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Download NEET PG 2018 Question Paper with Answers

Download NEET PG (The National Eligibility cum Entrance Test Postgraduate) 2018 Question Paper with Answers

This post was last modified on 30 July 2021

1.NervesofBranchialarchderivedfrom:
a)Mesoderm
b)Endoderm
c)Neuralcrest
d)Neuroectoderm

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CorrectAnswer-C
Answer-C.Neuralcrest
Branchialorpharyngealarchesaremassesofmesodermcovered
byectodermandlinedbyendoderm.Withinthesemasses,muscular
andskeletalcomponentsdevelop,aswellasaorticarchesand

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nervenetworks.Thearchesareseparatedbygrooves,visibleon
thesurfaceoftheembryoaspharyngealcleftsandintheinterioras
thepharyngealpouches
Inthehumanembryo,thearchesarefirstseenduringthe4thweek
ofdevelopment.

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Theyappearasaseriesofoutpouchingsofmesodermonboth
sidesofdevelopingpharynx.
Theneuralcrestarebilaterallypairedstripsofcellsarisinginthe
ectodermatthemarginsoftheneuraltube.Thesecellsmigrateto
manydifferentlocationsanddifferentiateintomanycelltypeswithin

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theembryo.
NeuralCrestDerivatives
Akeyfeatureofneuralcrestisthemigrationintootherembryonic
tissuestoformspecificneuralandnon-neuralpopulationsand
structures.

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Cranialneuralcrest
migration-dorsolaterallyandintopharyngealarches
craniofacialmesenchyme-cartilage,bone,cranialneurons,glia,

andconnectivetissuesoftheface
pharyngealarchesandpouches-thymiccells,toothodontoblasts,

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middleearbones(ossicles),striavasculariscells,andjaw
(mandible)
Inthebodyregion,neuralcrestcellsalsocontributetheperipheral
nervoussystem(bothneuronsandglia)consistingofsensory
ganglia(dorsalrootganglia),sympatheticandparasympathetic

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gangliaandneuralplexuseswithinspecifictissues/organs.
Intheheadregion,neuralcrestcellsmigrateintothepharyngeal
archesformingectomesenchymecontributingtissueswhichinthe
bodyregionaretypicallyderivedfrommesoderm(cartilage,bone,
andconnectivetissue).

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NeuralCrestOrigin
System
CellType
PeripheralNervous Neurons-sensoryganglia,sympatheticand
System

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parasympatheticganglia,entericnervous
(PNS)
system,andplexuses
Neuroglialcells,olfactoryensheathingcells
Schwanncells

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Endocrine
Adrenalmedulla
Calcitonin-secretingcells
CarotidbodytypeIcells
Integumentary

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Epidermalpigmentcells
Facialcartilage
Facialandanteriorventralskullcartilageand
andbone
bones

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Sensory
Innerear,cornealendotheliumandstroma
Connectivetissue Toothpapillae
smoothmuscle,andadiposetissueofskinof
headandneck

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Connectivetissueofmeninges,salivary,
lacrimal,thymus,thyroid,andpituitaryglands
Connectivetissueandsmoothmuscleinarteries
ofaorticarchorigin

2.Hardpalatecontains:

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a)Keratinised,submucosa,minorsalivarygland
b)Keratinised,absentsubmucosallayer,minorsalivarygland
c)Nonkeratinised,submucosallayer,minorsalivarygland
d)Nonkeratinised,absentsubmucosa,minorsalivarygland
CorrectAnswer-A

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Answer-A.Keratinised,submucosa,minorsalivarygland
Thehardpalateislocatedontheroofoftheoralcavity,posterior
andmedialtothealveolarprocessofthemaxilla.
Thebonystructureisformedbythepalatineprocessesofthe
maxillaandthehorizontalplatesofthepalatinebones.

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Theperiosteumiscoveredbyafirmlyattachedmucosacentrally,
althoughasubmucosaisapparentlaterallycontainingvessels.The
hardpalateiscontinuouswiththesoftpalateposteriorly.
MacroscopicFeatures
Thehardpalateistypicallyapalepinkcolourandmayhavean

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orangepeelappearancefromthepalatinesalivaryglands(more
commonposteriorly).
MicroscopicFeatures
Thehardpalateislinedwithakeratinisingstratifiedsquamous
epithelium
,tightlyboundtotheunderlyingperiosteumofthe

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palatinebone/maxilla.Thereisminimalsubmucosa,which
becomesmoreprominentposteriorly.




3.Whatisthetensorofvocalcords:

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a)Cricothyroid
b)LateralCricoarytenoid
c)Thyroarytenoids
d)Posteriorcricoarytenoids
CorrectAnswer-A

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Answer-A.Cricothyroid
Cricothyroid:
Tensorofvocalcords.
Lateralcricoarytenoid: Abductorofvocalcords.
Thyroarytenoid:

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Relaxorofvocalcords.
Posterior
Abductorofvocalcords
cricoarytenoid:
MusclesactingontheLarynx

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Movement

Muscles
ElevationofLarynx Thyrohyoid,mylohyoid
Depressionoflarynx Sternothyroid,sternohyoid
Openinginletof

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Thyroepiglotticus
larynx
Closinginletof
Aryepiglotticus
larynx

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Abductorofvocal Posteriorcricoarytenoidonly
cords
Adductor

Lateralcricoarytenoidtransverse&oblique
ofvocalcords

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arytenoids
Tensorofvocal

cords
Cricothyroid
Relaxerofvocal

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Thyroarytenoid
cords

4.Uretericbuddevelopsfrom:
a)Mesonephros
b)Metanephros

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c)Pronephros
d)Genitalsinus
CorrectAnswer-A
Answer-A.Mesonephros
Theuretericbud,alsoknownasthemetanephrogenic

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diverticulum
,isaprotrusionfromthemesonephricductduringthe
developmentoftheurinaryandreproductiveorgans.
Itlaterdevelopsintoaconduit(channel)forurinedrainagefromthe
kidneys,which,incontrast,originatefromthemetanephric
blastema.

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Themetanephrogenicblastemaormetanephricblastema(or
metanephricmesenchyme,ormetanephricmesoderm)isoneofthe
twoembryologicalstructuresthatgiverisetothekidney,theother
beingtheuretericbud.

5.AboutWeber'ssyndromewhichis

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incorrect:
a)Contralateralhemiplegia
b)IpsilateralOculomotornervepalsy
c)ContralateralParkinsonism
d)Anteriorcerebralpeduncle

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CorrectAnswer-D
Answer-D.Anteriorcerebralpeduncle
Weber'ssyndrome(superioralternatinghemiplegia)isaform
ofstrokecharacterizedbythepresenceofan
ipsilateraloculomotornervepalsyand

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contralateralhemiparesisorhemiplegia.
Itiscausedbymidbraininfarctionasaresultofocclusionof
theparamedianbranchesoftheposteriorcerebralarteryor
basilarbifurcationperforatingarteries.
Thislesionisusuallyunilateralandaffectsseveralstructuresin

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themidbrain:

Contralateralparkinsonismbecauseitsdopaminergicprojections
tothebasalgangliainnervatetheipsilateralhemispheremotorfield,
leadingtoamovementdisorderofthecontralateralbody.
Contralateralhemiparesisandtypicaluppermotorneuronfindings.

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Itiscontralateralbecauseitoccursbeforethedecussationinthe
medulla.
Difficultywithcontralaterallowerfacialmusclesandhypoglossal
nervefunctions.
IpsilateralOculomotornervepalsywithadroopingeyelidand

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fixedwidepupilpointeddownandout.Thisleadstodiplopia.


6.AboutSibson'sfasciawhichisincorrect:
a)Attachedtotheinnerborderof2ndrib
b)Coversapicalpartoflung

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c)Partofscalenusanteriormuscle
d)Vesselpassabovethefascia
CorrectAnswer-A
Answer-A.Attachedtotheinnerborderof2ndrib
ThesuprapleuralmembraneisknownasSibson'sfascia.

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Itreferstoathickeningofconnectivetissuethatcoverstheapexof
eachhumanlung.
Itattachestotheinternalborderofthefirstribandthetransverse
processesofvertebraC7.
Suprapleuralmembrane/Sibson'sfascia

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7.Thrombosisofposteriorinferiorcerebellar
arterycauses:
a)Lateralmedullarysyndrome
b)Webersyndrome
c)Medialmedullarysyndrome

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d)none
CorrectAnswer-A
Answer-A.Lateralmedullarysyndrome
Theposteriorinferiorcerebellarartery(PICA),thelargestbranch
ofthevertebralartery,isoneofthethreemainarterialblood

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suppliesforthecerebellum,partofthebrain.
Occlusionoftheposteriorinferiorcerebellararteryoroneofits
branches,orofthevertebralarteryleadstolateralmedullary
syndrome
alsocalledWallenbergsyndrome

8.Broca'sareasituatedin:

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a)Inferiorfrontalgyrus
b)Superiortemporalgyrus
c)Angulargyrus
d)Noneoftheabove
CorrectAnswer-A

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Answer-A.Inferiorfrontalgyrus
Broca'sarea
ortheBrocaarea(44)isaregioninthefrontallobeof
thedominanthemisphere(usuallytheleft)ofthehominidbrainwith
functionslinkedtospeechproduction.
Inabilitytospeakafterinjurytotheposteriorinferiorfrontalgyrusof

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thebrain.
PierrePaulBrocaheidentifiedthisregion,knownasBroca'sarea.
DifficultyinlanguageproductionasBroca'saphasia,also
calledexpressiveaphasia.
Broca'sareaisnowtypicallydefinedintermsofthepars

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opercularis
andparstriangularisoftheinferiorfrontalgyrus.


BROCA'SAREA(showninred).Coloredregionisparsopercularis
andparstriangularisoftheinferiorfrontalgyrus.Broca'sareaisnow
typicallydefinedintermsoftheparsopercularisandpars

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triangularisoftheinferiorfrontalgyrus.

9.Acutetonsillitiseffectswhichnerve:
a)GlossopharyngealNerve
b)FacialNerve
c)Trigeminalnerve

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d)VagusNerve
CorrectAnswer-A
Answer-A.GlossopharyngealNerve
Thenervessupplyingthepalatinetonsilscomefromthemaxillary
divisionofthetrigeminalnerveviathelesserpalatinenerves,and

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thetonsillarbranchesoftheglossopharyngealnerve.The
glossopharyngealnervecontinuespastthepalatinetonsiland
innervatestheposterior1/3ofthetonguetoprovidegeneraland
tastesensation.Thisnerveismostlikelytobedamagedduring
atonsillectomy,whichleadstoreducedorlostgeneralsensation

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andtastesensationtotheposteriorthirdofthetongue.
Relationsoftonsillarbed



10.StructuresnotpassingthroughAortic
opening:

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a)Azygosvein
b)Aorta
c)Thoracicduct
d)Vagus
CorrectAnswer-D

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Answer-D.Vagus
Aorticopening(Aortichiatus)isoneofthethreemajorapertures
throughthediaphragm&liesatthelevelofT12.
Severalstructurespassthroughtheaortichiatus:aorta,azygos
vein,thoracicduct.

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Vagus
passesthroughtheoesophagealhiatus.

11.WhatshouldbethevalueofBMItobe
consideredas"Lethal"inmen?
a)12
b)18

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c)13
d)14
CorrectAnswer-C
Answer:C?13
BMIValueof13isconsideredas"Lethal"inmen.

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Bodymassindex(BMI)isanestimateoftotalbodyfatmass
Simplyanindexofweightforheight.
Formula:
Weightinkilogramsdividedbythesquareofheightinmeters.
Bodymassindex=Weight(kg)/(Height)2(m)

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Uses:
Usedtoclassifyanddefineunderweight,overweight&obesityin
adults.
Classification&Metrics:
WorldHealthorganizationcategorizedBMIvaluesinto:

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Classification
BMIvalue
Normalweight
18.5to24.9kg/m2
Underweight

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<18.5
Pre-obesity(Pre-OB)
25to29.9kg/m2
Obesity(OB)
>30kg/m2

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ClassIobesity
30.0-34.9kg/m2
ClassIIobesity
ClassIIIobesity(Morbidform)

ClassIIIobesity(Morbidform)

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35.0-39.9kg/m2
Morethan40kg/m2
BMIvalueconsideredlethalforMenis13
FemaleswithstandandsurviveevenatlowerBMIrateupto11.

12.Whichreceptorsareblockedin

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MyastheniaGravis?
a)Achreceptors
b)Ca++receptors
c)Na2+receptors
d)Opioidreceptors

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CorrectAnswer-A
Answer:A-Achreceptors
Anautoimmunedisease
Antibodymediatedautoimmuneattackofacetylcholine
receptors.

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Inabilityofneuromuscularjunctionstotransmitsignalsfromnerveto
muscle
Resultinginmuscleweaknessandfatigability.
Unresponsiverespiratorymusclesmaycauserespiratoryfailurein
severecases.

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Analysisofneuromusculartransmissionreveal
Decreaseinacetylcholinereceptors(AChRs)
Lossofpost-junctionalfolds.
Circulatingantibodiestoacetylcholinereceptorspositive.
Diagnosis:

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Clinicaltest:
Strengthimprovementinresponsetoadministrationof
anticholinesteraseagents.
Treatment:
Anti-cholinesterasedrugs:
Allowsaccumulationoflargeramounts
ofacetylcholineinsynapticjunctions.

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Neostigmine.

13.WhatisthecharacteristicpatternseeninBrownsequard
syndrome-
a)C/Llossofjointsenseandposition
b)C/Llossofpain

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c)I/Llossofcompletesensoryfunctions
d)C/Lmotorfunctions
CorrectAnswer-B
Answer:B-Contralaterallossofpainsensations
Ifthespinalcordiscompletelytransected?Allthesensationsand

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motorfunctionsdistaltosegmentoftransectionareblocked.
Transectionofspinalcordonsinglesideresultsin"Brown
SequardSyndrome"
Functionsaffected:

Function

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Position
Description
affected
Motor

Ipsilateralside

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Completelossofmotor
functionsbelowthelevelof
transection
Sensory
Combinedeffects Somesensoryfunctionsare

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observed
lostontransectedsideand

othersonoppositeside.
Onthe

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Resultofdisturbancein
Contralateral
Spinothalamicpathway.
side:
Lossobserved2to6

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Sensationofpain, segmentsbelowthelevelof
cold,&heat
transection.
DiscreteCrude
Poorlylocalized(Still

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touch
persists).


Partialtransmissionoccursin
oppositeSpinothalamictract

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14.WhenVa/Qisinfinity?
a)PartialpressureofO2becomeszero
b)NoexchangeofO2&CO2
c)PartialpressureofCO2alonebecomeszero
d)PartialpressurebothCO2andO2remainnormal

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CorrectAnswer-B
Answer:B-NoexchangeofO2&CO2
Varepresentstheventilationinalveoli.
Qrepresentsthebloodflowthroughthealveolus.
TheratioofVaandQexplainstherespiratoryexchangewhenthere

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isanimbalancebetweenalveolarventilationandalveolarbloodflow.
Theventilation-perfusionratioisconsiderednormalthereisanequal
amountofbloodflow&ventilationthroughalveolus.
Va/qratioisZero-
Thereisinadequateornil,butperfusionpersists

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Va/qratioisinfinity-
Thereisadequateventilationbutnoperfusion
.
BothintheZeroandinfinityVa/Qratio,thereisnoexchangeof
gasesthroughtherespiratorymembranesofcorrespondingalveoli.
WhenVa/Qratioisinfinity,

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Thealveolarairequilibratesthehumidifiedinspiredair
Noexchangeofoxygenandcarbon-di-oxideoccurs.
PartialpressuresoftheO2andCO2are149mmHg&0mmHg
respectively

15.Cwaveisseenin-

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a)Iso-volumetriccontraction
b)Slowfillingatendofdiastole
c)Endofsystole
d)Startofdiastole
CorrectAnswer-A

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Ans.A.Iso-volumetriccontraction
Cwave:
ProducedbybulgingoftricuspidvalveintorightatriumduringIso-
volumetriccontractionofrightventricle.

16.Alphawavesareseenduring?

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a)Sleep
b)REMmovements
c)Relaxedstate
d)Activestate
CorrectAnswer-C

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Answer:C-Relaxedstate
Regardedasnormalwavefront
Occurwhenatrestandeyesclosedwithactive/wanderingmind
ie.,associatedwithadecreasedlevelofattention(either
duringrelaxed/subconsciousthinking
)

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RegularRhythm(Frequency8-13HzAmplitude-50-100V)

17.Inhypovolemicshockthereis-
a)Afferentarteriolarconstriction
b)Efferentarteriolarconstriction
c)Increasedbloodflowtokidney

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d)Normalcardiacoutput
CorrectAnswer-A
Answer:A.Afferentarterioleconstriction
Inadequatecirculationvolume.
Poorvenousreturntoheartwilldecreasethestrokevolume&

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cardiacoutput.
Compensationbytachycardia&increasedsystemicvascular
resistance(SVR).
Becomecoldperipherally(shutdown).
Mostcommoncauses-Fluidlossofanyetiology

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Hemorrhage
Salt&waterloss
Sepsis
Burns

18.Componentsresponsibleforcounter

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currentmechanisminkidneyareall
except:

a)Sodiumoutflowinthickascendinglimb
b)Wateroutflowinthindescendinglimb
c)Sodiumoutflowinthinascendinglimb

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d)FlowoftubularfluidfromPCTtoDCT
CorrectAnswer-C
Answer:C.Sodiumoutflowinthinascendinglimb
Counter-currentsystemoccursinkidney
Asysteminwhichinflowrunsparallelto,counterto,andinclose

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proximitytotheoutflowforsomedistance.
2countercurrentmechanismsavailable:
CountercurrentmultiplieratLoopofHenle
Generatehighmedullaryosmoticgradientpressure
Countercurrentexchangeratvasarectaofmedullarycapillaries

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Helpsinmaintainthemedullaryosmoticpressuregradient
Substancesinvolvedincountercurrentmechanisminclude:
Sodiumactivelyabsorbedwithco-transportofpotassium&chlorine
inthickascendinglimbofloopofHenle.
WaterreabsorbedinthindescendinglimbofloopofHenle.

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Ureadiffuseoutfromthemedullarycollectingductsintomedullary
interstitium.

19.Glucoseisabsorbedinintestineby?
a)Secondaryactivetransport
b)Facilitateddiffusion

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c)Simplediffusion
d)Primaryactivetransport
CorrectAnswer-B
Answer:B.Facilitateddiffusion
Facilitateddiffusionisadiffusionoflargewatersolublemoleculeby

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acarrierprotein.
Glucoseandaminoacidsaretransportedacrossthemembraneby
thismethod.

20.Insulinlikegrowthfactorissecretedby:
a)Liver

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b)Pituitarygland
c)Pancreas
d)Adrenalglands
CorrectAnswer-A
Answer:A.Liver

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Growthhormoneactsonthelivertoformsmallproteinscalled
"Somatomedins"
Somatomedinsincreasesbonegrowthinallaspect
Effectsaresimilartoinsulin,hencereferredtoas"Insulin-like
GrowthFactor"(IGF)
.

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Fourtypesavailable-
MostimportantisSomatomedinC-Specificallyreferredtoas
"Insulin-GrowthFactor-1/IGF-1"
Bindstoacarrierproteininblood
Hence,alongerdurationofactionthangrowthhormone.

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Half-life-about20Hrs(comparedtogrowthhormone-20mins)
BloodconcentrationofIGF-1followsthelevelsofgrowthhormone.
GrowtheffectsofGHaremostlyattributedtosomatomedin(rather
thanitsdirecteffectonbones&peripheraltissues)

21.WhatisProsopagnosia?

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a)Impairmentofconsciousness
b)Beingunawareofone'sproblems
c)Difficultyinidentifyingknownfaces
d)Failuretoidentifyobjects
CorrectAnswer-C

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Ans.C.Difficultyinidentifyingknownfaces.
Afeatureofanxietydisorder
Prosopagnosiaisdifficultyinidentifyingknownfaces
Otherfeaturesofanxietydisorderinclude,
Memoryimpairmentwithoutimpairmentofconsciousness

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Beingunawareofone'sproblem(Agnosognosia)

22.Tyrosinosisiscausedduetodeficiencyof
whichenzyme?
a)Fumarylacetoacetatehydrolase.
b)p-hydroxyphenylpyruvatedehydrogenase.

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c)Tyrosinetransaminase.
d)Tyrosineligase.
CorrectAnswer-A
Answer:A.Fumarylacetoacetatehydrolase
Severalmetabolicdisordersareassociatedwiththetyrosine

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catabolicpathway.TheprobablemetabolicdefectintypeI
tyrosinemia(tyrosinosis)isatfumarylacetoacetatehydrolase.
Itischaracterizedbybuildupoftoomuchoftheaminoacidtyrosine
inthebloodandtissuesduetoaninabilitytometabolizeit
Thetherapyemploysadietlowintyrosineandphenylalanine.

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Untreatedacuteandchronictyrosinosisleadstodeathfromliver
failure.

23.Lesch?Nyhansyndromeiscausedby
deficiencyofwhichenzyme?
a)OrotatePhosphoribosyltransferase

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b)Uracilphosphoribosyltransferase
c)QuinolinatePhosphoribosyltransferase
d)Hypoxanthine-guaninephosphoribosyltransferase(HGPRT)
CorrectAnswer-D
Answer:D.Hypoxanthine-guaninephosphoribosyltransferase

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(HGPRT)
Theconditioniscalledksch-Nyhanslmdrome,inwhichthereis
completedeficiencyofHGPRT.
HGPRTdeficiencycausesdecreasedutilization
ofPRPPinsalvagepathway.

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ThisresultsinincreasedproductionofpurinenucleotidefromPRPP
viade-novopathway.
Thediseaseischaracterizedbyhyperuricemia,
goutyarthritis,urinarystones,neurologicalsymptoms.

24.Fishodorsyndromeiscausedby

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deficiencyofwhichenzyme?
a)Fumarylacetoacetatehydrolase
b)Methanemonooxygenase
c)Monooxygenase3(FMO3)
d)D-aminoacidoxidase

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CorrectAnswer-C
Answer:C.Monooxygenase3(FMO3)
Trimethylaminuria,orfishodorsyndrome(FOS),isacondition
characterizedbythepresenceoftrimethylamine(TMA)--atertiary
aminewhoseodorisdescribedasresemblingthatofrottingfish--in

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theurine,sweat,andexpiredair.Thecauseofthesyndromeis
rootedinthedysfunctionalmetabolismofTMA,whichisnormally
oxidizedbyflavinmonooxygenase3(FMO3)intonon-odorous
trimethylamine-N-oxide(TMAO).
MostpatientswithFOSareeventuallydiagnosedwithprimary

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trimethylaminuria,whichiscausedbyadeficiencyinFMO3thatis
inheritedinanautosomalrecessivefashion.
Thediagnosisismadeonthebasisoftheclinicalpresentationand
urinalysis.UrinecanbeanalyzedfortheconcentrationofbothTMA
andTMAO,andtheresultsmaybegivenasanoxidizingratiobased

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ontheformula-TMAO/(TMAO+TMA)x100%.
Shortcoursesoforalneomycin,metronidazole,andamoxicillinhave
beenreportedtobeusefulinsomecases.

25.Galactosemiaisduetodeficiencyof
whichenzymes

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a)Galactose-1-phosphateuridyltransferase
b)HGPRT
c)Galactokinase
d)Epimerase
CorrectAnswer-A

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Answer:A.Galactose-1-phosphateuridyltransferase
Galactosaemia(Britishgalactosaemia)isararegeneticmetabolic
disorderthataffectsanindividual'sabilitytometabolizethesugar
galactoseproperly.Galactosemiafollowsanautosomalrecessive
modeofinheritancethatconfersadeficiencyinanenzyme

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responsibleforadequategalactosedegradation.

26.Whichofthefollowingismostabundant
endproductoffattyacidsynthesis-
a)Oleicacid
b)Palmiticacid

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c)Arachidonicacid
d)Glucose
CorrectAnswer-B
Answer:B.Palmiticacid
Fattyacidaresynthesizedbyextramitochondrialsystem.

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Thissystemispresentinmanytissuesincludingliverkidneybrain
lungmammaryglandandadiposetissues.
AcetylCoAisimmediatesubstrate.
Theendproductsofthissynthesisareusuallythesaturatedfatty
acidspalmitateandstearatewiththelatterpredominating.

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27.AboutDNApolymeraseIwhichoneis
correct?
a)Notrequiredinbacteria
b)RepairanydamagewithDNA
c)Involvedinokazakifragment

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d)ParticipateinDNAreplication
CorrectAnswer-A
Answer:A.Notrequiredinbacteria
DNApolymeraseI
participatesintheDNAreplicationof
prokaryotes.FunctionofPolIismainlytorepairanydamagewith

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DNA,butitalsoservestoconnectokazakifragmentsdeletingRNA
primersandreplacingthestrandwithDNA.

28.Whatdoeschaperonesassistin?
a)ProteinCleavage
b)ProteinFolding

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c)ProteinDegradation
d)ProteinModification
CorrectAnswer-B
Answer:B.ProteinFolding
FoldingofProteinsinVivoIsPromotedbyChaperones

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29.Fishyodouroccursduetodeficiencyof
thisvitaminfromdiet-
a)Biotin
b)Thiamine
c)Riboflavin

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d)Vit.A
CorrectAnswer-C
Answer:C.Riboflavin
Vitamin
B2orriboflavindeficiencycanbringaboutafishyodorin
thebody.

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*Fish-odorsyndrome,alsocalledtrimethylaminuria,isarare
metabolicdisordercausedbytheabsenceofenzynen-oxidase(A
Flavincontainingmonooxygenase,3(FMO3).Genefortrimethylamineoxidase
hasbeenmappedonchromosomeI(Iq23-q25).
*Trimethylamineisnormallyproducedintheintestinefromthe

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breakdownofdietarycholineandtrimethylamineoxidebybacteria.
*Eggyolkandliverarethemainsourcesofcholine,andfishisthe
majorsourceoftrimethylamineoxide.
*Trimethylamineisabsorbedand
oxidizedintheliverbytrimethylamineoxidase(flavin-

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containingmonooxygenases)totrimethylamineoxide,
whichisodorlessandexcretedintheurine.Deficiencyofthe
enzymeresultsinmassiveexcretionoftrimethylamineinurine.
*Consequently,tothesepatientssuchfoodsmaytaste
likerottenfishandimportafishyodortotheir

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salvia,sweatandurine.
Treatment
*Restrictionoffish,eggs,liverandothersourcesofcholine

(suchasnutsandgrains)inthedietsignificantlyreducetheodor.
-Treatmentwithshortcourseoforal

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metronidamle,neomycinorlactulosecausestemporaryreductionin
thebodyodor.
*RiboflavinsupplementcanbegiventoenhanceresidualFMO3
activity.

30.VMAisexcretedinurineinwhich

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condition-
a)Alkaptonuria
b)Phenylketonuria
c)Pheochromocytoma
d)Diabeticketoacidosis

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CorrectAnswer-C
Answer:C.Pheochromocytoma
VMAistheendproductofcatabolismofcatecholamines.
Inpheochromocytomaandneuroblastomathereisexcessive
synthesisofcatecholamineswhichcausesenhancedsynthesisof

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VMAanditsexcretionintheurine.
VMAistheurinaryproductofbothepinephrineandnorepinephrine.
Itisagoodscreeningtestforpheochromocytoma,andisalsoused
todiagnoseandfollowupneuroblastomaandganglioneuroma.

31.InCystinuriaallofthefollowingamino-

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acidsreabsorptiondefectispresent,
except

a)Lysine
b)Citrulline
c)Arginine

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d)Ornithine
CorrectAnswer-B
Ans.is'B'i.e.,Citrulline
Typesofcystinuria
*Type-I:Itishomozygouswithafullyrecessiveform.Thepatient

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excretesalargequantityofcystine,ornithine,lysine,and
arginine.GeneinvolvedisrBATonchromosome-2.
*Type-II&III:Theseareheterozygous
variantsofincompletelyrecessiveforms.Theyexcrete
cystine,ornithine,lysine,andargininemorethannormal

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butlessthanthehomozygousstate(Type-I).Geneinvolvedis
SLC7A9onchromosome79.
Cystinuria
*BiochemicalDefect
:Anautosomalrecessivedisorderthatresults
intheformationofadefectiveaminoacidtransporterintherenal

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tubuleandintestinalepithelialcells.
*Pathophysiology:Theaminoacidtransporterisresponsiblefor
transportingcystine,ornithine,lysine,andarginine.Defectivetubular
reabsorptionoftheseaminoacidsinthekidneysresultsinincreased
cystineintheurine,whichcanprecipitateandcausekidneystones.

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*ClinicalManifestations:Cystinekidneystonespresentingwith

severe,intermittentflankpainandhematuria.
*Labfindings:Increasedurinaryexcretionofcystine,ornithine,
arginine,andlysineonurineaminoacidchromatography;hematuria
andcystinecrystals(hexagonal)onthecoolingofacidifiedurine

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sediment.
*Imaging:RadiopaquekidneystonesonCTscan.Themost
specifictestisthecyanide?nitroprussidetest
*Treatment:Low-methioninediet;increasedfluidintake;
acetazolamidetoalkalinizetheurine.Ifthisfailsthenpatientsare

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usuallystartedonchelatingtherapywithpenicillamine.

