecausedbyelevatedervthropoietinlevels.
Clinicalmanifestations
1.Symptomsduetopolycythemia
Mostsymptomsarerelatedtotheincreasedredcellmassand
hematocrit,i.e.,Polycythemia.
Theelevationofhematocritisusuallyaccompaniedbyincreased
totalbloodvolume,andtogetherthesetwopromoteabnormalblood

---

flow,particularlyonthelowpressurevenoussideofthecirculation,
whichbecomesgreatlydistended.Thatresultsin-
Plethoraorcynosisowingtostagnationofdeoxygenatedbloodin
peripheralvessels.
Headache,diziness,hypertensionand
Dininshedvisionfromblockadeofretinalvessels.
2.Symptomsduetogranulocytosis
Basophilssecretehistaminethatresultsin-
Intesepruritis
Pepticulceration
Increasedvit13,,,bindingcapacitybecauseofincreasein
transcobalmineI&II.
3.SymptomsduetoThrombocytosis
Thereisincreasedriskofboththrombosisandmajorbleeding
episodes.
ThrombosisDVT,MI,Stroke,Buddchiarisyndrome.
BleedingUpperGIbleedingfrompepticulcer.
LaboratoryfeaturesofPolvcythemiavera.
IncreasedRedcellcount
IncreasedVitB12binding
(Polycythemia)
capacity
IncreasedWBCcount
Increasedbloodviscocity
(Leucocytosis)
Increasedplateletcount
DecreasedESR
(Thrombocytosis)
IncreasedLeucocytealkaline
Hyperuricemiaduetoincreased
phosphate(LAP)score
turnoverofcells.
Increasedhemoglobin
Increasedhistaminelevel

---

445.Mantlecelllymphomasarepositivefor
allofthefollowing,except?
a)CD23
b)CD20
c)CD5
d)CD43
CorrectAnswer-A
Ans.is'a'i.e.,CD23
Mantlecelllymphoma
Mantlecelllymphomaisatypeofnon-Hodgkinlymphoma
characterizedbythepresenceoftumorcellsthatcloselyresemble
thenormalmantlezoneofB-cellsthatsurroundgerminalcenters.
Immunophenotypeofmantlecelllymphoma
MantlecelllymphomaisaneoplasmofBcells.
ThereforeitexpressesBcellmarker:CD19,CD20
Surfaceimmunoglobulinheavychain(IgMandIgD).
EithercorXlightchain.
AsthetumorcellsarederivedfromtheMantlezone,theyare
positiveforBcellmarkerofmantlezonei.e.,CD-5.
MantlecelllymphomaisCD23negative,thisfeaturedistinguishesit
fromchroniclymphocyticleukemia(CLL)whichispositiveforboth
CD5andCD23.
TheothercharacteristicmarkerofmantlecelllymphomaiscyclinDI.
Cytogeneticabnormalities:
Mantlecelllymphomaisassociatedwithan11:14translocation
involvingtheIgHlocusonchromosome14andthecyclinD1locus
onchromosome11.
ThisleadstoincreasedexpressionofcyclinD1,whichpromotesGI
toSphaseprogressionduringthecellcycle.

---

toSphaseprogressionduringthecellcycle.
65yearsoldmanwithsplenomegaly,lymphadenopathyCD-23
negativeandCD-5positiveB-cellsuggestthediagnosisofmantle
celllymphoma.
Clinicalfeaturesofmantlecelllymphoma:
Itisusuallypresentinthefifthtoasixthdecadewithmale
preponderance.
Themostcommonpresentationispainlesslymphadenopathy.
Splenomegalymayoccur.
Occasionally,multifocalmucosalinvolvementofthesmallboweland
colonproduceslymphomatoidpolyposisofallformsofNHL,
mantlecelllymphomaismostlikelytospreadinthisfashion.

---

446.Bonemarrowfindinginmyelofibrosis?
a)Drytap(hypocellular)
b)Megaloblasticcells
c)Microcyticcells
d)Thrombocytosis18
CorrectAnswer-A
Ans.is'a'i.e.,Drytap(hypocellular)
Myelofibrosis
Thehallmarkofprimarymyelofibrosisisrapiddevelopmentof
obliterativemarrowfibrosis.
Myelofibrosissuppressesbonemarrowhematopoiesis,leadingto
peripheralbloodcytopenias.
Thisresultsinextensiveextramedullaryhematopoiesisinthe
spleen,liverandlymphnode-->Splenomegalyandhepatomegaly.
Bloodcellproductionfromsitesofextramedullaryhematopoisisis
disorderedandineffective-->Persistentcytopenia.Peripheral
bloodpicture
Leukoerythroblastosis-->Presenceoferythroidandgranulocytic
precursorsintheperipheralblood.
Tear-droperythrocytes(dacrocytes)-->Fibroticmarrowdistortsand
damagesthemembranesoferythroidproginators.
Bonemarrowfindings
Initiallymarrowishypercellular.
Withprogressionmarrowbecomeshypocellularanddiffuselyfibrotic
-->Bonemarrowaspirationisadrytap.
Thereisincreaselayingdownofreticulinfibrilnetwork.
Cellularityofbonemarrowisdecreased,butmegakaryocytesare
increasedanddemonstratefeaturesofdysmegakaryopoiesis.

---

Dilatedmarrowsinusoids.

---

447.Maltomaispositivefor?
a)CD3
b)CD10
c)CD23
d)CD5
CorrectAnswer-C
Ans.is'c'i.e.,CD23
Mantlecelllymphoma-
?Surfaceimmunoglobulinheavychain(IgM&IgD)
?CD19',CD20*
?CD5(+)ve&CD23(-)vedifferentiatingfeaturefromCLL
?CyclinD1

---

448.AMLcausingGumhypertrophy?
a)M1
b)M2
c)M3
d)M4
CorrectAnswer-D
Ans.is'd'i.e.,M4
Inacuteleukemiastheclinicalfeaturesareprimarilyseen
becauseof:
Replacementofnormalcellsofbonemarrowbyleukemiccells
resultinginanemia,thrombocytopenia,neutropenia.Infiltrationof
leukemiccellinvariousextramedullaryorganscausing,
hepalomegaly,splenomegaly.Gumhypertrophyduetoinfiltrationof
gumsbyleukemiccellsisonesuchfeature.Itischaracteristically
associatedwithAML-M5andAML-M4i.e.(acutemonocytic
leukemia).

---

449.DICiscommoninwhichAML-
a)Nonocytic(M5)
b)Promyelocytic(M3)
c)Erythrocytic(M6)
d)Megakaryocytic(M7)
CorrectAnswer-B
Ans.is'b'i.e.,Promyelocytic
Tumorcellsinacutepromyelocyticleukemia(M3)release
procoagulantandfibrinolyticfactorsthatcausedisseminated
intravascularcoagulation(DIC).

---

450.Localisedlangerhanscellshistiocytosis
affectinghead&neckis?
a)Letterer-siwedisease
b)Pulmonarylangerhanscellhistiocytosis
c)Hand-schuller-christiandisease
d)Eosinophilicgranuloma
CorrectAnswer-D
Ans.is`di.e.,Eosinophilicgranuloma
ClinicalmanifestationsofLangerhanscellhistiocvtosis
(Histocvtosis-X1
1.LettererSiwedisease(multifocal,multisystemLCH)
Mostfrequentlypresentbefore2yearsofage.
Characterizedbyinvolvementofmultiplesystem.
Mostcommonpresentationiscutaneouslesionsresembling
seborrheicdermatitis.
Othersarehepatosplenomegaly,lymphadenopathypulmonary
lesionsanddestructivebonelesions.
Extensivebonemarrowinfiltrationleadstopancytopenia.
2.Eosinophilicgranuloma(UnifocalandmultifocalunisystemLCH)
Involvementisrestrictedtoasinglesystemi.e.,skeletalsystem
whichmaybeunifocalormultifical.
Mostcommonlyeffectedbonesareskull,vertebrae,ribs,clavicle,
andfemur.
3.Hand-Schuller-Christiandisease
Characterizedbytriadofclaviralbonedefects,diabetesinsipidus,
andexophthalmos.

---

451.Whichisnotafeatureofparoxysmal
nocturnalhemoglobinuria-
a)IncreasedLAPscore
b)Thrombosis
c)Thrombocytopenia
d)Hemolysis
CorrectAnswer-A
Ans.is'a'i.e.,IncreasedLAPscore
ClinicalfeaturesofPNH
A.Intravascularhemolysis
*ThemainfeatureofPNHisincreasedintravascularhemolysisthat
resultsin-
HemoglobinemiaIncreasedurine
urobilinogen
HemoglobinuriaDecreasedserum
haptoglobin
HemosiderinuriaIncreasedserumLDH
Increasedserumbilirubin
Thehemolysisisparoxysmalandusuallyoccursinthenight
becauseduringsleepthepHofbloodgetsslightlyreducedand
acidicmediumleadstoactivationofthecomplement.
B.Thrombosis
InPNHthereisepsodicthrombosisduetoabsenceofCD-59on
platelets,thisresultsinexternilizationofphosphotidylserine,asite
forprothrombinasecomplexesandthusincreasethepropensityfor
thrombosis.
*Intrabdominalveinsarethemostcommonsitesofthrombosisthat
mayresultinBuddchiarysyndromeduetohepaticveinthrombosis.

---

C.Otherfeatures
Thrombocytopenia
Granulocytopenia
*DecreasedLAPscore
*Normoblastichyperplasiaofbonemarrow
*PNHpatientsarealsoatincreasedriskfordevelopingacute
myelogenousleukemiaandaplasticanemia.

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452.Allofthefollowing
immunohistochemicalmarkersare
positiveintheneoplaticcellsof
granulocyticsarcoma,except?
a)CD45RO
b)CD43
c)Myeloperoxidase
d)Lysozyme
CorrectAnswer-A
Ans.is'a'i.e.,CD45RO
Granulocyticsarcoms(Chloromaormyeloblastoma)
Granulocyticsarcomsorchloromaisasolidtumorcomposedof
myeloblasts.
AchloromaisanextramedullarymanifestationofAML,i.e.,itisa
solidcollectionofleukemiccellsoccuringoutsitedofthebone
marrow.
Thesetumoroftenhaveagreentintduetothepresenceof
myeloperoxidase.
Chloromasaremorecommoninmonocyticdifferentiation(M4&M5
type)AML.
ThoughchloromasoccursmostcommonlyinpatientswithAML,
theymayalsooccurinpatientwith:?
Myelodysplasticsyndrome
MyeloproliferativesyndromesMyelofibrosis,CML,Polycythemia
vera,Essentialthrombocytosisin)Withoutconcomitantdisease,i.e.,
Primarychloroma.
Chloromasarepositivefor:?

---

CD68CD20CD117Lysozyme
CD43CD34Myeloperoxidase

---

453.Pseudo-Pelger-Huetcellsorseenin
a)Hairycellleukemia
b)Multiplemyeloma
c)Mylodysplasticsyndrome
d)Hodgkin'slymphoma
CorrectAnswer-C
Ans.is'c'i.e.,Myelodysplasticsyndrome
PeripheralbloodshowsthepresenceofPseudo-Pelger-Huetcells,
giantplatelets,macrocytes,poikilocytesandmonocytosis.
Clinicalfeaturesareseeninonly50%patientsincludingweakness,
infectionandhemorrhageduetopancytopenia.
Usuallypatientsareofanoldage(meanageofonsetis>60years).
Theprognosisispoor.

---

454.Whichofthefollowingisnota
myeloproliferativedisease?
a)Polycythemiavers
b)Acutemyeloidleukemia
c)Chronicmyeloidleukemia
d)Essentialthrombocytosis
CorrectAnswer-B
Ans.is'b'i.e.,Acutemyeloidleukemia
Chronicmyeloproliferativedisorders
Thedisordersinthisgroupare?
ChronicmyeloidleukemiaEssentialthrombocytosis
PolycythemiaveraPrimarymyelofibrosis
Thesediseasearecharacterizedbyneoplasticproliferationof
multipotentprogenitorcellthatiscapableofgivingrisetomature
erythrocytes,platelets,granulocytes,monocytesandlymphocytes.
Animportantfeatureofmyeloproliferativedisordersisthatintheir
terminalphasetheyarecharacterizedbymarrowfibrosisand
peripheralbloodcytopenia.
Allofthemcanprogressovertimetoacuteleukemia,butonlyCML
doessoinvariably.
Remember
CML,Polycythemiaveraandessentialthrombocytosiscanprogress
tomyelofibrosisinterminalstage.

---

455.Anemiawithreticulocytosisisseenin-
a)Hemolysis
b)Irondeficiencyanemia
c)VitaminB12deficiency
d)Aplasticanemia
CorrectAnswer-A
Ans.is'a'i.e.,Hemolysis
Conditions
Acutebloodlossorhemorrhage
Postsplenectomy
Microangiopathicanemia
Autoimmunehemolyticanemia
Hemoglobulinopathy(Sicklecellanemiaandthalassemia)
Postanemiatreatmentlikefolatesupplementation,iron
supplementation&vitaminB12,supplementation

---

456.Intracorpuscularhemolyticanemiais
seenin?
a)Autoimmunehemolyticanemia
b)TIP
c)Thalassemia
d)Infection
CorrectAnswer-C
Ans.is`c'i.e.,Thalassemia
Intracorpuscularhemolysis:Hereditarysphlerocytosis,G6PD
deficiency,thalassemia,sicklecellanemia,PNH.
Extracorpuscularhemolysis:Microangiopathichemolyticanemia
(TTP,HUS,DIC),infection(malaria),prostheticvalve,
immunohemolyticanemiaandhyperplenism.

---

457.Nottrueabouthereditaryspherocytosis
a)Defectinankyrin
b)DecreasedMCV
c)DecreasedMCHC
d)Reticulocytosis
CorrectAnswer-C
Ans.is'c'i.e.,DecreasedMCHC
Laboratoryfindings
Spherocytosis4Peripheralsmearshowsmicrospherocyteswhich
aresmallRBCswithoutcentralpallor(Normallycentral1/3palloris
presentinredcells).
MCV?Reticulocytosis-)Asseen
withanytypeofhemolyticanemia.
MCHCT?Hemoglobin
Increasedunconjugatebilirubin?SerumHeptoglobinNormalto
decreased.
UrineurobilinogenT?Increasedosmoticfragility.
StoolstercobilinogenT

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458.Insicklecellanemiaallaretrueexcept-
a)Sicklecells
b)Targetcells
c)Howelljollybodies
d)Ringedsideroblast
CorrectAnswer-D
Ans.is'd'i.e.,Ringedsideroblast
Laboratoryfindingsofsicklecellanemia:?
Moderatetosevereanaemia.
Peripheralsmearwillshow
Sicklecells
Targetcells
Howell-Jollybodiesbecauseofautosplenctomy.
Apostivesicklingtestwithareducingsubstancelikesodium
metabisulfite.
SicklecellanemiaiscausedbyreplacementofnormalHemoglobin
bysickledhemoglobin(HbS).
HbSisformedbyreplacementofGlutaminebyValineatposition6
ThissubstitutionreplacesthepolarGlutamineresiduewitha
nonpolarValine.
ThereplacementofGlutaminebyValinegeneratesastickypatchon
thesurfaceofHBS.
Thestickypatchispresentonbothoxygenatedanddeoxygenated
HbS
ThedeoxygenatedHbSalsocontainsacomplementarysiteforthe
stickypatch.
Inoxygenatedhemoglobinthiscomplementarysiteismasked.
WhenHbSisdeoxygenatedthestickypatchpresentonitssurface

---

bindstothecomplementarypatchonanotherdeoxygenatedHbS
molecules.
ThisbindingleadstopolymerizationofdeoxyhemoglobinSforming
longfibrousprecipitates.
Theseextendthroughouttheerythrocyteandmechanicallydistortit,
causinglysisandmultiplesecondaryclinicaleffect.
So,ifHbScanbemaintainedinanoxygenatedstateorifthe
concentrationofdeoxygenatedHbScanbeminimized,formationof
thesepolymerswillnotoccurandsicklingcanbeprevented
(Rememberthecomplementarysiteforthestickypatchremains
maskedincaseofOxygenatedHbS).
RoleofHbAinpolymerization
UnlikeHbS,HbAdoesnotcontainanystickypatch,butitdoeshave
abindingsiteforthestickypatchofHbS.
ThusitcanbindtoHbSthroughitsreceptorsitebutthisbinding
cannotextendthepolymerbecauseHbAdoesnotcontainanysticky
patchtopromotebindingtostillanotherhemoglobinmolecule.
SoHbAinterfereswiththepolymerisationandaggreationofHbS
andreducestheintensityofsicklecellanemia.

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459.Personhavingheterozygoussicklecell
traitisprotectedfrominfectionof:
a)P.falciparum
b)P.vivax
c)Pneumococcus
d)Salmonella
CorrectAnswer-A
Ans.a.P.falciparum
Personhavingheterozygoussicklecelltraitisprotectedfrom
infectionofP.falciparum.
"Peoplewhoareheterozygousforthesicklecelltrait(HbS)become
infectedwithP.falciparum,buttheyarelesslikelytodiefrom
infection?.TheHbStraitcausestheparasitestogrowpoorlyordie
becauseofthelowoxygenconcentrations?."-Robbins8/ep387
HostResistancetoPlasmodium
TwogeneralmechanismsofhostresistancetoPlasmodium:
Inheritedalterationsinredcellsmakepeopleresistantto
Plasmodium?.
RepeatedorprolongedexposuretoPlasmodiumspeciesstimulates
animmuneresponsethatreducestheseverity
Peoplewhoareheterozygousforthesicklecelltrait(HbS)become
infectedwithP.falciparum,buttheyarelesslikelytodiefrom
infection?.
TheHbStraitcausestheparasitestogrowpoorlyordiebecauseof
thelowoxygenconcentrations?.
ThegeographicdistributionoftheHbStraitissimilartothatofP.
falciparum?,suggestingevolutionaryselectionoftheHbStraitin
peoplebytheparasite

---

HbC,anothercommonhemoglobinmutation,alsoprotectsagainst
severemalariabyreducingparasiteproliferation?.
HostResistancetoPlasmodium.
Peoplecanalsoberesistanttomalariaduetotheabsenceof
proteinstowhichtheparasitesbind?.
P.vivaxentersredcellsbybindingtotheDuffybloodgroup
antigen?.
ManyAfricans,includingmostGambians,arenotsusceptibleto
infectionbyP.vivaxbecausetheydonothavetheDuffyantigen?.
AntibodiesandTlymphocytesspecificforPlasmodiumreduce
diseasemanifestations.Cytotoxiclymphocytesmayalsobe
importantinresistancetoP.falciparum

---

460.Thalassemiagivesprotectionagainst?
a)Filaria
b)Kala-azar
c)Malaria
d)Leptospirosis
CorrectAnswer-C
Ans.is'c'i.e.,Malaria
TypesofanemiathathaveprotectiveeffectagainstP.falciparum
malaria:-
G6PDdeficiency,Sicklecellanemia,Thalassemia,HbC,Pyruvate
kinasedeficiency

---

461.Donathlandsteinerantibodyisseenin?
a)PNH
b)Waldenstrom'smacroglobulinemia
c)Paroxysmalcoldhemoglobinuri
d)Malaria
CorrectAnswer-C
Ans.is'c'i.e.,Paroxysmalcoldhemoglobinuria
Paroxysmalcoldhemogjobinuria(PCH)
PCHischaracterizedbyintermittentmassiveintravascular
hemolysisfrequentlywithhemoglobinuriaatlowtemprature.
TheautoantibodiesareofIgGclass,alsoknownasDonath-
Landsteinerantibody.
TheseantibodiesaredirectedagainstP-antigenonRBC.
Antigenantibodycomplexontheredbloodcellactivates
complement.
Asaresult,largeamountofmembraneattackcomplexformswhich
destroysredcellsdirectlyintravascularhemolysis.
Causesare:-
Syphilis,Mycoplasma,Mumps,Measles,Flusyndrome

---

462.Normaltransferrinissaturatedwithiron
?
a)20%
b)35%
c)50%
d)70%
CorrectAnswer-B
Ans.is'b'i.e.,35%
Innormalindividuals,transferrinisaboutonethirdsaturatedwith
iron,yieldingserumironlevelsthataverage120g/dlinmenand100
g/dlinwomen.
Serumferritin
Mostoftheferritinisstoredisdifferentorgans(liver,spleen,bone
marrow).
Verysmallamountsofferritinnormallycirculateintheplasma.
Sinceplasmaferritinisderivedlargelyformthestoragepoolofbody
iron,itslevelcorrelatewellwithbodyironstores.i.e.,whenthereis
irondepletion,bodystoreofironisreducedthatinturnleadsto
decreaseinplasmaferritin.
Transferrinsaturationandironbindingcapacity
Ironistransportedintheplasmabytransferrin.
Normallytransferrinis33%saturated(77%free)withiron,yield
serumironlevelsthataverage100-120g/dl.
So,ifserumtransferrinwillbe100%saturatedtheserumironwillbe
300g/dl.thatmeansthetotalironbindingcapacityoftransferrinis
300to350g/dl.
Whenironstoreisdepletede.g.,inirondificiencyanemia,thereis
increasedsynthesisoftransferrinthatresultsinincreasedtotaliron

---

bindingcapacity.
Whenironstoreisrepletede.g.,anemiaofchronicdisease,thereis
decreasedsynthesisoftransferrinthatresultsindecreasedtotaliron
bindingcapacity.
Serumtransferrinreceptors
Erythroidprecursorshavereceptorsfortransferrinbywhichthey
recieveironfromtransferrinthatisutilizedforhemoglobinsynthesis.
Whenerythroidprecursorsmature,thesereceptorsareshedinto
plasmaandcanbemasuredasserumtransferrinreceptors
concentration.
Inirondeficiencystate,thereisincreasederythropoisisinbone
marrowTconcentrationoferythroidprecursorthatresultsin
increasedtotalnumberoftransferrinreceptor-->Tserum
transferrinreceptorconcentration.

---

463.Responsetoironinirondeficiency
anemiaisdenotedby-
a)Restorationofenzymes
b)Reticulocytosis
c)Increaseinironbindingcapacity
d)Increaseinhemoglobin
CorrectAnswer-B
Ans.is'b'i.e.,Reticulocytosis
Responsetoirontherapy
oWhenspecificirontherapyisgiven,patientsoftenshowrapid
subjectiveimprovement,withdisappearanceormarkeddiminutionof
fatigue,lassitude,andothernon-specificsymptoms.Thisresponse
mayoccurbeforeanyimprovmentinanemiaisobserved.
Theearliesthematologicalevidenceofrecoveryisincrease
reticulocytesandtheirhemoglobincontent.Thereticulocytesattaina
maximalvalueonthe5thto10thdayafterinstitutionoftherapyand
thereaftergraduallyreturntonormal.Thereticulocyteresponsemay
notbedetectableinmildirondeficiencyanemia.
Thebloodhemoglobinlevelisthemostaccuratemeasureofthe
degreeofanemiainirondeficiencyanemia.Duringtheresponseto
therapy,theredcellcountmayincreasetemporarilytovaluesabove
normal,butthehemoglobinvaluelagsbehind.
Theredcellindicesmayremainabnormalforsometimeafterthe
normalhemoglobinlevelisrestored.Asrecoveryoccurs,a
normocyticcellpopulationgraduallyreplacesthemicrocytic
population;andoneoftheearlysignsofresponsetotherapyisan
increaseinRBWfrompretreatmentlevel.
Whentreatmentisfullyeffective,hemoglobinreachesnormallevels

---

by2monthsaftertherapyisinitiated,regardlessofstartingvalues.
Oftheepitheliallesionsinirondeficiency,thoseaffectingthetongue
andnailsarethemostresponsivetotreatment.

---

464.Whichdoesnotcausesideroblastic
anaemia?
a)INH
b)Chloramphenicol
c)Myelodysplasticanaemia
d)Mercury
CorrectAnswer-D
Ans.is'd'i.e.,Mercury

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465.ShelflifeofbloodwithCPDA-
a)2weeks
b)3weeks
c)5weeks
d)8weeks
CorrectAnswer-C
Ans.is'c'i.e.,5weeks
*Oncebloodisremovedfromthedonor,itstartsasequencesofin
vitrochangesthatchangeitsphysiologicalproperties.
*Ensuringthebloodanditsproductstransfusionsafe,theirstorage
isamust.
*Themainaimistominimizedamagetostoreblood.
*Additionofsomeadditivesolutionsincreasestheviabilityofblood,
particularlyRBCs:
AdditiveShelflifeofRBC
Acid-citrate-dextrose(ACD)21
days
Citratephosphatedextrose(CPD)21
days
Citratephosphatedextrose-adenine(CPD-A)
35days
Saline-adenine-Glucose-Mannitol(SAG-M)
42days

---

466.Bloodwhenstoredat4?Ccanbekeptfor
?
a)7days
b)14days
c)21days
d)28days
CorrectAnswer-C
Ans.is`c'i.e.,21days
Therecommendtemperatureforstorageofbloodis1-6?C.
Actuallybloodcanbestoredformorethan21days,dependingupon
thetypeofadditiveused.
"Routinebloodstorageislimitedto21daysat1-6?Cwhentreated
withacid-citrate-dextrose(ACD)orcitratephosphate-dextrose
(CPD);and35dayswhentreatedwithcitrate-phosposphate-
dextrose-adenine(CPD-A);and42dayswhentreatedwithsaline-
adenine-glucose-mannital(SAG-M)"
So,correctanswerofthisquestioncanbe:
1. 21days(wehaveonlythisoneintheoptions)
2. 35days
3. 42days(ThisisthebestanswerbecauseSAG-Mistheroutinly
usedadditivethesedays).
Plateletsarestoredat20-24?Cfor3-5days

---

467.Gastriccarcinomaisassociatedwithall
EXCEPT?
a)Inactivationofp53
b)OverexpressionofC-erb
c)OverexpressionofC-met
d)ActivationofRAS
CorrectAnswer-D
Ans.is'd'ActivationofRAS
Inthecourseofmulti-stepstomachcarcinogenesis,variousgenetic
andepigeneticalterationsofoncogenes,tumor-suppressorgenes,
DNArepairgenes,cellcycleregulatorsandcelladhesionmolecules
areinvolved.Geneticalterationingastriccancerinclude:
Intestinaltypegastriccancer:K-rasmutation,APCmutation,pS2
methylation,HMLH1methylation,pIemamethylation,p73deletion
andC-erbB-2amplification.
1. Diffusetypegastriccaner:CDHIgene(E-Cadherin)mutation,K-
samamplification.
2. Forbothtype:Telomerasereduction(telomeraseshortening),
hTERTexpression,geneticinstability,overexpressionofthecyclinE
&CDC25B&E2FIgenes,p53mutations,reducedexpression,
CD44aberrabonttranscripts,andamplificationoftheC-metCyclinE
genes.
Comingtoquestion:
Allthegivenfourgeneticalterationsmaybeassociatedwith
stomachcancer.
HoweveramongthegivenoptionsK-rasisbestanswerasitis
associatedwithgastriccancerinminimumpercentage(amongst
givenoptions):
Source:Textbookofmechanismofcarcinogenesisandcancer

---

Source:Textbookofmechanismofcarcinogenesisandcancer
prevention
K-rasmutation
-4 <10%
p53mutation
30-60%
C-erbB-2amplifcation --> 20%
C-metamplifciation
--> 20%

---

468.Linitisplasticaisatypeof?
a)Plasticlikeliningofstomach
b)Diffusecarcinomaofstomach
c)Benignulcer
d)GIST
CorrectAnswer-B
Ans.is`b'i.e.,Diffusecarcinomaofstomach
Linitisplastica
Involvementofabroadregionofthegastricwallorentirestomach
bydiffusestomachcancercauselinitisplastica.
ItisalsoknownasBrinton'sdisease.
Theappearanceofstomachislikeleatherbottle.
Theothercauseoflinitisplasticaare
Lyeingestion
Metastaticinfiltrationofstomach
Syphilis
Sarcoidosis
Non-hodgkinlymphomaofstomach

---

469.Intestinalangiodysplasiainvolves?
a)AVmalformation
b)Cavernoushemangioma
c)Capillaryhemangioma
d)Malignanttumor
CorrectAnswer-A
Ans.is'a'i.e.,AVmalformation
Angiodvsplasia
Angiodysplasiaischaracterizedbymalformedsubmucosalblood
vessels(AVmalformation).
Lesionsofangiodysplasiaareectaticnestoftortuousveins,venules
andcapillaries.
Mostcommonsiteiscaecumandrightcolon.
Usuallyoccursafter6thdecadeoflife.
Majorpresentationisbleeding(intestinalbleeding).
Pathogenesisofangiodysplasiahasbeenlinkedtomechanicaland
congenitalfactors:?
1.Mechanicalfactor
Normaldistensionandcontractionintermittentlyoccludesubmucosal
veinsandleadstodilatationandtortuosityofoverlyingvessels.
Becausececumhasthelargestdiameter,itdevelopsthegreatest
walltension.Thereforececumisthemostcommonsitefor
angiodysplasia.
2.Genetic(developmental)factor
SomedatalinkangiodysplasiawithaorticsstenosisandMeckel
diverticulumsuggestingthepossibilityofadevelopmental
component.

---

470.Multipleepidermoidcystsareseenin-
a)Turcot'ssyndrome
b)Gardner'ssyndrome
c)Peutz-Jeghersyndrome
d)Familialpolyposiscoli
CorrectAnswer-B
Ans.is'b'i.e.,Gardner'ssyndrome
oGardnersyndromeincludesadenomatouspolypsofthe
gastrointestinaltract,desmoidtumours,osteomas,epidermoidcysts,
lipomas,dentalabnormalitiesandperiampullarycarcinomas.

---

471.FeaturesofPeutz-Jegherssyndromeare
allexcept?
a)Autosomaldominant
b)Mucocutaneouspigmentation
c)Hamartomatouspolyp
d)Highriskofmalignacy
CorrectAnswer-D
Ans.is'd'i.e.,Highriskofmalignacy
oMalignancyisrareinharmartomatouspolypsofPeutz-Jeghers
syndrome.
Otherthreeoptionsarecorrect(seepreviousexplanation).

---

472.Mostcommonlocationofgastrinomais:
September2007
a)Pancreas
b)Duodenum
c)Jejunum
d)Gallbladder
CorrectAnswer-B
Ans.B:Duodenum
Zollinger-Ellisonsyndromeisadisorderwhereincreasedlevelsof
thehormonegastrinareproduced,causingthestomachtoproduce
excesshydrochloricacid.
Oftenthecauseisatumor(gastrinoma)oftheduodenumor
pancreasproducingthehormonegastrin.Gastrinthencausesan
excessiveproductionofacidwhichcanleadtopepticulcersin
almost95%ofpatients.
Gastrinomasmayoccurassingletumorsorasmultiple,small
tumors.Aboutone-halftotwo-thirdsofsinglegastrinomasare
malignanttumorsthatmostcommonlyspreadtotheliverandlymph
nodesnearthepancreasandsmallbowel.Nearly25percentof
patientswithgastrinomashavemultipletumorsaspartofacondition
calledmultipleendocrine
neoplasiatypeI(MENI).MENIpatientshavetumorsintheir
pituitaryglandandparathyroidglandsinadditiontotumorsofthe
pancreas.

---

473.Allofthefollowingareassociatedwith
carcinomacolonexcept?
a)Smoking
b)Alcohol
c)Fibrediet
d)Fattyfood
CorrectAnswer-C
Ans.is'c'i.e.,Fibrediet
Fibredietisprotectiveagainstcoloncancer(seeprevious
explanations).
RiskfactorsforColoncancer
1. Dietayfactores-explainaedinpreviousquetion
2. Hereditaryfactors
Polyposiscoli
Nonopolyposisherditarycoloncancer(alsoknownasLynch
syndrome)
Inflammatoryboweldisease
LongstandingIBDincreasestherisk
Riskismorewithulcerativecolitisthancrohn'sdisese.
Riskincreaseswiththedurationandextentofcolitis.
Leftsidedcolitiscarriessomewhatlessrisk.
Streptococcusbovisbacteremia
Individualswhodevelopendocarditisorsepticemiafromthis
bacteria,haveahighincidenceofoccultcolorectaltumorsand
passiblyupperGIcancersalso.
OtherRiskfactors
Ureterosigmoidostomy
Cigarettesmoking-islinkedtothedevelopmentofcolorectal

---

adenomas,particularlyafter>35yrsofuse.
Acromegaly
Pelvicirradiation
Aspirin&otherNSAIDsusehasbeenfoudtohaveaprotective
effect(Chemopervention)
OthersubstancefoundtohavechemoprentiveactionareOral
folicacidsupplementation,Oralcalciumsupplementation,Estrogen
replacementtherapy

---

474. Centrilobularnecrosisoflivermaybe
seenwith?
a)Phosphorus
b)Arsenic
c)CCI4
d)Ethanol
CorrectAnswer-C
Ans.is'c'i.e.,CC14
Zonalnecrosis
.Identicalregionsofallliverlobulesareinvolved.Itis
dividedinto:-
i)Centrizonal(centrilobular)necrosis
Necrosisisseenaroundcentralhepaticvein.Itisseenincardiac
failure/shock,chloroformtoxicity,carbontetrachloride(ccl4)toxicity,
halothaneandviralhepatitis.
ii)Peripheralzonal(periportal)necrosis
Necrosisisseenaroundportaltracts.Itisseenineclampsiaand
phosphoruspoisoning.
iii)Midzonalnecrosis
Itisrareandisseeninyellowfever.

---

475.Gilbertsyndrome,trueallexcept?
a)Causescirrhosis
b)Autosomaldominant
c)Normalliverfunctiontest
d)Normalhistology
CorrectAnswer-A
Ans.is'a'i.e.,Causescirrhosis
Gilbert'sSyndrome:?
oItisanautosomaldominantcondition.
oItischaracterizedbyunconjugatedhyperbilirubinemia(normally
thebilirubinistransportedintolivercellsbyintracellularproteins.In
theliverbilirubinisconjugated.Thisconjugationisbroughtaboutby
certainenzymes.InGilbert'ssyndrometheseenzymesareabsent
whichcauseunconjugatedhyperbilirubinemia).
Thehyperbilirubinemiaisusuallyprecipitatedbyfollowingconditions
?Stress,Fatigue,Alcoholuse,reducedcalorieintake,intercurrent
illness.
Thehepaticbiochemicaltestsarenormalexceptforelevated
bilirubinlevel(serumbilirubinconcentrationareusually<3mg/dl)
Embryonalcarcinoma Thehepatichistologyisnormal
Thereisnoassociationwithcirrhosis.

---

476.Councilmanbodiesareseenill-
a)Alcoholiccirrhosis
b)Wilson'sdisease
c)Acuteviralhepatitis
d)Autoimmunehepatitis
CorrectAnswer-C
Ans.is'c'i.e.,Acuteviralhepatitis
Pathologicalfeaturesofacuteviralhepatitis
1)Panlobularinfiltrationofmononuclearcells
Thismononuclearinfiltrationprimarilyconsistsof-->Lymphocytes,
Plasmacells,Eosinophils
Inflammatoryinfiltratemayspilloverintotheadjacentparenchyma
tocausenecrosisofperiportalhepatocytes4interfacehepatitis,
canoccurinbothacuteandchronichepatitis.
2)Hepaticcelldamage-Itconsitsof
a)Hepaticcellnecrosis-Thenecrosisisusuallyfocalor
centirzonal.
Sometimesseverenecrosissuchasbridgingorsubacutehepatic
necorsisoccurs.
b)Ballooningofcells-Damagedcellsshowdiffuseswelling
knownasballooningdegeneration.
c)Acidophilicdegenerationofhepatocytes-Inthissinglenecrotic
livercellhascoagulatedpinkcytoplasmanditshowspyknosisor
karyolysis.Thesearecalledcouncilmanbodies.

---

477.Microvesicularfattyliveriscausedby?
a)DM
b)Valproate
c)Starvation
d)IBD
CorrectAnswer-B
Ans.is'b'i.e.,Valproate
Steatosis
Accumulationoftriglyceridefatdropletswithintheheaptocytesis
knownassteatosisorfattyliver.Itmaybeoftwotypes?
1. MicrovesicularsteatosisMultipletinydropletsaccumulatethatdo
notdisplacethenucleus.
2. MacrovasicularsteatosisAsinglelargedropletaccumulatesthat
displacesthenucleus.
Causesofsteatosis
Microvesicular
Reye'ssyndrome
Acutefattyliverofpregnancy
Jamaicanvomitingsickness
Drugs-valproicacid,tetracycline,nucleosideanalogue
lman'sdisease
Lysosomalacidlipasedeficiency
Congenitaldefectsofureacycleenzymes
Earlystageofalcoholiccirrhosis
Chronicviralhepatitis
Macrovesicular
Alcoholicliverdisease
DM-->insulinresistance

---

Lipodystrophy
PEM,starvation
Dysbetalipoproteinemia
TPN,Jejunoilealbypass
Inflammatoryboweldisease
Syndromex(obesity,DM,hypertriglyceridemia
Drugs-->CCBs,syntheticestrogens,nucleosideanalogues

---

478.Peliosishepatisiscausedbyallexcept?
a)Analgesics
b)Anabolicsteroids
c)OCpills
d)Danazol
CorrectAnswer-A
Ans.is'a'i.e.,Analgesics
Peliosishepatitisisarareconditioninwhichthereisprimarily
sinusoidaldilatation.
Thelivercontainsbloodfilledcysticspaces,eitherunlinedorlined
withsinusoidalendothelialcells.
Peliosishepatitisisassociatedwithmanydiseasesincludingcancer,
TB,AIDSorposttransplantationimmunodeficiency.Itisalso
associatedwithexposuretoanabolicsteroidsandrarely,oral
contraceptivesanddanazol.

---

479.Whichoneofthefollowingisthemost
commontumorassociatedwithtypeI
neurofibromatosis?
a)Opticnerveglioma
b)Meningioma
c)Acousticschwannoma
d)Lowgradeastrocytoma
CorrectAnswer-A
Ans.is'a'i.e.,Opticnerveglioma
NeurofibromatosistypeI(Von-Recklinghewsendisease)
oNF-1isdiagnosedwhenanytwoofthefollowingsevensignsare
present.
1.Sixormorecafe-au-laitmacules
>5mminprepupertalindividuals
>15mminpostpubertalindividuals
Cafe-au-faitspotsarethehallmarkofneurofibromatosis
andarepresentinalmost100%ofthepatient.
2.Axillaryoringuinalfreckling
3.TwoormoreLischnodules.
Lischnodulesarehamartomaslocatedwithintheiris.
4.Twoormoreneurofibromaoroneplexiformneurofibroma.
Typicallyinvolvetheskin,butmaybesituatedalong
peripheralnervesandbloodvessels.
Theyaresmall,rubberylesionswithaslightpurplish
discolorationoftheoverlyingskin.
5.Adistinctiveosseouslesion.
Sphenoiddysplasiaorcorticalthinningoflongbones.
6.Opticglioma

---

6.Opticglioma
7.AfirstdegreerelativewithNF-1
Otherfindingsare:-
Pseudoarthrosisoftibia.
ScoliosisisthemostcommonorthopaedicprobleminNF-1,
butisnotspecificenoughtobeincludedasadiagnosticcriterian.
Shortstature

---

480.Perifascicularatropyofmusclefibresis
seenin?
a)Steroidmyopathy
b)Dermatomyositis
c)Inclusionbodymyositis
d)Nemalinemyopathy
CorrectAnswer-B
Ans.is'b'i.e.,Dermatomyositis
Dermatomyositisisaconnective-tissuediseaserelatedto
polymyositisthatischaracterizedbyinflammationofthemuscles
andtheskin.
Itisasystemicdisorderthatmayalsoaffectthejoints,the
esophagus,thelungs,and,lesscommonly,theheart.
Onthemusclebiopsy,therearetwoclassicmicroscopicfindingsof
dermatomyositis.Theyare:mixedB-&T-cellperivascular
inflammatoryinfiltrateandperifascicularmusclefiberatrophy.
Itisassociatedwithautoantibodies,especiallyanti-Jolantibody.

---

481.A/EareinvolvedinMENtypeIIA?
a)Parathyroid
b)Adrenal
c)Thyroid
d)Pituitary
CorrectAnswer-D
Ans.is'd'i.e.,Pituitary
MENtype2A(Sipplesyndrome)
Autosomaldominant
Itischaracterisedbymedullarycarcinomaofthyroid,
pheochromocytomaandhyperparathyroidism.
ItiscausedbymutationoftheRETproto-oncogeneincodon634.
Mappedtochromosome10.
Mutatedcodon-cysteinecodon
Type2Ahas3variants-
a)MEN2Awithfamilialmedullarycarcinomathyroid(1stfeatureof
type2A)
b)MEN2Awithcutaneouslichenamyloidosis
c)MEN2AwithHirschsprungdisease

---

482.Autoimmunethyroiditisisassociated
withallexcept-
a)DM
b)Mystheniagravis
c)Sly
d)Psoriasis
CorrectAnswer-D
Ans.is'd'i.e.,Psoriasis
*Autoimmunethyroiditis(Hashimotothyroiditis)patientsareat
increasedriskfordevelopingotherautoimmunedisease:-
i)Endocrine:Type1DM,autoimmuneadrenalitis.
ii)Non-endocrine:SLE,mystheniagravis,sjogrensyndrome.
*ThesepatientsarealsoatincreasedriskfordevelopmentofB-cell
non-Hodgkinlymphoma,especiallymarginalcelllymphomaofMALT
lymphoma.

---

483.Hurthlecellcarcinomaisavariantof?
a)Medullarycarcinoma
b)Papillarycarcinoma
c)Follicularcarcinoma
d)Anaplasticcarcinoma
CorrectAnswer-C
Ans.is'c'i.e.,Follicularcarcinoma
Follicularcarcinoma
Secondmostcommontypeofthyroidcancer.
Hurthlecellsareseen.
Differentiatedfromfollicularadenomabycapsularand/orvascular
invasion.
Unlikeinpapillarycarcinoma,lymphaticspreadisrare,andvascular
invasioniscommoninfollicularcancers.
Hurthlecelloroncocyticcarcinomaisavarriantoffollicular
carcinoma.
Papillarythyroidcarcinoma
Itisthemostcommontypeofthyroidcancer.
Carcinomacellshavenucleiwhichcontainfinelydispersed
chromatin,whichimpartsopticallyclearoremptyappearance,giving
risetothegroundglassorOrphanAnnieeyenuclei.
Invaginationofcytoplasmmaygiverisetotheappearanceof
intranuclearinclusins(Pseudoinclusions)orintranucleargrooves
thediagnosisofpapillarycarcinomaisbasedonthesenuclear
features.
Psammomabodiesarepresent
Lymphaticmetastasismaybeseenbutinvolvementofbloodvessels
israre.

---

Thenucleiofpapillarycarcinomacellscontainfinelydispersed
chromatin,whichimpartsanopticallyclearoremptyappearance,
givingrisetothedesignationgroundglassorOrphanAnnieeye
nuclei.

---

484.Allaregermcelltumorsexcept?
a)Seminoma
b)Leydigcelltumor
c)Embryonalcarcinoma
d)Endodermalsinus
CorrectAnswer-B
Ans.is'b'i.e.,Leydigcelltumor
Testiculartumor
*Testiculartumorsaredividedintotwomajorcatogaries:?
Germcelltumors
*Seminoma*Embryonalcarcinoma*Yolksac(endodermal
sinus)tumor
Spermatocyticseminoma
Choriocarcinoma
Teratoma
Sexcordtumors
Leydigcellstumor
Sertolicelltumor
*Approximately95%oftesticulartumorsaregermcelltumors.

---

485.Schiller-Duvalbodiesisseenin
a)Choriocarcinoma
b)EmbryonalcellCa
c)Endodermalsinustumour
d)Immatureteratoma
CorrectAnswer-C
Ans.is'c'i.e.,Endodermalsinustumor
Yolksactumor(endodermalsinustumororinfantileembryonal
carcinoma)-->Schiller-Duvalbodies.
Leydig(interstitial)celltumor-3Reinkecrystalloids.
Note:-Rienkecrystalsarealsoseeninthehiluscelltumorofovary.

---

486.Granulomatousmastitisiscausedbyall
except-
a)TB
b)Fungus
c)Staphylococcus
d)Antibodiestomilkantigens
CorrectAnswer-C
Ans.is'c'i.e.,Staphylococcus
Granulomatousmastitis
*Granulomatousinflammationispresentinlessthan1%ofall
breastbiopsyspecimens.
*Thecausesincludesystemicgranulomatousdisease(e.g.,
Wegenergranulomatosisorsarcoidosis)thatoccasionallyinvolve
thebreast,andgranulomatousinfectionscaused
bymycobacteriaorfungi.
*Infectionsofthistypearemostcommoninimmunocompromised
patientsoradjacenttoforeignobjectssuchasbreastprosthesesor
nipplepiercings.
*Granulomatouslobularmastitisisanuncommonbreast-limited
diseasethatonlyoccursinparouswomen.
*Thegranulomatousinflammationisconfinedtothelobules,
suggestingthatitiscausedbyahypersensitivityreactiontoantigens
expressedbylobularepitheliumduringlactation.

---

487.TypeofDCISresultinginpalpable
abnormality?
a)Comedocarcinoma
b)NoncomedoDCIS
c)Paget'sdisease
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Paget'sdisease
"Apalpablemassispresentin50%to60%ofwomenwithPaget
disease,andalmostallofthesewomenhaveanunderlyinginvasive
carcinoma.Incontrast,themajorityofwomenwithoutapalpable
masshaveonlyDCIS".--Robbin's
*ActuallythequestionhasbeenframedwronglyasPaget'sdisease
isnotatypeofDCIS.Itisadifferentlesion.But,ithasbeen
explainedalongwithmorphologyofDCIS.

---

488.Allaregoodprognosticfactorsfor
neuroblastomaexcept-
a)Trk-Aexpressionabsent
b)Absenceof1ploss
c)Absenceof17pgain
d)Absenceof11qloss
CorrectAnswer-A
Ans.is'a'i.e.,Trk-Aexpressionabsent
Intratumoralcalcification
DNAploidy-Hyperdiploidornear-triploid
Trk-AExpression
CD-44Expression

---

489.Flexner-Wintersteinerrossetteisseenin-
a)Hepatoblastoma
b)Nephroblastoma
c)Neuroblastoma
d)Retinoblastoma
CorrectAnswer-D
Ans.is'd'i.e.,Retinoblastoma
Rosettes
Rosettesarepathologicalfindingscharacterizedbyahaloorspoke
wheelarrangementofcellssurroundingacentralcoreorhub.
TypeofRosette
1.Flexner-WintersteinerRosettes
Ahaloofcellssurroundsalargelyemptycentralhubbutsmall
cytoplasmicextensionfromcellsprojectintothelumen.
Itischaracteristicofretinoblastoma.
MayalsobeseeninMedulloblastoma,Primitiveneuroectodermal
tumor,Pineoblastoma.
2.HomerWrightrosettes
Ahaloofcellssurroundsacentralhubthatcontainsameshworkof
fibres(neutrophilrichcentre).oHomer-Wrightrosettesare
characteristicofneuroblastomasandmedulloblastomas.
MayalsobeseeninPrimitiveneuroectodermaltumors(PNET),
Pineoblastomas,Retinoblastomas.
3.TrueependymalRosette
Ahaloofcellssurroundsanemptylumen.
Itischaracteristicofependymomas.
4.Perivascularpseudorosettes
Ahaloofcellssurroundsabloodvessel.

---

Thetermpseudoisusedbecausethecentralstructureisnotformed
fromthetumoritself,andrepresentsanonneoplasticelement.
Maybeseenin-

---

490.Markerofglomustumor?
a)CD-57
b)Cytokeratin
c)S-100
d)CD-34
CorrectAnswer-A
Ans.is'a'i.e.,CD-57
Glomustumorisabenignmesenchymalneoplasmofthe
subcutaneoustissueofthedistalextremitiesandhead&neck
region.
Immunohistochemistryshowssmoothmuscleactin,vimentin,
collagenIVandCD-57,withlittletonoexpressionof
neuroendocrine,endothelialorepithelialmarkers.
Markersthathavebeenprovedconsistentlynegativeinclude
cytokeratin,synaptophysin,chromograninA,CD-31andS-100
protein.
Glomangioma(Glomuvenousmalformation)
Glomangiomaisavariantofglomustumor
Itischaracterizedbymultipletumorsresemblingcavernous
hemangioma,linedbyglomuscells.
Glomangiomaisblue-red,extremelypainfulvascularneoplasm.
Itinvolvesaglomeriformarteriovenousanastomosis(glomusbody)
Itmaybefoundanywhereintheskin,mostofteninthedistalportion
offingersandtoes,especiallybeneaththenails(subungal).
Secondarythrombosisandphlebolithformationmayoccurinthese
lesions.

---

491.Mostcommonmediastinaltumoris?
a)Neurogenictumor
b)Pericardialcyst
c)Hernia
d)Teratoma
CorrectAnswer-A
Ans.is'a'i.e.,Neurogenictumors
oOverallmostcommonmediastinalmassesareneurogenictumors
(20%)followedbythymomas(19%),primarycysts(18%),
lymphomas(13%)andgermcelltumors(10%).
oMostofthemediastinalmassesarelocatedintheanterior
mediastinumfollowedbytheposterior(25%)andmiddle(19%).

---

492.Mostcommonocularlymphoma?
a)T-celllymphoma
b)Hodgkin'slymphoma
c)B-cellNHL
d)PreT-celllymphoma
CorrectAnswer-C
Ans.is'c'i.e.,B-cellNHL
non-Hodgkinlymphoma(NHL)isthemostcommontype
ofocularlymphoma.

---

493.Cryoprecipitateisusefulin?
a)HemophiliaA
b)Thrombosthenia
c)Afibrogenemia
d)Warfarinreversal
CorrectAnswer-C
Ans.is'c'i.e.,Afibrogenemia
Cryoprecipitatewasoriginallydevelopedforthetreatmentof
hemophiliaA.Itisnolongerthetreatmentofchoiceforthatdisorder
becauselessinfectiousalternativesareavailable.
Atthepresenttime,Cryoprecipitateismostoftenusedforcorrection
ofhypofibrinogenemiainbleedingpatients.

---

494.Whichofthefollowingdrugs,isusedfor
SmokingCessation?
a)Naltrexone
b)Bupropion
c)Buprenorphine
d)Methadone
CorrectAnswer-B
AnswerisB(Bupropion):
Bupropion(alongwithVareniclineandNicotinereplacement
therapy)isaUSFDAapprovedfirstlineagentforpharmacotherapy
inSmokingCessation.
USFDAApprovedAgentsforSmokingCessation
NicotineReplacementTherapy(TransdermalPatch,gum,lozenges,
oralinhaler,nasalspray)
Bupropion(AtypicalAntidepressantwithdopaminergicand
noradrenergicactivity)
Varenicline(SelectivepartialagonistattheAlpha4-Beta2Nicotinic
A-Cholinereceptorthatisbelievedtomediatenicotinedependence)
ClonidineandNortriptylinearetwoothermedicationsthathave
efficacybutareNOTUSFDAapprovedforthisindication.Theseare
classifiedassecondlineagents.

---

495.OmalizumabTruestatementis?
a)Anti-IgE
b)Usedasaddontherapyinmoderatetosevereasthma
prophylaxis
c)Givnsubcutaneously
d)Alloabove
CorrectAnswer-D
Ans.is'd'i.e.,Allofabove
Anti-IgE(Omalizumab).
OmalizumabisahumanizedmonoclonalantibodythatbindsIgE,
therebypreventingitsbindingtothehigh-affinityIgEreceptorand
blockingIgE-mediatedallergicresponsesandinflammation.
approvedforpatients>12yroldwithmoderatetosevereasthma,
Itisgivenevery2-4wksubcutaneouslybasedonbodyweightand
serumIgElevels.
Itsclinicalefficacyasan"add-on"therapyforpatientswithmoderate
tosevereallergicasthmaItisgenerallywelltolerated,althoughlocal
injectionsitereactionscanoccur

---

496.Alldrugsareavailableastransdermal
patchesinIndia,except
a)Fentanyl
b)Nitroglycerine
c)Hyoscine
d)Nicotine
CorrectAnswer-C
Ans.is'c'i.e.,Hyoscine
"TransdermalpatchesofNTG,fentanyl,nicotineandestradialare
availableinIndia,whereasthoseofisosorbidedinitrate,hyoscine
andclonidinearemarketedelsewhere".--KDT

---

497.Maximumfirstpassmetaboilsmisseen
bywhichroute?
a)Intravenous
b)Interaarterial
c)Rectal
d)Oral
CorrectAnswer-D
Ans.is'd'i.e.,Oral
Firstpassmetabolismisseenwithoralandrectalroutes.
Maximumfirstpassmetabolismisseenwithoralroute.
Inrectalroute,drugabsorbedintoexternalhemorrhoidalveins
bypassesliver,butnotthatabsorbedintointernalhaemorrhoidal
veinsFirstpassmetabolismoccurs,butlessthanoralroute
(avoidsfirstpassmetabolismto50%).
MostrapidonsetofactionisseenwithI.route.
BioavailabilitybyI.Vrouteis100%.

---

498.Allhavehighfirstpassmetabolism
except?
a)Lidocaine
b)Propranolol
c)Theophylline
d)Morphine
CorrectAnswer-C
Ans.is'c'i.e.,Theophylline

---

499.Eliminationafter4halflivesinfirstorder
Kineticsis
a)84%
b)93%
c)80.5%
d)4.75%
CorrectAnswer-B
Ans.is'b'i.e.,93%
Halflife Elimination
1t%2
50%
2t'/2
75%
30/2
87.5%
41
93.75%
5t'/
96.875

---

500.Inthemetabolismofalcohol,highdoses
ofaspirin&phenytoin,mechanismis?
a)Firstpasskinetics
b)Firstorderkinetics
c)Zeroorderkinetics
d)Secondorderkinetics
CorrectAnswer-C
Ans.is'c'i.e.,Zeroorderkinetics

---

501.Whichdrugcanbegivensubdermally?
a)Nicotine
b)Fentanyl
c)GTN
d)Progesterone
CorrectAnswer-D
Ans.is'd'i.e.,Progesterone
Progesteronecanbegivenintheformofsubdermalimplant.
Subdermalcontraceptiveimplantsinvolvethedeliveryofasteroid
progestinfrompolymercapsulesorrodsplacedundertheskin.
Thehormonediffusesoutslowlyatastablerate,providing
contraceptiveeffectivenessfor1-5years.

---

502.Maximumplasmaproteinbounddrugis
?
a)NTG
b)Verapamil
c)Aspirin
d)GTN
CorrectAnswer-B
Ans.is'b'i.e.,Verapamil
oAmongthegivenoptionsonlyverapamilhassignificantplasma
proteinbinding(seetextofthechapter).

---

503.Studystateplasmaconcentrationis
achievedafter?
a)2t1/2
b)3t1/2
c)4t1/2
d)5t1/2
CorrectAnswer-D
Ans.is'd'i.e.,5t1/2
Steadystate:
Iffixeddoseofadrugisadministeredafterregularintervals,its
plasmaconcentrationstartsincreasing.
However,asplasmaconcentrationrises,rateofeliminationalso
startsincreasing.
Whenrateofadministrationbecomesequaltorateofelimination,
plasmaconcentrationstabilizes.
Thisiscalledsteadystate.
1.Timetoreachsteadystatedependsont?.Ittakesapproximately
5half-lives.
2.Steadystateplasmaconcentrationacheiveddependsondose
rate.

---

504.Acidicdrugsbindto?
a)Globulin
b)a-Iglycoprotein
c)Albumin
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Albumin
Manynaturalsubstancescirculatearoundthebodypartlyfreein
plasmawaterandpartlyboundtoplasmaproteins,e.g.cortisol,
thyroxine.
Similarlydrugscirculateinproteinboundandfreestates,andthe
significanceisthatthefreefractionispharmacologicallyactive
whereastheproteinboundcomponentisareservoirofdrugthatis
inactivebecauseofthisbinding.
Acidicdrugsgenerallybindtoplasmaalbumin.
Basicdrugsbindtoa,acidglycoprotein.
Bindingtoalbuminisquantitativelymoreimportant.

---

505.Durationofactiondependson-
a)Clearance
b)Rateofelimination
c)Bioavailability
d)All
CorrectAnswer-D
Ans.is'd'i.e.,All

---

506.Whentwodifferentchemicalactontwo
differentreceptorsandtheirresponses
isoppositetoeachotheronthesame
celliscalledas?
a)Physiologicalantagonism
b)Chemicalantagonism
c)Reversibleantagonism
d)Competitiveantagonism
CorrectAnswer-A
Ans.is'a'i.e.,Physiologicalantagonism
Physiologicalantagonistsarethosethatproduceoppositeactionby
actingondifferentreceptors.
Antagonism
Whenonedrugdecreasesorinhibitstheactionofother.
EffectofdrugsA+B<effectofdrugA+effectofdrugB.
Antagonismmaybe:
1. Physical
2. Basedonphysicalproperty
3. Chemical
4. Thetwodrugsreactchemicallyandformaninactiveproduct.
5. Physiological/functional
6. Thetwodrugsactondifferentreceptorsorbydifferentmechanisms,
buthaveoppositeoverteffectsonthesamephysiologicalfunctionie
havepharmacologicaleffectinoppositedirection.
7. Receptor
Theantagonistinterfereswithbindingoftheagonistwithitsreceptor
orinhibitsthegenerationofresponseconsequenttosuchbinding.

---

---

507.Hofmanneliminationis?
a)Inactivationofdrugbymetabolizingenzyme
b)Unchangedexcretionbykidney
c)Excretioninfeces
d)Inactivationbymolecularrearrangement
CorrectAnswer-D
Ans.is'd'i.e.,Inactivationbymolecularrearrangement
Hofmannelimination
Thisreferstoinactivationofthedruginthebodyfluidsby
spontaneousmolecularrearrangementwithouttheagencyofany
enzyme.
Atracuriumiseliminatedbythismethod.

---

508.TypeEadversereactionis
a)Toxicity
b)Augmentedeffect
c)Teratogenesis
d)Withdrawalreaction
CorrectAnswer-D
Ans.is'd'i.e.,Withdrawalreaction
TypeA(Augmented)reaction
Excessofnormal,predictable,doserelatedpharmacodynamic
effect.
Mayoccurineveryone
eg-Posturalhypotension,hypoglycemia
TypeB(Bizzare)reaction
Duetounusualattributesofthepatientinteractionwiththedrug.
Notdoserelated
Notapartofnormalpharmacologicaleffectofadrug.
Occursonlyinsomepeople.
eg-Idiosyncracyanddrugallergy.
TypeC(chronic)reaction
Duetolongtermexposure
eg;Analgesicnephropathy,dyskinesiabylevodopa,
immunosuppressionbycorticosteroids.
TypeD(Delayed)effects
eg;Carcinogenesisorteratogenesis.
TypeE(Endingofuse)reaction
3eg;withdrawlreactionswithclonidine.

---

509.Whichofthefollowingdevelopfirst
duringdependenceofasubstance?
a)Tolerance
b)Physicaldependence
c)Psychologicaldependence
d)Withdrawalsymptoms
CorrectAnswer-C
Ans.is'c'i.e.,Psychologicaldependence
Drugdependence
Drugdependence,asthenamesuggests,isastatewhereaperson
becomesdependentonadrugdespiteknowingtheharmfuleffectof
thedrug.
Thisstatearisesfromrepeated,periodicorcontinuous
administrationofadrug,thatresultsinharmtotheindividual.
Thesubjectfeelsadesire,needorcompulsiontocontinueusingthe
drugandfeelsillifabruptlydeprivedofit(withdraw!syndrome)
Drugdependencyischaracterizedbythetriadof:
i.Psychologicaldependence
Firsttoappear
Thereisemotionaldistressifthedrugiswithdrawn
ii.Physicaldependence
Followspsychologicaldependence
Thereisphysicalillnessifthedrugiswithdrawn(withdraw!
symptoms)
iii.Tolerance
Tolerancemaybe
1. SelftoleranceTothedrugonwhichthesubjectisdependent
2. CrosstoleranceTotheothersimilar(usually)ordissimilar

---

(sometimes)drugs.
Thefrequencyofuseofdrugisusuallydailyanddurationis
inevitablygreaterthan2-3weeks.

---

510.Muscariniccholinergicreceptorsare
seenatallsites,except?
a)Stomach
b)CNS
c)Neuromuscularjunctio
d)Glands
CorrectAnswer-C
Ans.is'c'i.e.,Neuromuscularjunction
Cholinergicreceptors
Therearetwotypesofcholinergicreceptors:
MuscarinicFoundat-Allpostaganglionicparasympatheticsites,
Fewpostaganglionicsympatheticsites(sweatgland&blood
vessels),CNS.
Nicotinic--4Foundat-Ganglia(bothsympatheticand
parasympathetic),Skeletalmuscles,Adrenalmedulla,CNS
Muscarinic
Nicotinic
receptors
receptors
Type Organ
Type Organ
Neuromuscualr
M1
Gastricgland
NM
junction
M2
Heart
(Skeletalmuscle)
M3
Smoothmuscles,
NN
Ganglia,adrenal
glandsand
medulla
endothelium
M4
CNS
M5
CNS

---

511.TypeIIparalysisinorganophosphorous
poisoningtreatmentis?
a)Atropine
b)Oximes
c)Symptomatictreatment
d)Notreatment
CorrectAnswer-C
Ans.is'c'i.e.,Symptomatictreatment
Paralysisduetoorganophosphate(OP)poisoningcanbethree
types?
1.TypeI(cholinergicphase)
Treatmentofchoiceisatropinewithorwithoutoximes.
2.TypeII
Itisalsocalledasintermediatesyndrome.
Itdevelops1-4daysafterresolutionofacutecholinergicsymptoms.
Itismanifestedasparalysisandrespiratorydistress.
Itinvolvesproximalmuscleswithrelativesparingofdistalmuscle
groups.
Thepathogenesispresumedtobedysfunctionofneuromuscular
junctioncausedbydownregulationofpresynapticandpostsynaptic
nicotinicreceptorsduetoreleaseofexcessiveAchandCa'
respectively.
Atropineisineffective,symptomatictreatmentisgiven.
3.TypeIII

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512.Wrongaboutclonidineis-
a)Alpha2receptoragonist
b)FirstlineforAMID
c)Suddenwithdrawalcausesreboundhypertension
d)Controlsloosemotionsduetodiabeticneuropathy
CorrectAnswer-B
Ans.is'b'i.e.,FirstlineforADHD
*Behaviouraltherapyisthefirstlinetherapyforthetreatmentof
ADHD.ThefirstlinedrugforADHDisMethylphenidate.
*Clonidineisapartialagonistwithhighaffinityandhighintrinsic
activityat2receptors.
Suddenwithdrawalofclonidinemaycauselifethreatening
hypertensivecrisis.
*Clonidineisusedtocontrolloosemotionsduetodiabetic
neuropathy.Itmaybeactingby2receptormediatedenhancement
ofsaltabsorptioningutmucosa.

---

513.Dopaminereceptorwithinhibitoryaction
?
a)D5
b)Di
c)D2
d)None
CorrectAnswer-C
Ans.is'c'i.e.,D2
Twotypesofdopaminereceptors(DI,D2)wereoriginally
described.Threemore(D3,D4,D5)havenowbeenidentifiedand
cloned.AllareGproteincoupledreceptorsandaregroupedintotwo
families:
Dllike:(Dl,D5)areexcitatory
D2like:(D2,3,4)areinhibitory

---

514.Urinarybladderspasmolytichavinglocal
anaestheticproperty-
a)Tamsulosin
b)Terazosin
c)Oxybutynin
d)Yohimbine
CorrectAnswer-C
Ans.is'c'i.e.,Oxybutynin
oOxybutynin,anewerantimuscarinic,hashighaffinityforreceptors
inurinarybladderandsalivaryglandsalongwithadditionalsmooth
musclerelaxantandlocalanaestheticproperties.

---

515.Spasmolyticanalgesicis
a)Dicyclomine
b)Physostigmine
c)Tropicamide
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Dicyclomine
Antispasmodic(spasmolytic)drugsareusedinvariouscolic(pain)
e.g.abdominalcolicorrenalcolic.
Amongthegivenoptions,dicyclomineisspasmolytic.
Antispasmodicdrugs
1. Quaternarycompounds-Propantheline,Oxyphenonium,CIidinium,
Pipenzolate,Methylbromide,Isopropamide,Glycopyrrolate.
2. Tertiaryamines-Dicyclomine,Valethamate,Pirenzepine.
3. Vasoselectiveantispasmodic(drugsactingonurinarybladder)-
Oxybutynin,Tolterodine,flavoxate.Drotaverine

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516.Antigaucomatousdrugcausingspasmof
accommodation
a)Timolol
b)Pilocarpine
c)Dorazolamide
d)Latanoprost
CorrectAnswer-B
Ans.is'b'i.e.,Pilocarpine
OcularsideeffectsoftopicalagentsforPOAG
13-blocker:Allergicblepheroconjunctivitis,cornealhyposthesia,
blurredvision,dryeye,superficialpunctatekeratitis.
Cholinomietics(pilocarpine):Blurredvision,miosis,accommodative
spasm,browache.
Sympathomimetics
Non-selective(Dipivefrine):Follicularconjunctivities,rebound
congestion,macularedemainaphakic
Apraclonidine:Allergies,lidretraction,follicularconjunctivitis,
fluctuationinvisualacuity
Brimonidine:Ocularallergy,conjuntivalblanching.
Carbonicanhydraseinhibitors(Dorzolamide,brinaolamide):
Punctatekeratitis,ocularallergies.
Prostaglandinanalogues(Latanoprost):Punctatekeratitis,iris
pigmentation.

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517.Besidesitspropertiesofdecreasing
intraocularpressure,timololispreferred
inthetreatmentofglaucomabecauseit
a)Producesnomiosis
b)Possessmembranestabilizingactivity
c)Increasesoutflowofaqueoushumor
d)Isaselectivebeta-adrenoceptorblocker
CorrectAnswer-A
Ans.is'a'i.e.,Producesnomiosis
Advantagesoftopicaln-blockers(timolol)overmiotics
(pilocarpinel
Nochangeinpupilsize(nomiosis)Nofluctuationin
I.O.T.
NoinducedmyopiaConvenient
once/twicedailyapplications
Nociliaryspasm(nospasmofaccomodation)Fewsystemic
sideeffects.

---

518.Usesofalpha-2-agonistareallexcept?
a)Sedation
b)Glaucoma
c)BenignHyperplasiaofprostate
d)Hypertension
CorrectAnswer-C
BenignHyperplasiaofprostate.

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519.Beta1antagonistusedincongestive
cardiacfailure?
a)Atenolol
b)Metoprolol
c)Salbutamol
d)Terbutaline
CorrectAnswer-B
Ans.is`b'i.e.,Metoprolol
-blockersusedinCHF
Cardioselective-blockers(1-blockers)
Atenolol
Bisoprolol
Celiprolol
Esmolol
Metoprolol Nebivolol
Acebutalol Betoxalol
Non-
blockerwitha-blocking
selective
acting
Carvedilol Dilovalol
Medroxalol Bucindolol
Labetalol Bevantolol
Nipradilol
Amongallthesefollowingthreeareusedmostcommonly
1. Carvedilol
2. Metoprolol
3. Bisoprolol

---

520.Whichofthefollowingisnota
cardioselectivebetablocker?
a)Nebivolol
b)Atenolol
c)Betaxolol
d)Oxprenolol
CorrectAnswer-D
Ans.is'd'i.e.,Oxprenolol

---

521.Whichofthefollowingissecond
generation3blocker?
a)Propronolol
b)Timolol
c)Nodalol
d)Atenolol
CorrectAnswer-D
Ans.is'd'i.e.,Atenolol

---

522.Thesideeffectsofdigitalisareallexcept
?
a)Ventriculartachycardia
b)Vasodilatation
c)Nauseaandvomiting
d)VentricularBigemini
CorrectAnswer-B
Ans.is'b'i.e.,Vasodilatation
Digitaliscausesmildvasoconstriction(notvasodilatation).

---

523.Nesiritidecausevasodilatationthrough?
a)cAMP
b)cGMP
c)ATP
d)K'ions
CorrectAnswer-B
Ans.is'b'i.e.,cGMP
Nesiritide
NesiritideisarecombinantformofhumanBNP(Brainnatriuretic
peptide)thatdilatesthearterialandvenouscirculationinabalanced
manner.
Itisonlyavailableforparentraladministration(oralbioavilabilityis
poor)
Ithasnatriuretic,diureticandvasodilatorproperties.
Itdoesnothaveinotropicaction.
Ithasbeenapprovedforuseinacutecardiacfailure.
ItsV/2isonly18minutes.
ItactsbyincreasingcGMPinsmoothmusclecells.
Themainsideeffectishypotension.
Thelimitingfactorisitsbreakdownbyenzyme,neutral
endopeptidase(NEP)-inhibitorsofthisenzymeecadotrilarebeing
testedforCHF.

---

524.Whichofthefollowingisrenininhibitor?
a)Losartan
b)Benazepril
c)Remikiren
d)Imidapril
CorrectAnswer-C
Ans.is'c'i.e.,Remikiren

---

525.Verapamilisusedinall,except?
a)Anginapectoris
b)Atrialfibrillation
c)Ventriculartachycardia
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Ventriculartachycardia
UseofVerapamilasanantiarrhythmic
PSVT
Anginapectoris--AllCCB'sareeffectiveinreducingfrequency
andseverityofclassicalaswellasvariantangina.Itisbeneficialin
anginainthefollowingway
ClassicalanginaReducescardiacwork,mainlyasaresultof
reducedafterload.
VariantanginaPreventarterialspasm.
Hypertension
Hypertrophiccardiomyopathy
Suppressnocturnallegcramps
Migraine

---

526.Maximumtachycardiaisseenwith
a)Nifedipine
b)Verapamil
c)Propanolol
d)Amlodipine
CorrectAnswer-A
Ans.is'a'i.e.,Nifedipine

---

527.Whichistrueaboutcalciumchannel
blockers-
a)Verapamilcausesreflextachycardia
b)Diltiazamcausesreflextachycardia
c)Nifedipinecausesreflextachycardia
d)Nifedipinehaslongert1/2thanfelodipine
CorrectAnswer-C
Ans.is'c'i.e.,Nifedipinecausesreflextachycardia
DHPs(nifedipine)causereflextachycardia.
oFelodipine-itdiffersfromnifedipineinhavinggreatervascular
selectivity,largetissuedistributionandlongert1/2.

---

528.Sublingualnitroglycerinfortreatmentof
acutechestpaincancause?
a)Hypertension
b)Headache
c)Bradycardia
d)Sexualdysfunction
CorrectAnswer-B
Ans.is'b'i.e.,Headache
Duetovasodilatationtheremaybetachycardia,palpitation,flushing,
headache,dizzinessandfaintingmayoccur.
Adverseeffects
Duetovasodilatationtachycardia,palpitation,flushing,headache,
dizzinessandfaintingmayoccur.
Rashesarecommonparticularlywithpentaerythritoltetranitrate.
Methemoglobinemia.
Sildenafilcausesdangerouspotentiationofnitrateaction(cGMPis
increasedbynitratesanditsbreakdownbyphosphodiesteraseis
inhibitedbysildenafilmarkedaccumulationofcGMP)-severe
hypotension,MIanddeathmayoccurtheonlycontraindicationsof
nitratesusearehypotensionorsimultaneoususeofsildenofil.

---

529.Drugofchoiceforclassicalangina
attack?
a)CCBs
b)-blocker
c)GTN
d)Prazocin
CorrectAnswer-C
Ans.is'c'i.e.,GTN
Forimmediatepre-exertionalprophylaxisandacuteattack
Sublingualglyceraltrinitrate(Drugofchoice)

---

530.Shortestactingcalciumchannelblocker
?
a)VerapamiI
b)Amlodipine
c)Nimodipinc
d)Diltiazam
CorrectAnswer-C
Ans.is'c'i.e.,Nimodipine
NimodipineisshortestactingCCB.Katzung10/1/2-191
Nimodipineselectivelyrelaxescerebralvasculature-canbeusedin
subarachnoidhaemmorrhageorrupturedcongenitalintracranial
aneurism.
AmlodipineislongestactingCCB.
Amlodipinehasmaximumoralbioavailabilitv.
Nisoldipinehasminimumoralbioavailability.

---

531.Treatmentofchoiceforprinzmetal's
angina
a)Nitroglycerine
b)CCBs
c)P-blockers
d)Prazosin
CorrectAnswer-A
Ans.is'a'i.e.,Nitroglycerine
Treatmentofvariantangina
Prinzmetal'svariantanginaisduetospasmofcoronaryvessels.
Thedrugswhichdilatethecoronaryvessels,arethemaintreatment
ofPrinzmental'sangina.
Drugsare:
1. Nitrates
2. Calciumchannelblockers(verapamil,diltiazem)
Nitroglycerinisconsideredthedrugofchoiceforthepatientwith
variantangina.
Prazosinaselectivea-blockermayalsobeusedbecauseitprevents
amediatedvasospasm.
ii-blocker'sarecontraindicatedbecausetheycauseconstrictionof
coronaryarteryduetounopposedamediatedvasoconstriction.
Preventionofvariantangina
IncontrastNitratesarenotusedforthepreventionofvariantangina
becauseofdelevelopmentoftolerance.
CCBsaretheDOCforprevention.

---

532.Drugusedforsympathectomyin
experimentalanimalsis?
a)Guanethidine
b)Atropine
c)Diazoxide
d)Thebaine
CorrectAnswer-A
Ans.is'a'i.e.,Guanethidine
Guanethidineisusedforexperimentalsympthectomy.
Guanethidineapolarguanidinecompoundwhichistakenupinto
adrenergicnerveendingsbyactiveaminetransportandhasthree
importantfacetsofaction:
DisplacesNAfromstoragegranulesstochiometrically.
InhibitsnerveimpulsecoupledreleaseofNA
EngagesandblocksNAuptakemechanismattheaxonal
membrane.
Itwasusedforsympathectomyinexperimentalanimal.

---

533.Sideeffectofsalmeterolis?
a)Tremor
b)Seizure
c)Hypertension
d)Hyperkalaemia
CorrectAnswer-A
Ans.is'a'i.e.,Tremor
Themostcommonsideeffectsaremuscletremorandpalpitation
Hypokalemia
Hyperglycemia
Tolerance
Throatirritation
Ankleedema.
Othersideeffectsareanxiety,headache,musclecramps,dry
mouth,arrhythmia,flushing(duetovasodilatation),hypoxemia,MI,
disturbanceofsleepandbehavior.

---

534.Allarethefollowingarethefunctionsof
PGElexcept-
a)Erectiledysfunction
b)Erectiledysfunction
c)Inductionofpuberty
d)PDA
CorrectAnswer-C
Ans.is'c'i.e.,Inductionofpuberty

---

535.Whichdrugistobegiveninatruck
driverforrhinitis?
a)Cetrezine
b)Hydroxyzine
c)Promethazine
d)Buclizine
CorrectAnswer-A
Ans.is'a'i.e.,Cetrezine

---

536.Whichsecondgenerationantihistaminic
doesnotproduceanactivemetabolite
a)Loratidine
b)Terfenadine
c)Cetrizine
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Cetrizine
Importantfactsaboutanhistaminics
Loratidine,desloratidine,ebastineandmizolastineareamongstthe
longestactingantihistaminic(durationofaction24hrs).
Allsecondgenerationantihistaminicsaremetabolizedtoactive
productsexceptcetrizineandmizolastine.
LoratidinehasleastCNSdepressionaction.
Acrivastineistheshortestactingantihistaminic.
OlopatodineisarecentlyapprovedtopicalHI-antihistaminicusedas
nasalsprayforseasonalallergicrhinitis.

---

537.Prodrugofcetrizineis
a)Foxefenadone
b)Terfenadine
c)Hydroxyzine
d)Azelastine
CorrectAnswer-C
Ans.is'C'i.e.,Hydroxyzine
CetrizineisametaboliteofHydroxyzinewithamarkedaffinityfor
peripheralH1receptors;penetratesthebrainpoorly.
Itinhibitsthereleaseofhistamineandofcytotoxicmediatorsfrom
plateletsaswellaseosinophilchemotaxisduringthesecondary
phaseofallergicresponse.
Itisindicatedinupperrespiratoryallergies,pollinosis,urticaria,and
atopicdermatitis;alsousedasanadjuvantinseasonalasthma.

---

538.Aminophyllineinhibitswhichenzyme?
a)MAO
b)Alcoholdehydrogenase
c)Phosphodieseterase
d)CytochromeP450
CorrectAnswer-C
Ans.is'c'i.e.,Phosphodiesterase

---

539.Beta2agonistusedinrescuetherapyin
acuterespiratoryconditionsareall
except-
a)Terbutaline
b)Salbutamol
c)Bambuterol
d)Ketotifen
CorrectAnswer-D
Ans.is'd'i.e.,Ketotifen

---

540.Beta2-agonistcauseallexcept
a)Hyperkalemia
b)Hyperglycemia
c)Tremer
d)Palpitaion
CorrectAnswer-A
Ans.is'a'i.e.,Hyperkalemia
Adverseeffectsofinhalationalagonists
Themostcommonsideeffectsaremuscletremorandpalpitation
Hypokalemia
Hyperglycemia
Tolerance
Throatirritation
Ankleedema
Othersideeffectsareanxiety,headache,musclecramps,dry
mouth,arrhythmia,flushing(duetovasodilatation),hypoxemia,MI,
disturbanceofsleepandbehaviour.

---

541.Whichofthefollowingisnotusedin
acuteattackofseverepainduetogout?
a)Indomethacine
b)Colchicine
c)Febuxostat
d)Corticosteroids
CorrectAnswer-C
Ans.is'c'i.e.,Febuxostat

---

542.Abataceptis?
a)TNFalphainhibitor
b)Inhibitorofco-stimulationofTcells
c)IL-1receptorantagonist
d)MonoclonalantibodyagainstIL-6receptor
CorrectAnswer-B
Ans.is'b'i.e.,Inhibitorofco-stimulationofTcells
T-cellcostimulatoryblockers
Abatacept
Itisafusionproteinthatcombinestheextracellulardomainofthe
moleculeCTLA4(CD154)withtheFcportionofahuman
immunoglobulin.
Itinterfereswiththeinteractionsbetweenantigenpresentingcells
andTlymphocytes.Therefore,itaffectsearlystagesinthe
pathogeniccascadeofeventinRA.
CTLA4hashighaffinityforCD28whenabataceptbindstoCD28on
Tcellsurface,itpreventsthesecondsignalfrombeingdelivered,
thusturningdowntheTcellresponse.
AdditionaleffectsaredecreasingtheproductionofTcell-derived
cytokinesincludingTNF.

---

543.NSAIDScausegastriculcerbecause?
a)TheyinhibitCOX-2enzyme
b)Theyinhibitmucusproduction
c)TheyincreaseHCIproduction
d)Theydelaygastricemptying
CorrectAnswer-B
Ans.is'b'i.e.,Theyinhibitmucusproduction
Prostaglandinsfunctionasnaturalulcerprotectivesbyenhancing
gastricmucusandHCO3-production,aswellasbyimproving
mucosalcirculationandhealth.TheulcerogenicactionofNSAIDs
maybeduetolossofthisprotectiveinfluence.
PGEanaloguesarecytoprotectiveatlowdosesandinhibitgastric
acidsecretionathigherdoses.NSAIDsinhibitprostaglandin
secretionandthusantagonizesitscytoprotectiveeffect.
MisoprostolisusedinNSAIDsinducedulcers.

---

544.Whichofthefollowingisa
mineralocorticoidantagonist?
a)Spironolactone
b)Inamrinone
c)Nicorandil
d)Ketorolac
CorrectAnswer-A
Ans.is'a'i.e.,Spironolactone

---

545.Thiazidesacton?
a)PCT
b)DCT
c)Glomerulus
d)DescendinglimbofloopofHenle
CorrectAnswer-C
Ans.is'c'i.e.,DCT
Tubularabsorptioncanbedividedintofoursites.
Site1-Proximaltubule
FourmechanismsofNa'transporthavebeendefinedinthis
segment?
DirectentryofM.+alongelectrochemicalgradient.
Nat-K*symportalongwithactivereabsorptionofglucose,
aminoacids,organicanionsandPO43.
ExchangewithWbyNa*IWexchangerlocatedintheluminal
membraneofproximaltubule(PT)epithelialcells.ThePTcells
secreteWwiththehelpofcarbonicanhydrase.Wionexchanges
withNat-presentintubularfluidthroughNa+-H+exchanger
(antiporter)andformsH2CO3bycombiningwithHCO3-.ThisH2CO3
isbrokenintoH20+CO2bybrushbordercarbonicanhydrase;both
CO2andH20diffuseinsidethecellandrecombinetoformH2CO3
withthehelpofintracellularcarbonicanhydrase.ThisH,CO3isthe
sourceofF1*.ThedissociatedHCO3-inthecellistransportedto
corticalE.C.F.bybasolateralmembraneNa-F-HCO3-symporter
resultinginnetreabsorptionofNaHCO3.
Carbonicanydraseinhibitors(acetazolamide)act
predominantlyinPCTandinhibitNaHCO3reabsorption.

---

ThedisroportionatelylargeHCO3-,acetate,PO4-3,passivedriving
forcesforCl-todiffusethroughtheparacellularpathway,particularly
inthelaterPT.ThistakesNa'andH,0alongtomaintainelectrical
neutralityandisotonicity;reabsorptioninPTisisotonic.
Osmoticdiuretics(mannitol)aresoluteswhicharenotabsorbedin
proximaltubuleandthereforeretainwater.
SiteIIAscendinglimbofloopofHenle
Thethickascendinglimbcanbedistinguishedintotwodistinct
portion.
Medullaryportionlinedbycuboidalcells.
Corticalportionlinedbyflattenedcells.
Bothportionsarerelativelyimpermeabletowaterbutabsorbsalt
activelyandthusdilutetubularfluid.
Inthemedullaryportionadistinctluminalmembranecarrier
transportsionsinratioofNee-K+-2a.Thesodiumentersthecellis
pumpedtoECFbyNaATPaseatthebasolateralmembrane.
ThisNa?-K?-2C1:symportisinhibitedbyloopdiuretics(eg-
Furosemide).
Inaddition,aNa*-C1-symportermovesCI-downitselectrochemical
gradientintoECFandcarriesNa+along.
SiteIII-corticaldilutingsegmentofloopofHenleandearlyDT
ThissegmentisalsoimpermeabletoH20andcontinuestoabsorb
saltthroughNat-Ctsymporter.
Thiazidediureticsactatthissite.
SiteIV-latedistaltubuleandcollectingduct
InlateDTandCD,Naisactivelyreabsorbed;thecation-anion
balancebeingmaintainedpartlybypassiveCI-diffusionandpartly
bysecretionofK+andFr.
AbsorptionofNa+atthissiteoccursthroughaspecificamiloride
sensitiveNet'channelandiscontrolledtoalargeextentby
aldosterone.
Kparingdiureticsactatthissite.
CollectingtubuleisthemostimportantsiteofICsecretionbythe
kidneyandthesiteatwhichvirtuallyalldiureticinducedchangesin
KEbalanceoccur-asICsecretionoccursinexchangeofNat,higher
theNa+loadinCDhigherwillbeK+excretioninurine-->Diuretics

---

whichactonPCT(maximumabsortionofNa+occursatPCT)like
acetazolamidewillcausemaximumkaliuresis(ICexcretioninurine).
TheprincipalcellsarethemajorsitesofNat,IC-,andwater
transport,andintercalatedcellsaretheprimarysitesofFt'secretion.
Thecollectingtubuleisalsothesiteatwhichthefinalurine
concentrationisdetermined.ADH(vasopressin)controlsthe
permeabilityofthissegmenttowaterbyregulatingtheinsertionof
preformedwaterchannels(aquaporin2,AQP2)intotheapical
membraneviaaGprotein-coupledcAMP-mediatedprocess.
ADHalsostimulatestheinsertionofureatransporterUT1molecules
intotheapicalmembranesofmedullarycollectingtubulecells.Urea
concentrationinthemedullaplaysanimportantrolemaintainingthe
highosmolarityofthemedullaandintheconcentrationofurine.

---

546.Highdoseofmorphineisusedwithout
muchdangerin?
a)Gallbladdersurgery
b)Labour
c)Myocardialinfarction
d)Headinjury
CorrectAnswer-C
Ans.is'c'i.e.,Myocardialinfarction
Morphineshouldbegivenpromptlyinmyocardialinfarctiontoallay
apprehensionandreflexsympatheticstimulation.
Morphineshouldbeusedcautiouslyingallbladderandbiliarytract
dysfunctionasitcausesspasmofsphincterofoddiandcancause
acuteriseofintrabiliarypressure.
Usedduringlabour,morphinecancauseneonatalrespiratory
distress.
Headinjuryisacontraindicationformorphineuse.

---

547.Cardiacconductiondefectseenwith
Tricyclicantidepressantsaredueto?
a)NE&serotoninuptakeinhibitor
b)Antimuscarinicactiononheart
c)OnlyNEuptakeinhibition
d)BothNEuptakeinhibitionandantimuscarinicactiononheart
CorrectAnswer-D
Ans.is'd'i.e.,BothNEuptakeinhibitionandantimuscarinicaction
onheart
Thecommonestcardiovasculareffectoftricyclicantidepressant
overdoseissinustachycardia.
Duetoinhibitionofnorepincphrinereuptakeandtheanticholinergic
action.
However,themostimportanttoxiceffectoftricyclicsistheslowingof
depolarisationofthecardiacactionpotentialbyinhibitionofthe
sodiumcurrentandthisdelayspropagationofdepolarisationthrough
bothmyocardiumandconductingtissue.
ThisresultsinprolongationoftheQRScomplexandthePR/QT
intervalswithapredispositiontocardiacarrhythmias.
Thisinhibitionofsodiumfluxintomyocardialcellscanoccurtosuch
anextentthatdepressedcontractilitycanresultandthis,coupled
withthereductioninperipheralresistance,contributesto
hypotension.

---

548.RemissionwithSSRIorTCApatient
againhavingrelapse.Theremaybe
deficiencyof?
a)Pyridoxine
b)Cobalamine
c)Ascorbate
d)Retinol
CorrectAnswer-B
Ans.is`b'i.e.,Cobalamine
SubjectswithvitaminB12deficiencyanddepressionmaypresent
withhistoryofpastepisodeswithspontaneous
remissionorresponsetotreatmentwithantidepressantsandlater
recognitionordevelopmentBudeficiency"
Studieshavefoundthatsomepeoplewithdepressionmayhavelow
levelsoffolicacid,vitaminB12orvitaminD.

---

549.SedativewithGABAfacilitatingaction
butwithoutanticonvulsantandmuscle
relaxantpropertiesandnoeffecton
sleep?
a)Diazepam
b)Zolpidem
c)Phenobarbitone
d)Buspirone
CorrectAnswer-B
Ans.is'b'i.e.,Zolpidem
Amongthegivenoptions,threearesedative-hypnoticwith
GABAfacilitatoryaction-
Diazepam(abenzodiazepine)Butitalsohasanticonvulsantand
musclerelaxantproperty.it)PhenobarbitoneButithas
anticonvulsantproperty.
Zolpidem
Hasnoanticonvulsantandmusclerelaxantpropertyandhaveno
effectonsleeparchitecture.Zolpidem
Zolpidemisanon-benzodiazepinehypnotic.
MinimalsuppressiveeffectonREMsleeparchitectureisnot
disturbed.

---

550.Lithiumdirectlyaffectswhichion?
a)Sodium
b)Potassium
c)Magnesium
d)Calcium
CorrectAnswer-A
Ans.is'a'i.e.,Sodium
Diuretics(particularlythiazides)decreasetherenalexcretionof
lithiumandthusmayresultintoxicity.Thisisduetoincreased
reabsorptionofNa'andlithiumions(asacompensatoryresponseto
excessivelossofNat).
Interactionsoflithium
1. Diuretics(thiazide,furosemide)bycausingNa+losspromote
proximaltubularreabsorptionofNa+aswellasLiPlasmalevelof
lithiumrises.
2. Tetracyclines,NSAIDsandACEinhibitorscauselithiumretention.
3. Lithiumtendstoenhanceinsulin/sulphonylureainduced
hypoglycemia(lithiumhasinsulinlikeactiononglucose
metabolism).
4. LithiuminhibitstheactionofADHondistaltubulescauses
nephrogenicDI.
5. Lithiumreducethyroxinesynthesisbyinterferingiodinationof
tyrosine.

---

551.Whichofthefollowingisan
antipsychoticdrug?
a)Flupenthixol
b)Rasagiline
c)Clobazam
d)Divalproex
CorrectAnswer-A
Ans.is'a'i.e.,Flupenthixol
Antipsychotics(Neuroleptics)
Antipsychoticsareagroupofpsychoactivedrugscommonlyusedto
treatpsychosis,e.g.Schizophrenia.
Antipsychoticdrugsaredividedinto:
Typicalantipsychotics(firstgenerationantipsychotics)
1. Phenothiazines-Chlorpromazine,Thioridazine,Trifluperazine,
Fluphenazine.
2. Thioxanthenes-Thiothixene,Flupenthixol.
3. Butyrophenones-Haloperidol,Trifluperidol,Penfluridol.
4. Otherheterocyclics-Pimozide,Loxapine,Sulpiride
B)Atypical
antipsychotics(secondgenerationantipsychotics)
1.Clozopine3.Olanzopine5.Aripiprazole
2.Risperidon4.Quetiapine6.Ziprasidone

---

552.WhichofthefollowingisaTCA?
a)Amoxapin
b)Citalopram
c)Venlafaxine
d)Bupropion
CorrectAnswer-A
Ans.is'a'i.e.,Amoxapine
Antidepressants
A.Typical
Tricyclicantidepressants
NA+5HTreuptakeinhibitors:-Imipramine,Trimipramine,
Amitriptyline,Clomipramine.
PredominantlyNAreuptakeinhibitors:-Desipramine,Nortriptyline,
Amoxapine,Reboxetine.b)Selectiveserotoninreuptakeinhibitors:-
Fluoxetine,Paroxetine,Sertaline,Citalopram,Scitalopram.
B.Atypical:-Trazodone,Mianserine,Mitrazapine,Venalafaxin,
Duloxetine,Tianeptine,Amineptine,Bupropion.
C.MAOinhibitors:-Tranylcypramine,Meclobemide,Clorgyline.

---

553.Whichofthefollowingisatricyclic
antidepressant?
a)Vanalafexine
b)Fluoxetine
c)Doxepine
d)Citalopram
CorrectAnswer-C
Ans.is'c'i.e.,Doxepine

---

554.Visualfieldmonitoringisimportant
beforestarting?
a)Vigabatrin
b)Topiramate
c)Valproicacid
d)Carbamazepine
CorrectAnswer-A
Ans.is'a'i.e.,Vigabatrin

---

555.Trueaboutlamotrigene?
a)Decreasedefficacyindepression
b)Firstchoiceinabsenceseizure
c)t1/2is24hrs
d)Notmetabolisedinliver
CorrectAnswer-C
Ans.is'c'i.e.,t1/2is24hrs

---

556.WhichisaGABAtransaminaseinhibitor
?
a)TCA
b)Sertaline
c)Valproate
d)Gabpentin
CorrectAnswer-C
Ans.is'c'i.e.,Valproate
Mechanismofaction
FacilitationofGABAmediatedC1channelopening
BarbituratesandbenzodiazepinesbindtoGABAAreceptorandopen
Cl-channel.
ValproteandvigabatrineinhibitenzymeGABAtransaminasewhich
degradesGABArconc.ofGABA.
TiagabineinhibitstheuptakeofGABAintotheneuronesby
inhibitingGAT-1.
GabapentineenhancestheGABAreleasefromsynapticvesicles.

---

557.Sideeffectoftopiramateis?
a)Weightloss
b)Visualimpairment
c)Insomnia
d)Hemolysis
CorrectAnswer-A
Ans.'a'i.e.,Weightloss
Topiramate
Weakcarbonicanhydraseinhibitorwithbroad-spectrum
anticonvulsantactivity.
Actsvia-prolongationofNa+channelinactivation,GABA
potentiation,glutamatereceptorantagonism,neuronal
hyperpolarisationviaK+channels.
UsedinSPS,CPS,GTCS,myoclonicepilepsy,prophylaxisof
migraine.
Readilyabsorbedorallyandmainlyexcretedintheurine.
T1/2-24hrs.
Adverseeffectsimpairmentofattention,sedation,ataxia,word-
findingdifficulties,poormemory,weightloss,paresthesias,and
renalstones.

---

558.Duetowhichsideeffectfelbamatecan
bediscontiuned?
a)Aplasticanemia
b)Renalimpairment
c)Gastrointestinaldisorder
d)Seizures
CorrectAnswer-A
Ans.is'a'i.e.,Aplasticanemia
TwoseveresideeffectsoffelbamateareforwhichFDAhasissued
warningthatdrugnotbeusedarehepaticfailureandaplastic
anemia

---

559.Whichisnotusedinstatusepilepticus?
a)Lorazepam
b)Phenytoin
c)Phenobarbitone
d)Valproate
CorrectAnswer-D
Ans.is'd'i.e.,Valproate

---

560.AllaresideeffectsofClozapine,except?
a)Granulocytopenia
b)Seizures
c)Sedation
d)Extrapyramidalsideeffects
CorrectAnswer-D
Ans.is'd'i.e.,Extrapyramidalsideeffects
Sideeffectsofclozapine
Agranulocytosis
UnstableBP&Tachycardia
Worseningofdiabetes
Seisures
Urinaryincontinence
Hypersalivation(sialorrhoea)
Weightgain
Sedation

---

561.Mostcommonsideeffectofhaloperidol
?
a)Hypotension
b)Akathasia
c)Drynessofmouth
d)Ticdisorder
CorrectAnswer-B
Ans.is'b'i.e.,Akathasia
75%ofpatientsexperienceextrapyramidalsymptoms(Akathisia,
Parkinsonism,acutemusculardystonia)withallclassical(typical)
antipsychotics.
Haloperidolisatypicalantipsychotic.

---

562.Allareproducedbylareceptorsexcept-
a)Euphoria
b)Sedation
c)Dysphoria
d)Constipation
CorrectAnswer-C
Ans.is'c'i.e.,Dysphoria

---

563.PhaseIIblockisseenwith-
a)SChinfusion
b)SingledoseSCh
c)Mivacurium
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,SChinfusion
Undercertainconditionsdepolarizingagentsproducedual
mechanismofneuromuscularblockadewhichcanbedividedinto
twophases:
a.PhaseIblock
Rapidinonset
Resultfrompersistantdepolarizationofmuscleendplate.
b.PhaseIIblock
Slowinonset
ResultsfromdesensitizationofreceptortoACh.
PhaseIIblockisseenwhenfluorinatedanaestheticshavebeen
givenorwhenSChisinjectedinhighdoseorinfusedcontinuously.
SChalsoproducesphaseIIblockinpatientswithatypicalor
deficientpseudocholinesterase.

---

564.Anandamideis?
a)Opioid
b)CK1antagonist
c)D2blocker
d)Cannabinoidneurotransmitter
CorrectAnswer-D
Ans.is'd'i.e.,Cannabinoidneurotransmitter
Anandamide,alsoknownasN-arachidonoylethanolamineorAEA,is
anendogenouscannabinoidneurotransmitter.
ThenameistakenfromtheSanskritwordAnanda,whichmeans
"bliss,delight",andamide.
ItissynthesizedfromN-arachidonoylphosphatidylethanolamineby
multiplepathways.
Itisdegradedprimarilybythefattyacidamidehydrolase(FAAH)
enzyme,whichconvertsanandamideintoethanolamineand
arachidonicacid.
Assuch,inhibitorsofFAAHleadtoelevatedanandamidelevelsand
arebeingpursuedfortherapeuticuse.

---

565.Drugofchoiceforreversalofmuscle
relaxantafteranaerthesia
a)Pralidoxine
b)Neostigmine
c)Atropine
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Neostigmine
Reversalofneuromuscularblock
Nondepolarisingmusclerelaxantshaveantagonisticactionon
acetylcholine
Anticholinesterasesactbyinhibitingtheactionof
acetylcholinesterase(anenzymethatdegradesacetylcholineby
causingitshydrolysis).
Anticholinesterasesthusincreasethelevelofacetylcholineatthe
neuromuscularjunction.
Neostigminealsohassomeadditionaldirectactiononcholinergic
receptorsi.e.,itdepolarizesmotorendplate.
ItdoesnotincreasethereleaseofACH.AccumulatedACHactson
prejunctionalmuscarinicautoreceptorsandinhibitsthereleaseof
ACH.

---

566.Sugamadexisusedfor?
a)Organophosphatepoisoning
b)ReversalofNMblockers
c)Treatmentoflocalanaestheticpoisoning
d)Treatmentofcentralanticholinergicsyndrome
CorrectAnswer-B
Ans.is'b'i.e.,ReversalofNMblockers
Sugamadexisanovelreversingagentdevelopedforterminatingthe
actionofnondepolarizingmusclerelaxantsrocuroniumand
vecuronium.
Itisamodifiedy-cyclodextrinwithhighaffinityforrecuroniumand
vecuronium.
ItencapsulatesonemoleculeofNMblockerwithinitsmolecule
forminganinactivechelatewhichisexcretedinurinewithVAof2
hours.
Itssideeffectsaremildprecordialpain,nausea,alterationoftaste
andrarelyallergy.

---

567.Benzylisoquinolinemusclerelaxantis?
a)Vecuronium
b)Rocuronium
c)Doxacurium
d)Pancuronium
CorrectAnswer-C
Ans.is'c'i.e.,Doxacurium
Competitive(nondepolarizing)blockersareoftwotypes-
Benzylisoquinolonederivatives
Thisincludesd-TC,doxacurium,atracurium,cisatracurium,
mivacurium,metocurine.
Thesedrugshavetendencytoreleasehistamineandtoblock
autonomicganglion.
Amminiosteroidderivatives
Thisincludepancuronium,rocuronium,vecuronium,pipecuronium,
rapacuronium.
Thesedrugsdonotblockautonomicgangliaandhaveminimal
histaminereleasingproperty.

---

568.Whichanaestheticagenthasmaximum
MAC?
a)Ether
b)Methoxyfluorane
c)N20
d)Halothane
CorrectAnswer-C
Ans.is'c'i.e.,N20
Minimalalveolarconcentration
Itisthelowestconcentrationoftheanaestheticinpulmonaryalveoli
neededtoproduceimmobilityinresponsetoapainfulstimulus
(surgicalincision)in50%individuals.
ItisthemeasureofpotencyofinhalationGAs.
Blood:gaspartitioncofficient
Itisthemeasureofsolubilityofagentinblood.
Itdeterminesthespeedofonsetandrecovery.
Highertheblood:gaspartitioncofficient,lesserthespeedof
inductionandrecovary-4morebloodsolubleagentshaveslower
inductionandrecovery.
Oil:gaspartitioncofficient
Itisthemeasureoflipidsolubilityoftheagent,andtherefore
solubilityinthefat-richtissuesoftheCNS.
Thisequateswiththepotencyofindividualagents.
Thereisadirectrelationshipbetweentheminimumalveolar
concentration(MAC)valueofinhaledanaestheticagentsandlipid
solubilityintermsoftheoil/gaspartitioncofficient.
Remember

---

MaximumMAC-4N20
MinimumMACHalothane(Previouslyitwasmethoxyflurane,butitis
notusednow)
Maximumblood:gaspartitioncofficient-4Ether
Minimumblood:gaspartitioncofficientDesflurane
Maximumoil:gaspartitioncofficientHalothane(Previouslyitwas
methoxyflurane,butitisnotusednow)
Minimumoil:gaspartitioncofficient-->N20?

---

569.Increasedinsulinsecretionfrombeta
cellsisdoneby?
a)Metformin
b)Pramlidine
c)Repaglinide
d)Pioglitazone
CorrectAnswer-C
.Ans.is'c'i.e.,Repaglinide
Oralhypoglycemicdrugsmaybedividedintotwogroups:?
1.Group1
Thesedrugsreduceplasmaglucosebystimulatinginsulin
production,thereforecalledinsulinsecretogogues.
Hypoglycemiaisawellknownsideeffect.
Examplesare:
1. Sulfonylureas:firstgeneration(chlorpropamide,tobutamide);second
generation(Glimipiride,glyburide,glipizide,gliclazide).
2. Megalitinnide/D-phenylalanineanalogues:Nateglinide,Rapaglinide.
2.Group2
Thesedrugsreducebloodglucosewithoutstimulatinginsulin
production,thereforeareinsulinnon-secretogogues.
Thesedurgsdonotcuasehypoglycemiawhenusedaloneandcan
causehypoglycemia,onlywhenusedwithotheroralhypoglycemics.
Examplesare:
1. Biguanides:Metformin,Phenformin
2. Thiazolidinediones:Rosiglitazone,Pioglitazone,Troglitazone.
3. a-glucosidaseinhibitors:Acarbose,miglital.

---

570.Whichantidiabeticdrugisusedbothfor
typeI&IIDM-
a)Sulphonylureas
b)Metformin
c)Acarbose
d)Pramlinitide
CorrectAnswer-D
Ans.is'd'i.e.,Pramlinitide
oPramlinideistheonlyapproveddrug,besideinsulin,tobeusedin
bothtype-Iandtype-2DM.

---

571.Trueaboutsitagliptinisallexcept
a)UsedintypeIIDM
b)Usedincombinationwithotheroralhypoglycaemic
c)Cannotbeusedorally
d)Allaretrue
CorrectAnswer-C
Ans.is'c'i.e.,Cannotbeusedorally
Sitagliptin
ThisisorallyactiveinhibitorofDPP-4.
ItpreventsdegradationofendogenousGLP-1andotherincretins,
potentiatingtheiraction,resultinginlimitationofpostprandial
hyperglycemia.
Itisusedintype2DM.
OtherDPP-4inhibitorisvildagliptin.

---

572.Atmureceptor,buphrenorphineis?
a)Partialagonist
b)Partialantagonist
c)Completeagonist
d)Completeantagonist
CorrectAnswer-A
Ans.is'a'i.e.,Partialagonist

---

573.Thiazolidinedioneisassociatedwith
increasedriskof?
a)Heartfailure
b)Pulmonaryfibrosis
c)Myocarditis
d)renaldysfunction
CorrectAnswer-A
Ans.is'a'i.e.,Heartfailure
Thiazolidinediones
adverseeffects
Plasmavolumeexpansion,edema,weightgain,headache,myalgia
andmildanemia.
Fewcasesofhepaticdysfunctionandsomecardiovascularevents
havebeenreported-CHFmaybeprecipitatedtheyare
contraindicatedinliverdiseaseandinCHF.
Rosiglitazonehasbeenfoundtoincreasetheriskoffracture,
especiallyinelderlywomen.
GlitazoneswithinsulincanprecipitateCHFavoidsuch
combination.
Thesedrugspreventtype2DMinprediabetics.

---

574.Metforminisusedintreatment&control
of?
a)Diabetes
b)PCOD
c)Pregnancyinducedhypertension
d)Bothaandb
CorrectAnswer-D
Ans.is'd'i.e.,Bothaandb
Biguanidesactsby:
Suppresshepaticgluconeogenesisandglucoseoutputfromliver
majoraction.
Enhanceinsulinmediatedglucosedisposalinmuscleandfat
(Increasedperipheralutilizationofglucose)byenhancingGLUT-1
transportfromintracellularsitetoplasmamembrane.
Retartdintestinalabsorptionofglucose.
Promoteperipheralglucoseutilizationbyenhancinganaerobic
glycolysis.
Alsoknow
BesideDM,metforminisalsousefulinpolycysticovariandisease.
Metforministheonlyoralhypoglycemicthatreducesmacrovascular
eventsintype2DM.
MetoforminisoneofonlytwooralantidiabeticsintheWHOmodel
listofessentialmedicines(theotherbeingglibenclamide).

---

575.Drugusedinpostprandialsugarcontrol
is?
a)Alfaglucosidase
b)Biguinides
c)Sulfonylurea
d)Repaglinide
CorrectAnswer-D
Ans.is'd'i.e.,Repaglinide

---

576.Mechanismofactionofprophylthiouracil
?
a)Preventssynthesisofthyroglobulin
b)Preventsiodinetrapping
c)PreventsreleaseofT4&T3
d)Inhibitscoupling
CorrectAnswer-D
Ans.is'd'i.e.,Inhibitscoupling

---

577.Orallyactivehormoneis?
a)TSH
b)Thyroxine
c)GH
d)Prolacin
CorrectAnswer-B
Ans.is'b'i.e.,Thyroxine

---

578.Whichofthefollowingdrugsusedto
treattype-IIdiabetesmellituscauses
weightloss
a)Metformin
b)Glimepiride
c)Repaglinide
d)Gliclazide
CorrectAnswer-A
Ans.is'a'i.e.,Metformin
Effectofantidiabeticdrugsonweight
1. Increased:Sulfonylureas,insulin,pioglitazone
2. Decreased:Metformin,GLP-1antagonists,pramlinitide
3. Noeffect:DPP-4inhibitors

---

579.Whichoftheantithyroiddruginhibit
iodinetrapping?
a)Radioactiveiodine
b)Iodides
c)Methimozole
d)Thiocyanades
CorrectAnswer-D
Ans.is'd'i.e.,Thiocyanades

---

580.Shortactingglucocorticoidis?
a)Fludrocortisones
b)Dexamethasone
c)Hydrocortisone
d)Aldostrone
CorrectAnswer-C
Ans.is'c'i.e.,Hydrocortisone
Short-acting:
Cortisol
8-12hours
Intermediate-acting:
Prednisolone
18-36hours
Long-acting:
36-54hours

---

581.Longestactingglucocorticoidsis?
a)Prednisone
b)Prednisolone
c)Cortisone
d)Dexamethasone
CorrectAnswer-D
Ans.is'd'i.e.,Dexamethasone

---

582.Themostpotenttopicalcorticosteroidis
a)Betamethasonevalerate
b)Triamcinoloneacetonide
c)Hydrocortisoneacetate
d)Clobetasolpropionate
CorrectAnswer-D
Ans.is`d'i.e.,Clobetasolpropionate

---

583.Whichofthefollowingreducesthe
efficacyoforalcontraceptives?
a)Erythromycin
b)Griseofulvin
c)Cimetidine
d)Disulfiram
CorrectAnswer-B
Ans.is'b'i.e.,Griseofulvin
Contraceptivefailuremayoccurifthefollowingdrugsaregiven
concurrently:
(a)EnzymeinducerEnhancesthemetabolismofestrogen&
progesterone.
1. Phenytoin3.Carbamazepine5.Primidone
2.Phenobarbitone4.Rifampicin6.Griseofulvin
(b)Suppressionofintestinalmicrofloraenterohepatic
circulation.
1.Tetracyclines2.Ampicillin

---

584.ThirdgenerationIUCD?
a)Mirena
b)Nova-T
c)Lippe'sloop
d)CuT-200
CorrectAnswer-A
Ans.is'a'i.e.,Mirena

---

585.Thebestdrugforcontrolofesophageal
bleedingis?
a)Vasopressin
b)Octreotide
c)GnRH
d)Propranolol
CorrectAnswer-A
Ans.is'a'i.e.,Vasopressin
Terlipressin(analogueofvesopressin)isconsideredthevasoactive
agentofchoiceforacutevaricealbleeding.
Otherdrugsusedaresomatostatinanditsanalogocteride.

---

586.Drugofchoiceforbleedingoesophageal
varicesis?
a)Ethanolamineoleate
b)Octreotide
c)Propanolol
d)Phytonadione
CorrectAnswer-B
Ans.is'b'i.e.,Octreotide
Amongthegivenoptions,onlyocterideisused(otherwise
vasopressineanalogueterlipressineistheDOC).
Hasbeenexplainedinprevioussessions.

---

587.Whichamongthefollowingisan
absolutecontraindicationofHormone
replacementtherapy?
a)Endometriosis
b)Osteoarthritis
c)Heartdisease
d)Breastcarcinoma
CorrectAnswer-D
Absolutecontraindicationsofhormonereplacementtherapy(HRT):
UndiagnosedvaginalbleedingEstrogendependentcancerinthe
bodySevereliverdiseasePregnancyVenousthrombosisWell-
differentiatedandearlyendometrialcancer(oncetreatmentforthe
malignancyiscomplete,isnolongeranabsolutecontraindication.)

---

588.Drugofchoiceforpheochromocytoma?
a)Propranolol
b)Phenoxybenzamine
c)Prazosin
d)Nitroprosside
CorrectAnswer-B
Ans.is'b'i.e.,Phenoxybenzamine
Pharmacologicaltreatmentofpheochromocvtoma
Preoperativelyorwhentumourcannotberemoved,bloodpressure
controlisachievedbya-adrenoreceptorblockadewhichreverses
peripheralvasoconstrictionPhenoxybenzomineistheDOC
ForhypertensivecrisesorintraoperativecontrolofBP,phentolamine
istheDOC.Prazosinisanalternative.Nitroprussidecanalsobe
used-Harrison17th/ep.1561.
Inadrenalinesecretingtumors,iftachycardiapersists,13-blocker
canbeaddedafterstartingoc-blockers.
ACEinhibitororcalciumchannelblockerscanbeusedwhenblood
pressureisdifficulttocontrolwithphenoxybenzaminealone.
Metyrosinehasbeenusedwithsomesuccesstoblock
catecholaminesynthesisinmalignantpheochromocytoma.
Metaiodobenzylguanidine(MIBG)isactivelytakenupbyadrenergic
tissue123I-MIBGcanbeusedforselectivetherapeuticirradiation
offunctioningmetastasis.

---

589.ThebestagentforincreasingHDL
cholesterolis?
a)Statin
b)Nicotinicacid
c)Gugulipids
d)Fibrates
CorrectAnswer-B
Ans.is'b'i.e.,Nicotinicacid
Nicotinicacid(Niacin)
Therearethreemaintypeoflipasesrelatedtometabolismof
lipoproteins?
1. LipoproteinlipasePresentinbloodvesselsandcauseshydrolysis
oftryglyceridecontentofVLDLandchylomicrones.
2. HepaticlipaseConvertsIDLtoLDLbyhydrolysingthetriglyceride
contentofIDL.
3. HormonesensitivelipasePresentintracellularlyinperipheral
tissueandcausesintracellularlipolysisbyhydrolysingtriglycerides.
Niacin(Nicotinicacid)inhibitsintracellularlipolysisbyinhibiting
hormonesensitivelipaseintracellularFFAtolivertriglyceride
synthesis.
NiacinalsoincreasestheactivityoflipoproteinlipaseThydrolysis
ofVLDLtriglyceride.
NicotinicacidalsoreducestheproductionofVLDLinliverby
inhibitingTG-synthesisindirectlytheVLDLdegradationproducts
IDLandLDLarealsoreduced.
NicotinicacidisthemosteffectivedrugtoraiseHDL-CH.
IncreasedHDLisduetointerferenceofdirectpathwayofHDL
cholesteroltoliverwhichinvolvesapo-A,Niacindecreasesapo-A,

---

mediatedhepaticclearance.
NicotinicacidisusedintypeI,III,IV&Vhyperlipoproteinemias.

---

590.Allofthefollowingareadverseeffectsof
nicotinicacidexcept?
a)Vasodilation
b)Pancreatitis
c)Liverdysfunction
d)Hyperpigmentation
CorrectAnswer-B
Ans.is'b'i.e.,Pancreatitis
Adverseeffectsofnicotine
Adverseeffects1)Markedflushing,itching(pruritis)andheatdue
tocutaneousvasodilatation,2)Dyspepsia,vomitinganddiarrhoea,
3)Liverdysfunction,4)Hyperpigmentationanddrynessofskin,5)
Hyperglycemiaandhyperuricemia.
Thecutaneouseffectsofnicotinicacidincludeflushingandpruritis
offaceanduppertrunk,skinrashesandacanthosisnigricans.
Thesesymptomsareduetovasodilatoryactionofniacinthrough
releaseofPGsandcanbepreventedbypretreatmentwithaspirin.

---

591.MechanismofActionofclofibrate?
a)TheyincreaselipoproteinlipaseactivitythroughPPARalpha
andcauseincreasedlipolysisoftriglycerides
b)Inhibitslipolysisinadiposetissue
c)InhibitsHMGCoAreductase
d)Bindbileacidsandbilesaltsinsmallintestine
CorrectAnswer-A
Ans.is'a'i.e.,Theyincreaselipoproteinlipaseactivitythrough
PPARalphaandcauseincreasedlipolysisoftriglycerides
FibratesactbytranscriptionallyupregulatingLPL,apoA-Iandapo
A-1I,anddownregulateapoCIII,aninhibitoroflipolysisby
activatinganuclearreceptor,PPARalpha(peroxisomeproliferator
activatedreceptoralpha).oMajoreffectofthefibratesisto?
1. Increasedoxidationoffattyacidsinliverandstriatedmuscle
2. IncreasedlipolysisoflipoproteintriglycerideviaLPL.
3. ReduceTG(containedinVLDL)reducedVLDLsecretionbyliver.
4. IncreaseHDL

---

592.Drugthatbindsbileacidsintheintestine
andpreventstheirreturntoliverviathe
enterohepaticcirculationis?
a)Niacin
b)Fenofibrate
c)Cholestyramine
d)Gugulipid
CorrectAnswer-C
Ans.is'c'i.e.,Cholestyramine

---

593.Antitussiveopioidis?
a)Ethylmorphin
b)Pethidine
c)Methadone
d)Buprenorphine
CorrectAnswer-A
Ans.is'a'i.e.,Ethylmorphine
Antitussives(coughcentersuppressants)
Opioids:Codeine,ethylmorphine,pholcodeine.
Non-opioids:Noscapine,dextromethorphan,chlophedianol.
Antihistaminics:Chlorpheniramine,diphenhydromine,
promethazine.
Peripherallyactive:Prenoxdiazine.

---

594.Drugofchoiceforfamilial
hypercholesterolemia?
a)Gemfibrogil
b)Nicotinicacid
c)Lovastatin
d)Ceholestgramin
CorrectAnswer-C
Ans.is'c'i.e.,Lovastatin

---

595.Nottrueabouthypolipidemicdrugs
a)Cholesterolreducingdrugsarecontraindicatedinchildless
than8years
b)Gemfibrozilcausesmyopathy
c)Gemfibrozilcanincreasemyopathycausedbystatins
d)Lovastatincancausehepaticdysfunction
CorrectAnswer-A
Ans.is'a'i.e.,Cholesterol-reducingdrugsarecontraindicatedin
childlessthan8years
Contraindicationforusesofstatins(cholesterol-reducingdrugs)are-
Pregnancy
Breastfeeding
Activeliverdisease
Gemfibrozilcancausemyopathyanditcanaggravatemyopathy
causedbystatins.
Lovastatincancausehepaticdysfunction.

---

596.ClinicaleffectofvitaminDisreducedby
?
a)Simultaneousingestionofphytates
b)Simultaneousingestionoflactose
c)Acidicenvironment
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Simultoneousingestionofphytates
ThemainclinicaleffectofvitaminDistoenhanceintestinal
absorptionofcalcium.
Withanaverageintakeof1000mgofcalciumitsnetintestinal
absorptionisonly150-250mg/day.
Calciumisabsorbedmainlyintheduodenumandjejunum(proximal
intestine)byanactivetransportmechanismregulatedby1,25(OH)2
D,(calcitriol).
Parathormoneindirectlypromotesabsorptionofcalciumby
increasingtherenalsynthesisof1,25(OH)2D3.
Dietarylactose,proteinsandanacidicenvironmentpromotecalcium
absorption.
Ontheotherhand,phytates,phosphates,oxalates,tetracyclineand
andalkalineenvironmentimpaircalciumabsorption.

---

597.Parenteraldirectthrombininhibitor?
a)Ximelagatran
b)Dabigatran
c)Argatroban
d)Heparin
CorrectAnswer-C
Ans.is'c'i.e.,Argatroban
Parentraldirectthrombininhibitors
ArgatrobanBivalirudin
HirudinLepirudinoMelagatran
Desirudin
OralDirectthrombininhibitors
Dabigatran(recent)
Ximelagatran(withdrawn)

---

598.Whichpreventsplasminogenactivators?
a)Streptokinase
b)Aminocaproicacid
c)Reteplase
d)Clopidogrel
CorrectAnswer-B
Ans.is'b'i.e.,Aminocaproicacid
oEpsilonaminocaproicacid(EACA)competitivelyinhibits
plasminogenactivation.

---

599.Mechanismofactionoftransexaminic
acidis
a)Decreasevascularpermeability
b)Smoothmusclecontraction
c)ActivatesPlasminformation
d)Preventsfibrinolysis
CorrectAnswer-D
Ans.is`d'i.e.,Preventsfibrinolysis

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600.Gp2b3Ainhibitorsareallexcept?
a)Abciximab
b)Eptifibatide
c)Tirofiban
d)Prasugrel
CorrectAnswer-D
Ans.is'd'i.e.,Prasugrel
Glycoproteinslib/111ainhibitors
Theplateletglycoproteinmediatesplateletaggregationviabinding
ofadhesiveproteinssuchasfibrinogenandVonWillebrandfactor.
GPIIb/Inainhibitors,inhibitplateletaggregationbyblockingGPIlb/
Ma.
Theyaremorecompleteinhibitorsthaneitheraspirinorclopidogrel/
ticlopidinejjbecausetheyinhibitfinalpathwayinplateletaggregation
(whetheritismediatedbyADPorTXA2),whileaspirinblocksonly
TXA2pathwayandclopidogrelblocksonlyADPpathway.
Drugsare?
1. AbciximabAhumanizedmonoclonalantibodyagainstGPIIb/
111a.
2. Eptifibatide
3. TirofibanCompetitiveinhibitorsofGPI1b/IIIa
4. Lamifiban
InadditiontoinhibitingGplib/Iliareceptor,abciximabalsoinhibits
ayP3receptor(whichbindsvitronectin)anda.132(aleukocyte
integerin).Thisactionisresponsibleforanti-inflammatoryand
antiproliferativepropertiesofabciximab.

---

601.Warfarinactsby
a)InhibitionofVitaminKepoxidereductase
b)Inhibitionofgammaglutamylcarboxylase
c)ActivationofVitaminKepoxidereductase
d)Activationofgammaglutamylcarboxylase
CorrectAnswer-A
Ans.is'a'i.e.,InhibitionofVitaminKepoxidereductase

---

602.Whichofthefollowingisgivenorally
a)Argatraban
b)Alteplase
c)Rivaroxaban
d)Fondaparinux
CorrectAnswer-C
Ans.is'c'i.e.,Rivaroxaban
Rivaroxaban-itisanorallyactivedirectinhibitorofactivatedfactor
Xawhichhasbecomeavailableforprophylaxisandtreatmentof
DVT.
Alteplase-givenbyi.v.infusionduetoshorthalflifeof4-8minand
oftenrequiresheparincoadministration.
Argatroban-directthrombininhibitor;givenbyi.v.infusion;usedin
placeoflepirudinforshorttermindicationsinpatientswithheparin
inducedthrombocytopenia.
Fondaparinux-100%bioavailabilitywithsubcutaneousinjection

---

603.Hydroxyethylstarchisa?
a)Vasodilator
b)Inotrope
c)Plasmaexpander
d)Diuretic
CorrectAnswer-C
Ans.is'c'i.e.,Plasmaexpander
Plasmaexpanders
Thesearehighmolecularweightsubstanceswhichexertscolloidal
osmotic(oncotic)pressure,andwheninfusedi.v.retainfluidinthe
vascularcompartment.
Humanplasmaorreconstitutedhumaalbuminarethebest,
However,theformercarriestheriskoftransmittingserumhepatitis,
AIDS,andlatterisexpensive.Thereforesyntheticcolloidsaremore
oftenused.
Desirablepropertiesofplasmaexpanderare:
1. Shouldexertoncoticpressurecomparabletoplasma.
2. Shouldremainincirculationandnotleakoutintissues,orbetoo
rapidlydisposed.
3. Shouldbepharmacodynamicallyinert.

---

604.Antibioticsensitivitytestingcanbedone
usingallexcept
a)Etest
b)Kirby-Bauermethod
c)Cultureagarmethod
d)Brothdilutionmethod
CorrectAnswer-C
Ans.is'c'i.e.,Cultureagarmethod
Testsusedforantimicrobialsensitivityare:
1. Discsusceptibilitytest(mostcommonlyused)
2. Brothdilutionsusceptibilitytest
3. Kirby-Bauerdiscdiffusionmethod
4. E-test(Epsilonietertest)

---

605.Advantagesofamoxicillinoverampicillin
areallexcept?
a)Betterbioavailability&fasteraction
b)SpectrumincludesH.influenzae&Shigella
c)Incidenceofdiarrheaislower
d)Fooddoesnotinterferewithitsabsorption
CorrectAnswer-B
Ans.is'b'i.e.,SpectrumincludesH.influenzae&Shigella
Amoxicillinisaclosecongenerofampicillin;similartoitinall
respectsexcept:
Oralabsorptionisbetter;fooddoesnotinterferewithabsorption;
higherandmoresustainedbloodlevelsareproduced.
Incidenceofdiarrheaislower.
ItislessactiveagainstShigellaandH.influenzae.
Itisnowpreferredoverampicillinforbronchitis,urinaryinfections,
SABEandgonorrhoea.

---

606.Allofthefollowingaretherapeuticuses
ofpenicillinG,except
a)Bacterialmeningitis
b)Rickettsialinfection
c)Syphilis
d)Anthrax
CorrectAnswer-B
Ans.is'b'i.e.,Rickettsialinfection
PenicillinGistheDOCfor
1.
Meningococcalmeningitis 7.
Leptospira
Bacillusanthracis
Actinomycesisraelii
2.
8.
(anthrax)
(Actinomycosis)
Clostridiumperfringens
Borreliaburgdorferi
3.
9.
(gasgangrene)
(Lymedisease)
Clostridiumtetani
4.
10. Enterococci
(tetanus)
Corynebacterium
5.
11. Streptococci
diphtheriae
6.
Treponemapallidum
12. Susceptible
(syphilis)
pneumococci

---

607.Mechanismofactionofaminoglycosides
is?
a)Inhibitionofproteinsynthesis
b)Imagetocellmembrane
c)Coagulationofproteins
d)Inhibitionofcellwallsynthesis
CorrectAnswer-A
Ans.is'a'i.e.,Inhibitionofproteinsynthesis

---

608.Nottrueaboutclofazamine?
a)UsedinDLE
b)Causesichthyosisandhyperpigmentation
c)InterferesDNAsynthesis
d)Usedinleprareaction
CorrectAnswer-A
Ans.is'a'i.e.,UsedinDLE
oClofazimineinterfereswithtemplatefunctionofDNA,isusedin
leprareactionandcancauseicthyosisandhyperpigmentation.

---

609.Firstgenerationcephalosporinsare
activeagainst?
a)Gramnegativebacteria
b)Grampositivebacteria
c)Anaerobes
d)Dermatophytes
CorrectAnswer-B
Ans.is'b'i.e.,Grampositivebacteria

---

610.DrugusedinhepatitisBinfectionis-
a)Entecavir
b)Astacavir
c)Zanamivir
d)Abacavir
CorrectAnswer-A
Ans.is'a'i.e.,Entecavir
oEntecaviristheDOCforchronichepatitisBinfection.

---

611.Raltegravircancause?
a)Hypokalemia
b)Hypocalcemia
c)Hyperkalemia
d)Hypercalcemia
CorrectAnswer-C
Ans.is'c'i.e.,Hyperkalemia
1. Myopathy(musclepain,tiredness)andrhabdomyolysis.
2. Skinreactions.
3. Allergicreactions.
4. Liverproblems.
5. Immunereconstitutioninflammatorysyndrome(IRIS).
6. Nonspecific:nausea,vomiting,diarrhea,headache.
Notextbookhasmentionedanyelectrolyteabnormalityasaside
effectofraltegravir.
So,Ihadtofindtheanswerofthisquestionindirectly.
Raltegravircancauserhabdomyolysis,inwhichthereis
hyperkalemia.

---

612.Modeofexcretionofcyclophosphamide
is?
a)Lung
b)Liver
c)Kidney
d)Skin
CorrectAnswer-C
Ans.is'c'i.e.,Kidney
Cyclophosphomideisprimarilymetabolized(80%)andmetabolites
areexcertedinurine.
10to20%isexcretedunchangedinurineand4%isexcretedinbile.

---

613.Nottrueaboutaztreonam?
a)f3-lactarn
b)Monobactarn
c)Activeagainstpseudomonas
d)Showscrossreactivitywithotherpenicillins
CorrectAnswer-D
Ans.is'd'i.e.,Showscrossreactivitywithotherpenicillins
Aztreonam
Itbelongstomonobactamsgroupof13-lactamantibiotics.
Itisactiveagainstgramnegativeorganismsincluding
pseudomonas,buthasnoactivityagainstgrampositiveorganisms
oranaerobesfi-lactamantibioticwithaminoglycosidesspectrum.
Itistheonlyfi-lactamantibioticthatlackcross-reactivitywithother
P-lactamantibiotics,permitingitsusedinpatientsallergicto
penicillinsorcephalosporins.

---

614.Drugusefulinbreastcanceris?
a)Tamoxifen
b)Cyproterone
c)Testosterone
d)Chlorambucil
CorrectAnswer-A
Ans.is'a'i.e.,Tamoxifen
Pharmacotherapvofbreastcancer
ManybreastcarcinomaspossessestrogenreceptorsEstrogen
promotestheirgrowth.
DrugswhichdecreasetheactionofestrogenonbreastCAbyoneor
othermechanisms,canbeusedinbreastCA.DrugsusedinBreast
cancer
Selectiveestrogenreceptormodulators(SERMs)-Tamoxifen,
Tromifene.
Selectiveestrogenreceptordownregulators(SERDs)-Fulvestrant
Aromataseinhibitors-Letrozole,anastrozole,exemestone
LHRH(GnRh)analogues
Aminoglutethemide
Highdosesprogesterones-Megastrolacetate.

---

615.Allantiretroviraldrugsproduce
peripheralneuropathyexcept?
a)Stavudine
b)Zalcitabine
c)Didanosine
d)lndinavir
CorrectAnswer-D
Ans.is'd'i.e.,Indinavir
Characteristicsideeffectsofimportantantiretroviraldrugs
Lamivudin-Nausea,headache,fatigue.
Stavudine-Peripheralneuropathy,lipodystrophy,hyperlipidemia,
pancreatitis,rapidlyprogressiveascendingneuromuscular
weakness.
Didanosine-Peripheralneuropathy,pancreatitis,diarrhea,nausea,
hyperuricemia.
Zalcitabine-Peripheralneuropathy,oralulceration,pancreatitis.
Zidovudin-Macrocyticanemia,neutropenia,nausea,headache,
insomnia,asthenia.
Tenofovir-Asthenia,headache,diarrhea,nausea,vomiting,
flatulance,renalinsufficiency.
Efavirenz-CNSeffects,rash,Tliverenzymes.
Nevirapine-Rash,hepatitis,nausea,headache.
Indinavir-Nephrolithiasis,nausea,indirecthyperbilirubinemia,
headache,blurredvision,asthenia.

---

616.Whichofthefollowingisatopical
sulfonamide?
a)Sulfadoxine
b)Mafenide
c)Sulfamethopyrazine
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Mafenide
Classificationofsulfonamides
Short-acting-Sulfadiazine,Sulfisoxaxole,Sulfamethizole,
Sulfacystine.
Intermediate-acting-Sulfamethoxazole.
Long-acting-Sulfadoxine,Sulfamethopyrazine.
TopicalSulfonamides-Sulfacetamidesodium,Mafenide,silver
sulfadiazine.
SulfonamideforRAandulcerativecolitis-Sulfasalazine.

---

617.Tetracyclineinjectioncausespalsyof
whichnerve?
a)Ulnar
b)Median
c)Radial
d)SuperficialRadialNerveinjury
CorrectAnswer-C
Ans.is'c'i.e.,Radial

---

618.Erlotinibisusedin?
a)Coloncancer
b)Pancreaticcancer
c)Gallbladdercancer
d)GIST
CorrectAnswer-B
Ans.is'b'i.e.,Pancreaticcancer

---

619.Allareusedforcarcinomahead&neck
except?
a)5FU
b)Busulfan
c)Cisplatin
d)Methotrexate
CorrectAnswer-B
Ans.is'b'i.e.,Busulfan

---

620.Whichanticancerdrugpreventsspindle
formation?
a)Busulfan
b)Vincaalkaloids
c)5-FU
d)Methotrexate
CorrectAnswer-B
Ans.is'b'i.e.,Vincaalkaloids
Taxanes(PaclitaxelandDocetaxel)enhancespolymerizationof
tubulin(amechanismoppositetothatofvincaalkaloids)the
microtubulesarestabilizedandtheirdepolymerizationisprevented.
Vincaalkaloids(vincristine,vinblastine)preventpolymerizationand
assemblyofmicrotubules.
Mitoticinhibitors
EnhancespolymerizationPreventpolymerization
TaxanesVincaalkaloids

---

621.Whichoneofthefollowingstatementsis
falseregardingvincristine-
a)Itisanalkaloid
b)Itsuseisassociatedwithneurotoxicity
c)Itdoesnotcausealopecia
d)Itisausefuldrugforinductionofremissioninacute
lymphoblasticleukaemia
CorrectAnswer-C
Ans.is'c'i.e.,Itdoesnotcausealopecia
*Vincristinebelongstotheplantalkaloidgroupofanticancer.
*UsefulforinducingremissioninchildhoodALL(notusefulin
maintenancetherapy)
*Itcanalsobeusedforpediatricsolidtumors(Wilm'stumor,
neuroblastoma,rhabdomyosarcoma)andlymphomas.
*Prominentadverseeffects?
*Peripheralneuropathy
Alopecia
SIADH

---

622.Ranibizomabismonoclonalantibody
against?
a)IL-6
b)CD-20
c)VEGF
d)EGFR
CorrectAnswer-C
Ans.is'c'i.e.,VEGF

---

623.Whichofthefollowingisusedfor
prostaticcarcinoma?
a)Danazole
b)Clomiphene
c)Finasteride
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Finasteride

---

624.DrugcontraindicatedinG6PD
deficiency?
a)Chloroquine
b)Primaquine
c)Quinine
d)Halofantrine
CorrectAnswer-A:B:C
Ans.is'b>c>a'i.e.,Primaquine>Quinine>Chloroquine
Amongantimalarialdrugs,primaquine,quinineandoccasionally
chloroquinecancausehemolyticanemiainG6PDdeficiency.
But,primaquinehasthehighestpotentialtocausehemolyticanemia
inpatientswithG6PDdeficiencyand,thepatientswithG6PD
deficiencyarehighlysenstivetoprimaquine.
ThehemolyticpotentialinG6PDdeficiencypatients-

---

625.Pyridoxineisusedintreatmentof?
a)Galactosemia
b)Phenylketonuria
c)Propionicacidemia
d)Homocystinuria
CorrectAnswer-D
Ans.is'd'i.e.,Homocystinuria
InbornerrorofmetabolismandTreatment
Alkaptonuria
VitaminC,Folicacid
Homocystinuria
Pyridoxine+Folicacid
Alkalizationofurine+d-Penicillamine,
Cystinuria
Captopril
Hartnupdisease
Nicotinamide
Multiplecarboxylase
Biotin
eficiency
Methylmalonicacademia VitaminB12
Hyperoxaluria
Pyridoxine
Tyrosinemia
NTBC,LiverTransplantation

---

626.Peripheralneuropathyis/arecausedby:
a)Vincristine
b)Sulfonamide
c)Amiodarone
d)Paclitaxel
e)None
CorrectAnswer-A:C:D
Ans.(A)Vincristine(C)Amiodarone(D)Paclitaxel
[Ref:Harrison19th/2686-88,18th/3463-66;KDT7th/706]
Sulfonamidenotmentionedinlistofdrugscausingneuropathies

---

627.Peripheralneuropathyasasideeffectis
causedbywhichofthefollowinganti
cancerdrugs?
a)Vincristine
b)Cyclophosphamide
c)Etoposide
d)Irinotecan
CorrectAnswer-A
Ans.is'a'i.e.,Vincristine
Vincristine(Oncovin)
AlkaloidderivedfromVincarosae.
Vincristinebelongstotheplantalkaloidgroupofanticancer.
Rapidlyactinganticancer
Thisclassofdrugsarealsoknownasspindlepoison.
Thesedrugsbindtomicrotubularprotein(tubulin)
Thedrug-tubulincomplexthenattachesitselftomicrotubulesand
causesdepolymerizationofmicrotubules.
Depolymerizationofmicrotubulecauses
1. Mitoticarrestatmetaphase
2. Dissolutionofmitoticspindle
3. Interferencewithchromosomesegregation
UsefulforinducingremissioninchildhoodALL(notusefulin
maintenancetherapy)
Itcanalsobeusedforpediatricsolidtumors(Wilm'stumor,
neuroblastoma,rhabdomyosarcoma)andlymphomas.
Prominentadverseeffects?
PeripheralneuropathyAlopeciaSIADH

---

Vincristineisamarrowsparingdrugbutsometimesitmaycause
myelosuppressionwhichisverylessthanvinblastin.
Indicationsofvincristine?
HodgkinsdiseaseWilms'stumourCarcinomalung
Nonhodgkin:s.diseaseEwing'ssarcomaMyeloma
Vinblastineandvinorelbineareothervincaalkaloids.
oVinblastine'smostimportantclinicaluseisthecurativetherapyof
metastatictesticulartumor.
oVinblastinecancausebonemarrowsuppression(incontrastwith
vincristin),alopecia,andnausea&vomiting.oAstheyarrest
mitosis,allvincaalkaloidsactinMphase.

---

628.Gynaecomastiaiscausedbywhichdrug
?
a)Spironolactone
b)Rifampicin
c)Thiazide
d)Propanolol
CorrectAnswer-A
Ans.is'a'i.e.,Spironolactone

---

629.Alcoholmainlyincreases-
a)TG
b)LDL
c)VLDL
d)HDL
CorrectAnswer-D
Ans.is'd'i.e.,HDL
Regularintakeofsmalltomoderateamountsofalcohol(1-2
drinks)hasbeenfoundtoraiseHDLcholesterollevelsanddecrease
LDLoxidation.Thismayberesponsiblefor15-35%lowerincidence
ofcoronaryarterydiseaseinsuchindividuals.Riskreductionis
greatestinhighrisksubjectsandtheprotectionislostif>/=3drinks
areconsumeddaily.

---

630.Notahepatotoxicdrug?
a)Chlorpropamide
b)Allopurinol
c)Streptomycin
d)Halothane
CorrectAnswer-C
Ans.is'c'i.e.,Streptomycin

---

631.Botulinumtoxinactson
a)Synapse
b)Smoothmuscleofintestine
c)Centralnervoussystem
d)Sensorynerves
CorrectAnswer-A
Ans.is'a'i.e.,Synapse
Botulinumtoxinaffects
1. Neuromuscularjunction.
2. Postganglionicparasympatheticnerveendings.
3. Peripheralganglia.
Centralnervoussystemisnotinvolvedandthereisnosensory
involvement.
Botulinumtoxinactsbyinhibitingthecalciummediatedexocytosisof
AChfromthevesiclesinthesynapse.

