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This post was last modified on 30 July 2021

1.Syndromeassociatedwithposterior
inferiorcerebellararterythrombosis:
a)Wallenbergsyndrome
b)Medialmedullarysyndrome
c)Inferioralternatingsyndrome

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d)Dejerinesyndrome
CorrectAnswer-A
AnswerA.Wallenbergsyndrome
Wallenbergsyndromeisalsoknownaslateralmedullarysyndrome
ortheposteriorinferiorcerebellararterysyndrome.

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Wallenbergdescribedthefirstcasein1895.
Thisneurologicaldisorderisassociatedwithavarietyofsymptoms
thatoccurasaresultofdamagetothelateralsegmentofthe
medullaposteriortotheinferiorolivarynucleus.
Itisthemosttypicalposteriorcirculationischemicstrokesyndrome

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inclinicalpractice.
Etiology:
Wallenbergsyndromeiscausedmostcommonlyby
atherothromboticocclusionofthevertebralartery,followedmost
frequentlybytheposteriorinferiorcerebellarartery,andleastoften,

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themedullaryarteries.
Hypertensionisthecommonestriskfactorfollowedbysmokingand
diabetes.
Medialmedullarysyndrome,alsoknownasinferioralternating
syndrome,hypoglossalalternatinghemiplegia,loweralternating

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hemiplegia,orDejerinesyndrome,isatypeofalternatinghemiplegia

characterizedbyasetofclinicalfeaturesresultingfromocclusionof
theanteriorspinalartery.


2.SpaceofDisseisin:

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a)Spleen
b)Lymphnode
c)Liver
d)Bone
CorrectAnswer-C

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Ans.C.Liver
Theperisinusoidalspace(orspaceofDisse)isalocationintheliver
betweenahepatocyteandasinusoid.
Itcontainsthebloodplasma.
Microvilliofhepatocytesextendintothisspace,allowingproteins

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andotherplasmacomponentsfromthesinusoidstobeabsorbedby
thehepatocytes.


3.WhatareGittercells:
a)Macroglia

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b)ModifiedmacrophagesinCNS
c)Astrocytes
d)Oligodendrocytes
CorrectAnswer-B
AnswerB.ModifiedmacrophagesinCNS

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Gittercells:
Thesecellsaremacrophagesandbecauseoftheirappearancethey
arecalled"Gittercells".
Theylookthiswaybecausetheyarelipid-laden.
Thesemacrophagesarethoughttobemainlyderivedfrom

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circulatingbloodmonocytes,butsomeprobablyoriginatefrom
residentmicroglia.
Anytimethereisparenchymaldamage(e.g.inflammation,
infarction,parasitemigration)thesecellswillphagocytoselipidfrom
degeneratedmyelinandcellulardebris.

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Theselipid-ladenmacrophagesmigratetotheperivascularspaces

andleavetheCNSviathebloodorCSF.

4.Cholecystocavallineseparates:
a)Right&Leftliverlobe
b)LiverwithGallBladder

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c)RightLobeofLiverwithGallBladder
d)LeftLobeofLiverwithGallBladder
CorrectAnswer-A
AnswerA.Right&Leftliverlobe
Functionallobesandsegmentsoftheliver

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Thefunctionalrightandleftlobesoftheliverareseparatedbyan
imaginaryplanepassingalongtheflooroffossaforgallbladderand
thegrooveforinferiorvenacava(cholecysto-cavalline).
Ontheanterosuperiorsurfaceoftheliver,theplanepasseslittle
righttotheattachmentoffalciformligament.Thefunctionalrightand

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leftlobesoftheliveraremoreorlessofequalsize.

5.Whichofthefollowingexocrineglandular
ductsarenotobstructedincysticfibrosis:
a)Pancreas
b)Lung

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c)Sweatgland
d)Allofabove
CorrectAnswer-C
AnswerC.Sweatgland
MostCFpatientshave3distinctabnormalcharacteristics:

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Theductsofthemucus-secretingglandsareobstructedduetoan
increaseinviscosityofthesesecretionsleadingtoglandular
dilatationanddestruction.
CFpatientsarepronetochronicbacterialcolonizationand
infections.

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ThesweatglandsarenotobstructedinCFpatientsbecausein
serousglandssuchassweatglandsthereareabnormal
concentrationsofinorganicions,ratherthanglandularobstruction
withthickmucus.
Thequantitativepilocarpineiontophoresissweattestisauniformly

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acceptedmethodfordiagnosingCF.Thesweatglandductsmustbe
patentforthistest.
Obstructionofairwaysleadstobronchiectasisandatelectasis;
pancreaticductobstructionleadstopancreatitisandmalabsorption;
andpluggingofbileductsleadstoobstructivejaundice.

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6.BootshapeofheartinTOFisdueto:
a)Leftatrialenlargement
b)Rightatrialenlargement
c)Rightventricularhypertrophy
d)Biventricularhypertrophy

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CorrectAnswer-C
AnswerC.Rightventricularhypertrophy
Bootshapedheart.A`boot-shaped'heart("coeurensabot"in
French)isthedescriptiongiventotheappearanceofthehearton
plainfilminsomecasesofTetralogyofFallot.

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Itdescribestheappearancesofanupturnedcardiacapexdueto
rightventricularhypertrophyandaconcavepulmonaryarterial
segment.

7.Whichofthefollowingstructureisnot
derivedfromexternalobliquemuscle:

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a)Inguinalligament
b)Lacunarligament
c)Cooperligament
d)LineaSemilunaris
CorrectAnswer-D

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AnswerD.LineaSemilunaris
Theexternalobliquemuscle(oftheabdomen)(alsoexternal
abdominalobliquemuscle)isthelargestandtheoutermostofthe
threeflatmusclesofthelateralanteriorabdomen.
Inguinalligament(Poupart'sligament)isthefoldedlowerborderof

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externalobliqueaponeurosis
Lacunarligament(Gimbernatligament)isthecrescentshaped
expansionfromthemedialendofinguinalligamentattachedto
pectineallineofpubis.
Pectinealligament(Cooper'sligament)isstrongfibrousband

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extendinglaterallyfromthelacunarligamentalongpectineallineof
pubis.Similartolacunarligament,itismadeofexternaloblique
aponeurosis.
Reflectedpartofinguinalligamentextendsfromthelateralcrusof
superficialinguinalringformedbyinguinalligamentupwardstolinea

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alba.Itformstheposteriorwallofinguinalcanal.
Thelineasemilunaris(alsosemilunarlineorSpigelianline)isa
curvedtendinousintersectionfoundoneithersideoftherectus
abdominismuscle.

8.Contralaterallossofpainandtemperature

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isduetoinjuryto:
a)Anteriorspinothalamictract
b)Lateralspinothalamictract
c)Fasciculusgracilis
d)Fasciculuscuneatus

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CorrectAnswer-B
AnswerB.Lateralspinothalamictract
Damagetolateralspinothalamictractleadstolossofpainand
temperatureontheoppositesideofthebodybelowthelevelof
lesion,sincetheneuronsofthistractcrossestotheoppositesidein

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thespinalcord.
Anteriorspinothalamictractcarriescrudetouchandpressure
sensations.Fasciculusgracilisandfasciculuscuneatuscarries
consciousproprioception,finetouch,stereognosisandvibration
sensations.

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9.DuctofBelliniarepresentin:
a)Pancreas
b)Liver
c)Kidney

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d)Salivarygland
CorrectAnswer-C
AnswerC.Kidney
Papillary(collecting)ductsareanatomicalstructuresofthekidneys,
previouslyknownastheductsofBellini.

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Papillaryductsrepresentthemostdistalportionofthecollecting
duct.
Theyreceiverenalfiltrate(precursortourine)fromseveralmedullary
collectingductsandemptyintoaminorcalyx.

10.Structurederivedfromfirstpharyngeal

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arch:
a)Levatorpalatini
b)Buccinator
c)Stylohyoid
d)Anteriorbellyofdigastric

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CorrectAnswer-D
AnswerD.Anteriorbellyofdigastric
MESODERMALDERIVATIVESOFPHARYNGEALARCHES
Muscular
Skeletal

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Pharyngealarch
Nerve
contributions
contributions
Maxilla

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Zygomaticbone
Partoftemporal
Mylohyoid
andvomer,
Musclesof

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sphenoid,
mastication
Mandibular
Ist(also
mandible

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Anteriorbellyof
divisionof
called"mandibular
Meckel's
digastric

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TrigeminalNerve
arch")
cartilage:-Malleus,
Tensorveli
(V3).

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incus
palatini
Anteriorligament
Tensortympani ofmalleus
Sphenomandibular

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ligament
Reichert's
cartilage,stapes
Stapedius
(exceptfootplate)

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Stylohyoid

Posteriorbellyof Styloidprocess
IInd(alsocalled
digastric
Stylohyoid

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Facial
the"hyoidarch")
Facial
ligament
expression

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Smallercornuof
muscles
hyoid
Superiorpartof
bodyofhyoid

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Greatercornuof
hyoid
IIIrd
Stylopharyngeus
Glossopharyngeal

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Lowerpartofbody
ofhyoid
Cartilageoflarynx
Pharyngeal
exceptarytenoids Superiorlaryngeal

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IVth
muscles
superior
branchofVagus
Cricothyroid

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parathyroids,
epiglotticcartilage
Recurrent
Intrinsicmuscles Arytenoidcartilage laryngeal
VIth

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oflarynx(except oflarynx
nerve(branchof
cricothyroid)
vagus)


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11.Jointinvolvedinmovementofheadfrom
lefttoright.
a)Atlantoaxial
b)Atlantooccipital
c)C2-C3Joint

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d)C3-C4Joint
CorrectAnswer-A
AnswerA.Atlantoaxial
Atlanto-occipital(betweenskullandC1)jointpermitsnoddingof
head(aswhenindicatingapprovalorYES)andAtlanto-axialjoint

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permitstheheadtobeturnedfromsidetoside(asindicating
disapprovalorNO).

12.Whatisthenervesupplyof
Submandibulargland:
a)Auriculotemporalnerve

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b)Lingualnerve
c)Glossopharyngealnerve
d)Inferioralveolarnerve
CorrectAnswer-B
AnswerB.LingualNerve

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Thesubmandibularglandsreceiveautonomicinnervationthrough
parasympatheticandsympatheticfibres,whichdirectlyandindirectly
regulatesalivarysecretionsrespectively.
Parasympathetic
Parasympatheticinnervationoriginatesfromthesuperiorsalivatory

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nucleusthroughpre-synapticfibres,whichtravelviathechorda
tympanibranchofthefacialnerve(CNVII).
Thechordatympanithenunifieswiththelingualbranchofthe
mandibularnerve(CNVIII)beforesynapsingatthesubmandibular
ganglionandsuspendingitbytwonervefilaments.

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Post-ganglionicinnervationconsistsofsecretomotorfibreswhich
directlyinducetheglandtoproducesecretions,andvasodilator
fibreswhichaccompanyarteriestoincreasebloodsupplytothe
gland.Increasedparasympatheticdrivepromotessalivasecretion.


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Sympathetic
Sympatheticinnervationoriginatesfromthesuperiorcervical
ganglion,wherepost-synapticvasoconstrictivefibrestravelasa
plexusontheinternalandexternalcarotidarteries,facialarteryand
finallythesubmentalarteriestoentereachgland.Increased

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sympatheticdrivereducesglandularbloodflowthrough
vasoconstrictionanddecreasesthevolumeofsalivarysecretions,
resultinginamoremucusandenzyme-richsaliva.

13.Parathyroidglandisimplantedinwhich
muscle?

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a)Sartorius
b)Supinator
c)Deltoid
d)Brachioradialis
CorrectAnswer-D

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AnswerD.Brachioradialis
Parathyroidsurgery:Autotransplantation
Themostcommonplacesforauto-implantationofparathyroid
glandsarethebrachioradialismuscleandthepresternalregion.
Otherlocationscanalsobeused:thesternocleidomastoid,the

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subcutaneoustissueofupperlimbsandabdominalfat.

14.Rightcoronaryarteryarisesfrom?
a)RightAorticSinus
b)LeftAorticSinus
c)Posteriorcoronarysinus

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d)Anteriorcoronarysinus
CorrectAnswer-A
AnswerA.RightAorticSinus
RCAarisesfromanterioraorticsinusakaRightaorticsinus.
LCAarisesfromleftposterioraorticsinus.

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15.Bainbridgerefluxcauses?
a)Bradycardia
b)Increasedcardiacoutput
c)Decreasedvenousreturn
d)Increasedheartrate

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CorrectAnswer-D
Ans:D.Increasesheartrate.
BainbridgeReflex:
Positivefeedbackmechanismwithcompensatoryincreaseinheart
rate?Duetoriseinrightatrialpressure.

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Commonlyreferredtoas"atrialreflex".
Resultingfromincreasedbloodpressureorincreaseddistensionof
largesystemicveins&rightupperchamberofheart.

16.Golgitendonorganresponsiblefor?
a)Tension

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b)Length
c)Pressure
d)Proprioception
CorrectAnswer-A
Ans:A.Tension.

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Differencebetweenfunctionsofmusclespindle&golgitendon
organ:

Musclespindle:
Actsas"Musclelengthdetectors".
Alsodetectsrateofchangeinmusclelength.

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Golgitendonorgan:
Actsas"Muscletensiondetectors".
Alsodetectsrateofchangeinmuscletension.
Becauseoflocationofmusclespindle&golgitendonorgan.
Musclespindleareparalleltomusclefibers(extrafusalfibers).

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Golgitendonorganinseriestomusclefibers(extrafusalfibers).
Yet,Bothareactivatedbymusclestretch.

17.Hormonepredominatelysecretedafter14
dayonendometriumis?
a)Progesterone

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b)Estrogen
c)LH
d)FSH
CorrectAnswer-A
Ans:A.Progesterone.

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Eventsofovariancycle:
Bleedingcontinuesforabout4days.
By5thday,ovarianfollicleissufficientlydeveloped.
Secretesconsiderablequantitiesofestrogen.
Duringpre-ovulatoryphase:

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Estrogeninfluencesendometrialproliferativechanges.
Hence,"Preovulatoryphaseofuterinecycle"alsoreferred
"Proliferativephase".
Duringpost-ovulatoryphase:
Endometriumenterssecretoryphase.

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Hence,"Postovulatoryphaseofuterinecycle"alsoreferred
"Secretoryphase".
Duetocombinedactionofestrogen&progesterone.
Progesterone:
Moreimportant&responsibleforsecretorychanges.

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Peakson21stday.
Endofsecretoryphase:
Estrogen-primedendometrium.
Degenerationofcorpusluteumdeclinesestrogen&progesterone
levels.

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Resultsinwithdrawalbleeding?Menstruation.

18.Peripheralchemoreceptorsrespondto
hypoxiausingwhichchannel?
a)Calciumchannel
b)Sodiumchannel

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c)Potassiumchannel
d)Chloridechannel
CorrectAnswer-C
Ans:C.Potassiumchannel.
Carotidbodiesarecomposedofglomuscells(alsocalledtypeI),

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whichareofneuronalphenotypeandcontainavarietyof
neurotransmitters.
Glomuscellsareinfunctionalcontactwiththeafferentnerve
endings.
Glomuscellsareinitialsite(s)ofsensorytransduction.

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Hypoxiareleasestransmitter(s)fromglomuscells,whichinturnby
depolarizingthesensorynerveendingleadstoanincreasein
sensorydischarge.
OnehypothesisassumesthataK+-channelproteinisanO2sensor
andthathypoxiadepolarizesglomuscellsbyinhibitingtheK+

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channel,leadingtoanincreaseincytosolicCa2+,resultingin
transmitter(s)release.

19.Withincreaseinagewhichofthe
followingistrueforlungs?
a)Pulmonarycomplianceincreases

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b)Residualvolumedecreases
c)Mucocillaryclearanceincreases
d)Fibrousofinterstitiumdreaseses
CorrectAnswer-A
Ans:A.Pulmonarycomplianceincreases

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Anatomicalandphysiologicalchangesofrespiratorysystem
withaging:

Anatomical:
Airspacesize:Increased
Compliance:

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Chestwallcompliance:Decreased
Lungcompliance:Increasedtounchanged
Totalrespiratorysystemcompliance:Decreased
Musclestrength:
Maximalinspiratorypressure(MIP):Decreased

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Transdiaphragmaticpressure(Pdi):Decreased
Maximumvoluntaryventilation(MVV):Decreased
Lungfunction:
FEV1:Decreased
FVC:Decreased

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TLC:Unchanged
Vitalcapacity:Decreased
Functionalresidualcapacity:Increased
Residualvolume:Increased
DLCO/VA:Decreased

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Exercisecapacity:
VO2max:Decreased
Deadspaceventilation:Increased
Immunology:
Bronchialfluid:

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Neutrophils%:Increased
RatioofCD4+/CD8+cells:Increased
Epithelialliningfluidantioxidants:Decreased.