32.FibrinopeptideAandfibrinopeptideBare
acidicduetothepresenceofwhichamino
acidsinitsstructure-

a)Serineandthreonine

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b)Glutamateandaspartate
c)Histidineandlysine
d)Glutamineandvaline
CorrectAnswer-B
Answer:B.Glutamateandaspartate

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TheN-terminalAandBportionsoftheAandBchainsaretermed
fibrinopeptideA(FPA)andfibrinopeptideB(FPB),respectively.
Thesedomainsarehighlynegativelychargedasaresultofan
abundanceofaspartateandglutamateresidues.
Thenegativechargescontributetothesolubilityoffibrinogenin

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plasmaandimportantlyalsoservetopreventaggregationby
causingelectrostaticrepulsionbetweenfibrinogenmolecules.

33.HIAAinurinepresentin?
a)Alkaptonuria
b)Albinism

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c)Carcinoid
d)Phenylketonuria
CorrectAnswer-C
Answer:C.Carcinoid
Carcinoidsyndromedevelopsinsomepeoplewithcarcinoidtumors

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andischaracterizedbycutaneousflushing,abdominalcramps,and
diarrhea.
Carcinoidtumouroccurthroughoutthegastrointestinaltract,most
commonlyintheappendix,ileumandrectumindecreasingorderof
frequency.

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Right-sidedvalvularheartdiseasemaydevelopafterseveralyears.
Thesyndromeresultsfromvasoactivesubstances(including
serotonin,bradykinin,histamine,prostaglandins,polypeptide
hormones)secretedbythetumor,whichistypicallyametastatic
intestinalcarcinoid.

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Diagnosisisclinicalandbydemonstratingincreasedurinary5-
hydroxyindoleaceticacid(HIAA).
Tumorlocalizationmayrequirearadionuclidescanorlaparotomy.
Treatmentofsymptomsiswithsomatostatinoroctreotide,but
surgicalremovalisperformedwherepossible;chemotherapymay

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beusedformalignanttumors.

34.Warthinfinkeldeycellsareseenin
a)Measles
b)Rubella
c)Rabies

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d)Typhoid
CorrectAnswer-A
Answer:A.Measles
MultinucleatedcellslikeWarthinFinkeldeyareseeninMeasles
Measlesvirusinfectsbyinvasionofrespiratoryepithelium.

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Localmultiplicationleadstoviremia(day2-3),thenspreadtoRE
system.
TwotypesofMultinucleatedgiantcellsinbothepidermis&oral
epitheliumby7-11days.
WarthinFinkeldeycellsofreticuloendothelialsystem

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Epithelialgiantcellsofrespiratory&otherepithelia.
Warthin?Finkeldeycell:
Typeofgiantmultinucleatecellfoundinhyperplasticlymphnodes
earlyinthecourseofmeasles
Underthelightmicroscope,thesecellsconsistofalarge,grape-like

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clusterofnuclei.
AlsowithHIV-infectedindividualsandKimuradisease.
Rarelyinneoplastic(e.g.lymphoma)&non-neoplasticlymphnode
disorders.
Unknownorigin;Reportsofstainingwithmarkerssimilartofollicular

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dendriticcells,includingCD21.

35.CD59markerofwhichdisease
a)PNH
b)PTEN
c)BRR

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d)Cowdensyndrome
CorrectAnswer-A
Answer:A.Paroxysmalnocturnalhemoglobinuria(PNH)
Paroxysmalnocturnalhemoglobinuria(PNH)
isadisease,dueto
acquiredmutationsin"Phosphatidylinositol

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GlycanComplementationGroupA"gene(PIGA)
..
Associatedwithdeficiencyofglycosylphosphatidylinositol
(GPI)
anchorproteinsalongwithabsenceofexternalsurface
membraneproteinsattachingtoit.
CD55(DAF)andCD59(MIRL)aretwosuchcomplementdefence

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proteins
CD59deficiency:
CommonfindinginRBCs&WBCsofpatientswithchronic
hemolysissufferingfromPNH
Diagnosis:

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Thedefinitediagnosisbasedondemonstrationofasubstantial
proportionofpatient'sRBChavingincreasedsusceptibilityto
complement(C),duetothedeficiencyontheirsurfaceofproteins
(particularlyCD59&CD55)

36.Opsoninis

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a)C3a
b)C3b
c)C5a
d)C6
CorrectAnswer-B

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Answer:B.C3b
Theprocessofcoatingaforeignparticletargeting&preparingitfor
phagocytosisprocessis"Opsonization".Substancesinvolvedare
opsonins.
MainopsoninsfromcomplementsystemisC3

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Examplesofopsoninsinclude:
Antibodies:
IgGandIgA
Componentsofthecomplementsystem:
C3b,C4b,andiC3b

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MannoseBindingLectin(MBL):
InitiatestheformationofC3b
MembraneAttackComplex(MAC)
IncludesC5b,C6,C7,C8&polymericC9
Opsonization&complementproteins:

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MainlyC3b,iC3b&C4b
C3:
Mostabundantproteinofallcomplementaryproteins,
CleavesintoC3aandC3b
C3a-

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Bindsandactivatesmastcells&basophils,releasehistamine.
C3b-

Mostcriticalcomponentinbothclassical&alternativepathway
C3battachestobacterialsurfacesforopsonizationbyphagocytes

37.Bernard?Souliersyndromedueto

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deficiencyof
a)Gp2b/3a
b)Gp1b
c)vWf
d)TNF

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CorrectAnswer-B
Answer:B.Gp1b
Bernard
?Souliersyndrome(BSS)/HemorrhagicParous
ThrombocyticDystrophy
Rareautosomalrecessivecoagulopathy

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Causesadeficiencyofglycoprotein1b(Gp1b),receptorforvon
Willebrandfactor.


38.Cowdensyndrome
a)P53
b)PTEN

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c)Rb
d)Ras
CorrectAnswer-B
Answer:B.PTEN
"PhosphataseandTensin"homolog(PTEN)
-proteininhumans

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encodedbythePTENgene.Genemutationspromotesdevelopment
ofcancers.
Cowden'sdisease/MultipleHamartomaSyndrome-
PartofPTENhamartomatumorsyndrome
Anautosomaldominantsyndrome

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Trichilemmomas-Numeroustumorsofhairfolliclesinface
MultiplehamartomatouspolypsinGItract.
Veryhighriskofbreast&thyroidcarcinoma
Treatment:
B/Lmastectomiesrecommended

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Contraindicatedaremammography&otherradiationexposureof
breasttissue

39.Chromosomeinvolvedinmyotonic
dystrophyis
a)Chromosome19

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b)Chromosome20
c)Chromosome21
d)Chromosome22
CorrectAnswer-A
Answer:A-Chromosome19

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Myotonicdystrophyistransmittedbymutationinan'unstable
trinucleotiderepeatsequence'ingene19q133.
Features:
Anautosomaldominantdisorder
Mostcommonadultmusculardystrophy

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Characteristicsfeature:
Myopathyisdistal
(incontrasttoothermyopathies-mostly
proximal).
MuscleatrophyselectivelyinvolvestypeIfibresonly
Appearsby5years,causesaslowrelaxationofhand

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grip
followingaforcedvoluntaryclosure.

40.TRALIoccurswithinhowmanyhoursof
transfusion?
a)48Hrs
b)72Hrs

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c)6Hrs
d)12Hrs
CorrectAnswer-C
Answer:C-6Hrs
Transfusion-RelatedAcuteLungInjury(TRALI)
-Syndrome

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characterizedbyacuterespiratorydistressfollowing
transfusion.
Symptoms:
Typicallydevelopduring,orwithin6hoursoftransfusion.
Rapidonsetofdyspnea&tachypnea
.

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Associatedfever,cyanosis,&hypotension.
Clinicalexamination:
Revealsrespiratorydistress.
Pulmonarycrackles
maybepresentwithnosignsofCHFor
volumeoverload.

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CXR-EvidenceofB/LpulmonaryedemaunrelatedtoCHF(non-
cardiogenicpulmonaryedema),
Bilateralpatchyinfiltratesrapidlyprogressingtocomplete"white
out"
indistinguishablefromAcuteRespiratoryDistressSyndrome
(ARDS).

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41.Kidneyrespondstoshockby
a)Decreasesrenalbloodflow
b)Increasesafferentarterioleresistance
c)GFRremainsunaltered
d)Perfusionofkidneyincreases

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CorrectAnswer-B
Answer:B-Increasesafferentarterioleresistance
Kidneyutilizesthefollowingmechanismsasaresponseto
shock:
Releaseofaldosterone
fromhypoxickidney

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ReleaseofADHduetodecreasedeffectivecirculatingblood
volume.
ReducedGFRduetoarterioleconstriction
Tissuefluidshiftintoplasmaduetoloweredhydrostaticpressure
(Hypotension)

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42.Whichofthefollowingisepithelialtumor
ofstomach?
a)Carcinoid
b)Lymphoma
c)GIST

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d)Gastricadenocarcinoma
CorrectAnswer-D
Answer:D-Gastricadenocarcinoma
Malignantepithelialtumororiginatingfromglandularepithelium
ofgastricmucosa.

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Aggressivelyinvadethegastricwall.
Laurenclassification:
Twotypesofgastricadenocarcinomaarepresent.
Intestinaltype
Diffusetype

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Intestinaltype-Irregulartubularstructures
Diffusetype-Mucinous&colloidal"Leather-bottlestomach"

43.IdentifyanXlinkeddisorder?
a)Colorblindness
b)Thalassemia

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c)Azoospermia
d)RetinitisPigmentosa
CorrectAnswer-A
Answer:A-Colorblindness
Hereditarycolorblindness/Achromatopsia

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Theabilitytoappreciateoneormoreprimarycolorisdefective
(anomalous)orabsent(anopia)
DuetomutationsinXchromosome
Red&greenpigmentconescodedbyXchromosome;Bluecoded
onchromosome7

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Morecommoninmalesthanfemales
Acquired-(Opticnerve/maculardamage)
Ishiharachart-
Testred/greencolorblindness-Farnsworth100huetest
Others:

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Azoospermia&RetinitisPigmentosa-Y-chromosomelinkeddisorder
Thalassemia-Inherited(Autosomalrecessivepattern)blood
disorderscharacterizedbyabnormalhemoglobinproduction.Genes
inChromosome11and16involved.

44.HAndLvarietyseenin

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a)Mixedcellularityhodgkin
b)Lymphocytedepleted
c)Lymphocytepredominance
d)Nodularsclerosis
CorrectAnswer-C

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Answer:C-Lymphocytepredominance
Hodgkinlymphoma(HL)-common"MalignantLymphomas"
2entities:
ClassicalHL(cHL)
NodularLymphocyte?predominantHL(NLPHL).

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Cells:
ClassicalHL-HodgkinandReed/Sternberg(HRS)cells
NodularLymphocytepredominantHL-Lymphocytic&Histiocytic
(L&H)cells

45.Stellategranulomaseenin

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a)Sarcoidosis
b)Catscratchdisease
c)Cryptococcosis
d)Histoplasmosis
CorrectAnswer-B

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Answer:B-Catscratchdisease
BacterialinfectioncausesbyBartonellahenselae
Acquiredinfectedcat/kittenscratch
Histology:
Characterizedbygranulomatousinflammationoflymphnodes.

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Skinlesiondemonstratesacircumscribedfocusofnecrosis
Regionallymphnodesdemonstratefollicularhyperplasiawith
centralstellatenecrosis
withneutrophils,surroundedbypalisading
histiocytes(suppurativegranulomas)&sinusespackedwith
monocytoidBcells,usuallywithoutperifollicularandintrafollicular

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epithelioidcells.

46.Whichbestexplains"Flippingeffect"?
a)LDH1>LDH2
b)LDH2>LDH1
c)LDH2>LDH3

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d)LDH3>LDH2
CorrectAnswer-A
Answer:A-LDH1>LDH2
Lactatedehydrogenase,
tetramericenzymewith4subunits,
4Subunitswith2isoforms-Hisoform(Heart)&Misoform

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(Muscle)
Heart&RBCs-LDH-1(4H);
Reticuloendothelialsystem-LDH-2(3H1M)
Lungs-LDH-3(2H2M)
Kidneys,placenta,&pancreas-LDH-4(1H3M)

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Liver&striatedmuscle-LDH-5(4M)
Uses:
LDHlevelsaremoreinRBC
HelpfulinassessmentofHemolysis/Tissuebreakdown
Flippingeffect:

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UsuallyLDH2inpredominantinserum&LDH1ispredominantin
heart
HigherlevelsofLDH1thanLDH2(Flippedpattern)issuggestiveof
myocardialinfarction
DamagedcardiactissuesreleaseLDH1intobloodstream.

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47.Nudemiceisnotresistanttoxenograft
duetoabsenceof
a)Bcell
b)Tcell
c)Bothbandtcell

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d)None
CorrectAnswer-B
Answer:B-Tcell
Nudemicelacks"Thymus"&cannotgeneratematureT
lymphocytes.

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AbsenceofT-lymphocytesmakesitunabletomountadaptive
immuneresponses
requiringCD4,helperTcells,CD8and
cytotoxicTcells.
Adaptiveimmuneresponsesthatremainunresponsivetonude
miceinclude:

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Antibodyformation(CD4+helperTcells)
Cell-mediatedimmuneresponses(CD4+and/orCD8+Tcells)
Delayed-typehypersensitivityresponses(CD4+Tcells)
Killingofvirus-infectedormalignantcells(CD8+cytotoxicTcells)
Graftrejection(bothCD4+&CD8+Tcells)

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Uses:
Laboratorystudyanimal-Insightsintoimmunesystem,leukemia,
solidtumors,AIDS&otherimmunedeficiencydiseases.
AbsenceoffunctioningTcellspreventsthemrejectingtheallografts
&Xenografts.

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48.Anaplasiais
a)Changingonetypeofepitheliumtoanother
b)Nuclearchromatin
c)Lackofdifferentiation
d)Morphologicalchanges

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CorrectAnswer-C
Answer:C-Lackofdifferentiation
Referstoalackofdifferentiationinneoplasticcells.
Well-differentiatedtumorsresembletheirtissueoforigin
Poorly-differentiatedorundifferentiated(anaplastic)tumorcells

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appearprimitiveandlackspecializationalonganyparticularcellline.

49.Whichlevelofprolactindefinitelysuggest
prolactinoma?
a)300ng/ml
b)150ng/ml

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c)200ng/ml
d)100ng/ml
CorrectAnswer-C
Answer:C-200ng/ml
Prolactinomasarethemostcommontypeofhyperfunctioning

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pituitaryadenoma.
Benigntumorsofpituitaryglandproducingprolactin.
Hyperprolactinemiacausesamenorrhea,galactorrhea,lossoflibido,
andinfertility.
Becausemanymanifestationsofhyperprolactinemia(e.g.,

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amenorrhea)aremoreobviousinpremenopausalwomenthanin
menorpostmenopausalwomen,prolactinomasusuallyare
diagnosedatanearlierstageinwomenofreproductiveagethanin
otherpersonssoaffected.
Higherbloodprolactinconcentrationsareseen.

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mildelevationsofserumprolactin(lessthan200g/L)inapatient
withapituitaryadenomadonotnecessarilyindicateaprolactin-
secretingneoplasm.

50.Laxativeabusecauseswhichofthe
followingrenalstones?

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a)Uricacid
b)Ammoniumurate
c)Struvite
d)Caoxalate
CorrectAnswer-B

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Answer:B-Ammoniumurate
Basedonthechemicalnaturetwotypesofkidneystones
:
Calciumoxalate(majority).
OthersincludeUricacid,Struvite(Infectedstones),andCystine
stones(rarehereditarymetabolicdisorder

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Characteristicstoneformationinlaxativeabuse:
Laxativeabuseactsafactorinkidneystoneformation.
Laxativeabusecausespotassiumloss
Asacompensationmechanismkidneyproduceslargeamountof
ammonium.

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Resultinginformationofuncommonstonetype-ammoniumacid
urate.

51.Whichofthefollowingcanresultin
dactylitis
a)Hemophilia

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b)Vonwillebranddisease1
c)Measles
d)SickleCellAnemia
CorrectAnswer-D
Answer:D-SickleCellAnemia

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Dactylitis(Hand-FootSyndrome)isseeninsicklecellanemia
Severepainaffectingthebonesofhands,feet,orboth.
Often1stsymptomofsicklecellanemiainbabies.

52.Whichchromosomeisresponsibleforthe
productionofMIF?

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a)Chromosome16
b)Chromosome22
c)XChromosome
d)Ychromosome
CorrectAnswer-D

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Answer:D-YChromosome
Anti-MullerianHormone(AMH)/MullerianInhibitingFactor(MIF);
Mullerian-inhibitingHormone(MIH)/Mullerian-inhibitingSubstance
(MIS).
AMH-DownstreamgenesregulatedbySRYpathway

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SRY-Genein"Sexdeterminingregion"-shortarmofY
chromosome-Testisdeterminingfactor.
SecretedbySertolicellsofthetestes.
TheproductionofAMHiscontrolledbytwoautosomalgeneloci.
Hormonecode

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Receptorcode.
Glycoproteinhormone
Relatedtoinhibin&activin
Memberofthetransforminggrowthfactor-(TGF-)
Keyrolesareingrowthdifferentiationandfolliculogenesis.

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53.SiteofactionofamphotericinBis:
a)Ribosomes
b)Cellwall
c)Plasmamembrane
d)Protein

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CorrectAnswer-B
Answer:-B-Cellwall
PolyenedrugcompoundslikeAmphotericinBactsoncell
membrane-
AmphotericinB,antifungalagent.

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Chemicallyapolyenecompound
ObtainedfromStreptomycesnodosus.
Polyeneshaveahighaffinityfor"ergosterol"presentinthefungal
cellmembrane.
Bindsandgetsinsertedintothecellmembraneforming"Micropore".

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Markedincreaseinpermeabilityofcellmembrane.
PolyenedrugcompoundslikeAmphotericinBactsoncell
membrane
AmphotericinB,antifungalagent.
Chemicallyapolyenecompound

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ObtainedfromStreptomycesnodosus.
Polyeneshaveahighaffinityfor"ergosterol"presentinthefungal
cellmembrane.
Bindsandgetsinsertedintothecellmembraneforming"Micropore".
Markedincreaseinpermeabilityofcellmembrane.

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54.Whichantiretroviraldrugalsohasanti
hepatitisactivity?
a)Abacavir
b)Tenofovir
c)Nevirapine

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d)Emtricitabine
CorrectAnswer-D
Answer:D-Emtricitabine
Emtricitabine,NRTIdrugwithbothantiretroviral&anti-hepatitis
properties

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Nucleosidereversetranscriptaseinhibitorforthepreventionand
treatmentofHIVinfectioninadultsandchildren.
Alsousedincombinationwithtenofovir

55.Drugofchoiceforresistantrheumatic
chorea?

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a)Valproate
b)Haloperidol
c)Diazepam
d)Probenecid
CorrectAnswer-A

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Answer:-A-Valproate
Valproate,
Sulpiride,&diazepamareusedforsymptomatic
treatment.
AcuteRheumaticFever:
AbnormalimmuneresponsetogroupAstreptococcalinfection

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Commonlyaffectingthejoints,heart,brain,andskin.
Symptoms:Arthritis,relatedtocarditis&chorea.
Sydenham'schorea/Choreaminor
Characterizedbyrapid,uncoordinatedjerkingmovementsprimarily
affectingtheface,handsandfeet.

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Signs&symptomsofchoreausuallydonotrespondwellto
treatmentwithantirheumaticagents
Symptomatictreatmentincludeanticonvulsants(eg,valproate,
carbamazepine
)andneuroleptics(eg,pimozide,haloperidol,
risperidone,olanzapine

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56.AtpKa=pH-
a)Conc.ofdrugis50%ionicand50%non-ionic
b)Absorptionofdrugis50%ionicand50%ionic
c)Concofdrugis75%ionicand25%non-ionic
d)Concofdrugis25%ionicand75%non-ionic

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CorrectAnswer-A
Answer:A-Concentrationofdrugis50%ionic&50%Non-
ionic
NumericallyequalpKa&pHrepresents50%drugionization
pKaisnegativelogarithmofacidicdissociationofweakelectrolyte.

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Onequalconcentrationsofionized&unionizeddrugs,log1is
zero.
Thus,whenpKaisnumericallyequaltopH
(pKa=pH)50%drugisionized.

57.Physiologicaldoseofhydrocortisone

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(mg/kg/day)is-
a)5mg/kg/day
b)10mg/kg/day
c)15mg/kg/day
d)20mg/kg/day

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CorrectAnswer-B
Answer:-B-10mg/kg/day
Thenormalrateofsecretionoftwoprinciplecorticoids
Hydrocortisone-10mg/kg/day(nearlyhalfinmorninghours)
Aldosterone-0.125mg/daily

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58.Whatismechanismofactionofcolchicine
inacutegout?
a)Inhibitionofpurinemetabolism
b)Inhibitionofuricacidconversion
c)Migrationofleukocytes

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d)Leukocytes,lymphocytesinhibition&microtubularinhibitor
CorrectAnswer-D
Answer:D-Leukocytes,Lymphocytesmigrationinhibition&
microtubularinhibitor.
Colchicineactsbyinhibitingthegranulocytemigrationintothe

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inflamedjoint.
AnalkaloidfromColchiumautumnale
Specificallysuppressesgoutyinflammation.
Doesn'tinhibitthesynthesisorpromotetheexcretionofuricacid.
Mechanismofaction:

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Colchicineactsby,inhibitsthereleaseofglycoprotein
Bindstofibrillarproteintubulesinhibitinggranulocyte
migrationintotheinflamedjoint
.
Anacuteattackofgoutstartsbyprecipitationofuratecrystalsin
synovialfluid.

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Inflammatoryresponsestartswithgranulocytemigrationintojoint
Phagocytosinguratecrystalsreleasingglycoprotein
Glycoproteinincreaseslacticacidproductionandreleasing
lysosomalenzymescausingmorejointdestruction.

59.Basiliximabisan-

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a)IL-1receptorantagonist
b)Anti-CD3antibody
c)IL-2receptorantagonist
d)TNFinhibitor
CorrectAnswer-C

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Answer:-C-IL-2receptorantagonist
BasiliximabexhibitshighaffinitytowardsIL-2receptor,
inhibitingit.
Anti-CD-25antibody
HighaffinityforIL-2receptor

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Shortplasmahalflife-1week
Usefulinpreventingtransplantrejectionreactions.
Adverseeffects-Anaphylacticreactions&opportunisticinfections.

60.Pirenzapineisused-
a)Gastriculcer

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b)Glaucoma
c)Hypertension
d)Congestivecardiacfailure
CorrectAnswer-A
Answer:A-GastricUlcer

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Pirenzepine,aselectiveM1anticholinergicdruginhibiting
gastricacidsecretion.
Lowtherapeuticdoserange.
Usedfortreatinggastriculcer.

61.Whichofthefollowingantipsychotichave

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increasedprolactinsecretion-
a)Olanzapine
b)Ziprasidone
c)Clozapine
d)Risperidone

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CorrectAnswer-D
Answer:-D-Risperidone
Significantriseinprolactinlevelsduringrisperidonetherapyis
observed.
Risperidone-
Antipsychoticdrugwithcombined5-HT2aand

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dopamineD2antagonistactivity
Highaffinitytoalpha1,alpha2andH1receptors
MorepotentD2blockerthanclozapine
Amelioratessymptomsofschizophrenia
Prolactinlevelsriseduringrisperidonetherapy,butless

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epileptogenicthanclozapine.
Producesextrapyramidalsideeffectsarelessonlyatlowerdoses
(<6mg/day).
Blockadeofthesecontributetoefficacyandsideeffectslikepostural
hypotension.

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Frequentlycausesagitation.

62.Whichofthefollowingisglucocorticoid
synthesisinhibitor?
a)Mifepristone
b)Flutamide

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c)Finasteride
d)Metyrapone
CorrectAnswer-D
Answer:D-Metyrapone
Inhibits1113-Hydroxylaseinadrenalcortex

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Preventsthesynthesisofhydrocortisone


63.Whichofthefollowingstatementsis
incorrectw.r.tPrasugrel?
a)Notaprodrug
b)P2Ypurinergicreceptorblocker

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c)Hasastrongantiplateletactivity
d)CausesintracranialhemorrhageinTIApatients.
CorrectAnswer-A
Answer:A-Notaprodrug
Prasugrelisaprodrug,similartoClopidogrel

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Thienopyridinedrugclass
IrreversibleantagonistofP2Y12ADPreceptors
Rapidlyabsorbed,completelyactivated&exertsmore
consistentplateletinhibition.
Stronganti-plateletactivity

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Bleedingcomplicationsaremoreseriousandfrequent.
Contraindicatedinpatientswithhistoryofischemicstrokes
andTIA's


64.Q-Telongationisseeninwhichdrug?
a)Quinidine

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b)Amiodarone
c)MagnesiumSulfate
d)Lignocaine
CorrectAnswer-A
Answer:A-Quinidine

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SpecificpatternofQ-Tprolongationisreferredtoas"Torsades
depointes"

DrugscausingTorsadesdePointes
Quinidine(mostcommon)
Sotalol

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Procainamide
Disopyramide
Phenothiazines
Tricyclicantidepressants

65.Sacubitrilis,

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a)ACEinhibitor
b)Neutralendopeptidaseinhibitor
c)Calciumchannelinhibitor
d)Betaadrenergicblocker
CorrectAnswer-B

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Answer:B-Neuro-endopeptidaseinhibitor
Sacubitril,aprodruginhibitingneuro-endopeptidaseenzyme
ActivatedtoSacubitril,
Inhibitingenzymeneprilysin(Neutralendopeptidases)
Combinationdrugusedinheartfailurepatients

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UsuallycombinedwithACEinhibitorslikevalsartaninratioof1:1

66.Niacintherapyiscontraindicatedin
diabetesbecause-
a)Increasesthebloodsugarlevels
b)Causesscleroderma

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c)Difficulttogiveinjection
d)Increasesthemetabolismoforalhypoglycemicdrugs
CorrectAnswer-A
Answer:A-increasesthebloodsugarlevels
Niacintherapyhaspotentialeffectsonbloodsugarlevels.

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Increasesthebloodglucoselevelsindiabetespatients

67.Endothelinactsthroughwhichreceptors?
a)cAMP
b)cGMP
c)Na+receptors

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d)Calciumreceptos
CorrectAnswer-A
Answer:A-cGMP
Endothelin-1(ET-1)isapotentendogenousvasoconstrictor,mainly
secretedbyendothelialcells.

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68.Whichisthecentrallyactingalpha2
agonistmusclerelaxant-
a)Diazepam
b)Bromocriptine
c)Tizanidine

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d)Methocarbamol
CorrectAnswer-C
Answer:-C-Tizanidine
Centralalpha2adrenergicagonist
Mechanismofaction:

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Inhibitsthereleaseofexcitatoryaminoacidsinspinalinterneurons
Facilitatestheinhibitorytransmitterglycine
Inhibitspostsynapticreflexes
Reducingmuscletone,frequencyofmusclespasms.without
reducingthestrengthofmuscle.

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Indications:
Spasticityinneurologicaldisorders
Painfulmusclespasmofspinalorigin.
Contraindications:
Patientsonantihypertensivesspeciallyclonidine.

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69.Apixabanis-
a)Antithrombininhibitor
b)DirectXainhibitor
c)Plateletactivator
d)ClottingFactorXII

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CorrectAnswer-B
Answer:B-DirectXainhibitor
DirectXainhibitor
Anticoagulantfortreatment&prophylaxisofvenousthromboembolic
events

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DVT&PE

70.Anaerobesareresistantintrinsically
against-
a)Betalactamantibiotics
b)Aminoglycosides

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c)Azithromycin
d)Metronidazole
CorrectAnswer-B
Answer:B-Aminoglycosides
Anaerobicbacteriaparticularlyareresistantto

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aminoglycosidesduetolackofoxidativemechanismtodrive
druguptakingprocess.
Intrinsicresistance/Insensitivity
:
Innateabilityofbacteriatoresistactivityofparticularantimicrobial
agent

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Inherentstructuralorfunctionalcharacteristicsallowsfortolerance
ofaparticulardrugorantimicrobialclass.i.e.,Susceptibilitytothat
particulardrugisreduced.

71.Whichisnotbacteriostaticantibiotic-
a)Clindamycin

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b)Vancomycin
c)Tetracycline
d)Cephalosporins
CorrectAnswer-B
Answer:B-Vancomycin

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Bacteriostaticantibiotics
Limitbacterialgrowthbyinterferingwithbacterialprotein
production,DNAreplication,
orotheraspectsofbacterialcellular
metabolism.
Tetracyclines,sulfonamides,clindamycin,

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spectinomycin,trimethoprim,chloramphenicol,macrolidesand
lincosamides.
Bactericidalantibiotics
Inhibitcellwallsynthesis
(Irreversiblekilling)
Aminoglycosides.cephalosporins.fluoroquinolones.metronidazole.