---

632.Botulinumtoxinmimics-
a)Cholinergics
b)Anticholinergics
c)Adrenergics
d)Antiadrenergic
CorrectAnswer-B
Ans.is'b'i.e.,Anticholinergics

---

633.BotulinumtoxintypeBisusedinwhich
disease?
a)Glabellarlines
b)Strabismus
c)Cervicaldystonia
d)Blepharospasm
CorrectAnswer-C
Ans.is'c'i.e.,Cervicaldystonia

---

634.Whichofthefollowingisassociatedwith
hemorrhagicstroke?
a)Phenylpropanolamine
b)Terfenadine
c)Quinidine
d)Fenfluramine
CorrectAnswer-A
Ans.is'a'i.e.,Phenylpropanolamine
1. Manyreportsassociatingphenylpropanolamineuseforweightloss
withhaemorrhagicstrokeamongwomen,appearedinU.S.A.

---

635.Whichofthefollowingdrugcancasue
thyroiddysfunction?
a)Amiodarone
b)Ampicillin
c)Ibutilide
d)Acyclovir
CorrectAnswer-A
Ans.is'a'i.e.,Amiodarone
Drugscausinghypothyroidism
LithiumSulfonamidePhenobarbitonePhenytoin
AmiodaroneParaminosalycylicacid(PAS)Rifampicin
Carbamazepine

---

636.Alldrugshaverecentlybeenwithdrawn
fromIndiaexcept?
a)Gatifloxacin
b)Rafecoxib
c)Cotrimoxazole
d)Phenformin
CorrectAnswer-C
Ans.is'c'i.e.,Cotrimoxazole
DrugswhichhavebeenwithdrawanfromIndiaare(i)Rimonabant;
(ii)gatifloxacin;(iii)sibutramine;(iv)rofecoxib&valdecoxib;(v)
astemizole&terfinadine;(vi)fenfluramine&dexfenfluramine;
(vii)phenformin;(viii)tegaserod;and(ix)rosglitazone.

---

637.

---

Hurtisdefinedundersection?
a)320IPC
b)321IPC
c)319IPC
d)323IPC
CorrectAnswer-C
Ans.is`c'i.e.,319IPC
319IPC:Defineshurt.
320IPC:Definesgrievoushurt.
321IPC:Voluntarilycausinghurt.
322IPC:Voluntarilycausinggrievoushurt.
323IPC:Punishmentforvoluntarilycausinghurt(noprovocation,
nodangerousweapon)(1yearsimprisonment).
324IPC:Punishmentforvoluntarilycausinghurtbydangerous
weapon(3yearsimprisonment?fine).
325IPC:Punishmentforvoluntarilycausinggrievoushurt(no
provocation,nodangerousweapon)(7yearsimprisonment?fine).

---

638.AllsectionsofIPCarerelatedto
grievoushurt,except
a)Sec.320
b)Sec.331
c)Sec.326
d)Sec.319
CorrectAnswer-D
Ans.d.Sec.319
319.Hurt.--Whoevercausesbodilypain,diseaseorinfirmitytoany
personissaidtocausehurt.
Itisoftwotypes:i.Simpleandii.Grievous
Sec-319-->DefinesHurt.--Whoevercausesbodilypain,diseaseor
infirmitytoanypersonissaidtocausehurt.
Sec-320-->Definesthegrievoushurtandcomprisesof8clauses
Sec-326-->Voluntarilycausinggrievoushurtbydangerous
weapons/means,fine/punishmentupto10years.
Sec331-->Voluntarilycausinggrievoushurttoextortconfession,or
tocompelrestorationoftheproperty.shallbepunishedwith
imprisonmentofeitherdescriptionforatermwhichmayextendto
tenyears,andshallalsobeliabletofine.

---

639.IPC197isrelatedto:
NEET14
a)Causingdisappearanceofevidence
b)Issuingfalsecertificatebydoctor
c)Givingfalseevidence
d)bandcboth
CorrectAnswer-B
Ans.B.)Issuingfalsecertificatebydoctor
I.P.C197,Issuingorsigningfalsecertificate.
IPCsrelatedtoMedicalPractice:

---

640.Miscarriageispunishableunderwhich
IPC:
AIIMS13;NEET14
a)Sec320IPC
b)Sec311IPC
c)Sec312IPC
d)Sec314IPC
CorrectAnswer-C
Ans.Sec312IPC

---

641.Sections312to315dealwith?
a)Kidnapping&abduction
b)Attention&abetmenttosuicide
c)Causinggrievoushurt
d)Criminalabortion
CorrectAnswer-D
Ans.isD.i.e.,Criminalabortion
312,313,314and315IPC:Forcausingvoluntarymiscarriage
(criminalabortion).
312IPC:Causingmiscarriagewithconsent(3yearsofimprisonment
?fine).
313IPC:Causingmiscarriagewithoutconsentoflady(10yearsof
imprisonmentwhichcanextenduptolife?fine).
314IPC:Deathofpatientcausedbymiscarriage(10yearsof
imprisonment?fine).
315IPC:Deathofchildduringmiscarriage(10yearsimprisonment?
fine).

---

642.Miscarriageduetonegligenceofdoctor
isseenunderwhichIPC?
a)Sec310IPC
b)Sec311IPC
c)Sec312IPC
d)Sec314IPC
CorrectAnswer-C
Ans.is'c'i.e.,Sec312IPC
Sec312IPCrefersto"causingmiscarriage"ofawomanpregnant
withachild,punishableupto3years,butifsheis"quick"withher
childthepunishmentmayextendto7years.

---

643.Underwhichsection,policecanarresta
personandaskmedicalofficerto
examinehimwithoutvictimsconsent?
a)Sec330IPC
b)Sec53IPC
c)Sec190IPC
d)Sec304-AIPC
CorrectAnswer-B
Ans.is'b'i.e.,Sec53IPC
531PC:Anaccusedcanbeexaminedbyamedicalpractitionerat
requestofpolice,evenwithouthisconsentorbyforce.
304-AIPC:Causingdeathbynegligence(criminalnegligence)which
alsoincludesmedicalnegligence(Punishableup2yearsorfineor
both).
330.331,339,341IPCs:Torture.
190IPC:Threatofrefrainingapersonfromapplyingprotectiontoa
publicservant.

---

644.Accordingtowhichsection,aperson
canbepunishedformurderwith
imprisonmentfor10years
a)Sec301IPC
b)Sec300IPC
c)Sec302IPC
d)Sec304IPC
CorrectAnswer-C
Ans.is'c'i.e.,Sec302
302IPC:Punishmentformurder(deathorlifeimprisonment).
301IPC:Culpablehomicidebycausingdeathofpersonotherthan
personwhosedeathwasintended.
300IPC:Murder(definingmurder).
303IPC:Punishmentofmurderoflifeconvict(death).
304IPC:Punishmentofculpablehomicide,notamountingto
murder(10yearsimprisonmentffine).
305IPC:Abetmentofsuicideofchildorinsaneperson.
306IPC:Abetmentofsuicide.
307IPC:Attempttomurder(10yearsimprisonmentffine).
308IPC:Attempttocommitculpablehomicide(3-7years
imprisonment?fine).
309IPC:Attempttocommitsuicide(1yearsimprisonment?fine).

---

645.

---

Accordingtosection82IPCachild'sactis
notconsideredasacrimeifheis-
a)<4years
b)<7years
c)<12years
d)<18years
CorrectAnswer-B
Ans.is`b'i.e.,<7years
82Achildundertheageofsevenisincapableofcommittingan
offence.Thisissobecauseactionalobedoesnotamounttoguilt
unlessifisaccompaniedbyaguiltymind.And,achildofthattender
agecannothaveaguiltymindorcriminalintentionwithwhichtheact
isdone.Thispresumption,however,isonlyconfinedtooffenses
undertheIPCbutnottootherActs,e.g.,theRailwayAct.

---

646.Penaltyawardedaccordingtodowry
prohibitionact?
a)15000Rsand5years
b)30000Rsand7years
c)Lifeimprisonment
d)Imprisonmentfor10years
CorrectAnswer-A
Ans.is'a'i.e.,15000Rsand5years
AccordingtoDowryProhibitionact(1961),ifanypersongivesor
takesorabetsthegivingortakingdowryispunishablewith
imprisonmentforatermwhichshallnotbelessthan5yearsand
withafinewhichshallnotbelessthen15000rupeesortheamount
ofthevalueofsuchdowry,whicheverismore.
Note-Accordingtosection304BIPCpunishmentfordowrydeath
isimprisonmentforatleast10years,whichmaybeextendedtolife
imprisonment.

---

647.Quantumofpunishmentindowrydeath
is?
a)7years
b)5years
c)Death
d)10years
CorrectAnswer-D
Ans.is'd'i.e.,10years
304-BIPC:Dowrydeath:10yearsofimprisonmentwhichcan
extendtolife.
498-AIPC:Punishmentforcrueltybyhusbandorhisrelatives.
Dowrydeath
Insomecasesnewlymarriedgirlsareabused,harassed,cruelly
treatedandtorturedbythehusband,in-lawsandtheirrelativesforor
inconnectionwithanydemandfordowry.Inextremecases,the
womaniskilledbyburningorsomeothermethod.Lawinrelationto
dowrydeathare:
Lowprescribingpunishmentanddefinition(section304BIPC)
Husbandor(hisany)relativewillbetriedundersection304B,IPC
andshallhedeemedtohavecausedherdeath,ifawomandiesdue
tobodilyinjuryorburnsorotherwiseinsuspiciouscircumstances
within7yearsofmarriageanditisshownthatsoonbeforeher
deathshewassubjectedtoharassmentorcrueltybythem,in
connectionwith,anydemandfordowry.Suchdeathshallbecalled
dowrydeath.Punishmentincludesimprisonmentofnotlessthan10
years,butwhichmayextendtolifeimprisonment'.
Lowprescribingpunishmentforcausingcrueltytoamarried
women(Sec.498A,IPC)
Husbandor(hisany)relativewillbetriedundersection498A,IPC

---

Husbandor(hisany)relativewillbetriedundersection498A,IPC
forcausingcrueltytoamarriedwoman.Crueltyisdefinedasany
willfulconductwhichdrivesthewomantocommitsuicideorgrave
physicalormentalinjurytoherorharassmentofthewomenwitha
viewtocoerce(intimidate)herfordowry.Punishmentincludes
imprisonmentwhichmayextendupto3yearsandfine.

---

648.DowrydeathisunderwhichIPC?
a)IPC304A
b)IPC304B
c)IPC305A
d)IPC305B
CorrectAnswer-B
Ans.is'b'i.e.,IPC304B
304-BIPC:Dowrydeath:10yearsofimprisonmentwhichcan
extendtolife.

---

649.ClassIjudicialmagistratehaspowerto
givepunishmentof-
a)5yr,Rs.3000
b)3yr,Rs.5000
c)5yrRs.5000
d)3yr,Rs3000
CorrectAnswer-B
Ans.is'b'i.e.,3yr,Rs.5000
oPowersofMagistrate(sec29CrPC)
Class
Imprisonment Fine
Chief
Any
judicial
Upto7years
amount
magistrate
Class1
Rs
judicial
Upto3years
5000
magistrate
Class2
Rs
judicial
Uptolyear
1000
magistrate

---

650.Policeinquestisdoneinall,except:
NEET13,14
a)Suicidaldeath
b)Homicidaldeath
c)Dowrydeath
d)Deathbyanimals
CorrectAnswer-C
Ans.Dowrydeath

---

651.Magistrateinquestisdoneincaseof?
a)Deathbysuicide
b)Deathbyaccident
c)Deathinpsychiatryhospital
d)Deathinsuscpiciouscircumstances
CorrectAnswer-C
Ans.is'c'i.e.,Deathinpsychiatryhospital
Magistrate'sinquestisdoneundersec176CrPCiscaseof:-
1. Deathinprison,reformatories,Borstalschool.
2. Deathinpolicecostodywhileunderpoliceinterrogation.
3. Deathduetopolicefiring.
4. Dowrydeath;i.e.deathofamarriedfemalelessthan30yearsof
ageordeathwithin7yearsofmarriage.
5. Exhumation.
6. Deathinpsychiatryhospital.
7. Custodialrape.

---

652.Professionaldeathinmedicalprofession
is?
a)Deathofdoctor
b)Deathsentenceorderedbyjudge
c)Deathduringpolicefiring
d)RemovalofnameofdoctorfrompanelofRMP
CorrectAnswer-D
Ans.is'd'i.e.,RemovalofnameofdoctorfrompanelofRMP
MCImaintainsmedicalregister(Indianmedicalregister)ofmedical
practitioners.Theregistrarshouldkeeptheregisteruptodateby:?
A.Deletingnamesof(Erasureofname):(i)Thosedead,(ii)Those
awardedpenalerasure(professionaldeathsentence)for
professionalmisconduct,(iii)Enteriesmadeinerrororfraud.
B.Addingnamesof:(1)Freshgraduates,(ii)Whosetermof
temporaryerasureexpires.

---

653.Doctrineofresipsaloquiturmeans?
a)Commonknowledge
b)Medicalmaloccurance
c)Factspeaksforitself
d)Oralevidence
CorrectAnswer-C
Ans.is'c'i.e.,Factspeaksforitself
Doctrineofresipsaloquitur
Itmeans"thethingorfactspeaksforitself".
Inacaseofprofessionalnegligenceofaphysician,thepatientneed
notprovenegligence.
Itisappliedwhenfollowingconditionsarefulfilled:
1. Thatintheabsenceofnegligencetheinjurywouldnothave
occurredordinarily.
2. Thatthedoctorhadexclusivecontrolovertheinjuryproducing
instrumentortreatment.
3. Thatthepatientwasnotguiltyofcontributorynegligence.

---

654.Blanketconsentisconsenttaken-
a)Whenthepatientcomestodoctorfortreatment
b)Oralconsent
c)Writtenconsent
d)Takenatthetimeofadmissiontodoanysurgery
CorrectAnswer-D
Ans.is'i.e.,Takenatthetimeofadmissiontodoanysurgery
Blanketconsent:Itreferstoconsentwhichistakenusuallyona
printedform,atthetimeofadmissionofthepatient,authorizingthe
doctortodoanysurgeryunderanyanaesthesia.Legally,itisno
consent,i.e.itisofnovalueincourt.Tobelegallyvalid,theconsent
istobeobtainedforeachspecificprocedureandoperation.
Impliedconsent:Inthis,consentpresumedtobethere.Theveryfact
thatthepatienthascometothedoctorfortreatment,itispresumed
thathisconsentisthereforroutinephysicalexamination.e.g.
inspection,palpation,auscultationandpercussion.Impliedconsent
isanon-writtenbutlegallyeffectiveformofconsent,whichisnot
expresslyasserted.
Expressedconsent:Itisstated(oralorwritten)inclearandexplicit
language.Oralconsent,giveninpresenceoftwoormorewitnesses
isasvalidaswrittenconsent,butthereisnorecord.Writtenconsent
isbetterasthereisarecordofconsentavailable,incasesof
dispute.
Writteninformedconsent:Itisatypeofexpressedconsentinwritten
formwhichisgivenbythepatientafterbeinginformedofnatureof
illnessornatureofprocedureoroperationtobedone,its
alternatives,itsconsequencesandcomplications.

---

655.Schedule-3ofMCIincludes-
a)MBBSdegreeofindianuniversities
b)DNBdegree
c)DiplomaofCPS
d)MBBSdegreeofforeignuniversities
CorrectAnswer-C
Ans.is'c'i.e.,DiplomaofCPS
SchedulesofMCIAct
MCIwasestablishedin1934andMCIactwasrevisedin1956,
1964,1993,1999,and2002.TheschedulesofMCIincludeslistof
medicaldegreesrecognizedbyMCI:-
1. Schedule1:-IncludeslistofrecogniseddegreesawardedbyIndian
universities('")andalsoDNBawardedbyNationalBoardof
Examination,NewDelhi.
2. Schedule2:-Includeslistofrecognizedmedicaldegreesawarded
byforeignuniversitiesorob'.
3. Schedule3:-Includeslistofmedicalqualificationsawardedby
Indianorforeignboardsorsocieties,butarenotincludedin
schedule1or2.Ithastwoparts:?
PartI:IncludeslistofrecognizeddegreesotherthanMBBS
awardedbyIndianSocietiesandBoards,e.gLMPanddiplomaof
CPS.
PartII:IncludeslistofrecognizeddegreesotherthanMBBS
awardedbyForeignSocietiesandBoards

---

656.Testamentarycapacityis?
a)Abilitytogivewillfulstatement
b)Abilitytomakewill
c)Abilitytojudge
d)None
CorrectAnswer-A
Ans.is'b'i.e.,Abilitytomakewill
Testamentarycapacity(testament=will)isthementalabilityto
makeavalidwill.
Willdenotesanytestamentarydocument.Therequirementfora
validwillareasfollows.
Awrittenandproperlysignedandwitnesseddocumentmustexist.
Thetestatormustbeamajorandofsounddisposingmindatthe
timeofmakingthewill.Forceundueinfluenceordishonest
representationoffacts,shouldnothavebeenappliedbyothers.

---

657.Fordiagnosisofinsanity,maximumlimit
ofobservation?
a)5days
b)10days
c)30days
d)50days
CorrectAnswer-C
Ans.C.i.e.,30days
Insanityischaracterizedbycertainabnormalmentalandbehavioral
patterns.Simplyinsanemeansunsoundmind,i.e.insaneisthe
personwhichhasunsoundmind.Converselysanitymeanssound
mind(composmentis).
Lucidintervalistheperiodofsanity(soundmind)inaninsane
person,i.e.periodincourseofmentalillnesswhenthereiscomplete
cessationofmanifestationsofinsanity.Duringthisperiodheisquite
normalandcanmakevalidwill,sell/purchaseproperty,givevalid
evidenceandislegallyresponsibleforhisdeeds.
Beforemakingadiagnosisofinsanity,thepatientmaybekeptunder
observationinmentalhospitalorgeneralhospital/nursinghome.
Patientiskeptunderobservationfor10days,whichcanbe
extendeduptomaximum30days.
Twodoctors(atleastonebeingagovernmentdoctor)should
examinethepatientseparatelywithoutconsultingeachotherforat
leastthreeexaminations

---

658.Fingerprintwasfirstestablishedin?
a)England
b)China
c)India
d)Singapore
CorrectAnswer-C
Ans.is'c'i.e.,India
FingerprintswerediscoveredbyanICSofficerSirWilliam
Herschelle(1958).ButstudywassystemizedbySirFrancisGulton
(1892)andwasfurtherimprovizedbySirEdwardHenery.
Fingerprintsisthebestsystemofidentificationtilldateandteeth
(dentalstatus)isconsideredthesecondbest.
ThefirsteverfingerprintBureauoftheworldwasestablishedat
Calcutta(inWriter'sbuilding)inIndia

---

659.Locord'ssystemis?
a)Podography
b)Dactylography
c)Poroscopy
d)Cheiloscopy
CorrectAnswer-C
Ans.is'c'i.e.,Poroscopy
Dactylography(Galton'ssystem)-->Studyoffingerprints.
Poroscopy(Locard'ssystem)-4Studyofnumber,sizesand
distributionofporesofsweatglandsonridges(usedwhenonlya
partoffingerprintisavailable).
Podogram-->Studyoffootprint.
Cheiloscopy(queiloscopy)-->Studyoflipprints.
Rugoscopy(Palatoprints)Studyofanteriorpartofpalate.

---

660.Cheilographyisthestudyof?
a)Fingerprints
b)Lipprints
c)Breathanalysis
d)Footprints
CorrectAnswer-B
Ans.is'b'i.e.,Lipprints
Cheiloscopyorqueiloscopyisthestudyoflipprints.
Podogramisthestudyoffootprintswhichareduetoridgeonthe
soleandtoesofthefoot.
Palatoprints(rugoscopy)isthestudyofanteriorpartofpalate.
DactylographyDermatoglyphics/Galtonsystem-isthestudyofFinger
prints.Fingerprintpatternisabsolutelyindividuali.e.notwohands
areentirelyalike,notevenidenticaltwins.That'swhy,itisbest
(mostsensitiveandmostspecific)andmostreliablemethodof
identification(Quetelet'sruleofbiologicalvariation).

---

661.Reliablemethodofidentificationof
personis?
a)Gustafson'smethod
b)Galtonmethod
c)Scar
d)Anthropometry
CorrectAnswer-B
Ans.is'b'i.e.,Galtonmethod
GaltonmethodorFingerprintsordactylographyisthebestsystem
ofidentificationtilldate.
Thefingerprintsarecapableofendlessvariationsothatthereisone
chanceinsixtyfourbillionsoftwopersonshavingidenticalprints.
Dactylography/Dermatoglvphics/Galtonsystem/Fingerprints
Fingerprintsarepresentfrombirthbothonepidermisanddermis,
remainconstantthroughoutlifeandcan'tbealteredwithout
destroyingtrueskin.
Fingerprintpatternisabsolutelyindividuali.e.notwohandsare
entirelyalike,notevenidenticaltwins.That'swhy,itisbest(most
sensitiveandmostspecific)andmostreliablemethodof
identification(Quetelet'sruleofbiologicalvariation).DNAfinger
printingmaybesameinmonozygotictwins.
Thepatternisneitherinheritednoridenticalinanytwopersons.So
thepaternitycannotbeprovedthroughfingerprintpatterns.
However,paternitycanbeprovedbyDNAfingerprinting.
Loops(67%mostcommon)>whorls(25%)>arches(7%)>
composite(2%leastcommon)arefourmaintypesofpattern.
Itisacceptedthatchancesof2fingerprintsmatching16ridge
characteristicareinfinitelysmall(Parikh's).Inpractice8-16(Reddy)

---

/16-20(Seth,Simpson)pointsoffinecomparisionareacceptedas
proofofidentity.
Locard'sporoscopymethodisstudyofmicroscopicpores,formed
bymouthsofductsofsubepidermalsweatglandpresentonridgesof
fingers.Theseporesarepermanent,remainunchangedduringlife
andareveryusefulwhenonlyfragmentsoffingerprintsareavailable.
Eachmilimetercontains9-18pores.
CriminalsmayattempttomultilatefingerprintsbyapplyingCO2
snow,corrosiveagents,burnsorerodingagainsthardsurface.But
thesemannersdonotdestroyfingerprintspermanentlyunlesstrue
skiniscompletelydestroyed.

---

662.Lengthoftibiais?
a)10%ofheight
b)20%ofheight
c)30%ofheight
d)40%ofheight
CorrectAnswer-B
Ans.is'b'i.e.,20%ofheight
Statureisdeterminedindismemberedbody(skeletalremains)by:
1. Lengthfromthetipofmiddlefingertothetipofoppositemiddle
fingerwhenarmsarefullyextended.
2. Twicethelengthofonearm+30cm(oftwoclavicles)+4cm(for
thesternum).
3. Humeruslengthis1/5thofheight.
4. Thelengthfromthevertextothesymphysispubisishalfofthetotal
length.
5. ThelengthfromthesternalnotchtoSymphysispubisx3-3.
6. Thelengthofforearmmeasuredfromtipofmiddlefingeris=5/19of
totallength.
7. Theheightofheadmeasuredbytheverticaldistancefromthetopof
thehead(vertex)tothetipofchin=1/8ofthetotallength.
8. Thelengthofvertebralcolumn=34/100oftotallength.Tothelength
ofentireskeleton,add2.5to4cmforthicknessofthesoftparts.
9. Asageneralrulehumerusis20%,tibiais22%,femuris27%and
spineis35%ofindividualheight.

---

663.Firstsecondaryossificationcenter
appearsin
a)Lowerendoffemur
b)Upperendofhumerus
c)Lowerendoffibula
d)Upperendoftibia
CorrectAnswer-A
Ans.is'a'i.e.,Lowerendoffemur
Sitegivenin Secondaryossification
question
centerappearsat
Lowerendof 9thmonthintrauterinelife
femur
Upperendof Atbirth
tibia
Upperend
1/2-1yearofage
humerus
Lowerendof 1yearofage
fibula

---

664.Numberofteethcanbecountedbyall
thefollowingmethodsexcept-
a)Gustafsonmethod
b)Milemethod
c)Boydemethod
d)Framemethod
CorrectAnswer-D
Ans.is`d'i.e.,Framemethod
Agefromteethafter20years
Teetheruptionisusefulforageestimationuptoabout18years,
beyondwhichitisjustaguesswork.Themethodsusedare:?
A.Gustafson'smethod:Usefulonlyinpersonsolderthan21years
ofage,dependingonthephysiologicalchangesineachofthedental
tissues.
1.Attrition-duetowearandtearfrommastication,uppersurfaceof
teethdestroyedgradually,firstinvolvingtheenamel-dentine-pulp
(dependingonthefunctionaluseofteethandhardnessofenamel).
2.Paradentosis-recessionofgumsandperiodontaltissue
surroundingtheteeth,exposingtheneckandadjacentpartofroot-
teethfalloff(poorhygieneincreasesparadentosis).
3.Secondarydentineformation-developwithinthepulpcavityand
decreasesizeofthecavity,startfrombase-apex,obliteratethe
cavity,increasewithage,cariesandparadentosis.
4.Cementumapposition-neartheendofroot,increase
cementum,increasethickness,depositedthroughoutlife,andform
incrementallines(devisedbyBoyde).
5.Rootresorption-becauseofcementumanddentine,absorption
ofrootstartatapexandextendupward(maybepathological).

---

6.Transparencyoftheroot-seenafter30yearsofage,canalin
thedentineatfirstwiden,increasewithagebecauseofdepositionof
minerals.Theybecomeinvisibleanddentinebecomestransparent
(Mostreliableofallthecriteria).
B.Mile'smethod:Agecanbeknownbychangesofroot
transparency.
C.Boyde'method:Onenamelofthetooth,thereisalineatbirth
(neonatalline).Withincreaseinage,morelinesareadded,studyof
whichhelpsinagedetermination.
D.Stack'smethod:Ageofinfantcanbeknownfromheightand
weightoferuptingteeth.

---

665.Cephalicindexisusedfor
a)Race
b)Age
c)Sex
d)Stature
CorrectAnswer-A
Ans.is'a'i.e.,Race
Cephalicindex,heightindex&nasalindexareusedfor
determinationofrace.
Cephalicindex=maximumbreadthofskull/maximumlengthofskull
x100
Cephalic
Typeofskull
Race
index
Dolichocephalic(long
PureAryan,
70-75
headed)
Aborigines,Negroes
Mesaticephalic
Europeansand
75-80
(mediumheaded)
Chinese
Brachycephalic(short 80-85
Mongolian
headed)

---

666.Allaresignsofsomaticdeathexcept?
a)Cessationofrespiration
b)Cessationofheart
c)Non-respondingmuscles
d)Noresponsetoexternalstimuli
CorrectAnswer-C
Ans.is'c'i.e.,Non-respondingmuscles
Deathdenotesdeathofhumanbeing(46IPC).Itisdefinedas
cessationoflifeorcesationtoexist.Deathisoftwotypes(1)
somaticdeath(systemicdeathorclinicaldeath)and(2)molecular
death(cellulardeath).
Somaticdeath(systemicdeathorclinicaldeath)
Itisthecompleteandirreversiblestoppageofthecirculation,
respirationandbrainfunctions(bishop'stripodoflife).Somaticdeath
isassociatedwithimmediatesignsofdeath:?
1. Permanentandcompletecessationoffunctionofbrainandflat
electricEEGwithnoresponsetoexternalstimuli;i.e.braindeath.
2. Permanentandcompletecessationoffunctionofheartandflat
ECG.
3. Permanentandcompletecessationoffunctionoflungs.
Somaticdeathisduetostoppedaerobicprocesses.However,
anaerobicenzymaticprocessesarestillcontinuing,hence(i)
musclesstillrespondtomechanical,electricalandthermalstimuli,
(ii)pupilsstillrespondtomioticsandmydriatics.
Moleculardeath(cellulardeath)
Itoccursaftersomaticdeath.Itreferstodeathofallindividualcells.
Itoccurswhenevenanaerobicprocessesstop,duetonon
availabilityofATP.Atthisstage:

---

1. Musclesdonotrespondtostimuli.
2. Pupilsdonotrespondtostimuliordrugs.
3. Thereareearlysignsandlatesignsofdeath:
Earlysigns:Changesinskinandeye,coolingofthebody,post-
mortemlividity,changesinmuscles(e.g.primaryrelaxation,rigor
mortis).
Latesigns:Decomposition(putrefaction),adipocerefromationand
mummification.
4.Moleculardeathofvariousorgansoccuratdifferentintervals
aftersomaticdeath:
1. Nervoustissue-->After5minutes.
2. Liver--->After15minutes.
3. Heart-->After45minutes.
4. Kidney-->After1hours.
5. Muscles-->After3hours.
6. Cornea-->After6hours.
7. BloodAfter6hours.

---

667.Theidealplacetorecordbody
temperatureindeadbodyis?

a)Rectum
b)Axilla
c)Mouth
d)Groin
CorrectAnswer-A
Ans.is'a'i.e.,Rectum
Mostcommonsiteforrecordingtemperatureistherectum.
Thermameterisinsertedinrectumaround8-10cmfor2minutes.
Othersitesforrecordingtemperaturearenose,ear(external
auditorymeatus),vagina,andunderliver.

---

668.Elderlyindividuallivingaloneina
temperatezoneisfounddeadone
morning.Theelectricheaterisfoundto
bedamaged.Therigormortiswillsetin:
NEET14
a)Earlierthanexpected
b)Laterthanexpected
c)Willnotsetin
d)Willsetinasexpected
CorrectAnswer-A
Ans.Earlierthanexpected

---

669.Putrefactionisdelayedinallexcept?
a)Warmmoistatmosphere
b)Carbolicacidpoisoning
c)Anemia
d)Heavymetalspoisoning
CorrectAnswer-A
Ans.is'a'i.e.,Warmmoistatmosphere
Factorscausingdelayofputrefaction
Temperature<0?Cor>48?C(veryhightemperature).
Dryweatherand/ordecreasedairvelocity.
Morethan2meterdeepgrave.
Tightclothing.
Bodyindrysoil,andbodypackedincoffin.
Infantnotfed.
Wastingdiseaseslikeanemia.
Poisoning:Carbolicacid,ZnC12,strychnine(nuxvomica),and
heavymetals(arsenic,antimony).
Inwaterslowerthaninair(casper'sdictum).
Factorsfacilitatingputrefaction
Putrefactionisfacilitatedby(i)freeaccessofair(ii)moistureand(iii)
optimumwarnth(10?C-45?C).Thusdecompositionisfastin
shallowdamp,marshyshallowgraves,inbodieswithoutclothesand
coffin.

---

670.Differencebetweencontusionandpost-
mortemlividityisthatpost-mortem
lividity?
a)Showssequentialcolorchange
b)Easilywashable
c)Showsdiffuseirregularmargins
d)Hasraisedenzymelevels
CorrectAnswer-B
Ans.is'b'i.e.,Easilywashable

---

671.Virchowmethodoforganremovalis?
a)Organsremovedenmasse
b)Organsremovedonebyone
c)Insitudissection
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Organsremovedonebyone
Methodsofremovaloforgans
Virchow'stechnique-organsareremovedonebyone.Cranial
cavityisexposedfirst,followedbythoracic,cervical&abdominal
organs.
Rokitansky'stechnique-Itinvolvesinsitudissectioninpart,
combinedwithenblockremoval.
Lettulle'stechnique-Cervical,thoracic,abdominal&pelvicorgans
areremovedenmasse&dissectedasorganblock.

---

672.Methodofautopsyinwhichvarious
systemsorgansareremovedenmasse?
a)Rokitansky
b)Virchow
c)Gasses
d)Lettulle
CorrectAnswer-D
Ans.is'd'i.e.,Lettulle
Methodsofremovaloforgans
Virchow'stechnique-organsareremovedonebyone.Cranial
cavityisexposedfirst,followedbythoracic,cervical&abdominal
organs.
Rokitansky'stechnique-Itinvolvesinsitudissectioninpart,
combinedwithenblockremoval.
Lettulle'stechnique-Cervical,thoracic,abdominal&pelvicorgans
areremovedenmasse&dissectedasorganblock.

---

673.TimelimitofexhumationinIndiais-
a)Onemonth
b)Oneyear
c)Tenyears
d)Nolimit
CorrectAnswer-D
Ans.is'd'i.e.,Nolimit
Exumation
Itislawfuldiggingoutofaburiedbodyfromthegraveforthe
purposeofidentificationordeterminationofcauseofdeath.
Onlyamagistrate(executivemagistrate)canorderforexhumation.
Inindia,thereisnotimelimitforexhumation,i.e.canbedoneatany
timeafterdeath.
ItisdoneundersupervisionofmedicalofficerandMagistratein
presenceofapoliceofficerwhoprovideswitnessestoidentifygrave,
coffinanddeadbody,wheneverpossible,Magistrateshouldinform
therelativesandallowthemnottoremainpresentatthetimeof
enquiry.
Thewholeprocedureshouldbeconductedandcompletedinnatural
daylight.Therefore,itisusuallystartedearlyinmorning.

---

674.Idealtimetostartexhumation?
a)Midnight
b)Lateevening
c)Afternooninproperlight
d)Earlymorning
CorrectAnswer-D
Ans.is'd'i.e.,Earlymorning
Exumation
Exumationislawfuldiggingoutofaburriedbodyfromthegravefor
thepurposeofidentificationordeterminationofcauseofdeath.
Onlyamagistrate(executivemagistrate)canorderforexhumation.
Inindia,thereisnotimelimitforexhumation,i.e.canbedoneatany
timeafterdeath.
ItisdoneundersupervisionofmedicalofficerandMagistratein
presenceofapoliceofficerwhoprovideswitnessestoidentifygrave,
coffinanddeadbody,wheneverpossible,Magistrateshouldinform
therelativesandallowthemnottoremainpresentatthetimeof
enquiry.
Thewholeprocedureshouldbeconductedandcompletedinnatural
daylight.
Therefore,itisusuallystartedearlyinmorning.

---

675.Shapeofstabwounddependson-
a)Edgeofweapon
b)Shapeofweapon
c)Width
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Astabwoundisaninjurycausedbyamoreorlesssharppointed
weaponwhenitisdriveninthroughtheskinanditsdepthisthe
greatestdimension.
Thesizeandshapeofthestabwoundintheskinisdependenton
thetypeofweapon,cuttingsurface,edgesharpness,widthand
shapeofweapon,bodyregionstabbed,theangleofwithdrawal,the
directionofthurst,themovementofbladeinbody,cleavage
direction,movementofpersonstabbedandtheconditionoftension
orrelaxationofskin.
Withadouble-edgedweapontheshapeofthewoundwillbe
ellipticalorslitlikeandbothangleswillbesharporpointed.
Withasingle-edgedweapon,theshapewillbetriangularorwedge
shapedandoneangleofthewoundwillbesharp,theother
rounded,blunt,orsquared-off.Bluntendontheskinmayhavesmall
splits,so-called"fish-tailing"ifthebackedgeofthebladeisheavy.
Aspearoranotherroundobjectcausesacircularwound.

---

676.Allaretrueaboutantemortemcontusion
except?
a)Sequentialcolorchange
b)Noinflammation
c)Raizedenzymelevels
d)BloodcellsinsurroundingtissueAccidendal
CorrectAnswer-B
Ans.is'b'i.e.,Noinflammation

---

677.Grazeisatypeof?
a)Bruise
b)Contusion
c)Laceration
d)Abrasion
CorrectAnswer-D
Ans.is'd'i.e.,Abrasion
Abrasion
Itisadestructionoftheskin,whichinvolvesthesuperficiallayersof
theepidermisonly.Theyareof4types:
1. Scratches-itsaabrasionwithlengthbutnosignificantwidthoraa
verysuperficialincision.
2. Grazes-mostcommon.Theyoccurwhenthereismovement
betweentheskinandsomeroughsurfaceincontactwithit.
3. Pressureorfrictionabrasion-theyarecausedbycrushingofthe
superficiallayersoftheepidermisandareassociatedwithabruise
ofthesurroundingarea.
4. Impactorcontactabrasion-theyarecausedbyimpactwitharough
object,whentheforceisappliedatorneararightangletotheskin
surface.
5. Patternedabrasion-impactabrasionandpressureabrasion
reproducethepatternoftheobjectcausingitandarecalled
Patternedabrasion.

---

678.Browncolorofcontusionisdueto-
a)Haematodin
b)Reducedhemoglobin
c)Haemosiderin
d)Bilirubin
CorrectAnswer-C
Ans.is'c'i.e.,Haemosiderin
Colorchangeandageofbruise(Contusion)
Afterabruisehasappeared,ittendstogetsmallerfromperipheryto
centerandpassesthroughaseriesofcolourchanges.Theseare
duetodisintegrationofRBCsbyhemolysisandbreakdownof
hemoglobinintothepigmentshaemosiderin,haematodinand
bilirubinchangesare:-
1. Atfirst:Red(oxyhemoglobin)
2. Fewhoursto3days:blue(reducedhemoglobin)
3. 4thday:Bluish-blacktobrown(haemosiderin)
4. 5-6days:Greenish(haematodin)
5. 7-12days:Yellow(Bilirubin)
6. 2weeks:Normal(absorptionofpigment)

---

679.Primaryinjuryis?
a)Duetoflyingdebrisb
b)Duetoblastwind
c)Duetoshockwave
d)Duetocomplication
CorrectAnswer-C
Ans.is'c'i.e.,Duetoshockwave
Typesofblastinjuries
Theseareoffollowingtypes:?
1. Primary:Itisduetoshockwavewhichcausesinjurytohollow
organs.e.g.ears,lungs,eyes,GITetc.
2. Secondary:Theseareduetoflyingdebris(missiles).Classical
Marshallstriadi.e.bruises,abrasionsandpuncturelacerationis
diagnosticofexplosiveinjury.
3. Tertiary:Itisduetoblastwind,i.e.victmisthrownintoairand
strikesotherobjectsleadingtofracture,blunttraumaetc.
4. Quaternary:Anycomplicatingfactor(notinfirstthreecategories)
causesquaternaryinjury,e.g.anoxia,respiratoryproblemsetc

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680.Organsfirsttobeinjuredinairblast:
NEET13
a)Ear,lung
b)Kidney,spleen
c)Pancreas,duodenum
d)Liver,muscle
CorrectAnswer-A
Ans.Ear,lung

---

681.Mostcommonorganinvolvedinairblast
injuryis?
a)Eardrum
b)Stomach
c)Eye
d)Lung
CorrectAnswer-A
Ans.is'a'i.e.,Eardrum
Blastorshockwave
Whenanexplosionoccurs,theexplosivematerialproducesalarge
volumeofgasandreleasesalargeamountofenergy.Itproducesa
'shockwave'whichspreadconcentricallyfromthesiteofexplosion.
Theinjuriesdependontheenvironmentinwhichblastoccurs:-
1. Airblast(mostcommon):Explosionoccursinair.Thereis
barotraumatoairfilledholloworgans.Tympanicmembrane(ear
drum)ismostsensitiveandmostcommonlyinjured.Lungisthe
secondorgantobeinjuredandisthemostcommonlyinjuredhollow
organandmostcommoncauseoflifethreateninginjury.Otherparts
injuredaremiddleear,cochlea,eyes,bowels,mesentery,omentum
andbrain.Homogenoussolidorganslikeliverandmusclesare
usuallynotaffected.
2. Underwaterblast(explosionunderwater):Gastrointestinaltractis
injuredmostcommonly.Lungsarealsoinjured.
3. Solidblast:Explosiveisdetonatedneararigid/solidstructureand
waveofenergyspreadsthroughit.Ifpeopleareincontactwiththat
rigidstructure,injuriestakeplace.Theinjuriesaremostlyskeletal;
fractureoflegsandvertebralcolumnaremorecommon.GIT
damageismorecommonthanlung

---

---

682.Inblastinjury,whatistheorgantobe
damagedfirst-
a)Tympanicmembrane
b)Git
c)Liver
d)Lung
CorrectAnswer-A
Ans.is'a'i.e.Tympanicmembrane

---

683.Telefonomeans?
a)Beatingonsoles
b)Beatingonpalms
c)Beatingonears
d)Pullingofhair
CorrectAnswer-C
Ans.is'c'i.e.,Beatingonears
Telefono:Simultaneousbeatingofbothearswiththepalmof
hands.Thismayleadtoruptureoftympanicmembrane,causing
pain,bleedingandhearingloss.Itisdifficulttodetectthis.The
externalearmayalsogettornduringpullingoftheears.
Falanga:beatingofsoleswithbluntobject.Itisthemostcommon
typeoftorture.Itcancauseimmediate&longtermconsequences,
evendisability

---

684.Tattooingaroundtheentrywoundis
seenin?
a)Closeshot
b)Contactshot
c)Distantshot
d)Alloftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Closeshot

---

685.Whichisincorrectaboutexitwoundofa
bullet?
a)Bevelled
b)Everted
c)Abrasioncollar
d)NoCOHb
CorrectAnswer-C
Ans.is'c'i.e.,Abrasioncollar

---

686.chockingofrespiratorypassageby
bolusoffood?
a)Gaging
b)Overlying
c)Cafecoronary
d)Burking
CorrectAnswer-C
Ans.is'c'i.e.,Cafecoronary

---

687.Termcafecoronarywascoinedby?
a)RogerHaugen
b)J.Morton
c)NeilMarkson
d)M.Hoppefield
CorrectAnswer-A
Ans.is'a'i.e.,RogerHaugen
Apopularterm'cafecoronary'wascoinedbyDr.RogerHaugen,
MedicalExaminerofBrowardCounty,Floridaforsuchimpactionof
foodintherespiratorypassage".--KrishanVij

---

688.Causeofdeathincafecoronary?
a)Chocking
b)Laryngealedema
c)Cardiacarrest
d)Pulmonaryedema
CorrectAnswer-C
Ans.is'c'i.e.,Cardiacarrest
Bothasphyxiaandcardiacarrestarecausesofdeathincaf?
coronary.
Mostoftheguideshavegivenasphyxiaastheanswer.But
accordingtomecardiacarrestisthebetterone.Readfollowing
statements:
"Deathappearstobeduetosuddenheartattack."--Reddy
"Thebolusoffoodobstructthelarynx,stimulatinglaryngealnerve,so
stimulatingvagusnerveandthusresultinginsudden
cardiopulmonaryarrestandtherebysuddendeath."--S.K.Singhal
"Deathisduetoasphyxiaorreflexcardiacarrest."--Parikh
"Deathoccursduetocardiacarrestfollowingparasympathetic
stimulationthroughlaryngealnerveending."--R.N.Karmaker

---

689.Cafecornoraycommonlyoccurswhena
personis-
a)Intoxicated
b)Eatingfattyfood
c)Eatingmeat
d)Eatingfish
CorrectAnswer-A
Ans.is'a'i.e.,Intoxicated
Cafecoronary:Itreferstoaccidentalchockingbybolusoffood
obstructinglarynx.Deathismostlyduetoasphyxia,orduetoreflex
cardiacarrestcausedbystimulationoflaryngealnerveendings.Itis
commonwhengagreflexissuppressed,e.g.intoxicatedindividuals
andfollowinglargedoeseoftranquilizers.

---

690.Muggingiscompressionofneckby?
a)Woodensticks
b)Rope
c)Forearm
d)Hand
CorrectAnswer-C
Ans.is'c'i.e.,Forearm
Mugging(chokehold):Itiscompressionofneckbyforearmorinthe
bendofelbow.
Bansdola:Compressionofneckwithoneortwowoodensticksor
bamboo.
Garrotting:Itiscompressionofneckbyaropethrownfrombehind.
Spanishwindlassisatypeofgarrotting,whichusedtobetheofficial
modeofexecutioninspain.Inthis,anironcolloraroundtheneck
wastightenedbyascrewforstrangulation.
Throttling(manualstrangulation):Neckiscompressedbyoneor
bothhands.

---

691.Bansdolaisaformofstrangulation
by:
NEET14
a)Ligature
b)Hands
c)Woodensticks
d)Bendofelbow
CorrectAnswer-C
Ans.C.Woodensticks
Dependinguponthemethodusedtoconstricttheneck,
strangulationcanbedividedinto:
Ligaturestrangulation:
*Neckiscompressedbyaligatureofwhichusuallymultiplerounds
aregivenandnoknotistied.
Throttling(manualstrangulation):
*Neckiscompressedbyoneorbothhands.
*Whenneckiscompressedbytwopalms,itisknownaspalmar
strangulation.
Bansdola:
*Compressionofneckwithoneortwowoodensticksorbamboo.
Garrotting:
*Itiscompressionofneckbyaropethrownfrombehind.Spanish
windlassisatypeofgarrotting,whichusedtobethe
officialmodeofexecutioninspain.Inthis,anironcoloraroundthe
neckwastightenedbyascrewforstrangulation.
Mugging(chokehold):
*Itiscompressionofneckbyforearmorinthebendofelbow.

---

Strangulationbyknee/foot:
*Inthis,neckiscompressedbykneeorfoot.

---

692.Suicidalmarkishorizontalin?
a)Hanging
b)Strangulation
c)Bothoftheabove
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Strangulation

---

693.Hyoidbonefracturedoesnotoccur
in:
NEET14
a)Hanging
b)Strangulation
c)Throttling
d)Choking
CorrectAnswer-D
Ans.Choking
[RefParikh61Vep.3.24]
Itisverysimplequestion.Hyoidfracturewilloccuronlywhenthere
ispressureonhyoid(neck)fromoutside.
Inchoking,thereisnopressureonhyoid.
Fractureofhyoid:Throttling(manualstrangulation)>ligature
strangulation>Hanging.

---

694.Theoutercoveringofdiatomismadeof
?
a)Magnesium
b)Silica
c)Hydrocarbons
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Silicon
Theextracellularcoatofdiatomshassilica.
Diatomsareunicellularalgae,suspendedinwater.
Theyhavesilicaceouscellwall(i.e.cellwallcontainssilica)which
resistaciddigestionandputrefaction.
Onlylivebodywithacirculationcantransportdiatomsformlungto
brain,bonemarrow,musclesetc.
So,presenceofdiatomsinbrainandbonemarrowindicatesdeath
duetodrowning.
Fordetectionofdiatoms,bonemarrowoflongbones,e.g.femur,
tibia,humerusorsternumishighlysuitableandreliable.
Asdiatomsresistaciddigestion,toextractthemaciddigestion
techiniqueisused.
Diatomstestisnegativeindeadbodiesthrowninwaterandindry
drowning.
However,diatomstestisinvalid,ifdeceasedhaddrunkthiswater
beforesubmersionorspeciesofdiatomsdonotmatchwith
specimenfromthesiteofdrowning

---

695.WhatdoesGettlerstestdetects?
a)Diatomsindrowning
b)Chloridecontentofbloodindrowning
c)Weightindrowning
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Chloridecontentofbloodindrowning
Gettlertestestimateschloridecontentofbloodfrombothsidesof
heart.
Itisdonefordrowning.
Normallythechloridecontentisequalintherightandleftchambers
oftheheart(600mg/100m1).Infreshwaterdrowningdueto
hemodilutionthechloridecontentisdecreasedandinsaltwater
drowningduetohemoconcentrationthechloridecontentis
increasedinleftsideofheart.
A25%differenceinchlorideissignificantbutthetestisofdoubtful
value.

---

696.Immersionsyndromeisalsocalledas?
a)Hydrocution
b)Wetdrowning
c)Drydrowning
d)Secondarydrowning
CorrectAnswer-A
Ans.is'a'i.e.,Hydrocution
Immersionsyndrome-isalsocalledashydrocutionorsubmersion
inhibitionorvagalinhibition.
Atypicaldrowning
Itreferstodrowninginwhichevenaftersubmersionofbodyin
water,littleornowaterantersrespiratorypassagesandlungs.
Hencetypicalfindingsofwetdrowningintheformoffrothand
oedemaaquosun:oflungsarenotfound.Atypicaldrowningmaybe
:
1. Drydrowning:Oncontactwithwater,especiallycoldwater,there
resultsintenselaryngospasm,sothatwaterdoesnotenterthe
lungs.Deathisduetoasphyxiabecauseoflaryngospasm.
2. Immersionsyndrome(hydrocution/submersioninhibition/vagal
inhibition):Suddendeathoccursduetovagalinhibitionasaresult
of(a)suddenimpactwithcoldwater,(b)duckdiving(fallinginwater
withfeetfirst),and(c)horizontalentryinwaterwithimpacton
epigastrium.
3. Submersionofunconscious:Ifpersonisunconscioussincebefore
submersioninwater,littleornowaterentersrespiratorypassages.It
mayoccurinMI,cerebrovascularaccident,hypertension,epilepsy,
cerebralaneurysmandindrunkstate.
4. Neardrowning(secondarydrowningsyndrome/postimmersion

---

syndrome):Inthisdrowningissurvivedanddeathoccursatalater
stageafterremovalfromwater.Eitherthepersonhimselfcomesout
ofwaterorheisrecoveredalive,butduetocomplicationsof
submersion,hediesatalaterstage.Itisduetohypoxic
encephalopathyandfibrosingalveolitis.Thedeathoccursdueto
combinedeffectofcerebralhypoxia,pulmonaryedema,aspiration
pneumonitis,electrolytedisturbancesandmetabolicacidosis.

---

697.Platauf'shemorrages,incorrectis?
a)Signofdrowning
b)Subpleuralhemorrhage
c)Mostlyseeninmiddlelobe
d)Allaretrue
CorrectAnswer-C
Ans.is'c'i.e.,Mostalyseeninmiddlelobe
Paltauf'shemorrhages
Theyaresubpleuralhaemorrhagespresentincasesofdrowning
whenalveolarwallsruptureduetoincreasedpressureduringforced
expirationandproducehaemorrhages.
Theyareshiningpalepinkorbluishred,andmaybeminuteor3-
5cmindiameterseeninlungs.
Theyareusuallypresentinabout50%casesinlowerlobesoflungs
butmaybeseenontheanteriorsurfacesoflungsandtheinterlobar
surfaces.

---

698.MostcommondrowninginIndia-
a)Suicidal
b)Homicidal
c)Accidental
d)Infanticide
CorrectAnswer-C
Ans.is'c'i.e.,Accidental
Mostofthecasesofdrowning(2/3)inIndiaareaccidental.Rest1/3
beingsuicidal.Homicidaldrowningislesscommoninindia.
Suicidaldrowningisindicatedbyabsenceofsignsofstruggleor
assault(e.g.tornclothes,injurymarks).Adeterminedsuicidemay
tiehishandsandlegstogetherorattachweightstohisbodyortake
poisonorcutthroatbeforeimmersion.
Inhomicidaldrowning,therearesignsofstruggleandviolence
(assault)(e.g.headinjury,signsofstrangulation,orthrottling).Head
andfeetmaybetied,heavyweightmaybeattachedtobodyorbody
maybetiedupinsideagunnybag.Homicidaldrowningisveryrare
exceptininfantsandchildren.
Accidentaldrowningisquitecommonandusuallyseeninchildren,
non-swimmers,duringfloodsorduetofallinwelletc.

---

699.Diagnosticofantemortumdrowning?
a)Palatauf'shemorrhage
b)Weedsandgrassinclenchedhands
c)Emphysemaaquosum
d)Waterinesophagus
CorrectAnswer-B
Ans.is'b'i.e.,Weedsandgrassinclenchedhands

---

700.Alltestsareusedforinfanticideexcept?
a)Ploucquettest
b)Fodere'stest
c)Gettler'stest
d)Raygat'stest
CorrectAnswer-C
Ans.is'c'i.e.,Gettler'stest
Testsusedininfanticide(forrespiration)
Ploucquet'stest:Weightoflungismeasuredinrelationtobody
wieght.Beforebirthweightoflungis1/70ofbodyweightandafter
respirationitbecomes1/35ofbodyweightduetoincreasedblood
flowinlungbeds.
StatictestorFodere'stest:Theaverageweightofbothlungsbefore
respirationis30-40gmandafterrespirationis60-70cm.
Hydrostatictest(Raygat'stest,I"lifetest):Thespecificgravityofa
non-respiredlungis1040-1050andofarespiredlungis940-950,
so,afterrespirationlungfloatsonwater(specificgravityofwateris
1000).Falsepositivehydrostatictestmayoccur(i.e.non-respired
lungmayfloat)indecompositionandinattemptedartificial
respiration.Falsenegativehydrostatictest(i.e.respiredlungmay
sinkdown)mayoccurinatelectasis,pulmonaryoedema,
bronchopneumonia,andcongenitalsyphylis.
Breslau'ssecondlifetest:Itassumesthatalivebornchildwould
respireandtherefore,wouldalsoswallowsomeairintothestomach
andbowel.Hencetheyfloatonwater.Thistestisfalselypositivein
putrefaction(duetoputrefiedgases)orincasesofattempted
artificialrespiration.
Werdin'stest:Beforebirthmiddleearcontainsgelatinousembryonic

---

tissuewhichisreplacedbyairafterrespiration

---

701.Raygat'stestisusedfor?
a)Weightoflung
b)Specificgravityoflung
c)Consistencyoflung
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Specificgravityoflung
Hydrostatictest(Raygat'stest,1"lifetest):Thespecificgravityofa
non-respiredlungis1040-1050andofarespiredlungis940-950,
so,afterrespirationlungfloatsonwater(specificgravityofwateris
1000).Falsepositivehydrostatictestmayoccur(i.e.non-respired
lungmayfloat)indecompositionandinattemptedartificial
respiration.Falsenegativehydrostatictest(i.e.respiredlungmay
sinkdown)mayoccurinatelectasis,pulmonaryoedema,
bronchopneumonia,andcongenitalsyphylis.

---

702.Intercourseincloselyrelatedindividual
inrelation?
a)Incest
b)Adultery
c)Bestiality
d)Tribadism
CorrectAnswer-A
Ans.is'a'i.e.,Incest
Incest
Itmeanssexualintercoursebyamanwithawomanwhoisclosely
relatedtohimbyblood(prohibiteddegreesofrelationship).Example
daughter,granddaughter,sister,stepsister,aunt,ormother.
Thesecasesusuallyhavepsychologicalfeatures.
InIndia,incestisnotanoffence.
Adultery
Adulteryreferstovolutarysexualintercoursebetweenamarried
personandaperson(marriedornot),otherthanhis/herspouse.
Bestiality
Itisthesexualintercoursebyahumanbeingwithaloweranimal.
Tribadism(Lesbianismorfemalehomosexuality)
Sexualgratificationofawomenobtainedbyanotherwomanby
kissing,bodycontact,manipulationofbreastandgenitalia.Active
partneriscalleddykeorbutchandthepassiveagentiscalled
femme.ThisisnotanoffenceinIndia.

---

703.Incestisdefinedassexualintercourse
between?
a)Manandanimals
b)Manandcloselyrelatedwomen
c)Manandwomenotherthanwife
d)Manandman
CorrectAnswer-B
Ans.is'b'i.e.,Manandcloselyrelatedwomen

---

704.Mostcommonhymenruptureinavirgin
is?
a)Anterior
b)Anterolateral
c)Posterolateral
d)Posterior
CorrectAnswer-C
Ans.is'c'i.e.,Posterolateral
Hymenrupture:
Congenital:anterior
Duetointercourseorforeignbody:posterolateral(4/8or5/70'
clock)>posterior(60'clock).
Invirginrupture(tears)ofhymenduetosuddentretchingoccursin
posteriorhalfofmembraneusuallyatthesides(i.e.posterolaterally)
in4or8'Oclockor5or7'Oclockposition,orinthemidlineofhymen
(6'Oclockposition).
Withfirstintercoursetearsusuallyoccurinposteriormidline
becausethehymenliessuspendedacrossapotentialspacehere,
whereasanteriorlyperiurethraltissuesbuttressthehymen.
Morethan2tearsareunusual,Semilunarhymenoftenruptureson
bothsides.Annularhymenwhichnearlyclosesupthevaginalorifice
maysufferseveralhymenallacerationsindicatefirstsexual
intercourse.
Onedeep'Vshapedcleft/tearat6'0clockoranumberofclefts
usuallyinposteriorhafthymenmembraneindicatepassageofany
objectthroughhymeorificewhichislargeritsoriginalopening.'
Inprepubertalchildrenposteriortearmayinvolvefourchette
producingadeepUshapeddefect.Fourchetteistorn,fossa

---

navicularisdisappearandposteriorcommissuremayberuptured.
Thelatterinjuryusuallydoesnotoccurinconsentingsexual
intercourseunlessthereismuchdisproportionbetweenthemale
andfemaleparts.

---

705.QuodHancmeans?
a)Passivepartnerinsexualintercourse
b)Womenhavinghighsexualdesire
c)Sexualparternerinpedophilia
d)Maleimpotenttoparticularwomen
CorrectAnswer-D
Ans.is'd'i.e.,Maleimpotenttoparticularwomen

---

706.Latte'scrustofbloodstainisusedto
detect?
a)Natureofstain
b)Detectionspecies
c)Bloodgroup
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Bloodgroup
Bloodandbloodstains
Theexaminationofbloodandbloodstainsisanimportantpartof
crimedetection.Thepointsthatareusuallyrequiredtobe
determinedregardingstainsare:(1)natureofstain(whetherthe
stainsisbloodornot);(2)thespecies(humanoranimal)fromwhich
thebloodhascomefrom;and(3)bloodgroup.
Natureofstain(whetherthestainisbloodornot)
Todeterminethenatureofstain,followingtestsareused:
1.Chemicaltests
1. Thesetestsarebasedontheperoxidaseactivityofhaematin,which
is,derivedfromoxidationofhaemofhaemoglobinor
methemoglobin,present.Thisenzyme,inthepresenceofhydrogen
peroxideconvertscolourlesssaltsintocolouredbases.Thusthese
testsarebasedonH202andperoxidaseenzyme.Testsare:
2. Benzidinetest:Greenishbluecolour.
3. Phenolphthaleintest(kastlemyeretest):Deeppermanganate
colour.
4. Leucomalachitegreentest:Bluishgreenorpeacockbluecolour.
5. Guaiacumtest:Bluecolour.

---

6. Orthotoludinetest(kohntest):Blueorgreencolour.
7. Amidopyrinetest:Purplecolour.
2.Microchemicaltests
Thesetestsarebasedonpropertyofhaempartofhemoglobinto
formcharacteristiccolouredcrystals.Thetestsare:
1. Teichmann'shaemincrystaltest.
2. Takayamahemochromogencrystaltest.
3. Luminalspraytest:Itisespeciallyusefulinoldobscureblood
stains.
4. Spetroscopy
Itismostdelicateandreliabletest.Itisbasedontheprinciplethat
hemoglobinanditsderivativesgivecharacteristicabsorptionbands
whenviewedthroughaspectroscope.
4.Microscopy
MicroscopicexaminationofRBCsispossibleonlyinfreshstains.
Detectionofspecies(whetherthebloodhascomefromhuman
oranimal)
Fordetectionofspecies,serological(immunological)testsareused.
Thesetestsare:
1. Precipitintest
2. Haemaglutinationinhibitiontest(antiglobulinconsumptiontestor
absorptioninhibitiontest).
3. Geldiffusiontest.
4. Doublediffusiontest.
5. Precipitationelectrophoresis.
6. Latexagglutinationtest.
7. Isoenzymemethod(enzymologicaltest).
Detectionofbloodgroupofbloodstain
Thesetestsare:
1. Immunological(serological):(i)aborption-elutiontest,(ii)
absorption-inhibitiontest,(iii)mixedagglutinationtest,(iv)latextest.
2. Enzymologicalmethods.
3. Latte'scrustmethod.

---

707.Ruleof9inburnsisusedtodenote?
a)Depthofbums
b)%oftotalbodysurfacearea
c)Severityofbums
d)Typeofbums
CorrectAnswer-B
Ans.is'b'i.e.,%oftotalbodysurfacearea

---

708.Allareimmediatecausesofdeathina
caseofburn,except?
a)Suffocation
b)Embolism
c)Injury
d)Sepsis
CorrectAnswer-D
Ans.is'd'i.e.,Sepsis
Causesofdeathinburns
Causesofdeathinburnsmaybedividedinto:
1. Causesofimmediatedeath:Theseare(1)neurogenicshock
(primaryshock),(2)hypovolaemicshock(secondaryshock),(3)
suffocation,duetoinhaledCO,CO2,(4)cyanideintoxication,(5)fat
embolism,(6)cerebralorpulmonaryedema,and(7)accidental
injuriesduringburn.
2. Causesofdelayeddeath:Theseare:(1)renalfailure(acutetubular
necrosis),(2)infections(sepsis,gangrene,tetanus)and(3)
centrilobularnecrosisofliver.

---

709.ThemostcommonsubtypeofNon-
Hodgkin'slymphomainIndiais:
a)Diffusesmallcelllymphocyticlymphoma
b)DiffuselargeBcelllymphoma
c)Follicularlymphoma
d)Burkitt'slymphoma
CorrectAnswer-B
Answer-B.DiffuselargeBcelllymphoma
ThemostcommonsubtypeofNon-Hodgkin'slymphomtinIndiais
dilfuselargeBcelllymphoma.
DiffuselargeB-celllymphoma:MCsubtype(34%)
Follicularcentre-celllymphomas:12.6%.
B-celfsmalllymphocyticlymphoma:.5.7%
Mantle-celllymphoma:3.4%
MarginalzoneB-celllymphomas(includingMALTlymphomas):
8.2%

---

710.GeneresponsibleformutationofHBVis
?
a)Xgene
b)Sgene
c)Pgene
d)Cgene
CorrectAnswer-D
Ans.is-D-i.e.,Cgene
TwocategoriesofnaturallyoccurringHBVvariantshaveattracted
themostattention.
OneofthesewasidentifiedinitiallyinMediterraneancountries
amongpatientswithanunusualserologicclinicalprofile.Theyhave
severechronicHBVinfectionanddetectableHBVDNAbutwithanti-
HBeinsteadofHBeAg.
ThesepatientswerefoundtobeinfectedwithanHBAmutantthat
containedanalterationinthepre-coreregionrenderingthe
virusincapableofencodingHBeAg.
Anothermutation,inthecore-promoterregion,prevents
transcriptionofthecodingregionforHBeAgandyieldsanHBeAg
negativephenotype.
Patientswithsuchmutationsinthepre-coreregionandwhoare
unabletosecreteHBeAgtendtohavesevereliverdiseasethat
progressesmorerapidlytocirrhosis,ortheyareidentified
clinicallylaterinthecourseofthenaturalhistoryofchronichepatitis
Bwhenthediseaseismoreadvanced.
Both"wild-type"HBVandpre-core-mutantHBVcancoexistinthe
samepatient,ormutantHBVmayariselateduringwild-typeHBV
infection

---

---

711.Thestatementsregardingfalciparum
malariaareallexcept
a)Haemoglobinuriaandrenalfailure
b)Hypoglycemia
c)Cerebralmalaria
d)Adequatelypreventedwithchloroquinetherapy
CorrectAnswer-D
Ans.is'd'i.e.,Adequatelypreventedwithchloroquine
therapy[RefCMDT-14Chapter35p.1491]
MostspeciesofP.falciparumareresistanttochloroquine(so,it
doesnoteffectivelypreventP.falciparummalaria).
Pfalciparummalariacancause:-
1. Cerebralmalariawithimpairedconsciousness.
2. Blackwaterfevercausinghemolysis,hemoglobinuriaandrenal
failure.
3. Hypoglycemia
4. Bleeding
5. Pulmonaryedema
6. Acidosis

---

712.Whichofthefollowingistrueabout
malaria?
a)Gametocyteharbourersarecarrier
b)Allstageinerythrocyticschizogonyseeninfalciparuminfection
inperipheralblood
c)SchizontsofvivaxdonotcompletelyfilltheRBC
d)Allthecorrect
CorrectAnswer-A
Ans.is'a'i.e.,Gametocyteharbourersarecarrier
*Theindividualwhoharboursthegametocytesisknownasa
carrier.
*Onlyringform(youngtrophozoites)andgametocytesareseenin
peripheralblood.
*SchizontofP.vivaxalmostcompletelyfillsanenlargedR.B.C.

---

713.Amoebicliverabscesscanbediagnosed
bydemonstrating-
a)Cystsinthesterilepus
b)Trophozoitesinthepus
c)Cystsintheintestine
d)Trophozoitesinthefeces
CorrectAnswer-B
Ans.is'b'i.e.,Trophozoitesinthepus

---

714.Pseudomembranouscolitis,allare
trueexcept-
a)ToxinAisresponsibleforclinicalmanifestation
b)ToxinBisresponsibleforclinicalmanifestation
c)Bloodinstoolsisacommonfeature
d)Summitlesionsisearlyhistopathologicalfinding
CorrectAnswer-C
Ans.is'c'i.e.,Bloodinstoolsisacommonfeature

---

715.AllareseenwithPneumocystiscariniin
AIDSexcept
a)Pneumonia
b)Oticpolypoidmass
c)Ophthalmicchoroidlesion
d)Meningitis
CorrectAnswer-D
Ans.is'i.e.,Meningitis
P.jiroveci(formerlyknownasP.carinii)causesinterstitial
pneumoniainAIDSpatients.
Pneumocystisotomastoiditispresentwithunilateralotalgia,otorrhea,
hearinglossandapolypoidmassonotoscopy.
Ocularpneumocystisistypicallyrestrictedtochoroidallayer
producingmultiplefocalcircumscribedcreamytoyellow-white
lesions

---

716.Treponemapallidumwasdiscoveredby
?
a)RobertKoch
b)Twort
c)SchaudinnandHoffman
d)Ellerman
CorrectAnswer-C
Ans.is'c'i.e.,SchaudinnandHoffman
Bacteria
Discoveredby
Leprabacillus(M.Leprae)
Hansen(1874)
Gonococcus
Neisser(1879)
Staphylococcus
Ogston(1881)
Diphtheriabacillus(C.Diphtheria)
Loeffler(1884)
Tetanusbacillus(C.Tetani)
Nicolaier(1884)
Pneumococcus
Fraenkel(1886)
CausativeorganismforMaltafever
Bruce(1887)
(Brucella)
SchaudinnandHoffmann
Spirocheteofsyphilis(Tpallidum)
(1905)

---

717.Mycobacteriumtuberculosiswas
discoverdby?
a)Louispasteur
b)Robertkoch
c)Lister
d)Jener
CorrectAnswer-B
Ans.is'b'i.e.,Robertkoch
Scientist
Associatedwith
Proposedacontagiumvivuin(causeof
Fracastorius
infectiousdisease)
Suggestedthateachdiseaseiscaused
VonPlenciz
byaseparateagent
Earliestdiscoveryofpathogenic
AugustinoBassi
microorganism
Davaineand
Observedanthraxbacilliinbloodof
Pollender
animal
Fatherofmicrobiology(Alsoseeabove
LouisPasteur
explanation)
RobertKoch
Fatherofmedicalmicrobiology
DiscoveredM.tuberculosisandV
cholerae
Introducedstainingtechniquesmethods
ofobtainingbacteriain
purecultureonsolidmedia
SuggestedKoch'spostulate
JosephLister
FatherofAsepticsurgery
Provedthatsepsiscouldbepreventedby

---

Provedthatsepsiscouldbepreventedby
Handhygiene
AntonyVan
Inventedmicroscope(Fatherof
Leeuwenhoek
compoundmicroscope)
FatherofBacteriology
EdwardJenner
FatherofImmunology
PeytonRous
Isolatedviruscausingsarcomainfowl
VonBehring&
Describedantibody
Kitasato

---

718.Allorganismsshowsbipolarstaining
except?
a)Calymmatobactergranulomati
b)Y.pestis
c)Pseudomonasmallei
d)H.influenzae
CorrectAnswer-D
Ans.is'd'i.e.,H.influenzae
Safetypinappearance(Bipolarstaining)
1. yersiniapestis
2. Vibrioparahemolyticus
3. Burkholderiamallei
4. Burkholderiapseduomallei
5. Klebsiellagranulomatis

---

719.Whichofthefollowingisnotcapsulated
?
a)Pneumococcus
b)Cryptococcus
c)Meningococcus
d)Proteus
CorrectAnswer-D
Ans.is'd'i.e.,Proteus
Capsule
Manybacteriasecreteaviscidmaterialaroundthecellsurface.
Whenthisisorganizedintoasharplydefinedstructure,itisknown
ascapsule.
Capsulesareprotectiveandprotectthebacteriafromphagocytosis
andfromlyticenzymes.
Somebacterialoosetheircapsulesonrepeatedsubcultures.
Capsulatedorganisms
Pneumococcus
Yersinia
Bacillusanthrax
V.parahemolyticus
Bordetella
H.influenzae
Freshstrainsofstaphylococci,streptococci
Meningococci
and'Ecoli.
Cl.perfringensandCl.
Bacteroides
butyric=
Klebsiella
Cryptococcus.

---

720.Psedomonasiswhichtypeofbacteria?
a)Anaerobic
b)Microaerophilic
c)Microaerophilic
d)Obligateanaerobe
CorrectAnswer-C
Ans.is'c'i.e.,Microaerophilic

---

721.Specificreasontodisallowthesample
forculture?
a)Samplebroughtwithin2hrofcollection
b)Samplebroughtinsterileplasticcontainer
c)Samplebroughtinformalin
d)Sampleobtainedaftercleaningthecollectionsite
CorrectAnswer-C
Ans.is'c'i.e.,Samplebroughtinformalin
Guidelinesforproperspecimencollection
Collectspecimenbeforeadministeringantibioticsorantiviralswhen
possible.
Collectspecimenwithaslittleskincontaminationaspossibleto
ensurethatthesamplecollectedrepresentstheinfectedsite.
Utilizeappropriatecollectiondevices.Usesterileequipmentand
aseptictechniquetocollectspecimenstopreventintroductionof
microorganismsduringinvasiveprocedures.
Clearlylabelthespecimencontainerwithpatient'sname,hospital
numberorotheridentifyingnumber(i.e.birthdate,requisition
number),dateandtimeofcollection.
Collectanadequateamountofspecimen.Inadequateamountsof
specimenmayyieldfalse-negativeresults.
Ifaspecimeniscollectedthroughintactskin,cleansetheskinfirst.
Forexample,use70%alcoholfollowedbyiodinesolution(1to2%
tinctureofiodineor10%solutionofpovidoneiodine).
Collectfluidspecimensinsturdy,sterile,screwcap,leakproof
containerswithlidsthatdonotcreateanaerosolwhenopened.
Specimensobtainedbyaphysicianusingneedleaspirationshould
betransferredtoasteriletubeoranaerobictransportvialpriorto

---

transportofthespecimentothelaboratory.Ifthereislittlematerialin
thesyringe,thephysicianshoulddrawasmallamountofsterile
nonbacteriostatic0.85%NaC1throughthesyringeandthentransfer
thespecimentoasteriletube.Alternatively,andONLYifthe
specimenwillbecompromisedbytransferringitfromthesyringe,a
smallamountofsterile0.85%NaC1maybedrawnintothesyringe
priortoremovaloftheneedle.DONOTTRANSPORTSYRINGES
WITHNEEDLESATTACHEDAND/ORRECAPPED.Attachsyringe
capONLYifnecessary.Thephysicianshoulduseaprotective
devicewhileremovingtheneedletoavoidinjuryandshouldcapthe
syringewithasterilecappriortotransportingittothelaboratory.
AnyMicorbiologyandVirologyspecimenscollectedinformalinare
UNACCEPTABLEforculture.

---

722.Koch'spostulateisfullfilledbyall
except
a)M.tuburculosis
b)E.coli
c)T.pallidum
d)None
CorrectAnswer-C
Ans.is'c'i.e.,T.pallidum
Kochpostulates
RobertKochproposedaseriesofpostulatesthathavebeenapplied
broadlytolinkmanyspecificbacterialspecieswithparticular
disease.
Koch'spostulatesare:
1. Themicroorganismshouldbefoundinallcasesofthediseasein
questionanditsdistributioninthebodyshouldbeinaccordance
withthelesionsobserved.
2. Themicroorganismshouldbegrowninpurecultureinvitro(or
outsidethebodyofthehost)forseveralgenerations.
3. Whensuchapurecultureisinoculatedintosusceptibleanimal
species,thetypicaldiseasemustresult.
4. Themicroorganismmustagainbeisolatedfromthelesionsofsuch
experimentallyproduceddisease.
MicroorganismsthatdonotmeetthecriteriaofKoch'spostulates
1. Mycobacteriumleprae(leprosy)Cannotbeculturedinvitro
2. Treponemapallidum(syphilis)Neisseriagonorrhoeae
3. Noanimalmodelforexperimentalinfection
Microorganismthatpartiallysatisfythepostulates
E.coliinduceddiarrhea

---

---

723.Allaresporicidalagentsexcept?
a)Formaldehyde
b)Glutaraldehyde
c)Ethyleneoxide
d)Isopropylalcohol
CorrectAnswer-D
Ans.is'd'i.e.,Isopropylalcohol
Sporicidalagents
Bacterialsporesconstitutesomeofthemostresistantformsoflife.
Bynaturebacterialsporesareresistanttoextremephysical,
chemicalandthermalconditionsandaresecondonlytoprionsin
theirresistancetodisinfection.
Theyareresistanttomostofthedisinfectants.
Onlyafewagentsareeffectiveagainstthem.
Sporicidalagentsare-
Glutaraldehyde
Formaldehyde
Halogens
1. Iodinecompounds-,Iodine,Iodophors
2. ChlorinecompoundsSodiumhypochlorite,chlorinetablets
Ethyleneoxide
Peroxygenshydrogenperoxide,peraceticacid.
Betapropiolactone
Ozone
Followingcompondsareusuallysporostatic,butmaybecome
sporicidalathighertemperature?
Phenols
Cresols

---

Organomercurycompounds(Sodiumthioglycolate)
Chlorhexidine(Hibitane)

---

724.Sporesofbacteriaaredestroyedby
a)Alcohol
b)Lysol
c)Halogen
d)Ionizingradiation
CorrectAnswer-C
Ans.is'c'i.e.,Halogen
Amongstthegivenoptions,onlyhalogenshavesporicidalproperty

---

725.Allofthesterilizationmethodsare
properlymatchedexcept?
a)Catgutsuture-Radiation
b)Culturemedia-Autoclaving
c)Bronchoscope-Autoclaving
d)Glassware&syringes-Hotairove
CorrectAnswer-C
Ans.is'c'i.e.,Bronchoscope-Autoclaving

---

726.Percentageofglutaraldehydeused?
a)1%
b)2%
c)3%
d)4%
CorrectAnswer-B
Ans.is'b'i.e.,2%
2%Glutaradehyde(cidex)isanaldehydedisinfectantwithabroad
spectrumofactionagainstbacteria,fungi,viruses,aswellasspores
(slowaction).

---

727.Glassvesselsandsyringesarebest
sterilisedby-
a)Hotairoven
b)Autoclaving
c)Irradiation
d)Ethylenedioxide
CorrectAnswer-A
Ans.is`a'i.e.,Hotairoven
Hotairoven
Hotairovenareelectricaldevicesusedinsterilization.
Theovenusesdryheattosterilizearticles.
Hotairovenisusedfor
Glassware
Swabs
Liquidparaffin
Fatandgrease
Allglasssyringe
Forceps,scissors,scalpels
Dustingpowder

---

728.Whichofthefollowingisanintermediate
leveldisinfectant?
a)2%glutarldyhyde
b)Ethyleneoxide
c)Hypochlorite
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Hypochlorite

---

729.Lactosefermentationisseenin?
a)Bloodagar
b)Chocolateagar
c)MacConkeyagar
d)LJmedium
CorrectAnswer-C
Ans.is'c'i.e.,MacConkeyagar
Cultureondifferentialmediathatcontainspecialdyesand
carbohydratesdistinguisheslactose-fermenting(colored)fromnon-
lactose-fermenting(non-pigmented)coloniesandmayallowrapid
presumptiveidentificationofentericbacteria.
Suchmedia,usedtoseelactosefermentation,are:?
1. Eosine-methyleneblue(EMB)
2. MacConkey'sagar
3. Deoxycholateagar

---

730.Inbloodculturetheratioofbloodto
reagentis?
a)1:5
b)1:20
c)1:10
d)1:100
CorrectAnswer-C
Ans.is'c'i.e.,1:10

---

731.Whichanticoagulantisusedwhenblood
issentforbloodculture?
a)Sodiumcitrate
b)EDTA
c)Oxalate
d)SPS
CorrectAnswer-D
Ans.is'd'i.e.,SPS
Manydifferenttypesofbacteriaandfungihavebeenidentifiedas
causativeagentsofsepticemia.
Forthisreason,manydiverseculturemediaformulationsare
availableinpreparedbloodculturebottles.
Majorityofthesemediacontain0.03%SPS(Sodiumpolyanethal
sulfonate),apolyanionicanticoagulant,whichadditionallyinhibits
complementandlysozymeactivity,interfereswithphagocytosisand
inactivatesaminoglycosides.
Followingimportantbloodculturebottlesarethere:-
i)Brainheartinfusion(BHI)withPABA(para-aminobenzoicacid)
ii)Brucellabrothwith6%sorbitol
iii)Brucellabrothwith10%sucrose
iv)Columbiabroth
v)Thioglycolatemedium
vi)Trypticsoybroth

---

732.Allaretrueregardingresistanceof
penicillininstaphylococcusaureus,
except?
a)Penicillinaseproductionistransmittedbytransduction
b)MethicillinresistanceisduetochangeinPBP
c)HospitalstrainsmostlyproducetypeDpenicillinase
d)Penicillinaseproductionisplasmidmediated
CorrectAnswer-C
Ans.is'c'i.e.,HospitalstrainsmostlyproducetypeDpenicillinase
Resistancetoantibiotics
aPenicillinresistanceisofthreetypes?
1.Productionofbeta-lactamase(penicillinase)
Itinactivatespenicillinbysplittingbeta-lactamring
Itsproductioniscontrolledbyplasmid.
Plasmidistransmittedbytransduction(mainly)orconjugation.
Penicillinaseisaninducibleenzyme
Asaresultofthewidespreaddisseminationofplasmidscontaining
penicillinase,lessthan5%strainsofstaph.remainsusceptibleto
penicillin.
Staphylococciproducefourtypesofpenicillinases,AtoD.Hospital
strainsusuallyformtype'A'penicillinase.
2.Changesinbacterialsurfacereceptorsbylackorinaccessibilityof
certainpenicillin-bindingproteins(PBPs)intheorganism.
Methicillin-resistantismainlyduetothismechanismandis
independentofbeta-lactamaseproduction.
ItisduetotheproductionofPBP2a.
Thischange(inbacterialsurfacereceptors)isnormally

---

chromosomal.
TheresistancegeneismecAgenewhichisapartofalargemobile
geneticelement-staphylococcalcassettechromosome(SCCmec).
ThisgeneticmaterialhasbeentransferredtoStaph.aureusfromS.
seiuri.
3.Developmentoftolerancetopenicillin,bywhichthebacteriumis
onlyinhibitedbutnotkilled

---

733.Arrangementoflensfromeyetosource
oflight,inlightmicroscope?
a)Ocularlens:Subjectivelens:Condensorlens
b)Subjectivelens:Ocularlens:Condensorlen
c)Condensorlens:Sujectivelens:Ocularlens
d)Subjecivelens:Condensorlens:Ocularlens
CorrectAnswer-A
Ans.is'a'i.e.,Ocularlens:Subjectivelens:Condensorlens

---

734.Phagetypingcanbedonefor-
a)Salmonella
b)Streptococcus
c)Shigella
d)Pseudomonas
CorrectAnswer-A
Ans.is'a'i.e.,Salmonella
Phagetypingisamethodusedfordetectingsinglestrainsof
bacteria.
Itisusedtotracethesourceofoutbreaksofinfections.Theviruses
thatinfectbacteriaarecalledbacteriophages("phages"forshort)
andsomeofthesecanonlyinfectasinglestrainofbacteria.
Phagetypingprovidesarapid,accurate,andcheapmethodof
investigatingSalmonellastrainsforepidemiological
use.Salmonellastrainswithinaparticularserovarmaybe
differentiatedintoanumberofphagetypesbytheirpatternof
susceptibilitytolysisbyasetofphageswithdifferentspecificity.
Phasetypingisdonefor
1. Salmonella3.Staphaureus
2. V.cholerae4.Bacillusanthracis

---

735.Swarminggrowthoncultureis
characteristicofwhichGrampositive
organism?
a)Clostridiumwelchi
b)Clostridiumtetani
c)Bacilluscereus
d)Proteusmirabilis
CorrectAnswer-B
Ans.is'b'i.e.,Clostridiumtetani
Swarminggrowth
Swarminggrowthisduetothemotilityofbacteria.Inyoungculture,
discretecoloniesareseenbutthereafteractivelymotilecellsspread
onthesurfaceoftheplateinsuccessivewavestoformathinfilmy
layerinconcentriccircles.
Gram-positiveorganismshowingswarminggrowthC.tetaniand
Bacilluscereus
Gram-negativeorganismshowingswarminggrowthProteus
mirabilisandProteusvulgaris

---

736.Whichofthefollowingiscalledas
Preisz-Nocardbacillus-
a)C.diphtheriae
b)C.pseudotuberculosis
c)M.tuberculosis
d)Mycoplasma
CorrectAnswer-B
Ans.is'b'i.e.,C.pseudotuberculosis
Bacteriaandtheiralternatenames
Bordetella
BordetGengoubacillus
Clostridiumtetani
Nicolaire'sbacillus
Corynebacteriumdiphtheriae
Klebs-Loeffler'sbacillus
Corynebacteriumpseudotuberculosis Preisz-Nocardbacillus
Haemophilusaegyptius
Koch-Weeksbacillus
Haemophilusinfluenzae
Pfeiffer'sbacillus
Klebsiellapneumoniae
Friedlander'sbacillus
Klebsiellaozaenae
Abel'sbacillus
KlebsiellaRhinoscleromatis
Frisch'sbacillus
Mycobacteriumtuberculosis
Koch'sbacillus
Mycobacteriumintracellulare
Battey'sbacillus
Mycobacteriumparatuberculosis
Johne'sbacillus
Mycoplasma
Eatonagent
Pseudomonaspseudomallei
Whitmore'sbacillus

---

737.Dartingmotilitywhichoccurin
V.cholerae,alsofoundin-
a)Shigella
b)Campylobacterjejuni
c)Pneumococcus
d)Bacillusanthrax
CorrectAnswer-B
Ans.is'b'i.e.,Campylobacterjejuni
Darting(shootingstar)motilityisseenin
V.Cholerae
Gardnerellavaginalis
Campylobactor

---

738.PatientcamefromNagalandandshows
positivetestwithOXKantigen.
Diagnosisis?
a)Trenchfever
b)Scrubtyphus
c)Endemictyphus
d)Epidemictyphus
CorrectAnswer-B
Ans.is'b'i.e.,Scrubtyphus
WeilFelixreaction(DetectOXKantibodies)
.Thisreactionisanagglutinationtestinwhichseraaretestedfor
agglutininsto0antigensofcertainnon-motileproteusstrainsOX-
19,OX-2andOX-K.
Thebasisofthetestisthesharingofanalkali-stablecarbohydrate
antigenbysomerickettsiaeandbycertainstrainsofproteus,P.
vulgarisOX-19andOX-2andP.mirabilisOX-K.
Thetestisusuallydoneasatubeagglutination,thoughrapidslide
agglutinationmethodshavebeenemployedforscreening.
WeilFelixReaction
OX-
OX-
Disease
OX-2
19
K
RockyMountain
+
+
?
spottedfever
-
-
?
Rickettsialpox
+
-
_
Epidemictyphus
Brill-Zinsser
+/-
-
?
disease

---

Scrubtyphus
-
-
+
Endemictyphus
+
-
?
Trenchfever
-
?
Qfever
-

---

739.Whichofthefollowingstimulate
adenylatecyclasewithG-proteincoupled
action?
a)Shigatoxin
b)Choleratoxin
c)Diphtheriatoxin
d)Pseduomonastoxin
CorrectAnswer-B
Ans.is'b'i.e.,Choleratoxin

---

740.Mostcommonstaphylococcalphage
straincausinghospitalinfection?
a)80/81
b)79/80
c)3A/3C
d)69/70
CorrectAnswer-A
Ans.is'a'i.e.,80/81
Hospitalstrainsofstaphylococcusaureus
Certainstrainsofstaphylococcusarethecommoncauseofpost-
operativewoundinfectionsandotherinfectionsinthehospital
environment.
Thesestrainsareknownashospitalstrains.
Thehospitalstrainsshowthefollowingcharacteristics:
1. Theyareresistanttopenicillin,methicillinandotherroutinelyused
antibiotics.
2. Theybelongtocertainbacteriophagetypes.
3. Someofthestrains(egphagetype80/81)areknowntocause
hospitalinfectionsthroughouttheworld.Suchstrainsarecalledas
epidemicstrains.

---

741.MostcommonorganismcausingURTIin
adult?
a)Hinfluenza
b)Stapaureus
c)Streptopneumonia
d)Streptococcuspyogenes
CorrectAnswer-D
Ans.is'd'i.e.,Streptococcuspyogenes
Mostcommoncauseofupperrespiratorytractinfectionisviral
infection.Rhinovirusisthemostcommoncause.
Amongthebacteria,groupAbeta-hemolyticstreptococci
(streptococcuspyogenes)isthemostcommoncause.
Andmostcommontypeofinfectionispharyngitis.

---

742.Draughtsman(ConcentricRings)on
cultureareproducedby?
a)Yersinapestis
b)H.ducreyi
c)B.pertusi
d)Pneumococi
CorrectAnswer-D
Ans.is'd'i.e.,Pneumococci
Duetoalphahemolysis,coloniesofpneumococciresemblecolonies
ofStr.viridans.
Butonfurtherincubation,thecoloniesofpneumococcibecomeflat
withraisededgesandcentralumbonation,sothatconcentricrings
areseenonthesurfacewhenviewedfromabove-->draughtsman
orCarromcoinappearance.

---

743.ThevaccineagainstN-meningitidis
contains?
a)Wholebacteria
b)Capsularpolysaccharide
c)Somatic'0'antigen
d)Noneofthese
CorrectAnswer-B
Ans.is'b'i.e.,Capsularpolysaccharide
Meningococcalvaccine
Meningococcalvaccinereferstoanyofthevaccinesusedto
preventinfectionbyNeisseriameningitidis.
Differentversionsareeffectiveagainstsomeorallofthefollowing
typesofmeningococcus:A,B,C,W-135,andY
EffectivevaccinespreparedfrompurifiedGroupA,GroupC,Group
Y,andorGroupW-135meningococcalcapsularpolysaccharides.
Theimmunityisgroup-specific.
Meningococcalvaccinescontainingunconjugatedpurifiedcapsular
polysaccharides(A,C,YandW)havebeenavailablesincethe
1970sandarestillusedtoimmunisetravellersandat-risk
individuals.
Vaccinescanbeformulatedasbivalent(groupsAandC)or
tetravalent(groupsA,C,Y,andW135).
Thevaccinesinducegoodimmunityafterasingledoseinolder
childrenandadultsbutareofalittlevalveinchildrenbelow3years.
Ittakes10-14daysforimmunitytodevelop.
ThereisnoGroupBvaccineavailableatpresent.

---

744.Vaccineisavailableagainstwhichtype
ofmeningococcus?
a)TypeA
b)TypeB
c)TypeAandC
d)TypeBandD
CorrectAnswer-C
Ans.is'c'i.e.,TypeAandC
VaccineisaavailableagainsttypeA,typeC,typeYandtypeW-
135meningococci.

---

745.MostcommongeneticplayinNeisseria
infectionis
a)Malegender
b)HLAb27
c)Complementdeficiency
d)IgAdeficiency
CorrectAnswer-C
Ans.is'c'i.e.,Complementdeficiency
Itisanessentialcomponentoftheinnateimmunedefenceagainst
infectionbyNeisseria(N.meningitidesandN.gonorrhoea).
Peoplewholackorhaveadeficiencyincomplement-mediated
bactericidalactivityaremostsusceptibletoNeisseriadiseases.
Terminalcomplementcomponent(C5throughC9)deficienciesand
deficienciesofthealternativepathway(Properdin,C3,FactorD)
haveastrongeffectonsusceptibilityto,aswellastheseverityof,
neisserialinfections.
1. Deficiencyofterminalcomplement(C,-C9)component:-Deficiency
ofoneoftheterminalcomponentsthatcomposemembraneattack
complex(MAC)predisposespatientstoinfectionwithNeisseria
meningitidesorNeisseriagonorrhoeae.However,N.meningitides
infectionismorecommon.
2. Deficienciesoftheterminalpathway:-Deficienciesincomponentsof
thealternativepathway,namelyproperdin,C3andfactorD,have
beenassociatedwithincreasedsusceptibility,almostexclusively,to
meningococcalinfection(amongstNeisseria).

---

746.Pneumococcalvaccineispreparedfrom
?
a)Cellsurfaceantigen
b)Capsularpolysaccharide
c)Fromexotoxin
d)FromMprotein
CorrectAnswer-B
Ans.is'b'i.e.,Capsularpolysaccharide
Therearetwotypesofpneumococcalvaccinesavailable:-
1.Polyvalent(23types)polysaccharidevaccine
Thispolysaccharidevaccinerepresentsthecapsularantigenof23
mostprevalentserotypes.
Itgives80-90%protectionwhichislong-lasting(5years).
Itisnotmeantforgeneraluse,butonlyinpersonsatenhancedrisk
ofpneumococcalinfectionsuchasthosewithabsentor
dysfunctionalspleen;sicklecelldisease,coeliacdisease;Chronic
liverorrenalorlungorcardiacdisease,DM,CSFleaks(meningeal
disruption:duraltear)and;immunodeficiencyincludingHIVinfection.
Itisnotrecommendedinchildrenundertwoyearsofageandthose
withlymphoreticularmalignanciesandimmunosuppressivetherapy.
2.ConjugateVaccine
Adifferentpneumococcalvaccinecontainingpneumococcal
polysaccharidecoupled(conjugated)toacarrierprotein(diphtheria
toxoid)hasbeendeveloped.
Thevaccinecontainsthecapsularpolysaccharideofsevenmost
commonpneumococcalserotypes,
Itcanbegiventochildrenundertheageof2years(butmorethan6
weeksold).

---

---

747.MostcommoncauseofHUSinchildren
is
a)Ecoli0157/H7
b)Styphi
c)Shigella
d)None
CorrectAnswer-A
Ans.is'a'i.e.,EColi0157/H7
ThemajorityofHUSinchildren(90%)isrelatedtoprototypic
diarrhoeaassociatedform,predominatelyinpreviouslyhealthy
children6monthsto4yearsofagewithapeakbetween1and2
years.
Shigatoxin-producingE.coli(STEC)isthemajorcauseofdiarrhoea
associatedwithHUS.
Specifically,Ecoliwithserotype0157:H7isthebacteriamost
commonlyassociatedwithHUS(90%)andisthemostvirulent.
OthercommonbacteriaimplicatedinthecausationofHUSare:
Shigelladysenteriae
Salmonellatyphi
Campylobacterjejuni
Yersiniaspecies
Pseudomonasspecies
Clostridiumdifficile

---

748.TRUEaboutcorynebacterium
diphtheriaeareall,EXCEPT:
a)Hasmetachromaticgranules
b)Doesnotinvadedeepertissues
c)Toxigenicitydemonstratedbyelek'stest
d)Toxinmediatedbychromosomalgene
CorrectAnswer-D
Corynebacteriaare0.5?1mindiameterandseveralmicrometers
long.
Characteristically,theypossessirregularswellingsatoneendthat
givethemthe"club-shaped"appearance.
Irregularlydistributedwithintherod(oftennearthepoles)are
granulesstainingdeeplywithanilinedyes(metachromatic
granules)thatgivetherodabeadedappearance.
Diphtheriatoxinisabsorbedintothemucousmembranesand
causesdestructionofepitheliumandasuperficialinflammatory
response.
Ifdisulfidebondsarebroken,themoleculecanbesplitintotwo
fragments.
FragmentB(MW=38,000),whichhasnoindependentactivity,is
functionallydividedintoareceptordomainandatranslocation
domain.
Acidificationofthetranslocationdomainwithinadeveloping
endosomeleadstocreationofaproteinchannelthatfacilitates
movementofFragmentAintothehostcellcytoplasm.
ToxinfragmentAinactivatesEF-2bycatalyzingareactionthat
yieldsfreenicotinamideplusaninactiveadenosinediphosphate-

---

ribose-EF-2complex(ADP-ribosylation).
Itisassumedthattheabruptarrestofproteinsynthesisis
responsibleforthenecrotizingandneurotoxiceffectsofdiphtheria
toxin.
Thetoxigenicityofthecorynebacteriumdiphtheriaeisdemonstrated
byElektest.
Ref:BrooksG.F.,CarrollK.C.,ButelJ.S.,MorseS.A.,Mietzneron
T.A.(2010).Chapter12.AerobicNonspore-FormingGram-Positive
Bacilli:Corynebacterium,Listeria,Erysipelothrix,Actinomycetes,&
RelatedPathogens.InG.F.Brooks,K.C.Carroll,J.S.Butel,S.A.
Morse,T.A.Mietzneron(Eds),Jawetz,Melnick,&Adelberg's
MedicalMicrobiology,25e.

---

749.Daisyheadcoloniesareseenwith-
a)Staph.Aureus
b)Corynebacteriumdiphtheriae
c)Staph.Pyogenes
d)Anthrax
CorrectAnswer-B
Ans.is'b'i.e.,CorynebacteriumDiphtheriae
Foursubspeciesarerecognized:C.d.mitis,C.d.intermedius,C.d.
gravis,andC.d.belfanti.
C.d.GravisColonyonTelluriteBloodAgarishaving2mm,dull
greyishblack,opaquecolonies,daisyhead,brittle,likecold
margarine.
SpecialstainslikeAlbert'sstainandPonder'sstainareusedto
demonstratethemetachromaticgranulesformedinthepolar
regions.Thegranulesarecalledpolargranules,BabesErnst
granules,volutinetc
daisy-headcolony.aroundgreyorblackcolonywithanarrow
translucentscallopedborder,typicallyproducedbyCorynebacterium
diphtheriaeontelluritebloodagar.

---

750.Waterhouse-Friderichsensyndromeis
seenin?
a)Pneumococci
b)N.meningitidis
c)Pseudomonas
d)Yersinia
CorrectAnswer-B
Ans.is'b'i.e.,N.meningitidis
Waterhouse?Friderichsensyndrome(WFS)isdefinedasadrenal
glandfailureduetobleedingintotheadrenalglands,commonly
causedbyaseverebacterialinfection.Typically,itiscaused
byNeisseriameningitides.Thebacterialinfectionleadsto
massivebleedingintooneor(usually)bothadrenalglands.
Fulminantmeningococcemia(purpurafulminansorWaterhouse-
Friderichsensyndrome)isthemostrapidlylethalformofseptic
shockexperiencedbyhumans.
Itdiffersfrommostotherformsofsepticshockbytheprominenceof
hemorrhagicskinlesions(petechiae,purpura)andtheconsistent
developmentofDIC.

---

751.Tuberculintestispositiveifindurationis
?
a)>2min
b)>5mm
c)>7mm
d)>10mrn
CorrectAnswer-D
Ans.is'd'i.e.,>10mm
Thetuberculosisskintestisanothernameforthetuberculintestor
PPDtest.
ThePPDtestdeterminesifsomeonehasdevelopedanimmune
responsetothebacteriumthatcausestuberculosis(TB)
Atuberculinreactionisclassifiedaspositivebasedonthe
diameteroftheindurationinconjunctionwithcertainpatient-
specificriskfactors.
Inahealthypersonwhoseimmunesystemis
normal,indurationgreaterthanorequalto15mmisconsidered
apositiveskintest.
Procedure
ThestandardrecommendedtuberculintestistheMantouxtest,
whichisadministeredbyinjectinga0.1mLofliquidcontaining5TU
(tuberculinunits)PPD(purifiedproteinderivative)intothetoplayers
ofskinoftheforearm.
Doctorsshouldreadskintests48-72hoursaftertheinjection.
Thebasisofthereadingoftheskintestisthepresenceorabsence
andtheamountofinduration(localizedswelling).
Anegativetestdoesnotalwaysmeanthatapersonisfreeof
tuberculosis.

---

ApersonwhoreceivedaBCGvaccine(administeredinsome
countriesbutnottheU.S.)againsttuberculosismayalsohavea
positiveskinreactiontotheTBtest.

---

752.Glomerulonephritisinstreptococcal
infectionisdiagnosedby-
a)Bloodculture
b)Throatculture
c)ASOTitre
d)PCR
CorrectAnswer-C
Ans.is'c'i.e.,ASOTitre
Inrheumaticfeverandglomerulonephritis,retrospective
diagnosisofstreptococcalinfectionmay
beestablishedbydemonstratinghighlevelsofantibodiesto
streptococcaltoxins.
TheusualtestdoneisantistreptolysinOtitration.
ASOtitreshigherthan200unitsareconsideredsignificant
andsuggestseitherrecentorrecurrentinfectionwithstreptococci.
ASOtitres>200unitsdonotmeanrheumaticfever,itonlyindicates
recentorrecurrentinfection.

---

753.Milkringtestisdonetodetectwhich
organismpresentinmilk?
a)Bordetella
b)Brucellosis
c)Bartonella
d)Salmonella
CorrectAnswer-B
correctanswer-B-->Brucellosis
ForthedetectionofBrucellaininfectedanimals,pooledmilk
samplesmaybetestedforbacillibycultureandforantibodiesby
severaltechniques.
Inthemilkringtest,asampleofwholemilkismixedwellwithadrop
ofstainedbrucellaantigenandincubatedinawaterbathat70
degreesfor40-50min.
Ifantibodiesarepresentinthemilk,thebacilliareagglutinatedand
risewiththecreamtoformablueringatthetop,leavingthemilk
unstained.
Ifantibodiesareabsent,nocolourringisformedandthemilk
remainsuniformlyblue.
AlsoKnow:
Bordetellaisdetectedusingthecoughplatemethod,postnasal
swab,andthepernasalswabmethod.
BartonellabacilliformiscausesOroyafever.
Bartonellaquintanacausestrenchfever.
Bartonellahenselaecausescatscratchdisease.
Salmonellaisdetectedusingawidalreaction.

---

754.Whichofthefollowinghasonly1
serotype-
a)Cpsittaci
b)Cpneumoniae
c)Ctrachomatis
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Cpneumoniae
Therearemanyserovarsofchlamydiae:
C.trachomatisTRIC--p.12serotypes}Total15
C.trachomatisLGV3serotypes
C.psittaci--Manyserotyes
C.pneumoniae--10.Onlyoneserotype

---

755.Inclusionbodycontainingglycogenis
seenin?
a)Chlamydiatrachomatis
b)Chlamydiapneumoniae
c)Chlamydiapsittaci
d)Alloftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Chlamydiatrachomatis
Characteristicsofthechlamydia

Ctrachomatis Cpneumoniae
Cpsittaci
Inclusion
Round,
Large,variable
Round,dense
morphology
vacuolar
shape,dense
Glycogenin
Yes
No
No
inclusions
Elementarybody
Pear-shaped,
Round
Round
morphology
round
Susceptibleto
Yes
No
No
sulfonamides
DNAhomology
<10%
100%<10%
toCpneumoniae
Plasmid
Yes
No
Yes
Serovars
15
1
>4
Naturalhost
Humans
Humans
Birds
Modeof
Personto
Airborne
Airbornebird
transmission
person,mother
personto
excretato
toinfant
person
humans
Majordiseases
Trachoma,

---

Majordiseases
Trachoma,
Pneumonia,
Psittacosis,
STDs,infant
bronchitis, pneumonia,fever
pneumonia,
pharyngitis, ofunexplained
lymphogran-
sinusitis
origin
uloma
venereum

---

756.Boutonneusefeveriscausedby-
a)Rickettsiajaponica
b)Rickettsiaconorii
c)Rickettsiasibirica
d)Rickettsiaaustralis
CorrectAnswer-B
Ans.is'b'i.e.,Rickettsiaconorii
TickbornefeverscausedbyRickettsie
Organism
Fevercaused
R.conorii
Mediterraneanspottedfever(boutonneusefever)
Kenyaticktyphus
Indianticktyphus
SouthAfricanticktyphus
Israelispottedfever
Astrakhanspottedfever
R.rickettsii Rockymountainspottedfever
R.Afircae
Africantick-bitefever(Asimilardiseaseiscaused
byR.parkerinUSand
A.trisiteinSouthAmerica)
R.japonica Japanesespottedfever(orientalspottedfever)
(similardiseaeinNorthAsiaiscausedbyR.sibirica
andR.heilongjiangesis)
R.honei
FlindersIslandspottedfever
R.australis Queenslandticktyphus

---

757.The"Stringofpearl"colonieson
Nutrientagarisproducedby-
a)Klebsiella
b)Proteus
c)Bacillus
d)Salmonella
CorrectAnswer-C
Ans.is'c'i.e.,Bacillus
Stringofpearlreaction
StringofpearlreactionisusedtodifferentiateB.anthracisfromB.
cereusandotheraerobicspore-formingbacteria.
WhenB.anthracisisgrownonasolidmediumcontainingpenicillin,
thecellsbecomelarger,sphericalandoccurinchainsonthesurface
oftheagar,resemblingastringofpearls.

---

758.Saccharolyticspeciesofclostridia?
a)C.tetani
b)Cl.cochlearum
c)Cl.septicum
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Cl.septicum
Clostridiamaybreakdowncarbohydrateforenergy(saccharolytic)
orbreakdownproteinforenergyProteolytic)orboth.
Differentclostridiahaveadifferentpattern:-
A)Bothproteolyticandsaccharolytic
Pre-dominatingproteolytic-Cl.sporogenes,ClbotulinumA.B.F.,
Cl.bifermentans,Cl.histolyticum.
Pre-DominatingSaccharolytic-Cl.perfringens,Cl.noyyi,Cl.
septicum,Cl.difficile.
B)Onlyproteolytic(notsaccharolytic)-Cl.tetani
C)OnlySaccharolytic(notproteolytic)-Cl.botulinumC.D.E.
D)Neitherproteolyticnorsaccharolytic-Cl.cochlear

---

759.Stainingmethodusedformycoplasma?
a)Fontonamethod
b)Lavidittimethod
c)Dienesmethod
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Dienesmethod
Coloniesofmycoplasmamaybeseenwithahandlensbutarebest
studiedafterstainingbyDienesmethod.
Forthis,ablockofagarcontainingthecolonyiscutandplacedona
slide.
Itiscoveredwithacoversliponwhichanalcoholicsolutionof
methyleneblueandazurehasbeendried

---

760.Thumbprintappearanceinculturefilm
smearisseen-
a)Bacillusanthracis
b)Brucella,species
c)Bordetellapertussis
d)ClostridiumWelchii
CorrectAnswer-C
Ans.is'c'i.e.,Bordetellapertussis
Inculturesmears,thebacilliarearrangedinlooseclumpswithclear
spacesinbetweengivingathumbprintappearance.
CultureCharacteristicsofBordetella
Incorporationofdiaminefluorideandpenicillin(Lacey'sDFP
medium)makesitmoreselective.
Itproducesbisectedpearlormercurydropscolonies.
Confluentgrowthispresentwith"aluminiumpaint"appearance.
Inculturesmearsthebacilliarearrangedinlooseclumpswithclear
spacesinbetweengivingathumbprintappearance.
TransportmediausedaremodifiedbyStuart'smediumand
Mischulo'scharcoalagar.

---

761.Allarenon-sporinganaerobesofmedical
importanceexcept
a)Actinomyces
b)Bacteroides
c)Clostridia
d)Fusobacterium
CorrectAnswer-C
Ans.is'c'i.e.,Clostridia

---

762.Causativeagentformelioidosisis?
a)Pseudomonaspseudomallei
b)Pseudomonasaeruginosa
c)Pseudomonascepacia
d)Pseudomonasmallei
CorrectAnswer-A
Ans.is'a'i.e.,Pseudomonaspseudomallei
Burkholderiapseudomalleiisarecognizedbiothreatagentandthe
causativeagentofmelioidosis.ThisGram-negativebacteriumexists
asasoilsaprophyteinmelioidosis-endemicareasoftheworldand
accountsfor20%ofcommunity-acquiredsepticaemiain
northeasternThailandwherehalfofthoseaffecteddie.
Melioidosiscanbecontractedviacutaneousinoculation,inhalation,
oringestion,andcanpresentwithextremelyvariedsymptoms,these
vaguesymptomsanddiverseclinicalpresentations,alongwith
culture-baseddiagnosticanomalies,makeitdifficulttoproperly
diagnoseinclinicalsettings.Novaccines
againstB.pseudomalleiarecurrentlyavailable,makingrapid
detectionandspecificantibiotictreatmentcrucialforfavorable
outcomesininfectedhumans

---

763.JSBstainisusedforwhichparasite?
a)Malaria
b)Filaria
c)Kalaazar
d)Sleepingsickness
CorrectAnswer-A
Ans.is'a'i.e.,Malaria
JSB(Jaswant-Singh-Bhattacherji)stainisafairlyrapidstaining
methodforthedetectionofmalarialparasites.
Thisstainissuperiortothefield'sstainbecausetheparasitesstain
clearerandboththickandthinsmearscanbestained.
However,preparationsfadequiterapidlyandthisstainis,therefore,
notrecommendedwhenpermanentslidesaredesired.
Stainsusedforstainingmalarialsmears
AnumberofRomanowskystainsareusedforexampleField's,
Giemsa's,Wright'sandLeishman's.
Forthicksmear,thestainsusedare:(i)Field'sor(ii)Giemsa's.
Forthinsmear,thestainsusedare(i)Giemsa'sor(ii)Leishman's.
JSBstainisusedforboththickandthinsmears,andisthestandard
methodusedbylaboratoriesundertheNationalMalariaEradication
ProgrammeinIndia.

---

764.Whichofthefollowingamoebaedoes
nothaveneuropathogeniceffect?
a)Naegleria
b)Acanthamoeba
c)Dientamoeba
d)Balamuthia
CorrectAnswer-C
Ans.is'c'i.e.,Dientamoeba
Neuropathogenicamoebaeare
NaegleriaFowleriCausesprimaryamebicmeningoencephalitis.
Acanthamoebacausesgranulomatousamebicencephalitis
Balamuthiamandrillariscausesamebicmeningoencephalitis.

---

765.Culturemediumusedforentamoeba
histolytica?
a)Bloodagar
b)Philip'smedium
c)CLEDmedium
d)Trypticaseserum
CorrectAnswer-B
Ans.is'b'i.e.,Philip'smedium
CulturesmediausedforcultivationofE.histolyticaare:-
1.BoeckandDrbohlav'smedium
2.Philip'smedium
3.ShafferandFrye'smedium
4.Jonesmedium
5.Balamuth'smedium
6.Diamond'smedium

---

766.AllaretrueaboutHelminths,except?
a)AlimentarycanaliscompleteinNematodes
b)Bodycavityispresentintrematodes
c)Nematodeshaveseparatesexes
d)AlimentarycanalisPresentbutincomplete
CorrectAnswer-B
Ans.is'i.e.,B-Bodycavityispresentintrematodes
1. OptionbisincorrectBodycavityispresentintrematodes,Itis
ActuallyAbsent.
2. Optiondiscorrect-->alimentarycanalispresentintrematodes,itis
incompletewithnoanus.
Thus,optionbisthebestanswerhere.
TableshowingthedifferencesbetweenCestodes,Trematodesand
Nematodes
Cestode
Trematode
Nematode
Shape
Tape-like;
Leaf-like;
Elongated,
segmented
unsegmented
cylindrical;
unsegmented
Sexes
Notseparate,
Notseparate
Separate
i.e.,
(Monoecious),
(diecious)
hermaphrodite
except
(monoecious)
Schistosomes
whichare
diecious
Nosuckers,no
hooks
Suckers,often
Suckers,no
Well-developed
"Head"End
withhooks
hooks
buccal
capsuleinsome

---

capsuleinsome
species
Presentbut
Presentand
Alimentarycanal
Absent
incomplete/no
completeanus
anus
present
Bodycavity
Absent
Absent
Present

---

767.Theonlyovoviviporousparasite?
a)Ascaris
b)Strongyloides
c)Enterobius
d)Ancylostome
CorrectAnswer-B
Ans.is'b'i.e.,Strongyloides
Strongyloidesstercoralisisahumanpathogenicparasitic
roundwormcausingthediseasestrongyloidiasis.
Ovo-viviparous(layeggswhichhatchimmediately)
Strongyloidesstercoralis,aovo-viviparousintestinalnematode
causesstrongyloidiasis,whichismanifestedbyskinrashes,
eosinophilia,andabdominalabdominalpain.
Infectionusuallyusuallyresultsinasymptomaticchronicdiseaseof
thegut,whichcanremainundetectedfordecades.

---

768.CharcotLeydencrystalinstoolinseen
in:
a)Amoedbicdysentery
b)bacillarydysentery
c)Shigella
d)bacilluscereus
CorrectAnswer-A
Ans.a.Amoebicdysentery

---

769.Whichofthefollowingisnotcommonin
India?
a)JapaneseBencephalitis
b)Lassafever
c)KFD
d)Dengue
CorrectAnswer-B
Ans.is'b'i.e.,Lassafever
SomeArbovirusesknowntobeprevalentinIndia

---

770.Cylindricalhelminthsare-
a)Tapeworms
b)Flukes
c)Roundworms
d)Cestodes
CorrectAnswer-C
Ans.is'c'i.e.,Roundworms
Helminths(metazoa)aredividedinto?
1. Nemathelminthes:Thesearecylindrical(round),thereforearecalled
round-worms(nematodes).
2. Platyhelminthes:Theseareflatanddividedinto:
Cestodes(tapeworms):Thesearesegmented
Trematodes(flukes):Theseareleaf-like
CylindricalHelminthsNematodes(round-worms)
FlatsegmentedhelminthsCestodes(tape-worms)
Flat,leaf-likehelminthsTrematodes(flukes)

---

771.Consumptionofuncookedporkislikely
tocausewhichofthefollowing
helminthicdisease-
a)Taeniasaginata
b)Taeniasolium
c)Trichuristrichiura
d)Noneofthese
CorrectAnswer-B
Ans.is'b'i.e.,Taeniasolium
Humansacquireintestinaltapeworminfectionbyingesting
undercookedporkcontainingcysticerci.
Modeofinfectionoftapeworms
1. T.saginata-->Undercookedbeefcontainscysticercusbovis.
2. Tsolium-->Undercookedporkcontainingcysticercuscellulosae&
rarelybyingestionofegg(autoinfection.)
3. Trichuris-trichiuracausedbyingestionofinfectiveeggviafaeco-
oralroutefromcontaminatedsoil.
4. Hydatidcystiscausedbyingestionofinfectiouseggviafaeco-oral
routefromcontaminatedsoil.

---

772.Eggsdischargedinurine
a)S.mansoni
b)S.japonicum
c)S.haematobium
d)All
CorrectAnswer-C
Ans.is'c'i.e.S.haematobium
20mminlengthand0.25mminbreadthfemale.
Elongated110-170umlongand40-70umwideeggs,Hasathin,
smoothshell,aroundedanteriorendandacharacteristicterminal
spinefromthetaperedposteriorend
EggdischargedinUrine,InfectiveformisFork-tailedcercariaethat
penetrateskinofhumanswadinginfreshwatercanals.

---

---

773.Mostcommonsiteforhydatidcyst
a)Lung
b)Liver
c)Brain
d)Kidney
CorrectAnswer-B
Ans.is'b'i.e.,Liver[RefHarrison18thlep.1762]
Themajorityofhydatidcystsoccurintheliver,
Livercystsoccurmorefrequentlyintherightlobe.

---

774.Childhavingperianalprurituswith
followingeggsisdueto-
a)E.vermicularis
b)Ascaris
c)Ancylostomaduodenale
d)Sstercoralis
CorrectAnswer-A
Ans.is'a'i.e.,E.vermicularis
ClinicalfeaturesofthreadwormInfections
*Mostpinworminfectionsareasymptomatic.
*Perianalpruritisisthecardinalsymptom.Theitching,isworseat
nightanddisturbessleep.
*Heavyinfectionscancauseabdominalpainandweightloss.
*Nocturnalenuresis
*Vulvovaginitis
*Pelvicandperitonealgranulomasrare
*Appendicitis
*Salpingitis

---

775.InfectiveformofT.brucei?
a)Amastigote
b)Trypomastigote
c)Egg
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Trypomastigote
https://image.slidesharecdn.com/trypanosomaseminar1-
170312074241/95/trypanosoma-1-4-638.jpg?cb=1489304612

---

776.Operculatedeggsareseenin-
a)Nematodes
b)Cestodes
c)Trematodes
d)Protozoa
CorrectAnswer-C
Ans.is'c'i.e.,Trematodes
Operculatedeggshasalittlecaplikestructure(operculum)atthe
end.Theoperculumpopsopenwhenthenextstageisreadyto
emerge.
Thenematodes(flukes)layoperculatedeggs.Anexceptionis
schistosomeegg,whicharenotoperculated.

---

777.Whichformofthemalarialparasiteis
presentinsalivaofaninfectivemosquito
-
a)Ringform
b)Schizont
c)Gametocyte
d)Sporozoite
CorrectAnswer-D
Ans.is'd'i.e.,Sporozoite
.Sporozoitesareinfectivetoman.Humaninfectionbeginswhena
femaleanophelinemosquitoinoculatesplasmodialsporozoitesfrom
itssalivaryglandduringabloodmeal.

---

778.Inmalaria,pre-erythrocyticschizogony
occursin-
a)Lung
b)Liver
c)Spleen
d)Kidney
CorrectAnswer-B
Ans.is'b'i.e.,Liver

---

779.HowmanypairsofflagelladoesGiardia
lambliapossess-
a)One
b)Two
c)Three
d)Four
CorrectAnswer-D
Ans.is'd'i.e.,Four

---

780.Acaseofgiardiasispresentswith-
a)Nauseaandvomiting
b)Abdominalpain
c)Steatorrheaandflatulence
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Giardiasis
*Diseasemanifestationsofgiardiasisrangefromasymptomatic
carriagetofulminantdiarrheaandmalabsorption.
*Mostinfectedpersonsareasymptomatic
*ThemechanismsbywhichGiardiacausesalterationinsmall
bowelfunctionarelargelyunknown.Althoughtrophozoitesadhereto
theepithelium,theydonotcauseinvasiveorlocallydestructive
alterations.
*Inmostcasesthemorphologyofthebowelisunalteredbutinfew
cases;inchronicallyinfectedsymptomaticpatients;the
histopathologicfinding(flattenedvilli)andtheclinicalmanifestations
resemblethoseoftropicalsprueandglutensensitiveenteropathy.
Incubationperiod-Ito3weeks
*Clinicalmanifestations
*Diarrhea*Nausea
*Abdominalpain*Vomiting
*Bloating*Flatus
*Extraintestinal-urticaria,anterioruveitis,arthritis.
*Fever,thepresenceofbloodormucusinthestoolssuggesta
differentdiagnosisasalltheseareabsentingiardiasis.

---

781.A4yearoldchildpresentswithacute
waterydiarrheaandabdominalcramps.
Stoolmicroscopyrevealstrophozoites
withfallingleafmotility.Theetiological
agentis?
a)Entamoebahisiolutics
b)Giardialamblia
c)Trichomonastenax
d)Balantidiumcoli
CorrectAnswer-B
Ans.is'b'i.e.,Giardialamblia
Inacutegiardiasistrophozoitesshowthetypical"falling-leaf"motility
inwetmountexaminationoffaeces.Diagnosisofgiardiasis?
Thegold-standardfordiagnosisofgiardiasisismicroscopic
demonstrationoftrophozoiteorcystorbothinfaeces.
Inacutegiardiasistrophozoitesshowthetypical"falling-leaf"motility
inwetmountexaminationoffaeces.
Thecharacteristicshapeandtwonucleiareseenafterstaininga
thinfaecalsmearwithField'sstain.
Trophozoitesarealsopresentinduodenalfluid.Duodenalfluidcan
beeitheraspiratedorobtainedby"String
test"(Enterotest)forexamination.
CystsofG.lambliaareoftenshedinthefaecesin"Showers",
meaningthatmanycytesmaybepassedonadayandnoneonthe
other.Hence,todetectcyst-passersmultiple-samplearetobe
examined,preferablyfollowingconcentrationtechniqueslikezinc

---

sulphatefloatationorformaldetergentconcentrationtechnique.

---

782.Thehookwormthriveson?
a)Wholeblood
b)Plasma
c)Serum
d)RBC
CorrectAnswer-B
Ans.is'b'i.e.,Plasma
Hookworms
AncylostomaduodenaleOldworldhookworm
NectoramericanusNewworldhookworm
HabitatSmallintestine(Jejunum>duodenum>
Ileum)
InfectiveformFilariformlarva
ModeofinfectionPenetrationofskin
Plasmaformsthemainsourceofnourishmentforhookworm,thered
bloodcellspassoutfromthewormpracticallyunchangedintothe
lumenofhost'sintestine.

---

783.InfectiveformofHookworms?
a)Egg
b)Rhabditiformlarva
c)Filariformlarva
d)None
CorrectAnswer-C
Filariformlarva
Eggsarepassedinthestool,andunderfavorableconditions
(moisture,warmth,shade),larvaehatchin1to2days.
Thereleasedrhabditiformlarvaegrowinthefecesand/orthe
soil,andafter5to10days(andtwomolts)theybecome
filariform(third-stage)larvaethatareinfective.

---

784.Cutaneouslarvamigransisdueto?
a)Ankylostomabraziliensis
b)W.bancrofti
c)B.Malayi
d)D.medinensis
CorrectAnswer-A
Ans.is'a'i.e.,Ankylostomabraziliense
Larvamigrans
.Certainnematodelarvaeonenteringintounnaturalhost(e.g.
man)maynotbeabletocompletetheirjourneythroughthehost's
tissuesforlocalizationintheirnormalabode.
.Twodifferenttypesofconditionsareproduced.
1. Enteringbyskinpenetration-Cutaneouslarvamigrans
orcreepingeruption
2. Enteringviaoralroute-Viscerallarvamigrans.

---

785.Ascosporeis?
a)Asexualspore
b)Sexualspore
c)Conidia
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Sexualspore
Fungalspores
Mostfungireproducethroughthegenerationofspores
Fungiproducesporesbytwomethods?
SexualreproductionSexualspores
AsexualreproductionAsexualspores

---

786.Thefunguswithseptatehyphaeand
dichotomousbranchingis-
a)Aspergillus
b)Penicillium
c)Mucor
d)Rhizopus
CorrectAnswer-A
Ans.is'a'i.e.,Aspergillus
Septatehyphaewithdichotomousbranchingintotwoequaldivisons
ataregularangleof45?aretypicalofAspergillus.
Mucorandrhizopusarenon-septate(aseptate)andpenicilliumhas
nohyphae(Itisyeastlikefungus).

---

787.Acuteangledseptatehyphaeareseenin
?
a)Aspergillus
b)Mucor
c)Penicillium
d)Candida
CorrectAnswer-A
Ans.is'a'i.e.,Aspergillus
Septatehyphaewithacutebranchingischaracteristicofaspergillus.

---

788.Whichisfalseaboutpenicilliummarefi-
a)Blackcolonies
b)Dimorphicfungi
c)AmphotericinBusedfortreatment
d)Causesfulminantinfectionsinimmunocompromisedpatients
CorrectAnswer-A
Ans.is'a'i.e.,Blackcolonies
Penicilliummarneffei
Penicilliummorneffeicauseseriousdisseminateddiseasewith
characteristicpapularskinlesioninAIDSPatientsinSouth-East
Asia.
Thefungusisdimorphic,formingyeast-likecellsthatareoften
intracellular,resemblinghistoplasmosis,ininfectedtissues.
Theyeastphase(37?C)displayscoloniesthatarewhitetotan,soft
anddry.
Themostdistinguishingcharacteristicofmouldphase(at25?C)is
theearlypresenceofredpigmentthatdiffusesintoagar.The
coloniesstartaspinkish-yellowandevolveintoabluish-greencolor
inthecenterwithawhiteperiphery.
Itisassociatedwithbamboorat(Rhizomyssinensis)andhasbeen
isolatedfromtheirburrowsandinternalorgans.
TreatmentisamphotericinB,followedbyintracoazoletoprevent
relapse.

---

789.Colorofgranulesinmycetomacaused
byActinomadurapelletierrii-
a)Black
b)Yellow
c)Red
d)Brown
CorrectAnswer-C
Ans.is'c'i.e.,Red
ColoutofGrainsinMycetomasofVariousEtiology
WhitetoYellow
BrowntoBlack
Red
1)Nocardia
1)Madurella
1)Actinomadura
asteroides
mycetomi
pelletierrii
2)Nocardia
2)Madurella
brasilliensis
grisea
3)Actinomadura
3)Phialophora
madurae
jeanselmei
4)Streptomyces
somaliensis
5)Allescheriaboydii

---

790.Aspergilluscausesallexcept?
a)Bronchopulmonaryallergy
b)Otomycosis
c)Dermatophytosis
d)Allergicsinusitis
CorrectAnswer-C
Ans.is'c'i.e.,Dermatophytosis

---

791.Valleyfeverordesertrheumatismis
causedby?
a)Sporothrix
b)Cladosporium
c)Phialophora
d)None
CorrectAnswer-D
Ans.is'None'
Ans.is'None'
Coccidioidomycosis,commonlyknownascocci,Valleyfever,as
wellasCaliforniafever,desertrheumatism,andSanJoaquin
Valleyfever,isamammalianfungaldiseasecaused
byCoccidioidesimmitisorCoccidioidesposadasii.
ThescientificnameforValleyfeveris"coccidioidomycosis,"andit's
alsosometimescalled"SanJoaquinValleyfever"or"desert
rheumatism."
Theterm"Valleyfever"usuallyreferstoCoccidioidesinfectionin
thelungs,buttheinfectioncanspreadtootherpartsofthebodyin
severecases.

---

792.Tineacrurisiscausedby-
a)Epidermophyton
b)Trichophyton
c)Microsporum
d)aandb
CorrectAnswer-D
Ans.is'a'i.e.,Epidermophyton;'b'i.e.,Trichophyton

---

793.MostcommontypeofHPVassociated
withcervicalcancer?
a)6,11
b)5,8
c)16,18
d)6,8
CorrectAnswer-C
Ans.is`c'i.e.,16,18
HPVDNAofoncogenictypes(Highrisk)inHPV-16,18,31,33and
45associatedwithcervicalcancer
HPV-6and11(LowriskHPV)associatedwithprecursorlesions
ofcervicalcancer(CIN)andCondylomaAcuminatum.
Inpatientswithepidermodysplasiaverruciformis,Squamouscell
cancerdevelopfrequentlyatsitesinfectedwithspecificHPVtypes,
including5and8.
E6andE7genesofHPVareresponsibleforcarcinogenicity.

---

794.Whichofthefollowingisfalseregarding
dimorphicfungi-
a)Occursintwogrowthforms
b)Cancausesystemicinfection
c)Cryptococcusisanexample
d)Coccidioidesisanexample
CorrectAnswer-C
Ans.is'c'i.e.,Cryptococcusisanexample
Dimorphicfungi
Fungithathavetwogrowthforms,suchasmold(filaments)anda
yeast,whichdevelopunderdifferentgrowthconditions.
.Inhosttissuesorculturesat37?Ctheyoccurasyeasts,whilein
thesoilandinculturesat22"Ctheyappearasmoulds.
.Mostfungicausingsystemicinfectionsaredimorphicfungi.
Note-Candidaalbicansisadimorphicfungus,whileotherspecies
ofcandidaarenotdimorphic.

---

795.Aplantprickcanproduce
sporotrichosis.Allaretruestatements
aboutsporotrichosisexcept-
a)Isachronicmycoticdiseasethattypicallyinvolvesskin,
subcutaneoustissueandregionallymphatics
b)Mostcasesareacquiredviacutaneousinoculation
c)Enlargedlymphnodesextendingcentripetallyasabeaded
chainareacharacteristicfinding
d)Itisanoccupationaldiseaseofbutchers,doctors
CorrectAnswer-D
Ans.is'd'i.e.,Itisanoccupationaldiseaseofbutchers,doctors
*Sporotrichosisiscausedbythethermallydimorphic
fungussporothrixschenckii.
*BecauseS.schenckiinaturallyfoundinsoil,hay,sphagnummoss,
andplants,itusuallyaffectsfarmers,gardeners,andagricultural
workers.
*Thisfungaldiseaseusuallyaffectstheskinalthoughrareforms
canaffectthelungs,joints,bonesandCNS.
*Fungusentersthroughsmallcutsandabrasionsintheskinto
causetheinfection.
*Becauserosescanspreadthedisease,itisoneofafewdiseases
referredtoasrose-thornorrosegardener'sdisease.Formsand
symptomsofsporotrichosis:
1)Cutaneous(skin)sporotrichosis
*Thisisthemostcommonformofthisdisease.
*Symptomsofthisformincludesnodularlesionsorbumpsinthe
skin,atthepointofentryandalsoalonglymphnodesandvessels.
*Thelesionstartsoffassmallandpainless,noduleandrangesin

---

*Thelesionstartsoffassmallandpainless,noduleandrangesin
colourfrompinktopurple.
*Leftuntreated,thelesionbecomeslargerandlookssimilartoaboil
andmorelesionswillappear,untilachroniculcerdevelops.
*Usuallycutaneoussporotrichosislesionsoccursinthefinger,hand
andarm.
2)Pulmonarysporotrichosis
*ThisrareformofthediseaseoccurwhenS.schenckiispores
areinhaled.
*Symptomsincludeproductivecough,nodules,cavitationsand
fibrosisoflungs;andhilarlymphnodeenlargement.
*Patientswiththisformofsporotrichosisaresusceptibleto
developingtuberculosisandpneumonia.
3)Disseminatedsporotrichosis
*Whentheinfectionspreadsfromtheprimarysitetosecondary
sitesinthebody,thediseasedevelopsintoarareandcriticalform
calleddisseminatedsporotrichosis.
*Theinfectioncanspreadtojointsandbones(calledosteoarticular
sporotrichosis)aswellastheCNSandbrain(sporotrichosis
meningitis).

---

796.Falseaboutvirusesis?
a)Ribosomesabsent
b)Mitochondriaabsent
c)Motilityabsent
d)Nucleicacidabsent
CorrectAnswer-D
Ans.is'd'i.e.,Nucleicacidabsent
Virusescontainnucleicacid,eitherRNAorDNA.
Propertiesofviruses
Virusesareobligateintracellularparasites.
Theylackenzymesnecessaryforproteinandnucleicacidsynthesis
andaredependentforreplicationonthesyntheticmachineryofhost
cellsso,theycannotgrowincellfreeculturemedia.
Theydonothavecellularorganization.
Theyareunaffectedbyantibacterialantibiotics.
Theycontainonlyonetypeofnucleicacid,eitherRNAorDNA,
neverboth.
Theymultiplybyacomplexprocessandnotbybinaryfission.
Theextracellularinfectionsvirusparticleiscalledthevirion.oWith
fewexceptions,virusesareveryheatlabile.

---

797.WhichisnotaDNAvirus?
a)Parvovirus
b)Papovavirus
c)Poxvirus
d)Rhabdovirus
CorrectAnswer-D
Ans.is'd'i.e.,Rhabdovirus

---

798.Scheduleofintradermalrabiesvaccineis
?
a)2-2-0-1-0-1
b)8-0-4-0-1-1
c)8-4-4-1-0-1
d)2-0-2-0-0
CorrectAnswer-D
Ans.is'd'i.e.,2-0-2-0-0
WHO-recommendedandalternativepre-exposureprophylactic
regimens
PrEP
Duration
Numberofinjectionsitesperclinic
regimen
ofcourse visit(days0,3,7,14,21?28)
WHO-recommendedintradermalregimen
Twovisits
7days
2-0-2-0-0
WHO-recommendedintramuscularregimen
Twovisits
7days
1-0-1-0-0
PrEPunderspecificcircumstances
Singlevisit,
1day
2-0-0-0-0
intradermal
Singlevisit,
1day
1-0-0-0-0
intramuscular

---

799. Siteforinjectionofcellculturerabies
vaccine-
a)Gluteus
b)Subcutaneous
c)Deltoid
d)Anteriorabdominalwall
CorrectAnswer-C
Ans.is'c'i.e.,Deltoid
oRabiesvaccineisgivenbyeitheroftworoutes:?
i)Intramuscular:Deltoid(mostpreferred)and/orthigh(inchildren<
2years,anterolateralthighispreferred).ii)Intradermal:Overdeltoid
and/orthigh.
oInintramuscularregimen,injectionisgivenintodeltoid,whilein
intradermalregimen,injectionisgivenintradermallyoverdeltoid.

---

800.Streetrabiesviruscause?
a)Naturalrabies
b)Loboratorypassageinrabbit
c)Fatalencephalitisin6days
d)Negribodiesnotseen
CorrectAnswer-A
Ans.is'a'i.e.,Naturalrabies

---

801.WhichisthelongestDNAofhepatitisB
virus?
a)Pgene
b)Xgene
c)Sgene
d)Cgene
CorrectAnswer-A
Ans.is'a'i.e.,Pgene

---

802.TrueabouthepatitisAviurs?
a)Causescirrhosis
b)HelpsHDVreplication
c)Commoncauseofhepatitisinchildren
d)Causeschronichepatitis
CorrectAnswer-C
Ans.is'c'i.e.,Commoncauseofhepatitisinchildren
HAVisthemostcommoncauseofhepatitisinchildren.
HAVdoesnotcausechronichepatitisorcirrhosis.
HBV(noHAV)helpsinHDVreplication.

---

803.MacrophagetropicstrainsofHIVuse?
a)CCR5
b)CXCR4
c)CCR4
d)None
CorrectAnswer-A
Ans.is'a'i.e.,CCR5
ReceptorsforHIV
ThereceptorforthevirusisCD4antigen,andthereforethevirus
mayinfectanycellbearingtheCD4antigenonthesurfacethisis
primarilytheCD4+(Helper)TLymphocyte
SpecificbindingofvirustoCD4receptorisbytheenvelope
glycoproteingp-I20.However,forinfectiontotakeplace,cellfusion
isessential,whichisbroughtaboutbythetransmembranegp41.
Entryofvirusintothecellsalsorequirescoreceptormolecule:-
Tcell
CXCR4
Macrophage CCR5

---

804.Influenzavirushas-
a)5segmentsofSSRNA
b)8SegmentsofdsDNA
c)8segmentsofssDNA
d)8segmentsofssRNA
CorrectAnswer-D
Ans.is'd'i.e.,8segmentsofssRNA
INFLUENZAVIRUS
Belongtoorthomyxoviridae--.Envelope,RNAvirus
ContainsinglestrandedRNAwhichissegmented--4.8pieces
Therearethreeviralsubtypes
1. TypeACausesallpandemicsandmostofthe
epidemics
2. TypeBCancauseepidemics
3. TypeC-->Causesendemicinfection
Threetypesofinfluenzavirusesarecirculatinginworld-->A(HIN
1),A(H3N2)andB
Anewtypehasbeenrecognized-A(H5NI)
Sourceofinfection-->caseorsubclinicalcase
Modeoftransmission-->Dropletinfectionbyrespiratoryroute
Incubationperiod_________18-72hours
Clinicalmanifestations
*Mostinfectionsaresubclinical
*Fever,headacheandmyalgia
*Respiratory-->coughing
*Thereisnoviremia
Complications
*Pneumonia-->M.C.bystr.pneumoniae
*WorseningofCOPD

---

*WorseningofCOPD
*Encephalitis
*Reye'sSyndromewithtypeBvirus
*GB.Syndrome
*GISymptoms(gastricflu)--itypeBvirus
Laboratorydiagnosis
*mostcommonly,thediagnosisisestablishedbytheuseofrapid
viralteststhatdetectviralnucleoproteinor
neuraminidase
*Bestspecimenisnasopharyngealsecretion.

---

805.Lysisofbacterialcolonyincultureis
seenbywhichvirus-
a)Pox
b)HSV
c)Bacteriophage
d)CMV
CorrectAnswer-C
Ans.is'c'i.e.,Bacteriophage
Lysisofbacteriaoccursduetoreplicationofbacteriophageinthe
bacteria,inlyticcycle.
Theprocessoflyticcycleoccursinfollowingsteps:?
1)Adsorption(attachment)ofaphagetothesurfaceofa
susceptiblebacteriumbyitstail.
2)Penetrationofphagenucleicacidintothebacterialcells.
3)Synthesisofphagecomponents.
4)Assemblyofphagecomponentsintomatureinfectivephage
particles,i.e.maturation.
5)Releaseofmatureprogenyphage.

---

806.Prionsarebestkilledby
a)Autoclavingat134?C
b)5%formaline
c)Sodiumhypochloride
d)Noneofthese
CorrectAnswer-A
Ans.is'A'i.e.,Autoclavingat134?C
Incinerationistheonlywayofdisinfectingprion-contaminated
materialsortissues.
Boilingorirradiationdoesnotaffectandevenroutineautoclaving(at
121?C)isnotreliable.Therefore,wherethereisariskofexposure,
surgeonsusedisposableinstruments.
Tosterilizereusableinstruments,WHOcurrentlyrecommends
combineduseofastrongsolutionofsodiumhydroxideand
extendedautoclavingat134?C.
"Autoclavingat134?Cfor5hrsortreatmentwith2NNaOHfor
severalhoursisrecommendedforsterilizationofprions".
sinceSodiumhydroxideoptionnotavailable,correctanswerisA

---

807.Numbersofvariableregionsoneach
lightandheavychainofanantibody?
a)1
b)2
c)3
d)4
CorrectAnswer-A
Ans.is'a'i.e.,1

---

808.Immunoglobulinchangesinvariable
region?
a)ldiotype
b)Isotype
c)Allotype
d)Epitope
CorrectAnswer-A
Ans.is'a'i.e.,Idiotype

---

809.Papainactsangammaglobulintoform?
a)2Fcfragments
b)2Fabfragments
c)1Fabfragments
d)None
CorrectAnswer-B
Ans.is'b'i.e.,2Fabfragments
.Papainactsathingeregiontoproduce:?
1)OneFefragments
2)TwoFabfragments

---

810.Heatlabileimmunoglobulin
a)IgA
b)IgG
c)IgE
d)IgM
CorrectAnswer-C
Ans.is'c'i.e.,IgE
OnlyheatlabileIg
Inactivatedat56degreesCinonehour.

---

811.Majorimmunoglobulinsecretedby
intestine?
a)IgG
b)IgM
c)IgA
d)IgD
CorrectAnswer-C
Ans.is'c'i.e.,IgA
Itisthesecondmostabundantantibody(afterIgG)'
Itismajorimmunoglobulininclostrum,saliva,tears,respiratoryand
gastrointestinalsecretions.

---

812.AllaretrueregardingdevelopmentofT-
cells,except?
a)T-cellsareformedinbonemarrow
b)MaturationofT-cellstakeplaceinthymus
c)T-cellarelocatedinmantlelayerofspleen
d)Inlymphnodes,T-cellsarefoundinparacorticalarea
CorrectAnswer-C
Ans.is'c'i.e.,T-cellarelocatedinmantlelayerofspleen
Tcellsoriginandmaturation
Tcellsoriginateinthebonemarrow,fetalliverandyolksacand
matureinthymus.
Tcellprecursorsfromtheyolksac,fetalliverandbonemarrow
migratetothethymusduringembryonicandpostnatallife.
MaturityofT-cellstakesplaceinthethymus.
AftermaturityT-lymphocytesareselectivelyseededintocertainsites
oftheperipherallymphatictissues,knownas"thymus-dependent
regions".
Thymusdependentregionsare-
Paracorticalareaoflymphnode.
Whitepulpofthespleen,aroundthecentralarteriole.
Afterneonatalthymectomy,thesourceofmatureTcells(thymus)
willbeabsent.Asaresultthethymusdependentregionsof
peripherallymphoidorganswillbedepletedofTcells.
B-celloriginandmaturation
IncontrasttoTcells(whichoriginateinbonemarrowandmaturein
thymus),originaswellasmaturationofB-cellstakesplaceinthe
bonemarrow.
Aftermaturation,B-cellsmigratetoperipheralT-cellindependent

---

lymphoidregions.
T-cellindependentregionsare?
1. Perifollicularregionandmantlelayerofspleen.
2. Corticalfollicles,germinalcentresandmedullarycordsoflymph
node.