20.Functionalresidualvolumeis?
a)Afternormalinspiration

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b)Afternormalexpiration
c)Afterforcefulexpiration
d)Afterforcefulinspiration
CorrectAnswer-A
Ans:A.Afternormalinspiration

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FunctionalResidualCapacity(FRC)isthevolumeofairpresentin
thelungsattheendofpassiveexpiration.

21.Polyuriais-
a)70ml/kg
b)60ml/kg

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c)50ml/kg
d)40ml/kg
CorrectAnswer-C
Ans:C.50ml/kg
Consideredpolyuricifurineproductionisgreaterthan50ml/kg/day.

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22.Tubuloglomerularfeedbackcontrolis
usefulforwhichoneofthefollowing?
a)GFR
b)Plasmasodium
c)Plasmavolume

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d)Determiningtubularsecretion
CorrectAnswer-A
Ans:A.GFR.
Tubuloglomerularfeedback?Twocomponents:

*Afferentarteriolefeedbackmechanism

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-Usuallyreferredas"Tubuloglomerularfeedback"
*Efferentarteriolefeedbackmechanism.
Afferentarteriolarfeedbackmechanism:
*Transmitterinvolved?AdenosinecausingCa2+channelopening.
Efferentarteriolarfeedbackmechanism:

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*Activatesrenin-angiotensinsystemgeneratingangiotensinII
efferentarterioleconstriction?edGFR.
*Feedbackdependsonjuxtaglomerularapparatus&itsspecialized
cells.
-Maculadensa?Specializedepitheliumofdistaltubuleinclose

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contactwithafferentarteriole

23.Calcitoninlevelsincreasedin
a)Hyperthyroidism
b)Hyperparathyroidism
c)Hypoparathyroidism

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d)CushingSyndrome
CorrectAnswer-B
Ans:B.Hyperparathyroidism
Theserumcalcitoninlevelisstronglyincreasedinthistypeof
cancer.Aftersuccessfultotalthyroidectomy,calcitoninisno

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longerdetectable.Increasingconcentrationsofcalcitoninafter
therapyindicaterelapseormetastasis.Hyperparathyroidismis
presentin20-30%ofpatientswithmedullarthyroidcarcinoma.


24.WhenthevaluesofFev1=1.3&FCV=3.9.
Whichofthefollowingdoesthissignify?

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a)Normallungfunction
b)Obstructivelungdisease
c)Restrictivelungdisease
d)Both
CorrectAnswer-B

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Ans:B.Obstructivelungdisease
Measurementofthebronchodilatorresponseofforcedexpiratory
volumein1second(FEV1)isanimportantmethodinclinical
respiratorymedicine.
Thismeasurementisusedtopredicttheresponsetobronchodilator

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treatmentandispartofthediagnosisofCOPDandasthma.
Thebronchodilatorresponseofforcedvitalcapacity(FVC)hasless
clinicalusethanthebronchodilatorresponseofFEV1butmayadd
importantclinicalphysiologicalinformation
AirwayobstructionwasdefinedasFEV1/FVCratiobelowlowerlimit

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ofnormal(LLN)beforebronchodilation,andCOPDwasdefinedas
anFEV1/FVCratiobelowLLNafterbronchodilation.

25.Antegradeperistalsisdueto?
a)Ach
b)Serotonin

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c)SubstanceP
d)VIP
CorrectAnswer-D
Ans:D.VIP
Definedasamotorpatternofthegutorganmusculaturethatcan

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propelcontentintotheanal(antegradeperistalsis)ororal
(retrogradeperistalsis)direction.
Impulsestravelingoradactivateascendingcontraction:
Neurotransmittershereareacetylcholine,substanceP,and
neurokininA.

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Impulsestravelingcaudadactivatedescendingrelaxation:
NeurotransmittershereareVIP,NO,andPACAP(pituitaryadenylyl
cyclaseactivatingpolypeptide).

26.C-peptideseenin?
a)InPre-proinsulin

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b)InProinsulin
c)Asacombinedentitywithinsulinaftersecretion
d)Agastrointestinalproactivemolecul
CorrectAnswer-B
Ans:B.Inproinsulin

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Synthesisofinsulin:
Synthesizedaslargerpreprohormone(Pre-proinsulin)enteringER.
Removalof23amino-acidsignalpeptidetakesplace.
Convertedto"Prohormone-Proinsulin".
Proinsulinstructure:

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MadeupA&Bchain,connectedbyC-peptide/chain.
C-peptide?
Detachedfromgranulesbeforesecretion.
90%?97%insulinfromBcells.
AlongwithequimolaramountsofC-peptide.

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27.Inforcefulexpiration,whichofthe
followingneuronsgetsfired?
a)VRG
b)DRG
c)Pneumotaxiccentre

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d)Chemoreceptors
CorrectAnswer-A
Ans:A.VRG
Medullaryrespiratorygroup:
Principalareasinmedullaoblongataconcernedwithrespiratory

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regulation.
Includes,
Dorsalrespiratorygroup(DRG).
Ventralrespiratorygroup(VRG).
Pre-Botzingercomplex.

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Peripheralinputs.
Dorsalrespiratorygroup(DRG):
DRGneurons?
Mainlyconcernedwithinspiration.
Descend&terminateonspinalmotorneuronsinnervatingprimary

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inspiratorymuscles.
I.e.,Diaphragm&Externalintercostalmuscles.
Ventralrespiratorygroup(VRG):
VRGneurons?
Mainlyconcernedwithforcefulexpiration.

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Minimalactivitiesw.r.tinspiration.
Contributestobothexpiration&inspiration.

28.Slowconductionvelocityisseenwith
whichofthefollowingnervefibers?
a)Preganglionicautonomicnervefibers

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b)Postganglionicautonomicnervefibers
c)Motornerves
d)Sympatheticnervefibers
CorrectAnswer-B
Ans:B.Postganglionicautonomicnervefibers

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Erlanger&Gasserclassification:
Cfiber?Characteristics:
Diameter?0.2-1.0
Myelination?Unmyelinated
Conduction?0.2-2(minimum)

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Functions:
Pain?Slowpain("Protopathic/Secondpain)
Temperature
Pressure
Postganglionicautonomicfibers.

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Highsusceptibilityto:Localanesthetics

29.Testosteronesecretedby,
a)Leydig'scells.
b)Somatotropiccells.
c)Acidophiliccells.

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d)Gonadotropiccells
CorrectAnswer-A
Ans:A.Leydig'scells.
Thehypothalamussendsasignaltopituitaryglandtorelease
gonadotrophicsubstances(folliclestimulatinghormoneand

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luteinizinghormone).
Luteinizinghormone(LH)stimulatestestosteroneproduction.
Testosteroneisproducedbygonads(byLeydigcellsintestesin
men&byovariesinwomen).

30.Vasopressinactsthroughwhichchannels

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incollectingduct?
a)Aquaporin1
b)Aquaporin2
c)GLUT?
d)GLUT?4

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CorrectAnswer-B
Ans:B.Aquaporin2
Principalcellsofcollectingductcontainaregulatedsystemofwater
channelsantidiuretichormone(ADH,alsocalledarginine
vasopressin,AVP).

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ADHcontrolspermeabilityofthesecellstowaterbyregulating
insertionofpre-formedwaterchannels(aquaporin-2,AQP2)into
apicalmembrane.

31.Trueaboutdecorticaterigidity?
a)Removalofcerebralcortexandbasalganglia

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b)Flexionoflowerlimbs&extensionofupperlimbs
c)Rigidityislesspronouncedthandecerebraterigidity
d)Noneoftheabove
CorrectAnswer-C
Ans:C.Rigidityislesspronouncedthandecerebraterigidity.

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Decorticaterigidity:
Madebyremovingwholecerebralcortexbutleavingbasalganglia
intact.
Characterizedbyflexionofupperextrimitiesatelbow&extensionof
lowerextrimities.

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Flexionduetorubrospinaltractexcitationofflexorsinupper
extremities&hyperextensionoflowerextermity.
Decorticateanimaldoesnothaveintensehypertoniaasdecerebrate
animal.
Duetointactbasalgangliaindecorticateanimal.

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32.Zewellgersyndroneisduetoabsenceof
a)Lysosomal
b)Mitochondria
c)Peroxisome
d)Nucleus

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CorrectAnswer-C
Answer.C.Peroxisome
Zellwegersyndrome,alsocalledcerebrohepatorenalsyndrome,isa
rarecongenitaldisordercharacterizedbythereductionorabsence
offunctionalperoxisomesinthecellsofanindividual.

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Zellwegersyndromeisassociatedwithimpairedneuronalmigration,
neuronalpositioning,andbraindevelopment.
Inaddition,individualswithZellwegersyndromecanshowa
reductionincentralnervoussystem(CNS)myelin(particularly
cerebral),whichisreferredtoashypomyelination.

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33.Urea,creatinine,nitricoxideformedby
whichaminoacid
a)Histidine
b)Glycine
c)Cysteine

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d)Arginine
CorrectAnswer-D
Answer:D.Arginine
Arginine,asemiessentialorconditionallyessentialaminoacidin
humans,isoneofthemostmetabolicallyversatileaminoacids.

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Itservesasaprecursorforthesynthesisofurea,nitricoxide,
polyamines,proline,glutamate,creatine,andagmatine.

34.Whichofthefollowingisnotthesourceof
cytosolicNADPH?
a)Isocitratedehydrogenase

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b)ATPcitratelyase
c)Malicenzyme
d)G6PD
CorrectAnswer-B
Answer.B.ATPcitratelyase

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NADPHisacofactorusedinanabolicreactions,suchaslipidand
nucleicacidsynthesis,whichrequireNADPHasareducingagent.
ThemajorsourceofNADPHinanimalsandothernon-
photosyntheticorganismsisthepentosephosphatepathway.
Thekeyenzymesintheseprocessesare:NADP-linkedmalic

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enzyme,NADP-linkedisocitratedehydrogenase,NADP-linked
glutamatedehydrogenaseandnicotinamidenucleotide
transhydrogenase.

35.AllaretrueregardingmitochondrialDNA,
EXCEPT?

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a)Doublestranded
b)Inheritedfrommother
c)Highmutationrate
d)Allrespiratoryproteinsaresynthesizedwithinmitochondria
itself

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CorrectAnswer-D
Answer.D.Allrespiratoryproteinsaresynthesizedwithin
mitochondriaitself
MtDNAisorganizedasacircular,covalentlyclosed,double-
strandedDNA.

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Insexualreproduction,mitochondriaarenormallyinherited
exclusivelyfromthemother;themitochondriainmammaliansperm
areusuallydestroyedbytheeggcellafterfertilization.
MutationsofmitochondrialDNAcanleadtoanumberofillnesses
includingexerciseintoleranceandKearns?Sayresyndrome(KSS),

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whichcausesapersontolosefullfunctionofheart,eye,andmuscle
movements.

36.Whichapolipoproteinisresponsiblefor
Alzeihmersdisease
a)APOE4

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b)APOE3
c)APOE2
d)APOE1
CorrectAnswer-A
ANSWER.A.APOE4

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ThreecommonpolymorphismsintheAPOEgene,e2,e3,ande4,
resultinsingleaminochangesintheApoEprotein.
Thee4alleleofapolipoproteinE(APOE)isthemajorgeneticrisk
factorforAlzheimer'sdisease(AD).
thedifferentialeffectsofapoEisoformsonA?aggregationand

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clearanceplaythemajorroleinADpathogenesis.
Inparticular,APOEe4isassociatedwithincreasedriskforAD,
whereasAPOEe2isassociatedwithdecreasedrisk.

37.HyperammonaemiainhibitTCAcycleby
depleting?

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a)succinate
b)aketoglutarate
c)malate
d)fumarate
CorrectAnswer-B

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Answer:B.aketoglutarate
Theureacycleandthecitricacidcycleareindependentcyclesbut
arelinked.
Todetoxifyammoniainhyperammonemia,moreglutamateis
required.Thisglutamateisformedfromc-ketoglutarate.

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a-ketoglutarate?Transamination?glutamate+NH4+?glutamine.
Thusexcessivea?ketoglutarateisconsumedleadingtodecrease
availabilityofa?ketoglutarateforTCAcycle

38.whichaminoacidisusedtosynthesise
Nitricoxide?

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a)glycine
b)arginine
c)tyrosine
d)threonine
CorrectAnswer-B

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ANSWER:B.Arginine
Nitricoxideisproducedbyagroupofenzymescallednitricoxide
synthases.Theseenzymesconvertarginineintocitrulline,producing
NOintheprocess.OxygenandNADPHarenecessaryco-factors.
threedistinctgenesencodeNOSisozymes:neuronal(nNOSor

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NOS-1),cytokine-inducible(iNOSorNOS-2)andendothelial(eNOS
orNOS-3)

39.Menkesdiseaseisassociatedwithwhich
enzymedeficiency.
a)lysyloxidase

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b)Methioninesynthase
c)Glutamylaminopeptidase
d)Lysylhydroxylase
CorrectAnswer-A
Answers:A.lysyloxidase

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Oneoftheenzymes,lysyloxidase,requirescopperforproper
function.Thisenzymecross-linkstropocollagenintostrongcollagen
fibrils.
Menkesdisease(MNK),alsoknownasMenkessyndrome,isanX-
linkedrecessivedisordercausedbymutationsingenescodingfor

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thecopper-transportproteinATP7A,leadingtocopperdeficiency.
Thedecreasedsupplyofcoppercanreducetheactivityofnumerous
copper-containingenzymes.
Thesearenecessaryforthestructureandfunctionofbone,skin,
hair,bloodvesselsandthenervoussystemsuchaslysyloxidase.

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40.LCATdeficiencyincreasesthefollowing
a)HDL
b)LDL
c)VLDL
d)Chylomicron

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CorrectAnswer-A
Answer:A.HDL
Lecithincholesterolacyltransferasedeficiency(LCATdeficiency)isa
disorderoflipoproteinmetabolism.
AdeficiencyofLCATcausesaccumulationofunesterified

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cholesterolincertainbodytissues.Cholesteroleffluxesfromcellsas
freecholesterolandistransportedinHDLasesterifiedcholesterol.
LCATistheenzymethatesterifiesthefreecholesterolonHDLto
cholesterolesterandallowsthematurationofHDL.
LCATistheenzymethatesterifiesthefreecholesterolonHDLto

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cholesterolesterandallowsthematurationofHDL.LCATdeficiency
doesnotallowforHDLmaturationresultinginitsrapidcatabolismof
circulatingapoA-1andapoA-2.TheremainingformofHDL
resemblesnascentHDL.

41.A25yearoldalcoholicpresentedwith

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edema,hypertension,ocular
disturbance,andchangesinmentalstate
wasobserved,diagnosisofhighoutput
cardiacfailurewasmadewithWetBeri
Beri,thisisduetodeficiencyof?

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a)VitB3
b)VitB6
c)VitB9
d)VitB1
CorrectAnswer-D

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Answer:D.VitB1
Wetberiberiisthetermusedforthiaminedeficiencywith
cardiovascularinvolvement.
Inthefirststage,peripheralvasodilationoccurs,leadingtoahigh
cardiacoutputstate.Thisleadstosaltandwaterretentionmediated

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throughtherenin-angiotensin-aldosteronesysteminthekidneys.
Amorerapidformofwetberiberiistermedacutefulminant
cardiovascularberiberi,orShoshinberiberi.
Thepredominantinjuryistotheheart,andrapiddeterioration
followstheinabilityoftheheartmuscletosatisfythebody's

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demandsbecauseofitsowninjury.
Inthiscase,edemamaynotbepresent.Instead,cyanosisofthe
handsandfeet,tachycardia,distendedneckveins,restlessness,
andanxietyoccur.

42.GlutamineisIncreaseinCSF,bloodand

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urine,thisisduetodeficiencyof
a)CPS-I
b)Arginase
c)OTC
d)Argininosuccinatesynthetase

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CorrectAnswer-A
Answer:A.CPS-I
CPSIdeficiencyisoneoftheproximalureacycledefectsandisdue
toacompleteorpartialdeficiencyofthemitochondrialenzyme
carbamylphosphatesynthetaseI(CPSI)whichproducescarbamyl

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phosphatefromammonia,ATP,andHCO3.
CarbamoylphosphatesynthetaseI(CPS1orCPSI)transfersan
ammoniamoleculefromglutamineorglutamatetoamoleculeof
bicarbonatethathasbeenphosphorylatedbyamoleculeofATP.
Theresultingcarbamateisthenphosphorylatedwithanother

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moleculeofATP.Theresultingmoleculeofcarbamoylphosphate
leavestheenzyme.
CPS-Iistheratelimiting(pacemaker)enzymethispathway.
CPS-IisactiveonlyinthepresenceofN-AcetylGlutamate,an
allostericactivator.

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43.Trueabouttype1diabetesmellitus
a)Decreasedproteincatabolism
b)DecreasedhepaticGlucoseoutput
c)Increasedlipolysis
d)Increaseglucoseuptake

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CorrectAnswer-C
Answer:C.Increasedlipolysis
Uncontrolledinsulin-dependentdiabetesmellitus(typeIdiabetes)
involvesdecreasedglucoseutilization,withhyperglycemia,and
increasedfattyacidoxidation.