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penicillin.vancomycin

72.Whichofthefollowingcausesmelanosis
coli?
a)Senna
b)Sorbitol

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c)MagnesiumSulphate
d)Bisacodyl
CorrectAnswer-A
Answer:A-Senna
Laxativeabusewithdrugslikesennacausemelanosiscoli

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Anthranoidlaxatives(aloe,cascarasagrada,andsenna
)are
derivedfromnaturallyoccurringplants
Consideredtobestimulantlaxatives.
Safershorttermuse.
Longtermabusecancausemelanosiscoli&possibly

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increasesriskofcoloniccancer.


73.Whichamongthefollowingwillthechoice
ofantibioticforabedriddenpatientwith
catheter-relatedUTIandpneumonia.

a)Amoxicillin

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b)BetaLactamantibioticswithbetalactamase
c)3rdgencephalosporins
d)2ndgencephalosporins
CorrectAnswer-B
Answer:B-BetaLactamAntibiotics

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Containsbetalactamaseenzymeforpotentactionagainst
organismscausingUTI


74.Mycoplasmaisresistantto-
a)Ceftriaxone
b)Cephalosporins

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c)Aminoglycosides
d)Fluoroquinolones
CorrectAnswer-A
Answer:A-Ceftriaxone
MycoplasmashowsresistancetowardsCeftriaxone,athird

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generationcephalosporin(betalactamantibiotic)
Lackofcellwallinmycoplasmasmakesthemintrinsically
resistantto-lactams
&toallantimicrobialsthattargetcellwall.
Mycoplasmapneumoniae:
Mycoplasmapneumoniaeisapathogenicmycoplasmaresponsible

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forrespiratorytractinfectionsinhumans.
First-linetreatment:macrolides&relatedantibiotics,tetracyclines
andfluoroquinolonesispreferred.

75.Tadalafilshouldnotbegivenwith:
a)Vasodilator

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b)Antibiotics
c)Vasoconstrictors
d)Valproate
CorrectAnswer-A
Answer:A-Vasodilators

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Combinationwithvasodilatorsresultsinsuddenchangesof
bloodpressurevalues
Tadalafilrelaxesmusclesofthebloodvesselsandincreases
bloodflowtoparticularareasofthebody.
Usedtotreaterectiledysfunction(Impotence),andsymptomsof

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benignprostatichypertrophy(Enlargedprostate)
Eg:Takingtadalafilwithvasodilatordruglikenitratecancause
sudden&seriousdecreaseinbloodpressure
.

76.Estimatevolumeofringerlactateinfirst8
hrsfor40%burnsin50kgmalewith2?

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burns?

a)8lt
b)4lt
c)2lt
d)6lt

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CorrectAnswer-B
Answer:B.4lt
ParklandformulamostcommonlyusedIVfluid-LactatedRinger's
Solution
Fluidcalculation

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4xweightinkgx%TBSAburn
Give1/2ofthatvolumeinthefirst8hours
Giveother1/2innext16hours
Warning:Despitetheformulasuggestingcuttingthefluidrateinhalf
at8hours,thefluidrateshouldbegraduallyreducedthroughoutthe

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resuscitationtomaintainthetargetedurineoutput,i.e.,donotfollow
thesecondpartoftheformulathatsaystoreducetherateat8
hours,adjusttheratebasedontheurineoutput.
Exampleoffluidcalculation
50-kgmanwith40%TBSAburn

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Parklandformula:
4x50x40=8,000ml
Give1/2infirst8hours=4,000mlinfirst8hours
Adjustfluidratetomaintainurineoutputof50ml/hr

77.Posthumouschildis:

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a)Childdeliveredafterdeathofbiologicalmother
b)Childdeliveredafterdeathofbiologicalfather
c)Bornafterdeathofparents
d)hasbeenabandonedbyparents
CorrectAnswer-B

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Answer:B.Childdeliveredafterdeathofbiologicalfather
Achildbornafterdeathofhis/herbiologicalfather

78.

M'naghtenrulecomesunderwhichsectionof
IPC?

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a)Crpc84
b)Cpc48
c)Ipc84
d)IPC48
CorrectAnswer-C

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Answer:C.Ipc84
M'naghtenrule(legaltestorrightorwrongtest):
Itstatesthatanaccusedpersonisnotlegallyresponsible,ifitis
clearlyprovedthatatthetimeofcommittingthecrime,personwas
sufferingfromsuchadefectofreasonfromabnormalityofmindthat

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hedidn'tknowthenatureandqualityofacthewasdoingorthat
whathewasdoingwaswrongi.e.apersonisnotresponsibleifheis
notofsoundmind.
Itisacceptedinindiaaslawofcriminalresponsibilityandis
embodiedinsection841PCas-"nothingisanoffencewhichis

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donebyaperson,whoatthetimeofdoingit,byreasonof
unsoundnessofmindisincapableofknowingthenatureofact,or
thatheisdoingwhatiseitherwrongorcontrarytolaw".

79.Bluishdiscolorationofgastricmucosa
seeninwhichpoisoning?

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a)Mercury
b)Cadmium
c)Amytalsodium
d)Arsenic
CorrectAnswer-C

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Answer:C.Amytalsodium
S.
Poison
Color
No.

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1.
Coppersulfate,amytalcapsule
Blue
2.
Ferroussulfate

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Green
3.
Sulphurichydrochloric/aceticacid
Black/charred
4.

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Nitricacid
Yellow
5.
Carbolicacid
Buff/white

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6.
Arsenic
Whiteparticles
7.
Mercury

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Slate
8.
Cresols
Brown

80.Musclepain,nephropathycausedby

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whichmetalpoisoning
a)Arsenic
b)Cadmium
c)Mercury
d)Lead

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CorrectAnswer-A
Answer:A.Arsenic
Nephropathyiscausedbymostofheavymetals.Musclepainis
associatedwitharsenic.

81.Whichisthefirstorgantoputrefy:

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a)Brian
b)Heart
c)Prostate
d)Kidney
CorrectAnswer-A

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Answer:A.Brian
Theorderofputrefactionis-earliesttolastlarynx,trachea
Stomach,intestineliver,spleenBrain,LungsHeart,Kidney
Bladder,Uterus/ProstrateSkin,muscles,tendonlastly,
bones.)

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82.Locardisfamousfor:
a)Theoryofexchange
b)Fingerprintstudy
c)Formulaforestimationofstature
d)Systemofpersonalidentificationusingthebodymeasurement

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CorrectAnswer-A
Answer:A.Theoryofexchange
Edmundlocardisfamousfortheoryofexchange.

83.Whendoesbasiocciputfuseswith
basisphenoid?

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

a)18to22
b)22to25
c)14-16
d)12-14
CorrectAnswer-A

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Answer:A.18to22
Thebasioccipitalfuseswiththebasisphenoidatabout18to21
years.

84.Whatisthesmellofmummifiedbody?
a)Odourless

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b)Putrid
c)Pungent
d)Offensive
CorrectAnswer-A
Answer:A.Odourless

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Amummywillsmellodourless,thisisbecausetheinternalorgans
areremoved(whicharethebiggestfactorsinthedecayprocess)
andreplacedwithnatron(whichdriesthemout,preventing'proper'
decay).Therestofthebodyisalsodriedusingnatron.

85.Patientpresentedwithproximaltubule

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proteinuria.Whichmetalislikelytobe
associatedwithit?

a)Cadmium
b)Mercury
c)Gold

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d)Lead
CorrectAnswer-A
Answer:A.Cadmium
Earlykidneydamageandproteinuriaseeninpeople,occupationally
orenvironmentallyexposedtocadmium.

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86.Whichofthefollowingconstitutional
articleisnotrelatedtochildren:
a)23
b)21-A
c)42

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d)24
CorrectAnswer-C
Answer:C.42
ConstitutionalGuaranteesthataremeantspecificallyfor
childreninclude:

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

Righttofreeandcompulsoryelementaryeducationforallchildrenin
the6-14yearagegroup(Article21A)
Righttobeprotectedfromanyhazardousemploymenttilltheageof
14years(Article24)
Righttobeprotectedfrombeingabusedandforcedbyeconomic

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necessitytoenteroccupationsunsuitedtotheirageorstrength
(Article39(e))
Righttoequalopportunitiesandfacilitiestodevelopinahealthy
mannerandinconditionsoffreedomanddignityandguaranteed
protectionofchildhoodandyouthagainstexploitationandagainst

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moralandmaterialabandonment(Article39(f))
Righttoearlychildhoodcareandeducationtoallchildrenuntilthey
completetheageofsixyears(Article45)
Besides,ChildrenalsohaverightsasequalcitizensofIndia,
justasanyotheradultmaleorfemale:

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Righttoequality(Article14)
Rightagainstdiscrimination(Article15)
Righttopersonallibertyanddueprocessoflaw(Article21)

Righttobeingprotectedfrombeingtraffickedandforcedinto
bondedlabour(Article23)

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Rightofminoritiesforprotectionoftheirinterests(Article29)
Rightofweakersectionsofthepeopletobeprotectedfromsocial
injusticeandallformsofexploitation(Article46)
Righttonutritionandstandardoflivingandimprovedpublichealth
(Article47)

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87.WhichofthestatementregardingFactory
actiscorrect
a)Childagelessthan14carryingseriousworkearnmoremoney
b)Lessthan14yrnotdoneforfactoryact
c)Morethan72hourworkperweek

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d)Morethan82hoursaweek
CorrectAnswer-B
Answer:B-Lessthan14yrnotdoneforfactoryact
TheFactoryActprohibitstheemploymentofchildrenbelow14years
anddeclares15to18yearsasbelongingtotheadolescentgroup.

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Adolescentsrequirefitnesscertificatepriortoemploymentinajob.
Actalsoprescribedamaximum48hoursperweek,notexceeding9
Hoursperdaywithatleasthalfhourrestafter5hourcontinuous
work.

88.Burkholderiacepaciaisresistanttowhich

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

ofthefollowingdrugs:
a)Ceftazidime
b)Trimethoprim-sulfamethoxazole
c)Temocillin
d)Cefotetan

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

CorrectAnswer-D
Answer:D.Cefotetan
B.cepaciacomplexstrainsareintrinsicallyresistanttoawiderange
ofantimicrobialagents,includingaminoglycosides,polymyxin,first
andsecondgenerationcephalosporins,andcarboxypenicillins

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

AntimicrobialagentsthatareeffectiveagainstB.cepaciacomplex
includemeropenem,ceftazidime,piperacillin,temocillin,and
trimethoprim-sulfamethoxazole.

89.ShinglesIscausedbywhichofthe
following?

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

a)Varicella-zoster
b)Herpessimplex
c)CMV
d)None
CorrectAnswer-A

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Ans.A.Varicella-zoster
Shingles,alsocalledherpeszoster,isapainfulskinrash.
Shinglesiscausedbyreactivationofthevaricellazostervirus,the
samevirusthatcauseschickenpox.

90.Ureabreathtestisusedfordiagnosisof:

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

a)H.pylori
b)Campylobacterjejuni
c)E.coli
d)Lactobacillus
CorrectAnswer-A

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

Answer:A.H.pylori
Theureabreathtestisarapiddiagnosticprocedureusedtoidentify
infectionsbyHelicobacterpylori,aspiralbacteriumimplicatedin
gastritis,gastriculcer,andpepticulcerdisease.Itisbaseduponthe
abilityofH.pyloritoconvertureatoammoniaandcarbondioxide

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91.Hyperacutegraftrejectionoccursafter
howmuchtime?
a)24hours
b)2weeksright
c)Inminutes

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d)Years
CorrectAnswer-C
Answer:C.Inminutes
HyperacuteTransplantRejectionoccursalmostimmediatelyandis
oftenevidentwhileyouarestillinsurgery.Itiscausedbyaccidental

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ABOBloodtypemismatchingofthedonorandrecipientwhich
almostneverhappensanymore..Acuteonsetisinfewweeksto
month.Chroniconsetisfrommonthstoyears.

92.Australianantigenforhepatitisbis?
a)HbSag

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b)HbEag
c)HbDag
d)HbVDna
CorrectAnswer-A
Answer:A.HbSag

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HBsAg(alsoknownastheAustraliaantigen)isthesurfaceantigen
ofthehepatitisBvirus(HBV).ItindicatescurrenthepatitisB
infection.

93.Whichfungusismostcommonly
associatedwithorbitalcellulitisin

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

patientswithdiabeticketoacidosis.

a)Candida
b)Mucor
c)Aspergillus
d)Rhizopus

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

CorrectAnswer-C
Answer:C.Aspergillus
Orbitalcellulitistermisreservedforinfectionsbehindtheorbital
septumwhichmayormaynotspillovertolids.BacterialOCismore
commoninchildrenandfulminantinfection(&ischemicinfarction)

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withMucororAspergillustypicallyaffectspatientswithdiabetes(esp
ketoacidosis)andimmunosuppression.PresentationisExtensive
swellingoflidswithchemosisoftenobscureproptosis(i.e.most
commonlylateral&downwards).Proptosiswithimpairedmobility
resultingindiplopiaPainissevere,increasedbymovementofeye

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orpressureUnilateral,tender,warm&redperiorbitaledema,painful
ophthalmoplegia.

94.SabinFeldmandyetestisusedfor
diagnosisofwhichofthefollowing
condition:

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a)Botulism
b)Toxoplasmosis
c)Sarcoidosis
d)Yellowfever
CorrectAnswer-B

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Answer:B.Toxoplasmosis
ASabin?Feldmandyetestisaserologictesttodiagnosefor
toxoplasmosis

95.AcuteHemorrhagicConjunctivitisis
causedbywhichofenterovirustype?

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a)69
b)68
c)70
d)71
CorrectAnswer-C

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Answer:C.70
Acute
hemorrhagicconjunctivitis(AHC)ischaracterized
byconjunctivalcongestion,vasculardilatation,andonsetofedema
.Serologicstudieshavebeenusefulinshowingthepresenceof
neutralizingantibodiestoCoxsackiegroupA24(CA24)and

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enterovirusE70(EV70)strainsasthecausativeagent.

96.Echinococcusgranulosusarecommonly
seeninwhichofthegivenanimals:
a)Dog
b)Cat

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c)Fox
d)Pig
CorrectAnswer-A
Answer:A.Dog
Echinococcusgranulosus
,alsocalledthehydatidworm,hyper

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tape-wormordogtapeworm.Domesticdogs(Canisfamiliaris)have
beenrecognisedasthedefinitivehostoftheparasite.

97.Ananaerobecausingmultipleabscess
withdischargingsinuses,demonstrating
sulphurgranulesinpusis?

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a)Actinomycetes
b)Nocardia
c)Salmonella
d)Tularemia
CorrectAnswer-A

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Answer:A.Actinomycetes
Actinomycosisisararesubacutetochronicinfectioncausedbythe
gram-positivefilamentousnon-acidfastanaerobictomicroaerophilic
bacteria,Actinomyces.
Thechronicformhasmultipleabscessesthatformsinustractsand

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areassociatedwithsulfurgranules.About70%ofinfectionsaredue
toeitherActinomycesisraeliiorActinomycesgerencseriae.
Thecharacteristicofthediseaseisthesulfurgranuleswhichare
yellow.Theyareformedprimarilybymycelialfragmentswithsome
proteinaceouspolysaccharidecomplexes,whichactasaresistance

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mechanismtoavoidandinhibitphagocytosis.
Multipleabscesswithdischargingsinuses,demonstratingsulphur
granulesinpusarecharacteristicsofactinomycetes

98.Wholebloodisusedasasamplefor
whichtest?

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a)Bacteria
b)IGRA
c)Genexpert
d)Virus
CorrectAnswer-B

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Answer:B.IGRA
Interferon-GammaReleaseAssays(IGRAs)arewhole-bloodtests
thatcanaidindiagnosingMycobacteriumtuberculosisinfection

99.Whichorganismcausingacutebacterial
prostatitis?

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a)Enterococcus
b)Streptococcusviridans
c)Peptostreptococcus
d)E.coli
CorrectAnswer-D

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Answer:D.E.coli
Aerobicgram-negativebacilliarethepredominantpathogensin
bacterialprostatitis.E.colicause50%?80%ofcases;other
pathogensincludeEnterobacteriaceae(eg,KlebsiellaandProteus,
whichaccountfor10%?30%ofcases),Enterococcusspecies(5%?

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10%)

100.Whichofthefollowingorganism
releaseshistamineandcausescombroid
fishpoisoning-

a)Salmonella

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b)Staphylococcus
c)P.aeruginosa
d)Weissella
CorrectAnswer-C
Answer:C.P.aeruginosa

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Scombroidpoisoning
isoneofthemostcommoncausesof
morbidityassociatedwithfishintakewhichhavenotbeen
refrigeratedproperlyfromthetimetheywerecaughtuntilthetime
theywereserved.Bacteriaactoncompoundsinthefish,releasing
histamine.Processisinducedbyenzymesproducedbyprimarily

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entericgram-negativebacteria(e.g.,Morganellamorganii,
Escherichiacoli,KlebsiellaspeciesandPseudomonasaeruginosa)
foundinthefish'scutisandintestines.,.

101.Whoisthefatherofmicrobiology?
a)A.V.L.hook

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b)Robertbrown
c)J.CBose
d)Pasteur
CorrectAnswer-A
Answer:A.A.V.L.hook

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"AntonivanLeeuwenhoek
"iscommonlyknownas"theFatherof
Microbiology.
AntoniePhilipsvanLeeuwenhoek(24thOct,1632?26thAug,
1723)isknownas'TheFatherofMicrobiology'.Hewasknownso
becauseofhiscontributionstowardstheestablishmentof

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microbiology.HewasscientistfromDelft,Netherlandsandis
consideredtobe'TheFirstMicrobiologistintheWorld'.
leeuwenhoekiscalledasfatherofmicrobiology.Hewasthefirst
persontoseebacteriathroughhisselfmadesinglelensed
microscope.Andhenamedthem"animalcules".LouisPasteuris

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knowas"fatherofmordenmicrobiology".

102.Cutaneouslarvamigranscausedby
whichorganism?
a)Strongyloides
b)Toxocaracanis

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c)Ancylostomabraziliense
d)Necatoramericanus
CorrectAnswer-C
Answer:C.Ancylostomabraziliense
Cutaneouslarvamigrans(CLM)

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/Itisaskindiseaseinhumans,causedbythelarvaeofvarious
nematodeparasitesofthehookwormfamily(Ancylostomatidae).
ThemostcommonspeciescausingthisdiseaseintheAmericasis
Ancylostomabraziliense.
Theseparasitesliveintheintestinesofdogs,catsandwildanimals

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andshouldnotbeconfusedwithothermembersofthehookworm
familyforwhichhumansaredefinitivehosts,namelyAncylostoma
duodenaleandNecatoramericanus.
Colloquiallycalledcreepingeruptionduetoitspresentation,the
diseaseisalsosomewhatambiguouslyknownas"grounditch"or(in

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somepartsoftheSouthernUSA)"sandworms",asthelarvaeliketo
liveinsandysoil.
Anothervernacularnameisplumber'sitch.
ThemedicaltermCLMliterallymeans"wanderinglarvaeintheskin"

103.Afterkidneytransplantationwhich

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organismsinfectionismorelikelyto
happens-

a)CMV
b)Klebsiella
c)Streptococcus

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d)Staphylococcus
CorrectAnswer-A
Answer:A.CMV
CMVisthemostcommonviralinfectionafterKidney
Transplantation.MostcommonCMVsyndromeinkidneytransplant

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patientisfever(mostcommon),leukopenia,hepatosplenomegaly,
myalgiaandarthralgia.

104.Incidenceofadiseaseis4per1000of
populationwithdurationof2years.
Calculatetheprevalence?

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a)8/1000
b)4/1000
c)2/1000
d)6/1000
CorrectAnswer-A

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Ans.A.8/1000
Prevalence=(IncidenceRate)x(AverageDurationofDisease)

105.Cytotoxicandexpireddrugdisposalis
donebywhichmethod?
a)Dumping

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b)Autoclave
c)Landfill
d)Burning
CorrectAnswer-C
Ans.C.Landfill

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Colour
Typeof
Treatment
WasteCategory
coding

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Container
options
Humanandanimal
wastes,Microbialand Incineration/
Yellow

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PlasticBags
Biologicalwastesand DeepBurial
soiledwastes
(Cat1,2,3and6)
Microbiologicaland

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Autoclave/
Disinfected
Biologicalwastes,
Microwave/
Red

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container/
Soiledwastes,Solid
Chemical
Plasticbags
wastes

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Treatment)
(Cat3,6,7)
Autoclave/
Microwave/
Plasticbag,

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Wastesharpsand
Blue/White/
Chemical
Punctureproof solidwaste
Transparent

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Treatment
container
(Cat4&7)
Destruction
andShredding

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Discarded

medicines,
Disposalin
Black
Plasticbag

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Cytotoxicdrugs,
securedland
Incinerationashand fills
chemicalwaste
(Cat5,9&10)

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Generalwastesuch
Disposedin
Plastic
Green
asofficewaste,food

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secured
Container
waste&gardenwaste landfills

106.ForNRRtobe1coupleprotectionrate
shouldbe?

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a)50%
b)60%
c)55%
d)75%
CorrectAnswer-B

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Ans.B.60%
CoupleProtectionRate(CPR)
Itisanindicatoroftheprevalenceofcontraceptivepracticeinthe
community
Definition:thepercentageofeligiblecoupleseffectivelyprotected

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againstchildbirthbyoneortheotherapprovedmethodsoffamily
planning
Sterilization
IUD
Condom

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OCP's
NRR=1canbeachievedonlyiftheCPR>60%

107.NewRNTCPsoftwareonlinetomonitor
TBcontrolprogrammeis-
a)NIKSHAY

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b)NICHAY
c)E-DOTS
d)NIRBHAI
CorrectAnswer-A
Ans.A.NIKSHAY

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TokeepatrackoftheTBpatientsacrossthecountry,the
GovernmentofIndiahasintroducedasystemcalledNIKSHAY.
ThewordiscombinationoftwoHindiwordsNIandKSHAYmeaning
eradicationoftuberculosis.
NIKSHAY(www.nikshay.gov.in)isawebenabledapplication,which

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facilitatesmonitoringofuniversalaccesstoTBpatientsdatabyall
concerned.
ThesystemhasbeendevelopedjointlybytheCentralTBDivisionof
theMinistryofHealthandFamilyWelfareandNationalInformatics
Centre(NIC)anditwaslaunchedbytheGovernmentofIndiain

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June2012withissueofrequiredadministrativedirectionsfrom
CentralTBDivisionforuseofNIKSHAY

108.Studyunitofecologicalstudyis
a)Population
b)Patient

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c)Community
d)Case
CorrectAnswer-A
Ans.A.Population
Inecologicalstudiestheunitofobservationisthepopulationor

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community.
Diseaseratesandexposuresaremeasuredineachofaseriesof
populationsandtheirrelationisexamined.
Oftentheinformationaboutdiseaseandexposureisabstractedfrom
publishedstatistics.

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109.InascreeningtestforDMoutof1000
population,90werepositive.Thenthe
goldstandardtestwasdoneinwhich
100werepositive.Calculatethe

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sensitivity?

a)90/100
b)100/110
c)80/100
d)100/100

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CorrectAnswer-A
Ans.A.90/100
So,Truepositive(a)=90
Falsenegative(c)=10
Sensitivity=a/(a+c)=90/100

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Sensitivity=a/(a+c)=90/100

110.Whatisthemasschemoprophylaxisfor
meningococcalmeningitis?
a)Rifampicin
b)Chloramphenicol

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c)Tetracycline
d)Penicillin
CorrectAnswer-A
Ans.A.Rifampicin
RecommendedChemoprophylaxisforHigh-RiskClose

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Contacts:

Age
Dose
Duration
Cautions

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RIFAMPICIN:
<1
5mg/kg
Oralevery12hrs
month

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2days
>1
10mg/kg Oralevery12hrs Notrecommendedforusein
month
2day

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pregnancy
CEFTRIAXONE:
<15
125mg
IMsingledose

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years
>15
250mg
IMsingledose
years

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CIPROFLOXACIN
>18
500mg
Oralsingledose
Notrecommendedforusein

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years
pregnancy

111.Whichamongthefollowingisanactive
formofchlorination?
a)Hypochloriteion

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b)Hydrogenchloride
c)Hypochlorousacid
d)Chlorideion
CorrectAnswer-C
Ans.C.Hypochlorousacid

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Thedisinfectingactionofchlorineispredominantlydueto
hypochlorousacid.
Hypochlorousacidisthemosteffectiveformofchlorineanditis
almost70-80timesmoreeffectivethanhypochloriteions.


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112.Kala-Azarisfoundinallendemicareas
except.
a)WestBengal
b)UP
c)Bihar

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d)Assam
CorrectAnswer-D
Ans.D.Assam
UP,WestBengalBiharAndJharkhandaretheendemicstates
ofkalaAzar

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113.Riskamongexposedtoriskamongnon
exposedisdefinedtobe?
a)Relativerisk
b)Oddsratio
c)Attributablerisk

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d)Noneoftheabove
CorrectAnswer-A
Ans.A.Relativerisk
Peventwhenexposed
RR= Peventwhennotexposed

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Instatisticandepidemiology,relativeriskorriskratio(RR)isthe
ratiooftheprobabilityofaneventoccurring(forexample,developing
adisease,beinginjured)inanexposedgrouptotheprobabilityof
theeventoccurringinacomparison,non-exposedgroup.
RR=1meansthatexposuredoesnotaffecttheoutcome

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RR<1meansthattheriskoftheoutcomeisdecreasedbythe
exposure
RR>1meansthattheriskoftheoutcomeisincreasedbythe
exposure

114.Pasteurizationisdoneat-

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a)73oCFor20min
b)63oCFor30min
c)72oCFor30seconds
d)63oCFor30seconds
CorrectAnswer-B

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Ans.B.63oCFor30min
Pasteurizationofmilk,widelypracticedinseveralcountries,notably
theUnitedStates,requirestemperaturesofabout63?C(145?F)
maintainedfor30minutesor,alternatively,heatingtoahigher
temperature,72?C(162?F),andholdingfor15seconds(andyet

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highertemperaturesforshorterperiodsoftime).

115.Idealtimegapbetween2livevaccination
-
a)2weeks
b)4weeks

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c)8weeks
d)12weeks
CorrectAnswer-B
Ans.B.4weeks
Ifliveparenteral(injected)vaccines(MMR,MMRV,varicella,zoster,

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andyellowfever)andliveintranasalinfluenzavaccine(LAIV)arenot
administeredatthesamevisit,theyshouldbeseparatedbyatleast
4weeks.

116.Susceptiblepersondevelopeddisease
withinrangeofIPaftercomingincontact

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withprimarycase-

a)Secondaryattackrate
b)Casefatalityrate
c)Primaryattackrate
d)Tertiaryattackrate

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CorrectAnswer-A
Ans.A.Secondaryattackrate
SecondaryAttackRate(SAR)Numberofexposedpersons
developingthediseasewithintherangeoftheincubationperiod,
followingexposuretoprimarycase.

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117.Outof100womenwhowereofferedocp
forcontraception10womengot
pregnantwhenfollowedfor24months.
WhatisPearl'sindex?

a)10

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b)5
c)4
d)2
CorrectAnswer-B
Ans.B.5

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NumberofPregnancies*12
Pearl-Index=
*100
NumberofWomen*NumberofMonths
PearlIndex=10x12x100/100x24=5

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118.Whichofthefollowingdonotcause
hardnessofwater?
a)Calciumcarbonate
b)Calciumsulphate
c)Calciumbicarbonate

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d)Magnesiumbicarbonate
CorrectAnswer-A
Ans.A.Calciumcarbonate
Temporaryhardnessisatypeofwaterhardnesscausedbythe
presenceofdissolvedbicarbonateminerals(calciumbicarbonate

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andmagnesiumbicarbonate).
Permanenthardnessiscausedbydissolvedcalciumsulfate(which
isnotremovedbyboiling).

119.Whichofthefollowingisnotanexample
ofdirecttransmissionincommunicable

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diseases?

a)Transplacental(vertical)
b)Soil
c)Respiratory
d)STD

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CorrectAnswer-C
Ans.C.Respiratory
Themodesoftransmissionofinfectiousdiseasescanbe
classifiedas:
DirectTransmission.Directcontact;Dropletinfection;Contactwith

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soil;Inoculationintoskinormucosa;Transplacental
(vertical)transmission.
IndirectTransmission.Vehicle-borne;Water;food/milk;Vector-
borne.Mechanical;Biological.Airborne.


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120.Water'sviewisusedtoobtaindiagnostic
informationof:
a)Maxillarysinus
b)Ethmoidalsinuses
c)Frontalsinus

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d)Sphenoidsinus
CorrectAnswer-A
ANSWER:A.Maxillarysinus
Waters'view
(alsoknownastheOccipitomentalview)isa
radiographicview,whereanX-raybeamisangledat45?tothe

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orbitomeatalline.
Therayspassfrombehindtheheadandareperpendiculartothe
radiographicplate.
Itiscommonlyusedtogetabetterviewofthemaxillarysinuses.