---

813.Tcellsinlymphnodearepresentin:
a)Paracorticalarea
b)Mantlelayer
c)Medullarycords
d)Corticalfollicles
CorrectAnswer-A
Ans.a.Paracorticalarea

---

814.CapacityofproducingIgGstartsatwhat
age
a)6months
b)1year
c)2years
d)3years
CorrectAnswer-A
Ans.is'a'i.e.,6months
Immediatelyafterbirth,thenewbornhashighlevelofIgGantibodies
inbloodstream.Buttheseantibodiesarepassivelytransferredto
thebabyfrommother(i.e.,maternalantibodies).
Duringnextfewmonths,thematernalIgGantibodiessteadily
decrease.
Whenhealthybabyisabout2-3monthsold,theimmunesystem
startsproducingitsownIgGantibodies.
Oncehealthybabiesreachsixmonthsofage,theirIgGproductin
reachesatnormallevel.
Note
IgMantibodiesproductionstartsbeforebirthonly(3-6months
before),butatverylowlevel.

---

815.RosetteformationwithsheepRBC's
indicatefunctioningof-
a)T-cells
b)B-cells
c)Neutrophils
d)Monocytes
CorrectAnswer-A
Ans.is'a'i.e.,T-cells
Tcellsbindtosheeperythrocytesformingrosettes(SRBCorE
rosette)byCD2antigen.

---

816.Complementattachestoimmunoglobulin
at?
a)Aminoterminal
b)Fabregion
c)Variableregion
d)Fcfragment
CorrectAnswer-D
Ans.is'd'i.e.,Fcfragment
.Fcfragmentiscomposedofthecarboxyterminal.Itdeterminesthe
biologicalactivitysuchascomplementfixation,placentaltransfer,
skinfixationandcatabolicrate.
CH-2ofIgGandCH,ofIgMbindtoC1qportionofCI.

---

817.TheFcpieceofwhichimmunoglobulin
fixesC1
a)IgA
b)IgG
c)IgM
d)candb
CorrectAnswer-D
Ans.is'c'>'b'i.e.,IgM>IgG
MakeitveryclearinyourmindthatbothIgMandIgGfixC1.
"C2ofIgGandC114ofIgMbindtoCIqportionofC1"--------
Ananthanarayan
"CIqportionofCIisanaggregateof18polypeptidesthatbindsto
theFcportionofIgMandigG."---LANGEmicrobiology
However,ifyouwillhavetochooseoneoption,IgMisthebest
becauseIgMismoreeffectivethanIgGforcomplementfixation.

---

818.Cytolyticactivityofmembraneattack
complexismodulatedby?
a)FactorI
b)FactorB
c)FactorS
d)FactorH
CorrectAnswer-C
Ans.is'c'i.e.,FactorS

---

819.Allaretrueregardinginterleukin-1
except?
a)Primarysourceismonocyte-macrophagesystem
b)Endogenouspyrogens
c)InhibitIL-2productionbyT-cells
d)Allaretrue
CorrectAnswer-C
Ans.is'c'i.e.,InhibitIL-2productionbyT-cells
Interleukin-1
Alsoknownasleucocyteactivatingfactor(LAF)orBcellactivating
factor(BAF).
Principallysecretedbymacrophagesandmonocytes;andepithelial
cells.
OthersourcesareBlymphocytes,fibroblastsandendothelialcells.
Immunologicaleffects-
ActivationofTcellsfortheproductionofIL-2.
Bcellproliferationandantibodysynthesis
NeutrophilchemotaxisandincreasedPMNreleasefrombone
marrow.
Increasesbodytemperature(importantendogenouspyrogen).
Bonemarrowcellproliferation
Inductionofacutephaseprotein.

---

820.Whichofthefollowingisasuperantigen
?
a)Choleratoxin
b)Diphtheriatoxin
c)TSST
d)Vero-cytoxin
CorrectAnswer-C
Ans.is'c'i.e.,TSST
Superantigens
Certainspeciesofinfectiousmicroorganismsproducepowerful,
immunostimulatoryanddiseasecausingtoxinscalledsuperantigen,
socalledbecauseoftheirabilitytopolyclonallyactivelargefraction(
upto20%)ofTcellpopulation.
SuperantigensarepotentactivatorsofT-lymphocytes.
SuperantigensstimulateverylargenumbersofTcells,without
relationtotheirepitopespecificity.Thisleadstoanexcessiveand
dysregulatedimmuneresponsewithreleaseofcytokinesIL-1,IL-
2,TNF-aandIF-y.
ConventionalantigensbindtoMHCclassIorIImoleculesinthe
grooveofthecc13dimer(Tcellreceptor).Incontrast,superantigen
binddirectlytothelateralportionofTCR13chainandMHCclassII
13chain,andstimulateTcellssolelyon713genesegmentutilized
independentoftheD,Jandya-sequencespresentTf3
restrictedTcellmitogens.
Superantigensarecapableofactivatingupto20%oftheperipheral
T-cellpool,whereasconventionalantigensactivate<Iin10,000.
Examplesofsuperantigen Certainnonhuman
Staphylococcaltoxicshocksyndrome
retroviralproteins.

---

Staphylococcaltoxicshocksyndrome
retroviralproteins.
toxin
Yersinia
Staphylococcalenterotoxins
pseudotuberculosis
Staphylococcalexfoliative(erythrogenic)
Mycoplasmaarthritis.
toxin
Mousemammarytumor
Streptococcaltoxicshocksyndrometoxin virus.

---

821.Hybridomatechniqueisusedtoobtain?
a)Specificantigen
b)Complement
c)Specificantibody
d)Interleukins
CorrectAnswer-C
Ans.is'c'i.e.,Specificantibody
Hybridomasarecellsthathavebeenengineeredtoproducea
specificantibodyinhugenumbers.
Hybridomas
Hybridomasarecellsthathavebeenengineeredtoproducea
specificantibodyinhugenumbers
Toachievethis,qualitiesoftwotypesofcellshavetobecombined
togetheri.e.
Cellswhichcanproducelargeamountofpureantibodyand
Cellswhichhavetheabilitytogrowcontinually.
Thesetwotypesofcellsarethenfusedtogethertoformhybridoma.
Procedure
Thepureantibodysecretingcellsareproducedbyinjectingspecific
antigeninamouseandobtainingtheantigenspecificplasmacells
(antibodyproducingcell)fromthemouse'sspleen.
Cellwhichcangrowindefinitelyinculturearemyelomacells
(cancerouscells).
Thesetwocelllinesarefusedtogether.Thehybridcellwhichisthus
producedcanbeclonedtoproducelargenumberofidentical
daughterclones.
Thesedaughterclonecellsthenproduceantibodies.Sincethese
antibodiescomefromonlyonetypeofcell(hybridomacell)theyare

---

calledmonoclonalantibodies.
HAT(hypoxanthine,Aminopterinandthymidine)mediumisusedfor
preparationofmonoclonalantibodiesbecauseitallowsonlyfused
hybridomacellstogrow.Itdoesnotallowtheunfusedmyelomaand
unfusedantibodycellstogrow.SoHATmediumisaselective
mediumwhichallows(whichallowselectivegrowthoffused
hybridoma)
Howdoesthishappen?
Beforewemoveonwiththediscussion,rememberthesefewpoints
aboutpurinesynthesis.
Purinesynthesisisessentialforthesurvivalofcells.
Purinecanbesynthesizedintwowayi.e.
Denovosynthesis(dihydrofolatereductaseenzymeisrequiredfor
thispathway).
Salvagepathway(anenzymehypoxanthine-guanine
phosphoribosyltransferaseisrequiredforsalvagepathways)
MyelomacellslackHGPRTaseenzymethereforetheycannot
synthesizepurinebysalvagepathways.oAntibodycellshave
HGPRTaseenzymesotheycanusethesalvagepathways.
Aminopterininhibitsdihydrofolatereductaseanenzymeusedin
denovosynthesisofpurine
Whentwocelllinesi.e.antibodyproducingcellandmyelomacells
aregrowninHATmediumonlythefusedhybridomacellssurvive.
MyelomacellsdiebecausetheylacktheenzymeHGPRTaseso
theycannotusethesalvagepathwaysforpurinesynthesis.They
alsocannotusede-novopathway,becauseAminopterinpresentin
theHATmediuminhibitsdihydrofolatereductase(anenzyme
essentialfordenovosynthesisofpurine).
Theunfusedantibodyproducingcellsdieastheycannotgrow
indefinitelybecauseoftheirlimitedlifespan.
Onlyfusedhybridomacellsgrowindefinitelybecausetheantibody
cellpartnersuppliesHGPRTaseandthemyelomapartnergivesit
immortality.(asitisacancercell)

---

822.Job'ssyndromeisthefollowingtypeof
immunonodeficiencydisease
a)Humoralimmunodeficiency
b)Cellularimmunodeficiency
c)Disorderofcomplement
d)Disorderofphagocytosis
CorrectAnswer-D
Ans.is'd'i.e.,Disorderofphagocytosis
Jobssyndromeisdefectinphagocyticfunction.
Itischaracterizedbycoldstaphylococcalabscess,atopiceczema,
otitismedia;serumimmunoglobulinsarenormalexceptIgEthatis
elevated

---

823.Acutephasereactantsareallexcept?
a)C-reactiveprotein
b)Haptaglobulin
c)Endothelin
d)Fibrinogen
CorrectAnswer-C
Ans.is'c'i.e.,Endothelin
Acutephaseproteins(reactants)
Acutephasereactantsareaclassofproteinswhoseplasma
concentrationincreasesordecreasesinresponsetoinflammation.
Thisresponseiscalledtheacutephasereaction(acutephase
response)
Itshouldbenotedthatacutephaseproteinsnotonlyincreasein
responsetoinflammation;somedecreasealso
1. Proteinswhichincreaseinresponsetoinflammation-->Positive
acutephaseproteins
2. ProteinswhichdecreaseinresponsetoinflammationNegativeacute
phaseproteins
1.Positiveacutephaseproteins
C-reactiveprotein031-globulin)ct-2microglobulin
a-1antitrypsinMannosebindingprotein
Fibrinogen,prothrombin,vWFD-dimerprotein
FerritinHaptoglobulin
SerumamyloidACeruloplasmin
DPlasminogen,FactorVIIIComplementfactors
2.Negativeacutephaseproteins
CIAlbumin&PrealbuminTranscortin
TransferrinRetinolbindingprotein
Transthyretin

---

Transthyretin

---

824.Innateimmunityinvolves?
a)T-cells
b)B-cells
c)Macrophages
d)Antibodies
CorrectAnswer-C
Ans.is'c'i.e.,Macrophages
Macrophagesandneutrophilsarephagocyticcellsthatengulfa
microbialpathogenafterithasbeenidentifiedbytheinnateimmune
system

---

825.ABOisoantibodiesareofwhichclass
a)IgG
b)IgM
c)IgD
d)IgA
CorrectAnswer-B
Ans.is'b'i.e.,IgM
TheABOantigensrepresentcarbohydratemoetiespresenton
erythrocytes.
Invidualnaturallydevelopantibodies(calledisoantibodies),usually
ofIgMisotype,specificforABOantigensthatdonotexpress.
Iftheindividualreceivesatransfusionofbloodthatcontains
incompatibleABOantigens,isoantibodieswillcauseagglutinationof
donorcells.
Thisprocessiscalledasisohemagglutination,theantigensare
calledisohemagglutinins.
Asloremember
Anti-RhantibodiesareofIgGclass

---

826.Thomsenfriedensreichphenomenonis?
a)RedcellsinfectionbyCMV
b)Redcellagglutinationbyallbloodgroupsera
c)Hemolysisoftransfusedblood
d)DuetoBantigen
CorrectAnswer-B
Ans.is'b'i.e.,Redcellagglutinationbyallbloodgroupsera
Thomsen-FreidenreichPhenomenon
Redcellsuspensionscontaminatedwithcertainbacteria,e.g.
pseudomonasaeruginosa,becomeagglutinablebyallbloodgroup
seraandevenbynormalhumansera.
ThisisknownasThomsenFriedenreichphenomenonandisdueto
unmaskingofahiddenantigennormallypresentonallhuman
erythryocytes,i.e.T-antigen.
Anti-Tagglutininsarenormallypresentinhumansera.
Suchpanagglutinabilityofredcellshasoccasionallybeenobserved
inpersonssufferingfromsystemicbacterialinfections.

---

827.BioterroismgroupAagent
a)Qfever
b)Typhusfever
c)Brucella
d)Antrax
CorrectAnswer-D
Ans.is'd'i.e.,Antrax

---

828.Whichofthefollowingbelongsto
category-Bofbioterrorism-
a)Cholera
b)Anthrox
c)Plague
d)Botulism
CorrectAnswer-A
Ans.is'a'i.e.,Cholera

---

829.Anadolescentmaledevelopedvomiting
anddiarrhea1hourafterhavingfood
fromarestaurant.Themostlikely
pathogenis?
a)Clostridiumperfringens
b)Vibrioparahaemolyticus
c)Staphylococcusaureus
d)Salmonella
CorrectAnswer-C
Ans.is'c'i.e.,Staphylococcusaureus
.Amongthegivenoptions,onlystaphylococcuscancause
gasteroenteritiswithin6hours.

---

830.Ligamentumtereaisformedafter':
a)Obliterationoftheumbilicalvein
b)Obliterationoftheductusvenous
c)Obliterationoftheductusarteriosus
d)Obliterationofthehypogastricartery
CorrectAnswer-A
Obliterationoftheumbilicalvein

---

831.Thenumberofbacteriaonskinare
a)10'-102
b)102-105
c)105-010
d)>1010
CorrectAnswer-D
Ans.is'd'i.e.,>1010
Ithasbeencalculatedthatahumanadulthasabout1012bacteriaon
theskin.

---

832.Thenumberofbacteriapercmofskin
are?
a)10'-102
b)102-103
c)105-1010
d)>10'
CorrectAnswer-B
Ans.is`b'i.e.,102-103
Densityofbacterialpopulationatmostsitesisbetween100-1000
persquarecm.

---

833.Thepredominantcolonicbacteriaare-
a)Largelyaerobic
b)Largelyanaerobic
c)Bacteroides
d)Staphylococci
CorrectAnswer-B
Ans.is'b'i.e.,Largelyanaerobic
*Intheadultnormalcolon,theresidentbacterialfloraaremostly
(96-99percent)anaerobes:
*Anaerobicstreptococci(Peptostreptococci)-
Clostridia
*Anaerobiclactobacilli(bifidobacteria)-
Bacteroides
*1-4percentareaerobes:
*Enterococci*Pseudomonas*Coliforms*
Lactobacilli*ProteusRemember
*Induodenumandupperileum,predominantorganismsare-->
Lactobacilliandenterococci.
*Inlowerileumandcecum-->Floraresemblethefecalflora.

---

834.Bacterialcountindoudenum
a)105pergram
b)10'pergram
c)1010pergram
d)10'2pergram
CorrectAnswer-A
Ans.is'a'i.e.,105pergram
InGITofanadult:
Duodenum-4103-106bacteriapergram.
Jejunumandproximalileum10'-108bacteriapergram
Lowerileumandcecum108-1010bacteriapergram
Colonandrectum10"-1012bacteriapergram
Colonandrectumhavemaximumnumberofbacteriaandmostof
them(96-99%)areanaerobes:
Anaerobicstreptococci
Clostridia
Anaerobiclactobacilli
Bacteroides

---

835.Bacteriashowingantigenicvariation?
a)Yersinia
b)Bordetella
c)Brucella
d)Borrelia
CorrectAnswer-D
Ans.is'd'i.e.,Borrelia
Bacteriashowingantigenicvariationare:?
i)Neisseria(Meningococci,Gonococci)
ii)Streptococcusspp
iii)Mycoplasma
iv)Borreliaburgdorferi

---

836.Mostcommonorganismcausing
ventilatorassociatedpneumonia-
a)Legionella
b)Pneumococcus
c)Pseudomonas
d)Coagulasenegativestaphylococcus
CorrectAnswer-C
Ans.is'c'i.e.,Pseudomonas
StaphylococcusaureusandPseudomonasaeruginosacausemost
ofthecasesofventilatorassociatedpneumonia(VAP).
OthercommonorganismscausingVAPareenterococcusfaecium,
Acinetobacterbaumonnii,enterobacterspeciesandklebsiella
pneumoniae.
Mnemonic:ESKAPE(Enterococcus,staphylococcus,klebsiella,
Acinetobacter,Pseudomonas,enterobacter).
Assinglemostcommonorganism,pseudomonasisthecausative
agent?
-Pseudomonas
--> 21%
aeruginosa
-Staphylococcus
--> 20%
aureus
-Enterobacter
species
--> 9%
-Klebsiella
--> 8%
pneumoniae
-Acinetobacter
--> 6%

---

837.Mostcommonmodeoftransmissionof
nosocomialinfectionis-
a)Handcontact
b)Dropletinfection
c)Bloodandbloodproducts
d)Contaminatedwater
CorrectAnswer-A
Ans.is'a'i.e.,Handcontact
Modesoftransmissionofnosocomialinfections
Therearefollowingtypesofmodesoftransmissionofhospital-
acquiredinfections.
1)Contacttransmission
*Itisthemostcommonandmostpreventablemeansof
transmission.Itisdividedintotwotypes-
.0Directcontact:Itinvolvescontactofbodysurfacetobodysurface
withaphysicaltransferofmicroorganisms.Handcontactismost
commonmodeoftransmission.
ii)Indirectcontact:Itinvolvesbodysurfacecontactwitha
contaminatedintermediateobject.
2)Droplettransmission
*Itoccurswhendropletcontainingmicroorganismsfromaninfected
personarepropelledthroughtheair(e.g.coughing,sneezing)and
landonthemouth,eyesornoseofanotherperson.
3)Airbornetransmission
*Itresultswhenadropletcontainingmicroorganismsevaporates
andremainssuspendedinairforalongtime(thisshouldnotbe
confusedwithdropletinfection,inwhichtransmissionisimmediate
anddropletsdonotremainssuspendedintheair).

---

*Airbornetransmissionalsooccursbydustparticlescontaining
microorganism.
4)Vehicletransmission
*Itreferstotransmissionofinfectionbycontaminateditemssuch
asfood,water,medications,devicesandequipment.

---

838.Goldenyellowjellyfungusis?
a)Ttursurans
b)Tmontegrophytes
c)Trenellamesenterica
d)Efloccosum
CorrectAnswer-C
Ans.is'c'i.e.,Trenellamesenterica
Thetermjellyfungusissometimesappliedtoanyfunguswithajelly
likefruitingbody,butitisespeciallyappropriateforthemembersof
agroupoftexatraditionallyassignedtotheorderTremellales.
LargestgenusisTremella,whichconsistsofabout80species.
Tremellamesenterica(witchesbutter)isacommonlyencountered
specieswhichhasorangetogoldenyellowfruitingbodies.Therefore
itisalsocalledasgoldenyellowjellyfungusoryellowbrainoryellow
trembler.

---

839.Dukoralis:
a)Oralcholeravaccine
b)Oralrotavirusvaccine
c)Oraltyphoidvaccine
d)Readytousetherapeuticfood
CorrectAnswer-A
Dukoralisamonovalentcholeravaccinebasedonformalinandheatkilledwholecellsof
vibriocholerae01plusrecombinantcholeratoxinBsubunit.
Ref:Park21stedition,page211.

---

840.MDRTBmustbetreatedforatleast?
a)12months
b)18months
c)20months
d)36months
CorrectAnswer-C
Ans.is'c'i.e.,20months
Resistance
(or
Throughout RZE
intolerance) (6)
toH
Resistance
(or
Throughout HZEQ
intolerance) (12-18)
toR
ZEQ+S(for
Throughout
Resistance
another
(atleast20
toH+R
injectable
months)
agents)
1injectable
agent+3of
Resistance Throughout ofthese
toallfirst- (atleast20 4
linedrugs months
ethionamide
cycloserine,
Q,PAS
Intolerance
HRE
toZ

---

---

841.FatherofIndianSurgeryis?
a)Dhanvantari
b)Charaka
c)Susruta
d)Atreya
CorrectAnswer-C
Ans.is'c'i.e.,Susruta
Fatherof(Modern)Medicine:Hippocrates
FatherofIndianMedicine:Charaka
HinduGodofMedicine:Dhanvantari
Fatherof(Modern)Surgery:AmbroisePare
FatherofIndianSurgery:Sushruta
FatherofEpidemiology/ModernEpidemiology:JohnSnow
FatherofBacteriology:LouisPasteur
FatherofBiology:GregorMendel
Fatherof(Modern)Anatomy:Vesalius
FatherofPhysiology:ClaudeBernard
FatherofPsychoanalysis:SigmundFreud
FatherofHomeopathy:SemuelHahneman
FatherofAnti-sepsis:JosephLister

---

842.AIDSdayis?
a)7April
b)3May
c)5June
d)1December
CorrectAnswer-D
Ans.is'd'i.e.,1December

---

843.
ThelawyerwhodesignedthePublic
HealthAct1848was?
a)Johnsnow
b)EdwinChadwick
c)JosephLister
d)WilliamFan
CorrectAnswer-B
Ans.is'b'i.e.,EdwinChadwick
*Thegreatcholeraepidemicof1832ledEdwinChadwick(1800-
1890),alawyerinEngland,toinvestigatethehealthofthe
inhabitantsoflargetownswithaviewtoimprovetheconditions
underwhichtheylive.
*Chadwick'sreporton"TheSanitaryConditionsoftheLabouring
PopulationinGreatBritain",alandmarkinthehistoryofpublic
health,setLondonandothercitiesonthewaytoimprovehousing
andworkingconditions.
*Filthwasrecognizedasman'sgreatestenemyandwiththisbegan
ananti-filthcrusade,the"greatsanitaryawakening",whichledtothe
enactmentof'PublicHealthAct1948'inEngland.

---

844.Principleforchinesemedicine-
a)Yang
b)Vin
c)Both
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Both
*Chinesemedicineisbasedontwoprinciples:-
i)Yang:Activemasculineprinciple
ii)Vin:Negativefeminineprinciple
*Thebalanceofthesetwoopposingforcesmeantgoodhealth.
*TheChinesewereearlypioneersofimmunization.They
practisedvariolationtopreventsmallpox.
*TheChinesesystemof'bare-footdoctors'andaccupuncturehave
attractedworldwideattentioninrecentyears.

---

845.
BEINGSModelofdiseasecausation
doesnotinclude
a)Spiritualfactors
b)Socialfactors
c)Religiousfactors
d)Nutritionalfactors
CorrectAnswer-C
Ans.is'c'i.e.,Religiousfactors
Onewayofrememberingthecategoriesofcauseforthediseaseis
anacronymusedinthemodel(BEINGSmodel):
B:Biologicalfactorsandbehavioralfactors.
E:Environmentalfactors.
I:Immunologicalfactors.
N:Nutritionalfactors.
G:Geneticfactors.
S:Services,social,spiritualfactors.

---

846.AccordingtoMDGchildmortalityhasto
bereducedbyhow,muchby2015?
a)Onethird
b)Half
c)Twothird
d)Onefourth
CorrectAnswer-C
Ans.is'c'i.e.,Twothird[RefPark20th/ep.834]
3of8goalsofMDG(Goal4,5,6),8of18targetsand18of48
indicatorsare'directly'healthrelated.
1. Goal1:Eradicateextremepovertyandhunger.
2. Goal2:Achieveuniversalprimaryeducation.
3. Goal3:Promotegenderequalityandempowerwomen.
4. Goal4:Reducechildmortality(Reducebytwo-thirdstheunder-five
mortalityrate).
5. Goal5:Improvematernalhealth(Reducebythree-quartersthe
maternalmortalityratio.
6. Goal6:CombatHIV/AIDS,malariaandotherdiseases.
7. Goal7:Ensureenvironmentalsustainability.
8. Goal8:Developaglobalpartnershipfordevelopment.

---

847.MillenniumdevelopmentalgoalforHIV/
AIDS?
a)6
b)3
c)8
d)1
CorrectAnswer-A
Ans.is`a'i.e.,6
oGoal6istocombatHIV/AIDS;malariaandotherdiseases.

---

848.Accordingto'Biomedicalconcept'health
is
a)Relativeabsenceofpainanddiscomfort
b)Absenceofdisease
c)Asoundmindinsoundbody,inasoundfamily,insound
environment
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Absenceofdisease
Accordingtobiomedicalconcepthealthisdefinedas"absenceof
disease",andhasthebasisinthe"germtheoryofdisease"

---

849.Mostimportantcomponentoflevelof
livingis
a)Health
b)Education
c)Occupation
d)Housing
CorrectAnswer-A
Ans.is'a'i.e.,Health
Healthisthemostimportantcomponentbecauseitsimpairment
alwaysmeansimpairmentoflevelofliving.

---

850.Qualityoflifeisdefinedas?
a)Standardofliving
b)Levelofliving
c)Subjectivefeelingofwellbeing
d)Alloftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Subjectivefeelingofwellbeing
Oualityoflife
*Theleveloflivingandstandardoflivingareobjectivecriteriaof
wellbeing,whilequalityoflifecomprisestheindividual'sown
subjectiveevaluationofthese.
*Recentdefinitionofqualityoflifeisasfollows"acomposite
measureofphysicalmentalandsocialwellbeingasperceivedby
eachindividualorgroupofindividuals."
*WHOdefinitionisasfollows"theconditionofliferesultingfromthe
combinationoftheeffectsofthecompleterangeoffactorssuchas
thosedetermininghealth,happiness,education,etc."

---

851.Definitionofdiseasecontrolis?
a)Agentiseliminatedfromcommunity
b)Agentpersistsincommunitywithoutcausinghealthproblem
c)Agentpersistsincommunityandcausingpulichealthproblems
d)Anyoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Agentpersistsincommunitywithoutcausinghealth
problem
*Indiseasecontrol,thediseaseagentispermittedtopersistinthe
communityatalevelwhereitceasetobeapublichealthproblem
accordingtothetoleranceoflocalpopulation.
*Astateofequilibriumbecomesestablishedbetweenthedisease
agent,hostandenvironmentcomponentsofthediseaseprocess.

---

852.Apatientprescribedcrutchesfor
residualparalysisinpoliomyelitisisa
typeof-
a)Primaryprevention
b)Primordialprevention
c)Disabilitylimitation
d)Rehabilitation
CorrectAnswer-D
Ans.is'd'i.e.,Rehabilitation
Provisionofaidsforcrippledisrehabilitation,e.g.prescriptionof
crutchesforPRPP.
Itisatypeoftertiaryprevention.

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853.Secondarylevelofpreventionis
importantinallofthefollowingexcept?
a)Coronaryheartdisease
b)TB
c)Leprosy
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Coronaryheartdisease
Fornon-communicabledisease(e.g.CHD),primordialpreventionis
bestintervention.

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854.Apatienthadinjurytorightlegbyroad
trafficaccidentandhislegwas
amputated.Thisis?
a)Disease
b)Disability
c)Impairment
d)Handicap
CorrectAnswer-C
Ans.is'c'i.e.,Impairment
Anylossofanatomicalstructure(e.g.lossofleginthisquestion)is
calledasimpairment.
AccordingtoWHOdefinitions,
Disease:Anyabnormalconditionofanindividualthatimpairs
function
Impairment:Anylossorabnormalityofpsychological,physiological
oranatomicalstructureorfunction
Disability:(Becauseofimpairment,)anyrestrictionorinabilityto
performanactivityinarangeconsiderednormalforahumanbeing
Handicap:Adisadvantageforagivenindividual,resultingfroman
impairment/disability,thatlimits/preventsfulfillmentofarole
considerednormal(dependingonage,sex,social,culturalfactors)
forthatindividualForexample,
Event
Classification Interpretation
Accident
Disease
Impairsfunctionofaperson
Lossofanatomicalstructureintheform
Lossoffoot Impairment
offoot
Cannot
Walkingisanormalroutinedailyactivity
Disability
Walk
ofahumanbeing

---

Disability
Walk
ofahumanbeing
Losesouthisjobbecausehecannot
walk,socannotfulfillhisroleinthe
Unemployed Handicap
society,i.e,earningforhisfamily
members

---

855.Apersonhaslosthisleginanaccident
becauseofwhichheisnotabletowalk.
Thisis-
a)Disease
b)Disability
c)Impairment
d)Handicap
CorrectAnswer-B
Ans.is'b'i.e.,Disability
*Thisquestionisslightlydifferentfrompreviousone.
*Patientinthisquestionisnotabletowalk(duetolostleg).Thisis
calleddisability.
*Rememberthatthepatientinthisquestionalsohasimpairment,
i.e.lossofleg.(Buttheexaminerisaskingaboutinabilitytowalk,in
thisquestion).

---

856.Sullivan'sindexindicates
a)Lifefreeofdisability
b)PregnancyrateperHW
c)Hookwormeggs/gmofstool
d)Standardofliving
CorrectAnswer-A
Ans.is'a'i.e.,Lifefreeofdisability
Sullivan'sindex
Sullivan'sindexistheexpectationoflifefreeofdisability.
Itiscomputedbysubtractingfromthelifeexpectancytheprobable
durationofbeddisabilityandinabilitytoperformmajoractivities.
Sullivan'sindex=lifeexpectancy--Durationofbeddisability&
Inabilitytoperformminorwork
Itisadirectindicatorofhealthandwellbeinginacommunity.
tisoneofthemostadvancedhealthindicatorscurrentlyavailable.

---

857.Randomizationisdonetoreduce?
a)Recallbias
b)Selectionbias
c)Berksonianbias
d)Reportingbias
CorrectAnswer-B
Ans.is'b'i.e.,Selectionbias

---

858.Limitationofcasefatalityrate-
a)Notusefulinacuteinfectiousdisease
b)Notrelatedtovirulence
c)Timeperiodnotspecified
d)Itisnotrelatedtosurvivalrate
CorrectAnswer-C
Ans.is'c'i.e.,Timeperiodnotspecified
oLimitationsofcasefatalityrateisthattimeperiodisnotspecified.
oCFRistypicallyusedinacuteinfectiousdiseaseandisrelatedto
virulenceoforganism.
oCasefatalityrateisthecomplementofsurvivalrate.

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859.Allaretrueaboutincidence,except-
a)Numeratorincludesnewcases
b)Denominatorincludespopulationatrisk
c)Doesnotincludeunitoftime
d)Itisarate
CorrectAnswer-C
Ans.is'c'i.e.,Doesnotincludeunitoftime
oIncidenceratemustincludetheunitoftimeusedinthefinal
expression.Ifyouwrite16.7per1000,thiswouldbeinadequate.The
correctexpressionis16.7per100peryear.
oAllotheroptionsarecorrect.

---

860. Thedifferencebetweencontamination
andinfectionisthatininfection-
a)Infectiousagentisonbodysurfaceoronnonhumanobjects
b)Infectiousagentisinthebodyofhuman
c)Arthropodsonthebodysurface
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Infectiousagentisinthebodyofhuman
oInfection-->Infectiousagentinthebody.
oContamination--->Infectiousagentonbodysurfaceoronobjects.
oInfestation-->Arthropodsonbodysurface.

---

861.Thresholdlevelofherdimmunityfor
Pertussisis?
a)80%
b)70%
c)90%
d)50%
CorrectAnswer-C
Ans.is'c'i.e.,90%
Herdimmunity
Itisthelevelofresistanceofacommunityorgroupofpeopletoa
particulardisease.
Itoccurswhenthevaccinationofaportionofthepopulation(or
herd)providesprotectiontounprotected(non?vaccinated)
individuals.
Advantageofherdimmunity
Itisnotnecessarytoachieve100%immunizationtocontrola
diseasebyprovidingherdimmunity.
Whenacertainpercentageofpopulation,isvaccinated,thespread
ofdiseaseiseffectivelystopped.
Thiscriticalpercentageisreferredtoasherdimmunitythreshold.
DiseaseHerdimmunitythreshod
Diphtheria85%
Measles83-94%
Mumps75-86%
Pertussis92-94%
Polio80-86%
Rubella80-85%
Smallpox83-85%

---

---

862. Indiastarted2-dosevaccinationstrategy
formeasles,in-
a)2008
b)2009
c)2010
d)2011
CorrectAnswer-C
Ans.is'c'i.e.,2010
oIntheyear2010,theworld'stwomostpopulouscountriesmade
promisingadvancesinmeaslescontrol:-i)Chinaheldthelargest
everSIA,vaccinatingmorethan103millionchildren.
Indiastartedimplementationof2-dosevaccinationstartegy.

---

863.CongenitalacquiredimmunityisNOT
foundin-
a)Pertussis
b)Mumps
c)Rubella
d)Measles
CorrectAnswer-A
Ans.is'a'i.e.,Pertussis
Congenitalpassiveimmunity(maternalpassiveimmunity)
oMaternalpassiveimmunityisatypeofnaturallyacquiredpassive
immunity.
oItreferstoantibody-mediatedimmunityconveyedtoafetusbyits
motherduringpregnancy.oImportantinfection,againstwhich
immunityistransferredfrommothertochild?
1)Chickenpox3)Rubella5)Diphtheria
2)Measles4)Mumps6)Polio
oImportantdiseasesforwhichthereisnomaternalpassive
immunity?
1)Pertussis(whoopingcough)3)HepatitisB
2)TB

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864.Whichvaccineiscontraindicated
pregnancy
a)Choleravaccine
b)Typhoidvaccine
c)Meningococcalvaccine
d)Measlesvaccine
CorrectAnswer-D
Ans.is`d'i.e.,Measlesvaccine
Asaruleofthumbthevaccinationwithliveviralorbacterial
vaccineiscontraindicatedinpregnancy.
Theimportantonesare:-
Measles
Mumps
Poliomyelitis
Rubella
Yellowfever
Varicella
BCG

---

865.IdealtemperatureforDPTstorage?
a)Roomtemperature
b)4to8?C
c)0to-20?C
d)None
CorrectAnswer-B
Ans.is'b'i.e.,4to8?C
oStorage-->DPT/DTvaccineshouldnotbefrozen,theyshouldbe
storedinarefrigeratorbetween4to8?C.
oOptimumageEPIhasrecommendedthatDPTvaccinecansafely
andeffectivelyadministeredasearlyas6weeksafterbirth.
oNumberofdosesThreedosesareconsideredtobeoptimalfor
primaryimmunization.
oIntervalbetweendoses-->Thecurrentrecommendationisto
allowanintervalof4weeksbetween3doses,withabooster
injectionat11/2to2years,followedbyanotherbooster(DTonly)at
theageof5-6years.
DoseAge
DPTJ6weeksofage
DPT210weeksofage
DPT314weeksofage
DPT300,,16-24monthsofage
DT5yearsofage
Booster
oModeandsiteofadministration--->IMatupper&outerquadrant
ofglutealregion.
Alsoknow
oSincetheseverityofpertussisinfectiondecreaseswithagethe

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oSincetheseverityofpertussisinfectiondecreaseswithagethe
pertussiscomponentinDPTvaccineisnotusuallyrecommended
aftertheageof6years.
oTherefore,childrenovertheageof5yearswhohavenotreceived
DPT,needonly2dosesofDTvaccine4weeksapart,withabooster
dose6monthsto1yearlater.Thosechildrenwhoreceivedthe
primarycourseofDPTearlier,shouldreceiveonlyDTasboosterat
5-6yearsoratschoolentry.
oForimmunizingchildrenover12yearsofageandadults,the
preparationofchoiceisDT-->2dosesatanintervalof4to6
weeks,followedbyabooster6to12monthsaftertheseconddose.

---

866.Encephalopathycanoccuras
complicationofwhichvaccine?
a)OPV
b)Rubella
c)Measles
d)BCG
CorrectAnswer-C
Ans.is'c'i.e.,Measles

---

867.BCGvaccineisdilutedwith:
September2005
a)Normalsaline
b)Distilledwater
c)Dextrose
d)Colloids
CorrectAnswer-A
Ans.A:Normalsaline
BCGVaccine(Freeze-Dried)forintracutaneousadministration,as
preparedbyConnaughtLaboratoriesLimited,ismadefromaculture
ofanattenuatedstrainoflivingbovinetuberclebacillus(Bacillus
Calmette-Guerin).
Itissuppliedasafreeze-driedproductreadyforimmediateuse
followingreconstitutionwiththeaccompanyingdiluent,which
consistsofsterilephosphate-bufferednormalsaline.
Distilledwatermaycauseirritation.

---

868.Allvaccinesaregivenindisaster,except
?
a)Cholera
b)Influenza
c)Measles
d)Tetanus
CorrectAnswer-A
Ans.is'a'i.e.,Cholera
Vaccinesrecommendedindisasters
oFollowingvaccinesarerecommended
1)Children<10years:-DPT,inactivatedpolio(IPV),
H.influenzaetypeb(Hib),hepatitisB,pneumococcalconjugate
vaccine(PCV),measles-mumps-rubella(MMR),varicellavaccine,
influenza,hepatitisAandrotavirus.
2)Childrenandadolescents(11-18years):-Tetanus,diphtheria,
pertussis,meningococcalconjugatevaccine(MCV),Influenza.
3)Adults(>18years):-Tetanus,diphtheria,pertussis,
pneumococcalpolysaccharidevaccine(PPSV23),andinfluenza.
oVaccinationagainsttyphoidandcholeraisnotrecommended.

---

869.6thmonthimmunizationgivenis-
a)Measles
b)DPT
c)BCG
d)All
CorrectAnswer-A
Ans.is'a'i.e.,Measles
oMeaslesvaccineisgivenat6month.

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870.Screeningforconditionrecommended
when?
a)Lowcasefatalityrate
b)Diagnostictoolsnotavailable
c)Noeffectivetreatmentavailable
d)Earlydiagnosiscanchangediseasecoursebecauseof
effectivetreatment
CorrectAnswer-D
Ans.is'd'i.e.,Earlydiagnosiscanchangediseasecoursebecause
ofeffectivetreatment
Criteriaforscreening
oThecriteriaforscreeningarebasedontwoconsideration.
i)Diseasetobescreened
ii)Screeningtesttobeapplied
oDiseasetobescreened
Thediseasetobescreenedshouldfulfilthefollowingcriteriabefore
itisconsideredsuitableforscreening.
1. Theconditionsougthshouldbeanimportanthealthproblem(in
general,prevalenceshouldbehigh).
2. Thereshouldbearecognizablelatentorearlyasymptomaticstage.
3. Thenaturalhistoryofthecontition,includingdevelopmentfrom
latenttodeclareddisease,shouldbeadequatelyunderstood(sothat
wecanknowatwhatstagetheprocessceasestobereversible).
4. Thereisatestthatcandetectthediseasepriortotheonsetofsigns
andsymptoms.
5. facilitiesshouldbeavailableforconfirmationofthediagnosis.
6. Thereisaneffectivetreatment.
7. Thereshouldbeanagreed-onpolicyconcerningwhomtotreatas

---

patients(e.g.,lowerrangesofbloodpressure;border-linediabetes).
8. Thereisgoodevidencethatearlydetectionandtreatmentreduces
morbidityandmortality.
9. Theexpectedbenefits(e.g.,thenumberoflivessaved)ofearly
detectionexceedtherisksandcosts.

---

871.Screeningisusefulindiseasewhich
has?
a)Shortleadtime
b)Longleadtime
c)Botha&b
d)Norelationwithleadtime
CorrectAnswer-B
Ans.is'b'i.e.,Longleadtime

---

872.Rashofchickenpoxcanbedifferentiated
fromtherashofsmallpoxbyallexcept?
a)Pleomorphic
b)Centripetal
c)Deep-seated
d)Unilocular
CorrectAnswer-C
Ans.is'c'i.e.,Deep-seated
Rashofchickenpoxissuperficial(notdeepseated).

---

873.2monthsoldchildhavingbirthweight
2kg,withpoorfeeding,verysleepyand
wheezing.Thediagnosisis?
a)Nopneumonia
b)Severepneumonia
c)Veryseveredisease
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Veryseveredisease

---

874.3monthsoldinfant,nochestindrawing
withrespiratoryrate52/minute.
Diagnosisis
a)Nopneumonia
b)Pneumonia
c)Severepneumonia
d)Veryseveredisease
CorrectAnswer-B
Ans.is'b'i.e.,Pneumonia
Thisinfanthas:?
1. Fastbreathing(..50perminutebetween2monthsto1years).
2. Nochestindrawing.
DiagnosisisPneumonia.

---

875.Mostimportantfeaturetodiagnose
severepneumonia?
a)Cyanosis
b)Chestindrawing
c)Nasalflaring
d)Fastbreathing
CorrectAnswer-B
Ans.is'b'i.e.,Chestindrawing
Theonlysignforseverepneumoniaischestindrawing

---

876.Mostcommoncauseofdeathin
diphtheriaisdueto
a)Airwaycompromise
b)Toxiccardiomyopathy
c)Sepsis
d)Descendingpolyneuropathy
CorrectAnswer-B
Answer-B.Toxiccardiomyopathy
Mostcommoncauseofdeathindiphtheriacardiomyopathy

---

877.Mostcommoncauseofpost-measles
death?
a)Diarrhea
b)RTI
c)SSPE
d)Myocarditis
CorrectAnswer-B
Ans.is'b'i.e.,RTI
Respiratorytractinfection(RTI)isthemostcommoncauseofdeath.
"Pneumoniaisthemostcommonlife-threatening
complication"_______________________Park

---

878.Apersonisconsideredasacaseof
tuberculosisif-
a)Hascough
b)Sputumpositive
c)X-raysigns
d)Mantouxpositive
CorrectAnswer-B
Ans.is`b'i.e.,Sputumpositive
Caseoftubuculosisisdefinedas,eitheranyofthetwo:-
1. AtleastonesputumspecimenpositiveforAFBorculturepositivefor
M.TuberculosisorRNTCPendorsedrapiddiagnostictestpositive
forTB.
2. DiagnosedclinicallyasacaseofTBwithoutmicrobiologic
confirmation,andinitiatedonATT.
Somedefinitionsoftuberculosiscasesandtreatment
Caseoftuberculosis:Apatientinwhomtuberculosishasbeen
confirmedbybacteriologyordiagnosedbyaclinician.
Sputumsmearexamination-Laboratorytechniquetoscreensputum
fortuberculosis,whereacidfastbacilli(AFB)arestainedredbythe
ZiehlNeelsenmethod,andthenidentifiedandcountedusing
microscopy.Smearpositivetuberculosis-Atleastoneinitialsputum
smearspositiveforAFBoroneAFBpositive.
Smearnegativetuberculosis-Atleasttwonegativesmears,but
tuberculosissuggestivesymptomsandX-rayabnormalitiesor
positiveculture.
Adherence-Persontakesappropriatedrugregimenforrequired
time(alsoknownascompliance).
Newcase-Apatientwithsputumpositivepulmonarytuberculosis

---

whohasneverhadtreatmentfortuberculosisorhastakenanti-
tuberculosisdrugsforlessthan4weeks.
Relapse-Apatientwhoreturnssmearpositivehavingpreviously
beentreatedfortuberculosisanddeclaredcuredafterthe
completionofhistreatment.
Failurecase-Apatientwhowasinitiallysmearpositive,whobegan
treatmentandwhoremainedorbecamesmearpositiveagainatfive
monthsorlaterduringthecourseoftreatment.
Returnafterdefault-Apatientwhoreturnssputumsmearpositive,
afterhavinglefttreatmentforatleasttwomonths.Transferin-A
patientrecordedinanotheradministrativearearegisterand
transferredintoanotherareatocontinuetreatment(treatmentresults
shouldbereportedtothedistrictwherethepatientwasinitially
registered).Transferout-Apatientwhohasbeentransferredto
anotherarearegisterandtreatmentresultsarenotknown.Cured-
Initiallysmearpositivepatientwhocompletedtreatmentandhad
negativesmearresultonatleasttwooccasions(oneattreatment
completion).
Treatmentcompleted-Initiallysmearnegativepatientwhoreceived
fullcourseoftreatment,orsmearpositivewhocompletedtreatment,
withnegativesmearattheendofinitialphase,butnooronlyone
negativesmearduringcontinuationandnoneattreatmentend.
Cohort-AgroupofpatientsinwhomTBhasbeendiagnosed,and
whowereregisteredfortreatmentduringaspecifiedtimeperiod
(e.g.thecohortofnewsmear-positivecasesregisteredinthe
calenderyear2003).Thisgroupformsthedenominatorfor
calculatingtreatmentoutcomes.Thesumofthetreatment
outcomes,plusanycaseforwhichnooutcomeisrecorded(eg.still
ontreatment)shouldequalthenumberofcasesregistered.
Casedetectionrate:-Thecasedetectionrateiscalculatedasthe
numberofnotificationofnewandrelapsecasesinayeardividedby
theestimatedincidenceofsuchcasesinthesameyear

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879.Annualinfectionrateoftuberculosisis
definedas?
a)Percentageoftotalpatientspositivefortuberculintest
b)Percentageofnewpatientspositivefortuberculintest
c)Percentageofsputumpositivetotalpatients
d)Percentageofsputumpositivenewpatients
CorrectAnswer-B
Ans.is'b'i.e.,Percentageofnewpatientspositivefortuberculintest
Epidemiologicalindicesoftuberculosis
Indicesorparametersareneededtomeasurethetuberculosis
probleminacommunityaswellasforplanningandevaluationof
controlmeasures.
Thefollowingepidemiological-indicesareusedintuberculosis
problemmeasurementandprogrammestrategy:?
1.Prevalenceofinfection
Itisthepercentageofindividualswhoshowapositivereactiontothe
standardtuberculintest.
2.Incidenceofinfection(Annualinfectionrate)
Itisthepercentageofpopulationunderstudywhowillbenewly
infectedbyM.tuberculosisamongthenon-infectedofthepreceding
surveyduringthecourseofoneyear.
Itreflectstheannualriskofbeinginfected(orreinfected)inagiven
community,i.e.itexpressestheattackingforceoftuberculosisina
community.
Itisalsoknownastuberculinconversionindex.
Thisparameterisconsideredoneofthebestindicatorsfor
evaluatingthetuberculosisproblemanditstrend.
3.Prevalenceofdiseaseorcaserate

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Itisthepercentageofindividualswhosesputumispositivefor
tuberclebacillionmicroscopicexamination.
Itisthebestavailablepracticalindextoestimatethenumberof
infectiouscasesorcaseloadinacommunity.
4.Incidenceofnewcases
ItisthepercentageofnewTBcases(confirmedbybacteriological
examination)per1000populationoccurringduringoneyear.
5.Prevalenceofsuspectedcases
ThisisbasedonX-rayexaminationofchest.
6.Prevalenceofdrugresistantcases
Itistheprevalenceofpatientexcretingtuberclebacilliresistantto
anti-tuberculardrugs.
7.Mortalityrate
Thenumberofdeathsfromtuberculosiseveryyearper1,000
population.
Inthisquestion
OptionaPrevalanceofinfection.
OptionbIncidenceofinfection(annualinfectionrate).
OptioncPrevalanceofdisease(caserate)
OptiondIncidenceofdisease.

---

880.Accordingtoimmunizationschedule,
childrenshouldreceiveinfluenza
vaccine?
a)2dosesat1monthinterval
b)3dosesat1monthinterval
c)2dosesatonemonthintervalwithoneboosterdoselater
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,2dosesatonemonthintervalwithoneboosterdose
later
2dosesofvaccine,separatedbyanintervalof3-4weeksare
considerednecessarytoinducesatisfactoryantibodieslevel.
Theprotectivevalueis70-90%andimmunitylastsfor6-12months.
Revaccinationonanannualbasisisrecommended.
Influenzavaccines
1.Killedvaccines
2doses,3-4weeksapart,0.5ml(forage>3years),subcutaneous.
70-90%protectiveefficacy;duration3-6months.
IsrarelyassociatedwithGuillainBarreSyndrome(GBS).
2.Liveattenuatedvaccines
Stimulatelocal+systemicimmunity.
Antigenicvariationspresentsdifficultiesinmanufacture.
3.Newervaccines
Split-virusvaccine..
Alsoknownas'Sub-virionvaccine'
Highlypurified
Lessersideeffects

---

Lessantigenic-multipleinjectionsrequired
UsefulforchildrenoNeuraminidase-specificvaccine:
Sub-unitvaccinecontainingN-antigen
Permitssubclinicalinfection-longlastingimmunity
Recombinantvaccine:
Antigenicpropertiesofvirulentstraintransferredtoalessvirulent
strain.
Contraindicationstoinactivatedinfluenzavaccines:
Severeallergytochickeneggs
Historyofhypersensitivity/anaphylacticreactionspreviously.
DevelopmentofGuillainBaneSyndrome(GBS)within6weeksof
vaccine.
Infantslessthan6monthsage.
Moderate-to-severeillnesswithfever

---

881. ThedirectBCGvaccinationinIndiais
givenuptoageof-
a)10year
b)15year
c)20year
d)None
CorrectAnswer-D
Ans.is'None'
FirstyoushouldknowwhatdoesdirectvaccinationmeanDirect
BCGvaccination
WhenBCGvaccinationisgivenwithoutpriormantouxtest,it
isreferredasdirectBCGvaccination.
Itisrecommendedupto1yearofage.
IndirectBCGvaccination
oWhenBCGvaccinationisgivenaftermantouxtest,itisreferredas
indirectBCGvaccination.
Itisrecommendedbeyondtheageof1year.

---

882.Infectivityperiodofchickenpoxis?
a)1daybeforeand4daysafterappearanceofrash
b)4daysbeforeand5dayafterappearanceofrash
c)Onlywhenscabfalls
d)Entireincubationperiod
CorrectAnswer-A
Ans.is'a'i.e.,1daybeforeand4daysafterappearanceofrash
Periodofcommunicability:
Chickenpox:1?2daysbeforeto4?5daysafterappearanceof
rash
Measles:4daysbeforeto5daysafterappearanceofrash
Rubella:7daysbeforesymptomsto7daysafterappearanceofrash
Mumps:4?6daysbeforesymptomsto7daysthereafter
Influenza:1?2daysbeforeto1?2daysafteronsetofsymptoms
Diphtheria:14?28daysfromdiseaseonset
Pertussis:7daysafterexposureto3weeksafterparoxysmalstage
Poliomyelitis:7?10daysbeforeandafteronsetofsymptoms
HepatitisA:2weeksbeforeto1weekafteronsetofjaundice
HepatitisB:TilldisappearanceofHBsAg&appearanceofanti-HBs
Meningococcal:Untilabsentfromnasalandthroatdischarge
Tuberculosis:Aslongasnottreated

---

883.Shortestincubationperiodisofwhich
infection?
a)Chickenpox
b)Measles
c)Rubella
d)Influenza
CorrectAnswer-D
Ans.is'd'i.e.,Influenza

---

884.PoliocasedefinitionforAFPsurveillance
?
a)OnsetofAFP
b)Residualparalysis
c)Stoolspecimenpositiveforvirus
d)Alloftheabove
CorrectAnswer-D
Ans.is`d'i.e.,Alloftheabove
AFPSurveillance
Acuteflaccidparalysis(AFP)surveillanceiscarriedouttoidentifyall
remaininginfectedareas,monitorprogresstowardseradicationand
targetsupplementaryimmunizationappropriately.
ThetermAFPmeansparalysisofacuteonsetinvolvinglimbs
leadingtoflaccidity.PoliomylelitisismostimportantetiologyofAFP,
othercausesare-GBS(Guillain-Barresyndrome),transverse
myelitisandtraumaticneuritis.
AFPsurveillanceaimsatdetectingcasesofAFPandreportingthem
immediatelytodistrictimmunizationofficer.
SurveillanceiscarriedoutforallcasesofAFPandnotjustfor
poliomyelitis.AllcasesofAFParereported,regardlessofthefinal
diagnosis.AsparalyticpoliomyelitisisonecauseofAFP,
maintainingahighsensitivityofAFPreportingwillensurethatall
casesofparalyticpoliomyelitisaredetected,reportedand
investigated,resultinginpreventivecentralmeasurestointerruptthe
transmissionofdisease.
TheaimofAFPsurveillanceistodetectpoliovirustransmission,
andtheearlierthestooliscollected,thegreaterthechanceof
detectingpoliovirus.

---

WHOrecommendstheimmediatereportingandinvestigationof
everycaseofAFPinchildrenlessthan15yrs(AsAFPinaperson>
15yrsisunlikelytobepolio.Still,AFPsurveillancemustbeflexible
enoughtoreportanycaseofAFPinanadult,ifsuspectedtobedue
topoliomyelitis)
CasesofAFPareclassifiedasPolioif:
Wildpoliovirusisisolatedfromanystoolspecimen.
CasesofAFPwithoutisolationofwildpoliovirusmaybeclassified
as'poliocompatible'if:
Stoolspecimenswereinadequateand
Residualweaknesswaspresent60daysafteronsetofparalysisor
60-dayfollow-upwasnotdone(duetodeathorabsence)and
'Expertreview'concludesthatthesecasescouldnotbediscarded
as'non-polio'basedonavailabledata.

---

885.Allaretrueaboutpolio,except-
a)99%nonparalytic
b)Flaccidparalysis
c)Exaggeratedtendonreflexes
d)Asepticmeningitis
CorrectAnswer-C
Ans.is'c'i.e.,Exaggeratedtendonreflexes
oThereareabsenttendonreflexes(notexaggerated).
oParalyticpoliooccursinonly1%cases(thatmeans99%isnon-
paralytic).
oThereisflaccidparalysis.
oAspeticmeningitisoccursin1%ofcases.

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886.Criteriafordefiningpolioepidemicare
allexcept?
a)2ormorecases
b)Casesshouldoccurinsamelocality
c)Causedbysamevirustype
d)Casesoccurringduring6monthperiod
CorrectAnswer-D
Ans.is'd'i.e.,Casesoccuringduring6monthperiod
oAnepidemicofpolioisdefinedas2ormorelocalcasescausedby
samevirustypeinany4weekperiod.
So,ithasfollowingfeatures-
i)2ormorecasesofpolio
ii)Causedbysamevirustype
iii)Within4weekperiod

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887.
Intyphoidapermanentcarrierisone
whoexcretesbacilliformorethan-
a)3months
b)6months
c)1year
d)3years
CorrectAnswer-C
Ans.is'c'i.e.,1year
Convalescentcarriersshedthebacilliinfecesforthreeweeksto
threemonthspost-infection.
Temporarycarriersshedthebacilliforbetweenthreeandtwelve
months,andchroniccarriersshedthebacilliformorethan
oneyear
Bacillipresistinthegallbladderorkidneyandareeliminatedinthe
feces(fecalcarriers)orurine(Urinarycarrier),respectively.
oThedevelopmentofthecarrierstateismorecommoninwomen
andinolderagegroups(over40yrs)
oCarriersarethemorefrequentsourceofinfectionthancases.
oUrinarycarriageislessfrequentbutmoredangerousthan
intestinalcarriers.
oNote-->Permanentcarriersareamongstthechroniccarriers.

---

888.Allarepresentinmilddehydration,
except?
a)Thirst
b)Restlessness
c)Drytongue
d)NormalBP
CorrectAnswer-C
Ans.is'c'i.e.,Drytongue

---

889.ORSrequiredduringfirst4hoursina20
kgchild?
a)200-400ml
b)400-600ml
c)600-800ml
d)1200-2200ml
CorrectAnswer-D
Ans.is'd'i.e.,1200-2200ml
Weightbetween16-29.9kgORSrequirmentis1200-2200ml
duringfirst4hours.
GuidelinesforORStherapyduringfirstfourhours
4-I1
5-14
Age
<4mth
1-2yrs 2-4yrs
15yrs
mths
yrs
Weight(Kg)
<5
5-7.9
8-10.9 11-15.9 16-29.9 30orover
ORS(ml)
200-400 400-600 600-
800-
1200-
2200-4000
800
1200
2200

---

890.MalariaistransmittedinRuralareasby?
a)Anophelesstephensi
b)Anophelesdirus
c)Anophelesculicifacies
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Anophelesculicifacies

---

891. Mostcommonanophelesmosquitofor
malariainIndia-
a)Anophelesstephensi
b)Anophelessubpictus
c)Anophelesfluviatilis
d)Anophelesdims
CorrectAnswer-A
Ans.is'a'i.e.,Anophelesstephensi
"AnophelesstephensiisthemajormalariavectorinIndia
______________FoundationofCommunityMedicine

---

892.Operationalefficiencyofmalariacontrol
programme?
a)Infantparasiterate
b)Slidepositivityrate
c)Mosquitobiterate
d)Annualbloodexaminationrate
CorrectAnswer-D
Ans.is'd'i.e.,Annualbloodexaminationrate
MEASUREMENTOFMALAR1A
Inthepre-eradicationera,themagnitudeofthemalariaproblemina
countryusedtobedeterminedmostlyfromthereportsofthe
clinicallydiagnosedmalariacasesandtheclassicalmalariometric
measures,e.g.,spleenrate,parasiterateetc.
Ontheotherhand,duringeradicationera,themicroscopicdiagnosis
ofmalariacasesbecamethemainmethodofdiagnosisandthe
parametersusedaremostlyparasitologicalinnaturee.g.,API,
ABER,SPRandSFR.
Measurementsofmalariainthepreeradicationera
Spleenrate:
Definedasthepercentageofchildrenbetween2&10yearsofage
showingenlargementofspleen.Spleenrateiswidelyusedfor
measuringtheendemicityofmalariainacommunity.
Av.enlargedspleen:
Arefinementofspleenrate,denotingtheaveragesizeofspleen.
Parasiterate
Definedasonthepercentageofchildrenbetweentheagesof2&
10yrsshowingmalarialparsitesintheirbloodfilms.
Parasitedensityindex

---

Averagedegreeofparasitimia
Infantparasiterate
Percentageofinfantsshowingmalarialparasitesintheirbloodfilms.
Itisthemostsensitiveindexofrecenttransmissionofmalariaina
locality.Iftheinfantparasiterateiszeroforthreeconsecutiveyears
inalocality,itisregardedasabsenceofmalariatransmissioneven
though,theAnophelinevectorsresponsibleforprevious
transmissionsmayremain.
EradicationEra
AnnualParasiteIncidence(API)*=(Confirmedcasesduringone
year/populationundersurveillance)x1000
AnnualBloodExaminationRate=(No.ofslides
examined/population)x100
ABERisanindexofoperationalefficiency.
Inthemodifiedplanofoperation,theminimumprescribedis10
percentofthepopulationinayear.
Annualfalciparumindex
Slidepositivityrate
Slidepositivityrateisthepercentageofslidesfoundpositivefor
malarialparasite,irrespectiveofthetypeofspecies.
Slidefalciparumrate
ItisthepercentageofslidespositiveforP.falciparum.

---

893.Doseofchloroquineat4-8year-
a)150mg
b)300mg
c)450mg.
d)600mg.
CorrectAnswer-B
Ans.is'b'i.e.,300mg
o2tabletsof150mgaregiven.
Chloroquinetablestsasperagegroups
Chloroquinetablets150mgbase
Agein
Day1
Day2
Day3
years
<1
Y2
'A
1/4
1-4
1
1
'A
5-8
2
2
1
9-14
3
3
1V2
15&
4
4
2
above
DoseofprimaquineforPfalciparum(singledose)<1year
Contraindicated
1-4
years7.5mg.
5-8
years15mg.
9-14
years30mg.

---

15
years45mg.
DailydoseofprimaquineforPvivax(for14days)<1year
Contraindicated
1-4
years2.5mg
5-8
years5mg
9-14
years10mg
15
years15mg
Note:SingledoseofprimaquineforP.falciparumis3timesthedaily
doseofprimaquineforP.vivax.

---

894.Drugforprophylaxisofmalariain
chloroquineresistantP.falciparum?
a)Mefloquine
b)Quinine
c)Halofantrine
d)Artesunate
CorrectAnswer-A
Ans.is'a'i.e.,Mefloquine
Chemoprophylaxisofmalaria
Chemoprophylaxisisrecommendedfortravellersfromnon-endemic
areas,andasashorttermmeasureforsoldiers,policeandlabour
forcesservinginhighlyendemicareas.
Chemoprophylaxisshouldbeginaweekbeforearrivalinmalarious
areaandcontinuedforatleast4weeksorpreferably6weeksafter
leavingmalariousarea.
Drugsusedare:?
ChloroquineDOCforchemoprophylaxisin
chloroquinesensitiveP.falciparumareas.
Atovaquone/ProguanilUsedinareaswithchloroquineor
mefloquineresistantP.falciparum.
DoxycyclineUsedinareaswithchloroquineor
mefloquineresistantP.falciparum.
MefloquineUsedinareaswithchloroquine
resistantP.falciparum
HydroxychloroquineAlternativetochloroquineinareas
withchloroquinesensitiveP.falciparum

---

895.AnEnglishmantravelstoaplacewhich
isresistanttochloroquineand
mefloquine.Whatshouldhetakeas
prophylaxis?
a)Primaquine
b)Hydrchlorquine
c)Proguanil
d)Artesunate
CorrectAnswer-C
Ans.is'c'i.e.,Proguanil

---

896.Allarefeaturesofyellowfeverexcept?
a)IP3-6days
b)1attackgiveslifelongimmunity
c)Causedbyvectoraedes
d)Validityofvaccinationbeginsimmediatelyaftervaccination
CorrectAnswer-D
Ans.is'd'i.e.,Validityofvaccinationbeginsimmediatelyafter
vaccination
Yellowfever
Yellowfeverisazoonoticdiseasecausedbyarabro-virus.
Itaffectsprincipallymonkeys.
AgentFlavivirusfibricusagroupBarbovirusoftogavirusfamily.
VectorAedesaegyptimosquito.
ReservoirMonkeysandforestmosquitoes.Transavarian
transmissionofthevirusinmosquitoeshasbeenshowntooccurin
adverseconditions(e.g.,duringextendeddryseasons),inthe
absenceofsusceptiblehosts.oThereisnoevidencethatyellow
feverhaseverbeenpresentinAsia.
Environmentalfactorforyellowfever.
Atempratureof24?Cormoreisrequiredforthemultiplicationofthe
virusinthemosquito.
Itshouldbeaccompniedbyarelativehumidityofover60%forthe
mosquitoestolivelong.
UrbanizationisleadingtoextensionofyellowfeverinAfrica.
Measuresdesignedtorestrictthespreadofyellowfeverare
specifiedinthe"Internationalhealthregulation"ofWHO.
TheseareimplementedbytheGovtofIndiathroughstringentaerial
andmaritimetrafficregulations.

---

Broadlythesecomprise:-
i.Travellers
Alltravellers(includinginfants)exposedtoyellowfeverorpassing
throughendemiczonesofyellowfevermustpossesavalid
internationalcertificatefovaccinationagainstyellowfeverbefore
theyareallowedtoenteryellowfeverreceptiveareaslikeIndia.
Thevalidityofthecertificatebegins10daysafterthedateof
vaccinationandextendsupto10years.
Revaccinationperformedbeforetheendofthevalidityofcerticicate
rendersthecertificatevalidforafurtherperiodof10yearsstarting
onthedayofrevaccination.
Ifnosuchcertificatefovaccinationisavailable,thetravellaris
placedonquarantinefor6daysfromthedateofleavinganinfected
area.
ii.Mosquitoes
Theaircraftandshipsarrivingfromendemicareasaresubjectedto
aerosolsprayingwithprescribedinsecticides.
AirportsandSeaportsarekeptfreefromthebreedingofinsect
vectorsoveranareaextendingatleast400metresaroundtheir
perimeters.
The"aedesaegyptiindex"iskeptbelow1.

---

897.Theinternationalquarantineperiodfor
yellowfeverasapprovedbythe
GovernmentofIndiais?
a)6days
b)9days
c)10days
d)12days
CorrectAnswer-A
Ans.is'a'i.e.,6days
oQuarantineperiod-->6daysfromthedateofleaving
aninfectedarea.
oValidityofcertificate-->Starts10daysafterthedateof
vaccination.

---

898.Thedistancefromairportorseaport
whichhastobefreefrommosquitoesis
-
a)400m
b)500m
c)1km
d)100m
CorrectAnswer-A
Ans.is'a'i.e.,400m

---

899.Allofthefollowingarerelatedtoplague
except?
a)Aedesaegyptiindex
b)Totalfleaindex
c)Burrowindex
d)Cheopisindex
CorrectAnswer-A
Ans.is'a'i.e.,Aedesaegyptiindex
Aedesaegyptiindexisusedforyellowfever.
Inplague,fleaindicesareused.
Fleaindices
Fleaindicesareusefulmeasurmentsofthedensityoffleas.
Theyarealsousefulinevaluatingtheefectivenessofaspraying
programme.
Thefollowingindicesarewidelyusedinratfleasurveys:-
1. TotalfleaindexItistheaveragenumberoffleasofallspeciesper
rat.
2. CheopisindexItistheaveragenumberofX.cheopisperrat.Itis
aspecificfleaindex,soitisamoresignificantindexthantotalflea
index.Ifthisindexismorethanone,itisregardedasindicativeof
potentialexplosivenessofthesituation,shouldaplagueoutbreak
occur.
3. SpecificpercentageoffleasItisthepercentageofdifferent
speciesoffleasthatarefoundonrats.
4. BurrowindexItistheaveragenumberoffree-livingfleasper
speciesperrodentburrow.

---

900.Concentrationofdiethylcarbomazinein
DECmedicatedsaltinendemicfilariasis
is
a)2-4gm/kg
b)3-6gm/kg
c)5-10gm/kg
d)10-15gm/kg
CorrectAnswer-A
Ans.is'a'i.e.,2-4gm/kg
oTheuseofDEC-medicatedsaltisaspecialformofmass
treatmentusingverylowdosesofdrugoveralongperiodoftime.
oCommonsaltmedicatedwith1-4gofDECperkghasbeenused
forfilariasiscontrolinendemicareasofW.bancroftiandBmalayi,
particularlyinLakshadweepislands.
oTreatmentshouldbecontinuedforatleast6-9months.

---

901.Rashisabsentin?
a)Scrubtyphus
b)Epidemictyphus
c)Q.fever
d)Endemictyphus
CorrectAnswer-C
Ans.is'C'i.e.,Q.fever
QfeveriscausedbythebacteriumCoxiellaburnetii,commonly
foundinsheep,goatsandcattle.Thebacteriumcanalsoinfectpets,
includingcats,dogsandrabbits.
Theseanimalstransmitthebacteriathroughtheirurine,feces,milk
andbirthingproducts--suchastheplacentaandamnioticfluid.
Whenthesesubstancesdry,thebacteriainthembecomepartofthe
barnyarddustthatfloatsintheair.Theinfectionisusually
transmittedtohumansthroughtheirlungs,whentheyinhale
contaminatedbarnyarddust,theorganismcanalsogainentryinto
thebody,throughabrasions,conjuctivaeoringestionofcontaminated
food.
Qfeverisusuallyamilddiseasewithflu-likesymptoms.Inacute
onsetfever,chills,generalmalaiseandheadache,Thereisnorashor
locallesion.
Rarecomplicationsincludes
Endocarditis.endocarditiscanseverelydamageyourheartvalves.
EndocarditisisthemostdeadlyofQfever'scomplications.
Lungissues.SomepeoplewhohaveQfeverdeveloppneumonia.
Thiscanleadtoacuterespiratorydistress.
Liverdamage.SomepeoplewhohaveQfeverdevelophepatitis.
Encephalitis.
PreventioncanbedonebyPasteurisation

---

PreventioncanbedonebyPasteurisation

---

902.Basedonthetypeoflifecycle,zoonoses
areclassifiedintoallofthefollowing
except-
a)Cyclo-zoonoses
b)Meta-zoonoses
c)Anthropozoonoses
d)Sporozoonoses
CorrectAnswer-C
Ans.is'c'i.e.,Anthropozoonoses
Classificationofzoonoses
1)Basedondirectionoftransmission:(i)Anthropozoonoses,(ii)
Zoonthroponoses,and(iii)Amphixenoses
2)Basedontypeoflifecycle:(i)Directzoonoses,(ii)Cyclo-
zoonoses,(iii)Meta-zoonoses,and(iv)Sporozoonoses.

---

903.Allofthefollowingareanthropozoonosis
except
a)Rabies
b)Plaque
c)Anthrax
d)Schistosomiasis
CorrectAnswer-D
Ans.is'd'i.e.,Schistosomiasis
Zoonoses
Zoonosesarediseasesandinfectionswhicharenaturally
transmittedbetweenvertebrateanimalandman.
Thezoonosesmaybeclassifiedaccordingtothedirectionof
transmissionofdisease:?
l.Anthropozoonoses
Infectionistransmittedtomanfromlowervertebrateanimals.
Examples-4Rabies,plague,hydatiddisease,anthrax,trichinosis.
2.Zoonthroponoses
Infectionistransmittedfrommantolowervertebrateanimals
ExamplesHumantuberculosisincattle
3.Amphixenoses
Infectionismaintainedinbothmanandlowervertebrateanimals
thatmaybetransmittedineitherdirection.
ExamplesTcruzi,S.japonicum.

---

904.Toachieveneonataltetanuselimination,
incidenceofneonataltetanusper1000
livebirthsshouldbereducedtoless
than-
a)0.1
b)02
c)0.5
d)1.0
CorrectAnswer-A
Ans.is`a'i.e.,0.1
oDistrictsarebeingclassifiedintothreecategories,dependingon
neonataltetanusincidencerate,immunizationcoverageinpregnant
women,andproportionofcleandeliveriesbytrainedpersonnel.
1.Neonataltetanushighrisk:-
oNTincidencerate>1/1000livebirths
or
TT2coverage<70%
or
Attendeddeliveries<50%
2.Neonataltetanuscontrol
NTincidencrate<1/1000livebirth
or
TT2coverage>70%.
or
Attendeddeliveries>50%.
3.Neonataltetanuselimination
NTincidencerate<0.1/1000livebirth
or

---

or
TTCcoverage>90%.
or
Attendeddeliveries>75%

---

905.Ifaclawhanddevelopsinapatientwith
Leprosy,thdeformityis?
a)Grade0
b)GradeI
c)GradeII
d)GradeIII
CorrectAnswer-C
Ans.is`c'i.e.,GradeII

---

906.Pre-exposureprophylaxisdoseschedule
forrabiesvaccinegiveninalldays
except?
a)Day0
b)Day3
c)Day7
d)Day28
CorrectAnswer-B
Ans.is'b'i.e.,Day3
Preventionofrabies
Preventionofrabiesmaybeoffollowingtypes
Postexposureprophylaxis
Preexposureprophylaxis
Post-exposuretreatmentofpersonswhohavebeenvaccinated
previously.
Schedulesofvaccinationforpostexposureprophylaxis
A.Intramuscularschedules
Routineshedule6doseson0,3,7,14and28dayswithabooster
onday90.
Abbreviatedmultisiteschedule-42-1-1regimenonedoseisgivenin
therightarmandoneinleftarmonday0afterthatonedoseis
givenonday7and21.
B.Intradremalschedules
2-siteintradermalscheduleOnedoseofvaccineisgivenateachof
twositesondays0,3,7and28.
8-siteintradermalscheduleOnday"0"vaccineisgiveat8sites,
onday7vaccineisgivenat4sites,andondays28and90vaccine

---

isgivenatonesite.
Pre-exposureprophylaxis
Personswhorunahighriskofrepeatedexposuresuchas
laboratorystaffworkingwithrabiesvirus,veterinarian,animal
handlersandwild-lifeofficersshouldbeprotectedbypre-exposure
immunization.
Cell-culturevaccinegivenondays0,7and21or28(Total3doses)
Furtherboostershouldbegivenatintervalsof2years.
Inpost-exposureprophylaxisofimmunizedpatient
2dayintradermalregimen(1site)Day0andday3
IntramuscularregimenDay0
4siteintradermalregimen_(single-visit)Day0

---

907.SA-14-14-2?
a)Diploidcellinactivated
b)Killedvaccine
c)Livevaccine
d)Primaryimmunization2doses
CorrectAnswer-C
Ans.is'c'i.e.,Livevaccine[RefPark22"/ep.260,261;
Environmentalmedicinep.1812]
SA-14-142isacell-culture-derivedliveattenuatedvaccineforIE.
Primaryimmunizationisgivenbyasingledosefollowedbya
boosterafter1years.
Iamnotsureaboutoptionc,becausenotextbookhasmentioned
whether,SA-14-14-2vaccineprovideslifelongimmunityornot.But,
almostallliveattenuatedvaccinesprovidelifelongimmunity,
thereforeitmayprovidelifelongimmunity.
"Protectionfor10-12yearsmaybeachievedwithasingledoseof
thisvaccine".

---

908.Mosteffectivenaturalbarriertorabies
a)Heat
b)Humidity
c)Water
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Water
Rabiesisprimarilyazoonoticdiseaseofwarm-bloodedanimals,
particularlycarnivoroussuchasdogs,Cats,Jackalsandwolves.
Itistransmittedtomanusuallybybitesorlicksofrabidanimals.
Itisthecommunicablediseasewhichisalwaysfatal.
Rabiesisanenzooticandepizooticdiseaseofworld-wide
importance.
Geographicboundriesplayanimportantroleinthedistributionof
rabies.
Waterappearstobethemosteffectivenaturalbarrierstorabies
So,InIndia,LakshadweepandAndman&Nicobarislandsarefree
ofthedisease.
ARabiesfreeareahasbeendefinedasoneinwhichnocaseof
indigenouslyacquiredrabieshasoccurredinmanoranyanimal
speciesfor2years.
CountrieswhererabiesisnotfoundAustralia,china(Taiwan),
Cyprus,Iceland,Ireland,Malta,Japan,Newzealand,Britain.

---

909. Maximumdensityofmicrofilariasisin
bloodisreportedtobebetween-
a)9pmto11pm
b)11pmto2am
c)8pmto10pm
d)2amto5am
CorrectAnswer-B
Ans.is'B'i.e.,11pmto2am
ThemicrofilariaofW.bancroftiandB.malayioccurringinIndia
displayanocturnalperiodicity,i.e.,theyappearinlargenumbersat
nightandretreatfromthebloodstreamduringtheday.
Thisisabiologicaladaptationtothenocturnalbitinghabitsofvector
mosquitoes.
Themaximumdensityofmicrofilariainthebloodisreported
between10pmand2am.
Whenthesleepinghabitsofthehostarealtered,areversalin
periodicityhasbeenobserved.

---

910.Nightbloodsurveyisdonein?
a)Filaria
b)Typhoid
c)Malaria
d)Kala-azar
CorrectAnswer-A
Ans.is'a'i.e.,Filaria
ThemicrofilariaeofW.bancroftiandB.malayioccuringinIndia
displayanocturnalperiodicity,i.e.,theyappearinlargenumberat
nightandretreatfromthebloodstreamduringtheday.
Thisisabiologicaladaptationtothenocturnalbitinghabitsofvector
mosquitoes.
Themaximumdensityofmicrofilariaeinbloodisreportedbetween
10pmand2am.
Whenthesleepinghabitsofthehostarealtered,areversalin
periodicityhasbeenobserved

---

911.D.latumtransmittedby?
a)Cercariathroughcyclops
b)Cercariathroughfishmeal
c)Plerocercoidthroughfishmeal
d)Metacercariaincyclops
CorrectAnswer-C
Ans.is'c'i.e.,Plerocercoidthroughfishmeal

---

912.DiseasenotcoveredunderIntegrated
diseasesurveillanceproject(IDSP)is?
a)Meningococcaldisease
b)Tuberculosis
c)Herpeszoster
d)Cholera
CorrectAnswer-C
Ans.is'c'i.e.,Herpeszoster
Integrateddiseasesurveillanceproject(IDSP)
IDSPisadecentralizedstatebasedsurveillancesystemintendedto
detectearlywarningsignalsofimpendingoutbreaksandhelps
initiateaneffectiveresponseinatimelymannerinurbanandrural
areas.
Itwillalsoprovideessentialdatatomonitorprogressofon-going
diseasecontrolprogrammeandhelpallocatehealthresourcesmore
efficiently.
Itisa5yearsprojectandwaslaunchedinNovember2004.
ThecoreconditionsundersurveillanceinIDSPare:
A.RegularSurveillance
Vectorbornedisease-pMalaria
Waterbornedisease-3Acutediarrhealdisease(cholera),Typhoid
RespiratorydiseaseTB
VaccinepreventablediseaseMeasles
DiseaseundereradicationPolio
OtherconditionsRoadtrafficaccidents
OtherinernationalcommitmentsPlague
UnusualclinicalsyndromesMeningoencephalitis,Respiratory
distress,hemorrhagicfever

---

B.Sentinelsurveillance
STD/bloodbornedisease-pHIV/HBV,HCV,waterqualitymonitoring
OtherconditionsOutdoorairquality
C.Regularperiodicsurveys
NCDriskfactorsAnthropometry,Physicalactivity,BP,tobacco,
nutrition
D.Additionalstatepriorities
Eachstatemayidentifyuptofiveadditionalconditionsfor
surveillance.
Theseare(abovedescribed)aretheconditions(diseases)whichare
undersurveillanceinIDSP.Therearesomeclinicalsyndromeunder
surveillanceinIDSPtopickupallprioritydiseaseslistedinregular
surveillance(above)
1. Feverwithorwithoutlocalizingsigns:Malaria,Typhoid,JE,Dengue,
Measles
2. Coughmorethan3weeks:TB
3. Acutefluccidparalysis:Polio
4. Diarrhea:Cholera
5. Jaundice:Hepatitis,leptospirosis,Dengue,Malaria,Yellowfever
6. Unusualsyndromes:Antrax,plague,emergingepidemics.

---

913.Antiserumisavailableforpassive
immunizationagainst?
a)Rabies
b)Typhoid
c)Meales
d)Mumps
CorrectAnswer-A
Ans.is'a'i.e.,Rabies
Forpassiveimmunization
A.Antiserum
Rabies
Tetanus
Diphtheria
B.Humannormalimmunoglobulins
Rabies
Tetanus
HepatitisA
Measles
Mumps
C.Humanspecificimmunoglobulins
Diphtheria
HepatitisB
Varicella

---

914.Oncherciasiselimination,operational
definition?
a)O.volvulustransmissionhasreducedbelowaparticularpoint
b)Interventionhasstoped
c)Norecrudescence
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Oncherciasiselimination
Thereductionofinfectionandtransmissiontotheextentthat
interventionscanbestopped,butpost-interventionsurveillanceis
stillnecessary.
Operationaldefinitionincludes?
InterventionhavereducedO.volvulusinfectionandtransmission
belowthepointwheretheparasitepopulationisbeilvedtobe
irreversiblymovingtoitsdemise/extinctioninadefinedgeographical
area.
Interventionhavebeenstopped.
Post-interventionalsurveillanceforanappropriateperiodhas
demonstratednorecrudescenceoftransmissiontoalevel
suggestingrecoveryofO.volvuluspopulation.
Additionalsurveillanceisstillnecessaryfortimelydetectionof
recurrentinfection,ifariskofreintroductionofinfectionfromother
arearemains.

---

915.Transovariantransmissionisseenin-
a)Rickettesialdiseases
b)Malaria
c)Filaria
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Rickettesialdiseases
oTransovarialtransmissionisseeninRickettesialdisease(scrub
typhus,Rickettsialpox,RMSF,ITT,Qfever).

---

916.Apersonisobeseifhehasweightfor
height
a)1SDfrommedianweightforheight
b)2SDfrommedianweightforheight
c)3SDformmedianweightforheight
d)None
CorrectAnswer-B
Ans.is'b'i.e.,2SDfrommedianweightforheight
Obesity
Obesityisamedicalconditioninwhichexcessbodyfathas
accumulatedtotheextentthatitmayhaveanadverseeffecton
health,leadingtoreducedlifeexpectancy.
Bodymassindex(BMI)isusedtodefineobesity.
BMIdefineapersonoverweightwhenhisBMIisbetween25-30
kg/m2andobesewhenhisBMIisgreaterthan30kg/m2.
Bodyweight,thoughnotanaccuratemeasureofexcessfat,isa
widelyusedindex.
Inepidemiologicalstudiesitisconventionaltoaccept+2SD
(standarddeviations)fromthemedianweightforheightasacut-of
fpointforobesity.

---

917.Descendingorderofcancerprevalance
inmales?
a)Lung>oral>pharynx>esophagus
b)Oral>lung>pharynx>esophagus
c)Pharynx>lung>oral>esophagus
d)Esophagus>oral>stomach>lung
CorrectAnswer-B
Ans.is'b'i.e.,Oral>lung>pharynx>esophagus
MostcommoncancerinmalesinIndiaisoralcancerfollowedby
lungcancer.
Cancersindecreasingorderinmales(inIndia):Oralcavity>Lung
>Pharynx>Esophagus>Stomach.
Note:Sometextbookshavementionedthatlungcanceristhemost
commoncancerinmeninIndia,followedbyoralcavitycanceras
the2"4mostcommoncancer.Butmostofthetextbookshave
mentionedoralcavityasthemostcommonsiteofcancerinmenin
India.So,accordingtome'oralcavityisthemostcommonsite.
Cancersindecreasingorderinfemales(inIndia):cervix>breast>
ovarycavity>esophagus.
MostcommoncancerinmalesinIndiaOro-pharyngeal
Ca(Aero-digestiveCa).
MostcommoncancerinmalesinworldLungCa.
MostcommoncancerinfemalesinIndiaCervicalcancer.
MostcommoncancerinfemalesinworldBrastCa.
Mostcommonoverallcancerintheworld(combinedmale&
female)Lungcancer.
MostcommoncancerrelateddeathinmalesinIndia&inworld

---

Calung.
MostcommoncancerrelateddeathinfemalesinIndia&inworld
Breastcancer.

---

918.CADprimodialpreventionisby?
a)Lifestylechange
b)Coronarybypass
c)TreatmentofCAD
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Lifestylechange[RefPark22"dlep.339-341]
Primordial/primarypreventionisthebestpolicyforCHDaswell
asothernon-communicablediseases.Itincludesfollowing:
1. Changeinlifestyle
2. BPmonitoring
3. Saltrestriction
4. Exercise
5. Dietarymodification(prudentdiet

---

919.PreobesityisdefinedasaBMIof:
a)18.5-24.9
b)25-29.9
c)35-39.9
d)40-44.9
CorrectAnswer-B
Ans.B:25-29.9
BMIisanestimateoftotalbodyfatmassandisprobablythemost
usefulscaletodefineobesity.ObesityhasbeendefinedasaBMI
>30.0kg/m2intheWorldHealthOrganization(WHO)classification
Bodymassindex(BMI),calculatedfrommeasuredweightand
height,wasclassifiedusingtheWorldHealthOrganization
categoriesofunderweight(BMI<18.5kg/m2),normalweight(BMI
18.5to24.9kg/m2),pre-obesity(BMI25to29.9kg/m2)andobesity
(BMI30+kg/m2)

---

920.WhatistheBMIforanobese
person:
a)Lessthan18.5
b)18.5-24.9
c)25-29.9
d)Morethan30
CorrectAnswer-D
Ans.D:Morethan30
BMIisanestimateoftotalbodyfatmassandisprobablythemost
usefulscaletodefineobesity.ObesityhasbeendefinedasaBMI
>30.0kg/m2intheWorldHealthOrganization(WHO)classification
Bodymassindex(BMI),calculatedfrommeasuredweightand
height,wasclassifiedusingtheWorldHealthOrganization
categoriesofunderweight(BMI<18.5kg/m2),normalweight(BMI
18.5to24.9kg/m2),pre-obesity(BMI25to29.9kg/m2)andobesity
(BMI30+kg/m2)

---

921.Naturalfamilyplanningmethod?
a)Abstinence
b)Coitusinterruptus
c)BBT
d)Safeperoid
CorrectAnswer-C
Ans.is'c'i.e.,BBT
Miscellaneousmethodsofcontraceptions
Theseare(i)Abstinence,(ii)Coitusinterruptus,(iii)Safeperiod
(rhythmethod),and(iv)Naturalfamilyplanningmethods.
Abstinence
Thereiscompleteabstinencefromsexualintercourse.Itisnotused
andcanhardlybeconsideredasamethodofcontraceptiontobe
advocatedtothemasses.
Coitusinterruptus
Itistheoldestmethodofvoluntaryfertilitycontrol.Themale
withdrawsbeforeejaculation,andtherebytriestopreventdeposition
ofsemenintovagina.Failurerateisveryhigh25%.
Naturalfamilyplanningmethods
Theseare:?
1. Basalbodytemperature(BBT)method:Itisbasedontheprinciple
thatthereisriseBBTatorjustbeforeovulation.
2. Cervicalmucusmethod(Billingsmethodorovulationmethod):Itis
basedontheobservationthatatthetimeofovulationcervicalmucus
becomeswateryclearresemblingraweggwhite,smooth,slippery
andprofuse.
3. Symptothermicmethod:Thismethodcombinestemperature,
cervicalmucusandsafeperiod(calendermethod)methods.

---

---

922.Unmetneedsofcontraceptiontomet
accordingtoNFHS-3
a)Women<20years
b)Womenafterpuperium
c)Womenafter1'weekdelivery
d)Afterillegalabortion
CorrectAnswer-A
Ans.is'a'i.e.,Women<20years
Manywomenwhoaresexuallyactivewouldprefertoavoid
pregnancy,butneverthelessarenotusinganymethodof
contraception.
Thesewomenareconsideredtohave'unmetneed'forfamily
planning.
Theconceptisusuallyappliedtomarriedwomen.
AccordingtotheNationalFamilyHealthSurvey-3,Unmetneedfor
familyplanningishighest(27.1%)amongwomenbelow20years
ageandisalmostentirelyforspacingthebirthsratherthanfor
limitingthebirths.
Itisalsorelativelyhighforwomeninagegroup20-24years(21.1%)
with75%needforspacingand25%forlimitingthebirth.
Unmetneedforcontraceptionamongwomenaged30yearsand
abovearemostlyforlimitingbirth.
Agegroup Unmetneedofcontraceptionfor
<20years Forspacingthebirth
20-24years Forspacing(75%)andforlimitingbirth(25%)
30years
Forlimitingbirth

---

923.
Allofthefollowingarepostcoital
contraceptionmethodsexcept-
a)Mifepristone
b)IUD
c)Levonorgestrol
d)Barriermethods
CorrectAnswer-D
Ans.is'd'i.e.,Barriermethods

---

924.Ifannualgrowthrateofapopulationis
1.5-2%,whatnumberofyearswillbe
requiredtodoublethepopulation?
a)70-47years
b)47-35years
c)35-28years
d)28-23
CorrectAnswer-B
Ans.is'b'i.e.47-35years

---

925.Populationexplosion(explosivegrowth)
isdefinedasthegrowthrate?
a)0.5-1.0
b)1-1.5
c)1.5-2
d)>2
CorrectAnswer-D
Ans.is`d'i.e.,>2
Rate/Phase
Annualrateof
Stationarypopulation
growthin%
Slowgrowth
Nogrowth<5
Moderategrowth
0.5to0.1
Rapidgrowth
1.0to1.5
VeryRapedgrowth
1.5to2.0
Explosivegrowth
>2.0

---

926.CopperTisideallyinsertedat-
a)Justbeforemenstruation
b)Onthe26thday
c)Justaftermenstruation
d)Onthe14thday
CorrectAnswer-C
Ans.is'c'i.e.,Justaftermenstruation
Timingofinsertion
Althoughtheloopcanbeinsertedatalmostanytimeduringa
woman'sreproductiveyears(exceptduringpregnancy),themost
propitioustimeforloopinsertionisduringmensturationorwithin10
daysofthebeginningofamensturalperiod.
oDuringthisperiod,insertionistechnicallyeasybecausethe
diameterofthecervicalcanalisgreateratthistimethanduringthe
secretoryphase.
oTheuterusisrelaxedandmyometrialcontractionswhichmight
tendtocauseexpulsionareataminimum.
oInaddition,theriskthatawomanispregnantisremoteatthis
time.

---

927.Populationpyramidindicates?
a)Lifeexpectancy
b)Fertilitypattern
c)Sexratio
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Populationpyramid
Theageandsexdistributionofapopulationisbestrepresentedby
populationpyramid
Incountrieswithhighbirthratesasours,itisbroadbasedconical
pyramidbecauseofhighbirthrateandtaperingofpopulationwith
increaseinage.
Indevelopedcountrieswithlowbirthrate,thepyramidswellsinthe
middleandisnarrowatthebaseandisnotsoconicalatthetop.
(dumbbellshaped).
Utilityofpopulationpyramid
Shapeofpopulationpyramidindicatesfertilitypattern
1. Broadbase,Narrowtop(uprighttriangle):Highproportionof
youngerpopulation(developingcountries)
2. BulgeinMiddle:Highproportionofadults(developedcountries)
Span(height)ofpopulationpyramidindicateslifeexpectancy
1. Tallerpyramid:Higherlifeexpectancy(developedcountries)
2. Shorterpyramid:Lowerlifeexpectancy(developingcountries)
Symmetryofpopulationpyramidindicatessexratio
1. Symmetricpyramid:idealsexratio(developedcountries)
2. Asymmetricpyramid:unfavourablesexratio<1000(developing
countries)

---

---

928.Pearlsindex?
a)Per100womanyears
b)Per10womanyears
c)Per1000womanyears
d)Per50womanyears
CorrectAnswer-A
Ans.is'a'i.e.,Per100womanyears

---

929.InfantmortalityrateinIndiais,per1000
livebirths?
a)25
b)34
c)55
d)60
CorrectAnswer-B
Ans.is`b'i.e.,34
ThevalueforMortalityrate,infant(per1,000livebirths)inIndiawas
37asof2015.
IMRofIndiahasdeclinedbythreepoints(8%decline),from37per
1000livebirthsin2015to34per1000livebirthsin2016.

---

930.Present"Generalfertilityrates"?
a)84
b)118
c)128
d)138
CorrectAnswer-A
Ans.is'a'i.e.,84

---

931."Second"mostcommoncauseof
maternalmortalityinIndiais?
a)Toxemia
b)Anemia
c)Maternalhemmorrhage
d)Sepsis
CorrectAnswer-B
Ans.is'b'i.e.,Anemia
MostcommoncauseSeverebleeding(25%).
SecondmostcommoncauseAnemia(19%).
ThirdmostcommoncauseInfection/Sepsis(15%).
DirectcauseofmaternalmortalityinIndia
Severebleeding(25%)
Infection(15%)
Eclampsia(12%)
Obstructedlabour(8%)
Unsafeabortion(13%)
OtherdirectcausesEctopicpregnancy,Embolism,Anaesthesia
related.
Indirectcausescontribute
Anaemia(19%)
Malaria
Heartdiseases

---

932.Quarterofpostnatalmotherdeathis
causedby?
a)Infection
b)Bleeding
c)Eclampsia
d)Anemia
CorrectAnswer-B
Ans.is`b'i.e.,Bleeding
o25%ofmaternaldeatharecausedbyseverebleeding,generally
occuringpost-partum.

---

933.
Maximummaternalmortalityduring
peripartumperiodoccursat-
a)Lasttrimester
b)Duringlabor
c)Immediatepost-partum
d)Delayedpost-partum
CorrectAnswer-C
Ans.is'c'i.e.,Immediatepost-partum
oStudiesshowthatmortalityrisksformotherareparticularly
elevatedinthefirsttwodaysafterbirth,i.e.immediatepost-partum
period.
oAwomenismostvulnearbleatpost-partumperiod.About50-70%
maternaldeathoccuringinthepost-partumperiodofwhich45%
deathsoccurinfirst24hoursafterdeliveryandmorethantwo-third
druingthefirstweek.

---

934.Allofthefollowingarerequiredmore
duringlactationascomparedto
pregnancy,except?
a)Iron
b)VitaminA
c)Niacin
d)Energy
CorrectAnswer-A
Ans.is'a'i.e.,Iron
Requiredmoreduringlactationascomparedtopregnancy:Energy,
VitaminA,thiamin,riboflavin,VitaminC,niacin,andVitaminB12.
Requiredmoreduringpregnancy:Iron,protein,andfolate.
Samerequirmentinpregnancyandlactation:Fat,calcium,zinc,
magnesium,andvitaminB6.

---

935.Denominatorforcalculatingperinatal
mortalityrateis:
September2009
a)1000births
b)1000livebirths
c)1000stillbirths
d)1000population
CorrectAnswer-B
Ans.B:1000livebirths
164.Perinatalmortality,definedasnumberofstillbirths(28weeksof
gestationandmore)anddeathsinthefirstweekoflife(early
neonataldeaths)per1,000livebirths,isausefuladditionalindicator,
andworkisongoingtoimproveestimatesofstillbirthrates,amajor
componentofperinatalmortality.

---

936.Mostcommoncauseofinfantmortality?
a)LBW
b)Injury
c)ART
d)Tetanus
CorrectAnswer-A
Ans.is'a'i.e.,LBW

---

937.Maximumcalciumisseenin-
a)Jowar
b)Bajara
c)Ragi
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Ragi
Millets
oTheterm"millet"isusedforsmallergrains:-
i)Jowar(Sorghum)
ii)Bajara(Pearlmillet)
iii)Ragi
oAmongstmillets
MaximumproteinBajra
MaximumfatBajra
MaximumcarbohydrateJowar
Maximumminerals&CalciumRagi
MaximumvitBcomplexJowar
MaximumenergyBajra
MaximumironBajra

---

938.Ironrequirmentinanormalmensturating
adultfemale
a)15mg/day
b)20mg/day
c)30mg/day
d)35mg/day
CorrectAnswer-B
Ans.is'b'i.e.,20mg/day

---

939.Whichnuthashighestproteincontent-
a)Walnut
b)Groundnut
c)Almond
d)Coconut
CorrectAnswer-B
Ans.is'b'i.e.,Groundnut
oNutscommonlyconsumedinIndiaarecoconut,groundnut,
cashewnut,walnutandalmond.oGroundnuthasmaximumprotein
contents.
oThereisnoneedtorememberthistable.Iamsummarizingitfor
you.
GroundnuthasmaximumproteinandCarbohydrate.
Coconuthasminimumprotein.
Walnuthasmaximumfat.
Groundnuthasminimumfat.
oAlmondhasminimumcarbohydrate.
Almondhasmaximumminerals.
Coconuthasminimumminerals.

---

940.RichestsourceofvitaminDis:
September2003
a)Fish
b)Soyabean
c)Halibutliveroil
d)Vegetables
CorrectAnswer-C
Ans.Ci.e.Halibutliver

---

941.ThehighestconcentrationsofVitaminA
isseenin-
a)Polarbearliver
b)Codliveroil
c)Sharkliveroil
d)Papaya
CorrectAnswer-B
Ans.is'b'i.e.,Codliveroil
Amongstthegivenoptions,codliveroilhashighestconcentration.

---

942.Onecriteriaforprudentdiet?
a)Fatintake35-40%oftotalenergy
b)Dietarycholesterole<300mg/1000Kcalperday
c)Saltintake<10g/day
d)Saturatedfuts<10%oftotalenergy
CorrectAnswer-D
Ans.is'd'i.e.,Saturatedfats<10%oftotalenergy
DietarygoalsprescribedbyWHOexpertcommitteeprudent
diet
3Dietarymodificationistheprincipalpreventivestrategyinthe
preventionofCHD.TheWHOExpertCommittee(1)consideredthe
followingdietarychangestobeappropriateforhighincidence
populations.
Reductionoffatintaketo20-30percentoftotalenergyintake
Consumptionofsaturatedfatsmustbelimitedtolessthan10
percentoftotalenergyintake,someofthereductioninsaturatedfat
maybemadeupbymonoandpoly-unsaturatedfats.
Areductionofdietarycholesteroltobelow100mgper1000kcalper
day.
Anincreaseincomplexcarbohydrateconsumption(i.e.vegetables,
fruits,wholegrainsandlegumes)
Avoidanceofalcoholconsumption,reductionofsaltintaketo5g
dailyorless.
Otherspecificinterventionsaspartofprimordialpreventionof
coronaryheartdisease
Toachieveasmokefreesociety
ReductionofBloodpressurethroughprudentdiet.Regularexercise,
weightcontrol&cessationofsmoking.

---

RegularPhysicalActivity.

---

943.Inruralarea,cattleshedsshouldbe.....
awayfromthehouses?
a)5feet
b)10feet
c)20feet
d)25feet
CorrectAnswer-D
Ans.is'd'i.e.,25feet
Ruralhousing
Inruralareas,the'approved'standardsmaybelowerthanintowns.
Thefollowingminimumstandardshavebeensuggested:
Thereshouldbeatleasttwolivingrooms.
Ampleverandahspacemaybeprovided.
Thebuilt-upareashouldnotexceedone-thirdofthetotalarea.
Thereshouldbeaseparatekitchenwithapavedsinkorplatformfor
washingutensils.
Thehouseshouldbeprovidedwithasanitarylatrine.
Thewindowareashouldbeatleast10percentofthefloorarea.
Thereshouldbeasanitarywelloratubewellwithinaquarterofa
milefromthehouse.
Itisinsanitarytokeepcattleandlivestockindwellinghouses.Cattle
shedsshouldbeatleast25feetawayfromdwellinghouses.Acattle
shedshouldbeopenonallsides;anarea8fit4fitissufficientfor
eachheadofcattle.
Thereshouldbeadequatearrangementforthedisposalofwaste
water,refuseandgarbage.

---

944.Criteriaforslaughterhouse?
a)Glassareashouldbe25%offloorarea
b)Windowledessloped25?
c)Doorways1meterhigh
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Glassareashouldbe25%offloorarea

---

945.Mostcommoncauseofpollutionof
drinkingwater
a)Domesticwaste
b)Industrialwaste
c)Radioactivesubstances
d)Agriculturalpollutants
CorrectAnswer-B
Ans.is'b'i.e.,Industrialwaste
oTwomostcommoncausesofwaterpollution
i)Domesticsewage
ii)Industrialwastes
Amongthesetwoindustrialwastesarethemostcommon

---

946.PsychrometerPsychrometerisusedto
measure-
a)Humidity
b)Airvelocity
c)Roomtemperature
d)Radianttemperature
CorrectAnswer-A
Ans.is'a'i.e.,Humidity
Humidityismeasuredby
oDryandwetBulbhygrometer
oSlingpsychrometer
oAssmannpsychrometer
oAirvelocityismeasuredbyanemometer.
oRadianttempratureismeasuredbyGlobethermometer.oRoom
tempratureismeasuredbybulbthermometer.

---

947.Trueaboutslowsandfilteris
a)Occupieslessspace
b)Moreexpensive
c)Requireslongerduration
d)Sandsize0.4-0.7mm
CorrectAnswer-C
Ans.is'c'i.e.,Requireslongerduration
Theslowsandfilterrequiresmoretime(duration).
Thesizeofthesandissmaller(0.2-0.3mm).
Slowsandfilteroccupiesalargearea(morespace).
Thecostofconstructionischeaperfortheslowsandfilter.

---

948.Minimumcontactperiodrequiredduring
Chlorination?
a)30minutes
b)1hrs.
c)2hrs
d)4hrs
CorrectAnswer-B
Ans.is'b'i.e.,1hrs.
Principlesofchlorination
Watershouldbeclearandfreefromturbidity.Turbidityimpedes
efficientchlorination.
Thechlorinedemandofthewatershouldbeestimated.Itisthe
amountofchlorinethatisneededtodestroybacteriaandtooxidize
alltheorganicmatterandammoniacalsubstancespresentinwater.
Chlorinedemandofwateristhedifferencebetweentheamountof
chlorineaddedtothewaterandtheamountofresidualchlorine
remainingattheendofaspecificperiodofcontact(usually60
minutes)atagiventemperatureandpHofthewater.
Thepointatwhichthechlorinedemandofthewaterismetiscalled
breakpointchlorination.Iffurtherchlorineisaddedbeyond
breakpoint,freechlorinebeginstoappearinwater.
Thepresenceoffreeresidualchlorineforacontactperiodofatleast
onehourisessentialtokillbacteriaandviruses.
Theminimumrecommendedconcentrationoffreechlorineis
0.5mg/Iforonehour.Thisfreeresidualchlorineprovidesamarginof
safetyagainstsubsequentmicrobialcontamination.
Thesumofthechlorinedemandofthespecificwaterplusthefree
residualchlorineof.5mg/Lconstitutesthecorrectdoseofchlorine

---

tobeapplied.
Itisworthnotingherethatrecommendedresidualchlorinelevelfor
drinkingwateris0.5mg/litre,whileforswimmingpoolsanitationitis
1.0mg/litreandforwaterbodies&postdisasteritis0.7mg/litre.

---

949.Sandflytransmitsall,except?
a)Orientalsore
b)Leishmaniasis
c)Kala-azar
d)Relapsingfever
CorrectAnswer-D
Ans.is'd'i.e.,Relapsingfever
Sandfly:?
Habitats:Holesandcrevicesinwalls,holesintrees,darkrooms,
stables,andstorerooms.
Sanitationmeasuresarecarriedoutforadistanceof50feet.
Insecticideofchoice:DDT(1-2gm/m2singleapplication)
DDTissprayeduptoaheightof4-6feetofwallsQ:asSandfly
cannotfly,itonlyhops
Sandfly
Sandflyspecies
Diseasestransmitted
Phlebotomus
Kala-azar(VisceralLeishmaniasis)
argentipes
Phlebotomus
Sandflyfever,Orientalsore(Cutaneous
papatasi
Leishmaniasis)
Phlebotomussergenti Orientalsore(CutaneousLeishmaniasis)
Sergentomyia
Sandflyfever
punjabensis

---

950.Allinsectshavedevelopedresistanceto
DDTexcept?
a)Mosquito
b)Flea
c)Tsetseflies
d)Ticks
CorrectAnswer-C
Ans.is'c'i.e.,Tsetseflies
ArthropodsshowingresistancetoDDTArthropodsshowingno
resistancetoDDT
Houseflies(e.g.,Musca Sandlies
domestica)
(Phlebotomus)
Moquito(Culex,
Tsetseflies
Anopheles,Aedes)
(Gluossianae)
Flea(ratflea,Sandflea)
Lice(Pediculus
capitis/corporis,Phthirus
pubis)
Ticks&Mites

---

951.Whichofthefollowingisastomach
poison?
a)DDT
b)Pyrethrum
c)Parisgreen
d)Malathion
CorrectAnswer-C
Ans.is'c'i.e.,Parisgreen[RefPark22"/ep.728]
Inectisidesaredividedinto:?
1. Fumigants:Hydrogencyanide,SO2,methylbromide,carbon
disulphate.
2. Stomachpoisons:Parisgreen,Sodiumfluoride.
3. Contact(nerve)poisons:Thesearedividedinto
4. Natural:Pyrethrum,rotenone,Derris,nicotine,mineraloil.
Synthetic:Theseare
Organophosphates:Malathion,parathion,fenthion,diazinon,
fenitrothion,abate,chlorthion,dioxathion,chlorpyrifos,trichlorfon.
Carbamates:Carbaryl,propoxur,dimetilan,pyrolon.
Organochlorine:DDT,BHC(HCH),dieldrin,aldrin,chlordane,
lindane,heptachlor.
Syntheticpyrethroid(pyrethrumderivatives):Pothrin,resmethrin,
permethrin,biopermethrin,cypermethrin,cyphenothrin,
cycloprothrin,deltamethrin,cyfluthrin,etofenprox.

---

952.Thenumberoftimestheairinaliving
roomshouldberecycledis?
a)2-3times
b)Morethan6times
c)4times
d)None
CorrectAnswer-A
Ans.is'a'i.e.,2-3times[RefPark22"d/ep.685]
Standardsofventilation
Cubicspace:-Freshairsupply3000cubicfeetperpersonperhour
(rangeis300-3000c.ft).
Airchange:-2to3timesperhourinlivingroomand4to6timesper
hourinworkroomsandassemblies.
Floorspace:-50-100Sq.ft.perperson(heightsover10to12feet
arenottakenintoaccount).

---

953.Gascausinggreenhouseeffect?
a)CO2
b)Methane
c)Sulfurhexafluoride
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove

---

954.ThefollowingisnotaNervegas?
a)Sarin
b)Tabun
c)Soman
d)Pyrolan
CorrectAnswer-D
Ans.is'd'i.e.,Pyrolan
Nervegasesareaclassoforganophosphatesthatactbyinhibiting
enzymeacetylcholinesteraze,anenzymethatdestroys
acetylcholine.
Theclassicalexamplesaretabun,sarin,somanandcyclosarin.
Theseareusedaschemicalweaponsinwars,i.e.chemicalwarfare.

---

955.Stageofcontractionoffamilystartsat?
a)Marriage
b)Birthoffirstchild
c)Birthoflastchild
d)Leavinghomeoffirstchild
CorrectAnswer-D
Ans.is`d'i.e.,Leavinghomeoffirstchild

---

956.Customisdefinedas-
a)Establishedpatternofbehavior
b)Prescribedorderofcremony
c)Bantoaparticularactivity
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Establishedpatternofbehavior

---

957.Studyofpersontopersoninter-
relationshipinasociety-
Economics
a)Economics
b)Suciology
c)Psychology
d)Anthropology
CorrectAnswer-B
Ans.is'b'i.e.,Sociology

---

958.PatternsofInter-relationshipsbetween
personsinasocietyis?
a)Socialstructure
b)Socialpsychology
c)Herdstructure
d)Socialscience
CorrectAnswer-A
Ans.is'a'i.e.,Socialstructure
Patternsofinter-relationshipsbetweenpersonsinasocietyiscalled
socialstructure.Note-Studyofhumaninter-relationshipiscalled
sociology.

---

959.Atemporary,provisionalviewheldbythepeopleonapointofviewis:
a)Opinion
b)Belief
c)Practice
d)Attitude
CorrectAnswer-A
Opinionareviewsheldbypeopleonapointofdispute.
Theyarebasedonevidenceavailableatthetime.
Opinionsbydefinitionaretemporary,provisional.
Theycanbelookedonasbeliefsforthetimebeing.
Ref:Park'sTextbookofPreventiveandSocialMedicine,19thedition,Page542.

---

960.Mostcommontypeofmentalretardation
?
a)Mild
b)Moderate
c)Severe
d)Profound
CorrectAnswer-A
Ans.is'a'i.e.,Mild

---

961.InESIprogammecentral,state,Govt.
employeecontributetothefund.
Employer'scontributionis?
a)5.75%
b)4.75%
c)3.75%
d)2.75%
CorrectAnswer-B
Ans.is'b'i.e.,4.75%
FinanceofESIscheme
Theschemeisrunbycontributionbyemployeesandemployersand
grantsfromcentralandstategovernments-
1. Employerscontribution4.75%oftotalwagesbills
2. Employeecontribution1.75%oftotalwagesbills
3. Thestategovernment'sshareofexpenditureonmedicalcareis1/8
oftotalcostofmedicalcare.
4. TheESIcorporationsshareofexpenditureonmedicalcareis78of
totalcostofmedicalcare.Note-Employeesgettingdailywagesof
belowRs50areexemptedfrompaymentcontribution.

---

962.Shapeofnormaldistributioncurve?
a)Jshape
b)Ushape
c)Bellshape
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Bellshape
oStandardnormalcurve(Gaussiandistribution)isbellshapecurve.

---

963.Onestandarddeviationinnormal
standardcurveincludesvalue-
a)50%
b)68%
c)95%
d)100%
CorrectAnswer-B
Ans.is'b'i.e.,68%
o1SDincludes---->68%ofvalues
o2SDincludes---->95%ofvalues
o3SDincludes---->99.7%ofvalues

---

964.Significantvalueof`p'is?
a)0.01
b)0.02
c)0.04
d)0.05
CorrectAnswer-D
Ans.is'd'i.e.,0.05
Pistheprobabilitythatthedifferenceseenbetween2samples
occursduetochance".
Ifp..05itisconsideredstatisticallysignificant.
Itmeansthat
Thereis5%probabilitythattheresultcouldhavebeenobtainedby
chance.or
Theinvestigatorcanbe95%surethattheresultwasnotobtainedby
chance.

---

965.Spotmapisusedfor?
a)Localdistributionofdisease
b)Rural-urbanvariation
c)Nationalvariation
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Localdistributionofdisease
Innerandoutercityvariationsindiseasefrequencyarewellknown.
Thesevariationsarebeststudiedwiththeaidof"spotmaps"or
"shadedmaps".
Thesemapsshowataglanceareasofhighandlowfrequency,the
boundariesanddistribution.
Forexample,ifthemapshows"clustering"ofcases,itmaysuggest
acommonsourceofinfectionoracommonriskfactorsharedbyall
thecases.
TheclassicalexampleofuseofspotmapswasbyJohnsnowfor
choleraepidemicin1854.

---

966.Ifcorrelationbetweenweightandheights
areverystrongwhatwillbethe
correlationcoefficient?
a)+1
b)>1
c)0
d)None
CorrectAnswer-A
Ans.is'a'i.e.,+1
oAcorrelationsimplyexpressesthestrengthanddirectionofthe
relationshipbetweentwovariablesintermsofacorrelation
coefficient,signifiedby`r'.
oValuesofrvariesfrom-1to+1.;
oThestrengthoftherelationshipisindicatedbythesizeofthe
coefficient,whereasitsdirectionisindicatedbythesign(+or-)
oAplussign(+)means:Thatthereisapositivecorrelationbetween
thetwovariables-highvaluesofonevariable(suchassaltintake)
areassociatedwithhighvalueoftheothervariable(suchasblood
pressure)i.esaltintakeisdirectlyproportionaltobloodpressure.
oAnegativesign(-)means:Thatthereisanegativecorrelation
betweenthetwovariables-highvaluesofonevariables(suchas
cigaretteconsumption)areassociatedwithlowvaluesoftheother(
suchaslifeexpectancy).Cigaretteconsumptionisinversely
proportionaltolifeexpectancy
oIfthereisaperfectlinearrelationshipbetweenthetwovariablesso
thatitispossibletoknowtheexactvalueofonevariablefromthe
knowledgeofothervariable,thecorrelationcoefficient(r)willbe
exactly+or-1.00(+1or-1).

---

exactly+or-1.00(+1or-1).
oIfthereisabsolutelynorelationshipbetweenthetwovariablesso
thatitisimpossibletoknowanythingaboutone
variableonthebasisofknowledgeoftheothervariable.Thenthe
coefficientwillbe0.
Strengthofcorrelation
oThestrengthoflinearrelationshipbetweentworandomvariables
XandYisbasedonthevalueofcorrelationcoefficientandisoften
summarizedaccordingtothefollowingguidelines:-
ForPositiveCorrelationFornegativecorrelation
Interpretation
r<0.30-0.30r
veryweaklinearrelationship
0.305r<0.50-0.50<r5-
0.30weaklinearrelationship
0.50_.r<or0.80-0.80<r-
0.50moderatelinearrelationship
0.805..r<0.90-0.90<r-
0.80stronglinearrelationship
r0.901.5.-0.90
verystronglinearrelationship
oIfyouhavedifficultyininterpretingabovetable,Iamgivinginvery
simplelanguage:?
A.PositiveCorrelation
i)Correlationcoefficientlessthan0.30Veryweakpositive
correlation.
ii)Correlationcoefficient0.30to0.49--)WeakPositive
correlation
iii)Correlationcoefficient0.50to0.79ModeratePositive
correlation
iv)Correlationcoefficient0.80to0.89--)StrongPositive
correlation
v)CorrelationCoefficientequaltoorgreaterthan0.90-->very
strongpositivecorrelation.
B.NegativeCorrelation
i)Correlationcoefficientmorethan-0.30Veryweaknegative
correlation
ii)Correlationcoefficient-0.30to-0.497->Weaknegative

---

correlation
iii)Correlationcoefficient-0.50to-0.79-->Moderatenegative
correlation
iv)Correlationcoefficient-0.80to-0.89Strongnegative
correlation.
v)Correlationcoefficientequalorlessthen-0.90-->very
strongnegativecorrelation
Note:youshouldkeepinmindthatfornegativevalues,moremeans
towardsmorepositivesideandlessmeanstowardsmorenegative
side.Forexample;ifwearesaying,morethan-0.30,thatmean-
0.29,-0.28,-0.27....soon;andifwearesayinglessthan-0.90
thatmeans-0.91,-0.92....soon.

---

967.Typeofsampling,ifrandomsampleis
takenfromacharacteristicpopulation,
eg.Hindus,Muslims,Christiansetc?
a)Simplerandom
b)Systemicrandom
c)Stratifiedrandom
d)Cluster
CorrectAnswer-C
Ans.is'c'i.e.,Stratifiedrandom
Stratifiedrandomsamplingisparticularlyusefulwhereoneis
interestedinanalysingthedatabyacertaincharacteristicofthe
population,vizHindus,Muslims,Christians,agegroupetc,-aswe
knowthesegroupsarenotequallydistributedinthepopulation."
...............Park
Simplerandomsampling
Simplerandomsampling,also,knownas'unrestrictedrandom
sampling';isapplicableforsmall,homogenous,readilyavailable
populationandisusedinclinicaltrials.
Insimplerandomsamplingeachindividualischosenrandomlyand
entirelybychance.
So,eachindividualhasthesameprobabilityofbeingchosenatany
stageduringthesamplingprocess.
Forexample:?
Letusassumeyouhadaschoolwith1000students,dividedequally
intoboysandgirls,andyouwantedtoselect100ofthemforfurther
study.
Youmightputalltheirnamesinabucketandthenpull100names

---

out.
Notonlydoeseachpersonhaveanequalchanceofbeingselected,
wecanalsoeasilycalculatetheprobailityofagivenpersonbeing
chosen,sinceweknowthesamplesize(n)andpopulation(N)andit
becomesasimplematterofdivisionn/Nor100/1000=0.10
(10%).
Thismeansthateverystudentintheschoolhasa10%or1in10
chanceofbeingselectedusingthismethod.
Systematicrandomsampling
Inordertodosystematicrandomsampling,theindividualsina
populationarearrangedinacertainway(forexample,
alphabetically).
Arandomstartingpointisselectedandtheneverynth(forexample
10thor15th)individualisselectedforthesample.
Thatis,afterarrangingtheindividualsincertainpattern(e.g.,
alpabetically)astartingpointischosenatrandom,andchoices
thereafteratregularintervals.
Forexample,supposeyouwanttosample8housesfromastreetof
120houses.
120/8=15,Soevery15thhouseischosenafterarandomstarting
pointbetween1and15.
Iftherandomstartingpointis11,thenthehousesselectedare11,
26,41,56,71,86,101,and116.
Incontrasttosimplerandomsampling,somehouseshavealarger
selectionprobabilye.g.,inthisquestion11,26,41,56,71,86,100
and116.
Whiletheremainingnumbercannotbeselected.
Stratifiedrandomsampling
Whensub-populationsvaryconsiderably,itisadvantageousto
sampleeachsubpopulation(stratum)independently.
Stratificationistheprocessofgroupingmembersofthepopulation
intorelativehemogenoussubgroupsbeforesampling.
Thestratashouldbemutuallyexclusive,everyelementinthe
populationmustbeassignedtoonlyonestratum.
Thensystematicrandomsamplingmethodisappliedwithineach
stratum.
PopulationStratificationSystematicrandomsampling

---

Sample.
Thisoftenimprovestherepresentativenessofthesampleby
reducingsamplingerror.
Forexample,supposeinapopulationof1000,sampleof100isto
bedrawnforHbestimation,firstconvertthepopulationinto
homogenousstriata(e.g.,700malesand300females),thendraw
70malesand30femalesbydoingsystematicrandomsampling.

---

968.Peopleareseparatedintogroups,from
eachgrouppeopleareselected
randomly.Whattypeofsamplingisthis-
a)Simplerandom
b)Stratifiedrandom
c)Systemicrandom
d)Cluster
CorrectAnswer-B
Ans.is'b'i.e.,Stratifiedrandom
oSeparationofpeopleingroupsfollowedbyrandomsamplingfrom
thosegroupsisstratifiedrandomsampling.

---

969.Whichofthefollowingisseeninthe
recoveryphaseafteradisasterexcept
a)Rehabilitation
b)Reconstruction
c)Response
d)Preparedness
CorrectAnswer-D
Ans.is'd'i.e.,Preparedness
DisasterManagementincludesthreeaspects:
1.Disasterimpactandresponse:
Search,rescue,andfirst-aid
?Fieldcare
?Triage
?Tagging
?Identificationofthedead
2.Rehabilitationorrecovery:
?Watersupply
?Basicsanitationandpersonalhygiene
?Foodsafety
?Vectorcontrol
3.Mitigation:Measuresdesignedeithertopreventhazardsfrom
causingdisasterortoreducetheeffectsofthedisaster.Thisalso
includespreparednessforanyimpendingdisastersorindisaster-
proneareas.

---

970.Moribundpatient,triagecolor?
a)Red
b)Black
c)Yellow
d)Green
CorrectAnswer-B
Ans.is'b'i.e.,Black
Triage
Whenthequantityandseverityofinjuriesoverwhelmtheoperative
capacityofhealthfacilities,adifferentapproachtomedicaltreatment
mustbeadopted.
Theusualprincipleoffirstcome,firsttreated",isnotfollowedin
massemergencies.
Triageconsistsofrapidlyclassifyingtheinjuredandthelikelyhoodof
theirsurvivalwithpromptmedicalintervention.
Higherpriorityisgrantedtovictimswhoseimmediateorlong-term
prognosiscanbedramaticallyaffectedbysimpleintensivecare.
Moribundpatientswhorequireagreatdealofattention,with
questionablebenefithavethelowestpriority.
Themostcommontriageclassificationsystemusedinternationalis
fourcolourcodesystem.
Red
-, Highprioritytreatmentortransfer
Yellow
Mediumpriority
Green
Ambulatorypatients
Black
Deadormoribundpatients

---

971.Highpriorityintriageisfor-
a)Redcolor
b)Yellowcolor
c)Greencolor
d)Blackcolor
CorrectAnswer-A
Ans.is'a'i.e.,Redcolour

---

972.Whichwastecannotbeincinerated-
a)Anatomicwaste
b)Microbiologywaste
c)Halogenatedplastic
d)Infectiouswaste
CorrectAnswer-C
Ans.is'c'i.e.,Halogenatedplastic

---

973.Whichofthefollowingisthenodal
centrefordisastermanagement
a)PHC
b)CHC
c)Controlroom
d)None
CorrectAnswer-C
Ans.is`C'i.e.,Controlroom
oThecontrolroomisthenodalcenterintermsofdisaster
management.
oThecontrolroomplaysavitalroleindisastermanagement
activation.
oItcoordinatestheflowofinformationwithrespecttoactivities
associatedwithreliefoperations.
Duringnormaltimesitmaintainssystematicdata-based
informationoftheresourcesavailable,importantGovernmentand
non-Governmentofficials,localbodiesandNGOs.
Duringacrisis(disaster)itisexpectedtofunctionasacenterfor
decisionmakingandtokeepconstanttouchwiththeaffectedareas
toprovideorganizedreliefandrescueoperationsimmediatelyafter
occurrenceorreceiptwarningofdisaster.
oTherewillbeseparatecontrolroomsattheblocklevel.

---

974. Whichisthecalamitywithmostamount
ofdamage-
a)Flood
b)Earthquake
c)Landslides
d)Volcanoes
CorrectAnswer-A
Ans.is'a'i.e.,Floods

---

975.PropagandaIsdefinedas-
a)Forcingofknowledgeintomind
b)Activeaquiringofknowledge
c)Requiringknowledgeafterthinking
d)Trainingofpeopletousejudgmentbeforeacting
CorrectAnswer-A
Ans.is'a'i.e.,Forcingofknowledgeintomind

---

976.NoofinpatientbedsinPHC?
a)6
b)10
c)20
d)25
CorrectAnswer-A
Ans.is'a'i.e.,6[RefPark22"d/ep.845]
PHC6beds
CHC30beds

---

977.OnePHCcovershowmuchpopulationin
hillyarea?
a)10000
b)20000
c)30000
d)50000
CorrectAnswer-B
Ans.is'b'i.e.,20000

---

978.Highestlevelofhealthcaresystemin
India-
a)Primaryhealthcare
b)Secondaryhealthcare
c)Tertiaryhealthcare
d)Allaresame
CorrectAnswer-C
Ans.is'c'i.e.,Tertiraryhealthcare
Levelsofhealthcare
Itiscustomarytodescribehealthcareserviceat3levels,viz.
primary,secondaryandtertiarycarelevels.oTheselevelsrepresent
differenttypesofcareinvolvingvaryingdegreesofcomplexity.
1.Primarycarelevel
Itisthefirstlevelofcontactofindividuals,thefamilyandcommunity
withthenationalhealthsystem,where"primaryhealthcare",
("essential"healthcare)isprovided.
Asalevelofcare,itisclosetothepeople,wheremostoftheir
healthproblemscanbedealtwithandresolved.
Itisatthislevelthathealthcarewillbemosteffectivewithinthe
contextofthearea'sneedsandlimitations.
InIndia,primaryhealthcareisprovidedbyPHCandtheir
subcentresthroughtheagencyofmultipurosehealthworkers,
villagehealthguidesandtraineddais.
2.Secondarycarelevel
Thenexthigherlevelofcareisthesecondary(intermediate)health
carelevel.
Atthislevelmorecomplexproblemsaredealthwith.
InIndia,thiskindofcareisgenerallyprovidedindistricthospitals

---

andcommunityhealthcentreswhichalsoserveasthefirstreferral
level.
3.Tertiarycarelevel
Thetertiarylevelisamorespecializedlevelthansecondarycare
levelandrequiresspecificfacilitiesandattentionofhighly
specializedhealthworkers.
Thiscareisprovidedbytheregionalorcentrallevelinstitutions,e.g,.
MedicalCollegeHospitals,AllIndiaInstitutes,RegionalHospitals,
SpecializedHospitalsandotherApexInstitutions

---

979.MostbasiclevelofHealthCareSystem
inIndia-
a)Primaryhealthcare
b)Secondaryhealthcare
c)Tertiaryhealthcare
d)Allaresame
CorrectAnswer-A
Ans.is'a'i.e.,Primaryhealthcare

---

980.Serviceapplied,staffrecruitement,staff
trained,Equipmentordered,equipment
installed,productdeliveredwhichisthe
criticalstep
a)Staffrecruitment
b)Stafftrained
c)Equipmentordered
d)Equipmentinstalled
CorrectAnswer-D
Ans.is'd'i.e.,Equipmentinstalled

---

981.NVBDCPincludesallexcept?
a)Malaria
b)Filarial
c)Kalaazar
d)Chikungunya
CorrectAnswer-D
Ans.isdi.e.,Chikungunya
oNationalVectorBorneDiseasecontrolprogramme(NVBDCP)
includesmalaria,dengue,filaria,JEandkala-azar.Health
programmesinIndia
oSinceIndiabecomeindepedent,severalmeasureshavebeen
undertakenbyNationalGovernmenttoimprovethehealthofthe
people.
oProminantamongthesemeasuresaretheNATIONALHEALTH
PROGRAMMESwhichhavebeenlaunched
bythecentralGovernmentforcontrol/eradicationofthe
communicablediseases,improvementofenvironmental
sanitation,raisingthestandardofnutrition,controlofpopulattionand
improvingruralhealth.NationalHealthProgrammescurently
workinginIndia:?
1. NationalvectorBorneDiseaseControlProgrammeMalaria,Dengue,
Filaria,JE,Kala-azar.
2. Nationalleprosyeradicationprogramme.
3. RevisedNationalTBcontrolprogramme.
4. Nationalprogrammeforcontrolofblindness.
5. Nationaliodinedeficiencydisorderscontrolprogramme.
6. Nationalmenalhealthprogramme
7. NationalAIDScontrolprogramme

---

8. Nationalcancercontrolprogramme
9. UIP
10. NationalProgrammeforprevention&controlofdeafness.
11. PioletProgammeonprevention&controlofDM,CVD,&deafness.
12. Nationaltobaccocontrolprogramme
13. RCHprogramme.

---

982.Consumerprotectionactincludesall,
except?
a)Passedin1986
b)Decisionwithin3-6months
c)ESIhospitalsnotincluded
d)Righttosafety
CorrectAnswer-C
Ans.is'c'i.e.,ESIhospitalsnotincluded
Consumerprotectionact
ForthefirsttimeinIndia,theConsumerProtectionAct1986
providedconsumersaforumforspeedyredressaloftheir
grievancesagainstmedicalservices.
Accordingtothisact,thedecisionshouldbetakenwithin3-6
months.
Thereisnocourtfeepaymentandthepersoncanpleadhisown
case.
RecentlyevenESIhospitalshavebeenbroughtwithintheambitof
thisact.
COPRAisapieceofcomprehensivelegislationandrecognizessix
rightsofconsumer:-
1. Righttosafety
2. Righttobeinformed
3. Righttochoose
4. Righttobeheard
5. Righttoseekredressal
6. Righttoconsumereducation
Formedicalnegligence,complaincanbegiventoMCIorcanbe
filedinconsumercourt.

---

MCIcantakedisciplinaryaction,e.g.temporaryorpermanent
cancellationofregistrationofconcerneddoctor.But,MCIcannot
punishadoctororgiveacompensation.
Consumercourtsgivecompensation.Thelimitsofconsumercourts
are:-
1. DistrictconsumercourtUptoRs.20lacs.
2. StatecommissionRs.20lacstoRs.1crore.
3. NationalcommissionAboveRs.1crore.

---

983.Consumerprotectionactwaspassedin
?
a)1977
b)1986
c)1993
d)1998
CorrectAnswer-B
Ans.is'b'i.e.,1986
Consumerprotectionactwaspassedin1986.

---

984.Dowryprohibitionact1986,punishment
is?
a)Tyr,Rs25000
b)TyrRs15000
c)5yr,Rs25000
d)5yrRs15000
CorrectAnswer-D
Ans.is'd'i.e.,5yrRs15000
Accordingto"TheDowaryProhibitionAct,1961(Amended1986)",if
anypersonviolatestheactmaybepunishedwiththeimprisonment
foratermnotlessthan5yearsandwithafinewhichshallnotless
thanRs.15000oramountofthevalueofsuchdowrywhicheveris
more.
Alsoknow
Accordingtosection304BIPC,thepunishmentfordowrydeathis
imprisonmentforatermofminimum7years,whichmaybe
extendedtolifeimprisomment.

---

985.
ObjectivesofNationalMentalHealth
programmeareallaccept-
a)Promotecommunityparticipation
b)Promoteapplicationofmentalhealthknowledge
c)Providesfreeantipsychoticdrugstoall
d)Provideaccessibilityofmentalhealthcare
CorrectAnswer-C
Ans.is'c'i.e.,Providesfreeantipsychoticdrugstoall
NationalMentalHealthPrim-amine(NMIIPI
The(io%eminentofIndiahaslauchedtheNationalMentalHealth
Programmein1982,withthefollowingobjectives:
a)Toensureavailabilityandaccessibilityofminimummental
healthcareforallintheforeseeablefuture,particularlytothemost
vulnerableandunderprivilegedsectionofthepopulation.
b)Toencouragetheapplicationofmentalhealthknowledgein
generalhealthcareandinsocialdevelopment.
c)Topromotecommunityparticipationinthementalhealthservice
development.
oTheDistrictMentalHealthProgramme(DMHP)waslaunched
underNMHPintheyear1996,whichwasbasedon'BellaryModel'
withthefollowingcomponents.
a)Earlydetectionandtreatment.
b)Trainingofgeneralphvsiansandhealthworkers.
c)IEC':Publicawarenessgeneration.
d)Monitoring(forsimplerecordkeeping).
oTheNMHPwasre-strategizedinyear2003withfollowing
components:?
1)ExtensionofDMHPto100districts.

---

2)Upgradationofpsychiatricwinginmedicalcolleges/General
hospitals.
3)Modernizationofstatementalhospitals.
4)IEC
5)Monitoringandevalutation.

---

986.Juvenilejusticeactdefinesajuvenile
whichis
a)Malebelow16years
b)Femalebelow16years
c)Malebelow18years
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Malebelow18years

---

987.IndiraGandhiMatritvaSahyogYojanais
for?
a)>65yearsold
b)>50yearsold
c)>30yearsold
d)>19yearsold
CorrectAnswer-D
Ans.isdi.e.,>19yearsold
oTheIndiraGandhiMatritvaSahyogYojana(IGMSY)isaflagship
programofthegovernmentofIndiaintroducedin2010underthe
MinistryofWomenandChildDevelopment.
oItisaconditionalcashtransferschemethattargetspregnantand
lactatingwomen19yearsofageandolderwhohavetwochildren.
Itsgoalistopartlycompensatethemforwage-lossduringchildbirth
andchildcareandtoprovideconditionsforsaledeliveryandgood
nutritionandfeedingpractices.

---

988.NSABPstandsfor?
a)Nationalsurgicaladjuvantforbreastproject
b)Nationalsurgicaladjuvantforbreastandbowelproject
c)Nationalsurgicaladjuvantforbrainandbreast
d)Nationalsurgicaladjuvantforbowelandbrain
CorrectAnswer-B
Ans.is'b'i.e.,Nationalsurgicaladjuvantforbreastandbowel
project
TheNationalSurgicalAdjuvantBreastandBowelProject(NSABP)
isaclinicaltrialscooperativegroupsupportedsinceitsinceptionby
nationalcancerinstitute(NCI).

---

989.MentalHealthActwaspassedin?
a)1982
b)1987
c)1971
d)1950
CorrectAnswer-B
Ans.is'b'i.e.,1987

---

990.Weberfergusonapproachisusedfor?
a)Mastoidectomy
b)Maxillectomy
c)Myringoplasty
d)Mandibulectomy
CorrectAnswer-B
Ans.B.Maxillectomy
WEBERFERGUSONAPPROACH:
Thisapproachinvolvesanextensionofthelateralrhinotomyincision
thatincludesthesplittingofupperlip.
Indications:Exenterationofmaxillafortotalorsubtotalmaxillectomy
(splittingtheupperlipreleasesthefacialflapforadequatelateral
retractionandaddstransoralexposureofpalateandteeth)

---

991.Retroauricularincisionisalsoknown
as?
a)Rosen'sincision
b)Lempert's-Iincision
c)Lempert's-IIincision
d)Wilde'sincision
CorrectAnswer-D
Ans.is'd'i.e.,Wilde'sincision
[Ref:DhingraSth/ep.410]
Wilde'sincisionisusedforpostaural(retroauricular)approach.
Lempert'sincisionisusedforendauralapproach.
Rosen'sincisionisusedforstapedectomythroughendomeatalor
transcanalapproach,

---

992.Submandibularnodesareclassifiedas?
a)LevelIAnecknodes
b)LevelIBnecknodes
c)LevelIInecknodes
d)LevelIIInecknodes
CorrectAnswer-B
Ans.is'b'i.e.,Level1Bnecknodes
Divisionofnecknodesaccordingtolevels
LevelISubmental(IA)Submandibular(IB)
LevelIIUpperjugular
LevelIIIMidjugular
LevelIVLowerjugular
LevelVPosteriortrianglegroup(Spinalaccessoryand
transversecervicalchains)
LevelVIPrelaryngealPretrachealParatracheal
LevelVIINodesofuppermediastinum

---

993.

---

Modifiedradicalneckdissectionincludes
whichlevelofcervicallymphnodes?
a)I-Ill
b)I-IV
c)I-V
d)I-Vil
CorrectAnswer-C
Ans.is'c'i.e.,I-V
Radicalneckdissection
Duringradicalneckdissection,followingareremoved.
a. Lymphnodesofsubmental,submandibular,upper,middleandlower
jugular,andlateral(posterior)triangleregions,i.e.LevelItoValong
withitsfibrofattytissue.
b. Sternomastoidmuscle.
c. Internaljugularvein.
d. Spinalaccessorynerve.
e. Submandibularsalivarygland.
f. Tailoftheparotid.
g. Omohyoidmuscle.
Followingstructuresaresaved-
Carotidartery
Brachialplexus,phrenicnerve,vagusnerve,cervicalsympathetic
chain,marginalmandibularbranchoffacial,lingualandhypoglosal
nerve.
Modifiedneckdissection
Itissimilartoradicalneckdissectionbutwithpreservationofoneor
morefollowingstructures-
1. Spinalaccessorynerve

---

2. Internaljugularvein
3. Sternocleidomastoidmuscle
Thus,bothradicalneckdissectionandmodifiedradicalneck
dissectionremovelevelItoVnecknodes.
Differentlevelsofnecknodeshevebeenexplainedinprevious
sessions.

---

994.Coneoflightfocusesonwhichquadrant
oftympanicmembrane?
a)Anteroinferior
b)Posteroinferior
c)Anterosuperior
d)Posterosuperior
CorrectAnswer-A
Ans.is'a'i.e.,Anteroinferior
Coneoflight
Seeninanteroinferiorquadrantofthetympanicmembraneis
actuallythereflectionofthelightprojectedintotheearcanalto
examineit.
Thispartreflectsitbecauseitistheonlypartoftympanicmembrane
thatisapproximatelyatrightanglestothemeatus.
Thisdifferenceindifferentpartofthetympanicmembraneisdueto
thehandleofmalleuswhichpullsthetympanicmembraneand
causesittotentinside.
Thus,thehandleofmalleuscausestentingandbecauseoftenting
theantero-inferiorquardrantisatrightanglestothemeatusand
thusreflectsthelight(leadingtoconelight).

---

995.Maculaisstimulatedby?
a)Gravity
b)Headpositionchange
c)Linearacceleration
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Vestibularapparatus(Peripheralpartofvestibularsystem)
Thevestibularapparatuswithintheinnereardetectsheadmotion
andpositionandtransducesthisinformationtoaneuralsignal.The
vestibularapparatushasfollowingparts:-

---

996.Ossiclesofmiddleearareresponsible
forwhichofthefollowing?
a)Amplificationofsoundintensity
b)Reductionofsoundintensity
c)Protectingtheinnerear
d)Reductionofimpedancetosoundtransmission
CorrectAnswer-D
Ans.is'd'i.e.,Reductionofimpedancetosoundtransmission
Theearcanal(auditorycanal)actsasaresonator,i.e.itresonates
(amplifiesfrequencies)between2000and5000(average3000)
cyclespersecondandthereforemostenergywillbetransmittedto
thecochleainthesefrequencies.
However,ifthissoundenergyhitstheinnerearfluiddirectlymostof
theenergywouldbereflected,resultinginhearingloss(asallthe
soundwaveisreflectedandnothingisatransmittedaselectrical
impulse).
Therefore,thereisaneedforatransformermechanism,aneedthat
isfullfilledbymiddleearmiddleearconvertssoundofgreater
amplitudebutlesserforcetothatoflesseramplitudebutgreater
force.
Thisfunctionofthemiddleeariscalledimpedencematching
mechanismorthetransformeraction.