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Increasedfattyacidoxidationleadstoexcessiveproductionof
acetoaceticand3-hydroxybutyricacidsandofacetone,whichare
knownasketonebodies.
2.Acetoaceticand3-hydroxybutyricacidsdissociateatbodypHand
releaseHleadingtoametabolicacidosis.

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LCATistheenzymethatesterifiesthefreecholesterolonHDLto
cholesterolesterandallowsthematurationofHDL.
LCATdeficiencydoesnotallowforHDLmaturationresultinginits
rapidcatabolismofcirculatingapoA-1andapoA-2.Theremaining
formofHDLresemblesnascentHDL.

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44.ProteinwhichisnotsynthesisedInliveris
a)Phaseprotein
b)Immunoglobulins
c)Albumin
d)Plasmahormone

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CorrectAnswer-B
Answer:B.Immunoglobulins
Theliverservesseveralmetabolicfunctionswithinthebody
includingproteinsynthesisandmetabolism.Theliverisresponsible
foranarrayofproteins.

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Immunoglobulinsaresynthesisedinplasmacellswhicharebelieved
tobeendproductsofthedifferentiationofcellscalledB-
lymphocytes.
Theliverplaysacrucialroleintheproductionofnearlyallplasma
proteins(albumin,alpha-1-acidglycoprotein,majorityofcoagulation

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cascade,andfibrinolyticpathways).
Notableexceptionsinclude:globulins,factorIII,IV,VIII.
Proteinsproducedbytheliver:proteinS,proteinC,proteinZ,
plasminogenactivatorinhibitor,antithrombinIII.VitaminK
dependentproteinssynthesizedbytheliverinclude:FactorsII,VII,

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IX,andX,proteinSandC.

45.typeofcholesterolpresentingallstones?
a)Amorphouscholesterolmonohydrate.
b)Amorphouscholesteroldihydrate.
c)CrystallineCholesteroldihydrate.

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d)Crystallinecholesterolmonohydrate.
CorrectAnswer-D
Answer:D.Crystallinecholesterolmonohydrate.
Gallstonesarehardeneddepositsofdigestivefluidthatcanformin
yourgallbladder.

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Themostcommontypeofgallstone,calledacholesterolgallstone,
oftenappearsyellowincolor.Thesegallstonesarecomposed
mainlyofundissolvedcholesterol.
Precipitationofsolidcholesterolcrystalsfromsupersaturatedbile
hasanessentialroleincholesterolgallstoneformation.

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Gallstonesarecomposedprincipallyofcholesterolmonohydrate
crystals(cholesterolstones)ortheacidsaltofcalciumbilirubinate
(pigmentstones).
Whenbileisconcentratedinthegallbladder,itcanbecome
supersaturatedwiththesesubstances,whichthenprecipitatefrom

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thesolutionasmicroscopiccrystals.Thecrystalsaretrappedin
gallbladdermucus,producinggallbladdersludge.

46.collagenpresentinskinis
a)TypeII
b)TypeI

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c)TypeIII
d)TypeIV
CorrectAnswer-B
Answer:B.TypeI
Collagenisaproteinthatispartofcartilage,bone,andothertissues

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inanimalsandhumans.
Asthemaincomponentofconnectivetissue,itisthemostabundant
proteininmammals.
Collagenconsistsofaminoacidswoundtogethertoformtriple-
heliceslofelongatedfibrils.Itis,mostly,foundinfibroustissues

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suchastendons,ligaments,andskin.
Sofar,28typesofcollagenhavebeenidentifiedanddescribed.
Thefivemostcommontypesare:
TypeI:skin,tendon,vasculature,organs,bone(maincomponentof
theorganicpartofbone)

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TypeII:cartilage(maincollagenouscomponentofcartilage)
TypeIII:reticulate(maincomponentofreticularfibers),commonly
foundalongsidetypeI.
TypeIV:formsbasallamina,theepithelium-secretedlayerofthe
basementmembrane.

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TypeV:cellsurfaces,hair,andplacenta

47.whichofthefollowingisnotRibozyme?
a)PloyApolymerase
b)Ribonuclease
c)Transpeptidase

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d)PeptidylTransferase
CorrectAnswer-A
Answer:A.PloyApolymerase
Polyadenylationistheadditionofapoly(A)tailtoamessengerRNA.
Thepoly(A)tailconsistsofmultipleadenosinemonophosphates;in

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otherwords,itisastretchofRNAthathasonlyadeninebases.
polyadenylationispartoftheprocessthatproducesmature
messengerRNA(mRNA)fortranslation.It,therefore,formspartof
thelargerprocessofgeneexpression.

48.Type-Ihyperlipoproteinemiais

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characterizedby
a)ElevatedLDL
b)ElevatedHDL
c)Elevatedchylomicrons
d)Elevatedlipoproteinlipase

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CorrectAnswer-C
AnswerC.Elevatedchylomicrons
Lipoproteinlipasedeficiency(TypeIhyperlipoproteinemia)results
inincreasedlevelofchylomicrones.
Lipoproteinlipasedeficiencyisageneticdisorderinwhichaperson

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hasadefectivegeneforlipoproteinlipase,whichleadstoveryhigh
triglycerides,whichinturncausesstomachpainanddepositsoffat
undertheskin,andwhichcanleadtoproblemswiththepancreas
andliver,whichinturncanleadtodiabetes.
Thedisorderonlyoccursifachildacquiresthedefectivegenefrom

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bothparents(itisautosomalrecessive).Itismanagedbyrestricting
fatindiettolessthan20g/day.
Thediseaseoftenpresentsininfancywithcolickypain,failureto
thrive,andothersymptomsandsignsofthechylomicronemia
syndrome.

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Theconditionhasalsobeencalledfamilialchylomicronemia
syndrome,chylomicronemia,chylomicronemiasyndrome.and
hyperlipoproteinemtypeIa.

49.InKreb'scycleandUreacyclethelinking
aminoacidis

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a)Fumarate
b)Alanine
c)Arginine
d)Aspartate
CorrectAnswer-D

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Answer:D.Aspartate
Aspartatehelpsincondensationwithcitrullinetoformargino
succinicacid.
ArginosuccinicacidundergoesalyticreactiontoformArginineand
fumarate.

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oxaloacetate,theketoacidobtainedfromaspartateisintermediate
ofTCAcycle.
HenceaspartateisacommonintermediateofTCAcyclethrough
oxaloacetateandureacycle(directly)

50.VitaminAisstoredin

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a)CellsofIto
b)Hepatocyte
c)Endothelialcell
d)Kupffercell
CorrectAnswer-A

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AnswerA?CellsofIto
HSCs(hepaticstellatecells)(alsocalledvitaminA-storingcells,
lipocytes,interstitialcells,fat-storingcellsorItocells)existinthe
spacebetweenparenchymalcellsandliversinusoidalendothelial
cellsofthehepaticlobuleandstore50-80%ofvitaminAinthe

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wholebodyasretinylpalmitateinlipiddropletsinthecytoplasm.

51.Glanzmannthrombastheniaisdueto
a)DecreasedGpIb
b)DecreasedGpIIb/IIIa
c)Anti-GpIIb/IIIaantibodies

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d)InhibitionordeficiencyofADAMTS13
CorrectAnswer-B
Ans.is.b.DecreasedGpIIb/IIIa
Glanzmannthrombastheniaisanautosomalrecessivedisorder.
ThereisafailureofprimaryplateletaggregationwithADPor

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collagenduetoinheriteddeficiencyoftwoplateletsmembrane
glycoproteins.
ItiscausedduetodeficiencyofglycoproteinIIb-IIIa.

52.Apoptoticgeneis-
a)Bax

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b)Bcl2
c)Bclx
d)Mcl
CorrectAnswer-B
Answer-B.Bcl2

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RegulationisprimarilybytheBcl-2familyofgeneslocatedon
chromosome18.
Somemembersofthisfamilylikebak,bid,bin,Bcl-xs(toremember,
Sforstimulatingapoptosis)stimulateapoptosiswhereasotherslike
Bcl-2,Bcl-xl(toremember,Lforlowerapoptosis),etcinhibit

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apoptosis.
Genefamiliessuchascaspases,inhibitorofapoptosisproteins,B
celllymphoma(Bcl)-2familyofgenes,tumornecrosisfactor(TNF)
receptorgenesuperfamily,orp53geneareinvolved,and/or
collaborateintheprocessofapoptosis.

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53.Alphaoneantitrypsinworksby
a)inhibitionoftrypsin
b)inhibitionoftrypsinogen
c)inhibitionofelastase
d)inhibitionofchymotrypsin

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CorrectAnswer-C
Answer-C(inhibitionofelastase)
Explanation-Alpha-1antitrypsin(A1AT)isproducedintheliver,and
oneofitsfunctionsistoprotectthelungsfromneutrophilelastase,
anenzymethatcandisruptconnectivetissue.

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54.Whichoneofthefollowingisan
autosomalrecessivedisorder?
a)Albinism
b)Huntington'ssyndrome
c)Marfan'ssyndrome

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d)Neurofibromatosis-1
CorrectAnswer-A
Answer-A.Albinism
Explanation-Albinismiscausedbymutationsinoneofseveral
genes,andmosttypesareinheritedinanautosomalrecessive

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manner.

55.FishmouthappearanceofvalveinRHDis
dueto-
a)Ruptureofvalve
b)Calcification&fibrosis

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c)Hypertrophyofventricularwall
d)Noneoftheabove
CorrectAnswer-B
Answer-B.Calcification&fibrosis
Inrheumaticheartdisease,anautoimmuneattackonthemitral

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valveproducesthickeningofthevalveleaflets.Themitralvalveis
oftendescribedashavinga"fish-mouth"appearance.

56.Follicularlymphomapositivity?
a)Bcl-1
b)Bcl-6

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c)Bcl-2
d)Noneoftheabove
CorrectAnswer-C
Answer-C.Bcl-2
Atranslocationbetweenchromosome14and18resultsinthe

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overexpressionofthebcl-2gene.Asthebcl-2proteinisnormally
involvedinpreventingapoptosis,cellswithanoverexpressionofthis
proteinarebasicallyimmortal.Thebcl-2geneisnormallyfoundon
chromosome18,andthetranslocationmovesthegeneneartothe
siteoftheimmunoglobulinheavychainenhancerelementon

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chromosome14.

57.whatisthehistologicaldifference
betweentheminUlcerativecolitis&
Crohn'sdisease?

a)Diffusedistributionofpseudopolyps

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b)Mucosaledema
c)Cryptabscess
d)Lymphoidaggregatesinthemucosa
CorrectAnswer-C
differencesbetweenulcerativecolitisandCrohn'sdiseaseareas

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follows:
ulcerativecolitis
Crohnsdisease
commonsite ileocolitiswithrectalsparing
procolitis,rectum

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protective
Smoking
nofactors
factor
Appendicectomy

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antibioticduringthefirst
commonrisk
antibioticduringthefirst
yearoflife,turner
factors

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yearoflife,turnersyndrome
syndrome
-Methyldopa,Wiskott?
riskfactor
OCP,Smoking

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AldrichSyndrome,
Tcellinvolved
TH1
TH2
Earliest

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Erythematousmucosa
macroscopic
AphthousUlcer
withafinegranular
finding

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surface
Wallinvolved
Transmural
mucosa&submucosa
Pseudopolyp

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lesscommon
mostcommon
typeofulcer
serpentine
Collar-buttonulcers

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cobblestone
present
notpresent

cobblestone
present

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notpresent
appearance
skinlesions
seen
notseen

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Creepingfat
seen
notseen
non-caseatinggranuloma
Granuloma

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notseen
seen
classical-perinatal
Fistula
notseen

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(enterocutaneous)
strictures
common
notcommon
Toxic

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notseen
seen
megacolon
Cryptabscess
and

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lessmarked
moremarked
destruction
Rosethorn
seen

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notseen
appearance
Pyloricmetaplasiaisa
metaplasia
panethcellmetaplasia

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clinicalmarker
Renalcalculi
calciumoxalate
notpresent
uveitis,migratory

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polyarthritis,sacroiliitis,
ankylosing
Extraintestinal
spondylitis,erythema
SimilartoCrohndisease

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manifestations nodosum,clubbing,Primary
sclerosing
cholangitis
Named
TrueLoveWitt's

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criteriato
--------
criteria-UC
assess
theseverity

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58.Whatisthecauseofintracorpuscular
defectsinhemolysis?
a)Uremicsyndrome
b)PCH

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c)PNH
d)Portalhypertension
CorrectAnswer-C
Answer-C.PNH

59.Typeofnecrosisseeninbloodvessels

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duetoimmunereactions-
a)Coagulation
b)Liquefaction
c)Fibrinoid
d)None

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CorrectAnswer-C
Answer-C(Fibrinoid)
Insmallvesselvasculitis,fibrinplugsfrequentlyoccurinthevessel
lumen,butthetermfibrinoidisusuallyusedtorefertomaterial
outsidethelumenofavessel.Fibrinoidnecrosisalsooccursinthe

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wallsofarteriolesinmalignanthypertension.

60.Inapatientwithlipoproteinlipase
deficiency,whichofthefollowingis
increasedfollowingafattymeal?

a)Chylomicron

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b)LDL
c)HDL
d)Apo-A
CorrectAnswer-A
Answer-A.Chylomicron

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Lipoproteinlipasedeficiency(TypeIhyperlipoproteinemia):isarare,
autosomalrecessivedisordercausedbyadeficiencyoflipoprotein
lipase.Resultinginfastingchylomicronemiaand
hypertriglycerolemia.Thereisslowclearanceofchylomicronsand
VLDL.LowlevelsofLDLandHDL.Thereisnoincreasedriskof

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coronarydisease.

61.InWilson'sdisease,thereislessurinary
excretionof-
a)Phosphorus
b)Methyl-Histidine

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c)Phosphotyrosine
d)Serine
CorrectAnswer-B
Answer-B.Methyl-Histidine
EssentialsofDiagnosis&TypicalFeaturesofWilsondisease:

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Acuteorchronicliverdisease
Deterioratingneurologicstatus
Kayser-Fleischerrings
Elevatedlivercopper
Abnormalitiesinlevelsofceruloplasminandserumandurine

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copper.

62.WhatisthefunctionofIL1?
a)Enhanceshematopoiesis
b)Stimulatesmastcells
c)Hasantiviralproperties

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d)Endogenouspyrogen
CorrectAnswer-D
Answer-D(Endogenouspyrogen)
wasformerlyknownaslymphocyte-activatingfactor(LAF).
augmentstheactivityofmanycelltypes,especiallyTcells.

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isanendogenouspyrogen(EP).
inducesanincreaseinacutephasereactants.
isaheat-stableandpH-stablepeptidewithamolecularweightof
17.5kd.
occursintwoforms:IL-1?andIL-1?.

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63.CEAPscoreindicates-
a)Atrialdisorders
b)Venousdisorder
c)Neurologicaldisorde
d)Traumadisorder

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CorrectAnswer-B
Answer-B.(Venousdisorder)
ComprehensiveClassificationSystemforChronicVenousDisorders
(CEAP)
CEAPclassificationofchronic

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Clinicalclassification
venousdisease
C3
Edema
C4a

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Pigmentationoreczema
Lipodermatosclerosisor
C4b
athrophieblanche
C5

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Healedvenousulcer

64.IL-1activatedby-
a)Capsase1
b)Capsase3
c)Capsase8

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d)Capsase5
CorrectAnswer-A
Answer-A(Capsase1)
ThetwoinflammatorycytokinesactivatedbyCaspase-1are
excretedfromthecelltofurtherinducetheinflammatoryresponsein

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neighboringcells.

65.Parotidmassmixedconsistency
a)Pleomorphicadenoma
b)Sebaceouscyst
c)Dermoidcyst

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d)All
CorrectAnswer-A
Answer-A(Pleomorphicadenoma)
Itisalsoknownas"Mixedtumor,salivaryglandtype",whichrefers
toitsdualoriginfromepithelialandmyoepithelialelementsas

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opposedtoitspleomorphicappearance.

66.Krabbe'sdiseaseis-
a)DeficiencyofBeta-galactosylcermidase
b)Deficiencyofarylsulphatase
c)Alphagalactosidase

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d)Acidlipase
CorrectAnswer-A
Answer-A(DeficiencyofBeta-galactosylcermidase)
KrabbediseaseiscausedbymutationsintheGALCgenelocated
onchromosome14(14q31),whichisinheritedinanautosomal

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recessivemanner.MutationsintheGALCgenecauseadeficiency
ofanenzymecalledgalactosylceramidase.

67.Whatisthechoiceoftreatmentfor
idiopathicthrombocytopeniapurpura
(ITP)?

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a)Bloodtransfusion
b)Spontaneousrecovery
c)IVinfusion
d)Splenectomy
CorrectAnswer-D

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Answer-D(Splenectomy)
BeneficialeffectsofsplenectomyinchronicITPareduetoboth
removalofthemajorsiteofplatelet
destructionandthemajorsourceofautoantibodysynthesis.