121.Tracheostomyindicationis:

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a)Vocalcordreplacement
b)Pharynxreplacement
c)Tracheomalacia
d)Foreignbodyobstructingairway
CorrectAnswer-D

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Answer-D.Foreignbodyobstructingairway
Indications
oftracheostomy:
Upperrespiratorytractobstruction;Laryngeal,supralaryngeal,and
trachealcauses.(Causesofstridor)
Lowerrespiratorytractobstruction:(Secretoryobstruction,Wetlung

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syndrome).


122.Caldwell'sviewisusedfor:
a)Maxillarysinus
b)Frontalsinus

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c)Ethmoidalsinus
d)Alloftheabove
CorrectAnswer-B
Answer-B.Frontalsinus
Caldwell'sview
(orOccipitofrontalview)isaradiographicviewof

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skull,whereX-rayplateisangledat20?toorbitomeatalline.
Therayspassfrombehindtheheadandareperpendicularto
radiographicplate.
Itiscommonlyusedtogetbetterviewoffrontalsinuses.

123.Astigmatisminemmetropiceyeof

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elderlypersoncontributeto:
a)+1d
b)+2D
c)+3d
d)+4d

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CorrectAnswer-C
AnswerC.+3d
Laservisionenhancements
Whenplanningpresbyopia-correctingIOL(Intraocularlens)surgery
inapatientwithahighlevelofpre-existingastigmatism(ie,more

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than3D),
abiopticsapproach(ie,IOLfollowedbylaservision
enhancement)maybeneeded.
LRIsaloneareunlikelytocorrecttheastigmatismcompletely.Limbal
RelaxingIncisions(LRI)arearefractivesurgicalprocedureto
correctminorastigmatismintheeye.

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Thereareseveraldifferentstrategiesfortheseplannedlaservision
enhancements.Thefirstistoperformthepresbyopia-correctingIOL
surgeryfollowedbyLASIKorPRK.

124.100dayGlaucomaseeninwhichofthe
followingcondition:

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a)Centralretinalveinocclusion(CRVO)
b)Neovascularglaucoma
c)Centralretinalarteryocclusion(CRAO)
d)SteroidinducedGlaucoma
CorrectAnswer-A

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Answer-A,Centralretinalveinocclusion(CRVO)
100daysglaucomaisaneovascularglaucomaoccurringin
CRVO
.
CentralRetinalveinocclusion(CRVO)
1.Predisposingfactors:-

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Increasingage?seenin6th-7th-decadesoflife.
Systemichypertensionisthemostcommoncause.
Blooddyscrasias?hyperviscosityduetochronicleukemias
andpolycythemia
RaisedIOP(POAG)

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Periphlebitis?sarcoidosis,Beh?et'sdisease
2.ClassificationofCRVO:-
Non?Ischemic
Ischemic
3.ClinicalFeatures:-

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Tortuosityanddilationofretinalveins
Flameshapedhemorrhage?developinthenervefiberlayerofthe
retina,especiallyaroundtheopticdisc,asaresultofthehigh
intravascularpressurethatdilatestheveinsandcollateralvessels.
Cotton?woolspotsandappearanceofcollateralsattheopticdisc

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areitsprominentdiagnosticsigns.

Opticdiscedemaandhyperemiaareseen.
4.Complications:-Rubeosisiridisandneovascularglaucoma
(NVG)occurinmorethan50percentcaseswithin3months(so
alsocalledas90daysglaucoma),afewcasesdevelopvitreous

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hemorrhageandproliferativeretinopathy.
5.Treatment:-Panretinalphotocoagulation(PRP)orcryo-
application,ifthemediaishazy,mayberequiredtoprevent
neovascularglaucomainpatientswithwidespreadcapillary
occlusion.

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Photocoagulationshouldbecarriedoutwhenmostoftheintraretinal
bloodisabsorbed,whichusuallytakesabout3-4months.
100-dayglaucomaorNVGresultsfromconditionswhichleadto
neovascularizationintheeyeeg.PDR,CRVO,Retinalmalignancies
andrarelyinCRAO.

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Hemorrhagicglaucomaisalsoknownas100day
glaucoma
becauseitstarts3monthsaftertheepisodeofcentral
retinalveinocclusion.

125.QRothspotsisseenin:
a)Uvealmelanoma

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b)Acuteleukaemia
c)Botha&b
d)Noneoftheabove
CorrectAnswer-B
Answer-B.Acuteleukaemia

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Roth'sspots
areretinalhemorrhageswithwhiteorpalecenters.
Composedofcoagulatedfibrinincludingplatelets,focalischemia,
inflammatoryinfiltrate,infectiousorganisms,orneoplasticcells.
Roth'sspotsmaybeobservedinleukemia,diabetes,subacute
bacterialendocarditis,perniciousanemia,ischemicevents,

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hypertensiveretinopathyandrarelyinHIVretinopathy.
Roth'sspotsarenamedafterMoritzRoth.


126.Yokemuscleofrightlateralrectus:
a)Ltmedialrectus

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b)Ltsuperiorrectus
c)Ltlateralrectus
d)Ltinferioroblique
CorrectAnswer-A
Answer-A.Ltmedialrectus

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Contralaterallypairedextraocularmusclesthatwork
synergisticallytodirectthegazeinagivendirection.
Forexample,indirectingthegazetotheright,therightlateral
rectusandleftmedialrectusoperatetogetherasyokemuscles.
YokeMuscles:2Muscles(1ineacheye)thataretheprimemovers

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oftheirrespectiveeyesinagivenpossitionoofgaze
For-Example-whentheeyesmoveintorightgaze(dextroversin),
therightlateralrectus&theleftmedialrectusmuscleareyoke
muscles.

127.SevereConjunctivitiscausedby:

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

a)Neisseria
b)Staphylococcus
c)Streptococcus
d)Haemophilus
CorrectAnswer-A

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ANSWER-A.Neisseria
Themostcommoncausesofacutebacterialconjunctivitisare
Staphylococcusaureus,Streptococcuspneumoniae,and
Haemophilusinfluenzae.
HyperacutecasesareusuallycausedbyNeisseriagonorrhoeaeor

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N.meningitidis.
Chroniccasesofbacterialconjunctivitisarethoselastinglongerthan
3weeks,andaretypicallycausedbyStaphylococcusaureus,
Moraxellalacunata,orgram-negativeentericflora.
Neisseriagonorrhoeaecausesgonococcalconjunctivitis,which

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usuallyresultsfromsexualcontactwithapersonwhohasagenital
infection.
Theincidenceratesofgonococcalconjunctivitisincreaseduring
springandsummer.
Thisisapotentiallydevastatingocularinfection,becauseN.

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gonorrhoeaecancausesevereulcerativekeratitis,whichmay
rapidlyprogresstocornealperforation.

128.WhichisexampleoftheSimpleMyopic
Astigmatismamongtheprescriptions
givenbelow:

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a)Rx(+)sphere
b)Rxwillbeplano(-)
c)Rxwillbe(-)sphere
d)(-)(+)(+)(-)onboth90and180degreeaxis
CorrectAnswer-B

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Answer-B.Rxwillbeplano(-)
Wheneyewearprescriptionsarewritten,theycanbeclassifiedinto
differentareasdependingonthepowerorrefractiveerror.
Therearesevencategoriestowhichprescriptionscanfall:
1. SimpleHyperopia,theRxwillbe(+)sphere

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2. SimpleMyopia,theRxwillbe(-)sphere
3. SimpleMyopicAstigmatism,theRxwillbeplano(-)
4. SimpleHyperopicAstigmatism,theRxwillbe(+)
5. CompoundHyperopicAstigmatism,majormeridianpowerwillbe
(+)(+)onboth90and180degreeaxis

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6. CompoundMyopicAstigmatism,majormeridianpowerwillbe(-)
(-)onboth90and180degreeaxis
7. MixedAstigmatism,majormeridianpowerswillbeopposites(-)
(+)(+)(-)onboth90and180degreeaxis

129.Blowoutfractureoforbitinvolves:

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a)Floor
b)Medialwall
c)Lateralwall
d)Roof
CorrectAnswer-A

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Answer-A.Floor
Orbitalfloorfracture
,alsoknownas"blowout"fractureoftheorbit.
Blowoutfractureoforbitinvolves:
1. Fracturesoftheorbitalfloorarecommon:itisestimatedthatabout
10%ofallfacialfracturesareisolatedorbitalwallfractures(the

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majorityofthesebeingtheorbitalfloor),andthat30-40%ofallfacial
fracturesinvolvetheorbit.
2. Theanatomyoftheorbitalfloorpredisposesittofracture.
3. Theinferiororbitalneurovascularbundle(comprisingtheinfraorbital
nerveandartery)courseswithinthebonyflooroftheorbit;theroof

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ofthisinfraorbitalcanalisonly0.23mmthick,andtheboneofthe
posteriormedialorbitalflooraverages0.37mmthick.
4. Bycontrast,theboneofthelateralportionoftheorbitalfloor
averages1.25mmthick,over5timesthethicknessoftheboneover
theneurovascularbundle.Asonemightsuspect,itisthisverythin

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areaoftheorbitalflooroverlyingtheneurovascularbundlewhere
isolatedorbitalfloorfracturesinvariablyoccur.



130.Whichofthefollowingisendogenous
pyrogen

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a)PGE2
b)PGD2
c)PGF2alpha
d)PGI2
CorrectAnswer-A

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Answer:-A.PGE2
Pyrogen
Pyrogensaresubstancesthatcausefever.
Pyrogensmaybeexogenousorendogenous
ExogenousBacterialtoxins

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EndogenousIL-1,TNF-a,IL-6,Interferons,Ciliaryneurotrophic
factor
ThesepyrogensincreasethelevelofPGE,inthehypothalamusthat
elevatesthethermoregulatorysetpointandcausesfever.

131.InBarttersyndromedefectisseenin:

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a)DefectinPCT
b)DefectinDCT
c)Defectinthickascendinglimbofloopofhenle
d)None
CorrectAnswer-C

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Answer:C-Defectinthickascendinglimbofloopofhenle
Autosomalrecessivedisorder.
Geneticdefectinthethickascendinglimboftheloopofhenle
DefectsinNa-K-2C/coLtransporter,KorCl
channelsresultinlackofconcentratingability

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132.Notseeninallergicpulmonary
aspergillosisis
a)HighIgElevel
b)Recurrentpneumonia
c)Occurrenceinpatientswitholdcavitarylesions

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d)Pleuraleffusion
CorrectAnswer-B
Answer:B-Recurrentpneumonia
Allergicbronchopulmonaryaspergillosisisapulmonary
hypersensitivitydisordercausedbyallergytofungalantigensthat

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colonizethetracheobronchialtree.
Itmostcommonlyoccursinatopicasthmaticindividualsinresponse
toantigenofaspergillusspecies.
Maindiagnosticcriteria
ClinicalhistoryofAsthmaQ

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Pulmonaryinfiltrates(transient/fleetingorfixed)Q
Peripheraleosinophilia(>1000/,uL)Q
ImmediateskinreactivitytoAspergillusantigen(whealandflare
response)
SerumprecipitinstoA.fumigatus

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ElevatedserumIgElevels(>100Ong/ml)
Central/proximalbronchiectasis
Secondarydiagnosticcriteria
Historyofbrownishplugsinsputum
Identification/cultureofA.,fumigatusfromsputum

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Lateskinreactivitytoaspergillusantigen-CMDT
ElevatedIgE(andIgG)classantibodiesspecificforA.fumigatus-
Harrisons

Note
ElevatedIgE(andIgG)classantibodiesspecificforA.fumigatushas

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beenmentionedasasecondarydiagnosticcriteriainHarrison's
textbookwhileFishman'stextbookincludesthisasamain/major
diagnosticcriteria.

133.PseudoPPulmonale
a)Hypokalemia

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b)Hyponatremia
c)Hypocalcemia
d)Hypercalcemia
CorrectAnswer-A
Answer:A.Hypokalemia

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Insomecasestherecanbeanotched(orbifid)p-waveknownas"p
mitrale",indicativeofleftatrialhypertrophywhichmaybecausedby
mitralstenosis.Theremaybetallpeakedp-waves.Thisiscalled"p-
pulmonale"andisindicativeofrightatrialhypertrophyoften
secondarytotricuspidstenosisorpulmonaryhypertension.

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Asimilarpicturecanbeseeninhypokalemia(knownas"pseudop-
pulmonale").

134.AutomaticImplantableCardioverter
Defibrillator,(AICD)implantationisdone
forwhichoffollowingconditions:

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a)Brugadasyndrome
b)Ventricularfibrillation
c)AcutecoronarysyndromewithlowEF
d)Alloftheabove
CorrectAnswer-D

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Answer:D.Alloftheabove
AnAutomaticImplantableCardioverterDefibrillator,(AICD),isa
smallelectronicdevicethatisimplantedintoyourchesttomonitor
andcorrectanabnormalheartrhythm,orarrhythmia.Thesedevices
areusedtotreatseriousandlife-threateningarrhythmiasandare

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themosteffectivewayofdoingso.
Brugadasyndromeisaconditionthatcausesadisruptionofthe
heart'snormalrhythm.
Ventricularfibrillationisaheartrhythmproblemthatoccurswhen
theheartbeatswithrapid,erraticelectricalimpulse.

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Acutecoronarysyndromeisatermusedtodescribearangeof
conditionsassociatedwithsudden,reducedbloodflowtotheheart.

135.Whatisthelineoftreatmentfor
intractableSydenhamchorea?
a)Haloperidol

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b)Valproate
c)Warfarin
d)Risperidone
CorrectAnswer-B
Answer:B.Valproate

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Sydenham'schorea(SC)/Choreaminor/Rheumaticchorea
(RC)/St.Vitus'sDance
Majordiagnosticcriteriaforrheumaticdisease
Mostcommonacquiredchoreaduringchildhood
Characterizedbyrapid,uncoordinatedjerkingmovementsprimarily

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affectingtheface,handsandfeet
BenzodiazepinesfacilitatetheactionofGABAandvalproate
enhancestheactiononGABA,hencetheseagentsareusedtotreat
chorea

136.Neurofibromatosis1criteriaexcept

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a)Braintumor
b)Acousticneuromas
c)Pseudoarthrosis
d)Cafe-au-laitspots
CorrectAnswer-B

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Answer:B-Acousticneuromas
Clinicaldiagnosisrequirespresenceofatleast2of7criteriato
confirmpresenceofneurofibromatosis,type1.
Despitesuspicion,mostsignsdonotappearuntillatechildhood/
adolescent

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The7clinicalcriteriausedtodiagnoseNF1areasfollows:
Sixormorecaf?-au-laitspots/hyperpigmentedmaculesgreater
thanorequalto5mmindiameterinprepubertalchildren&15mm
postpubertal
Axillaryoringuinalfreckles(>2)

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Twoormoretypicalneurofibromasoroneplexiformneurofibroma
Opticnerveglioma
Twoormoreirishamartomas(Lischnodules)(oftenidentifiedonly
throughslit-lampexamination)
Sphenoiddysplasiaortypicallong-boneabnormalitiessuchas

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pseudarthrosis
Strongfamilyhistory(1stdegreerelativewithNF1)

137.Mostcommonsiteofchronicgastric
ulcer
a)Pyloricantrum

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b)Upperpartoflessercurvature
c)Lowerpartoflessercurvature
d)Segmentoflargeintestine
CorrectAnswer-A
Answer:A-Pyloricantrum

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Amajorcausativefactor(60%ofgastric&upto50?75%of
duodenalulcers)ischronicinflammationduetoHelicobacter
pylori
thatcolonizestheantralmucosa.

138.ApproximatetimeintervalbetweenHIV
infection&manifestationofAIDSis?

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a)7.5yr
b)10yr
c)12yr
d)11yr
CorrectAnswer-B

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Answer:B-10years
Theapproximatetimeframerequiredforincubationisusually10
years.
mediantimefrominfectiontothedevelopmentofAIDSinadultsis
about9years.AsmallproportionofuntreatedHIV-infectedpeople

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arelong-termnon-progressors,withCD4countsinthereference
rangefor10yearsormore.Somelong-termnon-progressorshave
undetectableviralloadsandareknownas`elitecontrollers'.

139.Heller'smyotomyisdonefor
a)Zenker'sdiverticulum

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b)Achalasiacardia
c)Bunions
d)Kneearthroscopy
CorrectAnswer-B
Answer:B-Achalasiacardia

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Achalasia,adisorderofesophaguscharacterizedbyprogressive
inabilitytoswallowsolids&liquids.
Causesincludeweakenedesophagealmuscles&issueswithlower
esophagealsphincterrelaxation
HellerMyotomy,surgicalprocedureofferslongtermsymptomatic

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relieftothesepatients.
Itinvolvesweakeningofmusclesatgastroesophagealjunction,
allowingthevalvebetweenoesophagus&stomachtoremainopen.

140.Myocardialstunningpatternnot
matchingtheECG.Whatisthe

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diagnosis.

a)Takotsubocardiomyopathy
b)Restrictivecardiomyopathy
c)Brigade'scardiomyopathy
d)Pericardialsomething

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CorrectAnswer-A
Answer:A-Takotsubocardiomyopathy
"MyocardialStunning"
isastatewherecertainsegmentsof
myocardium
(correspondingtoareaofmajorcoronary
occlusion)showsformsofcontractileabnormality.

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Asegmentaldysfunctionpersistingforavariableperiodoftime,
abouttwoweeks,evenafterischemiahasbeenrelieved(byfor
instanceangioplastyorcoronaryarterybypasssurgery).
Takotsubocardiomyopathy/Takotsubosyndrome,atemporary
conditionwhereyourheartmusclebecomessuddenlyweakenedor

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'stunned'.

141.Alternativedrugforcardiacarrestin
placeofepinephrineis?
a)Amiodaroneinfusion
b)Atropine

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c)Highdosevasopressin
d)Adenosine
CorrectAnswer-C
Answer:C-Highdosevasopressin
Vasopressinisanalternativevasopressorathighdoses,causes

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vasoconstrictionbydirectlystimulatingsmoothmuscleV1
receptors.
AmericanHeartAssociation(AHA)guidelinesstates"Vasopressinis
areasonablefirst-linevasopressorinpatientswithventricular
fibrillationorpulselessventriculartachycardia.Additionally,the

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guidelinescommentthatonedoseofvasopressin40Umayreplace
thefirstorseconddoseofepinephrineinallpulselesssudden
cardiacarrestscenarios,includingasystoleandpulselesselectrical
activity.

142.Patientpresentingwithcutaneous

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vasculitis,glomerulonephritis,peripheral
neuropathy,Whichinvestigationistobe
performednextthatwillhelpyou
diagnosethecondition?

a)ANCA

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b)RAfactor
c)Hbsag
d)MIF
CorrectAnswer-A
Answer:A-ANCA

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Anti-neutrophilcytoplasmicantibodies
(ANCAs):
Groupofautoantibodies
IgGtypemainly,
Producedagainstantigensincytoplasmofneutrophilgranulocytes&
monocytes.

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Particularlyassociatedwithsystemicvasculitis,socalled"ANCA-
associatedvasculitis".

143.Cryoglobulinemia
a)Hepatitisc
b)Ovariancancer

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c)Diabetes
d)Leukemia
CorrectAnswer-A
Answer:A.HepatitisC
Cryoglobulinemia/Cryoglobulinemicdiseasewithlargeamountsof

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cryoglobulinsinblood
Cryoglobulinsareproteins(mostlyimmunoglobulinsthemselves)
Becomeinsolubleatreducedtemperatures.
MixturesofmonoclonalorpolyclonalIgM,IgG,and/orIgA&blood
complementproteinslikeC4areassociatedwithcasesofinfectious

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diseases,particularlyHepatitisCinfection,

144.Causesofhypokalemicmetabolic
alkalosiswithhypertension
a)Liddlesyndrome
b)Barttersyndrome

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c)Gitelmansyndrome
d)Renaltubularacidosis
CorrectAnswer-A
Answer:A.Liddlesyndrome
Liddlesyndrome-Rarehereditarydisorder

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Increasedactivityoftheepithelialsodiumchannel(E-NaCh)
Activatingkidneystoexcretepotassiumretainingexcessivesodium
&water,leadingtohypertension.

145.GoldcriteriaforverysevereCOPD
a)Fev1/Fvc<70andFev1<30

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b)Fev1/Fvc<70andFev1<70
c)Fev1/Fvc<70andFev1<50
d)BothAandC
CorrectAnswer-A
Answer:A.Fev1/Fvc<70andFev1<30

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COPDshouldbeconsideredinanypatientwhohasdyspnea,
chroniccoughorsputumproduction,and/orahistoryofexposureto
riskfactorsforthedisease.
Spirometryisrequiredtomakethediagnosis.
Presenceofpost-bronchodilatorFEV1/FVC<0.70confirmsthe

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presenceofpersistentairflowlimitation.
StageIV/VerySevereCOPD
Severeairflowlimitation(FEV1/FVC<70%;FEV1<.30%predicted)
orFEV1<50%predictedpluschronicrespiratoryfailure.
PatientsmayhaveVerySevere(StageIV)COPDevenifFEV1is>

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30%predicted.

146.ABPIincreasesartificiallyin
a)Arteriosclerosiscalcifiedarteries
b)Ischemiculcers
c)Intermittentclaudication

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d)DVT
CorrectAnswer-A
Answer:A.Arteriosclerosiscalcifiedarteries
Theankle-brachialpressureindex(ABPI)/Ankle-Brachialindex
(ABI):

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Ratioofbloodpressureatankletobloodpressureinupperarm
(brachium).
Comparedtoarm,lowerbloodpressureinlegsuggestsblocked
arteriesduetoperipheralarterydisease(PAD).
Anklebrachialpressureindex(ABPI)isamethodforthe

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quantificationofperipheralvasculardiseasethatresultsfrom
advancedatherosclerosis.

147.Minimaldysfunctionsyndromeseenin
a)Dyslexia
b)ADHD

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c)Mentalsubnormality
d)Down'ssyndrome
CorrectAnswer-A
Answer:A.Dyslexia
ClinicalfeatureofMinimaldysfunctionsyndromeincludesdyslexia.

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Minimalbraindysfunction:
Neurodevelopmentaldisorder.
Characterizedbyevidencesofimmaturityinvolvingcontrolof
activity,emotions,&behavior
Specificlearningdisabilitiesinvolvingthecommunicatingskills

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neededinreading,writing,andmathematics.
Inabilitytomaintainattention&concentration
Inabilitytoskillfullyblendtheauditory&visualfunctionsessentialin
languageperformance

148.VanNuysprognosticindexisnotbased

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on:
a)Age
b)Microcalcification
c)Size
d)ERstatus

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CorrectAnswer-D
Answer:D.ERstatus
DCISmaybeclassifiedusingtheVanNuyssystem,whichcombines
the
1. Patient'sage,

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2. TypeofDCIS
3. Presenceofmicrocalcification,
4. Theextentofresectionmargin
5. Thesizeofthedisease.
VanNuysPrognosticIndex

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Parameter
Score1
Score2
Score3
VanNuys

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Group1
Group2
Group3
Classification
Non-high

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Non-High
Highnuclear
nucleargrade
nucleargrade gradewithor
withoutnecrosis withnecrosis

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withoutnecrosis
Margins
10mm
1?9mm
Size

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16?40mm
>40mm
Age
>60
40?60

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<40


149.Commoncauseofchronicpancreatitis
a)Chronicalcohol
b)Chronicpancreaticcalculi
c)pancreasdivisum

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d)Gallbladderstones
CorrectAnswer-A
Answer:A.Chronicalcohol
"Worldwide,alcoholconsumptionandabuseisassociatedwith
chronicpancreatitisinupto70%ofcases"

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150.ThefollowingstatementaboutKeloidis
true
a)Itcontaingrowthfactor
b)Extendedexcisionisthetreatmentofchoice
c)Itdonotextendbeyondthewound

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d)Noneoftheabove
CorrectAnswer-A
Answer:A.Itcontaingrowthfactor
Vaccinations,injections,insectbites,earpiercing,ormayarise
spontaneously.

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Keloidstendtooccur3monthstoyearsaftertheinitialinsult,and
evenminorinjuriescanresultinlargelesions.
Theyvaryinsizefromafewmillimeterstolarge,pedunculated
lesionswithasofttorubberyorhardconsistency.
Althoughtheyprojectabovesurroundingskin,theyrarelyextendinto

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underlyingsubcutaneoustissues.
Certainbodysiteshaveahigherincidenceofkeloidformation,
includingtheskinoftheearlobeaswellasthedeltoid,presternal,
andupperbackregions.
Theyrarelyoccuroneyelids,genitalia,palms,soles,oracross

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joints.
Keloidsrarelyinvolutespontaneously,whereassurgicalintervention
canleadtorecurrence,oftenwithaworseresult.

151.Whichofthefollowinglayersarecut
duringfasciotomy?

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a)Skin
b)Skin+subcutaneousfascia
c)Skin+subcutaneoustissue+Superficialfascia
d)Skin+subcutaneoustissue+Superficialfascia+deepfascia
CorrectAnswer-D

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Answer:D.Skin+subcutaneoustissue+Superficialfascia+deep
fascia
Fasciotomyorfasciectomyisasurgicalprocedurewherecomplete
openingofallfascialenvelopeisdonetorelievetensionorpressure
commonlytotreattheresultinglossofcirculationtoanareaoftissue

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ormuscle.Fasciotomyisalimb-savingprocedurewhenusedto
treatacutecompartmentsyndrome.

152.Whichstatementisnottrueregarding
crohn'sdisease:
a)Rectumisnotinvolved

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b)Continuouslesionvisualizedinendoscopy
c)Noncaseatinggranulomas
d)Cobblestoneappearance
CorrectAnswer-B
Answer:B.Continuouslesionvisualizedinendoscopy

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Crohn'sdiseaseisfrequentlyassociatedwith"skip
lesions,"discontinuousareasofactivediseaseinthecolonand
smallintestinewithinterveningsegmentsthatappearnormal.

153.Whichisthebestinvestigationfor
carcinomaheadofpancreas:

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a)Guidedbiopsy
b)ERCP
c)Transduodenal/transperitonealsampling
d)EUS
CorrectAnswer-D

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Answer:D
Medicalimagingtechniques,suchascomputedtomography(CT
scan)andendoscopicultrasound(EUS)areusedbothtoconfirmthe
diagnosisandtohelpdecidewhetherthetumorcanbesurgically
removed

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154.Anabdominalmassisbest
demonstratedincongenitalhypertrophic
pyloricstenosisby:

a)Inpalpationovertheepigastrium
b)Inlefthypochondriac

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c)Rightiliacfossa
d)Duringfeeding
CorrectAnswer-D
Answer:D.Duringfeeding
Congenitalhypertrophicpyloricstenosis

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Presentation
Vomitingisthepresentingsymptom(childvomitsmilkandnobileis
present)
Immediatelyaftervomitingthechildishungryi.e.lossofappetite
doesnotoccur.

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Weightlossisstrikingandrapidlytheinfantbecomesemaciatedand
dehydrated.
However,greaterawarenessofpyloricstenosishasledtoearlier
identificationofpatientsandhencewithfewerincidencesofchronic
malnutritionandseveredehydration-Nelson10th/1130

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Thediagnosisisusuallymadewithatestfeed:Inthis,thebaby
isfedwiththebottlebyanurseormotherandsurgeon:
IHPS/CHPScanbediagnosedclinically.Duringatestfeed,thereis
visiblegastricperistalsispassingfromlefttorightacrosstheupper
abdomenandinarelaxedbaby,thepyloric'tumor'ispalpableasan

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'olive'intherightupperquadrant.
Thediagnosiscanbeconfirmedbyanultrasound,whichshows

thethickenedpyloricmuscle.


155.CalculateGCSof25yearoldheadinjury

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patientwithfollowingparameters
confused,openingeyesinresponseto
pain,localizingpainwillbe-

a)6
b)11

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c)12
d)7
CorrectAnswer-B
Answer:B.11
Glasgowcomascale:

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156.RETproto-oncogeneisassociatedwith
thedevelopmentof
a)Medullarycarcinomathyroid
b)Astrocytoma
c)Paraganglioma

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d)Hurthlecelltumorthyroid
CorrectAnswer-A
Answer:A.Medullarycarcinomathyroid
RETproto-oncogeneisagrowthfactorreceptor(receptortyrosine
kinase)

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TheRETproteinisareceptorfortheglialcellline-derived
neurotrophicfactorandstructurallyrelatedproteinsthatpromotecell
survivalduringneuraldevelopment.
RETisnormallyexpressedinthefollowingcells
ParafollicularCcellsofthethyroid

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Adrenalmedulla
Medullarycarcinomamayoccurincombinationwithadrenal
phaeochromocytomaandhyperparathyroidism(HPT)(usuallydueto
hyperplasia)inthesyndromeknownasmultipleendocrineneoplasia
type2A(MEN-2A).