---

997.Endolymphresembles?
a)CSF
b)ICF
c)ECF
d)Plasma
CorrectAnswer-B
Ans.is'b'i.e.,ICF
EndolymphResemblesintracellularfluid,richinI+ions.
Perilymph(ectolymph)ResemblesECF,richinNa'ions.
PerilymphcommunicateswithCSFthroughcochlearacqueduct
thereforehascharacteristicssimilartoCSF.
Fluidintheinnerear
Therearetwomainfluidsintheinnerear:?
1. Perilymph
2. Endolymph
Perilymph
ItresemblesECFandisrichinNa+ions.Itfillsthespacebetween
bonyandthemembranouslabyrinth,i.e.,Scalavestibuliandscala
tympani.
ItcommunicateswithCSFthroughtheaqueductofCochleawhich
opensintothescalatympanineartheroundwindow.ThereforeIt
closelyresemblesCSF.
Itisformedby:-
1. Itisafiiterateofbloodserumandisformedbycapillariesofthe
spiralligament.
2. ItisadirectcontinuationofCSFandreachesthelabyrinthvia
aqueductofcochlea.
Endolymph

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Itfillstheentiremembranouslabyrinthincludingscalamedia
(cochlearduct).
Itresemblesintracellularfluid,beingrichinK"ions.
Itissecretedbythesecretorycellsofthestriavascularisofthe
cochleaandbythedarkcells(presentintheutricleandnearthe
ampullatedendsofsemicircularducts).

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998.Whichofthefollowingisresponsiblefor
localizationofsound?
a)Cochlearnerve
b)Cochlea
c)Superiorolivarynucleus
d)Cochlearnuclei
CorrectAnswer-C
Ans.is'c'i.e.,Superiorolivarynucleus
Localizationofsoundinspace
Ahumancandistinguishsoundsoriginatingfromsourcesseparated
byaslittleas1degree.Binauralreceptivefields(whichisafeature
ofmostauditoryneuronsabovethelevelofcochlearnuclei)
contributetosoundlocalization.Inotherwords,relaynucleiinthe
brainstem(especiallythesuperiorolivarynucleicomplex)
mediatelocalizationofsound.Theauditorysystemusesfollowing
cluestojudgetheoriginofsound:?
Timelagbetweentheentryofsoundintwoears:-Forexample,if
thesoundoriginatesfromtherightsideofaperson,itreachesthe
rightearearlierthantheleftear.Thistimelagismoreimportantfor
relativelylow-frequencysounds(below3000Hz).
Differenceinintensitiesbetweenthesoundinthetwoears:-Itis
importantforsoundsofhigherfrequencies(>3000Hz).
Soundscomingfromdirectlyinfrontoftheindividualandthebackof
theindividualcannotbedifferentiatedbytheabovetwo
mechanisms.Hereshapeofpinnaplaysarole,itchangesthe
qualityofthesounddependingonthedirectionfromwhichsound
comes.

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999.Trueaboutcentralnystagmus?
a)Changingdirection
b)Notsuppressedbyopticfixation
c)Horizontalorvertical
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Nystagmus
Nystagmusisrhythmicoscillatorymovementofeye.
Nystagmushasfollowingcharacteristics:?
1. Rapid,
2. Involuntary,
3. Repetitive
Nystagmusmaybe:?
1. Sidetoside(horizontalnystagmus)
2. Upanddown(verticlenystagmus)
3. Rotary
Vestibularnystagmushastwocomponents,i.e.aslowandafast.
Thedirectionofnystagmusisindicatedbythedirectionoffast
component.
Vestibularnystagmusmaybe:?
1. Peripheral:-duetolesionoflabyrinthorVIIInerve.
2. Central:-duetolesionofvestibularnuclei,brainstemorcerebellum.
i.Peripheralnystagmus
Diminshesorsuppresseswithgazefixation(opticfixation)
EnhancesindarknessorbyuseofFrenzelglasses
Unidirectionalfastcomponent
Directionistypicallyhorzonto-rotary,notpurelyhorizontalorrotary

---

andnotvertical
Directionisfixedtowardsundermostear
Presentinoneheadposition
ii.Centralnystagmus
Notsuppressedbyopticfixation
Fastcomponentcanbeunidirectionalorbidirectional
Canbehorizontal,verticalorrotary
Directionischanging
Presentinmultipleheadpositions

---

1000.Stimulationofhorizontalsemicircular
canalcausesnystagmusinwhich
directions?
a)Vertical
b)Horizontal
c)Rotary
d)Anyofthethree
CorrectAnswer-B
Ans.is'b'i.e.,Horizontal
Thecupulaeofthesemicircularcanalsarestimulatedbymovement
ofendolymphaticfluidandeachcanalcausesthenystagmusinits
ownplane:-
1. StimulationofhorizontalSCC4Horizontalnystagmus.
2. StimulationofsuperiorSCC4Rotarynystagmus.
3. StimulationofverticalSCCVerticalnystagmus

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1001.Bilateralpast-pointingisduetodefect
in?
a)Brainstem
b)Cerebellum
c)Vestibularsystem
d)Basalganglia
CorrectAnswer-C
Ans.is'c'i.e.,Vestibularsystem
Past-pointingisthedeviationoftheextremitiescausedbyeither
cerebellarhemisphereorvestibulardisease.
Testingisusuallydonewitharms.Thetraditionalmethodistohave
thepatientextendthearmandplacehisextendedfingeronthe
examiner'sindexfinger;thenwiththeeyeclosedraisethearm
directlyoverhead;thanbringitbackdownpreciselyontothe
examiner'sfinger.
Ifvestibularorcerebellarlesionisthere,pastpointing(deviationof
limb)willbepresent.
Thetwotypes(cerebellarandvestibular)pastpointinghavedifferent
patterns:-
1. Withvestibularin:balance,thenormallabyrinthwillpushthelimb
towardtheabnormalsideandthepatientwillmissthetarget.The
pastpointingwillalwaysbetothesamesideoftargetandwilloccur
witheitherlimb.
2. Withacerebellarhemisphericlesion,theipsilaterallimbswillhave
ataxiaandincoordination;pastpointingoccursonlywiththeinvolved
armandmaybetothesideoflesionorerraticallytoeithersideof
thetarget.
So,

---

Bilateralpast-pointingVestibularsystemdefect.
Unilateralpast-pointingCerebellarhemispheredefect.

---

1002.Allaretrueaboutotiticbarotrauma
except?
a)Conductivedeafness
b)Retractedtympanicmembrane
c)Catheterizationcanbeused
d)Occursduringsuddenascentinaircraft
CorrectAnswer-D
Ans.is'd'i.e.,Occursduringsuddenascentinaircraft
OtiticBarotrauma
Thisconditionisseenwhentheambientpressureisrising,e.g.in
scubadiving(underwaterdiving),descendinginanaircraft,or
compressioninpressurechamber.
Itoccursduetopressuredifferencesbetweentheinsideandoutside
oftheeardrum.
Clinicalfeatures
Eardiscomfortorpain,hearingloss,andtinnitusarecommon
Vertigoisuncommon
Otoscopyfindingsare:-
Congestedandretractedtympanicmembrane
Bloodmayextravasateintomiddleearproducinghaemotympanum
Onexaminationthereisconductivedeafness.
Pathogenesisofotiticbarotrauma
Themiddleearpressureisnormallymaintainedatalevelsimilarto
thatoftheatmospherebythefunctionofEustachiantubewhich
allowspassageofairfrommiddleeartopharynx.Suddenor
dramaticchangesofexternalpressuremaydefeatthismechanism
andcauseinjurytomiddleear.Whenatmosphericpressureis
higherthanthatofmiddleearbycriticallevelof90mmHg,

---

eustachiantubegetslockedasthesofttissuesofpharyngealendof
thetubeareforcedintothelumenbyhighatmosphericpressure.
Thisresultsinsuddennegativepressureinthemiddleearwhich
causesretractionoftympanicmembrane,hyperemia,transudation
withhemorrhageanddevelopmentof
Aero-otitismedia(barotrauma)
Atpressuredifference>100to500mmHg,tympanicmembranecan
rupturewhenthepressuredifferenceismorethan100mgHg,
tympanicmembranecanrupture.
TreatmentofotiticBarotrauma
Routineselftreatmentofpainassociatedwithchangingpressurein
aircraftincludeschewinggum,attemptingtoyawn&swallow,
blowingagainstclosednostrils,andusingdecongestantnasal
sprays.Theaimistorestoremiddleearareation.
Catheterizationorpolitzerizationcanalsobeused.Ifthe
eustachiantubewillnotopenwithothertreatments,surgerymaybe
necessory.Myringotomyandaspirationoffluidisthesurgical
procedureused.

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1003.Mostcommonlyusedtuningforkinear
examination?
a)128Hz
b)256Hz
c)512Hz
d)1024Hz
CorrectAnswer-C
Ans.is'c'i.e.,512Hz
Commonlyusedtuningforkhasafrequencyof512Hz.
Forksofotherfrequencies,e.g.256and1024Hzshouldalsobe
available.

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1004.Lomard'stestisusedtodiagnosis?
a)Conductivehearingloss
b)Sensorineuralhearingloss
c)Mixedhearingloss
d)Non-organichearingloss
CorrectAnswer-D
Ans.is'd'i.e.,Non-organichearingloss

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1005.Redlineinpuretoneaudiometryisfor-
a)Boneconduction
b)Airconduction
c)Rightear
d)Leftear
CorrectAnswer-C
Ans.is'c'i.e.,Rightear

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1006.AllaretrueaboutRinne'stestexcept?
a)Positiveinnormalear
b)Positiveinsensorineuralhearingloss
c)Minimum15-20dBairbonegapisrequiredinconductive
deafness
d)Boneconductionisbetterinsensorineuralhearingloss
CorrectAnswer-D
Ans.is'd'i.e.,Boneconductionisbetterinsensorineuralhearingloss
Rinne'sTest
TheRinnetestisatuningforktestthatcompareshearingbyair
conductionandboneconduction.TheRinnetestisbasedonthe
ideathathearingmechanismisnormallymoreefficientbyair
conduction(AC)thanitisbyboneconduction(BC),i.e.,AC>BCin
normalpersons.Forthisreason,atuningforkwillsoundlouderand
longerbyairconductionthanbyboneconduction.However,thisair
conductionadvantageislostwhenthereisaconductivehearingloss
inwhichcasethetuningforksoundslouderbyboneconductionthan
byair-conduction.
Method
AdministeringtheRinnetestinvolvesaskingthepatienttoindicate
whetheravibratingtuningforksoundslouderwhenitsbaseisheld
againstmastoidprocess(boneconduction)orwhenitsprongsare
heldnearthepinna,facingtheopeningofearcanal(airconduction).
Afterstrikingthefork,theclinicianalternatesitbetweenthesetwo
positionssothatthepatientcanmakeajudgementaboutwhichone
islouder.
InterpretationofRinne'stest
TheoutcomeoftheRinnetestistraditionallycalled"positive"ifthe

---

forkislouderbyairconductionandthisfindingimpliesthattheearis
normalorhassensorineuralhearingloss.Theresultsarecalled
"negative"ifthebone-conductionislouderthanair-conduction,
whichisinterpretedasrevealingthepresenceofconductive
deafnessi.e.,lesionsofeitherexternalear,tympanicmembrane,
middleearorearossicles..
InconductivedeafnessRinne'stestwillbenegativeiftheconductive
hearinglossisgreaterthan15-20dB(minimumairbonegap15-
20dB).Thatmeans,atleast15-20dBofconductivehearlossis
requiredtoshowboneconductionbetterthanairconduction,i.e.,
NegativeRinne'stest.AnegativeRinnetestfor256,512and1024
Hzindicatesaminimumair-bonegap(ABG)of15,30,45dB
respectively.Therefore,ABgapcanbemadeiftuningforksof256,
512and1024Hzareused:-
1. ARinnetestequalornegativefor256Hzbutpositivefor512Hz
indicatesair-bonegapof20-30dB.
2. ARinnetestnegativefor256and512Hzbutpositivefor1024Hz
indicatesair-bonegapof30-45dB.
3. ARinnenegativeforallthethreetuningforksof256,512,and1024
Hz,indicatesair-bonegapof4560dB.
Rationaleofpositivetest
Positivetest(AC>BC)isseenin:?
1.Normalperson
Ithasalreadybeenexplainedthatairconductionisbetterthanbone
conduction,thusRinnetestispositiveinnormalperson.
2.Sensori-neuralhearing
Insensorineuralhearingloss,thedefectisincochleaorVIIInerveor
itscentralconnection.Thereisnodefectinconductiveapparatusof
ear(airconduction)orinmastoidbone(boneconduction).Asair
conductionisbetterthanboneconduction,Rinnetestwillbe
positive(becausebothairconductiveapparatusandbone
conductiveapparatusarenormalandthepathologyisdistalto
them).
Negativetest(BC>AC)isseenin:?
1.Conductivedeafness
Astheconductiveapparatusisdefective,boneconductionbecomes
betterthanairconduction(BC>AC).

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2.Severeunilateralsensorineuralhearingloss
HeretheRinnetestisfalsenegative(nottruenegative)asitis
interpretedbythepatientthatBC>AC,butactuallyitisnot.In
realitythisresponseisfromtheoppositeearbecauseoftranscranial
transmissionofsoundduringboneconductiontesting.Thiscanbe
preventedbymaskingthenon-testearwithBarany'sboxwhile
testingtheboneconduction.Webertestwillhelpforsuchsituation.

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1007.Insensorineuralhearingloss,weber's
testislateralizedto
a)Normalear
b)Defectiveear
c)Notlateralized
d)Mayalternate
CorrectAnswer-A
Ans.A.Webertestislateralizedtotheunaffectedornormalear.
PURPOSE:Determinationofaconductivevs.
asensorineuralhearingloss.
Striketuningforkandplacebaseinthecenteroftheforeheador
thetopofthehead
Askifthetoneislouderintheleftear,therightearorequallyloudin
bothearsduetothesoundlocalizationprocess,
Inapatientwithaunilateralconductivehearingloss,thesound
willbelouderintheaffectedear(airbornesoundsmaskbone
conductioninthenormalear;conductivelosspreventsmaskingin
affectedearsoundisperceivedtobelouderinaffectedear)
Inapatientwithunilateralsensorineuralhearingloss,thesound
islouderinthenormalear(nosignalistransducedbythecochlea
ontheaffectedside,thereforethesoundislouderonthenormal
sideandisperceivedtobecomingfromthatside
Inanormalpersonorapersonwithsymmetricalhearingloss,itis
equallyloudinbothears.
Inotherwords,anormalpatient,theWebertuningforksoundis
heardequallyloudlyinbothears,withnooneearhearingthe
soundlouderthantheother(lateralization).Inapatientwith
hearingloss,theWebertuningforksoundisheardlouderin

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oneear(lateralization)thantheother.

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1008.Innoiceinducedhearingloss,
audiogramshowsatypicalnotchat
a)1000Hz
b)2000Hz
c)3000Hz
d)4000Hz
CorrectAnswer-D
Ans.is'd'i.e.,4000Hz
Noiseinducedhearingloss
Exposuretoloudnoisecanleadtopermanenthearingthreshold
shifts.
Thismayhappenimmediatelywithextremeexposure(nearby
explosionorgunfire),butmorecommonlyoccursslowlyovertime
withrepeatedexposuretoindustrialorenvironmentalnoise.
Patientswilloftenhaveatypical4-KHz(4000Hz)notch(dipat
4000Hz)intheiraudiogramcalledacousticdip.
Auditoryeffectsofnoiceare:?
1. Auditoryfatigue:-at90dBand4000Hz.
2. Hearingloss
3. Temporary:-At4000-6000Hz
4. Permanent:-Repeatedprolongedexposureto100dBorsingle
exposureto160dB.

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1009.Hearinglossof65dB,whatisthegrade
ofdeafness?
a)Mild
b)Moderate
c)Severe
d)Moderatelysevere
CorrectAnswer-D
Ans.is'd'i.e.,Moderatelysevere

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1010.SNHLisseeninallexcept?
a)Nailpatellasyndrome
b)DistalRTA
c)Battersyndrome
d)Alportsyndrome
e)None
CorrectAnswer-E
Ans.is'e'i.e.None
Allthegivenoptionsarecausesofsensorineuralhearingloss.
Treachercollin
syndrome
Congenitalcausesof
Alport's
SNHL
syndrome
Usher'ssyndrome
Pendred
Hurler'ssyndrome
syndrome
Michel'saplasia
Klippelfeilsyndrome
Crouzon's
Mondini'sanomaly
Type1(distal)Renal
disease
Schibe'sand
tubularacidosis
Barttersyndrome
Alexander'sanomalies
Jervell&langeNeilson
Leopard
LThl'sanomaly
syndrome
syndrome
Michel'saplasia
Biotinasedeficiency
Refsum
Nail-patellasyndrome
Albinism
syndrome
Alstromsyndrome
MELAS
Waardenburg
Brachio-oto-renal
Trisomy13,15,21
syndrome
(BOR)syndrome
Fabrydisease
Cockayne'ssyndrome

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1011.Allaretrueaboutconductivedeafness
except?
a)Rinne'stestisnegative
b)Absoluteboneconductionisnormal
c)Weberislateralizedtopoorerear
d)Thereisdecayinthresholdtone
CorrectAnswer-D
Ans.is'd'i.e.,Thereisdecayinthresholdtone

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1012.WaveIinbrain-stemresponse
audiometryarisesfrom?
a)Cochlearnerve
b)Superiorolivarycomplex
c)Laterallemniscus
d)Inferiorcolliculus
CorrectAnswer-A
Ans.is'a'i.e.,Cochlearnerve
BrainStemResponseAudiometry(BERA)
Itisanon-invasiveprocedurewhichobjectivelyhelpstofindthe
integrityofcentralauditorypathwaythroughtheVIIInerve,ponsand
midbrain.Itisaccuratetowithin10or15dBofthepsychoacoustic
thereshold.Itisthemostreliableaudiologicalmethodof
differentiatingbetweencochlearandRetrocochlearhearinglosses.It
isanobjectivetestandcanbedoneundersedation.
Itisusedbothasascreeningtestandasadefinativehearing
assessmenttestinchildren.Besttesttodetectdeafnessininfants
(reliablyrecordedevenfromprematureinfantsof30weeks
gestationalage)andmentallyretardedormalingeringsubjects.Itis
alsousedforIdentificationofthesiteoflesioninRetrocochlear
pathologiesandtodiagnosebrainstempathologye.g.multiple
sclerosisorpontinetumor.
WavesofBERA
Inanormalperson,7wavesareproducedinfirst10miliseconds.
Thefirst,thirdandfifthwavesaremoststableandareusedin
measurements.Siteoforiginofwavesare:-
WaveIDistalpartofEighthnerve
WaveIIProximal,partofEighthcranialnerve

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WaveIIICochlearnucleus
WaveIVSuperiorolivarycomplex
WaveVLateralleminiscus
WaveVI&VIIInferiorcolliculus

---

1013.Unilateralsensorineuralhearingloss
mayoccurin?
a)Coronavirus
b)Mumps
c)Pertussis
d)Rotavirus
CorrectAnswer-B
Ans.is'b'i.e.,Mumps
Infectionsoflabyrinth Acquiredcauses Systemicdisorders
Traumatolabyrinthor
ofSNHL (DM,Hypothyroidism,
VIIInerve(Head
Presbycusis
Renaldisorders)
injury,surgeryetc)
Meniere'sdisease Multiplesclerosis
Noiseinducedhearing Acousticneuroma Smoking&Alcoholism
loss
Suddenhearing
Ototoxicdrugs
loss

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1014.Vestibularfunctionisassessedby?
a)Fistulatest
b)Hallpikemanaeuver
c)Calorictest
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove

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1015.Mostcommoncauseofotomycosis?
a)Histoplasma
b)Rhinosporidium
c)Aspergillus
d)Actinomyces
CorrectAnswer-C
Ans.is'c'i.e.,Aspergillus
Otomycosis
Otomycosis,alsocalledacutefungalotitisexterna,describesa
fungaloryeastinfectionoftheexternalauditorymeatus.
Saprophyticfungipotentiallyresidingintheearcanalinclude
Aspergillus,Candidaalbicans,Phycomycetes,Rhizopus,
Actinomyces,andPenicillium.
Undercertainconditionsofincreasedheat,humidity,glucose
concentration(diabetes),immunosuppression,oroveruseof
systemicortopicalantibioticsandsteroids,thesesaprophyticfungi
canbecomepathogenic.
Aspergillusnigeraccountsfor90%ofotomycosisinfections.
Othercommonorganismsarecandidaalbicans(2"amostcommon)
andAspergillusfumigatus.
LesscommonorganismsarePhycomycetes,Rhizopus,
ActinomycesandPenicillium

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1016.Bullousmyringitisiscausedby?
a)Pseudomonas
b)Mycoplasma
c)Pneumococcus
d)Candida
CorrectAnswer-B
Ans.is'b'i.e.,Mycoplasma
Otitisexternahaemorrhagica
ThisconditionisalsoknownasBullousmyringitisormyringitis
bullosa.
Thisconditionisextremelypainfulandhassuddenonset.
Itisthoughttobeduetomycoplasmapneumoniaeorviral
infection,usuallyinfluenza
Theremaybeamildconductivedeafnessandamildlydischarging
ear.
Theappearanceofhaemorrhagicbullaeonthetympanicmembrane
andinthedeepmeatusischaracteristic.
Thebullaearefilledwithserosanguinousfluidandblood.
Onhealing,bullaelooklikeSago-grain.
Therefore"Sago-grain"appearanceoftympanicmembraneisseen
inhealedmyringitisbullosa.

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1017.Causeofmyringosclerosis?
a)Genetic
b)Grommetinsertion
c)Otosclerosis
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Grommetinsertion
Tvmpanosclerosis
Tympanosclerosisisaconditioninwhichthereiscalcificationof
tissueintheeardrum(tympanicmembrane)andmiddleear.
Tympanosclerosismaybeclassifiedas:-
1. Myringosclerosis:-Involvingonlythetympanicmembrane.
2. Intratympanictympanosclerosis:-Involvingothermiddleearsites:
ossicularchainor,rarely,themastoidcavity.
Exactetiologyoftympanosclerosisisnotknown.Itmaybean
abnormalhealingprocessandmostcommonlyoccursincasesof
serousotitismediaasacomplicationofventilationtube(gourmet)
insertion.
Characteristicchalkywhitepatchesareseenoninspectionofthe
eardrum.Itisworthnotingthatcholesteatomamaylooksimilarbut
thewhitenessappearsbehind,ratherthanin/onthetympanum.
Otherwisetympanosclerosisisasymptomatic.Conductivehearing
lossmayoccurinsomecases.

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1018.Retractionoftympanicmembrane
touchingthepromontory.Itiscalled?
a)Mildretraction
b)Severeretraction
c)Atelectasis
d)Adhesiveotitis
CorrectAnswer-C
Ans.is'c'i.e.,Atelectasis
Tympanicmembraneretraction
Theretractedsegmentofeardrumisoftenknown
asaretractionpocket.
Theterms"atelectasis"orsometimes"adhesiveotitismedia"can
beusedtodescriberetractionofalargeareaoftheparstensa.

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1019.Retractionoftympanicmembrane
touchingpromontory.Whatissade's
grade?
a)1
b)2
c)3
d)4
CorrectAnswer-C
Ans.is'c'i.e.,3
Atelecticgradesofparstensa
Sadeclassification::
Grade1=slightretractionofTMovertheannulus
Grade2=theTMtouchesthelongprocessoftheincus
Grade3=theTMtouchesthepromontory
Grade4=theTMisadherenttothepromontory

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1020.MostcommoncauseofASOMis?
a)Meningococci
b)Pneumococci
c)Hinfluenzae
d)Moraxella
CorrectAnswer-B
Ans.is'b'i.e.,Pneumococci
ASOMisanacuteinflammationofmiddleearcleftcausedby
pyogenicorganism.
ItisworthnotingthatASOMistheinfectionofmiddleearcleft,i.e.,
middleear(tympaniccavity),Eustachiantube,Attic,Aditus,antrum
andmastoidaircells.
ASOMisespeciallycommonininfantsandchildren.
MostofthetimeASOMusuallyfollowsrespiratorytractinfections
(i.e.,acutetonsillitis,commoncoldorinfluenza)andtheinfection
travelupbytheeustachiantubetothemiddleear.
Themostcommoncausativeorganismisstreptococcus
pneumoniae.OthercommonorganismsareH.influenzaeand
Moraxellacatarrhalis.Lesscommoncausativeorganismsare
streptococcuspyogenes,staphylococcusaureusandE.coli.

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1021.Posterosuperiorretractionpocketif
allowedtoprogresswillleadto?
a)SNHL
b)Secondarycholesteatoma
c)Tympanosclerosi
d)Primarycholesteatoma
CorrectAnswer-D
Ans.is'd'i.e.,Primarycholesteatoma
Retractionpocketsaremorecommoninthepostero-superiorportion
ofpars-tensaofear-drum(tympanicmembrane).
Tworeasonshavebeenattributedtothisfeatures:-
1. Thisareaismorevascular,hencecouldbesubjectedtointense
inflammatoryreaction.
2. Middlefibrouslayerinthisareaisincomplete,lackincircularfibers.
Longtermeffectsofprogressiveretractionmaybe:-
1. Fixationofatrophicsigmenttobonywallofmiddleearcavity.
2. Erosionofossicles,mostcommonlylongprocessofincus.
3. Formationofcholesteatoma(primaryacquiredcholesteatoma).
4. "Aposteriorsuperiorretractionpocket,ifallowedtoprogress,leads
toprimaryacquiredcholeastoma".
Acquiredcholesteatoma
Inmajorityofcasescholesteatomaisacquired.Acquired
cholesteatomamaybeeitherprimaryacquiredorsecondary
acquired:?
A.Primaryacquiredcholesteatoma
Thereisnohistoryofpreviousotitismediaorapre-existing
perforation.
Theoriesforitsgenesisare:-

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1. Retractionpocket(wittmaack'stheory):-Itisthemostaccepted
theory.Thereisinvaginationofparsflaccidaintheformofretraction
pocketduetonegativepressureinmiddleearasaresultof
Eustachiantubedysfunction.Thereisingrowth(migration)of
squamousepitheliumfromtheouterlayeroftympanicmembrane
(outerlayerofTMislinedbysquamousepithelium)throughthis
retractionpocket.Infectionsupervenesontheimpactedsquamous
epithelium/keratin.
2. Basalcellhyperplasia(Ruedi'stheory):-Thereisproliferationofthe
basallayerofparsflaccidainducedbysubclinicalchildhood
infections.Theseproliferatingbasalcellslaydownkeratinizing
squamousepithelium.
3. Squamousmetaplasia(Sade'stheory):-Pavementepitheliumof
atticundergoesmetaplasiaandtransformsintosquamous
epitheliumduetosubclinicalinfections.
B.Secondaryacquiredcholesteatoma
Thereispre-existingperforationinparstensa.
Theoriesonitsgenesisinclude:-
1. Epithelialinvasion(Habermann'stheory):-Theepitheliumfromthe
meatusorouterdrumsurfacegrowsintothemiddleearthrougha
pre-existingperforationespeciallyofthemarginaltypewherepartof
annulustympanicushasalreadybeendestroyed.
2. Metaplasia:-Middleearmucosaundergoesmetaplasiadueto
repeatedinfectionsofmiddleearthroughthepre-existing
perforation.

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1022.Treatmentofchoiceforatticoantraltype
ofCSOM?
a)Antiboiotics
b)Tympanoplasty
c)Modifiedradicalmastoidectomy
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Modifiedradicalmastoidectomy
Treatmentofatticoantraldisease
Sincecholesteatomaisgoingtoexpandanddestroyboneand
mucousmembrane,ithastoberemoved.
Therefore,surgeryisthemainstayoftreatment.
Primaryaimisremovalofdiseasebymastoidectomytomakeear
safefollowedbyreconstructionofhearingatalaterstage.
Modifiedradicalmastoidectomyisthesurgeryofchoice.
Twotypesofsurgicalprocedures(mastoidectomy)aredonetodeal
withcholesteatoma:-
1.Canalwalldownprocedures
Theseleavethemastoidcavityopenintotheexternalauditorycanal
sothatthediseasedareaisfullyexteriorized.
Thecommonlyusedproceduresforatticoantraldiseaseare
atticotomy,modifiedradicalmastoidectomyandrarelyradical
mastoidectomy.
Modifiedradicalmastoidectomyistheprocedureofchoice.
2.Canalwallupprocedures(corticalmastoidectomy)
Herediseaseisremovedbycombinedapproachthroughthemeatus
andmastoidbutretainingtheposteriorbonymeatuswall,thereby
avoidinganopenmastoidcavity.

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Forreconstructionofhearingmechanismmyringoplastyor
tympanoplastycanbedoneatthetimeofprimarysurgeryorasa
secondstageprocedure.

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1023.Cart-wheelappearanceoftympanic
membraneinASOMisdueto?
a)Perforationoftymparicmembrane
b)Edemaoftympanicmembrane
c)Congestedbloodvesselsalongmalleus
d)Granulationtissueontympanicmembrane
CorrectAnswer-C
Ans.is'c'i.e.,Congestedbloodvesselsalongmalleus
StagesofASOM
ASOMrunsthroughthefollowingstagesandthereforepresentation
dependsuponthestage:
1.Stageoftubalocclusion(Eustachiantubeobstruction)
EdemaandhyperaemiaofnasopharyngealendofEustachiontube
blocksthetube,leadingtoabsorptionofairandnegative
intratympanicpressure.
Thereisfeelingofdiscomfortandmildhearingloss(conductive)with
pinkretractedtympanicmembrane.
2.Stageofpresuppuration(Earlyinfection)
Thereiscollectionofinflammatoryexudatebehindthetympanic
membrane.
ThereismarkedThrobbingearache,hearingloss,tinnitusandfever.
Tympanicmembraneiscongested.Leashofbloodvessels
appearalongthehandleofmalleusandattheperipheryof
tympanicmembraneimpartingitaCart-wheelappearance.
3.Stageofsuppuration(suppurativestage)
Thereiscollectionoffrankpusinthemiddleear.
Patienthasexcruciatingearache,hearingloss,andconstitutional
symptomslikehighgradefever.

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Tympanicmembraneisredandbulgingwithlossoflandmarks.
4.Stageofresolution(Resolutionstage)
Thetympanicmembraneruptureswithreleaseofpusand
subsidenceofsymptoms.
Earacheisrelieved,fevercomesdownandchildfeelsbetter.

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1024.X-rayfindingsinchronicotitismedia?
a)Honeycombingofmastoid
b)Sclerosiswithcavityinmastoid
c)Clear-cutdistinctbonypartitionbetweencells
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Sclerosiswithcavityinmastoid

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1025.Delta-signisseenin?
a)Petrositis
b)Acutemastoiditis
c)Sigmoidsinusthrombosis
d)Glomustumor
CorrectAnswer-C
Ans.is'c'i.e.,Sigmoidsinusthrombosis
Contrast-enhancedCTscancanshowsinusthrombosisbytypical
delta-sign.Itisatriangularareawithrimenhancement,andcentral
lowdensityareaisseeninposteriorcranialfossaonaxialcuts.
Delta-signmayalsobeseenoncontrastenhancedMRI.

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1026.Blueeardrumisseenin?
a)Serousotitismedia
b)CSOM
c)Perforation
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Serousotitismedia
Anyaccumulationoffluidbehindtympanicmembranecauses
structuralchangesintympanicmembranecausingittoappearblue,
beitpus,bloodorserousfluid.
Themostcommoncauseoffluidaccumulationinmiddleear
isserousotitismediaorglueear(mostcommoncause)and
haemotympanum.
Othercausesofbluetympanicmembraneareglomustumor,
hemangiomaofmiddleear,andcholesterolgranuloma.

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1027.Allareintracranialcomplicationsof
otitismediaexcept?
a)Lateralsinusthrombophlebitis
b)Facialnervepalsy
c)Brainabscess
d)Hydrocephalus
CorrectAnswer-B
Ans.is'b'i.e.,Facialnervepalsy

---

IntracranialComplicationsfromOtitisMedia
Intracranialcomplicationsoccuraftertheinfectious(orinflammatory)
processproceedsbeyondthetemporalbone"requiringimmediate
andprecisetherapeuticintervention."
Mostcommonintracranialcomplicationsincludemeningitis,followed
bybrainabscessandlateralsinusthrombosis,subdural
empyema,epiduralabscess,andotichydrocephalus.

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1028.Gradenigosyndromeischaracterized
byallexcept?
a)Diplopia
b)Retro-orbitalpain
c)Persistenteardischarge
d)Vertigo
CorrectAnswer-D
Ans.isdi.e.,Vertigo
Infectionofmastoidandmiddleearmaybecomplicatedbythe
spreadofinfectionwithinthetemporalboneintopetrousapex.
Petrositisisanextensionofinfectionfrommiddleearandmastoidto
thepetrouspartofthetemporalbone.
Gradenigo'ssyndromeistheclassicalpresentationand
consistsofatriadof:-
Externalrectuspalsy(VIthnerve/abducentnervepalsy)causing
diplopia.
Deepseatedorbitalorretroorbitalpain(Vthnerveinvolvement).
Persistenteardischargeduetoipsilateralacuteorchronicotitis
media.
Associatedsymptomsofotitismediaarealsopresente.g.,
conductivedeafness.Othersymptomsarefever,headache,
vomiting,andsometimesneckrigidity.Somepatientmaygetfacial
paralysisandrecurrentvertigoduetoinvolvementoffacialand
statoacousticnerves.

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1029.Trueabouttubercularotitismediaare
allexcept?
a)Spreadsthrougheustachiantube
b)Causespainlesseardischarge
c)Maycausemultipleperforations
d)Usuallyaffectsbothears
e)None
CorrectAnswer-D
Answer-D.Usuallyaffectsbothears
Tuberculosisofmiddleearisacomparativelyrareentityusually
seeninassociationwithorsecondarytopulmonarytuberculosis,
infectionreachesthemiddleearthrougheustachiantube.
Clinicalfeatures
Generally,tuberculosisofmiddleearisunilateral.
Itischaracterizedbypainlessotorrhoeawhichfailstorespondtothe
usualantimicrobialtreatment.Thereispainlesswateryotorrhea.
Singleormultipleperforationoftympanicmembrane.

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1030.Frey'ssyndromeiscausedby?
a)Posttraumaticnervefibresoffacialnervewithparasympathetic
ofauriculotemporalnerve
b)Greaterauricularwithauriculotemporalnerve
c)Facialnervewithgreaterauricularnerve
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Posttraumaticnervefibresoffacialnervewith
parasympatheticofauriculotemporalnerve
Frey'ssyndrome(gustatorysweating)
GustatorysweatingorFrey'ssyndromeinvolvespost-parotidectomy
facialsweatingandskinflushingwhileeating.
Thesymptomsusuallyoccurseveralmonthsorevenyearsafter
parotidsurgery.
Thelikelypathophysiologyisaberrantregenerationofpostganglionic
secretomotorparasympatheticnervefibres(originatingfromtheotic
ganglion)misdirectedthroughseveralaxonalsheathsofpost-
ganglionicsympatheticfibresfeedingthesweatglands.These
sympatheticfibresaretothesweatglandsoftheskininthe
dissectedfield.
Thefrey'ssyndromeislikelyduetoinjurytoauriculotemporalnerve
withfaultyregeneration,thereforeFrey'ssyndromeisalsoknownas
Auriculotemporalsyndrome.
AvariantofFrey'ssyndromeinwhichthereisgustatoryfacial
flushingbutnotsweating,occursfollowingfacialparalysisdueto
faultyregenerationfollowinginjurytothefacialnerve.So,Frey's
syndromeisnotlimitedtoparotidsurgerywithinjuryto
auriculotemporalnerve.

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---

1031.Facialnervepalsycanbecausedby?
a)Cholesteatoma
b)Multiplesclerosis
c)Mastoidectomy
d)Alloftheabove
CorrectAnswer-D
Ans.is'd''i.e.,Alloftheabove
Causesoffacialparalysis
Central:-Brainabscess,pontineglioma,Polio,multiplesclerosis
Intracranialpart(cerebellopontineangle):-Acousticneuroma,
meningioma,congenitalcholesteatoma,metastaticcarcinoma,
meningitis
Intratemporalpart:-
Idiopathic:-Bell'spalsy,Melkersson'ssyndrome
Infections:-ASOM,CSOM,Herpeszosteroticus,malignantotitis
externa
Trauma:-Surgical(mastoidectomy,stapedectomy),accidental
(fracturesoftemporalbone)
Neoplasms:-Malignanciesofexternalandmiddleear,glomus
jugular,facialnerveneuroma,metastasis(frombreast,lungetc).
Extracranialpart:-Malignanciesorsurgeryorinjurytoparotidgland
Systemicdiseases:-Diabetes,hypothyroidism,uremia,PAN,
Sarcoidosis(Heerfordt'ssyndrome),leprosy,leukaemia,
demyelinatingdisease

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1032.Defectivefunctionofwhichofthe
followingcauseshyperacusis?
a)VIIInerve
b)7thnerve
c)Stapediusmuscles
d)Anyoftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Anyoftheabove
Hyperacusis
Hyperacusisishearingnormalvoiceaslouder.
Theprotectivemechanismsanormalearemploystominimizethe
harmfuleffectsofloudnoisearemalfunctioninginhyperacusis.
So,noisemayseemtooloudevenwithhearingprotection.
Thereissomespeculationthattheefferentportionoftheauditory
nerveisselectivelydamagedwhilethehaircellsthatallowusto
hearpuretonesinanaudiometricevaluationremainsintact.
Somehavesaiditinvolvesdirectmalfunctionoffacialnerve;asa
result,thestapediusmuscleisunabletodampensound.

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1033.Hyperacusisisdefinedas:
a)Hearingofonlyloudsound
b)Normalsoundsheardasloudandpainful
c)Completelydeaf
d)Abilitytohearinnoisysurroundings
CorrectAnswer-B
Sensationofdiscomfortorpainonexposuretonormalsounds.Seen
ininjurytonervetostapediusandincaseofcongenitalsyphilis
(Hennebertsign)

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1034.Schwartzesignseenin?
a)GlomusJugulare
b)Otosclerosis
c)Meniere'sdiseases
d)Acousticneuroma
CorrectAnswer-B
Ans.is'b'i.e.,Otosclerosis
Symptomsofotosclerosis
Hearingloss:-Bilateralconductivedeafnesswhichispainlessand
progressivewithinsidiousonset.Incochlearotosclerosis
sensorineuralhearinglossalsooccuralongwithconductive
deafness.
Paracusiswillissii:-Anotoscleroticpatienthearsbetterinnoisythan
quietsurroundings.
Tinnitus:-Morecommonincochlearotosclerosis.
Speech:-Monotonous,wellmodulatedsoftspeech.
Vertigo:-isuncommon.
Signsinotosclerosis
Tympanicmembraneisquitenormalandmobile.
In10%ofcasesflamingo-pinkblushisseenthroughthetympanic
membranecalledasSchwartzesign.
Varioustestsshowconductivehearingloss.
Tuningforktestsinotosclerosis
Asotoscleroticpatientshaveconductivedeafness,thetuningfork
testsresultswillbeasfollows:?
1. Rinnes:-Negative
2. Webers:-Lateralizedtotheearwithgreaterconductiveloss.
3. Absoluteboneconduction(ABC):-Normal(canbedecreasedin

---

cochlearotosclerosis).
4. Gellestest:-Nochangeinthehearingthroughboneconduction
whenairpressureofearcanalisincreasedbySiegle'sspeculum.
Audiometryinotosclerosis
Audiometryisoneoftheimportanttoolsinevaluationofapatientof
otosclerosis.Variousaudiometrictestsare:?
1.Puretoneaudiometry
1. Showslossofairconduction,moreforlowerfrequencieswith
characteristicrisingpattern.Boneconductionisnormal.Howeverin
somecases,thereisadipinboneconductioncurvewhichis
maximumat2000Hz(2KHz)andiscalledtheCarhart'snotch.
2.Impedanceaudiometry
Impedanceaudiometryshows:-
Tympanometry
PatientwithearlydiseasemayshowtypeAtympanogram(because
middleearareationisnotaffected)Progressivestapesfixation
resultsinclassicalAstypetympanogram.
Acoustic(stapedialreflex)
Itisoneoftheearliestsignofotosclerosisandpreceedesthe
developmentofairbonegap.Inearlystage,diphasicon-offpatternis
seeninwhichthereisabriefincreaseincomplianceattheonset
andattheterminationofstimulusoccurs.Thisispathognomonicof
otosclerosis.Inlaterstagethereflexisabsent.

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1035.Galle'stestisusedfor?
a)Otosclerosis
b)Juvenileangiofibroma
c)Nasalpolyp
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Otosclerosis
Gelle'stest
Itisaboneconductiontestandexaminestheeffectofincreasedair
pressureinearcanalonhearing.
Increasedairpressureinearcanal(bySiegle'sspeculum)pushes
thetympanicmembraneandossiclesinwardswhichraisesthe
intralabyrinthinepressureandcausesimmobilityofbasilar
membraneanddecreasedhearing.
However,ifearossiclesarealreadyfixedordisconnected,the
pressurecannotbetransferedtoinnerear
Nochangeinhearinginthissituation.
Baseofvibratingtuningforkisplacedonmastoidprocessandair
pressureinearcanalincreased(bySiegle'sspeculum).
Interpretationare:-
PositiveGelle's(decreasedhearingonincreasedpressure)
Normalorsensorineuralhearingloss.h)
NegativeGelle's(Noeffectofpressurechangeinhearing)
Disconnectedorfixedossicularchain.

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1036.Mostcommonboneaffectedby
otosclerosis
a)Externalauditorycanal
b)Bonylabyrinth
c)Mastoidprocess
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Bonylabyrinth
Otosclerosisisaprimarydiseaseofthebonylabyrinth.
Thereisabnormalbonegrowththatcauseshearingloss.
Thereisalteredboneremodeling.
Normally,thetypicalhumanoticcapsuleremodelingrateis
extremelylow.
Inotosclerosis,normalinhibitionofboneremodelingislostresulting
infociofboneremodeling.
Whenremodeledbonebridgesthestapediovestibularjoint,itfixates
thejointandimpedessoundtransmissionmanifestedasconductive
hearingloss.
Themostcommonsiteofdiseaseispromontoryintheregionofthe
anteriormarginofovalwindow,andinadvancedcasesthestapes
becomeankylosedinpositionbyamassofnewspongybone.
Othersites,whichmaybeinvolved,areroundwindowarea,
stapedialfootplate,internalauditorycanal,andsemicircularcanal.

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1037.Inotosclerosis,whichismostaffected?
a)Ovalwindow
b)Roundwindow
c)Footplateofstapes
d)Utricle
CorrectAnswer-A
Ans.is'a'i.e.,Ovalwindow
Themostcommonsiteofdiseaseispromontoryintheregionofthe
anteriormarginofovalwindow,andinadvancedcasesthestapes
becomeankylosedinpositionbyamassofnewspongybone.
Whyisitso?
Thisareaisinvolvedmostcommonlybecauseinthisareaislocated
thefissulaantefenestram,avestigialstructurewhichfrequently
containscartilaginousremnantsandwhichisparticularlyproneto
otoscleroticchanges.
MostcommontypeofotosclerosisStapedial
otosclerosis
MostcommonsiteofotosclerosisFissulaante
fenestram(i.e,justinfrontofovalwindow)
MostcommonsiteforStapedialotosclerosisFissulaante
fenestram(i.e,justinfrontofovalwindow)
MostcommonsiteforcochlearotosclerosisRoundwindow

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1038.Inotosclerosis,thetympanogramis:
a)Lowcompliance
b)Highcompliance
c)Normalcompliance
d)Noneoftheabove
CorrectAnswer-A
Inotosclerosis-Astypecurveisseenwhichisalowcompliance
curve.

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1039.Endolymphaticsacdecompressionis
donein?
a)Menieresdisease
b)Otosclerosis
c)Otitismedia
d)Vestibularschwannoma
CorrectAnswer-A
Ans.is'a'i.e.,Menieresdisease
TreatmentofMeniere'sdisease
Mosttreatmentsareforsymptomsbelievedtobecausedbyexcess
endolymphaticfluid.TreatmentofMeniere'sdiseaseisoftwotypes
:?
A)Medicalmanagement
B)Surgicalmanagement
Medicalmanagement:
TreatmentofMeniere'sdiseasebeginsfirstwithmedical
management.
Medicaltreatmentcontrolstheconditioninovertwothirdofpatients.
Medicalmanagementincludes:?
1.Antihistaminelabyrinthinesedatives(vestibularsedatives)
Manycasescanbecontrolledbyvestibularsedativeslike
prochlorperazine,promethazine,dimenhydramine,andcinnarzine.
2.Anxiolyticandtranquillizers
Manypatientsareanxious,thereforetheymaybehelpedby
anxiolyticandtranquillizerslikediazepam.
3.Vasodilators
Betahistinehydrochlorideappearstobethemostusefulrecent
additiontothemedicalarmamentariumandisroutinelyprescribed

---

formostpatients.Itincreaseslabyrinthinebloodflowbyreleasing
histamine.
Othervasodilatorsemployedincludenicotinicacid,thymoxamine,
inhaledcarbogen(5%CO2with95%02),andhistaminedrip.
Vasodilatorsincreasevascularityofendolymphaticsacandits
ductandtherebyincreasesreabsorptionofendolymphaticfluid.
4.Diuretics(furosemide)
Diureticswithfluidandsaltrestrictioncanhelptocontrolrecurrent
attacksifnotcontrolledbyvestibularsedativesorvasodilators.
5.Otherdrugs
Propanthelinebromide,phenobarbitoneandhyoscineareeffective
alternatives.
Surgicalmanagement
Surgicaltherapyformeneire'sdiseaseisreservedformedical
treatmentfailuresandisotherwisecontroversial.Surgical
procedurescanbedividedintotwomaincategories
Destructivesurgicalprocedures
Nondestructivesurgicalprocedures
Destructivesurgicalprocedures:rationaleistocontrolvertigo.
Endolymphatichydropscausesfluidpressureaccumulationwithin
theinnerear,whichcausestemporarymalfunctionandmisfiringof
thevestibularnerve.Theseabnormalsignalscausevertigo.
Destructionoftheinnerearand/orthevestibularnerveprevents
theseabnormalsignals.Theproceduresperformedare:
Labyrinthectomy
Intermittentlowpressurepulsetherapy(Meniettdevicetherapy)
Conservativesurgicalprocedures:areusedincaseswherevertigo
isdisablingbuthearingisstilluseful&needstobepreserved.They
are:
Decompressionofendolymphaticsac
Endolymphaticshuntoperation
Sacculotomy(Fick'soperation&Cody'stackprocedure)
Vestibularneuronectomy
Ultrasonicdestructionofvestibularlabyrinthtopreservecochlear
function.
Stellateganglionblockorcervicalsympathectomy
Intratympanicgentamycin

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Vestibularnervesection

---

1040.

---

Glomustumorinvadingtheverticalpartof
carotidcanal.Itis?
a)TypeB
b)TypeCI
c)TypeC2
d)TypeC3
CorrectAnswer-C
Ans.is`c'i.e.,TypeC2

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1041.FISCHclassificationisusedfor:
a)Juvenilenasopharyngealangiofibroma
b)Nasopharyngealca
c)Vestibularschwannoma
d)Glomustumour
CorrectAnswer-D
Aclassificationsystem(A-D)describingglomustumorsbasedon
anatomiclocationandsize,withlargerletteringrepresentingmore
extensivetumors.

---

1042.Siteofglomusjugulare?
a)Epitympanum
b)Hypotympanum
c)Mesotympanum
d)Internalear
CorrectAnswer-B
Ans.is'b'i.e.,Hypotympanum
Glomustumor
Glomustumoristhemostcommonbenigntumorofmiddleear.
Itarisesfromtheglomusbodies,thereforenamedGlomustumor.
Itiswellrecognisedthatglomustumorsarisefromparaganglions,
whicharenormallyoccuringstructuresusuallyfoundinclose
associationwithsympatheticganglionsalongtheaortaanditsmain
branches.
Thechiefcells(paraganglioniccells)oftheparaganglionsareof
neuralcrestoriginandarecomponentsofthediffuse
neuroendocrinesystem(DNES).
Theseparaganglioniccellsarederivedfromembryonic
neuroepithelium(neuralcrest).
Glomustumorsarealsoreferredtoaschemodectomasor
nonchromaffinparagangliomas.
Therearetwotypesofglomustumors:-
Glomusjugulare
Theseglomustumorsarisefromthedomeoftheinternaljugular
veininthehypotympanumandjugularforamen.Injugularforamen
theycaninvadeIXtoXIIcranialnerves.
Glomustympanicum
Theyarisefromthepromontoryofthemiddleearalongthecourse

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ofthetympanicbranchoftheIXthcranialnerve.
Althoughrare,glomustumorsarethemostcommontumorofthe
middleearandaresecondtoacousticneuroma(vestibular
schwannoma)asthemostcommontumorofthetemporalbone.
Itismorecommoninfemaleswithfemaletomaleratioof3-6:1.
Glomusjugularetumorshavealsobeennotedtobemorecommon
ontheleftside,especiallyinfemales.oMosttumorsoccurinpatient
40-60years.
Multicentrictumorsarefoundin3-10%ofsporadiccasesandin25-
50%offamilialcases.

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1043."Risingsun"appearanceisseenin-
a)ASOM
b)CSOM
c)Glomustumor
d)Acousticneuroma
CorrectAnswer-C
Ans.is'c'i.e.,Glomustumor
Clinicalfeaturesofglomustumor
Theearliestsymptomsofglomustumourispulsatiletinnitus
(earliest)andhearingloss.Hearinglossisconductiveandslowly
progressive.Thesearefollowedbybloodstainedotorrhoeaand
earache.
Beforethetympanicmembrane(eardrum)isperforatedared
swellingisseentoarisefromthefloorofmiddleear,i.e."Rising
sun"appearance.Thisresultsinaredreflexthroughtheintact
tympanicmembrane.
Sometimes,eardrummaybebluishandbulging.oPulsationsign
(Brownsign)ispositive,i.e.whenearcanalpressureisraisedwith
Siegle'sspeculum,tumorpulsatesvigorouslyandthenblanches;
reversehappenswithreleaseofpressure.
Aquinosignispositive,i.e.blanchingofmasswithmanual
compressionofipsilateralcarotidartery.
Whenthetumourperforatestheeardrumapolypuswillbeseenin
themeatusandthiswillbleedprofuselyiftouched.
Cranialnervepalsiesisalatefeatureappearingseveralyearsafter
auralsymptoms.IXthtoXIV'cranialnervesmaybeparalysed.This
cancausedysphagiaandhoarseness,andweaknessoftrapezius
andsternocleidomastoidmuscles,unilateralparalysisofsoftpalate,

---

pharynxandvocalcord.
Ausculationwithstethoscopeoverthemastoidmayrevealaudible
systolicbruit.
Someglomustumourssecretecatecholaminesandproduce
symptomsliketachycardia,arrhythmias,sweating,flushingand
headacheetc.
Facialpalsymaybecausedbyglomustympanicumtypeofglomus
tumor.
Audiometryshowsconductivedeafness,Howeverifinnerearis
invaded,mixedconductiveandsensorineuralhearinglossisseen.

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1044.Allofthefollowingcranialnervesare
involvedinAcousticneuroma,except?
a)Vagus
b)Glossopharyngeal
c)Oculomotor
d)Facial
CorrectAnswer-C
Ans.is'c'i.e.,Oculomotor
Clinicalfeaturesofacousticneuroma
Theclinicalfeaturesdependontheextentoftumorandinvolved
structure:?
Whentumorisstillconfinedtotheinternalauditorycanal
Cochleovestibularsymptomsaretheearliestsymptomsofacoustic
neuromawhentumourisstillconfinedtointernalauditorycanal.The
commonestpresentingsymptomsareunilateraldeafnessortinnitus,
oracombinationofboth.Hearinglossisretrocochlearsensorineural
type.Thereismarkeddifficultyinunderstandingspeech,outof
proportiontothepuretonehearingloss,acharacteristicfeatureof
acousticneuroma.Vestibularsymptomsareimbalanceor
unsteadiness.Truevertigoisveryrare.
WhentumorextendsbeyondIACandinvolvesotherstructures
Vhcranialnerve:-Itistheearliestnervetobeinvolved.Thereis
reducedcornealsensitivityandlossofcornealreflexwhichisthe
earliestsignofacousticneuroma.Numbnessorparaesthesiaofface
mayoccur.InvolvementofVthnerveindicatesthattumorisroughly
2.5cmindiameterandoccupiestheCPangle.
VIPnerve:-Sensoryfibresoffacialnerveareinvolved.Thereis
hypoesthesiaofposteriormeatalwall(Hitzelberg'ssign),lossof

---

taste,andlossoflacrimationonSchirmer'stest.Motorfibresare
moreresistant.
IXthandA'nerves:-Dysphagiaandhoarsenessduetopalatal,
pharyngealandlaryngealparalysis.
Brainstem:-Ataxia,weakness,numbnessofarms&legs,
exaggeratedtendonreflexes.
Cerebellum:-Ataxia,Dysdiadochokinesia,Nystagmus.
DuetoraisedICT:-Headache,neusea,vomiting,diplopiaduetoVI'
nerveinvolvement,andpapilloedema.

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1045.Associatedwithobjectivetinnitus?
a)Meinersdisease
b)Acousticneuroma
c)Earwax
d)Glomustumor
CorrectAnswer-D
Ans.is`d'i.e.,Glomustumor
Tinnitus
Tinnitusisringingsoundornoiseintheear.
Thecharacteristicfeatureisthattheoriginofthissoundiswithinthe
patient.
Twotypesoftinnitushavebeendescribed:?
a.Subjective
I.OtologicII.Non-otologic
ImpactedwaxDiseaseofCNS
FluidinthemiddleearAnaemia
AcuteandchronicotitismediaArteriosclerosis
AbnormallypatenteustachiantubeHypertension
Meniere'sdiseaseHypotension
OtosclerosisHypoglycaemia

---

1046.Referredearpainmaytravelthroughall
except?
a)Trigeminalnerve
b)Glossopharyngealnerve
c)Abducensnerve
d)Vagusnerve
CorrectAnswer-C
Ans.is'c'i.e.,Abducensnerve
Referredotalgia
AsearreceivesnervesupplyfromVth(auriculotemporalbranch),
IXth(tympanicbranch)andXth(auricularbranch)cranialnerves;
andfromC2(lesseroccipital)andC2andC3(greaterauricular),pain
maybereferredfromtheseremoteareas:
1.ViaVthcranialnerve
1. Dental:-Cariestooth,apicalabscess,impactedmolar,
malocclusion.
2. Oralcavity:-Benignormalignantulcerativelesionsoforalcavityor
tongue.
3. Temporomandibularjointdisorders:-Bruxism,osteoarthritis,
recurrentdislocation,ill-fittingdenture.
4. Sphenopalatineneuralgia
Viintensitywillhearit.Therefore,ifidenticalvibratingtuningforks
areheldatequaldistancesfrombothearstheyareheardinboth
ears.However,ifonetuningforkismovedclosertooneearthe
personhearsonlythatforkalthoughtheotherforkisstillvibrating
sufficientlyforhimtohear.Instengertest,twovibratingtuningforks
areheldequidistantfromeitherear.Ifthepatientisclaiming

---

deafnessinhisleftearhewillclaintohearonlytheforkonhisright
side.Theforkontheleftsideismovedcloser.Ifthepatientis
feigningdeafnesshewillperceiveonlythetuningforkontheleft
sideandwillclaimnottohearanything.Ifthepatienthasagenuine
hearinglossonthelefthewillstillhearthetuningforkontheright
side.
2.Tealtest
Thiscanbeusedwhenthepatientadmitstohearingbone
conductioninhis'deaf'ear.Theexaminerstandsbehindthepatient
andappliesatuningforktothemastoidprocessofhis'deaf'ear.
Thepatientadmitsto
aIXthcranialnerve
1. Oropharynx:-Acutetonsillitis,peritonsillarabscess,tonsillectomy.
Benignormalignantulcersofsoftpalate,tonsilanditspillars.
2. Baseoftongue:-Tuberculosisormalignancy
3. Elongatedstyloidprocess.
3.ViaXthcranialcerve:
Malignancyorulcerativelesionofvallecula,epiglottis,larynxor
laryngopharynx,oesophagus.
4.ViaC2andC3spinalnerves:
Cervicalspondylosis,injuriesofcervicalspine,cariesspine.

---

1047.Electrodeofcochlearimplantisplaced
at?
a)Horizontalsemicircularcanal
b)Scalamedia
c)Scalatympani
d)Scalavestibuli
CorrectAnswer-C
Ans.is'c'i.e.,Scalatympani
[RefEssentialsotolaryngology2d/ep.82]
Cochlearimplants
Internalcomponent:-
ltcontainsreceiver/stimulatorwhichisimplantedundertheskinand
electrodewhichisimplantedinthescalatympaniofthecochleaa
cochleostomyopeninginthebasalturnofcochlea.
Itmayalsobeplacedatotherlocationslikepromontoryorround
windowbutthesesiteshaspoorerperformance.

---

1048. Fractureofwhichofthefollowingbone
causesleakageofcerebrospinalfluid
throughear?
a)Mastoidprocess
b)Petroustemporal
c)Ethmoidplate
d)Cribriformplate
CorrectAnswer-B
Ans.is`b'i.e.,Petroustemporal
CSFotorrhea
CSFotorrhea,i.e.,leakageofcerebrospinalfluidthroughear
structure,isararebutpotentiallylifethreateningsituationthat
requiresrapidintervention.
Theunderlyingetiologyofspinalfluidleakthroughtemporalboneis
aviolationofthebonyandmeningealbarriersthatseparatethe
subarachoidspacefromthemiddleearandmastoid.
Thismeansthatadefectmustexistnotonlyinthebone,butalsoin
theduramatter.
CausesofCSFotorrheaare:?
1.Congenital:-Defectinoticcapsule.
2.Acquired:-Morecommonthancongenitalandcauseare:-
1. Surgery:-Post-operativeleakageisthemostcommoncauseofCSF
otorrhea.Surgicalcausesareacousticneuromaremoval,skullbase
surgeriesandsometimesmastoidsurgery.
2. Trauma:-FractureofpetrouspartoftemporalcanleadtoCSF
otorrhea.
3. Infection

---

3.Spontaneous:-Itiswithoutanobviousantecedentpathology.
Theremaybesomedefectinthetemporalbone.

---

1049.IndicationofBAHA(Bone-anclored
hearingaid)
a)Bilateralhearingloss
b)Sensorineuralhearingloss
c)Congenitalcanalatresia
d)Alloftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Congenitalcanalatresia
IndicationsforBAHA
Whenair-conduction(AC)hearingaidconnotbeused;
Canalatresia,congenitaloracquired,notamenabletotreatment.
Chroniceardischarge,notamenabletotreatment.
Excessivefeedbackanddiscomfortfromair-conductionhearingaid.
Conductiveormixedhearingloss,e.g.otoscierosisand
tympanosclerosiswheresurgeryiscontraindicated.
Single-sidedhearingloss.

---

1050.Muller'smanoeuverisused?
a)Tofindoutopeningofmouth
b)Toremovelaryngealforeignbody
c)Tofinddegreeofobstructioninsleepdisorderedbreathing
d)Toremoveforeignbodyfromear
CorrectAnswer-C
Ans.is'c'i.e.,Tofinddegreeofobstructioninsleepdisordered
breathing
Muller'smanoeuvre
Usedtofindthelevelanddegreeofobstructioninsleep-
disorderedbreathing.
Itisperformedwhileusingflexiblenasopharyngoscope.
Firsttheexaminerseestheupperairwaysatrestandthenduring
thetimewhenpatientmakesmaximalinspiratoryeffortwithnose
andmouthclosed.
Baseoftongue,lateralpharyngealwallandpalateareexaminedfor
collapsibilityandthenratedform0(minimalcollapse)to4+
(completecollapse).

---

1051.Hyponasalvoiceisseeninallexcept?
a)Adenoids
b)Nasalpolyp
c)Cleftpalate
d)Habitual
CorrectAnswer-C
Ans.is'c'i.e.,Cleftpalate
Causeofhyponasalityandhypernasality
HyponasalityHypernasality
CommoncoldVelopharyngealinsufficiency
NasalallergyCongenitallyshortsoftpalate
NasalpolypSubmucouspalate
NasalgrowthLargenasopharynx
AdenoidsCleftofsoftpalate
NasopharyngealmassParalysisofsoftpalate
FamilialspeechpatternPost-adenoidectomy
HabitualOronasalfistulaFamilialspeechpattern
Habitualspeechpattern

---

1052.Majorcontributionintheformationof
nasalseptumisbyallexcept?
a)Septalcartilage
b)Vomer
c)Ethmoid
d)Nasalbone
CorrectAnswer-D
Ans.is'd'i.e.,Nasalbone
Themedialwall,ornasalseptum,isformed(fromanteirorto
posterior)by:
(1)theseptalcartilage(destroyedinadriedskull)
(2)theperpendicularplateoftheethmoidbone,and
(3)thevomer.Itisusuallydeviatedtooneside.
Thevomercontributestotheinferiorportionofthenasalseptum;
theperpendicularplateoftheethmoidbonecontributestothe
superiorportion.

---

1053.Trueaboutexternalnose?
a)Upper2/3isbony
b)Lower1/3iscartilaginous
c)Singlelateralcartilage
d)Twonasalbones
CorrectAnswer-D
Ans.is'd'i.e.,Twonasalbones
Externalnosehasanosteocartilaginousframeworkofwhichupper
one-thirdisbonyandlowertwo-thirdiscartilaginous.
1. Bonypart:-Consistsoftwonasalbones.
2. Cartilagenouspart:-Consistsoftwoupperlateralcartilages,two
lowerlateralcartilages,twoormorelessaralar(orsesmoid)
cartilagesandaseptalcartilage.So,thereare3pairedand1
unpairedcartilages.

---

1054.Allofthefollowingarteriescontributes
toLittle'sareaEXCEPT:
a)AnteriorEthmoidalartery
b)PosteriorEthmoidalartery
c)Sphenopalatineartery
d)Greaterpalatineartery
CorrectAnswer-B
Kiesselbach'splexus
ItliesinKiesselbach'sarea/Kiesselbach'striangle/Little'sarea
Itisaregionintheanteroinferiorpartofthenasalseptumwherefour
arteriesanastomosetoformavascularplexusofthatname.The
arteriesare:
-AnteriorEthmoidalartery(fromtheOphthalmicartery)
-Sphenopalatineartery(terminalbranchoftheMaxillaryartery)
-Greaterpalatineartery(fromtheMaxillaryartery)
Septalbranchofthesuperiorlabialartery(fromtheFacialartery)
AlthoughthePosteriorEthmoidalarteryalsosuppliestheseptumof
thenose,itdoesnotcontributetotheplexus.

---

1055.Whatisnottrueaboutuseofintranasal
steroidsinnasalpolyposis?
a)Reducerecurrence
b)Reduceobstruction
c)Effectiveineosinophilicallypredominantpolyponly
d)Maycauseepistaxis
CorrectAnswer-C
Ans.is'c'i.e.,Effectiveineosinophilicallypredominantpolyponly
Intranasalsteroidshavebeenusedextensivelyasfirst-line
managementofnasalpolyposiswithfewsideeffects
Usually,patientswithsmallpolypsandlimitedinvolvementonCT
scanaregoodcandidatesfortopicaltherapyalone.
Intranasalsteroidsreducenasalobstruction,polypsize,drainage
andpolyprecurrence.
Theeffectofsteroidsseemstobenonspecific,improvingsymptoms
inbotheosinophilicallyandnoneosinophilicallydominated
polyps.
Nasalbleedingisthemostcommonadverseeventandcan
usuallybeminimizedbydirectingthemedicationawayfromnasal
septum.

---

1056.AllaretrueaboutRhinoscleroma,
except?
a)Mikuliczcells
b)Causedbyfungus
c)MorecommoninNorthernarea
d)Woodynose
CorrectAnswer-B
Ans.is'b'i.e.,Causedbyfungus
Rhinoscleromaiscausedbyabacterium.
Rhinoscleroma
ThecausativeorganismisKlebsiellarhinoscleromatisorFrisch
bacillus,whichcanbeculturedfromthebiopsymaterial.
Thediseaseisendemicinseveralpartsofworld.
InIndia,itisseenmoreofteninnorthernthaninthesouthernparts.
Biopsyshowsinfiltrationofsubmucosawithplasmacells,
lymphocytes,eosinophils,Mikuliczcells&Russellbodies.
Thelattertwoarediagnosticfeaturesofthedisease.
Thediseasestartsinthenose&extendstonasopharynx,
oropharynx,larynx,trachea&bronchi.
Modeofinfectionisunknown.
Bothsexesofanyagemaybeaffected.
Clinicalfeaturesofrhinoscleroma
Thediseaserunsthroughthefollowingstages:?
a.Atrophicstage:Itresemblesatrophicrhinitisandis
characterisedbyfoulsmellingpurulentnasaldischargeandcrusting.
b.Granulomatousstage:Granulomatousnodulesforminnasal
mucosa.Thereisalsosubdermalinfiltrationoflowerpartofexternal
noseandupperlipgivinga'woody'feel.Nodulesarepainlessand

---

non-ulcerative.
c.Cicatricialstage:Thiscausesstenosisofnares,distortionof
upperlip,adhesionsinthenose,nasopharynxandoropharynx.
Theremaybesubglotticstenosiswithrespiratorydistress.
Biopsyofrhinoscleromashowsinfiltrationofsubmucosawithplasma
cells,lymphocytes,eosinophils,MikuliczcellsandRussellbodies.
Thelattertwoarethediagnosticfeaturesofthedisease.
Treatment
Bothstreptomycin&tetracyclinearegiventogetherforminimumof
4-6wks.Steroidcanbecombinedtoreducefibrosis.Surgical
treatmentmayberequiredtoestablishtheairwayandcorrectnasal
deformity

---

1057.AllareseeninSamterstriadexcept?
a)Asthma
b)Nasalpolyp
c)Bacterialinfection
d)Aspirinsensitivity
CorrectAnswer-C
Ans.is'c'i.e.,Bacterialinfection
Samter'striad
Samter'striadisamedicalconditionconsistingofasthma,aspirin
sensitivity,andnasaL'ethmoidalpolyposis.Itoccursinmiddleage
(twentiesandthirtiesarethemostcommononsettimes)andmay
notincludeanyallergies.oMostcommonly,thefirstsymptomis
rhinitis.
Thedisordertypicallyprogesestoasthma,thenpolyposis,with
aspirinsensitivitycominglast.
Theaspirinreactioncanbesevere,includinganasthmaattack,
anaphylaxis,andurticariainsomecases.Patientstypicallyreactto
otherNSAIDSsuchasibuprofen,althoughparacetamolisgenerally
consideredsafe.
Anosmia(lackofsmell)isalsotypical,astheinflammationreaches
theolfactoryreceptorsinthenose.

---

1058.Strawberryoppearanceisseenin?
a)Lupusvulgarsis
b)Rhinoscleroma
c)Rhinosporidiosis
d)Angiofibroma
CorrectAnswer-C
Ans.is'c'i.e.,Rhinosporidiosis
Rhinosporidiosis
Rhinosporidiosisisachronicgranulomatousinfectionofthemucous
membranethatusuallymanifestsasvascularfriablepolypsthat
arisefromthenasalmucosa.Theetiologicalagentis
Rhinosporidiumseeberi.Rhinosporidiumseeberiisanaquatic
bacterum(notafungus).Infectionusuallyresultsfromalocal
traumaticinoculationwiththeorganism.ItisseeninIndia,Pakistan
andSriLanka.InIndia,mostofthecasesareseeninSouthern
states.Infectionofthenoseandnasopharynxisobservedin70%of
personswithrhinosporidiosis;infectionofpalpebralconjunctivaor
associatedstructures(includinglacrimalapparatus)isobservedin
15%ofcases.Otherstructuresofthemouthandupperairwaymay
besitesofdisease.Diseaseoftheskin,ear,genitalsandrectum
hasalsobeendescribed.Rhinosporidiosisisaninfectionthat
typicallylimitedtothemucosalepithelium.Thediseaseprogress
withlocalreplicationofRseeberiandassociatedhyperplastic
growthofhosttissueandalocalizedimmuneresponse.
ClinicalfeaturesofRhinosporidiosis
Rhinosporidiosispresentsassoftleafypolypoidalmass(softpolyp),
whichispinktopurpleincolourstuddedwithwhitedots,i.e.
strawberryappearance.Thisappearanceresultsfromsporangia,

---

whichisvisibleasgreyoryellowspotsinthevascularpolypoid
masses.Becausethepolypsarevascularandfriable,theybleed
easilyuponmanipulation.
Treatment
Thetreatmentofchoiceissurgicalexcision.Completeexcisionof
massisdonewithdiathermyknifeandcauterizationofbase.
Dapsoneisbeingtriedfortreatingrhinosporidiosisbutwithlimited
success.

---

1059.Trueaboutrhinophyma:
a)Premalignant
b)Commoninalcoholics
c)Acnerosacea
d)Fungaletiology
CorrectAnswer-C
Rhinophymaisaslow-growingbenigntumorwhichoccursdueto
hypertrophyofthesebaceousglands?ofthetipofthenose.
Seeninlongstandingcasesofacnerosacea.
Mostlyaffectsmenpastmiddleage.
Presentsasapink,lobulatedmassoverthenose.
Treatment
Paringdownthebulkofthetumorwithasharpknife,orcarbon
dioxidelaserorscalpel(dermabraions),andtheareaisallowedto
re-epithelize.
Sometimestumoriscompletelyexcisedandtherawareaiscovered
withskingraft.

---

1060.Potatotumoris
a)Rhinosporidiosis
b)Hypertrophiedsebaceousgland
c)Nosopharyngealangiofibroma
d)Tubercularinfection
CorrectAnswer-B
Ans.is'b'i.e.,Hypertrophiedsebaceousgland
Rhinophyma(Potatotumor)
Rhinophymaisabenigntumoroftipofnoseduetohypertrophyof
sebaceousgland.
Itiscausedbygranulomatousinfiltrationandoccursasa
complicationoflongstandingacnerosacea.
Alcoholismismistakenlyattributedasacauseofthisdisease,but
heavyalcoholconsumptiondoesaggravatethecondition.
Theusualpresentationisduetocosmeticappearanceor
obstruction.
Treatmentofchoiceisdebulkingoftumorbycarbandioxidelaser.

---

1061.Saddlenoseis?
a)Depressednose
b)Crookednose
c)Deviatednose
d)C-shaped
CorrectAnswer-A
Ans.is'a'i.e.,Depressednose
Saddlenose(Depressednose)
Nasaldorsumisdepressed(saggingofthebridgeofnose).
Depressednasaldorsummayinvolveeitherbony,cartilaginousor
bothbonyandcartilaginouscomponents.Mostcommonetiology:
Nasaltrauma
Causesarehematoma,excessivesurgicalremoval,trauma,syphilis,
abscess,Leprosy,andtuberculosis.
Crookedordeviatednose
Crookednoseistheexternaldeviationofnoseduetodeviationof
thedorsalborderofseptalcartilage,forminga`C'or'S'shaped
curve.
Incrookednose,themidlinedorsumiscurvedin'C'or'S'shaped
mannerfromthefrontonasalangletothetipofnose.
Inadeviatednose,themidlineisstraightbutdeviatedtooneside,
midlineisnotcurvedasincrookednose.

---

1062.Tonsillarfossaisboundedanteriorlyby
?
a)Pharyngobasilarfascia
b)Palatopharyngealfold
c)Buccopharyngealfascia
d)Palatoglossalfold
CorrectAnswer-D
Ans.is'd'i.e.,Palatoglossalfold
Palatinetonsilsaremassesoflymphoidtissuethatcanbeseenon
theleftandrightsidesatthebackofthethroat.
Therearetwopalatinetonsils,andeachpalatinetonsil(rightorleft)
liesinthetonsilarsinus(tonsilarfossa)onthelateralwallof
oropharynx.
Tonsillarfossaboundedbythepalatoglossalfoldinfrontandthe
palatopharyngealfoldbehind.
Tonsilsarelinedbynon-keratinizedstratifiedsquamousepithelium.
Medialsurfaceofeachtonsilhas15-20crypts,thelargestofwhich
iscalledIntratonsillarcleftorcryptamagna(whichrepresents
persistenceoftheventralportionofthesecondpharyngealpouch).
Tonsillarbedisformedfromwithin-outwardsby:-
LiPharyngobasilarfascia
Superiorconstrictor(above)andpalatopharyngeusmuscle
Styloglossus(below)
Buccopharyngealfascia

---

1063.Posteriorepistaxisoccursfrom:
a)Woodruffsplexus
b)Kiesselbach'splexus
c)Atherosclerosis
d)Littlesarea
CorrectAnswer-A

---

1064.PredisposingfactorforNasalmyiasis?
a)Allergicrhinitis
b)Vasomotorrhinitis
c)Atrophicrhinitis
d)Rhinitismedicomentosa
CorrectAnswer-C
Ans.is'c'i.e.,Atrophicrhinitis
Nasalmyiasis(Maggotsinnose)
Itresultsfromthepresenceofovaoffliesparticularlychrysomia
speciesinthenosewhichproduceulcerationanddestructionof
nasalstructure.Mostlyseeninatrophicrhinitiswhenthemucosa
becomesinsensitivetoflieslayingeggsinside.
Clinicalfeatures
Initialsymptoms(3-4daysmaggots):-Intenseirritation,sneezing,
headache,bloodstaineddisharge,lacrimation.oLater:-Maggots
maycrawloutofnoseandthereisfoulsmell.
Complications
Destructionofnose,sinuses,softtissuesofface,palateandeyeball.
Fistulaeinnoseandpalate.
Deathoccursduetomeningitis.
Treatment
Chloroformwaterorvapormustbeinstilledinordertoanaesthetize
orkillthemaggotsandsoreleasetheirgripfromtheskin.

---

1065.Mulberrynasalmucosaisseenin?
a)Lupusvulgaris
b)Vasomotorrhinitis
c)Atrophicrhinitis
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Vasomotorrhinitis
Vasomotorisanonallergicconditionthatinvolvesaconstantrunny
nose,sneezingandnasalcongestion,i.e.,thenoseisstuffyorrunny
forreasonsotherthanallergiesandinfections.Theexactetiologyis
unknown,buttriggersincludeemotions,odors,poorairquality,spicy
foods,andmedicationsideeffects.Pathogenesisinclude:-
Parasympatheticoveractivity
Hyperactivenasalmucosatoseveralnon-specificstimuliespecially
inwomenof20-40years.
Symptomsofvasomotorrhinitisincludeexcessiveclearrhinorrhoea,
nasalobstruction/congestion,irritation,paroxysmalsneezingand
post-nasaldrip.Nasalmucosaishypertrophied&congested;and
mucosaofturbinatesmaygivemulberrylikeappearanceandispale
toduskyredincolour.
Complicationsofvasomotorrhinitisincludehypertrophicrhinitis&
sinusitis,andnasalpolyp.
Mulberrynasalmucosaisalsoseeninchronichypertrophicrhinitis

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1066.Queckenstedtestisdonefor?
a)Glomustumor
b)CSFrhinorrhea
c)Otosclerosis
d)Acousticneuroma
CorrectAnswer-B
Ans.is'b'i.e.,CSFrhinorrhea
DetectionofCSFLeak
1.Biochemicaltests
ConcentrationsofGlucosearehigherinCSFthaninnasal
discharge.Glucosevalue>30-40mg%andproteinvalue<100mg
%(max200mg%)supportadiagnosisofCSFleak.
PresenceofI3,transferrinisthemostdefinitivetestfordetectionof
CSFandI32transferrinassayisthetestofchoicewhena
confirmatorytestisneeded,becauseofhighsensitivityaswellas
specificity.
I3-traceprotein(prostaglandinDsynthase)isalsoused,howeverit
isnonspecificasitisalsopresentinhumantestes,heartand
seroma.
2.Basicclinicaltests
Tissuetest(Handkerchieftest):-Unlikenasalmucous,CSFdoes
notcauseatissuetostiffen.
Filterpapertest:-Sampleofnasaldischargeonafilterpaper
exhibitsalightCSFborderandadarkcentralareaofblood,i.e.,
doubleringsignorhalosign.
Queckenstedtest:-Compressionofthejugularveinleasto
increasedCSFleakduetoincreaseinICP.
Rhinoscopy:-VisualizationofCSFleakfromparanasalsinus.

---

3.CSFtracers
Intrathecalfluoresceindyeadminstration,radionuclide
cisternography,CTcisternography.

---

1067.Paranasalsinusespresentatbirth?
a)Frontalandmaxillary
b)Ethmoidandmaxillary
c)Frontalandethmoid
d)Sphenoidandethmoid
CorrectAnswer-B
Ans.is'b'i.e.,Ethmoidandmaxillary
Maxillarysinus4Developatbirth;completelydevelopat9
years
EthmoidalsinusDevelopatbirth;completelydevelopatlate
puberty
FrontalsinusDevelopat2year;completelydevelopat
lateadolescence
SpenoidsinusDevelopat3-5years;completelydevelopat
12-15years

---

1068.Endoscopicsinussurgeryprerequisite?
a)MRIofparanasalsinus
b)CTofPNS
c)Mucocilliaryclearingtesting
d)Acoustictests
CorrectAnswer-B
Ans.is'b'i.e.,CTofPNS
Endoscopicsurgeryofinflammatorydiseasesofparanasalsinuses
(sinusitisorpolyp)requiresaverydetailedpreoperativeknowledge
oftheindividualanatomicalconditionsandpathologicalchanges.
CTscanareusedbesttovisualizesinusareas.
CTscanprovidesexcellentdefinitionofparanasalsinusesand
isaprerequisiteforendoscopicsurgery.
"CTscanlimitedstudycoronalcutsinbonewindowisprerequisite
forendscopicsinussurgery"----MohanBansal

---

1069.Mostcommonsinustobeinvolvedin
acutesinusitis?
a)Ethmoid
b)Maxillary
c)Sphenoid
d)Frontal
CorrectAnswer-B
Ans.is'b'i.e.,Maxillary
Mostcommonsinusaffectedby
Maxillary
sinusitisoverall
Mostcommonsinusaffectedin
Maxillary
adult
Mostcommonsinusaffectedin
Ethmoid
children
Leastcommonsinusaffected
Sphenoid
Sinusesinvolvedinorderof
Maxillary>Frontal>Ethmoid>
frequency
Sphenoid

---

1070.Allaremajorsymptomsofsinusitis
except?
a)Nasalbluckage
b)Facialcongertion
c)Nasalcongestion
d)Halitosis
CorrectAnswer-D
Ans.is'd'i.e.,Halitosis
Theclinicalsymptomsofacutesinusitishavebeenclassifiedinto
majorandminor
Major
Minor
Facialpainorpressure Headache
Purulentnasal
Cough
discharge
Fatigue
Fever
Halitosis
Nasalcongestion
Dentalpain
Nasalobstruction
Earpainor
HyposmiaorAnosmia pressure
Facialcongestionor
fullness

---

1071.ParanasalpolypCTview?
a)Corona!
b)Axial
c)Sagital
d)3D
CorrectAnswer-A
Ans.is'a'i.e.,Coronal
Bothcoronalandaxialviewareused,butcoronalviewsarebestto
studyparanasalsinuspolyps.

---

1072.Investigationofchoicefor
nasopharyngealangiofibroma?
a)X-ray
b)MRI
c)Plane-CT
d)CT-contrast
CorrectAnswer-D
Ans.is'd'i.e.,CTcontrast
Ref:DhingraSth/ep.262
CTscanofheadwithcontrastenhancementistheinvestigationof
choiceforJNA.

---

1073.Transversefractureofmaxillais?
a)LeFort-1
b)LeFort-2
c)LeFort-3
d)Cranifacialdisruction
CorrectAnswer-A
Ans.is'a'i.e.,LeFort-1
Itisclassifiedinto3types:?
1. LeFortI(transverse)fracturerunsaboveandparalleltotheplate.It
crosseslowerpartofnasalseptum,maxillaryantraandthe
pterygoidplates.
2. LeFortII(pyramidal)fracturepassesthroughtherootofnose,
lacrimalbone,flooroforbit,upperpartofmaxillarysinusand
pterygoidplates.Thisfracturehassomefeaturescommonwiththe
zygomaticfractures.
3. LeFortIII(craniofacialdysfunction).Thereiscompleteseparationof
facialbonesfromthecranialbones.Thefracturelinepassesthrough
rootofnose,ethmofrontaljunction,superiororbitalfissure,lateral
walloforbit,frontozygomaticandtemporozygomaticsuturesandthe
upperpartofpterygoidplates.

---

1074.Ethmoidalpolypis?
a)Duetoinfection
b)Single
c)Recurrent
d)Occursinchildren
CorrectAnswer-C
Ans.is'c'i.e.,Recurrent

---

1075.Teardropsignisseenin?
a)Fracturezygomaticarch
b)Fracturemaxilla
c)Fracturemandible
d)Blowoutfracture
CorrectAnswer-D
Ans.is'd'i.e.,Blowoutfracture
Fracturesoftheflooroftheorbit
ZygomaticfractureandLefortIImaxillaryfracturesarealways
accompaniedbyfracturesoforbitalfloor.
Isolatedfracturesoforbitalfloor,whenalargebluntobjectstrikes
theglobe,arecalled"blowoutfractures".
Clinicalfeatures
Ecchymosisoflid,conjunctivaandsclera.
Endophthalmoswithinferiordisplacementoftheeye-ball.This
becomesapparentwhenoedemasubsides.
Diplopia,whichmaybeduetodisplacementoftheeyeballor
entrapmentofinferiorrectusandinferiorobliquemuscles.
Hypoaesthesiaoranaesthesiaofcheekandupperlip,ifinfraorbital
nerveisinvolved.
Diagnosis
JWater'sviewshowaconvexopacitybulgingintotheantrumfrom
above,i.e.,Teardropopacity.
CTscanisdiagnostic.

---

1076.Mostcommoncauseofacutetonsilitis
?
a)Streptococcuspneumoniae
b)H.Influenza
c)13-hemolyticstreptococci
d)Staphylococcusaureus
CorrectAnswer-C
Ans.is'c'i.e.,13-hemolyticstreptococci
Tonsilsfrequentlyserveasthesiteofacuteinfection,whichcauses
acutetonsillitis.
Tonsillitisisparticularlycommoninchildren,especiallyinschool
goingagegroup.However,itcanoccurinadultalso.
Virusinitiatesanacutetonsillitisattackandpredisposestobacterial
infection.
8-hemolyticstreptococcusisthemostcommonorganismcausing
acutetonsillitis.
Otherbacteriacausingacutetonsillitisarestaphylococcus,
hemophilusandpneumococcus.

---

1077.Peritonsillarabscessiscausedmost
commonlyby?
a)Streptococcuspneumoniae
b)Staphylococcusaureus
c)Betahemolyticstreptococcus
d)H.influenzae
CorrectAnswer-C
Ans.is'c'i.e.,Betahemolyticstreptococcus
Peritonsillarabscess(Ouinsy)
Quinsyconsistsofsuppurationoutsidethecapsuleinthearea
aroundthecapsule.Thereiscollectionofpusbetweenthecapsule
oftonsilandthesuperiorconstrictormuscle,i.e.intheperitonsillar
area.
Peritonsillarabscessisacomplicationoftonsillitisandismost
commonlycausedbygroupAbeta-hemolyticstreptococcus.
ClinicalfeaturesofQuinsy
Clinicalfeaturesaredividedinto:?
General:Theyareduetosepticaemiaandresembleanyacute
infection.
1. Theyincludefever(upto104?F),chillsandrigors,generalmalaise,
bodyaches,headache,nauseaandconstipation.
2. Local:
3. Severepaininthroat.Usuallyunilateral.
4. Odynophagia.Itissomarkedthatthepatientcannotevenswallow
hisownsalivawhichdribblesfromtheangleofhismouth.Patientis
usuallydehydrated.
5. Muffledandthickspeech,oftencalled"Hotpotatovoice".
6. Foulbreathduetosepsisintheoralcavityandpoorhygiene.

---

7. Ipsilateralearache.ThisisreferredpainviaCNIXwhichsupplies
boththetonsilandtheear.
8. Trismusduetospasmofpterygoidmuscleswhichareinclose
proximitytothesuperiorconstrictor.
Examinationfindings
1. Thetonsil,pillarsandsoftpalateontheinvolvedsidearecongested
andswollen.Tonsilitselfmaynotappearenlargedasitgetsburied
intheoedematouspillars.
2. Uvulaisswollenandoedematousandpushedtotheoppositeside.
3. Bulgingofthesoftpalateandanteriorpillarabovethetonsil.
4. Mucopusmaybeseencoveringthetonsillarregion.
5. Cervicallymphadenopathyiscommonlyseen.Thisinvolves
jugulodigastriclymphnodes.
6. Torticollis:Patientkeepsthenecktiltedtothesideofabscess.
Treatmentofperitonsillarabscess
IVfluids
Antibiotics:Highdosepenicllin.(ivbenzipenicillin)istheDOC.In
patientsallergictopenicillinerythromycinistheDOC.
Incisionanddrainageperorally,iftheabscessdoesnotresolve
depitehighdoseofivantibiotics
Tonsillectomyisdone6weeksfollowinganattackofquinsy(interval
tonsillectomy).

---

1078.Killiandehiscenceisin?
a)Superiorconstrictor
b)Inferiorconstrictor
c)Middleconstrictor
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Inferiorconstrictor
Inferiorconstrictormusclehastwoparts:-(i)Thyropharyngeouswith
obliquefibres,and(ii)Cricopharyngeouswithtransversefibres.
Betweenthesetwopartsofinferiorconstrictorexistsapotentialgap
calledKillan'sdehiscence.Itisalsocalledthegatewaytotearas
perforationcanoccuratthissiteduringesophagoscopy.Itisalsothe
siteforherniationofpharyngealmucosaincaseofpharyngeal
pouch.

---

1079.Passavantsridgeisformedby?
a)Palatoglossus
b)Superiorconstrictor
c)Salpingopharyngeus
d)Palatopharyngeus
CorrectAnswer-D
Ans.is'd'i.e.,Palatopharyngeus
Pharynxhastwogroupofmuscles:?
*Intrinsicmuscles:-Stylopharyngeous,salpingopharyngeous,
palatopharyngeous.
*Extrinsicmuscles:-Superiorconstrictor,middleconstrictor,inferior
constrictor.
-Allmusclesofpharynxaresuppliedbycranialaccessorythrough
branchesofvagusviapharyngealplexusexceptstylopharyngeus
whichissuppliedbyglossopharyngeal.
-Inferiorconstrictormusclehastwoparts:-(i)Thyropharyngeous
withobliquefibres,and(ii)Cricophatyngeouswithtransversefibres.
-Betweenthesetwopartsofinferiorconstrictorexistsapotential
gapcalledKillan'sdehiscence.Itisalsocalledthegatewaytotear
asperforationcanoccuratthissiteduringesophagoscopy.Itisalso
thesiteforherniationofpharyngealmucosaincaseofpharyngeal
pouch.
-UpperfibersofpalatopharyngeusconstitutethePassavant's
musclewhichoncontractionraisesaridgecalledPassavant'sridge
onposteriorwallofnasopharynx.

---

1080.Lymphaticdrainageoforpharynxis
mainlythrough?
a)Superficialcervicallymphnodes
b)Submandibularnodes
c)Jugulodigastricnode
d)Jugulo-omohyoidnodes
CorrectAnswer-C
Ans.is'c'i.e.,Jugulodigastricnodes
Deepcervicallymphnodesaredividedintotwogroups:-(i)
jugulodigastric,and(ii)jugulo-omohyoid.
Lymphaticsfromoropharynxdrainintojugulodigastricnodes.
Lymphaticdrainageofpharynx
Lymphaticdrainageofpharynxmaybe:?
1.Nasopharynx
Nasopharynxdrainsintoupperdeepcervicalnodeseitherdirectlyor
indirectlythroughretropharyngealorparapharyngealnodes.
Nasopharynxalsodrainsintospinalaccessorychainofnodesinthe
posteriortriangleoftheneck.
2.Oropharynx
Lymphaticsfromtheoropharynxdrainintoupperjugularparticularly
thejugulodigastric(tonsillar)nodes.
Thesoftpalate,lateralandposteriorpharyngealwallsandthebase
oftonguealsodrainintoretropharyngealandparapharyngealnodes
andfromtheretothejugulodigastricandposteriorcervicalgroup.
3.Hyphopharynx
Pyriformsinusdrainsintoupperjugularchain&thentodeep
cervicalgroupoflymphnodes.
Postcricoidregiondrainsintoparapharyngealandparatracheal

---

groupoflymphnodes.
Posteriorpharyngealwalldrainsintoparapharyngeallymphnodes
andfinallytodeepcervicallymphnodes.

---

1081.Acuteretropharyngealabscess,not
true?
a)Duetolymphadenitis
b)Commoninadults
c)Swellingononesideofmidline
d)Incision&drainage
CorrectAnswer-B
Ans.is'b'i.e.,Commoninadults
Retropharyngealabscess
Retropharyngealspaceliesbehindthepharynx,i.e.between
buccopharyngealfasciacoveringpharyngealconstrictormuscles
(anteriorly)andprevertebralfasciacoveringtheprevertebral
muscles(posteriorly).
So,retropharyngealspaceliesbehindthepharyngealconstrictor
musclesandanteriortoprevertebralfasciacoveringtheprevertebral
muscles.
Abscessinthisspacemaypresentdifferentlydependinguponthe
age:?
Abscessininfants(acuteRetropharyngealabscess)
Itiscommonlyseenininfantsandchildrenbelow3yearsof
age.Mostcommonlyitresultsfromretropharyngeal
lymphadenitisduetoanupperrespiratorytractinfection.The
presentionisacute,i.e.childhashightemperatureandsorethroat.
Thereissmoothswelling(bulge)inposteriorpharyngealwall
ononesideofthemidline.Thereisdysphagia,difficultyin
breathing,stridor,croupycoughandtorticollis.Swellingcanbe
palpableperorallyontheposteriorpharyngealwall.Treatmentis
incisionanddrainage.

---

Abscessinadults(chronicretropharyngealabscess)
Ifanadultoranolderchildhasaretropharyngealinfectionitislikely
tobeduetoatuberculousinfectionofthecervicalspine(cariesof
cervicalspine).Sometimeitmaybesecondarytotuberculous
infectionofretropharyngeallymphnodes.Itisofslowonsetand
givesrisetopharyngealdiscomfort,ratherthanpain.Thereis
fluctuantswellinginposteriorpharyngealwall,centrallyinthe
midline(ifitissecondarytocariesofcervicalspine)orononeside
ofmidline(ifitissecondarytotuberculosisofretropharyngeal
nodes).Treatmentincludesincisionanddrainageofabscess
alongwithfullcourseofantituberculartreatment.

---

1082.Mostcommoncauseofretropharyngeal
abscessinadults?
a)TB
b)Toothextraction
c)Tonsillitis
d)Lymphadenitis
CorrectAnswer-A
Ans.is'a'i.e.,TB
Abscessininfants(acuteretropharyngealabscess)
Mostcommonlyitresultsfromretropharyngeallymphadenitisdueto
anupperrespiratorytractinfection.
Treatmentisincisionanddrainage.
Abscessinadults(chronicretropharyngealabscess)
Ifanadultoranolderchildhasaretropharyngealinfectionitislikely
tobeduetoatuberculousinfectionofthecervicalspine(cariesof
cervicalspine).Sometimeitmaybesecondarytotuberculous
infectionofretropharyngeallymphnodes.
Treatmentincludesincisionanddrainageofabscessalongwithfull
courseofantituberculartreatment.

---

1083.Treatmentofchoicefornasopharyngeal
carcinomais?
a)Surgery
b)Radiotherapy
c)Surgery&radiotherapy
d)Chemotherapy
CorrectAnswer-B
Ans.is'b'i.e.,Radiotherapy
Treatmentofnasopharyngealcarcinoma
Irradiationistreatmentofchoice(externalradiotherapy).
Radicalneckdissectionisrequiredforpersistentnodeswhen
primaryhasbeencontrolledandinpostradiationcervical
metastasis.
Systemicchemotherapyisusedaspalliationfordistantmetastases
orradiationfailure.
Foradvancedstages(stageIII&IV),thecureratecanbedoubled
whenchemotherapyiscombinedwithradiotherapy.

---

1084.Inletoflarynxisformedby:
a)Ventricularfold
b)Aryepiglotticfold
c)Glossoepiglotticfold
d)Vocalcord
CorrectAnswer-B
Thelaryngealinlet(laryngealaditus,laryngealaperture)isthe
openingthatconnectsthepharynxandthelarynx.Itsbordersare
formedby:thefreecurvededgeoftheepiglottis,anteriorly.
thearytenoidcartilages,thecorniculatecartilages,andthe
interarytenoidfold,posteriorly.

---

1085.

---

MostcommonpartoflarynxinvolvedinTB?
a)Anterior
b)Posterior
c)Middle
d)Anywhere
CorrectAnswer-B
Ans.is'b'i.e.,Posterior
Essentialotolaryngology2"d/ep.1139]
Diseaseaffectstheposteriorthirdoflarynxmorecommonlythan
anteriorpart.
Thepartsaffectedindescendingorderoffrequencyare:-i)
Interarytenoidfold,ii)Ventricularband,iii)Vocalcords,iv)Epiglottis.

---

1086.Valleculasignisseenin?
a)TBlaryngitis
b)Vocalnodule
c)Invertedpapilloma
d)Acuteepiglottitis
CorrectAnswer-D
Ans.is'd'i.e.,Acuteepiglottitis
Therearetwoimportantradiologicalsignsinacuteepiglottitis:?
1. Thumbsign
2. Volleculasign

---

1087.Bilateralrecurrentlaryngealnervepalsy
isseeninallexcept?
a)Thyroidcarcinoma
b)Lymphadenopathy
c)Thyroidsurgery
d)Aorticaneurysm
CorrectAnswer-D
Ans.is'd'i.e.,Aorticaneurysm

---

1088.Laryngitissiccaisassociatedwith?
a)Rhinosporidium
b)M.leprae
c)Klebsiellaazaenae
d)Klebsiellarhinoscleromatosis
CorrectAnswer-C
Ans.is'c'i.e.,Klebsiellaazaenae
Laryngitissicca(Atrophiclaryngitisorlaryngitisatrophica)
Itisarareentitycharacterizedbyatrophicchangesintherespiratory
mucosawithlossofthemucus-producingglands.
Itisusuallyassociatedwithatrophicrhinitisandpharyngitiscaused
byklebsiellaozaenae.
Themostcommonsitesinvolvedinlarynxarethefalsecords
(vestibularfolds),theposteriorregionandthesubglotticregion.
Morecommoninwomen.
Clinicalfeatures
Irritablecoughandhoarseness
Excessivecrustsformationwhicharesometimesbloodstained
(hemorrhagic)withfoulodour.Crustsarethemostimportant
diagnosticfeature.
Treatment
Eliminationofcausativefactorsandhumidification.
Laryngealsprayswithglucoseinglycerineoroilofpinehelpsin
crustremoval.Expectorantscontainingammoniumchlorideor
iodidesalsohelptoloosenthecrust.
Microlaryngoscopicremovalofcrustinlaryngitissiccaisthenew
modalityoftreatment.

---

1089.Hotpotatovoiceischaracteristicof?
a)Nasopharyngealcarcinoma
b)Glotticcarcinoma
c)Subglotticcarcinoma
d)Supraglotticcarcinoma
CorrectAnswer-D
Ans.is'd'i.e.,Supraglotticcarcinoma
Clinicalfeaturesofsupraglotticcarcinoma
Painonswallowingisthemostfrequentinitialsymptom--Devita
7th/ep.698
Massinneckmaybethefirstsign.
Hoarsnessisalatesymptom.
Painmaybereferredtoearbyvagusnerveandauricularnerveof
arnold.
Latesymptomsincludefoulbreath,dysphagiaandaspiration.
Largetumorscancause"hotpotatovoice/muffledvoice".
Hemoptysis,sorethroat,shortenessofbreath,stridor,otalgiaand
aspirationpneumoniamayalsooccur.

---

1090.Regardingranulaallaretrueexcept:
a)Retentioncyst
b)Arisesfromsubmandibulargland
c)Translucent
d)Plungingmaybeafeature
CorrectAnswer-B

---

1091.Mostcommoncauseoforoantralfistula
?
a)TB
b)Penetratinginjury
c)Toothextraction
d)latrogenic
CorrectAnswer-C
Ans.is'c'i.e.,Toothextraction
Oroantralfistula
Itiscommunicationbetweentheantrumandoralcavity.
Etiology
Dentalextraction:-Mostimportantcauseandmaxillaryfirstmolar
accountsfor50%oforal-antralfistulascausedbyextractions.
Maxillarysecondandthirdmolarextractionsaccountforother50%.
Infection:-TB,syphilis,leprosyofmaxillarybone.
Malignantneoplasm:-Causeserosionofantrum.
Fractureorpenetratinginjuriesofmaxilla.
Midlinegranuloma(aformoflymphoma)
FailureofsublabialincisiontohealafterCaldwell-Lucoperation.
Clinicalfeatures
Regurgitationoffood
Discharge(oftenfoulsmelling)
Inabilitytobuiltpositiveornegativepressureinmouth.

---

1092.Schatzki'sRingispresentat?
a)Upperendoftrachea
b)Lowerendoftrachea
c)Upperendofesophagus
d)Lowerendofesophagus
CorrectAnswer-D
Ans.is'd'i.e.,Lowerendofesophagus
Schatzki'sring
Itoccursatthejunctionofsquamousandcolumnarepitheliumatthe
lowerendofoesophagusandhasalsobeencalledlower
oesophagealring.
Usuallyseeninpatientsabove50yearsofage.
Causeisunknown.
Symptomaticpatientscomplainofintermittentdysphagiaandsome
mayevenpresentwithbolusobstruction.
Itmaybeassociatedwithhiatushernia.
Treatmentisoesophagealdilatation.

---

1093.Proofpunctureisdonethrough?
a)Superiormeatus
b)Middlemeatus
c)Inferiormeatus
d)Sphenoethmoidalrecess
CorrectAnswer-C
Ans.is'c'i.e.,Inferiormeatus
Prooffuncture(Antralpuncture)
Thisprocedureinvolvespuncturingthemedialwallofmaxillarysinus
intheregionofinferiormeatusandirrigatingthesinus.
Indications
1.Chronicandsubacutemaxillarysinusitiswithdualpurposeof:
Confirmingthediagnosisand
Washingoutthepus
2.Tocollectthespecimenoftheantralcontentsforcultureand
sensitivity,orcytologicalexaminationtoexcludeearlymalignancy.
Contraindications
Childrenlessthan12yearsofage.
Acutemaxillarysinusitisasitmayleadtoosteomyelitis
Fractureofmaxillaasfluidmaypassthroughfractureline.
Diabeteshearingit.Theexaminerthensaysthatheisgoingto
repeatthetest,butputsanon-vibratingforkonthemastoidwhileat
thesametimebringingavibratingforkclosetotheauricle.Ifthe
patientismalingering,hewillhearthetuningforkthroughair
conduction,butthinkthatitisbeingheardthroughthebone.Ifheis
reallydeafhewillnothearthefork.
3.Lomard'stest
Thisdependsuponthefactthattothenormalmanthesoundofhis

---

ownvoiceisnecessaryfortheproperregulationofitstoneand
loudness.TheBaranynoiseapparatusisadjustedtothepatient's
soundearanditsmachinerystartedinordertoaccustomhimtoits
gratingnoise.Heisgivenabook,andtoldtoreadaloudinhis
normalvoiceandnottostopreadingwhentheinstrumentissetin
action.Assoonasthenoisebegins,amanwhoseoppositeearis
profoundlydeafwillatonceraisehisvoiceand,ifhisdeafnessis
absolute,mayliterallyshout.Themalingerer,ontheotherhand,
claimingaone-sideddeafnesswhichisnotrealwillcontinuetoread
inaneventoneorinatoneonlyslightlyelevated.
4.Acousticreflex(stapedialreflexthreshold)
Ifstapedialreflexispresent,itrulesoutNOHLbecausestapedial
reflexisnotinvoluntarycontrol.
5.Electricresponseaudiometry(ERA)orcorticalevokedresponse
audiometry
ItisveryusefulinNOHLandcanestablishhearingacuityofthe
persontowithin5-10dBofactualthresholds.
6.Othertests
Gaulttest,Erhard'stest,delayedspeechfeedback.

---

1094.Allareabsoluteindicationsof
tonsillectomyexcept
a)Suspiciousmalignancy
b)Peritonsillarabscess
c)Chronictonsillits
d)Tonsilscausingobstructivesleepapnea
CorrectAnswer-C
Ans.is'c'i.e.,Chronictonsillits
Tonsillectomy
Tonsillectomy,asthenamesuggests,isthesurgicalprocedureto
removethetonsils.
Often,tonsillectomyisdoneatthesametimeasadenoidectomy.
Indications
Indicationsaredividedinto:?
A.Absolute
1.Recurrentinfectionsofthroat.Thisisthemostcommon
indication.Recurrentinfectionsarefurtherdefinedas:
Sevenormoreepisodesinoneyear,or
Fiveepisodesperyearfor2years,or
Threeepisodesperyearfor3years,or
Twoweeksormoreoflostschoolorworkinoneyear.
2.Peritonsillarabscess.
Inchildren.tonsillectomyisdone4-6weeksafterabscesshasbeen
treated.Inadults,secondattackofperitonsillarabscessformsthe
absoluteindication.
3.Tonsillitiscausingfebrileseizures.
4.Hypertrophyoftonsilscausing
Airwayobstruction(sleepapnoea)

---

Difficultyindeglutition
Interferencewithspeech.
5.Suspicionofmalignancy.
Aunilaterallyenlargedtonsilmaybealymphomainchildrenandan
epidermoidcarcinomainadults.Anexcisionalbiopsyisdone.
B.Relative
1. Diphtheriacarriers,whodonotrespondtoantibiotics
2. Streptococcalcarriers,whomaybethesourceofinfectiontoothers.
3. Chronictonsillitiswithbadtasteorhalitosiswhichisunresponsiveto
medicaltreatment.
4. Recurrentstreptococcaltonsillitisinapatientwithvalvularheart
disease.
C.AsapartofAnotherOperation
1. Palatopharyngoplatywhichisdoneforsleepapnoeasyndrome.
2. Glossopharyngealneurectomy.TonsilisremovedfirstandthenIX
nerveisseveredinthebedoftonsil.
3. Removalofstyloidprocess.

---

1095.Earlytonsillectomyisnotdonein?
a)Thyroidstorm
b)Suspectedmalignancy
c)Peritonsillarabscess
d)Rheumaticfever
CorrectAnswer-A
Ans.is'a'i.e.,Thyroidstorm
Uncotrolledsystemichypertensionisacontraindicationfor
tonsillectomy.
InthyroidstormthereisdangerouslyhighBP.
Contraindicationsoftonsillectomy
1. Haemoglobinlevellessthan10g%.
2. Presenceofacuteinfectioninupperrespiratorytract,evenacute
tonsillitis.Bleedingismoreinthepresenceofacuteinfection.
3. Childrenunder3yearsofage.Theyarepoorsurgicalrisks.
4. Overtorsubmucouscleftpalate.
5. Bleedingdisorders,e.g.leukaemia,purpura,aplasticanaemia,
haemophilia.
6. Atthetimeofepidemicofpolio.
7. Uncontrolledsystemicdisease,e.g.diabetes,cardiacdisease,
hypertensionorasthma.
8. Tonsillectomyisavoidedduringtheperiodofmenses.

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1096.Fenestrationoperationiswhichtypeof
tympanoplasty?
a)Type-2
b)Type-3
c)Type-4
d)Type-5
CorrectAnswer-D
Ans.is'd'i.e.,Type-5
Typesoftympanoplasty
Wullsteinclassifiedtympanoplastyintofivetypes:?
TypeI:Defectisperforationoftympanicmembranewhichis
repairedwithagraft.Itisalsocalledmyringoplasty.
TypeII:Defectisperforationoftympanicmembranewith
erosionofmalleus.Graftisplacedontheincusorremnantof
malleus.
TypeIII:Malleusandincusareabsent.Graftisplaceddirectly
onthestapeshead.Itisalsocalledmyringostapediopexyor
columellatympanoplasty.
TypeIV:Onlythefootplateofstapesispresent.Itisexposed
totheexternalear,andgraftisplacedbetweentheovalandround
windows.Anarrowmiddleear(cavumminor)isthuscreated,to
haveanairpocketaroundtheroundwindow.Amucosa-linedspace
extendsfromtheeustachiantubetotheroundwindow.Sound
wavesinthiscaseactdirectlyonthefootplatewhiletheround
windowhasbeenshielded.
TypeV:Stapesfootplateisfixedbutroundwindowis
functioning.Insuchcases,anotherwindowiscreatedonhorizontal
semicircularcanalandcoveredwithagraft.Alsocalledfenestration

---

operation.

---

1097.Intype-4thyroplasty,vocalcordis?
a)Mediallydisplaced
b)Laterallydisplaced
c)Lengthened
d)Shortened
CorrectAnswer-C
Ans.is'c'i.e.,Lengthened
Thyroplasty
Isshikidividedthyroplastyproceduresinto4categoriestoproduce
functionalalterationofvocalcords:-
1. TypeI:Medialdisplacementofvocalcord(donebyinjectionofgel
foam/Teflonpaste)
2. Type2:Lateraldisplacementofcord(donetoimprovetheairway).
3. Type3:Shortening(relax)thecord,tolowerthepitch(gender
transformationfromfemaletomale).
4. Type4:Lengthening(tightening)thecord,toelevatethepitch
(gendertransformationfrommaletofemale),forexampleasa
treatmentofandrophonia.

---

1098.Objectivetestinadenoids
a)Posteriorrhinoscopy
b)Anteriorrhinoscopy
c)Manualpalpation
d)Alloftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Posteriorrhinoscopy

---

1099.Mucoperichondrialflapinseptoplastyis
madeon?
a)Alarcartilage
b)Septalcartilage
c)Maxillaryspine
d)Sphenoidspine
CorrectAnswer-B
Ans.is'b'i.e.,Septalcartilage
Stepsinseptoplasty
Aunilateralincisionismadeinthemucoperichodrialflapatthelower
borderofseptalcartilageontheleftsideinrighthandedpersons.
Themucoperichondrialflapiselevatedononesidemakingan
anteriortunnel.
Anotherincisionismadeinthemucoperiosteumoverthenasal
spineonthesameside,elevatingthemucoperiosteumfromnasal
spineonbothsidesthusmakingtwomoretunnelscalledinferior
tunnels.Twotunnelsarejoinedbysharpdissection.
Septalcartilageisthenseparatedfromvomero-ethmoidbones
posteriorlyandnasalspineinferiorly.
Maxillarycrestisremovedtorealignseptalcartilage.
Bonyseptaldeformityiscorrectedbyremovingdeformedpart.
Deformedseptalcartilageiscorrected.
Trans-septalsuturesareputtocoaptmucoperichondrialflaps.
Nasalpackisput.
Thus(comingtoquestion)
Mucoperichondrialflap(andtunnel)aremadeonseptalcartilage.
Mucoperiostealflap(andtunnels)aremadeonnasalspine.

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1100.Killionsincisionisusedfor?
a)Septoplasty
b)SMR
c)Proofpuncture
d)Modifiedradicalmastoidectomy
CorrectAnswer-A
Ans.is'a'i.e.,Septoplasty
Techniqueofseptoplasty
1.Infiltratetheseptumwith1%lignocainewithadrenaline
1:100,000.
2.Incasesofdeviatedseptum,makeaslightlycurvilinearincision,
2-3mmabovethecaudalendofseptalcartilageontheconcave
side(Killian'sincision).Incaseofcaudaldislocation,atransfixionor
hemitransfixion(Freer's)incisionismade.
3.Raisemucoperichondrial/mucoperiostealflapononesideonly.
4.Separateseptalcartilagefromthevomerandethmoidplateand
raisemucoperiostealflapontheoppositesideofseptum.
5.Removemaxillarycresttorealigntheseptalcartilage.
6.Correctthebonyseptumbyremovingthedeformedparts.
Deformedseptalcartilageiscorrectedbyvariousmethods,suchas:
Scoringontheconcaveside
Cross-hatchingormorselizing
Shaving
Wedgeexcision
Furthermanipulationslikerealignmentofnasalspine,separationof
septalcartilagefromupperlateralcartilages,implantationof
cartilagestripinthecolumellaorthedorsumofnosemaybe
required.
7.Trans-septalsuturesareputtocoaptmucoperichondrialflaps.

---

7.Trans-septalsuturesareputtocoaptmucoperichondrialflaps.
8.Nasalpack.

---

1101.Allareearlycomplicationsof
tracheostomyexcept?
a)Hemorrhage
b)Pneumothorax
c)Injurytoesophagus
d)Trachealstenosis
CorrectAnswer-D
Ans.is'd'i.e.,Trachealstenosis
Complicationsof Late(withprolonged
tracheostomy useoftubeforweeks
Intermediate(firstfew
ormonths)
Immediate(at hoursordays)
Hemorrhage,dueto
thetimeof
Bleeding(reactionaryor
erosionofmajorvessel
operation)
secondary)
Laryngealstenosis
Hemorrhage
Displacementoftube
Trachealstenosis
Apnea
Blockingoftube
Tracheo-esophageal
Pneumothorax Subcutaneousemphysema fistula
InjurytoRLN
Tracheitisand
Problemof
Aspirationof
tracheobronchitis
decannulation
blood
Atelectasisandlung
Persistent
Injuryto
abscess
tracheocutaneous
esophagus
Localwoundinfectionand fistula
granulations
Problemof
tracheostomyscar

---

1102.Rosen'sincisionisusedfor?
a)Septoplasty
b)SMR
c)Stapedectomy
d)Tonsillectomy
CorrectAnswer-C
Ans.is'c'i.e.,Stapedectomy
Rosen'sincisionisthemostcommonlyusedforstapedectomy
throughendomeatalortranscanalapproach.Alsoknow
Lempert'sincisionisusedforenduralapproach.
Wilde'sincisionisusedforpostauralapproach.

---

1103.Trismusisseenincommonly?
a)Ludwigangina
b)Quinsy
c)Retropharyngealabscess
d)Parapharyngealabscess
CorrectAnswer-B
Ans.is'b'i.e.,Quinsy
Trismusisinabilitytoopen-mouth.
Normalopeningofmouthrangesbetween25-50mm.
Anyvaluelessthanthisisknownastrismus(roughlytheopening
shouldpermitaminimumofthreefingerswheninsertedsideways).
Causesofquinsyare:?
A.Commoncauses
Infectionaroundimpactedthirdmolor
Quinsy(peritonsillarabscess)
Submucousfibrosis
TMjointdysfunction
B.Lesscommoncauses
Ludwingsangina
Parotidglandinfectionandtumors
Malignantotitisexternaorfurncleinexternalauditorycanal.
Parapharyngealandretropharyngealabscess
Carcinomamandible
Tetanus
Radiationtherapy
Carcinomacheck
Malignanthyperthermia
Comingtothequestion

---

Trismuscanoccurinallthegivenoptions.
However,itismostcommonandmostcharacteristicofquinsy
(amongthegivenoptions).

---

1104.Allareseenintreachercollinsyndrome
except
a)Conductivedeafness
b)Cleftpalate
c)Mandibularhypoplasia
d)Choanalatresia
CorrectAnswer-D
Ans.is'd'i.e.,Choanalatresia
Treachercollinssyndrome
Itisrareconditionthatpresentsseveralcraniofacialdeformitiesof
differentlevels.
Thisisacongenitalmalformationinvolvingthefirstandsecond
branchialarches.
Thedisorderischaracterizedbyabnormalitiesoftheauricularpinna,
hypoplasiaoffacialbones,antimongoloidslantingpalpebralfissures
withcolobomaofthelowereyelidsandcleftpalate.
Importantclinicalfindingsare:-
1. Antimongoloidpalpebralfissures
2. Malformedmalleusandincus(normalstapes)
3. Colobomaoflowerlid
4. Conductivedeafness
5. Hypoplasiaofmandible(micrognathia)andmolarbones
6. Cleftpalate
7. Malformedpinnaandmeatalatresia
Itisthemostcommonbenignneoplasmofnasopharynx.
Itisahighlyvasculartumorandbloodsupplyofthetumormost
commonlyarisesfromtheinternalmaxillaryartery.
Juvenilenasopharyngealangiofibroma(JNA)occursalmost

---

exclusivelyinmales.
FemalewithJuvenilenasopharyngealangiofibroma(JNA)should
undergogenetictesting.
Onsetismostcommonlyintheseconddecades,therangeis7-19
years.
Theexactcauseisunknown.Asthetumourispredominantlyseen
inadolescentmalesintheseconddecadeoflife,itisthoughttobe
testosteronedependent.
Themostcommonsiteisposteriorpartofnasalcavityclosetothe
marginofsphenopalatineforamen.
Thetumorstartsadjacenttothesphenopalatineforamen.
Largetumorsarefrequentlybilobedordumbbelshaped,withone
portionoftumorfillingthenasopharynxandtheotherportion
extendingtothepterygopalatinefossa.
Clinicalfeatures
Symptomsdependonspreadoftumourtonasalcavity,paranasal
sinuses,pterygomaxillaryfossa,infratemporalfossa,cheek,orbits
(throughinferiororbitalfissure),cranialcavity(mostcommonsiteis
middlecranialfossa).
Nasalobstruction(80-90%)isthemostcommonsymptom,
especiallyintheinitialstages.Thisresultsindenasalspeech,
hyposmia,broadeningofnasalbridge.
pontaneousprofuse&recurrentepistaxisisthesecondmost
commonsymptom
Otalgia,conductivehearingloss,serousotitismedia,dueto
eustachiantubeobstruction.
Pinkorpurplishmassobstructingoneorbothchonaein
nasopharynx.
Tumourintheorbitcauses:proptosis;andfrog-facedeformity;
diplopiaanddiminshedvision.
Tumourininfratemporalfossacancausetrismusandbulgeof
parotid.
II,III,IV,V,VIcranialnervecanbeinvolved.
Splayingofnasalbones.
Swellingofcheekandfullnessofface.
Diagnosisandtreatment
ContrastCTistheinvestigationofchoice.

---

Biopsyshouldbeavoidedasitcancauseseverebleeding.
Surgicalexcisionisthetreatmentofchoice.

---

1105.Trueaboutpenderd'ssyndrome?
a)Blindness
b)Conductivedeafness
c)Sensorineuraldeafness
d)Alloftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Sensorineuraldeafness
ImportantfeaturesofPenderedsyndrome:
Congenitaldisorder
MutationingeneSLC26A4.Whichcodesforaproteincalled
pendrin(helpsintransportofionsacrossmembrane).
ImpairedactivityofPendrinisseenininnerearandthyroidgland.
Bilateralsensorineuralhearingloss.
Goiter.
Sometimeshypothyroidism.
Occasionallyvestibulardysfunction.
Nospecifictreatment.

---

1106.Bestviewfornasalbone?
a)Lateral
b)Towne's
c)Cald-well
d)Submentovertical
CorrectAnswer-A
Ans.is'a'i.e.,Lateral

---

1107.Whichofthefollowingisapneumatic
bone?
a)Parietalbone
b)Occipitalbone
c)Mastoidprocess
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Mastoidprocess
Pneumaticbonesareonewhichcontainlargeairspaceslinedby
epithelium.Examples:maxilla,sphenoid,ethmoid,etc.Theymake
theskulllightinweight,helpinresonanceofvoice,andactasair
conditioningchambersfortheinspiredair.
Abonethatisholloworcontainsmanyaircellscalledaspenumatic
bone.
Examplesaremastoidprocessoftemporalbone,maxilla,ethmoid,
sphlenoidandfrontalbone.Verysimpletorememberlast4asall
fourparansalsinusesarepneumaticbones.

---

1108.Whichstructurepreventsspreadof
infectionformmiddleeartobrain?
a)Tegmentympani
b)Cribriformplate
c)Fundustympani
d)Petrousapex
CorrectAnswer-A
Ans.is'a'i.e.,Tegmentympani
Tegmentympani(formingtheroofofmiddleearcavity)separates
thetympaniccavityfrommiddlecranialfossa.

---

1109.TrueregardinglaryngealTBis?
a)Commonlyinvolvesanterior2/3rdofvocalcord
b)Mouse-nibbledvocalcord
c)Morecommoninmales
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Mouse-nibbledvocalcord

---

1110.Achildhasgotacongenitalcataract
involvingthevisualaxiswhichwas
detectedbytheparentsrightatbirth.
Thischildshouldbeoperated:
a)Immediately
b)At2monthsofage
c)At1yearofagewhentheglobebecomesnormalsized
d)After4yearswhenentireocularandorbitalgrowthbecomes
normal
CorrectAnswer-A
Ans.A[Immediately]
Congenitalcataract-Timingofsurgery
1. Bilateraldense-cataractrequiresearlysurgery(i.e.by6weeksof
age)topreventthedevelopmentofstimulusdeprivationamblyopia
2. Bilateralpartial-cataractmaynotrequiresurgeryuntillaterifatall,
incasesofdoubt,itmaybeprudenttodefersurgerymonitorlens
opacity,andvisualfunctionandintervenelaterifvisiondeteriorates.
3. Unilateraldense-cataractmeritsurgentsurgery(withindays)
followedbyaggressiveanti-amblyopiatherapythecataractis
detectedafter16weeksofagethensurgerycanbedelayedlittle
becauseamblyopiaisrefractory
4.Partialunilateral-cataractcanusuallybeobservedortreated
nonsurgicallywithpupillarydilatationandpossiblypart-time
contralateralocclusiontopreventamblyopia"Thecriticalperiodof
developingthefixationreflexesinbothunilateralandbilateralvisual
deprivationdisordersisbetween2and4monthsofage,any
cataractdenseenoughtoimpairvisionmustbedealtwithbeforethis

---

ageandtheearliestpossibletimeispreferred"

---

1111.Inheadinjuryunilateraldilatationof
pupilisseendueto?
a)Occulomotornervecompression
b)OphthalmicN.compression
c)TrizeminalN.compression
d)None
CorrectAnswer-A
Ans.A.Occulomotornervecompression
Pupildilationisthoughttobetheresultofuncalherniationcausing
mechanicalcompressionofIIIrdcranialnerveandsubsequentbrain
stemcompromise,

---

1112.Proptosisisnotseenin
a)Grave'sdisease
b)Sarcoidosis
c)Pituitaryadenoma
d)Myxoedema
CorrectAnswer-D
Ans.is'd'i.e.,Myxoedema
Proptosisoccursinthyrotoxicosisnotinhypothyroidism
Choices
Logic
Cytokinesappearto
playamajorrolein
thyroid-associated
ophthalmopathyThere
isinfiltrationofthe
extraocularmuscles
byactivatedTcells;
thereleaseof
cytokinessuchas
Grave's
IFN-alphaandTNF
resultsinfibroblast
activationand
increased
synthesisof
glycosaminoglycans
thattrapwater,
therebyleadingto
characteristicmuscle
swelling
Approximately20%,of

---

Approximately20%,of
patientswith
ophthalmicfindingsof
sarcoidhavesoft
tissueinvolvementof
Sarcoidosis theorbitorlacrimal
glandandpresentas
amasslesionwith
proptosis,ptosis,or
ophthalmoplegia.
Macro-adenoma
Pituitary
associatedwith
adenoma
pituitaryapoplexycan
leadtoproptosis.

---

1113.Eyeofanewbornis?
a)Emmetropic
b)Hypermetropic
c)Myopic
d)Astigmatism
CorrectAnswer-B
Ans.is'b'i.e.,Hypermetropic
Eyeatbirth
Anteroposteriordiameterofeyeballisabout16.5mm(70%ofadult
size).Adultsizeisattainedby7-8years.
Cornealdiameterisabout10mm.Adultsize(11.7mm)isattained
by2yearsofage.
Anteriorchamberisshallowandangleisnarrow.
Lensissphericalatbirth.
Retina:-Apartfrommaculararea,theretinaisfullydifferentiated.
Maculadifferentiates4-6monthsafterbirth.
Myelinationofopticnervefibreshasreachedthelaminacribrosa.
Newbornisusuallyhypermetropicby+2to+3D.
Orbitismoredivergent(50?)ascomparedtoadult(450).
Lacrimalglandisstillunderdevelopedandtearsarenotsecreted.

---

1114.Normallevelofvisualacuityisattained
atwhichage
a)6months
b)1year
c)3years
d)6years
CorrectAnswer-C
Ans.is'c'i.e.,3years[RefKhurana4th
Eyeinpostnatalperiod
Fixationstartsdevelopingby4-6weeks.Criticalperiodfor
developmentoffixationreflexis2-4months.Developmentof
fixationiscompletedby6months.Sotherearethreepointsto
remember:?
Fixationstartsdeveloping4-6weeks(1-11/2months).
Criticalperiodfordevelopment2-4months.
1. Fixationdevelopmentiscompleted6months.
2. Maculaisfullydevelopedby4-6months.
3. Fusionalreflex,stereopsisandaccomodationiswelldevelopedby
4-6months.
Corneaattainsnormaladultdiameterby2yearsofage.
Lensgrowsthroughoutlife.
Fullvisualacuity(6/6)isattainedby3yearsofage.
AgeVisualacuity
Newborn6/240
Imonth6/180-6/90
4-6months6/18-6/9
3Years6/6

---

---

1115.Allarepartsofanteriorsegmentofeye
except?
a)Lens
b)Cornea
c)Vitreous
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Vitreous
Theeyeballisdividedintotwosegments:?
Anteriorsegment
1. Partofeyeballanteriortoposteriorborderoflensiscalledanterior
segment.
2. Itconsistsoflens,andstructuresanteriortoit,i.e.,cornea,irisand
twoaqueoushumor-filledspaces,i.e.,anteriorandposterior
chambers.
3. Anteriorchambers:-Itisboundedanteriorlybybackofcorneaand
posteriorlybytheiris&partofciliarybody.Itcontainsaqueous
humor.
4. Posteriorchamber:-Thistriangularchamberisboundedanteriorly
bytheposteriorsurfaceoftheiris&ciliarybodyandposteriorlyby
thelensanditzonules.Italsocontainsaqueoushumor.
5. Thus,bothanteriorandposteriorchambersarepartofanterior
segmentandbothcontainaqueoushumor.
Posteriorsegment
1. Partofeyeballposteriortolensiscalledposteriorsegment.
2. Itconsistsofvitreoushumor,retina,choroidandopticdisc.

---

1116.AttachementofVitreousisSrongestat
a)Fovealregion
b)Backoflens
c)Acrossoraserrata
d)Marginofopticdisc
CorrectAnswer-C
Ans.is'c'i.e.,Acrossoraserrata
Attachementofvitreous
Vitreousisattachedanteriorlytothelens(Hyloidcapsularligament
ofWieger)andciliaryepitheliuminfrontoftheoraserrata.
Thepartofvitreousabout4mmacrosstheoraserrataisknownas
the"baseofvitreous"wheretheattachementisstrongest
Posteriorlyvitreousisattachedtotheedgeoftheopticdiscand
maculalutea(fovealregion)formingring-shapedstructurearound
them

---

1117.ThejunctionbetweenRetina&Ciliary
bodyis??
a)Equator
b)Parsplicata
c)Parsplana
d)Oraserrata
CorrectAnswer-D
Ans.D.Oraserrata
Oraserrataistheserratedperipheralmarginwheretheretinaends'
Hereretinaisfirmlyattachedbothtovitreousandchoroid.
Parsplana(ofciliarybody)extendsanteriorlyfromoraserrata.

---

1118.Normalaqueousproductionrate-
a)2ml/min
b)5ml/min
c)21/min
d)51/min
CorrectAnswer-C
Ans.is'c'i.e.,2l/min
Theciliaryprocessesarethesiteofaqueousproduction.The
aqueoushumorisprimarilyderivedfromtheplasmawithinthe
capillarynetworkoftheciliaryprocess.Threemechanismsplaya
partinaqueousformationatdifferentlevels:-(i)Activesecretion
(70%),(ii)ultrafiltration(20%),(iii)Diffusion/osmosis(10%).Active
secretionoccursbythehelpofNa+ICATPasesystemand
bicarbonatesystemmediatedbycarbonicanhydrase(convertCO2
&H20intocarbonicacid).
Thenormalaqueousproductionis2.3microlit/min.Totalvolumeof
aqueousisabout0.31ml(0.25m1inanteriorchamberandabout
0.06mlintheposteriorchamber).Asitisderivedfromplasmaithas
similarconstituentsasplasma,butatdifferentconcentrations:-
i)Constituentshavingconcentrationlessthanplasma:-
ProteinNat,IC+,Ca',Mg',Urea,glucose.
ii)Constituentshavingconcentrationmorethanplasma:-Cl-,
HCO3-,Lactate,Pyruvate,Ascorbate.
Aqueoushumorisimportantinprovidingfollowingfunctions:-
1. Maintenanceofintraocularpressure(I0P):-Normalisbetween10
-21mmHg(mean16?2.57mmHg.
2. it)Nutritionalfunction:-Aqueousplaysanimportantrolebyproviding

---

substrateandbyremovingmetabolitesfromavascularcorneaand
lens.
3. Opticalfunction:-Maintainsopticaltransparency
4. Clearingfunction:-Aqueousservesasamechanismtoclearblood,
macrophages,remnantsoflensmatterandproductsofinflammation
fromtheanteriorchamber(takesplaceoflymphthatisabsentwithin
theeyeball).

---

1119.Whicharefirstorderneuroninoptic
pathway?
a)Bipolarcells
b)Ganglioniccells
c)Cellsoflateralgeniculatebody
d)Astrocytes
CorrectAnswer-A
Ans.is'a'i.e.,Bipolarcells
Invisualpathway
Sensoryorgans Photoreceptors(Rods&cones)
Neuronsoffirst -3Axonofbipolarcells(inRetina)
rder
Neuronsof
Axonsofganglioniccell(Retinai.e.,Optic
secondrder
disc,Opticnerve,Opticchiasma,optictracts)
Neuronsofthird Axonsfromnervecellsinlateralgeniculatebody
order
(opticadiation)

---

1120.Treatmentofchoiceforanisoeikonia?
a)Orthopticexercise
b)Spectacles
c)Surgery
d)Contactlens
CorrectAnswer-D
Ans.is'd'i.e.,Contactlens
Anisoeikonia
Anisoeikoniaisdefinedasaconditionwhereintheimagesprojected
onthevisualcortexfromthetworetinaeareabnormallyunequalin
sizeorshape.Causesmaybe
Opticalaniseikonia:-Whenthedifferencebetweenrefractiveerror
oftwoeyesisofhighdegree,theimageofanobjectmaybeof
differentsizeorshapeintwoeyes.Sothedefectisatrefractive
structureslevel.
Retinalaniseikonia:-Defectisatretinallevelandoccursdueto
displacementofretinalelementstowardsthenodalpointinoneeye
duetostretchingoredemaoftheretina.
Corticalaniseikonia:-Defectisathighercentrallevel.Thereis
asymmetricalsimultaneousperceptioninspiteofequalsizeof
imagesformedonthetworetinae.
Upto5percentaniseikoniaiswelltolerated.Forhighdegreeof
aniseikonia,treatmentofchoiceiscontactlenses.

---

1121.Shorteningof2mmofaxiallengthof
eyeballcauses?
a)3Dmyopia
b)6Dmyopia
c)3Dhypermetropia
d)6Dhypermetropia
CorrectAnswer-D
Ans.is.d.,6Dhypermetropia
Changeinaxiallengthcancauserefractiveerror.
Itisthecommonestformofametropia(bothmyopiaand
hypermetropia).
Inhypermetropia,thereisanaxialshorteningofeyeball.
So,imageisformedbehindtheretina.
Inmyopia,thereisanaxiallengtheningofeyeball.
So,imageisformedinfrontoftheretina.
1mmchangeinaxiallengthleadstoametropiaof3D.
Forexample1mmshorteninginaxiallengthcauseshypermetropia
of3D.

---

1122.Maximumcorrectionofmyopiacanbe
doneby?
a)Radialkeratotomy
b)LASIK
c)Photorefractivekeratotomy
d)Orthokeratology
CorrectAnswer-B
Ans.is'b'i.e.,LASIK
Amongstthegivenoptions,maximumcorrectioncanbeachievedby
LASIK.
Surgicalocedure
Myopiaorrection
Radialkeratomy
-2to-6D
Photorefractivekeratotomy -2to-6D
LASIK
Upto-12D
Extractionoflens
-16to-18D
PhakicIOL
>-12D
Interconaealring(ICR
1-6D
Orthokeratology
upto-5D

---

1123.Whichofthefollowingisnotacauseof
hypermetropia:
September2009
a)Shortaxiallengthoftheeyeball
b)Flatcornea
c)Increasedrefractiveindexofthecortexoflens
d)Anteriordislocationofthelens
CorrectAnswer-D
Ans.D:Anteriordislocationofthelens
Factorsresponsibleforhypermetropia:
Shortaxiallengthoftheeyeball
Curvaturehypermetropiacommonlyoccursasafactorin
astigmatism(cornealplana)
Indexhypermetropiaaccountsforthehypermetropiaofoldagedue
toincreasedrefractiveindexofthecortexofthelensrelativetothe
nucleussothatoverallrefractivepowerofthelensdecreases.
Itmaybeassociatedwithdiabetes,tumors,microphthalmia(a
growthdysfunctionduringfetusdevelopment)andfoveahypoplasia,
aconditionthataffectsthebloodvesselsintheretina.
Whiletheseconditionsmayresultinhypermetropia,oneofthemost
commonlycitedcausesoffarsightednessisconsideredtobeaging.

---

1124.Standardinperimetry?
a)GoldmantypeI
b)GoldmantypeII
c)GoldmantypeIII
d)GoldmantypeIV
CorrectAnswer-C
Ans.is'c'i.e.,GoldmantypeIII
Projectedstimuliinperimetryareusuallywhiteandofvariablesize
andintensity.
TherearefivedifferentsizesonGoldmannscaledesignatedby
RomannumeralItoV.
Thestandardusedinbothmanualandautomatedperimetryis
GoldmanIII(0.05"andareaof4mm2).oFailuretorecognizetarget
sizeIIInecessitatestestingwithstimulusV
Goldmanscale Stimulussize(mm2)
I
'/4
II
1
III
4
IV
16
v
64

---

1125.Slitlampexaminationhelpsin
examinationof?
a)Anterior2/3rdofchoroid
b)Anterior1/3rdofchoroid
c)Posterior1/3rdofchoroid
d)Posteriorcapsule
CorrectAnswer-D
Ans.is'd'i.e.,Posteriorcapsule
Slit-lampbimicroscopyisveryusefulinthediagnosisofeye
diseases.
oItshouldroutinelybeperformedinalmostalldiseasesoftheeye.
oFollowingstructuresareexamined?
1. Eyelidsandlashes
2. Conjunctiva
3. Cornea
4. Anteriorchamber
5. Iris
6. Lens:Anteriorcapsule,cortex,nucleus,posteriorcapsular
7. Anteriorvitreous

---

1126.Fundusfluoresceinangiographydoneinapatientfollowingcataract
surgeryshowsaflowerpetalpattern.WhatisheMOSTlikelysuffering
from?
a)Macularhole
b)Cystoidmacularedema
c)Centralserousretinopathy
d)Noneoftheabove
CorrectAnswer-B
Heisshowingfeaturesofcystoidmacularedema.Cystoidmacularedemareferstoa
conditioninwhichthereisfluidaccumulationinhoneycomblikespacesoftheouter
plexiformandinnernuclearlayers.Fluoresceinangiographydoneshowsleakageof
fluoresceindyefromtheperifovealretinalcapillariesandperipapillaryregion,and
accumulatinginaflower-petalpatternaroundthefovea.

Itmostfrequentoccurfollowingcataractsurgery,especiallyifthesurgerywas
complicatedorprolonged.Itusuallymanifestsat4?12weekspostoperatively.

Ref:FletcherE.C.,ChongN.,AugsburgerJ.J.,Corr?aZ.M.(2011).Chapter10.Retina.In
P.Riordan-Eva,E.T.Cunningham,Jr.(Eds),Vaughan&Asbury'sGeneralOphthalmology,
18e

---

1127.Diagnosisofallismadebyfluorescein
angiographyexcept?
a)Diabetesretinopathy
b)Hypertensiveretinopathy
c)Centralserousretinopathy
d)Choroidalneovascularization
CorrectAnswer-B
Ans.is'b'i.e.,Hypertensiveretinopathy

---

1128.Duringretinoscopyofa30yearsold
male,whichcycloplegicisused
routinely
a)Atropine1%ointment
b)Cyclopentolate1%drop
c)Homatropine2%drop
d)Noneoftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Noneoftheabove
Thereisnoneedforcycloplegiaasaroutineinadults(20-40years).
Cvcloplegicinretinoscopy
Cycloplegicsaredrugswhichcauseparalysisofciliarymuscles
(accommodation)anddilatationofpupil.Theuseofcycloplegicsis
usefulinrefractionandtherearecertainsituationswheretheyare
indicated.
Becauseoftheirstrongaccommodativereserve,veryyoungpeople
(<16years)shouldalwaysberefractedafter
theuseofcyclopleagics:-
1. <5yearsofage:-Atropine1%ointmentisthedrugofchoice.
2. 15-20years:-Homatropine(2%drop),cyclopentolate(1%drop)
ortropicamide(5%,10%drop)areused.Atropinemustbeusedif
thepatienthasaconvergentsquintorhashighhypermetropia.
Thereisnoneedforcycloplegiaasaroutineinadults(20-40years).
Howevercycloplegicsareindicatedinfollowingsituations:-
Accommodationisabnormallyactive(e.g.,spasmof
accommodation).
1. Objectivefindingsbyretinoscopydonotagreewiththepatient's

---

subjectiverequirement.
2. Symptomsofaccommodativeasthenopiaarepresent.
3. Ifthepupilissmall.
Ifthepatientisabove40years,cycloplegiaisrarelynecessary.Only
mydriatic(10%phenylephrine)maybeneededwhenthepupilis
narrowormediaisslightlyhazy.

---

1129.Inspecularmicroscopyendothelial
densityismeasuredby?
a)Opticaldoubling
b)Fixedframeanalysis
c)Opticalfocusing
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Fixedframeanalysis
Endothelialcelldensityinspecularmicroscopyiscountedbyfixed
frameanalysisandvariableframeanalysis.
Celldensity(ceIlsimrn2)=Cellcountinframe

---

1130.Retinitispigmentosaischaracterizedby
?
a)Centralscotoma
b)Centrocaecalscotoma
c)Tubularvision
d)Isoptericcontraction
CorrectAnswer-C
Ans.is'c'i.e.,Tubularvision
Importantfacts
Earliestvisualfielddefectinprimaryopenangleglaucoma
Isopetericcontraction.
Earliestclinicallysignificantvisual.fielddefectinprimaryopenangle
glaucoma-->Paracentralscotoma,
VisualfielddejectinrheugmatogenousretinaldetachmentLossof
peripheralfield.
VisualfielddefectinretinitispigmentosaTubularvision.
Mostcommonvisual,fielddefectinopticneuritisCentralor
centrocaecal.
VisualfielddefectinpapilloedemaEnlargementofblindspotand
progressivecontractionofvisual_field.
VisualfielddefectinLeber'sopticneuropathyCentmcaecal.
Characteristicvisual.fielddefectinanteriorischemicoptic
neuropathyAltitudinalvisualfielddefects.

