Download NEET PG 2014 Question Paper with Answers

Download NEET PG (The National Eligibility cum Entrance Test Postgraduate) 2014 Question Paper with Answers

1.Anteriorinterosseousnerveisabranchof?
a)Radialnerve
b)Mediannerve
c)Ulnarnerve
d)Axillarynerve
CorrectAnswer-B
Ans.is'b'i.e.,Mediannerve
Anteriorinterosseousnerveisabranchofmediannerve.
Anteriorinterosseousarteryisabranchofulnarartery.

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2.Olecranonprocessofulnahelpsin
formationof?
a)Radialnotch
b)Trochlearnotch
c)Olecranonfossa
d)Coronoidfossa.
CorrectAnswer-B
Ans.is'b'i.e.,Trochlearnotch
Innersurfaceofolecranonprocessformstrochlearnotchfor
articulationoftrochleaofhumerus.
Radialnotchisseeninlateralpartofupperendofshaft(noton
olecronon).
Olecranonfossaandcoronoidfossaarepartoflowerendof
humerus.

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3.Trueaboutclavicle?
a)Endochondralossification
b)Vertical
c)Nomedullarycavity
d)Rarelyfractures
CorrectAnswer-C
Ans:C.)Nomedullarycavity.
PeculiaritiesofClavicle:
1.Ithasnomedullarycavity
2.Itisthefirstbonetoossifyinthefetus(5th-6thweek)
3.Itistheonlylongbonehaving2primarycentersofossification
(othershaveonly1)
4.Itistheonlylongbonethatossifiesinmembraneandnotin
cartilage
5.Itistheonlylongbonelyinghorizontally
6.Itisthemostcommonfracturedlongboneinthebody
7.Itissubcutaneousthroughout

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4.Clavipectoralfasciaispiercedbyallexcept
?
a)Lateralpectoralnerve
b)Medianpectoralnerve
c)Thoracoacromialvessels
d)Cephalicvein
CorrectAnswer-B
Ans.is'b'i.e.,Medianpectoralnerve
Clavipectoralfasciaispiercedby-
Thoraco-Acromialvessels.
Lateralpectoralnerve.
Lymphaticspassingfrombreastandpectoralregiontoapical-axillary
1.n.
Cephalicvein.

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5.Rootvalueofsupinatorjerk-
a)C3C4
b)C4C5
c)C5C6
d)C8T1
CorrectAnswer-C
C5C6

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6.Smallmusclesofhandaresuppliedby:
a)C3
b)C4
c)C6
d)C5-7,C-8toT1
CorrectAnswer-D
Allsmallmusclesofhandi.e.thener,hypothenar,interossei&
lumbricalsaresuppliedbymedianandulnarnerveswhichoriginate
fromC5-7andC8andT1nerves.

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7.Bicipitalaponeurosisliesoverwhich
structureincubitalfossa?
a)Ulnarnerve
b)Radialnerve
c)Brachialartery
d)Anteriorinterosseousartery
CorrectAnswer-C
Bicipitalaponeurosispassessuperficialtothebrachialarteryand
mediannerve.Itliesdeeptosuperficialveins.
Duringvenipuncture,thebicipitalaponeurosisprovideslimited
protectionforbrachialarteryandmediannerve.

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8.Structureoverbicipitalaponeurosisin
cubitalfossa?
a)Ulnarnerve
b)Radialnerve
c)Brachialartery
d)Veins
CorrectAnswer-D
Veins

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9.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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10.Boundariesofquadrilateralspaceinclude
allexcept?
a)Teresmajor
b)Longheadoftriceps
c)Neckofhumerus
d)Deltoid
CorrectAnswer-D
Deltoid

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11.Axillaryarteryisdividedintothreeparts
by?
a)1strib
b)Clavicle
c)Pectoralisminormuscle
d)Teresminormuscle
CorrectAnswer-C
Axillaryartery
Itisthemainarteryofupperlimb.Itbeginsatthelevelofouter
borderoffirstribasacontinuationofsubclavianartery.Itendsatthe
leveloflowerborderofteresmajortocontinueasbrachialartery.
Theaxillaryarteryiscoveredanteriorlybypectoralisminor,which
dividesitintothreeparts:?
1)Firstpart:-Thispartisproximaltoupperborderofpectoralis
minor,i.e.extendsfromouterborderoffirstribtoupperborderof
pectoralisminor.ThebranchoffirstpartisSuperiorthoracicartery.
2)Secondpart:-Thispartisbehindpectoralisminor.Itgives
followingbranches.
A)Thoracoacromialartery:-Itpiercesclavipectoralfosciaand
givesfollowingbranches:-
(i)Acromial
(ii)Pectoral,
(iii)Clavicularanddeltoid.
B)Lateralthoracicartery
3)Thirdpart:-Thispartisdistaltolowerborderofpectoralisminor,
i.e.extendsfrompectoralisminor(lowerborder)toteresmajor
(lowerborder).Itgivesfollowingbranches?
A)Subscapularartery:-Itgivesoffcircumflexscapulararteryand

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thencontinuesusthoracodorsalartery.
B)Anteriorcircumflexhumeralartery.
C)Posteriorcircumflexhumeralartery.
Anteriorandposteriorcircumflexarteries(botharebranchesof3rd
partofaxillaryartery)formsanastomosisaroundsurgicalneckof
humerus.

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12.Posteriorwallofaxillaisformedby
a)Pectoralismajor
b)Pectoralismajor
c)Subscapularis
d)Intercostalmuscles
CorrectAnswer-C
Axilla(armpit)
Theaxillaisapyramidalspacesituatedbetweentheupperpartof
thearmandthechestwall.Itresemblesafoursidedpyramid,and
hasfollowing:(i)anapex(ii)abase(iii)fourwalls(anterior,
posterior,medialandlateral).
1. Anterior(pectoral)wall:-Formedby(i)Pectoralismajor,(ii)
Pectoralisminor,and(iii)Subclavius.Thelattertwomuscles
enclosedbyclavipectoralfascia.
2. Posterior(subscapular)wall:-Formedby(i)Subcapularis,(ii)Teres
major,and(iii)Latissimusdorsi.
3. Medial(thoracic)wall:-Formedby(i)Upperfourribs(withtheir
intercostalmuscles),and(ii)Upperpartofserratusanterior.
4. Lateral(humeral)wall:-Formedby(i)Upperpartofhumeruswith
bicipitalgroovelodgingthetendonoflongheadofbiceps,and(ii)
Corachobrachialisandshortheadofbiceps?
5. Base:-FormedbySkin,superficialfasciaanddeep(axillary)fascia.
Itisdirecteddownwards.
Apex:-Itisdirectedupwardsandmediallytowardstherootofneck.
Itcommunicateswithsupraclaviculartriangleofneck,hencereferred
toasCervicoaxillarycanal.Itistriangularinshapeandisbounded
anteriorlybyclavicle,posteriorlybyupperpartofscapulaand
mediallybyouterborderoffirstrib.Theaxillaryarteryandbrachial
plaxusentertheaxillathroughthiscanal.

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plaxusentertheaxillathroughthiscanal.

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13.Anterioraxillaryfoldisduetowhich
muscle?
a)Pectoralismajor
b)Pectoralisminor
c)Subscapularis
d)Teresmajor
CorrectAnswer-A
Anterioraxillaryfoldisroundedinshapedandisformedby
pectoralismajor(lowerborder).Posterioraxillaryfoldisformedby
teresmajorandlatisimusdorsi.

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14.Intracapsularbutextrasynovialis?
a)Longheadoftriceps
b)Longheadofbiceps
c)Shortheadofbiceps
d)Medialheadofbiceps
CorrectAnswer-B
Originoflongheadofbicepsisintracapsularbutextrasynovial,
enclosedbyaprolongationofsynovialmembraneofshoulderjoint.

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15.Howmanylactiferousductsopenin
nipple?
a)0-10
b)15-20
c)25-50
d)50-75
CorrectAnswer-B
Thenippleispiercedby15-20lectiferousducts.

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16.Structurerelatedtodeltopectoralgroove
?
a)Axillaryartery
b)Cephalicvein
c)Baselicvein
d)Radialnerve
CorrectAnswer-B
Ans.isb'i.e.,Cephalicvein
Deltopectoralgrooveisagroovebetweendeltoidmuscleand
pectoralismajormuscle.
Itistraversedbycephalicvein

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17.Commoninterosseousarteryisabranch
of-
a)Brachialartery
b)Radialartery
c)Ulnarartery
d)Profundabranchiiartery
CorrectAnswer-C
Branchesofulnarartery
A)Incubitalfossa
1)Anteriorulnarrecurrent:-Anastomoseswithinferiorulnar
collateralinfromofmedialepicondyle.
2)Posteriorulnarrecurrent:-Anastomoseswithsuperiorulnar
collateralbehindmedialcpicondyle.
3)Commoninterosseous:-Dividesinto
i)Anteriorinterosseous:Itisthedeepestarteryoffrontof
forearm.Itisaccompaniedbyanteriorinterosseousnerve(abranch
ofmediannerve).Itpiercesinterosseousmembraneatupperborder
ofpronatorquadratustoenterintoextensor(dorsal)compartment.
Itsbranchesare:(a)muscularbranchesfordeepmusclesoffrontof
forearm;(b)nutrientarterytoradiusandulna;and(c)medianartery.
ii)Posteriorinterosseous:Nearitsorigin,itgivesofinterosseous
recurrentarterywhichendsbyanastomosingwithmiddlecollateral
artery.
B)Inforearm
1)Palmarcarpalbranch
2)Dorsalcarpalbranch
C)Inpalm:-Theseareterminalbranches.
i)Deepbranch:-Completesthedeeppalmararchonmedialside

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byjoiningtheterminalpartofradialartery.
ii)Superficialbranch:-Formsthemajorpartofsuperficialpalmar
arch.

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18.Trueaboutbloodsupplyofscaphoid?
a)Mainlythroughulnarartery
b)Majorsupplyfromventralsurface
c)Majorsupplyfromdorsalsurface
d)Proximalsupplyinantegradefashion
CorrectAnswer-C
Majorbloodsupply(70-80%)ofscaphoidcomesthroughdorsal
surfaceviadorsalbranchesofradialartery.
Thesedorsalvesselsenterthescaphoidatorjustdistaltowaist
areaandsupplytheproximalpoleinretrogradefashion.

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19.3rdand4thlumbrical(lateraltwo
lumbricals)offootaresuppliedby?
a)Medialplantarnerve
b)Lateralplantarnerve
c)Peronealnerve
d)Noneoftheabove
CorrectAnswer-B
Behindthemedialmalleolus,beneaththeflexorretinaculumthe
tibialnervedividesintoitstwoterminalbranches:
i)Medialplantarnerve:-Itcorrespondsapproximatelytothemedian
nerveinthehandasfarasskinandmusclesuppliesareconcerned.
Itsuppliesmedialpartofsole,plantarsurfaceofmedial3rdAdigits,
andinnervatesflexordigitorumbrevis,abductorhallucis,flexor
hallucisbrevisandthefirstlumbrical.
ii)Lateralplantarnerve:-Itcorrespodsapproximatelytotheulnar
nerve.Itsuppliesthelateralpartofsole,plantarsurfaceoflateral
digitsandinnervatesflexordigitorumaccesorius,abductordigiti
minimi,flexordigitiminimibrevis,adductorhallucis,allintcrosseiand
2nd,3rd,4thlumbricals.

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20.Allaretrueaboutshortsaphenousvein
except?
a)Runsbehindlateralmalleolus
b)Runsonlateralsideofleg
c)Accompaniedbysuralnerve
d)Achillistendonismedialtovein
CorrectAnswer-B
Shortsaphanousveinrunsintheback(posteriorly)ofleg(not
laterally).
Itentersthebackoflegbypassingbehindthelateralmalleolusand
isaccompaniedbysuralnerve.
Inlegitascendslateraltotendocalcaneous(tendoachillis).Thus
tendoachillisismedialtovein.

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21.Nottrueaboutinferiorextensor
retinaculum?
a)Yshaped
b)Superiorslipattachedtolowerendoffibula
c)Inferiorslipattachedtodeepfasciaofsole
d)Lateralattachedtocalcaneum
CorrectAnswer-B
Ans.is'b'i.e.,Superiorslipattachedtothelowerendofthefibula
Inferiorextensorretinaculum
ItisaY-shapedbandlyinginfrontoftheanklejoint.
Attachments:-
Thestemoftheinferiorextensorretinaculumisattachedtothe
uppersurfaceofthecalcaneusinfrontofsulcuscalcanei.Passing
medially,thestemdividesintotwobands.Theupperbandpasses
upwardsandmediallytobeattachedtotibialmalleolus.Thelower
bandextendsdownwardsandmediallytoblendwithplantar
aponeurosis.
Structurespassingdeeptoitare:
1)Tibialisanteriortendon.
2)Extensorhallucislongustendon.
3)Dorsalispedisvessels.
4)Thedeepperonealnerve.
5)Extensordigitorumlongustendons.
6)PeroneusTertiustendon.

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22.Trueaboutpopliteusareallexcept?
a)Flexorofknee
b)Intracapsularorigin
c)Suppliedbytibialnerve
d)Causeslockingofknee
CorrectAnswer-D
Popliteus
Popliteusisadeepmuscleofposteriorcompartmentofleg.
Featuresofpopletiusare-
Origin
Lateralsurfaceoflateralcondyleoffemur,originisintracapsular.
Outermarginoflateralmeniscusofknee.
Insertion
Posteriorsurfaceofshaftoftibiaabovesolealline.
Nervesupply
Tibialnerve
Action
Ulockskneejointbylateralrotationoffemurontibiapriorflexion.
Accessoryflexorofknee.

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23.Trueregardingsemitendinosus?
a)Suppliedbycommonperonealpartofsciaticnerve
b)Proximalflashydistalthin
c)Distalflashyproximalthin
d)Proximalanddistalthinmiddlefleshy
CorrectAnswer-D
Semitendinosusisafusiform(spinadleshaped)muscleswithmain
massinmiddleofit.Itarisesinthintendonfromischialtuberosity
andendsinalongtendontoinsertonmedialsurfaceofproximal
partoftibia.oItissuppliedbytibialpartofsciaticnerve.

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24.Whichofthefollowingdorsiflexesthefoot
-
a)Tibialisposterior
b)Tibialisanterior
c)Peroneusbrevis
d)Extensordigitorumbrevis
CorrectAnswer-B
Tibialisanterior

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25.Arterypiercingtheobliquepopliteal
ligamentofknee-
a)Superiorgenicular
b)Inferiorgenicular
c)Middlegenicular
d)Popliteal
CorrectAnswer-C
Middlegenicular
Obliquepoplitealligamentisanexpansionfromthetendonof
semimembranosusattachmenttointercondylarlineoffemur.
Itiscloselyrelatedtopoplitealarteryandispiercedbymiddle
genicularvesselsandnerveandtheterminalpartoftheposterior
divisionoftheobturatornerve.

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26.Lateraldislocationofpatellaisprevented
by?
a)Rectusfemoris
b)Vastusintermedius
c)Vastuslateralis
d)Vastusmedialis
CorrectAnswer-D
Vastusmedialis

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27.Hunter'scanalisseenin?
a)Cubitalfossa
b)Poplitealfossa
c)Thigh
d)Calf
CorrectAnswer-C
Ans.is'c'i.e.,Thigh

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28.Trueaboutiliotibialtractallexcept?
a)Receivesinsertionofgluteusmaximus
b)Derivedfromfascialata
c)Insertedonlateraltibialcondyle
d)None
CorrectAnswer-D
IliotibialTract
Thefascialataisthickenedlaterallywhereitformsa5cmwide
bandcalledtheiliotibialtract.
Superiorlythetractsplitsintotwolaters.
Thesuperficiallaminaisattachedtotubercleofiliaccrest,anddeep
laminatothecapsuleofhipjoint.
Inferiorly,thetractisattachedtoasmoothareaonanteriorsurface
ofthelateralcondyleoftibia.
Theimportanceoftheiliotibialtractisasfollows.
a)Twoimportantmusclesareinsertedintoitsupperpart,between
thesuperficialanddeeplaminae.Thesearethethree-fourthspartof
thegluteusmaximus;andthetensorfasciaelatae.
b)Theiliotibialtractstabilizesthekneebothinextensionandin
partialflexion;andis,therefore,usedconstantlyduringwalkingand
running.

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29.Ligamentsupportingthetalusis?
a)Springligament
b)Deltoidligament
c)LCL
d)Cervicalligament
CorrectAnswer-A
Ans.A)Springligament
Springligament(Plantarcalcaneonavicularligament)connects
thecalcaneumwiththenavicularbone.
However,itsprincipaljobistoprovideaslingforthetalus,
tosupporttheheadoftalus(thoughithasnoattachmenttotalus).
Thisaidsinsupportingtheweightofthebody.
Weaknesorlengtheningalongthisligamentcancauseflatfoot

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30.Falseabouttibia-fibulais?
a)Nutrientarteryoftibiaisfromposteriortibialartery
b)Nutrientarteryoffibulaisfromperonealartery
c)Proximalendoftibiaisrelatedtocommonperonealnerve
d)Tibiaisthemostcommonsiteofosteomyelitis
CorrectAnswer-C
Commonperonealnerveisrelatedtoneckoffibula(nottibia).
Nutrientarteryoftibiaisabranchofposteriortibialartery.
Nutrientarteryoffibulaisabranchofperonealartery.
Tibiaisthecommonestsiteofosteomyelitis.

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31.Allarebranchesoflumbarplexusexcept?
a)Iliohypogastricnerve
b)Ilioinguinalnerve
c)Obturatornerve
d)Subcostalnerve
CorrectAnswer-D
Ans.is'd'i.e.,Subcostalnerve

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32.Articularsurfaceofthesarumextends
uptohowmanyvertebraeinmales?
a)1to11/2
b)2to21/2
c)3to31/2
d)4to41/2
CorrectAnswer-C
Articularsurfaceofsacrum:therougharticularsurfaceonthelateral
aspectsofthesacrumthatarticulateswiththeiliumoneachside.

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33.Lowerlimitofsacroiliacjointliesupto
whichlevelinfemales?
a)1to11/2
b)2to21/2
c)3to31/2
d)4to41/2
CorrectAnswer-B
,2to21/2

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34.Firstribisnotrelatedto?
a)Sympatheticchain
b)Scalenusanterior
c)Suprapleuralmembrane
d)T2Nerve
CorrectAnswer-D
Ans.is`d'i.e.,T2Nerve
Anteriorly,theneckofthefirstribisrelatedto(frommedialto
lateral):-(1)Sympatheticchain,(ii)Istposteriorintercostalvein,
(iii)Supeiorintercostalartery,and(iv)1stthoracicnerve.These
structuresarebetweenneckoffirstrib(posteriorly)andapexof
lung(anteriorly).
Followingareattachedtofirstrib:-Scalenusanterior,scalenus
medius,subclavius,serratusanterior(lstdigitation),costo-clavicular
ligamentandsuprapleuralmembrane.

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35.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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36.Trueaboutrightprincipalbronchus?
a)Narrower
b)Horizontal
c)Shorter
d)Allaretrue
CorrectAnswer-C
Featuresofrightbronchus(incomparisontoleftbronchus)
1)Shorter
2)Wider
3)Vertical(inthelineoftrachea).

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37.Thoracicductisformedby?
a)Unionofleftsubclavianandleftinternaljugularvein.
b)Unionofbrachiocephalicveinandinternaljugularvein
c)Continuationofupperendofcisternachyli
d)Noneoftheabove
CorrectAnswer-C
ThoracicductisalsocalledasPecquetduct.
Itisthelargestlymphaticductinbody,about45cm(18inches)long.
Ithasabeadedappearancebecauseofthepresenceofmany
valvesinitslumen.
Thoracicductbeginsasacontinuationoftheupperendofthe
cisternachylinearthelowerborderofT12vertebraandentersthe
thoraxthroughtheaorticopeningofdiaphragm(atT12).
ItthenascendsthroughtheposteriormediastinumandatT5level
crossesfromrightsidetotheleftsideandascendsalongleftmargin
ofoesophagustoentertheneck.
AtthelevelofC7vertebrae,archestowardsleftsidetoopenintoleft
brachiocephalicveinattheangleofunionofleftsubclavianandleft
internaljugularveins.

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38.Thoracicductopensinto?
a)Subclavianvein
b)Internaljugularvein
c)Rightbrachiocephalicvein
d)Leftbrachiocephalicvein
CorrectAnswer-D
Leftbrachiocephalicvein

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39.Posteriorrelationofhilumoflung?
a)Azygousvein
b)SVC
c)Vagusnerve
d)Archofaorta
CorrectAnswer-C
Vagusnerve

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40.Notrelatedtohilumofrightlung?
a)Azygousvein
b)Vagusnerve
c)SVC
d)Archofaorta
CorrectAnswer-D
Archofaortaisrelatedtoleftlung.

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41.Xiphoidfuseswithsternumbywhatage?
a)30years
b)35years
c)40years
d)45years
CorrectAnswer-C
Ans.is'c'i.e.,40years[RefParikh6thlep.2.30,2.31]
Sternum
Piecesofbodyunitebetween14-25years.
Xiphoiduniteswithbodyat40years.
Manubriumuniteswithbodyat60years.
Otherbones
Hyoid:greatercornuuniteswithbodyat40-60years.
Laryngealandcostalcartilagesossifyafter40years.
Vertebra:Osteophytesoutgrowth,lippingofvertebraanddisc
atrophyoccur.

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42.Bronchopulmonarysegmentsinrightand
leftlungsrespectively?
a)9,11
b)11,9
c)10,10
d)8,10
CorrectAnswer-C
Eachlunghas10bronchopulmonarysegments.

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43.AtthelevelofArchofaorta,the
relationshipofleftvagusnerveandleft
phrenicnerve?
a)Phrenicnerveanterior,vagusnerveposterior
b)Phrenicnerveposterior,vagusnerveanterior
c)Bothinsameplaneanteroposteriorly
d)Variableinrelationship
CorrectAnswer-A
Phrenicnerveanterior,vagusnerveposterior

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44.Posteriortotransversepericardialsinus?
a)Aorta
b)Pulmonarytrunk
c)SVC
d)Leftatrium
CorrectAnswer-C
Ans.is'c'i.e.,SVC
Transversesinusisashortpassagethatliesbetweenthereflection
ofserouspericardium(epicardium)aroundarterial(aortaand
pulmonarytrunk)andvenousendsofthehearttube.
Transversesinusisboundedanteriorlybyascendingaortaand
pulmonarytrunk,posteriorlybySVC,andinferiorlybyleftatrium.

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45.Trueaboutcremastericreflex?
a)Afferent:genitalbranchofgenitofemoralnerve
b)Efferent:genitalbranchofgenitofermoralnerve
c)Efferent:femoralbranchofgenitofemoralnerve
d)Afferent:pudendalnerve
CorrectAnswer-B
Ans.is'b'i.e.,Efferent:genitalbranchofgenitofemoralnerve

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46.Urethralcrestisanelevationseenin
urethradueto:
a)Prostaticglands
b)Insertionofdetrusormuscle
c)Insertionoftrigone
d)Preprostaticinternalsphincter
CorrectAnswer-A
Answer-A(Prostaticglands)
Theurethralcrestisananatomicalfeaturepresentintheurinary
systemofbothmalesandfemales.
Theprostaticportion(parsprostatica),thewidestandmostdilatable
partofthecanal,isabout3cmlong.
Upontheposteriorwallorfloorisanarrowlongitudinalridge,the
urethralcrest,formedbyanelevationofthemucousmembraneand
itssubjacenttissue.
Oneithersideofthecrestisaslightlydepressedfossa,theprostatic
sinus,thefloorofwhichisperforatedbynumerousapertures,the
orificesoftheprostaticductsfromthelaterallobesoftheprostate;
theductsofthemiddlelobeopenbehindthecrest.

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47.Pyramidalisissuppliedby?
a)Subcostalnerve
b)Ilioinguinalnerve
c)Iliohypogastricnerve
d)Genitofemoralnerve
CorrectAnswer-A
Ans.is'a'i.e.,Subcostalnerve

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48.Appendicesepiploicaeisafeatureof?
a)Duodenum
b)Stomach
c)Colon
d)Jejunum
CorrectAnswer-C
Characteristicfeaturesoflargeintestine
i)3longitudinalbands,formedbylongitudinalmusclecoat,called
Taeniaecoli.
ii)Sacculationorhaustration
iii)Fatfilledperitonealpouchescalledappendicesepiploicae.These
arenotfoundinappendix,caecum,andrectum.
iv)Greaterpartisfixedexceptforappendix,transversecolonand
sigmoidcolon.
v)Pyere'spatches(presentinsmallintestine)arenotpresent.

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49.

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Appendicesepiploicaeisseeninallpartof
largeintestineexcept-
a)Sigmoidcolon
b)Ascendingcolon
c)Caecum
d)Transversecolon
CorrectAnswer-C
Ans.is'c'i.e.,Caecum
Smallbagsofperitoneumfilledwithfat,calledappendices
epiploicaearepresentoverthesurfaceoflargeintestine,exceptfor
appendix,caecumandrectum.

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50.Inferiorrectalarteryisabranchof?
a)Inferiormesentericartery
b)Superiormesentericartery
c)Coeliactrunk
d)Internalpudendalartery
CorrectAnswer-D
Ans.is'd'i.e.,Internalpudendalartery

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51.Cremastericarteryisabranchof?
a)Internalpudendalartery
b)Externalpudendalartery
c)Inferiorepigastricartery
d)Superiorepigastricartery
CorrectAnswer-C
Inferiorepigastricartery

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52.Superficialepigastricarteryisabranch
of?
a)Internalpudendalartery
b)Externalpudendalartery
c)Internaliliacartery
d)Femoralartery
CorrectAnswer-D
Ans.is'd'i.e.,Femoralartery
Branchesoffemoralartery
1)Superficial:-Superficialexternalpudendal,superficial
epigastric,superficialcircumflexiliac.
2)Deepbranches:-Profundafemoris,deepexternalpudendal,
muscularbranches,descendinggenicularbranch(lastbranchinthe
adductorcanal).
Note:Superiorepigastricarteryisabranchofinternalthoracic
artery.

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53.Inferiorepigastricveindrainsinto?
a)Femoralvein
b)Externaliliacvein
c)Internaliliacvein
d)Internalpudendalvein
CorrectAnswer-B
Ans.is'b'i.e.,Externaliliacvein
InferiorepigastricveindrainsintoExternaliliacvein.
SuperiorepigasticveindrainsintoInternalthoracicvein.

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54.Superiorrectalveindrainsinto?
a)Inferiormesentericvein
b)Externaliliacvein
c)Internaliliacvein
d)Internalpudendalvein
CorrectAnswer-A
Ans.is'a'i.e.,Inferiormesentericvein
Superiorrectalveindrainsintoinferiormesentericvein.
Inferiorrectalveindrainsintointernalpudendalvein.

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55.Mostcommonlocationofaccessory
spleen?
a)Hilumofspleen
b)Greateromentum
c)Lesseromentum
d)None
CorrectAnswer-A
Accessoryspleenmaybefoundat:-
i)Hilumofspleen(mostcommonsite).
ii)Tailofpancrease.
iii)Derivativesofdorsalmesogastrium:-Greateromentum,
gastrophrenicligament,gastrosplenicligament,linorenalligament.
iv)Broadligamentofuterus(inmales)andspermaticcord(in
female);bothleftside.

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56.LengthofPosteriorvaginalwallis
a)Variable
b)Sameasanteriorvaginalwall
c)Lessthananteriorvaginalwall
d)Morethananteriorvaginalwall
CorrectAnswer-D
Ans.is'd'i.e.,Morethananteriorvaginalwall
Vagina
Thevaginaisafibromuscular,canalformingthefemalecopulatory
organ.
Itextendsfromvulvatouterus.
Mucousmembraneislinedbynonkeratinizedstratifiedsquamous
epithelium.
Theanteriorwallisabout8cmlongandtheposteriorwallisabout
10cmlong.
Thelumeniscircularattheupperendbecauseoftheprotrusionof
thecervixintoit.
Belowthecervix,anteriorandposteriorwallsareincontact.
Theinterioroftheupperendofthevagina(orvaginalvault)isinthe
formofacirculargroovethatsurroundstheprotrudngcervix.
Thegroovebecomesprogressivelydeeperformbeforebackwards
andisarbitrarilydividedintofourpartscalledthevaginalfornices:
Anteriorfornixliesinfrontofthecervixandisshallowest.
Posteriorfornixliesbehindthecervixandisdeepest.
Twolateralforniceslieoneoneachsideofthecervix.Lateralfornix
isrelatedtothetransversecervicalligamentofpelvicfasciainwhich
areembeddedanetworkofvaginalveinandtheuretergetscrossed
bytheuterineartery.

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Relationsofvagina
Anteriorwall
Upperhalfisrelatedtothebaseofthebladder.
Lowerhalftotheurethra.
Posteriorwall
Upperone-fourthisseparatedfromtherectumbytherectouterine
pouch.
Middletwo-fourthsareseparatedfromtherectumbyloose
connectivetissue.
Lowerone-fourthsisseparatedfromtheanalcanalbytheperineal
bodyandthemusclesattachedtoit.
Lateralwalls
Oneeachside:
Upperone-thirdisrelatedtothetransversecervicalligamentof
pelvicfasciainwhichareembeddedanetworkofvaginalveins,and
theuretergetscrossedbytheuterineartery.
Middleone-thirdisrelatedthepubococcygeuspartofthelevatorani.
Lowerone-thirdpiercestheperinealmembrane,belowwhichitis
relatedtothebulbofthevestibule,thebulbospongiosusandthe
ductofgreatervestibularglandofbartholin.
Arterialsupply
Vaginalbranchofinternaliliac(mainsupply)
Cervicovaginalbranchofuterineartery(inupperpart).
Middlerectalandinternalpudendalarteries(inlowerpart).

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57.Bareareaofliverisrelatedto-
a)Aorta
b)Hepaticvein
c)Portalvein
d)Gallbladder
CorrectAnswer-B
Hepaticvein
Betweentwolayersofcoronaryligaments,thereisalargetriangular
areaindiaphragmaticsurfaceofliverwhichisnotcoveredby
peritoneum.
Itiscalled'bareareaofliver'.
Itisrelatedtoinferiorvenacava(IVC).
Thehepaticveins(usuallythree)leavetheliverinbarearea.
Thisareaisclinicallyimportantasitisasitewhereinfectioncan
spreadfromabdominalcavitytothoraciccavity.

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58.Trueaboutcircumcavalureter?
a)Developmentalanomalyofureter
b)UreterpassesinfrontofIVCfromlateraltomedial
c)Mostlyinvolvesrightureter
d)Type2ismorecommon
CorrectAnswer-C
Circumcaval(retrocaval)ureterresultsfromalteredvasculature
ratherthanureteraldevelopment.Thus,preureteralvena-cavais
moreappropriateterm.
ThisdisorderinvolvesrightureterwhichpassesbehindIVCwinding
aboutandcrossesinfrontofitfrommedialtolateraldirection.
Theanomalyisdividedintotwotypes:?
1)Type1:Itismorecommonandhashydronephrosiswitha
typicallyobstructingpatterndemonstratingsomedegreeoffish-hook
shapeddeformityofureter.
2)Type2:Ithaslesserdegreeofhydronephrosisornotatall.

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59.Whichofthefollowingisaretroperitoneal
structure?
a)Ileum
b)Jejunum
c)Ureter
d)Appendix
CorrectAnswer-C
Ureter

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60.Falciparumligamentcontains?
a)Ligamentumvenosus
b)Ligamentumteres
c)Linorenalligament
d)Noneoftheabove
CorrectAnswer-B
Peritonealligaments
1. Gastrosplenicligament:-Itextendsfromhilumofspleentogreater
curvatureofstomach.Itcontainsshortgastricandleftgastroepiploic
vessels.
2. Linorenalligament:-Itextendsfromhilumofspleentoanterior
surfaceofleftkidney.Itcontainssplenicvesselsandtailof
pancreas.Itdevelopsfromdorsalmesogastrium.
3. Gastrophrenicligament:-Itconnectsthegreatercurvatureof
stomachtodiaphragm.Itdevelopsfromdorsalmesogastrium.
4. Phrenicocolicligament:-Itconnectsleftcolic(splenic)flexureto
diaphragm.Itsupportstheanteriorborderofspleen.
5. Falciformligament:-Itdemarcatestherightandleftlobesofliver.It
containsligamentumteres(remnantofleftumblicalvein)and
paraumblicalvein.Itdevelopsofventralmesogastrium(ventralpart).
6. Coronaryligaments:-Itcontainssuperiorandinferiorlayerswhich
connectlivertodiaphragm,andenclosesthetriangular'bareareaof
liver'.
7. Triangularligaments(arightandaleft):-Theseconnectrightand
leftlobesoflivertodiaphragm.Itdevelopsfromventral
mesogastrium.

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61.

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Partofcolonwithnomesentery?
a)Transversecolon
b)Sigmoidcolon
c)Ascendingcolon
d)Rectum
CorrectAnswer-C
Mesenteriesinintestine
1)Mesenteryproper:-Mesenteryofsmallintestine(jejunumand
ileum)isfanshapeddoublelayeredperitonealfoldwhichsuspends
thecoilsofjejunumandileum.Mesenteryhas:?
i)Attachedborder(rootofmesentery):-Itis15cmlongand
extendsfromduodenojejunalflexure(onleftsideofL2)toupperpart
ofrightsacroiliacjoint.
Rootofmesenterycrossesfollowingstructures:-
(i)3rdpart(horizontalpart)ofduodenum,
(ii)abdominalaorta,
(iii)IVC,
(iv)rightureter,and
(v)rightpsoasmajor.
ii)Freeborder(intestinalborder):-Itis6meterslongandis
attachedtogutformingitsvisceralperitoneum(serouscoat).
2)Transversemesocolon:-Itconnectstransversecolontoposterior
abdominalwallandcontainsmiddlecolicvessels.
3)Mesoappendix:-Itconnectstheappendixtotheilealmesentery
andcontainsappendicularvessels.
4)Sigmoidmesocolon:-Itconnectssigmoidcolontoposteriorpelvic
wallandcontainssigmoidvessels.
5)Mesorectum:Itcontainssuperiorrectalvessels(artery&veins)
withtheirbranches,lymphaticvesselsandlymphnodesalong

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withtheirbranches,lymphaticvesselsandlymphnodesalong
superiorrectalartery,andbranchesfrominferiormesentericplexus.

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62.Falseregardingtrigoneofbladder?
a)Linedbytransitionalepithelium
b)Mucosasmoothandfirmlyadherent.
c)Internalurethralorificeliesatlateralangleofbase
d)Developedfrommesonephricduct
CorrectAnswer-C
Trigoneofbladderhasfollowingfeatures:
1)Linedbytransitionalepithelium
2)Mucosaissmoothandfirmlyadherent
3)Uretersopenatlateralanglesofbaseandinternalurethral
orificeliesatapex.
4)HasTrigonalmuscleofbell(smoothmusclelayerjust
beneathmucosa).
5)Derivedfromabsorbedpartofmesonephricduct(Wolffian
duct).

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63.Trigoneofurinarybladderdevelopsfrom:
a)Mesoderm
b)Ectoderm
c)Endodermofurachus
d)Noneoftheabove
CorrectAnswer-A
Withdifferentialgrowthofthedorsalbladderwall,theureterscome
toopenthroughthelateralanglesofthebladder,andthe
mesonephricductsopenclosetogetherinwhatwillbetheurethra.
Thatpartofthedorsalbladderwallmarkedoffbytheopeningsof
thesefourductsformsthetrigoneofthebladder.
Thus,liningofthebladderoverthetrigoneismesodermalinorigin;
Thesmoothmuscleofthebladderwallisderivedfromthe
splanchnopleuricmesoderm.
Theapexofthebladderiscontinuouswiththeallantois,whichnow
becomesobliteratedandformsafibrouscore,theurachus.
Theurachuspersiststhroughoutlifeasaligamentthatrunsfromthe
apexofthebladdertotheumbilicusandiscalledthemedian
umbilicalligament
oLininingepitheliumofbladdermucosaistransitionalepithelium.
Whenemptymucosaisthrownintorugaeexceptintrigone,where
mucosaissmoothandfirmlyadherent.
ojustbeneaththemucosaoftrigonethereislayerofsmooth
muscle,TrtgonalmuscleofBellwhichreplacesthesubmucouscoat
intrigonearea

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64.Watershedzoneoflargeintestine?
a)Cecum
b)Ascendingcolon
c)Rectosigmoid
d)Transversecolon
CorrectAnswer-C
Thereareareasofcolonwithpoorbloodsupplyresultingfrom
incompleteanastomosisofmarginalarteries.Thesearewatershed
areasofcolonandinclude:
1. Splenicflexure(Griffithpoint):Watershedareabetweensuperior
mesentericarteryandinferiormesentericartery.
2. Rectosigmoidjunction(Sudeck'spoint):Watershedzonebetween
inferiormesentericarteryandinternaliliacartery.

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65.Ligamentextendingfromcervixand
vaginatolateralpelvicwall?
a)Broadligament
b)Pubocervicalligament
c)Roundligament
d)Transversecervicalligament
CorrectAnswer-D
TransversecervicalligamentsofMackenrodtarefan-shaped
condensationofendopelvicfasciaoneachsideofcervixabovethe
levatoraniandarounduterinevessels.
Theyconnectlateralaspectofcervixanduppervaginalwallto
lateralpelvicwall.
Theyforma'hammock'thatsupportstheuterus.

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66.TrueaboutScarpa'sfascia?
a)Deepfasciaofanteriorabdominalwall
b)AlsocalledBuck'sfascia
c)AttachedtoIliotibialtract
d)Formssuspensoryligamentofpenis
CorrectAnswer-D
Fasciaofanteriorabdominalwall
A)Superficialfascia
Thesuperficialfasciaofanteriorabdominalwall(belowthelevelof
umblicus)isdividedinto:Superficialfattylayer(fasciaofcamperor
camper'sfascia),anddeepmembraneuslayer(fasciaofscarpaor
scarpa'sfascia).
Thefattylayer(fasciaofcamper)iscontinuouswiththesuperficial
fasciaofadjoiningpartofthebody.
However,inthepenisitisdevoidoffatandinscrotumitisreplaced
bydartosmuscle,i.e.,inscrotumdartosmuscleispresentinsteadof
fattylayerofsuperficialfascia.
B)Deepfascia
Itispresentintheformofathinlayercoveringthemusclesandtheir
aponeurosesandlargeneurovascularstructures.Atsuperficial
inguinalringitcontinuesoverthespermaticcordasexternal
spermaticfasciaintoscrotumandcontinueoverthepenisasdeep
fasciaofpenis(Buck'sfascia).

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67.WhereistheCaveofRetziuspresent?
a)Betweenurinarybladderandrectum
b)Betweenurinarybladderandcervix
c)Infrontofthebladder
d)Betweenthecervixandtherectum
CorrectAnswer-C
SpaceofRetziusisahorse-shoeshapedpotentialspacewhich
intervenesbetweentheantero-lateralpelvicwallandthesidesofthe
bladderandprostate.

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68.Nerveenteringtheinguinalcanalthrough
deepinguinalring?
a)Ilioinguinalnerve
b)Pudendalnerve
c)Genitalbranchofgenitofemoral
d)Superiorrectalnerve
CorrectAnswer-C
Thespermaticcordinmalesandroundligamentofuterusin
females,entertheinguinalcanalthroughthedeepinguinalringand
passoutthroughsuperficialinguinalring.
Thusconsituentsofspermaticcordarealsocomponentsofinguinal
canal;theseareductusdeferens(vasdeferens),testicularartery,
cremestricartery,arterytoductusdeference,pampiniformplexus,
lymphatics,sympatheticplexus,genitalbranchofgenitofemoral
nerve,remainsofprocessvaginalis.
Note:Ilioiguinalnerveentersinguinalcanalthroughinterval
betweenexternalandinternalobliquemuscles(notthroughdeep
inguinalring).

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69.Initially,renalarteriesarebranchesof?
a)Internalpudendalartery
b)Externaliliacartery
c)Commoniliacartery
d)Aorta
CorrectAnswer-C
Duetoascentofkidneysduringdevelopment,thebloodsupply
ofkidneychanges:?
1)Initiallywhenthekidneysareinpelvis,therenalarteriesare
branchesofcommoniliacarteries.
2)Withprogressiveascent,thearteriestokidneysarederived
fromdifferentlevelsofaorta.

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70.Inaneonate,kidneyissuppliedby?
a)Internalpudendalartery
b)Externaliliacartery
c)Commoniliacartery
d)Aorta
CorrectAnswer-D
Upto5thweekofintrauterinelife,kidneyisinlumbarregionandrenal
arteriesarebranchesofcommoniliacartery(seeabove
explanation).
Afterthat,differentialgrowthofabdominalwallcausesthekidneyto
ascenttolumbarregion.Adultposition(lumbarregionofabdomen)
isattainedby9thweek.Druingprogressiveascent,thearteriesto
kidneyarederivedfromdifferentlevelsofaorta.
Afterfullascent,definitiverenalarteryisbranchofaortaat2nd
lumbarsegment.
Thus,neonatalkidneyissuppliedbyaorta.

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71.Externalobliqueformsallexcept?
a)Lacunarligament
b)Pectinealligament
c)Conjointtendon
d)Inguinalligament
CorrectAnswer-C
Inguinalligament(Poupart'sligament)isthefoldedlowerborderof
externalobliqueaponeurosis
Lacunarligament(Gimbernatsligament)isthecrescentshaped
expansionfromthemedialendofinguinalligamentattachedto
pectineallineofpubis.
Pectinealligament(Cooper'sligament)isstrongfibrousband
extendinglaterallyfromthelacunarligamentalongpectineallineof
pubis.Similartolacunarligament,itismadeofexternaloblique
aponeurosis.
Reflectedpartofinguinalligamentextendsfromthelateralcrusof
superficialinguinalringformedbyinguinalligamentupwardstolinea
alba.Itformstheposteriorwallofinguinalcanal.
Conjointtendon(falxinguinalis)isformedbytheaponeurosesof
internalobliqueandtransversusabdominismuscleandisattached
topubiccrest.

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72.Meckel'scaveisrelatedto?
a)Submandibularganglion
b)Trigeminalganglion
c)Oticganglion
d)Pterygopalatineganglion
CorrectAnswer-B
Ans.is'b'i.e.,Trigeminalganglion
Trigeminalganglion(Gasserionganglionorsemilunarganglion)lies
inaduralpouch,thecavumtrigeminale(Meckel'scave).

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73.Longestspinousprocessisseenin?
a)C2
b)C4
c)C5
d)C7
CorrectAnswer-D
Ans.is'd'i.e.,C7
CervicalVertebrae
Thereare7cervicalvertebraeofwhich3-6aretypicaland1st,2nd
and7thareatypical.Characteristicfeaturesoftypicalcervical
vertebraare:-
i. Foramentransversariumispresentinthetransverseprocess.
ForaminatransversariaofCltoC6vertebraetransmitvertebral
artery,vertebralveinandsympatheticplexus,andthatofC7
transmitsonlyvertebralveins.
ii. Bodyissmallandbroadtransversely(sidetoside).
iii. Spinousprocessissmallandbifid.
iv. Vertebralforamenislargeandtriangular.
v. Superiorarticularfacetisdirectedbackwardsandupwards,and
inferiorfacetisdirecteddownwardsandforwards.Articularprocess
areplacedhorizontally,Sothatdislocationcanoccurwithout
fracture.
vi. TheanteriortubercleontransverseprocessofC6vertebrais
prominentandiscalledcarotidtubercleorchaissagnac'stubercle.It
isrelatedtocommoncarotidarterywhichcanbepalpatedagainstit.
Erb'spointisoppositechassaignac'stubercle.Cricoidcartilageisat
samelevel(C6vertebra).

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Importantfeaturesofatypicalvertebraeare:?
1. Firstcervicalvertebra(atlas)isringlikebonehavinglateralmasson
eachsideconnectedbyasmalleranteriorarchandalarger
posteriorarch.Anteriorarchhasafacetfordensofaxis.Each
lateralmasshasanupperarticularfacetforoccipitalcondyleand
lowerfacetforbodyofC2(axis)vertebra.Clvertebradoesnothave
bodyandspinousprocess.
2. Secondcervicalvertebra(axis)ischaracterizedbypresenceof
odontoidprocessordens,apeg-likeprojectionfromthebody.
3. Seventhcervicalvertebraiscalledasvertebraprominensbecauseit
hasmostpromenentspinousprocesswhichisnotbifid.Foramen
transversariumtransmitsonlyvertebralvein,notvertebralartery.

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74.Sweatglandnearthelidmargins
a)Moll
b)Zeis
c)Meibomian
d)Krause
CorrectAnswer-A
Ans.is'a'i.e.,Moll
GlandsofMoll(Moll'sgland)areapocrinesweatglandsjustnextto
theeyelashes.
Zeisglandsaresebaceousglandsnearlidmargins.
Meibomiangland(tarsalglands)arespecializedsebaceousglandat
therimofeyelidsinsidethetarsalplate.
Krause'sglandsareaccessorylacrimalglandsunderneaththe
eyelid.

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75.Anteriorlymphaticsfromthenosedrain
into?
a)Pretrachealnodes
b)Submandibularnodes
c)Sublingualnodes
d)Superficialcervicalnodes
CorrectAnswer-B
Ans.is'b'i.e.,Submandibularnodes
Submandibularnodes
Thesenodesliedeeptoinvestinglayerofdeepcervicalfasciain
submandibulartriangle,betweenthedeepfasciaandsubmandibular
gland.
Thesenodesreceiveafferentsfromcentreofforehead;anteriorpart
ofnasalcavity;frontal,maxillaryandethmoidalairsinuses;inner
canthus(medialangleofeye);wholeofupperlipandanteriorpartof
cheekwithunderlyinggumandteeth;outerpartoflowerlipwith
lowergumsandteethexcludingincisors;anteriortwothirdoftongue
excludingthetip;floorofmouth;andangleofmouth.
Thesenodesalsoreceivesefferentsofsubmentalnodes.
Submandibularnodesdraininto(efferent)upperandlowerdeep
cervicalnodes.

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76.Killian'sdehisenceisseenin?
a)Oropharynx
b)Nasopharynx
c)Cricopharynx
d)Vocalcords
CorrectAnswer-C
Ans.is'c'i.e.,Cricopharynx
Inferiorconstrictormusclehastwoparts:-
(i)Thyropharyngeouswithobliquefibres,and(ii)Cricopharyngeous
withtransversefibres.
Betweenthesetwopartsofinferiorconstrictorexistsapotentialgap
calledKillan'sdehiscence.Itisalsocalledthegatewaytotearas
perforationcanoccuratthissiteduringesophagoscopy.Itisalsothe
siteforherniationofpharyngealmucosaincaseofpharyngeal
pouch.

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77.Fossaincudisisrelatedto?
a)Headofmalleus
b)Longprocessofincus
c)Shortprocessofincus
d)Footprocessofstapes
CorrectAnswer-C
FossaincudiscontainsshortprocessofIncus.
Headofmalleusisattachedtoepitympanumbyligamentofheadof
malleus.
Longprocessofincusisattachedtoheadofstapes.
Footplateofstapesliesoverovalwindow.

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78.Unpairedlaryngealcartilage?
a)Arytenoid
b)Corniculate
c)Cuneiform
d)Epiglottis
CorrectAnswer-D
TheskeletalsupportsoflarynxisprovidedbySixcartilages,3outof
whicharepaired(sotherearetotal9cartilages).
i)Unpaired:-Thyroid,cricoid,epiglottis.
ii)Paired:-Arytenoid,Corniculate,cuneiform.

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79.Whichistheonlynervewhichexitsthe
brainstemondorsalside?
a)Facial
b)Trigeminal
c)Trochlear
d)Abducent
CorrectAnswer-C
Uniquefeaturesoftrochlearnerveare:?
i)Mostselendercranialnerve.
ii)Onlycranialnervetoemergeonthedorsalaspectofbrain.
iii)Onlycranialnervetoundergocompleteinternaldecussation
beforeemergingi.e.righttrochlearnervearisesfromlefttrochlear
nucleusandviceversa.
iv)Has'longestintracranialcourse(Vagusnervehasoveralllongest
course).
v)Thinnestcranialnerve(smallestnerveintermsofthenumberof
axonsitcontains).

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80.Bloodsupplyofputamenincludesall
except?
a)Medialstriatearteries
b)Lateralstriatearteries
c)Anteriorchoroidalartery
d)Posteriorcommunicatingartery
CorrectAnswer-D
Bloodsupplyofbasalganglia
Caudatenucleusandputamenaresuppliedbylateralandmedial
striatebranchesofanterior,medialandposteriorcerebralarteries.
Putamenreceivesadditionalsupplyfromanteriorchoroidalartery.o
Globuspallidusissuppliedbylateralstriateandanteriorchoroidal
arteries.

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81.Medullaissuppliedbyallexcept?
a)Basilarartery
b)Anteriorspinalartery
c)Vertebralartery
d)Posteriorcerebralartery
CorrectAnswer-D
Posteriorcerebralartery

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82.LengthofEustachiantube?
a)12mm
b)24mm
c)36mm
d)48mm
CorrectAnswer-C
LengthofEustachiantubeis36mm.(reachedbytheageof7years)
Lateralthird(i.e.12mm)isbony.
Medial2/3(i.e.24mm)isfibrocartilaginous.

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83.Parasympatheticsupplytolacrimal
glandsarepassedthrough?
a)Lesserpetorsalnerve
b)Chordatympani
c)Greaterpetorsalnerve
d)Lingualnerve
CorrectAnswer-C
Greaterpetorsalnerve

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84.Onodicellsareseenin?
a)Sphenoidsinus
b)Maxillarysinus
c)Anteriorethmoidalsinus
d)Posteriorethmoidalsinus
CorrectAnswer-D
Ethmoidalsinusesaredividedintotwogroups:
A)Anteriorgroup
i)Anteriorethmoidalaircells
Anteriorethmoidalaircellsdraininto-eithertheethmoidal
infundibulumorthefrontonasalduct.Someaircellsmayinvadethe
orbitalfloor.TheseareknownastheHaller'cells.
ii)Middleethmoidalaircells
Alsoknownasbullarsinuses.Themiddleethmoidalaircellsdrain-
intothemiddlemeatusbyoneormoreorificesonorabovethe
ethmoidalbulla.
B)Posteriorgroup
Posteriorethmoidalaircellsusuallydrain-intothesuperiormeatus.
Theposteriorgroupliesveryclosetotheopticcanalandoptic
nerve.TheOnodicellisusuallyregardedasthemostposterior
ethmoidcellthatpneumatizeslateralandsuperiortothesphenoid
sinusandisintimatelyassociatedwiththeopticnerve.

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85.Hallercellsareseenin?
a)Roofofnose
b)Orbitalfloor
c)Lateralnasalwall
d)Maxillarysinus
CorrectAnswer-B
TheOnodiandHallercellsareethmoidalaircells.
Someaircellsmayinvadetheorbitalfloor.Theseareknownasthe
Haller'cells.
TheOnodicellisusuallyregardedasthemostposteriorethmoidcell
thatpneumatizeslateralandsuperiortothesphenoidsinusandis
intimatelyassociatedwiththeopticnerve.

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86.Whichvalveispresentatopeningof
nasolacrimalduct?
a)Hasner'svalve
b)Heistervalve
c)Spiralvalve
d)None
CorrectAnswer-A
Nasolacrimalductopensintoinferiormeatusandisclosedbya
mucosalflapcalledHasner'svalve.
Heistervalve(spiralvalve)ispresentincycticduct.

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87.Cribriformplateforms?
a)Roofofolfactoryregion
b)Floorofolfactoryregion
c)Nasalseptum
d)Alloftheabove
CorrectAnswer-A
Internalnose
Internalnosehasfollowingparts
i)Nasalcavityproper:-Internalnoseisdividedintorightandleft
nasalcavitiesbynasalseptum.Eachnasalcavitycommunicates
withtheexteriorthroughnarisornostrilsandwithnasopharynx
throughposteriornasalapertureorposterior?taresorchoana.
ii)Vestibuleofnose:-Anteriorandinferiorpartofthenasalcavityis
linedbyskinandiscalledvestibuleofnose.Itcontainssebaceous
glands,hairfolliclesandthehaircalledvibrissae.
Eachnasalcavityhasalateralwall,amedialwall(nasalseptum),a
roof,andafloor.
Theolfactorymucosalinesupper1/3ofnasalcavityincludingthe
roofformedbycribriformplate,andmedialandlateralwalluptothe
levelofsuperiorconcha.

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88.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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89.Laminapapyraceaisbetween?
a)Opticnerveandorbit
b)Maxillarysinusandorbit
c)Ethmoidsinusandorbit
d)Cranialcavityandorbit
CorrectAnswer-C
Thethinnestportionofmedialwalloforbitisthelaminapapyracea
whichseparatesethmoidsinusesfromorbit.oInfectionfrom
ethmoidalsinuscaneasilybreachthispaperthinboneandaffectthe
orbitalcontents.

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90.Falseaboutsternocleidomastoid?
a)Arisesfromsternumandclavicle
b)Insertesonmastoidprocess
c)Motorsupplybyspinalaccessorynerve
d)Tilttheheadonoppositeside
CorrectAnswer-D
Sternocleidomastoidtsternomastoidl
Origin
1. The,sternalhead
2. Theclavicularhead
Insertion
Itisinserted:
1. Byathicktendonintothelateralsurfaceofmastoidprocess,fromits
tiptosuperiorborder.
2. Byathinapponeurosisintothelateralhalfofthesuperiornuchalline
oftheoccipitalbone.Nervesupply
3. Thespinalaccessorynerveprovidesthemotorsupply.Itpasses
throughthemuscle.
4. BranchesfromtheventralramiofC2areproprioceptive.
Bloodsupply
Arterialsupply-onebrancheachfromsuperiorthyroidarteryand
suprascapulararteryand,twobranchesfromtheoccipitalartery
supplythebigmuscle.
Veinsfollowthearteries.
Actions
1.Whenonemusclecontracts:
a)Itturnsthechintotheoppositeside.
b)Itcanalsotilttheheadtowardstheshoulderofsameside.
2.Whenbothmusclescontracttogether:

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2.Whenbothmusclescontracttogether:
a)Theydrawtheheadforwards,asineatingandinliftingthe
headfromapillow.
b)Withthelonguscolli,theyflextheneckagainstresistance.
c)Italsohelpsinforcedinspiration.

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91.Thekeytotherootoftheneckisthescalenusanteriormuscle.Whichamong
thefollowingisTRUEaboutscalenusanterior?
a)NotPiercedbyphrenicnerve
b)Attachedtoscalenetubercleon2ndrib
c)Separatessubclavianarteryfromsubclavianvein
d)Piercedbyphrenicnerve
CorrectAnswer-A
Ans.(A)Notpiercedbyphrenicnerve
Thesubclavianveinformsanarchacrossthepleuraatalevelbelow
thearchofsubclavianartery.Thetwoarchesareseparatedfrom
eachotherbyscalenusanteriormuscle.
ScalenusanteriorarisesfromtheanteriortuberclesofC3-C6and
attachestothescalenetubercleandadjacentridgeontheinner
borderanduppersurfaceofthefirstrib.
Phrenicnervepassesverticallydownacrosstheobliquityofthe
muscle,plasteredtheretobytheprevertebralfascia.
Transcervicalandsuprascapulararteriesliebetweenthescalenus
anteriorandthecarotidsheath.

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92.Tonguemusclewhichisnotdeveloped
fromoccipitalmyotome?
a)Styloglossus
b)Hyoglossus
c)Genioglossus
d)Palatoglossus
CorrectAnswer-D
DEVELOPMENTOFTHETONGUE:?
I.Epithelium
a)Ant2/3--lingualswellingsof1starchandtuberculumimpar
b)Post1/3--largedorsalpartofhypobranchialeminence,Le.3rd
arch
c)Posteriormostpart--smalldorsalpartofthehypobranchial
eminence,i.e.4tharch
II.Muscles
Fromoccipitalmyotomesexceptpalatoglossuswhichisderivedfrom
the6tharch.

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93.Korner'sseptumisseenin?
a)Petrosquamoussuture
b)Temporosquamoussuture
c)Petromastoidsuture
d)Frontozygomaticsuture
CorrectAnswer-A
Mastoiddevelopsfromsquamousandpetrousbone.
Korner'sseptumispersistenceofpetrosquamoussutureintheform
ofabonyplate.
Korner'sseptumissurgicallyimportantasitmaycausedifficultyin
locatingtheantrumandthedeeper(ells,andthusleadtoincomplete
removalofdiseaseatmastoidectomy.Mastoidantrumcannotbe
reachedunlessthe
Kornersseptumhasbeenremoved.

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94.Whatistrueaboutchordatympani?
a)Postganglionicsympathetic
b)Preganglionicsympathetic
c)Preganglionicparasympathetic
d)Postgalglionicparasympathetic
CorrectAnswer-C
Chordatympaniarisesfromintratemporalpart(infallopioncanal)of
facialnerve.
*Itcarriespreganglionicsecretomotorfibers(notpostganglionic)to
submandibularandsublingualglands.
*Itjoinslingualnerveininfratemporalfossa.
*Itcarriestastesensationsfromanterior2/3oftongue.

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95.Vidiannerveisformedbyunionof?
a)Superficialpetrosalnerveanddeeppetrosalnerve
b)Greaterpetrosalnerveandsuperficialpetrosalnerve
c)Greaterpetrosalnerveanddeeppetrosalnerve
d)Greaterpetrosalnerveandexternalpetrosalnerve
CorrectAnswer-C
Greaterpetorsalnerveunitswithdeeppetrosalnervetoformnerve
topterygoidcanal(alsocalledvidiannerve).

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96.Woodruff'sareaislocatedat?
a)Antero-inferiorpartofnasalseptum
b)Posteroinferiorpartofnasalseptum
c)Superiorpartofnasalseptum
d)Posteroinferiorpartoflateralnasalwall
CorrectAnswer-D
PosteriorlyonthelateralnasalwallistheareaknownasWoodruff's
area.Itissituatedundertheposteriorendofinferiorturbinate.
Sphenopalatinearteryanastomoseswithposteriorpharyngeal
artery,inthisarea.

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97.Scutumispresentinmiddleear?
a)Roof
b)Lateralwall
c)Medialwall
d)Floor
CorrectAnswer-B
Lateralwall

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98.

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Notapartofbonylabyrinth?
a)Cochlea
b)Vestibule
c)Utricle
d)Semicircularcanal
CorrectAnswer-C
Theinnerearwithinthepetrouspartoftemporalboneconsistsofa
membranouslabyrinthenclosedinabony(osseous)labyrinth.So,
innerearhastwoparts:?
Bonylabyrinth:-Cochlea,Vestibule,Semicircularcanals.
Membranouslabyrinth:-Cochlearduct,utricle,Saccules,three
semicircularducts,andendolymphaticduct&sac.

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99.Lymphaticdrainageofthyroidglandis
mainly?
a)Sublingualnodes
b)Submandibularnodes
c)Deepcervicalnodes
d)Submentalnodes
CorrectAnswer-C
Lymphaticdrainageofthyroid
Lymphfromtheupperpartoftheglandreachestheupperdeep
cervicallymphnodeseitherdirectlyorthroughtheprelaryngeal
nodes.
Lymphfromthelowerpartoftheglanddrainstothelowerdeep
cervicalnodesdirectly,andalsothroughthepretrachealand
paratrachealnodes.

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100.Organofcortiissituatedin?
a)Basilarmembrane
b)Utricle
c)Saccule
d)Noneoftheabove
CorrectAnswer-A
Scalamedia(cochlearductormembranouslabyrinth)has3
walls:-
Thebasilarmembrane,whichsupportstheorganofcorti.
TheReissner'smembranewhichseparatesitfromthescala
vestibuli.
Thestriavasculariswhichcontainsvascularepitheliumandis
concernedwithsecretionofendolymph.

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101.Floorof4thventriclehas?
a)Infundibulum
b)Vagaltriangle
c)Mammillarybody
d)Tubercincrium
CorrectAnswer-B
Floorof4thventricle(Rhomboidfossa)
Itisdiamondorrhomboidalshapedandisformedbyposterior
surfaceofpons(uppertriangularpartorpontinepart)anddorsal
surfaceofmedulla(lowertriangularpartormedullarypart)junction
ofponsandmedullaformsintermediatepart.Featuresof4th
ventricleare:?
i. Mediansulcus(amidlinegroove)dividesthefloorintotwo
symmetricalhalves.
ii. Medialeminenceispresentaneachsideofmediansulcus.It
presentsfacialcolliculusformedbygenu(recurvingfibers)offacial
nerveloopingaroundabducentnucleus.Facialcolliculusliesinpons
(i.e.inpontinepartoffloor).
iii. Hypoglossaltriangleoverlyinghypoglossalnucleusandvagal
triangleoverlyingdorsalnucleusofvagus.Bothofthesetrianglelie
inthemedulla(medullarypartoffloor).
iv. Vestibularareaoverliesvestibularnuclei,partlyinponsandpartlyin
medulla.
v. Sulcuscoeruleus,abluishareaduetopresenceofpigmented
neuronscontainingsubstantiaferruginea.
vi. Superiorandinferiorfavea.

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102.Middlemeningealarterypassesthrough
?
a)Foramenovale
b)Foramenlacerum
c)Foramenrotundum
d)Foramenspinosum
CorrectAnswer-D
Foramenspinosum

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103.Nervewhichloopsaround
submandibularduct?
a)Mandibularnerve
b)Lingualnerve
c)Hypoglossalnerve
d)Recurrentlaryngealnerve
CorrectAnswer-B
Submandibularduct
Itis5cmlongductandrunsforwardsonhyoglossus,between
lingualandhypoglossalnerves.
Attheanteriorborderofthehyoglossusmuscleitiscrossedby
lingualnervewhichloopsaroundit.
Itopensintothefloorofmouth,onthesummitofthesublingual
papillaatthesideoffrenulumoftongue.

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104.Medullaoblongataisderivedfrom?
a)Telencephalon
b)Diencephalon
c)Mesencephalon
d)Myelencephalon
CorrectAnswer-D
Ans.isdi.e.,Myelencephalon
Nervoussystemdevelopsfromectoderm(neuroectoderm).Nervous
systemdevelopsfromneuraltubewhichinturndevelopsbyprocess
ofneurulation,i.e.formationofneuralplateanditsinfoldinginto
neuraltube.Structuresformedfromneuraltubeare:?
A)Fromcranialpart(enlargedcephalicpart)
Givesrisetobrain.Developmentalpartsare:
i)Forebrain(prosencephalon)
Telencephalon:Cerebralhemisphereandlateralventricle.
Diencephalon:Opticcupandstalk(givesrisetoretina),pituitary,
thalamus,hypothalamus,epithalamus,pinealgland,andthird
ventricle.
ii)Midbrain(mesencephalon)
Cerebralaqueduct.
iii)Hindbrain(rhombencephalon)
Metencephalon:Cerebellum,pons
MyelencephalonMedullaoblongata
B)Fromcaudalpart
Givesrisetospinalcord.

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105.Morulaishowmanycelled-
a)4
b)8
c)12
d)16
CorrectAnswer-D
Ans.is'd'i.e.,16
Atabout16cellsstagetheblastomerestightlyalignbytheprocess
ofcompactiontoformacompactballofcellscalledmorula
(mulberry).
Thisprocessofcompactionleadstosegregationofcellsintotwo
groups:
1. Innercells(innercellmass)
2. Outercells(outercellmass)
Morulaentersuterinecavity4daysafterfertilization.

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106.Dentalpapillagiveriseto?
a)Enamel
b)Dentalcuticle
c)Toothpulp
d)None
CorrectAnswer-C
Repeatfromprevioussessions.Seeexplanation-5ofsession-1

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107.Malleusandincusarederivedfrom?
a)1stArch
b)2ndArch
c)3rdArch
d)4thArch
CorrectAnswer-A
Ans.is'a'i.e.,1stArch
lst(mandibulararch):-
MuscularContribution:-Musclesofmastication,Anteriorbellyof
thedigastric,Mylohyoid,Tensortympani,Tensorvelipalatini.
SkeletalContributions:-Maxilla,mandible(onlyasamodelfor
mandible),Incusandmalleus,Meckel'scartilage,Ant.ligamentof
malleus,Sphenomandibularligament.
Nerve:-Trigeminalnerve(V2andV3).
Artery:-Maxillaryartery,externalcarotidartery.

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108.Opticcupisderivedfrom?
a)Neuralectoderm
b)Surfaceectoderm
c)Mesoderm
d)Neuralcrest
CorrectAnswer-A
Ans.is'a'i.e.,Neuralectoderm

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109.Opticcupgiveriseto?
a)Lens
b)Retina
c)Cornea
d)Sclera
CorrectAnswer-B
Retina

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110.Excretorysystemofkidneyisderived
from?
a)Uretericbud
b)Mesonephros
c)Metanephros
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Metanephros
Developmentofkidney
Uretericbud(mesonephros)arisefrommesonephricductandgives
risetocollectingsystemofkidney(renalpelvis,majorandminor
calyces,collectingtubule)andureter.
Metanephricmesoderm(blastemaormetanephors)arisefrom
nephrogeniccordwhichinturnisderivedfromintermediate
mesoderm.Itgivesrisetoexcretoryunit(nephron),i.e.glomeruli,
PCT,LoopofhenleandDCT.

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111.Uretericbudarisesfrom?
a)ParamesonephricDut
b)Mullerianduct
c)Mesonephricduct
d)Mesonephrictubule
CorrectAnswer-C
Genitalductsystem
During5thand6thweeks,bothmaleandfemaleshavetwogenital
ductsystems,deriverdfrommesoderm:
1. Mesonephricduct(wolffianduct)andmesonephrictubules.
2. Paramesonephricduct(Mullerianduct).
Mesonephricductisthemaingenitalductinmalesasitgivesriseto
mainlymalegenitalsystem:

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112.Derivativeofvitellinevein?
a)IVC
b)SVC
c)Ligamentumvenosum
d)Ligamentumteres
CorrectAnswer-A
Ans.is'a'i.e.,IVC

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113.Nottrueaboutdevelopmentofovary?
a)Developsingenitalridge
b)Sexcordsarederivedfromcoelomicepithelium
c)Oocytesaremesodermalinorigin
d)Atbirthovarycontains2millionfollicles
CorrectAnswer-C
Developmentofovary
Coelomicepitheliumonmedialsideofthemesonephrosbecomes
thickenedtoformgenitalridge,thesitewhereovarydevelops.
Genitalridgeiscoveredbygerminalepithelium(previouscoelomic
epithelium).Fromthesegerminalepithelium,cordsofcells(sex
cordsormedullarycords)proliferateandgrowintotheunderlying
mesoderm.
Primordialgermcellswhicharedevelopedfromendodermalcellsof
hindgut(partofyolksac),migratetoregionofdevelopingovary
(genitalridgearea)andgiverisetooocytes.
Thesexcordsbecomebrokenupintosmallmasses.Thecellsof
eachmasssurroundoneoocytetoformprimordialfollicle.
Atbirtheachovarycontainsabout2millionprimaryfollicles.

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114.Testisliesatdeepinguinalringupto?
a)4months
b)5months
c)7months
d)9months
CorrectAnswer-C
Thetestesdevelopinrelationtothelumbarregionoftheposterior
abdominalwall.
Duringfetallife,theygraduallydescendtothescrotum.
Theyreachtheiliacfossaduringthirdmonth,andlieatthesiteof
deepinguinalringupto7monthofintrauterinelife.
Theypassthroughinguinalcanalduringsevenmonth,andare
normallyinthescrotumbytheendofeighthmonth.

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115.Positionoftestisat24-28weeksof
intrauterinelife?
a)Inguinalcanal
b)Lumbarregion
c)Superficialinguinalring
d)Deepinguinalring
CorrectAnswer-D
Deepinguinalring

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116.Trueaboutnotochordareallexcept?
a)Definesaxisofembryo
b)Servesasprimaryinductor
c)Derivedfromhypoblast
d)Remainsasnucleuspulposus
CorrectAnswer-C
Notochordisabudlikestructureformedbyepiblastcellsextending
fromcranialendofprimitivestreaktocaudalendofprochordalplate,
inbetweentheectodermandendoderm.Siginificancesofnotochord
includesfollowing:-
i. Itdefinestheaxisofembryo.
ii. Itfunctionsastheprimaryinductor,inducingtheoverlyingectoderm
todevelopintoneuralplate(theprimordiumofCNS).
iii. Itservesasthebasisfordevelopmentofaxialskeleton.The
notochordisanintricatestructurearoundwhichvertebralcolumnis
formedandindicatesfuturesiteofvertebralbodies.However,the
notochorddoesnotgiverisetovertebralcolumn,afterdevelopment
ofvertebralbodies,thenotochorddegeneratesanddisappears,but
partsofitpersistasthenucleuspulposusofintervertebraldisc.

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117.Remnantofnotochordis?
a)Annulusfibrosus
b)Nucleuspulposus
c)Ligamentflavum
d)Intertransverseligament
CorrectAnswer-B
Ans.is'b'i.e.,Nucleuspulposus
Notochordisabudlikestructureformedbyepihlastcellsextending
fromcranialendofprimitivestreaktocaudalendofprochordalplate,
inbetweentheectodermandendoderm.Siginificancesofnotochord
includesfollowing:-
Itdefinestheaxisofembryo.
Itfunctionsastheprimaryinductor,inducingtheoverlyingectoderm
todevelopintoneuralplate(theprimordiumofCNS).
Itservesasthebasisfordevelopmentofaxialskeleton.The
notochordisanintricatestructurearoundwhichvertebralcolumnis
formedandindicatesfuturesiteofvertebralbodies.However,the
notochorddoesnotgiverisetovertebralcolumn,afterdevelopment
ofvertebralbodies,thenotochorddegeneratesanddisappears,but
partsofitpersistasthenucleuspulposusofintervertebraldisc.

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118.

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2ndpartofduodenumisderivedfrom?
a)Foregut
b)Midgut
c)Bothforegut&midgut
d)Hindgut
CorrectAnswer-C
Bothforegut&midgut

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119.Stromaofcorneadevelopsfrom?
a)Neuralectoderm
b)Surfaceectoderm
c)Mesoderm
d)Neuralcrest
CorrectAnswer-C
CornealepitheliumdevelopsfromSurfaceectoderm.
CornealstromadevelopsfromMesoderm.

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120.Femalegenitaltractdevelopsfrom?
a)Mesonephricduct
b)Mesonephrictubules
c)Mullerianduct
d)None
CorrectAnswer-C
Mesonephricduct(Wolffianduct)isthemaingenitalductinmales
asitgivesrisetomainlymalegenitalsystem.
Paramesonephricduct(Mullerianduct)givesrisetomainlyfemale
genitaltract

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121.Glomuscellsarederivedfrom?
a)Surfaceectoderm
b)Neuroectoderm
c)Mesoderm
d)Endoderm
CorrectAnswer-B
Glomuscellsarederivedfromneuralcrestwhichitselfisderivative
ofneuroectoderm.
Otherderivatesofneuralcrestare?
a)Neuralderivatives
Sensoryneuronsofspinaldorsalrootganglia.
Sympatheticchaingangliaandplexus(celiac/preaortic/renal
ganglia,entericplexusinGIT,i.e.AuerbachsandMeissner's)
ParasympatheticgangliaandplexusofGIT.
Schwanncellsofperipheralnerves,satellitecellsofallganglia.
Adrenalmedulla,chromaffincells,parafollicularC-cellsofthyroid
gland.
Melanocytesandmelanoblasts.
b)Mesenchymalderivatives
Dermalbonesofskull:Frontal,parietal,temporal,nasal,vomer,
palatine,mandible,maxillae.
Leptomeninges:arachnoidandpiamater(Durameteris
mesodermal).
Dentineofteeth(odontoblasts).
Eye:choroid,sclera,irisepithelium,pupillarymuscles
(sphincteranddilatorpupillae,ciliarymuscles).
Pharyngealarchcartilages.

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Retinalpigmentedepithelium.
Connectivetissuesofheadincludingdermis,tendon,ligaments.
Bulbarandconalridgesofheart.

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122.Epitheliumofvaginaarisesfrom?
a)Ectoderm
b)Wolffianduct
c)Mesoderm
d)Mesonephricduct
CorrectAnswer-C
Vaginaisderivedfromtwosources:-
1. Upper2/3rd:ItisderivedfromUtero-VaginalCanal,i.e.thefused
partofparamesonephricduct.Therefore,thispartismesodermalin
origin.
2. Lower1/3rd:Itisderivedfromsinovaginalbulbwhichinturnis
derivedfromurogenitalsinus.Thus,thispartisendodermalinorigin.

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123.WhichofthefollowingisderivedfromIst
arch?
a)Frontonasalprocess
b)Maxillaryprocess
c)Mandibularprocess
d)Bothmaxillary&mandibularprocesses
CorrectAnswer-D
Faceisdevelopedfromfivefacialprimordiaappearas
prominencesofmesenchyme:?
1. Onefrontonasalprocess:Beginsasaproliferationofmesenchyme
onventralsurfaceofdevelopingbrain.
2. Twomaxillaryprocesses:Growoutfromtheupperendofeachfirst
arch.
3. Twomandibularprocesses:Growfromeachfirstarch.

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124.SkeletalderivativeofIstarch?
a)Stapes
b)Hyoid
c)Maxilla
d)Laryngealcortilages
CorrectAnswer-C
Maxilla

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125.Styloidprocessisderivedfrom?
a)1starch
b)2ndarch
c)3rdarch
d)4tharch
CorrectAnswer-B
Styloidprocessisderivedfrom2ndpharyngealarch.

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

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127.Secondaryossificationcenterforlower
endoffemur?
a)Presentatbirth
b)Appearsat6monthsofage
c)Appearsat1yearofage
d)Appearsat5yearsofage
CorrectAnswer-A
Secondarycenteroflowerendoffemurappearsat9thmonthof
intrauterinelife(presentatbirth).
Ossificationoffemur
Thefemurossifiesfromoneprimaryandfoursecondarycentres.
Theprimarycentrefortheshaftappearsintheseventhweekof
intrauterinelife.Thesecondarycentresappear,oneforthelower
endattheendoftheninthmonthofintrauterinelife,oneforthe
headduringthefirstsixmonthsoflife,oneforthegreatertrochanter
duringthefourthyear,andoneforthelessertrochanterduringthe
twelfthyear.
Therearethreeepiphysesattheupperendandoneepiphysisatthe
lowerend.Theupperepiphyses;lessertrochanter,greater
trochanterandhead,inthatorder,fusewiththeshaftatabout
eighteenyears.Thelowerepiphysisfusesbythetwentiethyear.

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128.Sternochondraljointis?
a)Primarycartilaginous
b)Secondarycartilaginous
c)Fibrous
d)Synovial
CorrectAnswer-A
Ans.is'a'i.e.,Primarycartilaginous
Costochondral(sternochondral)jointsareprimarycartilaginous
joints.
Cartilaginousjoints
1)Primarycartilaginousjoints(synchondrosis,orhyalinecartilage
joint):Theseare:-
i. Jointbetweenepiphysisanddiaphysisofagrowinglongbone,i.e.
physis.
ii. Spheno-occipitaljoint
iii. 1stcostosternaljoint(1stchondrosternaljoint)
iv. Costochondraljoints
2)Secondarycartilaginousjoints(Symphysesorfibrocartilaginous
joints):Theseare:-
i. Symphysispubis
ii. manubriosternaljoint
iii. Symphysismenti
iv. Sacroccygealjoint
v. intervertebraldisc

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129.Innervatedstructuresofjointsareall
except?
a)Synovium
b)Capsule
c)Articularcartilage
d)Ligaments
CorrectAnswer-C
Ans.is'c'i.e.,Articularcartilage
Characteristicfeaturesofarticularcartilage
1)Hyalinecartilage
2)Noinnervation(nonervesupply).
3)Nobloodsupply(avascular).
4)Nolymphatics
5)Onlyhyalinecartilagewhichhasnoperichondrium.
6)Noabilitytorepairorregenerateitself.

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130.Submucosalplexusis?
a)Myentericplexus
b)Auerbach'splexus
c)Meissner'splexus
d)Tympanicplexus
CorrectAnswer-C
InnervationofGIT
Thegastrointestinaltracthasanervoussystemallitsowncalledthe
entericnervoussystem.Itliesentirelyinthewallofthegut,begining
intheesophagusandextendingallthewaytotheanus.Theenteric
nervoussystemiscomposedmainlyoftwoplexus:-
i)MyentericplexusorAuerbach'splexus
ii)Meissner'splexusorsubmucosalplexus
Extrinsicnerves(Parasympatheticandsympathetic)areconnected
tobothmyentericandsubmucosalplexuses.Entericnervoussystem
canfunctionindependentlyoftheseextrinsicnervesandthese
extrinsicnervesonlymodifytheactivityoftheentericnervous
system.
Therefore,peristalsisispresenteveniftheintestineisdeprivedof
extrinsicinnervation.
ParasympatheticstimulationenhancesGImotilityandsecretion
whereassympatheticstimulationinhibitsmotilityandsecretions.

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131.Hassall'scorpusclesarefoundin?
a)Lymphnodes
b)Spleen
c)Liver
d)Thymus
CorrectAnswer-D
Thedominantfeatureofmedullaofthymusisitsepithelial
components,whichareonionlikestructurescalledHassall's
Corpuscles,whichhaveanintenselyeosinophiliccoreofdead
material,

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132.DuctofBelliniarepresentin:
a)Pancreas
b)Liver
c)Kidney
d)Salivarygland
CorrectAnswer-C
AnswerC.Kidney
Papillary(collecting)ductsareanatomicalstructuresofthekidneys,
previouslyknownastheductsofBellini.
Papillaryductsrepresentthemostdistalportionofthecollecting
duct.
Theyreceiverenalfiltrate(precursortourine)fromseveralmedullary
collectingductsandemptyintoaminorcalyx.

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133.Breastisa?
a)Endocrinegland
b)Modifiedsweatgland
c)Modifiedsehaceousgland
d)Holocrinegland
CorrectAnswer-B
Breastisamodifiedsweatgland.Itisapocrinetypeofsweatgland.

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134.Valveofheisterisseenin
a)Cysticduct
b)Commonbileduct
c)Commonhepaticduct
d)Pancreaticduct
CorrectAnswer-A
Ans.is'a'i.e.,Cysticduct
Themucousmembraneofthecysticductformsaseriesof5-12
crescenticfolds,arrangedspirallytoformthesocalledspiralvalve
ofHeister.Thisisnotatruevalve.
Alsoknow
Hartmannspouch-dilatedposteromedialwallofneckofgall
bladder.
Sphinctercholedochus-alwayspresent-terminalpartofbileduct
Sphincterpancreaticus-usuallypresent-terminalpartofpancreatic
duct
Sphincterampullae(ofOddi)-surroundsthehepatopancreatic
ampulla

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135.Skinoverhypothenareminenceis
suppliedby?
a)Radialnerve
b)Mediannerve
c)Anteriorinterosseousnerve
d)Ulnarnerve
CorrectAnswer-D
Ulnarnerve

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136.Whichofthefollowingareinactive
duringnormalrespiration?
a)Pre-Botzingercomplex
b)Dorsalgroupofneurons
c)VentralVRGgroupofneurons
d)Pneumotaxiccenter
CorrectAnswer-C
Ans.is'c'i.e.,Ventralgroupofneurons
Medullaryrespiratorycenters
Theprincipalareasinthemedullaoblongataconcernedwith
regulationofrespirationare:?
1)Dorsalrespiratorygroup(DRG):-Thedorsalrespiratorygroupof
neuronsaremainlyconcernedwithinspiration.Theydescendand
terminateonspinalmotorneuronsinnervatingtheprimarymuscles
ofinspiration,i.e.,thediaphragmandtheexternalintercostal
muscles.
2)Ventralrespiratorygroup(VRG):-Theventralrespiratorygroup
ofneuronsismainlyconcernedwithforcefulexpirationbutalso
showssomeactivityduringinspiration.Therefore,theseneurons
contributetobothexpirationandinspiration.Theseneuronsare
dividedinto:?
i)TherostralVRGneurons:-Theseneuronsshowactivity
primarilysynchronouswithinspirationandthereforebecalled
inspiratory(I)neurons.Theyterminateonspinalmotorneurons
supplyingtheaccessorymusclesofinspiration,i.e.,
sternocleidomastoid,scalenesandanteriorserrati.
ii)TheventralVRGneurons:-Thesearemostlyexpiratory(E)
neurons.Butsincetheexpirationisgenerallyapassiveprocess,E

---

neuronsaresilentmostofthetime.However,theseneuronsshow
activitywhenexpirationisforceful,asduringexercise.These
neuronsterminateonspinalmotorneuronssupplythemusclesof
expiration,i.e.,internalintercostalandabdominalmuscles.
3)Pre-Botzingercomplex:-Theseneuronsareresponsiblefor
generationofrespiratoryrhythm,i.e.,thepacemakercellswhich
regulatetherateofrespirationarelocatedinPre-Botzingercomplex.
Pontinerespiratorycenters
Theimportantpontineareasconcernedwithrespirationare:?
1)Pneumotoxiccenter(nucleusparabrachialismedialis):-Itis
locatedinupperpartofponsandtransmitssignalstotheinspiratory
area.Thefunctionofthepneumotaxiccenterisprimarilytolimit
inspiration,i.e.,theprimaryeffectofthiscenteristocontrolthe
"switch-off"pointoftheinspiratoryrampthuscontrollingthedepthof
inspiration,i.e.,thedurationofthefillingphaseofthelungcycle.
Pneumotaxiccenteralsoinhibitsapneusticcenterfurtherinhibiting
inspiration.Thereforestrongstimulationofthiscenterresultsinan
earlyterminationofinspiratoryrampandhence,inspirationis
shortenedandthetidalvolumedecreases.Conversely,inthe
absenceofinputsfromthiscenter,inspiratoryrampcontinuesmuch
longerandhenceinspirationisprolongedandthetidalvolume
increases.
2)Apneusticcenter:-Thiscenterlocatedinthelower(caudal)part
ofpons.Theapneusticcenterexcitesinspiratorycenter(DRG)and
produceaprolongedinspiratorydrivewhichdelaystheonsetof
expiration.Thus,thoughtherespiratoryrhythmisestablishedinthe
medulla,thisrhythmisspoiltbyastronginspiratorydriveorginating
intheapneusticcenters.However,twoinfluencesseemstokeepthe
apneusticcenterincheck:(i)Pneumotaxiccenterofupperpons
and(ii)Influencefromstretchreceptorsinlungviavagus.Bothof
theseinfluenceinhibitinspiratoryactivity.

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137.Whatwilloccurwithincreaseinalveolar
ventilationrate?
a)DecreasedpartialpressureofO2inalveoli
b)DecreasedpartialpressureofCO2inalveoli
c)DecreasedCO2diffusionfrombloodtoalveoli
d)DecreasedO2diffusionfromalveolitoblood
CorrectAnswer-B
Ans.is'b'i.e.,DecreasedpartialpressureofCO2inalveoli
Alveolarventilationistheamountofinspiredairenteringingas-
exchangeareas(alveoli)perminuteduringquitebreathing.It
excludestheairwhichremainsindeadspace.

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138.Pulmonaryvasodilatationiscausedby?
a)Hypoxia
b)ThromboxaneA2
c)Histamine
d)Angiotensin-II
CorrectAnswer-C
Ans.is'c'i.e.,Histamine

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139.Isocapnicexerciseis?
a)Breathingforshortdurationagainstresistance
b)Breathingofdecreasedvolumeofventilation
c)Breathingofincreasedvolumeofventilationforlongperiod
d)Breathingofdecreasedvolumeforlongperiod
CorrectAnswer-C
Ans.is'c'i.e.,Breathingofincreasedvolumeofventilationforlong
period

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140.Mismatchofventilation/perfusionratiois
seenin
a)Apex
b)Base
c)Both
d)None
CorrectAnswer-C
Ans.is'C'i.e.,Both
Ventilationperfusionratio(V/O)
oConsideringthatcardiacoutputis5.0L/minandalveolar
ventilationisabout4.2L/min,theoverallventilation:perfusionratio
is0-8.Idealy,therefore,eachalveolusshouldhaveaV/Qratioof
0.8.However,thatisnotsoeveninnormallungs.
oDuetogravity,theapicalalveoliarebothunderventilatedand
underperfusedwhilethebasalalveoliarebothoverventilatedand
overperfused.However,gravityaffectsperfusionmuchmorethanit
affectsventilation.Hence,apicalalveoliaremoreunderperfused
thanunderventilatedwhilethebasalalveoliaremoreoverperfused
thanoverventilated.Therefore,V/Qismaximunatapex(about3-0)
andleastatbase(about0-6).
oSinceventilationisfarinexcessofperfusionatapex,
comparativelylittleoxygenistransferredfromthealveolitothe
blood,andCO2transferredtothealveoliisalsoless.Hencethegas
tensionattheapicesarequietclosetothoseofinspiredair,i.e.,
HighPa02andlowPaCO2.Ontheotherhand,atthebaseoflung
perfusionisbetterthanventilation;HencePa02andPaCO2ofbasal
alveoliarequietclosetothoseofpulmonaryartery,i.e.,lowPaO,

---

andhighPaCO2.Insimplewords,ventilation-perfusionmismatchis
responsibleforhighP02withlowPCO2atapexandLowPO2with
highPCO2atbase.

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141.Plateauofoxygen-hemoglobin
dissociationcurvesignifies?
a)NooxygenisavailableforbindingtoHb
b)NoHbmoleculeisavailabletobindwithO2
c)Alloxygenisreleasedtotissues
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,NoHbmoleculeisavailabletobindwithO2
Eachmoleculeofhemoglobincancombinewithuptofourmolecules
ofoxygen.
Combinationwiththefirstmoleculealterstheconformationofthe
hemoglobinmoleculeinsuchawayastofacilitatecombinationwith
thenextoxygenmolecule.
Inlightofthis,ifwelookatthecurve,asthePO2startsrisingfrom0
mmHgupwards,initiallyallhemoglobinmoleculesinbloodstarts
combiningwiththeirfirstoxygenmolecule.
Thisisthemostdifficultmoleculetocombinewith.
HencesaturationrisesonlyslowlywithinitialriseinPO2.AsPO2
risesfurther,hemoglobinmoleculescombinewiththeirsecond,third
andfourthmolecules,whichareprogressivelyeasiertocombine
with.
HencesaturationrisessteeplybetweenPO2of15mmHgand40
mmHg.
WhenPO2risesstillfurther,oxygenfindsmostofthehemoglobin
moleculescarryingfourmoleculesofoxygeneach.
Sincenomoleculesofhemoglobincancarrymorethanfour

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moleculesofoxygen,thereisnotmuchscopeformoreO2
combiningwithhemoglobin.
HencethecurvebecomesalmostflatagainbeyondthePO2of60
mmHg.

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142.Theoxygendissociationcurveof
myoglobin&hemoglobinisdifferentdue
to?
a)Hbcanbindto2oxygenmolecules
b)CooperativebindinginHb
c)Myogloobinhaslittleoxygenaffinity
d)Hemoglobinfollowsahyperboliccurve
CorrectAnswer-B
Ans.is`b'i.e.,CooperativebindinginHb
Cooperativebindingisresponsibleforsigmoidshapeoftheoxygen-
hemoglobindissociationcurve.
Asmyoglobinismonomeric(consistsofonepolypeptidechainonly),
itcanbindonlyonemoleculeofoxygenandforthesamereason
myoglobincannotshowthephenomenonofcooperativebinding.
Hence,theoxygen?myoglobindissociationcurveishyperbolaas
comparedtosigmoidshapeofHb-O2curve.
Hemoglobin-O2binding
Eachmoleculeofhemoglobincancombinewithuptofourmolecules
ofoxygen.Combinationwiththefirstmoleculealtersthe
conformationofthehemoglobinmoleculeinsuchawayasto
facilitatecombinationwiththenextoxygenmolecule.Inlightofthis,
ifwelookatthecurve,asthePO2startsrisingfrom0mmHg
upwards,initiallyallhemoglobinmoleculesinbloodstartscombining
withtheirfirstoxygenmolecule.Thisisthemostdifficultmoleculeto
combinewith.Hencesaturationrisesonlyslowlywithinitialrisein
PO2.AsPO2risesfurther,hemoglobinmoleculescombinewiththeir
second,thirdandfourthmolecules,whichareprogressivelyeasierto

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combinewith.HencesaturationrisessteeplybetweenPO2of15
mmHgand40mmHg.WhenPO2risesstillfurther,oxygenfinds
mostofthehemoglobinmoleculescarryingfourmoleculesofoxygen
each.Sincenomoleculesofhemoglobincancarrymorethanfour
moleculesofoxygen,thereisnotmuchscopeformoreO2
combiningwithhemoglobin.Hencethecurvebecomesalmostflat
againbeyondthePO2of60mmHg.
Thus,theprimaryreasonforthesigmoidshapeoftheoxygen-
hemoglobindissociationcurveisthatoutofthefourmoleculesof
oxygenthatcancombinewithahemoglobinmolecules,thefirst
combineswiththegreatestdifficultyandbindingofanoxygen
moleculesincreasesaffinitytonextO2molecule.Thisphenomenon
istermedascooperativebindingorcooperativity,i.e.,amoleculeof
O2bindstoahemoglobintetramermorereadilyifotherO2
moleculesarealreadybound.
MyoglobinO2binding
Myoglobinispresentinhigherconcentrationinred(slow)muscle
fibers.Myoglobinhasgreateraffinityforoxygenthanhemoglobin
anditsP50isonly5mmHg(ascomparedtoPO2ofhemoglobin
whichisabout26mmHg).Therefore,myoglobin-oxygen
dissociationcurveisshiftedfartotheleftthanHb-O2dissociation
curve.Ithasshapeofhyperbolaascomparedtosigmoidshapeof
Hb-O2curvebecauseitbinds1moleculeofO2permole(in
comparisontoHbwhichbinds4moleculesofO2permole).Therole
ofmyoglobinistobindO2atverylowPO2andreleasethemateven
lowerPO2,forexampleinexercisingmuscleswherePO2closeto
zero.

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143.Compensatorymechanisminacute
hemorrhage?
a)Decreasedmyocardialcontractility
b)Decreasedheartrate
c)Increasedheartrate
d)Increasedrespiratoryrate
CorrectAnswer-C
Ans.is'c'i.e.,Increasedheartrate
Compensatorymechanismsinacutehemorrhage
Inacutehemorrhagethereiscompensatorysympatheticstimulation
whichcauses:?
1)Generalizedvasoconstrictionwithincreasedtotalperipheral
resistance(TFR).
2)Increasedheartrate(tachycardia).
3)Increasedcardiaccontractility.
4)Increasedreninreleasecausingsodiumandwaterretention
throughRAAsystem.
5)Shiftoffluidfromintracellularandinterstitialspaceinto
vascularspace.

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144.'v'WaveinJVPisdueto?
a)Rightatrialcontraction
b)Leftatrialcontraction
c)Rightatrialrelaxation
d)Closureoftricuspidvalve
CorrectAnswer-A
Ans.isA
Thefirstelevation(awave)correspondstotheslightriseinatrial
pressureresultingfromatrialcontraction.
Thefirstdescent(xdescent)reflectsafallinatrialpressurethat
startswithatrialrelaxation.
Thesecondelevation(vwave)correspondstoventricular
systolewhenbloodisenteringtherightatriumfromthevena
cavaewhilethetricuspidvalveisclosed.
Finally,theseconddescent(ydescent)reflectsfallingrightatrial
pressureasthetricuspidvalveopensandblooddrainsfromthe
atriumintotheventricle.

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145.Bloodsupplyofbrainis?
a)1500ml/min
b)2000ml/min
c)750ml/min
d)250ml/min
CorrectAnswer-C
Ans.is'c'i.e.,750ml/min
Thecerebralbloodflow(CBF)isabout750ml/min(15%oftotal
cardiacoutput),or54ml/100gmbraintissueperminute.

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146.Majorneurotransmitterinafferentsin
nucleustractussolitariustoregulate
cardiovascularsystem?
a)Serotoxin
b)Glutamate
c)Glycine
d)Norepinephrine
CorrectAnswer-B
Ans.is'b'i.e.,Glutamate
Nucleustractussolitarius(NTS)liesinmedulla.
Itreceivesfollowingafferents:?
A)Generalvisceralafferents
i)Fromtonsil,pharynx,posteriorpartoftongue,carotidbodyand
sinusthroughglossopharyngealnerve.
ii)Frompharynx,larynx,trachea,esophagus,andotherthoracic
andabdominalviscerathroughvagusnerve.
B)Specialvisceralafferents
i)Fromanterior2/3oftongue(exceptcircumvallatepapillae)and
palatethroughfacialnerve
ii)Fromposterior1/3oftongue(includingcircumvallate
papillae)throughglossopharyngealnerve.
iii)Fromposteriormostpartoftongueandepiglottisthrough
vagusnerve.
NTSisinvolvedinregulationofcardiovascularsystemthrough
baroreceptorsandchemoreceptors.
Thereisageneralconsensusthatglutamateistheneurotransmitter
releasedatthetherminalsofbaroreceptorandchemoreceptor

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afferentsinNTS.--www.springer.com
However,cholinergic,GABAergic,andopioidergicmechanismsare
alsopresentinNTS.

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147.Dicroticnotchiscausedby
a)Closureofmitralvalve
b)Openingofmitralvalve
c)Closureofaorticvalve
d)Openingofaorticvalve
CorrectAnswer-C
Ans.is'c'i.e..Closureofaorticvalve
Aorticpressurecurve
Withtheonsetoftherapidejectionphaseoftheventricularsystole,
theaorticpressurerisessteeplytoreachamaximumofabout120
mmHg.Theejectionofbloodintotheaortacausesastretchonthe
aorticwallsandmakesthebloodintheentirearterialsystemto
moveatafasterrate.Thissetsupapressurewavethattravels
alongthearteries.Thepressurewaveexpandsthearterialwallasit
travels,andexpansionispalpableasthepulse.Inthelaterpartof
theventricularsystole,theaorticpressuredeclinesandcontinuesto
declinethroughoutthediastole,toreachaminimumofabout80mm
Hgduringtheisometriccontractionofthenextcardiaccycle.The
elasticrecoiloftheaortaandtheresistanceofarterioleshelpto
maintainrelativelyhighaorticpressureduringdiastole.
Anotch(incisuraordicroticnotch)isrecordedintheearlypartofthe
downstrokeoftheaorticpressurecurve.Itcorrespondstothe
closureoftheaorticvalve.Itisproducedbythesuddenbackward
flowofaorticbloodfollowedbytheimmediatecessationofbackflow
duetoclosureoftheaorticvalves.

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148.Skinbloodflowisdecreasedby?
a)Dopamine
b)Isoprenaline
c)Noradrenaline
d)Acetylcholine
CorrectAnswer-C
Ans.is'c'i.e.,Noradrenaline
Autophagyistheprocessbywhichcellssequesteranddegrade
theirowncytoplasmicorganelles.
Duringtheprocess,autophagicvacuoleisformed,whichisabilayer
vaculecontainingunnecessaryordysfunctionalorganelle.
Autophagicvaculefuseswithlysosometoformautophagosome
(autophagolysosome).
Then,hydrolyticenzymesoflysosomedegradetheorganelleof
autophagicvacuole.

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149.S2isassociatedwith?
a)Rapidventricularfilling
b)Atrialcontraction
c)Closureofsemilunarvalves
d)ClosureofAVvalves
CorrectAnswer-C
Ans.C.Closureofsemilunarvalves
S2isduetoclosureofsemilunarvalves(aorticandpulmonary
valves).

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150.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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151.Incirculatorybiomechanicswhichofthe
followingistrue?
a)Bloodviscosityisincreasedinanemia
b)Bloodviscosityisdecreasedinpolycythemia
c)Cardiacoutputisincreasedinanemia
d)CardiacoutputisdecreasedinBeri-Beri
CorrectAnswer-C
Ans.is'c'i.e.,Cardiacoutputisincreasedinanemia
Cardiacoutputisincreasedinconditionswhichcausedecreasein
peripheralvascularresistance:-
Exercise
1. AVfistulaorshunt
2. Severeanemia
3. Thyrotoxicosis
4. Wetberi-beri
5. Aboutotheroptions
Bloodviscosityislowinanemiaandhighinpolycythemia.

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152.Normalcapillarwedgepressure?
a)0-2mmHg
b)5-10mmHg
c)15-20mmHg
d)20-30mmHg
CorrectAnswer-B
Ans.is'b'i.e.,5-10mmHg
NormalcapillaryWedgepressureis4-12mmHg.Itisameasureof
leftatrialpressure.

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153.Mannitolinfusioncausesincreasein
a)Bloodviscosity
b)Osmolarity
c)Intra-oculartension
d)Intercranialtension
CorrectAnswer-B
Ans.is'b'i.e.,Omolarity

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154.Correctorderofvelocity?
a)Venacava>Aorta>Vein>Artery>Venule>Arteriole
b)Aorta>Venacava>Artery>Vein>Arteriole>Venule
c)Aorta>Artery>Venacava>Vein>Arteriole>Venule
d)Venacava>Vein>Aorta>Artery>Venule>Arteriole
CorrectAnswer-B
Ans.is`b'i.e.,Aorta>Venacava>Artery>Vein>Arteriole>Venul

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155.Effectofinfusionofhypotonicsaline?
a)IncreasedICFonly
b)IncreasedECFonly
c)IncreasedinbothICFandECF
d)IncreasedICFanddecreasedECF
CorrectAnswer-C
Ans.is'c'i.e.,IncreasedinbothICFandECF
Afterinfusionofhyptonicsalinecausesadeclineinplasma
osmolalityandashiftofwaterintointerstialspace(aswatermoves
fromhigherosmolaritytolowerosmolarity),causingdecreaseinICF
osmolality.
ThisresultsinshiftofwaterfromECFtoICF.
Finally,bothECFandICFcompartmentsareincreased(dueto
increaseswater)andosmolalityofbothcompartmentaredecreased.

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156.NormalQRSaxis?
a)+30to110?
b)-30to+110?
c)+110?to+150?
d)-110?to-150?
CorrectAnswer-B
Ans.is'b'i.e.,-30to+110?
Inanormalheart,theaveragedirectionofthevectorduringspread
ofthedepolarizationwavethroughtheventricles,calledthemean
QRSvector,isabout+59degrees.
Thismeansthatduringmostofthedepolarizationwave,theapexof
theheartremainspositivewithrespecttothebaseoftheheart.
Thenormalelectricalaxisoftheheart(meanelectricalaxisormean
QRSvector)liesbetween-30?and+100?.
Iftheaxisismorenegativethan-30?itiscalledleftaxisdeviation,
whereasiftheaxisismorepositivethan+100?,itiscalledrightaxis
deviation.

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157.HerringBreuerreflexisanincreasein?
a)Durationofinspiration
b)Durationofexpiration
c)Depthofinspiration
d)Depthofexpiration
CorrectAnswer-B
Ans.is'b'i.e.,Durationofexpiration
TheHering-Breuerinflationreflexisanincreaseinthedurationof
expirationproducedbysteadylunginflation,andtheHering-Breuer
deflationreflexisadecreaseinthedurationofexpirationproduced
bymarkeddeflationofthelung.

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158.Carotidandaorticbodiesarestimulated
when?
a)Oxygensaturationdecreasesbelow90%
b)Oxygensaturationdecreasesbelow80%
c)Oxygensaturationdecreasesbelow70%
d)Oxygensaturationdecreasesbelow60%
CorrectAnswer-A
Ans.is'a'i.e.,Oxygensaturationdecreasesbelow90%
Peripheralchemoreceptors(carotidandaorticbodies)arestimulated
ifarterialPO2isbelow60mmHg.
AtPO2of60mmHg,O2saturationisabout90%(89%).

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159.Baroreceptorare?
a)Carotidbody
b)Carotidsinus
c)Aorticbody
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Carotidsinus
Baroreceptorsaremechanoreceptorsthatarelocatedinthe
adventiaofcarotidarteryandaorta,atspecializedlocationscalled
sinuses.
1)Carotidsinusisalittlebulgeattherootofinternalcarotidartery,
locatedjustabovethebifurcationofthecommoncarotidartery.Itis
innervatedbythesinusnerve,abranchofglossopharyngeal(IX
cranial)nerve.
2)Aorticarch(aorticsinus)alsocontainsmechenoreceptors(stretch
receptors)whicharesimilartocarotidsinusreceptors.However,
theirafferentnervefiberstravelintheaorticnerve,abranchof
Vagus(Xcranial)nerve.
Thesinusnerve(fromcarotidsinus)andaorticnerve/vagalfibers
(fromaorticsinus)aretogethercalled`Sinoaorticnerves'.They,
together,arealsoreferedtoas'Buffernerves'becausetheyarethe
afferentsofcardiovascularreflexesthatbufferabruptchangesin
bloodpressure.

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160.Sleepcentreislocatedin-
a)Basalganglia
b)Medulla
c)Hypothalamus
d)Cerebellum
CorrectAnswer-C
Ans.is'c'i.e.,Hypothalamus

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161.Umamitasteisevokedby?
a)Glucose
b)Glutamicacid
c)Quinine
d)Sodiumchloride
CorrectAnswer-B
Ans.is'b'i.e.,Glutamicacid
TherearefourbasictastesnamelySweet,bitterSaltyandSour.
Theremechanismsofsensorytransductionare:
1)SweetreceptorisaGproteincoupledreceptorandleadstoan
increaseincAMPconcentrationinthesensorycellswhichresultsin
closureofK+channelsanddepolarization.
2)BitterreceptorsarealsoGproteincoupledreceptorsandcauses
riseinintracellularCa'byIP3-DAGsystem.RiseinintracellularCa+2
triggersneurotransmitterrelease.
3)Salty-tastingsubstancesdepolarizetastecellsbyactivating
amiloride-sensitiveNa+channels.
4)Sour-tastingsubstancesdepolarizetastecellsbyraisingthe
intracellularH+ionconcentration,whichcausesclosureofK+
channels.
Theumamitasteisthefifthtastewhichisunique.Theproposed
mechanismofumamitasteisthroughglutamatetastesensors
(glutamatereceptors)withreleaseofneuronalglutamicacid.
Innature,therearethreeumamisubstances:-
i)Monosodiumglutamate(MSG)
ii)Disodium51-guanosinemosphosphate(GMP)
iii)Disodium51-ionsinemonophosphate(IMP)

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162.Rewardcenterislocatedin?
a)Cerebellum
b)Amygdala
c)Hippocampus
d)Hypothalamus
CorrectAnswer-D
Ans.is'd'i.e.,Hypothalamus

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163.Whichisnotanextrapyramidaltract?
a)Reticulospinaltract
b)Rubrospinaltract
c)Corticospinaltract
d)Tectospinaltract
CorrectAnswer-C
Ans.is'c'i.e.,Corticospinaltract

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164.Whilewalkingorstanding,postureis
maintainby?
a)Basalganglia
b)Hypothalamus
c)Cerebellum
d)Amygdala
CorrectAnswer-C
Ans.is'c'i.e.,Cerebellum
Cerebellum,throughitsconnectionwiththerednucleusinfluences
theactivityofbrainstemreticularformationandtherebygamma
motorneuronactivity.
Throughitsconnectionswiththevestibularnucleusand
vestibulospinaltract,cerebelluminflunencestheactivityofalpha
motorneurons.
Thus,normalcerebellarfunctionisessentialforthemaintenanceof
normalmuscletoneandposture.
Thecerebellumseemstoplaycrucialrolesinwalkingaswellas
maintaingastandingposture.
Cerebellarvermisplaysanimportantroleinmaintenanceof
standingpostuk.
Basalgangliaisalsoinvolvedinmaintainingposturebyactingas
relaycenterforextrapyramidalpathways.Butitsroleisnotas
important.

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165.Myelinationinperipheralnervoussystem
isdoneby
a)Astrocytes
b)Oligodendrocytes
c)Ependymalcells
d)Schwanncells
CorrectAnswer-D
Ans.isdi.e.,Schwanncells
MyelinationincentralnervoussystemOligodendrocytes.
MyelinationinperipheralnervoussystemSchwanncell.

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166.SensoryperceptioninvolvesBrodmann's
area?
a)3,1,2
b)4,6
c)44,45
d)41,42
CorrectAnswer-A
Ans.A.3,1,2
Processingofgeneralsensoryinputsprimarilyoccursinprimary
somatosensoryareaofparietallobe.
PrimarysomatosensoryareaisBrodmann'sarea3,1,2.

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167.Vibrationsarefeltby?
a)Meissner'scorpuscle
b)Merkel'sdisc
c)Paciniancorpuscle
d)Ruffini'sendorgan
CorrectAnswer-C
Ans.is'c'i.e.,Paciniancorpuscle
Tactile(touch)receptors
Thesearegeneralexteroreceptorsforepicriticsenses.Theseare
dividedintosuperficialanddeepreceptors.
Superficialreceptorsarepresentintheepidermisorpapillarylayer
ofdermis.Inglabrous(nonhairy)skinthesereceptorsareMerkel's
disc(slowlyadapting)andMeissner'scorpuscle(rapidlyadapting).
Inhairyskintherearehairfolliclereceptors.
Deepreceptorsarepresentindeeperdermisorinthesubcutaneous
tissues.Thedeepreceptorsaresameinbothhairandnonhairyskin
andincludeRuffini'sendorgan(slowlyadapting)andPacinian
corpuscle(Rapidlyadapting).
Touch,pressureandvibrationaredifferentformsofsamesensation.
Pressureisfeltwhentheforceappliedontheskinissufficientto
reachthedeepreceptors,whereastouchisfeltwhentheforceis
insufficenttoreachthedeepreceptors,thereforedetectedby
superficialreceptors(Merkel'sdisc,meissner'scorpuscle).
Vibrationsarerhythmicvariationsinpressure(i.e.rhymicvariations
offorcethatreachesthedeepreceptors).Whetheratactilereceptor
sensespressureorvibrationdependsonwhetherthereceptoris
slowlyadaptingorslowlyadaping:?
i)Slowlyadapting(Ruffini'sendorgan):-Aremeanttodetect

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sustainedpressure;theyareuselessforvibrations.
ii)Rapidlyadapting(Paciniancorpuscle):-Stopdischargein
responsetosustainedpressure;theyareusefulonlywhenthe
pressurefluctuatesrapidly,i.e.duringvibrations.Thehighertherate
ofadaptationofareceptor,thegreateristhevibrationfrequencyit
candetect.
Thus,tactile(touch)sensationcanbedividedinto:?
A)Superficial(generallyconsideredastouch):-Detectedby
Meissner'scorpuscle(detecttextureofsurface,i.e.roughor
smooth)andMerkel'sdisc(detecttwopointdiscrimination).
B)Deep
i)Pressure(Deeptouch):-DetectedbyRuffini'sendorgan.
ii)Vibrations:-DetectedbyPaciniancorpuscle

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168.Senseorganwhichishavingefferent
supply
a)Golgitendonorgan
b)Organofcorti
c)Retina
d)Tastebud
CorrectAnswer-B
Ans.is'bi.e.,Organofcorti
Afferent(sensory)neuronscarryinformationformsenseorgansto
CNS(brain&spinalcord).
Haircells(inorganofcorti)arethesensoryreceporswhicharealso
innervatedbyefferentneurons.

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169.Falseregardingpapillaeoftongue?
a)Fungiformpapillaeattip
b)Circumvallatepapillaeatbase
c)Foliatepapillaeatbackedge
d)Filiformpapillaehavetastebudsattip
CorrectAnswer-D
Ans.is'd'i.e.,Filiformpapillaehavetastebudsattip
Intongue,tastebudsaregroupedinstructurescalledpapillae.Taste
budsarelocatedinthewallsofpapillae.Therearethreetypesof
papillae:-
i)Fungiformpapillae:-Areespeciallynumerousnearthetipandthe
marginsofthetongue.
ii)Circumvallate(Vallate)papillae:-Thesearethelargestpapillae
andaredistributedtoaV-shapedregionnearthebaseoftongue.
iii)Foliatepapillae:-Confinedtothebackedgeofthetongue.
Besidesthesethreetypesofpapillae,thereisalsoafourthtype,the
filiformpapillaebutthesehavenotastebuds.

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170.Feverisproducedby?
a)PGF2
b)PGE2
c)PGI2
d)PGD2
CorrectAnswer-B
Ans.is'b'i.e.,PGE2
Feveriselevatedbodytemperatureduetoresettingofhypothalamic
thermostatabovethenormallevel.
IL-1(mostpotent),TNF-andIL-6arepyrogens(feverproducing
cytokines).
Buttheydonotactdirectly.
TheystimulatethereleaseofPGE2,whichresetsthehypothalamic
thermostatathigherlevel.
Thus,PGE2isthefinaleffectorinproductionoffever.

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171.Endogenouspyrogensactby?
a)Increasingheatgeneration
b)Raisingthermostatpointofhypothalamus
c)Causingvasoconstriction
d)ByNon-shiveringthermogenesis
CorrectAnswer-B
Ans.is'b'i.e.,Raisingthermostatpointofhypothalamus
Bacterialtoxins(exogenouspyrogens)stimulateinflammatorycells
tosecretepyrogeniccytokines(endogenouspyrogens),e.g.IL-I,
TNF-a,andIL-6.
TheseendogenouspyrogenesstimulatePGE2releasein
hypothalamus,whichraisestemperaturesetpointofhypothalamus
tocausefever.

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172.Whichofthefollowingincreasesappetite
?
a)CART
b)-MSH
c)AGPP
d)Insulin
CorrectAnswer-C
Ans.is'c'i.e.,AGPP

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173.Sharppainistransmittedbywhichtype
offibres?
a)A
b)A
c)A
d)C
CorrectAnswer-C
Ans.is'c'i.e.,A
Sharpsomaticpain(fastpain)iscarriedbyASfibres.
Painiscarriedbytwotypesoffibers:?
i)AThesearerelativelyfast.Thereforethepaincarriesby
theseisfastpain(epicriticpainorfirstpain).
ii)CTheseareslow,thereforethepaincarriesbytheseisslow
pain(protopathicpainorsecondpain).

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174.Myosinandactinfilamentsarekeptin
placeby
a)Tropomyosin
b)Troponin
c)Actinin
d)Titin
CorrectAnswer-D
Ans.is'd'i.e.,Titin
Theside-by-siderelationshipbetweenthemyosinandactin
filamentsisdifficulttomaintain.
Thisisachievedbyalargenumberoffilamentousmoleculesofa
proteincalledtitin.
Titinmoleculesactasaframeworkthatholdsthemyosinandactin
filamentsinplacesothatthecontractilemachineryofthesarcomere
willwork.
Importantmuscleproteins
1. Myosin:-Myosinistheproteinthatconstitutesthethickfilaments.
Myosinofskeletalmuscleismyosin-ILMyosinparticipatesinthe
contractilemechanismandalsoactsasanATPase.
2. Actin:-Actinisthemajorproteinofthinfilament.Itistheactinthat
slidesovermyosinduringcontraction.
3. Tropomyosin:-Itistheotherproteinofthin.filament.Itcoversthe
activesites(myosin-bindingsites)onactin.WhenCa+2
concentrationofcytoplasm(sarcoplasm)israised,ituncoversthe
activesitesofactinandallowsthecontractionSo,the'cross-bridge
cycling'isswitchedofforonbythetropomyosinmoleculewhich
slidesontheactinmoleculetocoveroruncovertheactivesiteson

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it.

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175.Trueaboutcerebellarneuronal
connections?
a)Climbingfibresfrominferiorolivarynucleus
b)Mossyfibresfrominferiorolivarynucleus
c)ClimbingfibresareinhibitorytoPurkinjecells
d)MossyfibresareinhibitorytoPurkinjecells
CorrectAnswer-A
Ans.is'a'i.e.,Climbingfibresfrominferiorolivarynucleus
Neuronalcircuitincerebellum
Afferentforcerebellumcomesthroughtwofibers:climbingfibers
andMossyfibers.Climbingfiberswhichbringsinformationonlyfrom
theinferiorolivarynucleiandestablishexcitatorysynapeswith
purkinjecells.Allotherafferentinputtothecerebellumisbroughtby
theothertypesoffibers,calledMossyfiberswhichestablish
excitatorysynapsewithgranulecellsinthegranularcelllayer.The
axonofgranulecells,calledparallelfibers,stimulatethepurkinje
cells.Thusmossyfibers,liketheclimbingfibers,alsoendupin
stimulatingthepurkinjecells.
Granulecellsaretheonlystimulatory(excitatory)cellsincerebellar
cortex.
Theparallelfibers(axonsofgranulecells)alsostimulatethreetypes
ofinterneurons:-Stellateandbasketcellsinthemolecularlayer,
andGolgicellsinthegranularlayer.Stellateandbasketcellsinhibit
purkinjecells.Golgicells,alsoactivatedbycollateralfrommossy
fibers(besidesparallelfibers),inhibittransmissionfrommossyfibers
togranulecells.
Overall,climbingfiberinputsexertastrongexcitatoryeffectona
singlepurkinjecell,Whereasmossyfiberinputsexertaweak

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excitatoryeffectonmanypurkinjecellsviathegranulecells.
Aftercomplexinhibitingandexcitatoryinteractionsofvariousfibers
andcellsinthecortex,theoutputofcerebellarcortex,isprojectedto
deepcerebellarnucleibyaxonsofpyramidalcells(onlyoutputcells
ofcerebellarcortex).TheoutputofthePurkinjecellsisinhibitoryto
thedeepcerebellarnuclei.However,theoutputofdeepcerebellar
nucleitothebrainstemandthalamusisalwaysexcitatorybecause,
besideinhibitoryinputsofpurkinjecells,deepcerebellarnucleialso
receiveexcitatoryinputsfromafferentmossyandclimbingfibers
whichusuallyaremoreprominent.

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176.Post-tetanicpotentiationisdueto-
a)Hyperpolarizationofmusclefibres
b)RapidK+efflux
c)IncreasedavailabilityofCa++
d)RapidNa+influx
CorrectAnswer-C
Ans.is'c'i.e.,IncreasedavailabilityofCa++
"Repetitivestimulationenhancesforcedevelopmentduetorisein
intracellularCa++,aphenomenoncalledposttetanicpotentiation.Itis
duetoincreasedphosphorylationofmyosinelightchainwith
increasednumberofcrossbridges."

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177.Whichofthefollowinghassmall
representationinsomatosensoryareaof
cerebralcortex?
a)Lips
b)Thumb/fingers
c)Tongue
d)Trunk
CorrectAnswer-D
Ans.is'd'i.e.,Trunk
Adistincttopographicrepresentionofthebodycanbedemonstrated
insomatosensoryarea-I.
Eachsideofthecortexreceivessensoryinformationfromthe
oppositesideofthebodyonly(contralateralrepresentation).
Thebodyisrepresentedupsidedown(vertical)inthepostcentral
gyms,i.e.thefaceisrepresentedatthefootofthegyruswhereas
thelegsandfeetarerepresentedatthetopextendingonthemedial
surface.
Somepartsofbodylikeface(especiallylips,tongue)andfingers
haveaproportionatelylargerepresentationthantheotherareaslike
thetrunk.Thecorticalrepresentationofthepartofthebodyis
proportionatetoitsinnervationdensity(numberofsensory
receptors)ratherthanitssize.

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178.Restingmembranepotentialincardiac
muscle?
a)-70mV
b)+70mV
c)-90mV
d)+90mV
CorrectAnswer-C
Ans.is'c'i.e.,-90mV
NormalRMPinmyocardialfibersisabout-90mV.

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179.Noradrenalineismajorneurotransmitter
in?
a)Postganglionicparasympatheticfibres
b)Postganglionicsympatheticfibresexceptinsweatglands
c)Autonomicganglia
d)Preganglionicautonomicfibres
CorrectAnswer-B
Ans.is'b'i.e.,Postganglionicsympatheticfibresexceptinsweat
glands
Neurotransmitterinallpreganglionicautonomicnerves(both
sympatheticandparasympathetic)isacetylcholine(ACH)
Neurotransmitterinallganglia(bothsympatheticand
parasympathetic)isacetylcholine.
Neurotransmitterinpostganglionicparasympatheticfibresis
acetylcholine.
Inposganglionicsympatheticfibres,themajorneurotransmitteris
noradrenaline(NA)exceptinrenalandmesentricvasculaturewhere
itisdopamine,insweatglands,somebloodvesselswhereitis
acetylcholineandinadrenalmedullawhereitisadrenaline.
Mostofthevisceralorgansaresuppliedbybothsympatheticand
parasympatheticsystemexcept;
1. Bloodvessels,spleen,sweatglandsandhairfolliclesreceiveonly
sympatheticinnervation.
2. Ciliarymusclegastricandpancreaticglandsreceiveonly
parasympatheticinnervation.
Ingeneralsympatheticandparasympatheticsystemsare
antagonisticexcept:
Refractoryperiodofatrialfibresisdecreasedbyboth.

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Atalmostallorgansexceptheart,cholinergicsystemhasexcitatory
activityandadrenergicsystemhasrelaxingpropertiesSympathetic
systemstimulates(Tachycardia,Positiveinotropic)and
parasympatheticsystemdepresses(Bradycardia,Negative
inotropic)theheart.

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180.ReceptorforBDNF?
a)TrK-A
b)TrK-B
c)TrK-C
d)None
CorrectAnswer-B
Ans.is'B'i.e.,TrK-B

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181.Sensationswhichareappreciatedin
thalamus
a)Proprioception
b)Pain&temperature
c)Tactilesensations
d)Pressure
CorrectAnswer-B
Ans.is'b'i.e.,Pain&temperature
Painandtemperatureareprimarilyappreciatedbythethalamus.
Forotherformsofsensation,thethalamusisunabletoanalyzethe
detailsofsensations.
Fiberscarryingtactileandproprioceptiveinformationascendthrough
thethalamocorticalpathwaytoarea3ofprimarysomaticsensory
cortexthroughthethalamicradiation.
Therefore,ifthesomatosensorycortexisremoved,tactile
sensationsandproprioceptionsarelost,butpainandtemperature
sensationspersist.

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182.51S2ischeckedbywhichreflex?
a)Kneejerk
b)Patellarreflex
c)Calcanealreflex
d)None
CorrectAnswer-C
Ans.C.Calcanealreflex
S1S2ischeckedbyanklejerk(alsocalledCalcanealreflexor
achillesreflex).

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183.Mitralandperiglomerularcellsareseen
in?
a)Medulla
b)Olfactorybulb
c)Primaryvisualcortex
d)Geniculatebody
CorrectAnswer-B
Ans.is'b'i.e.,Olfactorybulb
Thesensoryreceptorsforolfaction(smell)arelocatedinthe
olfactorymucousmembrane.Inhuman,theolfactorymucous
membrane(olfactoryneuroepithelium)locatedintheroofofthe
nasalcavityneartheseptum.Becauseofitslocationhighinthe
nasalcavity,theolfactorymucosaisnotdirectlyexposedtotheflow
ofinspiredairenteringthenose.
Theolfactorymucosacontainsolfactoryreceptors.Theolfactory
receptorsareuniqueinthatthereceptorcellitselfisaneuron.The
olfactoryreceptorcellhasciliaprojectinginthenasalmucosawhich
actasreceptorforolfaction(Thesearedendritesofneuron/receptor
cells).Theaxonsofolfactoryneuron(olfactoryreceptorcells)form
olfactorynervewhichpassesthroughcribriformplateandterminates
intheolfactorybulb.Inolfactorybulbaxonsofolfactorynerve
synapsewithdendridesofmitralcellstoformtheolfactoryglomeruli.
Mitralcellsaretheprincipaloutputneuronsofolfactorybulband
theiraxonsformtheolfactorytract.
Theolfactorybulbalsocontainsperiglomerularcells,whichare
inhibitoryneuronsandgranulecellswhichhavenosynapseand
makereciprocalsynapseswithmitalandtuftedcells.
Likethetastefibers,olfactorytractalsoprojectstotheprimitiveparts

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ofthebrainaswellastheneocortex.Theprojectionstotheprimitive
partsareprincipallytothepyriformarea(olfactorycortex),amygdala
andentorhinalcortex,whichinturnprojectstothehippocampus.
Thepathwaytotheneocortexinvolvesarelayintheolfactory
tubercle,andtheninthethalamus,theoutputofwhichprojectsto
theorbitofrontalcortex.

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184.WeberFechnerlawisrelatedto?
a)Phantomlimb
b)Forceofcontractioninheart
c)Intensityofstimulusandsensationfelt
d)Corticalplasticity
CorrectAnswer-C
Ans.is'c'i.e.,Intensityofstimulusandsensationfelt

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185.Prostaglandinsareproducedby?
a)Neutrophils
b)Endothelium
c)Macrophages
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove

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186.Prostaglandinwasdiscoveredfrom?
a)Tear
b)Saliva
c)Seminalfluid
d)Blood
CorrectAnswer-C
Ans.C.Seminalfluid
Thenameprostaglandincomesfromtheprostategland.When
prostaglandinwasfirstisolatedfromseminalfluid,itwasbelievedto
havebeenaddedfromtheprostate."

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187.Aromataseproducesestrogenfrom-
a)Progesterone
b)Cortisol
c)Aldosterone
d)Androgen
CorrectAnswer-D
Ans.is'd'i.e.,Androgen

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188.Actionofprogesterone?
a)Increasedsensitivityofuterustooxytocin
b)InhibitsLHsecretion
c)Decreaseinbodytemperature
d)Causesproliferativechangesinuterus
CorrectAnswer-B
Ans.is'b'i.e.,InhibitsLHsecretion

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189.Corpusleuteumstartsregressingafter
howmanydaysofovulation?
a)5days
b)10days
c)24days
d)None
CorrectAnswer-B
Ans.is'b'i.e.,10days
Ifovumisnotfertilized,thecorpusluteumstartsdegenerating
aroundday24ofcycle(about10daysafterovulation)andis
eventuallyisreplacedbyfibroustissue,formingcorpusalbicans.
DegenerationofcorpusluteumisduetodeclineinlevelofLH(which
isrequiredformaintenanceofcorpusluteum)andincreasein
secretionofinhibinbylutealcellitself.

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190.Firstpolarbodyisformedafter?
a)Mitosis
b)Firstmeiosis
c)Secondmeiosis
d)Fertilization
CorrectAnswer-B
Ans.is'b'i.e.,Firstmeiosis
Oogenesis
Oogenesisreferstotheprocessofformationofovafromthe
primitivegermcells.Unlikefetaltestis(inwhichspermatogenesis
beingsatpuberty),thefetalovarybeginsoogenesisby10weeksof
gestation.oThesequenceofeventsinoogenesisare:
i)Theprimitivegermcellsundergomitoticdivisionstoformoogonia
(diploidOogoniumisuniqueinthatitistheonlyfemalecellinwhich
both'X'chromosomesareactive.
ii)Theoogoniaproliferatebymitosistoformprimaryoocytes(diploid
cells).
iii)Primaryoocytesformedfromtheoogoniaenteraprolonged
prophase(diplotenestage)ofthefirstmeioticdivisionandremainin
thisstageuntilovulationoccursafterpuberty.
iv)Primaryoocytescompletesthefirstmeioticdivisionatpuberty
justbeforeovulationtoformsecondaryoocyte(haploidcell)and1st
polorbody.
v)Secondaryoocyteimmediatelybeginssecondmeioticdivisionbut
thisdivisionstopsatmetaphaseandiscompletedonlyifthemature
ovum(ootid)isfertilizedwithsperm.Atthattimesecondpolorbody
(polocyte)isextrudedandthefertilizedovumproceedstoforma
newindividual.Fertilizationnormallyoccursintheampullaof

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fallopiantube.

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191.Fertilizationtakesplaceafterhowmuch
timeofovulation?
a)1-2days
b)5-6days
c)8-12days
d)>12days
CorrectAnswer-A
Ans.is'a'i.e.,1-2days

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192.Implantationoccursat?
a)2-3days
b)6-7days
c)15-20days
d)20-25days
CorrectAnswer-B
Ans.is'b'i.e.,6-7days

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193.Implantationoccursonwhichmenstrual
cycleday?
a)5-7days
b)20-22days
c)14-18days
d)26-28days
CorrectAnswer-B
Ans.is'b'i.e.,20-22days
Implantationoccursat6-7daysafterfertilization.
Ovulationoccursat14thdayofmenstrualcycleandfertilization
occurwithin24hoursafterovulation.
Thus,implantationwillcorrespondto20-22daysofmenstrualcycle.

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194.Blastocytecomesoutonwhichdayafter
fertilization?
a)4-7days
b)10-12days
c)12-15days
d)15-20days
CorrectAnswer-A
Ans.is'a'i.e.,4-7days
Freefloatingunimplantedblastocystisseenon4-5days.

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195.Growthhormonesecretionisstimulated
by?
a)Increasedbloodglucose
b)Decreasedbloodglucose
c)Cortisol
d)Somatostatin
CorrectAnswer-B
Ans.is'b'i.e.,Decreasedbloodglucose
RegulationofGHsecretion
GHsecretionisregulatedbyGHRHreleasedfromhypothalamus.
GHissecretedinapulsatilefashionthroughoutthelife,with
elevatedratesofsecretionimmediatelyafterbirthandatpuberty.
Interestingly,largeburstsofsecretionoccuratnightduringtheonset
ofdeepsleep.
StimulithatincreasesecretionofGHarehypoglycemia,exercise,
fasting,proteinmeals,aminoacids(likearginine),stress,glucagon,
pyrogen,lysinvasopressin,apomorphins,L-dopa&a-adrenergics,
estrogen,androgensand2-deoxyglucose.
StimulithatdecreasesecretionofGHareREMsleep,glucose,
Somatostatin,cortisol,FFA,GHitself,IGF-1,and
medroxyprogesteron.

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196.Hormonesrequiredduringpuberty?
a)LSH
b)Testesterone
c)Leptin
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Pubertyistriggeredbyareleaseofgonadotropins(FSHandLH)
frompituitarygland.
Thesehormonesactassignalstothegonads(testes/ovaries)that
triggertheproductionof-
i)Estrogen,progesteroneandsometestosteroneinwomen.
ii)Testosteroneinmen.
Inbothmalesandfemales,testosteroneisresponsiblefor
developmentofpubichair,acceleratedbonegrowth,bodyodorand
acneduringpuberty.Forboys,testosteroneisresponsibleforthe
processofvirilization,includingtheenlargementofthepenis,
increasedlibidoandgrowthoffacialandchesthair.
Estrogenisthemajorhormoneresponsibleforfemalepuberal
development.Itcausesdevelopmentofbreastandthickeningof
endometrium.
Progesteronecausesproliferationofaciniinmammaryglandsand
convertswaterycervicalsecretiontoviscidandscanty.
Leptinfacilitatesreleaseofgonadotropinreleasinghormone
(GnRH),therebyhelpinginpubertalonset.
Otherhormoneswhichareinvolvedinpubertyarethyroxineand
growthhormone.

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197.Pubarcheisdueto?
a)GH
b)Progesterone
c)Testosterone
d)Estrogen
CorrectAnswer-C
Ans.is'c'i.e.,Testosterone

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198.Cellswhichsurroundtheoocystin
graafianfolliclearecalled?
a)Discusproligerus
b)Cumulusoophoricus
c)Lutealcells
d)Villuscells
CorrectAnswer-B
Ans.is'b'i.e.,Cumulusoophoricus
Oocytelieseccentricallyinthegraafian(ovarian)follicle.
Itissurroundedbysomegranulsacellsthataregiventhename
cumulusoophoriacus(orcumulusovaricus).
Thecellsthatattachittothewallofthefolliclearegiventhename
discusproligerus.

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199.Followingchangesareseenduring
capacitationofaspermsexcept?
a)Increasedpermeabilitytocalcium
b)Decreasedpermeabilitytocalcium
c)Removalofcholesterolfromacrosome
d)Increasedmotility
CorrectAnswer-B
Ans.is'b'i.e.,Decreasedpermeabilitytocalcium
Capacitationofsperm(spermatozoa)
Spermatozoaleavingthetestis(seminiferousubules)arenotfully
mobile.Theycontinuetheirmaturationandacquiretheirmobility
duringtheirpassagethroughepididymis.Fromepididymisthey
cometovasdeference,distalendofwhichalsoreceivesthe
secretionsofseminalvesicle,andcontinuesastheejeculatoryduct.
Theejeculatoryductjoinstheprostaticurethra.
Onceejeculatedintothethefemale,vaginalsecretionsimprovethe
motilityandfertilizingabilityofsperms.Furtherexposureto
secretionsoffemalegenitaltract(inuterusand/orfallopiantube)
furtherimprovesthemobilityandfertilizingabilityofthesperms.The
beneficialeffectsofstayinthefemalegenitaltractarecollectively
calledcapacitation,fromtheisthmus,capacitatedspermsmove
rapidlytotheampullas,wherefertilizationtakesplace.
Followingchangesoccurduringcapacitation:-
Uterineandfallopiantubefluidswashawaythevariousinhibitory
factorsthatsuppressspermactivityinmalegenitaltract.
Removalofcholesterolvesiclefromacrosomesothatacrosomal
membranebecomesweakandcanreleaseenzymeatthetimeof
fertilization.

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Increasemembranepermeabilitytocalciumion.

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200.EstrogenBetareceptorsarefoundon
a)Uterus
b)Bloodvessels
c)Ovary
d)Vagina
CorrectAnswer-C
Ans.is'c'i.e.,Ovary

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201.Spermatogenesistakesplacein?
a)Epididymis
b)Seminiferoustubule
c)Ductusdeferens
d)Prostate
CorrectAnswer-B
Ans.is'b'i.e.,Seminiferoustubule
Spermatogenesisoccursinseminiferoustubules.
Spermatogenesisreferstotheprocessofformationofspermatozoa
(sperm)fromprimitivegermcells(spermatogonia).
Stepsinspermatogenesisinvolve:?
i)Spermatogonia(primitivegermcells)undergomitosistoform
primaryspermatocytes.Bothspermatogoniaandprimary
spermatocyteshavediploidchromosomes(46chromosomesor
diploidof23chromosomes).
ii)Primaryspermatocytesundergomeiosistoformsecondary
spermatocytes.Secondaryspermatocyteshavehaploid(23)
chromosomes.
iii)Secondaryspermatocytesundergomitosistoformspermatids.
iv)Spermatidsdonotdividefurtherbutundergomorphological
changestoformsperms(spermatozoa).Thisstepofformationof
spermatozoafromspermatidsiscalledspermiogenesis.The
spermiogenesistakesplaceinthedeepfoldsofcytoplasmofsertoli
cells.

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202.Conceptusentersuterinecavityinwhich
cellstage?
a)4cells
b)8cells
c)16cells
d)32cells
CorrectAnswer-C
Ans.is'c'i.e.,16cells
Fertilizationandimplantation
Fertilizationreferstofusionofmaleandfemalegametes(i.e.
spermatozoonandovum).Ittakesplaceinthemiddlesegment
(ampulla)offallopiantube.Beforefertilization,theovumandsperms
reachtheampullaforfertilization.Fusionofspermatocyteandovum
leadstoformationofzygote.Firstweekofdevelopmentbegins
immediatelyafterfertilizationandincludes:?
i)Cleavageofzygote:Zygote(fertilizedovum)startsdividing
immediatelyandlargezygoteissubdividedintosmallerdaughter
cellscalledblastomeres.Blastomeresarestillsurroundedbyzona
pellucida.Cleavageoccursinfallopiantube(uterinetube).
ii)Formationofmorula:Atabout16cellsstagetheblastomeres
tightlyalignbytheprocessofcompactiontoformacompactballof
cellscalledmorula(mulberry).Thisprocessofcompactionleadsto
segregationofcellsintotwogroups(i)innercells(innercellmass),
and(ii)outercells(outercellmass).Morulaentersuterinecavity4
daysafterfertilization.
iii)Formationofblastocyst:Asthemorulaenterstheuterine
cavity,uterinefluiddiffusesthroughzonapellucidaandfillssmall
intercellulargapsbetweenblastomeres,andmorulaisconvertedto

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blastocyst.Blastocystconsistsof:?
a)Zonapellucida:Outercovering.
b)Embryoblast:Agroupofcenterallylocatedcellsofinnercell
massandlatergiverisetotissuesofembryoproper.
c)Trophoblast:Athinouterlayerofcellsformedfromoutercells
massandlatergiveriseextraembryonictissues.
d)Blastocele:Cavityofblastocyst:
Theregionofblastocystcontainingembryoblastisknownas
embryonicpoleandtheoppositepole,theabembryonicpole.The
trophoblastsoverlyingtheembryoblastatembryonicpoleiscalled
polartrophoblastandthatoccupyingtherestofwallcalledmural
trophoblast.Between5-6daysafterfertilization,blastocysthatches
fromzonapellucida,andthisnakedblastocystisreadyfor
implantation

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203.Thyroidglandisstimulatedbywhich
hormoneduringpregnancy?
a)Prolactin
b)HCG
c)Humanplacentallactogen
d)ACTH
CorrectAnswer-B
Ans.is'b'i.e.,HCG
Theendocrinesystemundergoesnoteworthychangesduring
pregnancy.
Thepituitary,thyroidandparathyroidglandsappearenlarged.
Theenlargementofthyroidglandoccursundertheinfluenceof
hCGspituitarythyrotropin(TSH)andhumanchorionicthyrotropin
fromplacenta.Thisresultsinanincreaseinthyroxinewhich
stimulatesmetabolicactivityinmotherandfetus.
Increasedparathyroidhormonestimulatesliberationofcalciumion
frommaternalbonesforfetaluse.
IncreasedoutputofACTHfrompituitarystimulatessecretionof:-
i. Glucocorticoids:Itmobilizesaminoacidsforproteinsynthesisin
fetaltissues.
ii. Aldosterone:Promotesfluidretentioninpregnancy.

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204.FSHandLHbothareinhibitedby?
a)Cortisol
b)Aldosterone
c)Estrogen
d)Progesterone
CorrectAnswer-C
Ans.is'c'i.e.,Estrogen
Consistentwiththephenomenonofnegativefeedbackinwhichthe
secretionofthetargethormoneinhibitsitstrophichormone,
pregesteroneinhibitsLHandinhibininhibitsFSH.
Estrogen,whosesecretionisstimulatedbybothLHandFSH,
inhibitsbothLHandFSH.
Progesteroneandestrogenactatbothhypothalamicandpituitary
levelswhileinhibinsecretedbygranulosacellsactsonlyonthe
pituitary.
Undercertainconditions,estrogencausesstimulation(positive
feedback)ratherthaninhibitionofLH,e.g.,atovulation.

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205.Insulinsecretionisnormallystimulated
by?
a)GLP-1
b)GLP-2
c)VIP
d)-adrenergicreceptors
CorrectAnswer-A
Ans.is'a'i.e.,GLP-1
Recently,attentionhasbeenfocusedonglucagon-likepolypeptide
1(7-36)(GLP-1[7-36])asanadditionalgutfactorforinsulin
secretionandGLP-1(7-36)ismorepotentinsulinotropichormone.
Regulationofinsulinsecretion
Factorsaffectinginsulinsecretionare:-
i)Simulatinginsulinsecretion:-Glucose;Mannose;Aminoacids
(arginine,leucine);Intestinalhormones(GIP.Gastrin,Secretin,
CCK,GLP-1);-ketoacids;Parasympetheticstimulation
(acetylcholine);cAMP;-adrenergicstimulation;theophylline;
Sulfonylureas;andcertainendocrinehormoneslikegrowth
hormone,Glucagonandglucocorticoids.
ii)Inhibitinginsulinsecretion:-Somatostatin;2-deoxyglucose;
mannoheptulose;a-adrenergicstimulation,P-adrenergicinhibitors;
galanin;Diazoxide;Thiazidediuretics;K+depletion;Phenytoin;
Alloxan;microtubuleinhibitors;andinsulinitself.

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206.EffectofGLP-1?
a)Increasedaldosteronesecretionbyadrenal
b)IncreasedPTHsecretion
c)Increasedinsulinsecretionfrombeta-cellsofpancreas
d)IncreasedtestosteronesecretionfromLeydigcells
CorrectAnswer-C
Ans.is'c'i.e.,Increasedinsulinsecretionfrombeta-cellsof
pancreas

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207.Insulinmediatedglucosetransportis
seenin?
a)Adiposetissue
b)Brain
c)RBC
d)Kidney
CorrectAnswer-A
Ans.is'a'i.e.,Adiposetissue
Insulinstimulatestheuptakeofglucosebymyocytes(skeletal
muscle,cardiacmuscles),adipocytes(adiposetissue)and
hepatocytes.Tissuesthatdonotdependoninsulinforglucose
uptakeincludebrain,erythrocytes(RBC),theepithelialcellsof
kidney&intestine,Liver,andCornea&lensofeye.
Themechanismthroughwhichinsulinincreasesglucoseuptakeis
differentindifferenttissues.Inthemuscleandadiposetissues,
insulinincreasefacilitateddiffusionbyincreasingglucosetransporter
(GLUT4)onthecellmembrane.
Intheliver,insulinstimulatesglucoseentryintohepatocytes
indirectlybyinductionofglucokinasesothattheglucoseentering
thelivercellsispromptlyconvertedtoglucose-6-phosphate
(glucosetrapping).Thiskeepstheintracellularglucose
concentrationlowandfavoursentryofglucoseintotheliver.Thus,
thoughtheliverdonotdependoninsulinforglucoseuptake,insulin
stimulatesglucoseentryintohepatocytes.Thatmeansglucose
enterycanoccurinliverwithouttheactionofinsulin,butthisis
facilitatedbyinsulin.Ontheotherhand,myocytes(skeletaland
cardiacmuslces)andadipocytes(adiposetissue)aredependenton
insulinforglucoseuptake.

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---

208.Roleofgrowthhormonein
spermatogenesis?
a)Latedivisionofspermatocytes
b)Earlydivisionofspermatogonia
c)FormationofAcrosomes
d)StimulationofsertoliandLeydigcells
CorrectAnswer-B
Ans.is`b'i.e.,Earlydivisionofspermatogonia
Growthhormonespecificallypromotesearlydivisionsof
spermatogoniathemselves.IntheabsenceofGH,spermatogenesis
isseverelydeficientorabsent.
Growthhormoneisalsoessentialforgeneralmetabolicprocessin
testis.
Hormonesinvolvedinspermatogenesis
Spermatogenesisisinfluencedbymanyhormones.Hormones
requiredforspermatogenesisareFSH,LH,testosterone,estrogen,
growthhormonesinhibinandactivin.
FSHisresponsibleforinitiationofspermatogenesis.Itbindswith
sertolicellsandspermatogoniaandinducestheproliferationof
spermatogonia.Itstimulatescertolicellstosecreteendrogenbinding
protein,inhibin,mullerianinhibingsubstanceandestrogen.
LHstimulatesleydigcellstosecretetestosterone.
Testosteroneistheprincipleshormonewhichdirectlystimulates
spermatogenesis.Itisresponsibleforthesequenceofremaining
stagesofspermatogenesis(afterinitiatinbyFSH).Itisalso
responsibleformaintenanceofspermatogenesis.
Estrogenisformedfromtestosterone(byaromatase)insertolicells.
Itisessentialforspermeogenesis(laststepofspermatogenesis,i.e.
formationofspermatozoafromspermatids).

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formationofspermatozoafromspermatids).
Growthhormoneisessentialypromotesearlydivisionof
spermatogonia.
Inhibinplaysanimportantroleinregulationofspermatogenesisby
feedbackinhibitionofFSHsecretion.
ActivinstimulatesFSHsecretionandstimulatesspermatogenesis.

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209.Growthhormonehasitseffectongrowth
through?
a)Directly
b)IG1-1
c)Thyroxine
d)Intranuclearreceptors
CorrectAnswer-B
Ans.is'b'i.e.,IGI-1
GHhastwomajorfunctions:-
i)Growthofskeletalsystem:-Thegrowthismediatedby
somatomedins(IGF).Increaseddepositionofcartilage(including
chondroitinsulfate)andbonewithincreasedproliferationof
chondrocytesandosteocytes.
ii)Metaboliceffects:-Mostofthemetaboliceffectsareduetodirect
actionofGH.Theseincludegluconeogenesis,decreasedperipheral
utilizationofglucose(decreaseduptake),lipolysisandanabolic
effectonproteins.

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210.Growthhormonedoesnotcause?
a)Gigantism
b)Acromegaly
c)Diabetesmellitus
d)Hypothyroidism
CorrectAnswer-D
Ans.is'd'i.e.,Hypothyroidism
PhysiologicaleffectsofGrowthhormone
Growthhormonehastwomajoraction,i.e.,(1)Stimulationof
skeletalgrowth,and(2)Regulationofmetabolism.3)Stimulationof
skeletalgrowth
TheeffectofGHonskeletalgrowthismediatedbysomatomedins
(Insulin-likegrowthfactors:IGF).Theyaresynthesizedmainlyinthe
liver.Thegrowthpromotingactionofsomatomedinsishelpedby
theirinsulinlikeactions.GH,throughsomatomedin(IGF-1),
stimulatesproliferationofchondrocytesandosteocytesresultingin
increaseddepositionofchondroitinsulfateincatilageandincreased
ossificationofthenewlyformedcartilage.
GHdeficiencyinearlylifecausesdwarfism(smallheight).GH
excessinearlylifeleadstogigantism,whereasgrowthhormone
excessinadulthoodresultsinacromegaly.
2)Regulationofmetabolism
Proteinmetabolism:-GHhaspredominantlyanaboliceffectson
skeletalandcardiacmusclewhereitpromotesaminoacidtransport
intocellsandincreaseproteinsynthesis.
Carbohydrateandfatmetabolism:-TheeffectsofGHon
carbohydrateandfatmetabolismarecomplicatedbythefactthat
GHhasanti-insulineffects,whereassomatomedinsitproduceshave

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insulinlikeeffects:-
i)Anti-insulineffectsduetodirecteffectofGHincludedecreased
peripheralutilizationofglucose,increasedgluconeogenesis,
hyperglycemia,andlipolysis.Duetoitsanti-insulineffectsGH
excesscancauseinsulinresistantdiabetesmellitus.
ii)Insulinlikeeffectsduetosomatomedins(IGF)include
antilipolyticactivity,andotherinsulinlikeeffects.

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211.Whichofthefollowingisanionic
channel?
a)-1receptors
b)-1receptors
c)Nicotiniccholinergicreceptors
d)Muscariniccholinergicreceptors
CorrectAnswer-C
Ans.is'c'i.e.,Nicotiniccholinergicreceptors

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212.Chlorideshiftisdueto?
a)GenerationofHCO-3inRBCs
b)MetabolismofglucoseinRBCs
c)FormationofO2-HbcomplexinRBCs
d)None
CorrectAnswer-A
Ans.is'a'i.e.,GenerationofHCO-3inRBCs
Carbondioxideistransportedinbloodasplasmabicarbonate.
Redbloodcells(RBCs)playamajorroleinthemechanismbecause
RBCscontaintheenzymecarbonicanhydrasethatcatalyzesthe
reactionCO2+H2O=HCO3+
HencewhenCO2diffusesintotheRBC,itreactschemicallywith
watertogenerateHCO3-.
Theftionsaremoppedupbyhemoglobin,whichisanexcellent
buffer.
Thisenablesthereactiontoproceedintheforwarddirection.
TheHCO3-ionsgenerateddiffuseoutintotheplasmainexchange
forCl-ionsthatdiffuseintoRBCssimultaneously.
ThemovementofchlorideionsintoRBCiscalledChlorideshift.
Theaboveeventsresultsinanincreaseintotalnumberionsinside
theRBC,whichincreasesitsosmolarity.
Asaresult,waterenterstheRBCthroughosmosis.
TheRBCscarryingCO2inbicarbonateformwillthereforebe
somewhatlargerthannormal.
Hencethehematocritofvenousbloodisnormally3%greaterthan
thatofarterialblood.oInthelungs,Cl-movesoutoftheRBCsand
theyshrink.

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213.Insulinresistancedown-regulates-
a)GLUT-1
b)GLUT-2
c)GLUT-3
d)GLUT-4
CorrectAnswer-D
Ans.is'd'i.e.,GLUT-4

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214.MaximumamountofK+ionisseenin
whichGIsecretion?
a)Saliva
b)Colonic
c)Gastric
d)Jejunal
CorrectAnswer-A
Ans.is'a'i.e.,Saliva

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215.Toneofloweresophagealsphincteris
increasedby?
a)NO
b)VIP
c)Acetylcholine
d)Epinephrine
CorrectAnswer-C
Ans.is'c'i.e.,Acetylcholine
Loweresophagealsphincter
Unliketherestoftheesophagus,themusculatureofthe
gastroesophagealjunction(loweresophagealsphincter;LES)is
tonicallyactivebutrelaxesonswallowing.
ThetonicactivityoftheLESbetweenmealspreventsrefluxof
gastirccontentsintotheesophagus.oTheLESismadeupofthree
components.
Theesophagealsmoothmuscleismoreprominentatthejunction
withthestomach(intrinsicsphincter).
Fibersofthecruralportionofthediaphragm,askeletal,askeletal
muscles,surroundtheesophagusatthispoint(extrinsicsphincter)
andexertapinchcock-likeactionontheesophagus.Inaddition,the
obliqueorslingfibersofthestomachwallcreateaflapvalvethat
helpscloseofftheesophagogastricjunctionandprevent
regurgitationwhenintragastricpressurerises.
ThetoneoftheLESisunderneuralcontrol.
Releaseofacetylcholinefromvagalendingscausestheintrinsic
sphinctertocontact,andreleaseofNOandVIPfrominterneurons
innervatedbyothervagalfiberscausesittorelax.
Contractionofthecruralportionofthediaphragm,whichis

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innervatedbythephrenicnerves,iscoordinatedwithrespirationand
contractionsofchestandabdominalmuscles.
Thus,theintrinsicandextrinsicsphinctersoperatetogethertopermit
orderlyflowoffoodintothestomachandtopreventrefluxofgastric
contentsintotheesophagus.

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216.Pepsinogenisactivatedby?
a)Enterokinase
b)Enteropeptidase
c)H+
d)Trypsin
CorrectAnswer-C
Ans.isci.e.,H+
Pepsinissecretedbychiefcellsofstomachinaninactive
(zymogen)formcalledpepsinogen.
Acid(IF)inlumenofstomachconvertspepsinogentoactivepepsin.
Pepsinonceformedalsoattackspepsinogenproducingmorepepsin
moleculesbyautocatalysis.

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217.Bileacidhasadetergentactiondueto?
a)Formationofsoap
b)Formationofzwitterion
c)Amphipathicnatureofbilesalts
d)Formationofmediumchaintriglycerides
CorrectAnswer-C
Ans.isci.e.,Amphipathicnatureofbileacids
Bile-saltshelpindigestionoffatbyemulsificationoffatinsmall
intestinebydetergentactionofbilesalts.
Thedetergentactionofbilesaltsisduetotheiramphipathic
property.
Emulsificationincreasesthesurfacetovolumeratioofthelipid
dropletsfacilitatingtheactionoflipases.
Bilesaltsalsohelpinformationofmicelles.
Micellarformationsolubilizesthedigestedfatsandprovidesa
mechanismoftheirabsorptionintotheenterocytes.

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218.Digestionofdisaccharidesoccursat?
a)Mouth
b)Stomach
c)Smallintestine
d)Largeintestine
CorrectAnswer-C
Ans.is'c'i.e.,Smallintestine
Digestionofdisaccharides(maltose,sucroseandlactose)occursby
theenzymespresentinbrushborderossmallintestinalepithelial
cells.
Maltase(a-glucosidase)breaks1:4linkagesinmaltoseand
maltotrioseandreleasesglucose(twomoleculesofglucosefrom
maltoseandthreemoleculesofglucosefrommaltotriose).
Isomaltase(a-limitdextrinase)breaks1:6alinkagesofalpha-limit
dextrinandreleasesglucose.Isomaltasedextrinase)istheonly
enzymethatattacks1:6alinkage.
Sucroseishydrolysedintofructoseandglucosebysucrase(an
enzymepresentinbrushborderofintestinalepithelium).Lactoseis
hydrolysedintogalactoseandglucosebylactase((3-glucosidase).
Trehalasehydrolyzestrehelose(a1:1a-linkeddimerofglucose)
intotwoglucosemolecules.Trehaloseisfoundinmushrooms.

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219.Whichofthefollowingispassively
absorbedingut?
a)Glucose
b)Lipids
c)Fructose
d)Amino-acids
CorrectAnswer-B
Ans.is'b'i.e.,Lipids

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220.Amountofgastricjuicesecretedperday
?
a)500-1000ml
b)1000-1500ml
c)2000-2500ml
d)3000-3500ml
CorrectAnswer-C
Ans.is'c'i.e.,2000-2500ml

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221.Mainenzymeinvolvedindigestionof
fattyfood?
a)Linguallipase
b)Gastriclipase
c)Pancreaticlipase
d)Phospholipase
CorrectAnswer-C
Ans.is'c'i.e.,Pancreaticlipase
Ebner'sglandsonthedorsumofthetonguesecretelinguallipase
andthestomachalsosecretesalipase(gastriclipase).
However,theyareofverylittlesignificanceinfatdigestion.
Fatdigestionessentiallybeginsintheduodenumwithentryof
pancreaticandbiliarysecretions.oPancreaticjuicecontainslipase
(pancreaticlipase),themostimportantenzymeforfatdigestion.
Thepancreaticlipasedigeststriglycerides(triacylglycerols)intofree
fattyacidsand2-monoglycerides(2?monocylglycerols).
Pancreaticlipasehydrolyzes1-and3-bondsoftriglycerideswith
relativesparingof2-bonds,sotheprincipalproductsofitsactionare
freefattyacidsand2-monoglycerides.

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222.EffectofcholecystokininonGIT?
a)Increasesgastricacidsecretion
b)Increasessmallintestinalperistlasis
c)Increasesgastricmotility
d)Relaxesgallbladder
CorrectAnswer-B
Ans.is'b'i.e.,Increasessmallintestinalperistalsis

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223.Trueaboutironabsorptionareall,except
?
a)Majorsiteofabsorptionisduodenum
b)StoredasFerritin
c)Absorbedinferrousform
d)Pancreaticsecretionsimprovestheabsorption
CorrectAnswer-D
Ans.is'd'i.e.,Pancreaticsecretionsimprovestheabsorption
Ironabsorption
Ironisabsorbedfromuppersmallintestinemainlyduodenum.
Indietironoccursintwoforms,haemeironandinorganic(non-
haeme)iron.
Haemironisbetterabsorbedthaninorganiciron,butthemajor
fractionofdietisinorganiciron.
Inorganicironismostlyinferricform;needstobereducedtoferrous
formbecauseironisabsorbedinferrousform.
Afterabsorptionferrousformisonceagainoxidizedtoferricform
insideenterocytes.
Afractionofabsorbedironisrapidlydeliveredtoplasmatransferrin.
However,mostoftheironisdepositedintheenterocytesasferritin,
sometobetransferredmoreslowlytoplasmatransferrin,andsome
tobelostwhensenescentmucosalcells(enterocytes)aresloughed
intotheintestine.
Ironabsorptionisregulatedaccordingtothedemand,e.g.,when
thereisirondeficiency,absorptionincreases.
Thisregulationismediatedby"ironmetabolismregulatory
hormone",i.e.,hepcidinthatinhibitironabsorption.
Whenthereisirondeficiency,concentrationofhepacidinfallsand

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thereisincreaseironabsorption.
Hepacidinalsodecreasesreleaseofironfromstoragesites.
Transportandstorageofiron
Ironistransportedisbloodincombinationwithaglycoprotein
transferrin.
Ironistransportedintocellsthroughattachmentoftransferrinto
specificmembraneboundreceptors.
Ironisstoredasferritin(majorstorageform)orhaemosiderin.
Ferritinisacomplexofironandapoferritin(iron+apoferritinferritin).
Ironismainlystoredinreticulo-endothelialcells
monocytes/macrophagesofliver,spleen,bonemarrow.
Itisalsostoredinhepatocytes(parenchymalcellsofliver)and
myocytesofskeletalmuscles.Note:
Ironisstoredinferritininferricform.

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224.Ironabsorptionisincreasedbythefollowingfactorindiet:
a)Vitamin-C
b)Phyticacid
c)Fibrediet
d)Phosphates
CorrectAnswer-A
Inavegetariandiet,nonhemeironisabsorbedverypoorlybecauseoftheinhibitoryaction
ofavarietyofdietarycomponents,particularlyphosphates,phytatesandhighfibrecontent.
Ascorbicacidandmeatfacilitatetheabsorptionofnonhemeiron.Ascorbateforms
complexeswithand/orreducesferrictoferrousiron.Meatfacilitatestheabsorptionofiron
bystimulatingproductionofgastricacid;othereffectsalsomaybeinvolved.Eitherofthese
substancescanincreaseavailabilityseveralfold.
Ref:KaushanskyK.,KippsT.J.(2011).Chapter37.HematopoieticAgents:GrowthFactors,
Minerals,andVitamins.InB.C.Knollmann(Ed),Goodman&Gilman'sThe
PharmacologicalBasisofTherapeutics,12e.

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225.Maximumwaterreabsorptioninthe
Gastrointestinaltractoccursin?
a)Stomach
b)Jejunum
c)Ileum
d)Colon
CorrectAnswer-B
Ans.is'b'i.e.,Jejunum
WaterabsorptionfromGIT
Waterandelectrolytesneednodigestionandareabsorbedassuch.
Thereisapproximately9litersofwaterinput:Ingestedwater:2.0
litres,Saliva:1.5litres,gastricjuice:2.5litres,bile0.5litre,
pancreaticjuice:1.5litres,andsmallintestinesecretions1-0litre.
Outofthese9litres,7.7litres(85%)isabsorbedinsmallintestine
and1.0-1.5litres(5-10%)isabsorbedinlargeintestine(colon).
Total8.8litresofwaterisabsorbedand0.2litreisexcretedinfeces.
Insmallintestine,mostofthewaterisreabsorbedinthejejunum.

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226.Gammaglutamatecarboxypeptidaseis
linkedwithabsorptionof?
a)Riboflavin
b)Niacin
c)Folicacid
d)Pyridoxinel
CorrectAnswer-C
Ans.is'c'i.e.,Folicacid
Folicacidorpteroylglutamicacidisaparentcompoundforagroup
ofsubstancescalledfolates.
Naturallyoccurringfolicacidtypicallyoccursas
pteroylpolyglutamate,whichissimplefolicacidthathasbeen
conjugatedbygammapeptidelinkagewithsixadditionalglutamyl
units.
Thesepteroylpolyglutamatesarehydrolysedto
pteroylmonglutamatesintheprocessofintestinalabsorption.
Thesmallintestinalmucosacontainsgammaglutamate
carboxypeptidase,ahydrolyticenzymeusuallyknownasfolate
conjugase,withreleasesmonglutamicfolate,whichisrapidly
absorbedfromtheuppersmallintestine.Thusgammaglutamate
carboxypeptidaseisinvolvedintheabsorptionoffolicacid.

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227.Migratingmotorcomplexisduetowhich
GIhormone?
a)Gastrin
b)Motilin
c)CCK
d)VIP
CorrectAnswer-B
Ans.is'b'i.e.,Motilin
Migratorymotorcomplex(MMC)
Thegastricantrumshowsburstsofpropulsive(peristalitic)muscular
activityevery90minutes.Theactivityisconductedalongtheentire
lengthofthesmallintestine,fromstomachtodistalileum,atarate
ofabout5cmperminute.Assoonastheactivityreachesthe
terminalileum,anewwavebeginsinthestomach.Thepurposeof
MMCistoclearthestomachandsmallintestineofluminalcontents
inpreparationforthenextmeal.TheMMCsareinitiatedbymotilin.

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228.Gastricacidsecretionisstimulatedbyall
except-
a)Gastricdistension
b)Gastrin
c)Smelloffood
d)Somatostatin
CorrectAnswer-D
Therearefollowingphasesofgastricacidsecretion:?
1. Thecephalicphase:-Justassalivarysecretionmaystartbefore
foodentersthemouth,gastricsecretionisalsointitiatedbeforefood
entersthestomach.Sight,smelloreventhoughtoffoodstimulate
gastricacidsecretion.Itisbyparsympatheticsystemthroughvagus.
Thisphaseaccountsfor20%ofacidsecretion.
2. Thegastricphase:-Thisphaseofacidsecretioncomesintoplay
whenfoodmakescontactwiththegastricmucosa.Acidsecretionin
thisphaseisbroughtabouttwofactors:-(i)Hormonalstimulation
duetogastrinreleaseand(ii)Stretchofstomachwallduetogastric
distensionwhichactivatesavago-vagalreflexaswellasalocal
intragastricreflex.Thisphaseaccountsfor72-80%ofacidsecretion.
3. Theintestinalphase:-Oncethefoodentersupperportionofsmall
intestine(i.e.,duodenum)itcausessmallamountsofgastricjuice
secretionbecauseofgastrinreleasedfromdudenalmucosa.While
theintestinalphaseplayonlyaminorroleinstimulationofgastric
secretion,presenceoffoodintheintestineplaysamajorroleinits
inhibition.Withtheentryoffoodintotheduodenum,gastricsecretion
startsslowingdown.Thepresenceofacid,fats,andproductsof
proteindigestion;andincreasedosmolarityintheduodenuminhibit
gastricsecretionby:-(i)Hormonalmechanism:Thesementioned

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stimulicausethereleaseofseveralintestinalhormoneslikesecretin,
cholecystokinin(CCK),vasoactiveintestinalpeptide(VIP),gastric
inhibitorpolypeptide(GIP)andsomatostatin.Theselocalhormones
inhibitthegastricsecretionaswellasgastricmotility.(ii)Neural
mechanism(enterogastricreflex):Theabovementionedstimuli
inhibitgastricsecretionandmotilitybyintrinsicneuralreflex.

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229.Trueaboutcalciumreabsorptioninthekidney?
a)MostofthecalciumreabsorptionoccursinDCT
b)MajorregulatingfactorisParathormone
c)Parathormonedecreasescalciumreabsorption
d)Increasedplasmaphosphatedecreasescalciumreabsorption
CorrectAnswer-B
Majorregulatingfactorisparathormone.
Theprimarycontrollerofrenaltubularreabsorptionisparathormone.
ItincreasescalciumreabsorptioninLoopofHenle(thickascending
limb)anddistaltubules.
Mostofthecalcium(6590)isreabsorbedinPCT.
Increasedplasmaphosphateincreasescalciumreabsorption.

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230.Correctformulais?
a)GFR=Kfx10
b)Kf=GFRx10
c)Kf=GFRx125
d)GFR=Kfx125
CorrectAnswer-A
Ans.A.GFR=Kfx10
TheGFRisdeterminedby(l)thesumofthehydrostaticandcolloid
osmoticforcesacrosstheglomerularmembrane,whichgivesnet
filtrationpressure,and(2)theglomerularcapillaryfiltration
coefficient(Kr).
Mathematically,theGFRequalstheproductofKfandthenet
filtrationpressure.

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231.Fibrinisdegradedby?
a)Thrombin
b)Fibrin
c)Plasmin
d)None
CorrectAnswer-C
Coagulationmustbebalancedwithfibrinolysistolimitthe
hemostaticplugtothesiteofinjury.
Injuredvascularendotheliumsecretplasminogenactivatorthat
convertsinactiveplasminogentoactiveplasmin.
Plasminbreaksdownfibrinresultinginproductionoffibrin
degradationproducts.
Fibrinolyticsystemisregulatedbyplasminogenactivatorinhibitors
(PAIs)thataresecretedbyendothelium.

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232.GeneforRhantigenislocatedon
chromosome?
a)1
b)4
c)9
d)19
CorrectAnswer-A
Ans.is'a'i.e.,1

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233.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.

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234.Sirtuinsareassociatedwith?
a)Antioxidantmechanisminbody
b)Logetivityoflifespan
c)Regenerationofliverafterpartialresection
d)Carcinogenesisinhuman
CorrectAnswer-B
Ans.is'b'i.e.,Logetivityoflifespan

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235.Normaluricacidlevelis?
a)1-2mg/dl
b)2-3mg/dl
c)3-6mg/dl
d)10-15
CorrectAnswer-C
Ans.is'c'i.e.,3-6mg/dl

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236.Mostdiffusibleionacrossmembrane-
a)Na+
b)K+
c)Cl-
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Cl?
Amongthegivenoptions,Cl-haslowestpermeabilitycoefficientand
maximumpermeability.
Permeabilityofmembrane
Asthemajormiddleportionofmembrane(coreofthemembrane)is
formedbyhydrophobicregionofphospholipids,thisportionis
impermeabletotheusualwater-solublesubstances,suchasions,
glucoseandurea.Conversely,fat-solublesubstances,suchas
oxygen,carbondioxide,andalcohol,canpenetratethisportionof
themembranewithease.
Thepermeabilitycoefficientsofsmallmoleculesinthelipidbilayer
correlatewiththeirsolubilitiesinnonpolar(hydrophobic)regionand
thustheirpermeability.

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237.Dose-responsecurveinHormesis?
a)Straightline
b)Sigmoid
c)InvertedUorJshaped
d)Hyperbola
CorrectAnswer-C
Ans.is'c'i.e.,InvertedUorJshaped
Hormesisisadoseresponsephenomenoninwhichlowdoseshave
stimulatoryeffectwhilehighdoseshaveinhibitoryeffect.
ThedoseresponsecurvemaybeJ-shapedorinvertedUshapted,
thelatterbeingobserved,forexample,withtheeffectofchemotactic
peptidesonneutrophiladhesion.

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238.Beta-2transferrinisfoundin?
a)Blood
b)Urine
c)Tear
d)CSF
CorrectAnswer-D
Ans.is'd'i.e.,CSF
Beta-2transferrinisanisoformoftransferrin.
Itisfoundincerebrospinalfluid(CSF).
Itisnotfoundinotherbodyfluids(blood,mucus,tear,saliva,urine).
Therefore,itisaspecificmarkerforCSFandisusedfordiagnostic
ofCSFleaks.

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239.Whichofthefollowingisanexampleof
activetransport?
a)Movementofwateracrosscellmembrane
b)Movementofoxygenacrosscellmembrane
c)Co-transportofaminoacidswithsodium
d)Noneoftheabove
CorrectAnswer-C
Ans.is'C'i.e.,Co-transportofaminoacidswithNa+
ActivetransportofNa+andK+isoneofthemajorenergy-using
processesinthebody.
TheactivetransportofNa+iscoupledtothetransportofother
substances(secondaryactivetransport).
Forexample,theluminalmembranesofmucosalcellsinthesmall
intestinecontainasymportthattransportsglucoseintothecellonly
ifNa+bindstotheproteinandistransportedintothecellatthe
sametime.

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240.LifespanofneonatalRBC?
a)60-90days
b)90-120days
c)120-150days
d)150-200days
CorrectAnswer-A
Ans.is'a'i.e.,60-90days

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241.LifespanoffetalRBCis?
a)SameasadultRBC
b)1/4ofadultRBC
c)1/2ofadultRBC
d)2/3ofadultRBC
CorrectAnswer-D
Ans.is'd'i.e.,2/3ofadultRBC
"LifespanoffetalRBCisabout2/3'oftheadultRBC,i.e.about80
days."

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242.Autophagicvacuolesfusewith?
a)Golgicomplex
b)ER
c)Lysosome
d)Mitocondria
CorrectAnswer-C
Ans.is'c'i.e.,Lysosome

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243.Feedforwardinhibitionsynapseseenin
a)Medulla
b)Cerebellum
c)Basalganglia
d)Hypothalamus
CorrectAnswer-B
Ans.is`b'i.e.,Cerebellum
Feedforwardcontrolsystemisemployedduringtheregulationof
temperature.
Infeed-forwardinhibition,aneuronisconnectedthroughtwo
pathwaysoneexcitatoryandoneinhibitory.
Forexample,incerebellumthestimulationofBasketcellsproduces
IPSPs(inhibitorypostsynapticpotentials)inPurkinjecells.
However,thebasketcellsandthePurkinjecellsareexcitedbythe
sameparallel-fiberexcitatoryinput.
Thisarrangementiscalledfeed-forwardinhibitionandhelpsto
preventthedurationoftheexcitationproducedbyanygivenafferent
impulse.

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244.Motorproteininorganofcorti?
a)Kinesin
b)Albumin
c)Dynein
d)Myosin
CorrectAnswer-D
Ans.isdi.e.,Myosin
Theinnerhaircellsoforganofcortihave50-200ciliatedstructure
calledstereocilia.
Thetopofeachstereociliumislinkedtothesideofnextadjacent
higherstereociliumbymeansofathinfilamentousstrucuturecalled
thetip-link.
Mechanicallygatedionchannelsarelocatedattheseattachment
pointsonthesidesofstereocilia.Eachstereociliumcomprisesof
severalactinfilamentsencasedbyaplasmamembrane.
Theopeningandclosingoftheionchannelsisaccomplished
throughthebindingandunbindingofproteinsatterminalendsofthe
tiplinkswithagroupofchannelmotorproteins(myosin)whichmove
upanddowntheactinfilamentsofstereocilia.

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245.Typeofcollagenpresentincornea?
a)TypeI
b)TypeII
c)TypeIII
d)TypeIV
CorrectAnswer-A
Ans.is'a'i.e.,TypeI

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246.Whichofthefollowingispresentin
cornea?
a)Hyaluronicacid
b)Chondroitinsulfate
c)Dermatansulfate
d)Heparansulfate
CorrectAnswer-B
Ans.is'b'i.e.,Chondroitinsulfate

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247.Trueaboutgapjunctionsareall,except
?
a)Transmitelectricsignals
b)Allowionstopass
c)Intercellularspace1000nm
d)Seenincardiacmuscle
CorrectAnswer-C
Ans.is'c'i.e.,Intercellularspace1000nm
Gapjunctionsareintercellularconnectionsconsistofapairof
hemichannels(connexons)insertedintothemembraneofadjacent
cells.
Eachconnexoneismadeofsixidenticalproteinsubunitscalled
connexinswhichencloseacentralchannel.
Whenthecorrespondingconnexonsofadjacentcelllinkupend-to-
end,theyformacontinuouschannelthatpermitssubstancesto
passthroughfromcelltocell.
Atgapjunctions,theintercellularspacenarrowsdownto3nm,
therebyhelpinginbindingthecellstogether.oHowever,theirreal
physiologicalsignificanceliesinallowingionstoflowthroughthem,
i.e.theyconductioniccurrent.
Thisenableselectricalexcitationtospreadfromcelltocell,asin
smoothandcardiacmuscles.
TheporesizeofgapjunctionsdecreaseswhenintracellularCa'is
highorpHislow,bothofwhicharecommonlyassociatedwithcell
damage.Closureofgapjunctionsinresponsetothesestimuli
isolatesdamagedcellssothattheCa+2and1-1+donotspreadfrom
thedamagedtonormalcells.

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248.Instarvation,earliesttobecomedepleted
-
a)Carbohydrates
b)Proteins
c)Fats
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Carbohydrates
Metabolicalterationduringfasting-starvation
ohemetabolicchangesobservedinfastingaregenerallyopposite
tothosedescribedforabsorptive(fed)state.Intheabsenceoffood,
plasmalevelsofglucose,aminoacids,andTGsfall,triggeringa
declineininsulinsecretionandanincreaseinglucagonrelease.
Thisresultsindecreasedinsulin:glucagonratio.Whichis
responsibleformostofthemetabolicchanges.

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249.Falseabouttotalbodywater(TBW)?
a)ICFis2/3rdofTBW
b)InnewbornTBWis60%ofbodyweight
c)PrematurenewbornshavemoreTBW
d)Inadults,TBWis60%ofbodyweight
CorrectAnswer-B
Ans.is'b'i.e.,InnewbornTBWis60%ofbodyweight
Inatermnewborn,TBWis70-80%ofbodyweight.Itismorein
prematurenewbornthanintermnewborn.
Otheroptionsarecorrect.

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250.Whichofthefollowingequationis
correctregardingequilibriumpotential
fordiffusion?
a)EMF=25CA/CB
b)EMF=41CA/CB
c)EMF=61CA/CB
d)EMF=80CA/CB
CorrectAnswer-C
Ans.C.EMF=61CA/CB
Whentwoionicsolution(ions)AandBofdifferentconcentration(Ca
andCb)ofanionseparatedbyapermeablemembrane,theions
tendtodiffusealongtheirconcentrationgradient.
Sinceionsarechargedparticlestheirdiffusioncanbestoppedbyan
appropriateelectricalpotential(E)appliedacrossthemembrane.
Themagnitudeandpolarityofthepotential(equilibriumpotential)
thatmustbeappliedtosideAofthemembraneforstoppingthe
diffusionofions(Ea)isgivenbynernstequation,i.e.,theequilibrium
potentialforanioniscalculatedbyNernstequation.

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251.Whichoffollowingisamicrofilament?
a)Tubulin
b)Actin
c)Desmin
d)Vimentin
CorrectAnswer-B
Ans.is'b'i.e.,Actin

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252.Whichofthefollowingisnotan
intermediatefilament?
a)Keratin
b)Desmin
c)Tubulin
d)Lamin
CorrectAnswer-C
Ans.is`c'i.e.,Tubulin

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253.Allbelongtomolecularmotorfamily
except?
a)Kinesin
b)Dynein
c)Myosin
d)Actin
CorrectAnswer-D
Ans.is'd'i.e.,Actin
Molecularmotors
MolecularmotorsareproteinwithATPaseorGTPaseactivitythat
moveorganelles,proteins,andothercomponentsofcelltoallparts
ofthecells.Theseproteinsproduceforcemovementinwidevariety
ofcellularprocessesincludingvesiculartransport,celldivision,
nuclearmigration,musclecontraction,mechanochemical
transductionandothers.Molecularmotorsuseenergytogenerate
thisforce(molecularmotorsareATPase/GTPase).Important
cytoskeletalmolecularmotorsare:?
i)Kinesin(anATPase):-Involvedinaxoplasmictransportanduses
hydrolysisofATPtomovevesiclesdowntheaxontowardthe
positive(+)endofmicrotubuleformation.
ii)Dynein(anATPase):-ItalsousesATP.therearetwotypesof
dynein:?
a)Cytosolicdynein:-Involvedinaxoplasmicflowtomovevesiclein
oppositedirection,i.e.,towardsthenegativeendofmicrotubules.
b)Axonemaldynein:-Powerciliaryandflagellarmovement.
iii)Dynamin(aGTPase):-UsesGTPandisinvolvedinendocytosis.
iv)Myosin(anATPase)UsesATPandisinvolvedinmuscle
contractionbybindingwithactin.

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254.Electricpotentialofrestingmembrane
foragivenelectrolyteisgivenbywhich
equation?
a)Nernst
b)Goldman
c)Donnan-Gibbs
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Nernst

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255.Hemoglobinbinds/transportsallexcept?
a)CO
b)O2
c)SO2
d)CO2
CorrectAnswer-C
Ans.is'c'i.e.,SO2

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256.Allaretrueaboutphosphorusexcept?
a)Comprises1%ofthetotalbodyweight
b)85%remainsinthebones
c)Dietisnotacommonsource
d)ParathormoneactsonNaPiIIcreceptors
CorrectAnswer-D
Ans.is'd'i.e.,ParathormoneactsonNaPilicreceptors

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257.Extrinsicsystemofcoagulationis
activatedby
a)FactorXI
b)FactorX
c)FactorXII
d)FactorIII
CorrectAnswer-D
Ans.isdi.e.,FactorIII

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258.IncreasedBMRisassociatedwith?
a)Increasedbodyfatstore
b)Increasedglycognenesis
c)Increasedglycolysis
d)Increasedlipogenesis
CorrectAnswer-C
Ans.is'c'i.e.,Increasedglycolysis
IncreasedBMRisassociatedwithhypermetabolicstatewhichis
characterizedby:?
A)Carbohydratemetablism
i)Glycolysis
ii)Gluconeogenesis
iii)Glycogenesis
iv)Glycogenolysis
B)Lipidmetablism
i)Lipogenesis
ii)Lipolysis
iii)CholesterolSynthesis
iv)TriacylglycerolSynthesis
v)Lipoproteindegradation
vi)Ketogenesis
C)Proteinmetablism
i)Increasedproteindegradation
ii)Decreasedproteinbiosynthesis

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259.CarbohydrateinABObloodgroup
antigensis?
a)Glucose
b)Fructose
c)Inulin
d)Maltose
CorrectAnswer-B
Ans.'b'Fructose
ABOantigensareglycoproteins,i.e.saccharides(carbohydrates)
linkedwithpolypeptides.
Therearefourmaingroups:
BloodgroupA:ContainingAantigen
BloodgroupB:ContainingBantigen
BloodgroupAB:Containingboth'A'and'EVantigen
Bloodgroup0:NoABOantigen
'A'and'EVantigensarederivedfromH-antigen.H-antigenisformed
byaddingfucosetoterminalgalactoseofbackbonestrucuture.The
additionofN-acetyl-D-galactosamineorD-galactosetothe
galactoseresidueofH-antigenconfers'A'or'B'antigen,
respectively.

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260.FactorXis?
a)Hagemanfactor
b)Stuart-Prowerfactor
c)Christmasfactor
d)Tissuefactor
CorrectAnswer-B
Ans.is'B'i.e.,Stuart-Prowerfactor

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261.Gammaglobulinaresynthesizedin?
a)Liver
b)Spleen
c)Kidney
d)Plasmacells
CorrectAnswer-D
Ans.is'd'i.e.,Plasmacells
Liversynthesizesmostoftheproteinsofbodyexcept
immunoglobulins(gammaglobulins),whicharesynthesizedby
plasmacells.

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262.NOactsonplateletsthrough?
a)cAMP
b)Adenosine
c)cGMP
d)TX-A2
CorrectAnswer-C
Ans.is'c'i.e.,cGMP

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263.IsoformofLDHinskeletalmuscles?
a)LDH-1
b)LDH-2
c)LDH-3
d)LDH-4
CorrectAnswer-D
Ans.is'd'i.e.,LDH-4
SkeletalmusclescontainLDH-4andLDH-5

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264.Ureaseisa/an?
a)Oxidoreductase
b)Lyase
c)Ligase
d)Hydrolase
CorrectAnswer-D
functionally,belongtothesuperfamilyofamidohydrolasesand
phosphotriesterases
Hydrolases-->Alldigestiveenzymes(Pepsin,trypsin',Lipases,
esterases),lysosomalenzymes'urease'andphosphatase.

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265.Transferasesareclassifiedas?
a)EC-1
b)EC-2
c)EC-3
d)EC-4
CorrectAnswer-B
Ans.B.EC-2

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266.Trueaboutacidphosphataseis?
a)ActsatpH8-9
b)Prostateisoformistartarateresistant
c)Erythrocyteisoformisinhibitedbycupricions
d)Alloftheabove
CorrectAnswer-C
Acidphosphatase
Acidphosphatase(ACP)hydrolyzesphosphoricacidestersatpH5-
6.
Itisfoundindifferentisoformsinprostate,spleen,liver,
erythrocytes,plateletsandbones.
Prostaticanderythrocyteisoformcanbedifferentiatedby?
i)Prostaticisoformisinhibitedbytartarate(tartaratesensitive),
whereaserythrocyteisoformisnot.
ii)Erythrocyteisoformisinhibitedbyformaldehydeandcupricions,
whereasprostaticisoformisnot.
Acidphosphatase,particularlyprostaticenzyme,isunstableatroom
temperatureabove37?CandatpHabove7.0andmorethan50%of
theacidphosphataseactivitymaybelostin1houratroom
temperature.

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267.COactsbyinhibitingwhichcomponent
ofrespiratorychain?
a)Cytochromeb
b)CytochromeCoxidase
c)NADHCoQreductase
d)Oxidativephosphorylation
CorrectAnswer-B
Ans.'B'CytochromeCoxidase
InhibitorsofElectrontransportchain(Respiratorychain)
ComplexI:-Barbiturates(amobarbital),piericidinA,rotenone,
chlorpromazine,guanethidine.
ComplexII:-Carboxin,TTFA,malonate.
ComplexIII:-Dimercaprol,BAL,actinomycinA,Naphthyloquinone.
ComplexIV(cytochromecoxidase):-Carbonmonoxide(CO),
cyanide(CN),H2S,azide(N3-)

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268.NADHCoQreductaseisinhibitedby?
a)Rotenone
b)Carbonmonoxide
c)Antimycin
d)Atractyloside
CorrectAnswer-A
RotenoneinhibitscomplexI(NADH-CoQreductase).
Inhibitorsofelectrontransportchain?
Inhibitorsofrespiratorychainmaybedividedintothreegroups:?
1)Inhibitorsofelectrontransportchainproper
Theseinhibitorsinhibittheflowofelectronsthroughtherespiratory
chain.Thisoccursatfollowingsites.
i)ComplexI(NADHtoCoQ)isinhibitedby:-Barbiturates
(amobarbital),PiericidinA(anantibiotic),rotenone(aninsectiside),
chlorpromazine(atranquilizer),andguanethidine(an
antihypertensive).Theseinhibitorsblockthetransferofreducing
equivalentsfromFeSproteintoCoe.
ii)ComplexIIisinhibitedby:-CarboxinandTTFAinhibittransferof
electonfromFADH2toCoQ,whereasmalanatecompetitivelyinhibit
fromsuccinatetocomplexII.
iii)ComplexIII(CytochromebtocytochromeC1)isinhibitedby:-
Dimercaprol,antimycinA,BAL(Britishantilewisite),
Naphthyloquinone.Theseinhibitorsblockthetransferofelectrons
fromcytochromebtocytochromeCI.
iv)ComplexIV(cytochromeCoxidase)isinhibitedby:-Carbon
monoxide,CN?,H2Sandazide(N3).Theseinhibitorsblockthe
transferofelectronsfromcytochromeaa3tomolecularoxygenand

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thereforecantotallyarrestcellularrespiration.
2)Inhibitorsofoxidativephosphorylation
ThesecompoundsdirectlyinhibitphosphorylationofADPtoATP.
OligomycininhibitsFocomponentofFoF1ATPase.Atractiloside
inhibitstranslocase,atransportproteinthattransportsADPinto
mitochondriaforphosphorylationintoATP.
3)Uncouples
Asthenamesuggests,thesecompondsblockthecoupelingof
oxidationwithphosphorylation.Thesecompoundsallowthetransfer
ofreducingequivalentsinrespiratorychainbutpreventthe
phosphorylationofADPtoATPbyuncouplingthelinkagebetween
ETCandphosphorylation.Thustheenergyinsteadofbeingtrapped
byphosphorylationisdissipatedasheat.Uncouplersmaybe:-
i)Natural:-Thermogenin,thyroxine
ii)Synthetic:-2,4-dinitrophenol(2,4-DNP),2,4-dinitrocresol(2,4-
DNC),andCCCP(chlorocarbonylcyanidephenylhydrazone).

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269.Inoxidativepathway,NADPHis
producedin?
a)Cytosol
b)Mitochondria
c)Ribosome
d)Peroxisomes
CorrectAnswer-A
Ans.is'a'i.e.,Cytosol
NADPHisproducedmainlyinHMPshunt,whichoccurscytosol.
HMPisanalternativeroutefortheoxidationofglucose(beside
glycolysis).
Itisalsocalledas"pentosephosphatepathway","Dickens-
Horeckerpathway","Shuntpathway"or"phosphogluconate
oxidativepathway".
HMPshuntisrequiredforprovisionofreducedNADPHandfiver-
carbonsugarse.g.ribose(Pentosephosphates)fornucleicacid
synthesis.
Normally,90%ofglucoseisoxidizedbyglycolysisand10%is
oxidizedbyHMPshunt.
However,inliverandRBCsHMPshuntaccountsforoxidationof
30%glucose.
HMPshuntoccursinthecytosol.
Itishighlyactiveinliver,adiposetissue,adrenalcortex,lens,
cornea,lactating(butnotthenonlactating)mammarygland.Gonads
(testis,ovary)anderythrocytes.
Activityofthispathwayisminimalinmuscleandbrain,wherealmost
alloftheglucoseisdegradedbyglycolysis.

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270.RoleofmolecularoxygeninETC?
a)TransferofreducingequivalenttoCoQ
b)Transferofreducingequivalentfromcytosoltomitochondria
c)Toactaslastelectronacceptor
d)GenerationofATP
CorrectAnswer-C
Ans.is'c'i.e.,Toactaslastelectronacceptor
StructuralorganizationsofcomponentsofETC
3Componentsofrespiratorychaindonotfunctionasdiscrete
carriersofreducingequivalentbutareorganizedintofourcomplexes
eachofwhichactsasaspecificoxidoreductase.CoenzymeQand
cytochromeCarenotpartsofanycomplexandarenotfixedinthe
innermitochondria!membrane.Theothercomponentsarefixedin
themembrane.Thesecomponentsarearrangedinorderof
increasingredoxpotential.Therefore,reducingequivalents
(electrons)flowinonedirection,I--->II-->III-->IV,onlybecause
redoxcouplewithlowredoxpotentialisbetterelectrondonorwhere
astheonewithhighredoxpotentialiselectronacceptor.Thus,
reducingequivalents(electrons)flowthroughthechainfromthe
componentsofmorenegativeredoxpotentialtothecomponentsof
morepositiveredoxpotential.
i)ComplexI(NADH-CoQreductase)catalyzesthetransferof
electronfromNADHtocoenzymeQ(CoQ).
ii)ComplexII(Succinate-CoQreductaseorsuccinate
dehydrogenase)transferselectronsfromsuccinatetocoenzymeQ.
iii)ComplexIII(CoQ-cytochromeCreductase),transferselectron
fromCoQtocytochromeC.
iv)ComplexIV(cytochromeCoxidase)transferselectronsfrom
cytochromeCto02.

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cytochromeCto02.

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271.Whichofthefollowingisnottrue
regardingETC?
a)Occursinmitochondria
b)GeneratesATP
c)Noroleofinorganicphosphate
d)Involvestransportofreducingequivalent
CorrectAnswer-C
Ans.is'c'i.e.,Noroleofinorganicphosphate
Inorganicphosphate(Pi)isrequiredinETCtogenerateATP.
ADP+pi-->ATP
ETCoccursinmitochondriaandinvolvestransferofreducing
equivalenttogenerateATP

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272.Maximumenergyisliberatedby
hydrolysisof?
a)Creatinephosphate
b)ATP
c)Phosphoenolpyruvate
d)Glucose-6-phosphate
CorrectAnswer-C
Ans.C.Phosphoenolpyruvate
Acompoundthatliberates7Kcal/n:olormoreonhydrolysisiscalled
highenergycompound,oracompoundthatonhydrolysis
undergoesalarge(.7kcal/mol)decreaseinfreeenergy(AG)under
standardconditioniscalledhighenergycompound,i.e.,AG-7
Kcal/mol.

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273.Whichofthefollowingisanaldose
sugar?
a)Ribulose
b)Fructose
c)Glyceraldehyde
d)Alloftheabove
CorrectAnswer-C
Ans.C.Glyceraldehyde
Number
of
Sugar
Aldoses
Ketoses
carbon
Atoms
Trioses
3
Glyceraldehyde
Dihydroxyacetone
Tetroses 4
Erythrose
Erythrulose
Pentoses 5
Ribose,Xylose
Ribulose,Xylulose
Hexoses 6
Glucose,Galactose,Mannose Fructose
Heptoses 7
Glucoheptose
Sdoheptulose

---

274.

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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.NumberofATPproducedbyRBCwhen
GlycolysisoccursthroughRapoport
Leuberingpathway-
a)2
b)6
c)8
d)0
CorrectAnswer-D
Ans.'D'0
NetnumberofATPsproducedfrom1molofGlucoseby
AnaerobicGlycolysis-2ATPs
AerobicGlycolysis-7ATPs
Aerobicoxidation-32ATPs
Rapaport-LeuberingCycle-Zero

---

276.NumberofATPmoleculesandNADH
formedineachcycleofglycolysis?
a)4ATP,2NADH
b)2ATP,2NADH
c)4ATP,4NADH
d)2ATP,4NADH
CorrectAnswer-A
Ans.is'a'i.e.,4ATP,2NADH
Enegeticsofglvcolysis
Duringglycolysis2ATPareutilizedand4ATPareproducedat
substratelevel.2reducingequalentsNADH'areproducedand
reoxidizedbyelectrontransportchain,togenerata5ATPmolecules
(2.5ATPperNADH'molecule).Thustotal9ATPmoleculesare
producedand2areutilized,i.e.,Thereisnetgainof7ATP
moleculesinaerobicglycolysis.
Inanaerobicconditions,thereoxidationofNADHbyelectron
transportchainispreventedandNADHgetsreoxidizedby
conversionofpyruvatetolactatebylactatedehydrogenase.Thus,in
anaerobicglycolysisonly4ATPareproducedatsubstratelevel.
Therefore,thereisnetgainof2ATPmoleculesinanaerobic
glycolysis.
Note:-PreviouscalculationsweremadeassumingthatNADH
produces3ATPsandFADH2generates2ATPs.Thiswillamountto
anetgenerationof8ATPsperglucosemoleculeduringglycolysis.
Recentexperimentsshowthattheseoldvaluesareoverestimates
andNADHproduces2.5ATPsandFADH2produces1.5ATPs.
Thus,netgenerationisonly7ATPsduringglycolysis.

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277.Whichofthefollowingenzymedoesnot
catalyzesirreversiblestepinglycolysis?
a)Hexokinase
b)Phosphoglyceratekinase
c)Pyruvatekinase
d)Phosphofructokinase
CorrectAnswer-B
Ans.is'b'i.e.,Phosphoglycoratekinase
Glycolysisisregulatedat3stepswhichareirreversible.
Thesereactionsarecatalyzedbyfollowingkeyenzymes:?
1)Hexokinaseandglucokinase
2)Phosphofructokinase-I
3)Pyruvatekinase.

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278.UDPglucoseisnotusedin?
a)Uronicacidpathway
b)Glycogensynthesis
c)Galactosemetabolism
d)HMPshunt
CorrectAnswer-D
Ans.is'd'i.e.,HMPshunt
UDP-glucoseisderivedfromglucose-6-phosphateviaglucose-l-
phosphate.
ThemajorfateofUDP-glucoseisthesynthesisofglycogen.
OtherusesofUDP-glucoseare-
1.Inuronicacid(glucoronicacid)cycletogenerateUDP
glucuronate.
2.Galactosemetabolism
3.Glycosylationofproteins,lipidsandproteoglycans.

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279.SourceofenergyinKreb'scycleis-
a)NAD
b)NADP
c)NADPH
d)NADH
CorrectAnswer-D
Ans.'D'NADH
EnergeticsofTCAcycles(Kreb'scycle)
Alpha-ketoglutarateisoxidativelydecarboxylatedtoformsuccinyl
CoAbytheenzymealpha-ketoglutaratedehydrogenase.
TheNADHthusgeneratedentersintoETCtogenerateATPs.
AnothermoleculeofCO2isremovedinthisstep.
Thisistheirreversiblestepinthewholereactioncycle.

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280.NumberofATPgeneratedinoneTCA
cycle?
a)2
b)8
c)10
d)11
CorrectAnswer-C
Ans.is'c'i.e.,10
InasingleTCAcycle10moleculesofATPareproduced(12
moleculesaccordingtooldercalculations).
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:-

---

281.CoenzymeusedinKreb'scycle?
a)NAD
b)NADP
c)NADPH
d)NADH
CorrectAnswer-A
Niacinisusedascoenzymenicotinamideadeninedinucleotide
(NAD')fortransferofhydrogen.

---

282.TotalnumberofdehydrogenasesKrebs
cycle?
a)3
b)2
c)4
d)5
CorrectAnswer-C
Ans.is'c'i.e.,4

---

283.Incitricacidcycle,NADHisproduced
by-
a)Succinatethiokinase
b)Succinatedehydrogenase
c)Isocitratedehydrogenase
d)Fumarase
CorrectAnswer-C
Ans'C'Fumarase
NADHisproducedandCO2isliberatedat3steps:
i)Conversionofisocitratetoa-ketoglutaratebyisocitrate
dehydrogenase
ii)Conversionofalpha-ketoglutaratetosuccinylCoAbyalpha-
ketoglutaratedehydrogenase
iii)ConversionofL-malatetooxaloacetatebymalate
dehydrogenase.

---

284.Pyruvatedehydrogenasecontainsall,
except-
a)NAD
b)FAD
c)Biotin
d)CoA
CorrectAnswer-C
PDHcomplexismadeupofthreeenzymesandrequiresfive
coenzymes.
Theenzymesare:
i)E1:Pyruvatedehydrogenaseorpyruvatedecarboxylase
ii)E2:Dihydrolipoyltransacetylase
iii)E3:Dihydrolipoyldehydrogenase.
Thecoenzymerequiredarethiaminepyrophosphate(APP),lipoic
acid,FAD,NAD,andCoA.

---

285.Specificinhibitorofsuccinate
dehydrogenase?
a)Fluoroacetate
b)Arsenite
c)Malonate
d)Fluoride
CorrectAnswer-C
Ans.C.Malonate
Inhibitionoftheenzymesuccinatedehydrogenasebymalonate
illustratescompetitiveinhibitionbyasubstrateanalog.
Succinatedehydrogenasecatalyzestheremovalofonehydrogen
atomfromeachofthetwomethylenecarbonsofsuccinate.

---

286.Whichisnotacommonenzymefor
glycolysisandgluconeogenesis?
a)Aldolase
b)Glucose-6-phosphatase
c)Phosphoglyceratemutase
d)Phosphoglyceratekinase
CorrectAnswer-B
Sevenofthereactionsofglycolysisarereversibleandareusedin
thesynthesisofglucosebygluconeogenesis.
Thus,sevenenzymesarecommontobothglycolysisand
gluconeogenesis:
1. Phosphohexoseisomerase;
2. Aldolase;
3. Phosphotrioseisomerase,
4. Glyceraldehyde3-phosphatedehydrogenase;
5. Phosphoglyceratekinase;
6. Phosphoglyceratemutase;
7. Enolase.
Threereactionsofglycolysisareirreversiblewhicharecircumvented
ingluconeogenesisbyfourreactions.So,enzymesatthesesteps
aredifferentinglycolysisandgluconeogenesis.

---

287.Whichisnotastepofgluconeogenesis?
a)Conversionofglucose-6-phosphatetoglucose
b)Carboxylationofpyruvate
c)Conversionofoxaloacetatetophosphoenolpyruvate
d)Conversionofphosphoenolpyruvatetopyruvate
CorrectAnswer-D
Ans.'D'Conversionofphosphoenolpyruvatetopyruvate
Conversionofphosphoenolpyruvatetopyruvateisastepof
glycolysis(notofgluconeogenesis).
Reactioningluconeogenesis
Sevenreactionsofglycolysisarereversibleandthereforeareused
withthesameenzymeinthesynthesisofglucoseby
gluconeogenesis.However,threeofthereactionsofglycolysisare
irreversibleandmustbecircumventedbyfourspecialreactionsthat
areuniquetogluconeogenesisandcatalyzedby(I)Pyruvate
carboxylase,(ii)Phosphoenolpyruvatecarboxykinase,iii)fructose-
I,6-bisphosphatase,(iv)Glucose-6-phosphatase.
Allthreeirreversiblestepsofglycolysisshouldbebypassedfor
gluconeogenesistooccur.Thesethreebypassstepsare
circumventedbyfourspecialreactions.
A)Firstbypass(conversionofpyruvateintophosphoenolpyruvate):-
Conversionofpyruvateintophosphoenolpyruvatetakes
placethroughtworeactions:?
i)Carboxylationofpyruvate:-First,pyruvateentersthemitochondria
andisconvertedintooxaloacetatebypyruvatecarboxylase.
Pyruvatecarboxylaseisamitochondrialenzyme,thereforethis
reactionoccursinmitochondriaonly.
ii)Conversionofoxaloacetatetophosphoenolpyruvate:

---

-Oxaloacetateproducedinthemitochondriacannotcrossthe
membrane.Itisfirstreducedtomalate,whichthenmovesacross
themitochondrialmembraneintothecytosol.Malateis,then,
reoxidizedtooxaloacetateinthecytosol.Oxaloacetateisconverted
tophosphoenolpyruvatebyphosphoenolpyruvate(PEP)
carboxykinase.
B)Secondbypass:-Conversionoffructose-1,6-bisphosphateinto
fructose-6-phosphateiscatalyzedbyfructose-1,6-bisphosphatase.
Itspresencedetermineswhethertissueiscapableofsynthesizing
glucose(gluconeogenesis)orglycogen(gluconeogenesis)notonly
frompyruvatebutalsofromtriosephosphate.Itispresentinthe
liver,kidney,andskeletalmuscle,butisprobablyabsentfromheart
andsmoothmuscle.
C)Thirdbypass:-Conversionofglucose-6-phosphatetoglucoseis
catalyzedbyglucose-6-phosphatase.

---

288.RegulatingenzymesinGluconeogenesis
areall,except
a)Pyruvatecarboxylase
b)PEPcarboxykinase
c)PFK-1
d)Glucose-6-phosphatase
CorrectAnswer-C
Ans.is.C.PFK-1

---

289.Whichofthefollowingstepisspecific
forgluconeogenesis
a)PyrovatetoacetylCoA
b)Oxaloacetatetocitrate
c)OxaloacetatetoPEP
d)OxaloacetatetoPEP
CorrectAnswer-C
Ans.is'c'i.e.,OxaloacetatetoPEP

---

290.Tyrosineentersgluconeogenesisby
formingwhichsubstrate
a)SuccinylCoA
b)Alpha-ketoglutarate
c)Fumarate
d)Citrate
CorrectAnswer-C
Ans.'C'Fumarate
TCAcycleintermediatesarethesubstrateforgluconeogenesis.
GluconeogenicaminoacidsentertheTCAcycleaftertheir
transaminationintovariousintermediatesoftheTCAcycle:?
Histidine,proline,glutamineandarginineareconvertedtoglutamate
whichisthentransaminatedto-ketoglutarate.
Isoleucine,methionineandvalineenterbyconversionintosuccinyl
CoA.Propionate(ashortchainfattyacid)alsoenteratthislevel.
Tyrosine,andphenylalanineenterbyconversionintofumarate.
Tryptophanisconvertedtoalaninewhichisthentransaminatedto
pyruvate.
Hydroxyproline,serine,cysteine,threonineandglycineenterby
conversionintopyruvate.

---

291.FumarateofTCAisderivedfrom
transminationofwhichaminoacid
a)Phenylalanine
b)Methionine
c)Valine
d)Glutamine
CorrectAnswer-A
Ans.is.A.Phenylalanine

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292.Whichofthefollowingmetabolic
pathwayincarbohydratemetabolismis
requiredforsynthesisofnucleicacids?
a)Gluconeogenesis
b)Glycolysis
c)HMPshunt
d)Glycogenesis
CorrectAnswer-C
Ans.'C'HMPShunt.
HMPisanalternativeroutefortheoxidationofglucose(beside
glycolysis).Itisalsocalleda"pentosephosphatepathway",
"Dickens-Horeckerpathway","Shunt
pathway"or"phosphogluconateoxidativepathway"
MetabolicRoleofNADPHformedbyHMPShuntPathway
1.Requiredforreductivebiosyntheses,suchasfattyacid,
cholesterol,andsteroids.
2.Freeradicalscavenging
3.RBCmembraneintegrity
4.Preventionofformationofmeth-hemoglobin
5.Detoxification
6.Preservingtransparencyofthelensoftheeye
7.Bactericidalactivityofmacrophages
8.ProductionofriboseanddeoxyriboseforDNAandRNA
synthesis.

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293.TypeVIglycogenstoragediseaseisdue
tothedeficiencyof?
a)Musclephosphorylase
b)Glucose-6-phosphatase
c)Liverphosphorylase
d)Branchingenzyme
CorrectAnswer-C
TypeVIglycogenisalsocalledHer'sdiseaseanditiscausedby
enzymedefectliverphosphorylase.
Clinicalfeaturesarehepatomegaly,accumulationofglycogeninthe
liverandmildhypoglycemia.

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294.Pyruvatecanbeasubstratefor
a)Fattyacidsynthesis
b)TCAcycle
c)Cholesterolsynthesis
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Pyruvate
aItisadegradationproductofglucose(glycolysis)andglycogenic
aminoacids.Itcanbeconvertedtoglucose(gluconeogenesis
throughoxaloacetate)andacetylCoA(thereforeallbiosynthetic
productswhicharisefromacetylCoA)

---

295.Glucoseisconvertedtosorbitolby?
a)AldolaseB
b)Aldosereductase
c)Sorbitoldehydrogenase
d)Allofthese
CorrectAnswer-B
Ans.is'b'i.e.,Aldosereductase

---

296.Lactoseintoleranceisdueto?
a)DeficiencyofGalactokinase
b)DeficiencyofUridyltransferase
c)DeficiencyofLactase
d)DeficiencyofEnteropeptidase
CorrectAnswer-C
Ans.is'c'i.e.,DeficiencyofLactase
Lactoseintolerance
Itoccursduetodeficiencyoflactase,themostimportantmemberof
-galactosidaseenzymaticclass.
Lactasehydrolyseslactoseintoglucoseandgalactoseinthesmall
intestine.
Lactoseispresentinmilk.
Therefore,deficiencyoflactase,(-galactosidase)resultsin
intolerancetomilkandotherdairyproducts.
Clinicalfeaturesarebloating,diarrhea,failuretothrive,abdominal
distensionandabdominalcramp.