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Thesearetumorsoftheparafollicular(Ccells)derivedfromthe
neuralcrestratherthanthecellsofthethyroidfollicleasareother
primarythyroidcarcinomas
Whenthefamilialformisassociatedwithprominentmucosal
neuromasinvolvingthelips,tongueandinneraspectoftheeyelids,

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withaMarfanoidhabitus,thesyndromeisreferredtoasMENtype
2B.
RETassociations:MEN2a,MEN2b,Familialmedullarycarcinoma

thyroid.

157.Cutoffforsurgeryinanabdominalaortic

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aneurysminasymptomaticpatients-
a)5.5cm
b)6.5cm
c)7.5cm
d)8.5cm

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CorrectAnswer-A
Answer:A.5.5cm
Operativerepairoftheaneurysmwiththeinsertionofa
prostheticgraftorendovascularplacementofaorticstentgraft
isindicatedfor:

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Abdominalaorticaneurysmsofanysizethatareexpandingrapidly
orareassociatedwithsymptoms.
Forasymptomaticaneurysms,abdominalaorticaneurysmrepairis
indicatedifthediameteris>5.5cm.

158.Whichofthefontanelleisthelastto

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close?
a)Anterolateral
b)Anterior
c)Lateral
d)Occipital

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CorrectAnswer-B
Ans.B.Anterior
Theposteriorfontanellenormallycloses2to3monthsafterbirth
Thesphenoidalfontanelleisthenexttoclosearound6monthsafter
birth

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Themastoidfontanelleclosesnextfrom6to18monthsafterbirth;
Theanteriorfontanelleisgenerallythelasttoclosebetween18?24
months.

159.WhichenzymedeficiencycausesLesch?
Nyhansyndrome?

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a)Hypoxanthine-guaninephosphoribosyltransferase(HGPRT)
b)Xanthineoxidase
c)Adeninephosphoribosyltransferase(APRT)
d)AMPdeaminase
CorrectAnswer-A

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Ans.A.Hypoxanthine-guaninephosphoribosyltransferase
(HGPRT)
Lesch?Nyhansyndrome(LNS),alsoknownasjuvenilegout,isa
rareinheriteddisordercausedbyadeficiencyoftheenzyme
hypoxanthine-guaninephosphoribosyltransferase(HGPRT),

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producedbymutationsintheHPRTgenelocatedontheX
chromosome


160.Whichvaccineisnotincludein
indradhanushmission?

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a)Tuberculosis
b)Measles
c)JapaneseEncephalitis
d)Diphtheria
CorrectAnswer-C

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Ans.C.JapaneseEncephalitis
TheMissionIndradhanush,depictingsevencoloursofthe
rainbow,targetstoimmunizeallchildrenagainstsevenvaccine
preventablediseasesnamely:
Diphtheria

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Pertussis
Tetanus
ChildhoodTuberculosis
Polio
HepatitisB

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Measles.

161.WhichamongthefollowingistheMost
commoncauseforneonatalblindness?
a)Neisseriagonorrhoeae
b)Chlamydiatrachomatis

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c)Klebsiella
d)Enterobacter
CorrectAnswer-A
Ans.A.Neisseriagonorrhoeae
Ophthalmianeonatorum(ON)isdefinedasapurulentconjunctivitis

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occurringduringthefirstfourweeksoflife.
ThetwomostcommoncausativeagentsareNeisseriagonorrhoeae
andChlamydiatrachomatis,theformerbeingofmoreconcernhere
becauseofitspropensitytocauseblindness.

162.MusclesaffectedinDequervain

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tenosynovitis-
a)Abductorpollicislongusandextensorpollicisbrevis
b)Adductorpollicislongusandextensorpollicisbrevis
c)AbductorpollicislongusandFlexorpollicisbrevis
d)AdductorpollicislongusandFlexorpollicisbrevis

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CorrectAnswer-A
Ans.A.Abductorpollicislongusandextensorpollicisbrevis
DeQuervainsyndrome,isatenosynovitisofthesheathortunnel
thatsurroundstwotendonsthatcontrolmovementofthethumb.
DeQuervainsyndromeinvolvesnon-inflammatorythickeningofthe

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tendonsandthesynovialsheathsthatthetendonsrunthrough.
Thetwotendonsconcernedarethoseoftheextensorpollicisbrevis
andabductorpollicislongusmuscles.

163.WhatismeantbyPerilunatedislocations
?

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a)Lowerradius,scaphoidandlunateandcapitateallinsame
plane
b)Lowerradius,scaphoidandcapitateinalignment,lunatealone
outofplane
c)Lowerradius,scaphoidandLunateinalignment,capitatealone

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isoutofplane
d)Bothlunateandcapitateareoutofplane
CorrectAnswer-B
Ans.B.Lowerradius,scaphoidandcapitateinalignment,lunate
aloneoutofplane

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Perilunatedislocationandperilunatefracturedislocationareinjuries
thatinvolvetraumaticruptureoftheradioscaphocapitate(RSC)
ligament,thescapholunateinterosseousligament,andthe
lunotriquetralinterosseousligament.
Lateralradiographswillreveallossofcollinearitybetweenthe

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capitate,lunate,andradius
Typicallythecapitateislocateddorsaltothelunateandisaligned
withtheradius


164.Fallenfragmentsign-

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a)Simplebonecyst
b)Osteosarcoma
c)Adamantinoma
d)Aneurysmalbonecyst
CorrectAnswer-A

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Ans.A.Simplebonecyst
Thefallenfragmentsignreferstothepresenceofabonefracture
fragmentrestingdependentlyinacysticbonelesion.Thisfindingis
saidtobepathognomonicforasimple(unicameral)bonecyst
followingapathologicalfracture.

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Althoughithasoccasionallybeenreportedwithothercysticlesions,
e.g.eosinophilicgranuloma

165.Youarepostedasaninternin
causality.Whichamongthefollowing
patientswithfracturewillbeyour1st

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prioritytocallorthoPGandinform?

a)Patient'sfingerisblackening
b)Patientcan'textendhisarm
c)A10cmabrasion
d)IntraarticularfractureofElbowJoint

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CorrectAnswer-A
Ans.A.Patient'sfingerisblackening
BlackeningoffingerafterFractureisanindicationofcutofofblood
supplythatmayleadtoseverecomplicationlikegangrene.Sothis
shouldbethefirstPrioritytotreatamongalltheaboveoptions

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166.InRheumatoidarthritis,whichtypeof
cellsareprominentlypresent?
a)Bcells
b)Tcells
c)Macrophages

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d)Dendriticcells
CorrectAnswer-C
Ans.C.Macrophages
Synovialliningorintimallayer:Normally,thislayerisonly1-3cells
thick.InRA,thisliningisgreatlyhypertrophied(8-10cellsthick).

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Primarycellpopulationsinthislayerarefibroblastsand
macrophages.

167.8thand9thribcostalcartilageforms
whichtypeofjoint?
a)Costochondraljoint

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b)Interchondraljoint
c)Synovialjoint
d)Costovertebraljoint
CorrectAnswer-C
Ans.C.Synovialjoint

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Thesixth,seventh,eighth,ninthandtenthcostalcartilagesare
jointedwitheachotheralongthebordersbysynovialjoints.
Costochondraljointmeansthejointbetweentheribanditscostal
cartilage.
Thefirstcostalcartilageofbothsidesattachtothemanubrium

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sterni.Atthisjoint,nomovementispossible.
Thesecondcostalcartilagearticulateswiththebodyofsternumand
themanubriumsternibyasynovialjointwheremovementis
possible.
Thethirdtoseventhcostalcartilagesarticulatewithlateralborderof

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thebodyofsternumatmobilesynovialjoints.

168.Tomsmithsepticarthritisis-
a)AcuteGonococcalarthritis
b)Smallpoxarthritis
c)Septicarthritisofinfancy

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d)Chronicpyogenicarthritis
CorrectAnswer-C
Ans.C.Septicarthritisofinfancy
Septicarthritisofinfancy(Tomsmithsepticarthritis)
Itisasepticarthritisofhipseenininfants

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Theonsetisacutewithrapidabscessformation,whichmayburst
outorbeincisedandhealsrapidly.
Telescopetestispositive
Clinicallythisconditionresemblesacongenitaldislocationofhip

169.Whichofthefollowingiscorrect

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regardingplacenta?
a)Placentalarteryprovidesnutrientsthroughumbilicalcordto
baby
b)PlacentahasWharton'sjelly
c)Placentahas2veinsand1artery

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d)Estrogenissecretedbyplacenta
CorrectAnswer-B
Ans.B.PlacentahasWharton'sjelly
Theumbilicalcordisastructurethatprovidesvascularflowbetween
thefetusandtheplacenta.

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Itcontainstwoarteriesandonevein,whicharesurroundedand
supportedbygelatinoustissueknownasWharton'sjelly.

170.Acutefattylivercommonlyseenin
pregnancyat-
a)3rdtrimester

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b)1sttrimester
c)Immediatepostpartum
d)Intrapartum
CorrectAnswer-A
Ans.A.3rdtrimester

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Acutefattyliverofpregnancy(AFLP)isarare,potentiallyfatal
complicationthatoccursinthethirdtrimesterorearlypostpartum
period.
Acutefattyliverofpregnancyismorecommonlyassociatedwith:
Malefetus

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Firstpregnancy
Maternalobesity
Itisduetodefectinthelong-chain-3-hydroxyacyl-CoA-
dehydrogenasepathway.
Itisuncommoninsubsequentpregnancies.

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171.Establishmentoffetoplacental
circulationseenat-
a)11to13days
b)20to22days
c)7days

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d)25to26days
CorrectAnswer-B
Ans.B.20to22days
ImportantEventsFollowingFertilization

0'hour

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Fertilization(day-15fromLMP)
30hours
2cellstage(blastomeres)
40?50hours
4cellstage

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72hours
12cellstage
96hours
16cellstage.Morulaenterstheuterinecavity
5thday

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Blastocyst
4?5thday
Zonapellucidadisappears
5?6thday
Blastocystattachmenttoendometrialsurface

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6?7thday
Differentiationofcytoandsyncytiotrophoblastlayers
10thday
SynthesisofhCGbysyncytiotrophoblast
9?10thday

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Lacunarnetworkforms
10?11thday
Trophoblastsinvadeendometrialsinusoids
establishinguteroplacentalcirculation
Interstitialimplantationcompletedwithentire

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decidualcoverage
13thday
Primaryvilli
16thday
Secondaryvilli

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16thday
Secondaryvilli
21stday
Tertiaryvilli
21st?22nd

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Fetalheart.Fetoplacentalcirculation
day

172.Fimbriectomyprocedureisknownas-
a)Uchidamethod
b)Irvingmethod

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c)Madlenertechnique
d)Kroenermethod
CorrectAnswer-D
Ans.D.Kroenermethod
Uchidatechnique--Asalinesolutionisinjectedsubserosalinthe

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midportionofthetubetocreateableb.
Irvingmethod--Thetubeisligatedoneithersideandmidportionof
thetube(betweentheties)isexcised.
Madlenertechnique-Itistheeasiestmethod.Theloopofthetubeis
crushedwithanarteryforceps.

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Kroenermethodoffimbriectomyisnotacommonprocedure

173.RDAofiodineinlactationinmicrogram-
a)150
b)220
c)100

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d)250
CorrectAnswer-D
Ans.D.250
Toaccommodateincreasediodineneedsduringpregnancyand
lactation,theiodineRDAis220mcg/dayforpregnantwomenand

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250mcg/dayforlactatingwomen

174.WhichOneofthefollowingisnota
causeofsecondaryPostpartum
Haemorrhage?

a)Placentaprevia

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b)Retainedbitsofplacenta
c)Endometritis
d)Polyp
CorrectAnswer-A
Ans.A.Placentaprevia

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CausesofsecondaryPostpartumHaemorrhageare:
Retainedbitsofplacenta
Postpartuminfection
InfectionofCervicalandVaginalTears
PuerperalInversionofUterus

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UterinePolyporFibroid:
Undiagnosedcarcinomaofcervix
Chorion-epithelioma

175.Besttimetodoquadrupletest
a)8-12weeks

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b)11-15weeks
c)15-20weeks
d)18-22weeks
CorrectAnswer-C
Ans.C.15-20weeks

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Thequadscreenisdoneinthesecondtrimester,usuallybetween
15and20weeksofpregnancy.
Ideally,thetestshouldbeperformedinconjunctionwithfirst-
trimesterscreeningtests.

176.Drugthatisusedforfetallungmaturity

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is:
a)Dexamethasone
b)Folicacid
c)Beclomethasone
d)None

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CorrectAnswer-A
Ans.A.Dexamethasone
Betamethasoneanddexamethasonearecorticosteroids,alsocalled
glucocorticoids,thataregivenbeforebirth(antenatally)tospeedup
apretermfetuseslungdevelopment.

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Eitherisusedwhenamotherisinpretermlaborandbirthmayoccur
in24to48hours.

177.InUterineprolapsehowtoknowifringis
inplace?
a)Ifnotexpelledafterincreasedabdominalpressure

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b)IfBleedingdoesnotoccur
c)Ifpatientfeelsdiscomfort
d)None
CorrectAnswer-A
Ans.A.Ifnotexpelledafterincreasedabdominalpressure

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Avaginalpessaryisaremovabledeviceplacedintothevagina.
Itisdesignedtosupportareasofpelvicorganprolapse.
Avarietyofpessariesareavailable,includingtheringpessaries
Ifnotexpelledafterincreasedabdominalpressureringpessaryis
supposedtobeplacedinplace

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178.HTindicatedinmenopausalwomen
a)Hotflash
b)Cabreast
c)Endometriosis
d)Uterinebleeding

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CorrectAnswer-A
Ans.A.Hotflash
HormoneTherapy(HT)isoneofthegovernment-approved
treatmentsforreliefofmenopausalsymptoms.
Thesesymptoms,causedbylowerlevelsofestrogenat

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menopause,include:
Hotflashes,
Sleepdisturbances,and
Vaginaldryness.
HTisalsoapprovedforthepreventionofosteoporosis.

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179.Dilatation&curettage(D&C)is
contraindicatedin-
a)Pelvicinflammatorydisease(PID)
b)Endometriosis
c)Ectopicpregnancy

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d)None
CorrectAnswer-A
Ans.A.Pelvicinflammatorydisease(PID)
PredisposingriskfactorsforPIDare:
Sexualcontact

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HistoryofSTI
Proceduresinvolvingtheupperfemalegenitaltractincluding:
Dilatation&curettage(D&C)
Recentintrauterinedevice(IUD)insertion
Therapeuticabortion(T/A)

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180.Whichofthesestepsisfollowedfirstfor
themanagementofshoulderdystocia
afterMcRobertsmaneuver?

a)Sharpflexionofhipjointstowardsabdomen
b)Suprapubicpressure

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c)90degreerotationofposteriorshoulder
d)Emergencyc-section
CorrectAnswer-B
Ans.B.Suprapubicpressure
Applyingagentlesuprapubicpressureisthefirststepin

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managementofshoulderdystociaafterMcRobertsmaneuver.
Mnemonic"HELPERR"asaguidefortreatingshoulder
dystocia:
"H"standsforhelp
"E"standsforevaluateforepisiotomy.

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"L"standsforlegs(pullyourlegstowardyourstomachMcRoberts
maneuver)
"P"standsforsuprapubicpressure
"E"standsforentermaneuvers(internalrotationofbaby'sshoulders)
"R"standsforremovetheposteriorarmfromthebirthcanal.

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"R"standsforrollthepatient.

181.Truehermaphroditismkaryotype:
a)45X0streakedgonads
b)46XXOvotestis
c)47XY+9

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d)47XX
CorrectAnswer-B
Ans.B.46XXOvotestis
Truehermaphroditeorovotesticulardisorderofsexualdifferentiation
(OVO-DSD)isoneoftherarestvarietyofallintersexanomalies.

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Inabout90%ofcases,patientshave46XXkaryotype.
Rarely,46XY/46XXmosaicismmayoccur.

182.Peripartumcardiomyopathyoccursat-
a)Within7days
b)Within6weeks

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c)Within24months
d)Within5months
CorrectAnswer-D
Ans.D.Within5months
PPCMisastructuralheartmusclediseasethatoccursinwomen

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eitherattheendofpregnancyoruptofivemonthsaftergivingbirth.
Pearson'sdiagnosticcriteriaforperipartumcardiomyopathy:
Developmentofcardiacfailureinthelastmonthofpregnancyor
within5monthsafterdelivery
Absenceofanidentifiablecauseforthecardiacfailure

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Absenceofrecognizableheartdiseasepriortothelastmonthof
pregnancy,and
Leftventricularsystolicdysfunctiondemonstratedbyclassic
echocardiographiccriteria,suchasdepressedejectionfractionor
fractionalshorteningalongwithadilatedleftventricle.

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183.Nervemostlycompressedinpregnancy
puerperium:
a)Radialnerve
b)Mediannerve
c)Femoralnerve

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d)Facialnerve
CorrectAnswer-C
AnsC.Femoralnerve
Themostcommonpostpartumnerveinjuryisfootdropduetoinjury
totheperonealnerveandinjurytothelateralfemoralcutaneous

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nerve.
Obstetriciansmayconsiderfrequentpositionchangesinlabor,
avoidanceofprolongedhipflexion,andshorteningthepushingtime
byallowingforpassivedescentofthefetusbeforepushingbegins
asmeansofavoidinglateralfemoralcutaneousnerveinjury.

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184.Inpregnancywhichofthefollowinglevel
isalteredmostly:
a)TotalT3
b)FreeT3
c)FreeT4

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d)TSH
CorrectAnswer-A
AnsA.TotalT3
TotalT3levelsarealteredthroughoutpregnancy.
Hormonesduringpregnancy:

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Increased
Decreased
Unchanged
GrowthHormone
Luteinizinghormone ADH

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Follicle-stimulating
Free
hormone
T3,FreeT4
Di-Hydro

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Prolactin
EpiAndroSterone
TotalT3,TotalT4
Aldosterone
Testosterone,Androstenodione

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andcortisol
Insulin(duetoinsulinresistance)
Estrogen
Progesterone
TotalT3andtotalT4increaseduetostimulationofthyroidtissueby

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hCGduringtheearlyperiodofgestation.Butthereisnochangein
freeT3andT4duetoincreaseinTBG.
ThisleadstotransientfallinTSHduringanearlyweeksofgestation.

ThelevelofTSHreachesnormallevelduringsecondandthird
trimester.

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185.Paget'sisassociatedwithwhichother
cancer:
a)Vulva
b)Vagina
c)Cervix

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d)Uterus
CorrectAnswer-A
Ans.A.Vulva
ExtramammaryPaget'sdisease(EMPD),alsoextramammaryPaget
disease,isarare,slow-growing,usuallynoninvasiveintraepithelial

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(intheskin)adenocarcinomaoutsidethemammaryglandand
includesPaget'sdiseaseofthevulvaandtheextremelyrarePaget's
diseaseofthepenis.

186.WhatismeantbySuperfecundation?
a)Fertilizationoftwoormoreovainoneintercourse

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b)Fertilizationoftwoormoreovaindifferentintercoursesinsame
menstrualcycle
c)Fertilizationofovaandthenit'sdivision
d)Fertilizationofsecondovumfirstbeingimplanted
CorrectAnswer-B

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Ans.B.Fertilizationoftwoormoreovaindifferentintercourses
insamemenstrualcycle
Superfecundationisthefertilizationoftwoormoreovafromthe
samecyclebyspermfromseparateactsofsexualintercourse,
whichcanleadtotwinbabiesfromtwoseparatebiologicalfathers.

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Thetermsuperfecundationisderivedfromfecund,meaningthe
abilitytoproduceoffspring.

187.Fetalheartstartscontractingat-
a)10-12days
b)10-12weeks

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c)3-5weeks
d)3-5month
CorrectAnswer-C
Ans.C3-5weeks
Thefetalheartstartscontractingatapproximately23daysof

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gestation.

188.

Anesthesiaofchoiceforcesareansectionin
severepre-eclampsia:

a)Spinal

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b)GA
c)Epidural
d)Spinal+epidural
CorrectAnswer-C
Ans.C.Epidural

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ContinuousEpiduralAnesthesiaisthefirstchoiceforpatientswith
preeclampsiaduringlabour,Vaginaldeliveryandcesareansection.
Preeclampsiapatientshaveariskofsevereairwayedema,which
makesintubationdifficult
ContinuousEpiduralAnesthesiacanimproveuteroplacental

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perfusionandalsodecreasecatecholaminesecretions.

189.Whichofthefollowingisnotahigh-risk
pregnancy?
a)Previoushistoryofmanualremovalofplacenta
b)Anemia

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c)Diabetes
d)Obesity
CorrectAnswer-A
Ans.A.Previoushistoryofmanualremovalofplacenta
HighRiskPregnancyisseenin:

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Cardiovascularandrenalfactors:
Moderatetoseverepreeclampsia
Chronichypertension
Severeheartfailure(classII-IV,NYHAclassification)
Moderatetosevererenaldisorders

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Metabolicdisorders:
Obesity
Insulin-dependentdiabetes
Previousendocrineablation
Obstetrichistory:

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FetalexchangetransfusionbecauseofRhincompatibility
Stillbirth
Lateabortion(16?20wk)
Post-termpregnancy(>42wk)
Pretermnewborn(<37wkand<2500g)

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Intrauterinegrowthrestriction(weight<10thpercentileforestimated
gestationalage)
Polyhydramnios
Multifetalpregnancy

Previousbrachialplexusinjury

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Abnormalfetalposition
Otherdisorders:
Abnormalcervicalcytologicfindings
Sicklecelldisease
Severeanemia

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Thrombophilia
Autoimmunedisorders
Anatomicabnormalities:
Uterinemalformation
Insufficient(incompetent)cervix

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Exposuretoteratogens:
GroupBstreptococcalinfections
Smoking>10cigarettes/day(associatedwithprematureruptureof
membranes)
Currentpregnancycomplications:

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Pretermlaborat<37Wks
Pretermprematureruptureofmembranes
Moderatetoseverepreeclampsia
Polyhydramnios(hydramnios)oroligohydramnios
Post-term(>42wk)

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Uterinerupture
Placentaprevia
Abruptioplacentae
Chorioamnionitis
Prolapsedcord

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Fetalbradycardiafor>30min
Fetaltachycardiafor>30min
Fetalweight<2.5kg
Fetalweight>4kg
FetalacidosispH7

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190.Whichofthefollowingisnotusedin
preeclampsia?
a)Methyldopa
b)Atenolol
c)Labetalol

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d)Hydralazine
CorrectAnswer-B
Ans.B.Atenolol
Choiceofanti-hypertensivesinpregnancy
PIH/pre-eclampsia/severepre-eclampsia:Labetalol

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AcuteHypertension/Hypertensioncrisis:IVlabetalol>Nifedipine
>Hydralazine
ChronicHypertensioninpregnancy:Labetalol>Methyldopa.

191.Cutismarmorataoccursduetoexposure
to?

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a)Coldtemperature
b)Dust
c)Hottemperature
d)Humidity
CorrectAnswer-A

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Ans.A.Coldtemperature
Cutismarmorataisaconditionwhereintheskinhasapinkishblue
mottledormarbledappearancewhensubjectedtocold
temperatures.
Itisseenthroughoutinfancyandin50%ofchildren.

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Rewarmingrestorestheskintonormal.
Itiscausedbysuperficialsmallbloodvesselsintheskindilatingand
contractingatthesametime.

192.Murphy'seyeisseenin-
a)Macintoshlaryngoscope

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b)Endotrachealtube
c)LMA
d)Flexiblelaryngoscope
CorrectAnswer-B
Answer:B-EndotrachealTube

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The"Murphyeye"istheeponymousnameforaholeonthesideof
mostendotrachealtubes(ETTs)thatfunctionsasavent,and
preventsthecompleteobstructionofthepatient'sairway,shouldthe
primarydistalopeningofanETTbecomeoccluded

193.ModifiedMallamPatigradingisusedin

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assessmentof-
a)Difficultintubation
b)Airwayobstruction
c)Deathduetoaspiration
d)Intubation

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CorrectAnswer-A
Answer:A-Difficultyinintubation
ModifiedMallampaticlassification
Class0:Abilitytoseeanypartoftheepiglottisuponmouthopening
andtongueprotrusion

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ClassI:Softpalate,fauces,uvula,pillarsvisible
ClassII:Softpalate,fauces,uvulavisible
ClassIII:Softpalate,baseofuvulavisible
ClassIV:Softpalatenotvisibleatall
Test:Theassessmentisperformedwiththepatientsittingup

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straight,mouthopenandtonguemaximallyprotruded,without
speakingorsaying"ahh."
Difficultlaryngoscopy:Goodaccuracy(areaunderSummary
ReceiverOperatingCharacteristic[SROC]curve0.89?0.05)
Difficultintubation:Goodaccuracy(areaunderSROCcurve0.83

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?0.03)
Difficultmaskventilation:Poorpredictor
Usedalone,theMallampatitestshavelimitedaccuracyfor
predictingthedifficultairwayandthusarenotusefulscreeningtests
Mallampaticlassificationisonlyoneof11nonreassuringfindings

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duringairwayexamination

194.Whichnerveistestedforadequacyof
anaesthesia-
a)MedianNerve
b)UlnarNerve

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c)Radialnerve
d)Mandibularnerve
CorrectAnswer-A
Answer:A-Mediannerve
Mediannerveblockcanbeevaluatedbytestingthelateralaspectof

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theringfinger

195.Mosteffectivecircuitinspontaneous
anaesthesiais-
a)MaplesonA
b)MaplesonB

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c)MaplesonC
d)MaplesonD
CorrectAnswer-A
Answer:A-MaplesonA
MAPLESONA-(Magill)CIRCUIT

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Usefulinspontaneousventilation
Thepatientinspireswhateverisinthetube,usingthebagasa
volumereservoir.
Oneatedtubeandincomingfreshgas.Whenthebagisfull,exhaled
alveolargasisventedfrxpiration,thebagrefillsfromacombination

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ofexpiredgasgoingbackupthecorrugomtheexhalevalve,and
thenduringanyexpiratorypause,FGFpushestheremaining
alveolargasout.
TheoreticallyFGF=0.7xValvshouldpreventsignificantrebreathing
becausedeadspacegas(fresh)isnotwasted,butFGF=VAmore

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reliablypreventsrebreathing.
Tubevolumemustexceed(Vt-Vd)oralveolargascouldcontaminate
thebag.
InadequateFGFcausesrebreathing.Difficulttodetectfromthe
CO2waveformalone-allthathappensisthattherapidfallon

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inspirationisdelayed.IfVAexceedstubingvolume,CO2entersthe
bagandwillbeseenoninspirationonthecapnogram.
Controlledventilation
Iftheanaesthetistfullyclosedthevalvewhilesqueezingthebagand

didn'topenituntiljustbeforethebagfilled,thiscircuitwouldbeOK.

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Morecommonlythevalveispartiallyclosed-enoughtopermit
adequatetidalvolumesdespiteparallellossofgasoutthevalve.
FGFmustbeincreasedtocompensateforgaslostduringinspiration
-typically2.5xminuteventilation.
TheLacksystem

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Aco-axialMagill,withtheexpiratoryvalvebroughtcoaxiallybackto
theFreshGasoutlet.Notpopularduetoinefficiencyduring
controlledventilation.

196.Whatismechanismofactionof
Curaniumdrugsasmusclerelaxant?

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a)PersistentlydepolarizingatNeuromuscularjunction
b)ActcompetitivelyonAchreceptorsblockingpost-synaptically
c)RepetitivestimulationofAchreceptorsonmuscleendplate
d)Inhibitingthecalciumchannelonpresynapticmembrane
CorrectAnswer-B

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Answer:B-ActcompetitivelyonAchreceptorsblockingpost-
synaptically
Candocuroniumiodideisanaminosteroidneuromuscular-blocking
drugorskeletalmusclerelaxantinthecategoryofnon-depolarizing
neuromuscular-blockingdrugs.

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ActsonAchreceptorscompetitivelypost-synapticallyblockingthem.
Potentialadjunctiveuseinanaesthesiatofacilitateendotracheal
intubation&provideskeletalmusclerelaxation.
Candocuroniumdemonstratedashortdurationandarapidonsetof
action,withlittleornoganglionblockingactivity,anditwasonly

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slightlylesspotentthanpancuronium

197.Dyeusedindiagnosisofesophageal
perforation:
a)Iohexol
b)Bariumsulphate

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c)Gadolinium
d)Iodinedye
CorrectAnswer-B
Answer-B.Bariumsulphate
Bariumsulfateinsuspensionisfrequentlyusedmedicallyasa

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radiocontrastagentforX-rayimagingandotherdiagnostic
procedures.
ItismostoftenusedinimagingoftheGItractduringwhatis
colloquiallyknownasa"bariummeal".
Fluoroscopy

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mostsensitivewithinthefirst24hours.
patientexaminedsemi-supine(~20degrees)onfluoroscopytable
awater-solubleagentshouldbeusedinitiallyasbariumcancause
mediastinitis
esophagealperforationmayberepresentedasmucosalirregularity

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orgrossextraluminalcontrastextravasation
someauthorssuggesttheuseofsmallamountsofloworhigh
concentrationsofbariumifnoleakisevidentoninitialscreeningwith
watersolublecontrast
Iohexol
,tradenamesOmnipaqueamongothers,isacontrast

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agentusedduringX-rays.Thisincludeswhenvisualizingarteries,
veins,ventriclesofthebrain,theurinarysystem,andjoints,aswell
asduringcomputertomography.Itisgivenbymouth,injectionintoa
vein,orintoabodycavity.