---

1131.Trueaboutelectroretinogram?
a)a'waveispositivewave
b)'a'wavearisesfrompigmentedepithelium
c)b'wavearisesfromrodsandcones
d)'c'waveispositivewave
CorrectAnswer-D
Ans.is'd'i.e.,'c'waveispositivewave
Electroretinogram
Thechangesinducedbythestimulationoflightintheresting
potentialoftheeyearemeasuredbyelectroretinography.Itis
extinguishedorabsentincompletefailureoffunctionofrodsand
cones,e.g.pigmentaryretinaldystrophy,completeocclutionof
retinalartery,completeretinaldetachment,advancedsiderosisetc.
1. Negative'a'waverepresenttheactivityinrodsandcones.
2. Positive'b'wavearisesininnerretinallayers.
3. Positive'c'waveisassociatedwiththepigmentaryepithelium.
Uses:?
1. Diagnosisandprognosisofretinaldisorderssuchasretinitis
pigmentosa,Leber'scongenitalamaurosis,retinalischaemiaand
otherchorioretinaldegenerations.
2. Toassessretinalfunctionwhenfundusexaminationisnotpossible,
e.g.inthepresenceofdensecataractandcornealopacity.
3. Toassesstheretinalfunctionofthebabieswherepossibilitiesof
impairedvisionisconsidered.

---

1132.Arcuatefielddefectakintoglaucomais
seenin?
a)Pituitarytumor
b)Occipitallobeinfarct
c)Opticnervelesion
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Opticnervelesion
Anarcuatevisualfielddefectusuallyresultsfromdamagetoretinal
nervefibersorganglioncellsinthesuperioror
inferiorarcuatenervefiberbundles.
Insuchcasesthereisacentralfielddefectthatisnotcircularbut
insteadislimitedaboveorbelowbythehorizontalmeridian.
Thisvisualfielddefectmayoccurinpatientswithocclusionofblood
supplyofthesuperiororinferiorportionofmaculaorinpatientswith
glaucoma.
Inbothsettings,thescotomaisassociatedwithnormalvisualacuity,
sinceitdoesnotcompletelyaffectthemacula.
Virtuallyanylesion,whetherischemic,infiltrativeorcompressive,
cancausearcutefielddefect,andmaybelocatedineithertheretina
oropticnerve.
Importantcausesofarcuatescotomaare:-
1. Glaucoma
2. Opticneuritis
3. Anteriorischemicopticneuropathy(AION)
4. Branchretinalvascularocclusion(arteryorvein)
5. Opticnervedrusen

---

1133.Binocularsinglevisionistestedby?
a)Amslergrid
b)Synoptophore
c)Maddoxrod
d)Cardboardtest
CorrectAnswer-B
Ans.is'b'i.e.,Synoptophore
Gradesofbinocularsinglevision
Therearethreegradesofbinocularsinglevision,whicharebest
testedwiththehelpofasynoptophore.
1.Grade-I-Simultaneousperception
Itisthepowertoseetwodissimilarobjectsstimultaneously.
Itistestedbyprojectingtwodissimilarobjects(whichcanbejoined
orsuperimposedtoformacompletepicture)infrontofthetwoeyes.
Forexample,whenapictureofabirdisprojectedontotherighteye
andthatofacageontothelefteye,anindividualwithpresenceof
simultaneousperceptionwillseethebirdinthecage.
2.Grade-II-Fusion
Itconsistsofthepowertosuperimposetwoincompletebutsimilar
imagestofromonecompleteimage.
Theabilityofthesubjecttocontinuetoseeonecompletepicture
whenhiseyesaremadetoconvergeordivergeafewdegrees,
givesthepositiveandnegativefusionrange,respectively.
3.Grade-III-Stereopsis
Itconsistsoftheabilitytoperceivethethirddimension(depth
perception).
Itcanbetestedwithstereopsisslidesinsyno

---

1134.InvertedimageinPurkinjetestis
formedfrom?
a)Anteriorsurfaceofcornea
b)Posteriorsurfaceofc
c)Anteriorsurfaceoflens
d)Posteriorsurfaceoflens
CorrectAnswer-D
Ans.is'd'i.e.,Posteriorsurfaceoflens
Purkinjeimagestest
Normally,whenastrongbeamoflightisshowntotheeye,four
images(Purkinjeimages)areformedfromthefourdifferent
reflectingsurfaces:-
1"fromanteriorsurfaceofcorneaErectandmovesin
samedirection.
2ndfromposteriorsurfaceofcorneaErectandmovesinsame
direction.
3'dfromanteriorsurfaceoflensErectandmoveinsame
direction.
4thfromposteriorsurfaceoflensInvertedandmovesin
oppositedirection
Firstthreereflectingsurfacesareconvexandproduceerectimages,
while4thsurfaceisconcave,thereforeproducesinvertedimage.
Presenceofallfourimagesindicatespresenceofaclearlens.In
aphakia3rd&4thimagesareabsentandonlyfirsttwoimagesare
present.Incataract4thimageisabsentandfirst3imagesare
present.

---

1135.Inaphakiapurkinjeimagesabsentare?
a)1&3'
b)2nd&4m
c)2nd&3rd
d)3rd&4th
CorrectAnswer-C
Ans.is'c'i.e.,2nd&3rd

---

1136.Stocker'slineisseenin?
a)Pterygium
b)Glaucoma
c)Posteriorscleritis
d)Diabeticretinopathy
CorrectAnswer-A
Ans.is'a'i.e.,Pterygium
islineofirondepositioninthecornealepitheliumseenadjacentto
theheadofthepterygium.

---

1137.Cicatrisingtrachomaisseenin?
a)Stage-1
b)Stage-2
c)Stage-3
d)Stage-4
CorrectAnswer-C
Ans.is'c'i.e.,Stage-3
McCalIan'sclassification-McCallanin1908dividedtheclinical
courseoftrachomainto4stages
Stage1
(Incipient
Stage2
Stage3
Stage4(Healed
trachoma)
(Established (Cicatrising
trachoma)
Hyperaemia tracoma)
trachoma)
ofpalpebral
Appearance
ofmature
Diseaseiscured
Immature
Scarringof
follicle&
orisnot
follicle
palpebralconjunctiva
conjunctiva
markable
papillae
Mild
Progressive
Scarsareeasily
Sequelaeto
superfecial
corneal
visibleaswhite
cicatrisationcause
punctate
pannus
bandsNecrosis
symptoms
keratopathy
Stage2isfurthersubdividedinto:-
2a(Ha):-Presenceofmaturefollicles
b(Hb):-Markedpapillaryhyperplasia

---

1138.Allstatementsaretrueabouttrachoma
except
a)Trachomaiscausedbybedsonianorganismofpsittacosis-
lymphogranuloma-trachoma(PLT)group.
b)StrainsmainlyresponsibleareA,B,BaandC
c)Markedpapillaryhyperplasiawithlimbalfolliclesareseenin
stageIII
d)Cornealulcerstionisacomplication
CorrectAnswer-C
C.i.e.Markedpapillaryhyperplasiawithlimbalfolliclesareseenin
stageIII
>TrachomaiscausedbyaBedsonianorganism,theChlamydia
trachomatisbelongingtothePsittacosis-lymphogranulomatrachoma
(PLT)group.
>SerotypesA,B,BaandCareassociatedwithhyperendemic
(blinding)trachoma,whileserotypesD-Kareassociatedwith
paratrachoma(oculogenitalchlamydialdisease).
>Congestionofuppertarsalandfornicealconjunctiva.2.
Conjunctivalfollicles.Follicleslooklikeboiledsagograinsandare
commonlyseenonuppertarsalconjunctivaandfornix;butmayalso
bepresentinthelowerfornix,plicasemilunarisandcaruncle.
Sometimes,(folliclesmaybeseenonthebulbarconjunctiva
(pathognomicoftrachoma).
>Pannusi.e.,infiltrationofthecorneaassociatedwith
vascularizationisseeninupperpart
>GradingoftrachomaMcCallan'sclassificationMcCallanin1908,
dividedtheclinicalcourseofthetrachomaintofollowingfourstages:
StageI(Incipienttrachomaorstageofinfiltration).Itischaracterized
byhyperaemiaofpalpebralconjunctivaandimmaturefollicles.

---

byhyperaemiaofpalpebralconjunctivaandimmaturefollicles.
StageII(Establishedtrachomaorstageoffloridinfiltration).Itis
characterizedbyappearanceofmaturefollicles,papillaeand
progressivecornealpannus.Fig.4.14.TrachomatousHerbert'spits.
AB66ComprehensiveOPHTHALMOLOGYStageIII(Cicatrising
trachomaorstageofscarring).Itincludesobviousscarringof
palpebralconjunctiva.StageIV(Healedtrachomaorstageof
sequelae).Thediseaseisquiteandcuredbutsequelaedueto
cicatrisationgiverisetosymptoms.
-Theclinicaldiagnosisoftrachomaismadefromitstypicalsigns;at
leasttwosetsofsignsshouldbepresentoutofthefollowing:1.
Conjunctivalfolliclesandpapillae2.Pannusprogressiveor
regressive3.Epithelialkeratitisnearsuperiorlimbus4.Signsof
cicatrisationoritssequelae.

---

1139.Inphotophthalmiasiteoflesionsis:
a)Cornea
b)Retina
c)Opticnerve
d)Alloftheabove
CorrectAnswer-A
Ans.Cornea

---

1140.Phlyctenularconjunctivitisiscausedby
-
a)Chlaymydia
b)Staphylococcus
c)Pneumococcus
d)Aspergillus
CorrectAnswer-B
Ans.is'b'i.e.,Staphylococcus
Phlyctenularkeratoconjunctivitis
Phlyctenularconjunctivitisisanallergicresponseoftheconjunctival
andcornealepitheliumtosomeendogenousallergensand
characterizedbyformationofthephlyctens.Phlyctensaregrey,
yelloworpinkishwhitenodulesslightlyraisedabovethesurface,are
seenonthebulbarconjunctiva,generallynearthelimbus.Peakage
groupis3-15yearswithslightfemalepreponderance.

---

1141.Schwable'sringisseeninwhichlayer
ofcornea
a)Bowmann'smembrane
b)Stroma
c)Descemet'smembrane
d)Substantiapropria
CorrectAnswer-C
Ans.is'c'i.e.,Descemet'smembrane
Histologyofcornea
Thecorneahasfivedistinctlayers(fromsuperficialtodeep):?
Epithelium:-Itistheoutermostpartofcorneaandiscomposedof
stratifiedsquamousnon-keratinizedepithelialcells.
Bowman'smembrane:-Itisnotatruemembranebutsimplya
condensedsuperficialpartofstroma.destroyed,itdoesnot
regenerate.
Stroma(Substantiapropria):-Thislayerconstitutesmostofthe
cornea(90%ofthickness).Itconsistsofcollagenfibrils(lamellae)
embeddedinhydratedmatrixofproteoglycans.
Descemet'smembrane:-Thislayerboundsthestromaposteriorly.
Intheperipheryitappearstoendattheanteriorlimitoftrabecular
meshworkasSchwahle'sring.
Endothelium:-Itisasinglelayerofflatpolygnonalcells.The
endothelialcellscontain'active-pump'mechanismandisthemost
importantlayerinmaintainingthetransparencyofcornea.

---

1142.Scissorreflexisseenin?
a)Openangleglaucoma
b)Phlyctenularconjunctivitis
c)Keratoconus
d)Interstitialkeratitis
CorrectAnswer-C
Ans.is'c'i.e.,Keratoconus
Keratoconusisaprogressive,noninflammatory,bilateralectatic
cornealdisease,characterizedparaxiastromalthinningand
weakeningthatleadstocornealsurfacedistortion.
Essentialpathologicalchangesarethinningandectasiawhichoccur
asaresultofdefectivesynthesisofmucopolysaccharideand
collagentissue.
Itusuallystartsatpubertyandprogressesslowly.
Symptomsusuallybeginsasblurredvisionwithshadowingaround
images.
Visionbecomesprogressivelymoreblurredanddistortedwith
associatedglare,halosaroundlights,lightsensitivityandocular
irritation.
Visuallossoccursprimarilyfromirregularastigmatismandmyopia.
andsecondarilyfromcornealscarring
Thehallmarkofkeratoconusiscentralorparacentralstromal
thinning,apicalprotrusionofanteriorcorneaandirregular
astigmatism.
Thecorneathinsnearthecentreandprogressivelybulgesforwards,
withtheapexofconealwaysbeingslightlybelowthecentreofthe
cornea.
Importantfindingsanexaminationare-

---

1. Distartedwindowreflex(Cornealreflex)Q.
2. Fleisher'srine.
3. Yawningreflex(Scissorreflex).
4. Oildropreflex.
5. Munson'ssigns
Treatmentincludes:?
1. Spectaclesforregularormildirregularastigmatism.
2. Rigidgaspermeablecontactlensforhigherastigmatism.
3. Epikeratoplastyinpatientsintoleranttolensandwithoutsignificant
cornealscarring.
4. Keratoplastypenetratingordeeplamellarifthereissignificant
cornealscarring.

---

1143.Non-sterilehypopyonisseenin?
a)Pneumococcusinfection
b)Pseudomonasinfection
c)Fungalinfection
d)Gonococcalinfection
CorrectAnswer-C
Ans.is'c'i.e.,Fungalinfection
Hypopyonreferstoaccumulationofpolymorphonuclearleucocytesin
thelowerangleofanteriorchamber.Many
pyogenicorganisms(Staphylococcus,streptococci,gonococci,
Moraxella)andfungimayproducehypopyonbut
byfarthemostdangerousarepseudomonaspyogeneaand
pneumococcus.
Thus,anycornealulcermaybeassociatedwithhypopyon,however,
itiscustomarytoreservetheterm'hypopyon
cornealulcer'forthecharacteristiculcercausedbypneumococcus
andtheterm'cornealulcerwithhypopyon'for
theulcersassociatedwithhypopyonduetoothercauses.The
characteristichypopyoncornealulcercausedby
pneumococcusiscalled"ulcusserpens".
Itisworthnotingthatthehypopyoninbacterialcausesissterile
sincetheoutpouringofpolymorphonuclearcellsisduetotoxinand
notduetoactualinvasionbybacteria.Ontheotherhand,hypopyon
infungal(mycotic)cornealulcerisnon-sterileasthereisdirect
invasionbyfungi.

---

1144.Ameboidulcerisafeatureof
a)Parasiticcornealulcer
b)Mycoticcornealulcer
c)Herpeticcornealulcer
d)Bacterialcornealulcer
CorrectAnswer-C
Ans.isci.e.,Herpeticcornealulcer
HerpeticKeratitis
MostoftheocularinfectionarecausedbyHSV-1exceptinneonates
whereeyeinfectioncanbecausedbyHSV2throughinfected
genitaliaofmother.OcularinvolvementbyHSVmayoccurintwo
forms:-
Primaryherpes:-Typicallyisaunilateral
blepharoconjunctivitiswhichischaracterizedbyvesiclesontheskin
oflids,follicularconjunctivitis,preauricularsadenopathyand
sometimespunctatekeratitis.
Recurrentocularherpes:-Afterprimaryinfection,recurrent
diseasemayinvolveanyoralllayersofthecornea.Recurrent
herpatickeratitisisdividedinto:?
1)Epithelialkeratitis:-Manifestationsofepithelialkeratitisinclude
:-
1. Cornealvesicles:-Vesiclescoalesceanderupttoformdendriticor
geographiculcer.
2. Superficialpunctatekeratitis
3. Dendriticulcer:-Itisthemostcommonpresentationandisatypical
lesionofherpeskeratitis.Thereisanassociatedmarkeddiminution
ofsensation.
4. Geographiculcer(amoeboidulcer)

---

2)Stromalkeratitis:-Stromalkeratitismaybeoftwotypes:-
1. Disciformkeratitis:-Thisisduetodamagetoendothelialcells
asaresultofhypersensitivityreactiontotheHSVantigen.
2. Diffusestromalnecrotickeratitis:-Causedbyactiveviral
invasionandtissuedestruction.
3)Metaherpatickeratitis(Epithelialsteriletrophiculceration):-
Itisnotanactivedisease,butisamechanicalhealingproblemat
thesiteofpreviousherpeticulcer.

---

1145.Keratitisincontactlensweareris
causedbyallexcept?
a)Pseudomonas
b)Pneumococcus
c)Aspergillu
d)Chlamydia
CorrectAnswer-B
Ans.is'd'i.e.,Chlamydia
Ectopialentis
oEctopialentisisdefinedasdisplacementormalpositionofthe
crystallinelensoftheeye.Thelensisconsidereddislocated
(luxated)whenitliescompletelyoutsidethelenspatellarfossa.The
lensisdescribedassubluxatedwhenitispartiallydisplacedbut
containedwithinthelensspace.Causesare
i)Homocystinuria
ii)Marfansyndrome
iii)Weil-Marchesanisydrome
iv)EhlerDanlossyndrome
v)Hyperlysinemia
vi)Sulphiteoxidasedeficiency
vii)Sticklersyndrome
viii)Trauma
ix)Consecutive/spontaneous(Hypermaturecataract,buphthalmos,
highmyopia)

---

1146.Mostcommoninfectionincontactlens
usersis?
a)Streptococcus
b)Pseudomonas
c)Staphylococcus
d)Neisseria
CorrectAnswer-B
Ans.is'b'i.e.,Pseudomonas
Complicationsofcontactlenswear
Complicationsofcontactlenswearingare:?
Intolerance:-Somepeoplefindwearingcontactlensesintolerable.
Cornealcomplications:-Cornealabrasion,Cornealedema,Corneal
vascularization,Microbialkeratitis(Pseudomonas,acanthamoeba),
Sterilecornealinfiltrate.
Giantpapillaryconjunctivitis
Hypoxia:-Corneaisdeprivedofoxygenfromthetearfilmbythe
presenceofthecontactlens.Thecorneabecomesedematousand
newvesselsmaydevelopinthelimbalarea.
Sensitivity:-Thismaydevelopinresponsetothepreservative
(thiomersal)inthecleaningandsoakingsolution.Thisresultsin
allergicconjunctivitis.

---

1147.Immuneringisafeatureof?
a)Interstitialkeratitis
b)Fungalcornealulcer
c)Bacterialcornealulcer
d)Herpessimplexkeratitis
CorrectAnswer-B
Ans.is'b'i.e.,Fungalcornealulcer
Clinicalfeaturesoffungal(mycotic)cornealulcer
Symptomsaresimilartobacterialcornealulcersbutingeneralthey
arelessmarkedthantheequalsizedbacterialulcer.Ontheother
handsignsareveryprominent,i.e.signsaremoreprominentthan
symptoms.Followingsignscanbeseen:-
1. Greyish-whitedrylookingulcerwiththeelevatedrolledoutfeathery
&hyphatemargins.
2. Featheryfingerlikeextensionintosurroundingstromaunderintact
epithelium.
3. Asterileimmunering(yellowline)ofWesseley.
4. Multiplesmallsatellitelesions.
5. Non-sterile(infected)hypopyon(Pseudohypopyon).
6. Perforationisrareandcornealvascularizationisconspicuously
absent.

---

1148.Reis-Bucklerdystrophyaffectswhich
layerofcornea
a)Epithelium
b)Stroma
c)Bowman'smembrane
d)Endothelium
CorrectAnswer-C
Ans.is'c'i.e.,Bowman'smembrane

---

1149.NottrueaboutFuch'scorneal
dystrophy?
a)Posteriordystrophy
b)Endothelialdystrophy
c)Unilateralcondition
d)Occursinoldage
CorrectAnswer-C
Ans.is'c'i.e.,Unilateralcondition
Cornealdystrophiesarebilateral.
Fuch'sepithelialendothelialdystrophy
Fuchsdystrophyisfrequentlyseenasaslowlyprogressivebilateral
conditionaffectingfemalesmorethanmales,usuallybetweenfifth
andseventhdecadeoflife.
Primaryopenangleglaucomaisitscommonassociation.
Clinicalfeaturescanbedividedintofollowingfourstages:?
1. Stageofcorneaguttata.Itischaracterisedbythepresenceof
Hassal-Henletypeofexcrescensesinthecentralpartofcornea.A
gradualincreaseofcentralguttaewithperipheralspreadand
confluencegivesrisetothesocalled'beaten-metal'appearance.
Thestageisasymptomatic.
2. Oedematousstageorstageofendothelialdecompensationis
characteirsedbytheoccurrenceofearlystromaloedemaand
epithelialdystrophy.Patientscomplainsofblurringvision.
3. Stageofbullouskeratopathy.Thisstagefollowslong-standing
stromaloedemaandischaracterisedbymarkedepithelialoedema
withformationofbullae,whichwhenrupturecausepain,discomfort
andirritationwithassociateddecreasedvisualacuity.
4. Stageofscarring.Inthisstageepithelialbullaearereplacedbyscar

---

tissueandcorneabecomesopaqueandvascularized.Thecondition
maysometiemsbecomplicatedbyoccurrenceofsecondary
infectionorglaucoma.

---

1150.Superficialcornealvascularizationis
causedby?
a)Contactlens
b)Graftrejection
c)Chemicalburn
d)Interstitialkeratitis
CorrectAnswer-A
Ans.is'a'i.e.,Contactlens&'to'i.e.,Graftrejection
SuperficialDeep
Interstitial
Superficialcorneal
keratitis
ulcer
Disciforrn
Contactlensuser
keratitis
Trachoma
Deepcorneal
Rosaceakeratitis
ulcer
Phlyctenular
Chemicalburns
keratoconjunctivitiso
Sclerosing
Corneagraftrejection
keratitis
Viralinfectioncancausesuperficialcornealulceraswellas
disciformkeratitis.

---

1151.Cornealsensationsaredecreasedinall
ofthefollowingconditionsexcept:
a)Recurrentcornealerosionsyndrome
b)Herpetickeratitis
c)Neuroparalytickeratitis
d)Leprosy
CorrectAnswer-A
Ans.Recurrentcornealerosionsyndrome

---

1152.Interstitialkeratitisisseeninallexcept:
a)Syphilis
b)Acanthamoeba
c)HSVChlamydiaTrachomatis
d)HZV
CorrectAnswer-B
Bi.e.Achanthamoeba
>acquiredsyphilis)Q-Herpetickeratitis(includingchickenpox;
HSVisnowthemostcommoncause)Otherviralinfections(HSV,
Herpeszoster,EpsteinBarr,mumps,measelsetc)-Tuberculosis,
leprosy-Sarcoidosis-Trypanosomiasis,-Malaria-Cogan's
syndrome(d/tchlamydinQetc)"
v:shapes="_x0000_s1027">Interstitialkeratitis(IK)
Interstitialkeratitis(IK)isnonsuppurativeinflammationofcorneal
stromawithoutprimaryinvolvementofepitheliumorendothelium.In
mostcasestheinflammationisanimmunemediatedprocess
triggeredbyanappropriateantigen.Immunestromalkeratitis
manifestsasfocal,multifocalordiffusestromalopacitiesoran
immunering.Itisoftenaccompaniedbystromaledemaandmild
anteriorchamberreaction,whilesparingepitheliumand
endothelium.ItiscalledIKifaccompaniedbyvascularization.
HSVQisnowthemostcommoncauseofIK(esp.unilateral).Unlike
syphilitic(luetic)IK,HSVneovascularizationisusuallysectoral&
leadsuptostromalscar.
-Syphilisrelated(congenital>>acquired)IKisusuallybilateral,
althoughusuallynotsimultaneous.Itpresentswithcharacteristic
salmonpatchappearance,granulomatnusanteriorureitis,andghost
vesselsandfeatherydeepstromalscarringinhealedstage.

---

-Cogan'ssyndromeischronicbilateraldeepnonsyphiliticIKwith
vestibuloauditorychysfunction(i.e.neurosensorydeafness,vertigo
&tinnitus)becauseofsystemicautoimmunevasculitis(life
thereateningin10%).Serumantibodiestovarious?infectious
agents(Lymedisease,Chalamydia,type1poliovirus)havebeen
associatedwithCogan'ssyndrome.

---

1153.Thickestportionofsclerais?
a)Anteriortorectusmuscleinsertion
b)Posteriortorectusmuscleinsertion
c)Posteriorpole
d)Limbus
CorrectAnswer-C
Ans.is'c'i.e.,Posteriorpole
oThethicknessofthescleravariesaccordingtolocation:?
Atthelimbus,thesclerais0.8mmthick.
Anteriortotherectusmuscleinsertions,itis0.6mmthick.
Posteriortotherectusmuscleinsertions,itis0.3mmthick(Thinnest
portion).
Attheequator,itis0.5to0.8mmthick.
Attheposteriorpole,itisgreatestthan1mmthick.

---

1154.Thinnestportionofsclera?
a)Anteriortorectusmuscleinsertion
b)Posteriortorectusmuscleinsertion
c)Posteriorpole
d)Limbus
CorrectAnswer-B
Ans.is.b,Posteriortorectusmuscleinsertion
ThinnestportionofscleraPosteriortoinsertionsofrectusmuscle.
ThickestportionofscleraPosteriorpole.

---

1155.Mostcommontypeofscleritis?
a)Non-necrotizing
b)Necrotizing
c)Posterior
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Non-necrotizing
SCLERITISScleritisreferstoachronicinflammationofthesclera
proper.Itisacomparativelyseriousdiseasewhichmaycausevisual
impairmentandevenlossoftheeyeiftreatedinadequately.
Itusuallyoccursinelderlypatients(40-70years)involvingfemales
morethanthemales.
Classification:I.Anteriorscleritis(98%)
1.Non-necrotizingscleritis(85%)
(a)Diffuse(b)Nodular
2.Necrotizingscleritis(13%)
(a)withinflammation(b)withoutinflammation(scleromalacia
perforans)
II.Posteriorscleritis(2%)
1.Non-necrotizinganteriordiffusescleritis.Itisthecommonest
variety,characterisedbywidespreadinflammationinvolvinga
quadrantormoreoftheanteriorsclera.
Theinvolvedareaisraisedandsalmonpinktopurpleincolour.

---

1156.Drugofchoiceforintermediateuveitis
?
a)Atropine
b)Antibiotics
c)Topicalsteroids
d)Systemicsteroid
CorrectAnswer-D
Ans.is'd'i.e.,Systemicsteroids
Drugsusedinacuteanterioruveitis(iridocyclitis)
Topicalsteroids(Drugsofchoice)
Mydriatic-cycloplegics:Atropine(Drugof2"choice),Homatropine,
cyclopentolate,tropicamide,rnydricain(mixtureofatropine,
adrenaline&procaine)
Systemicsteroids
NSAIDs
Systemicimmunosuppressivescyclosporine,methotrexate,
cyclophosphamide
Intermediateuveitis
Systemicsteroidsarethedrugofchoice
Posterioruveitis
(choroiditis)
Systemicsteroidsarethedrugofchoice

---

1157.Redkeraticprecipitatesareseenin?
a)Granulomatousuveits
b)Hemorrhagicuveitis
c)Oldhealeduveitis
d)Acuteanterioruveitis
CorrectAnswer-B
Ans.is.bi.e.,Hemorrhagicuveitis
Keraticprecipitates(KPs)
KPsareproteinaceouscellulardepositsoccurringatthebackof
cornea(cornealendothelialdeposits).Keraticprecipitatesare
formedbytheaggregationofpolymorphonuclearcells,lymphocytes,
andepitheloidcells.Inthesettingofuveitis,thebimicrosopic
appearanceofKPmayyeildimportantdiagnosticcluesforthe
identificationoftheunderlyinginflammatorydisorder:?
MuttonfatKP:-Large,yellowishKPs,arecharacteristic
ofgranulomatousuveitis.Thesearecomposedofepitheloidcellsand
macrophages.Theyarelarge,thickfluffy,lardaceousKPs,havinga
greasyorwaxyappearance.
SmallormediumKPs(granularKPs):-Thesearecomposedof
lymphocytesandarecharacteristicofnon-granulomatousuveitis.
Thesearesmall,roundandwhitishprecipitates
RedKPs:-ComposedofRBCsandinflammatorycells.Theseare
seeninhemorrhagicuveitis.
OldKPs:-Inhealeduveitis.TheabovedescribedKPsshrink,fade,
becomepigmentedandirregularinshapewithcrenatedmargins.

---

1158.Snowbankingisseenin?
a)Whitecoatsdisease
b)Ealesdisease
c)Diabeticnephropathy
d)Intermediateuveitis
CorrectAnswer-D
Ans.isdi.e.,Intermediateuveitis
Parsplanitis(Intermediateuveitis)denotestheinflammationofpars
planapartofciliarybodyandmostperipheralpartoftheretina.
Mostcommonsymptomisfloaters;defectivevisionmayalsooccur.
Fundusexaminationinparsplanitisrevealswhitishexudates
presentneartheoraserrataintheinferiorquadrant.
Thesetypicalexudatesarereferredassnowballopacities.
Thesemaycoalescetoformagreywhitepiquecalledsnow
banking.

---

1159.Whichofthefollowingindicatesactivity
ofanterioruveitis?
a)Cellsinanteriorchamber
b)Circumcornealcongestion
c)Keraticprecipitate
d)Cornealedema
CorrectAnswer-A
Ans.is'a'i.e.,Cellsinanteriorchamber
Activityofacuteanterioruveitisisindicatedbypresenceofcells
(aquouscells)andflareinanteriorchamberGradingisdoneon
thesetwo.
Grade
Aquouscells
Grade
Aquousflare
0cells
0 noflare
+_
1-5cells
+1 Justdetectable
+1
6-10cells
+2 Moderateflare
+2
11-20cells
+3 Markedflare
+3
21-50cells
+4 Intenseflare
+4
>50cells

---

1160.Panophthalmitisinvolves?
a)Innercoatofeyeball
b)Innerandoutercoatbutsparingtenon'scapsule
c)Allstructureofeyeballincludingtenon'scapsule
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Allstructureofeyeballincludingtenon'scapsule
Endophthahnitis
Panophthalmitis
Endophthalmitisisdefinedas
Panopthalmitisisdefinedas
inflammationwithintheanterior
inflammationwithintheanterior
segment(aqueous)orposterior
(aqueous)segmentand'or
segment(vitreous)orbothtogether posterior(vitreous)segment
withpartialthicknessinvolvementof togetherwithinflammationof
theadjacentoccularwall(oneor
allthreecoatsoftheeye.
moreinnercoatsoftheeye)
Panophthalmitisoftenstartsas
Inflammationcharacteristically
anendophthalmitisthatthen
involvesthetheinnerstructuresof
involvesthesclera,tenon's
theeyeballLe.,uvealtissue
capsuleandmayalsoinvolve
(iris/ciliarybody/choroid)andRetina theorbitaltissue.
(Scleraisspared).

---

1161.Polyopia/diplopiaisseeninwhichtype
ofcataract?
a)Nuclear
b)Cortical
c)Posteriorsubcapsular
d)Anteriorpolar
CorrectAnswer-B
Ans.is'b'i.e.,Cortical

---

1162.Insenilenuclearcataractwhattypeof
myopiaisseen?
a)Curvaturemyopia
b)Indexmyopia
c)Axialmyopia
d)Positionalmyopia
CorrectAnswer-B
Ans.is'b'i.e.,Indexmyopia
Nuclearchangesofaginginduceamodificationofrefractiveindexof
lensandproduceanindexmyopia.
"Nuclearcataractscauseageneraldecreaseinthetransperancyof
thelensnucleus.Theyareassociated
withindexmyopia"--
Ophthalmicstudyguide
Causesoferrorsofrefraction
Possiblecausesofametropiaare:?
1)Axial
Itisthecommonestformofametropia(bothmyopiaand
hypermetropia).Inhypermetropia,thereisanaxialshorteningof
eyeball.So,imageisformedbehindtheretina.Inmyopia,thereis
anaxiallengtheningofeyeball.So,imageisformedinfrontofthe
retina.1mmchangeinaxiallengthleadstoametropiaof3D.For
example1mmshorteninginaxiallengthcauseshypermetropiaof
3D.
2)Curvature
Changeinthecurvatureofcorneaorlenswillcauseametropia.In
hypermetropia,thecurvatureofcorneaorlensislesserthannormal.
Inmyopia,thereisincreaseincurvatureofcorneaorlens./mm

---

changeincornealcurvatureleadsto6-7Dametropia.
3)Index
Ifrefractiveindexofopticalsystemislow,itwillresultin
hypermetropiaandhighrefractiveindexwillresultinmyopia.
4)Positional(Duetorelativepositionofthelens),
Aforwardshiftoflenscausesmyopia,backwardshiftresultin
hypermetropia.Absenceoflens(aphakia)causeshypermetropia.
5)Excessiveaccommodation
Excessiveaccommodationduetospasmofaccommodationcauses
myopia.

---

1163.Cataractiscausedby?
a)Hypoparathyroidism
b)Cigratesmoking
c)Non-ionizingradiation
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove

---

1164."Bread-crumb"appearanceisseenin?
a)Diabeticcataract
b)Toxoplasmosis
c)CMVretinitis
d)Complicatedcataract
CorrectAnswer-D
Ans.D.Complicatedcataract

---

1165.Elschnig'spearlsareasignof:
a)Chronicuveitis
b)Secondarycataract
c)Cystoidmacularoedema
d)Alloftheabove
CorrectAnswer-B
Ans.Secondarycataract

---

1166.Posteriorlenticonusisseenin?
a)Alport'ssyndrome
b)Lowe'ssyndrome
c)Marfansyndrome
d)Homocystinuria
CorrectAnswer-B
Ans.is'b'i.e.,Lowe'ssyndrome
Lenticonusreferstocone-shapedelevationoftheanteriorpole
(anteriorlenticonus)orposteriorpole(posterior
lenticonus)ofthelens.
AnteriorlenticonusisseeninAlport'ssyndrome.
PosteriorlenticonusisseeninLowe'ssyndrome.
Ondistantdirectophthalmoscopy,lenticonuspresentasanoil
globulelyinginthecenterofredreflex.
Slit-lampexaminationconfirmsthediagnosis.

---

1167.Ectopialentisis/areassociatedwith:
a)Homocystinuria
b)Alportsyndrome
c)Lowesyndrome
d)Marfansyndrome
e)Sulphiteoxidasedeficiency
CorrectAnswer-A:D:E
Answer-(A)Homocystinuria(D)Marfansyndrome(E)Sulphite
oxidasedeficiency
Marfansyndrome
Homocystinuria
Weil-Marchesanisyndrome
Sulfiteoxidasedeficiency
Hyperlysinemia

---

1168.Bilateralinferiorlenssubluxationis
seenin?
a)Marfansyndrome
b)Homocysteinuria
c)Oculartrauma
d)Noneoftheabove
CorrectAnswer-B
Ans.is`b'i.e.,Homocysteinuria

---

1169.Foldablelensismadeupof?
a)PMMA
b)Silicon
c)Hydrogel
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Silicon
Dependingonthematerialofmanufacturing,followingtypesof
IOLsarethere:-
RigidIOLs:-Madeentirelyfrompolymethylmethacrylate(PMMA).
Foldable10Ls:-Areusedafterphacoemulsificationandaremade
ofsilicon,acrylic,hydrogelandcollamer.
Rollable10Ls:-UltrathinIOLsandaresuedafterphokonit
technique(micro-incision:lmm).Thesearemadeofhydrogel.

---

1170.VonHerickanglegrade'3'ofanterior
chamberdenotes
a)Wideopenangle
b)Moderatelyopenangle
c)Moderatelynarrowangle
d)Closedangle
CorrectAnswer-B
Ans.is'b'i.e.,Moderatelyopenangle

---

1171.Krukenbergspindles-
a)Involvesanteriorsurfaceofcornea
b)Involvesanteriorlenssurface
c)Involvesposteriorsurfaceofcornea
d)Involvesposteriorsurfaceoflens
CorrectAnswer-C
Ans.is'c'i.e.,Involvesposteriorsurfaceoffcornea
Pigmentot-vglaucoma
Itisatypeofsecondaryopenangleglaucomawhereincloggingup
oftrabecularmeshworkoccursbythepigmentparticles.
Theconditiontypicallyoccursinyoungmyopicmales.
Thecharacteristicfeatureisthedepositionofpigmentgranulesin
theanteriorsegmentstructuressuchasiris,posteriorsurfaceofthe
cornea(Krukenberg'sspindle),trabecularmeshwork,ciliaryzonules
andthecrystallinelens.oGonioscopyshowspigmentaccumulation
alongtheschwalbe'slineespeciallyinferiorly(Sampalesi'sline).
Iristransilluminationshowsradialslit-liketransilluminationdefectsin
themidperiphery(pathognomonicfeature).
Treatmentisasforprimaryopenangleglaucoma

---

1172.Mostcommonsymptomin
buphthalmosis?
a)Lacrimation
b)Pain
c)Photophobia
d)Itching
CorrectAnswer-A
Ans.is'a'i.e.,Lacrimation
Thecommonestsymptomiswatering"
InBuphthalmos
MostcommonsymptomWatering(lacrimation)
2ndmostcommonsymptomPhotophobia
MosttroublesomesymptomPhotophobia(Childavoidslight)o
FirstsignCornealedemawithwatering
Frostedglassappearanceofthecornea(hazycornea)
Haabstriae
Largecornea
Deepanteriorchamber
Lensanteroposteriorlyflat

---

1173.Habbsstriaeareseenin?
a)Buphthalmos
b)Keratoglobus
c)Trachoma
d)Keratoconus
CorrectAnswer-A
Ans.is'a'i.e.,Buphthalmos
Examinationfindingsofprimarycongenitalglaucoma
(buphthalmos)
Firstsigniscornealedemawithwateringofeyewithmarked
photophobia
Haabstriae(Discretecornealopacitiesappearaslineswithdouble
contourduetoruptureinDescemetsmembrane)
Corneaishazywithfrostedglassappearance.
Cornealenlargement
Thin&bluesclera
Deepanteriorchamber
Lensisantero-posteriorlyflatandmaybesubluxatedbackward
Iridodonesis(tremulousiris)andatrophicpatchoniris
Largeeye(Buphthalmosorhydrophthalmos)
Variablecuppingandatrophyofdisc
RaisedIOP(neitheracutenormarked)
Axialmyopiaduetoincreasedaxiallengthwhichmaygiveriseto
anisometropicamblyopia

---

1174.Drugofchoiceforopenangleglaucoma
-
a)Acetazolamide
b)Latanoprost
c)Timolol
d)Brimonidine
CorrectAnswer-C
Ans.is'c'i.e.,Timolol
Importantacts
Angleclosureglaucoma
TreatmentofchoiceforacutecongestiveglaucomaLaseriridotomy
(1"choice),Peripheraliridectency(2"choice)
DrugofchoiceforacutecongestiveglaucomaPilocarpine
InitiallyIOPiscontrolled(firstdrugused)Systemicmannitolor
acetazolamide
Openangleglaucoma
TreatmentofchoiceTopicalantiglaucoma
drugs
Drugofchoice/3-blocker(Timolol,
betaxolol,levobunalol)
SurgeryofchoiceArgonordiodelaser
trabeculoplasty

---

1175.Acuteangleclosureglaucomafirstline
treatment?
a)Ivmannitol
b)Acetazolamide
c)Pilocarpine
d)Betablockereyedrops
CorrectAnswer-A
Ans.is'a'i.e.,I.V.Mannitol
Treatmentofangleclosureglaucoma
Definitivetreatment(treatmentofchoice)issurgery.However,
intiallydrugsareusedtodecreaseKWduringanacuteattack.
Approachoftreatmentisasfollows:-
Starti.v.mannitolori.v.acetazolamide
WhenIOTstartsfalling,starttopicalpilocarpineor-blocker
(timolol).
Apraclonidine/latanoprostmaybeadded.
OnceIOTisreduced,surgeryisdone.
Topicalpilocarpine2%isthepreferredantiglaucomatousdrug.
AftercontrolofIOP,Laser(Nd:YAG)peripheralirodotomyisthe
definitivemanagementofchoice.Iflaserisnotavailablesurgical
peripheraliridectomyistheprocedureofchoice.Othersurgical
proceduresusedarefilterationsurgeries(liketrabeculectomy,deep
sclerotomy,Viscoanulostomy).
Symptomatictreatmentduringanattackalsoincludesanalgesics,
antiemeticandtopicalcorticosteroidstoreduceinflammation.
Mydriatics(e.g.atropine)arecontraindicatedastheyprecipitate
glaucoma.
PACGisabilateraldisease,thefelloweyeisatriskofdevelopingan

---

acuteattackin50%casesinfuture.Thereforeaprophylactic
peripherallaseriridotomyshouldbeperformedinthefelloweye.

---

1176.Whichofthefollowingantiglaucoma
medicationscancausedrowsiness?
a)Latanoprost
b)Timolol
c)Brimonidine
d)Dorzolamide
CorrectAnswer-C
Ci.e.Brimonidine

---

1177.Posner-schlossmansyndromeis?
a)Ipsilateralopticatrophywithcontralateralpapilloedema
b)Unilateralglaucomatouschangeswithmildanterioruveitis
c)Granulomatousuveitiswithirisheterochromia
d)Noneoftheabove
CorrectAnswer-B
.Ans.is'b'i.e.,Unilateralglaucomatouschangeswithmildanterior
uveitis

---

1178.Causesofexudativeretinaldetachment
areallexcept-
a)Toxemiaofpregnancy
b)Scleritis
c)Highmyopia
d)Centralserousretinopathy
CorrectAnswer-C
Ans.is'c'i.e.,Highmyopia
Cause:retinaldetachment
1. Rheugmatogenous
Highmyopia,Cataractextraction(Aphakia,pseudophakia),Trauma,
Retinaldegeneration(1Iicedegeneration,snailtrackdegeneration,
retinoschisis).
Exudative
1. SystemicdiseaseToxaemiaofpregnancy,renalhypertension,blood
dyscrasias&polyartetitisnodosa.
2. Oculardisease
Inflammation:Harada'sdisease,sympatheticophthalmitis,posterior
scleritis&orbitalcellulitisqVascular:Centralserousretinopathy,
exudativeretinopathyofcoats
Neoplasm:Malignantmelanomaofchoroid,retinoblastoma
(exophytictype)
Suddenhypotony:perforationofglobe,intraocularoperation
1. Othercauses:Uvealeffusionsyndrome,choroidal
neovascularisation,haemangioma&metastatictumourofchoroid.
Tractional
Penetratinginjury,Proliferativediabeticretinopathy,sicklecell
retinopathy,Retinopathyofprematurity,CRVO,Eale'sdisease,post-

---

hemorrhagicretinitisproliferan-Toxociasis,plasticcyclitis

---

1179.
Primaryaimofretinaldetachment
surgery
a)Removalofvitreous
b)Drainageofsubretinalfluid
c)Vitrectomy
d)Encirclage
CorrectAnswer-D
Di.e.Encirclage
Themainobjectiveofthetreatmentofretinaldetachmentistoseal
andsupporttheretinalbreakQ.

---

1180.Neovascularizationinuvealtissue
[RubeosisIridis]ismostcommonly
causedby
a)DiabeticRetinopathy
b)CRVO
c)CRAO
d)Choroidalmelanoma
CorrectAnswer-A
Answer-A.DiabeticRetinopathy
Itisasecondaryangleclosureglaucomawhichresultsdueto
formationofneovascularmembraneovertheirisi.e.,
neovascularizationofiris(rubeosisiridis).
Causesofrubeosisiridisare:-
Common:-Diabeticretinopathy(mostcommoncause),central
retinalveinocclusion),Eale'sdisease,sickle-cellretinopathy.

---

1181.Retinaldetachmentoccursbetween
a)Layersofneurosensoryretina
b)Neurosensoryretinaandpigmentepithelium
c)Pigmentepitheliumandchoroid
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Neurosensoryretinaandpigmentepithelium
Retinahastotaltenlayersfromwithoutinward:-(i)Pigmented
epithelium,(ii)LayersofRods&cones,(iii)Externallimiting
membrane,(iv)Outernuclearlayer,(v)Outerplexiformlayers,(vi)
Innernuclearlayer,(vii)Innerplexiformlayer,(viii)Ganglioniccell
layer,(ix)Nervefibrelayer,(x)Internallimitingmembrane
Broadlytheselayersaresubdividedintotwolayersbasedonthe
function:?
Neurosensorylayerorsensorylayer(containinglayersiitoxof
above10layers):-forvision.
Pigmentedepithelium(layeri):-Providemetabolicsupportto
neurosensorylayerandactsasanantireflectivelayer.
So,innerlayersareincludedinneurosensorylayerandoutermost
layerisretinalpigmentedepithelium(RPE).
Retinaldetachmentisadisorderofeyeinwhichretinapeelsaway
fromitsunderlyinglayerofsupporttissue.Usually
thereisseparationbetweentheneuroepithelium(neurosensory
epitheliumorsensoryepithelium)andthepigmented
layer,becausethereisapotentialspacebetweenthesetwolayers
wherefluidcanaccumulatesandcancauseseparation.

---

1182.Allareseeninnon-proliferativediabetic
retinopathyexcept?
a)Microaneurysm
b)Neovascularization
c)Hardexudates
d)Macularedema
CorrectAnswer-B
Ans.is'b'i.e.,Neovascularization
ClassificationofDiabeticretinopathy
Nonproliferative
Proliferative
Backgroundretinopathy
1. Microaneurysm
2. Dotandblothemorrhage(deep Neovasculorizationofthedisc
hemorrhage)
(NVD)
3. Hardexudate
1. Neovasculaizationelsewhereinthe
4. Macularedema
retina(NVE)
B)Preproliferative
2. Viffeoushemorrhage
retinopathy
3. Fibrovascularproliferation
1. Cotton-woolspots(soft
4. Trsctionretinsldetachment
exudates)
5. Irissurfaceneovascularization
2. Venousbeading
(rubeosisiridisor
3. Extensivehemorrhage
neovascularglaacoma)
4. lntraretinalintravascularabn
ormalities(IRMA

---

1183.AllareseeninCMVretinitisexcept
a)Immunosuppresion
b)Brush-fireappearancePattern
c)Crackmudappearance
d)Perivasculitis
CorrectAnswer-C
Answer-C.Crackmudappearance
CMVretinitisisthemostcommonophthalmicmanifestationofCMV.
Thereischaracteristichemorrhagic,fullthicknessretinitis.
Occuringasacongenitalinfectionininfantsoranopportunistic
infectionintheimmunocompromisedhost.
CMVretinitisisawhitegranulargeographiclesionthatclears
centrallyasitenlarges,leavingaquietcentralareaofretinalatrophy
andmottledpigmentepithelium.Thishasalsobeendescribedas
"brush-firepattern.
Perivascularretinitis-Frostedbranchangitiswithretinal
perivasculitis.

---

1184.Umbrellaconfigrationonfluorescein
angiogrphyisseenin?
a)Retinitispigmentosa
b)Rheugmatousretinaldetachment
c)Centralserousretinopathy
d)Eale'sdisease
CorrectAnswer-C
Ans.is'c'i.e.,Centralserousretinopathy
Centralserousretinopathy
Centralserousretinopathyiscausedbyanaccumulationof
transparentfluidattheposteriorpoleespeciallyatmaculacausinga
circumscribedarearetinaldetachmentinthemacularregion.
Thereisdetachmentofneurosensoryretina(layersofrodsand
cones)withorwithoutretinalpigmentepitheliumdetachment.
Theconditionaffectsmalesbetween20-40yearsofage.
Patientpresentswithasuddenonsetofpainlesslossofvision
associatedwithrelativepositivescotoma,micropsiaand
metamorphosia.
Ophthalmoscopicfindingsincludemildelevationofmaculararea
demarcatedbyacircularringreflexandfovealreflexisdistortedor
absent.
Thediagnosisisconfirmedbyfluoresceinangiography.Itshows
focalleakageoffluoresceininfollowingtwopatterns:?
Ink-blotpatternorenlargingdotsign:-Asmallhyperfluorescent
spotwhichgraduallyincreasesinsize.
Smoke-stackpattern:-Smallhyperfluorescentspotwhichascends
verticallylikeasmokestackandgraduallyspreadslaterallytotakea
mushroomorumbrellaconfigration

---

---

1185.Photoretinitisisdueto?
a)Snowreflection
b)Solareclipse
c)Blunttrauma
d)Noneoftheabove
CorrectAnswer-B
Ans.isbi.e.,Solareclipse
Photoretitins
Photoretinitisreferstodamagetotheretinaresultingfromexposure
tothesunlightwithoutadequateprotection.
Inrecentyearsithasbecomeclearthatphotoretinitisistheresultof
photochemicalreactionfollowingexposure
oftheretinatoshorterwave-lengthinthevisiblespectrum(i.e.
blue/violet-bluelight)withasmallcontribution
byUV-Arays(andnotbyinfraredrayswhichwasthoughtearlier).
Therefore,photoretinitisisalsocalledasblue-lightretinalinjury.
Photoretinitisisassociatedwithreligioussungazing,solareclipse
observing,telescopysolarviewing,watchingbrightsunlight,or
exposuretotheflashoftheshort-circuitingofastrongcurrent.
Thesymptomsarepersistentoftheafterimage,progressinglater
intopositivescotoma,andmetamorphosia.
Ophthalmoscopically,theremaybenosignatfirst,orapalespotis
seenatthefoveawithabrownish-redringaroundit.
Latertherearedepositofpigmentsandsmall,greypunctatespots
aroundthefovea,oreventheformationofretinalhole

---

1186.Birdshotretinopathyischaracterizedby
allexcept?
a)Commoninfemales
b)Unilateral
c)HLA-A29positive
d)Creamyyellowspots
CorrectAnswer-B
Ans.is'b'i.e.,Unilateral
Bird-shotretinochoroidopathy
Itisarare,idiopathic,bilaterallysymmetricalchronicmultifocal
chorioretinitischaracterisedbynumerousflat
creamy-yellowspotsduetofocalchorioretinalhypopigmentation,
resemblingthepatternof"bird-shortscatterfromashotgun".
Thedisease,morecommoninfemalesthanmales,typicallyaffects
middle-agedhealthypersonswhoarepositiveforHLA-A29.
Itrunsalongchroniccourseofseveralyears.
Treatmentwithcorticosteroidsisusuallynoteffective

---

1187.Themostcommoncauseofvitreous
hemorrhageinadultsis
a)Retinalhole
b)Trauma
c)Hypertension
d)Diabetes
CorrectAnswer-D
Ans.is'd'i.e.,Diabetes
Diabeticretinopathyisthecommonestcauseofspontaneous
vitreoushemorrhageinadults".__Parson's
"Mostcommoncauseofvitreoushemorrhageisdiabeticretinopathy
inadults".--Atlasofophthalmology
Causesofvitreoushemorrhage
PosteriorvitreousdetachmentEale'sdisease&
Coat'sdisease
Retinealtear(break)duetotraumaVasculardisorders:-
Hypertensiveretinopathy,
orvitreoustraction.CRVO
ProliferativediabeticretinopathyAcutechorioretinitis,
periphlebitisoruveitis
BranchedretinalveinocclusionBleedingdisorders
(Polycythemia,anemia,SCA)
Age-relatedmaculardegenerationNeoplasm
RetinalmacroaneurysmTresonsyndrome

---

1188.Choroidalvascularizationisseenin?
a)Myopia
b)Hypermetropia
c)Presbyopia
d)Astigmatism
CorrectAnswer-A
Ans.is'a'i.e.,Myopia
1. Causesofchoroidalneovascularization
Age-relatedmaculardegeneration(ARMD)-mostsignificant
Chorioretinalscars
Angioidstreaks
Intraocularinflammation
Choroidalrupture(trauma)
Chorioretinaldystrophy
Pathologicalmyopia

---

1189.

---

Longestpartofopticnerve?
a)Intraocular
b)Intracranial
c)Intraorbital
d)Intracranial
CorrectAnswer-C
.Ans.is'c'i.e.,Intraorbital
Opticnerve
Eachopticnerve(secondcranialnerve)startsfromtheopticdisc
andextendsuptoopticchiasma,wherethetwonervesmeet.
Itisthebackwardcontinuationofthenervefibrelayeroftheretina,
whichconsistsofthesecondorderneuronsi.e.,axonoriginating
fromtheganglioncells.
Italsocontainstheafferentfibresofthepapillarylightreflex.
Morphologicallyandembryologically,theopticnerveiscomparable
toasensorytract.
Unlikeperipheralnervesitisnotcoveredbyneurilemma(soitdoes
notregeneratewhencut).
Thefibresofopticnerve,numberingaboutamillion,areveryfine(2-
10mindiameterascomparedto20mmofsensorynerves).
Opticnerveisabout47-50mminlengthandcanbedividedinto4
parts:?
Intraocularpart(1mm):-Itbeginsatopticdisc(opticnervehead)
andexitsthenervethroughaholeinsclerathatisoccupiedbya
meshlikestructurecalledthelaminacribrosa.Thenervefibresfrom
theretinaleavetheeyethroughpores(holes)inlaminacribrosa,a
sieve-likestructuremadeupofcollagenmeshwork.
Intraorbitalpart(30mm):-Extendsfrombackoftheeyeball(at

---

laminacribrosa)totheopticforamina.
Intracanalicularpart(6-9mm):-Itlieswithintheopticcanaland
closelyrelatedtoophthalmicarterywhichcrossesobliquelyoverit.
Intracranialpart(10mm):-Itliesabovethecavernoussinusand
convergeswithitsfellowfromcontralateralsidetoformoptic
chiasma.
LikeotherpartsofCNS,theopticnerveiscoveredbymeningeal
sheaths(Pia,archnoidandduramater)assoonasthenerveleaves
theeyeball.

---

1190.Nervecarryingmotorcomponentof
lightreflex?
a)1Stnerve
b)2"nerve
c)3'nerve
d)4thnerve
CorrectAnswer-C
Ans.is`C'i.e.,3rdnerve

---

1191.MarcusGunnpupilisdueto?
a)Totalafferentpupillarydefect
b)Relativeafferentpupillarydefect
c)Efferentpathwaydefect
d)Cerebrallesion
CorrectAnswer-B
Ans.is'b'i.e.,Relativeafferentpapillarydefect
MarcusGunnpupil
MarcusGunnpupilisseeninrelativeafferentpathwaydefect
(RAPD)
Anincompleteopticnervelesionorretinaldiseasecauseit(in
contrasttoamauroticlightreflex,wherethereistotalafferent
pathwaydefect).Itisbesttestedbyswingingflashlighttest.
Toperformthistest,abrightflashlightisshonetoonepupiland
constrictionofthatpupilisnoted.
Thentheflashlightisquicklymovedtothecontralateralpupilandthe
responseinthatpupilisnoted.
Thisswingingtoandfrooftheflashlightisrepeatedseveraltimes
whilethepupillaryresponseisobserved.
Normally,bothpupilsconstrictequallyandthepupiltowhomlightis
transferredremainstightlyconstricted.
Inthepresenceofrelativeafferentpupillarydefectinoneeye,both
thepupilwilldilatewhentheflashlight
ismovedfromthenormaltotheabnormaleye.
Thisisaparadoxicalresposne.
ThisiscalledMarcusGunnpupilandistheearliestindicatorofoptic
nervediseaseeveninthepresenceofanormalvisualacuity.
Relativeafferentpapillarydefect(RAPD)orMarcusGunnpupilisa

---

reliableandobjectvesignofunilateralorassymmetricdiseaseor
anylesioninafferentpapillarypathway,i.e.,retina,opticnerve,optic
chiasma,optictractormidbrain(pretectalnucleus).
However,RAPDismostcharacteristicoflesionsintheopticnerve.

---

1192.Normalvisionwithabsenceofdirect&
consensuallightreflex,whichnerveis
involved?
a)Optic
b)Oculomotor
c)Trigeminal
d)Abducens
CorrectAnswer-B
Ans.is'b'i.e.,Oculomotor
Thisquestioncanbesolvedbysimplebasicknowledge:-
Amongthegivenoptionsonlyoiticnerveandocculomotornewes
arerelatedtolightreflex'
aInopticnerveinjuryvisionisalsoimpaired(visionisnormalinthe
question)'
nThusanswerisoculomotornerve
Whenlightisshonetoone(e.g.left)eye.leftopticnervecanies
afferentimpulsetobrainandfrombrainefferent
impulsetoipsiplateral(left)eyecomesthroughipsilateral(left)
occulomotornerye(fordirectlightreflex)andefferent
forcontralatcral(right)eyecomesthroughcontralateral(right)
occulmotornerveforconsensuallightreflex'When
lightisshonetoother(right)eyc,rightopticnervecarriesafferent
impulsetobrainandfrombrain,efferentimpulseto
righteye(fordirectlightreflex)comesthroughrightocculmotor
nerveandeffcrentfbrlefteye(forconsensuallight
reflex)comesthroughleftocculomotornerve'So:-
OpticneweisresponsibtefordirectlightreJlexinipsilateraleyeand

---

consensuallightreflexforcontralateral
eye.(lnaboveexample,afferentforrightsideddirectandleftsided
consensuallightreflexisthroughrightoptic
nerve;andatl-erentforleftsideddirectandrightsidedconsensual
lightreflexisthroughleftopticnerve)'
Occulomotornerveisresponsiblefordirectandconsensuallight
reflexinthesameeye'(lnaboveexample'
efferentforrightsideddirectasrvellasconsensuallightreflexis
throughrightocculmotornerveandef'ferentfor
leftsideddirectaswellasconsensuallightreflexisthroughleft
occulomotornerve)'
Incompleteopticnervelesionofoneside(Amaurosislight
reflexortotalafferentpupillaryfect)
Theipsilateraldirectreflexislost
Theipsilateralconscnsualreflexisintact
Thecontralateraldirectreflexisintact
Thecontralateralconsensualreflexislost
Inocculomotornervelesionofoneside(efferent
pupillarydefect
Theipsilateraldirectreflexislost
Theipsilateralconsensualreflexislost
Thecontralateraldirectreflexisintact
Thecontralateralconsensualreflexisintact

---

1193.FosterKennedysyndromeis
a)I/LPapilloedemaCiLopticatrophy
b)I/LOpticatrophyC/Lpapilloedema
c)I/LOpticatrophyandpapilloedema
d)ULPapilloedemaC/Lpapilitis
CorrectAnswer-B
Ans.is'cib.,I/LOpticatrophyC/Lpapilloedema
Foster-Kennedysyndrome:-Thefrontallobe,pituitaryandmiddle-
eartumorsuchasmeningiomataoftheoflactory
groovearesometimesassociatedwithIpsilateralpressureatrophy
oftheopticnerveandcontralateralpapilledema.
Pseudo-Foster-kennedysyndrome:-Itischaracterizedby
occurenceofunilateralpapilloedemaassociatedwith
raisedICT(duetoanycause)andapre-existingopticatrophy(due
toanycause)ontheotherside.

---

1194.Altitudinalvisualfielddefectisseenin
?
a)Papilloedema
b)Retinitispigmentosa
c)Anteriorischemicneuropathy
d)Buphthalmos
CorrectAnswer-C
Ans.is'c'i.e.,Anteriorischemicneuropathy
Anteriorischemicopticneuropathv(AION)
Itisaconditionoflocalanoxiaoftheanteriorregionoftheoptic
nerve.
Itisduetotheinvolvementofposteriorciliaryarteryandmaybe
centralretinalarterycausinginfarctoftheanteriorpartoftheoptic
nerveandretina.
Itoccurscommonlyinneglectedacuteattackofclosedangle
glaucoma,severeanemia,afteramassivehaemorrhage,and
temporalarteritis.
Thereissuddenlossofvision.
Onexaminationthereisswellingofthediscresultinginoptic
atrophy.
Permanentaltitudinalvisualfielddefectsarepresent.
Theseinvolvetwoquadrantsofeitherthesuperiororinferiorvisual
field.

---

1195.Ocularbobbing?
a)Midbrain
b)Pons
c)Medulla
d)Cortex
CorrectAnswer-B
Ans.is'b'i.e.,Pons
Square-waveerks
Notlocalizing
Macrosquare-waveerks Cerebellum
Macrosaccadicoscillation Cerebellum
Voluntarynystagmus
Volitional
Saccadicpulses
Cerebellum,lowerbrainstem
Ocularflutter
Cerebellum,lowerbrainstem
Opsoclonus
Cerebellum,lowerbrainstem
Ocularbobbing
Pons

---

1196.Elevatorsofeye:
a)SRand10
b)I0andSO
c)IRandS
d)SOSR
CorrectAnswer-A
Ans.SRand10

---

1197.Yokemuscleforleftsuperiorrectusis?
a)Rightsuperiorrectus
b)Leftinferiorrectus
c)Rightinferioroblique
d)Rightsuperioroblique
CorrectAnswer-C
Ans.C.Rightinferioroblique
Yokemuscles(contralateralsynergists).
Itreferstothepairofmuscles(onefromeacheye)whichcontract
simultaneouslyduringversionmovements.
Forexample,rightlateralrectusandleftmedialrectusactasyoke
musclesfordextroversionmovements.
OtherpairofyokemusclesarerightMRandleftLR,rightLRandleft
MR,rightSRandleftIO,rightSOandleftIRandrightIOandleft
SR.

---

1198.Downwardandoutwardmomentofeye
iseffectedininjuryof?
a)3rdnerve
b)4thnerve
c)5thnerve
d)6thnerve
CorrectAnswer-B
Ans.B.4thnerve
Downwardandoutwardmovementiscausedbysuperioroblique,
suppliedbyuochlear(4snerve).

---

1199.Distanceofmedialrectusfromlimbus-
a)4.5mm
b)5.5mm
c)7.0mm
d)10mm
CorrectAnswer-B
Ans.is'b'i.e.,5.5mm
Muscle
Distanceofinsertionfromlimbus
Medialrectus 5.5mm
Inferiorectus 6.5mm
Lateralrectus 6.9mm
Superiorectus 7.7mm

---

1200.Duannesyndromeinvolves?
a)Superioroblique
b)Inferioroblique
c)Lateralrectus
d)Superiorrectus
CorrectAnswer-C
Ans.is'c'i.e.,Lateralrectus
retractionsyndromerepresentsthemostfrequentandmost
prominentcongenitalcranialdysinnervationdisorder(CCDD).
Itisduetofibrosisofthelateralrectusoraninnervationalanomaly
withCo-contractionofthelateralandmedialrecti.
Thereisdeficiencyofabduction,associatedwithimpaired
adduction,contractionofpalpebralfissureandobliquemovements
oftheeye.

---

1201.Down-beatnystagmusisseeninlesion
of?
a)Brainstem
b)Cerebellum
c)Basalganglia
d)Hippocampus
CorrectAnswer-B
Ans.is'b'i.e.,Cerebellum
Centralvestibularnystagmusmaybeoffollowingtypes?
Up-beatnystagmus
Inprimarypositionofgaze,thefastcomponentisupward.
Itisseeninlesionsofcentraltegmentumofbrain-stem.
Down-beatnystagmus
Inprimarypositionofgaze,thefastcomponentisdownward.
Itisusuallyassociatedwithposteriorfossadiseaseandistypicalof
compressionatthelevelofforamenmagnum.
ItisacommonfeatureofcerebellarlesionsandArnold-chiary
syndrome.
Periodicalternativenystagms
Itisajerknystagmuswhichshowsfluctuationsinamplitudeand
direction.
Itmayoccurduetovascularordemyelinatingvascularor
brainstem-cerebellarlesions.

---

1202.Downbeatnystagmusisseenin?
a)Arnoldchiarimalformation
b)Brainstemdamage
c)Pontinehemorrhage
d)Labyrinthinedamage
CorrectAnswer-A
Ans.is'a'i.e.,Arnoldchiarimalformation
Down-beatnystagmusareseenincerebellarlesionandArnold-
chiarymalformation

---

1203.Forcedductiontestistofindout?
a)Ocularmusclepalsy
b)Ocularmusclespasm
c)Angleofdeviation
d)Refractiveerror
CorrectAnswer-A
Ans.is'a'i.e.,Ocularmusclepalsy
Forcedductiontest
Itisperformedtodifferentiatebetweentheincomitantsquintdueto
paralysisofextraocularmuscleandthatduetomechanical
restrictionoftheocularmovements.
FDTispositive(resistanceencounteredduringpassiverotation)in
casesofincomitantsquintduetomechanicalrestrictionand
negativeincasesofextraocularmusclepalsy.

---

1204.Positiveforcedductiontestisseenin?
a)Extraocularmusclepalsy
b)Mechanicalrestrictionofocularmovement
c)Concomitantsquint
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Mechanicalrestrictionofocularmovement
forcedductiontest:Resistanceencounteredduringpassiverotation
andisseeninincomitantsquintduetomechanicalrestriction.
Negativeforcedductiontest:Noresistanceduringpassiverotation
andisseeninextraocularmusclepalsy

---

1205.Mostcommonsiteofdistantmetastasis
inintraorbitalmalignantmelanomais?
a)Brain
b)Lung
c)Liver
d)Lymphnodes
CorrectAnswer-C
Ans.is`ci.e.,Liver
Malignantmelanomamostlyariseinuveaanduvealmalignant
melanomaisthemostcommonprimaryintraoculartumor.
Themostcommonsitefordistantmetastasisofuvealmelanomais
liver.
Theliveristhemostcommonsiteofmetastasisofuveal
melanoma"--Clinicaloncology
Theliveristhemostcommonsiteofmetastatisfromprimaryocular
melanoma"--Smith&Nesi's
Uvealmelanoma
Uvealmelanomaisthemostcommonprimaryintraoculartumorin
adults.
Mostofthe(85%)uvealmelanomasariseinthechoroid.
So,choroidalmelanomaisthemostcommonprimaryintraocular
tumorinadults.
Tumorarisesfromdendriticmelanocytes(neuralcrest,
neuroectodermalorigin).
Histologicallychoroidalmelanomacanbedividedinto:-
Spindlecellmelanomas:-Thesemelanomascontain
predominantlyspindlecells.
ThesemelanomasarefurthersubdividedintoSpindleAorSpindleB

---

dependinguponthetypeofcells.
Epitheloidcellmelanomas:-Containepitheloidlikecells.
Mixedcellmelanomas:-Containbothspindlecellsandepitheloid
cells.
Choroidalmelanomapresentsasasessileordomeshapedmass
locateddeeptothesensoryretina.
Asecondarynon-rheugmatogenousretinaldetachmentfrequently
occurs.
Involvementofvortexveinbytumorresultsinglaucoma.
Withcontinuedgrowth,achoroidalmelanomacanruptureBruch's
membaneandassumeamushroomshape.
Whenthatoccurs,tumorhasatendencytobleed,andvitrealor
subretinalhemorrhagemayoccur.

---

1206.Theearliestchangenoticedin
hypertensiveretinopathyis:
a)Softexudate
b)Arteriolarspasm
c)Venospasm
d)Hardexudate
CorrectAnswer-B
Ans.Arteriolarspasm

---

1207.Basalcellcarcinomaisseeninmost
commonlyinwhicheyelid?
a)Uppermedial
b)Upperlateral
c)Lowermedial
d)Lowerlateral
CorrectAnswer-C
Ans.is'c'i.e.,Lowermedial
Basalcellcarcinomaisthecommonestmalignanttumorofthelids
(90%)usuallyseeninelderlypeople.
Itislocallymalignantandinvolvesmostcommonlylowerlid(50%)
followedbymedialcanthus(25%),upperlid(10-15%)andouter
canthus.
"Basalcellcarcinomaisseeninthelowerlidneartheinnercanthus
usually"RenuJogi

---

1208.Mostcommoncauseofptosis?
a)Myastheniagravis
b)Paralysisof3rdnerve
c)Idiopathic
d)Congenital
CorrectAnswer-D
Ans.is'd'i.e.,Congenital
Ptosis
Ptosisisdroopingofuppereyelid.Ptosisoccurswhenthemuscles
thatraisetheeyelid(levatorpalpebraesuperiorsandmuller's
nuscles)arenotstrongenoughtodosoproperly.EtiologyofPtosis
maybe:?
A)Congenitalmyogenicptosis:-Itisthemostcommontypeof
ptosisandisoftenbilateral.
Itisassociatedwithmaldevelopmentorcongenitalweaknessof
levatorpalpebraesperioris.Congenitalmyogenicptosisis
characterizedbydroopingofoneorbothlidsatbirth,witha
diminishedorabsentlidcreaseandlidlagondowngazedueto
tetheringeffectofabnormalmuscle.Itmayoccurinfollowingforms
Simplecongenitalptosis:-Notassociatedwithotheranomaly
Congenitalptosiswithsuperiorrectusweakness
BlepharophimosissyndromeCongenitalptosis,blepharophimosis,
telecanthusandepicanthusinversus.
Congenitalsynkineticptosis(MarcusGunnjaw-winkingPtosis):-
Retractionofptoticlidwithjawmovementlikechewing,i.e.,with
stimulationofipsilateralpterygoidmuscle.
B)Acquirdptosis:-Dependinguponthecauseacquiredptosis
maybe

---

Neurogenic:-Itisduetoparalysisof3rdnerve,Horner'ssyndrome,
ophthalmoplegicmigraine,multiplesclerosis.Neurogenicptosismay
alsooccurduetolesionofsympatheticnerve)supplyingmuller's
muscle.
Myogenic:-ItisduetoacquireddefectofLPSmuscleandmaybe
seeninmyastheniagravis,dystrophiamyotonica,ocularmyopathy,
oculopharyngealmusculardystrophy,thyrotoxicosis,Lambert-
Eatonmystheniasyndrome
Mechanical:-Itisduetoexcessiveweightontheupperlide.ginlid
tumors,multiplechalazia,lidedema.Itmayalsooccurdueto
scarring(cicatracialptosis)inatientswithocularpemphigoidand
trachoma.
Aponeuroticptosis:-Itisduetodefectofthelevatoraponeurosisin
thepresenceofnormalfunctioningmuscle,e.g.involutional(senile)
ptosis,post-operativeptosis.

---

1209.UpperLidRetractorsinclude
a)Mullermuscleandsuperiorrectus
b)Levatorpalpabraesuperiorisandsuperioroblique
c)Superiorobliqueandsuperiorrectus
d)Levatorpalpabraesuperioris&mullermuscle
CorrectAnswer-D
Ans.is'd'i.e.,Levatorpalpabraesuperioris&mullermuscle
Thelevatorpalpebraesuperiorisistheimportantuppereyelid
retractor.Injuryorweaknesstothismuscleleadstoptosis.
Thismuscleissuppliedbyocculomotor(3')nerve.
DeeppartoftheelevatormuscleistheMuller'smuscle,whichis
sympatheticallyinnvervated.
Inhyperthyroidism,sensitizationoftheMullermuscleleadstoupper
eyelidretractionandpseudoproptosis.
Ontheotherhand,inHorner'ssyndromelossofthismuscleaction
leadstoptosis.
Thecapsulopalpebralfasciaassistsinlowereyelidretractionand
coordinateswitheyeballmovement.Itarisesasanextensionofthe
inferiorrectusandinsertsintotheloweredgeofthelowertarsusand
theadjacentorbitalseptum.

---

1210.Apatientwithptosis,upper4mmof
corneaiscoveredbyuppereyelid.
GradeofPtosisis?
a)Mild
b)Moderat
c)Severe
d)Profound
CorrectAnswer-A
Ans.is'a'i.e.,Mild
Inunilateralcasesofptosis,differencebetweentheverticalheightof
palpebralfissuresofthetwosidesindicatesthedegreeofptosis.
Inbilateralcasesitcanbedeterminedbymeasuringtheamountof
corneacoveredbytheuppereyelidandthensubstracting2mm.
Dependinguponitsamounttheptosisisgradedas-
1:1Mild:2mm
Moderate:3mm
Severe:4mm
Inthisquestion,4mmofcorneaiscoveredbyuppereyelid.
Substracting2mmfromthismeansthereis2mmofptosis,i.e.mild
grade

---

1211.Hardoleuminternumis?
a)AcuteinfectionofZeisgland
b)AcuteinfectionofMollgland
c)AcuteinfectionMeibomiangland
d)ChronicinfectionofZeisgland
CorrectAnswer-C
.Ans.is'c'i.e.,AcuteinfectionMeibomiangland
AcuteinfectionofZeis(Moll)glandStye(Hardoleumexternum).
Acuteinfectionoftarsalgland(Meibomiangland)Hardoleum
internumoChronicinfectionoftarsalgland(Meihoniumgland)
Chalazion
Differencesbetweenstye(Hordeolumexternum),chalazionand
Hordeoluminternum
Stye
Hordeolum
(Hordeolum
Chalazion
internum
externum)
Onset
Acute
Chronic
Acute
Gland
Zeis'sgland
Meibomiangland
Meibomiangland
Typesof
Suppurative
Lipogranulomatous Suppurative
inflammation
Acutepainand
Painless
Symptoms
swelling
disfigurement
Severepain
Localized,hard
Hardnontender
Yellowpointseen
Signs
andtender
swelling
on
swellingnearthe awayfromlid
evertingthelid
lidmargin
margin
Hotfomentation, Drainageby
Incisionand
Treatment
Antibiotics
incision
drainage

---

Antibiotics
incision
drainage
andremovalof
andcurettage
Antibioticsand
eyelash
Intralesional
analgesic
steroid
Diathermy,
antibiotic

---

1212.Congenitaldacrocystitis,theblockis
at?
a)Lacrimalcalnaliculi
b)Nasolacrimalduct
c)Punctum
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Nasolacrimalduct
Congenitaldacryocystitis(Dacryocvstitisneonatorum)
Itistheinflammationoflacrimalsacinthenewborn.Itisdueto
congenitalblockageofnasolacrimalduct.Congenitaldacryocystitis
usuallypresentsasamildgradechronicinflammation.Itis
characterizedby:?
1. Epiphoradevelopsaftersevendaysofbirthfollowedby
mucopurulentdischarge.
2. Regurgitationofmucopurulentdischargeonpressureoverthesac
area,i.e.,positiveregurgitationtest
3. Swellingoverthesacarea
Treatmentincludes:?
1. Massageoverlacrimalsacwithtopicalantibiotics:-Cures
obstructioninabout90%ofinfantsspontaneousrecanalizationof
obstructednasolacrimalductcanoccurupto9months.
2. Lacrimalsyringing:-Syringingwithnormalsalineandantibiotic
solutionisperformediftheconditionisnotcureduptotheageof9-
12months.
3. Probingofnasolacrimalduct:-Itisperformediftheconditionisnot
curedby1-12months
4. Intubationwithsilicontube

---

5. Dacryocystorhinostomy:-Itisperformedifthechildisbroughtvery
lateorabovedescribedproceduresfail.

---

1213.Dacrocytorhinostomyinvolves?
a)Openinguptheterminalblockedendofnasolacrimalduct
b)Connectingthelacrimalsactonosebybreakingthemedialwall
c)Completeexcisionoflacrimal
d)Insertionofdrainagetubeinthelacrimalsac
CorrectAnswer-B
Ans.is'b'i.e.,Connectingthelacrimalsactonosebybreakingthe
medialwall
Dacryocystorhinostomyisthesurgicalprocedurewhichinvolves
removalofboneadjacenttolacrimalsac(medialwall)and
incorporatingthelacrimalsacwithlateralnasalmucosa(atmiddle
meatus)inordertobypasstheobstructioninnasolacrimalduct.
Advantageofdacryocystorhinostomyoverdacryocystectomyisthat
thereisnoepiphoraorwateringofeyesposteoperatively.
Indicationsofdacryocystorhinostomyare:-
1. Congenitaloracquirednasolacrimalductobstruction.
2. Functionalobstructiontolacrimaloutflow(e.g.lacrimalpump
weakness)orfacialnervepalsy.
3. Historyofdacryocystitis
Dacryocystorhinostomycanbedoneeitheropen(external)approach
orendonasal(endoscopic)approach.

---

1214.Dacrocystorhinostomy,wheretheduct
isopened?
a)Superiormeatus
b)Inferiormeatus
c)Middlemeatus
d)Sphenoethmoidalrecess
CorrectAnswer-C
Ans.is'None>c'i.e.,Middlemeatus
CMVretinitisisthemostcommonophthalmicmanifestationofCMV,
occuringasacongenitalinfectionininfantsoranopportunistic
infectionintheimmunocompromisedhost.
Adultscommonlyaffectedincludethoseindividualswithacquired
immunodeficiencysyndrome(AIDS),oncologypatients,andpatients
onimmunosuppresivetherapy.
Thereischaracteristichemorrhagic,fullthicknessretinitis.
Inearlystagethereareyellow-whiteexudates(areasofretinal
necrosis)associatedwithareasofvasculitisandretinalhemorrhage.
Theremaybeexudativeretinaldetachmentandultimately,there
occurstotalretinalatrophy.
TherearethreedistinctvariantsofCMVretinitis:?
1.Classical(fulminant)retinitis
Itisnecroticretinitis
Largeareasofretinalhemorrhagealongawhitened,edematousor
necroticretina,usuallyinposteriorpoleinthedistributionofnerve
fiberlayeralongthevasculararcades.
Itisalsoknownas"Pizza-Picretinopathy"or"cottagecheesewith
catchup".
2.Granular(indolent)retinitis

---

Withoutedema,hemorrhageorvascularsheathing,progressing
alongactiveborderofretinalperiphery.
3.Perivascularretinitis
Frostedbranchangitiswithretinalperivasculitis.
1. AnotherfindinginCMVretinitisisawhitegranulargeographiclesion
thatclearscentrallyasitenlarges,leavingaquietcentralareaof
retinalatrophyandmottledpigmentepithelium.Thishasalsobeen
describedas"brush-fire"pattern.
2. Itshouldberememberedthatvitreoushemorrhage,though,isnot
commoninCMVretinitis,itmayoccurafterinitiationoftreatmentof
AIDS(HAART).
3. Inroutinecoursethereisnovireoushemorrhageorvitritisdueto
immunocompromisedstateofthesepatients.But,oncethe
treatmentofAIDSisstarted,theirimmunestatusmayimprove,and
capableofproducinginflammation.Whichmaycausevitritisand
vitreoushemorrhage.

---

1215.Surgeryofchoiceforchronicacquired
dacryocystitis
a)Dacryocystorhinostomy
b)Dacryocystectomy
c)Conjunctivo-cystorhinostomy
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Dacryocystorhinostomy
Treatmentofchronicdacryocystitis
Congenital
Adult(acquired)
Massageoverlacrimalsacwithantibioticeyedrops
Conservative:-Massage,antibioticdrops,probing,
Syringing(irrigation)withnormalsaline&syringing
antibioticsolution
Dacryocystorhinostomy(DCR):-Surgeryofhoice
Probingofnasolacrimalduct
Dactyocystectomy(DCT)
Intubationwithsiliconetube
Conjunctivocystorhinostom
Dacryocystorhinostomy(DCR)

---

1216.Copperdepositionincornealeadsto?
a)Keratoconus
b)Keratoglobus
c)KFring
d)Siderosis
CorrectAnswer-C
Ans.is'c'i.e.,KFring
RetentionofForeignbodies
Theretentionofaforeignbodyaddsconsiderablytothedangerofa
penetratinginjury.
Theforeignbodiesmostlikelytopenetrateandberetainedinthe
eyeareminutechipsofironorsteel(accountingfor90%ofthe
foreignbodiesinindustry),stone,andparticlesofglass,leadpellets,
copperpercussioncapsandlessfrequently,spiculesofwood.
Inchippingstonewithanironchisel,itiscommonlyachipofthe
chiselandnotofthestonewhichenterstheeye.
Chalcosisisperforatinginjurytoeyewithmetalcontainingcopper
(Cu).Copperdepositioncanleadto:?
1. Grayish-green/goldenbrowndiscolorationofperipheralcornea
calledKayser-Fleisherring.
2. Sunflower(Petalofflower)cataractduetodepositionofcopper
undertheposteriorcapsuleofthelens.
3. Goldenplaqueatposteriorpoleoftheretina.
Siderosisiscausedbyanironforeignbody.Irondepositioncan
cause:?
1. Characteristicandearliestmanifestationisrustydepositsofironina
ringshapedmanneronanteriorsurfaceofcapsuleofthelens.Later
cataractdevelops.

---

2. Initiallyirisisstainedgreenishandlaterbecomereddish-brown--->
Heterochromiairidis.
3. Pigmentarydegenerationofretina.
4. Secondaryopenangleglaucoma.

---

1217.

---

Commotioretinaeaffectswhichpartofretina
-
a)Posteriorpole
b)Peripheralretina
c)Inferior-nasalpart
d)Superior-nasalpart
CorrectAnswer-A
Ans.is'a'i.e.,Posteriorpole
Berlin'soedema,alsocalledcommotioretinae,occursinblunt
traumatoeye.
Itmanifestsasmilkywhitecloudinessinvolvingaconsiderablearea
oftheposteriorpolewitha'cherry-red'spotinthefovealregion.
Itmaydisappearaftersomedaysormaybefollowedbypigmentary
changes.

---

1218.Retrobulbarinjectionisgivenin
a)Insidemusclecone
b)Outsidemusclecone
c)Subtenonspace
d)Subperiosteum
CorrectAnswer-A
Ans.is'a'i.e.,Insidemusclecone
Retrobulbarinjection:-Injectioninretrobulbarspaceinsidethe
musclecone.
Peribulbarinjection:-Injectioninperibulbar/retrobulbarspace
outsidethemusclecone.
Sub-Tenoninjection:-Injectionbeneaththetenoncapule,i.e.in
subtenonspace.Itisalsocalledparabulbarblock.

---

1219.Allareophthalmologicalemergencies
except?
a)CRAO
b)CRVO
c)Acutecongestiveglaucoma
d)Endophthalmitis
CorrectAnswer-B
Ans.is'b'i.e.,CRVO
Ocularemergenciesincludethoseconditionsthatresultinacute,
severepaininassociationwithsuddenvisionloss,orthatmaylead
tovisionlossifleftuntreated;andtraumaticconditionsthataffect
globeoradnexa.
Comonophthalmicemergenciesare:-
1. Acutecongestiveglaucoma
2. Ulcerativeortraumaticcornealdiseases
3. Hyphema
4. Acuteblindness
5. Eyelidorconjunctivallaceration
6. Anteriorlenssubluxation
7. Rupturedglobe
8. Opticneuritis
9. Endophthalmitis
10. Orbitalcellulitis
11. Centralretinalarterialocclusion(CRAG)
12. Retinaldetachment

---

1220.Treatmentofcongenitalptosiswith
poorelevationis
a)Levatorresection
b)Frontalissling
c)FSoperation
d)Noneofthe
CorrectAnswer-B
Ans.is'b'i.e.,Frontalissling
Surgeriesforptosis
DependingupontheLPSaction,threemaintypesoftechniquesare
available.
1. Iflevatoractionisgood:-LPSisshortened,i.e,resectionofLPS.
TheoperationsareBlaskovicsoperation,Everbuschoperationand
Fasanella-servatoperation.Fasanella-servatoperationis
indicatedinHomersyndrome.
2. IfLPSisparalysedSuperiorrectusmuscleisusedtoliftthelid.The
operationiscalledMotaisoperation.
3. IfbothLPSandsuperiorrectusareparalysedFrontalis
sling/suspensionoperation(Hess'soperation)isdone.Itisindicated
inMarcusGunnjawwinkingsyndrome,blepharophimosis
syndrome,total3rdnervepalsy,AberrantregenerationofYdnerve.

---

1221.Enucleationoftheeyeballis
contraindicatedin?
a)ndophthalmitis
b)Panophthalmitis
c)Intraoculartumoursd
d)Painfulblindeye
CorrectAnswer-B
Ans.is'b'i.e.,Panophthalmitis
Enucleation
Enucleationistheremovalofeyeballwithaportionofopticnerve
fromtheorbitwhilepreservingallotherorbitalstructures.
Indications
Absolute:-Retinoblastoma,malignantmelanoma.
Relative:-Painfulblindeye,mutilatingocularinjury,anterior
staphyloma,phthisisbulbi,endophthalmitis,congenitalanophthalmia
orseveremicrophthalmia.
Contraindications
Enucleationiscontraindicated:-
Aftertheonsetofsympatheticophthalmia
Panophthalmitis:-Infectioncanspreadviathecutendsofoptic
nervesheathcausingmeningitis

---

1222.Parachutelesionsareseenin?
a)Eale'sdisease
b)Diabetes
c)Sicklecellanemia
d)Alloftheabove
CorrectAnswer-D
Ans.isdi.e.,Alloftheabove

---

1223.Typeoflaserusedforiridotomy?
a)Excimer
b)Kryptonred
c)Nd:YAG
d)Diode
CorrectAnswer-C
Ans.is'c'i.e.,Nd:YAG

---

1224.Specificforalbinism
a)Redreflex
b)Decreasedvisualactivity
c)Photophobia
d)Nystagmus
CorrectAnswer-A
Ans.is'a'i.e.,Redreflex
Allthegivenoptionsareseeninalbinism.But,redreflexisspecific.
Ocularfeaturesinalbinism-
aRedreflex
Pinkorblueiris
Dazzlingglare
Photophobia
Decreasedvision
Nystagmus
Clearretinalandchoroidalvessels,separatedbyglisteningwhite
space
Strabismus(mildtomoderate)

---

1225.Epithelialxerosisofconjunetivais
causedby?
a)Trachoma
b)Diphtheria
c)Xerophthalmia
d)Pemphigus
CorrectAnswer-C
Ans.is'c'i.e.,Xerophthalmia
Xerosisofconjunctiva
referstoaconditionwheretheconjunctivabecomesdryand
lusterless.Dependingupontheetiology,conjunctivalxerosiscanbe
dividedintotwogroups:?
Parenchymatousxerosis:-Itoccursfollowingcicatricial
disorganizationofconjunctivaduetolocalcauseswhichcanbe:?
1. Trachoma
2. Diphthericmembranousconjunctivitis
3. Stevens-Johnsonsyndrome
4. Pemphigus
5. Thermal,chemicalorradiationalburn
6. Lagophthalmosduetosymblepheron.
Epithelialxerosis:-Itoccursduetovitamin'A'deficiency
(Xerophthalmia).

---

1226.Allnerveareinvolvedinsuperiororbital
fissuresyndromeexcept?
a)1t
b)3rd
c)4'h
d)6th
CorrectAnswer-A
Ans.is'a'i.e.,1"
Superiororbitalfissuresyndrome
Thesuperiororbitalfissureisacleftbetweenthelesserandgreater
wingofsphenoid.
Thestructurespassedthroughsuperiororbitalfissureare3rd,4th,6rn
nerve,ophthalmicdivisionofSthnerve,superior&inferiordivisionof
ophthalmicveinandsympatheticfibres.
Thereforesymptomsofsuperiororbitalfissuresyndromearesame
asincavernoussinusthrombosis,i.e.,painfulophthalmoplegia:-
Pain(retro-orbitalpain)andsensorydisturbancesinthe
V1(ophthalmicdivisionof5thnerve)distribution
IpsilateralophthalmoplegiaOrd4thand6thnerveinvolvement).

---

1227.ContraindicationofLASIK?
a)>20years
b)Keratoconus
c)Normalcornea
d)Myopiaof-8D
CorrectAnswer-B
Ans.is'b'i.e.,Keratoconus
PatientselectioncriteriaforLASIK
Patientsabove20yearsofage
Stablerefractionforatleast12months
Motivatedpatients
Myopiaupto-12D
Absenceofcornealpathology
Cornealthickness>500
ContraindicationsofLASIK
Monocularpatient
Infectionsegconjunctivitis,
Glaucoma
Autoimmunedisease
Thincornea(<450micron
Keratoconus
Poorendothelialcellcountincornea(<1500)
Dryeye
Diabeticretinopathy
YokeMuscles
RightsuperiorrectusLeftinferioroblique
Movement
LeftsuperiorrectusRightinferioroblique
Dextroelevation
Levoelevation
RightinferiorrectusLeftsuperioroblique
Dextrodepression LeftinferiorrectusRightsuperioroblique

---

Levodepression
Rightlateralrectusleftmedialrectus
Dextroversion
Levoversion
LeftlateralrectusRightmedialrectus
YokeMuscles
RightsuperiorrectusLeft
inferioroblique
LeftsuperiorrectusRight
inferioroblique
RightinferiorrectusLeft
superioroblique
LeftinferiorrectusRight
superioroblique
Rightlateralrectusleftmedialrectus
LeftlateralrectusRightmedialrectus

---

1228.Cornealulcerresemblingfungalulceris
seenininfectionwithwhichofthe
agents?
a)Nocardiaasteroides
b)Mycobacterium
c)Klebsiellapneumoniae
d)Chlamydiatrachomatis
CorrectAnswer-A
Ans:A.Nocardiaasteroides
(Ref:Yanoff&Duker4Iep219;SmolinandThoft's'TheCornea4Ie
p248)
KeratitiscausedbyNocardiaasteroides,whichisafilamentous
bacteria,closelyresemblesthemorphologyofcornealulcerscaused
byfungi.
CornealinfectionswithNocardia,Actinomyces,andStreptomyces
typicallyfollowanindolentclinicalcourse,whichmaysimulate
mycotickeratitiswithhyphaledges,satellitelesions,andelevated
epitheliallesions.
Theulcerischaracteristicallysuperficial,withawreath-shapedgray-
whiteinfiltrateandanunderminednecroticedge.
Thebasemightassumeacrackedwindshieldappearance.
Nocardiakeratitisoftenresemblesfungalinfection,witha
filamentousappearingborderandsatellitelesions.Infectionappears
tobeindolent;theanteriorchamberreactionisoftenminimal.
However,rarely,moresevereanteriorchamberreactionand
hypopyonseen.

---

1229.Thispatientcametothecasualtywith
palpitations.HisECGhasbeenshown
below.Whatisyourdiagnosis?
a)Ventriculartachycardia
b)A-Vdissociation
c)Supraventriculartachycardia
d)Sinustachycardia
CorrectAnswer-C
Answer-C.Supraventriculartachycardia
Theoverallrhythmisrapidandrgular.TheR-Rintervalisalmost
exactly1.5largeboxesinduration-establishingtherateat180-190
beatsperminthisisanECGshowingnarrowcomplextachycardia
mostprobablyduetoAVNRT(AvNodalReentrantTachycardia)aka
supraventriculartachycardia.
[RefHarrison's18th/ep.1888]

---

1230.DiagnosetheUnderlyingMedical
disorderbyECGchangeinPhotograph
a)Hypokalemia
b)Hyperkalemia
c)Hypercalcemia
d)Hypocalcemia
CorrectAnswer-D
AnsisDHypocalcemia
ImageshowsProlongedQ-Tinterval
LongQTsyndrome(LQTS)isararecongenitalandinheritedor
acquiredheartconditioninwhichdelayedrepolarizationoftheheart
followingaheartbeatincreasestheriskofepisodesoftorsadesde
pointes(TdP,aformofirregularheartbeatthatoriginatesfromthe
ventricles).Theseepisodesmayleadtofaintingandsudden
deathduetoventricularfibrillation.Episodesmaybeprovokedby
variousstimuli,dependingonthesubtypeofthecondition

---

1231.WhatisReifensteinsyndrome?
a)Associatedwithgonadaldysgenesis
b)Partialandrogeninsensitivitysyndromeduetoreceptor
mutation
c)Associatedwithmentalretardation
d)5-alphareductasedeficiendyassociatedwithperineo?scrotal
hypospadias
CorrectAnswer-B
Answer-B.Partialandrogeninsensitivitysyndromedueto
receptormutation
Itispartialandrogeninsensitivitysyndromebecauseoflesssevere
androgenreceptormutation.
Patientsoftenpresentininfancywith:
1. Perineoscrotalhypospadiasandsmallundescendedtestes.
2. Gynecomastiaatthetimeofpuberty.
3. Thoseindividualsraisedasmalesrequirehypospadiasrepairin
childhoodandbreastreductioninadolescence.
4. Supplementaltestosteronerarelyenhancesandrogenization
significantly,asendogenoustestosteroneisalreadyincreased.

---

1232.Nelson'ssyndromeismostlikelyseen
after:
a)Hypophysectomy
b)Adrenalectomy
c)Thyroidectomy
d)Orchidectomy
CorrectAnswer-B
TheanswerisB(Adrenalectomy):
AdrenalectomypredisposestothedevelopmentofNelson's
syndrome.
Nelsonsyndrome
Nelsonsyndromeisadisordercharacterizedbytherapid
enlargementofapreexistingACTHpituitaryadenomaafter
adrenalectomy.
Thissyndromeoccursbecausethefollowingadrenalectomy,the
suppressiveeffectofcortisolonACTHsecretionandtumorgrowthis
removedresultinginincreasedACTHsecretionandtumorgrowth.
PatientswithNelson'ssyndromepresentwithhyperpigmentation
andwiththemanifestationofanexpandingintrasellarmasslesion
(visualfielddefects,headache,cavernoussinusinvasion,etc.)
Thesetumorsrepresentoneofthemostaggressiveandrapidly
growingofallpituitarytumors.
ACTHlevelsaremarkedlyelevated.
PreoperativeRadiotherapymaybeindicatedtopreventthe
developmentofNelson'ssyndromeafteradrenalectomy.

---

1233.Dent'sdiseaseischaracterizedbyall
except
a)Chloridechanneldefect
b)Malesareaffected
c)Nephrolithiasis
d)DefectinlimbofLoopofHenle
CorrectAnswer-D
Answer-D.DefectinlimbofLoopofHenle
Dent'sdiseasereferstoheterogenousgroupofX-linkeddisorders.
Itbcharacterizedbymanifestationsofproximaltubuledysfunction
(PT)dysfunctionassociatedwithhypercalciurianephrolithiasis,
nephrocalcinosisandprogressiverenalfailure
Thesefeaturesarefoundinmalesonly.
mutationingeneencodingCLS-S,aVoltagegatedChloidechannel.

---

1234.Followingareabsoluteindicationfor
hemo-dialysisexcept
a)GIbleeding
b)Convulsions
c)Pericarditis
d)Hyperkalemiaof6.5mEq/L
CorrectAnswer-D
Answer-D.Hyperkalemiaof6.5mEq/L
Importantindicationsforhemodialysisare:
1. Severemetabolicacidosiswhersodiumbicarbonatecannotbeused
(duetoriskoffluidoverload).
2. Severehyperkalemia
3. Drugpoisoninglikelithium&aspirin
4. Uremia(Uremicpericarditis,encephalopathyorGIbleeding).

---

1235.Insclerodermafeaturesareallexcept:
a)DecreaseintoneofLES
b)Restrictivecardiomyopathy
c)Syndactyly
d)Halitosis
CorrectAnswer-C
Answer-C.Syndactyly
Syndactylyisnotassociatedwithscleroderma.
Loweresophagealsphinctertoneisdecreasedinscleroderma.
Sclerodermacancauserestrictivecardiomyopathy.
Halitosis(badsmellinbreath)canoccurinscleroderma.

---

1236.40yearoldmalepatientpresentstothe
Emergencydepartmentwithcentral
chestpainfor2hours.TheECGshows
STsegmentdepressionandcardiac
troponinsareelevated.Patienthasa
positivehistoryofpreviousPCI3
monthsback.Heisadministered
Aspirin,Clopidogrel,Nitratesand
LMWH,intheEmergencyDepartment
andshiftedtothecoronaryareunit.The
bestrecommendedcourseoffurther
actionshouldinclude.
a)ImmediateRevascularizationwithThrombolytics
b)EarlyRevascularizationwithPCI
c)Continueconservativemanagementandmonitoringofcardiac
enzymesandECG
d)Continueconservationmanagementandplanfordelayed
Revascularizationprocedureafterpatientisdischarged
CorrectAnswer-B
AnswerisB(EarlyRevascularizationwithPCI)
ThepatientpresentingasacaseofNSTEMItotheemergency
department.
Thepresenceofelevatedcardiactroponinsandhistoryofprevious
PCIplacethepatientintoahigh'riskcategory'.

---

ThePatientinquestionisth10a'highrisk'patientwithNSTEMI
Suchpatientsarecandidatesforearlyinvasivemanagementwith
PCl/CABG.

---

1237.Themostcommontranslocationseen
inpatientswithMultipleMyelomais
a)t(11;14)
b)t(4;14)
c)t(14;16)
d)t(14;20)
CorrectAnswer-A
AnswerisA(t(11;14))
ThemostcommontranslocationseeninpatientswithMultiple
Myelomais01;14).
`ThemostcommontranslocationseeninpatientswithMultiple
Myelomaist(11;14)(q13;q32)involvingtheBCL1locuson
chromosome11g13andtheimmunoglobulinheavy(IgH)chain
locusonchromosome14q13whichleadstooverexpressionof
CyclinD1'-TheWashingtonManualofSurgicalPathology
`ThetwomostcommontranslocationseeninpatientswithMultiple
Myelomaaret(11;14)andt(4;14).Boththesetranslocationsoccur
withalmostsimilarfrequencies,howevertheincidenceof
translocation1(11;14)appearstobemarginallyhigher.Patients
witht(4;14)fallwithinapoorprognosissubgroup,whilethosewith
1(11;14)haveastandardrisk'-ThePrinciplesofClinical
Cytogenetics
ThetwomostcommontranslocationseeninpatientswithMultiple
Myeloma
t(11;14)(q13;q32):Associatedwithstandardprognosis
t(4;14)(p16;q32):Associatedwithaggressivebehaviourandpoor
prognosis
Themostcommontranslocationinmultiplemyelomaassociated

---

withapoorprognosisistranslocationt(4;14)

---

1238.Bestformanagementofrespiratory
alkalosis?
a)Rebreathinginpaperbag
b)IPPV
c)Normalsaline
d)Acetazolamide
CorrectAnswer-A
Answer-A.Rebreathinginpaperbag
Changingventilatorsettingmaybeusedtopreventortreat
respiratoryalkalosisinpersonswhoarebeingmechanically
ventilated.Personswithhyperventilationsyndromemaybenefitfrom
reassurance,rebreathingfromapaperbagduringsymptomatic
attacks,andattentiontothepsychologicalstress.

---

1239.Adrenalreserveisbesttestedbymeans
ofinfusionwith
a)Glucocorticoids
b)ACTH
c)GnRH
d)Metyrapone
CorrectAnswer-B
Answer-B.ACTH
GlucocorticosteroidreservecanbeevaluatedbytheACTH
stimulationtest
Amoresensitivetestofadrenalreserveisthestandardised24-hour
ACTHinfusiontest.UndermaximalACTHstimulationthecortisol
secretionincreasestenfold.Ifgtucocorucoidcoverageisrequired
duringtheACTHstimulationtest,dexamethasonecanbeused
becauseitdoesnotinterferewiththelaboratoryvaluesof
endogenousglucocorucoids.

---

1240.DOCofGTCSinpregnancy
a)Lamotrigine
b)CBZ
c)Levetiracetam
d)Valproate
CorrectAnswer-A
Ans.is'a'i.e.,Lamotrigine
Lamotrigineisoftenbettertoleratedandislessteratogenicthan
valproate.
Lamotriginehasbeenincreasinglyprescribedinpregnancyover
olderantiepilepticdrugssuchascarbamazepineandsodium
valproate.

---

1241.Bloodtransfusionshouldbecompleted
withinhoursofinitiation
a)1-4hours
b)3-6hours
c)4-8hours
d)8-12hours
CorrectAnswer-A
Ans.is'a'i.e.,1-4hours
Fromstartingtheinfusion(puncturingthebloodwiththeinfusionset)
tocompletion,infusionpackshouldtakeamaximumof4hours.

---

1242.Whatistheofcorrectionofsodium
deficit
a)0.5mmol/hour
b)1mmol/hour
c)1.5mmol/hour
d)2.0mmol/hour
CorrectAnswer-A
Ans.is'a'i.e.,0.5mmol/Hr
Forserioussymptomatichyponatremia,thefirstlineoftreatmentis
promptintravenousinfusionofhypertonicsaline,withatarget
increaseof6mmol/Lover24hours(notexceeding12mmol/L)and
anadditional8mmol/Lduringevery24hoursthereafteruntilthe
patient'sserumsodiumconcentrationreaches130mmol/L.

---

1243.

---

Characteristicfeaturesofalesioninthe
lateralpartofthemedullaincludeallexcept
a)IpsilateralHomer'ssyndrome
b)Contralaterallossofproprioceptiontothebodyandlimbs
c)Nystagmus
d)Dysphagia
CorrectAnswer-B
Ans.is'b'i.e.,Contralaterallossofproprioceptiontothebodyand
limbs
Damagetolateralpartofmedulla(lateralmedullarysyndromeor
wallenbergsyndrome)causes:?
1)Ipsilateral:Facialsensoryloss,facialpain,ataxia,nystagmus,
homersyndrome.
2)Contralateral
Otherfeaturesarenausea&vomitng,vertigodysphagiaand
horseness.

---

1244.Mostcommoncauseofpleuraleffusion
inAIDSpatients
a)Kaposisarcoma
b)TB
c)PneumocystisJiroveci
d)Mycoplasma
CorrectAnswer-A
Ans.is'a'i.e.,Kaposisarcoma
Ophthalmologicaldiseases
Themostcommonabnormalfindingsonfundoscopicexamination
arecottonwoolspots.
CMVretinitisisthemostsevereocularcomplicationandoccurs
whenCD4T-cellscountislessthan50/ml.Ittypicalpresentsas
perivascularhemorrhageandexudaewithCottage-Cheese
appearance.
Acuteretinalnecrosissyndrome,alsocalledprogressiveouter
retinalnecrosis(PORN)iscausedbyHSVandVZV
OthermanifestationsarechorioretinitisbytoxoplasmaandPcarinii,
kaposisarcomaofeyelid,andlymphoma.

---

1245.Grahamsteelmurmurisseenin
a)PS
b)PR
c)TR
d)TS
CorrectAnswer-B
Answer-B.PR
Grahamsteel'smurmur
Adiastolicmurmuraudiblealongtheleftsternalborderdueto
pulmonaryregurgitationinpatientswithpulmonaryhypertension.
Grahamsteelmurmurisahighpitcheddecressendomurmur
loudestduringinspiration
Grahmsteel's-EarlyDM-PR

---

1246.Themostaccurateinvestigationfor
assessingventricularfunctionis:
a)MultisliceCT
b)Echocardiography
c)Nuclearscan
d)MRI
CorrectAnswer-B
Bi.e.Echocardiography
Transthoracicechocardiographyisthemostcommonlyusedcardiac
imagingexaminationafterthechestX-rayandprobablyapproaches
theelectrocardiograminitsclinicalutility.Itisharmlessand
relativelycomfortableforthepatientandisthefirst-linetechniquefor
evaluatingmostabnormalitiesofthecardiacchambers,valvesand
greatvessels.
Diagnotic
Chest Transthoracic
Transesophageal Nuclear
Multislice
utility
X-ray echocardiogram echocardiogram medicine CT
technique
Anatomy
Myocardium +
++
+++
+
++
Valves
+
++
+++
0
+
Coronaries 0
0
+
0
++
Pericardium +
+
+
0
++
Pulmonary +++
0
0
0
+++
vessels
Calcification +++
+
+
0
+++
Function
Myocardium ++
++
+++
++
+
Valves
+
++
+++
0
+

---

Valves
+
++
+++
0
+
Coronaries 0
0
+
++
++
Limitations
Radiation
-
0
0
--
hazard
Risk/
0
0
--
-
-
discomfort
Spatial
--
-
resolution
Temporal
-
-
resolution
Operator
-
---
-
skill
Cost
--
+++=Majorutility;++=moderateutility,+=minorutility;0=no
utility/nolimitations;-=minorlimitation---=moderatelimitation;---
majorlimitation

---

1247.CVPismonitoredinA/E
a)Anteriorjugularvein
b)Internaljugularvein
c)Externaljugularvein
d)Inferiorvenacava
CorrectAnswer-D
Answer-D.Inferiorvenacava
Commonlyusedveincannulationsitesforcentralvenous
accessinclude:
Jugularvein
Externaljugularvein
Internaljugularvein(central,posterior,anteriorapproaches)
Subclavianvein(supraclavicular,infraclavicular,axillary
approaches)
Femoralvein
Basilicvein

---

1248.Centralvenousmonitoringisdonefor
allexcept
a)Regulatingthespeedandamountoffluidinfusion
b)Administeringthrombolytics
c)Decidingtheneedforplasmainfusion
d)Decidingtherequirementforbloodtransfusion
CorrectAnswer-B
Answer-B.Administeringthrombolytics
1)Administrationofnoxiousmedications
2)Hemodynamicmonitoring-
Bloodtransfusionorplasmatransfusion
3)Plasmapheresis,apheresis,hemodialysis,orcontinuousrenal
replacementtherapy
4)Poorperipheralvenousaccess

---

1249.Thrombosisismostcommonly
associatedwithwhatsiteinCVP
a)Internaljugularvein
b)Subclavianvein
c)Femoralvein
d)Externaljugularvein
CorrectAnswer-C
Answer-C.Femoralvein
Advantages-
Rapidaccesswithhighsuccessrate
DoesnotinterferewithCPR
Doesnotinterferewithintubation
Noriskofpneumothorax
Trendelenburgpositionnotnecessaryduringinsertion
Disadvantages-
DelayedcirculationofdrugsduringCPRPreventspatient
mobilization
Difficulttokeepsitesterile
DifficultforPAcatheterinsertion
Increasedriskofiliofemoralthrombosis

---

1250.Serumasciticfluidgradientof1.5
(SAAG)withasciticfluidproteinof
2.8gm/d1.themostlikelycauseis
a)Nephriticsyndrome
b)Cardiacfailure
c)TB
d)Portalhypertension
CorrectAnswer-B
Answer-B.Cardiacfailure
Serumtoascitesalbumingradient>1.5suggestseithercirrhosisor
cardiacfailure.
Thetotalproteinconcentration>2.5suggestsascitesduetocardiac
cause
Thetotalproteinconcentrationhelpstodifferentiateuncomplicated
ascitesfromcirrhosisfromcardiacascitesbothofwhichhavea
SAAG1.1g/dL.

---

1251.Coronarystealphenomenoncaused
dueto
a)Arterialdilation
b)Coronarymicrovesseldilation
c)Epicardialvesseldilation
d)Capacitancevesseldilation
CorrectAnswer-B
Answer-B.Coronarymicrovesseldilation
Coronarystealisthetermgiventobloodbeingstolenfromone
regionofthecoronarytreebyanother.
Itisalsocalledcoronarystealsyndrome.
Itiscommonlyseenwithpowerfulcoronarydilatordrugslike
dipyridamoleorhydralazine.
Thesedrugsarepotentarteriolardilatorsanddilatesresistance
vesselstoo.
Theobstructedbranchhassignificantarteriolardilationevenwhen
oxygendemandislowbecauseoftheaccumulationofmetabolites
intheischemictissue.

---

1252.DecreasedCVPisseenin
a)Pneumothorax
b)PEEP
c)Bacterialsepsis
d)Heartfailure
CorrectAnswer-C
Answer-C.Bacterialsepsis
Decreased
Hypovolemia
Septicshock
Deepinhalation(transient)
Increasedvenouscompliance

---

1253.Besttomonitorintraoperative
myocardialischemia(infarction)is
a)ECG
b)CVPmonitoring
c)Transesophagealechocardiography
d)Invasiveintracarotidarterialpressure
CorrectAnswer-C
Ci.e.Transesophagealechocardiography
Tranoesophagealechocardiographyprovidesarealtimepictureof
all4cardiacchambersandvalves.Itcanidentifyanymalfunctioning
valvesinadditiontoanywallmotionabnormalitiesrelatedto
myocardiaischemia.Itisveryusefulduringanesthesia.Abnormal
motionofventricularwalldetectedinthiswayisareliableindexof
myocardialischemiaandmayguidedrugtherapy,canidentifyif
therapyhassuccessfullytreatedtheischemiaorindicatetheneed
forfurthersurgicalrevascularization
CVP(catherterincentralvein)measuresrightsidedfillingpressure
whereaspulmonaryarterycathetermeasures/monitorsleftheart
fillingpressure.
Arterialcannulationmeasuresdirectsystemicarterialpressureand
facilitatesamplingofarterialbloodforanalysis.

---

1254.Lemierre'ssyndromeis
a)Carotidsinusaneurysm
b)ThromobophlebitisofIJV
c)TraumaticocclusionofIJV
d)Anyoftheabove
CorrectAnswer-B
Answer-B.ThromobophlebitisofIJV
Rarethrombophlebitisofthejugularveinswithdistantmetastatic
sepsisinthesettingofinitialoropharyngealinfections(pharyngitis,
t/-peritonsillarabscess).

---

1255.WideQRSdurationis-
a)>0.8sec
b)>0.9sec
c)>.12sec
d)None
CorrectAnswer-C
Answer-C.>.12sec
QRSduration0.08-0.12sec.
QTinterval
0.40sec.
PRinterval
0.12-20sec.
QRSAxisrange+90to-30?

---

1256.AbsentPWaveisseenin:
a)AtrialFibrillation
b)Cor-pulmonale
c)MitralStenosis
d)COPD
CorrectAnswer-A
AnswerisA(AtrialFibrillation)
PwaveistypicallyabsentinAtrialFibrillation.COPDandCor-
PulmonaleareassociatedwithtallpwavesfromRightAtrial
Enlargement(P-Pulmonale)whileMitralStenosisistypically
associatedwithawideandnotchedpwavefromLeftAtrial
Enlargement(P-Mitrale)
CausesofAbsentWave:
Atrialfibrillation(p'waveisabsentorreplacedbyfibrillaryTwave)
Atrialflutter(p'waveisreplacedbyflutterwave,whichshowssaw-
toothappearance).
SAblockorsinusarrest
Nodalrhythm(usuallyabnormal,smallpwave).
Ventricularectopicandventriculartachycardia.
Supraventriculartachycardia(p'waveishiddenwithinQRS,dueto
tachycardia).
Hyperkalemia.
Idioventricularrhythm
RightAtrialEnlargement(RAE)istypically
PPulmonale
associatedwithtallPwaves
(COPDandCor-Pulmonaleareassociatedwith
tallpwavesfromRAE)
LeftAtrialenlargement(LAE)istypically

---

associatedwithwidePwaves
PMitrale
(MitralStenosisistypicallyassociatedwithawide
andnotchedpwavefromLAE

---

1257.Torsadesdepointesisseeninall
except
a)Hyponatremia
b)Hypocalcemia
c)Hypomagnesemia
d)Hypokalemia
CorrectAnswer-A
Answer-A.Hyponatremia
HypokalemiaQ
HypocalcemiaQ
Hypomagnesemia

---

1258.SinusbradycardiawithMItreatment
a)Atropine
b)Digoxin
c)Calciumchannelblocker
d)Propranolol
CorrectAnswer-A
Answer-A.Atropine
TheSAnoderategenerallyincreasesaftertheadministrationofa
vagolyticdrug,suchas"atropine".

---

1259.ECGimage,Uwaveseen,patientison
furosemide&betablocker.Diagnosis
a)Hypocalcemia
b)Hypokalemia
c)Hyperkalemia
d)Hypercalcemia
CorrectAnswer-B
Ans.is'b'i.e.,Hypokalemia
E.C.G.manifestationsofelectrolytedisorders
Hvperkalemia
AtallpeakedandsymmetricalT-wavesisthefirstchangeseenon
ECGinpatientswithhyperkalemia.oRRintervallengthensand
QRSdurationincreases.
FlatteningordisappearanceofPwave.
STelevation.
WideningoftheQRScomplexesduetoasevereconductiondelay
andmaybecome'sinewave'.
TheprogresionandtheseverityoftheE.C.Gchangedonot
correlatewellwiththeserumpotassiamconcentration.
Hvpokalemia
Similartohyperkalemia,hypokalemiaproducechangesontheE.C.
Gwhicharenotnecessaryrelatedtoserumpotassiamlevel.
DepressionoftheSTsegment
DecreaseinamplitudeofTwaves
IncreaseinamplitudeofUwaves
UandTwavemergeinsomecasestoformaT-Uwavewhichmay
bemisdiagnosedasprolongedQTinterval.
PwavecanbecomelargerandwiderandPRintervalprolong

---

slightly.
QRSdurationmayincreasewhenhypokalemiabecomesmore
severe.
Hvpocalcemia
ProlongationoftheQTinterval
Duetoprolongationofthephase2oftheventricularactionpotential
andlengtheningoftheSTsegmentwhiletheTwave(which
correlatewithtimeforrepolarisationremainsunaltered).
Hvpercalcemia
ShorteningoftheQTinterval
(Primarilyduetoadecreaseinphase2oftheventricularaction
potentialandresultantdecreaseinSTsegmentduration).
Iltpothermia
Causesslowimpulseconductionthroughallcardialtissuesresulting
in:?
ProlongationofalltheECGintervals
RR
PR
QRS'
QT
Thereisalso"elevationoftheJpoint"(OnlyiftheSTsegmentis
unalteredproducingcharacteristicsTorosbornewave.)

---

1260.InCOPDwhichistrue
a)FEV1/FVC<0.7
b)FEV1/FVC
c)RV4
d)TLV1
CorrectAnswer-A
Answer-A.FEV1/FVC<0.7
SpirometryfindingsinCOPDincludesreducedFEV1andareduced
FEV1/FVCratio.Diffusioncapacityforcarbonmonoxidereflects
theabilityoflungtotransfergasacrossalveolar/capillaryinterface.
Diffusioncapacityislowinpatientswithemphysemaandinfiltrative
lungdiseases.Itisincreasedinpatientswithpulmonary
hemorrhage,congestiveheartfailureandasthma.

---

1261.Whichofthefollowingismarkedly
decreasedinrestrictivelungdisease
a)FVC
b)FEVI
c)FEVI/FVC
d)RV
CorrectAnswer-A
Answer-A.FVC
Forcedvitalcapacity(FVC)-Decreased(morethanobstruction)
Forcedexpiratoryvolumein1second(FEV,)-Decreasedin
proportiontoFVC
FEVi/FVC-Nearnormalorincreased
Forcedmidexpiratoryflowrate-Reduced
Totallungcapacity-Decreased
Residualvolume-Generallydecreased
Functionalresidualcapacity-Decreased

---

1262.Cepaciasyndromefulminantillness
seenin
a)Sarcoidosis
b)Cysticfibrosis
c)Tuberculosis
d)Immotileciliasydrome
CorrectAnswer-B
Answer-B.Cysticfibrosis
Capaceasyndromeisarapidclinicaldeteriorationinpatientswith
cysticfibrosisduetonewacquisitionoforchroniccolonizationwith
Burkholderiacepaciacomplexandcarriesaveryhighmortality.
Inchronicallycolonizedpatientsthedeteriorationisoftentriggered
byanintercurrentillness.

---

1263.
Mostimportantfeaturetodiagnose
severebpneumonia-
a)Cyanosis
b)Chestindrawing
c)Nasalflaring
d)Fastbreathing
CorrectAnswer-B
Ans.is'b'i.e.,Chestindrawing
oTheonlysignforseverepneumoniaischestindrawing.

---

1264.Themostdefinitivemethodof
diagnosingpulmonaryembolismis:
a)Pulmonaryarteriography
b)Radioisotopeperfusionpulmonaryscintigraphy
c)EKG
d)Venography
CorrectAnswer-A
AnswerisA(Pulmonaryarteriography):
`Selectivepulmonaryangiographyisthemostspecificexamination
availableforestablishingthedefinitivediagnosisofPE.'-Harriosn
16th/1563
Mostdefinitiveinvestigation:Pulmonaryangiographyisan
invasiveprocedure,anditisthemostdefinitiveprocedure.Itis
howevercertainlynottheinitialinvestigationofchoice.
Theinitialinvestigationofchoiceinacaseofsuspected
pulmonaryembolismiseitheralungventilationperfusionscanora
CTofthechestwithintravenouscontrast.
`CTscanningofthechestwithintravenouscontrastistheprincipal
imagingtestfordiagnosisofPE.'-Harrison`Lungscanning(V/Q
scan)isnowasecondlinediagnostictestforPE'
Mostdefinitive/specifictestforPEQBest
initialimagingtestfordiagnosisofPE?
PulmonaryangiographyQCTscan
withintravenouscontrastQ(Preferredchoice,againstalungV-Q
scan)

---

1265.Empyemathoracisismostcommonly
causedbywhichorganism
a)Streptococcuspneumoniae
b)Pseudomonas
c)Mycoplasma
d)Stapylococcusaureus
CorrectAnswer-A
Answer-A.Streptococcuspneumoniae
Empyemathoraciciscommonlycausedbythosebacteriasthat
causepneumoniassuchasstreptococcuspneumoniaeand
staphlococcusaureus.E.coli,FLinfluenzas,Klebsiellapneumoniae.

---

1266.Mostcommoncauseoflobar
consolidation
a)Mycoplasma
b)Chlamydia
c)Streptococcus
d)Legionela
CorrectAnswer-C
Answer-C.Streptococcus
Lobarpneumoniastypicallyoccurswithprimarypneumoniascaused
byvirulentagents,mostcommonlypneumococci.

---

1267.ClinicalfeatureofBronchiestasisareall
except
a)Hemoptysis
b)Nightsweats
c)Chestpain
d)Productivecough
CorrectAnswer-B
Answer-B.Nightsweats
Theclassicclinicalmanifestationsofbronchiectasisarecoughand
thedailyproductionofmucopurulentandtenacioussputumlasting
monthstoyears.
complaintsincludedyspnea,wheezinghemoptysis,andpleuritic
chestpain.

---

1268.Allofthefollowingarefeaturesof
interstitiallungdiseaseexcept
a)Exertionaldyspnea
b)Earlyproductivecough
c)Digitalclubbing
d)Coarsecrepitationduringclubbing
CorrectAnswer-B
Answer-B.Earlyproductivecough
Coughisusuallynonproductive,aproductivecoughisunusual
Hemoptysis
Wheezing
Chestpain
Clubbingcanoccurwithinterstitiallungdisease.

---

1269.ChestX-rayshowsB/Llunginfiltrates
nextinvestigationis
a)Sputumexamination
b)CT
c)Bronchoscopy
d)Antibiotics
CorrectAnswer-B
Answer-B.CT
PresenceofB/Llunginfiltratessuggestsinterstitiallungdisease.
Highresolutioncomputedtomography(HRCT)isobtainedinalmost
allpatientswithdiffusepulmonaryparenchymaldisease.

---

1270.Besttestforlungfibrosis
a)Chestx-ray
b)MRI
c)HRCT
d)Biopsy
CorrectAnswer-C
Ans.is'c'i.e.,HRCT
Lungfibrosisisadiffuseparenchymallungdisease.
Idiopathicpulmonaryfibrosisisthemostcommonformofidiopathic
interstitialpneumonia.
Wehavealreadydiscussedthatbestinvestigationforinterstitiallung
diseaseisHRCT
Estimatedrelativefrequencyoftheinterstitiallungdisease
Relativefrequency,
Diagnosis
%
Idiopathicinterstitial
40
pneumonias
Idiopathicpulmonaryfibrosis
55
Nonspecificinterstitial
25
pneumonia
Respiratorybronchiolitis-ILD
15
and
Cryptogenicorganizing
3
pneumonia
Acuteinterstitialpneumonia
<1
Occupationalandenvironmental 26
Sarcoidosis
10

---

Sarcoidosis
10
Connectivetissuediseases
9
Drugandradiation
1
Pulmonaryhemorrhage
<1
syndromes
Other
13

---

1271.Drugofchoiceininterstitiallung
diseaseis
a)Antibiotics
b)Steroid
c)Bronchodilators
d)Aspirin
CorrectAnswer-B
Answer-B.Steroid
Theusualinitialtreatmentis"oralprednisolone".
Forseveredisease,-"Pulsemethylprednisolone"isused.

---

1272.Laststageofacuteasthmais
a)Hypocapnia
b)Hypercapnia
c)Hyperoxia
d)Alkalosis
CorrectAnswer-B
Answer-B.Hypercapnia
LatestagesofAsthmaarecharacterizedby"hypercapnia".
InasthmapatientswithimpendingrespiratoryfailuretheCO,level
exceeds45mmHg.

---

1273.AGN(acuteglomerulonephritis)is
diagnosedby
a)Hyalinecast
b)WBCcast
c)RBCcast
d)Granularcast
CorrectAnswer-C
Answer-C.RBCcast
PresenceofRBCcastsinurineischaracteristicofnephritic
syndromeduetoglomerulonephritis.

---

1274.CystatinClevelsareusedinurology
for
a)DetectingUTI
b)EstimatingGFR
c)EstimatingdifferencebetwenCRFandARF
d)ScreeningofRenaCa
CorrectAnswer-B
Answer-B.EstimatingGFR
GFRestimationsdeterminedbycreatininebasedequationsarenot
precise,soothersubstancessuchas"cystatinC"arebeingexplored
toestimateGFR.

---

1275.WhichisnotseenindistalRTA
a)UrinepH<5.5
b)Hypokalemia
c)Hypercalciuria
d)Nephrolithiasis
CorrectAnswer-A
Answer-A.UrinepH<5.5
Normalaniongapmetabolicacidosis/acidemia
Hypokalemia
Urinarystoneformation(relatedtoalkalineurine,hypercalciuria,and
lowurinarycitrate).
Nephrocalcinosis(depositionofcalciuminthesubstanceofthe
kidney)
Bonedemineralisation(causingricketsinchildrenandosteomalacia
inadults)

---

1276.Whichofthefollowingisnotafeature
ofdistalrenaltubularacidosis
a)Normalaniongap
b)Renalhypercalciuria
c)Alkalineurine
d)Hyperkalemia
CorrectAnswer-A
Answer-A.Normalaniongap
Normalaniongapmetabolicacidosis/acidemia
Hypokalemia
Urinarystoneformation(relatedtoalkalineurine,hypercalciuria,and
lowurinarycitrate).
Nephrocalcinosis(depositionofcalciuminthesubstanceofthe
kidney)
Bonedemineralisation(causingricketsinchildrenandosteomalacia
inadults)

---

1277.Hyperkalemiaaciduriaisseenin
a)TypeIRTA
b)TypeIIRTA
c)TypeIVRTA
d)Sigmoidocolostomy
CorrectAnswer-C
Answer-C.TypeIVRTA
Type4RTAisdueeithertoadeficiencyofAldosteroneortoa
resistancetoitseffects.
Itwasincludedintheclassificationofrenaltubularacidosesasitis
associatedwithamild(normalaniongap)metabolicacidosis
(hyperchloremicacidosis)duetoaphysiologicalreductionin
proximaltubularammoniumexcretion(impairedammoniagenesis),
whichissecondarytohypoaldosteronism,andresultsinadecrease
inurinebufferingcapacity.

---

1278.Apatientwithdiabetes,hyperkalemia,
urinarypH<5.5Causeis
a)Uremia
b)Pseudohyperaldosteronism
c)TypeIRenaltubularacidosis
d)TypeIVRTA
CorrectAnswer-D
Answer-D.TypeIVRTA
HyperkalemiawithurinarypH<5.5alongwithdiabetessuggests
typeIVrenaltubularacidosis.

---

1279.Calciphylaxisisaseverelife
threateningconditionwhichoccursis
a)Parathyroidectomy
b)Medullarycarcinomathyroid
c)Hyperthyroidism
d)EndstageRenaldisease
CorrectAnswer-D
Answer-D.EndstageRenaldisease
Calciphylaxisisarareandseriousdisordercharacterizedby
systemicmedialcalcificationofthearteriolesthatleadstoischemia
andsubcutaneousnecrosis.
Calciphylaxisisoneofseveraltypesofextra-osseouscalcification
(whichalsoincludesintimal,medial,andvalvularcalcification)that
mayoccurinpatientswithend-stagerenaldisease(ESRD).
CalciphylaxismostcommonoccursinpatientswithESRDwhoare
onhemodialysis.

---

1280.Thehallmarkofhenochschonlein
purpurais
a)Palpablepurpura
b)Abdominalpain
c)Arthritis
d)Renaldysfunction
CorrectAnswer-A
Answer-A.Palpablepurpura
Palpablepurpuraisessentialfordiagnosis.
Diagnosisisconfirmedbypresenceofpalpablepurpurawithnormal
plateletcountalongwithoneormoreofthefollowing:abdominal
pain,arthralgia/arthritisandmesangialdepositionofIgA.

---

1281.Interstitialnephritisiscommonwith
a)NSAID
b)Blackwaterfever
c)Rhabdomyolysis
d)Tumorlysissyndrome
CorrectAnswer-A
Ans.is'a'i.e.,NSAID
DRUGSCAUSINGINTERSTITIALNEPHRITIS
Antibiotics
Diuretics
Anticonvulsants Miscellaneous
Lactams
Thiazide
Phenytoin
Captopril
H
Sulfonamides Furosemide Phenobarbitone
2receptor
blockers
Quinolones Triamterene Carbamazepine Omeprazole
Vancomycin NSAIDS
Valproicacid
Mesalazine
Erythromycin
Indinavir
Minocycline
Allopurinol
Rifampicin
Ethambutol
Acyclovir

---

1282.Renalarterystenosismayoccurinall
ofthefollowing,except:
a)Atherosclerosis
b)Fibromusculardysplasia
c)Takayasu'sarteritis
d)Polyarteritisnodosa
CorrectAnswer-D
AnswerisD(Polyarteritisnodosa)
Amongsttheoptionsprovidedrenalarterystenosisisleastlikelyto
beseeninassociationwithPolyarteritisnodosa.
AtherosclerosisandFibromusculardisease
-Renalarterystenosisisproducedpredominantlyby
atheroscleroticocclusivedisease(80%to90%ofpatients)or
tibromusculardysplasia(10-15%ofpatients).-CMDT'06p460
-hecommoncauseofrenalarterystenosisinthemiddleagedand
elderlyisanatheromatousplaqueatoriginofrenalartery.Harrison
-Inyoungerwomenstenosisisduetointrinsicstructural
abnormalitiesofthearterialwallcausedbyaheterogenousgroupof
lesionscalled'fibromusculardysplasia'.-Harrison16`"/1707
PANorTakayasuarteritis?
CMDTdonotmentionPANorTakayasuarteritisasacausefor
renalarterystenosis.
However,Takayasuarteritisiscertainlyamorecommoncauseof
renalarterystenosisthanPAN.
Takayasuarteritis(Aorto-arteritis)isbeleivedstobethemost
commonofrenovascularhypertensioninIndiaandChina.?
DiseasesofKidneyandUrinaryTract8th/1279
Anumberofresearchpublications,howevershowTakayasuarteritis
asacauseforrenalarterystenosis.

---

asacauseforrenalarterystenosis.
PAN
Althoughrenalinvolvementisseeninupto60%ofpatientswithPAN
itspathologydoesnotinvolverenalarterystenosis.
Thepathologyinvolvesarteritiswithoutglomerulonephritisandis
characterisedbyaneurysmsofsmallandmediumsizedarteries.
Stenosisofmainrenalarteryisanunusualassociation'.
CausesofRenalarterystenosis:
1. Atherosclerosis
2. Fibromusculardysplasia
3. NonspecificAortoarteritis
4. Takayasuarteritisandgiantcellarteritis(Takayasu>Giantcell)
5. Antiphospholipidsyndrome
6. Transplantrenalarterystenosis
7. Renalarteryembolism
8. Dissectinganeurysmofaorta
9. Radiationarteritis

---

1283.A:Gmaintainedin
a)Nephriticsyndrome
b)Cirrhosis
c)Proteinlosingenteropathy
d)Multiplemyeloma
CorrectAnswer-A
Answer-A.Nephriticsyndrome
Decreasedalbumin/Globulinratioisseen:
Multiplemyelomaormetastaticsdisease
AIDS
Renaldisease
Liverdisease(cirrhosis)
Intestinaldisease(Proteinlosingenteropathy)
Cachexicpatient
CHF
A/Gratioisdecreasedinnephroticsyndrome.

---

1284.Whichisnotastroke
a)TIA
b)Hemiplegia
c)SAH
d)Intracerebralhemorrhage
CorrectAnswer-A
Answer-A.TIA
Strokeoccurswhenpoorbloodflowtobrainresultsindeathofbrain
cells.
Strokeisoftwotypes:-
1. Ischemicstroke:Itisthemostcommontypeandoccursdueto
thrombosisofcerebralbloodvessels.
2. Hemorrhagicstroke:Itoccursduetohemorrhageeitherinbrain
tissue(Intracerebralhemorrhage)orinsubarachnoidspace
(subarachnoidhemorrhage).
Symptomsofstrokeare:-
1. Suddenonsetofhemiparesis/hemiplagia

---

1285.Mostcommonlocationofhypertensive
intracranialhemorrhageis:
AI06;NIMHANS08;DNB10;WB11
a)Subarachnoidspace
b)Basalganglia
c)Cerebellum
d)Brainstem
CorrectAnswer-B
Ans.Basalganglia
Themostcommonsitesforhypertensiveintracranialhemorrhage
are:
?Basalganglia(putamen,thalamusandadjacentdeepwhite
matter)
?Deepcerebellum
?Pons
Soamongtheoptionsprovidedbasalgangliaisthesinglebest
answerofchoice.
Ref:Harrison'sPrinciplesofInternalMedicine,16thEdition,Pages
2390-92.

---

1286.ThefeaturesofCushingtriadareall
except
a)Bradycardia
b)Hypotension
c)Irregularbreathing
d)Hypertension
CorrectAnswer-D
Answer-D.Hypertension
Cushing'striadisasignofincreasedintracranialpressure.
Itisthetriadof:-Hypertension,BradycardiaandIrregularbreathing

---

1287.Aliceinwonderlandsyndromeoccurs
in
a)SSPE
b)Epilepsy
c)Cerebralhemorrhage
d)Multiplesclerosis
CorrectAnswer-B:C
Answer-(B)Epilepsy&(C)Cerebralhemorrhage
Infectious:CMV,EBV(IMN),InfluenzaAencephalitis,coxsackieB1
encephalitis,scarletfever,typhoidencephalopathy,VZV
encephalitis.
CNSlesions:-Acutedisseminatedencephalomyelitis,cavernous
angioma,cerebralarteriosclerosis,braintumor,cerebral
hemorrhage.
Paroxysmalneurologicaldisorders:Epilepsy(temporallobe
epilepsy),migraine1

---

1288.Thecommoncauseofsubarachnoid
hemorrhageis:
a)Arterio-venousmalformation
b)Cavernousangioma
c)Aneurysm
d)Hypertension
CorrectAnswer-C
AnswerisC(Aneurysm):
`Themostcommoncauseofsubarachnoidhaemorrhageisrupture
ofasaccularaneurysm(excludingheadtrauma)'?Harrison.
Previouslyaskedfrequentlyasfollows:(Excludinghandtrauma)
Mostcommoncauseofsubarachnoidhaemorrhageisruptureofa
saccularaneurysmQ
Mostcommoncauseofsubarachnoidhaemorrhageisruptureofa
BerryaneurysmQ
Mostcommoncauseofsubarachnoidhaemorrhageisruptureof
'CircleofWillis'aneurysmQ.
(SaccularaneurysmsaresynonymouswithBerryAneurysmsand
mostcommonlyoccurintheanteriorcirculationontheCircleof
Willis).

---

1289.Isolatedpainfulthirdnervepalsyisa
featureofaneurysmsof:
a)Posteriorcommunicatingartery
b)Anteriorcommunicatingartery
c)Vertebrobasillaryartery
d)Ophthalmicartery
CorrectAnswer-A
Ans.Posteriorcommunicatingartery
Themostcommonofallintracranialaneurysms,posterior
communicatingarteryaneurysmspresentwithipsilateralthird
nervepalsy(thusdilatingthepupil)
Isolatedcranialnervepalsyfrequentlyinvolvesthethirdcranial
nerveduetoitsanatomicsurroundingswhenleavingthebrainstem.
(PCOM)isthemostcommontypeofaneurysmtoforminthebasal
cistern.ThemajorityofsymptomaticaneurysmsofthePCOM
presentasanoculomotornervepalsy(ONP),whichcandevelop
directlyviamasseffectofthegrowinganeurysmorindirectlyvia
ruptureoftheaneurysm

---

1290.Watershedinfarctinbrain
a)Occursintheproximalportionofmainarteries
b)Occursinthecentralportionofmainarteries
c)Occursintheterminalportionofmainarteries
d)Anyoftheabove
CorrectAnswer-C
Answer-C.Occursintheterminalportionofmainarteries
Borderzoneorwatershedinfarctsareischemiclesionthatoccursin
characteristiclocationatthejunctionbetweentwomainarterial
territories.
Watershedstrokesarenamedthatwaybecausetheyaffectthe
watershedareasofthebrain.
Theseareasarethinstripsofbrainwhicharesandwichedin
betweenthefarthestendbranchesoftwoadjacentvascular
territories.

---

1291.InWilsonsdiseasecopperdeposition
occursin
a)Pons
b)Medulla
c)Cerebellum
d)Basalganglia
CorrectAnswer-D
Answer-D.Basalganglia
Inbrain,thetoxicinjuryprimarilyaffectsthebasalganglia
particularlytheputamenwhichdemonstratesatrophyandcavitation.

---

1292.Impotenceisafeatureofwhichofthe
following:
a)Multiplesclerosis
b)Poliomyelitis
c)Amyotropiclateralsclerosis
d)Meningitis
CorrectAnswer-A
AnswerisA(Multiplesclerosis):
Multiplesclerosisisassociatedwitherectiledy.slitnctionor
impotence.
NeurologicaldisordersassociatedwithErectiledysfunction
include:
Spinalcordinjury
Multiplesclerosis
Peripheralneuropathy

---

1293.Allofthefollowingarefeaturesof
Obstructivejaundiceexcept:
September2007
a)Normalalkalinephosphatase
b)Mildlyelevatedserumaminotransferaseslevel
c)Claycolourstools
d)Pruritis
CorrectAnswer-A
Ans.A:Normalalkalinephosphatase
Obstructiontotheflowofbileincommonbileductmayresultfrom
choledocholithiasis,malignancyodheadofpancreas,bileductsor
ampullaofVater.
Charcot'striadofintermittentfever,painandjaundiceis
characteristicofascendingcholangitisandindicatesbiliary
obstruction.
Hepatomegalyispresentinmostcasesofobstructivejaundiceand
isduetocongestionandstretchingoutofintrahepaticbiliaryspaces.
Apalpablegallbladderusuallyindicatesobstructionofthedistal
CBD,duetoothercauseslikeunderlyingmalignancy,thanstone
(Courvoisier'slaw).
Hepaticbileflowsuppressionleadstojaundiceaccompaniedby
darkurine(bilirubinuria)andlightcoloured(alcoholic)stools.
Bilesaltsandpigmentsinurineandabsenturobilinogenalsofavour
thediagnosisofobstructivejaundice.
Serumalbuminandprothrombintimearegoodindicatorsofliver
functionderangement.Serumbilirubinlevelsindicateseverityof
jaundiceandhighdirectbilirubinrulesouthemolyticjaundice.
MildelevationofSGPTlevelsarealsoseeninobstructivejaundice

---

MildelevationofSGPTlevelsarealsoseeninobstructivejaundice
consistentwithliverdysfunction.Anelevatedalkalinephosphatase
is,alwayspresentinobstructivejaundice.

---

1294.Abdominojugularreflexappearsafter
compressingabdomenfor
a)5sec
b)10sec
c)15sec
d)30sec
CorrectAnswer-C
Answer-C.15sec
Thisisdonebyapplyingfirmpressurewiththepalmofthehandto
therightupperquadrantoftheabdomenfor10-15secondswiththe
patientsbreathingquietlywhilethejugularveinisobserved.
Apositiveabdominojugularrefluxsignisdefinedbyanincreasein
thejugularvenouspressureofgreaterthan3cm,sustainedfor
greaterthan15seconds.

---

1295.Extraintestinalmanifestationsof
Inflammatoryboweldiseaseincludeall
ofthefollowing,Except:
a)Uveitis
b)Sclerosingcholangitis
c)Osteoarthritis
d)Skinnodules
CorrectAnswer-C
AnswerisC(Osteoarthritis):
Osteoarthritisisnotanextraintestinalmanifestationofinflammatory
boweldisease
Uveitis,SclerosingCholangitis,andskinnodules(Erythema
nodosum)areallrecognizedextraintestinalmanifestationsof
inflammatoryboweldisease.