68.Fluoroquinoloneswithmaximum

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bioavailabilityis?
a)Moxifloxacin.
b)Gatifloxacin.
c)Levofloxacin
d)Ciprofloxacin

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CorrectAnswer-C
Ans.C.Levofloxacin.
Pharmacokineticsoffluoroquinolones:
Goodoralbioavailability(exceptnorfloxacin).
Levofloxacin-100%bioavailability.

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Multivalentcationsinterferewithabsorption(liketetracycline).

69.Mechanismofactionofbuspironeis?

a)5HT1Apartialagonism.
b)5HT1Bantagonism.

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c)5HT1Bpartialagonism.
d)5HT2Cantagonism.
CorrectAnswer-A
Ans.A.HT1Apartialagonism
5HT1A:

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*Presynapticautoreceptor.
*Modulatesserotoninrelease.
Partial5HT1Aagonists:
*Buspirone,isapirone,gepirone.
*Usefulasanti-anxietydrug.

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70.Whichstatementbestdescribes
mechanismofactionofazole?
a)Synthesisofergosterol
b)Thymidylatesynthase
c)TargetingBeta-1,3?glucan

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d)Disruptionofcellwall.
CorrectAnswer-A
Ans.A.Synthesisofergosterol
Inhibitionof14a-lanosteroldemethylase,akeyenzymeinergosterol
biosynthesis?resultingindepletionofergosterol&accumulationof

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toxic14a-methylatedsterolsinmembranesofsusceptibleyeast
species?Destructionoffungus.

71.Whichisthefollowingisorallyactive
directXainhibitor?
a)Rivaroxaban

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b)Agrataban
c)Dabigatran
d)Bilverudin
CorrectAnswer-A
Ans.a.Rivaroxaban

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Rivaroxaban,apixaban&edoxabanarefactorXainhibitors.
Dabigatranetexilateisdirectthrombininhibitor.

72.Whichamongthefollowingismost
probablereasonforpreferenceof
Cisatracuriumoveratracurium?

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a)Decreasedhistaminerelease
b)Increasedhistaminerelease
c)DuetoeliminationbyHofmannelimination
d)IncreasedCNStoxicity

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CorrectAnswer-A
Ans.A.Decreasedhistaminerelease
Cisatracurium:
*UndergoesHofmannelimination.
*Doesnotprovokehistaminerelease?Hence,preferredover

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atracurium.
*Noeffectonheartrate/BP/nilautonomiceffect.
*Produceslesslaudanosinethanatracurium?Hence,lessCNS
toxicity(seizures).

73.Whichofthefollowingdrugisusedin

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SIADH?
a)Tolvapatan
b)Desmopressin
c)Vwbfactor
d)Terlipressin

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CorrectAnswer-A
Ans.A.Tolvaptan
Tolvaptan:
*Vasopressinantagonists.
*OrallyactivenonpeptideselectiveV2receptorantagonist.

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*MetabolizedbyCYP3A4?Notgiventopatientsreceivingthis
isoenzymeinhibitor.
*Givenoncedaily.
*t?:6?8hours.
Actions:

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*Increasesfreewaterclearancebykidney(aquaretic).
*CorrectslowerplasmaNa+levels.
Uses:
*Usefulforhyponatremiatreatment.
*HyponatremiacausedbyCHF,cirrhosisofliverorsyndromeof

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inappropriateADHsecretion(SIADH).
Sideeffect:
*Thirst&drymouth(mostfrequent).
*Fever,G.I.upset&hyperglycaemia.

74.DrugactingonK+channelsincludewhich

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ofthefollowing?
a)Spironolacton
b)Amiloride.
c)Nicorandil
d)Methyldopa

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CorrectAnswer-C
Ans.C.Nicorandil
Nicorandil:
Cardioprotectivepotassiumchannelopener.
Causesischemicpreconditioning&coronarydilation?Byactivating

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myocardialATPsensitiveK+channels.
AlsopossessesNO-releasingproperty.
Usefulinangina.

75.Imipenem,anewerantibioticwithabroad
antibacterialspectrum,iscoadministered

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withcilastatin.Whichofthefollowingis
thebestreasonforthesame?

a)CombinationofantibioticsissynergisticagainstPseudomonas
specie
b)Cilastatinaidsgastrointestinalabsorptionofactivemoiety,

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imipenem
c)Cilastatininhibitsbeta=lactamaseenzymedestroyingimipenem
d)Cilastatininhibitsanenzymeinkidneydestroyingimipenem
CorrectAnswer-D
Ans.D.Cilastatininhibitsanenzymeinkidneydestroying

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imipenem
Imipenem-cilastatin0.5gi.v.6hourly(max4g/day).
Effectiveinserioushospital-acquiredrespiratory,urinary,abdominal,
pelvic,skin&softtissueinfectionsincludingneutropenic,cancer&
AIDSpatients.

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ForPs.aeruginosainfections,itshouldbecombinedwith
gentamicin.

76.DOCforsmokingcessation?
a)Acamprosate
b)Varenicline

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c)Thalidomide
d)Tryptophan
CorrectAnswer-B
Ans.B.Varenicline(IfBupropionisnotanoption)
Anti-smokingdrugs:

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Bupropion(alongwithVarenicline&Nicotinereplacementtherapy)
isaUSFDAapprovedfirst-lineagentforpharmacotherapyin
smokingcessation.
Varenicline:
Effectiveagentsforsmokingcessation.

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Syntheticdrugwithpartialagonistactionat4?2nicotinicreceptors.
Hasantagonistpropertiespersistingduetolonghalf-life&high
receptoraffinity.
Hence,preventsstimulanteffectofnicotineat
presynaptic4?2nicotinicreceptors-->resultsindopaminerelease.

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77.DOCforCyclosporiasis?
a)Trimethoprimsulfamethoxazolecombination
b)Paromomycin
c)Metronidazole
d)Cyclosporin

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CorrectAnswer-A
Ans.A.Trimethoprimandsulfamethoxazolecombination.
CombinationoftrimethoprimwithsulfamethoxazoleisDOCfor
cyclosporiasis&Isosporiasis(Protozoalinfection).

78.Mechanismofactionofcurarelikedrugs?

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a)BlocksAChsynthesis
b)BlocksAChreceptors
c)Persistentdepolarization
d)AgonisticwithAchreceptors
CorrectAnswer-B

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Ans.B.BlocksAChreceptors
Tubocurarine,Cisatracurium,Rocuronium:Competitiveantagonistat
nAChreceptorsmainlyatNMjunction.
d-tubocurarine:
Obsoleteclinicalusage.

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PrototypeNMblocker.
Longeractingisoquinolinederivative.
MOA:Actspredominantlyatnicotinicreceptorsiteblockingtheir
receptors?Bycompetingwithacetylcholine(competitive
antagonism).

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79.Adrugwithhighplasmabindingprotein
propertyhaswhichofthefollowing
properties?

a)LessGFR
b)Lessdruginteraction

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c)Highervolumeofdistribution
d)Lesstubularsecretion
CorrectAnswer-A
Ans.A.LesserGFR
Onlyfreedrugscanbefilteredthroughglomerulus.

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Hence,PPBdecreasesGFR.
Tubularsecretionisanenergyrequiringcarriermediatedactive
transport.
hence,PPBdonotinterferewithtubularsecretion.

80.MechanismofactionofOseltamivir?

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a)Proteinsynthesisinhibitor
b)Thymidylatesynthetaseinhibitor
c)Neuraminidaseinhibitor
d)Pyrimidineanalogs.
CorrectAnswer-C

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Ans.C.Neuraminidaseinhibitor
Neuraminidaseinhibitors:
Analogsofsialicacid.
InterfereswithreleaseofprogenyinfluenzaA&Bvirusfrominfected
hostcells.

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Competitively&reversiblyinteractwithactiveenzymesite?>
resultinginclumpingofnewlyreleasedinfluenzavirionstoeach
other&tomembraneofinfectedcell.

81.Trueaboutcolchicinesis/are?
a)Actsbyneutrophilrecruitment

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b)Causesmetaphasearrest
c)Usefulinurate-loweringtherapy
d)Alloftheabove
CorrectAnswer-D
Ans.D.Alloftheabove.

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Colchicine:
MOA:
Actsbyinhibitinggranulocytemigrationintoinflamedjoint.
Depolymerizationofmicrotubulesleadstoneutrophilrecruitmentto
inflamedtissue?Alteringneutrophilmotility.

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Decreasessecretionofchemotacticfactors&superoxideanionsby
activatedneutrophils.
Causesmetaphasearrest.
Mostcommon&doselimitingtoxicity:
Diarrhea.

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Alsocausekidneydamage,myopathy&bonemarrowdepression.
Indications:
Asarate-loweringtherapy(dailycolchicines)suppressingattacks
precipitatedbyabruptserumuricacidchanges.

82.Whichofthefollowingdrugisalpha2

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agonist?
a)Apraclonidine
b)Timolol
c)PGanalogues
d)Verampamil

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CorrectAnswer-A
Ans.A.Apraclonidine
Apraclonidine?Selectivealpha2agonist.
Usefulinglaucoma.
Alphaagonists(Brimonidineandapraclonidine)arecontraindicated

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inhypertensivecrisis.
Dipivefrinisaprodrugwhichisconvertedintoepinephrineinsidettre
eyeUall,socansafelybeusedinhypertension.

83.DrugtodifferentiateMyastheniagravis
fromcholinergiccrisis?

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a)Pyridostgmine
b)Edrophonium
c)Methacholine
d)Clonidine
CorrectAnswer-B

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Ans.B.Edrophomium.
Edrophonium?Usedasadiagnostictestformyasthenia.
Steps:
2mgdoseinjectedintravenously.
Ifnoreactionoccursafter45seconds,anadditional8mg

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administered.
Ifthepatienthasmyastheniagravis,animprovementinmuscle
strengthlastingforabout5minutesusuallyobserved.

84.ConversionofNorepinephrineto
epinephrineismainlyby?

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a)S-adenosylmethionine
b)Arginine
c)Phenylalanine
d)Dehydrogenease
CorrectAnswer-A

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Ans.A.S-adenosylmethionine
S-adenosylmethionineisrequired&enzymeisphenylethanolamine
N-methyltransferase.
S-adenosylmethioninedonatesmethylgroupforconversionofNEto
EinpresenceofPhenylethanolamineNMethyltransferaseenzyme

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85.Carbapenemwhichhastendencytocause
maximumseizures?
a)Imipenem
b)Ertapenem
c)Doripenem

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d)Meropenem
CorrectAnswer-A
Ans.A.Imipenem.
Imipenem:
Carbapenemgrp.ofdrugs.

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Maximumtendencytocauseseizures.

86.DOCfordiphtheriacarrierstateis?
a)Penicillin
b)Antitoxin
c)PenicillinOrerythromycin

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d)Ciprofloxacin
CorrectAnswer-C
Ans.C.Penicillinorerythromycin
Contactsshouldreceiveantibiotics.
BenzathinepenicillinG(600,000unitsforpersonsyoungerthan6

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yearsoldand1,200,000unitsforthose6yearsoldandolder)
Oralerythromycin(40mg/kg/dayforchildrenand1g/dayforadults)
for7-to10-daycourse.
Identifiedcarriersincommunityalsoreceiveantibiotics.
Maintainclosesurveillanceandbeginantitoxinatthefirstsignsof

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illness.

87.

HealthyHumanvolunteerspartofwhich
clinicaltrialphase?

a)Phase1

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b)Phase0
c)Phase3
d)Phase4
CorrectAnswer-A
Ans:A,Phase1.

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PhaseIofclinicaltrialishumanpharmacologyandsafety.
PhaseIinvolvesnormalhumanvolunteers.

88.DOCforscorpionstingbiteis?
a)EDTA
b)Neostigmine

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c)N-acetylcysteine
d)Prazosin
CorrectAnswer-D
Ans:d.Prazosin
DOCforpoisoningduetostingofscorpion?Prazosin.

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Prazosin:
Analpha-blocker.
Managementofscorpionstingbite:
DependingupontheseverityofScorpionpoisoning:
Immunotherapy-(dosedependingonantivenomtiter)

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Prazosin
Midazolam
Aspirin

89.MOAofTeduglutideinshortbowel
syndrome?

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a)GLP-2inhibitor
b)HT1ainhibitor
c)GLP-1analogs
d)C-peptideanalogs
CorrectAnswer-A

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Ans.A.GLP-2inhibitor
Glucagon-likepeptide-2(GLP-2)?Importantintestinotrophicgrowth
factor&mediatorofintestinaladaptation.
FDAapprovedteduglutide(Gattex--NPS)totreatshortbowel
syndromeinadultpatientsrequiringadditionalnutritionfromI.V.

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parenteralnutrition.
Effectivelyimprovesfluidabsorption.

90.DOCforchemotherapyinducedvomiting
is?
a)Graneseteron

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b)Prazosin
c)Clonidine
d)Dimenhydrinate
CorrectAnswer-A
Ans.A.Granisetron.

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Granisetron:
Serotonin5-HT3receptorantagonist.
Usedasanantiemetictreatingnausea&vomitingfollowing
chemotherapy&radiotherapy.
Maineffect:

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Reducesvagusnerveactivity(VagusN.activatesvomitingcenterin
medullaoblongata).

91.Whatistheadvantageoffixeddose
combinationofdrugs.
a)Increasesefficacyofdrug

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b)Decreasesadverseeffects
c)Patientcomplianceimproved
d)Alloftheabove
CorrectAnswer-D
Ans.D.Alloftheabove

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AdvantagesofFDC:
Safeandeffective.
Reduces"pillburden"?Enhancingoveralltreatmentoutcome.
Increasesefficiency.
Reduceincidenceofadversedrugeffects.

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Improvespatientcompliance.
Offerslowcost(comparedtoindividualcomponentsofactive
ingredients).

92.DOCfordigitalisisinducedcentro-chilar
tachycardia?

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a)Lidocaine
b)Reducingdosageofdigoxinitself,reversesthecondition
c)Verapamil
d)Betablockers
CorrectAnswer-A

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Ans.A.Lidocaine
Digitalistoxicity:
Features:
Generallyunwell&lethargy.
Nausea&vomiting.

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Confusion.
Yellow-greenvision.
Arrhythmias(e.g.AVblock,bradycardia)
Dizziness.
Precipitatingfactors:

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Renaldisease
Hypokalaemia
Hypomagnesemia
Hypoalbuminemia
Hypothermia

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Hypothyroidism
Hypercalcemia.
Hypernatremia
Acidosis.
Myocardialischaemia.

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PartialAVblock.

Drugs:
Amiodarone.
Quinidine.
Verapamil.

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Spironolactone.
Furosemide.
Hydrochlorothiazide-
CompetewithDCTsecretion,hence
reducingexcretion.
Management:

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Digibind.
Correctventriculararrhythmiabylignocaine.
Bradyarrhythmiasbypropanolol.
Atrialtachyarrhythmiasbyatropine.
Phenytoin.

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MonitorK+

93.AntiretroviraltherapyistobegiveninHIV
infectedpatientsirrespectiveofpresence
ofsymptomsifCD4countislessthan?

a)100

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b)150
c)200
d)350
CorrectAnswer-C
Ans.C.200

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OfferARTtosymptomaticpatientsiftheCD4countis200?350
cells/mm3
ConsiderARTforasymptomaticpatientswithCD4countbetween
200-350cells/mm3andmonitorcloselyfornewsymptoms.
IftheCD4countis200?250cells/mm3,physicianscanconsider

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repeatingtheCD4testin4weeksinasymptomaticpatients.
Thisistoruleoutthepossibilityofa20%marginoferrorin
laboratoryresults.
PatientsshouldstartARTbeforetheCD4countdropsbelow200
cells/mm3

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Ref:http://naco.gov.in/upload/Policies%20&%20Guidelines/1.%20Antiretroviral%20Therapy%20Guidelines%20for%20HIV-
infected%20Adults%20and%20Adolescents%20Including%20Post-
exposure.pdf

94.Filgrastimisusedintreatmentof:
a)Anemia

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b)Neutropenia
c)Malaria
d)Filarial
CorrectAnswer-B
Ans.is.B.Neutropenia

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Filgrastimisarecombinanthumangranulocytecolonystimulating
factor(G-CSF)whichisa175-aminoacidglyco-protein.
Itdiffersfromthenaturalgranulocytestimulatingfactorduetoits
lackinglycosylationandthepresenceofanextraN-terminal
methionine.Ithasprovedtobeeffectiveinthetreatmentofsevere

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neutropenia.
Ref:GoodmanandGilman'sThePharmacologicalBasisof
Therapeutics,11thEdition,Pages1429-32;Immunopharmacology
ByManzoorM.Khan,Pages49-50

95.Trueabouttreatmentofearlybreast

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carcinoma?
a)Aromataseinhibitorsarereplacingtamoxifeninpremenopausal
women
b)Postmastectomyradiationtherapyisgivenwhen4ormore
lymphnodesarepositive

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c)Tamoxifenisnotusefulinpost-menopausalwomen
d)Inpremenopausalwomen,multidrugchemotherapyisgivenin
selectedpatients
CorrectAnswer-B
Ans.B.Postmastectomyradiationtherapyisgivenwhen4or

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morelymphnodesarepositive
Tamoxifen:
Effectiveinbothpre&postmenopausalwomen(ifhormonereceptor
positive)
DOCinpremenopausalwomen

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Aromataseinhibitors:
Provenmorebeneficialthantamoxifeninpostmenopausalwomen.
MOA:
Byloweringestrogeninpost-menopausalwomenwithhormone-
receptor-positivebreastcancer.