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198.Braggpeakeffectpronouncedin:
a)Xray
b)Proton
c)Neutron
d)Electron

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CorrectAnswer-B
Answer-B.Proton
Nowadaysprotontherapy(PT)representsanestablishedalternative
tophotonradiotherapyforthetreatmentofspecifictypesofcancer.
Thetherapeuticuseofprotonbeams(andofchargedparticlesin

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general)ismotivatedprimarilybytheirinverteddepth-doseprofile
comparedtophotons,beingcharacterizedbytheso-calledBragg
peak.
Severalbeamsofdifferentenergycanthenbecombinedinorderto
achievetheprescribeddoseinaregionaslargeasthetarget

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volume,resultingintheproductionofwhatisdefinedastheSpread-
OutBraggPeak(SOBP).


199.SaltandPepperpotappearanceofskull
seenin:

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a)Hyperparathyroidism
b)Multiplemyeloma
c)Hyperthyroidism
d)Pseudohyperparathyroidism
CorrectAnswer-A

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Answer-A.Hyperparathyroidism
Pepperpotskull
isoccasionallyusedinplaceofsaltandpepper
skulltodescribethetypicalradiographicappearanceofmultiple
smallradiolucentlesionsoftheskullvault.
Inprimaryhyperparathyroidism,extensiveresorptionboneinthe

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skullincombinationwithcysticareasofosteopeniaare
termedpepperpotskull.
Classicallyseeninhyperparathyroidism,andisoccasionallyused
(inaccurately)todescribetheraindropskullofmultiplemyeloma.
:SullX-raywithatypical"pepper-pot"appearance

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200.ImagingtechniquesusedinUterus
anomaliesEXCEPT:
a)HSG
b)MRIguidedHSG
c)CTguidedHSG

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d)USG
CorrectAnswer-C
AnswerC.CTguidedHSG
Imagingstudies,suchasahysterosalpingogram
(HSG)
andultrasound,oranMRIarerequiredtovisualisethe

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uterusandconfirmthatacongenitaluterineanomalyispresent.
Ahysterosalpingogramisnotconsideredasusefulduetothe
inabilityofthetechniquetoevaluatetheexteriorcontourofthe
uterusanddistinguishbetweenabicornuateandseptateuterus.
Inaddition,laparoscopyand/orhysteroscopymaybeindicated.

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201.Semensqueeze
a)Erectiledysfunction
b)Prematureejaculation
c)Retrogradeejaculation
d)Antegradeejaculation

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CorrectAnswer-B
Answer:B-PrematureEjaculation
SqueezeTechnique:
VariationoftheMastersandJohnsonmethod.
Asamanapproachesclimax,eitherheorhispartnersqueezesthe

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tipofthepenisjustbelowtheheadofthepenisasheapproaches
thepointofclimax.
Pressureisheldthereuntilthesensationofimpendingorgasm
diminishes.
Thispressurecanevenbehelduntilthereissomereductionin

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erection.
Theprocesscanthenbestartedoveragainsothatovertimeaman
prolongsthetimeperioduntilhereachesejaculation.
Usefultotreatcasesofprematureejaculation

202.ApatientwithahistoryofRTAbefore2

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monthspresentswithcomplaintsof
dreamsofaccidents.Heisableto
visualizethesamescenewheneverhe
visitstheplace.Henceisafraidtogo
backtotheaccidentsite.Identifythe

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typeofdisorderthathemightbe
sufferingfrom?

a)Adjustmentdisorder
b)PTSD
c)Anxietydisorder

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d)OCD
CorrectAnswer-B
Answer:B-Post-traumaticStressdisorder
Post-traumaticstressdisorder,basicallyatypeofanxiety
disorder

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Thoughitsharesfeatureswithotheranxietydisorders,hasitsown
specificcharacteristicsinpresentation.
Criteria1:
Etiologicallysignificanttraumashouldbepresenttobeclassified
underthiscondition.

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Criteria2:
"Intentionality"or"aboutness",animportantfactorinPTSD.
PTSDconcernswithmemoryintrusionofpaststressorsintopresent.
Nightmares,flashbacks,orrelivingexperiencesshouldberelatedto

thepastexperience.

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Criteria3:
Avoidastimulusoractivitythatprovokesthememoryofpastevent.

203.Freud'stheoryofdreamincludesall
except:
a)Displacement

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b)Condensation
c)Symbolisation
d)Correlation
CorrectAnswer-D
Answer:-D-Correlation

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SigmundFreudtheoryofdream:
Dreamworkinvolvestheprocessofcondensation,displacement,
andsecondaryelaboration.
Conceptofunconsciousmind:
PrimaryassumptionofFreudiantheoryisthattheunconsciousmind

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governsbehaviortoagreaterdegreethanpeoplesuspect.
Goalofpsychoanalysisistomaketheunconscious,conscious.
Theoryofdream:
Freudtheoryofdreamelaboratesthestateofunconsciousmindwith
respecttodreaminterpretation,

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Processinvolvedincludecondensation,displacement,and
secondaryelaboration.
Displacementtakesplacewhenwetransformthepersonorobject
wearereallyconcernedabouttosomeoneelse.
Theprocessofcondensationisthejoiningoftwoormore

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ideas/imagesintoone.

204.Expressionandconsequentreleaseof
previouslyrepressedemotioniscalled
as

a)Regression

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b)Dissociation
c)Abreaction
d)Alloftheabove
CorrectAnswer-C
Answer:C-Abreaction

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Theexpressionandconsequentreleaseofapreviouslyrepressed
emotion,achievedthroughrelivingtheexperiencethatcausedit.
Donetypicallythrough
Hypnosis
Suggestion

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205.Allarehabitdisorderexcept
a)Nailbiting
b)Thumbsucking
c)Tempertantrum
d)Tics

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CorrectAnswer-C
Answer:C-Tempertantrum
Definition:
Habitdisorderisatermusedtodescribeseveralrelateddisorders
linkedbythepresenceofrepetitiveandrelativelystablebehaviour

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thatseemtooccurbeyondtheawarenessofthepersonperforming
thebehaviour.
Thefirstgroupofhabitdisorderincludes"TicDisorder"
Ticsareinvoluntarymovements,sounds,orwordsthataresudden,
rapid,recurrentandnon-rhythmic"

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InadditiontoTD's,body-focussedbehaviours,
Recurrenthairpulling-Trichotillomania(TTM)
Skinpicking(SP)
Nailbiting,areincludedwithinhabitdisorders.
Headbanging,rockingofbody,teethgrinding&thumbsucking

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arerepetitivedisorders.
Seeninchildrenbetweenagegroupof6monthsto2years.
Benign&self-limited.
Themovementsserveameansoftensiondischarginginchildren.
Aschildrenbecomeolder,theylearntoinhibitsomeoftheirrhythmic

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patterns.
Undueattentionbyparentscanleadtoaggravationofthese
problems.


206.Newnameofmentalretardation
accordingtoAmericanAssociationof

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MentalRetardation

a)FeebleMindedness
b)Madness
c)Intellectualdisability
d)Mentallyunstable

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CorrectAnswer-C
Answer:C-Intellectualdisability
Intellectualdisability(ID),alsoknownasgenerallearningdisability,
Mentalretardation(MR),isageneralizedneurodevelopmental
disordercharacterizedbysignificantlyimpairedintellectualand

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adaptivefunctioning.

207.Now-a-daysDownsyndromeIsreferred
toas.
a)Submentaldisorder
b)Oligophrenia

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c)Madness
d)Mentallyunstable
CorrectAnswer-A
Answer:A-Submentaldisorder
MajorityofchildrenwithDownsyndromefunctioninmildto

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moderaterangeofmentalretardation.
Downsyndrome/Trisomy21-
Geneticdisordercausedbypresenceofallorpartofathirdcopy
ofchromosome21.
Typicallyassociatedwithphysicalgrowthdelays,characteristicfacial

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featuresandmildtomoderateintellectualdisability.

208.A55yearsagedchronicalcoholicmale,
presentedwithirrelevanttalks,tremor
andsweating.Hehadhislastdrink3
daysback.Whatwilltheprobable

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diagnosis?

a)Deliriumtremens
b)Korsakoffpsychosis
c)Post-Acutewithdrawalsyndrome
d)Discontinuationsyndrome

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CorrectAnswer-A
Answer:A-DeliriumTremens
Thedescriptionofsymptomsisrelatedtothecondition"Delirium
Tremens"
DeliriumTremens/AlcoholWithdrawalDelirium(AWD):

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Mostsevereformofethanolwithdrawalmanifestedby,
Alteredmentalstatus(Globalconfusion)
Autonomichyperactivity(Sympatheticoverdrive)
Mechanism:
Alcoholabuseaffectsneurotransmittersystemsinbrainmainlyby,

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LossofGABAinhibitorymechanism-Reduceschlorideion
influx.
AlcoholactsasNMDAreceptorantagonist-Withdrawalincreases
theexcitatoryneurotransmitter.
Theclinicalmanifestationsofethanolwithdrawalarecombination

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effectsofGABA&NMDAreceptoractivity.
Thuscausingtremors,diaphoresis,tachycardia,anxiety&in

severecasesSeizure.


209.Identifythetypeofmuscleshowninthe

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imagebelow.
a)Cruciate
b)Multipennate
c)Parallel
d)Unipennate

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CorrectAnswer-B
Answer-B.Multipennate
Themuscledepictedaboveisthepectoralismajor.
PectoralisMajorhasmultiplerowsofdiagonalfibreswithasingle
tendon,Henceisamultipennatemuscle.

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210.Functionofthemuscleshowninpicture:
a)Flexion
b)Extension
c)Adduction

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d)Abduction
CorrectAnswer-A
Answer-A.Flexion
Lumbricals
arefourshorthandmuscleslocatedinthemetacarpus
deeptothepalmarfascia.

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Thelumbricalsareintrinsicmusclesofthehandthatflexthe
metacarpophalangealjointsandextendtheinterphalangealjoints.
Thelumbricalsareusedduringanupstrokeinwriting.


211.Followingimageisalsoknownas?

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a)5-hydroxytryptamine(5-HT)
b)N-methylphenylamine
c)3-Methoxytyramine
d)Phenethylamine
CorrectAnswer-A

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Ans:A.5-hydroxytryptamine(5-HT)
Serotonin/5-hydroxytryptamine(5-HT)isamonoamine
neurotransmitter.
Followinghydroxylationoftryptophanto5-hydroxytryptophanby
livertryptophanhydroxylase,subsequentdecarboxylationforms

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serotonin(5-hydroxytryptamine),apotentvasoconstrictorand
stimulatorofsmoothmusclecontraction.


212.Choosethebestmethodofdiagnosisfor
theclinicalsignrepresentedinthe

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image.

a)Serumcopper
b)Serumceruloplasmin
c)Karyotyping
d)PCR

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CorrectAnswer-B
Answer:B-SerumCeruloplasmin
Imagerepresents"Kayser-Fleischer"ring
KFringisgoldenbrownringduetodepositionofcopperin
Descement'smembraneofcornea.

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Clinicalfeatureof"Wilson'sdisease"
Wilson'sDisease:
Rareautosomalrecessivedisease.
Characterizedbyabnormalcoppermetabolism
Ophthalmicpresentation:

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Depositionofcopperinposteriorcapsuleoflensresultsinsunflower
cataract.
Diagnosis:
Sternlieb'scriteria:


PresenceofKFrings

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Decreasedserumceruloplasmin(coppercontainingenzyme/
ferroxidase)levels
Measuringhepaticcopperlevelsinliverbiopsy
24-Hrurinecopperexcretion
KayserFleischerring:

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Excesscirculatingcopperdepositsindescemet'smembrane.
Usuallygoldenbrownlocatedinperipheralcornea,beginningat
schwalbe'slineupto5mmintocornea.
DetectedviaGonioscopyinearlierstage&seenbynakedeyesin
advancedstage.

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213.Identifytheconditionrepresentedinthe
image.
a)Seminoma
b)Germcelldifferentiatetumor

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c)Non-seminoma
d)Teratoma
CorrectAnswer-A
Answer:A-Seminoma
Seminoma-Germcelltumoroftesticle/rarelymediastinumorother

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extra-gonadallocations.
Malignantneoplasm;
Oneofmosttreatable&curablecancers;
Survivalrate>95%ifdiscoveredinearlystages.
Usuallyunaffectedfertility&othersexualfunctionsremainsintact.

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Originatesingerminalepitheliumofseminiferoustubules
Histology:
Typicallyprominentlymphocyticinfiltrateinthefibrousstroma
separatingtheclustersoftumorcells.
Treatment:

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Requiresremovalofonetesticle.


214.Identifytheconditionshowninthe
image.
a)LobarPneumonia

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b)Bronchopneumonia
c)Acuteglomerulonephritis
d)Congestedkidney
CorrectAnswer-A
Answer:A-LobarPneumonia

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Imagedepictstheredhepatizationoflungs
Redhepatizationisseeninconditionslikelobarpneumonia.
LobarPneumonia:.
Pneumococcalpneumonia-Mostcommoncauseoflobar
pneumonia

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Progressesfromaredhepatizationphasetoagrayhepatization
phase
Redhepatization:
Characterizedbyconsolidationofairspacesoflungs.
C/Srevealslungsappearbrown-red,firm,&airless.resemblingliver.

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Histological:
Congestedalveolarcapillaries&alveolarspacesarefilledwith
erythrocytes,neutrophils,andfibrin.
Redcellsdisintegrate,withpersistenceoftheneutrophilsandfibrin.


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215.Identifytheconditionrepresentedin
belowimage
a)Miliarytuberculosis
b)Bronchiectasis
c)COPD

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d)Lungcancer
CorrectAnswer-A
Answer:A-Miliarytb
Miliarytuberculosis(TB)iswidespreaddisseminationof
Mycobacteriumtuberculosis

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Resultofhematogenousspread.
Distinctivepatternseenonachestradiograph
Tinysizedlesions(1?5mm),seenastinyspotsdistributed
throughoutlungfieldsappearingsimilartomilletseeds
Hence,theterm"miliary"tuberculosis.

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MiliaryTBmayalsoinfectliver&spleen.


216.Identifytheorganismrelatedtoblood
smearimage-
a)P.falciparum

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b)S.Typhi
c)Treponemapallidum
d)Toxoplasmagondii
CorrectAnswer-A
Answer:A.-->P.falciparum

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Malariaparasitecanbeseeninthebloodsmearofpatientsaffected
bythediseaseatspecificstagesinthedisease.
Plasmodiumfalciparum--ring-shapedtrophozoite.Theredbloodcell
containingfourring-shapedtrophozoites.
Notetheveryhighpercentageofredcellscontainingringforms.

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Thishigh-levelparasitemiaismoreoftenseeninPlasmodium
falciparuminfectionthanininfectionbytheotherplasmodia.
Thethicksmearsallowdetectionwhereasthethinsmearsallow
identificationofthespecies.Thisthinsmearshowsmultiplemalaria

trophozoitesinsideredbloodcells(Earlyringform).However,

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trophozoitescanalsobeseenoutsideredbloodcells.


217.Whichisthickenednerveshownhere:
a)FacialNerve
b)Greaterauricularnerve

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c)VagusNerve
d)GlossopharyngealNerve
CorrectAnswer-B
Answer-B.Greaterauricularnerve
Thegreaterauricularnerveisacutaneousbranchofthecervical

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plexusthatinnervatestheskinoftheauricleaswellasskinoverthe
parotidglandandmastoidprocess.Thegreaterauricularnervealso
suppliesbranchesthatinnervatethedeeplayeroftheparotidfascia.
Origin
ThegreaterauricularnervearisesfromtheventralramiofC2and

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C3spinalnerves,althoughitreceivesconsiderablymorefibresfrom
C2.
Course



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Thegreaterauricularnerveemergesalongtheposterioraspectof
thesternocleidomastoidmuscleatthepunctumnervosum(Erb
point)andascendsverticallyacrosstheobliquesternocleidomastoid
muscle.Whenthegreaterauricularnerveapproachestheinferior
poleoftheparotidglanditdividesintoanteriorandposteriorterminal

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branches.


218.Whichtypeofretractorisshowninthe
image
a)Morrisretractor

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b)Czernyretractor
c)Richardsonretractor
d)Lowerlidretractor
CorrectAnswer-A
Answer:A.Morrisretractor

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Morrisretractor-
Thisisabigretractorwhichisusefulforgivingmaximumexposure
inlargeincisionssuchasthoseusedintheabdomen.
ltcanbeusedtoimprovevisibilityononesideofanincision(by
puttingfirmlyinthatdirection);soisvaluableduringtheinitialphase

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ofalaparotomy.
SirHenryMorris(1844-1926)wasasurgeonattheMiddlesex
Hospital.London,UK.


219.Whichofthefollowingstatementistrue

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aboutsuturematerialintheimage:
a)Madeofrabbitsubmucosa
b)Madeofcatsubmucosa
c)Notdegraded
d)Degradedbyenzymaticdegradation

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CorrectAnswer-D
Answer:D.Degradedbyenzymaticdegradation
Catgut-
Types-plain
Rawmaterial-Collagenderivedfromhealthysheeporcattle

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Tensilestrengthretentioninvivo-Lostwithin7-10days.Marked
patientvariability.Unpredictableandnotrecommended.
Absorptionrate-Phagocytosisandenzymaticdegradationwithin7-
10days
Tissuereaction-high

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Contraindications-Notforuseintissuesthathealslowlyandrequire
prolongedsupport.Syntheticabsorbableissuperior.
Uses-Ligatesuperficialvessels,suturesubcutaneoustissues.
Stomasandothertissuesthathealrapidly.


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220.APatienthashistoryofRTA2years
back,atthesamesighthedeveloped
painandswelling.Xrayshowsthe
followingfeatures.Whatwillbethe
diagnosis?

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a)Osteogenicsarcoma
b)Ewing'ssarcoma
c)Chronicosteomyelitis
d)Multiplemyeloma
CorrectAnswer-C

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Ans.C.Chronicosteomyelitis
Garr?sclerosingosteomyelitis,orchronicnonsuppurativesclerosing
osteomyelitis,isaformofchronicosteomyelitis.
Mildinflammationandinfectionleadtosubperiostealbone
deposition.

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Thediseaseisfrequentlyasymptomatic.
Thecharacteristicradiographicappearanceisanareaofperiosteal


proliferationsurroundedbysuccessivelayersofcondensedcortical
bone(arrows),describedasanonionskinappearance.

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221.IdentifythebonenumberedintheX-ray
belowthatmostcommonlyfracture
whenapersonfallsonoutstretched
hands?

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a)1
b)2
c)3
d)4
CorrectAnswer-A

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Ans.A.1
Adistalradiusfracture,alsoknownasawristfracture,isabreakof
thepartoftheradiusbonewhichisclosetothewrist.
Symptomsincludepain,bruising,andswellingofrapidonset
Thewristmaybedeformed.

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Inyoungerpeople,thesefracturestypicallyoccurduringsportsora
motorvehiclecollision.Inolderpeople,themostcommoncauseis
fallingonanoutstretchedhand.


fallingonanoutstretchedhand.

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SpecifictypesincludeColles,Smith,Barton,andHutchinson
fractures


222.IdentifytheconditionshownintheCT
Scanimagebelow.

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a)Dandywalkermalformation
b)Cerebellarvermishypoplasia
c)Megacisternamagna
d)None
CorrectAnswer-A

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Ans.A.Dandywalkermalformation





223.IdentifytheXrayHSGShownbelow:

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a)Septateuterus
b)Uterusdidelphys
c)Unicornuateuterus
d)Bicornuateuterus
CorrectAnswer-C

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Ans.C.Unicornuateuterus


224.InawomancomplainingofAUB
followingimagewasseeninendoscopic
examinationofuterus.Whatwillbethe

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diagnosis?

a)Leiomyoma
b)Adenomyosis
c)Ovarianneoplasm
d)Carcinomaofuterus

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CorrectAnswer-A
Ans.A.Leiomyoma
Leiomyomaisthemostcommonpelvictumorinwomen
Benign,originatefrommyometrialsmoothmuscles
Symptomsinclude:

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AUB
Pelvicpainandpressure
Infertilityoradversepregnancyoutcome


225.Identifythefollowinglesion.

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a)Beckernevus
b)Hypopigmentedmacule
c)Spitznevus
d)Epidermalnevus
CorrectAnswer-A

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Ans.A.
BeckerNevus:
Usuallystartsinadolescenceasanirregularsmooth
hyperpigmentedmacule.
Usuallyinvolvestheshoulder,anteriorchestandscapularregion.

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Slowlygrowsinsizeofapalmwileacquiringthickdarkhair.
Oftenlesionresemblingacnevulgarisindifferentstagesmayappear
onthesurface.
Notreatmentisrequired.


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226.Achildhasarashasshowninthe
picture.Hisfamilyhistoryispositivefor
asthma.Whatcouldbethemost
probablediagnosis?

a)Seborrheicdermatitis

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b)Atopicdermatitis
c)Allergiccontactdermatitis
d)Erysipelas
CorrectAnswer-C
Ans.C.Allergiccontactdermatitis

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ACDisaformofcontactdermatitisthatmanifestsasanallergic
responsecausedbycontactwithasubstance.Itsahypersensitive
reactioncharacterisedbythepresenceofrashoraskinlesioninthe
formofpapules,blistersorvesiclesetc.Thedifferentialfeatures
are

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Itisconfinedtotheareawherethetriggertouchedthezone,
Itoccursafteradayortwooftheexposureand
Thesymptomsreappearwhenincontactwiththeallergen.

Thesymptomsreappearwhenincontactwiththeallergen.


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227.Spotradiographfromadoublecontrast
esophagram.Imagerepresents:
a)Esophagealatresia
b)Esophagealstenosis
c)Felineoesophagus

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d)Tracheoesophagealfistula
CorrectAnswer-C
Answer-C.Felineoesophagus
Inthegivenimage,therearenumerous1-2mmradiolucentfoldsacrosstheesophagus.
Thefoldsareangledconcerningtothecenteroftheesophagusina"herringbone"pattern.

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Thefoldsoccurtransiently.
Thefelineesophagusalsoisknownasanoesophagealshiver,referstothetransient

transversebandsseeninthemidandloweresophagusonadouble-contrastbarium
swallow.
Thesefinemucosalfoldsareatransientfindingproducedbycontractionofthemuscularis

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mucosa.Asimilarappearancemaybeseenincats.Itisusuallyanormalvariantbutmay
beassociatedwithGERD.
Thesefinefoldsareprobablyofnosignificanceandrelatetothetechniqueastheyare
mostandrelatetothetechniqueastheyaremostoftenseenwhentheesophagusinonly
partiallydistended.

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Radiographicfeatures
Thefoldsare1-2mmthickandrunhorizontallyaroundtheentirecircumferenceofthe
oesophageallumen.Thefindingsaretransient,seenfollowingrefluxandnotduring
swallowing.Theappearanceisconfinedtothedistaltwo-thirdsofthethoracicesophagus.


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228.MRIofskullrepresents:
a)VeinofGalen
b)DandywalkerSyndrome
c)Pneumocephalus
d)Crouzonsyndrome

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CorrectAnswer-A
AnswerA.VeinofGalen
TheveinofGalenislocatedunderthecerebralhemispheresand
drainstheanteriorandcentralregionsofthebrainintothesinuses
oftheposteriorcerebralfossa.

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TheveinofGalen,alsoknownasthegreatcerebralveinorgreat
veinofGalen,
isashorttrunkformedbytheunionofthetwo
internalcerebralveinsandbasalveinsofRosenthal.Itliesinthe
quadrigeminalcistern.Itcurvesbackwardandupwardaroundthe
posteriorborderofthespleniumofthecorpuscallosumtodraininto

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theconfluenceoftheinferiorsagittalsinusandtheanteriorextremity
ofthestraightsinus.
AneurysmalmalformationsofVeinofGalenMalformations(VGAM)
typicallyresultsinhighoutputcongestiveheartfailureormay

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representdevelopmentaldelay,hydrocephalusandseizures.
VGAMresultsfromaneurysmalmalformationwitharteriovenous
shuntingofblood.


229.Whatisadiagnosisbasedonagiven

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image:
a)Uterusdidelphys
b)BicornuateUterus
c)UnicornuateUterus
d)Septateuterus

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CorrectAnswer-C
Answer-C.UnicornuateUterus
Aboveimageisunicornuateuterusasseenona
hysterosalpingogramrepresents:
ThisresultsfromfailureofnormaldevelopmentofoneM?llerianduct

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andisassociatedwithincreasedspontaneousabortionandobstetric
complications,andrenalabnormalities.
OnT2-weightedMRimages,theunicornuateuterusdemonstratesa
curved,elongateduteruswithtaperingofthefundalsegmentoff

midline(the`banana-like'configuration)bestseenontheaxial

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oblique(longaxis)images.


230.X-rayofskullshowingwhichlesionsin
thebrain:
a)Paget'sdisease

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b)Multiplemyeloma
c)Osteosarcoma
d)Osteomyelitis
CorrectAnswer-A
Answer-A.Paget'sdisease

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Pagetdiseaseofthebone
isacommon,chronicbonedisorder
characterizedbyexcessiveabnormalboneremodeling.Itfrequently
affectsthepelvis,spine,skullandproximallongbonesandhas
characteristicradiographicfeatures.
Radiographicfeatures

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Theconditionisfoundmostcommonlyinthesacrumandlumbar
spine,followedbyskull,pelvis,andfemur.


Intheskull,thediseasebeginsasadestructiveprocessaffecting
theoutertableandsparingtheinnertable.

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Thefullpictureofosteoporosiscircumscriptaisrarelyseen.Inthe
reparativestage,sclerosisoftheinnertableispronounced,andlater
thediploicspacesandtheoutertablebecomethickened.
Aclassical,widespread'cottonwool'effectresults.
Thecranialcavityisnotencroachedupon.

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231.CTofThoraxrepresents:
a)AscendingAorticdissection
b)DescendingAorticdissection
c)Aorticaneurysm

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d)Cysticfibrosis
CorrectAnswer-B
AnswerB.DescendingAorticdissection
Aorticdissectionisadevastatingdiseasethatoccursasaresultof
thedegenerationofthethoracicaorta.

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Middle-agedmenarethemostoftenaffectedwithonly5%of
dissectionsoccurringintheunder40agegroup.
Theclassicalpresentationisthesuddenonsetofarazor-sharppain
betweenshoulderblades.
Therearetwomajortypesofclassification,theDeBakeyandthe

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Stanford.
TheStanfordclassificationissimplerwithtwotypesof
dissectiondescribed,TypeAandTypeB.TypeAisequivalenttoa
DeBakeyTypeIorType11dissection,involvingtheascending

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arch,whereasTypeBjustinvolvesthedescendingaorta.TypeAis
generallytreatedwithurgentsurgerywithTypeBgenerallybeing
treatedconservatively.
Signonchestradiograph-
Themostcommonabnormalityisthewideningofthemediastinum

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whichisoftenassociatedwithanindistinctoutlineoftheaortaoran
irregularwavycontour.
Morecharacteristicbutalessfrequentradiologicalfindingis
localizeddilatationoftheaorticknuckleandupperdescendingaorta,
givingrisetoaprominenthumpsignwhichwillindicateaneurysmal

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dilatationorunfolding
ofthearch.
TheCTscanwillshowthetrueandfalselumensassociatedwith
dissection.


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232.CTscanofabdomenshowinganarea
thatbranchingintotheliver.Identifythe
structure?

a)SVC
b)IVC

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c)Portalvein
d)Splenicvein
CorrectAnswer-C
Ans:C.Portalvein


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Theportalveinorhepaticportalveinisabloodvesselthatcarries
bloodfromthegastrointestinaltract,gallbladder,pancreas,and
spleentotheliver.

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TheliverisfurthersubdividedintoCouinaudsegmentsbasedonthe
vascularsupply.
ThecaudatelobeorsegmentIhaveautonomousbloodsupplyfrom
bothleftandrightbranchesoftheportalveinandhepaticartery
alongwithindependentvenousdrainagedirectlyintotheIVC.

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233.Identifyartery`X'inthegiven
angiographyanatomyimage:
a)Superiormesentericartery
b)Subclavianartery

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c)Celiacartery
d)Brachiocephalicartery
CorrectAnswer-A
Answer?A.Superiormesentericartery
Thesuperiormesentericartery(SMA)isamajorarteryofthe

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abdomen.Itarisesfromtheabdominalaorta,andsuppliesarterial
bloodtotheorgansofthemidgut?whichspansfromthemajor
duodenalpapilla(oftheduodenum)totheproximal2/3ofthe
transversecolon.

AnatomicalPosition

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Thesuperiormesentericarteryisthesecondofthethreemajor
anteriorbranchesoftheabdominalaorta(theothertwoarethe
coeliactrunkandinferiormesentericartery).Itarisesanteriorlyfrom
theabdominalaortaattheleveloftheL1vertebrae,immediately
inferiortotheoriginofthecoeliactrunk.