---

1296.Genitourinarycomplicationof
ulcerativecolitis
a)Cystitis
b)Pyelonephritis
c)Urinarycalculi
d)Urethritis
CorrectAnswer-C
Answer-C.Urinarycalculi
Urinarycalculi(oxalatestonesinilealdisease),localextensionof
Crohndiseaseinvolvingureterorbladder,amyloidosis,drug-related
nephrotoxicity.

---

1297.Liverbiopsyindicationisallexcept
a)Amoebichepatitis
b)Wilson'sdisease
c)ChronichepatitisBandC
d)Autoimmunehepatitis
CorrectAnswer-A
Answer-A.Amoebichepatitis
GradingandstagingofchronichepatitisBandC
Diagnosisof:
Hemochromatosis(quantitativeestimationofhepaticiron)
Wilson'sdisease(quantitativehepaticcopper)
Focalliverlesions
Evaluationof:
Cholestaticliverdisease:Primarybiliarycirrhosis,primary
sclerosingcholangitis
Abnormalliverbiochemicaltestsinapatientwithanegativeor
inconclusiveserologicwork-up
Treatmentefficacy
Sideeffectsoftreatmentregimens(suchasmethotrexatefor
rheumatoidarthritis)
Postlivertransplantbyprotocolorforevaluationofabnormalliver
biochemicaltests
Donorliver
Feverofunknownorigin

---

1298.Useofspironolactoneinlivercirrhosis
is
a)Decreaseedema
b)Improvesliverfunction
c)Decreaseafterload
d)Decreaseintravascularvolume
CorrectAnswer-A
Answer-A.Decreaseedema
Treatmentofascitesinpatientwithcirrhosisisaimedatthe
underlyingcauseofthehepaticdiseaseandatthesodiumwater
retention
Diuretictherapytypicallyconsistsoftreatmentwithspironolactone
andfurosemideinaratioof100:40mg/daywithdosestitrated
upwardasneeded(upto400mgspironolactoneandfurosemideina
ratioof100:40mg/day).

---

1299.Peasoupdiarrheaisseenin-
a)Cholera
b)Typhoid
c)Yersinosis
d)Hepatitis
CorrectAnswer-B
Answer-B.Typhoid
PeaSoupdiarrhoeaischaracteristicofsalmonellainfection.
About2weeksafterinfectionwithsalmonellatyphimostpeople
sufferingfromtyphoiddevelopayellowgreenfoulliquidstoolthat
resemblespeasoupinappearancei.e.,peasoupstool.

---

1300.Causeofvasodilatationinspidernevi-
a)Estrogen
b)Testosterone
c)Hepatotoxins
d)FSH
CorrectAnswer-A
Estrogen[Ref:Harrison171h/ep.1920;Robbin's7th/e
p.882]
Spidernevirefertodilated,visiblesmallbloodvesselsintheskin.
-Itiscalledspidernevibecauseitconsistsofcentral"feeding"blood
vesselwithnumerousfineradiatinglegsemanating.fromthecentral
body.
Spiderneviarecausedduetovasodilatationofvesselsandare
usuallyassociatedwithcirrhosis.
Cirrhosisisassociatedwithvasodilatationandhyperdynamic
circulation.
"Thecauseofvasodilatationinchrrhosisisuncertainbutitis
believedtoberelatedtotheincreasedlevelofestrogenintheboth.
Estrogenisafemalesexhormonewhichismetabolizedbyliver.
Thusinliverdiseasesitsleveltendstoincreasewhichisbelieveto
causevasodilatation,resultinginspidernaevi.

---

1301.Mostsignificantriskfactorfor
developmentforgastriccarcinomais
a)Panethcellmetplasia
b)Pyloricmetaplasia
c)Intestinalmetaplasia
d)Ciliatedmetaplasia
CorrectAnswer-C
Answer-C.Intestinalmetaplasia
A)Environmentalfactors
B)Hostfactors:Chronicgastritis(causinghypochlorhydriaor
intestinalmetaplasia),partialgastrectomy,gastricadenoma,
Barrett'sesophagus,andMenetrierdisease.
Intestinalmetaplasiaisthemostsignificantprecursorlesionfor
Gastriccancer
C)Geneticfactors

---

1302.Adultmalewithchronicatrophic
gastritis,growthonskirrowsmedium&
rapidureasetestpositive.Diagnosisis
a)Hpylori
b)H.influnzae
c)Kpneumonia
d)V.Cholarae
CorrectAnswer-A
Answer-A.Hpylori
AllfavorthediagnosisofHpyloriinfection.

---

1303.SeeninSIADH
a)Generalizededema
b)Ascites
c)NormalBP
d)Drymucousmembrane
CorrectAnswer-C
Answer-C.NormalBP
Hyponatremia(dilutionalhyponatremiawithNet'<135mmol/L)
Decreasedplasmaosmolality(<280mosm/kg)withinappropriately
increasedurineosmolality>150mosm).
Highurinesodium(over20meq/1)
Lowbloodureanitrogen<10mg/L
Hypouricemia(<4mg/dL)
Clinicaleuvolemia

---

1304.Adiabeticpatienthavingsensory
involvement,tingling,numbness,ankle
swelling,nopain.Diagnosisis
a)Charcotsjoint
b)Gout
c)Rheumatoidarthritis
d)Ankylosingspondylitis
CorrectAnswer-A
Answer-A.Charcotsjoint
Itisaprogressivedestructivearthritisassociatedwithlossofpain
sensation?,proprioception?orboth,inadditionnormalmuscular
reflexesthatmodulatejointmovementsaredecreased.
Itismostcommonlycausedbydiabetesmellitus.
[RefHarrison18`5/ep.2855,2856;17th/ep.2180-2181]

---

1305.PatienthavingCushingsyndromedue
toadrenaltumor.Drugtobegiven
a)Cortisol
b)Betamethasone
c)Ketoconazole
d)Fludrocortisones
CorrectAnswer-C
Answer-C.Ketoconazole
TREATMENT-
Treatmentofchoice-removalofpituritarycorticotropetumour
(transphenoidalapproach)
Pituitaryirradiation
Metyraponeandketoconazole
Adrenocorticalcarcinoma-mitotane

---

1306.Metabolicchangeinseverevomitingis
a)Metabolicalkalosis
b)Respiratoryalkalosis
c)Metabolicacidosis
d)Hyperkalemia
CorrectAnswer-A
Answer-A.Metabolicalkalosis
Persistentgastricvomitingleadsto
Hyponatremia
Hypokalemia
Hypochloremia
Alkalosis

---

1307.Treatmentofhypercalcemiaincludesall
except
a)Steroids
b)Bisphosphonates
c)Phosphate
d)Strontium
CorrectAnswer-D
Answer-D.Strontium
Treatmentofacutehypercalcemia
Hydrationwithsaline
Forceddiuresis:Salineplusloopdiuretics(furosemide)
Bisphosphonates(pamidronate,zoledronate)
Calcitonin
Specialtherapies:Phosphate(oral),glucocorticoids,dialysis

---

1308.Myelodysplasticsyndromeiscommon
inwhichagegroup
a)2-10yrs
b)15-20yrs
c)25-40yrs
d)>50yrs
CorrectAnswer-D
Answer-D.>50yrs
Myelodysplasticsyndromeoccursmostcommonlyinolderadults
withmedianageatdiagnosisinmostcasesof65yearsandamale
preponderance.Onsetofthediseaseearlierthanage50isunusual.

---

1309.Thebestdrugtolowerprolactinlevelin
afemalewithinfertilityis
a)Bromocriptine
b)GnRH
c)Testosterone
d)Corticosteroid
CorrectAnswer-A
Answer-A.Bromocriptine
Thetreatmentofchoiceforprolactinomais"bromocriptine".
Bromocriptineisadopamineagonistwhichinhibitsthesecretionand
synthesisofprolactin.

---

1310.Whichofthefollowingisnotcommonly
seeninPolycythemiaVera
a)Thrombosis
b)Hyperuricemia
c)Proneforacuteleukemia
d)Spontaneoussevereinfection
CorrectAnswer-D
Answer-D.Spontaneoussevereinfection
Clinicalfeatures-
Hyperviscosity,hypovolaemia,hypermetabolism,erythocytosis,
thrombosis.
Headache,vertigo,tinnitus,syncopeorevencoma,transientvisual
loss
Splenomegaly,haemtemesisandmelena,bleeding.
Pruritis&pepticulceration(basophiliawithhistaminerelease)
Hyperuricaemia-uratestonesandgout

---

1311.Evanssyndromeis
a)Anemiaandthrombocytopenia
b)Pancytopenia
c)Lymphopeniaandanemia
d)Thrombocytosisandlymphocytosis
CorrectAnswer-A
Answer-A.Anemiaandthrombocytopenia
Evanssyndrome(ES)referstothecombinationofCoombs-positive
warmautoimmunehemolyticanemia(AIHA)andimmune
thrombocytopenia(ITP),although,lesscommonly,somepatients
willalsohaveautoimmuneneutropenia(15percentinoneseries).

---

1312.Allaremajorcomplicationsofmassive
transfusionexcept
a)Hypokalemia
b)Hypothermia
c)Hypomagnesemia
d)Hypocalcemia
CorrectAnswer-A
Answer-A.Hypokalemia
ComplicationsofMassivetransfusion:-
Coagulopathy
Citratetoxicity
Hypothermia
Metabolicalkaptosis
Hyperkalemia
Acuterespiratorydistresssyndrome
Coagulationfactordepletion

---

1313.Megaloblasticanemiaisseenin?
a)ilealresection
b)Crohn'sdisease
c)Intestinallymphaticectasia
d)aandb
CorrectAnswer-D
Ans.is'a'i.e.,ilealresection'b'i.e.,Crohn'sdisease
1. Crohn'sdiseaseisatypeof
ilitis.
2. Chronicpancreatitisisamalabsorptionstate.
"About40%ofpatientswithchronicpancreatitishavevitaminB12
malabsorption"

---

1314.RegardingMSUDwhichisnottrue
a)Deficiencyofbranchedchainaminoacidenzymes
b)Hyperaminoaciduria
c)Asymptomatic
d)FeC13turnsnavyblue
CorrectAnswer-C
Answer-C.Asymptomatic
Itisaninherited(autosomalrecessive)disorderofbranchedchain
aminoacidi.e.-Valine,LeucineandIsoleucine.
Maplesyrupurinedisease(MSUD)isd/tdefectinenzyme-a-keto
aciddehydrogenase.
Diagnosis
Theketoacidsmaybedetectedbyaddingafewdrops2-4din
itrophenylhydrazine(DNPH)reagentwhichproducesayellow
precipitateinpositivetest.
Ferricchloridegivesnavybluecolourwiththepatientsurine.

---

1315.Resultofliquoriceingestion
a)Hyperkalemicalkalosis
b)Hypokalemicalkalosis
c)Hypokalemicacidosis
d)Hypermalemicacidosis
CorrectAnswer-B
Answer-B.Hypokalemicalkalosis
Liquorice(Licorice)ingestioncausesapparentmineralocorticoid
excess(pseudohyperaldosteronism)duetoinhibitionofenzyme11-
13-HSD.
Thiscausesmetabolicalkalosis,hypokalemiaandvolumeoverload.

---

1316.Mostcommoncarcinomaassociated
withRA
a)DiffuselargeBcelllymphoma
b)Largegranularlymphocyticleukemia
c)Chroniclymphocyticleukemia
d)Noneoftheabove
CorrectAnswer-B
Answer-B.Largegranularlymphocyticleukemia
Lymphogranularproliferationmaybepresentinpatientswith
Rheumatoidarthritisandinminorityitwillproceedto"largegranular
lymphocyticleukemia"inRheumatoidarthritis

---

1317.Whichofthefollowingdrugsisuseful
inacuteattackofgout?
a)Furosemide
b)Sulfinpyrazone
c)Allopurinol
d)Piroxicam
CorrectAnswer-D
Ans.is'd'i.e.,Piroxicam
Drugsusedinacutegout
i)NSAIDsDrugofchoice
ii)Colehicine
iii)Corticosteroids

---

1318.TTKGinhypokalemiais-
a)<3-4
b)>6-7
c)>9-10
d)>10-15
CorrectAnswer-A
Answer-A.<3-4
AnormalTTKinnormalsubjectsonnormaldietis8-9
Withoutotherdisease,hypokalemiashouldproduceaTTKG<3

---

1319.Systemicsclerosisshowsallexcept
a)Acroosteolysis
b)Tufting
c)Calcinosiscutis
d)Digitalulcers
CorrectAnswer-B
Answer-B.Tufting
Skininvolvementinsystemicsclerosis
Pruritusintheearlystages
Edemaintheearlystages
Sclerodactyly
Digitalulcers
Pittingatthefingertips
Telangiectasia
Calcinosiscutis

---

1320.Tetanyisseenin
a)Hypocalcemia
b)Hypercalcemia
c)Hypoparathyroidism
d)Hyperparathyroidism
CorrectAnswer-A
Answe-A.Hypocalcemia
Acutehypocalcemiadirectlyincreasesperipheralneuromuscular
irritability.
Tetanyconsistsofrepetitivehighfrequencydischargesafterasingle
stimulus.
Hyperexcitabilityofperipheralneuronsisprobablythemostimportant
pathophysiologiceffectofhypocalcemia.

---

1321.Ininflammatorymyopathy,whichgroup
ofmusclesisnotaffected
a)Ocular
b)Facial
c)Proximalmusclesoflimb
d)Distalmusclesoflimb
CorrectAnswer-C
Answer-C.Proximalmusclesoflimb
Inflammatorymyopathiesrepresentthelargestgroupofacquired
andpotentiallytreatablecauseofskeletalmuscleweakness.
Theyareclassifiedintothreemajorgroups:
1. Polymyositis
2. Dermatomyositis
3. Inclusionbodymyositis
Thesedisorderspresentasprogressiveoftensymmetricmuscle
weakness.
Theproximalmusclesareinvolvedpredominantly,firstofthelower
limborgirdlefollowedbyproximalmusclesofupperlimb.
Occularmusclesarespared.
Distalmusclesofthelimbareinvolvedrarely.

---

1322.Featuresoftumorlysissyndromeare:
a)Hypocalcemia
b)Hypophosphatemia
c)Alkalosis
d)Hypokalemia
CorrectAnswer-A
AnswerisA(Hypocalcemia):
TumorLysissyndromeisassociatedwithHypocalcemia.
TumorLysisSyndromeisalsoassociatedwithHyperphosphatemia,
HyperkalemiaandAcidosis.

---

1323.POEMSSyndromeincludesall,EXCEPT:
a)Polyneuropathy
b)Organomegaly
c)Endocrinopathy
d)Multiplesclerosis
CorrectAnswer-D
Thefeaturesofthissyndromearepolyneuropathy,organomegaly,endocrinopathy,
multiplemyeloma,andskinchanges(POEMS).
Patientsusuallyhaveasevere,progressivesensorimotorpolyneuropathyassociatedwith
scleroticbonelesionsfrommyeloma.Polyneuropathyoccursin~1.4%ofmyelomas,but
thePOEMSsyndromeisonlyararesubsetofthatgroup.
Unliketypicalmyeloma,hepatomegalyandlymphadenopathyoccurinabouttwo-thirdsof
patients,andsplenomegalyisseeninone-third.
Ref:Harrison'sprincipleofinternalmedicine17thedition,Chapter106.

---

1324.Minamatadiseaseiscausedbytoxicity
of:
a)Arsenic
b)Antimony
c)Lead
d)Mercury
CorrectAnswer-D
Asignificantexampleofmercuryexposureaffectingpublichealth
occurredinMinamata,Japan,between1932and1968,wherea
factoryproducingaceticaciddischargedwasteliquidintoMinamata
Bay.
Thedischargeincludedhighconcentrationsofmethylmercury.The
baywasrichinfishandshellfish,providingthemainlivelihoodfor
localresidentsandfishermenfromotherareas.
Formanyyears,noonerealisedthatthefishwerecontaminated
withmercury,andthatitwascausingastrangediseaseinthelocal
communityandinotherdistricts.
Atleast50000peoplewereaffectedtosomeextentandmorethan
2000casesofMinamatadiseasewerecertified.
Minamatadiseasepeakedinthe1950s,withseverecasessuffering
braindamage,paralysis,incoherentspeechanddelirium.
Ref:http://www.who.int/mediacentre/factsheets/fs361/en/index.html

---

1325.SignsofBartter'ssyndrome-
a)Hypokalemia
b)Hypernatremia
c)Hyperkalemia
d)Acidosis
CorrectAnswer-A
Answer-A.Hypokalemia
Inheritedformsofhypochloremicmetabolicalkalosisand
hypokalemiawithouthypertensionareduetogeneticmutationsof
variousiontransportersandchannelsofthethickascendinglimbof
Henle'sloop(TAL)anddistalconvolutedtubule(DCT).
[Ref:HarrisonsPrinciplesofInternalMedicine,18thEdition,Pages
2360,61]

---

1326.VitaminEcauses
a)Hemorrhagicstroke
b)Cardiacfailure
c)Ataxia
d)Megalablasticanemia
CorrectAnswer-C
Ans.is'c'i.e.,Ataxia
VitaminE(tocopherol)isafat-solublevitaminwithantioxidant
properties;Itprotectscellmembranesfromoxidationand
destruction.
VitaminEisfoundinavarietyoffoodincludingoils,meat,eggs,and
leafyvegatables.
Therearemultipleformsandisomersoftocopherolandtherelated
compounds,tocotrienols.
ThecurrentevidencetheprimarybioactiveformofVitaminEisalfa-
tocopherol.
SerumvitaminElevelsarestronglyinfluencedbyconcentrationof
serumlipids,anddonotaccuratelyreflecttissuevitaminlevels.
EffectivevitaminElevelsarecalculatedastheratioofserumalpha-
tocopherolpergramtotallipids.
AbsorptionofdietaryvitaminErequireseffectivepancreaticexocrine
functionandfatabsorption,unlessprovidedinasyntheticwater-
solubleform.
Vitamin
VitaminEdeficiencyisuncommoninhumansexceptinspecial
circumstances.
Thisisduetotheabundanceoftocopherolsinthediet.

---

1327.DescriptionofWaterhouseFriedrich
syndrome
a)Adrenalhemorrhagepostmalignancy
b)Congenitaladrenalsdeficiency
c)Adrenalhemorrhageaftermeningococcalinfection
d)Adrenalhemorrhageaftercorticosteroidwithdrawal
CorrectAnswer-C
Answer-C.Adrenalhemorrhageaftermeningococcalinfection
WaterhouseFriderichsensyndromeormassiveadrenalhemorrhage
isanuncommonusuallyfatalconsequenceofoverwhellingsepsis.
Itismostfrequentlyseenasaresultof"meningococcalinfection".

---

1328.XDR-TBisdefinedasResistanceto:
a)INHplusrifampicin
b)FluoroquinolonesplusINHplusamikacin
c)Fluoroquinolonesplusrifampicinpluskanamycin
d)FluoroquinolonesplusINHplusrifampicinplusamikacin
CorrectAnswer-D
Ans.is.'d'i.e.,FluoroquinolonesplusINHplusrifampicinplus
amikacin
ExtensivedrugresistanceTB(XDR-TB)isreferredtoresistanceto
rifampicinandisoniazidaswellastoquinoloneandatleastoneof
thefollowingsecondlinedrugkanamycin,capreomycinoramikacin.
XDR-TB=resistancetoINH,rifampcin,Quinolone,and
capreomycin/kanamycin/amikacin

---

1329.Intotalparenteralnutrition,noneedto
measuredaily
a)Electrolyte
b)Fluidintakeandoutput
c)LFTalbumin
d)Magnesium
CorrectAnswer-C
Answer-C.LFTalbumin
Monitoringofparenteralnutritiondaily:-
Measurementoffluidintakeandoutput
Serumelectrolyte
Glucose
Calcium
Magnesium
Phosphate
Monitorthefollowingparametersweekly:-
Aminotransferase
Bilirubin
Triglycerides

---

1330.Browntumorsareseenin:
a)Hypeparathyroidism
b)Pigmentedvillonodularsynovitis
c)Osteomalacia
d)Neurofibromatosis
CorrectAnswer-A
Browntumorsarehighlyvascularlyticlesionsoftheskeletonseeninbothprimaryand
secondaryhyperparathyroidism.
Theyresultfromtheaccumulationofabundantfibrovasculartissueandosteoclastlikegiant
cells.
Ref:Robbin'sBasicPathology,7thEdition,Pages1186,1286;OrthopaedicPathologyBy
VincentJ.Vigorita,BernardGhelman,DouglasMintz,2007,Page187.

---

1331.Drugofchoiceforkala-azaris
a)Antimonials
b)AmphotericinB
c)Quinine
d)Parmomycin
CorrectAnswer-A
Answer-A.Antimonials
Firstline:Pentavalentantimony(Sodiumstibogluconateisthedrug
ofchoice),andamphotericin-B.
Alternatives:Paromomycin,pentamidine,miltefosine,sitamoquine

---

1332.Whichdrugisusedinthetreatmentof
TypeItyrosinemia?
a)Nitisinone
b)Alogliptin
c)Pemoline
d)Milrinone
CorrectAnswer-A
Ans.A.Nitisinone
[RefNelson20'Vep.641]
Adietlowinphenylalanineandtyrosinecanslowbutdoesnothalt
theprogressionofthecondition.
Thetreatmentofchoiceisnitisinone,whichinhibitstyrosine
degradationat4-HPPD.Thistreatmentpreventsacutehepaticand
neurologiccrises.
Althoughnitisinonestopsorgreatlyslowsdiseaseprogression,
somepretreatmentliverdamageisnotreversible.

---

1333.DMDnotseenis
a)Musclepseudohypertrophy
b)Weakness
c)Tenderness
d)Cardiomyopathy
CorrectAnswer-C
Answer-C.Tenderness
DMD,alsocalledpeudohypertrophicmuculardystrophy,isthemost
commonhereditaryneuromusculardystrophy.ItisanX-linked
recessivedisorder.
Itiscausedbyamutationingeneresponsibleforproducing
dystrophin(asarcolemmalprotein).
Thereisprogressivemuscleweaknessaffectingproximalmusclesof
limbs.
Childwalksclumsily,hasdifficultyinclimbingstairsandthegaitis
waddling(Trendelenburg).
Scoliosis,epilepsyandmildmentalretardation

---

1334.Mostsensitivetestformyaesthenia
gravis
a)Edrophoniumtest
b)SinglefibreEMG
c)MultiplefibreEMG
d)Repetitivenervestimulation
CorrectAnswer-B
Answer-B.SinglefibreEMG
Diagnosis-
Anti-AchRradioimmunoassay
Electrophysiologicaltesting
Single-fibreelectromyography(mostsensitive)

---

1335.A25yearoldfemalepresentswithgeneralizedrestrictionofeye
movementinalldirection,intermittentptosis,proximalmuscleweakness
andfatigability.WhichistheMOSTusefultestinmakingthediagnosis?
a)CPK
b)Edrophoniumtest
c)EMG
d)Musclebiopsy
CorrectAnswer-B
ThispatientisshowingsignsandsymptomsofMyastheniagravis.Edrophoniumtestisthe
mostusefultestinmakingadiagnosisofthisconditionbecauseoftherapidonsetand
shortdurationofitseffect.Thistestisconsideredtobepositiveifthereisanyimprovement
intheweaknessofthispatientafteradministrationofedrophonium.
Otherdiagnostictestsusedfordiagnosingmyastheniagravisare:
Acetylcholinereceptorantibodies:Presenceofthisantibodiesisvirtuallydiagnosticof
MG,butanegativetestdoesnotexcludethedisease.
Rapidnervestimulationtest:Inthistestelectricshocksaredeliveredatarateof2or3
persecondtotheappropriatenerves,andactionpotentialsarerecordedfromthemuscles.
Inthesepatientsthereisarapidreductionof>10?15%intheamplitudeoftheevoked
responses.
Ref:DrachmanD.B.(2012).Chapter386.MyastheniaGravisandOtherDiseasesofthe
NeuromuscularJunction.InD.L.Longo,A.S.Fauci,D.L.Kasper,S.L.Hauser,J.L.
Jameson,J.Loscalzo(Eds),Harrison'sPrinciplesofInternalMedicine,18e.

---

1336.Dyslipidemiaassociatedwithalcohol
consumption
a)DecreasedHDL
b)IncreasedHDL
c)Decreasedtriglycerase
d)Decreasedlipoprotein
CorrectAnswer-B
Answer-B.IncreasedHDL
SeremHDLcholesterolincreasesby4.0mg/dl(.1mmol/L)
SerumapolipoproteinA.1increaseby8.8mg/dl
SerumTriglycerideincreasesby5-4mgmg/dl

---

1337.Migraineisdueto
a)Dilatationofcranialarteries
b)Constrictionofcranialarteries
c)Corticalspreadingdepression
d)Meningialinflammation
CorrectAnswer-C
Answer-C.Corticalspreadingdepression
Corticalspreadingdepressionisaselfpropagatingwaveofneuronal
andglialdepolarizationthatspreadsacrossthecerebralcortex.
Theactivationoftrigeminalafferentsbycorticalspreading
depressioninturncausesinflammatorychangesinthepain-
sensitivemeningesthatgeneratetheheadacheofmigrainethrough
centralandperipheralreflexmechanisms.

---

1338.Balthazarscoringsystemisusedfor?
a)AcutePancreatitis
b)AcuteAppendicitis
c)Acutecholecystitis
d)Cholangitis
CorrectAnswer-A
Answer-A.AcutePancreatitis
BalthazarscoreisusedintheCTseverityindex(CTSI)forgrading
ofacutepancreatitiswhichhastwocomponents.
Usingimagingcharacteristics,Balthazarandassociateshave
establishedtheCTseverityindex.ThisindexcorrelatesCTfindings
withthepatient'soutcome
1)Gradingofpancreatitis
A:Normalpancreas0
B:Enlargementofpancreas1
C:Inflammatorychanges2
D:Ill-definedsinglefluidcollection-43
E:Twoormoreill-definedfluidcollections4
2)Pancreaticnecrosis
None0
30%2
>30-50%4
>50%6

---

1339.Triagesystemusedfor
a)Burn
b)Earthquack
c)Polytrauma
d)Floods
CorrectAnswer-C
Answer-C.Polytrauma
Theusualprincipleoffirstcome,firsttreated",isnotfollowedin
massemergencies.
Triageconsistsofrapidlyclassifyingtheinjuredandthelikelyhoodof
theirsurvivalwithpromptmedicalintervention.
Higherpriorityisgrantedtovictimswhoseimmediateorlong-term
prognosiscanbedramaticallyaffectedbysimpleintensivecare.

---

1340.Ilealobstructionduetoroundworm
obstructiontreatmentis
a)Resectionwithendtoendanastomosis
b)Resectionwithsidetosideanastomosis
c)Enterotomy,removalofwormsandprimaryclosure
d)Diversion
CorrectAnswer-C
Answer-C.Enterotomy,removalofwormsandprimaryclosure
Diversionisthefirststepincaseofcolonicobstruction,followedby
resectionandanastomosisofaffectedsegmentandthenclosureof
diversioncolostomyatalaterdate.
IntestinalluminalobstructionsuchasduetoBezoarsorfecolithsof
wormintestationsaredealtwithbyenterotomyandremovalfollowed
byprimaryclosure.

---

1341.Surgeryforperforationduetoround
wormis
a)Resectionwithendtoendanastomosis
b)Resectionwithsidetosideanastomosis
c)Primaryclosure
d)Diversion
CorrectAnswer-A
Answer-A.Resectionwithendtoendanastomosis

---

1342.Whichisacleansurgery
a)Herniasurgery
b)Gastricsurgeru
c)Cholecystectomy
d)Rectalsurgery
CorrectAnswer-A
Answer-A.Herniasurgery
CleanWound(ClassI)
Includethoseinwhichnoinfectionispresent;onlyskinmicroflora
potentiallycontaminatethewound.Nohollowviscusisentered.No
inflammation
Examples:Herniarepair,breastbiopsy

---

1343.Bestprognosticfactorforheadinjuryis
:
a)Glasgowcomascale
b)Age
c)Modeofinjury
d)CT
CorrectAnswer-A
AnswerisA(Glasgowcomascale):
AmongsttheoptionprovidedGCSisthesinglebestanswerof
choice.
DeterminingthepatientprognosisafterTBI(TraumaticBrain
Injury)isdifficultandcomplex.
Severalindependentvariableshavebeenidentifiedthatcorrelate
withseverity.
MoststudieshaveindicatedGlasgowComaScaleinthefieldandat
arrivalattheemergencydepartmentasahighlypredictiveindicator
ofprognosis.Harrison17th/2601
Insevereheadinjuryeyeopening,thebestmotorresponseand
verbaloutputhavebeenfoundtoberoughlypredictiveofoutcome.
TherehavebeensummarizedusingtheGlasgowcomascale.
Comascore=E+M+V
Patientscoring3or4havean85%chanceofdyingorremaining
vegetative.
Patientsscoring11orabovehaveonlya5--10%chanceofdying
orremainingvegetative.
Intermediatescorescorrelatewithproportionalchancesofrecovery.
OtherPoorprognosis

---

indicators:Harrison
CTevidenceofcompressionof
? Olderage
? cisterns/midlineshift
Delayedevacuationoflarge
? IncreaseICP
? intracerebralhemorrhage
CarrierstatusforapolipoproteinE-4
? Hypoxia&Hypotension
? allele

---

1344.Thetensilestrengthofwoundreaches
thatoftissueby?
a)6weeks
b)2months
c)4months
d)None
CorrectAnswer-D
Ans.is'None'
Itneverequalsthetensilestrengthofunwoundedskin.
Robbin'swrites-"Howlongdoesittakeforaskinwoundtoachieve
itsmaximalstrength?Whensuturesareremovedfromanincisional
surgicalwound,usuallyattheendofthefirstweek,woundstrength
isapproximately10%thatofunwoundedskin.Woundstrength
increasesrapidlyoverthenext4weeks,slowsdownat
approximatelythethirdmonthaftertheoriginalincision,andreaches
aplateauatabout70%to80%ofthetensilestrengthofunwounded
skin."

---

1345.Steroidisinjurioustowoundwhen
given
a)On1stday
b)<2weeks
c)2-4weeks
d)>4weeks
CorrectAnswer-B
Answer-B.<2weeks
Steroidsusedafterfirst3to4dayspostinjurydonotaffectwound
healingasseverlyaswhenusedinimmediatepostoperativeperiod.
Delayinuseofsuchdrugsforabout2weekspostinjuryappearsto
lesserthewoundhealingimpairment.

---

1346.Insurgicalpatientmalnutritionisbest
assessedby
a)Serumalbumin
b)Hblevel
c)Midarmcircumference
d)Tricpesskinfoldthickness
CorrectAnswer-A
Answer-A.Serumalbumin
Serumalbuminisclassicmethodtopredictpostoperative
complications,hospitallengthofstay,morbidityandmortalityand
mighttobeassociatetonurtitionalstatusanddiseaseseverity.

---

1347.Thecommandooperationis-
a)Abdomino-perinealresectionoftherectumforcarcinoma
b)Disarticulationofthehipforgasgangreneoftheleg
c)Extendedradicalmastectomy
d)Excisionofcarcinomaofthetongue,thefloorofthemouth,part
ofthejawandlymphnodesenbloc
CorrectAnswer-D
Ans.is'd'i.e.,Excisionofcarcinomaofthetongue,thefloorofthe
mouth,partofthejawandlymphnodesenbloc

---

1348.Dacronvasculargraftisa:
a)Textilebiologic
b)Textilesynthetic
c)Nontextilebiologic
d)Nontextilesynthetic
CorrectAnswer-B
Dacrongraftisatypeoftextilesyntheticgraft.Itisassociatedwithincreasedriskof
thrombosisduetolowflowrates.
Theyareprecoatedwithcollagen,whicheliminatestheneedforpre-clotting.
Itisnowreservedforaorticandhighpressure,largediameterbypassgraftsorusedas
aorticendografts.
Ref:DiabeticFoot:LowerExtremityArterialDiseaseandLimbSalvage,AntonN.Sidawy,
2006Edition,Chapter22,Page234;MasteryofVascularandEndovascularSurgeryBy
GeraldB.Zelenock,2006Edition,Chapter50,Page414;VascularAccess:Principlesand
PracticeBySamuelEricWilson,5thEdition,Page115;VascularSurgeryByAlunH.
Davies,Page135.

---

1349.Abbesflapisusedfor
a)Eyelid
b)Tongue
c)Lip
d)Ear
CorrectAnswer-C
Answer-C.Lip
Abbeflap,alsocalledlipswitchflap,isusedforlipreconstruction.

---

1350.InLAHSHALterminologyforcleftlip&
cleftpalate,LAHSHALdenotes
a)Bilateralcleftpalateonly
b)Bilateralcleftliponly
c)Bilateralcleftlip&palate
d)Nocleft
CorrectAnswer-C
Answer-C.Bilateralcleftlip&palate
LAHSHALclassificationofcleftlipandpalatewasproposedby
Kreins0.
Itisadiagrammaticclassificationofcleftcip&palate.Accordingto
thisclassification,mouthisdividedintosixparts.
LAHSALcodeindicatescompletecleftwithandincompetecleftwith
smalllatter.

---

1351.Postoperativeabscesstreatmentof
choice
a)Hydration
b)IVantibiotics
c)Imageguidedaspiration
d)Reexploration
CorrectAnswer-C
Answer-C.Imageguidedaspiration
Thediagnosisandtreatmentofintraabdominalabscesseshave
improvedwiththeadventofimagingtechniquessuchas
ultrasonographyacdCT.Theseadvanceshavemademinimally
invassivedrainagetechniquesavailable;suchtechniques
complementtraditionalsurgicaldrainageforpatientswithabdominal
abscesscavities.

---

1352.Maythurnerorcockettsyndrome
involves
a)Commoniliacarteryobstruction
b)Internaliliacarteryobstruction
c)Internaliliacveinobstruction
d)Leftiliacveincompression
CorrectAnswer-D
Answer-D.Leftiliacveincompression
May-Thurnersyndrome/cockettsyndrome/iliocaval/iliacvein
compressionsyndrome.Occursduetocompressionofleftiliacvein
byoverridingrightiliacartery.
Itresultsinleftiliofemoraldeepveinthrombosis.

---

1353.Methodofreductionofinguinalhernia
a)Kugelmaneuvve
b)Taxis
c)Macvayproceedure
d)Stopa'stechnique
CorrectAnswer-B
Answer-B.Taxis
Taxis(herniareduction)wasthetreatmentofchoiceforincarcirated
hernia.
Manualreductionofherniaisknownastaxis.Taxisisanarchaic
termusedtodescribeanattemptatreductionofaherniathatis
acutelyirreducible(incarcirated).

---

1354.Complicationoftotalparenteral
nutritioninclude?
a)Hyperglycemia
b)Hyperkalemia
c)Hyperosmolardehydration
d)aandb
CorrectAnswer-D
Ans.is'a'i.e.Hyperglycemia,'b'i.e.Hyperkalemia
Metaboliccomplication
Azotemia
Essentialfattyaciddef.
Fluidoverload
Metabolicboneds.
Liverdysfunction
Glucoseimbalance(Hyperglycemia,hypoglycemia)
Traceelements&vitamindeficiency
Electrolyteabnormalities
nHypernatremia,hyponatremia
nHyperkalemia,hypokalemia
aHyperphosphatemia,hypophosphatemia
nHypermagnesemia,hypomagnesemia
nHypercalcemia,hypocalcemia
nHighserumzinc,lowserumzinc
nHighserumcopper,lowserumcopper

---

1355.Subclavianstealsyndromeis
a)Reversalofbloodflowintheipsilateralvertebralartery
b)Reversalofbloodflowinthecontralateralcarotidartery
c)Reversalofbloodflowinthecontralateralvertebralartery
d)B/Lreversalofbloodflowinvertebralarteries
CorrectAnswer-A
Answer-A.Reversalofbloodflowintheipsilateralvertebral
artery
Subclavianstealsyndromemayoccurifthefirstpartofthe
subclavianarteryisoccluded.Armexercisecausessyncope
becauseofreversedflow,inthevertebralarteryleadingtocerebral
ischemia.
Itcanbetreatedbyangioplastyorsurgeryandisrare.
Thatistheresultofanipsilateralhemodynamicallysignificantlesion
oftheproximalsubclavianartery.

---

1356.MostcommoncauseofacquiredAV
fistulais
a)Bacterialinfection
b)Fungalinfection
c)Blunttrauma
d)Penetratingtrauma
CorrectAnswer-D
Answer-D.Penetratingtrauma
"Penetratinginjuriesarethemostcommoncause,butfistulasare
sometimesseenafterblunttrauma"?CSDT

---

1357.
Theprocedureofchoiceforthe
evaluationofaorticaneurysmis-
a)Ultasonography
b)Computedtomography
c)Magneticresonanceimaging
d)Arteriography
CorrectAnswer-B
Ans.is'b'i.e.Computedtomography
"CTisthemostprecisetestforimagingaorticaneurysm"-Sabiston
'Asapreoperativescanningtool,CTscanisthegoldstandard.
AngiographyhaslargelybeenreplacedbycontrastCTscanning"-
Schwartz

---

1358.Bestapproachinthoracictraumais
a)Midlinesternotomy
b)Parasternalthoracotomy
c)Anterolateralthoracotomy
d)Posterolateralthoracotomy
CorrectAnswer-C
Answer-C.Anterolateralthoracotomy
left'anterolateralthoracotomyisthebestinitialoperativeapproach
forunstablepatientsrequiringresuscitationorwhenthelocationof
theintrathoracicinjuryisunclear.

---

1359.Venousairembolismismostcommon
inwhichpositioninsurgery
a)Sitting
b)Prone
c)Lateral
d)Lithotomy
CorrectAnswer-A
Answer-A.Sitting
Venousairembolismisapotentialhazardwhenevertheoperative
siteisabovethelevelofpatientsheart.
The'sitting'positionanditsmodification"beachchair"positionsare
associatedwithagreaterincidenceofvenousairembolism

---

1360.
SurgeryinvaricoseveinsisNOT
attemptedinpresenceof-
a)Deepveinthrombosis
b)Multipleincompetentperforators
c)Varicoseveinswithlegulcer
d)Alloftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Deepveinthrombosis
Deepveinthrombosisisacontraindicationforvaricoseveins.
Varicoseveinsurgeryshouldneverbeattemptedinacasewhere
deepveinthrombosisexistsalongwithvaricoseveins,becausein
thesecasessuperficialveinsaretheonlyvalvedvenouspathway
andexcisingthemwillonlyaggravatethecondition.

---

1361.Fatalexsanguinationsoccursmostly
in
a)Closedfractureoffemurshaft
b)Openfractureoffemur&tibia
c)Partialtransactionofartery
d)Completeresectiontransactionofartery
CorrectAnswer-C
Answer-C.Partialtransactionofartery
"Bleedingismoreoftenexsanguinatingaftersharpinjuryandpartial
vesseltransection".

---

1362.Thetreatmentofchoiceforsquamouscellanalcancer?
a)Laserfulgaration
b)Chemoradiotherapy
c)Abdominoperennialresection
d)Platinum-basedchemotherapy
CorrectAnswer-B
SquamouscellanalcancerisrarebutassociatedwithHumanpapillomavirusinfection
(HPV),Analintra-epithelialneoplasia(AIN)andimmunosuppression.
Thecurrenttreatmentofanalcanalcarcinomaischemoradiotherapy(combinedmodality
therapy).
Chemotherapyincludeacombinationof5-FUwithmitomycinCorCisplatin.
Ref:BaileyandLoveShortPracticeofSurgery,25thEdition,Page1269;TheMD
AndersonManualofMedicalOncology,2ndEdition,Chapter22.

---

1363.Premalignantlesionforcarcinoma
rectumis
a)Familialpolyposis
b)FAP
c)Juvenilepolyp
d)Adenomatouspolyp
CorrectAnswer-A
Answer-A.Familialpolyposis
PrecancerouslesionsforCArectum
1. Villouspapilloma
2. Adenomas
3. Familialpolyposis

---

1364.Mostcommonsiteforanalfissureis
a)3O'clock
b)6O'clock
c)2O'clock
d)10O'clock
CorrectAnswer-B
Answer-B.6O'clock
Thevestmajorityofanalfissuresoccurinposteriormidline.
FissureinAno(orAnalfissure)
Mostcommonsiteismid-lineposterioly
MCsymptomis-4painassociatedwithdefecation
Fissurestartsproximallyatthedentateline

---

1365.Prepyloricorchannelulcerinthe
stomachistermedas-
a)type1
b)type2
c)type3
d)type4
CorrectAnswer-C
Ans.is'c'i.e.,Type3
.Situatedinprepyloricregion
.Associatedwithgastricacidhypersecretion

---

1366.Alvaradoscoreconsistof
a)Leucopenia
b)Anorexia
c)Diarrhea
d)Periumbilicalpain
CorrectAnswer-B
Answer-B.Anorexia
ThemostwidelyusedistheAlvaradoscore.Ascoreof7ormoreis
stronglypredictiveofacuteappendicitis.
Alvaradoscore
Symptoms
Score
Migrationofpain
1
Anorexia
1
Nausea&vomiting
1
Signs
Tendernessintherightlowerquadrant
2
Reboundtenderness
1
Elevatedtemperature
1
Laboratory
Leucocytosis
2
Ashiftofwhitebloodcellcounttotheleft 1
10
Total

---

1367.Mostcommonageforintussusception
is
a)0-6Months
b)6Months-3yrs
c)3-5Yrs
d)>5yrs
CorrectAnswer-B
Answer-B.6Months-3yrs
Intussusceptionisthetelescopingofoneportionoftheintestineinto
theother.
Itisthemostcommoncauseofintestinalobstructioninearly
childhood(3monthsto6years)

---

1368.Retrocardiaclucencywithairfluidlevel
isseenin
a)Hiatushernia
b)Distalendesophagealobstruction
c)Eventrationofdiaphragm
d)None
CorrectAnswer-A
Answer-A.Hiatushernia
Hiatusherniashowsretrocardiclucencywithairoranair-fluidlevel
abovethediaphragm.

---

1369.Mostcommonsiteforcarcinoidtumor
is
a)Esophagus
b)Lung
c)Appendix
d)Ileum
CorrectAnswer-D
Answer-D
Historically,themostcommonsiteofgastrointestinal(GI)carcinoid
tumorswastheappendix.
Currently,however,themostcommonsiteofcarcinoidsintheGI
tractisthesmallintestine(30%),followedbytherectum(19.6%).
Inmoststudies,theappendixisonlythethirdmostcommonsiteof
GIcarcinoids,andinsomestudies,itisthefourthmostcommon.

---

1370.Mostcommondifferentialdiagnosisfor
appendicitisinchildrenis
a)Gastroenteritis
b)Mesentriclymphadenopathy
c)Intussusception
d)Meckel'sdiverticulitis
CorrectAnswer-B
Answer-B.Mesentriclymphadenopathy
Differentialdiagnosisofappendicitisinchildren-
1. Acutegastroenteritis
2. Intussusception
3. Meckel'sdiverticulitis
4. Mesentriclymphadenitis(MC)
5. Inflammatoryboweldisease
6. Constipation
7. Functionalpain

---

1371.AbdominalsurgeryunderLA,patient
suddenlyfeltpaindueto
a)Liver
b)Gut
c)Parietalperitoneum
d)Visceralperitoneum
CorrectAnswer-C
Answer-C.Parietalperitoneum
Embryologicallyparietalperitoneumisderivedfromthe
somatopleurallayerofthelateralplatemesoderm.Itsbloodsupply
andnervesupplyarethesameasthoseoftheoverlyingbodywall.
Becauseofthesomaticinnervation,itispainsensitive."--BDC
Anatomy

---

1372.Featuresofintestinalobstruction:
clinically/investigationby:
a)Abdominaldistension
b)Vomiting
c)FluidlevelinX-ray>4
d)aandb
CorrectAnswer-D
Ans.is'a'&'b'i.e.Abdominaldistension&Vomiting
Aboutoption'c'
>5air-fluidlevelsinx-rayabdomensuggestintestinalobstruction
Grainger'sDiagnosticradiologywrites-"3to5fluidlevelslessthan
2.5cminlengthmaybeseen,particularlyintherightlower
quadrant,withoutanyevidenceofintestinalobstructionorparalytic
ileus."

---

1373.A55yearmalehashistoryofdysphagia
withvomitingofundigestedfood
throughouttheday,weightloss,
emaciated&dehydrated.Nomass
palpableperabdomen.Themodalityof
treatmentis
a)IVtotalparenteralnutrition
b)Endoscopicdilation
c)IVnormalsaline
d)pHmonitoring
CorrectAnswer-B
Answer-B.Endoscopicdilation
Thesymptom&signcomplexindicatesdiagnosisofAchalasia.
Oneofthetreatmentmodalitiesforachalasiacardiaisendoscopic
dilation.

---

1374.Hosepipeappearanceofintestineisa
featureof
a)Crohnsdisease
b)Malabsorptionsyndrome
c)Ulcerativecolitis
d)Hirsprungdisease
CorrectAnswer-A
Answer-A.Crohnsdisease
Crohn'sdiseasehasahosepipeappearance.

---

1375.Inoldageforrectalprolapsepalliative
surgeryinapatientunfitforsurgeryis
a)Delorme'sprocedure
b)Well'sprocedure
c)Thiersch'soperation
d)Lowanteriorresection
CorrectAnswer-C
Answer-C.Thiersch'soperation
Tighteningtheanuswithavarietyofprostheticmaterials(anal
encirclement)-
Analencirclementproceduresgenerallyhavebeenabandoned.Anal
encirlementhaslimitedapplicationandisreservedbymost
surgeonsforpatientsofthehighestsurgicalriskorlimitedlife
expectancybecauseitcanbedoneunderlocalanesthesia.The
originalThierschprocedureinvolvedplacingasilverwirearoundthe
externalsphincterwithintheishiorectalfat.Nowsyntheticmeshor
siliconetubesareusedinsteadofwire.Thesafetyofcurrent
anesthetictechniquesandthelowmorbidityandrelativefunctional
successofperinealproctectomyhavemadeanalencirclement,for
themostpart,aprocedureofthepast.

---

1376.40yearoldmalecomplaintsofGERD,
onendoscopyshowsdysplasia.
Treatment
a)Fundoplication
b)Esophagealresection
c)PPI
d)Dietmodification
CorrectAnswer-B
Answer-B.Esophagealresection
Ifseveredysplasiaorintranuralcarcinomaisfoundonmucosal
biopsy,anesophagealresectionshouldbedone.

---

1377.Renalstoneswhicharelaminatedand
irregularinoutlineare
a)Uricacid
b)Calciumoxalate
c)Struvite
d)Cystine
CorrectAnswer-B
Answer-B.Calciumoxalate
Calciumoxalatestones-Usuallysingle,hard(akaMulberry
stone)-
Darkcoloredd/tstainingwithalteredblood.
Spiky.
OnsectionWavyconcentriclaminae.
Theremaybesecondaryphosphatedepositonsurface.
Highcalciumcontent.

---

1378.Apatientwhohasfallenoveraloosemanholecoverisbroughttothe
clinic.Onexaminationaperinealhematomaandbloodintheexternal
meatusisnoted.Ruptureofwhichofthefollowingstructurehasresulted
inperinealhematoma?
a)Ruptureofmembranousurethra
b)Ruptureofbulbarurethra
c)Pelvicorganblunttrauma
d)Ruptureofbladder
CorrectAnswer-B
Thebulbarurethraiscrushedupwardsontopubicbone,typically
withsignificantbruising.
Cyclingaccidents,loosemanholecoverandgymnasiumaccidents
astridethebeamaccountfornumbrofcases.
CLINICALFEATURES
Thesignsofarupturedbulbarurethraareperinealbruisingand
haematoma,typicallywithabutterflydistribution'Thereisusually
bleedingiromtheurethralmeatusandretenrionofurineisalso
typicallypresent.
Ruptureofthemembranousurethratypicallyoccursin
associationwithafracturedpelvisandmaybeassociatedwithan
extraperitonealruptureofthebladder.
Themostcommoncausesofpelvicfractureareroadtraffic
accidents,severecrushinjuriesandfalls.
Theclinicalfearuresincludeurinaryretention,bloodattheurethral
meatus.
Thereistypicallymarkedbruisingofthepubicarea,scrorumand
penis.

---

1379.Adsontestispositivein:
September2007
a)Cervicalspondylosis
b)Cervicalrib
c)Cervicalvertebrafracture
d)Superiorvenacavasyndrome
CorrectAnswer-B
Ans.B:Cervicalrib
Adson'stestisusedtoassessforthepresenceofThoracicOutlet
Syndrome(cervicalrib)atthescalenetriangle.

---

Process
Thepatientisplacedinasittingposition,handsrestingonthighs.
Theexaminerpalpatesradialpulseonsidebeingtested
Patientactivelyrotatesheadtoipsilateralsidebeingtestedwhilethe
examinerlaterallyrotatesandextendsthepatient'sshoulder
Patienttakesadeepbreathandisinstructedtoholdit
Theexaminerpalpatestheradialpulsewhilemovingtheupper
extremityinabduction,extension,andexternalrotation.Thepatient
thenisaskedtorotateherheadtowardtheinvolvedsidewhile
takingadeepbreathandholdingit.Apositiveexamwillresultina
diminishedorabsentradialpulse.

---

1380.Inacaseofperforationperitonitis,
emergencylapratomy,2ndpost
operativedaydevelopsoliguria.
Diagnosis
a)SevereUTI
b)Fluidretention
c)Dehydration
d)Catheterobstruction
CorrectAnswer-C
Answer-C.Dehydration
Oliguriamayreflectinadequaterenalarteryperfusiondueto
hypotension,hypovolemiaorlowQT.Itcanalsobeasignofintrinsic
renaldysfunction.

---

1381.Etiologyofbloodydischargefrom
nipple
a)Ductpapiloma
b)Breastabscess
c)Fibroadenoma
d)Cyst
CorrectAnswer-A
Answer-A.Ductpapiloma
Table1:Causesofnippledischarge
Physiologic
Ductabnormalities
Intraductalpapilloma
Ductectasia
Periductalmastitis
Carcinoma
Galactorrhea
Hyperprolactinemia
Hypothyroidism
Medications:oralcontraceptives,cimetidine,verapamil,
phenothiazine,metoclopramide,alpha-methyldopa
Conditionsthatmaymimcnippledischarge
Eczemawithdrainage
Paget'sdiseaseofthebreast
Nippleadenoma

---

1382.Carcinomabreastisleastseenin
a)Superiorouterquadrant
b)Inferiorouterquadrant
c)Subareolar
d)Lowerinnerquadrant
CorrectAnswer-D
Answer-D.Lowerinnerquadrant
Upperinner-+12-15%
Upperouter=50%
Lowerinner3-5%
Lowerouter6-10%
Central/areolar20%
[RefLove&Bailey25th/ep.840,S.Das7thiep.607]

---

1383.WhichofthefollowingstageofBreastCacorrespondswithfollowing
feature?
Breastmassof6x3cm.size
Ipsilateralsupraclavicularlymphnode
Distantmetastasiscannotbeassessed
a)T4N3MX
b)T4N1M1
c)T4N0M0
d)T3N3cMX
CorrectAnswer-D
AccordingtoTNMstagingsystemforbreastcancer,
T3:Tumor>5cmingreatestdimension
N3c:Metastasisinipsilateralsupraclavicularlymphnode(s)
MX:Distantmetastasiscannotbeassessed
Ref:HuntK.K.,NewmanL.A.,CopelandE.M.,BlandK.I.(2010).Chapter17.TheBreast.
InF.C.Brunicardi,D.K.Andersen,T.R.Billiar,D.L.Dunn,J.G.Hunter,J.B.Matthews,R.E.
Pollock(Eds),Schwartz'sPrinciplesofSurgery,9e.

---

1384.Intraoperativesentinellymphnode
detectioninaxillaisdonebyusing
a)Mammography
b)Isosulfanbluedye
c)MRI
d)CT
CorrectAnswer-B
Answer-B.Isosulfanbluedye
Lymphaticmappingisperformedbyusingisosulfanbluedye,
technetium-labelledsulfurcolloidalbuminoracombinationofboth.

---

1385.Sentinellymphnodebiopsyin
carcinomabreastisdoneif-
a)LNpalpable
b)Breastmassbutnolymphnodepalpable
c)Breastlumpwithpalpableaxillarynode
d)MetastaticCAbreast
CorrectAnswer-B
Answer-B.Breastmassbutnolymphnodepalpable
Axillarynodesifclinicallypalpableareremovedbysurgical
dissection.

---

1386.Indicationforsentinelnodebiopsyis
a)Nonpalpableaxillarylymphnode
b)Palpableaxillarylymphnode
c)Mass>5cm
d)Metastasis
CorrectAnswer-A
Answer-A.Nonpalpableaxillarylymphnode
Thiswillbeofgreatsignificanceinearlybreastcarcinomaswherein
lymphnodesarenotclinicallypalpablenordetectedby
investigationssuchasultrasound/CTscanoftheaxilla..Indication:
Earlybreastcancerwith(T1orT2No)clinicallynodenegativeaxilla.

---

1387.Breastconservationsurgeryis
contraindicatedinallexcept-
a)Tumor>4cm
b)Multicentrictumor
c)AxillaryLNinvolvement
d)Diffusemicrocalcifications
CorrectAnswer-D
Answer-D
Breastconservativesurgery
Indications
Lump<4cm
Contraindications
Clinicallynegativeaxillary
Tumour>4cm
nodes
Plositiveaxillarynodes>N1
Mammographicallydetected Tumourmarginisnotfreeoftumour
lesion
afterbreastconservativesurgery
Well-differentiatedtumour
needsMRM
withlowSphase
Poorlydifferentiatedtumour
Adequatesizedbreastto
Multicentrictumour
allowproperRTtobreast
Earlierbreastirradiation
Breastofadequatesizeand Tumour/breastsizeratioismore
volume
(centeraltumour)
Feasibilityofaxillary
Tumourbeneaththenipple
dissectionandradiotherapy
Extensiveintraductalcarcinoma
tointactbreast

---

1388.Thefollowingaresuitableforsimple
mastectomyexcept-
a)Pagetsdisease
b)Fibroadenoma
c)Cystosarcomaphyllodes
d)None
CorrectAnswer-B
Answer-B.Fibroadenoma
Indicationsforsimplemastectomy
A)Withoutanaxillaryprocedure
1. Risk-reducingmastectomy
2. Localrecurrenceinapreviouslytreatedbreastcanceriii)Malignant
phyllodestumor(cystosarcomaphyllodes)b)Withconcomitant
axillaryprocedure
3. Locallyadvancedbreastcancer(includingpagetdisease)
4. Multifocalbreastcancer
5. Extensiveductalcarcinomainsitu(DCIC)
6. Patientisunsuitableforbreast-conservativeapproach

---

1389.
Treatmentofchoiceformedullary
carcinomaofthyroidis:
a)Totalthyroidectomy
b)Partialthyroidectomy
c)1131ablation
d)Hemithyroidectomy
CorrectAnswer-A
Ans.is'a'i.e.Totalthyroidectomy
Treatmentofthyroidmalignanciesisasfollows:-(Note-thisisa
veryimportantandoftenrepeatedtopicinPGexams,soiftime
permitsonemustturnthepagesofSchwartzSxoranyother
standardbookfordetailedstudy).
PapillaryThyroidCarcinoma(PCT)
High-risktumorsorbilateraltumors
-Totalthyroidectomy(orneartotalthyroidectomy).
Lowrisk
-Thetreatmentiscontroversial.Conservativeapproachadvocates
hemithyroidectomy(lobectomy+isthmusectomy).
-Moreradicalapproachadvocatestotalthyroidectomy(orneartotal
thyroidectomy).-SchwartzSxandDevita'sOncologyareinfavour
ofradicalapproach.
(HighandLowriskdecidedbyanyoneofthemanyclassification
systems)
Ifenlargedlymphnodesarefound
-Modifiedradicalneckdissectionisdoneoftheaffectedside.
Whenpatientsarefoundtohaveaminimalpapillarythyroid
carcinomainathyroidspecimenremovedforotherreasons,
unilateralthyroidlobectomyandisthmusectomyisusually

---

consideredtobeadequatetreatment,unlessthetumorhas
evidenceofangioinvasion,multifocality,orpositivemargins.
FollicularThyroidCarcinoma(FTC)
FNAbiopsyisunabletodistinguishbenignfollicularlesionsfrom
follicularcarcinomastherefore,preoperativediagnosisofcanceris
difficultunlessdistantmetastasesarepresent.
PatientsdiagnosedbyFNAbiopsyasfollicularlesionsshould
undergothyroidlobectomy+isthmusectomy(becauseatleast80%
ofthesepatientswillhavebenignadenomas).
Theresectedlobeissubjectedtohistology(intraoperativefrozen?
sectionexamination,thoughusuallynothelpfulshouldbeperformed
inhighriskcases).

---

1390.Whichofthefollowingisusedinthe
treatmentofwelldifferentiatedthyroid
carcinoma
a)I131
b)99mTc
c)32p
d)MIBG
CorrectAnswer-A
Answer-A.I131
I131istheradioisotopeofchoiceforradiotherapyofthyroid
carcinomaandhyperparathyroidism.

---

1391.Sistrunk'soperationisusedin
a)Parotidtumour
b)Thyroglossalfistula
c)Thyroglossalcyst
d)bandc
CorrectAnswer-D
Ans.Twooptionsarecorrecti.e.,'b'i.e.Thyroglossalfistula&'c'i.e.
Thyroglossalcyst
Sistrunkprocedureisusedforexcisionofthyroglossalductcyst

---

1392.Treatmentformalignantmelanomais
a)Wideexcision
b)Radiotherapy
c)Excision
d)Chemotherapy
CorrectAnswer-A
Answer-A.Wideexcision
ManagementofMalignantMelanoma
Widelocalexcisionoftheprimarytumoristhemanagementof
choice.
Therecommendedmarginofresectiondependsonthethicknessof
thetumor.

---

1393.Mouressignisseenin
a)Carcinoma
b)Appendicitis
c)Varicosevein
d)Pancreatitis
CorrectAnswer-A
Answer-A.Carcinoma
"Innormalpersons,aclickisfeltwhenlarynxismovedfromsideto
sideoververtebralcolumn,thisiscalledlaryngealclick(postcricoid
crepitus)Itisabsentinpostcricoidcarcinoma".--Moure'ssign

---

1394.TrueaboutMarjolinsulcer-
a)Developsinlongstandingscar
b)SqcellCadevelops
c)Slowgrowinglesion
d)All
CorrectAnswer-D
Ansis'a'i.e.Developsinlongstandingscar;'b'i.e.sqcellCa
develops;'c'i.e.Slowgrowinglesion
BaghdadsoreororientalsoreorDelhiboiliscausedbyLeishmania
Tropica.

---

1395.Whichoneofthefollowingpreservativeisusedwhilepackingcatgut
suture?
a)Isopropylalcohol
b)Colloidaliodine
c)Glutaraldehyde
d)Hydrogenperoxide
CorrectAnswer-A
10%isopropylalcoholistheroutinepackingfluidusedinpackingcatgutsutures.
Catgutisavailableinglasstubescontainingisopropylalcoholandsmallquantityofwater.
Catgutispreparedfromtheintestineofsheep.
Ref:PharmaceuticsByDr.R.S.Gaud,Page196;VeterinaryMedicine/smallanimal
clinician,Volume72,Issues1-6,Page835.

---

1396.Acuteorchitisallareseenexcept
a)Increasedlocaltemprature
b)Decreasedbloodflow
c)Etythematousscrotum
d)RaisedTLC
CorrectAnswer-B
Answer-B.Decreasedbloodflow
USGshowsincreasedbloodflowinacutestage.
Ischemicorchitismaysetin,inlatestagesresultinginreducedblood
flowonUSG.

---

1397.Prehnsignispositivein
a)Acuteepidydimoorchitis
b)Chronicorchitis
c)Testiculartorsion
d)None
CorrectAnswer-A
Answer-A.Acuteepidydimoorchitis
Onelevationoftestisthe-
Painisnotrelievedintorsion(testisnegative)
Painrelievedinepidydimoorchitis(testispositive)

---

1398.Commonestsiteofcarcinomatongue-
a)Apical
b)Lateralborders
c)Dorsum
d)Posterior1/3
CorrectAnswer-B
Ans.is'b'i.e.,Lateralborders
Mostcommonsiteismiddleofthelateralborderortheventral
aspectofthetongue.

---

1399.Allaretrueaboutcarcinomapenis
except
a)Mostcommontypeisverrocous
b)Spreadsbybloodbornemetastasis
c)Leadstoerosionofartery
d)Slowlyprogressive
CorrectAnswer-A
Answer-A.Mostcommontypeisverrocous
MCtype?SCC
ETIOLOGY-
Premalignantlesions-
Genitalwarts-Bushke-Lowensteintumourisagiantpenile
condyloma(verrucouscarcinomaofpenis)
ErythroplasiaofQueyratorPaget'sdiseaseofpenis-precancerous
lesion
SPREAD-
Bloodspreadisrare
DeathmayoccurduetoerosionsoffemoralvesselsbyiguinalLN.
Slowlyprogressive

---

1400.Intesticulartorsion,surgerywithinhow
muchtimecansaveviabilityoftestis
a)6hr
b)12hr
c)24hr
d)1week
CorrectAnswer-A
Answer-A.6hr
"Morethan80%testescanbesalvagedifsurgeryisperformed
within6hours".
[RefSchwartz9th/ep.1469]

---

1401.WhichofthefollowingnerveiscommonlydamagedduringMcBurney's
incision?
a)Subcostalnerve
b)10ththoracicnerve
c)11ththoracicnerve
d)Iliohypogastricnerve
CorrectAnswer-D
ThenervecommonlydamagedduringMcBurney'sincisionisIliohypogastricNerve.
Damagetothisnerveresultinthedevelopmentofrightinguinalhernia.
McBurney'sincision/gridironincisioniscommonlydoneforappendectomy.
Inthisanobliqueincisionismadeintherightiliacfossaabout5cmaboveandmedialtothe
anteriorsuperioriliacspineatrightangletothespinoumbilicalline.
Ref:AnatomyofAbdomenandLowerLimbBySingh,Page46.

---

1402.Investigationusingdyetofindout
stoneinsalivarygland
a)Sialography
b)Mammography
c)MRangiography
d)USG
CorrectAnswer-A
Answer-A.Sialography
Salivaryductstones&strictures
Chronicsialadenitis
Tumorsofsalivaryglands

---

1403.Allofthefollowingarecausesofhemobilia,EXCEPT:
a)TraumatoAbdomen
b)Malignancy
c)Ruptureofhepaticarteryaneurysm
d)Hepatitis
CorrectAnswer-D
Hemobiliapresentswiththetriadofbiliarycolic,obstructivejaundice,andoccultorgross
intestinalbleeding.
Causesare,
Hepatictrauma
Ductalparasitism(Ascarislumbricoides)
Orientalcholangiohepatitis
Hepaticneoplasms
Ruptureofahepaticarteryaneurysm
Hepaticabscess
Choledocholithiasis
Thediagnosismaybesuspectedfromatechnetium-99m-labeledredbloodcellscan,but
anarteriogramisusuallyrequiredfordiagnosisandplanningoftherapy.
Ref:DohertyG.M.(2010).Chapter25.BiliaryTract.InG.M.Doherty(Ed),CURRENT
Diagnosis&Treatment:Surgery,13e.

---

1404.ERCPisindicatedforthefollowing
except
a)DistalCBDtumor
b)Hepaticportatumor
c)Proximalcholangiocarcinoma
d)Gallstonepancreatitis
CorrectAnswer-C
Answer-C.Proximalcholangiocarcinoma
ERCPisnottechnicallypossibleinproximalbiliaryobstructions.

---

1405.Alagillesyndromeis
a)Bileductpaucity
b)IHBRdilation
c)PBC
d)PSC
CorrectAnswer-A
Answer-A.Bileductpaucity
yndromicpaucityofinterlobularbileducts(Alagillesyndrome)isthe
mostcommonformoffamilialintrahepaticcholestasis.Chronic
cholestasisaffects95%ofpatients.Peripheralpulmonicstenosisis
observedinapproximately90%.Vertebralarchdefectsareseen
(e.g.,butterflyvertebrae,hemivertebrae,andadecreaseinthe
interpediculardistance).Ophthalmologicexaminationmayreveal
posteriorembryotoxon,retinalpigmentation,andirisstrands.

---

1406.Hemorrhagicpancreatitis,bluish
discolorationofflank
a)Greyturnersign
b)Cullensign
c)Trosseuesign
d)None
CorrectAnswer-A
Answer-A.Greyturnersign
Inacutepancreatitis:
1. Cullen'ssign:Ecchymosis(bluish-purplecolor)aroundumbilicus
(periumbilicalarea)
2. Greyturner'ssign:Ecchymosis(bluish-purplecolor)inflank

---

1407.Complicationofchronicpancreatitis
includeallexcept-
a)Renalarterythrombosis
b)Pseudocyst
c)Splenicveinthrombosis
d)Fistulae
CorrectAnswer-A
Answer-A.Renalarterythrombosis
Complications-
Obstructivejaundice
Carcinomaofpancreas
Pseudocysts
Pancreaticductleakwithascitesorfistula
Thrombosisofsplenicvein
AbscessPerforation

---

1408.TheCTseverityindexinacutepancreatitisisdescribedby:
a)Balthazar
b)Mengini
c)Chapman
d)Napelon
CorrectAnswer-A
TheCTseverityindex(CTSI)-describedbyBalthazar
BalthazarCTSeverityIndex
CTGradeScore
A.Normal-0
B.Enlargedgland-1
C.Peri-pancreaticinflammation-2
D.Onefluidcollection-3
E.Twoormorecollections-4
NecrosisScore
30%-50%-(4)
>50%-(6)
Ref:ACRAppropriatenessCriteria,AcutePancreatitis.

---

1409.Kehr'ssignseeninsplenicruptureis-
a)Painoverleftshoulder
b)Painoverrightscapula
c)Periumbilicalpain
d)Painoverrenalangle
CorrectAnswer-A
Ans.is'A'i.e.,Painoverleftshoulder
Insplenicrupturethepainmaybereferredtothetipoftheleft
shoulder.
ThisisknownasKehr'ssign.
Itoccursduetoirritationoftheundersurfaceofthediaphragmwith
bloodandthepainisreferredtotheshoulderthroughtheaffected
fibresofphrenicnerve(C4andC5).
Kehr'ssigncanbeelicitedbybimaualcompressionoftheleftupper
quadrantafterthepatienthasbeeninTrendelenburg'spositionfor
about10minutespriortothemanoeuvre.

---

1410.Duringfunctionalendoscopicsinus
surgerythepositionofpatientis
a)Trendelenberg
b)Lateral
c)Reversetrendelenberg
d)Lithotomy
CorrectAnswer-C
Answer-C.Reversetrendelenberg
Usingthereversetrendelenburgpositionduringfunctional
endoscopicsinussurgery(FESS)issafe,simple,andcost-free
methodthathasbeenfoundtoreduceintraoperativebloodloss.

---

1411.Head&faceburnininfantis
a)15%
b)18%
c)12%
d)32%
CorrectAnswer-B
Answer-B.18%
"Infantshave21%oftheTBSAintheheadandneck"--Sabiston
Childrenhavearelativelylargerportionofthebodysurfaceareain
theheadandneckwhichiscompensatedforbyarelativelysmaller
surfaceareainthelowerextremities.Infantshave21%ofTBSAin
theheadandneckand13%ineachleg.

---

---

1412.Plasmaexpandersareusedin
a)Endotoxicshock
b)Neurogenicshock
c)Vasovagalshock
d)Anaphylacticshock
CorrectAnswer-A
Answer-A.Endotoxicshock
Usesofplasmaexpanders4tocorrecthypovolemia,e.g.inburns,
hypovolemicandendotoxicshock,severetrauma.
Contraindications-Severeanaemia,cardiacfailure,pulmonary
edema,renalinsufficiency.

---

1413.Whiplashinjuryistearofwhich
ligament
a)Ligamentaflava
b)Ant.longitudinalligament
c)Post.longitudinalligament
d)Supraspinalligament
CorrectAnswer-B
Answer-B.Ant.longitudinalligament
Hyperextensiontheorydescribeswhiplashinjury.
Hyperextensionmostcommonlyresultsinanteriorcervicalcolumn
injuriesintheformofanteriorlongitudinalligamentandintervertebral
discruptures.

---

1414.Hingefractureis:
a)Depressedfracture
b)Suturalfracture
c)Orbitalfracture
d)Basilarfracture
CorrectAnswer-D
Ans.Basilarfracture

---

1415.Neurosurgeryisindicatedforallexcept
a)SDH
b)EDH
c)Intracerebralbleed
d)Diffuseaxonalinjury
CorrectAnswer-D
Answer-D.Diffuseaxonalinjury
Diffuseaxonalinjurydoesnothaveanyspecifictreatment
Symptomatictreatmentandstabilizationofpatientisrequired.
Subduralhematoma,(SDH),epiduralhematoma(EDH)and
intracerebralhematoma(parenchymalhemorrhage)mayrequire
surgery

---

1416.BloodlossinclassIIIhemorrhagic
shock-
a)<750ml
b)750-1500ml
c)1500-2000ml
d)>2000ml
CorrectAnswer-C
Ans.is'c'i.e.,1500-2000ml
Parameters
ClassI
ClassII
ClassIII
ClassIV
BloodLoss(mL)
Upto750
750?1500
1500?2000
>2000
BloodLoss(%BV) Upto15%
15?30%
30?40%
>40%
Pulserate
<100
>100
>120
>140
(beats/min)
BloodPressure
Normal
Minimal
Decreased
Significantlydecreased
decrease
PulsePressure
Normal
Narrowed
Narrowed
Unobtainableorvery
narrow
Hourlyurine
0.5mL/kg 0.5mL/kg
<0.5cc/kg
Minimal
output
CNS/Mental
Slightly
Mildlyanxious Anxiousand
Confusedorlethargic
status
anxious
confused

---

1417.Youngmalewithhistoryoftrauma
havingleftsidedtestisswollen&
erythematous.Othersidenormal
diagnosis
a)Torsion
b)Carcinoma
c)Hematoma
d)Hernia
CorrectAnswer-C
Answer-C.Hematoma
Blunttraumatotestiscancausehematoma.
Thereisassociatedtenderness,swellingandecchymosisofthe
hemiscrotum.

---

1418.Allthefollowingaretrueof
Craniopharyngiomaexcept
a)DerivedfromRathke'spouch
b)Containsepithelialcells
c)Presentinsellaorinfra-sellarlocation
d)Causesvisualdisturbances
CorrectAnswer-C
AnswerisC(Presentinsellaorinfrasellarlocation):
Someoftheselesionsarisefromthesella,butmostaresuprasellar
Q(Notinfra-sellar).Theyarisefromnearthepituitarystalkand
commonlyextendintothesuprasellarcistern.
CraniopharyngiomasarisefromRathke'spouchandconstitute3-5%
ofallintracranialneoplasms.
Someoftheselesionsarisefromthesella,butmostaresuprasellar
Q(Notinfra-sellar).Theyarisefromnearthepituitarystalkand
commonlyextendintothesuprasellarcistern.
Consistsofnestsofcordsofstratifiedsquamousorcolumnar
epitheliumembeddedinaspongyreticulum--Robbins61h/1129
Visualcomplaintsarethepresentingfeatureinabout80%ofadults
and60%ofchildren.

---

1419.Steroidsaregiveninrheumaticfever
whenthereis-
a)Carditis
b)Chorea
c)Subcutaneousnodules
d)All
CorrectAnswer-A
Ans.is'a'i.e.,Carditis
SuppressivetherapyofRF
oIfpatienthascarditiswithCHF-->Steroids
IfpatientshascarditiswithoutCHF-->Steroidsoraspirin
(steroidsarepreferred)
Ifpatientdoesnothavecarditis-->AspirinThe
totaldurationofsuppressivetherapyis12weeks.

---

1420.Acrodermatitishemorrhagicaisdueto
deficiencyof
a)Zinc
b)Manganese
c)Copper
d)Selenium
CorrectAnswer-A
Ans.is'a'i.e.,Zinc
SymptomsofZincDeficiency
MilddeficiencySeveredificiency
GrowthretardationDwarfism
Cardiomyopathy
Hypogonadism
Infertility
Lossoftaste
Poorwoundhealing
Deformedbones
Diarrhoea
Alopecia
Nightblindness
Skinstriae
Nailchanges
Acrodermatitisenteropathicaisaninheritedautosomalrecessive
disorderwithimapiredintestinaldisorderandtransportofZinc.
Patientsufferswithpustularandbullousdermatitis,alopecia,growth
retardationdiarrhoes,secondaryinfection,lethargy,irritabilityand
depression.OralZincsupplementationleadstoremission.
Zinc

---

2ndmostabundanttraceelementinthebody.
Mostcommoncatalyticmetalioninthecellcytoplasm.
Componentofmorethan100enzymeslikeDNApolymerase,RNA
polymerase,transferRNAsynthetase.
Itplaysroleinallstagesofinsulinmetabolism.

---

1421.Childdrawstriangleatwhatage?
a)3years
b)5years
c)6years
d)7years
CorrectAnswer-B
Ans.is'b'i.e.,5years
AgeMilestone
12-24monthsTriestoscribblespontaneously
2yearsDrawsaverticalorhorizontalline
3yearsDrawsacircle
4yearsDrawsacross(plussign)anddrawsa
rectangle
5yearsDrawsatriangle

---

1422.Headcontrol/neckholdingispossible
inaninfantby:
September2012
a)1month
b)2months
c)3months
d)6months
CorrectAnswer-C
Ans.Ci.e.3months
Whenachildistriedtopulltosit:-
i)Headlag-->Ageislessthan4weeks
ii)Partialheadlag-->2-3months
iii)Head(Neck)Control--->3months.
iv)Liftingofheadup-->5months.

---

1423.SittinginTripodpositionatwhich
month?
a)5months
b)6months
c)8months
d)9months
CorrectAnswer-B
Answer-B.6months
6MonthSitwithsupport,sitsintripodposition
8MonthSitwithoutsupport
9MonthStandwithsupport
12MonthStandwithoutsupportWalkwithsupport
15MonthWalkalone,creepupstair

---

1424.Weightofnewbornquadrupletsby-
a)9months
b)12months
c)2year
d)3years
CorrectAnswer-C
Answer-C.2year
Triple-1yr
Fourtimes-2yrs
Fivetimes-3yrs

---

1425.From6weeksto12weeks...Infant
weightincreasesatrateof-
a)30g/d
b)40g/d
c)50g/d
d)60g/d
CorrectAnswer-A
Answer-A.30g/d
AverageweightofNewbornbabyis3kg.
Newbornlosesextracellularfluidabout10%ofbodyweightandstart
gainingweightandbecomeequaltobirthweightatday10oflife.
Subsequently,theygainweightatarateofapproximately25to30
gmperdayforthefirst3monthoflife.

---

1426.Armspanandheightbecomesameat
whatage(year)-
a)9
b)11
c)13
d)15
CorrectAnswer-B
Answer-B.11
Inunder-5children,armspanis1to2cmsmallerthanbodylength.
During10-12yearsofage,armspan=height.
Inadultsarmspanismoreinadultsby2cm.
Abnormallylargearmspanisseeninpatientswith:(1)
Arachnodactyly(Marfansyndrome)(2)Eunuchoidism(3)
Klinefelter'sSyndrome(4)Coarctationofaorta.

---

1427.WhenICFandECFofchildbecomes
equaltoadultperson-
a)1year
b)2year
c)3year
d)4year
CorrectAnswer-A
Ans.is'a'i.e.,1year
oInfetus,ECFismuchlargerthanICF.
oBytheageof1year,ratioofICFtotheECFvolumeapproaches
adultlevel.

---

1428.Firstpermanentteethtoeruptis:
September2008
a)Firstpremolar
b)Secondpremolar
c)Firstmolar
d)Secondmolar
CorrectAnswer-C
Ans.C:Firstmolar
Attheageofabout6-7year,firstpermanentmolarteetherupts
behindthesecondtemporarymolar.
Attheageof9,thereare12permanentteeths.Attheageof11,
thereare20permanentteethsAttheageof14,thereare28
permanentteeths

---

1429.Nocturnalenuresismaybeconsidered
normalupto:
March2005
a)3years
b)4years
c)5years
d)6years
CorrectAnswer-D
Ans.D:6years
Nocturnalenuresisisnormalupto6yearswhileitsnormaluptothe
ageof4yearsfordaytime.

---

1430.Thefollowingarecharacteristicof
autismexcept-
a)Onsetafter6yearsofage
b)Repetitivebehaviour
c)Delayedlanguagedevelopment
d)Severedeficitinsocialinteraction
CorrectAnswer-A
Ans.is'a'i.e.,Onsetafter6yearsofage
Autism
Autismisaneurologicdisrodercharacterizedby?
1. Qualitativeimpairmentinsocialinteraction
2. Qualitativeimpairmentincommunication.
3. Restrictedrepetitiveandstreotypedpatternsofbehaviour,interests,
andactivities.
Onsetofsymptomsisusuallybefore3yearsofage.
3-5timesmorecommoninboys,butmoreseverewhenoccursin
girls.
Morecommonamonglowsocio-economicgroups.

---

1431.Inproteindeficiencyallareseenexcept
-
a)Flakypaintlikeskin
b)Glossitis
c)Nailchange
d)Cherrylikeskin
CorrectAnswer-D
Answer-D.Cherrylikeskin
rednessontheskin,brittlenails,thinhair
Glossitis
Riskofinfections
Fattyliver
Proteindeficiencymayleaveitsmarkontheskin,hairandnails.

---

1432.Inachildhavingdiarrhoeawithperianal
moistcrust.Thediagnosisis-
a)Acrodermatitisenteropathica
b)Riboflavindificiency
c)Pellagra
d)Noneofabove
CorrectAnswer-A
Answer-A'Acrodermatitisenteropathica
Acrodermatitisenteropathicaisarareautosomalrecessivedisorder
causedbyaninabilitytoabsorbsufficientZincfromthediet.
Associatedmanifestations:-Chronicdiarrhoea,stomatitis,glossitis,
Paronychia,Naildystrophy,Growthretardation,irritability,delayed
woundhealing,Bacterial&candidalinfection.

---

1433.VitaminB6isusedintreatmentof-
a)Homocystinuria
b)Xanthourenicaciduria
c)Cystathionuria
d)Allofabove
CorrectAnswer-D
Answer-D.Allofabove
VitB6dependentconvulsion.
VitB6responsiveanemia.
Xanthurenicacidmia
Cystathioninuria
Homocystinuria

---

1434.Apneaofprematurity?
a)>10sec
b)>15sec
c)20sec
d)>30sec
CorrectAnswer-C
Ans.is'c'i.e.,20sec
Apneaofprematuritydefinedassuddenstoppageofbreathingthat
lastsfor20secorisassociatedwithbradycardiaorcyanosis.
Apneaofprematurityshouldbedifferentiatedfromperiodic
breathingwhichisnormalphenomenonispretermneonate

---

1435.Allofthefollowingarefeaturesof
prematurityinaneonate,except-
a)Nocreasesonsole
b)Abundantlanugo
c)Thickearcartilage
d)Emptyscrotum
CorrectAnswer-C
Ans.is'c'i.e.,Thickearcartilage
Theearsinaprematureneonatearesoftandflatwithearcartilage
beingdeficientandpliant(andnotthick)
FeaturesofprematurityinaNeonate:
oBabyissmallinsizeusuallylessthan47cmlong.
oHeadisrelativelylarge,suturesarewidelyseparatedand
fontanellearelarge
oFaceissmallandbuccalpadoffatisminimal
Skinisthinandpinkishandappearsshinyduetogeneralized
edema.
Skiniscoveredwithabundantlanugoandthereislittlevernix
caseosa.
Subcutaneousfatisreduced
oThebreastnoduleislessthan5mmwide
oTheearsaresoftandflatwithearcartilagebeingdeficientand
pliant
oTestesarenotdescendedintoscrotalsac.(Emptyscrotum)
Scrotalsacispoorlypigmentedandhaslessrugosities.
oInfemaleslabiamajoraappearswidelyseparated,exposingthe
labiaminoraandtheclitoris.
oDeepcreasesarenotwelldevelopedinthesole.

---

(Theremaybeasingledeepcreaseovertheanterioronethirdof
thesole)oNeonatalreflexessuchasMoro,Suckling&Swallowing
aresluggish.
oThereishypotoniawithapoorrecoilofflexedforearmwhen
extended.

---

1436.Thecharacteristicsofcaput
succedaneumincludeallofthe
followingexcept:
a)Crossesmidline
b)Crossesthesutureline
c)Itdoesnotdisappearwithin2-3days
d)Itisadiffuseedematousswellingofthesofttissuesofthescalp
CorrectAnswer-C
Itdoesnotdisappearwithin2-3days
Location-subcutaneousplane
Clinicalfeatures-
Softengraduallyanddisappearwithin2-3days
Diffusecrossessuturelineilldefinedmargin.
Notassociatedwithprolongedjaundice

---

1437.Whichofthefollowingistheprincipal
modeofheatexchangeinaninfant
incubator?
a)Radiation
b)Evaporation
c)Convection
d)Conduction
CorrectAnswer-C
Ans.is'c'i.e.,Convection
"Convectionwarmedincubatorsarebeingroutinelyusedforthermal
regulationoftheprematureneonate'sambientair"-Ghai6'/e154

---

1438.ProstaglandinanalogueusedinPDAis
-
a)Anaprastone
b)Misoprost
c)Danaprostone
d)PGE-2
CorrectAnswer-B
Answer-B.Misoprost
Prostaglandininhibitorsuchasindomethacinandspecialformof
ibuprofenareusedforductclosureinpreterm.
PGE-1usedtokeepopenductareAlprostadilormisoprostol.

---

1439.DrugusedtokeepPDAopen-
a)PGE1
b)PGI2
c)PGE
d)PGH2
CorrectAnswer-A
Answer-A.PGE1
Prostaglandinnt1fbe,;infusionusuallyefectiveinkeepingthe
ductusarteriosusopenbeforesurgicalinterventiontoreduce
hypoxemiaandacidemiabeforesurgeryinductusdependentlesion
like.

---

1440.TrueaboutEbsteinanomalyis?
a)Rightventriculardilatation
b)Rightatrialdilatation
c)Leftventriculardilatation
d)Leftatrialdilatation
CorrectAnswer-B
Ans.is'b'i.e.,Rightatrialdilatation
Ebstein'sanomaly
Ebsteinanomalyconsistsofdownwarddisplacementofanabnormal
tricuspidvalveintotherightventricle.oNormallytricuspidvalvehas
threeleafletsAnterior,posteriorandseptal.
Fixedendoftheseleafletsisattachedtovalveringintricuspidarea.
InEbsteinanomaly,anteriorleafletisattachedtovalveringas
normal,buttheothertwoleaflets(posteriorandseptal)are
displaceddownwardandareattachedtothewallofleftventricle.
Theportionofrightventricleabovehetricuspidvalvebecomesa
partofrightatrium--?atrializedrightventricle.Hemodynamics
Thetricuspidvalveanomalyresultsinobstructionofbloodflowas
wellasregurgitationofbloodfromtherightventricleintotheright
atriumDilatationandhypertrophyofrightatriumduetovolume
overload.
Bloodflowsrightatriumtoleftatriumthroughpatentforamenovale
orASDRighttoleftshuntandcyanosis.Clinicalmanifestations
1. CyanosisFatigue
2. DyspneaonexertionParoxysmalattacksoftachycardiaSigns
3. CyanosisandclubbingS.,widersplitbutvariable
4. DominantVwaveonJVP.RightventricularS3
5. SystolicthrillattheleftsternalborderRightatrialS4.

---

Sinormal
Systolicmurmurduetoregurgitationattricuspidvalve.
Delayeddiastolicmurmurduetoobstructionattricuspidvalvelike
tricuspidstenosis.
Bothsystolicanddiastolicmurmurproducedatthetricuspidvalve
havescratchycharacterlikepericardialfrictionrib.

---

1441.Whichconditionismostcommonly
associatedwithcoarctationofaorta?
a)PDA
b)Bicuspidaorticvalve
c)Aorticstenosis
d)VSD
CorrectAnswer-B
AnswerisB(BicuspidAorticValve)
Themostcommonassociatedcardiacanomalywithcoarctationof
aortaisbicuspidaorticvalve(Harrison's17th/1462)Coarctationof
aortaisassociatedwithabicuspidaorticvalveinmorethan70%of
cases-(Nelson18th/1900)
Associatedanomalieswith
Shonecomplex
coarctationofAortaQ
? BicuspidAorticvalve('(commonest) CoarctationofAorta
? PDAQ

Leftsidedobstructive
VSDQ
?
lesions
? Tubularhypoplasiaofaorticarch('
(Mitralvalveabnormalities
? AorticstenosisQ(valvular/
andsubaorticstenosis)
subvalvular)
OtherAssociatedlesionsthathavebeenaskedpreviously
Mitralvalveabnormalities(Subvalvularmitralring/parachutemitral
valve)
Turner'ssyndrome('

---

1442.Hilardanceonfluoroscopyisseenin:
a)ASD
b)TOF
c)VSD
d)TGV
CorrectAnswer-A
Ans.ASD
FluoroscopicexaminationdoneinapatientwithASDshowshilar
dancesignduetopulsationofcentralpulmonaryartery.
CXRfeaturesofASD:
Thereisnoenlargementofleftatriumexceptinfewcasesof
Lutembachersyndrome.
TheheartinASDissometimesdisplacedtotheleft.
Theascendingaortaanditsarchtendstoappearsmallerthan
normal,probablyduetorotationoftheascendingaortabyenlarged
rightatriumandrightventriclecausingsagittalalignmentofthe
aorticarch.KerleyBlinesinapatientwithASDshouldalways
suggestanassociatedmitralvalveabnormality(Lutembacher
syndrome).
TheGooseneckdeformityisseeninASDoncardioangiography.
Ref:ClinicalDiagnosisofCongenitalHeartDiseaseByM.Satpathy
page78,Radiodiagnosis,NuclearMedicine,Radiotherapyand
RadiationOncologyByBipinValchandjiDagapage139.

---

1443.WPWsyndromeisassociatedwith-
a)Ebsteinanomaly
b)TOF
c)VSD
d)TAPVC
CorrectAnswer-A
Answer-A.Ebsteinanomaly
Wolff-Parkinson-Whitesyndrome(WPW)isoneofseveraldisorders
oftheconductionsystemoftheheartthatarecommonlyreferredto
aspre-excitationsyndromes.
PeoplewithWPWmayhavemorethanoneaccessorypathway
seeninindividualswithEbstein'sanomaly.

---

1444.Commonesttypeofcong.cyanotic
heartdiseaseis-
a)ASD
b)SD
c)TOF
d)PDA
CorrectAnswer-C
Ans.is'c'i.e.,TOF
Tetralogyoffallotisthecommonestcyanoticcongenitalheart
disease.
CyanoticCongenitialheartdiseases
oCyanoticCHDsareRighttoLeftshunts.
oThesearefurtherdividedinto:?
1)CyanoticCHDwithdecreasedpulmonarybloodflow.
ThisgroupincludesTOF,Pulmonaryatresiawithintact
septum,tricuspidatresia,totalanomalouspulmonaryvenousreturn
withobstruction.
Theselesionshavefollowingcomponents:-
a)Obstructiontopulmonarybloodflowattricuspidrightventricularor
pulmonaryvalvelevel.
b)Apathwaybywhichsystemicvenousbloodentersthesystemic
circulationviaapatentforamenovaleorASDorVSD.
Degreeofcyanosisdependsonthedegreeofobstructionto
pulmonarybloodflow:-
i)Mildobstruction
Cyanosisisprecipitaedbystress,butmaybeabsentatrest.
ii)Severeobstruction
Pulmonarybloodflowisdependentonpatencyoftheductus
arteriosus.Whentheductuscloses(10-21days),theneonate

---

arteriosus.Whentheductuscloses(10-21days),theneonate
experienceprofoundhypoxemia,cyanosisandshock.
2)CyanoticCHDwithincreasedpulmonarybloodflow.
Thisgroupoflesionsisnotassociatedwithobstructionto
pulmonarybloodflow.
Cyanosiscausedbyanyofthefollowingmechanisms.
i)Abnormalventricular-arterialconnection(e.g.,Transpositionof
greatvessels)Inthis,aortaarisesfromrtventricle,Sothatsystemic
venousbloodreturningtotherightatriumispumpeddirectlybackto
thebody,andoxygenatedbloodreturningfromlungispumpedback
intothelungs.
ii)Totalmixingofsystemicvenousandpulmonaryvenousblood
(e.g.,totalanomalouspulmonaryvenousreturn,truncusarteriosus,
acommonatriumorventricle)Deoxygenatedsystemicvenousblood
andoxygenatedpulmonaryvenousbloodmixcompletelyinthe
heartand,asaresult,oxygensaturationisequalinthepulmonary
arteryandaorta.Ifpulmonarybloodflowisnotobstructed,these
infantshaveacombinationofCyanosisandheartfailure.In
Contrast,ifpulmonarystenosisispresent,theseinfantshave
cyanosisalone.

---

1445.Mostcommonsyndromeassociated
withA-Vcanaldefect-
a)Downsyndrome
b)Klinfiltersyndrome
c)Turnersyndrome
d)Marfansyndrome
CorrectAnswer-A
Answer-A.Downsyndrome
Itisalsocalledasatrioventricularcanaldefect(AVCD)or
endocardialcushiondefect.
Itcoversaspectrumofcongenitalheartmalformationcharacterized
bycontiguousatrialandventricularseptaldefectswithmarkedly
abnormalAVvalve.
AVSDmaybe:-
1. IncompleteAVSD:Itisthesimplestformandnothingelsebut
ostriumprimumtypeofASDinwhichthereisacommon
atrioventricularjunctionbutseparatevalvularorificesforrightand
leftventricles.ItismorecommoninDownsyndrome.
2. CompleteAVSD:Thereisacommonatriventricularjunctionand
singlecommonvalvularorifice.

---

1446.MostcommonASDindownsyndrome
is?
a)Ostiumprimum
b)Ostiumsecundum
c)Absentatrialseptum
d)Sinusvenosus
CorrectAnswer-A
Ans.is'a'i.e.,Ostiumprimum
About40%childrenwithdownsyndromehavecongenitalheart
disease.
Endocardialcushiondefect(ASDwithostiumprimum)accountfor
40-60%ofcases.

---

1447.Brainabscessincyanoticheartdisease
iscommonlylocatedin
a)Cerebellarhemisphere
b)Thalamus
c)Temporallobe
d)Parietallobe
CorrectAnswer-D
Ans.is'd'i.e.Parietallobe
Brainabscessesincongenitalcyanoticheartdiseasesoccurdueto
hematogenousseedingofbloodbornebacteria.Thesebloodborne
bacteriabypassthepulmonarycapillarybedd/trighttoleftshunt.
Theycommonlyinfectparietal&frontallobes(territoryofmiddle
cerebralartery).
LocationofBrainAbscesses
Etiology
Location
Otitismedia,
Temporallobe>Cerebellum
mastoiditis
Paranasalsinusitis,
Frontallobes
dentalinf.
Parietallobe,post-frontallobes
Hematogenous
(MCAterritory)

---

1448.Inwhichofthefollowingdifferential
cyanosisfound?
a)VSDwithreversalofshunt
b)PDAwithreversalofshunt
c)ASDwithreversalofshunt
d)TetralogyofFallot
CorrectAnswer-B
Ans.is'b'i.e.,PDAwithreversalofshunt
Differentialcyanosis
oWhenoneextremityispinkandtheotherextremityiscyanotic,itis
referredtoasdifferentialcyanosis.

---

1449.%ofchildrenwithsimplefebrileseizure
developingepilepsyis-
a)1-2%
b)2-5%
c)5-10%
d)10-15%
CorrectAnswer-A
Answer-A.1-2%
Between2%to7%ofallchildrenwithfebrileseizuresdevelop
epilepsyiffolloweduptotheageof25years.Riskdependsontype
offebrileseizure:
1. Simplefebrileseizures42%ofallchildrenwithsimplefebrile
seizures.
2. Complexfebrileseizures-6-8%ofallchildrenwithcomplexfebrile
seizures.

---

1450.Drugofchoiceforinfantilespasmis?
a)Vigabatrin
b)Adrenocorticotropichormone(ACTH)
c)Ethosuximide
d)Carbamazepine
CorrectAnswer-A
Ans.'a'i.e.,Vigabatrin
Vigabatrin(drugofchoice),ACTH(2ndchoice)and
corticosteroidsareusedfortreatment.

---

1451.Themostcommoncauseofmeningitis
inchildrenaged5yrsis-
a)Hinflunzae
b)N.meningitides
c)Staphylococcus
d)E.coli
CorrectAnswer-B
Ans.is'b'i.e.,N.meningitides
Commonestcausesofmeningitis
Neonatal-GroupBstreptococcusmost
common,E.colisecondmostcommon.
2monthsto3years?Pneumococci>Meningococci>H.
influenzae
3yearsto20yearsMeningococcus
>20years?Pneumococci

---

1452.Mostcommoncauseofneonatal
meningitis-
a)Staphylococcus
b)E.coli
c)H.influenze
d)Pneumococcus
CorrectAnswer-B
Ans.is'b'i.e.,E.coli
"GroupBstreptococcusfollowedbyE.coliarethetwomostcommon
causesofneonatalmeningitis".
Mostcommoncauseofneonatalmeningitis-->GroupB
streptococcus(Str.agalactiae)Secondmostcommoncauseof
neonatalmeningitis--E.coli

---

1453.CommondeformityinchiariH
malformationis-
a)Syringomyelia
b)Meningomyelocele
c)Hydrocephalus
d)Allofabove
CorrectAnswer-D
Answer-D.Allofabove
Chiarimalformationisdividedinto:
1. TypeI:Producesymptomsduringadolescenceoradulthoodis
usuallynotassociatedwithhydrocephalus.Thedeformityconsistsof
displacementofcerebellartonsilsintothecervicalcanal.
2. TypeII:Itischaracterizedbyprogressivehydrocephaluswitha
myelomeningoceleinnewborns.Thereisafailureofpontineflexure
duringembryogenensis,whichresultsinelongationof4thventricle;
kinkingofbrainstemandbreakingofquadrigeminalplate(tectum);
alongwithdisplacementofinferiorvermis,ponsandmedullainto
cervicalcanal.Thiscauseswideningofcervicalcanal
(syringomyelia).
3. TypeIII:Usuallyassociatedwithoccipitalencephaloceleand
causesabundantneurologicaldeficit.
4. TypeIV:Characterisedbylackofcerebellerdevelopmentand
usuallynotcompatablewithlife.

---

1454.RegardingDandy-Walkersyndrome,all
areseenexcept-
a)Hydrocephalus
b)Archnoidcyst
c)Posteriorfossacyst
d)Cerebellarvermisdeficiency
CorrectAnswer-B
Ans.is'b'i.e.,Arachnoidcyst
Dandy-walkermalformation
oTheDandy-Walkermalformationconsistsofacysticexpansionof
the4thventricleintheposteriorfossaandmidlinecerebellar
hypoplasia.
oThereis:?
oHydrocephalus(90%ofcases)
oAgenesisofthecerebellarvermisandcorpuscallosum.
oRapidincreaseinheadsizewithprominentocciput.

---

1455.GrimacewithAPGARscore-
a)0
b)1
c)2
d)3
CorrectAnswer-B
Ans.is`bi.e.,1

---

1456.Achildoflessthanoneyearwith
asthmatreatment-
a)MDIwithSpacer
b)MDIwithMask
c)MDIwithSpacerwithMask
d)MPIwithmask
CorrectAnswer-C
Answer-C.MDIwithSpacerwithMask
MDIalonerequirebetterpressandbreathco-ordinationsoused
above12yearsofage.
MDIwithspacerovercomebreathco-ordinationsousedabove4
yearsofage.
MDIwithspacerwithmaskcanbeusedsuccessfullyinchildren
below4yearsofage.

---

1457.Treatmentofbronchiolitisincludesall
except-
a)Macrolides
b)Humidoxygen
c)Bronchodilator
d)Allofabove
CorrectAnswer-A
Answer-A.Macrolides
Bronchiolitisispredominantlyaviraldisease.
1. RSV(mostcommon)
2. Parainfluenzavirus3,1,2
3. Adenovirus
4. Influenzavirus
5. Mycoplasmapneumoniae
Treatmentismainlysymptomaticwhichincludeshumidatmosphere,
bronchodilators(n-agonist,ipratromium,epinephrinenebulized)and
antipyretics.Thoughantibioticshavenorole,ribavarin,when
indicated,istheantiviralagentofchoice.

---

1458.Inchild,foreignbodyinlung-
a)Rigidbronchoscopy
b)Chestx-ray
c)Flexibleendoscopy
d)Directlaryngoscopy
CorrectAnswer-A
Ans.is'a'i.e.,Rigidbronchoscopy
oTreatmentofchoiceisremovalofforeignbodybyrigid
bronchoscopewithappropriateantibiotics.

---

1459.Inwhichdisease,symptomsimprove
withcrying-
a)Tetralogyoffallot
b)Choanalatresia
c)Bronchialasthma
d)Allofabove
CorrectAnswer-B
Ans.is'b'i.e.,Choanalatresia
oBilateralchoanalatresiaisaveryseriouslife-threateningcondition
becausethebabyisunabletobreathdirectlyafterbirthasneonates
areobligatenasalbreathers.
oInsomecases,thismaypresentascyanosiswhilethebabyis
feedingbecausetheoralairpassagesareblockedbythetongue.
oThecyanosismayimprovewhenthebabycries,astheoralairway
isusedatthistime.
oThesebabiesmayrequireairwayresuscitationsoonafterbirth.

---

1460.Mostcommonpulmonarytumorin
childrenis-
a)Carcinoid
b)Smallcellcarcinoma
c)Adenocarcinoma
d)Squamouscellcarcinoma
CorrectAnswer-A
Answer-A.Carcinoid
Themostcommontumortypesarecarcinoid,inflammatory
myofibroblastictumor,andpleuropulmonaryblastoma
Rarepediatriclungtumorsincludingsmallcellcarcinoma,
adenocarcinoma,andpulmonarycapillaryhemangiomatosiswere
alsoseen.

---

1461.Allofthefollowingaretrueabout
KernicterusEXCEPT:
a)KernicterusisduetoUnconjugatedHyperbilirubinemia
b)YellowishstainingofBasalGangliaisseen
c)Prematurityisariskfactor
d)Notassociatedwithincreasedmorbidity
CorrectAnswer-D
NotassociatedwithincreasedmorbidityREF:Nelson171hedition
page687
KERNICTERUSORBILIRUBINENCEPHALOPATHY:
Kernicterus,orbilirubinencephalopathy,isaneurologicsyndrome
resultingfromthedepositionofunconjugatedbilirubininthebasal
gangliaandbrainstemnuclei.
Thegreatestriskassociatedwithhyperbilirubinemiaisthe
developmentofkernicterus(bilirubinencephalopathy)athigh
indirectserumbilirubinlevels.
Thelevelofserumbilirubinassociatedwithkernicterusisdependent
inpartonthecauseofthejaundice.Kernicterushasdeveloped
whenbilirubinlevelsexceed30mg/dL,althoughtherangeiswide
(21-50mg/dL).
Itsonsetisusuallyinthe1stwkoflife,butitmay_bedelayedtothe
2nd-3rdwk.
Kernicterusdevelopsatlowerbilirubinlevelsinpreterminfantsand
inthepresenceofasphyxia,intraventricularhemorrhage,hemolysis,
ordrugsthatdisplacebilirubinfromalbumin.Theexactserum
bilirubinlevelthatisharmfulforVLBWinfantsisunclear.Kernicterus
doesoccurinpatientswithbreastmilkjaundicebutisvery
uncommon.

---

Thesurfaceofthebrainisusuallypaleyellow.Oncutting,certain
regionsarecharacteristicallystainedyellowbyunconjugated
bilirubin
Overtneurologicsignshaveagraveprognosis;75%ormoreofsuch
infantsdie,and80%ofaffectedsurvivorshavebilateral
choreoathetosiswithinvoluntarymusclespasms.Mentalretardation,
deafness,andspasticquadriplegiaarecommon.Infantsatrisk
shouldhavescreeninghearingtests.

---

1462.Mostcommoncauseofperrectal
bleedingininfantis-
a)Analfissure
b)Rectalpolyp
c)Intussusception
d)Hypertension
CorrectAnswer-A
Answer-A.Analfissure
Analfissuresarethemostcommoncauseofrectalbleedingin
infantsandchildren.

---

1463.Mostcommonanomalyofupper
urogenitaltractis-
a)Ureteropelvicjunctionstenosis
b)Ectopicuretheralopening
c)Ureterocele
d)Ectopicureter
CorrectAnswer-A
Answer-A.Ureteropelvicjunctionstenosis
Mostcommoncauseofurinarytractobstructioninchildren-
Posteriorurethralvalves.
Mostcommoncauseoflowerurinarytractobstructioninchildren->
Posteriorurethralvalves.
Mostcommoncauseofupperurinarytractobstructioninchildren4
PUJobstruction.

---

1464.Whichofthefollowingistrueof
Wilson'sdiseaseallexcept-
a)Autosomalrecessive
b)Serumceruloplasminlevel<20mg/d1
c)Urinarycopporexcretion<100microgram/c11
d)Zincacetateisusedasmaintencetherapy
CorrectAnswer-C
Urinarycopperexcretion<100microgram/di[Ref:Harrison17"'/ep.
2450,2449]
Symptomaticpts.ofWilsondiseaseinvariablyhaveurinecopper
levels>100pgperday.
Wilsondiseaseisanautosomalrecessivedisordercausedby
mutationintheATP7Bgene(acoppertransportingATPase)
Diagnosis-ThegoldstandardfordiagnosisisLiverbiopsywith
quantitativecopperassayQ.
Otherdiagnostictestsusedare?
-SerumceruloplasminlevelQ
-KFrings(2
-Urinecopperexcretiono
-DNAHelpful-yeanalysisQ
Serumcoppervalueshavenodiagnosticvalue,sincetheymaybe
low,normalorelevateddependinguponthestageofevolutionof
disease.
Table:UsefulDiagnosticTestsforWilson
Disease
Normal
Test
Value
WilsonDisease
180-350

---

180-350
Serum
mg/L

(18-35 ?Lowin85%
ceruloplasmin
mg/d1)

?Presentin99%
-Ifneurologicor
psychiatric
KFrings Absent
symptomspresent.

?Presentin30-50%
-inhepatic

presentationand
presymptomaticstate
?Urinarycopper

excretionis
increased
->1.6intnol(>100mg)
0.3-0.8
24-hurineCu
insymptomatic
mmol patients
?0.9to>mmol(60to

>100mg)
-inpresymptomatic

patients
0.3--0.8 ?Livercopperis
LiverCu
mmol/g increased
(20-50mg) ?>3.1mmol(200

tissue mg)
Haplotype

analysis
0Matches
2Matches
Treatment
ZincisthetreatmentofchoiceforWilsondiseaseQ.
Itproducesanegativecopperbalance
-Byblockingintestinalabsorptionofcopper
-Byinducinghepaticmetallothioneinsynthesiswhichsequesters
additionaltoxiccopper.
Table:RecommendedAnticopperTreatmentsforWilson
Disease
DiseaseStatus
FirstChoice SecondChoice

---

DiseaseStatus
FirstChoice SecondChoice
Initialhepatic
manifestations
?Hepatitisorcirrhosis
without
decompensation
Trientine
?HepatitisorCirrhosis
Penicillainine
with
Zinc
andzinc
decompensation Trientineandzinc
Hepatic
-Mild
Trientineandzinc transplantation
-Moderate
Hepatic Trientineand
-Severe
transplantation
zinc
Initial
Tetraioinolybdate Trientineand
neurologic/psychiatric
andzinc
zinc
Maintenancetherapy
Zinc
Trientine
Presymptomatictherapy
Zinc
Trientine
Pediatric
Zinc
Trientine
Pregnant
Zinc
Trientine

---

1465.Featuresofcystinuriaare
a)Impairedproximaltubularreabsorptionofcystine
b)Autosomalrecessive
c)Recurrentrenalstone
d)Alloftheabove
CorrectAnswer-D
Answer-D.Alloftheabove
Cystinuria
BiochemicalDefect:Anautosomalrecessivedisorderthatresults
intheformationofadefectiveaminoacidtransporterintherenal
tubuleandintestinalepithelialcells.
Pathophysiology:Theaminoacidtransporterisresponsiblefor
transportingcystine,ornithine,lysine,andarginine.Defectivetubular
reabsorptionoftheseaminoacidsinthekidneysresultsinincreased
cysteineintheurine,whichcanprecipitateandcausekidneystones.
ClinicalManifestations:Cysteinekidneystonespresentingwith
severe,intermittentflankpainandhematuria.
Labfindings:Increasedurinaryexcretionofcystine,ornithine,
arginine,andlysineonurineaminoacidchromatography;hematuria
andcysteinecrystals(hexagonal)onthecoolingofacidifiedurine
sediment.
Imaging:RadiopaquekidneystonesonCTscan.Themostspecific
testisthecyanide?nitroprussidetest
Treatment:Low-methioninediet;increasedfluidintake;
acetazolamidetoalkalinizetheurine.Ifthisfailsthenpatientsare
usuallystartedonchelatingtherapywithpenicillamine.

---

1466.Whichofthefollowingisbestfor
transportofthenewbornwith
maintainanceofwarmtemperature?
a)KangarooMotherCare(KMC)
b)Transportincubator
c)Thermacolbox
d)Hotbottle
CorrectAnswer-A
Ansis'a'i.e.,KangarooMotherCare(KMC)
"Preferablymothershouldaccompanyandbabycanbetransported
inKMCposition.EvenfathercanprovideKMCduringtransportif
mothercannotacompany."

---

1467.Seconddegreeconsanguineous
marriage,babywithdiarrhoea,perianal
diaperarearedness-
a)Lactoseintolerance
b)Shigelladiarrhoea
c)Salmonella
d)Fungal
CorrectAnswer-A
Answer-A.Lactoseintolerance
InLactoseintolerance,thereisdeficiencyofenzymelactase.
SoNonaturalbreakdownoflactose-acarbohydratepresentinmilk.
Thiscausesdiarrhoea.
Stoolcontainsreducingsugarwhichcausesperianalexcoriation.

---

1468.Mostcommonintraabdominalsolid
organtumorinchildis?
a)Neuroblastoma
b)Rhabdomyoblastoma
c)Wilm'stumor
d)Hypernephroma
CorrectAnswer-A
Ans.is'a'i.e.,Neuroblastoma
Mostcommonabdominalcancerofchildhood.
Mostcommoncancerofinfancy.
Mostcommonextracranialsolidtumorofchildhood(mostcommon
solidtumorofchildhoodisbraintumor).

---

1469.OnUSGamasswasfoundinabdomen
whichwasdisplacingthekidney
laterallyin1yearoldchild-
a)Neuroblastoma
b)Nephroblastoma
c)RCC
d)Alloftheabove
CorrectAnswer-A
Answer-A.Neuroblastoma
Thecommonestintra-abdominaltumorinfirsttwoyearsoflife
Neuroblastoma

---

1470.Inchildrenmostcommonposterior
fossatumouris:
a)Meningiomas
b)Astrocytoma
c)Medulloblastoma
d)Glioblastomamultiforme
CorrectAnswer-B
AnswerisB(Astrocytoma):
CerebellarAstrocytomasarethemostcommonposterior.fossa
tumorsinchildren.
Medulloblastomaarethesecondmostcommonposteriorfossa
tumorsinchildrenandthemostcommonmalignantposteriorfossa
tumorsinchildren.
AlthoughCPDTandNelson'stextbookmentionanequalincidence
ofcerebellarastrocytomaandmedulloblastomaintheposterior
fossainchildren,mostotherstandardtextbooksmentioncerebellar
astrocytomasasthemostcommonposteriorfossatumorsin
children.

---

1471.DrugsusedinALLinchildareall
except-
a)Methotrexate
b)Vincristine
c)Vinblastine
d)Cyclophosphamids
CorrectAnswer-C
Answer-C.Vinblastine
TreatmentofALLisdividedinto4stages.Thetotaldurationof
treatmentrangesbetween2and2%years.
1.Inductionofremission
Inductiontherapyisusedtoattainremision,i.e.,toeradicatethe
leukemiccellsfrombonemarrow.
Drugsusedare4Vincristine,Prednisolone,L-Asparginase,
Anthracycline.Durationoftherapyis4-6weeks..
2.CNStherapy
MostchildrenwithleukemiahavesubclinicalCNSinvolvementatthe
timeofdiagnosis.Moreover,CNSactsasasanctuarysitewhere
leukemiccellsareprotectedfromsystemicchemotherapybecause
ofbloodbrainbarrier.So,treatmenttokeepleukemiacellsfrom
spreadingtotheCNSisoftenstartedwithinduction.
Treatmentinclude4Intrathecalmethotrexatepluscranialradiation.
3.Intensification
Ifthepatientgoesintoremission,thenextstepistointensifythe
therapyforashortperiod.
Drugsusedare4Methotrexate,L-Asparginase,
Epipodophyllotoxin,Cyclophosphamide,Cytarabine.
4.Maintenancetherapy

---

Afterconsolidation,thepatientisgenerallyputonamaintenance
therapytomaintainetheremissionstateandpreventrelapse.
Drugsusedare46-mercaptopurine,Methotrexate,Prednisolone,
Vincristine.Durationofmaintenacetherapyis2-2.5years.

---

1472.34weekprimigravidapunjabikhatri
comeswithhistoryofconsanguineous
marriage,withhistoryofrepeatedblood
transfusiontohersiblingsince8
monthsofage.Thefirstdiagnostictest
is-
a)HPLC
b)Bloodsmear
c)Bonemarrow
d)Hbelectrophoresis
CorrectAnswer-B
Answer-B.Bloodsmear
TypeofhemoglobinisdetectedbyHbelectrophoresis.
Inthiscase,Hbelectrophoresisofthewomanshouldbedone.Ifshe
comespositiveforabnormalhemoglobin,sheshouldbecounselled
aboutterminationofpregnancy.

---

1473.Malepseudohermaphroditismisseenin
?
a)5-areductasedeficiency
b)21hydroxylasedeficiency
c)17hydroxylasedeficiency
d)aandc
CorrectAnswer-D
Ans.is'a'i.e.,5-areductasedeficiency;'c'i.e.,17hydroxylase
deficiency
Malepseudohermaphroditism
GenotypeisXY
Externalgenitaliaarefemale
CausesofMalePseudohermaphroditism
A.Defectintesticulardifferentiation
1. DeletionofshortannYchromosome3.Mixedgonadal
dysgenesis(MGD).
2. XYpuregonadaldysgenesis.4.Dysgenetic
malepseudohennaphroditism(DMP).
B.Defectintesticularhormonesynthesis
1.Leydigcellaplasia
2.Inbornerroroftestosteronebiosynthesis
i)17-alphahydroxyalsedeficiencyiv)3beta-hydroxy
steroiddehydrogenasedeficiency.
ii)17-20lyasedeficiencyv)20-22
desmolasedeficiency
iii)17-ketosteroidreductasedeficiency.
C.Defectinmullerianinhibitinghormoneaction
D.Defectinandrogenaction

---

1. 5-alphareductasedeficiency4.Reifenstein
syndrome
2. Testicularfeminizationsyndrome5.Undertermined
etiology
3. Incompletetesticularfeminizationsyndrome
Truehermaphroditism
Bothovarianandtesticulartissuesarepresenteitherinthesame
(ovotestis)oroppositegonads.

---

1474.3betahydroxysteroiddehydrogenase
deficiencycausesincreaseproduction
of-
a)DHEA
b)Progesterone
c)Deoxycortisol
d)Estradiol
CorrectAnswer-A
Answer-A.DHEA
Thereiselevatedlevelofpregenolone,17a-OHpergeneloneDHEA
anddecreaslevelofprogesterone,deoxycortisolandestradiol.

---

1475.Whichofthefollowingiscausedby
congenital17hydroxylasedeficiency:
a)Hyperkalemia
b)Hermaphroditism
c)Hypertension
d)Virilism
CorrectAnswer-C
Hypertension
17-hydroxylase(17-OH)deficiencysyndromeisararegenetic
disorderofsteroidbiosynthesiscausingdecreasedproductionof
glucocorticoidsandsexsteroidsandincreasedsynthesisof
mineralocorticoidprecursors.Reducedorabsentlevelsofboth
gonadalandadrenalsexhormonesresultinsexualinfantilismin46,
XXfemalesandambiguousgenitaliain46,XVmales.Excessive
mineralocorticoidactivityproducesvaryingdegreesofhypertension
QandhypokalemiaQ.Patientsusuallyarediagnosedwiththis
conditionduringanevaluationofdelayedpuberty.absentsecondary
sexualcharacteristicsorprimaryamenorrhea.Q

---

1476.Featuresofhypothyroidismininfancy
includethefollowingexcept-
a)Prematureclosureofposteriorfontanelle
b)Coarsefacies
c)Umbilicalhernia
d)Constipation
CorrectAnswer-A
Ans.is'a'i.e.,Prematureclosureofposteriorfontanelle
oThereisdelayedclosureofposteriorfontanelle.

---

1477.Gonadstotestesdifferentiation-
a)SRYgene
b)WNT-4gene
c)DAX1gene
d)None
CorrectAnswer-A
Ans.is'a'i.e.,SRYgene
o46XXchromosomewithgeneticfactorsuchasDAX1and
signallingmoleculeWNT-4arenecessaryfordevelopmentofovary.
oYchromosomecontainsSRYgenewhichdifferentiatesgonadsto
testes.

---

1478.2-5yearoldchildwithDM,targetHbA,
Cis-
a)<8%
b)<7%
c)<9%
d)<6%
CorrectAnswer-C
Answer-C.<9%
Inchildrenbelow5yearofage,targetHBA1Cis7.5-9%.

---

1479.ThesodiumcontentofReSoMal
(rehydrationsolutionformalnourished
children)is-
a)90mmol/L
b)60mmol/L
c)45mmoUL
d)30mmol/L
CorrectAnswer-C
Ans.is'c'i.e.,45mmol/L

---

1480.PrenataldiagnosisofDownSyndrome
isby-
a)Karyotyping
b)Tripletest
c)Fetalultrasonography
d)Allofabove
CorrectAnswer-D
Answer-D.Allofabove
Followingmethodsareused:
1. Tripletest:Itincludes(i)Unconjugatedestrogen(estriol):
decreased;(ii)Maternalserumalpha-fetoprotein(MSAFP):
decreased;and(iii)hCG:increased(Note:Allthesethreemarkers
aredecreasedinEdwardsyndrome)
2. Newmarkers:Theseare(i)IncreasedinhibinAinmaternalblood;
and(ii)DecreasedPAPA(pregnancyassociatedplasmaprotein).
3. USG:Itshows:(i)Increasednuchaltranslucency(increasednuchal
foldthickness)infirsttrimester;(ii)Ductusvenousflowreversed;
and(iii)Nasalbonehypoplasia.
4. Karyotyping:Itcanbedonebychorionicvillussamplingat10-12
weeksoraminocentesisat16-18weeks.

---

1481.5yearoldchilddevelopfeverandrash
onfirstdayandrashdisappear,after
fewdaysdevelopchilddevelopataxia.
Mostprobablediagnosisis-
a)Measles
b)Fifthdisease
c)Chickenpox
d)Rockymountainspottedfever
CorrectAnswer-A
Answer-A.Measles
Information:
1. Rashon1stday
2. Complicationlikeataxia
3. Diagnosisischickenpox.

---

1482.MajorsignforAIDSsurveillancein
WHOcasedefinition?
a)>10%weightloss
b)Cough>1month
c)Generalizedlymphadenopathy
d)DisseminatedHerpes
CorrectAnswer-A
Ans.is'a'i.e.,>10%weightloss
WHOcasedefinitionforAIDSsurveillance
ForthepurposeofAIDSsurveillanceanadultoradolescent(six
yearsofage)isconsideredtohaveAIDSifatleast2ofthefollowing
majorsignsarepresentincombinationwithoneminorsign.
MajorSigns
Weightloss>10%ofbodyweight
Chronicdiarrhoeaformorethan1month
Prolongedfeverformorethan1month
Minorsigns
Persistentcoughformorethanonemonth
Generalizedpruriticdermatitis
Historyofherpeszoster
Chronicprogressiveordisseminatedherpessimplexinfection
Generalizedlymphadenopathy
OropharyngealCandidiasis.
ExpandedWHOcasedefinitionforAIDSsurveillance
Forthepurposeofsurveillanceonadultoradolescent(>12yearsof
age)isconsideredtohaveAIDSifatestfor
HIVantibodygivesapositiveresultandoneormoreofthefollowing
conditionsarepresent:

---

>10%bodyweightlossorcachexia,withdiarrhoeaorfeverorboth,
foratleast1month,notknowntobeduetoaconditionunrelatedto
HIVinfection.

---

1483.MCsymptomofAIDSininfantis-
a)GIinfection
b)Persistentcough
c)Failuretothrive
d)Lymphadenopathy
CorrectAnswer-A
Answer-A.GIinfection
Featuresinolderchildren-
Growthfailure
Fever
Diarrhea
Secondaryinfection

---

1484.Babybornetopatientsuspectedof
chlamydialinfectionsampletobetaken
fordiagnosis-
a)Conjunctival
b)Urethral
c)Urinesample
d)Blood
CorrectAnswer-A
Answer-A.Conjunctival
About70%ofbabyborntopositivechlamydalinfectiondevelop
conjuctivitisatday5oflifesosampletakenfordiagnosisis
conjuctival.
Chlamydalinfectionismostcommoncauseofconjuctivitisin
newborn.
Chlamydalinfectioncauseswateringdischangeformeye(unlike
purulentdischangeinGonococcal).
[RefDebbie-MetalNewborn&InfantNursingReview(NAINR2004)]

---

1485.FeaturesofRefsumdiseaseareall
except-
a)Ataxia
b)CCF
c)Ichthiois
d)Retinitispigmentosa
CorrectAnswer-B
Answer-B.CCF
Peroxisomaldisorder.
Defectiveenzyme-phytonoylCoAoxidase.
Clinicalfeatureincludes
1. Impairedvision(retinitispigmentosa).
2. Icthyosis
3. Peripheralneuropathy.
4. Ataxia

---

1486.Inwhichoneofthefollowingconditions
isgasunderdiaphragmnotseen-
a)Perforatedduodenalulcer
b)Typhoidperforation
c)Afterlaparotomy
d)Spontaneousruptureofoesophagus
CorrectAnswer-D
Ans.is'd'i.e.,Spontaneousruptureofoesophagus
Chilaiditi'ssyndrome:Conditioncharacterisedbyinterpositionof
smallorlargebowelbetweenliverandrightdiaphragm.
Radiologicallyitgivesgasunderdiaphragm.
Iatrogenicpneumoperitoneum:Certainprocedurelikeperitoneal
dialysis,IatrogenicallyairpushedbeforeputtingPDcannulatoavoid
injuryofviscerainsuchcasegasunderdiaphragmcanbeseen.
Allcaseswhenintestineorviscerapreforatwecangetgasunder
diaphragm.

---

1487.Youngchildwithlaughingspells.
Diagnosis-
a)Hypothalamichamartoma
b)Tetralogyoffallot
c)Nitrousoxidepoisoning
d)Noneoftheabove
CorrectAnswer-A
Answer-A.Hypothalamichamartoma
Laughingspills(alsoknowasGelasticseizure)
Gelasticseizuresareepilepticeventscharacterizedbyboutsof
laughter.Laughter-likevocalizationisusuallycombinedwithfacial
contractionintheformofasmile.Autonomicfeaturessuchas
flushing,tachycardia,andalteredrespirationarewidelyrecognized.
Gelasticseizureshavebeenassociatedclassicallytohypothalamic
hamartomas.

---

1488.Griselsyndromeallaretrueexcept
a)Post-adenoidectomy
b)Conservationtreatment
c)Inflammationofcervicalspineligaments
d)Noneedforneurosurgeon
CorrectAnswer-D
Ans.d.Noneedforneurosurgeon
GriselSyndrome:
Non-traumaticatlanto-axialsubluxationmayoccursecondarytoany
inflammatoryprocessintheupperneck
Itisdescribedfollowingtonsillectomyandadenoidectomy
Conservationtreatment:Cervicalimmobilization,Analgesiaand
Antibioticstoreducetheriskofneurologicaldeficit
GriselSyndrome
Non-traumaticatlanto-axialsubluxationmayoccursecondarytoany
inflammatoryprocessintheupperneckQ
Dueinfectionintheperi-odontoidvascularplexusQthatdrainsthe
region,bringingaboutparaspinalligamentlaxity
DescribedfollowingtonsillectomyandadenoidectomyQ
Itmaybeassociatedwithoveruseofdiathermyeitherforremovalof
adenoidorfollowingcurettageQ,whenusedforhemostasis.
ChildrenwithDownsyndrome?haveatlanto-axialinstability
Treatment:
CervicalimmobilizationQ
AnalgesiaQ
AntibioticsQtoreducetheriskofneurologicaldeficit

---

1489.ThirteenpairofRibsareseenin?
a)Downsyndrome
b)Holtoram
c)Turner
d)Fibrousdysplasia
CorrectAnswer-A
Answer-A.Downsyndrome
7pairTrisomy21,cleidocranialdysplasia
11pairTrisomy18,21
13pairTrisomy21
14pairVATERSyndrome
[RefAbnormalnumberoffetalribsinUSGbyLiatGindeset.al.]

---

1490.Articularcartilage,trueis?
a)Veryvascularstructure
b)Surroundedbythickperichondrium
c)Hasnonervesupply
d)Fibrocartilage
CorrectAnswer-C
Ans.is'c'i.e.,Hasnonervesupply
Articularcartilage
Thearticulatingsurfacesofasynovialjointarecoveredbyarticular
cartilage.
Thearticularcartilagehasfollowingfeatures:-
1. Itisahyalinecartilage
2. Itisavascular
3. Itisnon-nervous(nonervesupply)
4. Doesnothaveperichondrium
Articularcartilagelackstheabilitytoproperlyrepairandregenerate
itself.Theregenerationcapacityofcartilageislimitedduetoits
isolationfromsystemicregulation,anditslackofofvasculatureand
nervesupply.

---

1491.InArticularcartilage,mostactive
chondrocytesareseenin?
a)Zone1
b)Zone2
c)Zone3
d)Zone4
CorrectAnswer-C
Ans.is'c'i.e.,Zone3
oTherearefourzones(layers)ofarticularcartilagefromthe
articularsurfacetosubchondralbone.
1. Superficialzone(Zone-1)
Itisthethinnestzone.
Itconsistsoftwolayers:(i)Asheetofdenslypackedcollagenwith
littlepolysaccharideandtocells,coversthejointsurface,and(ii)
flattenedelipsoid-shapedchondrocytes,withtheirmajoraxis
paralleltojointsurface.2.Transitionzone(Zone-2)
Compositionisintermediatebetweensuperficialzoneandmiddle
zone.
3.Middlezoneorradialzoneordeepzone(Zone-3)
Thechondrocytesarespheroidalinshapewiththeirmajoraxis
perpendiculartojointsurface.
Chondracytesaremostactivesyntheticallyinthiszone.
Thiszonecontainsthelargestdiametercollagenfibrils,thehighest
concentrationofproteoglycansandthelowestconcentrationof
water.
4.Calcifiedcartilagezone(Zone-4)
Itseparatesthemiddlezonefromsubchondralbone.
Thecellsaresmallwithsmallamountofendoplasmicreticulumand

---

golgiapparatuswithverylittlemetabolic
activity.
Cellsaresurroundedbycalcifiedcartilage.

---

1492.Flexortendongraftrepairgraftistaken
from?
a)Plantaris
b)Palmarislongus
c)Extensordigitorum
d)Extensorindicis
CorrectAnswer-D
Ans.is'd'i.e.,Extensorindicis
Besidecoveringtheboneandsharingsomeofitsbloodsupplywith
thebone,periosteum(particularlycambiumlayer)alsoproduces
bonewhenitisstimulated.
Practicallyanythingthatbreaks,tears,stretches,inflamesoreven
touchestheperiosteum,stimulatesthereactiveboneformationby
periosteum.
Thisiscalledperiostealreaction.
DifferentialDiagnosisofPeriostealReaction
Arthritis
Psoriaticarthritis
Reactivearthritis
Metabolic
Hypertrophicpulmonaryosteoarthropathy
Thyroidacropathy
Congenital
Pachydermoperiostosis
Periostealreactionofnewborn
Trauma
Stressfracture
Fracture
DrugsFluorosis

---

DrugsFluorosis
HypervitaminosisA
Prostaglandins
TumorsOsetosarcoma
Ewing'ssarcoma
Chondroblastoma
Eosinophilicgranuloma
Osteoidosteoma
Leukemiaandlymphoma
Infection
Genetic
Caffeydisease
Vascular
Venousstasis
Neuropathicarthropathyisalsoassociatedwithperiosteal
reaction.

---

1493.Intramembranousossificationisseenin
whichbones?
a)Pelvis
b)Longbones
c)Maxilla
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Maxilla
Boneformation
Boneformation(ossification)occursbytwomethods:1)
Endochondralossification,2)Intramembranousossification.
Inboth,mesenchymalconnectivetissueisreplacedbybonebutby
differentmechanics.
Endochondralossification
1. Thistypeofossificationinvolvesthereplacementofacartilaginous
modelbybone.
2. Boneformationtakesplaceinpre-existingcartilage.
3. Mesenchymaltissuefirstformscartilagewhichislatterossifiedto
becomebone.
4. Mostofthelongsbonesdevelopbyendochondralossification.
5. Otherbonesarevertebrae,pelvis,skullbasebones.
6. Interstitialgrowthoflongboneatepiphysealcartilageoccursby
endochondralossification.
Intramembranousossification
1. Mesenchymalcellsgiverisetoosteogeniccellswhichdevelopinto
osteoblasts.
2. steoblastsbegintolaydownosteoidwhichlattermineralisedtoform
bone

---

3. Thus,thereisdirectformationofbonefrommesenchymaltissue
(withnocartilageformationasoccursinEndochondralossification).
4. Thistypeofossificationtransformsmembraneintobone.
5. Theboneformationoccursattheperipherywithlayersofbone
beinglaiddownanalogoustothering-likediameterofatree.
6. Thistypeofgrowthiscalledappositionalgrowth.
7. Skullvault,maxilla,mostofthemandibleandclavicleareformedby
intramembranousossification.

---

1494.Pionfractureis
a)Bimalleolar
b)Trimalleolar
c)DistalfemurIntraarticular
d)DistaltibiaIntraarticular
CorrectAnswer-D
Answer-D.DistaltibiaIntraarticular
Pilonfracture-Comminutedintra-articularfractureofdistaltibialend

---

1495.Dignosticsignofafracture-
a)Abnormalmobilityatfracturesite
b)Painatthefracturesite
c)Tenderness
d)Swelling
CorrectAnswer-A
Ans.is'a'i.e.,Abnormalmobilityatfracturesite
1.Unfailingsigns(diagnosticorpathognonionic)-
?Abnormalmobility
?Crepitus
?Tenderness
2.Reliablesigns
?Shortening
?Bruise
3.Importantsigns
?Swelling
?Lossoffiinction
?Deformity
?Blisters
4.Lateorinconsistentsigns
?Ecchymosis
?Swellingduetocallus

---

1496.Whichofthefollowingisnota
diarthrosis?
a)Elbowjoint
b)Interphalangealjoint
c)Skullsutures
d)Hipjoint
CorrectAnswer-C
Ans.is'c'i.e.,Skullsutures
Functionalclassificationofjoints(movement)
Jointscanalsobeclassifiedfunctionallyaccordingtothetypeand
degreeofmovementtheyallow:
1. Synarthrosis-Permitslittleornomobility.Mostsynarthrosisjoints
arefibrousjoints(e.g.,skullsutures).
2. Amphiarthrosis-Permitsslightmobility.Mostamphiarthrosisjoints
arecartilaginousjoints(e.g.,intervertebraldiscs).
3. Diarthrosis-Freelymovable.Alldiarthrosisjointsaresynovialjoints
(e.g.,shoulder,hip,elbow,knee,etc.),andtheterms"diarthrosis"
and"synovialjoint"areconsideredequivalentbyTerminologia
Anatomica

---

1497.Thefatherofjointreplacementsurgery
is?
a)Manning
b)Girdlestone
c)Charnley
d)Ponseti
CorrectAnswer-C
Ans.is'c'i.e.,Charnley
Fatherofthemodernhipreplacement:ProfessorSirJohn
Charnley(1911-82).
ProfessorSirJohnCharnleywasaBritishorthopaedicsurgeon,
inventorandskilledcraftsman.Heisbestknownforhisdevelopment
ofthefirsttrulysuccessfuloperationfortotalarthroplastyofthehip,
thelow-frictionarthroplasty.Aswellaspublishingsignificantworks
onclosedfracturemanagementandcompressionarthrodesis,he
canalsobeaccreditedwithpioneeringworkinthedevelopmentof
clean-airoperatingconditionsandbody-exhaustsuits.

---

1498.Mostcommontypeofshoulder
dislocationis?
a)Preglenoid
b)Subcoracoid
c)Subclavicular
d)Posterior
CorrectAnswer-A
Ans.is'a'i.e.,Preglenoid
Anteriordislocationoftheshoulderisthemostcommontypeof
shoulderdislocation.Headofthehumeruscomesoutoftheglenoid
cavityandliesanteriorly.Anteriordislocationofshouldercouldbe:?
1. Preglenoid-Itisthemostcommontypeofanteriordislocationand
headliesinfrontofglenoid.
2. Subcoracoid-Theheadliesbelowthecoracoidprocess.
3. Subclavicular(infraclavicular)-Theheadliesbelowtheclavicle.
4. Intrathoracic-Itisveryrare.

---

1499.Painfularcsyndromeiscausedby
impingementof?
a)Subacromialbursa
b)Subdeltoidbursa
c)Rotatorcufftendon
d)Bicepstendon
CorrectAnswer-C
Ans.is'c'i.e.,Rotatorcufftendon
Painfularcsyndrome
Painintheshoulderandupperarmduringmidrangeof
glenohumeralabduction.
Causes-supraspinatustendontearortendinitis,subacromial
bursitis,fractureofgreatertuberosity.
Thespacebetweentheupperendofhumerusandtheacromion
getscompromisedsothatduringmidabductionthetendonofrotator
cuffgetsnippedbetweenthegreatertuberosityandacromion.

---

1500.Inextensiontypeofsupracondylar
fracture,theusualdisplacement
a)Anterolateral
b)Anterolateral
c)Posteromedial
d)Posterolateral
CorrectAnswer-D
Ans.is'd'i.e.,Posterolateral
Typesofsupracondylarfracture
Supracondylarfractureisbroadlyclassifiedintoextensiontypeand
flexiontype.1.Extensiontype
Itisthemostcommontype(97-99%).
Distalfragmentisextended(tiltedbackward/posteriorly)inrelationto
proximalfragment.
Occursduetohyperextensioninjuryafterfallonoutstretchedhands.
Generally,displacementofdistalfragmentmaybe:?
Posteromedial(70-80%)
Posterolateral(20-30%)
2.Flexiontype
Itislesscommontype(1-3%)
Distalfragmentisflexed(tiltedforward/anteriorly)inrelationto
proximalfragments.
Themechanismofinjurygenerallyisbelievedtobeafalldirectly
ontotheelbowratherthanafallonoutstretchedhand.
Astheextensiontypefractureismorecommon(97-99%),themost
commonelbowinjuryinchildrenisextensiontypeofsupracondylar
fracture.

---

1501.TrueSupracondylarfractureoffemur?
a)TypeA
b)TypeB
c)TypeC
d)TypeD
CorrectAnswer-A
Ans.is'a'i.e.,TypeA
AusefulclassificationisfromtheAOgroup:typeAfractureshave
noarticularsplitsandaretruly'supra-condylar';typeBfracturesare
simplyshearfracturesofoneofthecondyles;andtypeCfractures
havesupra-condylarandintercondylarfissures

---

1502.Latecomplicationofelbowdislocation
a)Mediannerveinjury
b)Brachialarteryinjury
c)Myositisossificans
d)Alloftheabove
CorrectAnswer-C
Answer-C.Myositisossificans
Latecomplications
Stiffness
Myositisossificans
Unreduceddislocation
Recurrentdislocation

---

1503.Complicationsofelbowdislocationare
allEXCEPT:
March2004
a)Vascularinjury
b)Mediannerveinjury
c)Myositisossificans
d)Radialnerveinjury
CorrectAnswer-D
Ans.di.e.Radialnerveinjury
1)Earlycomplications
Vascularinjury:-Brachialarterymayinjured.Itmayresult
incompartmentsyndromeandVolkmann'sischemiccontracture.
Nerveinjury:-Medianandulnarnerveinjury
2.Latecomplications
.Stiffness?Myositisossificans
.Unreduceddislocation?Recurrentdislocation

---

1504.Fractureofproximalforearmcast
positionis?
a)Pronatedflexion
b)Neutralposition
c)Supinatedposition
d)Positiondoesnotmatter
CorrectAnswer-C
Ans.is'c'i.e.,Supinatedposition
Fractureproximalthird-supinationofforearm
Fracturemiddlethird-midpronationofforearm
Fracturedistalthird-pronationofforearm

---

1505.Essexloprestilesioninupperlimb-
a)Injurytointerosseousmembrane
b)RadialheadandDERfracture
c)Radialshaft
d)Radialshaftandradio-ulnarjointfracture
CorrectAnswer-A
Ans.is'a'i.e.,Injurytointerosseousmembrane
TheEsscx-Ioprestifractureisafractureoftheradialheadwith
concomitantdislocationofthedistalradio-ulnarjointwith
disruptionoftheinterosseousmembrane

---

1506.Barton'sfractureis?
a)Fracturedistalendhumerus
b)Extra-articularfracturedistalendradius
c)Intra-articularfracturedistalendradius
d)Intra-articularfracturedistalendradiuswithcarpalbone
subluxation
CorrectAnswer-A
Ans.is'd'i.e.,Intra-articularfracturedistalendradiuswithcarpal
bonesubluxation
Barton'sfracture
Barton'sfractureisanintra-articularfractureofdistalradiuswith
subluxationofcarpals.
Whencarpalssubluxationoccursanteriorly(volar),itiscalledvolar
Barton'sfracture.Itisthecommonesttype.
Whencarpalssubluxateposteriorly(Dorsal),itiscalledDorsal
Barton'sfracture.
TheBarton'sfractureisdifficulttomanagebyconservativemethods
:reductionisoftenimperfectandtendstobeunstable,sothat
redisplacementoftenoccurs.
Therefore,ofteninternalfixationbysmallbuttressplatingis
recommended.

---

1507.Madelung'sdeformityinvolves-
a)Humerus
b)Proximalulna
c)Distalradius
d)Carpals
CorrectAnswer-C
Ans.is'c'i.e.,Distalradius
Madelung'sdeformity
Madelung'sdeformityisacongenitaldisorderthataffectsgrowthof
distalradius.
Theprimarydefectisfailureofnormalgrowthofmedialandpalmar
halvesofthedistalradialphysis,leadingtocurvatureinanmedial
(ulnar)andpalmardirection.
Theulnaisrelativelylongandbecomesprominentdorsally.
Thecarpus(carpalbones)sinks,alongwiththemedial(ulnar)halfof
thedistalradialarticularsurface,intothegapsbetweenthetwo
forearmbones.