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Inpost-menopausalwomen,mostofbody'sestrogenisfrom
androgen.
Aromataseinhibitorsinhibitsaromataseenzyme?blocking
androgenintoestrogen?loweringestrogenproducedoutside
ovaries.

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Uses:
1stlinetherapyinpostmenopausalwomen,adjuvantsettingor

secondaryagentafter1to2yearsofadjuvanttamoxifentherapy.
Advantages:
Reducedincidenceofendometrialcancer.

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Adverseeffects:
Bonemineraldensityalteration-?osteoporosis&increasedfractures
inpostmenopausalwomen.
Otheroptions:
Inpremenopausalwomenwithanyformofadjuvantsystemic

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therapyshouldreceivemultidrugchemotherapy.

96.ApatientofRAistakingmethotrexate,
steroidsandNSAIDssince4monthsbut
activityofdiseaseprogressionissame.
Whatshouldbethenextprobablestep?

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a)StartmonotherapywithantiTNFalphadrugs
b)Continuemethotrexateandsteroids
c)Stoporalmethotrexateandstartparenteralmethotrexate
d)Addsulfasalazine
CorrectAnswer-D

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Ans.D.Addsulfasalazine

97.IVMannitolisusedfortreatmentof
a)Acutecongestiveglaucoma
b)Pulmonaryedema
c)Acuterenalfailure

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d)CHF
CorrectAnswer-A
Ans.A.Acutecongestiveglaucoma.
Mannitolmaybeusedtoreduceintraocularpressurewhengiven
intravenously.

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98.Variationinsensitivityofresponseto
differentdosesofadrugindifferent
individualisobtainedfrom?

a)Doseresponsecurve
b)Therapeuticindex

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c)Bioavailability
d)Phase1clinicaltrials
CorrectAnswer-A
Ans.A.Doseresponsecurve
Thedose?responserelationship,orexposure?responserelationship,

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describesthechangeineffectonanorganismcausedbydiffering
levelsofexposuretoastressorafteracertainexposuretime,ortoa
food.
Appliestoindividuals,ortopopulations.

99.Whichoneoffollowingisfunctionsof

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PGI2?
a)Inhibitsplateletaggregation
b)Isavasodilator
c)IspyrogeniclikePGE2
d)Alloftheabove

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CorrectAnswer-D
Ans.D.Alloftheabove.
FunctionsofPGI2:
InhibitsInhibitsplateletaggregation,vasodilatorplusbronchodilator
&pyrogeniclikePGE2.

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100.Deglovingskininvolvesremovalof?
a)skin,subcutaneousfat,fascia,muscle
b)skin,subcutaneousfat,fascia
c)skinonly
d)skinsubcutaneousfat

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CorrectAnswer-D
Answer:D.skinsubcutaneousfat
Theclinicalentityofdeglovinginjurymeansthattheskinhasbeen
lost,butthemusculoskeletalunitisintact,andhence,the
movementsoftheparthavebeenpreserved.

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Degloving,alsocalledavulsion,isatypeofsevereinjurythat
happenswhenthetoplayersofyourskinandtissuearerippedfrom
theunderlyingmuscle,connectivetissue,orbone.Itcanaffectany
bodypart,butit'smorecommoninthelegs
Dependingontheanglethatthetirepullasacrosstheextremity,the

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skinandsubcutaneoustissuemaybepulledorshearedoffon
leadingedgeofextremity.

101.Sexualperversions(Exhibitionism)is
undersection
a)Section290

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b)Section294
c)Section230
d)Section291
CorrectAnswer-B
Answer:B.Section294

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EXHIBITIONISM:sexualgratificationbyexposingone'sgenitalia.
Punishableundersec294I.P.C.withimprisonmentupto3monthsor
fine

102.1staffectedinrigormortis
a)Eyelids

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b)Myocardium
c)Jaw
d)Neck
CorrectAnswer-B
Answer-B.Myocardium

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stateofthemusclesinadeadbodywhentheybecomestifforrigid
withsomedegreeofshortening.
Allmusclesofbodyareinvolvedi.e.voluntaryorinvoluntary.
However,itdoesnotstartinallmusclessimultaneously(nysten's
rule).

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Involuntarymuscles(heart)areinvolvedfirstthanvoluntary
muscles.
Sequenceofmusclesinvolvementisasfollows:Heart>upper
eyelid>neck>jaw>face>chest>upperlimb>abdomen>lower
limb>fingerandtoes.

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103.

Punishmentforperjuryisunderwhich
sectionIPC?

a)Sec193
b)Sec191

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c)Sec197
d)Sec190
CorrectAnswer-A
AnswerA.Sec193
Definespunishmentforfabricatingfalseevidence

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Thewitnessisliabletobeprosecutedforperjury,andthe
imprisonmentmayextenduptosevenyears.
193IPC:punishmentforfalseevidence,(punishmentforperjury):
imprisonmentupto7years+hne
IgIIpC:(i)Givingfalseevidence(perjury)underoath.

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I92IPC:Fabricatingfalseevidence(perjury)

104.Gastriclavageisnotcontraindicated
afteringestionofwhichacid.
a)HCL
b)H2SO4

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c)Carbolicacid
d)Nitricacid
CorrectAnswer-C
Answer-C.CarbolicAcid
Theonlyobsolutecontraindicationiscorrosivepoisoningi.e

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alkalis,mineralacid,vegetableacidandorganicacids(except
carbolicacid).
Carbolicacidistheonlycorrosiveinwhichgastriclavagecanbe
used.
Gastriclavagemustbedone(exceptwhencontraindicated)

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irrespectiveofwhethervomitinghasoccuredornot,toprevent
aspirationofcontent.
Carbolicacidistheonlycorrosiveinwhichgastriclavageisnot
contraindicated.

105.Visceraintoxicologystoredin

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a)Glycerine
b)Rectifiedspirit
c)Formalism
d)Saturatedsaltsolution
CorrectAnswer-D

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Answer-D.Saturatedsaltsolution
Toxicologicalvisceraispreservedinasaturatedsolutionof
commonsalt(sodiumchloride).
Fortoxicologicalanalysis,visceraisneverpreservedinalcohol,
formalin,orbilesalt.

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Infact,formalindenaturesproteinsandchemicaitoxinsandwould
interferewiththedetectionofpoisonsduringchemicalanalysis'

106.Twoidenticaltwinswillnothavesame
a)Fingerprints
b)DNAcopies

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c)Iriscolor
d)Bloodgroup
CorrectAnswer-A
Answer:A.Fingerprints
IdenticaltwinshavethesameDNA,buttheirfingerprints

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(dactylography)arestilldiferentandtheydonotchange.
Thesecanbeeasilyusedtodifferentiatebetweenanidenticalset
oftwins.
IdenticaltwinshavethesamesetofDNA,thereforeDNA
fingerprintingcannotdifferentiatethem.

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107.InAllegedhistoryofgunshot
injury.thereisburning,blackening,
tattooingaroundthewoundDirtcollar,
theinjuryis

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a)Closeshotentrywound
b)Closeshotexitwound
c)Distantshotentrywound
d)distantshotexitwound
CorrectAnswer-A

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Answer:A.Closeshotentrywound
Buring,blackening,tattooingaroundthewoundarefeaturesof
closeshotentry.
Andmayoccurincontactshotwhenmuzzleendisnotpressed
firmly.

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Themuzzleendisnotpressedfirmlyorisloosenedbyrecoil,flame,
gasandsootmayescapesidewaysandsoiltheadjoiningskin......
Parikh.
Greasecollarordirtcollarisseenatfirearmentrywound.Itisa
blackcoloredringliningtheentrancewoundontheskin.

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Itisproducedbyremovalofsubstancesfromthebulletasit
passes_throughtheskin,

108.AchildishavingBatteredbaby
syndromehowwillyouidentify
a)Stabwound

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b)Gunshotwound
c)Bruiseofdifferentages
d)Noneofthese
CorrectAnswer-C
Ans-C.Bruiseofdifferentages

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Abatteredchildisonewhohasreceivedrepetitivephysicalinjuries
asaresultofnon-accidentalviolenceproducedbyaparentora
guardian.
multiplebruisepresentoverbody,Lacerationoftheoralmucosa,
Parentsgivevaguehistoryofaccidenttobethecauseofthe

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injuries.
ItisalsocalledCaffeysyndrome,Caffey-Kempesyndrome,
maltreatmentsyndromeorParent-infanttraumaticstresssyndrome
Theinjuriesmaybecausedbyhand,foot,teeth,stick,belt,shoe,
hotwater,lightedcigarette,hotfryingpanoranyhouseholdarticle

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Accidentalinjuriestypicallyinvolvebonyprominences[head
(forehead,occipitalorparietalregion),nose,chin,palm,elbows,
kneesandshin],matchthehistorygivenbytheparentsandare
keepingwiththedevelopmentofthechild

109.Apatientishavinggastrointestinal

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problemsincludingabdominalpainand
distension,bloodyormucus-filled
diarrhea,andtenesmus,withrectal
prolapse,Astool,ovaandparasites
examrevealsthepresenceoftypical

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Barrel-shapedeggs,possiblecausative
agentis?

a)Campylobacter
b)Clostridiumdifficile
c)Giardialamblia

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d)Trichuris
CorrectAnswer-D
Answer:D.Trichuris
whipwormcancausegastrointestinalproblems,suchasabdominal
pain,diarrhea,mucousorbloodystoolsweightloss,painful

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urination,andweakness.
Rectalprolapseisahallmark,albeitrare,symptomofaheavyT.
trichiurainfectionthatoccursinchildrenmorefrequentlythanadults.
Whenrectalprolapseoccurs,wormscanoftenbeidentifiedonthe
edematousrectum.

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Inawhipworminfection,therectumlosesitsinternalsupport
becausethewormsburytheirthinheadsintotheintestinallining,
looseningtheelasticepitheliumandweakeningthesurrounding
muscles.


110.Contactisolationisdonefor

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a)MRSA
b)Mumps
c)Diphtheria
d)Asthama
CorrectAnswer-C

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Answer:C.Diphtheria
AtypeofbacteriacalledCorynebacteriumdiphtheriaecauses
diphtheria.
Theconditionistypicallyspreadthroughperson-to-personcontactor
throughcontactwithobjectsthathavethebacteriaonthem,suchas

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acuporusedtissue.
Evenifaninfectedpersondoesn'tshowanysignsorsymptomsof
diphtheria,they'restillabletotransmitthebacterialinfectionforup
tosixweeksaftertheinitialinfection
Thebacteriamostcommonlyinfectyournoseandthroat.Once

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you'reinfected,thebacteriareleasedangeroussubstancescalled
toxins.Thetoxinsspreadthroughyourbloodstreamandoftencause
athick,graycoatinginnose,throat,lungs.

111.Achildissufferingfromrecurrent
chronicinfectionswithencapsulated

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bacteriaisduetodeficiencyofsubclass
.

a)IgG1
b)IgG2
c)IgG3

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d)IgG4
CorrectAnswer-B
Answer:B.IgG2
IgG2antibodiesarepredominantlyagainstthepolysaccharide
(complexsugar)coating(capsule)ofcertaindisease-producing

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bacteria(suchas,StreptococcuspneumoniaeandHaemophilus
influenzae).
Inyoungchildren,theabilitytomakeIgG2antibodiestothe
polysaccharidecoatingsofbacteriadevelopsmoreslowlythanthe
abilitytomakeantibodiestoproteins.

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112.D.O.Cforisospora
a)PenicillinG
b)Benzathinepenicillin
c)Co-trimoxazole
d)Albendazole

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CorrectAnswer-C
Answer:C.Co-trimoxazole
Themostcommonantibioticthatisprescribedisco-trimoxazole
(trimethoprimsulfamethoxazole),morecommonlyknownasBactrim,
Septra,orCotrim.

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ForImmunocompetenthostsPreferedregimen:Trimethoprim-
sulfamethoxazole160mg/800mgPObidfor7-10days..

113.CoxsackievirusA16causes
a)Yellowfever
b)Hand-foot-mouthdisease

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c)Rockymountainspottedfever
d)Encephalomyocarditis
CorrectAnswer-B
Answer:B.Hand-foot-mouthdisease
Hand,FootandMouthDisease(HFMD)iscausedbycoxsackieA-

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16
ThevirusesthatcauseHFMDarespreadthroughclosepersonal
contact,throughtheairfromcoughingandthefecesofaninfected
person.
CoxsackievirusA16isthemostcommoncause,andenterovirus71

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isthesecond-mostcommoncause.Otherstrainsofcoxsackievirus
andenteroviruscanalsoberesponsible.
Ittypicallybeginswithafeverandfeelinggenerallyunwell.Thisis
followedadayortwolaterbyflatdiscoloredspotsorbumpsthat
mayblister,onthehands,feetandmouthandoccasionallybuttocks

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andgroin.

114.Pneumocystisjeroviciis:
a)AssociatedwithCMV
b)Diagnosisisbysputummicroscopy
c)Seenonlyinimmunocompromisedpatients

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d)Alwaysassociatedwithpneumatocele
CorrectAnswer-B
Answer:B.Diagnosisisbysputummicroscopy
Humanisolateof.Pneumocystiswhichisassociatedwithsevere
pneumoniainimmunocompromisedstateparticularlyAIDS.

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P.jeroviciisanextracellularpathogen.Growthinthelungis
limitedtosurfactantlayerabovealveolarepithelium.
Serologicevidencesuggestthatmostindividualsareinfectedin
earlychildhood(thusoption"c"iswrong)butthepneumoniais
seenonlyinimmunocompromisedstate.

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Diagnosisismadebydetectionoforganisminproperspecimen
Sputum:Quickandnoninvasive.
Broncho-alaeolarlaoage(BAL)fluid:Mainstayofpneumocystis
diagnosis.
Transbronchialbiopsy:IfdiagnosiscannotbemadebyBAL.

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115.Allaretrueaboutcongenital
ToxoplasmosisEXCEPT
a)Chorioretinitis
b)Conjunctivitis
c)Hydrocephalus

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d)Cerebralcalcification
CorrectAnswer-B
AnswerB.Conjunctivitis
Occursonlywhenmothergetsprimarytoxoplasmosisinfection
whetherclinicalorasymptomaticduringpregnancyor<6months

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beforeconception(i.e.noriskifacquired>6monthsbefore
conception).
Asgestationalageisincreased,riskoftransmissiontofetus
increased,i.e.max.in3rdtrimesterwhile
severityoffetaldamageisdecreased,i.e.infantisusually

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asymptomaticifinfectiontransmitin3rdtrimester.
Chorioretinitisisusuallytreatedwithacombinationofcorticosteroids
andantibiotics.
Itcauses:hydrocephalous,diffusecerebral
calcification,hepatosplenomegaly,mentalretardation

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myocarditis,lymphadenitis,microencephaly,myocarditis,
chorioretinitis,multiorganfailure,Pneumonitis

116.trueaboutTRIADcongenitalrubella
syndrome
a)PDA,cataractanddeafnessisseen

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b)Hepatosplenomegaly,mentalretardation,deafness
c)Chorioretinitis,multiorganfailure,pneumonitis
d)Noneofthese
CorrectAnswer-A
Answer:A.PDA,cataractanddeafnessisseen

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Congenitalrubellasyndrome(CRS)canoccurinadevelopingfetus
ofapregnantwomanwhohascontractedrubella,usuallyinthefirst
trimester.Ifinfectionoccurs0?28daysbeforeconception,theinfant
hasa43%riskofbeingaffected.
Infectionin2ndtrimester?maybedeafnessonly.

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>6wks?nomajorabnormalities
Diagnosis:Isolationofvirusincellculturesofthroatsamples,urine
orothersecretions.
DetectionofIgMinsingleserumsampleshortlyafterbirth.
PersistanceofRubellaIgGantibodiesserumbeyond1yearor

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risingantibodytiteranytimeduringinfancyinanunvaccinatedchild

117.Discdiffusionmethodisalsoknownas
a)KirbyBauer
b)VDRL
c)Darkfieldmicroscopy

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d)Noneofthese
CorrectAnswer-A
Answer:A.KirbyBauer
Thediskdiffusiontest,oragardiffusiontest,orKirby?Bauertest
(disc-diffusionantibioticsusceptibilitytest,disc-diffusionantibiotic

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sensitivitytest,KBtest),isatestoftheantibioticsensitivityof
bacteria.
Itusesantibioticdiscstotesttheextenttowhichbacteriaare
affectedbythoseantibiotics.Inthistest,waferscontaining
antibioticsareplacedonanagarplatewherebacteriahavebeen

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placed,andtheplateislefttoincubate.
Ifanantibioticstopsthebacteriafromgrowingorkillsthebacteria,
therewillbeanareaaroundthewaferwherethebacteriahavenot
grownenoughtobevisible.Thisiscalledazoneofinhibition

118.Rubellavirusbelongstowhichfamily?