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297.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.

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298.Immediateenergysupplyformuscle
contraction?
a)GTP
b)ATP
c)Creatinephosphate
d)Fattyacid
CorrectAnswer-C
TheimmediatesourceofenergyforallmusclecontractionisATP,
followedimmediatelybycreatinephosphate.
TheimmediatesourceofenergyforallmusclecontractionisATP,
followedimmediatelybycreatinephosphate.
InsternousexerciseATPstoreissufficientonlyfor1-2secondsand
creatinephosphateforanother5-7seconds.
Thus,energyrichphosphagenstores(ATPandcreatinephosphate)
permitseveremusclecontractionfor8-10secondsonly.
Afterthis,energyisobtainedfromthemetabolismofstored
glycogenorfromcirculatingglucoseandfreefattyacids,depending
upontheavailabilityofoxygen.
Energysourceduringinexercisecanbesummarizedby:-
i)Shortburstofintenseactivity(e.g.,100metersprintorweight
lifting):-AllenergycomesfromATPandcreatinephosphate.
Breakdownofthesecompoundisananaerobicprocesses.
ii)Littlelongerintenseexercise(e.g.,200metersprintor100
meterswim):-BesidesATPandcreatinephosphate,glycogenis
metabolisedbyanerobicglycolyticpathwaystoprovideaready
sourceofenergy.So,muscleworkisanaerobic.
iii)Longerdurationexercise(e.g.,jogging,marathanrun):-The

---

muscleworkisaerobicandenergycomesfromaerobicutilization
ofglucoseandfreefattyacids.Moreglucoseisutilizedattheinitial
stage,butastheexerciseisprolonged,freefattyacidsbecomethe
predominantfuel.

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299.Mainsourceofenergyin1minis?
a)Glycogen
b)FFA
c)Phosphates
d)Glucose
CorrectAnswer-A
Sourceofenergyformuscularactivity
TheimmediatesourceofenergyforallmusclecontractionsisATP,
followedimmediatelybycreatinephosphate.
Instrenuousexercise,theATPstoreissufficientonlyfor1-2
secondsandcreatinephosphateforanother5-7seconds.
Thus,energy-richphosphagenstores(ATPandcreatinephosphate)
permitseveremusclecontractionfor8-10secondsonly.
Afterthis,energyisobtainedfromthemetabolismofstored
glycogenorfromcirculatingglucoseandfreefattyacids,depending
upontheavailabilityofoxygen.
Energysourceduringinexercisecanbesummarizedby:-
i)Theshortburstofintenseactivity(e.g.,100-metersprintorweight
lifting):-AllenergycomesfromATPandcreatinephosphate.The
breakdownofthesecompoundsisanaerobicprocesses.
ii)Littlelongerintenseexercise(e.g.,200-metersprintor100-meter
swim):-BesidesATPandcreatinephosphate,glycogenis
metabolizedbyanaerobicglycolyticpathwaystoprovideaready
sourceofenergy.So,muscleworkisanaerobic.
iii)Longerdurationexercise(e.g.,jogging,marathonrun):-The
muscleworkisaerobicandenergycomesfromaerobicutilizationof
glucoseandfreefattyacids.Moreglucoseisutilizedattheinitial
stage,butastheexerciseisprolonged,freefattyacidsbecomethe

---

predominantfuel.

---

300.Whichofthefollowingisincreasedin
lipoproteinlipasedeficiency?
a)VLDL
b)LDL
c)HDL
d)Chylomicrons
CorrectAnswer-D
Type1hyperlipoproteinemias
Lipoproteinfractionelevated-Chylomicrons
Metabolicdefect-LipoproteinlipaseorApoCIIdeficiency.
Features-Eruptivexanthoma,hepatomegaly,Painabdomen.
Management-Restrictionoffatintake,supplementationwithMCT

---

301.Majorsourceofenergyforbrainin
fasting/starvation?
a)Glucose
b)Glycogen
c)Fattyacids
d)Ketonebodies
CorrectAnswer-D
Thereisnostoredfuelinthebrain,butitutilized60%oftotalenergy
underrestingconditions.
Glucoseisvirtuallythesolefuelforthebrain,exceptinprolonged
starvingwhenketonebodiesarethemajorsource.
Fattyacidsdonotserveasfuelforthebrain,becausetheyare
boundtoalbumininplasma;hencecannotcrosstheblood-brain
barrier.

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302.DefectintypeIIhyperlipidemia
a)Apo-E
b)Lipoproteinlipase
c)LDLreceptor
d)None
CorrectAnswer-C
AlsocalledFamilialhypercholesterolemia.
TypeIIA
(Primaryfamilialhypercholesterolemia)
ThereisanelevationofLDL.Patientsseldomsurviveinthesecond
decadeoflifeduetoischemicheartdisease.ThecauseistheLDL
receptordefect.
Receptordeficiencyintheliverandperipheraltissueswillresultin
theelevationofLDLlevelsinplasma,leadingto
hypercholesterolemia.TheLDLreceptordefectmaybeduetothe
followingreasons:
1. LDLreceptordeficiency.
2. DefectivebindingofB-100tothereceptor.
3. Thereceptor-LDLcomplexisnotinternalized.
SecondarytypeIIhyperlipoproteinemiaisseeninhypothyroidism,
diabetesmellitus,nephroticsyndrome,andcholestasis.

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303.Ratelimitingstepinfattyacidsynthesis
is?
a)ProductionofacetylCoA
b)Productionofoxaloacetate
c)Productionofmalonyl-CoA
d)Productionofcitrate
CorrectAnswer-C
Productionofmalonyl-CoAistheinitialandrate-limitingstepinthe
fattyacidsynthesis.
Acetyl-CoAneedstobeconvertedtotheactivatedform,whichwill
serveasthedonorofcarbonunitstothegrowingfattyacidchain.
Malonyl-CoA,a3-carboncompoundissuchanactivatedform.Itis
producedbycarboxylationofacetyl-CoA,areactioncatalyzedby
acetyl-CoAcarboxylase.
Acetyl-CoAcarboxylaserequiresbiotinasacofactor.The
reactionalsorequiresHCO -
3 andATP
Thereactiontakesplaceintwosteps:
(i)CarboxylationofbiotininvolvingHCO3andATP.
(ii)transferofthecarboxylgrouptoacetyl-CoAtoformmalonyl-CoA.

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304.Whichofthefollowingistheratelimitingstepincholesterolsynthesis?
a)HMGCoAsynthase
b)HMGCoAreductase
c)Thiokinase
d)Mevalonatekinase
CorrectAnswer-B
Initiallyincholesterolsynthesis,twomoleculesofacetyl-CoAcondensetoformacetoacetyl-
CoAcatalyzedbycytosolicthiolase.
Acetoacetyl-CoAcondenseswithafurthermoleculeofacetyl-CoAcatalyzedbyHMG-CoA
synthasetoformHMG-CoA,whichisreducedtomevalonatebyNADPHinareaction
catalyzedbyHMG-CoAreductase.
Thislaststepistheprincipalregulatorystepinthepathwayofcholesterolsynthesisandis
thesiteofactionofthemosteffectiveclassofcholesterol-loweringdrugs,thestatins,which
areHMG-CoAreductaseinhibitors.
Ref:BothamK.M.,MayesP.A.(2011).Chapter26.CholesterolSynthesis,Transport,&
Excretion.InD.A.Bender,K.M.Botham,P.A.Weil,P.J.Kennelly,R.K.Murray,V.W.
Rodwell(Eds),Harper'sIllustratedBiochemistry,29e.

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305.Mineralrequiredforcholesterol
biosynthesis?
a)Fe
b)Mn
c)Mg
d)Cu
CorrectAnswer-C
Mgisrequiredinstage2ofcholesterolsynthesis.
Biosynthesis(DeNovoSynthesis)ofcholesterol
Theliveristhemajorsiteforcholesterolbiosynthesis.Some
cholesterolisalsosynthesizedintheintestineadrenalcortex,
gonadsandskin.Themicrosomal(smoothendoplasmicreticulum)
andcytosolfractionofcellareresponsibleforfircholesterol
synthesis;However,mostofthereactionsinsynthesisoccurinthe
cytosol.
CholesterolisaC-27compound.All27-carbonatomsofcholesterol
arederivedfromasingleprecursor,i.e.acetyl-CoA(activated
acetate).
Thefirsttwomoleculesofacetyl-CoAcondensetoformacetoacetyl-
CoA.Next,thethirdmoleculeofacetyl-CoAcondenseswith
acetoacetyl-CoAtoform3-hydroxy-3-methylglutaryl-CoA(HMG-
CoA).ThenHMG-CoAisconvertedtomevalonatebyHMG-CoA
reductase,thekeyregulatoryenzymeofcholesterolsynthesis.

---

306.Lipoproteininvolvedinreverse
cholesteroltransport?
a)LDL
b)VLDL
c)IDL
d)HDL
CorrectAnswer-D
TheHDLparticlesarereferredtoasscavengersbecausetheir
primaryroleistoremovefree(unesterified)cholesterolfromthe
extrahepatictissues.
HDLparticlestransportcholesterolfromextrahepatictissuestothe
liver(i.e.reversecholesteroltransport)whichisthenexcreted
throughbile.
Reversecholesteroltransport
Allnucleatedcellsindifferenttissuessynthesizecholesterol,butthe
excretionofcholesterolismainlybytheliverinthebileorby
enterocytesinthegutlumen.So,cholesterolmustbetransported
fromperipheraltissuetotheliverforexcretion.Thisisfacilitatedby
HDLandiscalledreversecholesteroltransportbecauseittransports
thecholesterolinreversedirectiontothatistransportedfromthe
livertoperipheraltissuesthroughtheVLDLLDLcycle.
Process
HDLissynthesizedintheliverandsmallintestine.NascentHDL
containsphospholipidsandunesterifiedcholesterolandApo-A,C,E.
ThisnascentHDLissecretedintocirculationwhereitacquires
additionalunesterifiedcholesterolfromperipheraltissues.Withinthe
HDLparticle,thecholesterolisesterifiedbylecithin-cholesterol
acetyltransferase(LCAT)toformcholesterylesterandadditional

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lipidistransportedtoHDLfromVLDLandchylomicrons.Apo-
A1activatesLCAT.

---

307.Lipoproteinassociatedwithcarrying
cholesterolfromperipheraltissuesto
liveris?
a)HDL
b)LDL
c)VLDL
d)IDL
CorrectAnswer-A
Thetotalbodycholesterolcontentvariesfrom130-150grams.
LDL(low-densitylipoprotein)transportscholesterolfromtheliverto
theperipheraltissuesandHDL(high-densitylipoprotein)transports
cholesterolfromtissuestotheliver.
CellsofextrahepatictissuestakeupcholesterolfromLDL.

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308.Enzymedeficientingangliosidoses?
a)-glucuronidase
b)Iduronidase
c)-galactosidase
d)Hyaluronidase
CorrectAnswer-C
Ans.'C'-galactosidase
Generalizedgangliosidosesisalipidstoragedisorder.
Enzymedefect--galactosidase
Lipidaccumulates-Ganglioside(GM1)
Clinicalfeatures-Mentalretardation,hepatomegaly,skeletal
deformities.Foamcellsinthebonemarrow.Cherryredspotinthe
retina.

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309.Huntersyndromeisduetodeficiencyof
a)Betagalactosidase
b)Sphingomyelinase
c)IduronateSulfatase
d)Hyaluronidase
CorrectAnswer-C
Ans.is'c'i.e.,IduronateSulfatase

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310.Tay-Sachdiseaseisduetodeficiencyof
a)HexosaminidaseA
b)HexosaminidaseB
c)Sphingomyelinase
d)-galactosidase
CorrectAnswer-A
Ans.is.A.HexosaminidaseA

---

311.Alcoholismetabolizedby?
a)Alcoholdehydrogenase
b)MEOS
c)Catalase
d)Alloftheabove
CorrectAnswer-D
Ethylalcohol(ethanol)isreadilyabsorbedfromGITanddegraded
byoxidation(oxidativeprocess).
Liveristhemajorsiteforethanoloxidation.
Atleastthreeenzymesystemsarecapableofethanoloxidation:-
i)Alcoholdehydrogenase(ADH)Majorpathway
ii)Microsomalethanoloxidisingsystem(MEOS):Itinvolves
cytochromeP450.
iii)Catalaseofperoxisomes.
Theproductofallthreeoxidationpathwaysisacetaldehyde,whichis
rapidlyoxidizedtoacetatebyaldehydedehydrogenase(ALDH).

---

312.Oxidationofverylongchainfattyacids
takesplacein?
a)Cytosol
b)Mitochondria
c)Ribosomes
d)Peroxisomes
CorrectAnswer-D
Amodifiedformof-oxidationisfoundinperoxisomesandleadsto
thebreakdownofvery-long-chainfattyacids(eg,C20,C22)withthe
formationofacetyl-CoAandH2O2,whichisbrokendownby
catalase.
Thissystemisnotlinkeddirectlytophosphorylationandthe
generationofATP,andalsodoesnotattackshorter-chainfatty
acids.
Theperoxisomalenzymesareinducedbyhigh-fatdietsandinsome
speciesbyhypolipidemicdrugssuchasclofibrate.
Anotherroleofperoxisomal-oxidationistoshortenthesidechain
ofcholesterolinbileacidformation

---

313.whichofthefollowingoccursonlyin
mitochondria
a)ECT
b)Ketogenesis
c)Ureacycle
d)Steroidsynthesis
CorrectAnswer-C
Ans.D.UreaCycle
Ketogenesisoccursprimarilyinthemitochondriaoflivercells.
Fattyacidsarebroughtintothemitochondriaviacarnitine
palmitoyltransferase(CPT-1)andthenbrokendownintoacetyl
CoAviabeta-oxidation
Ineukaryotes,animportantelectrontransportchainisfoundin
theinnermitochondrialmembranewhereitservesasthesiteof
oxidativephosphorylationthroughtheactionofATPsynthase.
Mitochondriaareessentialsitesforsteroidhormone
biosynthesis.Mitochondriainthesteroidogeniccellsofthe
adrenal,gonad,placentaandbraincontainthecholesterolside-
chaincleavageenzyme,P450scc,anditstwoelectron-transfer
partners,ferredoxinreductaseandferredoxin.Thisenzyme
systemconvertscholesteroltopregnenoloneanddetermines
netsteroidogeniccapacity,sothatitservesasthechronic
regulatorofsteroidogenesis.
ureaisproducedthroughaseriesofreactionsoccurringin
thecytosolandmitochondrialmatrixoflivercellsboth

---

314.Whichofthefollowingisnota
glycerosphingolipid?
a)Lecithin
b)Cardiolipin
c)Plasmalogens
d)Sphingomyelin
CorrectAnswer-D
Phospholipidsare:
i. Glycerophospholipids(glycerolcontaining):-Phosphatidylcholine
(lecithin),phosphatidylethanolamine(cephaline),phosphatidylserine,
phosphatidylinositol,plasmalogens,lysophospholipids,cardiolipin.
ii. Sphingophospholipids(sphingosinecontaining):-Sphingomyelin

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315.Highestmobilityonelectrophoresis
a)HDL
b)VLDL
c)LDL
d)Chylomicrons
CorrectAnswer-A
Asinlipoproteinelectrophoresis,HDLshowsthehighest
mobilityfollowedbyVLDL,IDL,andLDL.
Chylomicronsmigrateaccordingtotheirnet-charge
betweenHDLandVLDLbecauseisotachophoresishasnegligible
molecularsieveeffects.

---

316.Inargininosuccinasedeficiency,what
shouldbesupplementedtocontinuethe
ureacycle?
a)Aspartate
b)Arginine
c)Citrullin
d)Argininosuccinate
CorrectAnswer-B
Argininosuccinase(argininosuccinatelyase)catalyzesthecleavage
ofargininosuccinateintoarginineandfumarate.Thus,in
argininosuccinasedeficiency,argininecannotbeproduced.
Supplementationwithargininebasehelpsreplenishthisaminoacid.

---

317.Immediateprecursorofcreatine
a)Carbamoylphosphate
b)Arginosuccinate
c)Guanidoacetate
d)Citrulline
CorrectAnswer-C
Ans.'C'Guanidoacetate
Creatineandcreatininearenotaminoacids,butspecialized
productsofaminoacids.
Creatineissynthesizedfromglycine,arginine,andmethionine.
Thesynthesisstartswiththeformationofguanidinoacetatefrom
glycineandarginineinthekidney.
Furtherreactionstakeplaceintheliverandmuscle.

---

318.Whichoneofthefollowingcanbeahomologoussubstitutionforisoleucine
inaproteinsequence?
a)Methionine
b)Asparticacid
c)Valine
d)Arginine
CorrectAnswer-C
Isoleucineisoneoftheaminoacidwithanaliphaticsidechain.
Otheraminoacidswithanaliphaticsidechainisglycine,alanine,valineandleucine.
Amongtheoptionsprovided,valineistheonlyaminoacidwithanaliphaticsidechainand
soitcanbeahomologoussubstitutionforisoleucineinaproteinsequence.
Ref:Harper'sIllustratedBiochemistry,26thEdition,Chapter3,Page15;HumanGene
EvolutionByDavidN.Cooper,1999,Page299.

---

319.Bondinvolvedinformationofprimary
structureofprotein/polypeptide?
a)Hydrogen
b)Peptide
c)Disulfide
d)aandbboth
CorrectAnswer-D
Ans:D.aandbboth
Theprimarystructureisstabilizedbyapeptidebond,whichisatype
ofcovalentbond
Bondsresponsibleforproteinstructure
Twotypesofbondsstabilizeproteinstructure:-
Covalent(strong):-Peptidebonds,Disulfidebond.
Non-covalent(weak):-Hydrogenbond,hydrophobicinteractions,
electrostatic(orionicorsalt)bond,VanderWaalsinteractions.

---

320.Ureaissynthesizedinallexcept
a)Liver
b)Brain
c)Kidney
d)Spleen
CorrectAnswer-D
Ureaissynthesizedinliverbutsmallquantities(notsignificant)may
beformedinbrainandkidneyalso.
Ammoniaisultimatelydisposedofbyformationofureaby"Kreb's
Henseleitureacycle"intheliver.
Ureacycletakesplacebothinmitochondriaandcytosol.
Firsttworeactionsofureacycleoccurinthemitochondria,and
remainingreactionsoccursincytosol

---

321.Ratelimitingstepinureacycleis
catalyzedby?
a)Arginase
b)Argininosuccinase
c)Carbamoyl-phosphatesynthase
d)Ornithinetranscarbamylase
CorrectAnswer-C
Ans.is'c'i.e.,Carbamoyl-phosphatesynthase
Biosynthesisofureaoccursinfivesteps.
1)Carbamoylphosphatesynthase-I(CPS-I),amitochondria!
enzyme,catalyzestheformationofcarbamoylphosphateby
condensationofCO,andammonia.TwomoleculesofATPare
requiredforthereaction.CPS-Iistheratelimitingenzymeofurea
cycle.ItisanallostericenzymeandallostericallyactivatedbyN-
acetylglutamate.
Thereisonecytosoliccarbamylphosphatesynthase-II(CPS-II)
whichusesglutamineratherthanammoniaasthenitrogendonor
andfunctionsinpyrimidinesynthesis.
2)Ornithinetranscarbamoylasecatalyzestheformationofcitrulline
fromcarbamoylphosphateandornithine.
3)Arginosuccinatesynthasecatalyzestheformationof
arginosuccinatefromcitrullineandaspartate.ThisreactionrequiresI
ATP,but2highenergyphosphatebondsareconsumedasATPis
convertedtoAMP+PPi.Theaminogroupofaspartateprovidesone
ofthetwonitrogenatomsthatappearinurea(Theotheroneis
providedbyammoniaNH4).
4)Arginosuccinatelyase(arginosuccinase)catalysesthecleavage
ofarginosuccinateintoarginineandfumarate.Fumarateentersin
TCAcycle.

---

TCAcycle.
5)Arginasecatalysestheformationofureafromarginineby
hydrolyticcleavageofargininetoyieldureaandornithine.Ornithine
isthusregeneratedandcanentermitochondriatoinitiateanother
roundoftheureacycle.

---

322.Citrullinemiaisduetodeficiencyof?
a)Argininosuccinatelyase
b)Argininosuccinatesynthase
c)Arginase
d)Ornithinetranscarbamylase
CorrectAnswer-B
Ans.is.B.Argininosuccinatesynthase

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323.Aminoacidcarryingammoniafrom
muscletoliver?
a)Alanine
b)Glutamine
c)Arginine
d)Lysine
CorrectAnswer-A
Ans.is'a'i.e.,Alanine.
DISPOSAL/DETOXIFICATIONOFAMMONIA
1.FirstlineofDefense(Trappingofammonia)
Beinghighlytoxic,ammoniashouldbeeliminatedordetoxified,as
andwhenitisformed.Evenveryminutequantityofammoniamay
producetoxicityincentralnervoussystem.
But,ammoniaisalwaysproducedbyalmostallcells,including
neurons.
Theintracellularammoniaisimmediatelytrappedbyglutamicacidto
formglutamine,especiallyinbraincells.
Theglutamineisthentransportedtoliver,wherethereactionis
reversedbytheenzymeglutaminase.
Theammoniathusgeneratedisimmediatelydetoxifiedintourea.
Asparticacidmayalsoundergosimilarreactiontoformasparagine.
2.TransportationofAmmonia
Insidethecellsofalmostalltissues,thetransaminationofamino
acidsproduceglutamicacid.
However,glutamatedehydrogenaseisavailableonlyintheliver.
Therefore,thefinaldeaminationandproductionofammoniais
takingplaceintheliver.
Thus,glutamicacidactsasthelinkbetweenaminogroupsofamino

---

acidsandammonia.
Theconcentrationofglutamicacidinbloodis10timesmorethan
otheraminoacids.
Glutamineisthetransportformsofammoniafrombrainand
intestinetoliver;whilealanineisthetransportformfrommuscle.
3.Finaldisposal
Theammoniafromalloverthebodythusreachesliver.Itisthen
detoxifiedtoureabylivercells,andthenexcretedthroughkidneys.
Ureaistheendproductofproteinmetabolism.
Transportofalaninefrommuscletoliver(glucose-alanine
cycle)hastwofunctions:?
i)Providingsubstrateforgluconeogenesis
ii)Transportofammonia(NH4-)toliverforureasynthesis.

---

324.Mousyodorofurineisseenin?
a)Alkaptunuria
b)Phenylketonuria
c)Hartnupdisease
d)Albinism
CorrectAnswer-B

---

325.Cabbage-likeodourisseenin?
a)Alkaptonuria
b)Phenylketonuria
c)Hartnupdisease
d)Tyrosinemia
CorrectAnswer-D
Ans.is.D.Tyrosinemia

---

326.Ifurinesampledarkensonstanding:the
mostlikelyconditionsis?
a)Phenylketonuria
b)Alkaptonuria
c)Maplesyrupdisease
d)Tyrosinemia
CorrectAnswer-B
Ans.is'b'i.e.,Alkaptonuria
Alkaptonuria
Itisduetodeficiencyofhomogentisateoxidase.Asaresult
homogentisicacid(homogentisate)isexcretedexecessivelyinurine.
Therearcthreeimportantcharacteristicfeaturesinalkaptonuria?
i)Urinebecomesdarkafterbeingexposedtoair.Itisdue
spontaneousoxidationofhomogentisateintobenzoquinoneacetate,
whichpolymersetoformblack-brownpigmentalkaptonwhich
impartsacharacteristicblack-browncolourtourine.
ii)Alkaptondepositionoccursinsclera,ear,nose,cheeksand
intervertebraldiscspace.Aconditioncalledochronosis.Theremay
becalcificationofintervertebraldiscs.
iii)Onchronosisarthritisaffectingshoulder,hips,knee.
Benedict'stestisstronglypositiveinurineandsoistheferric
chloride(FeC13)test.Benedict'sreagentgivesagreenishbrown
precipitatewithbrownishblacksupernatent.Fehling'sreagent
(FeC13)givesbluegreencolour.

---

327.DerivativeofPOMC
a)Norepinephrine
b)Dopamine
c)ACTH
d)Acetylcholine
CorrectAnswer-C
Pro-opiomelanocortin(POMC)comprises285aminoacidresidues
(MW31000)andservesasaprecursorofmany
proteins/polypeptide.
DerivativesofPOMCare:-
i)Pituitaryhormones:ACTH,MSH
ii)-lipotropichormone(-LPH)
iii)-lipotropichormone(-LPH)
iv)-endorphin
v)CLIP(corticotropin-likeintermediatelobepeptide).

---

328.Cofactorfordopaminehydroxylase?
a)Fe
b)Mg
c)Mn
d)Cu
CorrectAnswer-D
Dopamine8-hydroxylaseisa'copper'containingmonooxygenase
thatrequiresascorbicacidandmolecularoxygen.
Itcatalyzestheformationofnorepinephrine.

---

329.Notanessentialaminoacid?
a)Arginine
b)Histidine
c)Glutamate
d)Lysine
CorrectAnswer-C
Ans'C'Glutamate
EssentialorIndispensable
Theaminoacidsmayfurtherbeclassifiedaccordingtotheir
essentialityforgrowth.Theyare
Isoleucine
Leucine
Threonine
Lysine
Methionine
Phenylalanine
Tryptophan
Valine

---

330.Nicotinicacidisderivedfrom?
a)Glutamine
b)Tryptophan
c)Glutathione
d)Phenylalanine
CorrectAnswer-B
Ans.'B'Tryptophan.
NicotinicAcidPathwayofTryptophan-
About97%ofmoleculesoftryptophanaremetabolizedinthemajor
pathway.About3%ofmoleculesaredivertedatthelevelof3-
hydroxyanthranilicacid,toformNAD+.
Theenzyme,QPRT(quinolinatephosphoribosyltransferase)is
therate-limitingstep.
About60mgoftryptophanwillbeequivalentto1mgofnicotinic
acid.Thedevelopmentofpellagralikesymptomsinthemaizeeating
populationisduetotryptophandeficiencyinmaize.
Hydroxyanthranilateproductionisdependentonpyridoxal
phosphate.HenceinvitaminB6deficiency,nicotinamidedeficiency
isalsomanifested.

---

331.AminoacidswithextraNH (amino
2
group)instructure-
a)Aspartate
b)Glutamate
c)Histidine
d)Alanine
CorrectAnswer-C
Ans.is.C.Histidine
Theaminoacidswillundergoalphadecarboxylationtoformthe
correspondingamine.
Someimportantaminesareproducedfromaminoacids.For
example,
HistidineHistamine+CO2
TyrosineTyramine+CO2
TryptophanTryptamine+CO2
LysineCadaverine+CO2
GlutamicacidGamma-aminobutyricacid(GABA)+CO2

---

332.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

---

333.Whichofthefollowingaminoacidsis
purelyketogenic?
a)Phenylalanine
b)Leucine
c)Proline
d)Tyrosine
CorrectAnswer-B
Ans:B.)Leucine
Aminoacids:
Ketogenic:
Leucine,Lysine
Glucogenic:
Valine,Cysteine,Serine,Alanine,Histidine,Threonine,Arginine,
Glycine,Glutamate,Proline/Hydroxyproline
BothGlucogenic&Ketogenic:
Isoleucine,Tyrosine,Tryptophan,Phenylalanine

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334.Aminoacidwhichisopticallyinert?
a)Valine
b)Alanine
c)Glycine
d)Threonine
CorrectAnswer-C
Ans.'C'Glycine
Thea-carbonofaminoacidshasfourdifferentgroupsattachedtoit
andsoisachiralorasymmetriccarbon.
Hence,therearetwopossibleenantiomers,LandD,i.e.,mirror
imagewithreferenceto-carbon.
Thechiralcarbonisalsoresponsibleforopticalactivityand
stereoisomerism.
Theonlyexceptionisglycine,whichisthesimplestaminoacid.
Glycinehasnochiralcarbon(chirality)becausea-carbonofglycine
doesnothavefourdifferentgroupsattachedtoit.
ThereforeglycinedoesnothaveopticalactivityorDandLforms
(enantiomers).

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335.AlphahelixandBetapleatedsheetare
examplesof?
a)Primary
b)Secondarystructure
c)Tertiary
d)Quaternarystructure
CorrectAnswer-B
Ans.'B'Secondarystructure
Structuralorganizationofproteins
Everyproteinhasauniquethree-dimensionalstructure,whichis
referredtoasitsnativeconformationandmadeupofonly20
differentaminoacids.Proteinstructurecanbeclassifiedintofour
levelsoftheorganization.
1)Primarystructures
Thelinearsequenceofaminoacidresiduesandthelocationof
disulfidebridges,ifany,inapolypeptidechainconstituteits
primarystructure.Insimplewords,theprimarystructureof
proteinsreferstothespecificsequenceofaminoacids.The
primarystructureismaintainedbythecovalent'peptide'bond.
2)Secondarystructure
Forstabilityoftheprimarystructure,hydrogenbondingbetweenthe
hydrogenofNHandoxygenofC=0groupsofthepolypeptide
chainoccurs,whichgivesrisetotwisting,foldingorbendingofthe
primarystructure.Thus,regularfoldingandtwistingofthe
polypeptidechainbroughtaboutbyhydrogenbondingiscalled
secondarystructure.Importanttypesofsecondarystructures
area-helix,beta-pleatedsheet,andbeta-bends.
3)Tertiarystructure

---

Thepeptidechain,withitssecondarystructure,maybefurtherfolded
andtwistedaboutitselfformingthree-dimensionalarrangementof
thepolypeptidechain,i.e.,tertiarystructurereferstotheoverall
foldingpatternofapolypeptidewhichformsthethree-dimensional
shape.Thetertiarystructure(three-dimensionalshape)is
maintainedbyweaknon-covalentinteractionswhich
includehydrogenbonds,hydrophobicinteractions,ionicbond
(electrostaticbondsorsaltbridges)andVan-derwall
forces.Covalentlinkage(disulfidebond)alsoplayssome(butminor)
role.
4)Quaternarystructure
Manyproteinsaremadeupofmorethanonepolypeptidechain
(polymers).Eachpolypeptidechainisknownasprotomer(or
subunit).Thesubunitislinkedwitheachotherbynon-covalent
bonds.Thestructureformedbytheunionofsubunitsisknownas
quaternarystructure,i.e.,thespatialrelationofsubunits(peptide
chains)withoneanotheriscalledthequaternarystructure.Mainly
threenon-covalentbondsstabilizequaternary
structure:Hydrophobic,hydrogenandionic(electrostatic).
Dimericproteinscontaintwopolypeptidechains.Homodimers
containtwocopiesofthesamepolypeptidechain,whileina
heterodimerthepolypeptidesdiffer.

---

336.Cystathioninelyaserequireswhich
cofactor?
a)Thiamine
b)Riboflavin
c)Pyridoxine
d)Niacin
CorrectAnswer-C
Ans.'C'Pyridoxine
Hydrolyticcleavage(hydrolysis)ofcystathionineformsHomoserine
pluscysteine.
Thisreactioniscatalyzedbytheenzymecystathioninelyase
(cystathionase),whichrequirescofactorpyridoxalphosphate(the
activeformofpyridoxine).

---

337.Taurineismadefrom?
a)Glycine
b)Tyrosine
c)Cysteine
d)Phenylalanine
CorrectAnswer-C
Ans.is'c'i.e.,Cysteine
Taurineissynthesizedfromcysteine.

---

338.Iftyrosinelevelinbloodisnormal
withoutexternalsupplementation,
deficiencyofwhichofthefollowingis
ruledout?
a)Tryptophan
b)Phenylalanine
c)Histidine
d)Isoleucine
CorrectAnswer-B
Ans.is'b'i.e.,Phenylalanine
Tyrosineissynthesizedfromphenylalanine.
Inphenylalaninedeficiencyorindisordersinwhichphenylalanine
cannotbeconvertedintotyrosine(phenylketonuria),tyrosine
becomesanessentialaminoacidandshouldbesupplementedfrom
outside.

---

339.Nitrogen-9ofpurineringisprovidedby?
a)Glycine
b)Aspartate
c)Glutamine
d)CO2
CorrectAnswer-C
Indenovosynthesis,purineringisformedfromvarietyofprecursors
isassembledonribose-5-phosphate.Precursorsfordenovo
synthesisare-
i)GlycineprovidesC4,C5andN7
ii)AspartateprovidesN1
iii)GlutamineprovidesN3andN9
iv)TetrahydrofolatederivativesfurnishC2andC8
v)CarbondioxideprovidesC6

---

340.Firstproductofpurinemetabolism
a)Uricacid
b)Xanthine
c)P-alanine
d)CO2
CorrectAnswer-B
Humanscatabolizepurinestouricacid.
But,firstpurinesarecatabolizedtoxanthine,whichisfurther
catabolizedtopurine.

---

341.Allantoinistheendproductof
metabolismof?
a)Glycogen
b)Purine
c)Pyrimidine
d)Histidine
CorrectAnswer-B
Innon-primatemammals,endproductofpurinemetabolismis
allantoinduetopresenceofenzymeuricase.Uricaseconvertesuric
acidtoallantoin.
Humanslacktheenzymeuricase.Therefore,endproductofpurine
catabolisminhumansisuricacid.

---

342.Firstpurinenucleotide,whichis
synthesizedinpurinebiosynthesis?
a)AMP
b)GMP
c)IMP
d)UMP
CorrectAnswer-C
Thebiosynthesisofpurinebeginswithribose-5-phosphate,derived
frompentosephosphatepathway(PPP).
Firstintermediateformedinthispathway,5-phosphoribosyl-
pyrophosphate(PRPP),isalsoanintermediateinpurinesalvage
pathway.

---

343.Salvagepathwayofpurinebiosynthesis
isimportantfor?
a)Liver
b)RBCs
c)Kidney
d)Lung
CorrectAnswer-B
Purinenucleotidesynthesisoccursbytwopathways:
1.Denovosynthesis
2.Salvagepathway
Liveristhemajorsiteofpurinenucleotidebiosynthesis(denovo).
Certaintissuescannotsynthesizepurinenucleotidesbydenovo
patyway,eg.brain,erythrocytesandpolymorphonuclearleukocytes.
Thesearedependentonsalvagepathwayforsynthesisofpurine
nucleotidesbyusingexogenouspurines,whichareformedby
degradationofpurinenucleotidessynthesizedinliver.

---

344.Vitamininvolvedindecarboxylation?
a)Biotin
b)Pyridoxine
c)Niacin
d)Thiamine
CorrectAnswer-B
Ans.is.B.Pyridoxine
Pyridoxalphosphateisacoenzymeformanyenzymesinvolvedin
amino1309acidmetabolism,especiallytransaminationand
decarboxylation.
Itisalsothecofactorofglycogenphosphorylase,wherethe
phosphategroupiscatalyticallyimportant.Inaddition,itisimportant
insteroidhormoneaction.
Pyridoxalphosphateremovesthehormone-receptorcomplexfrom
DNAbinding,terminatingtheactionofthehormones.

---

345.VitaminCisrequiredfor?
a)Posttranslationalmodification
b)Synthesisofepinephrine
c)Tyrosinemetabolism
d)Alloftheabove
CorrectAnswer-D
VitaminC(ascorbicacid)
Ascorbicacid(VitaminC)isalsocalledantiscorbuticfactor.
Itisveryheatlabile,especiallyinbasicmedium.
Ascorbicaciditselfisanactiveform.
MaximumamountofvitaminCisfoundinadrenalcortex.
Ascorbicacidfunctionsasareducingagentandscavangeroffree
radicals(antioxidant).Itsmajorfunctionsare:-
i)Incollagensynthesis:-VitaminCisrequiredforpost-translational
modificationbyhydroxylationofprolineandlysineresidues
convertingthemintohydroxyprolineandhydroxylysine.Thusvitamin
Cisessentialfortheconversionofprocollagentocollagen,whichis
richinhydroxyprolineandhydroxylysine.Throughcollagen
synthesis,itplaysaroleinformationofmatrixofbone,cartilage,
dentineandconnectivetissue.
ii)Synthesisofnorepinephrinefromdopaminebydopamine-(3-
monoxygenase(dopamine-13-hydroxylase)requiresVitaminC.
iii)Carnitinesynthesis
iv)Bileacidsynthesis:-7-a-hydroxylaserequiresvitaminC.
v)Absorptionofironisstimulatedbyascorbicacidbyconversionof
ferrictoferrousions.
vi)Duringadrenalsteroidsynthesis,ascorbicacidisrequiredduring

---

hydroxylationreactions.
vii)Tyrosinemetabolism-OxidationofP-hydroxy-phenylpyruvateto
homogentisate.
viii)Folatemetabolism-Folicacidisconvertedtoitsactiveform
tetrahydrofolatebyhelpofVitaminC.

---

346.Mostimportantvitamin,whichpromotes
woundhealing?
a)VitaminC
b)VitaminD
c)VitaminA
d)Niacin
CorrectAnswer-A
VitaminCisrequiredforcollagensynthesis.
Duetoitsimportantroleincollagensynthesis,vitaminCisrequired
foradequatewoundhealing.

---

347.Deficiencyofwhichvitamincauses
excretionofxantheurenicacidinurine?
a)Folicacid
b)Pyridoxin
c)Niacin
d)VitaminB12
CorrectAnswer-B
Ans.is'b'i.e.,Pyridoxin

---

348.FIGLUexcretiontestisusedfor
assessmentofdeficiencyof?
a)VitaminB12
b)Niacin
c)Folicacid
d)Pyridoxin
CorrectAnswer-C
Ans.is'c'i.e.,Folicacid
Assessmentoffolatedeficiency
Followingtestsarcusedforassessmentoffolatedeficiency.
i)Bloodlevel:-Normallevelinserumisabout2-20nanogram/ml
andabout200micorgram/mlofpackedcells.
ii)HistidineloadtestorFIGLUexcretiontest:-Histidineisnormally
metabolizedtoformiminoglutamicacid(FIGLU)fromwhich
formiminogroupisremovedbyTHF.Thereforeinfolatedeficiency,
FIGLUexcretionisincreasedinurine.

---

349.NotacomponentofPCR?
a)Primer
b)Taqpolymerase
c)DNAPolymerase
d)Restrictionenzyme
CorrectAnswer-D
StepsinPCR
PCRusesDNApolymerasetorepetitivelyamlifytargetedportionof
DNA.EachcycledoublestheamoutofDNAinthesample,leading
toexponentialincreasewithrepeatedcyclesofamplification.Thus
amplificationafter'n'numberofcyclein(2)".Twentycyclesprovide
anamplificationof106(million)and30cyclesof109(billion).
PCRoccursinfollowingsteps-
i)IsolationoftargetDNAsequence:-
ii)Primersconstruction:-
iii)DenaturationofDNA:-
iv)AnnealingofprimerstosinglestrandedDNA:-
v)Chainextension:-
ThusfollowingarerequiredinPCR:-TargetdoublestrandedDNA,
twospecificprimers,athermostableDNApolymerase(Taq
polymerase),deoxyribonucleotides(dNTP).

---

350.WhichisnotastepofPCR?
a)Annealing
b)Extension
c)Transformation
d)Denaturation
CorrectAnswer-C
Ans.is'c'i.e.,Transformation[RefLippincott's5thlep.479-83;
Harper28th/ep.395]StepsinPCR
IsolationoftargetDNAsequencePrimerconstruction
DenaturationofDNAAnnealingofprimerstosinglestranded
DNAChainextension.

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351.Northernblotisusedtodetect?
a)Protein
b)Immunoglobulin
c)RNA
d)DNA
CorrectAnswer-C
Ans:C.RNA
VisualizationofaspecificDNAorRNAfragmentamongthemany
thousandofcontaminatingmoleculesrequirestheconvergenceof
numberoftechniquescollectivelytermedtheblottransfer.
SouthernblotDetectsDNA
NorthernblotDetectsRNA
WesternblotDetectsproteins(proteinsareseparatedby
electrophoresis,renaturedandanalysedforaninteractionby
hybridizationwithaspecificlabelledDNAprobe).

---

352.Sexdeterminingregionislocatedon?
a)LongarmofYchromosome
b)ShortarmofYchromosome
c)LongarmofXchromosome
d)ShortarmofXchromosome
CorrectAnswer-B
ProductofSRYgeneissex-determiningregionYprotein.
Thisproteinisinvolvedinmalesexualdevelopment.

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353.Whichofthefollowingisanucleoside?
a)Adenine
b)Uridine
c)Thymine
d)Guanine
CorrectAnswer-B
Ans.is.B.Uridine

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354.RNApolymerasehaswhichactivity
a)Primase
b)Helicase
c)Ligase
d)Topoisomerase
CorrectAnswer-A
DNAsynthesiscannotcommencewithdeoxyribonucleotides
becauseDNApolymerasecannotaddamononucleotidetoanother
mononucleotide.
Thus,DNApolymerasecannotinitiatesynthesisofcomplementary
DNAsynthesisstrandofDNAonatotallysinglestrandedtemplate.
Forthis,theyrequireRNAprimer,whichisashortpieceofRNA
formedbyenzymeprimase(RNApolymerase)usingDNAasa
template.
RNAprimeristhenextendedbyadditionofdeoxyribonucleotides.
Lateron,theribonucleotidesoftheprimerarereplacedby
deoxyribonucleotides.
PrimaseisactuallyaDNAprimasewhichhasRNApolymerase
activity.ThisDNAprimaseisalsocalledDNApolymerase.

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355.NumberofstructuralgeneinLacoperon
a)3
b)4
c)5
d)6
CorrectAnswer-A
LactoseoperoneorLacoperon
ThelacoperonisaregionofDNAinthegenomeofE.colithat
containsfollowinggeneticelements?
i)Threestructuralgenes:-Thesecodefor3proteinsthatare
involvedincatabolismoflactose.Thesegenesare'Z'gene(codes
forP-galactosidase),'Y'gene(codesforgalactosidepermease),and
'A'gene(codesforthiogalactosidetransacetylase).
ii)Regulatorygene(laci)Itproducesrepressorprotein.
iii)Apromotorsite(P):-ItisthebindingsiteforRNApolymerase.It
containstwospecificregions?
a)CAPsite(Cataboliteactivatorproteinbindingsite).
b)RNApolymerasebindingsite
iv)Anoperatorsite(0):-Repressorbindstothissiteandblocks
transcription.
3Structuralgenesareexpressedonlywhen'0'siteisempty
(repressorisnotbound)andtheCAPsiteisboundbyacomplexof
cAMPandCAP(catabolitegeneactivatorprotein).

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356.Theenzymeinvolvedininitiationof
peptidechainsynthesis-
a)Topoisomerase
b)Transformylase
c)RNApolymerase
d)Peptidyltransferase
CorrectAnswer-B
Ans.'B'Transformylase
Stepsineukaryotictranslation(proteinsynthesis)
Therearethreemajorsteps,inproteinsynthesis(translation):-(i)
Initiation,(ii)Elongation;and(iii)Termination.
Inprokaryotesandinmitochondria,thefirstaminoacidmethionine
ismodifiedbyformylation,i.e.theinitiatortRNAcarriesanN-
formylatedmethionine.Theformylgroupisaddedbytheenzyme
transformylase(formyl-transferase).
InEukaryotes,theinitiatortRNAcarriesamethioninethatisnot
formylated.

---

357.MostcommonphysiologicalformofDNA
a)A-form
b)B-form
c)Z-form
d)C-form
CorrectAnswer-B
DNAcanexistinatleastsixforms,i.e.A,B,C,D,EandZ.
TheB-formofDNAisthemostcommonformofDNAandisright-
handedhelix.
ItisthestrandardDNAstructurewith10basepairsperturn.
WatsonandCrickmodeldescribestheB-formofDNA.
OtherformsofDNAareA-form(contains11basepairsperturnand
isrighthandedhelix)andZ-form(contains12basepairsperturn
andislefthandedhelix).
Z-formisfavoredbyalternatingG-Csequencesinalcoholandhigh
saltsolution;andisinhibitedbyalternatingA-Tsequnces(Note-B
formhasminimumbasepairsperturn,i.e.10).

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358.Quarternaryammoniumcompound
disinfectantsare?
a)Anionic
b)Cationic
c)Neutral
d)Gases
CorrectAnswer-B
Quaternaryammoniumcompoundsarecationicdetergents.
Theyhavemicrocidalandviricidalactivities.
Theycanbeusedforinstrumentdisinfectionandskinantisepsis.

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359.AST/ALT>2occursindeficiencyof
a)Glucose-6-phosphotase
b)Branchingenzyme
c)Acidmaltase
d)Liverphosphorylase
CorrectAnswer-C
Ans.is'c'i.e.,Acidmaltase[RefReadbelow]
Inliverdiseases,ALT(alaninetransaminase)iselevatedmorethan
AST(aspartatetransaminase).So,inliverdiseasesALT/ASTratio
iselevated.
But,whenASTishigherthanALT,amuscle,sourceofthese
enzymesshouldbeconsidered.
Amongthegivenoptions,onlyacidmaltasedeficiency(Pompe's
disease)ismyopathicformofglycogenstoragedisease(muscular
glycogenosis).Thus,AST/ALTratiomaybemorethan2.
Otherthreeoptionsareliverglycogenoses(AST/ALT<1,asALTis
raisedmorethanAST).

---

360.Ratelimitingstepinhemesynthesisis
catalyzedby?
a)ALAdehydratase
b)ALAsynthase
c)UPGdecarboxylase
d)Ferrochelatase
CorrectAnswer-B
Ans.B.ALAsynthase
Synthesisofheme
Hemesynthesistakesplaceinallcells,butoccurstogreatestextent
inbonemarrowandliver.
Thefirststepinthesynthesisofhemeisthecondensationofglycine
andsuccinylCo-Atoform&-aminolevulinicacid(Delta-ALA),which
occursinmitochondria.
ThisreactioniscatalyzedbyDelta-ALAsynthasewhichrequires
pyridoxalphosphate(PLP)ascofactor.
Thisistheratelimitingstepinhemesynthesis.

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361.Ratelimitingstepinporphyrine
synthesis-
a)ALAdehydratase
b)ALAsynthase
c)UPGdecarboxylase
d)Ferrochelatase
CorrectAnswer-B
Ans.is.B.ALAsynthase

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362.Hemesynthesisrequires
a)Ferrousiron
b)Glycine
c)SucchylCoA
d)All
CorrectAnswer-D

---

363.Endproductofporphyrinmetabolism?
a)Albumin
b)CO2&NH2
c)Bilirubin
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Bilirubin
Hemeisthemostimportantporphyrin.
Itisdegradedintobilirubin.

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364.Strongestinteractionsamongthe
following
a)Covalent
b)Hydrogen
c)Electrostatic
d)VanderWaals
CorrectAnswer-A
Ans.A.Covalent
StrongestbondCovalent
WeakestbondVanderwalsforces
Moleucularinteractions
Therearetwotypesofinteractionsbetweenmoleculesthatstabilize
molecularstructures:-
1. Covalentbonds,e.g.peptidebondsanddisulphidebonds.
2. Non-covalentbonds.

---

365.Whichofthefollowingisa
homopolysaccharide?
a)Heparin
b)Chitin
c)Hyaluronicacid
d)Chondroitinsulfate
CorrectAnswer-B
Ans.is'b'i.e.,Chitin
Polysaccharidesareclassifiedinto?
a)Homopolysaccharides(Homoglycans):-Thistypeof
polysaccharideismadeupofseveralunitsofsamemonosaccharide
unitonly.Examplesarestarch(multipleunitsofglucose),glycogen
(multipleunitsofglucose),cellulose(multipleunitsofglucose),Inulin
(multipleunitoffructose),Dextrin,Dextran(multipleunitsof
glucose),andchitin.
b)Heteropolysaccharides(Heteroglycans):-Thistypeof
polysaccharidecontainstwoormoredifferenttypesof
monosacharideunits.Examplesareheparin,heparansulfate,
chondroitinsulfate,dermatansulfate,hyaluronicacid,keratan
sulfateandbloodgrouppolysaccharides.

---

366.Proteinsareseparatedonthebasisof
chargein?
a)SDS-PAGE
b)Ultracentrifugation
c)Affinitychromatography
d)HPLC
CorrectAnswer-D
Ans.is'd'i.e.,HPLC

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367.Followingistrueregardingsulhydryl
groupsexcept?
a)TheyarepresentincoenzymeAandlipoicacid
b)TheyarepresentinCaptoprilandpenicillamine
c)Theyarenotinvolvedinreductionofperoxides
d)Theyarepresentincysteine
CorrectAnswer-C
Ans.is'c'i.e.,Theyarenotinvolvedinreductionofperoxides
SulfhydrylGroup(orthiolgroup)
ItisanSHgroupoforganiccompounds.
Sulfhydrylgroupshavegreatandvariedreactivity.Theyoxidize
easily,withtheformationofdisulfidesand
sulfenic,sulfinic,orsulfonicacids,andtheyreadilyundergo
alkylation,acylation,andthiol-disulfideexchange.
Theyformmercaptidesuponreactingwiththeionsofheavymetals,
andtheyformmercaptalsandmercaptolsuponreactingwith
aldehydesandketones,respectively.
Sulfhydrylgroupsplayanimportantroleinbiochemicalprocesses.
ThesulfhydrylgroupsofcoenzymeA,lipoicacid,and4'-
phosphopantotheineparticipateinenzymaticreactionsforthe
formationandtransferofacylresiduesthatarerelatedtolipidand
carbohydratemetabolism.
Thesulfhydrylgroupsofglutathioneplayanimportantroleinthe
neutralizationofforeignorganiccompoundsandthereductionof
peroxides;theyarealsoofmajorimportanceinthefulfillmentby
glutathioneofitsfunctionasacoenzyme.
Inproteins,residuesoftheaminoacidcysteinehavesulfhydryl
groups.

---

Ascomponentsoftheactivecentersofanumberofenzymes,
sulfhydrylgroupsparticipateinthecatalyticeffectoftheenzymes
andinthebindingofsubstrates,coenzymes,andmetalions.
Drugscontainingsulfhydrylgroupsare:captopril,zofenopriland
penicillamine.

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368.Replacementofcolumnarepitheliumin
respiratorytracttosquamousepithelium
is?
a)Hyperplasia
b)Hypoplasia
c)Metaplasia
d)Noneoftheabove
CorrectAnswer-C
Ans.is`c'i.e.,Metaplasia
Metaplasia
Metaplasiaisareversiblechangeinwhichonedifferentiatedcell
typeisreplacedbyanotherdifferentiatedcelltype.
Metaplasiarepresentsanadaptivesubstitutionofcellsthatare
sensitivetostressbycelltypesbetterabletowithstandtheadverse
environment.

---

369.Inapoptosis,proteinhydrolysisisdueto
activationof
a)lipases
b)Transcarboxylase
c)Catalase
d)Caspases
CorrectAnswer-D
Answer-D.Caspases
Theexecutionphaseofapoptosis
Inthisphase,initiatecaspases(Caspase-8&9)activateother
caspasesknownasexecutionCaspases(Caspases-3&7).After
beingactivatedthecaspasesactonmanycellularcomponents.
Inthenucleus,thetargetofcaspaseactivationincludesproteins
involvedintranscription,DNAreplication,andDNArepair.Caspases
activateendonucleases(DNAases)thatcausesdouble-stranded
breaksinDNA.

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370.Executioncaspasesofapoptosisare
a)Caspase1&3
b)Caspase3&5
c)Caspase1&5
d)Caspase3&7
CorrectAnswer-D
Answer-D.Caspase3&7
InitiatecaspasessCaspase-8&9.
ExecutioncaspasesCaspase-3&7.
Initiatecaspasesareactivatedininitiationphaseofapoptosis.

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371.Executioncaspasesofapoptosisare?
a)Caspase1&3
b)Caspase3&5
c)Caspase1&5
d)Caspase3&7
CorrectAnswer-D
Ans.is'd'i.e.,Caspase3&7

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372.AnnexinVisamarkerof
a)Apoptosis
b)Necrosis
c)Artherosclerosis
d)Inflammation
CorrectAnswer-A
Ans.is'a'i.e.,Apoptosis
oAnnexinVassaysprovidessimpleandeffectivemethodtodetect
apoptosisataveryearlystage.
oThisassaymakesadvantageofthefactthatphosphatidylserine
(PS)istranslocatedfromtheinner(cytoplasmic)
leafletoftheplasmamembranetotheouter(cellsurface)leaflet
soonaftertheinductionofapoptosisandthatthe
annexinVproteinhasstrongspecificaffinityforphosphatidylserine.
oPhosphatidylserineontheouterleafletisavailabletobindlabelled
annexinVprovidingthebasisforasimplestainingassay.
oAlloftheannexinproteinssharethepropertyofbindingcalcium
andphospholipids.
oAnnexinVisacauseofsyndromecalledantiphospholipidantibody
syndrome.
oAnnexinVnormallyformsashieldaroundcertainphospholipid
moleculesthatblockstheirentryintocoagulation(clotting)reactions.
oIntheantiphospholipidantibodysyndrome;theformationofthe
shieldisdisruptedbytheabnormalantibodies.Withouttheshield,
thereisanincreasedquantityofphospholipidmoleculesoncell
membranesspeedingupcoagulationreactionsandcausingthe
abnormalbloodclottingcharacteristicofantiphospholipidantibody
syndrome.

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---

373.Lipidperoxidationofpolyunsaturated
lipidsofsubcellularmembranes
produces?
a)Lipofuscin
b)Hemosiderin
c)Bothofabove
d)Noneofabove
CorrectAnswer-A
Ans.is'a'i.e.,Lipofuscin
Lipofuscinisaninsolublepigment,alsoknownaslipochromeor
wear-and-tearpigment.
Lipofusciniscomposedofpolymersoflipidsandphospholipidsin
complexwithprotein,suggestingthatitisderivedthroughlipid
peroxi-dationofpolyunsaturatedlipidsofsubcellularmembranes.

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374.Hypertrophyis-
a)Increaseincellnumber
b)Increaseincellsize
c)Decreaseincellnumber
d)Decreaseincellsize
CorrectAnswer-B
Ans.is'B'i.e.,Increaseincellsize
Hypertrophy
*Hypertrophyreferstoanincreaseinthesizeofcellswithout
increaseinthenumber,resultinginanincreaseinthesizeoftissue.
*Hypertrophyinvolvescellenlargementwithoutcelldivision.
*So,hypertrophiedorganhasjustlargercells,butnonewcells(by
contrast,inhyperplasiathereisincreaseinnumberofnewcells
withoutincreaseinsize).
*NucleiinhypertrophiedcellshaveahigherDNAcontentthanin
normalcellsbecausethecellsarrestinthecellcyclewithout
undergoingmitosis.
*Myocardium(heartmuscle)andskeletalmuscleundergo
hypertrophy.
*Themostcommonstimulusforhypertrophyisincreasedworkload.
Mechanismofhypertrophy
*Theincreaseincellsizeisduetosynthesisofmorestructural
proteins.
*Thegenesthatareinducedduringhypertrophyincludethose
encodingtranscriptionfactors(C-fos,C-jun),growthfactors(TGF-(3,
TGF-1,FGF);andvasoactiveagents(a-agonists,endothelin-1,
angiotensinII).
*Theremayalsobeaswitchofcontractileproteinsfromadultto

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fetalorneonatalforms,e.g.,duringmyocardialhypertrophy,thea-
myosinheavychainisreplacedby13-formofthemyosinheavy
chain,whichleadstodecreasemyosineATPaseactivityanda
slower,moreenergeticallyeconomicalcontraction.
*Inaddition,somegenesthatareexpressedonlyinembryoniclife
arere-expressedinhypertrophiedmyocardium,e.g.,inthe
embryonicheart,thegeneforAtrialnatriuraticpeptide(ANP)is
expressedinbothatriumandventricle.Afterbirth,ventricular
regulationofthegeneisdownregulated.Myocardialhypertrophyis
associatedwithreinductionofANFgeneexpression.ANPinduces
saltexcretionbykidneyLbloodvolume&pressure,decreasework
load.
Whydothesechangesoccur?
*Asalreadyexplained,themostcommonstimulusformyocardial
hypertrophyisincreasedworkload.
*Alltheabovemorphologicalchangesthatoccurinhypertrophy
eitherincreasemuscleactivity(tohandletheincreasedworkload)or
decreasetheworkloadtoheart.

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375.Metastaticcalcificationischaracterized
by?
a)Hypercalcemia
b)Hypocalcemia
c)Eucalcemia
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Hypercalcemia
Pathologiccalcifications
Dystrophiccalcification:Depositionofcalciumatsitesofcellinjury
andnecrosis.
Metastaticcalcification:Depositionofcalciuminnormaltissues,
causedbyhypercalcemia(usuallyaconsequenceofparathyroid
hormoneexcess)

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376.Calcificationofsofttissueswithoutany
distrubanceofcalciummetabolismis
called-
a)Ionotrophiccalcification
b)Monotrophiccalcification
c)Dystrophiccalcification
d)Calciuminducedcalcification
CorrectAnswer-C
Ans.is'c'i.e.,Dystrophiccalcification

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377.Necrosiswithcellbodiesretainedas
ghostcellsis?
a)Coagulativenecrosis
b)Liquefactive
c)Caseous
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Coagulativenecrosis
Themicroscopicanatomyofcoagulativenecrosisshowsalighter
stainingtissuecontainingnonucleiwithverylittlestructuraldamage,
givingtheappearanceoftenquotedas"Ghostcells"->outlinesof
cellsareretainedsothatthecelltypecanstillbeidentifiedbuttheir
cytoplasmicandnucleardetailsarelost.

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378.TheFentonreactionleadstofreeradicalgenerationwhen:
a)Radiantenergyisabsorbedbywater
b)Ferrousionsareconvertedtoferricions
c)Nitricoxideisconvertedtoperoxynitriteanion
d)Hydrogenperoxideisformedby,myeloperoxidase
CorrectAnswer-B
Fentonreactioninvolvestheferrousironcatalyzedconversionofhydrogenperoxideintoa
hydroxideionandahydroxylfreeradicalwiththeconcurrentoxidationofferrousironto
ferriciron.
Fentonreaction:H.J.HFentondiscoveredin1894thatseveralmetalshaveaspecial
oxygentransferpropertieswhichimprovetheuseofhydrogenperoxide.
Actually,somemetalshaveastrongcatalyticpowertogeneratehighlyreactivehydroxyl
radicals(.OH).
Sincethisdiscovery,theironcatalyzedhydrogenperoxidehasbeencalledFenton's
reaction.
HydrogenperoxideisconvertedtohydroxylradicalsintheFentonreaction.
Theironcanexistinanumberofdifferentoxdationstates.Thereforetheoxidationoffe2+
byh2o2canproceedthroughaoneelectrontransferoratwoelectrontransfer.Fentons
reactionisaninnersphereoneelectrontransferprocess.Theh2o2formsacomplex
withfe2+beforeelectrontransfertakesplace.Afteradditionoftheironandthehydrogen
peroxide,theyaregoingtoreacttogethertogeneratesomehydroxylradicalsasitshowsin
thefollowingequations:
Fe2++H2O2---->Fe3++.OH+OH-
Fe3++H2O2---->Fe2++.OOH+H+
Importance:Hydroxylradicalsarethemostpowerfulofthereactiveoxygenspecies.Itis
capableofdestroyinganyorganicmolecule.
Uses:Usedtotreatalargevarietyofwaterpollutionsuchasphenols,formaldehyde,
BTEX,pesticidesandrubberchemicals.
Ref:FreeRadicalsinMedicine,ByRaduOlinescu,Dr.TerranceL.Smith,Page28

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---

379.Whichofthefollowingisnotafree
radicalscavenger-
a)Glutathioneperoxidase
b)Superoxidedismutase
c)Catalase
d)Xanthineoxidase
CorrectAnswer-D
Answer-D.Xanthineoxidase
Freeradicalscavgers(anti-oxidants)inbody
1. Non-enzymaticVitaminsE,A&C,glutathione,cysteine,
ceruloplasmin,transferrin,lactoforrin,ferritin.
2. EnzymesCatalase,superoxidedismutase,glutathione
peroxidase

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380.Enzymethatprotectsthebrainfromfree
radicalinjuryis-
a)Myeloperoxidase
b)Superoxidedismutase
c)MAO
d)Hydroxylase
CorrectAnswer-B
Ans.is'b'i.e.,Superoxidedismutase
Antioxidantmechanisms
Cellshavemultiplemechanismstoremovefreeradicalsandthereby
minimizinginjury.
Severalnonenzymaticandenzymaticsystemscontributetothe
inactivationoffreeradicalreactions.
A.Non-enzymaticsystem
oAntioxidants(Vit'E',VitA,VitC,glutathioneandCysteine)block
theinitiationoffreeradicalformationandinactivatefreeradicals.
oTissueproteins(transferrin,ferritin,lactoferrin,andceruloplasmin).
Asalreadyexplained,ironandcoppercancatalyzetheformationof
freeradicals,thesetransportandstorageproteinsdecreasethe
reactivefreeironandcopper,therebyminimizingthefreeradical
formation.
B.Enzymaticsystem
oAseriesofenzymesactasfreeradical-scavengingsystemsand
breakdownhydrogenperoxideandsuperoxideanion.
1.Catalase
oPresentinperoxisomesanddecomposesH202
2H 0
2 2__________02+2H20

---

1. 2.Superoxidedismutase(SOD)
oManganese-superoxidedismutaseispresentinmitochondria,
whilecopper-zinc-superoxidedismutaseisfoundinthecytosol.
oItconvertssuperoxidetoH202
202-+2HSOD2H202+02
3.Glutathioneperoxidase
oPresentinmitochondria&cytosol.oItcatalyzesfreeradical
breakdown.
H202+2GSH__GSSG+2H20
20H+2GSH_>GSSG+2H20
oTheintracellularratioofoxidizedglutathione(GSSG)to
reducedglutathione(GSM)isareflectionoftheoxidativestateof
thecell.

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381.Cellularswellingwithblebsandmyelin
figuresarethechangesseenin
a)Reversiblecellinjury
b)Irreversiblecellinjury
c)Metaplasia
d)Anaplasia
CorrectAnswer-A
Answer-A.Reversiblecellinjury
Pathologicalfeaturesofreversiblecellinjuryare:Cellularswelling
(earliest);lossofmicrovilli;cytoplasmicmembraneblebs;ER
swelling;Myelinefigures;detachmentofribosomefromER;
cytoplasmic(lipid)vacuole;clumpingofchromatin.

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382.Firstchangeseeninacuteinflammation
is:
September2009
a)Increasedpermeability
b)Vasodilation
c)Neutrophilmigration
d)Vasoconstriction
CorrectAnswer-D
Ans.D:Vasoconstriction
Cardinalsigns:
Rubor(redness)duetodilatationofarterioles
Calor(heat)
Dolor(pain)duetopressureonnerveendingsbyedemafluidand
chemicalmediatorbradykinine
Tumor(swelling)duetoedema.
Functiolaesa(lossoffunction)duetoinhibitionofmovementbypain
andtissuenecrosis.

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383.Leukocyteadhesiontoendotheliumis
mediatedbyallexcept?
a)Lselectin
b)Eselectin
c)VCAM1
d)VCAM4
CorrectAnswer-D
Ans.is'd'i.e.,VCAM4
EndothelialmoleculeP-selectin
E-selectinICAM-1VCAM-1Glycam-1
CD31(PECAM)

---

384.Endothelialmoleculeparticipatingin
rollingis
a)CD34
b)CD65
c)CD56
d)CD100
CorrectAnswer-A
Answer-A.CD34
AdhesionmoleculesinvolvedinRolling:
1. Endothelialmolecules:P-selectin,E-selectin,GlyCam-1,CD-34.
2. Leucocytemolecules:Sialyl-LewisX-modifiedprotein,L-selectin.

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385.Matrixmetalloproteinasesis?
a)Cathepsin
b)Znmetalloproteinases
c)Cumetalloproteinases
d)Cdmetalloproteinases
CorrectAnswer-A
Ans.isbi.e.,Znmetalloproteinases
Theoutcomeoftherepairprocessoftissuesisinfluencedbya
balancebetweensynthesisanddegradationofECMproteins.
Afteritsdeposition,theconnectivetissueinthescarcontinuestobe
modifiedandremodeled.
ThedegradationofcollagensandotherECMcomponentsis
accomplishedbyafamilyofmatrixmetalloproteinases(MMPs),so
calledbecausetheyaredependentonmetalions(e.g.,zinc)fortheir
activity.
MMPsincludeinterstitialcollagenases,whichcleavefibrillarcollagen
(MMP-1,-2and-3);gelatinases(MMP-2and9),whichdegrade
amorphouscollagenandfibronectin;andstromelysins(MMP-3,-10,
and,11),whichdegradeavarietyofECMconstituents,including
proteo-glycans,laminin,fibronectin,andamorphouscollagen.

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386.Whatgeneratesintracellularsignals
whencellsaresubjectedtoshear
stress
a)Cadherins
b)Selectins
c)Integrins
d)Focaladhesionmolecules
CorrectAnswer-D
Answer-D.Focaladhesionmolecules
Focaladhesioncomplexesarelarge(>100proteins)
macromolecularcomplexesthatcanbelocalizedat
hemidesmosomes,andincludeproteinsthatcangenerate
intracellularsignalswhencellsaresubjectedtoincreasedshear
stress,suchasendotheliuminthebloodstream,orcardiacmyocytes
inafailingheart.

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387.Trueaboutwoundhealingwithprimary
intentionis
a)Byday5epidermisrecoversitsnormalthickness
b)Intenseinflammatoryreaction
c)Woundcontractionoccurs
d)Abundantgranulationtissuegrows
CorrectAnswer-A
Answer-A.Byday5epidermisrecoversitsnormalthickness
Healingbyprimaryintention
Itoccursinwoundswithopposededges,e.g.,surgicalincision.
Thehealingprocessfollowsaseriesofsequentialsteps:-
Immediateafterincision
Incisionalspacefilledwithbloodcontainingfibrinandbloodcells.
Dehydrationofthesurfaceclotformsscabthatcoversthewound.
Within24hours
Neutrophilsappearatthemarginsofwound.
In24-48hours
Epithelialcellsmovefromthewoundedgesalongthecutmarginof
dermis,depositingbasementmembranecomponentsastheymove.
Theyfuseinthemidlinebeneaththesurfacescab,producinga
continuousbutthinepitheliumlayerthatclosesthewound.
Byday3
Neutrophilsarelargelyreplacedbymacrophages.
Granulationtissueprogressivelyinvadestheincisionspace.
Collegenfibersnowpresentinthemarginbutdonotbridgethe
incision.
Byday5
Incisionalspaceislargelyfilledwithgranulationtissue.

---

Neovascularizationismaximum.
Collegenfibrilsbecomemoreabundantandbegintobridgethe
incision.
Theepidermisrecoversitsnormalthickness.
Duringsecondweek
Leukocytesandedemahavedisappeared.
Thereiscontinuedaccumulationofcollegenandproliferationof
fibroblast.
Bytheendoffirstmonth
Scarismadeupofacellularconnectivetissuedevoidof
inflammatoryinfiltratecoverednowbyintactepidermis.

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388.Thedefinitionofexudateis
a)Extravascularfluidthathasahighproteinconcentrationand
containscellulardebris
b)Extravascularfluidthathasalowproteinconcentration
c)Extravascularfluidwithhighglucoseconcentration
d)Extravascularfluidwithlowglucoseconcentration
CorrectAnswer-A
Answer-A.Extravascularfluidthathasahighprotein
concentrationandcontainscellulardebris
Exudateisaninflammatoryfluidthatcontainshighproteincontent,
cellulardebris,andspecificgravity>1.020.Itoccursdueto
increasedvascularpermeability.

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389.Intuberculosisthecytokinecausing
feveris
a)ILI
b)IL2
c)IL3
d)IL4
CorrectAnswer-A
Answer-A.ILI
Pyrogenes
Pyrogenesaresubstancesthatcausefever.
Pyrogensmaybeexogenousorendogenous
Exogenous-4Bacterialtoxins
EndogenousIL-1,TNF-a,IL-6,Interferons,Ciliory'sneurotropic
factor

---

390.Whichacutephasereactantinduces
rouleauxformation
a)Creactiveprotein
b)Fibrinogen
c)SerumamyloidA
d)IL1
CorrectAnswer-B
Answer-B.Fibrinogen
Fibrinogenbindstoredcellsandcausesthemtoformstacks
(rouleatix)thatsedimentmorerapidlyatunitgravitythando
individualredcells.

---

391.Activationofna?veBlymphocytesby
proteinantigensis?
a)TCellindependent
b)NKcelldependent
c)NKcellindependent
d)Tcelldependent
CorrectAnswer-D
Ans.isdi.e.,Tcelldependent
Uponactivation,Blymphocytesproliferateandthendifferentiateinto
plasmacellsthatsecretedifferentclassesofantibodieswithdistinct
functions.
AntibodyresponsestomostproteinantigensrequireTcellhelpand
aresaidtobeT-dependent.
ManypolysaccharideandlipidantigenscannotberecognizedbyT
cellsbuthavemultipleidenticalantigenicdeterminants(epitopes)
thatareabletoengagemanyantigenreceptormoleculesoneachB
cellandinitiatetheprocessofB-cellactivation;theseresponsesare
saidtobeT-independent.

---

392.Mantouxtestisbasedonwhich
hypersensitivity?
a)Type1
b)Type2
c)Type3
d)Type4
CorrectAnswer-D
Ans.is'd'i.e.,Type4
Followingaretheexamplesoftype4hypersensitivityreactions
:-
Type1diabetesmellitus
Hashimotothyroiditis
Crohn'sdisease
Multiplesclerosis
Contactdermatitis
Mantouxtest

---

393.Atopyinhypersensitivityis?
a)SystemictypeIhypersensitivity
b)LocaltypeIhypersensitivity
c)SystemictypeIIhypersensitivity
d)LocaltypeIIhypersensitivity
CorrectAnswer-B
Ans.is`b'i.e.,LocaltypeIhypersensitivity
Anaphylaxis-3Acute,potentiallyfatal,systemic.
Atopy->Chronic,Nonfatal,Localized.

---

394.Macrophageactivationsyndrome
characterizedbyallexcept?
a)ActivationofCD8+Tcells
b)Presenceofcytokinestorm
c)Itistheothernameforhemophagocyticlymphohistiocytosis
d)Lowlevelsofplasmaferretin
CorrectAnswer-D
Ans.is'd'i.e.,Lowlevelsofplasmaferretin
HemophagocyticLymphohistiocytosis
Hemophagocyticlymphohistiocytosis(HLH)isareactivecondition
markedbycytopeniasandsignsandsymptomsofsystemic
inflammationrelatedtomacrophageactivation.Forthisreason,itis
alsosometimesreferredtoasmacrophageactivationsyndrome.
Pathogenesis
ThecommonfeatureofallformsofHLHissystemicactivationof
macrophagesandCD8+cytotoxicTcells.
Theactivatedmacrophagesphagocytosebloodcellprogenitorsin
themarrowandformedelementsintheperipheraltissues,whilethe
"stew"ofmediatorsreleasedfrommacrophagesandlymphocytes
suppresshematopoiesisandproducesymptomsofsystemic
inflammation.
Theseeffectsleadtocytopeniasandashock-likepicture,
sometimesreferredtoas"cytokinestorm"orthesystemic
inflammatoryresponsesyndrome.
FamilialformsofHLHareassociatedwithseveraldifferent
mutations,allofwhichimpacttheabilityofcytotoxicTcellsandNK
toproperlyformordeploycytotoxicgranules.
ThemostcommontriggerforHLHisinfection,particularlywith

---

Epstein-Barrvirus(EBV).
ClinicalFeatures
Mostpatientspresentwithanacutefebrileillnessassociatedwith
splenomegalyandhepatomegaly.
Hemophagocytosisisusuallyseenonbonemarrowexamination,
butisneithersufficientnorrequiredtomakethediagnosis.
Laboratorystudiestypicallyrevealanemia,thrombocytopenia,and
veryhighlevelsofplasmaferritinandsolubleIL-2receptor,both
indicativeofsevereinflammation,aswellaselevatedliverfunction
testsandtriglyceridelevels,bothrelatedtohepatitis.
Coagulationstudiesmayshowevidenceofdisseminated
intravascularcoagulation.Ifuntreated,thispicturecanprogress
rapidlytomultiorganfailure,shock,anddeath.
Treatment
Involvestheuseofimmunosuppressivedrugsand"mild"
chemotherapy.
PatientswithgermlinemutationsthatcauseHLHorwhohave
persistent/resistantdiseasearecandidatesforhematopoieticstem
celltransplantation.
Withouttreatment,theprognosisisgrim,particularlyinthosewith
familialformsofthedisease,whotypicallysurviveforlessthan2
months.

---

395.HLAassociatedwithrheumatoidarthritis
is?
a)HLAB27
b)HLADR4
c)HLABI9
d)HLADR2
CorrectAnswer-B
Ans.is`b'i.e.HLADR4
AssociatedwiththedevelopmentofRheumatoidarthritis
?HLA-DR4
?HLA-DR10
?HLA-DR9
ProtectsagainstthedevelopmentofRheumatoidarthritis
?HLA-DR5
?HLA-DR2
?HLA-DR3

---

396.Whichofthefollowinginterleukinis
secretedbyThelper2cells?
a)IL11
b)IL7
c)IL1
d)IL13
CorrectAnswer-D
Ans.is'd'i.e.,IL13
A)Thelper-1(TF,')secretes4IL-2andinterferon-y
B)Thelper-2(T 2
0 )secretes->IL-4,IL-5,IL-6,IL-13

---

397.Interleukin2isproducedby
a)Thelpercells1
b)Thelpercells2
c)Naturalkillercells
d)Basophils
CorrectAnswer-A
Ans.is'a'i.e.,Thelpercells1
A)Thelper-1(TF,')secretes4IL-2andinterferon-y
B)Thelper-2(T 2
0 )secretes->IL-4,IL-5,IL-6,IL-13

---

398.Nonprofessionalantigenpresentingcell
isA/E?
a)Endothelialcell
b)Epidermalcell
c)Fibroblasts
d)Redbloodcells
CorrectAnswer-D
Ans.is'd'i.e.,Redbloodcells
Non-professionalantigenpresentingcell
Anon-professionalAPCdoesnotconstitutivelyexpresstheMajor
HistocompatibilityComplexclassII(MHCclassII)proteinsrequired
forinteractionwithnaiveTcells;theseareexpressedonlyupon
stimulationofthenon?professionalAPCbycertaincytokinessuch
asIFN-y.
AllnucleatedcellsexpresstheMajorHistocompatibilityComplex
classInecessarytobeconsideredanonprofessionalAPC.
Aserythrocytesdonothaveanucleus,theyareoneofthefewcells
inthebodythatcannotdisplayantigens.

---

399.Largegranularlymphocytesare?
a)Bcells
b)NKcells
c)Tcell
d)Plasmacells
CorrectAnswer-B
Ans.is'b'NKcells
Nullcells(Largegranularlymphocytes)
Nullcellsarecalledsobecausetheylackfeaturesofsurface
markersofbothBandTlymphocytes.
Theaccountfor5to10%ofperipheralbloodlymphocytes.
Theyarealsocalled"largegranularlymphocytes(LGL)"asthey
containlargeazurophiliccytoplasmicgranules.
Membersofthisgroupare:
a)Antibodydependentcytotoxiccells(ADCC)
b)Naturalkillercells(NKCells)

---

400.NKcellshowspresenceof?
a)CD44
b)CD16
c)CD54
d)CD32
CorrectAnswer-B
Ans.is'b'i.e.,CD16
Thesecellspossesscytotoxicactivityagainstvirusinfectedcells,
tumorcellsandtransplantedforeigncells.
CytotoxicityofNKcellsisneitherantibodydependentnorMHC
restricted.Activityisnonimmuneasitdoesnotrequireantigenic
stimulation.
NK-cellsarepositiveforCD16andCD56.
NKcellsareusuallynegativeforCD3,butasubsetispositivefor
CD3calledNK/T-cells.

---

401.LEcellisseenin?
a)Lupuserythmatosus
b)Lupusvulgaris
c)HNPCC
d)Medullarycarcinomaofthyroid
CorrectAnswer-A
Ans.is'a'i.e.,Lupuserythematousus
InSLE,antinuclearantibodies(ANPs)cannotpenetrateintactcells.
However,nucleiareexposed,ANAcanbindtothem.
Intissues,nucleiofdamagedcellsreactwithANAs,losetheir
chromatinpattern,andbecomehomogeneous,toproducelupus-
erythematous(LE)bodiesorhemotoxylinbodies.
WhentheseLEbodiesareengulfedbyphagocyticcells(neutrophil
ormacrophage/monocyte),thephagocyticcellsarecalledLEcells.

---

402.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

---

403.Inceasedaccumulationoffluidinthe
interstitialspaceisdescribedas?
a)Edema
b)Effusion
c)Transudate
d)Exudate
CorrectAnswer-A
Ans.is'a'i.e.,Edema
Edema:accumulationoffluidintheinterstitialspace
Effusion:accumulationoffluidinthebodycavities

---

404.HyperimmuneIgEsyndromeisalso
called
a)Jobssyndrome
b)WiscottAldrichsyndrome
c)Chediak-Higashisyndrome
d)Digeorgesyndrome
CorrectAnswer-A
Answer-A.Jobssyndrome
Job'ssyndrome,alsocalledHyper-IgEsyndromeor
HyperimmunoglobulinEsyndrome,isanautosomaldominant
disorderduetomutationsinSignalTransducerandActivatorof
Transcription-3(STAT-3).
Thereisdefectinphagocytosis.IgElevelsareelevated.Other
immunoglobulinsarenormal.

---

405.CellsresponsibleforGVHDis?
a)ImmunocompetentTcelldonor
b)ImmunocompetentTCellrecipient
c)ImmunocompetentBcelldonor
d)ImmunocompetentBcelldonor
CorrectAnswer-A
Ans.is'a'i.e.,ImmunocompetentT-celldonor
Graft-versus-hostdisease(GVHD):?
GVHDoccurswhenimmunologicallycompetentcells(Tcells)or
theirprecursorsaretransplantedintoimmunologicallycrippled
recipients,andthetransferredcellsrecognizealloantigensinthe
hostandattackhosttissues.
MostcommonlyinvolvedtissuesinGraftversushostdisease:-
Liver
Skin
Gut

---

406.Leukocytemigrationthrough
endotheliumisinducedby?
a)Selectin
b)NCAM
c)CCAM
d)PECAM
CorrectAnswer-D
Ans.is'd'i.e.,PECAM
Migrationoftheleukocytesthroughtheendotheliumiscalled
transmigrationordiapedesis.
Transmigrationofleukocytesoccursmainlyinpostcapillaryvenules.
Themoleculesinvolvedintransmigrationarememberofthe
immunoglobulinsuperfamilycalledCD31orPECAM-1(platelet
endothelialcelladhesionmolecule).

---

407.ComplementCIsynthesizedfrom-
a)Liver
b)Macrophage
c)Intestinalepithelium
d)Endothelium
CorrectAnswer-C
Answer-C.Intestinalepithelium
CIissynthesizedinintestine;C2andC4aresynthesizedby
macrophages;C5andC8aresynthesizedinspleen;andC3,C6
andC9aresynthesizedinliver.
[Ref:ShorttextbookofmedicalmicrobiologybySatishGuptep.92]

---

408.RASTtestisusedindiagnosisof
a)Allergicdermatitis
b)Seborrhoeicdematitis
c)Mycosisfungoides
d)Squamouscellcarcinoma
CorrectAnswer-A
Ans.is'a'i.e.,Allergicdermatitis
RAST:Radioallergosorbentassay
ItisthemethodusedtomeasuretotalaswellasspecificIgEagainst
aparticularallergenoracomplex.
Diagnostictestsinallergiccontactdermatitis
DiagnosticTests(ifindicated)
Patchtesting
Photopatchtesting
Testsforimmediatehypersensitivity
Radioallergosorbentassaytest(RAST)
Openandsemiopenpatchtests(readat10and45minutes)
Pricktest
Scratch-chambertest
Repeatopenapplication"use"test
Potassiumhydroxideexaminationtofungi,glassfibers
Fungal,bacterial,andviralsmearsandcultures
Skinbiopsies
Dimethylglyoximetestfordetectingnickel,othertests(detectionof
chromatesandformaldehyde)
Chemicalanalysis

---

409.Performareproducedby
a)NKcell
b)CytotoxicTcell
c)Plasmacell
d)Monocyte
CorrectAnswer-A
Answer-A.NKcell
Perforinsareholeformingproteins,causetransmembranepores
throughwhichcytotoxicfactorsenterthecellanddestroyitby
apoptosis.
Perforinsareproducedby:
N.K.Cells
[Ananthanarayan126]

---

410.HLAB51isassociatedwith?
a)Behcet'sdisease
b)Chrugstrausssyndrome
c)Microscopicpolyangitis
d)Polyarteritisnodosa
CorrectAnswer-A
Ans.is'a'i.e.,Behcet'sdisease
Behcet'sdisease:?
Behcetdiseaseisasmall-tomedium-vesselneutrophilicvasculitis
thatclassicallypresentsasaclinicaltriadofrecurrentoralaphthous
ulcers,genitalulcers,anduveitis.
Therecanalsobegastrointestinalandpulmonarymanifestations,
withdiseasemortalityrelatedtosevereneurologicinvolvementor
ruptureofvascularaneurysms.Thereisanassociationwithcertain
HLAhaplotypes(HLAB51,inparticular)

---

411.EBVreceptormimics?
a)CD20
b)CD21
c)CD22
d)CD23
CorrectAnswer-B
Ans.is'b'i.e.,CD21
CD21->EBVreceptor:MatureBcellsandfolliculardendriticcells.

---

412.Traumatobreastcauseswhichtypeof
necrosis?
a)Coagualtivenecrosis
b)Liquefactivenecrosis
c)Caseousnecrosis
d)Fatnecrosis
CorrectAnswer-D
Ans.is'd'i.e.,Fatnecrosis
Fatnecrosis
Fatnecrosismaybeoftwotypes:?
Enzymaticfatnecrosis
Thisisduetoactionoflipaseonadiposetissue.
Itoccursmostfrequentlyinacutepancreatitisduetoleakageof
lipase.
Dependingontheseverityofacutepancreatitis,fatnecrosismay
occurin:-aAdiposetissuecontiguoustopancrease,
retroperitonealfat.
Adiposetissueinanteriormediastinum.
Bonemarrow
Omentalandabdominalfat
NonenzymaticorTraumaticfatnecrosis
Occursduetotrauma
Isseeninsubcutaneoustissueofbreast,thigh,andabdomen.

---

413.Mostcommoncauseofdeathin
amyloidosisis?
a)Heartfailure
b)Renalfailure
c)Sepsis
d)None
CorrectAnswer-A
Ans.is'a'i.e.,HeartFailure
`Mostcommoncauseofdeathisheartfailureand/orabnormal
cardiacrhythm'Essentialspathology

---

414.Fibrosisisdueto?
a)TGF-
b)TNF-
c)IL-7
d)IL-10
CorrectAnswer-A
Ans.is'a'i.e.,TGF-13
"TFG-bispracticallyalwaysinvolvedasanimportantfibrogenic
agent"--Robbins
Mediatersinvolvedinfibrosis:?
i)Growthfactors:-TGF-(3,PDGF,FGF
ii)Cytokines:IL-1,IL-4,TNF,IL-13

---

415.Mostimportantgrowthfactorsin
angiogenesis?
a)PDGF
b)TGFalpha
c)TGFbeta
d)VEGF
CorrectAnswer-D
Ans.is'di.e.,VEGF
Twomostimportantangiogenicfactorsare:
i)Vascularendothelialgrowthfactor(VEGF)-->most
important.
ii)Basicfibroblastgrowthfactor(FGF-2).

---

416.WhichisthebestmarkerofSLE?
a)AntiSmantibodies
b)AntidsDNAantibodies
c)Antihistoneantibodies
d)AntiRoAntibodies
CorrectAnswer-B
Ans.is'b'i.e.,AntidsDNAantibodies
Antibodiestodouble-strandedDNAandtheSmith(Sm)antigenare
virtuallydiagnosticofSLE".

---

417.Pendredsyndromeduetomutationof?
a)Bartillin
b)Pendrin
c)Fibrillin
d)Reticulin
CorrectAnswer-B
Ans.is`b'i.e.,Pendrin
PendredsyndromeorPendreddisease:?
PendredsyndromeorPendreddiseaseisageneticdisorderleading
tocongenitalbilateral(bothsides)sensorineuralhearinglossand
goitrewithoccasionalhypothyroidism.
IthasbeenlinkedtomutationsinthePDSgene,whichcodesforthe
pendrinprotein(solutecarrierfamily26,member4,SLC26A4).The
geneislocatedonthelongarmofchromosome7(7q31).Itisan
autosomalrecessivedisorder.

---

418.Inheritancepatternofmyotonic
dystrophyis?
a)Autosomalrecessive
b)Autosomaldominant
c)Xlinkeddominant
d)Xlinkedrecessive
CorrectAnswer-B
Ans.is`b'i.e.,Autosomaldominant
Myotonicdystrophy
Myotonicdystrophyisanautosomaldominantmultisys-temdisorder
associatedwithskeletalmuscleweakness,cataracts,
endocrinopathy,andcardiomyopathy

---

419.Neurofibromatosisshowswhichofthe
followingmodeofinheritance?
a)AD
b)AR
c)Xlinkeddominant
d)Xlinkedrecessive
CorrectAnswer-A
Ans.is'a'i.e.,AD
Neurofibromatosisshowsautosomaldominantinheritance
pattern
Singlegenedisorders(Mendeliandisorders)typicallyfollowoneof
thethreepatternsofinharitance?
a. Autosomaldominance
b. Autosomalrecessive
c. X-linked
Autosomaldominantdisorders
Normallyagenepairhastwoalleles.
Whenoneallelebecomesabnormalduetomutationitiscalled
heterozygousstate.
Whenboththeallelesbecomeabnormalduetomutationitiscalled
homozygousstate.
Autosomaldominantdisordersaremanifestedinheterozygous
state,i.e.onlyifoneallelisabnormalthediseasewillbemanifested.

---

420.Theinheritancepatternoffamilial
Retinoblastomasis-
a)Autosomalrecessive
b)Autosomaldominant
c)X-linkeddominant
d)X-linkedrecessive
CorrectAnswer-B
Ans.is'b'i.e.,Autosomaldominant
Huntingtondisease
Neurofibro-matosis
Myotonicdys-trohy
Tuberousscle-rosis
Retinoblastoma

---

421.GeneresponsibleforWilsondiseaseis
situatedonwhichchromosome?
a)Chromosome11
b)Chromosome12
c)Chromosome13
d)Chromosome14
CorrectAnswer-C
Ans.is'c'i.e.,Chromosome13
Wilsondiseaseisanautosomalrecessivedisordercausedby
mutationoftheATP7Bgene,resultinginimpairedcopperexcretion
intobile&failuretoincorporatecopperintoceruloplasmin.
TheATP7Bgeneislocatedonchromosome13.

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422.BarrbodyisNOTseenin:
PGI07;WB08
a)Turnersyndrome
b)Klinefeltersyndrome
c)Down'ssyndrome
d)Marfan'ssyndrome
CorrectAnswer-A
Ans.Turnersyndrome
Barrbody(Sex-chromatin)
Itisadenselystaininginactivatedcondensed'X'chromosomethatis
presentineachsomaticcellsoffemale.oItisfoundinthenucleus.
Itisusedasatestofgeneticfemaleness-4itispossibleto
determinethegeneticsexofanindividualaccordingastowhether
thereisachromatinmasspresentontheinnersurfaceofthe
nuclearmembraneofcellswithrestingorintermitentnuclei.
Rememberfollowingfactandthequestionwillseemveryeasy.
Chromatidbody(Barrbodyorsexchromatin)isderivedfromoneof
thetwoX-chromosomeswhichbecomesinactivated.
ThenumerofBarrbodiesisthusonelessthanthenumberofX-
chromosomes.

---

423.Whichofthefollowingisnotahereditary
disease?
a)Neurofibromatosis
b)Cretinism
c)Huntingtonsdisease
d)Hereditaryspherocytosis
CorrectAnswer-B
Ans.is'b'i.e.,Cretinism
Cretinism:?
Cretinismisaconditionofseverelystuntedphysicalandmental
growthduetountreatedcongenitaldeficiencyofthyroidhormones
(congenitalhypothyroidism)usuallyduetomaternalhypothyroidism.
Thuscretinismisanonhereditarycondition.

---

424.Boysaremorelikelytobeaffectedby
whichgeneticdisorders?
a)AD
b)AR
c)Xlinkeddominant
d)Xlinkedrecessive
CorrectAnswer-D
Ans.is'd'i.e.,Xlinkedrecessive
X-linkeddisorders
Exceptforafewconditions,allX-linkeddisordersareX-linked
recessive.
AsmalehasonlyoneX-chromosome,themalewithaffectedgene
onX-chromosomewillalwaysmanifestthedisease.
Ontheotherhand,femalehas2X-chromosomes,heterozyogous
femalewillbecarrierbecauseofexpressionofnormalallelonthe
otherX-chromosome.
SoaboyhasmoreprobabilitytomanifestXlinkedrecessiveas
comparedtogirls

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425.Classicexampleofmissensemutation?
a)Thalassemia
b)Sicklecelldisease
c)Sideroblasticanemia
d)Hemochromatosis
CorrectAnswer-B
Ans.is'b'i.e.,Sicklecelldisease
Insicklecellanemiathereismissensetypeofpointmutation.
Mutations
AmutationisapermanantchangeintheDNA.
Mutationsthataffectgeniicells(spermorovum)aretransmittedto
progenyandmaygiverisetoinheriteddisease.
Mutationsthataffectsomaticcellsarcnottransmittedtoprogenybut
areimportantinthegenesisofcancersandcongenital
malformations.
Mutationsmaybeclassifiedintothreecategories?
1.Genemutations
Thevastmajorityofmutationsassociatedwithhereditarydisease
aregenemutations.
Thesemayofdifferenttypesdependingwhetheritinvolvescomplete
geneorsinglebase?
(a)Pointmutation
Asinglenucleotidebaseissubustitutedbyadifferentbase.
Whenapyrimidinebaseissubustitutedbyotherpyrimidinebaseor
apurinebaseissubstitutedbyotherpurine
Transition.
Whenapurineissubstitudedbyapyrimidineorvice-versa
Transversion.

---

Thismayalterthecodeinatripletofbases,i.e.incodonandleads
toreplacementofoneaminoacidbyanotherinthegeneproduct.
Becausethesemutationsalterthemeaningofthegeneticcode,they
areoftentermedmissensemutation.
ExampleissicklemutationinwhichCTCcodonin13-chainof
hemoglobinthatcodesforglutamicacidischangedtoCACcodon
thatcodesforvaline.
Anothertypeofpointmutationisnonsensemutationinwhichapoint
mutationmaychangeanaminoacidcodontoastopcodon.
3Exampleis13-thalassemiainwhichCAGcodoninI3-chainof
hemoglobinthatcodeforglutaminischangedtostopcodonUAG
afterpointmutation.
(b)Deletionandinsertions
Deletionorinsertionofoneortwobaseleadtoalterationsinthe
readingframeoftheDNAstrand-->frameshiftmutation.
Ifthenumberofbasepairsinvovedisthreeoramultipleofthree
framshiftdoesnotoccur(becausecodonistriplet),insteadan
abnormalproteinmissingoneormoreaminoacidsissynthesized.
(c)Trinucleotiderepeatmutation
Normallyacodonistripletietrinucleotide.
Inthistypeofmutationacodon,ietrinucleotidesequence
undergoesamplificationandthesamecodonisrepeated
continuouslysomanytimesinthechain.
ForexampleinfragileX-syndrome,CGGcodonisrepeated250-
4000times,ie.thereare250-4000tandemrepeatesofCGG.
2.Chromosomemutation
Resultfromrearrangementofgeneticmaterialthatgiveriseto
visiblestructuralchangesinthechromosome.3.Genomemutation
Involveslossorgainofwholechromosome,e.g.monosomy-Turner
syndrome,trisomy-Downsyndrome.

---

426.Rbgeneislocatedonwhich
chromosome?
a)6
b)9
c)13
d)21
CorrectAnswer-C
Ans.is'c'i.e.,13[RefRobbin's9tVep.290]
Retinoblastomagene(RBgene)islocatedon14bandonthelong
armofchromosome13(13q14).RBgeneisatumorsupressor
gene.
RetinoblastomadevelopswhenboththenormalallelesoftheRB
genesareinactiveoraltered.ItistypicalexampleofKnudson'stwo
hithypothesis.

---

427.Mostcommonknowncausesof
congenitalanamoliesinhumansare
a)Chromosomalaberrations
b)Maternalinfections
c)Drugs
d)Irradiation
CorrectAnswer-A
Answer-A.Chromosomalaberrations
Genetic
Chromosomalaberrations-10-15
Mendelianinheritance
Environmental
Maternal/placentalinfections-2-3
Maternaldiseasestates-6-8
Drugsandchemicals-1
Irradiations
Multifactorial20-25
Unknown-40-60

---

428.WhichisnotafeatureofDowns
syndrome
a)Clinodactyly
b)Pigmentedbirthmarks
c)Hypotonia
d)RespiratorytractInfections
CorrectAnswer-B
Ans.is'b'i.e.,Pigmentedbirthmarks
Otherclinicalfeaturesinclude:?
1)General:-Mentalretardation,shortstature
2)Cranio-facialBrachycephaly,epicanthicfold,
protrudingtongue,smallears,upwardslopingpalpebralfissures
(Mongoloidslant),strabismus,nystagmus,Brushfiedspotsin
iris.
3)Limbs:-Fifthfingerclinodactyly,singlepalmarcrease
(simiancrease),widegapbetweenfirstandsecondtoes(sandle
gap).
4)Congenitalheartdisease:-CommonAVcanal,ASD(most
common),VSD,PDA,fallottetralogy.
5)GIT:-Analatresia,Duodenalatresia,Hirschsprung
disease,annularpancreas.
6)Increasedincidenceofleukemia(1%).Leukemiascommon
areALL(mostcommon),AML(M7-AML)transient
myeloproliferativedisorders,andJuvenilCML.

---

429.AllofthefollowingaretrueforTurners
syndromeexcept:
March2012
a)Heightismorethan145cm
b)Webbingofneck
c)Increasedcarryingangle
d)Coarctationofaortamaybeseen
CorrectAnswer-A
Ans:Ai.e.Heightismorethan145
Turnersyndrome
AdultstatureinTurnersyndromepatientsislessthan145cm
Associatedcongenitaldefectsarecommoninheart(coarctationof
aorta)
Lymphedema,
Shortstature,
Webbedneck,
Lowposteriorhairline,
Cubitusvalgus(increasedcarryingangle),
Fingerdeformities,
Short4thmetacarpal,
45X0karyotype
Downsyndrome
MCtrisomy,
Brachycephalicskull,
Hypotonia,
Palpebralfissureslopesupwards,
Markedepicanthicfolds,

---

Brushfield'sspots,
Increasednuchalfoldthickness,
Iliacindexlessthan60,
Simiancrease(singlepalmarcrease),
MCassociatedcardiaclesions:VSD
Duodenalatresia,CML&transientmyeloproliferativedisordersare
seen
MaybeassociatedwithAlzheimer'sdementia,
MCcauseofdownsyndrome:Maternalnon-disjunction
Klinefeltersyndrome
47XXY
MCcauseofhypergonadotrophichypogonadism,
Subnormalintelligence
FragileXsyndrome
Largeforehead,
Largehead,
Macro-orchidism,
Moderatelytoseverelyretarded

---

430.Diagnosethedisorderbylookingatthe
karyotypeshowninthepicturebelow?
a)Down'ssyndrome.
b)Patausyndrome.
c)Turnersyndrome.
d)Klinefelter'ssyndrome.
CorrectAnswer-C
Turner'ssyndrome
Turner'ssyndromeisthemostcommonsexchromosomaldisorder
inphenotypicfemales.
Turner'ssyndromeresultsfromcompleteorpartiallossofone
Xchromosome(45,X)andischaracterisedbyhypogonadism
inphenotypicfemales
FeaturesofTurnersyndromeinchildren:?
Themostseverelyaffectedpatientsgenerallypresentduringinfancy
withedema(owingtolymphstasis)ofthedorsumofthehandand
footandsometimesswellingofthenapeftheneck.
Swellingoftheneckisrelatedtomarkedlydistendedlymphatic
channels,producingsocalledcystichygroma.

---

Astheseinfantsdevelop,theswellingsubsidesbutoftenleave
bilateralneckwebbingandpersistentloosenessofskinontheback
oftheneck.
Congenitalheartdiseaseisalsocommon,particularlypreductal
coarctationofAortaandbicuspidAorticvalve.
C.VSabnormalitiesaremostimportantcauseofmortalityinchildren
withTurner'ssyndrome.
FeaturesofTurner'ssyndromeinAdolescentsandAdult:-
Atpubertythereisfailuretodevelopnormalsecondarysex
characteristics.
Thegenitaliaremainsinfantile,breastdevelopment
isinadequateandthereislittlepubichair.Nipplesare
widelyspaced.
Turnersyndromeisthesinglemostimportantcauseofprimary
amenorrhoeaaccountingforapproximately1/3ofthecases.
Shortstature(heightrarelyexceeds150cm).
Thementalstatusofthesepatientsisusuallynormalbutsubtle
defectsinnonverbal,visualspatialinformationprocessinghave
beennoted(mentalretardationisassociatedwiththepresenceof
extrachromosomenotwithlossofXchromosome).
About50%ofthepatientsdevelopautoantibodiesdirectedto
thethyroidglandanduptoonehalfofthesepatients
develophypothyroidism.
Otherfeaturesincludelowposteriorhairline,webbingofneck,
cubitusvalgus,streakovaries.oGlucoseintolerance,obesityand
insulinresistancearealsoseen.

---

431.NormalupperlimitofCA-125is?
a)25U/ml
b)45U/ml
c)65U/ml
d)85U/ml
CorrectAnswer-A
Ans.is`a'i.e.,25U/ml
Thenormalvalueislessthan35U/mL
1)Carcinoembryonicantigen(CEA)
Itisaglycoproteinproducedbyfetalgut,pancreasandliver.
Itisusedastumormarkerforcolorectalcancer(majoruse),lung
cancer,breastcancerandovariancancer.Itisalsoincreasedin
non-neoplasticconditionslikealcoholiccirrhosis,hepatitis,IBD(CD,
UC),smokingandpancreatitis.
Incolorectalcanceritisusedforscreening;responseandfollowup
aftersurgery(CEAshoulddiseapperin6weeksafterresection),
prognosis(higherlevelssuggestshightumorburden)andtosee
recurrenceonfollowup.CEAantigenhasnocorrelationwithhepatic
metastasis.
CEAlackssensitivityaswellasspecificity,hencecannotbeusedto
confirmthediagnosis.
2)Alpha-fetoprotein(AFP)
Itisaglycoproteinsynthesizednormallyearlyinfetallifebyyolksac,
fetalliverandfetalGIT.Itisstructurallyandgeneticallyrelatedto
albumin.
AFPisraisedinlivercancer(hepatocellularcarcinoma),lung
carcinoma,pancreaticcarcinoma,coloncarcinoma,andnon-
seminomagermcelltumoroftestis/ovary(yolksac

---

tumor/endodermalsinustumor,embryonalcarcinoma,teratoma).
AFPisalsoraisedinsomenon-neoplasticconditionslikecirrhosis,
hepatitis,andpregnancy.
3)Humanchorionicgonadotropin(HCG)
Itisaplacentalhormonesynthesizedbysyncytiotrophoblasts.Itis
glycoproteinwithtwosubunits(dimer):a-subunitand/3-subunit.But
onlythePsubunitofHCGistypicallymeasuredasatumourmarker
becauseofspecificityofthe13subunit.Thei3subunitofHCGhas
uniquesequencesthatarenotsharedwithotherhumanglycoprotein
hormones.
Itisdetectedbyradioimmunoassayusingantibodiestothe13chain.
a-HCGisnotusedastumourmarkerbecauseaunitoftheFSH,LH
andTSHareidentical.Sotherecanbecrossreactivitybetweena
subunitsofthesehormone.Thatiswhyincaseoftesticulartumours
thepatientsalsoundergosimultaneousassayofLHtobecertain
thatthemarkerdetectedis13HCG.
HCG(13-HCG)israisedingestationaltrophoblasticdisease
(hydatidiformmoles),gonadalgermcelltumor(embryonal
carcinoma,choriocarcinoma),andpregnancy.
4)CA-125
MostimportantcancerwithelevatedCA-125isepithelialovarian
cancer.CA-125isalsoelevatedincancersofendometrium,cervix,
fallopiantubes,pancreas,breast,lungandcolon.
Non-neoplasticconditionscausingelevationofCA-125are
pregnancy,mensturation,endometriosis,PID,abdominalTB,
peritonitisanduterinefibroid.
Tumormarkersfortesticular/ovariantumor
1. AFP(alpha-fetoprotein):Teratoma,Yolksactumor(endodermal
sinustumor),embryonalcarcinoma.
2. HCG(humanchorionicgonadotrophin):Choriocarcinoma,
embryonalcarcinoma.
3. a,-antitrypsin:Yolksactumor(endodermalsinustumor).
4. Placentalalkalinephosphatase:Seminoma.
5. Other:Placentallactogen,LDH.

---

432.Carcinoembryonicantigenisraisedin
whichofthefollowingnonneoplastic
conditions-
a)Hepatitis
b)Pancreatitis
c)Hemolyticanemia
d)Ulcerativecolitis
CorrectAnswer-B
Ans.is'b'i.e.,Pancreatitis
1)NeoplasticconditionswithraisedCEA-->Colorectalcancer,
lungcancer,breastcancer,ovariancancer.
2)Non-neoplasticconditionswithraisedCEA-->Alcoholic
cirrhosis,hepatitis,IBD(UC,CD),smoking,pancreatitisand
hemolyticanemia.

---

433.Alpha-fetoproteinisatumormarkerfor
a)Hepatocellularcarcinoma
b)Multiplemyeloma
c)Seminoma
d)Breastcarcinoma
CorrectAnswer-A
Answer-A.Hepatocellularcarcinoma
Alpha-fetoprotein(AFP)
AFPisawellestabilishedtumormarker
Itisaglycoprofeinsynthesizednormailyearlyinfetallifebytheyolk
sac,fetalliverandfetalGIT.
AFPisraisedin-
Carcinomas>LiverCa,LungCa,ColonCa,PancreaticCa,Non-
seminomagermcelltumoroftestis.
Non-neoplasticconditions>Cirrhosis,Hepatitis,Pregnancy

---

434.Inhibinistumormarkerfor?
a)Granulosacelltumor
b)Malignantmelanoma
c)Prolactinoma
d)Breastcarcinoma
CorrectAnswer-A
Ans.is'a'i.e.,Granulosacelltumor
Granulosacelltumorispositiveforvimentin,inhibin,CD99.

---

435.Mesotheliomaispositiveforwhich
intermediatefilament
a)Vimentin
b)Cytokeratin
c)GFAP
d)Desmin
CorrectAnswer-B
Answer-B.Cytokeratin
Cytokeratin-Carcinoma,mesothelioma,Non-seminomaGCT

---

436.Calretininisusedin
a)Mesothelioma
b)Hamartoma
c)Choristoma
d)Chordoma
CorrectAnswer-A
Answer-A.Mesothelioma
Calretininandcytokeratinarepositiveincasesofmalignant
mesothelioma.

---

437.Markerofangiosarcomais
a)CD31
b)Cytokeratin
c)Vimentin
d)CD55
CorrectAnswer-A
Answer-A.CD31
Theendothelialoriginofthesetumorscanbedemonstratedby
immunohistochemicalstainingforCD31orvonWillebrandfactor.

---

438.Keratinizationandpearlformationis
characteristicof
a)Squamouscellcarcinoma
b)Basalcellcarcinoma
c)Melanoma
d)Lymphoma
CorrectAnswer-A
Answer-A.Squamouscellcarcinoma
Histologically,squamouscellcarcinomaischaracterizedbythe
presenceofkeratinizationand/orintercellularbridges.Keratinization
maytaketheformofsquamouspearlsorindividualcellswith
markedlyeosinophilicdensecytoplasm

---

439.Gradeoftumordenotes
a)Degreeofdifferentiation
b)Degreeofanaplasia
c)Stageofdisease
d)Vascularinvasion
CorrectAnswer-A
Answer-A.Degreeofdifferentiation
Gradingisbasedonthedegreeofdifferentiationoftumorcellsand
thenumberofmitosiswithinthetumor.

---

440.Carcinomaduetoinheritedmutationof
p53protooncogene
a)Lifraumenisyndrome
b)Familialadenomatouspolyposis
c)Retinoblastoma
d)Osteosarcoma
CorrectAnswer-A
Answer-A.Lifraumenisyndrome
Li-Fraumenisyndromeisduetomutationinp-53gene.

---

441.BRCA2notassociatedwith
a)breastcancer
b)Prostatecancer
c)Ovariancancer
d)Vulvalcancer
CorrectAnswer-D
Ans.is'd'i.e.,Vulvalcancer
BRCA-1erBRCA-2arecommonlyassociatedwith-->Carcinomas
ofovaryandbreast.
LesscommonlyBRAC-2isalsoassociatedwith-->Carcinomasof
colon,prostateandpancreas.
[RefRobbin'sViep.1076;ClinicalSurgerybyMichalM.Henry&
JeremyN.Thompson2"a/ep.453]

---

442.ModifiedBloomRichardsoncriteriafor
CarcinomaBreastincludes-
a)Desmoplasia
b)Lymphovenousembolism
c)Mitoticrate
d)All
CorrectAnswer-C
Ans.is'c'i.e.mitoticrate
Gradingofbreastcancer
oPresently,mostmethodsforgradingusethepreviouslycited
three-tieredsystemsfordescribingtumorstructureintermsoftubule
formation,nucleargradeandmitoticcount,withthelatterusually
expressedasthenumberofmitosisper10high-magnificationfield.
oEachelementisscoredonascalefrom1to3accordingtocriteria
ofthespecificgradingsystem,andthefinalgradeisdeterminedby
thesumofmitosis.
oTotalsof3to5indicateawell-differentiatedorlow-gradetumor;6
to7,amoderatelydifferentiatedorintermediate-gradetumor;and8
to9,apoorlydifferentiatedorhigh-gradetumor.
oThismethodofscoringisknownastheNottinghamcombined
histologicgradeofElston-EllismodificationoftheScarff-Bloom-
Richardsongradingsystem,oftenreportedasamodifiedScaff-
Bloom-Richardsongrade.
ModifiedBloom-RicharsonhistologicalgradingTubuleformation
oScore1:->75%oftumorhastubules
Score2:-10-75%oftumorhastubules
oScore3:-<10%oftumorhastubules
Nuclearsize(nuclearpolymorphism)
oScore1:-tumornucleisimilartonormalductnuclei(2-3xRBC)

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oScore1:-tumornucleisimilartonormalductnuclei(2-3xRBC)
Score2:-Intermediatesizenuclei
Score3:-verylargenuclei,usuallyvesicularwithprominentnucleoli
Mitoticcount
oScore1:-0-7mitosisoScore2:-8-14mitosisoScore3:->15
mitosis

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443.Excessivefibrosisintumorincalled-
a)Anaplasia
b)Metaplasia
c)Desmoplasia
d)Dysplasia
CorrectAnswer-C
Ans.is'c'i.e.,Desmoplasia
Insometumors,parenchymalcellsstimulatetheformationofan
abundantcollagenousstroma,referredtoasdesmoplasia,eg
scirrhouscarcinomaofbreast.

---

444.Krasmutationisseenin
a)Pancreaticcarcinoma
b)Prostatecarcinoma
c)Gastriccarcinoma
d)Hepaticcarcinoma
CorrectAnswer-A
Answer-A.Pancreaticcarcinoma
K-RASpointmutation:Cancersofcolon,lungandPancreas.
H-RASpointmutation:Cancersofkidneyandbladder
N-RASpointmutation:Melanomaandhematologicalmalignancies
[RefRobbin's8thiep.279&7h/ep.295]

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445.Sentinellymphnodebiopsyisusedfor?
a)Melanoma
b)Basalcellcarcinoma
c)Squamouscellcarcionoma
d)Thyroidcarcinoma
CorrectAnswer-A
Ans.is'a'i.e.,Melanoma
Sentinellymphnodebiopsyisusedforbreastcarcinomaand
melanoma.

---

446.Pointmutatoninwhichprotooncogeneis
responsibleforthedevelopmentof
gastrointestinalstromaltumor
a)KIT
b)ALK
c)RET
d)FLT3
CorrectAnswer-A
Ans.is'a'i.e.,KIT
Approximately75%to80%ofallGISTshaveoncogenic,gain-of-
functionmutationsofgeneencodingthetyrosinekinasec-KIT.
Approximately8%ofGISTshavemutationsthatactivatearelated
tyrosinekinase,plateletderivedgrowthfactorreceptora(PDGFRA).
Consitutivelyactivec-KITorPDGFRAreceptortyrosinekinases
activateRASandP13K/AKTpathwaysandtherebypromotetumor
cellproliferation.

---

447.ParaneoplasticsyndromeHypercalcemia
ofmalignancy,isproduceddueto
ectopicproductionofwhichhormoneby
lymphomas?
a)PTHrP
b)1,25dihydroxyvitaminD
c)PGE2
d)Parathormone
CorrectAnswer-B
Ans.is'b'i.e.,1,25dihydroxyvitaminD
Parathyroidhormone-relatedprotein(PTHrP)
1,25dihydroxyvitaminD
Parathyroidhormone(PTH)(rare)ProstaglandinE2(PGE2)(rare)

---

448.DICisseeninallexcept
a)Carcinomapancreas
b)Carcinomaprostate
c)Carcinomalung
d)Carcinomakidney
CorrectAnswer-D
Answer-D.Carcinomakidney
CancersassociatedwithDIC
Capancreas
Calung
Acutepromyelocyticleukemia
Caprostate
CaStomach

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449.Thephenomenonbywhichthecancer
cellsareabletosustainandproliferate
underadverseconditionsofhypoxiais?
a)Warburg
b)Wanton
c)Wormian
d)Wolf
CorrectAnswer-A
Ans.is'a'i.e.,Warburg
OttoWarburgdescribedthebioenergeticsandmetabolicfeatures
thatpermitcancercellstosurviveunderadverseconditionssuchas
hypoxiaandenabletheirproliferation,progression,invasiveness,
andsubsequentdistantmetastasis.
ThisphenomenonisthuscalledthegrowthpromotingWarburg
phenomenon.

---

450.Laddertearsare?
a)Spiraltearsofaorticintima
b)Verticaltearsofaorticintima
c)Horizontaltearsofaorticintima
d)Obliquetearsofaorticintima
CorrectAnswer-C
Ans.is'c'i.e.,Horizontaltearsofaorticintima
Laddertearsarethehorizontaltearsofintima
Itisinjurytoaortaduetodeceleration.
Itissocalledbecauseitresemblestherungsofaladder.

---

451.HepatitisBassociatedwith?
a)Wegener'sgranulomatosis
b)Systemiclupuserythmatosus
c)Polyarteritisnodosa
d)Sjogrensyndrome
CorrectAnswer-C
Ans.is'c'i.e.,Polyatrteritisnodosa
ThehepatitisBsurfaceantigenispresentin25%ofpatientswith
PolyarteritisNodosa.
HepatitisCantibodyispresentinpatientswithessentialmixed
cryoglobinuriaandrarelyinpatientswithpolyarteritisnodosa.

---

452.pANCApositivevasculitisis
a)Wegener'sgranulomatosis
b)Churg-Strausssyndrome
c)Polyarteritisnodosa
d)Alloftheabove
CorrectAnswer-B
Answer-b.Churg-Strausssyndrome
PANCA
Typicallyfoundin:
Microscopicpolyangiitis
Churg-Strausssyndrome
Idiopathiccrescenticglomerulonephritis
Goodpasteur'ssyndrome.
pANCA'sarealsoassociatedwithcertainnon-vasculiticentitiessuch
ascertainrheumaticandnonrheumaticautoimmunediseases,
Inflammatoryboweldiseases,certaindrugs.Infectionssuchas
endocarditisandbacterialairwayinfectioninpatientswithcystic
fibrosis

---

453.Patientwithchronichypertensionwill
showfollowingchangesonhistologyof
kidney
a)Hyalinearteriosclerosis
b)Hyperplasticarteriosclerosis
c)Onionskinlesions
d)Vessellumendilatation
CorrectAnswer-A
Ans.is'a'i.e.,Hyalinearteriosclerosis
Hypertensionisassociatedwithtwoformsofsmallbloodvessels
disease?
1.Hyalinearteriolosclerosis
Thereishomogenous,pink,hyalinethickeningofarteriolarwall.The
lumenbecomesnarrow.Itischaracteristicofbenignhypertension.It
mayalsooccurindiabetesandaging.
2.Hyperplasticarteriosclerosis
Itischaracteristicofmalignanthypertension.Thereisconcentrentic,
laminatedthickeningofarteriolarwallonionskinning.Thereis
mucinousintimalthickeningandfibrousintimalthickening.
Theremaybeaccompaniedfibrinoiddepositswithnecrosisofthe
vesselswallfibrinoidnecrosis(ornecrotizingarteriolitis).
Favouredsitesforhyperplasticarteriosclerosisarekidney,small
intestine,gallbladder,peripancreaticfat,andperiadrenalfat.
Besidethesehypertensionalsocauses:-
1. Atherosclerosisinlargearteries.
2. Degenerativechangesinthewallsoflargeandmediumarteriesthat
potentiatebothaorticdissectionandcerebrovascularhemorrhage.

---

---

454.Histologicfindinginhyperplastic
arteriosclerosis
a)Concentriclayeronionskinlesion
b)Mucinousintimalthickening
c)Fibrinoidatherosclerosis
d)Alltheabove
CorrectAnswer-D
Answer-D.Alltheabove
Itischaracteristicofmalignanthypertension.
Thereisconcentrentic,laminatedthickeningofarteriolarwallonion
skinning.
Thereismucinousintimalthickeningandfibrousintimalthickening.
Theremaybeaccompaniedfibrinoiddepositswithnecrosisofthe
vesselswallfibrinoidnecrosis.

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455.Obliterativeendarteritisofthevasa
vasorumofaortaisseenin
a)Syphilis
b)Wegener's
c)Chrugstrauss
d)Coldhemoglobinuria
CorrectAnswer-A
Answer-A.Syphilis
Syphiliticaneurysmisduetoobliterativeendarteritisthatinvolves
vasovasorumofaortainthetertiarystageofsyphilis.

---

456.Antischkowcellsare?
a)Modifiedmacrophages
b)Modifiedneutrophils
c)ModifiedBcells
d)ModifiedRBCs
CorrectAnswer-A
Ans.is'a'i.e.,Modifiedmacrophages
PathologicFeaturesofAcuteRheumaticFever
Aschoffbodiesfocalinflammatorylesionsseeninacuterheumatic
feverconsistingoffociofTlymphocytes,occasionalplasmacells,
andplumpactivatedmacrophages.
TheseactivatedmacrophagescalledAnitschkowcells
(pathognomonicforRheumaticFever)haveabundantcytoplasm
andcentralround-to-ovoidnuclei(occasionallybinucleate)inwhich
thechromatincondensesintoacentral,slender,wavyribbon(hence
alsocalled"caterpillarcells").
Pancarditis-DuringacuteRF,diffuseinflammationandAschoff
bodiesmaybefoundinanyofthethreelayersoftheheart,resulting
inpericarditis,myocarditis,orendocarditis
Verrucaearesmall(1to2mm)vegetationsoverlyingnecroticfoci
andalongthelinesofclosureofvalves.oMacCallumplaquesare
irregularlythickenedsubendocardiallesionsusuallyintheleft
atrium.oMitralstenosis-FishMouthorButton-Holestenosis.

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457.WhichisoenzymeofLDHisseeninheart
a)LDH1
b)LDH2
c)LDH3
d)LDH4
CorrectAnswer-A
Answer-A.LDH1
MostprominentisoenzymedinheartmuscleisLDH-1.LDH-2is2nd
mostprominentform(afterLDH1)

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458.Whichwormcausesmyocarditis?
a)Trichuris
b)Trichinella
c)Enterobius
d)Strogyloides
CorrectAnswer-B
Ans.is'b'i.e.,Trichinella
Trichinosisisthemostcommonhelminthicdiseasecausing
myocarditis.

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459.Carcinoidsyndromeproducesvalvular
diseaseprimarilyofthe
a)Venousvalves
b)Tricuspidvalve
c)Mitralvalve
d)Aorticvalve
CorrectAnswer-B
AnswerisB(Tricuspidvalve);
Themostcommonsiteofinvolvementisthe?Ventricularsurfaceof
Tricuspidvalve.
'Cardiacmanifestationsincarcinoidsyndromeareduetofibrosis
involvingtheendocardium,primarilyontherightsidealthoughleft
sidelesionsalsooccur.Densefibrousdepositsaremostcommonly
ontheventricularaspectofthetricuspidvalveandlesscommonly
onthepulmonaryvalvecusps.'
Theycanresultineitherconstrictionofvalves(stenosis)or
fixationofvalvesinopen(regurgitation)
-Abnormalityproducedduetotricuspidvalveinvolvement?
TricuspidregurgitationQ
-Abnormalityproducedduetopulmonaryvalveinvolvement?
PulmonarystenosisQ

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460.Whichofthefollowingisnotalarge
vesselvasculitiis?
a)Takayasuarteritis
b)Cogansyndrome
c)Chrugstrausssyndrome
d)Giantcellarteritis
CorrectAnswer-C
Ans.is'c'i.e.,Churgstrausssyndrome
Largevesselvasculitis:Giantcellarteritis(temporalarteritis),
Takayasuarteritis,Cogansyndrome.
Mediumvesselvasculitis:PAN(classicalPAN),kawasakidisease,
Buerger'sdisease.
Smallvesselvasculitis:HSP,Wegner'sgranulomatosis,
microscopicpolyangitis,churgstrausssyndrome,Cryoglobulinemia,
SLE,idiopathiccrescenticglomerulonephritis,Bechet'ssyndrome,
renallimitedvasculitis.

---

461.Mostcommonsiteofglomustumoris?
a)Underfingernails
b)Undertoenails
c)Neck
d)Axilla
CorrectAnswer-A
Ans.is'a'i.e.,Underfingernails
Glomustumor(Glomangioma)
Benigntumorarisingfromthesmoothmusclecellsoftheglomus
bodywhichisanarteriovenousanastomosisinvolvedin
thermoregulation.
Mostcommonlypresentinthedistalportionofthedigits(under
fingernails).
Histologically,thereispresenceofbranchingvascularchannelsand
stromacontainingnests/aggregatesofglomuscellsarrangedaround
vessels.

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462.Mostcommontypeofhodgkins
lymphomais?
a)Lymphocytepredominant
b)Lymphocytedepletion
c)Nodularsclerosis
d)Mixedcellularity
CorrectAnswer-C
Ans.is'c'i.e.,Nodularsclerosis
BestPrognosis
Worstprognosis
MostcommonHL
MostcommontypeHLinIndia
LeastcommontypeHL
Lymphocyticpredominancetype.-->Lymphocyticdepletiontype.--
>Nodularsclerosistype.
-->Mixedcellularitytype.Lymphocyticdepletiontype

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463.Lacunartypeofreedsternbergcellis
seenin?
a)Nodularsclerosis
b)Lymphocytepredominance
c)Mixedcellularity
d)Lymphocytedepletion
CorrectAnswer-A
Ans.is'a'i.e.,Nodularsclerosis

---

464.Popcorncellsareseeninwhichvariety
ofhodgkin'sdisease?
a)Nodularsclerosis
b)Mixedcellularity
c)Lymphocytepredominant
d)Lymphocytedepletion
CorrectAnswer-C
Ans.is'c'i.e.,Lymphocytepredominant
Popcorncellsarefoundinlymphocyticpredominanttypeof
Hodgkin'sLymphoma.

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465.Birbeckgranulesincytoplasmisseenin
?
a)Langerhanscellhistiocytosis
b)Hodgkin'slymphoma
c)Nonhodgkinslymphoma
d)Gastrointestinalstromaltumor
CorrectAnswer-A
Ans.is'a'i.e.,Langerhanscellhistiocytosis
Birbeckgranulesarecharacteristicoflangerhanscellhistiocytosis
Tumourcellsinthelangerhan'scellhistiocvtosisarederivedfrom
dendriticcellsandexpress:
S-100
CD1a
HLA-DR
Thesecellsarecharacterizedbythepresenceofbirbeckgranulesin
theircytoplasmundertheelectronmicroscope,Birbeckgranules
havepentalaminar,rodliketuularappearanceandsometimesa
dilatedterminalend(tennis-racketappearance)

---

466.Shapeofbirbeckgranulesis?
a)Tennisracket
b)Hockeystick
c)Bat
d)Ball
CorrectAnswer-A
Ans.is'a'i.e.,Tennisracket
Undertheelectronmicroscope,Birbeckgranuleshavea
pentalaminar,rodlike,tubularappearanceandsometimesadilated
terminalendresemblingtennis-racketappearance.

---

467.Mostcommonsiteforeosinophilic
granulomais?
a)Radius
b)Skull
c)Lumbarvertebra
d)Femur
CorrectAnswer-B
Ans.is'b'i.e.,Skull
Themostcommonsitesareskullbones,longbones,spinal
vertebrae,mastoidandmandible.

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468.PelgerHuetanamolyshowspresenceof
?
a)Hyposegmentedneutrophil
b)Hypersegmentedneutrophil
c)Unsegmentedneutrophil
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Hyposegmentedneutrophil
PelgerHuetanomaly
Itisageneticdisorderwithanautosomaldominantinheritance
pattern.
ItisabloodlaminopathyassociatedwiththelaminBreceptor.
Itischaracterizedbyawhitebloodcelltypeknownasaneutrophil
whosenucleusishyposegmented.
Heterozygotesareclinicallynormal,althoughtheirneutrophilsmay
bemistakenforimmaturecells,whichmaycausemistreatmentina
clinicalsetting.
Homozygotestendtohaveneutrophilswithroundednucleithatdo
havesomefunctionalproblems.

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469.MALTomaislocatedinwhichlayerof
gastrointestinaltract
a)Laminapropria
b)Submucosa
c)Muscularispropria
d)Serosa
CorrectAnswer-A
Answer-A.Laminapropria
Extranodalmarginalzonelymphomaormucosa-associated
lymphoidtissuelymphoma(MALToma).
Itisthemostcommonformofmarginalzonelymphoma.MALT
lymphoma(MALToma)isdividedintogastric(arisinginstomach)
andnon-gastric(arisinginsmallintestine,salivarygland,thyroid
etc).GastricMALTomahasbeenassociatedwithH.pyloriinfection.
ImmunophenotypeofMALTomasshowspositivityforCD20andCD
23.TheyarenegativeforCD3,CD10andCD5.
Histologically,MALTomatakesformofadenselymphocyticinfiltrate
inthelaminaproprialayerofGIT.

---

470.Trueaboutgastriclymphoma-
a)NonHodgkinslymphomacommonestvariety
b)Diagnosisismadebybiopsy
c)H-Pylorihasdirectrelationship
d)All
CorrectAnswer-D
Ans.is'a'i.e.,NonHodgkinslymphomacommonestvariety;'b'i.e.,
Diagnosisismadebybiopsy;`c'i.e.,H-Pylorihasdirectrelationship
Gastriclymphoma
Thestomachisthemostcommonsiteforextranodallymphoma.
oNearlyallgastriclymphomasareB-celllymphomasofmucosa-
associatedlymphoidtissue(MALTlymphoma)oMajorityofcases
(80%)areassociatedwithchronicgastritisandH.Pyloriinfection.
oThemoststrikingevidencelinkingH.PylorigastritistoMALToma
isthateradicationofinfectionbyantibioticsinducesdurable
remissionwithlowrateofrecurrence.
oGastriclymphomarepresents5%ofallgastricmalignancies.
Itismostprevalentissixthdecadeoflife.
oLikeothertumorsofmatureBcells,MALTomasexpressB-cell
markersCD19andCD20.TheydonotexpressCD5,CD10and
CD23.
oDiagnosisismadebyendoscopicbiopsy.
oGastriclymphomasarechemosensitiveandchemotherapyalone
oralongwithsurgeryisusedforthetreatmentofgastriclymphoma.
Aboutoption'a'
oMostcommonvarietyofgastriclymphomaisNHL(MALToma).
Veryrarely,Hodgkin'slymphomamayalsooccurinstomach.

---

471.Whichofthefollowingisnottrueabout
idiopathicthrombocytopenicpurpura?
a)AntibodiesofIgMclass
b)AutoantibodiestoGpIIb/IliaorIBIX
c)Increasedmegakaryocytesinbonemarrow
d)Spleenisnormalinsize
CorrectAnswer-A
Ans.is'a'i.e.,AntibodiesofIgMclass
Idopathicthrombocytopenicpurpura:?
TherearetwoclinicalsubtypesofprimaryI.T.P,acuteandchronic
bothareautoimmunedisordersinwhichplateletdestructionresults
fromformationofantiplateletantibodies.
Pathogenesis
ChronicITPiscausedbytheformationofautoantibodiesagainst
plateletmembraneglycoproteinsmostoftenHb-lIlaorIb-IX.
Inoverwhelmingmajorityofcasestheantiplateletantibodiesareof
the.IgL,class.
Themechanismofplateletdestructionissimilartothatseenin
autoimmunehemolyticanemias.Opsonizedplateletsarerendered
susceptibletophagocytosisbythecellsofthemononuclear
phagocytesystem.
Thespleenisthemajorsiteofthedestructionofplatelets.
Pathology
Theprincipalmorphologiclesionsofthrombocytopenicpurpuraare
foundinthespleenandbonemarrowbuttheyarenotdiagnostic.
Thepointtostressisthatdespitetheincreaseddestructionof
plateletsinspleen,thespleensizeremainsnormal.

---

Onhistologicalexaminationthereiscongestionofthesinusoidsand
hyperactivityandenlargementofthesplenicfolliclesmanifestedby
theformationofprominentgerminalcentres.Sometimesscattered
megakaryocytesarefoundwithinthesinusesandsinusoidalwalls.
Thisrepresentsaverymildformofextramedullaryhematopoiesis.
Thesesplenicfindingsarenotsufficientlydistinctivetobe
considereddiagnostic.
BoneMarrow
Bonemarrowrevealsamodestlyincreasednumberof
megakaryocytes.
Thesefindingsarenotspecificforautoimmunethrombocytopenic
purpura,butmerelyreflectacceleratedthrombopoiesis,beingfound
inmostformsofthrombocytopeniaresultingfromincreasedplatelet
destruction.
Theimportanceofbonemarrowexaminationistoruleout
thrombocytopeniasresultingfrombonemarrowfailure.
Adecreaseinthenumberofmegakaryocytesgoesagainstthe
diagnosisofI.T.P.

---

472.Defectofglanzmann'sthrombostheniais
?
a)Gp1Ib-IlIa
b)GpIIIa-Ilb
c)GpIla-Illb
d)Gpfilb-Ila
CorrectAnswer-A
Ans.is'a'i.e.,GpI1b-IlIa
DefectinGlanzmann'strombstheniaGpIIb/IIIa
DefectinBernardsouliersyndromeGpIb/IX

---

473.Giantplateletsareseenin?
a)Bernardsouliersyndrome
b)vWD
c)Polycythemiarubravera
d)Leukemia
CorrectAnswer-A
Ans.is'a'i.e.,Bernardsouliersyndrome
BernadSoulierdisease-DefectintheplateletGpIb-IXcomplex
BT,mildthrombocytopenia,deficientorlowlevelsofplateletGpIb-IX
complexbyflowcytometry
Ristocetinaggregationtestisdefective

---

474.PTisusedtotest?
a)Extrinsicandcommonpathway
b)Intrinsicandcommonpathway
c)Intrinsicpathway
d)Extrinsicpathwa
CorrectAnswer-A
Ans.is'a'i.e.,Extrinsicandcommonpathway
PatientswithhemophiliahavedeficiencyoffactorVIIIthatresultsin
prolongedPTT.

---

475.Whichofthefollowingstatementsabout
coagulationfactorVIIisnottrue
a)DeficiencyisinheritedasanAutosomalRecessivetrait
b)DeficiencyisassociatedwithprolongedAPTT
c)DeficiencycanbemanagedbyFreshFrozenplasma
d)HasashorterhalflifeincomparisontoHagemanfactor(XII)
CorrectAnswer-B
AnswerisB(DeficiencyisassociatedwithprolongedAPTT)
FactorVIIdeficiencyisassociatedwithisolatedprolongationofPT,
APTTisnormalinFactorVIIdeficiency
Geneticandlaboratorycharacteristicofinheritedcoagulation
disorders
Inheritance
Laboratory
Treatment
Prevalence
Minimum
Clotting
Abnormality'
inGeneral
Hemostatic
factor
aPTI
Population
leNels
deficiency
PTTT
Iin
Fibrinogen AR
100mg/dL Cryoprecipitate
1.000,000 +
+
+
Iin
Prothrombin AR
20-30%
FFP/Pa's
2.000,000 +
+
1in
FactorV
AR
+/- +1-
I5-10"/a
HP
1.000,000
1in
FactorIII
AR
-
+
-
15-20%
FFP/PCCs
500,000
FAINT
FactorVIII X-linked
Iin5.000
30%
+
-
concentrates
FactorIX
X-linked
Iin30.000
30%
FIXconcentrates
+
-
-

---

FactorIX
X-linked
Iin30.000
30%
FIXconcentrates
+
-
-
Iin
FactorX
AR
+1- +/- -
15-20%
FFP/PCICs
1.000,000
Iin
FactorXI
AR
15-20%
FFP
1,000,000
FactorXII
AR
'SO
+
-
h
h
HK
AR
ND
+
Ii
h
Prckallikrein AR
ND
_,
6
h
Iin
FactorXIII AR
+/-
2-5%
Cryptoprecipitate
2,000,000


Valueswithinnsrmalrange(-)orprolonged(?)Noriskforbleeding,
treatmentisnotindicated
HK,high-molecularweightkininogen;AR,autosomalrecessive;
aPTT,activatedpartialthromboplastintime;PT,prothrombintime;
TT,thrombintime;ND,notdetermined;FFP.freshfrozenplasma;
PCCs,prothrombincomplexconcentrates.

---

476.UnderBloodsafetyprogramme
compulsorytestsdoneareallexcept?
a)HIV
b)VDRL
c)Malaria
d)HepatitisE
CorrectAnswer-D
Ans.is'd'i.e.,HepatitisE
Bloodsafety:?
UnderBloodSafetyProgrammeallthebloodbankshavetoensure
thatbeforetransfusionofbloodtothepatientthemandatorytestsfor
HIV,VDRL,HepatitisB,HepatitisCandMalariaaredone.

---

477.Followingstatementistruefor
hemophiliapatients?
a)AllFemalesarecarriersandallmalesareaffected
b)AllMalesarecarriersandallfemalesareaffected
c)Femalesaremostlycarriersandallmalesareaffected
d)Malesaremostlycarriersandallfemalesareaffected
CorrectAnswer-C
Ans.is'c'i.e.,Femalesaremostlycarriersandallmalesareaffected
HemophiliaisanX-linkedrecessivehemorrhagicdiseasedueto
mutationsintheF8gene(hemophiliaAorclassichemophilia)orF9
gene(hemophiliaB).
ThediseaseaffectsIin10,000malesworldwide,inallethnic
groups;hemophiliaArepresents80%ofallcases.
Malesubjectsareclinicallyaffected;women,whocarryasingle
mutatedgene,aregenerallyasymptomatic.
Familyhistoryofthediseaseisabsentin30%ofcasesandinthese
cases,80%ofthemothersarecarriersofthedenovomutated
allele.

---

478.Bloodisstoredatwhattemperaturein
bloodbank?
a)-2to-4degreesCelsius
b)-2to0degreesCelsius
c)1to6degreesCelsius
d)6to12degreesCelsius
CorrectAnswer-C
Ans.is'c'i.e.,1to6degreesCelsius
Storagetemperatureofblood:1-6?C
StoragetemperatureofpackedRBCs:40?C
StoragetemperatureofFFP:-20?C
Storagetemperatureofplatelets:20-24?C

---

479.Normalreticulocytecountinnewbornis-
a)0-1%
b)1-1.5%
c)3-6%
d)6-9%
CorrectAnswer-C
Ans.is'c'i.e.,3-6%
Normalreticulocytecountinadultsis1-1.5%andinnewbornsis3-
6%
invalidquestionid

---

481.Loadingdosedependson?
a)Volumeofdistribution
b)Eliminationrate
c)Halflife
d)Plasmavolume
CorrectAnswer-A
Ans.is'a'i.e.,Volumeofdistribution
Loadingdoseisgovernedbyvolumeofdistributionandvolumeof
distributionisaffectedbylipidsolubility.
Maintenancedoseisgovernedbyclearance(excretion)ofdrugand
halflife.

---

482.Maintainencedoseiscalculatedbyusing
valueof?
a)Clearance
b)Volumeofdistribution
c)Oralbioavailability
d)Dailydosage
CorrectAnswer-A
Ans.is'a'i.e.,Clearance
Drugdosing
Fordrugswithlongert1/2adosethatissufficienttoattainthetarget
concentrationaftersingleadministration,ifrepeatedwillaccumulate
accordingtoplateauprincipalandproducetoxicitylateron.
Ontheotherhand,ifthedosingissuchastoattaintargetlevelat
steadystate,thetherapeuticeffectwillbedelayedbyabout5half
livesandthislapseoftimemaybeundesirablesometime.
Suchdrugsareoftenadministeredbyinitialloadingdoseand
subsequentmaintenancedoses.
Loadingdose

---

483.Depotpreparationsareadministeredby
?
a)Subcutaneousroute
b)Intravenousroute
c)Intramuscularroute
d)Bothsubcutaneousandintramuscularroute
CorrectAnswer-D
Ans.D.Bothsubcutaneousandintramuscularroute
Adepotinjectionisaninjection,usuallysubcutaneousor
intramuscular,ofapharmacologicalagentwhichreleasesitsactive
compoundinaconsistentwayoveralongperiodoftime.
Depotinjectionsareusuallyeithersolidoroilbased.

---

484.Mostvariableabsorptionisseenwith
whichroute?
a)Oral
b)Intramscular
c)Intravenous
d)Perrectal
CorrectAnswer-A
Ans.is'a'i.e.,Oral
Oraladministrationofdrugsissafe,convenientandeconomical,but
hasthepotentialforthemostvariableabsorption
pattern.
Clinicalpharmacology
Routesofdrugadministration
Drugsareadministeredbyvariousroutes.
Differentrouteshavedifferentcharacteristics,sothattherouteof
administrationmayhaveaprofoundeffectuponthespeedand
efficiencywithwhichthedrugsact.
Theroutesofdrugadministrationmaybe:
i)Localroute
ii)Systemicroute
Localroute-Drugisadministeredatthesiteoflesion.
Systemicroute-Drugisadministeredthroughsystemicroutesis
intendedtobeabsorbedintothebloodstreamanddistributedall
over,includingthesiteofaction,throughcirculation.

---

485.Aboutrectalroutetrueis?
a)Usedforirritantandunpleasantdrugs
b)Cannotbeusedinunconsciouspatient
c)Thereispredictableabsorptionofdrug
d)Diazepamcannotbegivenviarectalrouteofadministration
CorrectAnswer-A
Ans.is'a'i.e.,Usedforirritantandunpleasantdrugs
Rectalrouteofadministration
Itisarouteofsystemicdrugdelivery.
Irritantorunpleasantdrugscanbeputintotherectumas
suppositoriesorretentionenemas.
Canbeusedinapatientwithrecurrentvomitingandinunconscious
patient.
Absorptionofdrugisslower,irregularandunpredictable.
Drugabsorbedintotheexternalhemorrhoidalvein(50%)bypasses
theliverbutnotthatabsorbedintotheinternalhemorrhoidalvein.
Diazepam,indomethacin,ergotamineandparacetamolcanbeused
viarectalrouteofadministration.

---

486.Transdermalpatchisnotusedfor
followingdrug?
a)GTN
b)Fentanyl
c)Nicotine
d)Naloxone
CorrectAnswer-D
Ans.is`d'i.e.,Naloxone

---

487.Xenobioticsaremetabolizedto?
a)Increasewatersolubility
b)Increaselipidsolubility
c)Makethemnonpolar
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Increasewatersolubility
BIOTRANSFORMATION(METABOLISM)
Mostofthedrugsaretreatedbythebodyasforeignsubstances
(xenobiotics).
Likeotherforeignsubstances(xenobiotics),bodytriestoeliminate
drugsbyvariousmechanismsforriddingitselfofchemicalintruders.
Biotransformationmeanschemicalalterationofthedruginthebody.
Whydrugtransformationisnecessary?
Kidneyplaysapivotalroleinterminatingtheactivityofdrugs.
Forrenalexcretionthedrugtendstobepolar(lipidinsoluble/water
soluble)sothatitcannotdiffusebackfromtubularlumenandcan
beexcreted.
Butpharmacologicallyactiveorganicmolecules(drugs)tendtobe
lipophlic(nonpolar)andremainsunionizedoronlypartiallyionizedat
physiologicalpH.
Biotransformationisneededtorendernonpolar(lipidsoluble)
compoundspolar(watersoluble)sothattheyarenotreabsorbedin
therenaltubulesandareexcreted.
Sitesandprocessesofbiotransformation
Primarysiteofdrugmetabolismisliver,othersare-kidney,
intestine,lungandplasma.
Biotransformationofdrugsmayleadto:-

---

Activemetabolitefromanactivedrug
Manydrugsarepartiallyconvertedtooneormoreactive
metabolites.
Theeffectsobservedarethesumtotalofthatduetotheparentdrug
anditsactivemetabolite.
Activationofinactivedrugs
Fewdrugsareinactiveassuchandneedconversioninthebodyto
oneormoreactivemetabolites.
Suchadrugiscalledprodrug.

---

488.Branchthatdealswithmedicinaldrugs
obtainedfromplantsandothernatural
resources-
a)Pharmacognosy
b)Pharmacogenetics
c)Pharmacogenomics
d)Pharmacopia
CorrectAnswer-A
Ans.is'a'i.e.,Pharmacognosy
Pharmacognosy:Itisthebranchthedealswiththeknowledge
pertainingtothemedicinaldrugsobtainedfromplantsandother
naturalsources.
Pharmacogenetics:Studyofgeneticbasisforvariabilityindrug
response
Pharmacogenomics:Useofgeneticinformationtoguidethechoice
ofdruganddoseonanindividualbasis.

---

489.Pharmacoviglanceisusedfor?
a)Tomonitordrugtoxicity
b)Tomonitorunauthorizeddrugmanufacture
c)Monitoringofstudents
d)Checkcosts
CorrectAnswer-A
Ans.is'a'i.e.,Tomonitordrugtoxicity
Pharmacovigilance
Pharmacovigilanceisthescienceandactivitiesrelatingtodetection,
assessment,understandingandpreventionofadverseeffectsorany
otherdrugrelatedproblem.

---

490.FalseregardingCytochromeP450is?
a)Theyareessentialfortheproductionofcholesterols,steroids,
prostacyclinsandthromboxaneA2
b)Theyabsorblightwith45nmwavelength
c)Theyoccurpredominantlyinliver
d)Theyarenonhemeproteins
CorrectAnswer-D
Ans.isdi.e.,Theyarenonhemeproteins
CYTOCHROMEP450
TheyCYP450areessentialfortheproductionofcholesterols,
steroids,prostacyclinsandthromboxaneA2.
Theyarealsoessentialforthemetabolismofforeignchemicalsand
detoxificationofdrugs.
CYP450enzymesaresonamedbecausetheyareboundto
membraneswithinacell(cyto)andcontainahemepigment(chrome
andP)thatabsorbslightatawavelengthof450nmwhenexposed
tocarbonmonoxide.
Therearemorethan50CYP450enzymes,buttheCYP1A2,
CYP2C9,CYP2C19,CYP2D6,CYP3A4,andCYP3A5enzymes
metabolize90percentofdrugs.

---

491.Glucuronidationtakesplacein?
a)Liver
b)RBC
c)Pancreas
d)Thyroid
CorrectAnswer-A
Ans.is'a'i.e.,Liver
GLUCURONIDATION
Thisisthemostimportantsyntheticreactioncarriedoutbyagroup
ofUDP-glucuronosyltransferases(UGTs).
Glucuronidationoccursmainlyintheliver,althoughtheenzyme
responsibleforitscatalysis,UDP?glucuronyltransferase,hasbeen
foundinallmajorbodyorgans(e.g.,intestine,kidneys,brain,
adrenalgland,spleen,andthymus).
Compoundswithahydroxylorcarboxylicacidgroupareeasily
conjugatedwithglucuronicacidwhichisderivedfromglucose.
Examplesare-chloramphenicol,aspirin,paracetamol,lorazepam,
morphine,metronidazole.
Notonlydrugsbutendogenoussubstrateslikebilirubin,steroidal
hormonesandthyroxineutilizethispathway.
Glucuronidationincreasesthemolecularweightofthedrugwhich
favoursitsexcretioninbile.
Drugglucuronidesexcretedinbilecanbehydrolysedbybacteriain
thegut-theliberateddrugisreabsorbedandundergoesthesame
fate.Thisenterohepaticcyclingofthedrugprolongsitsaction,e.g.
phenolphthalein,oralcontraceptives.

---

492.Counterfeitdrugis?
a)Fakemedicine
b)Containsthewrongingredient
c)Theyhaveactiveingredientinwrongdose
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove
Counterfeitmedicineisfakemedicine.
Itmaybecontaminatedorcontainthewrongornoactiveingredient.
Theycouldhavetherightactiveingredientbutatthewrongdose.
Counterfeitdrugsareillegalandmaybeharmfultoyourhealth.

---

493.Youngchildweighing20kgwasgivena
druginthedose100mg/kgbodyweight.
Theplasmaconcentrationofthedrugis
2mg/dlandtheclearanceis200ml/hr.
Whatisthetimerequiredtoreachsteady
stateplasmaconcentration-
a)10hrs
b)20hrs
c)30hrs
d)40hrs
CorrectAnswer-B
Ans.is'b'i.e.,20hours
Volumeofdistribution=totaldose/plasmaconcentration
Totaldose=dose/kgxbodyweight=100x20=2000mg
Volumeofdistribution=2000/2=1000
Halflife=0.693xVolumeofdistribution/clearance=0.693x
1000/200=3.5hours
Timerequiredtoreachsteadystateplasmaconcentrationis5.5half
lives=5.5x3.5=19.25hours
Thereforethemostappropriateansweris20hours.

---

494.IfVmaxdecto80%duetoaninhibitor
andKmissameasbeforewhichisthe
typeofinhibition?
a)CompetitiveEquilibriumtype
b)Noncompetitive
c)CompetitiveNonEquilibriumtype
d)Noneoftheabove
CorrectAnswer-B
Ans.B.Noncompetitive
DecreaseinVmaxwithnochangeinKmisseeninNon-competitive
inhibition.

---

495.Plasmaproteinbounddrugdistributedin
whichcompartment?
a)Extracellular
b)Intravascular
c)Interstitial
d)Extravascular
CorrectAnswer-B
Ans.is'b'i.e.,Intravascular
Clinicalsignificanceofproteinbinding:
1. Highplasmaproteinbounddrugsarelargelyrestrictedtothe
vascularcompartmentandtendtohavelowervolumeofdistribution.
2. Theboundfractionisnotavailableforaction.
3. Highdegreeofproteinbindinggenerallymakesthedruglongacting,
becauseboundfractionisnotavailableformetabolismorexcretion,
unlessitisactivelyexcretedbyliverorkidneytubules.
4. 1nnephroticsyndromeandotherconditionscausing
hypoproteinemia,proteinbindingwillbealtered.5.Highlyprotein
bounddrugsarenotremovedbyhaemodialysisandneedspecial
techniquesfortreatmentofpoisoning.
5. Proteinbounddrugscangiverisetodisplacementinteractions:
6. Inhypoalbuminemia,bindingmaybereducedandhigh
concentrationsoffreedrugmaybeattained,e.g.phenytoinand
furasemide.

---

496.Followingaretheadvantagesof
sustainedreleasepreparationoverthe
conventionalpreparationsexcept?
a)Decreasedfrequencyofadministration
b)Improvedcompliance
c)Lessincidenceofhighpeaksideeffects
d)Drugswithhalflife>4hoursaresuitable
CorrectAnswer-D
Ans.is'd'i.e.,Drugswithhalflife>4hoursaresuitable
Actsforalongerperiod.
Frequencyofadministrationisreduced-moreconvenient.
Improvedpatientcompliance-asinglemorningdoseislesslikelyto
beforgotten/omittedthana6or8hourlyregimen;amonthlyor
quarterlyadministeredcontraceptiveoveronethathastobetaken
daily.
Largefluctuationsinplasmaconcentrationareavoided.
Sideeffectsrelatedtohighpeakplamaleveljustafteradose(e.g.
nifedipine)wouldbeminimized.
Betterround-the-clockcontrolofbloodsugar,etc.
Drugeffectcouldbemaintainedovernightwithoutdisturbingsleep,
e.g.antiasthmatics,anticonvulsants,etc.

---

497.Whichantiepilepticdrugisleastsecreted
inbreastmilk?
a)Ethosuximide
b)Clonazepam
c)Gabapentin
d)Carbamazepine
CorrectAnswer-B
Ans.is'b'i.e.,Clonazepam

---

498.Agonistantagonistcombinationacting
onthesamereceptoris?
a)Isoprenalineandpropranolol
b)Adrenalineandhistamine
c)Salbutamolandleukotriene
d)Estrogenandtamoxifen
CorrectAnswer-A
Ans.is'a'i.e.,Isoprenalineandpropranolol
Receptorantagonists(Pharmalogicalantagonists)
Receptorantagonistsarethosedrugsthatblockstheactionof
agonistbyactingonsamereceptors.Example:
Isoprenalineis1and2receptoragonistwhilepropranololhas
antagonisticactionon1and2receptors.
Note:
Physiologicalantagonists
Physiologicalantagonistsarethosethatproduceoppositeactionby
actingondifferentreceptors.
Example
1. HistaminecausesbronchoconstrictionviaH1receptorsandthis
actionisantagonizedbyadrenalinewhichcausesbronchodilodation
through1receptors
2. Leukotrienescausebronchoconstrictionviacystinylleukotriene
receptorsandthisactionisantagonisedbysalbutamolwhichcauses
bronchodilatationthrough2receptors.

---

499.Whichofthefollowingdrugsubstrate
combinationsdonotmatch?
a)CYP3A4/5-simvastatin
b)CYP2D6-SSRI
c)CYP2C8/9-mifepristone
d)CYP2C19-propranolol
CorrectAnswer-C
Ans.is'c'i.e.,CYP2C8/9-mifepristone

---

500.Approximatedoseofdrugina5years
oldchild?
a)Sameasadultdose
b)1/2ofadultdose
c)1/3ofadultdose
d)'Aofadultdose
CorrectAnswer-C
Ans.C.1/3ofadultdose
Therearethreerule'sbywhichdrugcloseinchildrencan
calculatedby:
1. Forchildren2yearsoldandolder(Young'srule)
2. Forinfantandchildren<2years(Fried'srule)
3. Child'sdosebyweightcanbecalculatedbyClark'srule:
Child'sdose=[Weight(1b)/150]*adultdose.

---

501.Adrughaving40%absorptionand
hepaticextractionratioof0.6.Whatis
thebioavailabilityofthatdrug?
a)16%
b)24%
c)20%
d)28%
CorrectAnswer-A
Ans.is'a'i.e.,16%
Absortionofdrugis40%i.e.if100mgofdrugistaken40mgwillbe
absorbed.
Hepaticextractionratiois0.6i.e.outoftheabsorbeddose60%will
beremovedbyliver;sofromtheabsorbed40mg60%removedi.e.
24mgremoved.
Thusfinallytheremaining16mgofthetotaldosetakenreachesthe
systemiccirculation.Sobioavailabilityis16%as16mgofthetotal
100mgfinallyreachedthesystemiccirculation

---

502.Essentialdrugs?
a)Includedinnationalpharmacopoeia
b)ShouldalwaysbepresentatPHC
c)Thosethatsatisfytheprimaryhealthcareneedsofthe
population
d)Lifesavingmedications
CorrectAnswer-C
Ans.is'c'i.e.,Thosethatsatisfytheprimaryhealthcareneedsof
thepopulation
WHOhasdefinedEssentialMedicationsasthosethatsatisythe
priorityhealthcareneedsofmajorityofthepopulation.

---

503.Mostcommonmitochondrialenzymefor
metabolismdetoxificationreactionis?
a)CYP3A4
b)CYP1A2
c)CYP2A6
d)CYP2B6
CorrectAnswer-A
Ans.is'a'i.e.,CYP3A4
SubtypesofcytochromeP-450
Dependingupontheextentofaminoacidsequencehomology,the
cytochromeP-450(CYP)isoenzymesaregroupedintofamilies
designatedbycapitalletters(A,B,C....).
Individualisoenzymesareagainallotednumerals(1,2,3....).
ExamplesareCYP1A2,2A6,2B6,2C8,3A4/3A5.
Inhumanbeings,onlyafewmembersofthreeisoenzymefamilies
carryoutmetabolismofmostofthedrugs.
Cyp3A4/5carryoutbiotransformationoflargestnumber(nearly
50%)ofdrugs.
ImportantinducersofCYP3A4/3A5
Barbiturates
Glucocorticoids
Rifampin
Macrolideantibiotics
Carbamazepine
Phenytoin
Pioglitazone

---

504.Cholinergicdrugwhichactsonheartby
decreaseinlevelsofcAMPanddueto
openingofK+channelsis?
a)Methacholine
b)Oxotremorine
c)Bethanechol
d)DMPP
CorrectAnswer-A
Ans.'a'i.e.,Methocholine

---

505.FunctionofM2receptorinheart?
a)SAnodehyperpolarisation
b)AVnodeincreasedvelocityofconduction
c)Increasedcontractilityofventricles
d)IncreasedAchreleasefromcholinergicnerveendings
CorrectAnswer-A
Ans.is'a'i.e.,SAnodehyperpolarization

---

506.Dopamineat1-2Microgram/Kg/minproduces?
a)Renalvasodilatation
b)Positiveionotropiceffect
c)Mesentericvasoconstriction
d)Generalisedvasoconstriction
CorrectAnswer-A
Ans.is'a'i.e.,Renalvasodilatation
Dopamineproducesdose-dependentaction:
Atlowdose(1-2?g/kg/min)causesdilationofrenalandmesenteric
vesselsoftenreferredtoasrenaldose.
Atmoderatelyhighdose(2-10?g/kg/min)producesapositive
ionotropiceffectbystimulating1receptoronheartcardiacdose.
Athighdoses(>10?g/kg/min)producesvasoconstrictionby
stimulating1receptorsvasculardose.

---

507.Mostcommonlyusedcholinesterase
regeneratoratNMjunctionis?
a)Pralidoxime
b)Obidxime
c)Diacetylmonoxime
d)Edrophonium
CorrectAnswer-A
Ans.is'a'i.e.,Pralidoxime
Pralidoximeismostcommonlyusedcholinesterasereactivater.
OXIMES
OximesPralidoxime2-PAM,obidoximeanddiacetyl-monoxime
(DAM)]areusedinorganophosphatepoisoning.oOximesactsby
reactivatingcholinesteraseenzyme.
Mechanismofaction
Inorganophosphatepoisoningesteraticsiteofcholinesteraseis
phosphorylatedandanionicsiteisfree.
Phosphorylatedcholinesterasereactsveryslowlywithwater.
However,ifmorereactiveOHgroupsintheformofoximesare
provided,reactivationoccursmorethanamilliontimefaster.
OximesattachtoanionicsiteandprovidemorereactiveOHgroups.
OximesareineffectiveinCarbamatespoisoning.
Pralidoximeiscontraindicatedincarbamatespoisoning,becausenot
onlyitdoesnotreactivatecarbamylatedenzyme,ithasweakanti-
chEactivityofitsown.
Remember
Obidoximeismorepotentthanpralidoxime.
Pralidoximeandobidoximearelipidinsoluble,whilediacetyl-
monoxime(DAM)islipidsolublesoitcancrossBBBandregenerate

---

AChEinbrain.
Atropineisusedinbothorganophosphateandcarbamate
anticholinesterasepoisoning.

---

508.Selectivebeta2blockeris?
a)Butoxamine
b)Betoxolol
c)Esmolol
d)Bisoprolol
CorrectAnswer-A
Ans.is'a'i.e.,Butoxamine

---

509.Betablockerwithmembranestabilizing
propertyareallexcept?
a)Acebutolol
b)Betaxolol
c)Carvedilol
d)Bevantolol
CorrectAnswer-D
Ans.is'd'i.e.,Bevantolol

---

510.Longestactingbetablokeris?
a)Nodalol
b)Esmolol
c)Carvedilol
d)Acebnolol
CorrectAnswer-A
Ans.is'a'i.e.,Nodalol
Nodalolislongestacting-blocker.
Esmololisshortestacting-blocker.
Remember
NodalolislongestactingP-blocker.
Esmololisshortestactingn-blocker
Acebutololpossessesallactivitiesi.e.,cardioselectivity,partial
agonistactivity,membranestablizingactivityandlipidinsolubility.
BetablockersapprovedfortreatmentofCHF:Carvedilol(most
widelyused),metaprolol,bisoprolol.
Carvedilolisa13/+132+aladrenoreceptorblockerwitha:i3
blockingpropertyofI:9.Itproduces
peripheralvasodilatationduetoa-1blockadeaswellascalcium
channelblockade(directeffect).
Atenolol,sotalolandnodalolareprimarilyexcretedbykidney
shouldnotbegiveninrenalfailure.
Sotalol,penbutololandpindololhavealmost100%bioavailibility.
Penbutololhasmaximumoralabsorption.
Carvedilolhasmaximumplasmaproteinbinding.
Celiprololhasminimumplasmaproteinbinding.

---

511.Amphetaminecauseswhichofthe
following?
a)IUGR
b)Cardiacanamoly
c)Cleftlip
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove
Followingarethefetalorneonataleffectsofamphetamines:
IUGR
Abruptioplacentae
Glassyeyedlook
Prematurity
Hypoglycemia
Lethargy
Cardiacanamolies
Sweating
Feedingproblems
Cleftpalate
Poorvisualtracing

---

512.Neostigmineisusedinthefollowing
except?
a)Myastheniagravis
b)Cobrabite
c)Atonyofbladder
d)Glaucoma
CorrectAnswer-D
Ans.is'd'i.e.,Glaucoma

---

513.Betablockerwithdisomerresponsible
forbetablockeractionis?
a)Nebivolol
b)Timolol
c)Esmolol
d)Propranolol
CorrectAnswer-A
Ans.is'a'i.e.,Nebivolol
Nebivololisanovelbetal-blockerwithagreaterdegreeofselectivity
forbetal-adrenergicreceptorsthanotheragentsinthisclassanda
nitricoxide(NO)-potentiating,vasodilatoryeffectthatisunique
amongbeta-blockerscurrentlyavailabletoclinicians.Nebivololisa
racemicmixturewithbeta-blockeractivityresidinginthed-isomer;in
contrast,I-nebivololisfarmorepotentinfacilitatingNOrelease.
Note:
Betablockerswith1isomerhavingbetablockingactivityare:?
Propranolol,atenolol,metoprolol,esmolol,timolol

---

514.Patientonverapamilshouldnotbegiven
betablockeras?
a)Conductionblock
b)Bronchospasm
c)Neurogenicshock
d)Anaphylaxis
CorrectAnswer-A
Ans.is'a'i.e.,Conductionblock
AdverseeffectsofCCBs
Nausea,constipationandbradycardiaaremorecommonwith
verapamil.
Verapamilcanaccentuateconductiondefect-shouldbeavoidedin
2nd&3rddegreeblock,insicksinussyndromeandalongwith13-
blocker.
MostcommonsideeffectsofDHPsarepalpitation,flushing,
hypotension,headache,ankleedema,drowsinessandnausea.
Nifedipinecanparadoxicallyincreasethefrequencyofanginain
somepatients.
Nifedinecancausevoidingdifficultyinelderly(relaxanteffecton
bladder)andglucoseintolerance(decreasesinsulinrelease).

---

515.Nonselectivebetaadrenergicantagonist
is
a)Nodalol
b)Atenolol
c)Bisoprolol
d)Esmolol
CorrectAnswer-A
Ans.is'a'i.e.,Nodalol

---

516.Mechanismofactionoftimololis?
a)Nonselectivebetablocker
b)Nonselectivealphablocker
c)Selectivebeta1blocker
d)Selectivebeta2blocker
CorrectAnswer-A
Ans.is'a'i.e.,Nonselectivebetablocker
Timololisanonselectivebetablocker(betal+beta2).
Thuswhenitisusedinthetreatmentofglaucomaitcanprecipitate
anattackofasthmabyblockingbeta2receptors.

---

517.Betablockersmaskalleffectsof
hypoglycemiaexcept?
a)Sweating
b)Palpitations
c)Dizziness
d)Tremors
CorrectAnswer-C
Ans.is'c'i.e.,Dizziness
Symptomsofhypoglycemiaareattributableto:-
i)Sympatheticstimulation:Sweating,tremor,tachycardia
palpitationsandanxiety.Thesearethewarningsigns.
ii)Cerebralglucosedeficiency:Decreasedcognitivefunctions,
dizzinessanddecreasedconcentration.
Useofbeta-blockers,especiallyindiabeticswhoaretaking
treatment,maymasktypicalsympatheticsystemmediated
symptomsofhypoglycemiasuchassweating,tremor,tachycardia,
andpalpitations.
Thus,dangerousseverehypoglycemiacanoccurwithoutany
warningsigns.

---

518.CB1antagonistusedinsmoking
cessationis?
a)Naloxona
b)Rimonabant
c)Vareniloline
d)Bupripion
CorrectAnswer-B
Ans.is'b'i.e.,Rimonabant
Rimonabant
Aselectivecannabinoidreceptor-1(CB-1)antagonistwhichisbeing
triedasantismokingandantiobesitydrug.

---

519.IVdiazepamhaswhichofthefollowing
effectwhichisnotseenbyotherroutes
?
a)Analgesia
b)Sedation
c)Hypotension
d)Coronarydilatation
CorrectAnswer-D
Ans.is'd'i.e.,Coronarydilatation
Mechanismofactionofbenzodiazepines(BZDs)
Benzodiazepinesactpreferentiallyonmidbrainascendingreticular
formation(whichmaintainswakefulness)andonlimbicsystem
(thoughtandmentalfunction).
Musclerelaxationisproducedbyactiononmedulla.
Ataxiaisduetoactiononcerebellum.
BZDsactsonGABAAreceptors.
GABA,,,receptorhas5subunitsa/p,p,a/y.
GABAbindingsiteisonp.subunit,whileBZDsbindingsiteisona/
ysubunit.
BZDsreceptorincreasetheconductanceofCl-channel.
BZDsdonotthemselvesincreaseCl-conductance,i.e.theyhave
onlyGABAfacilitatorybutnoGABAmimeticaction.(Barbiturates
havebothGABAfacilitatoryandGABAmimeticactions).
EffectonCNS
Incontrasttobarbiturates,BZDsarenotgeneraldepressant,but
exertrelativelyselectiveanxiolytic,hypnotic,musclerelaxantand
anticonvulsanteffects.

---

TheantianxietyactionofBZDsisnotdependentontheirsedative
property-->withchronicadministrationreliefofanxietyis
maintained,butdrowsinesswanesoffduetodevelopmentof
tolerance.
Stage2sleepisincreased,whileREM,Stage3&4sleepare
decreased.
Nitrazepamistheonlybenzodiazepine,whichincreasesREMsleep.
Clonazepananddiazepamhavemoremarkedmusclerelaxant
property.
Clonazepam,diazepam,nitrazepamandflurazepamhavemore
prominentanticonvulsantactivitythanotherBZDs.
Diazepam(butnototherBZDs)hasanalgesicaction.
Diazepamproducesshortlastingcoronarydilatationoni.v.injection.
Diazepamdecreasesnocturnalgastricsecretionandpreventsstress
ulcers.

---

520.WhichofthefollowingSSRIisa
prodrug?
a)Fluoxetine
b)Paroxetine
c)Citalopram
d)Fluvoxamine
CorrectAnswer-A
Ans.is'a'i.e.,Fluoxetine
Selectiveserotoninreuptakeinhibitors(SSRI)
5-HT(serotonine)isthemajorplayerindepressiveillnessand
serotonergicpathwaysarecloselyrelatedtomooddisorders
especiallydepression.
Thus,drugsaffectingthe5-HTlevelsintheneuralsynapseand
serotonergicpathwaysareeffectiveinthetreatmentofdepression.
Therefore,theSSRIshavebeenshowntoalleviatedepressionand
arethemostcommonlyuseddrugsinthetherapyof
depression.
Thesedrugsactbyinhibitingreuptakeof5-HT.
Thesedrugsarenow1stchoicefordepression.
AdvantagesoverTCAs.
1.Littleornosedation,noweightgain.
2.Nointerferencewithpsychomotororcognitivefunction.
3.Noanticholinergicsideeffects.
4.Noposturalhypotension(noactionofa-adrenergicreceptors).
5.Nopropensitytocauseseizuresorarrythmias.

---

521.Drugusedintreatmentofmigraine?
a)5HT1agonist
b)5HT1antagonist
c)Dlagonist
d)D1antagonist
CorrectAnswer-A
Ans.is'a'i.e.,5HT1agonist

---

522.Followingarethesideeffectsof
fenfluramineexcept?
a)Pulmonaryhypertension
b)Valvulardefects
c)Suddendeaths
d)Dizziness
CorrectAnswer-D
Ans.is'd'i.e.,Dizziness
FenfluramineandDexfenfluramine
Theyreducethefoodseekingbehaviorbyenhancingthe
serotonergictransmissioninthehypothalamus.
Theywereextensivelyusedforslimming
Tolerancedevelopstotheanorecticactionofin2-3
monthsEchocardiographicabnormalities,valvulardefects,
pulmonaryhypertensionandsuddendeathsarethedocumented
sideeffects.
ThesedrugshavebeendiscontinuedbyUSFDA.

---

523.Followingisfalseaboutaripiprazole
except?
a)OnlyantipsychoticwithD1agonisticactivity
b)Ithas5HT1Aantagonisticaction
c)Ithasmaximumsedatingpotential
d)Itisthedrugofchoiceintreatmentofacutemania
CorrectAnswer-D
Ans.is`d'i.e.,Itisthedrugofchoiceintreatmentofacutemania
Atypicalantipsychotics-->Olanzapine,risperidone,aripiprazoleor
quetiapinewithorwithoutbenzodiazepineisthetreatmentofchoice
foracutemania.
Aripiprazole
OnlyantipsychoticwithD2agonisticactivity.(allothersareD2
antagonists).
Longestacting
Italsohas5HT,Aagonisticand5HT2antagonisticactivity-Also
knownasdopamine-serotininestabilizer.
Itisleastsedatingantipsychoticcancauseinsomnia.

---

524.Whichistheantidepressantwithno
anticholinergiceffects?
a)Imipramine
b)Mianserine
c)Fluoxamine
d)Amitryptiline
CorrectAnswer-C
Ans.is'c'i.e.,Fluoxamine
Antidepressantswithnoanticholinergic(antimuscarinic)
action.
Bupropion
Escitalopram
Fluvoxamine
Paroxetine
Trazodone
Citalopram
Duloxetine
Venlafaxine
Sertaline
MirtazapineFluoxetineistheonlySSRIwhichhassome
anticholinergicaction.
Remember
Antidepressantswithnosedativeaction
Bupropion
Citalopram
Fluvoxamine
Protriptyline
Duloxetine

---

Escitalopram
Venlafaxine
(Note:First6drugsaresameinbothgroups)

---

525.Inverseagonistofbenzodiazepine
receptoris-
a)Phenobarbitone
b)Flumazenil
c)Betacarboline
d)Gabapentin
CorrectAnswer-C
Ans.is`c'i.e.,Betacarboline

---

526.Dantroleneactson?
a)Raynodinereceptor
b)Cannabinoidreceptor
c)Bothoftheabove
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Raynodinereceptor
Dantrolene
Dantroleneisadirectlyactingskeletalmusclerelaxant.
Mechanismofaction
Normallyexcitation(depolarizationofendplate)iscoupledwith
contractionbyCa"Excitationcontractioncoupling.
DantroloneactsonRyanodinereceptors(RyR)Calciumchannelsin
sarcoplasmicreticulumofskeletalmusclesandpreventstheir
depolarizationtriggeredopeningnoreleaseofintracellular
Ca+2NoexcitationcontractioncouplingNocontraction.
Thatmeansmusclecontractionisuncoupledfromdepolarizationof
themembrane.
DantroleneisDOCformalignanthyperthermia.
Itcanalsobeusedin
1. Neurolepticmalignantsyndrome.
2. ToreducespasticityinUMNdisorders,hemiplegia,paraplegia,
cerebralpalsyandmultiplesclerosis.
Muscularweaknessisthedoselimitingsideeffect.
Othersideeffectsaresedation,malaise,lightheadedness,
troublesomediarrhoeaandlivertoxicity.Remember
Quininealsoactsasdirectlyactingmusclerelaxant.
Itincreasesrefractoryperiodanddecreasesexcitabilityofmotorend

---

plates.
Itcanbeusedinnocturnallegcramp.

---

527.Allreleasehistamineexcept?
a)Pancuronium
b)D-TC
c)Succinylcholine
d)Mivacurium
CorrectAnswer-A
Ans.is'a'i.e.,Pancuronium
PropertiesofNMBlockers
LongestactingNeuromuscularblockerPancuronium(durationof
action120-180minutes).(Goodman&Gilman11th/ep.222)(Note:
InsomebookspipecuroniumorDoxacuriumhavegivenasthe
longeractivity).
Shortestandfastestactingneuromuscularblocker
Succinylcholine(suxamethonium)-durationofaction5-8minutes.
Shortestactingcompetitive(nondepolarizing)neuromuscularblocker
Mivacurium(durationofaction12-18minutes).
FastestactingnondepolarizingblockerRocuronium(canbeusedfor
endotrachealintubationasanalternativetoSch).
Non-depolarizingneuro-muscularblockerscancauseganglion
block,vagalblockandHistaminerelease(differentagentshas
differentpropensity).
HistaminereleaseiscausedbyD-TC(maximumtendency),
succinylcholine,mivacurium,doxacurium,atracurium,tubocurarine
cancausebronchoconstriction.
VirtuallynohistaminereleasePancuronium
VagalblockiscausedbyPancuronium,recuronium,Gallamine.
MaximalvagalblockandtachycardiaiscausedbyPancuronium
(Previouslyitwasgallamine,butitisnotusednow).

---

Vagalstimulationiscausedbysuccinylcholine(cancause
bradycardia).
Ganglionblockiscausedbyd-Tc,Metocurine,Alcuronium.
Maximumganglionblockadeiscausedbyd-TC.
GanglionstimulationiscausedbySuccinylcholine.

---

528.Atomoxetineisusedfor?
a)Nocturnalenuresis
b)ADHD
c)Tempertantrums
d)Patentductusarteriosus
CorrectAnswer-B
Ans.is'b'i.e.,ADHD
Atomoxetineitisselectivenorepinephrinereuptakeinhibitorandis
approvedforuseinADHD.
Itisindicatedinchildren>6yearsandinadultswithconcentration
andattentionproblems.
Atomoxetineabsorbedorally,hydroxylatedbyCYP2D6and
excretedinurine,mainlyasglucuronide.
Whilemajorityofindividualsareextensivemetabolizers(EM),few
arepoormetabolizers(PM)duetopolymorphismofCYP2D6.
InhibitorsofCYP2D6likefluoxetine,paroxetine,quinidineincrease
concentrationandtoxicityofatomoxetine.
ItshouldnotbegivenwithMAOinhibitorsandiscontraindicatedin
glaucoma.

---

529.Fomepizoleactsasantidotefor?
a)Methanolpoisoning
b)Cannabispoisoning
c)Leadpoisoning
d)CadmiumPoisoning
CorrectAnswer-A
Ans.is'a'i.e.,Methanolpoisoning

Methanolishighlytoxicalcohol.Itismetabolizedtoformaldehyde
(byalcoholdehydrogenas)andformicacid(byacetaldehyde
dehydrogenase).
Itistheaccumulationofformicacidwhichcausestoxiceffectsin
methanolpoisoning.Accumulationofformicacidresultsinlactic
acidosis/highaniongapmetabolicacidosiswithlowplasma
bicarbonates,blindnessduetoretinaldamage,papilledema.
Methanolpoisoningcanbetreatedbysupportivemeasures,gastric
lavageandsodiumbicarbonate(totreatacidosis).Ethanolisuseful
becauseitcompetitivelyinhibitstheconversionofmethanoltoformic
acid.Fomepizolecanalsobeusedasitisaspecificinhibitorof
alcoholdehydrogenase.Folicacidorfolinicacid.Enhancethe
metabolismformicacidtoCO2.Hemodialysismayalsobeused.

---

530.Weightgainisseenwithallofthe
followingantipsychiatricmedications
except?
a)Quitiapine
b)Resperidone
c)Clozapine
d)Molindone
CorrectAnswer-D
Ans.is`d'i.e.,Molindone
Antipsychoticsusuallycauseweightgain.Quitiapine,olanzapine,
clozapineandresperidone,allhavebeenimplicatedinweightgain.
Molindonehasoftenbeenreportedtocauseweightlossratherthan
weightgain.

---

531.Whichdrugisusedinamytrophiclateral
sclerosis?
a)Riluzole
b)Glatirame
c)Tacrine
d)Olanzapine
CorrectAnswer-A
Ans.is'a'i.e.,Riluzole
Drugsusedinneurodegenerativedisorders
Multiplesclerosis
Beta-interferonorglatiramedecreasethefrequencyofrelapsesin
relapsingremittingMS.Recently,natalizumab(amonoclonal
antibody)hasbeentried.
Amyotropiclateralsclerosis
Riluzole(NMDAantagonist)isusefulinALS.Torelievespasticity
Baclofenmaybeused.

---

532.Rotigotineis?
a)Dopamineagonist
b)Dopamineantagonist
c)GABAagonist
d)GABAantagonist
CorrectAnswer-A
Ans.is'a'i.e.,Dopamineagonist
Rotigotine
Rotigotineisadopamineagonistdrugandisindicatedinthe
treatmentofparkinosonism.
Rotigotineisintendedtobedeliveredthroughtransdermalpatches,
soastoensureaslowandconstantdosageina24-hourperiod.
Sideeffectsare--skinreactionatthepatchsite,nausea,vomiting,
diziness,drowsiness,insomnia.

---

533.Natalizumabisusedintreatmentof?
a)Muliplesclerosis
b)Breastcarcinoma
c)Psoriasis
d)Bcelllymphoma
CorrectAnswer-A
Ans.is'a'i.e.,Multiplesclerosis
Treatmentofmultiplesclerosis
1.Treatmentofacuteattack
Corticosteroids(Methylprednisolone,prednisolone)areused
2.Treatmentwithdisease-modifingagentsthatreducethebiological
activityofMS
Diseasemodifyingagentsformultiplesclerosisare(i)IFN-13la;(ii)
IFN-13lb,(iii)Glatiramer;(iv)Natalizumab;(v)Finoglimod:(vi)
Mitoxantrone;(vii)Cladaribine.
3.Othertreatmentoptions
Otheroff-labeltreatmentoptionsare(i)methotrexate;(ii)
cyclophosphamide;(iii)IVimmunoglobulins;(iv)azathioprine.
4.SymptomaticTreatment
Itincludeshealthydiet,regualrexercise.
Treatmentofrigidity(baclofen,diazepam,tizanidine,dantroline)
Treatmentofweakness(Potassiumchannelblockerslike4-
aminopyridine)
Treatmentofpainbyanticonvulsants(carbamezapine,phenytoin,
gabapentin,pregabalin),orantidiepressants(mexiletin).
TreatmentofUTI,bladderdysfunction,constipation,depression,
fatigueandcognitiveproblems.

---

534.Mostcommonreceptorfortypical
antipsychoticsis?
a)D1
b)D2
c)D3
d)D4
CorrectAnswer-B
Ans.is'b'i.e.,D2
ANTIPSYCHOTICS
Antipsychotic(neuroleptic)drugscanbedividedintotypicaland
atypical.
Typical
BlockD2receptors
Havesignificantextrapyramidalsymptoms(exceptforthioridazine)-
Parkinsonism,Acutemusculardystonia,Akathisia,Malignant
neurolepticsyndrome,Tardivedyskinesia.
Atypical
Thesearenewergeneration(secondgeneration)antipsychoticsthat
haveweakD2blockingbutpotent5-HT2antagonisticactivity.
CalledatypicalbecausetheyhavenoD2blockingproperty(except
resperidone).
Extrapyramidalsideeffectsareminimal(Resperidonecancause
someextrapyramidaleffects).
Havenoantiemeticeffect.
ExamplesareClozapine,Risperidone,Olanzapine,Quetiapine,
Aripiprazole,Ziprasidone.

---

535.Patientontreatmentoncarbidopa+
levodopafor10yrsnowhasweaningoff
effect.Whatshouldbeaddedtorestore
action?
a)Tolcapone
b)Amantadine
c)Rasagiline
d)Benzhexol
CorrectAnswer-A
Ans.isAi.e.,Tolcapone
BothEntacaponeandtolcaponeenhanceandprolongthe
therapeuticeffectoflevodopa-carbidopainadvancedandfluctuating
parkinsonsdisease.Theymaybeusedtosmoothenoffthe'wearing
off',increase'on'timeanddecrease'off'time,improveactivitiesof
dailylivingandallowlevodopadosetobereduced.
Tolcapone
ItisadrugusedtotreatParkinson'sdisease(PD).
Itisaselective,potentandreversiblenitrocatechol-typeinhibitorof
theenzymecatechol-O-methyltransferase(COMT).
Incomparisonwithentacapone,anothernitrocatecholCOMT
inhibitor,tolcaponehasalongerhalflife(2.9hoursvs.0.8hours)
andcanbetterpenetratetheblood?brainbarrier,actingbothinthe
centralnervoussystemandintheperiphery.However,entacapone
islesstoxicfortheliver.
Tolcaponeimprovesthebioavailabilityandreducestheclearanceof
levodopaandsubsequentlydopaminefromtheCNS.
Withoutadministrationoftolcapone,thebeneficialeffectsof

---

levodopatendtowearoffmorequickly,resultinginmotor
fluctuations.

---

536.Patientofjuvenilemyoclonicepilepsyon
valproatecomestoyouat5monthsof
pregnancywithlevelHscannormalwhat
willyouadvise?
a)Changethedrug
b)Continuethedruginsamedose
c)Decreasethedoseofdrug
d)Increasethedoseofdrug
CorrectAnswer-B
Ans.is'b'i.e.,Continuethedruginsamedose
Valproicacidhastheriskoffetalmalformationsduringthefirst
trimesterofpregnancy.
ThispatienthasnormallevelIIscanat5monthsofpregnancyso
theriskperiodofvalproateisalreadyoverandvalproateisthedrug
ofchoiceinjuvenilemyoclonicepilepsy.
Thusthedrugshoudbecontinuedinthesamedoses.

---

537.Vareniclineactsby?
a)Partialnicotinereceptoragonist
b)Nicotinereceptorantagonist
c)Bothagonistandantagonistatnicotinereceptor
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Partialnicotinereceptoragonist
Varenicline
Itispartialagonistatthenicotinereceptor.
Itisusedinnicotineaddicts.

---

538.DrugswhichpotentiateeffectofNMDAat
NMDAreceptorsareallexcept?
a)Ketamine
b)Asparticacid
c)Dalanine
d)Homocysteicacid
CorrectAnswer-A
Ans.is'a'i.e.,Ketamine
KetamineisNMDAreceptorblockersoitdoesnotpotentiatethe
NMDAaction.

---

539.WhichdoesnotactbyblockingNMDA
receptors?
a)Methoxetamine
b)Methadone
c)Ketamine
d)Diltiazem
CorrectAnswer-D
Ans.is'd'i.e.,Diltiazem
DrugsactingbyblockingNMDAreceptorsare:
i. Methoxetamine
ii. Phencyclidine
iii. Methadone
iv. Dizocilpine
v. Felbamate
vi. Dextropropoxyphene
vii. Acamprost
viii. Tramadol
ix. Ketamine
x. Pethidine
xi. Atomoxetine
xii. Nitrousoxide

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540.Mostcommonrenalsequeloflithium
toxicityis?
a)NephrogenicDM
b)Renaltubularacidosis
c)Glycosuria
d)MPGN
CorrectAnswer-A
Ans.is'a'i.e.,NephrogenicDM
Lithiumassociatedrenaltoxicity
Theuseoflithiumsaltsforthetreatmentofmanic-depressiveillness
mayhaveseveralrenalsequelae,themostcommonofwhichis
nephrogenicdiabetesinsipidusmanifestingaspolyuriaand
polydipsia.
Lithiumaccumulatesinprincipalcellsofthecollectingductby
enteringthroughtheepithelialsodiumchannel(ENaC),whereit
inhibitsglycogensynthasekinase3anddown-regulates
vasopressin-regulatedaquaporinwaterchannels.
Lessfrequently,chronictubulointerstitialnephritisdevelopsafter
prolonged(greaterthan10-20years)lithiumuseandismostlikelyto
occurinpatientsthathaveexperiencedrepeatedepisodesoftoxic
lithiumlevels.

---

541.
Magnan'sphenomenonoccursin
addictionof:
a)Alcohol
b)Cocaine
c)LSD
d)Opiates
CorrectAnswer-B
Cocaine

---

542.Mostserioussideeffectofvalproateis
a)Fulminanthepatits
b)Spinabifida
c)Weightgain
d)Thrombocytopenia
CorrectAnswer-A
Ans.is'a'i.e.,Fulminanthepatits
Valproate
Valproateactsbymultiplemechanism:
1. ProlongationofinactivatedNa*channel.
2. InhibitionofTtypeCa'current.
3. InhibitionofdegradationofGABAbyGABAtransminase
facilitationofGABAmediatedCl-channelopening.
Itsmostseriousadverseeffectisfulminanthepatitisespeciallyin
childrenbelow3years.
Usedduringpregnancy,ithasproducedspinabifidaandother
neuraltubedefects.
Uses(otherthanepilepsy)-->mania&bipolarillness,prophylaxisof
migraine,trigeminalneuralgia,tardivedyskinesia.
AdverseeffectofValproate
Neurological-Ataxia,sedation,tremor
Systemic-Hepatotoxicity,thromobocytopenia,GIirritation,weight
gain,transientalopecia,hyperammonemia,pancreatitis,coagulation
disorder.

---

543.Oxcarbazepinetrueisallexcept?
a)Metabolisesitself
b)Lesschancesofhyponatremiathancarbazepine
c)Itislessenzymeinducerthancarbamazepine
d)Lesschancesofhepatotoxicitythancarbamazepine
CorrectAnswer-B
Ans.is'b'i.e.,Lesschancesofhyponatremia
Oxcarbazepine
Itisrapidlyconvertedintoactivemetabolite.
Druginteractionsandautoinductionofitsownmetabolismareless
marked,becauseitisaweakenzymeinducer.
Riskofhepatotoxicityislowerthanwithcarbamazepine.
Chancesofhyponatremiaaremorewithoxcarbazepinecomparedto
carbamazepine.
It1.5timeslesspotentthancarbamazepine.

---

544.Treatmentofchoiceforcheesereaction
?
a)Prazocin
b)Pentazocin
c)Phentolamine
d)Phenoxybenzamine
CorrectAnswer-C
Ans.is'c'i.e.,Phentolamine
Cheesereaction
Certainvarietiesofcheese,beer,wines,pickedmeatandfish,yeast
extractcontainlargequantitiesoftyramine,dopa.
InMAOinhibitedpatientstheseindirectlyactingsympathomimetic
aminesescapedegradationintheintestinalwallandliver
reachingintosystemiccirculationtheydisplacelargeamountofNA
fromadrenergicnerveendingsHypertensivecrisis,cerebrovascular
accidents.
Thiscanbetreatedbyi.v.injectionofarapidlyactingphentolamine.
Prazosinandchlorpromazinearealternative.

---

545.Followingarethesideeffectsof
thiazidesexcept?
a)Hypokalemia
b)Hypocalcemia
c)Hepaticcoma
d)Impotence
CorrectAnswer-B
Ans.is'b'i.e.,Hypocalcemia
Followingarethesideeffectsofthiazides:
Hypokalemia
Acutesalinedepletion,hemoconcentrationandincreasedriskof
peripheralvenousthrombosis
Dilutionsalhyponatremia
Nauseaomittingdiarrhea
Rarelyheadache,giddiness,weakness,parethesias,impotence
Hearingloss
Rashes,photosensitivity
Hyperuricemia
HyperglycemiahyperlipidemiaoHypercalcemia
Magnesiumdepletion
Aggravatedrenalinsufficiency
Briskdiuresisleadingtomentaldisturbanceandhepaticcoma

---

546.A=ACEinhibitor,B=betablocker,C=
calciumchannelblocker,D=diuretics.
Forelderlywithhypertension
antihypertensivedrugofchoiceis?
a)AorD
b)AorB
c)AorC
d)CorD
CorrectAnswer-D
Ans.is'd'i.e.,CorD
Pharmacologicaltreatmentofhypertension
Indicationsofdrugtherapy(theBritishhypertensionsociety
guidelines).
WhensustainedBPexceeds160/100mmHgor.
WhenBPisintherangeof140-159/90-99mmHgandthereis
targetorgandamageorcardiovasculardisease.
FordiabeticswhenBPexceeds140/90mmHg.
TheoptimaltargetistolowerBPtoorbelow140/85mmHgin
nondiabeticsand140/80mmHgindiabetics(WHOtargetis130/85
mmHg).
Drugtherapy
AsimplesteppedAB/CDregimenisused.

---

547.Digitalisproduceswhichofthefollowing
changesinECG?
a)TallTwaves
b)STsegmentelevation
c)ProlongedQTinterval
d)ProlongedPRinterval
CorrectAnswer-D
Ans.is'd'i.e.,ProlongedPRinterval
TherearesomecharacteristicECGchangesbydigitalisuse,some
ofwhichoccurattherapeuticconcentrationandsomeoccursattoxic
level:
Attherapeuticlevel
ProlongationofPRinterval
ScoopingofSTsegmentAlsoknownasdigitaliswaveordigsag
thereisdownslopingSTdepression(initially)
ShorteningofQTinterval
DecreasedTwaveamplitude/orTwaveinversion
Attoxiclevel:Abovechangesareamplified
ProlongationofPRintervalconductionblockmayoccur
Twaveinversion
STdepression
QTintervalshortensfurther
IncreasedautomaticityArrhythmias

---

548.Anti-inflammatorydoseofaspirin?
a)500mg/d
b)1-2g/d
c)3-6g/d
d)6-12g/d
CorrectAnswer-C
Ans.is'c'i.e.,3-6g/d
Theanti-inflammatoryactionofaspirinisexertedathighdosesof3-
6g/dayor100mg/Kg/day.
Theanti-inflammatoryactionismainlyduetoinhibitionofCOX,
causinginhibitionofPGssynthesis.
InadditiontoCOXinhibition,quenchingoffreeradicalsmay
contributetoitsanti-inflammatoryaction.

---

549.Mechanismofactionoflevosimendenis
?
a)Inoconstrictor
b)Potassiumchannelopener
c)Sodiumchannelopener
d)Betablocker
CorrectAnswer-B
Ans.isbi.e.,Potassiumchannelopener
Levosimendon
AnewionodilatorisLevosimendon
Ithasinodilatoreffectby:
i)Inotropiceffect:Levosimendoniscalciumsensitiser,i.e.it
increasesthesensitivityofthehearttocalciumthatresultsin
increasedcardiaccontractilitywithoutariseinintracellularcalcium.
ii)Vasodilatoryeffect:byopeningATP-sensitivepotassium
channelsinvascularsmoothmusclesitcausessmoothmuscle
relaxation.

---

550.Antihypertensivewhichcannotbegiven
inpregnancy?
a)Labetolol
b)Propranolol
c)Esmolol
d)Hydralazine
CorrectAnswer-B
Ans.is'b'i.e.,Propranolol

---

551.Fluoroquinolonewithminimum
bioavailability?
a)Levofloxacin
b)Moxifloxacin
c)Norfloxacin
d)Ciprofloxacin
CorrectAnswer-C
Ans.is'c'i.e.,Nortloxacin

---

552.Maximumsterilisingactionisshownby
whichantiTBdrug?
a)Rifampicin
b)INH
c)Pyrazinamide
d)Streptomycin
CorrectAnswer-A
Ans.is'a'i.e.,Rifampicin
Therearethreemainpropertiesofantituberculardrugs:-
i. Bactericidalactivity(tuberculocidalactivity).
ii. Sterilizingactivity.
iii. Abilitytopreventresistance
Bactericidalactivity
Isoniazidandrifampicinarethemostpowerfulbactericidaldrugs,
activeagainstallpopulationsofTBbacilli.Pyrazinamideand
streptomycinarealsobactericidalagainstcertainpopulationsofTB
bacilli.
Sterilizingactivity
Sterilizingacitivityistheabilitytokillallthebacilliinlesionsas
rapidlyaspossible.
Rifampicinisthemostpotentsterilizingantituberculardrug.
Pyrazinamideisalsohavingsterilizingaction.
Topreventresistance
Ethambutolandthioacetazoneareusedinassociationwithmore
powerfuldrugstopreventemergenceofresistance.

---

553.Neuropsychiatrysymptomsareseen
withwhichantiTBdrug?
a)INH
b)Rifampicin
c)Pyrazinamide
d)Streptomycin
CorrectAnswer-A
Ans.is'a'i.e.,INH
AdverseeffectsofINH
Peripheralneuritis(mostcommon),hepatitis,opticneuritis&
atrophy,seizure,ataxia,muscletwitching,toxicencephalopathy,
psychoses,rashes,fever,arthralgia,acne,lupuslikesyndrome,
hemolyticanemiainG6PDdeficiency.
Note:Mostcommonantituberculardrugwhichisimplicatedin
causingperipheralneuropathyisINH.

---

554.WhichantiTBdrugisavoidedinHIV
patient?
a)INH
b)Rifampicin
c)Pyrazinamide
d)Streptomycin
CorrectAnswer-B
Ans.is'bi.e.,Rifampicin
AllHIV-infectedTBpatientsarecandidatesforART,andtheoptimal
timingforitsinitiationisassoonaspossibleandwithinthefirst8
weeksofanti-TBtherapy.
Rifampin,apotentinducerofenzymesofthecytochromeP450
system,lowersserumlevelsofmanyHIVproteaseinhibitorsand
somenon-nucleosidereversetranscriptaseinhibitors-essential
drugsusedinART.
Insuchcases,rifabutin,whichhasmuchlessenzyme-inducing
activity,hasbeenrecommendedinplaceofrifampin.However,
dosageadjustmentforrifabutinand/ortheantiret-roviraldrugsmay
benecessary.

---

555.Cyclicpeptidechainispresentin?
a)GramicidinA
b)GramicidinB
c)GramicidinD
d)GramicidinS
CorrectAnswer-D
Ans.isdi.e.,GramicidinS
Gramicidin
Gramicidinisaheterogeneousmixtureofthreeantibiotic
compounds,gramicidinsA,BandC,makingup80%,6%,and14%,
respectively,allofwhichareobtainedfromthesoilbacterialspecies
BacillusbrevisandcalledcollectivelygramicidinD.
GramicidinDcontainslinearpentadecapeptides,thatischainsmade
upof15aminoacid.
ThisisincontrasttogramicidinS,whichisacyclicpeptidechain.
GramicidinisactiveagainstGram-positivebacteria,exceptforthe
Gram-positivebacilli,andagainstselectGram-negativeorganisms,
suchasNeisseriabacteria.Itstherapeuticuseislimitedtotopical
application,asitinduceshemolysisinlowerconcentrationsthan
bacteriacelldeath,soitcannotbeadministeredinternally.

---

556.DrugofchoiceforMRSAinfection?
a)Ciprofloxacin
b)Oxacillin
c)Vancomycin
d)Clindamycin
CorrectAnswer-C
Ans.is'c'i.e.,Vancomycin
Methicillinresistancestaphylococcusaureus(MRSA)
MRSAisabacteriumresponsibleforseveraldifficult-to-treat
infectionsinhumans.
Itmayalsobereferredtoasmulti-drugresistantstaphylococcus
aureusoroxacillinresistantstaphylococcusaureus(ORSA).
MRSAisbydefinitionanystrainofstaphylococcusaureusthatis
resistanttoa13-lactamsincludingpenicillin,methicillin,cloxacillin,
nafcillin,oxacillinandcephalosporins.
Resistancedevelopsduetoalterationintranspeptidase(penicillin
bindingprotein)onwhichall13-lactamantibioticact:so,MRSAis
resistanttoall0-lactamantibiotics.
MRSA(especiallycommunityacquiredMRSA;CA-MRSA)display
enhancedvirulence,spreadingmorerapidlyandcausingdisease
muchmoreseverethantraditionalstaphylococcusaureus.

---

557.Colistinisobtainedfrom?
a)Bacteria
b)Fungi
c)Actinmycetes
d)Herbs
CorrectAnswer-A
Ans.is'a'i.e.,Bacteria
Amongstthegivenoptionsnodrugsisobtainedfromfungus.
Antibioticsareobtainedfrom-
1.Fungi-Penicilllin,Cephalosporin,Griseofulvin.
2.Bacteria-PolymyxinB,Colistin,Bacitracin,Tyrothricin,
aztreonam.
3.Actinomycetes-Aminoglycosides,Tetracyclines,
Chloramphenicol,macrolides,Polyenes.

---

558.HIVintegraseinhibitoris?
a)Elvitegravir
b)Abacavir
c)Maraviroc
d)Tenofovir
CorrectAnswer-A
Ans.is'a'i.e.,Elvitegravir
Integraseinhibitors
RaltegravirandElvitegraviractbyinhibitingenzymeintegrase.

---

559.Treatmentagentforscarletfeveris
a)Penicillin
b)Ciprofloxacin
c)Erythromycin
d)Chloramphenicol
CorrectAnswer-A
Ans.is'a'i.e.,Penicillin
Treatment:
Immediatehospitalizationandisolationofthepatientisindicated.
Penicillinisthetreatmentofchoice.

---

560.Treatmentforimpetigo?
a)Dicloxacillin
b)Ciprofloxacin
c)Gentamycin
d)Amoxicillinandclavulanicacid
CorrectAnswer-A
Ans.is'a'i.e.,Dicloxacillin
Treatmentofimpetigoiseitherdicloxacillinorcephalexincanbe
givenatadoseof250mgfourtimesdailyfor10days.
Topicalmupirocinointmentisalsoeffective.

---

561.WhichofthefollowingcanprolongQT
interval?
a)Nalidixicacid
b)Ofloxacin
c)Gatifloxacin
d)Pefloxacin
CorrectAnswer-C
Ans.is'c'i.e,Gatifloxacin

---

562.Whichofthefollowingdrugshasboth
antihelminthandantiprotozoalactivity?
a)Nitazoxanide
b)Emetine
c)Chloroquine
d)Diloxanidefuroate
CorrectAnswer-A
Ans.is'a'i.e.,Nitazoxanide
Nitazoxanide
Thisisthesalicylamidecogeneroftheantihelminthniclosamide,
introducedforthetreatmentofgiardiasisandcryptosporidiosisand
isalsoactiveagainstotherprotozoaandhelminthesincludingE.
histolytica,T.vaginalis,AscarisandH.nana.
Itisaprodrugwhichonnabsorptionisconvertedintoactivefor
tizoxanide.
TizoxanideisaninhibitorofPFORenzymethatistheessential
pathwayofelectrontransportenergymetabolisminanaerobic
organisms.

---

563.Whichoftheseisnotusedforthe
treatmentoftyphoid?
a)Chloramphenicol
b)Ciprofloxacin
c)Ceftriaxone
d)Cefixime
CorrectAnswer-D
Ans.is'd'i.e.,Cefixime

---

564.Antifungalwhichcanbeusedorallybut
notivis?
a)Voriconazole
b)AmphoterecinB
c)Terbinafine
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Terbinafine

---

565.Bacterianotaffectedbystreptogramins
is?
a)E.coli
b)Staphylococcuaureus
c)Legionella
d)M.pneumoniae
CorrectAnswer-A
Ans.is'a'i.e.,E.coli
Streptograminsareactiveagainstgram-positivecocciand
organismsresponsibleforatypicalpneumonia(e.g.,M.pneumoniae,
Legionellaspp.,andChlamydiapneumoniae),butlargelyinactive
againstgram-negativeorganisms.
Theyarebactericidalagainststreptococciandmanystrainsof
staphylococci,butbacteriostaticagainstE.faecium.

---

566.NotadrugrecommendedforP.
falciparumis?
a)Quinine
b)Ciprofloxacin
c)Artemether
d)Doxycycline
CorrectAnswer-B
Ans.is'b'i.e.,Ciprofloxacin

---

567.Cephalosporincausing
thrombocytopeniais?
a)Cefixime
b)Ceftazidime
c)Cefoperazone
d)Cefdinir
CorrectAnswer-B
Ans.is'b'i.e.,Ceftazidime
Adverseeffectsofcephalosporins
Hypersensitivityreaction-Itisthemostusualsideeffect.Thereis
crossallergybetweenpenicillinsandcephalosporinein5-10%of
cases.
Diarrhea-duetoalterationofgutflora,maximumwithoral
cephradineandparentralcefperazone(cefperazoneissignificantly
excretedinbile)Maycausepseudomembranouscolitiscaused
byCl.difficle.
Superinfection-Mostcommonorganismsarecandidaand
pseudomonas,lesscommonarestaphylococci,proteus.
Ceftriaxoneachieveshighconcentrationinbileand,asthecalcium
salt,mayprecipitatetocausesymptomsresemblingcholelithiasis
(Biliarypseudolithiasis).
Nephrotoxicity-highestwithcephaloridine.
Bleeding-ceftriaxone,cefoperazone,moxalactam&cefamandole
cancausehypoprothrmbinemiaandbleeding.
Disulfiramlikereaction-cefamandole,cefoperazone,moxalactam
andcefotetancancausedisulfiramlikereactionwithalcohol.
Neutropeniaandthrombocytopeniacanbecausedbyceftazidim.

---

568.XDRTBisresistanceto?
a)Isoniazid
b)Isoniazid+Rifampicin
c)Isoniazid+Rifampicin+Ethambutol
d)Isoniazid+Rifampicin+Kanamycin
CorrectAnswer-D
Ans.isdi.e.,Isoniazid+Rifampicin+Kanamycin
Treatmentofextensivedrugresistance(XDR)TB
XDR-TBisdefinedasresistancetoanyfluoroquinoloneandatleast
oneofthefollowingthreesecond-linedrugs(capreomycin,
kanamycin,amikacin),inadditiontomultidrugresistance.
TheRegimenforXDR-TBwouldbeof24-30monthsduration,with
6-12monthsIntensivePhase(IP)and18monthsContinuation
Phase(CP).
Regimenis:-
i)Intensivephase(6-12months):Sevendrugs:Capreomycin,PAS,
moxifloxacin,highdoseINH,clofazimine,Linezolid,amoxyclay.
ii)Continuationphase(18months):Sixdrugs:PAS,moxifloxacin,
highdoseINH,clofazimine,linezolid,amoxyclay.

---

569.Maximumlivertoxicityisseenwith
whichanti-TBdrug?
a)Isoniazid
b)Rifampicin
c)Pyrazinamide
d)Streptomycin
CorrectAnswer-C
Ans.is'c'i.e.,Pyrazinamide
Threefirstlineantituberculardrugsareassociatedwith
hepatotoxicity:?
i)Rifampicin
ii)INH
iii)Pyrazinamide
Ofthethree,rifampicinisleastlikelytocausehepatocellular
damage,althoughitisassociatedwithcholestaticjaundice.
Pyrazinamideisthemosthepatotoxicofthefirstlinedrugs.
Amongthesecond-linedrugs,ethionamide,PASandprotionamide
canalsobehepatotoxic,althoughlesssothananyofthefirstline
drugs.

---

570.Whyquinineisunsafeinpregnancy?
a)Itcauseshemolysis
b)Itcauseshypokalemia
c)Itcauseshyponatremia
d)Itcausessmoothmusclecontraction
CorrectAnswer-A
Ans.is'a'i.e.,Itcauseshemolysis
Quinineoccasionallycauseshemolysis,especiallyinpregnant
womenandinpatientswithfalciparummalariaresultingin
hemogloginuriaandkidneydamage.Alsoifusedinpregnancy
specialcareshouldbetakentopreventhypoglycemia.
Ouinine
Itislevorotatoryalkaloidobtainedfromcinchonabark.Itsd-isomer
quinidineisusedasanantiarrhythmic.
Quinineisanerythrocyticschizontocideforallspeciesof
plasmodium.
Quininehasnoeffectonpreandexoerythrocyticstage.
Mechanismofactionissimilartochloroquine.