---

1508.Gamekeepersthumbis?
a)Thumbmetacarpophalangealjointulnarcollateralligament
rupture
b)Thumbmetacarpophalangealjointradialcollateralligament
rupture
c)Thumbinterphalangealjointulnarcollateralligamentrupture
d)Thumbinterphalangealjointradialcollateralligamentrupture
CorrectAnswer-A
Ans.is'a'i.e.,Thumbmetacarpophalangealjointulnarcollateral
ligamentrupture
Injurytothethumbmetacarpophalangealjointulnarcollateral
ligamentiscommonlyreferredtoasgamekeeperthumborskier's
thumb,althoughtheoriginal"gamekeeper"description(Campbell,
1955)referredtoanattritionalulnarcollat-eralligamentinjury.
Snowskiingaccidentsandfallsonanoutstretchedhandwith
forcefulradialandpalmarabductionofthethumbaretheusual
causes.

---

1509.Gardenspadedeformityisseenin?
a)Barton'sfracture
b)Colle'sfracture
c)Smith'sfracture
d)Bennet'sfracture
CorrectAnswer-C
Ans.is'c'i.e.,Smith'sfracture
Smithfracture(Reversecolle'sfracture)
Itisafractureofdistalthirdofradiuswithpalmardisplacement.
Hence,itiscalledasreversecollesfracture(Incollesfracturethere
isdorsaldisplacement).
Itislesscommonthancollesfractureandiscausedbyfallonthe
backofhand.
Thedeformityisoppositetothatofcolle'sfractureandiscalledthe
'gardenspadedeformity'.
Treatmentisclosedreductionandimmobilizationincastwith
forearminsupinationandwristinextension.oPercutaneouspinning
maybedoneinunstablefractures.

---

1510.Fractureneckfemurcauseofnon-
union?
a)Injurytobloodsupplywithshearingstress
b)Poornutritionofthepatient
c)Smoking
d)Oldageandosteoporosis
CorrectAnswer-A
Ans.is'a'i.e.,Injurytobloodsupplywithshearingstress
Causesofnon-unioninfractureneckoffemurare:?
1. Fracturemorphology-highfractureangleandincreasedshear.
2. Displacedfracturegrade3/4.
3. Fracturecomminution.
4. Inadequatereductionandstabilityoffixation.
5. Poorbonequality.
6. Injurytovascularity-directandtamponadeeffect.
7. Absenceofcambiumlayerinperiosteum.
8. Factorsinsynovialfluidwhichinhibitthecallusformation.
9. Lackofhematoma.
10. Washingawayanddilutionofosteogenicfactors.

---

1511.Trueaboutproximalfragmentin
supratrochantricfractureis?
a)Flexion
b)Abduction
c)Externalrotation
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Deformityincasesoffracturesubtrochantericfemur
Theproximalfemurissurroundedbyverylargeandpowerful
muscles.
Inthecaseofafracture,theirspatialarrangement,combinedwith
theiroriginandinsertion,resultsinaverycharacteristicdeformity.
Theproximalfragment,asaresultofcontractionoftheabductors,
theexternalrotators,andtheiliopsoasmuscle,isflexed,abducted,
andexternallyrotated.
Theadductorscausetheshafttobeadducted,andtheforceof
gravitycausesthedistalfragmenttofallintosomeexternalrotation.
Allthemusclesthatspanthefracturecombinetocauseshortening.
Thus,theresultantdeformityisoneofananteriorandlateralbowing
oftheproximalshaft,combinedwithconsiderableshorteningand
variabledegreesofexternalrotation.

---

1512.Bulgesigninkneejointisseenafter
howmuchfluidaccumulation?
a)100m1
b)400m1
c)200m1
d)<30ml
CorrectAnswer-D
Ans.isi.e.,<30ml
Thebulgetestisusedtodeterminethepresenceoffluidintheknee
joint.Itisusefulwhenonlyalittlefluidispresentinthejoint.
Thesuprapatellarbursaisfirstemptiedoffluidbysqueezingdistally
fromabout15cmabovethepatella.Themedialcompartmentofthe
kneejoinisemptiedbypressingonthesideofthejointwiththefree
hand.Thehandisthenliftedawayandthenthelateralsideis
sharplycompressed.
Ifthetestispositive,arippleisseenontheflattened,medial
surface.
Thetestisnegativeiftheeffusionistense-upto120ml.
Thebulgetestisusedtodetermineminimalfluidinthekneejoint.It
candetectaslittleas4-6mloffluidinthekneejoint.

---

1513.Blockvertebraeareseenin?
a)Pagetsdisease
b)Leukemia
c)TB
d)Klippel-Feilsyndrome
CorrectAnswer-D
Ans.isi.e.,Klippel-Feilsyndrome
Ablockvertebraisatypeofvertebralanomalywherethereisa
failureofseparationoftwoormoreadjacentvertebralbodies
Associations
1. Thereisafrequentassociationwithhemivertebrae/absentvertebra
aboveorbelowblocklevel,posteriorelementfusion
2. FusionofmultiplecervicalvertebralbodiesisalsoseeninKlippel-
FeilsyndromeandVACTRELanamoly.

---

1514.Commoncausesofvertebraplana
a)TB
b)Eosinophilicgranuloma
c)Metastasis
d)Alloftheabove
CorrectAnswer-A
Ans.is'd'i.e.,Alloftheabove
Vertebraplana
Thistermisusedtodescribeuniformcollapseofavertebralbody
intoathin,flatdisc.Themostcommoncauseiseosinophilic
granuloma,withthethoracicvertebraemostfrequentlyaffected.
Causesare:?
1. Histocytosis-X(Eosinophilicgranuloma)
2. Leukemia
3. TB
4. Metastasis,Multiplemyeloma,Ewing'ssarcoma,lymphoma
5. Osteochondritisofvertebralbody(Calve'sdisease)
6. Hemangioma
7. Trauma
8. Steroids

---

1515.DISCprolapseiscommonatallsite
except?
a)L4-L5
b)L5-S1
c)C6-C7
d)T3-T4
CorrectAnswer-D
Ans.is'd'i.e.,T3-T4
Herniationofintervertebraldiscisacommoncauseofcombined
backpainandsciatica(Paininbackwithradiationtolowerlimb).
Prolapsedintervertebraldiscisoftenprecipitatedbyinjury,butit
mayalsooccurintheabsenceofanyrememberedinjury.
ThediscbetweenLcandSpandbetweenL4andL5arethosemost
oftenaffected(80%).
Lowercervicalregion(C's-C6andC6_7)isaffectedin19-20%.

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1516.Hangman'sfractureis?
a)SubluxationofC5overC6
b)FracturedislocationofC2
c)Fracturedislocationofanklejoint
d)Fractureofodontoid
CorrectAnswer-B
Ans.is'b'i.e.,FracturedislocationofC2
Hangman'sfracture
Hangman'sfractureisbilateralfractureoftheparsinterarticularisof
axis(C2)withtraumaticspondylolisthesisofaxis(C2)overC3
vertebrae.ThusHangman'sfractureisnotsimplyafracture,but
fracturedislocationofaxis(C2).
Themechanismofinjuryisextensionwithdistraction(intrue,judicial
hangman'sfracture)andhyper-extension,axialcompression&.
flexion(incivilianinjuries,whicharenowmorecommon).
ItissecondmostcommontypeofAxis(C2)fracture,secondonlyto
odontoidfractures.
Fatalatiesarecommon,However,neurologicaldeficitisunusualas
thefractureofposteriorarchdecompressthespinalcord.
Mostofthefatalitiesoccuratthesceneofinjury,acutepost
admissionmortalityislow.
SuccessfulhealingofC2traumaticspondylolishesisisreportedto
approach95%.Thisismostcommonlyachievedwithnon-operative
measures,eveninthepresenceofdisplacementofparsinter-
articularis.
Undisplacedfracturesaretreatedinasemi-rigidorthosis,and
displacedfractureareclosedreduced&treatedwithhalo-vest.

---

Occasionally,thehangman'sfractureisassociatedwithaC2/3facet
dislocation.Thisisaseverelyunstableinjury;openreductionand
stabilizationisrequired.

---

1517.Mostcommoncauseofkyphotic
deformity?
a)Trauma
b)Osteoporosis
c)Ankylosingspondylitis
d)Rickets
CorrectAnswer-B
Ans.is'b'i.e.,Osteoporosis
Kvphosis
Kyphoticdeformitiesarecharacterizedbyonincreaseddorsal
curvatureinthesagittalplaneofspinalalignment.
Posturalkyphosis(Posturalroundback)andscheuermann'sdisease
arethemostcommoncausesofkyphosis,particularlyin
adolescents.
Mostcommoncauseinolderpersonsisosteoporosis.
Othercommoncausesaretuberculosisofthevertebralbodies,
ankylosingspondylitis,rickets,cancersandspinabifida.
Therearethreetypesofkyphoticdeformities:
1. KnuckleProminenceofonespinousprocess
2. Gibbus-3Prominenceoftwoorthreespinousprocesses
3. Kyphus--->Diffuseroundingofthevertebralcolumn

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1518.Mostcommonnerveusedfornerve
conductionstudyinHreflex?
a)Mediannerve
b)Ulnarnerve
c)Tibialnerve
d)Peronealnerve
CorrectAnswer-C
Ans.is'c'i.e.,Tibialnerve
Itisrecordedoverthesoleusorgastrocnemiusmuscles.
Itisusedmos
TheHreflexisbasicallyanelectrophysiologicallyrecordedAchilles
tendonstretchreflex.oItisperformedbystimulatingthetibialnerve
inpoplitealfossa.
tcommonlytoevaluateSiradiculopathyortodistinguishitfroman
L5radiculopathy.

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1519.Apersonisnotabletoextendhismetacarpophalangealjoint.Injuryto
whichofthefollowingnerveresultinthis?
a)Ulnarnerve
b)Radialnerveinjury
c)Mediannerveinjury
d)Post.Interosseousnerveinjury
CorrectAnswer-D
Damagetoposteriorinterosseousnerveresultininabilitytoextendthefingersatthe
metacarpophalangealjointsandradialdeviationofthewristonwristextensioncausedby
weaknessofextensorcarpiulnarismuscle.
Posteriorinterosseousnerveordeepulnarnerveisapuremotorbranchofradialnerve
intheforearm.Itsuppliestheextensormusclesofforearmincludingtheextensorcarpi
ulnaris.
Ulnarnervepalsyresultinlossoffineintrinsicmotionsofhand.Itresultinanabduction
deformityofthelittlefingerfromparalysisoftheinterossei,interosseousmusclewasting,
andpartialclawhandfrominterphalangealflexiondeformitiesoftheringandlittlefingers.
Radialnerveinjuryresultinwristdrop.Axillaryorproximalinjuryresultintriceps
weaknessinadditiontowristdrop.Injuryintheaxillacausesdamagetotricepsbrachii,
anconeus,brachioradialisandextensorcarpiradialislongus.
Ref:NeurologyinClinicalPractice:Theneurologicaldisorders,Volume2editedbyWalter
GeorgeBradleypage2315.LeBlondR.F.,DeGowinR.L.,BrownD.D.(2009).Chapter14.
TheNeurologicExamination.InR.F.LeBlond,R.L.DeGowin,D.D.Brown(Eds),DeGowin's
DiagnosticExamination,9e.

---

1520.Mostcommonnerveinjuredinfracture
ofmedialepicondyleofhumerus
is:
March2007
a)Radialnerve
b)Ulnarnerve
c)Mediannerve
d)Musculocutaneousnerve
CorrectAnswer-B
Ans.B:UlnarNerve
Certainlesionsarecommonlyassociatedwithfracturestospecific
areasofthehumerus.
Attheupperend,thesurgicalneckofthehumerusandanatomical
neckofhumeruscanbothbeinvolved,thoughfracturesofthe
surgicalneckaremorecommon.Theaxillarynervecanbedamaged
infracturesofthistype.
Mid-shaftfracturesmaydamagetheradialnerve,whichtraverses
thelateralaspectofthehumeruscloselyassociatedwiththeradial
groove.
Themediannerveisvulnerabletodamageinthesupracondylar
area.
Theulnarnerveisvulnerabletodamagenearthemedialepicondyle,
aroundwhichitcurvestoentertheforearm.

---

1521.Saturdaynightpalsyiswhichtypeof
nerveinjury?
a)Neuropraxia
b)Axonotemesis
c)Neurotemesis
d)Completesection
CorrectAnswer-A
Ans.is'a'i.e.,Neuropraxia
Seddon'sclassificationofnerveinjuries
Seddonidentifiedthreetypesofinjuries
1.Neuropraxia
Thereiscontusionoftheperipheralnervewhichcausesreversible
physiologicalnerveconductionblock.Theaxiscylinder(i.e.,axon
withitsendoneurium)ispreserved.Thus,thereisphysiological
conductionblockwithoutanatomicdisruption.Theinjuryis
temporaryandrecoveryiscomplete.Itisseenincrutchpalsy,
tourniquetpalsy,andsaturdaynightpalsy.
2.Axonotemesis
Thereisinjurytoaxonbutendoneuriumispreserved.Spontaneous
recoveryisexpectedinsomecases.Thisisseeninclosedfractures
anddislocations.
3.Neurotemesis
Thereiscompleteanatomicalsectionofnerve.Norecovery
possible.Itisseeninopenwound.

---

1522.Whichofthefollowingmovementsis
restrictedinPerthe'sdisease-
a)Adduction&externalrotation
b)Abduction&externalrotation
c)Adduction&internalrotation
d)Abduction&internalrotation
CorrectAnswer-D
Ans.is.'d'i.e.,Abduction&internalrotation
ClinicalfeaturesofPerthesdisease
Perthesdiseaseiscommoninmaleofagegroup5-10years.
Paininthehip,oftenradiatingtoknee.
Limp(antalgiclimp)
Limitationofmovement:-Abduction,internalrotationandextension
arelimited,thereforethereisadduction,externalrotation,and
flexiondeformity.
Shorteningoflimb.
Positivetrendelenburgtest.
Duringthediseaseprocess,boneageis1-3yearslowerthanthe
normal.Afterhealing,boneagereturnstonormal.

---

1523.RadiologicalsignincaseofPerthe's
disease?
a)Epiphysealcalcification
b)Organizedcalcification
c)Lateralsubluxationfemurhead
d)Restrictionofabduction
CorrectAnswer-B
Ans.is'b'i.e.,Organizedcalcification
Seronegativespondvloarthropathies
Theseronegativespondyloarthropathiesareagroupofdisorders
thatsharecertainclinicalfeaturesandgeneticassociations.The
wordseronegativereferestotheabsenceofrheumatoidfactorin
thisgroupofdisorders.Theseronegativespondyloarthropathies
include?
1. Ankylosingspondylitis
2. Reactivearthritis-->Reitersyndromeandenteritisassociated
arthritis
3. Psoriaticarthritis
4. Arthritisassociatedwithinflammatoryboweldisease,i.e.
enteropathicarthritis
Featuresofseronegativespondyloarthropathies
oOnsetusuallybefore40years
AbsenceofRAfactor
HLA-B27positive
Presenceofuveitis

---

1524.CauseofCoxavera?
a)Congenital
b)Perthe'sdisease
c)SCFE
d)Alloftheabove
CorrectAnswer-A
Ans.is'd'i.e.,Alloftheabove
Coxavera
Coxaverareferstoreducedanglebetweentheneckandshaftofthe
femur.
Coxaveramaybecongenitaloracquired.
1.Congenital(developmental/Infantile)coxavera
1. Thisiscoxavararesultingfromsomeunknowngrowthanomalyat
theupperfemoralepiphysis.
2. Itisnoticedasapainlesslimpinachildwhohasjuststarted
walking.
3. Inseverecases,shorteningofthelegmaybeobvious.
4. Onexamination,abductionandinternalrotationofthehiparelimited
andthelegisshort.
5. X-rayswillshowareductioninneck-shaftangle.
6. Theepiphysealplatemaybetoovertical.
7. Theremaybeaseparatetriangleofboneintheinferiorportionof
themetaphysis,calledFairbank'striangle.
8. Treatmentisbyasubtrochantericcorrectiveosteotomy.
2.Aquiredcoxa-vera
Aquiredcoxa-veraisseenin:-
1. SCFE(slippedcapitalfemoralepiphysis)
2. Sequelaeofavascularnecrosisoffemoralepiphysis

---

Legg-CalvePerthe'sdisease
Femoralneckfracture
Traumatichipdislocation
PostreductionofCDH
Septicnecrosis
Associatedwithpathologicalbonedisorders
1. Osteogenesisimperfecta
2. Fibrousdysplasia
3. Osteopetrosis

---

1525.Von-Rosen'ssignispositivein?
a)Perthe'sdisease
b)SCFE
c)DDH
d)CTEV
CorrectAnswer-C
Ans.is'c'i.e.,DDH
RadiologicalfeaturesofDDH/CDH
InVonRosen'sviewfollowingparametersshouldbenoted.
1. Perkin'sline:Verticallinedrawnattheouterborderofacetabulum
2. Hilgenreiner'sline:Horizontallinedrawnattheleveloftri-radiate
cartilage
3. Shenton'sline:Smoothcurveformedbyinferiorborderofneckof
femurwithsuperiormarginofobturatorforamen.
4. Acetabularindex:Normallyis30?
5. CEangleofWiberg:Normalvalueis15-30?
Normallytheheadliesinthelowerandinnerquadrantformedby
twolines(Perkin's&Hilgenreiner's).IuDDHtheheadliesinouter&
upperquadrant
Shenton'slineisbroken
Delayedappearance&retardeddevelopmentofossificationofhead
offemur
Slopingacetabulum
Superior&lateraldisplacementoffemoralhead
Von-Rosen'sline
Thisisaline,whichhelpsinthediagnosisofDDHininfantsless
than6months.
ForthisAPviewofpelvisistakenwithbothlowerlimbin45?

---

abductionandfullinternalrotation.
Upwardprolongationoflongaxisofshaftofthefemurpoints
towardsthelateralmarginoftheacetabulumandcrossesthepelvis
intheregionofsacroiliacjoint.
InCDH,upwardprolongationofthislinepointstowardsanterior
superioriliacspineandcrossesthemidlineinthelowerlumber
region--->PositiveVon-Rosen'ssign.

---

1526.SplintusedinCTEVaftercorrection?
a)Bohler-Brownsplint
b)Thomassplint
c)DennisBrownsplint
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,DennisBrownsplint
TreatmentofCTEVatbirth
Ideallytreatmentshouldbebegunimmediatelyafterbirth,certainly
notmorethan1weeklater
Theprinciplesoftreatmentare:-
1.Correctionofdeformitybymanipulation
2.Maintenanceofthiscorrectionbyimmobilizingthefootinover-
correctedpositioninbetweenthemanipulations.Threemethodsare
availableformaintenance:-
1. Aplasterofpariscast(mostcommonlyused)
2. Metalsplints(Denisbrownsplint)
3. Adhesivestrapping
Amongthese,retentioninaplasterismuchtobepreferred,because
itholdsthefootintheover-correctedpositionmoreefficientlyandfor
alongerperiodthandometalsplintsorstrapping.
Theplastermustextendtotheupperthigh,withthekneeflexed90?.
Theplastermustbechangedeveryweekforthefirst6weeksand
thenevery2weeksuntilthecorrectionisachieved.

---

1527.Salter'spelvicosteotomyisdonefor
treatmentof?
a)CTEV
b)SCFE
c)DDH
d)None
CorrectAnswer-C
Ans.is'c'i.e.,DDH
TreatmentofCDH/DDH
TheaimoftreatmentinDDHistoachieveandmaintainanearly
concentricreductionandmaintainituntilthehipbecomesclinically
stableandaroundacetabulumcoverit.
Treatmentplanisaccordingtotheage:?
1. 1-6monthsofage:-Pavilkharnessand/orVon-rosensplintare
usedtomaintainthereduction.Ifdislocationpersists,closed
reductionortractionfollowedbycastingisdone.
2. 6-18monthsofage:-Closedreductionortractionfollowedby
casting.Ifclosedreductionfails,openreductionfollowedbycasting
isrecommended.
3. 18months-3years:-Openreductionwithfemoralshortening(if
femoralsiteisinvolved)orsalterasteotomy(ifacetabulumis
involved).
4. 3-8years:-Openreductionwithfemoralshorteningwithorwithout
acetabularreconstructiveosteotomy.
Acetabularreconstructionproceduresare:-
1. Salter'sosteotomy
2. Chiari'spelvicdisplacementosteotomy
3. Pemberton'spericapsularosteotomy

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---

1528.Rockerbottomfootisdueto?
a)OvertreatmentofCTEV
b)Malunitedfracturecalcaneum
c)Horizontaltalus
d)Neuraltubedefect
CorrectAnswer-A
Ans.is'a'i.e.,OvertreatmentofCTEV
Rockerbottomfoot
Rockerbottomfootisafootwithaconvexplantarsurfacewithan
apexofconvexityatthetalarhead(normalplantarsurfaceis
concave).CausesofRockerBottomfootare:-
1. Congenitalverticaltalus
2. OvercorrectionofCTEV
3. ImpropercorrectionofCTEV,i.e.forcefulcorrectionofequinesby
dorsiflexionbeforecorrectionofadduction,varusandinversion.
4. Edward'ssyndrome,Escobarsyndrome,Apert'ssyndrome.
Congenitalverticaltalusmaybeassociatedwitharthrogryposis,
Prunebellysyndrome,neurofibromatosis,andspinalmuscular
dystrophy

---

1529.DeformityintransientsynovitisofHip?
a)Abduction
b)Flexion
c)Externalrotation
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
TransientsynovitisofHip
Transientsynovitisofhipisalsoknownasobservationhip,toxic
synovitisorirritablehip.Itsaself-limiting,inflammatoryconditionof
thesynovium,thatlastsonlyashorttime(thereforeknownas
transient)Itisthemostcommoncauseofhippainandlimpin
childrenunder10yrsofage.Causeisnotknownbutassociation
hasbeenseenwitharecenthistoryofanupperrespiratorytract
infection.
Presentationiswithhippainorlimp.Thelimbisinattitudeofslight
flexion,abductionandexternalrotation.Thechildmayhavelow
gradefever.TheESR,C-Reactiveprotein&WBCscountarenormal
(ThisdifferentiatesTransientsynovitisfromSepticarthiritisaserious
condition,inwhichpatienthashighgradefeverandelevatedESR,
C-ReactiveproteinandWBCcount).Radiographorultrasoundmay
showwideningofthejointspaceHowever,mostofthetimex-rayis
normal.
Usuallythetreatmentofaclinicallysuspectedcaseoftransient
synovitisofhipisBedrest,NSAIDSandobservation.
USGguidedaspirationisindicatedfor:-
1. Temperature>99.5?F
2. ESR>20(RaisedESR)

---

3. SeverehippainwithROM

---

1530.Commonfracturesinchildrenareall
except?
a)Lacteralcondylehumerus
b)Supracondylarhumerus
c)Fractureofhand
d)Radius-ulnafracture
CorrectAnswer-C
Ans.is'c'i.e.,Fractureofhand
Commonfracturesinchildren
1. Forearmbonesfractures
2. Supracondylarfractureofthehumerus
3. Fractureoflateralcondyleofhumerus
4. Epiphysealinjuries
5. Spiralfractureoftibialshaft

---

1531.ThurstonHollandsignisseenin?
a)TypeI
b)TypeII
c)TypeIII
d)TypeIV
CorrectAnswer-B
Ans.is'b'i.e.,TypeII
Epiphyseal(PhyseallInjuries
oThejunctionbetweenthemetaphysisandepiphysis,i.e.physeal
plate/growthplate,istheweakestpointofalongboneinchildren
andis,therefore,mostvulnerabletoshearingforces.
oSalterandHarrishaveclassifiedepiphysealinjuriesintofivetypes
?
TypeI:Completeseparationofepiphysisfromthemetaphysis
withoutfracture.Commoninrickets,scurvyandosteomyelitis.
TypeII:Thefractureinvolvesthephysisandatriangleof
metaphysealbone(ThurstonHollandsign).Thisisthecommonest
typeofepiphysealinjuryaccountingfor73percentofcasesover10
yearsofage.
TypeIII:Thefractureisintra-articularandextendsalongthephysis
andthenalongthegrowthplate.Thisinjuryisrelativelyuncommon.
TypeIV:Thefractureisintra-articularandextendsthroughthe
epiphysis,physisandmetaphysis.Perfectreductionisnecessary
andopenreductionismoreoftennecessarytopreventgrowth
arrest.
TypeV:Crushingofepiphysis.Growtharrestusuallyfollows.
TypeVI(Rang'stype):Thereisaperipheralphysis(perichondrial
ring)injury.

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---

1532.Pictureframevertebraisseenin?
a)Paget'sdisease
b)Osteopetrosis
c)Osteoporosis
d)Ankylosingspondylitis
CorrectAnswer-A
Ans.is'a'i.e.,Paget'sdisease
RadiologicalfeaturesofPaget'sdisease
Radiographicfeaturesdependonthestageofthedisorder:?
A.Intheearlyosteolyticphase
Activeboneresorptionisevidentasaradiolucentwedgedareain
longbonestermedas'candleflame'or`bladeofgrass'.
Intheflatbonessuchasthecalvariumortheiliacbone,purely
osteolyticlesionisnoted,knownasosteoporosiscircumscripta.
B.Laterphasesofnewboneformation
Boneremodellingappearsradiographicallyasthickeningofthe
cortex,coarsetrabeculationandenlargementorexpansionofan
entireboneorareaofalongbone.
Vertebralcorticalthickeningofthesuperiorandinferiorendplates
createsa'pictureframevertebra'.
Diffuseradiodenseenlargementofavertebraisreferredtoas'ivory
vertebra'.
Skullx-rayshowsfocalpatchydensities-cottonballappearance,
whichisquitecharacteristicofPagetdisease.
Pelvicradiographdemonstratedisruptionoffusionofthesaro-iliac
jointsandsofteningwithprotrusioacetabuli.
Longbonesrevealbowingdeformitiesandtypicalpageticchanges
ofcorticalthickeningandexpansionandareasoflucencyand

---

sclerosis.

---

1533.AllarefeaturesofPaget'sdisease
except?
a)Defectinosteoclasts
b)Commoninfemale
c)Cancausedeafness
d)Cancauseosteosarcoma
CorrectAnswer-B
Ans.is'b'i.e.,Commoninfemale
Pagetdisease
Paget'sdiseaseischaracterizedbyincreasedboneturnoverand
enlargementandthickeningofthebone,buttheinternalarchitecture
isabnormalandtheboneisusuallybrittle.Primarydefectisin
osteoclastswithincreasedosteoclasticactivity.Thisresults
secondarilyincreaseinosteoblasticactivity(normalosteoclastsand
osteoblastsactinaco-ordinatedmanner).So,characteristiccellular
changeisamarkedincreaseinosteoclasticandosteoblastic
activity.Boneturnoverisacclerated,plasmaalkalinephosphataseis
raised(asignofosteoblasticactivity)andthereisincreased
excretionofhydroxyprolineinurine(duetoosteoclasticactivity).
ClinicalfeaturesofPaget'sdisease
Paget'sdiseaseisslightlymorecommoninmalesandisseenafter
40yearsofage.
Thepelvisandtibiabeingthecommonestsites,andfemur,skull,
spine(vertebrae)andclaviclethenextcommonestoMostofthe
patientwithPaget'sdiseaseareasymptomatic,thedisorderbeing
diagnosedwhenanx-rayistaken
forsomeunrelatedconditionoraftertheincidentaldiscoveryof
raisedserumalkalinephosphatase.

---

Whenpatientsdoespresent,theypresentbecauseanyofthethree:
-
1. Pain:-Dullconstantache
2. Deformities:-Bowingoflongbones,platybasia.
3. Complicationsofthedisease
ComplicationsofPaget'sdisease
FollowingcomplicationscanoccurinPaget'sdisease:-
1. Fracture:Arecommoninweightbearingbones
2. Cranialnervecompression:-Maycauseimpairedvision,facial
palsy,trigeminalneuralgiaordeafness.
3. Otosclerosis:-AnothercauseofdeafnessinPaget'sdisease.
4. Spinalcanalstenosisandnerverootcompression
5. Highoutputcardiacfailure
6. Osteoarthritis:ofHipandknee
7. Rarelyosteosarcoma

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1534.Allaretrueaboutchronicosteomyelitis
except?
a)Reactivenewboneformation
b)Cloacaisanopeningininvolucrum
c)Involucrumisdeadbone
d)Sequestrumishardandporus
CorrectAnswer-C
Ans.is'c'i.e.,Involucrumisdeadbone
Pathologyinchronicosteomyelitis
Chronicosteomyelitisoccursmostcommonlyinlongbones.Boneis
destroyedordevitalizedintheaffectedpart.Cavitiescontainingpus
andpiecesofdeadbone(sequestra)aresurroundedbyvascular
tissue,andbeyondthatbyareasofsclerosisduetoreactionnew
boneformation,whichmaytaketheformofadistinctbonysheath
(involucrum)Oftensinustrackleadstotheskinsurface;thesinus
tendstohealandpresentdownrecurrently,butifasequestrumis
presentitneverhealspermanently.Thisisbecausesequestraact
assubstrateforbacterialadhesioninmuchthesamewayasforeign
implants,ensuringthepersistenceofinfectionuntiltheyare
removedordischargedthroughperforationsintheinvolucrumand
sinusesthatdraintotheskin.
Sequestrum
Sequestrumisapieceofdeadbone,surroundedbyinfected
granulationtissuetryingtoeatthesequestrumaway.
Thesequestrumishard,rough,porus,lightinweightandlighterin
colourthannormal.Normalpatternofboneislost.(Note:
SequestruminsyphilisandTBisheavierthannormalbonebecause
sclerosisusuallyprecedesthedeathofthebone).

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Onx-ray,sequestrashowupasunnaturaldensefragments,in
contrasttothesurroundingosteopenicbone.
Involucrum
Involucrumisreactivenewboneoverlyingasequestrum.
Theremaybesomeholesintheinvolucrumforpustodrainout.
Theseholesarecalledcloaca.

---

1535.Brodie'sabscessis?
a)Acuteosteomyelitis
b)Subacuteosteomyelitis
c)Chronicosteomyelitis
d)Septicarthritis
CorrectAnswer-C
Brodie'sabscessisasub-acuteformofosteomyelitis,presentingas
acollectionofpusinbone,oftenwithaninsidiousonset.
Classically,thismaypresentafterprogressiontoa
drainingabscessextendingfromthetibiaoutthroughtheskin.
Occasionallyacuteosteomyelitismaybecontainedtoalocalized
areaandwalledoffbyfibrousandgranulationtissue.Thisis
termedBrodie'sabscess.
MostfrequentcausativeorganismisStaphylococcusaureus.
Usuallyoccursatthemetaphysisoflongbones.Distaltibia,proximal
tibia,distalfemur,proximalordistalfibula,anddistalradius.
Brodie'sabscessisbestvisualizedusingcomputed
tomography(CT)scan.
Associatedatrophyofsofttissuenearthesiteofinfectionand
shorteningoftheaffectedbone.Osteoblastomamaybeaclassic
signforBrodie'sabscess.
Inthemajorityofcases,surgeryhastobeperformed.
Ifthecavityissmallthensurgicalevacuationandcurettageare
performedunderantibioticcover.
Ifthecavityislargethentheabscessspacemayneedpacking
withcancellousbonechipsafterevacuation.

---

1536.PoorprognosticindicatorofPott's
paraplegia
a)Earlyonset
b)Activedisease
c)Healeddisease
d)Wetlesion
CorrectAnswer-C
Ans.is'c'i.e.,Healeddisease
PrognosisofPott'sparaplegia
Good
Poor
DegreePartial(onlysensoryormotor)
Completeparaplegia(gradeIV)
DurationShorter
Longer(>12months)
TypeEarly(acute)onset
Late(chronic)onset
SpeedofonsetSlow(insidious)
Rapid(sudden)
AgeYoungerOld
GeneralconditionGood
Poor
VertebraldiseaseActive
Healed
Kyphoticdeformity<600>
60?
CordonMRINormal

---

Myelomalaciaorsyringomyelia
PreoperativeWetlesionDry
lesion

---

1537.Aspiratedsynovialfluidinseptic
arthritiswillhave?
a)Clearcolor
b)Highviscosity
c)Markedlyincreasedpolymorphonuclearleukocytes
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Markedlyincreasedpolymorphonuclearleukocytes
Appearance-Purulent
Clarity-Opaque
Viscocity-Decreased
Cellcount->80000(>80%PMNs)
Example-Bacterialarthritis

---

1538.Motheatenboneis?
a)Osteoidosteoma
b)Multiplemyeloma
c)Eosinophilicgranuloma
d)Chondromyxoidfibroma
CorrectAnswer-B
Ans.is'b'i.e.,Multiplemyeloma
Patternsofbonedestructionpresentinalyticlesion?
1. Geographic:Sharpclearlydefinedmargins.Lessaggressive,
benign.Eg:nonossifyingfibroma,chondromyxoidfibroma,
eosinophilicgranuloma.
2. Motheatenappearance:Holesindestroyedbone.Rapidgrowth,
malignantEg:Myeloma,metastasis,lymphoma.
3. Permeative:Illdefined,diffuse,somewhatsubtledestructive
processofbone.Eg:Lymphoma,leukemia,Ewing'ssarcoma,
osteomyelitis.

---

1539.Allaretrueaboutaneurismalbonecyst
except?
a)Eccentric
b)Expansile&lytic
c)Treatedbysimplecurettage
d)Metaphysisoflongbones
CorrectAnswer-C
Ans.is'c'i.e.,Treatedbysimplecurettage
Aneurysmalbonecyst
Aneurysmalbonecystoccurinchildrenandyoungadults(5-20
years).
Thetermaneurysmalisusedbecauseitcausesexpansionof
overlyingcortexlikevascularexpansionofananeurysm.
Themetaphysisoflongbonesisinvolvedmostcommonly.Most
commoninfemurandtibia;howeveranylongbonecanbeinvolved.
Othercommonsitesareposteriorelementsofvertebraeandpelvis.
athology
Cysticspacesofvariablesizes&numberwhicharefilledwithblood
butnotlinedwithvascularendothelium.Thewallofvascularspace
islinedwithfibroblastcellswithcollagen,giantcells,hemosiderin&
osteoid(secondarytomicrofractures).
Clinicalfeatures
Withexpandinglesions,painmaybeapresentingfeature.
Largecystcanalsocauseswelling
Pathologicalfracturemayoccur(butlessfrequentthansimplebone
cyst).
Radiologicalfeaturesofaneurysmalbonecyst
Eccentric,expansileosteolyticlesion

---

Thecharacteristicfeatureis'blown-out'distensionofonesurfaceof
thebone.
Overlyingcortexmaybeintactordisrupted.
Extensivesclerosisattheinterfacebetweennormalandexpanded
cortex(buttersing)maybepresent.
Delicatethintrabeculaeischaracteristicandanexpansileballooning
lesionmayproducea'soap-bubbleappearance'.
Lesionoccursatmetaphysisoflongbones.Othercommonlocations
includetheposteriorelementsofthespine(pedicle,lamina,
transverseprocess,spinousprocess)andpelvis.
Treatment
Surgeryisthetreatmentofchoice.Curettageandbonegraftingis
theprocedurecommonlyfollowed.

---

1540.Commonestmalignanttumorofskeletal
system?
a)Multiplemyeloma
b)Metastasis
c)Osteosarcoma
d)Chondrosarcoma
CorrectAnswer-B
Ans.is`b'i.e.,Metastasis
CommonestbonemalignanciesSecondaries
CommonestprimarymalignanttumorA-Multiple
myeloma
Commonestprimarymalignanttumor
Osteosarcoma
oflongbones
Commonestbenigntumorofbone-
Osteochondroma
(Osteochondromaisnottrueneoplasmsinceitsgrowthstopswith
cessationofgrowthattheepiphysealplate)
Commonesttruebenigntumorofbone
Osteoidosteoma
Commonestbenigntumorofhand
Enchondroma

---

1541.Allarecommonsitesofprimaryfor
bonemetastasisexcept
a)Breast
b)Breast
c)Brain
d)Brain
CorrectAnswer-C
Ans.is`c'i.e.,Brain
Metastaticbonediseaseisthecommonestmalignancyofbonesand
ismuchmorecommonthanprimarybonetumors.
Thecommonestsitesforbonemetastasesarevertebrae(most
common),pelvis,theproximalhalfofthefemurandthehumerus.
Extremitiesdistaltoelbowandkneeareleastcommonlyinvolved
sites.
Spreadisusuallyviathebloodstream;occasionally,visceraltumors
spreaddirectlyintoadjacentbonese.g.,thepelvisandribs.
Certaintumorsareknowntobecommonsourcesofbone
metastasis.
Thefollowingprimarytumorsarethemostcommontometastasize
inthebone;breast,prostate,lung,thyroid,kidney,and
gastrointestinaltract.
Thecommonestsourceofmetastaticbonediseaseiscarcinomaof
thebreast
Inmalesmostcommonsourceisprostatecarcinoma.
Bladderanduterinecarcinomasarelesscommonsources.
Inchildren,skeletalmetastasesoriginatefromneuroblastoma,
Ewing'ssarcoma,andosteosarcoma.

---

---

1542.Whichofthefollowingisleastlikely
associatedwithvascularinjury?
a)Fracturesupracondylarfemur
b)Fracturesupracondylarhumerus
c)Fractureshaftoffemur
d)Fractureshiafthumerus
CorrectAnswer-D
Ans.is'd'i.e.,Fractureshafthumerus
Vascularinjurymaybeseenin-
1. Fracturesupracondylarhumerus--->Brachialartery
2. Fractureshaftfemur(especiallydistal3rd)--->Poplitealartery
3. Fracturesupracondylarfemur-->Poplitealartery

---

1543.Exsanguinatingbloodlossin?
a)Closedhumerusfracture
b)Closedtibiafracture
c)Openfemurfracture
d)Openhumerusfracture
CorrectAnswer-C
Ans.is'c'i.e.,Openfemurfracture
Exsanguinationistheprocessofbloodloss,toadegreesufficientto
causedeath.
Shaftfemurfractureoutoftheaboveisassociatedwithmaximum
bloodlossandmorebloodlossisexpectedincasesofopen
fracture.Thus,themostprobableanswerisopenfractureshaft
femur.
Twoimportantfractureswhichcancausesignificantbloodlossare-
1. Fracturepelvis
2. Fractureshaftfemur

---

1544.DrippingCandleWaxlesiononspine?
a)Metastasis
b)TBspine
c)Osteopterosis
d)Melorheostosis
CorrectAnswer-D
Ans.is'd'i.e.,Melorheostosis
Melorheostosis
Melorheostosisisamedicaldevelopmentaldisorderand
mesenchymaldysplasiainwhichthebonycortexwidensand
becomeshyperdenseinasclerotomaldistribution.
CausedbyamutationoftheLEMD3gene.
Canbedetectedbyradiographduetothickeningofbonycortex
resembling"drippingcandlewax".
Disordertendstobeunilateralandmonoostotic,withonlyonelimb
typicallyinvolved.Caseswithinvolvementofmultiplelimbs,ribs,and
bonesinthespinehavealsobeenreported.
Therearenoreportedcasesofinvolvementofskullorfacialbones.
Melorheostosiscanbeassociatedwithpain,physicaldeformity,skin
andcirculationproblems,contractures,andfunctionallimitation.Itis
alsoassociatedwithabenigninnereardysplasiaknownas
osteosclerosis.

---

1545.Bunioniscommonlyseenat?
a)GreattoeMTPjoint
b)Medialmalleolus
c)LateralMalleolus
d)Shinoftibia
CorrectAnswer-A
Ans.is'a'i.e.,GreattoeMTPjoint
Bunion
Ahalluxabductovalgusdeformity,commonlycalledabunion,isa
deformitycharacterizedbylateraldeviationofthegreattoe,often
erroneouslydescribedasanenlargementofboneortissuearound
thejointattheheadofthebigtoe.
Thebumpitselfispartlyduetotheswollenbursalsacoranosseous
(bony)anomalyonthemetatarsophalangealjoint.Thelargerpartof
thebumpisanormalpartoftheheadofthefirstmetatarsalbone
thathastiltedsidewaystostickoutatitstop.

---

1546.Ischialbursitisisalsoknownas?
a)Clergyman'sknee
b)Housemaid'sknee
c)Weaver'sbottom
d)Studentselbow
CorrectAnswer-A
Ans.is'c'i.e.,Weaver'sbottom
Prepatellar
Hr?,1semaid's
bursitis
knee
Infrapatellar
Clergyman's
bursitis
knee
Olecranon
Student's
bursitis
elbow
Weaver's
Ischia]bursitis bottom
Onlateral
Tailor'sankle
malleolus
Ongreattoe
Bunion

---

1547.Mostcommonsiteofmyositis
ossificans?
a)Knee
b)Elbow
c)Shoulder
d)Wrist
CorrectAnswer-B
Ans.is'b'i.e.,Elbow
Myositisossificansistheextraskeletalhetrotropicossificationthat
occursinmusclesandothersofttissues.
Traumaisthemostimportantcauseofmyositisossificans.
Usuallythereishistoryofseveresingleinjury.
Itismorecommoninchildren.
Mostcommonlyinvolvedjointiselbowfollowedbyhip.
Thereishistoryoftraumaaroundtheelbow,i.e.fracture
supracondylarhumerus,dislocationofelboworsurgerywith
extensiveperiostealstripping.
Massagetotheelbowandvigorouspassivestretchingtorestore
movementsareaggravatingfactor.
Itoccursinmuscleswhicharevulnerabletotearunderheavyloads,
suchasquadriceps,adductors,brachicilis,biceps,anddeltoid.
X-rayfindingischaracteristicandshowsdistinctperipheralmarginof
matureossificationandaradiolucentcenterofimmatureosteoid&
primitivemesenchymaltissue

---

1548.Turn-bucklecastisusedfor?
a)Fractureshafthumerus
b)Fractureshaftfemur
c)Scoliosis
d)Cervicalspineinjury
CorrectAnswer-C
Ans.is'c'i.e.,Scoliosis.
NameofthecaseUse
MinervacastCervicalspinedisease
Risser'scastScoliosis
Turn-bucklecastScoliosis
ShoulderspicaShoulderimmobilisation
U-slabFractureofthehumerus
HangingcastFractureofthehumerus
Colle'scastColles'fracture
HipspicaFractureofthefemur
CylindercastFractureofthepatella
PTBcastFractureofthetibia

---

1549.Whichofthefollowingisanorthopedic
emergency?
a)Intraarticularfracture
b)Septicarthritis
c)Fracturelateralcondylehumerus
d)Fractureneckfemur
CorrectAnswer-B
Ans.is'b'i.e.,Septicarthritis
Timingofsurgery
Fracturesurgerycanbedividedintoemergency,urgencyorelective.
Emergency
Emergencysurgeryisimmediateforlifeandlimbthreatening
problems.Examplesare:-
1. Fractureordislocationwithvascularinjury.
2. Fractureswithcompartmentsyndrome
3. Irreducibledislocationorfracturedislocationofmajorjoint.
4. Compound(open)fractures
5. Septicarthritis
6. Spinalinjurieswithdeterioratingneurologicaldeficity.
Urgency
Urgentsurgeryisthesurgery,whichshouldbedoneearly(within
12-36hours),butafterarrangingpropersurgicalfacilities,Important
examplesare:-
1. Intra-articularfractures
2. Fractureneckfemur
3. Fracturelateralcondylehumerusinchildren.
4. Displacedsupracondylarfracturehumerusinchildren.
Elective

---

Electivesurgeryisplannedproperlyandcanbedoneevenafter
somedelay(3-4daysto3-4weeks).
Mostofthesurgeriesinorthopaedicsareelective.Exampleare:-
1. Closedfracturelongbone
2. ITfracture
3. Mostoftheorthroscopicprocedures
4. Arthroplasty

---

1550.Maximumweightthatcanbegivenwith
skeletaltractionis:
September2009
a)5kg
b)10kg
c)15kg
d)20kg
CorrectAnswer-D
Ans.D:20kg
Tractionisusuallyappliedtothespine,pelvis,neck,arms,orlegs.
Theforceisgeneratedbyweightorforceagainsttheweightofthe
body.
Thetwomaintypesoftractionareskintractionandskeletaltraction.
Ofthesetwotypes,manyspecializedformshavebeendevelopedto
treatconditionsinspecificpartsofthebody.
Withskintraction,weightsareattachedtotheskin,whichapplies
thepullingforcetothebone.Itisusedwhenlight(3to4kg)or
short-termtractionisneeded.
Withskeletaltraction,pinsareattachedtothebonesothatthe
pullingforceisapplieddirectlytothebone.Skeletaltractionisused
whenskintractionisnotpossibleandwhengreaterweight(upto20
kg)isneeded.

---

1551.Whicharthritiscausesnoperiosteal
reaction
a)Psoriaticathritis
b)Reactivearthritis
c)Neropathicarthritis
d)Rheumatoidarthritis
CorrectAnswer-D
Answer-D.Rheumatoidarthritis
ArthritiswithPeriostealReactionarePsoriaticarthritis,Reactive
ArthritisAndNeuropathicArthropathy.

---

1552.Pencilincupdeformityisseenin?
a)Rheumatoidarthritis
b)Ankylosingspondylitis
c)AVN
d)Psoriaticarthritis
CorrectAnswer-D
Ans.is`Di.e.,Psoriaticarthritis
Gull'swingappearance-Psoriaticarthritis
Operaglassdeformity-Psoriaticarthritis
Cupandpencildeformity-Psoriaticarthritis

---

1553.Windsweptdeformityinfootisseenin
?
a)Rickets
b)RA
c)Hyperparathyroidism
d)Scurvy
CorrectAnswer-B
Ans.is'b'i.e.,RA
Windsweptdeformity
1. Knee:-Avalgusdeformityofonekneeinassociationofvarus
deformityofotherkneeisknowaswindsweptdeformity.Itisseenin
:Rickets,Physealoseochondromatosis,Hereditarydysplasia
(epiphysealdysplasia)ofboneandRheumatoidarthritis.
2. Foot:-Deviationofall-toesinonedirection(usuallylaterally)is
knownaswindsweptdeformity.ItisseeninRheumatoidarthritis.
3. Hand:-Deviationofallfingers(usuallymedialy)isknowas
windsweptdeformity.ItisseeninRheumatoidarthritis,SLE,and
Jacoud'sarthropathy.

---

1554.Mostcommonsiteofosteochondritis
dessicans?
a)Lateralpartofthemedialfemoralcondyle
b)Medialpartofthemedialfemoralcondyle
c)Lateralpartofthelateralfemoralcondyle
d)Medialpartofthelateralfemoralcondyle
CorrectAnswer-A
Ans.is'a'i.e.,Lateralpartofthemedialfemoralcondyle
JointSiteofosteochondritisdessicans
KneeLateralsurfaceofthemedialfemoralcondyle
ElbowCapitulumofhumerus
HipFemoralhead
AnkleTalus

---

1555.Whichcancauseloosebodyinthejoint
-
a)RA
b)Ankylosingspondylitis
c)OA
d)SLE
CorrectAnswer-C
Ans.is'c'i.e.,OA
Causesofloosebodiesinclude:-
1. Osteoarthritis
2. Osteochondritisdessicans
3. Osteochondralfracture(injury)
4. Synovialchondromatosis
5. Charcot'sdisease
Amongthese,osteochondralfracturecausessingleloosebodies,
whileallothercancausemultipleloosebodies,maximumby
synovialchondromatosis(uptohundrades).

---

1556.Mostcommoncauseofneuropathic
joint?
a)Leprosy
b))Tabesdorsalis
c)Diabetes
d)Nerveinjury
CorrectAnswer-C
Ans.is`c'i.e.,Diabetes
Neuropathicjoint(Charcot'sjoint)
oItisaprogressivedestructivearthritisassociatedwithlossofpain
sensationx,proprioceptionorboth,inadditionnormalmuscular
reflexesthatmodulatejointmovementsaredecreased.
Withouttheseprotectivemechanisms,jointsaresubjectedto
repeatedtrauma,resultinginprogressivecartilageandbone
damage.
oItismostcommonlycausedbydiabetesmellitus.
CausesofNeuropathicjointdisease(Charcoat'sjoint)
CausesofNeuropathicjointdisease(Charcoat'sjoint)
Diabetesmellitus Amyloidosis
(mostcommon)
TabesDorsalis
Leprosy
Congenital
Meningomyelocele indifference
topain
Peroneal
Syringomyelia
muscular
atrophy

---

---

1557.Insal-Salvatiindexisusedfor?
a)Olecranon
b)Patella
c)Talus
d)Scaphoid
CorrectAnswer-B
Ans.is'b'i.e.,Patella
Tworadiologicalindicesarecommonlyusedfordeterminingthe
positionofpatella-
Insall-Salvatiindex
1. Itistheratioofpatellartendonlengthtopatellalength.
2. Normallyitis1-0.
3. Anindexof1.2ormoreisseeninpatellaalta(highridingpatella).
4. Anindexof0.8orlessisseeninpatellabaja(lowlyingpatella).
Blackbume-Peellindex
1. Itistheratioof(i)thedistanceoftibialplateautoinferiorarticular
surfaceofpatella(numerator),to(ii)lengthofarticularsurfaceof
patella(denominator).
2. Normallyitis0.8.
3. Anindexof1ormoreisseeninpatellaalta.

---

1558.Anterolateralarthroscopyofkneeisfor
?
a)Toseepatellafemoralarticulation
b)Toseetheposteriorcruciateligament
c)Toseetheanteriorportionoflateralmeniscus
d)Toseetheperipheryoftheposteriorhornofmedial
CorrectAnswer-A
Ans.is'a'i.e.,Toseepatellafemoralarticulation
StandardPortalsInKneeArthroscopy:
Anterolateralportal?
1. Almostallthestructureswithinthekneejointcanbeseenexcept
theposteriorcruciateligament,theanteriorportionofthelateral
meniscusandtheperipheryoftheposteriorhornofthemedial
meniscusintightknees.
2. Located1cmabovethelateraljointlineand1cmlateraltothe
marginofthepatellartendon.
Anteromedialportal?
1. Usedforadditionalviewingoflateralcompartmentandinsertionof
probeforpalpationofmedialandlateralcompartmentstructures.
2. Placed1cmabovethemedialjointline,1cminferiortothetipof
patella,and1cmmedialtotheedgeofthepatellartendon.
Posteromedialportal?
1. Locatedonthesofttriangularsoftspotformedbytheposteromedial
edgeofthefemoralcondyleandtheposteromedialedgeoftibia.
2. Usedforviewingtheposteromedialstructuresandforrepairor
removalofthedisplacedposteriorhornofmeniscaltearsandfor
posteromedialloosebodyremoval.
Superolateralportal-

---

1. Usedfordiagnosticallyviewingthedynamicsofpatello-femoral
joint,excisionofmedialplicae.
2. Locatedjustlateraltothequadricepstendonandabout2.5cm
superiortothesuperolateralcornerofpatella.

---

1559.Halopelvictractionisusedfor
correctingwhichdeformity
a)Spine
b)PectusCarinatum
c)Spondyloptosis
d)CoxaVara
CorrectAnswer-A
Ans.is'a'i.e.,Spine
Head-pelvicskeletaltractionwasfirstattemptedin1958.Withthe
descriptionofthe"halo"skulltractionapparatusbyPerryandNickel
(1959),amethodwasprovidedforimmobilisingtheunstablecervical
spine.Fromthisdeveloped"halo-femoral"traction,nowusedby
somesurgeonsforthecorrectionofspinaldeformitiesbeforeand
afteroperation.

---

1560.Short4thmetacarpalisafeatureof
a)Hyperparathyroidism
b)Hyperparathyroidism
c)Pseudohypoparathyroidism
d)Scleroderma
CorrectAnswer-C
Ans.is`c'i.e.,Pseudohypoparathyroidism
Short41kmetacarpal/metatassal(metacarpalsign)
Post-traumatic
Postinfection(fromsicklecellanemia)
Turner'ssyndrome
Pseudohypoparathyroidism
Pseudopseudohypoparathyroidism
Hereditarymultipleexostosis
Chondroectodermaldysplasia(Ellis-vanCreveldsyndrome)

---

1561.Frozenpelvisisseenin?
a)Osteoarthritis
b)Pottsdisease
c)Actinomycosis
d)Reitersdisease
CorrectAnswer-B
Ans.is'b'i.e.,Pottsdisease
Atermforsignificantinvolvementofthepelvicfloorbymalignancy,
usuallycarcinoma,orttuberculosis;inwhichthereismassive
extensionofpathologytotheurinarybladder,femalegenitaltract,
andsigmoidcolon.Adequateresectionofafrozenpelvisisvirtually
impossible;chemotherapyandradiationtherapyarepalliativeat
best.

---

1562.Allaretrueaboutconstrictionring
except?
a)Alsocalledschroeder'sring
b)Canbecausedbyinjudiciousoxytocinuse
c)Ringcanbepalpatedperabdomen
d)Inhalationofamylnitraterelaxesthering
CorrectAnswer-C
Ans,C.Ringcanbepalpatedperabdomen

---

1563.21yrcollegegirlwithmild
endometriosistreatment-
a)CyclicalOCpill
b)ContinuousOcpill
c)Progesteroneonlypill
d)Danazole
CorrectAnswer-A
Ans,A.CyclicalOCpill

---

1564.Notseeninendometriosis?
a)Vaginaldischarge
b)Dysparenuria
c)Infertility
d)Chronicpelvicpain
CorrectAnswer-A
Ans.A.Vaginaldischarge
ClinicalfeaturesofEndometriosis
Pain
Infertility
Dysmenonhea
Dyspareunia(deep)

---

1565.USGof28weeksgestationshowing
oligohydramniosislikelytobedueto?
a)Gastroinstestinalobstruction
b)Renalpathwayobstruction
c)Anencephyaly
d)Neuromusculardisorder
CorrectAnswer-B
Ans,B.Renalpathwayobstruction
Urinarytractobstructionisanimportantcauseofoligohydramnios.

---

1566.AnovulatoryDUBisdueto?
a)Absenceofprogesterone
b)Excessofestrogen
c)Hypothalmicpitutarydefect
d)Highprogesterone
CorrectAnswer-A
Ans.A.Absenceofprogesterone
Noprogesteroneisproducedwhenovulationdoesnotoccur,and
thusproliferativeendometriumpersists.
Atthetissuelevel,persistentproliferativeendometriumisoften
associatedwithstromalbreakdown,decreasedspiralarteriole
density,andincreaseddilatedandunstablevenouscapillaries.
Atthecellularlevel,theavailabilityofarachidonicacidisreduced,
andprostaglandinproductionisimpaired.
Forthesereasons,bleedingassociatedwithanovulationisthought
toresultfromchangesinendometrialvascularstructureandin
prostaglandinconcentration,andfromanincreasedendometrial
responsivenesstovasodilatingprostaglandins.

---

1567.Incarcinomacervixsurgerytoretain
conceptionisdoneinwhichstage?
a)1B1
b)1B2
c)2A
d)2B
CorrectAnswer-A
Ans.A.1B1
ConceptsisretaineduptotermonlyinstageIA1.
Inotherstages,hysterectomyisdonewithfetusleftinsitu(ifitisnot
viable);ordeliveryoffetusbyclassiccesareanhysterectomy
followedbyradiation(iffetusisviable).

---

1568.Bishopscoringisdonefor?
a)Exchangetransfusioninnewborn
b)Inductionoflabour
c)VentilationofNewborn
d)GestationofNewborn
CorrectAnswer-B
Ans.B.Inductionoflabour
Bishopscore,alsoBishop'sscore,alsoknownascervixscoreisa
pre-laborscoringsystemtoassistinpredictingwhetherinductionof
laborwillberequired.

---

1569.Teratozoospermiarefersto?
a)Absenceofsemen
b)Absenceofsperm
c)Alldeadspermsinejaculate
d)Morphologicallydefectivesperms
CorrectAnswer-D
Ans.D.Morphologicallydefectivesperms

---

1570.Ovarianreserveisbestindicatedby
a)LH
b)FSH
c)LH/FSHratio
d)Estrogen
CorrectAnswer-B
Bi.e.FSH
OvarianreservecanbebestassessedbymeasuringFSHlevelson
3rddayofmenstrualcycle,clomiphenecitratechallenge/
provocativetest(measuresFSHlevelsoncycleday10after
antiestrogenclomiphenecitrate100mgadministrationfromday5to
9).SeruminhibinBlevelandultrasonicscanningtocountthe
numberofantralfolliclesinovaryareothermethods.
OvarianReserve
-Itreferstothesizeofresting/nongrowing/primordialfollicle
population,whichreflectsthequantity(no)ofgrowingfolliclesand
qualityofoocyteswithinit.Soovarianreservedeterminesthe
functionalreproductivepotentialofovary.
-UndertheinfluenceofFSHandLH,thereisrapidgrowthofseveral
folliclesinovary,duringfirstfewdaysofeachmenstrualcycle.But
afteraweekonly1folliclebeginstooutgrowalltheothers/which
involutebyaprocesscalledatresiaandthuspreventingmorethan
onechildfromdevelopingwitheachpregnancy).
-Ovarianreserve(&capacityofovarytoproduceeggs)declinewith
advancingage.Bestpredictorofovarianreserveisage.Teststhat
candetermineovarianreserveinclude

---

1571.Bispinousdiameterinanatomicoutlet?
a)10.5cm
b)11cm
c)11.5cm
d)12cm
CorrectAnswer-B
Ans.B.11cm
Anatomicaloutlet
Antero-posterior(13cm)
Distancebetweenlowerborderofsymphysispubistothetipof
coccyx.
Transversediameter(bispinous-11cm)
Distancebetweentheinnerbordersofischialtuberosities
Posteriorsagittaldiameter(8.5cm)
Distancebetweensacroccygealjointandanteriormarginofanus.

---

1572.Mostsuitabletypeofpelvisinfemale?
a)Gynaecoid
b)Android
c)Anthropoid
d)Platypelloid
CorrectAnswer-A
Ans.A.Gynaecoid
Gynaecoidpelvisroundinshape&ismostspacious.

---

1573.WhichpelvisisassociatedwithDTA?
a)Android
b)Antrhropoid
c)Platypelloid
d)Gynaecoid
CorrectAnswer-A
Ans.A.Android

---

1574.Inobstructivelabormostimportant
parameteris?
a)Diameterofpelvicinlet
b)Diameterofpelvicoutlet
c)Biparietaldiameter
d)Bitemporaldiameter
CorrectAnswer-B
Ans.B.Diameterofpelvicoutlet
Thenarrowestdiameterforthefetustopassthroughispelvicoutlet.

---

1575.Maximumdiameterthatpassedthrough
maternalpelvis?
a)Suboccipitalbregmatic
b)Biparietal
c)Suboccipitalfrontal
d)Occipitofrontal
CorrectAnswer-B
Ans,B.Biparietal
Occipitofrontalislargediameteranddeflexedheadmaycomplicate
asdeeptransversearrestandobstructedlabour.
Incaseofspaciousgynaecoidandanthropoidpelvisitendsupin
facetopubisdelivery.
Mento-verticalisthelargestdiameterbutitcannotpassthroughthe
maternalpelvis.

---

1576.Semenexaminationcanbedone?
a)Immediatelyinsemisolidform
b)Afterliquefaction
c)Within15-30minutesofliquefaction
d)11/2-2hrirrespectiveofliquefaction
CorrectAnswer-D
Ans.D.11/2-2hrirrespectiveofliquefaction
Semenanalysis
Bestspecimenobtainedbymasturbation
3-5daysofabstinenceisbest,notmorethanthat
Specimenshouldbeexaminedwithin11/2-2hr
Liquefactionusuallycompleteswithin15-20minandifdelayedit
indicatesprostaticdysfunction.Thusduringsemenanalysistimingof
liquefactionisimportantbuttimingofanalysisisnotsetaccordingto
liquefaction.

---

1577.Lithotomypositionincreasesvaginal
openingbyhowmanycm-
a)1cm
b)2cm
c)3cm
d)4cm
CorrectAnswer-B
Ans.B.2cm
Indorsallithotomyposition,theantero-posteriordiameterofthe
outletmaybeincreasedto1.5-2cm.
Furthermore,thecoccyxispushedbackwhiletheheadilescends
downtotheperineum.

---

1578.Endometrialbiopsyisusuallydoneat?
a)Justbeforemenstruation
b)10-12daysaftermenstruation
c)Justaftermenstruation
d)Atthetimeofovulation
CorrectAnswer-A
Ans.A.Justbeforemenstruation

---

1579.Oligomenorrhoeameans?
a)Cycle<20days
b)Cyclemorethan45days
c)Cyclemorethan28days
d)Cyclemorethan35days
CorrectAnswer-D
Ans.D.Cyclemorethan35daysnee

---

1580.Magnificationobtainedbycolposcopy
is?
a)1-2times
b)5-6times
c)15-25times
d)10-20times
CorrectAnswer-D
Ans.D.10-20times
Colposcopeprovidesamagnificationof10-20times.
Colpomicroscopeprovidesamagnification100-300times.

---

1581.OnwhichdayLH&FSHshouldbe
measured?
a)1-3rdday
b)7thday
c)14thday
d)10thday
CorrectAnswer-A
Ans.A.1-3rdday
LevelofthehormoneFSH,LHandestradiolarcmeasuredonday3
ininfertilityworkup.
AnelevatedFSHlevelonday3isanindicationofpoorovarian
reserve.
HormonalassessmentFSH/LHdevelopingfollicleproducesestrogen
whichsignalsthehypothalamustoincreaseorreducetheamountof
FSHproducedbythepituitarygland.Whengoodfolliclesarenot
developingestrogenlevelsarelowerandmoreFSHisproduced.
ThisleaktohigherlevelofFSHonday3.
Day3FSHfertilitytestbnottheonlyparameterusedtoassess
ovarianreserve.

---

1582.Bestparameterforestimationoffetal
agebyultrasoundin3rdtrimesteris?
a)Femurlength
b)BPD
c)Abdominalcircuference
d)Intraocculardistanc
CorrectAnswer-A
Ans.A.Femurlength
Bestparametersforestimationoffetalagebyultrasound
1sttrimester?CrownRumplength(CRL)
2ndtrimester-Correctedbiparietaldiameter(cBPD)orhead
circumference(HC)
3dtrimester-Headcircumferenceandfemurlength
Overall-Crownrumplength

---

1583.Commonestvarietyofcompound
presentationis?
a)Headwithhand
b)Headwithfoot
c)Headwithbothfoot
d)Head,hand&foot
CorrectAnswer-A
Ans.A.Headwithhand
WhenacePhalicpresentationiscomplicatedbythepresenceofa
handorafootorbothalongsidetheheadorpresenceofoneorboth
handsbythesideofthebreechitiscalledcompoundpresentation.
Commonestvarietyofcompoundpresentation-Headwithhand
Rarestvarietyofcompoundpresentation-Headwithhandandfoot
both.

---

1584.Hegarsign?
a)Uterinecontraction
b)Quickening
c)Bluishdiscolorationofvagina
d)Softeningofisthmus
CorrectAnswer-D
Ans.D.Softeningofisthmus
Hegarssign
Presentin2/3ofcases.
Demonstratedin6-10week
Signsisbasedonthefadthat:
1. Upperpartofthebodyoftheuterusisenlargedbygrowingfetus.
2. Lowerpartofthebodyisemptyandextremelysoft(justabovethe
cervix)
3. Cervixiscomparativelyfirm.
Becauseofvariationinconsistentonbimanualexamination(two
fingersinanteriorfornixandtheabdominalfingersbehindthe
uterus)theabdominalandvaginalfingersseemtoopposebelow
thebodyoftheuterus.

---

1585.Pregnantwomengoingforlongjourney
&prolongedsittingisassociatedwith
dangerof?
a)Thromboembolism
b)Seatbeltcompression
c)Pretermlabor
d)Bleeding
CorrectAnswer-A
Ans.A.Thromboembolism
Prolongedsittingincaroraeroplaneisavoidedduetovenousstasis
orthromboembolism.

---

1586.Headofbabyisremovedinbreech
deliverybywhichmaneuver?
a)Lovsetsmaneover
b)Pinardsmaneover
c)Prague
d)BurnMarshallmethod
CorrectAnswer-D
Ans.D.BurnMarshallmethod

---

1587.Praguemanueverisusedfor?
a)Aftercomingheadinbreech
b)Deeptransverseassest
c)Extractionofextendedarms
d)Externalcephalicversion
CorrectAnswer-A
Ans.A.Aftercomingheadinbreech
Sometimestheheadrotatesposteriorlyso,thatthefaceisbehind
thepubis.
Deliveryinthispositionisdifficultand'Praguemaneuver'maybe
tried.

---

1588.

---

Trialoflabourinpreviouscaseariansection
canbedonein?
a)PlacentapreviatypeIII
b)Previoustwoclassicalcaseariansection
c)SuspectedCPD
d)Previouscaesariansectionwithadequatepelvis
CorrectAnswer-D
Ans.D.Previouscaesariansectionwithadequatepelvis
Adequatepelvisisanindicationoftrialoflabour.
Otherthreeoptionsarecontraindications.

---

1589.Hematomaduringlabourisnotdueto?
a)Improperhaemostasis
b)Extensionofcervicallaceration
c)Ruptureofparavaginalvenousplexus
d)Obliterationofdeadspacewhilesuturingvaginalwall
CorrectAnswer-D
Ans.D.Obliterationofdeadspacewhilesuturingvaginalwall
Failureofobliterationofdeadspacecauseshematoma(not
obliterationofdeadspace).

---

1590.Treatmentofjaundiceinthirdtrimester
?
a)Terminationofpregnancy
b)Terminationat42weeks
c)Terminationat38weeks
d)Waitforspontaeouslabour
CorrectAnswer-C
Ans,C.Terminationat38weeks
Inpatientsofintrahepaticcholestasisofpregnancythereis
increasedperinatalmortality.
HencefetalsurveillanceisdonewithbiweeklyNST.
Conventionalantepartumtestingdoesnotpredictfetalmortalityas
thereissuddendeathincholestasisduetoacutehypoxia.
Hencedeliveryisrecommendedat37-38weeks.
InthosepatientswithjaundicewithSbilirubin>1.8mg%,
terminationofpregnancyshouldbedoneat36weeks.

---

1591.Rateofturnoverofamnioticfluidis?
a)500cc/h
b)1L/hr
c)1500cc/h
d)2L/h
CorrectAnswer-A
Ans.A.500cc/h
SpecificgravityofAmnioticfluid:1.008to1.010
Osmolality:250mosm/L
Completelyreplacedin3hours.
Rateofamnioticfluidturnoveris500cc/hr.

---

1592.Maximumamountofamioticfluidis
seenathowmanyweeks?
a)16
b)30
c)12
d)38-40
CorrectAnswer-D
Ans.D.38-40

---

1593.Uteruspostpregnancybecomesa
pelvicorganin?
a)4weeks
b)6weeks
c)12weeks
d)2week
CorrectAnswer-D
Ans,D.2week
Bytheendof2weeks-uterusisapelvicorgan.
Bythemdof6week-uterusreturnsalmosttoitsnormalsize(pre
pregnantsize).

---

1594.Assistedheaddeliveryisdonein?
a)Browpresentation
b)Facepresentation
c)Persistentoccipitoposteriorposition
d)Twinpresentation1522.%of
CorrectAnswer-C
Ans.C.Persistentoccipitoposteriorposition
Occipitoposteriorpositions
"Inpracticeabout5-1O%ofwomenadmittedinlabourwithcephalic
presentationspresentwithoccipito-posteriorpresentations.
Giventimeandpatience,manyofthesewillrotateandgetcorrected
tooccipito-anteriorpositionanddelivernormally.

---

1595.%ofwomendeliveringontheirEDDis
?
a)25%
b)50%
c)4%
d)15%
CorrectAnswer-C
Ans.C.4%
BasedontheNoegelesfomulalabourstartsapproximatelyon:-
Expecteddate?4%

---

1596.Roleofergometrinetostoppostpartum
hemorrhageisdueto?
a)Increaseduterinemuscletone
b)Vasoconstriction
c)Increasedplateletaggregation
d)Increasedcoagulation
CorrectAnswer-A
Ans.A.Increaseduterinemuscletone
Ergometrineactsdirectlyonmyometriumandexcitesuterine
contractions,whichclosesbloodvesselsinbetweenthushelpsin
controllingPPH.
Vasoconstrictiveactionofergometrinedoesnotcontrolbleedingbut
maycauseriseinB.P.gangreneoftoe,PreciPitatebronchospasm.
Option(c)&(d),arenottheactionofergometrine.

---

1597.Continence&incontinenceofurineis
seenin?
a)VVF
b)Vesicoperitoneal
c)Ureterovaginal
d)Uretrovaginal
CorrectAnswer-C
Ans.C.Ureterovaginal
Continenceandincontinenceofurineisseeninureterovaginal
fistula.

---

1598.
Typeofsutureusedincomplete
perinealtearis-
a)Catgut
b)Silk
c)Vicryl
d)Vicrylandcatgut
CorrectAnswer-D
Ans.D.Vicrylandcatgut
Rectumisdissectedtoclearofscartissue&fresheningofcut
edges.
Cutedgesofrectumandanusaresuturedwithvicryl.
Deepmuscleofperenialbodyandlevatoraniareidentifiedand
suturedwithNol-catgut.
Superficialmuscleissuturedwithvicrylcatgutsutures.

---

1599.Uterineruptureismostcommonin-
a)Antlowersegment
b)ClassicalC.S
c)Placentaprevia
d)Normallabour
CorrectAnswer-B
Ans.B.ClassicalC.S

---

1600.Chancesofuterineruptureareleastin-
a)LSCS
b)Classic
c)Inverted
d)Lowvertical
CorrectAnswer-A
Ans.A.LSCS

---

1601.Ageofmetropathichemorrhagicais?
a)20-25
b)50-55
c)60-65
d)40-45
CorrectAnswer-D
Ans,D.40-45
Metropathiahemorrhagica
SpecializedformofDUB.
Mostlyseeninpremenopausalwomen.
Maximumageincidence:Betweenages40-45years.
Patientcomplainsofprolongedamenorrhea(of6-8weeks)followed
byexcessivepainlessbleeding(anovularbleeding).

---

1602.Managementofecclampsiain34weeks
ofpregnancyis-
a)Continueofconvulsionandwaitfor37wktocomplete
b)Waitforspontaneouslabours
c)BPcontineu
d)Antihypertensive,anticonvulsantandterminationofpregnancy
CorrectAnswer-D
Ans.D.Antihypertensive,anticonvulsantandterminationof
pregnancy

---

1603.HematuriainpreviousLSCSpatient
indicates-
a)Urinarytractinfection
b)Placentaprevia
c)Ruptureuterus
d)None
CorrectAnswer-C
Ans.C.Ruptureuterus

---

1604.Battledoorinsertionofplacenta?
a)Cordattachedtothemarginofplacenta
b)Placentaattachedtothemargin
c)Cordattachedtothemembranes
d)Placentaattachedtothecentre
CorrectAnswer-C
Ans.C.Cordattachedtothemembranes
Changeinfetalheartrate(tachycardia/lossofbeattobeat
variability/decelerations)isearliestsignofimpendingscar
dehiscence,followedbymaternaltachycardia.

---

1605.Metrorrhagiaisproducedbythe
followingexcept?
a)Polyp
b)CAendometrium
c)IUD
d)Intramuralfibroid
CorrectAnswer-D
Ans,D.Intramuralfibroid

---

1606.Bonney'stestisuseddetermine?
a)Uterineprolapsed
b)Stressurinaryincontinence
c)Vesicovaginalfistula
d)Utericfistula
CorrectAnswer-B
Ans.B.Stressurinaryincontinence

---

1607.Reddegenerationoffibroidisseenin?
a)Earlypregnancy
b)Midpregnancy
c)Puperium
d)Nulliparouswomen
CorrectAnswer-B
Ans.B.Midpregnancy

---

1608.Radicalhysterectomyinstagelbca
cervixbetterthanradiotherapyallare
trueexcept?
a)Chanceofsurvivalmore
b)Chanceofrecurrenceless
c)Ovaryfunctioncanbepreserved
d)Lesscomplicated
CorrectAnswer-A
Ans,A.Chanceofsurvivalmore

---

1609.Bilateralovariancarcinoma+capsule+
ascitis+paraaorticLN.Whichstage?
a)1C
b)2C
c)3C
d)4C
CorrectAnswer-A
Ans.A.1C

---

1610.RadiationtopointAincervixis?
a)8000rad
b)6000rad
c)10000rad
d)4000rad
CorrectAnswer-A
Ans.A.8000rad

---

1611.Mostcommonpresentationofcervical
canceris-
a)Deeppelvicpain
b)Rectalpain
c)Bleedingpervaginum
d)Weightloss
CorrectAnswer-C
Ans,C.Bleedingpervaginum

---

1612.Treatmentofsimplehyperplasiaof
endometriumis?
a)Progesterone
b)Estrogen
c)Hysterectomy
d)Cryosurgery
CorrectAnswer-A
Ans,A.Progesterone

---

1613.Mostcommonpresentingfeatureof
completemoleis?
a)Vomiting
b)Amenorrhoea
c)Amenorrhoea
d)Bleedingpervaginum
CorrectAnswer-D
Ans,D.Bleedingpervaginum
Clinicalfeaturesofcompletemole
Vaginalbleedingisthemostcommonsymptomcausingpatientto
seektreatmentforcompletemolepregnancy.
Abnormaluterinebleedingusuallyduringthefirsttrimesteristhe
mostcommonpresentingsymptomoccurringinmorethan90%of
patientswithmolarpregnancies.

---

1614.AndrogenicXXchromosomeis?
a)Partialmole
b)Completemole
c)Turner'ssyndrome
d)Steinleventhalsyndrome
CorrectAnswer-B
Ans,B.Completemole
CharacteristicsofcompleteMole
CompleteH.moleshowsnoevidenceoffetaltissueatall.
Completehydatiformmolesexhibitcharacteristicswellingand
trophoblastichyperplasia.
Mostcommonkaryotypeis46XX.
Themolarchromosomesareentirelyofpaternalorigin,although
mitochondrialDNAisofmaternalorigin.
Thecompletemolearisesfromanovumthathasbeenfertilizedbya
haploidsperm,whichthenduplicatesitsownchromosomescalled
Anilrogenesis.
Theovumnucleusmaybeeitherabsentorinactivated.

---

1615.Highchanceofruptureintubal
pregnancyareseeninwhich?
a)Ampulla
b)Isthmus
c)Interstitial
d)Fimbrial
CorrectAnswer-B
Ans.B.Isthmus
M.C.siteoftubalrupture=Isthmus

---

1616.Mostcommonsiteofectopicpregnancy
is-
a)Tubal
b)Abdominal
c)Ovarian
d)Uterine
CorrectAnswer-A
Ans,A.Tubal
Mostcommonsiteofectopicpregnancyisfallopiantube.
IntubalpregnancyM.C.siteisampulafollowedbyIsthmus.

---

1617.%ofectopicpregnancyseenin
fallopiantubeis?
a)75%
b)90%
c)80%
d)67%
CorrectAnswer-B
Ans,B.90%
M.C.siteofectopicpregnancy=Fallopiantube(97%).

---

1618.Drugsusedinectopicpregnancy?
a)PGE2
b)PGI
c)PGF2
d)None
CorrectAnswer-C
Ans.C.PGF2

---

1619.Mostcommoncongenitaluterine
anomalyis?
a)Bicornuateuterus
b)Septateuterus
c)Unicornuateuterus
d)Arcuateuterus
CorrectAnswer-B
Ans.B.Septateuterus

---

1620.WheniscopperTinserted?
a)3daysafterperiodsareover
b)Within10daysofstartofmenstrualcycle
c)PIDjustbeforemenstruation
d)Justaftermenstruation
CorrectAnswer-B
Ans,B.Within10daysofstartofmenstrualcycle
ldealtimeforinsertionofCu-Tiswithin10daysofthestartofthe
menstrualcycle
Ithastheadvantagethatcervicalcanalisdilated,uterusisrelaxed
andchancesofpregnancyareremore.
PostPartuminsertionwithin48hoursofdeliveryor6weeksafter
delivery.
Post-MTPinsertionimmediatelyfollowingD&E(inearlypregnancy)

---

1621.Mostcommoncauseofannularcervix
is?
a)Obstructivelabor
b)Prepitatelabor
c)Primarycervicaldystocia
d)Iatrogenic
CorrectAnswer-C
Ans,C.Primarycervicaldystocia
Annularcervixisdetachmentofthecervixfollowingprolonged
labourinprimarycervicaldystocia.

---

1622.Intrauterineadhesionsbestseenby?
a)USG
b)CT
c)Hysteroscopy
d)MRI
CorrectAnswer-C
Ans.C.Hysteroscopy
Hysteroscopyistheendoscopictechniqueofvisualizingtheinterior
ofuterusdirectly,
Itisbothdiagnosticandtherapeutic.

---

1623.Insulinresistanceinpregnancyisdue
to?
a)Estrogen
b)Progesterone
c)HPL
d)GH
CorrectAnswer-A:C
Ans.C>A.HPL>Estrogen
DuringPregnancyinsulinlevelsareincreasedbecauseofincreased
insulinsecretionaswellasincreaseininsulinresistanceduetoa
numberofcontrainsulinfactorsbutthemostimportanthormone
causinginsulinresistanceisHumanplacentallactogen.

---

1624.Gestationaldiabetesmellitus?
a)Isfirstrecognizedduringpregnancy
b)PrevioushistoryofIUGR
c)ThereisnorecurranceofGDMinfuturepregnancy
d)Noriskofovertdiabetes
CorrectAnswer-A
Ans.A.Isfirstrecognizedduringpregnancy
Gestationaldiabetesmellitusisdefinedascarbohydrateintolerance
ofvariableseveritywithonsetorfirstrecognitionduringPregnancy.
Pregnancyisaformofstressthatcancauselatentdiabetesto
manifestjustasdosurgicaloperationsoracuteinfections.
Inmostofthecasesthecarbohydrateintolerancerevertsbytheend
ofpuerperiumbutthismanifestationmaybethefirstindicationof
diabetesyettocome.
Morethanhalfthewomenwithgestationaldiabeteswilldevelop
frankdiabeteswithinthenext20years.
Howeverinsomeofthesecarbohydrateintolerancemaypersist
beyondthepuerperiumandtheseareinrealitycasesofpre-
gestationaldiabeteswhichhavebecomeovertduringpregnancy.

---

1625.Trueaboutgestationaldiabetesis?
a)Theseareincreasedchancesofcongenitalmalformation
b)Only2%ofwomenpresentwithovertdiabetes
c)Thereischanceofmacrosomia
d)Usuallydiagnosedinearlypregnancy
CorrectAnswer-C
Ans.C.Thereischanceofmacrosomia

---

1626.Mostcommonpresentingsymptomof
TBendometritisis-
a)Abdominalpain
b)Infertility
c)Amenorrhoea
d)Vaginaldischarge
CorrectAnswer-B
Ans,B.Infertility
MostcommonsymptomofGenitalTBis:-
Infertility(35-60%)iseitherduetoblockageoffallopiantubeordue
tolossoftubalfunctioneveniftubesarepatent.

---

1627.PIDafterinsertionofIUDisseeninhow
manyweeks?
a)3
b)5
c)7
d)14
CorrectAnswer-A
Ans,A.3
TheriskofdevelopingPIDis2-10timesgreateramongtheIIJD
users.
Theriskismoreinthefirst3weeks.
Infectionwithchlamydiaandactinomycosismostcommon.

---

1628.AcutePID,mostcommonrouteof
spread?
a)Descending
b)Ascendinginfection
c)Lymphatics
d)Hematogenous
CorrectAnswer-B
Ans,B,Ascendinginfection
M/crouteofspreadofPIDis:-
Ascendinginfectionalongwithsperms.
AllPIDsaresexuallytransmittedexceptTB.

---

1629.Bestwaytolookatendometrialactivity
isby-
a)HSG
b)Biopsy
c)USG
d)Colposcopy
CorrectAnswer-B
Ans,B.Biopsy
Endometrialsamplingorcurettageorbiopsyisthebestmethodto
assessendometrialactivity.

---

1630.Blockgiveninforcepsdelivery?
a)Pudendal
b)Ilioinguinal
c)Genitofemoral
d)Posteriorfemoral
CorrectAnswer-A
Ans,A.Pudendal
ForforcepsoPerationpudendalblockisgivensupplementedby
perinealandlabialinfiltration.

---

1631.Causeofbigbaby?
a)Hyperglycemia
b)Hyperinsulinemia
c)Multiparity
d)Postmaturity
CorrectAnswer-A:B:C:D
Ans,AlloftheaboveA,B,C,D

---

1632.Decubitusulceris?
a)Duetotrauma
b)Duetovenouscongestion
c)Duetofrictioncreatedbythighs
d)Dueto
CorrectAnswer-B
Ans,B.Duetovenouscongestion
Decubitusulcerisatrophiculceralwaysfoundatthedependentpart
oftheprolapsedmass(inprolapseduterus).
Itisduetodecreasedcirculationduetonarrowingofuterinevessels
bystretchingefectwithadditionalkeratinizations,cracks.

---

1633.Patientwithhistoryofvaginalprolapse
withulceronit.Diagnosis?
a)Carcinoma
b)Pressureerosion
c)Syphilis
d)Decubitusulcer
CorrectAnswer-D
Ans,D.Decubitusulcer

---

1634.SERMsare?
a)Agonistonestrogenreceptor
b)Antagonistonestrogenreceptor
c)Someareagonistsomeantagonistonestrogenreceptor
d)Usedduetoreducedchancesofhotflushes,thromboembolism
CorrectAnswer-C
Ans,C,Someareagonistsomeantagonistonestrogen
receptor
SERM'sareselectiveestrogenreceptormodulatorscalledSERMs
blockstheeffectsofestrogeninthebreasttissue.
TheyblocktheeffectofestrogenbyactingonestrogenrecePtors.

---

1635.Femalewithhirsutismwith
ammenorrhoeaandobesity.Diagnosis
?
a)PCOD
b)Ovariantumor
c)Androgeninsensitivitysyndrome
d)Turnersyndrome
CorrectAnswer-A
Ans,A.PCOD
Theclinicalandlaboratoryfeaturesofthepatientdescribedinthe
questionmatchwiththoseofPCOSasdepictedinthetable.
SothemostappropriateanswerisPCOD.

---

1636.HAIRANsyndromeisseenin?
a)PCOD
b)Endometeriosis
c)CAovary
d)Adrenaltumours
CorrectAnswer-A
Ans,A.PCOD
PCODisalsoknownasHAIRANSyNDROME

---

1637.RegardingPCODallaretrueexcept?
a)HighFSH/LH
b)HighDHEA
c)RaisedLH
d)TEstrogen
CorrectAnswer-A
Ans,A.HighFSH/LH
PCODisalsoknownasHAIRANSyNDROME

---

1638.WhichhormoneincreasesinPCOD?
a)LH
b)FSH
c)Estrogen
d)TSH
CorrectAnswer-A
Ans,A,LH
Steinleventhalsyndromeisalsocalled`PolycysticOvarian
Syndrome'

---

1639.SteinLevinthalsyndromewhat
hormoneisraised?
a)LH
b)FSH
c)GnRH
d)Progesterone
CorrectAnswer-A
Ans,A.LH

---

1640.Whatshouldnotbedoneduring
deliveryofRhnegative?
a)IVFluids
b)Externalversion
c)Manualremovalofplacentashouldbedonegently
d)Ergometiretobewithheldatdeliveryofant.shoulder
CorrectAnswer-A
Ans,A.IVFluids

---

1641.Historyofyellowgreenwatery
dischargeandpruritus?
a)Trichomonasvaginalis
b)Candida
c)Bacterialvaginosis
d)Clamydiatracomatis
CorrectAnswer-B
Ans.B.Candida
DuringRhPregnancfstePsshouldbetakentopreventfeto
maternalbleeding;-
Precautionsduringcaesariansectiontopreventbloodspillinginto
peritonealcavity
Prophylacticergometinewithdeliveryofantshouldertobewithheld.
Amniocentesisshouldbedoneaftersonographic.Localizationof
placentatopreventplacentalinjury.
Forcibleattemptforexternalversionshouldnotbedone.
Manualremovalofplacentashouldbedonegently.
Torefrainfromabdominalpalpationinabruptionplacenta.

---

1642.Mostcommongenitalinfectionin
pregnancyis?
a)Candida
b)Gonorrhea
c)Trachoma
d)Cytomegalovirus
CorrectAnswer-A
Ans,A.Candida
Seventypercentshowtypicaldischarge,whichisprofuse,thin,
creamyorslightlygreenincolour,irritatingandfrothy.
Thevaginalwallsaretender,angrylookingandthedischarge
causespruritusandinflammationofthevulva.

---

1643.Decreasedfetalheartsoundisdueto
whichdrug-
a)Oxytocin
b)Sodiumbicarbonate
c)IVfluids
d)Iron
CorrectAnswer-A
Ans,A,Oxytocin
Vaginitisduetocandidaismorecommonthantrichomonasandis
moreprevalentinDiabeticpregnancy.
Treatmentismiconazolevaginalcreamfor7days.

---

1644.DoseofmifepristoneinMTPis?
a)10mg
b)20mg
c)100mg
d)200mg
CorrectAnswer-A
Ans,A.10mg
Decreasedfetalheartrateorfetaldistressisduetofetalhypoxia.

---

1645.Ayoungsexuallyactivefemalehas
intensivepruritusandwatery
discharge,smearshows?
a)Trichomonasvaginalis
b)Candidavaginitis
c)Gardenllavaginalis
d)HIV
CorrectAnswer-D
Ans,D.HIV

---

1646.Treatmentfortrichomonasvaginalisis
?
a)Metronidazole
b)Azithromycin
c)Ciprofloxacin
d)None
CorrectAnswer-A
Ans.A.Metronidazole
ThedrugofchoiceforTrichomonasvaginitsisMetronidazole.

---

1647.Whichorganismcausespuerperal
sepsis?
a)CMV
b)Toxoplasmagondii
c)GroupAbetahemolyticstreptococci
d)GroupBbetahemolyticstreptococci
CorrectAnswer-C
Ans,C.GroupAbetahemolyticstreptococci
MostcommoncauseofpuerperalsepsisisGroupAstreptococcus.
Otherorganismsthatareimplicatedare:StriptococcusgroupB,C
andG,staphylococcusaureus,E.coli,Enterobacterspeciesand
chlamydiatrachomatis.

---

1648.A40yearoldmalereportedwith
recurrentepisodesoforalulcers,large
areasofdenudedskinandflacid
vesiculo-bullouseruptions.Whichis
themostimportantbed-side
investigationhelpfulinestablishingthe
diagnosis-
a)Gramstainingoftheblisterfluid
b)Cultureandsensitivity
c)Skinbiopsyandimmunoflurescence
d)Tzancksmearfromthefloorofbulla
CorrectAnswer-D
Ans.D.i.e.Tzancksmearfromthefloorofbulla

---

1649.Characteristicofchroniceczema?
a)Erythema
b)Induration
c)Lichenification
d)Edema
CorrectAnswer-C
Ans.is'c'i.e.,Lichenification
Phase
Clinicalfeatures
Histology
(stage)
Spongiosis
VesiclesaErythema
Acute
(intracellular
EdemaoCrusts
edema)
Erythmatous,
hyperpigmented
Subacute
Parakeratosis
plaque
Scales&Crusts
Thickeningof
Chronic Lichenification
stratummalpighi

---

1650.Deadlayerofepidermis?
a)Stratumbasale
b)Straumspinosum
c)Stratumcorneum
d)Stratumgranulosum
CorrectAnswer-C
Ans.is'c'i.e.,Stratumcorneum
Stratumbasale,stratumspinosumandstratumgranulosum,
togetherformthelivinglayerandconstitutethesiteofsynthesisof
keratin(Keratinismostlysynthesizedinstratumspinosum).
Stratumcorneumisthedeadlayer.
Layersofepidermis(Fromdeeptosuperficial)
Inpalm&sole(5layers).Elsewhere(4layers)
StratumbasaleStratumbasale
StratumspinosumStratumspinosum
Stratumgranulosumiv)StratumlucidumStratumgranulosum
StratumcorneumStratumcorneum

---

1651.Spongiosisinvolves?
a)Stratumbasal
b)Stratumcarneum
c)Stratumgranulosum
d)Stratumspinosum
CorrectAnswer-D
Ans.is'd'i.e.,Stratumspinosum
Separationofkeratinocytesduetolossofintracellularbridges-->
Acantholysis
Intracellularedemaofkeratinocytes--->Ballooning
Stratumbasale
Acantholyticcellsofpemphigusvulgarisarederivedfromstratum
basal.
BasalcelldegenerationoccursinLichenplanus.
Stratumspinosum
Intercellular(inbetweenthecells)edema-->Spongiosis
Thickening-->Acanthosis
Stratumgranulosum
ThickeningHypergranulosis
Stratumcorneum
-->
Retentionofnucleiwithincells
Parakeratosis
-->
Thickening
Hyperkeratosis
Stratumcorneumisinvolvedin
-->
Micromunro
abscess,
Dermatophytes

---

Dermatophytes

---

1652.LinesofBlaschko'sarerelatedto?
a)Keratinocytes
b)Bloodvessels
c)Nerves
d)Bones
CorrectAnswer-A
Ans.is'a'i.e.,Keratinocytes
Blaschko'slinescorrespondtothepathwaysfollowedby
keratinocytesmigratingfromneuralcrestduringembryogenesis.
ThelinesfollowaV-shapeoverspine,anS-shapeonabdomen,
invertedU-shapefrombreastareatoupperarmandperpendicular
downthefrontandbackofthelowerextrimities.
AnumberofinflammatoryconditionscanfollowBlaschko'slines-
1. Lichenstriatus
2. Linearlichenplanus.
3. Inflammatorylinearverrucousepidermalnaevus(ILVEN).
4. Blaschkodermatitis(Blaschtitis).
5. Incontinentiapigmenti.
6. Goltzsyndrome.
7. Linearmorphoea.
8. Segmentalvitiligo.
9. Focaldermalhypoplasia.
10. CHILDsyndrome.
11. HypomelanosisofIto.
12. Linearcutaneouslupuserythematosus

---

1653.Differenceinacnerosacea&acne
vulgaris-
a)Pustule
b)Erythema
c)Papule
d)Absenceofcomedone
CorrectAnswer-D
Ans.is'd'i.e.,Absenceofcomedone

---

1654.Whichhormoneisresponsibleforacne
?
a)Estrogen
b)Thyroid
c)Testosterone
d)Gonadotropins
CorrectAnswer-C
Ans.is'c'i.e.,Testosterone
PredisposingfactorsforAcnevulgaris
Geneticfactors
Hormones-4Androgens,glucocorticoids.
Psychologicalstressanddepression.
EnvironmentalfactorsHightemperature&humidity.
Cosmetics-3Containinglenolin,petroleum,vegetableoils.
Infection-->Propionibacterium,Pityrosporum,Staph.epidermidis.
Mensturalcycle-4Premensturalaggravation.
Hyperkeratosisofpilosebaceousostia.
DrugsAntepileptics(Carbamazepine,phenytoin,phenobarbitone),
antitubercular(INH,rifampin,ethionamide),antidepressants,
cyclosporine,VitaminB12.Coughsyrupscontaininghalogens
(Iodides,bromides).

---

1655.Eyebrowsdon'tgrowbeyondcertain
lengthastheyhaveashort?
a)Anagenphase
b)Telogenphase
c)Telogenphase
d)Exogenphase
CorrectAnswer-A
Ans.is'a'i.e.,Anagenphase
Hairgrowsincyclesofvariousphases.Anagenisgrowthphase.
Catagenisinvolutingorregressionphase.Telogenisrestingphase.
Exogenissheddingphase.
Normally90%ofthefolliclesareinanagenphase,10-14%arein
Telogenand1-2%areincatagen.
Thecyclesdurationisvariableforthedifferentpartsofthebody.For
eyebrows,thecycleisfinishedin3-4monthswhileforscalpittakes
3-4yearstofinish.
Thisisthereasonwhyeyebrowshavemuchshorterlengthlimitas
comparedtoscalphair.

---

1656.Brownmacularpigmentationinmalar
areainapregnantfemaleisdueto?
a)Acnerosacea
b)Cholasma
c)Acanthosisnigricans
d)Urticaricpigmentosa
CorrectAnswer-B
Ans.is`b'i.e.,Cholasma
Chloasma(Melasma)
Melasma(Chlosma)isthemostcommoncauseforfacial
pigmentationinIndianpatients.ThereisBrownmacular
pigmentationonthemolarareaofface,foreheadandsometimes
chin.Itusuallyaffectsyoungandmiddleagedwomen.When
melasmaresultsfrompregnancyitisreferredaschloasma.
Twomajoretiologicalfactorsare:-
1. Hormonal(estrogen)-->Appearsinpregnancyorinpersonon
OCPs.
2. Sunexposure--->EspeciallyUVB.
FortreatmentCombinationoftopicalhydroquinone(2-4%),retinoic
acidandatopicalcorticosteroids.Otherdrugsare-->Glycolicacid
(4-10%),Azelicacid,topicalvitaminC.

---

1657.Whichofthefollowingcausenon-
cicatracialalopecia?
a)Teniacapitis
b)SLE
c)Alopeciaareata
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove

---

1658.Nailpittingiscausedbyallexcept?
a)Lichenplanus
b)Hyperthyroidism
c)Fungalinfection
d)PityriasisRosacea
CorrectAnswer-D
Ans.is'd'i.e.,PityriasisRosacea

---

1659.Hanifin&Rajkeisthediagnosticcriteria
for
a)Atopicdermatitis
b)Contactdermatitis
c)Urticaria
d)Erythroderma
CorrectAnswer-A
Ans.is'a'i.e.,Atopicdermatitis
HanifinandRajkacriteriaisfordiagnosisofatopicdermatitis.
Diagnosticcriteria(HanifinandRajka)
Basedmainlyonclinicalexperience
Majorcriteria
1. Familyhistoryofatopy
2. Chronicity
3. Pruritus
4. Typicalmorphologyanddistribution
Minorcriteria
1. Dryskin
2. Chelitis
3. Elevatededge
4. Dennie'sline/denniemorganfold(infraorbitalfold)
5. Whitedermographism
6. Peripheraleosinophillia
7. Immediate(typei)hypersensivity
8. Facialpallor,orbitaldarkening
9. Foodintolerance
10. Conjunctivitis(recurrent),keratoconus,cataract
11. Pityriasisalba

---

12. Handdermatitis
13. Recurrentinfections
Atleast3majoror2majorplus2minorcriteriaarenecessaryfor
diagnosis

---

1660.Mostcommonmetalincontactallergic
dermatitisis?
a)Gold
b)Silver
c)Aluminium
d)Nickel
CorrectAnswer-D
Ans.is'd'i.e.,Nickel
Contactdermatitis
Contactdermatitisislocalizedrashorirritationofskincausedby
contactwithaforeignsubstance.Contactdermatitisisalocalized
disease,i.e.,lesionoccursatthesiteofcontact.However,insever
cases,thelesionsmayextendoutsidethecontactareaoritmay
becomegeneralized(referredtoasideruption).
Contactdermatitisismainlyoftwotypes:?
A.Irritantcontactdermatitis
Duetodirectirritantactionofthemateriale.g.Solvents,Alkalis,
Detergents.Mostcommonsitesarehands&forearms.
B.Allergiccontactdermatis
Itisduetodelayedhypersensitivity(typeIVhypersensitivity)toa
particularantigeninasensitizedindividual.Themostcommon
allergenscausingallergiccontactdermatitisarepollenandmetals:
?
1. Parthenium(Congressgrass)
2. Nickel

---

1661.Grattagetestisusedfor-
a)Tineacapitis
b)Lichenplanus
c)Pemphigusvulgaris
d)Psoriasis
CorrectAnswer-D
Ans.is'd'i.e.,Psoriasis
Bedsidetestsforpsoriasis
Twobedsidetestscanbedonetoconfirmtheclinicaldiagnosisof
psoriasis:-
i.Grattagetest
Scrapingthelesionwithaglassslidecausesaccentuationofthe
silveryscales.
ii.Auspitz'sSign
Scrapingthelesionwithglassslidecausesaccentuationosslivery
scales(asinGrattagetest).Ifscrapingiscontinuedfurther,a
glisteningwhiteadherentmembrane(Burlkey'smembrane)appears.
OnremovingBurlkey'smembranepunctate(finepinpoint)bleeding
becomevisible,whichisreferredtoasAuspitz'ssign.

---

1662.Treatmentofchoiceforlichenplanus?
a)Topicalcorticosteroids
b)Systemiccorticosteroids
c)Antihistaminics
d)Acitretin
CorrectAnswer-A
Ans.is'a'i.e.,Topicalcorticosteroids
TreatmentofLichenplanus
Thefirstlinetreatmentoflichenplanusaretopicalcorticosteroids.
Secondchoicewouldbesystemiccorticosteroidsforsymptom
controlandpossiblymorerapidresolution.
Oralantihistaminicsaregivenforpruritic.
PUVAcanbeusedforextensivelesions.
Acitretincanbeusedformucosallesions.

---

1663.Nikolsky'ssignisseenin?
a)Pemphigus
b)Herpeszoster
c)Bullousimpetigo
d)Alloftheabove
CorrectAnswer-D
Ans.is`d'i.e.,Alloftheabove
Niko!sky'ssignisseenin?
Pemphigus
Toxicepidermalnecrolysis
Bullousimpetigo
Stevenjonsonsyndrome
Staphylococcusscaldedskinsyndrome
HSV&VZVinfection
Epidermolysisbullosa
Malignancy(leukemia)
Mycosisfungoides
Bullouslichenplanus

---

1664.Tzanksmearinvaricella-zostershows?
a)Acantholysis
b)Spongiosis
c)MultinucleatedGiantcell
d)Necroticcell
CorrectAnswer-C
Ans.is'c'i.e.,MultinucleatedGiantcell

---

1665.Acantholysisis/arenotseenin:
a)Lichenplanus
b)Bullouspemphigoid
c)Dermatitisherpetiformis
d)Hailey-Haileydisease
e)Pemphigusvulgaris
CorrectAnswer-A:B:C
Ans.(A)Lichenplanus(B)Bullouspemphigoid(C)Dermatitis
herpetiformis
Acantholysis:
Separationofepidermalcellsfromeachother.
AcantholyticdisordersincludesPemphigusfamily(including
paraneoplasticpemphigus),eosinophilicspongiosis,Darier's
disease,Hailey-Hailey'sdisease(Familialbenignchronic
pemphigus)andtransientacantholyticdermatosis(Grouer's
disease),aswellasspecifichistologicalpatternssuchasfocal
acantholyticdyskeratosisandepidermolytichyperkeratosis.

---

1666.Erythemamultiformeismostcommonly
causedby?
a)Herpessimplex
b)Idiopathic
c)TB
d)Drugs
CorrectAnswer-B
Ans.is'b'i.e.,Idiopathic
IdiopathicerythemamultiformeisthemostcommoncauseofEM.
HerpessimplexisthemostimportantinfectiouscauseofEM.
CausesofErythemamultiforme
Idiopathic--)Mostcommoncause
Viral-->HSV(mostimportant)HBV,Mumps,Adenovirus
BacteriaStreptococci,tuberculosis
Fungal-->Coccidioidomycosis,Histoplasmosis.
Drugs--->Antibiotics(Sulphonamide),Phenytoin,NSAIDS.
Autoimmunedisease-->SLE,thyroiditis,RA
Others-->Sarcoidosis,Pregnancy,Malignancy.

---

1667.Treatmentofdermatitisherpetiformis?
a)Glutenfreediet
b)Dapsone
c)Sulfonamide
d)Alloftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Glutenfreediet
Tineacapitisshowsgreenishfluorescence.
Erythrasmagivesacoralpinkhue.
Pseudomonasinfectiongivesayellowish-greencolour

---

1668.Sexworkerwithdischargingulcer,
gramnegativediplococci&growthon
modifiedThayermartinmedia.
Diagnosis?
a)N.gonococci
b)Syphilis
c)LGV
d)Chaneroid
CorrectAnswer-A
Ans.is'a'i.e.,N.gonococci
Informationinthisquestionare?
1. Gramnegativediplococci.
2. GrowthonmodifiedThayer-martinmedia.
oNeisseriagonorrhoeaeisagramnegativediplococciandThayer-
martinmediumistheselectivemediumforgonococci.
Labdiagnosisofgonorrhea
Urethraldischargeisthemostimportantspecimen.
Transportmedia
1. LaItprocessingistooccurwithin6hrs--->StuartmediumorAmies
medium.
2. Ifprocessingistooccur>6hrs-->JEMBECorGono-Pak
system(mediawithself-containedCO2-generatingsystem).
Cluturemedia
1. Inacutecases-->ChocolateagarorMuller-Hintonagar.
2. Inchroniccases--->Selectivemedium-Thayermartinmedium.
Normallythediagnosisofgonorrhoeaismadebyisolatingthe
organisminculture.

---

Itmaynotbepossibletoobtaingonococciinculturefromsome
chroniccasesorfrompatientswithmetastaticlesionssuchas
arthritis.Serologicaltestmaybeofvalueinsuchinstances.
Inserologicaltestsantibodiestogonococcalpili,LPSandouter
membraneproteinsaredetected.oVarioustestsare?
1. Complementfixationtext
2. Precipitation
3. Passiveagglutination
4. lmmunofluorescence
5. Radioimmunoassay
6. Enzyme-linked
7. immunosorbentassay(ELISA)
However,noserologicaltesthasbeenfoundusefulforroutine
diagnosticprocedure.Immunobloting

---

1669.Drugofchoicefortreatingchylmydia
withgonorrheais?
a)Ciprofloxacin
b)Norfloxacin
c)Nalidixicacid
d)Doxycycline
CorrectAnswer-D
Ans.is'd'i.e.,Doxycycline

---

1670.Singledosetreatmentforgonorrhea?
a)Azithromycin
b)Tetracyline
c)Ceftriaxone
d)Erythromycin
CorrectAnswer-C
Ans.is'c'i.e.,Ceftriaxone
Foruncomplicatedgonococcalinfection,singledoseofIM
ceftriaxoneisthedrugofchoice.
Itisgivenalongwithazithromycin(singledose)ordoxycyline(BD
for7days)tocoverchlamydialinfection

---

1671.FeatureofGranulomatosiswith
polyangiitis:
a)Nasalpolyp
b)PerforatedNasalseptum
c)Persistantsinus
d)Crustingofnasalmucosa
e)Collapseofnasalbridge
CorrectAnswer-B:C:D
Answer-(B)PerforatedNasalseptum(C)Persistantsinus
(D)Crustingofnasalmucosa
Granulomatosiswithpolyangiitis(Wegener)isadistinct
clinicopathologicentitycharacterizedbygranulomatousvasculitisof
theupperandlowerrespiratorytractstogetherwith
glomerulonephritis.
Disseminatedvasculitisinvolvingbothsmallarteriesandveinsmay
occur.
Nasalfindingsincludecrustinggranulations,septalperforation&a
saddlenose
Destructionoftheseptumwithacharacteristicimplosionofthenasal
bridge.

---

1672.manwithpainindefecation,no
gastrointestinalsymptoms,clustered
ulcersextendingintoanalcanal.
Diagnosis-
a)CMV
b)Gonorrhea
c)Herpesgenitalis
d)HIV
CorrectAnswer-C
Ans.is'c'i.e.,Herpesgenitalis
Herpesgenitalisisasexuallytransmitteddisease,characterizedby
appearanceofmultiplepainfulvesiclesinclusteresingenitalarea
whichlateronmayulcerate.Thesesmallulcersmaycombineto
formalargeulcer.Firstattackofthisininfectionmaybeassociated
withflulikesymptomsbutGITsymptomsareusuallyabsent.
Gonorrheaischaracterizedbyacuteanteriorarthritisassociated
withthickyellowurethraldischarge.Perianalulcerationisnota
featureofgonorrhea.
AlthoughHIVcanbeconsideredinthedifferentialdiagnosisof
Perianalulcers,butisusuallyassociatedwithGITsymptoms.
PerianalulcerationisnotafeatureofCMVinfection.

---

1673.Ulceronecroticnoduleisseenin?
a)Lucioleprosy
b)Lucioleprosy
c)Indeterminateleprosy
d)Histoidleprosy
CorrectAnswer-A
Ans.is'a'i.e.,Lucioleprosy
Luciophenomenon
Itisfoundinlucioleprosywithtype2leprareaction.Itisprevalentin
mexico.
Characterizedbypainfultenderredpatchesparticularlyon
extremitieswhichlateronbecomenecroticandfinallydevelopinto
brownblackeschar.
Ulcersaremorepersistentonlegs.
Tuberculoidandindeterminateleprosyarecharacterizedby
hyperpigmentedmaculewithimpairmentofsensations.
Inhistoidleprosy,classicalfeatureiserythematousshinyred
subcutaneousorcutaneousnodules,espovertheextensoraspect
ofextremities,back,buttocks&face.Ulcerationisunusual.

---

1674.Nervesarenotinvolvedin?
a)Tuberculoidleprosy
b)Lepromatousleprosy
c)Indeterminateleprosy
d)Borderlinetuberculoidleprosy
CorrectAnswer-C
Ans.is'c'i.e.,Indeterminateleprosy

---

1675.Matchsticktestispositivein?
a)Rhinophyma
b)Rhinosporiodosis
c)Lupusvulgaris
d)P.versicolor
CorrectAnswer-C
Ans.is'c'i.e.,Lupusvulgaris
Lupusvulgaris
Lupusvulgarisisachronicandprogressiveformofcutaneous
tuberculosisthatoccursintuberculinsensitivepatients.Itisthemost
commontypeofcutaneoustuberculosisandhasmostvariable
presentation.Seeninchildrenandyoungadults,thoughnoageis
exempted.Occursonexposedarealikeface(nose,eyelid,pinna);
andsometimesonbuttock,trunk.
Lesionsareusuallysolitaryandcharacterizedby:-
1. Reddishbrown(erythematous
2. Annularinshape
3. Indurated
4. Slowlyincreasesinsize(graduallyprogressive).
5. Healingwithtissuepaperlikescarringatcentre(mostcommon)or
edge.
6. Peripheralcrusting
7. Blanchingwithglassslide(diascopy)willrevealgreygreenfoci
Applejellynodules.
8. Match-sticktestpositive--->Applejellynodulehasnoresistanceto
pressurebyasharpmatch-stick.
Reappearanceofnewnoduleswithinpreviouslyatrophicorscarred
lesionsischaracteristic.Cartilage(Ear,nose)intheaffectedareais

---

progressivelydestroyed(Lupusvorax);boneisusuallyspared.
Buccal,nasalandconjuctivalmucosamaybeinvolvedprimarilyor
byextension.Treatmentisantituberculardrugs(ATT).

---

1676.CircleofHebraisinvolvedin?
a)Pediculosiscorpora
b)Pityriasisversicolar
c)Scabies
d)Leprosy
CorrectAnswer-C
Ans.is'c'i.e.,Scabies
Scabies
ScabiesiniscausedbymitesofthefamilySarcoptidae,which
includesSarcoptesscabiei,thescabiesmite.Usuallyaffects
childrenbutcanoccuratanyage.Morecommoninlow
socioeconomicstrataasovercrowdingandpoorhygienefacilitate
thespread.Themostimpmeanofspreadisdirectcontactwiththe
infectedindividual.Scabiesiswatersheddiseasewhichoccursdie
toinadequateuseofwaterandimproperhygiene.
Clinicalfeatures:?
1. Severeitchingisthemostprominentclinicalfeatureabdhas
followingcharacterstics
Worseatnight
Generelised
Affectingseveralfamilymembers
2.Bodyareasmostcommonlyinvolvedarewebspacesoffingers,
wrists,elbow,axillaandgroinarea,areasknownascircleofHebra.
3.Burrowisserpentine(S.shaped),threadlikegreybrownline
whichrepresentstheintraepidermaltunnelcreatedbymoving
femalemiteinstratumcorneum.Burrowispathognomicsignof
scabies.Burrowsareverydifficulttodemonstrateininfants.
4.Paulesandpapulovesiculareruptionsduetohypersensitivityto
mite

---

mite
5.Pustulescanoccurduetoseceondaryinfection
6.Excoriationandscratchmarks
7.Historyofinvolvementoffamilymembers

---

1677.Scalpandfaceareinvolvedin?
a)Adultscabies
b)Nodularscabies
c)Infantilescabies
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Infantilescabies
Type
Feature
oInfantile Scalp,face,palmsandsolesareinvolved
scabies
o
Crustedhyperkeratoticlesionsonface,palms,
Norwegian soles,nails.Itchingisnotprominent.Mitesare
scabies
foundinthousand,mostsevereformofscabies
Crusted
Extensivecrusts
scabies
Nodular
Extensivecrusts
scabies
Genital
Extensivecrusts
scabies
Animal
Historyofcontactwithcatordog.Atypical
scabies
presentation

---

1678.Treatmentofchoiceofscabiesin
pregnancy?
a)Ivermectin
b)Garna-benzenhexachloride
c)Permethrin
d)Garna-benzenhexachloride
CorrectAnswer-C
Ans.is'c'i.e.,Permethrin
'Premethrinisthedrugofchoiceforinfantsaswellaspregnantand
nursingwomen'.--Evidencebaseddermatology
Alternativesarebenzyl-benzoateandcrotamitone.
Gammabenzenhexachlorideandivermectinarenotrecommended.

---

1679.Skinscrapping&KOHmountingis
donefor?
a)Leprosy
b)Varicella
c)Fungus
d)HSV
CorrectAnswer-C
Ans.is'c'i.e.,Fungus
Laboratorydiagnosisoffungalinfection
Laboratorydiagnosisoffungalinfectiondependson:?
1. l.Recognitionofthepathogenintissuemicroscopy:-Tissue
specimens,suchasskinscraping,aregenerallyexaminedaswet
mountsaftertreatmentwith10%KOH.KOH(alkali)digestscells
andothertissuematerials,enablingthefunguselementstobeseen
clearly.Periodicacidschiff(PAS)andmethanaminesilveraretwo
mostcommonlyusedstainsforthedemonstrationoffungal
elementsintissuesections.
2. Culture:-Culturemediausedmostcommoninmycologyis
Sabauraud'sglucoseagar.
3. Serology:-ELISAcomplementfixationtest,Immunodiffusion.
4. PCR:-DetectionoffungalDNAisclinicalmaterial.

---

1680.Dermatophyesaffect?
a)Keratin
b)Dermisofskin
c)Stratumbasal
d)Stratumbasal
CorrectAnswer-A
Ans.is'a'i.e.,Keratin
Dermatophytesarekeratinophillicfungi,livingonlyonthesuperficial
deadkeratin.Thatiswhytheyinfectskin,hairandnail.Inskinthey
infectmostsuperficiallayeroftheepidermisi.e.stratumcorneum.
Theydonotpenetratelivingtissues.Dermatophytescauseavariety
ofclinicalconditions,collectivelyknownasdermatophytosis,tineaor
ringworm.Dermatophyteshavebeenclassifiedinto3genera:-
trichophyton,microsporum,epidermophyton.
1. Trichophytonaffects;-skin,hair,nails
2. Microsporumaffects;-skin,hair(nailsarenotaffected)
3. Epidermophytonaffects:-skin,nails(hairarenotaffected)
Deepfungalinfections(eg:-maycetoma,chromoblastomycosis,
pheohyphomycosis,sporotrichosis,lobomycosis,rhinosporidiosis)
involvesubcutaneoustissue.
Dermatophytosisisitchyandscaly

---

1681.Thefollowingdrugiseffectivein
treatmentofptyriasisversicolor?
a)Ketoconazole
b)Metronidazole
c)Griseofulvin
d)Chloroquine
CorrectAnswer-A
Ans.is'a'i.e.,Ketoconazole
Pityriasisversicolor(Tineaversicolor)
Tineaversicolorisamisnomerasitisnotcausedbydermatophyte;
Pityriasisversicolorismoreappropriateterm.Itiscausedbya
nondermatophytefunguscalledPityrosporumovale(Malasezia
furfur).Itusuallyaffectsyoungadults.
Clinicalfeatures
Therearemultiplesmallscalyhypopigmentedmacules(macules
maybehyperpigmentedalso).Scalingisfurfuraceousorrice
powderlike.Maculesstartaroundthehairfolliclesandthenmerge
witheachothertoformlargeareas.Affectstrunkandshoulders
(mainlychestandback).Theremaybelooseningofscaleswith
fingernails-4Coupledonleorstrokeofnail.Lesionsarerecurrentin
nature(mayreappearaftertreatment).
DiagnosisofP.versicolor
Examinationofscalesin10%KOHshowsshorthyphaeandround
spores(Sphagettiandmeatballappearance).Wood'slampshows
applegreenfluorescence(blue-greenfluorescence).Skinsurface
biopsy--)Acyanoacrylateadhesive(crazyglue)isusedtoremove
thelayerofstratumcorneumonglassslideandthenstainedwith
PASreagent.

---

TreatmentofP.versicolor
1. Systemicagents:-Systemicazolesprovideaconvenient
therapeuticoption.Drugsusedareketoconazole,Fluconazoleor
intraconazole.
2. Topicalantifungals:-Topicalantifungalsusedare:-
i.Azoles-->Clotrimazole,econazole,Miconazole,Ketoconazole.
ii.Others-->SeleniumSulfide,Sodiumthiosulphate,whield's
ointment(3%salicylicacid+6%Benzoicacid).

---

1682.AllareseeninBehchetssyndrome
except
a)Genitalulcers
b)Genitalulcers
c)Oralulcers
d)Pyodermagangrenosum
CorrectAnswer-D
Ans.is'd'i.e.,Pyodermagangrenosum

---

1683.Pathergytestisusedfor?
a)Reither'ssyndrome
b)Bechet'ssyndrome
c)Lichenplanus
d)Atopicdermatitis
CorrectAnswer-B
Ans.is'b'i.e.,Bechet'ssyndrome
CriteriafordiagnosisofBechet'sdisease
Recurrentoralulcerforatleast3timesin12months.
Plusanytwoofthefollowings:?
1. Recurrentgenitalulcer.
2. Eyeinflammationwithlossofvision.
3. Charactersticskinlesion(erythemanodosum).
4. Positivepathergytest(skinpricktest).

---

1684.Erythroderma%ofskininvolvedis?
a)>90%
b)<30%
c)30-60%
d)60-70%
CorrectAnswer-A
Ans.is'a'i.e.,>90%
Erythroderma(generalizedexfoliativedermatitis)
Erythrodermaisthetermusedwhenthemajorityoftheskinis
erythmatousredcolorandusuallyassociatedwithcrusts,theremay
beassociatederosions,pustules,sheddingofnailsorhair.
"Exfoliativedermatitis(erythroderma)referstoascaling
erythematousdermatitisinvolving90%ormoreofthecutaneous
surface".
Exfoliativedermatitisischaracterizedby:-
1. Erythema
2. Scaling
Thisoftenobscurestheprimarylesions,Forexampleinpsoriasis
tehcharacteristiclesioniserythmatousplaquewithsilveryscale,on
extensors.Whenerythermaoccursasacomplication,mostofthe
cutaneoussurfaceisinvolvedbyerythmawhichobscuresthe
primarylesionsofpsoriasis.
CausesofErythroderma(exfoliativedermatitis)
1.Skindisorders
Psoriasis
Dermatitis/Eczema(atopic,stasis,contact,seborrheic)
Pityriasisrubrapilaris

---

Lichenplanus
2.Systemicdiseases-->CutaneousT-celllymphoma
3.Drugs-->Gold,Allopurinol,Phenytoin,penicillin,Sulfonamides.
4.Idiopathic(secondarytosolidtumorsoflung,liver,prostate,
thyroid,colon).
Treatmentoferythroderma(exfoliativedermatitis)
Topicalcorticosteroidsaretheprimarycategoryofmedicationused
totreatexfoliativedermatitis.Asedativeantihistaminicmaybea
usefuladjunctforpruriticpatients.Systemicantibioticsmaybeused
ifinfectionissuspected.
Systemiccorticosteroidsmaybeusefulinseverediseasefor
remissioninduction,butnotformaintenance.Systemic
corticosteroidsshouldnotbeusedinpsoriasis(psoriatic
erythroderma);Acitretinormethotrexatearepreferred.

---

1685.Treatmentofgraunolmainguinaleis?
a)Tetracycline
b)Azithromycin
c)Clarithromycin
d)Streptomycin
CorrectAnswer-B
Ans.is'b'i.e.,Azithromycin
GranulomainguinaleorGranulomavenerumorDonovanosis
CausedbyCalymmatobecteriuntgranulomatis,agramnegative
intracellularbacteria.
IPis1-4weeks.
Beginsasoneormoresubcutaneousnodulesthaterodethrough
skintoproduceulcer.Ulcerhasfollowingcharacterstics.
1. Painless
2. Bleedingwithredgranulationtissue
3. Indurated
SubcutaneousgranulomasofinguinalregioninDonovenosislook
likeenlargedlymphnodesbutthesearenotenlargedlymphnodes.
Therefore,theseareknownasPseudobubos.Sitesofthelesions
aregenitalia(90%),inguinal(10%),andanalregions.
Complicationsarepseudoelephentiasis,phimosis,paraphymosis.
Diagnosis
PreferredmethodisdemonstrationoftypicalintracellularDonavan
Bodieswithinlargemononuclearcellsvisualisedinsmearprepared
fromlesionorbiopsyspecimen.Itshowssafetypinappearance.
Treatment
AzithromycinistheDOC.Alternativesaredoxycycline(2ndchoice)
andchloremphenicol.

---

Streptomycin,onceused,isnotusednow.

---

1686.A15cmhyperpigmentedmaculeonan
adolosentmaleundergoeschanges
suchascoarceness,growthofhair&
acne.Diagnosisis?
a)Melanocyticnevus
b)Beckernevus
c)Sebaceousnevus
d)Sebaceousnevus
CorrectAnswer-B
Ans.is'b'i.e.,Beckernevus
BeckerNevus
Usuallystartsinadolescenceasanirregularsmooth
hyperpigmentedmacule.
Usuallyinvolvesshoulder,anteriorchestandscapularregion,
althoughanypartofthemaybeinvolved.
Slowlygrowsinsizeofapalmwileacquiringthickdarkhair.
Oftenlesionresemblingacnevulgarisindifferentstagesmayappear
onsurface.
Notreatmentisrequired.

---

1687.15mm/cmhyperpigmentedlesionon
shoulderenlargingandhairoverit?
a)Melanocyticnevus
b)Beckernevus
c)Sebaceousnevus
d)Comedonevus
CorrectAnswer-B
Ans.is'b'i.e.,Beckernevus
BeckerNevus
Usuallystartsinadolescenceasanirregularsmooth
hyperpigmentedmacule.
Usuallyinvolvesshoulder,anteriorchestandscapularregion,
althoughanypartofthemaybeinvolved.
Slowlygrowsinsizeofapalmwileacquiringthickdarkhair.
Oftenlesionresemblingacnevulgarisindifferentstagesmayappear
onsurface.
Notreatmentisrequired.

---

1688.Onback,bigblackpatchdiagnosisis?
a)Seborrheicmelanosis
b)Beckernevus
c)Lichenplanuspigmentosus
d)Pityriasisversicolor
CorrectAnswer-B
Ans.is`b'i.e.,Beckernevus
BeckerNevus
Usuallystartsinadolescenceasanirregularsmooth
hyperpigmentedmacule.
Usuallyinvolvesshoulder,anteriorchestandscapularregion,
althoughanypartofthemaybeinvolved.
owlygrowsinsizeofapalmwileacquiringthickdarkhair.
Oftenlesionresemblingacnevulgarisindifferentstagesmayappear
onsurface.
Notreatmentisrequired.
Seborrheicmelanosis
Brownishblackpigmentationtypicallydistributrdoverseborrhea
areas(forehead&beard,retroauricularfolds,neck,upperpartof
chest,interscapularareas)accompaniedbyerythemaanditching.
Lichenplanuspigmentosus
Hyperpigmenteddarkbrownorslategreymaculesdistributedmainly
overexposedareasandflexures.
Pityriasisversicolor
Darkbrowntoblackoverlappingconfluentpatcheswithsatellite
lesions,mainlyoveruppertrunkandextendingtoupperarms,neck
andabdomen.

---

1689.Frequencyofwoodslampis?
a)365nm
b)400nm
c)320nm
d)200nm
CorrectAnswer-A
Ans.is`a'i.e.,360nm
Wood'slamp
Wood'slamphasanultravioletlightlamp(365nm)withafilter
containingnickleoxideandbariumsilicate.TheUVlight,when
absorbedbycertainsubstances,fluorescencesindarkandthecolor
offluorescenceisusefulindiagnosisofthecondition.
Condition
Fluorescentcolours
Tineacapitis
Brightyellowgreen
Erythrasma
Coralredorpink
Vitiligo
Milkywhite
Albinism
Bluewhite
Leprosy
Bluewhite
Tuberoussclerosis
Bluewhite
Pseudomonasinfection

---

Greenishwhite
Porphyria
Pinklorange
Tineaversicolor
Goldenyellow

---

1690.Drugcausingfixeddrugeruption?
a)Sulfonamide
b)Erythromycin
c)Aminoglycoside
d)None
CorrectAnswer-A
Ans.is`a'i.e.,Sulfonamide
Drugscausingfixeddrugeruption
Paracetamol(Phenacetin)
Sulfonamides
NSAIDs
Aspirin
Barbiturates
Dapsone
Tetracyclines
Phenylbutazone

---

1691.Drugcausingexanthema?
a)Atropine
b)Phenytoin
c)Sulfonamide
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove

---

1692.Schamberg'spurpuraareseenon?
a)Face
b)Feet
c)Chest
d)Arms
CorrectAnswer-B
Ans.is'b'i.e.,Feet
Schamberg'spurpura
Mostcommonfromofpigmentedpurpuradermatosis(PPD).
Puncatepurpuramaculesdeveloponlowerextrimities,particularly
aroundankles&pretibialregion.
Mostlyasymptomatic

---

1693.Notacutaneousporphyria?
a)Erythropoeiticporphyria
b)Hereditarycoproporphyria
c)Congenitalerythropoeiticporphyria
d)Sideroblasticanemia
CorrectAnswer-B
Ans.is'b'i.e.,Hereditarycoproporphyria
Porphyrias
Porphyriasareheterogenousgroupofdisorderscharacterizedby
defectivemetabolismofporphyrins.Porphyrinsareimportant
intermediatesinbiosynthesisofhemefromglycineandsuccinyl
CoA.Eachstepiscontrolledbyspecificenzyme.So,prophyriasare
duetoinheritedoracquireddeficiencyofenzymesinhemebio-
syntheticpathways(alsocalledporphyriaspathway).Theymanifest
witheitherneurologicalcomplicationsorskinproblems(orrarely
both).Basedonthesiteofoverproductionandaccumulationof
porphyrins,porphyriasarebroadlyclassifiedas:?
A.Acute(hepaticprophyria)
1. Acuteintermettantporphyria
2. 5-ALAdehydratasedeficiency
3. HereditaryCoproporphyria
4. Variegateporphyria
5. Porphyriacutaneatarda
B.Cutaneous(erythropoeitic)porphyria
1. Erythropeiticprotoporphyria
2. Congenitalerythropoeiticporphyria
3. X-linkedsideroblasticAnemia
Theacute(hepatic)porphyriasprimarilyaffectnervoussystem

---

resultinginabdominalpain,vomiting,acuteneuropathy,seizures,
muscleweakenss,psychiatric/mentalsymptoms(i.e.,Hallucination,
depression,anxiety,paronoia);andautonomicnervousdisturbances
likehypertension,tachycardia,constipation,arrhythmias,sweating.
Thecutaneous(erythropoietic)porphyriasprimarilyaffectskin
causingphotosensitivity(photodermatitis)blisters,itching,
maculopapularrash.Thereisnoabdominalpain.
Therearesomevariationinabovepresentation.
1. Followingtwotypesofhepatic(acute)porphyriasalsoaffectskin:-
Hereditarycoproporphyriaandvarigatedporphyria.Thereforethese
twohavebothneuropsychiatricaswellasskinmanifestations.
2. Porphyriacutaneatarda(ahepaticporphyria)doesnothave
neuropsychiatricsymptom,ratherithasonlyskinmanifestation.
3. X-linkedsideroblasticanemia(anerythropoieticporphyria)has
neitherneuropsychiatricnorskinsymptoms.

---

1694.Whichofthefollowingultra-violet
radiationcausemostskindisorder?
a)UV-A
b)UV-B
c)UV-C
d)None
CorrectAnswer-B
Ans.is`b'i.e.,UV-B
Ultravioletradiation(UVR)
UVRiselectromagneticradiationwithwavelength(200-400nm)
shorterthanvisiblelight,butlongerthanxrays.Therearethree
segmentsofUVR.
1.UV-C/ShortwaveUV-radiation(200-290nm)
Itismostdangerousasithasseriouseffectsontheskin.But,Itis
notmedicallyimportantasitisabsorbedbyozonelayerandhence
doesnotreachthesurfaceofearthinmeasurableamounts.
2.UV-B/mediumwaveUV-radiation(290-320nm)
MedicallymostimportantUVRasitcausesmostofthedermatoses,
e.g.,sunburn,tanning,photoaging.Itisabsorbedinepidermis.Itis
usedinphototherapyasnarrowbandUV-B(NBUVB)whichhas
wavelengthof311nm.
3.UV-A/LongwaveUV-radiation(320-400nm)
Itisabsorbedindermis.Itisfurtherdividedinto:?
1. UVA-2--->320-340nm
2. UVA-1--->340-400NM
Wood'slampusesUVA-1(365NM).UVAisalsousedin
photochemotherapy(PUVA).

---

1695.Whichofthefollowingporphyriasisnot
inheritedasanAutosomalDominant
disorder-
a)AcuteIntermittentPorphyria
b)CongenitalErythropoieticPorphyria
c)PorphyriaCutaneaTarda
d)HereditaryCoproporphyria
CorrectAnswer-B
Ans.is'b'i.e.,Congenitalerythropoieticporphyria
InheritanceofPorphyrias
AutosomaldominantAutosomal
RecessiveX-linked
oAcuteintermittentporphyria(AIP)oALAdehydratase
deficiencyoX-linkedprotoporphyria
oPorphyriacutaneaTarda(PCT)oCongenital
erythropoieticporphyria
oHereditarycoproporphyria(HCP)oErythropoietic
protoporphyriaoVariegateporphyria(VP)

---

1696.Lovibondprofilesignisseenin?
a)Koilonychia
b)Platynochia
c)Clubbing
d)Onycholysis
CorrectAnswer-C
Ans.is'c'i.e.,Clubbing
ClinicalindicatorsofclubbingareLovibondprofilesignand
curth'smodifiedprofilesign".
Lovibondangleistheanglelocatedatthejunctionbetweenthenail
plateandproximalnailfold.Itisnormallylessthan160?.Inclubbing,
theangleexceeds180?(Lovibondprofilesign).

---

1697.Acanthosisnigricansisseenin?
a)Diabetes
b)GITcancer
c)Hypothyroidism
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Acanthosisnigricans
Acanthosisnigricansisabrowntoblack,velvetyhyperpigmentation
oftheskin.Itisusuallyfoundinbodyfolds,suchasposterior&
lateralfoldsofneck,axilla,groin,umblicus,forehead.Ittypically
occursinindividualsyoungerthan40yearsofage.
Histopathologicallypapillomatosisischaracteristicallyseen;
however,thereisnohypermelanosisandthereisonlymild
acanthosis,ifpresent.
Itisassociatedwith
1. Obesity(mostcommon)
2. Endocrinopathies-->Hypothyroidism,hyperthyroidism,insuline
resistancediabetes,Cushing'sdisease,PCOD,Bloomsyndrome.
3. Internalmalignancy-->Gastricadenocarcinoma

---

1698.Potatonoseisseenin?
a)Acnevulgaris
b)Rhinosporoidosis
c)Acnerosacea
d)Lupusvulgaris
CorrectAnswer-C
Ans.is'c'i.e.,Acnerosacea
Acnerosacea
Acnerosacea,commonlycalledrosacea,isachronicnon-curable
skindiseasewithperiodicupsanddown.
Itoccursinmiddleage(30-50years).Itismorecommoninfemales,
butismoresevereinmales.
Rosaceaisacentrofacialdisease,i.e.,itinvolvesthecentral
faceCheeks,Chin,Forehead,Nose,makingtypicalcruciate
patternofinvolvement.
Periorbital&perioralareasarespared.
Clinicalfeaturesareintermittantflushingfollowedbymore
permanenterythmaandtelangiectasia.
Onthisback-ground,erythmatouspapules,papulopustulesand
rarelynodulesdevelop.
Lesionsmaybeexacerbatedbylight(photosensitive)andspicy
foods.
Complicationsare:?
1. Rhinophyma:-Rhinophymaislarge,bulbous,ruddyappearanceof
nosecausedbygranulomatousinfiltrationofskin.Itisslowly
progressiveconditionduetohypertrophyofsebaceousglandonthe
tipofnose.ItisalsoknownasPotatonose.
2. Ophthalmologic:-Blephritis,Conjuctivits,Keratitis,.

---

3. Lymphedema:-Infra-orbitalandonforehead.

---

1699.Keivmsskintestisusedfordiagnosis
of
a)Sarcoidosis
b)Wegenersgranulomatosis
c)Gravesdisease
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Sarcoidosis
Kveimtest(Nickerson-kveimorKveim-Siltzbachtest)wasaskintest
usedtodetectsarcoidosis.
Itisnotusedknow.

---

1700.Theterm"balancedanaesthesia"has
beengivenby?
a)Simpson
b)Fischer
c)Lundy
d)Mortan
CorrectAnswer-C
Ans.is'c'i.e.,Lundy
Term'balancedanaesthesia'wasintroducedbyLundyin1926.
Balancedanaesthesia
Thecardinalfeatureofgeneralanaestheticsare:?
1. Lossofallsensations,especiallypain
2. Sleep(unconciousness)andamnesia
3. Immobilityandmusclerelaxation
4. Abolitionofreflexes
Inmodernpracticeofbalancedanaesthesiathesemodalitiesare
achievedbyusingcombinationofinhaledandiv.drugs.

---

1701.Etherwasfirstusedasananaesthetic
by?
a)Priesly
b)Morton
c)Wells
d)Simpson
CorrectAnswer-B
MortonREF:http://en.wikipedia.org/wiki/William_T.G_Morton
WilliamThomasGreenMorton(August9,1819-July15,1868)was
anAmericandentistwhofirstpubliclydemonstratedtheuseof
inhaledetherasasurgicalanaestheticin1846

---

1702.Whocoinedtermanaesthesia?
a)Morton
b)Holmes
c)Morgan
d)Priestly
CorrectAnswer-A
Ans.is'a'i.e.,Morton
Secondgaseffectanddiffusionhypoxia
Ininitialpartofinduction,diffusiongradientfromalveolitobloodis
highandlargerquantityofanaestheticisenteringblood.
IftheinhaledConcentrationofanaestheticishigh(egN20),
Substantiallossofalveolargasvolumewilloccuranditcreates
negativeintralveolarpressurethatleadstoremovalofmoregas
fromcylindertoalveoli-->Concentrationeffect.
Ifanotherinhalationagentis(egHalothane)isbeinggivenatthe
sametime,italsowillbedeliveredtolungfromthecylinder(dueto
negativeintraalveolarpressure)-->Secondgaseffect.
Duringrecoveryreverseoccurs-N20havinglowbloodsolubility,
rapidlydiffusesintoalveolianddilutesthealveolarair-->partial
pressureofoxygeninalveoliisreduced.
Theresultinghypoxiaisknownasdiffusionhypoxia.
Diffusionhypoxiacanbepreventedbycontinuing100%02
inhalationforafewminutesafterdiscontinuingN20,insteadof
straightawayswitchingovertoair.
Remember
Concentrationeffectandsecondarygaseffectduringinduction.
Diffusionhypoxia-->duringrecovering.

---

AlltheseoccurwithN20only

---

1703.ThefollowingincreasesIntraOcular
pressure:
a)Thiopentone
b)Althesin
c)Ketamine
d)Barbiturate
CorrectAnswer-C
Ketamine

---

1704.Circuitofchoiceforcontrolled
ventilation?
a)Magillcircuit
b)TypeC
c)TypeD
d)TypeE
CorrectAnswer-C
Ans.is'c'i.e.,TypeD

---

1705.Capnographyhelpstoknowthe
following
a)Correctintubation
b)Pulmonaryembolism
c)Adequateventilation
d)Lungperfusion
e)Significantmetabolicchange
CorrectAnswer-A:B:C:D:E
Answer-A,CorrectintubationB,Pulmonary
embolismC,AdequateventilationD,Lung
perfusionE,Significantmetabolicchange
ConditionsthataffectETCO2
Increased
Hypoventilation
Rebreathing
Malignanthyperthermia,
Neurolepticmalignantsyndrome
Increasedskeletalmuscleactivity(shivering
Hypermetabolism
Hyperthyroidism&thyroidstorm
Decreased
Hyperventilation
Pulmonaryembolism
Hypoperfusion,hypotension,hypovalemia,shock
Hypothermia

---

1706.SupremeLMAcharacteristicis
a)Hasnobiteblock
b)Usedininfants
c)Highpressure,lowvolume
d)Hasbuiltindraintube
CorrectAnswer-D
Ans.is'd'i.e.,Hasbuiltindraintube
LMAsupremeisoneofthemostadvancedlaryngealmaskairway
(LMA).
IthasfeaturesofusualLMAwithadditionalBuilt-indraintubeanda
biteblock.
Ithashighvolume/lowpressurecuffwhichgenerateshigherseal
pressure.oItalsoprovidesaconduitforactivesuctioningof
stomach.
Itcanbeusedininfantsaswellasinadults.

---

1707.Criticaltemperatureofoxygenis?
a)20
b)118
c)36.5
d)400C
CorrectAnswer-B
Ans.is'b'i.e.,-118

---

1708.Criticaltemperatureforliquidnitrogen
is?
a)36.5?C
b)-20?C
c)-147?C
d)-242?C
CorrectAnswer-C
Ans.is'c'i.e.,-147?C
Criticaltemperature(Tc)ofasubstanceisthetemperatureatand
abovewhichvapourofthatsubstancecannotbeliquified,nomatter
howmuchpressureisapplied(Note:Belowcriticaltempraturea
substancecanexistasaliquidorgasdependingonpressure).
CriticaltemperatureofN2is-146.9?C;thatmeansN2canbe
liquifiedbelow-146.9?C-->So,liquidnitrogenmustbestoredbelow
-146.9?C.

---

1709.
Whichanaestheticbelongstoester
group?

a)Procaine
b)TimesNewRoman
c)Lignocaine
d)Propofol
CorrectAnswer-A
Ans.is'a'i.e.,Procaine
Esters(aminoesters):-Procaine,chlorprocaine,tetracaine
(amethocaine),Benzocaine,Cocaine.
Amides(aminoamides)Lignocaine,Mepivacaine,Prilocaine,
Bupivacaine,Etidocaine,Ropivacaine,Dibucaine.