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a)Rheovirus
b)Togavirus
c)Picornavirus
d)Orthomyxo

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CorrectAnswer-B
And.B.Togavirus
Rubellavirus(RuV)isthepathogenicagentofthediseaserubella,
andisthecauseofcongenitalrubellasyndromewheninfection
occursduringthefirstweeksofpregnancy.

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RubellavirusistheonlymemberofthegenusRubivirusand
belongstothefamilyofTogaviridae,whosememberscommonly
haveagenomeofsingle-strandedRNAofpositivepolaritywhichis
enclosedbyanicosahedralcapsid.

119.Whichofthefollowinginfection

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resembleserythroblastosis?
a)EBV
b)CMV
c)HSV
d)STAPHYLOCOCCUS

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CorrectAnswer-B
ANSWER:B.CMV
Cytomegalovirusinfectionisacommonherpesvirusinfectionwitha
widerangeofsymptoms:fromnosymptomstofeverandfatigue
(resemblinginfectiousmononucleosis)

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InfectionwithCMV,likethatwithEpstein-Barrvirus(EBV,atype4
herpesvirus),cancauseatypeofinfectiousmononucleosisin
adolescentsandyoungadults.BothCMVandEBVmononucleosis
causefeverandfatigue.ButEBValsocausesaseveresorethroat.
CMVdoesnot.

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120.Diagnostictestforneurosyphilis
a)VDRL
b)RPR
c)TPI
d)FTA-ABS

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CorrectAnswer-A
Answer:A.VDRL
ExaminationofCSFforpleocytosis,increaseproteinconcentration,
VDRLreactivity.
ApositiveCSFVDRLmakesthediagnosisofneurosyphilis.

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Ifbothtesti.e.VDRLandFTA-ABSIgM(specific)testare
positiveintheinfantthencongenitalsyphilisshouldbestrongly
suspectedandthechildshouldbetreated.
Apositivetestconfirmsneurosyphilisbutanegativeresultdoesnot
ruleoutneurosyphilis.DuetothelowsensitivityoftheCSFVDRL,

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fluorescenttreponemalantibodyabsorptiontest(FTA-ABS)canbe
usedtosupplementVDRL.

121.Flaskshapedulcersinintestinecaused
by
a)Giardialamblia

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b)Entamoebahistolytica
c)Helicobacterpylori(H.pylori)
d)E.vermicularis
CorrectAnswer-B
AnswerB.Entamoebahistolytica

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Diseaseoccurswhenamoebacomesincontactwiththecellslining
theintestine.
Itthensecretesthesamesubstancesitusestodigestbacteria,
whichincludeenzymesthatdestroycellmembranesandproteins.
Thisprocesscanleadtopenetrationanddigestionofhuman

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tissues,resultingfirstinflask-shapedulcerationsintheintestine.
Entamoebahistolyticaingeststhedestroyedcellsbyphagocytosis
andisoftenseenwithredbloodcells(aprocessknownas
erythrophagocytosis)insidewhenviewedinstoolsamples

122.Whattypeofculturemediaisusedfor

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Ligionella?
a)(BCYE)agarmedia
b)MacConkeyagar
c)Baird?Parkeragar
d)Sabouraud'sagar

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CorrectAnswer-A
Answer:A.(BCYE)agarmedia
BCYEisselectiveforcertainGram-negativebacteria,especially
Legionellapneumophila.
Theorganismsarenutritionallyfastidious,non-sporeforming,

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aerobic,gram-negative,slenderrods.
Mediacontainingcysteine,yeastextract,a-ketoglutarate,andiron
(BCYE)arerequiredforisolationofLegionella.
SelectiveBCYE(mediumcontainingantibiotics),isrecommended
forspecimenslikelytobecontaminatedwithotherbacteria.

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123.SpecialStainforcryptococcus:
a)ZNstain
b)Gramstain
c)Mucicarminestain
d)Malachitegreen

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CorrectAnswer-C
Ans:C.Mucicarminestain
Mucicarminestainprovidesspecificstainingofpolysaccharidecell
wallinC.neoformans.
Thisislimitedtomicroorganismswithacellwallthatiscomposed,at

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leastinpart,ofapolysaccharidecomponent.

124.A36yrsoldmalepatientc/,ocoughcold
fever/rustysputum/sputumnegfortb
,h/ooftravelinchina&eatencrab,
Nametheinfection

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a)Paragonimuswestermani
b)Faciolahepatica
c)Fasciolopsisbuski
d)Entamoebahistolytica
CorrectAnswer-A

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Ans:A.Paragonimuswestermani(lungfluke).
Duringinvasionandmigrationoftheflukes,diarrhea,abdominal
pain,fever,cough,urticaria,hepatosplenomegaly,pulmonary
abnormalities,andeosinophiliamaydevelop.
Unembryonatedeggsarepassedinthesputumofahuman.

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Duringthechronicphase,thelungsaredamagedmost,butother
organsmaybeinvolved.
TheclinicalpictureresemblesandisoftenconfusedwithTB.
Praziquantelisthetreatmentofchoice.

125.Microbiologicaltestfordiagnosing

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leptospirainfection?
a)Coldagglutination
b)Standardagglutination
c)Microscopicagglutinationtest(MAT)
d)Noneofthese

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CorrectAnswer-C
Answer:C.Microscopicagglutinationtest(MAT)
Dark-fieldmicroscopyorbyimmunofluorescenceorlightmicroscopy
afterappropriatestainingused
Microscoplcagglutinationtest[MAT](GoldStandard)also

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Macroscopicagglutlnationtest
Differentialdiagnosislistforleptospirosisisverylargeduetodiverse
symptoms.

126.Greencolouroftriageisforwhich
patient?

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a)Lowpriority
b)Morbidity
c)Ambulatory
d)Highpriority
CorrectAnswer-C

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Ans.C.Ambulatory
Triage
Whenthequantityandseverityofinjuriesoverwhelmtheoperative
capacityofhealthfacilities,adifferentapproachtomedicaltreatment
mustbeadopted.

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Theusualprincipleoffirstcome,firsttreated",isnotfollowedin
massemergencies.
Triageconsistsofrapidlyclassifyingtheinjuredandthelikelihoodof
theirsurvivalwithpromptmedicalintervention.
Higherpriorityisgrantedtovictimswhoseimmediateorlong-term

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prognosiscanbedramaticallyaffectedbysimpleintensivecare.
Moribundpatientswhorequireagreatdealofattention,with
questionablebenefithavethelowestpriority.
Themostcommontriageclassificationsystemusedinternationalis
fourcolourcodesystem.

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Red
Highprioritytreatmentortransfer
Yellow Mediumpriority
Green Ambulatorypatients
Black

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Deadormoribundpatients

127.ConcurrentlistofIndianConstitution
includeswhichofthefollowing?
a)Internationalimmigrationruleforquarantine
b)Preventionofextensionofcommunicablediseasefromoneunit

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toanother
c)Minesandoilfieldworkersrules
d)Establishmentandmaintenanceofdrugstandards
CorrectAnswer-B
Ans.B.Preventionofextensionofcommunicablediseasefromone

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unittoanother
ThefunctionsoftheUnionHealthMinistryaresetoutintheseventh
scheduleofArticle246oftheconstitutionofIndiaunderthreelists.
1. UnionList
2. ConcurrentList

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3. Statelist
The52itemscurrentlyontheConcurrentlistare:
1.Criminallaw,includingallmattersincludedintheIndianPenal
Code
2.Criminalprocedure,includingallmattersincludedintheCodeof

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CriminalProcedure.
3.Preventivedetentionforreasonsconnectedwiththesecurityofa
State,themaintenanceofpublicorder,orthemaintenanceof
suppliesandservicesessentialtothecommunity;personssubjected
tosuchdetention.

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4.RemovalfromoneStatetoanotherStateofprisoners,accused
personsandpersonssubjectedtopreventivedetentionforreasons
specifiedinEntry3ofthislist.
5.Marriageanddivorce;infantsandminors;adoption;wills,

intestacyandsuccession;jointfamilyandpartition;allmattersin

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respectofwhichpartiesinjudicialproceedingswereimmediately
beforethecommencementofthisConstitutionsubjecttotheir
personallaw.
6.Transferofpropertyotherthanagriculturalland;registrationof
deedsanddocuments.

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7.Contractsincludingpartnership,agency,contractsofcarriage,
andotherspecialformsofcontracts,butnotincludingcontracts
relatingtoagriculturalland.
8.Actionablewrongs
9.Bankruptcyandinsolvency.

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10.TrustandTrustees.
11.Administrators?generalandofficialtrustees.
11-A.Administrationofjustice;constitutionandOrganisationofall
courts,excepttheSupremeCourtandtheHighCourts.
12.Evidenceandoaths;recognitionoflaws,publicactsandrecords,

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andjudicialproceedings.
13.Civilprocedure,includingallmattersincludedintheCodeofCivil
ProcedureatthecommencementofthisConstitution,limitationand
arbitration.
14.Contemptofcourt,butnotincludingcontemptoftheSupreme

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Court.
15.Vagrancy;nomadicandmigratorytribes.
16.Lunacyandmentaldeficiency,includingplacesforthereception
ortreatmentoflunaticsandmentaldeficients.
17.Preventionofcrueltytoanimals.

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17-A.Forests.
17-B.Protectionofwildanimalsandbirds.
18.Adulterationoffoodstuffsandothergoods.
19.Drugsandpoisons,subjecttotheprovisionsofEntry59ofListI
withrespecttoopium.

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20.Economicandsocialplanning.
20-A.Populationcontrolandfamilyplanning.
21.Commercialandindustrialmonopolies,combinesandtrusts.
22.Tradeunions;industrialandlabourdisputes.
23.Socialsecurityandsocialinsurance;employmentand

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unemployment.

24.Welfareoflabourincludingconditionsofwork,providentfunds,
employers'liability,workmen'scompensation,invalidityandoldage
pensionsandmaternitybenefits.
25.Education,includingtechnicaleducation,medicaleducationand

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universities,subjecttotheprovisionsofEntries63,64,65and66of
ListI;vocationalandtechnicaltrainingoflabour.
26.Legal,medicalandotherprofessions.
27.Reliefandrehabilitationofpersonsdisplacedfromtheiroriginal
placeofresidencebyreasonofthesettingupoftheDominionsof

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IndiaandPakistan.
28.Charitiesandcharitableinstitutions,charitableandreligious
endowmentsandreligiousinstitutions.
29.PreventionoftheextensionfromoneStatetoanotherof
infectiousorcontagiousdiseasesorpestsaffectingmen,animalsor

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plants.
30.Vitalstatisticsincludingregistrationofbirthsanddeaths.
31.Portsotherthanthosedeclaredbyorunderlawmadeby
Parliamentorexistinglawtobemajorports.
32.Shippingandnavigationoninlandwaterwaysasregards

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mechanicallypropelledvessels,andtheruleoftheroadonsuch
waterways,andthecarriageofpassengersandgoodsoninland
waterwayssubjecttotheprovisionsofListIwithrespecttonational
waterways.
33.Tradeandcommercein,andtheproduction,supplyand

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distributionof,-
(a)theproductsofanyindustrywherethecontrolofsuchindustryby
theUnionisdeclaredbyParliamentbylawtobeexpedientinthe
publicinterest,andimportedgoodsofthesamekindassuch
products

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(b)foodstuffs,includingedibleoilseedsandoils
(c)cattlefodder,includingoilcakesandotherconcentrates
(d)rawcotton,whetherginnedornotginned,andcottonseed;and
(e)rawjute.
33-A.Weightsandmeasuresexceptestablishmentofstandards.

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34.Pricecontrol.
35.Mechanicallypropelledvehiclesincludingtheprinciplesonwhich
taxesonsuchvehiclesaretobelevied.

36.Factories.
37.Boilers.

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38.Electricity.
39.Newspapers,booksandprintingpresses.
40.Archaeologicalsitesandremainsotherthanthosedeclaredby
orunderlawmadebyParliamenttobeofnationalimportance.
41.Custody,managementanddisposalofproperty(including

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agriculturalland)declaredbylawtobeevacueeproperty.
42.Acquisitionandrequisitioningofproperty.
43.RecoveryinaStateofclaimsinrespectoftaxesandotherpublic
demands,includingarrearsofland-revenueandsumsrecoverable
assucharrears,arisingoutsidethatState.

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44.Stampdutiesotherthandutiesorfeescollectedbymeansof
judicialstamps,butnotincludingratesofstampduty.
45.Inquiriesandstatisticsforthepurposesofanyofthematters
specifiedinListIIorListIII.
46.Jurisdictionandpowersofallcourts,excepttheSupremeCourt,

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withrespecttoanyofthemattersinthisList.
47.FeesinrespectofanyofthemattersinthisList,butnot
includingfeestakeninanycourt.

128.Lastpointwherereproductiveandchild
healthprogrammeareinclude:

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a)Sub-centre
b)Anganwadi
c)District
d)Taluka
CorrectAnswer-C

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Ans.C.District
ThevariousactivitiesofReproductiveandchildHealthProgramme
(RCH)arctargetedatthedistrictlevel.
"TheRCHprogrammeisbasedonadiiThrentialapproach.Inputsin
allthedistrictshavenotbeenkeptuniform.

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Whilethecarecomponentarethesameforalldistricts,theweaker
districtswillgetmoresupportandsophisticatedfacilitiesare
proposedforrelativelyadvanceddistricts.Onthebasisofcrudebirth
rateandfemaleliteracyrate?allthedistrictshavebeendividedinto
threecategories`A,B,&C'Allthedistrictswillbecoveredina

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phasedmanneroveraperiodofthreeyears."

129.Healthcenterinremotestareafor
planningandmanagementofschemes:
a)Anganwadi
b)Blockcentre

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c)Sub-centre
d)PHC
CorrectAnswer-C
Ans.C.Sub-centre
TheSub-Centreisthemostperipheralandfirstcontactpoint

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betweentheprimaryhealthcaresystemandthecommunity.Sub-
Centresareassignedtasksrelatingtointerpersonalcommunication
inordertobringaboutbehavioralchangeandprovideservicesin
relationtomaternalandchildhealth,familywelfare,nutrition,
immunization,diarrhoeacontrolandcontrolofcommunicable

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diseasesprogrammes.
TheSub-Centresareprovidedwithbasicdrugsforminorailments
neededfortakingcareofessentialhealthneedsofmen,womenand
children.

130.Diagnosticpowerofatesttocorrectly

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diagnoseadiseaseis-
a)Negativepredictivevalue
b)Positivepredictivevalue
c)Sensitivity
d)Specificity

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CorrectAnswer-B
Ans.B.Positivepredictivevalue
Positivepredictivevalueistheabilityofatesttocorrectlydiagnose
theproportionofcasesinwhichpersonswithapositivescreening
testresulthavethediseaseinquestion.

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Negativepredictivevalueistheproportionofcasesinwhichpeople
withnegativetestresultdonothavethediseaseinquestion.
Sensitivityisdefinedastheabilityofthetesttoidentifycorrectlyall
thosewhohavethedisease,i.e.truepositive.
Specificityisdefinedastheabilityofthetesttoidentifycorrectly

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thosewhodonothavethedisease,i.e.truenegative.

131.Paradoxicalcarriersare-
a)Apersonwhoacquiresthemicroorganismduetohiscontact
withthepatient.
b)Apersonwhoacquiresthemicroorganismanothercarrier.

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c)Apersonwhoisclinicallyrecoveredfromaninfectiousdisease
butstillcapableoftransmittingtheinfectiousagenttoothers.
d)None
CorrectAnswer-B
Ans.B.Apersonwhoacquiresthemicroorganismanothercarrier.

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Paradoxicalcarrieraredefinedaspersonwhoacquiresthe
microorganismanothercarrier.

132.AccordingtoIMNCI,ababyof6month
age,criteriaforfastbreathingismore
than_____/min

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a)60
b)50
c)40
d)30
CorrectAnswer-B

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Ans.B.50
Asthechildrengetolder,theirbreathingrateslowsdown.
Therefore,thecut-offpointhasfastbreathingwilldependontheage
ofthechild.oFastbreathingispresentwhentherespiratoryrateis
:?