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Afterarisingfromtheabdominalaorta,thesuperiormesenteric
arterydescendsdowntheposterioraspectoftheabdomen.At
thispoint,ithasseveralimportantanatomicalrelations:
AnteriortotheSMA
?pyloricpartofthestomach,splenicveinand
neckofthepancreas.

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PosteriortotheSMA?leftrenalvein,uncinateprocessofthe
pancreasandinferiorpartoftheduodenum.
Theuncinateprocessistheonlypartofthepancreasthathooks
aroundthebackoftheSMA.


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MajorBranches
Thesuperiormesentericarterythengivesrisetovariousbranches
thatsupplythesmallintestines,cecum,ascendingandpartofthe
transversecolon(fig).


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234.Awomanshowssymptomsofmassive
pulmonarythromboembolism.Thegross
appearanceofliverautopsyisshown.
Whichofthefollowingstatementbest
characterizesthepatient'scondition?

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a)MetastasisfromPE
b)Angiosarcoma
c)Colonicadenocarcinomawithmetastasis
d)Locallyinvadedhepatocellularcarcinoma
CorrectAnswer-C

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Answer:C.Colonicadenocarcinomawithmetastasis
Thefigureshowsappearanceofmetastaticlesionsfromamalignant
neoplasmwithmultipletumormasses
Theliveristhemostcommonsiteofmetastasesfortumorsitesthat
draininitiallyviatheportalcirculation.Metastaticliverdiseaseis

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foundin10%to25%ofpatientshavingsurgeryforprimary
colorectalcancer

colorectalcancer
Surgicalresectionisthemosteffectivetherapyformetastatic
colorectalcancerisolatedtotheliver.

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235.WhatisthestructureseeninthegivenX-
raybelow
a)Stent
b)Surgicalclips

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c)Foleycatheter
d)Intravesicalwire
CorrectAnswer-A
Ans.A.Stent
PlainabdominalX-rayshowingastentintherightandleftureter.

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Uretericstents,alsoknownasdoubleJstentsorretrograde
uretericstents
,isaurologicalcatheterthathastwo"J-shaped"
(curled)ends,whereoneisanchoredintherenalpelvisandthe
otherinsidethebladder.
Ureteralstentsareimplantsusedtoprovidedrainageoftheupper

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urinarytractwhenobstructionoftheureterispresentoranticipated.
Thisobstructionmaybeduetointernalorexternalissues,suchas
edemaaftermanipulationoftheureter,ureteralstricture,passageof


stonefragmentsorexternalcompressionoftheureter.Stentsare

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alsofrequentlyusedinreconstructivesurgery.
Stent-relatedcomplications
DevelopmentofUTIsorformationofencrustations,complicating
subsequentstentremoval.
bilateraluretericstents

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236.Whatisthediagnosisbasedonthe
followingX-ray?
a)UterineFibroid
b)BladderCarcinoma

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c)Bladderstone
d)RenalTuberculosis
CorrectAnswer-C
Ans.C.Bladderstone
Multiplebladdercalculi.Fourovalradiopaquebladderstonesare

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visiblecentrallyinthepelvis.Mostbladdercalculiareroundoroval,
buttheymayalsobeamorphous,laminated,orevenspeculated.
Calculimayformasaresultofinfection(especiallywithproteusin
anabnormallyfunctioningbladder)whenthecalculiaremagnesium
ammoniumphosphateandapatite.

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Calculiareoftenasymptomaticbutmaypresentwithhaematuria,
suprapubicpain,disruptionoftheurinestreamorrecurrentinfection.
Theymayappearasradiopaquespiculated(jackstone),laminatedor
amorphouslesions.
Aswithuppertractcalculi,oncontrastinvestigations,theyare

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usuallyseenasfillingdefects,astheyaremostlylessradiopaque


thancontrast.
Ultrasoundreliablydemonstratesthemashighlyechogenic
mobilefoci,especiallywhenthebladderisfull.

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237.Aredsofttofirmswellingonsternum
thatonbiopsyshowsfollowing
histology.Whatisthediagnosis?

a)Hemangioma

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b)Osteochondroma
c)Osteoidosteoma
d)Pagetdisease
CorrectAnswer-A
Ans.A.Hemangioma

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Clinicalpresentation
Thesetumoursareslowgrowingandaregenerallyasymptomatic
unlesstheyexertmasseffectonsensitivestructures.Occasionally
theymaypresentasaswellingorapalpablemass,especiallyinthe
skull.Whenlargeandstrategicallylocatedtheymaypresentwitha

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pathologicalfracture.
Iftheyarehigh-flowlesions,shunt-relatedsymptomsmayalsobe
present.
Pathology
Primaryintraosseoushaemangiomasareslowgrowingvascular

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neoplasms,usuallylocatedinthemedullarycavity.Theyare

classifiedasbenign,butrarelymaybelocallyaggressive.
Histology
Histologically,intraosseoushaemangiomasdemonstrate
hamartomatousvasculartissuewithinendothelium,butmayalso

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containfat,smoothmuscle,fibroustissue,andthrombi.


238.Whichofthefollowingiscarryingagent
forthediseasewithgivencharacteristic
onpolarizedmicroscopy?

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a)Anopheles
b)Ixodesscapularisticks
c)Louse
d)Ratflea
CorrectAnswer-B

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Answer:B.Ixodesscapularisticks
BabesiosisinfectstheRBCsandresidesinsidetheRBCs(
intraerythrocytic).
IntraerythrocyticinfectionofBabesiosisischaracterizedbythe
maltesecross.

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TheMaltesecrossisacharacteristicarrangementofparasiteswithin
theerythrocytesParasiteswithinerythrocytesarearrangedsuch
thatpointedendsoffourparasitescomeincontacttherebygivinga
tetradconfigurationresemblingamaltesecross.
Tetradformsor'Maltesecross'appearanceisconsidered

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pathognomicofBabesiosis.
BabesiosiscaneasilybeconfusedwithP.falciparummalaria.
FollowingtwofeaturesdistinguishBabesiosisfrommalaria
PresenceofmaltesecrossinBabesiosis(absentinmalaria)
AbsenceofpigmentHemozoininBabesiosis(presentinmalaria)

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Note-
Maltesecrossisalsoseenincryptococcusandaspergillus.


239.Chordomaarisesfrom:
a)Pharyngealbursa
b)Notochord

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c)Rathke'spouch
d)Luschka'sbursa
CorrectAnswer-B
Answer:-B.Notochord
Chordomaisarareslow-growingneoplasmthoughttoarisefrom

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cellularremnantsofthenotochord.
Chordomascanarisefromboneintheskullbaseandanywhere
alongthespine.Thetwomostcommonlocationsarecraniallyatthe
clivusandinthesacrumatthebottomofthespine.
Therearethreehistologicalvariantsofchordoma:classical(or

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"conventional"),chondroidanddedifferentiated.

240.WhatistheeffectofProgesteroneonly
pills?
a)Completelysuppressesovulation
b)Thinliningofuterus

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c)Thickcervicalmucus
d)Alloftheabove
CorrectAnswer-D
Answer:D.Alloftheabove
Progestogen-onlypills/Progestin-onlyPills(POP)/Morning

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afterpills-
Contraceptivepills
Containonlysyntheticprogestins&doesn'tcontainestrogen.
Mechanism:
Mucusthickeningintheneckofthewomb:

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Penetrationofspermtoreacheggandwombbecomesdifficult.
Preventsovulation:
Theliningoftheuterusbecomesthin
Fertilizedeggimplantationisprevented
Advantages:

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Doesn'tinterferewithbreastfeeding
Alsohelpsinpremenstrualsymptomsandpainfulperiods

241.Whichmetalresultsin"Saturninegout"
formation?
a)Cadmium

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b)Lead
c)Beryllium
d)Mercury
CorrectAnswer-B
Answer:B.Lead

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Onemanifestationofchronicleadtoxicityistherheumatologicentity
knownassaturninegout.
Illicitlydistilledbeveragesmayinadvertentlycontainharmfultoxins,
likemetalliclead.
Leadhasbeenknowntoplayaroleinpurinemetabolism&renal

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insufficiency

242.Whichdrugdecreasesthebone
resorptioninosteoporosis?
a)Teriparatide
b)Risedronate

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c)Cortisone
d)Cimetidine
CorrectAnswer-B
Answer:B-Risedronate
Risedronatebisphosphonatesinhibitsboneresorptionby

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actionsonosteoclastprecursorsinosteoporosispatients

Risedronate:
Aminobisphosphonate
Indications:
Prevention&treatmentofosteoporosis

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Mechanismofaction:
Inhibitsboneresorptionbyactiononosteoclasts
Reduceboneremodelling
Morepotentinblockingthebonedissolutionprocess.
Teriparatide,anPTHanalog,recombinanthumanPTHisalsoused,

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yetinseverecasesofosteoporosis,improvingtheskeletal
microarchitecture

243.Phenylketonuriaisduetodeficiencyof:
a)Phenylalanine
b)Phenylalaninehydroxylase(PAH)

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c)Phenylene
d)Allofthese
CorrectAnswer-B
AnswerB.Phenylalaninehydroxylase(PAH)
Abirthdefectthatcausesanaminoacidcalledphenylalanineto

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buildupinthebody.
PKUisanautosomalrecessivemetabolicgeneticdisorder.
PKUischaracterizedbyhomozygousorcompound
heterozygousmutationsinthegeneforthehepatic
enzymephenylalaninehydroxylase(PAH),renderingit

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nonfunctional.
Thisenzymeisnecessarytometabolizetheamino
acidphenylalanine(Phe)totheaminoacidtyrosine(Tyr).When
PAHactivityisreduced,phenylalanineaccumulatesandis
convertedintophenylpyruvate(alsoknownasphenylketone),which

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canbedetectedintheurine.
ThePAHgeneislocatedonchromosome12inthebands12q22-
q24.1.Morethan400disease-causingmutationshavebeenfoundin
thePAHgene.

244.WHICHISNOTCORRECT:

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a)MRIneededtoaccesshaemorrhage
b)GCSassessmenthelpsinprognosis
c)Haematomamustbeoperated
d)alloftheabove
CorrectAnswer-C

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Answer-C.Haematomamustbeoperated
Treatmentofhematomadependsonthelocation,symptoms,and
theclinicalsituation.Somemayrequirenotreatmentatallwhile
othersmaybedeemedamedicalemergency.
Simpletherapiesathomemaybeutilizedintreatingsuperficial

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(undertheskin)hematomas.Mostinjuriesandbruisescanbe
treatedwithresting,icing,compression,andelevatingthearea.This
isrememberedbytheacronymRICE.
Thesemeasuresusuallyhelptoreduceinflammationanddiminish
itssymptoms.

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Rest
Ice(Applytheiceorcoldpackfor20minutesatatime,4to8times
aday.)
Compress(Compressioncanbeachievedbyusingelastic
bandages.)

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Elevate(Elevationoftheinjuredareaabovetheleveloftheheartis
recommended.)
Medicaltreatmentforahematoma
Forcertainsmallandsymptom-freehematomasnomedical
treatmentmaybenecessary.Ontheotherhand,symptomatic

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hematomasorthoselocatedincertainlocationssometimesrequire
medicalorsurgicaltreatment.

Eventhoughnospecificmediationisavailableforthetreatmentof
hematomas,managementofanyrelatedsymptomscanbeachieved
bymedications.Forexample,painfromahematomacanbetreated

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withpainmedicationssuchasacetaminophen(Tylenol).
Surgicaldrainageisacommonmethodoftreatmentforcertain
hematomas.

245.Maastrichtclassificationofdonation
aftercardiacdeath.Whatcategoryis

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stage3?

a)Awaitingcardiacarrest
b)Broughtindead
c)Unsuccessfulresuscitation
d)Cardiacarrestafterbrain-stemdeath

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CorrectAnswer-A
Answer:A>Awaitingcardiacarrest
Thefirstlevelofdefinitionissimpleandbasedonwhetherthe
situationisuncontrolled(categoriesIandII)orcontrolled(categories
III,IV,andV).

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CategoryI,thepatientisdeclared"deadonarrival"and,
CategoryII,thereisan"unsuccessfulresuscitation"whetherit
occurredoutorinthehospitalforbothsituations.
CategoryIIIisthemostusualsituationinwhichthetreating
physicianandfamilyare"awaitingcardiacarrest"todeclarethe

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deathofthepatient.
CategoryIVisalwayscharacterizedby"cardiacarrestduringbrain
death."ThespecialsituationoftheBelgianlawallowingthe
euthanasiaiselaborated
CategoryV"euthanasia,"andincludespatientswhograntaccessto

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medicallyassistedcirculatorydeath.Organdonationafter
euthanasiaisallowedunderthescopeofdonationaftercirculatory

246.Whatisthecauseofmyocardialshock
otherthanMI?
a)acutemitralregurgitation

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b)ventricularseptalrupture
c)isolatedrightventricularshock
d)alloftheabove
CorrectAnswer-D
Answer:D>Alloftheabove

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Leftventriculardysfunction(LVD)-
Mostfrequentcauseof
cardiogenicshock
Followedby,
Acutemitralvalveregurgitation
Ventricularseptaldefect

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Isolatedrightventricularshock
Tamponade/cardiacrupture

247.Nitricoxideactsbyincreasing?
a)BRCA1
b)BRCA2

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c)Interleukin
d)cGMP
CorrectAnswer-D
Answer:D>cGMP
Nitricoxidediffusestothesurroundingsmoothmuscle

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cells,increasingcGMP.
Cyclicguanosinemonophosphate(cGMP)
Cyclicnucleotidederivedfromguanosinetriphosphate(GTP).
Function:
cGMPactsasasecondmessengermuchlikecyclicAMP.

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Mechanismofaction:
Activationofintracellularproteinkinasesinresponsetothebinding
ofmembrane-impermeablepeptidehormones.

248.Positiveacidschiffmacrophagesseenin
?

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a)Whipplesdisease
b)Crohnsdisease
c)AIDS
d)Noneoftheabove
CorrectAnswer-A

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Answer:A>Whipplesdisease.
Thetraditionallaboratorydiagnosisisbasedonlightmicroscopy,
whichshowsdiastase-resistant,periodicacid-Schiff(PAS)-positive,
non-acid-fastgranulesin.....Thedistinctioncouldbemade
byacid-faststaining,whichispositiveforpatientsinfectedwithM.

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aviumandnegativeforthosewithWhipple'sdisease.

249.Aboypresentedwithmultiplenon
suppurativeosteomyelitiswithsicklecell
anaemia.Whatwillbethecausative
organism?

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a)Salmonella
b)S.aureus
c)H.influenzae
d)Enterobacterspecies
CorrectAnswer-A

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Ans.A.Salmonella
Followingarethevariousmicro-organisminvolvedin
osteomyelitis

Agegroup
Mostcommonorganisms

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Newborns(younger S.aureus,Enterobacterspecies,andgroupA
than4mo)
andBStreptococcusspecies
Children(aged4mo S.aureus,groupAStreptococcusspecies,
to4y)

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Haemophilusinfluenzae,andEnterobacter
species
Children,
S.aureus(80%),groupAStreptococcus
adolescents(aged4 species,H.influenzae,andEnterobacter

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ytoadult)
species
Adult
S.aureusandoccasionallyEnterobacteror
Streptococcusspecies

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Sicklecellanemia
Salmonellaspeciesaremostcommonin
patients
patientswithsicklecelldisease

250.Termpathologyrefersto:

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a)Work
b)Function
c)Details
d)Explains
CorrectAnswer-A

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Ans.A.Work
Pathology
isthemedicaltermforthewayadiseaseworks.
Thescienceofthecausesandeffectsofdiseases,especiallythe
branchofmedicinethatdealswiththelaboratoryexaminationof
samplesofbodytissuefordiagnosticorforensicpurposes.

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251.1yrchildweighing6kgissufferingfrom
AcuteGastroenteritisalongwithsignsof
sunkeneyes&skinpinchgoingbackto
normalveryrapidly.Whatwillbeyour
management?

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a)RLinfusion120mlinthefirsthourfollowedby360mlinthe
next5hours
b)RLINFUSION180mlinthefirsthourfollowedby420mlinthe
next5hours
c)RLINFUSION180MLINthefirsthourfollowedby480mlinthe

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next5hours
d)RLINFUSION240mlinthefirsthourfollowedby360mlinthe
next5hours
CorrectAnswer-B
Ans.B.RLINFUSION180mlinthefirsthourfollowedby420ml

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inthenext5hours
Severedehydrationconstitutesamedicalemergencyrequiring
immediateresuscitationwithintravenousfluids.
Intravenousaccessshouldbeobtained,andpatientsshouldbe
administeredabolusof20-30mL/kglactatedRinger's(LR)or

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normalsaline(NS).
Ifpulse,perfusion,and/ormentalstatusdonotimprove,asecond
bolusshouldbeadministered.
Afterthis,thepatientshouldbegivenaninfusionof70mL/kgLRor
NSover5hours(children<12months)or2.5hours(olderchildren).

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Ifnoperipheralveinsareavailable,anintraosseouslineshouldbe
placed.Serumelectrolytes,bicarbonate,urea/creatinine,and

placed.Serumelectrolytes,bicarbonate,urea/creatinine,and
glucoselevelsshouldbesent.

252.Whatconstitutesmalpighianlayer?

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a)Corneumlucidum
b)Corneumspinosum
c)Spinosumandbasale
d)Basalegranulosum
CorrectAnswer-C

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Ans.C.Spinosumandbasale
TheMalpighianlayeroftheskinisgenerallydefinedasboththe
stratumbasaleandstratumspinosumasaunit,althoughitis
occasionallydefinedasthestratumbasalespecifically,orthestratum
spinosumspecifically.ItisnamedafterMarcelloMalpighi.

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253.Mechanismofactioncolchicineinacute
gout
a)Uricacidnephrolithiasis
b)DeficiencyofenzymeXanthineoxidase
c)Increaseinserumurateconcentration

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d)Renaldiseaseinvolvinginterstitialtissues
CorrectAnswer-B
Ans.B.DeficiencyofenzymeXanthineoxidase.
Goutisahereditarydisorderwithincreaseinserumuricaciddue
toincreasedproduction,ordecreasedexcretionofuricacidanduric

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salt.
Thoughttobecausedbylackofanenzymeneededtocompletely
metabolisepurinesforrenalexcretion.
Table1.MetabolicRiskFactorsforGout
Obesity,eating13w-1nel-richfoods(highlevelsofmeatand

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seafoodconsumption)
Excessivealcoholintake
Metabolicsyndrome
Obesity
Hypertension

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Hyperlipidernia
Hyperglycemia
Type2diabetesmellitus
Hypertension
Hyperlipidernia

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Serumurate--elevatingmedications
Historyofurolithiasis
Chronickidneydisease,glomerular,orInterstitialrenaldisease;

Chronickidneydisease,glomerular,orInterstitialrenaldisease;
polycystickidneydisease

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Potentialgeneticoracquiredcauseofuricacidoverproduction,
includingmalignancy
Lead,orheavy-metalintoxication

254.Oxygentherapymaynotbeusefulin
a)Asthma

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b)Pneumonia
c)Subglotticstenosis
d)Pulmonaryfibrosis
CorrectAnswer-D
Ans:D.Pulmonaryfibrosis

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ManyEMSprotocolsindicatethatoxygenshouldnotbewithheld
fromanypatient,whileotherprotocolsaremorespecificor
circumspect.However,therearecertainsituationsinwhichoxygen
therapyisknowntohaveanegativeimpactonapatient'scondition
likeparaquatpoisoning,pulmonaryfibrosisandlungdamage

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resultingfrombleomycintreatment.

255.Newbornbabywithheartratelessthan
60beatsperminutecanberesuscitated
byallexcept

a)chestcompression

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b)oxygentherapy
c)tactilestimulation
d)slappingtheback
CorrectAnswer-D
Ans:D.slappingtheback

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Thefirstthreesareindicatedwhileslappingthebackisnot
recommendedinanewbornwhohas
Heartratelessthan60beatsperminute.



256.Mobitztype2seconddegreeAVblockis

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seeninallexcept:
a)Hypothyroidism
b)CoronaryArteryDisease
c)Sarcoidosis
d)Cushingsyndrome

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CorrectAnswer-D
Ans:D.Cushingsyndrome
Delayorlackofconductionthroughtheatrioventricular(AV)node
andbelowhasmultiplecauses.Degenerativechanges(eg,fibrosis,
calcification,orinfiltration)arethemostcommoncauseofnon-

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ischeamicAVblock.IdiopathicfibrosisorcalcificationoftheAV
conductionsystem,commonlyseenintheelderly,cancause
completeAVblock.
CausesofMobitztype2seconddegreeAVblockare-
Damageoftheconductionsystemfromcoronaryarterydisease,

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valvesurgery,myocardialinfarction,myocarditis,infiltrative
cardiomyopathies(sarcoidosis,hemochromatosis),myxedema,
Lymedisease,neuromusculardisease,andAVjunctionablation[6]

257.Whencanonediagnoseacute
respiratorydistressinachild?

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a)Within7daysofknownclinicalinsult
b)Respiratoryfailurenotfullyexplained
c)Leftventriculardysfunction
d)Alloftheabove
CorrectAnswer-D

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Ans:D.Alloftheabove
PediatricCriticalCareMedicine2015
Excludepatientswith1:m11-natalrelatedlung
Age
disease

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Iiming
Within7daysofknownclinicalInsult
originof
Respiratoryfailurenotfullyexplainedbycardiacfailure
Edema

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orfluidoverloadChest
Chest
imagingfindingsofnewinfiltrate(siconsigentwithacute
Imaging
pulmonary

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Noninvasivemechanical lovasivemechanical
ventilation
ventilation-
PARRS(Noseverity
Mild

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Moderate Severe
gratification)
Oxygenation Fullface-maskbi-level
EK01<
O1t16

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ventilationor
4501c8
16
CiSt
CPAPz5crnHAa

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Ss09.c7.51 7.5OSI
1233
PFratios300
<12.31
SFratio52E4I

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Specia-lPopulations
tandardCriteriaaboveforage,timing,originofedema
Cyanotic

Cyanotic
andchestimagingwithanacutedeteriorationIn

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Heart
oxygenationnotexplainedbyunderlyingcardiac
Disease
disease.
standardCriteriaaboveforage,timing,andoriginof

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Chronic
edemawithchestimagingconsistentwithnewinfiltrate
Lung
andacutedeteriorationinoxygenationfrom
Disease

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baselinewhichmeetoxygenationcriteriaabove_
StandardCriteriaforage,timingandoriginofedema
Left
withchestimagingchangesconsistentwithnew
Ventricular infiltrateandacutedeteriorationinoxygenationwhich

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dysfunction meetcriteriaabovenotexplainedbyleftventricular
dysfunction.

258.A6-year-oldboyexperiencedlife
threateningshock,hisCTscanshowed
largeamountofascites,bowelwall

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thickeningandpoororabsent
enhancementofthestrangulatedbowel
segment,showinggangrenousbowelon
surgicalexploration.
Trueaboutanastomosisis-

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a)Shouldbedonebycontinuouslayersasittakeslesstime
b)ShouldbeDonewithcatgut
c)ShouldbeDonebysinglelayerseromuscularlembertsutures
d)ShouldbeDonebySinglelayertakingsubmucosa
CorrectAnswer-C

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AnsC.ShouldbeDonebysinglelayerseromuscularlembert
sutures
DiagnosisisofcongenitalIHwithstrangulatedsmallbowelwith
gangrenoussmallbowel
Transmesentericherniawasthemostcommontypeinolderchildren

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aswellasinneonates.
IHresultsfromincompleteclosureofsurgicallycreatedmesenteric
defects,andusuallyacquiredresultingfrompreviousabdominal
surgeryespeciallyRoux-en-Yanastomosis
Anastomosisshouldbedonebysinglelayerseromuscularlembert

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sutures
TheLambertsuturegenerallyisusedinabdominalsurgery.Itisan
invertingsuture,thatcanbeeithercontinuousorinterrupted,usedto

invertingsuture,thatcanbeeithercontinuousorinterrupted,usedto
jointwosegmentsofanintestinewithoutenteringthelumen(the

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innerchannelthroughwhichstomachcontentsflow).

259.InACLSwhichdrugcanbegiven
followingventricularfibrillationafter
cardiacarrestotherthanepinephrine?

a)Amiodarone

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b)Dopamine
c)Adenosine
d)Atropine
CorrectAnswer-A
Ans.A.Amiodarone

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V-FiborVFisthemostcommonrhythmthatoccursimmediately
aftercardiacarrest.Inthisrhythm,theheartbeatswithrapid,erratic
electricalimpulses.
Treatment:
Shock/Defibrillation:every2minutesinasingleoneshock,

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successive,shockableincrements
200joules-FollowedbyimmediateCPRfor2minutes/giveand
circulateadrug(s)
300joules-FollowedbyimmediateCPRfor2minutes/giveand
circulateadrug(s)

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360joules-FollowedbyimmediateCPRfor2minutes/giveand
circulateadrug(s)
Drugs:
GiveEpinephrine1mgofa1:10,000solu,onevery3to5minutes
[NoLimit]

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Giveeither:
Amiodarone[ifnotcontraindicated,canbegiven2x]:300mgfirst
dose/150mgseconddoseat3to5minutesincrements.

Lidocaine:Firstdose:1mg/kgor1.5mg/kg.Canrepeatitathalfthe
originaldoseuptoatotalof3mg/kg[Secondandremainingdoses

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aregivenateither0.5mg/kgor0.75mg/kgdependingonyourstar,ng
dosage.]

260.Whichofthefollowingstatementisfalse
aboutMRvaccinationcampaign
launchedbyWHO?

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a)Childrenfrom9monthstolessthan15vaccinated
b)Congenitalrubellasyndrome(CRS),responsibleforirreversible
birthdefects
c)Indiahasnotyetlaunchedthiscampaign
d)Willreplaceroutineimmunizationformeaslesvaccine

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CorrectAnswer-C
Answer:C.Indiahasnotyetlaunchedthiscampaign
Oneoftheworld'slargestvaccinationcampaignagainstmeasles,a
majorchildhoodkillerdisease,andcongenitalrubellasyndrome
(CRS),responsibleforirreversiblebirthdefects.

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India,alongwithtenotherWHOSouthEastAsiaRegionmember
countries,haveresolvedtoeliminatemeaslesandcontrol
rubella/congenitalrubellasyndrome(CRS)by2020
Allchildrenfrom9monthstolessthan15yearsofagewillbegiven
asingleshotofMeasles-Rubella(MR)vaccinationduringthe

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campaign
Followingthecampaign,MRvaccinewillbecomeapartofroutine
immunizationandwillreplacemeaslesvaccine,currentlygivenat9-
12monthsand16-24monthsofageofchild.
Forthosechildrenwhohavealreadyreceivedsuchvaccination,the

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campaigndosewouldprovideadditionalboostingtothem.

261.Whichofthefollowingtrueregarding
HemophiliaA
a)SerumlevelsoffactorVIIIaredecreased
b)DeficiencyoffactorIX

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c)PTincreased
d)FITdecreased
CorrectAnswer-A
Answer:A.SerumlevelsoffactorVIIIaredecreased
HemophiliaisanXlinkeddisorderofcoagulationcausedbythe

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deficiencyinacirculatingplasmaprotein.HemophiliaAiscausedby
thedeficiencyoffactorVIII,andhemophiliaBiscausedbythe
deficiencyoffactorIX.
ItisPTTwhichisaffected(increased)andnotPT(unaffected).
FactorVIIIisinvolvedintheintrinsicpathwaywhichismeasuredby

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PTTandnotinextrinsicpathwaywhichismeasuredasPT.
Bleedingisthecommonmanifestationofhemophiliaandthe
commonbleedingmanifestationsarehemarthoses,hematomas,
mucocutaneousbleeding,intracranialbleeding,hematuriaand
pseudotumor.

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262.Markedbleedingisseeninwhichof
followingconditions?
a)VMAdisease
b)HaemophiliaA
c)HaemophiliaB

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d)ALL
CorrectAnswer-D
Answer:D.ALL
Bleedingdisorderscanbeinheritedoracquired.Inheriteddisorders
arepasseddownthroughgenetics.Acquireddisorderscandevelop

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orspontaneouslyoccurlaterinlife.Somebleedingdisorderscan
resultinseverebleedingfollowinganaccidentorinjury.Inother
disorders,heavybleedingcanhappensuddenlyandfornoreason.
Therearenumerousdifferentbleedingdisorders,butthefollowing
arethemostcommonones:

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HemophiliaAandBareconditionsthatoccurwhentherearelow
levelsofclottingfactorsinyourblood.Itcausesheavyorunusual
bleedingintothejoints.Thoughhemophiliaisrare,itcanhavelife-
threateningcomplications.
FactorII,V,VII,X,orXIIdeficienciesarebleedingdisorders

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relatedtobloodclottingproblemsorabnormalbleedingproblems.
vonWillebrand'sdisease
isthemostcommoninheritedbleeding
disorder.ItdevelopswhenthebloodlacksvonWillebrandfactor,
whichhelpsthebloodtoclot.