---

1710.Inophthalmologyapatientisallergicto
aminoesters.Whatcanbeused?
a)Cocaine
b)Procaine
c)Prilocaine
d)Bupivacaine
e)Tetracaine
CorrectAnswer-C:D
Ans.is'c'i.e.,Prilocaine&'d'i.e.,Bupivacaine
[Ref:Lee's13th/ep.486]
Prilocaine&bupivacaineareamides(amcinonide).Otherthreeare
aminoesters.

---

1711.Inpseudocholinesterasedeficiency,
drugtobeusedcautiouslyis-
a)Barbiturate
b)Succinylcholine
c)Halothane
d)Gallamine
CorrectAnswer-B
Ans.is'b'i.e.,Succinylcholine
Cholinesterase
Atcholinergicnerveendings,inerythrocytes,andgraymatterthere
isanenzymethatspecficallydestroysacetylcholine,true
cholinesteraseoracetylcholinestrase.
Invarioustissues,especiallyinplasma,liver,whitematter&
intestine,thereareotheresteraseswhicharenotspecificfor
acetylcholinebutwhichalsodestroyotheresters,thesearecalled
nonspecificorpseudocholinesteraseorbutyrylcholinesterase.
Thedrugshydrolyzedbypseudocholinesteraseare(Miller5th/ep.
419,420)
1. Succinylcholine
2. Cocaine
3. Mivacurium
4. Bambuteral
5. Remifentanil
6. Procaine
Pseudocholinesteraseismoresensitivetoorganophosphate
anticholinesterase,whiletrueacetylcholinesteraseismoresensitive
tocarbamateanticholinesterase(Physostigmine).
Condionswherepseudocholinesteraseleveldecreases.

---

1. Pregnancy
2. Malnutrition
3. CRF
4. Burns
5. Collegenvasculardisease
6. Hypothyroidism
7. Malignancy
8. Liverfailure

---

1712.A6yearoldboytakenforophthalmic
examinationunderanaesthesia.His
fathertoldthathehaslowerlimb
weakness&hiselderbrotherdiedat14
yearsofage.Whichanaetheticdrughas
tobeavoided-
a)Succinylcholine
b)Pancuronium
c)Atracurium
d)Dexacurium
CorrectAnswer-A
Ans.is'a'i.e.,Succinylcholine
Succinylcholine
SChisadepolarisingskeletalmusclerelaxant.
Itcausessustainedpartialdepolarizationofmuscleendplate-->
intiallyproducetwitchingandfasciculationfollowedbyflaccid
paralysis.
Itistheshortestandfastestactingskeletalmusclerelaxant.
Itistheonlymusclerelaxantwhichstimulateautonomicgangliaand
vagus.
SChisthemostcommonlyusedmusclerelaxantforpassing
endotrachealtube(mivacuriumandrocuroniumarealternatives).
SChisrapidlyhydrolysedbyplasmacholinesterase,somepatients
havegeneticallydeterminedabnormalityordeficiencyof
pseudocholinesterase,inthem,SChcausesphaseIIblock.
Itcancausemusclefasiculationsandsoreness,changeinBPand

---

HR,arrythmia,histaminereleaseandICeffluxfrommuscles.
Dangeroushyperkalemiacanoccurinpatientswithburn,crush
injury,musculardystrophy,GB.Syndrome,paraplegiaor
hemiplagia,mystheniagravisandrhabdomyolysiscontraindicatedin
suchpatients.oItcanaccentuatemalignanthyperthermiacaused
byhalothane.
SChcausesincreaseinallpressures-->inraocular,intracranial,
BP,andintrabdominal-->contraindicatedinglaucoma,headinjury.

---

1713.Blood:Gaspartitioncoefficientisa
measureof?
a)Potencyofanaestheticagent
b)Speedofinductionandrecovery
c)Lipidsolubilityofagent
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Speedofinductionandrecovery
Minimumalveolarconcentration(MAC)-->Measureofpotency.
Blood:GaspartitioncoefficientBloodsolubilityofanaestheticagent
anddeterminesthespeedofinduction&recovery.
Oil:Gaspartitioncoefficient-4Lipidsolubilityofanaestheticagent
andisrelatedtopotencyofanaestheticagent.

---

1714.LeastMACisofwhichinhalational
agent?
a)Xenon
b)Halothane
c)Sevoflurane
d)Isoflurane
CorrectAnswer-A
Ans.is'a'i.e.,Xenon
MAC
Agent
(%)
Ether
1.9
Halothane 0.75
Enflurane
1.68
Isoflurane
1.2
Desflurane 6.0
Sevoflurane 2.0
Nitrous
105
oxide
"XenonhasMACof71%"--Morgan
Methoxyflurone(MAC=0.16%)>Trilene(0.2%)>Halothane
(0.74%)>Chloroform(0.8%)>Isoflurane(1.15%)>Entlurane
(1.68%)>Ether(1.92%)>Sevoflurane(2.0%)>Desflurane(6,0%)
>Cyclopropane(9.2%)>N20(104%).

---

1715.Fastestinductionandrecoveryisseen
with?
a)Desflurane
b)N,0
c)Halothane
d)Enflurane
CorrectAnswer-A
Ans.is'a'i.e.,Desflurane
decreasingorder(IncreasingorderofB:Gpartitioncoefficientand
bloodsolubility):-
Desflurane(0.42)Q>Cyclopropane(0.44)>N20(0.47)>
Sevoflurane(0.69)Q>Isoflurane(1.38)>
Enflurane(1.8)>Halothane(2.4)>Chloroform(8)>Trilene(9)>
Ether(12)>Methoxyflurane(15)Q.

---

1716.AllarefalseaboutN20except?
a)Leastpotent
b)Goodmusclerelaxant
c)Lighterthanair
d)Nodiffusionhypoxia
CorrectAnswer-A
Ans.is'a'i.e.,Leastpotent
NitrousoxideN2Q
Itiscolourless,odourless,heavierthanair,nonirritatingand
noninflammablegas.oItisalsocalledlaughinggas.
MACis105%(leastpotent)-evenpureN20at1atmospheric
pressurecannotproduceadequateanaesthesia.oIthasgood
analgesicbutpoormusclerelaxantactivity.
Itissuppliedunderpressureinbluecolouredsteelcyclinders.
Ithasverylowbloodsolubility-->inductionisquickandsmooth
withrapidrecovery.
SecondgaseffectanddiffusionhypoxiaoccurwithN20only.
N20isgenerallyusedasacarrierandadjuvanttootheranaesthetics
-->Amixtureof70%N20+25-30%02+0.2-2%anotherpotent
anaestheticisemployedformostofthesurgicalprocedures.
Entonoxisamixtureof50%N20and50%02.
Ithaslittleeffectonrespiration,heartandBP.
ItcancausebonemarrowdepressionandvitB12deficiency.
N20istheonlyanaestheticreportedtoproducehematologictoxicity
andneurotoxicitywithlongtermadministration.
BothtoxicitiesaretheresultoftheinteractionofN20withvitB12.

---

Completebonemarrowfailurecanbeexpectedafterseveraldaysof
continuousexposure.
Bonemarrowchangesarepreventablebypretreatingpatientswith
largedosesoffolinicacid.
OthermanifestationsofvitB12deficiencyeg.megaloblastic
anemia,subacutecombineddegenerationofcordmayalsooccur.
Methemoglobinemiaandlaryngospasmmayoccur.
Itiscontraindicatedinpatientswithaircavitieslikepneumothorax,
pneumoperitoneumandvolvulus-->expansionandincreasein
pressureoccur.

---

1717.Hepatotoxicinhalationalagent?
a)Halothane
b)Enflurane
c)Desflurane
d)Sevoflurane
CorrectAnswer-A
Ans.is'a'i.e.,Halothane
Allinhalationalagentcausemildhepatotoxicitybydecreasing
hepaticbloodflow.
Isofluraneistheagentofchoiceinliverdiseaseasithasleasteffect
onHepaticbloodflow.
Directhepatotoxicity(Hepatitis,Hepaticnecrosis)iscausedby:-
Halothane,Chloroform,trilene,methoxyflurane

---

1718.Apatientaftergivinginhalational
anaestheiadevelopedfulminant
hepatitis,patientwasexposedtosame
drugpreviously.Whichisthedrug?
a)Halothane
b)N20
c)Enflurane
d)Isoflurane
CorrectAnswer-A
Ans.is'a'i.e.,Halothane
Halothane
Itisavolatileliquidwithsweetodour,nonirritatingand
noninflammable.
Itisapotentanaestheticwithpooranalgesicandmusclerelaxant
properties.
Halothanecausesdirectdepressionofmyocardialcontractilityby
reducingintracellularCa+2.
ItcausesfallinBPandCO.
Heartratedecreasesduetovagalstimulation.
Ittendstosensitizethehearttoarrhythmogenicactionofadrenaline
--*contraindicatedinpheochromocytoma.
Itcausesgreaterdepressionofrespirationandventilationperfusion
mismatch.
Itdilatesthebronchi-->inhalationagentofchoiceinasthmatics
(intravaneousanaestheticofchoiceinasthmaticsisketamine).
Itisahepatotoxicdrugandcanalsocausemalignanthyperthermia
(Succinylcholineaccentuateit).

---

Recoveryissmoothandreasonablyquick.
Itcausespostanaestheticshiveringandchills.
Itinhibitsintestinalanduterinecontractions-->agentofchoicefor
assistingexternalorinternalversionduringlatepregnancy.
Becauseitsuterinerelaxantactionitiscontraindicatedduring
labour.
Itisparticularlysuitableforinductionandmaintenanceinchildren
andasmaintenanceanaestheticinadults.

---

1719.Inhalationalagentofchoicefor
neurosurgery?
a)Halothane
b)Enflurane
c)Isoflurane
d)N20
CorrectAnswer-C
Ans.is'c'i.e.,Isoflurane
AnaestheticagentsofchoiceforvaousconditionsDaycare:
Ischemicheart
disease:
Congenitalheart
Propofol
disease
Etomidate
Lefttorightshunt:
Isoflurane
Righttoleftshunt:
Ketamine
CHF:
Ketamine
Shock
Ketamine
Toproducedelibrate Isoflurane
hypotenion
Thiopentone
Epilepsy:
Methohexitone
Forelectroconvulsive Thiopentone
therapy:
Isoflurane
Thyrotoxicosis:
Isoflurane
Cardiacsurgery:
Neurosurgery:

---

1720.Whichofthefollowingissafeevenif
injectedintraarterial?
a)Thiopentone
b)Propofol
c)Mida7olam
d)Methohexitone
CorrectAnswer-B
Ans.is'b'i.e.,Propofol
Accidentalextravasationorintra-arterialinjectionofpropofoldoes
notcauseadversereactions"
PrimerofAnaesthesia"Intraartierialinjectionofpropofoldoesnot
causevascularinjury"?EssentialsofAnaesthesia
Etomidateisalsosafe.?Miller's
Drugsassociatedwithsevercomplicationsafterintraarterial
injection
1. Benzodiazepines:Diazepam,midazolam,temazepam,
chlordiazapoxide
2. Phenothiazines:Promethazine,chlorpromazine,promazine
3. Barbiturates:Thiopentone,methexitone,secobarbitone,
pentobarbitone
4. Amphetamines
5. Antibiotics:Flucloxacillin,Penicillin
6. Narcotics:Heroin,mepridine,propoxyphene,cocaine
7. QMiscellaneous:Tubocurarine,atracurium

---

1721.Maximumglobalwarmingisby?
a)Desflurane
b)Isoflurane
c)Sevoflurane
d)Halothane
CorrectAnswer-A
Ans.is'a'i.e.,Desflurane
Desfluraneisagreenhousegas.
Itcausesmaximumglobalwarming.
Globalwarmingpotential(asanequalamountofO2)
Isoflurane210times
Sevoflurane510times
Desflurane1620times

---

1722.Whichanaestheticdrugcontributesto
greenhouseeffect?
a)Enflurane
b)Desflurane
c)Sevoflurane
d)Halothane
CorrectAnswer-B
Ans.is'b'i.e.,Desflurane

---

1723.Regardingpropofol,whichoneofthe
followingisfalse?
a)Itisusedasanintravenousinductionagent
b)Itcausesseverevomiting
c)Itispainfuloninjectingintravenously
d)Ithasnomusclerelaxantproperty
CorrectAnswer-B
Ans.is'b'i.e.,Itcausesseverevomiting
Propofol
Propofolisamilkywhitepowderthatispreservativefree;therefore,
itmustbeusedwithin6hours.Itisanoilbasedpreparation,
thereforeinjectionispainful.
Propofolisthemostfrequentlyusedintravenousanaesthetictoday.
--Miller6thie-318
Itcanbeusedforbothinductionaswellasmaintenace.
Itdoesnotpossessanticonvulsiveaction(unlikethiopentone).
ItcausesfallinBPandbradycardia.
Likethiopentalitdoesnotpossessmusclerelaxantaction.
Propofolpossesssignificantantiemeticandantipruritic
action.Miller6th/e-324
Propofoldecreasespolymorphonuclearleukocytechemotoxisbut
notaherence,phagocytosisandkilling(Thiopentoneblocksall
these)--)increasedlifethreatninginfections.
Propofolisparticularlysuitableforoutpatientsurgery.
Intermittentinjectionorcontinuousinfusionofpropofolisfrequently
usedfortotalLv.anaesthesia(TINA)whensupplementedby
fentanyl.

---

ItisanaestheticsofchoiceforintubationinICUandforpatientswith
malignanthyperthermia.
Sideeffects-painoninjection,myoclonus,apnea,LBPandrarely
thrombophlebitis.
Propofolinfusionsyndrome
1. Alethalsyndrome,associatedwithinfusionofpropofolfor48hours
orlonger.
2. Occursinchildrenandcriticallyill.
3. Itoccursasaresultoffailureoffreefattyacidmetabolismand
failureofthemitochondrialrespiratorychain.
4. Featuresare-cardiomyopathywithacutecardiacfailure,metabolic
acidosis,skeletalmyopathy,hyperkalemia,hepatomegalyand
lipemia

---

1724.Dissociativeanaesthesiaisproduced
by-
a)Ketamine
b)Etomidate
c)Propofol
d)Thiopentone
CorrectAnswer-A
Ans.is'a'i.e.,Ketamine
Dissociativeanaesthesiaischaracterizedbyprofoundanalgesia,
immobility,amnesiawithlightsleepandfeelingofdissociationfrom
onceownbodyandthesurroundingsCatalepticstate.
oKetamine(phencyclidine)inducesdissociativeanaesthesia.

---

1725.Inducingagentofchoiceinshock?
a)Isoflurane
b)Desflurane
c)Ketamine
d)Thiopentone
CorrectAnswer-C
Ans.is'c'i.e.,Ketamine
InducingagentofchoiceinAsthma&COPDKetamine.
InhalationalagentofchoiceinAsthma&COPDHalothane.

---

1726.Whichofthefollowinganesthetic
agentshaveanalgesicproperty:
a)Ketamine
b)Nitrousoxide
c)Thiopentone
d)aandb
CorrectAnswer-D
Ai.e.Ketamine;Bi.e.Nitrousoxide

---

1727.Intraocularpressureisincreasedby
whichanaesthetic?
a)Ketamine
b)Propofol
c)N20
d)Isoflurane
CorrectAnswer-A
Ans.is'a'i.e.,Ketamine

---

1728.Disadvantageofketamineis?
a)Increasedheartrate
b)IncreasedICT
c)Delirium
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Whenadministeredtoadultpatientsasasoleanaestheticagent,
ketaminefrequentlycauseemergencereactioncharacterizedby
anxiety,hallucination,delirium.Moreover,ketamineshows
cardiovascularstimulantproperty(increasesheartrateandBP),
increasessalivaryandbronchialsecretions,andmayincrease
intracranial,intraocularandpulmonarypressure.Allofthese
featureshavebeenadvocatedaslimitationsforitsusefulness.

---

1729.Whichanaestheticiscontraindicatedin
renalfailure?
a)Isoflurane
b)Desflurane
c)Halothane
d)Methoxyflurne
CorrectAnswer-D
Ans.is'd'i.e.,Methoxyflurne
Methoxyflurane
Itwasmostpotentinhalationagent(leastMAC),butnotusednot
(nowHalothaneismostpotent).oItshouldnotbeusedinclosed
circuit(reactswithrubbertubingofthelosedcircuit).
Ithasslowestonset&recovery(howevernowetherhasslowest
onset&recoveryasmethoxyfluraneisnotused).oBoilingpointis
morethanwater(104?C).
Intrarenalmetabolismofmethoxyfluraneandsubsequentintrarenal
productionoffluorideionisthesignificantcauseofmethoxyflurane
renaltoxicity.
Itcancausehighoutputrenalfailureandhepatotoxicity

---

1730.Duringrapidinductionofanesthesia?
a)Sellick'smaneuverisnotrequired
b)Pre-oxygenationismandatory
c)Suxamethoniumiscontraindicated
d)Patientismechanicallyventilatedbeforeendotracheal
intubation
CorrectAnswer-B
Ans.is'b'i.e.,Pre-oxygenationismandatory
Duringrapidsequenceinductionpreoxygenationisdoneforfull3
minutes.Schisthemusclerelaxantofchoiceforintubation.
Sallieck'smaneuverisdonetopreventaspiration.Manualventilation
beforeintubationisavoidedasthisinflatesthestomachand
encouragesregurgitation&aspiration.
Rapidsequenceanaesthesia
Whenanaesthesiaisgivenforemergencysurgery,itiscalleda
"rapidsequenceanaesthesia".Thepatientshavefullstomach
becausethereisnostarvationforanaesthesia(itisanemergency
surgery)andgastricemptyingisdelayedduetotrauma,acute
abdomen.Therefore,theobjectiveofrapidsequenceanaesthesiais
tosecuretheairwayrapidlyandpreventaspirationofgastric
contents.
Procedureofrapidsequencehasfollowingsteps:-
LiThepatientispreoxygenatedforfull3minutes.
Intravenousinductionagent(thiopentoneorpropofol)isgiven.
Sellick'smaneuver(cricoid/pressure)isdonetopreventaspiration.
Afterensuringthecorrectpositionoftubecricoidpressureis
releasedandmaintenanceanaesthesia(NCO66%,02%33%,&
inhalationalagent)isgiven.Anon-depolarizingblockerisnow

---

added.
Suxamethenium(succinylcholine)isgivenasitquicklyrelaxesthe
laryngealmusclessothatrapidintubationcanbedone.
Notdoneduringrapidsequenceanaesthesia:?
1. Manualventilationbeforeintubationisavoidedasthisinflatesthe
stomachandencouragesregurgitation&aspiration.
2. Premedicationsarenotgiven.

---

1731.Drugusedforemergencyintubationis
?
a)Propofol
b)Ketamine
c)Eomidate
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Propofol
Emergencyintubationinanaesthesiareferstorapidsequence
anaesthesia(orrapidsequenceintubation).
Anyinducingagentcanbeused,butthiopentalandpropofolarethe
preferredagent.

---

1732.Inpediatricepiduralanaestheisia,
volumeoflocalanaestheticgivento
causesacraldermatomeblockis?
a)0.5-1ml/kg
b)2-4ml/kg
c)5-10ml/kg
d)None
CorrectAnswer-A
Ans.is'a'i.e.,0.5-1ml/kg
Twomostcommonlyusedlocalanaestheticsforcaudalblockin
childrenare:-
1. Bupivacaine0.25%concentrationindoseof1ml/kg.
2. Ropivacaine0.2%concentrationindoseof1.2ml/kg.
Foreasycalculationofvolume:-
1. 0.5mUkgforsacralblockade.
2. 0.75ml/kgforlowerthoracicblockade.
3. 1.25ml/kgforupperthoracicblockade.

---

1733.Shortestactinglocalanaesthetics?
a)Lignocaine
b)Bupivacaine
c)Etidocaine
d)Chlorprocaine
CorrectAnswer-D
Ans.is'd'i.e.,Chlorprocaine
Short
Intermediateduration
Longduration(>120
durationLow (30-90min)
min)
potency
Intermediatepotency
Highpotency
Chloiprocaine
BupivacaineoTetracaine
Lignocaineo
(shortest
oEtodicaineo
MepivacaineoPrilocaine
acting)
Ropivacaine
aCocaine
Procaine
Dibucaine(longestacting)

---

1734.Allareusedforlocalinfiltrationexcept
?
a)Lidocaine
b)Ropivacaine
c)Dibucaine
d)Bupivacaine
CorrectAnswer-C
Ans.is'c'i.e.,Dibucaine

---

1735.Eutecticmixtureoflocalanaesthetic
(EMLA)creamis
a)Bupivacaine2.0%+Prilocaine2.5%
b)Lidocaine2.5%+Prilocaine2.5%
c)Lidocaine2.5%+Prilocaine5%
d)Bupivacaine0.5%+Lidocaine2.5%
CorrectAnswer-B
Ans.is'b'i.e.,Lidocaine2.5%+Prilocaine2.5%
Eutecticmixtureoflocalanaesthetic(EMLA)
Thisisuniquetopicalpreparationwhichcananaesthetiseintactskin.
Itisamixtureof2.5%lidocaineand2.5prilocaine.
Itactsslowlyandthecreammustheldincontactwithskinforat
least1hour.
EMLAisused:tomakevenepuncturepainlessespeciallyin
children,andforprocedurelikeskingrafting&circumcision.
Assystemicabsorptionofprilocainecancausemethemoglobinemia,
EMLAshouldnotbeusedonmucocutaneousmembraneorinvery
smallchild.

---

1736.Localanaesthesiacausing
methemoglobinemia?
a)Procaine
b)Prilocaine
c)Etodicaine
d)Ropivacaine
CorrectAnswer-B
Ans.is'b'i.e.,Prilocaine
Prilocaineandbenzocainecancausemethemoglobinemia.
Importantfacts
ChlorprocaineistheshortestactingLA.
Dibucaineisthelongestacting,mostpotentandmosttoxicLA.
BupivacaineisthemostcardiotoxicLA(Ropivacaineisanewer
bupivacainecongenerwithlesscardiotoxicity).oLevobupivacaine
(TheS(-)enantiomerofbupivacaine)islesscardiotoxicandless
pronetocauseseizure.oPrilocainecancauseMet
haemoglobinemia.
LignocaineisthemostcommonlyusedLA.
Bupivacainehasthehighestlocaltissueirritancy.
Chlorprocaineiscontraindicatedinspinalanaesthesiaasitcan
causeparaplegiaduetopresenceofneurotoxicpreservative
sodiummetabisulphite.
ProcaineistheLAofchoiceinmalignanthyperthermia

---

1737.Notasignofstellateganglionblock?
a)Miosis
b)Exopthalomos
c)Nasalcongestion
d)Conjunctivalredness
CorrectAnswer-B
Ans.is'b'i.e.,Exopthalomos
Thereisenophthalmos(notexophthalmos)
Stellateganglionblock
Stellateganglionisformedbyfusionoflowercervicalandfirst
thoracicganglion.Itisblockedanteriortothetubercleoftransverse
processofC6vertebrai.e.,chassaignactubercleatthelevelof
cricoidcartilage.
Signsofsuccessfulblockare:-Hornersyndrome(miosis,ptosis,
anhydrosis,enophthalmos,absenceofciliospinalreflex),flushingof
face,conjuctivalcongestion,Nasalstuffiness(Gutman'ssign),
Injectionoftympanicmembrane(muller'ssyndrome),Increasedskin
tempratureandlacrimation.
Stellateganglionblockisindicatedin:-
1. Treatmentofacuteherpeszosterinthedistributionofthetrigeminal
nerve,cervicalandupperthoracicdermatomes.
2. Acutevascularinsufficiencyofupperlimbandface.
3. Frostbite
4. Reflexsympatheticdystrophyofface,neckandupperextremities.
5. Raynaud'ssyndromeofupperextremities.

---

1738.Mostcommonlyusedapproachof
brachialplexusblock?
a)Interscalene
b)Supraclavicular
c)Infraclavicular
d)Axillary
CorrectAnswer-B
Ans.is`B'i.e.,Supraclavicular
Brachialplexusblock
Thisisthesecondmostcommonlypractisedblockaftercentral
neuraxialblock(spinal&epiduralanaesthesia).Brachialplexus
blockisusedforupperlimbsurgeries.
Brachialplexuscanbeblockedby4approaches:-
1.Interscaleneapproach
Brachialplexusisblockedbetweenanteriorandmiddlescalene.
Thisapproachisnotusedroutinelyduetocloseproximityofvital
structures.Ulnarnerveisusuallysparedbythisapproachbecause
injectionisgivenincloseproximityofuppernerverootsandinferior
nerveroots(C8-T1)maybespared.
Thistechniqueprovidesexcellentanaesthesiaandanalgesiafor
shoulderandupperarmprocedures.(incontrasttootherthree
approacheswhichdonotprovideadequateshoulderanaesthesia).
ComplicationsincludeHornersyndrome(duetostellateganglion
block),phrenicnerveblock,intravascularinjectionintocarotidsand
epiduralorintrathecalinjections.
2.Supraclavicularapproach
Thisisthemostcommonlyusedapproach.Itinvolvestheinjection
oflocalanaestheticincloseproximityto

---

thetrunksofthebrachialplexusbyinsertingtheneedlelateralto
subclavianvessels.Thesupraclavicular
blockisperformedwherethebrachialplexusismostcompact,
consequently,itproducesreliableandrapid
onsetanaesthesiaandisparticularlyusefulinafastpaced
ambulatorysurgerycentre.
Pneumothoraxisthemostcommoncomplication.Other
complicationsincludephrenicnerveblock,intravascularinjectionin
subclavianarteryorvein,Hornersyndrome,hematomaformation.
3.Infra-clavicularapproach
Infraclavicularblockinvolvestheinjectionoflocalanaestheticin
closeproximityofcordsofthebrachialplexus.Theaxillarynerve
maybesparedasthisnerveexitsthebrachialplexussheath
proximaltothelevelofinfraclavicularblock.
4.Axillaryapproach
Axillaryblockinvolvestheinjectionoflocalanaestheticinclose
proximityofterminalbranchesofthe
brachialplexus.Themajordisadvantageofthisapproachisthat
mucocutaneousandintercostobrachialnervesarespared.Soarm
surgerycannotbeperformed.Incontrasttointerscaleneapproach,
mostintense
blockoccurin(C7-T1)ulnardermatomesandleastinC5-C6
dermatomes.

---

1739.Highspinalanaesthesiaisassociated
with?
a)DecreasedBP&decreasedheartrate
b)IncreasedBP&decreasedheartrate
c)DecreasedBP&increasedheartrate
d)IncreasedBP&increasedheartrate
CorrectAnswer-A
Ans.is'a'i.e.,DecreasedBP&decreasedheartrate
Spinalanesthesiaascendingintothecervicallevels(highspinal
anesthesia)causesseverehypotension,bradycardiaandrespiratory
insufficiency.Complicationsofspinalanaesthesia
Intraoperative
Postoperative
Haedache
(postdural
puncture
headach)-
most
common
Hypotension
Cranialnerve
(mostcommon)
palsies(any
Bradycardia10th
cranialnerve
Respiratorydepression exceptthe
Cardiacarrest
1st,9th&most
Hypothermiainelderly commonly6th
nerveis
involved)
Cauda
equina

---

equina
syndrome
Arachnoiditis

---

1740.Smoothinductionisseenby-
a)Ether
b)Halothane
c)Isoflurane
d)Enflurane
CorrectAnswer-C
Ans.is'c'i.e.,Isoflurane
Inductionbyinhalationagents

UnpleasantIntermediateSmooth

EtherHalothaneIsoflurane
EnfluraneDesflurane
Sevoflurane
Nitrousoxide

---

1741.Bestlocalanaestheticforophthalmic
surgeryis
a)Tetracaine
b)Prilocaine
c)Procaine
d)Bupivacaine
CorrectAnswer-D
Ans.is'd'i.e.,Bupivacaine
Thechoiceoflocalanaestheticforocularsurgeryvaries.
Butlidocaine(2%)andbupivacaine(0.5-0.75%)areusedmost
commonly.
Generallytheuseof1:1mixtureof2%lidocaine(xylocaine)and
0.50%bupivacainealongwithadrenalineandhyaluronidasein
facial,retrobulbarandperibulbarblocksiscommon.

---

1742.Percentageofadrenalinewith
lignocaineforlocalinfilterationis?
a)1:1000
b)1:10000
c)1:100
d)1:50000
CorrectAnswer-D
Ans.is'd'i.e.,1:50000
Themostcommonconcentrationsofepinephrinecombinedwith
localanaestheticsare1:50,000(0.02mg/ml),1:100,000(0.01
mg/ml)and:200000(0.005mg/ml).
The1:50000concentrationismanufacturedincombinationwith2%
lidocaine.
The1:100,000concentrationismanufacturedincombinationwith
2%lidocaineand4%articaine.
The1:200,000concentrationismanufactureincombinationwith4%
prilocaine,4%articaineand0.5%bupivacaine

---

1743.Drugofchoiceinlignocainetoxicity-
a)Bretylium
b)Amiodarone
c)Isoprenaline
d)Diazepan
CorrectAnswer-D
Ans.is`d'i.e.,Diazepan
Iflignocainetoxicityissuspected,stoptheinjectionimmediately.
Ensureadequateoxygenation,whetherbyfacemaskorby
intubation.
Anticonvulsantssuchasbenzodiazepinesandbarbituratesarethe
drugofchoiceforseizurecontrol.oSuccinylcholineissometimes
alsousedtoterminatetheneuromusculareffectsofseizures.
IfCVSsymptomsoccur(cardiacdepressionandhypotension),IV
fluidandvasopressoragentsmayberequired.
Ifmetabolicacidosisdevelops,useofsodiumbicarbonatecanbe
considered,although,asinotherinstancesofacutemetabolic
acidosis,thisiscontroversial.

---

1744.DrugofchoiceforBier'sblock?
a)Bupivacaine
b)Etidocaine
c)Ropivacaine
d)Lidocaine
CorrectAnswer-D
Ans.is'd'i.e.,Lidocaine
IntravenousregionalAnaesthesia(Bier'sblock)
Intravenousregionalanaesthesia(IVRA)isusedmostoftenfor
surgeryoftheforearmandhand,butcanalsobeusedfordistalleg
andfoot.
FirstIVcanulaisinsertedusuallyinthedorsumofhand.
Thentourniquetcuffisappliedtoproximalarm.
Limbiselevatedandexsanguinatedwiththehelpofanelastic
bandage(Esmarch).
Nowtourniquetcuffisinflatedabovesystolicpressure(sothatno
bloodcanenterinthatlimbandthelimbremainsexsanguinated).
Nowthelocalanaestheticsolutionisslowlyinjectedintocannula.
Theveinsarefilledwithonlylocalanaestheticasthereisnoblood
ocalanaestheticcannotbedrainedoutfromupperlimbandcan
notenterinsystemiccirculationbecauseofinflatedcuffinproximal
arm.
Thearmisanaesthetizedin6-8minutes.
LidocainewithoutadrenalineistheDOCforthis
technique.--Goodman&Gilmanllthie381oAfew
clinicianprefersprilocaineoverlidocainebecauseofitshigher
therapeuticindex-leasttoxicLA.
Torniquetcuffdeflation,prematurereleaseorfailureoftorniquetcan

---

causereleaseofLAintocirculationand
toxicitymayoccurSo,cardiotoxicLAslikebupivacaineand
etidocainearecontraindicatedforBier'sblock.

---

1745.Conscioussedationis?
a)CNSdepressionwithuncociousness
b)Sedationwithinabilitytorespondtocommand
c)Sedationwithabilitytorespondtocommand
d)Anyoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Sedationwithabilitytorespondtocommand
Conscioussedationisatechniqueinwhichdrugsareusedto
produceastateofCNSdepression(butnot
unconsciousness),enablingsurgicalproceduretobecarriedout
whilemaintainingcommunicationwiththepatient
whoisabletorespondpurposefullytocommandsandmaintaina
patentairwaythroughout.
Theprotectiveairwayreflexesarenotlost,thereforeconscious
sedationissafer.
However,byitself,itisnotabletosuppresspainofdental
procedures;localanaestheticmustbeinjectedinaddition.
Drugsusedforconscioussedationare-
1. N,O
2. Diazepamormidazolam
3. Propofol
4. IMpromethazine
5. IVfentanyl

---

1746.Trueaboutconscioussedationareall
except?
a)CNSdepression
b)Patientisconscious
c)Protectivereflexesareabolished
d)Patientcanobeycommands
CorrectAnswer-C
Ans.is'c'i.e.,Protectivereflexesareabolished
conscioussedation,protectivereflexesareintact(hasbeen
explainedinprevioussessions).

---

1747.ThelatestAHA2010forCPCRinbasic
lifesupportbytwoindividualsfor
cardiacexternalmassage&ventilation
inadultis?
a)30-2
b)15-1
c)15-2
d)30-1
CorrectAnswer-A
Ans.is'a'i.e.,30-2

---

1748.Dopplereffectresultsfromchangein-
a)Amplitudeofsound
b)Frequencyofsound
c)Directionofsound
d)Noneoftheabove
CorrectAnswer-B
Answer-B.Frequencyofsound
TheDopplereffectresultsfromanapparentshiftinsoundfrequency
assoundwavearereflectedfrommovingtargets,usuallyblood
cells.
Ifmotionistowardthetransducer,thefrequencyofreturningechois
higherthatofthetransmittedsound.

---

1749.X-rayArtifactis-
a)Aradiolucentarea
b)Anyabnormalopacityintheradiograph
c)Producedwhenpatientmoveswhiletakingtheshoot
d)Alltheabove
CorrectAnswer-C
Answer-C.Producedwhenpatientmoveswhiletakingthe
shoot
Artifactscanpresentinavarietyofwaysincludingabnormalshadow
notedonaradiographordegradedimagequalityandhavebeen
producedbyartificialmeansfromhardwarefailure,operatorerror
andsoftware(post-processing)artifacts.
Commoncauses:-
Improperhandlingofthefilms
Errorswhileprocessingthefilms
Patientmovementwhiletakingtheshoot

---

1750.FrequencyofultrasoundwavesinUSG
-
a)2000Hz
b)5000Hz
c)<2MHz
d)>2MHz
CorrectAnswer-D
Answer-D.>2MHz
Theultrasoundmachineemitshigh-frequencysoundwaves,ranging
from2-15MHz.Whosefrequenciesareconsiderablyabovethe
upperlimitofhumanear'saudiblerange,i.e.,greaterthan20000
Hz.Speedofthesesoundwavesinthebodyis1540m/s(in
comparisontoair,wherevelocityofsoundwaveis330m/s).

---

1751.Gyromagneticpropertyofprotonis
seenin-
a)MRI
b)CT
c)PETscan
d)USG
CorrectAnswer-A
Answer-A.MRI
Ultrasonographyisbasedonpiezoelectriceffect.
MRIisbasedongyeromagneticpropertyofprotonW9.

---

1752.EnhancementinCTcontrastisdueto-
a)Iodine
b)Gadolinium
c)Silver
d)Mercury
CorrectAnswer-A
Answer-A.Iodine
Iodinatedcontrastsarethemostcommonlyusedradiocontrast
mediainradiographyandCT.
GadoliniumisthemostcommonlyusedMRcontrastagent.

---

1753.Whichdelivershighestdoseof
radiation-
a)Cardiacperfusionscan
b)CTchest
c)CTbrain
d)Mammogram
CorrectAnswer-A
Answer-A.Cardiacperfusionscan
Medicaldiagnosticimagingisamajorsourceofradiationexposure
toclinitiansandthepatients.Followingtabledepictstheradiation
exposurethroughtheroutinemedicalimaging.

---

1754.Bestviewforcollapseofmiddlelobe
lungis-
a)Lateral
b)AP
c)Oblique
d)Lordotic
CorrectAnswer-D
Answer-D.Lordotic
Thelordoticviewisalsousefulforrecognizingcollapseoflingulaor
middlelobewhentheseareasbecomeverythinandcastminimal
shadowonthePAview.

---

1755.Doubleshadowbehindrightatriumand
straighteningofleftmainbronchus
indicates-
a)Rightatriumenlargement
b)Rightventricleenlargement
c)Leftatriumenlargement
d)Leftventricleenlargement
CorrectAnswer-C
Answer-C.Leftatriumenlargement
Leftatriumenlargement
RefSutton7h/ep.280-350]

---

1756.Leftatrialenlargementisseenin-
a)Mitralstenosis
b)Tricuspidregurgitation
c)AR
d)None
CorrectAnswer-A
Answer-A.Mitralstenosis
Duetoleftatrialenlargement:-Straighteningofleftheartborder,
elevationofleftmainbronchuswithwideningofcarina,doubleatrial
shadow(Doubledensitysign),posteriordisplacementofesophagus
onbariumswallow,Prominentposterosuperiorpartofcardiac
shadow.

---

1757.Inpatientwithhighclinicalsuspicionof
pulmonarythromboembolism,best
investigationwouldbe?
a)D-dimer
b)CTangiography
c)Catheterangiography
d)ColorDoppler
CorrectAnswer-B
Bi.e.CTangiography
SpiralorhelicalchestCTscanwithintravenouscontrast(CT
pulmonaryangiography)istheprincipalimagingtestforthe
diagnosisofpulmonaryembolsmQ.Itacquiresimagewith<1m
resolutionandvisualizesupto6thorderbranchesandsmall
peripheralemboliwitharesolutionsuperiortoconventionalinvasive
contrastpulmonaryangiography.Itobtainsexcellentimagesofright
&leftventricleandcanbeusedfordiagnosisaswellasrisk
stratification.Inpatientswithpulmonaryembolism,RVenlargement
indicates5timesmorelikelihoodofdeathwithinnext30days.
Inadequatebreathholdingcanimpairtheimagequalityb/ochange
inarterialflowratesandmotionartefactduringbreathing.The
adventofmultidetectorCT(MDCT)allowsexaminationofwhole
lungduringsinglebreath-hold.Itisnoninvasive.
Ventilation-perfusionlungscanningisnowsecondlinediagnostic
testaforPE,andmostlyusedinpatientswhocannottolerate
intravenouscontrast.Itsutilityisgreatestwhenaccompaniedwitha
normalchestx-rayimplyingthataventilation-perfusionmismatchis
notduetoparenchymaldisease.Highprobability(>80%)scanhave

---

2largesegmentalV-Pmismatches(perfusiondefects&normal
ventilation)withanormalchestradiograph.Andverylowprobability
scanshavemicroparticles(10-1001.1m)ofTc99micro-
aggregatealbumin(MAA)inpatientslyingsupine.Ventilation
scintigraphyisperformedbyinhalatingKrypton-81,(best),Xenon
133,Tc99-diethylenetriaminepentaaceticacid(DTPA),or
technegas.Lasttwocan'tbeadministeredduringperfusionscanas
botharelabelledwithTc99.Eightimages(anterior,posterior,
obtique&lateralonbothsides)areaquired.
Conventionalpulmonaryangiography:NoninvasiveCTwithcontrast
havevirtuallyreplacedinvasivepulmonaryangiographyasa
diagnostictool.However,itremainsthegoldstandardtesta.

---

1758.AirbronchogramonchestXraydenotes
-
a)Intrapulmonarylesion
b)Extrapulmonarylesion
c)Intrathoraciclesion
d)Extrathoraciclesion
CorrectAnswer-A
Answer-A.Intrapulmonarylesion
Airinbronchiisvisualizeditiscalledairbronchogram.Air
bronchogramindicatesintrapulmonarypathology,Itexcludesany
pleuralormediastinalpathology.

---

1759.Calcifiedpulmonarymetastasisisseen
inwhichcarcinoma-
a)Pancreaticcarcinoma
b)Thyroidcarcinoma
c)Endometrialcarcinoma
d)None
CorrectAnswer-B
Answer-B.Thyroidcarcinoma
Differentialdiagnosisofcalcifiedpulmonarymetastasis:-
1. Osteosarcoma
2. Coloncarcinoma
3. Chondrosarcoma
4. Giantcelltumorofbone
5. Thyroidcarcinoma
6. Ovariancancer
7. Synovialsarcoma
8. Breastcarcinoma

---

1760.Differentialdiagnosisofsolitary
pulmonarynoduleareallexcept-
a)Bronchogeniccarcinoma
b)Mycetoma
c)Tuberculoma
d)Hamartoma
CorrectAnswer-B
Answer-B.Mycetoma
Granulomas:-Tuberculoma(mostcommoncause),Histoplasma,
Coccidioidomycosis,cryptococcosis.
Otherinfections:-Organizingpneumonia,hydatidcyst.
Benignneoplams:-Hamartoma,Fibroma,Neurofibroma,Carcinoid
tumours,Lipoma,Bronchialadenoma
Malignantneoplasm:-Carcinomabronchus,Alveolarcell
carcinoma,metastasis(frombreast,Sarcoma,Renalcellcarcinoma,
Seminoma),Pulmonaryblastoma,Pulmonarysarcoma.
Inflammatory-Wegener'sgranulomatosis,rheumatoidarthritis,
Sarcoidosis.
Congenital:-Sequestration,Bronchogeniccyst,AVmalformation.
Miscellaneous:-Pulmonaryinfarct,Roundedatelectasis,Mucoid
impaction.

---

1761.Mostcommonfeatureofsarcoidosison
chestX-rayis:
March2011,March2013
a)Pleuraleffusion
b)Cavitation
c)Bilateralhilarlymphadenopathy
d)Pneumothorax
CorrectAnswer-C
Ans.C:Bilateralhilarlymphadenopathy
Sarcoidosismaybediscoveredunexpectedlyonroutinechestfilms
asbilateralhilarlymphadenopathy
Sarcoidosis/Sarcoid/Besnier-Boeckdisease/Besnier-Boeck-
Schaumanndisease
Itisadiseaseinwhichabnormalcollectionsofchronicinflammatory
cells(granulomas)formasnodulesinmultipleorgans.
Thecombinationoferythemanodosum,bilateralhilar
lymphadenopathyandarthralgiaiscalledLofgrensyndrome.
Thissyndromehasarelativelygoodprognosis
ChestX-raychangesaredividedintofourstages
1. Stage1:Bihilarlymphadenopathy
2. Stage2:Bihilarlymphadenopathyandreticulonodularinfiltrates
3. Stage3:Bilateralpulmonaryinfiltrates
4. Stage4:Fibrocysticsarcoidosistypicallywithupwardhilarretraction,
cysticandbullouschanges

---

1762.Inferiorribnotchingisseenin
a)Coarctationofaorta
b)Rickets
c)ASD
d)Multiplemyeloma
CorrectAnswer-A
Ai.e.Coarctationofaorta
Inferiorribnotchingincoarctationofaortaisd/tpressureerosionof
intercostalarteriesQItusuallytakesseveralyearstodevelop,sois
unusualbefore10yearsofage.

---

1763.Amongthecausesofribnotchingare:
a)Coarctationofaorta
b)Congenitalinterruptionofaorta
c)Chronicsuperiorvenacavaobstruction
d)Alloftheabove
CorrectAnswer-D
Ans.Alloftheabove

---

1764.Thesignwithpatchofdullnessbeneath
theangleofleftscapulainapatient
withpericardialeffusionisnamedas-
a)Carvallo'ssign
b)Ewart'ssign
c)Homan'ssign
d)Hoffmann'ssign
CorrectAnswer-B
Answer-B.Ewart'ssign
Heartsoundsbecomefaint-
Theapeximpulsevanishes;butsometimesitremainspalpable,
medialtotheleftborderofcardiacdullness.
Thebaseoftheleftlungmaybecompressedbypericardialfluid,
producingEwart'ssign,apatchofdullnessbeneaththeangleofthe
leftscapula.
Thechestroentgenogrammayshowa"waterbottle"or"flask
shaped"configurationofthecardiacsilhouette

---

1765.Waterbottleheartisseenin-
a)PDA
b)Chronicemphysema
c)Pericardialeffusion
d)Constrictivepericarditis
CorrectAnswer-C
Answer-C.Pericardialeffusion
"Water-bottle"orflaskedshapedormoneybagheart-Pericardial
effusion,hypothyroidism

---

1766.Flaskshapedheartisseeninfollowing
except:
a)Ebsteinanomaly
b)Pericardialeffusion
c)TOF
d)TAPVC
CorrectAnswer-D
Di.e.TAPVC
DuetodilationofSVC(superiorvenacava)&leftverticalvein,
TAPVC(totalanomalouspulmonaryvenousconnection/return)of
supradiaphragmaticvarietyshowsdoublecontour/"Figgerof8"/
SnowmanconfigurationofcardiacsilhouetteQ.

---

1767.Forpericardialcalcifications,whichis
thebestinvestigation-
a)MRI
b)Transesophagealechocardiography
c)USG
d)CTscan
CorrectAnswer-D
Answer-D.CTscan
CTisthebestmethodfordepictionofpericardialcalcification,a
findingsuggestiveofconstrictivepericarditisintheappropriate
clinicalsetting.

---

1768.DVT,investigationofchoiceis-
a)Doppler
b)Plethysmography
c)Venography
d)X-ray
CorrectAnswer-A
Answeris'a'i.e.Doppler
DopplerUSGisthefirstinvestigationofchoiceforDVT.

---

1769.Fluorescinangiographyisusedto
examine-
a)Ciliaryvasculature
b)Retinalvasculature
c)Cornealvasculature
d)Conjuctivalvasculature
CorrectAnswer-B
Answer-B.Retinalvasculature
Fluoresceinangiographyisaradiologicalexaminationofretinal
vasculatureaftertheadministrationofafluoresceindye.

---

1770.Bariumswallowisusedfor-
a)Colon
b)Esophagus
c)Duodenum
d)Jejunum
CorrectAnswer-B
Answer-B.Esophagus
Bariumswallow-Mainlyforesophagus

---

1771.Thebestinvestigativemodalityforgall
bladderstones-
a)Oralcholecystogram
b)Percutaneoustranshepaticcholangiography
c)Ultrasound
d)Intravenouscholangiogram
CorrectAnswer-C
Ans.is'c'i.e.Ultrasound
Ultrasonography:-Thisistheinvestigationofchoiceforthe
detectionofgallstones,andobstructivejaundice.USGshows
echogenicfocuswithposterioracousticshadowing.
Themostspecificsignofacontracted,stone-filledgallbladderisa
hypoechoicwallsuperficialtoacurvilinearechofromthestonesand
anacousticshadow:-WEStriad(Wall,Echo,Shadow)orthe
"Doublearcshadowsign".
IOCfordiagnosisofgallstone-acutecholecystitis,acuteacalculous
cholecystitis,chroniccholecystitisisUltrasound

---

1772.Pulledupcecumisseenin-
a)IleocecalTB
b)Carcinomacecum
c)Intussuption
d)Carcinoma
CorrectAnswer-A
Answer-A.IleocecalTB
ConicalcecumorAmputedcecumCecumisshrunkeninsizeand
pulledoutoftheiliacfossaduefibrosisandcontractionof
mesocolon.
Stierlinsign:-Narrowingofterminalileumwithrapidemptyingintoa
shortened,rigidorobliteratedcecum.
Stringsign

---

1773.Thestudyusingbariumforsmall
intestineisknownas-
a)Bariummealfollowthrough
b)Bariumswallow
c)Bariumenema
d)Noneoftheabove
CorrectAnswer-A
Answer-A.Bariummealfollowthrough
InmostcasesthejejunumandIleumareexaminedfollowingthe
bariumexaminationoftheuppergastrointestinaltract,referredtoas
the"bariummealandfollowthrough"orsimply"bariumfollow
through".

---

1774."Stringofbeads"appearanceon
horizontalabdominalviewX-rayis
suggestiveof:
a)Intussusception
b)Sigmoidvolvulus
c)Smallbowelobstruction
d)Largebowelobstruction
CorrectAnswer-C
Ans.Smallbowelobstruction
Stringofbeadssignisvirtuallydiagnosticofsmallbowelobstruction

---

1775.Doublebubblesignseenin:
a)Duodenalatresia
b)Duodenalstenosis
c)Volvulus
d)All
CorrectAnswer-D
Ans.isD
'a','b'&'c'i.e.Duodenalatresia,DuodenalstenosisandVolvulus
Doublebubblesignisseeninduodenalatresia,duodenalweb,
deudenalstenosis,Ladd'sband,Annularpancreas,Malrotationof
gut,preduodenalvein.
Distalgasismoreoftenseenwithmidgutvolvulus,duodenal
stenosisandduodenalweb

---

1776.Wirelesscapsuleendoscopyisdoneto
visualizewhichofthefollowing
condition?
a)Esophagealvarices
b)Gastriccarcinoma
c)Crohn'sdisease
d)Ulcerativecolitis
CorrectAnswer-C
Crohn'sdisease
Wirelesscapsuleendoscopy(WCE)allowsdirectvisualizationof
theentiresmall-bowelmucosa.Thediagnosticyieldof
detectinglesionssuggestiveofactiveCDishigherwithWCEthan
CTenterographyorsmall-bowelseries.WCEcannotbeusedin
thesettingofasmall-bowelstricture.Capsuleretentionoccurs
in<1%ofpatientswithsuspectedCD,butretentionratesof4-
-6%areseeninpatientswithestablishedCD.

---

1777.Investigationwithleastradiationdose
inthediagnosisMeckel'sdiverticulum
is-
a)CT
b)MRI
c)Contrastradiography
d)Technetium-99mscanning
CorrectAnswer-C
Answer-C.Contrastradiography
Itisageneralrulethattheascendingorderoftheradiationdoseis
MRI<X-ray<CT-Scan.Technetium-99mhastheradiation
exposuremorethanX-raybutlessthanCT-Scan.Socontrast
radiographywillhavetheminimumradiationexposureasitinvolves
takingaradiographaftersmallbowelenemafordiagnosisof
meckel'sdiverticulum.

---

1778.EndoscopicUSGcriteriaforchronic
pancreatitis,whenechogeniclesionis-
a)>1mm
b)1.5mm
c)>2mm
d)>3mm
CorrectAnswer-D
Answer-D.>3mm
Parenchymalfeatures
Echo-poorlesion
Echo-richlesion(>3mmindiameter)
Accenuationoflobularpattern
Glandsize,cyst
Ductalfeatures
Increasedductwallechogenicity
Narrowing,dilatation
Calculi

---

1779.Mostsensitivetesttodetectearlyrenal
TBis-
a)Intravenousurography
b)CT
c)MRI
d)USG
CorrectAnswer-A
Answer-A.Intravenousurography
IVPremainstheprimarymodalityusedtoimagethepatientswith
renal,ureteric,andbladdertuberculosis.Earlyfindingsarebest
detectedonIVP.ItistheinvestigationofchoiceforurinaryTB.

---

1780.Investigationofchoiceforfocal
neurologicdeficitinemergencyroomis
-
a)CT
b)MRI
c)Lumbarpuncture
d)CECT
CorrectAnswer-A
Answer-A.CT
InIndiansetupCTScanistheinvestigationofchoiceinthe
emergencyroomtoscreenpatientsofacutefocalneurologicdeficit.

---

1781.CTScanfindingincarotidcavernous
sinusfistulais-
a)Enlargedsuperiorophthalmicvein
b)Enlargedinferiorophthalmicvein
c)Enlargedsuperiorophthalmicartery
d)Enlargedinferiorophthalmicartery
CorrectAnswer-A
Answer-A.Enlargedsuperiorophthalmicvein
Contrast-enhancedCTscanandMRIwilldemonstrateadilated
superiorophthalmicveinandcavernoussinus.
Ultrasonographymayalsodemonstratesuperiorophthalmicvein
engorgement.
Magneticresonanceangiography(MRA)isalsoveryusefulin
identifyingfistulasaswellasparticularvesselinvolvement.

---

1782.Onimagningdiffuseaxonalinjuryis
characterizedby-
a)Multiplesmallpetechialhemorrhage
b)Patchilldefinedlowdensitylesionmixedwithsmallhyperdens
ofpetechialhemorrhage
c)Crescenticextra-axialhematoma
d)Whitematterlucencies
CorrectAnswer-A
Answer-A.Multiplesmallpetechialhemorrhage
Multiplesmallpetechialhemorrhage<2cmdiameterincerebral
hemisphere.

---

1783.Rheseviewisusedfor-
a)Superiororbitalforamen
b)Inferiororbitalforamen
c)Opticforamen
d)Sellaturcica
CorrectAnswer-C
Answer-C.Opticforamen
Opticforamen-Rheseview

---

1784.Prevertebralspacethicknessinadultis
-
a)7mm
b)14mm
c)22mm
d)30mm
CorrectAnswer-A:C
Answer-A&C.22mm(A)7mm
<7mmatC1level
<5mmatC3-C9level
<22mmatC6level

---

1785.Osteolyticmetastasisisseenwith-
a)Lung
b)Kidney
c)Thyroid
d)Alloftheabove
CorrectAnswer-D
Answer-D.Alloftheabove
Osteolytic,characterizedbydestructionofnormalbone,presentin
multiplemyeloma(MM),renalcellcarcinoma,melanoma,non-small
celllungcancer,non-hodgkinlymphoma,thyroidcanceror
langerhans-cellhistiocytosis.

---

1786.Investigationofchoiceinwholebody
imaginginmetastasisis-
a)MagneticResonanceImaging
b)Angiography
c)Venography
d)CTScan
CorrectAnswer-A
Answer-A.MagneticResonanceImaging
Whole-bodyMRimagingwithuseofarollingtableplatformin
conjunctionwithfastT2-weightedturbospin-echoand3Dgradient-
echosequencesisatime-savingandaccuratealternativeto
conventionalmultimodalityevaluationofpatientswithtumorsfor
metastases.

---

1787.Tsignisseenin-
a)GenitalTB
b)Membraneintwinpregnancy
c)Molarpregnancy
d)Choriocarcinoma
CorrectAnswer-B
Answer-B.Membraneintwinpregnancy
'Tsign'referstoappearanceoftheinter-twinmembraneina
monochorionictwinpregnancy.

---

1788.Investigationofchoiceincongenital
uterineanamolyis-
a)MRI
b)CT
c)HSG
d)Hysteroscopy
CorrectAnswer-D
Answer-D.Hysteroscopy
Hysteroscopyisthegoldstandardinthediagnosisaswellas
therapeuticmanagement.

---

1789.Whichoneofthefollowinghasthemaximumionizationpotential?
a)Proton
b)Electron
c)Heliumion
d)Gamma(y)?Photon
CorrectAnswer-C
Heliumionhasmaximumionizingpotential.
TheionizingpotentialofatomsrangesfromafeweVforalkalielementsto24.6eVfor
heliumwhichhasthemaximumionizingpotential.
Ref:RadiationPhysicsforMedicalPhysicistsByErvinB.Podgorsak,Page7

---

1790.TheX-rayviewforsupraorbitalfissure
is:
a)Towne's
b)Caldwell
c)AP
d)nasal
CorrectAnswer-B
Ans.Caldwell
Superiororbitalfissurecanalsobeseenonwater'sview,butbestis
caldwellview.
"Thesuperiororbitalfissurecaneasilyindentifiedandnormallyhas
aslightlyconcavelateralappearacne"
-Textbookoforalradiology

---

1791.Maximumradiationdosetolerable
tissueis-
a)Hemopoietictissue
b)Testis
c)Ovary
d)Bone
CorrectAnswer-D
Answer-D.Bone
Highlyradiosensitive
Lymphoidtissue
Bonemarrow
GITepithelium
Gonads(Testis,ovary)
Embryonictissue

---

1792.Epidermoidcystcanbedifferentiated
fromarachnoidcystby-
a)MRI
b)USG
c)Myelography
d)CTscan
CorrectAnswer-A
Answer-A.MRI
Myelographycannotdifferentiatereliablybetweenanepidermoid
cystandanoncommunicatingarachnoidcyst.
IthaslargelybeenreplacedbyMRI.

---

1793.Welldressedmancameforfeelingof
womentrappedinmanbodyis
sufferingfrom?
a)Paraphilia
b)Transverium
c)Genderidentitydisorder
d)Protterurism
CorrectAnswer-C
Ans.is'c'i.e.,Genderidentitydisorder
Genderidentitydisorder
Thesedisordersarecharacterizedbydisturbanceingenderidentity,
i.e.,thesenseofone'smasculinityorfaminityisdisturbed.Gender
identitydisordershasfollowingtwocharacteristics:?
1.Astrongandpersistentcrossgenderidentificationwhichis
manifestedby:?
1. Repeatedlystateddesiretobe,ortheinsistencethatheorsheis,
oftheothersex.
2. Wearingtheclothesofothersex(crossdressing),Preferencefor
cross-sexrolesinplaysorfantasies,Preferenceforplaymatesofthe
othersex.
2.Persistentdiscomfortwithhisorhersex.
Importantgenderidentitydisordersare:-
1. Transsexualism:-Ithasallthecharacteristicofgenderidentity
disorder(seeabove).Themostcharacteristicfeatureisthatthereis
markedpreoccupationwiththewishtogetridofone'sgenitalsand
secondarysexcharacteristicsandtoadoptthesexcharacteristicsof
othersex(perceived-gender),e.g.,Femaletransexualsrequestfor

---

hysterectomyormastectomy.
2. Dual-roletransvestism:-Itischaracterizedbewearingofclothesof
oppositesexinordertoenjoythetemporaryexperienceof
membershipoftheoppositesex,butwithoutanydesireforamore
permanentsexchange(unliketranssexualism).Bothtransexualism
anddual-roletransvestismshouldbedifferentiatedfrom
transvestism(fetishistictransvestism)whichisnotagenderidentity
disorderandcharacterizedbywearingtheclothesofothersexfor
thepurposeofsexualexcitment.
3. Gender-identitydisorderofchildhood:-Thisdisorderissimilarto
transsexualismwithaveryearlyageofonset(2-4yearsofage).

---

1794.Psychoanalysiswasstartedby?
a)EugenBleuler
b)SigmundFreud
c)Bleuler
d)Erikson
CorrectAnswer-B
Ans.is'b'i.e.,Sigmundfreud
Name
Contribution
Psychoanalysis,freeassociation,(oedipus&electra
Sigmund
complex),cocaineinpsychiatry,
Freud
Repression,ego-defence
mechanisms,psychodynamictheory.
Phillippe
Moralandhumanetreatmentofmentallyill
Pinel
Jones
Propagatedtherapeuticcommunityconcept.
Maxwell
Kuble
Classifiedfivestagesofdeath.
RossErik
Erikson
Dividedlifecyclein8stages

---

1795.TermPsychiatrywascoinedby?
a)Moral
b)Johannreil
c)Bleuler
d)Pinel
CorrectAnswer-B
Ans.is'b'i.e.,Johannreil
IMPORTANTCONTRIBUTORSINPSYCHIATRY
Term
Coinedby
Moral
Emil
Kraepelin
Demenceprecoce
Kahlbaum
Dementiaprecox
Hecker
Catatonia,cyclotymia Eugen
Hebephrenia
Bleuler
Schizophrenia
Eugen
Ambivalence
Bleuler
Freeassociation
Sigmund
Psychoanalysis,
Freud
Psychodynamics
Sigmunnd
Id,ego,Superego
Freud
Psychiatry
Sigmund
Freud
Johann
christionReil

---

1796.Hallucinations,trueis?
a)Perceivedintheinnersubjectivespace
b)Thereismisinterpretationofexternalstimulus
c)Thereisnoexternalstimulus
d)Canbecontrolledbyvoluntaryeffort
CorrectAnswer-C
Ans.is'c'i.e.,Thereisnoexternalstimulus
CharacteristicsofHallucinations:?
1. Absenceofcorrespondingexternalperceptualstimuli.
2. Vividness,forceandrealityvalueofanormalperception.
3. Theexperienceoccursspontaneously
4. Itcannotbeproducedorterminatedatwillbysubject(notin
consciousorvoluntarycontrol).
5. Perceivedasbeinginexternalobjectivespace.
6. Haverelativepermancy(i.e.remainconstantandunchanged).
7. Hallucinationsareusuallyexperiencedalongsideand
simultaneouslywithnormalperception.

---

1797.Cotard'ssyndromehas?
a)Persecutorydelusions
b)Religiousdelusions
c)Nihilisticdelusions
d)Hypochondricaldelusions
CorrectAnswer-C
Ans.is'c'i.e.,Nihilisticdelusions
Typesofdelsions
Basedonthecontentsofdelusions,theyaredividedinto:-
1. Persecutorydelusions(paranoid):-Thepatientfeelsthatheis
beingpersecutedagainst.Thereisfalsebeliefthatoneisbeing
harmed,threatened,cheated,poisoned,harassedorspiedonorisa
victimofconspiracytodamagehisreputation.Thesupposed
persecutorofthepatientmaybepeopleintheenvironment(e.g.,
membersoffamily,neighbours,formerfriend)ormaybepoliticalor
religiousgroups.Thesedelusionsoccurinschizophrenia(especially
paranoid),severeaffectivedisorders(severmaniaorsevere
depression),andorganicbrainsyndrome.Thisisthemostcommon
typeofdelusion.Delusionofpersecutionmayoccurinthecontextof
primarydelusionalexperiences,auditoryhallucinations,bodily
hallucinationsorexperiencesofpassivity.
2. Grandiosedelusion(expansivedelusions):-Falsebeliefthatoneis
exceptionallypowerful,talentedorimportant.Thesedelusionsseen
mostcommonlyinmania,However,canalsooccurinschizophrenia
andorganicstates.
3. Delusionsofreference:-Falsebeliefthatcertainobjects,peopleor
eventshaveintensepersonalsignificanceandreferspecificallyto
oneself,e.g.,believingthatatelevisionnewsreaderistalking

---

directlyaboutoneself,orpeoplewalkingontheroadaretalking
abouthim.Thesedelusionsareseeninschizophrenia,maniaand
organicstates.
4. Religiousdelusions:-Falsebeliefpertainingtoareligioustheme,
oftengrandioseinnature,e.g.,believingthatoneisaspecial
messengerfromGod.Thesedelusionsareseeninschizophrenia.
5. Delusionsoflove(erotomania):-Falsebeliefthatanotherpersonis
inlovewithone(commonerinwoman).Inoneform,termedde
clerambaultsydrome,awoman(usually)believesthataman,
frequentlyolderandofhigherstatus,isinlovewithher.
6. Delusionofinfidility(morbidjealousy,othellosyndrome:-False
beliefthatone'sloverhasbeenunfaithful.Theseareseenin
schizophrenia,alcoholrelatedpsychosis,organicstates.
7. Delusionofmisidentification:-a)Capgrassyndrome(Delusionof
double):-Beliefthatafamiliarpersonhasbeenreplacedbyan
exactdoublei.e.animpostor.b)Fregolisyndrome:-Beliefthata
completestrangerisactuallyafamiliarpersonalreadyknowntoone.
8. Delusionofselfaccusationorguilt:-Falsefeelingofremorseof
guilt.ItoccurinDepression.
9. Nihilisticdelusions:-Falsebeliefthatoneself,othersortheworldis
non-existentorabouttoend.Therearepessimisticideasthatthe
patient'scareerisfinished,heisabouttodie,worldisdoomed.
Theseoccursinseveredepression.Ifnihilisticdelusionsare
accompaniedbyideasconcerningbodilyfunctionfailure,e.g.,
putrefactionofintestines,etc.,thesyndromeiscalledCOTARD's
SYNDROME.
10. Hypochondriacaldelusions:-Falsebeliefaboutone'shealth,
patientwronglybelievesthathehasseveremedicalillness,contrary
totheallmedicalevidences.Itisseenindepression.
11. Delusionofinfestations:-Falsebeliefthatoneisinfestedwithsmall
butvisibleorganisms.Asamonosymptomaticdelusionaldisorder
thisiscalledEKBOMSYNDROME.Itisseeninacuteconfusional
state(duetodrugsoralcoholwithdrawal),inschizophrenia,in
dementingillness,andasdelusionaleloborationoftactile
hallucinatoryexperiences(secondarytoformication).
12. Delusionofcontrol:-Beliefthathisactions,impulsesorthoughts
arecontrolledbyanoutsideagencyandaccordinglycalledasmade

---

action,madeimpulseormadeaffect.Alsocalledsomaticpassivity
experiences(passivityphenomenon).Commonlyseenin
schizophrenia.
13. Delusionsconcerningpossessionofthoughts-Patientswith
delusionsaboutpossessionofthoughtsmaylosetheconvictionthat
theirthoughtsaretheirown.Mostcommonlyseeninschizophrenia.
Delusionsofthoughtinsertion-thoughtshavebeenimplantedbyan
outsideagency.
Delusionsofthoughtwithdrawal-thoughtsarebeingtakenoutof
theirmind.Thisisusuallyaccompaniedby"thoughtblock".
Delusionsofthoughtbroadcast-unspokenthoughtsareknownto
otherpeoplethroughradio,telepathyorinsomeotherway.

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1798.Waxyflexibilityisafeatureof?
a)Echopraxia
b)Catatonia
c)Stereotype
d)Mannerism
CorrectAnswer-B
Ans.'B'i.e.,Catatonia
Catatoniamaybeoffollowingtypes:-
Catatonicexcitement:-Excited,uncontrolledmotoractivity,not
influencedbyexternalstimuli.
Catatonicposturing:-Voluntaryadoptionofanunusualorbizarre
positionthatisthenmaintainedforsometime.
Catatonicrigidity:-Maintainingafixedpositionandrigidityresisting
allattemptstobemoved.
Waxyflexibility(flexibilitycereaorcatalepsy):-Maintainingof
particularpostureimposedonthepatientbytheexaminer,evenif
thepostureisbizarreanduncomfortable,i.e.,thepatientcanbe
moldedlikewaxintoapositionthatisthenmaintained.
Catatonicstupor:-Patientismuteandimmobile(akineticmutism)
butfullyconscious.
Catatonicnegativism.-Aseeminglymotivelessresistancetoall
instructionsorattemptstobemoved.
Automaticobedience:-Exactlyreversetonegativism,i.e.,
unhesitatingcompliancetoallinstructionswithoutapparent
consciouscontrol.

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1799.Visualhallucinationsareseeninall
except?
a)Delirium
b)Depression
c)Schizophrenia
d)Alcoholwithdrawal
CorrectAnswer-B
Ans.is'b'i.e.,Depression
Typeof
Causes
hallucination
Schizophrenia,Organicbrainsyndrome,Alcoholic
Auditory
hallucinosismanic-depressiveillness,Brain
lesionsPontineortemporallobelesions.
Organicbraindisturbances:-Delirium,delirium
tremens,occipitallobetumors,epilepsy,dementia
Intoxication(LSD,amphetamines,Alcohol,
mescaline),alcoholwithdrawal.
Brainlesions
Visual
1. Unformedvisualhallucinations:-Disordersof
occipitallobeoroculardiseases.
2. Formedvisualhallucinations:-Disordersof
temporallobe,upperbrainsteinorthalamus
Schizophrenia
Temporallobediseases(e.g.,complexpartial
lfactory&
seizure).
gustatory
Olfactoryhallucinationmayalsooccurindepression
&schizophrenia

---

Tactile
Schizophreni
Formication:-Cocaine,alcoholwithdrawal
Note:Epilepsyandcerebraldisorderscancausehallucinationsof
allmodalitiesdependingonthesiteoflesions.

---

1800.Whichofthefollowingcancause
delirium?
a)Hypoxia
b)Barbiturates
c)Alcoholwithdrawal
d)Alloftheabove
CorrectAnswer-A
Ans.is`d'i.e.,Alloftheabove
Importantcausesofdelirium
1.Trauma:-Headinjury,subduralhematoma
2.Infection:-Septicemia,pneumonia,endocarditis.
3.Metabolic:-Hypoxia,hypercapnia,uremia,CHF,Hepaticfailure,
porphyria,metabolicacidosisoralkalosis,water&electrolyte
imbalance.
4.Endocrine:-Hypo-orhyperpituitarism,Hypo-orHyperthyroidism,
Hypo-orhyperparathyroidism,hypo-orhyperadrenalism.
5.Drugintoxication:-Alcohol,barbiturates,TCA,anticholinergics,
anticonvulsants.
6.Drugwithdrawal:-Alcohol(deliriumtremens),sedatives,
hypnotics.
7.Nutritionaldeficiency:-Vitamin(Thiamine,pyridoxine,Niacin,
B12,Folicacid),Protein.8.0ther:-Post-operative,seizures,sleep
deprivation

---

1801.TotalscoreinMiniMentalStatus
Examination(MMSE)is?
a)25
b)30
c)32
d)35
CorrectAnswer-B
Ans.is'b'i.e.,30

---

1802.Diagnosticcriteriafordrugdependence
includesallexcept-
a)Tolerance
b)Withdrawalsymptoms
c)Earlycompletionoftasks
d)Largerdosethanusual
CorrectAnswer-A
Ans.is'c'i.e.,Earlycompletionoftasks
Diagnosticcriteriaforsubstanceabuse
Tomakeadiagnosisofdependence,threeormoreofthefollowing
criteriashouldbepresent.
Tolerance:-Samedoseproducesmarkedlydiminishedeffecton
continuoususe,thereforeincreaseddosesarerequiredtoproduce
sameeffect.
Withdrawalsymptomsonabstinence.
Substanceistakeninlargeramountorlongerperiodthanwas
intended.
Persistentdesire(craving)orsenseofcompulsiontotakethe
substance.
Agreatdealoftimespenttoobtainthesubstance,tousesubstance
ortorecoverfromitseffect.
Neglectofimportantsocial,occupationalandrecreationalactivities.
Continuedsubstanceusedespiteclearevidenceofovertlyharmful
consequences

---

1803.Falseregardingdeliriumtremens?
a)Tremors
b)Opthalmoplegia
c)Visualhallucination
d)Cloudingofconsciousness
CorrectAnswer-B
Ans.is'b'i.e.,Ophthalmoplegia
Deliriumtremens
Deliriumtremensisthemostseverealcoholwithdrawalsyndrome.It
occursusuallywithin2-4daysofcompleteorsignificantalcohol
abstinence.Thisisanacuteorganicbrainsyndrome(delirium)with
characteristicfeaturesofdelirium.
1. Cloudingofconsciousnesswithdisorientationintimeandplace.
2. Poorattentionspananddistractability.
3. Visual(andalsoauditory)hallucination,andillusion.Tactile
hallucinationofinsectcrawlingundertheskin(formication)mayalso
occur.
4. Markedautonomicdisturbanceswithtachycardia,sweating,
hypertension,mydriasis,coarsetremers.
5. Insomnia,psychomotoragitation,ataxia,anxiety.
Benzodiazepinesarethedrugsofchoicefordeliriumtremens.
Chlordiazepoxideistheagentofchoicewithdiazepamasan
alternative.

---

1804.Apatientisknownalcoholicsincelast
20yrs,suddenlyhedevelopsrestless
tremors,agitation.Diagnosis?
a)Deliriumtremens
b)Psychosis
c)Wernicke'sencephalopathy
d)Kursakoff'ssyndrome
CorrectAnswer-A
Ans.is'a'i.e.,Deliriumtremens

---

1805.Earliestsymptomshowing
improvementfromclassicaltriadof
Wernicke'sincephalopathv.tothiamine
therapy?
a)Ataxia
b)Ophthalmoplegia
c)Confusion
d)Allareequallyresponsive
CorrectAnswer-B
Ans.is'b'i.e.,Ophthalmoplegia
ResponsetothiaminetreatmentinWernicke'sencephalopathy
Ocularsymptoms:-Earliesttorespond,ophthalmoplegia(ocular
palsies)improveswithinhoursofthiamineadministration.However,
horizontalnystagmusmaypersist.
Ataxia:-Ataxiarespondsmoreslowlythanocularpalsiesandhalf
thepatientsrecoverincompletelywitharesidualataxia.
Encephalopathy:-ConfusionandotherCNSsymptomsimprove
moreslowly.Asthesymptomsofencephalopathyimprove,
Korsakoff'ssyndromemaybecomeapparentinsomepatients

---

1806.Allaresymptomsofmorphine
withdrawalexcept?
a)Mydriasis
b)Yawning
c)Lacrimation
d)FallinBP
CorrectAnswer-D
Ans.is'd'i.e.,FallinBP
Morphinewithdrawal
Manifestationsofmorphinewithdrawl
1. Lacrimation
2. Anxiety&fear
3. Mydriasis
4. Diarrhea
5. Palpitation
6. Sweating
7. Restlessness
8. Insomnia
9. Dehydration
10. Rapidweightloss
11. Yawning
12. Gooseflash(Piloerection)
13. Abdominalcolic
14. RiseinBP
Deliriumandconvulsionsarenotacharacteristicfeatures(contrast
barbiturates)andareseenonlyoccasionally.
Treatmentconsistsofwithdrawlofmorphineandsubstitutionwith
oralmethadonefollowedbygradualwithdrawlofmethodone.

---

RecentlytheNMDAantagonistsandnitricoxidesynthatase
inhibitorshavebeen

---

1807.Classicaltriadofglobalconfusion,
ataxiaandophthalmoplegiaisseenin?
a)Alzheimer'sdisease
b)Deleriumtremors
c)Wernicke'sencephalopathy
d)Korsakoffpsychosis
CorrectAnswer-C
Ans.is'c'i.e.,Wernicke'sencephalopathy

---

1808.Drugusedforcocainewithdrawal
symptomsis-
a)Floxetine
b)Lorazepam
c)Phenobarbital
d)Nodrug
CorrectAnswer-D
Ans.is'd'i.e.,Nodrug
"Tolerancedevelopsswiftlybuttherearenowithdrawalsymptoms.
Treament,ifneeded,issymptomatic.Oftennomedicinesare
neededandtheusercanstopitsusebyhimselfwhenheiscoerced
todosobythecourtortheemployer"-Namboodiri
"Nopharmacologicalagentsreliablyreducetheintensityof
withdrawal,butrecoveryoveraweakortwoisgenerally
uneventful"-Kaplan&Saddock

---

1809.Allareseeninnicotinewithdrawal
except?
a)Hyperhydrosis
b)Anxiety
c)Bradycardia
d)Insomnia
CorrectAnswer-A
Ans.is'a'i.e.,Hyperhydrosis

---

1810.RoleofmarijuanainAIDSrelated
cachexia?
a)Euphoric
b)Pschostimulator
c)Increasesappetite
d)Decreaseemeticfeeling
CorrectAnswer-C
Ans.is'c'i.e.,Increasesappetite
Mari-juanaorcannabissativacontainstheactiveprinciple
tetrahydrocannabinol(THC),whichasanappetitestimulanteffect.

---

1811.Delusionsarefeaturesofallexcept?
a)Delirium
b)Schizophrenic
c)OCD
d)Alcoholwithdrawal
CorrectAnswer-C
Ans.is'c'i.e.,OCD
Delusionsareseeninpsychoticdisorders
Organic
1. Delirium(Acuteconfusionalstate)
2. Substance:-Abuse(alcohol,amphetamines)andwithdrawal
(alcohol).
Nonorganic
1. Schizophrenia
2. Affect/mooddisorders(Mania&depression)
3. Othernon-organicpsychosis:-Delusionaldisorders,Schizoaffective
disorders.
Delusionsarenotseeninneuroticdisorders-,Anxietydisorders
obsessive-compulsivedisorders,Dissociative(conversion)
disorders,Somatoformdisorders,Stress-relateddisorders

---

1812.Allarefeaturesofpsychosisexcept?
a)Lossofinsight
b)Presenceofdelusions
c)Preservedcontactwithreality
d)Personalitydisturbances
CorrectAnswer-C
Ans.is'c'i.e.,Preservedcontactwithreality
Psychosis
Psychosisisamentalstateinvolvingthelossofcontactwithreality,
causingdeteriorationofnormalsocialfunctioning.Thecharacteristic
featuresofpsychosisare:-
1. Grossimpairmentinrealitytesting,i.e.,lossofcontactwithreality.
2. Markeddisturbanceinpersonalityandbehaviorwithimpairmentin
social,interpersonalandoccupationalfunctioning.
3. Markedimpairmentinjudgement.
4. Lossofinsight(insightisanassessmentofhowawarethepatientis
oftheirownmentalillness).
5. Presenceofcharacteristicsymptomslikedelusionsand
hallucinations,thesearecalledpsychoticsymptoms.
Themajorpsychosisare:?
1. Organicpsychoticdisorders,e.g.,Delirium,substancerelated
psychosis,headtrauma.
2. Non-organicpsychoses
3. Majorpsychoses:-Schizophrenia,mooddisorders(depression,
mania,bipolar).
4. Otherpsychoticdisorders(thirdpsychosis):-Delusionaldisorders,
acuteandtransientpsychoticdisorders,schizoaffectivedisorder
Neurosis

---

Neurosisisageneraltermreferringtomentaldistressthat,unlike
psychosis,doesnotpreventrationalthoughtanddailyfunctioning.
Characteristicfeaturesare:-
1. Symptomscausesubjectivedistresstothepatient.
2. Insightispresent(symptomsarerecognisedasundesirable).
3. Thepersonalityandbehaviourarerelativelypreservedasisthe
judgement.
4. Thecontactwithrealityispreserved.
5. Absenceoforganiccausativefactor
ImportantneuroticdisordersareAnxietydisorders(Panic),Phobia
(Phobicanxietydisorder),obsessivecompulsivedisorder,
Dissociativeconversiondisorder.

---

1813.Allarefeaturesofneurosisexcept?
a)Symptomscausesubjectivedistress
b)Contactwithrealitypreserved
c)Personalitydisturbances
d)Insightismaintained
CorrectAnswer-C
Ans.is'c'i.e.,Personalitydisturbances

---

1814.Bleuler'ssymptomsforschizophrenia
areallexcept?
a)Looseningofassociation
b)Affectdisturbances
c)Autism
d)Hallucinations
CorrectAnswer-D
Ans.is'd'i.e.,Hallucinations
EugenBleulerrenameddementiaprecoxasSchizophrenia.He
recognizedthatschizophreniaisagroupofdisordersratherthana
distinctentity.Therefore,heusedtheterm,agroupof
schizophrenias.
Bleulerdescribedthecharacteristicsymptoms(fundamental
symptoms)forschizophreniawhicharealsoknownas4'A'sof
Bleuler:?
1. Ambivalence(coexistenceoftwooppositefeelingsandattitude
towardsthesamethinginthesamepersonatthesametime).
2. Autism(Preoccupationwithfantasies,delusionsandhallucinations
totheexclusionofreality).
3. Affectdisturbances(e.g.,inappropriateaffect)
4. Associationdisturbances(e.g.,Looseningofassociation,thought
disorder).
Healsodescribedaccessarysyptomsofschizophrenia:-delusions,
hallucinations,andnegativism.

---

1815.Allarediagnosticsymptomsof
schizophreniaexcept?
a)Catatonia
b)Hallucinations
c)Disorganizedspeech
d)Socialwithdrawal
CorrectAnswer-D
Ans.is'd'i.e.,Socialwithdrawal
Diagnosticcriteriaforschizophrenia
Characteristicsymptoms:-Two(ormore)ofthefollowingfora1
monthsduration(orlessifsuccessfullytreated):?
1. Delusions
2. Hallucinations
3. Disorganizedspeech
4. Grosslydisorganizedorcatatonicbehavior
5. Negativesymptoms,i.e.,affectiveflattening,alogia.
Note:-Onlyoneoftheaboveisrequiredifdelusionsarebizarreor
therearethirdpersonhallucinations(runningcommentaryortwo
voicesarguingorconversing).
Social/occupationaldysfunction
Duration:-Continuoussignsofdisturbancepersistforatleast6
months.This6monthsperiodmustincludeatleast1monthof
symptomsthatmeetcriteriaA.
Exclusionofmooddisorderandschizoaffectivediorder.
Exclusionofsubstanceabuse/generalmedicalcondition.

---

1816.Goodprognosticfactorfor
schizophreniais?
a)Bluntedaffect
b)Earlyonset
c)Presenceofdepression
d)Malesex
CorrectAnswer-C
Ans.is'c'i.e.,Presenceofdepression
Goodprognosticfactors:-Acuteonset;lateonset(onsetafter35
yearsofage);Presenceofprecipitatingstressor;Goodpremorbid
adjustment;catatonic(bestprognosis)&Paranoid(2ndbest);short
duration(<6months);Married;Positivesymptoms;Presenceof
depression;familyhistoryofmooddisorder;firstepisode;pyknic
(fat)physique;femalesex;goodtreatmentcompliance&good
responsetotreatment;goodsocialsupport;presenceofconfusion
orperplexity;normalbrainCTScan;outpatienttreatment.

---

1817.Poorprognosticfactorfor
Schizophrenia-
a)Presenceofdepression
b)Femalesex
c)Presenceofstressor
d)Earlyonset
CorrectAnswer-D
Ans.is'd'i.e.,Earlyonset
Poorprognosticfactors:-Insidiousonset,earlyonset(before20
yearsofage);absenceofprecipitatingstressor;poorpremorbid
adjustment;hebephrenicsubtype(worstprognosis),simple,
undifferentiatedandchroniccatatonicsubtype;longduration
(chroniccourse-->>2years);single/divorced;Negative
symptoms;absenceofdepression;familyhistoryofschizophrenia;
pasthistoryofschizophrenia;asthenic(thin)physique;malesex;
poortreatmentcompliance&poorresponsetotreatment;poor
socialsupport;flatorbluntedaffect;ventricularenlargementonbrain
CTscan;hospitalization&indoortreatment

---

1818.Schizophreniaismorecommonin
whichsocioeconomicstrata?
a)Middle
b)Upper
c)Low
d)Uppermiddle
CorrectAnswer-C
Ans.is'c'i.e.,Low
'Schizophreniaismoreprevalentinpatientshavingalower
socioeconomicstatus".-Namboodiri
EtiologyofSchizophrenia
Theexactetiologyisnotclear.Expertsthinkschizophreniais
causedbyseveralfactors.
1.Heredity(Geneticfactors)
Schizophreniarunsinfamilies.Theillnessoccurin0.5-1%of
generalpopulation.However,Firstdegreerelativeofschizophrenic
patientshavea10timesmorelifetimeriskofhavingillness.Therisk
is3-6timesand2timesmoreinsecondandthirddegreerelatives,
respectively
2.Environmentalfactors
Environmentalfactorsandstressareimportantinprecipitating
schizophreniainmanyindividuals.Thesefactorsare:?
1. Socioeconomic:-Lowsocio-economicstatus,Industrialization;
Immigration;famileswithhighexpressedemotions;Nuclearfamilies;
Schisms&skewedfamilies;andpseudomutul&pseudohostile
families.
2. Drugs:-Drugscausingschizophrenialikestateareamphetamine
(mostcommoncausativedrug),LSD,Phencyclidine,ketamine,

---

Mescaline,Cocaine,Cannabis.
3. Metabolic&Neurologicaldisorders:-Schizophrenialikesymptoms
mayoccurinHuntington'schorea(earlystage),homocystinuria,
acuteintermittentporphyria,Wilson'sdiseaseand
hemochromatosis.
3.Biochemicalfactors
Dopaminehypothesisisthemostacceptedhypothesisfor
schizophrenia.Thereishyperactivityofdopaminergicsystem.This
hypothesisissupportedby:1)Amphetamineandcocainewhich
releasedopamineincentralsynapsesinduceschizophrenialike
symptoms;and2)Antipsychoticdrugscontroltheschizophrenic
symptomsbyblockingdopamine(D,)receptors.However,the
dipaminehypothesishasbeenquestionedalsoasHomovanillic
acid(HVAtheprincipalmetaboliteofdopamine)isnotelevatedand
prolactinlevelisnotdecreased(Dopaminehasinihibitoryactionon
prolactinrelease).
Otherneurotransmittersinvolvedare:-Increasedserotonin,
DecreasedGABA,variablechange(Increasedordecreased)
glutamate,andincreasednorepinephrine.

---

1819.Schizophreniaresultswith?
a)IncreasedGABA
b)Decreasednorepinephrine
c)Increaseddopaminergicactivity
d)Decreaseddopaminergicactivity
CorrectAnswer-C
Ans.is'c'i.e.,Increaseddopaminergicactivity
Dopaminehypothesisisthemostacceptedhypothesisfor
schizophrenia.Thereishyperactivityofdopaminergicsystem.This
hypothesisissupportedby:1)Amphetamineandcocainewhich
releasedopamineincentralsynapsesinduceschizophrenialike
symptoms;and2)Antipsychoticdrugscontroltheschizophrenic
symptomsbyblockingdopamine(D,)receptors.However,the
dipaminehypothesishasbeenquestionedalsoasHomovanillic
acid(HVAtheprincipalmetaboliteofdopamine)isnotelevatedand
prolactinlevelisnotdecreased(Dopaminehasinhibitoryactionon
prolactinrelease).
Otherneurotransmittersinvolvedare:-Increasedserotonin,
DecreasedGABA,variablechange(Increasedordecreased)
glutamate,andincreasednorepinephrine.

---

1820.Instuporcatatonia,allareseenexcept-
a)Agitation
b)Catalepsy
c)Mutism
d)Akinesia
CorrectAnswer-A
Ans.is'a'i.e.,Agitation
Agitationisseeninexcitedcatatonia(notisstuporcatatonia).
Featuresofcatatonicschizophreniamaybe:?
1. Excitedcatatonia:-Itischaracterizedbyincreasedinpsychomotor
activity,i.e.restlessness,agitation,excitement,aggressiveness,
violence.Theimpulsiveactivityoccursinresponsetohallucination
anddelusions.
2. Stuporous(retartedcatatonia):-Itischaracterizedbyextreme
retardationofpsychomotoractivity.Itincludesmutism,rigidity,
negativism,posturing,stupor,echolalia,echoproxia,catalepsy(waxy
flexibility),ambitendency,gegenhalten,stereotypies,stupor,
mannerism,Grimicing,automaticobedience.

---

1821.Allaretrueabouttype1schizophrenia
except?
a)Acuteillness
b)Goodprognosis
c)Negativesymptoms
d)Intellectmaintained
CorrectAnswer-C
Ans.is'c'i.e.,Negativesymptoms
TypeI(Reactiveoracute
TypeII(Process
schizophrenia)
schizophrenia)
Negativesymptoms
(Affectflattening,
Characteristic
Positivesymptoms
poverityof
symptoms
(Hallucination,Acute
speechlossofdrive
Typeofillness
Delusion,Thought)
Chronic
Responseto
Good
Poor
neuroleptics
Reversible
Longstanding
Outcome
Absent
Sometimespresent
Intellectual
Dopamineoveractivity
Structuralchangesin
impairment
Good
brain(dilated
Etiology
ventricleonCTscan
Poor

---

1822.Gansersyndromeisafeatureof?
a)OCD
b)Conversiondisorder
c)Dissociativedisorder
d)Schizoidpersonalitydisorder
CorrectAnswer-C
Ans.is'c'i.e.,Dissociativedisorder
Dissociativedisorder
Theessentialfeatureofthedissociativedisorderisadisruptionin
theusuallyintegratedfunctionsofconsciousness,memory,identity
orperceptionoftheenvironment.Dissociativedisorderare:-
1. Dissociative(psychogenic)amnesia:-Itisthemostcommontypeof
dissociativedisorder.Dissociativeamnesiaischaracterizedby
retrogradeamnesia(inabilitytoretrievestoredmemoriesandevents
leadinguptoonsetofamnesia)andabsenceofantegradeamnesia
(inabilitytoformnewlongtermmemories).
2. Dissociativefugue:-Adissociativefuguemaybepresentwhena
personimpulsivelywandersortravelsawayfromhomeandupon
arrivalinthenewlocationisunabletorememberhis/herpast(i.e.,
amnesiaforearlylife).Thereislossofpersonalidentityandthe
personassumesanewidentity.Thereisabsenceofawarenessof
amnesiaduringfugueepisode,i.e.,Patientdeniesanymemoryloss
duringfuguestate.Onrecoverythereisamnesiaforfugueepisodes
andrecoveryofmemoryofearlierlife(i.e.,beforetheepisodeof
fugue).
3. Dissociativeidentitydisorder(multiplepersonalitydisorder):-More
thanonepersonalityappearstopossesstheindividuals,Showing
theircharacteristicbehavior.Atanyinstancebehaviorandmemories

---

ofonepersonalityisexhibited,patientthenisunawareoftheother's
existance.
4. Depersonalizationdisorder:-Feelingofdetachmentfromselfis
referredtoasdepersonalization.Individualswiththisdisorderwill
reportfeelingasiftheyarelivinginadreamorwatchingthemselves
onmoviescreeni.e.,feelingdetachedfromselfandasifoneisan
outsideobserverofoneself.Peoplewiththisdisorderfeellikethey
are"goingcrazy"andtheyfrequentlybecomeanxiousand
depressed
5. Dissociativedisordersnototherwisespecified:-Thesearethe
disordersthatarecharacterizedbydissociativeresponsethatdonot
meetdiagnosticcriteriaforoneoftheotherdissociativedisorder.
Importantonesare:-
DissociativeTrance(Possession)disorders:-Thereistemporary
exchangeofperson'spersonalitybyanewpersonalityusually
attributedtoaspiritordivinepower.Usuallythepersonisawareof
theexistanceoftheother,i.e.,possessor(unlikedissociativeidentity
disorder).
Ganser'ssyndrome:-Alsoknownassyndromeofapproximate
answers.Thisischaracterizedbygivingapproximateanswers
togetherwithacloudingofconsciousness,andfrequently
accompaniedbyhallucinationsandotherdissociative,somatoform
orconversionsymptoms.

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1823.Neurotransmitterinmania-
a)Increaseddopaine
b)Decreaseddopamine
c)Increasednorepinephrine
d)Decreasednorepinephrine
CorrectAnswer-C
Ans.is'c'i.e.,Increasednorepinephrine
Neurotransmittersinmooddisorders
Mostacceptedbiochemicalhypothesisformooddisordersisthe
monoaminehypothesis,accordingtowhichserotininand
norepinephrinearethemajorneurotransmittersinvolvedinmood
disorders:-
1. Depression-->Decreaseinserotoninandnorepinephrine.Serotonin
isthemostimportantneurotransmitterindepression.
2. Mania-->Increasedlevelofnorepinephrine
Patientssufferingfromseveredepressionwithsuicidal
intent/attemptappeartohaveamarkeddecreaseinserotinin.
AcetylcholineandGABAaretheotherneurotransmitterswhichare
involvedinmooddisorders.

---

1824.Fordiagnosisofmaniasymptoms
shouldbe-
a)>1week
b)>3weeks
c)>2week
d)>4weeks
CorrectAnswer-A
Ans.is'a'i.e.,>1Week
DiagnosticcriteriaforMania
Threeormoreofthefollowingforatleast1week:-
1. Inflatedselfesteemorgrandiosity
2. Decreasedneedforsleep
3. Overtalkativness
4. Flightofideasorracingthoughts
5. Distractibility
6. increasedgoaldirectedactivityorpsychomotoragitation
7. Excessiveinvolvementinpleasurableactivitiesthathaveahigh
potentialforpainfulconsequences.
Themooddisturbanceissufficientlyseveretocausemarked
impairmentinoccupational&socialfunctioning,orthereare
psychoticfeatures.
Ifthesymptomsoccurfor4days,anddonotcauseimpairmentof
social/occupationalfunctioning,andpsychoticfeatureareabsent,
thenthediagnosisishypomania.

---

1825.Pathognonomicofmaniacepisodeis?
a)Elevatedmood
b)Grandiosity
c)Decreasedappetite
d)Increasedsleep
CorrectAnswer-B
Ans.is'b'i.e.,Grandiosity
Option'a'isconfusingone.Yes,elevatedmoodisoneofthemost
classicalsymptomofmania.Butitisnotpathognomonic.
Pathognomonicmeansasymptomwhichcanbeusedfordiagnosis.
Elevatedmoodisnotasymptomofdiagnosticcriteriaofmania.
Diagnosticcriteriaformania
Threeormoreofthefollowingforatleast1week:-
1. Inflatedselfesteemorgrandiosity
2. Decreasedneedforsleep
3. Overtalkativeness
4. Flightofideas
5. Distractibility
6. PsychomotoragitationorIncreasedgoaldirectedactivitie
7. Excessiveinvolvementinpleasurableactivities
Importantsymptomsofmania
1. Elevatedmood:-Euphoria,elation,exatlation,ectasy,highself
esteem.
2. Thought&speech:-Pressureofspeech(Talkativeness),flightof
ideas,delusionofgrandeur,delusionofpersecution,distractibility.
3. Increasedpsychomotoractivity:-Overactiveness,restlessness,
increasedenergy.
4. Goaldirectedactivity:-Patientisalert,tryingtodomanythingsat

---

onetime.
5. Psychoticfeatures:-Delusionsandhallucination.
6. Other:-Increasedsexualdrive,aggressivebehavior,decreased
needforsleep(insomnia),spendingexcessivemoney,increased
appetite,impairedjudgement,social&occupationaldysfunction,
absentinsight.

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1826.Cyclothymiaisatypeof?
a)Bipolarmooddisorder
b)Majordepression
c)Dysthymia
d)Persistantmooddisorder
CorrectAnswer-D
Ans.is'd'i.e.,Persistantmooddisorder
Persistentmooddisorder
Mooddisordersmayrunachroniccourseoveryearswithfluctuation
ofmoodinterposedwithsymptomfreeintervals.Ifsymptomspersist
formorethan2years,theyarereferredtoaspersistentmood
disorders.Twomostimportantpersistantmooddisordersare:?
1. Cyclothymia:-Itisasubduedversionofbipolardisorder,
characterizedbyepisodesofdepressionandhypomaniathatneve,.
havesufficientintensitytomeetfulldiagnosticcriteriaforbipolar
disorder.
2. Dysthemia:-Longstanding(persistent,i.e.,2years)mild
depressionwhichisnotsevereenoughtomeetfulldiagnostic
criteriaformajordepression.Symptomsaremoreprominentthan
signs(moresubjectivethanobjectivedepression).Thismeansthat
disturbancesinappetiteandlibidoareuncharacteristic,and
psychomotoragitationorretardationisnotobserved.

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1827.Allarerequiredtodiagnosemajor
depressionexcept?
a)Depressedmood
b)Isomnia
c)Nihlisticideas
d)Decreasedconcentration
CorrectAnswer-C
Ans.is'c'i.e.,Nihlisticideas
Diagnosticcriteriaformajordepression
5ormoreoffollowingsymptomsshouldbepresentmostoftheday
foratleast2weeks:?
1. Depressedmood
2. Lossofinterestorpleasureinallactivities.
3. Decrease/increaseappetiteorloss/gainofweight.
4. Insomniaorhypersomnia(Increasedordecreasedsleep).
5. Psychomotorretardationoragitation(decreasedorincreased
psychomotoractivity).
6. Fatigueorlossofenergy(weaknessorlethargy).
7. Feelingsofworthlessnessorexcessiveguilt.
8. Diminishedconcentration
9. Recurrentthoughtsofdeathorrecurrentsuicidalideationorsuicidal
attempt.
Atleastoneofsymptomsshouldbeeither:?
1. Depressedmoodor2)Lossofinterestorpleasure--)Thesetwo(1
&2)areessentialcriteria.Therefore1essentialcriterianand4other
criteria(total5)shouldbepersent.

---

1828.Suicideismostcommonin?
a)Depression
b)Alcoholdependence
c)Dementia
d)Schizophrenia
CorrectAnswer-A
Ans.is'a'i.e.,Depression
Causes/Riskfactorsforsuicide
Psychiatricdisorders:-Depression(mostcommon),alcoholism
(2ndmc),Drug/Substancedependence,Schizophrenia,Dementia.
Physicalillness:-Cancer,AIDS,Multiplesclerosis,Headtrauma.
Psychosocialfactors:-Failureinlove,maritaldifficulties,family
dispute,illegitimatepregnancy.
Biologicalfactors:-Decreaseinserotonin
Other-Malesex,Age>40years,Single(Unmarried,divorcedor
widowed),previoussuicideattempt,socialisolation.

---

1829.Folie-a-deuxmeans?
a)Delusionofpersecution
b)Sharingofdelusion
c)Delusionofdouble
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Sharingofdelusion
Itisalsoknownassharedpsychoticdisorderorsymbioticpsychosis.
Itischaracterizedbysharingofdelusionsbetweentwoperson(Folie
adeux)orrarelybetweenmoreindividuals(Folieatrois,Foliea
quatre,Folieafamine).
Thereisadominant(active)personwhoinducesdelusionsintothe
other(passivereceptorordependentperson)-4Dependentperson
acceptsthedelusionofdominantperson.
Onseparationoftwo,dependentpersonmaygiveuphisdelusions,
howevertheactive(dominant)personoftenrequirestreatment

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1830.Whichofthefollowingisdelusion?
a)Othellosyndrome
b)Declerambault'ssyndrome
c)Pyromania
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Othellosyndrome&'la'i.e.,Declerambault's
syndrome
Delusionaldisorders(Persistentdelusionaldisorders)
Delusionaldisorder,previouslycalledasparanoiddisorder,isa
groupofdisorderswherelongstandingdelusionsaretheprimaryor
onlymanifestationofillness.Persistentdelusionsmustbepresent
foratleast3months(ICD-10)orforatleast1month(DSM-IV).
Dependingonthecontentfollowingtypeofdelusionsmayoccur.
1. Delusionsofpersecution:-Thesearethemostcommontypeof
delusions.Thepatientbelievesthatheisconspiredagainstand
harassedorbodilyinjured,spiedorfollowedorpoisonedbyother.
Patientbelievesthatheisunderthesurveillanceofpolice,ashis
neighbourshavecomplainedagainsthim;orheiswatchedandthe
newsinthenewspaperrefertohim.
2. Somatic(Hypochondrical)delusions:-Therearedelusionsrelated
tothepatientsbodyoritspart.Thisconditionisalsoreferredtoas
monosymptomatichypochondricalpsychosis(MHP)or
hypochondricalparanoia.Examplesare:?
Bodyoritspartbeinguglyormisshapen,i.e.,noseisdeformed-->
Delusionaldysmorphophobia.
Infestationsbywormsorforeignbodies--->Delusionalparsitosis.
Emittingafoulodor-->Delusionalhalitosis.

---

3.Delusionsofgrandeur:-Delusionsofinflatedselfesteemand
selfimage.Thepatientmaybelievethatheisanimportantperson
whoisabletohelpother,ormayreporthearingthevoiceofGod
andtheSaints,Confirmingtheirelevatedstatus.
4.Delusionsofjealousy(infidelity):-Contentofdelusionsis
predominantlyjealousy(infidelity)involvingthespouse-->Othello
syndromeorConjugalparanoia.Elobratestepsaretakentoprevent
thespousetogooutsite(Locksthespouse,notallowinghergo
outside),ortocatchthespouseredhanded(privatedetectives).
5.Delusionoflove(Erotomanicdelusionorerotomania):-More
prevalentamongfemalesandthereisaneroticconvictionthata
personwithhigherstatusisinlovewithpatient--)Declerambault's
syndrome.

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1831.Thedeliusionwhichinvolves
replacementofafamiliarpersonby
someoneelseis?
a)Capgrassyndrome
b)Cotardsyndrome
c)Othellosyndrome
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Capgrassyndrome
DSMischaracterizedbymisidentificationdelusionsofotherorself.
Fourmainsyndromesaredifferentiated:?
1. Capgrassyndrome(Delusionofdouble):-Patientfalselyseesa
familiarpersonasacompletestrangerwhoisimportingonhimasa
familiarperson.
2. Fregolisyndrome(illusiondefregoli):-Thepatientfalselyidentifies
strangerasfamiliarperson.
3. Syndromeofsubjectivedouble:-Thepatientsownselfisperceived
asbeingreplacedbyadouble.
4. Syndromeofintermetamorphosis:-Afalsebeliefthatapersoncan
transformintoanotherperson.
Thesesyndromemostcommonlyappearinschizophrenia.Other
causesareAlzheimersyndrome,headinjuries,anddelusional
disorders.

---

1832.Doppelgangeris-
a)Shadowfollowingperson
b)Feelingofdoubleofoneself
c)Indentificationofstrangerasfamiliar
d)Noneoftheabove
CorrectAnswer-B
Ans.is`b'i.e.,Feelingofdoubleofoneself
Doppelgangers(subjectivedouble)isthedelusionthatthereis
doubleofoneself.Apersonfeelsthatdoubleofhimselfexists
elswhere.

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1833.Acuteandtransientpsychoticdisorder,
onsetofsymptoms?
a)<1weeks
b)<2weeks
c)<3weeks
d)<4weeks
CorrectAnswer-B
Ans.is'b'i.e.,<2weeks
Acuteandtransientpsychoticdisorder
Thesepsychoticdisordersarecharacterizedbyanabrupt(lessthan
48hours)oranacute(Lessthan2weeks)onsetofsymptoms.
Threetypeshavebeenrecognized(accordingtoICD-10).
1. Acutepolymorphicpsychoticdisorderwithoutsymptomsof
schizophrenia:-Hallucinations,delusions,andotherpsychotic
symptomsarepresentandarevariedandconstantlychanging,just
likeemotionalstatus.Noneofthemisconsistentastoqualifyfora
diagnosisofschizophrenia.Thepolymorphicandunstablepictureis
characteristicofillness.
2. Acutepolymorphicpsychoticdisorderwithsymptomsof
schizophrenia:-Polymorphicandunstablesymptomsoccuralong
withconsistentsymptomsofschizophrenia.
3. Acuteschizophrenia-likepsychoticdisorder:-Exceptforacuteand
shorterdurationofsymptomstheyresembleschizophreniaintotal.
Symptomsoccurforlessthanlmonth.UnderDSMIVclassification,
itisclassifiedasbriefpsychoticdisorder.

---

1834.Timeintervalbetweenacuteand
persistentpsychoticdiseaseis?
a)1week
b)2week
c)3week
d)1months
CorrectAnswer-D
Ans.is`d'i.e.,1months
Ifsymtomsareforlessthan1months,itistransientpsychotic
disorderandifthereareformorethan1months,itispersistent
psychoticdisorder(persistentdelusionaldisorder).
Note:-Diagnosiccriteriafordelusionaldisorder(Persistentdelusion
disorder)hasdifferentdurationsinDSMIVandICD-10:-
1. AccordingtoDSMIV,symptoms(Nonbizzaredelusion)shouldbe
for>1months.
2. AccordingtoICD-10,Symptomsshouldbefor>3months.

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1835.Notusedforerectiledysfunction?
a)Betablockers
b)Siledenafil
c)PG-E,
d)Papaverine
CorrectAnswer-A
Ans.is'a'i.e.,Betablockers
Drugsusedforerectiledysfunction
1.Phosphodiesterase-5inhibitors(Siledenafil,Todafil,
Vardenafil).
ByinhibitingPDE-5,thesedrugspreventdegradationofcGMPand
potentiatetheactionofNO.
ThesearetheDOCforpharmacologicaltherapyoferectile
dysfunction.
2.Alprastadil(ProstaglandinEl)
Itisapowerfulvasodilator
Itactsbyincreasingarterialinflowbyvasodilationandreducing
outflowbycontractingthecarporalsmoothmusclethatoccludes
drainingvenules.
ItistheDOCforpatientsnotrespondingtoPDE-5inhibitors.
Itisdirectlyinjectedintocorporacavernosa.
3.Papaverine
Itisanonspecificphosphodiesteraseinhibitor.
Injectionofpapaverinewithorwithoutphentolamineintocorpus
cavernosumproducespeniletumiscencetopermitintercourse.
Repeatedinjectioncancausepenilefibrosis.
4.Androgens
Canbeusedwhenandrogendeficiencyisdemonstratedtobe

---

responsibleforthelossoflibidoanderectiledysfunction.
5.Apomorphine(Laurence9th/ep.546)
Adopamineantagonist,isgivenbysubcutaneousinjection.

---

1836.Allareanxietydisordersexcept?
a)Phobias
b)OCD
c)Conversionreaction
d)PTSD
CorrectAnswer-C
Ans.is'c'i.e.,Conversionreaction
Anxietydisordersare:-
1. Panicdisorderwithorwithoutagoraphobia
2. Agoraphobiawithorwithoutpanicdisorder
3. Specificphobia
4. Socialphobia
5. Obsessive-compulsivedisorder
6. Posttraumaticstressdisorder
7. Generalizedanxietydisorder

---

1837.Drugofchoiceforgeneralizedanxiety?
a)3-blocker
b)Alprazolam
c)Buspirone
d)Phenytoin
CorrectAnswer-B
Ans.is'b'i.e.,Alprazolam
Treatmentofgeneralizedanxiety
Benzodiazepinesarethedrugofchoice.Drugsinthisgroupare
diazepam,Lorazepam,Alprazolam,Oxazepam,chlordiazepoxide.
Otherdrugsusedarebuspirone;TCA(amptriptyline,imipramine,
clomipramine,desipramine);SSRIs(Fluoxetine,Sertaline,
Paroxetine,Citalopram);SNRIs(Venalafaxine),13-blockers.
AnticonvulsantswithGABAergicpropertiesmayalsobeeffective
againstanxiety,e.g.,Gabapentin,Oxcarbazepine,Tiagabine,
pregabalin,andValproate(divalporex).

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1838.Astudentunabletodeliverspeech
beforeaudienceissufferingfrom?
a)Socialphobia
b)OCD
c)Agoraphobia
d)Claustrophobia
CorrectAnswer-A
Ans.is'a'i.e.,Socialphobia
Phobicdisorders
Phobiaispersistentandmorbidfearofspecificsituation,objector
activity.Thefearismorbidbecause:?
1. Thefearisirrational:Theobjectsorsituationsdonotproducefear
innormalpersons.
2. Thefearisoutofproportiontothedangerousnessperceivedthatthe
affectedpersonavoidsthesituationpermanently.
3. Patientisunabletocontrolthefearandisverydistressedbyit.
Thecommontypesofphobiaare:?
1.Agoraphobia
Thisisanexampleofirrationalfearofsituations.Itisthecommonest
typeofphobiaencounteredinclinicalpractice.
Itischaracterizedbyanirrationalfearofbeinginplacesawayfrom
familiarsettingofhomeandpatientbelievesthathecannotescape
fromtheseplaces,toasaferplace(usuallyhome).Thisfearresults
inavoidanceoftheseplaceswhichincludepublicplaces,stores,
crowd,travellingaloneinbus,trainorplane,Theaters,Tunnels,
Bridge,standinginlinesmallenclosedroomsorlifts.
Thepatientisafraidofalltheplacesorsituationsfromwhere
escapemaybeperceivedtobedifficultifhesuddenlydevelops

---

embrassingorincapaciatingsymptoms.Theseembrassingor
incapaciatingsymptomsaretheclassicalsymptomsofpanic.Afull-
blownpanicattackmayoccur(agoraphobiawithpanicdisorder)or
onlyafewsymptoms(likedizzinessortachycardia)mayoccur
(agoraphobiawithoutpanicdisorder).
2.Socialphobia
Insocialphobiathereisirrationalfearofoneormoresocialor
performancesituationsinwhichthepersonisconcernedabout
negativeevaluationorscrutinybyothers,forexample:Public
speaking;writing/drinking/eatinginpublic;usingpubliclavatories.
Fearedsocialorperformancesituationsmayproduceanxiety
symptoms,evenapanicattack.Therefore,fearedsocialor
performancesituationsareavoided.
3.Specific(simple)phobia
Thesearephobiaslimitedtohighlyspecificsituationsorobjects,for
example.
1. Claustrophobia:-Fearofclosedspaces
2. Acro/Aerophobia:-Fearofhighplaces
3. Zoophobia:-Fearofanimals
4. Pyrophobia:-Fearoffire
5. Xenophobia:-Fearofstrangers
6. Algophobia:-Fearsofpain
7. Thanatophobia:-Fearofdeath
8. Mysophobia:-Fearofdirt&germs
9. Erythrophobia:-Fearofblushing
10. Sitophobia:-Fearofeating
11. Ailurophobia:-Fearofcats
12. Sitaphobia:-Fearofdogs
13. Hydrophobia:-Fearofwater

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1839.Ataxiaabasiaisseenin?
a)Conversiondisorder
b)PTSD
c)Depression
d)Manic
CorrectAnswer-A
Ans.is'a'i.e.,Conversiondisorder
Symptomsofconversiondisorder
Sensorysymptoms(inICD-10dissociativeanesthesia&Sensory
loss):-Anaesthesiaandparesthesiaarecommon,especiallyof
extremities.Allsensorymodilities(Pain,temperature,touch,
proprioception)areaffectedatsamelevel,andthedisturbanceisnot
consistenttothedistributionofdermatomes.Thus,cliniciansmay
seethecharacteristicgloveandstockinganaesthesiaofhandsor
feetorhemianesthesiaofbodybeginningpreciselyalongthe
midline.Deafness,blindnessorcontractedvisualfields(tubularor
tunnelvision).
Motorsymptoms(InICD-10Dissociativemotordisorder):-
Abnormalmovement,paralysis,Weakness,gaitdisturbances
(ataxia-abasia),Aphonia,Torticollis,Opisthotonus,blepherospasm.
Seizuresymptoms(InICD-10Dissociativeconvulsions):-Earlier
knownashystericalfitsorpseudoseizures,dissociativeconvulsions
arecharacterizedbyconvulsivemovementsandpartiallossof
consciousness.Dissociativeconvulsionsshouldbedifferentiated
fromtrueconvulsions:-
1. Tonguebiting,Urinaryincontinenceandinjuryareuncomomn(in
contrasttotrueconvulsions,Inwhichthesearecommon).
2. Neveroccursduringsleep(incontrast,trueconvulsionscanoccur

---

anytimeandduringsleep).
3. Usuallyoccurinsafeplaceorindoors(incontrast,trueconvulsions
canoccuranywhere).
4. Usuallyoccurswhenpeopleareobserving(incontrast,true
convulsioncanoccurwithorwithoutpeopleobservation).
5. Normalprolactinlevelinpostictalperiod(incontrast,serumprolactin
isusuallyraisedinpost-ictalperiodaftertrueconvulsions).
6. Thereisnoorpartialamnesiaabouttheepisode(Incontrast,true
convulsionhascompleteamnesia).

---

1840.Allareincludedindiagnosticcriteriaof
somatizationdisorderexcept?
a)Sexualsymptom
b)Painsymptom
c)GIsymptom
d)Visualsymptoms
CorrectAnswer-D
Ans.is'd'i.e.,Visualsymptoms
Somatizationdisorder
Theessentialfeaturesofsomatizationdisorderaremultiple
recurrentsomaticsymptomsoflongduration(chronic)thatare
causedbypsychologicalbasisandnophysicalillnesscanbefound.
Thedisorderbeginsbeforetheageof30yearsandthenhasa
chroniccourse(overaperiodofseveralyears).Diagnosticcriteria
forsomatizationdisorder
Eachofthefollowingshouldbepresent:?
1. Fourpainsymptoms:-Pain,atleastatfourdifferentsitesor
functions?9Head(headache),abdomen,back,joint,extremites,
chest,rectum,duringmensturationorsexualintercourseor
urination.
2. Twogastrointestinalsymptoms:-Nausea,bloating,vomiting,
diarrhea.
3. Onesexualsymptom:-Erectiledysfunction(Impotence),ejaculatory
dysfunction,irregularmenses,excessivemensturalbleeding.
4. Onepseudoneurologicalsymptom:-Conversionsymptoms
(impairedcoordinationorbalance,paralysis,weakness,blindness,
deafness,glove&stockinganesthesia,Paresthesia,seizure,
aphonia);Dissociativesymptoms(amnesia);lossofconsciousness.

---

---

1841.Inpersonalitydisorder,featuresareall
except
a)Egodystonia
b)Startsinchildhood
c)Behaviorismaladaptive
d)Disorderresultsinpersonaldistress
CorrectAnswer-A
Ans.'A'i.e.,Egodystonia
Featuresofpersonalitydisorders
Mostoftenthefirstsignofapersonalitydisorderappearsinlate
childhoodoradolescenceandcontinuesduringadulthood.
Someonewithapersonalitydisorderholdsattitudesandbehavesin
waysthatcancauseconsiderableproblemsforthemselvesand
others.
Behaviourislong-standing(notlimitedtoanepisodeofmental
illness).
Behaviourispervasiveandmaladaptive.
Disorderresultsinpersonaldistressandsocialoroccupational
dysfunction.
Behaviorisfixedandinflexible.
Personalitydisordersareego-syntonic.
Theyarenotduetoadirectresultofdiseaseorsubstance.

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1842.Suspiciousnessisacharacteristic
featureof?
a)Paranoidpersonalitydisorder
b)Schizoidpersonalitydisorder
c)Schizotypalpersonalitydisorder
d)Anankasticpersonalitydisorder
CorrectAnswer-A
Ans.is'a'i.e.,Paranoidpersonalitydisorder
Paranoidpersonalitydisorder
ItischaracterizedbygeneralisedmistrustandSuspiciousnessabout
themotivesandactionsofothersandatendencytointerpretthem
asmalevolent.Thepatientbelievesthat:-
1. Othersareexploitingordeceivingtheperson.
2. Friendsareuntrustworthyandnotloyal.
3. Thespouse/partnerisunfaithful.
4. Thereishiddenmeaninginneutralorfriendlyremarks.
5. Manypatientshavefeelingofself-importanceandthinktheyare
unusuallytalented

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1843.Borderlinepersonalitydisorder?
a)Chronicfeelingofemptiness
b)Unstableinterpersonalrelationship
c)Grandiosity
d)Lowselfesteem
CorrectAnswer-B
Ans.is'b'i.e.,Unstableinterpersonlrelationship
Borderlinepersonalitydisorder
Thecentralfeatureofborderlinepersonalitydisorderisapervasive
patternofunstableandintenseinterpersonalrelationship,self
perceptionandmood.
Thepatientmakerecurrentsuicidalthreatsandgestureandasmall
proportionofpatientscarryouttheactorselfmultilationlikecutting
orburning.
Thepatientshavedifficultyincontrollingtheirangerandimpulsitivity.
Thereisuncertaintyaboutpersonalidentity.

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1844.Personalityassociatedbipolardisorder
-
a)Antisocial
b)Anakastic
c)Borderline
d)Narcissistic
CorrectAnswer-D
Ans.is'd'i.e.,Narcissistic
SymptomsofNarcissisticpersonalitydisordercanbeconfusedwith
manicphaseofbipolardisorder".
Narcissisticpersonalitydisorder
Narcissisticpatientsaregrandioseandrequireadmirationfrom
other.
ThisischaracterizedbyIdeasofgrandiosity&inflatedsenseofself
importance;lackofempathywithothers;attentionseekingbehavior;
exploitationofothers;andanarrogant,haughtyattitude.

---

1845.OCDisassociatedwithwhich
personality?
a)Anakastic
b)Borderline
c)Narcissistic
d)Histrionic
CorrectAnswer-A
Ans.is'a'i.e.,Anankastic
Obsessive-Compulsive(anankastic)personalitydisorder:-People
withobsessive-compulsivepersonalitydisorderaremarkedly
preoccupiedwithorderliness,perfectionism,andcontrol.Theylack
flexibilityoropenness.Theirpreoccupationsinterferewiththeir
efficiencydespitetheirfocusontasks.Theyareoftenstingyaswell
asstuborn.

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1846.Mosteffectivetreatmentinborderline
personalitydisorders?
a)Pharmacotherapy
b)Behaviourtherapy
c)Combinationofbothpharmacotherapyandbehaviouraltherapy
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Behaviourtherapy
"Dialecticalbehavioraltherapy(DBT),atypeofcognitivebehavioral
therapy(CBT),hasbeendevelopedspecificallyforthetreatmentof
borderlinepersonalitydisorder,anditappeartobethemost
effectivetreatmentforthiscondition".

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1847.18yearoldgirlwithcircumscribedbald
patchwithnoorganicdisease&no
behaviouraldisorderhas?
a)Depression
b)Trichotillomania
c)OCD
d)Phobia
CorrectAnswer-B
Ans.is'b'i.e.,Trichotillomania
Asthereisnoorganicorbehavioraldisorders,thisgirlissuffering
withimpulsecontroldisorderofcompulsivehairpulling,knownas
Trichotillomania.
Impulsecontroldisorder
Thesedisordersarecharacterizedbyfailuretoresistanimpulsive
behaviorthatmaybeharmfultoselforothers.Theremaybea
feelingofreleaseoftensionbydoingtheactandafeelingofguilt
aftertheactisover.Importantimpulsecontroldisorderare:-
1. Pyromania(Pathologicalfiresetting)
2. Kleptomania(Pathologicalstealing)
3. Trichotillomania(Compulsivehairpulling)
4. Pathologicalgambling
5. Intermittentexplosivedisorder
6. Impulsecontroldisordernototherwisespecified
Oniomania(Compulsiontoshop/buying)
Internetcompulsion(Internetaddiction)
CellularorMobilephonecompulsion
Compulsivesexualbehavior(sexualaddiction).

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1848.Trichotillomania?
a)Irresistabledesiretosetfire
b)Irresistabledesiretostealthings
c)Compulsivehairpulling
d)Pathologicalgambling
CorrectAnswer-C
Ans.is'c'i.e.,Compulsivehairpulling

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1849.Pyromaniareferstoanirresistibleurge
to?
a)Setthingsonfire
b)Eatoutofproportion
c)Sleepforlongperiods
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Setthingsonfire

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1850.REMsleepisassociatedwithallexcept
?
a)Dreams
b)Deltawaves
c)Lossofmuscletone
d)IncreasedBP
CorrectAnswer-B
Ans.is'b'i.e.,Deltawave
StagesofSleep
Sleepisbasicallydividedintotwophases:?
Non-REM(NREM)orslow-wavesleep:-ItiscalledNon-REMsleep
becausenorapideyemovement(REM)isthereoneletrooculogram,
ratherthereissloworquiscenteyemovement.Itisalsoreferredas
S-sleep(synchronizedsleep)orquietsleepororthodoxsleep
becausetherediminishedphysiologicalfunctionsandalowlevelof
overallactivity.Itisfurtherdividedinto:?
1. Stage1:-Itisatransitionfromwakefulnesstosleepandis
characterizedbydisappearanceofalphaactivityandappearanceof
thetaactivity.Thereissloweyemovements.
2. Stage2:-ItischaracterizedbytypicalEEGactivityi.e.,Sleep
spindlesandIC-complex'.Noeyemovementoccurs.
3. Stage3&4:-Stage3&4arestagesofdeepsleep.Thesearealso
calledslowwavesleepasthesestagesarecharacterizedbyslow
deltawaves.Deltawaveappearancestartsinstage3and
dominatedinstage4.
REMsleep:-TheREMsleepissonamedasthereisrapidroving
movementsofeye,i.e.,rapideyemovement(REM)onelectro-
oculogram.Itisalsocalledparadoxicalsleepbecausethereisa

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paradoxicalelevationofbrainactivity&metabolismand
physiologicalactivity.Thehigh-amplitudeslowwavesseeninstage
3,4ofREMsleepisreplacedbyrapidlowvoltageactivity(beta
wave).FeaturesofREMsleepare:-
1. EEGBetawave,Reappearanceofalphawave,Saw-toothwave(low
voltagefastactivity),Pontogenital-occipitalspikes.
2. Dreaming
3. Otherfeatures:-Generalizedmuscularatony,Penileerection,
autonomichyperactivity(Increasedpulserate&BP)andintermittent
movementofsmallmusclegroups.

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1851.Sleepwalkingisseeninwhichstageof
sleep?
a)REM
b)Stage1-2NREM
c)Stage2-3NREM
d)Stage3-4NREM
CorrectAnswer-D
Ans.is'd'i.e.,Stage3-4NREM
Importanteventsoccuringduringsleep
Deepsleep/slowwavesleepdisorder:-Theseeventsoccurduring
stage3&4ofNREM.Importantdisordersare:?
1. Somnambulism(Nightwalking):-Patientwalksduringsleep.
2. Sleepterrorornightterrors(pavornocturnes):-Thepatient
suddenlygetsupscreaming,withautonomicarousal(tachycardia,
sweating).Sleepterrorsarerarelyrememberedinthemorning(in
contrasttonightmares).Notreatmentisrequiredonlyreassurance
isrequired.However,inseverecasesbenzodiazepinecanbeused.
3. Sleep-relatedenuresis(Nocturnalenuresis/bedwetting):-
Repetitivevoidingoccursduringsleep.Firstlineoftreatmentis
behaviourtherapy.Ifbehavioraltherapyfails,desmopressin(DOC)
andImipraminecanbeused.
4. Bruxism(Teethgrinding)
5. Sleep-talking(Somniloquy).
REMsleepevents
1. Nocturnalpeniletumescence:-Itisspontaneousoccurenceofan
erectionofthepenisduringsleep.Itisanormalphenomenonand
occursfor80-120minutespernightNocturnalpeniletumescence
canbeusedtodifferentiatebetweenpsychogenicimpotenceand

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organicimpotenceasnocturnalpeniletumescenceispreservedin
psychogenicimpotencebutnotinorganiccauseofimpotence.
2. Nightmares(dreamanxietydisorder):-Theyarecharacterizedby
fearfuldreamsoccuringinthelastonethirdofnightsleep.The
personwakesupfrightnedandremembersthedreamvividly(in
contrasttonightterror).
3. Narcolepsy:-Thisischaracterizedbyexcessivedaytimesleep,
oftendisturbednighttimesleepanddisturbancesintheREMsleep.
Ageofonsetisbetween10-20years.Thereisirresistabledesireto
sleepandboutsofsuddensleepeachlastingfor10-30minutes
occuringduringdaytime.Inmajorityofcasesnarcolepsyis
associatedwithoneormoreaccessorysymptoms:?
Cataplexy:-Itisthemostcommonaccessorysymptomandis
characterizedbysuddendecreaseinmuscletoneeither,localor
generalized.
Hypnagogichallucination:-Hallucinationoccuringjustbeforefalling
asleep.Whenhallucinationoccursjustbeforeawakeningitiscalled
hyponopompichallucinations.
Sleepparalysis(leastcommon)
Treatmentofnarcolepsyincludestimulantmedications
(methyphenidate,amphetamines)ormodafinil.

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1852.Bruxismisseenin?
a)NREMstage1,2
b)NREMstage3,4
c)REM
d)Anyoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,NREMstage3,4
Slowwavesleep(stage3&4ofNREMsleep)disorders:-Sleep
walking(somnambulism),nightterror(sleepterroror
pavornocturnus),Nocturnalenuresis,Bruxism(teethgrinding),and
sleeptalking(somniloquy).
REMsleepevents/disorder:-Nightmares,nocturnalpenile
tumescence,Narcolepsy.

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1853. Childwakesupatnightsweatingand
terrifieddoesnotrememberthe
episode-diagnosis?
a)Narcolepsy
b)Nightmares
c)Nightterrors
d)Somnambulism
CorrectAnswer-C
Ans.is'c'i.e.,Nightterrors
Sleepterrorornightterrors(pavornocturnus):-Thepatient
suddenlygetsupscreaming,withautonomicarousal(tachycardia,
sweating).Sleepterrorsarerarelyrememberedinthemorning(in
contrasttonightmares).Notreatmentisrequiredonlyreassurance
isrequired.However,inseverecasesbenzodiazepinecanbeused.

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1854.AlphawavesinEEGrepresent?
a)Eyeclosedwithactivemind
b)Eyeopen,fullyawakeandalert
c)Deepsleep
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Eyeclosedwithactivemind
EEGrhythmsandsleepwakecycle
FollowingEEGrhythms(Berger'srhythm)areimportantinrelationto
sleepwakecycle:?
1. Alpharhythm:-Inadulthumanswhoareawakebutatrestwith
mindwanderingandtheeyeclosed,ocrhythmisprominent.Itisa
regularrhythmwithafrequencyof8-13Hzandamplitudeof50-100
V.Itismostmarkedinparietalandoccipitallobe.Itisassociated
withdecreasedlevelofattention,i.e.,personisawakebuthas
decreasedattention(relaxed)->Personisthinkingbutwith
decreasedattention(subconsciousthinking).
2. Betarhythm:-Whenattentionisfocusedonsomething,thealpha
rhythmisreplacedbyBetarhythm.Itisanirregular13-30Hzlow
voltageactivity.Itismostevidentonfrontallobeandoccurswhen
patientisfullyawakeandalert.Thereforethisreplacementofbeta
rhythmforalpharhythmiscalledarousaloralertingresponseor
alphablock.Thisphenomenoncanbeproducedbyanyformof
sensorystimulationormentalconcentrationsuchassolving
arithmeticproblems.Personisthinkingwithamaximum
concentrationConsciousthinking.
3. Thetarhythm(4-7Hz):-Whenpersonwithalpharhythmbecomes
slightlymorerelaxed(asoccurswhenthereistransitionfrom

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wakefullnesstosleep,i.e.,stage1ofREM),alpharhythmis
replacedbythetarhythm.Thinkingispresentbutwithevenless
attentivenessthanwhichwaspresentinalpharhythmstage(Deep
subcsonciousthinking).Twotypesofthetarhythmhavebeen
described:-
Hippocampal(occursinmammalsotherthanmen,i.e.,catdogs,
etc).
Cortical(occursinmen)
4.Deltarhythm(3-5Hz):-Itispresentwhenthepersonisindeep
sleep(NREMstage3&4)andthereisnothinking.

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1855.Floodingisatreatmentmodalityused
in?
a)Phobia
b)Depression
c)Mania
d)Schizophrenia
CorrectAnswer-A
Ans.is'a'i.e.,Phobia

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1856.Psychosurgeryisusedin?
a)Phobia
b)Generalizedanxiety
c)OCD
d)Depression
CorrectAnswer-C
Ans.is'c'i.e.,OCD

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1857.
PatientandPsychotherapis,both
participateactivelyin?
a)Psychoanalysis
b)Psychoanalyticpsychotherapy
c)Psycodynamicpsychotherapy
d)Alloftheabove
CorrectAnswer-B
Ans.B.Psychoanalyticpsychotherapy
Psychoanalytic(psychodynamic)psychotherapyisamuchmore
directfromofpsychonalysis.
Thepatientandtherapistsitfacetoface.
Howevertherapistusuallytalksquitealot,comparedtosilencein
psychoanalysis.
Treatmentisaninteractiveprocessbetweenthepatientand
therapist.

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1858.IndicationsforECTareallexcept?
a)Severedepressionwithsuicidalrisk
b)Catatonicschizophrenia
c)Severepsychosis
d)Severmanicattack
CorrectAnswer-D
Ans.is'd'i.e.,Severmanicattack
IndicationsofECT
Severedepressionwithsuicialriskorwithpsychoticfeaturesorwith
stupor.
Sometypesofschizophrenia(catatonicorparanoid)
Schizophrenicordepressivestupor
Severecatatoniawithstupor
Severepsychoses(schizophreniaormania)withriskofsuicideor
homicideorphysicalassault.

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1859.WhatiscontraindicationforECT?
a)Arrthmia
b)Epilepsy
c)HIV
d)Cerebralaneurysm
CorrectAnswer-D
Ans.is'd'i.e.,Cerebralaneurysm
ContraindicationsofECT
Absolute:-Increasedintracranialtension.cerebrovascularresponse
toECTincludemarkedincreasedincerebralbloodflowandblood
flowvelocity.Cerebraloxygenconsumptionincreasesaswell.The
rapidincreaseinsystemicbloodpressuremaytransiently
overwhelmcerebralautoregulationandmayresultinincreasedin
intracranialpressure.Therefore,theuseofECTisprohibitedin
patientswithknownspaceoccupyinglesion(braintumor)orhead
injury,cerebral(intracranial)aneurysm.
Relative:-Recentmyocardialinfarction,severehypertension,
cerebrovascularaccident,severepulmonarydisease,Retinal
detachment,Pheochromocytoma.

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1860.ECTiscontraindicatedin-
a)Veryillpatients
b)RaisedICT
c)Heartdisease
d)Pregnancy
CorrectAnswer-B
Ans.is'b'i.e.,RaisedICT

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1861.Repressedinformationcanbebrought
intoconsciousmindbyallexcept?
a)Dream
b)Focusedattention
c)Hypnosis
d)Somaticstimulation
CorrectAnswer-B
Ans.is'b'i.e.,Focusedattention
Preconciousthoughtsarereadilyaccessibletoconciousnessby
focusedattention,butnotunconsciousthoughtswhichcontains
repressedmemory.
Freudadvancedthe'topographictheoryofmind'intheyear1900in
thebook'theinterpretationofdreams'.Itdividesthemindintothree
divisions:?
1. Unconscious:-Atraumaticeventwhichhadoccuredduring
childhoodare"repressed"(forceddown)intodeeperlayerof
unconsciounesswheretheyliedormantwithoutproducingany
symptoms.
2. Preconscious:-Thisistheregionofmindbetweentheunconscious
andtheconscious,withaccesstoboth.Theunconsciousmental
contentscanreachtheconsciousonlythroughthepreconscious.
So,Itactsasasensorofconscioustomentainrepressivebarrierfor
unconsciousmentalcontents.
3. Conscious:Itreferstoattentionconcernedwithregistrationof
stimulifrombothwithandwithout.
Focusedattentioncanbringpreconciousthoughtstoconsciousness.
Butrepressedmemoryisinunconscious.
Methodsusedtorecoverrepressedthoughtsare:-

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1. Hypnosis
2. Dreaminterpretation
3. Automaticwriting
4. Somaticstimulation
5. EMDR(eyemovementdesensitizationandreprocessing)

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1862.Pagophagiainvolveseating?
a)Ice
b)Sand
c)Clay
d)Salt
CorrectAnswer-A
Ans.is'a'i.e.,Ice
Eating
Geophagia
clay
Pagophagia
Eatingice
Eating
Plambophagia
lead
Eating
Amylophagia
starch
Eating
Coprophagia
feces
Eating
Cautopyreiophagia burnt
matches
Eating
Tricophagia
hair
Eating
Lithophagia
stones
Eating
Geomelophagia
raw
potatoes

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1863.Allareusedintreatmentofnocturnal
eneuresisexcept?
a)Imipramine
b)Alarmsetup
c)Voidingofurinebeforesleeping
d)Maintainenceofcalendarofdaynightwetting
CorrectAnswer-D
Ans.is'di.eMaintainenceofcalendarofdaynightwetting
Allareused.
Treatmentofnocturnaleneuresis
Itconsistsof:?
1. Appropriatetoilettrainingandrestrictingfluidatnight.Encouraging
thechildtoemptytheirbladderbeforebed.
2. Alarmtherapy
3. Behavioraltherapyusing"bellandpadapparatus"
4. Motivationaltherapy
5. Ifnon-pharmacologicaltreatmentfails-4Imipramineisthedrugof
choice.Otherdrugsusedareoxybutyninanddesmopressin.
Recordkeepingishelpfulindeterminingabaselineandfollowingthe
child'sprogressandmayitselfbeareinforcer.Astarchartmaybe
particularlyhelpful.

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1864.Allofthefollowingareusedtoimprove
attentiondeficitinchildrenexcept?
a)Cognitiveenhancementtherapy
b)Cognitivebehaviouraltherapy
c)Cognitiveremeditationtherapy
d)Flooding
CorrectAnswer-D
Ans.is'd.i.e.,Flooding
Inattentiondeficitfollowingcanbeused:
1. Cognitiveenhancementtherapy(alsocalledcognitiveremediation
therapy)
2. Cognitivebehavioraltherapy
3. Clinicalbehaviortherapy
4. Directcontingencymanagement
5. Intensive,packagedbehavioraltreatment

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1865.Pavlov'sexperimentisanexampleofwhichofthefollowinglearning
theory?
a)Modeling
b)Classicalconditioning
c)Operantconditioning
d)Learnedhelplessness
CorrectAnswer-B
Pavlov'sexperimentisanexampleofClassicalconditioning.
Classicalconditioningisaprocessoflearning,bywhichapreviouslyneutralstimuluselicit
anidenticalorsimilarresponsetooneoriginallyelicitedbyanotherstimulusasaresultof
pairingofthetwostimuli.
Ref:Kaplan&Sadock'sComprehensiveTextbookofPsychiatry,9thedition,page647.
BeginningPsychologyByMalcolmHardy,5theditionpage54;UniversalPrinciplesof
DesignByWilliamLidwell,page174;Psychology:ConceptsandApplicationsByJeffrey
S.Nevid,3rdeditionpage176.

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1866.Fatherofmodernpsychiatryis?
a)Bleuler
b)Freud
c)Pinel
d)Kraepelin
CorrectAnswer-C
Ans.is'c'i.e.,Pinel
FatherofpsychoanalysisSigmundfreud
FatherofmodernpsychiatryPhileppelpinel

---

1867.Oedipuscomplexisrelatedtowhich
phaseofpsychosexualdevelopment?
a)Oral
b)Anal
c)Genital
d)Phallic
CorrectAnswer-D
Ans.is`d'i.e.,Phallic

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1868.Concretethinkingstageofcognitive
development?
a)0-2years
b)2-5years
c)5-10years
d)10-15years
CorrectAnswer-C
Ans.is'c'i.e.,5-10years
Cognitivedevelopmentstages
Childrenarenotlittleadults.Untiltheyreachtheageof15orsothey
arenotcapableofreasoningasanadult.JeanPigetdescribedfour
majorstagesofintellectual(cognitive)developmentwhichare
relatedtomajordevelopmentinbraingrowth.
1. Sensori-motorstage(birth2years)
2. Pre-operationalstage(2-7years)
3. Concreteoperationalstage(7-11years)
4. Formaloperationalstage(>11years)

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1869.AllarefeaturesofKorsakoffsyndrome
except
a)Antegradeamnesia
b)Retrogradeamnesia
c)Ataxia
d)Confabulation
CorrectAnswer-C
Ans.'C'i.e.,Ataxia
Korsakoffsyndrome
Korsakoff'ssyndromeisthechronicamnesticsyndromethatfollows
Wernicke'sencephalopathy,andthetwosyndromesarebelievedto
bepathophysiologicallyrelated.Korsakoff'ssyndromeis
characterizedbysevereandirreversiblememoryimpairmentsand
confabulationbehaviourintheabsenceofintellectualdeclineor
attentiondeficit.Importantclinicalfeaturesare:?
1. Memory:-TheKorsakoffsyndromeischaracterizedbyboth
antegrade(i.e.,learning)andretrograde(i.e.,amemoryofpast
events)amnesia.Antegradeamnesiaisseverewithalackofinsight.
Retrogradeamnesiaisnotassevere.Newlearningandrecent
memoryareimpairedbutremotememoryisrelativelypreserved.
Althoughremotememoryisrelativelypreserved,thepatientis
unabletoorganizetheminatemporalcontextanddistortthe
relationshipbetweenfactsandfilltheremotememorygapsby
confabulation.Thereisaprofounddeficitofexplicit(consciousor
declarative)typeoflongtermmemory,withlittleimpairmentof
implicit(unconsciousornon-declarative)typeoflongtermmemory.
2. Personality:-Passiveandmalleablesuchthattheydisplayalackof
initiatives,interest,orconcernanddiminishedspontaneity.

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3. Other:-Perseveration,lackofmotivation(amotivationalsyndrome),
apathy,passivity.
4. Generalintelligence,language,andmotor&perceptualskillsarenot
impaired.

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1870.ReadthefollowingECG.It
demonstrateswhichofthefollowing?
a)SVT
b)WPWsyndrome
c)Atrialfibrillation
d)Ventricularfibrillation
CorrectAnswer-D
Ans:D.Ventricularfibrillation
TheECGisshowingaveryhighheartrate,extremelyirregular
rhythm,absentPwaveandfibrillatorybaselineventricular
fibrillation.
Ventricularfibrillationiswhentheheartquiversinsteadof
pumpingduetodisorganizedelectricalactivityintheventricles.
Itisatypeofcardiacarrhythmia.Ventricularfibrillationresults
incardiacarrestwithlossofconsciousnessandnopulse.Thisis
followedbydeathintheabsenceoftreatment.
invalidquestionid

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