---

571.AntiHIVdrugusedforpreventionof
verticaltransmission?
a)Nevirapine
b)Lamivudine
c)Efavirez
d)Tenofovir
CorrectAnswer-A
Ans.is'a'i.e.,Nevirapine
Treatmentduringpregnancy
HIVinfectedmothercantransmitthevirustofetus/infantduring
pregnancy,duringdeliveryorbybreastfeeding.
Earlydiagnosisandantiretroviraltherapytomotherandinfant
significantlydecreasetherateofintrapartumandperinatal
transmission(verticaltransmission)ofHIVinfection.
ZidovudinetreatmentofHIVinfectedpregnantwomenfromthe
beginningofsecondtrimesterthroughdeliveryandofinfantfor6
weeksfollowingbirthdecreasestherateoftransmissionfrom22.6%
to<5%.
Singledoseofnevirapinegiventothemotherattheonsetoflabor
followedbyasingledosetothenewbornwithin72hoursofbirth
decreasedtransmissionby50%.Thisisthepreferedregimennowin
developingcountries.

---

572.Amelanocyticnaevussurroundedbyadepigmentedhaloiscalled:
a)Sutton'snevus
b)Meyerson'snaevus
c)Cockadenaevus
d)Nevusanaemicus
CorrectAnswer-A
Sutton'snevus/halo'snevus:ahaloofdepigmentationappearsarounda
preexistingmelanocyticnaevus.
Meyerson'snaevusisusedtodescribeamelanocyticnaevusthathasdevelopedan
associatedinflammatoryreaction,whichlookslikeeczema.
Ref:Rook'stextbookofdermatology,8theditionPg54.20.

---

573.Mosteffectiveagenttopreventmotion
sicknessis?
a)Ephedrine
b)Nedocromil
c)Cyproheptidine
d)Hyoscine
CorrectAnswer-D
Ans.is`d'i.e.,Hyoscine
Motionsicknessismoreeasilypreventedthancured.
Transdermalhyoscine(scopolamine)isthebestagentforthe
preventionof/notionsickness.
Antihistaminescanalsobeusedforprevention.

---

574.Agentusedfortreatmentofheparin
inducedthrombocytopenia?
a)Lepirudin
b)Abciximab
c)Warfarin
d)Alteplase
CorrectAnswer-A
Ans.is'a'i.e.,Lepirudin
Heparininducedthrombocytopenia(HIT)
Heparininducedthrombocytopeniaisanimportantadverseeffectof
heparinadministration,usuallycausedbyunfractionatedheparin,
butmayalsobeseenwiththeuseoflowmolecularweightheparin
(LMWH).
HITmaybeoftwotypes:
1. Type1(Non-immunemediated):-Itismildandheparinmaybe
continued.
2. Type2(Immunemediated):-Itisduetoformationofantibodies
againstplatelets.Paradoxicalthrombosiscanoccur.Heparinmust
bediscontinuedimmediately.WarfarinandLMWare
contraindicated.Lepirudin(adirectthrombininhibitor)is
anticoagulantofchoice.Alternativesaredanaparoid,hirudinand
Argatroban.

---

575.Anticancerdrugwithdisulfuramlike
action-
a)Procarbazine
b)Nitrosurea
c)5FU
d)Methotrexate
CorrectAnswer-A
Ans.is'a'i.e.,Procarbazine
Disulfiramlikereaction
Certaindrugswhentakenconcurrentlywithalcoholproduce
disulfiramlikeactions.
Thatmeansthesedrugsproducesimilardistressingsymptomsas
disulfiram,whentakenwithalcoholflushing,burningsensation,
throbbingheadache,prespiration,unesasiness,tightnessinchest,
vomiting,dizziness,visualdisturbances,mentalconfusion,postural
faintingandcirculatorycollapse.
ThedrugscausingDisulfiramlikeactions
i. Chlorpropramide
ii. Animalcharcol
iii. Cephalosporins(Cefoperazone,moxalactam,cefamandole)
iv. Griseofulvin
v. Metronidazole
vi. Procarbazine
vii. Citratedcalciumcarbamide
viii. Tinidazine
ix. Cynamide

---

576.TADALAFILfalseis?
a)Itislongestactingphosphodiesteraseinhibitor
b)ItcannotbeusedforthetreatmentofPAH
c)Itisusedinerectiledysfunction
d)Itshalflifeis17-5hours
CorrectAnswer-B
Ans.is'b'i.e.,ItcannotbeusedforthetreatmentofPAH
1. Tadalafilisthelongestactingphosphodiesteraseinhibitorusedfor
erectiledysfunction.
2. Itshalflifeis17.5hours.
3. Itcanbeusedasonce-dailyphosphodiesterasetype5(PDE5)
inhibitorforthetreatmentofpulmonaryarterialhypertension(PAH).

---

577.Whichofthefollowingdrugsis
contraindicatedinliverdysfunction?
a)Pefloxacin
b)Vancomycin
c)Amikacin
d)Hydralazine
CorrectAnswer-A
Ans.is'a'i.e.,Pefloxacin

---

578.Irreversiblehearinglosscausedby?
a)Gentamycin
b)Clarithromycin
c)Bothoftheabove
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Gentamycin
Gentamycinisthemostcommonlyusedoftheaminoglycosides.It
producesvestibulartoxicityandirreversiblehearingloss.
Clarithromycinisknowntoproducereversiblehearingloss.

---

579.Mechanismofactionofcolchicineis?
a)Inhibitsgoutyinflammation
b)Inhbitsthereleaseofchemotacticfactors
c)Inhibitsgranulocytemigration
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove
Colchicine
Itisneitheranalgesicnorantiinflammatory.
Itspecificallyinhibitsgoutyinflammation.
Itisinhibitsreleaseofchemoattractantmolecules.
Itinhibitsgranulocytemigrationintothejoint.
Itisantimitoticcausesmetaphasearrestbybindingtomicrotubules.
Itincreasesgutmotility.

---

580.Hypolipidemicdrugsactonallexcept?
a)HMGCoAreductase
b)Lipoproteinlipase
c)AcylCoA,cholesterolacyltransferase1
d)Peripheraldecarboxylase
CorrectAnswer-D
Ans.is'd'i.e.,Peripheraldecarboxylase
Hypolipidemicdrugs
1. HMG-CoAreductaseinhibitors(statins)-Lovastatin,Simvastatin,
Pravastatin,Atorvastatin,Rosuvastatin.
2. Bileacidsequestrants(Resins)-cholestyramine,colestipol.
3. Activatelipoproteinlipase(fibricacidderivatives)-clofibrate,
gemfibrozil,bezafibrate,fenofibrate.
4. Inhibitlipolysisandtriglyceridesynthesis-Nicotinicacid.
5. Other-Probucol,Gugulipid,Ezetimibe,Avasimibe,Torcetrapib.
Ezetimibeinhibitsintestinalcholesteroleabsorption.
AvasimibeinhibitsenzymeacylCoenzymeA:cholesterolacyl
transferase-1(ACAT-1)whichcausesesterificationofcholesterol.
Torcetrapibinhibitscholesterolestertriglyceridetransportprotein
THDLcholesterol.

---

581.Mannitolisnotusefulfor?
a)Glaucoma
b)RaisedICT
c)Impendingrenalfailure
d)Pulmonaryedema
CorrectAnswer-D
Ans.is'd'i.e.,Pulmonaryedema
Mannitol
Itisanonelectrolyteoflowmolecularweightthatis
pharmacologicallyinert.
Itraisesosmolarityofplasmaandtubularfluid.
Mannitoldecreasestubularwaterandelectrolytereabsorptionby?
1. Duetoosmoticeffect,fluidisretainedinthelumenofPT.
2. InhibitstransportprocessesinthickAscL+1-mostimportantcause
ofdiuresis.
3. ExpandsECF(rintravascularvolume)-drawswaterfromthe
intracellularcompartmentincreasesGFRandinhibitsrenin
release.
4. Increasesrenalbloodflow,especiallytomedulla-3medullary
hypertonicityisreducedcorticomedullaryosmoticgradientis
dissipatedpassivesaltreabsortionisreduced.
Uses-RaisedIOT(glaucoma),raisedICT,tomaintain.GFRand
urineflowinimpendingrenalfailure,andtocounteractlow
osmolalityofplasma/ECFduetorapidhemodialysis.
ContraindicationsAcutetubularnecrosis(ARF),anuria,
pulmonaryedema,AcuteLVF,cerebralhemorrhage.

---

582.VitKisavailableasallexcept?
a)Menoquinone
b)Menadione
c)Phytonadione
d)Phytoquinone
CorrectAnswer-D
Ans.is'd'i.e.,Phytoquinone
Vitamin-K
Itisafatsolublevitamin.
Itisthemajorcoagulantofhumanbody(coagulantsaresubstances
whichpromotecoagulation).
Itisofthreetypes?
a)K1(fromplants)-Phytonadione
b)K2(Producedbybacteria)-Menaquinones
C)K3(Synthetic)-Menadione
HalflifeofvitKis72hours-MahenderbhanSingh5th/e-348
litKactsasacofactoratalatestageinthesynthasisofcoagulation
factorsbyliver-Prothrombin(factorII),FactorVII,IXandX(also
protein'C'&Protein'8").
Itcatalyzesthefinalstepinactivationofthesefactorsi.e.gamma
carboxylationofglutamateresidueswhichconfersonthemthe
capacitytobindCa+2andtogetboundtophospholipidssurfaces-
propertiesessentialforparticipationinthecoagulationcascade.

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583.

---

Drugsforparalyticileusforbowelresection
surgeryareallexcept?
a)Alvinopam
b)Dihydroergotamine
c)Naloxone
d)Methylnaltrexone
CorrectAnswer-C
Ans.is'c'i.e.,Naloxone
PharmacologicManagementofPostopparalyticileus(P01):
Minimizingthesympatheticinhibitionofgastrointestinalmotility,
decreasinginflammationandstimulationofgastrointestinal11-opioid
receptorsaretheultimategoalsofpharmacologicmanagement.
A)Minimizingsympatheticinhibition
Bothpropranolol,anonspecific13-receptorantagonist,and
dihydroergotamine,ana-receptorantagonist,havebeen
investigatedfortreatmentofPOI.
Neostigmineisanacetylcholinsteraseinhibitorthatcausesan
increaseincholinergic(parasympathetic)activityinthegutwall,
whichisbelievedtotherebystimulatecolonicmotility.
Useofedrophoniumchlorideandbethanecholchloride,which
competitivelyinhibitacetylcholineonthebindingsiteof
acetylcholinesterase,hasbeenreportedtoshowimprovementof
POI.
Cisaprideisaserotonin(5-HT)4receptorantagonistthatpromotes
acetylcholinereleasefrompostganglionicnerveendingsinthe
myentericplexusandisthoughttoindirectlyimprovegastrointestinal
motility.
Metocloprimideissuspectedtoenhancegastrointestinalmotility

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withoutstimulatinggastricsecretion,butitsusehasnotbeen
substantiatedforPOI.
B)Decreasinginflammation
Decreasinginflammationmaybeindicatedinpatientswhoareabout
toundergomajorintestinalsurgery,asthisisthoughttobean
importantcontributingfactortoPOI.
Nonsteroidalanti-inflammatory(NSAIDs)agentscanbeusedin
conjunctionwithopioidanalgesicsfortheirdualeffectsonpain
controlandinflammatoryinhibition.
C)Stimulationofgastrointestinaliii-opioidreceptors
Stimulationofgastrointestinal.1-opioidreceptorscantheoretically
influencegastrointestinalmotilitydirectly;therefore,blockingthe
peripheralgastrointestinaleffectsofcentrallyactingopioidsusedfor
analgesiamayhelppreventPOI.
Twonoveldrugsarebeinginvestigatedforthisreason:alvimopan
andmethylnaltrexone.
BothdrugsareIf-opioidreceptorantagonists,andbothappearto
offerpromisingresultsforpreventingprolongedPOI.
Opioidtherapyforpostoperativeorchronicpainisfrequently
associatedwithadverseeffects,themostcommonbeingdose-
limitinganddebilitatingboweldysfunction,soalvimopanand
methylnaltrexonemayalsobeusefulinthetreatmentofchronic
opioidboweldysfunction.
Thecurrentlyavailableopioidantagonistssuchasnaloxoneareof
limitedusebecausetheyalsoactatcentralopioidreceptorsto
reverseanalgesiaandelicitopioidwithdrawal.
Alvimopanandmethylnaltrexoneareperipherallyactingif-opioid
receptorantagoniststhathavebeenstudiedinpatientsundergoing
abdominalandpelvicsurgeryandhavebeenshowninseveral
studiestosignificantlyaccelerategastrointestinalrecovery.
AlvimopanreceivedFDAapprovalforthetreatmentofPOIonMay
20,2008.
D)Alternativemedications
Bisacodyladministrationversusplacebotwicedailystartingon
postoperativeday1,patientswhoreceivedbisacodylhad
significantlyearlierbowelmovementsthanthosewhoreceived
placebo(25hv.56h),butfurtherstudiesareneededtoassessthe

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effectoflaxativesonPOI.

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584.Drugscausingpepticulcerareallexcept
?
a)Clopidogrel
b)NSAID
c)Mycophenolatemofetil
d)Propylthiouracil
CorrectAnswer-D
Ans.is'd'i.e.,Propylthiouracil
Drug/Toxincausingpepticulcerdisease:
Bisphosphonates
Chemotherapy
Clopidogrel
Crackcocaine
Glucocorticoids(whencombinedwithNSAIDs)
Mycophenolatemofetil
Potassiumchloride

---

585.Thecommonestside-effectofCisapride
is-
a)Abdominalcramps
b)Diarrhea
c)Headache
d)Convulsions
CorrectAnswer-B
Ans.is'b'i.e.,Diarrhea
Cisaprideisaprokineticagentandoftenproducesloosestools
(diarrheaisthusthecommonestsideeffect)

---

586.DrugnotactingonP2y12receptoris?
a)Ticlopidine
b)Clopidrogel
c)Dipyridamole
d)Prasugrel
CorrectAnswer-C
Ans.is'c'i.e.,Dipyridamole
Dipyridamole:inhibitsphosphodiesteraseaswellasblocksuptakeof
adenosinetoincreaseplateletcAMPwhichinturnpotentiatesPGI2
andinterfereswithaggregation.
Ticlopidine,ClopidogrelandprasugrelactontheP2y12receptor
andinhibitsADPaswellasfibrinogeninducedplateletaggregation.
Note:PrasugrelisthelatestmostpotentandfastestactingP2Y12
purinergicreceptorblocker.Itisusedinacutecoronarysydromes
andwhenstrongantiplateletactionisrequired).

---

587.ActivesubstanceinDakinsskindressing
agentusedinburnsis?
a)Mafenideacetate
b)Silversulfadiazine
c)Sodiumhypochlorite
d)Nystatin
CorrectAnswer-C
Ans.C.Sodiumhypochlorite
Dakin'sskindressingagentcontainssodiumhypochlorite'
Itisusedforsuperficialanddeepburns.

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588.Omalizumabis?
a)AntiIgMantibody
b)AntilgGantibody
c)AntiIgEantibody
d)AntiIgDantibody
CorrectAnswer-C
Ans.is'c'i.e.,AntiIgEantibody

---

589.Nicotinicacid?
a)IncreasesHDL
b)Increasedtriglyceridesynthesis
c)TypeIIhyperlipoproteinemia
d)DecreasedhydrolysisofVLDL
CorrectAnswer-A
Ans.is'a'i.e.,IncreasesHDL
Nicotinicacid(Niacin)
Therearcthreemaintypeoflipasesrelatedtometabolismof
lipoproteins?
1. LipoproteinlipasePresentinbloodvesselsandcauseshydrolysis
oftryglyceridecontentofVLDLandchylomicrones.
2. HepaticlipaseConvertsIDLtoLDLbyhydrolysingthetriglyceride
contentofIDL.
3. HormonesensitivelipasePresentintracellularlyinperipheral
tissueandcausesintracellularlipolysisbyhydrolysingtriglycerides.
Niacin(Nicotinicacid)inhibitsintracellularlipolysisbyinhibiting
hormonesensitivelipaseintracellularFFAtoliver-4.1,
triglyceridesynthesis.
NiacinalsoincreasestheactivityoflipoproteinlipaseThydrolysis
ofVLDLtriglyceride.
NicotinicacidalsoreducestheproductionofVLDLinliverby
inhibitingTG-synthesisindirectlytheVLDLdegradationproducts
IDLandLDLarealsoreduced.
NicotinicacidisthemosteffectivedrugtoraiseHDL-CH.
IncreasedHDLisduetointerferenceofdirectpathwayofHDL
cholesteroltoliverwhichinvolvesapo-AiNiacindecreasesapo-
A,mediatedhepaticclearance.

---

NicotinicacidisusedintypeI,III,IV&Vhyperlipoproteinemias.

---

590.DrugthatdecreasesLpAinblood?
a)Statin
b)Nicotinicacid
c)Ezetimibe
d)CETPinhibitors
CorrectAnswer-B
Ans.is'b'i.e.,Nicotinicacid
NicotinicacidreducesLp(a)whilestatinsdonothaveanyeffecton
Lp(a).

---

591.Plateletadhesionisinhibitedby?
a)Nitricoxide
b)SubstanceP
c)Thrombin
d)IL2
CorrectAnswer-A
Ans.is'a'i.e.,NitricOxide

---

592.Whichofthefollowingisthelongest
actingoralanticoagulant?
a)Bishydroxycoumarin
b)Warfarin
c)Acenocoumarol
d)Phenindione
CorrectAnswer-A
Ans.is'a'i.e.,Bishydroxycoumarin
Bishydroxycoumarin(Dicumarol)isthelongestactingoral
anticoagulant.
Ethylbiscoumacetateistheshortestactinganticoagulant.

---

593.Methysergideisbannedasitcauses?
a)Pulmonaryfibrosis
b)Pleuraleffusion
c)Syncope
d)Myocarditis
CorrectAnswer-A
Ans.is'a'i.e.,Pulmonaryfibrosis
Methysergide
Itischemicallyrelatedtoergotalkaloidsandantagonizestheaction
ofserotoninonsmoothmusclesincludingthatofbloodvessels,
withotproducingergotlikeeffects.
Itisapotent5HT2A/2Cantagonist.
Ithasbeenusedformigraineprophylaxis,carcinoidand
postgastrectomydumpingsyndrome.
Prolongedusehascausedabdominal,pulmonaryandendocardial
fibrosis,becauseofwhichithasgoneintodisrepute.

---

594.Whichofthefollowingisaunivalent
directthrombininhibitor?
a)Argatroban
b)Hirudin
c)Bivalirudin
d)Lepirudin
CorrectAnswer-A
Ans.is'a'i.e.,Argatroban
Directthrombininhibitors(DTIs)
Thisisaclassofmedicationsthatactasanticoagulantsbydirectly
inhibitingthethrombin(unlikeheparinwhichinhibitsthrombin
indirectlythroughantithrombinso,heparinisanindirectthrombin
inhibitor).

---

595.Streptokinasecausesincreasein?
a)Plasmin
b)Thrombin
c)Kallikrein
d)AngiotensinII
CorrectAnswer-A
Ans.is'a'i.e.,Plasmin
Streptokinase
Fibrinolyticdrug
ObtainedfromgroupCstreptococci
Streptokinaseisinactiveassuch.Itcombineswith'circulating
plasminogenmoleculestoformanactivatorcomplex,whichthen
causeslimitedproteolysisofotherplasminogenmoleculesto
generateactiveenzymeplasmin.

---

596.LTantagonistsareusedinasthmafor?
a)Alongwithbetaagoniststoreducesteroids
b)Inplaceofbetablockersassoletherapy
c)Prophylactictherapyformildtomoderateasthma
d)Definitivetherapyinacuteattackofasthma
CorrectAnswer-C
Ans.is'c'i.e.,Prophylactictherapyformildtomoderateasthma
MonteleukastandzafirleucastarecystenylLT1(cysLT1)receptor
antagonists.
Theyareindicatedforprophylactictherapyofmildtomoderate
asthmaasalternativestoinhaledglucocorticoids.

---

597.Followingistrueaboutirondextran
except?
a)Itisparenteralironpreparation
b)Itcanbegiveneitherivorim
c)Itbindstotransferrin
d)Itisnotexcreted
CorrectAnswer-C
Ans.is'c'i.e.,Itbindstotrnasferrin

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598.Comparedtohighmolecularweight
heparinfollowingistrueaboutlow
molecularweightheparin?
a)Monitoringisnotneededforlowmolecularweightheparin
b)Dailytwosubcutaneousdosesareessential
c)Theyareeasilyfilteredattheglomerulus
d)Theydonotinteractwithplasmaproteins
CorrectAnswer-B
Ans.is'b'i.e.,Dailytwosubcutaneousdosesareessential
AdvantagesofLMWH
Longer,moreconsistentandpredictableresponse-->Singledaily
doseissufficientbysubcutaneousroute.oLowerriskof
osteoporosisandHITsyndrome.
Bleedingchancesareless:LMWheparinshaveadifferent
anticoagulantprofile.
TheyselectivelyinhibitfactorXawithlittleeffectonantithrombinand
coagulationingeneral.
TheyactonlybyinducingconformationalchangeinATIII.
Theyappeartohavelesserantiplateletaction.
AsaresulttheyhaveasmalleffectonaPTTandwholeblood
clottingtime.
SinceaPTT/clottingtimesarenotprolonged(much)laboratory
monitoringisnotneeded,andtheincidenceofhaemorrhagic
complicationisless.
Theyareeasilyfilteredfromglomerularcapillariesbecauseofthere
smallermolecularweight.
LMWheparinsdonotinteractwithplasmaproteins.

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---

599.ProphylacticdoseofvitaminKgivento
newborninfantsatdeliveryis?
a)1mg
b)5mg
c)10mg
d)15mg
CorrectAnswer-A
Ans.is'a'i.e.,1mg
VitaminKDeficiencyinNewborns
ThesymptomsofvitaminKdeficiencyareduetohemorrhage
NewbornsareparticularlysusceptibletovitaminKdeficiency
becauseoflowfatstores,lowbreastmilklevelsofvitaminK,sterility
oftheinfantileintestinaltract,liverimmaturity,andpoorplacental
transport.
Intracranialbleeding,aswellasgastrointestinalandskinbleeding,
canoccurinvitaminK-deficientinfants17daysafterbirth.
Thus,vitaminK(1mgIM)isgivenprophylacticallyatthetimeof
delivery.

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600.Whichofthefollowingisnotananti
histaminicdrugoftheethanolamine
group?
a)Clemastine
b)Diphenhydramine
c)Dimenhydrinate
d)Chlorpheniramine
CorrectAnswer-D
Ans.isdi.e.,Chlorpheniramine
Ethanolaminederivativegroupofantihistaminicsare:
Carbinoxaminemaleate
Clemastinefumarate
DiphenhydrmineHC1
Dimenhydrinate

---

601.Allofthefollowingcanprecipitate
porphyriaexcept?
a)Steroids
b)Griesiofulvin
c)Penicillin
d)Estrogen
CorrectAnswer-C
Ans.is'c'i.e.,Penicillin
Penicillinisasafedruginacuteintermittentporphyria
Drugsprecipitatingacuteintermittentporphyria
Barbiturates
Griseofulvin
Chlorpropramide
Rifampicin
Oralcontraceptives
Estrogen
Phenytoin
Sulfonamides

---

602.Heparinactivatesfollowingfactors
except?
a)IIa
b)VIIa
c)IXa
d)Xa
CorrectAnswer-B
Ans.is`b'i.e.,Villa
ChemicalnatureandpreparationofHeparin
Heparinisasulfatedmucopolysaccharidewhichoccursinthe
secretorygranulesofmastcells.
Itisthestrongestorganicacidinthebodyandinthesolutionit
carriesanelectronegativecharge.
Itispreparedcommerciallyfromavarietyofanimaltissues
(generallyporcineintestinalmucosaorbovinelung).
MechanismofActionofHeparin
Heparinactsbyactivatingantithrombinwhichisanaturallyoccuring
inhibitorofactivatedcoagulationfactorsofintrinsicandcommon
pathway.

---

603.Bromocriptineisusedinfollowing
clinicalsituationsexcept?
a)TypeIIDM
b)HepaticComa
c)Cyclicalmastalgia
d)Hypoprolactinemia
CorrectAnswer-D
Ans.is`d'i.e.,Hypoprolactinemia
UsesofBromocriptive
Bromocriptineisapowerfuldopamineagonist.Itsuppresses
prolactinsecretionwhilepromotingsecretionofgonadotropins.
Itstherapeuticusesare:
i. Suppressionoflactationingalactorrhea
ii. Cyclicalmastalgia
iii. Inductionofovulationinanovulatoryinfertilitycausedby
hyperprolactinemia
iv. Parkinsonism
v. Acromegalyduetosmallpitutarytumours
vi. Hepaticcoma
vii. Recently,ithasbeenapprovedfortreatmentoftype2DM.

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604.FollowingistrueaboutGnRHagonists
except?
a)Usedincasesofprecociouspuberty
b)Theyhaveactionsimilartogonadotropinreleasinghormone
c)Longactingpreparationscanbeusedasnasalspray
d)Ganirelixisthemostpotentagent
CorrectAnswer-D
Ans.is'd'i.e.,Ganirelixisthemostpotentagent
GnRHagonists
LongactingGnRH(LHRH)agonistscausesreversible
pharmacologicalorchiectomy(medicalcastration)andareusedfor
precociouspuberty,prostaticcarcinoma,endometriosis,
premenopausalbreastcancer,uterineleiomyoma,polycysticovarian
diseaseandtoassistinducedovulation.
GnRHagonistshaveactionsimilartoGonadotropinreleasing
hormone,i.e.,theyincreasethesecretionofgonadotropins(FSH,
LH).
Thenhowdotheysuppressgonadolfunction?Letssee.
GnRHagonistsincreasesGnsecretion.
Butafter1-2weekstheycausedesensitizationanddown-regulation
ofFSH/LHreceptors.(continousexposuretoagonistmaycause
downregulationofreceptors)-->suppressionofgonadalfunction.
Spermatogenesis/ovulationceaseandtestosterone/estrogenlevels
falltocastrationlevelbecausetheactionofGonadotropins(FSH&
LH)isnotthere(thesehormonespromotegametogenesisand
secretionofgonadalhormones).
PreparationofsuperactiveGnRHanaloguesare-->Busereline,
Goserelin,Leuprolide,Nafarelin,Triptorelin.

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Superactive/LongactingGnRHareusedasnasalsprayorSC
injection.
Cetrorelix,ganirelixandabarelixareGnRhantagonists.Theseare
usedsubcutanouslyforthetreatmentofuterinefibroid&
endoinetriosisandforcontrolledovarianstimulationinin-vitro
fertilization.
GnRhagonistsaswellasGnRhantagonistscancausehotflushes,
lossoflibidoandosteoporosisasadverseeffects.

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605.Femaleoncarbimazoletherapypresents
withsuddenfever,rigorsandsore
throat.Whichistheinvestigationof
choiceforthispatient?
a)Checkbloodcounts
b)CheckCreactiveprotein
c)TakethroatSwab
d)Treatformalaria
CorrectAnswer-A
Ans.is'a'i.e.,Checkbloodcounts
Themostcommonsideeffectofcarbimazoleismaculopapular
pruriticrash,whilemostseriousadverseeffectisagranulocytosis
whichisreversible.
Patientinthegivenquestionpresentswithsuddenonsetfever,
rigorsandsorethroat.Infectionofanysitewhichissuddenonset
andrapidlyprogressiveinapatientoncarbimazoletherapythe
suspicionshouldbedevelopmentofagranulocytosis,soitis
essentialtodobloodcounts.

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606.HbA1Cisdecreasedmostby?
a)Biguanides
b)Sulfonylureas
c)Thiazolidinediones
d)Acarbosc
CorrectAnswer-B
Ans.is'b'i.e.,Sulfonylureas
Effectoforalhypoglycemicinloweringbloodglucosecanbe
measuredbyreductioninHbAlClevel
i)OralhypoglycemicwithmaximumdecreaseinHbAlc
sulfonylureas.
ii)OralhypoglycemicwithminimumdecreaseinHbAICGlucosidase
inhibitors(Acrarbose,Migital)

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607.Cabergolineisusedin-
a)Acromegaly
b)Hyperprolactinoma
c)Bothaandb
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Bothaandb
Prolactinisphysiologicallyinvolvedinlactation.Inabreastwhich
hasbeenprimedbyfemalehormones(estrogenandprogesteron),
prolactininducesandmaintainslactationbystimulatingsynthesisof
milk.Prolactinistheonlypituitaryhormonewhichisprimarily
undertheinhibitorycontrolofhypothalamus.Itssecretionis
inhibitedbydopamine(prolactininhibitingsubstance)through
D2receptors.Therefore,dopamineagonistsinhibitprolactin
release,andD,antagonists(antipsychotics,metoclopromide)cause
hyperprolactinemia.
oBromocripitine,asyntheticergot,isapotentdopamineagonist
withgreateractiononD2receptors.OnDireceptorsitactsas
partialagonistorantagonist.Italsohasaweaka-adrenergic
blockingaction.Bromocriptinedecreases(i)Prolactinsecretion,
(ii)GImotility,and(iii)GHsecretioninacromegaly.Itstimulates
CTZtocausenauseaandvomiting.Itisusedin
hyperprolactinemia,suppressionoflactationingalactorrhea,
cyclicmastalgia,parkinsonism,acromegaly,hepaticcoma,and
type2DM(recentlyapproved).
CabergolineisanotherD2agonist,whichismorepotentandlonger
actingthanbromocriptine.Itispreferredforacromegalyand

---

hyperprolactinemia.Quinagolide,otherD,agonist,itseffectivefor
hyperprolactinemia.

---

608.Tamoxifene?
a)SSRI
b)SERM
c)SNRI
d)DNRI
CorrectAnswer-B
Ans.is`b'i.e.,SERM
Tamoxifenisaselectiveestrogenreceptormodulator(SERM).

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609.Letrozolebelongstowhichgroup?
a)SERM
b)SERD
c)LHRHanalogues
d)Aromatseinhibitors
CorrectAnswer-D
Ans.is'd'i.e.,Aromataseinhibitors
Aromataseinhibitors
AromataseinhibitorsaredrugswhichinhibittheenzymeAromatase.
Aromataseisanenzymeresponsiblefortheconversionof
testosterone(androgens)toestrogens.
Thisconversionofandrogenstoestrogensoccurinseveraltissues
includingovary,adrenalcortex,peripheraltissues.
InhibitionofAromataseleadstodecreaseinestrogenlevel.
Aromataseinhibitorspreventtheconversionofandrogensto
estrogensonlyinpostmenopausalwomen,notinpremenopausal
women.
Inpremenopausalwomen,asthelevelofestrogensdecreaseit
activatesthepituitaryhypothalamicaxis.Activationofpituitary
hypothalamicaxisleadstoincreasedsecretionofpituitary
gonadotropins.Thepituitarygonadotropinsinturnincreasethe
secretionofestrogens.Thustheestrogenlevelreturnsbacktotheir
normallevel.
Ontheotherhandaromataseinhibitorseffectivelydecreasethe
secretionofestrogeninpostmenopausalwomen.
Inpostmenopausalwomen,theproductionofestrogenfrom
androgensoccurs,onlyinextraovariansitessuchasperipheral
tissueswheretheconversionofandrogenstoestrogensisblocked

---

byaromataseinhibitors.
Useofaromataseinhibitors
Aromataseinhibitorsareusedinthet/tofHormonereceptorpositive
breastcarcinomasinpostmenopausalwomen.Theyarenot
effectiveinpremenopausalwomen.
HowareAromataseinhibitorsusefulinBreastcarcinomas?
Inbreastcarcinomas,estrogendeliversgrowthsignalstothe
hormonereceptors.Thehormonereceptorsuponreceivingthe
growthsignals,causetheproliferationoftumorcells.
Aftertheinhibitionbyaromataseinhibitors,estrogenlevel
decreases,thisleadstolesserdeliveryofgrowthsignalsandinturn
lesserproliferationoftumorcells.
Aromataseinhibitorsareoftwotypes:
TypeI(steroidal)aromataseinhibitor-Theycauseirreversible
inhibitionofaromatase,e.g.Exmestane,formestane.
TypeII(non-steroidal)aromataseinhibitor-Theycausereversible
inhibitionofaromatasee.g.Anastrazole,Letrozole,vorozale.
Aboveclassificationisbasedonchemicalstructure(steroidalornon-
steroidal)andtypeofinhibition(reversibleorirreversible).Basedon
theevolutionthearomataseinibitorsarc:
i. FirstgenerationAminoglotethimide
ii. SecondgenerationSteroidaltypeI(Example,formestane),non-
steroidaltypeII(Anastrazole,Letrozole,Vorozole,fadrozole)
Sideeffects-Hotflushes,nausea,diarrhoea,dyspepsia,thinningof
hairandJointPain(Arthralgia)andincreasedriskoffracture.
Thereisnoendometrialproliferation(noriskofendometrial
carcinoma),noriskofvenousthromboembolismandno
deteriorationoflipidprofile.
Remember
Anastrozoleandletrozolearenonsteroidolcompound,while
exemestaneissteroidol.oExemestanealsohasweakandrogenic
activity.
Anastrozoleismorepotentthanletrozole.
FirstgenerationaromataseinhibitorsAminoglutethimide.
SecondgenerationaromataseinhibitorsLetrozole,anastrozole,
fadrozoleandexemestone.

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610.DMPAisgivenoncein-
a)3months
b)6months
c)9months
d)45days
CorrectAnswer-A
Ans.is'a'i.e.,3months
HORMONALCONTRACEPTIVES
Thesearehormonalpreparationsusedforreversiblesuppressionof
fertility.
Typesofmethods
A.Oral
Combinedpill(monophasicpills)
Itcontainsanestrogenandaprogestin.
Thisisthemosteffectiveandpopularmethod.
Efficacyis98-99%
Preparationare-
Ethinylestradiol30pg(?03mg)+Norgestrel0.3mg
Ethinylestradiol50.tg(?05mg)+Levonorgestrel0.25mg
Ethinylestradiol30pig(?03mg)+Desogestreol0.15mg
Onetablet(containingestrogenandprogesterone)istakendailyfor
21daysstartingon51"dayofmensturation.
Phasedregimens
Theestrogendoseiskeptconstant(orvariedslightlybetween30-40
mg),whiletheamountofpregestinislowinfirstphaseand
progressielyhigherinthesecondandthirdphases.
Preparationsare
Biphasicpills

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Day1-10Ethinylestradiol35mg+Norethindrone0.5mg
Day11-21Ethinylestradiol35mg+Norethindrone1mg.
Triphasicpills
Day1-7Ethinylestradiol35mg+Norethindrone0.5mg
Day8-14Ethinylestradiol35mg+Norethindrone0.75mg
Day15-21Ehinylestradiol35mg+Norethindrone1mg
Minipill(progestinonlypill)
Alowdoseprogestinpillistakendailywithoutanygap.
PreparationsNorethindrone(0.35mg)orNorgestrel75mg.
Postcoital(emergency)pills.
a)Levonorgestrel0.5mg+ethinylestradiol0.1mg-->within72
hoursofunprotectedintercourseandrepeatedafter12hours-
Yuzpemethod.
b)Levonorgestrelalone0.75mgtakentwicewith12hourgapwithin
72hoursofunprotectedintercoursemethodofchoicefor
emergencycontraception.
c)Mifepristone600mgsingledosewithin72hoursofunprotected
intercourse.
B.Injectable
Theyaregiveni.m.asoilysolution
1.Longactingprogestinalone
a)Depotmedroxyprogesteroneacetate(DMPA)150mgat3month
intervals.or
b)Norethindrone(norethisterone)enanthate(NEE)200mgat2
monthsintervals.
c)Themostimportantundesirablepropertyiscompletedisruptionof
mensturalbleedingpatternandtotalamenorrhoea(morecommon
withDMPA).
2.Longactingprogestin+longactingestrogen-onceamonth.

---

611.Pramlintideis?
a)Syntheticamylinanalogue
b)InhibitorofDPP4
c)GLP1analogue
d)PPARgamma
CorrectAnswer-A
Ans.is'a'i.e.,Syntheticamylinanalogue
NEWERANTIDIABETICDRUGS
Exenatide
Exenatideisasyntheticglucagon-likepeptide-1(GLP-1)analogue.
GLP-1isanimportantincretinthatisreleasedfromgutinresponse
tooralglucose.
ButGLP-1cannotbeusedclinicallyasitisdegradedrapidlyby
enzymedipeptidlypeptidase(DPP-4).
ExenatideisresistanttoDPP-4.
ItactssimilartoGLP-1Enhancementofpostprandialinsulin
release,suppressionofglucagonreleaseandappetiteaswellas
slowingofgastricemptying.
Itisgivenbysubcutaneousroute&usedintype2DM
Nauseaismostimportantsideeffect.
Sitagliptin
ThisisorallyactiveinhibitorofDPP-4.
ItpreventsdegradationofendogenousGLP-1andotherincretins,
potentiatingtheiraction,resultinginlimitationofpostprandial
hyperglycemia.
Itisusedintype2DM.
OtherDPP-4inhibitorisvildagliptin
Pramlintide

---

Thisisasyntheticamylinanalogue(Amylinisapolypeptide
producedbypancreatic(3-cellswhichreducesglucagonsecretion
froma-cellsanddelaysgastricemptying).
Pramlintideattenuatespostprandialhyperglycemiaandexertsa
centrallymediateanorecticaction.oItisgivenbysubcutaneous
routeandisusedinbothType1andType2DM.
Glucomannan
Thisispowderedextractfromtuberofkonjar.
Itispromotedasadietaryadjunctfordiabetes.
Itswellsinstomachbyabsorbingwaterandisclaimedtoreduce
appetite,bloodsugar,serumlipidsandrelieveconstipation.
Bromocriptine
RecentlybromocriptinehasbeenapprovedbyFDA,asanadjunctto
dietandexercisetoimproveglycemiccontrolintype2DM.Ithas
beenfoundthatdopaminealterinsulinresistancebyactingon
hypothalmusandbromocriptineblocksO2receptors.

---

612.Whichdrugpreventperipheral
conversionofT4toT3-
a)Propylthiouracil
b)Propranolol
c)Iodides
d)aandbboth
CorrectAnswer-D
Ans.is'a'i.e.,Propylthiouracil&'b'i.e.,Propranolol

---

613.1,25dihydrocholecalciferolactson?
a)Surfacereceptors
b)Cytosolicreceptors
c)Intranuclearreceptors
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Intranuclearreceptors

---

614.Doseofcentchromanis?
a)30mg
b)60mg
c)120mg
d)240mg
CorrectAnswer-A
Ans.is'a'i.e.,30mg
Cetchroman(Saheli)
Ormeloxifene,researchproductofCentralDrugResearchInstitute,
Lucknow,India.
Itisapotentnon-steroidalcompoundwithpotentanti-estrogenic
andweakestrogenicproperties.Itistakenorally(30mg)twicea
weekforfirstthreemonthsthenonceaweek.
Itworksprimarilybypreventingimplantationoffertilizedovum.It
doesnotinhibitovulation.
ItisavoidedinPCOD,withliverandkidneydiseasesandin
tuberculosis.Theremaybeatendencyofoligomenorrhoea.
Thefailurerateis1-4/100womanyearsofuse.Failurerateisless
withincreaseddoses.Itisdevoidofanysignificantadverse
metaboliceffect.
Thismayalsobeusedasaemergencycontraceptive.

---

615.Reasonforhepaticinvolvementinoral
contraceptivesis?
a)Estrogen
b)Progesterone
c)Estrogen+Progesterone
d)Mixedtraceelements
CorrectAnswer-A
Ans.is'a'i.e.,Estrogen
Hepatotoxicitywithoralcontraceptivepills
WhileearlyformulationsofOCPswereassociatedwithfrequent
serumenzymeelevations,currentformulationsandhormonal
replacementtherapyhavenotbeenlinkedtoALToralkaline
phosphataseelevationsatratesanyhigherthanoccurwithplacebo.
EstrogensinOCPscancausemildinhibitionofbilirubinexcretion
leadingtojaundiceinpatientswithinheritedformsofbilirubin
metabolismsuchastheDubinJohnsonsyndrome.
Itcaninduceaclinicallyapparentcholestaticliverinjurywhich
typicallyarisesduringthefirstfewcyclesoftherapy,andrarelyafter
thesixmonths.
Ithasalsobeenlinkedtohepatictumors,bothbenignand
malignant.

---

616.Incretinlikefunctionisseenin?
a)Exenatide
b)Miglital
c)Poiglitazone
d)Repaglinide
CorrectAnswer-A
Ans.is'a'i.e.,Exenatide
Exenatideisasyntheticglucagon-likepeptide-1(GLP-1)analogue.
GLP-1isanimportantincretinthatisreleasedfromgutinresponse
tooralglucose.
ButGLP-1cannotbeusedclinicallyasitisdegradedrapidlyby
enzymedipeptidlypeptidase(DPP-4).
ExenatideisresistanttoDPP-4.
ItactssimilartoGLP-1Enhancementofpostprandialinsulin
release,suppressionofglucagonreleaseandappetiteaswellas
slowingofgastricemptying.
Itisgivenbysubcutaneousroute&usedintype2DM
Nauseaismostimportantsideeffect.

---

617.Whichisalongactinginsulin?
a)Lispro
b)Aspart
c)Glargine
d)Glulicine
CorrectAnswer-C
Ans.is'c'i.e.,Glargine

---

618.Specialfeatureofglargineinsulinis?
a)Itproducesasmoothpeaklesseffect
b)Itisnotsuitableforoncedailyadministration
c)ItremainssoubleatpH7
d)Itcancontrolmealtimehyperglycemia
CorrectAnswer-A
Ans.is'a'i.e.,Itproducesasmoothpeaklesseffect
InsuinGlargine
Itislongactingbiosyntheticinsulin.
ItremainssolubleatpH4oftheformulationandprecipitatesat
neutralpHonsubcutaneousadministration.
Onsetofactionisdelayed.
Itproducesasmoothpeaklesseffect.
Itissuitableforoncedailyadministration.
Lowincidenceofnighttimehypoglycemia.
Itdoesnotcontrolmealtimeyperglycemia.

---

619.Longactingcorticosteroidis?
a)Triamcinolone
b)Betamethasone
c)Hydrocortisone
d)Prednisolone
CorrectAnswer-B
Ans.is'b'i.e.,Betamethasone
Shortactingglucocorticoids(t1/2:8-12hrs.):Cortisol,
hydrocortisone.
Intermediateactingglucocorticoids(t1/2:12-36hrs.):Prednisolone,
methylprednisolone,triamcinolone.
Longactingglucocorticoids(t1/2:36-54hrs.):Dexamethasone,
betamethasone.

---

620.Adrenocorticalsuppressioncausing
drugsareallexcept?
a)Prednisone
b)Ketoconazole
c)Mitotane
d)Spironolactone
CorrectAnswer-D
Ans.is'd'i.e.,Spironolactone
Drugscausingadrenocorticalsuppressionare:
Steroids(prednisone,hydrocortisone,anddexamethasone)
Aminoglutethimide
Fludrocortisone
Ketoconazole
Megestrol
Metyrapone
Mitotane

---

621.Drugwhichdecreasesefficacyof
testosterone
a)Isoniazid
b)Ketoconazole
c)Rifampicin
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Ketoconazole

---

622.Danazolhaswhichofthefollowing
actions?
a)Weakandrogenic
b)Progestational
c)Anabolic
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove
Danazole
Ithasweakandrogenic,anabolicandprogestationalactivity.
Themostprominentactionissuppressionofgonadotropin(FSH/LH)
frompitutaryinbothmenandwomeninhibitionof
testicular/ovarianfunction.
Usesare:
1. Endometriosis(majoruse)
2. Fibrocysticbreastdisease
3. Infertility
4. Menorrhagia
5. Hereditaryangioneureticedema
Sideeffectsarecompleteamenorrhoea,androgeniceffects(acne,
hirusitism,decreasedbreastsize,deepeningofvoice,edema,
weightgain),lossoflibidoinmen,hotflushesinwomen,night
sweatsandmusclecramp.
Liverenzymemayberaised.

---

623.Fastestactingantithyroiddrugs?
a)IodidesofNa/K
b)Propylthiuracil
c)Methimazole
d)Nitrates
CorrectAnswer-A
Ans.is'a'i.e.,IodidesofNa
IodineandIodides
Iodineisthefastestactingthyroidinhibitor
Mostimportantactionisinhibitionofhormonerelease(thyroid
constipation);butallfacetsofthyroidsynthesismaybeaffected.
Excessiodideinhibitsitsowntransportinthyroidcellsandmayalter
theredoxpotentialofcells,thusinterferingiodinationreduced
T4/T3synthesis(Wolff-chaikoffeffect).

---

624.MechanismofactionTrilostane?
a)11betahydroxylaseinhibitor
b)1alphahydroxylaseinhibitor
c)3betahydroxysteroiddehydrgenaseinhibitor
d)7alphahydrolaseinhibitor
CorrectAnswer-C
Ans.is'c'i.e.,3betahydroxylsteroiddehydrogenaseinhibitor

---

625.Insulinsecretionincreasingdrugby
actingonbetacellsofpancreasis-
a)Rapaglinide
b)Metformin
c)Poiglitazone
d)Acarbose
CorrectAnswer-A
Ans.is'a'i.e.,Rapaglinide
Oralhypoglycemicdrugsmaybedividedintotwogroups.
1.Group1
Thesedrugsreduceplasmaglucosebystimulatinginsulin
production,thereforecalledinsulinsecretogogues.
Hypoglycemiaisawellknownsideeffect.
Examplesare:
i)Sulfonylureas:firstgeneration(chlorpropamide,tobutamide);
secondgeneration(Glimipiride,glyburide,glipizide,gliclazide).
ii)Megalitinnide/D-phenylalanineanalogues:Nateglinide,
Rapaglinide.
2.Group2
Thesedrugsreducebloodglucosewithoutstimulatinginsulin
production,thereforeareinsulinnonsecretogogues.
Thesedurgsdonotcuasehypoglycemiawhenusedaloneandcan
causehypoglycemia,onlywhenusedwithotheroralhypoglycemics.
Examplesare:
i)Biguanides:Metformin,Phenformin
ii)Thiazolidinediones:Rosiglitazone,Pioglitazone,Troglitazone.
iii)a-glucosidaseinhibitors:Acarbose,miglital.

---

626.Bevacizumabisusedin?
a)Carcinomacolon
b)Livercarcinoma
c)Renalcellcarcinoma
d)Pancreaticcarcinoma
CorrectAnswer-A
Ans.is'a'i.e.,Carcinomacolon

---

627.Bevacizumabis?
a)AntiVEGFantibody
b)Histonedecyclaseinhibitor
c)Proteosomeinhibitor
d)Her2neuinhibitor
CorrectAnswer-A
Ans.is'a'i.e.,AntiVEGFantibody

---

628.Whichofthefollowinganticancerdrugs
arecompetitiveinhibitorsoftyrosine
kinase?
a)Imatinibandsunitinib
b)Letrozole
c)Bicalutamide
d)Fulvestrant
CorrectAnswer-A
Ans.is'a'i.e.,Imatinibandsunitinib
Moleculartargetedagents
Tyrosinekinaseinhibitors
CompetitiveinhibitorsImatinib,Nilotinib,Sunitinib,Dasatinib,
Erlotinib,Gefitinib,Lapatinib,Sorafenib(Rememberallendwith'
nib').
MonoclonalantibodiesCetuximab,panitumumab.
HER2/neu(ERBB2)inhibitorsMonoclonalantibody-Trastuzumab.
TargetedantibodyGemtuzumab(antiCD-33),Rituximab(anti-
CD20),Alemtuzumab(antiCD-52).
Vascularendothelialgrowthfactor(VEGF)inhibitorMonoclonal
antibody-Bevacizumab.
ProteosomeinhibitorsBortezomib.
HistonedeacetylaseinhibitorVorinostat
DNA-methyltransferaseinhibitor5-azacytidine,2-deoxy-5
azacytidine.
All-trans-retinoicacid.
Biologicalresponsemodifier-RecombinantIL-2(aldesleukin,
denileukin).

---

---

629.Thalidomideisusedin?
a)Mutilplemyeloma
b)Squamouscellcarcinoma
c)Basalcellcarcinoma
d)Masopharyngealcarcinoma
CorrectAnswer-A
Ans.is'a'i.e.,Multiplemyeloma
Clinicalusesofthalidomide
AIDSrelatedaphthousulcers
AIDSrelatedwastingsyndrome
Multiplemyelomaandothersolidtumours
Preventionofgraftversushostdiseaseaftertransplantation
Rheumatoidarthritis
Ankylosingspondylitis
Crohn'sdiseaseandBechet'ssyndrome
ErythemaNodusumLeprosum

---

630.Daclizumabactsthrough?
a)cGMPactivation
b)Adenylcyclaseinhibition
c)IL2receptorblocker
d)IL10receptorblocker
CorrectAnswer-C
Ans.is'c'i.e.,IL2receptorblocker
Monoclonalantibodies(daclizumabandbasiliximab)thatblockthe
interleukin2receptorandareusedinpreventionofgraftrejectionas
immunosuppresant.

---

631.MechanismofactionofactinomycinDis
?
a)InhibitsDNAdependentRNAsynthesis
b)ActivatesDNAdependentRNAsynthesis
c)InhibitsRNAdependentDNAsynthesis
d)ActivatesRNAdependentDNAsynthesis
CorrectAnswer-A
Ans.is'a'i.e.,InhibitsDNAdependentRNAsynthesis
Theanticancerantibioticsare
Actinomycin-D(Dactinomycin)
Daunorubicin(Rubidomycin)
MitomycinC
Doxorubicin
Mitoxantrone
Mithramycin(plicamycin)
Bleomycins
Theseanticancer,antibioticsobtainedfrommicro-organismsand
haveprominentantitumouractivity.
Mechanismofaction:TheyareintercalatedbetweenDNAstrands
andinterferewithitstemplatefunction.
Actinomycin`D'inhibitsDNAdependentRNAsynthesis.
BleomycincauseDNAbreakageandfreeradicalformation.
Doxo-anddaunorubicininhibitTopoisomeraseI&II.
Mitomycinactslikealkylatingagents.
MitoxantranebindstoDNAtoproducestrandbreakageandinhibits
bothDNA&RNAsynthesis.
Remember
Allantitumorantibioticsarecellcyclenonspecificexceptfor

---

bleomycinwhichactsinG2phase.

---

632.Tocilizumabisantibodyagainst?
a)IL2
b)IL4
c)IL6
d)IL8
CorrectAnswer-C
Ans.is'c'i.e.,IL6
Tocilizumab
ItistheantibodydirectedagainstIL6receptor
Itisapprovedforusein:
i. Rheumatoidarthritis
ii. Neuromyelitisoptica
iii. Castleman'sdisease
iv. Systemicjuvenileidiopathicarthritis

---

633.Mechanismofactiontacrolimusis?
a)Inhibitionofcalcineurin
b)Antimetabolite
c)mTORinhibitor
d)InhibitionofDNAsynthesis
CorrectAnswer-A
Ans.is'a'i.e.,Inhibitionofcalcineurin
Tacrolimus
Itisamacrolideimmunosuppressantagent.
Itsmechanismofactionissimilartocyclosporine,i.e.inhibitionof
transcriptionofIL-2andT-cellproliferation,butitbindstoother
immunophilincalledFKBP(incontrasttocyclosporinewhichbinds
tocyclophilin).Subsequentstepsaresome,i.e.inhibitionof
calcineurin,whichinhibitsTcellactivation.
Tocrolimusis10-100timesmorepotentthancyclosporine.
Itisalsomoretoxicthancyclosporin.
Adverseeffectsarenephrotoxicity(mostcommon),neurotoxicity,
hyperglycemia(DM).
MechanismofnephrotoxicityPeriglomerularafferentarteriolar
vasoconstricationandreducedGFR.

---

634.Hydroxyureamechanismofactionin
cancerisbyinhibitingtheenzyme?
a)Ribonucleotidediphosphatereductase
b)Ribonucleotideoxidase
c)DNAlyase
d)DNAsynthetase
CorrectAnswer-A
Ans.is'a'i.e.,Ribonucleosidediphosphatereductase
Hydroxyurea
Itblockstheconversionofribonucleotidestodeoxyribonucleotides
byinhibitingtheenzymeribonucleosidediphosphatereductase;thus
inhibitstheDNAsynthesis;Sphasespecific.
Myelosuppressionisthemajortoxicity.GIdisturbancesand
cutaneousreactions(pigmentation)alsooccur.
ItisusedinCML,psoriasis,polycythemiaveraandsomesolid
tumors.
Itisalsousedasradiosensitizerbeforeradiotherapyandisafirst
linedrugforsicklecelldiseaseinadults.

---

635.Nitrosoureasusedinthetreatmentof
cancerare?
a)Carmustine
b)5FU
c)Methotrexate
d)Cisplatin
CorrectAnswer-A
Ans.is'a'i.e.,Carmustine
Nitrosoureas
Nitrosoureas(Lomustineandcarmustine)arehighlylipidsoluble
alkylatingagents-crossblood-brainbarrierEffectivein
meningealleukaemiasandbraintumours.
Nitrosoureasarehighlylipidsolubleandcancrossbloodbrain
barrierusedinbraintumorslikegliomas.
BecausetheycrossBBB,mostcommonadverseeffectsare
nausea,vomitingandotherCNSeffects.
Bonemarrowdepressionispeculiarlydelayed,takingnearly6
weekstodevelop.delayedneutropenia
Nitrosoureascancausevisceralfibrosisandrenaldamage.
invalidquestionid

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637.Nullityofmarriageisconsideredwhen?
a)Adulteryinfirst7years
b)Infertilityofhusband
c)Assaultinfirst7yrs
d)Age>55years
CorrectAnswer-B
Ans.is'b'i.e.,Infertilityofhusband
Undersection12ofHinduMarriageAct1955orsection24of
SpecialMarriageAct1954,awifemayseekdivorceontheground
thatherhusbandwasimpotentatthetimeofmarriageand
continuestobeimpotentthereforeheisincapableoffulfillingthe
rightsofconsummationofmarriagebyanactofsexualintercourse.
Conditionsfornullityofmarriage
Anymarriagecanbedeclarednullandvoidunderfollowing
conditions:?
1)Bigamy,i.e.onespousehasmadeonemoremarriage
2)Impotence
3)Ifeitherpartyisunderage
4)Ifonespouseishavingunsoundmindatthetimeofmarriage,
virulentformofleprosyorveneraldiseaseinacommunicableform.
5)Ifonespousehasnotbeenheardofasbeingaliveforaperiodof
7yearsorundergoingasentenceofimprisonmentfor7years.
6)Iftheconsenthasbeenobtainedbycoercionorfraud.
7)Ifthewomanalreadypregnantwithsomeoneelse'schildatthe
timeofmarriage.

---

638.WHOdefinitionofabdominalobesityis?
a)Waist-hipratio>0.80infemales
b)Waist-hipratio>0.85infemales
c)Waist-hipratio>0.90infemales
d)Waist-hipratio>0.95infemales
CorrectAnswer-B
Ans.is'b'i.e.,Waist-hipratio>0.85infemales
Assessmentofobesity
Followingparametersareusedtoassessobesity:?
1)Skinfoldthickness(SFT)
Sinceitismostaccessible,SFTisthemostcommonmethodused
toassessobesity.
Measurementsaretakenat4sites:midtriceps(bestsite),biceps,
subscapularandsuprailiacregions.
Thesumofmeasurements_50mmingirlsand240mminboys
indicateobesity.
Atsinglemidtricepslevel(bestsitetomeasureSFT),thickness18
mminboysand32mmingirlsindicateobesity.
TheinstrumentusedtoestimateSFTisHarpendenskincallipers.
2)Waistcircumference(WC)andWaist/Hipratio(WHR)
Thesearegoodpredictorsformetaboliccomplicationsandriskof
cardiovasculardisease.
Thecut-offforwaistcircumferenceis102cmsinboys(forIndia
90cms)and88cmsingirls(forIndia.80cms).WHR>1.0in
menand>0.85inwomenindicatesobesityandabdominalfat
accumulation.
3)Waist-Heightratio(WHtR)
Itisthebestindicatorofcardiovascularrisk.Itisindependentof

---

ageandsex.Cut-offvalueis0.5.
4)Indicesbasedonweightand/orheight
Theseare:?
i)Bodymassindex(Qetelet'sindex)
Itisusedinternationallyasreferencestandardforassessingthe
prevalenceofobesity.
Itisdependentbothonheightandweight(hasbeenexplained
earlier).
ii)Ponderalindex
Itisdependentbothonheightandweight.
Itisdefinedasheight(cm)dividedbycuberootofweight(kg).

---

639.Constitutionbywhichwecanforce
peopleonhungerstriketoeatis?
a)Article21
b)Article35
c)Article48
d)Article52
CorrectAnswer-A
Ans.is'a'i.e.,Article21
Indianconstitution(Article21)ensuresrighttolife;thereisno
equivalentrighttodie.SinceIndianconstitutionissupreme,force
feedinginhungerstrikersislawfulinIndia.

---

640.Howmuchispunishmentforsex
determination?
a)3years
b)5years
c)7years
d)9years
CorrectAnswer-A
Ans.is'A'i.e.,3years
Sincethequestionisaboutpunishmentforsexdeterminationnot
repeatoffenceofsexdeterminationanswerwillbe3years
Thefamiliesofapregnantwomanwhoaskforsexdeterminationare
alsoliabletobepunished.
Notadheringtotheprovisionsofthisactcouldwarrantpunishment
intheformofupto3yearsimprisonmentanduptoRs10,000fine,
andonrepeatoffenceupto5yearsimprisonmentanduptoRs
50,000fine.
Thenameoftheregisteredpractitionerwouldberemovedfromthe
statecouncilfor5yearsifguiltyandpermanentlyifrepeatoffenceis
committedundersection23oftheact.

---

641.Apersonisdeclareddeadifnotseenby
relativesforhowmanyyears?
a)3years
b)7years
c)10years
d)12years
CorrectAnswer-B
Ans.is'b'i.e.,7years
Apersonislegallydeclareddeadifnotseenfor7yearsfromthe
dateofdeclaredmissing.
TheIndianEvidenceAct,undersection108provides7yearsfrom
thedatewhenceapersonisdeclaredtobemissingandhis
whereaboutsarenotknownforpresumingapersontobedead
(Deathinabsentia).

---

642.

---

Punishmentforperjuryiscoveredunder
section-
a)191IPC
b)193IPC
c)195IPC
d)1971PC
CorrectAnswer-B
Ans.is'b'i.e.,193IPC

---

643.Grevioushurtcomesundersection:
a)319
b)320
c)324
d)326
CorrectAnswer-B
320

---

644.IPC319dealswith?
a)Definitionofhurt
b)Voluntarilycausinghurt
c)Definitionofgrievoushurt
d)Voluntarilycausinggrievoushurt
CorrectAnswer-A
Ans.is'a'i.e.,Definitionofhurt

---

645.WhichIPCincludesvitriolage?
a)318
b)319
c)320
d)321
CorrectAnswer-C
Ans.is'c'i.e.,320
Vitriolageisapotentialcauseofpermanentdisfigurementofface
andthusiscoveredundergrevioushurtandsocomesunderIPC
320.
Vitriolage'isthrowingofanycorrosiveonanotherperson.Eyesare
affectedmostcommonly.Itcomesundersector320IPS.

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646.

---

Doctorwhodidsurgeryonwrongsideofthe
pateientispunishableundersection?
a)S.304AIPC
b)S.WC
c)S.305AIPC
d)S.305IPC
CorrectAnswer-A
Ans.is'a'i.e.,S.304AIPC
Section304AIPC
Causingdeathbynegligence:Whosoevercausesthedeathofany
person,bydoinganyrashornegligentactnotamountingtoculpable
homicideshallbepunishedwithimprisonmentforatermwhichmay
extendto2yearsorwithfine,orwithboth.
Doctordoingsurgeryonthewrongsideofthepatientisanexample
ofgrossinattentionandrecklessnessshownbythedoctorandis
thusanexampleofcriminalnegligence.
CriminalnegligenceispunishableunderS.304AIPC.

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647.Incaseofdeathinlockup,theinquestis
heldby
a)Apoliceofficer
b)Magistrate
c)Panchayatofficer
d)DistrictAttorney
CorrectAnswer-B
Bi.e.Magistrate

---

648.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)

---

649.Majorityisobtainedbyapersonunder
courtguardianshipbyageof?
a)19years
b)20years
c)21years
d)22years
CorrectAnswer-C
Ans.is'c'i.e.,21years
Apersonattainsmajorityoncompletionof18years.Howeverifa
personisundertheguardianshipofcourt,heattainsmajorityafter
21years(IndianMajorityAct1875).

---

650.Accordingtojuvenilejusticeact,ageof
juvenileis?
a)<14years
c)<18years
d)<20years
CorrectAnswer-C
Ans.is'c'i.e.,<18years
JuvenileJusticeAct2000
Juvenilejustice(careandprotectionofchildrenAct,2000(now
AmendmentAct2006)covers:-
i. Juvenilesinconflictchildwhoisallegedtohavecommittedan
offence.
ii. Childreninneedofcareandprotectionchildrenwhoare
neglected,abused,orabandoned.
Thisactdefinesajuvenile/childasapersonwhohasnot
completedtheageof18years.

---

651.Whichlineofdeathcertificaterepresent
majorantecedentcauseofdeath-
a)Ia
b)Ib
c)Ic
d)II
CorrectAnswer-C
Ans.is'c'i.e.,Ic
Internationaldeathcertificate
Thebasisofmortalitydataisdeathcertificate.
Forensuringnationalandinternationalcomparability,itisnecessary
tohaveauniformandstandardizedsystemofrecordingand
classifyingdeaths.
ForthispurposeWHOhasrecommendedinternationaldeath
certificate.
Consistoffourlines:
1. LineIa:Diseaseorconditiondirectlyleadingtodeath
2. LineIb:Antecedent/underlyingcause
3. LineIc:Mainantecedent/underlyingcause
4. LineII:Othersignificantconditionscontributingtodeathbutnot
relatedtodisease/conditioncausingit
Exampleofadeathcertificate:
1. LineIa:Renalfailure
2. LineIb:Diabeticnephropathy
3. LineIc:Diabetesmellitus
4. LineII:Hypertension
Conceptofunderlyingcause,LineIcisthemostimportantlinein
deathcertificate,thusalsoknownas`EssenceofDeathCertificate'.

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652.Exceptiontotheruleofprofessional
secrecyisallowedunderfollowing
circumstancesexcept?
a)Courtoflaw
b)Casesofsuspectedcrime
c)Innegligentsuits
d)Ininterestofrelatives
CorrectAnswer-D
Ans.is'd'i.e.,Ininterestofrelatives
Professionalsecrecyisanimpliedethicalandlegalobligation(or
contract),thatthedoctorwillnotdivulgeanythinghecomestoknow
concerningpatientduringthecourseofhisprofessionalwork.Doctor
isliabletodamagesforitsbreech.
However,itisjustifiedincertaincircumstances,todisclose
informationtoproperauthority,andthisisknownasprivileged
communication.Itisdefinedasacommunicationmadebydoctorto
aproperauthoritythathascorrespondinglegal,social,andmoral
dutiestoprotectthepublic.Privilegedcommunicationismadein
certaincircumstanceswherethedoctorisjustifiedindisclosing
informationabouthispatient.Suchcommunicationisregardedas
privilegedandisanexceptiontothegeneralruleofprofessional
secrecybetweendoctorandpatient.Exampleare:?
1)Incourtoflaw:Whenaskedbyjudge.
2)Ascompulsorduty:Everydoctorhastogivedetailsofbirth,
deathandcommunicabledisease.
3)Asasocialduty:Ifhealthofapatientcancausedangerto
society,e.g.:-

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i)Railwayenginedriverbeingcolourblind.
ii)Busdriverbeingepileptic,drugaddictorhypertensive.
iii)Pilothavingrefractiveerrors.
iv)HotelwaitorsufferingfromTBorbeingtyphoidcarrier.
v)SwimmingpoolusersufferingfromSTD(e.g.syphilis)or
infectiousdisease.
vi)PersonsufferingfromSTDorHIVinfectionlikelytomarry.
vii)Casesoffoodpoisoining.
viii)Waterpollution.
4)Incasesofsuspectedcrime.
5)Inselfinterest,bothincivilandcriminalsuitsbypatient.
6)Whenaservantissentbymaster.
7)Innegligentsuitswhendoctorisemployedbyoppositepartyto
cross-examinepatientwhofiledthesuit.
8)Ininsurancereports,hecanreportanydiseasefound.Buthe
shouldnotanswerqueriesofinsurancecompanyorsolicitorwithout
thepatientconsent.
9)Intheinterestofpatient:Ifpatientisnottakingpropercare,
detailscanbecommunicatedtotherelatives.

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653.Judgecanaskclarifyingquestionswhen
?
a)Aftercrossexam
b)Beforecrossexam
c)Beforerecrossexam
d)Atanytimehewishes
CorrectAnswer-D
Ans.is'd'i.e.,Atanytimehewishes
Thejudgemayaskanyquestion,inanyform,aboutanyfact,
relevantorirrelevant,atanystageoftheexaminationtoclearup
doubts.
Recordingofevidence
Afteroathadministration,theevidenceisrecordedunder
followingsteps:-
i. Examinationinchief(directexamination):Itistheexaminationof
thewitnessbylawyerofthepartycallingthewitness.Ingovernment
prosecutions,itisdonebypublicprosecutor(PP)/district
governmentpleader(DGP).Theobjectiveistoelicitallrelevant,and
convincingfacts.Noleadingquestionsarepermitted.Leading
questionmeansthequestion,whichleadsthewitnesstodesired
answer.However,ifthewitnessisdeclaredhostile,leading
questionscanbeasked.
ii. Cross-examination:Examinationofthewitnessisconductedbythe
lawyeroftheoppositeparty.Ingovernmentprosecutionsitisdone
bydefencelawyer.Theobjectiveistoelicit,removeormodifyfacts
andtotesttheaccuracyofstatementorwitness.Leadingquestions
areallowed.
iii. Re-examination(Redirectexamination):Itisconductedlike

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examinationinchiefandsobythelawyerofsameparty.The
objectiveistoclearoutanydiscrepancies/doubt,thathavearisen
duringcross-examination.Leadingquestionsarenotallowed.The
witnessshouldnottellanynewthingatthisstage,otherwise
opposinglawyerispermittedforre-crossexamination.
iv. Courtquestions:Atanystage,duringtherecordingofevidence,the
judgemayaskquestionstoclearhisdoubts.

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654.Whichofthegustafson'sparameteris
themostaccurate?
a)Attrition
b)Periodontosis
c)Rootresorption
d)Transperencyofthetooth
CorrectAnswer-D
Ans.is'd'i.e.,Trnasperencyofthetooth
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,increasecementum,
increasethickness,depositedthroughoutlife,andformincremental
lines(devisedbyBoyde).
5. Rootresorption-becauseofcementumanddentine,absorptionof
rootstartatapexandextendupward(maybepathological).

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

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655.Whichofthefollowingteetheruptearlier
intheupperjaw?
a)Centralincisor
b)Lateralincisor
c)Canine
d)Firstmolar
CorrectAnswer-B
Ans.isb'i.e.,Lateralincisor

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656.Commonlyusedlongbonefor
identification?
a)Femur
b)Radius
c)Ulna
d)Humerus
CorrectAnswer-A
Ans.is'a'i.e.,Femur
Staturecanbecalculatedfromthelengthoflongbonesandusedfor
identification.
Femurandtibiagivemoreaccuratevaluescomparedtohumerus
andradius
Statureisdeterminedinthedismemberedbody(skeletalremains)
by:
1. Lengthfromthetipofthemiddlefingertothetipoftheopposite
middlefingerwhenarmsarefullyextended.
2. Twicethelengthofonearm+30cm(oftwoclavicles)+4cm(for
thesternum).
3. Humeruslengthis1/5thofheight.
4. Thelengthfromthevertextothesymphysispubisishalfofthetotal
length.
5. ThelengthfromthesternalnotchtoSymphysispubisx3.3.
6. Thelengthoftheforearmmeasuredfromthetipofthemiddlefinger
is=5/19oftotallength.
7. Theheightofheadmeasuredbytheverticaldistancefromthetopof
thehead(vertex)tothetipofchin=1/8ofthetotallength.
8. Thelengthofthevertebralcolumn=34/100oftotallength.Tothe
lengthoftheentireskeleton,add2.5to4cmforthethicknessofthe

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softparts.
9. Asageneralrulehumerusis20%,thetibiais22%,thefemuris27%
andthespineis35%oftheindividualheight.

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657.Accordingtofederationdentallowerleft
canineisdesignatedas?
a)32
b)33
c)42
d)43
CorrectAnswer-B
Ans.is'b'i.e.,33

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658.Mostcommonfingerprinttypeis?
a)Loops
b)Whorls
c)Composite
d)Arches
CorrectAnswer-A
Ans.is'a'i.e.,Loops
Dactylography/DermatogIvphics/Caltonsystem/Finger
prints
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,formedby
mouthsofductsofsubepidermalsweatglandpresentonridgesof

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fingers.Theseporesarepermanent,remainunchangedduringlife
andareveryusefulwhenonlyfragmentsoffingerprintsareavailable.
Eachmilimetercontains9-18pores.
CriminalsmayattempttomultilatefingerprintsbyapplyingCO2
snow,corrosiveagents,burnsorerodingagainsthardsurface.But
thesemannersdonotdestroyfingerprintspermanentlyunlesstrue
skiniscompletelydestroyed.

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659.Tattooinginolddecomposedbodycan
bevisualizedbyuseofallexcept?
a)H2O23%
b)Gammarays
c)Infraredphotography
d)Examinationwithmagnifyingglass
CorrectAnswer-B
Ans.is'b'i.e.,Gammarays
Latenttattoomarksarefadedmarksandtheycanbevisualizedby
Useofultravioletlight
Infraredphotograpy
Rubbingthepartandexaminingundermagnifyingglass
Iftattoomarksareobscuredbydecompositiontheycanbe
visualizedbytreatingwith3%H2O2.
Tattomarkscanbedevelopedbytreatingtheskinby0.5%caustic
potash.
Histopathologyoflocallymphnodesforpigment.

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660.AgeoferuptionofPermanent1stmolor
?
a)6years
b)8years
c)10years
d)12years
CorrectAnswer-A
Ans.is'a'i.e.,6years

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661.Howmanycuspsarepresentinchewing
surfaceofpremolars?
a)2
b)3
c)4
d)5
CorrectAnswer-A
Ans.is'a'i.e.,2
Premolarsorbicuspids
Theyhavetwocuspsonthechewingsurfaceofteeth.Therootis
usuallysinglebutmaybedouble.

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662.Ageunderwhichchildisconsidered
incapableofcommittinganoffenceis?
a)3years
b)7years
c)14years
d)18years
CorrectAnswer-B
Ans.is'b'i.e.,7years

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663.InIndiaexhumationisorderedby?
a)Magistrate
b)HealthSecretory
c)HealthMinister
d)AnylocalMLA
CorrectAnswer-A
Ans.is'a'i.e.,Magistrate
Exhumation
Exhumationislawfuldiggingoutofaburriedbodyfromthegravefor
thepurposeofidentificationordeterminationofcauseofdeath.
Onlyamagistrate(executivemagistrate)canorderforexhumation.
Inindia,thereisnotimelimitforexhumation,i.e.canbedoneatany
timeafterdeath.
ItisdoneundersupervisionofmedicalofficerandMagistratein
presenceofapoliceofficerwhoprovideswitnessestoidentifygrave,
coffinanddeadbody,wheneverpossible,Magistrateshouldinform
therelativesandallowthemnottoremainpresentatthetimeof
enquiry.
Thewholeprocedureshouldbeconductedandcompletedinnatural
daylight.
Therefore,itisusuallystartedearlyinmorning.

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664.

---

Preauricularsulcusisapartof?
a)Humerus
b)Femur
c)Pelvis
d)Skull
CorrectAnswer-C
Ans.is`c'i.e.,Pelvis
Preauricularsulcusisusedfordeterminationofsex.
Itismorefrequent,broadanddeepinfemalepelvis.
Thereisattachmentofanteriorsacroiliacligament.

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665.Softfriableextraduralhematomawith
honeycombappearanceseeninautopsy
incasesofdeathdueto?
a)Coagulopathy
b)Thermalinjury
c)Postmortemtrauma
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Thermalinjury
Whentheheadisexposedtointenseheat,sufficienttocause
charringoftheskull,heathematomasoccur.
Theyhavetheappearancelikeextraduralhemorrhage,butsignsof
injurybluntforcedonotaccompanyit.
Itconsistsofsoftfriableclotoflightchocklatecolourandmaybe
pink,ifbloodcontainsCO.
Theclothashoneycombedappearanceduetobubblesofsteam
producedbyheat.
Thickness-11/2to15mmandvolume120ml.
Thusthefindingsdescribedinthequestionhavetypicalappearance
secondarytoexcessheatasseeninthermalinjuriesduetoburns.

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666.Fencingattiudeofthedeadbodiesis
causedby?
a)Ciagulationofproteins
b)Emulsificationoffact
c)Exposuretoexcesscold
d)Electricshock
CorrectAnswer-A
Ans.is'a'i.e.,Coagulationofproteins
Pugilisticattitude(boxing/fencing/defenceattitude)
Itisheatstiffeningcausedbydenaturationandcoagulationof
proteins.
Itisindicativeofexposuretointenseheat.
Thereisflexionatalljointsand?clawingoffingers.
Thisphenomenonoccursbothinantemortemandpostmortem
burns.

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

---

668.Backof10-14yearsoldcontributeshow
muchpercentagetototalbodysurface
area?
a)13%
b)15%
c)16%
d)19%
CorrectAnswer-C
Ans.is'c'i.e.,16%

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669.Bonepearlappearanceisseenin?
a)Electricalburns
b)Hydrocution
c)Strangulation
d)Throttling
CorrectAnswer-A
Ans.is'a'i.e.,Electricalburns
Electricburns
Electricburnsareattimes,alsoreferredtoasjouleburns.
Technically,jouleburnisanendogenousburn,i.e.burnsproduced
duetoreleaseofheatfromthebody,onapplicationofelectric
current.Electricburnsmaybeoffollowingtypes:?
1)Contactburns:Duetocontactwithlivewire.
2)Sparkburns:Duetosparkingofcurrent,e.g.inlooseelectrical
fitting.
3)Flashburns:Causedonbeingnearthemainpowerline,without
actualcontact.Burnsresultduetoarcingofcurrentfromtheselines.
Characteristicfeaturesofelectricburnsare:?
1)Theremaybeholesinclothesorshoes.
2)Thereisawoundofentryandwoundofexitofelectriccurrent:-
i. Entrywound:Itisnon-bleeding,thick,leathery,greyishwhite,
depressed,hardandcauliflowerlike,knownascraterformation.
Highvoltagecurrentmaycauseburnsoverlargeareasofskin,i.e.
crocodileskinlesions.Theskinmaygetcolouredduetometallic
pigment:green(inbrasselectrode),black(inironelectrode),blue
(incopperelectrode)andgrey(inaluminiumelectrode).
ii. Exitwound:Itislikealacerationandisbleeding.
3)Metalsfromelectrodemaymeltandassmallballs(currentpearls)
maybecarriedtotissue.Calciumphosphateofbonesmayalsomelt

---

maybecarriedtotissue.Calciumphosphateofbonesmayalsomelt
andisradiologicallyseenasbonepearls(waxdripping).
4)MusclesshowZenker'sdegeneration.
Causesofdeath
Commonestcauseofdeathisventricularfibrillation.Othercauses
includeshock,cardiopulmonaryarrest,cerebralanoxia,paralysisof
respiratorymuscles,andmechanicalinjuriesduetofall.

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670.Filigreeburnoccurin:
FMGE09;NJI10;JIPMER11
a)Lightning
b)Electrocution
c)Vitriolage
d)Infanticide
CorrectAnswer-A
Ans.Lightning

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671.Followingisfalseregardingthebullet
entrywoundinskull?
a)Punchedinholeinoutertable
b)Innertableshowsbevellingsurface
c)Nopiecesofbonearepresentinthebullettrack
d)Woundisfunnelshapedwiththefunnelopeninginthedirection
inwhichthebulletistravelling
CorrectAnswer-C
Ans.is'c'i.e.,Nopiecesofbonearepresentinthebullettrack
Firearm/bulletwoundsintheskull
Woundofentranceshowsapunchedin(clean)holeintheouter
table.Coneshapedboneisdetachedfromtheinnertableforminga
craterthatislargerthantheholeoftheoutertableandshows
beveling(slopingsurface).
Fissuredfracturesareseenradiatingfromthedefect.
Irregularlacerationsmaybeseeninvolvingtheleptomeninges.
Piecesofbonefromthewoundofentryareoftendrivenintothe
cranialcavityandmayestablishthebullettrack.
Atthepointofexitapunchedoutopeningisproducedintheinner
tableandbeveledopeningintheoutertable.
Thewoundisfunnelshapedwiththefunnelopeninginthedirection
inwhichthebulletistravellingbothinentranceandexitwound.
Theexitwoundislargerduetodeformityandtumblingofthebullet
afterenteringtheskull.

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672.Bulletentrywound,forbulletenteringat
acuteangleisidentifiedbywhatshape
ofabrasioncollar?
a)Circular
b)Rectangular
c)Oval
d)Noneoftheabove
CorrectAnswer-C
Ans.is`c'i.e.,Oval
Ifbulletentersatacuteangletotheskinthentheabrasioncollaris
ovalandifthebulletentersatrightangletotheskintheabrasion
collariscircular.

---

673.Blackgunpowdercomposition?
a)Charcoal60%+Potassiumnitrate20%+sulphur20%
b)Charcoal25%+Potassiumnitrate70%+sulphur05%
c)Charcoal15%+Potassiumnitrate75%+sulphur10%
d)Charcoal65%+Potassiumnitrate20%+sulphur15%
CorrectAnswer-C
Ans.is'c'i.e.,Charcoal15%+Potassiumnitrate75%+sulphur
10%
Theclassicalgunpowderisknownasblackpowder,consistsof
charcol(15%),Sulphur(10%),andpotassiumnitrate(75%).
Dependingonfineness,theblackgunpowderisdesignatedasFG,
FFG,FFFG.etc.(F=fineness).Pyrodexisanothergunpowderwith
samecomponents,butwithdifferentratios.
Blackgunpowderproducessmoke,i.e.Itissmokeproducing
powder.Smokelesspowder,inadditiontoblackpowder,has
nitrocellulose(singlebase),ornitrocelluloseplusnitroglycerine
(doublebase),ornitrocelluloseplusnitroglycerineplus
nitroguanidine(triplebase).Semismokelesspowderhas80%black
powderand20%smokelesspowder(nitrocellulose).

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674.Presenceofspiralgroovesinthebarrel
ofweaponisreferredtoas?
a)Rifling
b)Incendiary
c)Cocking
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Rifling
Typeoffirearmweapons
Bore(caliber)istheinnerdiameterofbarrel.Basedoninsideof
barrel(i.e.,bore),thefirearmweaponsaredividedinto:?
1. Smoothboreweapons:Barrelorboreissmoothinside,e.g.,shot
gun,muskets,andmuzzleloaders.
2. Rifledweapons:Barrelorboreisrifledfrominside,i.e.,has
longitudinallytwisedgrooves.Exampleare:Pistals,riflesand
revolvers.
Pistalsandrevolversaresmall,soreferredtoashandguns.

---

675.Maximumsofttissuebruisinginneckis
seenin-
a)Strangulation
b)Hanging
c)Burking
d)Smothering
CorrectAnswer-A
Ans.is'a'i.e.,Strangulation
Asmanualstrangulation(throttling)isamongthemostviolentform
ofasphyxia,hyoidfractureandotherinjurytoneckstructuresis
morecommon.

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676.Hyoidbonefracturemostcommon
occursin?
a)Manualstrangulation
b)Hanging
c)Smothering
d)Traumaticasphyxia
CorrectAnswer-A
Ans.is'a'i.e.,Manualstrangulation
Asmanualstrangulation(throttling)isamongthemostviolentform
ofasphyxia,hyoidfractureandotherinjurytoneckstructuresis
morecommon.

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677.Whatisthesituationoftheknotof
ligatureincasesoftypicalhanging?
a)Infrontofchin
b)Angleofmandible
c)Occiput
d)Mastoid
CorrectAnswer-C
Ans.is'c'i.e.,Occiput
Typicalhanging:Theligaturerunsfromthemidlineabovethe
thyroidcartilage,symmetricallyupwardonbothsideofnecktothe
occipitalregion,thepointofsuspension(knotofligature)beingon
occiput(atnapeofneck).
Atypicalhanging:Anyvariationfromtypicalknotsite(i.e.otherthan
occiput/napeofneck)iscalledatypicalhanging.Mostcommonsite
ofknotisnearonesideofmastoidprocessorangleofmandible.

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678.Tortureinwhichlegsorthighsaretied
withbambooandthetorturerpresseson
thetwosidesoftheclamptocausepain
iscalled?
a)Falanga
b)Telefono
c)Mercelago
d)Chepuwa
CorrectAnswer-D
Ans.is'd'i.e.,Chepuwa
Physicaltorture
Tortureisdefinedasdeliberate,systemicorwantoninflictionof
physicalormentalsufferingbyoneormorepersonsactingaloneor
ontheordersofanyauthority,toforceapersontoyieldinformation,
tomakeaconfessionorforanyotherreason.
Torturemaybephysicalorpsychological.Importantmethodsof
physicaltortureare:?
1.Beating:Beatingmaybeoffollowingtypes?
i. Falanga(Falolka/Baatinada):Beatingofsolesoffeetwithblunt
object.
ii. Telefono:Simultaneousbeatingofbothearswithpalms.
iii. Quirofana:Beatingonabdomenwhileupperhalfofbodylying
unsupportedontable.
2.Electric:Electrictorturemaybe-
i. Piacana:Placingelectricwiresinvagina,mouth,anusorover
nipplesandtestis.
ii. Blackslave:Heatedmetalskewerinsertedintoanus.

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3.Nearsuffocation:Theseare-
i. Drysubmarine:Plasticbagcoveringheadandface.
ii. Wetsubmarine(Labaneva/Latina/Pileta):Forcedimmersionof
victim'sheadinwater,oftencontaminatedwithurineorvomitor
blood.
4.Suspension:Suspensionmaybe-
i. La-Bandera:Bywrist.
ii. Mercelago:Byankles.
5.Forcedposture:Itmaybe?
i. Planton:Prolongedstanding.
ii. Cabellete(Sawhorse):Forcedstruddlingofabar.
iii. Parrot'sperch(Jack/paudeGrava):Headdownbyahorizontalpole
placedunderknees,withthewristsboundtotheankles.
iv. Chepuwa:Tightclampingofthighsorlegswithbamboo,andthe
torturermaypresstwosidesofclampswithhislegsormaystandon
twosidesofclamps(practicedonBhutaneserefugeesinNepal).

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679.Mostcommonorganaffectedin
underwaterblast?
a)Intestine
b)Liver
c)Spleen
d)Heart
CorrectAnswer-A
Ans.is'a'i.e.,Intestine
Themostcommonorganaffectedinunderwaterblastinjuryis
intestine.
Explosioninjury
Anexplosionisaphenomenonresultingfromsuddenreleaseof
energywhichisthendissipatedbyablastwave,bytranslocationof
objects,orbythegenerationofheat.Injuriesinexplosionoccurdue
tofourfactors:?
1)Blastorshockwave
Whenanexplosionoccurs,theexplosivematerialproducesalarge
volumeofgasandreleasesalargeamountofenergy.Itproducesa
'shockwave'whichspreadconcentricallyfromthesiteofexplosion.
Theinjuriesdependontheenviornmentinwhichblastoccurs:-
i. Airblast(mostcommon):Explosionoccursinair.Thereis
barotraumatoairfilledholloworgans.Tympanicmembrane(ear
drum)ismostsensitiveandmostcommonlyinjured.Lungisthe
secondorgantobeinjuredandisthemostcommonlyinjuredhollow
organandmostcommoncauseoflifethreateninginjury.Otherparts
injuredaremiddleear,cochlea,eyes,bowels,mesentery,omentum
andbrain.Homogenoussolidorganslikeliverandmusclesare
usuallynotaffected.

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ii. Underwaterblast(explosionunderwater):Gastrointestinaltractis
injuredmostcommonly.Lungsarealsoinjured.
iii. Solidblast:Explosiveisdetonatedneararigid/solidstructureand
waveofenergyspreadsthroughit.Ifpeopleareincontactwiththat
rigidstructure,injuriestakeplace.Theinjuriesaremostlyskeletal;
fractureoflegsandvertebralcolumnaremorecommon.GIT
damageismorecommonthanlung.
2)Flameorhotgases
Burnsorburningofbodymayoccur.
3)Flyingmissiles(debris)
Flyingpiecesofexplosivedebrismaybedriventhroughairagainst
theskincausingbruises,abrasions,lacerations,andragged
perforations.
4)Anoxia
Variousgasesliberatedduringexplosionmaycauseanoxia,e.g.
carbonmonoxide,nitrousoxide,nitricoxide,HCNandSO,.

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680.Bulletwhichisleftinsidethebodyfor
longisreferredtoas?
a)Souvenirbullet
b)Tracerbullet
c)Tumblingbullet
d)Tandembullet
CorrectAnswer-A
Ans.is'a'i.e.,Souvenirbullet
Projectileisanobjectpropelledbyforceofrapidlyburninggases.In
shotguntheseareleadshotsandpellets(recentlysteelisalsoused
insteadoflead)andinrifledweapons(pistal,rifle,revolver),these
arebullets.
Tipofthebulletisknwonasnose.Varietiesofbulletsare:-
i. Incendiary(igniting)bullet:Thetipofbulletcontainsselfigniting
materiale.g.bariumnitrateandpowderedaluminiumand
magnesium(inthepast,phosphoruswasused),sothatitcatches
fireonhittingthetarget.Itisusedtocausefireinusually
inflammabletargetslikefueltanks(ofaircraftsetc).
ii. Explosivebullet:Thetipcontainsadetonatororleadazide,sothat
thebulletexplodesonhittingthetarget.
iii. Dum-dumbullet(expandingbullet):Itisajacketedbulletwithisnose
tipchiseledorcutoff.Itisdesignedtoincreaseindiameterand
expanduponstrikingthetarget,thusproducinglargerdiameter
woundsoflimitedpenetration.
iv. Tandembullet(Piggeytailbullet):Itiscalledone-behind-otherbullet
becausetwobulletsareejectedoneaftertheother,whenfirstbullet
failedtoleavetheburrelandisejectedbysubsequentlyfiredbullet.
Therefore,bothenterbodythroughsameenterancewound(some

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times,theymayenterthroughdifferententries),butthewoundsof
exitarealwaystwo.
v. Tandem(Duplex)cartridgeisoneinwhichtwobulletsarepresentin
samecartridge.Itisusedinmilitaryrifles.
vi. Tracerbullet:Itleavesatraceinatmospherealongthepathsothat
aperson(gunner)canobservethestrike.Burningofbariumnitrate
producesflameandpowderedmagnesiumalongwithstrontium
nitrateareaddedtogiveredcolortotheflame.
vii. Tumblingbullet:Onethatrotatesinendonendduringitsmotion.
viii. Yawningbullet:Onewhichtravelsinanirregularfashionand
causesakeyholeenterywound.Yawmeansdeviationbetween
longaxisofbulletandtheaxisofpathofbullet.
ix. Souvenirbullet:Abulletleftinbodyforlongtimeandissurrounded
byfibroustissue.
x. Frangilebullet:Designedtofragmentuponimpact.
xi. Mushroomingofbullet:Asoftnosebullet,anhittingthetargetmay
getdeformedtoassumetheshapeofamushroom.

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681.Featurewhichdifferentiatestruefrom
artificialbruiseis?
a)Roundshapewithirregularmargins
b)Irregularshapewithregularmargins
c)Swellingofsurroundingarea
d)Erythemaofsurroundingarea
CorrectAnswer-A
Ans.is'a'i.e.,Roundshapewithirregularmargins
Such"injury"isanartificial/falsebruisethatmaybeproducedby
applyingthejuicesofvariousirritantvegetablepoisons.
Otheragentsthatcanproduceartificialbruisemayincludemadar
juiceorPlumbagoroot.Thejuice,likevitriol,hasbeenthrownonthe
facewithevilintention.Homicidalpoisoningbyinternal
administrationofthejuiceisveryrare.

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682.Incisedwoundwhichisnotafeature?
a)Lengthisthegreatestdimention
b)Widthismorethanthethicknessoftheblade
c)Marginsareinverted
d)Hesitationcutsareseeninsuicidalattempt
CorrectAnswer-C
Ans.is'c'i.e.,Marginsareinverted
Marginsareeverted,clear,andcleancut.

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683.Incisedlookinglacerationisseenat?
a)Forehead
b)Hand
c)Thorax
d)Abdomen
CorrectAnswer-A
Ans.is'a'i.e.,Forehead
LACERATIONS(TearorRupture)
Lacerationsaretearsorsplitsofskin,mucousmembraneand
underlyingtissue(e.g.,muscleorinternalorgans).Lacerationsare
producedbyapplicationofbluntforcetobroadareaofthebody,
whichcrushorstretchtissuesbeyondthelimitsoftheirelasticity.
Localizedportionsoftissuearedisplacedbytheimpactoftheblunt
force,whichsetsuptractionforcesandcausestearingoftissues.
Featuresoflacerationsare:?
i)Hairandhairbulb,nervesandbloodvesselsarecrushedThere
maybeparalysis(nervecrushed)andhemorrhageisnot
pronounced(bloodvesselscrushed).
ii)Siteofinjuryisthesiteofimpact.
iii)Shapeofinjuryisirregular,marginsareirregularand
contused/abradedandshowtagsoftissue.
iv)Sizeofinjurydoesnotcorrespondstoimpactingsurface.
Therearefollowingtypesoflaceration:?
1)Splitlaceration:Splittingoccursbycrushingofskinbetween
twohardobjects.Bluntforceonareaswheretheskinisclosetorigid
structureslikebonewithscantysubcutaneoustissue,mayproduce
awoundthatbylinearsplittingoftissuemaylooklikeincisedwound,
i.e.,incisedlikeorincisedlookingwound.Examplesofsucharea

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arescalp,eyebrows,cheekbones(zygomatic),lowerjaw,iliac
crest,perineumandskin.Awoundproducedbyafallonkneeor
elbowwithlimbflexedandbyasharpstonealsosimulatesincised
wound.
2)Strechlacerations:Overstretchingoftheskin,ifitisfixed,will
causelaceration,forexample,bykicking,suddendeformityofbone
occursafterfracture,makingitcompound.
3)Avulsion(shearinglaceration):Anavulsionisalaceration
producedbysufficientforce(shearingforce)deliveredatanacute
angletodetach(tearoff)aportionofatraumatizedsurfaceorviscus
fromitsattachment,theshearingandgrindingforcebyaweight.
Flayingistypeofavulsioninwhichshearingandgrindingforceby
weight(suchasoflorrywheelpassingoveralimb)mayproduce
avulsion(separationofskinfromunderlyingtissue/deglovingofa
largearea).
4)ears:Tearsoftheskinandtissuescanoccurfromimactbya
againstirregularorsemi-sharpobjects,suchasdoorhandleofa
car.Thisisanotherformofoverstretching.
5)Cutlaceration:Cutlacerationsmaybeproducedbyaheavy
sharpedgedinstrument.

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684.Countercoupinjuryseeninwhen?
a)Movingheadissuddenlydecelerated
b)Stationeryheadissuddenlyaccelerated
c)Fallofheavyobjectonhead
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Movingheadissuddenlydecelerated
Countrecoupinjuryiscausedwhenmovingheadissuddenly
deceleratedbyhittingafirmsurface.
Itcaneitherbeasubduralorsubarachnoidhemorrhage.
Braininjuries
Coupinjuryisdefinedastheinjuryofskulland/orbrainatthesiteof
impact,e.g.ablowonforehead,resultinginfractureoffrontalbone
andinjuryorhaemorrhageinfrontallobe.
Contrecoupinjuryisdefinedasaninjurytotheskullorbrain,on
opposite(contralateral)sideoftheareaofimpact.
Cerebralconcussion(stunning)occursduetoheadtraumaandis
characterizedbygrossphysiologicaldisturbanceofbrainwithout
anyanatomicaldamage.Thereissuddenlossofconsciousnesswith
atendencytospontaneousrecovery.Theconditionismoresevere
whendamageiscausedtothemovinghead(deccelerationinjury)
thanwhenitresultsfromblowstoskull.Recoveryfromconcussion
isoftenfollowedbyretrogradeamnesia.

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685.Puppe'sruledealswith?
a)Chemicalinjuries
b)Multipleimpactinjuries
c)Sexualassault
d)Percentageofburns
CorrectAnswer-B
Ans.is`b'i.e.,Multipleimpactinjuries

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686.Lucidintervalmaybeseenin?
a)Intracerebralhemorrhage
b)Alcoholintake
c)Insanity
d)Subduralhemorrhage
CorrectAnswer-C
Ans.is`e'i.e.,Insanity
Lucidintervalisseenininsanityandepiduralhaemorrhage.
Lucidintervalisastateofconsciousnessbetweentwoepisodesof
unconsciousnessinsubacute/chronicepiduralhaemorrhage.Itis
significantthatduringthisperiod(lucidinterval),thepersoncan:
(i)Makeavalidwill,(ii)Cangivevalidevidence,and(iii)Islegally
responsibleforactdone(civil/criminal).
Lucidintervalisalsoseenininsanity,i.e.theperiodofsanity
betweentwophasesofinsanity.

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687.Frigidityis?
a)Inabilitytoinitiatesexualarousalinmales
b)Inabilitytoinitiatesexualarousalinfemales
c)Inabilitytoinitiateandmaintainsexualarousalinmales
d)Inabilitytoinitiateandmaintainsexualarousalinfemales.
CorrectAnswer-D
Ans.is'd'i.e.,Inabilitytoinitiateandmaintainsexualarousalin
females
Frigidity:Inabilitytoinitiateandmaintainsexualarousalinfemales.

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688."Last"toputrefyinmaleis:
a)Uterus
b)Prostate
c)Testes
d)Liver
CorrectAnswer-B
Prostate

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689.Analcoituswithoppositesexis-
a)Bestiality
b)Sodomy
c)SinofGomorrah
d)Fellatio
CorrectAnswer-B
Ans.is'b'i.e.,Sodomy
Analintercoursebetweentwomalesorbetweenamaleandfemale
iscalledsodomy.Itiscalledsodomyasitusedtobepracticedina
towncalledsodomy.

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690.Impotenceisnotafeatureof-
a)Doublepenis
b)Bilateralcastration
c)Hypospadias
d)Penileamputation
CorrectAnswer-C
Ans.is'c'i.e.,Hypospadias
"Congenitalproblemssuchashypospadiasarenotusually
associatedwitherectiledysfunction"--MichaelCFoster

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691.Whichofthefollowingisnotasexual
offenceinIndia-
a)Incest
b)Sodomy
c)Indecentassault
d)Bestiality
CorrectAnswer-A
Ans.is'a'i.e.,Incest
Incest
Itmeanssexualintercoursebyamanwithawomanwhoisclosely
relatedtohimbyblood(prohibiteddegreesofrelationship),e.g.a
daughter,granddaughter,sister,stepsister,aunt,ormother.
Thesecasesusuallyhavepsychologicalfeatures.
InIndia,incestassuchisnotanoffence.

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692.Takingoffonesclothesandrunning
nakedinapublicraceiscalled?
a)Mooning
b)Exhibitionism
c)Voyeurism
d)Undinism
CorrectAnswer-B
Ans.is'b'i.e.,Exhibitionism
Exhibitionism(Sec294IPC):Itisawillfulandintentionalexposure
ofthegenitaliainapublicplacewhileinthepresenceofothersto
obtainsexualpleasure.Mayormaynotbeassociatedwith
masturbation(punishment=3months+fine).
Voyeurism=Scoptophilia=Peepingtom:Sexualgratificationis
obtainedbylookingatthesexualorgansofotherpersons,watching
theactofsexualintercourse,orwitnessingundressingbyawoman.
Frotteurism:Sexualsatisfactionisobtainedbyrubbingagainst
personsinacrowd.Iftheyattemptintercourse,theyhavepremature
ejaculationortheyareimpotent.Itisanuncommonperversionand
rarelyoccursalone.
Undinism:Inthis,sexualpleasureisoftenobtainedbywitnessing
theactofurinationbysomeoneofthesameoroppositesex.

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693.Evidencenotusedinrape?
a)Semeninvagina
b)Semenonclothes
c)Presenceofsmegabacilliinvagina
d)Presenceofsmegmaunderprepuce
CorrectAnswer-D
Ans.is'd'i.e.,Presenceofsmegmaunderprepuce
Examinationinacaseofrape
A.Examinationofvictim
Victimcannotbeexaminedwithoutwritteninformedconsent.
Informedwrittenconsentshouldbeobtainediftheageofvictimis
above12years.Ifsheislessthan12yearsofageorifsheis
mentallyunsound,thewrittenconsentofparent/guardianshouldbe
taken(Sec.90IPC).Victim(female)shouldbeexaminedbyor
undersupervisionofafemaleRMP(Sec.53(2)CrPC).
Findingwhicharesuggestiveofrapeare:-
1. Signsofstruggleonclothes(tear,blood,semen,mudetc),bodyand
genitals(abrasion,contusion,bitesornailmarksetc).
2. Presenceofthesemeninthevagina(proofofsexualintercourse).
3. Presenceofspermatozoainthevagina.
4. Locardsprincipalofexchangestatesthatwhenevertwobodies
comeincontactwitheachother,thereisexchangeofmaterial
betweenthetwoandsoacriminalcanbelinkedtocrime.Incaseof
rape,pieceofcloth,button,hair,blood,saliva,semenorsmegma
fromtheaccusedmaybefoundonthebodyofvictimandconversly
materialsofvictimmaybefoundonthebodyofaccused.
5. Presenceofsmegmabacilliinvaginaissuggestiveofcoitus.
B.Examinationofaccused

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1. Anaccusedcanbeexaminedevenwithouthisconsent(Sec53(A)
CrPC).FindingsmaybePresenceoftornfrenulumisconsistentwith
arecentintercourse.
2. Thepresenceofsmegmaunderprepuceisinconsistentwithrecent
intercouresasitgetsrubbedoffduringsexualintercourseandmay
bedepositedinvagina.Ittakesabout24hourstoaccumulate.Thus,
absenceofsmegmamayindicatesexualintercourse,providedno
bathistaken.
3. Presenceofvaginalepithelialcellsonpeniscanbedetectedby
lugol'siodine.

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694.Immersionsyndromeoccursdueto?
a)Vagalinhibition
b)VagalStimulation
c)Sympatheticstimulation
d)Sympatheticinhibition
CorrectAnswer-A
Ans.is'a'i.e.,Vagalinhibition
Typesofdrowning
Drowningisclassifiedas(1)typicaland(2)atypical.
1.Typicaldrowning(wetdrowning)
Typicaldrowningreferstoobstructionofairpassagesandlungsby
inhalationofwaterorotherfluid.Thereforeitisalsocalledwet
drowningandfindingsoffluidandfrotharepresentinPM
examination.Typicaldrowningmaybe:-
i. Freshwaterdrowning:Infreshwaterdrowninglargequantitiesof
watercrossthealveolarmembraneintocirculationcausing
hypervolaemiaandhemodilution.RBCsimbibewaterandburst
(hemolysis)withliberationofpotossium.Therefore,heartisexposed
tovolumeoverload,potassiumexcess,sodiumdeficit
(hyponatremia),andanoxia.Anoxiaandhyperkalemiacause
ventricularfibrillationanddeathin4-5minutes.
ii. Saltwaterdrowning:Hypertonicityofinhaledwatercauseslossof
fluidfromcirculationintothelungsgivingrisefulminatingpulmonary
edemawithprogressivehypovolaemia,circulataryshock,and
eventuallycardiacstandstill(asystole)withdeathin8-12minutes.
2.Atypicaldrowning
Itreferstodrowninginwhichevenaftersubmersionofbodyin
water,littleornowaterantersrespiratorypassagesandlungs.

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Hencetypicalfindingsofwetdrowningintheformoffrothand
oedemaaquosumoflungsarenotfound.Atypicaldrowningmaybe
:-
i. Drydrowning:Oncontactwithwater,especiallycoldwater,there
resultsintenselaryngospasm,sothatwaterdoesnotenterthe
lungs.Deathisduetoasphyxiabecauseoflaryngospasm.
ii. Immersionsyndrome(hydrocution/submersioninhibition/vagal
inhibition):Suddendeathoccursduetovagalinhibitionasaresult
of(a)suddenimpactwithcoldwater,(b)duckdiving(fallinginwater
withfeetfirst),and(c)horizontalentryinwaterwithimpacton
epigastrium.
iii. Submersionofunconscious:Ifpersonisunconscioussincebefore
submersioninwater,littleornowaterentersrespiratorypassages.It
mayoccurinMI,cerebrovascularaccident,hypertension,epilepsy,
cerebralaneurysmandindrunkstate.
iv. Neardrowning(secondarydrowningsyndrome/postimmersion
syndrome):Inthisdrowningissurvivedanddeathoccursatalater
stageafterremovalfromwater.Eitherthepersonhimselfcomesout
ofwaterorheisrecoveredalive,butduetocomplicationsof
submersion,hediesatalaterstage.Itisduetohypoxic
encephalopathyandfibrosingalveolitis.Thedeathoccursdueto
combinedeffectofcerebralhypoxia,pulmonaryedema,aspiration
pneumonitis,electrolytedisturbancesandmetabolicacidosis.

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695.Whatofthefollowingisseeninfresh
waterdrowning?
a)Hypovolemia
b)Hemoconcentration
c)Hyperkalemia
d)Hypernatremia
CorrectAnswer-C
Ans.is'c'i.e.Hyperkalemia

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696.Legalagebywhichfetusiscapableof
independentexistenceis?
a)240days
b)230days
c)220days
d)210days
CorrectAnswer-D
Ans.is'd'i.e.,210days
Viabilitymeansthephysicalabilityofafoetustoleadaseparate
existenceafterbirthapartfromitsmother,byvirtueofacertain
degreeofdevelopment.Achildisviableafter210days(7months)
ofintrauterinelife,andinsomecasesafter180days(6months)but
inmostofthesecasesfetusisimmature.
Fulltermmatureinfantshow:-
Length(crown-heellength)48-52cm,headcircumference30-35cm.
Ossificationcenteratlowerendoffemur(appearsattheendof9
monthsorjustbeforebirth)andOssificationcenterofcuboidand
uppertibiamayalsopresent(Note:someossificationcentersare
alsopresent,buttheyappearbeforetheattainmentofviabilityso
theirpresencedoesnothaveimportance.Theseare(i)Clavicle,
mandible,ribsvertebraattheendof2ndmonth,(ii)Calcaneum(os
calcis)andmanubriumsterniattheendof5thmonthand(iii)
Sternumattheendof6month).Othercenterwhichappearsat
attainmentofviabilityisprimaryossificaioncenteroftaluswhich
appearsattheendof7thmonth.

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697.RuleofHaaseisusedtocalculate?
a)Ageoffetus
b)Lengthoffemur
c)Diameterofskull
d)Percentageofburns
CorrectAnswer-A
Ans.is'a'i.e.,Ageoffetus
RuleofHaase
Hess'srule(Haase'srule):Itisaroughmethodforcalculatingthe
ageoffetusbymeasuringthelengthfromcrowntoheel.
Upto5thmonthofgestation,lengthoffoetusincmissquareofthe
monthofgestationandbeyound5months,lengthincmis5times
themonthofgestation.

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698.Whatistheproofofeyesbeingopenfor
fewhoursafterdeath?
a)Kevokiansign
b)Tachenoir
c)Bothoftheabove
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Tachenoir
Iftheeyelidsareopenforafewhoursafterdeath,afilmofcell
debrisandmucousformstwoyellowtrianglesonthescleraoneither
sideoftheiris,whichbecomebrownandthenblackcalledtache
noirwithing3-4hours.

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

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700.Spaldingsignisseenin?
a)Drowning
b)Mummification
c)Maceration
d)Starvation
CorrectAnswer-C
Ans.is'c'i.e.,Maceration
Deadborn:Adeadbornchildisonewhichhasdiedinuteroand
showsoneofthefollowingsignsafteritiscompletelyborn:?
1)Rigormortis:Rigormortismayoccurindeadfetusbeforebirthor
atbirth.
2)Maceration:Macerationisaprocessofasepticautolysis.It
occurswhenadeadfetusremainsintheuterusfor3-4days
surroundedbyliquoramniibutwithexclusionofair.Skinslippageis
theearliestsign(occurswithin12hours).Thereisgasinthegreat
vesselsandchambersofheart(Robert'ssign).Exceptforlungand
uterus,whichremainunchangedforalongtime,allotherorgans
becomesoft,oedematousandloosetheremorphology.Theone
importantradiologicalsignsuggestiveofmacerationis'Spaulding's
sign'i.e.skullbonesoverrideeachother.Thesmellissomewhat
rancid.
3)Putrefaction(decomposition):Ifthemembranesareruptured
afterdeathoffetusandairgainsentryintoliquoramnii,fetus
undergoesputrefactioninsteadofmaceration.Bodyisgreenish,foul
smellingandbloated.
4)Mummification:Itresultswhenthereisdeficientbloodsupply,
scantyliquorandnoairentersuterus.Bodyisthin,shrivelleddark
brownandemittingsmelllikerottencheese.

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---

701.Rigormortisinfetusatbirthcanbeseen
in?
a)Deadborn
b)Stillborn
c)Superfoetation
d)Superfecundation
CorrectAnswer-A
Ans.is'a'i.e.,Deadborn
Signsofdeadborn(intrauterinedeath:IUD)are(i)Rigormortisat
birth,(ii)Maceration,(iii)Putrefaction,and(iv)Mummification.

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702.Followingisnottrueaboutadipocere
formation?
a)Itisamodificationofputrefaction
b)Itisdevelopedinpresenceofair
c)Itoccursindeadbodieslyinginwater
d)Bodyhasanoffensivesweetsmell
CorrectAnswer-B
Ans.is'b'i.e.,Itisdevelopedinpresenceofair
Adipocereformation(saponification).
Adipocereisamodificationofputrefaction,whichoccursinthe
absenceofair.Thatiswhenthereisexcessivemoisture(humidity)
andwarnth(warmtemperature),butabsenceofairi.e.warmhumid
climate,normalputrefactiondoesnotoccur,rathersaponification
occurs.
Thusadipoceseformationoccursindeadbodieswhicharelyingin
water(immeredinwater)orburnedindamplaysoil.
Saponification(adipocerformation)istheconversionofdeadbody
intosoft,fattywaxysubstanceduetoconversionofunsaturated
liquidfatstosaturatedsolidfatsundertheinfluenceofintrinsic
lipaseandlecithinaseproducedbyCl.perfringens.Theprocess
involvesgradualhydrolysisandhydrogenationofbodyfatsinto
higherfattyacidswhichcombinewithcalciumandammoniumions
toforminsolublesoaps.Ultimately,palmitic,oleic,stearicand
hydroxystearicacidsareformed,mixtureoftheseisknownas
adipocere.
Adipocereformationstartsinsubcutaneousfatandismarkedin
areashavingexcessivefat,eg.cheeks,femalebreast,buttocksand
abdomen.Slowlythewholebodyincludingmusclesandinternal

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viscerachangeintoadipocere.Adipocerehasoffensiveorsweetish
smell,howeverinearlystages,smellisammonical.
Bodyisconvertedintosoft,waxyandbrittlesubstance,itfloatson
water,itcanbecuteasily,itdissolvesinalcoholandethers,andit
meltsonheating.Facialfeaturesandinjuriesonbodyarewell
preserved,thusidentficationofbodyanddeterminationcauseof
death(incaseofinjury)arepossible.
Normallyadipocereformationrequires3weekstoupto3to6
months.Howevershortestrecordedperiodinindiais3days22
hours.Inindia,ithasbeenobservedtobeginwithin4-5days.
Adipoceremaypersistforyearsordecades.Adipoceredoesnot
occurinfoetuslessthan7month's.
Medicolegalimportance:(i)Identificationofbody(facialfeaturesare
preserved),(ii)causeofdeath(injurymarksarepreserved),(iii)time
sincedeathcanbeestimated.

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703.Mummificationisenhancedby?
a)Moistandhotair
b)Moistandcoolair
c)Dryandhotair
d)Dryandcoolair
CorrectAnswer-C
Ans.is'c'i.e.,Dryandhotair
Mummification
Itisamodificationofputrefaction,whichoccursintheabsenceof
moisture.Thatiswhenthereisexcessairandwarmthbutno
moisture(humidity),i.e.hotdryandwindyclimate,mummification
takesplaceinplaceofnormalputrefaction.Thusmummification
occursindeserts,especiallyinsummerandalsoinbodiesburiedin
shallowgraveinsandysoil.
Mummificationischaracterizedbydessicationordryingofthedead
body.Thereisdrying,dehydrationandshrivelingofdeadbody.It
proceedsfromexteriortointerior.Thereforefirsttobeinvolvedis
skin,especiallyofexposedbodypartslikelips,nosetip,hands
(fingers)andfeet(toes).Theskinisshrunken,contracted,dry,
brittle,leathery,strechedacrossbonyprominencesandrustybrown
toblackincolor.Internalvisceraalsodryup,darkenincolorand
blendwitheachothertoformasinglemass.Bodyemitssmelllike
rottencheese.Facialfeaturesandinjuriesarewellpreserved,thus
identificationofbodyandcauseofdeathcanbedetermined(like
adipocereformation).
Timerequiredformummificationvariesbetween3months-2years.
Ifproperlypreserved,amummifiedbodycanremainforyears.
Chronicarsenicorantimonypoisoningfavormummification.

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Medicolegalimportance:(i)Identificationofbody(facialfeaturesare
preserved),(ii)causeofdeath(injurymarksarepreserved),(iii)time
sincedeathcanbeestimated.

---

704.Suspendedanimationisseenin
followingexcept?
a)Sunstroke
b)Cerebralconcussion
c)Cholera
d)Deleriumtremens
CorrectAnswer-D
Ans.is'd'i.e.,Deliriumtremens
Suspendedanimationmaybeseeninelectrocution,drowning,
cholera,afteranesthesia,shock,sunstroke,cerebralconcussion,
narcoticpoisoning,newborninfantsandyogis/voluntary.

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705.Whengroupofmusclesofdeadbody
wereinstateofstrongcontration
immediatelypriortodeathandremainso
evenafterdeath,thisistermedas?
a)Gasstiffening
b)Rigormortis
c)Cadavericspasm
d)Coldstiffening
CorrectAnswer-C
Ans.is'c'i.e.,Cadavericspasm
Cadavericspasm(instantaneousrigor)isdefinedasthecondition
whereinagroupofmuscles,whichwereincontractionorspasmat
thetimeofdeath,continuetobeinspasmevenafterdeath,without
thestageofprimaryrelaxation.
Itisaconditioninwhichthemusclesofthebodywhichwereina
stateofcontractionimmediatelybeforedeath,continuetobesoafter
deathwithoutpassingthroughthestageofprimaryrelaxation.
Cadavericspasm,beinganantemortemphenomenon,reflectsthe
lastactofthesubjectperformedbeforeandatthetimeofhisdeath.
Thecauseandmannerofdeathmaybejudged.
ItmaybeduetoexhaustedATPintheaffectedmuscleswiththe
persistenceofcontractionevenafterdeathandtheresultingfailure
ofthechemicalprocessesrequiredforactivemuscularrelaxationto
occurduringmoleculardeath.Adrenocorticalexhaustion,which
impairsresynthesisofATPmaybethepossiblecause

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706.Atriamortisothernamefor?
a)Gatewaysofdeath
b)Gatewaysoflife
c)Gatewaysofair
d)Gatewaysofwater
CorrectAnswer-A
Ans.is'a'i.e.,Gatewaysofdeath

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707.Postmortembloodiscollectedfrom
whichvessel?
a)Femoralartery
b)Femoralvein
c)Cephalicvein
d)Brachialartery
CorrectAnswer-B
Ans.is'b'i.e.,Femoralvein
Beforeautopsy10-20mlofbloodiscollectedfromthefemoralvein
ingroin.Jugular/subclavianveincanalsobeused.

---

708.Barberio'stestuseswhichofthe
following?
a)Picricacid
b)Aceticacid
c)Hydrochloricacid
d)Sulfuricacid
CorrectAnswer-A
Ans.is'a'i.e.,Picricacid

---

709.Whichoffollowingtestsinusedto
detectsemen?
a)Phenolphthaleintest
b)Reine'stest
c)Barberio'stest
d)Paraffintest
CorrectAnswer-C
Ci.e.Barberio'stest:
Barberio'stestisusedforidentificationofseminalstains
Fewdropsofbarberio'sreagent(containingpiericacid)areaddedto
theseminalstain.
PositivetestisindicatedbyformationofYellowandneedleshaped
crystalsofsperminepicrate.
(Spermineinseminalstainreactswithpicricacidtoformthese
crystals)
Phenolphthaleintest(Kastle-Meyertest)isusedforidentificationof
haemoglobininbloodstains-Parikh6th/7.16
Paraffintest(orDermalnitratetest)isusedtodetectgunpowderon
skini.e.todetermineifsuspecthaddischargedafirearm-Parikh
6"/7.39
Reine'stesthasnotbeenmentionedinforensicliterature
Forensicteststodetect
Seminal
BloodStains
Stain
-Barberio's
-BenzidinetestQ
testO
-Fluorence
-Phenophthalein
testQ
(Kastle?

---

testQ
(Kastle?
-Acid
Meyer)testQ
phosphatase
testQ
-Takayama's
-Creatine
Haemochromogen
phosphatase crystal
test
testQ
-Elisatest
-Teichmann's
Haemincrystal
testQ
-Spectroscopic
test

---

710.Sodiumflouridemaybeusefor
preservationof
a)Cyanide
b)Arsenic
c)Alcohol
d)Urine
CorrectAnswer-C
Ans.is'c'i.e.,Alcohol[RefParikh6th/ep.2.62;Essentialsof
forensicmedicine&toxicology23rd/ep.101]
Sodiumflurideshouldbeaddedtourineorvitreoushumor,ifalcohol
estimationisrequired;andalsotosamplesforanalysisforcocaine,
cyanidesandCO.

---

711.Alkalinediuresisistreatmentofchoice
inpoisoningwith?
a)Benzodiazepine
b)Barbiturates
c)Dhatura
d)Morphine
CorrectAnswer-B
Ans.is'b'i.e.,Barbituratepoisoning
Eliminationofpoisonfromcirculationcanbebyfollowingmethods:?
A)ForceddiuresiswithorwithoutalterationofurinarypH
DiuresisandiontrappingviaalterationofurinarypHmayprevent
therenalreabsorptionofpoisonsthatundergoexcretionby
glomerularfilterationandactivetubularsecretion.Forceddiuresis
maybeoffollowingtypes:?
1)Alkalinediuresis:Poisonswhicharetrappedandexcretedin
alkalineurinearebarbiturates(phenobarbitone),chlorpropamide,
diffunisol,sulfonamidesandsalicylates.
2)Aciddiuresis:Itisdoneforamphetamines,cocaine,strychnine,
phencyclidine,quinidine,quinine,chloroquine,TCAandtocainide.
3)Salinediuresis:Itisusefulforalcohol,thallium,bromide,lithium,
fluoride,chromium,potassiumandisoniazide.
B)Extracorporalremovaltherapies
Theseareperitonealdialysis,hemodialysis,hemoperfusion(resinor
charcol),hemofiltration,plasmapheresisandexchangetransfusion.
Commonlyusedproceduresare:?
1)Haemodialysis:Itisusefulinpoisoningwithalcohol(ethanoland
methanol),aspirin(salicylates),acetone,atenolol,acetaminophen,
barbiturates(phenobarbitone),bromide,boricacid,chloralhydrate,
ethyleneglycol,fluoride,lithium,trivalentarsenic,procainamide,

---

ethyleneglycol,fluoride,lithium,trivalentarsenic,procainamide,
theophylline,thiocyanate,sodiumchlorateandsotalol.Hemodialysis
isnotusefulincoppersulphate,benzodiazepines,
organophosphates,kerosineanddigitalispoisonings.
Inallpoisonings,wherehemodialysisisindicatedperitonealdialysis
isalsousedwithonemoreindicationofmercurypoisoning.
2)Hemoperfusion(chorcolorresin):Itisusedinacetaminophen,
barbituratescarbamazepine,chloralhydrate,caffeine,CC14,
chloramphenical,phenytoin,procainamide,salicylates,theophylline,
valproate,dapsoneandmethotrexate.

---

712.AmylNitrateisusedasanantidote
in...poisoning:
a)CO2
b)CO
c)Cyanide
d)Nitricacid
CorrectAnswer-C
Ci.e.Cyanide

---

713.Phossyjawiscausedby?
a)Whitephosphorus
b)RedPhosphorus
c)Arsenic
d)Antimony
CorrectAnswer-A
Ans.is'a'i.e.,WhitePhosphorus
Phossyjawiscausedbyphosphoruspoisoning.Allphosphorus
poisoningarecausedbywhite(yellow)phosphorus(Red
phosphorusisnontoxic).
Phosphoruspoisoning
Phosphorusisaprotoplasmicpoisonaffectingcellularoxidationand
causinganoxicnecorbiosis,classicallyaffectingliver.Itincreasesfat
depositionandinhibitsglycogendepositioninliver.Itisusedinfire
works(Diwalipoisoning)andasratpoison.Lethaldoseis60-120
mg.
Phosphorusoccursintwoforms:?
1)White/yellowphosphorus:Itiswhite,andbecomesyellowon
exposuretoair.Itistranslucent,waxy,luminousandcrystalline
cylinders.Ithasgarliclikeodor.Itisinsolubleinwaterandluminous
indark.Itsfumesshowphosphorescence.
2)Redphosphorus:Itisreddishbrown,inert,odourlessand
tasteless.Itisnontoxic(thuspoisoningoccursonlyduetowhite
phosphorus).Itisputonthesides(strikingsurface)ofmatchbox
(alongwithpowderedgalss).
Acutepoisoning
Ithasfollowingstages:
i)1stStage(GIirritation):Thereisnausea,vomiting,diarrheaand
garlicodor.Thisstagelastsfor8hoursto3days.

---

garlicodor.Thisstagelastsfor8hoursto3days.
ii)2ndStage(Asymptomatic):Thisstagelastsfor3days.
iii)3rdStage:Thereisliverandkidneydamageduetoabsorbed
phosphorus.Initiallyliverisenlargedduetoacutefattyinfiltration.
Laterlivershruksduetonecrosis,i.e.acuteyellowatrophy.
Chronicpoisoning
Toothacheisthefirstsymptomwhichisassociatedwithlooseningof
teeth,necrosisofgumsandosteomyelitisofjaw.Thereforechronic
phosphoruspoisoningisalsoknowasphossyjaw(orglassjaw).
Postmortemappearance
Thereisgarlicodor.Visceraandstoolglowindark(dueto
luminosity).
Topreserveluminosity,visceraarepreservedinsaturatedsaline
solution.Rectifiedspiritisnotusedasitcauseslossofluminosity.

---

714.Whichtypeofneuropathyisseenin
arsenicpoisoning?
a)Symmetricperipheralmotorneuropathy
b)Asymmetricalperipheralmotorneuropathy
c)Symmetricalperipheralsensoryneuropathy
d)Asymmetricalperipheralsensoryneuropathy
CorrectAnswer-D
Ans.is'd'i.e.,Asymmetricalperipheralsensoryneuropathy
Neurologicalmanifestationsofarsenicpoisoning
Headache,vertigo,hyperthermia,tremors,convulsions,coma,
generalparalysis.
Peripheralneuropathythatismoresensorythanmotoroccursin
asymmetricdistalstockingglovedistributionafteronetotwoweeks
ofacuteorchronicexposure.

---

715.Whatistheupperpermissiblelimitof
alcoholallowedwhiledrivinginIndia-
a)20mg%
b)30mg%
c)40mg%
d)50mg%
CorrectAnswer-B
Ans.is'b'i.e.,30mg%
ThestatutorylimitofalcohollevelinbloodinIndiawhiledriving
beyondwhichdrivingisconsideredascrimeis30mg%.
ItiscoveredunderS.185MotorVehicleAct1988.
ThepunishmentforfirstoffenceisfineuptoRs.2000/-or6months
ofimprisonmentorbothandforsecondorsubsequentoffencefine
uptoRs.3000/-orimprisonmentupto2yearsorboth.

---

716.Whatisthelevelofalcoholinblood
beyondwhichpersoniscondidered
intoxicated?
a)40mg%
b)80mg%
c)120mg%
d)140mg%
CorrectAnswer-D
Ans.is'd'i.e.,140mg%
Allindividualswithabloodalcohollevelof140mg%areconsidered
intoxicatedtothepointwheretheycannotdealwithunusual,
emergencyornon-customaryproblems.

---

717.Thepathwaysfollowedbycorrosive
acidsinstomachiscalled?
a)Curlingulcer
b)Cushingulcer
c)Magenstrasse
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Magenstrasse
Magenstrasseisthetermappliedtothepathwayacidicagents
followinstomach.
Thepathwayofacidsandalkalisinfoodfilledstomachstartsalong
thelessercurvatureofthestomachandleadstothepylorus,which
explainsthelocationofgreatestdamageinfoodfilledstomach.
Stomachwithoutfoodhavesignificantinjuryinthelowerhalfoftwo
thirdsandmayhavesparingoffundus.

---

718.ChocolateBrownpostmortemstainingis
seenin?
a)KClpoisoning
b)Opiumpoisoning
c)H2Spoisoning
d)Cyanidepoisoning
CorrectAnswer-A
Ans.is'a'i.e.,KClPoisoning

---

719.Bitteralmondodourispercievedin
poisoningwith?
a)Cobalt
b)Arsenic
c)Cyanide
d)Lead
CorrectAnswer-C
Ans.is'c'i.e.,Cyanide

---

720.Trousseausignpositiveinwhich
poisoning?
a)Citricacid
b)Oxalicacid
c)Aceticacid
d)Carbolicacid
CorrectAnswer-B
Ans.is'b'i.e.,Oxalicacid
Trousseou'ssignandchovstek'ssignareseeninhypocalcemia.
Oxalicacidpoisoningcancausehypoclacemia.
Oxalicacid
Itisalsoknownassaltofsorreloracidofsugar.Itisusedtoerase
writing,asbleachingagentandincalicoprinting.Itoccursinleaves
ofrhubarb.
Localeffects:Oxalicacidrarelydamagestheskinbutreadily
corrodethemucusmembraneofdigestivetract.
Systemic:(i)Shock:Largedosescancausedeathfromshock;(ii)
Hypocalcemia:Oxalicacidreadilycombineswithcalciumtocause
hypocalcemia,whichmaypresentastingling,numbness,twitching,
tetany,andconvulsions,(iii)Renaldamage:Itisduetooxaluria
whichmaycausetubularnecrosis.
Antidote:Anycalciumpreparation(e.g.calciumgluconate/chloride,
limewater,suspensionofchalk)whichconvertspoisoninto
insolublecalciumoxalateisanantidoteforoxalatepoisoning.

---

721.Tactilehallucinationseeninabusewith?
a)Heroine
b)Cocaine
c)Cannabis
d)Alcohol
CorrectAnswer-B
Ans.is'b'i.e.,Cocaine
Magnan'ssymptomsistactilehallucination(formication)i.e.feeling
ofbugscrawlingundertheskinisseenwithcocaineabuse/
poisoning.
Cocaine
CocaineisanalkaloidderivedfromtheCocabush,Erythrexylum
CoCa.Itwasthefirstlocalanaestheticwhichwasusedclinically.
Toxicityofcocainemaybe:?
A)Acutetoxicity:-Acutecocaineintoxicationischaracterizedby:?
1)Sympathetichyperactivity:-Tachycardia,hypertension,
mydriasis,sweating,nausea&vomiting.
2)Hypomanicstate:-Increasedpsychomotoractivity,grandiosity,
elation,hypervigilance,Increasedspeechoutput.
B)Chronicoveruse:-Chronicoverusecancause:?
1)Psychoticepisodes(Cocainepsychosis):-Persecutorydelusions
withtactilehallucinations(formination).Tactilehallucinationsare
manifestedasbugscrawlingundertheskinCocainebugsor
magnan'ssymptoms.
2)Other:-Anxietyreaction,compulsivebehavior,deliriumand
delusionaldisorders.
3)Blackpigmentationoftongueandteeth
Acombinationofcocaineandherointakenbyinjectioniscalled
speedball.

---

speedball.

---

722.Pupildilatationisseeninpoisoningwith
-
a)Dhatura
b)Ethylalcohol
c)Briumcarbonate
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove
Poisoningofthefollowingisassociatedwithdilatedpupils
Atropine
Tricyclicantidepressants
Phenothiazines
Dhatura
Ethylalcohol
Bariumcarbonate

---

723.FataldoseofKCNis?
a)50-60mg
b)120-130mg
c)180-190mg
d)280-300mg
CorrectAnswer-D
Ans.is'd'i.e.,280-300mg
Fataldoseofhydrocyanicacidinthepureformis50-60mgwhile
assodiumorpotassiumcyanideis200-300mg.

---

724.Pinpointpupilsareseeninallexcept?
a)Pontinehemorrhage
b)Organophosphoruspoisoning
c)Opiumpoisoning
d)Barbituratepoisoning
CorrectAnswer-D
Ans.is'd'i.e.,Barbituratepoisoning
Pinpointpupilcanbecausedby:Opioids(morphine),
organophosphates,phenothiazines,clonidine,mushroompoisoning,
chloralhydrate,carbolicacidandpontinehemorrhage.

---

725.Nysten'srulepertainsto?
a)Rigormortis
b)Identification
c)Bulletinjuries
d)Putrefaction
CorrectAnswer-A
Ans.is'a'i.e.,Rigormortis
Rigormortis
Itisdefinedascontraction,stiffening,shortenigandopacityof
musclesafterdeath.
Itoccursaftermolecular(cellular)death.Intropicalcountries(e.g.
india),itbegins1-2hoursafterdeath,takesfurther2hoursto
develop,andlastsfor18-36hoursinsummerand24-48hoursin
winter.
Intemperatecountries,itbeginsin3-6hours,takesfurther2-3hours
todevelopandlastsfor2-3days.
Allmusclesofbodyareinvolved,i.e.voluntaryorinvoluntary.
However,itdoesnotstartinallmusclessimultaneously(nysten's
rule).
Involuntarymuscles(heart)areinvolvedfirstthanvoluntarymuscles.
Sequenceofmusclesinvolvementisasfollows:Heart>upper
eyelid>neck>jaw>face>chest>upperlimb>abdomen>lower
limb>fingerandtoes.
Itpassesoffinthesameorderinwhichithasappeared.

---

726.Hungerpangsareseenhowlongafter
starvation?
a)6hours
b)12hours
c)24hours
d)48hours
CorrectAnswer-C
Ans.is'c'i.e.,24hours
Whenhungercontractionsstarttooccurinthestomach,theyare
informallyreferredtoashungerpangs.Hungerpangsusuallydonot
beginuntil12to24hoursafterthelastingestionoffood.

---

727.Extremehungerinstarvationlastsupto-
a)6-12hours
b)12-24hours
c)24-36hours
d)36-48hours
CorrectAnswer-D
Ans.is'd'i.e.,36-48hours
Starvationistheresultofactualdeprivationoffoodoradministration
ofunsuitablefood.Starvationmaybe:?
1. Acute(complete):Suddenandcompletestopageoffood.
2. Chronic(partial):Gradualdeficientsupplyoffood.
3. Anacutestarvation,thereservecarbohydrates,thenfatandlastthe
proteinsareusedup.
4. Feelingofhungerwithhungerpainlastsfor30-48hours.
5. After4-5days,thereisemaciation,absorptionfatandlossofweight
(7-8kgin10days).

---

728.Forphagetyping,howmanyphagesof
staphylococcusaureusareused?
a)12
b)15
c)20
d)23
CorrectAnswer-D
Ans.is'Di.e.,23
Bacteriophagetypingofstaphylococcusisbasedonthe
susceptibilityofcoccitobacteriophages.
Thisiscarriedoutbypatternmethodwhereasetof23standard
typingphagesofS.aureusisusedtotypestaphylococcalisolates
anddistinguishthemfromoneanotherbytheirpatternsof
susceptibilitytolysis.
Thephage-typeofastrainisknownbythedesignationofthe
phagesthatlyseit.
Forexample,ifastrainislysedbyphages83A,84and85,itis
calledtype83A/84/85.

---

729.MostcommonbiotypeofS.aureus
causinghumaninfection?
a)A
b)B
c)C
d)D
CorrectAnswer-A
Ans.is'a'i.e.,A
Staphylococcusaureushasbeenclassifiedintosixbiotypes:A,B,
C,D,EandF.
MosthumanpathogenicstrainsbelongtobiotypeA.

---

730.Inpontaicfever,whichantigenisseenin
urine?
a)Lipopolysaccharide-1
b)Lipopolysaccharide-2
c)Lipopolysaccharide-4
d)Lipopolysaccharide-6
CorrectAnswer-A
Ans.is'a'i.e.,Lipopolysaccharide-1
Legionellaareclassifiedintoserogrouponthebasisofgroupspecific
lipopolysaccharide(somaticantigenor'O'antigen).
Legionellapneumophilasero-group-1(LP-1)isthemostcommon
infectingorganism.
UrinetestdetectLP-1.

---

731.Sporesofclostridiumperfringensare
located?
a)Inthemiddleofcells
b)Atthepolesofcells
c)Betweenmiddleandpoleofcells
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Betweenmiddleandpoleofcells
Clostridiumperfringens(C.perfringens)isaspore-forminggram-
positivebacteriumthatisfoundinmanyenvironmentalsourcesas
wellasintheintestinesofhumansandanimals.C.perfringensis
commonlyfoundonrawmeatandpoultry
Sporesofclostridiummaybe:?
1. Terminal:Locatedatpoles.
2. Central:Locatedinthemiddleofthecells.
3. Subterminal:Betweenthemiddleofthecellandpoleofthecells.

---

732.Subterminalsporesareseenin?
a)Clperfringens
b)Cltetani
c)Cltertium
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Clperfringens

---

733.Doublezoneofhemolysisisseenin?
a)Staphylococcusareus
b)Streptococcuspyogenes
c)Clostridiumperfringens
d)Corynebacteriumdiphtheriae
CorrectAnswer-C
Ans.is'c'i.e.,Clostridiumperfringens
TwoimportantcharacteristicfeatureofCl.perfringensare:?
1. Targethemolysis(doublezonehemolysis)onbloodagar.Itisa
narrowzoneofcompletehemolysisbythetatoxinwhichis
surroundedbyawiderincompletehemolysisbyalpha-toxin.
2. Naegler'sreactiondetectsalphatoxin(phospholipaseorlecithinase
C).WhenCL.perfringensisgrownonamediumwiththeantitoxin
spreadononehalfoftheplate,coloniesontheotherhalfwithoutthe
antitoxinwillbesurroundedbyazoneofopacity.Therewillbeno
opacityaroundthecoloniesonthehalfoftheplatewiththeantitoxin,
duetothespecificneutralisationofthealpha-toxin.

---

734.Virulencefactorforclostridiumtetani?
a)Endotoxin
b)Tetanolysin
c)Tetanospasmin
d)Bacteremia
CorrectAnswer-C
Ans.is'c'i.e.,Tetanospasmin
PathogenicityofCItetani
Cl.tetanihaslittleinvasivepropertyandisconfinedtotheprimary
siteoflodgment.Tetanusresultsfromtheactionofthepotent
exotoxinitproduces.
ToxinsofCItetani
1)Tetanolysin(Hemolysin)
Notrelevantinthepathogenesisoftetanus.
2)Tetanospasmin(neurotoxin)
Responsiblefortetanus
Itisplasmidcoded
Inthebrainstemandspinalcorditblocksreleaseoftheinhibitory
neurotransmitterglycineand'yaminobutyricacid(GABA).
Itresemblesstrychnineinitseffects,butitactspresynaptically,while
strychnineactspostsynaptically.oTetanustoxinandbotulinumtoxin
resembleeachotherintheiraminoacidsequences.
3)Nonspasmogenic,peripherallyactiveneurotoxin
Itsroleisnotknown

---

735.Mechanismofactioninpathogenesisof
PseudomembranouscolitisbyCIdifficle
?
a)Duetoinvasiveness
b)Duetoendotoxin
c)Duetoexotoxin
d)DuetoNMblockade
CorrectAnswer-C
Ans.is'c'i.e.,Duetoexotoxin
Pathogenesisofpseudomembranouscolitisisdueto
productionoftwolargetoxinsbyC.difficile:
i)ToxinA(anenterotoxin)
Isapotentneutrophilchemoattractant
CausesdisruptionofcellcytoskeletonbyglycosylationofGTP-
bindingproteinsthatregulatetheactincellcytoskeleton.
ii)ToxinB(acytotoxin)
Causesdisruptionofcellcytoskeletonbysimilarmechanism.

---

736.Grampositive,catalasenegativecocci?
a)Staphaureus
b)Staphepidermidis
c)Staphsaprophyticus
d)Pneumococcus
CorrectAnswer-D
Ans.is'd'i.e.,Pneumococcus

---

737.Bullousimpetigoiscausedby?
a)Streptococcus
b)Staphylococcus
c)Staphylococcus
d)Y.Pestis
CorrectAnswer-B
Ans.is'b'i.e.,Staphylococcus
Impetigo
Impetigoisahighlycontagious,Gram-positivebacterialinfectionof
superficiallayerofepidermis.ImpetigooccursinTwoforms:?
1.Non-bullousimpetigo(Impetigocontagiosa)
Itisthemostcommonbacterialinfectionofchildren(occursmainly
inchildrenincontrasttoBullousimpetigowhichoccursininfants).It
iscausedbybothstaphylococcusaureusandhemolyticgroupA
streptococcus(Str.pyogens),thoughitismostlycausedbystaph
aureus.Mostcommonlyoccursonface,i.e.,aroundnose&mouth;
andexposedparts,i.e.,arms,legs.Presentserythematous
macule/papulewhichchangesintovesiclewhichsoonruptureswith
formationofcrusting.Crusthascharacteristicfeatures:-
1. Honey-yellowcolourinstreptococcalimpetigo.
2. Waxyinstaphylococcalimpetigo.
Lesionhealwithoutscarring.Mucousmembraneinvolvementis
rare.Lymphadenopathyiscommon
2.Bullousimpetigo
Itiscausedbystaphylococcusaureusmostoftenphagetype71.It
usuallyoccursininfantsandmanifestsasvesiclethatdevelopinto
bullaandlaterapustulewithoutanysurroundingerythema.Itmainly
occursonface.Mucousmembranemaybeinvolved(incontrastto

---

impetigocontigiosa).Lymphadenopathyisrare.

---

738.Scarletfeveriscausedby
a)Streptococcusagalactie
b)Streptococcuspyogenes
c)Streptococcuspneumoniae
d)Streptococcusequisimilus
CorrectAnswer-B
Ans.is'b'i.e.,Streptococcuspyogenes
Infectionscausedbystreptococcuspyogenes
Scarletfeverconsistsofstreptococcalpharyngitis,accompaniedby
acharacteristicrashwhichhasatinyredpinpointappearancewith
sand-paperliketexture.
Itoccursduetoproductionoferythrogenictoxin
Respiratoryinfections
Sorethroatisthemostcommonofstreptococcaldisease.Itmaybe
localisedastonsillitisasinolderchildrenandadultsoritmayinvolve
thepharynxmorediffusely(pharyngitis)asinyoungerchildren.Otitis
media.

---

739.Infectiveendocarditisaftertooth
extractionisprobablydueto?
a)Streptococcusviridans
b)Streptococcuspneumoniae
c)Streptococcuspyogenes
d)Staphylococcusaureus
CorrectAnswer-A
Ans.is'a'i.e.,Streptococcusviridans
Viridansstreptococciarenormallyresidentinthemouthandupper
respiratorytract.Theycausetransientbacteremiafollowingtooth
extractionorotherdentalprocedures;andgetimplantedon
damagedorprostheticvalvesorinacongenitallydiseasedheart,
andgrowtoformvegetations.
Theyareordinarilynonpathogenicbutcanonoccasioncause
disease.Inpersonswithpreexistingcardiaclesions,theymaycause
bacterialendocarditis,Str.sanguisbeingmostoftenresponsible.
Str.mutansisimportantincausationofdentalcaries.
Thetransientviridansstreptococcalbacteremiainducedbyeating,
tooth-brushing,flossingandothersourceofminortrauma,together
withadherencetobiologicalsurfaces,isthoughttoaccountforthe
predilectionoftheseorganismstocauseendocarditis.
Viridansstreptococciarealsoisolated,oftenasapartofamixed
flora,fromsitesofsinusitis,brainabscessandliverabscess.
Viridansstreptococcalbacteremiaoccursrelativelyfrequentlyin
neutropenicpatients,particularlyafterbonemarrowtransplantation
orhighdosechemotherapyforcancer.
Treatmentofvaridansstreptococcalinfectionsinclude:-
1. BacteremiainneutropenicpatientsVancomycin.

---

2. OtherinfectionPenicillin.

---

740.Shigellaarebedividedintosubgroupon
thebasisofabilitytoferment-
a)Lactose
b)Maltose
c)Fructose
d)Mannitol
CorrectAnswer-D
Ans.is'd'i.e.,Mannitol
Fermentationofmannitolisofimportanceinclassification
Shigella
MannitolfermentingMannitolnonfermenting
Sh.flexneri(subgroupB)Sh.dysenteriae(sub
groupA)
Shboydii(subgroupC)
Sh.Sonnei(subgroupD)

---

741.Shigatoxinactsby?
a)ActivatingadenylylcyclasetoincreasecAMP
b)ActivatingguanylylcyclasetoincreasecGMP
c)Inhibitingproteinsynthesis
d)InhibitingDNAreplication
CorrectAnswer-C
Ans.is'c'i.e.,Inhibitingproteinsynthesis

---

742.Selectivemediumforshigella?
a)Chocolateagar
b)BYCEmedium
c)Hektoenagar
d)EMJHmedium
CorrectAnswer-C
Ans.is'c'i.e.,Hektoenagar

---

743.Phenylalaninedeaminasetestispositive
in?
a)Salmonella
b)Proteus
c)Vibriocholerae
d)Helicobacter
CorrectAnswer-B
Ans.is'b'i.e.,Proteus
Thedistinctivecharacterofproteusgenusisdeaminationofphenyl
alaninetophenylpyruvicacid(PPA+ye)

---

744.Entericfeveriscausedby:
September2005
a)Salmonellatyphi
b)SalmonellaparatyphiA
c)SalmonellaparatyphiB
d)Alloftheabove
CorrectAnswer-D
Ans.D:Alloftheabove
TyphoidfeveriscausedbySalmonellatyphi.
ParatyphoidfeveriscausedbySalmonellaparatyphiA,BandC.
Thetermentericfeverencompassesbothtyphoidandparatyphoid
fevers.

---

745.SalmonellaeotherthanStyphiandS
paratyphicause?
a)Typhoidfever
b)Entericfever
c)Gastroenteritis
d)Alloftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Gastroenteritis
SALMONELLOSIS
Salmonellosisisreferredtotheinfectioncausedbybacteriaof
genussalmonella.
Salmonellosisisoftwotypes?
1. TyphoidalSalmonellosiscausedbyS.typhiandparatyphi'A','B'and
'C'(hasbeenexplained,seepreviousexplanations)
2. Non-typhoidalSalmonellosis
Non-tvphoidalSalmonellosis(NTS)
Itisthemostcommontypeofsalmonellosis(morecommonthan
typhoidalsalmonellosis)
CommonNTSspeciesare?
i. S.enteritidis
ii. S.heidelburg
iii. S.hadar
iv. S.typhimurium
v. S.newport
Unliketyphoidsalmonella(S.typhiandS.paratyphi),whereonly
reservoirishumans;non-typhoidalsalmonellacanbeacquiredfrom
multipleanimalreservoirs.
Transmissionismostcommonlyassociatedwith?

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i. Animalfoodproductsespeciallyeggs,poultry,undercookedmeat
ii. Dairyproducts
iii. Freshproducecontaminatedwithanimalwaste

---

746.Chroniccarrieroftyphoidshedbacillifor
?
a)1-3weeksaftercure
b)3weeksto3monthsaftercure
c)3months-1yearaftercure
d)Morethan1yearaftercure
CorrectAnswer-D
Ans.is'd'i.e.,Morethan1yearaftercure
Carriers
Bacillipresistinthegallbladderorkidneyandareeliminatedinthe
feces(fecalcarriers)orurine(urinarycarrier),respectively.
Thedevelopmentofthecarrierstateismorecommoninwomenand
inolderagegroups(over40yrs)
Carriersarethemorefrequentsourceofinfectionthancases.
Urinarycarriageislessfrequentbutmoredangerousthanintestinal
carrier-ParkPSM
Urinarycarrierisgenerallyassociatedwithsomeurinarylesions
suchascalculiorschistosomiasis.
PresenceofViantibodyindicatesthecarrierstate.

---

747.Enrichmentmediaforcholera?
a)VRmedium
b)TCBSmedium
c)Cary-Blairmedium
d)Alkalinepeptonewater
CorrectAnswer-D
Ans.is'd'i.e.,Alkalinepeptonewater

---

748.OptimalpercentageofNaCIforV
cholerae?
a)1%
b)2%
c)3%
d)4%
CorrectAnswer-A
Ans.is'a'i.e.,1%

---

749.Transmissionofcholeraisthrough?
a)Fecallycontaminatedfood
b)Fecallycontaminatedwater
c)Contaminatedfoodbyvomitsofacase
d)Alloftheabove
CorrectAnswer-D
Manistheonlyreservoir.Theimmediatesourceofinfectionarethe
stoolsandvomitsofcasesandcarrier.Infectionisacquiredthrough
fecallycontaminatedwaterorfood.Chlorinationofwateriseffective
againstVcholerae.
Therearefollowingtyesofcarrierincholera.
i)Incubatory:Shedvibriosonlyinthebriefincubationperiodof
1-5days.
ii)Convalescent:Shedvibriosfor2-3weeks.
iii)Healthyorcontactcarrier:Hashadsubclinicalinfectionand
shedvibriosforlessthan10days.
iv)Chroniccarriers:Canshedvibriosformonthsoryearsand
mayhavepersistentinfectioningallbladder.

---

750.Mosthalophilicvibrio?
a)Vcholerae
b)Vvulnificus
c)Valginolyticus
d)Vparahemolyticus
CorrectAnswer-C
Ans.is'c'i.e.,Valginolyticus
Valginolyticusismostsalttolerant(mosthalophilic)speciesof
vibrio.

---

751.Trueaboutvibrioparahemolyticus?
a)Polarflagella
b)Nonhalophilicvibrio
c)Non-capsulated
d)RequiresNaCI
CorrectAnswer-D
Ans.is'd'i.e.,RequiresNaCI
Itishalophilicvibrio.
*Inhabitsthecoastalsea,whereitisfoundinftshesarthopodssuch
asshrimpsandctabsandmolluscssuchasoyster.
*Itresemblesthecholeravibrioexceptthat:
-->Itiscapsulated.
-->Showsbipolarstaining
*Producesperitrichousflagellawhengrownonsolidmediun(V.
choleraehaspolarflagella),inliquidmediumpolarflagellaare
formed.
*Itgrows,onlyinmediacontainingNaCl,optimumconc.is2-4
%,ltsenteropathogeniciscloselylinkedto
itsabilitytocausehemolysisonWagatsumaagarttheKanagawa
phenomenon.

---

752.Kanagawa'sphenomenonisseenin?
a)Pseudomoneaaeuroginosa
b)Vibrioparahemolyticus
c)Shigellasonie
d)Proteusmirabilis
CorrectAnswer-B
Ans.is'b'i.e.,Vibrioparahemolyticus
Strainsofvibrioparahemolyticusisolatedfrompatientsarealways
hymolyticonWagatsumaagar,whilestrainsfromenvironmental
sourcesarealwaysnon-hemolytic.
Thislinkageofenteropathogenicitytoabilityofhemolysison
WagatsumaagariscalledKanagawa'sphenomenon.

---

753.Trueaboutvibriovulnificus?
a)Causesdiarrheacommonly
b)Halophilic
c)Drugofchoiceispenicillin
d)Producesshigatoxin
CorrectAnswer-B
Ans.is'bi.e.,Halophilic
V.Vulnificus
V.vulnificusisahalophilicvibrio.Ithasbeenlinkedtotwodistinct
syndrome.

---

754.TrueaboutCampylobacterjejuni?
a)Obligateaerobe
b)Oxidasenegative
c)Growsat42?C
d)Non-motile
CorrectAnswer-C
Ans.is'C'i.e.,Growsat42?C
Campylobacterjejuni
Morphology
Gramnegative
Commashaped
MotilewithasinglepolarflagellumDartingortumblingmotility
Noncapsulated
NonSporing
Culture
Growthoccursundermicroaerophilicconditions(5%O2,10%
CO2and85%N2).
Thermophilic,growingat42?C(Cangrowat37?C,butincubationat
highertemperaturessuppressesnormalfecalflora.)
Biochemicalreactions
Donotfermentcarbohydrate
Catalaseandoxidase-positive
Nitratereductionpositive

---

755.Culturemediumforcampylobactorjejuni
?
a)BYCEmedium
b)Skirrow'smedium
c)Thayer-Martinmedium
d)TCBSmedium
CorrectAnswer-B
Ans.is'b'i.e.,Skirrow'smedium

---

756.Culturemediausedfor0157:H7Entero
hemorrhagicEcoli?
a)Sorbitolcontainingagar
b)Mannitolcontainingagar
c)Sucrosecontainingagar
d)Dextrosecontainingagar
CorrectAnswer-A
Ans.is'a'i.e.,Sorbitolcontainingagar
Cultureof0157:H7E.coli
E.coli0157:H7isnotidentifiedonroutinestoolcultures.
E.coli0157:H7canbespecificallydetectedbytheuseofmodified
MacConkeymediawhichcontainssorbitolinplaceoflactose
(SMAC).
SorbitolMacConkeymediaisspecificallyusefulforthedetectionof
E.coli0157:H7asunlikemoststrainsofE.coli,the0157:H7strain
doesnotfermentsorbitol.
NonfermentingcoloniesonaSorbitolMacConkeyplate(SMAC)
thereforesuggestthediagnosisofE.coli0157:H7.
SorbitolMacConkeymediaisthescreeningmethodofchoicefor
E.coli0157:H7.

---

757.Ecolicausinghemolyticuremic
syndrome?
a)Enteropathogenic
b)Enterotoxigenic
c)Enteroinvasive
d)Enterohemorrhagic
CorrectAnswer-D
Ans.is'd'i.e.,Enterohemorrhagic
SCHERICHIACOLI
Atleastsixdistinct"pathotypes"ofintestinalpathogenicE.coliexist
:
EnteropathogenicE.colilEnteroadherentE.colil
Itcausesdiarrhoeaininfantsandchildrenusuallyoccuringas
institutionaloutbreaks.
Itdoesnotproduceenterotoxin,noraretheyinvasive.Theyadhere
tothemucosaofsmallintestineandcausedisruptionofthebrush
bordermicrovilli.
ThesestrainscanbeidentifiedbytheiradhesiontoHEP-2cells.
EnterotoxigenicE.coli
Itcausestraveller'sdiarrhoea[ETECisthemostcommoncauseof
traveller'sdiarrhea!.
Itproducesenterotoxins.Theycanproduceheatlabiletoxin(LT)or
heatstabletoxinorboth.
Toxinproductionalonemaynotleadtoillness.Thestrainshouldfirst
beabletoadheretointestinalmucosa.Thisadhesivenessis
medicatedbyfimbrialorcolonisationfactorantigen(CFA).
EnteroinvasiveE.coli
Theythemselvesresembleshigellaandtheirinfectionresembles

---

shigellosis(remember:shigaliketoxiniselaboratedby
enterohemorrhagicE.coli).
Theyproducemilddiarrhoeatofrankdysentryandoccurinadultas
wellasinchildren.
Theyhavebeentermedenteroinvasivebecausetheyhavethe
capacitytoinvadeintestinalepithelialcellsinvivoandpenetrate
HeLaorHEP-2cellsintissueculture.
Thisabilityofpenetrationisplasmiddeterminedwhichcodesfor
outermembraneantigenscalledthe'virulencemarkerantigen'
(VMA).Thedetectionofplasmidcanbediagnostic.
ForlaboratorydiagnosisofEIEC,theserenytestusedtobe
employed.
Thesestrainsarenonmotile,donotfermentlactoseorfermentit
latewithacidwithoutproducinganygas.
EnterohemorrhagicE.coliorverotoxigenicE.coli
Thesestrainsproduceverocytotoxin(VT)orshigaliketoxin(SLT)
Theycancausemilddiarrhoeatofatalhemorrhagiccolitis.
Shigaliketoxinbelongstoclassribosomeinactivatingproteins
(RIPs).Itinhibitsproteinsynthesisbyinhibitingribosomalfunction.
Thistoxinalsoactsonvascularendotheliumtopromotethe
synthesisofcoagulationfactorVIII,vWF-*Plateletaggregation.
Theycancausehemolyticuremicsyndromeparticularlyinyoung
childrenandtheelderly.
0157:H7isthemostprominentserotypeofEHEC,associatedwith
HUS,but06,026,055,091,0103,0111,0113andOX3havealso
beenassociatedwiththissyndrome.
TheprimarytargetforVTisvascularendothelium.
ThetypicalEHECisserotype0157:H7whichdoesnotferement
sorbitalunlikemajorityofE.coli(butHarrisonwritesthatfewspecies
ofthisserotypecanfermentsorbital).
Someotherserotypelike026:H1alsobelongstothisgroup.
LaboratorydiagnosisofVIECdiarrheaisestablishedby
demonstrationofthebacilliorVTinfecesdirectlyorinculture.

---

758.Satellitismisseeninculturesof?
a)Hemophilus
b)Streptococcus
c)Klebsiella
d)Proteus
CorrectAnswer-A
Ans.is'a'i.e.,Haemophilus
Satellitism
ThegrowthofHaemophilusinfluenzaeisscantyonbloodagar,as
thefactorVisnotfreelyavailable,beingimprisonedinsidethered
bloodcells.Growthis,therefore,betterifthesourceoftheVfactoris
alsoprovided.
WhenStaphaureusisstreakedacrossaplateofbloodagaron
whichaspecimencontainingH.influenzaehasbeeninoculated,
afterovernightincubation,thecoloniesofH.influenzaewillbelarge
andwelldevelopedalongsidethestreakofstaphylococcus,and
smallerfurtheraway.Thisphenomenoniscalledsatellitism.
Satellitismisduetoahighconcentrationoffactor'V'instaphaureus
whichisreleasedintomediumandisusedbyH.influenzae.

---

759.MycobacteriumtuberculosisgrowsinLJ
mediain?
a)10-14days
b)2-3weeks
c)4-8weeks
d)>10weeks
CorrectAnswer-C
Ans.is'c'i.e.,4-8weeks
Mtuberculosisproducesvisiblecoloniesonsolidmedia(L.J.media)
in4-8weeks
Useofliquidmediawithradiomimeticgrowthdetection(BACTEC-
460)andtheidentificationofisolatesbynucleicacidprobesgive
resultin2-3weeks.

---

760.Liquidmediumfortuberculosis?
a)LJmedium
b)Dorsetmedium
c)Loeffler'smedium
d)MGIT
CorrectAnswer-D
Ans.is'd'i.e.,MGIT
Mycobacterialgrowthindicatortube(MGIT)isanautomatedliquid
culturemethod.Itcontains7mlofmodifiedMiddlebrook7H9Broth
base.

---

761.FastestmethodfordiagnosisofTB-
a)Geneexpert
b)LJmedium
c)TBMGIT
d)BAC,IEC
CorrectAnswer-A
Ans.is'a'i.e.,Geneexpert
GeneXpertMTB/RIF
TheXpertMTB/RIFdetectsDNAsequencesspecificfor
Mycobacteriumtuberculosisandrifampicinresistanceby
polymerasechainreaction.
ItisbasedontheCepheidGeneXpertsystem,aplatformforrapid
andsimple-to-usenucleicacidamplificationtests(NAAT).
TheXpertMTB/RIFpurifiesandconcentratesMycobacterium
tuberculosisbacillifromsputumsamples,isolatesgenomicmaterial
formthecapturedbacteriabysonicationandsubsequentlyamplifies
thegenomicDNAbyPCR.
Theprocessidentifiesalltheclinicallyrelevantrifampicinresistance
inducingmutationsintheRNApolymerasebeta(rpoB)geneinthe
mycobacteriumtuberculosisgenomeinarealtimeformatusing
fluorescentprobescalledmolecularbeacons.
Resultsareobtainedfromunprocessedsputumsamplesin90
minutes,withminimalbiohazardandverylittletechnicaltraining
requiredtooperate.

---

762.WhichtypeofpulmonaryTBismost
likelytogivesputumpositive?
a)Fibronodular
b)Pleuraleffusion
c)Cavitary
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Cavitary
SputumsmearsareusuallypositiveinpatientswithlaryngealTB,
endobronchialTBandcavitarypulmonaryTB"--Kelley's
"PatientswithcavitarypulmonaryTBhavehighbacterialloadintheir
sputum"--Internet

---

763.Trueaboutdiphtheriatoxin?
a)Heatstable
b)ActsthroughcGMP
c)Consistsofthreefragments
d)Specialaffinityforbrain
CorrectAnswer-A
Ans.is'a'i.e.,Heatstable
"Diphtheriatoxinisaheat-stablepolypeptide,composedoftwo
fragments"-Medicalmicrobiology
Diphtheriatoxin
Thediphtheriatoxinactsbyinhibitingproteinsynthesis.Itinhibits
polypeptidechainelongationinthepresenceofnicotinamideadinine
dinucleotide(NAD)byinactivatingelongationfactor,EF-2.
Thediphtheriatoxinisaproteinwhichconsistsoftwofragments,A
andB.
Bothfragmentsarenecessaryforthetoxiceffect:
1. FragmentA-hasenzymaticactivityandinhibitsproteinsynthesisby
inhibitingthechainelongationbyinactivatingtheelongationfactor-
2(Ef-2)
2. FragmentB-responsibleforbindingthetoxintothecells.
Toxinhasspecialaffinityforcertaintissuessuchasmyocardium,
adrenalsandnerveendings.
Thestrainalmostuniversallyusedfortoxinproductionisthe"Park
williams8strain".

---

764.Howdoeschlamydiadifferfromother
usualbacteria?
a)Lackcellwall
b)Cannotgrowincellfreeculturemedia
c)Containsinclusionbody
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Containsinclusionbody
Chlamydiaproducesbasophilic(intracytoplasmic)inclusionbodiesin
infectedcellsincontrasttoeosinophilicinclusionbodiesproduced
bymostvirusesandhencetheyaresometimesreferredtoas
Basophilicviruses.
Uniquepropertiesofchlamydiaeare
Chlamydiaisanobligateintracellularparasite.Thismeanstheycan
surviveonlybyestablishigresidenceinsideanimalcells
Theyneedtheirhost'sATPasanenergysourcefortheirown
cellularactivity.Theyareenergyparasitesusingacellmembrane
transportsystemthatusesATPfromthehostsystemandgivesout
ADP.
Thisobligateintracellularexistencemakesitimpossibletoculture
theseorganismsonnonlivingartificialmedia.Duetotheirsmallsize
andfailuretogrowincell-freemediatheywereconsideredtobe
viruses.
ChlamydiaegrowsinculturesofavarietyofeukaryoticcelllinesMc
CoyorHeLacells.Itmaybenecessarytotreatcellswithpolyanionic
compoundssuchasDEAD-dextrantoreducetheelectrostatic
barriertoinfection.Antimetabolitesuchascycloheximideisaddedto
favourcompetitionforhostcellaminoacidpools.Alltypesof

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chlamydiaeproliferateinembryonatedeggsparticularyintheyolk
sac.
Thespecialfeaturesinstructureandchemicalcompositionof
chlamydiaeare:
1. Theoutercellwallresemblesthecellwallofgramnegativebacteria
2. Ithasarelativelyhighlipidcontent
3. Itisrigidbutitdoesnotcontaintypicalbacterialpeptidoglycan;
perhapsitcontainatetrapeptidelinkedmatrix.
4. NAcetylmuramicacidalsoappearstobeabsentfromchlamydiae
cellwall.

---

765.Apatientissufferingfrompneumonia.
Laboratorystudyshowsacid-fast
filamentousbacterium.Thecausative
organismis?
a)M.tuberculosis
b)Actinomyces
c)Nocardia
d)MycobacteriumAviumintracellulare
CorrectAnswer-C
Ans.is'c'i.e.,Nocardia
Symptomsofpneumoniabyafilamentousacidfastbacterium
suggestthediagnosisofNocardia.

---

766.Frie'stestisusefulfordiagnosisof?
a)Mycoplasma
b)Rickettsia
c)Sarcoidosis
d)Chlamydia
CorrectAnswer-D
Ans.is'd'i.e.,Chlamydia
Friestest(skinhypersensitivitytest)wasusedforLGV(causedby
chlamydiatrachomatis).
Butitisnotusednowbecauseofhighfalsepositiveresults.

---

767.Safetypinappearanceisseenin?
a)Vibriovulnificus
b)Vibrioparahemolyticus
c)Pseudomonasaeuroginosa
d)H.influenzae
CorrectAnswer-B
Ans.is`b'i.e.,Vibrioparahemolyticus
Bipolarstaining(safetypinappearance)
Somebacteriadisplayasafetypinappearanceduetothe
accumulationofdyeatthepolesofthecells.
Thischaracteristiciscalledbipolarstaining.
Bacteriashowingbipolarstainingare?
1. Calymmatobactergranulomatis(Donovanigranulomatis)
2. Vibrioparahemolyticus
3. Pseudomonasmallei
4. Yersiniapestis
5. Pseudomonaspseudomallei
6. H.ducreyi

---

768.Pseudomonasexotoxininhibitsprotein
synthesisbyinhibiting?
a)RNApolymerase
b)EF-2
c)Transpeptidase
d)Reversetranscriptase
CorrectAnswer-B
Ans.is'b'i.e.,EF-2
Exotoxin'A'ofP.aeruginosainhibitsproteinsynthesisthrough
interferencewithadenosinediphosphateribosylationofelongation
factor-2.
Remember
Bacterialtoxinsinhibitingproteinsynthesis:
ExotoxinAofPaeruginosa
Shigatoxin(Shigella)
Diphtheriatoxin
ShigaliketoxinorverocytotoxinofEHEC.

---

769.NewYorkagarisusedfor?
a)Salmonella
b)Clostridia
c)Neisseria
d)BacillusAnthracis
CorrectAnswer-C
Ans.is'c'i.e.,Neisseria
NewYorkCity(NYC)mediumisprimarilydesignedforisolationof
pathogenicNeisseria.
Italsosupportsthegrowthofgenitalmycoplasma(Mycoplasma
hominisandUreoplasmaUrealyticum).
Itisusefulinthediagnosisofgonorrheaandmycoplasmainfection.
Itconsistsofprimarilyapeptone-cornstarchagar-basebufferedwith
phosphatesandsupplementedwithhorseplasma,horse
hemoglobin,dextrose,yeastautolysateandantibiotics.

---

770.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.

---

771.Indianticktyphusiscausedby:
a)Rtyphi
b)Rconorii
c)Rakari
d)Cburnetii
CorrectAnswer-B
Ans.is.'b'i.e.,Rconorii

---

772.LGV(lymphogranulomavenerum)is
causedby?
a)Treponemapallidum
b)Chlamydiatrachomatis
c)Calymmatobactergranulomatosis
d)HDucreyi
CorrectAnswer-B
Ans.is'b'i.e.,Chlamydiatrachomatis
Lymphogranulomavenereum(LGV)isalong-term(chronic)
infectionofthelymphaticsystem.
Itiscausedbyanyof3differenttypes(serovars)ofthe
bacteriaChlamydiatrachomatis.
Thebacteriaarespreadbysexualcontact.Theinfectionisnot
causedbythesamebacteriathatcausegenitalchlamydia.
Chlamydiatrachomatiscauseseye(conjunctivitis,trachoma),
respiratory(pneumonia),andgenitaltract(urethritis,
lymphogranulomavenereum)infections.
DiagnosismadewithnucleicacidtestforCtrachomatis,LGV
serovarsdiagnosedserologically.

---

773.PLETmediumisusedin?
a)Plague
b)Anthrax
c)Typhoid
d)Cholera
CorrectAnswer-B
Ans.is`b'i.e.,Anthrax
SelectivemediaforB.antracisisPLETmedium,consistingof
polymyxin,lysozyme,ethylenediaminetetraaceticacid(EDTA)and
thallousacetateaddedtoheartinfusionagar.

---

774.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.

---

775.Weilfelixreactionisheterophile
antibodiesreactionduesharingof
Rickettsialantigenwith
a)Shigella
b)Proteus
c)Chlamydia
d)Mycoplasma
CorrectAnswer-B
Ans.is'b'i.e.,Proteus
Weilfelixreaction
Thisreactionisanagglutinationtestinwhichseraaretestedfor
agglutininsto0antigensofcertainnonmotileproteusstrainsOX-19,
OX-2andOX-K.
Thebasisofthetestisthesharingofanalkali-stablecarbohydrate
antigenbysomerickettsiaeandbycertainstrainsofproteus,P.
vulgarisOX-19andOX-2andP.mirabilisOX-K.
Thetestisusuallydoneasatubeagglutination,thoughrapidslide
agglutinationmethodshavebeenemployedforscreening

---

776.ModeoftransmissionofListeria
a)Ingestion
b)Inhalation
c)Skininoculation
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Ingestion
LISTERIOSIS
Modeoftransmission;
FoodborneMostcommon(mostcasesareduetoserotype4b)
NosocomialInlate-onsetneonatalinfection.
Lmonocytogenesentersthebodythroughthegastrointestinaltract
afteringestionofcontaminatedfoodssuchascheese,fruit,or
vegetables.
Theorganismhasseveraladhesionproteins(Ami(anautolysin
amidase),FbpA(fibronectinbindingprotein),andflagellinproteins)
thatfacilitatebacterialbindingtothehostcellsandthatcontributeto
virulence.
Ironisanimportantvirulencefactor.Listeriaproducessiderophores
andisabletoobtainironfromtransferrin.

---

777.Frischbacillusaffectsmostcommonly
a)Mouth
b)Nose
c)Eye
d)Ear
CorrectAnswer-B
Ans.is'b'i.e.,Nose
FrischbacillusisKlebsiellarhinoscleromatis,whichcauses
rhinoscleroma,agranulomatousdiseaseofthenose.
Kpneumoniaesubspeciesrhinoscleromatisformrhinoscleroma,a
destructivegranulomaofthenoseandpharynx.
Klebsiellagranulomatis(formerlyCalymmatobacterium
granulomatis)causesachronicgenitalulcerativedisease,
granuloma
inguinale,anuncommonsexuallytransmitteddisease

---

778.Bileesculinagarisusedfor?
a)GroupAstreptococcus
b)GroupBstreptococcus
c)GroupCstreptococcus
d)Enterococcus
CorrectAnswer-D
Ans.is'd'i.e.,Enterococcus
Enterococcus
MajorityoftheinfectionsarecausedbyE.faecalisandE.faecium.
LessfrequentlyisolatedspeciesareE.gallinarum,E.durans,E.
hiraeandE.avium.
Enterococciarenormalinhabitantsofthelargebowelofhuman
adults,althoughtheyusuallymakeup<1%oftheculturable
intestinalmicroflora.
Theyarecatalasenegative(asallstreptococci).
Theircharacteristicfeatureisthattheycangrowinpresenceof
:?
1. 40%bile
2. 6.5%Sodiumchloride
3. AtpH9.6
4. At45?C(relativeheatresistantsurving60?Cfor30minutes)
5. In0-1%methylenebluemilk
Theyhydrolyzeesculin.Theygrowinpresenceof40%bileand
hydrolyzeesculinBileesculinpositive.
TheyarePYR(PyrrolidonylArylamidase)positive.
Theyareusuallynon-hemolytic(gamma-hemolytic),butsome-times
mayshowalphaorbetahemolysis.

---

779.Rashisnotcausedby?
a)Salmonella
b)Shigella
c)Meningococci
d)Staphylococcus
CorrectAnswer-B
Ans.is'b'i.e.,Shigella
Salmonella(typhoid)andmeningococcicausemorbiliformrash.
StaphylococcuscausesscarlentiformrashinTSSandSSSS.
InfectionscausingExanthems(acutegeneralizedrash)
Morbilliform
Viral:Measles(rubeola),rubella,erythemainfectiosum,EBV,CMV,
adenovirus,echovirus,earlyHIV,coxasackievirus.
Bacterial:Typhoid,Earlysecondarysyphiis,Earlyrickettsia,Early
meningoccemia.
Scarlentiform
Scarletfever(streptococcus).
Toxicshocksyndrome.
Staphylococcalscaldedskinsyndrome.

---

780.Mostcommoncauseofinfectiondueto
catheterinurinarytract?
a)Ecoli
b)Coagulasenegativestaphylococci
c)Staphaureus
d)Pseudomonas
CorrectAnswer-A
Ans.is'a'i.e.,Ecoli
"Ecolicause80%ofacuteUTIinpatientswithout
catheterization".
"E.coilisthemostcommoncauseofcatheterassociatedUTItoo".

---

781.Manhaduncookedmeatatdinner3days
back,Nowpresentingwithdiarrhea.
Stoolexaminationshowscomashaped
organismwithRBCandWBC.Causative
organismis?
a)Vibriocholerae
b)Shigella
c)Campylobacterjejuni
d)Yersiniaenterocolitia
CorrectAnswer-C
Ans.is'c'i.e.,Campylobacterjejuni
Thisisacaseofdysentery(RBCinstoolsalongwithWBC).
Amongthegivenoptions,'b','c'and'd'cancausedysentery.But,
comashapedorganismiscampylobactorjejuni.
Basedonthedepthofintestinalinvasion,therearedifferentclinical
manifestationsofinfectionwithorganismscausingdiarrhea:-
Nocellinvesion(noninflammatory)
Thebacteriabindtointestinalepithelialcellsbutdonotenterthe
cell.
Diarrheaiscausedbythereleaseofenterotoxins.
Waterydiarrheawithnofecalleukocytesandnosystemicsymptoms
(e.g.fever)occurs.
Organismsare:
1. Vcholerae
2. Clostridiumperfringens
3. Cryptosporidia

---

4. Adenovirus
5. ETEC
6. B.cereus
7. Microsporidia
8. Staph.aureus
9. Giardia
10. Rotavirus
Invasionoftheintestinalepithelialcells(Inflammatory)
Theorganismshavevirulencefactorsthatallowbindingand
invasionintocells.
Toxinsmaybethenreleasedthatdestroythecell.
Thecellpenetrationresultsinasystemicimmuneresponsewith
fecalleukocytesaswellasfever.
ThecelldeathresultsinRBCleakageintothestool(dysentery).

---

782.Reservoirofplagueis?
a)Domesticrat
b)Wildrat
c)Ratflea
d)Man
CorrectAnswer-B
Ans.is'b'i.e.,Wildrat

---

783.Sterolsarefoundin?
a)CellwallofRicketssia
b)CellmembraneofRicketssia
c)CellwallofMycoplasma
d)CellmembraneofMycoplasma
CorrectAnswer-D
Ans.is'd'i.e.,CellmembraneofMycoplasma
Mycoplasmalackcellwall.Theyareboundedbytriplelayeredunit
membranethatcontainssterol.oThustheyrequirecholesteroleand
relatedsterols.

---

784.Mechanismactionofbotulinumtoxin?
a)IncreasedcAMP
b)IncreasedcGMP
c)Inhibitionofacetylcholinerelease
d)Inhibitionofnoradrenalinerelease
CorrectAnswer-C
Ans.is'c'i.e.,Inhibitionofacetylcholinerelease
BotulinumToxin
Cl.botulinumproducesapowerfulexotoxinthatisresponsibleforits
pathogenicity.
Thetoxindiffersfromotherexotoxinsinthatitisnotreleasedduring
thelifeoforganism.Itisproducedintracellularlyandappearsinthe
mediumonlyonthedeathandautolysisofthecell.
Itisthemosttoxicsubstanceknown.
Toxinisheatlabile,butsporesarehighlyheatresistant.
Itactsbyblockingthereleaseofacetylcholineatsynapsesand
neuromuscularjunction.Itactspresynaptically.
Toxinofalltypes(A,B,C,D,E,F,G)areneurotoxinexceptC2
whichisacytotoxin(enterotoxin).

---

785.Allselectivemediaarecorrectlymatched
except?
a)Vcholerae-TCBSmedium
b)Pseudomonas-Cetrimideagar
c)Mtuberculosis-LJmedium
d)Campylobacter-BCYEmedium
CorrectAnswer-D
Ans.is'd'i.e.,Campylobacter-BCYEmedium

---

786.AgarmediausedforHaemophilus
influenza?
a)Bloodagar
b)Chocolateagar
c)Tryptoseagar
d)BYCEagar
CorrectAnswer-B
Ans.is'b'i.e.,Chocolateagar

---

787.Earliestgrowthofdiphtheriaisdetecton
whichmedia?
a)Potassiumtelluritemediawithiron
b)McConkey'sagar
c)Dorseteggmedium
d)Loeffler'sserumslope
CorrectAnswer-D
Ans.is'd'i.e.,Loeffler'sserumslope
DiphtheriabacilligrowonLoeffler'sserumslopeveryrapidlyand
coloniescanbeseenin6-8hours,longbeforeotherbacteriagrow.

---

788.Tunicareactionispositivein?
a)Rprowazekii
b)Rtyphi
c)Rtsutsugamushi
d)Rakari
CorrectAnswer-B
Ans.is'b'i.e.,Rtyphi
Neill-Mooser(Tunica)reaction
Whenmaleguineapigsareinoculatedintraperitoneallywithblood
fromacaseofendemictyphusorwithacultureofR.typhi(R.
mooseri)theydevelopfeverandacharacteristicscrotal
inflammation.
ThisreactionisusedtodifferentiateR.typhiandR.prowazekii.

---

789.Mostcommonspeciesofpseudomonas
causingintravascularcatheterrelated
infectionsis?
a)P.cepacia
b)P.aeruginosa
c)P.maltiphila
d)P.mallei
CorrectAnswer-B
P.aeruginosa[Ref-Harrison17th/ep.838,839;TheInternet
journalofAnaesthesiology]
Mostcommonspeciesofpseudomonasassociatedwith
intravascularcatheterisPseudomonasAeruginosa.
Intravascularcatheterrelatedinfections
Indwellingvascularcathetersarealeadingsourceofbloodstream
infections.
Amongstindwellingvascularcatheters,centralvenouscathetersare
themostcommonculprits.
Pathogenesis
Therearefourpotentialsourcesforcatheterrelatedinfections?
1)Theskininsertionsite
2)Thecatheterhub
3)Hematogenousseedingfromadistantinfection
4)Contaminatedinfusate
Theskininsertionsiteandthecatheterhubarebyforthetwomost
importantsources.
Approximately65%ofcatheterrelatedinfectionsoriginatefromthe
skinflora,30%fromthecontaminatedhuband5%fromother

---

pathways.
Forshorttermcatheters,skincontaminationisthemostlikely
mechanismofpathogenesis.
Ontheotherhand,forlongtermcatheters,hubcontaminationis
more.frequentbecausesuchcathetersoftenhavetobeintercepted
andmanipulated.
Skinorganismsmigratefromtheskininsertionsitealongthe
externalsurfaceofcatheter,colonizingthedistalintravasculartipof
thecatheter,andultimatelycausingblood-streaminfection.Onthe
otherhand,inhubrelatedinfections,organismsareusually
introducedintothehubfromthehandsofmedicalpersonnelandthe
organismsmigratealongtheinternalsurfaceofthecatheter,where
theycancauseabloodstreaminfection.
Microbiology
Mostofthemicro-organismsimplicatedinCRIsarisefromtheskin
flora.
Staphylococciarethemostfrequentlyisolatedpathogens,
paricularlycoagulase-negativestaphylococci.
Etiologyofcatheterrelatedinfection
Microorganism
Percentage
?Coagulasenegative
30-40
staphylococci
?Staphaureus
5-10
?Enterococci
4-6
?Candidaspp.
3-6
?Pseudomonas
2-5
aeruginosa
?Enterobacterspp
1-4
?Acinetobacterspp.
1-2
?Serratiaspp.
<1
?Others
<1-5

---

790.Whichofthefollowingisincubatedat
temperature40-44degrees?
a)Vibriocholerae
b)Pseudomonasaeruginosa
c)Vibrioparahemolyticus
d)Ecoli
CorrectAnswer-B
Ans.is'b'i.e.,Pseudomonasaeruginosa
"Theoptimumtemperatureforgrowthofpseudomonasaeruginosa
is37degreeandisabletogrowattemperatureashighas42?C"-
EssentialsofMicrobiology
Pseudomonasaeruginosa
Morphology
Gramnegativebacilli
Motilebypolarflagellum
Noncapsulatedbutmanystrainshavemucoidslimlayer
especiallytheorganismswhichareisolatedfromcysticfibrosis
patient.
Culture
Obligateaerobe
Coloniesemitadistinctive,musty,mawkish,earthyorsweetgrape-
likeodourorcorntocolikeodour.
Cetrimideagarisaselectivemedia.
Pseudomonasaeruginosaproducesanumbersofpigments.The
productionofthesepigmentsaccountsforthecolourofcolonies.
PyocyaninisproducedonlybyP.aeruginosaanditinhibitsthe
growthofmanyotherbacteria.
Pyoverdinmaybeproducedbymanyotherspecies.

---

---

791.Varicellazostervirusbelongstowhich
familyofDNAviruses?
a)Poxviridae
b)Herpesviridae
c)Adenoviridae
d)Papovaviridae
CorrectAnswer-B
Ans.is`b'i.e.,Herpesviridae
DNAviruses
Poxviridae:-Variola,vaccinia,cowpox,monkeypox,tanapox,
molluscumcontagiosumHerpesviridae:-HSV-1,HSV-2,varicella-
zoster,EBV,CMV,HTLV-1,RK-virusAdenovirideAdenovirus
ParvoviridaeParvovirus,Adenosatellovirus,Densovirus
PapovaviridaePapillomavirus(HPV),Polyomavirus
HepadnaviridaeHepatitis-Bvirus

---

792.Molluscumcontagiosumvirusbelongs
to?
a)Poxviruses
b)Herpesviruses
c)Picornaviruses
d)Adenovirus
CorrectAnswer-A
Ans.is'a'i.e.,Poxviruses

---

793.Whichofthefollowingisnotapox
virus?
a)Cowpox
b)Molluscumcontagiosum
c)Smallpox
d)Chickenpox
CorrectAnswer-D
Ans.is'd'i.e.,Chickenpox
Poxvirusescausingdiseaseinhumans
Variola(smallpox)
Buffalopox
Cowpox
Molluscumcontagiosum
Vaccinia
Monkeypox
Orf
Tanapox
Chickenpoxiscausedbyvaricella-zostervirus,whichisaherpes
virus.

---

794.DoublestrandedRNAviruswith
segmentedgenome?
a)Influenza
b)Rotavirus
c)Arenavirus
d)Bunyavirus
CorrectAnswer-B
Ans.is'b'i.e.,Rotavirus

---

795.DoublestrandedRNAvirus?
a)Rotavirus
b)Measlesvirus
c)Mumpsvirus
d)Influenzavirus
CorrectAnswer-A
Ans.is'a'i.e.,Rotavirus

---

796.SmallestVirusis?
a)Herpesvirus
b)Adenovirus
c)Parvovirus
d)Poxvirus
CorrectAnswer-C
Ans.is`c'i.e.Parvovirus

---

797.Mostcommonpoxvirusinfectionin
humanis?
a)Smallpox
b)Monkeypox
c)Cowpox
d)Mulluscumcontagiosum
CorrectAnswer-D
Ans.is'd'i.e.,Mulluscumcontagiosum
Amongthegivenoptions,smallpox(variola)virusandmolluscum
contagiosumaffecthumanastheirprimaryhost.
Smallpoxhasbeeneradicated.
Molluscumcontagiosumisacommonskininfection.

---

798.CauseofHerpesZoster?
a)PrimaryinfectionwithVZV
b)RecurrentinfectionwithVZV
c)ReactivationoflatentinfectionofVZV
d)MultipleinfectionwithVZV
CorrectAnswer-C
Ans.is'c'i.e.,ReactivationoflatentinfectionofVZV
Varicellazostervirusinfection
Varicella(Chickenpox)andHerpeszosteraredifferent
manifestationsofthesamevirusinfection.Thevirusistherefore
calledvaricellazostervirus(VZA)
PrimaryinfectionwithVZVcauseschickenpox.
ReactivationoflatentVZV,whenimmunityhasfallentoineffective
levelscauses-Herpeszoster
Thevirusremainsdormantinsensoryganglionoftrigeminalnerve
andreachestheeyealongoneormorebranchesoftheopthalmic
divisionofthe5thnerve
HerpesZoster(Shingles)
Occursinoldage60yearsorabove
Asaconsequenceofreactivationoflatentinfectionfromthedorsal
rootganglion.oUnilateralvesiculareruptionswithinadermatomal
distribution
DermatomesfromT3toL3andtrigeminalnerve(especially
ophthalmicbranch)areinvolved.oZosterophthalmicus-dueto
reactivationinophthalmicbranchoftrigeminal(gasserian)gangliao
RamsayHuntSyndrome-duetoreactivationingeniculateganglion
offacialnerve.oComplicationsPostherpeticneuralgia-most
debilitatingcomplication

---

1. Meningealirritation
2. Transversemyelitis
3. Cutaneousdissemination
4. Patient'swithhodgkin'sdiseaseandnonhodgkin'slymphomaareat
greatestriskforprogressivehespeszoster.
5. Bacterialsuperinfection

---

799.Wrongstatementaboutchickenpox/
herpeszoster?
a)CausedbyVZV
b)Chicken-poxprimaryinfection
c)Herpes-zosterrecurrentinfection
d)Latentinfectionintrigeminalganglion
CorrectAnswer-C
Ans.is'c'i.e.,Herpes-Zosterrecurrentinfection
Herpes-Zosterisduetoreactivationoflatentinfection(notdueto
recurrentinfection).Otheroptionsarecorrect.

---

800.Mostcommoncomplicationofchicken-
pox-
a)Bacterialinfection
b)Meningitis
c)Pneumonia
d)Nephritis
CorrectAnswer-A
Ans.is'a'i.e.,Bacterialinfection
Complicationsofchickenpox
Themostcommoninfectiouscomplicationofvaricellaissecondary
bacterialsuperinfectionoftheskin,whichisusuallycausedby
streptococcuspyogenesorStaphylococcusaureus.
Themostcommonextracutaneoussiteofinvolvementinchildrenis
CNS.
Varicellapneumoniaisthemostseriouscomplicationfollowing
chickenpoxinadults.

---

801.Whichmyxovirusdoesnothave
hemagglutininandneuraminidasebut
havemembranefusionprotein-
a)Measles
b)Parainfluenza
c)RSV
d)Influenza
CorrectAnswer-C
Ans.is'c'i.e.,RSV
RSVdoesnotposseshemagglutininorneuraminidase.
Theviralenvelopehastwoglycoproteins?
i)GproteinBywhichvirusattachestocellsurface
ii)F-protein(Fusionprotein)whichbringaboutfusionbetween
viralandhostcellmembranes.Itisalsoresponsibleforcelltocell
fusion,whichleadstocharacteristicsyncytialformation.

---

802.Virusmostsensitivetoinactivationby
biocides?
a)Adenovirus
b)Herpesvirus
c)Parvovirus
d)Poliovirus
CorrectAnswer-B
Ans.is'b'i.e.,Herpesvirus
Envelopedvirusesaremostsensitivetoinactivationbybiocides.
AmongthegivenoptionsonlyHerpesvirusisenvelopedvirus.
Adenovirus,parvovirusandpoliovirus(picornavirus)arenon-
envelopedviruses.

---

803.Exanthemasubitumiscausedby?
a)HHV-6
b)HHV-8
c)Parvovirus
d)Coxsackievirus
CorrectAnswer-A
Ans.is'a'i.e.,HHV-6
HHV-6causesroseolainfantum(alsocalledexanthemasubitumor
sixthdisease).

---

804.HHV-6causes?
a)Erythemainfectiosum
b)Kaposisarcoma
c)Roseolainfantum
d)Herpangina
CorrectAnswer-C
Ans.is'c'i.e.,Roseolainfantum

---

805.Allcauseviralhepatitisexcept-
a)Measles
b)EBV
c)Rhinovirus
d)Reovirus
CorrectAnswer-C
Ans.is'c'i.e.,Rhinovirus
Importantvirusescausinghepatitis:?
1)Hepatotropicviruses:HAV,HBV,HCV,HDV,HEV.
2)Herpesviruses:CMV,EBV,HSV-1,VZV.
3)Flaviviruses:Yellowfever,denguefever.
4)Filoviruses:Marburgvirus,Ebolavirus.
5)OccasinalcausesMeaslesvirus,adenovirus,Echoviruses,
Coxsackieviruses,influenzavirus,parvoviruses,reoviruses,mumps
virus.

---

806.Whichflaviviruscauseshepatitisin
human?
a)HepatitisA
b)HepatitisB
c)HepatitisC
d)HepatitisD
CorrectAnswer-C
Ans.is'c'i.e.,HepatitisC

---

807.Whichofthefollowinghepatitisviruses
isaDNAvirus?
a)HepatitisCvirus
b)HepatitisBvirus
c)Deltaagent
d)HepatitisEvirus
CorrectAnswer-B
Ans.is'b'i.e.,HepatitisBvirus
HepatitisBvirus(HBV)
HepatitisBvirusisthemostwidespreadvirusandthemost
importantcauseofviralhepatitis.oHBVbelongstoHepadnaviridae
HBVishepadnavirustype-1
HepatitisBistheonlyhepatitisviruswhichhasDNA.Allothersare
RNAviruses.
HBVcontainstwolinearstrandsofDNA.Oneofthestrands(the
plusstrand)isincompleteandotheriscomplete(theminus
strand)PartiallydoublestrandedDNA.
HBVcontainsbothDNA-dependentDNApolymeraseandRNA
dependentreversetranscriptase.
InsteadofDNAreplicationdirectlyfromaDNAtemplate,HBVrelys
onreversetranscriptionofminusstrandDNAfromapregenomic
RNAintermediate(likeretrovirus).

---

808.Whichisnotparenterallytransmitted
a)HAV
b)HBV
c)HCV
d)HDV
CorrectAnswer-A
Ans.is'a'i.e.,HAV

---

809.Defectivehepatitisvirusis?
a)HAV
b)HBV
c)HCV
d)HDV
CorrectAnswer-D
Ans.is'd'i.e.,HDV
HepatitisD(HDV)orDeltavirus
ItisdefectiveRNAvirusdependentonthehelperfunctionofHBVfor
itsreplicationandexpression.
ItcontainssinglestrandedRNA(ssRNA)-DefectiveRNA.
Ithasnoindependentexistenceandcansurviveandreplicateonly
aslongasHBVinfectionpersistsinthehost.
Itresemblessomeplantviruses,suchasviroidsorsatelliteviruses.
IthasbeenclassifiedingenusDeltavirus.
DeltacoreofHDVisencapsidatedbyanouterenvelopeofHBsAg,
soitrequirecooperativefunctionofHBV.
IntracellularreplicationofHDVRNAcanoccurwithoutHBVbutliver
injuryrequiresthepresenceofHBV.
HDVcancausetwotypesofinfection.

---

810.Maternalmortalityismorein?
a)HAV
b)HBV
c)HCV
d)HEV
CorrectAnswer-D
Ans.is'd'i.e.,HEV
HepatitisEvirus
Alsoknownasentericallytransmittednon-Anon-B(NANB)virusor
epidemicNANB.
ItisclassifiedinthegenusHerpesvirusunderthefamilycaliciviridae.
ItisaRNAviruswithsingle-strandedpositivesenseRNA
Itistransmittedbyfecal-oralroute.
InIndia,HEVisresponsibleforthemajorityofepidemicand
sporadichepatitisinadults.
AnepidemiologicalfeaturethatdistinguishesHEVfromotherenteric
agentsistherarityofsecondarypersontopersontransmission
(Secondaryattackrateisverylow2-3%asagainst10-20%inHAV
infection)
Auniquefeatureistheclinicalseverityandhighcasefatalityrateof
20-40%inpregnantwomen,especiallyinthelasttrimesterof
pregnancy.
Itischaracteristicallyassociatedwithcholestasis

---

811.Eantigen(HBeAg)ofhepatitisBvirusis
aproductofwhichgene
a)S
b)C
c)p
d)x
CorrectAnswer-B
Ans.is'b'i.e.,C
Genes&geneproducts
ThegenomeofHBVismadeofcircularDNA,butitisunusual
becausetheDNAisnotfullydoublestranded-->oneofthestrands
isincompleteandotheriscompletepartiallydoublestranded
DNA.
Therearefourknowngenesencodedbygenome-->'C',X',`P','S'.

---

812.DNApolymeraseofHBVisencodedby
whichofthefollowing?
a)Sgene
b)Cgene
c)Pgene
d)Xgene
CorrectAnswer-C
Ans.is`c'i.e.,Pgene
DNApolymeraseofHBVisencodedbyPgene

---

813.InfectivityofHBVisindicatedby?
a)HBeAg
b)HbsAg
c)HBVDNA
d)AntiHBsAg
CorrectAnswer-A
Ans.is'a'i.e.,HBeAg

---

814.SerummarkerafterHepatitisB
vaccination?
a)Anti-HBsAg
b)Anti-HBeAg
c)Anti-HBcAg
d)HBsAg
CorrectAnswer-A
Ans.is'a'i.e.,Anti-HBsAg

---

815.SupercarrierofHBVshowsfollowing
serummarkers?
a)HBsAg
b)HbsAg+HBVDNA
c)HbsAg+HBeAg+HBVDNA
d)Anti-HBsAg+HBVDNA
CorrectAnswer-C
Ans.is'c'i.e.,HbsAg+HBeAg+HBVDNA
InHBVinfection,therearetwotypesofcarriers:
SuperCarriers
HightitreofHBsAg,HBeAg,DNApolymeraseandHBVinthe
circulation
Highlyinfective
Simplecarriers
LowtitreofHBsAgwithnegativeHBeAg,DNApolymeraseand
HBV
Havelowinfectivity

---

816.A17yearsoldfemalepresentswithsore
throat,lymphadenopathyandpositive
heterophileantibodiestest.Diagnosisis
?
a)Tuberculosis
b)Streptococcalpharyngitis
c)Infectiousmononucleosis
d)Cytomegalicinclusiondisease
CorrectAnswer-C
Ans.is'c'i.e.,Infectiousmononucleosis
Laboratorydiagnosis
InIMN,thereispredominantlylymphocytosiswithpresenceof20%
ormoreatypicallymphocytes.Theseatypicallymphocytesare
activatedT-lymphocyteswhichhaveroundorirregularlyshaped
nuclei,withabundantflowingcytoplasmthatcharacteristicallyhasa
dark-stainingperipheri.

---

817.Sucklingmiceisusedforisolationof?
a)Coxsachievirus
b)Pox
c)Herpes
d)Adenovirus
CorrectAnswer-A
Ans.is'a'i.e.,Coxsackievirus
Itisnecessarytoemploysucklingmicefortheisolationofcoxsackie
viruses.
Inoculationisusuallymadebyintracerebral,subcutaneousand
intraperitonealroute.
Adultmicearenotsusceptible.

---

818.Syncytiumformationisapropertyof?
a)Herpesvirus
b)Adenovirus
c)Measlesvirus
d)Rabiesvirus
CorrectAnswer-C
Ans.is'c'i.e.,Measlesvirus

---

819.TrueaboutNipahvirusareallexcept?
a)Isaparamyxovirus
b)Causeshemorrhagicfever
c)Emerginginfection
d)PresentinIndia
CorrectAnswer-B
Ans.is'b'i.e.,Causeshemorrhagicfever
Nipahvirusisanemerginginfectiousagentbelongsto
paramyxoviridae.
ItwasfirstisolatedinMalaysiain1998,causingencephalitisin
domesticpigs,withdirecttransmissionfrompigstohuman.
TherehavebeenNipahvirusinfectionoutbreaksinpigsinMalaysia
andSingaporeandhumandiseaseinMalaysia,Singapore,India
andBangladesh.
Typicallythehumaninfectionpresentsasanencephalitissyndrome
markedbyfeverheadache,drowsiness,disorientation,mental
confusion,comaanddeath.

---

820.CausativeorganismofSARS
a)HiN,
b)Coronavirus
c)Rotavirus
d)RSV
CorrectAnswer-B
Ans.is'b'i.e.,Coronavirus

Severeacuterespiratorysyndrome

InNovember2002,Chinaexperiencedanoutbreakofanunusual
respiratoryinfectionwithmanydeaths
Severeacuterespiratorysyndrome(SARS).oItiscausedby
Coronavirustype?4.
SARSspreadsbyinhalationoftheviruspresentindropletsor
aerosolsofrespiratorysecretionsofpatients.
Fecalaerosolsmayalsobeinfectious.oIncubationperiodisless
than10days.

---

821.Influenzapandemicis
a)Seasonaltrend
b)Cyclicaltrend
c)Seculartred
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Cyclicaltrend
Diseasesoccurringincyclesspreadoverashortperiodshow
cyclicaltrendsoftimedistribution.
-Itisatypeofperiodicfluctuation.
-Examples:
-Influenzapandemic:every7?10yearsduetoantigenicvariations.
-Measles:every2-3yearsintheprevaccinationera.
-Rubella:6-9yearsintheprevaccinationera.
-Non-infectiousconditionscanalsoshowcyclicaltrends.

---

822.OncogenicDNAvirusis?
a)Retrovirus
b)HBV
c)HIV
d)HTLV
CorrectAnswer-B
Ans.is'b'i.e.,HBV

---

823.WindowperiodinHIVinfection?
a)1-2weeks
b)4-8weeks
c)8-12weeks
d)>12weeks
CorrectAnswer-B
Ans.is'b'i.e.,4-8weeks
Windowperiod
Ittakes2-8weekstomonthsforantibodiestoappearafterinfection.
Thisperiod,frominfectiontoappearanceofantibodies,iscalledas
windowperiod.
Duringthisperiodpatientsisseronegativei.e.serologicaltests
(ELISAandWesternblot)arenegative.oTheindividualmaybe
highlyinfectiousduringthisperiod.

---

824.ThechancethatahealthworkergetsHIV
fromanaccidentalneedleprickis-
a)1%
b)10%
c)95%
d)100%
CorrectAnswer-A
Ans.is'a'i.e.,1%
CommonmodesoftransmissionofHIVandtheirrelativerisk
Approximate
Typesof chanceof
exposure infectionper
exposure
Sexualintercourse:0.1-1.0%anal,vaginal,oral
IIBloodandblood
products,FactorVII>90%etc.Blood
transfusion
IIITissueandorgan50-90%donation,
semen,cornea,
bonemarrow,kidneyetc.
IVInjectionsand0.5-1.0%injuries;
sharedneedles
bydrugaddicts
Injectionswithunsterile
Needle-stickandother
injuriesinhealthstaff?
Surgicalwounds

---

Surgicalwounds
VMothertobaby:30%Transplacental
Atbirth
Afterbirth
Breastmilk

---

825.Paralysisinpolioischaracterizedby?
a)Spasticity
b)Symmetrical
c)LMNtype
d)Progressive
CorrectAnswer-C
Ans.is'c'i.e.,LMNtype
Clinicalmanifestationsofpolio
Incubationperiodrangesfrom3-35days(usually7-14days).
Theclinicalspectrumincludes:-
1. Subclinical(inapparent)infections(95%):Mostcommonandplay
predominantroleinspreadofinfection.
2. Minor(abortive)illness(4.8%):Presentwithfever,sorethroat,
headacheandmalaise.
3. Asepticmeningitis/nonparalyticpolio(1%):Therearesignsand
symptomsofmeningitis.
4. Paralyticpolio(Thereisflaccidparalysiswithabsentreflexes.
Respiratoryparalysisisthemostcommoncauseofdeath.

---

826.Viruscausingoropharyngealcarcinoma
?
a)EBV
b)HPV
c)HHV-8
d)HTLV
CorrectAnswer-B
Ans.is'b'i.e.,HPV

---

827.Breakbonefeveriscausedby?
a)Yellowfever
b)Japaneseencephlitis
c)Denguefever
d)KFD
CorrectAnswer-C
Ans.is'c'i.e.,Denguefever
Breakbonefever(Saddlebackfever)iscausedbydenguevirus.
Denguefever
Denguefeveriscausedbyarboviruses(atleast4serotypeshave
beenrecognized)
ItistransmittedbyAedes(Aedesaegyptiisthemainvector).
Thereservoirofinfectionisbothmanandmosquito.
ThetransmissioncycleisMan-mosquito-man
Denguefeveroccursbothepidemicallyandendemically.Epidemics
startsinrainyseasonandareusuallyexplosive.
Aedesmosquitobecomesinfectivebyfeedingonapatientfromthe
daybeforeonsettothe5thdayofillness.
VariousmanifestationsofDengueinfection
A)Classicaldenguefever?
i. Alsoknownasbreakbonefever
ii. Incubationperiod2-7days(3-10days-4Park)
iii. Onsetissuddenwithchillsandfever.Feverisusuallybetween39?c
and40?ctemperaturereturnstonormalafter5-6daysorsubsideon
aboutthe3rddayandriseagainafter5-8daysafteronset(saddle
backfever).
iv. Rashesappearin80%ofcasesduringremissionorduringsecond
febrilephase.Therashlastsfor2hourstoseveraldaysandmaybe

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followedbydesquamation.
B)DengueHemorrhagicfever(DHF)-
Itisasevereformofdenguefevercausedbyinfectionwithmore
thanonedenguevirus.
Thesevereillnessisthoughttobeduetodoubleinfectionwithmore
thanonedenguevirus.
Denguehemorrhagicfeverisbelievedtoresultfromreinfectionwith
avirusofdifferentserotype(duetoenhancingantibodies)
DHFusallyoccursaftersequentialinfectionwithanytwoofthefour
serotypesofdenguevirus.
Sequenceofinfectionmaybeimportant;serotype1followedby
serotype2ismoredangerousthanserotype4followedbyserotype
2.

---

828.ViruscausingLatentinfection(orLatent
periodisshownbywhichvirus)-
a)Rubella
b)HBV
c)Pertussis
d)Rotavirus
CorrectAnswer-B
Ans.is'b'i.e.,HBV

---

829.Trueregardingarbovirusisallexcept?
a)KFDistransmittedbyTick
b)DenguevirushasoneSerotype
c)YellowfeverisnotseeninIndia
d)DenguefeveristransmittedbyAedes
CorrectAnswer-B
Ans.is'b'i.e.,DenguevirushasoneSerotype
KFDismainlytransmittedbyHardtick,butsofttickcanalsotransmit
thedisease.
Denguevirushasfourserotypes.
YellowfeverisnotendemicinIndia,itisdistributedinAfricaand
SouthAmerica.
DenguefeveristransmittedbyAedesmosquito.

---

830.Whichpriondiseaseaffecthuman?
a)Scrapie
b)Madcowdisease
c)Kuru
d)Bovinespongiformencephalopathy
CorrectAnswer-C
KuruprionInfectionthroughritualisticcannibalism

---

831.Owleyeintranuclearinclusionbodyis
seenin?
a)Herpeszoster
b)Herpessimplex
c)CMV
d)EBV
CorrectAnswer-C
Ans.is'c'i.e.,CMV
CYTOMEGALOVIRUS(CMV)
Alsoknownassalivaryglandvirus
CMVisthelargestvirusamongstherpesviruses
Theyarecharacterizedbyenlargmentofinfectedcells(cytomegalic
cells)andintranuclearinclusions.
Intranuclearinclusioniseccentricallyplacedandissurroundedbya
halo-owl'seyeappearance
OnceinfectedanindividualcarriesCMVforlife
CMVisthemostcommonorganismcausingintrauterineinfection.
CMVisthemostcommonpathogencomplicatingorgan
transplantation.