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Childlessthan2monthsofage:60breathsperminute
Childaged2monthsupto12months:50breathsperminute
Childaged12monthsupto5years:40breathsperminute

133.Allofthefollowingareexamplesof
Dietaryfibreexcept-

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a)Pectin
b)Lignin
c)Cellulose
d)Gums
CorrectAnswer-D

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Ans.D.Gums
Dietaryfibreconsistsofunabsorbablecellwallandother
constituentsofvegetablefoodlikecellulose,lignin,hemicellulose,
gums,pectins,glycoproteinsandotherpolysaccharides.
Dietaryfibreabsorbswaterintheintestine,swells,increasebulkof

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stoodbyincreasingwatercontentoffaecesandsoftenit,decreases
transittimebyfacilitatingcolonictransit.
"Thepresenceoffibreshortensthetransittimesandincreasesthe
stoolbulk"
Dietaryfibreisoftwotypes:

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1. Solublefibres:Itabsorbsupto15timesitsweightinwaterasit
movesthroughGIT,producingsofterstools.Itsgoodsourcesare
oat,flaxseeds,peas,beans,apple,citrusfruits,carrots,barleyand
psyllium.
2. Insolublefibre:Itpromotesmovementofmaterialthroughdigestive

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systemandincreasesstoolbulk.It'sgoodsourcesarewheatflour,
wheatbran,nutsandvegetables.

134.Crossproductratioisdeterminedby
whichstudy?
a)Casecontrol

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b)Cohort
c)Crosssectional
d)RCT
CorrectAnswer-A
Ans.A.Casecontrolstudy

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Crossproductratio:
Riskincasecontrolstudyiscalculatedbyoddsratio(crossproduct
ratio).

135.Inanormalcurvewhatistheareathat
comesunder1standarddeviation-

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a)50%
b)68%
c)95%
d)100%
CorrectAnswer-B

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Ans.B.68%
1SDincludes68%ofvalues
2SDincludes95%ofvalues
3SDincludes99.7%ofvalues

136.2yearoldboyofweight12kgwith

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vitaminAdeficiencywhatisoraldoseof
vitaminA

a)50,000I.U
b)1lakhI.U.
c)1.5lakhI.U

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d)2lakhI.U
CorrectAnswer-D
Ans.D.2lakhI.U
Treatment:
Oraltherapy:TheoralregimenofvitaminAis200,000IUondayof

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presentation,nextday,and2-4weekslater.
Childrenlessthan1yearofageorlessthan8kgshouldreceivehalf
thedoseoftheabovedose.Repeat200,000IUevery6monthsup
to6yearsofagetopreventrecurrence.
Parenteraltherapy:Ifthepatienthasseveredisease,isunableto

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takeoralfeeds,orhasmalabsorption,thepreferabledoseis
100,000IUofvitaminAgivenintramuscularly.
ChildrenwithseveremeaslesshouldalsoreceivevitaminAasthey
areverylikelytobebenefitedfromsuchtherapybothintermsof
savingsightandreducingcasefatality.

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Prevention
ProphylaxisconsistsofperiodicadministrationofVitaminA
supplements.WHOrecommendedschedule,whichis
universallyrecommendedisasfollows:
Infants6?12monthsoldandanyolderchildrenweighinglessthan8

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kg?100,000IUorallyevery3?6months

Childrenover1yearandunder6yearsofage?200,000IUorally
every6months
Infantslessthan6monthsold,whoarenotbeingbreastfed?50,000
IUorallyshouldbegivenbeforetheyattaintheageof6months

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137.Notapersonalprotectiveequipment
a)Goggles
b)Badgesfordetectingradiation
c)Gloves

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d)Labcoat
CorrectAnswer-B
Ans.B.Badgesfordetectingradiation

138.Confoundingfactorisdefinedas

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a)Factorassociatedwithboththeexposureandthediseaseand
isdistributedunequallyinstudyandcontrolgroups.
b)Factorassociatedwithexposureonlyandisdistributed
unequallyinstudyandcontrolgroups.
c)Factorassociatedwithboththeexposureandthediseaseand

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isdistributedequallyinstudyandcontrolgroups
d)Factorassociatedwiththediseaseandisdistributedequallyin
studyandcontrolgroups.
CorrectAnswer-A
Ans.A.Factorassociatedwithboththeexposureandthedisease

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andisdistributedunequallyinstudyandcontrolgroups.
Epidemiologicalstudiessearchforthecausesofdiseases,basedon
associationswithvariousriskfactorsthataremeasuredinthestudy.
Inadditiontotheexposuresthatthestudyisinvestigating,theremay
beotherfactorsthatareassociatedwiththeexposureandarealso

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riskfactorsforthedisease.Iftheprevalenceoftheseotherfactors
differsbetweengroupsbeingcompared,theywilldistortthe
observedassociationbetweenthediseaseandexposureunder
study.Suchvariablesmaypartiallyorcompletelyaccountforany
apparentassociationbetweenanexposurevariableanddisease.

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Thesedistortingfactorsarecalledconfoundingfactorsorvariables.
ThusaConfoundingfactorisdefinedasonewhichisassociated
withboththeexposureandthediseaseandisdistributedunequally
instudyandcontrolgroups.Itisitselfarisk.factor.forthedisease.

139.Thesignificanceofdifferencebetween

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proportionscanalsobetestedby-
a).`t'test
b)Chisquaretest
c)ANOVA
d)Correlationandregression

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CorrectAnswer-B
Ans.B.Chisquaretest
Chi-Squaretestoffersamethodoftestingthesignificanceof
differencebetweentheproportions.
Itsadvantageliesinthefactthatitcanalsobeusedwhenmorethan

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twogroupsaretobecompared.
Byusingthistest,wecanfindoutifthedifferencebetweentwo
proportionsorratioshasoccurredbychance.Thesteps
involvedare-

1. Testingthenullhypothesis.

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2. Applyingchi-squaretest.
3. Calculatingthedegreeoffreedom.
4. Comparingwithprobabilitytables.

140.PairedTtestisdefinedas-
a)Testusedtoassessquantitativeobservationsbeforeandafter

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anintervention
b)Testthatisusedwhentheobservationareintheformof
proportions(forqualitativedata)
c)Testappliedwhenseparateobservationsaremadeon
individualsoftwoseparategroups,andtheseneedtobe

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compared
d)None
CorrectAnswer-A
Ans.A.Testusedtoassessquantitativeobservationsbeforeand
afteranintervention

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Pairedt-tests
Thepairedt-testisusedtocomparethevaluesofmeansfromtwo
relatedsamples,forexampleina`beforeandafter'scenario.
Thedifferencebetweenthemeansofthesamplesisunlikelytobe
equaltozero(duetosamplingvariation)andthehypothesistestis

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designedtoanswerthequestion"Istheobserveddifference
sufficientlylargeenoughtoindicatethatthealternativehypothesisis
true".
Theanswercomesintheformofaprobability?thep-value.

141.Bestrepresentativeofincidenceof

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diseaseindifferenttimeline-
a)Histogram
b)Linediagram
c)Scattereddiagram
d)Bardiagram

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CorrectAnswer-B
Ans.B.Linediagram
Linediagramsareusedtoshowthetrendofeventswithpassageof
time.
Itisusedtoshowthetrendofeventswithpassageoftimeand

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showshowthefrequencyofaparticulareventorvariablevaryover
time.

142.Fortrenchtypeofsanitaryfillingthe
amountoflandrequiredfor2meterdeep
trenchfor10000populationis-

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

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Ans.A.1acre
GeneralWHOGuidelinesforShallowTrenchesis3-5Metrefor100
People.SoAbout300-500MeterofShallowTrenchesfor10,000
People.
Alsothereshouldbeaperimeterof30maroundthetrench.

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Now1Acre=4046SqMeter[200mX200m]
HenceAnsweris1Acre.

143.Riskofgeneticdiseases
inconsanguineousmarriagebetween
firstcousins?

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a)1-2%
b)4-8%
c)8-10%
d)12-14%
CorrectAnswer-B

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Ans.B.4-8%
Consanguinityisamarriagebetweenrelativesandhasvarious
degrees.Closelyrelatedindividualshaveahigherchanceof
carryingthesameallelesthanthoselesscloselyrelatedand
thereforechildrenfromconsanguineousmarriagesaremore

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frequentlyhomozygousforvariousallelesthanthosefromnon-
consanguineousunions.
Generallyspeaking,frequencyofcongenitalmalformationsamong
newbornsoffirstcousinunionsisabout2timesthefrequency
amongthegeneralpopulation.Inotherwordsinsteadofarateof2-

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3%ofbirthdefectsinthegeneralpopulation,therisktofirstcousin
couplesisaround4-6%.

144.Whichisnotaepidemiological
indicator?
a)ABER

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b)Annualparasiteindex
c)Annualfalciparumincidence
d)NoneoftheAbove
CorrectAnswer-A
Answer?A.ABER

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ABERorAnnualBloodExaminationRateisnotanepidemiological
indicatorbutanindicatorofoperationalefficiencyofMalariaControl
Programme.

145.Doseofdiphtheriaantitoxinis-
a)1000to5000IU

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b)10000to100000IU
c)1000to2000IU
d)None
CorrectAnswer-B
Ans.B.10000to100000IU

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DATmanufacturedbyInstitutoButantanisasterile,transparent
(clear)serumsolutionsuppliedin10mLampoulescontaining
10,000IUeach.
DATmustbestoredintherefrigeratorat2?8?C(36?46?F).
DONOTFREEZE.Onceanampouleisopened,theDATserum

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solutionshouldbeusedimmediately.

146.VerticaltransmissionofHIVishighest
with-
a)Electivecaesareansection
b)HighviralRNAload

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c)Breastfeeding
d)Termdelivery
CorrectAnswer-B
Ans.B.HighviralRNAload
Vaginalandemergencycaesareansectiondeliveries,prematurity,

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andlowCD4cellcountweremoststronglyassociatedwithinfant,s
infectionstatusinunivariateanalyses.
Childrendeliveredvaginallyorbyemergencycaesareansection
weremorelikelytobeinfectedthanthosedeliveredbyelective
caesareansection,withareductioninriskof79%associatedwith

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thelatter(P<0.001).
Similarly,infantsdeliveredbefore37weeksweremorethantwiceas
likelytobeinfectedthaninfantswhowerenotpremature.
Caesareansectionbeforeonsetoflabourandruptureofmembranes
approximatelyhalvestheriskofmother-to-childtransmission.

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Transmissionrate:
Duringpregnancy:5?10%
Duringlabouranddelivery:10?15%
Duringbreastfeeding:5?20%
Overallwithoutbreastfeeding:15?25%

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Overallwithbreastfeedingtosixmonths:20?35%
Overallwithbreastfeedingto18?24months:30?45%


147.Themostcommonsiteofthebranchial
cystis:

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a)Posteriorborderofsternocleidomastoid
b)Anteriorborderofsternocleidomastoid
c)Digastricmuscle
d)Omohyoidmuscle
CorrectAnswer-B

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Answer.B.Anteriorborderofsternocleidomastoid
Abranchialcleftcyst(BCC)commonlypresentsasasolitary,
painlessmassintheneckofachildoryoungadult.
Theyaremostcommonlylocatedalongtheanteriorborderandthe
upperthirdofthesternocleidomastoidmuscleintheanteriortriangle

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oftheneck.


148.Inspiratorystridorisfoundinwhatkind
oflesions:
a)Supraglottic

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b)Subglottic
c)Tracheal
d)Bronchus
CorrectAnswer-A
AnswerA.Supraglottic

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Generally,aninspiratorystridorsuggestsairwayobstructionabove
theglottis.
Whileanexpiratorystridorisindicativeofobstructioninthelower
trachea.
Abiphasicstridorsuggestsaglotticorsubglotticlesion.

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149.InRetinitispigmentosadecreasedlevel
of?
a)Arachidonic
b)Trielonic
c)Thromboxane

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d)Docosahexanoicacid
CorrectAnswer-D
Answer.D.Docosahexanoicacid

150.Whatisagainsttherulecorrectionin
astigmatism:

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a)-1.25cyl90
b)-2spherical180
c)-3cyl180
d)+2cyl180
CorrectAnswer-A:D

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TypesofregularastigmatismDependingupontheaxisandthe
anglebetweenthetwoprincipalmeridia,regularastigmatismcanbe
classifiedintothefollowingtypes:
1.With-the-ruleastigmatism.Inthistypethetwoprincipalmeridia
areplacedatrightanglestooneanotherbuttheverticalmeridianis

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morecurvedthanthehorizontal.Thus,correctionofthisastigmatism
willrequiretheconcavecylindersat180?20?orconvexcylindrical
lensat90?20?.Thisiscalled'with-the-rule'astigmatism,because
similarastigmaticconditionexistsnormally(theverticalmeridianis
normallyrendered0.25Dmoreconvexthanthehorizontalmeridian

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bythepressureofeyelids).
2.Against-the-ruleastigmatismreferstoanastigmaticconditionin
whichthehorizontalmeridianismorecurvedthanthevertical
meridian.Therefore,correctionofthisastigmatismwillrequirethe
presciptionofconvexcylindricallensat180?20?orconcave

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cylindricallensat90?20?axis.
***WEHAVETOMUGTHISUP:Aplusat90,orminusat180
accountsfor"withtheruleastigmatism***


151.Morbidfearofdarknessknownas:

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a)Claustrophobia
b)Xenophobia
c)Mysophobia
d)Nyctophobia
CorrectAnswer-D

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Answer.D.Nyctophobia
Nyctophobiaisanextremefearofnightordarknessthatcancause
intensesymptomsofanxietyanddepression.
Afearbecomesaphobiawhenit'sexcessive,irrational,orimpacts
yourday-to-daylife.

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Claustrophobiaisaformofanxietydisorder,inwhichanirrational
fearofhavingnoescapeorbeingclosed-incanleadtoapanic
attack.
xenophobia.:fearandhatredofstrangersorforeignersorof
anythingthatisstrangeorforeign.

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Mysophobia,alsoknownasverminophobia,germophobia,
germaphobia,bacillophobiaandbacteriophobia,isapathological
fearofcontaminationandgerms.

152.Achildhasptosisandpoorlevator
function.Whatsurgerywillyoudo?

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a)Levatormuscleresection
b)Mullerectomy
c)FasanellaServatsurgery
d)Frontalissuspensionsurgery
CorrectAnswer-D

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AnswerD.Frontalissuspensionsurgery
Mullermuscleresectionsaretypicallyusedforrepairofminimal
ptosis(2mm)andaregenerallyconsideredsuperiortothe
Fasanella-Servatprocedure(tarsoconjunctivalmullerectomy)in
maintainingeyelidcontourandpreservingthetarsus.

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Whenlevatorfunctionispoor,thesurgeonshouldconsiderutilizing
theaccessoryelevatorsoftheeyelidinptosisrepair.Thistypeof
surgeryismostcommonlyrequiredincongenitalptosiswithpoor
levatorfunctionorinvariousformsofneurogenicptosiswithpoor
levatorfunction.

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Frontalissuspensionsurgeryperformedwhenlevatorfunctionispoor
orabsent,theeyelidissuspendeddirectlyfromthefrontalismuscle
sothatmovementofthebrowisefficientlytransmittedtotheeyelid.
Thus,thepatientisabletoelevatetheeyelidbyusingthefrontalis
muscletoliftthebrow.Frontalissuspensioncanbeperformed

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transcutaneouslyortransconjunctivally.Thissurgeryconnectsthe
eyelidtothebrowwithaslingmaterialandutilizesthepowerofthe
frontalismuscletoelevatethepoorlyfunctioningeyelid.

153.Whichdrugcausesocularhypotension
withapneainaninfant?

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a)Latanoprost
b)Timolol
c)Brimonidine
d)Dorzolamide
CorrectAnswer-C

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Answer.C.Brimonidine
Brimonidineisarelativelyselectivealpha-agonist,whichreduces
intraocularpressure(IOP)bydecreasingaqueousproductionand
increasinguveoscleraloutflow.
Brimonidinepassesthroughtheblood-brainbarrier,potentially

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causingcentralnervoussystem(CNS)toxicity.
Therehavebeenreportsofbradycardia,hypotension,hypothermia,
hypotonia,andapneaininfantsaftertopicalbrimonidine.

154.Chemotherapyagentsfor
retinoblastoma:

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a)vincristine,carboplatinandetoposide
b)vinblastine,etoposideandbleomycin
c)vinblastine,vincristineandetoposide
d)vinblastine,vincristineandcisplatin
CorrectAnswer-A

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Answer.A.Vincristine,carboplatinandetoposide
ChemotherapyforRetinoblastoma
Chemotherapy(chemo)istheuseofanti-cancerdrugstotreat
cancer.
Chemocanbegivenindifferentwaystotreatretinoblastoma.

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Someofthechemodrugsusedtotreatretinoblastomainclude:
1. Carboplatin
2. Cisplatin
3. Vincristine
4. Etoposide

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5. Cyclophosphamide
6. Topotecan
7. Doxorubicin
Mostoften,2or3drugsaregivenatthesametime.
Astandardcombinationiscarboplatin,vincristine,andetoposide,

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althoughforverysmalltumors,onlycarboplatinandvincristinemay
beenough.
Otherdrugsmightbeusedifthesearenoteffective.