263.Reedsternbergcellsarefoundin

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a)Hodgkin'sdisease
b)Sicklecellanaemia
c)Thalassemia
d)CML
CorrectAnswer-A

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ReedSternbergcellsareyouderivedfromBlymphocytes,
classicallyconsideredcrippledgerminalcenterBcells,Seenagainst
aseaofBcellswhichgivethetissueamoth-eatenappearance.
Theyarelargeandareeithermultinucleatedorhaveabibbed
nucleus(thusresemblingan"owl'seye"appearance)withprominent

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eosinophilicinclusion-likenucleoli.
TheyareCD30andCD15positive,usuallynegativeforCD20and
CD45.
Thepresenceofthesecellsisnecessaryforthediagnosisof
Hodgkin'slymphoma-theabsenceofReed-Sternbergcellshasvery

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highnegativepredictivevalue.
Theycanalsobefoundinreactivelymphadenopathy(suchas
infectiousmononucleosis,carbamazepineassociated
lymphadenopathy)andveryofteninothertypesofnon-Hodgkin
lymphomas.

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264.BywhichmethodforeignDNAis
introducedintoacellbyavirusorviral
vector?

a)Transduction

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b)Transcription
c)Lysogenicconversion
d)Transformation
CorrectAnswer-A
Ans.A.Transduction

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Transduction
istheprocessbywhichforeignDNAisintroduced
intoacellbyavirusorviralvector.Anexampleistheviraltransfer
ofDNAfromonebacteriumtoanother.

265.Whichoneofthefollowingshows
allostericinhibition?

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a)Malonicacid&succinate
b)2,3BPG
c)Aminoacidalanine&pyruvatekinase
d)Citrate
CorrectAnswer-B

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Answer:B.2,3BPG
Negativeallostericmodulation(alsoknownasallosteric
inhibition
)occurswhenthebindingofoneliganddecreasesthe
affinityforsubstrateatotheractivesites.Forexample,when2,3-
BPGbindstoanallostericsiteonhemoglobin,theaffinityfor

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oxygenofallsubunitsdecreases.

266.Whichofthefollowingisseenin
seropositiverheumatoidarthritis?
a)Multiplejointsaffected
b)Symmetricaljointsymptoms

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c)Jointpainandswelling
d)All
CorrectAnswer-D
Answer:D.All
PositiveforRheumatoidfactorinbloodisseropositivity.

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Patientswithpositiverheumatoidfactorusuallypresentwith
symptomslike
Jointdeformities&disability
Symmetricalinvolvementofjoints
Inflammation

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Swellingandpainfulinmultiplejoints
,especiallyofhandsand
feet.
Morningstiffness(shortterm)
Developmentoffirmlumpsnearjoints-"Rheumatoidnodules"
Deteriorationofbone&cartilage(X-rayfindings)

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267.Whichofthefollowingisnotseenin
Anteriormediastinum
a)Thyroidtumour
b)Thymoma

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c)Lymphoma
d)Neurogenictumor
CorrectAnswer-D
Answer:D.Neurogenictumor
Theanteriormediastinumistheportionofthemediastinumanterior

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tothepericardiumandbelowthethoracicplane.
Itformstheanteriorpartoftheinferiormediastinum
containsthethymus,lymphnodes,andmaycontaintheportionsof
aretrosternalthyroid.

MediastinalTumorsandOtherMasses

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Superior
Anterior
Posterior
Middle
Mediastinum

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Mediastinum
Mediastinum
Mediastinum
Neurogenic
Bronchogenic

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Lymphoma
Thymoma
tumors
cyst
Thymoma

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Teratoma
Lymphoma
Pericardialcyst
Gastroenteric
Thyroidlesions

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Lymphoma
Lymphoma
hernia
Metastatic
Thyroidlesions

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carcinoma
Parathyroid
Parathyroid
tumors
tumors

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268.Struvitestoneiscausedbywhichmetal?
a)Magnesium
b)Calcium
c)sodium&potassium

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d)both(a)&(b)
CorrectAnswer-A
Ans.A.Magnesium
Struvite,acrystallinesubstanceiscomposedofmagnesium
ammoniumphosphate(MgNH4PO4?6H2O).

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Struviteurinarystoneshavealsobeenreferredtoas"infection
stones"and"triplephosphate"stones.
Struvitestones
canbecausedbyalkalineurine,steroidtherapy,
abnormalretentionofurine,aurinarytractinfection,oranother
disorderoftheurinarytract.

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Therearefiveprimarytypesofcommonlyencounteredurinary
stones,i.e.,calciumoxalate,calciumphosphate,magnesium
ammoniumphosphate,uricacid,andcystine.

269.Whichofthefollowingstatementsabout
Gravesdiseaseisfalse?

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a)Resultsinhyperthyroidism
b)Autoimmunedisorder
c)CommoninMale
d)ReferredasToxicdiffusegoitre
CorrectAnswer-C

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Ans.C-Commoninmale
Graves'disease:
Autoimmune
systemdisorder
Bothmenandwomengetaffected;
Yet,10timesmorecommoninwomenthanmen

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Affectsyoungerwomen<40years
Resultsinoverproductionofthyroidhormones(hyperthyroidism).
Signsandsymptoms:
Anxiety
Irritability

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Heatsensitivity
Increasedperspiration/warmandmoistskin
Weightloss
Goiter(Glandularenlargement)
Menstrualcyclechanges

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Erectiledysfunction/reducedlibido
GravesOphthalmopathy-Bulgingeyes-Exophthalmos
Gravesdermopathy
-Thick,redskinonshins/topoffeet.
Antibodyforgravesdisease-Thyrotropinreceptorantibody
(TRAb)actsonthe
regulatorypituitaryhormoneinterferingthe

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normalsecretionofthyroxine.

TRAboverridesnormalregulationcausinganoverproductionof
thyroidhormones(hyperthyroidism).


270.Aldosteronesynthesisisstimulatedbywhichofthe
following?

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a)ACTH
b)Hyperkalemia
c)Hypernatremia
d)Exogenoussteroids
CorrectAnswer-B

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Ans.B.Hyperkalemia
Mineralocorticoidsecretionisstimulatedbyhyperkalemia,
angiotensin-II,ACTHandhyponatremia,inreducingorderof
efficacy.
1.Aldosteronesecretioninresponsetohyperkalemiaisthemost

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importantandformsthebasisforrenalregulationofbodypotassium
balance.
2.StimulationofaldosteronebyangiotensinII(throughtherenin-
angiotensinsystem)isimportantforthecorrectionofhypovolemia
andhypotensioninconditionslikesaltdepletionorrenalischemia.

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3.StimulationofaldosteronesecretionbyACTHresultsindiurnal
variationofaldosteronesecretion.However,ACTHisnotan
importantphysiologicalregulatorforaldosteronesecretion.
4.Hyponatremiaisaweakstimulatorofaldosteronesecretion

271.Whichofthefollowingisfalseabout

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Alzheimer'sdisease?
a)Onein10peopleage65andolderhasAlzheimer'sdisease
b)Alzheimer'sdiseaseiscurable
c)Causedementia
d)Alloftheabove

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CorrectAnswer-B
Ans.B.Alzheimer'sdiseaseiscurable
Alzheimer'sdisease
Alsocalled:seniledementia.Aprogressive
diseasethatdestroysmemoryandotherimportantmental
functions.

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Memorylossandconfusionarethemainsymptoms.
Currently,thereisnocureforAlzheimer's.Butdrugandnon-drug
treatmentsmayhelpwithbothcognitiveandbehavioralsymptoms.
ThetreatmentsavailableforAlzheimer'sdonotsloworstop
theprogressionofthedisease,buttheymayhelpwiththe

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symptomsforatime.
TherearethreecholinesteraseinhibitorstotreatAlzheimer's:
Donepezil(Aricept)
Rivastigmine(Exelon)
Galantamine(Reminyl)

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Peoplemayexperience:
Cognitive
:mentaldecline,difficultythinkingandunderstanding,
confusionintheeveninghours,delusion,disorientation,
forgetfulness,makingthingsup,mentalconfusion,difficulty
concentrating,inabilitytocreatenewmemories,inabilitytodosimple

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maths,orinabilitytorecognisecommonthings
Behavioural:aggression,agitation,difficultywithselfcare,

irritability,meaninglessrepetitionofownwords,personalitychanges,
restlessness,lackofrestraint,orwanderingandgettinglost
Mood:anger,apathy,generaldiscontent,loneliness,ormood

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swings
Psychological:depression,hallucination,orparanoia
Alsocommon:behavioralsymptoms,inabilitytocombinemuscle
movements,jumbledspeech,orlossofappetite

272.Whichofthefollowingistrueabout

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vitaminK?
a)Anticoagulant
b)Prolonguseofantimicrobialleadstodeficiency
c)Dietaryallowanceis15-20mg
d)Alloftheabove

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CorrectAnswer-B
Ans.B.Prolonguseofantimicrobialleadstodeficiency
Certainpeopleareatincreasedriskifthey:
takecoumarinanticoagulantssuchaswarfarin,whichthinsthe
blood

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aretakingantibiotics
haveaconditionthatcausesthebodytonotabsorbfatproperly(fat
malabsorption)
haveadietthatisextremelylackinginvitaminK
VitaminKisagroupofstructurallysimilar,fat-solublevitaminsthe

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humanbodyrequiresforcompletesynthesisofcertainproteinsthat
areprerequisitesforbloodcoagulationandwhichthebodyalso
needsforcontrollingbindingofcalciuminbonesandothertissues
ThebodyneedsvitaminKtoproduceprothrombin,aproteinand
clottingfactorthatisimportantinbloodclottingandbone

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metabolism.
WithoutvitaminK,bloodcoagulationisseriouslyimpaired,and
uncontrolledbleedingoccurs.Preliminaryclinicalresearchindicates
thatdeficiencyofvitaminKmayweakenbones,potentiallyleading
toosteoporosis,andmaypromotecalcificationofarteriesandother

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softtissues
Dietaryallowanceforadultsperday-50-100mg.


273.Whichdrugsneedscontinuous
monitoringofprothrombintime?
a)Aspirin

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b)Lepirudin
c)Digoxin
d)Coumadin
CorrectAnswer-D
Ans.D.Coumadin

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Coumadin
(warfarin)isananticoagulant.
Warfarinisacoumarinanticoagulantusedfortheprophylaxisand
treatmentofthromboemboliccomplicationsassociatedwithcardiac
valvereplacementandatrialfibrillation,aswellastheprophylaxis
andtreatmentofvenousthrombosisandpulmonary

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embolism.Increasedmetabolismofwarfarinresultsininsufficient
prolongationofprothrombintime.

274.Whichofthefollowingaretheriskfactor
forcutaneouslymphoma?
a)Age

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b)Gender
c)Weakenedimmunesystem
d)All
CorrectAnswer-D
Answer:D.All

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RiskFactorsforLymphomaoftheSkin
AgeAgeisanimportantriskfactorforthisdisease,withmostcases
occurringinpeopleintheir50sand60s.Butsometypesofskin
lymphomacanappearinyoungerpeople,eveninchildren.
GenderandraceMost(butnotall)typesofskinlymphomaaremore

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commoninmenthaninwomen.Mostalsotendtobemorecommon
inAfrican-Americansthaninwhites.Thereasonsforthisarenot
known.
WeakenedimmunesystemSkinlymphomasmaybemorecommon
inpeoplewithacquiredimmunodeficiencysyndrome(AIDS),who

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haveaweakenedimmunesystem.Theymayalsobemorecommon
inpeoplewhohavehadanorgantransplantsuchasaheart,kidney
orlivertransplant.Thesepeoplemusttakedrugsthatsuppresstheir
immunesystem,whichmayraisetheriskofskinlymphoma(or
lymphomasinotherpartsofthebody).

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InfectionsInfectionwiththehumanimmunodeficiencyvirus(HIV),
thevirusthatcausesAIDS,mayincreaseaperson'sriskofskin
lymphoma.

275.WhichisnotincludedinAIDSrelated
complex?

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a)Ectopicpregnancy
b)Recurrentgenitalcandidiasis
c)Generalisedlymphadenopathy
d)Chronicdiarrhea
CorrectAnswer-A

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Answer-A.Ectopicpregnancy
HIVsymptoms:AIDSrelatedcomplex(ARC)
ItbelongstoclassBofHIVsymptoms.Thepatientsatthisstage
havevariousdiseasesthatoccurbecausetheHIvirushas
weakenedtheimmunesystem.

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ThefollowingHIVsignsmayhavepatientswithARC:
Long-lastingdiarrhea(overfourweeks)
Unintendedheavyweightloss
Longlastingfever
Nightsweats

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Bacterialinfectionscausedbybacteria
Bacterialbloodpoisoning(sepsis)
Phthisis
Herpeszoster
Oralhairyleukoplakia(whitishchangesonthelateraltongueborder)

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Fungicausedbyfungi
HIVsymptoms?Women:vaginalinflammationcausedbyfungi,
malignantchangesinthecervix

276.Whichisthetreatmentofchoicefor
irradiationinChordoma?

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a)Protons
b)Electrons
c)Gammaradiation
d)3D-CRT
CorrectAnswer-A

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Answer:A-ProtonTherapy
Chordoma:
Slow-growingneoplasm
Arisingfromcellularremnantsofnotochord.
Arisefromboneinskullbaseandalongspinalcord.

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Mostcommonlocations-
Craniallyatclivus
Insacrumatbottomofspine
Radiationtherapy:
Arerelativelyradioresistant

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Highdosesofradiationrequiredtocontrol.
Hence,highfocusradiationlikeprotontherapyandcarbonion
therapyarepreferredthanconventionalradiationmethods.
Closeproximitytovitalstructureslikebrainstem,requireshigh
precisionandaccuracyforanyplannedsurgicalresection.

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Radiationwithhighaccuracyandminimaldamagewithmaximal
safetyisdelivered.

277.Whatdifferentiatesdeliriumfrom
dementia?
a)Confusion

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b)Difficultyincommunicating
c)Hallucination
d)Suddenchange
CorrectAnswer-D
Answer:D.Suddenchange

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Delirium
Alsocalledtheacuteconfusionalstate,deliriumisamedical
conditionthatresultsinconfusionandotherdisruptionsinthinking
andbehavior,includingchangesinperception,attention,moodand
activitylevel.

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Indementia,changesinmemoryandintellectareslowlyevident
overmonthsoryears.Deliriumisamoreabruptconfusion,emerging
overdaysorweeks,andrepresentsasuddenchangefromthe
person'spreviouscourseofdementia.Thinkingbecomesmore
disorganized,andmaintainingacoherentconversationmaynotbe

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possible.
Thehallmarkseparatingdeliriumfromunderlyingdementiais
inattention.Theindividualsimplycannotfocusononeideaortask.

278.Genitalwartsarecausedbywhichvirus?
a)Herpessimplex

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b)Humanpapilloma
c)Cytomegalovirus
d)Varicellazoster
CorrectAnswer-B
Ans.B.Humanpapilloma

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Genitalwarts
aresoftgrowthsthatappearonthegenitals.Genital
warts
areasexuallytransmittedinfection(STI)causedbycertain
strainsofthehumanpapillomavirus(HPV).Theseskingrowthscan
causepain,discomfort,anditching.

279.Whichdrugregimenisgivenina

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pregnantwomanwithHIVinfection?
a)Tenofovirdisoproxilfumaratewithemtricitabine
b)Tenofovirdisoproxilfumaratewithlamivudine
c)Abacavirwithlamivudine
d)All

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CorrectAnswer-D
Ans.D.All
PreferredRegimensforHIVAntiretroviralTherapy(ART)in
Pregnancy
Two-NRTIbackbone

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Regimensincludethefollowing:
Tenofovirdisoproxilfumaratewithemtricitabine(TDF/FTCco-
formulated)ortenofovirdisoproxilfumaratewithlamivudine(3TC)
oncedaily(usewithcautioninrenalinsufficiency)or
Abacavirwithlamivudine(ABC/3TC)oncedaily(onlyifHLA-B5701?

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negative);avoidcombinationwithritonavir-boostedatazanavirifthe
pretreatmentHIVviralloadexceeds100,000copies/mL.
ForwomenwhohavenevertakenHIVmedicines,thepreferredHIV
regimenshouldincludetwonucleosidereversetranscriptase
inhibitors(NRTIs)
plusanintegrasestrandtransferinhibitor

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(INSTI),anon-nucleosidereversetranscriptaseinhibitor
(NNRTI)
,oraproteaseinhibitor(PI)withlow-doseritonavir(brand
name:Norvir).
Theregimengenerallyshouldincludeatleastoneofthe
followingNRTIsthatpasseasilyacrosstheplacenta:

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abacavir
(brandname:Ziagen)
emtricitabine(brandname:Emtriva)

lamivudine(brandname:Epivir)
tenofovirdisoproxilfumarate(brandname:Viread)
zidovudine(brandname:Retrovir)

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280.Whichofthefollowingstructure
developsfromdorsalmesentery?
a)Greateromentum
b)Lesseromentum
c)Liver

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d)Diaphragm
CorrectAnswer-A
Ans.A.Greateromentum
Theportionofthedorsalmesenterythatattachestothegreater
curvatureofthestomach,isknownasthedorsalmesogastrium.The

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partofthedorsalmesenterythatsuspendsthecolonistermedthe
mesocolon.Thedorsalmesogastriumdevelopsintothegreater
omentum.

281.WhichofthefollowingisthebestStent
forFemoropoplitealBypass?

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a)Dacron
b)Reversedsaphenous
c)PTFE
d)None
CorrectAnswer-C

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Answer:C-PTFE-coveredself-expandingnitinolstents
PTFE-coveredstentsareengineeredwitha30?100-micronpore
sizetoallowfortheendothelialliningofthestent-graftandvessel
healing.
Thetwomaingrafttypesusedforlowerextremitybypassesarethe

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greatsaphenousveinsandpolytetrafluoroethylene(PTFE)grafts.
Oneofthemostwidelyusedstent-graftsinthetreatmentofchronic
lowerextremityischemiaistheViabahnendoprosthesis(Gore
Medical,Flagstaff,Ariz).
Itisconstructedwithexpandedpolytetrafluoroethylene(ePTFE)liner

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attachedtoanexternalnitinolstent.
Theinnersurfaceisbondedwithheparin.

282.Trileneisdegradedby:
a)EnzymaticDegradation
b)NonEnzymaticdegradation

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c)ChemicalDegradation
d)None
CorrectAnswer-A
Answer:A.EnzymaticDegradation
Trileneortrichloroethyleneisagoodanalgesic,lessdepressant,

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andnon-flammable.
Cardiacdysrhythmia,ortachypnoeamayoccurduring
administration.
Itshouldnotbeusedintheclosedcircuitasitreactswithsoda-lime
toproduceatoxicgas(phosgene).

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Recoveryisslowandnauseaaswellasvomitingmaybepresent.
Itshouldnotbeusedwithadrenalineinfiltrationlestdysrhythmiabe
convertedtoventricularfibrillation.
Degradation:
Broughtaboutbyenzymaticdegradation

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Theenzymethatstartsonebranchofthispathway,toluene1,2-
dioxygenase,hasmanyothercatalyticabilities,whichare
documentedinatableoftheReactionsofToluene1,2-Dioxygenase.
Thespontaneousdegradationoftrichloroethyleneepoxidecan
produceasmanyasfourproducts:dichloroacetate,carbon

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monoxide,glyoxylate,andformate.Thenumber,type,and
proportionofproductsseendependsonthelocalenvironment.

283.Theearliestfeatureof3rdcranialnerve
involvementindiabetesmellituspatient
is-

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a)Normallightreflex
b)Abnormallightreflex
c)Normallightandaccommodationreflex
d)Abnormallightandaccommodationreflex
CorrectAnswer-A

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Answer:A.Normallightreflex
Theoculomotornerveisthethirdcranialnerve.Itenterstheorbit
viathesuperiororbitalfissureandinnervatesmusclesthatenable
mostmovementsoftheeyeandthatraisetheeyelid.Thenervealso
containsfibersthatinnervatethemusclesthatenablepupillary

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constrictionandaccommodation(abilitytofocusonnearobjectsas
inreading).Theoculomotornerveisderivedfromthebasalplateof
theembryonicmidbrain.Inpeoplewithdiabetesandolderthan50
yearsofage,anoculomotornervepalsyoccurs.

284.Duringsquintsurgery,anesthesiologist

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seesthemachineandseethebp
suddenlydropsto40.Whatwillbebest
immediatemanagement-

a)Giveatropine
b)Increaselevelofanesthesia

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c)Askthesurgeontostopthesurgery
d)Giveadrenaline
CorrectAnswer-D
Answer:D.Giveadrenaline
Adrenalineshouldbegiventoraisethebloodpressure.

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Epinephrine,alsoknownasadrenalinoradrenaline,is
ahormone,neurotransmitter,andmedication.Epinephrineis
normallyproducedbyboththeadrenalglandsand
certainneurons.
Itplaysanimportantroleinthefight-or-flightresponseby

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increasingbloodflowtomuscles,outputoftheheart,pupil
dilation,andbloodsugar.Itdoesthisbybinding
toalphaandbetareceptors.
Physiologicresponsestoepinephrinebyorgan

Organ

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Effects
Heart
Increasesheartrate;contractility;conductionacross
AVnode
Lungs

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Increasesrespiratoryrate;bronchodilation
Systemic
Vasoconstrictionandvasodilation
Liver
Stimulatesglycogenolysis

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Systemic
Triggerslipolysis
Systemic
Musclecontraction

285.Allarespecialvisceralefferentcolumn

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except-
a)Glossopharyngealn
b)Nucleusambiguus
c)vagusnerve
d)trigeminalnerve

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CorrectAnswer-B
Answer:B.Nucleusambiguus
Specialvisceralefferentfibers
(SVE)aretheefferentnervefibers
thatprovidemotorinnervationtothemusclesofthepharyngeal
archesinhumans,TheonlynervescontainingSVEfibersarecranial

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nerves:thetrigeminalnerve(V),thefacialnerve(VII),the
glossopharyngealnerve(IX),thevagusnerve(X)andtheaccessory
nerve

286.WhichofthefollowingconditionisNOT
causedbyParvovirusB19?

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a)Roseolainfantum
b)Aplasticanemiainsicklecelldisease
c)Fetalhydrops
d)Erythemainfectiosum
CorrectAnswer-A

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Answer:A.Roseolainfantum
PrimaryinfectionbyparvovirusB19oftenproducesanacute,
severe,andsometimesfatalanemiamanifestedasarapidfallinred
bloodcellcountandhemoglobin.
Thesepatientsmaypresentinitiallywithnoclinicalsymptomsother

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thanfever;thisiscommonlyreferredtoasaplasticcrisis.
Erythemainfectiosum
(alsoreferredtoasfifthdiseaseoracademy
rash)isamorecommondiseasethatisclearlyattributableto
parvovirusB19.
ActivetransplacentaltransmissionofparvovirusB19canoccur

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duringprimaryinfectionsinthefirst20weeksofpregnancy,
sometimesresultinginstillbirthoffetusesthatareprofoundly
anemic.
Theprogresscanbesoseverethathypoxicdamagetotheheart,
liver,andothertissuesleadstoextensiveedema(hydropsfetalis).

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287.Whichofthefollowingstatementsisnot
trueaboutiliolumbarligament?
a)Upperfibresattachedtoiliaccrest
b)Lowerfibresattachedtobaseofsacrum
c)Helpinmaintaininglumbosacraljointstability

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d)UpperattachmenttotransverseprocessofT12
CorrectAnswer-D
Answer:D-UpperattachmenttotransverseprocessofT12
TheligamentattachestoL5
Iliolumbarligament:

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Strongligamentpassingfromthetipoftransverseprocessoffifth
lumbarvertebra
toposteriorpartofinnerlipofiliaccrest
Upperbandsgetsattachedtotheiliaccrest.
Lowerbands
getsattachedtobaseofsacrum.
Majorfunctionistostrengthenthelumbosacraljoint.

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288.Wherewillbetheplacementlocationfor
AuditoryBrainstemImplant?
a)Scalatympani
b)Recessof4thventricle
c)IAC

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d)backofear
CorrectAnswer-B
Answer:B-Recessof4thventricle.
Theimplantisusuallyplacedinthelateralrecessofthefourth
ventricleatthetimeoftumorresectiontostimulatethe

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cochlearnucleus

AuditoryBrainstemImplant(ABI):
TumorresectionsurgeryinNFpatientsresultincochlearnerve
damageorlossoffunctionofnerveresultingindeafness.
ABIareusefulinrestoringauditoryperceptiontodeafpatientswith

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neurofibromatosistype2(NF2)
Alsousedintreatmentofcongenitallydeafchildrenwithcochlear
malformationsorcochlearnervedeficiencies.
Placementlocation:Lateralrecessof4thventricle

289.Whichconditionisassociatedwith

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Congenitaladrenalhypoplasia?
a)Malepseudohermaphroditism
b)Femalepseudohermaphroditism
c)Truepseudohermaphroditism
d)Sequentialpseudohermaphroditism

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CorrectAnswer-B
Answer-B-
CongenitalAdrenalHyperplasia:
Thisisthemostcommoncauseofandrogenicexcessinfetuseswith
femalepseudohermaphroditism.

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Thehyperplasticglandssynthesizedefectiveenzymesthatcause
impairedcortisolsynthesis.
ThisleadstoexcessivepituitaryACTHthesecretionofthefetal
adrenalglandswithsecretionoflargeamountsofcortisol
precursors,includingandrogenicprehormones.

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Theseprehormones,forexample,androstenedione,areconverted
totestosteroneinfetalextra-adrenaltissues.

290.Whichistrueregardingataxia
telangiectasia:
a)IncreaseinAFP

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b)Increasestheriskofsquamouscellcarcinoma
c)Autosomaldominant
d)Noneofabove
CorrectAnswer-A
Answer:A-IncreaseinAFP

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Increaseinalpha-fetoproteinisobservedinAtaxia
telangiectasia

Ataxia-telangiectasia/Ataxia-telangiectasiasyndrome/Louis-Bar
syndrome
Rare,neurodegenerative,autosomalrecessivedisordercausing

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severedisability.
Ataxiareferstopoorcoordination;Telangiectasiareferstosmall
dilatedbloodvessels.
Partsaffected:
Cerebellum-movement&coordinationdifficulties

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Immunesystem-Predisposingtoinfections.
Geneticrepairsystem-PreventingprocessforrepairingDNA-
Cancerrisk
Features:
Increasedincidenceoflymphoma&Leukemia

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Increasedalpha-Fetoproteinlevels
Oculomotorapraxia
(difficultyincoordinationbetweenhead&eye
movements)
Dysarthria

291.Adiabeticpatient2daysafterpost

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cataractsurgerydevelopsdevelops
hypopyon.Whatwillbethe
management?

a)Intravitrealantibiotics
b)Eyedrops

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c)Surgery
d)Notreatmentrequired
CorrectAnswer-A
Ans.A.Intravitrealantibiotics

292.

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WhatistheThinnestpartofneuro-retinalrim
accordingtoISNTrule?

a)Inferior
b)Superficial
c)Temporal

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d)Medial
CorrectAnswer-C
Ans.C.Temporal
TheISNTruleisaneasywaytorememberhowtheopticnerveis
supposedtolookinanormaleye.Normallytheneuro-retinalrimis

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thickestInferiorlyandthinnestTemporally.Withglaucoma,however,
youbegintoseeverticalthinning,withatrophyalongtheinferiorand
superiorrims.

293.Leidenthrombophiliaiscausedby
mutationaldeficiencyofwhichofthe

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followingfactors?

a)FactorV
b)FactorVII
c)FactorIX
d)FactorX

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CorrectAnswer-A
Ans.A.FactorV
FactorVLeiden
thrombophiliaisaninheriteddisorderofblood
clotting.FactorVLeidenisthenameofa
specificmutation(geneticalteration)thatresultsinthrombophilia,or

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anincreasedtendencytoformabnormalbloodclotsinblood
vessels.FactorVLeidenisthemostcommoninheritedformof
thrombophilia.

294.Anteversionofuterusismaintainedby?
a)Cardinalligament

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b)Uterosacralligament
c)Pubocervicalligament
d)Roundligament
CorrectAnswer-D
Ans.D.Roundligament

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Inmostwomen,theuterusisantevertedandanteflexed.The
functionoftheroundligamentismaintenanceoftheanteversionof
theuterus(apositionwherethefundusoftheuterusisturned
forwardatthejunctionofcervixandvagina)duringpregnancy.
Normally,thecardinalligamentiswhatsupportstheuterineangle

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(angleofanteversion).

295.Long-standingpelvicinflammationmay
leadtowhichofthefollowing
conditions?

a)Pyometra

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b)Uterinepolyposis
c)Pseudopregnancy
d)Cysticendometrialhyperplasia
CorrectAnswer-A
Ans.A.Pyometra

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Pyometraiscollectionofpusduetoobstructionofflowintheuterine
cavity.
ItmaybeduetoLong-standingPIDorsecondarytocervical
stenosis.

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