---

832.Trueabouthydatidcystareall,except?
a)Mostcommonsiteisliver
b)Calcificationiscommoninlung
c)Mayinvolvekidney
d)Livercystsaremorecommoninrightlobe
CorrectAnswer-B
Ans.is'b'i.e.,Calcificationiscommoninlung
Hydatiddisease
Livercysts
Themajorityofhydatidcystsoccurintheliver,causingsymptoms:
Chronicabdominaldiscomfort
Palpableabdominalmass
Allergicreactionsduetocystrupture-skinrash,anaphylacticshock,
ordeath.
Abscessformationduetosecondrybacterialinfection
Livercystsoccurmorefrequentlyintherightlobe.
Lungcyst
Secondmostcommonorgan(afterliver)
Usuallyasymptomatic
Occasionallymaycausesymptoms.
Leastcommonsiteofcalcifiedhydatidcyst.
Radiographicsigns
1. Meniscussign
2. Water-lilysign,camalotesign
3. Risingsunsign,serpentsign
4. Emptycystsign

---

833.ParasitesforwhichmodifiedZNstainis
used?
a)Isospora
b)Microsporidia
c)Plasmodium
d)Echinococcus
CorrectAnswer-A
Ans.is'a'i.e.,Isospora

---

834.Apatientpresentswithfever.Peripheral
smearsshowsbandacrossthe
erythrocytes.Diagnosisis?
a)PFalciparum
b)Pvivax
c)Povate
d)Pmalariae
CorrectAnswer-D
Ans.is'd'i.e.,Pmalariae
Bandacrosserythrocytes(band-formtrophozoites)ischaracteristic
ofPmalariae.

---

835.BandformofPmalariaeis?
a)Schizointstage
b)Trophozoitestage
c)Merozoitestage
d)Gametocytestage
CorrectAnswer-B
Ans.is'b'i.e.,Trophozoitestage

---

836.Schizointarenotseeninperipheral
bloodofwhichmalarialparasites?
a)Pvivax
b)Pfalciparum
c)Povale
d)Pmalariae
CorrectAnswer-B
Ans.is'b'i.e.,Pfalciparum
Inperipheralsmearoffalciparummalariafollowingformsareseen
Earlyringform
Gametocytes
Maturetrophozoitesandschizointarenotfoundinperipheralblood
becauseschizogonyoccursinsidethecapillaryofinternalorgans
(spleen,liverandbonemarrow).

---

837.Babesiosisistransmittedby?
a)Tick
b)Mites
c)Flea
d)Mosquito
CorrectAnswer-A
Ans.is'a'i.e.,Tick
Babesia
Babesiosisisaprotozoandiseasecausedbytwospeciesof
Babesia:BabesiamicrotiandBabesiadivergens.
ItistransmittedbyIoxdidtick.
BabesiainfectstheRBCsandresidesinsidetheRBCs(
intraerythrocytic).IntraerythrocyticinfectionofBabesiosisis
characterisedbymaltesecross.Maltesecrossisacharacteristic
arrangementofparasiteswithintheerythrocytesParasiteswithin
erythrocytesarearrangedsuchthatpointedendsoffourparasites
comeincontacttherebygivingatetradconfigurationresemblinga
maltesecross.Tetradformsor'Maltesecross'appearanceis
consideredpathognomicofBabesiosis.
ClinicallyBabesiosispresentswithchills,fever,mild
hepatosplenomegaly,andmildhemolyticanemia.oTreatment
includesAtovaquoneplusazithromycinorquinineplusclindamycin.
BabesiosiscaneasilybeconfusedwithP.falciparummalaria.
FollowingtwofeaturesdistinguishBabesiosisfrommalaria:?
1. PresenceofmaltesecrossinBabesiosis(absentinmalaria)
2. AbsenceofpigmentHemozoininBabesiosis(presentinmalaria)
Note-Maltesecrossisalsoseenincryptococcusandaspergillus.

---

838.SabinfeldmanDyetestisusedto
demonstrateinfectionwith?
a)Filaria
b)Toxoplasma
c)Histoplasma
d)Ascaris
CorrectAnswer-B
Ans.is?b'i.e.,Toxoplasma
ThepolyclonalIgGantibodiesevokedbyinfectionareparasiticidalin
vitrointhepresenceofserumcomplementandarethebasisforthe
Sabin-Feldmandyetest.
Laboratorydiagnosisoftoxoplasmosis
Laboratorydiagnosiscanbemadeby
1. Microscopicdemonstrationoftheparasite
2. Isolationoftheparasitebyanimalinoculationortissueculture.
3. Polymerasechainreaction
4. Serology
Themostcommonmethodoflaboratorydiagnosis
PersonsshouldinitiallybetestedforthepresenceofToxoplasma
specificIgGantibodiestodeterminetheir
immunestatus.ApositiveIgGtitreindicatesinfectionwiththe
organismatsometime(recentorpast).
ThenanIgGpositivepersonshouldhaveanIgMtest.Anegative
testessentiallyexcludesrecentinfection.However,apositiveIgM
testdoesnotalwaysmeanarecentinfectionbecausetoxoplasma
specificIgMantibodiesmaypersistformonthstoyearfollowing
primaryinfection.Therefore:?
NegativeIgMwithpositiveIgGalwaysmeansapastinfection.

---

PositiveIgMwithpositiveIgGindicatespossibilityofrecentinfection,
butnotwith100%surety.Itmayormaynotberecentinfection.To
differentiatebetweenrecentandpastinfection,IgGaviditytestis
used.
ItisworthnotingherethatathirdsituationisalsopossiblewhenIgM
testispositivebutIgGtestisnegative.Inthissituationasecond
sampleshouldbetakenafter2-4weeksandshouldbetested:?
IfthesecondsampleispositiveforIgGandIgM,itindicatesthatthe
firstsamplewastakenearlyinthediseasewhenIgGwasnotyet
developed.
IfthesecondsampleisstillnegativeforIgGwithpositiveIgM,it
indicatesfalsepositiveIgMtest.
TestsforIgGantibodies
TestsforIgMantibodies
IgGELISA/EIA
IgMindirectflourscentantibody
Sabin-Fieldmandyetest
test(IgMIFA)
IgGindirectflourscent
DoublesandwichELISA
antibodytest(IgGIFA)
IgMcaptureEIA
Diffemtialagglutination(
Immunosorbantagglutination
AC/HS)
assay(ISAGA)
Aviditytest

---

839.Ovoviviparousparasitewhichis
associatedwithautoinfection?
a)Ancylostomaduodenale
b)Strongyloidesstercoralis
c)Enterobiusvermicularis
d)Ascaris
CorrectAnswer-B
Ans.is'b'i.e.,Strongyloidesstercoralis
Amongthegivenoptions,strongyloidesandenterobiuscancause
autoinfection.
Strongyloidesisovoviviparous,whereasenterobiusisoviparous.

---

840.Apatientpresentswithheadache,high
feverandmeningismus.Within3dayshe
becomesunconscious.Mostprobable
causativeagent?
a)Naegleriafowleri
b)Acanthamoebacastellani
c)Entamoebahistolytica
d)Trypanosomacruzi
CorrectAnswer-A
Ans.is'a'i.e.,Naegleriafowleri
AmongstthegivenoptionsNaeglariaandAcanthamoebacause
amoebicencephalitis.
"TheprognosisofNaeglariaencephalitisisuniformalypoor,most
patientsdiewithinaweek".
"Acanthamoebaencephalitisfollowsamoreindolentcourse".

---

841.Tachyzoitesareseenin?
a)Toxoplasma
b)Toxocara
c)Pulmonaryeosinophilia
d)Ascaris
CorrectAnswer-A
Ans.is'a'i.e.,Toxoplasma
Toxoplasmosisisthediseasecausedbyinfectionwiththeobligate
intracellularparasiteToxoplasmagondii.
TherearetwodistinctstagesinthelifecycleofTgondii:?
Nonfelinestage
Inthisstagetissuecysts(containgbradyzoites)orsporulated
oocystsareingestedbyintermediatehosts(Human,mouse,sheep
orpig).
Thecystisrapidlydigestedbytheacidic-pHgastricsecretion
releasingbradyzoitesorsporozoites.
Thesebradyzoitesorsporozoitesenterthesmall-intestinal
epitheliumandtranformintorapidlydividingtachyzoites
(endozoites).
Thetachyzoitescaninfectandreplicateinallmammaliancells
exceptredbloodcells.
Tissuecystscontainingmanybradyzoitedevelop7-10daysafter
systemictachyzoiteinfection.
Thesetissuecystsoccurinavarietyofhostorgansbutpersist
principallywithintheCNSandmuscle.
Felinestage(sexualstage)
Thisstagetakesplaceinthedefinitivehost(cat)
Thiscycleisassociatedwithformationofoocysts,whichare

---

excretedincatfeces.
Matureoocystscontain2sporocysts,eachwith4sporozoites.
Theformationoftissuecystsincatsconstitutestheotherpartof
felinecycle.

---

842.Mucocutaneousleishmaniasisiscaused
by-
a)L-braziliensis
b)L.tropica
c)L.donovani
d)L-orientalis
CorrectAnswer-A
Ans.is'a'i.e.,L.braziliensis
Leishmaniasis
oVisceralleishmaniasis(Kalaazar)-L.donovani
CutaneousLeishmaniasis
a)Orientalsore-L.tropica
b)Mucocutaneousleishmaniasis(Espundia)-L.brasiliensis

---

843.Thecysticformofallareseeninman
except?
a)E.histolytica
b)Giardia
c)Trichomonas
d)Toxoplasma
CorrectAnswer-C
Ans.is'c'i.e.,Trichomonas
Protozoalparasiteshavetwophases.
Cysticphase
TrophozoiteCysticphaseisnotseenin:
Trichomonas
Entamoebagingivalis
Dientamoebafragilis

---

844.Whichofthefollowingisasexualspore
?
a)Chlamydospore
b)Sporangiospore
c)Ascospore
d)Phialoconidia
CorrectAnswer-C
Ans.is'c'i.e.,Ascospore

---

845.Trueaboutcryptococcusareallexcept
a)Primarilyinfectslung
b)Ureasenegative
c)India-inkisused
d)Allaretrue
CorrectAnswer-B
Ans.is`bi.e.,Ureasenegative
CRYPTOCOCCUSNEOFORMANS
Theonlypathogenicyeast
Fourcapsularserotypes-A,B,CandD
Ithaspolysaccharidecapsule
Mostinfectionsinimmunocompromizedpatientsarecausedby
serotypeA.
PigeondroppingscommonlycontainsserotypeAandD.
EucalyptustreecontainserotypeB.
Itisureasepositive.
Modeoftransmission
Byinhalationofthefungusintothelung(mostcommon)
Throughskinormucosa(sometimes).

---

846.Whichofthefollowingfungiis/are
difficulttoisolateculture?
a)Candida
b)Dermatophytes
c)Cryptococcus
d)Malasseziafurfur
CorrectAnswer-D
Ans.is'D'i.e.,Malasseziafurfur
Malasseziafurfurdoesnotgrowonregularsabouraud'smedium.
Itrequirescomplexmediatogrow
M.furfurisalipiddependentfungusand1%emulsifiedoliveoilis
addedtosabouraudmediumforitscultivation
Twomediaarenowwidelyemployedforallmalasseziaspecies.
1. Dixonmedium
2. Modifieddixonmedium

---

847.KOHwetmountispreparedfor?
a)HerpesZoster
b)Candida
c)Gonorrhea
d)Trichomonasvaginalis
CorrectAnswer-B
Ans.is'b'i.e.,Candida

---

848.Allaretrueaboutcandidaexcept?
a)Pseudohyphaeseen
b)Producechlamydospore
c)Itisamould
d)Itisadimorphicfungus
CorrectAnswer-C
Ans.is'c'i.e.,Itisamould
Candida
Candidaisayeastlikefungus(notmould).
Candidaalbicansisthemostcommoncauseofmucosal
candidiasis.
Allcandidaspeciespathogenicforhumansarealsoencounteredas
commensalsofhumans,particularlyinthemouth,stoolandvagina.
Theygrowrapidlyonsimplemediaasovalbuddingcellsat25?to
37?C.
Intissue,bothyeastsandpseudohyphaearepresent.
Candidaalbicansisdifferentiatedbyothercandida:
Itformstruehyphae(mycelia)orgermtubeswhengrowninserum.
Itformsthickwalledlargesporescalledchlamydosporeswhen
grownincornmealagar.
Itisdimorphic.
RememberCandidaalbicanscanproduceyeast,truehyphae
andpseudohyphae.
ArapidmethodofidentifyingC.albicansisbasedonitsabilityto
formgermtubeswithintwohourswhenincubatedinhumanserum
at37?CReynolds-Braudephenomenon(Alsoknownasgermtube
test)

---

849.NottrueaboutHistoplasmacapsulatum
?
a)Dimorphicfungus
b)MaymimicTB
c)Capsulated
d)Mostlyasymptomic
CorrectAnswer-C
Ans.is'c'i.e.,Capsulated
Histoplasmacapsulatum
Adimorphicfungus
NonencapsulatedTheonlymedicallyimportantcapsulated
fungusiscryptococcus.
Infectionisacquiredbyinhalationofmicroconidia(smallspores)in
dustcontaminatedwithbirdorbatdropping.
Itcausesintracellularinfectionofreticuloendothelialsystem.
ClinicalmanifestationsMajorityofpatientsareasymptomatic

---

850.Intermediatehostforguineaworm?
a)Fish
b)Man
c)Cyclops
d)Crab
CorrectAnswer-C
Ans.is'c'i.e.,Cyclops

---

851.R-factorinbacteriaistransferedby?
a)Transduction
b)Transformation
c)Conjugation
d)Verticaltransmission
CorrectAnswer-C
Ans.is'c'i.e.,Conjugation
Conjugation
Bacterialconjugationisthetransferofgeneticmaterialbetween
bacteriathroughdirectcelltocellcontactorthroughabridge-like
connectionbetweentwocells.
Conjugationisprocesswherebyadonor(male)bacteriummakes
physicalcontactwitharecipient(female)bacterium.
Donorstatusisdeterminedbythepresenceofplasmid.
Thisplasmidcodesforspecializedfimbria(sexpilus)andforself
transfer.
Sexpilus(conjugationtube)helpsintransferofgeneticmaterial
frommalebacteriumtofemalebacterium.
Theplasmidisknownastransferfactor(sexfactororfertilityfactor).
PlasmidmaybeRfactor,whichcodesfortransferrablemultipledrug
resistance.
TheDNAoftheplasmidreplicatesduringtransfersothateach
bacteriumreceivesacopyRecipientbecomesdonorandthedonor
retainsitsdonorstatus.

---

852.HEPAfilterisusedtodisinfect?
a)Water
b)Air
c)Culture
d)Blood
CorrectAnswer-B
Ans.is'b'i.e.,Air
HEPA(High-efficiencyparticulateair)filterisusedtoremove
microorganismsfromair.
HEPAfiltertrapsairborneparticlesandmicrobes.
Itcanremove>95%ofallparticlesincludingmicroorganismswitha
diameter>0.3p.m.

---

853.Fecesaredisinfectedbestby?
a)1%formaldehyde
b)5%cresol
c)5%phenol
d)Isopropylalcohol
CorrectAnswer-B
Ans.is'b'i.e.,5%cresol
"Themosteffectivedisinfectantforgeneraluseisacoal-tar
disinfectantwithaRideal-Walker(RW)coefficientof10ormore
suchascresol".

---

854.Endoscopetubeissterilizedby?
a)Glutaraldehyde
b)Formalin
c)Autoclaving
d)Boiling
CorrectAnswer-A
Ans.is'a'i.e.,Glutaraldehyde
2%Glutaraldehyde(cidex)ismostoftenusedforequipmentsuchas
endoscopethatcannotbesterilizedordisinfectedbyheat.

---

855.Laproscopeissterilizedby?
a)2%formalin
b)2%glutaraldehyde
c)Autoclaving
d)Boiling
CorrectAnswer-B
Ans.is'b'i.e.,2%glutaraldehyde
Allendoscopes(e.g.laproscope)aresterilizedby2%glutaraldehyde
(cidex).

---

856.Heatlabileliquidsaresterilizedby?
a)Hotairoven
b)Autoclaving
c)Membranefilter
d)Moistheat
CorrectAnswer-C
Ans.is'c'i.e.,Membranefilter
Filtersareusedtosterilizeheat-labilesolutions.
Membranefiltersareusedtosterilizepharmaceuticalsubstances,
ophthalmicsolutions,liquidculturemedia,oils,antibioticsandother
heatsensitivesolutions.

---

857.Coldsterilizationis?
a)Sterilizationbynegativetemperature
b)Sterilizationbyionizingradiation
c)SterilizationbyliquidCO2
d)Sterilizationbynon-ionizingradiation
CorrectAnswer-B
Ans.is'b'i.e.,Sterilizationbyionizingradiation

---

858.Lethaleffectofdryheatisdueto?
a)Denaturationofproteins
b)Oxidativedamage
c)Toxicityduetometabolites
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
HEATSTERILIZATION
Heatisthemostreliablemethodofsterilisationandshouldbethe
methodofchoiceunlesscontraindicated.oSterilizationbyheatisof
twotypes.
Dryheat
Killingeffectisduetoproteindenaturation,oxidativedamageand
thetoxiceffectofelevatedmetabolites.

---

859.Temperaturerequiredforholdingperiod
of20minutesinHotairoven-
a)160?C
b)170?C
c)120?C
d)130?C
CorrectAnswer-B
Ans.is'b'i.e.,170?C

---

860.Rideal-Walkercoefficientisrelatedwith
?
a)Disinfectingpower
b)Parasiticclearance
c)Dietaryrequirement
d)Statisticalcorrelation
CorrectAnswer-A
Ans.is'a'i.e.,Disinfectingpower
Traditionaltestingofdisinfectants
Twotraditionaltestsfordeterminingtheefficiencyofdisinfectants
are:?
1)Rideal-Walkertest:Phenolistakenasthestandardwithunit
asphenolcoefficient(pheno1=1)
2)Chick-Martintest:Thedisinfectantactsinthepresenceof
organicmatter(driedyeastorfeces).

---

861.Bestindicatorforsterilizationby
autoclaving?
a)Bacillussubtilis
b)Geobacillus
c)Bacilluspumilis
d)Clostridium
CorrectAnswer-B
Ans.is'b'i.e.,Geobacillus
Biologicalindicators
Biologicalindicatorsarestandardisedpreparationsof
microorganismsusedtoassesstheeffectivenessofasterilization
process.
Theyusuallyconsistofapopulationofbacterialsporesplacedonan
inertcarrier,forexampleastripoffilterpaper,aglassslideora
plastictube.
Mostcommonly,sporesofBacillusstereothermophilus(Geobacillus
stearothermophilus)areused.SporesofBacillussubtilisand
Bacilluspumilisarealseused.

---

862.Sterilizationisdefinedas?
a)Disinfectionofskin
b)Completedestructionofallmicroorganisms
c)Destructionofpathogenicorganisms
d)Decreasebacterialcountfromobjects
CorrectAnswer-B
Ans.is'b'i.e.,Completedestructionofallmicroorganisms
Sterilization
Theprocessbywhichanarticlesurfaceormediumisfreedofall
livingmicroorganismseitherinthevegetativeorsporestate
Completeabsenceofmicroorganism.
Disinfection
Destructionorremovalofallpathogenicorganismscapableofgiving
risetoinfectionreductioninthemicroorganismstosuchalevel
whichisdeemednolongerharmfultohealth.
Unlikesterilization,disinfectionisnotsporicidal(doesnotkill
spores).
Decontamination
Theprocessofrenderingofanarticleorareafreeofdangerfrom
contaminants,includingmicrobial,chemical,radioactiveandother
hazards.
Antisepsis
Itisdefinedas"Preventionofinfection,usuallybyinhibitingthe
growthofbacteriainwoundortissues".
Antiseptics
Chemicaldisinfectantswhichcanbesafelyappliedtoskinor
mucousmembranearecalledantisepticsorskindisinfactant.
Bestandmostcommonlyusedantisepticispovidoneiodine

---

(betadine).Commonlyusedskindisinfactantsforhandwashingare
povidoneiodine(betadine),chlorhexidineandisopropylalcohol.
Disinfectants
Antimicrobialsappliedonlytoinanimateobject.Theyarenotused
forsurfacedisinfection(A"9)(skinormucousmembrane).
Germicides
Theseincludebothantisepticsanddisinfectant.

---

863.Stoolspecimenistransportedin?
a)Caryblairmedium
b)Bloodagar
c)SeleniteFbroth
d)CompyBAPmedium
CorrectAnswer-A
Ans.is'a'i.e.,Caryblairmedium
Transportmediaforstoolspecimenare:?
a. Cary-Blairmedium
b. Bufferedglycerolsaline
c. Stuartmedium
Inoculatemediaforroutinestoolcultureare:-
a. Bloodagar
b. MacConkeyagar
c. HektoenentericHE(agar)
d. Selectivemediaforcampylobactor:CampyBAP,skirrow
e. SeleniteFbrothorGNBroth
f. Xylose-lysinedeoxycholateagar(XLDagar)
Forspecificsituations,selectivemediaareused:-
i. Vibrio:TCBSagarorAlkalinepeptonebroth.
ii. Yersinia:Cefsulodin-Irgasan-Novobiosin(CIN)agarorPhosphate
BufferedSaline(PBS)broth.
iii. E.coli0157:H7:Sarbitol-MacConkeyagar.

---

864.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

---

865.Tripleironsugarmediumcontainsall,
except?
a)Lactose
b)Sucrose
c)Glucose
d)Maltose
CorrectAnswer-D
Ans.isdi.e.,Maltose
Triplesugarironagarisusedforthedifferentiationof
microorganismsonthebasisof:?
i. Fermentationofdextrose(glucose),lactoseandsucrose.
ii. ProductionofH2S.
Itisrecommendedfordifferentiationofentericgramnegativebacilli
fromclinicalspecimens,dairysamplesandfoodproducts.
Contentsofthemediumare:?
i. Enzymaticdigestofcaseinandanimaltissue.
ii. Yeastenrichedpeptone.
iii. Threesugars:Dextrose(glucose),lactoseandsucrose.
iv. Ferricammoniumcitrate.
v. Sodiumchloride.
vi. Sodiumthiosulfate.
vii. Phenolred.
viii. Agar.
Whencarbohydratesarefermented,acidproductionisdetectedby
thephenolredindicator,whichisyellowinacidandredinalkaline
conditions.
Sodiumthiosulfateisreducedtohydrogensulfide(H2S)andH2S

---

reactswithanironsaltyieldingtypicalblackironsulfide.Ferric
ammoniumcitrateishydrogensulfideindicator.
Results
Twoareasoftubeareexamined:(i)Buttofthetube,and(ii)Slantof
thetube.
Analkalineslant(red)-acidbutt(yellow)indicatesfermentationof
dextrose(glucose)onlyred/yellow.ExamplesareProteus
mirabilis,salmonellathyphimuriumandshigellaflexneri.
Anacidslant(yellow)-acidbutt(yellow)indicatesfermentationsof
dextrose(glucose),lactoseand/orsucroseyellow/yellow.
ExampleisEcoli.
Analkalineslant(red)-alkalinebutt(red)indicatesnofermentation
(non-fermenter)red/red.ExampleisPseudomonasaeruginosa.
AnalkalineprecipitateinbuttindicatesH2Sproduction.Itis
producedbyProteusmirabilisandSalmonellatyphimurium.

---

866.IndicatorusedinMaConkeyAgar?
a)Methyleneblue
b)Methylred
c)Neutralred
d)Bromothymolblue
CorrectAnswer-C
Ans.is'c'i.e.,Neutralred
MacConkeyagarisaselectivemediumforentericgramnegative
bacilli.
Itisusedtodifferentiatelactosefermentingentericbacillifrom
lactosenon-fermenters.
CompositionofMacConkeyagar?
1)Enzymaticdigestofgelatin,caseinandanimaltissue:Toprovide
nutrition.
2)Lactose:Fermentablecarbohydrate.
3)Bilesalts:Selectiveagentandinhibitsgrampositiveorganisms.
4)Crystalviolet:Inhibitsgrampositivebacteria.
5)Sodiumchloride:Suppliesessentialelectrolytesandosmotic
balance.
6)Neutralred:pHindicator(whenlactoseisfermented,thepHof
mediumdecreases,changingcolorofneutralredtopink).
7)Agar:Solidifyingagent.

---

867.Bloodagarisanexampleof?
a)Enrichedmedia
b)Indicatormedia
c)Enrichmentmedia
d)Selectivemedia
CorrectAnswer-A
Ans.is'a'i.e.,Enrichedmedia

---

868.Bestspecimenforanaerobicculture?
a)Exudatesfromwound
b)Pusaspiratedinvial
c)Swabfromwound
d)Mid-streamurine
CorrectAnswer-B
Ans.is'b'i.e.,PUSaspiratedinvial
Idealspecimensforanaerobicculturesaresamplesofneedle
aspiratesandpropertissuespecimens.Anaerobicswabsareusually
discouraged.
Importantspecimensare:-
i. Localabscess:Needleaspirates.
ii. Pulmonary:Transtrachealaspirates,lungaspirates,pleuralfluid,
protectedbronchialwash.
iii. Abdominal:Abdominalabscessaspirate.
iv. Urinarytract:Suprapubicbladderaspirate.
v. Genitaltract:Culdocentesisspecimen,endometrialswabs.
vi. CNS:CSF,Aspirateofabscess.
Aspiratedmaterialtheninjectedintooneofthefollowing:?
a. Anaerobicswab
b. Thioglycollateenrichmentbroth
c. Oxygenfreevials
Exudates,swabsfromburns,woundandskinabscessesare
generallyunacceptableforanaerobicculture.Cystsandabscessare
contaminatedwithnormalanaerobicflora.
Voidedandcatheterizedurinearecontaminatedwithdistalurethral
anaerobesandarethereforeunacceptableforanaerobicculture.

---

869.Aerobicbloodcultureshouldbe
incubatedforhowmanydays,before
discarding?
a)2days
b)5days
c)10days
d)14days
CorrectAnswer-D
Ans.is'd'i.e.,14days
Bloodspecimensof5or10mlgenerallyareaddedtobottles
containing,50or100mlofreagent(medium)toachievea1:10
bloodmediumratio.
Allbottlesshouldbetransportedtothelaboratoryassoonas
possibleandimmediatelyincubetedat35?2?Cinanupright
position(Note-Lowerincubationtemperaturemaybepreferredfor
isolationofsomespecificbacteria,e.g.Listeriagrowswellat20-
25?C).
Atotalincubationperiodof7daysisgenerallysufficientforroutine
isolationprocedure,whichcanbeextendedupto14daysbefore
discardingthosethatdonotshowevidenceofgrowth.

---

870.DrugresistanceinTuberculosisisdueto
?
a)Transformation
b)Transduction
c)Conjugation
d)Mutation
CorrectAnswer-D
Ans.is'd'i.e.,Mutation

---

871.Methodusedforacidfaststaining?
a)Robertson'smethod
b)ZiehlNeelsen
c)Silverimprignationmethod
d)Darkgroundillumination
CorrectAnswer-B
Ans.is'b'i.e.,ZiehlNeelsen
Acidfaststaining
Afterstainingwithanilinedye,acidfastorganismsresist
decolourisationwithacids.
MethodmostcommonlyusedismodifiedZiehlNeelsen.

---

872.Metachromaticgranulesareseenin?
a)Gardenellavaginali
b)Corynebacteria
c)Argobacterim
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Polvpmetahosphate/volutingranules
Somebacteriacontaingranulescomposedofpolymetaphosphate.
Theywerefirstdescribedinspirillumvolutans,sotheywerecalled
asVolutingranules.
ThesegranulesarealsoknownasBabesErnstgranulesorpolar
bodiesormetachromaticgranules.
Thesegranulesstainreddishvioletwithmethyleneblueortoluidine
blue.
Thesegranulesarestronglybasophilic.
Inthegranules,thereisstoredphosphateintheformoflinear
chainsofinorganicphosphate.Thesegranulesrepresent
intracellularphosphatereservewhennucleicacidsyntheisdoesnot
occur.
Thephosphateisincorporatedintonucleicacidduringthesynthesis
ofthelatter.
Whennucleicacidsynthesisispreventedbystarvation,the
granulesaccumulateinthecytoplasm.So,volutinmetachromatic
granulesaremostfrequentincellsgrownunderconditionsof
nutritionaldeficiency(starvation)andtendtodisappearwhenthe
deficientnutrientsaresupplied.
Volutinmetachromaticgranulesarecommonin-

---

i. Corynebacteriadiptheriae
ii. Gardenellavaginalis
iii. Agrobacterimtumefaciens
iv. Mycobacteria
v. Spirillumvoluants

---

873.Bifringencepolarizationmicroscopyis
usedfor?
a)Flagella
b)Intracellularstructures
c)Capsule
d)Spores
CorrectAnswer-B
Ans.is`b'i.e.,Intracellularstructures
Polarizationmicroscopeenablesthestudyofintracellularstructure
usingdifferencesinbifringence.

---

874.Thermophilebacteriagrowat?
a)20?C
b)20-40?C
c)40-60?C
d)60-80?C
CorrectAnswer-D
Ans.is'd'i.e.,60-80?C
Temperaturerequirementofbacteria
Bacteriavaryintheirrequirementsoftempratureforgrowth.
1. Psychrophilicbacteriagrowbestattemperaturebelow20?C
2. Thermophilicbacteriagrowbestbetween55-80?C
3. Mesophilicbacteriagrowbestbetween25-40?C

---

875.Cellwalldeficientorganismsare
a)Chlamydia
b)Mycoplasma
c)Streptococcus
d)Anaerobes
CorrectAnswer-B
Ans.is'b'i.e.,Mycoplasma
Mycoplasma
Smallestfreelivingorganism,areprokaryotes
Lackcellwall,areboundedbyatriplelayeredunitmembranethat
containssterol(thereforemycoplasmasrequiresterolforgrowth).
Theirlackofcellwallisassociatedwithcellularpleomorphismand
resistancetocellwall-activeantimicrobialagents,suchas
penicillinsandcephalosporins(13-lactamdrugs).
Multiplicationisbybinaryfission.
Uniqueamongprokaryotesistherequirmentofmostmycoplasmas
forcholesterolandrelatedsterols.

---

876.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

---

877.Peritrichousflagellaeareseenin?
a)Vibriocholerae
b)Proteus
c)Campylobacter
d)Legionella
CorrectAnswer-B
Ans.is'b'i.e.,Proteus

---

878.Trueaboutendotoxin?
a)Protein
b)Highlyantigenic
c)Noenzymaticactivity
d)Producedbygrampositivebacteria
CorrectAnswer-C
Ans.is'c'i.e.,Noenzymaticactivity

---

879.Whichofthefollowingisanexampleof
heterophileantibodytest?
a)Widaltest
b)Weil-Felixreaction
c)Rose-walertest
d)Bloodgrouping&crossmatching
CorrectAnswer-B
Ans.is'b'i.e.,Weil-Felixreaction
Heterophilicagglutinationreaction
Someorganismsofdifferentclassorspeciessharecloselyrelated
antigens.
Whenserumcontainingagglutinin(antibody)ofoneorganismgives
agglutinationreactionwithantigenofotherorganism,itiscalled
heterophilicagglutinationtest.
Examplesare
StreptococcusM.G.agglutinationtestforprimaryatypical
pneumonia.
Weil-Felixreactionfortyphusfever.
PaulBunnelltestforIM1V.

---

880.Complementcomponentsare:
a)Lipids
b)Proteins
c)Lipoproteins
d)Polysaccharide
CorrectAnswer-B
Ans.b.Proteins

---

881.Complementcomponentsare?
a)Lipoproteins
b)Glycoproteins
c)Polysaccharides
d)Lipid
CorrectAnswer-B
Ans.is'b'i.e.,Glycoproteins
Theproteinsandglycoprotiensthatconstitutethecomplement
systemaresynthesizedbyhepatocytes"--Internet
"Mostofthecomplementglycoproteinsaresynthesized
predominantlybytheliver,butmacrophagesandmanyothercell
typesarealsosourcesofvariouscomplementcomponents"-
Medicalimmunology
"Complementcomponentsareglycoproteins"--Textbookof
HumanBloodPlasmaProtiens

---

882.C1esteraseinhibitordeficiencycauses?
a)Neisseriainfection
b)Hereditaryangioneuroticedema
c)Hemolyticdisease
d)Hemolyticuremicsyndrome
CorrectAnswer-B
Ans.is'b'i.e.,Hereditaryangioneuroticedema
HereditaryangioneuroticedemaisduetoC1inhibitor(CIesterase
inhibitor)deficiency.

---

883.Membraneattackcomplex(MAC)in
complementsystemis:
a)C3b
b)C13
c)C5_9
d)C24
CorrectAnswer-C
Ans.c.C5_9

---

884.Runtdiseaseis?
a)Graftrejection
b)Graftvshostdisease
c)Hostvsgraftdisease
d)TypeIIIhypersensitivity
CorrectAnswer-B
Ans.is'b'i.e.,Graftvshostdisease

---

885.AcquireIgAdeficiencymayoccurin?
a)SevereCongenitaltoxoplasmosis
b)SevereMeaslesinfection
c)SevereBrucellosis
d)SevereLeptospirosis
CorrectAnswer-A
SevereCongenitaltoxoplasmosis
BlockinBcelldifferentiationduetodefectiveinteractionbetweenT
andBcells.NaiveBcellsarenotabletodifferentiateintoIgA-
producingcells.

---

886.Neutrilizationtestis
a)Widaltest
b)Weil-Felixtest
c)PaulBunneltest
d)Naglerreaction
CorrectAnswer-D
Ans.is`d'i.e.,Naglerreaction
Neutralizationreaction
Whenantibodyreactswithatoxinorotherbiologicallyactive
antigen,itmayneutralizetheeffectoftoxinorantigen.
Thisabilitytousedinneutralizationtest.
Neutralizationtestsareoftwotypes

---

887.IgEbindstowhichcell?
a)Tcells
b)Bcells
c)Mastcells
d)NKcells
CorrectAnswer-C
IgEbindstoMastcellsandbasophils,andmediateTypeI
hypersensitivity.

---

888.WhichofthefollowingStaphylococcal
infectionisnottoxinmediated:
a)Toxicshocksyndrome
b)Scaldedskinsyndrome
c)Foodpoisoning
d)Septicshock
CorrectAnswer-D
Ans.is(d)Septicshock
ToxinmediatedillnessofS.
Disease
Toxininvolved
-Toxicshocksyndrome
Toxicshocksyndrometoxin
-Foodpoisoning
Enterotoxin
-Staphylococcalscaldedskin
Exfoliative/epidermolytic
syndrome
toxin
Note:Septicshockisduetobacteremia.

---

889.WhichofthefollowingisAmphixenoses
?
a)Anthrax
b)Rabies
c)Trypanosomacruzi
d)Salmonella
CorrectAnswer-C
Ans.is'C'i.e.,Trypanosomacruzi
Zoonoses
Zoonosesarediseasesandinfectionswhicharenaturally
transmittedbetweenvertebrateanimalandman.
Thezoonosesmaybeclassifiedaccordingtothedirectionof
transmissionofdisease:
1.Anthropozoonoses
Infectionistransmittedtomanfromlowervertebrateanimals.
ExamplesRabies,plague,hydatiddisease,anthrax,trichinosis.
2.Zoonthroponoses
Infectionistransmittedfrommantolowervertebrateanimals
ExamplesHumantuberculosisincattle
3.Amphixenoses
Infectionismaintainedinbothmanandlowervertebrateanimals
thatmaybetransmittedineitherdirection.
ExamplesTcruzi,S.japonicum.

---

890.Whichvaccinecancauseadverseeffects
inpersonswithallergytoegg?
a)Measles
b)Rubella
c)Rabies
d)Mumps
CorrectAnswer-C
Ans.is'c'i.e.,Rabies
DuckembryoVaccinehaslessneuroparalyticcomplications,butcan
causeallergicreactions.Personsallergictoeggs,shouldnotbe
giventhisvaccine.
RabiesVaccine
Rabiesvaccinesarefluidordriedpreprationoffixedvirusgrownin
theneuraltissuesofrabbits,sheep,goats,miceorratsorin
embryonatedduckseggorincellcultures.
Inactivationofvirusiscommonlydonebytreatmentwithformalinor
13.Propiolactone(B.P.L.)oAntirabiesvaccinefallintotwomain
categries.

---

891.MostcommonNosocomialinfection?
a)Pneumonia
b)UTI
c)Surgicalwoundinfection
d)Nephritis
CorrectAnswer-B
Ans.is'b'i.e.,UTI
MostcommonnosocomialinfectionUrinarytractinfection.
MostofthenosocomialUTIsoccurafterurinarycatheterization.
SecondmostcommonnosocomialinfectionPneumonia.
Mostofthenosocomialpneumoniasareacquirethroughrespiratory
intubation,mechanicalventilationandsuctionofthematerialfrom
mouth.

---

892.Whichofthefollowingisnotrelatedto
epidemiology?
a)Promotionofhealth
b)Identificationofetiologyofdisease
c)Tocollectdataofmagnitudeofhealthproblem
d)Toteachamedicalstudenthowtoconductsafedelivery
CorrectAnswer-D
Ans.is'd'i.e.,Toteachamedicalstudenthowtoconductsafe
delivery
AccordingtotheInternationalEpidemiologicalAssociation(IEA),
epidemiologyhasthreemainaims:
a)Todescribethedistributionandmagnitudeofhealthanddisease
problemsinhumanpopulations.
b)Toidentifyaetiologicalfactors(riskfactors)inthepathogenesisof
disease;and
c)Toprovidethedataessentialtotheplanning,implementationand
evaluationofservicesfortheprevention,controlandtreatmentof
diseaseandtothesettingupofprioritiesamongthoseservices.
Inordertofulfiltheseaims,threeratherdifferentclassesof
epidemiologicalstudiesmaybementioned:descriptivestudies,
analyticalstudies,andexperimentalorinterventionstudies.
Theultimateaimofepidemiologyistoleadtoeffectiveaction:
a)Toeliminateorreducethehealthproblemoritsconsequences;
and
b)Topromotethehealthandwell-beingofsocietyasawhole.

---

893.Indiacausingmaximumdeath?
a)Drowning
b)Roadtrafficaccident
c)Burns
d)Poisoning
CorrectAnswer-B
Ans.is'b'i.e.,Roadtrafficaccident
Amongtheaccidentaldeaths,maximumdeathsarecausedbytraffic
accidents,followedbydrowning(2ndm.c.cause)andpoisoning(3rd
m.c.cause).

---

894.Durkheimworkwasrelatedto?
a)Recommendationofmultipurposeworker
b)ManagementinHealthmanpower
c)Divisionoflabor
d)Integratationofmedicalandhealthservices
CorrectAnswer-C
Ans.is'c'i.e.,Divisionoflabor
FourmajorworksofDurkheimare:?
1. DivisionofLaborinsociety.
2. Rulesofsociologicalmethods.
3. Suicide
4. Elementaryformsofreligiouslife.

---

895.Medicalauditisdone?
a)Toimprovepatientscare
b)Fordoctor'sbenefit
c)Forhospitalstaffmanagement
d)Fordecreasingcostoftreatment
CorrectAnswer-A
Ans.is'a'i.e.,Toimprovepatientscare
Medicalaudit
Anobjectiveandsystematicwayofevaluatingthephysicians
performanceisknown"MEDICALAUDIT"
TheEvaluationofthe"PROCESS"ofmedicalcareiscarriedoutby
comparingwithapre-determinedstandard.
Medicalauditistheprofessionalreviewofservicesprovidedbythe
hospitalagainstgivenstandard.
Itisdefinedastheretrospectiveevaluationofqualityofmedicalcare
throughthescientificanalysisofmedicalrecords.
Medicalauditisanimportantcomponentofqualityassurance,which
inturnisanessentialpartofanymanagementprocess.

---

896.Clinicalauditmeans?
a)Measuringhospitalrecords
b)Measuringcurrentpatientscareagainstexplicitcriteria
c)Measuringinput-outputanalysis
d)Measuringshortesttimeneededtocompletetask
CorrectAnswer-B
Ans.is'b'i.e.,Measuringcurrentpatientscareagainstexplicit
criteria
Clinicalauditisaqualityimprovingprocess,inwhichpatientscareis
improved.
Inthis,currentpatientsoutcomeandoutcomesaremeasured
againstexplicitauditcriteria(againstreferencestandards).

---

897.Disabilityadjustedlifeyear(DALY)isa
measureof?
a)Lifeexpectancy
b)Effectivenessoftreatment
c)Qualityoflife
d)Humandevelopment
CorrectAnswer-B
Ans.is'b'i.e.,Effectivenessoftreatment
Disability-adjustedlifeyear(DALY)
DALYisameasureof:-
Theburdenofdiseaseinadefinedpopulation
Theeffectivenessofinterventions
Itexpressesyearslosttoprematuredeathandyearslivedwith
disabilityadjustedfortheseverityofthedisability.
Thatmeans,DALYmeasuresbothmortalityanddisability
together(incontrasttosullivan'sindexwhichisrelatedtodisability
only).
OneDALYisonelostyearofhealthylife.
DALYcombinesfollowing:-
Yearsoflostlife(YLL).
Yearslosttodisability(YLD)
DALY=YLL+YLD
Japaneselifeexpectancystatisticsareusedasastandardfor

---

measuringprematuredeath,asJapanesehavethelongestlife
expectancy.
Health-adjustedlifeexpectancy(HALE)
HALEistheindicatorusedtomeasurehealthylifeexpectancy.
HALEisbasedonthelifeexpectancyatbirthbutincludesan
adjustmentfortimespentinpoorhealth.
Itistheequivalentnumberofyearsinfullhealththatanewborn
canexpecttolivebasedoncurrentratesofillhealthandmortality.

---

898.Humandevelopmentindexincludesall
except?
a)Longevity
b)Knowledge
c)Income
d)Literacyrate
CorrectAnswer-D
Ans.is'd'i.e.,Literacyrate
Humandevelopmentindex
HDIisacompositeindexcombiningindicatorsrepresentingthree
dimensions.
i. Longevity:Lifeexpectancyatbirth.
ii. Knowledge:Meanyearsofschooling(grossenrolmentratio)and
expectedyearofschooling.(InoldereditionsofPark,i.e.,21st/eand
olderthanthat,itwasadultliteracyrateinsteadofexpectedyear
schooling).
iii. Income:GNIPerCapita(InoldereditionsofPark,itwasGDPper
capitainsteadofGNIpercapita).

---

899.Primordialpreventionisdonetoprevent
developmentof?
a)Disease
b)Riskfactors
c)Impairment
d)Disability
CorrectAnswer-B
Ans.is'b'i.e.,Riskfactors
LEVELSOFPREVENTION
Therearefourlevelsofprevention:?
1. Primordialprevention
2. Primaryprevention
3. Secondaryprevention
4. Tertiaryprevention
PrimordialLevelofPrevention:Isprimaryprevention(seebelow)in
purestsense
Itisthepreventionoftheemergenceordevelopmentofriskfactors
incountriesorpopulationgroupsinwhichtheyhavenotyet
appeared
ModesofIntervention:
1. IndividualEducation
2. MassEducation
PrimordialLevelisBestlevelofpreventionforNon-communicable
diseases

---

900.Screeningisatypeof?
a)Primordialprevention
b)Secondaryprevention
c)Primaryprevention
d)Tertiaryprevention
CorrectAnswer-B
Ans.is'bi.e.,Secondaryprevention
Insecondaryprevention,actionhaltstheprogressofadiseaseatits
incipientstageandpreventscomplication.
Screeningtests(e.g.-Papsmear),helpsindiagnosisatearlystage
sothatadequatetreatmentcanhaltdiseaseprogressionand
preventcomplication.

---

901.

---

Lackofabilityofaparttodonormalfunction
iscalledas?
a)Impairment
b)Disease
c)Disability
d)Handicap
CorrectAnswer-C
Ans.is'c'i.e.,Disability
AccordingtoWHOdefinitions,
Disease:Anyabnormalconditionofanindividualthatimpairs
function
Impairment:Anylossorabnormalityofpsychological,physiological
oranatomicalstructureorfunction
Disability:(Becauseofimpairment,)anyrestrictionorinabilityto
performanactivityinarangeconsiderednormalforahumanbeing

---

902.Quarantineperiodofcholera?
a)1day
b)2days
c)5days
d)10days
CorrectAnswer-C
Ans.is'c'i.e.,5days

---

903.NottrueaboutAlma-Atadeclaration?
a)Washeldin1978
b)Communityparticipation
c)Healthforall
d)Bestapproachforhealthforallisbasichealthcare
CorrectAnswer-D
Ans.is'd'i.e.,Bestapproachforhealthforalisbasichealthcare
TheDeclarationofAlma-Ata(1978)byemphasizingtheneedfor
"individualandcommunityparticipation"gaveanewmeaningand
directiontothepracticeofhealtheducation.
In1978,theAlma-AtaInternationalconferenceonPrimaryHealth
CarereaffirmedHealthforAllasthemajorsocialgoalfo
governments,andstatedthatthebestapproachtoachievethegoal
ofHFAisbyprovidingprimaryhealthcare,especiallytothevast
majorityofunderservedruralpeopleandurbanpoor.
Itwasenvisagedthatbytheyear2000,atleastessentialhealthcare
shouldbeaccessibletoallindividualsandfamiliesinanacceptable
andaffordableway,withtheirfullparticipation.
TheAlma-AtaConferencecalledonallgovernmentstoformulate
nationalpolicies,strategiesandplansofactiontolaunchandsustain
primaryhealthcareaspartofanationalhealthsystem.
Itislefttoeachcountrytodevelopitsnormsandindicatorsfor
providingprimaryhealthcareaccordingtoitsowncircumstances.

---

904.Inachildwhoisallergictoegg,which
vaccineshouldbeavoided?
a)Measles
b)MMR
c)Influenza
d)DPT
CorrectAnswer-C
Ans.is'c'i.e.,Influenza

---

905. Activeandpassiveimmunityshouldbe
giventogetherinallexcept-
a)Tetanus
b)Rabies
c)Measles
d)HepatitisB
CorrectAnswer-C
Ans.is`c'i.e.,Measles
Firstseethedifferencebetweenactiveandpassiveimmunity.
Activeimmunity
oActiveimmunitydevelopsbecauseofactiveparticipationof
immuniologicalsystemofthehost.
oThatmeans,afterantigenicstimulation,thehostdevelops
antibodiesorcellularimmuneresponseagainstthatantigendueto
activationofselfBand/orcells.
oAntigenicstimulationmaybe:?
i)Clinicalinfection
ii)Subclinicalinfection
iii)Vaccination(liveattenuatedvaccineorkilledvaccineortoxoid).
Passiveimmunity
oThehost'simmunesystemdoesnottakeactiveparticipationbut
dependsonready-madeantibodiesorTcellstobetransferredtoit.
oExamples:
i)Administerationofimmunoglobulinorantiserum
ii)Transplancentaltransferofantibodiesfrommothertofetus.
iii)Administrationoflymphocytes.
Comingbacktoquestion
oInsomediseasespassiveimmunizationisoftenundertakenin
conjunctionwithinactivatedvaccineproducts,toprovideboth:?

---

conjunctionwithinactivatedvaccineproducts,toprovideboth:?
i)Immediate(buttemporary)passiveimmunity.
ii)Slowlydevelopinglonglastingactiveimmunity.
oThediseaseinwhichsimultaneousactiveandpassive
immunizationareused:?
i)Tetanusiii)Diphtheria
ii)Rabiesiv)HepatitisB
oInmeaslesalso,bothactiveandpassiveimmunizationareused,
butnotsimultaneously.Becausetheantibodyresponsetolive
attenuatedmeaslesvaccineisdiminishedinpersonswhoreceive
immunoglobulincancurrently.oSo,thepersonpassivelyimmunized
shouldbegivenlivemeaslesvaccine8-12weekslater.
So,bothactiveandpassiveimmunityareused:?
i)Simultaneously-->Tetanus,rabies,Diphtheria,HepatitisB.
Atdifferenttime-->Measles.

---

906.Postexposureprophylaxisisgiveninall
except?
a)Rabies
b)Chickenpox
c)Measles
d)Typhoid
CorrectAnswer-D
Ans.is'd'i.e.,Typhoid
Post-exposureimmunization
Postexposureimmunizationisprophylacticimmunization
immediatelyafterexposuretoapathogen,inordertoprevent
infectionbythepathogenandthedevelopmentofdisease.
Postexposureimmunizationisgivenfor-
i. Varicella(chickenpox)
ii. Measles
iii. Rabies
iv. Tetanus
v. Hepatitis
vi. Meningococcalmeningitis

---

907.Isolationisnotdonein?
a)Cholera
b)Diphtheria
c)Mumps
d)Hepatitis
CorrectAnswer-C:D
Ans.is(D)Hepatitis(C)Mumps
Isolationhasadistinctivevalueinthecontrolofsomeinfectious
diseases,e.g.,diphtheria,cholera,streptococcalrespiratorydisease,
pneumonicplague.
Insomediseaeswherethereisalargecomponentofsubclinical
infectionandcarrierstate,eventhemostrigidisolationwillnot
preventthespreadofdisease,e.g.,polio,hepatitisandtyphoid
fever.
Mumpsishighlyinfectiousbeforeitisdiagnosedhenceisolationfor
mostcasesofmumpshasprovedfutile-Park.
Measlesisalsohighlyinfectiousduringprodromalperiod,isolationis
mostusefulifdiagnosiscanbeestablishedinthe
prodromal/catarrhalstage.Butmostcasesofmeaslesare
diagnosedwiththeappearanceofrashwhencommunicability
beginstodecline.Isolationinmeaslesisthereforenotlikelytobe
veryeffective.

---

908.NotifiablediseasestoWHOareallexcept
?
a)Cholera
b)Plague
c)Yellowfever
d)Tuberculosis
CorrectAnswer-D
Ans.is'd'i.e.,Tuberculosis

---

909.Vaccinewhichshouldnotbefrozen-
a)OPV
b)Measles
c)HBV
d)Yellowfever
CorrectAnswer-C
Ans.is'c'i.e.,HBV
OPVandmeaslesvaccinesarestoredindeepfreezers.(Note:
Yellowfevervaccineisalsofreezdried,butisnotusedinIndia).
Vaccinewhichmustbestoredinthecoldpartbutneverallowedto
freez.
Typhoid
DPT
TT
HepatitisB
DT
BCG
Diluents

---

910.Nottrueaboutvaccines?
a)Twolivevaccinescanbegivenatsametimeatdifferentsites
b)Twolivevaccinesatsamesiteshouldbegivenatleast3weeks
apart
c)Invaccinevialmonitorifthecolorofinnersquareissameas
outerbackground,vaccineisgoodforuse
d)Liveandkilledvaccinescanbegiventogether
CorrectAnswer-C
Ans.is'c'i.e.,Invaccinevialmonitorifthecolorofinner
squareissameasouterbackground,vaccineisgoodforuse
VaccineVialmonitor
AnimportantimprovementinPPIduring1998hasbeentheuseof
vaccinevialmonitor.
Colourmonitorsorlabelsareputonvaccinebottles.
Eachlabelhasacircleofdeepbluecolour.
Insideitisawhitesquarewhichchangescolourandgradually
becomesblue,ifvaccinebottleisexposedtohighertemprature.
Whenthecolourofthewhitesquarebecomesbluelikethatof
surroundingcircle,thevaccineshouldbeconsideredineffective.
Thereby,thehealthworkercaneasilyascertainthatthevaccine
beinggiveniseffectiveornot.

---

911.Whichofthefollowingisnotakilled
vaccine?
a)Polio
b)HBV
c)HAV
d)Yellowfevervaccine
CorrectAnswer-D
Ans.is'd'i.e.,Yellowfevervaccine
Yellowfevervaccineisakilledvaccine.

---

912.HepatitisAvaccineavailable?
a)Liveattenuated
b)Killed(Inactivated)
c)Bothliveandinactivated
d)Subunitvaccine
CorrectAnswer-C
Ans.is'c'i.e.,Bothliveandinactivated
TwotypesofhepatitisAvaccinesareused:-
1. Formaldehydeinactivatedvaccine
2. Liveattenuatedvaccine

---

913.Trueaboutcarriers?
a)Infectionwithclinicalsymptoms
b)Servesassourceofinfection
c)Moreinfectiousthancases
d)Lessdangerousthancases
CorrectAnswer-B
Ans.is'b'i.e.,Servesassourceofinfection
Acarrierisdefinedas"aninfectedpersonoranimalthatharboursa
specificinfectiousagentintheabsenceofclinicaldiseaseand
servesasapotentialsourceofinfection".
Asarulecarriersarelessinfectiousthancases,but
epidemiologicallytheyaremoredangerousthancasesbecausethey
escaperecognition,andcontinuingastheydotoliveanormallife
amongthepopulationorcomunity,theyreadilyinfectthesusceptible
individualsoverawiderareaandlongerperiodoftime.

---

914.Healthycarrierarenotseenin
a)Salmonella
b)Diphtheria
c)Measles
d)Cholera
CorrectAnswer-C
Ans.is'c'i.e.,Measles
Theinfectiousagentisshedbytheinfectedhostasitmultipliesin
thembutthehostdoesnotmanifestsignsofthedisease.
Subclinicalinfectiondoesnotoccurinmeasles

---

915.Intervalbetweenprimaryandsecondary
cases?
a)Latentperiod
b)Communicableperiod
c)Serialinterval
d)Generationtime
CorrectAnswer-C
Ans.is'c'i.e.,Serialinterval
Latentperiod,serialintervalandgenerationtime,allare
approximatemeasureofincubationperiod,i.e.,theseperiodcan
givesomeideaaboutincubationperiod.
Latentperiod
Theperiodfromdiseaseinitiationtodiseasedetection.
Itisusedinnon-infectiousdiseaseastheequivalentofincubation
periodininfectiousdisease.
Serialinterval
Thegaptimebetweenonsetofprimarycaseandsecondarycase.
Bycollectinginformationaboutawholeseriesofsuchonset,weget
adistributionofsecondarycasesfromwhichwecanguessthe
incubationperiod.
Generationtime
Intervalbetweenreceiptofinfectonbyhostandmaximalinfectivity
ofthehost.
Generationtimeisroughlyequaltotheincubationperiod.
Aboutoption'b'
Communicableperiod
Thetimeduringwhichaninfectiousagentmaybetransferred
directlyorindirectlyfromaninfectedpersontoanotherperson.

---

Theperiodofcommunicabilityhasnorelationwithincubationperiod,
itmerelyreflectsthedurationwhentheinfectiousagentmaybe
transferred.Thismayoccurduringincubationperiod,duringactual
illnessorduringconvalsescence.
Generallycommunicablediseaesarenotcommunicablein
incubationperiodexcept-measles,Chickenpox,Pertussishepatitis
A,i.e.,thesediseasesarecommunicableduringtheirlateincubation
period.

---

916.Transmissionofmicrofilariainmosquito
is?
a)Cyclo-developmental
b)Cyclo-propagative
c)Propagative
d)Cyclical
CorrectAnswer-A
Ans.is'a'i.e.,Cyclodevelopmental
Invectorborndiseases,anarthropodoranylivingcarrier(e.g.,
snail)actsasavectorandtransportsaninfectiousagenttoa
susceptibleindividual.
Transmissionbyavectormaybeoffollowingtypes:?
A.Mechanicaltransmission
Theinfectiousagentismechanicallytransportedbyvector,e.g.,
throughsoulingoffeetofflyingarthropod.
Thereisnodevelopmentormultiplicationofinfectiousagentwithin
thevector.
B.Biologicaltransmission
Theinfectiousagentundergoesreplication(changeinnumber)or
development(changeinform)orbothinvector.
So,inectiousagentrequiresanincubationperiod(extrinsic
incubationperiod)beforevectorcantransmitittohost.
Thistypeoftransmissionisofthreetypes:-
i)Propagative
Agentundergoesmultiplication(changeinnumber)inthevector.
ThereisnodevelopmentNochangeinform.
ExamplePlaguebacilliinratefleas.
ii)Cyclo-developmental

---

AgentundergoesonlydevelopmentChangeinform.
NomultiplicationNochangeinnumber.
ExampleMicorfilariainmosquito.
iii)Cyclo-propagative
AgentundergoesbothdevelopmentandmultiplicationChangein
formandnumber.
ExampleMalariaparasite(plasmodiumsp.)inmosquito.

---

917.Multifactorialcausationofdiseasetheory
wasproposedby
a)LouisPasteur
b)Pettenkofer
c)Robertkoch
d)Aristotle
CorrectAnswer-B
Ans.is'b'i.e.,Pettenkofer
Multifactorialcausationofdiseasetheorywasproposedby
Pettenkofer.

---

918.Continuousscrutinyofhealthrelated
factorsiscalled?
a)Isolation
b)Surveillancec
c)Monitoring
d)Quarntine
CorrectAnswer-B
Ans.is'b'i.e.,Surveillance
Monitoring
Monitoringistheperformanceandanalysisofroutinemeasurements
aimedatdetectingchangesintheenvironmentorhealthstatusof
population,e.g.monitoringofairpollution,waterquality,andgrowth
&nutritionalstatus.Surveillance
Surveillanceisthecontinuousscrutinyofthefactorsthatdetermine
theoccurrenceanddistributionofdiseaseandotherconditionsofill
health.
Insimplewords"surveillanceissystemicongoingcollection,
collationandanalysisofdataandthetimelydisseminationof
informationtothosewhoneedtoknowsothatactioncanbetaken".
Accordingtoabovedefinition,monitoringbecomesonespecificand
essentialpartofthebroaderconceptembracedbysurveillance.
Followingexamplewillhelptodifferentiatethesetwo?
Intobaccocontrol-
Surveillanceincludescollectionofdataaboutprevalenceoftobacco
use,itshealthandenconomicconsequences,itssocio-cultural
determinatsandtobaccocontrolpolicyresponsesandtobacco
industryactivities.Bycollectingalltheseinformationeffective
tobaccocontrolinterventionscanbetaken.

---

Monitoringwillcontinouslyoversighttheactivitiesofthistobacco
controlinterventions,toensurethattheyareproceedingaccording
toplan.Itkeepstrackofachievement,resourcessupplyand
utilization,staffmovement,etc,sothatifanythinggoeswrong,
immediatecorrectivemeasurecanbetaken.
So,
1. Insurveillance,dataiscollected&collated,andthisinformationis
usedtoknowwhatactiontobetaken-makingaplanofaction.
2. Monitoringthankeepawatchthatthisplanofactionisworking
properlyItisapartofcontinuedsurveillance.
"Surveillanceisasystemicmethodforcontinuousmonitoringof
diseaseinapopulation,inordertobeabletodetectchangesin
diseasepatternsandthentocontrolthem".Epidemiologyglossary

---

919.AssociationofTwovariablesexplained
by3rdvariableis?
a)Spuriousassociation
b)Indirectassociation
c)Directassociation
d)Causalassociation
CorrectAnswer-B
Ans.is'b'i.e.,Indirectassociation
Association
Descriptivestudieshelptosuggestanaetiologicalhypothesis.
Analyticandexperimentalstudiestestthehypothesis,derivedfrom
descriptivestudiesandconfirmorrefutetheobservedassociation
betweensuspectedcausesanddisease.
Associationmaybedefinedastheconcurrenceoftwovariables
moreoftenthanwouldbeexpectedbychance.
Inotherwords,eventsaresaidtobeassociatedwhentheyoccur
morefrequentlytogeherthanonewouldexpectbychance.
Associationcanbeoffollowingtypes:-
1.Spuriousassociation
Observedassociationbetweenadiseaseandsuspectedfactoris
spurious,i.e.,notreal.
Inotherwordsthereisanobservedassociationwhennoneactually
exists.
2.Indirectassociation
Theindirectassociationisastatisticalassociationbetweena
variableofinterestandadiseaseduetothepresenceofanother
factor,knownorunknown,thatiscommontoboththevariableand

---

thedisease.
Thisthirdfactor(i.e.,thecommonfactor)isalsoknownasthe
confoundingvariable.
Forexample,endemicgoitre(disease)isfoundathighaltitudes
(variable),showingtherebyanassociationbetweenaltitudeand
endemicgoitre.Butitisduetoiodinedeficiencywhichiscommonat
highaltitude.So,iodinedeficiencyactsasaconfoundingfactorasit
isassociatedwithbothhighaltitudeandendemicgoitre.
3.Direct(causal)association
a)Onetoonecausalrelationship
Twovariablesarestatedtobecausallyrelatedifchangeinoneis
followedbychangeinother.
IfItdoesnot,thentheirrelationshipcannotbecausal.
b)Multifactorialcausation
Thecausalthinkingisdifferentinnon-communicabledisease(e.g.,
CHD)wheretheetiologyismultifactorial,i.e.,morethanonefactors
areassociatedwithdiseasecausation.

---

920.Missingcasesaredetectedby?
a)Activesurveillance
b)Passivesurveillance
c)Sentinelsurveillance
d)Prevalencerate
CorrectAnswer-C
Ans.is'c'i.e.,Sentinelsurveillance
Surveillance
Surveillanceisdefinedas"thecontinousscrutinyofthefactorsthat
determinetheoccurrenceanddistributionofdiseaseandother
conditionsofillhealth".
Surveillancemaybeoffollowingtypes:?
1)Passivesurveillance
Dataisreporteditselftohealthsystem,e.g.apatient(clinicalcase)
iscomingtoadoctor.
MostofthenationalhealthprogrammesinIndiarelyonpassive
surveillancefordatacollection.
2)Activesurveillance
Dataiscollectedactivelybyhealthsystem,e.g.collectionofblood
slideseveryfortnightfromhousetohousetocontrolmalaria.
ActivesurveillanceinIndiaisdonein:-
1. Nationalleprosyeliminationprogramme(modifiedleprosy
eliminationcampaigns).
2. NationalvectorBornediseasecontrolprogramme(VVBDCP)e.g.
malaria.
3)Sentinelsurveillance
1. Sentinelsurveillancehelpsinidentifyingmissingcasesand
supplementingnotifiedcases.

---

2. SentinelsurveillanceinIndiaisdoneinnationalAIDScontrol
programme.

---

921.Firststepinepidemicdonebyan
epidemiologist?
a)Identitythecases
b)Confirmthediagnosis
c)Identifythepronepeople
d)Identifythecausativefactors
CorrectAnswer-B
Ans.is'b'i.e.,Confirmationofdiagnosis
StepsforInvestigationofEpidemic:
Verificationofdiagnosis:
Isthefirststepininvestigationofanepidemic'
Confirmationofexistenceofanepidemic:
Comparewithdiseasefrequenciesduringsameperiodinprevious
years
Epidemicthreshold:Anarbitrarylimitof'2standarderrorsfromthe
endemicoccurrence'
Definingthepopulationatrisk:
Obtainingthemapofthearea
Calculationof'appropriatedenominatorofpopulationatrisk'
Rapidsearchforallcasesandtheircharacteristics:
Medicalsurvey
Epidemiologicalcasesheet
Searchingformorecases:Searchfornewcasesiscarriedout
everyday,tilltheareaisdeclaredfreeofepidemic;thisperiodis
usuallytakenas'twicetheincubationperiodofthediseasesincethe
occurrenceoflastcase'
Dataanalysis:
Formulationofhypothesis

---

Testingofhypothesis
Evaluationofecologicalfactors
Furtherinvestigationofpopulationatrisk
Writingthereport

---

922.Proportionalmortalityrateis?
a)Numberofdeathduetoaparticularcause
b)Numberofdeathduringthatyear
c)Numberofdeathinonemonth
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Numberofdeathduetoaparticularcause
Proportionalmortalityrate(ratio)
Proportionalmortalityratemeasurestheproportionoftotaldeath
duetospecificcauseorproportionofdeathsinaparticularage
group.
Itisdefinedas"numberofdeathsduetoaparticularcause(orin
specificagegroup)per100totaldeaths".
Itisthe'simplestmeasureofestimatingtheburdenofdisears'inthe
community.
Itisauseful'healthStatusindicator';indicatesmagnitudeof
preventablemortality.
Itisusedwhenpopulationdataisnotavailable.
Itdoesnotindicatetheriskofmembersofpopulationcontractingor
dyingfromthedisease.

---

923.Bestindicatorforburdenofdisease?
a)Incidence
b)Crudedeathrate
c)Causespecificdeathrate
d)Proportionalmortalityrate
CorrectAnswer-D
Ans.is'd'i.e.,Proportionalmortalityrate

---

924.Casefatalityrateisa?
a)Rate
b)Ratio
c)Proportion
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Proportion

---

925.Naturalhistoryofdiseaseisstudiedwith
?
a)Longitudinalstudies
b)Cross-sectionalstudies
c)Both
d)None
CorrectAnswer-A
Ans.is'a'i.e.,Longitudinalstudies
Longitudinalstudies
Inthistypeofstudy,observationsarerepeatedinthesame
populationoveraprolongedperiodusingfollowupexaminations.
Theyareusefulto
1. Studythenaturalhistoryofthedisease
2. Foridentifyingriskfactorsofdisease
3. Forfindingouttheincidencerateorrateofrecurrenceofnewcases
ofthedisease.
Note:Longitudinalstudiesaredifficulttoorganizeandmoretime
consumingthancross-sectionalstudies.

---

926.Incidenceiscalculatedby?
a)Crosssectionalstudy
b)Cohortstudy
c)Casecontrolstudy
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Cohortstudy

---

927.Casecontrolstudyisanexampleof?
a)Prospectivestudy
b)Retrospectivestudy
c)Combinedretrospectiveandprospectivestudy
d)Studyatonepointoftime
CorrectAnswer-B
Ans.is'b'i.e.,Retrospectivestudy

---

928.Exampleofcasecontrolstudy(risk
factoranddisease/outcome)?
a)Maternalsmokingandcongenitalmalformation
b)VaginaladenocarcinomaandintrauterineexposuretoDES
c)Thalidomideexposureandteratogenicity
d)Alloftheabove
CorrectAnswer-D
Ans.is`d'i.e.,Alloftheabove
Importantriskfactorsandtheiroutcomes/diseaseswhichhave
beenstudiedbycase-controlstudyare:-
i. Cigarettesmokingandlungcancer.
ii. Maternalsmokingandcongenitalmalformation.
iii. Radiationandleukemia.
iv. OCPusedandhepatocellularcarcinoma.
v. Herpes-simplexandBellspalsy.
vi. Artificialsweetenersandbladdercancer.
vii. DESexposureinfetallifeandvaginaladenocarcinoma.
viii. OCPuseandthromboembolicdisease.
ix. Thalidomideuseinpregnancyandteratogenicity.

---

929.Studysuitableforrarediseases?
a)Cohortstudy
b)Case-controlstudy
c)Bothoftheabove
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Case-controlstudy

---

930.Bestepidemiologicalstudyis-
a)RCT
b)Meta-analysis
c)Cohortstudy
d)Case-controlstudy
CorrectAnswer-B
Ans.is'b'i.e.,Meta-analysis
Herearethedifferentepidemiologicalstudieswithdecreasingorder
ofaccuracytotesttheassociationbetweenriskfactoranddisease
:?
1. Systematicreviewandmeta-analysisOverallmostreliable
2. Randomizedcontrolledtrials(controlledclinicaltrails)Most
reliableindividualstudy.
3. Retrospective(Non-concurrent/historic)Cohortstudy.
4. Prospective(concurrent)Cohortstudy.
5. Casecontrolstudy
6. Cross-sectionalstudy
7. Ecologicalstudy

---

931.Matchingisnotrequiredinwhich
epidemiologicalstudy?
a)Casecontrolstudy
b)Cohortstudy
c)Casereport
d)Randomizedcontroltrial
CorrectAnswer-C
Ans.is`c'i.e.,Casereport
Casereport:
Inmedicine,acasereportisadetailedreportofthesymptoms,
signs,diagnosis,treatment,andfollow-upofanindividualpatient.
Casereportsmaycontainademographicprofileofthepatient,but
usuallydescribeanunusualornoveloccurrence.Sinceitinvolves
informationonsinglecaseitdoesnotrequirematching.
Othersi.e.casecontrolstudy,cohortstudyandrandomizedcontrol
trialsarebasedonthecomparativestudyoftwogroups.
Todecreasethebiasintheobservationsinthetwogroupsunder
considerationitisessentialthatthegroupsbematchedforallthe
characteristicsexceptfortheoneunderstudy.Thusmatchingis
essentialintheseepidemiologicalstudies.

---

932.Randomizedstudyisdoneinpeoplewho
arevolunteerforthestudy.Whichtype
ofbiasmayoccur?
a)Hawthornebias
b)Berkesonianbias
c)Selectionbias
d)Attentionbias
CorrectAnswer-C
Ans.is'c'i.e.,Selectionbias

---

933.Nottrueaboutpropagatedepidemics?
a)Gradualrise
b)Gradualfall
c)Persontopersontransmission
d)Nosecondarywave
CorrectAnswer-D
Ans.is'd'i.e.,Nosecondarywave

---

934.TotalnumberofTBcasesina
communityof6000population150.
NumberdeathduetoTBare30.Whatis
theTBspecificdeathrate(per1000
population)?
a)20
b)10
c)5
d)0-5
CorrectAnswer-D
Ans.is'd'i.e.,0-5
Specificdeathrates
Whenanalysisisplannedtothrowlightonetiology,itisessentialto
usespecificdeathrates.
Thespecifieddeathratehelpsidentifyparticular'atrisk'group(s)for
prevention.
Italsopermitscomparisonbetweendifferentcauseswithinsame
population.
Thespecificdeathratesmaybe?
a)Causeordiseasespecific,e.g.TB,cancer,accident.
b)Relatedtospecificgroups-e.g.agespecific,sexspecific.

---

935.Aninfectiousdiseaseshowsiceberg
phenomenon.Thatmeansithas?
a)Morecasefatalityrate
b)MoreSAR
c)Moresubclinicalcases
d)Morecomplications
CorrectAnswer-C
Ans.is'C'i.e.,Moresubclinicalcases
Icebergofdisease
Diseaseinacommunitymaybecomparedwithaniceberg.
Thefloatingtipoftheicebergrepresentswhatthephysicianseesin
thecommunity,i.e.clinicalcases(Diagnosedcase,symptomatic
caseoftheclinicallyapparentcase).
Thevastsubmergedportionoftheicebergrepresentsthehidden
massofdisease,i.e.latent,inapparent,presymptomaticand
undiagnosedcasesandcarriersinthecommunity.
The"waterline"representsthedemarcationbetweenapparentand
inapparentdisease.
Anepidemiologistisconcernedwiththehiddenportionofthe
icebergwhereastheclinicianisconcernedwiththetipofthe
iceberg.
ScreeningisdoneforaHiddenportionoftheicebergwhereas
diagnosisisdoneforthetipoftheiceberg.
TheicebergphenomenonofdiseaseisnotshownbyRabies,
Tetanus,Rubella,andMeasles.
Theclinicianconcernedonlywiththetipoficeberg,i.esymptomatic
casesthatareseeninclinicaltreatment,thiscanresultininaccurate
viewofthenatureandcausesofadiseaseresultsbecausethe

---

minorityofthecasesarestudied(hiddencases:-submergedportion
oficebergisnotstudied)Clinician'sFallacy
Diseaseswithagreatdealofsubclinicalinfection(therefore
haveicebergphenomenon)are:
1. Polio
2. Japaneseencephalitis
3. Influenza
4. Mumps
5. HepatitisAandB
6. Diphtheria

---

936.Relationshipbetweenpositivepredictive
valueandprevalence?
a)PPVPrevalence
b)PPV1/Prevalence
c)PPVxPrevalence=1
d)PPV=1/Prevalence
CorrectAnswer-A
Ans.is'a'i.e.,PPVPrevalence
PrevalenceaffectsthePPVthemost.PPVisdirectly
proportionaltotheprevalenceofthediseaseinthepopulation.
However,bothsensitivityandspecificitycanchangethe
predictivevalue.
Theprevalenceofadiseaseinapopulationishigh,themore
accuratewillbethepositivepredictivevalueofascreening
test.Iftheprevalencedeclines,thePPVwillbelow.
NPVvariesinverselywiththeprevalence

---

937.Screeningisnotrecommendedif?
a)Prevalenceofdiseaseishigh
b)Lifeexpectancycanbeprolongedbyearlydiagnosis
c)Diagnostictestshouldbeavailable
d)Diseaseswithnolatentperiod
CorrectAnswer-D
Ans.is'd'i.e.,Diseasewithnolatentperiod
Thediseasetobescreenedshouldfulfilthefollowingcriteria
beforeitisconsideredsuitableforscreening:?
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.

---

938.Thevalidityofatestdenotes?
a)Precision
b)Accuracy
c)Reproducibility
d)Reliability
CorrectAnswer-B
Ans.is'b'i.e.,Accuracy
Screeningtesttobeapplied
Thescreeningtesttobeappliedshouldfulfillthefollowingimportant
criteriabeforeitisconsideredsuitableforscreening:-
1.Acceptability
Thetestshouldbeacceptabletothepeopleatwhomitisaimed.
Ingeneralpainfulorembarrassingtestse.g.,perrectalorvaginal
examinationarenotlikelytobeacceptable.
2.Repeatability(reliability)
Repeatabilitymeansthetestmustgiveconsistentresultswhenitis
repeatedmorethanonceonthesameindividualunderthesame
conditions.
Thatmeanstheresultsofthetestareprecise(exact),So
repeatabilityissometimescalledprecision,reliabilityor
reproducibility.
3.Validity(accuracy)
Validityreferstowhatextentthetestaccuratelymeasureswhichis
purportstomeasures.
Thatmeansavalidtestdistinguishthepeoplewhohavethedisease
fromthosewhodonot.
Validityhascomponents-->Sensitivityandspecificity.

---

939.Positivepredictivevalueisafunctionof
sensitivity,specificityand
a)Absoluterisk
b)Relativerisk
c)Incidence
d)Prevalence
CorrectAnswer-D
Ans.d.Prevalence
Thepredictivevalueofapositiveresultfallsasthedisease
prevalencedeclines.
PositivePredictiveValue
Inadditiontosensitivityandspecificity,theperformanceofa
screeningtestismeasuredbyits'predictivevalue',whichreflects
thediagnosticpowerofthetest.
Thepredictiveaccuracydependsuponsensitivity,specificityand
diseaseprevalence.
Thepredictivevalueofapositivetestindicatestheprobabilitythata
patientwithapositivetestresult,has,infact,thediseasein
questions.
Themoreprevalentadiseaseinthegivenpopulation,themore
accuratewillbethepredictivevalueofapositivescreeningtest.
Thepredictivevalueofapositiveresultfallsasthedisease
prevalencedeclines

---

940.Numeratorinnegativepredictivevalue?
a)Truepositive
b)Falsepositive
c)Truenegative
d)Falsenegative
CorrectAnswer-C
Ans.is'c'i.e.,Truenegative
specificity=Truenegatives/Truenegatives+Falsepositives
Sensitivity=TruePositives/Truepositives+Falsenegatives
Positivepredictivevalue=Truepositives/(true+false)positives
Negativepredictivevalue=Truenegatives/(true+false)negatives

---

941.Formulatocalculatesensitivityofa
screeningtest?
a)Truepositive/truepositive+falsenegative
b)Truenegative/truepositive+falsenegative
c)Truepositive/truenegative+falsepositive
d)Truenegative/truenegative+falsepositive
CorrectAnswer-A
Ans.is'a'i.e.,Truepositive/truepositive+falsenegative
Theformulaforthepositivelikelihoodratio("LR+")considers
bothsensitivityandspecificity:it'ssensitivitydividedby(1-
specificity),orthetruepositiveratedividedbythefalsepositives.
Thisshowshowmuchmorelikelyisapersonwiththediseaseto
scorepositivethanapersonwithoutthedisease.

---

942.Positivemortalityindicatoris?
a)IMR
b)Childmortalityrate
c)MMR
d)Lifeexpectancy
CorrectAnswer-D
Ans.is'd'i.e.,Lifeexpectancy
Mortalityindicators
Theseare:?
i. Crudedeathrate
ii. Maternalmortalityrate
iii. Expectationoflife(lifeexpectancy)
iv. Diseasespecificmortalityrate
v. Infantmortalityrate
vi. Agespecificdeathrate
vii. Childmortalityrate
viii. Adultmortalityrate
ix. Under-5proportionalmortalityrate
x. Yearsofpotentiallifelost
Amongtheseonlylifeexpectancyisapositivemortalityindicator,i.e.
increaselifeexpectancymeansimprovementinhealth.
Allotherare'negative'healthindicators,i.e.increasevalueofthese
indicatorsimpliespoorhealthofcommunity.

---

943.Whatistherouteofadministrationof
avianinfluenzavaccine?
a)Intranasal
b)Intramuscular
c)Subcutaneous
d)Intradermal
CorrectAnswer-B
Ans.is'b'i.e.,Intramuscular
VaccineAvianInfluenza:
OnApril17,2007,FDAlicensedthefirstvaccineintheUnited
StatesforthepreventionofH5N1influenza,commonlyreferredto
asavianinfluenzaor"birdflu".
Thisinactivatedinfluenzavirusvaccineisforuseinpeople18
through64yearsofagewhoareatincreasedriskofexposuretothe
H5N1influenzavirussubtypecontainedinthevaccine.
ThisvaccineisderivedfromtheA/Vietnam/1203/2004influenza
virus.
Itisadministeredasatwo-doseregimen.One90microgramdoseis
givenintramuscularly,intheupperarm,andasecond90microgram
doseisgiveninthesamemanner,28dayslater.

---

944.Mortalityrateinmeaslesencephalitisis-
a)1-2%
b)10-20%
c)20-30%
d)30-40%
CorrectAnswer-B
Ans.is'bi.e.,10-20%
"Themortalityrateinencephalitisassociatedwithmeaslesisabout
10-20%"--Park
"Casefatalityrateinacutemeaslesencephalitisis15%"
wwwcdc.gov.

---

945.Mortalityrateofmeaslesindeveloping
countries?
a)10%
b)20%
c)30%
d)40%
CorrectAnswer-A
Ans.is'a'i.e.,10%
Measles-associatedmortalityisusuallyhigheramongthevery
youngandveryold.
Mortalityindevelopingcountriesmaybeashighas10to15%due
tooneorseveralfactors,includingtheearlyageofinfection,
malnutrition,diarrhea,concomitant/secondarybacterialinfections,
andlackofaccesstogoodmedicalcare.
Mostcommoncauseofdeathispneumoniainchildrenand
encephalitisinadults.

---

946.Measleseliminationcriteriaareallexcept
?
a)Absenceofendemicmeasles
b)Formorethan12months
c)Incidence<1per1lacpopulation
d)Transmissionatlowlevel
CorrectAnswer-D
Ans.is'd'i.e.,Transmissionatlowlevel
WHOdefineseliminationofmeaslesastheabsenceofendemic
measlesforaperiodof12monthsinthepresenceofadequate
surveillance.
Oneindicaterofmeasleseliminationisasustainedmeasles
incidence<1/100,000population.
In2005,theWorldHealthAssemblysetagoalofachievinga90%
reductioninglobalmeaslesmortalityby2010ascomparedwith
levelin2000.

---

947.Trueaboutmeaslesareallexcept?
a)Koplik'sspotsispathognomonic
b)Sourceisacase
c)Infectivityislow
d)Affectagegroup1to3years
CorrectAnswer-C
Ans.is'c'i.e.,Infectivityislow
Measleshashighinfectivitywithsecondaryattackrateof80%.
Otheroptionsarecorrect.

---

948.Koplikspotispathognomicofwhich
infection?
a)Rubella
b)Influenza
c)Mumps
d)Measles
CorrectAnswer-D
Ans.is'd'i.e.,Measles

---

949.MostrapiddiagnosisofpulmonaryTB
canbedoneby?
a)Sputumculture
b)Sputummicroscopy
c)RadiometricBACTECmethod
d)Genexpert
CorrectAnswer-B
Ans.is'b'i.e.,Sputummicroscopy
Sputumsmearmicroscopyisthequickestandeasiestprocedure.
Butitlacksbothsensitivityandspecificity.
Sputumcultureissensitiveandmostspecific.Butittakes2-8weeks
forcultureonroutineL.J.media(solidmedium).
Mtuberculosisproducesvisiblecoloniesonsolidmedia(L.J.media)
in4-8weeks.
StudieshaveshownthattherateofIsolationofpositivecultureswas
significantlyfasterwiththeBactecmethodwith87%ofthepositives
beingobtainedat7daysand96%by14days.
GeneXPertshouldbeusedastheinitialdiagnostictestin
individualssuspectedofhavingMDR-TBorHIV-associatedTB
(strongrecommendation),"and"Xpertmaybeusedasafollow-on
testtomicroscopywhereMDRand/orHIVareoflesserconcern,
especiallyinsmear-negativespecimens(conditional
recommendation).
TheGeneXpertMTB/RIFassayisanovelintegrateddiagnostic
deviceforthediagnosisoftuberculosisandrapiddetectionofRIF
resistanceinclinicalspecimens.

---

950.AllaretrueaboutDOTS,except?
a)Shortcourseofchemotherapy
b)Drugsaregivenfreeofcost
c)Superviseddrugsintakeinintensivephase
d)Dailytreatmentisrecommended
CorrectAnswer-D
Ans.is'd'i.e.,Dailytreatmentisrecommended
Directlyobservedtreatmentshortcourse(DOTS)
IntheRevisedNationalTuberculosisControlProgramme(RNTCP),
patientsareprovidedshortcoursechemotherapyasDOTS.
Allpatientsareprovidedshort-coursechemotherapyfreeofcharge.
Duringtheintensivephaseoftreatmentahealthworkerwatchesas
thepatientswallowsthedruginhispresence.oDuringcontinuation
phase,thepatientisissuedmedicineforoneweekinamultiblister
combipackofwhichthefirstdoseisswallowedbythepatientinthe
presenceofhealthworker.
Theconsumptionofmedicineinthecontinuationphaseisalso
checkedbyreturnofemptymultiblistercombipackwhenthepatient
comestocollectmedicineforthenextweek.
Inthisprogramme,alternatedaytreatmentisgiven.
UnderRNTCP,activecasefindingisnolongerpursued.Case
findingispassive.Patientspresentingthemselveswithsymptoms
suspiciousoftuberculosisaretreatedwithDOTStherapy.
Thecolourofboxes(containingthedrugsforfullcourseof
treatment)isaccordingtothecategoryofregimen?
i. CategoryIpatientsRed
ii. CategoryIIpatientsBlue
iii. CategoryIIIpatientsGreen

---

---

951.AsperRNTCPguidelinesfirstdoinTB
suspectcase?
a)ChestX-ray
b)Sputumculture
c)Sputummicroscopy
d)Startshort-coursechemotherapy
CorrectAnswer-C
Ans.is'c'i.e.,Sputummicroscopy
TreatmentstratgicsinRNTCP
UndertheRNTCPactivecasefindingisnotprusued.
Casefindingispassive.
Patientspresentingthremselveswithsymptomssuspiciousof
tuberculosisarescreenedthrough2sputumsmearexamination.
SputummicroscopicexaminationisdoneindesignatedRNTCP
microscopycentres.
Itisessentialtoexamine2sputumspecimensofeachpatientbefore
aconclusivediagnosiscanbemade.
Ifonly1sputumsmearispositive,chestx-rayhelpsindiagnosis.
Oncethediagnosisisconfirmed,treatmentisstartedaccordingto
DOTS(Directlyobservedtherapyshortterm).
Patientareexpectedtocollectdrugsonceamonth(notdaily)on
fixeddatesfromthenearesttreatmentcentre.

---

952.STOPTBStrategywaslauchedin?
a)2002
b)2006
c)2010
d)2013
CorrectAnswer-B
Ans.is'b'i.e.,2006
STOPTBStrategy
In2006,WHOlaunchedthenewStopTBStrategy.
ThecoreofthisstrategyisDOTS.
Thestrategyistobeimplementedoverthenext10yearsas
describedintheGlobalPlantoStopTB2006-2015.
ThetargetsandindicatorsforTBcontrolareasdefinedwithinthe
frameworkofMDGs.
ThesewillbeusedtomeasuretheprogressmadeunderthestopTB
strategy.
Itfocusesonthefiveprincipalindicatorsthatareusedtomeasure
theimplementationandimpactofTBcontrol.
Theyare:casedetection,treatmentsuccess,incidence,prevalence
anddeaths.
Theglobaltargetsforcasedetectionandtreatmentsuccesshave
beensetbyWHO'sWorldHealthAssembly.
i. By2015:TheglobalburdenofTB(prevalenceanddeathrates)will
bereducedby50%relativeto1990levels.Thismeansreducing
prevalenceto150per100,000orloweranddeathsto15per
100,000peryearorlowerby2015(includingTBcasescoinfected
withHIV).ThenumberofpeopledyingfromTBin2015shouldbe
lessthanapproximately1million,includingthosecoinfectedwith

---

HIV.
ii. By2050:TheglobalincidenceofTBdiseasewillbelessthanor
equalto1casepermillionpopulationperyear.

---

953.AccordingtoDOTS-PLUSguidelines
2013treatmentofmultidrugresistance
TBincludesallexcept?
a)Totalduration24-27months
b)Intensivephase-6drugs
c)Continutationphase-2drugs
d)Intensivephase6-9months
CorrectAnswer-C
Ans.is'c'i.e.,Continutationphase-2drgus
Treatmentofmultidrugresistance(MDR)TB
MDR-TBisdefinedasresistancetoatleastbothINHandrifampicin.
PreviouslyitwasclassifiedasCategoryIVunderDOTS(DOTS-
PLUS).
Thetreatmentisgivenintwophases,theintestivephase(IP)and
thecontinuationphase(CP).Thetotaldurationoftreatmentfor
regimenforMDR-TBis24-27months,dependingontheIPduration.
oTreatmentregimencomprises:-
i. Intensivephase(6-9months):Sixdrugs:Kanamycin(Km),
levofloxacin(Lvx),ethionamide(Eto),pyrazinamide(Z),ethambutol
(E),andcycloserine(Cs).
ii. Continuationphase(18months):Fourdrugs:Levofloxaxcin,
ethionamide,ethambutolandcycloserine.
iii. Totaldurationoftreatmentis24-27months.
Treatmentofextensivedrugresistance(XDR)TB
XDR-TBisdefinedasresistancetoanyfluoroquinoloneandatleast
oneofthefollowingthreesecond-linedrugs(capreomycin,
kanamycin,amikacin),inadditiontomultidrugresistance.

---

TheRegimenforXDR-TBwouldbeof24-30monthsduration,with
6-12monthsIntensivePhase(IP)and18monthsContinuation
Phase(CP).
Regimenis:-
i. Intensivephase(6-12months):Sevendrugs:Capreomycin,PAS,
moxifloxacin,highdoseINH,clofazimine,Linezolid,amoxyclay.
ii. Continuationphase(18months):Sixdrugs:PAS,moxifloxacin,
highdoseINH,clofazimine,linezolid,amoxyclay.

---

954.WhichdrugisnotincludedinRNTCP
regimeforMDRTB?
a)Cycloserine
b)Ethionamide
c)Levofloxacin
d)PAS
CorrectAnswer-D
Ans.is`d'i.e.,PAS

---

955.OneTBunitisrecommendedforhow
muchpopulationinHillyareas?
a)50,000
b)100,000
c)150,000
d)250,000
CorrectAnswer-D
Ans.is'd'i.e.,250,000

---

956.DefinitionofrelapseinTB?
a)Apatientwhoreturnssputumpositiveafterleavingtreatment
foratleast2months.
b)Apateintwhoreturnssputumpositivewhichwascuredby
previoustreatment
c)Apatientwhoremainssputumpositiveafter5monthsof
treatment
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Apateintwhoreturnssputumpostivewhichwas
curvedbyprevioustreatment
Somedefinitionsoftuberculosiscasesandtreatment
Caseoftuberculosis:Apatientinwhomtuberculosishasbeen
confirmedbybacteriologyordiagnosedbyaclinician.
Sputumsmearexamination-Laboratorytechniquetoscreensputum
fortuberculosis,whereacidfastbacilli(AFB)arestainedredbythe
ZiehlNeelsenmethod,andthenidentifiedandcounted.
usingmicroscopy.
Smearpositivetuberculosis-Atleastoneinitialsputumsmears
positiveforAFBoroneAFBpositive.
Smearnegativetuberculosis-Atleasttwonegativesmears,but
tuberculosissuggestivesymptomsandX-rayabnormalitiesor
positiveculture.
Adherence-Persontakesappropriatedrugregimenforrequired
time(alsoknownascompliance).
Newcase-Apatientwithsputumpositivepulmonarytuberculosis
whohasneverhadtreatmentfortuberculosisorhastakenanti-
tuberculosisdrugsforlessthan4weeks.

---

Relapse-Apatientwhoreturnssmearpositivehavingpreviously
beentreatedfortuberculosisanddeclaredcuredafterthe
completionofhistreatment.
Failurecase-Apatientwhowasinitiallysmearpositive,whobegan
treatmentandwhoremainedorbecamemearpositiveagainatfive
monthsorlaterduringthecourseoftreatment.
Returnafterdefault-Apatientwhoreturnssputumsmearpositive,
afterhavinglefttreatmentforatleasttwomonths.
Transferin-Apatientrecordedinanotheradministrativearea
registerandtransferredintoanotherareatocontinuetreatment
(treatmentresultsshouldbereportedtothedistrictwherethepatient
wasinitiallyregistered).Transferout-Apatientwhohasbeen
transferredtoanotherarearegisterandtreatmentresultsarenot
known.Cured-Initiallysmearpositivepatientwhocompleted
treatmentandhadnegativesmearresultonatleasttwooccasions
(oneattreatmentcompletion).
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.

---

957.DailydoseofINHforTB?
a)600mg
b)300mg
c)150mg
d)1500mg
CorrectAnswer-B
Ans.is'b'i.e.,300mg

---

958.InRevisedNationalTuberculosisControl
programmethesilentfeaturesareto
achieve?
a)Curerate85%&diagnosis85%
b)Curerate85%&diagnosisrate70%
c)Curerate80%&diagnosis85%
d)Curerate80%&diagnosisrate80%
CorrectAnswer-B
Ans.is'b'i.e.,Curerate85%&diagnosisrate70%
RevisedNationalTuberculosisControlProgramme
TheGovernmentofIndia,WHOandWorldBanktogetherreviewed
theNTPintheyear1992.Basedonthefindingsarevisedstrategy
forNTPwasevolved.
Thesalientfeaturesofthisstrategyare:-
Achievementofatleast85percentcurerateofinfectiouscases
throughsupervisedShortCourseChemotherapyinvolvingperipheral
healthfunctionaries.
Augmentationofcasefindingactivitiesthroughqualitysputum
microscopytodetectatleast70percentestimatedcases;and
InvolvementofNG0s;Information,Educationandcommunication
andimprovedoperationalresearch.
Fora"TB-freeIndia"followingobjectiveshavebeenproposed:
i. Toachieve90%notificationrate
ii. Toachieve90%successrateforallnewcasesand85%for
retreatmentcases
iii. Tosignificantlyimprovethesuccessfuloutcomesoftreatmentof
drugresistantTBcases

---

iv. TodecreasemorbidityandmortalityofHIVassociatedTB
v. ToimproveoutcomesofTBcareintheprivatesector

---

959.Whichofthefollowinganti-leproticdrug
isnotgivenundersupervision?
a)Rifampicin
b)Clofazimine
c)Dapsone
d)Allaregivensupervised
CorrectAnswer-C
Ans.is'c'i.e.,Dapsone

---

960.Secondaryattackrateofchickenpox?
a)70%
b)90%
c)65%
d)80%
CorrectAnswer-B
Ans.is`b'i.e.,9%

---

961.Trueaboutrashofchickenpox?
a)Deepseated
b)Centripetal
c)Affectspalm&sole
d)Slowevolution
CorrectAnswer-B
Ans.is'b'i.e.,Centripetal

---

962.Spreadofchickenpoxismaximum?
a)Afterformationofscab
b)Justbeforeandafteronsetofrash
c)Oneweekbeforeonsetofrash
d)Duringconvelescence
CorrectAnswer-B
Ans.is'b'i.e.,Justbeforeandafteronsetofrash
Communicableperiod(periodofmaximuminfectivity)inchickenpox
is2daysbeforeto5daysafteronsetofrash.

---

963.Incubationperiodofmeaslesis:
a)18-72hours
b)10-14days
c)3-4days
d)20-25days
CorrectAnswer-B
Ans.b.10-14days

---

964.Incubationperiodofinfluenza-
a)18-72hrs
b)1-6hrs
c)5-10days
d)<1hrs
CorrectAnswer-A
Ans.is'a'i.e.,18-72hrs

---

965.PrevalenceofInfluenzainIndia?
a)10per10000population
b)10per100000population
c)10per1000population
d)Dataregardingprevalenceofinfluenzaisnotadequate
CorrectAnswer-D
Ans.is'd'i.e.,Dataregardingprevalenceofinfluenzaisnot
adequate

---

966.Inepidemicsmeaslesvaccineistobe
givenwithinhowmanydaysofexposure
?
a)3days
b)7days
c)10days
d)15days
CorrectAnswer-A
Ans.is'a'i.e.,3days
Incubationperiodofmeaslesvirusis10days.
Incubationperiodofliveattenuatedmeaslesvirusoflivevaccineis7
days.
Thus,ifthevaccineisgivenwithin2-3daysofexposure,the
replicationofvaccinevirustakespreferenceoverreplicationofwild
virus.
"Susceptiblecontactsovertheageof9-12monthsmaybeprotected
againstmeasleswithmeaslesvaccine,providedthatthisisgiven
within3daysofexposure.Thisisbecause,theincubationperiodof
measlesinducedbyvaccineisabout7days,compairedwith10
daysforthenaturallyacquirdmeasles."--Park

---

967.Mostcommonpresentationofmumps?
a)Painandlacrimationofeye
b)Painandswellingofparotidglands
c)Painandswellingofsubmandibularandsublingualglands
d)Asepticmeningitis
CorrectAnswer-B
Ans.is'b'i.e.,Painandswellingofparotidglands

---

968.Mostcommonmanifestationofmumps
inadultmales-
a)Asepticmeningitis
b)Encephalitis
c)Orchitis
d)Sinusitis
CorrectAnswer-C
Ans.is'c'i.e.,Orchitis
Orchitisisthemostcommonmanifestationofmumpsamong
postpubertalmales.

---

969.Mostcommontypeofpoliois?
a)Non-paralyticpolio
b)Paralyticpolio
c)Abortiveillness
d)Inapparentinfection
CorrectAnswer-D
Ans.is`d'i.e.,Inapparentinfection

---

970.Mortalityofrabiesis?
a)25%
b)50%
c)75%
d)100%
CorrectAnswer-D
Ans.is'd'i.e.,100%
Rabies
Rabiesisprimarilyazoonoticdiseaseofwarm-bloodedanimals,
particularlycarnivoroussuchasdogs,Cats,Jackalsandwolves.

---

971.HIVscreeningforbloodtransfusionis
doneby-
a)NACO
b)ASHA
c)Ministryofeducation
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,NACO[RefPark23rd/ep.437]
Accesstosafebloodfortheneedyistheprimaryresponsibilityof
NACO(NationalAIDScontrolorganization).
Guidelinesforbloodbank,blooddonorsanddialysisunithavebeen
formulated.
Thestrategyistoensuresafecollection,processing,storageand
distributionofbloodandbloodproducts.
TestingofeveryunitofbloodismandatoryforHIV,HBV,HCV,
malaria,syphilis.

---

972.Clustertestingtechniqueisusefulin
whichofthefollowingconditions?
a)SexuallyTransmittedDiseases
b)Poliomyelitis
c)Measles
d)Smallpox
CorrectAnswer-A
Explanation:Followingmethodsareusedforcasedetectionof
STD:
?CONTACTTRACING:Contacttracingisthetermusedforthe
techniquebywhichthesexualpartnersofdiagnosedpatientsare
identified,located,investigated,andtreated.
?CLUSTERTESTING:Herethepatientsareaskednameother
personsofeithersexwhomoveinthesamesocio-sexual
environment.Thesepersonsarethenscreened.
Ref:Park'stextbookofPreventiveandSocialMedicine,21stedition,
Page313

---

973.PrevalenceofHIVinfectioninantenatal
womenislessthan1%andinhighrisk
populationislessthan5%.Thestate
belongsto?
a)GroupI
b)GroupII
c)GroupIII
d)GroupIV
CorrectAnswer-C
Ans.is`c'i.e.,GroupIII
BasedonsentinelsurveillancedataHIVprevalenceinadult
populationcanbebroadlyclassifiedinthreegroupsofstate/UTsin
thecountry.

---

974.InAIDscontrolprogramme,For
treatmentofSTDs,bluecoloredpackis
usedfortreatmentof-
a)Urethraldischarge
b)Scrotalswelling
c)Genitalulcers
d)Ano-rectaldischarge
CorrectAnswer-C
Ans.is'c'i.e.,Genitalulcer
NACOcentersprovidingART(asofsept2006)
TheNationalAIDScontrolorganization(NACO)hasincreasedthe
numbersofcentresprovidingARTfrom54to91centreswith
another9morecentresalsogettingoperationalsoon.
Allthe9lcentreshavespeciallyappointedandtraineddoctors,
counsellorsandlaboratorytechnicianstohelpinitiatepatientson
ARTandfollowthemregularly.
Atthese91centresmedicinesfortreating85000patientshavebeen
madeavailable.
TheARTisacombinationofthreepotentdrugs,whichisbeing
giventothepersonswithadvancedstageofAIDS.
Apartfromprovidingfreetreatment,alltheARTcentresare
providingcounsellingtotheinfectedpersonssothattheymaintain
regularlyoftheirmedication.
ACOhasbrandedtheSTI/RTIservicesas"Surakshaclinic"andhas
developedacommunicationstrategyforgeneratingdemandfor
theseservices.

---

975.Choleravaccinationisindicated?
a)Tocontrolepidemics
b)Fortravellers
c)Inendemicareas
d)InNeonates
CorrectAnswer-C
Ans.is'c'i.e.,Inendemicareas
Choleravaccinationshouldbeconsideredinareaswherecholerais
endemic.
However,itshouldalwaysbedoneinconjunctionwith
implementationofsafewater,sanitationandhygienepromotion
programme.
Inresourcepoorareas,vaccinationshouldbetargetedatchildren
aged2years.
Choleravaccinehasnotbeenrecommendedinoutbreak/epidemic
settingsorcomplexhumanitarianemergenciesbecauseofthe
logisticalchallangesofadministering2-dosevaccine,andconcern
thatlong-scalevaccinationwoulddivertlimitedresourcesfrom
higherprioritymeasures.
Asitdoesnotpreventepidemiccholeratransmission,itisnot
recommendedforgeneralpopulation.
Choleratransmissionisnotrecommendedfortravelers,as
counselingaboutriskavoidanceismorecosteffectivethan
vaccination.

---

976.Allaretrueaboutepidemiological
featuresofcholeraexcept?
a)Epidemicisselflimiting
b)Poorsanitationisacauseofepidemic
c)ElTorbiotypehasdecreasedendemicity
d)Onsetofepidemicisabrupt
CorrectAnswer-C
TheElTorbiotypeshavegreaterendemictendencythanits
classicalcounterpartinthatitcausesahigherinfection-to-caseratio
(i.e.moreinapparentinfectionsandmildcases).
Aboutotheroptions
Choleraepidemichasanabruptonset.Itstartsascommonsource
epidemicandoftentreatanacutehealthproblem.Thenitcontinues
asapropagatedepidemicsascasesbecomethesourceforthe
otherpersons.
Choleraepidemicinacommunityisself-limiting.Thisisattributedto
theacquisitionoftemporaryimmunity,aswellasduetothe
occurrenceofalargenumberofsubclinicalcases.
Poorenvironmentalsanitationisthemostimportantpredisposing
factorforepidemic

---

977.Todeterminetheendemicityofhepatitis
B,whatshouldbemeasured?
a)HBsAg
b)HBcAg
c)HBeAg
d)Anti-HBeAg
CorrectAnswer-A
Ans.is'a'i.e.,HBsAg
HBsAgtestingiswidelyusedasamarkerofHBVinfectionin
epidemiologicalsurveys.
SerologicalmarkersforHBV
SerologicalmarkersforHBVinfectionare:?
HBsAg(surfaceantigenorAustraliaantigen):Itisthefirstmarker
whichappearsintheserum.ItistheepidemiologicalmarkerforHBV
infection.
HBcAg(coreantigen):Itisnotdemonstrableinserumbecauseitis
enclosedbyHBsAgcoat.
HBeAg(envelopeantigen):Itismarkerofactivereplicationand
highinfectivity.Itisqualitativemarkerofreplication.HBsAgcarrier
motherswhoareHBeAgpositivealmostinvariably(>90%)transmit
hepatitisBinfectiontotheiroffspring,whereasHBsAgcarrier
motherswithantiHBerarely(10to15%)infecttheiroffspring.
Anti-HBcAg:Itisthefirstantibodyappearsinserum.IgManti-HBc
Agisamarkerofacuteorrecentinfection.IgGanti-HBcAg
indicatesremoteinfection.
Anti-HBsAg:Itisprotectiveantibody.Itistheonlyserological
markerpresentaftervaccination.Afteraninfection,itspresence
indicatesrecoveryandendofperiodofcommunicability.

---

Anti-HBeAg:Itspresenceindicatestopageofreplicationandlow
infectivity.
HBVDNA:ItisquantitativemarkerofHBVreplication.

---

978.Anepidemiologistvisitsavillageand
wantstocollectdataforrecentparasitic
activity.Whatshouldbemeasure?
a)Spleenrate
b)Infantparasiterate
c)Slidepositivityrate
d)Slidefalciparumrate
CorrectAnswer-B
Ans.is'b'i.e.,Infantparasiterate
MEASUREMENTOFMALARIA
Inthepre-eradicationera,themagnitudeofthemalariaproblemina
countryusedtobedeterminedmostlyfromthereportsofthe
clinicallydiagnosedmalariacasesandtheclassicalmalariometric
measures,e.g.,spleenrate,parasiterateetc.
Ontheotherhand,duringeradicationera,themicroscopicdiagnosis
ofmalariacasesbecamethemainmethodofdiagnosisandthe
parametersusedaremostlyparasitologicalinnaturee.g.,API,
ABER,SPRandSFR.
Measurementsofmalariainthepreeradicationera
a)Spleenrate:
Definedasthepercentageofchildrenbetween2&10yearsofage
showingenlargementofspleen.Spleenrateiswidelyusedfor
measuringtheendemicityofmalariainacommunity.
b)Av.enlargedspleen:
Arefinementofspleenrate,denotingtheaveragesizeofspleen.
c)Parasiterate:
Definedasonthepercentageofchildrenbetweentheagesof2&

---

10yrsshowingmalarialparsitesintheirbloodfilms.
d)Parasitedensityindex:
Averagedegreeofparasitimia
e)Infantparasiterate
Percentageofinfantsshowingmalarialparasitesintheirbloodfilms.
Itisthemostsensitiveindexofrecenttransmissionofmalariaina
locality.Iftheinfantparasiterateiszeroforthreeconsecutiveyears
inalocality,itisregardedasabsenceofmalariatransmissioneven
though,theAnophelinevectorsresponsibleforprevious
transmissionsmayremain.
EradicationEra
a)AnnualParasiteIncidence(API)*
=(Confirmedcasesduringoneyear/populationundersurveillance)
x1000
b)AnnualBloodExaminationRate=(No.ofslides
examined/population)x100
ABERisanindexofoperationalefficiency.
Inthemodifiedplanofoperation,theminimumprescribedis10
percentofthepopulationinayear
c)Annualfalciparumindex
d)Slidepositivityrate
Slidepositivityrateisthepercentageofslidesfoundpositivefor
malarialparasite,irrespectiveofthetypeofspecies.
Slidefalciparumrate
ItisthepercentageofslidespositiveforP.falciparum.

---

979.IndexofoperationalefficiencyofMalaria
?
a)API
b)ABER
c)Infantparasiterate
d)Spleenrate
CorrectAnswer-B
Ans.is'b'i.e.,ABER
Annualbloodexaminationrate(ABER)isanindexofoperational
efficiency.

---

980.FalseabouttransmissionofRubella?
a)Dropletinfection
b)Verticaltransmission
c)Infectioninearlypregnancycausesmilderdisease
d)Fetusaffectedinlatepregnancymayhaveonlydeafness
CorrectAnswer-C
Ans.is'c'i.e.,Infectioninearlypregnancycausesmilderdisease

---

981.Riskperiodformaximumfetaldamage
bycongenitalrubella?
a)Firsttrimesterofpregnancy
b)Secondtrimesterofpregnancy
c)Thirdtrimesterofpregnancy
d)Riskissamethroughoutthepregnancy
CorrectAnswer-A
Ans.is'a'i.e.,Firsttrimesterofpregnancy
Ingeneral,theearlierinpregnancyinfectionoccurs,thegreaterthe
damagetothefetus.Maximumdamagetothefetusoccurswhen
infectionisacquiredinthefirsttrimesterofpregnancy.

---

982.AFPsurveillanceregistryindicatoris?
a)NumberofAFPcasesreported
b)Numberofwildpolio-viruspositivecases
c)Numberofnon-polioAFP<5years
d)Numberofnon-polioAFP<15years
CorrectAnswer-A
Ans.is'a'i.e.,NumberofAFPcasesreported
ThenumberofAFPcasesreportedeachyearisusedasan
indicatorofacountry'sabilitytodetectpolio,evenincountrieswhere
thediseasenolongeroccurs.
Poliosurveillance
Itisthemostimportantpartofwholepolioeradicationintiative.Ithas
twocomponents:?
Acuteflaccidparalysis(AFP)surveillance
Acuteflaccidparalysisisdefinedasacuteonset(<4weeks)of
flaccidparalysis(reducedtone)withoutotherobviouscausein
childrenWHOrecommendstheimmediatereportingand
investigationofeverycaseofAFPinchildrenlessthan15years.

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983.Polioissaidtobeeradicatedifnocase
ofpoliobywildpoliovirusoccursinan
areafor?
a)1year
b)2years
c)3years
d)4years
CorrectAnswer-C
Ans.is'c'i.e.,3years
Certificationofpolioeradicationisconductedanregionalbases.
Eachregioncanconsidercertificationonlywhenallcountriesinthe
areademonstratetheabsenceofwildpoliovirustransmissionforat
leastthreeconsecutiveyears.

---

984.Doseofrabiesimmunoglobulinforpost-
exposureprophylaxis?
a)10IU/kg
b)20IU/kg
c)30IU/kg
d)401U/kg
CorrectAnswer-B
Ans.is'b'i.e.,20IU/kg
Doseofrabiesimmunoglobulin(equineimmunoglobulin)20IU/kg
bodyweight.
DoseofF(ab)2products40IU/kgbodyweight.

---

985.Anamericanwantsprophylaxisfor
Hepatitis-AbeforecomingtoIndiafor10
days.Whatshouldbegiven?
a)TwodoseofHAVvaccine
b)immunoglobulin
c)Antiviraldrugprophylaxis
d)Nothingisrequired
CorrectAnswer-B
Ans.is'b'i.e.,Immunoglobulin
Advicefortravellers
Someoftherecommendationpertaintothefollowing:?
1. Avoidbathingwithpollutedwaterasthismayresultinear,eyeand
skininfections.Excessiveheatandhumidityorover-exertionin
theseconditionsmayleadtoexhaustionfromlossofwaterandsalt.
2. Themeasuresforpreventionofinsectbites.
3. DiarrhoealDiseases:"Becarefulwhatyoueat"iscommonadviceto
travellers,butveryfewtruelyunderstanditsimplications.Diarrhoea
affectsanestimated20-50percentofalltravellers.Contaminated
fooddrinksarethemostcommonsourceoftheseinfections.Careful
selectionandpreparationoffoodanddrinkofferthebestprotection.
Unfortunatelyappearanceoffoodisnoguideastoitssafety.The
mainpersonalproectionistoconsiderunpasteurizedmilk,non-
bottleddrinks,uncookedfood(apartfromthefruitsandvegetables
thatcanbepeeledorshelled),aslikelytobecontaminatedand
thereforeunsafe.Thefoodshouldbethroughlyandfreshlycooked.
Useboiledwaterorbottledmineralwater(nowavailable
everywhere).Travellersshouldbeawareoftheimportanceoforal

---

rehydrationfluidscontainingsaltandglucoseforcountering
dehydration.
4. Malaria:Thereisahighriskofacquiringmalariainendemicareas.
Travellersareadvisedtoprotectthemselvesbychemoprophylaxis.
Drugprophylaxisshouldbeginatthelatestonthedayofarrivalin
themalariousareasandcontinuedfor4-6weeksafterleavingthe
malariousareas.
5. HepatitisA:Normalhumanimmunoglobulininadoseof0.02-0.05
mg/kgofbodyweighthasbeenrecommendedevery4months.
Ideallyimmunoglobulinshouldnotbegivenwithin3weeksbefore,
oruntill2weeksafteradministrationofalivevaccine.Ahighlysafe,
inactivatedHAVvaccineisavailableinseveralEuropeancountries.
6. HepatitisE:ThereisnovaccineagainsthepatitisEand
immunoglobulinpreparedinEuropeandUSAdoesnotgivemuchof
protection.Avoidenceofcontaminatedfoodandwateristheonly
effectiveprotectivemeasure.
7. HepatitisB:HepatitisBvaccinesareavailableandaresafe.Three
dosesofvaccineconstitutethecompletecourse.Thefirsttwodoses
aregivenonemonthapartandthethirddoseabout6monthslater.
8. STDandHIV:MeasuresforpreventingSTDarethesamewhether
theindividualistravellingabroadornot,i.e.avoidanceofsex
altogetherorlimitittoasinglefaithful,uninfectedpartner.Useof
condomisanimportantpreventivemeasure.Toreducetheriskof
acquiringHIVandhepatitisBfromsyringesandneedles,travellers
shouldavoidinjectabledrugsandifaninjectionisessentialthey
shouldmakesurethattheneedleandsyringecomefromsterile
pack.
9. Yellowfever:Vaccinationcertificateforyellowfeveristheonly
certificaterequiredforinternationaltravel.Yellowfevervaccineis
recommendedfortravellerstocountiresdesignatedasyellowfever
endemiczone.
10. Tetanus:Itisawiseprecautionforthetravellertohaveabooster
doseoftetanustoxoidif10yearsormorehaveelapsedsincethe
lastinjectionofacompletecourseorbooster.

---

986.AmplifierforJapaneseencephalitis?
a)Horse
b)Pigs
c)Dogs
d)Monkey
CorrectAnswer-B
Ans.is'b'i.e.,Pigs

---

987.ApatientcomeswithCLWonknee10x2
cm,12hoursold.HehadtakenTT6
monthsbackforanotherinjury.What
shouldbedone?
a)Nothingshouldbedone
b)OnedoseofTTwithimmunoglobulin
c)FullcourseofTT
d)FullcourseofTTwithimmunoglobulin
CorrectAnswer-B
Ans.is'b'i.e.,OnedoseofTTwithimmunoglobulin
Preventionoftetanusafterinjury
Allwoundsmustbethoroughlycleanedsoonafterinjury-removalof
foreignbodies,soildust,necrotictissue.Thisprocedurewillabolish
anaerobicconditionswhichfavourgerminationoftetanusspore.

---

988.MajorsignforAIDSsurveillanceinWHO
casedefinition?
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.

---

989.Typhoidoralvaccineisgiven?
a)1,3,5days
b)1,2,3days
c)1,2,4days
d)1,7,14days
CorrectAnswer-A
Ans.is'a'i.e.,1,3,5days
ANTI-TYPHOIDVACCINES
Theoldparenteralkilledwhole-cellvaccinewaseffectivebut
producedstrongside-effects.
So,theyarenotusednow.
Twosafeandeffectivevaccinesarenowlicensedandavailable:-
1.TheVipolysachharidevaccine
1. ItiscomposedofpurifiedVicapsularpolysaccharidefromtheTy2
strainofS.Typhi.
2. Itisadministeredsubcutaneouslyorintramuscularly.
3. Onlyonedoseisrequired.
4. Thevaccineconfersprotection7daysafterinjection.
5. Tomaintainprotection,re-vaccinationisrecommendedevery3
years.
6. Thevaccineislicensedforindividualsaged2years.Itdoesnot
elicitimmuneresponseinchildren<2years.
7. Thevaccineisstablefor6monthsat37?Candfor2yearsat20?C.
Therecommendedstoragetempratureis2-8?C.
8. TheVipolysaccharidevaccinecanbeco-administeredwithother
vaccinesrelevantforinternationaltravellers-suchasyellowfever
andhepatitisA
9. Acyclovirisgiventopreventthedevelopmentofsystemicdiseasein

---

varicellainfectedimmunosuppresedpatients&canhaltthe
progressionofzosterinadults.
Varicellazosterimmunoglobulingivenwithin72hrsofexposurecan
preventchickenpoxandisrecommendedinexposed
immunocompromisedpersons.
Aliveattenuatedvaricellavaccineisrecommendedforchildren
between12-18months.Itiseffectiveevenifgivenwithin3-5days
afterexposure.
2.TheTy21aoralvaccine
Itisanorallyadministered,liveattenuatedTy2strainofS.Typhiin
whichmultiplegenes(includingforViCapsularpolysaccharide)
havebeenmutatedchemically.
Thislyophilizedvaccineisavailablein2preparations:?
1.EntericcoatedcapsulesUsedfortravellerstodeveloping
countries.Itisusedinindividuals5yearsofage.
2.LiquidsuspensionUsedbypublichealthprogrammesforyoung
childrenindevelopingcountries.Itcanbeadministeredfromtheage
of2years.
1. Vaccineisadministeredon1,3and5theday,i.e.,a3-doseregimen
isrecommended.
2. Vaccineconfersprotection7daysafterthelastdose.
3. Therecommendationistorepeatthisseries(3doses)every3years
forpeoplelivinginendemicareas,andeveryyearforindividuals
travellingfromnon-endemictoendemiccountries.
4. Ty21arequiresstorageat2-8?C,itretainspotencyfor
approximately14daysat25?C.
5. Proguanilandantibacterialdrugsshouldbestoppedfrom3days
beforeuntil3daysaftergivingTy21a,asthesedrugsmayharm
livebacteria.
6. Thevaccineisnotefficaciousifadministeredatthetimeofongoing
diarrhea.
7. Avoidedduringdiarrhoeaasefficacywillreduce.
8. CanbegiventoHIV+ve,asymptomaticpersonswithCD4cellcount
of>200/mm3
9. Welltoleratedandhaslowratesofadverseevents.
10. Notrecommendedincongenitaloracquiredimmunodeficiency,
acutefebrileillness,acuteintestinalinfectionandinpatientson

---

antimitoticdrugs
11. Maybegivensimultaneouslywithlivevaccinesofpolio,cholera,
yellowfeverandMMR.

---

990.Trueabouttyphoidvaccinesareall
except?
a)Vipolysaccharidevaccineisgiveninsingledose
b)Storagetemperatureis+2to+8?C
c)Typhoralvaccineisgivenin3doses
d)Typhoralvaccinecannotbegivenwithotherlivevaccines
CorrectAnswer-D
Ans.is'd'i.e.,Typhoralvaccinecannotbegivenwithotherlive
vaccines

---

991.Rabiesvaccinewasfirstdevelopedby?
a)RobertKoch
b)LouisPasteur
c)EdwardJenner
d)Loeffler
CorrectAnswer-B
Ans.is'b'i.e.,Louispasteur
Louispasteurisassociatedwith:
Developmentoflivevaccine(firstwasanthrax)
Developmentofvaccineforrabies(hydrophobia)
Introductionoftechniqueofsterilization
Disprovethetheoryofspontaneousgeneration(abiogenesis)
Establishedthedifferentgrowthneedofdifferentbacteria(helpedin
complexmedia)
Coinedthetermvaccine

---

992.Trueaboutinfluenza?
a)Incubationperiod2-3weeks
b)Mostinfectionsaresubclinical
c)Type-AviruscausesReye'ssyndrome
d)PandemiciscausedbyType-Bvirus
CorrectAnswer-B
Ans.is'b'i.e.,Mostinfectionsaresubclinical
Influenza
InfluenzavirusaRNAvirus,belongstoorthomyxovirus.
Therearethreeviralsubtypes:i)TypeA(causesallpandemicsand
mostepidemics);typeB;andtypeC(notcirculatingcurrently).
Currentlytheinfluenzavirusescirculatingintheworldare:111N,of
typeA(causesswineflu);H2N2oftypeA;H3N2oftypeA;H5NIof
typeA(causesbirdfluoravianinfluenza);H7N9oftypeA(caused
epidemicofavianinfluenzainChinain2013);andtypeB.
Influenzashowscyclictrendwithepidemicoccuringevery2-3years
incaseofinfluenza-Aandevery4-7yearsincaseofinfluenza-B.
Pandemicsarecausedbyonlyinfluenza-Aevery10-15years.
Influenzaaffectsallagesandbothsexes.
Sourceofinfectionofinfluenzaisaclinicalcaseorsubclinicalcase.
Majorreservoirofinfluenzavirusexistsinanimalandbirds.
Incubationperiodis18-72hours.Mostoftheinfectionsare
subclinical.Clinicalcasespresentwithcough,fever,myalgiaand
headache.

---

993.Aedesaegyptiindexnearportsshould
belessthan-
a)1%
b)5%
c)8%
d)10%
CorrectAnswer-A
Ans.is'a'i.e.,1%
ForthesurveillanceofAedesmosquitoes,theWHOusesanindex
knownasAedesaegyptiindex.
Thisisahouseindexandisdefinedas"Thepercentageofhouses
andtheirpremises,inalimitedwell-definedarea,showingactual
breedingofAedesaegyptilarvae".
Thisindexshouldnotbemorethan1%intownsandseaportsin
endeicareastoensurefreedomfromyellowfever.
Internationalhealthregulationforyellowfever
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.

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994.AllaretrueregardingJapanese
encephalitisexcept?
a)Causedbyflavivirus
b)Humansaredead-endhosts
c)Transmittedbyculex
d)Cattlesareamplifierhosts
CorrectAnswer-D
Ans.is'd'i.e.,Cattlesareamplifierhosts
Japaneseencephalitis
CausedbyagroupBarbovirus(flavivirus)
ItisaZoonoticdiseaseieinfectingmainlyanimalsandincidentally
man.
Insouth,epidemicshaveoccuredinKarnataka,Andhrapredesh,
TamilNadu,andKerala.
Human,cattle,andhorsesaredead-endhostsasthedisease
manifestsasfatalencephalitis.
Pigsactasanamplifyinghostandhaveaveryimportantroleinthe
epidemiologyofthedisease.
Infectioninswineisasymptomatic,exceptinpregnantsows,when
abortionandfetalabnormalitiesarecommonsequelae.
ThemostimportantvectorisCulextritaeniorhynchus,whichfeeds
oncattleinpreferencetohumans.
ThenaturalhostsoftheJapaneseencephalitisvirusarebirds,not
humans.
InNovember2011,theJapaneseencephalitisviruswasreported
inCulexbitaeniorhynchusinSouthKorea

---

995.Endemictyphusistransmittedby?
a)Louse
b)Fleac
c)Tick
d)Mite
CorrectAnswer-B
Ans.is'b'i.e.,Flea

---

996.Incalendarmethodofcontraception,
firstdayoffertileperiodis?
a)10thdayofshortestmensturalcycle
b)18thdayofshortestmensturalcycle
c)10thdayoflongestmensturalcycle
d)18thdayoflongestmensturalcycle
CorrectAnswer-A
Ans.is'a'i.e.10thdayofshortestmensturalcycle
SafePeriod(rhythmmethod)
ThisisalsoknownasthecalendarmethodfirstdescribedbyOgino.
Themethodisbaseduponthefactthatovulationoccursfrom12to
16daysbeforetheonsetofmensturation.
Calculationisasfollows:
Theshortestcycleminus18daysgivesthefirstdayofthefertile
period.
Thelongestcycleminus10daysgivesthelastdayoffertileperiod.
Forexample,ifawoman'smensturalcyclevariesfrom28-31days,
thefertileperiodduringwhichsheshouldnothaveintercoursewould
befromthe10thdayto21stdayofthemensturalcycle,counting
dayoneasthefirstdayofthemensturalperiod.Thus,the1stdayof
fertileperiodis10thdayofshortestcycle.

---

997.Billingsmethodofcontraceptionis
basedon?
a)Changeintemperature
b)Changeincervicalmucus
c)Safeperiod(calendarmethod)
d)Coitusinterruptus
CorrectAnswer-B
Ans.is'b'i.e.,Changeincervicalmucus

Miscellaneousmethodsofcontraceptions
Theseare(i)Abstinence,(ii)Coitusinterruptus,(iii)Safeperiod
(rhythmmethod),and(iv)Naturalfamilyplanningmethods.
Abstinence
Thereiscompleteabstinencefromsexualintercourse.Itisnotused
andcanhardlybeconsideredasamethodofcontraceptiontobe
advocatedforthemasses.
Coitusinterruptus
Itistheoldestmethodofvoluntaryfertilitycontrol.Themale
withdrawsbeforeejaculationandtherebytriestopreventthe
depositionofsemenintothevagina.Thefailurerateisveryhighat
25%.
Naturalfamilyplanningmethods
Theseare:?
Basalbodytemperature(BBT)method:Itisbasedontheprinciple
thatthereisariseBBTatorjustbeforeovulation.
Cervicalmucusmethod(Billingsmethodorovulationmethod):Itis
basedontheobservationthatatthetimeofovulationcervicalmucus
becomeswateryclearresemblingraweggwhite,smooth,slippery
andprofuse.

---

andprofuse.
Symptothermicmethod:Thismethodcombinestemperature,
cervicalmucus,andsafeperiod(calendarmethod)methods.

---

998.NotacoppercontainingIUD?
a)CuT-200
b)Nova-T
c)Multiload-250
d)LNG-20
CorrectAnswer-D
Ans.is`di.e.,LNG-20
LNG-20isthirdgenerationIUDwhichdoesnotcontaincooper.
Otherthreeoptionsare2"dgeneration(coppercontaining)IUDs.

---

999.Absolutecontraindicationforinsertionof
IUD
a)HistoryofPID
b)Congenitaluterinemalformation
c)Undiagnosedvaginalbleeding
d)Purulentcervicaldischarge
CorrectAnswer-C
Ans.is'c'i.e.,Undiagnosedvaginalbleeding
Contraindications
ABSOLUTE:
a. Suspectedpregnancy
b. Pelvicinflammatorydisease
c. Vaginalbleedingofundiagnosedetiology
d. Cancerofthecervix,uterusoradnexaandotherpelvictumours
e. Previousectopicpregnancy
RELATIVE:
a. Anaemia
b. Menorrhagia
c. HistoryofPIDsincelastpregnancy
d. Purulentcervicaldischarge
e. Distortionsoftheuterinecavityduetocongenitalmalformations,
fibroid
f. Unmotivatedperson

---

1000.Contraceptionwithincreasedriskof
actinomycosis?
a)OCPs
b)Condom
c)IUCD
d)Vaginal
CorrectAnswer-C
Ans.is`c'i.e.,IUCD

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1001.Pearlsindex?
a)Per100womanyears
b)Per10womanyears
c)Per1000womanyears
d)Per50womanyears
CorrectAnswer-A
Ans.is'a'i.e.,Per100womanyears

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1002.IroncontentofMALA-D?
a)10mg
b)19-5mg
c)29.5mg
d)40mg
CorrectAnswer-B
Ans.is'b'i.e.,19-5mg
MALA-Dcontains-
i)30ug(0.03mg)ofethinylestradiol.
ii)0.15mgofdesogestrel(D-norgestrel).
Eachbrowncolouredfilmcoatedtabletcontains60mgferrous
fumarateequivalenttoferrousiron19.5mg.

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1003.MinimumnumberofANCvisitsrequired
asper2010MOHFW(MinistryofHealth
andFamilyWelfare)guidelines?
a)1
b)2
c)3
d)4
CorrectAnswer-D
Ans.is'd'i.e.,4
Now,atleast4antenatalvisits,duringpregnancy,are
recommended.

---

1004.Indiabelongstowhichstageofthe
demographiccycle?
a)Slowstationary
b)Highstationary
c)Earlystationary
d)Lateexpanding
CorrectAnswer-D
Ans.is'd'i.e.,Lateexpanding
Demographicprocess
Fertility
Mortality
Marriage
Migration
SocialMobility
Demographiccycle
Stage1:Highstationary
Highbirthrateandhighdeathraterenderthepopulationstationary.
Narrowdemographicgap.
Stage2:Earlyexpanding
Deathratedeclinesandbirthrateremainsunchanged
Thedemographicgapstartsincreasingandthenbecomesmaximum
Stage3:Lateexpanding
Deathratedeclinefurtherandbirthratefalls
Indiaisinthisstage,currently
Thedemographicgapstartsdeclining
Stage4:Lowstationary
Lowbirthrateandlowdeathraterendersthepopulationstationary
Narrowdemographicgap
Stage5:Declining

---

Stage5:Declining
Populationbeginstodeclineasbirthrateislowerthandeathrate
Thedemographicgapisnegative

---

1005.Percentageofwomen15-24yearsage
groupinIndia?
a)10%
b)20%
c)30%
d)40%
CorrectAnswer-B
Ans.is'b'i.e.,20%
InIndiapercentageofwomenin15-24yearsagegroup.

---

1006.LeastNeonatalmortalityrateisseenin
-
a)Delhi
b)TamilNadu
c)Karnataka
d)Maharashtra
CorrectAnswer-B
Ans.is'b'i.e.,TamilNadu
Overall,leastneonatalmortalityisrecordedinKerala.However,
amongthegivenoptionsTamilnaduhasminimumneonatal
mortaltiy.

---

1007.Denominatorinperinatalmortalityrate
?
a)Totalbirths
b)Totallivebirths
c)Livebirths+Stillbirth
d)Totalnumberofnewborns
CorrectAnswer-B
Ans.is'b'i.e.,Totallivebirths

---

1008.CurrentMMRinIndiais(per1laclive
births)?
a)400
b)280
c)180
d)110
CorrectAnswer-C
Ans.is'c'i.e.,180

---

1009.InMCHprogramme,bestindicatorfor
motherandchildhealth?
a)MMR
b)IMR
c)Stillbirthrate
d)Neonatalmortalityrate
CorrectAnswer-B
Ans.is'b'i.e.,IMR
IMRisbestindicatorfor:-
1. Healthstatusofacommunity.
2. Levelofliving.
3. EffectivenessofMCHservices.
IMRissecondbestindicatorofsocioeconomicstatusofcountry
(under5mortalityrateismorerefinedindicatorforsocioeconomic
status).

---

1010.Notababyfriendlyhospital
recommendation?
a)Breastfeedingwithhalf-hourofbirth
b)Breastfeedingondemand
c)Useofartificialteatswhenrequired
d)Nooralfeedotherthanbreastmilk
CorrectAnswer-C
Ans.is'c'i.e.,Useofartificialteatswhenrequired
Babyfriendlyhospitalinitiatives
Babyfriendlyhospitalinitiative(BFHI)waslaunchedforpromotion,
protectionandsupportofbreastfeeding.
ItwaslaunchedbyWHOandUNICEF.
BFHIhaslistedfollowingtensteps,whichthehospitalmustfulfill.
1. Haveawrittenbreastfeedingpolicythatisroutinelycommunicated
toallhealthcarestaff
2. Trainallhealthcarestaffinskillsnecessarytoimplementthispolicy.
3. Informallpregnantwomenaboutthebenefitsandmanagementof
breastfeeding.
4. Helpmothersinitiateberastfeedingwithinahalf-hourofbirth.
5. Showmothershowtobreastfeed,andhowtomaintainlactation
eveniftheyshouldbeseparatedfromtheirinfants.
6. Givenewborninfantsnofoodordrinkotherthanbreastmilk,unless
medicallyindicated.
7. Practicerooming-in-allowmothersandinfantstoremaintogether-
24hoursaday.
8. Encouragebreastfeedingondemand.
9. Givenoartificialteatsorpacifiers(alsocalleddummiesorsoothers)
tobreastfeedinginfants.

---

10. Fostertheestablishmentofbreastfeedingsupportgroupsandrefer
motherstothemondischargefromthehospitalorclinic.

---

1011.Averagedailybreastmilkoutputduring
first6months?
a)100-200ml
b)200-300ml
c)300-400ml
d)500-600ml
CorrectAnswer-D
Ans.is'd'i.e.,500-600ml
Undernormalconditions,Indianmotherssecrete450-600mlof
milkdaily
Maximumoutputofmilkisat5-6months(730ml/day)afterwhich
theoutputconstantlydeclines.
At12monthstheoutputis525ml/day-Parkp.455

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1012.ProteincontentinF-75milkformula?
a)0.5gmper100ml
b)0-9gmper100ml
c)1-5gmper100ml
d)2.0gmper100ml
CorrectAnswer-B
Ans.is`b'i.e.,0.9gmper100ml

---

1013.WHOdefinesadolescentagebetween?
a)10-19yearsofage
b)10-14yearsofage
c)10-25yearsofage
d)9-14yearsofage
CorrectAnswer-A
Ans.is'a'i.e.,10-19Yearsofage

---

1014.Stageofcontractionoffamilystartsat?
a)Marriage
b)Birthoffirstchild
c)Birthoflastchild
d)Leavinghomeoffirstchild
CorrectAnswer-D
Ans.is`d'i.e.,Leavinghomeoffirstchild

---

1015.Fluoridehelpsin?
a)Vision
b)Dentition
c)Myelination
d)Jointstability
CorrectAnswer-B
Ans.is'b'i.e.,Dentition

---

1016.Recommendedleveloffluoridein
drinkingwater?
a)0.2-0.5mg/L
b)0-5-0.8mg/L
c)0.8-1.2mg/L
d)1.2-2.0mg/L
CorrectAnswer-B
Ans.is'b'i.e.,0.5-0.8mg/L
Therecommendedleveloffluorideindrinkingwaterinthecountryis
acceptedas0.5to0.8mg/Liter.-Park
Maximumpermissiblelimitis1.5mg/Lit.

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1017.Dentalfluorosisoccursiffluoridelevel
ismorethan
a)0.5mg/dl
b)1-5mg/dl
c)3mg/dl
d)6mg/dl
CorrectAnswer-B
Ans.is'b'i.e.,1-5mg/dl
Dentalfluorosis>1.5mg/L(PPM)
Skeletalfluorosis3-6mg/L(PPM)
Cripplingfluorosis>10mg/L(PPM)

---

1018.Neurolathyrismisdueto?
a)Argemoneoil
b)Jhunjhunia
c)Khesaridal
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Khesaridal

---

1019.Recommendeddailydietaryrequirment
offolate(folicacid)inchildren?
a)80-120g
b)200g
c)400g
d)600g
CorrectAnswer-A
Ans.is'a'i.e.,80-120g
Recommendeddailyallowancesoffolicacidare:-
a. Healthyadults200microgm.(mcg)
b. Pregnancy500mcg
c. Lactation300mcg
d. Children80-120mcg

---

1020.Extraenergy,neededperdayduring
pregnancy?
a)150Kcal
b)200Kcal
c)300Kcal
d)350Kcal
CorrectAnswer-D
Ans.is'd'i.e.,350Kcal

---

1021.RecommendedcontentofIodineinsalt
atproductionlevel?
a)10ppm
b)15ppm
c)20ppm
d)30ppm
CorrectAnswer-D
Ans.is'd'i.e.,30ppm
Goitrecontrol
Therearefollowingessentialcomponentsofnationalgoitrecontrol
programme.
1.Iodizedsalt
Theiodizationofsaltisnowthemostwidelyusedprophylacticpublic
healthmeasureagainstendemicgoitre.
InIndiathelevelofiodizationisfixedunderthePreventionoffood
adulteration(PFA)actandisnotlessthan30ppmattheproduction
pointandnotlessthan15ppmofiodineattheconsumerlevel.
Iodizedsaltismosteconomical,convenientandeffectivemeansof
massprophylaxisinendemicareas.
RecentlytheNationalinstitureofNutritionatHyderabadhascome
outwithanewproduct,commonsaltfortifiedwithironandiodine--
>twoinonesalt(twinfortifiedsaltordoublefortifiedsalt).
Iodizedoil-->Itisanothereffectivemethodforcontrollinggoitre.IM
injectionofiodizedoil(mostlypoppyseedoil)isgiven.Anaverage
doseof1mlwillprovideprotectionfor4years.
2.Iodinemonitoring
Neonatalhypothyroidismisasensitivepointertoenvironmental
iodinedeficiencyandcanthusbeaneffectiveindicatorfor

---

monitoringtheimpactofaprogramme.
3.Manpowertraining
4.Masscommunication
"TheWHOregionalstrategyforthecontrolofIDDhasitsprincipal
objectivethereductionofprevalenceofgoitreinareasofendemicity
to10%orbelowbytheyear2000".

---

1022.Pulsescontainallexcept?
a)Lysine
b)Cystein
c)Arginin
d)Protein
CorrectAnswer-B
Ans.is`b'i.e.,Cystein
Pulses
Pulsescompriseavarietyofgrams,alsoknownasdhal.
Pulsescontain20to25%ofprotein,whichisdoublethatfoundin
wheatandthreetimesthatfoundinRice.
Infact,pulsescontainmoreproteinthaneggs,fishorfleshfood.But
inregardtoquality,pulseproteinsareinferiortoanimalproteins.
Pulseproteinsarepoorinmethionineandtoalesserextentof
cystein.
Ontheotherhandpulseproteinsarerichinlysine.
Soyabeamisexceptionallyrichinprotein.
PulsesarerichinmineralsandB-groupvitaminssuchasriboflavin
andthiamin.
Indrystatepulsesdonotcontainvitamin'C'.However,Germinating
pulsescontainhigherconcentrationofvitamin'C'and'B'vitamins.
Fermentationalsomodifiesthenutritivevalueofpulsesinthat
vitamincontentofriboflavin,thiamineandniacinisenhanced.
Pulsearecalled"poorman'smeat".

---

1023.AminoaciddeficientinbothWheatand
Maize?
a)Lysine
b)Threonine
c)Tryptophan
d)Methionine
CorrectAnswer-A
Ans.is'a'i.e.,Lysine
Wheat
Nexttorice,wheatisthemostimportantcereal.
Thelimitingaminoacidsinwheatproteinsarelysineandthreonine.

---

1024.Goodsourcesofvitamin'C'areall
except?
a)Amala
b)Lime
c)Guava
d)Egg
CorrectAnswer-D
Ans.is'd'i.e.,Egg
VitaminC
Alsoknownasascorbicacid.
Itisthemostsensitiveofallvitaminstoheat.
Man,monkeyandguineapigsaretheperhapstheonlyspecies
knowntorequirevitamin'C'intheirdiet.
TherichestsourceofvitaminCisIndiangoosebery(Amla).
ImportantsourcesofvitaminCindecreasingorder:?
Amla>Guava>Cabbage>Amaranth>Lime>Cauliflower>
Orange>Spinach>Tomato>Potato

---

1025.Maximumproteinisfoundin?
a)Egg
b)Soyabean
c)Rice
d)Wheat
CorrectAnswer-B
Ans.is'b'i.e.,Soyabean

---

1026.Proteincontentin100gramsofcow
milk
a)4.3
b)3.2
c)2.2
d)1.2
CorrectAnswer-B
Ans.is'b'i.e.,3.2

---

1027.TrueaboutIndianreferencefemale
a)Height161cm
b)Weight60kg.
c)BMI22
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Height161cm
Referencemanandwoman
Energyintakerecommendationsareformulatedfora"reference
man"anda"referencewoman"whoseprofilesaredescribed,and
thennecessaryadjustmentaremadeforsubjectsdeviatefromhe
standardreference.
1.Indianreferenceman
Heisbetween18-29yearsofage.
Heweights60kg.
Hisheightis1.73meterandBMIis20.3
Heisfreefromdiseaseandphysicallyfitforactivework.
Oneachworkingdayheisemployedfor8hoursinoccupationthat
usuallyinvolvesmoderateactivity.
Spends8hoursinbed,4to6hourssittingandmovingaroundand2
hoursinwalkingandinactiverecreationorhouseholdduties.
2.AnIndianreferencewoman
Sheisbetween18-29yearsofage
Sheweights55kg.
Herheightis1.61meterandBMIis21.2
Sheisengagedfor8hoursinhousholdwork,inlightindustryorin
othermoderateactivity.
Spends8hoursinbed,4to6hourssittingandmovingaroundand2

---

hoursinwalkingandinactiverecreationorhouseholdduties.

---

1028.Weightofanindianreferencewomanis
?
a)45kg
b)50kg
c)55kg
d)60kg
CorrectAnswer-C
Ans.is'c'i.e.,55kg

---

1029.RDAofvitaminAinanadolescent
female?
a)400mcg
b)350mcg
c)600mcg
d)800mcg
CorrectAnswer-C
Ans.is'c'i.e.,600mcg

---

1030.FirstocularsignofVitaminAdeficiency
?
a)Bitot'sspot
b)Conjunctivalxerosis
c)Nightblindness
d)Keratomalacia
CorrectAnswer-B
Ans.is'b'i.e.,Conjunctivalxerosis

---

1031.Iodizedsaltisgiventopreventgoitreto
?
a)Allpopulation
b)PopulationofHimalayanbelt
c)PopulationofHillyareas
d)Populationofvillagearea
CorrectAnswer-A
Ans.is'a'i.e.,Allpopulation
InIndia,theentirepopulationispronetoIDDduetodeficiencyof
iodineinthesoilofthesubcontinentconsequentlythefoodderived
fromit.
Theiodizationofsaltisnowthemostwidelyusedprophylacticpublic
healthmeasureagainstendemicgoitre.
InIndiathelevelofiodizationisfixedunderthePreventionoffood
adulteration(PFA)actandisnotlessthan30ppmattheproduction
pointandnotlessthan15ppmofiodineattheconsumerlevel.

---

1032.Proteinrequirementinadultmale?
a)0.5gm/kg/day
b)1gm/kg/day
c)1.5gm/kg/day
d)2gm/kg/day
CorrectAnswer-B
Ans.is'b'i.e.,1gm/kg/day

---

1033.Nutrientwhichislostmaximumin
polishedrice?
a)Proteins
b)Thiamine
c)Ascorbicacid
d)Calcitriol
CorrectAnswer-B
Ans.is'b'i.e.,Thiamine
Effectofmillingonrice
Themillingprocessdeprivesthericegrainofitsvaluablenutritive
elements

---

1034.Zincsupplementgivenin12month
baby-
a)lgm/day
b)10mg/day
c)5mg/day
d)15mg/day
CorrectAnswer-C
Ans.is'c'i.e.,5mg/day
Therequirementsforinfantsrangebetween3.5-5.0mg/day.

---

1035.RDAofzincinachild?
a)10mg
b)20mg
c)6-8mg
d)4-5mg
CorrectAnswer-C
Ans.is'c'i.e.,6-8mg
RDAofZincinchildren
1-3years-->3mg
4-8years-55mg
9yearsandabove(male)-->8-11mg
9yearsandabove(female)-->8mg

---

1036.Biologicalvalueofproteinis
a)Increaseinweightperunitproteinconsumed
b)Percentageofingestedproteinretainedinsidethebody
c)Percentageofabsorbednitrogenretained
d)Percentageofenergyprovidedbyaproteinoffood
CorrectAnswer-C
Ans.is'c'i.e.,Percentageofabsorbednitrogenretained
Assessmentofproteins
Proteincanbeassessedqualitativelyorquantitatively:?
1)Proteinquantity
Itisassessedbytheprotein-energyratio.
2)Proteinquality
Itisassessedbyamino-acidscore,biologicalvalue,netprotein
utilization,proteinefficiencyratio,andproteindigestibilitycorrected
aminoacidscore.
ProteinenergyRatio(Protein-energypercentage)
Itisaquantitativemeasureforassessmentofprotein.
Itmeasuresthepercentageofenergythatisprovidedbytheprotein
inthefood.

---

1037.Breastmilkisdeficientinwhichvitamin
a)VitaminA
b)VitaminB1
c)VitaminK
d)VitaminC
CorrectAnswer-C
Ans.is'c'i.e.,VitaminK
Exclusivebreasfedinfantsmayhavefollowingdeficiencies-
1. VitB12(ifmotherisstrictvegetarian)
2. Fluoride
3. VitD
4. VitK
"Breastfedinfantsareprotectedasthebreastmilkcontainsadequate
amountsofvitaminC,exceptwhenthemotherisdeficientinVitamin
C".

---

1038.Diseaseassociatedwithexcessive
maizediet?
a)Wernicke'sencephalopathy
b)Pellagra
c)Beri-Beri
d)Scurvy
CorrectAnswer-B
Ans.is'b'i.e.,Pellagra
ExcessofLeucineinterferesinconversionofTryptophanintoNiacin,
andaggravatesthepallagrogenicactionofmaize.
Similartomaize,Jowaralsocontainsexcessofleucine.
Leucineinterfereswithconversionoftryptophantoniacin.
PellagrahasbeenreportedinIndiainTelanganaareaofAndhra
PradeshbecauseofJower(Sorghumvulgare)consumption.

---

1039.ICDSmealsforpregnantwomen
provides?
a)300calories&10gramsprotein
b)500calories&15gramsprotein
c)600calories&10gramsprotein
d)600calories&20gramsprotein
CorrectAnswer-D
Ans.isdi.e.,600calories&20gramsprotein
UnderICDSSchemesupplementarynutritionisgivento:
Childrenbelow6yrs
Nursingmothers
Expectantmothers
Theaimistosupplementnutritionalintakefor
1. Eachchild6-72monthsofage500caloriesand12-15gramsof
protein(financialnormofRs6.00perchildperday).
2. Severelymalnourishedchild6-72monthsofage800caloriesand
20-25gramsprotein(financialnormofRs6.00perchildperday).
3. Eachpregnantandnursingwoman600caloriesand18-20grams
ofprotein(financialnormofRs5.00perbeneficiaryperday).
Undertherevisednutritionalandfeedingnormsforsupplementary
nutrition,Stategoverments/UTshavebeenmandatedtoprovide
morethanonemealtothechildrenwhocometoAWCs,which
includeprovidingamorningsnackintheformof
milk/banana/egg/seasonalfruit/micronutrientfortifiedfoodfollowed
byahotcookedmeal.Forchildrenbelow3yearsofageand
pregnant&lactatingmothers,"takehomeration"istobeprovided.
Supplementarynutritionisgivenfor300daysayear.

---

1040.Mid-daymealsprovidedinschools
provide?
a)1/2oftotalcalories&1/2ofprotein
b)1/3oftotalcalories&1/2ofprotein
c)1/2oftotalcalories&1/3ofprotein
d)1/3oftotalcalories&1/4ofprotein
CorrectAnswer-B
Ans.is`b'i.e.,1/3rdoftotalcalories&1/2ofdailyprotein
requirement

---

1041.VitamindeficientinFamines?
a)A
b)D
c)B12
d)B6
CorrectAnswer-A
Ans.is'a'i.e.,A[RefFoodscarcityandFaminep.100]
Intimesoffoodscarcityandfamine,themostimportantdeficiency
diseaseisxerophthalmia(vitaminAdeficiency),whichcancause
permanentblindnessandmayalsocontributetoincreased
incidence,severityanddurationofinfectiousdiseaseslikemeasles,
diarrheaandrespiratorytractinfection.
Wherepeoplearetotallydependentonfoodaidrations,other
deficiencydiseasesmayalsodevelop:-
1. Scurvy(VitaminCdeficiency)
2. Pellagra(Niacindeficiency)
3. Nutritionalanemia(Ironorfolicaciddeficiency)

---

1042.UnderMCHprogramme,adultIFAtablet
contains?
a)100mgelementalironand0.1mgFA
b)100mgelementalironand0.5mgFA
c)20mgelementalironand0.1mgFA
d)20mgelementalironand0-5mgFA
CorrectAnswer-B
Ans.is'b'i.e.,100mgelementalironand0.5mgFA
IronandFolicAcidcontentperIFAtablet:
Adulttablet:100mgelementalironand500mcgfolicacid
Pediatrictablet:20mgelementalironand100mcgfolicacid
Forpreterminfants,recommendedIronandFolicAcidcontentper
IFAtablet:
Pediatrictablet:10--15mgelementalironand100mcgfolicacid.

---

1043.Kala-azaristransmittedby?
a)Reduvidbug
b)Sandfly
c)Tsetsefly
d)Mosquito
CorrectAnswer-B
Ans.is'b'i.e.,Sandfly

---

1044.Vectorfortransmissionofsleeping
sickness?
a)Sandfly
b)Blackfly
c)Tse-tsefly
d)Hardtick
CorrectAnswer-C
Ans.is'c'i.e.,Tse-tsefly

---

1045.Vagabonddiseaseistransmittedby?
a)Louse
b)Mite
c)Tick
d)BlackFly
CorrectAnswer-A
Ans.is'a'i.e.,Louse
Vagabond'sdiseaseispediculosiscorporis,causedbybodylouse.

---

1046.Whichstageoflarvaofhouseflyis
voraciousfeeder-
a)1
b)2
c)3
d)4
CorrectAnswer-A
Ans.is'a'i.e.,1
Thelarvaofhousefly(maggot)moultstwice,i.e.therearethree
instarstages.
Thefirstinstarlarvaisavaraciousfeeder,feedingmainlyon
decomposingliquidorganicmatter.

---

1047.Falseregardinglarvaeofanopheles?
a)Longsiphontube
b)Paralleltowater
c)Palmatehairs
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Longsiphontube

---

1048.Virusnotsensitivetodisinfectionby
chlorination
a)Rotavirus
b)Norwalkvirus
c)Poliovirus
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Poliovirus
Chlorination
Chlorinationisoneofthegreatestadvancesinwaterpurification.
Chlorinekillspathogenicbacteria,buthasnoeffectonspores,
certainviruses(e.g.,polio,viralhepatitis)andcystofE.histolytica,in
usualdoses.
Mechanismofaction
Whenchlorineisaddedtowater,thereistheformationof
hypochloricandhypochlorousacid
Thehypochloricacidisneutralizedbythealkalinityofthewater.
Thehypochlorousacidionizestoformhydrogenionsand
hypochloriteions.
Thedisinfectingactionofchlorineismainlyduetothehypochlorous
acidandtoasmallextentduetothehypochloriteions.
Thehypochlorousacidisthemosteffectiveformofchlorinefor
waterdisinfection,itis70-80timesmoreeffectivethanhypochlorite
ion.

---

1049.Humananatomicalwastesare
treated/disposedby?
a)Autoclaving
b)Chemicaldisinfection
c)Incineration
d)Microwaving
CorrectAnswer-C
Ans.is'c'i.e.,Incineration
Humananatomicalwastessuchashumantissues,organs,and
bodypartsareclassifiedasWasteCategoryNo.ITheyare
disposedin'plasticbags'witha'yellowcolorcode'andtreatedby
'Incinerationordeepburial'.

---

1050.LevelofHardnessifthevalueis50-150
mg/L?
a)Softwater
b)Moderatelyhardwater
c)Hardwater
d)Veryhardwater
CorrectAnswer-B
Ans.is'b'i.e.,Moteratelyhardwater

---

1051.Cytotoxicdrugsaretreated/disposedby
?
a)Autoclaving
b)Chemicaldisinfection
c)Incineration
d)Microwaving
CorrectAnswer-C
Ans.is'c'i.e.,Incineration
CytotoxicdrugsarecategoryNo.5wasteswhicharedestroyedby
incinerationanddisposedbysecuredlandfills.

---

1052.Yellowbagisusedfor-
a)Wastesharp
b)Cytotoxicdrugs
c)Animalwaste
d)Chemicalwaste
CorrectAnswer-C
Ans.is'c'i.e.,Animalwaste

---

1053.Incinerationisdoneforwastecategory
?
a)Category7
b)Category9
c)Category6
d)Category5
CorrectAnswer-C
Ans.is'c'i.e.,Category6

---

1054.Bestwaytodisposee-wasteis?
a)Burning
b)Incineration
c)Inalandfill
d)Recycling
CorrectAnswer-D
Ans.is'd'i.e.,Recycling
E-Waste
E-wasteisapopular,informalnameforelectronicproductsnearing
theendoftheir"usefullife.
"E-wastesareconsidereddangerous,ascertaincomponentsof
someelectronicsproductscontainmaterialsthatarehazardous,
dependingontheirconditionanddensity.
Thehazardouscontentofthesematerialsposeathreattohuman
healthandenvironment.
Discardedcomputers,television,VCRs,stereos,copiers,fax
machines,electriclamps,cellphones,audioequiopmentand
batteriesifimproperlydisposedcanleachleadandothersubstances
intosoilandgroundwater.
Manyoftheseproductscanbereused,refurbished,orrecycled,or
recyledinanenvironmentallysoundmannersothattheyareless
harmfultotheecosystem.
ManagmentofE-Waste
Inindustriesmanagementofe-wasteshouldbeginatthepointof
generation.Thiscanbedonebywasteminimizationtechniquesand
bysustainableproductdesign.Wasteminimizationinindustries
involvesadopting:
1. inventorymanagement,

---

2. production-processmodification,
3. volumereduction,
4. recoveryandreuse
Inventorymanagement
Propercontroloverthematerialsusedinthemanufacturingprocess
isanimportantwaytoreducewastegeneration.
Byreducingboththequantityofhazardousmaterialsusedinthe
processandtheamountofexcessrawmaterialsinstock,the
quantityofwastegeneratedcanbereduced.
Developingreviewproceduresforallmaterialpurchasedisthefirst
stopinestablishinganinventorymanagementprogram.
Anotherinventorymanagementprocedureforwastereductionisto
ensurethatonlytheneededquantityofamaterialisordered.
Production-processmodification
Changescnabemadeintheproductionprocess,whichwillreduce
wastegeneration.
Thisreductioncanbeaccomplishedbychangingthematerialsused
tomaketheproductorbythemoreefficientuseofinputmaterialsin
theproductionprocessorboth.
Volumereduction
Volumereductionincludesthosetechniquesthatremovethe
hazardousportionofawastefromanon-hazardousportion.
Thesetechniquesareusuallytoreducethevolume,andthusthe
costofdisposingofawastematerial.
Recoveryandreuse
Thistechniquecouldeliminatewastedisposalcosts,reduceraw
materialcostsandprovideincomefromasalablewaste.
Wastecanberecoveredon-site,oratanoff-siterecoveryfacility,or
throughinterindustryexchange.

---

1055.MostcommoncancerinmalesinIndia
?
a)Carectum
b)Caoralcavity
c)Catestis
d)Cabladder
CorrectAnswer-B
Ans.is'b'i.e.,Caoralcavity
MostcommoncancerinmalesinIndia:Lip/oralcavity

---

1056.BlindnesscriteriainIndia?
a)Vision<3/60
b)Vision<6/60
c)Vision<12/60
d)Vision<18/60
CorrectAnswer-B
Ans.is'b'i.e.,Vision<6/60
Nationalprogrammeforcontrolofblindness(NPCB),Indiadefines
blindnessasvisualacuityof<6/60inbetterevewithbestpossible
correctionIncontrasttoWHO,whichdefinesblindnessasvisual
acuityof<3/60).

---

1057.GoalofNPCBwastoreduceprevalence
ofblindnessto?
a)<0.3%by2000
b)<0.3%by2005
c)<0.5%by2010
d)<0.5%by2015
CorrectAnswer-A
Ans.is'a'i.e.,<0.3%by2000
NATIONALPROGRAMMEFORCONTROLOFBLINDNESS
(NPCB)
ThenationalprogramforControlofBlindness(NPCB)has
beenre-designatedrecentlyastheNationalProgrammefor
ControlofBlindnessandVisualImpairment
Launchedin1976
Itsobjectiveistoreducetheprevalenceofeyediseasesingeneral,
andtheprevalenceofblindnessfrom1.40%to0.3%by2000AD.
ApexCentre(NationalEyeInstitute)is
Dr.RajendraPrasadCentreforOphthalmicSciences(NewDelhi,
AIIMS).
RevisedstrategiesofNPCB
a)TomakeNPCBmorecomprehensivebystrengtheningservices
forothercausesofblindnesslikecornealblindness(requiring
transplantationofdonatedeyes),refractiveerrorsinschool-going
children,improvingfollow-upservicesofcataractoperatedpersons
andtreatingothercausesofblindnesslikeglaucoma;Toshiftfrom
theeyecampapproachtoafixedfacilitysurgicalapproachandfrom
conventionalsurgerytoIOLimplantationforbetterqualityofpost-

---

operativevisioninoperatedpatients.
b)ToexpandtheWorldBankprojectactivitieslikeconstructionof
dedicatedeyeoperationtheatres,eyewardsatthedistrictlevel,
trainingofeyesurgeonsinmoderncataractsurgeryandothereye
surgeriesandsupplyofophthalmicequipment,etc.tothewhole
country.
c)TostrengthentheparticipationofVoluntaryOrganizationsinthe
programandtoearmarkgeographicareastoNGOsand
GovernmentHospitalstoavoidduplicationofeffortandimprovethe
performanceofGovernmentUnitslikeMedicalColleges,District
Hospitals,SubDivisionalHospitals,CommunityHealthCentres,
PrimaryHealthCentres.
d)Toenhancethecoverageofeyecareservicesintribalandother
under-servedareasthroughtheidentificationofbilateralblind
patients,preparationofvillage-wiseblindregisterandgiving
preferencetobilateralblindpatientsforcataractsurgery.

---

1058.RevisedstrategyforNPCBincludesall
except?
a)Fixedfacilitysurgery
b)IOLimplantationforcataract
c)Mobilesurgicalcamps
d)Uniformdistribution
CorrectAnswer-C
Ans.is'c'i.e.Mobilesurgicalcamps
NATIONALPROGRAMMEFORCONTROLOFBLINDNESS
(NPCB)
ThenationalprogramforControlofBlindness(NPCB)hasbeenre-
designatedrecentlyastheNationalProgrammeforControlof
BlindnessandVisualImpairment
Launchedin1976,
Itisa100%centrallysponsoredscheme.
Itsobjectiveistoreducetheprevalenceofeyediseasesingeneral,
andtheprevalenceofblindnessfrom1.40%to0.3%by2000AD.
ApexCentre(NationalEyeInstitute)is
Dr.RajendraPrasadCentreforOphthalmicSciences(NewDelhi,
AIIMS).
RevisedstrategiesofNPCB
a)TomakeNPCBmorecomprehensivebystrengtheningservices
forothercausesofblindnesslikecornealblindness(requiring
transplantationofdonatedeyes),refractiveerrorsinschool-going
children,improvingfollow-upservicesofcataractoperatedpersons
andtreatingothercausesofblindnesslikeglaucoma;Toshiftfrom
theeyecampapproachtoafixedfacilitysurgicalapproachandfrom
conventionalsurgerytoIOLimplantationforbetterqualityofpost-
operativevisioninoperatedpatients.

---

operativevisioninoperatedpatients.
b)ToexpandtheWorldBankprojectactivitieslikeconstructionof
dedicatedeyeoperationtheatres,eyewardsatthedistrictlevel,
trainingofeyesurgeonsinmoderncataractsurgeryandothereye
surgeriesandsupplyofophthalmicequipment,etc.tothewhole
country.
c)TostrengthentheparticipationofVoluntaryOrganizationsinthe
programandtoearmarkgeographicareastoNGOsand
GovernmentHospitalstoavoidduplicationofeffortandimprovethe
performanceofGovernmentUnitslikeMedicalColleges,District
Hospitals,SubDivisionalHospitals,CommunityHealthCentres,
PrimaryHealthCentres.
d)Toenhancethecoverageofeyecareservicesintribalandother
under-servedareas(uniformdistribution)throughtheidentificationof
bilateralblindpatients,preparationofvillage-wiseblindregisterand
givingpreferencetobilateralblindpatientsforcataractsurgery.

---

1059.Themostcommoncauseofblindness
inIndiais?
a)Cataract
b)Trachoma
c)Refractiveerrors
d)VitaminAdeficiency
CorrectAnswer-A
Ans.is'a'i.e.,Cataract

---

1060.UnderNationalCancercontrol
Programme,oncologywingswere
sanctionedto-
a)RegionalCancerinstitutes
b)DistrictHospitals
c)MedicalcollegeHospitals
d)VoluntaryAgeneciestreatingcancerpatients
CorrectAnswer-C
Ans.is'c'i.e.,MedicalcollegeHospital
oGovernmenthospitalandgovernmentmedicalcollegesare
providedwithagrantofRs3.00croresforthedevelopmentof
oncologywing.

---

1061.RCH-IImajorstrategiesareallexcept?
a)Essentialobstetriccare
b)Emergencyobstetriccare
c)Familyplanning
d)Strengtheningreferralsystem
CorrectAnswer-C
Ans.is'c'i.e.,Familyplanning
4componentsofRCHprogrammeare(i)Familyplanning;(ii)Child
survivalandsafemotherhood;(iii)Clientapproachtohealthcare,
and(iv)PreventionofRTI/STD/AIDS.
ReproductiveandChildhealthProgramme
RCHprogrammewaslaunchedinOctober1997.
Reproductiveandchildhealthapproachhasbeendefinedas:-
1. Peoplehavetheabilitytoreproduceandregulatetheirfertility.
2. Womenareabletogothroughpregnancyandchildbirthsafety.
3. TheOutcomeofpregnanciesissuccessfulintermsofmaternaland
infantsurvivalandwellbeing.
Couplesareabletohavesexualrelationsfreeoffearofpregnancy
andofcontractingdisease.
RCHphaseIprogrammeincorporatedthefollowingcomponents.

---

1062.Aproblemvillageisonewhere?
a)Sourceofwater>1.6kmaway
b)Wateravailable>15metersdepth
c)Excessoffluorideinwater
d)Alloftheabove
CorrectAnswer-D
Ans.is`d'i.e.,Alloftheabove
Aproblemvillagehasbeendefinedasone
Wherenosourceofsafewaterisavailablewithinadistanceof1.6
km,or
Wherewaterisavailableatadepthofmorethan15meters,or
Wherewatersourcehasexcesssalinity,iron,fluoridesandother
toxicelements,or
Wherewaterisexposedtotheriskofcholera.

---

1063.Mentalhealthprogrammewasstarted
in?
a)1982
b)1987
c)1990
d)1995
CorrectAnswer-A
Ans.is'a'i.e.,1982
TheGovernmentofIndiahaslaunchedtheNationalMentalHealth
Programme(NMHP)in1982.
Alsoknow
Mentalhealthactwasstartedin1987.

---

1064.Mostcommontypeofmental
retardation?
a)Mild
b)Moderate
c)Severe
d)Profound
CorrectAnswer-A
Ans.is'a'i.e.,Mild

---

1065.Basiclaboratoryserviceisnotavailable
atPHCforwhichdisease?
a)TB
b)Malaria
c)Syphilis
d)Leprosy
CorrectAnswer-D
Ans.is'd'i.e.,Leprosy
BasiclaboratoryservicesatPHC
i. Routineurine,stoolandbloodtests.
ii. Bleedingtime,clottingtime.
iii. DiagnosisofRT1/STDswithwetmounting,Gramastain,etc.
iv. Sputumtestingfortuberculosis(ifdesignatedasamicroscopy
centerunderRNTCP).
v. Bloodsmearexaminationformalarialparasite.
vi. Rapidtestsforpregnancy.
vii. RPRtestforSyphilis/YAWSsurveillance.
viii. Rapiddiagnostictestsfortyphoid(TyphiDot)andmalaria.
ix. Raidtestkitforfaecalcontaminationofwater.
x. Estimationofchlorinelevelofwaterusingorthotoludinereagent.

---

1066.Mostimportantmeasuretoprevent
hospitalinfection?
a)Useofantibiotics
b)Useofantiseptics
c)Properhandwashing
d)Formalinfumigation
CorrectAnswer-C
Ans.is'c'i.e.,Properhandwashing
Therearefollowingtypesofmodesoftransmissionofhospital-
acquiredinfections:
1)Contacttransmission
i. Itisthemostcommonandmostpreventablemeansoftransmission.
Itisdividedintotwotypes-
ii. Directcontact:Itinvolvescontactofbodysurfacetobodysurface
withaphysicaltransferofmicroorganisms.Handcontactismost
commonmodeoftransmission.
iii. Indirectcontact:Itinvolvesbodysurfacecontactwitha
contaminatedintermediateobject.
Ashandcontactisthemostcommonmodeoftransmission,thebest
preventivemeasureofnosocomialinfectionisproperhandhygiene.
2)Droplettransmission
Itoccurswhendropletcontainingmicroorganismsfromaninfected
personarepropelledthroughtheair(e.g.coughing,sneezing)and
landonthemouth,eyesornoseofanotherperson.
3)Airbornetransmission
Itresultswhenadropletcontainingmicroorganismsevaporatesand
remainssuspendedinairforalongtime(thisshouldnotbe
confusedwithdropletinfection,inwhichtransmissionisimmediate

---

anddropletsdonotremainssuspendedintheair).
Airbornetransmissionalsooccursbydustparticlescontaining
microorganism.
4)Vehicletransmission
Itreferstotransmissionofinfectionbycontaminateditemssuchas
food,water,medications,devicesandequipment.

---

1067.Trueaboutcriticalpathmethodareall
except
a)Networkanalysis
b)Longestpath
c)Cannotbedelayed
d)Shortestpath
CorrectAnswer-D
Ans.is'd'i.e.,Shortestpath
Networkanalysis
Anetworkanalysisisagraphicofalleventsandactivitiestobe
completedinordertoreachanendobjective.Itbringsgreater
disciplineinplanning.Thetwocommontypesofnetworktechnique
are:
a)ProgrammeEvaluationandReviewtechnique(PERT)
b)CriticalPathmethod(CPM)
ProgrammeEvaluationandReviewtechnique(PERT)
PERTisamanagementtechniquewhichmakespossiblemore
detailedplaningandmorecomprehensivesupervision.
PERTismethodtoanalyzetheinvolvedtasksincompletingagiven
project,especiallythetimeneededtocompleteeachtask,and
identifyingtheminimumtimeneededtocompletethetotalproject.
TheessenceofPERTistoconstructanarrowdiagram,which
representsthelogicalsequenceinwhicheventsmusttakeplace.It
ispossiblewithsuchadiagramtocalculatethetimebywhicheach
activitymustbecompleted,andtoidentifythoseactivitiesthatare
critical.
Criticalpathmethod(CPM)
Thelongestpathofthenetworkiscalledthecriticalpath.Critical

---

pathmethoddeterminestheactivitiesofaprojectwhicharecritical
andaregivenlongestpath.Otheractivitiesaretotalfloat,i.e.they
canbedelayedwithoutmakingtheprojectlonger.Anydelayin
activityonthecriticalpathresultsindelayoftheproject.oInthe
abovefigure,thelongestpathisfromequipmentorderedto
equipmentinstalled.
Thatmeans,thisisthecriticalpathandinstallatingofequimentis
themostcriticalstep(taking10months).oOtheractivitiesaretotal
float,i.e.theycanbedelayedforsometimeswithoutdelayingthe
project.

---

1068.NFHS-3wasconductedin?
a)1992-93
b)1998-99
c)2005-06
d)2009-10
CorrectAnswer-C
Ans.is'c'i.e.,2005-06
Nationalfamilyhealthsurvey(NFHS)
Isalarge-scale,multi-roundsurveyconductedinarepresentative
sampleofhouseholdsthroughoutIndia.
3roundsofthesurveyhavebeenconductedtilldate.
1. NFHS-1:1992-93
2. NFHS-2:1998-99
3. NFHS-3:2005-06
GoalsofNFHSsurvey:
1. ToprovideessentialdataneededbyMinistryofHealth&Family
Welfareandotheragenciesforpolicyandprogrammepurposes
2. Toprovideinformationonimportantemerginghealthandfamily
welfareissues
FewkeyfindingsofNFHS-3,India(2005-06)
1. Literacyrate:Male-83%,Female-59%.
2. IMR:57per1000livebirths.
3. TFR:2.6
4. Contraceptiveprevalence:56%(Sterilization37%)
5. 3ANcheckups:51%.
6. TookIFA:65%(TookIFAfor90days)ormore:23%.
7. Received>2TTinjections:76%
8. Institutionaldeliveries:41%

---

9. Deliveryassistedbyhealthprofessionals:48%.
10. Deliveryconductedbyaskilledprovider:47%.
11. Anemia-children:79%
12. Anemia-pregnancy:58%
13. Womenexperienceddomesticviolence:37%

---

1069.Allarecomponentsof'Healthforall'
except?
a)Adequacy
b)Acceptibility
c)Equity
d)Resourceallocation
CorrectAnswer-D
Ans.is'd'i.e.,Resourceallocation
HealthforAll
Healthforall'isdefinedas"attainmentofalevelofhealththatwill
enableeveryindividualtoleadasociallyandeconomically
productivelife".
ThefundamentalprincipleofHFAstrategyisequity,thatis,an
equal,healthstatusforpeopleandcountries,ensuredbyan
equitabledistributionofhealthresources.
ThebestapproachtoachievethegoalforHFAisbyproviding
primaryhealthcare.
Atleastessentialhealthcareshouldbeaccessibletoallindividuals
inanacceptableandaffordableway.
ThesevenprinciplesofhealthforalloutlinebyWHO
i. Therighttohealth
ii. Healthpromotion
iii. Equityinhealth(equitabledistribution)
iv. Primaryhealthcare
v. Communityparticipation
vi. Intersectoralcooporation
vii. Intersectoralcollaboration
Primaryhealthcare(PHC)isoneofthemostimportantcomponent.
ThebasicrequirmentsforPHCare(8A'sand3C's)-

---

ThebasicrequirmentsforPHCare(8A'sand3C's)-
Appropriateness
Availability
Adequacy
Accessibility
Acceptibility
Affordability
Assessability
Accountability
Completeness
Comprehensiveness
Continuity

---

1070."3by5"initiativeinAIDScontrol
programmeis?
a)Providing3millionpeopletreatmentbyendof2005
b)Providingtreatmentto3outof5patients
c)ReducingincidenceofAIDSby3%by2005
d)Alloftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Providing3millionpeopletreatmentbyendof
2005
3by5target
On1stDecember2003,WHOandUNAIDSannouncedadetailed
plantoreachthe"3by5target"ofprovidingantiretroviraltreatment
(ART)tothreemillionpeoplelivingwithHIV/AIDSinthedeveloping
countriesbytheendof2005.
UltimategoalofthisstrategyistoprovideuniversalaccesstoART
toanyonewhoneedsit.
IthasfivePillars(focusareasofconcerns):?
1. SimplifiedstandardtoolstodeliverART
2. Anewservicetoensureeffective,reliablesupplyofmedicinesand
diagnostics
3. Disseminationandapplicationofnewknowledgeandsuccessful
strategy
4. Urgent,sustainedsupporttocountries
5. Globalleadership,backedbystrongpartnership

---

1071.ImpactindicatorforASHA?
a)NumberofASHAtrained
b)Infantmortalityrate
c)%ofinstitutionaldeliveries
d)%ofJSYclaimsmadetoASHA
CorrectAnswer-B
Ans.is'b'i.e.,Infantmortalityrate
MonitoringandEvaluationofASHA'swork
GovernmentofIndiahassetupfollowingindicatorsformonitoring
ASHA(41).
1.ProcessIndicators
a)NumberofASHAsselectedbydueprocess
b)NumberofASHAstrained;and
c)%ofASHAsattendingreviewmeetingafteroneyear
2.OutcomeIndicators
a)%ofnewbornwhowereweighedandfamiliescounseled.
b)%ofchildrenwithdiarrhoeawhoreceivedORS.
c)%ofdeliverieswithskilledassistance.
d)%ofinstitutionaldeliveries.
e)%ofJSYclaimsmadetoASHA
f)%ofcompletelyimmunizedin12to23monthsagegroup.
g)%ofunmetneedforspacingcontraceptionamongBPL.
h)%offevercaseswhoreceivedchloroquinewithinfirstweekina
malariaendemicarea.
3.ImpactIndicators
a)IMR
b)Childmalnutritionrates
c)NumberofcasesofTB/leprosydetectedascomparedtoprevious
year.

---

year.

---

1072.Ujjwalaschemedoesnotinclude?
a)Rescue
b)Rehabilitation
c)Reintegration
d)Reward
CorrectAnswer-D
Ans.is`d'i.e.,Reward

---

1073.Byssinosisisduetoexposureof?
a)Coaldust
b)Cottondust
c)Sugarcanedust
d)Silica
CorrectAnswer-B
Ans.is'b'i.e.,Cottondust
Byssinosisisduetoexposuretocottondustintextileindustries.

---

1074.Whichofthefollowingisusedto
representcontinuous(quantitative)data
?
a)Bardiagram
b)Piechart
c)Histogram
d)Mapdiagram
CorrectAnswer-C
Ans.is`c'i.e.,Histogram

---

1075. Whichisbesttorepresentthedataof
followingtable-
Year
1991 1992 1993 1994
Number
75
125 50
25
ofLBW
bodies
a)Barchart
b)Histogram
c)Frequencypolygone
d)Scatterdiagram
CorrectAnswer-A
Ans.is'a'i.e.,Barchart
WecanplotthelowbirthstatisticsofahospitalonBarchart,
histogramorfrequencypolygondependingonwhattypeofdatawe
want.
ToknowthetotalnumberofLBWneonatesindifferentyearsand
comparethefrequenciesBarchart.
ToknowthenumberofLBWneonatesindifferentrangeofweights
atagiventime-)Histogramorfrequencypolygone.

---

1076.Testusedtoassessquantitative
observationsbeforeandafteran
intervention?
a)UnpairedT-test
b)PairedT-test
c)Chi-squaretest
d)Fisher-T-test
CorrectAnswer-B
Ans.is'b'i.e.,PairedT-test
Apairedt-testisusedtocomparetwopopulationmeanswhere
youhavetwosamplesinwhichobservationsinonesamplecan
bepairedwithobservationsintheothersample
thismightoccurin:
?Before-and-afterobservationsonthesamesubjects(e.g.
students'diagnostictestresultsbeforeandafteraparticular
moduleorcourse).
?Acomparisonoftwodifferentmethodsofmeasurementor
twodifferenttreat
mentswherethemeasurements/treatmentsareappliedtothe
samesubjects(e.g.bloodpressuremeasurementsusinga
stethoscopeandadynamap).
Pairedtest:Isappliedtopaireddata,wheneachindividualgivesa
pairofobservationssuchas:whenobservationsaremadebefore
andaftertheplayofafactore.g.pulseratebeforeandafteradrug.
Further,itproceedssimilartotheunpairedtest.

---

1077.Peoplearearrangedalphabeticallyby
theirnamesandthenevery3rdperson
ischosenforstudy.Thetypeof
samplingis?
a)Stratifiedrandom
b)Systematicrandom
c)Simplerandom
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Systematicrandom
Simplerandomsampling
Simplerandomsampling,also,knownas'unrestrictedrandom
sampling';isapplicableforsmall,homogenous,readilyavailable
populationandisusedinclinicaltrials.
Insimplerandomsamplingeachindividualischosenrandomlyand
entirelybychance.
So,eachindividualhasthesameprobabilityofbeingchosenatany
stageduringthesamplingprocess.Forexample
Letusassumeyouhadaschoolwith1000students,dividedequally
intoboysandgirls,andyouwantedtoselect100ofthemforfurther
study.
Youmightputalltheirnamesinabucketandthenpull100names
out.
Notonlydoeseachpersonhaveanequalchanceofbeingselected,
wecanalsoeasilycalculatetheprobailityof

---

1078.Positiveheadimpulsetestis
suggestiveof?
a)Injurytovestibularnuclei
b)Injurytoperipheralvestibularnerve
c)Lesioninthebrainstem
d)InjurytoOcculomotornerve
CorrectAnswer-B
Ans.is`b'i.e.,Injurytoperipheralvestibularnerve
HeadImpulseTest
Itisalsocalledheadthrusttest.
Itistestforthediagnosisofinjurytovestibularnervewhichforms
theperipheralvestibularpathway.
Clinicianasksthepatienttofixhisgazeonatargetandthenperform
passivehorizontalandverticalheadimpulsesandobservesthe
patient'seyes.
Observationofarefixationsaccadeaftertheheadimpulseindicates
decreaseddecreasedvestibuloocularreflexsecondarytoperipheral
vestibularlesions(vestibularnerveinvolvement).

---

1079.Minitracheostomyisperformed
through?
a)Cricothyroidmembrane
b)2ndand3rdtrachealrings
c)Anyoftheabove
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Cricothyroidmembrane
CricothyrotomyorLaryngtomyorMinitracheostomy
Itistheproceduretoopentheairwaythroughthecricothyroid
membrane.
Patient'sheadandneckareextended,lowerborderofthroid
cartilageandcricoidringisidentified.Skininthisareaisincised
verticallyandthencricothyroidmembraneisopenedwitha
transverseincision.
Itisanemergencyproceduretobuytimeforthepatienttobeshifted
totheoperationtheatre.

---

1080.Sagograinappearanceisseenin?
a)Healedmyringitisbullosa
b)Otomycosis
c)Malignantotitisexterna
d)Keratosisobturans
CorrectAnswer-A
Ans.is'a'i.e.,Healedmyringitisbullosa
Otitisexternahaemorrhagica
ThisconditionisalsoknownasBullousmyringitisormyringitis
bullosa.
Thisconditionisextremelypainfulandhassuddenonset.
Itisthoughttobeduetomycoplasmapneumoniaeorviralinfection,
usuallyinfluenza'.
Theremaybeamildconductivedeafnessandamildlydischarging
car.
Theappearanceofhaemorrhagicbullaeonthetympanicmembrane
andinthedeepmeatusischaracteristic.Thebullaearefilledwith
serosanguinousfluidandblood.
Onhealing,bullaelooklikeSago-grain.
Therefore"Sago-grain"appearanceoftympanicmembraneisseen
inhealedmyringitisbullosa.

---

1081.Mostcommoncauseoftrigeminal
neuralgia?
a)Infection
b)Trauma
c)Vascularcompression
d)Iatrogenic
CorrectAnswer-C
Ans.is'c'i.e.,Vascularcompression
Trigeminalneuralgia(ticdouloureux)ischaracterizedbyintermittent,
shootingpainintheface.
Itisduetoinvolvementoftrigeminalnerve.
95%ofcausesoftrigeminalneuralgiaareduetopressureon
trigeminalnerveclosetowhereitentersthebrainstem,pastthe
Gasserianganglion.Inmostcases,thispressureseemstobe
causedbyanarteryorveincompressingtrigeminalnerve.
Othercausesaretumor,cysts,AVmalformationandmultiple
sclerosis.
Mostcommonlyuseddrugsfortreatmentoftrigeminalneuralgiaare
carbamazepine,gabapentinandvalproate.

---

1082.WhenapatientsaysAhtherightuvula
pressesthepalatewhichofthe
followingnerveisdamaged?
a)RghtXCN
b)RightXIICN
c)LeftXCN
d)RightXIICN
CorrectAnswer-C
Ans.is'c'i.e.,LeftXCN
Assessmentofthemovementofsoftpalate-BothIXandXCNsare
tested:
Theglossopharyngealnerve(IXCN)isamixednervewithmotor,
sensoryandsomeparasympatheticactivity.Itcarriessensoryinput
fromthepalateandpharynxandthetastefromtheposteriorthirdof
thetongue.Itprovidesafferentlimbofthegagreflex.
Thevagus(XCN)isalsoamixednervewithmotor,sensoryand
parasympatheticactivity.Itprovidesthemotorsupplytothepharynx,
softpalateandlarynxandprovidestheefferentlimbtothegag
reflex.
Normallyonoralexaminationthesoftpalateissymmetricalwiththe
uvuladanglinginthecentreanddividingthesoftpalate.
WhenthepatientisaskedtosayAAAh!Thesoftpalateshould
elevatesymmetricallyandtheuvulashouldremaincentric.Ifthereis
unilateralweaknessofthesoftpalatetheuvulaispulledawayfrom
theweakenedside.
Nowinthequestiongivenwhenthepatientsaysaaahtheright
uvulapressesthepalatei.e.therightsidesoftpalatepullstheuvula
awayfromtheweakleftside.Theweaknessoftheleftsoftpalate

---

awayfromtheweakleftside.Theweaknessoftheleftsoftpalate
canbebecauseoftheweaknessoftheleftIXorXcranialnerves.

---

1083.Lumpyfeelinginthroatrelievedon
takingfoodisattributedto?
a)Globuspharyngeus
b)Pharyngealpouch
c)Diverticulardisease
d)Esophagealatresia
CorrectAnswer-A
Ans.is'a'i.e.,GlobusPharyngeus
GlobusPharyngeus
Symptomwhereinapatientdescribessomethingstuckinthroatora
sensationoflumportightnessinthroatwhichisrelievedbytaking
foodortalking.

---

1084.Strawberrytongueisseenin?
a)Streptococcalscarletfever
b)Kawasakidisease
c)Bothoftheabove
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Bothoftheabove
Strawberrytongue
Itisalsocalledraspberrytongue
Itbasicallyreferstoglossitis,whichmanifestswithhyperplastic
(enlarged)fungiformpapillae,givingtheappearanceofastrawberry.
Whitestrawberrytongueiswherethereisawhitecoatingonthe
tonguethroughwhichthehyperplasticfungiformpapillaeprotrude.
Redstrawberrytongueiswherethewhitecoatingislostandadark
red,erythematoussurfaceisrevealed,interspacedwiththe
hyperplasticfungiformpapillae.
Whitestrawberrytongueisseeninearlyscarletfever(asystemic
infectionofgroupAhemolyticstreptococci).
Redstrawberrytongueoccurslater,after4-5days.
Otherconditionsinwhichstrawberrytongueisseenare:Kawasaki
disease,toxicshocksyndrome,andvitaminB12deficiency.

---

1085.Treatmentofmiddleearpapillomais?
a)Myringotomyandsimpleexcision
b)Myringectomyandsimpleexcision
c)Tympanomastoidectomy
d)Localinfiltrationwithpodophyllin
CorrectAnswer-C
Ans.is'c'i.e.,Tympanomastoidectomy
Middleearpappilomas
Themiddleearpapillomasarerarepresentationsandmedical
literatureismainlylimitedtocasereportsorcaseseries.
Theseincludeaggressivepappilarytumors,schneideriantypeof
pappilomasandinvertedpappilomas.
Theyareassociatedwithhearingdifficultyandvertigoandmaybe
associatedwithVonHippelLindausyndrome.
Theytendtobeslowlygrowing,locallyaggressivenon
metastasizingneoplasms
Theapproachfortreatmentofsuchpathologyisusuallyradicaland
tympanomastoidectomyisconsideredthetreatmentofchoice.This
givesthebestchanceofcure.

---

1086.Besttimeforhearingassessmentinan
infant?
a)1stmonthoflife
b)3-6months
c)6-9months
d)9-12months
CorrectAnswer-A
Ans.is'a'i.e.,1stmonthoflife
TheAmericanAcademyofPediatrics(AAP),JointCommitteeon
Infanthearing(2007),hasrecommendedthatallnewborninfantsbe
screenedforhearingimpairmenteitherasneonateorbefore1
monthofageandthatthoseinfantswhofailnewbornscreening
haveanaudiologicexaminationtovarifyhearinglossbeforeageof
3months.

---

1087.Followingproteinisnotfoundinorgan
ofcorti?
a)Myosin
b)Microtubuleassociatedprotein2
c)Microtubuleassociatedprotein4
d)Fodrin
CorrectAnswer-C
Ans.is'c'i.e.,Microtubuleassociatedprotein4
Proteinspresentincochlea
Actin-bindingandmicrotubule-associatedproteinsregulate
microfilamentandmicrotubulenumber,length,organizationand
locationincells.
Infreeze-driedpreparationsoftheguineapigcochlea,bothactin
andtubulinarefoundinthesensoryandsupportingcellsofthe
organofCorti.
Fodrin(brainspectrin)co-localizedwithactininthecuticularplates
ofbothinnerandouterhaircellsandalongthelateralwallofthe
outerhaircells.
Alpha-actininco-localizedwithactininthecuticularplatesofthehair
cellsandintheheadandfootplatesofthesupportingcells.Itwas
alsofoundinthejunctionalregionsbetweenhaircellsand
supportingcells.oProfilinco-localizedwithactininthecuticular
platesofthesensoryhaircells.
Myosinwasdetectedonlyinthecuticularplatesoftheouterhair
cellsandinthesupportingcellsintheregionfacingendolymph.
Gelsolinwasfoundintheregionofthenervefibers.
TubulinisfoundinmicrotubulesinallcellsoftheorganofCorti.
Insupportingcells,microtubulesarebundledtogetherwithactin

---

microfilamentsandtropomyosin,aswellasbeingpresentas
individualmicrotubulesarrangedinnetworks.
Anintenselystainednetworkofmicrotubulesisfoundinbothouter
andinnersensoryhaircells.
Themicrotubulesintheouterhaircellsappeartocoursethroughout
theentirelengthofthecells,andbasedontheirstainingwith
antibodiestothetyrosinatedformoftubulintheyappeartobemore
dynamicstructuresthanthemicrotubulesinthesupportingcells.
Themicrotubule-associatedproteinMAP-2ispresentonlyinouter
haircellswithintheorganofCortiandco-localizeswithtubulinin
thesecells.NootherMAPs(1,3,4,5)arepresent.
Tauisfoundinthenervefibersbelowbothinnerandouterhaircells
andintheosseousspirallamina.

---

1088.Darwintubercleisseenin?
a)Tragus
b)Helix
c)Antihelix
d)Lobule
CorrectAnswer-B
Ans.is'b'i.e.,Helix
Darwin'stubercle(orauriculartubercle)isacongenitalearcondition
whichoftenpresentsasathickeningonthehelixatthejunctionof
theupperandmiddlethirds.
Thefeatureispresentinapproximately10.4%ofthepopulation.This
acuminatenodulerepresentsthepointofthemammalianear.

---

1089.Incisuraterminalisisbetween?
a)Tragusandcruxofhelix
b)Earlobuleandantihelix
c)Antihelixandexternalauditorymeatus
d)Tragusandearlobule
CorrectAnswer-A
Ans.is'a'i.e.,Tragusandcruxofhelix
Incisuraternzinalisistheareabetweenthetragusandcrusofhelix

---

1090.Callauralfistulaisanabnormalityof?
a)1"branchialarch
b)Ptbranchialcleft
c)2ndbranchialarch
d)2ndbranchialcleft
CorrectAnswer-B
Ans.is'b'i.e.,Ptbranchialcleft
Collauralfistulaisa1"branchialcleftanomalywhicharisesfrom
failureoffusionoftheventralpartofthePtcleft.
Itsupperpartopensintofloorofexternalauditarycanal.
Itslowerpartopensintheneckbetweenangleofmandibleand
sternocleidomastoidmuscle.

---

1091.Potatotumordueto?
a)Hypotrophyofsebaceousglandsofnose
b)Hypertrophyofsebaceousglandsofnose
c)Hypotrophyofsweatglandsofnose
d)Hpertrophyofsweatglandsofnose
CorrectAnswer-B
Ans.is'b'i.e.,Hypertrophyofsebaceousglandsofnose
Rhinophyma(Potatotumor)
Rhinophymaislarge,bulb-shaped,red-colored(ruddy)nose.Itisa
slowgrowingbenigntumorduetohypertrophyofthesebaceous
glands.Thecauseofrhinophymaisunknown,thoughitisthoughtto
beasevereformofacneroscea.Rhinophymawasoncethoughtto
becausedbyheavyalcoholconsumption,butthisisnotthecase.
Rhinophymaoccursequallyinthosewhodonotdrinkatalland
thosewhodrinklargequantitiesofalcohol.Itmostlyaffectsmen
pastmiddleage.Red/pinkcolourofthetumorisduetoengorgment
ofsuperficialvessels.
Treatment
Surgerytoreshapethenoseisthebestknowntreatmentfor
rhinophyma.Surgerymaybedonewithalaser(carbondioxide
laser),scalpel(sharpknife)orarotatingbrush(dermabrasion)and
theareaisallowedtore-epithelialize.Sometimes,tumouris
completelyexcisedandtherawareaisskin-grafted.

---

1092.Surgicalmarkingsforfindingthefacial
nerveisare?
a)Tympano-mastoidsuture
b)Tragalpointer
c)Posteriorbellyofdigastric
d)Alltheabove
CorrectAnswer-A
Ans.is'a'i.e.,Tympano-mastoidsuture
Surgicallandmarkstoidentifymaintrunkofthefacialnerveare
asfollows:
i. Tympanomastoidsutureline-itislocatedbetweenthemastoidand
thetympanicbones.Themainfacialtrunklies6-8mmdistaltothe
endofthesuture.
ii. Tragalpointer-themainnervetrunklies1.0to1.5cmdeepand
slightlyanteriorandinferiortothetipoftheexternalearcanal
cartilage.
iii. Posteriorbellyofdigastric-themainnervetrunklies1cmdeepto
themedialattachmentoftheposteriorbellyofdigastricmuscleto
thedigastricgroove(mastoidnotch)ofthemastoidbone.
iv. Mastoidbone-mainnervetrunkisidentifiedinsidethemastoid
bonebymastoidectomy.

---

1093.Whichofthefollowingisnotacauseof
oropharyngealcarcinoma?
a)Occupationalexposuetohydrochloricacid
b)Smoking
c)HumanPapillomaVirusinfection
d)Occupationalexposuretoisopropyloil
CorrectAnswer-A
Ans.is'a'i.e.,Occupationalexposuretohydrochloricacid
Etiologyoforopharyngealcarcinoma
i. Tobaccoinanyform-cigarettesmokingorchewing
ii. Heavyalcoholabuse
iii. Beetlenutchewing
iv. Plummervinsonsyndrome,cirrhosis
v. Syphilis
vi. Trauma
vii. Dentalirritation
viii. Poororalhygiene
ix. Occupationalexposuretoisopropylalcohol,sulphuricacidand
nickel
x. HPVinfection

---

1094.Falseregardingtheforeignbodyof
oropharynxis?
a)Impactedforeignbodiesmostoftenlodgeinthesofttissueat
thebaseoftongue
b)Foodparticlesarethemostcommonoropharyngealforeign
bodiesinchildren
c)Clinicalhypopharyngealforeignbodiesareamenabletoclinical
examination
d)EndoscopyandMDCTareusedinthediagnosis
CorrectAnswer-B
Ans.is'b'i.e.,Foodparticlesarethemostcommon
oropharyngealforeignbodiesinchildren
Oropharyngealforeignbodies
Mostingestedforeignbodiesdonotimpactintheoropharynx
Sharpforeignbodieslikefishandchickenbonesmostcommonly
impactinthesofttissuesatthebaseofthetongue.
Hypopharyngealforeignbodiescanbedetectedbygoodphysical
examination.
EndoscopyandMDCTareusedinthediagnosisofforeignbodiesof
cervicalesophagus.
Coinsarethemostcommonimpactedoropharyngealforeignbodies
encounteredinchildrenfollowedbyfoodparticles.

---

1095.Ostmannfatpadisrelatedto?
a)Earlobule
b)Buccalmucosa
c)Eustachiantube
d)Tipofnose
CorrectAnswer-C
Ans.is'c'i.e.,Eustachiantube
TherearesmallfatbodieslocatedinfermedialtoEustachiantube.
ThesearecalledOstmannfatpads.
Theyareimportantinnormalclosureofeustachiantubeand
preventingtransmissionofnasopharyngealpressuretomiddleear.
ThesefatpadsareabsentinPatuloustubesyndrome.

---

1096.Fowlsmellingnasaldischargeisseen
inallexcept?
a)NasalMyiasis
b)Choanalatresia
c)Foreignbodyinnose
d)Rhinolith
CorrectAnswer-B
Ans.is`b'i.e.,Choanalatresia
Diseaseswithfowlsmellingnasaldischargeare:
Nasalmyiasis
Foreignbodyinnose
Rhinolith
Inchoanalatresiathereispresenceofnasaldischargewithoutair
bubbles.

---

1097.Cauliflowerearisdueto?
a)Hematoma
b)Carcinoma
c)Fungalinfection
d)Herpes
CorrectAnswer-A
Ans.is'a'i.e.,Hematoma
Hematomaoftheauricle
Itisthecollectionofbloodbetweentheauricularcartilageandits
perichondrium.
Itusuallyoccursduetoblunttraumaandoftenseeninboxers,
wrestlersandrugbyplayers,thereforeitisalsocalledBoxer'sear.
Extravasatedbloodmayclotandthenorganise,resultingintypical
deformitycalled,Cauliflowerear.Ifhaematomagetsinfected,severe
perichondritismaysetin.

---

1098.Fowlsmellingeardischargewith
presenceofpalegranulationtissuein
earinanadolescentboyissuggestive
of?
a)Cholesteatoma
b)Exostosis
c)Otomycosis
d)Malignantotitisexterna
CorrectAnswer-A
Ans.is'a'i.e.,Cholesteatoma
Fowlsmellingeardischargewithpresenceofgranulationtissuein
earinadolescentboyissuggestivechronicsuppurativeotitsmediaof
theunsafetype(atticoantraldisease).Suchpatientshaveunderlying
cholesteatomaalongwithevidenceofbonedestruction.
Clinicalfeaturesofcholesteatoma/atticoantralCSOM
Otorrhoea:-Scanty,foulsmellingdischargeduetobone
destruction.
Hearingloss:-Initiallyconductiveduetodestructionofossicles.
Latersensorineuralelementmaybeadded,whichresultsinmixed
hearingloss.
Bleeding:-Mayoccurfromgranulationorthepolypwhencleaning
theear.
Tympanicmembraneshowposteriormarginaloratticperforation.
Alsogranulationtissueandpolypsmaybepresentinear.

---

1099.

---

Centralpartofcholesteatomacontains?
a)Keratindebris
b)Keratinizedsquamousepithelium
c)Coulmnarepithelium
d)Fibroblasts
CorrectAnswer-A
Ans.is'a'i.e.,Keratindebris
Cholesteatoma
Destructiveorexpandinggrowthinthemiddleearormastoid
process
Thetermcholesteatomaisamisnomer,becauseitneithercontains
cholesterolcrystalsnorisitatumortomeritthesuffix`oma'.
Cholesteatomahasthepropertytodestroybone.Itmaycause
destructionofearossicles,erosionofbonylabyrinth,canaloffacial
nerve,sinusplateortegmentympaniandthuscauseseveral
complications.Bonedestructionbycholesteatomahasbeen
attributedtovariousproteolyticenzymesliberatedbyosteoclasts
andmononuclearinflammatorycells,seeninassociationwith
cholesteatoma.
Cholesteatomaconsistsoftwoparts:?
i)Matrix:-Madeupofkeratinizingsquamousepithelium.
ii)Keratindebris(centralwhitemass):-Producedbythematrix.
Therefore,cholesteatomaalsoreferredtoasepidermosisor
keratoma.

---

1100.Whichofthefollowingisincludedinthe
Levensoncriteriaforcongenital
cholesteatoma?
a)Whitemassmedialtonormaltympanicmembrane
b)Atticoantralperforationofthetympanicmembrane
c)Definitehistoryofotorrhoea
d)Historyofpriorotologicprocedures
CorrectAnswer-A
Ans.is'a'i.e.,Whitemassmedialtonormaltympanic
membrane
Levensoncriteriaforcongenitalcholesteatoma
1. WhitemassmedialtonormalTM.
2. Normalparsflaccidaandtensa.
3. Nohistoryofotorrheaorperforations.
4. Nopriorotologicprocedures.
5. Priorboutsofotitismedianogroundforexclusions.

---

1101.Whichofthefollowingstructuresisnot
atimmediateriskoferosionby
cholesteatoma?
a)Longprocessofincus
b)Fallopiancanalcontainingfacialnerve
c)Horizontal/lateralsemicircularcanal
d)Baseplateofstapes
CorrectAnswer-D
Ans.is'd'i.e.,Baseplateofstapes
Cholesteatomahasthepropertytodestroythebonebyvirtueofthe
enzymesreleasedbyit.
Structuresimmediatelyattheriskoferosionare:-
i. Longprocessofincus.
ii. Fallopiancanalcontainingfacialnerve.
iii. Horizontal/lateralsemicircularcanal

---

1102.Acutesuppurativeotitsmediain
childrenismostcommonlycausedby?
a)St.pneumoniae
b)S.epidermidis
c)S.aureus
d)Pseudomonas
CorrectAnswer-A
Ans.is'a'i.e.,St.pneumonia[RefDhingra5thlep.54]
ASOMisespeciallycommonininfantsandchildren.Mostofthetime
ASOMusuallyfollowsrespiratorytractinfections(i.e.,acute
tonsillitis,commoncoldorinfluenza)andtheinfectiontravelupby
theeustachiantubetothemiddleear.
Themostcommoncausativeorganismisstreptococcuspneumoniae

---

1103.Mostcommonorganismculturedin
CSOMis?
a)Staphylococcusaureus
b)Staphylococcusepidermidis
c)Streptococcuspneumonia
d)Pseudomonasaeruginosa
CorrectAnswer-D
Ans.is'd'i.e.,Pseudomonasaeruginosa
MicrobiologyofCSOM
PuscultureinbothtypesofaerobicandanaerobicCSOMmayshow
multipleorganisms.
Mostcommonlyisolatedorganismsaregramnegativebacilli,i.e.,
Pseudomonas,proteus,E.coli.
Theseorganismsarenotcommonlyfoundintherespiratorytract,
whilecommonlyfoundintheskinofexternalear.

---

1104.Mostcommonnervetobedamagedin
CSOMis
a)III
b)VII
c)IV
d)VI
CorrectAnswer-B
FacialnerveistheM/CnervetobedamagedinCSOM.

---

1105.Atticoantraldiseaseistreatedby?
a)Modifiedradicalmastoidectomy
b)Antibiotics
c)Grommetinsertion
d)Synringing
CorrectAnswer-A
Ans.is'a'i.e.,Modifiedradicalmastoidectomy
Treatmentofatticoantraldisease
Sincecholesteatomaisgoingtoexpandanddestroyboneand
mucousmembrane,ithastoberemoved.Therefore,surgeryisthe
mainstayoftreatment.Primaryaimisremovalofdiseaseby
mastoidectomytomakeearsafefollowedbyreconstructionof
hearingatalaterstage.Modifiedradicalmastoidectomyisthe
surgeryofchoice.
Twotypesofsurgicalprocedures(mastoidectomy)aredonetodeal
withcholesteatoma.
1)Canalwalldownprocedures
Theseleavethemastoidcavityopenintotheexternalauditorycanal
sothatthediseasedareaisfullyexteriorized.
Thecommonlyusedproceduresforatticoantraldiseaseare
atticotomy,modifiedradicalmastoidectomyandrarelyradical
mastoidectomy.
Modifiedradicalmastoidectomyistheprocedureofchoice.
2)Canalwallupprocedures(corticalmastoidectomy)
Herediseaseisremovedbycombinedapproachthroughthemeatus
andmastoidbutretainingtheposteriorbonymeatuswall,thereby
avoidinganopenmastoidcavity.
Forreconstructionofhearingmechanismmyringoplastyor

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tympanoplastycanbedoneatthetimeofprimarysurgeryorasa
secondstageprocedure.

---

1106.InapatientwithCSOM,labrynthine
fistulamostcommnonlyinvolves?
a)SuperiorSCC
b)LateralSCC
c)PosteriorSCC
d)Utricle
CorrectAnswer-B
Ans.is'b'i.e.,LateralSCC
Labrynthinefistulaisalmostexclusivelyreportedinassociationwith
chronicotitismediaandcholesteatoma.
Themostcommonlyaffectedcanalislateral(horizontal)semicircular
canal,butinvolvementoftheposteriorandsuperiorcanalsaswell
asotherregionsoflabyrinthhavebeenreported.
Theincidenceoflabrynthinefistulainchronicotitismediais
approximately10%.

---

1107.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.

---

1108.Allaretrueforgradenigo'ssyndrome
except?
a)Associatedwithintermittenteardischarge
b)Associatedwithconductivehearingloss
c)Causesdiplopia
d)Leadstoretroorbitalpain
CorrectAnswer-A
Ans.is'a'i.e.,Associatedwithintermittenteardischarge
Gradenigo'ssyndrome,alsocalledGradenigo-Lannois
syndrome,isacomplicationofotitismediaandmastoiditisinvolving
theapexofthepetroustemporalbone.

---

Symptoms
Componentsofthesyndromeinclude:
retroorbitalpainduetopainintheareasuppliedbytheophthalmic
branchofthetrigeminalnerve(fifthcranialnerve),
abducensnervepalsy(sixthcranialnerve)
otitismedia
Othersymptomscanincludephotophobia,
excessivelacrimation,fever,andreducedcornealsensitivity.The
syndromeisclassicallycausedbythespreadofaninfectionintothe
petrousapexofthetemporalbone.

---

1109.Followingisthepreferredtreatmentof
SerousOtitisMedia-
a)Grommetsurgery
b)OralAmoxicillinfor5-10days
c)Modifiedradicalmastoidectomy
d)Bedrest,antipyreticsandadequatefluidintake
CorrectAnswer-A
Ans.is'a'i.e.,Grommetsurgery
Treatmentofotitismedia
Followingtwotreatmentshavebeendescribed:?
1)Watchfulwaiting
Watchfulwaitingistheactivemonitoringoftheconditionandhearing
inanticipationofspontaneousresolution.Guidlinesaimedatboth
primarycareandspecialistotolaryngologistbroadlyagreethata
watchfulwaitingperiodforaboutthreemonthsistheinitial
managementofchildrenwithserousotitismedia.Therefore,unless
therearealsosignsofaninfection,mosthealthcareproviderswill
nottreatSOMatfirstInstead,theywillrechecktheproblemin2-3
months.Thisshouldbecoupledwithreassurancethatdoingnothing
isaslikelyasdoingsomethingtoresultinresolutionoftheSOMand
theassociatedsymptoms.
2)Surgery
Surgicalinterventionisrecommendedwhenwatchfulwaitingand
monitoringofhearinghasconfirmedfailureofresolutionofSOM.
Followingsurgicalinterventionareusedcommonly:-
i. Myringotomyandaspirationoffluid:-Anincisionismadeintympanic
membraneandfluidaspiratedwithsuction.
ii. Grommet(ventilationtube)surgery:-Ifmyringotomyandaspiration

---

combinedwithmedicalmeasureshasnothelpedandfluidrecurs,a
grommetisinsertedtoprovidecontinuedaerationofmiddleear.
ThisisthemostcommonsurgicalinterventionforSOM.Most
preferedsiteofgrommetinsertionisantero-inferiorthrough
circumferentialorradialincision.
iii. Surgicaltreatmentofcausativefactor:-Adenoidectomy,
tonsillectomyetc.
Medicalmeasuresarecontroversialandinvolve:?
1. Decongestants
2. Antiallergicmeasures
3. Antibiotics
4. Middleearaeration:-Valsalvamaneuver,Politzerisationor
eustachiantubecatheterization,Chewinggum.

---

1110.Multipleperforationoftympanic
membranecharacteristicof?
a)TubercularOtitisMedia
b)SyphiliticOtitisMedia
c)Pseudomonasinfection
d)FungalOtitisMedia
CorrectAnswer-A
Ans.is'a'i.e.,Tubercularotitismedia
Tubercularotitismedia
Tuberculosisofmiddleearisacomparativelyrareentityusually
seeninassociationwithorsecondarytopulmonarytuberculosis,
infectionreachesthemiddleearthrougheustachiantube.
Theraremodesofinfectionarethroughhematogenousspreadfrom
tubercularfocusinlung,tonsils,cervicallymphnodes;ordueto
ingestionofinfectedcow'smilk.
Itusuallyaffectschildrenandyoungadults.
Clinicalfeatures
Generally,tuberculosisofmiddleearisunilateral.
Itischaracterizedbypainlessotorrhoeawhichfailstorespondtothe
usualantimicrobialtreatment.Thereispainlesswateryotorrhea.
Singleormultipleperforationoftympanicmembrane.Theremaybe
multipleperforationsintheearlystages,buttheycoalesceintoa
largetympanicmembraneperforationaccompaniedbyapale
granulationtissue.
Periauricularfistulae,lymphadenopathyandfacialpalsyare
infrequentfindings.
Latecomplicationsincludefacialparalysis,labyrinthitis,postauricular
fistulae,subperiostealabscess,petrousapicitisandintracranial

---

extensionofinfection.

---

1111.Patientwiththinpainlessotorrhoea,
multipleperforationsofthetympanic
membraneandfailuretorespondto
antimicrobialtreatment.Whatisthe
mostprobablecausativeorganism?
a)Mycobacteriumtuberculosis
b)Staphylococcusaureus
c)Candidaalbicans
d)Aspegillusfumigatus
CorrectAnswer-A
Ans.is'a'i.e.,Mycobacteriumtuberculosis
Thinpainlessotorrhoea,multipleperforationsofthetympanic
membraneandfailuretorespondtoantimicrobialtreatmentarethe
featuresoftubercularotitismediaanditiscausedbyMycobacterium
tuberculosis.

---

1112.Conductinghearinglosswithintact
tympanicmembrane?
a)Presbycausis
b)Meniere'sdisease
c)Glueear
d)Acousticneuroma
CorrectAnswer-C
Ans.is'c'i.e.,Glueear
Amongthegivenoptions,onlyglueear(serousotitismedia)isa
causeofconductivedeafness.

---

1113.Lengthofexternalauditorymeatusis?
a)12mm
b)16mm
c)20mm
d)24mm
CorrectAnswer-D
Ans.is'd'i.e.,24mm
Externalauditorycanal(Externalacousticmeatus)
Externalauditorycanalisa'S'shapedcanalwithlengthof24-
25mmanditisdividedintotwoparts:?
1)Cartilagenouspart
Itformsouter/lateral1/3(8mm)oftheexternalauditorycanal.Ithas
twofissures/deficienciesintheanteriorpartcalledfissureof
santorinithroughwhichparotidorsuperficialmastoidinfectioncan
appearinthecanalandviceversa.Skincoveringitisthickandhas
ceruminousglands(modifiedapocrinesweatglands),pilosebaceous
glandsandhair.Sincehairisconfinedtocartilaginouspart,
furunclesareseenonlyintheouterthirdofthecanal.
2)Bonypart
Itformsinner/medial2/3(16mm)ofexternalauditorycanal.Skin
liningthebonypartisthinandisdevoidofhairandceruminous
glands.Isthmusisthenarrowestportionofbonycanalandis5mm
lateraltotympanicmembrane.Foreignbodiesgetlodgedinisthmus
aredifficulttoremoveasitisthenarrowestpart.`Foramenof
Huschke'isadeficiencypresentinantero-inferiorpartofbonycanal
inchildrenupto4yearsofage,permittinginfectiontoandfrom
parotid.

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1114.Notacauseofobjectivetinnitus?
a)Palatalmyoclonus
b)Glomustumor
c)Carotidarteryaneurysm
d)Presbyacusis
CorrectAnswer-D
Ans.is'd'i.e.,Presbyacusis
Tinnitus
Tinnitusisringingsoundornoiseintheear.
Thecharacteristicfeatureisthattheoriginofthissoundiswithinthe
patient.

---

1115.Whichofthefollowingisfalse
regardingFrey'ssyndrome?
a)Itisalsocalledgustatorysweating
b)Itiscausedbyinjurytoauriculotemporalnerve
c)Itoccursimmediatelyaftertheparotidsurgery
d)Itiscausedbyaberrantregenerationofpost
CorrectAnswer-C
Ans.is'c'i.e.,Itoccursimmediatelyaftertheparotidsurgery
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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1116.Synkinesisisasequelof?
a)Facialnerveparalysis
b)Trigeminalnerveparalysis
c)Superficialtemporalnerveparalysis
d)GreaterPetrosalnerveparalysis
CorrectAnswer-A
Ans.is'a'i.e.,Facialnerveparalysis
ClinicalfeaturesofBell'spalsy
Acuteonset,ipsilateralfacialparalysis.
Facialparalysisisusuallyprecededbypainbehindtheear.
Patientisunabletoclosehiseyes.
Bellsphenomenon,i.e.onattemptingtoclosetheeye,eyeballturns
upandout.
Facebecomesasymmetricalandsalivadribblesfromangleof
mouth.
Ipsilaterallossoftastesensation,salivationandlacrimation.
Intolerancetohighpitchedorloudsound(hyperacusis).
Mostpatients(80%)recoverwithinfewweekstomonths.
SynkinesisandcrocodileteararesequelaeofBell'spalsy:-
SynkinesisorfacialsynkinesisisacommonsequelaetoBell'spalsy.
Thisisduetocrossinnervationofnervefibresduringrecovery.
Whenthepatientwishestoclosetheeye,cornerofmouthalso
twichesandviceversa.
Crocodiletear(gustatorylacrimation)isduetofaultyregenerationof
parasympatheticfibreswhichnowsupplylacrimalglandinsteadof
thesalivaryglands.

---

1117.Glomusjugularecommonlyarisesfrom
?
a)Hypotympanum
b)Mesotympanum
c)Epitympanum
d)Prussaksspace
CorrectAnswer-A
Ans.is'a'i.e.,Hypotympanum
Therearetwotypesofglomustumors:-
i)Glomusjugulare
Theseglomustumorsarisefromthedomeoftheinternaljugular
veininthehypotympanumandjugularforamen.Injugularforamen
theycaninvadeIXtoXIIcranialnerves.
ii)Glomustympanicum
Theyarisefromthepromontoryofthemiddleearalongthecourse
ofthetympanicbranchoftheIXthcranialnerve.

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1118.Followingarethelaboratorytestsfor
thediagnosisofvestibulardysfunction
except?
a)Electronystagmography
b)Optokinetictest
c)Galvanictest
d)Gelle'stest
CorrectAnswer-D
Ans.is'd'i.e.,Gelle'stest
Vestibularsystem
Thevestibularsystemcontributestobalanceandtothesenseof
spatialorientation.
Itisasensorysystemthatprovidestheleadingcontributionabout
movementandsenseofbalance.
Itincludesthelabyrinth(semicircularcanalsandotolith:utricle&
sacules)oftheinnerearandissituatedinthevestibuluminthe
innerear.
Thesymptomsofvestibulardysfunctionarevertigo,dizzinessand
Unbalance.

---

1119.NotatestforEustachiantubepatency?
a)Tympanometry
b)Toynbee
c)Valsalva
d)Frenzelmaneuver
CorrectAnswer-A
Ans.is'a'i.e.,Tympanometry
TestsforEustachiantubepatency
Valsalvatest
Methylenebluetest
Sonotubometry
Politzertest
Toynbeetest
Frenzelmaneuver
Catheterization
Inflation-Deflationtest

---

1120.Horizontalaccelerationwithforward
movementinthesagittalplaneis
detectedby?
a)MaculaofUtricle
b)MaculaofSaccule
c)Lateralsemicircularcanal
d)Posteriorsemicircularcanal
CorrectAnswer-A
Ans.is'a'i.e.,Maculaofutricle

---

1121.

---

Exostosisduetorepetitiveexposuretocold
wateriscommoninwhichpartofthe
temporalbone?
a)Squamouspart
b)Tympanicpart
c)Ptreouspart
d)Mastoidpart
CorrectAnswer-B
Ans.is'b'i.e.,Tympanicpart
Surfer'sear
Itisthecommonnameforanexostosisorabnormalbonegrowth
withintheexternalauditorycanal.
Surfer'searisnotthesameasswimmer'sear,althoughinfection
canresultasasideeffect.
Irritationfromcoldwindandwaterexposurecausesthebone
surroundingtheearcanaltodeveloplumpsofnewbonygrowth
whichconstricttheearcanal.Theconditionissonamedduetoits
prevalenceamongcoldwatersurfers.Coldwatersurfersexperience
surfer'searataboutsixtimestherateofwarmwatersurfers.
Commonsiteforsurfer'searisexternalauditorycanal.Tympanic
partofthetemporalboneisaUshapedcurvedbonyplatethat
formsmostofthepartoftheexternalauditorycanal.Thusexostosis
iscommoninthetympanicpartofthetemporalbone.
Note:Partsoftemporalboneare:squamous,tympanic,styloid,
petrous,andmastoid.

---

1122.Whichofthefollowingisnota
derivativeofthemiddleearcleft?
a)Semicircularcanal
b)Mastoidaircell
c)Tympaniccavity
d)Eustachiantube
CorrectAnswer-A
Ans.is'a'i.e.,Semicircularcanal
Themiddle-earcleftinthetemporalboneincludes:?
i. Eustachiantube
ii. Themiddleear(tympaniccavity)
iii. Adituswhichleadsposteriorlytothemastoidantrumandaircells.

---

1123.Whenthepatientfailstounderstand
normalspeech,butcanunderstand
shoutedoramplifiedspeechthe
hearingloss,istermed?
a)Mildhearingloss
b)Moderatehearingloss
c)Severehearingloss
d)Profoundhearingloss
CorrectAnswer-C
Ans.is'c'i.e.,Severehearingloss
Severehearingloss
Whatisseverehearingloss?Onaverage,themostquietsounds
heardbypeoplewiththeirbettereararebetween70and95dB.
Peoplewhosufferfromseverehearinglosswillbenefitfrom
powerfulhearingaids,butoftentheyrelyheavilyonlip-readingeven
whentheyareusinghearingaids.Somealsousesignlanguage.

---

1124.Presenceofdeltasignoncontrast
enhancedCTSCANsuggestspresence
of?
a)LateralSinusthrombophlebitis
b)Cholesteatoma
c)Cerebellarabscess
d)Mastoiditis
CorrectAnswer-A
Ans.is'a'i.e.,LateralSinusthrombophlebitis
LATERALSINUSTHROMBOPHLEBITIS(SIGMOIDSINUS
THROMBOSIS)
Lateralorsigmoidsinusthrombophlebitisarisesfrominflammationin
theadjacentmastoid.Itmayoccurasacomplicationof:?
i. Acutecoalescentmastoiditis
ii. CSOMandcholesteatoma
Clinicalfeatures
HecticPicket-Fencetypeoffeverwithrigor.
Headache,Progressiveanemiaandemaciation.
Griesinger'ssign:-odemaovertheposteriorpartofmastoiddueto
thrombosisofmastoidemissaryveins.
Papilloedema
Tobey-Ayertest:-Compressionofveinonthethrombosedside
producesnoeffectwhilecompressionofveinonhealthyside
producesrapidriseinCSFpressurewhichwillbeequaltobilateral
compressionofjugularveins.
Crowe-Becktest:-Pressureonjugularveinofhealthysideproduces
engorgementofretinalveins.Pressureonaffectedsidedoesnot

---

producesuchchange.
Tendernessalongjugularvein
Imagingstudies
Contrast-enhancedCTscancanshowsinusthrombosisbytypical
delta-sign.Itisatriangularareawithrimenhancement,andcentral
lowdensityareaisseeninposteriorcranialfossaonaxialcuts.
Delta-signmayalsobeseenoncontrastenhancedMRI.

---

1125.Ohgren'slinepassesfrom?
a)Medialcanthustoangleofmandible
b)Lateralcanthustoangleofmandible
c)Medialcanthustomastoidprocess
d)Lateralcanthustomastoidprocess
CorrectAnswer-A
Ans.is'a'i.e.,Medialcanthustoangleofmandible

---

1126.Whichofthefollowingisnottrueabout
invertedpapilloma?
a)Itisalwaysunilateral
b)Itismorecommoninmales
c)10-15%ofthecasesmaybeassociatedwithsquamouscell
carcinoma
d)ItisalsocalledRingertztumor
CorrectAnswer-D
Ans.is'd'i.e.,ItisalsocalledRingertztumor
InvertedPapilloma(Transitionalcellpapilloma/Schneiderion
papilloma)
Invertedpapillomaisabenignneoplasmoccursmostlybetween40-
70yearswithmalepreponderance(5:1).oItarisesfromthelateral
wallofnoseandisalwaysunilateral.Rarely,itmayarisefromnasal
septum.oFeaturesofinvertedpapillomaare:-
Itshowsfingerlikeepithelialinvasionsintotheunderlyingstromaof
theepitheliumratherthanonsurfacesocalledinvertedpapilloma.
Itisusuallyunilateralandisalocallyaggressivetumour.
Patientscomplainofnasalobstruction,rhinorrhea&unilateral
epistaxis.
In10-15%casestheremaybeassociatedsquamouscell
carcinoma.
Treatmentisadequatelocalexcision.Ifitarisesinmaxillarysinus,
thenaradicalantrostomyiscarriedout.Ifitarisesintheethmoidal
sinus,anexternalethmoidectomyisdone.Ifitarisesfromnose,
treatmentiswidesurgicalexcisionbylateralrhinotomy.
Hasatendencytorecurevenafterremoval.

---

1127.

Invertedpapillomaofnosearisefrom?

a)Nasalseptum
b)Roofofthenose
c)Tipofthenose
d)Lateralwallofthenose
CorrectAnswer-D
Ans.is'd'i.e.,Lateralwallofthenose
InvertedPapilloma(Transitionalcellpapilloma/Schneiderion
papilloma)
Invertedpapillomaisabenignneoplasmoccursmostlybetween40-
70yearswithmalepreponderance(5:1).
Itarisesfromthelateralwallofnoseandisalwaysunilateral.
Rarely,itmayarisefromnasalseptum.
Featuresofinvertedpapillomaare:-
Itshowsfingerlikeepithelialinvasionsintotheunderlyingstromaof
theepitheliumratherthanonsurfacesocalledinvertedpapilloma.
Itisusuallyunilateralandisalocallyaggressivetumour.
Patientscomplainofnasalobstruction,rhinorrhea&unilateral
epistaxis.
In10-15%casestheremaybeassociatedsquamouscell
carcinoma.
Treatmentisadequatelocalexcision.Ifitarisesinmaxillarysinus,

---

thenaradicalantrostomyiscarriedout.Ifitarisesintheethmoidal
sinus,anexternalethmoidectomyisdone.Ifitarisesfromnose,
treatmentiswidesurgicalexcisionbylateralrhinotomy.
Hasatendencytorecurevenafterremoval.

---

1128.Whichofthefollowingisfalse
regardingfrontalsinusitis?
a)Painshowsperiodicity
b)Mostcommonsinusinvolvedininfantsandchildren
c)Painisreferredtoasofficeheadache
d)Tendernessispresentjustabovethemedialcanthusofeye
CorrectAnswer-B
Ans.is'b'i.e.,Mostcommonsinusinvolvedininfantsandchildren
MostcommonsinusinvolvedininfantandchildrenisEthmoidsinus.
Clinicalfeaturesofacutesinusitis
Mostcommonpresentingpatient'scompliantispersistentnasal
dischargewhichcanbeofanyquality(thin,thick,clear,orpurulent).
Nasaldischargefromasinusinfectioncanbeblood-tingedfrom
excessivenoseblowingandirritation.Theclinicalsymptomsof
acutesinusitishavebeenclassifiedintomajorandminor.

---

1129.Samterstriadisseeninpatientswith?
a)Asthma
b)Chronicpancreatitis
c)Crohn'sdisease
d)Livercellcarcinoma
CorrectAnswer-A
Ans.is'a'i.e.,Asthma
Samter'striad
Samter'striadisamedicalconditionconsistingofasthma,aspirin
sensitivity,andnasal/ethmoidalpolyposis.Itoccursinmiddleage
(twentiesandthirtiesarethemostcommononsettimes)andmay
notincludeanyallergies.
Mostcommonly,thefirstsymptomisrhinitis.
Thedisordertypicallyprogesestoasthma,thenpolyposis,with
aspirinsensitivitycominglast.
Theaspirinreactioncanbesevere,includinganasthmaattack,
anaphylaxis,andurticariainsomecases.Patientstypicallyreactto
otherNSAIDSsuchasibuprofen,althoughparacetamolisgenerally
consideredsafe.
Anosmia(lackofsmell)isalsotypical,astheinflammationreaches
theolfactoryreceptorsinthenose.

---

1130.Nasopharyngealcarcinomaseenin
whichoccupation?
a)Asbestosindustry
b)Cementindustry
c)Woodworkers
d)Chimneyworkers
CorrectAnswer-C
Ans.is'c'i.e.,Woodworkers
RefDhingra4h/ep.235;NasopharyngealcarcinomaByAndrew
VanHasselt,
AlanG.Gibb2d/ep.4
Wooddustsexposureisariskfactorofnasopharyngealcarcinoma
and
AdenocarcinomaofPNS.
FormaldehydeexposureisariskfactorofNasopharyngeal
carcinoma.

---

1131.Trottertriadnotincludedis?
a)Conductivedeafness
b)Temporoparietalneuralgia
c)Palatalparalysis
d)Seizures
CorrectAnswer-D
Ans.is'd'i.e.,Seizures
Trotter'striad
Trotter'striadoccursinnasopharyngealcarcinoma
Itincludes:-
i)Conductivedeafness(duetoEustachiantubeblockage)
ii)Temporo-parietalneuralgia(duetoinvolvementofipsilateralVth
cranialnerve)
iii)Palatalparalysis(duetoinvolvementofXthcranialnerve)

---

1132.Followingistrueaboutlaryngomalacia
except?
a)Omegashapedepiglottis
b)Reassuaranceofthepatientisthetreatmentofchoice
c)Conditionisfirstnoticedinthefirstfewweeksoflife
d)Expiratorystridor
CorrectAnswer-D
Ans.is'd'i.e.,Expiratorystridor
Laryngomalacia
Itisthemostcommoncongenitalabnormalityofthelarynx.
Laryngomalaciaisthemostfrequentcauseofstridorornoisy
breathingininfants.Itoccursasaresultofafloppyportionofthe
larynx(insupraglotticlarynx)thathasnotyetdevelopedthestrength
toproviderigidsupporttotheairway.Duringinspirationnegative
pressureiscreatedthroughlarynx,whichresultsinacollapseof
thesestructuresintotheairwayandanarrowerbreathingpassage.
Partialobstructionisthesourceofthenoisewithbreathing(stridor),
andsometimescyanosis.
Thehallmarksignincludesintermittentstridormostlyininspiration.It
isusuallymoreprominentwhentheinfantislyingonhis/herback
(supineposition,crying,feeding,excitedorhasacold.Stridorgets
relievedonplacingthepatientinproneposition.Thisisusuallyfirst
noticedinthefirstfewweeksoflife.
Itmayworsenoverthefirstfewmonthsandbecomelouder.Thisis
becauseasthebabygrows,inspiratoryforceisgreater,which
causesgreatercollapseofthelaryngealstructuresintotheairway.
Thisisusuallyworstat3-6monthsandthengraduallyimprovesas
therigidityofthecartilageimproves.

---

Mostchildrenaresymptomfreeby1to2years.
Sometimes,cyanosismayoccur.
Directlaryngoscopyshows:-
Omegashapedepiglottis,i.e.elongatedandcurledonitself.
Floopy,tall,foreshortenedandthinaryepiglotticfolds.
Prominentarytenoids.
Inmostpatientslaryngomalaciaisaselflimitingcondition.
Treatmentoflaryngomalaciaisreassurancetotheparentsandearly
antibiotictherapyforupperrespiratorytractinfections.

---

1133.Patientpresentswithmouthbreathing,
recurrentserousotitismediaand
adenoidfacies.Whatisthebestlineof
management?
a)Adenoidectomy
b)Tonsillectomy
c)Antibiotics
d)Supportivetherapy
CorrectAnswer-A
Ans.is'a'i.e.,Adenoidectomy
Thetriadofnasalandauralsymptomswithadenoidfaciespointsto
thediagnosisofenlargedadenoids.
Forthetreatmentofenlargedadenoidswhensymptomsarenot
markedbreathingexcercise,decongenstantnasaldropsand
antihistaminicsareusedandwhensymptomsaremarked,
adenoidectomyisdone.
Wehaveapatientwithmarkedandrecurrentsymptomsthus
adenoidectomyisthetreatmentofchoice.

---

1134.Rhinitismostcommonbacterialcause
?
a)Haemophilusinfluenza
b)Streptococcushaemolyticus
c)Pasturellamultocida
d)Cornybacteriumdiphtheria
CorrectAnswer-A
Ans.is'a'i.e.,Haemophilusinfluenza
Acutebacterialrhinitisismostcommonlyseenamongchildren,but
adultmaydeveloptheconditionafternasaltrauma,viralupper
respiratorytractinfection,orsurgery.
Theclinicalpresentationofacutebacterialrhinitismaybeidentical
tothatofcommoncold.
MostcommoncausativeorganismsincludeS.pneumoniae,H.
influenzaeandMoraxellaCatarrhalis.
Note:Overall,mostcommoncauseofinfectiverhinitisisviral
infection(viralrhinitis).

---

1135.Whichofthefollowingorganismsis
knowntocauseAtrophicrhinitis?
a)Klebsiellaozaena
b)Klebsiellapneumonia
c)Streptococcuspneumonia
d)Streptococcusfoetidis
CorrectAnswer-A
Ans.is'a'i.e.,Klebsiellaozaena
Atrophicrhinitis(Ozaena)
Atrophicrhinitisisachronicinflammationofnosecharacterizedby
atrophyofnasalmucosa,includingtheglands,turbinatebonesand
thenerveelements.Atrophicrhinitismaybeprimaryorsecondary:
?
1)Primaryatrophicrhinitis
Theprimarypathologyisinflammationandatrophyofthenose.
Generally,atrophicrhinitisreferstoprimaryatrophicrhinitis.
Causesare:-
i)Hereditary
ii)Endocrinalpathology-Startsatpuberty.Stopsaftermenopause
iii)Racialfactors-SeenmoreinWhitesandYellowraces
iv)Nutritionaldeficiency-DeficiencyofvitaminA,D,Eandironmay
beresponsibleforit.
v)Infective-Klebsiellaozanae,Diphtheriods,P.vulgaris,E.coli,
Staphylococci,Streptococci.
vi)Autoimmuneprocess-Causingdestructionofnasal,
neurovascularandglandularelementsmaybethecause.
2)Secondaryatrophicrhinitis
Specificinfections,suchassyphilis,lupus,leprosy,and

---

rhinoscleroma,maycausedestructionofthenasalstructures
leadingtoatrophicchanges.Canalsoresultsfromlongstanding
purulentsinusitis,radiotherapyofnose,excessivesurgicalremoval
oftheturbinateandascomplicationofDNSontherootsideofnose.

---

1136.Vidianneurectomyisdonefor?
a)Allergicrhinitis
b)Atrophicrhinitis
c)Vasomotorrhinitis
d)Chronichypertrophicrhinitis
CorrectAnswer-C
Ans.is'c'i.e.,Vasomotorrhinitis
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.
Treatment
Treatmentofvasomotorrhinitisincludes:-
1.Conservativetreatment
Avoidanceofphysicalfactorswhichprovokesymptoms.
Antihistaminicsandoralornasaldecongestants.

---

Topicalorsystemicsteroids
2.Surgicaltreatment
Nasalobstructioncanberelievedbymeasureswhichreducethe
sizeofhypertrophiednasalturbinate:-Cryosurgery,submucosal
diathermy,Linearcauterization,partialortotalturbinectomy,
submucosal
resectionofturbinate.
ExcessiverhinorrhoeainvasomotorRhinitisnotcorrectedby
medicaltherapyandbothersometothepatient,isrelievedby
sectioningtheparasympatheticsecretomotorfibrestonosei.e.,
vidianneurectomy.

---

1137.Young'soperationisdonefor
a)Allergicrhinitis
b)Atropicrhinitis
c)Vasomotorrhinitis
d)Idiopathicrhinitis
CorrectAnswer-B
Ans.is'b'i.e.,Atrophicrhinitis[RefDhingra5th/ep.171;
Essentialotolaryngology2"d/ep.523]
SurgicaltreatmentofAtrophicrhinitis
1. Young'soperation
2. ModifiedYoung'soperation
3. Narrowingofthenasalcavityby(Lautenslagersoperation)
4. Lautenslagersoperation

---

1138.Whichofthefollowingisthemostcommonformofmalignantmelanoma?
a)Nodular
b)Superficialspreading
c)Acrallentiginous
d)Mucosal
CorrectAnswer-B
Thecommonesttypeofmelanomaisthesuperficialspreadingmelanoma(SSM).The
melanomaprogressthrough3phases:insitu,radialgrowth,verticalgrowth.
NB:Aprimarymelanomawithnorecognizableadjacentinsituorradialgrowthphaseis
nodularmelanoma.

Melanomawithsimilarprevalenceinallethnicgroups-acrallentiginous

Ref:Rook'stextbookofdermatology,Edition-8,Page-54.45.

---

1139.Rhinoscleromaoccursdueto?
a)Autoimmunecause
b)Inflammatorycause
c)Klebsiellarhinoscleromatisinfection
d)Mycoticinfection
CorrectAnswer-C
Ans.is'c'i.e.,Klebsiellarhinoscleromatisinfection
Rhinoscleroma
ThecausativeorganismisKlebsiellarhinosclerontatisorFrisch
bacillus,whichcanbeculturedfromthebiopsymaterial.
Thediseaseisendemicinseveralpartsofworld.
InIndia,itisseenmoreofteninnorthernthaninthesouthernparts.
Biopsyshowsinfiltrationofsubmucosawithplasmacells,
lymphocytes,eosinophils,Mikuliczcells&Russellbodies.
Thelattertwoarediagnosticfeaturesofthedisease.
Thediseasestartsinthenose&extendstonasopharynx,
oropharynx,larynx,trachea&bronchi.
Modeofinfectionisunknown.
Bothsexesofanyagemaybeaffected.

---

1140.Complicationoftraumatodangerarea
offace?
a)Cavernoussinusinfection
b)Meningitis
c)Visualloss
d)Lossofmemory
CorrectAnswer-A
Ans.is'a'i,e.,Cavernoussinusinfection
Theareaofupperlipandthelowerpartofnoseisthedangerarea
offace.Itisduetothatthisareaisthecommonsiteofinfection.
Thisareaisdrainedbyfacialveinwhichcommunicateswiththe
cavernoussinusthroughthesuperiorophthalmicveinandpterygoid
venousplexusthroughtheemissaryvein.
Incaseofanyinfectionofthisareaitmayspreadtothecavernous
sinuscausinginfectionand/orthrombosis.

---

1141.Tympanoplastydealswith
reconstructionof-
a)Tympanicmembrane
b)Ossicularchain
c)Bothaandb
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Bothaandb
Tympanoplastyisthesurgicaloperationperformedfor
reconstructionoftympanicmembraneand/ormiddleearossicles.
Myringoplastyisthereconstructionoftympanicmembrane.
Ossiculoplastyisthereconstructionofossicularchain.
Tympanoplasty=Myringoplasty?ossiculoplasty

---

1142.Graftformyringoplasty
a)Temporalisfascia
b)Iliacusfascia
c)Colesfascia
d)Ihotibialband
CorrectAnswer-A
Ans.is'a'i.e.,Temporalisfascia
Graftmaterialusedformyringoplastyare:
i. Temporalisfascia(mostcommon)
ii. Tragalcartilage
iii. Perichondriumfromthetragus
iv. Vein

---

1143.Pyriformfossaissituatedin?
a)Oropharynx
b)Hypopharynx
c)Nasopharynx
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Hypopharynx
Pyriformfossaisapartoflaryngopharynx(hypopharynx)

---

1144.Mostcommonsiteforcarcinoma
pharynxinfemalessufferingfrom
plummervinsonsyndromeis
a)Postcricoidregion
b)Posteriorwall
c)Lateralwall
d)Pyriformisfossa
CorrectAnswer-A
Ans.is'a'i.e.,Postcricoid
Plummer-Vinsonsyndrome
Plummer-Vinsonsyndrome,alsoknownasBrown-Kelly-Paterson
syndromeorsederopenicdysphagia,seeninmiddleaged
edentulouswomen.
TheplummerVinsionPatersonBrownKellySyndromeis
characterizedby:-
Dysphagia
Chronicirondeficiencyanemia
Atrophicoralmucosaandglossitis
Brittle,spoon-shapedfingernails(Koilonychia)
Thecauseofdysphagiaisusuallyacervicalesophagealweb,but
abnormalpharyngealandesophagealmotilitymayplayarole.
Thesyndromecharactersticallyoccursinmiddleagededentulous
(withoutteeth)women.
Itisapremalignantlesion.Approximately10%ofpatientdevelop
squamouscellCaofesophagus,oralcavityorthehypopharynx.
Asiron-deficiencyanemiaisacommonfinding,itisalsoknownas
sideropenicdysphagia.

---

Carcinomadevelopsinpost-cricoidregion.

---

1145.Turbanepiglottisisseenin?
a)TB
b)Leprosy
c)Laryngealpapilloma
d)Epiglottitis
CorrectAnswer-A
Ans.is'a'i.e.,TB
Tubercularlarvn_gitis
Tubercularlaryngitisisalmostalwayssecondarytopulmonary
lesions,mostlyaffectingmalesinmiddleage(20-40years).Disease
affectstheposteriorthirdoflarynxmorecommonlythananterior
part.Thepartsaffectedindescendingorderoffrequencyare:-i)
Interarytenoidfold,ii)Ventricularband,iii)Vocalcords,iv)Epiglottis
Clinicalfeatures
Weaknessofvoicewithperiodsofaphoniaearliestsymptoms.o
Hoarsness,cough,dysphagia(odynophagia)
Referredotalgia
LaryngealexaminationinTBlaryngitis
Hyperaemiaofthevocalcordinitswholeextentorconfinedto
posteriorpartwithimpairmentofadductionisthefirstsign.
Swellingintheinterarytenoidregiongivingamammilated
appearance.
Ulcerationofvocalcordgivingmouse-nibbledappearance.
Superficialraggedulcerationonthearytenoidsandinterarytenoid
region.
Granulationtissueininterarytenoidregionorvocalprocessof
arytenoid.
Pseudoedemaoftheepiglottis"turbanepiglottis".

---

Swellingofventricularbandsandaryepiglotticfolds.
Markedpallorofsurroundingmucosa.

---

1146.Anothernamefororalthrushis?
a)Candidiasis
b)Herpangina
c)Vincent'sinfection
d)Handfootandmouthdisease
CorrectAnswer-A
Ans.is'a'i.e.,Candidiasis
Oralthrush
Alsocalled:oralcandidiasis
Itisthefungalinfectionoftheoralcavity.Itiscausedbycandida
albicans.
Itmanifestsasgreyishwhitepatchesontheoralmucosaand
tongue.\Whenwipedoffitleavesanerythematousmucosa.
Thisismorecommonininfantsandchildren.Adultssufferingfro
diabetes,malignancy,takingbroadspectrumoralantibiotics,
radiation,cytotoxicdrugsorsteroidscanalsobeaffected.
Itistreatedbytopicalapplicationofnystatinorclotrimazole.
ChronicHypertrophicCandidiasis(CandidialLeukoplakia)
Appearsasawhitepatchintheoralcavitywhichcannotbewiped
off.
Itmostlyaffectstheanteriorbuccalmucosajustbehindtheangleof
mouth.
Itistreatedbyexcisionofthelesion.

---

1147.BSGTstandsfor?
a)Bagolinistriatedglassestest
b)Bagolinismoothglassestest
c)Bagolinishinyglassestest
d)Bagolinisecondgluetest
CorrectAnswer-A
Ans.is'a'i.e.,Bagolinistriatedglassestest
Bagolinistriatedglassestest,orBSGT,isasubjectiveclinicaltestto
detectthepresenceorextentofbinocularfunctionsandisgenerally
performedbyanorthoptist.Itismainlyusedinstrabismusclinics.

---

1148.Melanocytesinconjunctivaarederived
from?
a)Neuralectoderm
b)Surfaceectoderm
c)Mesoderm
d)Neuralcrest
CorrectAnswer-D
Ans.is'd'i.e.,Neuralcrest

---

1149.Densityofcellsinadultcorneal
endothelium?
a)2000cells/mm2
b)3000cells/mm2
c)4000cells/mm2
d)5000cells/mm2
CorrectAnswer-B
Ans.is'b'i.e.,3000cells/mm2
Thecelldensityofcornealendotheliumisaround3000cells/mm2in
youngadults,whichdecreaseswiththeadvancingage.

---

1150.NomovementofRedreflexin
retinoscopy-
a)Norefractiveerror
b)Myopiaof3D
c)MyopiaofID
d)Hypermetropia
CorrectAnswer-C
Ans.is'c'i.e.,MyopiaofID
Retinoscopy
Retinoscopy,alsocalledskiascopyorshadowtest,isanobjective
methodoffindingouttheerrorofrefractionbythemethodof
neutralization.
Retinoscopyisbasedonthefactthatwhenalightisreflectedfroma
mirrorintotheeye,thedirectioninwhichthelightwilltravelacross
thepupilwilldependupontherefractivestateoftheeye.
Withthehelpofaretinoscope,lightisthrownontothepatient'seye
andthroughaholeintheretinoscope'smirrortheexaminer
observesofredreflexinthepupillaryareaofthepatient.
Thentheretinoscopeismovedinhorizontaltheverticalmeridia
keepingawatchonredreflex,whichalsomoveswhenthe
retinoscopeismoved.

---

1151.Maximumrefractiveindex?
a)Cornea
b)Air
c)Lens
d)Vitreous
CorrectAnswer-C
Ans.is'c'i.e.,Lens
1. Refractiveindexofvariouseyeparts
1. Cornea-1.376
2. Aqueoushumor-1.336
3. Lens(fromcortextocore)-1.386-1.406
4. Vitreoushumor-1.336
2. Howtomemorise!
a.Therefractiveindexdependsupontheopticaldensity
1. Aqueousandvitreousbeingfluidshavelowdensity-
havelowrefractiveindex.
2. Corneaislessopticallydensethanlens.(corneaisthinnerthan
lens!)
b.Soremember4values
1. i.1.336-aqueous/vitreous
2. ii.1.376-cornea
3. iii.1.386-cortexoflens
4. iv.1.406-coreorcentroidoflens
c.Alsoremember,therefractiveindexoftheanteriorsurfaceoflens
isgreaterthantheposteriorsurface.

---

1152.Imbert-Ficklawisassociatewith?
a)Schiotztonometry
b)Applanationtonometry
c)Pachymetry
d)Keratometry
CorrectAnswer-B
Ans.is'b'i.e.,Applanationtonometry
Applanationtonometry
TheconceptofapplanationtonometrywasintroducedbyGoldmann
is1954.ItisbasedonImbert-Ficklawwhichstatesthatthepressure
insideasphere(P)isequaltotheforce(W)requiredtoflattenits
surfacedividedbytheareaofflattening(A);i.e.,P=W/A.

---

1153.Cornealendothelialcellcountis
measuredby?
a)Specularmicroscope
b)Ophthalmoscope
c)Synoptophore
d)Amsler'sgrid
CorrectAnswer-A
Ans.is'a'i.e.,Specularmicroscope
Cornealendotheliumisexaminedwithspecularmicroscope,which
allowsaclearmorphologicalstudyofendothelialcellsincluding
photographicdocumentation.
Thecelldensityofendotheliumisaround3000cells/mm2inyoung
adults,whichdecreaseswithadvancingage.

---

1154.Quantificationofcornealsensationis
doneby?
a)Pachymeter
b)Keratometer
c)Aesthesiometer
d)Tonometer
CorrectAnswer-C
Ans.is'c'i.e.,Aesthesiometer
MeasurementofCornealSensitivity
Cornealsensitivitymaybetestedbytouchingitinvariousplaces
withawispofcotton-wooltwistedtoafinepointandcomparingthe
effectwiththatontheother,normalcornea.Thereisingenerala
briskreflexclosureofthelids.
Cornealsensationsareoftendiminishedafteranygrossdisorder,
butthechangeisofdiagnosticsignificanceincertaincases,
particularlyherpeskeratitiswhereminimalcornealchangesare
accompaniedbyagrossdiminutionofsensation.
Quantificationofthecornealsensationispossibletosomedegree
bytheuseofacornealaesthesiometerinwhichasinglehorsehair
ofvaryinglengthisusedinsteadofawispofcotton-wool.The
longestlengthwhichinducesblinkingisameasureofthethreshold
ofcornealsensitivity.

---

1155.Amsler'sgridisusedtoevaluate?
a)Central10degressofvision
b)Central20degreesofvision
c)Peripheralvision
d)Lensopacity
CorrectAnswer-A
Ans.is'a'i.e.,Central10degressofvision
Metamorphopsiaisaphenomenonwhereinthepatientperceives
objectstohaveanaltered,irregularcontourorshape.Forexample,
graphpaperlinesmaybebentorobscuredinareas.
ThiscanbereviewedforanychangesovertimeusinganAmsler
grid,whichteststhecentral10?ofvision.
Itisassociatedwithdiseasesaffectingthemaculasuchascentral
serouschoroidopathy,age-relatedmaculardegeneration,diabetic
macularoedemaandmacularhole.

---

1156.Objectivemethodsforcheckingthe
refractiveerrorareallexcept
a)Ophthalmoscopy
b)Retinoscopy
c)Refractometry
d)Keratometry
CorrectAnswer-A
Ans.is'a'i.e.,Ophthalmoscopy
Theprocedureofdeterminingandcorrectingrefractiveerrorsis
termedasrefraction.Therefractioncomprisestwocomplementary
methods:?
A)Objectivemethods:Objectivemethodsofrefractioninclude:-(i)
Retinoscopy,(ii)Refractometry,(iii)Keratometry.
B)Subjectivemethods:Theseare:-(i)Subjectiveverificationof
refraction,(ii)Subjectiverefiningofrefraction,(iii)Subjective
binocularbalancing.

---

1157.Floatersareseeninfollowingexcept?
a)Vitreoushemorrhage
b)Retinaldetachment
c)Uveitis
d)Acutecongestiveglaucoma
CorrectAnswer-D
Ans.is`d'i.e.,Acutecongestiveglaucoma
Floaters
Afloaterissomethinginthefluidsoftheeyethatcastsashadowon
theretinaandlookslikeadarkspotorspotsfloatingaroundinthe
fieldofvision.Floatersareusuallydescribedbypatients,assmall,
semitranslucentparticlesofvaryingshapesmovingacrossthevisual
fieldwiththemovementoftheeye.Floatercanonlybeseenwiththe
eyesopenandinalightedenvironment.Floatersareusuallygreyor
black,sincetheyareactuallyshadowontheretina.
Causesoffloatersare:-
i. Posteriorvitreousdetachment(PVD)
ii. Bleeding(vitreoushemorrhage)
iii. Retinaldetachment
iv. Inflammationofeye(uveitis)
v. Highmyopia

---

1158.Newborneyeis?
a)Myopic
b)Hypermetropic
c)Presbyopic
d)Noneoftheabove
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(45?).
Lacrimalglandisstillunderdevelopedandtearsarenotsecreted.

---

1159.Gazefixationtakesplaceatwhichage?
a)3months
b)6months
c)1year
d)2years
CorrectAnswer-B
Ans.is'b'i.e.,6months
GazeFixationstartsdevelopinginthefirstmonthandiscompleted
in6months.
Maculaisfullydevelopedby4-6months.
Fusionalreflexes,stereopsisandaccommodationiswelldeveloped
by4-6months.
Corneaattainsnormaladultdiameterby2yearsofage.
Lensgrowsthroughoutlife.

---

1160.Subconjunctivalcystisseenin?
a)Toxoplasmosis
b)Cysticercosis
c)Leishmaniasis
d)Chaga'sdisease
CorrectAnswer-B
Ans.isbi.e.,Cysticercosis
Parasiticcystsoccursinsubconjunctivalcysticercus,hydatidcyst
andfilarialcyst.

---

1161.Causeofblindnessinpterygium?
a)Astigmatism
b)Lossofvisualaxis
c)Cataract
d)Limitationofocularmovements
CorrectAnswer-A
Ans.is'a'i.e.,Astigmatism
Ptervgium
Pterygiumisanon-cancerous(non-neoplastic)growthof
conjunctiva,characterizedbyawing-shapedfoldofconjunctiva
encroachinguponthecorneafromeithersidewithinthe
interpalpebralfissure.Pterygiumisalwayssituatedinthepalpebral
aperture.
PathologicallyPterygiumisadegenerativeandhyperplastic
conditionofconjunctiva.Thesubconjunctivaltissueundergoes
elastoticdegenerationandproliferatesasvascularizedgranulation
tissueundertheepithelium,whichultimatelyencroachesthecornea.
Thecornealepithelium,Bowman'slayerandstromaaredestroyed.
Etiology&Clinicalfeatures
Pterygiumismorecommoninpeoplewithexcessoutdoorexposure
tosunlight(UVrays),dryheat,highwindandabundanceofdust.
Thereforeitismorecommoninthosewhoworkoutdoors.
Clinicallyitpresentsasatriangularfoldofconjunctivaencroaching
thecorneaintheareaofpalpebralaperture,usuallyonthenasal
side.Otherfindingsarestocker'sline(depositionofiron)
Ptergyiumisanasymptomaticconditionintheearlystages,except
forcosmeticintolerance.Visualdisturbanceorcornealastigmatism
mayoccur.Visualdisturbancesareduetoencroachmentof

---

pterygiumonpupillaryareaorcornealastigmatism.
Occasionallydiplopiamayoccurduetolimitationofocular
movements.
Treatment
Asymptomaticpterygiumwhichisnotprogressiveisbestleftalone.
Surgicalexcisionistheonlysatisfactorytreatmentandis
indicatedfor:-(1)Cosmeticreasons,(2)Continuedprogression
threateningtoencroachontothepupillaryarea(oncethepterygium
hasencroachedpupillaryarea,waittillitcrossesontheotherside),
(3)Diplopiaduetointerferenceinocularmovement.

---

1162.Whatisthemostcommonproblem
followingsurgicaltreatmentof
pterygium?
a)Recurrence
b)Cornealulceration
c)Astigmatism
d)Scleralscarring
CorrectAnswer-A
Ans.is'a'i.e.,Recurrence
Surgicalexcisionofpterygiumisitsonlysatisfactorytreatment
andisindicatedfor?
1. Cosmeticreasons
2. Continuedprogressionthreateningtoencroachontothepupillary
area(oncethepterygiumhasencroachedpupillaryarea,waittillit
crossesontheotherside)
3. Diplopiaduetointerferenceinocularmovements.
Recurrenceofthepterygiumaftersurgicalexcisionisthemost
commonproblemafterpterigiumexcisionandisseenin30-50%of
thecases.
Thepostoperativecomplicationsofpterigiumsurgeryare:
1. Recurrence(mostcommon)
2. Others:Bleeding,cornealthinning,scarring,fornixloss,
symblepharonformation,rectusmuscleinjury,wounddehiscence,
dellenformation,graftchemosis,conjunctivalgranuloma,epithelial
inclusioncysts,astigmatismetc.

---

1163.Causeofblindnessintrachoma?
a)Scarring
b)Pannus
c)Chronicdacrocystitis
d)Entropion
CorrectAnswer-A
Ans.is'a'i.e.,Scarring
Thelaterstructuralchangesoftrachomaarereferredtoas
"cicatricialtrachoma".
Theseincludescarringintheeyelid(tarsalconjunctiva)thatleadsto
distortionoftheeyelidwithbucklingofthelid(tarsus)sothateye
lashesrubontheeye(trichiasis).
Rubbingofeyelashesofscarredeyelidsagainstthecornea
leadstocornealopacitiesandscarringandthentoblindness.
Thusactualcauseofblindnessiscornealopacityandscarring,
whichmaybesecondarytoeyelidscarring.

---

1164.Angularconjunctivitisiscausedmainly
by
a)Moraxellaaxenfeld
b)Staphylococcusaureus
c)Streptococcuspneumonae
d)Pseudomonasaeruginosa
CorrectAnswer-A
Ans.is'a'i.e.,Moraxellaaxenfeld
Angularconjunctivitis(diplobacillaryconjunctivitis)
Itisatypeofchronicconjunctivitischaracterizedbymildgrade
inflammationconfinedtoconjunctivaandlidmarginsneartheangles
associatedwithmacerationofthesurroundingskin.
Moraxellaaxenfeld(Moraxellalacunata),adiplobacillus,isthe
commonestcausativeorganism.
Lesscommonly,staphylococcusaureuscanalsocauseangular
conjunctivitis.
Sourceofinfection:Nasaltractofhealthypeopleandthenasal
dischargeofpatientswithangularconjunctivitis.
Itspreadsfromthenasalcavitytotheeyebycontaminatedhands
andhandkerchief.
Angularconjunctivitisrespondstotetracycline
ointment,Oxytetracyclinefor10to14days.
Eyedropscontainingzincinhibittheproteolyticfermentandareof
greatvaluealthoughlessrapidlyeffective,andmaybeusedin
additiontotetracycline.

---

1165.Keratitisiscausedby?
a)Bacteria
b)Atopy
c)Protozoa
d)All
CorrectAnswer-D
Ans.is'd'i.e.,All
Causesofkeratitis
1.Infectivekeratitis
a. Bacterial
b. Viral
c. Fungal
d. Chlamydial
e. Protozoal
f. Spirochaetal
2.Allergickeratitis
a. Phlyctenularkeratitis
b. Vernalkeratitis
c. Atopickeratitis
3.Trophickeratitis
a. Exposurekeratitis
b. Neuroparalytickeratitis
c. Keratomalacia
d. Atheromatousulcer
4.Keratitisassociatedwithdiseasesofskinandmucousmembrane.
5.Keratitisassociatedwithsystemiccollagenvasculardisorders.
6.Traumatickeratitis,whichmaybeduetomechanicaltrauma,
chemicaltrauma,thermalburns,radiations.

---

7.Idiopathickeratitise.g.,
a. Mooren'scornealulcer
b. Superiorlimbickeratoconjunctivitis
c. SuperficialpunctatekeratitisofThygeson

---

1166.Munson'ssignisafeatureof?
a)Keratoconus
b)Cornealulcer
c)Pterygium
d)Posteriorstaphyloma
CorrectAnswer-A
Ans.is'a'i.e.,Keratoconus
Kerotoconus
Keratoconusisaprogressive,noninflammatory,bilateralectatic
cornealdisease,characterizedparaxia/stromalthinningand
weakeningthatleadstocornealsurfacedistortion.
Essentialpathologicalchangesarethinningandectasiawhichoccur
asaresultofdefectivesynthesisofmucopolysaccharideand
collagentissue.
Itusuallystartsatpubertyandprogressesslowly.
Symptomsusuallybeginsasblurredvisionwithshadowingaround
images.
Visionbecomesprogressivelymoreblurredanddistortedwith
associatedglare,halosaroundlights,lightsensitivityandocular
irritation.
Visuallossoccursprimarilyfromirregularastigmatismandmyopia,
andsecondarilyfromcornealscarring.oThehallmarkof
keratoconusiscentralorparacentralstromalthinning,apical
protrusionofanteriorcorneaandirregularastigmatism.
Thecorneathinsnearthecentreandprogressivelybulgesforwards,
withtheapexofconealwaysbeingslightlybelowthecentreofthe
cornea.
Importantfindingsanexaminationare-

---

i)Distartedwindowreflex(Cornealreflex)e.
ii)Fleisher'srine.
iii)Yawningreflex(Scissorreflex).
iv)Oildropreflex.
v)Munson'ssigns
Treatmentincludes:?
1)Spectaclesforregularormildirregularastigmatism.
2)Rigidgaspermeablecontactlensforhigherastigmatism.
3)Epikeratoplastyinpatientsintoleranttolensandwithout
significantcornealscarring.
4)Keratoplastypenetratingordeeplamellarifthereissignificant
cornealscarring.

---

1167.Safesizeofcornealgraftwithless
chancesoffailureis?
a)7.5mm
b)6.5mm
c)5.5mm
d)4.5mm
CorrectAnswer-A
Ans.is'a'i.e.,7.5mm
Correlationofcornealgraftdiameterandchancesofgraftfailure
Increasedcornealgraftsizehasbeenreportedinsomestudiestobe
asignificantriskfactoreforgraftrejection.
Otherstudiesrefutethisandpointtosmallergraftsizeasmorelikely
toberejected.
Thereisincreasedriskofrejectionandendothelialfailureinsmall
graftswithrecipientsize<7mmandalsoincreasedriskofrejection
inlargegraftswithgraftsize>8.5mm.
Thusthecornealgraftwithgraftdiameterbetween7and8.5mm
hasmorechancesofsurvival.

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1168.Koeppe'snodulesaretypeof?
a)Granulomatousuveitis
b)Nongranulomatousuveitis
c)Coroiditis
d)Parsplanitis
CorrectAnswer-A
Ans.is'a'i.e.,Granulomatousuveitis
Nodulesontheirissurface.Theseareobservedin
granulomatousuveitis(Koeppe'sandBusacca'snodules),
melanoma,tuberculomaandgummaoftheiris
Irisnodules
Therearemanytypesofnodulesthatdeveloponirisin
granulomatousuveitis:-
i. Keoppenodule:-Seenatpupillarymargin.
ii. Busacca'snodule:-Seenontheperipheralpartofanteriorsurface
ofiris.
iii. Tubercularnodules:-Scatteredthroughouttheirisandciliarybody,
mostlyinstroma.Theyaremorecommonatpupillarymargin.
iv. Syphiliticnodules:-Atpupillarymargin.
v. Sarcoidnodules:-Atpupillarymarginorinthestromaoftheiris.

---

1169.Parsplanitisis?
a)Anterioruveitis
b)Intermediateuveitis
c)Posterioruveitis
d)Panuveitis
CorrectAnswer-B
Ans.isbi.e.,intermediateuveitis
Uveitis
Uveitisreferstotheinflammationofuvealtissue.
However,practicallythereisalwayssomeassociatedinflammation
oftheadjacentstructuressuchasretina,vitreous,scleraand
cornea.
Duetocloserelationshipbetweentheanatomicallydistinctpartof
theuvealtract,theinflammatoryprocessusuallyinvolvetheuveaas
awholeandaregenerallynotlimitedtoasinglepart.
However,theuveitisisclassifiedaccordingtothepartofuveawhich
isclinicallymoreaffected.Forexample,thetermiritisisusedwhen
irisappearstobemoreaffected.
Anatomicalclassificationofuveitis
1.Anterioruveitis.Itisinflammationoftheuvealtissuefromirisup
toparsplicataofciliarybody.Itmaybesubdividedinto-
Iritis,inwhichinflammationpredominantlyaffectstheiris.
Iridocyctitisinwhichirisandparsplicatapartofciliarybodyare
equallyinvolved,and
Cyclitis,inwhichparsplicatapartofciliarybodyispredominatly
affected.
2.Intermediateuveitis.Itincludesinflammationoftheparsplana
andperipheralpartoftheretinaandunderlying`choroid'.Itisalso

---

called'parsplanitis'.
3.Posterioruveitis.Itreferstoinflammationofthechoroid
(choroiditis).Alwaysthereisassociatedinflamationofretinaand
hencetheterm`chorioretinitis'isused.
4.Panuveitis.Itisinflammationofthewholeuvea.

---

1170.Anterioruveitisearliestlesion?
a)Aqueousflare
b)Keraticprecipitates
c)Circumcornealcongestion
d)Blurringofvision
CorrectAnswer-A
Ans.is'a'i.e.,Aqueousflare
Aqueousflareistheearliestsignofacuteanterioruveitis.
Keraticprecipitatesisthepathognomicsignofacuteanterioruveitis
Clinicalfeaturesofacuteanterioruveitis
Acuteanterioruveitisisthemostcommonformofuveits,accounting
for60-70%ofcases.Itischaracterizedbysuddenonsetand
durationlessthan3months.Presentationistypicalwithsudden
onsetofunilateralpain,photophobia,redness,lacrimationand
blepherospasm.Visionmaybenormalinitially.However,laterthere
maybedistrubanceinvisionduetociliaryspasm(inducedmyopia),
cornealhaze(duetoedema&1(13s)andaqueousturbidity.
Externalexaminationshowsfollowingsigns:-
i. Circumcorneal(ciliary)congestionWhichhasaviolaceoushue.
ii. Cornealedema,posteriorcornealopacities.
iii. Keraticprecipitates(KPs):-areproteinaceouscellulardepositsatthe
backofcorneaonendothelium.
iv. Anteriorchambersigns:-Aqueouscells,Aqueousflare,hypopyon,
hyphaemia(inhemorrhagicuveitis),deepanteriorchamber(If
posteriorsynachiaeoccurs).
v. Irissigns:-Blurred&indistinctiris,i.e.muddyiris,insteadofbeing
clearandsharplydefined.
vi. Papillarysigns:-Narrow(miotic)pupil,irregularpupildueto

---

segmentalposteriorsynechiaewhichgivesfestoonedappearance
(festoonedpupil)whendilatedwithatropine,sluggishpupillary
reaction,ectropionpupillae(evertionofpupillarymargins),occlusio
pupillae(duetocompleteocclusionofpupilbyorganisedexudate).

---

1171.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

---

1172.Whichofthefollowingconditionisassociatedwiththedevelopmentof
posteriorstaphyloma?
a)Pathologicalmyopia
b)Retinoblastoma
c)Acidinjury
d)Sympatheticophthalmia
CorrectAnswer-A
Posteriorstaphyloma,theposterioroutpouchingofthewallofthe
eye,isanimportantcomponentofthediagnosisofpathologic
myopia;indeed,itisoneofthehallmarksofpathologicmyopia.
Withtheexceptionofinferiorstaphylomarelatedtotilteddisc
syndrome,itdoesnotoccurinpathologiesotherthanpathologic
myopia.
Thus,thepresenceofstaphylomaisspecifictopathologicmyopia
andcriticallyimportantindifferentiatingsimpleschoolmyopiawith
goodbestcorrectedvisualacuity(BCVA)andpathologicmyopia
thatcouldcausethelossofBCVA.

---

1173.FollowingisfeatureofFusch'shetero
chromiciridocyclitis?
a)Heterochromiaofiris
b)Keraticprecipitates
c)Posteriorsubcapsularcataract
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove
Fuch'sheterochromiciridocyclitis(Fuch'suveitissyndrome)
Itisaformofanteriorandintermediateuveitis.
Theconditionisusuallyunilateralandchronicinnatureandis
characterizedbyachronicnon-granulomatousuveitisandeventually
resultsinirisheterochromia(achangeinthecolourofiris).
Thediseasehasfollowingcharacteristicfeatures:
i)Heterochromiaofiris
ii)Diffusestromalirisatrophy
iii)FineKPsatbackofcornea
iv)Faintaqueousflare
v)Absenceofposteriorsynechiae
vi)Afairlycommonrubeosisiridis,sometimesassociatedwith
neovascularisationoftheangleofanteriorchamber.
vii)Comparativelyearlydevelopmentofcomplicatedcataractand
secondaryglaucoma(usuallyopenangletype).Glaucomahasbeen
reportedin10-59%ofcases.
Treatment
Fuch'sheterchromicuveitisrespondsvariabletosteroidsand
cycloplegics.Thecomplicationsoflongtermuseofthesedrugsmay
attimesoutweightheirpotentialbenefits.Therefore,treatmentwith

---

topicalsteroidsisgiventoiritiswhichissufficientlyactivetorequire
thetreatment,otherwisethepatientisroutinelyfollowedwithout
givinganytreatment.
Cataractrespondswelltomostformsofintraocularsurgeries,
includingthestandardIOLimplantation.Hyphemiamayoccur
becauseofrubeosisiridis(neovascularizationofiris).
Glaucomacontrolmaybesomewhatmoreproblematic,withsurgical
optionsindicatedforlaterformsofdisease

---

1174.Recurrentnon-granulomatousuveitisis
seenin?
a)Vogtkoyanagi-Haradasyndrome
b)Posner-Schlossmansyndrome
c)Tuberculosis
d)Sarcoidosis
CorrectAnswer-B
Ans.is`b'i.e.,Posner-Schlossmansyndrome
Glaumatocycliccrisis
Glamatocycliticcrisis(Posner-Schlossmansyndrome)isa
unilateralrecurrentnon-granulomatousiritisthatisassociatedwith
anelevatedocularpressureduringtheattacks.Thisself-limiting
conditiontendstooccurinpersonsduringthethirdtosixthdecade
andthevisualfields,theopticnervehead,andanteriorchamber
anglearenormal.Amildinflammatoryreactionisveryrarelypresent
asevidencedbyafewkeraticprecipitatesontheposteriorsurfaceof
thecornea.Thecauseoftheglaucomaremainsunknown,buta
trabeculitisissuspected.Manypatients(55%)subsequentlydevelop
openangleglaucoma.

---

1175.

---

Opticcanalisapartof?
a)Lesserwingofsphenoid
b)Greaterwingofsphenoid
c)Ethmoid
d)Pterygoid
CorrectAnswer-A
Ans.is'a'i.e.,Lesserwingofsphenoid
Theopticnerveleavestheorbitistheopticcanaltoenterthecranial
vault.
Theopticcanalisthemostposteriorlandmarkoftheorbit.It
measures10mminlength.
Thethinpieceofboneseparatingtheopticcanalfromthesuperior
orbitalfissureistheopticstrut.
Theopticstrutandopticcanalareapartofthelesserwingof
sphenoidbone.

---

1176.Treatmentofpresbyopiaisbyuseof
whichlens?
a)Convex
b)Concave
c)Biconcave
d)Concavoconvex
CorrectAnswer-A
Ans.is'a'i.e.,Convex
Presbvopia
Presbyopiaisavisionconditioninwhichthecrystallinelensofeye
losesitsflexibility,whichmakeitdifficulttofocusontheobjects
closertotheeye.Presbyopiaisnotanerrorofrefractionbuta
conditionofphysiologicalinsufficiencyofaccommodationleadingto
aprogressivefallinnearvision.Presbyopiaisanagerelated
problem,thereforealsocalledeyesightofoldage.
Symptomsareusuallyseenafter40yearsofage.
Presbyopiaisnotadisease,ratheranaturalpartoftheaging
processoftheeye.
Thetreatmentofpresbyopiaistheprescriptionofappropriate
convexglassesfornearwork.

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1177.GlandofMollopensin/onthe?
a)Skin
b)Hairfollicle
c)Tarsalplate
d)DuctsofMeibomianglands
CorrectAnswer-B
Ans.is'b'i.e.,Hairfollicle
GLANDSOFEYELIDS:
i. Meibomianglands:Thesearealsoknownastarsalglandsandare
presentinthestromaoftarsalplatearrangedvertically.Theyare
modifiedsebaceousglands.Theirductsopenatthelidmargin.Their
secretionconstitutestheoilylayerofthetearfilm.
ii. GlandsofZeis:Thesearealsosebaceousglands,whichopeninto
thefolliclesofeyelashes.
iii. GlandsofMoll:Thesearemodifiedsweatglandssituatednearthe
hairfollicle.TheyopenintothehairfolliclesorintotheductsofZeis
glands.Theydonotopendirectlyontotheskinsurfaceor
elsewhere.
iv. AccessorylacrimalglandsofWolfring:Thesearepresentnearthe
upperborderofthetarsalplate.

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1178.AllaretrueaboutBullouskeratopathy
except?
a)SeeninMaculardystrophy
b)Treatmentislamellarkertoplasty
c)Lensescanbeprescribedforsuchpatients
d)SeeninFuch'sdystrophy
CorrectAnswer-A
Ans.is'a'i.e.,SeeninMaculardystrophy
Fuch'sepithelial-endothelialdystrophy
Fuch'sdystrophy-slowlyprogressivebilateralconditionaffecting
femalesmorethanmales.Primaryopenangleglaucomais
associatedwiththiscondition.
Stagesandclinicalfeatures
i)Stageofcorneaguttata
Hassal-Henletypeofexcrescencesinthecentralpartofcornea.
Agradualincreaseofcentralguttaewithperipheralspreadand
confluencegivesrisetothesocalled'beaten-metal'appearance.
Thisstageisasyptomatic.
ii)OedematousstageorStageofendothelialdecompensation
Earlystromaledemaandepithelialdystrophy
Patientscomplainofblurringofvision.
iii)StageofBullouskeratopathy
Followslongstandingstromaledema
Markedepithelialedemawithformationofbullae,whichwhen
rupturecausepain,discomfortandirritationwithassociated
decreasedvisualacuity.
iv)Stageofscarring
Corneabecomesopaqueandvascularized.

---

Maybecomplicatedbysecondaryinfectionorglaucoma.
Treatment
i. Edematousstage:5%Sodiumchloride(Hypertonicsaline)
ii. Bullouskeratopathy:Bandagesoftcontactlenses.
iii. Penetratingkertaoplasty:treatmentofchoice.

---

1179.AllofthefollowinghasHLAB27
associatedwithuveitisexcept?
a)Ankylosingspondylitis
b)Reiterssyndrome
c)Behcetssyndrome
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Behcetssyndrome
AfewexamplesofHLA-associateddiseaseswithuveitisareas
follows:
i)HLA-B27:Acuteanterioruveitisassociatedwithankylosing
spondylitisandalsoinReiter'ssyndrome.
ii)HLA-B5:UveitisinBehcet'sdisease.
iii)HLA-DR4andDW15:VogtKoyanagiHarada'sdisease.

---

1180.FundusinretinitisPigmentosais?
a)Whitespotswithreddisc
b)Jet-blackspotswithpale-waxydisc
c)Nopigmentation
d)Dilatationofarterioles
CorrectAnswer-B
Ans.is'b'i.e.,Jet-blackspotswithpale-waxydisc
Examinationfindingsinretinitispigmentosa
Ophthalmoscopicfindingsarecharacteristicandinclude:-
i. Retinalpigmentarychanges(Bonespiculeintraneuralretinal
pigmentation):-Retinastuddedwithsmall,jet-blackspots
resemblingbonecorpuscleswithaspideryoutline.These
pigmentarychangesaretypicallyperivascularandretinalveins
(neverarteries)haveasheathofpigmentforpartoftheircourse.
Thesechangesaffectequatorialregioninitiallysparingtheposterior
poleandperiphery.Laterinthecourseofdiseasewholeretinais
involved.
ii. Attenuatedandthreadlikeretinalarteriolesandveins.
iii. Paleandwaxyopticdisc(consecutiveopticatrophy).
iv. Thinningandatrophyofretinalpigmentepithelium(RPE)inmidand
farperipheralretinawithrelativesparingofRPEatmacula.
Electroretinogram(ERG)andparticularlytheelectro-oculogram
(EOG)aremarkedlysubnormal.

---

1181.Vitreoushemorrhageproduces?
a)Suddenpainlesslossofvision
b)Suddenpainfullossofvision
c)Gradualpainlesslossofvision
d)Gradualpainfullossofvision
CorrectAnswer-A
Ans.is'a'i.e.,Suddenpainlesslossofvision

---

1182.Whatistheimmediatemanagementof
vitreoushemorrhageineye?
a)Notreatment
b)Steroids
c)Antibiotics
d)Vitrectomy
CorrectAnswer-A
Ans.is'a'i.e.,Notreatment
Treatmentofvitreoushaemorrhage:
1. Conervativetreatment:Bedrest,elevationofpatient'sheadand
bilateraleyepatches.Thiswillallowthebloodtosettledown.
2. Treatmentofthecause:Oncethebloodsettlesdown,indirect
ophthalmoscopyshouldbeperformedtolocateandfurthermanage
thecausativelesionsuchasaretinalbreak,phlebitis,prolifrative
retinopathy,etc.
3. Vitrectomybyparsplanarouteshouldbeconsideredtoclearthe
vitreous,ifthehaemorrhageisnotabsorbedafter3months.

---

1183.Cherryredspotisseenin?
a)Niemann-Pick'sdisease
b)TaySach'sdisease
c)Centralretinalarteryocclusion
d)Alloftheabove
CorrectAnswer-D
Ans.is'di.e.,Alloftheabove
Causesofcherryredspot
GM2gangliosidoses(Taysachs&sandhoff)
Hurler'ssyndrome
GM1gangliosidoses
Cryoglobulinemia
Niemann-Pick'sdisease
Laber'scongenitalamaurosis
Gaucher'sdisease
Sialidosis(galactosialidosis)
Metachromaticleukodystrophy
MucopolysacharidosisVII
Centralretinalarteryocclusion(CRAO)
Multiplesulfatasedeficiency
Trauma(Berlin'sedema/commotioretinae)
Poisoning:-Carbonmono-oxide,methanol
QuinineandDapsone
Shprintzen-Goldbergsyndrome
Farber'sdisease
HallervordenSpatzdisease
Goldberg'sdisease
Rarelyinkrabbe'sdisease

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1184.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.

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1185.Retinaltearsseenmostcommonlyseen
in?
a)Primaryretinaldetachment
b)Secondaryretinaldetachment
c)Tractionalretinaldetachment
d)Exudativeretinaldetachment
CorrectAnswer-A
Ans.is'a'i.e.,Primaryretinaldetachment
Retinaldetachmentisadisorderofeyeinwhichretinapeelsaway
fromitsunderlyinglayerofsupporttissue.Usuallythereis
separationbetweentheneuroepithelium(neurosensoryepithelium)
andthepigmentedlayer.
Theretinalseparationisdividedinto:
1. Primary:-Rheugmatogenousretinaldetachment.
2. Secondary:-Tractionalretinaldetachmentandexudativeretinal
detachment.
Rhegmatogeneousretinaldetachment
Thisisthecommonesttypeofretinaldetachment.Thisisduetoa
retinalbreak/tear/holewhichallowstheliquidvitreoustoseepsinto
thesubretinalspaceandseparatesthesensoryretinafromthe
pigmentaryepithelium.
Predisposingfactorsinclude:(i)Myopia,(ii)Previousintraocular
surgery:cataractextraction,(aphakia)orpseudoaphakia);(iii)
Trauma;(iv)Retinaldegeneration(Latticedegeneration;Snailtrack
degeneration,Senileordegenerativeretinoschisis.
Tractionalretinaldetachment
Itisduetopullingontheretinausuallyfromfibro-vascularbandin
thevitreouscavity,i.e.,vitroretinalband.

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Exudativeretinaldetachment(solidretinaldetachment)
Itoccursduetotheretinabeingpushedawaybyaccumulationof
fluidoraneoplasmbeneaththeretina.Thistypeofdetachmentis
causedbyinflammatorydisordersorbytumors.

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1186.Methanolattacks?
a)Cones
b)Rods
c)Ganglioncellsofretina
d)Germinalcelllayer
CorrectAnswer-C
Ans.is'c'i.e.,Ganglioncellsofretina
Methylalcoholismetabolisedveryslowlyandthusstaysforalonger
periodinthebody.
Itisoxidisedintoformicacidandformaldehydeinthetissues.These
toxicagentscauseoedemafollowedbydegenerationoftheganglion
cellsoftheretina,resultingincompleteblindnessduetooptic
atrophy.

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1187.Diabeticischemicmaculopathyis
characterizedbyallexcept?
a)Itoccursduetomicrovascularblockage
b)Mildvisualloss
c)Areasofnonperfusionareevidentonfluoresceinangiography
d)Microaneurysmsandhemorrhagesareseen
CorrectAnswer-B
Ans.is`b'i.e.,Mildvisualloss
Ischaemicdiabeticmaculopathy
Itoccursduetomicrovascularblockage.
Clinicallyitischaracterisedbymarkedvisuallosswith
microaneurysms,haemorrhages,mildornomacularoedemaanda
fewhardexudates.
Fluoresceinangiographyshowsareasofnon-perfusionwhichin
earlycasesareintheformofenlargementoffovealavascularzone
(FAZ),lateronareasofcapillarydropoutsareseenandinadvanced
casesprecapillaryarteriolesareblocked.

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1188.Refsum'ssyndromeisassociatedwith
?
a)Retinitispigmentosa
b)Xerophthalmia
c)Chalcosis
d)Diabetesretinopathy
CorrectAnswer-A
Ans.is'a'i.e.,Retinitispigmentosa
Associationsofretinitispigmentosa
Ocularassociations:Theseincludemyopia,primaryopenangle
glaucoma,microphthalmos,conicalcorneaandposterior
subcapsularcataract.
Systemicassociations:Theseareintheformoffollowing
syndromes:-
i)Laurence-Moon-Biedlsyndrome:Itischaracterisedbyretinitis
pigmentosa,obesity,hypogenitalism,polydactylyandmental
deficiency.
ii)Cockayne'ssyndrome:Itcomprisesretinitispigmentosa,
progressiveinfantiledeafness,dwarfism,mentalretardation,
nystagmusandataxia.
iii)Refsum'ssyndrome:Itischaracterizedbyretinitispigmentosa,
peripheralneuropathyandcerebellarataxia.
iv)Usher'ssyndrome:Itincludesretinitispigmentosaand
labyrinthinedeafness.
v)Hallgren'ssyndrome:Itcomprisesretinitispigmentosa,vestibulo-
cerebellarataxia,congenitaldeafnessandmentaldeficiency.

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1189.Whichgasismostcommonlyusedwith
pneumaticretinopathy?
a)SF6
b)C3F8
c)CO2
d)N3
CorrectAnswer-A
Ans.is'a'i.e.,SF6
Sulfurhexafluoridegas(SF6)ismostcommonlyusedwith
pneumaticretinopexy.

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1190.Whichantiglaucomadrugdecreases
aqueousformation?
a)Prostaglandins
b)Beta-blockers
c)Mannitol
d)Pilocarpine
CorrectAnswer-B
Ans.is'b'i.e.,Beta-blockers

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1191.Selectivealpha2agoinstusedin
glaucoma?
a)Tirriolol
b)Epinephrine
c)Dipivefrine
d)Brimonidine
CorrectAnswer-D
Ans.is'd'i.e.,Brimonidine

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1192.MainMOAbrimonidineinglaucoma?
a)Decreasedaqueoussecretion
b)Increasedtrabecularoutflow
c)Increaseduveoscleraloutflow
d)Reducevitreousvolume
CorrectAnswer-A
Ans.is'a'i.e.,Decreasedaqueoussecretion

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1193.Followingarethesideeffectsof
apraclonidineexcept?
a)Liddermatitis
b)Follicularconjunctivitis
c)Eyelidretraction
d)Wateringofmouth
CorrectAnswer-D
Ans.is'd'i.e.,Wateringofmouth
Apraclonidine
Topicalapplicationlowerstheintraocularpressureby25%.
Itdecreasesaqueousproductionbyprimaryalphalandsubsidiary
alpha2actioninciliarybody.
Itching,liddermatitis,follicularconjunctivitis,mydriasis,eyelid
retraction,drynessofmouthandnosearecommonsideeffects.
Itsuseisrestrictedtoshorttermcontrolofspikesofintraocular
tensionafterlasertrabeculolastyoriridotomy.

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1194.Drugkeptasalastresortinthe
managementofprimaryopenangle
glaucomais?
a)Latanoprost
b)Topicalbetablocker
c)Brimonidine
d)Oralacetazolamide
CorrectAnswer-D
Ans.is'd'i.e.,Oralacetazolamide
TreatmentofPOAG(Primaryopenangleglaucoma)
FollowingtreatmentoptionsareavailableforPOAG:
Medicaltherapy:-Totalmedicaltherapyisthetreatmentofchoice
forPOAG.Topical13-blockers(Timolol,Betoxalol,Levobunolol,
carteolol)arethedrugsofchoice.Topicalprostaglandinanalogues
(Latanoprost,bimatoprost,travoprost)arethesecondchoicedrugs.
OthertopicaldrugsforPOAGare:-LIAlphaagonists(non-selective
:epinephrine,dipivefrine;andSelective-a2:apraclonidine,
brimonidine)
Carbonicanhydraseinhibitors(Dorzalamide,brinzolamide)
Cholinomimeticdrugs(Pilocarpine,physostigmine,echothiophate,
carbachol)Pilocarpirehasseveraldrawbacks,therefore,isbeing
consideredasanadjunctivetherapyonlyasalastresort.
ApproachtotreatmentofPOAG
StartmonotherapywithtopicalP-blockerorlatanoprost.
IftargetIOTisnotattainedeitherchangeovertothealternativedrug
oruseboththeaboveconcurrently.
Brimonidine/dorazolamide/dipivefrineareusedonlywhenthereare

---

contraindicationstoPGanaloguesor13-blockers.
Topicalmioticsandoralacetazolamideareaddedonlyasthelast
resort.
Systemictherapyisconsideredonlyasalastresort.Drugsusedfor
systemictherapyare:-(i)Carbonicanhydraseinhibitors
(Acetazolamide,Dichlorphenamide,methazolamide),(ii)
Hyperosmoticagents(mannitol,glycerol).

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1195.Followingisacauseofsecondaryangle
closureglaucoma?
a)Pseudophakia
b)Corticosteroidinduced
c)Anglerecessionglaucoma
d)Congenitalglaucoma
CorrectAnswer-A
Ans.is'a'i.e.,Pseudophakia
Causesofsecondaryangleclosureglaucoma
Pupillaryblock:uveitis,psudophakia
Anglefibrosis:neovascularglaucoma

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1196.Laserusedtomanageaftercataract:
March2005,September2009
a)Excimerlaser
b)Argongreenlaser
c)Diodelaser
d)Nd:YAGlaser
CorrectAnswer-D
Ans.D:Nd:YAGlaser
TheNd:YAGlaserisasolidstatelaserthatusesaneodymium-
dopedyttrium-aluminum-garnetcrystalasthelasingmedium.Itis
opticallypumpedwithalampordiodeandmostcommonlyemits
infraredlightat1064nm.Itcanbeusedineitherapulsedor
continuousmode.PulsedYAGlasersaretypicallyQ-switchedto
achievehigh-intensitypulses,whichcanbefrequencydoubledto
emitlightat532nm.
TherearenumerousophthalmicapplicationsforNd:YAG
lasers.
Theyaremostcommonlyusedtotreatposteriorcapsular
opacificationaftercataractsurgery
Tocreateaperipheraliridotomyinpatientswithnarrowanglesor
angle-closureglaucoma.
YAGlaserscanalsobeusedtocuttheanteriorcapsuleforcapsular
blocksyndromeandcapsularphimosis
Tocutvitreousstrandsintheanteriorchamber.
Inmalignantglaucoma,disruptionoftheanteriorhyaloidfaceis
performedwiththeYAGlaser
Inrefractoryglaucomas,theselaserscanbeusedfor
cyclophotoablationoftheciliarybody.

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Theyhavealsobeenhelpfulfordrainingpremacularsubhyaloid
hemorrhagesinpatientswithValsalvaretinopathy.
Panretinalphotocoagulationcanbeperformedwithfrequency-
doubledNd:YAGlasers.
Otherapplicationsincludethetreatmentofrecurrentcorneal
erosionsandvitreousfloaters.
Excimer(Argonfluoride)laserisusedinphotorefractivekeratectomy
(PRK),phototherapeutickeratectomy(PTK),LASIK,LASEK
Argongreenlaserisusedintrabeculoplasty,iridoplasty,
pupillomydriasisandretinalphotocoagulationDiodelaserisusedin
retinalphotocoagulation

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1197.Phacoemulsificationincisionisat?
a)Sclero-cornealjunction
b)Cornea
c)Sclera
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Sclero-cornealjunction
Inphacoemulsificationverysmall3cmmincisionistakenatthe
sclerocornealjunction.
Phacoemulsification
ItisnothingelsebutanadvancementinthemethodofdoingECCE.
Herethenucleusisconvertedintopulporemulsifiedusinghigh
frequencysoundwaves,andthensuckedoutoftheeyethrougha
small(3.2mm)incision.AspecialfoldableIOListheninsertedinto
theposteriorchamberthroughthesameincision.ECCEby
phacoemulsificationwithfoldableposteriorchamberIOListhe
procedureofchoiceforcataract.
Thestepsinphacoemulsificationinclude:(i)Corneoscleralincision,
(ii)Continuouscurvilinearcapsulorrhexis,(iii)Hydrodissectionand
hydrodelineation(iv)Emulsificationandaspirationofnucleusand
thencortex,and(v)FoldableIOLimplantationinposteriorchamber.
Recoverywithphacoemulsificationisfastestasincisionisverysmall
andnosuturesaretaken.

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1198.Bilateralinferiordislocationoflensis
seenin?
a)Marfanssyndrome
b)Homocystinuria
c)WeilMarchesanisyndrome
d)Trauma
CorrectAnswer-B
Ans.is`b'i.e.,Homocystinuria
Ectopialentis
Ectopialentisisdefinedasdisplacementormalpositionofthe
crystallinelensoftheeye.Thelensisconsidereddislocated
(luxated)whenitliescompletelyoutsidethelenspatellarfossa.The
lensisdescribedassubluxatedwhenitispartiallydisplacedbut
containedwithinthelensspace.

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1199.Lensdislocationinmarfanssyndrome
is-
a)Superotemporal
b)Inferonasal
c)Forward
d)Backward
CorrectAnswer-A
Ans.is'a'i.e.,Superotemporal

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1200.Diabeticcataractisduetoaccumulation
of:
March2009
a)Fructose
b)Galactose
c)Glucose
d)Sorbitol
CorrectAnswer-D
Ans.D)Sorbitol
Theenzymealdosereductase(AR)catalyzesthereductionof
glucosetosorbitolthroughthepolyolpathway,aprocesslinkedto
thedevelopmentofdiabeticcataract.

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1201.Cataractiscasesofdiabetesmellitusis
duetoaccumulationof?
a)Glycatedcrytallins
b)Calcifiedcrystallins
c)Glycatedfibrillins
d)Calcifiedfibrillins
CorrectAnswer-A
Ans.is'a'i.e.,Glycatedcrytallins
Diabeticcataract
Senilecataracttendstodevelopatanearlierageandmorerapidly
thanusualindiabeticsubjects.Thelensesofanadultdiabeticare
saidtobeinthesameconditionasanon-diabeticwhois15years
older.Indiabeticadults,coin-paredtonon-diabetics,cataractsare
moreprevalent,aredependentonthedurationofdiabetesand
progressmorerapidly.Themechanismsarebelievedtobe
glycation,carbamylationofcrystallinsandincreasedoxidative
damage.
Truediabeticcataractisarareconditionoccurringtypi-callyin
youngpeopleinwhomthediabetesissoacuteastodisturbgrossly
thewaterbalanceofthebody.Alargenumberoffluidvacuoles
appearundertheanterior-tdposteriorpartsofthecapsule,initially
manifestingasmyopiaandthenproducingadiffuseopacitywhichat
thisstageisreversible.
Thelensthenrapidlybecomescataractous,withdense,white
subcapsularopacitiesintheanteriorandposteriorcortexresembling
asnowstorm-'snowflake'cataract.Fine,needle-shaped
polychromaticcorticalopacitiesmayalsoform.Withappropriate
treatmenttocontrolhyperglycaemia,therapidprogressiontomature

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cataractmaybearrestedatthisstage.

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1202.Softcontactlensesaremadeof:
a)Polymethylmethacrylate
b)Hydroxymethylmethacrylate
c)Glass
d)Silicone
CorrectAnswer-B
Ans.Hydroxymethylmethacrylate

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1203.Ganglioniccellsare,neurons?
a)Firstorder
b)Secondorder
c)Thirdorder
d)None
CorrectAnswer-B
Ans.is'b'i.e.,Secondorder

---

1204.Primaryactionofinferioroblique?
a)Abduction
b)Adduction
c)Extorsion
d)Elevation
CorrectAnswer-C
Ans.is'c'i.e.,Extorsion

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1205.Rightesotropiaisevidentwith?
a)Leftlateralrectusparalysis
b)Rightlateralrectusparalysis
c)Leftmedialrectusparalysis
d)Rightmedialrectusparalysis
CorrectAnswer-A
Ans.is'a'i.e.,Leftlateralrectusparalysis

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1206.Disscociatedverticaldeviationseenin
?
a)AVdissociation
b)Infantileesotropia
c)Congenitalesotropia
d)Superiorobliquepalsy
CorrectAnswer-C
Ans.is'c'i.e.,Congenitalesotropia
Theusualageofpresentationofcongenital(infantile)esotropiais
between2-4monthsofage.Presentationatbirthisveryrare.
Infantileesotropiahasbeenclassicallydescribedaslargeangle
constantesotropia(notvariable).
Theclassicletriadofassociatedmotorabnormaliesincongenital
esotropiaisinferiorobliqueoveraction,dissociatedverticaldeviation
(DVD)andlatentnystagmus.
"Itseems,fromareviewofliterature,thatinfantswithesotropia
have,onaverage,refractiveerrorssimilartothenormalage
matchedpopulation".--Handbook

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1207.Followingisafeatureofconcomitant
squint?
a)Constantamountofdeviationinalldirectionsofgaze
b)Associatedlimitationofocularmovements
c)Differentamountofdeviationindifferentdirectionsofgaze
d)Developsinthepatientsat15-20yearsofage.
CorrectAnswer-A
Ans.is'a'i.e.,Constantamountofdeviationinalldirectionsof
gaze
MANFESTSQUINT(HETEROTROPIA)
Inmanifestsquintthedeviationofeyeispresentassuchandcannot
becompensatedbyfusion.Twomaintypesofmanifestsquintare
concomitantsquintandparalyticsquint.
A)Concomitantsquint
Inconcomitantsquinttheeyesarenotinalignmentandthedegree
ofmalalignmentremainsconstantinallthedirectionsofgazeand
thereisnolimitationofocularmovements.Concomitantsquintmay
beoffollowingtypes:
1)Esotropia(Convergentsquint):-Itdenotesinwarddeviationof
eye.Itcanbeunilateraloruniocular(thesameeyealwaysdeviates
inwards)oralternating(eitheroftheeyesdeviatesinwardsandthe
othereyetakesupfixation,alternately).Concomitantesotropiaisthe
mostcommontypeofsquintinchildren.Followingtypesofesotropia
arethere:-
i)Congenitalesotropia(infantileesotropia)
Truecongenital(infantile)esotropiausuallyappearsbetweenthe
ageof2and4months.However,rarelyitmaybepresentfrombirth.
Theinwardturnoftheeyeisconstantoflargeamount,i.e.,deviation

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is>35prismdiopters(17-5').
Binocularvision(botheyesfixingsimultaneously)doesnotdevelop.
Thereisalternatefixationinprimarygaze,i.e,whentheinfantlooks
straight,hefixesthegazewithoneeyeatatimealternately.On
lateralgazethereiscrossfixation,i.e,userighteyetofixacrossthe
nosetoviewtheobjectstotheleftandviceversa.Amblyopia
developsin25-40%ofcases.
Latenthorizontalnystagmus(common)andmanyrotatory
nystagmusmayoccur.Inferiorobliqueoveractionmaybepresent
initiallyordeveloplateranddissociatedverticaldeviationdevelopin
80%byageof3years.
Itismoredifficulttohelpthistypeofstrabismuswithnonsurgical
methods,thus,surgeryisthetreatmentofchoice.Surgical
proceduretomakebothmedialrectiweakbyrecession.Surgery
shouldbedoneasearlyaspossibletoavoiddevelopmentof
amblyopiaandforthedevelopmentofproperbinocularvision.The
usuallyrecommendedtimeisbetween6month-2yearsofage(and
preferablybefore1yearofage).Itisimportanttotreattheamblyopia
beforeperformingsurgerybypatchingofnormaleye.
ii)Accommodativeesotropia
Accommodativeesotropiaoccursduetooveractionofconvergence
associatedwithaccommodationreflex.Accommodativeesotropiais
themostcommontypeofsquintinchildren(Previouslyitwas
believedthatcongenitalesotropiaisthemostcommontypesquintin
children.Howevernowitisverymuchclearthataccommodative
esotropiaisthemostcommonone).Itesotropiaisnotedaround2-3
yearsofage,itismostlikelyaccommodativeesotropia.Onthe
basesofAC/A(accommodativeconvergence/accomodation)ratio,
accommodativeesotropiaisdividedintotwotypes:(a)Refractive
(NormalAC/Aratio);(b)Non-refractive(abnormalAC/Aratio).
AC/Aratiogivestherelationshipbetweentheamountof
convergencethatisgoverenedbyagivenamountof
accommodation.
a. NormalAC/Aratioaccommodativeesotropia:-Thisoccursin
childrenwithhypermetropia.Esotropiaisaphysiologicalresponseto
excessivehypermetropia.Patientswithhighhypermetropiagenerate
largeamountofaccommodationtoseeclearlyatnearfixation.This

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excessiveaccommodationmaycauseesotropiaasaccommodation
isassociatedwithconvergence.AC/Aratioisnormal.
b. LargeAC/Aratioaccommodativeesotropia:-Childrenhavelarge
amountsoffocusingpowerandsometimestheincreaseof
accommodationisaccompaniedbyadisproportionatelylarge
increaseofconvergence.Thisoccursinpatientwithhypermetropia
butmayoccurinmyopiaandwithoutanyrefractiveerror.AC/Aratio
ishigh.
Usually,therearenosymptomsexceptforcosmeticembarrassment
tothepatient.Thereisnodiplopiaastheimageinthesquintingeye
isautomaticallysuppressed,i.e.,amblyopiadevelopsinsquinting
eye.Themainfeatureisthefailureofbinocularvision.
2)Exotropia(divergentsquint):-Itischaracterizedbyoutward
deviationofeye.Thisisverylesscommonthanesotropia.
3)Hypertropia(Verticalsquint):-Itischaracterizedbyvertical
deviationofeye.Itisalsorare.
B)Incomitantsquint
Incomitantsquintisasquintinwhichtheangleofdeviationdiffers
dependinguponthedirectionofgazei.e,amountofdeviationvaries
indifferentdirectionsofgaze.Therearemanytypeofincomitant
squints(paralytic,restrictive,'A'&'V'pattern),howeverthemost
commontypeisParalyticsquintandthewordincomitantsquintis
usuallyusedforparalyticsquint.Therefore,Iwillexplainparalytic
squinthereParalyticsquintisthemostcommontypeofsquintin
adults.Paralyticsquintisthestrabismusresultingfromcompleteor
incompleteparalysisofoneormoreextraocularmuscles.Thereare
manycauseslikeneurogenic(e.g.meningitis,cranialnervepalsy
etc.),myogenic(myopathies),orneuromuscularjunctionlesions.o
Symptomsofparalyticsquintare:-
i)Diplopia:Itisthemainsymptom.Itismostmarkedinthedirection
ofactionofparalysedmuscle.Forexampleinleftrectuspalsy,the
maximumdiplopiaoccurswhenpatienttriestoseehorizontallyon
leftsideandinleftsuperiorobliquepalsy(causesDextrodepression)
diplopiaismaximumwhenpatienttriestolookdownwardandright.
Itisworthnotingherethatindiplopia,iftheimagesareseparated
horizontallyitisprobablethateitheralateraloramedialrecutsis
affected;whentheimagesareseparatedverticallyortheimageis
tilted(torsion)itislikelythatoneormoreoftheverticalrectiorthe

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tilted(torsion)itislikelythatoneormoreoftheverticalrectiorthe
obliquesareaffected.
ii)Othersymptoms:Confusion,nausea&vertigo,oculardeviation,
lossofstereopsis.
Signsofparalyticsquintare:-
i)Secondarydeviationismorethanprimarydeviation:-Primary
deviationisthedeviationintheaffectedeyeandisawayfromthe
actionofparalysedmuscle.Secondarydeviationisthedeviationof
normaleyeseenundercover,whenthepatientismadetofixwith
thesquintingeye.
ii)Restrictionofocularmovements
iii)Compensatoryheadposture:-Patientswithaparalyticsquint
movetheirheadsuchthattheeyesoccupyapositionintheorbit
wheretheangleofsquintisminimalandthiscanavoidconfusion
anddiplopia.Headisturnedtowardstheactionofparalysedmuscle.
Whenthehorizontalrecti(medialorlateral)areaffected,the
characteristicpostureisaturnofthefacetorightorleft,e.g.inleft
lateralrectuspalsytheheadisturnedtotheleftandinleftmedial
recutspalsytheheadisturnedtotheright.Whenaverticalrectus
(superiororinferior)oranobliquemuscleisaffected,atiltofthe
headtotherightorleftwithdepressionorelevationofthechinis
adoptedtoreduceboththeverticaldeviationandrotation,e.gin
superiorobliquepalsy(dextrodepressionoflefteyeisaffected)the
headistiltedtoleftsothatthelefteyecanseedownandmedially.
iv)Thereisfalseprojectionororientation
v)Thereisnoamblyopiaandvisualacuityisnormalasparalytic
squintdevelopsinadultswhenvisualacuityhasalreadydeveloped.

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1208.Diplopiaisusuallyseenin?
a)Paralyticsquint
b)Non-paralyticsquint
c)Bothoftheabove
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Paralyticsquint

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1209.Followingaretheclinicalfeaturesof
Leberopticneuropathyexcept
a)Seeninthe2ndor3rddecadeoflife
b)Itisaexampleofgradualpainlessvisualloss
c)Malescantransmitthedisease
d)Noleakofdyeisobservedinfluoresceinangiography
CorrectAnswer-C
Ans.is'c'i.e.,Malescantransmitthedisease
Leber'sHereditaryopticneuropathv
Leber'shereditaryopticneuropathyischaracterizedbysequential
subacuteopticneuropathyinmalesaged11-30years.The
underlyinggeneticabnormalityisapointmutationinmitochondria!
DNA.SincemitochondrialDNAisexclusivelyderivedfrommother,
malesdonottransmitthediseaseandthediseaseistransmittedby
carrierfemales.
Itischaracterizeedbybilateral,painless,subacutevisualfailurethat
developsduringyoungadultlife.Malesarefourtofivetimesmore
likelythanfemalestobeaffected.Affectedindividualsareusually
entirelyasymptomaticuntiltheydevelopblurringaffectingthecentral
visualfieldofoneeye;Similarsymptomsappearintheothereyean
averageoftwotothreemonthslate.Inabout25%ofcases,visual
lossisbilateralatonset.
Onexamination,patientsgenerallyhavebilateralimpairmentsof
visualacuity.Thereiscentrocecalscotomathatbeginsnasaltothe
blindspotandextendstoinvolvefixationofbothsidesofthevertical
meridian.Pupillaryreactionsareoftennormal.Ophthalmoscopic
examinationshowsfundusabnormalitiesinacutephaselikeswelling
ofthedisc,peripapillaryretinaltelangiectasia,butcharacteristically

---

thereisnoleakfromtheopticdiscduringfluoresceinangiography.
Laterinatrophicphase,discbecomesatrophicandpale.

---

1210.Homonymoushemianopiatypeof
visualfielddefectisseeninallexcept?
a)Lateralgeniculatebody
b)Totalopticradiation
c)Optictract
d)Opticchaisma
CorrectAnswer-D
Ans.is'd'i.e.,Opticchaisma

---

1211.Bitemporalhemianopiaischaracteristic
of?
a)Glaucoma
b)Opticneuritis
c)Pituitarytumor
d)Retinaldetachment
CorrectAnswer-C
Ans.is'c'i.e.,Pituitarytumor
Characteristicvisualfielddefectofcentralchiasmaticlesionis
bitemporalhemianopia.Pituitarytumorcausescentralchiasmatic
lesion.
Bitemporalhemianopiaresultsduetocentral(sagittal)lesionofthe
opticchiasma,commoncausesofwhicharetumorsofthepituitary
gland(mostcommon),craniopharyngioma,suprasellarmeningioma,
gliomaofthirdventricle,chiasmalarachnoiditis,andthirdventricular
dilatation.

---

1212.Wernicke'shemianopicpupillary
reponseisseeninlesionsat?
a)Optictract
b)Opticchiasma
c)Opticradiation
d)Lateralgeniculatebody
CorrectAnswer-A
Ans.is'a'i.e.,Optictract

---

1213.Marcusgunnjawwinkingphenomenon
duetorelationbetweenwhichcranial
nerves
a)VII+VIII
b)III+V
c)V+VII
d)III+VI
CorrectAnswer-B
Ans.is'b'i.e.,III+V
MarcusGunnphenomenon(a.k.a.MarcusGunnJaw-Winkingor
Trigemino-oculomotorSynkineses)
ITisanautosomal-dominantconditionwithincompletepenetrance,
inwhichnursinginfantswillhaverhythmicupwardjerkingoftheir
uppereyelid.
Thisconditionischaracterizedasasynkinesis:whentwoormore
musclesthatareindependentlyinnervatedhaveeithersimultaneous
orcoordinatedmovements.

---

1214.Apersonwithdefectivebluecolor
appreciationiscalled?
a)Deuteranomalous
b)Deuteranopia
c)Tritanopia
d)Tritanomalous
CorrectAnswer-D
Ans.is`d'i.e.,Tritanomalous

---

1215.Brushfieldspotinirisisseenin-
a)Neurofibromatosis
b)Downsyndrome
c)Tuberoussclerosis
d)Toxoplasmosis
CorrectAnswer-B
Ans.is'b'i.e.,Downsyndrome
BrushfieldspotsarewhitespotsintheirisinpatientswithDown
syndrome.

---

1216.Mostcommonorbitalcystinchildren-
a)Neuroentericcyst
b)Dermoidcyst
c)Lymphoma
d)Clobomatouscyst
CorrectAnswer-B
Ans.is'b'i.e.,Dermoidcyst
Epidermaldermoidcyst(dermoid)isbyforthemostcommonorbital
cysticlesioninchildren,accountingforover40%ofallorbitallesions
ofchildhoodandfor89%ofallorbitalcysticlesionsofchildhoodthat
cometobiopsyorsurgicalremoval.
Mostimportantsecondarycystisamucocelethatcanoccurin
childrenwithcysticfibrosis.

---

1217.Mostcommonmalignantintraorbital
tumorinadultis?
a)Lymphoma
b)Rhabdomyosarcoma
c)Dermoidcyst
d)Sarcoma
CorrectAnswer-A
Ans.is'a'i.e.,Lymphoma
Anorbitaltumorisanytumorthatoccurswithintheorbitoftheeye.
Theorbitisabonyhousingintheskullthatprovidesprotectionto
theentireeyeballexceptthefrontalsurface.Itislinedbytheorbital
bonesandcontainstheeyeball,itsmuscles,bloodvessels,nerves
andfat.
Anintraoculartumoristhetumorwhichoccurswithintheeyeball.
Mostcommonintraoculartumorinadultsismetastasis.Metastasis
isparticularlycommonfromcarcinomaofbreastandlung.
Mostcommonprimaryintraoculartumorinadultsisuveal
melanoma.Mostoftheuvealmalignantmelanomaariseinchoroid.
Mostcommonprimaryintraoculartumorischildrenis
retinoblastoma.
Mostcommonorbitaltumorsinadultsarebenignvasculartumors
Cavernoushamangioma.
Mostcommonmalignantorbitaltumorinadultlymphoma
Mostcommonorbitaltumorsinchildrenarebenigntumors
Dermoidcyst>capillaryhemangioma
Mostcommonmalignantorbitaltumorinchildren
rhabdomyosarcoma.
Overallmostcommonprimarymalignanttumorofeyeismalignant

---

melanomafollowedbyretinoblastoma
MostcommonmalignanteyelidtumorBasalcellcarcinoma.
MostcommonepithelialtumoroflacrimalglandPleomorphic
adenoma(benignmixedtumor)
OverallmostcommontumoroflacrimalglandLymphoidtumour
andinflammatorypseudo-tumors
Mostcommonmalignanttumorofconjunctiva&cornea
Squamouscellcarcinoma.

---

1218.Mostcommonprimaryintraocular
neoplasminachildis?
a)Metastasis
b)Retinoblastoma
c)Basalcellcarcinoma
d)Squamouscellcarcinoma
CorrectAnswer-B
Ans.is'b'i.e.,Retinoblastoma

---

1219.Retinoblastomacanoccurbilaterallyin
howmanypercentageofthecases?
a)10-15%
b)15-20%
c)20-25%
d)25-30%
CorrectAnswer-D
Ans.is'd'i.e.,25-30%
RETINOBLASTOMA
Retinoblastomaisthemostcommonintraoculartumorinchildren.
Thetumorisconfinedtoinfancyandveryyoungchildren(1-2
years).Thereisnosexpredisposition.Retinoblastomaisunilateral
in70-75%ofcasesandbilateralin25-30%ofcases.
Etiology
Retinoblastomagene(RBgene)islocatedon14bandonthelong
armofchromosome13(13q14).RBgeneisatumorsupressor
gene.Retinoblastomadevelopswhenboththenormalallelesofthe
RBgenesareinactivedoraltered.ltistypicalexampleofKnudson's
twohithypothesis.InHereditaryretinoblastomafirstgeneticchange
(firsthit)inRBgeneisinheritedfromanaffectedparent,whereas
secondmutation(secondhit)occursinpostnatallifeandbothalleles
arelost.Innon-hereditaryretinoblastoma,bothmutations(firstand
secondhits)occurpostnataly.

---

1220.Axialproptosisisproducedbytumors
lyingin?
a)Retrobulbarspace
b)Subperiostealspace
c)Tenonspace
d)Peripheralspace
CorrectAnswer-A
Ans.is'a'i.e.,Retrobulbarspace
SURGICALSPACESINTHEORBIT
Theseareofimportanceasmostorbitalpathologiestendtoremain
inthespaceinwhichtheyareformed.
Therefore,theirknowledgehelpsthesurgeoninchoosingthemost
directsurgicalapproach.Eachorbitisdivisibleintofoursurgical
spaces.
1.Thesubperiostealspace
Thisisapotentialspacebetweentheboneandtheperiorbita
(periosteum).
2.Theperipheralspace
Itisboundedperipherallybytheperiorbitaandinternallybythefour
rectiwiththinintermuscularsepta.Tumourspresenthereproduce
eccentricproptosisandcanusuallybepalpated.Forperibulbar
anaesthesia,injectionismadeinthisspace.
3.Thecentralspace
Itisalsocalledmuscularconeorretrobulbarspace.Itisbounded
anteriorlybytheTenon'scapsuleliningbackoftheeyeballand
peripherallybythefourrectimusclesandtheirintermuscularsepta
intheanteriorpart.Intheposteriorpart,itbecomescontinuouswith
theperipheralspace.Tumourslyinghereusuallyproduceaxial

---

proptosis.Retrobulbarinjectionsaremadeinthisspace.
4.Tenon'sspace
Itisapotentialspacearoundtheeyeballbetweenthescleraandthe
tenonscapsule.

---

1221.Pulsatileproptosisisafeatureof?
a)Orbitalvarix
b)Retinoblastoma
c)Cortico-cavernousfistula
d)Covernoussinusthrombosis
CorrectAnswer-C
Ans.is'c'i.e.,Cortico-cavernousfistula
Proptosis
Proptosisisbulgingoftheeyeball(forwardbulging)beyondthe
orbitalmargins.Thoughthewordexophthalmosissynonymouswith
proptosis;somesourcedefinexophthalmosasaprotrusionofglobe
greaterthan18mmandproptosisasaprotrusionequaltoorless
than18mm.Proptosismaybeclassifiedasfollows:?
UnilateralProptosisProptosisofoneeye.
Inflammatorylesions:-Orbitalcellulitis,abscess,cavernoussinus
thrombosis,etc.
Vasculardisturbances:-Haemorrhage,varicoseorbitalveins,
haemangioma,etc.
Cystsandtumour:-Dermoidcyst,osteoma,lymphoma,
lymphosarcoma,glioma,meningiomaofopticnerve,retinoblastoma
andmetastaticdepositsinorbitNeuroblastoma,breast,prostate,
lung,GIT,Kidney,Ewing'stumor,melanoma,wilmstumor
(Nephroblastoma)].
Systemicdiseases-Leukemiasandendocrinedisturbancessuch
asGraves'diseaseandthyrotropicexophthalmosininitialstages.
Paralysisofextraocularmusclesasincompleteophthalmoplegia.
MucoceleofPNS'-Frontal(mostcommon),ethmoid,maxillary.
BilateralProptosisProptosisofbotheyes.

---

evelopmentalanomaliesoftheskull-Oxycephaly(towerskull).
Endocrineexophthalmos,boththyrotoxicandthyrotropic.
Inflammatorylesions-Cavernoussinusthrombosis.
Tumours-lymphosarcoma,lymphoma,pseudotumour,
nephroblastoma,Ewing'ssarcoma.
Systemicdisease-Histocytosis(Hand-schullerchristondisease),
amyloidosis,wegner'sgranulomatosis.
Intermittentproptosis
Proptosisdevelopingintermittentlyandrapidlyinoneeyewhen
venousstasisisinducedbyforwardbendingorloweringthehead,
turningtheheadforcibly,hyperextensionoftheneck,coughing,
forcedexpirationwithorwithoutcompressionofthenostrils,or
pressureonjugularveins.Themostimportantcasueisorbitalvarix
(varicocele).
Pulsatileproptosis:-Pulsatileproptosisisseenin
caroticocovernousfistula;saccularaneurysmofophthalmicartery;
andduetotransmittedcerebralpulsationasseeninmeningocele,
neurofibromatosisandtraumaticoroperativehiatus.

---

1222.Styeissuppurativeinflammationof
glandsof?
a)Zeis
b)Meibonian
c)Wolfring
d)Alltheabove
CorrectAnswer-A
Ans.is'a'i.e.,Zeis

---

1223.Meibomianglandssecretewhich
componentofsweat?
a)Water(aqueous)
b)Mucin
c)Protein
d)Lipid
CorrectAnswer-D
Ans.is'd'i.e.,Lipid
Themajorfunctionoflacrimalapparatusistosecreteanddrainthe
tear.
Tearfilmconsistsof3layers:-
i. Mucousormucinlayer(innermost):-Secretedbyconjunctivalgoblet
cells,cryptsofHenle,glandsofManz.
ii. Aqueouslayer(intermediate):-Thisformsthebulkofthetear.Itis
secretedbymainlacrimalandaccessorylacrimalglands.
iii. Lipidlayer(outermost):-SecretedbytheMeibomionZeis,andMoll
glands.

---

1224.Treatmentofdacryocystitisinthree
monthsoldchild?
a)Dailyprobing
b)Weeklyprobing
c)Massaging
d)Syringing
CorrectAnswer-C
Ans.is'c'i.e.,Massaging
Spontaneousrecanalizationofobstructednosolacrimalductoccurs
duringfirst6-8weeksandsometimesafter6-12monthsin90%of
infants.Thereforeupto9-12monthsonlymassageandantibiotic
dropsareindicated.Aftertheageof12monthshighpressure
syringingisindicated.

---

1225.Treatmentofacutedacrocystitisin
stageofcellulitisis?
a)Antibiotics
b)Abscessdrainage
c)DCT
d)DCR
CorrectAnswer-A
Ans.A.Antibiotics
Treatmentofacutedacyrocystitis
Duringcellulitisstage
Itconsistsofsystemicandtopicalantibioticstocontrolinfection;and
systemicanti-inflammatoryanalgesicdrugsandhotfomentationto
relievepainandswelling.

---

1226.Forcongenitalobstructionof
nasolacrimalduct,probingisdoneat
whatage?
a)2months
b)6months
c)10months
d)14months
CorrectAnswer-B
Ans.is'b'i.e.,6months
ProbingofcongenitalnasolacrimalductblockadewithBowman's
probe
Itshouldbeperformed,incasetheconditionisnotcuredbytheage
of3-4months.
Somesurgeonsprefertowaittilltheageof6months.
Itisusuallyperformedundergeneralanaesthesia.
Whileperformingprobing,caremustbetakennottoinjurethe
canaliculus.

---

1227.Treatmentformildptosisis?
a)Fasanellaservatoperation
b)Levatorresection
c)Frontalisslingoperation
d)Everbusch'soperation
CorrectAnswer-A
Ans.is'a'i.e.,Fasanellaservatoperation
Fasanella-Servatoperation.Itisperformedincaseshavingmild
ptosis(1-5-2mm)andgoodlevatorfunction.Init,upperlidiseverted
andtheuppertarsalborderalongwithitsattachedMuller'smuscle
andconjunctivaareresected.

---

1228.Kayserflescherringisseenin?
a)Siderosis
b)Chalcosis
c)Openangleglaucoma
d)Chemicalinjuries
CorrectAnswer-B
Ans.is'b'i.e.,Chalcosis
Chalcosis
Itreferstothespecificchangesproducedbythealloyofcopperin
theeye.
Mechanism.Copperionsfromthealloyaredissociated
electrolyticallyanddepositedunderthemembranousstructuresof
theeye.Unlikeironionsthesedonotenterintoachemical
combinationwiththeproteinsofthecellsandthusproduceno
degenerativechanges.
Clinicalmanifestations
i. Kayser-Fleischerring:Itisagoldenbrownringwhichoccursdueto
depositionofcopperunderperipheralpartsoftheDescemet's
membraneofthecornea.
ii. Sunflowercataract:Itisproducedbydepositionofcopperunderthe
posteriorcapsuleofthelens.Itisbrilliantgoldengreenincolourand
arrangedlikethepetalsofasunflower.
iii. Retina:Itmayshowdepositionofgoldenplaquesattheposterior
polewhichreflectthelightwithametallicsheen.

---

1229.`Ischemicnecrosis'inalkaliburnis?
a)StageI
b)StageII
c)StageIII
d)StageIV
CorrectAnswer-A
Ans.is'a'i.e.,StageI
Alkaliburnsareamongthemostseverechemicalinjuriestoeye.
Commonalkaliesresponsibleforburnsareliquidammonia(most
harmful),lime,causticpotashorcausticsoda.oClinicalfeaturesare
dividedintothreestages.
1)Acuteischemicnecrosis(StageI):-Inthisstagetherearesigns
inconjunctiva(edema,congestion,necrosis,copiousdischarge),
cornea(sloughing,edemaandopacity)andiris(iridocyclitis).
2)Reparation(StageII):-Conjunctivalandcornealepithelium
regenerate,andthereiscornealneovascularization.
3)Complications(StageIII):-Symblepharon,recurrentcorneal
ulceration,complicatedcataract,secondaryglaucoma.

---

1230.Bett'sclassificationdealswith?
a)Oculartrauma
b)Ocularforeignbody
c)Squint
d)Maculopathy
CorrectAnswer-A
Ans.is'a'i.e.,Oculartrauma
BETTS(BirminghamEyeTraumaClassificationSystem)
Oculartraumaclassificationgrouphasorganizedeyeinjuriesusing
standardtechnologytodescribevariousformsofocularinjury.This
iscalledBETTS-BirminghamEyeTraumaClassificationSystem.

---

1231.Steroidiscontraindicatedin?
a)Herpetickeratitis
b)Atopicdermatitis
c)Fungalcornealulcer
d)Exposurekeratitis
CorrectAnswer-C
Ans.is'c'i.e.,Fungalcornealulcer
Topicalcorticosteroidsenhancefungalreplicationandcorneal
invasionandtherefore,contraindicatedinafungalcornealulcer.
Now,option'a'requiresspecificmentionhere:-
Topicalcorticosteroidsarecontraindicatedinherpetickeratitis.But
notinallformsofherpetickeratitis:-
i. Epithelialherpetickeratitis(Dendriticulcer,geographiculcer)Topicla
corticosteroidsarecontraindicated.
ii. Stromalkeratitis(Disciform&Diffusenecrotic)Topical
corticosteroidsalongwithtopicalantiviraldrugsareusedasthefirst
lineoftreatment.
So,myopinionforthistypeofquestionisthat:-
i. Ifherpetickeratitishasgivenastheoption,thenlookatother
options.Ifanyoftheotheroptionsisaclearcutcontraindicationfor
corticosteroid(e.g.fungalcornealulcerinthisquestion),consider
thatoptionasyouranswer.Ifnotheroptionisacontraindicationfor
topicalcorticosteroid,considereherpetickeratitisastheanswer.
ii. Ifexaminerhasspecificallymentioneddendriticulcerasanoption,
consideritastheanswer.

---

1232.Tubularvisionseenin-
a)Myopia
b)Hypermetropia
c)Presbyopia
d)Opticneuritis
CorrectAnswer-A
Ans.is'a'i.e.,Myopia
CausesofTubularvision
Retinitispigmentosa
HighMyopia
Primaryopenangleglaucoma
CRAOwithsparingofcilioretinalartery

---

1233.InxerophthalmiaclassificationX2
stageis?
a)Bitotsspots
b)Cornealxerosis
c)Cornealulceration
d)Cornealscar
CorrectAnswer-B
Ans.isbi.e.,Cornealxerosis
WHOclassification(1982)
Thenewxerophthalmiaclassification(modificationoforiginal1976
classification)isasfollows:
1. XNNightblindness
2. X1AConjunctivalxerosis
3. X1BBitot'sspots
4. X2Cornealxerosis
5. X3ACornealulceration/keratomalaciaaffectinglessthanone-third
cornealsurface.
6. X3BCornealulceration/keratomalaciaaffectingmorethanone-third
cornealsurface.
7. XSCornealscarduetoxerophthalmia
8. XFXerophthalmicfundus.

---

1234.Whatisthecorrectsequenceof
xerophthalmia
a)Nightblindness4Conjunctivalxerosiscornealxerosis-
cornealulcer
b)Conjunctivalxerosiscornealxerosiscorneal
ulcerNightblindness
c)Cornealxerosiscornealulcer4Nightblindness
Conjunctivalxerosis
d)CornealulcerNightblindnessConjunctivalxerosis-3
cornealxerosis
CorrectAnswer-A
Ans.A.Nightblindness4Conjunctivalxerosiscorneal
xerosis-cornealulcer

---

1235.Increasedintraoculartensioncanbe
diagnosedby?
a)Tonometer
b)Pachymeter
c)Placido'sdisc
d)Keratometer
CorrectAnswer-A
Ans.is'a'i.e.,Tonometer
Theexactmeasurementofintraocularpressureisdonebyan
instrumentcalledtonometer.Indentation(Schiotztonometer)and
applanation(e.g.,Goldmann'stonometer)tonometersarefrequently
used.

---

1236.Followingistrueaboutbehcet's
diseaseexcept?
a)Itshowspresenceofaphthousulceration,genitalulcerationand
uveitis
b)Uveitisisbilateral,acuterecurrentiridocyclitiswithhypopyon
c)Ithasgoodvisualprognosis
d)Chlorambucilcanbeusedtocontrolthedisease
CorrectAnswer-C
Ans.is'c'i.e.,Ithasgoodvisualprognosis
BEHCET'SDISEASE
Itisanidiopathicmultisystemdiseasecharacterisedbyrecurrent,
non-granulomatousuveitis,aphthousulceration,genitalulcerations
anderythemamultiforme.
Etiology
Itisstillunknown;thebasiclesionisanobliterativevasculitis
probablycausedbycirculatingimmunecomplexes.Thedisease
typicallyaffectstheyoungmenwhoarepositiveforHLA-B51.
Clinicalfeatures
UveitisseeninBehcet'sdiseaseistypicallybilateral,acuterecurrent
iridocyclitisassociatedwithhypopyon.Itmayalsobeassociated
withposterioruveitis,vitritis,periphlebitisretinaeandretinitisinthe
formofwhitenecroticinfiltrates.
Treatment
Nosatisfactorytreatmentisavailable,andthusthediseasehasgot
comparativelypoorvisualprognosis.Corticosteroidsmaybyhelpful
initiallybutultimateresponseispoor.Insomecasesthedisease
maybecontrolledbychlorambucil.

---

1237.Howmanyincisionsareusedinthe
dividedsystemapproachofpars
planavitrectomy?
a)1
b)2
c)3
d)4
CorrectAnswer-C
Ans.is'c'i.e.,3
Techniquesofperformingvitrectomy
A)Open-skyvitrectomy
Thistechniqueisemployedtoperformonlyanteriorvitrectomy.
Openskyvitrectomyisperformedthroughtheprimarywoundto
managethedisturbedvitreousduringcataractsurgeryor
aphakickeratoplasty.
B)Closedvitrectomy(Parsplanavitrectomy)
Parsplanaapproachisemployedtoperformcorevitrectomy,
subtotalandtotalvitrectomy.Parsplanavitrectomyisahighly
sophisticatedmicrosurgerywhichcanbeperformedbyusingtwo
typeofsystems:
1. Fullfunctionsystemvitrectomyisnow-a-dayssparinglyused.It
employsamultifunctionsystemthatcomprisesvitreousinfusion,
suction,cutterandillumination(VISC),allinone.
2. Dividedsystemapproachisthemostcommonlyemployedtechnique
inmodernvitrectomy.Inthistechniquethreeseparateincisionsare
giveninparsplanaregion.Thatiswhytheprocedureisalsocalled
three-portparsplanavitrectomy.Thecuttingandaspiration

---

functionsarecontainedinoneprobe,illuminationisprovidedbya
separatefiberopticprobeandinfusionisprovidedbyacarmula
introducedthroughthethirdparsplanaincision.

---

1238.Followingistrueaboutoculocardiac
reflexexcept?
a)Itisalsocalledaschnerphenomenon
b)Itismediatedbyocculomotorandvagusnerve
c)Itischaracterizedbybradycardiafollowingtractiononextra-
ocularmuscles
d)Reflexismoresensitiveinneonates
CorrectAnswer-B
Ans.is'b'i.e.,Itismediatedbyocculomotorandvagusnerve
Oculocardiacreflex
Oculocardiacreflex,isalsoknownasAschnerphenomenon,
Aschnerreflex,orAschner-Dagninireflex,oItischaracterizedby
decreaseinpulserate(bradycardia)associatedwithtractionapplied
toextraocularmusclesand/orcompressionoftheeyeball.
Thereflexismediatedbynerveconnectionsbetweentheophthalmic
branchofthetrigeminalcranialnerveviatheciliaryganglion,and
thevagusnerveoftheparasympatheticnervoussystem.
Thisreflexisespeciallysensitiveinneonatesandchildren,
particularlyduringstrabismuscorrectionsurgery.However,this
reflexmayalsooccurwithadults.
Bradycardia,junctionalrhythmandasystole,allofwhichmaybelife-
threatening,canbeinducedthroughthisreflex.

---

1239.Pleomorphicadenomaofthelacrimal
glandmovestheeyeball?
a)Downwardsandoutwards
b)Downwardsandinwards
c)Upwardsandoutwards
d)Upwardsandinwards
CorrectAnswer-A
Ans.is'a'i.e.,Downwardsandoutwards
BenignmixedtumouroflacrimalglandIPleomorphicadenoma'
Itisalsoknownaspleomorphicadenomaandoccurspredominantly
inyoungadultmales.
Clinicallyitpresentsasaslowlyprogressivepainlessswellinginthe
upper-outerquadrantoftheorbitdisplacingtheeyeballdownwards
andoutwards.
Itislocallyinvasiveandmayinfiltrateitsownpseudocapsuleto
involvetheadjacentperiosteum.
Histologically,itischaracterisedbypresenceofpleomorphic
myxomatoustissue,justlikebenignmixedtumourofsalivarygland.
Treatmentconsistsofcompletesurgicalremovalwiththecapsule.
Recurrencesareverycommonfollowingincompleteremoval.

---

1240.Illuminatedfrenzelglassesareusedin
detecting?
a)Nystagmus
b)Heterophoria
c)Esotropia
d)Astigmatism
CorrectAnswer-A
Ans.is'a'i.e.,Nystagmus
Illuminatedfrenzelgalsses(+20lenses)areusefulforabolishing
fixationandthusrevealingperipheralvestibularnystagmus.

---

1241.Whichmetabolicderangementisseen
inpregnancy?
a)Metabolicacidosis
b)Metabolicalkalosis
c)Respiratoryacidosis
d)Respiratoryalkalosis
CorrectAnswer-D
Answer-D.Respiratoryalkalosis
Hyperventilationinpregnancywillleadtorespiratoryalkalosis.
Thehyperventilationthatoccurduringpregnancyisprobablyduein
parttoprogesteronestimulatingthecentre.
Lungvolumechangesandalteredcompliancemayalsocontribute.
Theeffectisachronicrespiratoryalkalosiswhichiscompensatedby
renalexcretionofbicarbonate.

---

1242.Turnersyndromeismaximally
associatedwith?
a)Horseshoekidney
b)Coarctationofaorta
c)VSD
d)ASD
CorrectAnswer-B
Ans.is'b'i.e.,Coarctationofaorta
AmongthegivenoptionsAorticcoarctationismostcommon.
Turner'ssyndromeiscommonlyassociatedwithcongenitalheart
diseases.
ThemostcommonanomalyassociatedisbicuspidAorticvalvesin
onethirdtoonehalfofthepatients(50%).
OthercongentialanomaliesassociatedwithTurner'ssyndrome-->
Aorticcoarctation(30%),Aorticstenosis,Mitralvalveprolapse,
Anomalouspulmonaryvenousdrainage.

---

1243.Allofthefollowingaretrueabouttreatmentofmigraine,EXCEPT:
a)Naratriptanactslongerthansumatryptan
b)Sumatryptanisusedinacuteattackofmigraine
c)Sumatryptanactson5HT1B/1Dreceptorsingreatvessels
d)Sumatryptanisusedforchronicmigraine
CorrectAnswer-D
Sumatriptanisanagonistat5-HTserotoninreceptors,inparticular5HT
receptors.Itisusedin
1B/1D
thetreatmentofacutemigraineattacksbutisnotrecommendedformigraineprophylaxis.Thedrug
providesrapidreliefofmigraineheadacheaswellasreliefoftheassociatedmanifestationsof
migraineincludingnausea,vomiting,photophobiaandphonophobia.
Short-acting,rapidlyeffectivetriptansincludealmotriptan,sumatriptan,rizatriptan,zolmitriptan,
andeletriptan,whereasnaratriptanandfrovatriptanhavethelongesthalf-lives.
5HT
receptoragonistsaresumatriptan,naratriptan,rizatriptan,andzolmitriptan.
1B/1D
Ref:InstantPharmacologyByKouroshSaeb-Parsy,RaviG.Assomull,FakharZ.Khan,
KasraSaeb-Parsy,EamonnKelly,1999,Page300;Harrison's17thedchapter15

---

1244.Whichofthefollowingisnotusedfor
investigationoffatmalabsorption
a)13CTrioctanoin
b)13CTriolein
c)13CTripalmitin
d)13CTriclosan
CorrectAnswer-D
Answer-D.13CTriclosan
Testsusedforfatmalabsorption
1. "CTriolenebreathtest
2. '3CTripalmitinbreathtest
3. '3CMixed-Triglyceridebreathtest
4. "C-Trioctanoinbreathtest

---

1245.Typhoidistreatedbyallexcept
a)Erythromycin
b)Ceftriaxone
c)Amikacin
d)Ciprofloxacin
CorrectAnswer-A
Ans.is'a'i.e.,Erythromycin
Theolderagentsusedforthetreatmentoftyphoidwere:
Chloramphenicol
Ampicilin
TrimethoprimSulfamethoxazole
Betalactam
ParenteralCeftriaxone
OrallCefixime
Thesedrugsarenotusednowdaysbecauseofwidespread
resistance.oNowdaysthedrugofchoiceforTyphoidalloverthe
worldisa"Fluroquinolone"(Ciprofloxacin,ofloxacin).
Animportantpointtoremember
Highleveloffluoroquinoloneresistance(ciprofloxacin)havebeen
reportedfromIndiaandotherpartsofSouthEastAsiainS.
paratyphiandS.typhiinfection.
NalidixicacidresistantS.typhi(NARST)havedecreased
ciprofloxacinsensitivityandarelesseffectivelytreatedwith
fluoroquinolones.
Thefluroquinolonesshouldnotbeusedasfirstlinetreatmentfor
typhoidfeversinpatientsfromIndiaandotherpartsofSouthAsia
withhighratesoffluroquinoloneresistanceunlessantibiotic
susceptibilitydatademonstratesfluoroquinoloneornalidixicacid

---

sensitivity.

---

1246.Drugtreatmentisgivenforhowmany
daysinpneumococcalmeningitis
a)5days
b)7days
c)14days
d)21days
CorrectAnswer-C
Ans.is'c'i.e.,14days
Recommendationsfordurationoftreatment
Pneumococcalmeningitis-->10-14days
Meningococcalmeningitis5-7days
Hibmeningitis-->7-14days
Listeriameningitis-->21days

---

1247.Thetreatmentofchoiceinacute
hyperkalemiaoflifethreateningto
cardiacmyocytesis
a)Infusionofcalciumgluconate
b)Oralresins
c)Intravenousinfusionofinsulin
d)blocker
CorrectAnswer-A
Ans.is`a'i.e.Infusionofcalciumgluconate
Emergentt/tofhyperkalemiaisneededinconditionswith
severehyperkalemia(IC>7meq/L).Inthesecasescardiac
toxicityormuscularparalysisispresent.
Calciumgluconateisthefastestactingagentamongtheagents
usedinthet/tofhyperkalemia?.
Itactswithinminutesbutanimportantpointtonoteisthatit
doesnotcausetranscellularmovementofpotassium,instead,
itactsoncardiaccellmembrane

---

1248.VitaminEdeficiencycauses
a)Hemorrhagicstroke
b)Cardiacfailure
c)Ataxia
d)Megalablasticanemia
CorrectAnswer-C
Answer-C.Ataxia
ClinicalManifestations
Axonaldegeneration
Hemolyticanaemia
Peripheralneuropathy
Spinocerebellarataxia
Dryskin
Thrombocytosis
Ataxia

---

1249.Whichofthefollowingcirculating
antibodieshasthebestsensitivityand
sepcificityforthediagnosisofceliac
disease?
a)AntiSaccharomycesantibody
b)Anti-tissuetransglutaminaseantibody
c)Anti-gliadinantibody
d)Anti-gliadinantibodyantibody
CorrectAnswer-A
Ans.is'a'i.e.Antisaccharomycesantibody
Serologicevaluationinceliacdisease
ImmunoglobulinA(IgA)anti-tissuetransglutaminase(TTG)antibody
isthesinglepreferredtestfordetectionofceliacdiseasein
individualsovertheageoftwoyears.
Serumantibodyassays
Avarietyofserologicstudieshavebeendescribedtoaidinthe
diagnosisofceliacdisease,including:
IgAendomysialantibody(IgAEMA)
IgAtissuetransglutaminaseantibody(IgAtTG)
IgGtissuetransglutaminaseantibody(IgGtTG)
IgAdeamidatedgliadinpeptide(IgADGP)
IgGdeamidatedgliadinpeptide(IgGDGP)
SerumIgAendomysialandtissuetransglutaminaseantibodytesting
havethehighestdiagnosticaccuracy.
TheIgAandIgGantigliadinantibodytestshavelowerdiagnostic
accuracywithfrequentfalsepositiveresultsascomparedwithIgA
tTGandIgADGPassaysandarethereforenolongerrecommended

---

forinitialdiagnosticevaluationorscreening
However,theneweranti-deamidatedgliadinpeptide(DGP)assays
describedaboveshowhighdiagnosticaccuracy.
IgAEMA,IgAtTG,IgADGPandIgGDGPlevelsfallwithtreatment;
asaresult,theseassayscanbeusedasanoninvasivemeansof
monitoringtheresponsetoagluten-freediet.
Assaysensitivityandspecificity
IgAendomysialantibodies-Sensitivity85to98
percent;specificity97to100percent
IgAtissuetransglutaminaseantibodiesSensitivity90to98
percent;specificity95to97percent--
IgAdeamidatedgliadinpeptideSensitivity94
percent;specificity99percent
IgGdeamidatedgliadinpeptideSensitivity92
percent;specificity100percent

---

1250.Asepticmeningitiscausedby
a)Indomethacin
b)Ibuprofen
c)Aspirin
d)Icatibant
CorrectAnswer-B
Ans.is'b'i.e.,Ibuprofen
MedicationsknowntocauseasepticmeningitisMedications
Medication
Common
Uncommon
SulindacNaproxen
NSAIDs
Ibuprofen
Diclofenac
Rofecoxib
Antimicrobials
Trimethoprim/sulfamethoxazole Sulfonamides
Immunomodulating Monoclonalantibody
Azathioprine
agents
OKT3IntravenousIgG
Metrizamide
Cytarabine
Intrahecalagents
Methylprednisolone
acetate
Other
Carbamazepine
Causesofacuteasepticmeningitis
Infectious
cases
Lynedisease
Leptospirosis
Mycobacteriumtuberculosis
infection
Bacterial Subacutebacterialendocarditis

---

Subacutebacterialendocarditis
Parameningealinfection
(epiduralsubduralabcess,sinus
orearinfection)Partiallytreated
bacterialmeningitis
Echovirusinfection
Coxaackievirusinfection
Mumps
St.Louisencephalitis
Easternequineencephalitis
Viral
Westernequineencephalitis
Calciforniaencerphalitis
Herpessimplexvirustype2
infectionHIVinfection
Lymphocyticchoriomeningitis
Poliovirusinfection

---

1251.HighSteppageGaitisseenin
a)Footdrop
b)Frontallobestroke
c)Tabesdorsalis
d)Leprosy
CorrectAnswer-C
Ans.is'c'i.e.,Tabesdorsalis
Highsteppinggaitorsteppagegaitorfootdropgaitisduetofoot
drop-+legisliftedmoreinordertogetclearanceandfirsttotouch
thegroundisforefoot(nottheheelasoccurinnormalgait).
Itmayoccurinallmotorperipheralneuropathiesinvolvingcommon
peronealnerve-->Tabesdorsalis,leprosyetc.
[RefHarrison18th/echapter377]

---

1252.FeatureofAcutesevereAsthmainclude
allofthefollowing,Except:
a)Tachycardia>120/min
b)Pulsusparadoxus
c)Respiratoryacidosis
d)Drowsy
CorrectAnswer-A
AnswerisA.Tachycardia>120/min
Diaphoresis
Bradycardia
Paradoxicalthrocobadominalmovements
PEER<33%
Hypotension
Pulsusparadoxus
Hypercapnea
Silentchest

---

1253.Inapatientwithbronchialasthmasilent
chestsignifies
a)GoodPrognosis
b)BadPrognosis
c)GravePrognosis
d)NotaPrognosticsign
CorrectAnswer-C
Ans.is'c'i.e.,GravePrognosis
Silentchest(Little/noairmovementwithoutwheezesinBronchial
Asthmasuggestsagraveprognosis/impendingrespiratoryfailure
(LifethreateningAsthma).
Signsofimpendingrespiratoryfailureinclude:
Drowsinessorconfusion
Diaphoresis
Bradycardia
Paradoxicalthoracoabdominal
SignsofimpendingrespiratoryfailureinAsthma
Drowsinessorconfusion
Diaphoresis
Bradycardia
Paradoxicalthracoabdominalmovements
PEFR<33%
Hypotension
Pulsusparadoxus
Hypercapnea
Silentchest

---

1254.Whichiscorrectaboutpneumonia
a)Bronchophonia
b)Decreasedvocalfremitus
c)Shiftingoftrachea
d)Amphoricbreathing
CorrectAnswer-A
Ans.is'a'i.e.,Bronchophonia
PhysicalexaminationfindingsofCommonpulmonary
conditions
Endobronchial
Pleuraleffusion Pneumonia tumor
Pneumothorax
Tracheal
Shiftedor
Shiftedor
Midline
Shiftedormidline
position
midline
midline
Reducedor
Reducedor Reducedor
Chestwall
Reduced
normal
normal
normal
Normalor
Fremitus
Decreased
Increased
None
decreased
Percussion Dull
Dull
NormalorDull Hyperresonant
Breath
Normalor
Decreased
Increased
Decreased/absent
sounds
Decreased
Crackles
None
None
None
None
Wheeze
None
None
Possible
None
Bandabove
Egophony
Present
None
None
effusion(skodiac)
Tracheal
position

---

Deviated
Awayfrom
Pneumo
thorax
Effusion
Deviated
towards
Collapse
Consolidation
Tactilevocalfremitus
Tactilevocalfremitusisvibrationfeltonthepatientschestduringlow
frequencyvocalisation.
Commonlythepatientisaskedtorepeataphrasewhilethe
examinerfeelsforvibtationsbyplacingahandoverthepatientchest
orback.
Tactilefremitusisnormallymoreintenseintherightsecond
intercostalspaceaswellasintheinterscapularregionasthese:
Tactilefremitus

IncreasedConsolidation
DecreasedorabsentPleuraleffusionorPneumothorax
Reasonforincreasedfremitusinaconsolidatedlungisthefactthat
thesoundwavesaretransmittedwithlessdecayinsolidorfluid
medium(consolidation)thaninagaseousmedium(consolidation)
thaninagaseousmedium(aeratedlung).Converselythereasonfor
decreasedfremitusinapleuraleffusionorpneumothorax(orany
pathologyseparatingthelungtissueitselffromthebodywall)isthat
thisincreasedspacediminishesorpreventsentirelysound
transmission
Egophonyisachangeintimbre(E0toA)butnotpitchorvolume.
Itisduetodecreaseintheamplitudeandanincreaseinthe
frequencyofthesecondformantproducedbysolid(including
compressedlung)interposedbetweentheresonatorandthe
stethoscopehead.
Thesoundofaspoken"E"changeto"A"overanareaof
consolidation.Thespoken"E"ishearedas"A"whenlisteningover
theconsolidationbecausethefrequenciesofthevibrationsare

---

alteredbytheconsolidation.Egophonyor"E"to"A"changesmay
alsooccurinsmallbandlikeareajustaboveapleuraleffusion
becauseofcompressionoflungtissuethatoccursjustabovethe
effusion.

---

1255.SystemicMillaryTBspreadsvia
a)Artery
b)Vein
c)Bronchus
d)Lymphatic
CorrectAnswer-A
.Ans.is'a'i.e.,Artery
Systemicmiliaryensueswheninfectivefociinthelungsseedthe
pulmonaryvenousreturntotheheart;theorganismssubsequently
disseminatethroughthesystemicarterialsystem.

---

1256.DOCforacuteattackofHereditary
angioneuroticedema
a)Danazol
b)Cl,inhibitorconcentrate
c)Icatibant
d)Methylprednisolone
CorrectAnswer-B
Ans.is'b'i.e.,Clinhibitorconcentrate
Medication
C1inhibitorconcentrate(Plasma-derived)(Berinert,BerinertP,
Cinryze.
RecombinantC1inhibitorConestatalfa(Ruconest,Rhucin).
BradykininBzreceptorantagonistIcatibant(Firazyr).
KallikreininhibitorEcallantide(Kalbitor)
Plasma

---

1257.Type5Hypersensitivitymimics
a)Type1
b)Type2
c)Type3
d)Type4
CorrectAnswer-B
Ans.is'b'i.e.,Type2
TypeVhypersensitivityreactionswereadditionallyaddedtothe
schemeoriginallydescribedbyCoombsandGell.Contrarytotype
IVandinagreementwithtypesI,11andIIIrespectively,theyare
mediatedbyantibodiestoo.
ThetypeVreactionsaresometimesconsideredasasubtypeof
thetypeIIhypersensitivity.
Asitsmechanismsdonotdestroytargetcells,theyareresponsible
forinductionoforgan/tissuedysfunctionsonlymostofauthorsprefer
ittobeandindependent,the5'typeofhypersensitivityreactions

---

1258.Broca'saphasiais?
a)Fluentaphasia
b)Nonfluentaphasia
c)Sensoryaphasia
d)Conductionaphasia
CorrectAnswer-B
AnswerisB(Non-fluentAphasia):
Broca'sAphasiaisaNon-FluentExpressive(Motor)Aphasiawith
preservedcomprehensionandimpairedrepetition

---

1259.AllofthefollowingareFluentAphasia's
Except:
a)AnomieAphasia
b)Wernicke'sAphasia
c)ConductionAphasia
d)Broca'sAphasia
CorrectAnswer-D
AnswerisD(Broca'sAphasia):
NeurologicDifferentialDiagnosis:ACase-BasedApproach
(CambridgeUniversityPress,2014)/36
Broca'sAphasiaisaNon-FluentExpressive(Motor)Aphasiawith
preservedcomprehensionandimpairedrepetition.
Non-FluentAphasias
Global
Broca's
MixedTranscortical
TranscorticalMotor
FluentAphasias
Anomie
Wernicke's
Conduction
TranscorticalSensory

---

1260.Comprehensioninintactwithaphasia
in
a)Wernicke's
b)Broca's
c)Globalaphasia
d)Transcorticalsensory
CorrectAnswer-B
Ans.is'b'i.e.,Broca's

---

1261.FluentAphasiawithpreserved
comprehensionandimpairedrepetition
is:
a)Broca's
b)Wernicke's
c)Anomie
d)Conduction
CorrectAnswer-D
AnswerisD(conduction):
ConductionAphasiaisa'Fluent'Aphasiawithpreserved
comprehensionandimpairedRepetition.
Clinical
Non-FluentAphasias
FluentAphas'as
Syndrome
Features
Wernicke's Transcortical


Transcortical Motor
Sensory
Fluent
No No
No
No Yes Yes Yes
Yes
Comprehension No No
Yes Yes Yes Yes No
No
Repeat
No Yes
Yes
No Yes No No
Yes

---

1262.Aphasiawhichaffectsthearcuatefibres
iscalled
a)Globalaphasia
b)Anomieaphasia
c)Conductionaphasia
d)Broca'saphasia
CorrectAnswer-C
Ans.is'c'i.e.,Conductionaphasia
ArcuatefibersarebundleofnervefibresthatconnectBrocasareato
theWernicke'sarea.
Damagetothearcuatefasciculuscausesadisordercalled
conductionaphasia

---

1263.Erb'sPointincardiologyrefersto:
a)Right2ndintercostalspace
b)Left2ndintercostalspace
c)Right3rdintercostalspace
d)Left2ndintercostalspace
CorrectAnswer-C
AnswerisC(Right3rdintercostalspace)
Incardiology,Erb'spointreferstothethirdintercostalspaceonthe
leftsternalborderwherebothcomponentsofS2(A2andP2)canbe
wellappreciated.
BothcomponentsofS2(A2andP2)areusuallywelltransmittedto
theErb'spoint.ThephysiologicalsplittingofS2intoA2andP2is
believedtobeappreciatedbestattheErb'spointorinthepulmonic
area.
A2isbestheardovertheaorticareaintherightsecondintercostal
space
P2isbestheardoverthepulmonicareaintheleftsecondintercostal
space
Secondheartsound(S2)isbestheardoverthepulmonicarea
(SincebothA2andP2canbeheardatthepulmonicarea)andat
theErb'sPoint.NotethatevenatthepulmonicareaA2islouder
thanP2
Secondintercostalspacetotherightofthe
1. Aorticarea
sternum(alongrightuppersternalborder)
Pulmonic
Secondintercostalspacetotheleftofthesternum
2. area
(alongleftuppersternalborder)
Thirdintercostaltotheleftofthesternum(alongleft
3. Erb'spoint
sternalborder)

---

sternalborder)
Tricuspid
FourthorFifthintercostalspacetotheleftofthe
4. area
sternum(alongleftlowersternalborder)
Mitralarea
5.
Fifthintercostalspaceontheleftmidclavicularline.
(Apex)

---

1264.Drugformanagementofhypertension
inPhaeochromocytoma
a)Phenoxybenzamine
b)Phentolamine
c)Labetalol
d)Esmolol
CorrectAnswer-A
Ans.is'a'i.e.,Phenoxybenzamine
Onceapheochromocytomaisdiagnosed,allpatientsshould
undergoaresectionofthepheochromocytomafollowingappropriate
medicalpreparation.
Resettingapheochromocytomaisahigh-risksurgicalprocedure
andanexperiencedsurgeon/anesthesiologistteamisrequired.
Someformofpreoperativepharmacologicpreparationisindicated
forallpatientswithcatecholamine-secretingneoplasms.
Preoperativemedicaltherapyisaimedat:
Controllinghypertension(includingpreventingahypertensivecrisis
duringsurgery)oVolumeexpansion
Inpatientswithundiagnosedpheochromocytomaswhoundergo
surgeryforotherreasons(andwhothereforehavenotundergone
preoperativemedicaltherapy),surgicalmortalityratesarehighdue
tolethalhypertensivecrises,malignantarrhythmias,andmultiorgan
failure.
Combinedalpha-andbeta-adrenergicblockade
Combinedalpha-andbeta-adrenergicblockadeisthemostcommon
approachtocontrolbloodpressureandpreventintraoperative
hypertensivecrises.
Alpha-adrenergicblockade

---

Analpha-adrenergicblockerisgiven10to14dayspreoperativelyto
normalizebloodpressureandexpandthecontractedbloodvolume.
Phenoxybenzamineisthepreferreddrugforpreoperative
preparationtocontrolbloodpressureandarrhythmiainmostcenters
intheUnitedStates.Itisanirreversible,long-acting,nonspecific
alpha-adrenergicblockingagent.
Theinitialdoseis10mgonceortwicedaily,andthedoseis
increasedby10to20mgindivideddoseseverytwotothreedays
asneededtocontrolbloodpressureandspells.
Thefinaldoseofphenoxybenzamineistypicallybetween20and
100mgdaily.
Beta-adrenergicblockade
Afteradequatealpha-adrenergicblockadehasbeenachieved,beta-
adrenergicblockadeisinitiated,whichtypicallyoccurstwotothree
dayspreoperatively.
Thebeta-adrenergicblockershouldneverbestartedfirstbecause
blockadeofvasodilatoryperipheralbetaadrenergicreceptorswith
unopposedalpha-adrenergicreceptorstimulationcanleadtoa
furtherelevationinbloodpressure.
Thealternativestoaand13adrenergicagentsarecalcium
channelblockersandmetyrosine.
Calciumchannelblockers
Althoughperioperativealpha-adrenergicblockadeiswidely
recommended,asecondregimenthathasbeenutilizedinvolvesthe
administrationofacalciumchannelblocker.
Nicardipineisthemostcommonlyusedcalciumchannelblockerin
thissetting;thestartingdoseis30mgtwicedailyofthesustained
releasepreparation.
Metyrosine
Anotherapproachinvolvestheadministrationofmetyrosine(alpha-
methylPara-tyrosine),whichinhibitscatecholaminesynthesis.

---

1265.Causesofhyperparathyroidismareall
except
a)Solitaryadenoma
b)Malignant
c)Thyroidmalignancy
d)Parathyroidhyperplasia
CorrectAnswer-C
Ans.:C.)Thyroidmalignancy
Hyperparathyroidism
Pathology
IncreasedlevelsofthePTHleadtoincreasedosteoclasticactivity.
Theresultantboneresorptionproducescorticalthinning
(subperiostealresorption)andosteopaenia.
Subtypes
primaryhyperparathyroidism
parathyroidadenoma(~80%)
multipleparathyroidadenomas(4%)
parathyroidhyperplasia(10-15%)
parathyroidcarcinoma(1-5%)
secondaryhyperparathyroidism
causedbychronichypocalcaemiawithrenalosteodystrophybeing
themostcommoncause(othersincludemalnutrition,vitaminD
deficiency)
resultsinparathyroidhyperplasia
tertiaryhyperparathyroidism
autonomousparathyroidadenomacausedbythechronic
overstimulationofhyperplasticglandsinrenalinsufficiency

---

1266.1yearoldmalechildishavingaHeart
Rate40/min,BP90/60.Hisserum
Potassium=6.5whatisthenextbest
management?
a)Ipratropium
b)Adrenaline
c)Sodiumbicarbonate
d)Calciumchloride
CorrectAnswer-C
Answer-C.Sodiumbicarbonate
Forsevereelevation7meq/L
Youneedtoshiftpotassiumintothecellstogetherwith
eliminationofpotassiumfromthebody
1. Stabilizetheheart
2. Shiftpotassiumintocells
3. Promotespotassiumexcretion
Shiftpotassiumintothecells
CalciumChloride:reducetheeffectofpotassiumatthemyocardial
cellmembrane
Sodiumbicarbonate
Glucoseplusinsulin
Nebulizedalbuterol
Promotespotassiumexcretion
Diuretics(Furosemide)
Kayexalate
Dialysis
[RefHarrison's18`51echapter45]

---

---

1267.Persistentpriapismisdueto
a)Sicklecellanaemia
b)Hairycellleukaemia
c)Paraphimosis
d)Urethralstenosis
CorrectAnswer-A
Ans.is'a'i.e.,Sicklecellanemia
Priapismisdefinedaserectionlastingfor>4hours.
Low-flowpriapismmaybeduetoanyofthefollowing:
Anexcessivereleaseofneurotransmitters
Blockageofdrainingvenules(eg,mechanicalinterferenceinsickle
cellcrisis,leukemia,orexcessiveuseofintravenousparenteral
lipids)
Paralysisoftheintrinsicdetumescencemechanism
Prolongedrelaxationoftheintracavernoussmoothmuscles(most
oftencausedbytheuseofexogenoussmooth-musclerelaxants
suchasinjectableintra-cavernosalprostaglandinEI)
Prolongedlow-flowpriapismleadstoapainfulischemicstate,which
cancausefibrosisofthecorporealsmoothmuscleandcavernosal
arterythrombosis.Thedegreeofischemiaisafunctionofthe
numberofemissaryveinsinvolvedandthedurationofocclusion

---

1268.Thetypeofarteritiswhichmayleadto
myocardialinfarctioninchildrenis
a)Kawasakidisease
b)Takayasuarteritis
c)Polyarteritisnodosa
d)Microscopicpolyangitis
CorrectAnswer-A
Ans.is'a'i.e.,Kawasakidisease
oKawasakidiseaseisanacute,selflimitedvasculitisofunknown
etiologythatoccurspredominantlyininfantsandyoungchildrenof
allraces.
Coronaryarteryaneyrysmsorectasiadevelopsin15-25%of
untreatedchildrenwiththediseaseandmayleadtoischemicheart
disease,myocardialinfarction,orevensuddendeath.IntheUSA,
Kawasakidiseasehassurpassedacturerheumaticfeverasteh
leadingcauseofacquitedheartdiseaseinchildren

---

1269.Onionskinspleenisseenin
a)ITP
b)Thalassemia
c)SLE
d)Scleroderma
CorrectAnswer-C
Ans.is'c'i.e.,SLE
ThecharacterisitchistopathologicpictureofthespleeninSLE
isperiaterialfibrosisoranionskinlesion.
FirstdescribedbyLibmanandSacks,thislesionisdefinedasthe
preseneof3toasmanyas20seperatedlayersofthenormally
denselypackedperiarterialcollagenofthepenicillaryorfollicular
arteriesproducingtheappearanceofconcentricrings(onionpeel).

---

1270.Mostcommonpulmonarymanifestation
inAIDS
a)TB
b)Pneumonia
c)Bronchiectasis
d)Mycobacterialaviumintracellular
CorrectAnswer-B
Ans.is'b'i.e.,Pneumonia
RespiratorycomplicationsinAIDS
RespiratorydiseasesinAIDSinclude
A)Acutebronchitisandsinusitis
TheyarecausedbyS.pneumoniaeandHinfluenzaeandarevery
common.
B)Pulmonarydiseases
Pulmonarydiseasesare:-
1.Pneumonia
Mostcommonpulmonarymanifestationispneumonia:
Bacterialpneumonia:ItiscausedmostcommonlybySpneumoniae
andpneumococcalinfectionistheearliestseriousinfectioninAIDS.
Hinfluenzaeisalsoacommoncause.
Pcannapneumonia:Itisthemostcommoncauseofpneumoniain
AIDS.RiskisgreaterwhenCD4countlessthan200/ml.
2.Tuberculosis
IndevelopingcountrieslikeIndia,mostimportantpathogenisM
tuberculosis.OthercommonpathogencausingTBisMAC(atypical
mycobacteria).
3.Otherpulmonarydiseases
Thesearefungalinfections(cryptococcus,histoplasma,aspergillus),

---

neopasms(Kaposisarcoma,lymphoma)andidiopathicinterstitial
pneumonia.

---

1271.Mostcommonpresentationofextra-
pulmonaryTB
a)Tubercularlymphadenitis
b)PeritonealTB
c)PericardialTB
d)Tubercularmeningitis
CorrectAnswer-A
Answer-A.Tubercularlymphadenitis
Themostcommonpresentationofextra-pulmonaryTBinbothHIV
sero-negativeandHIV-infectedpatientstoabout35%ingeneral,
lymphnodediseaseisparticularlyfrequentamongHIVinfected
patientsandinchildren.

---

1272.ChronichemodialysisinESRDpatient
isdone
a)Onceperweek
b)Twiceperweek
c)Thriceperweek
d)Daily
CorrectAnswer-C
Ans.is'c'i.e.,Thriceperweek
ForthemajorityofpatientswithESRD,between9and12hof
dialysisarerequiredeachweek,usuallydividedintothreeequal
sessions.
Currenttargetsofhemodialvsis
Ureareductionratio(thefractionalreductioninbloodureanitrogen
perhemodialysissession)of>65-70%.
Bodywater-indexedclearancextimeproduct(KT/V)above1.2or
1.05.

---

1273.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

---

1274.MELDscoreincludes
a)Serumcreatinine
b)Transaminase
c)Albumin
d)Alkalinephosphatase
CorrectAnswer-A
Answer.A.Serumcreatinine
TheModelforEnd-stageLiverDisease(MELD)isaprospectively
developedandvalidatedchronicliverdiseaseseverityscoring
systemthatusesapatient'slaboratoryvaluesfor?
LiSerumbilirubin
Serumcreatinine
Theinternationalnormalizedratio(INR)forprothrombintimeto
predictthreemonthsurvival.
Patientswithcirrhosis,andincreasingMELDscoreisassociated
withincreasingseverityofhepaticdysfunctionandincreasedthree-
monthmortalityrisk.
Givenitsaccuracyinpredictingshort-termsurvivalamongpatients
withcirrhosis,MELDwasadoptedbytheUnitednetworkfororgan
sharing(UNOS)in2002forprioritizationorpatientsawaitingliver
transplantationintheUnitedstates.

---

1275.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

---

1276.Drugofchoiceforthetreatmentof
acutegoutinpatientsinwhomNSAIDs
arecontraindicatedis?
a)Colchicine
b)Allopurinol
c)Xyloricacid
d)Paracetamol
CorrectAnswer-A
Ans.is'a'i.e.,Colchicine
TreatmentofGout
1)Acutegout
NSAIDsarethedrugsofchoice
Colchicineisthefastestactingdrug.Howeveritisreservedforthe
patientsinwhichNSAIDsarecontraindicated,becausecolchicine
cancausegastrointestinaldisturbances.
IfneitherNSAIDsnorcolchicinaretolerated,oralprednisoloneis
used.
Allopurinolanduricosuricdrugs(sulfinpyrazone,probenacid)arenot
effectiveinacutegoutbecausetheywillnotrelievesymptomsas
theydon'thaveanti-inflammatoryproperty.
2)Chronicgout
Allopurinalisthedrugofchoice.
Otherdrugsaresulfinpyrazoneandprobenacid.

---

1277.Alldrugsusedintreatmentofacute
goutexcept
a)Allopurinol
b)Aspirin
c)Colchicine
d)Naproxen
CorrectAnswer-A
Ans.is'a'i.e.,Allopurinol
Managementofgout
Treatmentofacutegout
Toproviderapidandsafepainrelief
Drugsusedare:
i)NSAIDs:
Thesearethemostfrequentlyuseddrugstotreatgoutbecausethey
aresowelltolerated.
IndomethacinistheagentofchoicebutotherNSAIDsmaybejust
aseffective.Aspirinisusuallyavoidedbecauselowdosesofaspirin
aggravatehyperuricemia.
ii)Colchicinee:
ColchicineiseffectivebutlesswelltoleratedthanNSAIDs
iii)GlucocorticoidsQ:
UsuallyreservedforpatientsinwhomcolchicinesorNSAIDsare
contraindicatedorineffective.
Treatmentofchronicgout(maintainserumuratelevelsat5.0
mg/dlorless)AllopurinolQ:
Xanthineoxidaseinhibitor
Agentofchoiceformostpatientswithgouty'
Uricosuricagents

---

Probenecid2
SulfinpyrazoneQ
Treatmentofgoutaccordingtothestage
Notreatmentindicated,the
causesshouldbe
Asymptomatic determinedandany
hyperuricemia associatedproblemshould
beaddressedrigorously)
Acutegouty
NSAIDsorcolchicinesor
arthritis
glucocorticoid
Intercritical
Prophylacticcolchicines(to
period
reducefurtherattacks)
Acute
Uratelowering
tophoaecous drug
gout
(allopurinolorprobenecid,
sulfinpyrinazole)

---

1278.WhichofthefollowingendocrinetumorsismostcommonlyseeninMEN
I?
a)Insulinoma
b)Gastrinoma
c)Glucagonoma
d)Somatostatmoma
CorrectAnswer-B
Amongsttheoptionsprovided,gastrinomasarethemostcommonenteropancreatictumors
associatedwithMENIwithinsulinomasbeingthesecondmostcommon.
Ref:Harrison'sPrinciplesofInternalMedicine,17thEdition,Page2358&2359;16th/
2232;Davidson'sprinciplesandpracticeofMedicine,20thEdition,Chapter20,Page803

---

1279.Goodsyndromeis
a)Thymomawithimmunodeficiency
b)ThymomawithM.Gravis
c)Thymomawithserumsickness
d)Thymomawithpureredcellaplasia
CorrectAnswer-A
Ans.is'a'i.e.,Thymomawithimmunodeficiency
Good'ssyndrome(thymomawithimmunodeficiency)isararecause
ofcombinedBandTcellimmunodeficiencyinadults.
ClinicalfeaturesofGood'ssyndromeare:-
Increasedsusceptibilitytobacterialinfectionswithencapsulated
organismsandopportunisticviralandfungalinfection.
Themostconsistentimmunologicalabnormalitiesare:-
Hypogammaglobulinaemiaand
ReducedorabsentBcells
Treatment
Resectionofthethymomaandimmunoglobulinreplacementto
maintainadequatethroughIgGvalues

---

1280.AnAdultwithasthmapresentswith
asthmasymptomseverydayandwakes
upinthenightapproximately2to3
daysinaweek.
Hecanbeclassifiedashaving:
a)IntermittentAsthma
b)MildPersistentAsthma
c)ModeratePersistentAsthma
d)SeverePersistentAsthma
CorrectAnswer-C
AnswerisC(ModeratePersistentAsthma):
'GiudelinesforthediagnosisandmanagementofAsthma'Summary
Report2007(N1HPublicationNumber08-5846);Koda-Kimbleand
Young'sAppliedTherapeutics:TheClinicalUseofDrugs
10TH/568,569,570
ModeratePersistentAsthmainanadult(>12years)isdefinedas
Day-TimeSymptomsthatoccurdailyandNight-TimeSymptoms
occurringmorethan1nightperweekbutnoteverynight.

---

1281.InaPatientwithclinicalsignsof
Asthmawhichofthefollowingtestswill
confirmthediagnosis:
a)IncreaseinFEV1/FVC
b)>200mlincreaseinFEVIafterMethacholine
c)DiurnalvariationinPEF>20Percent
d)ReductionofFEVI>20%afterbronchodilators
CorrectAnswer-C
AnswerisC(DiurnalvariationinPEF>20Percent):
DemonstrateOutflowObstruction
DecreasedFEV1
DecreasedPEF
DecreasedFEV1/FVC
Whilerespiratorysymptomssuggestasthma,thesinequanonfor
thediagnosisofasthmaisthepresenceofReversibleAirflow
Obstructionand/orAirwayHyper-responsivenessorIncreasedPeak
ExpiratoryFlow(PEF)Variabilityinsubjectswithoutairways
obstruction.
ReversibleAirflowObstruction
Reversibilityisdemonstratedbyrepeatingspirometryresults15
minutesafteradministeringashortactingbronchodilator
>12%reversibilityinFEV1
>200mlincreaseinBaselineFEV1
PositiveReversibilityResultsStrongly(ConsideredDiagnostic)
IncreasedPeakExpiratoryFlowRate(PEF)Variability
DemonstrationofDiurnalVariationinthePeakExpiratoryFlowRate

---

AdiurnalvariationinPEFofmorethan20percentStronglysuggests
adiagnosisofAsthma(ConsideredDiagnostic)
AirwayHyper-responsiveness
MeasuredbyMethacholineorHistaminechallenge.
IncreasingConcentrationsofMethacholineareadministeredandif
theFEV1dropsto>20percentofbaselinewithanystandarddose
thetestisconsideredpositive.
PositiveteststronglysuggestsadiagnosisofAsthma

---

1282.APatientwithhistoryofshortnessof
breathhasDecreasedFEV1/FVCRatio,
NormalDLCO.A200mlincreasein
baselineFEVIisobserved15minutes
afteradministrationofbronchodilators.
Thelikelydiagnosisis
a)Asthma
b)ChronicBronchitis
c)Emphysema
d)InterstitialLungDisease
CorrectAnswer-A
Ans.is'a'i.e.,Asthma
DiagnosisofAsthmarequire
DemonstrationofAirwaysobstruction
DecreaseintheratioofFEVI/FVC
DemonstrationofacutereversibilityofairflowAdminister2-4puffsof
quickactingbronchodilatore.g.,albuterolandrepreatspirometry10-
15minAnincreaseinFEV1of12%ormoreaccompaniedbyan
absoluteincreaseinFEVlofatleast20ml
Abronchoprovocator(Methacholine)isadministered
hyperresponsivenessoftheairwayisdemonstratedbyreductionof
FEV1to20%

---

1283.PatientdiagnosedwithHIVand
Tuberculosis.HowtostartATTandc-
A.R.T
a)StartATTfirst
b)StartcARTfirst
c)Startbothsimultaneously
d)StartcARTonly
CorrectAnswer-A
Ans.is'a'i.e.,StartATTfirst
InacasewhenHIVandTBarediagnosedtogetherATTshouldbe
startedfirst.
ATTstartedfirst,becauseofIRIS(ImmuneReconstitution
Inflammatorysyndrome).
IfARTstartedfirst,itmayimproveCD4cellsatfirst,butlatera
previouslyacquiredinfection(TB,Herpes),respondswithan
overshelminginflammatoryresponsethatparadoxicallymakesthe
symptomofinfectionworse.
Therefore,startingofATT-2weeksbeforeART,haveshownto
decreasetheincidenceofIRIS.

---

1284.Mostcommoncauseoflungabscess
a)Staphaureus
b)Oralanaerobes
c)Klebsiella
d)Tuberculosis
CorrectAnswer-B
Ans.is'b'i.e.,OralAnaerobes
Mostnonspecificlungabscessesarepresumedtobedueto
anaerobicbacteria.

---

1285.NormalCRPwithelevatedESRseenin
a)RA
b)SLE
c)Scleroderma
d)Polymyalgiarheumatica
CorrectAnswer-B
Ans.is'b'i.e.,SLE
BothESRandCRParemarkersofinflammation
ErythrocytesedimentationrateorESRisusedtoseparate
inflammationfromnon-inflammation.
Anothersignofinflammationistheriseinbloodlevelofnumberof
proteinscalledasacutephaseproteins.
OneoftheproteinsisC-reactiveprotein(CRP).
LikeESRandotheracutephaseproteins,CRPalsogoesupin
inflammation.
Insystemiclupushowevertheleveldoesnotriseunlessthereis
infectionassociated.
Thenormalresponsetoactiveinflammatorydiseaseisanincrease
inplasmaCRPconcentration.oForreasonsthatremainuncleartht
responseiseithersignificantlylowerinmagnitudeorentirelyabsent
inafewinflammatoryconditions.
Thishasprovendiagnosticallyusefulbecausethereareveryfew
inflammatoryconditionsinwhichESRissignificantlyraised
(reflectinganinflammatoryprocess)butplasmaCRPisonlyslightly
raisedorevennormal.
Oneoftheseconditionsissystemiclupuserythematosus(SLEor
lupus),arelativelycommonchronicautoimmunediseasethat
predominantlyaffectswomenofchild-bearingage.

---

Whenthisinflammationoccursinthelupuspatientitisaccompanied
asexpectedbyamarkedincreaseinESR.Howeverincontrstto
mostotherinflammatorycondition,theplasmaCRPremains
resolutelynormal.ThecombinationofraisedESRandnormalCRP
isausefuldiagnosticfeatureofSLE.
OtherdisorderswhereCRPisnotincreased
Osteoarthritis,leukemia,anemia
Polycythemia,viralinfection
Ulcerativecolitis,pregnancy,estrogen

---

1286.Incorrectabouttakayasuarteritis
a)Sparespulmonaryartery
b)Renovascularhypertension
c)Bloodpressuredifferencebetweenleftandrightlimbs
d)Stronglypositivemantoux
CorrectAnswer-A
Answer-A.Sparespulmonaryartery
Takayasuarteritisisgranulomatousvasculitisoflargeandmedium
arteries.Itischaracterizedprincipallybyoculardisturbanceand
markedweakeningofpulsesintheupperextremities->Pulseless
disease.
Itisalsocharacterizedbyastrongpredilectionforaorticarchandits
branches-Aorticarchsyndrome.
Subclavianarteryisinvolvedmostcommonly
Othervesselsinvolvedarecommoncarotid,abdominalaorta,
coeliac,superiormesenteric,renal,vertebral,iliac,pulmonaryand
coronaryarteries.

---

1287.Restrictiveandconstrictivepericarditis
occurstogetherin
a)Radiation
b)Adriamycin
c)Amyloidosis
d)Postcardiotomysyndrome
CorrectAnswer-A
Ans.is'a'i.e.,Radiation
Progressivefibrosiscancauserestrictivemyocardialdiseasewithout
dilation.Thoracicradiation,commonforbreastandlungcanceror
mediastinallymphoma,canproduceearlyorlaterestrictive
cardiomyopathy.Patientswithradiationcardiomyopathymay
presentwithapossiblediagnosisofcontrictivepericarditis,asthe
twoconditionsoftencoexist.

---

1288.Vitaminnotdeficientinceliacdisease
is?
a)VitaminD
b)VitaminB12
c)Folicacid
d)VitaminA
CorrectAnswer-C
FolkacidREF:SheilaCrowe-2010page384,Harrison17thed
chapter288
Vitaminsdeficientinceliacdiseaseare:
1. VitaminA
2. VitaminD
3. VitaminK
4. VitaminB12

---

1289.Skipgranulomatouslesionsareseenin
?
a)Ulcerativecolitis
b)Crohn'sdisease
c)Whipple'sdisease
d)Reiter'sdisease
CorrectAnswer-B
Ans.is'b'i.e.,Crohn'sDisease
FeaturesofCD
Intheaffectedsegment,mesentricfatwrapsaroundthebowel
surface-->creepingfat
oTheintestinalwallisrubberyandthick,asaconsequenceof
edema,inflammation,fibrosis,andhypertrophyofthemuscularis
propria-->lumenisalmostalwaysnarrowed-->stringsignon
bariummeal.
oAclassicfeatureofCDisthesharpdemarcationofdiseased
bowelsegmentsfromadjucentuninvolvedbowel.oWhenmultiple
bowelsegmentsareinvolved,theinterveningbowelisnormal-->
skiplesions.oThereareserpentinelinearulceralongtheaxisof
bowel.
Astheinterveningmucosatendstoberelativelyspared,themucosa
acquiresacoarselytexturedCobblestoneappearance.
oNarrowfissuresdevelopbetweenthefoldsofthemucosa.
Fissurescanpenetratedeeplythroughthebowelwallandleadingto
boweladhesionsandserositis.oFurtherextensionoffissuresleads
tofistulaorsinustractformation.
oThereistransmuralinflammationaffectingalllayersofbowelwall.
Sarcoidlikenoncaseatinggranulomasmaybepresentinalltissue
layers.

---

layers.
oNeutrophilicinfiltrationintothecryptsresultsinformationofcrypt
abscess.
oFibrosisofthesubmucosa,muscularispropria,andmucosa
eventuallyleadstostrictureformation.
ThereisanincreasedincidenceofcancerofGITinpatientswith
long-standingCD,buttheriskofcancerinCDisconsiderablyless
thaninpatientswithchronicUC.

---

1290.Whichofthefollowingisassociated
withhighestriskofAnaphylaxis
a)Irondextran
b)Ironsucrose
c)Ferumoxytol
d)IronGluconate
CorrectAnswer-A
Answer-A.Irondextran
Theriskofanaphylaxisismaximallyassociatedwithhighmolecular
weightdextran(notsowithlowmolecularweightdextran).

---

1291.RaresttypeofVonWillebranddisease:
a)vWDtype1
b)vWDtype2A
c)vWDtype2N
d)vWDtype3
CorrectAnswer-D
Ans.is'd'i.e.,vWDtype3
Condition Defect
Mildtomoderatequantitative
vWD
deficiencyofvWF(ie,about20-
type1
25%ofnormallevels).
Themostcommonqualitative
vWD
abnormalityofvWF,isassociated
type2A withselectivelossoflargeand
medium-sizedmultimers
Lossofonlylargemultimersas
vWD
mutantvWFspontaneouslybinds
type2B toGplbintheabsenceof
subendothelialcontact
Characterizedbyadefectresiding
vWD
withinthepatient'splasmavWF
type2N thatinterfereswithitsabilityto
bindFVIII
Involvesqualitativevariantswith
decreasedplatelet-dependent
vWD
functionnotresultingfrom
type2M absenceofhighmolecularweight
multimers

---

multimers
Asevere,quantitativedeficiency
associatedwithverylittleorno
vWD
detectableplasmaorplatelet
type3
vWF,haveaprofoundbleeding
disorder

---

1292.Apatienthasecchymosisand
petechiaealloverthebodywithno
hepato-splenomegaly.Allaretrue
except
a)Increasedmegakaryocytesinbonenarrow
b)Bleedingintothejoints
c)Decreasedplateletinblood
d)Diseaseresolvesitselfin80%ofPatientsin2-6
CorrectAnswer-B
Ans.is'b'i.e.,Bleedingintothejoints
FeaturesofAcuteandChronicIdiopathicThrombocytopenic
Purpura
Feature
AcuteITP
ChronicITP
Peakageof
Children2-6
Adults,20-40
incidence
year
year
3:1femaleto
Sexpredilection None
male
Antecedent
Common1-2 Unusual
infection
week
Onsetof
BeforeAbrupt Insidious
bleeding
Hemorrhagic
Presentin
Usuallyabsent
bullaeinmouth severecases
Plateletcount
<20000/4
3000-80000/8L
Eosinophiliaand Common
Rare
yphocytosis
Spontaneous
Occursin
Monthsoryears

---

Spontaneous
Occursin
Monthsoryears
remission
80%cases
Uncommon

---

1293.DevelopmentofLymphomainSjogren's
syndromeissuggestedbyallofthe
followingexcept
a)Persistentparotidglandenlargement
b)Cyoglobilinemia
c)Leukopenia
d)HighC4compementlevels
CorrectAnswer-D
Ans.is'd'i.e.,HighC4complementlevels
Lymphoaisawell-knowncomplicationofSjogren'ssyndromeMost
lymphomasareextra-nodal,lowgrademarginalBcelllymphomas.
DevelopmentofLymphomainSjogren'ssyndromeissuggestedby
lowC4complementlevels.
LymphomainSjogren'ssyndrome
ThedevelopmentofLymphomasinpatientswithSjogren
syndromeissuggestedby:-
Persistentparotidglandenlargement
Purpura
Leukopenia
Cryoglobulinemia
LowC4complementlevels

---

1294.Allofthefollowingaretrueabout
Rheumatoidarthritis,except
a)PIPandDIPjointsinvolvedequally
b)Pathologylimitedtoarticularcartilage
c)Womenareaffected3timesmorecommonlythanmen
d)20%ofpatientshaveextraarticularmanifestations
CorrectAnswer-D
Ans.is'd'i.e.,20%ofpatientshaveextraarticularmanifestations
AssociationofRheumatoidArthritiswithHLADR-4
TheclassIImajorhistocompatibilitycomplexalleleHLA-DR4and
relatedallelesareknowntobeamajorgeneticriskfactorfor
Rheumatoidarthritis.
RheumatoidArthritisisstronglyassociatedwithHLADR4
ThegeneticriskforRheumatoidarthritisisassociatedwithallelic
variationintheHLA-DRBI"genei.e.DRB10401,04,05".
SomeoftheHLADRB1allelesbestowahighriskofdisease
Clinicalfeatures:
Itoccursbetweentheageof20to50years.
Womenareaffectedabout3timesmorecommonlythanmen.
Followingpresentationsarecommon:
a)Anacute,symmetricalpolyarthritis:
Painandstiffnessinmultiplejoints(atleastfour)
Symptomsofarticularinflammation.
Commonin-
MPjointsofhand
PIPjointsoffingers
Wrists,knees,elbows,ankles

---

---

1295.ThepathognomonicfindinginmiliaryTBiswhichofthefollowing?
a)Bonemarrowinfiltrations
b)Choroidtubercles
c)MiliarymottlinginchestX-Ray
d)Histologicalfindinginliverbiopsy
CorrectAnswer-B
Eyeexaminationmayrevealchoroidaltubercles,whicharepathognomonicofmiliaryTB,seeninup
to30%ofcases.
Reference:
HarrisonsPrinciplesofInternalMedicine,18thEdition,Page1349

---

1296.InAIDSpatientpresentingwithfever,
coughadiagnosisofpneumocystin
pneumoniaisbestestablishedby
a)CTscanchest
b)Bronchoalveolarlavage
c)Stainingofintra-nuclearinclusionwithsilverstaining
d)Aspirationandculture
CorrectAnswer-B
Ans.is'b'i.e.,Bronchoalveolarlavage
DiagnosisofPCPrequires
Demonstrationoftheorganisminsamplesobtainedfrominduced
sputum.
Bronchoalveolarlavage,transbronchialbiopsy,oropen-lungbiopsy.
Ifthehistologicalexaminationfails:?
uPCRisrequiredtomakethediagnosis

---

1297.Hemodialysiscanbeperformedforlong
periodsfromthesamesitedueto
a)Arteriovenousfistulareducesbacterialcontaminationofsite
b)Arteriovenousfistularesultsinarterializationofvein
c)Arteriovenousfistulareduceschancesofgraftfailure
d)Aretiovenousfistulafacilitatessmallboreneedlesforhighflow
rates
CorrectAnswer-B
Ans.is'b'i.e.,Arteriovenousfistularesultsinarterializationofvein
Thetstu/agraft,orcatheterhemodialvsisisoftenreferredtoas
adialysisaccess.
Anativefistulacreatedbytheanastomosisofanarterytoavein
(e.g.theBresica-Ciminofistula,inwhichthecephalicveinis
anastomosedend-to-sidetotheradialartery)resultsin
arterializationofthevein.
Thisfacilitatesitssubsequentuseintheplacementoflargeneedles
(typically15Gauge)toaccessthecirculation.
Fistulashavethehighestlong-termpatencyrateofalldialysis
accessoptions.
Themostimportantcomplicationofarteriovenousgraftsis
thrombosisofthegraftandgraftfailure,dueprincipallytointimal
hyperplasiaattheanastomosisbetweenthegraftandrecipientvein.
Manypatientsundergoplacementofanarteriovenousgraft(i.e.,the
interpositionofprostheticmaterial,usuallypolytetrafluoroethylene,
betweenanarteryandavein)oratunneleddialysiscatheter.

---

1298.Themostcommonneurological
disorderseeninCRFpatients
a)Dementia
b)Peripheralneuropathy
c)Bakesintestinaldilator.
d)Restlesslegsyndrome
CorrectAnswer-B
Ans.is'b'i.e.,Peripheralneuropathy
Peripheralneuropathyisthemostcommonneurologicalproblemin
CRF,whichmaybe?
i)Uremicperipheralneuropathy(duetouremia).
ii)MoreoftenapresentingfeatureofthecauseofCRFDiabetic
neuropathy(DMisthemostcommoncauseofCRF).

---

1299.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.)

---

1300.InZollingerEllisonsyndromewhatis
raised?
a)Insulin
b)VIP
c)Gastrin
d)Glucagon
CorrectAnswer-C
Ans.is'c'i.e.,Gastrin
ZollingerEllisonsyndrome?
Severepepticulcerdiseasesecondarytogastricacid
hypersecretionduetounregulatedgastrinreleasefromanon13cell
endocrinetumour(gastrinoma),definesthecomponentsofZollinger
Ellisonsyndrome.
PathophysiologyofZollingerEllisonsyndrome
ThedrivingforceresponsibleforclinicalmanifestationsofZollinger
EllisonsyndromeishypergastrinemiaoriginatingfromGastrinoma
(autonomusneoplasm,non[3cellneoplasm)
Gastrinoma
Hypergastrinemia
Hyperacidemia
Pepticulcer,erosiveesophagitisanddiarrhoea
OtherimportantcharacteristicofGastrinoma
oOver80%ofthesetumoursareseeninGastrinomatriangle?
(triangleformedbetweenduodenumandpancreas)mostofthem
areseenintheheadofpancreas.
oAbout2/3'ofthesetumoursaremalignant?.
oAboutonehalfofthesetumoursaremultiple?.

---

oAboutonefourthofthepatientshavemultipleendocrineneoplasia
(MENI)syndromewithtumoursofparathyroid,pituitaryand
pancreaticisletsbeingpresent.
Remember:
Mostcommonsiteofgastrinoma'sis
Duodenum(50-70%),(Pancreas20-40%)
MostcommonhormonetobesecretedACTH
besidesgastrinis
Mostcommonsiteofpepticulcersproducedisls'partof
Duodenum.
MostvaluableprovocativetestinTheSecretin
injectiontests.identifyingpatientswithZESis
Basalacidoutputisgreaterthan60%ofoutpuBAO>MAO
inducedbymaximalstimulation
Thetermpancreaticendocrinetumourismisnomerbecausethese
tumourscanoccureitheralmostexclusivelyinthepancreasorat
bothpancreaticandextrapancreaticsites

---

1301.Menke'sdisease"isadiseaseof
a)Impairedzinctransport
b)Impairedcoppertransport
c)Impairedmagnesiumtransport
d)Impairedmolybdenumtransport
CorrectAnswer-B
Ans.is'b'i.e.,Impairedcoppertransport
Menke'sdiseaseiscausedduetodefectinthecopper
transport.
Thereisdefectinthetransportofcopperpresentintheintestinal
mucosatothebloodstream.
Themucosalliningofintestinecontainshighlevelofcopperbound
tometallothioneinprotein.
Ratherthanbeingtransporatedtobloodstream,thecopper
remainedinthemucosaandwaslostwhenintestinalcellswere
naturallysoughedoff.
Menkesdiseaseiscausedduetodefectinthe"MNK"gene.
Theproteinnormallyfunctionbymovingcopperfromtheintestinal
mucosalcellsintothebloodstream,whereitishoundbyproteins
suchasalbuminandtransportedtoorgansandtissues.
Serumcopperiscriticalforthefunctioningofseveralenzymes
LysyloxidaseItisimportantforthecrosslinkingofcollagenand
elastinsuchthatdeficienciesleadtoproblemsinconnectivetissues
suchasbones
CytochromeoxidaseInvolvedintemperaturemaintenance
TyrosinaseNecessaryforpigmentation
Clinicalfeaturesofmenkesdisease
Growthretardation

---

Coarsehair,brittleandivorywhite(resultofdepigmentations).The
hairfibresaretwiistedandbrokenhelically(kinkyhair).
Seizures
Cerebralandcerebellardegeneration(postmortemanalysis)
Hypothermia
Thrombosis
Poorbonedevelopment
Increasedtendencytowardsaneurysms

---

1302.Anosmiaisearlyclinicalfeatureof
a)Alzheimer
b)Parkinson'sdisease
c)Huntington'schorea
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
Maincausesofanosmia
Maincausesofanosmia
Nasal.
Smoking.
Chronicrhinitis(allergic,atrophic,cocaine,infectious-Herpes,
influenza).
Overuseofnasalvasoconstrictors.
Olfactoryepithelium.
Headinjurywithtearingofolfactory,filaments
Cranialsurgery.
Subarachnoidhemorrhage,meningitis.
Toxic(organicsolvents,certainantibiotics-aminoglycosides,
tetracyclines,corticosteroids,methotrexate,
opiates,1-dopa).
Metabolic(thiaminedeficiency,adrenalandthyroiddeficiency,
cirrhosis,renalfailure,menses).
Wegenergranulomatosis.
Compressiveandinfiltrativelesions(craniopharyngioma,
meningioma,aneurysm,meningoencephalocele).
Degenerativedisease(Parkinson,Alzheimer,Huntington
Temporallobeepilepsy.

---

Malingeringandhysteria

---

1303.Whichofthefollowingistheleast
commonbacteriaresponsibleforAcute
ExacerbationofChronicBronchitis
a)Streptococcuspneumoniae
b)Moraxellacatarrhalis
c)Haemophilusinfluenza
d)Staphylocccusaureus
CorrectAnswer-D
AnswerisD(Staphylocccusaureus):
TheGlobalInitiativeforChronicObstructiveLungDisease(GOLD);
ReportproducedbytheNationalHeart,Lung,andBloodInstitute
(NHLBI)andtheWorldHealthOrganization(WHO)
StaphylococcusAureusisnotacommonbacterialpathogen
responsibleforAcuteExacerbationofChronicBronchitis.
CommonBacterialPathogens(30%-50%)ResponsibleforAcute
ExacerbationsofCOPD
Haemophilusinfluenza
Streptococcuspneumonia
Moraxellacatarrhalis
PseudomonasaeruginosaandEnterobacteriaceaearealso
commonlyisolated,particularlyfrompatientswithsevereCOPD.
AcuteExacerbationofCOPD:BacterialInfections
TheGOLD,theNHLBIandtheWHO,definesexacerbationofCOPD
asacuteincreaseinsymptomsbeyondnormalday-to-dayvariation.
Thisgenerallyincludesoneormoreofthefollowingcardinal
symptoms.
Coughincreasesinfrequencyandseverity

---

Sputumproductionincreasesinvolumeand/orchangescharacter
Dyspneaincreases
Constitutionalsymptoms,decreaseinpulmonaryfunction,and
tachypneaarevariablypresentduringanexacerbation,buttheCXR
isusuallyunchanged.
Inthepresenceofsevereunderlyingairflowobstruction,
exacerbationcancauserespiratoryfailureanddeath.
Itisestimatedthat70to80%ofexacerbationsofCOPDaredueto
respiratoryinfections.
Theremaining20to30%areduetoenvironmentalpollutionorhave
anunknownetiology.Viralandbacterialinfectionscausemost
exacerbations
Bacterialinfectionsappeartotrigger33%to50%ofCOPD
exacerbations.
Non-typeableH.influenzae,M.catarrhalis,andS.pneumoniaeare
thebacteriamostfrequentlyisolatedbronchoscopicallyfrompatients
havinganexacerbationofCOPD
Pseudomonasaeruginosaandothermembersoffamily
Enterobacteriaceaearealsocommonlyisolated,particularlyfrom
patientswithsevereCOPD.
ExacerbationsofCOPDarestronglyassociatedwithacquisitionof
newstrainofH.influenzae,M.catarrhalis,S.pneumoniae,orP.
aeruginosa.
Asaresult,ithasbeenproposedthatacquisitionofnewbacterial
strainplayscentralroleinthepathogenesisofanexacerbation.
TheideathatexacerbationsofCOPDareduetoacquisitionofnew
strainofbacteriahaslargelyreplacedolderhypothesisthat
increasesinconcentrationofcolonizingbacteriaaretheprimary
causeofexacerbations.

---

1304.Pseudo-hemoptysisisseenmostlywith
a)Streptococcus
b)E.coli
c)Serratiamarcescens
d)R.S.V
CorrectAnswer-C
Ans.is'C'i.e.,Serratiamarcesens
Pseudo-hemoptysisisexpectorationofbloodotherthanthe
respiratorytracti.e.GITorblooddrainingfromthelarynx.
Serratiamarcescensisacauseofpseudohemoptysis.

---

1305.Fingerisglovesignisseenin
a)PulmonaryalveolarProteinosis
b)PneumocystisCarinii
c)Tuberculosis
d)Bronchocele
CorrectAnswer-D
Ans.is'd'i.e.,Bronchocele
Rabbitearappearance
Mickeymouseappearance
Toothpasteshapedopacities
Y-shapedopacities
V-shapedopacities
Aetiology
Obstructive
Inbronchialobstruction,theportionofthebronchusdistaltothe
obstructionisdilatedwiththepresenceofmucoussecretions
(mucusplugging).Causesofbronchialobstructioninclude:
Bronchialhamartoma
Bronchiallipoma
Bronchialcarcinoid
Bronchogeniccarcinoma
Congenitalbronchialatresia(rarely)
Nonobstructive
Causesinclude.-
Asthma
Allergicbronchopulmonaryaspergillosis(ABPA)
Cysticfibrosis

---

1306.Whichofthefollowingdisordersis
leastlikelyassociatedwithprogression
tolymphoma
a)Sjogren'ssyndrome
b)Araxiatelangiectasia
c)Severecombinedimmunodeficiency
d)LynchIIsyndrome
CorrectAnswer-C
Ans.is'c'i.e.,Severecombinedimmunodeficiency
Choice
Cancersassociated
NHLmainlyMALT-oma
Sjogren
involvingsalivary
syndrome
glands>stomach
Elevatedincidenceof
cancers,approximately
100-foldincomparison
tothegeneral
population.Inchildren,
morethan85%of
Ataxia
neoplasmcasesare
telengectasia acutelymphocytic
leukemiaorlymphoma.
Inadultswithataxia-
telangiectaisa,solid
tumorsaremore
frequent
Gastrointestinalcancer
associatedwith

---

associatedwith
endometrial/ovarian
Lynch-II
carcinoma.Earlyonset
syndrome
braintumorand
lymphomaalsoseenin
children

---

1307.Womanof30-yearswithRaynaud's
phenomenon,polyarthritis,dysphagia
of5-yearsandmildSclerodactyl,blood
showingAnti-centromereantibody
positive,thelikelycauseis
a)CREST
b)Mixedconnectivetissuedisorder
c)SLE
d)Rheumatoidarthritis
CorrectAnswer-A
Ans.is'a'i.e.,CREST
Thediseaseisdividedintotwocategories:?
1)Diffusescleroderma
.Thereiswide-spreadinvolvementofskinatonset.Thereis
rapidprogressionwithearlyvisceralinvolvement.Itisassociated
withAnti-DNAtopoisomerase(anti-Scl70)antibodies.
2)Limited(localized)scleroderma(morphea)
.Skininvolvementisconfinedtofinges,forearmandface.It
isassociatedwithslowprogressionandlatevisceralinvolvement.
SomepatientsdevelopCRESTsyndrome(Cacinosis,Raynaud's
phenomenon,esophagealdysmotility,
sclerodactyly,andtelangiactasia).Itisassociatedwith
anticentromereantibodies.

---

1308.Allofthefollowingarefeaturesof
Sclerodermaarefollowingexcept
a)Diffuseperiostealreaction
b)Esophagealdysmotility
c)Erosionoftipofphalanges
d)LungNodularinfiltrates
CorrectAnswer-A
Ans.is'a'i.e.,Diffuseperiostealreaction
Skininvolvementinsystemicsclerosis
Skininvolvementisanearlyuniversalfeatureofsystemicsclerosis
(SSc).
Itischaracterizedbyvariableextentandseverityofskin.Thickening
andhardening.
Thefingers,hands,andfacearegenerallytheearliestareasofthe
bodyinvolved.
Edematousswellinganderythemamaypreceedeskininduration.
Otherprominentskinmanifestationsinclude:
Pruritusintheearlystages
Edemaintheearlystages
Sclerodactyly
Digitalulcers
Pittingatthefingertips
Telangiectasia
Calcinosiscutis
Radiographsofthehandsmayreveal
Softtissuecalcifications(calcinosiscutis).
Resorptionofthedistalphalangealtufts(acro-osteolysis).
Lesscommonradiographicfindingsare:

---

Articularerosions
Jointspacenarrowing
Demineralization
Thesymptomsofthefemaleandpresenceofantinuclearantibody
pointstowardsthediagnosisofsystemicsclerosis.Itisacaseof
systemicsclerosisorscleroderma.
Thecluestothediagnosisofsclerodermaare:
Sclerodactyly
Raynaud'sphenomenon
Dysphagia
Presenceofantinuclearantibody
Thoughsystemicsclerosisisamultisystemdisease,thetwomost
distinguishingfeaturesofsystemicsclerosisare:
oStrikingcutaneouschanges
Notableskinthickening.Thisisthemosteasilyrecognized
manifestationofscleroderma.
Raynaud'sphenomenon
Thisisthefirstmanifestationofdiseaseinalmosteverypatients.
Dysphagia
Attributabletoesophagealfibrosisanditsresultanthypomotlityis
presentinmorethan50%ofpatients.
Remember,
WheneverskinthickeningispresentalongwithRaynaud's
phenomenon,itisalmostalwaysacaseofscleroderma".
Thesetwofeaturesarenotpresentinanyothermultisystemdisease
whoseclinicalfeaturesoverlapwiththatofsystemicsclerosise.g.
SLE,rheumatoidarthritis,inflammatorymyopathy,Sjogren
syndrome".
AlthoughskinchangesandRaynaud'sphenomenonarethemajor
diagnosticclues,sclerodermaisamultisystemdiseasethatmost
commonlytargetsperipheralcirculation,muscles,joints,
gastrointestinaltract,lung,heartandkidney.
So,thesymptomsencounteredinearlypresentationofscleroderma
includemusculoskeletaldiscomfort,fatigue,weightloss,andheart
burnanddysphagiaassociatedwithgastroesophagealreflex
disease(GERD).
Whenthesesymptomsareaccompaniedbytheskinthicknessand

---

Raynaudcphenomenon,diagnosisofscleroderma
shouldbeconsidered.
Roleofautoantibodiesinthediagnosisofscleroderma
Autoantibodiesarefoundinnearlyeverypatientwithscleroderma
(sensitivity>95%),buttheyarenotspecificforscleroderma0.
Sclerodermaisassociatedwithwidearrayofautoantibodies.
TwoANA'Swhicharemoreorlessuniquetosclerodermaare:
Seeninpatientswith
Antitopoisomerase diffusesystemic
antibody(20-40%) sclerosis
Patientswiththis
autoantibodyaremore
likelytohavepulmonary
.fibrosisandperipheral
vasculardisease
Patientswiththese
autoantibodieshave
poorprognosis
Theseautoantibodies
Anticentromere
areseeninpatientswith
antibody(20-40%)
limitedsystemic
sclerosis

---

1309.Whichofthefollowingisnotasignof
uppermotorneuronparalysis
a)Babinskisign
b)Spasticparalysis
c)DenervationpotentialinEMG
d)Exaggerationoftendonreflexes
CorrectAnswer-C
Ans.is'c'i.e.,DenervationpotentialinEMG
Differencebetweenupperandlowermotorneuronparalysis

Uppermotor
Lowermotorneuron
neuron
paralysis
paralysis
Muscles
affectedin
Individualmusclesmay
groupsnever
beaffected
individual
muscles
oAtrophy
Atrophypronouncedup
slightanddue to70%ofthetotalbulk
todisuse
Spasticitywith FlaccidityandhypotoniaQ
hyperactivityof ofaffectedmuscleswith
thetendon
lossoftendonreflexes
reflexesand
Extensor
Plantarreflexifpresentis
plantarreflex
ofnormalflexortype
(Babinskisign)

---

(Babinskisign)
Fascicular
Fasciculationmaybe
twitches
present
absent
Normalnerve
Abnormalnerve
conduction
conductionstudies;
studies;no
denervationpotential
denervation
(fibrillations,
potentialsin
fasciculationspositive
E.M.G.
sharpwaves)inEMG

---

1310. Involvementofpyramidaltractleadsto
allofthefollowingexcept
a)Spasticity
b)Fasciculation
c)Hyper-reflexia
d)PositiveBabinskisign
CorrectAnswer-B
AnswerisB(Fasciculation):
FasciculationsareafeatureofLowerMotorNeuronLesions.
InvolvementofPyramidaltractindicatesanUpperMotorNeuron
Lesion.HypertoniawithSpasticity,Hyper-reflexiaandaPositive
BabinskiSignwithanExtensorPlanterresponseareallfeaturesof
anuppermotorneuronlesion(PyramidalTractLesion).

---

1311.Mostcommonoralinfectionindiabetes
mellitus
a)Candida
b)Aspergillus
c)Streptococcus
d)Stphylococcus
CorrectAnswer-A
Ans.is'a'i.e.,Candida
IndividualswithDMhaveagreaterfrequencyandseverityofthe
infection.Thereasonsforthisincludeincompletelydefined
abnormalitiesincell-mediatedimmunityandphagocytefunction
associatedwithhyperglycemia,aswellasdiminished
vascularization.Hyperglycemiaaidsthecolonizationandgrowthofa
varietyoforganisms(candidaandotherfungalspecies).

---

1312.Doughyskinandwoodyindurationof
tongueisseenin
a)Hypernatremia
b)Hyponatremia
c)Hypokalemia
d)Hyperkalemia
CorrectAnswer-A
Ans.is'a'i.e.,Hypernatremia
Becauseofintracellularwaterloss(hypernatremicdehydration),the
pinchedabdominalskinofahypernatremicdehydratedpatienthasa
"doughy"feelandthereisdrywoodytongue.

---

1313.Allarefeaturesofhypernatremiaexcept
a)Convulsions
b)Elevatedintracranialtension
c)Periodicparalysis
d)Doughyskin
CorrectAnswer-C
Ans.is'c'i.e.,Periodicparalysis
Periodicparalysis,isseeninhyponatermia
ClinicalfeaturesofHypernatremia:?
Mostpatientswithhypernatremiaaredehydratedandhavethe
typicalsignsandsymptomsofdehydration.
Hypernatremiaevenwithoutdehydrationcausescentralnervous
systemsymptomsthattendtoparallelthedegreeofsodium
elevationandtheacuityoftheincrease.
Patientsareirritable,restlessweakandlethargic
Somehavehighpitchedcryandhyperpnea.
Alertpatientareverythirsty.
Hypernatremiacausesfeveralthoughmanypatientshave
underlyingprocessthatcontributestothefever
Exceptfordehydration,thereisnocleardirecteffectof
hypernatremiaonotherorgansortissuesexceptthebrain.
Complicationofhypernatremia:?
Brainhemorrhageisthemostdevastatingconsequenceof
hypernatremia.Astheextracellularosmolarityincreaseswater
movesoutofbraincells,resultingindecreaseinbrainvolume.This
canresultintearingofintracerebralveinsandbridgingvesselsas
thebrainmovesawayfromtheskullandthemeninges.Patientmay
havesubarachnoid,subduralandparenchymalhemorrhage.

---

Seizureandcomaarepossiblesequaleofthehemorrhageeven
thoughseizuresaremorecommonduringt/t.
Thromboticcomplicationsarecommoninseverehypernatremic
dehydrationandincludestroke,duralsinusthrombosis,peripheral
thrombosisandrenalveinthrombosis.
Theintracranialtensioncanbeincreasedduetohemorrhage

---

1314.WhichofthefollowingisMOST
commonlyaffectedbyCrohn'sDisease
a)Cecum
b)Rectum
c)Sigmoidcolon
d)TerminalIleum
CorrectAnswer-D
Ans.is'd'i.e.,Terminalileum
InflammatoryBoweldiseasesiteofinvolvement
Ulcerative
Crohn's
cocitis
Anypartofthe
Limitedtothe
Goutfrommouth colon
toanus
Involvesthe
Mostcommonly
entirecolon
affectedissmall
startingfromthe
intestine
rectum
particularlyileum (retrograde
manner)
Rectumismost
Terminalileitisor commonly
affected
Ileumnot
involvedmayget
Granulomatous
involvedmayget
colitis
involvedinsome
cases

---

cases
(backwashileitis).
Rectumspared
Fullthicknessof
theintestine
involvedbutin
patchymanner
skiplesions

---

1315.VitaminBlevelinchronicmyeloid
leukemiais
a)Elevated'
b)Decreased
c)Normal
d)Markedly
CorrectAnswer-A
Ans.is'a'i.e.,Elevated
CMLtherewillberisein
B1,level
LDHlevel
AnddecreasedlevelsofALP.

---

1316.Whichisthemostcommonorgan
involvedinsarcoidosis
a)Lung
b)Liver
c)CNS
d)Eye
CorrectAnswer-A
Ans.is'a'i.e.,Lung
Followingorgansarecommonlyaffected:?
1)Lungandlymphnodes(95%)
2)Skin(24%-43%)
3)Eye(12-29%

---

1317.Followingstatementsaboutsarcoidosis
isfalse
a)Elevatedlevelofangiotensinconvertingenzyme(ACE)
b)Bilateralparotidenlargementistherule
c)Pleuraleffusioniscommon
d)Facialnervepalsymaybeseen
CorrectAnswer-C
Ans.is'c'i.e.,Pleuraleffusioniscommon
DiffuseEffusionisanuncommonatypicalmanifestationin
Sarcoidosisreportedinupto5%ofpatients.
Parotidenlargementisaclassicfeatureofsarcoidosisandbilateral
involvementistherule
Neurologicaldiseaseisreportedin5-10%ofpatientswith
sarcoidosis
Facialnervepalsyisthesinglemostcommonneurological
manifestationofsarcoidosisseeninupto50%ofpatientswith
Neurosarcoidosis.
Angiotensinconvertingenzyme(ACE)levelsareraisedin
sarcoidosis
Lunginvolvementinsarcoidosis
Mostcommoninvolvedorgan(90%).
CharacterizedbyB/Lhilaradenopathy.
Cavitationsarerare
Pleuraleffusionarerare(1-2%)

---

1318.Followingstatementsaboutsarcoidosis
isfalse
a)Thefirstmanifestationofthediseaseisanaccumulationof
mononuclearinflammatorycells,mostlyCD8+THI
lymphocytesinaffectedorgans
b)TheHeerfordt-Waldenstromsyndromedescribesindividuals
withfever,parotidenlargement,anterioruveitis,andfacial
nervepalsy
c)Elevatedlevelofangiotensinconvertingenzyme(ACE)area
feature
d)Bilateralparotidinvolmentistherule
CorrectAnswer-A
Ans.is'a'i.e.,Thefirstmanifestationofthediseaseisan
accumulationofmononuclearinflammatorycells,mostlyCD8+THI
lymphocytesinaffectedorgans

---

1319.Themostcommoncauseofseizuresin
apatientofAIDSis
a)Toxoplasmosis
b)Cryptococcalmeningitis
c)Progressivemultifocalleucoencephalopathy
d)CNSlymphoma
CorrectAnswer-A
Ans.is'a'i.e.,Toxoplasmosis
NeurologicalmanifestationsofH.I.V.
AIDSdementiacomplex(HIVencephalopathy)isaresultofdirect
effectsofHIVonCNS(notanopportunisticdisease).Itissubcortical
dementia.
Mostcommoncauseofseizures-->Toxoplasma
Mostcommoncauseofmeningitis-->Cryptococcus
M.C.causeoffocalneurologicaldeficit-->Toxoplasma
ToxoplasmosisisthemostcommonCNSinfectioninAIDS.
CNSlymphomaandprograssivemultifocalleukoencephalopathy
mayoccur.

---

1320.Generesponsibleforresistanceto
rifampicin
a)RpoBgene
b)KatGgene
c)RpmBgene
d)EmbBgene
CorrectAnswer-A
Ans.is'a'i.e.,RpoBgene
Gene
ATTDrug
responsiblefor
drugresistance
inhAandKatG
INH
gene
Ethambutol
embBgene
Rifampicin
rpoBgene
Pyrazinamide pncAgene

---

1321.Bechterewsdiseasealsoknownas
a)Rheumatoidarthritis
b)Ankylosingspondylitis
c)Osteoarthritis
d)Syphiliticarthritis
CorrectAnswer-B
Ans.is'b'i.e.,Ankylosingspondylitis
ANKYLOSINGSPONDYLITIS(MARIE-STRUMPELLDISEASE)
Ankylosingspondylitisisachronicprogressiveinflammatorydisease
ofthesacroiliacjointsandtheaxialskeleton.
Prototypeofseronegative(absenceofrheumatoidfactor)
spondyloarthropathies.
Inflammatorydisorderofunknowncause.
Usuallybeginsinthesecondorthirddecadewithamedianageof
23,in5%symptomsbeginafter40.oMaletofemaleratiois2-3:1
StrongcorrelationwithHLA-B27
90-95%ofcasesarepositiveforHLAB27.
Jointsinvolvedinankvlosingspondylitis
Ankylosingspondylitisprimarilyaffectsaxialskeleton.
Thediseaseusuallybeginsinthesacro-iliacjointsandusually
extendsupwardstoinvolvethelumbar,thoracic,andoftencervical
spine.
Intheworstcasesthehipsorshouldersarealsoaffected.Hipjoint
isthemostcommonlyaffectedperipheraljoint.oRarelyknee
(Ebenzar4thie593)andankle(Apley's9th/e67)arealsoinvolved.
Clinicalfeatures
Lowbackpainofinsidiousonset
Durationusuallylessthan3months

---

Significantmorningstiffnessandimprovementwithexerciseo
Limitedchestexpansion
Diffusetendernessoverthespineandsacroiliacjoints
Lossoflumbarlordosis,increasedthoracickyphosis
Decreasedspinalmovements(especiallyextension)inalldirections.
Radiologicalfeaturesofankvlosingspondvlitis
Radiographicevidenceofsacroiliacjointisthemostconsistent
findinginankylosingspondylitisandiscrucialfordiagnosis.The
findingsare:?
SclerosisofthearticulatingsurfacesofSIjoints
Wideningofthesacroiliacjointspace
Bonyankylosisofthesacroiliacjoints
Calcificationofthesacroiliacligamentandsacro-tuberousligaments
Evidenceofenthesopathy-calcificationattheattachmentofthe
muscles,tendonsandligaments,particularlyaroundthepelvisand
aroundtheheel.
oX-rayoflumbarspinemayshow:-
Squaringofvertebrae:Thenormalanteriorconcavityofthe
vertebralbodyislostbecauseofcalcificationoftheanterior
longitudinalligament.
Lossofthelumbarlordosis
Bridging`osteophytes'(syndesmophytes)
Bamboospineappearance

---

1322.Thetreatmentoptionsforpatientswith
RRMS(relapsing-remittingmultiple
sclerosis)areallexcept
a)IFN-1b
b)IFN-1a
c)Glatirameracetate
d)TNF-a
CorrectAnswer-D
Ans.is'd'i.e.,TNF-a
TreatmentofRRMSisdividedinto:-
i)Inacuteattack:Corticosteroidsaregiven
ii)Prophylaxisofacuteattack(relapse)duringremission:Disease
modifyingagentsforMSareusedtoreducethebiologicalactivity.
TreatmentisstartedbyIFN-PlaorIFN-[31borGlatirameror
fingalimod.Ifthereispoorresponseorintolerancetothesedrugs,
Natalizumabisstarted.

---

1323.DOCforTourettesyndrome
a)Haloperidol
b)Valproate
c)Bcomplex
d)Clonidine
CorrectAnswer-D
Ans.is'd'i.e.,Clonidine
EarlierHaloperidolwasconsideredasDOCforTourettesyndrome.
ClonidineisconsideredasDOCforTourettesyndrome

---

Treatment
There'snocureforTourettesyndrome.Treatmentisaimedat
controllingticsthatinterferewitheverydayactivitiesandfunctioning.
Whenticsaren'tsevere,treatmentmightnotbenecessary.
Medication
Medicationsthatblockorlessendopamine.Fluphenazine,
haloperidol(Haldol),risperidone(Risperdal)andpimozide(Orap)
canhelpcontroltics.
Botulinum(Botox)injections
Centraladrenergicinhibitors.Medicationssuchasclonidine
(Catapres,Kapvay)andguanfacine(Intuniv)--typicallyprescribed
forhighbloodpressure--mighthelpcontrolbehavioralsymptoms
suchasimpulsecontrolproblemsandrageattacks.
Antidepressants.Fluoxetine(Prozac,Sarafem,others)
Antiseizuremedications.
Therapy
Behaviortherapy.CognitiveBehavioralInterventionsforTics,
includinghabit-reversaltraining,canhelpyoumonitortics,identify
premonitoryurgesandlearntovoluntarilymoveinawaythat's
incompatiblewiththetic.
Psychotherapy.InadditiontohelpingyoucopewithTourette
syndrome,psychotherapycanhelpwithaccompanyingproblems,
suchasADHD,obsessions,depressionoranxiety.
Deepbrainstimulation(DBS).Forsevereticsthatdon'trespondto
othertreatment,DBSmighthelp.DBSinvolvesimplantingabattery-
operatedmedicaldeviceinthebraintodeliverelectricalstimulation
totargetedareasthatcontrolmovement.

---

1324.SSPEisnotdiagnosedby
a)EEG
b)AntibodiestomeaslesinCSF
c)Antibodiestomeaslesinblood
d)Antigeninbrainbiopsy
CorrectAnswer-C
Ans.is'c'i.e.,Antibodiestomeaslesinblood[Ref.Nelsonl8n/e
chapter2431]
ThediagnosisofSSPEcanbeestablisheilthrougltdocumentationof
acompatibleclinicalcourseandatleastIofthefollowing
supportingfindings.
MeaslesantibodydetectedinCSF.
Characteristicelectroencephalographicfindings.
Typicalhistologicfndingsand/orisolationofviursorviralantigenin
braintissueobtainedbybiopsyorpost-mortemexamination.
CSFanalysisrevealsnormalcellsbutelevatedIgGandIgM
antibodytitersindilutionsof>1.8.Electroencephaloraphicpatterns
arenormalinstagel,butinthemyclonicphasesuppression-burst
episodesareseenthatarecharacteristicofbutnot
pathognomicfor,SSPE.Brainbiopsyisnolongerroutinelyindicated
fordiagnosiso/SSPE.

---

1325.BronchiectasisSiccaisseenwith
a)Tuberculosis
b)Pertussis
c)Cysticfibrosis
d)Kartagenersyndrome
CorrectAnswer-A
Ans.is'a'i.e.,Tuberculosis
BronchiectasisSiccaorDryBronchiectasisistypically
associatedwithTuberculosis.
Tuberculosisisassocitedwithatypeofdrybronchiectasiscalled
BronchiectasisSicca,whichispredominantlyseeninupperlobes.
DryBronchiectasis(BronchiectasisSicca)istypicallycharacterized
byabsenceofcopiousamountofsputumwhichisusuallyahall
markofbronchiectasis.
Drycoughassociatedwithhemoptysisisthetypicalpresentation
Endobronchialtuberculosiscommonlyleadstobronchiectasis,either
frombronchialstenosisorsecondarytractionfromfibrosis.Traction
bronchiectasischaracteristicallyaffectsperipheralbronchi(which
lackcartilagesupport)inareasofend-stagefibrosis

---

1326.Brock'sSyndromeis
a)BronchiectasisSicca
b)MiddleLabeBronchiectasis
c)Kartagener'sSyndrome
d)Sarcoidosis
CorrectAnswer-B
Ans.is'b'i.e.,MiddleLobeBronchiectasis
Brock'sSyndrome
Rightmiddlelobebronchiectasisoccurringasalatesequelofprimaiy
tuberculosisisknownasBrock'ssyndromeormiddlelobe
syndrome.
Brock'ssyndromeisbelievedtobecausedbypressureoflymph
nodesinprimarytuberculosisonthemiddlelobebronchus.
Ithasbeendescribedasatypicaloutcomeofhilarnodeinvolvement
bytuberculosisinchildhood.
Thistermisalsoappliedtorecurrentatelectasisoftherightmiddle
lobeintheabsenceofendobronchialobstruction.
Bronchiectasisdevelopsafterrecurrentepisodesofatelectasisand
fibrosis

---

1327.Upperlobebronchiectasisisseenin
whichdisease?
a)Cysticfibrosis
b)Aspergilloma
c)HIV
d)Bronchogeniccarcinoma
CorrectAnswer-A
Answer-A.Cysticfibrosis
Upperlobebronchiectasis-
Cysticfibrosis
Tuberculosis
Nontuberculousmycobacterialinfections

---

1328.BilateralPainlessparotidenlargement
isseeninallexcept
a)Mumps
b)Alcoholics
c)Sarcoidosis
d)Diabetesmellitus
CorrectAnswer-A
Ans.is'a'i.e.,Mumps
Bilateralparotidenlargementisseenin
Viral
Metaboliccauses
Endocrinal Sarcoidosis
infectionQ
Mumps
Diabetesmcuitus
Gonadal
Amyloidosis
Sjogren's
Influenza Hyperlipoproteinemia hypofunction syndrome
Epstein
Chronicpancreatitis Acromegaly
barrvirus
Coxackie Hepaticcirrhosis
virusA
CMV
HIV

---

1329.Therapeutichypothermiaisofbenefitin
preventingneurologicalcomplications
in
a)Sepsis
b)Poly-trauma
c)Cardiacarrest
d)lschemicstroke
CorrectAnswer-C
Ans.is'c'i.e.,Cardiacarrest
Inducingmildtherapeutichypothermiainselectedpatientssurviving
out-of-hospitalsuddencardiacarrestcan
significantlyimproveratesoflong-termneurologicallyintactsurvival
andmayprovetobeoneoftheimportant
clinicaladvancementsinthescienceofresuscitation.
Thetypesofmedicaleventsthathypothermictherapiesmay
effectivelytreatfallintofourprimarycategories:
Cardiacarrest
Ischemicstroke
Trumaticbrainorspinalcordinjurywithoutfever.
Neurogenicfeverfollowingbraintrauma

---

1330.DistributionofweaknessinPyrimidal
tractlesions?
a)Extensorsmorethanflexorsinlowerlimb
b)Flexorsmorethanextensorsinupperlimb
c)Antigravitymusclesareaffected
d)Antigravitymusclesarespared
CorrectAnswer-D
Ans.is'd'i.e.,Antigravitymusclesarespared
ThefollowingclinicalfeaturescharacterizeaUMNlesion:
Increasedtone(spasticitv)
Initially,UMNweaknessmaybeflaccid,withabsentordiminished
deeptendonreflexes.Thereislittleunderstandingofthereasons
behindthisinitialflaccidityanditisoftenreferredtoas'shock'.
IncreasedtoneofaUMNtypeiscalledspasticity.Itmaydevelop
severalhours,daysorevenweeksaftertheinitiallesionhas
occurred.Spasticityismanifestedby:
Spasticcatch':
Mildspasticitymaybedetectedasaresistancetopassive
movementor'catch'inthepronatorsonpassivesupinationofthe
forearmandintheflexorsofthehand/forearmonextensionofthe
wrist/elbow.
The'clasp-knife'phenomenon:
Inmoreseverelesions,followingstrongresistancetopassiveflexion
ofthekneeorextensionoftheelbow,thereisasuddenrelaxationof
theextensormusclesofthelegandflexormusclesinthearm.
Clonus:
Rhythmicinvoluntarymuscularcontractionsfollowanabruptly
appliedandsustainedstretchstimulus,e.g.attheanklefollowing

---

suddenpassivedorsiflexionofthefoot.
`Pyramidal-pattern'weakness
Theantigravitymusclesarepreferentiallysparedandstronger
Theflexorsoftheupperlimbsandtheextensorsofthelowerlimbs.
Thepatientcandevelopacharacteristicpostureofflexedand
pronatedarmswithclenchedfingers,andextendedandadducted
legswithplantarflexionofthefeet.
Inupperextremiteis
Relativesparingoftheflexors
Moreinvolvementoftheextensor
Inlowerextremities
Predominantinvovlementoftheflexorswith
Relativesparingoftheextensoror
Absenceofmusclewastingandfasciculations
FocalmusclewastingandjasciculationsarefeaturesofanLMN
lesion.Withchronicdisuse,somelossofmusclebulkcanoccur
afteraUMNlesion,butthisisrarelysevereorfocal.
Brisktendonreflexesandextensorplantarresponses
Thetendonreflexesarebrisk.Thecremastericandabdominalor
'cutaneous'reflexesaredepressedorabsent.Theplantarresponses
areextensor(upgoingtoes'or'positive'babinskisign).
Anti-gravitymusclesaretypicallysparedinpyramidaltractlesions.
Weakness,inpyramidaltractlesionsisoftentermedas'pyramidal'
indistributionaffectingextensorsmorethanflexorsintheupper
limb,andflexorsmorethanextensorsinthelowerlimb(Anti-gravity
musclesarespared).
PyramidalweaknessLossofpowermostmarkedinthe
extensorsmusclesinthearmsandflexorsinthelegs
ProximalweaknessShoulders,hips,trunks,neckand
sometimesface.Associatedwithmyopathy.
DistalweaknessAffectshandsandfeets.Associated
withperipheralmotorneuropathy.
GlobalweaknessGeneralizedweaknessinlimbs
whichmayresultfromseverepathologies.

---

1331.Aldosereductaseinhibitordrugsare
usefulin
a)Cataract
b)Diabetesmellitus
c)Hereditaryfructoseintolerance
d)Essentialfructosuria
CorrectAnswer-B
Ans.is'b'i.e.,Diabetesmellitus
AldosereductasecatalyzestheNADPH-dependentconversionof
glucosetosorbitol,thefirststepinpolyolpathwayofglucose
metabolism.
Aldosereductaseinhibitorsareaclassofdrugsbeingstudiedasa
waytopreventeyeandnervedamageinpeoplewithdiabetes
mellitus.
Examplesofaldosereductaseinhibitorsinclude:
Tolrestat(withdrawnfrommarket)
Apalrestat
Ranirestat
Fidarestat

---

1332.Mostcommoncauseofhypernatremia
a)Adipsicdiabetesinsipidus
b)Carcinoidsyndrome
c)Renallosses
d)Sweating
CorrectAnswer-C
Ans.is`c'i.e.,Renallosses
Majorcausesofhypernatremia
Unreplacedwaterloss(whichrequiresanimpairmentineither
thirstoraccesstowater)
Insensibleandsweatlosses
Gastrointestinallosses
CentralornephrogenicdiabetesinsipidusoOsmoticdiuresis
Glucoseinuncontrolleddiabetesmellitus
Ureainhigh-proteintubefeedings
Mannitol
Hypothalamiclesionsimpairingthirstorosmoreceptorfunction
Primaryhypodipsia
Resetosmostatinmineralocorticoidexcess
Waterlossintocells
Severeexerciseorseizures
Sodioutnoverload
Intakeoradministrationofhypertonicsodiumsolutions

---

1333.Notacauseofhypernatremia
a)Adipsicdiabetesinsipidus
b)Decreasedinsensiblelosses
c)Nephrogenicdiabetesinsipidus
d)Carcinoidsyndrome
CorrectAnswer-B
Ans.is'b'i.e.,Decreasedinsensiblelosses
Majorcausesofhypernatremia
Unreplacedwaterloss(whichrequiresanimpairmentineitherthirst
oraccesstowater)
Insensibleandsweatlosses
Gastrointestinallosses
Centralornephrogenicdiabetesinsipidus
Osmoticdiuresis
Glucoseinuncontrolleddiabetesmellitus
Ureainhigh-proteintubefeedings
Mannitol
Hypothalamiclesionsimpairingthirstorosmoreceptorfunction
Primaryhypodipsia
Resetosmostatinmineralocorticoidexcess
Waterlossintocells
Severeexerciseorseizures
Sodioumoverload
Intakeoradministrationofhypertonicsodiumsolutions

---

1334.Hyponatremiaisseenin
a)Hyperthyroidism
b)Hypothyroidism
c)Diabetesinsipidus
d)Increasedinsensiblelosses
CorrectAnswer-B
Ans.is'b'i.e.,Hypothyroidism[RefHarrison's18th
Hypothyroidismischaracterisedbylowcardiacoutputleadingto
increasedAVPproductionandresultanthyponatremia.
Addisondiseasemustberuledoutinchroniccasesofhyponatremia
Majorcausesofhyponatremia
DisordersinwhichADHlevelsareelevated
Effectivecirculatingvolumedepletion
Truevolumedepletion
Heartfailure
Cirrhosis
Thiazidediuretics
SyndromeofinappropriateADHsecretion,includingresetosmostat
pattern
Hormonalchanges
Adrenalinsufficiency
Hypothyroidism
Pregnancy
DisordersinwhichADHlevelsmaybeappropriately
suppressed
Advancedrenalfailure
Primarypolydipsia
Beerdrinker'spotomama

---

Hyponatremiawithnormalorelevatedplasmaosmolality
Highplasmaosmolality(effectiveosmols)
Hyperglycemia
Mannitol
Highplasmaosmolality(ineffectiveosmols)
Renalfailure
Alcoholintoxicationwithanelevatedserumalcohloconcentration
Normalplasmaosmolality
Psedohyponatremia(laboratoryartifact)
Hightriglycerides
Chloestaticandobstructivejaundice(lipoproteinx)
Multiplemyeloma
Absorptionofirrigantsolutions
GlycineSorbitolMannitol

---

1335.Backwashileitisisseenin
a)Ulcerativecolitis
b)Crohn'sdisease
c)Coloniccarcinoma
d)healpolyp
CorrectAnswer-A
Ans.is'a'i.e.,Ulcerativecolitis
Ulcerativecolitisalwaysinvolvestherectumandextendsproximally
incontinuousfashiontoinvolvepartorallpartofthecolon.
Involvementofterminalileuminulcerativecolitisiscalledbackwash
ileitis

---

1336.Whatistrueaboutulcerativecolitis?
a)Involvesrectumandthenwholecolonbackwards
b)Involvesonlycolon
c)Skiplesionsseen
d)Ileumnotinvolved
CorrectAnswer-A
Ans.is-A.Involvesrectumandthenwholecolonbackwards
Ulcerativecolitis(UC)isalong-termconditionthatresults
ininflammationandulcersofthecolonandrectum.

---

1337.Whichofthefollowingisgiventotreat
thrombocytopeniasecondarytoanti-
cancertherapyandisknownto
stimulateprogenitormegakaryocytes
a)Filgrastim
b)Oprelvekin
c)Erythropoietin
d)Anagrelide
CorrectAnswer-B
Ans.is'b'i.e.,Oprelvekin
Oprelvekin(IL-11)isusedtopreventandtreatthrombocytopenia.
[RefHarrison's18thchapter85andKatzung11th580-581]

---

1338.Lambda-Pandasignistypicallyseen
in
a)Sarcoidosis
b)Tuberculosis
c)Histoplasmosis
d)Leishmaniasis
CorrectAnswer-A
Ans.is'a'i.e.,Sarcoidosis
LambdasignandPandasignonGalliumscanaretypically
describedforsarcoidosis.
Activepulmonaryand/ormediastinalsarcoidosisisgalliumavidand
apositivegalliumscancansupportthediagnosisofsarcoidosis.
Typicalpatternsofuptakehavebeendescribedas'panda'and
'lambda'signs.
LambdasignFormedfromincreaseduptakeinbilateralhilar
andrightparatrachealnodes
PandasignFormedfromincreaseduptakeintheparotids
andlacrimalglands
ALambdasignincombinationwithaso-calledPandasign(Lambda-
PandaSign)isahighlyspecificpatternforsarcoidosis.
Thedegreeofuptaketypicallydependsontheactivityofdisease
andgalliumscanispositiveonlyinthesettingofactiveparenchymal
diseaseandnegativeinremission

---

1339.Allareindicationsforstopping
effendingATTdrugpermanentlyexcept
a)Gout
b)Autoimmunethrombocytopenia
c)Opticneuritis
d)Hepatitis
CorrectAnswer-D
Ans.is'd'i.e.,Hepatitis
Forpatientswithsymptomatichepatitisandthosewithmarked(five
tosixfold)elevationsinserumlevelsofaspartateaminotransferase,
treatmentshouldbeimmediatelystoppedanddrugsreintroduced
oneatatimeafterliverfunctionhasreturnedtonormal.
IndicationsforstoppingtheA.T.T.permanently
Hyperuricemiaandarthralgia
Opticneuritis
Autoimmunethrombocytopenia

---

1340.Interferongammareleaseassay
measuresIFNreleaseagainstwhichM.
TBantigen
a)ESAT-6
b)ESAT-7
c)CF-11
d)CF-12
CorrectAnswer-A
Ans.is'a'i.e.,ESAT-6
3Interferon-gammareleaseassays(IGRAs)arediagnostictools
forlatenttuberculosisinfection(LTBI).
TheyaresurrogatemarkersofMycobacteriumtuberculosisinfection
andindicateacellularimmuneresponsetoM.tuberculosis.
aIGRAscannotdistinguishbetweenlatentinfectionandactive
tuberculosis(TB)diseaseandshouldnotbeusedfordiagnosisof
activeTB,whichisamicrobiologicaldiagnosis.ApositiveIGRA
resultmaynotnecessarilyindicateactiveTB,andanegativeIGRA
resultmaynotruleoutactiveTB.
3BecauseIGRAsarenotaffectedbyBacilleCalmette-Guerin
(BCG)vaccinationstatus,IGRAsareusefulforevaluationofLTBIin
BCG-vaccinatedindividuals,particularlyinsettingswhereBCG
vaccinationisadministeredafterinfancyormultiple(booster)BCG
vaccinationsaregiven.
Assayantigens
M.tuberculosis-specificantigensinclude:-
Earlysecretedantigenictarget6(ESAT-6)and
Culturefiltrateprotein10(CFP-10).

---

Theseareencodedbygeneslocatedwithintheregionofdifference
1(RD1)segmentoftheM.tuberculosisgenome.
TheyaremorespecificforM.tuberculosisthanpurifiedprotein
derivative(PPD)becausetheyarenotsharedwithanyBCGvaccine
strainsormostspeciesofNTMotherthanMmarinum,M.kansasii,
Mszulgai,andM.flavescens.
Typesofassays
TwoIGRAsareavailableinmanycountries:-
TheQuantiFERON-TBGoldIn-Tube(QFT-GIT)assay,whichhas
replacedthesecond-generationQuantiferonTBGold(QFT-G)
assay,andtheT-SPOTTBassay.
TheQFT-GITassayisanenzyme-linkedimmunosorbentassay
(ELISA)-based,whole-bloodtestthatusespeptidesfromthreeTB
antigensi.e.,
CFP-10,and
TB7.7)inanin-tubeformat
Theresultisreportedasquantificationofinterferon(IFN)-gammain
internationalunits(IU)permL.
Anewerassay,theQuantiFERON-TBGoldPlus(QFT-Plus),
becameavailablein2015.
ThistestisavailableinEuropebutnotinNorthAmerica.TheQFT-
PlusassayhastwoTBantigentubes,unliketheQFTassay(which
hasasingleTBantigentube).
Sensitivityandspecificity
IGRAshavespecificity>95percentfordiagnosisoflatentTB
infection.ThesensitivityforT-SPOTTBappearstobehigherthanfor
QFT-GITorTST(approximately90,80,and80percent,
respectively)[2].ThehighersensitivityofT-SPOTTBmaybeuseful
forevaluatingindividualswithimmunosuppressiveconditions.
TSTspecificityishighinpopulationsnotvaccinatedwithBCG(97
percent).AmongpopulationswhereBCGisadministered,itismuch
loweralthoughvariable(approximately60percent).

---

1341.Muehrckelinesinnailsareseenin
a)Nephroticsyndrome
b)Barrtersyndrome
c)Nailpatellasyndrome
d)Acutetubularnecrosis
CorrectAnswer-A
Ans.is'a'i.e.,Nephroticsyndrome
Muehrcke'slinesarecharacteristicofhypoalbuminemia.Nephrotic
syndromecauseshypoalbunemia.

---

1342.Herpessimplexinfectioncanleadto?
a)Frontallobeinfarction
b)Parietallobeinfarction
c)Temporallobeinfarction
d)Occipitalneuralgia
CorrectAnswer-C
Answer-C.Temporallobeinfarction
Herpessimplexinfectionhasapredilectionfortheinvolvementof
Temporallobe.
ThelesionsinHSVencephalitisareintensehemorrhagicnecrosisof
theinferiorandmedialtemporallobeandthemediorbitalpartof
frontallobes.

---

1343.Braindeathissaidtooccurifthere
is:
March2008
a)Absentspinalreflexes
b)Corticaldeathfollowingwidespreadbraininjury
c)Absenceofbrainstemreflexes
d)Coretemperatureofthebodyisbelow35degreeC
CorrectAnswer-C
Ans.C:Absenceofbrainstemreflexes
Brainstemisresponsiblefortherespiratorydriveandmostlyforthe
maintenanceofBP.Allmotoroutputsfromthebraintravelthrough
thebrainstem.Apartfromsmellandvision.Allsensorytrafficcoming
intothebraincomesthroughthebrainstem.Thebrainstemalso
mediatesthecranialnervereflexes.Henceaproperlyfunctioning
brainstemisapreconditionforfullconsciousness.
Irreversiblebraindamageandlossofbrainfunction,isevidencedby
cessationofbreathingandothervitalreflexes(mediatedbybrain
stem),unresponsivenesstostimuli,absenceofmuscleactivity,and
aflatelectroencephalogramforaspecificlengthoftime.

---

1344.OccupationalLungDiseasecommonly
seeninTextileIndustryWorkersis:
a)Byssinosis
b)Bagassosis
c)Farmer'sLung
d)Asbestosis
CorrectAnswer-A
AnswerisA(Byssinosis)
OccupationalLungDiseaseinTextileIndustryWorkers(Cotton
industry)
Byssinosisisanasthma-likeconditioncausedbyinhalationofcotton
fiberdustoverprolongedperiodoftime.
Workersoccupationallyexposedtocottondust(butalsotoflax,
hemporjutedust)intheproductionofyarnsfortextileandrope
makingareatriskofByssinosis.
Exposureoccursthroughoutthemanufacturingprocessbutismost
pronouncedintheportionsofthefactoryinvolvedwiththetreatment
ofcottonbeforespinning(blowing,mixing,cardingorstraightening)
Byssinosisismorecommonduringmillingandprocessingofcotton
thanduringspinning.

---

1345.Durationofapneainobstructivesleep
apneais
a)<10sec
b)<20sec
c)<30sec
d)<60sec
CorrectAnswer-A
Ans.is'a'i.e.,<10sec
Sleepapnea?
oSleepapneaisdefinedasintermittentcessationofairflowatthe
noseandmouthduringsleep.
oByconventionapneasofatleast10secondsdurationhavebeen
consideredimportantbutinmostpatientstheapneasare20sto30
secondsindurationandmaybeaslongas2-3minutes.
oSleepapneaisoftwotypes-
Sleepapnea
Obstructivesleepapnea Centralsleepapnea
Occursdueto
Occursduetoocclusionof transientabolition
upperairwayatthelevelof ofthecentralneural
oropharynx
drivetotherespiratory
muscles
Primaryand
secondarycentral
alveolarhypoventilation
Conditionsassociatedare syndrome,hypoxia
adenotonsillarhypertrophy, (highaltitude)

---

retrognathia,
cardiovascular
macroglossiaalcohol,
disease,pulmonary
obesity
congestion,central
nervoussystem
disease,prolonged
circulationtime.
Clinicalfeaturesofsleepapnea-
Excessivedaytimesleepiness
Cardiorespiratorydisturbanceswhichinclude
Recurrentrespiratoryfailure
Pulmonaryhypertension
Heartfailure
Systemichypertension7Chronichypoventilation
Polycythemia
oArterialbloodgasanalysisrevealshypoxemiaandhypercapnia.

---

1346.Obstructivesleepapnoeamayresultin
allofthefollowingexcept
a)Systemichypertension
b)Pulmonaryhypertension
c)Cardiacarrhythmia
d)Impotence
CorrectAnswer-C
Ans.is'c'i.e.,Cardiacarrhythmia
Daytimefunctionandcognition
OSAisassociatedwithexcessivedaytimesleepiness,inattention,
andfatigue,whichmayimpairdailyfunction,induceorexacerbate
cognitivedeficits,andincreasethelikelihoodoferrorsand
accidents.
Cardiovascularmorbidity
PatientswithOSA,areatincreasedriskforabroadrangeof
cardiovascularmorbidities,includingsystemichypertension,
pulmonaryarterialhypertension,coronaryarterydisease,cardiac
arrhythmias,heartfailure,andstroke.
Metabolicsyndromeandtype2diabetes
PatientswithOSAhaveanincreasedprevalenceofinsulin
resistanceandtype2diabetes.
Nonalcoholicfattyliverdisease
IntermittentnocturnalhypoxiaduetoOSAmaycontributetothe
developmentandseverityofnonalcoholicfattyliverdisease
(NAFLD),independentofsharedriskfactorssuchasobesity.
Perioperativecomplications
PatientswithOSAmaybeatgreaterriskforperioperative
complicationssuchaspostoperativeoxygendesaturation,acute

---

respiratoryfailure,postoperativecardiacevents,andintensivecare
unittransfers.
Mortality
PatientswithuntreatedsevereOSA(ie,AHI30eventsperhour)
haveatwo-tothreefoldincreasedriskofall-causemortality
comparedwithindividualswithoutOSA,independentofotherrisk
factorssuchasobesityandcardiovasculardisease.

---

1347.Nottrueobstructivesleepappoea
a)Nocturnalasphyxia
b)Alcoholismisacofactor
c)Pronetohypertension
d)Overnightoximetryisdiagnostictoreplacepolysomnography
CorrectAnswer-D
Ans.is'd'i.e.,Overnightoximetryisdiagnostictoreplace
polysomnography
Cardinalfeaturesinadultsinclude:
Obstructiveapneas,hypopneas,orrespiratoryeffortrelated
arousals
Daytimesymptomsattributabletodisruptedsleep,suchas
sleepiness,fatigue,orpoorconcentration
Signsofdisturbedsleep,suchassnoring,restlessness,or
resuscitativesnorts
Clinicalpresentation
MostpatientswithOSAfirstcometotheattentionofaclinician
becausethepatientcomplainsofdaytimesleepiness,orthebed
partnerreportsloudsnoring,gasping,snorting,orinterruptionsin
breathingwhilesleeping.
Daytimesleepiness,distinctfromfatigue,isacommonfeatureof
OSA
Sleepinessistheinabilitytoremainfullyawakeoralertduringthe
wakefulnessportionofthesleep-wakecycle.
SnoringistheothercommonfeatureofOSA.Whilesnoringis
associatedwithasensitivityof80to90percentforthediagnosisof
OSA,itsspecificityisbelow50percent.
Clinicalfeaturesofobstructivesleepapnea(OSA)
Daytimesleepiness
Obesity

---

Daytimesleepiness
Obesity
Largeneck
Nonrestorativesleep circumference
Systemic
Loudsnoring
hypertension
Witnessedapneasby Hypercapnia
bedpartner
Awakeningwith
Cardiovascular
choking
disease
Nocturnal
Cerebrovascular
restlessness
disease
Insomniawith
Cardiac
frequentawakenings dysrhythmias
Narrowor
Lackofconcentration "crowded"
airway
Pulmonary
Cognitivedeficits
hypertension
Changesinmood
Corpulmonale
Morningheadaches
Polycythemia
Vivid,strange,or
Floppyeyelid
threateningdreams
syndrome
Gastroesophageal
Nocturia
reflux
Polysomnography
Full-night,attended,in-laboratorypolysomnographyisconsidered
the"gold-standarddiagnostic"testforOSA.
Itinvolvesmonitoringthepatientduringafullnight'ssleep.
Unattended,outofcentresleep"(OCST)maybeusedasan
alternativetopolysomnographyforthediagnosisofOSAinpatients
withahighpre-testprobabilityofmoderatetosevereOSA,provided
therearenomedicalcomorbiditiessuchasheartfailurethat
predisposetoalternativeoradditionalsleeprelatedbreathing
disorders.
ThediagnosisofOSAisbaseduponthepresenceorabsenceof
relatedsymptoms,aswellasthefrequencyofrespiratoryevents

---

duringsleep(ie,apneas,hypopneas,andrespiratoryeffortrelated
arousalsIRERAsJasmeasuredbypolysomnographyorout-of-
centersleeptesting(OCST).
Inadults,thediagnosisofOSAisconfirmedifeitherofthetwo
conditionsexists:
Thereare"fil_y"ormorepredominantlyobstructiverespiratory
events(obstructiveandmixedapneas,hypopneas,orRERAs)per
hourofsleep(forpolysomnography)orrecordingtime(forOCST)in
apatientwithoneormoreofthefollowing:
Sleepiness,nonrestorativesleep,fatigue,orinsomniasymptoms.
Wakingupwithbreathholding,gasping,orchoking.
Habitualsnoring,breathinginterruptions,orbothnotedbyabed
partnerorotherobserver
Hypertension,mooddisorder,cognitivedysfunction,coronaryartery
disease,stroke,congestiveheartfailure,atrialfibrillation,ortype2
diabetesmellitus
Thereare15ormorepredominantlyobstructiverespiratoryevents
(apneas,hypopneas,orRERAs)perhourofsleep(for
polysomnography)orrecordingtime(forOCST),regardlessofthe
presenceofassociatedsymptomsorcomorbidities

---

1348.Tophiingoutfoundinallregions
except
a)Prepatellarbursae
b)Muscle
c)Helixofear
d)Synovialmembrane
CorrectAnswer-B
Ans.is'b'i.e.,Muscle
LocationofTophi
Theyareclassicallylocatedalongthehelixoftheear.
Canalsobeseenin:-
Fingers
Toes
Prepattelarbursa
Olecranon
Althoughgouttypicallycuasesjointinflammation,itcanalsocause
inflammationinothersynovial-basedstructures,suchasbursaeand
tendons.
Tophiarecollectionsofuratecrystalsinthesofttissues.Theytend
todevelopafteraboutadecadeinuntreatedpatientswhodevelop
chronicgoutyarthritis.
Tophimaydevelopearlierinolderwomen,particularlythose
receivingdiuretics.

---

1349.Earlylossofbladdercontrolisseenin
a)ConusMedullaris
b)CaudaEquina
c)GullainBarreSyndrome
d)AmyotrophicLateralSclerosis
CorrectAnswer-A
AnswerisA(ConusMedullaris):
Harrison's18thLossofbladdercontrolisanearlyandmarked
featureofconusmedullaris.
Cauda
Conus
Feature
Equina
GBS
AMLS
Medullaris syndrome
Earlyand
Lateandless
Absent
Bladder
Uncommon
Marked
marked
/uncommon
'Bladder
'Bladder
'Ifbladder
'Eveninlate
Involvement dysfunction involvementis dysfunctiona stagesof
is
a
late
prominent
aprominent
theillness
presentation
featureand
featureand
boweland
incauda-
comes
earlyinthe
bladder
comesearly equina
course,
functions
inthe
syndrome
diagnostic
are
courseof
possibilities
preserved'
disease'
otherthan
GBS
shouldbe

---

considered

---

1350.Subacturecombineddegenerationof
cordiscausedduetodeficiencyof
a)VitaminB1
b)VitaminB5
c)VitaminB6
d)VitaminB12
CorrectAnswer-D
Ans.is'd'i.e.,VitaminB12
Subacatecombineddegenerationofthespinalcordisthetermused
forthedegenerationofthespinalcordduetovitaminB12deficiency.
Thespinalcord,brain,opticnerves,peripheralnervesmayallbe
affectedinvitaminB12deficiencybutthespinalcordisusually
affectedfirstandexclusively.
Thetractsmainlyinvolvedinthespinalcordare:oPosterior
column
Corticospinaltract
Lateronperipheralnervesareinvolved
ClinicalfeaturesofvitaminBdeficiencyorsubacutecombined
degenerationofthecord:
Patientfirstnoticesmildgeneralweakenssandparesthesia
consistingoftingling'pinsandneedle'.
Astheillnessprogressesthegaitbecomesunsteadyandstiffness
andweakenssofthelimbsandlegsdevelop.Ifthediseaseremains
untreatedataxicparaplegiaevolve.
Sometimestheremaybelossofsuperficialsensations,suchas
tactile,painandthermalsensations,butthesesignsarerare.
Lossof"vibrationsense"isthemostconsistentsignandisusually

---

accompaniedbylossofpositionsensee.
Motorsignsseenare:-
Lossofstrengthinproximallimbmuscles
Spasticity,changesintendonreflexes
Clonusandextensorplantarresponses
Sometimestendonreflexesmaybeabsente(duetoinvolvementof
peripheralnerve)oGaitisataxic
Now,
TheClinicopathologicalCorrelation
Clinical
Tracts
features
involved
Paresthesia,
inpairmentof Duetolesion
deep
inposterior
sensationand column
ataxia
Weakness,
Dueto
spasticityand corticospinal
increased
tract
tendon
involvement
reflexes
Dueto
Occasional
spinothalamic
findingsof
tract
lossofpain
involvement
and
(rarely
temperature
involved)
Distaland
Involvementof
symmetrical
peripheral
impairmeatof nerve
superficial
(occassionally)

---

1351.Footulcersindiabetesareduetoall
except
a)Decreasedimmunity
b)Neuropathy
c)Microangiopathy
d)Macroangiopathy
CorrectAnswer-A
Ans.is'a'i.e.,Decreasedimmunity
ThereasonsfortheincreasedincidenceoffootulcersinDMinvolve
theinteractionofseveralpathogenicfactors
Neuropathy(Microvascularcomplication)
Motorandsensoryneuropathyleadtoabnormalfootmuscle
mechanicsandstructuralchangesinthefoot(hammertoe,clawtoe
deformity,prominentmetatarsalheads,Charcotjoint).
Autonomicneuropathy
Resultsinanhidrosisandalteredsuperficialbloodflowinthefoot,
whichpromotedryingoftheskinandfissureformation.PADand
poorwoundhealingimpedetheresolutionofminorbreaksinthe
skin,allowingthemtoenlargeandtobecomeinfected.
Abnormalfootbiomechanics.
P.A.D.(Macrovascularcomplication)
Thisleadstoocclusivearterialdiseasethatresultsinischemiainthe
lowerextremityandanincreasedriskofulcerationindiabetic
patients.
Poorwoundhealing.
Gradesofdiabeticfootulcers
Grade0skinintactbutbonydeformitiesproducea"footatrisk".
Grade1localized,superficialulcer.

---

Grade2deepulcertotendon,bone,ligament,orjoint.
Grade3deepabscess,osteomyelitis
Grade4gangreneoftoesorforefoot
Grade5gangreneoftheentirefoot

---

1352.NotacauseofGynaecomastia
a)Hypothyroidism
b)Kallman
c)obesity
d)Klinefeltersyndrome
CorrectAnswer-A
.Ans.is'a'i.e.,Hypothyroidism
CausesofGynaecomastia
Puberty
Duringpuberty,theserumoestradiolrisestoadultlevelsbefore
testosterone,causingtransientgynaecomastia.Thisnormally
resolveswithinsixmonthstotwoyears.
Cirrhosis
Gynaecomastiaoccursduetoalteredsexhormonemetabolism,and
anincreaseintheoestradiol;freetestosteroneratio.
Hypogonadism
PrimaryhypogonadismcausesacompensatoryriseinLH,inturn
causingincreasedperipheralaromatizationoftestosteroneto
oestradiol.
Secondaryhypogonadism,duetopituitaryorhypothalamicdisease
(e.g.prolactinexcess,Kallman'ssyndromehaemachromatosis),
mayalsocausegynaecomastiadespiteLHdeficiency,sincethe
adrenalcortexcontinuestoproduceoestrogenprecursors,which
areconvertedtooestrogensinperipheraltissues.
Tumours
Testiculartumours:
Germcelltumoursaccountforover95%testiculartumours.
Gynaecomatiaoccursin5%ofpatients,duetohCGsecretion

---

stimulatingoestradolproductionbythetestes.
Leydigcelltumourscausegynaecomastiain20?30%ofcases.
Thesetumourspresentwithprecociouspubertyinboys,orpoot
libidoandgynaecomastiainyoungmales.Approximately10%of
thesetumoursaremalignant.
Sertolicellturnourscausegynaecomastiathroughexcess
aromatizationofandrogentstooestrogens.Theseturnoursmay
occurinPeutz-Jeger'ssyndrome.
Adrenocorticalturnoursmaycausegynaecomastiathrough
overproductionofandrogenssuchasandrostenedione,whichare
convertedtooestrogensinperipheraltissues.
EctopichCG-secretingtumoursincludelung,gastric,renal,and
hepatocellularcarcinomas.
Hypogonadismfromchemotherapyorradiotherapymayalsocause
gynaecomastiainpatientswithtesticulartumours.
Gravesdisease
Gynaecomastiamayoccurduetoincreasedsexhormone-binding
globulin(SHBG),anddecreasedfreetestosteronelevels.
Chronicrenalfailure:
Halfofpatientsreceivinghaemodialysisdevelopgynaecomastiadue
todecreasedleydigcellfunction.Gynaecomastiamayalsooccur
followingkidneytransplantationduetociclosporinuse.
Androgeninsensitivitysyndrome:
Completeandrogeninsensitivity,.formerlytermed'testicular
feminizationsyndrome',causesafemalephynotypeinpatientswho
aregenotypemales.Thesepatientsareregardedasfemale,and
thereforepresentwithinfertilityandamenorrhoearather
gynaecomastia.Partialandrogenreceptordefectsmaycause
gynaecomastiainphenotypicmales.
Drugscausegvnaecomastia
Anti-androgens
Cyproteroneacetate
Finasteride/dutasteride
Gastrointestinaldrugs
Cimetidine/ranitidine
Cancerchemotherapy
Alkylatingagents/vincaalkaloids(duetotesticulardamageand

---

hypogonadism)
Imatinib(tyrosinekinaseinhibitorusedforchronicmyeloidleukemia
(CML)andgastrointestinalstromaltumour(GIST).
Cardiovasculardrugs
Spironolactone(displacesoestrogenfromSHBG,increasingfree
oestrogen:testosteroneratio)
Digoxin
Amiodarone
Methyl-dopa
Antimicrobialdrugs
Isoniazid
Ketoconazole
Metronodazole
Anti-viraldrugs
Highlyactiveanti-retroviral(HAART)therapy(especiallyprotease
inhibitors)
Neurologicaldrugs
Phenothiazines
Metoclopramide
Tricyclicanti-depressants
Opiates

---

1353.Braintumorcausinghypernatremiain
children
a)Medulloblastoma
b)Cerebellarastrocytoma
c)Craniophyrangioma
d)Brainstemglioma
CorrectAnswer-C
Ans.is'c'i.e.,Craniophyrangioma
Craniophyrangiomaleadstocentraldiabetesmellitusandresultant
lossofwaterleadstohypernatremia.

---

1354.Poorlycontrolleddiabeteswithblood
sugarof450mg%isassociatedwith:
a)Hyponatremia
b)Hypernatremia
c)Hypokalemia
d)Hypomagnesemia
CorrectAnswer-A
Ans.is'a'i.e.,Hyponatremia
Poorlycontrolleddiabetesdrawswateroutofcellsresultingin
hyponatremia.
nPlasmaconcentrationfallsby1.4mmol/Lforevery100mg/d1rise
inplasmaglucoseconcentrationofsodium.

---

1355.Allofthefollowingdrugsmaybeused
inthetreatmentofulcerativecolitis
Except
a)Corticosteroids
b)Azathioprine
c)Sulfasalazine
d)Methotrexate
CorrectAnswer-D
Ans.is'd'i.e.,Methotrexate
Methotrexateincrohn'sdisease
Methotrexatehasbeenshowntobeeffectiveforinducingremission
inpatientswithsteroiddependentandsteroidrefractorycrohn's
disease.
Agentsthatmaybeusedfortreatmentofulcerativecolitis
5-ASA
Glucocorticoids
Azathioprineand6mercaptopurine
CyclosporineorTNFalphatherapy(Infliximab).
Tacrolimusisamacrolideantibodythathasshowntobeeffectivein
adultswithsteroiddependentorrefractoryulcerativecolitis.
Drugsusedincrohn'sdisease
Cyclosporineorinfliximab
6-Mercaptopurineorazathioprine
GlucocorticoidIV
Glucocorticoidoral
Glucocorticoidrectal
5-ASArectalororal

---

---

1356.Treatmentofchoiceinacute
sarcoidosisis
a)Prednisolone
b)Cyclosporin
c)Infliximab
d)IVimmunoglobulins
CorrectAnswer-A
Ans.is'a'i.e.,Prednisolone
Prednisolone(corticosteroid)isthetreatmentofchoiceforboth
acuteandchronicphaseofsarcoidosisthatrequirestreatment.

---

1357.Thefollowingarethecomplicationof
haemodialysisexcept-
a)Hypotension
b)Peritonitis
c)Hypertension
d)bleedingtendency
CorrectAnswer-B
Ans.is'b'i.e.,Peritonitis
Patientswithendstagerenaldisease(ESRD)onlongtermdialysis
therapyhaveveryhighmortalityduetopredominantly
cardiovascularcauses.
'Suddencardiacdeathisthesinglemostcommonformofdeathin
hemodialysis,accountingfor20%to30alldeathsinthiscohort.'
Dialysispatientshaveextraordinarityhighmortailtyrateswithcardic
diseaseaccountingfor43percentdeaths
inthispopulation.Dataindicatesthatapproximately27%ofthe
mortailtiesareduetosuddencardicdeath.
Moreoncardiovascularcomplicationsindialysis
CardiovasuculardiseaseisthemajorcauseofdeathinESRD
patientsandatherosclerosesispresentinalllongtermdialysis
patients.
Prematurecardiacdeathhasreachedepidemiclevelsinworld
dialysispopulationoccurringfivetotentimesascommonlyasinage
matchedgeneralpopulationandaccountingforatleasthalfofall
patientsdeath.oHypertensionisamajorriskfactor
Otherriskfactorare:-
Hyperphosphetemiaandelevatedcalciumphosphoruswithcalcium
depositionincoronaryarteries.

---

Anemia
Hypertriglyceridemia
LowHDLcholesterol
Increasedlipoprotein(a)
Insulindeficiencyorresistance
Hyperhomocysteinem
Alsoknow
Complicationsofdialysis
Acute
Longterm
complicationsof complications
hemodialysis
oHypotension
oCardiovascular
oCramps
oAnemia
Secondary
Nauseaand
hyperparathyrodism
vomiting
and
Headacheo
Malnutrition
oHepatitis(A,B,C,
Chestpaino
D,E
Backpain
Depression
oDialysis
Itching
encephalopathy
Feverandchills
Malignanttumours
Carpaltunnel
syndrome
Uremicneurophty

---

1358.Mostcommonacutecomplicationof
dialysisis
a)Hypotension
b)Bleeding
c)Dementia
d)Musclecramps
CorrectAnswer-A
Ans.is'a'i.e.,Hypotension
Hypotensionisthemostcommonacutecomplicationof
hemodialysisparticularlyamongpatientswithdiabetesmellitus.
Factorsinvolvedare:-
Excessiveultrafiltration,withinadequatecompensatoryvascular
filling,impairedvasoactiveorautonomicresponse,osmolarshifts,
overzealoususeofantihypertensives

---

1359.Themostlikelydiagnosisinthecaseof
apatientwithmultiplepulmonary
cavities,hematuriaandredcellcastsis
a)Anti-GBMdisease
b)Churg-Strauss
c)Systemiclupuserythematousus
d)Wegner'sgranulomatosis
CorrectAnswer-D
Ans.is'd'i.e.,Wegner'sgranulomatosis
MultilungcavitiesandhematuriaarecharacteristicofWegner's
granulomatosis.
Anti-GBMdisease(Goodpasture'ssyndrome)usuallydoesnot
causelungcavities.
Churg-strausssyndromeusuallydoesnotcausehematuria.
SLEisnotausualcauseoflungcavities.

---

1360.Hung-upreflexesareseenin
a)Chorea
b)Atheotosis
c)Cerebralpalsy
d)Cerebellarpalsy
CorrectAnswer-A
Ans.is'a'i.e.,Chorea
Hungupkneejerk
Whenpatellortendonistappedwhilethefootishangingfree,theleg
maybeheldinextensionforfewsecondsbeforerelaxingowingto
prolongedcontractionofquadriceps.
Thisisseenin"chorea".
Otherneurologicalsignsassociatedwithchorea
Milkmaidsgrip
Pianosign
Handwriting
Milkmaid'sgrip
Inabilitytomaintainsustainedvoluntarycontractionofmusclegroup
ataconstantlevel.
Inabilitytoapplysteadypressureduringhandshakeleadingtoa
characteristicsqueezeandreleaseofgrip.
Patient'shavedifficultymaintainingsustainedeyelidclosureand
sustainedtongueprotrusion

---

1361.Arsenicpoisoningcauses
a)Polyneuritis
b)Mononeuritismultiplex
c)Radiculopathy
d)Myelopathy
CorrectAnswer-A
Ans.is'a'i.e.,Polyneuritis
Thereissensoryandmotor(i.e.mixed)polyneuropathy,withpainful
paresthesiaofhandsandfeetandmuscletenderness.

---

1362.Tropicalpulmonaryeosinophiliais
causedbecauseof
a)Occultfilariasis
b)Cerebralmelaria
c)Penumonicplague
d)Asthmaticbronchitis
CorrectAnswer-A
Ans.is'a'i.e.,Occultfilariasis
Occultfilariasisisarareconditionwhichiscausedby
hypersensitivityreactiontofilarialantigen.
Microfilatiaareabsentintheblood.
Lymphaticfilariasisisabsent.
Indirectevidenceoffilarialinfectionisobtainedbydemonstrating
antifilarialantibodies

---

1363.AllthefollowingarefeaturesofTropical
pulmonaryEosinophiliaexcept-
a)Eosinophilia>3000/mm3
b)Microfilariainblood
c)Paroxysmalcoughandwheeze
d)Bilateralchestmottlingandincreasedbronchovascular
markings
CorrectAnswer-B
AnswerisB(Microfilariainblood):
InTPE,Microfilariaarerapidlyclearedfromthebloodstreambythe
lungs.
Thus,microfilariaearesequestratedinthelungsandarenotfound
intheblood.
TropicalPulmonaryEosinophilia
TropicalPulmonaryEosinophilia(TPE)isadistinctsyndromethat
developsinindividualsinfectedwithLymphaticfilarialspecies.
Clinicalsymptomsresultfromallergicandinflammatoryreaction
elicitedbytheclearedparasites.
FeaturesofTropicalPulmonaryeosinophilia(TPE):
Malemorecommonlyaffectedthanfemales(4:1)
Historyofresistanceinfilarialendemicregion
Paroxysmalcoughandwheezingthatareusuallynocturnal
Weightloss,lowgradefever,adenopathy
Eosinophilia>3000eosinophilia/,uLe
ChestX-Ray:increasedbronchovascularmarkings,diffusemiliary
lesions,ormottledopacities.
RestrictivechangesonPulmonaryfunctiontest2
ElevatedlevelsofIgEe&Antifilarialantibodytiters.

---

InTPE,Microfilariaarerapidlyclearedfromthebloodstreambythe
lungs.
Thus,microfilariaearesequestratedinthelungsandarenotfound
intheblood.

---

1364.Inanklyosingspondylitisjoint
involvementisleastin?
a)Wristandhand
b)Sacroiliacjoint
c)Acromio-clavicularjoint
d)Costochondraljunction
CorrectAnswer-A
Ans.is'a'i.e.,Wristandhand
Ankylosingspondylitis(marie-strumpelldisease)
Ankylosingspondylitisisachronicprogressiveinflammatorydisease
ofthesacroiliacjointsandtheaxialskeleton.
Prototypeofseronegative(absenceofrheumatoidfactor)
spondyloarthropathies.
Inflammatorydisorderofunknowncause.
Usuallybeginsinthesecondorthirddecadewithamedianageof
23,in5%symptomsbeginafter40.
Maletofemaleratiois2-3:1
StrongcorrelationwithHLA-B27
90-95%ofcasesarepositiveforHLA-B27.
Jointsinvolvedinankylosingspondylitis
Primarilyaffectsaxialskeleton.
Thediseaseusuallybeginsinthesacro-iliacjointsandusually
extendsupwardstoinvolvethelumbar,thoracic,andoftencervical
spine
Intheworstcasesthehipsorshouldersarealsoaffected.oHipjoint
isthemostcommonlyaffectedperipheraljoint.oRarelykneeand
anklearealsoinvolved.
Pathology

---

Enthesitisi.e.inflammationoftheinsertionpointsoftendons,
ligamentsorjointcapsuleonboneisoneofthehallmarksofthis
entityofdisease.
Primarilyaffectsaxial(spinal)skeletonandsacroiliitisisoftenthe
earliestmanifestationofA.S..
Involvementofcostovertebraljointsfrequentlyoccur,leadingto
diminishedchestexpansion(normal5cm)
Peripheraljointse.g.shoulders,andhipsarealsoinvolvedin1/3rd
patients.
Extraarticularmanifestationslikeacuteanterioruveitis(in5%);rarely
aorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.
Pathologicalchangesproceedinthreestages?
Inflammationwithgranulationtissueformationanderosionof
adjacentbone.
Fibrosisofgranulationtissue
Ossificationofthefibroustissue,leadingtoankylosisofthejoint.
Inflammatoryboweldisease(CD,UC)mayalsobeseen.
Clinicalfeatures(symptoms)
Lowbackpainofinsidiousonset
Durationusuallylessthan3months
Significantmorningstiffnessandimprovementwithexercise
Limitedchestexpansion
Diffusetendernessoverthespineandsacroiliacjoints
Lossoflumbarlordosis,increasedthoracickyphosis
Decreasedspinalmovements(especiallyextension)inalldirections.
Radiologicalfeaturesofankvlasingspondylitis
Radiographicevidenceofsacroiliacjointisthemostconsistent
findinginankylosingspondylitisandiscrucialfordiagnosis.
Thefindingsare:-
DSclerosisofthearticulatingsurfacesofSIjoints
Wideningofthesacroiliacjointspace
Bonyankylosisofthesacroiliacjoints
Calcificationofthesacroiliacligamentandsacro-tuberousligaments
Evidenceofenthesopathy-calcificationattheattachmentofthe
muscles,tendonsandligaments,particularlyaroundthepelvisand
aroundtheheel.
X-rayoflumbarspinemayshow:-

---

LiSquaringofvertebrae:Thenormalanteriorconcavityofthe
vertebralbodyislostbecauseofcalcificationoftheanterior
longitudinalligament.
Lossofthelumbarlordosis.
Bridging'osteophytes'(syndesmophytes)
Bamboospineappearance
Intheearlydiseaseprocess,plainx-raysmaybereadasnormal.
MoreaccurateandearlydiagnosiscanbedonebyusingMR1
and/orCTscan.
DynamicMRIwithfatsaturation,eithershorttauinversionrecovery
(STIR)sequneceorTIweightedimageswithcontrastenhancement
ishighlysensitiveandspecificforidentifyingearlyintra-articular
inflammation,cartilagechanges,andunderlyingbonemarrow
edemainsacroilitis.
Magneticresonanceimagingallowsforvisualizationofacute
sacroilitis,spondylitis,andspondylodiscitis,andcanalsodetect
acuteinflammationoftheentheses,boneandsynovium.Theability
todetectearlyinflammatiionandacuratelyvisualizecartilaginous
andenthesallesionsmakesmagneticresonanceimagingauseful
assessmenttoolinthespondyloarthropathies.

---

1365.Leastcommonsiteinvolvedin
osteoarthritisis
a)Hipjoint
b)Kneejoint
c)Carpometacarpaljointofthumb
d)Distalcarpophalangealjoint
CorrectAnswer-C
Ans.is'C'
Inthehandthejointsspecificallyinvolvedare?
Distalinterphalangealjoin&(ofparticularimportanceisthepointthat
thisjointisnotinvolvedinrheumatoidarthritis).
Proximalinterphalangealjoin&
FirstcarpometacarpaljointsQ
Rememberthesetwoimportantfeaturesofjointinvolvementin
osteoarthritis
Itdoesnotinvolvethemetacarpophalangealjointso
ItdoesnotinvolvethewristjoINTEGER(2.Italsodoesnotinvolve
thecarpometacarpalQjoint(exceptatthebaseofthumb).
Osteoarthritisinvolvesthecarpometacarpaljointatthebaseof
thumb,infactitisthesecondmostcommonareaofinvolvementin
osteoarthritis.
Otherjointswhicharecommonlyinvolvedinosteoarthritisare
Hips,
Knees,
Lowerlumbar
Cervical.
Jointswhichareusuallysparedinosteoarthritisare

---

WristsQ,carpometacarpale
ElbowsQ
Shoulderjoint

---

1366.65-year-oldmanpresentswithanemia,
posteriorcolumandysfunction,and
planterextensor.Whichofthefollowing
isthelikelycause
a)Tabesdorsalis
b)Frederich'sataxia
c)VitaminB1deficiency
d)VitaminB12deficiency
CorrectAnswer-D
Ans.is'd'i.e.,VitaminB12deficiency
Anemiaalongwithinvolvementofposteriorcolumnischaracteristic
ofsubacutecombineddegenerationofspinalcordcausedbyvitamin
B12deficiency.

---

1367.WhichisnottrueofTabesdorsalis?
a)Seeninneurosyphilis
b)Paresthesiaisseen
c)Deeptendonreflexesareretained
d)Abdominalpainandvisceralsymptomsoccur
CorrectAnswer-C
DeeptendonreflexesareretainedREF:Harrison'sPrinciplesof
InternalMedicine17thedchapter372
TABESDORSALIS:
Theclassicsyndromesoftabesdorsalisandmeningovascular
syphilisofthespinalcordarenowlessfrequentthaninthepastbut
mustbeconsideredinthedifferentialdiagnosisofspinalcord
disorders.
Thecharacteristicsymptomsoftabesarefleetingandrepetitive
lancinatingpains,primarilyinthelegsorlessoftenintheback,
thorax,abdomen,arms,andface.Ataxiaofthelegsandgaitdueto
lossofpositionsenseoccursinhalfofpatients.
Paresthesias,bladderdisturbances,andacuteabdominalpainwith
vomiting(visceralcrisis)occurin15-30%ofpatients.
Thecardinalsignsoftabesarelossofreflexesinthelegs;impaired
positionandvibratorysense;Romberg'ssign;and,inalmostall
cases,bilateralArgyllRobertsonpupils,whichfailtoconstricttolight
butaccommodate.Diabeticpolyradiculopathymaysimulatetabes.

---

1368.Maximumlossofsodiuminachild
occursin
a)Gastricjuice
b)Ilealfluid
c)NoncholeraDiarrhoea
d)Cholera
CorrectAnswer-B
Ans.is'b'i.e.,healfluid
Cationsandanionsinbiologicalfluidsinmeq/dl
Fluid
Sodium Potassium Chloride
Gastric 60
10
85
juice
heal
130
10
115
fluid
Diarrhea 10-90 10-80
10-110
stool

---

1369.Allofthefollowingstatementsabout
geneticsofG6PDdeficiencyaretrue,
except
a)X-linkedinheritance
b)MoresevereinMen
c)ContradictsLyonHypothesis
d)MayaffectHeterozygousfemales
CorrectAnswer-C
Ans.is'c'i.e.,ContradictsLyonHypothesis
GeneticsofG6PD
ThegeneforG6PDislocatedontheXchromosome(bandXq28)
[8]andhasbeenclonedandsequenced.oEventhoughfemales
havetwoXchromosomespercell,normalmalesandfemaleshave
thesameenzymeactivity
intheirredcellsbecauseoneoftheXchromosomesineachcellof
thefemaleembryoisinactivatedandremains
inactivethroughoutsubsequentcelldivisions(Lyonhypothesis).
G6PDdeficiencyisexpressedinmalescarryingavariantgene,
whileheterozygousfemalesareusuallyclinicallynormal.
However,themeanredbloodcellenzymeactivityinheterozygous
femalesmaybenormal,moderatelyreduced,orgrosslydeficient
dependinguponthedegreeoflyonizationandthedegreetowhich
theabnormalG6PDvariantisexpressed.
G6PDsupportsLyon'shypothesis:-
Accordingtolyon'shypothesisoneofthetwochromosomeineach
cellofthefemaleembryoisinactivatedandremainsinactive
throughoutsubsequentcelldivision.

---

G6PDisinheritedasanX-linked(recessive)disorder,itismore
commoninmales.
HeterozygousFemalemayalsobeaffecteddependontheextentof
lyonisation(inactivationofoneX-chromosome)buttheoverall
averagedegreesofhemolysisinheterozygousfemaleisless.
Aheterozygousfemalewith50percentnormalG6PDactivityhas50
percentnormalredcellsand50percentG6PD-deficientredcells.
Thedeficientcellsareasvulnerabletohemolysisastheenzyme-
deficientredbloodcellsinmales.
Male
Males,whohaveonlyonecopyoftheXchromosome,areeither
normalorhemizygousforthevariantglucose6-phosphate
dehydrogenase(G6PD)gene.
Thus,G6PDdeficiencyisexpressedinmalescarryingavariant
geneontheirXchromosomethatproducessufficientenzyme
deficiencytoleadtosymptoms.Alloftheredcellsinaffectedmales
arevulnerabletohemolysis.
Female
Females,whohavetwocopiesoftheXchromosome,areeither
normal,heterozygous,orhomozygousforthevariantgene.
Heterozygousfemalesareusuallyclinicallynormal.
However,theirmeanredbloodcellenzymeactivitymaybenormal,
moderatelyreduced,orgrosslydeficientdependinguponthedegree
ofXchromosomeinactivation(lyonization)andthedegreetowhich
theabnormalG6PDvariantisexpressed.
Afemalewith50percentnormalG6PDactivity,duetoinactivationof
oneXchromosomeineachcellvialyonization,has50percent
normalredcellsand50percentG6PD-deficientredcells.
Thedeficientcellsareasvulnerabletohemolysisastheenzyme-
deficientredbloodcellsinmales.
Homozygousfemalesareasseverelyaffectedclinicallyas
hemizygousmales.Alloftheirredcellsarevulnerabletohemolysis

---

1370.WithregardstoG6PDdeficiency,which
ofthefollowinginfalse
a)Affectsthepentosephosphatepathway
b)Associatedwithneonataljaundice
c)Acutehaemolysiscanbeprecipitatedbybroadbeans
d)X-linkedrecessivedisorderthatdoesnotaffectheterozygous
famales
CorrectAnswer-D
Ans.is'd'i.e.,X-linkedrecessivedisorderthatdoesnotaffect
heterozygousfamales
Glucose6-phosphatedehydrogenase(G6PD)deficiency,anX-
linkeddisorder,isthemostcommonenzymaticdisorderofredblood
cellsinhumans,affecting400millionpeopleworldwide.
Clinicalspectrum
TheclinicalexpressionofG6PDvariantsencompassesaspectrum
ofhemolyticsyndromes
ThefourformsofsymptomaticG6PDdeficiency:
Acutehemolyticanemia
Favism
Congenitalnonspherocytichemolyticanemia
Neonatalhyperbilirubinemia
G6PDdeficiencyisexpressedinmalescarryingavariantgenethat
resultsinsufficientenzymedeficiencytoleadtosymptoms.
Acutehemolyticanemia
AlmostallindividualswiththemostprevalentG6PDvariants,G6PD
A-andG6PDMediterranean,areasymptomaticinthesteadystate.
Theyhaveneitheranemia,evidenceofincreasedredcell
destruction,noranalterationinbloodmorphology,.oHowever

---

suddendestructionofenzymedeficienterythrocytescanbe
triggeredbycertaindrugsorchemicals,byselectedinfections,and
rarelybymetabolicabnormalities(eg,diabeticketoacidosis).
Clinicalcourse
Attwotofourdaysafterdrugingestion,thereisthesuddenonsetof
jaundice,pallor,anddarkurine,withorwithoutabdominalandback
pain.
Thisisassociatedwithanabruptfallinthehemoglobin
concentrationof3to4g/dL,duringwhichtimethe
peripheralbloodsmearrevealsredcellfragments,
microspherocytes,andeccentrocytesor"bite"cells.
Theanemiainducesanappropriatestimulationoferythropoiesis,
characterizedbyanincreaseinreticulocytesthatisapparentwithin
fivedaysandismaximalat7to10daysaftertheonsetof
hemolysis.
Evenwithcontinueddrugexposure,theacutehemolyticprocess
endsafteraboutoneweek,withultimatereversaloftheanemia.
Incitingevents
PatientswithclassIIorIIIvariantsdevelopintermittenthemolysis
onlyafteroneormoreofthefollowingincitingevents.
Infection
Oxidantdrugs
Chemicalagents(eg,mothballs,anilinedyes,hennacompounds)
Diabeticketoacidosis
Ingestionoffavabeans
Drugsandchemicals
Primaquine,dapsone,andanumberofotherdrugscanprecipitate
hemolysisinG6PDdeficientsubjects.
Foods:favabeansandbittermelon
G6PDdeficiencycanalsobeprecipitatedbythetheingestionof
freshfavabeans(favism).
Manifestationoffavismbegins5-24hrsafterfavabeaningestionand
includeheadache,nausea,backpain.
Congenitalnonspherocytichemolyticanemia
PatientswithclassIG6PDvariantshavesuchsevereG6PD
deficiencythatlifelonghemolysisoccursintheabsenceofinfection
ordrugexposure.

---

Suchpatientsfallunderthecategoryofhavingcongenital
nonspherocytichemolyticanemia.
TheseG6PDvariantshavelowinvitroactivityand/ormarked
instabilityofthemolecule,andmosthaveDNAmutationsatthe
glucose-6-phosphateorNADPbindingsites.
ThesesitesarecentraltothefunctionofG6PD,whichoxidizes
glucose-6-phosphateandreducesNADPtoNADPH.Itispresumed
thatthefunctionaldefectissoseverethattheredcellscannot
withstandeventhenormaloxidativestressesencounteredinthe
circulation.
Anemiaandjaundiceareoftenfirstnotedinthenewbornperiod,and
thedegreeofhyperbilirubinemiaisfrequentlyofsufficientseverityto
requireexchangetransfusion.
Afterinfancy,hemolyticmanifestationsaresubtleandinconstant.
Mostindividualshavemildtomoderateanemia(hemoglobin8to10
g/dL)withareticulocytecountof10to15percent.Palloris
uncommon,scleralicterusisintermittent,splenomegalyisrare,and
splenectomygenerallyisoflittlebenefit.
Hemolysiscanbeexaggeratedbyexposuretodrugsorchemicals
withoxidantpotentialorexposuretofavabeans.
Somedrugswithrelativelymildoxidantpotentialthataresafein
patientswithclassIIorclassIIIG6PDvariantsmayincrease
hemolysisinpatientswithclassIvariants.
Neonatalhyperbilirubineinia
TheclinicalpictureofneonataljaundiceduetoG6PDdeficiency
differsfromneonataljaundiceseeninhemolyticdiseaseofthefetus
andnewborn(HDFN)associatedwithRh(D)incompatibilityintwo
mainrespects.
G6PDdeficiency-relatedneonataljaundiceisrarelypresentatbirth;
thepeakincidenceofclinicalonsetisbetweendaystwoandthree.
aThereismorejaundicethananemia,andtheanemiaisrarely
severe.Theseverityofjaundicevarieswidely,frombeingsubclinical
toimposingthethreatofkernicterusifnottreated

---

1371.Plateletsinstoredblooddonotlive
after
a)24hours
b)48hours
c)72hours
d)96hours
CorrectAnswer-C
Ans.is'c'i.e.,72hours
Plateletsareprovidedasapooledpreparationfromoneorseveral
donors,usuallyasa6-unitbag,whichisthe
usualamountgiventoanaverage-sizedadult.
Eachunitcontainsapproximately8x101?plateletsandshould
increasetheplateletcountbyabout7000-10,000/pLina75kgadult.
Plateletsstoredatroomtemperaturecanbeusedforupto5days
andhavealifespanof8days.
Thosestoredat4?Careusefulforonly24hours(only50-70%of
totalplateletactivityispresentat6hours)andhavealifespanof
only2-3days.
ABOcompatibilityshouldbeobservedforplatelets,butisnot
essential.Foreachdonorused,thereisasimilarriskoftransmitting
hepatitisandHIVasforoneunitofblood.
Plateletshouldbeadministeredthrougha170pmfilter.

---

1372.Schober'ssignisfor:
a)Flexionoflumbarspine
b)Chestexpansion
c)Painwithmotionofhip
d)Neckpainandstiffness
CorrectAnswer-A
Ai.e.Flexionoflumberspine
Schober'stestismeasureofflexiononlumberspineQ.Thistestis
doneinankylosingspondylitisQ

---

1373.Earliestandoftentheonlypresentation
ofTBkidneyis
a)Increasedfrequency
b)Colickypain
c)Hematuria
d)Renalcalculi
CorrectAnswer-A
Ans.is'a'i.e.,Increasedfrequency
Urinaryfrequency,dysuria,nocturia,hematuria,andflankor
abdominalpainiscommonpresentations.
However,patientsmaybeasymptomaticandthediseaseis
discoveredonlyafterseveredestructivelesionsofthekidneyshave
developed.
Urinalysisgivesabnormalresultsin90%ofcases,revealingpyuria
andhematuria.
Thedocumentationofculture-negativepyuriainacidicurineraises
thesuspicionofTB.
IVpyelography,abdominalCT,orMRImayshowdeformitiesand
obstruction,andcalcificationsandureteralstricturesaresuggestive
findings.
Cultureofthreemorningurinespecimensyieldsadefinitive
diagnosisinnearly90%ofcases.

---

1374.Mostcommoncauseofdiarrheain
AIDSpatients?
a)Salmonellatyphimurium
b)Cryptosporidium
c)Candida
d)isophora
CorrectAnswer-B
Ans.is'b'i.e.,Cryptosporidium
MostcommoncauseofdiarrheainHIVCryptosporidium.
DiseasesofOropharvnxandGIsysteminH.I.V.
Theseare:?
Orallesions:Thrush(oralcandidiasis),oralHairyleukoplakia
(causedbyEBV),andaphthousulcer.Esophageal:Esophagitisby
CMV,HSVorcandida.
Diarrhea:Diarrheaiscausedby:-
Bacteria:Salmonella,Shigella,Campylobacter,andmycobacteria
aviumintracellulare.
Fungal:Histoplasma,Coccidioides,penicillium.
Other:CMV,microsporidia,isosporahelli,andcryptosporidia.
AIDSenteropathy(HIVenteropathy)

---

1375.Notseenwithuremiclung
a)alveolarinjury
b)Pulmonaryedema
c)Interstitialfibrosis
d)Fibrinousexudateinalveoli
CorrectAnswer-C
Ans.is'c'i.e.,Interstitialfibrosis
Uremiclungisreferredtoabnormalitiesexpressedchestx-ray
abnormalitiesseeninpatientswithCKD.
Thepathogenesiswasbelievedtoberelatedtobloodureanitrogen
andcreatinineretention.
Thereis:
Itspathophysiologyisbasedonuremia-inducedincreased
permeabilityofpulmonaryalveolo-capillaryinterfaces,leadingto
Interstitialandintra-alveolaredema
Atelectasis
Alveolarhemorrhage
Pulmonaryhyalinemembraneformation.
Thesechangesarecompoundedbybleedingdiathesissecondaryto
plateletdysfunctioninadvancedrenaldisease.
Thepulmonarysymptomsandradiographicfindingsarereversible
withhemodialysis.

---

1376.OliguricphaseofARFischaracterized
byA/E
a)Chestpain
b)Acidosis
c)Hypertension
d)Hypokalemia
CorrectAnswer-D
Ans.is'd'i.e.,Hypokalemia
Maintenancephase(Oliguricphase)(Lastsfor1-2weeks)Uremic
complicationsandelectrolyteabnormalitiesariseduringthisphase-
?GFRreachesitslowestpoint,urineoutputislowest(typically5-10
ml/min)
?Duetofluidoverloadanddecreasedelectrolyteexcretion,following
electrolyteabnormalitiesareseen
?Hyperkalemia-(d/treducedexcretion)
.Hyponatremia-s(d/tvolumeoverload)
.Hyperphosphatemia4(d/treducedexcretion)
.Hypermagnesemia-(d/treducedexcretion)
.Hyperuricemia->(d/treducedexcretion)
.Hypocalcemia->(d/tdepositionofcalciumphosphate)
.ElevationofB.U.N.4(d/treducedexcretion)
.Hyposmolality->(d/tvolumeoverload)
.Anemia4(d/tImpairederythropoiesisHemolysis,bleedingDilution)

---

1377.InEEGtypeofwaveseeninmetabolic
encephalophathy
a)Alpha
b)Beta
c)Gamma
d)Delta
CorrectAnswer-D
Ans.is'cl'i.e.,Delta
E.E.G.changesinmetabolicencephalopathy
Inmetabolicencephalopathychangesaretypicallynonfocal
E.E.G.hasbeenwidelyusedtoevaluatemetabolicencephalopathy.
TheE.E.G.findingsareabnormalinacuteencephalopathicstages.
Itisdifficulttoestablishadiagnosisofmetabolicencephalopathy
withcertainitythroughE.E.G.
ThereisgeneralizedslowingoftheE.E.Gwithanexcessofthe
deltaandthetawaveswithsuppressionofnormalalphaandbeta
waveactivityandoccasionallybilateralspikesandwavescomplexes
occurringinabsenceofseizureactivity".
Inmetabolicencephalopathies,theE.E.Gevolutioncorrelateswell
withtheseverityofencephalopathy.oHoweverEEGhaslittle
specificityindifferentiatingetiologiesinmetabolicencephalopathy.
Forexample,thoughtriphasicwavesaremostfrequentlymentioned
inhepaticencephalopathy,theycanalsobeseeninuremic
encephalopathyoreveninagedpsychiatricpatientstreatedwith
lithium.oSpikesandwavesmayappearinhypoorhyperglycemia
uremicencephalopathyorvitamindeficiencies.
CommonprinciplesofEEGchangesinmetabolic

---

encephalopathyare:-
Varieddegreesofslowing
Associatedmixturesofepilepticdischarge
Highincidenceoftriphasicwaves
Reversibilityaftertreatmentofunderlyingcauses
Metabolic
EEGrythm
encephalopathy
Dominantactivityis
GradeI(almost alpharhythmwith
normal)
minimaltetaactivity
Dominantteta
GradeII(mildly backgroundwith
abnormal)
somealphaand
deltaactivities.
Continuousdelta
GradeII
activity
(moderately
predominates,little
abnormal)
activityoffaster
frequencies
Low-amplitudedelta
GradeIV
activityor
(severely
suppression-burst
abnormal)
pattern
GradeV
Nearly"flat"tracing
(extremely
orelectrocerebral
abnormal)
inactivity.

---

1378.Alveolarhypoventilationispresentin
A/E:
a)Bulberpoliomyelitis
b)COPD
c)Kyphoscoliosis
d)Lobarpneumonia
CorrectAnswer-D
Di.eLobarPneumonia
Theimportantcausesofhypoventilation:-
i)Obstructioninairways:-Foreignbody,COPD(chronic
bronchitis,emphysema).
ii)Decreaseinrespiratorydrive:-Itisduetodecreasein
stimulationofrespirationfromCNSe.g.braininjury,meningitis,
bulbarpoliomyelitis,Drugs(morphine,sedative,anesthetics),
hypothyroidism.
iii)Decreaseinfunctioningofrespiratorymuscles:-Mysthenia
gravis,poliomyelitis,kyphoscoliosis,myopathy,polymyositis,GB
syndrome,interstitiallungdisorders,AML.
iv)Increasedloadonrespiratorysystem:-Itmaybedueto:?
a)Reducedchestwallcompliance:-Pleuraleffusion,
pneumothorax,ascitis,ribcagedisorder(kyphoscoliosis),ankylosing
spondylitis.
b)Reducedlungcompliance:-Atelectasis,lungresection,alveolar
edema,PEEP.

---

1379.Asbestosiscausesallexcept
a)Shaggyheartborders
b)Honeycombing
c)Hilarlymphadenopathy
d)Basalperibronchialfibrosis
CorrectAnswer-C
Ans.is'c'i.e.,Hilarlymphadenopathy
Asbestosiscausesfibrosisinthelowerlobesofthelung.
Pleuralplaqueformedbyasbestosismostcommonlyaffects
anterolateralandposterolateralaspectsofparietalpleuraandover
thedomeofdiaphragm

---

1380.Themostcommoncauseofsudden
deathinsarcoidosisis
a)Pneumonia
b)Corpulmonale
c)Arrythmias
d)Liverfailure
CorrectAnswer-C
Ans.is'c'i.e.,Arrhythmias
Cardiacinvolvementoccursinitiallywithinflammationand
granulomaformationfollowedbyscarring.Theinitialinflammation
canleadtotriggeredventriculararrhythmiaswithsubsequent
scarringresultinginthesubstrateforreentrantmonomorphic
ventriculartachycardia.

---

1381.MostcommoncauseofunilateralHilar
lymphadenopathy
a)Histoplasmosis
b)Sarcoidosis
c)Aspergillosis
d)Tuberculosis
CorrectAnswer-D
Ans.is'd'i.e.,Tuberculosis
PrimaryTBmostcommonlypresentswithfocalalveolarpneumonia
andassociatedunilateralhilarormediastinaladenopathy.

---

1382.Mostcommoncauseofembolicstroke
is?
a)Intra-CardiacThrombi
b)ParticulateMatterFromIVDrugInjections
c)ProteinCdeficiency
d)Antiphospholipidsyndrome
CorrectAnswer-A
AnswerisA(IntracardiacThrombi):
ThemostcommoncauseofembolicstrokesareIntro-cardiac
Thrombi.
Themostcommonsourcesofsystemicembolismandembolic
strokeareIntra-cardiacthrombiformedasaresultofatrial
fibrillation,ST-elevationMI,leftventriculardysfunctionorheart
failure.
AtrialFibrillationisthesinglemostimportantpredisposingfactor
(AtrialThrombus)followedbyMyocardialInfarction(LeftVentricular
Thrombus).

---

1383.Mostcommonsiteforberryaneurysm
rupture
a)Anteriorcirculationofbrai
b)Posteriorcirculationofbrain
c)Ascendingaorta
d)Descendingaorta
CorrectAnswer-A
Ans.is'a'i.e.,Anteriorcirculationofbrain
Themostcommonsitesindescendingorderoffrequencyare-
LiProximalportionofanteriorcommunicatingartery(atthejunction
ofanteriorcommunicatingarterywithcerebralartery)
Attheoriginoftheposteriorcommunicatingarteryfromthestemof
theinternalcarotidartery.
Atthefirstmajorbifurcationofmiddlecerebralartery.
Atthebifurcationofinternalcarotidintomiddleandanteriorcerebral
arteries.
Vertibrobasilarbifurcation(3%)

---

1384.Obesityisseeninallexcept
a)Cushingsyndrome
b)Pickwiniansyndrome
c)Praderwillisyndrome
d)Sipplesyndrome
CorrectAnswer-D
Ans.is`d'i.e.,Sipplesyndrome
Importantsyndromesassociatedwithobesity
Albrighthereditaryosteodystrophy(pseudohypoparathyroidismtype
la)
Alstromsyndrome
Bardet-Biedlsyndrome
Beckwith-Wiedemannsyndrome
Carpentersyndrome
Cohensyndrome?Prader-willisyndrome

---

1385.Causeofdeathindiabeticketoacidosis
inchildren
a)Cerebraledema
b)Hypokalemia
c)Infection
d)Acidosis
CorrectAnswer-A
Ans.is'a'i.e.,Cerebraledema
Highbloodsugarwillcrosstheblood-brainbarrierand
simultaneouslywilldrawwaterinsideleadingtocerebraledema.
Cerebraledemaaccountsfor60-90%ofallDKArelateddeathsin
children.
InfectionisaprecipitatorforthedevelopmentofDKA.
Otherprecipitatingfactorscanbetissueischemia,inadequate
insulinadministration,drugs(cocaine)andpregnancy.

---

1386.Acutehyponatremiabecomes
symptomaticat
a)<135mEq
b)<125mEq
c)<120mEq
d)<110mEq
CorrectAnswer-B
Ans.is'b'i.e.,<125mEq
Serumlevelofsodiumatwhichsymptomsdevelop
Acute<125meq/L
Chronic<120meq/L
Hyponatremiaiscommonlydefinedasaserumsodium<135
mmol/L(<135mEq/L).Neurologicalsymptoms
occuratdifferentlevelsoflowsodium,dependingnotonlyonthe
absolutevaluebutalsoontherateoffall.
Inpatientswithhyponatremiathatdevelopsoverhours,life-
threateningseizuresandcerebraledemamayoccur
atvaluesashighas125mmol/L.
Incontrast,somepatientswithmorechronichyponatremiathathas
slowlydevelopedovermonthstoyearsmaybeasymptomaticeven
withserumlevels<110mmol.
Acuteorhvperacutehvponatremia
Thehyponatremiadevelopedwithintheprevious24hours,itis
called"acute."
Ifthehyponatremiadevelopedoverjustafewhoursduetoa
markedincreaseinwaterintake(self-inducedwaterintoxication,as
maybeseeninmarathonrunners,psychoticpatients,andusersof
ecstasy),itiscalled"hyperacute."

---

Chronichyponatremia
Ifitisknownthatthehyponatremiahasbeenpresentfbrmorethan
48hours,orifthedurationisunknown(suchasinpatientswho
develophyponatremiaathome),itiscalled"chronic."
Mildtomoderatehyponatremia
Mildhyponatremiaisusuallydefinedasaserumsodium
concentrationbetween130and135meq/L.
Moderatehyponatremiaisoftendefinedasaserumsodium
concentrationbetween121and129meq/L.
Severehvponatremia
Severehyponatremiacanbedefinedasaserumsodiumof120
meq/Lorless.
Symptomsofhvponatremia
Absentsymptoms
Patientswithhyponatremiaarefrequentlyasymptomatic,particularly
ifthehyponatremiaischronicandofmildormoderateseverity(ie,
serumsodium>120meq/L).
However,suchpatientsmayhavesubclinicalimpairmentsin
mentationandgait.
Mildtomoderatesymptoms
Mildtomoderatesymptomsofhyponatremiaarerelatively
nonspecificandincludeheadache,nausea,vomiting,fatigue,gait
disturbances,andconfusion.
Inpatientswithchronichyponatremia(ie,>48hoursduration),these
findingsarenotassociatedwithimpendingherniation;however,in
patientswithmoreacutehyponatremia,suchsymptomsshouldbe
consideredominousandmayevolvewithoutwarningtoseizures,
respiratoryarrest,andherniation.
Severesymptoms
Severesymptomsofhyponatremiainclude
uSeizures
Obtundation
Coma
Respiratoryarrest.

---

1387.WhatistheNeutrophilcountfor
moderateneutropenia
a)<500/mm'
b)500-1000/mm'
c)>1000/mm3
d)100/mm3
CorrectAnswer-B
Ans.is'b'i.e.,500-1000mm'
MildneutropeniaIspresentwhentheANCis1000-
15000cells/?L
ModerateneutropeniaIspresentwithanANCof500-1000/4
SevereneutropeniaANClowerthan500cells/pL.
Theriskofbacterialinfectionisrelatedtoboththeseverityand
durationoftheneutropenia.

---

1388.KeratodermaBlenorrhagicaistypically
seenin
a)RheumatoidArthritis
b)PsoriaticArthritis
c)ReactiveArthritis
d)Ankylosingspondylitis
CorrectAnswer-C
AnswerisC(ReactiveArthritis):
KeratodermaBlenorrhagicaisthecharachteristicskinlesionseenin
patientswithReactiveArthritis.
'ThecharachteristicskinlesionsinReactiveArthritis,Keratoderma
Blenorrha2ica,consistofvesiclesthatbecomehyperkeratotic,
ultimatelyformingacrustbeforedisappearing.InpatientswithHIV
infection,theselesionsareoftenextremelysevereandextensive
sometimesdominatingtheclinicalpicture'-

---

1389.Keratoderma-Blenorrhagicumis
pathogno-monicof
a)Behcet'sdisease
b)Reiter'sdisease
c)Lyme'sdisease
d)Glucagonoma
CorrectAnswer-B
Ans.is'b'i.e.,Reiter'sdisease
KeratodermaBlenorrhagicaisthecharacteristicskinlesion
seeninpatientswithReactiveArthritis.
"TheCharacteristicskinlesionsinReactiveArthritis,Keratoderma
Blenorrhagica,consistofvesiclesthatbecomehyperkeratotic,
ultimatelyformingacrustbeforedisappearing.Theseareseenin
palmsandsoles.

---

1390.Goutcanbeprecipitatedbyallofthe
following
a)Thiazides
b)Furosemide
c)Cyclosporine
d)Highdosesalicylates
CorrectAnswer-D
Ans.is'd'i.e.,Highdosesalicylates
HighdoseSalicylatesareuricosuricanddonotcause
Hyperuricemia.
DiureticsincludingThiazidesandFurosemideareknowntocause
Hyperuricemia.CyclosporineandTacrolimusarealsoassociated
withHyperuricemia.
HighDosesofSalicylates>3.0g/dayareuricosuric,whileLow
doses(0.3to3.0g/day)areassociatedwithuricacidretentionand
Hyperuricemia.
Alsoknow
Causesofdrugordietinducedhvperuricemia.
Diuretics(thiazidesandloopdiuretics)
Cyclosporineandtacrolimus.
Lowdosesalicylates.
Ethambutol.
Pyrazinamide.
Ethanol.
Levodopa.
Methoxyflurane.
Laxativeabuse(alkalosis).
Saltrestriction.

---

---

1391.RelativeriskofdevelopingTBin
patientsalreadyinfectedwithTB
bacilusishighestin
a)Diabetes
b)Recentinfection
c)Posttransplantation
d)Malnutrition
CorrectAnswer-C
Ans.is'c'i.e.,Posttransplantation
RelativeriskofdevelopingT.B.
Post
20-
transplantation
70
HIV
30
Silicosis
30
Recentinfection
12
Diabetes
3-4
Malnutrition
2-3

---

1392.I.R.I.S.is
a)Immunereconstitutionidiopathicsyndrome
b)Immunereconstitutionimmunologicalsyndrome
c)Immunereconstitutioninflammatorysyndrome
d)Inflammatoryreconstitutionimmunesyndrome
CorrectAnswer-C
Ans.is'c'i.e.,Immunereconstitutioninflammatorysyndrome
CausesofbonemarrowsuppressioninpatientswithHIV
infection
HIVinfection Medications
Mycobacterial Zidovudine
infections
Fungal
Dapsone
infections
B19
parvovirus
Trimethoprim/Sulfamethoxazole
infection
Pyrimethamine
5-Flucytosine
Lymphoma
GanciclovirInterferona
Trimetrexate
Foscarnet

---

1393.Inrenalfailure,metabolicacidosisis
dueto
a)Increasedfrproduction
b)LossofHCO,
c)Decreasedammoniasynthesis
d)Useofdiuretics
CorrectAnswer-C
Ans.is'c'i.e.,Decreasedammoniasynthesis
ThepredominantreasonformetabolicacidosisinC.R.Eis
decreasedammoniaproduction.
Metabolicacidosisisacommondisturbanceinadvancedchronic
kidneydisease
Themajorityofpatientscanstillacidlytheurinebuttheyproduce
lessammoniaand,therefore,cannotexcretethenormalquantityof
protonsincombinationwiththisurinarybuffer.

---

1394.DiagnosticfeatureofCRFis
a)Broadcastsinurine
b)Elevatedbloodurea
c)Proteinuria
d)Bleedingdiathesis
CorrectAnswer-A
Ans.is'a'i.e.,Broadcastsinurine
Casts?
Urinarycastsareformedonlyinthedistalconvolutedtubulee(DCT)
orthecollectingdude(distalnephron).
Theproximalconvolutedtubuleandloopofhenlearenotthe
locationsforcastformation.
Castsare
formedthroughthesolidificationofmaterialsinthetubulesof
nephrons
Laterthematerialisflushedoutofthekidneyupontheproductionof
moreurineleavingasmallsolidifiedmicroscopiccylinderthatcan
alsocontainwhateverothermaterialsthatmightbewithinthe
tubulesofthekidneysatthetimeofcastformation.
Themicroscopicdetectionofvarioustypesofcastscanoftenbe
helpfuldiagnostictoolinthestudyofvarioustypesofrenaldiseases

---

1395.Eosinophilicmeningitisisseenwithall
except?
a)Coccidiomycosis
b)Cryptococcalmeningitis
c)Leptomeningealmetastasis
d)Helminthicinfections
CorrectAnswer-B
Ans.is'b'i.e.,Cryptococcalmeningitis
Causesofeosinophilicmeningitis
Infectious,parasiticcauses
Roundworm(nematode)infections-commonlypresentas
eosinophilicmeningitis
Angiotronglyluscantonensis-migratinglarvaeinherentlyneurotropic
Gnathostomaspinigerum-migratinglarvaeinvisceraland/orneural
tissues
Baylisascarisprocyonis-migratinglarvaeinherentlyneurotropic
Tapeworm(cestode)infections-maypresentaseosinophilic
meningitis
Cysticercosis-CystsdevelopinCNSand/orvisceraltissues
Fluke(trematode)infections-occasionallycauseeosinophilic
meningitis
Paragonimuswestermani-ectopicspinalorcerebrallocalization.
Schistosomiasis-ectopicspinalorcerebrallocalization.
Fascioliasis-ectopicCNSlocalization.
Otherroundworminfectionswhichoccasionallycause
eosinophilicmeningitis
Toxocariasis-migratinglarvae
Nonparasitic,infectiouscauses

---

Coccidioidomycosis
Cryptococcosis-CSFeosinophiliarare
Myiasis-withCNSpenetration
Virusandbacteria-areofuncertaincausality
Noninfectiouscauses
Idiopathichypereosinophilicsyndromes
Ventriculoperitonealshunts
LeukemiaorlymphomawithCNSinvolvement(Hodgkin's)
Nonsteroidalantiinflammatorydrugs
Antibiotics-ciprofloxacin,trimethoprim-sulfamethoxazole,
intraventriculargentamicinorvancomycin
Myelographycontrastagents

---

1396.Christmastreeappearanceofurinary
bladderisseenin
a)Neurogenicbladder
b)Stressincontinence
c)Autonomousbladder
d)Enuresis
CorrectAnswer-A
Ans.is'a'i.e.,Neurogenicbladder
Christmastreeappearanceofthebladderisseeninneurogenic
bladdercausedbydetrusorhyperreflexia.
Detrusorhyperreflexiaiscausedbylesionsofthespinalcordabove
thesacralsegmentsbutbelowthepons.Suchpatientshave
noperceptionofbladderfillingoremptyingandvoluntaryvoidingis
notpossible.
Voidingwhenitdoesoccurisinvoluntarywithsimultaneous
contractionsofthedetrusorandexternalsphinctermuscles.
Commonneurologicalconditionresultingindetrusorhyperreflexia
include
Multiplesclerosis
Myelodysplasia,
Spinalcordtrauma
Spinalcordtumours,
A-Vmalformationotthespinalcord
Radiologically,patientswithlongtermsuntreateddetrusor
hyperreflaxiahavecharacteristicchangesoftheurinarytact.
Bladderisverticallyoriented,withanirregularcontours,consistent
withtrabeculation.Therearefrequentlymultipeldiverticula,Sucha
bladderisreferredtoasachristmastree.

---

Automatic
Autonomous
bladder
bladder
Caudaequina
AboveT5or damage/
Lesionsite
higher
lowermotero
neuron
Smallspastic damageLarge
Manifestation bladder
flaccidbladder
Hasnourge
sensationand
urgecomes
continuous
againand
DRIBBLING
againdueto occurs,Soitis
repeated
likethe
Whythis
contractions bladderis
name
andhence
workingallthe
empties
timebutBrain
repeatedly
hasnocontrol
aftersome
overitand
time
hencecalled
autonomous
bladder
NoVURbut
Christmas
stillbladderis
Radiological tree
largeand
data
appearance
holdslotsof
residualurine

---

1397.Allofthefollowingaremorecommonly
seeninKlebsiellaPneumoniathanin
PneumococcalPneumonia,Except:
a)Lowerlobeinvolvement
b)AbscessFormation
c)PleuralEffusion
d)Cavitation
CorrectAnswer-A
TheanswerisA(LowerLobeInvolvement):
Pneumococcalpneumoniahasapredilectiontoinvolvetheright
lowerlobe,whereasKlebsiellausuallyaffectsoneoftheupper
lobes.
Features
Pneumococcal KlebsiellaPneumonia

Pneumonia

Consolidation ?LobarConsolidation
?LobarConsolidationwith
Pattern
withpositiveair
positiveair
bronchogramsign
bronchogramsign
Lobe
?Thepredilectionto
?Thepredilectionto
Predilection
involveLowerLobe
involveUpperLobe
(Anylobemaybe
(Anylobemaybe
involved)
involved)
?UsuallyUnilobar
?OftenMultilobar
(Usuallydonot
(Tendencytoexpand
expandinvolvedlobe)
involvedlobe)
?Abscessformation
?AbscessFormation
Abscess
uncommon
common
Pleural
?PleuralEffusion
?PleuralEffusion

---

Effusion
uncommon
common
Cavitation
?Cavitationisrare
?Cavitationiscommon

---

1398.MostcommonpatternofPneumonia
seeninKlebsiellainfectionis:
a)LobarPneumonia
b)Bronchopneumonia
c)InterstitialPneumonia
d)MiliaryPneumonia
CorrectAnswer-A
AnswerisA(LobarPneumonia):
ThemostcommonpatternofPneumoniaseeninKlebsiellainfection
isLobarPneumonia
StreptococcusPneumoniae(Pneumococcus)andKlebsiellaare
twocommonorganismsthatproducealobarpatternof
Pneumonia.
Theradiographicpatternofpneumonia.
Lobar
Lobular(bronchopneumonia)
Interstitial

---

1399.FriedlanderPneumoniarefersto
Pneumoniacausedby:
a)Klebsiella
b)Pneumococcus
c)H.lnfluenzae
d)Staphylococcus
CorrectAnswer-A
AnswerisA(Klebsiella):
KlebsiellaPneumoniaisalsoknownasFriedlanderPneumonia.
Klebsiellainitiallydescribedin1882byFriedlanderwasalsoknown
asFriedlander'sbacillus.CommunityacquiredPneumoniacaused
byFriedlander'sbacillus(Klebsiella)wastermedasFriedlander
Pneumonia.

---

1400.thediffusioncapacityoflung(DL)is
decreasedinallofthefollowing
conditionsexcept
a)Inerstitiallungdiseas
b)Goodpasture'ssyndrome
c)PneumocystisJiroveci
d)Primarypulmonaryhypertension
CorrectAnswer-B
Ans.is'b'i.e.,Goodpasture'ssyndrome
Gasdiffusiontests:
Gasdiffusiontestsmeasuretheamountofoxygenandothergases
thatcrossthealveoliintotheblood.
Thesetestsevaluatehowwellgasesarebeingabsorbedintothe
bloodfromlungs.Gasdiffusiontestsinclude.
Carbonmonoxidediffusingcapacity(transferfactorDLcy)
Arterialbloodgases
Carbonmonoxidediffusingcapacity(DL):
Thismeasureshowwellthelungtransfersasmallamountofcarbon
monoxideintotheblood0.
Normally,inthelung,agashastocrossthealveolarmembrane,
capillarymembranetoreachthebloodwhereitcombineswith
hemoglobin.
Soquietobviouslythediffusioncapacityofgasdependsupon
Drivingpressureofthegas
Surfaceareaofalveolarcapillarymembrane
Thicknessofalveolarcapillarymembrane
Diffusioncoefficientofthegas

---

Redbloodcellvolume.
Reactionratewithhemoglobinandhemoglobinlevelofpatient.
DegreeofV/Qmismatching.

---

1401.Ruptureofberryaneurysmmost
commonlyresultsin
a)Subarachnoidhemorrhage
b)Subduralhemorrhage
c)Extraduralhemorrhage
d)Intra-parenchymalhemorrhage
CorrectAnswer-A
Ans.is'a'i.e.,Subarachnoidhemorrhage
Mostcommoncauseof
Trauma
subarachnoidhemorrhage
Ruptureof
Berry
Mostcommoncauseof
aneurysm
spontaneoussubarachnoid (or
hemorrhage
Saccular
aneurysm)
Alsoknow
Mycoticaneurysm?
Mycoticaneurysmiscausedbyasepticembolusthatweakensthe
wallofthevesselinwhichitlodges.

---

1402.TargetBPbeforethrombolysisin
ischemicstrokeisbelow
a)185/110mmHg
b)165/100mmHg
c)145/100Hg
d)120/80mmHg
CorrectAnswer-A
Ans.is'a'i.e.,185/110mmHg
Recommendedtargetbloodpressurebeforethrombolysisinpatients
withischemicstrokeislessthan185/110mmHg.

---

1403.Themostcommoncauseofmalignant
adrenalmassis
a)Adrenocorticalcarcinoma
b)Malignantphaeochromocytoma
c)Lymphoma
d)Metastasisfromanothersolidtissuetumor
CorrectAnswer-D
Ans.is'd'i.e.,Metastasisfromanothersolidtissuetumor
Themostcommoncauseofadrenaltumorsismetastasisfrom
anothersolidtumorlikebreastcancerandlungcancer.
Malignant
Percentage
Adrenocorticalcarcinoma
2-5%
Malignant
<I%
pheochromocytoma
Adrenalneuroblastoma
<0-1%
Lymphomas(incl.primary
<1%
adrenalymphoma)
Metastases(mostfrequent:
15%
Breast,lung)

---

1404.Thedrugusedinthemanagementof
medullarycarcinomathyroidis
a)Cabozantinib
b)Rituximab
c)Tenofovir
d)Anakinra
CorrectAnswer-A
Ans.is'a'i.e.,Cabozantinib
Medullarythyroidcancers(MTCs)areneuroendocrinetumors
ofthyroidparaf011icularcellsthatdonotconcentrateiodine.
TheprimarytreatmentforMTCisextensiveandmeticuloussurgical
resection.
Thereisalimitedroleforexternal-beamradiotherapy.
Forpatientswithasymptomaticmetastatictumorsgenerally
lessthan1to2cmindiameter,growingindiameterlessthan
20percentperyear
Systemictherapyisnotrequired
Suchpatientsshouldbemonitoredfordiseaseprogression.Known
sitesofmetastaticdiseaseshouldbeimagedbyCTorMRIevery6
to12months,andpotentialnewsitesofdiseaseshouldbeimaged
every12to24months.
Forpatientswithmetastatictumorsatleast1to2cmindiameter,
growingbyatleast20percentperyear,orOrpatientswith
symptomsrelatedtomultiplemetastaticfocithatcannotbe
alleviatedwithsurgeryorexternalbeamradiotherapy
Administersystemictreatmentaspartofaclinicaltrial.
ForpatientswithmetastatictumorsatleastIto2cmindiameter,

---

growingbyatleast20percentperyear,or
forpatientswith.symptomsrelatedtomultiplemetastaticfoci
whocannotparticipateinaclinicaltrial

Anoraltyrosinekinaseinhibitor(TKI)issuggested,ratherthan
traditionalcytotoxicchemotherapy.
ForinitialTKItherapy
Cabozantiniborvandetanibratherthansorafeniborsunitinib.
Cytotoxicchemotherapy,ofwhichdacarbazine-basedregimens
suchascyclophosphamide-vincristinedacarbazinearepreferable,is
analternativeoptionforpatientswhocannottolerateorwhofail
multipleTKIs
Drugsusedinmedullarycarcinomathyroid
Tyrosine
Cvtotoxic
kinase
chemotherapy
inhibitors
Cabozanitib Cyclophosphamide
Vandetanib Vincristine
Sorafenib
Dacarbazine
Sunitinib

---

1405.Incorrectaboutcerebralsaltwasting
syndrome
a)Urinesodium>20mEq/d1
b)Hyponatremia
c)Fludrocortisoneisused
d)Expansionofplasmavolume
CorrectAnswer-D
Ans.is'd'i.e.,Expansionofplasmavolume
Cerebralsaltwastingsyndrome(renalsaltwasting)
Cerebralsaltwasting(CSW)ischaracterizedbyhyponatremiaand
extracellularfluiddepletionduetoinappropriatesodiumwastingin
theurineinthesettingofacutediseaseincentralnervoussystem
(CNS),usuallysubarachnoidhemorrhage.
CSWisamuchlesscommoncauseofhyponatremiainpatientswith
cerebralinjurythanthesyndromeofinappropriateADHsecretion
(SIADH).
ThepathophysiologyofCSWisrelatedtoimpairedsodium
reabsorption,possiblyduetothereleaseofbrainnatriuretic
peptideand/ordiminishedcentralsympatheticactivity.
Regardlessofthemechanism,sodiumwastingcanleadsequentially
tovolumedepletion,increasedADHrelease,hyponatremiadueto
theassociatedwaterretention,andpossiblyincreasedneurologic
injury.
Laboratoryfindings
Hyponatremiawithalowplasmaosmolality
Aninappropriatelyelevatedurineosmolality(above100
mosmol/kgandusuallyabove300mosmol/kg)
Aurinesodiumconcentrationabove40meq/L,and

---

Alowserumuricacidconcentrationduetouratewastinginthe
urine.
CSWmimicsallofthelaboratoryfindingsintheSIADH
TheonlycluetothepresenceofCSWratherthanSIADHisclinical
evidentofextracellularvolumedepletion,suchashypotensionand
decreasedskinturgor,and/orincreasedhematocrit,inapatientwith
aurinesodiumconcentrationabove40meq/L
UnlikeSIADH,volumerepletioninCSWleadstoadiluteurine,due
toremovalofthehypovolemicstimulustoADHrelease,and
subsequentcorrectionofthehyponatremia.
Treatment
IVhypertonicsalinesolutionsareemployedtocorrectintravascular
vloumedepletionandhyponatremiaandtoreplaceongoingurinary
sodiumloss
Flurocortisonepromotessodiumre-absorption

---

1406.A70kgadultmalepresentswithserum
sodiumof110meq/dl.Calculate
correctionrequiredin24hours
a)100mEq
b)200mEq
c)300mEq
d)400mEq
CorrectAnswer-D
Ans.is`d'i.e.,400mEq
Goalsoftherapyinhyponatremia
Inpatientswhoaretreatedtoincreasetheserumsodium,thegoal
ofinitialtherapyistoraisetheserumsodiumconcentrationby4to6
meq/Lina24-hourperiod.
Inpatientswhorequireemergencytherapy,thisgoalshouldbe
achievedquickly,oversixhoursorless;thereafter,theserum
sodiumcanbemaintainedataconstantlevelfortheremainderof
the24-hourperiodtoavoidoverlyrapidcorrection.
Everyeffortshouldbemadetokeeptheriseinserumsodium
lessthan9meq/Linanv24-hourperiod.
Ingeneral,thesamerateofrisecanbecontinuedonsubsequent
daysuntilthesodiumisnormalornearnormal.Therationalefor
theserecommendationsisasfollows:
Sodiumdeficit=TotalbodywaterxdesiredSNa-ActualSNa=.6x
70x120-110=420mEq
Treatmentofhvponatrentia
Aprviatitleaet_uIsuponriskstratification
Thefollowinggeneralapproachfortreatingpatientswith

---

hyponatremiaisbaseduponthedurationandseverityofthe
hyponatremiaanduponthepresenceandseverityofsymptoms:
Disposition
Patientswithacuteorhyperacutehyponatremia,mostpatientswith
severehyponatremia,andmanysymptomaticpatientswith
moderatehyponatremiashouldbetreatedinthehospital.
Incontrast,patientswithmildhyponatremiaandasymptomatic
patientswithmoderatehyponatremiausuallydonotrequire
hospitalization.
Emergencytherapy
Aggressivetherapytoraisetheserumsodiumassoonaspossible
(typicallywithhypertonicsaline)isindicatedinthefollowingsettings.
Patientswithseveresymptomsduetohyponatremia,suchas
seizuresorobtundation.
Patientswithacutehyponatremiawhohavesymptomsdueto
hyponatremia,evenifsuchsymptomsaremild.Becauseof
osmoticallydrivenwaterflowacrosstheblood-brainbarrier,an
acuteonsetofhyponatremiacanresultinlife-threateningcerebral
edema.Thus,evenmildsymptomsinacutehyponatremiapresenta
medicalemergencythatrequirespromptandaggressivetreatment
withhypertonicsalinetopreventbrainherniation.
Patientswithhyperacutehyponatremiaduetoself-inducedwater
intoxication,eveniftherearenosymptomsatthetimeofinitial
evaluation.Brainherniationhasbeenreportedinsuchpatients,and
theserumsodiummayworsenspontaneouslyduetodelayed
absorptionofingestedwater
Symptomaticpatientswhohaveeitheracutepostoperative
hyponatremiaorhyponatremiaassociatedwithintracranial
pathology.Aswithhyperacutehyponatremia,herniationmayoccur;
andtheserumsodiummaydecreasefurtherbecauseofabsorption
ofingestedwaterortheexcretionofhighconcentrationsofsodium
intheurine(desalination).

---

1407.Uricaseusedinthetreatmentofchronic
goutis
a)Allopurinol
b)Benzbromarone
c)Pegloticase
d)Methotrexate
CorrectAnswer-C
Ans.is'c'i.e.,Pegloticase
PegloticaseisarecombinantmammalianUricaselinkedto
polyethyleneglycol(PEG)approvedforthetreatment
ofHyperuricemiainpatientswithtreatmentrefractorygout.
PegloticasefacilitatestheconversionofUricacidintoallantoin,
whichisfarmoresoluble.Pegloticaseisapprovedforintravenous
administrationanditsuseisassociatedwithrapidandmarked
declineinserumuricacidlevels.
AgentsinhibitingIL-1actionareusedforthetreatmentof
refractoryGout
Anakinra
Canakinumab

---

1408.A14yearoldboypresentswitrecurrent
episodesofhepatitisOpthalmoscopic
evalutionrevealsKFringsandserum
ceruloplasminlevelsare<20mg/dl.
Thetreatmentofchoiceforinitial
therapyis
a)Zinc
b)Penicillamine
c)Tetrathromolybdate
d)Hepatictransplantation
CorrectAnswer-A
AnswerisA(Zinc)
PresenceofKFringsanddecreasedceruloplasminlevelssuggest
thediagnosisofWilson'sdisease.
Thepatientinquestionispresentingwithintialhepaticdisease
withoutanyevidenceofhepaticdecompensation.
Zincisthetherapyofchoiceforpatientswithhepatitisorcirrhosis
withoutevidenceofhepaticdecompensationorneuropsychiatric
symptoms.

---

1409.AllareseeninacuteHiVsyndrome
except
a)Diarrhoea
b)Pneumonia
c)Wightloss
d)Myelopathy
CorrectAnswer-B
Ans.is'b'i.e.,Pneumonia
ClinicalfindingsintheacuteHIVsyndrome
General
Neurologic
Dermatology rash
Fever
Meningitis
Erythematous
ulceration
Pharyngitis
Encephalitis
maculo-papular
Lymphadenopathy
Peripheral
Mucocutaneous
Headache/retroorbital
neuropathy
pain
Myelopathy
Arthralgias/myalgias
Lethargy/malaise
Anorexia/weightloss
Nausea/vomiting/diarrhea
[RefHarrison19th/ep.1249]

---

1410.Nephrocalcinosisisseeninallexcept
a)Polycystickidney
b)Hyperparathyroidism
c)Medullaryspongekidney
d)Renaltubularacidosis
CorrectAnswer-A
Ans.is'a'i.e.,Polycystickidney
CausesofNephrocalcinosis
Medullaryspongekidney
Hyperparathyroidism
Hypoparathyroidism
Renaltubularacidosis(specificallydistalRTA)
Renaltuberculosis
Renalpapillarynecrosis
Hyperoxaluria
Immobilization
Milk-alkalisyndrome
HypervitaminosisD
Sarcoidosis

---

1411.Roundpneumoniaisseenwith
a)Streptococcalpneumonia
b)Keroseneoilaspiration
c)Lungcancer
d)Mendelsonsyndrome
CorrectAnswer-A
Ans.is'a'i.e.,Streptococcalpneumonia
StreptococcusPneumoniae(pneumococcus)isthemostcommon
organismresponsibleforroundpneumonia.
RoundPneumoniaissphericalpneumoniathatisusuallyseenin
childrenduetothelackofcollateralairdrift.
StreptococcusPneumoniae(pneumococcus)isthemostcommon
organismresponsibleforroundpneumonia.
Roundpneumoniaisimportantastheymaysimulateatumormass
fromwhichtheymustbedifferentiated

---

1412.AnelderlymaleadmittedforPneumonia
presentswithdiarrheaandgripping
abdominalpainfivedaysafter
dischargefromthehospital.Drugwhich
islikelytobenefitis
a)Imodium
b)Metranidozole
c)Diphenoxylate
d)Levofloxacin
CorrectAnswer-D
Ans.is'd'i.e.,Levofloxacin
Developmentofpneumoniaandgastrointestinalsymptoms(diarrhea
&grippingabdominalpain)within10daysafterdischargefrom
hospitalhintstoapossiblediagnosisofLegionnaire'sdisease.The
drugsofchoiceforlegionnairs'sdiseaseincludeAzithromycinand
RespiratoryFluoroquinolonessuchaslevofloxacin,gatifloxacin,
GemifloxacinandMoxifloxacin
Itisacaseoflegionnaire'sdisease.
Legionnairesdiseaseusuallypresentsasatypicalpneumoniae.
Theuniquefeatureoflegionnairesdiseaseisthattheclinical
manifestationofthisdiseaseareusuallymoreseverethanthoseof
mostatypicalpneumoniasandthecourseandprognosisof
legionellapneumoniamorecloselyresemblethoseofbacteremic
pneumococcalpneumoniathanthoseofpneumoniaduetoother
organisms
Thinkaboutthediagnosisaslegionaire'sdiseasewheneverthe

---

questiontalksaboutapneumonialikepicturealongwithanyof
thefollowing-
Gastrointestinaldisturbancessuchasdiarrhoea.
Neurologicalabnormalitiessuchasconfusionandheadachealtered
sensorium.
Highfever(>40?Cor>104?F)
Numerousneutrophils,butnoorganismsrevealedbygram'sstaining
ofrespiratorysecretions.
Failuretorespondto$lactamdrugs(penicillinsandcephalosporins)
andaminoglycosideantibiotics.Hyponatremia(S.Na-<131meq/1)
Elevationinliverfunctiontests.
Occurrenceofillnessinanenvironmentinwhichthepotablewater
supplyisknowntobecontaminatedwithlegionella.
Onsetofsymptomswithin10daysofdischargefromhospital.
Occurenceofillnessinimmunocompromisedindividual

---

1413.Causesofhaemorrhagicpleural
effusionareallexcept
a)Pulmonaryinfarction
b)Mesothelioma
c)Bronchialadenoma
d)Tuberculosis
CorrectAnswer-C
Ans.is'c'i.e.,Bronchialadenoma
Causesofhemorrhagicpleuraleffusion
Trauma
Malignancy
Postpericardiotomysyndrome
Asbestosrelatedeffusion
Tuberculosis

---

1414.Followingischaracteristicneurologic
findinginprimaryamyloidosis
a)Peripheralmotorandsensoryneuropathy
b)Peripheralneuropathyassociatedwithcerebralmanifestation
c)Guillain-Barretypeofsyndrome
d)Spinalcordcompressioninthoracicregion
CorrectAnswer-A
Ans.is'a'i.e.,Peripheralmotorandsensoryneuropathy
ATTRusuallypresentsasasyndromeoffamilialamyloidotic
polyneuropathyorfamilialamyloidoticcardiomyopathy.
Peripheralneuropathyusuallybeginsasalower-extremitysensor
andmotorneuropathyandprogressestotheupperextremities.
Autonomicneuropathyismanifestbygastrointestinalsymptomsof
diarrheawithweightlossandorthostatichypotension.

---

1415.Reactivearthritisisusuallycausedby
a)Shigellaflexneri
b)Shigellaboydii
c)Shigelashiga
d)Shigeladysentriae
CorrectAnswer-A
Ans.is'a'i.e.,ShigellaFlexneri
OrganismsthathavebeenassociatedwithReiterArthritis
includethefollowing:
Ctrachomatis(L2bserotype)
Ureaplasmaurealyticum
Neisseriagonorrhoeae
Shigellaflexneri
SalmonellaentericaserovarsTyphimurium
Mycoplasmapneumoniae
Mycobacteriumtuberculosis
Yersiniaenterocoliticaandpseudotuberculosis
Campylobacterjejuni
Clostridiumdifficile
Beta-hemolytic(example,groupA)andviridansstreptococci

---

1416.DoseofrTPAinischaemicstrokeis
a)60mg
b)90mg
c)100mg
d)120mg
CorrectAnswer-B
Ans.is'b'i.e.,90mg
RecommendeddoseforthrombolysiswithIVTPAis0.9mg/kgwith
themaximumdosebeing90mg.10%shouldbegivenasabolus
overoneminute,followedbyremaining90%asacontinuous
infusionover60minutes.

---

1417.Cerebralangiographywasperformed
by
a)SirWalterDandy
b)GeorgeMoore
c)Seldinger
d)EgasMoniz
CorrectAnswer-D
Ans.is'd'i.e.,EgasMoniz
EgasMonizfirstperformedcerebralAngiographyin1927.nHe
receivedtheNobelPrizefordevelopingfordevelopingfrontal
leucotomyasatreatmentforpsychiatricdiseases.

---

1418.Mauriac'ssyndromeischaracterizedby
allexcept
a)Diabetes
b)Obesity
c)Dwarfism
d)Cardiomegaly
CorrectAnswer-D
Ans.isDi.e.,Cardiomegaly
MauriacSyndrome
ChildrenwithpoorlycontrolledtypeIdiabetesmaydevelopMauriac
syndrome.Itischaracterizedby:-
Growthattenuation
Delayedpuberty
Hepatomegaly
Abnormalglycogenstorageandsteatosis
Cushingoidfeatures
Rareinthemoderneraofinsulintherapybutisoccasionally
reported.

---

1419.Whichofthefollowingisassociated
withhyponatremiaandlowosmolality
a)Hyperlipidemia
b)SIADH
c)CHF
d)CKD
CorrectAnswer-C
Ans.is'c'i.e.,CHF
CHFischaracterisedbylowperfusionofkidneysstimulating
R.A.A.Sandresultantabsorptionofsaltanddisproportionateamout
ofwaterwouldleadtohyponatremiawithdecreasedosmolality.
Isotonichyponatremiaisseenwithhyperlipidemiaand
hvperproteinemialikeinparaproteinemia.
Intravenousimmunoglobulintherapyalsointerfereswith
measurementofserumsodium.
Majorcausesofhyponatremia
DisordersinwhichADHlevelsareelevated
Effectivecirculatingvolumedepletion
Truevolumedepletion
Heartfailure
Cirrhosis
Thiazidediuretics
SyndromeofinappropriateADHsecretion,includingresetosmostat
pattern
Hormonalchanges
Adrenalinsufficiency
Hypothyroidism
Pregnancy

---

DisordersinwhichADHlevelsmaybeappropriately
suppressed
Advancedrenalfailure
Primarypolydipsia
Beerdrinker'spotomania
Hyponatremiawithnormalorelevatedplasmaosmolality
Highplasmaosmolality(effectiveosmols)
Hyperglycemia
Mannitol
Highplasmaosmolality(ineffectiveosmols)
Renalfailure
Alcoholintoxicationwithanelevatedserumalcohloconcentration
Normalplasmaosmolality
Psedohyponatremia(laboratoryartifact)
Hightriglycerides
Chloestaticandobstructivejaundice(lipoproteinx)
Multiplemyeloma
Absorptionofirrigantsolutions
GlycineSorbitolMannitol

---

1420.Bencejonesproteinuriaisbest
detectedby
a)Dipstickmethod
b)Sulfosalicylicacid
c)Heattest
d)Electrophoresis
CorrectAnswer-D
Ans.is`d'i.e.,Electrophoresis
BenceJonesproteinsareseeninmultiplemyeloma.
Urinaryproteinelectrophoresiswillexhibitadiscreteproteinpeak.
Inmyelomaplasmacellsproduceimmuno-globulinofasingleheavy
andlightchain,amonoclonalproteincommonlyreferredtoasa
paraprotein.
Heattestisfalsenegativein50%ofpatientswithlightchain
myeloma.
Dipstickdetectsalbuminandnotparaproteins.

---

1421.Whichofthefollowingstatements
aboutHematochromatosisisnottrue
a)Hypogonadismmaybeseen
b)Arthropathymayoccur
c)DiabetesMellitusmaydevelop
d)Desferrioxamineistreatmentofchoice
CorrectAnswer-D
AnswerisD(Desferrioromineistreatmentofchoice):
Thetherapyofhematochromatosisinvolvesremovalofexcessbody
iron.
Ironremovalisbestachievedbyperiodicphlebotomieswhichisthe
treatmentofchoiceforHematochromosis.
Chelatingagentslikedesferoxaminearelesseffectiveandindicated
whenanemiaorhypoproteinemiaissevereenoughtopreclude
phlebotomy.
Chelatingagentsarenotthetreatmentofchoicefor
Hematochromatosis.

---

1422.HIVRNAbyPCRcandetectaslowas
a)30copiesviralRNA/mlofblood
b)40copiesviralRNA/mlofblood
c)50copiesofviralRNA/mlofblood
d)60copiesofviralRNA/mlofblood
CorrectAnswer-B
Ans.is'b'i.e.,40copiesviralRNA/mlofblood
ThisassaygeneratesdataintheformofnumberofcopiesofHIV
RNApermillilitreofserumorplasmaandcanreliablydetectasfew
as40copiesofHIVRNApermililitreofplasma.
Researchbasedassaycandetectdowntoonecopy/ml.

---

1423.Biomarkernotinvolvedinacutekidney
injuryis
a)NGAL
b)KIM1
c)MicroRNA122
d)CystatinC
CorrectAnswer-C
Ans.is'c'i.e.,MicroRNA122
Biomarkersofacutekidneyinjury
Alanineaminopeptidase(AAP)
Alkalinephosphatase(AP)
a-glutathione-S-transferase(a-GST)
y-glutamyltranspeptidase(yGT)
N-acetyl-13-glucosaminidase(NAG)
pfmicroglobulin
aimicroglobulin
Retinol-bindingprotein(RBP)
CystatinC
Microalbumin
Kidneyinjurymolecule-1(KIM-1)
Clusterin
Neutrophilgelatinaseassociatedlipocalin(NGAL)
Interleukin-18(IL-18)
Cysteine-richprotein(CYR-61)
Osteopontin(OPN)
Fattyacidbindingprotein(FABP)
Sodium/hydrogenexchangerisoform(NHE3)
Exosomalfetuin-A

---

---

1424.Mostcommonsiteofcerebralinfarction
isintheterritoryof
a)Anteriorcerebralartery
b)Middlecerebralartery
c)Posteriorcerebralartery
d)Posteriorinferiorcerebellarartery
CorrectAnswer-B
Ans.is'b'i.e.,Middlecerebralartery
Hemiplegiamostcommonlyoccursduetolesionofmiddlecerebral
artery

---

1425.Hemiplegiaismostoftencausedby
thrombosisof?
a)Anteirorcerebralartery
b)Middlecerebralartery
c)Posteriorcerebralartery
d)Basiliarartery
CorrectAnswer-B
Ans.is'b'i.e.,Middlecerebralartery
MiddleCerebralArtery
Deepbranchesofthemiddlecerebralarteryonthelenticulostriate
branchessupplytheinternalcapsule(posteriorlimb).
Motortractsaredenselypackedinthisregionandhenceocclusion
ofdeepbranchesorlenticulostrialsbranchesleadstoDensse
Hemiplegia/PuremotorHemiplegia.
Anteriorchoroidalarterysuppliestheposteriorlimbofinternal
capsule(andnotanteriorlimbofinternalcapsule).
Anteriorchorodialarteryarisesfromtheinternalcarotidarteryand
suppliestheposteriorlimbofinternalcapsule.Thecomplete
syndromeofanteriorchoroidalarteryocclusionconsistsof
contralateralhemiplegiahemianesthesia(hypoesthesia)and
homonymoushemianopia
PosteriorCerebralArtery
Theposteriorcerebralarterysuppliesthemidbrain,thalamuslateral
geniculatebodies,posteriorofchroidplexus,occipitallobes,inferior
andmedialaspectofthetemporallobeandposteriorinferiorareas
oftheparietallobe
OcclusionofthePosteriorCerebralArteryusuallyresultsin
twocommonclinicalsyndromedependingontheareas

---

involved
P1Syndrome
P2Syndrome
Occlusionof
the
Occlusionofthe
distalsegment
proximalsegment
ofPCA
ofPCAfromitsoriginto distaltothe
itsunionwiththe
junctionof
posterior
PCAwith
communicatingartery
theposterior
communicating
artery
P2syndrome
P1syndromepresent
presents
primarilywiththe
primarily
followingsigns
withthe
followingsigns
Temporallobe
Midbrainsigns
signs
Thalamicsigns
Occipitallobe
Subthalamicsigns
signs

---

1426.TruestatementaboutPneumocystic
Jiroveciis:
a)OftenassociatedwithCMVinfection
b)Usuallydiagnosedbysputumexamination
c)Infectionoccursonlyinimmunocompromisedpatients
d)AlwaysassociatedwithPneumatocele
CorrectAnswer-B
PneumocystisJiroveciisusuallydiagnosedbysputumexamination.
Ref:MedicalMicrobiologyByJawetz,24thEdition,Pages648-49;
WashingtonManualofPulmonaryMedicine,2006,Page104;
PneumocystisPneumoniaByWalzer,Cushion,3rdEdition,Page
418;Harrison'sPrinciplesofInternalMedicine,16thEdition,Pages
1194-95

---

1427.Indicationforprophylaxisin
pneumocystiscarinipneumoniainclude
a)CD4count<200
b)Tuberculosis
c)Viralload>25,000copies/ml
d)Oralcandidiasis
CorrectAnswer-A
Ans.is'A'i.e.,CD4count<200
PROPHYLAXISOFPNEUMOCYSTICCARINIPNEUMONIA
Primaryprophylaxisisindicatedfor
PatientswithCD4-cellcountsof<200/4
Historyoforopharyngealcandidiasis
Secondaryprophylaxisisindicatedfor
BothHIVinfectedandnon-HIVinfectedpatients.
Whohasrecoveredfrompneumocystosis
PrimaryandsecondaryprophylaxismaybediscontinuedinHIV
infectedpersonsonce.
CD4+countshaverisento>200/p1andremainedatthatlevelfor3
months.
Alsoknow
Firstchoiceagentforprophylaxis
Trimethoprim,sulphamethoxazole.
Otheragentsusedinprophylaxis.
Dapsone,pentamidine.

---

1428.CVjunctionabnormalitiesareseenin
allofthefollowingexcept
a)Rheumatoidarthritis
b)Ankylosingspondylitis
c)Odontoiddysgenesis
d)Basilarinvagination
CorrectAnswer-B
Answer-B.Ankylosingspondylitis
Developmentalandacquiredabnormalities
Atlantoaxialinstability
1. Errorsofmetabolism(e.g.Morquio'ssyndrome)
2. Infections(e.g.Grisel'ssyndrome)
3. Inflammatory(e.g.rheumatioidarthritis,Psoriasis,Ankylosing
Spondylitis)
4. Traumaticatlanto-axialdislocation,Atlantal-dislocation,Down
syndrome
5. Malignancy(e.g.Chordoma,Plasmacytoma,Osteoblastoma,
Neurofibromatosis)
6. Degenerative(e.g.fetalwarfarinsyndrome,Conradi'sSyndrome,
Goldenharsyndrome

---

1429.Mostcommoncauseofunilateralpedal
edema
a)Pregnancy
b)Lymphedema
c)Venousinsufficiency
d)Milroydisease
CorrectAnswer-C
Ans.is'c'i.e.,Venousinsufficiency
Themostlikelycauseoflegedemainpatientsoverage50is
venousinsufficiency.
Venousinsufficiencyaffectsupto30%ofthepopulation,whereas
heartfailureaffectsonlyapproximately1%.
Themostimportantcauseofunilateralpedaledemaisvenous
insufficiency.
Milroysdisease:
ThedefectinMilroy'sdiseaseispresentfrombirthandsymptoms
areusuallyfirstexperiencedinchildhood.
Themostcommonproblemisone-sidedlegswelling,unilateral
edema,whichisprogressiveandcanaffectbothlegs.
Impairedintestinallymphaticscancausesteatorrheadueto
impairedtransportofchylomicrons

---

1430.Allofthefollowingstatementsabout
PulsusBigeminusaretrue,except:
a)MustbedistinguishedfromPulsusAlternans
b)Isasignofdigitalistoxicity
c)Compensatorypauseisabsent
d)RhythmisIrregular
CorrectAnswer-C
AnswerisC(Compensatorypauseisabsent):
PulsusBigeminusisassociatedwithacompensatoryPause.
CompensatorypauseisabsentinPulsusAlternans
PulsusBigeminusisadisorderofrhythm(Irregularrhythm)caused
byanormalheatalternatingwithaprematurecontractionanda
compensatorypauseresultinginalternationofthestrengthofpulse.
Thestrokevolumeoftheprematurebeatisdiminishedinrelationto
thatofthenormalbeats,andthepulsevariesinamplitude
accordingly.PulsusBigeminusmostcloselymimicsPulsus
Alternansfromwhichitmustbedistinguished.InPulsusAlternans
therhythmisregularandthecompensatorypauseisabsent.

---

1431.PulsusBigeminusisseenintherapy
with:
a)Digitalis
b)BetaBlockers
c)ACEInhibitors
d)CalciumChannelBlockers
CorrectAnswer-A
AnswerisA(Digitalis)
PulsusBigeminusisrecognizedasacauseofdigitalistoxicity.
PulsusBigeminusisadisorderofrhythm(Irregularrhythm;
arrhythmia)mostcommonlycausedbyPrematureVentricular
Contractionsthatresultsinapulsewithirregularrhythmthat
alternatesinamplitude(pressure)frombeattobeat.Themost
commoncauseofPulsusBigeminusisDigitalisandPulsus
Bigeminusisrecognizedasacauseofdigitalistoxicity.

---

1432.Whichisbestforplaquemorphology
a)CCTA
b)MRI
c)CMR
d)IVUS
CorrectAnswer-A
Ans.is'a'i.e.,CCTA
Coronarylesionspronetorupturehaveadistinctmorphology
comparedwithstableplaques,andprovideauniqueopportunityfor
noninvasiveimagingtoidentifyvulnerableplquesbeforetheyleadto
clinicalevents.Thiscanbeachievedusinganon-invasivecardiac
imagingusingcoronaryCTangiography.
oLargeplaquevolume,lowCTattenuation,napkin-ringsign,
positivere-moedlling,andspottycalcificationareallassociatedwith
ahighriskofacutecardiovasculareventsinpatients.Intravascular
USGcangivecomparableresultsbutisaninvasivetest

---

1433.Mostcommoncauseofheartblockin
infantsis
a)SLE
b)Surgeryforcongentitalheartdisease
c)Viralmyocarditis
d)Rheumaticfever
CorrectAnswer-B
Ans.is'b'i.e.,Surgeryforcongentitalheartdisease
Inchildren,themostcommoncauseofpermanentacquired
completeAVblockissurgeryforcongenitalheartdisease.
Postsurgicalcompleteratrioventricularblock(AVB)isthemost
commoncauseforacquiredAVblockinchildren,resultingfrom
traumatotheAVnodeattimeofsurgery(i.e.,hemorrhage,
ischemia,necrosis,inflammation,traumaticdisruption).
Thesecondmostcommoncauseiscongenitalheratdisease
associatedwithcompleteAVblock.
OtheretiologiesofacquiredAVblockareoftenreversibleand
include:
Digitalisandotherdrugintoxications.
Viralmyocarditis.
Acuterheumaticfever,Lymedisease,andinfectiousmononucleosis.

---

1434.S2isbestappreciatedin:
a)3rdleftintercostalspace
b)2ndrightintercostalspace
c)4thleftintercostalspace
d)5leftintercostalspace
CorrectAnswer-A
AnswerisA(3rdleftintercostalspace)
Bestareastoauscultateforbothcomponentsofthesecondheart
sound(A2andP2)areeithertheleftsternalborderatthelevelof
secondintercostalspace(Pulmonicarea)ortheleftsternalborderat
thelevelofthirdintercostalspace(Erb'spoint).
ThesecondheartsoundhastwocomponentsA2(fromAortic
closure)andP2(frompulmonaryclosure).P2isasoftsoundthatis
poorlytransmitted.Itisbestheardatthepulmonicareaandis
transmittedonlyasfarastheErb'spoint.A2isaloudsoundbest
heardovertheaorticareabutsinceitiswidelytransmitteditmaybe
heardacrossallareasofthechestevenasfarastheapex.Second
heartsound(S2)isbestheardoverthepulmonicarea(Sinceboth
A2andP2canbeheardatthepulmonicarea).Notethatevenatthe
pulmonicareaA2islouderthanP2.Theotherareatoauscultatefor
bothcomponentsofthesecondheartsoundisattheleftsternal
borderofthethirdintercostalspace(Erb'spoint)

---

1435.Rytand'smurmurisseenin
a)A-VBlock
b)Mitralstenosis
c)Aorticstenosis
d)Aorticregurgitation
CorrectAnswer-A
Ans.is'a'i.e.,A-VBlock
RytandMurmur
Rytan'smurmurismid-diastolic(orlate-diastolic)murmurthatis
heardinpatientswithcompleteartioventricularheartblock.
Rytand'smurmurisbestheardattheapexandmaybe
confusedwithmitralstenosis.
Theslowheartrate,variabledurationofthemurmurchanging
intensityoftheSIandlackofopeningsnaparehelpful
Alsoknow
CareyCoombsmurmurRheumaticfever
AustinFlintmurmurAorticregurgitation
Graham-SteelmurmurPulmonaryregurgitation
RytandsmurmurCompleteheartblock
DocksmurmurLeftAnteriorDescending
(LAD)arterystenosis
MillwheelmurmurDuetoairemboli(airinPV
cavity)

---

1436.Mostcommonmechanismof
arrhythmia?
a)Re-entry
b)Earlyafterdepolarization
c)Lateafterdepolarization
d)Automaticity
CorrectAnswer-A
Answer-A.Re-entry
Re-entryappearstobebasisformostabnormalsustainedSupra
VentricularTachycardias(SVTs)andVTs.
Examplesofre-entryare:-
VFduetoacutemyocardialischemiaand

---

1437.-30to-90degreeaxisdeviation
indicates
a)LeftAxisDeviation
b)RightAxisDeviation
c)ExtreneRightAxisDeviation
d)NormalCardiacAxis
CorrectAnswer-A
Ans.is'a'i.e.,LeftAxisDeviation
Cardiacaxis
Theelectricalsignalrecordedontheelectrocardiogram(ECG)
containsinformationrelativetodirectionandmagnitudeofthe
variouscomplexes.
Theaveragedirectionofanyofthecomplexescanbedetermined.
NormalCardiacAxis
ThenormalQRSelectricalaxis,asestablishedinthefrontalplane,
isbetween-30and90?(directeddownwardorinferiorandtotheleft)
inadults.
LeftAxisDeviation
Anaxisbetween-30?and-90?(directedsuperiorandtotheleft)is
termedleftaxisdeviation.RightAxisDeviation
Iftheaxisisbetween90?and180?(directedinferiorandtothe
right),thenrightaxisdeviationispresent.ExtremeRightAxis
Deviation
Anaxisbetween-90'and-180?(directedsuperiorandtotheright)is
referredtoasextremerightorleftaxis.Indeterminate
IftheQRSisequiphasicinallleadswithnodominantQRS
deflection,itisindeterminateaxis.
Causesofaxisdeviationinclude

---

Rightaxis
Leftaxisdeviation
deviation
Normalvariation Normalvariation(physiologic,
(verticalheartwith oftenwithage)
anaxisof90?)
Mechanicalshifts, Mechanicalshifts,suchas
suchas
expiration,highdiaphragm
inspirationand
(pregnancy,ascites,abdominal
emphysema
tumor)
Rightventricular
Leftventricularhypertrophy
hypertrophy
Leftposterior
Leftbundlebranchblock
fascicularblock
Dextrocardia
Leftanteriorfascicularblock
Congenitalheartdisease(prim
Ventricularectopic umatrialseptalHefect,
rhythms
endocardialcushiondefect)
Ventricularectopic Emphysema
rhythms
Pre-excitation
syndrome(Wolff- Hyperkalemia
Parkinson-White
Lateralwall
myocardial
Ventricularectopicrhythms
infarction
Secundumatrial
Pre-excitationsyndromes
septaldefect
(Wolff-Parkinson-White
Inferiorwallmyocardial
infarction

---

1438.LeftAxisDeviationisseenas
a)PositiveinLeadIandPositiveinLeadII
b)PositiveinLeadIandNegativeinLeadII
c)NegativeinLeadIandNegativeinLeadII
d)NegativeinLeadIandpositiveinLeadII
CorrectAnswer-B
AnswerisB(PositiveinLeadIandNegativeinLeadII)
LeftaxisdeviationisseenaspositivedeflexioninLeadIanda
NegativedeflectioninLeadII.
Calculatingthecardiacaxis:
Rightaxis
Leftaxis

NormalAxis
deviation
deviation
LeadI
Positive
Negative
Positive
Positiveor
LeadII
Positive
Negative
negative
Positiveor
LeadIII
Positive
Negative
negative
Note:
LeadI:POSITIVEBETWEEN-90TO+90(CLOCKWISE)LeadII:
POSITIVEBETWEEN-30TO+150(CLOCKWISE)LeadIII:
POSITIVEBETWEEN+30TO-150(CLOCKWISE)

---

1439.LBBBisseenwithallexcept
a)AcuteMI
b)Ashmannsyndrome
c)Hypokalemia
d)Hyperkalemia
CorrectAnswer-C
Ans.is'c'i.e.,Hypokalemia
CausesofLBBBare:-
Aorticstenosis
Ischaemicheartdisease
Hypertension
Dilatedcardiomyopathy
AnteriorMI
Primarydegenerativedisease(fibrosis)oftheconductingsystem
(Lenergredisease)
Hyperkalaemia
Digoxintoxicity
Ashmannphenomenon(hasbothLBBBandRBBB)
AtrialfibrillationhasanarrowcomplexqRSbutAshmann
phenomenonseeninatrialfibrillationischaracterizedbybroad
complexqRSwithusuallyaRBBBmorphology.Thusifanimpulse
landsonthebundleofHISandfindstherightbundlerefractorythen
RBBBwilloccur.Alsorememberthattherefractoryperiodofright
fascicleixmorethanthatoftheleftfascicleresultinginRBBBmostly
inthesepatients.
ECGfindingsofLBBB
Normallytheseptumisactivatedfromlefttoright,producingsmallQ
wavesinthelateralleads.InLBBB,thenormaldirectionofseptal

---

depolarisationisreversed(becomesrighttoleft),astheimpulse
spreadsfirsttotheRVviatherightbundlebranchandthemtothe
LVviatheseptum.
ThissequenceofactivationextendstheqRSdurationto>120ms
andeliminatesthenormalseptalQwavesinthelateralleads.
Theoveralldirectionofdepolarisation(fromrighttoleft)produces
tallRwavesinthelateralleads(IaVLV5V6)deepSwavesinthe
rightprecordialleads(V4R)andusuallyleadstoleftaxisdeviation.
Astheventriclesareactivatedsequentially(right,thenleft)rather
thansimultaneously,thisproducesabroadornotched(`W-shaped)
Rwaveinthelateralleads.
Non-concordanceinSTsegmentandTwavechanges.
Thepointisthatthetwofascilesofbundleofhishavedifferent
refractoryperiodswiththerightfasciclehavinghigherrefractory
periodthantheleft.
ThismeansthatifanimpulselandsonthebundleofHISandfinds
therightbundlerefractorythenRBBBwilloccur.
Inatrialfibrillationbecauseoffasterconduction,normallywesee
narrowcomplexqRSbutsometimeswemayseebroadcomplex
qRSalsowhichistechnicallycalledAshmannphenomenon.
MostlyinAshmannphenomenonRBBBisseenbasedonthe
physiologicalprincipleofrefractoryperiodofrightfasciclemorethan
theleftone.However,rarelyLBBBcanalsobeseeniftheimpulse
landstofindtheleftfasciclerefractory.IrrespectiveofRBBBor
LBBB,broadcomplexqRSwilloccurincaseofatrialfibrillationand
AshmannphenomenonisoccurrenceofbroadcomplexqRSinatrial
fibrillationandnottheoccurrenceofRBBBasisthepopular
perception.
Hyperkalemiacancausedefectiverepolarizationandhencecause
Bundlebranchblockthatculminatesinsinewavepattern.
InacuteMI,ischemiacandamagetheleftbundleleadingtoLBBB.

---

1440.Apatientinregularrhythmpresents
withabsentPwavesonECG.LeadsII,
IIIandAVFrevealaSaw-ToothPattern.
Whichofthefollowingisthemostlikely
diagnosis:
a)AtrialFibrillation
b)AtrialFlutterwithVariableBlock
c)AtrialFlutterwithFixedBlock
d)MultifocalAtrialTachcardia
CorrectAnswer-C
AnswerisC(AtrialFlutterwithFixedBlock)
TheabsenceofanydiscerniblePwavesonECG,togetherwiththe
presenceofSawToothFlutterwavesininferiorleads(LeadsII,III
andAVF)stronglysuggestsadiagnosisofAtrialFlutter.The
presenceofaregularrhyti,,osuggestsaFixedBlock.
Findings/Features
Diagnosis
IrregularRhythmwithnodiscerniblePwave
AtrialFibrillation
(Chaoticbaselinewithfibrillaryfwaves)
IrregularrhythmwithnodiscerniblePwave
AtrialFlutterwith
(Sawtooth,Ilutterwavesespeciallyininferior variableblock
leadsandVI)
RegularrhythmwithnodiscerniblePwaves
AtrialFlutterwith
(Sawtoothflutterwavesespeciallyininferior fixedblock
leadsandV1)
IrregularRhythmwithmultiplePwave
MultifocalAtrial
morphologies(PwavesDiscernible)
Tachycardia
andVaryingPRintervals

---

andVaryingPRintervals

---

1441.AwideandnotchedPwaveistypically
seenin:
a)MitralStenosis
b)Cor-Pulmonale
c)COPD
d)Pulmonaryembolism
CorrectAnswer-A
AnswerisA(MitralStenosis)
MitralStenosisistypicallyassociatedwithaWideandNotchedP
wavefromLeftAtrialEnlargement(LAE)Cor-Pulmonale,COPDand
PulmonaryembolismareallassociatedwithRightAtrial
EnlargementresultinginaTallPwave(notawidepwave)

---

1442.Wrongabourcontinuousmurmur
a)Seenwithcoarctationofaorta
b)PeaksatS2
c)Heardbothinsystoleanddiastole
d)Increaseonsquatting
CorrectAnswer-D
Ans.is'd'i.e.,Increaseonsquatting
Acontinuousmurmurisdefinedasonethatbeginsinsystoleand
extendsthroughS2intopartorallofdiastole.
Itneednotoccupytheentirecardiaccycle.
Continuousmurmursarenotaffectedbydynamicauscultation
maneuverslikesquattingetc.
Theycanofternbedifficulttodistinguishfromindividualsystolicand
diastolicmurmursinpatientswithmixedvalvularheartdisease.
Theclassicexampleofacontinuousmurmuristhatassociatedwith
apatentductusarteriosus,whichusuallyisheardinthesecondor
thirdinterspaceataslightdistancefromthesternalborder.

---

1443.Bananashapedleftventricleisseenin
a)HOCM
b)DCM
c)RCM
d)Takotsubocardiomyopathy
CorrectAnswer-A
Ans.is'a'i.e.,HOCM
Spherical Dilated
ventricle
cardiomyopathy
Stress
Apical
cardiomyopathy/
ballooning Tako-Tsubo
Spade-
Apicalhypertrophic
shaped
cardiomyopathy
ventricle
Myocardial
Distortion infarctions/
ofventricle aneurysms/
remodeling
Banana-
Hypertrophic
shaped
cardiomyopathy
ventricle

---

1444.AQRSdurationbetween100and120
millisecondssuggestsallofthe
following,Except:
a)Normal
b)LeftanteriorFascicularBlock
c)LeftposteriorFascicularBlock
d)LeftBundleBranchBlock
CorrectAnswer-D
AnswerisD(LeftBundleBranchBlock)
LeftBundleBranchblockistypicallyassociatedwithaQRSduration
greaterthan120milliseconds.
PartialBlocks(Fascicularorhemiblocks)intheleftbundlesystem
(leftanteriororposteriorfascicularblocks)generallydonotprolong
theQRSdurationsubstantiallyandQRSdurationtypicallyremains
lessthan120milliseconds.

---

1445.WideQRScomplex0.12secondsmay
beseeninallofthefollowing,except
a)Hyperkalemia
b)WolfParkinsonWhiteSyndrome
c)VentricularTachycaridia
d)LeftAnteriorFascicularBlock
CorrectAnswer-D
Ans.is'd'i.e.,LeftAnteriorFascicularBlock
LeftAnteriorFascicularBlockisapartialblockintheleftbundle
systemanddoesnotprolongtheQRSduration
significantly.TypicallytheQRSdurationisslightlyprolongedand
remainsbetween0.10to0.12seconds.
MajorcausesofawideORScomplex
IntrinsicintraventricularconductiondelayoLeftbundlebranchblock
andvariants
RightbundlebranchblockandvariantsoOthernonspecificIVCD
patterns
Extrinsicintraventricularconductiondelay
Hyperkalemia
Drug-induced-type1antiarrhythmicdrugsandrelatedsodium
channelblockingagents(eg,tricyclicantidepressantsand
phenothiazines)
VentricularbeatoPrematureoEscape
Paced
Ventricularpreexcitation
Wolff:Parkinson-White(WPW)patternandvariants
Factitious
ECGunintentionallyrecordedatfastpaperspeeds(50or100mm/s)

---

WideQRScomplextachyarrhythmias
Ventriculartachycardia
Supraventriculartachycardiaoratrialfibrillationorflutterwith
aberrantintraventricularconductiondueto:
Bundlebranchblock
Atrioventricularbypasstract(preexcitationsyndromeswith
orthodromicconduction

---

1446.WideQRScomplexistypicallyseenin
a)BundleBranchblock
b)Sicksinussyndrome
c)MobitztypeIblock
d)MobithztypeIIblock
CorrectAnswer-A
Ans.is'a'i.e.,BundleBranchblock
Repeatfromprevioussession.
Intrinsicintraventricularconductiondelayssuchasleftbundleblock
andrightbundlebranchblockareassociatedwithwideQRS
complex.

---

1447.STelevationisseeninallofthe
followingconditionsexcept:
a)Myocardialinfarction
b)Coronaryarteryspasm
c)Constrictivepericarditis
d)Ventricularaneurysm
CorrectAnswer-C
AnswerisC(Constrictivepericarditis)
STsegmentismeasuredfromtheendofQRScomplextothe
beginningoftheTwave,andrepresentsthetimeintervalbetween
ventriculardepolarizationandrepolarization.

---

1448.InvertedTwavesareseenin
a)Hyperkalemia
b)Hyperthermia
c)Wellensyndrome
d)Coronarysyndrome
CorrectAnswer-C
Ans.is'c'i.e.,Wellensyndrome
SevereanteriorwallIschemia(withorwithoutinfarction)maycause
prominentT-waveinversionsintheprecordialleads.Thispattern
(sometimesreferredtoasWellensT-waves)isusuallyassociated
withahigh-gradestenosisoftheleftanteriordescendingcoronary
artery.
HyperkalemiahastallTentedT-waves.
CoronarysyndromeXischaracterisedbyblockageofperforators
whiletheepicardialcoronaryarteryisnormal.Inthesepatients
stentingofcoronariesisnotuseful.Nitratesaremainstayoftherapy.

---

1449.LowQRSvoltageonECGindicates?
a)Pulmonaryembolism
b)Pericardialeffusion
c)Corpulmonale
d)Infectiveendocarditis
CorrectAnswer-B
Ans.is'b'i.e.,Pericardialeffusion
CausesoflowvoltageQRScomplexes
Adrenalinsufficiency
Anasarca
Artifactualorspurious,eg,unrecognizedstandardizationofECGat
one-halftheusualgain(i.e.,5mm/mv)
Cardiacinfiltrationorreplacement(e.g.,amyloidosis,tumor)
Cardiactransplantation,especiallywithacuteorchronicrejection
Cardiomyopathy,idiopathicorsecondary
Chronicobstructivepulmonarydisease
Constrictivepericarditis
Hypothyroidism,usuallywithsinusbradycardia
Leftpneumothorax(mid-leftchestleads)
Myocardialinfarction,extensive
Myocarditis,acuteorchronic
Normalvarian
Obesity
Pericardialeffusion
Pericardialtamponade,usuallywithsinustachycardia
Pleuraleffusions

---

1450.Whichofthefollowingiscauseof
RBBB
a)Itcanoccurinanormalperson
b)Pulmonaryembolism
c)Corpulmonale
d)Alloftheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alloftheabove
CausesofRBBB
Normalphysiological
Pulmonaryembolism/corpulmonale
Pulmonaryarteryhypertension
ASD
Rheumaticheartdisease

---

1451.AlternatingRBBBwithLeftanterior
hemiblockisseenin
a)1'degreeheartblock
b)Completeheartblock
c)MobitztypeIIblock
d)Bi-fascicularblock
CorrectAnswer-D
Ans.is'd'i.e.,Bi-fascicularblock
BifascicularblockcombinationofRBBBwith
eitherleftanteriorhemiblockorleftposteriorhemiblock.
TrifascicularblockRBBBpluseither
LAHB/LPHB+firstdegreeAVblock.
CompleteheartblockdestructionofAVnodeleadingtoAV
dissociation

---

1452.LowQRSvoltageonECGwithleft
ventricularhypertrophyon
Echocardiographysuggestsa
diagnosisof:
a)Pericardialeffusion
b)CardiacAmyloidosis
c)Corpulmonale
d)Infectiveendocarditis
CorrectAnswer-B
AnswerisB(CardiacAmyloidosis)
LowQRSvoltageonECGwithleftventricularhypertrophyon
Echocardiographysuggestsadiagnosisofinfiltrative
cardiomyopathylikeamyloidosis.
ThecombinationoflowQRSvoltageplusathickleftventricleon
echocardiogramstronglysuggeststhediagnosisofinfiltrative
cardiomyopathylikecardiacamyloidosis.Theincreasedthicknessis
theamyloid.Itisnotmuscle(nottruehypertrophy),doesnot
depolarizeandthereforeaddsnothingtoQRSvoltage

---

1453.InLVH,SV1+RV6ismorethanmm
a)25
b)30
c)35
d)45
CorrectAnswer-C
Ans.is'c'i.e.,35
ArrhythmiasbyKathrynLewisp.219]oInLVH,SV-1plusRV-6
ismorethan15mm.
TodiagnosetheleftventricularhypertrophyonECGoneofthe
followingcriteriashouldbemet:?
Thesokolow-lyoncriteriaismostoftenused-
RinV,orV6+5inV>35mminmen
Thecornell-criteriahasdifferentvalues
RinaVLandSinV3>28mminmen
RinaVLandSinV3>20mminwomen
AstheleftventricularwallbecomesthickerQRScomplexesare
largerinleadsV1-V6
SwaveisdeepinV,
RwaveishighinV4
STdepressioninV,,-V,(strainpattern)

---

1454.Whichisnotahighpitchedheartsound
a)Midsystolicclick
b)Pericardialshudder
c)Openingsnap
d)Tumorplopsound
CorrectAnswer-D
Ans.is'd'i.e.,Tumorplopsound
Lowpitchheartsoundsare:
S3
S4
Tumorplopsound
Midsystolicclicksare
Heardinmitralvalveprolapseduringsystoleandarehighpitch
sounds.
Thepericardialknock(PK)is
Alsohigh-pitchedandoccursslightlylaterthantheopeningsnap,
correspondingintimingtotheabruptcessationofventricular
expansionaftertricuspidvalveopeningandtoanexaggeratedy
descentseeninthejugularvenouswaveforminpatientswith
constrictivepericarditis.
Atumorplopis
Alower-pitchedsoundthatcanbeheardinpatientswithatrial
myxoma.
Itmaybeappreciatedonlyincertainpositionsandarisesfromthe
diastolicprolapseofthetumoracrossthemitralvalve

---

1455.Broadcomplextachycardia,dueto
ventriculartachycardiaissuggestedby
allexcept
a)Fusionbeats
b)AVdissociation
c)Capturebeats
d)Terminationoftachycardiabycarotidsinusmassage
CorrectAnswer-D
Ans.is`d'i.e.,Terminationoftachycardiabycarotidsinusmassage

---

1456.Whichofthefollowingarrhythmiais
mostcommonlyassociatedwith
alcoholbingeinthealcoholics
a)Ventricularfibrillations
b)Ventricularprematurecontractions
c)Atrialflutter
d)Atrialfibrilation
CorrectAnswer-D
Ans.is'd'i.e.,Atrialfibrilation
Wheneverthepulseisirregularlyirregularatrialfibrillationis
almostalwaysthediagnosis.
Arrythmiaoccuringafteradrinkingbingeisk/aHolidayheart
syndrome.
ArrythmiasknowntofollowdrinkingBingeinorderof
frequency
Atrialfibrillation(MC)
Atrialflutter
VentricularprematureContractions
Alsoknow
ThemostcommoncardiaceffectofchronicdrinkingisDilated
Cardiomyopathy

---

1457.Treatmentofasymptomaticbradycardia
is
a)Notreatmentisrequired
b)Giveatropine
c)Isoprenaline
d)Cardiacpacing
CorrectAnswer-A
Ans.is'a'i.e.,Notreatmentisrequired
Thenormalheartratehasbeenconsideredhistoricallytorangefrom
60to100beatsperminute,withsinusbradycardiabeingdefinedas
asinusrhythmwitharatebelow60beatsperminute.
Treatmentisnotindicatedinasymptomaticpatientswithsinus
bradycardia.
nPharmacologictherapymaybeimportantinanacute
myocardialinfarctionwhentheSAnodeisdepressedbyexcessive
parasympathomimeticactivityorpossiblyischemia.Treatmentis
indicatedwhenSinusbradycardiaresultsinhemodynamic
compromise.

---

1458.WPWsyndromeiscausedby
a)BundleBranchBlock
b)Rightsidedaccessorypathway
c)Ectopicpacemakerinatrium
d)LeftbudleBranchblock
CorrectAnswer-B
Ans.is'b'i.e.,Rightsidedaccessorypathway
Anatomy(LocationofAccessorypathway)inW.RWsyndrome
Electrophysiologicalstudiesandmappinghaveshownthat
accessory.Atrioventricularpathwaysmaybelocatedanywhere
alongtheA-Vrignorgrooveintheseptum.
Themostfrequentlocationsare:-
Leftlateral(50%),posteroseptal(30%)rightanteroseptal(10%).
Rightlateral(10%).
PreexcitationresultingfromleftsidedaccessoryiscalledtypeA
preexcitation.
Preexcitationresultingfromrightsidedaccessorypathwayiscalled
typeBpreexcitation.

---

1459.Canon'a'waveisseenin
a)Junctionalrhythm
b)Atrialfibrillation
c)Atrialflutter
d)Ventricularfibrillation
CorrectAnswer-A
Ans.is'a'i.e.,Junctionalrhythm
Regularly?>Duringjunctionalrhythm
?IrregularlyA-Vdissociationwithventricular
tachycardiacompleteheartblock.

---

1460.Whichofthefollowingisnotseenin
SecondaryAdrenalinsufficiency
a)Pigmentation
b)Posturalhypotension
c)Hypoglycemia
d)Lassitude
CorrectAnswer-A
Secondaryadrenalinsufficiencyisadrenalhypofunctionduetoa
lackofadrenocorticotropichormone(ACTH).
Secondaryadrenalinsufficiencymayoccurin
Panhypopituitarism
Isolatedfailureofadrenocorticotropichormone(ACTH)production
Patientsreceivingcorticosteroids(byanyroute,includinghighdoses
ofinhaled,intra-articular,ortopicalcorticosteroids)
Patientswhohavestoppedtakingcorticosteroids
SymptomsarethesameasforAddisondiseaseandincludefatigue,
weakness,weightloss,nausea,vomiting,anddiarrhea,butthereis
usuallylesshypovolemia.

---

1461.Whichofthefollowingisnotexpected
inacaseofMicrocyticHypochromic
Anemia:
a)ReducedserumIron
b)ReducedTotalRBCdistributionWidth
c)NormalFerritinlevels
d)IncreasedTIBC
CorrectAnswer-B
AnswerisB(ReducedTotalRBCdistributionwidth
MicrocyticHypochromicAnemiasaretypicallyassociatedwitha
NormalorHighRedCellDistributionWidth
Condition
Iron
Thalassemia Sideroblastic Anemiaofchronic
Test
deficiency
anemia
disease
(normal
values)
Microcytic
Microcytic
Microcytic
Normocytic
hypochromic hypochromic hypochromic
normochromic
Smear
>
Microcytic
Micro/hypochromic
(MCV<80)
(butMicro/Hypo
maybepresent)
Serumiron
Low(<30)
Normal
Normal
.1.(<50)
(50-
150n/d1)
TIBC
High(>360)
Normal
Normal
,i,(<300)
(300-360
(Chandrasoma
?g/dl)
Taylor)
%
<10(J')

---

%
<10(J')
NorTed
Nor"I'
4,
Saturation
(30-80)
(30-80)
(10-20)
(30-50%)
Ferritin
<15(fed)
T(50-300)
T(50-300)
(R/1)
NormalorT
(50-200
(30-200)
?g/L)
Hemoglobin
Normal
Abnormal
Normal
Normal
pattern
Free
Ted
Normal
Ted
Ted
Erythrocyte
Protporphrin
RDW
Ted
Normal
Normal
Normal

---

1462.OnmedicalcheckupofaPunjabi
studentfollowingfindingswereseen
Hbof9.9gm/d1,RBCcountof5.1
million,MCVof62.5flandRDWof
13.51%.Whatisthemostprobable
diagnosis?
a)HbD
b)Thalassemiatrait
c)Irondeficiencyanemia
d)Anemiaofchronicdisease
CorrectAnswer-B
Answer-B.Thalassemiatrait
NormalRDWwithlowMCVisseenin--
1. Anemiaofchronicdisease
2. Heterozygousthalassemia(Thalassemiatrait)
3. HemoglobinEtrait.

---

1463.Megaloblasticanemiashouldbetreated
withbothfolicacidvitaminB12
because:
a)Folicacidalonecausesimprovementofhematologicsymptoms
butworseningofneurologicalsymptoms
b)ItisaCofactor
c)Itisenzyme
d)Noneoftheabove
CorrectAnswer-A
AnswerisA(Folicacidalonecausesimprovementinhematologicin
symptomsbutworseningofneurologicalsymptoms)
MegaloblasticanemiamaybecausedbyadeficiencyofvitaminB12
(cobalamine)ordeficiencyoffolate.Unlessitisclearlyestablished,
whichofthetwodeficienceis/folateorcobalamine)isthecause
anemiatreatmentshouldincludeadministrationofboth.folkacid
and.vitaminBp.Ifonlyfolicacidisadministeredinapatientwith
mezaloblasticanemiaduetovitaminBI2deficiency,worseninzof
neurologicalsymptoms(cobalamineneuropathy)isseendespitean
improvementinthehematological.symptoms(anemia)
'Althoughprompthematologicresponseheraldedbyreticulocytosis
followstheadministrationoffolicacid,itshouldhecautionedthatthe
hematologicsymptomsofavitaminB,2deficiencyanemiaalso
respondtofolatetherapy.HoweverMatedoesnotpreventandmay
evenexacerbatetheprogressionofneurologicaldeficitstypicalof
vitaminB12deficiencystates'
Beforelargedosesoffolicacidaregiven,cobalaminedeficiency

---

mustbeexcludedandifpresentcorrected,otherwisecobalamine
neuropathymaydevelopdespitearesponseoftheanemiaof
cobalaminedeficiencytoPalatetherapy.

---

1464.Whichofthefollowingstatements
regardingtheschillingtestforvitamin
B12malabsorptionismostaccurate?
a)Theschillingtestresultsareabnormalinpatientswithdietary
vitaminB12deficiency.
b)Inpatientswithperniciousanemia,theresultsoftheschilling
testnormalizeafteroraladministrationofintrinsicfactor,
c)Inpatientswithilealdisease,theresultsoftheschillingtest
normalizeafteroraladministrationofintrinsicfactor
d)Pancreaticexocrineinsufficiencydoesnotcauseschillingtest
resultstobeabnormal.
CorrectAnswer-B
AnswerisB(Inpatientswithperniciousanemia,theresultsofthe
Schillingtestnormalizeafteroraladministrationofintrinsicfactor):
AnabnormalSchilling'stestthatcorrectsornormalizesafter
administrationofintrinsicfactorsuggestsadiagnosisofPernicious
Anemia(IntrinsicFactorDeficiency).
Shilling'stestisdonetodeterminethecauseofcyanocobalamine
deficiency(VitaminB12).Schillingtestis
abnormalinconditionsthataffectcobalamineabsorptionincluding
Perniciousanemia,ChronicPancreatitis,Bacterialovergrowth
syndromeandIlealdysfunction.
AnAbnormalSchilling'stestthatcorrectsafteradministrationof
IntrinsicFactorindicatesPerniciousAnemia
AnAbnormalSchilling'stestthatcorrectsafteradministrationof
PancreaticEnzymessuggestsExocrinePancreaticInsufficiency
(fromChronicPancreatitis)

---

AnAbnormalSchilling'stestthatcorrectsafteradministrationoffive
daysofantibioticssuggestsBacterialOvergrowthSyndrome
AnAbnormalSchilling'stestthatdoesnotcorrectafter
administrationofintrinsicfactor,pancreaticenzymesand/or
antibioticssuggestsIlealmucosaldysfunction

---

1465.Mentzerindexmorethan13suggestsa
diagnosisof
a)Irondeficiencyanemia
b)Thalassemia
c)HereditarySpherocytosis
d)AutoimmuneHemolyticAnemia
CorrectAnswer-A
Ans.is'a'i.e.,IrondeficiencyAnemia
Mentzerindexmorethan13suggestsadiagnosisofIron-deficiency
anemia.
Mentzerindex
TheMentzerindexisusedtohelpindifferentiatingirondeficiency
anemiafrombetathalassemia.
Theindexiscalculatedasthequotientofthemeancorpuscular
volume(MCV,infL)dividedbytheredbloodcellcount(RBC,in
millionspermicroleter).
IftheMentzerindexislessthan13,thallassemiaissaidtobemore
likely.
IftheMentzerIndexisgreaterthan13,Theniron-deficiencyanemia
issaidtobemorelikely.
Principle
Inirondeficiency,themarrowcannotproduceasmanyRBCsand
theyaresmall(imcrocytic),sotheRBCcountandtheMCVwillboth
below,andasaresult,theindexwillbegreaterthan13.
Conversely,inthalassemia,whichisadisorderofglobinsynthesis,
thenumberofRBCsproducedisnormal,butthecellsaresmaller
andmorefragile.Therefore,theRBCcountisnormal,buttheMCV
islow,sotheindexwillbelessthan13.

---

Inpractice,theMentzerindexisnotareliableindicatorandshould
not,byitselfbeusedtodifferentiatethetwoconditions.
Valuefor Valuefor
iron
Index
Formula
iron
deficiency thalassemia
anemia
Mentzer
MCV/RBC >13
<13
index
count
Shineand
MCV2x
>1530
<1530
Lalindex
MCHx0.01
MCV?RBC
Englandand -(5xHb) >0
<0
Fraserindex 5.19
Srivastava
MCH/RBC >3.8
<3.8
index
MCV2x
Greenand
RDWx
>65
<65
kingindex
Hb/100
Redcell
MCVx
distribution
>220
<220
RDW/RBC
widthindex

---

1466.Whichofthefollowingstatements
aboutirondeficiencyanemiaiscorrect
a)DecreasedTIBC
b)Increasedferritinlevels
c)Bonemarrowironisdecreasedafterserumironisdecreased
d)Bonemarrowironisdecreasedearlierthanserumiron
CorrectAnswer-D
Ans.is'D'i.e.,Bonemarrowironisdecreasedearlierthanserum
iron
"Inirondeficiencyanemiathefirstchangeisdecreaseinironstores
"
Thedecreaseinironstoresisdemonstratedbydecreasedserum
ferritinlevel.
Remember,
Serumferritinreflectstheamountofstorageironinthebody.
Asthetotalbodyironlevelbeginstofallacharacteristic,
sequenceofeventsensue:
FirstStageorPrelatentStageofIronDepletion
Whenironlossexceedsabsorption,anegativeironbalanceexists.
Storedironbeginstobe,mobilizedfromstores.Theironpresentin
themacrophagesofliver,spleenandbonemarrowaredepleted
Decreaseinstoredironisreflectedbydecreaseinserumferritin.
Atthisstageallotherparametersofironstatusarenormal.
SecondStageorStageofLatentIronDeficiency:
Ironstoresareexhaustedbutthebloodhemoglobinlevelremains
higherthanthelowerlimitofnormal.oAftertheexhaustionofiron
stores:
TheplasmaironconcentrationfallsQ.

---

Plasmaironbindingcapacityincreases2.
Percentagesaturationfallsbelow15%Q.
ThepercentageofsideroblastdecreasesinthebonemarrowQ.
ThirdStageorStageofApparentIronDeficiencyAnemia
Supplyofirontomarrowbecomesinadequatefornormal
hemoglobinproduction,
SothebloodhemoglobinconcentrationfallsQbelowthelowerlimitof
normalandirondeficiencyanemiaisapparent.

---

1467.DirectCoomb'stestdetects:
a)AntibodiesattachedtoRBCSurface
b)Antibodiesintheserum
c)AntigensattachedtoRBCSurface
d)Antigensintheserum
CorrectAnswer-A
AnswerisA(AntibodiesattachedtoRBCSurface)
DirectCoomb'stestdetectsIgGAntibodies(orcomplements)
attachedtothesurfaceofRBCs.IndirectCoomb'stestdetectsIgG
antibodiesintheserum(e.g.Anti-DAntibodies).

---

1468.Alloffollowingcauseintravascular
hemolysis,except
a)Mismatchedbloodtransfusion
b)Paroxysmalcoldhemoglobinuria
c)Thermalburns
d)Hereditaryspherocytosis
CorrectAnswer-D
Ans.is'd'i.e.,Hereditaryspherocytosis
Bloodtransfusion
ABOmismatchedtransfusion
Infectedblood
Thermalburns
Snakebites
Sepsis
Bacterial/parasiticinfections
Clostridialsepsis
Malaria
Bartonellosis
Mycoplasmapneumoniae
Mechanicalheartvalves
Paroxysmalhemoglobinuria
PNH
PCH

---

1469.Whichofthefollowingisnotseenin
HereditarySpherocytosis
a)DirectCoomb'sPositive
b)IncreasedOsmoticFragility
c)Splenomegaly
d)Gallstones
CorrectAnswer-A
Ans.is'a'i.e.,DirectCoomb'spositive
HereditarySpherocytosis
Membranecytoskeletonthatliescloselyopposedtotheinternal
surfaceoftheplasmamembrane,isresponsibleforelasticityand
maintenanceofRBCshape.
Membraneskeletonconsists:?
SpectrinThechiefproteincomponent
responsibleforbiconcaveshape.
Ankyrinandband4-2Bindsspectrintoband3
Band3Atransmembraneiontransport
protein.
Band4.1BindsspectrintoglycophorinA,
atransmembraneprotein.
Hereditaryspherocytosisisanautosomaldominantdisorder
characterizedbyintrinsicdefectsinredcellmembrane.Thisresults
inproductionofredcellsthataresphere(spherocytes)ratherthan
biconcave.
Themutationmostcommonlyinvolvesthegenecodingforankyrin,
followedbyBand-3(anionictransportchannel),spectrin,andBand
4.2(alsocalledpalladin).

---

Alsoknow
Mostcommon,defectinhereditaryelliptocytosisisinspectrin
PathogensisofHereditaryspherocytosis
Lossofmembranecytoskeletonproteins(ankyrin,spectrin,Band3,
4.2)resultsinreducedmembranestability.Reducedmembrane
stabilityleadstospontaneouslossofmembranefragmentsduring
exposuretoshearstressesinthecirculation.Thelossofmembrane
relativetocytoplasmforcesthecellstoassumethesmallest
possiblediameterforagivenvolumecellsbecome
microspherocytes.
Becauseoftheirspheroidalshapeandreducedmembraneplasticity,
redcellsbecomelessdeformableandaretrappedintospleenas
theyareunabletopassthroughtheinterendothelialfenestrationsof
thevenoussinusoids.Inthesplenicsinusoides,redcellsare
phagocytosedbyREcellsExtravascularhemolysis.
ClinicalfeaturesofHereditoryspherocytosis
Theclinicalfeaturesarethoseofextravascularhemolysis:
AnemiaMildtomoderate
Jaundice(Mainlyindirectbilirubin)Splenomegaly
GallstonesElevatedexcretionof
bilirubinpromotesformationofpigmentstone.
LegulcerRareclinical
manifestation.
AplasticcrisisTriggeredbyparvo-
virusinfection.
Laboratoryfindings
Spherocytosis-->Peripheralsmearshowsmicrospherocyteswhich
aresmallRBCswithoutcentralpallor(Normallycentral1/3palloris
presentinredcells).
MCV4
MCHCr
Increasedunconjugatebilirubin
Urineurobilinogen1'
Stoolstercobilinogen
Reticulocytosis-4Asseenwithanytypeofhemolyticanemia.
Hemoglobin1
SerumHeptoglobin-->Nonnaltodecreased.

---

Increasedosmoticfragilityonpinktest.
Coomb'stestisusedtodistinguishhereditaryspherocytosisfrom
autoimmunehemolyticanemias.
Autoimmunehemolyticanemiasarecoomb'spositive_whereas
hereditaryspherocytosisiscoomb'snegative.

---

1470.UsuallyassociatedwithparvovirusB19
infectioninthosewithhereditary
spherocytosis
a)Mildtomoderatesplenomegaly
b)Aplasticcrisis
c)Gallstones
d)Hemolyticcrisis
CorrectAnswer-B
Ans.is'b'i.e.,Aplasticcrisis
ParvovirusB19selectivelyinfectserythroidprecursorsandisthe
mostcommonaetiologicalagentthatinduces
aplasticcrisisinpatientswithhereditaryspherocytosis(andother
Hemolyticdisorders).
Transientaplasticcrisis
Personswithdecreasederythrocytescausedbyconditionssuchas
irondeficiencyanemia,humanimmunodeficiencyvirussicklecell
disease,spherocytosisorthalassemiaareatriskoftransient
aplasticcrisisifinfectedwithparvovirusB19.
Theviruscausesacessationoferythrocyteproduction.
ParvovirusinfectionmaybethefirstmanifestationinHS.
Itbeginswithreticulocytosisandthrombocytosis

---

1471.Withregardstohereditary
spherocytosis,whichofthefollowingis
false
a)Usuallyhasautosomaldominantinheritance
b)Causedbymutationsingenesforproteinssuchasspectrin,
ankrinorband3
c)Redbloodcellsaredestroyedinthespleen
d)Aplasticcrisesarecommon
CorrectAnswer-D
Ans.is'd'i.e.,AplasticCrisisarecommon
Aplasticcrisisarearare/uncommoncomplicationofHereditary
Spherocytosistypicallycausedbyvirallyinduced
bonemarrowsuppression.
ThemostcommonaetiologicalagentthatinducesAplasticCrisisin
patientswithHereditarySpherocytosisisParvovirusB19
Hereditaryspherocvtosisusuallyhasautosomaldominant
inheritancecausedbymutationingenesforproteinssuchas
spectrin.ankrinorband3.
ThegenesresponsibleforHSincludeakyrin,bspectrin,band-3-
protein,a-spectrin,andprotein4.2.Inapproximatelytwo-thirdsto
three-quarterofHSpatients,inheritanceisautosomaldominant.In
theremainingpatients,inheritanceisnon-dominantdueto
autosomalrecessiveinheritanceofadenovomutation.
InpatientswithhereditaryspherocvtosisRedbloodcellsare
destroyedinthespleen
ThespleenplaysacriticalroleinthepathobiologyofHS,as
destructionofspherocytesinthespleenistheprimarycauseof

---

hemolysisinHSpatients.
AplasticCrisisisanUncommonComplication
Aplasticcrisisfollowingvirallyinducedbonemarrowsuppressionare
uncommon,butmayresultinsevereanaemiawithserious
complicationsincludingcongestiveheartfailureorevendeath.
Themostcommonaetiologicalagentinthesecasesisparvovirus
B19.
Parvovirusselectivelyinfectserythropoieticprogenitorcellsand
inhibitstheirgrowth

---

1472.Allofthefollowingaretrueregarding
splenectomyinpatientswithhereditary
spherocytosis,except?
a)Avoidinmildcases
b)Delaysplenectomyuntilatleast4yearsoldage
c)Anti-pneumococcalvaccinationmustbegivenbefore
splenectomy
d)Prolongedanti-pneumococcalantibioticprophylaxismustbe
givenaftersplenectomy
CorrectAnswer-D
Ans.is'd'i.e.,ProlongedAnti-pneumococcalAntibioticProphylaxis
mustbegivenaftersplenectomy
SplencectomvinpatientswithHereditaryspherocytosis
Avoidsplenectomyinmildcases.
Delaysplenectomyuntilatleast4yearsofageaftertheriskof
severesepsishaspeaked.
Anti-pneumococcalvaccinationbefoesplenectomyisimperative
whileanti-pneumococcalprophylaxispost-splenectomyis
controversial.

---

1473.Mostcommonheavychaindiseaseis
a)Franklindisease
b)Seligmanndisease
c)Muheavychaindisease
d)Waldenstromcryoglobulinemia
CorrectAnswer-B
Ans.is'b'i.e.,SeligmannDisease(Alphaheavychaindisease)
Therearefourforms:
*Alphachaindisease(Seligmann'sdisease)-mostcommontype
*Gammachaindisease(Franklin'sdisease)
*Muchaindisease
*Deltachaindisease

---

1474.Leukoerythroblasticpicturemaybeseeninallofthefollowingconditions,
except:
a)Myelofibrosis
b)Metastaticcarcinoma
c)Gaucher'sdisease
d)Thalassemia
CorrectAnswer-D
LeukoerythroblastosisreferstothepresenceofimmaturenucleatedRBCs,immaturewhite
bloodcells,andmegakaryocytefragmentsontheperipheralbloodsmear.Itoccurdueto
bonemarrowinfiltration.
Whenmarrowinfiltrationcausesanemiaorpancytopenia,itisreferredtoas
myelophthisicanemia.Themostcommoncauseofmyelophthisisincludesmetastatic
carcinomaofthelung,breast,orprostate.Othercausesincludehematologicmalignancies
(leukemia,lymphoma),infections(tuberculosis,fungi),andmetabolicdiseases(Gaucher
disease,Niemann-Pickdisease).Thalassemiaisnotassociatedwithleukoerythroblastosis.

Ref:CURRENTDiagnosis&TreatmentinFamilyMedicine,3rdEdition,Chapter31

---

1475.ChronicNon-Spherocytichemolytic
anemiaisseeninwhichclassofG6PD
deficiency
a)ClassI
b)ClassII
c)ClassIII
d)ClassIV
CorrectAnswer-A
Ans.is'a'i.e.,ClassI
ThefourformsofsymptomaticG6PDdeficiency:
Acutehemolyticanemia
Favism
Congenitalnonspherocytichemolyticanemia
Neonatalhyperbilirubinemia
Congenitalnonspherocvtichemolyticanemia
PatientswithclassIG6PDvariantshavesuchsevereG6PD
deficiencythatlifelonghemolysisoccursintheabsenceofinfection
ordrugexposure.
Suchpatientsfallunderthecategoryofhavingcongenital
nonspherocvtichemolyticanemia.
TheseG6PDvariantshavelowinvitroactivityand/ormarked
instabilityofthemolecule,andmosthaveDNAmutationsatthe
glucose-6-phosphateorNADPbindingsites.
ThesesitesarecentraltothefunctionofG6PD,whichoxidizes
glucose-6-phosphateandreducesNADPtoNADPH.Itispresumed
thatthefunctionaldefectissoseverethattheredcellscannot
withstandeventhenormaloxidativestressesencounteredinthe

---

circulation.
Anemiaandjaundiceareoftenfirstnotedinthenewbornperiod,and
thedegreeofhyperbilirubinemiaisfrequentlyofsufficientseverityto
requireexchangetransfusion.
Afterinfancy,hemolyticmanifestationsaresubtleandinconstant.
Mostindividualshavemildtomoderateanemia(hemoglobin8to10
g/dL)withareticulocytecountof10to15percent.Palloris
uncommon,scleralicterusisintermittent,splenomegalyisrare,and
splenectomygenerallyisoflittlebenefit.
Hemolysiscanbeexaggeratedbyexposuretodrugsorchemicals
withoxidantpotentialorexposuretofavabeans.
Somedrugswithrelativelymildoxidantpotentialthataresafein
patientswithclassIIorclassIIIG6PDvariantsmayincrease
hemolysisinpatientswithclassIvariants.
DiseasevariantsofGlucose6phosphatedehvdrogenase
deficiency
TheWorldHealthOrganizationhasclassifiedthedifferentG6PD
variantsaccordingtothemagnitudeoftheenzymedeficiencyand
theseverityofhemolysis.ClassesIVandVareofnoclinical
significance.
Types Features
Variantshavesevereenzyme
deficiency(lessthan10percent
Class ofnormal)andhavechronic
I
(nonspherocytic)hemolytic
anemia.
Variants,suchasG6PD
Mediterranean,alsohave
severeenzymedeficiency,but
Class thereare,usuallyonly
II
intermittentepisodesofacute
hemolysisassociatedwith
infection,drugs,orchemicals.
Variants,suchasG6PDA-,
havemoderateenzyme
Class deficiency(10to60percentof
normal)withintermittent

---

III
episodesofacutehemolysis
usuallyassociatedwith
infection,drugs,orchemicals
Class Variantshaveno
IV
enzyme.deficiencyorhemolysis.
Class Variantshaveincreased
V
enzymeactivity

---

1476.Sicklecellanemialeadstoresistancetowards?
a)P.falciparum
b)P.ovale
c)P.malariae
d)P.vivax
CorrectAnswer-A
Individualswithsicklecelltrait(hemoglobingenotypeAS)areresistanttothelethaleffects
ofPlasmodiumfalciparuminfection.
Thisisbecausethesicklecelltraitspreventsthedevelopmentofhighparasitemia,probably
partlyasaresultofparasitizedredcellssicklinginthecirculationandbeingremovedbythe
spleenbeforetheycandevelopintoschizonts.
AbsenceofRBCDuffyantigenconfersresistancetoP.Vivax.
Ref:Harrison's17thedchapter213;EssentialsofclinicalimmunologybyHelenChapel,
Man;e.Haeney,SirajMisbah,5thedition,Page48;LectureNotes:Tropical
MedicineeditedbyG.V.Gill,NickBeeching,2011,Page62.

---

1477.Whichofthefollowingisaquantitative
defectinglobinsynthesis
a)Thalassemia
b)Sicklecellhemoglobinopathy
c)G6PDdeficiency
d)Diamond-Blackfansyndrome
CorrectAnswer-A
Ans.is'a'i.e.,Thalassemia
Thethalassemiasyndromesareaheterogeneousgroupofdisorders
causedbyinheritedmutationsthatdecreasethesynthesisofeither
thec-globinorp-globinchainsthatcomposeadulthemoglobin,HbA
(c2p2),leadingtoanemia,tissuehypoxia,andredcellhemolysis
relatedtotheimbalanceinglobinchainsynthesis.

---

1478.Themostimportantdiagnositicfeature
forbetathalassemiatrait
a)RaisedHbF
b)ReducedMCH
c)ReducedMCV
d)RaisedHbA2
CorrectAnswer-D
Ans.is'd'i.e.,RaisedHbA2
AnabnormalincreaseinthelevelofHbA2isthemostsignificant
parameterinthediagnosisofbeta-thalassemiacarriers.HbA-2is
constanlyelevatedinheterozygouscarriersof[3-thalassemiainall
theethnicgroupsstudied.Thevaluesrangefrom3.5to7%.
Investigationsinthalassemia
Hemoglobinelectrophoresisshouldalwaysbethefirstinvestigation
toinclude/excludethediagnosisofthalasemia.Thelevelofnormal
adulthemoglobinHbAismarkedlydecreasedwithproportionate
increaseinHbA2andHbF.
X-rayskullshows:?
i)Crew-cutappearance
ii)Haironendappearance

---

1479.Deletionofonealphaglobingeneon
onechromosomeisbestdefinedas
a)HbBartshydropsfetails
b)Alphathalassemiamajor
c)Alphathalassemiatrait
d)Alphathalassemiasilentcarrier
CorrectAnswer-D
Ans.is'd'i.e.,Alphathalassemiasilentcarrier
Clinical
Condition
Defect
Genotype
syndrome
Deletionof1
SilentThalassemia
-a/aa
Normal
alphagenes
Deletionof2 -a/-a
Microscopic
Thalessemiatrait
alphagenes (homogygous) hypochromic
Bloodpicture
(heterogenous) but
No/Minimal
Anemia
Deletionof3
Hemolytic
HbHdisease
--/-a
alphagenes
anemia
Hydropsfetalis(Hb
Deletionof4 --/--
Fatalinuteroor
Barts)
alphagenes
atbirth

---

1480.Whichofthefollowingiscausedby
deletionofallfouralphaglobingenes
a)Betathalassemiamajor
b)HbBarts
c)HbH
d)a?thalassemiatrait
CorrectAnswer-B
Ans.is'b'i.e.,HbBarts
Clinical
Condition
Defect
Genotype
syndrome
Deletionof1
SilentThalassemia
-a/aa
Normal
alphagenes
Deletionof2 -a/-a
Microscopic
Thalessemiatrait
alphagenes (homogygous) hypochromic
Bloodpicture
(heterogenous) but
No/Minimal
Anemia
Deletionof3
Hemolytic
HbHdisease
--/-a
alphagenes
anemia
Hydropsfetalis(Hb
Deletionof4 --/--
Fatalinuteroor
Barts)
alphagenes
atbirth

---

1481.InBetathalassemia,themostcommon
genemutationis
a)Intron1inversion
b)Intron22
c)619bpdeletion
d)3.7bpdeletion
CorrectAnswer-A
Ans.is'a'i.e.,Intron1inversion
Thalassemiasareautosomalrecessivedisorder
Themostcommonmutationcausing13thalassemiasis
intron/inversion
Alsoknow:
Synthesisofalphachainiscontrolledby2geneclusterson
Chromosome16
Synthesisofbetachainiscontrolledby2geneclusterson
Chromosome11
ThalassemiamutationsinIndia
Multations
Frequency
IVS1-5(G-->C)
48%
619bpdefection
18%
IVS-1(GT)
9%
FR41/42(TCTT)
9%
FR8/9(+G)
5%
Codonl5(G-->A)
6%
Others
100%

---

1482.Whichisthemostcommoncytogenetic
abnormalityinadultmyelodysplastic
syndrome(MDS)-
a)Trisomy8
b)20q?
c)5q?
d)Monosmy7
CorrectAnswer-C
AnswerisC(5q-)
`Monosomy7isbyfarthemostcommoncytogeneticabnormalityin
children(pediatricMDS)whereas5q-isobservedmostfrequent!,'in
adults'?MyelodysplasticSyndromesbyJohnBennett(2002)/300
CytogeneticAbnormalitiesinMDS:FactstoRemember
Monosomy7isthemostfrequentcytogeneticabnormalityin
children.QDeletion5q(5q)isthemostfrequentcytogenetic
abnormalityinadultsQ.Trisomy8isthemostfrequenttri.somyQ.
DifferencesbetweenMyelodysplasticSyndromesinchildren
andAdults(`MyelodysplasticSyndromes'2002/300;'Childhood
Leukemias'2'"/549)
FeatureChildren
Adults
?Frequency
Lesscommon
Morecommon
?Presenceof
Uncommon
Morecommon(,-
sideroblasts
(<2%)
-25%)
?Cytogenetic
Abervations
Mostcommon
Lesscommon
-7/7q- (r,30%)
(,=-40%)

---

-7/7q- (r,30%)
(,=-40%)
Uncommon(--L- Mostcommon
-5/5q- 1-2%)
(z20%)

---

1483.ReversedCoarctationisseenin:
a)GiantcellArteritis
b)PolyarteritisNodosa
c)TakayasuArteritis
d)KawasakiDisease
CorrectAnswer-C
AnswerisC(TakayasuArteritis):
Takayasuarteritisisalsoknownas'ReversedCoarctation'.
TakayasuArteritis
Condition CoarctationofAorta
(ReversedCoarctation)
Obstructionismost
Obstructionismost
commonlyseeninproximal
commonlyfoundjust
Pathology
aspectofbranchesofthe
distaltotheoriginofthe
(Siteof
aorticarchincludingthe
leftSubclavianartery
Obstruction)
SubclavianandCommon
therebysparingthe
Carotidtherebyaffectingthe
upperlimbvessels
upperlimbvessels
Absenceordiminished
Absenceordiminishedpulse
Pulses
pulseinthelowerlimbs
intheupperlimbs
Blood
Increasedbloodpressure Decreasedbloodpressurein
Pressure
intheupperlimbs
theupperlimbs

---

1484.MostcommonvariantofTakayasu
DiseaseinIndiais:
a)Type-1
b)Type-2
c)Type-3
d)Type-4
CorrectAnswer-C
AnswerisC(Type-3):
ThemostcommontypeofTakayasuarteritisreportedinIndiais
TypeIII.
MoststudiesfromIndiahavereportedTypeIIIasthemostcommon
formofTakayasuarteritisinIndiaaccountingfor53to76percentof
cases.
Classification/ PredominantSiteInvolved
Type
Type-I(Shimizu- Archofaortaanditsbranches
Savo)
Thoraco-abdominalaortaanditsbrancheswithout
Type-II(Kimoto) involvementoftheaorticarch
Type-III(Inada) CombinedfeaturesofbothType-I&Type-II
Pulmonaryinvolvement(inadditiontofeaturesof
Type-I,IIorIII)
Type-IV(Oata)
Involvementofcoronaryarteries(inadditionto
featuresofType-1,IIorIII)

---

1485.InTakayasu'sarteritisthereis
a)Intimalfibrosis
b)Renalhypertension
c)Coronaryaneurysm
d)Alloftheabove
CorrectAnswer-B
Ans.is`b'i.e.,Renalhypertension
Potential
Artery
clinical
manifestation
Arm
claudication,
Subclavian
Raynaud's
phenomenon
Visual
changes,
syncope
Commoncarotid transient,
ischaemic
attacksstroke
Abdominal
AbdominalAorta pain,nausea
vomiting
Hypertension,
renalfailure,
aortic
Renal
insufficiency,
congestive
heartfailure

---

heartfailure
Visual
Vertebral
changes,
dizziness
Abdominal
Coeliacaxis
pain,nausea
vomiting
IliacLeg
claudication
Atypicalchest
Pulmonary
paindyspnea
Chestpain
Coronary
myocardial
infarction

---

1486.Markerofacutekidneyinjuryallexcept
a)Clusterin
b)Osteopontin
c)Alanineaminopeptidase
d)Acidphosphatase
CorrectAnswer-D
Ans.is'd'i.e.,Acidphosphatase
Alanineaminopeptidase(AAP)Kidneyinjury
molecule-1(KIM-1)
Alkalinephosphatase(AP)Clusterin
utathione-S-transferase(a-GST)Neutrophil
gelatinaseassociatedlipocalin(NGAL)
yglutamyltranspeptidase(TGT)Interleukin-18(IL-
18)
N-acetyl-0-glucosaminidase(NAG)Cysteine-rich
protein(CYR-61)
2-microglobulinOsteopontin(OPN)
microglobulinoRetinol-bindingprotein(RBP)Fattyacidbinding
protein(FABP
CystatinCSodium/hydrogen
exchangerisoform(NHE3)o
MicroalbuminExosomalfetuin-A

---

1487.Lepsroycauses?
a)MembranousGN
b)Focalglomerulosclerosis
c)MembranoproliferativeGN
d)MesangioproliferativeGN
CorrectAnswer-A
Ans.is'a'i.e.,MembranousGN
InfectiousdiseasescausingmembranousGN
?HepatitisB
?Hydatiddisease
? Leprosy
andC
?Filariasis
?Syphilis
? Enterococcal
?Malaria
?Endocarditis
? Schistosomiasis

---

1488.Nephroticsyndromeisthehallmarkof
thefollowingprimarykidneydiseases
except
a)MembranousGlomerulopathy
b)IgAnephropathy
c)Minimalchangedisease
d)FocalsegmentalGlomerulosclerosis
CorrectAnswer-B
Ans.is'b'i.e.,IgAnephropathy
MostcommonpresentationofIgAnephropathyisgrasshematuria.
Itisthemostcommonformofglomerulonephritisworldwide
CausesofNephroticsyndrome
Minimalchangedisease
FocalsegmentalglomerulosclerosisoMembranous
glomerulonephritisoDiabetesnephropathy
ALandAAamyloidosis
Lightchaindepositiondisease
Fibrillaryimmunotactoiddisease

---

1489.Thetermend-stagerenaldisease
(ESRD)isconsideredappropriatewhen
GFRfallsto
a)50%ofnormal
b)25%ofnormal
c)10-25%ofnormal
d)5-10%ofnormal
CorrectAnswer-D
Ans.is'd'i.e.,5-10%ofnormal

---

1490.CharacteristicECGfindingof
pulmonaryembolism
a)Sinustachycardia
b)SQ3T3
c)Twaveinversion
d)Epsilonwaves
CorrectAnswer-B
Ans.is`b'i.e.,SJQ3T3
E.C.G.changesofpulmonaryembolism?
Sinustachycardiaisthemostfrequentandnonspecificfindingon
electrocardiographyinacutepulmonaryembolism.
FeaturessuggestingacuterightheartstrainontheECGoccur
relativelyinfrequently,theseinclude.
Acuterightaxisdeviation
Ppulmonale
Rightbundlebranchblock
InvertedTwaves
STsegmentchangesinrightsidedleads.
EarlierthefollowingE.C.G.changeswereconsideredhighly
predictiveofacutepulmonaryembolism,buttheseobservations
werefoundinlessthan12%ofpatientswithpulmonaryemboliin
recentstudies.TheseE.C.G.featuresare-
SwaveinleadI
QwaveinleadIII
InvertedTinleadIII("S1Q31.3")
SwavesinleadI,IIandIII("Si,S2S3")
Alsoknow

---

Areterialbloodgasanalysisinpulmonaryembolism:
Arterialbloodgasanalysisshows
Midtomoderatehypoxemia
IncreasedP(A-a)0,
MildlyreducedPaCO2
AlmostallpatientswithpulmonaryembolismhavePaO,<80mmHg
butnoabsolutelevelofPa02canbeusedtoexcludethediagnosis.

---

1491.Pleuraleffusioninrheumatoidarthritis
istypicallyassociatedwiththe
followingfeaturesexcept
a)Glucose>60mg/dl
b)Protein>3gm/di
c)Pleuralfluidprotientoserumproteinratioof>0.5
d)PleuralfluidLDHtoserumLDHratioof>0.6
CorrectAnswer-A
Ans.is'a'i.e.,Glucose>60mg/dl
Causesoflowglucosepleuralfluid
Malignancy
Rheumatoidarthritis
Empyema
Hemothorax
Paragonimiasis
Churgstrausssyndrome
Lupuspleuritis(occasionally)

---

1492.Bowelpuncturedduringlaproscopy
a)Trocarkept
b)trocarremoval
c)trocarrepositioned
d)None
CorrectAnswer-A
Answer-A.Trocarkept
Toassistinidentifyingtheprecisesiteofinjuty.

---

1493.Whatisnotdoneincaseofpuncture
woundofleftcolon
a)Primarysuture
b)Hemicolectomy
c)Externalization
d)Resectionandanastomosis
CorrectAnswer-B
Answer-B.Hemicolectomy
Smallwoundarerepairedprimarilybysimplesuturing.
Moreextensivewoundaretreatedbyresectionandanastomosis.
Somemayrequirecolostomy(externalization)
[RefBaileyerLove25th/ep.1184]

---

1494.Whatisthepercentagebodysurface
areainvolvedinhead+faceinburns
a)13
b)15
c)17
d)09
CorrectAnswer-D
Answer-D.09
Accordingtoruleof9(Wallace'sformula),burnsurfaceareais
calculatedas:
1. 9%fortheheadandneck.
2. 9%foreachupperlimb.
3. 9%forthefrontofeachlowerlimb.
4. 9%forthebackofeachlowerlimb.
5. 9%forthefrontofthechest.
6. 9%forthebackofthechest.
7. 9%forthefrontoftheabdomen.
8. 9%forthebackoftheabdomen.
9. 1%forthegenitalia.
[RefBailey&Love25thlep.381]

---

1495.Burstabdomenmostcommonlyoccurs
onthe
a)2ndday
b)3rdday
c)7thday
d)9thday
CorrectAnswer-C
Ans.is'c'i.e.,7"'day
Burstabdomenoccursmostlybetweenthe7"and10thdayafter
operation(butmayoccuranytimeaftersurgeryfrom1tomorethan
20days)(refSabiston18/e)

---

1496.PlungingRanulais
a)Cysticgrowthofsublingualgland
b)Lymphnode
c)Atumorinfloorofmouth
d)None
CorrectAnswer-A
Answer-A.Cysticgrowthofthesublingualgland
Plungingranulaisarareformofmucousretentioncystthatarises
fromthesublingualsalivaryglands.
Mucuscollectsbelowtheglandandperforatesthroughthe
mylohyoidmusclediaphragmtoentertheneck.

---

1497.Sialolithiasisismostcommonlyseenin
whichgland
a)Parotid
b)Sublingual
c)Submandibular
d)Minorsalivarygland
CorrectAnswer-C
Answer-C.Submandibular
Mostcommonsiteforsalivaryglandstone(Sialolithiasis)is
submandibulargland,especiallyductofsubmandibulargland
(Wharton'sduct).

---

1498.Whichstructureisnotpreservedin
modifiedradicalmastectomy
a)Cephalicvein
b)Pectoralisminor
c)Pectoralismajor
d)BranchesoflntercostobrachialN.
CorrectAnswer-A
Answer-A
Inthemodifiedradicalmastectomy,theprocedureinvolvesremoval
ofthebreastbutpreservationofthepectoralismajormuscle.The
extentofpreservationofthepectoralisminorandaxillarynodes
varies.
Preservethoracodorsalnerve/vessels.

---

1499.Duputyrensandpeyoniesarebothtype
of
a)Fibromatosis
b)Fibroblastichyperplesia
c)Burncontracture
d)Myalgias
CorrectAnswer-B
Answer-B.Fibroblastichyperplesia
DupuytrencontractureandPeyranie'sdiseasesarefibroblastic
hyperplasia.
Dupuytren'scontractureischaracterizedintheestablishedphaseby
flexioncontractureofoneormorefingersfromthickeningand
shorteningofpalmaroponeurosis.

---

1500.MidgutVolvulussymptomsappearat
a)1"week
b)3rdweeks
c)2"weeks
d)4thweeks
CorrectAnswer-A
Answer-A.1"week
Midgutvolvuluscanhappenatanyage,butmostcommonlyoccurs
duringthefirstfewweeksoflife.Biliousemesisisusuallythefirst
signofvolvulus.

---

1501.Orchidopexyforincompletely
descendedtestisisdoneaftertheage
of:
September2011
a)Atbirth
b)1year
c)2years
d)5years
CorrectAnswer-B
Ans.B:1year
Orchidopexyisusuallyperformedaftertheageof1yeartoavoidthe
riskofoperatingonatinypatientRemember:
Incompletedescentoftestesmayincreasedliabilitytomalignant
change
Alltypesofmalignanttesticulartumoursaremorecommonin
incompletelydescendedtesteseveniftheyhavebeenbroughtdown
surgically

---

1502.Whichofthefollowingstatementabout
RenalCellCarcinoma(Hypemephroma)
isfalse:
a)Originateinthecortex
b)HistologicallyareusuallyAdenocarcinomas
c)Maypresentwithvaricocele
d)Radiosensitive
CorrectAnswer-D
AnswerisD(Radiosensitive):
Renalcellcarcinomaisarelativelyradioresistanttumor.
RenalcellcarcinomaoriginatesintheRenalcortex
`RenalcellcarcinomaoriginatesintheRenalcortexandtendsto
growoutintoperinephrictissuecausingthetypicalbulgeormass
effectthataidsintheirdetectionbydiagnosticimagingstudies'?
Smith'sUrology
RenalCellcarcinomaareadenocarcinomas
HistologicallyRenalcellcarcinomaismostoftenamixed
adenocarcinoma--Smith'sUrology
Renalcellcarcinomasmaypresentwithvaricocele
'RenalcellcarcinomasmaypresentwithRapidlydeveloping
varicocele.Varicoceleisusuallyobservedontheleftside.This
occursbecauseleftgonadalveinisobstructedwhereitjoinstheleft
renalvein.
RenalcellcarcinomasareRelativelyRadioresistanttumors
Renalcellcarcinomasaregenerallyconsideredradioresistant
tumors
RoleofRadiotherapyinrenalCellcarcinoma

---

PreoperativeRadiationhasshownnoimpactonsurvival
PostoperativeRadiationhasalsoshownnoevidenceofimproved
survivalbutmaybeusedasitshowsimprovementinlocalcontrol.
PalliativeRadiotherapyhasbeenshowntobeeffectiveinmetastatic
diseasetobrain,boneandlungs.

---

1503.Mostcommonnervedamagedduring
herniarepair
a)ilioinguinalnerve
b)Iliohypogastric
c)Genitofumoral
d)None
CorrectAnswer-A
Answer-A.ilioinguinalnerve
Therenervesareexposedtoinjuryduringinguinalherniarepair.
1. Ilioinguinalnerve
2. Genitofemoralnerve
3. Iliohypogastricnerve
Themostcommonlyinjurednerveisilioinguinalnerve.

---

1504.Progressivedysphagiaisseeninall
except
a)CAesophagus
b)Diffuseesophagealspasm
c)Stricture
d)Achalasiacardia
CorrectAnswer-B
Answer-B.Diffuseesophagealspasm
Propgressivedysphagisisseenin
CAesophagus
Stricture
Achalasiacardia
Dysphagiaequalforbothsolidsandliquidsfromonset:
1. Achalasia
2. Diffuseesophagealspasm

---

1505.Incarcinomaofanusdistalmarginof
clearanceofanalcanalofatleast
a)2cm
b)5cm
c)4cm
d)7cm
CorrectAnswer-A
Ans.is'a'i.e.,2cm
[RefBailey&Love25th/ep.1233]

---

1506.Khersignisseenin
a)Splenictrauma
b)Hepatictrauma
c)Renaltrauma
d)Pacreatictrauma
CorrectAnswer-A
Answer-A.Splenictrauma
Insplenicrupturethepainmaybereferredtothetipoftheleft
shoulder.
ThisisknownasKehr'ssign.
Itoccursduetoirritationoftheundersurfaceofthediaphragmwith
bloodandthepainisreferredtotheshoulderthroughtheaffected
fibresofphrenicnerve(C4andC5).

---

1507.ABPIofimminentnecrosis
a)<0.3
b)0.3
c)<0.6
d)>0-6
CorrectAnswer-A
Answer-A.<0.3
LowerABPIisanindicationofperipheralvasculardiseaseoflower
limb.
Criticalischemia(restpainortissuenecrosis)mostcommonlyis
associatedwithanABI<0.4.

---

1508.Anklebrachialpressureindexis
a)1.0
b)10
c)01
d)None
CorrectAnswer-A
Answer-A.1.0
Ankle-brachialpressureindex(ABPI)istheratioofBPinankleto
BPinarm(upperlimb).
NormalABPIisaround1(0.9-1.2).

---

1509.InAinhum,constrictiondevelops
usuallyatthelevelofinterphalangeal
jointof
a)Greattoe
b)2ndtoe
c)Littletoe
d)None
CorrectAnswer-C
Answer-C.Littletoe
Ainhumisbilateralpainfulconstrictionatthebaseof5thtoe(little
toe).
Thisleadstobilateralautoamputationoflittletoes.

---

1510.Breastconservationsurgerynot
indicated?
a)Largependularbreast
b)SLE
c)Diffusemicrocalcification
d)All
CorrectAnswer-D
Answer(a)Largependularbreast;(b)SLE;(c)Diffuse
microcalcification

---

1511.Trueaboutcarcinomaofmalebreastis
a)InvasivelobularCaismostcommon
b)Estrogenreceptornegative
c)Seeninyoungmales
d)BRCA2mutationisassociatedwithincreasedrisk
CorrectAnswer-D
Answer-D.BRCA2mutationisassociatedwithincreasedrisk
Theaverageageofmendiagnosedwithbreastcanceris68years
(oldage).
Breastcancersinmalehaveestrogenreceptorsandhighestorgen
levelisariskfactorforbreastcarcinomainmales.
MenwhoinheritabnormalBRCA-1andBRCA-2geneshavean
increasedriskformalebreastcancer.
Mostbreastcancersinmenareductalcarcinomas.

---

1512.Mostcommoncarcinomabreastinmale
s
a)Lobularcarcinomainsitu
b)Ductalcarcinomainsitu
c)InfiltratingductalCa
d)None
CorrectAnswer-C
Answer-C.InfiltratingductalCa
Mostbreastcancersinmenareductalcarcinomas.

---

1513.Pressureinlaproscopyis
a)10-12mmHg
b)12-14mmHg
c)14-16mmHg
d)16-18mmHg
CorrectAnswer-B
Answer-B.12-14mmHg
Inlaproscopywithstandardpressurepneumoperitoneum,thegas
pressureis12-14mmHg.

---

1514.Mostcommonsiteofdirecthernia
a)Hesselbach'striangle
b)Femoralgland
c)Nositepredilection
d)None
CorrectAnswer-A
Answer-A.Hesselbach'striangle
ItentersthecanalthroughinguinaltriangleofHesselbach.
Commoninelderly
Alwaysacquired
Herniationthroughposteriorwalloftheinguinalcanal
Globular/roundinshape;descendsdirectlyforwardbulge.
TrusscannotpreventprogressionofSlidingtypeofinguinalhernia

---

1515.Lymphdrainageisincreasedfrom
lowerlimbsby
a)Massasaging
b)Running
c)Cycling
d)Sleeping
CorrectAnswer-A
Answer-A.Massasaging
Inthehealthylimb,lymphflowislargelyduetointrinsiclymphatic
contractility,althoughthisisaugmentedbyexercise,limbmovement
andexternalcompresion(massaging).
Lymphaticpump/suctionpump:
1. Skeletalmusclecontraction(skeletalmusclepump);
2. Squeezingactionofsmoothmuscleliningthelargerlymphatics;
3. Positiveintra-abdominalandnegativeintrathoracicpressure.
4. Therefore,compressionoftissuesbyobjectsoutsidethebody(e.g.,
massageoffoot)increaseslymphflow.

---

1516.Noduleonthyroidwith
lymphadenopathy
a)Radiation
b)Chemotherapy
c)Excisionofnodule
d)Totalthyroidectomy+MRND
CorrectAnswer-D
Answer-D.Totalthyroidectomy+MRND
TotalThyroidectomyisthetreatmentofchoiceforpatientswithMTC
becauseofhighincidenceofmulticentricity.
Inpatientswithpalpablecervicalnodesorinvolvedcentralneck
nodes,ipsilateralorbilateralmodifiedradicalneckdissectionis
recommended.

---

1517.Treatmentofcontaminatedwoundof
leg
a)Debridementandantibiotics
b)Hyperbaricoxygen
c)Amputation
d)None
CorrectAnswer-A
Answer-A.Debridementandantibiotics
Afterdebridement,woundisreassessedandfurthermanagement
dependsonthetypeofwound.
1. IfitissmallandcleanPrimaryclosurecanbedone
2. IfitislargeandcleanCoverageprocedure(skingraft/musclepedicle
graft)shouldbedone.
3. Ifitisstillcontaminated-Dailydressinganddebridementisdonetill
thewoundisclean.

---

1518.IndicationsofLivertransplantationare
All/Except
a)Biliaryatresia
b)Sclerosingcholangitis
c)HepatitisA
d)Cirrhosis
CorrectAnswer-C
Ans.is'c'i.e.HepatitisA
Livertransplantationisindicatedforthosechildrenandadults,who
intheabsenceofcontraindicationssufferfromsevere,irreversible
liverdiseaseforwhichalternativemedicalorsurgicaltreatments
havebeenexhaustedorareunavailable.
Mostcommonindication
inchildren________Biliaryatresia
inadults-->Cirrhosis
Harrison17/ewrites-"Currently,chronichepatitisCandalcoholic
liverdiseasearethemostcommonindicationsforliver
transplantation,accountingforover40%ofalladultcandidateswho
undergotheprocedure."
Indicationsfor
verTransplantation
Children
Adults
Biliaryatresia
Primarybiliarycirrhosis
Secondarybiliary
Neonatalhepatitis
cirrhosis
Congenitalhepatic
Primarysclerosing
fibrosis
cholangitis
Alagille'sdisease
Autoimmunehepatitis

---

Alagille'sdisease
Autoimmunehepatitis
Byler'sdisease
Caroli'sdisease
al-antitrypsin
Cryptogeniccirrhosis
deficiency
Inheriteddisordersof Chronichepatitiswith
metabolism
cirrhosis
Wilson'sdisease
Hepaticveinthrombosis
Tyrosinemia
Fulminanthepatitis
Glycogenstorage
Alcoholiccirrhosis
diseases
Lysosomalstorage
Chronicviralhepatitis
diseases
Primaryhepatocellular
Protoporphyria
malignancies
Crigler-Najjardisease Hepaticadenomas
typeI
Familial
Nonalcoholic
hypercholesterolemia steatohepatitis
Primaryhyperoxaluria Familialamyloid
typeI
polyneuropathy
Hemophilia
ContraindicationstoLiverTransplantation
Absolute
Relative
Uncontrolledextrahepatobiliary Age>70
infection
Priorextensivehepatobiliary
Active,untreatedsepsis
surgery
Uncorrectable,life-limiting
Portalveinthrombosis
congenitalanomalies
Activesubstanceoralcohol
Renalfailure
abuse
Advancedcardiopulmonary
Previousextrahepatic
disease
malignancy(not
includingnonmelanomaskin
cancer)
Extrahepatobiliarymalignancy
Severeobesity

---

Extrahepatobiliarymalignancy
Severeobesity
(notincluding
nonmelanomaskincancer)
Metastaticmalignancytothe
Severemalnutrition/wasting
liver
Cholangiocarcinoma
Medicalnoncompliance
AIDS
HIVseropositivity
Life-threateningsystemic
Intrahepaticsepsis
diseases
Severehypoxemia
secondarytoright-to-left
intrapulmonaryshunts(P02<
50mmHg)
Severepulmonary
hypertension(meanPA
pressure>35mmHg)
Uncontrolledpsychiatric
disorder

---

1519.Cock'speculiartumoris
a)BasalcellCA
b)SquamouscellCA
c)Ulceratedsebaceouscyst
d)Cylindroma
CorrectAnswer-C
Ulceratedsebaceouscyst[Ref.Love&Bailey23/epage173,595;
DastextbookofSurgery3/ep81]RepeatfromMay04
Cock'speculiartumourisasebaceouscystlinkedgrowththatcan
resembleasquamouscellcarcinoma.
Theproliferatingcystisusuallysolitary,butitoftenarisesfroma
simpletrichilemmalcystsinthehairfollicleepithelium.

---

1520.Mostimportantdiagnosticfeatureof
congenitalhypertrophicpyloric
stenosis
a)Metabolicalkalosis
b)Nonbiliousvomiting
c)Jaundice
d)Fever
CorrectAnswer-B
Answer-B.Nonbiliousvomiting
metabolikalkalosisalsooccurs,non-biliousvomitingisthemost
importantfeatureofCHPS.

---

1521.Criteriaforviabilityofmuscleareall
except
a)Colour
b)Intactfascia
c)Contractability
d)Bleedingwhencut
CorrectAnswer-B
Answer-B.Intactfascia
Nonviablemusclecanbeidentifiedby4cs-
Color?Consistency
Contraction,and?Circulation(bleedingoncut)

---

1522.Gallstoneimpactedcausingintestinal
obstruction
a)Raynodspentad
b)Hepatitis
c)Gallstoneileus
d)Obstructivejaundice
CorrectAnswer-C
Answer-C.Gallstoneileus
Gallstoneileusreferstomechanicalintestinalobstructionresulting
fromthepassageofalargegallstoneintothebowellumen.
Thestoneenterstheduodenumthroughacholecystoentericfistula.
ThesiteofobstructionbytheimpactedGallstonesisusuallythe
terminalendoftheileumprovidedthatthemoreproximalsmall
bowelisofnormalcaliber.

---

1523.Amiddleagedmalecomplainsofache
andmumbnessandsensatedoffatigus
overhiscalfmusclesthatdevelopson
exerciseandisrelievedonrest;this
conditionisnotassociatedwith
a)Smoking
b)Hypocalcemia
c)Peripheralarterialdisease
d)Hypertensionanddiabetes
CorrectAnswer-B
Answer-B.Hypocalcemia
Hyperlipidemia
Diabetes
Hypertension
Cigarettesmoking
Alcohol,lipoprotein(a)
Chlamydiapneumonae
Physcialinactivity
Herpesvirus
CMVinfection

---

1524.Setonusedinfistulainanois
a)Drainingseton
b)Cuttingseton
c)Dissolvingseton
d)None
CorrectAnswer-B
Answer-B.Cuttingseton
seton(Tightseton):Madeupofsilk/prolene/monofilamentnylonand
usedinfistulainano
Itpromotesslowtransectionofexternalsphinctermuscleasaresult
ofpressurenecrosiswithminimumseparationofds.cutafistula.

---

1525.MultipleairfluidlevelsinX-rayof
abdomenisseenin
a)Hollowvisceraperforation
b)Pyoperitoneum
c)Intestinalobstruction
d)None
CorrectAnswer-C
Answer-C.Intestinalobstruction
Theobstructionmaybeduetoadhesion,hernia,neoplasm,foreign
bodyetc.
Anormalpersonhasonaverage4airfluidlevels.Mostofthemare
seeninthecolon.
Forthediagnosisofsmallintestinalobstruction,weshouldseemore
than2airfluidlevelsamongthedilatedloopsofsmallbowel.

---

1526.Mondor'sdiseaseis?
a)ThrombophlebitisoftheSuperficialveinsofBreast
b)Carcinomaofthebreast
c)Premalignantconditionofthebreast
d)Filariasisofthebreast
CorrectAnswer-A
Ansis'a'i.e.,ThrombophlebitisofSuperficialveinsofBreast
Mondor'sdisease
isthrombophlebitisofthesuperficialveinsofanteriorchestwalland
breastalthoughithasalsobeenseeninthearm.
frequentlyinvolvedveinsarelateralthoracicvein,thoracoepigastric
veinandsuperficialepigastricveins.
aetiologyisunknown
alsoknownas'stringphlebitis',itpresentsasatendercord-like
structure.
Thewomenmaypresentwithacutepaininthelateralasepctof
breastortheanteriorchestwall.Atendercord-likesuperficial
thrombosedveinisformedandwhentheskinoverthebreastis
stretchedbyraisingthearm,anarrowshallowsubcutaneousgroove
alongsidethecordbecomesapparent.
rarelyitmaybebilateral.
Management
it'sabenignself-limiteddisorder
Thedifferentialdiagnosisislymphaticpermeationfromanoccult
carcinomaofbreast
Whenthediagnosisisuncertainoramassispresentnearthecord,
abiopsymaybedone.Treatment
antiinflammatorydrugsandwarmcompresses

---

restrictedarmmovementsaswellasbrassieresupportofbreast
itusuallyresolveswithin4to6weeks.Whensymptomspersistsor
arerefractorytotreatment,theinvolvedveinsegmentmaybe
excised.

---

1527.Treatmentofribfracture?
a)Immediatethoracotomy
b)IPPV
c)Analgesics
d)bandc
CorrectAnswer-C
Answeris'c'i.e.Analgeic
Ribfracturesarethemostcommoninjuriesafterbluntchesttrauma.
Ribs4to10areusuallyfractured.
Managementof#rib
-Paincontrolwithoralori.v.analgesicsorintercostalnerveblocks
orepiduralanalgesia.(Poorpaincontrolsignificantlycontributesto
complicationssuchasatelectasisandpneumonia)
-Cheststrappingisnolongeradvised.
Managementofflailchest,asmentionedinpreviousquestion,may
needIPPV.

---

1528. TriangleofDoomisboundedbyallof
thefollowingexcept:
a)Cooper'sligament
b)Vasdeferens
c)Gonadalvessels
d)Peritonealreflection
CorrectAnswer-A
Ansisai.e.Cooper'sligament
Thetriangleofdoomisbounded
Mediallybythevasdeferens
Laterallybythevesselsofthespermaticcord(gonadalvessels)
Inferiorlybyperitonealreflection
Apexorientedsuperiorlyatinternalring.
Thecontentsofthespaceinclude
Externaliliacvessels
Deepcircumflexiliacvein
Femoralnerve
Genitalbranchofthegenitofemoralnerve

---

---

1529.Commonesttypeofanalcanalcarcinomais?
a)Squamouscellcarcinoma
b)Adenocarcinoma
c)Adenoacanthoma
d)Papillarytype
CorrectAnswer-A
Squamouscellcarcinomaisthemostcommontypeofanalcancer.Thiscancer
beginsintheouterliningoftheanalcanal.
Mainlythreetypesofmalignantneoplasmareseeninanalcanal
Squamouscellcarcinoma(mostcommon)
Basalcellcarcinoma(2ndmostcommon)
Melanoma
Alsoremember:
MostcommontypeofrectalandcoloncancerAdenocarcinoma

Ref:S.Dastextbookofsurgery3/e,Page1078.

---

1530.Blunttraumachest,firststepin
managementafterinitialresuscitationis
a)CTscan
b)Angiography
c)X-raychest
d)USG
CorrectAnswer-C
Answer-C.X-raychest
FirstinvestigationofchoiceinanytypeofchestinjuryischestX-ray.

---

1531.Allaretrueaboutamoebicliverabscess
except:
a)Morecommoninfemales
b)Morecommoninleftlobeofliver
c)Metronidazoleismainstayoftreatment
d)aandb
CorrectAnswer-D
AnsisD
ai.e.Morecommoninfemales&bi.e.Morecommoninleftlobeof
liver
"Malepreponderanceofgreaterthan10:1hasbeenreportedinall
studies"
Therightlobeoftheliverismorecommonlyaffectedthantheleft
lobe.
amebicliverabscessis7-12timesmorecommoninmenthanin
women,withapredominanceamongmenaged18-50years.
Metronidazole800mgTDSfor5?10days
Aspiration
Repeatedimagingofliver

---

1532.Falseabouthydatidcystofliver:
a)Mostlyasymptomatic
b)Mostcommonlylocatedinrightlobeofliver
c)Mostcommoncausativeorganismisechinococcusgranulosus
d)Hepaticresectionisneverdone
CorrectAnswer-D
Ansis'd'i.e.Hepaticresectionisneverdone
Laparoscopicaspiration,unroofingandevacuationofthehepatic
hydatidcystscanbedone.

---

1533.Hemorrhageafterthyroidectomyisdue
to
a)Externalcarotidartery
b)Internalcarotidartey
c)Superiorthyroidartery
d)Inferiorthyroidartery
CorrectAnswer-C
AnswerC.Superiorthyroidartery
Isusuallyduetoslippingofligatureonthesuperiorthyroidartery.
Hematomasmaycauseairwaycompromiseandmustbeevacuated
immediately.

---

1534.Foreignbodyaspirationinsupine
positioncauseswhichofthefollowing
partsofthelungcommonlytobe
affected-
a)Apicalleftlobe
b)Apicallobeofrightlung
c)Apicalpartofthelowerlobe
d)Posterobasalsegmentofleftlung
CorrectAnswer-C
Ans.is'c'i.e.Apicalpartofrightlowerlobe
Rightupperlobe-posteriorsegment
Rightlowerlobe-superiorsegment
Leftlowerlobe-superiorsegment
Rightbasilarsegments(oflowerlobe)

---

1535. Intralobarsequestrationoflungtakes
itsbloodsupplyfrom-
a)Internalmammaryartery
b)Descendingabdominalaorta
c)Pulmonaryartery
d)Noneoftheabove
CorrectAnswer-B
Ans.is'b'i.e.,Descendingabdominalaorta
Asequestrationconsistsofnormallydevelopedbronchiolesand
alveolisuppliedbysystemicratherthanpulmonaryarteries.
ThisbloodsupplyisfromtheAortaeitheraboveorbelowthe
diaphragm.
Mostly(approx95%)thisisfromthedescendingthoracicaorta.
Othercharacteristicfeaturesofsequestration-
Theyoccurmostcommonlyinthelowerlobes,L>R
.Lungsequestrationsareoftwotypes

---

1536.Dumpingsyndromeisdueto:
a)Diarrhoea
b)Presenceofhypertoniccontentinsmallintestine
c)Vagotomy
d)Reducedgastriccapacity
CorrectAnswer-B
AnswerisB(PresenceofHypertonicContentsinsmallintestine)
DUMPINGSYNDROMEreferstoasyndromeofabdominaland
vasomatorsymptomswhichresultsfromdumpingoffoodstuffswith
ahighosmoticload,frontthestomach,intothesmallbowel.
Lossofstoragecapacityofstomachandablation,bypassor
destructionofpylorus,resultsinrapidemptyingofhyperostnolar
chymeintoduodenummmandsmallintestine.Extracellularfluid
thenshiftsintotheintestinallumentorestoreisotonicityresultingin
decreasedintravascularvolume,whichgivesrisetothevasomotor
symptoms.Notethatwhilereducedgastriccapacitycontributes,
option(b)isamoreaccurateanswer.
DumpingSyndromeisactuallyoftwotypes:
Earlydumpingsyndrome(asdescribedabove)
Latedumpingsyndrome:ThisisReactivehypoglvcemiae.The
carbohydrateloadinthesmallintestinelatercausesariseinplasma
glucose,whichinturncausesinsulinlevelstorisecausinga
secondaryhypoglycemia.

---

1537.Incaseofbenignmixedparotid
tumoursT/tofchoiceis-
a)SuperficialParotidectomy
b)Totalparotidectomy
c)Leavefacialnerveandremoveallgland
d)RadicalParotidectomy
CorrectAnswer-A
Ansis'a'ieSuperficialparotidectomy
Schwartzwrites-"Treatmentofbenignneoplasmsissurgical
excisionoftheaffectedglandor,inthecaseoftheparotid,excision
ofthesuperficiallobewithfacialnervedissectionandpreservation.
Theminimalsurgicalprocedureforneoplasmsoftheparotidis
superficialparotidectomywithpreservationofthefacialnerve.
'Shellingout'ofthetumormassisnotrecommendedbecauseofthe
riskofincompleteexcisionandtumorspillage."
Superficialparotidectomyisthetreatmentofchoicefor
mostbenigntumorsinthesuperficiallobe.

---

1538.Linitisplasticaisatypeof:
a)Gastriculcer
b)Castomach
c)Duodenalulcer
d)Noneoftheabove
CorrectAnswer-B
Linitisplasticaisatypeofadenocarcinoma.Adenocarcinomaisthemostcommon
formofstomachcancer.Linitisplasticaspreadstothemusclesofthestomachwall
andmakesitthickerandmorerigid.
Linitisplasticaisasubtypeofgastriccancerthatischaracterizedbydiffuseinfiltrating
adenocarcinomawithoutobviouscartersandulcers.
Itisthoughttooriginatefromparietalcellportionofgastricmucosa.
Becauseofitsdiffusenature,thisformofgastriccancerususallyinvolvesthewhole
stomach.
Ref:ClinicalScenariosinSurgicalOncologyeditedbyVijayP.Khatri

---

1539.Trueaboutblindloopsyndrome,all
except
a)Syndromeofbacterialovergrowth
b)Steatorrhea,mayeloblasticanemia&deficiencyoffatsoluble
vitamins
c)Surgeryisnotindicated
d)14C-xyloseor14C-cholyglycinebreathtestsareindirecttests
forbacterialovergrowth
CorrectAnswer-C
Answer-C.Surgeryisnotindicated
Features
Diarrhea
Steatorrhea
Megaloblasticanemia(vit.B12deficiency)
Weightloss
Abdominalpain
Fatsolublevitamindeficiency
Treatment
Parentralvit.B1,therapy
Broadspectrumantibiotics:
1. Tetracyclineorco-amoxyclav
2. Cephalexin+metronidazole
3. Chloremphenical

---

1540. Livertransplantationwasfirstdoneby
?
a)Starzl
b)Huggins
c)Carrel
d)ChristianBenard
CorrectAnswer-A
Ans.is'a'i.e.,Starzl
Thefirsthumanlivertransplantwasperformedin1963byDr.
ThomasStarzl.

---

1541.%ofmalignancyinductectasiais
a)Norisk
b)1.5:1
c)7:1
d)10:1
CorrectAnswer-A
Answer-A.Norisk
Ductectasia
Cysts
Apocrinemetaplasia
Apocrinemetaplasia
Mildhyperplasia
Adenosis
Fibroadenoma(withoutatypia)
Noincreasedriskforcancer

---

1542.Tissuesuturinggluecontains:
a)Cyanoacrylate
b)Ethanolamineoleate
c)Methacrylate
d)Polychloroprene
CorrectAnswer-A
Ansis'a'i.e.Cyanoacrylate
Mosttissueadhesivesorgluearecyanoacrylatepolymers,suchas
n-butyl-2-cyanoacrylate(eg,Histoacryl?,PeriAcryl?)or2-octyl
cyanoacrylate(eg,Dermabond?,Surgiseal).
Cyanoacrylatetissueadhesivesareliquidmonomersthatundergo
anexothermicreactiononexposuretomoisture(eg,ontheskin
surface),changingtopolymersthatformastrongtissuebond.When
appliedtoalaceration,thepolymerbindsthewoundedgestogether
toallownormalhealingoftheunderlyingtissue.
Comparedwithwoundsclosedwithsutures,thetensilestrengthof
woundsclosedbytissueadhesivesislessatthetimeofinitial
application,butequalizesbyoneweekpost-repair.
Advantages:
Lesspainfulapplication,andsometimesnoneedforlocalanesthetic
injection
Morerapidapplicationandrepairtime
Cosmeticallysimilarresultsat12monthspost-repair
Waterproofbarrier
Antimicrobialproperties
Betteracceptancebypatients
Noneedforsutureremovalorfollow-up
Indicationsandcontraindications:

---

Foruseoftissueadhesivesthewoundneedstobeclean,drywith
nearperfecthemostasisandundernotension.
Complexstellatelesionsorcrushinjuriesshouldnotbeclosedwith
tissueadhesivessincegoodwoundapproximationisdifficultto
achieve.
Tissueadhesivesarenotrecommendedforlacerationsofthehands,
feet,orjoints,sincerepetitivemovementscouldcausetheadhesive
bondtobreakbeforesufficienttensilestrengthisachieved.
Tissueadhesivesarenotrecommendedfortheoralmucosaorother
mucosalsurfacesorareasofhighmoisturesuchastheaxillaeand
perineum.
Lacerationsinvolvingthehairlineorvermilionborderrequiremore
precision,andshouldberepairedwithtraditionalsutures.

---

1543.Dysphagialusoriaisdueto?
a)Esophagealdiverticulum
b)Aneurysmofaorta
c)Esophagealweb
d)Compressionbyaberrantbloodvessel
CorrectAnswer-D
Dysphagialusoriaisadisorderofswallowingcausedduetovascularanomaliesand
includes:
Arightaorticarch
Adoubleaorticarch
AvascularconstrictingringformedbyaPDAoraligamentumarteriosumandpulmonary
arteryoraorticarch
Anabnormalrightsubclavianartery
Anabnormalinnominateartery
Diagnosisismadebylipoidalswalloworarteriography.
Ref:BaileyandLove24/e,Page995

---

1544.Recurrentanalfistula,mostappropriate
investigationis
a)EndorectalUS
b)Colonoscopy
c)MRI
d)Proctoscopy
CorrectAnswer-C
Answer-C.MRI
MRIismostaccurateinvestigationfordeterminingpresenceand
courseofrecurrentanalfistulae.

---

1545.Analfissurediagnosedby
a)TRUS
b)Colonoscopy
c)Clinicalexamination
d)Baenema
CorrectAnswer-C
Answer-C.Colonoscopy
Analfissureisalinearulcerofthelowerhalfoftheanalcanal,thus
canbediagnosedbyvisuallyinspectingtheanalvergewithgentle
separationoftheglutealcleft.
Thehistoryistypicalofpainandbleedingwithdefecation

---

1546.70yroldfemalewithbleedingfrom
proximalcolon
a)Colitis
b)Polyp
c)Diverticulitis
d)Cacolon
CorrectAnswer-D
Answer-D.Cacolon
Bleedingperrectuminoldagesuggeststhediagnosisofcolorectal
carcinoma.
Symptomsofcolorectalcarcinomaarenon-specificandgenerally
developwhenthecancerislocallyadvanced.
Symptomsvarywiththeanatomiclocationofthetumor.
Abd.pain
Anemia(microcytichypochronicanemiaindicativeofirondef.)
Fatigue,palpitationandevenanginapectoris
Massinrightiliacfossa
Acecalcarcinomacanactasleadpointinintussusception

---

1547.A25yearoldmanpresentswith3days
historyofpainintherightlower
abdomenandvomitings.patient's
generalconditionissatisfactoryand
clinicalexaminationrevealsatender
lumpinrightiliacfossa.Themost
appropriatemanagementinthiscase
wouldbe
a)Immediateappendicectomy
b)Exploratorylaprotomy
c)OschnerSherrenregimen
d)Externaldrainage
CorrectAnswer-C
Ans.is'c'i.e.,OschnerSherrenregimen
Thepatientispresentingwithtypicalclinicalfeaturesofappendical
mass.
Ifanappendixmassispresentandtheconditionofthepatientis
satisfactory,thestandardtreatmentistheconservativeOchsner-
Sherrenregimen.
Thisstrategyisusedastheinflammatoryprocessisalready
localisedandthatinadvertentsurgeryisdificultandmaybedan
gerous.
Itmaybeimpossibletofindtheappendixand,occasionally,afaecal
fistulamayform.
Forthesereasons,itiswisetoobserveanon-operativeprogramme

---

buttobepreparedtooperateshouldclinicaldeterioration

---

1548.A27yearoldpatientpresentedwithleft
sidedabdominalpain6hoursafter
RTA.Hewashemodynamicallystable
andFASTpositive.CTscanshowed
gradeIIIsplenicinjury.Whatwillbe
appropriatetreatment
a)Splenectomy
b)Splenorrhaphy
c)Splenicarteryembolization
d)Conservativemanagement
CorrectAnswer-D
Answer-D.Conservativemanagement
"Inearlyreports,mostinvestigatorsexpressedextremecaution
regardingnonoperativemanagementofgradesIIIandIV,evenwith
hemodynamicstability.Asexperiencehasaccumulated,mostfeel
comfortablewithobservingstablegradeIIIinjuries,andmanyhave
begunobservinggradeIVandVinjuries".--Sabiston

---

1549.Retractionballseenin
a)Burns
b)Acutepancreatitis
c)Diffuseaxonalinjury
d)Tracheobronchialinjury
CorrectAnswer-C
Answer-C.Diffuseaxonalinjury
Atthedistaltipoftheamputatedaxonthereisoftenandenlarged
ballshapedcollectionofcytoplasmtermeda'retractionball'.
Axonalretractionballs-TheHallmarkofDiffuseAxonalInjury.

---

1550.Prophylacticthyroidectomyisindicated
in
a)Hashimotothyroiditis
b)MENtype2
c)Riedelthyroiditis
d)De-Quervain'sthyroiditis
CorrectAnswer-B
Answer-B.MENtype2
MENtype2syndromeconsistsofmedullarycarcinomathyroid,for
patientsinlowtohigh-riskgroups,prophylacticthyroidectomyis
recommendedbyage5.
ProphylacticthyroidectomyisindicatedinMEN2Bsyndrome.
Medullarythyroidcarcinoma(MTC)canbeinheritedasfamilial
MTC,MEN2AorMEN2Bsyndromes.
TheseconditionsareautosomaldominantandoccurduetoRET
proto-oncogenemutation.
IndividualswithRETmutationareverylikelytodevelopMTCata
youngerage.Oncethemutationisconfirmed,itisadvisedto
undergoprophylacticthyroidectomy.

---

1551.ProphylacticThyroidectomyforMEN2
isrecommendedatageof
a)5years
b)Before1year
c)Whendetected
d)Anytime
CorrectAnswer-A
Answer-A.5years
MENtype2syndromeconsistsofmedullarycarcinomathyroid,for
patientsinlowtohighriskgroups,prophylacticthyroidectomyis
recommendedbyage5.

---

1552.Thefollowingisthecommonestsitefor
venousulcer:
March2013(a,e)
a)Lowerthirdoflegandankle
b)Instepoffoot
c)Lower2/3rdofleg
d)Middle1/3rdofleg
CorrectAnswer-A
Ans.Ai.e.Lowerthirdoflegandankle
Venousulcersusuallyliejustproximaltothemedialorlateral
malleolus.
Venousulcersareaccompaniedbylipodermatosclerosisand
hemosiderosis(ifthesearenotpresentthentheulcerisprobablynot
ofvenousorigin).

---

1553.Cleftpalateisideallyrepairedat
a)5monthofage
b)1yearofage
c)Beforegoingtoschool
d)6-8yearsofage
CorrectAnswer-B
Answer-B.1yearofage
TimingofRepairofCleftPalate
AccordingtoSabiston-before12months
AccordingtoSchwartz-at9to12monthsofage
AccordingtoBailey&Love-between6and18months

---

1554.Heller'smyotomyisdonefor:
September2007,2009,2010
a)Esophagealcarcinoma
b)Pylorichypertrophy
c)Achalasiacardia
d)Inguinalhernia
CorrectAnswer-C
Ans.C:Achalasiacardia
Achalasiaisassociatedwithlossofganglioncellsintheesophageal
myentericplexus.
TheseimportantinhibitoryneuronsinduceLESrelaxationand
coordinateproximal-to-distalperistalticcontractionoftheesophagus
Achalasiaisanesophagealmotordisordercharacterizedby
increasedloweresophagealsphincter(LES)pressure,diminished-
to-absentperistalsisinthedistalportionoftheesophaguscomposed
ofsmoothmuscle,andlackofacoordinatedLESrelaxationin
responsetoswallowing.
Bariumradiologymayshow'bird'sbeak'appearance.
Esophageal(Heller)myotomyisasurgicalprocedurethatis
performedwithminimallyinvasivetechniques.Thelaparoscopic
approachappearstobemostappropriate.

---

1555.Radiofrequencyablationis
a)DerivedfromACcurrent
b)Usedtoseparatefascialplanesduringsurgery
c)Usesmicrowave
d)Usedforhemostasis
CorrectAnswer-A
Answer-A.DerivedfromACcurrent
Radiofrequencyablationisamedicalprocedureinwhichpartofthe
electricalconductionsystemoftheheart,tumororother
dysfunctionaltissueisablatedusingtheheatgenerationfromhigh
frequencyalternatingcurrent(intherangeof350-500KHz).

---

1556.Malignantmelanomafalseis
a)Radiosensitive
b)Surgeryisthetreatmentofchoice
c)Acrallentiginoushasworstprognosis
d)Treatmentismidelocalexcision
CorrectAnswer-A
Answer-A.Radiosensitive
Melanomaareamongthemostradioresistanttumors.
Thereare4commontypeofmelanoma(theseareinorderof
decreasingfrequency)
1. Superficialspreadingtype(mostcommon)
2. Nodular
3. Lentigomaligna
4. Acrallentiginous(leastcommon)
Widelocalexcisionoftheprimarytumoristhemanagementof
choice.
[RefSabistonIV/Yep.742;Schwartz10th/ep.488,490;Harrison
17thlep.541;ChandrasomaTaylor3rd/ep.895]

---

1557.DVTnotcommoncauses
a)Prolongedimmobilizationa
b)Extensivepelvicsxof>30minutes
c)Obesity
d)Agelessthan40
CorrectAnswer-D
Answer-D.Agelessthan40
A)VenousThrombosis
1. Inherited:FactorVLeiden(Leidenfactor),antithrombinIII
deficiency,ProteinSdeficiency,ProteinCdeficiency.
2. Acquired:Oldage,immobilization,prolongedbedrest,major
surgery(e.gorthopaedicshipsurgery),majortrauma,pregnancy
andpureperium,obesity,infection.
B)Botharterialandvenousthrombosis
1. Inherited:Homocystinuria/homomtinemia,dysfibrinogenemia.
2. Acquired:Malignancy,antiphospholipidsyndrome(lupus
anticoagulant),hormonaltherapy(estrogencomponentofDCPs),
polycythemia,PNH,DIG.

---

1558.Fogarty'scatheterisusedfor
a)Embolization
b)Embolectomy
c)Radiofrequencyablation
d)Angiography
CorrectAnswer-B
Answer-B.Embolectomy
Fogarty'scatheterisanembolectomycatheterindicatedforthe
removaloffresh,softemboliandthrombifromvesselsinthearterial
system.
TheFogartyembolectomycatheterhasbeenfoundusefulin
minimizingbloodlossinlargesurgicalproceduresaboutthehipand
pelvis.Itsutilityliesintheabilitytoachievetemporaryintraluminal
occlusionofthecommoniliacarterywhiletheproposedsurgical
procedureisbeingcarriedout.

---

1559.

---

Aganglionicsegmentisencounteredinwhich
partofcolonincaseofHirschsprungdisease
?
a)Distaltodilatedsegment
b)InWholecolon
c)Proximaltodilatedsegment
d)Inthedilatedsegment
CorrectAnswer-A
Ans.is'a'i.e.,Distaltodilatedsegment
Congenitalaganglionicmegcolon(Hirschsprungdisease)
oHirshsprungdiseaseacongenitaldisordercharacterizedby
aganglionosisofaportionoftheintestinaltract.
oAnintestinalsegmentlacksbothMeissnersubmucosaland
Auerbachmyentericplexuses.Thisleadstofunctionalobstruction
andintestinaldilationProximaltotheaffectedsegment.
oHistologicalfindingsare:-
(i)Absenceofganglioncellsandgangliainthemusclewalland
submucosaoftheaffectedsegment.
(ii)Thickeningandhypertrophyofnervetrunk.
oRectumisalwaysaffectedwithinvolvementofmoreproximal
colontovariableextent-->mostcasesinvolvetherectumand
sigmoidonly.
oProximaltotheaganglionicsegment,thecolonundergoes
progressivedilationandhypertrophy.oWithtime,theproximal
innervatedcolonmaybecomemassivelydistended-->megacolon.

---

1560."Corkscrewappearance"is
characteristicof?
a)Carcinomaesophagus
b)Hypertrophicpyloricstenosis
c)Diffuseesophagealspasm
d)Sigmoidvolvulous
CorrectAnswer-C
DiffuseesophagealspasmREF:Wofganag5thep.846/748
Sign
Disease
Rattailappearance
Carcinomaesophagus
Birdbeakappearance
Achalasia
Beaksign/doubletrack/tramtrack Hypertrophicpyloricstenosis
MedusaheadcoloniesonCT
Roundworm
Pincer/claw/coiledspring/target/
Intussception
meniscussign
Coffeebeansign
Sigmoidvolvulous
Leadpipeappearance
Ulcerativecolitis
Stringofkantor/bull'seye
Chron'sdisease
Thumbprintingsign
Ischemiccolitis
Sawtoothappeanceonbarium
Diverticulosis
enema
Applecoresign
Carcinomacolon
Corkscrewappearance
Diffuseesophagealspasm
Stringsign
Hypertrophicpyloricstenosis

---

1561.Choledochalcystisdilatationof
a)Gallbladder
b)CBD
c)Hepaticduct
d)Bileduct
CorrectAnswer-D
Answer-D.Bileduct
Acholedochalcystisanisolatedorcombinedcongenitaldilatation
oftheextrahepaticorintrahepaticbiliarytree.

---

1562.Falseaboutretroperitonealfibrosisis
a)Ureterismostcommonlyinvolved
b)Morecommoninfemales
c)Primaryidiopathicformiscalledormond'sdisease
d)Corticosteroidsaremainstayoftreatment
CorrectAnswer-B
Answer-B.Morecommoninfemales
RETROPERITONEALFIBROSIS(ORMOND'SDISEASE)
RPFisanuncommoninflammatoryconditioncharacteristedby
proliferationoffibroustissueintheretroperitoneum.
Themajorstructureinvolvedare-
1. Ureter-Mostcommonlyinvolved
2. Aorta
3. Inferiorvenacava
Corticosteroids,withorwithoutsurgery,arethemainstayofmedical
therapy.

---

1563.Mostcommonlyaffectedinormond's
disease
a)Aorta
b)IVC
c)Ureter
d)Gonadalvessels
CorrectAnswer-C
Answer-C.Ureter
Themajorstructureinvolvedare-
1. Ureter-Mostcommonlyinvolved
2. orta
3. Inferiorvenacava

---

1564.Mucoceleofgallbladder,false
statementis
a)Complicationofgallstones
b)Treatmentisearlycholecystectomy
c)Obstructionatneckofgallbladder
d)Gallbladderisneverpalpable
CorrectAnswer-D
Answer-D.Gallbladderisneverpalpable
ItisoneofthecomplicationsofGallstones.
Causedduetoobstructionofthestoneattheneckofthebladder.
Thet/tisearlycholycystectomy.

---

1565.Whichofthefollowingisnotasign
seeninacuteapendicitis
a)Rovsing's
b)Rosenstein'ssign
c)Boa'ssign
d)Hamburgersign
CorrectAnswer-C
Ans.is'C'
Accessorysignsofappendicitis
Aure-Rozanova'ssign:Increasedpainonpalpationwithfingerin
rightPetittriangle(canbeapositiveShchetkin-Bloomberg's).
Bartomier-Michelson'ssign:Increasedpainonpalpationatthe
rightiliacregionasthepersonbeingexaminedliesonhisorherleft
sidecomparedtowhenhe/sheliesontheback.
Dunphy'ssign:Increasedpainintherightlowerquadrantwith
coughing.
Hamburgersign:Thepatientrefusestoeat(anorexiais80%
specificforappendicitis)
Kocher's(Kosher's)sign:Fromtheperson'smedicalhistory,the
startofpainintheumbilicalregionwithasubsequentshifttothe
rightiliacregion.
Massouhsign:DevelopedinandpopularinsouthwestEngland,the
examinerperformsafirmswishwithhisorherindexandmiddle
fingeracrosstheabdomenfromthexiphoidprocesstotheleftand
therightiliacfossa.ApositiveMassouhsignisagrimaceofthe
personbeingexamineduponarightsided(andnotleft)sweep.
Obturatorsign:Thepersonbeingevaluatedliesonherorhisback
withthehipandkneebothflexedatninetydegrees.Theexaminer

---

holdstheperson'sanklewithonehandandkneewiththeother
hand.Theexaminerrotatesthehipbymovingtheperson'sankle
awayfromhisorherbodywhileallowingthekneetomoveonly
inward.Apositivetestispainwithinternalrotationofthehip.
Psoassign,alsoknownas"Obraztsova'ssign",isrightlower-
quadrantpainthatisproducedwitheitherthepassiveextensionof
therighthiporbytheactiveflexionoftheperson'srighthipwhile
supine.Thepainthatiselicitedisduetoinflammationofthe
peritoneumoverlyingtheiliopsoasmusclesandinflammationofthe
psoasmusclesthemselves.Straighteningoutthelegcausespain
becauseitstretchesthesemuscles,whileflexingthehipactivates
theiliopsoasandcausespain.
Rovsing'ssign:Paininthelowerrightabdominalquadrantwith
continuousdeeppalpationstartingfromtheleftiliacfossaupwards
(counterclockwisealongthecolon).Thethoughtistherewillbe
increasedpressurearoundtheappendixbypushingbowelcontents
andairtowardtheileocaecalvalveprovokingright-sidedabdominal
pain.
Sitkovskiy(Rosenstein)'ssign:Increasedpainintherightiliac
regionasthepersonisbeingexaminedliesonhis/herleftside

---

1566.Investigationofchoicefor74yrold
malepatientscantybleedingperrectum
irregularbowelhabits
a)Sigmoidoscopy
b)Bariumenema
c)Colonoscopy
d)Bariummealfollowthrough
CorrectAnswer-B
Answer-B.Bariumenema
Theclinicalfeaturessuggestdiagnosisofdiverticulosis.
Theyaremainlyfoundinthecolon(mainlytheleftsideofcolon)with
sigmoidcolonbeingthemostcommonsite.
ColonicdiverticulosisisbestdiagnosedbyBariumenema.

---

1567.Obstructionanddilatationoflarge
intestineinabsenceofanymechanical
obstruction
a)Ogilvesyndrome
b)Hirschsprungdisease
c)Chagasdisease
d)None
CorrectAnswer-A
Answer-A.Ogilvesyndrome
Ogilviesyndrome,oracutecolonicpseudo-obstruction(ACPO),isa
clinicaldisorderwiththesigns,symptoms,andradiographic
appearanceofanacutelargebowelobstructionwithnoevidenceof
actualphysicalcauseoftheobstruction.

---

1568.Thyroidnoduleincreasedradioisotope
uptakeIOCis
a)Biopsy
b)Thyroidscan
c)FNAC
d)None
CorrectAnswer-C
Answer-C.FNAC
isotopescanningathyroidnodulecanbe'hot,'warm'or'cold'.
FNACistheinvestigationofchoiceforsolitarythyroidnodule.

---

1569.Thetendencyofcoloniccarcinomato
metastasizeisbestassessedby-
a)Sizeoftumor
b)Carcinoembryonicantigen(CEA)levels
c)Depthofpenetrationofbowelwall
d)Proportionofbowelcircumferenceinvolved.
CorrectAnswer-C
Ans.isc)i.e.depthofpenetrationofbowelwalls
Schwartzwrites
"Regionallymphnodeinvolvementisthemostcommonformof
spreadofcolorectalcarcinomaandusuallypreceedsdistant
metastasisorthedevelopmentofcarcinomatosis.theTstage(depth
ofinvasion)isthesinglemostsignificantpredictoroflymphnode
spread."
Fromtheabovegivenlines'depthofpenetrationofbowelwall'
appearstobepredictorofdistantmetastasesaswell.
CEAlevelisamarkerforrecurranceofcolorectalcaaftersurgical
resection.
Thoughitspreoperativelevelshassomeprognosticsignificance,itis
notapredictorfordistantmetastasis.
CEAlevelisusedtofollowuppostoperativecasesofcolorectal
cancer,forearlydetectionofrecurrance.

---

1570.Whatisintussuscepiens
a)Theentirecomplexofintussusception
b)Theenteringlayer
c)Theouterlayer
d)Theprocessofreducingtheintussusception
CorrectAnswer-C
Answer-C.Theouterlayer
Anintussusceptioniscomposedofthreeparts:
Theenteringorinnertube-intussusceptum
Thereturningormiddletube
Thesheathoroutertube-intussuscipiens

---

1571.Gumtumorwith5cmindimensionand
contralaterallymphnodeenlargement
of2cm.Thereisnodistantmetasis.
Thestageoftumor:
a)T3N2M0
b)T2N2M0
c)T1N2Mo
d)T3N3M0
CorrectAnswer-A
Answer-A.T3N2M0
TNMSTAGINGOFORALCARCINOMA
Primarytumor,asfollows:
T0-Noprimarytumor
Tis-Carcinomainsitu
T1-Tumor2cmorsmaller
T2-Tumor4cmorsmaller
T3-Tumorlargerthan4cm
T4-Tumorlargerthan4cmanddeepinvasiontomuscle,bone,or
deepstructures(eg,antrum)
Lymphaticnodeinvolvement,asfollows:
N0:Noregionallymphnodemetastasis
N1:Metastasisinasingleipsilaterallymphnode
N2a:Metastasisinasingleipsilaterallymphnode>3cmbutnot>6
cm
N2b:Metastasisinmultipleipsilaterallymphnodes,none>6cmin
greatestdimension
N2c:Metastasisinbilateralorcontralaterallymphnodes,none>6

---

cmingreatestdimension
N3:Metastasisinanylymphnode>6cm
Tumormetastasis(M),asfollows:
M0-Nometastasis
M1-Metastasisnoted
Staging
StageI:T1,N0,M0.
StageII:T2,N0,M0.
StageIII:
T3,N0,M0
T1,T2,T3,N1,M0
StageIV:
T4,N0,M0
AnyT,N2orN3,M0
AnyT,anyN,anyM

---

1572.WhichisM.C.siteforiatrogenic
oesophagealperforation-
a)Abdominalportion
b)Cervicalportion
c)Abovearchofaorta
d)Belowarchofaorta
CorrectAnswer-B
Ansis'b'ieCervicalportion
Oesophagealperforationisoftwotypes
Iatrogenic(MC):
-CommonsiteiscervicalesophagusJustabovetheupper
sphinctcr.
Spontaneousrupture:asseeninBoerhaavessyndrome(Ruptureof
esophagusaftervomitting)
-commoninthelower1/3ofesophagus.

---

1573.ThemostcommontypeofTracheo-
OesophagealFistulais-
a)Esophagealatresiawithouttracheoesophagealfistula
b)Esophagealatresiawithproximaltracheoesophagealfistula
c)Esophagealatresiawithdistaltracheoesophagealfistula
d)Esophagealatresiawithproximalanddistalfistula
CorrectAnswer-C
Ans.is'c'i.e.,Esophagealatresiawithdistal
tracheoesophagealfistula
TEFisclassifiedintofivetypesbasedonpresenceofesophageal
atresiaandlocationoffistula:?
1)TypeA:ThereisesophagealatresiawithoutTEF.Thereisno
gasinabdomen.Itis2'dmostcommontype.
2)TypeB:ThereisproximalTEF.Thereisnogasinabdomen.
3)TypeC:ThereisproximalesophagealatresiawithdistalTEF.
Gasinabdomenispresent.Itismostcommon.
4)TypeD:Bothproximalanddistalfistulaarepresent.Gasin
abdomenispresent.Itisleastcommon.
5)TypeE:IsolatedTEF(HorNtype)isthere.

---

1574.Flapcommonlyusedinbreast
reconstructionis?
a)Serratusanterior
b)TRAM
c)Flapfromarm
d)Deltopectoralflap
CorrectAnswer-B
Ans.is'b'i.e.TRAM
(Mostcommon)SinglePedicleDoublePedicleFreeflap
Deepinferiorepigastricperforatorflap

---

1575.Mostcommoncauseofduodenal
obstructioninadults
a)Lymphoma
b)Capancreas
c)Caliver
d)Cagallbladder
CorrectAnswer-B
Answer-B.Capancreas
Mostcommoncauseofduodenalobstruction(gastricoutlet
obstruction)inadultsPepticulcerdisease.
MostcommoncauseofgastricoutletobstructionPyloricstenosis
MostcommoncancercausingduodenalobstructionPancreatic
cancer.

---

1576.Mostcommoncauseofsmallintestine
obstructionis?
a)Intussception
b)IdiopathicadhesionsTumors
c)Tumors
d)Postoperativeadhesions
CorrectAnswer-D
PostoperativeadhesionsREF:Bailey&Love25theditionpage
1188,http://emedicine.medscape.com/article/774140overview
"Themostcommoncauseofsmall-bowelobstruction(SBO)is
postsurgicaladhesions"
Themostcommoncausesofintestinalobstructioninadultsare:
Intestinaladhesions--bandsoffibroustissueintheabdominal
cavitythatcanformafterabdominalorpelvicsurgery
Inchildren,themostcommoncauseofintestinalobstructionis
telescopingoftheintestine(intussusception).

---

1577.M.C.siteofCAoesophagusis-
a)Middle1/3rd
b)Upper1/3rd
c)Lower1/3rd
d)Lowerendofesophagus
CorrectAnswer-A
Ansis(a)ieMiddle1/3rd
Well,Iamnotquitesureoftheanswer.
EsophagealCarcinomaisoftwocommonhistologicaltypes
i)SquamouscellCa-theMCtypeinworld(-95%accordingto
Sabiston)
ii)Adenocarcinoma-whereincidenceisincreasingatarapid
rateandisnowtheMCtypeinUSA(Ref.Harrison,Schwartz)
DistributionofSquamousCellCa.
Upper1/310%
Middle11360%
Lower1/330%
Adenocarcinomaismainlylocatedinlower1/3.
Nowhere,IcouldgettheMCsiteofesophagealcarcinomaoverall
(includingbothsquamousandadenovariety).[Harrisonwritesthe
MCsitetobelower1/3,butitgivesincidenceforUSpopulation
only,notforthewholeworld]
Butonethingissure-squamouscellCaistheMCtypeof
esophagealcancerinworld[(Ref:Bailey&Love,25/ep1026(24/e
p1009);Robbins8/ep772(7/ep806);SabistonI8/ep1090(I7/e
p1118)]
SoIpresumethattheoverallMCsitewouldbetheMCsiteinvolved
bytheMCtypeofesophagealcanceri.e.-*Middle1/3

---

Soremember
MCtypeofesophagealCainworld->SquamousCellCa(--95%)
MCsite->Middle1/3

---

1578.Caseofdiagnosedcholecystitis
presentationacutepainsharpgoingto
thebackdiagnosis
a)Acutepancreatitis
b)Cholecystitis
c)Appendicitis
d)Aorticaneurysm
CorrectAnswer-A
Answer-A.Acutepancreatitis
Clinicalfeatures-
Acutesevere,refractory,upperabdominalpainradiatingtoback
Somepatientsmaygainreliefbysittingorleaningforwards
Icteruscanbecausedbybiliaryobstructioningallstonepancreatitis
Greyturner'ssign?bluishdiscolourationoftheflanks
Cullen'ssign?bluishdiscolorationaroundumbilicus
Foxsign?discolorationbelowinguinalligament
Shock,acuterenalfailure,ARDS,MODS
Leftsidedpleuraleffusion

---

1579.Manpresentedwithacuteabdomen,
whenmanwasputinkneechest
positionhelpedtorelievethepainwhat
mightbethecause.
a)Acutepancreatitis
b)Cholecystitis
c)Superiormesentericarteryischemia
d)Renal
CorrectAnswer-A
Answer-A.Acutepancreatitis
Acutesevere,refractory,upperabdominalpainradiatingtoback
Somepatientsmaygainreliefbysittingorleaningforwards
Icteruscanbecausedbybiliaryobstructioningallstonepancreatitis
Greyturner'ssign?bluishdiscolourationoftheflanks
Cullen'ssign?bluishdiscolorationaroundumbilicus
Foxsign?discolorationbelowinguinalligament
Shock,acuterenalfailure,ARDS,MODS
Leftsidedpleuraleffusion

---

1580.Mangunshotwoundinthoraxchest
tube1900mlblood,200mlofbloodlost
perhr.nextstep
a)Bloodtransfusion
b)Thoracotomy
c)PPV
d)FFP
CorrectAnswer-B
Answer-B.Thoracotomy
Initialdrainageofmorethan1500mlbloodorongoinghemorrhage
ofmorethan200ml/hrover3-4hoursisgenerallycon?sideredan
indicationforthoracotomy.

---

1581.Mostcommoncauseofacuteabdomen
inyounggirl
a)Acuteappendicitis
b)ovariantorsion
c)Mitzschmerz
d)Renalcolic
CorrectAnswer-A
Answer-A.Acuteappendicitis
Mostcommoncauseofacuteabdomeninyoundwomenisacute
appendicitis.
Othercausesareintestinalobstruction,diverticulitis,adnexaltorsion,
ovariancystrupture/hemorrhage,PID,endometriosisand
dysmenorrhea.

---

1582.Lateralborderoftonguecarcinoma
afterresection
a)Chemotherapy
b)Radiotherapy
c)Observation
d)Neckdissection
CorrectAnswer-D
Answer-D.Neckdissection
Ifregionallymphnodesareinvolved-Modifiedradicalneck
dissectionorselectiveneckdissectionisdone.
Indicationsforpostoperativeradiationtherapyincludeevidenceof
perineuralorangiolymphaticspreadorpositivenodaldisease.

---

1583.Commonestcauseofpyogenicliver
abscess?
a)StrictureofCBD
b)BiliaryColic
c)Appendicitis
d)SigmoidDiverticulitis
CorrectAnswer-A
Ansis'a'ieStrictureofCBD
Mostcommonrouteofinfectiontoliverisalongthebileduct.Itmay
bedueto:-
i)StoneimpactedinCBD.
ii)BenignormalignantstrictureofCBD.
MostcommoninfectingorganismsareE.coliandKlebsiella
pneumonia

---

1584.Followingisleastcommonabout
angiodyplasiaofcolon-
a)Involvementofcecum
b)Involvementofrectumin50%ofcases
c)Affectingagegroup>40yrs.
d)CauseoftroublesomelowerG.I.hemorrhage
CorrectAnswer-B
Ans.is'b'i.e.,Involvementofrectumin50%cases
Site:Occurmostcommonlyintheascendingcolonandcaecum;
howevertheycanalsooccureinrestofcolonandsmallbowel.
Clinicalfeatures
Anemia-mostcommonpresentation
Hemoatochezia
Malena
Thereisanassociationwithaorticstenosis(heyd'ssyndrome).

---

1585.Curlingsulcerisseenin-
a)Burnpatients
b)Patientswithheadinjuries
c)ZollingerEllisonsyndrome
d)Analgesicdrugabuse
CorrectAnswer-A
Ans.is'a'i.e.,Burnpatients
Curlingulcers:arestressulcersassociatedwithburnsandmost
commonlyfoundinthefirstpartofduodenum.

---

1586.Decubitusulceris
a)Venousulcer
b)Wetgangrene
c)Trophiculcer
d)Postthromboticulcer
CorrectAnswer-C
Aswer-C.Trophiculcer
Trophiculcersareneurogeniculcerswhicharecausedbyvarious
factorssuchasimpairmentofnutritionofthetissues,inadequate
bloodsupplyandneurologicaldeficit.

---

1587.Maximumweightreductionisbywhich
surgery
a)BPD
b)RouxenYgastricbypass
c)Sleevegastrectomy
d)Gastricbanding
CorrectAnswer-A
Answer-A.BPD
Mixedprocedures
1. Gastricbypass(RouxenYgastricbypass)
2. Sleevegastrectrneywithduodenalsnitch
3. Implantablegastricstimulation
Ingeneralmalabsorptiveproceduresleadtomoreweightlossthan
restrictiveprocedureshowevermorbidityrisksaregreater.
StudieshaveshownthatitismaximumwithBiliopancreaticdiversion
(BPD).

---

1588.Mostcommonorganismassociated
withbreastabscess
a)Streptococcus
b)Staphylococcusaureus
c)Klebsiella
d)None
CorrectAnswer-B
Answer-B.Staphylococcusaureus
Staphylococcusaureusisthemostcommoncauseofbreast
abscess.
MostarecausedbyS.aureusand,ifhospital-acquired,arelikelyto
bepenicillin-resistant.
Staphylococcusaureuscausestheclottingofmilkinthe
blockedductandmultiply.Ductinitiallygetsblockedby
epithelialdebrisorbytheretractednipple.

---

1589.Allistrueaboutskullfractureexcept
a)Puppesrulegivesthesequenceoffracture
b)Pondfractureisamilddepressedfracture
c)Fissuredfractureismostcommon
d)Skullfracturesareduetotraction
CorrectAnswer-B
Answer-B.Pondfractureisamilddepressedfracture
TypesofSkullfracture-
1. Linearorfissuredfracture:arethemostcommonskullfractures.
2. DepressedFracture
3. Comminutedfracture
4. Pondorindentedfracture-Thisisasimpledentoftheskull,
occurringonlyinskullofinfants,foreg.inobliquebulletwounds.
5. Gutterfractures
6. Ringorforamenfractures
Puppe'srule
Ithelptoassessthechronologicalorderinwhichfracturewere
formed,sincelaterfractureswilltypicallystopatpreviouslyformed
ones.

---

1590.Hunterianperforatorsareseenin?
a)Upperthigh
b)Lowerthigh
c)Calf
d)Midthigh
CorrectAnswer-D
Ans.is'd'i.e.,Midthigh
Mid-thigh(Mid-hunter)-Adductorcanal-Greatsaphenouswith
femoral
Hunterperforator(Hunterianperforatororadductorcanalperforator)
isseeninmidthigh.

---

1591.Apatientwithexternalhemorrhoidsdevelopspainwhilepassingstools.
Whichofthefollowingnervemediatingthispain?
a)Pudendalnerve
b)Hypogastricnerve
c)Sympatheticplexus
d)Splanchnicvisceralnerve
CorrectAnswer-A
Externalhemorrhoidsarecoveredbythemucousmembraneofthelowerhalfoftheanal
canalortheskin,andtheyareinnervatedbytheinferiorrectalnerves.Inferiorrectalnerve
isabranchofpudendalnerve.Lowerhalfofanalcanalissensitivetopain,temperature,
touch,andpressure.
Thepectinatelineindicatesthelevelwheretheupperhalfoftheanalcanaljoinsthelower
half.
Themucousmembraneoftheupperhalfissensitivetostretchandisinnervatedby
sensoryfibersthatascendthroughthehypogastricplexuses.
Theinvoluntaryinternalsphincterissuppliedbysympatheticfibersfromtheinferior
hypogastricplexuses.
Thevoluntaryexternalsphincterissuppliedbytheinferiorrectalnerve,abranchofthe
pudendalnerveandtheperinealbranchofthefourthsacralnerve.

---

1592.Cecumformstheposteriorwallof
whichhernia
a)Slidinghernia
b)Rollinghernia
c)Incisionalhernia
d)Hiatushernia
CorrectAnswer-A
Answer-A.Slidinghernia
Slidingherniaisdefinedasanyherniainwhichpartofthesac
(usuallytheposterior)isformedbythewallofaviscus.
Cecumisinvolvedontherightsideandsigmoidcolonisinvolvedon
leftside.
Itshouldbeclearlyunderstoodthatthecaecum,appendixorpartof
colonwhollywithinahernialsacdoesnotconstituteaslidinghernia
(Thevisceramustformawallofthesactobetermedassliding
hernia).
[Ref:Bailey&Love26th/ep.956]

---

1593.Inlastdecade,duodenalulcerandits
morbidityisreduceddueto
a)Lifestylemodification
b)EradicationofHpylori
c)Protonpumpinhibitors
d)None
CorrectAnswer-C
Answer-C.Protonpumpinhibitors
Inlastdecades,withtheintroductionofprotonpumpinhibitorsand
increasedknowledgeofperforatedpecticulcer(PPU)etiologythe
incidenceofPPUhasreportedlydecreasedinwesterncountries.

---

1594.Posteriorduodenalulcerisrelatedto
a)Gartoduodenalartery
b)Spleenicartery
c)LeftgastricArtery
d)Supmesentricartery
CorrectAnswer-A
Answer-A.Gartoduodenalartery
Gastroduodenalarteryisthemostcommonarteryinvolvedin
duodenalulcerhaemorrhage.
Alsoremember
Pepticulceristhemostcommoncauseofmassiveupper
gastrointestinalbleed(Duodenalulcers>Gastriculcer)

---

1595.Postioninsurgeryforpilonidalsinus
a)Sim's
b)Tredelenberg
c)Lithotomy
d)Jackknife
CorrectAnswer-D
Answer-D.Jackknife
Formostprocedures,patientisplacedinpronejackknifeposition
withslighttrendelenburg.
Jackknifeposition
Ananatomicalpositioninwhichthepatientisplacedonthestomach
withthehipsflexedandthekneesbentata90?angleandthearm
outstretachedinfrontofthepatient.

---

1596.Lengthofflexiblesigmoidoscope
a)30cm
b)40cm
c)60cm
d)70cm
CorrectAnswer-C
Answer-C.60cm
Thelengthofrigidsigmoidoscopeis25cm,whereasflexible
sigmoidoscopeare60cmlong.
[RefBailey&Love25th/ep.1221;www.medicinenet.com]

---

1597.Trueaboutreactionaryhemorrhage
followingsurgery:
UP10
a)Hemorrhageoccurringwithin48h
b)Hemorrhageoccurringwithin36h
c)Hemorrhageoccurringwithin24h
d)Hemorrhageoccurringduringsurgery
CorrectAnswer-C
Ans.Hemorrhageoccurringwithin24h
HemorrhageaccordingtotheTimeofappearancecanbeclassified
asbelows
Primaryhemorrhage
Isonewhichoccuratthetimeofinjuryoroperation.
Reactionaryhemorrhage
Inmajorityofcasesreactionaryoccurwithin4to6hours.Such
bleedingmayalsooccurdueto:
Restlessness
Coughing
Vomitingwithraisesthevenouspressure
Secondaryhemorrhage
Thisoccursusuallyafter7to14daysofinjuryoroperation.
Thisisusuallyduetoinfectionandsloughingofapartofthearterial
wall.

---

1598.Inbreastcarcinomametastasis,
prognosisdependsbestupon-
a)Estrogenreceptorstatus
b)Axillarylymphnodestatus
c)Sizeoftumour
d)Siteoftumour
CorrectAnswer-A
Ansis'a'i.e.,Estrogenreceptorstatus
Incaseofmetastasis,theprognosisnomoredependsuponthe
lymphnodestatus.
Thelymphnodestatusisthemostimportantprognosticindicatorfor
tumorlocalizedtobreast,asthepresenceofnodalmetastasis
impliessystemicdisseminationofcancerandhenceabad
prognosis.Butonceametastasisisdiscovered,thelymphnode
statusisoflittlesignificance.Metastaticdiseaseconfersthebreast
tumorTNMstageIVstatus,withworstprognosis.CurrentlystageIV
diseasesarenotcurative.
Schwartz9/ewrites-"TreatmentforstageIVbreastcancerisnot
curative,butmayprolongsurvivalandenhanceawomen'squalityof
life.Hormonaltherapiesthatareassociatedwithminimaltoxicityare
preferredtocytotoxicchemotherapy.Appropriatecandidatesfor
initialhormonaltherapyincludewomenwithhormonereceptor-
positivecancers;womenwithboneorsofttissuemetastasisonly;
andwomenwithlimitedandasymptomaticvisceralmetastasis.
Abouthormonereceptors,CSDT11/e,p329writes-"thepresence
orabsenceofestrogenandprogesteronereceptorsinthecytoplasm
oftumorcellsisofparamountimportanceinmanagingallpatients
withbreastcancer,especiallythosewithrecurrentormetastatic

---

disease.Theyareofprovedvalueindeterminingadjuvanttherapy
andtherapyforpatientswithadvanceddisease.Upto60%of
patientswithmetastaticbreastcancerwillrespondtohormonal
manipulationiftheirtumorscontainestrogenreceptors.However
fewerthan5%ofpatientswithmetastaticER-negativetumorscan
besuccessfullytreatedwithhormonalmanipulation."

---

1599.Charcot'striadisdefinedbyallofthe
followingexcept:
September2007,March2009
a)Fever
b)Gallstones
c)Jaundice
d)Pain
CorrectAnswer-B
Ans.B:Gallstones
Cholangitisisduetopartialorcompleteobstructionofthebiliarytree
withresultingbilestasisandsecondarybacterialormicrobial
infectionofthebiliarytree
Causes?
Commonbileductstones
Benignbiliarystricture(primarysclerosingcholangitis)
Malignancy(headofpancreasadenocarcinoma,ampullaofVater,
bileducttumors)
Chronicpancreatitis
Prosthesisorstentsinthecommonbileduct
Features:
Charcot'striad-rightupperquadrantpain,fever,jaundice
Reynolds'pentad-rightupperquadrantpain,fever,jaundice,
hypotension,andmentalstatuschanges(delirium,anxiety,and
coma)
Nauseaand/orvomiting
Rightupperquadranttenderness(mildtomoderate)

---

1600.Herniacommoninchildren
a)Umbilical
b)Bockdelac
c)Morgagni
d)Inguinal
CorrectAnswer-A
Answer-A.Umbilical
"Congenitalumbilicalherniasrepresentthemostcommon
abdominalwalldefectininfantandchildren".
Theincidenceofumblicalherniasis5-10%inwhitechildrenand
maybeashighas25-50%inblackchildren.

---

1601.Gangrenenotcausedby
a)Frostbite
b)Burger'sdisease
c)Varicoseveins
d)Atherosclerosis
CorrectAnswer-C
Answer-C.Varicoseveins
Importantcausesofgangrene
Diabetes
PVD(Buerger'sdisease)
Trauma
Obesity
Atherosclerosis
Raynaud'sdisease
Frostibite

---

1602.Bilateralbreastcarcinoma
a)Invasivelobular
b)Infiltractiveductal
c)Ductalcainsitu
d)None
CorrectAnswer-A
Answer-A.Invasivelobular
Lobularcarcinoma(invasive)isfrequentlybilateral.
Histologichallmark:patternofsingleinfiltratingtumorcellsoften
onlyonecellinwidthorinlooseclustersorsheets.
Signetringcellscommon.Lobularcarcinomahaveadifferent
patternofmetastasiscomparedtootherbreastcancers.

---

1603.Mostcommonconotruncalanomaly
a)TGA
b)Tetralogyoffallot
c)Truncusarteriosus
d)Doubleouletrightventricle
CorrectAnswer-A
Answer-A.TGA
Conotruncaldefectsareabnormalitiesofoutflowtractseptationor
ectomesenchymaltissuemigrationabnormalities.
Mostcommonconotructaldefectistranspositionofgreatarteries
(TGA).

---

1604.Fallotphysiologyincludesallexcept
a)TOF
b)Eisenmengercomplex
c)TGA
d)Tricuspidatresia
CorrectAnswer-B
Answer-B.Eisenmengercomplex
Theseincludes
1. TOF
2. SingleventriclewithPS
3. TGAwithVSD&PS
4. CorrectedTGAwithVSD&PS
5. TA
6. DoubleoutletrightventriclewithPS

---

1605.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.

---

1606.MostcommonASDis?
a)Ostiumprimum
b)Patentforamenovale
c)Ostiumsecondum
d)Sinusvenosus
CorrectAnswer-C
Ans.is'c'i.e.,Osteumsecondum
ASDcanoccurinanyportionofatrialseptum-
Secundum
Primum
Sinusvenosus
Absentatrialseptum(leadstosingleatrium)
Ostiumsecondumdefect
Defectinregionoffossaovalis
MostcommonformofASD

---

1607.Mostcommoncardiovascular
abnormalityindownsyndromeis?
a)VSD
b)Endocardialcushiondefect
c)TOF
d)COA
CorrectAnswer-B
Ans.is'b'i.e.,Endocardialcushiondefect
About40%ofdownsyndromehaveCHD.
EndocardialcushionAtrioventricularseptaldefectaccountfor40-
60%ofcases.
Otherfeatureindownsyndrome.
Hypotonia,flatface,upwardandslantedpalpebralfissuresand
epicanthicfolds,speckledirises(Brushfieldspot);varyingdegreesof
mentalandgrowthretardation;dysplasiaofthepelvis,cardiac
malformations,andsimiancrease;short,broadhands,hypoplasiaof
middlephalanxof5thfinger,duodenalatresia,andhigharched
palate;5%ofpatientswithDownsyndromearetheresultofa
translocation-t(14q21q),t(15q21q),andt(13q21q)-inwhichthe
phenotypeisthesameastrisomy21.
Otherfeature?
1. Duodenalatresia
2. Annularpancreas
3. Tracheoesophagealfistula
4. Hirschsprungdisease
5. Shortstature
6. Shortsternum
7. Brachycephaly

---

8. Delayedfontanelclosure
9. Threefontanels
10. Frontalsinushypoplasia
11. Peripheraljointlaxity
12. Atlantoaxialinstability(C1-C2subluxation)
13. Exaggeratedspacebetween
14. Mottledskinininfancy
15. Drycoarseskininadolescence1stand2ndtoes
IncreasedRiskforDevelopmentof-
Leukemia:AML,ALL
Myelodysplasia
Transientlymphoproliferativesyndrome
Celiacdisease
Hypothyroidism
Diabetesmellitus
Obesity
Refractiveerrors
Strabismus
Mitralvalveprolapse
Conductiveand/or
Obstructivesleepapnea
Epilepsysensorineuralhearingloss
ADHD
Alzheimerdisease
Conductoppositionaldisorders

---

1608.Figureof8inchestX-ray?
a)SupracardiacTAPVC
b)Tetralogyoffallot
c)TGA
d)Noneofabove
CorrectAnswer-A
Ans.is'a'SupracardiacTAPVC
Tertralogyoffallot--*bootshapedheart
Transpositionofgreatvessel-*eggonside
TPVC(supracardioe)-->snownanorfigureof8configuration

---

1609.LargePDAleadsto?
a)Endocardialvalvulitis
b)Eisenmengersyndrome
c)CHF
d)Allofabove
CorrectAnswer-D
Ans.is'd'i.e.,Allofabove
Patentductusarteriosus(PDA)
SmallPDAmaynotcauseanycomplicationbutlargedefectif
untreadmayleadsto:
PulmonaryhypertensionLefttoRightshuntleadstotoomuch
circulationofbloodinlungwhichleadstopulmonaryhypertension.
Eisenmenger'ssyndrome-Largestandingpulmonaryhypertension
leadstopermanentlungdamageandcausesRighttoLeftshunt.
Endocarditis.
ArrhythmiaEnlargementofheartduetoPDAincreaseriskof
arrhythmias

---

1610.Drugusedincongenitalheartdisease
tokeepPDApatent
a)PGEi
b)PGE2
c)PGI2
d)Indomethacin
CorrectAnswer-A
Ans.is'a'i.e.,PGE,
ProstaglandinEl(PGE1)infusionusuallyeffectiveinkeepingthe
ductusarteriosusopenbeforesurgicalinterventiontoreduce
hypoxemiaandacidemiabeforesurgeryinductusdependentlesion
like.
Pulmonaryatresia
TOFwithseverePS
TOFwithpulmonaryatresia
TranspositionofgreatarterieswithVSDandPS
Indomethacinisusedforductalclosure

---

1611.PDAtrueisallexcept?
a)Morecommoninpretermbaby
b)Lefttorightshunt
c)Acyanoticcongenitalheartdisease
d)Morecommonintermbaby
CorrectAnswer-D
Ans.is'di.e.,Morecommonintermbaby
Duringfetallife,mostofthepulmonaryarterialbloodisshunted
throughtheductusarteriosusintotheaorta.
Functionalclosureoftheductusnormallyoccurssoonafterbirth,but
iftheductusremainspatentwhenpulmonaryvascularresistance
falls,aorticbloodisshuntedintothepulmonaryartery.
Theaorticendoftheductusisjustdistaltotheoriginoftheleft
subclavianartery,andtheductusentersthepulmonaryarteryatits
bifurcation
FemalepatientswithPDAoutnumbermales2:1.
PDAisalsoassociatedwithmaternalrubellainfectionduringearly
pregnancy.
Itisacommonprobleminprematureinfants,whereitcancause
severehemodynamicderangementsandseveralmajorsequelae

---

1612.Pulmonaryplethoraisseenwith-all
except
a)TGA
b)Hypoplasticleftheartsyndrome
c)Ebsteinanomalis
d)Doubleoutletrightventricle
CorrectAnswer-C
Answer-C.Ebsteinanomalis
Pulmonaryoligamia
TOF
TA
Ebstein'sanomaly
Pulmonaryatresia

---

1613.Majorcriteriaforrheumaticfever-AJE
a)Carditis
b)Arthralgia
c)Erythemamarginatum
d)Subcutaneousnodule
CorrectAnswer-B
Ans.is'b'i.e.,Arthralgia
Jone'scriteria
Majorcriteriaare:Carditis,arthritis,subcutaneousnatule,chorea,
anderythemamarginatum

---

1614.NotincludedinmodifiedJonescriteria?
a)Polyarthalgia
b)Carditis
c)Chorea
d)Erythemamarginatum
CorrectAnswer-A
Ans.is'a'i.e.,Polyarthalgia
AllthegivenoptionsareincludedinmodifiedJonescriteria.Carditis,
choreaanderythemamarginatumaremajorcriteria.Only
polyarthralgia(arthralgia)isminorcriterian.

---

1615.MostcommoncardiacdefectinTurner
syndrome
a)Coartactionofaorta
b)VSD
c)ASD
d)TOF
CorrectAnswer-A
Ans.is'a'i.e.,Coartactionofaorta
DisordersAssociatedwithTurnerSyndrome
Shortstature
Congenitallymphedema
Horseshoekidney
Patelladislocation
Increasedcarryingangleofelbow
Madelungdeformity(chondrodysplasiaofdistalradialepiphysis)
Congenitalhipdislocation
Scoliosis
Widespreadnipples
Shieldchest
Redundantnuchalskin(inuterocystichygroma)
Lowposteriorhairline
Coarctationofaorta
Bicuspidaorticvalve
Cardiacconductionabnormalities
Hypoplasticleftheartsyndrome
Gonadaldysgenesis(infertility,primaryamenorrhea)
Gonadoblastoma(ifYchromosomematerialpresent)
Learningdisabilities(nonverbalperceptualmotorandvisuospatial

---

skills)[in70%]
Developmentaldelay(in10%)
Socialawkwardness
Hypothyroidism(acquiredin15-30%)
Type2diabetesmellitus(insulinresistance)
Strabismus
Cataract
Red-greencolorblindness(asinmales)
Recurrentotitismedia
Sensorineuralhearingloss
Inflammatoryboweldisease
Celiacdisease

---

1616.Mostcommoncauseofacquiredheart
diseaseinchildren
a)Acuterheuamaticfever
b)Kawasaki
c)Takayasu
d)Diabetes
CorrectAnswer-A
Ans.is'a'i.e.,AcuteRheumaticfever
Acuterheumaticfever
Mostcommoncauseofacquiredheartdiseaseinchildren.
CausedbygroupAf3hemolyticstreptococci
Usuallyseeninschoolgoingchildren
Jonescriteria=veryimpotrant
Mitralvalvemostcommonfollowedbyaorticvalve
Inacutephase-MRseen
InRI-IDMSseen

---

1617.Singleumblicalarteryisassociated
with?
a)NTD
b)Hydropsfetalis
c)Congenitalheartdisease
d)Inuterodeath
CorrectAnswer-C
Ans.is`c'i.e.,Congenitalheartdisease
Approximately30%ofinfantswithasingleumbilicalarteryhave
congenitalabnormalities.
Trisomy18isoneofthemorefrequentabnormalities.
Themostcommoncongenitalanomaliesinchromosomallynormal
fetusesandneonateswere.
Genitourinary(6.48%)
Cardiovascular(6.25%)
Musculoskeletal(5.44%).

---

1618.Notafindinginpottersyndrome?
a)Bilateralrenalagenesis
b)Polyhydromnios
c)PulmonaryHyperplasia
d)Flatchain
CorrectAnswer-B
Ans.is'b'i.e.,Polyhydromnios
Pottersyndrome
Bilateralrenalagenesisisincompatiblewithextrauterinelifeandis
termedPottersyndrome.
Deathoccursshortlyafterbirthfrompulmonaryhypoplasia.
Thenewbornhasacharacteristicfacialappearance,termedPotter
facies.Theeyesarewidelyseparatedwithepicanthicfolds,theears
arelowset,thenoseisbroadandcompressedflat,thechinis
receding,andtherearelimbanomalies.
Bilateralrenalagenesisshouldbesuspectedwhenmaternal
ultrasonographydemonstratesoligohydramnios,nonvisualizationof
thebladder,andabsentkidneys.

---

1619.Sittingwithoutsupportisappearat
whichmonth
a)5month
b)6month
c)7month
d)8month
CorrectAnswer-B
Ans.is'b'i.e.,6month
3monthNeckholding
5monthRollover
6monthSitsintripodposition
8monthSittingwithoutsupport
9monthStandwithsupport

---

1620.Childknowshis/hersexbyageof?
a)2year
b)3year
c)4year
d)5year
CorrectAnswer-B
Ans.is'b'i.e.,3year
Ridestricycle
Standsmomentarilyonone
foot.
Drawsacircle
Candressorundress
himselfcompletely
Buildstowerof10cubes
Knowshisageandsex.
Repeatasentenceof6
syllables
Hasavocabularyof250
words.
Counts3objectscorrectly.
Canwithholdand
postponebowel
movement.

---

1621.Handednessdevelopsbyageof?
a)2years
b)3years
c)4years
d)5years
CorrectAnswer-B
Ans.is'b'i.e.,3year
Handednessisusuallyestablishedbythe3rdyr.Frustrationmay
resultfromattemptstochangechildren'shandpreference.
Variationsinfinemotordevelopmentreflectbothindividual
proclivitiesanddifferentopportunitiesforlearning.Childrenwhoare
seldomallowedtousecrayons,forexample,developamature
pencilgrasplater

---

1622.10montholdchildcannotperform?
a)Standingwithsupport
b)Pincergroup
c)Walkingwithsuppor
d)Twowordswithmeaning
CorrectAnswer-D
Ans.is'd'i.e.,Twowordswithmeaning
oAchildcantransfertheobjectsfromonehandtoanotherby5-7
months.
oAchildcanbuildatowerof6cubesby21months
oAchildcanpullhimselfupbytheageof10months.
oAchildmakesasimplesentencefirsttimebytheageof2years.
oPincergraspdevelopsby9months.

---

1623.mentalretardationcanbeprovedif
delayedmilestonesandslowor
retardedgrowthseenuptowhichage
(inyear)?
a)12
b)16
c)18
d)20
CorrectAnswer-C
Ans.is'c'i.e.,18year
a)Significantlysub-averageintellectualfunctioning:anIQscore
of70orbelowonanindividuallyadministeredIQtest(forinfants,a
clinicaljudgmentofsignificantlysub-averageintellectual
functioning).

---

1624.Heightofchildacquire100cmin?
a)2.5year
b)3.5year
c)4.5year
d)5.5year
CorrectAnswer-C
Ans.is'c'i.e.,4.5year
1Year-75cm
2Year-90cm
41/2Year-100cm

---

1625.Swallowingbreathingreflex-notseen
infetusfor?
a)14weeks
b)12weeks
c)16weeks
d)Appearinallaboveperiod
CorrectAnswer-B
Ans.is'b'i.e.,12weeks
Behaviouraldeveopmentinintrauterinelife
Musclecontractionsfirstappeararound8wk,soonfollowedby
lateralflexionmovements.
By13-14wk,breathingandswallowingmotionsappearandtactile
stimulationelicitsgracefulmovements.oThegraspreflexappears
at17wkandiswelldevelopedby27wk.
Eyeopeningoccursaround26wk.
Duringthe3rdtrimester,fetusesrespondtoexternalstimuliwith
heartrateelevationandbodymovements

---

1626.CharacteristicsofSMR-2inboys?
a)Appearanceofpubichair
b)Appearanceofaxillaryhair
c)Enlargementofscrotum
d)Allofabove
CorrectAnswer-C
Ans.is'c'i.e.,Enlargementofscrotum
Scanty&longpubichairappearatSMR-2.Enlargementofscrotum
isthereatSMR-2.

---

1627.Firstsignofpubertyinfemale?
a)TannerstageI
b)TannerstageII
c)Pubichair
d)Axillaryhair
CorrectAnswer-B
Ans.is`b'i.e.,Tannerstage11
Thelarche-firstsignofpubertyinGirlaroundageof10yearin
Girl
Definition:-Beginingofsecondary(Postnatal)breastdevelopment
atonsetofpubertyingirls.
Tannerstage2breastdevelopment.
Becauseofrisinglevelofestradiol
Breastdevelopmentduringpubertyinmaletermedasgynecomastia
notthelarche.

---

1628.Inmarasmuswastingisdueto?
a)Prolongedieterydeficiencyofcalori
b)Prolongedieterydeficiencyofprotein
c)Excesscatabolismoffat&musclemasstoprovideenergy
d)Allofabove
CorrectAnswer-D
Ans.is'd'i.e.,Allofabove
Marasmus
Prolongedeficiencyofcalory&proteinduetostarvation.
Monkeyfacies-lossofbuccalfat.
Baggypantsappearance-looseskinofthebuttockshangingdown.
Lossofaxillaryfat.
Appetiteispreserved.
Noedema.

---

1629.Kwashiorkornottrueis?
a)Apathy
b)Flakypaintdermatosis
c)Increasedtransaminase
d)Voraciousappetit
CorrectAnswer-D
Ans.is'd'i.e.,Voraciousappetite
Thereisdecreasedappetiteinkwasiorkor(notvaraciousappetite).
Kwashiorkar
KwashiorkarrepresentstheuncompensatedphaseofPEM.
Itischaracterizedbyclassical'triad'ofedema(Dueto
hypoalbuminemia),markedlyretardedgrowth,andpsychomotor
(mental)changes

---

1630.Acutemalnutritioninachildisclinically
assessedby:
September2005
a)Bodymassindex
b)Weightforage
c)Heightforage
d)Weightforheight
CorrectAnswer-D
Ans.D:Weightforheight
Anindicatorknownasweight-for-heightisusedtodetermine
whetherachildisacutelymalnourishedornot.Thechild'sweightis
comparedtothe'normal'weightforthatheight.
Basedonthisinformation,theWorldHealthOrganisation(WHO)
hasdevelopedchartsknownasinternationalstandardsforexpected
growth.
Ifachild'sweightfallswithintherangeconsiderednormalforhis/her
height,thechildisfoundtobewell-nourished.Iftheweightisless
thantheinternationalstandards,thechildisconsideredacutely
malnourishedorwasted.WHOhascreatedcut-offpointstoindicate
theseverityofthemalnutrition.
Ifachild'sweight-for-heightislessthan-2z-scores(orstandard
deviations)ofnormalchildren,s/heisconsideredtosufferfrom
moderateacutemalnutritionorwasting.
Ifthechild'sweight-for-heightislessthan-3z-scores(standard
deviations)ofnormalchildrens/hesuffersfromsevereacute
malnutritionandisconsideredtobeseverelywasted.
Anothermeasurementusedtodetermineachild'snutritionalstatus
isthemid-upperarmcircumference(MUAC)measurement.

---

isthemid-upperarmcircumference(MUAC)measurement.
BecauseMUACmeasurementsrequireasimple,colour-coded
measuringbandratherthanweighingscalesandheightboards,they
areoftenusedduringcrisissituations.
Usefulforchildrenbetweensixmonthsandfiveyearsofage,a
MUACmeasurementoflessthan12.5cmindicatesthatachildis
sufferingfrommoderateacutemalnutrition.
IftheMUACmeasurementisunder11.0cm,however,theunder-
fivechild'slifemaybeindangerasheorsheissufferingfrom
severeacutemalnutrition.
Althoughnoanthropometricmeasureisaperfectmarkerofacute
malnutrition,inthepast,therehasbeenatendencytoviewW/H
measuresasthegold-standardanthropometricmeasuretodiagnose
acutemalnutritioninemergencies.DiscrepanciesbetweenMUAC
andW/HhavethereforebeenexplainedbyMUACbeingapoor
indicatorofnutritionalstatus.
Athirdwayofdiagnosingacutemalnutritionisbytestingforthe
presenceofoedema.
Oedemaaffectsachild'sappearance,givinghimorherapuffy,
swollenlookineitherlowerlimbsandfeetorface.
Itcanbedetectedbysmallpitsorindentationsremaininginthe
child'sloweranklesorfeet,afterpressinglightlywiththethumbs.
Thepresenceofoedemainbothfeetandlowerlegsisalways
consideredasignofsevereacutemalnutrition.

---

1631.3yearoldchildwithnormalheightfor
age,abnormalweightforageand
abnormalweightforheight,whatItis
notbe?
a)Acutemalnutrition
b)ChronicMalnutrition
c)Acuteonchronic
d)Noneofabove
CorrectAnswer-B
Ans.is'b'i.e.,Chronicmalnutrition
Forthispurposewastingandstuntingaremeasured:-
i)Wasting(deficitinweightforheight)4Acutemalnutrition.
ii)Stunting(deficitinheightforage)-Chronicmalnutrition.
iii)Wastingandstunting-Acuteonchronicmalnutrition.

---

1632.Pigmentationandgrowthretardationis
seenin?
a)Zincdeficiency
b)Riboflavindeficiency
c)Niacindeficiency
d)VitAdeficiency
CorrectAnswer-A
Ans.is'a'i.e.,Zincdificiency
Dwarfism(growthretardation)
Diarrhea
Dermatitis
Hepatosplenomegaly
Irondeficiencyanemia
Acrodermatitisenteropathica
Hyperpigmentation

---

1633.Keshandiseaseinduetodeficiencyof
a)Selenium
b)Copper
c)Zinc
d)Iron
CorrectAnswer-A
Ans.'a'Selenium
Seleniumisrequiredforthesynthesisoftheaminoacid
selenocysteine.Selenocysteineispresentattheactivesiteof
severalhumanenzymesthatcatalyzeredoxreactions.Impairments
inhumanselenoproteinshavebeenimplicatedintumorigenesisand
atherosclerosis,andareassociatedwithseleniumdeficiency
cardiomyopathy(Keshandisease)

---

1634.Weightofchildis70%ofnormal
accordingtoIAPclassification,
categorisedin?
a)Mild
b)Moderate
c)Severe
d)Normal
CorrectAnswer-B
Ans.is`b'i.e.,Moderate

---

1635.Mostcommoncauseoflower
respiratorytractinfectionin3yearold
childis
a)Klebsella
b)H-influenza
c)Streptococcalpneumonia
d)Stapheaureus
CorrectAnswer-C
Ans.is'c'i.e.,Streptococcalpneumonia
Mostcommoncauseofpaediatricpneumoniaisrespiratorysyncytial
virus(RSV).Othervirusescausingpneumoniaareinfluenzavirus
(2^dmostcommonvirus),adenovirus,rhinovirus,andparainfluenza
virus.
Mostcommonbacterialcauseofpediatricpneumoniais
streptococuspneumoniae(pneumococcus).Bacteriacausing
atypicalpneumoniacommonlyaremycoplasmaandchlamydia.

---

1636.Falseregardingcroupis?
a)Diseaseincludeepiglottis,laryngitis,laryngotrachictis
b)Brassycoughismainpresentingfeature
c)Causesupperairwayobstruction
d)Allofabove
CorrectAnswer-C
Ans.is'c'i.e.,Causesupperairwayobstruction
Croupisvarietyofconditionwhichincludeacuteepiglottis,laryngitis,
trachiobronchitis.
Infectionoflowerrespiratorytract.
Brassycoughmainpresentingfeature.
Treatment
Humidified
I.V.fluid
Antibiotics
Nebulisation
Steroid.

---

1637.Koplikspottrueis?
a)Pathognomicofmeasls
b)PresentonbuccalmucosaoppositeP'molar
c)Alwayspresent
d)Allofabove
CorrectAnswer-A
Ans.is'a'i.e.,Pathognomicofmeasls
Measle
CausedbyRNAvirus.
Highlycontagiousdropletspreadfromsecretionofnoseandthroat4
daybeforeand5daysafterrash.
Secondaryattackrate>90%incontact.
Prodromalphase-characterizedbyfever,rhinorrhea,conjuctival
congestionanddryhackigcough.
Koplikspots-bluish-grayspecksor"grainsofsand"onaredbase-
developonthebuccalmucosaoppositethesecondmolars
Generallyappear1-2daysbeforetherashandlast3-5days
Pathognomonicformeasles,butnotalwayspresent
RashappearsonD4firstbehindpinnaonneckthespreadofface,
thrunkandabdomen.
SSPEislongtermcomplicationseeninmeasls.

---

1638.
Posttermbabywithtachypnea-
commonestcause?
a)Transienttachypneaofnewborn
b)Meconiumaspirationsyndrome
c)Hyalinemembranedisease
d)Infection
CorrectAnswer-B
Ans.is'b'i.e.,meconiumaspirationsyndrome
TransientTachypneaoftheNewborn
Transienttachypneaofthenewbornisthemostcommoncauseof
neonatalrespiratorydistress,constitutingmorethan40percentof
cases.1
Abenigncondition,itoccurswhenresidualpulmonaryfluidremains
infetallungtissueafterdeliveryoRespiratoryDistressSyndrome
Respiratorydistresssyndromeofthenewborn,alsocalledhyaline
membranedisease,isthemostcommoncauseofrespiratory
distressinprematureinfants
ImmaturetypeIIalveolarcellsproducelesssurfactant,causingan
increaseinalveolarsurfacetensionandadecreaseincompliant
MeconiumAspirationSyndrome
Meconium-stainedamnioticfluidoccursinapproximately15percent
ofdeliveries,causingmeconiumaspirationsyndromeintheinfantin
10to15percentofthosecases,typicallyintermandpost-term
infants
Infection
Bacterialinfectionisanotherpossiblecauseofneonatalrespiratory
distress.
CommonpathogensincludegroupBstreptococci(GBS),

---

Staphylococcusaureus,Streptococcuspneumoniae,andgram-
negativeentericrods.
Pneumoniaandsepsishavevariousmanifestations,includingthe
typicalsignsofdistressaswellastemperatureinstability

---

1639.Influenzavaccinecause?
a)Localswelling
b)Fever
c)Itching
d)Allofabove
CorrectAnswer-D
Ans.is'd'i.e.,Allofabove
Mildproblemsfollowinginactivatedfluvaccine:
Soreness,redness,orswellingwheretheshotwasgiven
Hoarseness
Sore,redoritchyeyes
Cough
Fever
Aches
Headache
Itching
Fatigue
Iftheseproblemsoccur,theyusuallybeginsoonaftertheshotand
last1or2days.
Moderateproblemsfollowinginactivatedfluvaccine:
Youngchildrenwhogetinactivatedfluvaccineandpneumococcal
vaccine(PCV13)atthesametimemaybeatincreasedriskfor
seizurescausedbyfever.Askyourdoctorformoreinformation.Tell
yourdoctorifachildwhoisgettingfluvaccinehaseverhada
seizure.
Problemsthatcouldhappenafteranyvaccine:
Brieffaintingspellscanhappenafteranymedicalprocedure,
includingvaccination.Sittingorlyingdownforabout15minutescan

---

helppreventfainting,andinjuriescausedbyafall.Tellyourdoctorif
youfeeldizzy,orhavevisionchangesorringingintheears.
Severeshoulderpainandreducedrangeofmotioninthearmwhere
ashotwasgivencanhappen,veryrarely,afteravaccination.
Severeallergicreactionsfromavaccineareveryrare,estimatedat
lessthan1inamilliondoses.Ifoneweretooccur,itwouldusually
bewithinafewminutestoafewhoursafterthevaccination.

---

1640.Childwithrash-wrongis
a)Typhus-day5
b)Varicella-day1
c)Typhoid-day5
d)Measles-day4
CorrectAnswer-C
Answer-C.Typhoid-day5
VerySickPersonMustTakeDoubleTablets
VeryVaricella(day1)
SickScarletfever(day2)
PersonPox-smallpox(day3)
MustMeasles(day4)
TakeTyphus(day5)
DoubleDengue(day6)
TabletsTyphoid(day7)

---

1641.Infanthasfever,oneepisodeoffebrile
convulsionsadmittedforobservation,
feverthansubsidedandfollowedby
rashonabdomen&chest,maculo
papularerythematous-whatisthe
cause?
a)Chickenpox
b)Measles
c)Typhoid
d)Dengue
CorrectAnswer-A
Ans.is'a'i.e.,Chickenpox
Inthisquestion,infanthaddeveloprashonfirstdayoffever&
distributionofrashisinfavourofchickenpox,orvaricella.
MnemonicforDayofappearanceofrashinafebrilepatientis
VerySickPersonMustTakeDoubleTablets
Very-Varicella(day1)
Sick-Scarletfever(day2)
Person-Pox-smallpox(day3)
Must-Measles(day4)
Take-Typhus(day5)
Double-Dengue(day6)
Tablets-Typhoid(day7)
Chickenpox(Varicella):
Causedbyvirus
Childdevelopfeverwithrash

---

Rasharemacular,maculo-papular,vesicular(pleomorphic)
Distributionisusuallycentripetal
Complicationinclude-moreseeninimmunocompromisedchild.
a. Mildthrombocytopenia
b. Hematurea
c. GIBledding
d. Encephalitis
e. Pneumonia

---

1642.Trueaboutforemilk&hindmilk?
a)Foremilkhasfat
b)Hindmilkrelievehunger
c)Foremilkrelievehunger
d)Hindmilkisrichinprotein
CorrectAnswer-B
Ans.is'b'i.e.,Hindmilkrelivehunger
Theforemilk(themilk"infront");isproducedatthebeginningof
eachfeeding.Itcontainswater,vitamins,andproteinandrelieve
thurst.
Thehindmilk;ispushedoutlatter,itisheavier,richerinlipidand
satisfyhunger.

---

1643.MostcommonGImalignancyof
childhood
a)Adenocarcinoma
b)Lymphoma
c)Sarcoma
d)carcinoid
CorrectAnswer-B
Ans.is'b'i.e.,Lymphoma
OverallhemangiomaismostcommonTumorininfant.
HemangiomaisusuallybenigninNature.
Leukemiaismostcommonmalignancyinpediatricagegyp.
2"'mostcommonisCNSTumor=Lymphomaisthemostcommon
malignancyofthegastrointestinaltractinchildren.About30%of
childrenwithnon-Hodgkinlymphomapresentwithabdominal
tumors.

---

1644.Mostcommonintraabdominalsolid
organtumorinchildis?
a)Neuroblastoma
b)Rhabdomyoblastoma
c)Wilm'stumor
d)Hypernephroma
CorrectAnswer-A
Ans.is'a'i.e.,Neuroblastoma
Mostcommonabdominalcancerofchildhood.
Mostcommoncancerofinfancy.
Mostcommonextracranialsolidtumorofchildhood(mostcommon
solidtumorofchildhoodisbraintumor).

---

1645.Mostcommonmalignancyinchildrenis
?
a)ALL
b)AML
c)Neuroblastoma
d)Wilm'stumor
CorrectAnswer-A
Ans.is'a'i.e.,ALL
Leukemiaismostcommonmalignancyinpediatricagegroup.o
Leukemia/lymphoma=40%(ALLismorecommonthanAML)
CNSTumor=30%
Embryonal&Sarcoma=10%
2ndmostcommonisCNSTumor(30%)

---

1646.Pedigreeanalysischart?
a)Usedforgrowthmonitoring
b)Toassesssideeffectduringchemotherapy
c)Usedtoseegentictransmission
d)Toassessdevelopmentaldelayininfant
CorrectAnswer-C
Ans.is'c'i.e.,Usedtoseegenetictransmission
Pedigree
Providegraphicdepictionofafamilystructuremedicalhistory.
Personprovidinginformationisformedasproband.
Specialsymbolisusedforeachdesignation.
Threegenerationpedigreeshouldbemade.
Closertherelationshipofprobandtotheperson,greaterischange
ofsharedgeneticcomponent.

---

1647.Praderwillisyndrome,chromosomal
defect?
a)Chromosome15
b)Chromosome5
c)Chromosome10
d)Chromosome21
CorrectAnswer-A
Ans.is'a'i.e.,Chromosome15
Prader-Willisyndromeisacomplexgeneticconditionthataffects
manypartsofthebody.
Ininfancy,thisconditionischaracterizedbyweakmuscletone
(hypotonia),feedingdifficulties,poorgrowth,anddelayed
development.Beginninginchildhood,affectedindividualsdevelop
aninsatiableappetite,whichleadstochronicovereating
(hyperphagia)andobesity.
SomepeoplewithPrader-Willisyndrome,particularlythosewith
obesity,alsodeveloptype2diabetesmellitus(themostcommon
formofdiabetes).
PeoplewithPrader-Willisyndrometypicallyhavemildtomoderate
intellectualimpairmentandlearningdisabilities.oBehavioral
problemsarecommon,includingtemperoutbursts,stubbornness,
andcompulsivebehaviorsuchaspickingattheskin.Sleep
abnormalitiescanalsooccur.
Additionalfeaturesofthisconditionincludedistinctivefacialfeatures
suchasanarrowforehead,almond-shapedeyes,andatriangular
mouth;shortstature;andsmallhandsandfeet.Somepeoplewith
Prader-Willisyndromehaveunusuallyfairskinandlight-coloredhair.
Bothaffectedmalesandaffectedfemaleshaveunderdeveloped

---

genitals.Pubertyisdelayedorincomplete,andmostaffected
individualsareunabletohavechildren(infertile).

---

1648.HemophiliaX-linked?
a)HemophiliaA
b)HemophiliaB
c)HemophiliaC
d)BothA&B
CorrectAnswer-D
Ans.is'D'i.e.,Botha&b
HemophiliaA(alsoknownasclassichemophiliaorfactorVIII
deficiency)andhemophiliaB(alsoknownasChristmasdiseaseor
factorIXdeficiency)areinheritedinanX-linkedrecessivepattern.
HaemophiliaCiscausedbyadeficiencyofcoagulationfactorXIand
isdistinguishedfromhaemophiliaAandBbythefactitdoesnot
leadtobleedingintothejoints.Furthermore,ithasautosomal
recessiveinheritance

---

1649.Turnersyndrome-karyotypingis?
a)45,X0
b)46X0
c)47XXX
d)Trisomy21
CorrectAnswer-A
Ans.is'a'i.e.,45XO
45X0
Lymphademaofdorsumofhand&fat
Looseskinfoldatnapeofneck
Shortstature
ShortNeck(withwebbingofneck)
Anomaliesear
Broadshieldlikechestwithwidelyspacedsmallnipple
Renalanomalies(Horse-shoe,soubleorcleftrenalpelvis)
Coartofaorta

---

1650.21-Hydroxylasedeficiency-falseis?
a)Mostcommoncauseofcongenitaladrenalhyperlasia
b)Autosomalrecessive
c)Femalpseudohermaphroditism
d)Malepseudohermephroditism
CorrectAnswer-D
Ans.is'd'i.e.,Malepseudohermephroditism
Congenitaladrenalhvperplasia(CAH)
GroupofARdisorder
MCadrenaldisorderinchildhood
Mostcommon21-hydroxylasedeficiency=Thereiselevatedlevelof
pregenolone,17-OHpergeneloneDHEAanddecreaslevelof
progesterone,deoxycortisol,andestradiolso21hydroxylase
deficiencycausesfemalepseudohermaphroditism.

---

1651.Incongenitaladrenalhyperplasia
precociouspubertyinmaleisdueto?
a)21alphahydroxylasedeficiency
b)11(3hydroxylasedeficiency)
c)Both
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Both
21hydroxylaseand3-13-HSD
?Saltlosing
?Virilizationoffemale(Femalepseudohermaphroditism)
?Precociouspubertyinmale

---

1652.Precociouspubertyisseenin-
a)Hypothyroidism
b)CNSirridation
c)Mccune-Albrightsyndrome
d)All
CorrectAnswer-D
Ans.is'a'i.e.,Hypothyroidism;'b'i.e.,CNSirradiation;'c'i.e.,Mc
CuneAlbrightsyndrome
Precociouspuberty
oPubertybeforetheageof8yearsingirlsor9yearsinboysis
consideredprecociouspuberty.oMenarchebeforetheageof10
yearsingirlsisalsoconsideredasprecocious.
oPrecociouspubertyisoftwotypes
1.Centralortrueprecociouspuberty
ResultsfromexcessiveGnRH,gonadotropinsandtargetsex
hormoneelaboratedbyprematureactivationofhypothlamic
pituitary-gonadal(HPG)axis.
2.Peripheralorpseudo-precociouspuberty
Duetoincreasedsexsteroidsecretionfromeitherthe
adrenalglandorthegonads.
ItisindependentofHPGaxisactivation
CausesofPrecociouspuberty
A.Centralprecociouspuberty
1.Idiopathic:Sporadicorfamilial.
2.Centralnervoussystemabnormalities
i)CongenitalanomaliesofCNS:Hypothalamichamartoma,
hydrocephalus,porencephaly,arachnoidcysts.
ii)AcquiredlesionsofCNS:Inflammation,granuloma,trauma,

---

surgery,radiation,chemotherapy.
iii)TumorsofCNS:Pinealtumors,opticglioma,ependymoma,
camiopharyngioma.
iv)Hypothyroidism
B.Peripheralprecociouspuberty:Isosexual
Girls
1.Ovariancauses:McCune-Albrightsyndrome,benignfollicular
cysts,granulosa-thecacelltumors;Gonadoblastoma
2.Adrenalcauses:Feminizingadrenalneoplasia
3.Exogenousestrogenadministration
Boys
1.Testis:Leydigcelltumor,adrenalresttumor,testotoxicosis.
2.Adrenal:CAH(21or11-(3hydroxylasedeficiency),virilizing
tumors.
3.hCGsecretingtumors:Hepatoma,hepatoblastoma,
choriocarcinoma,chorionepithelioma,teratoma,dysgerminoma.
Exogenoustestosterone
C.Heterosexualprecocity
1.Girls:VirilizationingirlsduetovirilizingCAH,ovarianoradrenal
neoplasia,polycysticovariandisease.
2.Boys:Feminizationduetoestogenproducingadrenaltumors,
exogenousestrogen,marijuanasmoking.
Note-Hypothyroidismusuallycausesdelayedpuberty,butjuvenile
hypothyroidismsometimescancauseprecociouspuberty.

---

1653.Delayedpubertyinfemale?
a)Nobreastbuddingin10years
b)Menarche>16year
c)menarche>1yearofbreanbudding
d)FSH
CorrectAnswer-B
Ans.is'b'i.e.,Menarche>16year
DelayedPuberty
Morecommoninboythangirl
Mostcommoncauseinconstitutionaldelay
Girls-Delayedpubertyisdefinedas
Lackofsecondarysexualcharacterbyageof17years
Absenceofmenarchebyageof16year
5yearafterpubertalonset.
Boys-Lackofpubertalchangesbytheageof14years.

---

1654.Hypergonadotropichypogonadismis
seaninallexcept?
a)Turnersyndrome
b)Downsyndrome
c)Klinefeltersyndrome
d)Swyer'ssyndrome
CorrectAnswer-B
Ans.is'b'i.e.,Downsyndrome
Hypergonadotropichypogonadism
AlsoK/aprimaryorperipheralhypogonadism.
Characterisedbyhypogonadismduetoanimpairedresponseofthe
gonadstothegonadotropin,FSHandLH.
Inturnalackofsexsteroidproductionandelevatedgonadotropin
level.
Causes:
Chromosomalabnormalitis
Turner'ssyndrome
Klinefeltersyndrome
Swyer'ssyndrome
Enzymedefect
17,hydroxylase
17,20lyasedeficiency

---

1655.Femalehermaphroditeis?
a)Femalesexualcharactersticwithtestes
b)Malesexualcharatersticwithovary
c)XY
d)Femalesexualcharacteristicwithbothtestes&ovary
CorrectAnswer-B
Ans.is'b'i.e.,Malesexualcharacteristcwithovary
Femalepseudohermaphroditism
Haveinternalgenitaliafemaletype
Katy()typeXX
Masculinisationofexternalgenitalia
Mostcommon-CAN
Congenitaladrenalhyperplasia
M-C.21hydroxylasedeficiency
Othercauseexcessmaternalandrogendueto-oMaternalovarian
tumor.
Maternaldrugintake
Treatment
Hormonaltherapy

---

1656.Fanconi'sanemia-falseis?
a)Autosomalrecessive
b)Pancytopenia
c)TypeIRTA
d)Allaretrue
CorrectAnswer-C
Ans.is'c'i.e.,TypeIRTA
Fanconianemia
Autosomalrecessive
Pancytopenia
Hyperpigmentationoftrunk,neck,andinlertriginousarea.
Growthfailure
Fanconifacies(smallhead,smalleyes)
Renalabormality
ProximalRTA(typeIIRTA)
Renaltubularacidosis3types
DistalRTA(typeI)
ProximalRTA(typeII)
HyperkalemicRTA(typeIV)

---

1657.Exchangebloodtransfusionwhatis
used?
a)Wholeblood
b)EPP
c)Serum
d)Packcell
CorrectAnswer-A
Ans.is'a'i.e.,Wholeblood
Exchangetransfusionistheprocessofslowlyremovingpatient
bloodandreplacingwithfreshdonorwholeblood.

---

1658.ITPfalseis?
a)Plattettransfusionshouldbeavoided
b)Anticedenthistoryoffebrileillness
c)Overactiveimmunesystem
d)Steroidshouldbeavoided
CorrectAnswer-D
Ans.is'd'i.e.,Steroidshouldbeavoided
Idiopathicthrombocytopenicpurpura(ITP)
Commonestbleedingdisorderpresentinginchildrenbetween1-7
yearofage.
ITPisproposedtobeoccurduetooveractiveimmuneresponse.
AntecedentH/ofebrileillnesspresent.
Treatment
Platlettransfusionshouldbeavoided
IVIGorsteroid.

---

1659.Ininfant,bonemarrowbiopsyisdone
from?
a)Sternum
b)Iliaccrest
c)Tibia
d)Allofabove
CorrectAnswer-C
Ans.is'c'i.e.,Tibia
Sternum:-->
Hematopoiticallyactive
Siteincooperativepatientlikeadult
Ilium:
Apprehesivepatient
Usefulinolderchildren&adult
Tibia:
Usefulinnewborn&infantandchildrenbelow2yearofage.

---

1660.Caseofhemorrhagicdiseaseof
newbornbleedon2ndday?
a)2,7,9,10
b)3,7,9,10
c)2,8,9,10
d)2,5,9,10
CorrectAnswer-A
Ans.is'a'i.e.,2,7,9,10
HemorrhagicdiseaseofnewbornisduetodeficiencyofVitaminK
dependentfactors-->II,VII,IXandX.

---

1661.Childhavinglonghistoryof
hemoglobin5gm%nextstep?
a)Bloodtransfusion
b)CBC,reticountwithperiphesalsmear.
c)StartIron
d)Hbelechophoresis
CorrectAnswer-B
Ans.is'b'i.e.,CBC,reticountwithperipheralsmear
Inabovequestion,ifchildisstable,thennoneedtogiveblood
transfusion.
BeforestartingIron,wehavetoruleouttypesofanemiaasIronis
indicatedonlyinnutritioralanemia.
Hbelectrophoresisisindicatedifthereisfeatuerofhemolytic
anemia(thalassemia)sooverallournextstepiscomplete
hemogramwithmanualperipheralsmearexamination.(obtionb).

---

1662.Mildlyelevatedbilirubin,normalliver
enzymesareseenin?
a)Malaria
b)Thalassemia
c)G-6PDdeficie
d)Allofabove
CorrectAnswer-D
Ans.is'd'i.e.,Allofabove
Mildlyelevatedbilirubinespeciallyindirectandnormalliverenzyme
seeninhemolyticanemia.
Inabovequestionallcauseshemolyticanemia.

---

1663.Baby'0*positive,bloodgroup,mother
Rhnegative,cordbilirubin7mg%,
conjugatedInowtreatmentis?
a)Nothing
b)Stopbreastfeedingfor48hours
c)Continuebreastfeedingandphototherapy
d)Stopbreastfeedandprepareforexchangebloodtransfusion
CorrectAnswer-D
Ans.is'd'i.e.,Stopbreasttadandprepareforexchangeblood
transfusion
?Inhemolyticdisease,immediateexchange
transfusionindication:
a)Cordbilirubinis>4.5mg/dlandHb<11gm%
b)Bilirubinrising>1mg/dl/hourdespitephototherapy
c)Hblevel11-13gm/dlandbilirubinrisingmorethan0.5mg/dl/hour
d)Bilirubinisrisinginspiteofphototherapy

---

1664.Inneonate,intramuscularinjection
givenat-
a)Deltoid
b)Gluteal
c)Thigh
d)Abdomen
CorrectAnswer-C
Answer-C.Thigh
Anterolateralaspectofthighbecauseoflackofimportantblood
vessel&nerveispreferredsiteupto12monthofage.

---

1665.Catbitesinchildtreatment-falseis
a)Cleaningthewoundthoroughly
b)Puncturewoundmostcommon
c)Mayrequirerabiesvaccination
d)Allofabove
CorrectAnswer-D
Ans.is`d'i.e.,Allofabove
Themostcommontypeofinjuryfromcatandratbitesisapuncture
wound.Catbitesoftenpenetratetodeeptissue
Infectionisthemostcommoncomplicationofanytypeofbite
injuries.
Treatmentincludescleansingofwound,debridement,wound
culture,tetanusandantirabiesimmunization,andinitiationof
antibiotics.
Amoxicillin-clavulanateisanexcellentchoiceforempiricaloral
therapyforhumanandanimalbitewoundsbecauseofitsactivity
againstmostofthestrainsofbacteriathathavebeenisolatedfrom
infectedbiteinjuries.

---

1666.Mostcommonsiteofextra-pulmonary
TBinchildrenis?
a)Abdominal
b)Genitourinary
c)Lymphnode
d)Congenital
CorrectAnswer-C
Ans.is'c'i.e.,Lymphnode
MostcommonsiteofextrapulmonaryTBislymphnode
Mostchildrenwhodeveloptuberculosisdiseaseexperience
pulmonarymanifestations25to35percentofchildrenhavean
extrapulmonarypresentation.
Themostcommonextrapulmonaryformoftuberculosisislymphatic
diseaseaccountingforabouttwothirdsofcasesofextrapulmonary
tuberculosis.thesecondmostcommonformismeningealdisease
occurringin13%ofpatients

---

1667.Mostcommonorganinvolvedin
congenitalTbis?
a)Liver
b)Pancreas
c)Kidney
d)Lung
CorrectAnswer-A
Ans.is'a'i.e.,Liver
Congenitaltuberculosis
Althoughitisrareasmotherhavingtuberculosisprimarilypresent
withinfertility.
Tuberculousbacillisometimespassthroghumblicalveinandmay
developfocusinliver(hepaticcomplex).
Whenneonateaspirateamnioticfluidcontainingbacillithendevelop
GItuberculosisorlunginfection.
Neonateusuallypresentasrespiratorydistress,
hepatosplenomegalylymphadenopathy.
Overallliverismostcommonlyinvolvedincongenitaltuberculosis

---

1668.IdealtimetostartIrontherapyina
marasamicchildwithfeverand
hemoglobin7gm%is
a)Immedietly
b)Atdischarge
c)Whenfevergoesdown
d)Atanytime
CorrectAnswer-C
Ans.is'c'i.e.,Whenfevergoesdown
Ironat3mg/kg1dayshouldstartedwhenchildgainingweightonce
stabilisationphaseisover.oThecoreoftheacceptedWHO
managementprotocolis10stepsintwophases?
1. Stabilization
2. Rehabilitation.
These10essentialstepsarelistedbelow:
1. Treat/preventhypoglycemia;
2. Treat/preventhypothermia;
3. Treat/preventdehydration;
4. Correctelectrolyteimbalance;
5. Treat/preventinfection;
6. Correctmicronutrientdeficiencies;
7. StartcautiousfeedingwithF-75;
8. Achievecatch-upgrowthbyfeedingF-100afterappetitereturns;
9. Providesensorystimulationandemotionalsupport;and
10. Prepareforfollow-upafterrecovery
F-75isthe"starter"formulausedduringinitialmanagementof
malnutrition,beginningassoonaspossibleandcontinuingfor2-7

---

daysuntilthechildisstabilized.Severelymalnourishedchildren
cannottoleratenormalamountsofproteinandsodiumorhigh
amountsoffat.Theymaydieifgiventoomuchproteinorsodium.
Theyalsoneedglucose,sotheymustbegivenadietthatislowin
proteinandsodiumandhighincarbohydrate.F-75hasisspecially
mixedtomeetthechild'sneedswithoutoverwhelmingthebody's
systemsintheinitialstageoftreatment.UseofF-75prevents
deaths.F-75contains75kcaland0.9gproteinper100ml.
AssoonasthechildisstabilizedonF-75,F-100isusedasa"catch-
up"formulatorebuildwastedtissues.F100containsmorecalories
andprotein:100kcaland2.9gproteinper100ml.

---

1669.Non-obstructivehydrocephalus-trueis
?
a)Alsokincommunicatinghydrocephalus
b)Duetoobliterationofsubarachrodcistemaeormalfunctionof
arachnoidvilli
c)Dilatationofall4ventricle
d)Allofabove
CorrectAnswer-D
Ans.is'd'i.e.,Allofabove
Hhy_LQggPllalusisnotaspecificdisease;rather,itrepresentsa
diversegroupofconditionsthatresultfromimpairedcirculationand
absorptionofCSFor,intherarecircumstance,fromincreased
productionbyachoroidplexuspapilloma
flyLk.QCSPLlalusresultingfromobstructionwithintheventricular
systemiscalledobstructiveornoncommunicatinghydrocephalus
TheCSFcirculatesfromthebasalcisternsposteriorlythroughthe
cisternsystemandovertheconvexitiesofthecerebralhemispheres.
CSFisabsorbedprimarilybythearachnoidvillithroughtight
junctionsoftheirendotheliumbythepressureforcesthatwerenoted
earlier.
CSFisabsorbedtoamuchlesserextentbythelymphaticchannels
directedtotheparanasalsinuses,alongnerverootsleeves,andby
thechoroidplexusitself.
Hydrocephalusresultingfromobliterationofthesubarachnoid
cisternsormalfunctionofthearachnoidvilliiscallednonobstructive
orcommunicatinghydrocephalus

---

1670.Febrileseizuremostcommon-age
groups?
a)1monthto1year
b)6monthto5year
c)6monthto2year
d)2monthto5year
CorrectAnswer-B
Ans.is'b'i.e.,6monthto5year
Febrileconvulsion:-
Commonestprovokedseizure
Between6monthsto5year
Neurologicallynormalchild
Occurswhentempriseabruptly
Simplebenignfebrileconvulsion
Fitsoccurwithin24hourofonsetoffever.
Durationlessthan10min.
Usuallysingleperfebrileepisode
Generalisedtypeofconvulsion
Atypicalfebrileseizures
Presenceoffamilyhistoryofepilepsy
Neurodevelopmentalretardation
Focalneurologicaldeficit.

---

1671.Whatisrecurrenceoffebrileseizure-
a)10-20%
b)20-30%
c)30-50%
d)50-70%
CorrectAnswer-C
Answer-C.30-50%
Recurrentfebrileseizuresoccurin30-50%ofcases.
Morethan90%offebrileseizuresaregeneralized.
Acuterespiratoryillnessaremostcommonlyassociatedwithfebrile
seizures.

---

1672.Drugusedforabsenceseizure?
a)Lamotrigine
b)Carbamazepine
c)Phenytoin
d)Vigabatrine
CorrectAnswer-A
Ans.is'a'i.e.,Lamotrigine
DrugofchoiceforabsenceseizuresisValproate(Previouslyitwas
ethosuxamide).Otherdrugsusedarelamotrigineandclonazepam.

---

1673.Childcomeswithbloodsugar32mg/dl
withconvulsionsTreatmentis?
a)5%dextrose2ml/kg
b)10%dextrose2ml/kgbolus
c)10%dextrose4ml/kg
d)5%Dextrose4ml/kg
CorrectAnswer-C
Ans.is'c'i.e.,10%Dextrose4ml/kg
SymtomaticHypoglycemia(<40mg/d1)shouldbemanagedwith
10%IVDextrose.
Inseizures,doseof10%dextroseis4ml/kg.

---

1674.Minimumintervalbetween2live
vaccineimmunization?
a)2weeks
b)4weeks
c)6week
d)8weeks
CorrectAnswer-B
Ans.is'b'i.e.,4weeks
Basicprincipleofimmunization
Minimum4weekintervalrecommendedbetween2live
vaccineadministrationexceptOPVandoraltyphoid.
Twoormorekilledvaccinemaybeadministratedsimultaneouslyor
atanygiveninterval
Aliveandkilledvaccinegivensimultaneouslybutatdifferentsite.
Ifimmunisationstatusunknown,giveageappropriatevaccine
Mixingofvaccineinsamesyringenotrecommended
LivevaccineshouldbeavoidedinAIDS,

---

1675.AchildhavingH/0profusewatery
diarrhoeanottakingoralyandnot
passedurinesince2days,whattobe
given
a)Milk
b)ORS
c)I.V.fluid
d)I.V.antibiotic
CorrectAnswer-C
Ans.is'c'i.e.,I.V.fluid
Childhavinghistoryofprofusewaterydiarrhoeawithpoororalintake
andnotpassedurinesince2daysissufferingfromdiarrhoeawith
dehydrationandprobablyacuterenalfailureofprerenaltypes.
HerebestchoiceisintravenousI.V.fluid
IfI.V.accessnotpossible,thenyoucangivefeedthroughRyle's
tubeorintraosseousfluid.

---

1676.Fluidofchoiceinchildwithburn<24
houris
a)Freshfrozenplasma
b)Isolye-P
c)Ringerlactate
d)Platlettranfusion
CorrectAnswer-C
Ans.is'c'i.e.,Ringerlactate
Fluidresuscitationinburninjury
Parklandformulaa
a.Initial24hours:Ringer'slactated(RL)solution4ml/kg/%burn
foradultsand3ml/kg/%burnforchildren.RLsolutionisaddedfor
maintenanceforchildren:
a. 4ml/kg/hourforchildrenweighing0-10kg
b. 40ml/hour+2ml/hourforchildrenweighing10-20kg
c. 60ml/hour+1ml/kg/hourforchildrenweighing20kgorhigher
Thisformularecommendsnocolloidintheinitial24hours.
bNext24hours:Colloidsgivenas20-60%ofcalculatedplasma
volume.Nocrystalloids.Glucoseinwaterisaddedinamounts
requiredtomaintainaurinaryoutputof0.5-1ml/hourinadults
and1ml/hourinchildren.

---

1677.Erythroposisstartsinfetalliverduring
?
a)2-4weeks
b)4-6weeks
c)6-8weeks
d)8-10weeks
CorrectAnswer-C
Ans.is'c'i.e.,6-8weeks
Developmentalhematopoiesisoccursinthreeanatomicstages:?
1. Mesoblastic
2. Hepatic
3. Myeloid
Mesoblastichematopoiesisoccursinextraembryonicstructures,
principallyintheyolksac,andbeginsbetweenthe10thand14th
daysofgestation.
By6-8wkofgestationtheliverreplacestheyolksacastheprimary
siteofbloodcellproduction,andby10-12wkextraembryonic
hematopoiesishasessentiallyceased.
Hepatichematopoiesisoccursintheliverthroughouttheremainder
ofgestation,althoughproductionbeginstodiminishduringthe
secondtrimesterasbonemarrow(myeloid)hematopoiesis
increases.
Theliverremainsthepredominanthematopoieticorganthroughwk
20-24ofgestation

---

1678.Antiendomysialantibodyisusedin
screeningof?
a)Myastheniagravis
b)Autoimmunehepatitis
c)Coeliacdiseases
d)Gravesdisease
CorrectAnswer-A
Ans.is'a'i.e.,Coeliacdiseases
Coeliacdisea.se(CD)isapermanentintoleranceofthesmall
intestinetogluten,characterizedbygluten-dependentchangesin
villousmorphologyand/orsignsofimmunologicalactivation
detectableinthelaminapropriaofintestinalmucosa.
Thepresenceofserumanti-endomysialantibodies(EMA)is
generallyconsideredtobehighlysuggestiveforCDbecauseoftheir
highvaluesofsensitivityandspecificity.
Otherantibodiesusedfordiagnosis
Tissuetransglutaminase,
Antigliadinantibodies
TreatmentisGluten-freediet

---

1679.Trueaboutbartter'ssyndromeareall
except?
a)Hyperkalemicalkalosis
b)Presentsinneonatewithototoxicityhavebartingenemutation
c)DecreasedK+assorptionfromthickdescendingloop
d)Autosomalrecessive
CorrectAnswer-A
Ans.is'a'i.e.,Hyperkalemicalkalosis
Antibodiesincoeliacdiseaseareanti-endomysian,antigliadinand
anti-transglutaminase.

---

1680.Posteriorurethralvalve-trueA/E?
a)Palpablebladder
b)Hydronephrosis
c)Painfulstressincontinence
d)RecurrentUTI
CorrectAnswer-C
Ans.is`c'i.e.,Painfulstressincontinence
Posteriorurethralvalve
Mostcommoncauseofsevereobstructiveuropathyinchildren.
30%ofchildrenexperiencedendstagerenaldisease/CRF
Dilatedprostaticurethra.
Hypertrophyofbladdermuscle
Vesicoureticrefluxseenin50%ofcases.
Backpressurechange:
Hydronephrosis
Distendedbladder
Thinurinarystream
RecurentUTIbecauseofurinarystasis

---

1681.2yearoldboyofweight12kgwith
vitaminAdeficiencywhatisoraldose
ofvitaminA
a)50,000I.U
b)1lakhI.U.
c)1.5lakhI.U
d)2lakhI.U
CorrectAnswer-D
Ans.D.2lakhI.U
Treatment:
Oraltherapy:TheoralregimenofvitaminAis200,000IUondayof
presentation,nextday,and2-4weekslater.
Childrenlessthan1yearofageorlessthan8kgshouldreceivehalf
thedoseoftheabovedose.Repeat200,000IUevery6monthsup
to6yearsofagetopreventrecurrence.
Parenteraltherapy:Ifthepatienthasseveredisease,isunableto
takeoralfeeds,orhasmalabsorption,thepreferabledoseis
100,000IUofvitaminAgivenintramuscularly.
ChildrenwithseveremeaslesshouldalsoreceivevitaminAasthey
areverylikelytobebenefitedfromsuchtherapybothintermsof
savingsightandreducingcasefatality.
Prevention
ProphylaxisconsistsofperiodicadministrationofVitaminA
supplements.WHOrecommendedschedule,whichis
universallyrecommendedisasfollows:
Infants6?12monthsoldandanyolderchildrenweighinglessthan8
kg?100,000IUorallyevery3?6months

---

Childrenover1yearandunder6yearsofage?200,000IUorally
every6months
Infantslessthan6monthsold,whoarenotbeingbreastfed?50,000
IUorallyshouldbegivenbeforetheyattaintheageof6months

---

1682.Alopeciathinbrittlenail,sparsehair
withthinenameldiagnosisis?
a)Ectodermaldysplasia
b)Alopeciaaerata
c)Alopicacongenita
d)Noneofabove
CorrectAnswer-A
Ans.is'a'i.e.,Ectodermaldysplasia
Ectodermaldysplasia
Groupofsyndrome
Allderivedfromectodemalstructure
Abnormalitiesoftwoormoreectodermalstructuresuchas
Hair
Teeth
Nail
Sweatgland
Craniofacialstructure
Digit

---

1683.Hairansyndromeisconsistsof?
a)Hyperandrogenism
b)Acanthosisnigricans
c)Insulinresistance
d)Allofabove
CorrectAnswer-D
Ans.is'd'i.e.,Allofabove
HAIR-ANsyndromeconsistsofhyperandrogenism(HA),insulin
resistance(IR),andacanthosisnigricans(AN).
Itisasubsetofpolycysticovarysyndrome

---

1684.RenaltubuleracidosiswithABGvalue
pH=7.24P02=80;PaCO2=36Na=131;
HCO3=14C1=90;BE=-13Glucose=
135aboveABGpicturesuggest?
a)Metabolicacidosis
b)Respiratoryacidosis
c)Respiratoryalkalosis
d)Metabolicalkalosis
CorrectAnswer-A
Ans.is'a'i.e.,Metabolicacidosis
ThegivenvalueshavelowpH,andlowHCo2-Indicatemetabolic
acidosis
PCO2inlowernormalrange(normalvalue35-45mm/hg)

---

1685.GrimacewithAPGARscore-
a)0
b)1
c)2
d)3
CorrectAnswer-B
Ans.is`bi.e.,1

---

1686.0.9%NaCIcontainsTrueas?
a)0.9gmofNaclin1000mloffluid
b)77megofsodiumis1000mloffluid
c)154megofchloridein1000mloffluid
d)30megofsodiumin1000mloffluid.
CorrectAnswer-C
Ans.is'c'i.e.,154meqofchloridein1000mloffluid
Nomalsaline(Isotonicsaline)
Contains-9gmsofNaclin1000mloffluid
154meq/sodiumin1000mloffluid
154meqChloridein1000mloffluid

---

1687.Confirmationofmaleintersexby?
a)USGabdomen
b)Genetictesting
c)Hormonalstudy
d)Allofabove
CorrectAnswer-B
Ans.is'b'i.e.,Genetictesting
Intersex:(DSD)
Discrepancybetweenmorphologyofgonadsandthatofextemal
genitalia
NowDisorderofSexdevelopment(DSD)ispreferredinsteadof
intersex
Distinctlynotdefinedasmaleorfemale
Intersextraitnotalwaysmanitestatboth
SomeasnotawareofintersexanditisconfirnedbyGenetictesting
Mostcommonisvirilisationoffemale46XXDSD.
46XXDSD-
Phenotypeisxx&gonadsareovarybutexternalgenitaliaisvirilised.
(duetolackofantimullerianhormone(AMH))
Mostcommoniscongenitaladrenalhyperplasia(CAH)
Mostcommonly21ahydroxylase&11[3-Hydroxylasedeficiency.

---

1688.Drugusedinneonatalresuscitation
a)Adrenaline
b)Sodabicarbonate
c)Naloxone
d)Allofabove
CorrectAnswer-D
Ans.is'd'i.e.,Allofabove
Drugusedduringneonatalresuscitation
Epinephrine./Adrenalin
NSorRL
Naloxone
Sodium-by-carbonate

---

1689.Reyesyndromefalseis?
a)Associatedwithsalicylateingestion
b)Hepatomegaly
c)Jaundice
d)Hypoglycemia
CorrectAnswer-C
Ans.is'c'i.e.,Jaundice
Revesyndrome
Detrimentaleffectstomanyorgans,especiallythebrainandliver,as
wellascausinglowbloodsugarandincreaseammonialevel.
SecondaryMitochondriahepatopathy
H/oviralinjection(Influenza,varicella)&salicylateinteractions.
Highermortalityrate.
Thediseasecausesfattyliverwithminimalinflammationand
cerebraledema(swellingofthebrain).
Jaundiceisnotusuallypresent.Withraisedenzymewithnormal
bilirubin.
Childrenofages4to12aremostcommonlyafflicted.
Earlydiagnosisisvital;althoughmostchildrenrecoverwith
supportivetherapy,itmayleadtoseverebraininjuryanddeath

---

1690.3yearoldchildcomeinERwithH/o
vomiting,loosewateymotionfor3
days.onexamination,childwas
drowsy,sunkeneye.Hypothermiaand
skinpinchtaketimetorevertback,
diagnosis?
a)Nodehydration
b)Milddehydration
c)Somedehydration
d)Severedehydration
CorrectAnswer-D
Ans.is'd'i.e.,Severedehydration
Achildwithseveredehydrationwillhaveatleasttwoofthefollowing
foursigns:sensoriumisabnormallysleepyorlethargic,sunken
eyes,drinkingpoorlyornotatall,andaveryslowskinpinch.
Achildwithsomesignsofdehydrationwillhavetwoofthefollowing
:restlessnessorirritability,sunkeneyes,drinkingeagerlyorslow
skinpinch.
Achildwitheitheroneornoneofthesesignsisclassifiedashaving
nosignsofdehydration.

---

1691.Induschenethekneejerk?
a)Exaggerrated
b)Decrease
c)Maybenormalinitiallylateronincrease
d)Maybenormalinitiallylaterondecrease
CorrectAnswer-D
Ans.is'd'i.e.,Maybenormalinitiallylaterondecrease
DuchenneandBecker'smusculardystrophy.
X-likerecessiveSoexpressionofgeneisessentiallyconfirmed
inmales.
FemalesareaffectedonlyifX-chromosomecarryingthenormal
alleleislostorinactivated
Beckerismilderformwithlateonsetandslowprogression.
Induchenni,onsetisearlywithdeloyedmisection.
Pseudohypertrophyofcalfmuscle,glutei,deltiod,
Gowersignmaypositiveatageof3year.
Cardiacinvolvementstartedat10yearofage.
Deeptendonreflexesremainnormaloraredecreasedin
patientswithDMD.
Anklejerksarerelativelypreserveduntiltheterminalstages,
whilethekneejerkreflexislessbriskthantheanklesbyage
six,butiseventuallylost.
Histopathologyshowsdiffusedegeneration&regenerationof
musclefibre.
SerumCPXaremarkedlyhigh.

---

1692.Intrauterinehydronephrosisof32-34
weeks-management?
a)Intrauterinedrainage
b)Waituntil3weeks
c)Immediatedelivery
d)RequireserialUSGandotherassociatedanomalies
CorrectAnswer-D
Ans.is`d'i.e.,RequireserialUSGandotherassociatedanomalies
Antenatalhydronephrosis(ANH)istransientandresolvesbythe
thirdtrimesterinalmostone-halfcases.
Thepresenceofoligohydramniosandadditionalrenalorextrarenal
anomaliessuggestssignificantpathology.oAllpatientswithANH
shouldundergopostnatalultrasonography
Theintensityofsubsequentevaluationdependsonanteroposterior
diameter(APD)oftherenalpelvisand/orSocietyforFetalUrology
(SFU)grading.
PatientswithpostnatalAPDexceeding10mmand/orSFUgrade3-
4shouldbescreenedforupperorlowerurinarytractobstructionand
vesicouretericreflux.
SurgeryisconsideredinpatientswithincreasingrenalpelvicAPD
and/oranobstructedrenogramwithdifferentialrenalfunction<35-
40%oritssubsequentdecline.

---

1693.10-year-oldboywithanulceratedlesion
withunderminededgesovertheupper
chestwithsatellitelesioninanterior
axillaryfoldfortwomonths.Axillary
lymphnodespresent.Histopathology
showeddermalabscesswithilldefined
histiocytes.AFBstainingofthetissue
waspositive.ChestXrayshowed
infiltrationsandcavities.Mantouxtest
waspositive.
a)Scrofuloderma
b)Skinabscess
c)Furuncle
d)Cellulitis

---

d)Cellulitis
CorrectAnswer-A
Answer-A.Scrofuloderma
Scrofulodermaoccursasaresultofspreadofinfectiontotheskin
fromanunderlyingtuberculosisfocus,usuallyalymphnodebutalso
infectedbonesorjoints.Thelesionsstartasfirm,painlessand
subcutaneousnodulesthatgraduallyenlargeandsuppurateand
then,formulcersandsinustractsintheoverlyingskin.Typical
ulcershaveunderminededgesandafloorofgranulationtissue.

---

1694.Goldenharsyndromeisassociatedwith
whichprominentocularmanifestation:
a)Microcornea
b)Megalocornea
c)Sclerocornea
d)Epibulbardermoids
CorrectAnswer-D
Ans.Epibulbardermoids
Goldenharsyndrome(oculoauriculovertebraldysplasiawith
hemifacialmicrosomia)isararecongenitaldevelopmentalanomaly
involvingthefirstandsecondbranchialarches.
Theclassicfeaturesofthissyndromeincludeocularchangessuch
asmicrophthalmia,epibulbardermoids,lipodermoidsandcoloboma;
auralfeaturessuchaspreauriculartragi,hearinglossandmicrotia;
andvertebralanomaliessuchasscoliosis,hemivertebraeand
cervicalfusion.
Otherocularanomaliesarerarebutincludemicrophthalmos,
microcornea,anophthalmos,eyelidcolobomas,irisandchoroid
colobomas,motilitydisorders,strabismus,blepharoptosis,palpebral
fissure,irisatrophy,polarcataract,anomalouslacrimaldrainage
system,andretinalandopticnerveanomalies

---

1695.TrueaboutSLEis?
a)Autoimmunedisease
b)ChildhoodSLEhadpoorprognosisthanadultSLE
c)PresenceofANA
d)Allaretrue
CorrectAnswer-D
Ans.is'd'i.e.,Allaretrue
SLE(sytemiclupusErythematosus)
Autoimmunedisorder
Inflammationofbloodvessel
ChildhoodSLEhadpoorpnognosisthanadultSLE
HallmarkofSLEispresenceofantinucleanantibody(ANA)
Morecommoninfemale.
MalarrashinpathognomicofSLE
Non-erosivearthritis
Nephritis
Encephalopathy
Pleuritis/Pericarditis
Cytopenia

---

1696.8yearoldchildwithhematuriain5
daysafterthroatinfection?
a)Poststreptococcalnephropathy
b)IgAnephropathy
c)Nephroticsyndrome
d)canbeaorb
CorrectAnswer-B
Ans.is'b'i.e.,IgANephnopathy
IgAnephropathy
PredominantdepositionofIgAinglomeruli.
RECURRENTepisodeofgrossrematuriathatalsoprecipitationby
URTIinlast2-5days.
PSGN
AcuteGNfollowinginfectionbygroupA--hemolyticstreptococci.
Commoninschoolagechildren.oStreptococcalinfectionusuallyof
throat(4or12strain)orskin(strain49)by1-4weekpriortoAGN.
Edema,oliguria,hypertension,ARF,hematureaofabruptonset.

---

1697.Meconiumcanpasseduptodaysin
healthybady-
a)1
b)3
c)5
d)7
CorrectAnswer-B
Answer-B.3
Meconiumispassedwithin24hoursofbirth.
Meconiumstoolsarepassedupto3days.
Transitionstoolsarepassedzith&5thdays.
RegularmilkstoolsarepassedAfter5days.

---

1698.InHSPgrosshematureaisseeninwhat
%ofchildren?
a)5-10%
b)10-20%
c)20-30%
d)30-40%
CorrectAnswer-C
Ans.is'c'i.e.,20-30%
Henoch-schonlein_purpura(HSP)
Smallvesselvasculitis
Purpuricrash
Arthritis
Abdominalpain
Glomerulonephritis
Grosshematuriaisseenin20-30%ofcases

---

1699.Childhaslesiononbuttockssince2
yearspreadingperipherallywithcentral
scarringnonsymptomaticdiagnosis?
a)Erythemaannularcetrifugam
b)Erythemamigrains
c)Erythemamarginatum
d)ErythemaGyratum
CorrectAnswer-A
Ans.is'a'i.e.,Erythemaannulasecetrifugam
Erythemaannularecentrifugum:anasymptomaticorpruritic
eruptionofvariableduration.Theeruptionmaybeassociatedwith
anunderlyingdisease(eg,infection,malignancy,sarcoidosis,other
systemicillness)
Theeruptionbeginsaserythematouspapulesthatspread
peripherallywhileclearingcentrally.Theselesionsenlargeatarate
ofapproximately2-5mm/dtoproduceannular,arcuate,figurate,
circinate,orpolycyclicplaques
Lesionsdemonstrateapredilectionforthethighsandthelegs,but
theymayoccurontheupperextremities,thetrunk,ortheface.The
palmsandthesolesarespared.
Erythemamigrans:Theselesionsaretypicallylessnumerous,less
circinateinconfiguration,andoftenaccompaniedbyahistoryofa
tickbite.
Erythemagyratumrepens:EACcanbedistinguishedfromthis
conditionbyitsslowerrateofspreadandbyitslessbizarre
configuration.Also,erythemagyratumrepensisalmostalways
associatedwithanunderlyingmalignancy.

---

Erythemamarginatumrheumaticum:Thisisanonscalinggyrate
erythemathatbydefinitionisfoundinassociationwithrheumatic
fever(10-18%ofpatientswithrheumaticfever).

---

1700.7yearoldboyisillandhasfever.what
isthecaloricrequirement?
a)1200kcal/d
b)1500kcal/d
c)1900kcal/d
d)2200kcal/d
CorrectAnswer-C
Ans.is'c'i.e.,1900kcal/day
Children
6year7->1690
9year->1950

---

1701.Boypowerschoolpreferenceno
spokenatschool,normalspeechat
otherplace,IQassessmentnormal
diagnosisis?
a)Selectivemutism
b)ADHD
c)Autism
d)Dyslexia
CorrectAnswer-A
Ans.is'a'i.e.,Selectivemutism
Autismtypicallydiagnosedbefore36monthofage.
Autismisaneurodevelopmentaldisorderofunknownetiology,but
withastronggeneticbasis.
Itdevelopsandistypicallydiagnosedbefore36moofage.
Itischaracterizedbyabehavioralphenotypethatincludes
qualitativeimpairmentintheareasoflanguagedevelopmentor
communicationskills,socialinteractionsandreciprocity,and
imaginationandplay.
Selectivemutismisdefinedasafailuretospeakinspecificsocial
situations,despitespeakinginothersituations;itistypicallya
symptomofanunderlyinganxietydisorder.Childrenwithselective
mutismcanspeaknormallyincertainsettings,suchaswithintheir
homeorwhentheyarealonewiththeirparents,butdonotspeakin
othersocialsettings,suchasatschooloratotherplacesoutside
theirhome.
Attention-deficit/hyperactivitydisorder(ADHD)isthemostcommon
neurobehavioraldisorderofchildhood,1ofthemostprevalent

---

chronichealthconditionsaffectingschool-agedchildren.
ADHDischaracterizedby:
Inattention,includingincreaseddistractibilityanddifficultysustaining
attention.
Poorimpulsecontrolanddecreasedself-inhibitorycapacity
Motoroveractivityandmotorrestlessness.
Dyslexiaischaracterizedbyanunexpecteddifficultyinreadingin
childrenandadultswhootherwisepossesstheintelligence,
motivation,andopportunitiestolearnconsiderednecessaryfor
accurateandfluentreading.Dyslexiaisthemostcommonandmost
comprehensivelystudiedofthelearningdisabilities

---

1702.Kangaroomothercare-Falseis?
a)Canalsobegivenbyfather
b)Especiallyforlowbirthweightbody
c)Effectivethermalcontrol
d)Allofabove
CorrectAnswer-A
Ans.:A.)Canalsobegivenbyfather
KANGAROOMOTHERCARE
?KMCiscareofpretermorLBWinfantsbyplacingskin-to-skin
contactwiththemother
?Position:verticalpositionbetweenthemother'sbreastsandunder
herclothes
?Thepositionismaintaineduntiltheinfantnolongertoleratesit
(indicatedbysweatingorbabyrefusestostayinKMCposition)
?Kangaroonutrition:exclusivebreastfeeding
?ContinuousKMCisanalternativetominimalcareinanincubator
forinfantswhohavealreadyovercomemajorproblemswhile
adaptingtoextra-uterinelife
Abletosuckandswallowproperly
Thrivinginneutralthermalenvironment
?IntermittentKMC(atleast1-2hour)whencontinuousKMCisnot
possible
?AllmotherscanprovideKMCirrespectiveofage,parity,education,
cultureorreligion
?Initiatedinafacilityandcontinuedathome
Clinicalbenefits
?Significantlyincreasesmilkproductioninmothers
?Increasesexclusivebreastfeedingrates

---

?Reducesincidenceofrespiratorytractandnosocomialinfection
?Bettercardiorespiratorystability
?Fewerapneicepisodes
?Improvedweightgain
?Improvesthermalprotectionininfantsandthereisareduced
chanceofhypothermia
?Improvesemotionalbondingbetweentheinfantandmothers
?Reducesthedurationofhospitalstay
?Improvedsurvivalinlowresourcesetting
CriteriaforeligibilityforKMC
?IndicatedinallstableLBWbabies
?Verysickbabiesneedingspecialcareshouldbecaredforunder
radiantwarmerinitially.KMCshouldbestartedafterthebabyis
hemodynamicallystable
?ShortKMCsessionscanbeinitiatedduringrecoverywithongoing
medicaltreatment
?KMCcanbeprovidedwhilethebabyisbeingfedviaorogastric
tubeoronoxygentherapy
?BW>1800g:generallystableatbirthandKMCinitiatedsoonafter
birth
?BW1200--1799g:manybabieshavesignificantneonatal
problems.ItmighttakeafewdaystostartKMC
?BW<1200g:itmighttakedaystoweeksbeforeinitiatingKMC
WhentostopKMC
?Whenthebabyattainsaweightof2500gandagestationof37
weeks
?Ababywhouponbeingputinkangarooposition,tendstowriggle
out,pulllimbsoutorcries,isnotinneedofKMCanymore

---

1703.Hypocalcemiainachildmaybe
associatedwith
a)Digeorgesyndrome
b)Hypoparathyroidism
c)Magnesiumdeficiency
d)Allofabove
CorrectAnswer-D
Ans.is'd'i.e.,Allofabove
Causesofhypocakemia
Hypoparathyroidism
Digeorgesyndrome
PTHreceptordefect(pseudohypoparathyroidism)
Magnesiumdificiency
Exogenousorganicphosphateexcess
VitDdifeciency

---

1704.3daysoldnewbornwithunknown
inbornerrorof
metabolism,hyperammonemiain
blood.
a)Maplesyrupurinedisease
b)Ureacycleenzymedificiency
c)Organicacidurea
d)Phenylketonuria
CorrectAnswer-B
Ans.is'b'i.e.,Ureacycleenzymedeficiency
Ureacycleenzymedefect
Catabolismofaminoacidleadstofreeammoniawhichishighly
toxic
Freeammoniaisconvertedintoureabygroupof5enzyme
Newbornisusuallyasymphomaticbutleteronbecomesymptomatic
aftergivingprotein
Treatmentisdieteryproteinrestriction
MSUD(maplesyrupurinedisease)
Defectivedecorboxglationofbranchchainaminoacid(leucine,
Isoleuvine,valine)
Autosomalrecessine
Smellofmaplesyrupinurine.
Phenylketonuria
Autosomalrecessive
Deficiencyofphenylalaninehydroxylase.
Defectinconversionofphenylalaninetotyrosine.
Thisleadstoincreaselevelofphenylalanine.

---

Thisincreasephenlylalanineconvertedintophenylpyruvateand
phenylacetate.
Thisphenylacetategivesmousyormustyodourinurine/body.
Otherpointtoremember?
Sweatyfeatodour-Isovalericacademia
InAlkaptanuria-Urinebecomedarkishbrownwhenexposedtoair
whilepurplishbrowninporphyria.
Smokysweat-MSUD
MousyorMusty-Phenylketonuria
Boiledcabbage-Tyrosinemia

---

1705.13yearoldfemalehavingsuddenonset
highgradefeverwithdelirium.CT.
findings/oinvolvementoflimbic
system&medialtemporallobe-Dxis
a)Subarachnoidhemorrhage
b)Herpessimplexencephalitis
c)Pyomeningitis
d)Cerebralmalaria
CorrectAnswer-B
Ans.is'b'i.e.,Herpessimplexencephalitis
Herpessimplexencephalitis
Acutenecrotisinginfectioninvolvingfrontal,temporallobe&limbic
system.
FeatureNonspecific-fever,headache,nuchalrigidity.convulsion,
alteredsensorium.
ConfirmedbyCSFexamin&radioimaging.
TreatmentsupportiveandAcyclovir

---

1706.Jaipurfootwasinventedby?
a)P.K.Sethi
b)S.K.Verma
c)B.L.Sehgal
d)H.R.Gupta
CorrectAnswer-A
Ans.is'a'i.e.,P.K.Sethi
P.K.Sethi.PramodKaranSethi(28November1927-6January
2008)wasanIndianorthopaedicsurgeon.WithRamChandra
Sharma,heco-inventedthe"Jaipurfoot",aninexpensiveand
flexibleartificiallimb,in1969.

---

1707.Metaphysealfracturetouchingphysis
butnotcrossingit,comesunderwhich
typeofSalterHarrisphysealinjury?
a)I
b)II
c)III
d)IV
CorrectAnswer-B
Ans.is'b'i.e.,II
SalterandHarrishaveclassifiedepiphysealinjuriesintofive
types-
TypeI:Completeseparationofepiphysisfromthemetaphysis
withoutfracture.Commoninrickets,scurvyandosteomyelitis.
TypeII:Thefractureinvolvesthephysisandatriangleof
metaphysealbone(ThurstonHollandsign)i.e.metaphysealfracture
touchingthephysisbutnotcrossingit.Thisisthecommonesttype
ofepiphysealinjuryaccountingfor73percentofcasesover10
yearsofage.
TypeIII:Thefractureisintra-articularandextendsalongthephysis
andthenalongthegrowthplate.Thisinjuryisrelativelyuncommon.
TypeIV:Thefractureisintra-articularandextendsthroughthe
epiphysis,physisandmetaphysis.Perfectreductionisnecessary
andopenreductionismoreoftennecessarytopreventgrowth
arrest.
TypeV:Crushingofepiphysis.Growtharrestusuallyfollows.
TypeVI(Rang'stype):Thereisaperipheralphysis(perichondrial
ring)injury.

---

---

1708.Whichofthefollowingistrueabout
halluxvalgus?
a)Greattoepointslaterally
b)Greattoepointsmedially
c)Lateralangulationofthe1stmetatarsophalyngealjoint
d)Dorsalangulationofthelstmetatarsophalyngealjoint
CorrectAnswer-A
Ans.is'a'i.e.,Greattoepointslaterally
Halluxvalgus
Halluxvalgusislateral(outward)deviationofgreattoeatthe
metatarsophalangealjoint.
Itisthecommonestfootdeformity.
Itiscommoninwomenpastmiddleage,andisnotinfrequenteven
inyoungwomen.
Commoncausesare:
Rheumatoidarthritis
Wearingpointedshoeswithhighheels
Hereditaryfactors
Idiopathic
Pathology
Outwarddeviationofthegreattoe.
Afterseveralyearstwosecondarychangesoccur:-
i)Formationofathickwalledbursa(bunion)overthemedial
prominenceof1"metatarsalhead.
ii)Osteoarthritisofmetatarsophalangealjoint.
Itisworthnotingthatmedialprominenceovermetatarsalheadlooks
likeanexostosis,butthereisnotrueexostosis.
Lateraldeviationofgreattoecausesovercrowdingoflateraltoes

---

andsometimesoverridingofadjacenttoes.

---

1709.Callusformationisseenbetweenwhat
durationoffracturehealing?
a)0-2weeks
b)2-4weeks
c)4-12weeks
d)12-16weeks
CorrectAnswer-C
Ans.is'c'i.e.,4-12weeks
Healingofafracture
Theprocessoffracturehealingvariesaccordingtothetypeofbone
involvedandtheamountofmovementatthefracturesite.Following
healingprocessesarethere:?
Indirectfracturehealing(healingbycallus)
Thisisthe'natural'formofhealingintubularbonesandinthe
absenceofrigidfixationwhenthereismicromovementatfracture
site.Thereisformationofinternalandexternalcallus.Thisstageis
dividedinthreephaseswhicharefurthersubdividedintofivestages
:

---

1710.Mostcommoncauseofamputationin
Indiais?
a)Diabeticgangrene
b)Gasgangrene
c)Roadtrafficaccident
d)Tumors
CorrectAnswer-C
Ans.is'c'i.e.,Roadtrafficaccident
Amputation
Amputationisaprocedurewhereapartofthelimbisremoved
throughoneormorebones.
Disarticulationisaprocedurewherethelimbisremovedthrougha
joint.
Indicationsofamputation
Indicationsofamputationsmaybeabsoluteorrelative:?
A)Absoluteindications
Gasgangrene
Diabeticgangrene
Irreparablelossofbloodsupplyduetotraumaordisease
Peripheralvasculardisease(Burger'sgangrene)
B)Relativeindications
Trauma
Tumors
Severelossoffunctionoflimb
Nerveinjuries
Congenitalanomalies
Overallmostcommoncauseofamputationistrauma(injury)toa
limb.

---

Mostcommoncauseoftraumaisroadtrafficaccident.

---

1711.Whichofthefollowingstructurearenot
normallyvisualizedduringthe
arthroscopyoftheknee?
a)Meniscus
b)Cruciateligaments
c)Collateralligaments
d)Patellaarticularsurface
CorrectAnswer-C
Ans.is'c'i.e.,Collateralligaments
Thefollowingstructuresarevisualizedduringtheknee
arthroscopy:-
i)Medialandlateralmeniscus
ii)Anteriorandposteriorcruciateligaments
iii)Kneearticularcartilage
iv)Patello-femoraljoint
v)Loosebodiesinjoint

---

1712.Cockupsplintisusedintreatmentof?
a)Radialnervepalsy
b)Ulnarnervepalsy
c)Mediannervepalsy
d)Posteriorinterosseousnervepalsy
CorrectAnswer-A
Ans.is'a'i.e.,Radialnervepalsy
Splints
Anymaterialwhichisusedtosupportafractureiscalledsplint.
Splintsareusedforimmobilizingfractures;eithertemporarilyduring
transportationorfordefinitivetreatment.
Themostcommonlyemployedsplintsisplasterofparis(POP)
splint.VariousPOPsplintsare.
1. Casts:-HerethePOProllcompletelyencirclesthelimb.
2. Slab:-Itisnotcompletelyencirclesthelimb,butonlyonehalfor
onethirdcircumference.
3. Spica:-Thisencirclesapartofthebody;e.g.,hipspicafor
fracturesaroundhip.

---

1713.Thomassplintisusedforimmobilizing
fracturesof?
a)Femur
b)Tibia
c)Radius
d)Ulna
CorrectAnswer-A
Ans.is'a'i.e.,Femur
Splints
Anymaterialwhichisusedtosupportafractureiscalledsplint.
Splintsareusedforimmobilizingfractures;eithertemporarilyduring
transportationorfordefinitivetreatment.
Themostcommonlyemployedsplintsisplasterofparis(POP)
splint.VariousPOPsplintsare:-
1)Casts:-HerethePOProllcompletelyencirclesthelimb.
2)Slab:-Itisnotcompletelyencirclesthelimb,butonlyonehalfor
onethirdcircumference.
3)Spica:-Thisencirclesapartofthebody;e.g.,hipspicafor
fracturesaroundhip.

---

1714.Functionalcastbracingnotusedin
fractureof?
a)Humerus
b)Tibia
c)Ulna
d)Thoracolumbarspine
CorrectAnswer-D
Ans.is'd'i.e.,Thoracolumbarspine
Functionalcastbracingisusedforthefractureof:-
i. Humerus
ii. Femur
iii. Ulna
iv. Tibia

---

1715.Gallowstractionisusedforfracture:
a)Shaftfemur
b)Neckfemur
c)Shafttibia
d)Tibialtuberosity
CorrectAnswer-A
Ans.a.Shaftfemur
Gallow'stractionisusedfortreatmentoffractureshaftoffemur,in
infantsandchildren
Gallow'sTraction
Gallow'stractionisusedfortreatmentoffractureshaftoffemur,in
infantsandchildren
Weightmustnotbe>12kgs
Boththefracturedandthenormalfemurareplacedinskintraction
andinfantissuspendedbythesefromaspecialframe.Thebuttocks
shouldbeliftedjustoffthebedsothattheweightofthebody
providescountertractionandthefractureisreduced
UsesofTractions
Name
Use
Bryant's
Fractureshaftoffemurin
TractionQ
children
Gallow's
Fractureshaftoffemurin
TractionQ
children
Russel's
Fractureshaftoffemurin
TractionQ
olderchildren
Perkin's
Fractureshaftoffemurin
TractionQ
adults
Fractureshaftoffemurin

---

90?-90?
Fractureshaftoffemurin
TractionQ
children
Agnes-Hunt CorrectionofHipdeformit
TractionQ
Well-Leg
Correctionofadductionor
TractionQ
abductiondeformityofhip
Dunlop
Supracondylarfractureof
TractionQ
humerus
Smith's
Supracondylarfractureof
TractionQ
humerus
UsesofTractions
Name
Use
Calcaneal
Openfracturesof
Traction
ankleorleg
Metacarpal Openforearm
Traction
fractures
Head-Halter Cervicalspine
Traction
injuries
Crutchfield
Cervicalspine
TractionQ
injuries
Halo-Pelvic Scoliosis
Traction

---

1716.Whataboutdurhampinistrue?
a)Itisusedtogiveskeletaltraction
b)Ithasthreadsinthecenterofpin
c)Itisusedtogiveskeletaltractionthroughcalcaneum
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove
Denhampin
Itisatypeofpinusedtogiveskeletaltraction.
Threadedportionofthepinengagesthebonycorticesandreduces
thechancesofpinsliding.
Thistypeofpinisusedcommonlytogiveskeletaltractionthrough
thecancellousbonei.e.calcaneum.Itcanalsobeusedtogive
tractionthroughosteoporoticbones.

---

1717.Patientcomeswithcrushinjuryto
upperlimb,doctorisconcernedabout
gangreneandsepsiswhatcanhelp
decidebetweenamputationandlimb
salvage?
a)MESS
b)Gulitonscore
c)GustiloAndersonclassification
d)ASIAguidelines
CorrectAnswer-A
Ans.is'a'i.e.,MESS
MESS(MangledExtremitySeverityScore):
Estimatesviabilityofanextremityaftertrauma,todetermineneed
forsalvagevsempiricamputation.
Followingparametersarelookedfor:-
i)Limbischemia
ii)Patientagerange
iii)Shock
iv)Injurymechanism

---

1718.Themostcommonbonefractured
duringbirth
a)Clavicle
b)Scapula
c)Radius
d)Humerus
CorrectAnswer-A
Ai.e.Clavicle
Clavicleisthemostcommonbonetobefracturedinchildrenand
duringbirth.

---

1719.Allaretrueaboutcollesfractureexcept
?
a)Inoldage
b)Dorsalshift
c)Atcortico-cancellousjunction
d)Gardenspadedeformity
CorrectAnswer-D
Ans.is'd'i.e.,Gardenspadedeformity
COLLESFRACTURE
Colle'sfractureisanextra-articularfractureatthedistalendof
radius,atitscortico-cancellousjunction.Itisthemostcommon
fractureinpersonover40yearsofageandespeciallyinwomen
aftermenopause(Postmenopausalfemales).Theassociationofthe
fracturewithosteoporosisisnowwellestablishedanditisoneofthe
fragilityfracture,seeninosteoporosis.Thefracturenearlyalways
causedbyfallonoutstretchedhand.
Displacementincolle'sfracture
Thefracturelinerunstransverselyatthecortico-cancellousjunction.
Inthemajorityofthecases,oneormoredisplacementsofthedistal
fragmentoccur:-
i. Dorsaldisplacement(Dorsalshift)
ii. Lateraltilt(lateralangulation)
iii. Dorsaltilt(Dorsalangulation)
iv. Supination(externalrotation)
v. Lateraldisplacement(lateralshift)
vi. Impaction(proximalmigration)
vii. Clinicalfeaturesofcollesfracture
Painandswellingatthewrist.

---

Typicaldeformity:Thereisadorsalhollowordepressionjust
proximaltothefractureandimmediatelydistaltothisthereisa
markedprominencecausedbylowerfragmentbeingdisplaced
backwards,carryingwithitthewholeofthecarpusandhand.This
givesappearanceofafork,Sonameddinnerfork/silverfork/spoon
shapeddeformity.

---

1720.Mostcommontypeofsupracondylar
fractureinchildren?
a)Posteromedialextension
b)Posterolateralextension
c)Anteromedialflexion
d)Anterolateralflexion
CorrectAnswer-A
Ans.is'a'i.e.,Posteromedialextension
Supracondylarfractureofhumerus
Supracondylarhumeralfracturesarethemostcommonelbow
fracturesinchildren.Mostcommonagegroupaffectedis5-8years.
Boysareaffectedmorethangirls.Leftsideismorecommonthan
right.
Mechanismofinjury
Mostlyitoccursduetohyperextensioninjury.
Fractureiscausedbyafallontotheoutstretchedhandwith
hyperextensionatelbow.
Typesofsupracondylarfracture
Supracondylarfractureisbroadlyclassifiedintoextensiontypeand
flexiontype.
1)Extensiontype
Itisthemostcommontype(97-99%).
Distalfragmentisextended(tiltedbackward/posteriorly)inrelationto
proximalfragment.
Occursduetohyperextensioninjuryafterfallonoutstretchedhands.
Generally,displacementofdistalfragmentmaybe:-
i)Posteromedial(70-80%)
ii)Posterolateral(20-30%)

---

2)Flexiontype
Itislesscommontype(1-3%)
Distalfragmentisflexed(tiltedforward/anteriorly)inrelationto
proximalfragments.
Themechanismofinjurygenerallyisbelievedtobeafalldirectly
ontotheelbowratherthanafallonoutstretchedhand.
Astheextensiontypefractureismorecommon(97-99%),themost
commonelbowinjuryinchildrenisextensiontypeofsupracondylar
fracture.
Clinicalfeaturesofsupracondylarfracture
Followingafall,thechildisinpainandelbowisswollen.
Inextensiontypeofinjury,`S'shapeddeformityoftheelbowis
obvious.
Thereislossofbothactiveandpassivemovementsofelbow.
Symptomsrelatingtovascularandnerveinjurymaybeseen.
Unusualposteriorprominenceofthepointofelbow(tipofolecrenon)
becauseofbackwardtiltofthedistalfragment.
Threepointbonyrelationshipismaintainedasthefractureisabove
thelevelofcondyles.
Dimplesignduetooneofthespikesofproximalfragment
penetratingthemuscleandtethringtheskin.

---

1721.Notacomplicationoffractureneckof
femur?
a)Non-union
b)Malunion
c)AVN
d)Osteoarthritis
CorrectAnswer-B
Ans.is'b'i.e.,Malunion
Complicationsoffemoralneckfracture
Fracturesoftheneckofthefemuraremorepronetoserious
complicationsthaninanyotherfracture.Allthecomplicationsaffect
fractureswithdisplacementratherthanimpactedabducted(valgus
impacted)fractures.
Theimportantcomplicationsare:
1)Avascularnecrosisoffemoralhead
AVNisthemostcommoncomplicationoffemoralneckfracture.
Itoccursin15-35%ofcasesofdisplacedfracturesand
2)Non-union
Non-unionisthesecondmostcommoncomplicationoffemoralneck
fracture.
Itoccursin10-30%ofcasesofdisplacedfracturesand
3)Secondaryosteoarthritis
Itoccursafewyearsfollowingfractureneckfemur.
Avascularnecrosisorcollapseoffemoralheadleadstosecondary
osteoarthritisofthehipjoint.

---

1722.Garden'sclassificationusedforwhich
fracture?
a)Surgicalneckhumerus
b)Shafthumerus
c)Neckoffemur
d)Shaftfemur
CorrectAnswer-C
Ans.is'c'i.e.,Neckoffemur
Garden'sclassification
Garden'sclassificationisthemostusefulandmostaccepted
classificationoftheneckoffemur.Thisisbasedonthedegreeof
displacementofthefracture.Following4stagesoffracturearethere
:?
1)Stage1:Thefractureisincomplete,withheadtiltedinpostero-
lateraldirection,i.e.intovalgus,thereforeisknownasvalgus
(abduction)impactedfracture.
2)Stage2:Completefracturebutundisplaced.
3)Stage3:Completefracturewithpartialdisplacement.
4)Stage4:Completefracturewithtotaldisplacement.
Thedegreeofdisplacement,inGarden'sclassification,isjudged
fromchangeinthedirectionofmedialtrabecularstreamoftheneck,
inrelationtothebonytrabeculaeintheweightbearingpartofthe
headandinthecorrespondingpartoftheacetabulum.
i)Stage1:-Thereisanobtuseanglelaterallyatthetrabecular
stream.
ii)Stage2:-Trebeculaebetweenheadandneckarebrokenbut
theyareinalignmentwitheachotherandwithtrabeculaeinthe
acetabulum.

---

iii)Stage3:-Allthreetrabeulaeareoutofalignment.
iv)Stage4:-Acetabularandheadtrabeculaeareinalignmentbut
headandnecktrabeculaearenotaligned.

---

1723.Radiologicalfactorsindicatingan
unstablepelvisareallexcept?
a)Posteriorsacroiliaccomplexdisplacementby>1cm
b)Avulsionfractureofsacralorischialendofthesacrospinous
ligament
c)AvulsionfracturesoftheL5transverseprocess
d)Isolateddisruptionofpubicsymphysiswithpubicdiastasisof2
cm.
CorrectAnswer-D
Ans.is'd'i.e.,Isolateddisruptionofpubicsymphysiswith
pubicdiastasisof2cm
Radiographicfactorsindicatingunstablepelvisare:-
Posteriorsacroiliaccomplexdisplacementby>lcm
Avulsionfractureofsacralorischialendofthesacrospinous
ligament
AvulsionfracturesoftheL5transverseprocess
Disruptionofpubicsymphysiswithpubicdiastasisof2cmwith
posteriorpelvicinjuryorinjurytoanterior/posteriorsacroiliac
ligamentorsacrospinousligaments.
Presenceofgapratherthanimpactionintheposteriorpelvicring.

---

1724.Pipkin'sclassificationsystemisused
for?
a)Fracturefemurhead
b)Fracturefemurshaft
c)Fractureproximaltibia
d)Fracturecalcaneum
CorrectAnswer-A
Ans.is'a'i.e.,Fracturefemurhead
Pipikin'sclassificationoffemoralheadfracture
TypeI:Femoralheadfractureinferior(caudal)tofovea.
TypeII:Femoralheadfracturesuperior(cephalad)tofovea.
TypeIII:Femoralheadfracturewithassociatedfemoralneck
fracture.
TypeIV:TypeI,IIorIIIwithassociatedacetabularfracture.

---

1725.Oneofthecommonfracturesthatoccur
duringboxingbyhittingwithaclosed
fistis?
a)Monteggiafracturedislocation
b)Galeazzifracturedislocation
c)Bennett'sfracturedislocation
d)Smith'sfracture
CorrectAnswer-C
Ans.is'c'i.e.,Bennett'sfracturedislocation
ThecommonmechanismofinjuryforBenett'sfractureisanaxial
blowdirectedagainstthepartiallyflexedmetacarpal,inmostcases
during'fistfights'.
Benett'sfracture
Benett'sfractureisanintra-articularfracturedislocationofthe
palmarbaseoffirstmetacarpalboneofthethumbwitheither
subluxationordislocationoffirstcarpometacarpaljoint,i.e.
trapezometacarpaljoint.Thecommonmechanismofinjuryisan
axialblowdirectedagainstthepartiallyflexedmetacarpal,inmost
casesduring"Fistfights".Patientcomplainsofpain,swellingand
tendernessoverthebaseofthethumb.Movementsofthumbare
restricted.
DisplacingforceinBennett'sfractures
FollowingarethedeformingforcesinBennett'sfracture:-
i)Atthedistalfragment,itistheadductorpollicis.
ii)Attheproximalfragment,itistheabductorpollicislongus.
Baseofthethumbmetacarpalispulleddorsallyandmediallybythe
abductorpollicislongus,whilethedistalattachmentofadductor

---

pollicisfurtherleversthebaseintoabduction.

---

1726.Mostcommoncomplicationofmid
shafthumerusfractureis?
a)Radialnervepalsy
b)Mediannervepalsy
c)Nonunion
d)Malunion
CorrectAnswer-A
Ans.is'a'i.e.,Radialnervepalsy
Complicationsofhumerusshaftfracture
1. Nerveinjury:-Radialnerveisthemostcommonlyinjurednervein
fractureshafthumerus.Itisparticularlycommoninobliquefractures
atthejunctionofmiddleanddistalthirdofthebone(Holstein-Lews
fracture).
2. Vascularinjury:-Brachialarterydamage.
3. Delayedunionornon-union:-Delayedunionornon-unionmay
occur,especiallyintransversefractureofthemidshaft.Thecauseof
non-unionisdistractionatfracturesiteduetogravityandweightof
plaster.
4. Jointstiffness:-Shoulder&elbowstiffness.

---

1727.Motorcyclist'sfractureis?
a)Stellatefractureacrossbaseofskull
b)Transversefractureacrossbaseofskull
c)LaminafractureofCIvertebra
d)SpinousprocessfractureofC7vertebra
CorrectAnswer-B
Ans.is`b'i.e.,Transversefractureacrossbaseofskull
Motorcyclist'sfracture
Becauseoftheinherentinstabilityoftwowheeledvehicles,therider
andpassangerinevitablyfalltothegroundinacrash.Injuriescan
occurtoanypartofthebody,butthelimbsandheadareparticularly
susceptibletoseriousinjury.
Impactwiththeroadsurfaceoranothervehicleatspeedoften
causesskullfracture,eveninthepresenceofahelmet.
Atransversefractureacrosstheflooroftheskull,usuallycalleda
"hingefracture",issometimesreferredtoasmotorcyclistfracture.At
autopsy,thebaseoftheskullmaybeappriciatedtohavedivided
intotwohalves,eachmovingindependentlyofeachotherlikea
hinge,theso-calledmotorcyclistfracture.

---

1728.Marchfractureisfractureof:
September2007
a)Calcaneus
b)2ndmetatarsal
c)Distalfibula
d)Proximaltibia
CorrectAnswer-B
Ans.B:2ndmetatarsal
Astressfractureofthe2ndor3rdmetatarsalboneissometimes
calleda'marchfracture'becausesoldiersrunninginbootsoftenget
it.
Thefracturehealsspontaneously,sotreatmentispurely
symptomatic.

---

1729.Whatisnottrueaboutpulledelbow?
a)Occursduetosuddenaxialpullonextendedelbow
b)Forearmisheldinpronationandextention
c)Mostcommonlyoccursbetween2-5yearsofage
d)Treatmentisquickpronationandflexionofelbow
CorrectAnswer-D
Ans.is'd'i.e.,Treatmentisquickpronationandflexionof
elbow
Pulledelbow
Ifayoungchildisliftedbythewrist,theheadoftheradiusmaybe
pulledpartlyoutoftheannularligament,i.e.,subluxationofthehead
oftheradius.
Itoccurswhenforearmispronated,elbowisextendedand
longitudinaltractionisappliedtothehandorwrist,e.g.,lifting,
spinningorswingingachildwithwristorhand.Pulledelbowmost
commonlyoccursbetweentheageof2-5years.
Clinicalfeaturesofpulledelbow
Historyofsuddenaxialpullonextendedelbow.
Immediatelychildstartscryingandisunabletomovetheaffected
elbow.
Theforearmisheldinpronationandextensionandanyattemptto
supinateisresisted.
Childdoesnotallowtotouchtheaffectedlimb.
X-rayseemstobenormal.
Treatmentofpulledelbow
Treatmentissimple.Thechild'sattentionisdiverted,theelbowis
quicklysupinatedandthenslightlyflexed.
Thisreducesthesubluxationordislocationandtheradialheadis

---

relocatedwithasnap.

---

1730.Hangman'sfractureisthefracture
involvingwhichcervicalvertebra?
a)C1
b)C2
c)C3
d)C4
CorrectAnswer-B
Ans.is'b'i.e.,C2
Hangman'sfractureisabilateralfractureoftheparsinterarticularis
oftheaxis(C2)withatraumaticspondylolisthesisofaxis(C2)over
theC3vertebrae.ThusHangman'sfractureisnotsimplyafracture,
butfracture-dislocationoftheaxis(C2).
Themechanismofinjuryisanextensionwithdistraction(intrue,
judicialhangman'sfracture)andhyper-extension,axialcompression
&flexion(incivilianinjuries,whicharenowmorecommon).
ItisthesecondmostcommontypeofAxis(C2)fracture,secondonly
toodontoidfractures.
Fatalitiesarecommon,However,neurologicaldeficitisunusualas
thefractureoftheposteriorarchdecompressesthespinalcord.
Mostofthefatalitiesoccuratthesceneofinjury,acutepost-
admissionmortalityislow.
SuccessfulhealingofC2traumaticspondylolisthesisisreportedto
approach95%.Thisismostcommonlyachievedwithnon-operative
measures,eveninthepresenceofdisplacementofparsinter-
articularis.

---

1731.Mostcommonsitefortheosteoporotic
vertebralfractureis?
a)Dorsolumbarspine
b)Cervicalspine
c)Lumbosacralspine
d)Dorsalspine
CorrectAnswer-A
Ans.is'a'i.e.,Dorsolumbarspine
Osteoporosisisanasymptomaticdisorderunlesscomplications
(predominantlyfractures)occur.
Mostcommonsymptomofosteoporosisisbackpainsecondaryto
vertebralcompressionfracture.
Dorso-lumbarspineisthemostfrequentsite.
Othercommonsitesoffracturearelowerendradius(Colle's
fracture)andfractureneckfemur.
Osteoporoticfracture(fragilefractures)are:(i)Fracturevertebrae
(mostcommon),(ii)Colle'sfracture,(iii)Fractureneckfemur.
Serumcalcium,phosphateandalkalinephosphatasearenormalin
osteoporosis.

---

1732.Whendoyouoperateforprolapseddisc
?
a)Busyexecutiveneedsquicksurgery
b)Onlywithweaknessnopain
c)Severepaininterferingwithactivityandnotrelievedbyrestand
treatmentof8weeks
d)PatientofPIDwithdifficultyinambulation
CorrectAnswer-C
Ans.is'c'i.e.,Severepaininterferingwithactivityandnotrelieved
byrestandtreatmentof8weeks
IndicationsforsurgeryincasesofProlapsedintervertebraldiscare
:-
i)Failureofconservativetreatment(evenafter8weeksof
treatment).
ii)Progressiveneurologicaldeficit.
iii)Cauda-equinasyndrome.
iv)Severesciatictilt.

---

1733.Vertebralrotationinscoliosisis
checkedin
a)Forwardbending
b)Backwardbending
c)Sideways
d)Withoutbending
CorrectAnswer-A
Ans.is'a'i.e.,Forwardbending
Theforwardbendingtestisverysensitiveindemonstratingthe
vertebralrotationthattakesplaceinastructuralscolioticcurve.
Quantificationoftherotationisdonebymeasuringtheribhumpby
useofinclinometerorscoliometer.
Severityofthecurveinscoliosisismeasuredbycobb'sangle,i.e.an
anglebetweenlinepassingthroughthemarginsofvertebraatends
ofcurve.Tousethecobbmethod,onemustfirstdecidewhich
vertebraearetheend-vertebraeofthecurve.Theseendvertebrae
arethevertebraeattheupperandlowerlimitsofcurvewhichtilt
mostseverelytowardtheconavityofthecurve.Othermethodused
tomeasurescoliosisangleisFerguson'smethod.

---

1734.Testusedforprolapsedlumbar
intervertebraldiscis-
a)Activestraightlegraisingtest
b)Laseguetest
c)Thomastest
d)Apley'sgrindingtest
CorrectAnswer-B
Ans.is'b'i.e.,Laseguetest
ClinicalexaminationinPID
Forwardstooping(bending),twistingorcoughingaggravatethe
pain.
Thetrunkistiltedtooneside(sciaticscoliosisorsciatictilt).
Movementsoflumbarspinearerestrictedespeciallyflexion.
Straightlegraising(SLR)testispositive,i.e.straightlegraisingis
possible40?orless(AIIMSO4).
Laseguetest(amodificationofSLRtest)ispositive.

---

1735.Lumbarcanalstenosispresentsas?
a)Claudication
b)Scolioticdeformity
c)Kyphoticdeformity
d)Radiculopathy
CorrectAnswer-A
Ans.is'a'i.e.,Claudication
Thepatientoflumbarcanalstenosisisusuallyamanagedover50,
complainsofaching,heaviness,numbnessandparaesthesiainthe
thighsandlegs;itcomesonafterstandinguprightorwalkingfor5-
10minutes,andisconsistentlyrelievedbysitting,squattingor
leaningagainstawalltoflexthespine(hencetheterm'spinal
claudication').

---

1736.Posteriorglidingoftibiaonfemuris
preventedby?
a)Anteriorcruciateligament
b)Posteriorcruciateligament
c)Medialcollateralligament
d)Lateralcollateralligament
CorrectAnswer-B
Ans.is'b'i.e.,Posteriorcruciateligament
Posteriorcruciateligament
PCLbeginsfromposteriorpartofintercondylarareaoftibiaandruns
upwards,forwardsandmediallytoattachtheanteriorpartofthe
lateralsurfaceofmedialcondyleoffemur.
PCLisextrasynovialbutintracapsular,i.e.,liesbetweensynovium
andcapsuleofthekneejoint.
Itprovidesantero-posteriorstabilityandpreventsposteriorglidingof
tibiaonfemur.
Itistautinflexion.
Bloodsupplyofcruciate(anterior&posterior)ligamentsisfrom:-
1. Middlegenicularartery(majorsupply)
2. Inferiorgenicular(medial&lateral)artery(lessimportant).
Nervesupplyofcruciateligaments(ACL&PCL)isfromposterior
articularbranchoftibialnerve.

---

1737.Lachmann'stestisusedfor?
a)ACLinjury
b)PCLinjury
c)MCLinjury
d)LCLinjury
CorrectAnswer-A
Ans.is'a'i.e.,ACLinjury
ACLinjury
ACListhemostcommonlyinjuredligamentofknee.
Mostcommonmechanismofinjuryistwisting(medialrotation)with
valgusinjuryonsemiflexedknee.
OftenwiththismechanismMCLandmedialmeniscusarealso
injured.ThistripleinjuryofACL,MCLandmedialmeniscusiscalled
O'Donghuetriad.
IsolatedACLcanalsobeinjuredbyhyperextensioninjury.
TestsforACLinjury
FollowingtestsareusedforACLinjury:?
i. Lachman'stest
ii. Pivotshifttest
iii. Flexion-rotationdrawertest
iv. Anteriordrawertest
v. Jerktest
vi. Loose'stest
Lachman'stestisthemostsensitivetestforanteriorcruciate
ligamenttears.Itisdonewiththekneeflexedat20degrees.Soit
canbedoneinacuteaswellaschronicinjuries.(becauseinacute
caseswithhemarthrosismoreflexionisusuallynotpossibleso
performinganteriordrawertestisdifficult).

---

---

1738.Whichamongthefollowingisnota
featureofUnhappytriadof0'
Donoghue?
a)ACLinjury
b)Medialmeniscusinjury
c)Medialcollateralligamentinjury
d)Fibularcollateralligamentinjury
CorrectAnswer-D
Ans.is'd'i.e.,Fibularcollateralligamentinjury
Themostcommonmechanismofligamentdisruptionofkneeis
adduction(valgus),flexionandinternalrotationoffemurontibia
whichusuallyoccurinsportsinwhichthefootisplantedsolidlyon
thegroundandlegistwistedbyrotatingbody(i.e.,football,soccer,
basketball,skiing).
Themedialstructuresmedial(tibial)collateralligament(MCL)and
medialcapsularligamentarefirsttofail,followedbyACLtears,ifthe
forceisofsufficientmagnitude.Themedialmeniscusmaybe
trappedbetweencondylesandhaveaperipheraltear,thus
producingunhappytriadof0'Donoghue.

---

1739.Commonestligamentinjuredinankle
injury?
a)Anteriortalofibularligament
b)Calcaneofibularligament
c)Posteriortalofibularligament
d)Springligament
CorrectAnswer-A
Ans.is'a'i.e.,Anteriortalofibularligament
Theankleisoneofthemostcommonsitesforacute
musculoskeletalinjuries.Sprainsconstitute85%ofallankleinjuries,
and85%ofthoseinvolvealateralinversionmechanism.
InversionSprain-Inversionanklesprainsoccurwhenthefootturns
inorouttoanabnormaldegreerelativetotheankle.Themost
commonmechanismofananklesprainisacombinationof
plantarflexionandinversionwherethefootispointingdownwardand
inward.
Thelateralligamentsareinvolvedinaninversionanklesprainand
hencemostcommonlydamaged.Theseligamentsareonthe
outsideoftheankle,whichincludestheanteriortalofibular(ATFL),
calcaneofibular(CFL)andposteriortalofibularligaments(PTFL).
InjurytotheATFListhemostcommon.WhenboththeATFLand
CFLareinjuredtogether,ankleinstabilitywillbemorenoticeable.
ThePTFListhestrongestofthethreeligamentsandisrarelyinjured
inaninversionsprain.

---

1740.Puttiplatoperationisdonefor?
a)Elbowinstability
b)Shoulderinstability
c)Rotatorcufftear
d)BicepsTendinitis
CorrectAnswer-B
Ans.is'b'i.e.,Shoulderinstability
Importantsurgeriesforrecurrentanteriordislocationofshoulderare:
i)Barkart'soperationiii)Bristow's
operationv)EdenHybinetteoperation
ii)Putti-Platt'soperationiv)McLaughin's
operationvi)Magnum&Stackoperation

---

1741.Investigationofchoiceforentrapment
neuropathyis?
a)CTSCAN
b)Clinicalexamination
c)Ulrasonography
d)EMGNCV
CorrectAnswer-D
Ans.is'd'i.e.,EMGNCV
Thediagnosisofmononeuropathyinentrapmentneuropathyis
basedonelectrodiagnosticstudies(EMG/NCV)andMagnetic
resonanceimaging(MRI).
Entrapmentneuropathyisamedicalconditioncausedby
entrapmentandcompressionofaperipheralnervewhereverit
traversesfibro-osseoustunnels.
Sitesofentrapmentneuropathyare:-
i. Carpaltunnel:-Mediannerve(carpaltunnelsyndrome)
ii. Cubitaltunnel:-Ulnarnerve(cubitaltunnelsyndrome)
iii. Guyan'scanal:-Ulnarnerve(Guyan'scanalsyndrome)
iv. Tarsaltunnel:-Posteriortibialnerve(Tarsaltunnelsyndrome)
v. Inguinalligament:-Lateralcutaneousnerveofthigh(meralgia
paraesthetica).
vi. Suprascapularnotch:-Suprascapularnerve
vii. Neckoffibula:-Commonperonealnerve
viii. Fascialtunnelofsuperficialperonealnerve:-Superficialperoneal
nerve
ix. ArcaseofFrohse:-Posteriorinterosseoussyndrome
x. Thoracicoutlet:-Lowertrunkofbrachialplexus
xi. Compressioninthefoot:-Digitalnerve(Morten'smetatarsalgia)

---

---

1742.Froment'ssignispositiveincasesof
weaknessof?
a)Thumbadduction
b)Thumbabduction
c)Thumbflexion
d)Thumbextension
CorrectAnswer-A
Ans.is'a'i.e.,Thumbadduction
Normallywhenapersonisaskedtograspabookbetweenthe
thumbandindexfinger,hewillgraspthebook
firmlywiththumbextended,takingfulladvantageoftheadductor
pollicisandthefirstdorsalinterosseousmuscles.
Iftheulnarnerveisinjuredtheadductorpolliciswillbeparalysed
andthepatientwillholdthebookbyusingtheflexorpollicislongus
(suppliedbymediannerve)producingflexionattheinterphalangeal
joint.
Thisbecomesmorepronouncediftheexaminertriestopullthebook
outwhilethepatienttriestoholdit.
Thissignisknownas`Froment'ssign'orthe'booktest'.

---

1743.Inabilitytopronateforearmisdueto
injurytowhichnerve?
a)Ulnar
b)Radial
c)Mediannerve
d)Musculocutaneous
CorrectAnswer-C
Ans.is'c'i.e.,Mediannerve
Pronationoftheforearmisbytwomusclespronatorteresand
pronatorquadratus.Thesetwomusclesaresuppliedbymedian
nerve.Thusinjurytomediannerveproducesinabilitytopronate
forearm.
Themediannerveisalsocalledlabourer'snerve.Themediannerve
arisesbytworoots,onefromthelateralcord(C5,6,7)andtheother
fromthemedialcord(C8,T1).Thevariousmusclessuppliedby
mediannerveare:?
1)Intheforearm
Alltheflexormusclesoftheforearm,excepttheflexorcarpiulnaris
andthemedialhalfofflexordigitorumprofundustotheulnartwo
fingers.Thesemusclesare:-
i. Pronaterteres
ii. Flexordigitorumsuperficialis
iii. Flexorpollicislongus
iv. Flexorcarpiradialis
v. Flexordigitorumprofundus(lateralhalf)
vi. Pronatorquadratus
vii. Pulmarislongus
2)Inhand

---

Mediannervesupplies:-
i. Thenarmuscles(exceptadductorpollicis)-Flexorpollicisbrevis,
opponenspollicisandabductorpollicisbrevis.Adductorpollicisis
suppliedbyulnarnerve.
ii. Firsttwolumbricals

---

1744.Whichofthefollowingdeformityis
evidentincaseoferbspalsy?
a)Policemantipdeformity
b)Wingingofscapula
c)Clawhand
d)Wristdrop
CorrectAnswer-A
Ans.is'a'i.e.,Policemantipdeformity
Deformity(positionofthelimb)inErb'spalsy
i)Arm:Hangesbytheside;itisadductedandmediallyrotated
ii)Forearm:Extendedandpronated
nThedeformityisknownas'policeman'stiphand'or'porter'stip
hand'.

---

1745.Highsteppinggaitisseenin?
a)CTEV
b)Commonperonealnervepalsy
c)Polio
d)Cerebralpalsy
CorrectAnswer-B
Ans.is'b'i.e.,Commonperonealnervepalsy
Firsttotouchthegroundistheforefoot,andnottheheel.

---

1746.Sunderlandclassificationisusedfor?
a)Nerveinjury
b)Muscleinjury
c)Tendoninjury
d)Ligamentinjury
CorrectAnswer-A
Ans.is'a'i.e.,Nerveinjury
Sunderlandisanextensionoftheseddonclassificationandincludes
5typesofnerveinjuries.

---

1747.ArthritisinvolvingDIP,PIP,1st
carpometacarpalwithsparingofMCP
andwristjointsistypicalof?
a)Osteoarthritis
b)Rheumatoidarthritis
c)Ankylosingspondylitis
d)Psoriaticarthritis
CorrectAnswer-A
Ans.is'a'i.e.,Osteoarthritis
1stCarpometacarpaljointWrist-Osteoarthritis

---

1748.Heberdennodedenotesinvolvementof
?
a)Distalinetrphalangealjoint
b)Proximalinterphalangeljoint
c)Metacarpophalangealjoint
d)Metatarsophalangealjoint
CorrectAnswer-A
Ans.is'a'i.e.,Distalinetrphalangealjoint
Inosteoarthritisofhand:
i)Distalinterphalangealjoint:-Heberden'snode
ii)Proximalinterphalangealjoint:-Bouchard'snode

---

1749.Whichofthefollowingisnottheextra-
articularmanifestationsofankylosing
spondylitis?
a)Acuteanterioruveitis
b)Aorticvalvedisease
c)Pulmonaryfibrosis
d)Dilatedcardiomyopathy
CorrectAnswer-D
Ans.is'd'i.e.,Dilatedcardiomyopathy
Extraarticularmanifestationsofankylosingspondylitisareacute
anterioruveitis(in5%);rarelyaorticvalvedisease,carditisand
pulmonaryfibrosisalsooccur.
Ankylosingspondylitis(marie-strumpelldisease)
Ankylosingspondylitisisachronicprogressiveinflammatorydisease
ofthesacroiliacjointsandtheaxialskeleton.
Prototypeofseronegative(absenceofrheumatoidfactor)
spondyloarthropathies.
Inflammatorydisorderofunknowncause.
Usuallybeginsinthesecondorthirddecadewithamedianageof
23,in5%symptomsbeginafter40.
Maletofemaleratiois2-3:1
StrongcorrelationwithHLA-B27
90-95%ofcasesarepositiveforHLA-B27.
Jointsinvolvedinankylosingspondylitis
Ankylosingspondylitisprimarilyaffectsaxialskeleton.
Thediseaseusuallybeginsinthesacro-iliacjointsandusually
extendsupwardstoinvolvethelumbar,thoracic,andoftencervical

---

spine.
Intheworstcasesthehipsorshouldersarealsoaffected.Hipjoint
isthemostcommonlyaffectedperipheraljoint.
Rarelyknee(Ebenzar4th/e593)andankle(Apley's9th/e67)are
alsoinvolved.Pathology
Enthesitisi.e.inflammationoftheinsertionpointsoftendons,
ligamentsorjointcapsuleonboneisoneofthehallmarksofthis
entityofdisease.
Primarilyaffectsaxial(spinal)skeletonandsacroiliitisisoftenthe
earliestmanifestationofA.S..
Involvementofcostovertebraljointsfrequentlyoccur,leadingto
diminishedchestexpansion(normal5cm)oPeripheraljointse.g.
shoulders,andhipsarealsoinvolvedin1/3rdpatients.
Extraarticularmanifestationslikeacuteanterioruveitis(in5%);rarely
aorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.
Pathologicalchangesproceedinthreestages?
1. Inflammationwithgranulationtissueformationanderosionof
adjacentbone.
2. Fibrosisofgranulationtissue
3. Ossificationofthefibroustissue,leadingtoankylosisofthejoint.

---

1750.Trueaboutankylosingspondylitisare
allexcept?
a)Affectsmales
b)30-40yrs
c)90%HLA-B5
d)Bamboospine
CorrectAnswer-C
Ans.is'c'i.e.,90%HLA-B5
Ankylosingspondylitis(marie-strumpelldisease)
Ankylosingspondylitisisachronicprogressiveinflammatorydisease
ofthesacroiliacjointsandtheaxialskeleton.
rototypeofseronegative(absenceofrheumatoidfactor)
spondyloarthropathies.
Inflammatorydisorderofunknowncause.
Usuallybeginsinthesecondorthirddecadewithamedianageof
23,in5%symptomsbeginafter40.
Maletofemaleratiois2-3:1
StrongcorrelationwithHLA-B270-95%ofcase
9sarepositiveforHLA-B27.
Jointsinvolvedinankylosingspondylitis
Ankylosingspondylitisprimarilyaffectsaxialskeleton.
Thediseaseusuallybeginsinthesacro-iliacjointsandusually
extendsupwardstoinvolvethelumbar,thoracic,andoftencervical
spine.
Intheworstcasesthehipsorshouldersarealsoaffected.Hipjoint
isthemostcommonlyaffectedperipheraljoint.
Rarelyknee(Ebenzar4th/e593)andankle(Apley's9thle67)are
alsoinvolved.Pathology

---

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

---

1751.Whichofthefollowingisnotafeature
ofrheumatoidarthritis?
a)Heberdennodes
b)Swanneckdeformity
c)Ulnardeviationoffingersatmetacarpopalyngealjoint
d)Symmetricreductionofjointspace
CorrectAnswer-A
Ans.is'a'i.e.,Heberdennodes
Heberdennodesisafeatureofosteoarthritisandnotrheumatoid
arthritis.
ImportanthanddeformitiesofhandinRA
Boutonnieredeformity:FlexioncontractureofPIPjointand
extensionofDIPjoint.
Swanneckdeformity:HyperextensionofPIPjointandflexionatDIP
joint.
Z-deformity:Radialdeviationofwristwithulnardeviationof
fingers.
Hyperextensionof1stinterphalangealjointandflexionofMPjoint.

---

1752.Swanneckdeformityisseenin:
March2013(a,c,e)
a)Ankylosingspondylitis
b)Rheumatoidarthritis
c)Osteoarthritis
d)Reiter'ssyndrome
CorrectAnswer-B
Ans.Bi.e.Rheumatoidarthritis
Rheumatoidarthritis
RAisadiseaseof:Synovium/synovialmembrane
RAstartsin:Synovium
BodytissuemostlyaffectedinRA:Synovium
Characteristicfeature:
-Persistentinflammatorysynovitis,
-Peripheraljoint,
-Symmetricaldistribution
Causes:
-Immunological,
-Familial,
?Infective(implicated)
Mostlyaffects:Females(threetimes)
Earliestlesioninrheumatoidsynovitis:
?Microvascularinjury,
?Increaseinnumberofsynovialliningcells
JointscharacteristicallyinvolvedinRA:
?MCP,
?PIP(symmetricarthritis)
Boutonnieredeformity:

---

?FlexioncontractureofthePIP
?ExtensionofDIP
Criteriafordiagnosis:Any4criteriamustbepresent
Pathognomicfeature:Rheumatoidnodule
Extra-articularmanifestationsareseenin:Individualswithhightitres
ofRF(autoantibodiestotheFccomponentofIgG)

---

1753.CASPARcriteriaisusedindiagnosisof
?
a)Psoriaticarthritis
b)Rheumatoidarthritis
c)Ankyosingspondylitis
d)Reactivesynnovitis
CorrectAnswer-A
Ans.is'a'i.e.,Psoriaticarthritis
Classificationcriteriaforpsoriaticarthritis(CASPAR)isusedforthe
diagnosisofpsoriaticarthropathy.
TheCASPAR(classificationCriteriaforPsoriaticArthritis)Criteria
TomeettheCASPARcriteriaapatientmusthaveinflammatory
articulardisease(joint,spine,orentheseal)with3pointsfromanyof
thefollowingfivecategories:
1. Evidenceofcurrentpsoriasis,apersonalhistoryofpsoriasis,orfa
familyhistoryofpsoriasis.
2. Typicalpsoriaticnaildystrophyobservedoncurrentphysical
examination.
3. Anegativetestresultforrheumatoidfactor.
4. Eithercurrentdactylitisorahistoryofdactylitisrecordedbya
rheumatologist.
5. Radiographicevidenceofjuxtaarticularnewboneformationinthe
handorfoot.

---

1754.Mostcommonjointinvolvedingoutis?
a)Knee
b)Hip
c)MPjointofgreattoe
d)MPjointofthumb
CorrectAnswer-C
Ans.is'c'i.e.,MPjointofgreattoe
Goutisthecommonendpointofagroupofdisordersthatproduce
hyperuricemia.
Itismarkedbytransientattacksofacutearthritisintitiatedby
crystallizationofmonosodiumurateintothejoints,leading
eventuallytochronicgoutyarthritisanddepositionofmassesof
uratesinjointsandothersites,creatingtophi.
Mostcommonjointinvolvedingoutisbigtoe,i.e.
metatarsophalangealjointofgreattoe.
Tophiarepathognomicofgout.Theyareformedbylarge
aggregationsofuratecrystals.Theuratecrystalsaresurrounded
by-

---

1755.Whichjointismostcommonlyaffected
inpseudogout-
a)Knee
b)Hip
c)MPjointgreattoe
d)MPjointthumb
CorrectAnswer-A
Ans.is'a'i.e.,Knee
Pseudogout
Itisoneoftheformsof"Calciumpyrophosphatedihydrate"(CPPD)
arthropathy.
Pseudogoutcommonlyinvolvesthelargerjoints.Kneejointismost
commonlyinvolved;othersitesarewrist,elbow,shoulder,ankle.
Involvementofsmalljointsisuncommon.
Agegroupis>60yrs.
InCPPDarthropathy,CPPDdepositionoccursinarticulartissues.It
canpresentinanyofthefollowingthreeforms:?
1)Asympatomaticchondrocalcinosis
2)Acutesynovitis-Pseudogout
3)Chronicpyrophosphatearthropathy
TheradiologichallmarkofCPPDis"chondrocalcinosis.
Chondrocalcinosisisseenaspunctateand/orlinearradiodense
depositsinfibrocartilaginousjointmenisciorarticularhyaline
cartilage.
Definitivediagnosisismadebysynovialfluidpolarisedlight
microscopywhichshowsweaklypositive,birefringent,rhomboid
crystalsofCPPD.[Ingoutpolarizedlightshows-stronglynegative
birefringent,needleshapedcrystalsofmonosodiumurate]

---

---

1756.Needleshapedcrystalsnegatively
birefringentonpolarizedmicroscopyis
characteristicofwhichcrystal
associatedarthropathy?
a)Gout
b)CPPD
c)Neuropathicarthropathy
d)Hemophilicarthropathy
CorrectAnswer-A
Ans.is'a'i.e.,Gout
CrystalofPseudogout
Madeupofcalciumpyrophosphate
Weaklypositivebirefringent,rhomboid
Crystalofgout:-
Madeupofuricacid(monosodiumurate)
Stronglynegativebirefringent,needleshaped

---

1757.Loosebodyinjointmostcommonsite
is-
a)Knee
b)Hip
c)Elbow
d)Ankle
CorrectAnswer-A
Ans.is'a'i.e.,Knee
Loosebodyinjoint
Aloosebodyisafree-floatingpieceofbone,cartilageorforeign
objectinajoint.
Thekneeisthemostcommonjointwhereonewouldfindaloose
body.
Causesofloosebodiesinclude:-
i)Osteoarthritis
ii)Osteochondritisdessicans
iii)Osteochondralfracture(injury)
iv)Charcot'sdisease
v)Synovialchondromatosis

---

1758.Charcot'sjointindiabetesaffects
commonly-
a)Shoulderjoint
b)Kneejoint
c)Hipjoint
d)Tarsaljoint
CorrectAnswer-D
Answer-D.Tarsaljoint
TabesdorsalisKnees,hip&ankles
Loosebodyinjoint
Aloosebodyisafree-floatingpieceofbone,cartilageorforeign
objectinajoint.
Thekneeisthemostcommonjointwhereonewouldfindaloose
body.
Causesofloosebodiesinclude:-
i)Osteoarthritisiii)Osteochondral
fracture(injury)v)Synovialchondromatosis
ii)Osteochondritisdessicansiv)Charcot'sdisease

---

1759.Mostcommonsiteofmetastasisin
skeleton?
a)Femur
b)Tibia
c)Vertebrae
d)Skull
CorrectAnswer-C
Ans.is'c'i.e.,Vertebrae
Metastasis
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.In
children,skeletalmetastasesoriginatefromneuroblastoma,Ewing's
sarcoma,andosteosarcoma.

---

---

1760.Calcificationinosteosarcomaisdueto
presenceof
a)Osteoidmatrix
b)Osteoblasts
c)Highcalciumlevelsinserum
d)Highcalcitonin
CorrectAnswer-A
Answer-A.Osteoidmatrix
Thepatternofmineralization(calcification)onradiographmaybe
helpfulinidentifyingtumormatrix.
Dense,homogenousmineralization(calcification)istypicalof
osteoidmatrix,formedbybenignandmalignantbone-forming
lesions
Calcifiedringsandarcs,densepunctatecalcification,andflocculent
calcification(small,looselyaggregatedmasses)arepatternof
mineralizationofchondroidmatrix,formedbybenignandmalignant
cartilageformingtumors.

---

1761.SunrayappearanceonX-rayisseenin
?
a)Osteosarcoma
b)Osteochondroma
c)Osteoclastoma
d)Chondroblastoma
CorrectAnswer-A
Ans.is'a'i.e.,Osteosarcoma
Codman'striangleandsunrayappearancearetypicalof
osteosarcoma.
However,youshouldkeepinyourmindfollowingveryimportant
facts:-
Sunray(sunburst)appearanceandcodman'striangleindicates
periostealreaction(periostealnewboneformation).
Boththesearetypicalofosteosarcomabutmayalsooccurinother
rapidlygrowingbonetumors(Ewing'ssarcoma),andinfection
(osteomyelitis).
Similarly,onionpeelappearanceindicatesperiostealnewbone-
formationandistypicalforEwing'ssarcoma.Butthiscanalsooccur
inoseosarcomaandosteomyelitis.
Thecruxisthat,aggresivelygrowingtumorsandinfectionstimulate
theperiosteumwhichthenreactbyformingnewbone,(thereforeitis
calledperiostealreaction)whichmaytakeanyoftheaboveform.

---

1762.Inosteogenicsarcomapredominant
histologicalfindingis?
a)Giantcells
b)Osteoidformingtumorcells
c)Fibroblasticproliferation
d)Chondroblasts
CorrectAnswer-B
Ans.is'b'i.e.,Osteoidformingtumorcells
Histologicappearanceofosteosarcoma
Itappearspaleandextendingthroughthecortexongrosscut
sectionexamination.
Onhistologicalsectionsitconsistsofmalignantstromaltissue
showingosteoidformation.
OsteoidboneformationbytumorcellsisdiagnosticofOGS.

---

1763.DevelopmentofChondrosarcomasis
relatedwith?
a)Maffuccisyndrome
b)Feltysyndrome
c)aandbboth
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Maffuccisyndrome
Chondrosarcomasdevelopinginpatientswithollier'sandmaffucci
syndromeiscalledsecondarychondrosarcoma.
Secondarychondrosarcoma
Itisthechondrosarcomaarisinginbenignprecursoreither
osteochondromaandenchondroma.
Therearenoreliablefiguresabouttheriskofdevelopingsecondary
chondrosarcomainbenignprecursors.
Theriskofchondrosarcomainsolitaryosteochondromais2%and
thatforosteochondromatosisis5-25%.
Patientswithollier'sdiseaseandmaffuccisyndromehavea25-
30%riskofdevelopingchondrosarcoma.

---

1764.Osteoidosteomaconsistsof-
a)Osteoblasts
b)Osteoclasts
c)Bothofabove
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Bothofabove
OsteoidOsteoma
Osteoidosteomaisthemostcommontruebenigntumorofthe
bone.Thisisabenigncircumscribedlesionthatmayariseinthe
cortexoflongbonesoroccasionallyinthecancellousboneofspine.
Thecharacteristicfeatureistheformationofasmallnidusofosteoid
tissue,surroundedbyareactivezoneofdensesclerosis(Sclerotic
newboneformation).
Microscopically,thetumoriscomposedofthin,irregular,trabeculae
withinacellulargranulationtissuecontainingosteoblastsand
osteoclasts.Trabeculaearemorematureinthecenter,whichisoften
partiallycalcified.Reactive,scleroticbonesurroundsthenidus.
Clinicalfeaturesofosteoidosteoma
Thetumoroccursbetween10-30yearsofageandismorecommon
inmales.
Thediaphysisoflongbonesisinvolved,mostcommonbone
involvedisthetibiafollowedbyfemur.Posteriorelementsofthe
vertebraemayalsobeinvolved.
Thepresentingcomplaintisanaggingpain,worstatnight,andis
relievedbysalicylatesorotherNSAIDs,adiagnosticfeature.
OnX-ray,thereisasmallradiolucentarea(nidus)surroundedby
denssclerosis.

---

X-ray,insomecases,showlocalscleroticthickeningoftheshaft
thatmayobscurethesmallcentralniduswithintheareaof
rarefaction.
Bonescanshowsincreaseduptakeinthenidus.
Theonlytreatmentiswideenblockexcisionalongwithinternal
fixationwithorwithoutbonegrafting.

---

1765.Whichisthecommonesttruebenign
bonetumor?
a)Osteoidosteoma
b)Hemangioma
c)Osteochondroma
d)Enchondroma
CorrectAnswer-A
Ans.is'a'i.e.,Osteoidosteoma
Osteoidosteomaisthemostcommontruebenigntumorofthe
bone.Thisisabenigncircumscribedlesionthatmayarisein
thecortexoflongbonesoroccasionallyinthecancellousboneof
spine.Thecharacteristicfeatureistheformationofasmall
nidusofosteoidtissue,surroundedbyareactivezoneofdense
sclerosis(Scleroticnewboneformation).

---

1766.Deformityofhipinstageoftubercular
synovitisstageis?
a)Flexion,abductionexternalrotation
b)Flexion,adductioninternalrotation
c)Flexionadductionexternalrotation
d)Flexionabductioninternalrotation
CorrectAnswer-A
Ans.is'a'i.e.,Flexion,abductionexternalrotation
Synovitis-Flexionabductionexternalrotationapparentlengthening

---

1767.Perkin'slineonX-rayisusedfor
diagnosisof-
a)Perthe'sdisease
b)CDH
c)CTEV
d)AVNHip
CorrectAnswer-B
Ans.is'b'i.e.,CDH
RadiologicalfeaturesofDDH/CDH
InVonRosen'sviewfollowingparametersshouldbenoted
Perkin'sline:Verticallinedrawnattheouterborderofacetabulum
Hilgenreiner'sline:Horizontallinedrawnattheleveloftri-radiate
cartilage
Shenton'sline:Smoothcurveformedbyinferiorborderofneckof
femurwithsuperiormarginofobturatorforamen.
Acetabularindex:NormallyisS30?
CEangleofWiberg:Normalvalueis15-30"
Normallytheheadliesinthelowerandinnerquadrantformedby
twolines(Perkin's&Hilgenreiner's).InDDHtheheadliesinouter&
upperquadrant
Shenton"slineisbroken
Delayedappearance&retardeddevelopmentofossificationofhead
offemur
Slopingacetabulum
Superior&lateraldisplacementoffemoralhead
Von-Rosen'sline
Thisisaline,whichhelpsinthediagnosisofDDHininfantsless
than6months.

---

ForthisAPviewofpelvisistakenwithbothlowerlimbin450
abductionandfullinternalrotation.
Upwardprolongationoflongaxisofshaftofthefemurpoints
towardsthelateralmarginoftheacetabulumandcrossesthepelvis
intheregionofsacroiliacjoint.
InCDH,upwardprolongationofthislinepointstowardsanterior
superioriliacspineandcrossesthemidlineinthelowerlumber
regionPositiveVon-Rosen'ssign.

---

1768.Ortolanitestispositivewhenthe
examinerhearsthe?
a)Clunkofentryonabductionandflexionofhip
b)Clunkofentryonextensionandadductionofhip
c)Clickofexitonabductionandflexionofhip
d)Clickofexitonextensionandadductionofhip
CorrectAnswer-A
Ans.is'a'i.e.,Clunkofentryonabductionandflexionofhip
ClinicaltestsforCDH/DDH
Ininfancytwotestsareused.
Barlow'stest
Thistestisdonewithin2-3daysofbirth.
Thetesthastwoparts:?
1. Part1:-Infantisinsupinepositionwithhipandkneein90?of
flexion,Thehipisslowlyadducted&pushedtodislocatethehipand
onecanhearaclunckofexitoffemoralheadoutoftheacetabulum.
2. Part2:-Nowthehipisgentelyabductedandpulledtoreducethe
hip.Thiswillcause'clunk'indicatingreductionofhip.
Itisquiteobviousthatpart1canbedoneonlydislocatablehip;but
notinalreadydislocatedhipastheheadisalreadyoutofthe
acetabulum.
Ortolani'stest
Thistestissimilarto2ndpartofBarlow'stest,i.e.slowabductionof
hipinflexedpositionofhip&kneetoreducethehip.

---

1769.ThetypicaldeformityinCTEVis?
a)Ankleequinus
b)Subtalarinversion
c)Forefootadduction
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove
CTEVisthecommonestandmostimportantcongenitaldeformityof
thefoot.
CTEVismorecommonmalesinthaninfemales(malestofemale
ratio2.5:1).
InhalfofthecasesCTEVisbilateral.
Rightandleftfootareaffectedequally.
Thedeformityconsistsoffollowingelements:?
i)Equinus,i.e.Plantarflexionatanklejoint(tibiotalarjoint).
ii)Inversionoffootatsubtalarjoint(talocalcanealjoint).
iii)Forefootadduction,atmid-tarsaljoints,especiallyattalo-
navicularjoint.
iv)Sometimesforefootcavus,i.e.excessivearchingofthefootat
mid-tarsaljoints.

---

1770.Cozen'stestisusedforthediagnosisof
?
a)Tenniselbow
b)Golfer'selbow
c)Baseballer'spitcherelbow
d)Carpaltunnelsyndrome
CorrectAnswer-A
Ans.is'a'i.e.,Tenniselbow
SignsandTests
Adson'stest:forthoracicoutletsyndrome
Allen'stest:fortestingpatencyofradialandulnararteries
Alli'stest:forCDH
Anviltest:fortestingtendernessofthespine
Apethumb:formediannerveinjury
Apley'sgrindingtest:formeniscusinjury
Apprehensiontest:forrecurrentdislocationoftheshoulder
Barlow'stest:forCDH
Bluesclera:Osteogenesisimperfecta
Bryant'stest:foranteriordislocationoftheshoulder
Callways'test:foranteriordislocationoftheshoulder
Chovstek'ssign:fortetany
Clawhand:forulnarnerveinjury
Cointest:fordorsolumbartuberculosisofspine
Cozen'stest:fortenniselbow
Drawertest:forACLandPCLinjutries
Anterior:forACLinjury
Posterior:forACLinjury
Finkelstein'stest:fordeQuervain'stenovaginitis

---

Footdrop:forcommonperonealnerveinjury
Froment'ssign:forulnarnerveinjury
Gaenslen'stest:forSIjointinvolvement
Galleazzisign:forCDH
Gower'ssign:formusulardystrophy
Hamiltonrulertest:foranteriordislocationoftheshoulder
Kanavel'ssign:forinfectioninulnarbursa
Lasegue'stest:fordiscprolapse
Lachmanntest:forACLinjury
Ludloffssign:foravulsionoflessertrochanter
McMurray'stest:formeniscusinjury
Nagffzigertest:fordiscprolapse
Ober'stest:fortightilio-tibialband(e.g.,inpolio)
O'Donoghuetriad:traidofMCL,ACL&medialmeniscusinjuries
occurringtogether
Ortolani'stest:forCDH
Pivotshifttest:forACLinjury
Policemantip:forErb'spalsy
Runner'sknee:Patellartendinitis
Sulcussign:forinferiordislocationoftheshoulder
Thomas'test:forhipflexiondeformity
Trendelenburg'stest:forunstablehipduetoanyreaseon(e.g.,
CDH)
Tinel'ssign:fordetectingimprovingnerveinjury
Volkmann'ssign:forischaemiccontractureofforearmmuscles
Wristdrop:forradialnerveinjury

---

1771.Infectionofulnarbursaisdiagnosedby
-
a)Kanavel'ssign
b)Chowstek'ssign
c)Gower'ssign
d)Ludloff'ssign
CorrectAnswer-A
Ans.is'a'i.e.,Kanavel'ssign
Kanavel'ssignisforinfectionofulnarbursa.

---

1772.De-quervian'stenovaginitisinvolves?
a)Abductorpollicislongus
b)Extensorpollicisbrevis
c)Bothoftheabove
d)Noneoftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Bothoftheabove
De-Quervian'stenovaginitisischaracterizedbypainoverthestyloid
processoftheradiusandpalpablethickeninginthecourseofthe
abductorpollicislongusandextensorpollicisbrevistendons.
Thefibroussheathsoftheabductorpollicislongusandextensor
pollicisbrevistendonsarethickenedwheretheycrossthetipofthe
radialsyloidprocess.
Thetendonsthemselvesappearnormalasdoesthesynoviallining
ofsheath.
Exactcauseisunknow.Excessivefrictionfromoverusemaybea
factor,becausetheconditionseemspronetofollowrepetitive
actionssuchaswringingclothes,orinmorerecenttimesexcessive
typingormanipulations.
Theconditionisfivetimescommonerinwomenthanmen,
predominantlyinmiddleage.
Themainsymptomispainonusingthehand,especiallywhen
movementtensestheabductorpollicislongusandextensorspollicis
brevistendons(asinliftingasaucepanorateapot).
Onexamination,thereislocaltendernessatthepointwherethe
tendonscrosstheradialstyloidprocess.
Thethickenedfibroussheathareusuallypalpableasfirmnodule.
Passiveadductionofthewristorthumbcausesthepatienttowince

---

withpain.
Finkelstein'stestisusedtodiagnoseDe-Quervain'stenovaginitis.
Toperformthetest,thepatientsasktoflextheirthumbandclench
theirfistoverthethumbfollowedbyulnardeviation.Thisproduces
sharppainalongthedistalradius.

---

1773.CausesofCarpaltunnelsyndromeare
allexcept?
a)DM
b)RA
c)Leprosy
d)Gout
CorrectAnswer-C
Ans.is'c'i.e.,Leprosy
Carpaltunnelsyndrome
Carpaltunnelsyndromeisthemostcommonandwidelyknown
entrapmentneuropathyinwhichthebody'speripheralnerveis
compressedortraumatized.Carpaltunnelsyndromeoccurswhen
themediannerveiscompressedinthecarpaltunnelbelowflexor
retinaculum.Thecarpaltunnelisanarrowrigidpassagewayof
ligamentandbonesatthebaseofhand,infrontofdistalpartof
wrist.Carpaltunnelhousesthemediannerveand9tendons(4FDS,
4FDP&FPL).
Causesofcarpaltunnelsyndrome
Therearemanycausesofcarpaltunnelsyndrome:
1)Idiopathic:-Thisisthemostcommoncause.
2)Pregnancyandmenopause
3)Metabolic:-Gout,Diabetesmellitus
4)Endocrine:-Hypothyroidism,Myxedema,Acromegaly,
Hyperparathyroidism.
5)DepositiondisorderAmyloidosis,Sarcoidosis,Rheumatid
arthritis,Leukemia,CRF,Mucopolysaccharoidosis.
6)Alcoholism
7)Localcauses:-Malunitedcolle'sfracture,osteo-arthritisofthe

---

carpalbones,synovititsofflexortendonsheath,hematoma.
Clinicalfeaturesofcarpaltunnelsyndrome
Carpaltunnelsyndromeismorecommoninwomenandoccurs
between35-50years.
Symptomsusuallystartgradually,withfrequentburning,tingling,
paresthesiaandnumbnessinthedistributionofmediannerve,i.e.,
lateralthree&halfoffingersandlateral2/3rdofpalm.
Thesymptomsoftenfirstappearduringnight,sincemanypeople
sleepwithflexedwrists.(Flexiondecreasesthespaceincarpal
tunnelwhichresultsinincreasedpressureovermediannerve).
Sensorysymptomscanoftenbereproducedbypercussingover
mediannerve(Tinel'ssign)orbyholdingthewristfullyflexedfora
minute(Phalen'stest).
Asthediseaseprogresses,clumsinessofhandandimpairmentof
digitalfunctiondevelop.
Laterinthedisease,thereissensorylossinmediannerve
distributionandobviouswastingofthenareminence.ClinicalTests
forCarpaltunnelsyndrome
Therearesomeprovocativetestswhichactasimportantscreening
methods:?
1)Wristflexion(Phalen'stest):-Thepatientisaskedtoactively
placethewristincompleteflexion.Iftinglingandnumbnessdevelop
inthedistributionofmediannerve,thetestispositive.Thisisthe
mostsensitiveprovocativetest.
2)Tourniquettest:-ApneumaticBPcuffisappliedproximaltothe
elbowandinflatedhigherthanthepatient'ssystolicBP.Thetestis
positiveifthereisparesthesiaornumbnessintheregionofmedian
nervedistributioninhand.
3)Mediannervepercussiontest(Tinel'ssign):-Themediannerve
isgentlytappedatthewrist.Thetestispositiveifthereistingling
sensation.
4)Mediannervecompressiontest:-Directpressureisexerted
equallyoverbothwristsbytheexaminer.Ifsymptomsofcarpal
tunnelsyndromeappear,thetestispositive.

---

1774.Indexfingerinfectionspreadsto?
a)Thenarspace
b)Midpalmarspace
c)Hypothenarspace
d)Flexionspace
CorrectAnswer-A
Ans.is'a'i.e.,Thenarspace
Thenarspacecommunicateswiththeindexfingerwhilethemid
palmarspacecommunicateswiththemiddle,ringandlittlefingers.
Thusinfectionofindexfingerleadstothenarspaceinfectionwhile
theinfectionofmiddle,ringorlittlefingerleadstomidpalmarspace
infection.

---

1775.Causesofpainfularcsyndromeis/are
?
a)Supraspinatustendinitis
b)Subacromialbursitis
c)Fractureofgreatertuberosity
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove
PainfulArcsyndrome
Thisisaclinicalsyndromeinwhichthereispainintheshoulderand
upperarmduringthemidrangeofglenohumeralabduction.
Followingarethecommoncauses:
i. Minortearsofthesupraspinatustendon
ii. Supraspinatustendinitis
iii. Calcificationofsupraspinatustendon
iv. Subacromialbursitis
v. Fractureofthegreatertuberosity
Inalltheseconditions,thespacebetweentheupper-endofthe
humerusandtheacrominongetscompromised,sothatduringmid-
abductionthetendonoftherotator-cuffgetsnippedbetweenthe
greatertuberosityandacrominon.
X-rayoftheshouldermayshowcalcificdeposit,orafractureofthe
greatertuberosityoracromion.oTreatmentconsistsofultrasonics
tothetenderpointandanti-inflammatorydrugs.
Somecasesneedaninjectionofhydrocortisoneinthesubacromial
spaceorexcisionoftheanterior,oftenprominentpartofthe
acromion.

---

1776.Ringshapedepiphysesisseenin?
a)Osteogenesisimperfecta
b)Morquiossyndrome
c)Zellwegersyndrome
d)Multipleepiphysealdysplasia
CorrectAnswer-A
Ans.is'a'i.e.,Osteogenesisimperfecta
Ringshapedepiphysis
i)Hypothyroidism(healingphase)iv)
Osteoporosis
ii)Osteogenesisimperfectav)Rickets
(healingphase)
iii)Osteopetrosisvi)Scurvy

---

1777.Fatembolismsyndromeismost
commonlyseenafter?
a)Femurfracture
b)Acetabularfracture
c)Pelvisfracture
d)Calcanealfracture
CorrectAnswer-A
Ans.is'a'i.e.,Femurfracture
Fatembolismmeanscirculationoffatglobuleawayfromitssiteof
origin.
Whenfatembolismcausessymptomsitiscalledfatembolism
syndrome.
Causesoffatembolism
1. Fractureoflongbone(mostcommon)-Blunttrauma
2. RecentCorticosteroidadministration
3. Softtissuetrauma
4. Acutepancreatitis
5. Burns
6. D.M.
7. Parenterallipidinfusion
8. Liposuction
9. Sicklecellcrisis
10. Decompressionsickness

---

1778.Mostcommoncauseofacute
compartmentsyndromeinchildrenis?
a)Fracturesupracondylarhumerus
b)Transphysealhumerusfracture
c)Fractureradius/ulna
d)Fractureshafthumerus
CorrectAnswer-A
Ans.is'a'i.e.,Fracturesupracondylarhumerus
Compartmentsyndromeismostcommonlycausedby
extremityfractures:-
i. Supracondylarfractureofhumerusisthemostcommoncauseis
children.
ii. Crushinjuriestoforearmarethemostcommoncauseinadults.
iii. Otherinjuriesarefracturebothbonesforearm,elbowdislocation.

---

1779.Zscoremeasuresthebonemineral
densitycompredto?
a)Age,Raceandsexmatchedindividuals
b)Raceandsexmatchedindividuals
c)Sexmatchedindividuals
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Age,Raceandsexmatchedindividuals
TScoreandZscorearethemeasuresofbonemineraldensity.
Zscore:Measuresthebonemineraldensityintermsstandard
deviationfromthemeanbonemineraldensityofage,raceandsex
matchedindividuals.
Tscore:Measuresthebonemineraldensityintermsstandard
deviationfromthemeanbonemineraldensityofraceandsex
matchedindividualsofnormalyoungeragegroup.

---

1780.Sectoralsignispositivein?
a)Avascularnecrosisoffemurhead
b)Osteoarthritisofhip
c)Protrusioacetabuli
d)Slippedcapitalfemoralepiphyses
CorrectAnswer-A
Ans.is'a'i.e.,Avascularnecrosisoffemurhead
ClinicalfeaturesofAVN
IntheearlierstagesofAVN,thepatientisasymptomatic,andbythe
timepatientpresents,thelesioniswelladvanced.
Commonhistoriespatientgives(Anyofthefollowing):-
i)DislocationofHip
ii)Alcoholism
iii)Steroidintakeforanydisorder
iv)Nephroticsyndrome
Painisacommoncomplaint.Painisfeltinthegrainandmayradiate
toknee.
Decreasedrangeofmotionespeciallyinternalrotationfollowedby
abduction.
SectoralsignorDifferentialrotation:-Internalrotationispossiblein
extendedpositionofhip,butasseenasthehipisflexedto90?no
internalrotationispossible.ThisisthecharacteristicsignofAVN.o
Limpwithantalgicgait.
Trendelenberg'stestpositive.

---

1781.Keinbock'sdiseaseisosteochondritis
of?
a)Scaphoid
b)Lunate
c)Calcaneum
d)Tibialtuberosity
CorrectAnswer-B
Ans.is'b'i.e.,Lunate
Perthes'sdisease-Femoralhead
Panner'sdisease-Capitulum
Kienbock'sdisease-Lunatebone
OsgoodShlatter'sdisease-Tibialtubercle
Sever'sdisease-Calcanealtuberosity
Kohler'sdisease-Navicularbone

---

1782.Osteoporosisischaracterizedbyallthe
followingexcept?
a)Decreasedbonemineraldensity
b)DecreasedSerumCalcium,phosphorusandalkaline
phosphataseisseen
c)Glucocorticoidscancauseosteoposis
d)Dorsolumbarspineisthemostcoomonsiteofosteoporotic
fracture
CorrectAnswer-B
Ans.is'b'i.e.,DecreasedSerumCalcium,phosphorusandalkaline
phosphataseisseen
Osteoporosisisastateofdecreasedmassperunitvolumeofa
normallymineralizedbone.Osteoporosisisthecommonest
metabolicbonedisease.Osteoporosisischaracterizedbyan
abnormallylowbonemass(lowbonedensity)anddefectsinbone
structure,acombinationofwhichrenderstheboneunusuallyfragile
andatgreaterthannormalriskoffracture.Bonedepletionmaybe
broughtaboutbypredominantboneresorption,decreasedbone
formationoracombinationofthetwo.

---

1783.Polyspermyisinhibitedbywhichion?
a)Ca
b)Na
c)K
d)Cl
CorrectAnswer-A
Ans,A.Ca
Thecalciumwaveamplifiesthelocalsignalatthesiteofsperm-
oocyteinteractionanddistributesitthroughouttheoocytecytoplasm.
Theincreaseincalciumconcentrationisthesignalthatcausesthe
oocytetoresumecelldivision,initiatingthecompletionofmeiosisII
andsettingofthedevelopmentalprogrammethatleadsto
embryogenesis.

---

1784.Whichofthefollowingispresentin
normalvagina?
a)Trichomonasbuccalis
b)Trichomonashominis
c)Trichomonasvaginalis
d)Trichomonasbovis
CorrectAnswer-C
Ans.C.Trichomonasvaginalis

---

1785.Maximumamnioticfluidat?
a)32weeks
b)34weeks
c)36weeks
d)40weeks
CorrectAnswer-C
Ans,C.36weeks

---

1786.At20weeksofgestationamnioticfluid
volumeis?
a)200ml
b)400ml
c)600ml
d)800ml
CorrectAnswer-B
Ans,B.400ml

---

1787.Fertilizedovumreachestheuterusat
whatdayofmenstrualcycle?
a)6th
b)14th
c)20th
d)25th
CorrectAnswer-C
Ans,C.20th
Implantationofthefertilizedovumoccursintheendometriumofthe
anteriororposteriorwallofthebodynearthefundusonthe&ilayof
fertilizationwhichcorrespondstothe20thdayoftheregular
menstrualcycle.

---

1788.

---

Fertilizationusuallyoccursinwhichpartof
fallopiantube?
a)Fimbrialend
b)Ampulla
c)Interstitium
d)Isthmus
CorrectAnswer-B
Ans.B.Ampulla
Fertilizationistheprocessoffusionofthespermatozoonwiththe
matureovum.
Itbeginswithspermeggcollisionandendswithproductionofa
mononucleatedsinglecellcalledthezygote.
Itsobjectivesare:
1. Toinitiatetheembryonicdevelopmentoftheeggand
2. Torestorethechromosomenumberofthespecies.
Almostalways,fertilizationoccursintheampullarypartoftheuterine
tube.

---

1789.Physiologicchangeinleukocyte
numbersinpregnancyis
a)Neutrophilicleukocytosis
b)Lymphocyticleukocytosis
c)Neutropenia
d)Basophilicleukocytosis
CorrectAnswer-A
Ans.A.Neutrophilicleukocytosis
Physiologicalchangeobservedinleukocytenumbersinpregnancy
isneutrophilicleukocytosis.
Itoccurstothetuneof8000/mm3andmayupto20,000/mm3in
labour.
Theincreasemaybeduetotheriseinlevelsofestrogenand
cortisol.

---

1790.Weightofuterusattermis?
a)400-500gm
b)600-700gm
c)800-900gm
d)900-1000gm
CorrectAnswer-D
Ans.D.900-1000gm
Theuterusinthenon-pregnantstateweightisabout60gm,witha
cavityof5-70mlandmeasuresabout7.5cminlength.
Attermitweighsabout900-1000gmandmeasures35cmin
length.

---

1791.Duringpregnancyestrogencauses
whichofthefollowing?
a)Growthofductsofbreasts
b)Growthofalveoliofbreasts
c)Bothaandb
d)Noneoftheabove
CorrectAnswer-C
Ans.C.Bothaandb
Theincreasedsizeofthebreastsisevidentintheearlyweeksof
pregnancy.
Theincreaseinsizeisduetohypertrophyandproliferationofthe
ductsandthealveoli.
Estrogenisresponsibleforthehypertrophyandproliferationofthe
ductsandalveoliwhileprogesteroneisonlyresponsibleforthe
hypertrophyandproliferationofthealveoli.

---

1792.Maternalsidelayeroftheplacentais
called?
a)Deciduabasalislayer
b)Deciduacapsularislayer
c)Deciduaparietalis
d)Deciduaspongiosa
CorrectAnswer-A
Ans.,A.Deciduabasalislayer
Deciduabasalis(Decidualplate)isthepartofendometriumrelated
toembryonicpoleofconceptusandformsthematernalpartof
placenta.

---

1793.Whichofthefollowingisnota
physiologicalchangeofpregnancyin
urinarybladder?
a)Edematousmucosa
b)Increasedfrequencyat14weeks
c)Stressincontinence
d)Pressureonbladderinlatepregnancy
CorrectAnswer-B
Ans.B.Increasedfrequencyat14weeks
Physiologicalchangesinbladderinpregnancy
Markedcongestionandhypertrophyofthemusclesandelastic
tissuesofthebladderwall.
Edematousbhddermucosainlatepregnancyespeciallyin
primigravida.
Increasedfrequencyofmicturitionat6-8weekswhichsubsidesby
12weeksandreappearsinlatepregnancyduetopressureofthe
graviduterusonbladder.
Stressurinaryincontinenceinlatepregnancy.

---

1794.Urinaryretentionearliestinpregnancy
isseenat?
a)10weeks
b)18weeks
c)22weeks
d)34weeks
CorrectAnswer-A
Ans,A.10weeks
Urinaryretentioninpregnancyisrare
Itisclassicallydescribedinsomewomenwithretroverteduterus,
whichbecomesimpactedinthepelvis,usuallyseenearliest
between8-12weeksofpregnancyandcausesoutflowobstruction.

---

1795.BetaHCGisdetectedearliestbywhich
dayofconception?
a)8days
b)15days
c)21days
d)30days
CorrectAnswer-A
Ans,A.8days
hCGisaglycoproteinproducedbythesyncytiotrophoblast.
hCG-cisidenticaltothecsubunitofLH,FSH,andTSH.
Itspresenceintheurineinearlypregnancyisthebasisofthe
variouslaboratorytestsforpregnancy,anditcansometimesbe
detectedintheurineasearlyas14dafterconceptionandinserum
asearlyas8-9days,

---

1796.DoublingtimeofbetaHCGinearly
pregnancyis?
a)24hrs
b)48hrs
c)72hrs
d)96hrs
CorrectAnswer-B
Ans,B.48hrs
BetahCGusuallydoubleaboutevery2days(48hours)duringfirst
fourweakofpregnancy.
Aspregnancyprogresses,doublingtimebecomeslonger.By6-7
weeksbetahCGlevelsmaytakeaslongas3.5daystodouble.

---

1797.Tubalpatencytestinwhichphaseof
themenstrualcycle?
a)Menstrual
b)Preovulatory
c)Leuteal
d)Premenstrual
CorrectAnswer-B
Ans,B.Preovulatory
Thetestingoftubalpatencyanddetectingtubalpathologyaredone
inpre-ovulatoryphaseofthemenstrualcycle.
Ifperformedinthepost-ovulatoryperiod,insufflationmightdisturb
animplantedorfertilizedovumandmayalsocausepelvic
endometriosis.

---

1798.Followingphysiologicalchangesare
seeninvaginainpregnancyexcept?
a)Jacquimierssign
b)Increasedlengthofanteriorvaginalwall
c)pHacidic
d)Decreasednumberofnavicularcells
CorrectAnswer-D
Ans,D.Decreasednumberofnavicularcells
Thevaginalwallsbecomehypertrophied,edematousandmore
vascular.
Increasedbloodsupplytovenousplexussurroundingthewallsgives
bluishcolorationofthemucosa(Jacquemier'ssign).
Thelengthoftheanteriorvaginalwallisincreased.
Thesecretionofvaginabecomescopious,thinandcurdywhite,due
tomarkedexfoliatedcellsandbacteria.
ThepHbecomesacidic(3.5-6)duetomoreconversionofglycogen
intolacticacidbylactobacillusacidophilusconsequentonhigh
estrogenlevel.
TheacidicpHpreventsmultiplicationofpathogenicorganisms.
Thereispredominanceofnavicularcellsinclusterandplentyof
lactobacilli.

---

1799.FHScanbeusuallyheardby
stethoscopeat?
a)14weeks
b)18weeks
c)22weeks
d)26weeks
CorrectAnswer-B
Ans,B.18weeks
Fetalheartsound(FHS)ismostconclusiveclinicalsignof
pregnancy.Withanordinarystethoscopeitcanbedetectedbetween
18-20weeksofPregnancY.

---

1800.Whatisthefetoplacentalrelationshipat
24weeksofgestation?
a)3
b)4
c)5
d)6
CorrectAnswer-A
Ans,A.3
Therelationshipbetweenthefetalandplacentalweightscanbe
studiedbythesocalledfetoplacentalrelationship(fetalweight/
placentalweightratio).
Thefetoplacentalrelationshipincreasesasthepregnancyadvances.

---

1801.Downsyndromeisearliestdiagnosedat
?
a)8-10weeks
b)10-12weeks
c)12-14weeks
d)14-16weeks
CorrectAnswer-B
Ans.B.10-12weeks
Earliestdiagnosisofgeneticdefectscanbedonebyuseofchorionic
villoussampling.
Chorionicvilloussamplingiscarriedouttranscervicallyat10-12
weeksandtransabdominallyfrom10weekstoterm.

---

1802.Chorionicvillusbiopsyisdoneearliest
inwhichweekofgestation?
a)9weeks
b)11weeks
c)13weeks
d)15weeks
CorrectAnswer-B
Ans,B.11weeks
Itiscarriedouttranscervicallybetween7O-12weeksand
transabdominallyfrom10weekstoterm.

---

1803.Whenisfolicacidstartedinpregnancy
?
a)4weekspriortoconception
b)8weekspriortoconception
c)4weeksafterconception
d)8weeksafterconception
CorrectAnswer-A
Ans.A.4weekspriortoconception
Folicacidsupplementation(4mg/day)isstated4weekspriorto
conceptionandcontinuedupto12weeksofpregnancy.
Thiscanreducetheincidenceofneuraltubedefects.

---

1804.TermplacentaweighttoBabyweight
ratiois?
a)1:3
b)1:4
c)1:5
d)1:6
CorrectAnswer-D
Ans,D.1:6
ThetermPlacenta
Placentaattermisacirculardiscwithadiameterof15-20cm.
Ithasthicknessof3cmatcenterandthinsoftowardstheedges.
Itfeelsspongyandweighsabout500gm.
Theratioofplacematweightattermandthebabyweightis1:6.
Itoccupiesabout30%oftheuterinewall.

---

1805.Firsttrimesterdiagnosisfor
anencephalyisbyincreased?
a)Alphafetoproteininmaternalserum
b)Alphafetoproteininamnioticfluid
c)BetaHCGinmaternalserum
d)BetaHCGinamnioticfluid
CorrectAnswer-B
Ans,B.Alphafetoproteininamnioticfluid
Inthefirsthalfofthepregnancythediagnosisofanencephalyis
madebyelevatedalphafetoproteininamnioticfluidandconfirmed
bysonography.

---

1806.Whichofthefollowingistrueabout
EDD?
a)Lessthan10%ofdeliveriesoccuronEDD
b)Lessthan20%ofdeliveriesoccuronEDD
c)80%ofthedeliveriesoccuronEDD
d)90%ofthedeliveriesoccuronEDD
CorrectAnswer-A
Ans,A.Lessthan10%ofdeliveriesoccuronEDD
Fewerthan5%ofallthepregnanciesendontheexpecteddateof
delitery(EDD).
13%ofthebirthsoccurpreterm.
5-7%ofthepregnanciesaredeliveredpostterm.
Majorityofthedeliveriesoccurwithin7daysofEDD.

---

1807.a)Mostcommonpositionof
engagementinvertexpresentation?
a)LOA
b)ROA
c)LOP
d)ROP
CorrectAnswer-A
Ans,A.LOA
Vertexoccupyingtheleftanteriorquadrantofthepelvisisthe
commonestandiscalledleftoccipito-anteriorposition.

---

1808.Whichistheengagingdiameterin
occipitoposteriornresentation?
a)Suboccipitofrontal
b)Mentovertical
c)Submentovertical
d)Bitrochanteric
CorrectAnswer-A
Ans,A.Suboccipitofrontal

---

1809.Whichisthemostcommon
presentationintwinpregnancy?
a)Vertex-vertex
b)Vertex-breech
c)Breech-Breech
d)Vertex-Footling
CorrectAnswer-A
Ans.A.Vertex-vertex

---

1810.DirectOccipitoposteriorpositionisa
favourablepositioninwhichtypeof
pelvis?
a)Anthropoid
b)Androidpelvis
c)Gynaecoid
d)Mongoloid
CorrectAnswer-A
Ans,A.Anthropoid
DirectOccipitoposteriorpositionisafavourablepositionin
anthropoidtypeofpelvis.

---

1811.PersistentOPpositionismostcommon
inwhichpelvis?
a)Android
b)Gynaecoid
c)Anthrpoid
d)Mixed
CorrectAnswer-A
Ans,A.Android
WithandroidtypeofpelvistheoccipitoPosteriorpositioniscommon
duetofunnelshapeofthepelvis.

---

1812.Contraindicationforinductionoflabour
isallexcept?
a)Hypertensivediseaseofpregnancy
b)Heartdiseaseofpregnancy
c)Pelvictumor
d)Vasaprevia
CorrectAnswer-A
Ans.A.Hypertensivediseaseofpregnancy
Hypertensivediseaseofpregnancyisanindicationforinductionof
labour.Otherthreearecontraindications.

---

1813.Medicalmanagementofectopic
pregnancyhasdecreasedsuccessif?
a)Gestationalsac<3cm
b)Durationofgestation<5weeks
c)Cardiacactivitypresent
d)BetaHCG<8000IU/L
CorrectAnswer-C
Ans.C.Cardiacactivitypresent
MedicalmanagementofanectoPicPregnancyisdonewhen:
Patientishemodynamicallystable
Noevidenceofacuteintraabdominalbleeding
Readytocomplywithfollowupcare
SerumbetaHCG<10,000IU/L
Absentembryonicheartactivity
Diameterofectopicgestationalmasslessthan4cm.

---

1814.AllaretheprognosticfactorsofBoer-
meiselsystemexcept-
a)Extentofadhesions
b)Thicknessoftubalwall
c)Sizeofhydrosalpinx
d)Infectingorganism
CorrectAnswer-D
Ans,D.Infectingorganism
Boer-meiselsystemofprognosticclassificationforchronic
pelvicinflammatorydiseaseincludes:
Extentofadhesions
Natureofadhesionsflimsyordense
Sizeofhydrosalpinx
Macroscopicconditionofhydrosalpinx
Thicknessoftubalwall

---

1815.Pregnantuteruswillcompressureters
at?
a)Pelvicbrim
b)Uterovesicaljunction
c)Trigone
d)Ureterovesicaljunction
CorrectAnswer-A
Ans,A.Pelvicbrim
Uretersbecomeatonicduetohighprogesteronelevelinpregnancy,
Dilatationoftheureterabovethepelvicbrimwithstasisismarked
ontherightsideespeciallyintheprimigravidae.
Itisduetodeoxtrorotationoftheuteruspressingtherightureter
againstthepelvicbrimandaboduetopressurebyrightovarian
vein,whichcrossestherightureteratrightangle.

---

1816.Followingisgiventoapatientwithpre
termlabourexept-
a)Glucocorticoids
b)Tocolyticdrugs
c)Antibiotics
d)Betablocker
CorrectAnswer-D
Ans.D.Betablocker
Tocolyticdrugs[Note:betamimeticandnotbetablockerisa
tocolytic]

---

1817.Mostcommoncauseoftenthdaypost
partumbleeding?
a)Retainedbitsofmembrane
b)Infection
c)Endometritis
d)Bloodcoagulopathy
CorrectAnswer-A
Ans.A.Retainedbitsofmembrane
Postpartumhemorrhage(PPH)isdefinedasbloodlossofmorethan
500mlfollowingbirthofbaby.

---

1818.Amultgravida4kgfetusisinlabour
since15hoursandhas5cmdilationof
cervixforlast8hours.Whatisthe
furthermanagementofthispatient?
a)Waitandwatch
b)Amniotomy
c)InjectionOxytocin
d)Caesariansection
CorrectAnswer-D
Ans.D.Caesariansection

---

1819.Thetreatmentofchoiceforbartholin
cystis?
a)Marsupilisation
b)Aspiration
c)Observe
d)Curettageandclosure
CorrectAnswer-A
Ans.A.Marsupilisation
Bartholin'scyst
Bartholin'scystisformedwhenductofbartholinsglandisblocked
eitherbyinflammationorbyinspissatedsecretion.
Itappearsasaswellingontheinnersideofthejunctionofthe
anteriortwo-thirdswiththeposteriorone-thirdofthelabiummajus.
Asmallcystremainsasymptomatic,butalargeronebulgesacross
thevaginalintroitusandcausesdyspareunia,discomfortandmay
getinfectedwhenitneedsexcisionormarsupialization

---

1820.Gartner'scystareseenat?
a)Anterolateralvaginalwall
b)Antero-lateralcervix
c)Posterolateralvaginalwall
d)Posterolateralcervix
CorrectAnswer-A
Ans,A,'.Anterolateralvaginalwall
Gartnersductcystarisesfromtheremnantsofthemesotephricduct
andliesintheanterolateralaspectofvaginalwall.

---

1821.Mostcommoncauseofdeathofbabyin
vasapreviais?
a)Infection
b)Maternalexanguination
c)Fetalexanguination
d)Bothbandc
CorrectAnswer-C
Ans,C.Fetalexanguination
Vasaprevia
Initaleashofbloodvesselshappentotraversethroughthe
membranesoverlyingtheinternalos,infrontofpresentingpart.
Ruptureofmembranesinvolvingtheoverlyingvesselsleadsto
vaginalbleeding.
Asitisentirelyfetalblood,thismayresultinfetalexanguinationand
evendeath.

---

1822.Sheehansyndromeis?
a)Pitutaryadenoma
b)Pitutarynecrosis
c)Adrenalnecrosis
d)Adrenaladenoma
CorrectAnswer-B
Ans.,B.Pitutarynecrosis
Sheehan'ssyndromeisanteriorpituitorynecrosisfollowingsevere
PPH,shockorsevereinfection.

---

1823.Mostcommoncauseofmenorrhagiain
adolescents?
a)Thyroiddisorder
b)Coagulationdisorders
c)Leiomyomas
d)Polyps
CorrectAnswer-B
Ans,B.Coagulationdisorders
Inadolescentagegroup,abnormaluterinebleedingresultsfrom
anovulationandcoagulationdefectsatdisproportionatelyhigher
ratescomparedwitholderreproductive-agedwomen
Coagulationdisordersaccountfor20%ofcasesofmenorrhagiain
adolescents.

---

1824.Notassociatedwithendometrial
hyperplasia?
a)PCOD
b)Glucoseintolerance
c)HRT
d)Unopposedexposuretoprogesterone
CorrectAnswer-D
Ans.D.Unopposedexposuretoprogesterone
Followingarethecausesofendometrialhyperplasia
Follicularcystsofovary
PCOD
Granulosaandthecacelltumorsofovary
HRT
Glucoseintolerance
Unopposedexposuretoestrogen(endogenousorexogenous)

---

1825. Followingarethecausesofmaternal
deathsinpatientswithhypertensive
disorderofpregnanacyexcept?
a)Cardiacfailure
b)ARDS
c)Chronicrenalfailure
d)Cerebralhemorrhage
CorrectAnswer-C
Ans.C.Chronicrenalfailure
Causesofmaternaldeathsincasesofhypertensivedisorders
ofpregnancyare
Cardiacfailure
Cerebralhemorrhage
ARDS
Puerperalsepsis
Pulmonaryedema
Acuterenalfailure
Pulmonaryembolism
Aspirationand/orsepticpneumonia
Cardio-pulmonaryarrest
Post-partumshock

---

1826.Classicalnameofmidcycleabdominal
painwithvaginalbleedingiscalled?
a)Endometriosis
b)Mittelschmez
c)Meteropathiahemorrhagica
d)Menometrorrhagia
CorrectAnswer-B
Ans.B.Mittelschmez
Mittelschmerzisamid-cyclepain,notlastingmorethan12-24
hours,aroundovulation.Painislocatedinoneoftheiliacfossaand
maybeaccompaniedwithvaginalbleeding.

---

1827.Followingistrueaboutleuteomaof
pregnancy?
a)Usuallybilateral
b)Itisabenignselflimitingcondition
c)Itconsistsofleutenizedcells
d)Alltheabove
CorrectAnswer-D
Ans.D.Alltheabove
LeuteomaofPregnancy
Itusuallyappearsasbilateral,multinodular,solidmassesinovaries.
Itischaracterizedbyreplacementofnormalovarianparenchymaby
solidproliferationofleutenizedstromalcellsunderinfluenceof
humanchorionicgonadotroPin.
Itisbenignself-limitingconditionandrequiresnotreatment.

---

1828.ClinicalalarmingsignofMgSO4toxicity
is?
a)Lossofkneejerk
b)Lossofsuperficialabdominalreflexes
c)Lossofpinpricksensation
d)Lossofproprioception
CorrectAnswer-A
Ans.A.Lossofkneejerk

---

1829.FalseaboutMgSo4is?
a)Notusedasantihypertensive
b)Itsdoseisdifferentforeclampsiaandpreeclampsia
c)Deeptendonreflexesismonitoredfortoxicity
d)Itactsasamembranestabilizerandneuroprotector
CorrectAnswer-B
Ans.B.Itsdoseisdifferentforeclampsiaandpreeclampsia
Doseofmagnesiumsulphateformanagementofpre-eclampsiaand
eclampsiaisthesame.

---

1830.18weekspregnancyofalady,lasttwo
timeshistoryofmidtrimesterabortion,
whichwaspainless.Whatisthe
diagnosis?
a)Incompetentos
b)Chromosomalabnormality
c)Bivalveuterus
d)Progesteronedeficiency
CorrectAnswer-A
Ans.A.Incompetentos
Mostcommoncauseofsecondtrimesterpregnancylossiscervical
incompetence,inwhichpatientpresentswithrecurrentpainless
abortion.

---

1831.Followingarethefeaturesoftruelabour
pain?
a)Uterinecontractionsatregularintervals
b)Progressiveeffacementanddilationofcervix
c)Formationofbagofmembranes
d)Alltheabove
CorrectAnswer-D
Ans.D.Alltheabove
FeaturesoftruelabourPains
Uterinecontractionsatregularintervals
Frequencyofcontractionsincreasegradually
Intensityanddurationofcontractionsincreaseprogressively
Associatedwithshow
Progressiveeffacementanddilationofcervix
Descentofthepresentingpart
Formationofbagofforewaters
Notrelievedbyenemaandsedatives

---

1832.HRTimproves?
a)Bonedensity
b)Demetia
c)Coronaryarterydisease
d)Endometrialcancer
CorrectAnswer-A
Ans,A.Bonedensity
Hormonereplacementtherapyimprovesbonedensity,

---

1833.Mostcommonriskfactorforruptureof
scarreduterusis
a)Useofoxytocininlabour
b)Grandmultiparity
c)Forcepsapplication
d)Obstructedlabour
CorrectAnswer-A
Ans,A.Useofoxytocininlabour
Themostcommoncauseofruptureofscarreduteruskuseofhigh
dosesofoxytocinfortheaugmuntationoflabour.

---

1834.Invalueabletoolinthediagnosisof
chronicpelvicpainis?
a)Endometrialbiopsy
b)Ultrasound
c)Laparoscopy
d)Colposcopy
CorrectAnswer-C
Ans,C.Laparoscopy
Laproscopyisaninvalueablediagnostictoolintheinvestigationof
chronicpelvicpain.

---

1835.Mostcommonsiteofectopicpregnancy
is?
a)Ovary
b)Fallopiantube
c)Peritoneum
d)Cervix
CorrectAnswer-B
Ans.B.Fallopiantube

---

1836.Leastcommonsiteofectopic
pregnancyinfallopiantubesis?
a)Interstitium
b)Ampulla
c)Infundibulum
d)Isthumus
CorrectAnswer-A
Ans,A.Interstitium
Mostcommonsiteforectopicpregnancyfallopiantubes,

---

1837.CriteriaforPuerperalpyrexiais
temperature?
a)100.4degreesFontwoseparateoccasions
b)101degreesFontwoseparateoccasions
c)100.4degreesFonthreeseparateoccasions
d)101degreesFonthreeseparateoccasions
CorrectAnswer-A
Ans,A.100.4degreesFontwoseparateoccasions
Puerperalpyrexia
Ariseoftemperaturereaching100.4degreesF(38degreesC)or
more(measuredorally)ontwoseparateoccasionsat24hoursapart
(excludingfirst24hours)withinfirst10daysfollowingdeliveryis
calledpuerperalpyrexia.

---

1838.Investigationofchoicefordiagnosisof
PIDis?
a)Laparoscopy
b)Colposcopy
c)Hysteroscopy
d)Ultrasonography
CorrectAnswer-A
Ans,A.Laparoscopy
Laparoscopyisconsideredtheinvestigationofchoiceforthe
diagnosisofpelvicinflammatorydisease.

---

1839.Whichdrugispreferredforthe
treatementof21hydroxylasedeficient
femalefetustopreventgenital
virilization?
a)Materalcortisol
b)Maternaldexamethasone
c)Maternalhydrocortisone
d)Maternalmethylprednisolone
CorrectAnswer-B
Ans,b.Maternaldexamethasone
FetusisatriskofCAHmaternaldexamethasonetherapycan
suppressthefetalHPAaxisandprevent
genitalvirilizationinaffectedfemalefetus.

---

1840.Speilbergcriteriaisusedfor?
a)Ovarianpregnancy
b)Ovarianmalignancy
c)Cervicalpregnancy
d)Cervicalmalignancy
CorrectAnswer-A
Ans,A.Ovarianpregnancy

---

1841.Mainfactorresponsibleforincreased
perinatalmortalityintwinpregnancyis
?
a)Prematurity
b)IUGR
c)Polyhydramnios
d)Uterinerupture
CorrectAnswer-A
Ans,A.Prematurity

---

1842.Cryptomenorrhoeaisafeatureof?
a)Vaginalatresia
b)Turnersyndrome
c)Emptysellasyndrome
d)Gonadalagenesis
CorrectAnswer-A
Ans,A.Vaginalatresia

---

1843..Whichofthefollowingantiepileptic
drugisassociatedwithcausing
congenitalheartdiseaseinfetus?
a)Barbiturates
b)Valproate
c)Carbamazepine
d)Phenytoin
CorrectAnswer-A
Ans.A.Barbiturates

---

1844.Engagementofheadinlabourmeans?
a)Smallesthorizontalplaneofthepresentingparthascrossedthe
pelvicbrim
b)Greatesthorizontalplaneofthepresentingparthascrossedthe
pelvicbrim
c)Smallesthorizontalplaneofthepresentingparthascrossedthe
pelvicoutlet
d)Greatesthorizontalplaneofthepresentingparthascrossedthe
pelvicoutlet
CorrectAnswer-B
Ans.B.Greatesthorizontalplaneofthepresentingparthas
crossedthepelvicbrim
Whenthegreatesthorizontalplaneofthepresentingparthas
passedtheplaneofpelvicbrimthepresentingpartissaidtobe
engaged.

---

1845.Whichofthefollowinghasmaximum
diabetogenicpotencyinpregnancy?
a)Estrogen
b)Progesterone
c)Cortisol
d)Prolactin
CorrectAnswer-C
Ans,C,Cortisol

---

1846.Oldcompleteperinealtearisrepairedat
?
a)Immediately
b)3-6months
c)6-9months
d)9-12months
CorrectAnswer-B
Ans,B.3-6months
Thedefinitivesurgeryforcompleteperinealtearkrepairoftheanal
sphinctercomplex(sphinaeroptasty)withrestorationoftheperineal
body(perineoraphy).
Forthefreshinjuriesthebesttimeofrepairiswithin24hoursafire
injury,
Foroldperinealtearsthisshouldpreferablebedone3-6months
followinginjury.

---

1847.Amenorrhoeafollowing
hyperprolactinomaiscausedby?
a)InhibitionofGnRHpulsesecretion
b)Inhibitionofadrenalsteoridogenesis
c)Itcauseshypergonadotropichypogonadism
d)Itleadstoformationofovariancysts
CorrectAnswer-A
Ans,A.InhibitionofGnRHpulsesecretion
ProlactininhibitsGnRHpulsesecretionandsuppresses
ganadotropinlevels.
Hyperprolactinemiacausesamenorrhea,anovulationand
Hypogonadism.

---

1848.Sequenceoflochia?
a)Rubra-Serosa-Alba
b)Serosa-Alba-Rubra
c)Alba-Rubra-Serosa
d)Alba-Serosa-Rubra
CorrectAnswer-A
Ans,A,Rubra-Serosa-Alba
Lochia
Itisthevaginaldischargeforthefirstfortnightduringpeurperium.
Thedischargeoriginatesfromtheuterinebody,cervixandvagina.

---

1849.Followingistrueregardingthe
managementofintrauterinefetaldeath
except?
a)In50%ofcasesspontaneousexpulsionoccursin2weeks
b)Fibrinogenlevelsshouldbecheckedweekly
c)Deliverybymedicalinductionispreferredifspontaneous
expulsiondoesnotoccur
d)Caesariansectionhaslimitedplaceinmanagementof
intrauterinefetaldeath
CorrectAnswer-A
Ans,A,In50%ofcasesspontaneousexpulsionoccursin2
weeks

---

1850.Followingistrueabouttamoxifene
except?
a)Itisaselectiveestrogenreceptormodulator
b)Itisacompetitiveinhibitorofestrogenatreceptorsite
c)Itdecreasesriskofvenousthromboembolism
d)Itcanbeusedforinductionofovulation
CorrectAnswer-C
Ans,C,Itdecreasesriskofvenousthromboembolism

---

1851.Whatistheriskofrecurrenceof
anencephalyinsubsequentpregnancy?
a)1%
b)2%
c)3%
d)4%
CorrectAnswer-B
Ans,B.2%
Theriskofrecurrenceofanencephalyinsubsequentpregnancyis
2%.

---

1852.Anothernameformancehsteroperation
foruterineprolapseis?
a)Fothergill
b)Mercy
c)McDonald
d)Purandare
CorrectAnswer-A
Ans,A,Fothergill
ManchesteroperationalsocalledFothergill'soperation.

---

1853.Definitivetreatmentforacaseofsevere
preeclampsiais-
a)MgS0,
b)Deliveryofbaby
c)Antihypertensivedrugs
d)Rest
CorrectAnswer-B
Ans,B.Deliveryofbaby
ForalltypesofPIH,irrespectiveofseverity,definitivemanagement
isterminationofpregnancy"

---

1854.LEEPstandsfor?
a)Loopelectrosurgicalexcisionprocedure
b)Loopelectromagneticexcisionprocedure
c)Loopelectrodiagnosticexcisionprocedure
d)Loopelectrochemicalexcisionprocedure
CorrectAnswer-A
Ans,A,Loopelectrosurgicalexcisionprocedure
LEEP
StandsforLoopElectrosurgicaldiagnosticprocedure.
Itisalsoknownaslargeloopexcisionofthetransformationzone
(LLETZ).

---

1855.Simultaneousadministrationof
estrogenandprogesteroneinhormone
replacementtherapyincreasesriskof?
a)Ovariancancer
b)Breastcancer
c)Cervicalcancer
d)Bothaandb
CorrectAnswer-D
AnsD.Bothaandb
RiskduetobothestrogenandprogesteroneinHRT:-
Breastcancer
Ovariancancer
RiskduetoonlyestrogeninHRT:-
Endometrialcarcinoma

---

1856.
Durationofsecondstageoflabor
dependsupon-
a)Sizeoffetus
b)Mother'sbuild
c)Parity
d)Lieoffetus
CorrectAnswer-C
Ans,C,Parity
Thedurationofthenormalsecondstageisusuallyverymuch
shorterthanthenormalfirststageoflabour.
Aswiththefirststagethedurationofthesecondstage
willmainlydependsonwhetheritisthefirstlabourorthewoman
haspreviouslygivenbirthtoaviableinfanti.e.itdependsonthe
paritystatusofthemother,

---

1857.
Vasapreviaisseeninwhichtypeof
placenta?
a)Central
b)Vilamentous
c)Peripheral
d)Noneoftheabove
CorrectAnswer-B
Ans.B.Vilamentous
Vasaprevia
Ifaleashofbloodvesselshappentotraversethroughthe
membranesoverlyingtheinternalos,infrontofpresentingpart,the
conditioniscalledvasaprevia.
Thesearetheunsupportedumbilicalvesselsinvilamentous
placenta.

---

1858.

---

Whichisnotapartofbasicessential
obstetriccare?
a)Bloodtransfusion
b)Parenteralantibiotics
c)Parenteraloxytocicdrugs
d)Parenteralsedativesforeclampsia
CorrectAnswer-A
Ans.A.Bloodtransfusion
Basicessentialobstetriccareservicesatthehealthcenterlevel
shouldincludeatleastthefollowing:
Parenteralantibiotics
Parenteraloxytocicdrugs
Parenteralsedativesforeclampsia
Manualremovalofplacenta
Manualremovalofretainedproducts

---

1859.Mediolateralepisiotomyispreferred
because?
a)Reducesdamagetoanalsphincterandanalcanal
b)Lessbloodloss
c)Easytosuture
d)Easytechnique
CorrectAnswer-A
Ans,A.Reducesdamagetoanalsphincterandanalcanal
Mediolateralepisiotomyreducestheriskofdamagetoanal
sphincterandanalcanalthoughtitmayslightlyincreasethe
bleeding.

---

1860.Monzygotictwinwithonehealthybaby
bornattermandonedeadmummified
fetusissuggestiveof?
a)Fetusacardiacus
b)Fetuspapyraceous
c)Hydatidiformmole
d)Vanishingtwin
CorrectAnswer-B
Ans.B.Fetuspapyraceous
FetusPaoyraceousorcompressus-
Isastatewhichoccursincaseoftwinswhenoneofthefetusesdies
early.
Thedeadfetusisflattenedmummifedandcompressedbetweenthe
membranesoflivingfetusanduterinewaII.
Itmayoccurinbothvarietiesoftwinsbutismorecommonin
monozygotictwinsandisdiscoveredatdeliveryorearlierby
sonography.

---

1861.Sarcomabotryoidesallaretrueexcept
?
a)Alsocalledembryonalrhabdomyosarcoma
b)Commonlyarisesfromvagina
c)Itpresentswithbloodstainedwateryvaginaldischarge
d)ItcanbetreatedwithVACregime
CorrectAnswer-B
AnsB.Commonlyarisesfromvagina
Sarcomabotyroides(Embrvonalrhabdomyosarcoma)
Specialtypeofmixedmesodermaltumourcommonlyarisingfrom
cervix,rarelyfromvagina&uterus.

---

1862.Followingaretheindicatonsof
hysterosalpingographyexcept
a)Fallopiantubepatencyininfertility
b)Studyuterineanamoly
c)Detectuterinesynechiae
d)Detectendometriosis
CorrectAnswer-D
Ans,D.Detectendometriosis
IndicationsofHysterosaIpingography
Tostudythepatencyoffallopiantubesininfertilityandpostoperative
tuboplasty
Toassessthefeasibilityoftuboplastybystudyingtheextentoftubal
pathologist.
Tostudytheuterineanomalysuchasseptateandcornuateuterus
Todetectuterinesynechiae
Todetectuterinepolyp
TostudytheincompetenceofinternalOS

---

1863.Mostcommoncauseofearlyabortion-
a)Genetic
b)Maternal
c)Immunologic
d)Anatomicabnormalities
CorrectAnswer-A
Ans.A.Genetic

---

1864.Followingaretheultrasounddoppler
parametersusedinthediagnosisof
intrauterinegrowthrestrictionexcept?
a)Abdominalcircumference
b)Dopplervelocimetry
c)Increaseddiastolicvelocityinmiddlecerebralartery
d)Ponderalindex
CorrectAnswer-A
Ans,A.Abdominalcircumference

---

1865.Whatisusedtoaididentificationof
areasofdysplasiaincolposcopy?
a)3-5%aceticacid
b)Acetocarminered
c)1%formicacid
d)1%alcohol
CorrectAnswer-A
Ans.A.3-5%aceticacid
Colposcopyisthemainstayinthediagnosisofcervicaldysplasia
andprecancerouslesions.

---

1866.Whichofthefollowingisanabsolute
indicationforcaesariansection?
a)Centralplacentaprevia
b)Breechpresentation
c)Badobstetrichistory
d)Previouscaesariandelivery
CorrectAnswer-A
Ans,A.Centralplacentaprevia
Absoluteindicationsforcaesariansection-
Centralplacentaprevia
Contractedpelvisorcephalopelvicdisproportion(absolute)
Pelvicmasscausingobstruction(cervicalorbroadligamentfibroid)

---

1867.34weekspregnancywithlowlying
placentaprevia,floatinghead,Hb-11
gm%.Whatshouldbethefurtherlineof
management?
a)Expectantmanagement
b)Inductionoflabour
c)Caesariansection
d)Bloodtransfusion
CorrectAnswer-A
Ans.A.Expectantmanagement

---

1868.Riskfactorsfortheectopicpregnancy
are?
a)IUCD
b)Historyofinfertility
c)Tubalendometriosis
d)Alltheabove
CorrectAnswer-D
Ans,D,Alltheabove

---

1869.Notariskforectopicpregnancy?
a)Useofcondom
b)OCP
c)PID
d)Previousectopicpregnancy
CorrectAnswer-A
Ans.A.Useofcondom

---

1870.Followingarethecausesof
oligohydramniosexcept?
a)IUGR
b)Postmaturity
c)Maternaldehydration
d)Labetolol
CorrectAnswer-D
Ans,D.Labetolol

---

1871.Redcellvolumeisincreasedbywhat
percentageinpregnancy?
a)10-20%
b)20-30%
c)30-40%
d)40-50%
CorrectAnswer-B
Ans.B.20-30%

---

1872.Howmuchtimeafterreduced
movementfetalheartstops?
a)1hr
b)2hrs
c)6hrs
d)12hrs
CorrectAnswer-D
Ans,D,12hrs
Onanaveragefetalheartstopsafter12-48hoursofdiseasedfetal
movementsinintrauterinefetaldeath.

---

1873.Lileyszone3at35weeksgestation
managementis?
a)Followup
b)Intrauterineinfusion
c)Pretermterminationofpregnancy
d)Cordocentesis
CorrectAnswer-C
Ans,C.Pretermterminationofpregnancy
Achartthatusesthespectrographicmeasurementofamnioticfluid
bilirubinlevelsplottedagainstgestationalagetoestimatethe
severityoffetalhemolysisresultingfromRhisoimmunizntion.

---

1874.Upperagelimittodiagnoseapatientas
havingprimaryamenorrhoeais?
a)13years
b)14years
c)15years
d)16years
CorrectAnswer-D
Ans.D.16years
Ayounggirlwhohasnotyetmenstruatedbyher16yearsofage
haspimaryamenonhoearatherthandelayedmetarche.
Delayedpubertyisdefinedasfailureofdevelopmentofsignsof
sexualdevelopmentbytheageof14yearsinboy.
IngirlsdelayedpubertyisdefinedasfailureofbreastbuddingbyI3
yearsorabsenceofmenarchebyI5yearorlackofsecondary
sexualcharactersbyl7years.

---

1875.Swisscheesepatternisseenin?
a)Metropathicahemorrhagica
b)Serouscystadenoma
c)Mucinouscystadenoma
d)Dermoid
CorrectAnswer-A
Ans.A.Metropathicahemorrhagica
Microscopicappearanceofendometriumshows:Glandular
hyperplasiawithcysticdilationoffewglandsofvariablesizesgivingit
aswisscheeseappearance.

---

1876.Couvelaireuterusisseenin?
a)Placentaprevia
b)Abruptioplacentae
c)Plencentaaccrete
d)Velamentousplacenta
CorrectAnswer-B
Ans.B.Abruptioplacentae
Couvelaireuterus
Alsocalleduteroplacentalapoplexy.
Itisseeninassociationwithsevereformsof"concealedabruptio
placen"

---

1877.Conditionwherethereisingrowthof
theendometrium,bothglandularand
stromalcomponentinmyometriumis?
a)Adenomyosis
b)Courvelaireuterus
c)Placentaaccreta
d)Uterinefibroid
CorrectAnswer-A
Ans,A.Adenomyosis
Adenomyosisisaconditionwherethereisingrowthofthe
endometrium,boththeglandularandstromalcomponents,directly
intothemyometrium.

---

1878.
InPIDduetoneiserrieagonorrhea,
tubaldamageis?
a)Peritubal
b)Endotubal
c)Extratubal
d)Juxtatubal
CorrectAnswer-B
Ans.B.Endotubal
Gonococcalinfectioninvolvesthemucosaandmainlyremainsan
endoluminalpathologywhiletheotherbacterialPIDtendtoinvolve
deepertissuesandcanalsoinvolveextratubaltissues.Sothemost
probableanswerisendotubal.

---

1879.20yearoldfemalewithprimary
amenorrhoeawithnormalpresentation
ofeverythingexceptnoaxillaryor
pubichair.Whatisthediagnosis?
a)Testicularfeminizationsyndrome
b)Kallmansyndrome
c)Turnerssyndrome
d)Klienfelterssyndrome
CorrectAnswer-A
Ans,A.Testicularfeminizationsyndrome
Phenotypicallynormalfemaleswithabsenceofaxillaryand
pubichairwithprimaryamenorrhoeahavetwodifferential
diagnosis:
Testicularfeminizingsyndromeand
Mullerianagenesis.

---

1880.Transverselieiscausedbyallexcept?
a)Multiparity
b)Prematurity
c)Anencephaly
d)Placentaprevia
CorrectAnswer-C
Ans,C.Anencephaly
Etiologytransverselie:
Multiparity
Twins
Contractedpelvis
Pelvictumors
Intrauterinedeath
Prematurity
Hydramnios
Placentaprevia
Congenitalmalformationofuterus-arcuate,subseptate

---

1881.Mostcommonbreechpresentationin
primigravidais?
a)Flexedbreech
b)Frankbreech
c)Footlingpresentation
d)Incomplete
CorrectAnswer-B
Ans,B.Frankbreech
Breechwithextendedlegs/Frankbreech

---

1882.Estimationoffetalhemoglobinisdone
by?
a)Gerhardtest
b)Kleihauser-BetkeAcidElutionTest
c)Grinderstest
d)Simpsonstest
CorrectAnswer-B
Ans.B.Kleihauser-BetkeAcidElutionTest
ModifiedKeihauser-BetkeAcidElutiontest:itkusedtonotethe
numberfetalredcellsper0lowpowerfields.
Ifthereare80fetalerythrocytein50lowpowerfieldsinmaternal
peripheralbloodfilms,itpresentsthetransplacentalhemorrhageof4
mloffetalblood.

---

1883.Mostcommonmodeofspreadfor
genitaltuberculosisis?
a)Hematogenous
b)Lymphatic
c)Direct
d)Ascending
CorrectAnswer-A
Ans.A.Hematogenous
Fromanyoftheprimarysites,thepelvicorgansinvolvedby
hematogenousspreadinabout90%ofthecases.

---

1884.Whatisthenextstepininvestigatinga
45yrsoldfemalewithpostcoital
bleedingandvisiblecervicalmasson
speculumexamination?
a)Dilatationandcurettage
b)Conisation
c)Colposcopy
d)Hysteroscopy
CorrectAnswer-C
Ans.C.Colposcopy

---

1885.TreatmentofIBIcacervix?
a)Wertheim'shysterectomy
b)Radiotherapy
c)Chemotherapy
d)Chemoradiotherapy
CorrectAnswer-A
Ans.A.Wertheim'shysterectomy

---

1886.ManagementofStageIIAcarcinoma
cervixinthirdtrimesterofpregnancyis
?
a)Radicalhysterectomy,pelviclymphadenetomyafterclassic
caesariandelivery
b)Periodiccytologyandevaluation
c)Conebiopsy
d)Chemotherapyandbrachytherapy
CorrectAnswer-A
Ans.A.Radicalhysterectomy,pelviclymphadenetomyafter
classiccaesariandelivery

---

1887.Inhibinisatumormarkerfor?
a)Granulosacelltumor
b)Dysgerminoma
c)Serouscystadenoma
d)Krukenbergtumor
CorrectAnswer-A
Ans.A.Granulosacelltumor

---

1888.CallExnerbodiesseenin?
a)Granulosacelltumors
b)Serouscystadenomas
c)Dysgerminoma
d)Krukenbergtumor
CorrectAnswer-A
Ans.A.Granulosacelltumors
TheformationofCall-Exnerbodiesisadistinctfeatureofgranulosa
cellsandcanbereadilyrecognizedincertaintypesofgranulosacell
tumours.

---

1889.Mostcommongermcelltumorofovary
is?
a)Dysgerminoma
b)Serouscystadenoma
c)Yolksactumor
d)Dermoidcyst
CorrectAnswer-D
Ans.D.Dermoidcyst

---

1890.Whichofthefollowingisthemost
commonmalignantgermcelltumorof
ovary?
a)Yolksactumor
b)Dysgerminoma
c)Polyembryoma
d)Choriocarcinoma
CorrectAnswer-B
Ans,B.Dysgerminoma

---

1891.Mostcommonmalignantovariantumor
is?
a)Serouscystadenocarcinoma
b)Mucinouscysadenocarcinoma
c)Malignantteratoma
d)Sarcoma
CorrectAnswer-A
Ans,A.Serouscystadenocarcinoma

---

1892.Mostcommonovariancysttoundergo
torsionis?
a)Dysgerminoma
b)Benigncysticteratoma
c)Ovarianfibroma
d)Brenner'stumor
CorrectAnswer-B
Ans,B.Benigncysticteratoma
Benigncysticteratomaisthemostcommonovarianneoplasmto
undergotorsion.

---

1893.Followingthecriteriaforconservative
surgeryinpatientswithovarian
carcinomaexcept?
a)FIGOstageIIdisease
b)Youngpatientwithnoorfewchildren
c)Welldifferentiatedseroustumor
d)Noinfiltrationofcapsule,lymphaticsormesoovarium
CorrectAnswer-A
Ans.A.FIGOstageIIdisease
Requirementsforconservativesurgeryinpatientswith
ovarianCancerare:
FIGOstageIAdisease
Welldifferentiatedserous,mucinous,endometroidorclearcell
tumor
Youngpatientwithnoorfewchildren
Nootherpelvicpathologyprecludingpregnancy

---

1894.Mostcommoncauseofvulval
carcinomais?
a)HPVinfection
b)EBVinfection
c)Herpesgenitalisinfection
d)Syphilisinfection
CorrectAnswer-A
Ans.A.HPVinfection
HPVinfectionisacommonriskfactorforthedevelopmentof
invasivevulvalcarcinoma.

---

1895.Mostcommoncancerinpregnancy?
a)Melanoma
b)Breastcarcinoma
c)Gastriccarcinoma
d)Thyroidcarcinoma
CorrectAnswer-B
Ans.B.Breastcarcinoma
Breastcarcinomaisthemostcommoncancerinpregnancy
constituting46%(1:3000to10,000)ofthecasesfollowedby
hematologicalmalignanciesconstituting18-25%oofthecases,

---

1896.Mostcommontypeoffibroidis?
a)Intramural
b)Subserosal
c)Cervical
d)Submucosal
CorrectAnswer-A
Ans.A.Intramural

---

1897.Sentinellymphnodebiopsyisusedto
mapthelymphnodestatusofwhich
cancers?
a)Breast
b)Melanoma
c)Vulva
d)Alltheabove
CorrectAnswer-D
Ans,D.Alltheabove
Lymphaticmappingandsentinellymphnodebiopsy
Techniqueusetoknowthelocallymphnodestatusincancersof
breast,vulvaandmelanoma

---

1898.Meigssyndromeisassociatedwith
whichtumor?
a)Fibroma
b)Cystadenoma
c)Dysgerminoma
d)Teratoma
CorrectAnswer-A
Ans.A.Fibroma
Meigssyndromecombinationoffibromawithascitesandhydrothorax,
usuailyrightsided.
Seenin1-5%patients.

---

1899.Carcinomaendometriumwith
involvementofthevaginalwallis
includedinwhichstage?
a)IIIA
b)IIIB
c)IIIC
d)IVA
CorrectAnswer-B
Ans.B.IIIB

---

1900.Investigationofchoiceinendometriosis
?
a)Laproscopy
b)Hysteoscopy
c)CTscan
d)MRI
CorrectAnswer-A
Ans.A.Laproscopy
Laproscopyisconsideredasgoldstandardinvestigationfor
diagnosisofendometriosis.
Itisdiagnosticaswellastherapeutic,

---

1901.Drugcommonlyusedintreatmentof
endometriosisis?
a)LH
b)GnRH
c)MPA
d)FSH
CorrectAnswer-B
Ans.B.GnRH

---

1902.FirstlinetreatmentofinfertilityinPCOS
is?
a)Clomiphene
b)FSH
c)GnRH
d)Assistedreproductivetechniques
CorrectAnswer-A
Ans.A.Clomiphene
ClomiphenecitrateisthefirstlineoftreatmentofinfertilityinaPCOS
woman.

---

1903.Clomiphenecitrateisusedfor?
a)Anovulation
b)Endometriosis
c)Pubertymenorrhagia
d)Hormonereplacementtherapy
CorrectAnswer-A
AnsA.Anovulation

---

1904.CopperIUCDasacontraceptive
measurecanbeusedmaximumtillwhat
timeaftercontact?
a)2days
b)3days
c)4days
d)5days
CorrectAnswer-D
Ans.D.5days
IntroductionofCopperlUDwithinamaximumperiodof5dayscan
preventconceptionfollowingaccidentalunprotectedexposure.

---

1905.AbsolutecontraindicationofOCpills
areallexcept?
a)Suspiciousvaginalbleeding
b)Cervicalcancer
c)Uterineanamoly
d)OldSTD
CorrectAnswer-D
Ans.D.OldSTD
CurrentSTDisanabsolutecontraindication(notpastSTDs).

---

1906.Mostcommoninfectioninlongterm
IUCDuse-
a)Actinomyosis
b)Mucormycosis
c)Aspergillosis
d)Candidiasis
CorrectAnswer-A
Ans.A.Actinomyosis
ActinomycosisisaninfectioncommoninpatientssinginertIUCDs.

---

1907.MechanismofactionofIUCDisall
except?
a)Inhibitovulation
b)Inducebiochemicalchangesinendometrium
c)Increasetubalmotility
d)Inflammatoryresponeinendometrium
CorrectAnswer-A
Ans,A.Inhibitovulation
Actpredominantlyintheuterinecavityanddonotinhibitovulation.

---

1908.ComponentsofMalaDareallexcept?
a)0.03mgEthinylestradiol
b)0.15mgdesogestrel
c)0.15mglevenogestrel
d)Irontablets
CorrectAnswer-B
Ans,B.0.15mgdesogestrel

---

1909.Nottrueincompletehydatidiformmole
?
a)Triploid
b)Absenceoffetalparts
c)Diffusetrophoblastichyperplasia
d)BetaHCG>50,000
CorrectAnswer-A
Ans,A.Triploid
Triploidyanddiploidyareseeninpartialmole.Completemolehas
46XXkaryotype.

---

1910.Riskofscarruptureinlowersegmentof
previousscarpresentis?
a)05-1.5%
b)15-25%
c)2.5-3.5%
d)3.5-4.5%
CorrectAnswer-A
Ans.A.05-1.5%

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1911.Heliotopresignisseenin?
a)Dermatomyositis
b)Scleroderma
c)Photodermatitis
d)Vitiligo
CorrectAnswer-A
Ans.is'a'i.e.,Dermatomyositis
Cutaneoussignsofdermatomyosits
Gottron'spapules:-lilacorviolaceouspapulesonknuckle,dorsaof
hands.
Gottron'ssign:-Violaceouserythemawithedemaovershoulder,
arms,forearms.
Heliotropesign:-Violaceouserythemawithedemaovereyelids,
periorbitalregion.
Poikiloderma:-Atrophyofskin,hypopigmentaion,dilatedblood
vesselsovertrunk.
Mechanichand:-Symmetrichyperkeratosisalongulnaraspectof
thumbandradialaspectoffingers.
ShawlSign:-Violaceouserythemaextendingfromdorsolateral
aspectofhands,forearms,andarmstoshoulder&neck.
Calcinosiscutis:-Calciumdepositsinskin(inJuvenilevariant).
Miscellaneoussigns:-Photosensitivity,vasculitis,panniculitis,Nail-
foldtelangiectasia.
Extracutaneousinvolvement
1. Proximalmyositis
2. Cardiomyopathy
3. Raynaud'sphenomenon
4. Arthralgia

---

---

1912.Gottronsignsissignin?
a)dermatomyositis
b)herpesinfection
c)Bacterialinfection
d)Alloftheabove.
CorrectAnswer-A
Dermatomyositis(DM)isaconnective-tissuediseaserelated
topolymyositis(PM)thatischaracterizedbyinflammationofthe
musclesandtheskin.WhileDMmostfrequentlyaffectstheskinand
muscles,itisasystemicdisorderthatmayalsoaffectthejoints,the
esophagus,thelungs,andtheheart.

---

1913.Patientpresentswithdischargeper
urethrumandmicroscopyshows
presenceofintracytoplasmicgram
negativecocci;whatisthemost
probablediagnosis?
a)Gonorrhea
b)Donovanosis
c)Bacterialvaginosis
d)Syphilis
CorrectAnswer-A
Ans.is'a'i.e.,Gonorrhea
Presenceofpusdischargeperurethruminmaleswithpresenceof
intracytoplasmicgramnegativecocciarepointerstothepresenceof
N.gonorrheainfection.
GONOCOCCALINFECTION
N.Gonorrhoeaeisanintracytoplasmicgramnegativecoccus.
N.gonorrhoeaeisexclusivelyahumanpathogenalthough
chimpanzeeshavebeeninfectedartificially.
Itisneverfoundasanormalcommensalalthoughaproportionof
thoseinfected,particularlywomen,mayremainasymptomatic.
Acuteurethritisismostcommonmanifestation.Purulentdischarge
perurethraisthemostcommonmanifestation.
Theprocessmayextend,alongtheurethra,toprostate,seminal
vesicle,epididymis.

---

1914.Christmastreeappearanceinskinis
seenin?
a)Pityriasisrosea
b)Pityriasisrubrapilaris
c)Psoriasis
d)Vitiligo
CorrectAnswer-A
Ans.is'a'i.e.,Pityriasisrosea
Pityriasisrosacea
P.roseaisacommonscalydisorder,occuringusuallyinchildren
andyoungadults(10-35years).
Characterizedbyround/ovalpinkbrownpatcheswithasuperficial,
centrifugalscale,distributedovertrunkinaChristmastreepattern.
Thediseaseisthoughttobeviraldisease,isselflimiting,and
subsidesin6-12weeks.
Theexactetiologyisnotknown,butitisconsideredtobeaviral
disease;HumanHerpesvirus6(HHV6)andHumanHerpesvirus7
(HHV7)mayplayarole.
ClinicalmanifestationsofP.rosea
Thediseasestartswithanupperrespiratoryprodromeoramildflu.
After1-2weeks,Annularerythmatousplaqueappearsontrunkthat
isreferredtoasmotherpatchorheraldpatch.
Overthenext1-2weeks,freshpatchappearalloverthetrunk,ina
ChristmastreeconfigurationorFirtreeConfigration.
Thelesionsarepinkishinwhiteskin,hencethenamerosea.
However,onthedarkIndianskinthelesionsareskincolouredor
brown.
Themostcharacteristicclueforthediagnosisisthepresenceofa

---

finescaleattheedgeofthelesionreferrredtoascentrifugalscaleor
collarettescalesorcigarettepaperscales.
Lesionssubsidewithhyperpigmentation.
Trunkisinvolvedpredominantly,Sometimes(in20%ofpatients)
lesionsoccurpredominantlyonextremitiesandneck(inverse
pattern).

---

1915.Pomphyloxaffects?
a)Palms&soles
b)Groin
c)Scalp
d)Trunk
CorrectAnswer-A
Ansis'a'i.e.,Palms&soles
POMPHOLYX
Anattackofpompholyxischaracterizedbythesuddenonsetof
cropsofclearvesicles,whichappear'sago-like'.
Itchingmaybesevere,precedingtheeruptionofvesicles.
Theattacksubsidesspontaneouslyin2-3weeks.
Inmildcases,onlythesidesofthefingersmaybeaffected,butina
typicalcasethevesiclesdevelopsymmetricallyonthepalmsand/or
soles

---

1916.Pseudobuboseenin:
a)Chancroid
b)Syphilis
c)Lymphogranulomainguinale
d)Lymphogranulomavenerum
CorrectAnswer-C
Ans.is.'c'i.e.,Lymphogranulomainguinale

---

1917.Erythrasmaiscausedby?
a)Comybacterium
b)Staphylococcus
c)Streptococcus
d)HerpesVirus
CorrectAnswer-A
Ans.is'a'i.e.,Cornybacterium
Erythrasmaisaskindiseasethatcausesbrown,scalyskinpatches.
ItiscausedbytheGram-positivebacterium
Corynebacteriumminutissimum.Itisprevalentamongdiabeticsand
theobese,andinwarmclimates;itisworsenedbywearing
occlusiveclothing.

---

1918.HPVcauses?
a)Condylomalata
b)Condylomaacuminata
c)Bubo
d)Chancre
CorrectAnswer-B
Ans.is'b'i.e.,Condylomaacuminata

---

1919.Drugofchoiceforgenitalwartsis?
a)Acyclovir
b)Podophyllin
c)Minocyclin
d)Interferonalpha
CorrectAnswer-B
Ans.is'b'i.e.,Podophyllin

---

1920.Depigmentingagentofchoiceinin
treatmentofdermatologicaldisorders
is
a)Hydroquinone
b)Zinc
c)Kojicacid
d)Azelaicacid
CorrectAnswer-A
Ans.is'a'i.e.,Hydroquinone
Skindepigmentingagentsinclinicaluseare
Hydroquinone-mosteffectiveandwidelyused
Kojicacid
Kojicdipalmitate
Azelaicacid

---

1921.Nailpittingisseenwith?
a)Paronychia
b)Ectodermaldysplasia
c)Alopeciaareate
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove

---

1922.Vitiligoisassociatedwiththefollowing
except
a)Addison'sdisease
b)Mensyndrome
c)Perniciousanemia
d)Crohnsdisease
CorrectAnswer-D
Ans.is'd'i.e.,Crohnsdisease
Vitiligoisassociatedwiththefollowingautoimmunediseases:-
Alopeciaareata
Diabetesmellitus
Hyperthyroidism
Hypothyroidism
Perniciousanemia
Addisondisease
Multipleendocrinopathysyndrome

---

1923.Treatmentofnodulocysticacneis
a)Erythromycin
b)Tertacycline
c)Isoretinonine(Retinoicacid)
d)Steroids
CorrectAnswer-C
Ci.e.Isoretinonine

---

1924.Trueabouterythema
toxicumneonatorumis?
a)Itispresentin3-5%ofthenewborns
b)Itismostlypresentatbirth
c)Itiscalledthefleabittenrashofnewborn
d)Topicalantibioticsisthetreatmentofchoice
CorrectAnswer-C
Ans.is'c'i.e.,Itiscalledthefleabittenrashofnewborn
ErythemaToxicumNeonatorum
Itistheharmless,erythematous,shortlivederuptionsofthe
newborn.
Itispresentin30-50%ofthenewborns
Itisconsideredapartofnormaltransitionfromthewaterywombto
thedryexternalenvironment.
Itappearsmostofteninthefirst2daysoflifeandisrarelypresentat
birth
Itconsistsofwidespreaderythematousmaculesmostpresentinthe
trunkandtheproximalpartsoftheextremities.
Hurwitzcalleditthefleabittenrashofnewborn.
Noactivetherapyisneededforthetreatment.

---

1925.Whatisthethemostprobable
diagnosisofachildwhopresentswith
whiteumbilicatedlesionsonface?
a)Molluscumcontagiosum
b)Herpessimplexinfection
c)Erythematoxicumneonatorum
d)Humanpappilomavirusinfection
CorrectAnswer-A
Ans.is'a'i.e.,Molluscumcontagiosum
Pearlywhiteumblicatedpapuleonfaceinchildrenismost
commonlyseeninMolluscumcontagiosum.
Molluscumcontagiosum
Itisacommonviralinfectioninchildren.Itiscausedbypoxvirus,
i.e.,Molluscumcontagiosumvirus.Itischaracterizedbymultiple
pearlywhite,dome-shapedpapuleswhichareumbilicatedcentrally.
Onusingahandlens,manyofthepapuleshasamosaic
appearance.Epidermalcellscontaineosinophilicintracytoplasmic
inclusionbodies(MolluscumorHenderso-Patersonbodies).
Autoinoculationcangiverisetolesionsarrangedlinearlyalongline
oftrauma---->pseudoismorphic(pseudokoebner's)phenomenon.
M.C.mayinvolveanypartofthebodyInchildrenfaceisinvolved
mostcommonly.AnogenitalmolluscumcontagiosumisaSTD.
Treatement
Curretage,electrocautery,cryotherapyaresimpleandeffective
methods.Imiquimed,arecentlyintroducedimmunostimulant,is
helpfulinpatientswithmultiplelesionsandinsmallchildren.

---

1926.Haascheibencellsinepidermisare
responsiblefor?
a)Touch
b)Temperature
c)Pressure
d)Proprioception
CorrectAnswer-A
Ans.is'a'i.e.,Touch

---

1927.Applejellynodduleisseenin?
a)Lupusvulgaris
b)Cutaneousanaphylaxus
c)Erythroderma
d)Erysepals
CorrectAnswer-A
Ans.is'a'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).

---

1928.Flaccidbullaewithmucosal
involvementandintraepidermal
acantholysisarecharacteristicof?
a)Pemphygusvulgaris
b)Pemphigusfoliaceous
c)Psoriasis
d)Vitiligo
CorrectAnswer-A
Ans.is'a'i.e.,Pemphygusvulgaris
Amongthegivenoptions,twoarevesicullabullousdisorders:-
1. Pemphigusvulgaris
2. Pemphigusfoliaceous
Bothofthesecauseflaccidbullaewithintraepidermalblisters.
but,mucosalinvolvementiscommoninpemphigusvulgaris(notinP
foliaceous).

---

1929.IgAdepositionindermoepidermal
junctionskinseenin?
a)Dermatitisherpetiformis
b)Bullouspemphigoid
c)LinearIgAdisease
d)Epidermolysisbullosa
CorrectAnswer-C
Ans.is'c'i.e.,LinearIgAdisease

---

1930.Notafeatureofscabiesis?
a)Serpentineburrow
b)Severeitching
c)Webspaceaffection
d)Genitaliaarenotaffected
CorrectAnswer-D
Ans.is'd'i.e.,Genitaliaarenotaffected

---

1931.Trueaboutthelesionsoflichenplanus
?
a)Polygonalviolaceouspaple
b)Affectskinandmucousmembranes
c)Arepruritic
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove

---

1932.AntigendefectinPemphigusVulgaris-
a)Desmoglein-1
b)Desmoglein-3
c)Desmocollin-3
d)Desmocollin-2
CorrectAnswer-B
Ans.is'b'i.e.,Desmoglein-3

---

1933.Coloroftuberoussclerosislesionson
woodlampexamination?
a)Brightgreen
b)Milkywhite
c)Goldenyellow
d)Bluewhite
CorrectAnswer-D
Ans.is'd'i.e.,Bluewhite
Woodlamp
Thisisasourceofultravioletlight(320-400nm)fromwhichvirtually
allvisiblerayshavebeenexcludedbyaWood's(nickeloxide)filter.
Primarilyemits360nm.
UVlight,whenabsorbedbycertainsubstances,fluorescencesin
darkandcolorproduced,isusefulindiagnosisofthecertain
conditions
Condition
Fluorescencecolour
Tineacapitis
Brightyellowgreen
Erythrasma
Coralredorpink
Vitiligo
Milkywhite
Albinism
Bluewhite
Leprosy
Bluewhite
Tuberoussclerosis
Bluewhite
Pseudomonasinfection Greenishwhite
Porphyria
Pink/orange
Tineavesicolor
Goldenyellow

---

1934.Alopeciaareataisa/an?
a)Autoimmunedisorder
b)Allergicdisorder
c)Anaphylacticdisorder
d)Bacterialinfection
CorrectAnswer-A
Ans.is'a'i.e.,Autoimmunedisorder

---

1935.Whitfield'sointmentconsistsof?
a)3%salicylicacid+6%benzoicacid
b)3%benzoicacid+6%salicylicacid
c)2%salicylicacid+4%benzoicacid
d)2%benzoicacid+4%salicylicacid
CorrectAnswer-A
Ans.is'a'i.e.,3%salicylicacid+6%benzoicacid
Whitfield'sOintment
Whitfield'sointmentissalicylicacidandbenzoicacidinasuitable
base,suchaslanolinorvaseline.
Theoriginalointmentcontains3%salicylicacidand6%benzoic
acid,butotherratiosarealsoused.
Itisusedforthetreatmentoffungalinfections,suchasathlete'sfoot.
Itseffectivenessisunclear.
Itcanhaveaslightburningeffectthatgoesawayafterafew
minutes.
ItisnamedforArthurWhitfield(1868-1947),aBritishdermatologist

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1936.Sphagettiandmeatballappearanceis
seenin?
a)Pityriasisrosacae
b)Tineacapitis
c)Tineacarporis
d)Tineaversicolor
CorrectAnswer-D
Ans.is'd'i.e.,Tineaversicolo
Pitvriasisversicolor(tineaversicolor)
Tineaversicolorisamisnomerasitisnotcausedbya
dermatophyte;itiscausedbyanondermatophyticfunguscalled
Pityrosporumovale(malaseziafurfur).Usuallyaffectsyoungadults.
Clinicalfeatures
Therearemultiplescalyhypopigmented(morecommon)or
hyperpigmentedmacules.Scalingisfufuraciousorricepowderlike.
Maculesstartaroundthehairfolliclesandtheymergewitheach
othertoformlargeareas.Affectstrunkandshoulders(mainlychest
andback).Theremaybelooseningofscaleswithfingernails-
coupledonleorstrokeofnail.Lesionsarerecurrentinnature.
Diagnosis
1. Examinationofscalesin10%KOHshowsshorthyphaeandround
spores(sphagettiandmeatballappearance).Wood'slampshows
applegreenfluorescence(blue-greenfluorescnce).
2. Skinsurfacebiopsy-acyanoacrylateadhesiveisusedtoseparate
thelayerofstratumcorneumonglassslideandthenstainedwith
PASreagent.
Treatment
1. Systemicagents:-systemicazolesprovideconvenienttherapeutic

---

option.Drugsusedareketokonazole,fluconazoleoriatroconazole
2. Topicalantifungalsusedare?
Azolesclotrimazole,econazole,miconazole,ketoconazole
Others:-seleniumsulphide,sodiumthiosulphate,whitefield's
ointment(3%salicylicacid+6%benzoicacid).

---

1937.Whichofthefollowingcancauseboth
cicatricialaswellasnoncicatrical
alopecia?
a)Alopeciaareata
b)Telogeneffluvium
c)SLE
d)Hypothyroidism
CorrectAnswer-C
Ans.is'c'i.e.,SLE

---

1938.FoxFordyceDiseaseeffects:
a)Sebaceousglands
b)EccrineGlands
c)Apocrineglands
d)Anygland
CorrectAnswer-C
Apocrineglands

---

1939.Miliariaarisesfromobstructionof?
a)Eccrinesweatglands
b)Apocrinesweatglands
c)Sebaceousglands
d)Ectopicsebaceousglands
CorrectAnswer-A
Ans.is'a'i.e.,Eccrinesweatglands
Milliria
Occurasaresultofeitherobliterationordisruptionoftheeccrine
sweatduct.
Threeforms:-
1. Miliariacrystallina-Clear,thin-walledvesicles,1-2mmindiameter,
withoutaninflammatoryareola,areusuallysymptomlessand
developincrops,mainlyonthetrunk.
2. Miliariarubra-erythematouspapulesespeciallyinareasoffriction
withclothing,andinflexures,produceintenseprickingsensation.
3. Miliariaprofunda-Thisnearlyalwaysfollowsrepeatedattacksof
miliariarubra,oComplications:-Secondaryinfectionand
disturbanceofheatregulation

---

1940.Infectiouscauseoferythema
multiformeingivenimageis-
a)Staphylococcus
b)TB
c)HSV
d)EBV
CorrectAnswer-C
Answer-C-Herpessimplexvirus
Herpessimplexistheprimarycauseoferythemamultiforme,and
thevirusispresentin70percentofrecurrenterythemamultiforme
cases.Bothtypesofherpessimplexvirus(HSV)cancausethe
condition,butHSV-1,whichalsocausescoldsores,isresponsible
formostcases.
CausesofErythemamultiforme
IdiopathicMostcommoncause
ViralHSV(mostimportant)HBV,Mumps,Adenovirus
BacteriaStreptococci,tuberculosis
FungalCoccidioidomycosis,Histoplasmosis.
DrugsAntibiotics(Sulphonamide),Phenytoin,NSAIDS.
AutoimmunediseaseSLE,thyroiditis,RA

---

OthersSarcoidosis,Pregnancy,Malignancy.

---

1941.Patchyhairlosswithvelvetyskin
pointstothediagnosisof
a)Alopeciaaereata
b)Trichotelomania
c)Hyperthyroidism
d)Adenomasebacicum
CorrectAnswer-C
Ans.is'c'i.e.,Hyperthyroidism
Hairlossincombinationwithvelvetyskinisseeninpatientswith
excessofthyroidhormoneproduction;thusthemostprobable
answerishyperthyroidism

---

1942.Blackpiedraiscausedby?
a)Piedraiahortae
b)Trichosporonasahi
c)Trichosporonovoides
d)Trichosporoninkin
CorrectAnswer-A
Ans.is'a'i.e.,Piedraiahortae
Piedraisanasymptomaticsuperficialfungalinfectionofthehair
shaftalsoknownastrichomycosisnodu-laris.Blackpiedrais
causedbyPiedraiahortae,whereaswhitepiedraiscausedby
pathogenicspeciesoftheTrichosporongenus,namelyTrichosporon
asahii,Trichosporonovoides,Trichosporoninkin,Trichosporon
mucoides,Trichosporonasteroides,andTrichosporoncutaneum.

---

1943.Keratodermicsandlesisafeatureof?
a)Pityriasisrosacea
b)Lichenplanus
c)Psoriasis
d)Pityriasisrubrapilaris
CorrectAnswer-D
Ans.is`d'i.e.,Pityriasisrubrapilaris
Pityriasisrubrapilaris
Itisachronicpapulosquamousdisorderofunknownetiology
characterizedby:?
1. Scaling(PityriasismeansscalingSkindisorder)
2. Erythmatousplaque(Rubra)
3. Follicularpapules(Pilaris)
Hencethenamepityriasisrubrapilaris.
Twopeaksofageareseen:?
1. 5-10yearsinjuveniletype
2. 40-60yearsinadulttype
Clinicalpresentation
Characteristiclesionsareerythmatous(orangetopink),follicular,
scalyplaques.Acharacteristicfeatureofplaquesisthepresenceof
distinctislandsofnormalskin.
Sitesofpredilection
Trunk-->Lesionsonthetrunkevolveincraniocaudal(Cephalo
caudal)direction.Typically,follicularlesionsareseenonthedorsum
ofhandsonknuckles-->Nutmegpapules.Associatedfeatures
1. Diffuseerythemaandscalingofface.
2. Orangishthickeningofpalmsandsoles(Keratodermicsandals).
3. Nails-->Distalyellowbrowndiscolorationandnailplatethickening.

---

ComplicationsErythroderma
Treatment
Localizedlesions-->Topicalcorticosteroids+Keratolytics(Salicylic
acid,urea)
Erythroderma-4VitaminA,Acitretin(Retinoids),oralmethotrexate

---

1944.Inscabieswhichskinlayerisaffected?
a)Stratumcorneum
b)Stratumbasale
c)Stratumlucidum
d)Stratumgerminatum
CorrectAnswer-A
Ans.is'a'i.e.,Stratumcorneum
Aftercopulation,themalemitediesandthefemalemiteburrowsinto
thesuperficialskinlayer(stratumcornuem)attherateof2mm/day.
Femalemitelayseggswhichhatchintolarva,whichmouldsand
matureintoadultmites.
Themitethenburrowsintostratumcorneum.
Theseburrowisvisibleclinicallyasanirregulargray-brownline.
Burrowisapathognomicsignforscabies.

---

1945.Groovesignofgreenbaltisseenin?
a)LGV
b)Donovanosis
c)Chancroid
d)GenitalHerpes
CorrectAnswer-A
Ans.is'a'i.e.,LGV
GroovesignofGreenblatt'ispathognomonicofLGVwheninguinal
lymphnodesareenlarged,theyareseparatedbyPoupart'sligment,
producingagroove.

---

1946.Mutationinwhichcollagenispresentin
epidermolysisbullosa?
a)II
b)IV
c)V
d)VII
CorrectAnswer-D
Ans.is'd'i.e.,VII
MolecularpathologyofEB
Normalbasementmembraneisbetweenepidermalbasallayerand
dermis.Thisbasementmembrane(basallamina)isattachedto
basalcellshemidesmosomeswiththehelpofkeratincontaining
intermediatefilamentsandisattachedtodermis(dermalpapillary
layer)withthehelpoftypeVIIcollegencontainingfibrils.Anydefect
inthisanchoringcomplexleadstoseparationofskin;thesiteof
separationdependsonthetypeofdefect
1. EBsimplex-->Mutationingenecodingforkeratin5&14(major
keratinofBMZ)andseparationwillbeepidermal.
2. EBjunctional-->MutationinLantinina-3(LAMa-3),LAM[I-3,LAM
7-2genes.Aslamininispartofbasementmembranetheseparation
willbeatdermo-epidermaljunction(DEJ).
3. EBdystrophicans-->MutationincollagenVII-Algene.Ascollagen
VIIcontainingfibrilsjoinBMtodermalpapilla,separationwillbein
thedermis.
Anyoftheabovedefectresultsindefectivecohesivenesswhich
leadstovulnerabilitytotraumaandblistersformation.Asthe
diseaseisinherited,Familyhistorymaybepositive.

---

1947.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

---

1948.Onychomycosisismostcommonly
causedby?
a)a)Trichophytonrubrum
b)Trichophytonmentagrophytes
c)Epidermatophytonfloccosum
d)a)Candida
CorrectAnswer-A
Ans.is'a'i.e.,Trichophytonrubrum
TineaUnguium(Onychomycosis)
Tineaunguiumisdermatophyticinfectionoffingersandtoenails.
MostcommoncausativespeciesisT-rubrum.Toenailsaremore
commonlyinvolved.T.Unguiummaybeoftwotypes:?
1. Distalsubungalonychomycosis:-Thisismostcommontypeof
fungalinfectionofnail(90%).Itstartsatthedistaledgeofthenail
plateandslowlygrowsinwardstoinvolveentirenailplate.
2. ProximalSubungalonychomycosis:-Startsatthebaseofnailand
slowlyinvolvestheentirenailplate.

---

1949.Gasusedinrapidairbaginflation
a)Sodiumazide
b)Nitrocellulose
c)Mercuricnitrate
d)Potassiumnitrate
CorrectAnswer-A
Ans.is'a'i.e.,Sodiumazide
Chemistryofairbags
Theinclusionofairbagsinthemodernautomobileshasledto
decreaseintheautomobileinjures.
Thetermairbagisamisnomerasairisnotinvolvedintheinflation
process.
Ratheranairbaginflatesrapidly(inabout30ms)duetoexplosive
productionofN2gas.Sodiumazideisusedwhichisrapidly
decomposedtoNitrogengas.

---

1950.Whatisthenextstepinmanagementin
managingachildwithdifficult
intubationwith4failedattemptsat
intubation?
a)UseLMA
b)Abandontheprocedure
c)TryETtubeintibationagain
d)Cricothyrotomy
CorrectAnswer-A
Ans.is'a'i.e.,UseLMA

---

1951.Currentmodeofanalgesiabestfor
intrapartumpainrelief?
a)Epiduralanalgesia
b)Spinalanaesthesia
c)Inhalational
d)Localanalgesia
CorrectAnswer-A
Ans.is'a'i.e.,EpiduralAnalgesia
Continuouslumbarepiduralanalgesiaistheprocedureofchoicefor
painreliefduringnormallabourandvaginaldelivery(Intrapartum
pain).

---

1952.Elderlypatientwithfracturerighthip
anestheticofchoice
a)Spinal/epidural
b)General
c)Localinfiltration
d)Noneoftheabove
CorrectAnswer-A
Ans.is'a'i.e.,Spinal/epidural

---

1953.Whichofthefollowinginhalational
agentsensitizesmyocardiumto
catecholamine
a)Sevoflurane
b)Isoflurane
c)Ether
d)Halothane
CorrectAnswer-D
Ans.is'd'i.e.,Halothane
Someinhalationalagentsensitizethehearttoadrenaline-->
Arrhythmiascanoccur-->Thereforetheseagentsare
contraindicatedinPheochromocytomaandalongwithadrenaline.
Halothanehasmaximumpropensity.
OtheragentssensitizingthehearttoadrenalineareTrilene,
Cyclopropane,Chloroform,Enflurane

---

1954.Whichofthefollowingisnotprimarily
usedtoanesthetizemucosa?
a)Benzocaine
b)Lidocaine
c)Bupivacain
d)Tetracaine
CorrectAnswer-C
Ans.is'c'i.e.,Bupivacaine

---

1955.Postspinalheadachelastsfor?
a)10min
b)Ihrs
c)10days
d)1week
CorrectAnswer-C
Ans.is'c'i.e.,10days
PostduralpunctureheadacheisduetoCSFleak.Typicallocationis
bifrontaloroccipital.
Headachegetsworsenonsittingoruprightpostureandisrelieved
bylyingdownpositionandabdominalpressure-->Thehallmarkof
postduralpunctureheadachei.e.,associationwithbodyposition.
Theonsetofheadacheisusually12-72hoursfollowingthe
procedure,however,itmaybeseenalmostimmediately.Inmost
casesitlastsfor7-10days.
PDPHisbelievedtoresultfromleakageofCSFfromaduraldefect
anddecreasedICT.LossofCSFataratefasterthatitcanbe
producedcausestractiononstructuresupportingthebrain,
particularlyduraandtentorium.Tractiononcranialnerve
(particularly6thnerve)producesdiplopia.
FactorsthatincreasetheincidenceofPDPHareyoungage,female
sex,Pregnancy,largeboreneedleandmultiplepunctures.
UseofsmallboreneedlecanpreventPDPH.
Intiallyconservativetreatmentisgivenwhichincludesanalgesics
(NSAIDs),oralori.v.,fluids,Sumatriptan,cosyntropin,caffeineand
recumbentposition.
Ifconservativetreatmentfails,epiduralbloodpatchcanbeused.It
involvesinjecting15-20mlofautologusbloodintotheepidural

---

spacewhichstopleakageofCSFbycoagulationandmasseffect

---

1956.Onsetofpostspinalheadacheis
usuallyathoursafterspinalanesthesia
a)0-6
b)6-12
c)12-72
d)72-96
CorrectAnswer-C
Ans.is'c'i.e.,12-72

---

1957.Trueaboutpostduralheadacheisall
except:?
a)Orientingbevelededgeneedleparalleltolongaxispreventsit
b)Thinboreneedlepreventsit
c)Itismorecommoninmales
d)Timingofambulationhasnoeffectoveritsincidence
CorrectAnswer-C
Ans.is`c'i.e.,Itismorecommoninmales
FACTORSTHATINCREASETHEINCIDENCEOFHEADACHE
AFTERSPINALPUNCTURE
Age:Younger,morefrequent.
Sex:Females>males
Needlesize:Larger>smaller
Needlebevel:Lesswhentheneedlebevelisplacedinthelongaxis
oftheneuraxis
Pregnancy:Morewhenpregnant
Duralpunctures:Morewithmultiplepunctures
FACTORSTHATDONOTINCREASETHEINCIDENCEOF
HEADACHEAFTERSPINALPUNCTURE
Insertionanduseofcathetersforcontinuousspinalanaesthesia
Timingofambulation
Aboutoptiona
Orientinganeedlebevelparallelwiththeaxisofthespine,suchthat
thelongitudinalfibresofthedurawouldmorelikelybeseparated
thancut,resultsinalowerincidenceofpostspinalpuncture
headache.

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1958.Localanaestheticcausing
methemoglobinuriais?
a)Dibucaine
b)Chlorprocaine
c)Procaine
d)Benzocaine
CorrectAnswer-D
Ans.is'd'i.e.,Benzocaine
ImportantfactsaboutLAs
ChlorprocaineistheshortestactingLA.
Dibucaineisthelongestacting,mostpotentandmosttoxicLA.
Procaine&chlorprocaineareleastpotentLAs.
BupivacaineisthemostcardiotoxicLA(Ropivacaineisanewer
bupivacainecongenerwithlesscardiotoxicity).
Levobupivacaine(TheS(-)enantiomerofbupivacaine)isless
cardiotoxicandlesspronetocauseseizure.
PrilocaineandBenzocainecancauseMethaemoglobinemia
LignocaineisthemostcommonlyusedLA.
Bupivacainehasthehighestlocaltissueirritancy.
Chlorprocaineiscontraindicatedinspinalanaesthesiaasitcan
causeparaplegiaduetopresenceofneurotoxicpreservativesodium
metabisulphite.
ProcaineistheLAofchoiceinmalignanthyperthermia

---

1959.PercentageoflidocaineinEutectic
mixture-
a)1%
b)2.5%
c)5%
d)10%
CorrectAnswer-B
Ans.is'b'i.e.,2-5%
EutecticmixtureoflocalAnaesthetics
Thisisuniquetopicalpreparationwhichcananaesthetiseintactskin.
Itisamixtureof2.5%lidocaineand2.5prilocaine.
Itactsslowlyandthecreammustheldincontactwithskinforat
least1hour.
EMLAisused:tomakevenepuncturepainlessespeciallyin
children,andforprocedurelikeskingrafting&circumcision.
Assystemicabsorptionofprilocainecancausemethemoglobinemia,
EMLAshouldnotbeusedonmucocutaneousmembraneorinvery
smallchild.

---

1960.Percentageoftetracaineusedineye
surgery?
a)0.5%
b)1%
c)2%
d)4%
CorrectAnswer-A
Ans.is'a'i.e.,0.5%
Cataractsurgerycanbeperformedusingtopicalanaesthesiaalone.
Tetracaine0.5%andLidocaine4%canbeused.
Advantagesofthismethodisthatitavoidsthepotential
complicationswithretorbulbarandperibulbarinjections.
Dsadvantagesincludethepotentialforeyemovementduring
surgery,increasedpatientanxiety,anddiscomfortfromthe
microscopelight

---

1961.Inepiduralanaesthesiadrugisinjected
?
a)Outsidethedura
b)Insidetheduramater
c)Insidearachnoidmater
d)Insidepiamater
CorrectAnswer-A
Ans.is'a'i.e.,Outsidethedura

---

1962.Localanaestheticwithprolongedaction
?
a)Procaine
b)Cocaine
c)Lidocaine
d)Dibucaine
CorrectAnswer-D
Ans.is'd'i.e.,Dibuca
Dibucaineisthelongestactinglocalanaesthetic
Chlorprocaineistheshortestactinglocalanaesthetic
Decreasingorderofduration:-Dibucaine>Bupivacine=
Tetracaine=Ropivacaine=Etidocaine>Prilocaine=Lignocaine=
Mepivacaine=Cocaine>Procaine>Chlorprocaine.

---

1963.DrugusedtoprolongactionofLAin
Hypertensivepts?
a)Clonidine
b)Felypressin
c)Dexmeditomidate
d)Noradrenalin
CorrectAnswer-B
Ans.is'b'.e.,Felypressin

---

1964.Supraclavicularblockisusedfor
surgeryof?
a)Shoulder
b)Forearm
c)Arm
d)All
CorrectAnswer-D
Ans.isD.`(A)Shoulder(B)Forearm(C)Arm

---

1965.Mostcommoncomplicationofcoeliac
plexusblock?
a)Hypotension
b)Parasthesias
c)Diarrhea
d)Pneumothorax
CorrectAnswer-A
Ans.is'a'i.e.,Hypotension
Celiacplexusblock
Theceliacplexusissituatedretroperitoneallyintheupperabdomen.
ItisatthelevelofT12andL,vertebraeanteriortothecruraofthe
diaphragm.Itcontainsvisceralafferentandefferentfibersdivided
fromT5toT1,bymeansofgreater,lesserandleastsplanchnic
nerves.Celiacplexusinnervatesmostoftheabdominalviscera,
thereforethisprocedureblocksthenerveswhichcomefromthe
pancreas,liver,gallbladder,stomach,intestine,spleen,kidneyand
adrenalglands.
Aceliacplexusblockcanbecombinedwithanintercostalblockto
provideanesthesiaforintra-abdominalsurgery.
Becauseceliacplexusblockresultsinblockadeoftheautonomic
nervoussystem,thisblockmayhelptoreducestressandendocrine
responsestosurgery.Forthesamereason,themostcommon
complicationofceliacplexusblockisposturalhypotenstionbecause
ofblockadeoflumbarsympatheticchainleadingtoupperabdominal
vesseldilationandvenouspooling.
Celiacplexusblockcanbedonebyfollowingthreeapproaches:-
Retrocrural(classic)approach,anterocruralapproachand

---

splanchnicnerveblock.
Celiacplexusblockisgiventotreatintractablepaininchronic
pancreatitis,gastric&pancreaticmalignancies.
Itcanbecombinedwithanintercostalblocktoprovideanesthesia
forintra-abdomivalsurgery.
PosturalhypotensionistheMostcommoncomplicationofclassic
retrocruralandsplanchnicnerveblock,
WhereasmostcommoncomplicationofAnterocruralapproachis
transientdiarrhoea

---

1966.Falseaboutlocalanesthetics
a)Prilocaineislesstoxicthanlignocaine
b)Lignocaineisusedasanantiarrhythmic
c)Mixtureofligno+prilocaineisknownaseutectic
d)Lidocaineisshorteractingthanbupivacaine
CorrectAnswer-A
Ans.is'a'i.e.,Prilocaineislesstoxicthanlignocaine

---

1967.Riskfactorsassociatedwithhealthcare
associatedpneumonia(HCAP)-
a)Acutecarehospitalizationforatleast2daysinthepreceding
90days
b)Homeinfusiontherapy
c)Immunosuppressivediseaseorimmunosuppressivetherapy
d)Antibiotictherapyinthepreceding90days
e)Hospitalizationfor>48h
CorrectAnswer-A:B:C:D:E
Answer-(A)Acutecarehospitalizationforatleast2daysinthe
preceding90days(B)Homeinfusiontherapy
(C)Immunosuppressivediseaseorimmunosuppressive
therapy(D)Antibiotictherapyinthepreceding90days
(E)Hospitalizationfor>48h
Acutecarehospitalizationforatleast2daysinthepreceding90
days
Residenceinanursinghomeorextendedcarefacility
Homeinfusiontherapy,includingchemotherapy,withinthepast30
days
Long-termdialysiswithinthepast30days
Homewoundcare
Familymemberwithaninfectioninvolvingamultipledrugresistant
pathogen
Immunosuppressivediseaseorimmunosuppressivetherapy

---

1968.PudendalNerveBlockInvolve
a)LiL2L3
b)L2L3L4
c)SiS2S3
d)S2S3S4
CorrectAnswer-D
Di.e.S2S3S4

---

1969.InBier'sblockaestheticagentgivenby
whichroute?
a)Intravenous
b)Peribulbarregion
c)Retrobulbararea
d)Dermal
CorrectAnswer-A
Ans.is'a'i.e.,Intravenous
Intravenousregionalanaesthesia(IVRA)isusedmostoftenfor
surgeryoftheforearmandhand,butcanalsobeusedfordistalleg
andfoot.
FirstIVcannulaisinsertedusuallyinthedorsumofhand.
Thentourniquetcuffisappliedtoproximalarm.
Limbiselevatedandexsanguinatedwiththehelpofanelastic
bandage(Esmarch).
Nowtourniquetcuffisinflatedabovesystolicpressure(sothatno
bloodcanenterinthatlimbandthelimbremainsexsanguinated).
Nowthelocalanaestheticsolutionisslowlyinjectedintocannula.
Theveinsarefilledwithonlylocalanaestheticasthereisnoblood
-->localanaestheticcannotbedrainedoutformupperlimband
cannotenterinsystemiccirculationbecauseofinflatedcuffin
proximalarm.
Thearmisanaesthetizedin6-8minutes.
LidocainewithoutadrenalineistheDOCforthistechnique.-
Goodman&GilmanIlth/ep.381
Afewclinicianprefersprilocaineoverlidocainebecauseofitshigher
therapeuticindex-leasttoxicLA.
Torniquecuffdeflation,prematurereleaseorfailureoftorniquetcan

---

causereleaseofLAintocirculationandtoxicity
mayoccur-->So,cardiotoxicLAslikebupivacaineandetidocaine
arecontraindicatedforBier'sblock.

---

1970.Whichofthefollowingis
contraindicatedinheadinjury?
a)Ketamine
b)Halothane
c)N,0
d)Propofol
CorrectAnswer-A
Ans.is'a'i.e.,Ketamine

---

1971.Ketaminecontraindicatedinallexcept?
a)Headinjury
b)Hypertension
c)Asthma
d)Glaucoma
CorrectAnswer-C
Ans.is`c'i.e.,Asthma
Ketamineincreasescerebralbloodflow,metabolism,oxygen
consumptionandintracranialtension,unlikethiopentone,
propofol&etomidate,whichhavecerebroprotectiveeffect,therefore
ketamineiscontraindicatedinheadinjury,intracranialspace
occupyinglesionsandforneuroanaesthesia.
CerebrovascularresponsivenesstoCO2ispreserved,andreducing
thearterialCO2tensionbyhyperventilationattenuatestheketamine
inducedriseinICT.
Ketaminehasdirectmyocardialdepressant(negativeionotropic)&
vasodilatoreffect.However,ketaminealsohas
indirectsympathomimeticeffect.Indirectsympathomimeticeffect
predominatesoverdirectmyocardialdepressant&vasodilatoreffect;
usualresponseisincreasedBP,cardiacoutputandheartrate-
Cardiac02demandisincreased.
Ketamineiscontraindicatedinaorticaneurysm,hypertensiveand
ischemicheartdisease.Ketaminealsosensitizes
thehearttoadrenaline-arrhythmiasmayoccur.
Asketaminecausesympatheticstimulation,itistheintravenous
anaestheticofchoiceinpatientswithshockandhypovolemia.
Ketamineincreasesintra-oculartension-Contraindicatedin
glaucoma&openeyesurgery.

---

Itisapotentbronchodilatorandrelievesbronchospasm-
Intravenousanestheticagentofchoiceinasthmatic(inhalational
anaestheticagentofchoiceinasthmaticsishalothane)
Itincreasesuterinetoneandintensityofuterinecontraction-agent
ofchoiceinpatientswithobstetrichaemorrhageandflacciduterus.
Injectionofketamineisnotpainful(allotheri.v.inducingagents
causepainoninjection).

---

1972.Whichofthefollowingisfastestacting
inhalationalanaestheticagent?
a)Halothane
b)Desflurane
c)Sevoflurane
d)Isoflurane
CorrectAnswer-B
Ans.is'b'i.e.,Desflurane
Blood:Gaspartitioncoefficient(B:Gcofflcient)
Itisthemeasureofsolubilityoftheagentintheblood.Agentwith
lowbloodsolubility(lowB:Gcoefficient)willhavehigh
concentrationinalveolarairasitwilldiffuselessthroughthealveolar
capillarymembranebecauseoflowbloodsolubility.Sincealveolar
concentrationdeterminestheinductionandrecovery,induction&
recoverywillbefastwithagentwithlessB:Gpartitioncoefficient;
andinduction&recoverywillbeslowerwithagentswithhighB:G
partitioncoefficient.
DesfluranehasminimumB:Gpartitioncoefficient(leastblood
solubility)HasFastestonsetandrecovery.oMethoxyfluranehas
maximumB:Gpartitioncoefficient(Maximumbloodsolubility)-4
Hasslowestonset&recovery.
Speedofonset&recoveryindecreasingorder(Increasingorderof
B:Gpartitioncoefficientandbloodsolubility):?
Desflurane(0.42)>Cyclopropane(0.44)>N2O(0.47)>Sevoflurane
(0.69)>Isoflurane(1.38)>Enflurane(1.8)>Halothane(2.4)>
Chloroform(8)>Trilene(9)>Ether(12)>Methoxyflurane(15)

---

1973.CharacteristicEECpatternseenin
surgicaltolerancestageofanesthesia
is?
a)Alpha
b)Beta
c)Delta
d)Theta
CorrectAnswer-C
Ans.is'c'i.e.,Delta

---

1974.Thiopentoneisnotusedin?
a)Inductionofanesthesia
b)Medicallyinducedcoma
c)Astruthserum
d)Asantidepressant
CorrectAnswer-D
Ans.is'd'i.e.,Asantidepressant

---

1975.Allofthefollowingaboutthiopentone
aretrueexcept?
a)ItdecreasesICT
b)Ithasanticonvulsantaction
c)IVinjectionispainless
d)Itcancausereflextachycardia
CorrectAnswer-C
Ans.is'c'i.e.,IVinjectionispainless

---

1976.Propofolinfusionsyndromeallexcept?
a)Occurswithinfusionofpropofolfor48hoursorlonger
b)Occursincriticallyillpatients
c)Featuresarenauseaandvomiting
d)Featuresarecardiomyopathy,hepatomegaly
CorrectAnswer-C
Ans.is'c'i.e.,Featuresarenauseaandvomiting
Propofolinfusionsyndrome
Alethalsyndrome,associatedwithinfusionofpropofolfor48hours
orlonger.
Occursinchildrenandcriticallyill.
Occursasaresultoffailureoffreefattyacidmetabolismandfailure
ofthemitochondrialrespiratorychain.
Featuresare-cardiomyopathywithacutecardiacfailure,metabolic
acidosis,skeletalmyopathy,hyperkalemia,hepatomegalyand
lipemia.

---

1977.Anestheticagent/swhichhavetocolytic
effectare?
a)Halothane
b)Enflurane
c)Isoflurane
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove
Halothane,enfluraneandisofluraneproduceadosedependent
decreaseinuterinetone(tocolysis).
Studiesofisofluranedemonstratethathalogenatedcompounds
reduceboththefrequencyofuterinecontractionsandtheinterval
betweenthem.

---

1978.Actionofwhichanestheticagentis
throughNMDAreceptors?
a)Xenon
b)NO
c)Succinylcholine
d)Etomidate
CorrectAnswer-A
Ans.is'a'i.e.,Xenon
Xenon
ItexertsanaestheticactionbynoncompetitiveblockadeofNMDA
receptors.
Xenonhasbeenusedasageneralanesthetic.
Xenoninteractswithmanydifferentreceptorsandionchannelsand
likemanytheoretically

---

1979.Followingarehepatotoxicanesthetic
agentsexcept?
a)Halothane
b)Chloroform
c)Ether
d)Propofol
CorrectAnswer-D
Ans.is`d'i.e.,Propofol
Zimmermannp.458]
Followingarethegroupsofhepatotoxicanestheticagents:
GroupI:Drugswithwellknownhepatotoxicpotentialandcontaining
Chlorineorbromine.Eg:chloroform.
GroupII:DrugswhichcontainfluorineEg:halothane,
methoxyflurane.
Desflurane,enflurane,sevoflurane,isoflurane,nitrousoxideand
carbontetrachloridearealsolinkedwithhepatotoxicity.

---

1980.Drugsusedfordaycaresurgeryareall
except?
a)Propofol
b)Sevoflurane
c)Doxacurium
d)Desflurane
CorrectAnswer-C
Ans.is'c'i.e.,Doxacurium

---

1981.Anaestheticofchoicefordaycare
srgeryis?
a)Thiopentone
b)Nitrousoxide
c)Propofol
d)Halothane
CorrectAnswer-C
Ans.is'c'i.e.,Propofol

---

1982.AllofthefollowingareNondepolarising
muscularblockersexcept
a)Pancuranium
b)Dexacurium
c)D-Tubocurarine
d)Succinylcholine
CorrectAnswer-D
Ans.is'd'i.e.,Succinylcholine

---

1983.Whichamongthefollowingisa
depolarisingmusclerelaxant?
a)Decamethonium
b)Dtubocurarine
c)Doxacurium
d)Atracurium
CorrectAnswer-A
Ans.is'a'i.e.,Decamethonium
Morgan4th/ep.214]
Seeexplanation-4ofsession-3.

---

1984.Longestactingamongmusclerelaxant
is?
a)Doxacurium
b)Rocuronium
c)Vecuronium
d)Atracurium
CorrectAnswer-A
Ans.is'a'i.e.,Doxacurium
Amongthegivenoptions,onlydoxacuriumislongacting.
Seeexplanation-4ofsession-3.

---

1985.Atracuriumisexcretedby
a)Renalexcretion
b)Hepaticelimination
c)Nonenzymaticdegradation
d)Alloftheabove
CorrectAnswer-C
Ans.is'c'i.e.,Nonenzymaticdegradation
Theuniquefeatureofatracuriumisinactivationinplasmaby
spontaneousnonenzymaticdegradation(Hofmannelimination)in
additiontothatbyalkalineesterhydrolysis.
Consequentlyitsdurationofactionisnotalteredinpatientswith
hepatic/renalinsufficiencyorhypodynamiccirculationPreferred
musclerelaxantforsuchpatientsaswellasforneonatesandthe
elderly.oAtracuriumismetabolisedtolaudanosinethatis
responsibleforseizures.
ItcancausehistaminereleaseHypotension&bronchoconstriction.

---

1986.Whichisasafemusclerelaxantinrenal
failure?
a)Cisatracurium
b)Rocuronum
c)Vecuronium
d)Succinylcholine
CorrectAnswer-A
Ans.is'a'i.e.,Cisatracurium
Theuniquefeatureofatracuriumandcisatracuriumisinactivationin
plasmabyspontaneousnonenzymaticdegradation(Hofman
elimination)inadditiontothatbyalkalineesterhydrolysis.
Thereforebothofthesedonotrequirehepaticorrenalroutesfor
eliminationthereforecanbeusedsafelyinhepaticandrenalfailure.
Moreover,cisatracuriumdoesnotprovokehistaminerelease,
thereforeitispreferredoveratracurium.

---

1987.Shortestactingnondepolarizing
musclerelaxantis?
a)Mivacurium
b)Doxacuronium
c)Pipecurium
d)Vecuronium
CorrectAnswer-A
Ans.is'a'i.e.,Mivacurium
Suxamethonium(succinylcholine)istheshortestactingskeletal
musclerelaxant.oMivacuriumistheshortestactingnondepolarizing
skeletalmusclerelaxant.

---

1988.Trueaboutmalignanthyperthermiais
allexcept
a)MostcommoncauseisSch
b)Dantroleneisthedrugofchoice
c)EndtidalCO,isincreased
d)Bradycardiaoccurs
CorrectAnswer-D
Ans.is'd'i.e.,Bradycardia

---

1989.DISSisusedfor?
a)Correctapplicationofcylindertoanaesthesiamachine
b)Toprovideanalgesia
c)TomonitorBP
d)TomonitorCVP
CorrectAnswer-A
Ans.is`a'i.e.,Correctapplicationofcylindertoanaesthesia
machine

---

1990.Laryngealmaskairwaynotusedin?
a)Babyweighing<1500gms
b)PregnantPatients
c)OcularSurgeries
d)Difficultairway
CorrectAnswer-B
Ans.is`b'i.e.,PregnantPatients
IndicationsofLMA
1. Asanalternativetointubationwheredifficultintubationisanticipated
(difficultairway).
2. Tofacilitateendo-trachealintubationinapatientwithdifficult
airways.
3. Situationsinvolvingadifficultmaskfit.
4. Securingairway(ascardiopulmonaryresuscitation)inemergency
whereintubationandmaskventilationisnotpossible.
5. Forminorsurgeries(shortsurgeries),whereanaesthetistwantsto
avoidintubation.
6. Asaconduitforbronchoscopes,smallsizetubes,gumelastic
bougies.
7. Forextraandintra-ocularsurgeriesincludingretinopathysurgeryin
prematureinfants--)LMAisparticularlyusefulinophthalmic
surgeryasproblemscreatedbyothertwoairwaysareeliminated:-
8. Facemaskcreatesprobleminsurgicalfieldaccessduetoitssize
(LMAprovidesabetteraccess).
9. EndotrachealintubationmaycauseraisedIOT(LMAhasnoeffect).
ContraindicationsofLMA
1. Conditionswithhighriskofaspirationi.e.,fullstomachpatients,
hiatushernia,pregnancy.

---

2. Oropharyngealabscessormass(tumor).
3. Massivethoracicinjury
4. Massivemaxillofacialtrauma

---

1991.Thelaryngealmaskairwayusedforsecuringtheairwayofapatientinall
ofthefollowingconditions,EXCEPT:
a)Inadifficultintubation
b)Incardiopulmonaryresuscitation
c)Inachildundergoinganelective/routineeyesurgery
d)Inapatientwithalargetumourintheoralcavity
CorrectAnswer-D
Oropharyngealabscessormassisacontraindicationtotheuseoflaryngealmaskairway.
Ref:ShortTextbookofAnaesthesiaByAjayYadav,2ndEdition,Page36

---

1992.Whichofthefollowingsystemscanbe
usedtoproducePEEP?
a)Springsystem
b)Ballvalvesystem
c)Pneumaticsystem
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove
anesthesiabyHartiganp.179]PEEPValve
APEEPValveisadevicewhichmaintainstheairwayatend
exhalation.
SpringvalvesystemisthesimplestPEEPvalvesystem.Othervalve
systemsforPEEPareelectronic,magnetic,pneumaticandballvale.
PEEPdevicesmaybeintegratedintoventilatorormaybeseparate
devicesthatareattacheddirectlyintoanesthesiacircuit,CPAP
deviceormanualresuscitationbag.

---

1993.Whatisthepressureatwhichoxygenis
stored?
a)75psi
b)1600psi
c)760psi
d)2200psi
CorrectAnswer-D
Ans.is'd'i.e.,2200psi

---

1994.Themostappropriatecircuitfor
ventilatingaspontaneouslybreathing
infantduringanaesthesiais?
a)jacksonReesmodificationofAyre'sTpiece
b)MaplesonAorMagill'scircuit
c)MaplesonCorWaterstoandfrocanister
d)Bainscircuit
CorrectAnswer-A
Ans.is'a'i.e.,JacksonReesmodification

---

1995.Standardmethodtodifferentiate
betweenendotrachealandesophageal
intubationis?
a)EndtidalCO2
b)ChestX-rays
c)Auscultation
d)Partialpressureof02
CorrectAnswer-A
Ans.is'a'i.e.,EndtidalCO2

---

1996.Treatmentinpostoperativeshivering?
a)Pethidine
b)Piritramide
c)Methadone
d)Pentazocine
CorrectAnswer-A
Ans.is'a'i.e.,Pethidine
Post-anaesthesiashivering(PAS)
Postanaesthesia(postoperative)shiveringoccursin40%of
patientsrecoveringfromgeneralanaesthesia.
Sometimeitisprecededbycentralhypothermiaandperipheral
vasoconstriction,indicatingthatitisathermoregulatorymechanism
PethidineismosteffectivedrugfortreatmentofPAS.
Otherdrugsusedare--clonidine,doxapram,ketanserin,alfentonil,
butorphanol,chlorpromazine.

---

1997.Hyperbaricoxygenisnotusefulin?
a)Anemia
b)Vertigo
c)Gasgangrene
d)CompartmentSyndrome
CorrectAnswer-B
Ans.is'b'i.e.,Vertigo

---

1998.Henryslawstatesthat?
a)Ataconstanttemperaturegasdissolvesinsolutionin
proportiontoitspartialpressure
b)AtaconstantPressuregasdissolvesinsolutioninproportionto
itstemperature
c)Ataconstanttemperaturegasdissolvesinsolutionin
proportiontoitsfatsolubility
d)Ataconstantpressuregasdissolvesinsolutioninproportionto
itsfatsolubility
CorrectAnswer-A
Ans.is'a'i.e.,Ataconstanttemperaturegasdissolvesinsolutionin
proportiontoitspartialpressure

---

1999.Warfarintobestopped____________
daysbeforesurgery?
a)2to3days
b)4to5days
c)6to7days
d)8to9days
CorrectAnswer-B
Ans.is'b'i.e.,4to5days
Warfarinmayincreaseperi-operativebleeding,exceptforminor
proceduressuchascataractsurgerywithoutbulbarblocks.No
consensusexistsontheoptimalperioperativemanagementof
patientsreceivingwarfarin.
Theusualrecommendationistowithholdwarfarinstarting4to5
dayspreoperatively(iftheINRisbetween2.0and3.0)toallowthe
INRtodecreasetolessthan1.5,whichisalevelconsideredsafefor
surgicalproceduresandneuraxialblockade.
IftheINRisgreaterthan3.0,itisusuallynecessarytowithhold
warfarinlongerthan4to5days.
IftheINRismeasuredthedaybeforethesurgicalprocedureand
remainshigherthan1.8,asmalldoseofvitaminK(1to5mg
administratedorallyorsubcutaneously)canreverseanticoagulation.
VitaminKhasaneffectwithin6to10hoursafteroralor
subcutaneousadministration(morepredictablewithoral
administration),anditpeakswithin24hoursto48hours.
Administrationofhigherdosesmayleadtowarfarinresistancewhen
therapyisinitiatedagain.

---

2000.IVdoseof1:10000concentrationof
epinephrineinpretermbabyis?
a)0.1m1
b)0.2ml
c)0.3ml
d)0.4ml
CorrectAnswer-B
Ans.is'b'i.e.,0-2ml
Epinephrine
TheIVdoseof1:10,000concentrationis0.1m1/Kg.Thusitisabout
0.5mlfortermbabyand0.2mlforpretermbaby.
Endotrachealtubedosingis1m1/Kg.thusitisabout3m1forterm
babyand1mlforpreterm.

---

2001.Macintoshindicatorisusedfor?
a)ToassessdegreeofNMblockade
b)Localizationofextraduralspace
c)ToassesslevelofGA
d)Tomonitorrespiratorydepression
CorrectAnswer-B
Ans.is'b'i.e.,Localizationofextraduralspace
Variousmethodshavebeenusedtolocatetheepidural(extradural
space),mostofwhichrelyonsubatmosphericpressure.
Theseare:-
Lossofresistancetoairorsaline(mostcommontechnique).
Gutierrez'smethod:Ahangingdropofsalineonthehubofneedleis
drawninastheepiduralspaceisentered(morereliableinthorocic
thanlumbarregion).
Odom'sindicator:Afine-boreglasstubefilledwithsalineanda
bubblethatmovesinresponsetoadropinpressure.
Macintosh'sindicator:Asmallrubberballoonfilledwithair
connectedtoanadaptorcausingittodeflateonenteringthe
epiduralspace.
Macintosh'sspring-loadedneedle.
Ultrasoniclocalization.
Oxfordepidularspacedetector.

---

2002.Followinggroupofdrugsisnotthefirst
lineinthemanagementofchronic
pain?
a)Opioids
b)Antiepileptics
c)Serotonergicdrugs
d)Dopamineantagonist
CorrectAnswer-D
Ans.is'd'i.e.,Dopamineantagonist

---

2003.Whichofthefollowingarefeaturesof
pulmonaryoxygentoxicity?
a)Increasedcapillaryendothelialpermeability
b)Decreasedmucociliarytransportinairways
c)Inhibitionofphagocytosisfunctionofalveolarmacrophages
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,Alltheabove
1. Prolongedinhalationofhighconcentrationof0,isknowntodamage
thelungs.
2. Pulmonarytoxicityof0,isrelatedtotheoxygentensioninalveoli.
Thepulmonaryoxygentoxicityhasthefollowingfeatures
Increasedcapillaryendothelialpermeabilitycausingaccumulationof
fluidintheinterstitialspace.
Depressionofmucociliarytransportfunctionofairway
Inhibitionofphagocytosisofalveolarmacrophages
Changesinthesurfactantactivityanditsproduction.

---

2004.USGisdonetovisualizeallexcept-
a)Fluid
b)Bile
c)Bloodflow
d)Bone
CorrectAnswer-D
Answer-D.Bone
USGisdonetovisualizesofttissuesandfluids.Butnotforbone.

---

2005.RegardingHRCT,allaretrueexcept-
a)MeanshighreconstructionCTimaging
b)Hasnarrowbeamcollimation
c)Investigationofchoiceforinterstitiallungdisease
d)Hassmallfieldofvision
CorrectAnswer-A
Answer-A.MeanshighreconstructionCTimaging
PrinciplesofHRCT(HighresolutionCT)are:
1. Narrowbeamcollimation(Thincollimation)
2. Highfrequencyreconstructionalgorythm,e.g.,bonealgorithm
3. Smallfieldofvision

---

2006.APETscanuseswhichofthefollowingtracermaterials?
a)FDG
b)CDF
c)ADP
d)MIBG
CorrectAnswer-A
Positronemissiontomography(PET)usespositron-emitting
radioisotope(tracer)-18F-FDG
APETscanusesasmallamountofaradioactivedrug,ortracer,to
showdifferencesbetweenhealthytissueanddiseasedtissue.
ThemostcommonlyusedtraceriscalledFDG(fluorodeoxyglucose),
sothetestissometimescalledanFDG-PETscan.
Veryexpensive.
Bettercontrastandspatialresolution

---

2007.AllofthefollowingaboutMRIare
correctexcept:
a)MRIiscontraindicatedinpatientswithpacemakers
b)MRIisusefulforevaluatingbonemarrow
c)MRIisbetterforcalcifiedlesions
d)MRIisusefulforlocalizingsmalllesioneinthebrain
CorrectAnswer-C
Ci.e.MRIisbetterforcalcifiedlesions
*MRIisverypoorindetectionofcalcification.ItisinferiortoCT
scan,mammographyandx-rayindetectingcalcification.Thatiswhy
itlagsbehindmammographyinearlydetectionofnoninvasiveductal
carcinomainsitu(DCIS)Q,whichmostcommonly
hasmicrocalcificationasitsonlypresentingfeature.Andsimilarlyit
hasaverylimitedroleindetectionofrenalstonesandgall
stonesQ.However,itisimportanttonotethatonlyupto60%ofgall
stoneshaveenoughcalciumdensity(morethanthatofbile)toget
visualizedonCT.Becausofitssuperiorcalcificationdetection
abilities,MDCTisusedinAgatstonscoring(Coronarycalcium
scoring)ofcalcifiedplaquesofcoronaryarteryusingcoronary
calciumasasurrogatemarkertodetectthepresenceandmeasure
theamountofcoronaryatherosclerosis.Becausewithexceptionof
patientswithrenalfailurecalcificationofarteriesoccursexclusively
incontextofatherosclerosis.
SimilarlynonenhancedhelicalCTissuperiortoallotherimaging
modalitiesindiagnosisofurinarytractcalculiQbutatthecostof
higherradiationexposure.
NowthereisnoneedtosaythatMRIisbetterthatCTforevaluation
ofbonemarrow,smallbrainlesions,meniscus/ligamentinjuries,
softtissuetumorsandmeningealpathology.ButMRIisverypoorin

---

softtissuetumorsandmeningealpathology.ButMRIisverypoorin
detectionofcalcification.

---

2008.AnabsolutecontraindicationofMRIis:
a)Pacemaker
b)Prostheticcardiacvalves
c)Insulinpump
d)Choclearimplants
CorrectAnswer-A
Pacemaker[Ref:Harrison17/ep2494;GraingerDiagnostic
Radiology4/ep122;
variouswebsites-http://www.mr-tip.com/servl.php?ope=dbl
&dbs=Prosthetic%20Heart%20Valves
http://www.imrser.org/PDF/Shellock.HeartValves.JMRLpdf;http
://www.mrtip.com/sery1.php?type=dh1&dbs=Prosthetic
%20Heart%20Valves
;andjournal-_RadioGraphics2004;24:1257-1267
MRisconsideredamongthesafestimagingmodalitiesforpatients,
evenatveryhighfieldstrengths,morethan3-4tesla.
ButFerromagneticobjectsundermagneticfieldcanbevulnerableto
4adverseeffects:
Movement(causingstructuralinjury),
Currentconduction(potentiallycausingelectricalshock),
Heating(possiblycausingburninjury),and
Artifactgeneration
Seriousinjuriescanbecausedbyattractionofferromagneticobjects
intothemagnet,whichwouldactasmissilesifbroughttoocloseto
themagnet.
Ferromagneticimplants,suchasaneurysmclips,maytorque(turn
ortwist)duetothemagneticfield,causingdamagetovesselsand
evendeath.

---

Metallicforeignbodiesintheeyehavemovedandcaused
intraocularhemorrhage.
Pacemakersandpacemakerleadsareacontraindication,asthe
pacemakercanmalfunctionandcausearrhythmiaorevendeath.
HoweverwithgrowingexpansionofMR,increasingnumberof
implantmedicaldevicesarebeingMRsafe.Sonewerpacemaker
andaneurysmclipsarebeingmadewhichareMRsafe.
AbsoluteContraindicationsfortheMRIscan:
Electronically,magnetically,andmechanicallyactivatedimplants
Ferromagneticorelectronicallyoperatedactivedeviceslike
automaticcardioverterdefibrillators
Cardiacpacemakers
Metallicsplintersintheeye
Ferromagnetichaemostaticclipsinthecentralnervoussystem
(CNS)
Patientswithanimplantedcardiacpacemakerhavebeenscanned
onrareoccasions,butpacemakersaregenerallyconsideredan
absolutecontraindication.
RelativeContraindicationsfortheMRIscan:
Cochlearimplants
Otherpacemakers,e.g.forthecarotidsinus
Insulinpumpsandnervestimulators
Lendwiresorsimilarwires(MRISafetyrisk)
Prostheticheartvalves(inhigh.fields,ifdehiscenceissuspected)
Haemostaticclips(body)
Nonierromagneticstapedialimplants
Womenwitha.first-trimesterpregnancy
Tattoos(onlyaprobleminhigher-strengthmagnetic.fieldi.e.more
than3tesla)
1Reflittp://www.mr-tip.com/sery1.php?type=dbl&dbs=Prosthetic
%20Heart%20Valvesi

---

2009.Radiocontrastiscontraindicatedinallofthefollowingconditionsexcept?
a)Renalfailure
b)Patientonmetformin
c)Dehydration
d)Obesity
CorrectAnswer-D
Obesityisnotacontra-indicationfortheadministrationofradio-contrastagent.
Ref:RadiologicTechnologyataGlanceByTheresaS.Reid-Paul;pages66.

---

2010.Allofthefollowingaretrueabout
neutroncontraststudyexcept-
a)Providesspatialresolution
b)Hydrogenandboronhavehighneutroncrosssection
c)Allowsvisualizationoflightelementsinsideheavymetallic
objects
d)Isanexampleofdestructivetesting
CorrectAnswer-D
Answer-D.Isanexampleofdestructivetesting
Neutronsinteractwithmatterinawaythatisquitecomplementaryto
X-rays,andsoneutronimagingandneutronradiographyare
importanttechniquesfornon-destructivetesting,mostsuitedfor
visualizationoflightelementsintheinteriorof(heavy)metallic
objects.
Examplesofhighabsorptioncross-sectionmaterialsinclude
hydrogenandboronwhileironhaslowerneutroncross-section.

---

2011.InnormalX-rayofshoulderwhichis
superiormoststructure-
a)Greatertubercle
b)Surgicalneckofhumerus
c)Coracoidprocess
d)Headofhumerus
CorrectAnswer-C
Answer-C.Coracoidprocess
Fromsuperiortoinferior(importantstructureonX-raysholder):-
Clavicle:Acromian:Coracoid:Superiormarginofhumeralhead:
greatertubercle:anatomicalneck:surgicalneck.

---

2012.MaximalvalveofHUUnit-
a)Water
b)Fat
c)Softtissue
d)Bone
CorrectAnswer-D
Answer-D.Bone
BonehasmaximumHU+1000

---

2013.Piezoelectriccrystalmostwidelyused
inultrasonographyprobesis-
a)Quartz
b)Molybdenum
c)Titanium
d)Leadzirconatetitanate
CorrectAnswer-D
Answer-D.Leadzirconatetitanate
Leadzirconatetitanate(PZT)isthemostwidelyusedmaterialinthe
ultrasoundtransducers/probesreplacingthefirstlydiscovered
bariumtitanate.

---

2014.Theprincipleusedinradiotherapyis:
a)Cytoplasmiccoagulation
b)Ionisingthemolecules
c)DNAdamage
d)Lowdosecausestissuenecrosis
CorrectAnswer-C
Ans.DNAdamage
Radiotherapyisthetreatmentofcancerwithionizingradiation.
ItworksbydamagingtheDNAwithinthetumorcells,makingthem
unabletodivideandgrow.
Thegoalofradiationtherapyistomaximizethedosetotumorcells
whileminimizingexposuretonormal,healthycells.
Ref:EmamiBetal.1991

---

2015.Adderheadappearanceisseenin:
March2011
a)Posteriorurethralvalve
b)Uretrocoele
c)Bladdertumour
d)Horseshoekidney
CorrectAnswer-B
Ans.B:Ureterocoele
The'adderhead'onexcretoryurographyistypicalofureterocoele
Ureteroceleisacysticdilatationofthedistalureter.
CobraheadorAdderheadappearanceisdiagnosticofureterocele.
Spiderlegappearanceinpolycystickidney.
Ref:Bailey&Love,25thEdition,Page1290

---

2016.Mostsensitiveinvestigationfor
minimumgasinabdomenis-
a)ChestX-rayAPView
b)CTScan
c)X-rayabdomeninsupineposition
d)X-rayabdomeninerectposition
CorrectAnswer-B
Answer-B.CTScan
CTScanissuperiortoplainradiographsindetectionofminute
quatitiesofpneumoperitoneum
ThusCTScanisregardedasthemostsensitiveinvestigationfor
detectionofminutequantitiesofintraperitonealgas.
BestradiographicviewforpneumoperitoneumisChestx-ray.Itis
usuallythefirstinvestigationofchoice.

---

2017.Cottonwoolskullisaradiological
featureof-
a)Pagetsdisease
b)Eosinophilicgranuloma
c)Fibrousdysplasia
d)Fibrousdysplasia
CorrectAnswer-A
Answer-A.Pagetsdisease
Cottonwoolskull-Paget'sdisease
Groundglassskull-Fibrousdysplasia
Punchedout/Raindroplesionofskull-Multiplemyeloma
Geographicskull-Eosinophilicgranuloma

---

2018.Themostsensitiveimagingmodalityfor
diagnosisofuretericstoneinpatient
withacuterenalcolicis-
a)XrayKUB
b)USG
c)NoncontrastCTabdomen
d)ContrastenhancedCTabdomen
CorrectAnswer-C
Answer-C.NoncontrastCTabdomen
Non-contrastspiralCThasnowbecometheinvestigationofchoice
todiagnoserenalanduretericstones.
Investigationofchoiceforrenalanduretericstonesnon-contrast
spiralCT

---

2019.Radiologicalfeaturesofcoarctationof
aortais/are-
a)Reversefigureof3sign
b)Docksign
c)Doubleaorticknuckle
d)Alloftheabove
CorrectAnswer-D
Answer-D.Alloftheabove
RadiologicalsignsofCOAare:i)Reversefigureof3sign(double
bulgesignorEsign),ii)Dock'ssign;iii)Doubleaorticknuckle.
Globularheartwitholigemiclungfields
Reversefigureof'3'sign
Doubleaorticknuckle

---

2020.Eyeoftigerappearanceisseenin-
a)HallevordenSpatza
b)Suparanuclearpalsy
c)Levodopa-responsive
d)All
CorrectAnswer-D
Answer-D.All
Thisappearancecanbeseenin:
1. Hallervorden-Spatzsyndrome:classicalbutnot100%
pathognomonic
2. Progressivesupranuclearpalsy
3. Early-onsetlevodopa-responsiveparkinsonism
4. Cortical-basalganglionicdegeneration

---

2021.Tuftingofdistalphalanxis
characteristicallyseenin
a)Gout
b)Hyperkalemia
c)Hypoparathyroidism
d)Hyperparathyroidism
CorrectAnswer-D
Ans.is.D.Hyperparathyroidism
Acro-osteolysisisthetermusedtodescriberesorptionofthedistal
phalangealtufts.Causesare:-
1. Scleroderma
2. Trauma&thermalinjury
3. Hyperparathyroidism
4. Epidermalysisbullosa
5. Arthropathy(RA,Psoriasis)
6. Neuropathy(diabetes,syringomyelia

---

2022.SoapBubbleappearanceinX-rayis
seenin
a)MultiplecysticKidney
b)Neuroblastoma
c)Cysticlymphagiectasis
d)Meconiumileus
CorrectAnswer-D
Di.e.Meconiumileus
SoapbubbleappearanceinXrayisseeninmeconiumileusdueto
admixtureofgaswithmeconium.

---

2023.MercedesBenzsignisseenin:
a)Gallstone
b)Bladderstone
c)Renalstones
d)Foreignbodybronchus
CorrectAnswer-A
GallstoneREF:Sutton'stextbookofradiology,Thedition,volume1
page713
MercedesBenzsign/Seagullsign/Crowfeetsign:
Gallbladderstoneifradiopaquehasastellatefacetedappearance
withgascontainingfissuresontheplainradiographandiscalledas
MercedesBenzsign/SeagullsignorCrowfeetsign

---

2024.Coffeebeansignisseenin?
a)Gastricvolvulus
b)Sigmoidvolvulus
c)Hypertrophicpyloricstenosis
d)Midgutvolvulus
CorrectAnswer-B
SigmoidvolvulusREF:Wofganag5thep.846/748
Sign
Disease
Rattailappearance
Carcinomaesophagus
Birdbeakappearance
Achalasia
Beaksign/doubletrack/tramtrack Hypertrophicpyloricstenosis
MedusaheadcoloniesonCT
Roundworm
Pincer/claw/coiled
Intussception
spring/target/meniscussign
Coffeebeansign
Sigmoidvolvulous
Leadpipeappearance
Ulcerativecolitis
Stringofkantor/bull'seye
Chron'sdisease
Thumbprintingsign
Ischemiccolitis
Sawtoothappeanceonbarium
Diverticulosis
enema
Applecoresign
Carcinomacolon
Corkscrewappearance
Diffuseesophagealspasm
Stringsign
Hypertrophicpyloricstenosis

---

2025.Followingaresuggestiveofbenign
lesiononmammogram-
a)Macrocalcification
b)Floatingcalcification
c)Tramlinecalcification
d)Alltheabove
CorrectAnswer-D
Answer-D.Alltheabove
Calcificationpatternsinbenignlesionsofbreaston
mammography:
1. Macrocalcification
2. Popcorn(infibroadenoma)
3. Rodlikewide-spread
4. Eggshellcurvilinear
5. Tramline/tortous

---

2026.Anamolyscandoneathowmanyweeks
ofgestation-
a)14
b)16
c)18
d)20
CorrectAnswer-D
Answer-D.20
AnamolyScanisdonebetween18-21weeksofpregnancy.Itisalso
calledasmidpregnancyor20-weekscan.

---

2027.Flowingwaxappearanceonanterior
andposteriorbordersofvertebraeis
seenin-
a)Ankylosingspondylitis
b)DISH
c)Psoriaticarthropathy
d)Rheumatoidarthritis
CorrectAnswer-B
Answer-B.DISH
Diffuseidiopathicskeletalhyperostosis:DISH(hyperostotic
spondylosis,Forestier'sdisease)isamultifocalentityofolderpeople
characterizedby'flowingossificationsofthespine"involvingfouror
morecontiguousvertebraeandhyperostosisofsomeligamentous
attachments.

---

2028.Caldwellviewisdonefor
a)Sphenoidsinus
b)Maxillarysinus
c)Ethmoidsinus
d)Frontalsinus
CorrectAnswer-D
Caldwellviewistheoccipitofrontalview.Thefrontalsinusesare
seenclearlyinthisview.

---

2029.Radiologicalviewwhichbestshows
maxillarysinusandorbitis-
a)Water'sview
b)Caldwellview
c)Lateralview
d)Towneview
CorrectAnswer-A
Answer-A.Water'sview
BestviewformaxillarysinusWater'sview(occipito-mentalview)
BestviewforfrontalsinusCaldwellview(occipito-frontalview)
BestviewforsphenoidsinusBasalview(submentoverticalview)

---

2030.Bestviewforsphenoidsinusis-
a)Water'sview
b)Caldwellview
c)Basalview
d)Towne'sview
CorrectAnswer-C
Answer-C.Basalview
BestviewformaxillarysinusWater'sview(occipito-mentalview)
BestviewforfrontalsinusCaldwellview(occipito-frontalview)
BestviewforsphenoidsinusBasalview(submentoverticalview)

---

2031.Followingaretheindicationsofbarium
mealX-rayexcept-
a)Duodenalulcer
b)Carcinomastomach
c)Carcinomaheadofpancreas
d)IschemicColitis
CorrectAnswer-D
Answer-D.IschemicColitis
IndicationsforBariummealX-ray
Duodenalulcer
Periampularycarcinoma
Psendocystofpancreas
Carcinomastomach
Chronicduodenalileus
Carcinomaheadofpancreas
Duodenaldiverticula

---

2032.Inachildrenectopickidneyscanbe
diagnosedby-
a)DTPA
b)DMSA
c)MAG3
d)Noneoftheabove
CorrectAnswer-B
Answer-B.DMSA
Indicationsforstaticrenalscintigraphy(Tc-99m-DMSA):
1. Assessmentofrefluxnephropathy(scars)
2. Spaceoccupyinglesions(corticalmass)
3. Investigationofhorseshoe,solitaryorectopickidney

---

2033.Gestationalsaccanbeseenusing
ultrasonographyattheearliestby:
Gujarat07
a)3rdweek
b)4thweek
c)5thweek
d)8thweek
CorrectAnswer-C
Ans.5thweek
Thegestationalsaccanbevisualizedasearlyas41/2weeksby
transvaginalUSGand5weeksbytransabdominalUSG.

---

2034.Firstlineinvestigationfordeepvenous
thrombosisis-
a)Ultrasonography
b)Venography
c)MRI
d)Nuclearimaging
CorrectAnswer-A
Answer-A.Ultrasonography
Ultrasonographyisthecurrentfirst-lineimagingexaminationforDVT
becauseofitsrelativeeaseofuse.

---

2035.Whichofthefollowingisnotachest
radiographicfeatureofleftatrial
enlargement?
a)Doubleleftheartborder
b)Elevatedleftmainbronchous
c)Splayingofcarina
d)Enlargementofleftatrilaappendage
CorrectAnswer-A
Answer-A.Doubleleftheartborder
Singsofleftatrialenlargement
Straighteningofleftheartborder(duetoenlargementofleftatrial
appendage).
Elevationofleftmainbronchuswithwidening(Splaying)ofcarina.
Doubledensity(atrial)sign.
Posteriordisplacementofesophagusonbariumswallow.

---

2036.Floatingwaterlilysignisseenin
a)Aspergillosis
b)Hamartoma
c)Hydatidcyst
d)Cavitatingmetastasis
CorrectAnswer-C
Hydatidcyst[RefRadiologyReviewManualbyDahnert5/e,p699;
vviviv.emedicine.00In/Ined/TOPIC629.htn]
Separatedmembranesfloatingwiththecystgivetheappearanceof
waterlily.
Itispathognomonicofhydatidcyst.

---

2037.HRCTfeaturesofinterstitialpneumonia
areallexcept-
a)Reticularopacities
b)Honeycombing
c)Groundglassopacities
d)Nobronchieactaticfeatures
CorrectAnswer-D
Answer-D.Nobronchieactaticfeatures
ClassicalHRCTfeaturesofinterstitialpneumoniaare:
1. Reticularopacitiesinbasalandperipheraldistribution.
2. Tractionbronchiestasis.
3. Honeycombing(clusteredairspaces3-10mmdiameter/insubpleural
location.

---

2038.Followingarethecausesofcavityin
lungsexcept-
a)Staphylococcus
b)Wegeners
c)Hydatid
d)Sarcoidosis
CorrectAnswer-D
Answer-D.Sarcoidosis
Causesoflungcavitiesare:
1)Necrotizinginfections
2)Vascular:Pulmonaryinfarction.
3)Neoplastic:
1. Carcinomabronchus:-Especiallysquamouscellcarcinoma.
2. Metastases
3. Lymphoma
4)Granulomas:-Wegener'sgranulomatosis,Rheumatoidarthritis
(alsoKaplan'ssyndrome)
5)Abnormallung:-Infectedemphysematosbulla,sequestrated
segment,bronchogeniccyst.
6)Traumatic:-Haematoma

---

2039.Beadedlumenwithfimbrialfluidisseen
in-
a)TBoffallopiantube
b)TBofendometrium
c)TBofOvary
d)None
CorrectAnswer-A
Answer-A.TBoffallopiantube
Fallopiantubeisthemostcommonsiteoffemalegenitaltractwhich
isaffectedintuberculosis.
Onhysterosalpingography,thefallopiantubeoftenshowragged
outlineswithmultiplestrictures,givingabeadedappearance;in
somepatientstheentiretubeappearsrigidandmayexhibitsmall
terminalsacculationoftheampullaryend.

---

2040.Followingareradiologicalfindingsin
rheumatoidarthritisexcept-
a)Symmetricalinvolvement
b)Juxta-articiularosteopenia
c)Marginalerosion
d)Subchondralsclerosis
CorrectAnswer-D
Answer-D.Subchondralsclerosis
Rheumatoidarthritis
Bilateralsymmetricalinvolvement
Marginalerosion
Ankylosis
Periarticularsofttissueswelling
Subchondralcysts
Subluxationordislocation
Juxta-articularosteopenia
Narrowingofjointspace(Later)
Arthritismultilans(late)

---

2041.Whichofthefollowingis/are
radiologicalfeaturesoffluorosis?
a)Osteosclerosis
b)Corticalthickening
c)Enthesopathy
d)Alltheabove
CorrectAnswer-D
Answer-D.Alltheabove
Radiologicalfeaturesoffluorosisare:
Osteosclerosis-particularlyaffectingtheaxialskeleton.
Corticalthickeningwithencroachmentonmedullarycavity.
Enthesopathywithligamentousossification.
Largespinalosteophytes.

---

2042.Depthofgastriccarcinomasis
assessedby-
a)Abdominalultrasound
b)Bariummeal
c)Endoluminalultrasound
d)Laproscopy
CorrectAnswer-C
Answer-C.Endoluminalultrasound
Fivelayersofthegastricwallcanbeidentifiedbyendoluminal
ultrasoundandthedepthofinvasionoftumorcanbeassessedby
exquisiteaccuracy.

---

2043.Radiologicalsignsofacutepancreatitis
onplainradiographyare-
a)Sentinelloopsign
b)Coloncutoffsign
c)Renalhalosign
d)Alltheabove
CorrectAnswer-D
Answer-D.Alltheabove
Radiologicalfeaturesofacutepancreatitis:-
1. AirinduodenalC-loop
2. Coloncutoffsign
3. Gaslessabdomen
4. Sentinalloopsign
5. RenalHalosign

---

2044.Goldstandardinvestigationforchronic
pancreatitis?
a)MRI
b)ERCP
c)Pancreaticfunctiontests
d)Fecalfatestimation
CorrectAnswer-B
Answer-B.ERCP
ERCPhasbeenconsideredthemostsensitiveradiologictestforthe
diagnosisofchronicpancreatitis,withspecificERCPfindingsthat
arehighlycorrelativewiththedegreeorstageofchronicdisease.

---

2045.MostsensitiveinvestigationforDiffuse
axonalinjuryis-
a)MRI
b)CT
c)Xray
d)PETscan
CorrectAnswer-A
Answer-A.MRI
MRIisthemostsensitiveinvestigationfordiffuseaxonalinjuries.
ItshowsmultiplesmallfacesofincreasedintensityonT,IATand
decreasedintensityonTy.

---

2046.MostcommonviewusedforX-raychest
-
a)PAview
b)APview
c)Lateralview
d)Obliqueview
CorrectAnswer-A
Answer-A.PAview
Importantviewsforchestx-rayare:
1. Posterior-anteriorview(PAview)
2. Anterior-posteriorview(APview)
3. Lateralview
4. Lateraldecubitusview

---

2047.Bestinvestigationforbonemetastases
is-
a)MRI
b)CT
c)BoneScan
d)XRay
CorrectAnswer-C
Answer-C.BoneScan
Bonescan(scintigraphy)istheinvestigationofchoiceforbone
metastasis.

---

2048.Doubletracksignisseenin-
a)Duodenalatresia
b)CHPS
c)Gastriculcer
d)Achalasia
CorrectAnswer-B
Answer-B.CHPS
Double/tripletracksignisseenincongenitalhypertrophicpyloric
stenosis.

---

2049.HalflifeofRa-226-
a)8days
b)28years
c)16-22years
d)38years
CorrectAnswer-C
Answer-C.16-22years
HalflifeofRa-226is16-22years.

---

2050.Whichviewistakenforaorticwindow-
a)AP
b)LAO
c)RAO
d)LPO
CorrectAnswer-B
Answer-B.LAO
`Aleftanterioroblique(LAO)viewisusefultoassessthoracicaorta,
aorticwindowandthechamberofheart".
Clinicalradiology
Aorticwindowisthespacebetweenascendinganddescending
thoracicaorta.

---

2051.Bestimagingmodalityinpatientswith
breastimplantsis:
a)MRIscan
b)CTscan
c)Mammography
d)Radionuclidescan
CorrectAnswer-A
Ans.MRIscan
Itisthebestimagingmodalityforthebreastsofwomenwith
implants.
MRIcanbeusefirltodistinguishscarfromrecurrenceinwomenwho
havehadpreviousbreastconservationtherapyforcancer

---

2052.Theprimarydiagnosticevaluationfor
developmentaldyslasiaofhipis-
a)Clinicalexamination
b)X-ray
c)USG
d)CTScan
CorrectAnswer-C
Answer-C.USG
Ultrasonographyisnowtheprimaryimagingtechniqueinthe
diagnosisandfollowupofDDHandhasbeenshowntobemore
accuratethanclinicalandradiologicalassessmentwithasensitivity
of100%andspecificityof98%.

---

2053.HummingbirdsigninbrainMRIisseen
in?
a)Multiplesclerosis
b)Progressivesupranuclearpalsy
c)Parkinson'sdisease
d)Alzheimerdisease
CorrectAnswer-B
Ans.is'b'i.e.,Progressivesupranuclearpalsy
[RefClinicalneurology-113]
HummingbirdsignonbrainMRIisaradiologicalsignofprogressive
supranuclearpalsy.

---

2054.Investigationofchoiceforpancoast
tumoris-
a)MRI
b)HRCT
c)CECT
d)Bronchography
CorrectAnswer-A
Answer-A.MRI
Radiologicalinvestigationofchoiceforpubnonarymalignenciesis
CTscanexcepinsuperiorsulcus(pancoasttumor)whereMRIis
preferred.

---

2055.Welldefinedroundedopacityisthe
lungwithcauseirregularcalcificationis
afeatureof:
a)Hamartoma
b)Hydatidcyst
c)Amoebicabscess
d)Calung
CorrectAnswer-A
Ans.Hamartoma
Irregularcentralcalcification(Popcorncalcification)ischaracteristic
ofhamartoma.

---

2056.EmileDurkheimislinkedwithworkon
whichconditioninpsychiatry?
a)Suicide
b)Obsessivecompulsivedisorder
c)Anxietydisorder
d)Schizophrenia
CorrectAnswer-A
Ans.A.Suicide
Suicide(French:LeSuicide)
Itwasagroundbreakingbookinthefieldofsociology.
ItwaswrittenbyFrenchsociologistEmileDurliiheimandpubtshedin
1897.
Itwasostensiblyacasestudyofsuicide,apublicationuniqueforits
timethatprovidedanexampleofwhatthesociologicalmonograph
shouldlooklike.

---

2057.Highestinsightis?
a)Intellectual
b)Emotional
c)Psychological
d)Affective
CorrectAnswer-B
Ans.b.Emotional
NezirogluandStevensproposedfourdifferentlevelsof
insights:
Trueemotionalinsight
Intellectualinsight
Partialinternallyandexternallybasedinsight
Denialofillness
Trueemotionalinsightisrepresentativeofthehighestlevelofinsight
possible.Initthepatients'awarenessandunderstandingoftheir
ownthoughts,feelingsandmotivescanbeusedtochangebehavior.

---

2058.Extracampinehallucinationstermwas
givenby?
a)EugeneBleuler
b)WilliamHarvey
c)RobertMacinoff
d)EdenSperoff
CorrectAnswer-A
Ans.A.EugeneBleuler
Extracampinehallucinations
ThetermextracampineisindebtedtoLatinwordsextra-outside
andcampaneus-field.
Itwasintroducedinorshortlybefore1903bySwissPsychiatrist
EugeneBleulertodenoteahallucinationthatisexperiencedby
affectedindividualasbeingoutsidetherangeofnormalperception.

---

2059.Hypomimiais?
a)Decreasedabilitytocopy
b)Decreasedexecution
c)Deficitofexpressionbygesture
d)Deficitoffluentspeech
CorrectAnswer-C
Ans.C.Deficitofexpressionbygesture
Hypomimia
Hypomimiaoramimiaisadeficitorabsenceofexpressionby
gestureormimicry.
Thisisusuallymostobviousasalackoffacialexpressivemobility
(mask-likefacies).
Thisisafeatureoffrontalsubcorticaldisease.

---

2060.Serial7substractionisusedtotest?
a)Workingmemory
b)Longtermmemory
c)Mathematicalability
d)Recallpower
CorrectAnswer-A
Ans.A.Workingmemory
Serialsevenssubstractiontest
Serialsevens,countingdownfromonehundredbysevens,isa
clinicaltestusedtotestmentalfunction;forexample,tohelpassess
mentalstatusafterpossibleheadinjuryorinsuspectedcasesof
dementia.
Thiswell-knowntest,inactivedocumentedusesinceatleast
l944,wasadoptedaspartofthemini-mentalstateexamination.
Thetestisalsousedindeterminingwhenapatientisbecoming
unconsciousunderanaesthetic,forexamplepriortomajordental
surgery.

---

2061.Whichofthefollowingaresectionsof
mentalstateexamination?
a)Moodandaffect
b)Speechandlanguage
c)Cognition
d)Alltheabove
CorrectAnswer-D
Ans.D.Alltheabove

---

2062.Obsessiveattentionbyanindividual
towardsanotherpersoniscalled?
a)Stalking
b)Percieving
c)Following
d)Pressurizing
CorrectAnswer-A
Ans.A.Stalking
Stalking
Stalkingisunwantedorobsessiveattentionbyanindividualorgroup
towardanotherPerson.
Stalkingbehaviorsarerelatedtoharassmentandintimidationand
mayincludefollowingthevictiminpersonormonitoringthem.
Thewordstalkingisused,withsomedifferingmeanings,in
psychologyandpsychiatryandalsoinsomelegaljurisdictionsasa
termforacriminaloffense.

---

2063.Mostcommonofallpsychiatric
disordersare-
a)Anxietydisorder
b)Schizophrenia
c)Depression
d)Mania
CorrectAnswer-A
Ans.A.Anxietydisorder
Mostcommonpsychiatricdisorder>Anxietydisorders.
2dmostcommonpsychiatricdisorder>Depression.

---

2064.Patientwantstoscratchforitchingin
hisamputatedlimbisanexampleof?
a)Illusion
b)Pseudohallucination
c)Phantomlimbhallucination
d)Autoscopyhallucination
CorrectAnswer-C
Ans.C.Phantomlimbhallucination
Phantomlimbhallucination-Thepersonfeelshisbodypartsintact
intheirrespectiveplacesevenaftertheyarelostthroughamputation
orinjury.
Inthequestiongivenpatientfeelsitchingintheamputatedlimband
triestoscratchthelimb.Thusitisanexampleofphantomlimb
hallucination.

---

2065.Myxedemamadnessincludes?
a)Auditoryhallucinationsandparanoia
b)Visualhallucinationsanddepression
c)Auditoryhallucinationsanddepression
d)Paranoiaanddepression
CorrectAnswer-A
Ans.A.Auditoryhallucinationsandparanoia
Psychiatricdisordersinhypothyroidism
Theseincludedepressedmood,apathy,impairedmemoryandother
cognitivedefects.
Hypothyroidismcancontributetothedevelopmentoftreatment
refractorydepression.
Myxedemamadnessconsistingofauditoryhallucinationsand
paranoiaisseeninsomePatients.

---

2066.APACHEIIdoesnotinclude?
a)Acutephysiologyscore
b)Age
c)Sex
d)Chronichealthevaluation
CorrectAnswer-C
Ans.C.Sex
Acutephysiologyandchronichealthevaluation
Knausetal(1981)introducedthefirsttheAcutePhysiologyand
ChronicHealthEvaluation(APACHE)modelin1981andrevisedit
toAPACHEIIin1985.APACHEIIIwaspresentedin1991butasthe
regressionanalysismodellingisnotinthepublicdomainitsuptake
hasbeenslow.
APACHEIIismadeupoffourbasiccomPonents:
1)Acutephysiologyscore;
2)Chronichealthevaluation;
3)Age;
4)Urgencyofadmissiontocriticalcare

---

2067.SSRIsshouldbecarefullyusedinthe
youngforthemanagementof
depressionduetoincreasein?
a)Nihilismideation
b)Guiltideation
c)Suicidalideation
d)Enviousideation
CorrectAnswer-C
Ans.C.Suicidalideation
In2003,thUKMedicineandHealthCareproductsregulatory
agencyconcludedthatallSSNs,withtheexceptionoffluoxetine,
werecontraindicatedinthetreatmentofdepressioninyoungpeople
duetoincreaseinsuicidalideationanddubiousefficacy.

---

2068.Ifapersonisasked,"whatwillhedoif
heseesahouseonfire"?,Thenwhatis
beingtestedinthatperson?
a)Socialjudgement
b)Testjudgement
c)Responsejudgement
d)Noneoftheabove
CorrectAnswer-B
AnS.B.Testjudgement
Judgement
Itistheabilitytoassessasituationcorrectlyandactappropriately
withinthatsituation'
Socialjudgement:isobservedduringthehospitalstayandduring
theinterviewsession.Itincludesevaluationofpersonaljudgement.
TestJudgement:isassessedbyaskingthepatientwhathewould
doincertaintestsituationslike-houseonfire,manlyingonroad.
Itisratedasgood/intactnormalorpoor/impaired/abnormal'

---

2069.Whatisproducedbythe
supersensitivityofDopaminereceptors
?
a)Dyskinesia
b)Hyperphagia
c)Hyperpathia
d)Hypomania
CorrectAnswer-A
Ans.is'a'i.e.,Dyskinesia
(Ref:Pathophysiology,pharmacologyandbiochemistryof
dyskinesiap.195)
Increasedneostriataldopaminereceptordensityanddopaminergic
supersensitivityintheneuroendocrinesystemareassociatedwith
thedevelopmentoftardivedyskinesia.

---

2070.ThemostcommonsubstanceofabuseinIndia:
a)Cannabis
b)Tobacco
c)Alcohol
d)Opium
CorrectAnswer-A
Bymostestimates,cannabis(Indianhempplant)remainstheworld'smostcommonlyused
illicitdrug.
CannabisisperhapsthemostwidelyuseddruginIndiatoo,duetoit'seasyavailability.
Cannabis,asubstancethathasbeentraditionallyusedinIndiaasanintoxicant.
ItisproducedfromtheplantcannabissalivaorIndianHempplant.Itgrowsinthewildover
mostpartsofthecountry.
Ref:Kaplan&Sadock'sSynopsisofPsychiatry9thEdition,Page444,424-27;Park's
SocialandPreventiveMedicine18thEdition,Page635;ShorterOxfordTextbookof
Psychiatry5thEdition,Page332-342

---

2071.Illusionisadisorderof?
a)Thought
b)Perception
c)Affect
d)Emotion
CorrectAnswer-B
Ans,B.Perception
Disordersofperception
1. Alteredperception-Sensorydistortion(micropsia,hyeracusis),
Illusion.
2. Falseperception-Hallucination.

---

2072.Ropeseenassnakeisanexampleof-
a)Illusion
b)Hallucination
c)Delusion
d)Pseudohallucination
CorrectAnswer-A
Ans.A.Illusion
llusionsarealteredperceptioninwhicharealeternalobjectis
combinedwithimagerytoproducefalseinternalpercept.
Insimplewords,illusionismisinterpretationofanactualsensory
input.
Forexample:-
1. Hearingoncenameinatrainwhistle:-Trainwhistleisarealeternal
stimulus,whichisperceivedasoncename(falseinternalpercept).
2. Mistakingastickorropeforsnakeindarkroom:-Stickisareal
externalobject,whichisperceivedfalselyassnake.

---

2073.Womanfirmlyandpersistentlyfeelsher
husbandischeatingonherandshe
disapprovestoaccePtanyproofgiven
inthehusbandssupport'Theother
familymembersdonot
supportherbelief.Thisisanexampleof-
a)Illusion
b)Delusion
c)Hallucination
d)Perversion
CorrectAnswer-B
Ans.B.Delusion
Inthequestiongiventhewomanhasafalseunshakablebeliefthat
herhusbandischeatingonherandshedisapprovesallherrelatives
andproofsinsupportofherhusband.
Thusthisisanexampleofdelusion.

---

2074.Allofthefollowingareformalthought
disorderEXCEPT:
March2013(b,c,h)
a)Schizophrenia
b)Delusion
c)Looseningofassociation
d)Mania
CorrectAnswer-B
Ans.Bi.e.Delusion
Delusionisadisorderofthoughtcontent(NOTaformalthought
disorder/disorderofthoughtprocess)
Delusion
Disorderofthought;
Falseunshakenbeliefnotamenabletoreasoning
Hallucination
Disorderofperception;
Perceptionintheabsenceofexternalstimuli;
Notdependentofwillofobserver
Illusion
Misinterpretationofexternalstimuli

---

2075.Withdrawalofwhichofthefollowing
causespiloerecton?
a)Morphine
b)Cannabis
c)Smoking
d)Alcohol
CorrectAnswer-A
Ans.A.Morphine
Manifestationsofmorphinewithdrawal
Lacrimation
Anxiety&fear
Sweating
Restlessnessr
Yawning
Gooseflash(Piloerection).

---

2076.Schizotypalpersonalitybelongsto
whichclusterofpersonalitydisorders?
a)A
b)B
c)C
d)D
CorrectAnswer-A
Ans.A.A
ClusterA:Paranoid,Schizoid,Schizotypal.
ClusterB:Antisocial(Dissocial),Histrionic,Narcissistic,Borderline.
ClusterC:Anxious(avoidant),Dependent,obsessive-compulsive
(anankastic).

---

2077.Cardinalfeatureofantisocial
personality-
a)Violationofrulesofsociety
b)Attention-seekingbehavior
c)Unstableinterpersonalrelationship
d)Grandiosebehaviour
CorrectAnswer-A
Ans.A.Violationofrulesofsociety
Theessentialfeaturesofantisocialpersonalitydisorderarea
disregardforandviolationoftherightsoftheotherandtherulesof
thesociety.

---

2078.Markedlyinappropriatesensitivity,self
importanceandsuspiciousnessare
clinicalfeaturesof
a)Aantisocial
b)Historic
c)Schizoid
d)Paranoid
CorrectAnswer-D
Di.e.ParanoidP

---

2079.

---

Whichpersonalitydisorder/scanbeapartof
autisticsPectrumofdisorders?
a)Schizoid
b)Schizotypical
c)Borderline
d)Alltheabove
CorrectAnswer-D
Ans.D.Alltheabove
Followingpersonalitydisorderscanbediagnosedlaterinlifein
patientswithchildhoodautisticspectrumofdisorders:Borderline,
Obsessivecompulsive,narcissitic,paranoid,schizotypicaland,
avoidant,personality.

---

2080.Patientswhoaregrandioseandrequire
admirationfromothershaswhichtype
ofpersonality?
a)Narcissistic
b)Histrionic
c)Borderline
d)Antisocial
CorrectAnswer-A
Ans.A.Narcissistic
GrandiosityandadmirationfromothersarefeatureofNarcissistic
personalitydisorder.

---

2081.MaxdurationoftimespentisinNREM
stage?
a)I
b)II
c)III
d)IV
CorrectAnswer-B
Ans,B.II
REMsleepoccupies20-30%oftotalsleepandNREMsleepocupies
60-70%(stateI:5-70%,stageII:40-50%,stageIII&IV:15_20%)

---

2082.Allaretrueaboutnarcolepsyexcept:
a)Daydreaming
b)Hypnagogichallucinations
c)Cataplexy
d)Suddensleep
e)DecreasedREMlatency
CorrectAnswer-A
Ans.(A)Daydreaming
[RefNeerajAhuja7th/Ij8-39;Kaplan&SailocklsTextbookof
psychiatry11th/547-50;Harrison19th/189,t7th/172-ZB;CMDT
2016/1072]
Narcolepsy:
Disordercharacterizedbyexcessivedaytimesleepinessoften
distributednighttimesleepanddisturbancesinREMsleep.
HallmarkofthisdisorderisdecreasedREMlatency,I.e.decreased
latentperiodbeforethefirstREMperiodoccurs.
NormalREMlatencyis90-100minutes,innarcolepsy,REMsleep
occurswithin10minutesoftheonsetofsleep.
Classicaltetradofsymptoms:
Sleepattacks(MC)
Cataplexy
Hallucinationsatsleeponset(Hypnagogic)anduponwaking
(Hypnopompic)
Sleepparalysis.

---

2083.Allthefollowingaretrueregardingpseudocyesis,EXCEPT:
a)Thepatientsusuallyhaveanintensedesiretohavechildren
b)Changeinthebreastmaybepresent
c)Theremaybeconsiderableincreaseinthesizeoftheabdomen
d)Thelabourpaininvariablycontinuetopersistevenifsheistold
thatsheisnotpregnant
CorrectAnswer-D
Pseudocyesisorphantompregnancyisusuallyseeninpatientsnearingmenopauseorin
youngwomenwhointenselydesirechildren.
Mostofthemsufferfromsomeformsofpsychicorhormonaldisorder.
Theabdomenmaydistendduetodepositionoffat.
Thepregnancymayprogresstofulltermandthelabourpainmaystopabruptlywhen
informedthatsheisnotpregnant.
Ref:TextbookofForensicMedicineandToxicologybyNarayanReddy,Edition21,Page-
333

---

2084.Posttraumaticstressdisorder(PTSD)
isdifferentiatedfromallotherdisorders
by:
a)Nightmaresaboutevents
b)Autonomicarrousalandanxiety
c)RecallofeventsandavoidanceofsimilarexperiencesinPTSD
d)Depression
CorrectAnswer-C
Ci.e.Recallofeventsandavoidanceofsimilarexperiencesin
PTSD
-PTSDarisesasresponsetotraumaticevent(criteriaA)thatis
characterizedbypersistentre-experience(criteriaB),persistent
avoidanceandnumbness(C),hyperarousal(D),of>1month
duration(criteriaE)causingsignificantdistress&impaired
functioning(criteriaF)Q.Theonsetmaybedelayed(6monthsto
yearsafterevent).
-PTSDarisesasadelayed/protractedresponsetoanexceptionally
stressfulorcatastrophiclifeeventorsituationwhichislikelytocause
pervasivedistressinalmostanyperson(eg.disaster,war,rape,
torture,seriousaccident).Itmaydevelopevenafter6monthsto
yearsafterstressorQ.
-PTSDischaracterizedbyperistent/recurrentintrusivedistressing
recollectionsofstressfuleventeitherinflashbacks(images,
thoughtsorperceptions),dreams,relivingexperiences,illusions,
hallucinationsordistress/physiologicalreactivityonexposureto
remindersoftraumaticevents.Thereismarked(persistent)
avoidanceofstimuli/eventsorsituationsthatarouserecollectionof

---

stressfuleventsandincreasedarousal(hyperarousal)andnumbing
ofgeneralresponsivenessQ.
Partialamnesiaforsomeaspectsofstressfulevents,anhedonia
(inabilitytoexperiencepleasure)andalexithymia(characterizedby
inabilitytoidentify&articulatefeelings)maybepresent.

---

2085.Catatoniaisatypeof:
September2007
a)Schizophrenia
b)Phobia
c)Depression
d)OCD
CorrectAnswer-A
Ans.A:Schizophrenia
Schizophreniaisasevere,persistent,debilitating,andpoorly
understoodpsychiatricdisorderthatprobablyconsistsofseveral
separateillnesses.
Symptomsincludedisturbancesinthoughts(orcognitions),mood
(oraffects),perceptions,andrelationshipswithothers.Thehallmark
symptomsofschizophreniaareauditoryhallucinationsand
delusions,whicharefixedfalsebeliefs.Thesymptomsof
schizophreniamaybedividedintothefollowing4domains:
Positivesymptoms:Theseincludepsychoticsymptoms,suchas
hallucinations,whichareusuallyauditory;delusions;and
disorganizedspeechandbehavior.
Negativesymptoms:Theseincludeadecreaseinemotionalrange,
povertyofspeech,lossofinterests,andlossofdrive.
Cognitivesymptoms:Theseincludeneurocognitivedeficits,suchas
deficitsinworkingmemoryandattentionandexecutivefunctions
suchastheabilitytoorganizeandabstract.
Moodsymptoms:Schizophreniapatientsoftenseemcheerfulorsad
inawaythatdoesnotmakesensetoothers.Theyoftenare
depressed.
CatatoniaSchizophrenia
Thissyndromeoccursinchildren,adolescents,andadults;is

---

Thissyndromeoccursinchildren,adolescents,andadults;is
associatedwithaheterogeneousgroupofcomorbidconditions;and
ischaracterizedbyavarietyofsymptomsandsignsofimpairmentof
theexpressionofvoluntarythoughtsandmovements.
Typically,thesyndromeofcatatoniaisepisodic,withperiodsof
remission.
Itcanpresentsinthreeclinicalforms:
Excitedcatatonia
Stuporouscatatonia
Catatoniaalternatingbetweenexcitementandstupor.

---

2086.Spousejealousyisafeatureof?
a)Othellosyndrome
b)Chronicalcoholism
c)Stockholmsyndrome
d)Clerambault'ssyndrome
CorrectAnswer-A
Ans.A.Othellosyndrome
OthelloSyndrome:
Whenthecontentofdelusionsispredominantlyjealousy(infidelity)
involvingthespouse,personfeelsanunreasonablefearthata
partnerhasbeenunfaithful,ispresentlyunfaithful,orplanstobe
unfaithful,itiscalledasOthelloSyndromeorconjugalparanoia.
Elaboratestepsaretakentopreventthespousetogooutside
(Locksthespouse,notallowinghertogooutside).

---

2087.Allofthefollowingaretrueabout
pseudohallucinationsexcept?
a)Arisesininnersubjectiveself
b)Patientdescribesthesensationsbeingperceivedbymindeye
c)Areundervoluntarycontrol
d)DistressingflashbackofPTSDisanexample
CorrectAnswer-C
Ans.C.Areundervoluntarycontrol
Pseudohallucination
Pseudohallucinationisaperceptualexperience,whichdiffersfroma
hallucinationinthatitappearstoariseintheinnersubjectivespace,
notthroughoneoftheexternalsensoryorgans.
Patientstendtodescribethesesensationsasbeingperceivedwith
the'innereye'or'mindeye'(orear).
However,liketruehallucinationspseudohallucinationsarenotunder
voluntarycontrol.
Exampleinclude:Distressingflashbacksinpost-traumaticstress
disorderortherecentlybereavedwidowwakinguptobriefly'see'
herhusbandsittingatthefootofthebed,

---

2088.Deliriumisdefinedas?
a)Acuteonsetofdisturbedconsciousness
b)Chroniconsetofdisturbedconsciousness
c)Progressivegeneralizedimpairmentofintellectualfunctionsand
memorywithoutimpairmentofconsciousness
d)Disorientationwithoutcloudingofconsciousness
CorrectAnswer-A
Ans.A.Acuteonsetofdisturbedconsciousness
Deliriumisdefinedbytheacuteonsetoffluctuatingcognitive
impairmentandadisturbanceofconsciousness.
Itisalsoreferredtoasacuteconfusionalstateoracuteorganicbrain
syndrome.

---

2089.Allthefollowingdrugsareusedto
preventrelapseandmaintain
abstinenceincasesofalcohol
withdrawalexcept?
a)Disulfiram
b)Acamprosate
c)Naltrexone
d)Propranolol
CorrectAnswer-D
Ans.D.Propranolol
Detoxification(treatmentofwithdrawal):-BZDsarethedrugsof
choice,e.g.chlordiazepoxiile(Idchoice),Diazepam(2ndchoice).
Maintenanceafterdetoxification(topreventrelapseand
maintenanceofabstinence):-
1. Aversiveagent(ileferentagents):-Disulfiram,CCC,metronidazole,
Natrafezole.
2. Anticravingagent:-Naltrexone,Acamprosate,fluoxetine,
Topiramate,Nalmefene.

---

2090.Treatmentofacutealcohol
withdrawal:
Punjab09
a)Diazepam
b)Bupropion
c)Disulfiram
d)Acamprosate
CorrectAnswer-A
Ans.Diazepam

---

2091.TrueaboutRETTSyndrome?
a)Macrocephaly
b)Cardiacarrhythmia
c)Seizures
d)Mentalretardation
e)Autisticbehaviour
CorrectAnswer-B:C:D:E
Ans.is'b'i.e.,Cardiacarrhythmia,'c'i.e.,Seizures,'d'i.e.,Mental
retardation&'e'i.e.,Autisticbehaviour
Rett'sSyndrome
Thisisthecharacteristicfeatures,thattheybegintoloosetheir
acquiredskills,e.g.,cognitiveandheadgrowthisnormalduring
earlyperiodafterwhichthereisanarrestofgrowth.
Acquiredmicrocephaly
Mostchildrendeveloppeculiarsighingrespirationswithintermittent
periodsofapneathatmaybeassociatedwithcyanosisBreath
holdingspells.
AutisticbehaviourImpairedsocialinteraction,languageand
communication.
Generalizedtonic-clonicconvulsionsoccurinthemajority.
Feedingdisorderandpoorweightgain

---

2092.Whichofthefollowingcouldbeacomponentofconversiondisorder?
a)Pseudoseizures
b)Derealisation
c)Depersonalisation
d)Amnesia
CorrectAnswer-A
Pseudoseizurecanoccurinconversiondisorder.
Paralysis,blindnessandmutismarethemostcommonconversiondisordersymptoms.
Anaesthesiaandparesthesiaespeciallyoftheextremitiesarethemostcommonsensory
symptoms.
Othersensorysymptomsincludesdeafness,blindnessandtunnelvision.
Motorsymptomsassociatedwithitare:abnormalmovements,gaitdisturbance,weakness
andparalysis.
Onegaitdisturbanceseeninthisisataxiaabasia,whichisawildlyataxic,staggeringgait
accompaniedbygross,irregular,jerkytruncalmovementsandthrashingandwavingarm
movements.
Ref:KaplanandSadock'sConciseTextbookofClinicalPsychiatry,3rdEditionBy
BenjaminJ.Sadock,Page279

---

2093.Labelleindifferenceisseenin
a)ConversionReaction
b)Schizophrenia
c)Mania
d)Depression
CorrectAnswer-A
Ai.e.Conversionreaction
LabelleindifferenceQisin-appropiateattitudeofcalmorlackof
concernaboutone'sdisability.Itisseeninconversion(dissociative)
disorderQ(butnotspecific),physicalillnessetc.

---

2094.Whichisthemostcommontypeof
persistentdelusionaldisorder?
a)Delusionofpersecution
b)Somaticdelusion
c)Delusionofjealousy
d)Delusionofgrandeur
CorrectAnswer-A
Ans.A.Delusionofpersecution
Delusionofpersecutionisthemostcommontypeofpersistent
delusionaldisorder.

---

2095.Dysthymiais?
a)Chronicdepression
b)Chronicmania
c)Bipolardisorder
d)Personalitydisorder
CorrectAnswer-A
Ans.A.Chronicdepression
Persistentdepressivedisorder(Dysthymia)
Depressionmayrunachroniccourseoveryearswithfluctuationof
moodinterposedwithsymptomfreeintervals(lessthan2months).
Ifsymptomspersistformorethan2years,theyarereferredtoas
persistentdepressivedisorderordysthymia.

---

2096.BipolarIIdisorderincludes?
a)Cyclothymicdisorder
b)Dysthymia
c)Singlemaniacepisode
d)Majordepressionandhypomania
CorrectAnswer-D
Ans.D.Majordepressionandhypomania
BipolarII:Oneormoremajordepressiveepisodestogetherwithat
least1hypomanicepisode.

---

2097.Paraphiliasareallexcept:
a)Bisexuality
b)Homosexuality
c)Bestiality
d)Frottuerism
CorrectAnswer-A
Ai.e.Bisexuality
-Abnormal&unorthodoxsexplaybyusingunusalobjectsorparts
ofbodyareknownasparaphilliaeg.Sadomasochism,
Transvestism,Uranism,Beastality,Fortteurism,Urolangia,
Homosexualityetc.
-Bisexualitymeanshermaphroditei.e.anindividualwithbothovary
&testis&externalgenitalsofbothsexes.

---

2098.DrugsusedinADHDare-
a)Atomoxetine
b)Methylphenidate
c)Dextro-amphetamine
d)All
CorrectAnswer-D
Ans.is'a'i.e.,Atomoxetine;'b'i.e.,Methylphenidate;'c'i.e.,Dextro-
amphetamine
SomecommonstimulantsusedtotreatADHDinclude:
Adderall(amphetamine)
Ritalin(methylphenidate)
Concerta(methylphenidate)
Focalin(dexmethylphenidate)
Daytrana(methylphenidatepatch)
MetadateorMethylin(methylphenidate)
DexedrineorDextrostat(dextroamphetamine)
Vyvanse(lisdexamfetaminedimesylate)

---

2099.Psychoticpatientonantipsychotic
drugsdevelopstorticolliswithin4days
oftherapy.whatisthetreatment?
a)Centralanticholinergic
b)Peripheralanticholinergic
c)Betablocker
d)Dantrolene
CorrectAnswer-A
Ans.A.Centralanticholinergic
Thisisacaseofdruginducedmusculardystonia,whichistreated
bycentralanticholinergic.
Drugofchoiceforantipsychoticinducedextrapyramidalsideeffects
1. Acutemusculardystonia-+Centralanticholinergic
2. Akathisia-Betablocker
3. Parkinsonism-Centralanticholinergic.
4. Neurolepticmalignantsyndrome-Dantrolene
5. TardivedyskinesiaTerabenazine(TBZ)

---

2100.ECTiscontraindicatedin-
a)Veryillpatients
b)RaisedICT
c)Heartdisease
d)Pregnancy
CorrectAnswer-B
Ans.is'b'i.e.,RaisedICT

---

2101.Visualanaloguescale(VAS)most
widelyusedtomeasure
a)Sleep
b)Sedation
c)Painintensity
d)DepthofAnaesthesia
CorrectAnswer-C
Ci.e.Painintensity

---

2102.Trueaboutanorexianervosaisall
except?
a)Bingeeatingiscommon
b)Unknowninmale
c)Ammenorrhoeastartsbeforeseverelossofweight
d)Self-inducedvomiting
CorrectAnswer-B
Ans.is'b'i.e.,Unknowninmale
Anorexianervosaislesscommoninmale,butcanbeseen.
Thereisbingeeatingandselfinducedvomiting.
"Amenorrheaoftenprecedessevereweightloss"?Essentialsof
psychiatry
ANOREXIANERVOSA
Theterm'`anorexianervosa"isamisnomeraslossofappetiteisa
raresymptom.Thisdisorderischaracterizedbyselfimposeddietary
restrictionsleadingtomalnutritionandsevereweightloss.
Clinicalfeatures
Femalesarefarmorecommonlyaffectedthanmales.Onsetusually
occursbetweentheageof10-30years,usuallyinmidadolescence.
Adeliberateandpersistentrestrictionoffoodisusuallytheearliest
presentingsymptom.Thereisintensefearofbecomingofobese,
evenifbodybecomesverythinandunderweight.
Thereisabody-imagedisturbance.Thepersonisunableto
perceivethebodysizeaccurately.
Somepatientscannotcontinuouslycontroltheirvoluntaryrestriction
offoodintakeandSohaveeatingbinges.Thesebingesusually
occursecretlyandoftenatnightandarefrequentlyfollowedbyself-
inducedvomiting.Patientsabuselaxativesandevendiureticsto

---

loseweight,andritualisticexercising,extensivecycling,walking,
joggingandrunningarecommonactivities.
Patientswithanorexianervosaexhibitpeculiarbehavioraboutfood.
Theyhidefoodalloverthehouse,frequentlycarrylargequantitiesof
candiesintheirpocketsandpurses.Theytrytodisposeoffoodin
theirnapkinsorhideintheirpockets,whileeatingmeals.Theycut
theirmeatintoverysmallpiecesandspendagreatdealoftime
rearrangingthepiecesontheirplates.
Thereissignificantweightlossandpatientisunderweight.
Amenorrheaisseeninalmostallwomenandlossoflibidomay
occurinmalepatients.Theremaybepoorsexualadjustment.
Obsessivecompulsiveneurosis,depressionandanxietylike
psychiatricillnessmaycoexist.
Complicationsofmalnutritionmayoccur,e.g.,hypoglycemia,
hypothermia,lowBP,bradycardia,leucopenia,endocrinechanges
(raisedGHandCortisol,reducedgonadotrophin),andappearance
oflanugohair.

---

2103.Maindifferencebetweenanorexia
nervosaandbulimianervosalies
in:
March2013
a)Symptomatology
b)Weight
c)Gender
d)Age
CorrectAnswer-B
Ans.Bi.e.Weight
Anorexianervosaandbulimia
Bothanorexianervosaandbulimiaarecharacterizedbyan
overvalueddriveforthinnessandadisturbanceineatingbehavior.
Themaindifferencebetweendiagnosesisthatanorexianervosais
asyndromeofself-starvationinvolvingsignificantweightlossof15
percentormoreofidealbodyweight,whereaspatientswithbulimia
nervosaare,bydefinition,atnormalweightorabove.
Bulimiaischaracterizedbyacycleofdieting,binge-eatingand
compensatorypurgingbehaviortopreventweightgain.
Purgingbehaviorincludesvomiting,diureticorlaxativeabuse.
Excessiveexerciseaimedatweightlossoratpreventingweightgain
iscommoninbothanorexianervosaandinbulimia.

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2104.Mostcommoncausedementiainadult:
a)Alzheimer's
b)Multiinfrct
c)Pick'disease
d)Metaboliccause
CorrectAnswer-A
Ai.e.Alzheimer's

---

2105.Followingarethemajorsymptomsof
obsessivecompulsivedisorders?
a)Contamination
b)Pathologicaldoubts
c)Intrusivethoughts
d)Alltheabove
CorrectAnswer-D
Ans.is'd'i.e.,AIItheabove
[RlKaplan&Saddock's|tr/ep.605)
OCDhasfourmajorsymptompatterns:-
Contamination:-
Contaminationisthemostcommonpatternofanobsessionfollowed
bywashing(washer)
Pathologicaldoubts:-
Doubtsisthesecondmostcommonpatternofanobsession,
followedbyacompulsivechecking(checkers).
Intrusivethoughts(Pureobsessions):-
Inthisthirdmostcommonpattern,thereareintrusiveobsessional
thoughtswithoutacompulsion.
Suchobsessionsareusuallyr4retitiousthoughtsofasexualor
aggressiveactthatisreprehensibletothepatient.
Symmetry:-
Thisisthefourthmostcommonpatterninwhichthereisan
obsessionforsymmetryorprecision,whichcanleadtocompulsion
ofslowness.
Patientscanliterallytakehourstoshavetheirfacesortoeatameal.

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2106.Whichofthefollowingdrugisnotgiven
inacute
mania:
September2009
a)Lithium
b)Lamotrigine
c)Valproate
d)Olanzapine
CorrectAnswer-B
Ans.B:Lamotrigine
Lamotrigineisnotrecommendedforacutemania.
Itisespeciallyusefulinrapidlycyclingbipolardepression.

---

2107.A3yearoldboywithnormal
developmentalmilestoneswithdelayed
speechanddifficultyincommunication
andconcentration.Heisnotmaking
friends.Mostprobablediagnosisis?
a)Autism
b)ADHD
c)Mentalretardation
d)Specificlearningdisability
CorrectAnswer-A
Ans.is'A'i.e.,Autism
Delayedspeech,difficultyincommunicationandconcentrationina3
yearoldchildsuggeststhediagnosisofautism.
Autismischaracterizedbyimpairedsocialinteractionand
communication,andbyrestrictedandrepetitivebehavior.These
signsallbeginbeforeachildisthreeyearsold.
Autismaffectsinformationprocessinginthebrainbyalteringhow
nervecellsandtheirsynapsesconnectandorganize
Itisoneofthreerecognizeddisordersintheautismspectrum,the
othertwobeingAspergersyndrome,whichlacksdelaysincognitive
developmentandlanguage,andpervasivedevelopmentalDisorder-
nototherwisespecified(commonlyabbreviatedasPDD-NOS)

---

2108.EugeneBlueler's4Asincludefollowing
except?
a)Autism
b)Affect
c)Anhedonia
d)Association
CorrectAnswer-C
Ans.C.Anhedonia
Bleuler's4'As'are:(l)Ambivalence(2)Autism;(3)Affect
disturbances(inappropriateaffect);and(4)Associationdisturbances
(looseningofassociation,thoughtdisorder).

---

2109.Keysymptominalcoholwithdrawal
syndromeis:
a)Sleepdisturbance
b)Visualhallucinations
c)Tremors
d)Delirium
CorrectAnswer-C
Ans:C.Tremors
Keysymptom-Tremor.
WithdrawalSyndromes
Substance Features
Yawning?,Insomnia,Dysphoricmood
Waterlossfromdifferentorifices?(Lacrimation?,
Opioid
sweating?,diarrhea?,vomiting,
Increasedvitals?(BP,Pulse,RR,Temperature)?
Pupillarydilation,piloerection?
Hangover(MC)?
Hallucinations?(usuallyauditory)andillusions?
Insomnia?
Tremors/Seizures(Alcoholicseizures/Rumfits):Classic
sign
Deliriumtremens:
Alcohol
Occurswithin5days?ofcompleteorsignificant
abstinence?fromheavyalcohol
Recoveryoccurswithin7days
Characteristicfeaturesarecloudingofconsciousness?,
disorientation?,hallucinations(mostlyvisualand

---

auditory)?,illusion?,autonomicdisturbances?,agitation?
andinsomnia?.
IncreasedordecreasedSleep(hypersomnia?or
insomnia)Psychomotoractivity
Cocaine
Vividunpleasantdreams?
Increasedapetiteandfatigue

---

2110.Lithiumistreatmentofchoicefor
a)UnipolarMDPprophylaxis
b)BipolarMDPprophylaxis
c)Schizophrenia
d)Acutemania
CorrectAnswer-B
Bi.e.BipolarMDPprophylaxis
Lithium:Indications:
Establishedindications:
Treatmentofacutemania
Prophylaxisofbipolarmooddisorder.
Possibleclinicalindications:
Treatmentoftheschizo-affectivedisorder
Prophylaxisofunipolarmoodilisorder
treatmentofcyclothymia
Treatmentifacutedepression(asanadjuvantforrefractory
depression)
Treatmentofchronicakoholism(inpresenceofsignificantdepressive
symptoms)6psychoactiveusedisorders(e'gcocainedePendence)
Treatmentofimpulsiveaggression.
TreatmentofKeine-Levinsyndrome

---

2111.Appetitefornonnutritivesubstancesis
called?
a)Pica
b)Apprepritant
c)Bulimia
d)Bolean
CorrectAnswer-A
Ans.A.Pica
Picaischaracterizedbyanappetiteforsubstancesthatarelargely
non-nutritive,suchaspaper,clay,metal,chalk,soil,glass,orsand.

---

2112.NotinvolvedinWernicke-Korsakoff
syndrome:
a)Mammilarybody
b)Thalamus
c)Periventriculargreymatter
d)Hippocampus
CorrectAnswer-C
Ci.e.Periventriculargreymatter
Korsakoff'sPsychosis(KP)
Itisthecommonestcauseoforganicamnesticsyndrome.Itisalso
k/aWernicke-Korsakovsyndrome,becauseitoftenfollowsan
acuteneurologicalsyndromecalledWernicke'sencephalopathy
comprisingdelirium,ataxia,opthalmoplegia,nystagmus&peripheral
neuropathy.
ItisapotentiallyreversibleconditionQcausedbythiamine
deficiencymostcommonlyassociatedwithchronicalcoholabuse
malnutrition.Butothercausesofmalnutritioneg.starvation,
hyperemesisgravidarum,dialysis,cancer,AIDS,gastricplicationor
prolongedIVhyperalimentation,alonecanalsoresultinthiamine
deficiency&KP.
Neuropathologicallesioncausedbythiaminedeficiencyisusually
widespreadbutmostconsistentchangesareseeninbilateral
dorsomedial(&anterior)nucleusofthalamus,mammillarybodies,
andhippocampus,informofsmallvesselshyperplasia;petechial
hemorrhages,astrocytichypertrophy&degenerationQ.Itdisruptsa
criticalcircuitbetweenhippocampus&frontallobes.Thechanges
arealsoseeninperiventricular(around3rdventricle),periaqueductal
greymatter,cerebellum,andbrainstem(midbrain,pons,medulla

---

fornix)assymmetricallesions.
Thecardinalfeatureisaprofounddeficitofepisodicmemory,
confabulationandlackofinsightintotheamnesiaQ.Itpresentsas:
Changeinpersonality(frontallobelike)suchthattheydisplaylackof
initiative,interestorconcern&diminishedspontaneity.
-Executivefunctiondeficitsinvolvingattention,planning,setshifting,
&inferentialreasoning.
-Apathy,passivity&confabulationQareoftenprominent.Thereis
disorientationfortime,emotionalblunting,&inertia.
-Thereislittleimpairmentinimplicitmemoryandtheirabilityto
perform(complete)complexmotorproceduresremainintactQ.
Typicallygeneralintelligence,perceptualskills&languageremain
relativelynormalQ.
Memorydisorder
-Profounddeficitofepisodictypeexplicit(declarative)memory1/t
lossofautobiographicinformation(oftenextendingbackformany
years).
Severeanterogradeamnesia(learningdefect)forverbal&visual
materialwithalackofinsightintotheamnesia.Eventsarerecalled
immediatelyaftertheyoccur,butforgottenafewminuteslater.Thus
digitspan,testingtheshorttermmemorystore,isnormal.Storageis
mildlyimpairedbutretrieval&learningareseverelyimpairedQ.
Whenpatientslearnnewmaterialtheywillforgetitatanormalrate,
butlearningthenewmaterialisextremelydifficult,andinsevere
casesnewlearningisimpossible.Sothesepatientshavedifficult
encoding&consolidatingexplicitmemory.
-Retrogradeamnesiabacktotheonsetofillness,isassevereas
anterogradeloss;buttheoverallretrogradememoryimpairment(i.e.
beforetheonsetofillness)isnotassevereasthatofanterograde
memory.
Newlearning&recentmemoryisgrosslydefectivebutretrograde
(remote)memoryisrelatively(variably)preserved,andshowa
temporalgradient,witholdermemoriesbetterpreserved.Asaresult
thesepatientsretainmoredistantmemoriesdramaticallymore
proficientlythantheylearnnewmaterial.
-Althoughremotememoryissurprisinglyintact,patientsareunable

---

toorganizetheminatemporalcontext.Sotheydistortthe
relationshipbetweenfactsandfilltheremotememorygapsby
confabulationQ(avivid&whollyfictitiousaccountofrecentactivities
whichthepatientbelievestobetrue).

---

2113.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.

---

3. Other:-Perseveration,lackofmotivation(amotivationalsyndrome),
apathy,passivity.
4. Generalintelligence,language,andmotor&perceptualskillsarenot
impaired.

---

2114.Badtripisseenwith?
a)Cocaine
b)Cannabis
c)LSD
d)Heroin
CorrectAnswer-C
Ans.C.LSD
Acutepanicreactionwithlossofcontrolononself,calledBadtrip,is
characteristicofLSDorotJrerhallocinogens.

---

2115.Maniaischaracterizedby:
a)Paranoiddelusion
b)Lossoforientation
c)Highselfesteem
d)All
CorrectAnswer-C
Ci.e.Highselfesteem

---

2116.Antipsychoticdrugcausingretinal
pigmentdisorderis?
a)Thiaoridazine
b)Clozapine
c)Chlorpromazine
d)Noneoftheabove
CorrectAnswer-A
Ans.A.Thiaoridazine
Bluepigmentationofskin,cornealandlenticularopacities,retinal
degenrationcanoccurwiththioridazine.

---

2117.Antipsychoticdrugwithleastextra
pyramidalsymptoms?
a)Pimozide
b)Thioridazone
c)Clozapine
d)Flupromazine
CorrectAnswer-C
Ans.C.Clozapine
Antipsychoticswithnoextrapyramidalsideeffectsclozapine,
aripiprazole,quetiapine.
Amongsttypicalantipsychotics,thioridazonehasleastextrapyramial
sideeffects.

---

2118.Followingistrueaboutalcoholic
dependencesyndromeexcept-
a)Notolerance
b)Withdrawalsymptoms
c)CAGEquestionnaire
d)Physicaldependence
CorrectAnswer-A
Ans.A.Notolerance
Alcoholdependencehasfollowingcriteria:-(i)Tolerance;(ii)
Withdrawalsymptoms;(iii)Takeninlargeramountorlonger
duration;(iv)Persistentcraving(desire)totakealcohol;(v)Agreat
dealoftimespenttoobtainalcoholortouseit;(vi)Neglectofother
activities(social,occupational);and(vii)Continuedusedespiteclear
evidenceofovertlyharmfulconsequences.
TheCAGEquestionnaireisatoolusedtoassessindividualsfor
potentialalcoholproblems,includingdependence.
Alcoholproducesbothphysicalaswellaspsychological
dependence.

---

2119.DSMIVcriterionfordepressionis?
a)1week
b)2weeks
c)3weeks
d)4weeks
CorrectAnswer-B
Ans.B.2weeks
Forthediagnosisofminordepression2-4andformajordepression
>5DSMIVsymptomsarerequiredforatleastforatwoweek
period.

---

2120.Theclinicaleffectsofthe
antidepressantdrugsismainlybased
on?
a)Changeinneurotransmitterreceptorsensitivity
b)Decreasedlevelofneurotransmitters
c)Changeinefficacyofneurotransmitters
d)Noneoftheabove
CorrectAnswer-A
Ans.A.Changeinneurotransmitterreceptorsensitivity
Temporalcorrelationofclinicaleffectswithchangesinreceptor
sensitivityhasgivenrisetohypothesisthatchangesin
neurotransmitterreceptorsensitivitymayactuallymediatethe
clinicaleffectsofantidepressantdrugs.
Theseclinicaleffectsincludenotonlyantidepressantandanxiolytic
actionsbutalsothedevelopmentoftolerancetotheacuteside
effectsofantidepressantdrugs.

---

2121.Identifytheinstrumentdepictedinthe
image
a)Osteometricboard
b)Shakir'sboard
c)Radiometricboard
d)Thermometricbord
CorrectAnswer-A
Ans.is'a'i.e.,Osteometricboard[RefNarayanReddy30thiep.
116]
ItisHepburnosteometricBoardformeasurementoflengthoflong
bones.
UsedFormeasurementofBonelengthoflargeboneslikeTIBIA&
FEMUR.

---

2122.Achildwithpneumoniahasfollowing
chestX-ray.Mostlikelycausative
organismis-
a)Str.pneumoniae
b)Staphaureus
c)Str.pyogenes
d)Listeria
CorrectAnswer-B
Answer-B.Staphaureus
ThegivenchestX-rayisshowinglargepneumatoceleinrightlung
-->characteristicofstaphaureuspneumonia.

---

2123.Chestx-rayofachildpresentingwith
acutebreathlessness.Diagnosis
a)Pneumothorax
b)Penumaocele
c)Normal
d)Noneofabove
CorrectAnswer-A
Answer-A.Pneumothorax
Theabovefilmshowsarightsidedtensionpneumothoraxwithright
sidedlucencyandleftwardmediastinalshift.Thisisamedical
emergency.Andrequireimmediateintercostalsdrainage.

---

2124.1dayoldmalebabydeliveredbyLSCS
hadswellingoverbackinmidline.
a)Iron
b)Folicacid
c)Thiamine
d)VitA
CorrectAnswer-B
Answer-B.Folicacid
Thefigureisshowingmeningocele(aneuraltubedefect).Neural
tubedefectcanbepreventedbyfolicacidsupplementation.

---

2125.Followingfiguredenotes-
a)Standarddistribution
b)Negativelyskewed
c)Positivelyskewed
d)Righthanded
CorrectAnswer-C
Ans.is'c'i.e.,5%
Shadedarearepresentstheregionbeyond2standarddeviationsof
thenormaldistributioncurve;thusrepresentsanareaof
approximately5%.

---

2126.Whatpercentageofthenormal
distributioncurveisrepresentedbythe
shadedarea?
a)1%
b)3%
c)5%
d)7%
CorrectAnswer-C
Ans.is'c'i.e.,5%[RepHighyieldbiostatisticsp.11,12]
Normal Positivelyskewed(rt.Handed)Negatively
distribution
skewed(lefthanded)distribution
deviation

---

invalidquestionid

---