155.Drugusedinacutecongestiveglaucoma
are:

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a)Atropine
b)Pilocarpine
c)Acetazolamide
d)BothB&C
CorrectAnswer-D

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Answer.D.BothPilocarpine&Acetazolamide
Managementofangleclosureglaucoma
Acutecongestiveglaucomaalsoisknownasacuteangleclosure
glaucoma.
ImmediatemedicaltherapyinacuteACconsistsofcommencing

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IOP-loweringeyemedicationssuchastopical?-blocker,a2-agonist
andevenprostaglandinanaloguesassoonaspossible.
OncetheIOPissufficientlyreducedtoallowirisreperfusion,
pilocarpineisinstilledtoinducemiosisinanattempttowidenthe
anteriorchamberanglesandreestablishaqueousoutflow.

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Mydriaticdrugssuchasatropine,cyclopentolate,tropicamideand
phenylephrineareprecipitatingfactorforangleclosureglaucoma,so
notused(contraindicated)initstreatment.

156.WhichistheMostcommonocular
findinginmyastheniagravis?

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a)Ptosis
b)Lagophthalmos
c)Proptosis
d)Enophthalmos
CorrectAnswer-A

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Answer.A.Ptosis
Inmorethanhalfthepeoplewhodevelopmyastheniagravis,
theirfirstsignsandsymptomsinvolveeyeproblems,suchas:

1. Droopingofoneorbotheyelids(ptosis).
2. Doublevision(diplopia),whichmaybehorizontalorvertical,and

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improvesorresolveswhenoneeyeisclosed.

157.Esotropiaisusuallyassociatedwith:
a)Myopia
b)Hypermetropia
c)Astigmatism

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d)Presbyopia
CorrectAnswer-B
Ans.B.Hypermetropia
Accommodativeesotropiaisoneofthemostcommontypesof
strabismusinchildhood.

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Theincidenceisestimatedat2%ofthepopulation.
Itisusuallyfoundinpatientswithmoderateamountsofhyperopia.
Asthepatientaccommodatesorfocusestheeyes,theeyes
converge.

158.Whichwallofheartenlargementcanbe

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seenonbariumswallowinpatientwith
mitralstenosis-

a)Leftatrium
b)Rightatrium
c)Leftventricle

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d)Rightventricle
CorrectAnswer-D
Answer.D.Rightventricle
Mitralstenosisisassociatedwithrightventricularhypertrophy.
LeftventriculardiastolicpressureisnormalinisolatedMS.

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Mitralstenosis:Features
leftatrialpressureisincreased
pulmonaryarterialpressureisincreased
Increasedrightventricularafterloadimpedestheemptyingofthis
chamberandRightventricularenddiastolicpressureandvolume

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increase.
Rightventricularhypertrophyoccurs.

159.Whichofthefollowingstatementsistrue
aboutthebundleofkent?
a)Abnormalpathwaybetweentwoatria

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b)Itismuscularornodalpathwaybetweentheatriaandventricle
inWPWsyndrome
c)ItisslowerthantheAVnodalpathway
d)None
CorrectAnswer-B

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Answer.B.Itismuscularornodalpathwaybetweentheatria
andventricleinWPWsyndrome
TheWolff-Parkinson-Whitesyndromeisdefinedbythecombination
ofanatrioventricularpre-excitation(bundleofKent)andparoxysmal
supraventriculartachycardias.Thediagnosisofatrioventricularpre-

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excitationinsinusrhythmisestablishedontheassociationbetween
ashortPRinterval,awideQRS,adeltawave,anormalterminal
QRSportionandfrequentrepolarizationdisorders.

160.Deepvenousthrombosiswhichis
incorrect?

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a)Clinicalassessmenthighlyreliable
b)Mostlybilateral
c)Mostcommonclinicallypresentsaspainandtendernessincalf
d)Somecasesmaydirectlypresentaspulmonary
thromboembolism

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CorrectAnswer-B
Answer.B.Mostlybilateral
Wellsscoreorcriteria:(possiblescore-2to9)
Activecancer(treatmentwithinlast6monthsorpalliative):+1point
Calfswelling=3cmcomparedtoasymptomaticcalf(measured10

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cmbelowtibialtuberosity):+1point
Swollenunilateralsuperficialveins(non-varicose,insymptomatic
leg):+1point
Unilateralpittingedema(insymptomaticleg):+1point
PreviousdocumentedDVT:+1point

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Swellingofentireleg:+1point
Localizedtendernessalongthedeepvenoussystem:+1point
Paralysis,paresis,orrecentcastimmobilizationoflowerextremities:
+1point
Recentlybedridden=3days,ormajorsurgeryrequiringregionalor

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generalanestheticinthepast12weeks:+1point
Alternativediagnosisatleastaslikely:-2points

161.Punchedoutulcerinesophagusisseen
in
a)herpes

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b)cmv
c)Oesophagitis
d)candida
CorrectAnswer-C
Answer.C.Oesophagitis

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Itislikelytopresentwithasingle,largeshallowlinearulceras
opposedtothemultiplevesicular/"punched-out"ulcersseenin
herpesesophagitis.

162.Typeofsensationlostonsamesideof
BrownSequardsyndrome-

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a)Pain
b)Touch
c)Proprioception
d)Temperature
CorrectAnswer-C

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Answer.C.Proprioception
Damagetoonehalfofthespinalcord,resultinginparalysisandloss
ofproprioceptiononthesame(oripsilateral)sideastheinjuryor
lesion,andlossofpainandtemperaturesensationontheopposite
(orcontralateral)sideasthelesion.

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163.Achondroplasiashowswhichtype
inheritance-
a)XLR
b)XLD
c)Autosomalrecessive

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d)Autosomaldominant
CorrectAnswer-D
Answer.D.Autosomaldominant
Achondroplasiaisinherited
inanautosomaldominantpattern,
whichmeansonecopyofthealteredgeneineachcellissufficientto

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causethedisorder.

164.MELDscoreincludes
a)Serumcreatinine
b)Transaminase
c)Albumin

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d)Alkalinephosphatase
CorrectAnswer-A
Answer.A.Serumcreatinine
TheModelforEnd-stageLiverDisease(MELD)isaprospectively
developedandvalidatedchronicliverdiseaseseverityscoring

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systemthatusesapatient'slaboratoryvaluesfor?
LiSerumbilirubin
Serumcreatinine
Theinternationalnormalizedratio(INR)forprothrombintimeto
predictthreemonthsurvival.

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Patientswithcirrhosis,andincreasingMELDscoreisassociated
withincreasingseverityofhepaticdysfunctionandincreasedthree-
monthmortalityrisk.
Givenitsaccuracyinpredictingshort-termsurvivalamongpatients
withcirrhosis,MELDwasadoptedbytheUnitednetworkfororgan

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sharing(UNOS)in2002forprioritizationorpatientsawaitingliver
transplantationintheUnitedstates.

165.Infarctsinvolvingwhichportionofthe
myocardiumcauseaneurysmasapost-
MIcomplication-

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a)Subendocardial
b)Anteriortransmural
c)Posteriortransmural
d)Inferiorwall
CorrectAnswer-D

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Answer.D.Inferiorwall
Leftventricularaneurysmformation:
Leftventricularapicalaneurysmformationusuallyoccursfollowing
antero-apicalmyocardialinfarction,afterLADocclusion.
Thisweakeningoftheapicalwallresultsinanoutpouchingor

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"dyskinesis"oftheapexoftheheartduringsystole.

166.Riskfactorsforalzheimer'sdisease
include-
a)Klinefeltersyndrome
b)LowBP

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c)Down'ssyndrome
d)None
CorrectAnswer-C
Answer.C.Down'ssyndrome
PeoplewithDownsyndromearebornwithanextracopyof

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chromosome21,whichcarriestheAPPgene.Thisgeneproducesa
specificproteincalledamyloidprecursorprotein(APP)withage
thesegetaccumulatedinthebraincellandaffectsthefunctioningof
thebrainleadingtoalzheimer'sdementia.

167.Afemalepatientof26years,presents

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withoralulcers,photosensitivityand
skinmalarrashinfacesparingthe
nasolabialfoldsofbothside.

a)Sturgewebersyndrome
b)SLE

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c)Dermatitis
d)Psoriasis
CorrectAnswer-B
Answer-B(SLE)
Commonsymptomsincludepainfulandswollenjoints,fever,chest

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pain,hairloss,mouthulcers,swollenlymphnodes,feelingtired,and
aredrashwhichismostcommonlyontheface.

168.Mostcharacteristiccardiovasculardefect
seeninRubella-
a)Pulmonaryarterystenosis

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b)Coarctationofaorta
c)Ankylosisspondylitis
d)Rheumaticfever
CorrectAnswer-A
Answer.A.Pulmonaryarterystenosis

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Theclassictriadforcongenitalrubellasyndromeis:
Sensorineuraldeafness(58%ofpatients)
Eyeabnormalities?especiallyretinopathy,cataract,and
microphthalmiaCongenitalheartdisease?especiallypulmonary
arterystenosisandpatentductusarteriosus.

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169.OsbornJwavesisseenin-
a)Hypothermia
b)Hyperkalemia
c)Hypocalemia
d)Hypokalemia

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CorrectAnswer-A
Answer.A.Hypothermia
Causepeoplesufferingfromhypothermiawithatemperatureofless
than32?C(90?F).

170.Alcoholicshowswhichtypeof

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cardiomyopathy-
a)Hypercardiomyopathy
b)Dilatedcardiomyopathy
c)Pericarditis
d)Myocarditis

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CorrectAnswer-B
Answer.B.Dilatedcardiomyopathy
Alcoholiccardiomyopathyisadiseaseinwhichthechroniclong-
termabuseofalcohol(i.e.,ethanol)leadstoheartfailure.Alcoholic
cardiomyopathyisatypeofdilatedcardiomyopathy.

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171.WhichisnotrelatedtoHIV
a)PrimaryCNSlymphoma
b)Tertiarysyphilis
c)Oesophagealcandidasis
d)None

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CorrectAnswer-B
Answer.B.Tertiarysyphilis
TertiarySyphilishasnorelationtoHIVstatusandprimarilybasedon
thedurationoftheinfectionandcomplicationsofSyphilis.


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172.Essentialmajorbloodculturecriteriafor
infectiveendocarditis.
a)Singlepositivecultureofhacek
b)Singlepositivecultureofcoxiella
c)Singlepositivecultureofcornybacterium

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d)Botha&b
CorrectAnswer-A
Answer.A.SinglepositivecultureofHACEK

173.Respiratorycentresarestimulatedby
a)Oxygen

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b)Lacticacid
c)Carbondioxide
d)Calcium
CorrectAnswer-C
Answer.C.Carbondioxide

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Thebody'srespiratorycenterinthemedullaisnormallystimulated
byanincreasedconcentrationofcarbondioxide,andtoalesser
extent,bydecreasedlevelsofoxygeninarterialblood.Stimulation
oftherespiratorycentercausesanincreaseintherateanddepthof
breathing,thusblowingoffexcesscarbondioxideandreducing

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bloodacidity.

174.Whichmurmurincreasesonstanding?
a)HOCM
b)MR
c)MS

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d)VSD
CorrectAnswer-A
Answer.A.HOCM
MurmurwillgetsofterwithValsalvaorstandingfromsquatting
becauselessbloodisbeingejectedthroughtheaorticvalve.Rapid

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squattingfromastandingpositionforcesincreasedvenousreturn
andwouldhavetheoppositeeffectofValsalvaorrapidstanding.

175.Mostcommonindicationforliver
transplantinchildren-
a)Biliaryatresia

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b)Cirrhosis
c)Hepatitis
d)Drugreactions
CorrectAnswer-A
Answer-A(Biliaryatresia)

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Indicationsforlivertransplantationininfantsandchildreninclude
acuteliverfailure(ALF),chronicliverfailurewithpruritus,
complicationsofcholestasisandfailuretothrive.Inyoungchildren,
themostcommonliverdiseaseleadingtotransplantationisbiliary
atresia

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176.Mostcommontypeofgallstoneis-
a)Mixedstones
b)Purecholesterolstones
c)Pigmentstones
d)Calciumbilirubinate

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CorrectAnswer-A
Answer-A
Mixed-Between4%and20%ofstonesaremixed.
Pigment-Between2%and30%ofstonesarebilirubinstones.
Cholesterol-Between35%and90%ofstonesarecholesterol

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stones.
Themostcommontypeofgallstoneswasmixedcholesteroltype
gallstoneswith67.5%followedbyblackpigmentandbrownpigment
typesas23.83%and5.89%,respectively.
Mixedstonesare90%common.Itcontainscholesterol,calcium

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saltsofphosphatecarbonate,palmitate,proteins,andaremultiple
faceted.

177.Serpiginousulcerdistalesophagus-
a)CMV
b)Herpes

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c)Pill
d)Corrosive
CorrectAnswer-A
Answer-A(CMV)
CMVclassicallycausesserpiginousulcersinthedistalesophagus

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thatmaycoalescetoformgiantulcers.

178.Omphaloceleiscausedby?
a)Duplicationsofintestinalloops
b)Abnormalrotationoftheintestinalloop
c)Failureofguttoreturntothebodycavityfromitsphysiological

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herniation
d)Reversedrotationoftheintestinalloop
CorrectAnswer-C
Answer-C(Failureofguttoreturntothebodycavityfromits
physiologicalherniation)

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Failureofguttoreturntothebodycavityfromitsphysiological
herniation.Exomphalos(omphalocele)isherniationofabdominal
viscerathroughanenlargedumbilicalring.Theviscera,whichmay
includeliver,smallandlargeintestines,stomach,spleen,orbladder,
arecoveredbyamnion.Theoriginofomphaloceleisafailureofthe

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boweltoreturntothebodycavityfromitsphysiologicalherniation
duringthe6thto10thweeks.

179.Dohlmanprocedurefor-
a)Meckel'sdiverticulum
b)Zenker'sdiverticulum

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c)Dermatomyositis
d)Menetrier'sdisease
CorrectAnswer-B
Answer-B(Zenker'sdiverticulum)
Thetreatmentofpharyngealpouches(Zenker'sDiverticulum)may

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bebyeitheropensurgicalorendoscopictechniques.The
endoscopicDohlman'sprocedureisanidealtechniqueinthe
elderly.

180.Ifamotherisdonatingkidneytoherson
isanexample-

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a)Isograft
b)Allograft
c)Autograft
d)Xenograft
CorrectAnswer-B

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Answer-B(Allograft)
Allograft?Graftingbetweentwonon-identicalmemberofsame
speciesbutnotsamegenotypes.Itincludesthetransplantationof
heart,kidney,lungetc,fromamemberswhodonatetheirorgans.
Anti?rejectiondrugsorimmunosuppressantneedtobetakento

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preventthebodyfromrejectingatransplantedorgan.
Mosthumantissueandorgantransplantsareallografts.

181.Uvulavesicaeisproducedbywhich
prostatelobe?
a)Anteriorlobe

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b)Postlobe
c)Medianlobe
d)Laterallobe
CorrectAnswer-C
Answer-C(medianlobe)

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Themucousmembraneimmediatelybehindtheinternalurethral
orificepresentsaslightelevation,theuvulaofurinarybladder,
causedbythemedianlobeoftheprostate.
Itisoftenenlargedinbenignprostatichypertrophy.

182.TrueaboutBarrett'sesophagusareallof

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thefollowingexcept:
a)Causesadenocarcinoma
b)Patientisusuallyasymptomatic
c)Histologyofthelesionshowsmucussecretinggobletcells
d)Chronicgastroesophagealrefluxisapredisposingfactor

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CorrectAnswer-A
Answer-
Barrettesophagusisapremalignantconditionthatinvolvesthe
distalesophagusandappearstoberelatedtochronic
gastroesophagealreflux(GORD).

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Thereismetaplasticchangeintheliningmucosaofesophagus.
PatientisusuallyasymptomaticinacaseofBarrett'sEsophagus.
HistologyofthelesioninacaseofBarrett'sesophagusshows
mucussecretinggobletcells.
DiagnosisofBarrett'sesophagusismadebydemonstrationof

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columnarmucosa,whichonhistopathologyshowsIntestinaltypeof
metaplasia
ChronicrefluxisacasueofBarrett'sEsophagus.

183.Parathyroidautoimplantationtakesplace
inwhichofthemuscle?

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a)Biceps
b)Triceps
c)Brachioradialis
d)Sartorius
CorrectAnswer-C

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Answer-C(Brachioradialis)
Atotalparathyroidectomywithaforearmautograftinvolvesremoval
ofallparathyroidtissueintheneck,withreimplantationofasmall
amountofmorcellatedtissuewithinapocketformedinthe
brachioradialismuscle.

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184.Bell'spalsyisassociatedwiththelesion
inwhichofthenerve?
a)11thcranialnerve
b)7thcranialnerve
c)9thcranialnerve

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d)3rdcranialnerve
CorrectAnswer-B
Answer-B(7thcranialnerve)
Bell'spalsyoccursduetoamalfunctionofthefacialnerve(VII
cranialnerve),whichcontrolsthemusclesoftheface.Facialpalsyis

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typifiedbyinabilitytocontrolmovementinthemusclesoffacial
expression.

185.Cushingulcerisseenincaseof-
a)Burns
b)Headinjury

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c)Cellnecrosis
d)Stress
CorrectAnswer-B
Answer-B(Headinjury)
Cushingulcersareassociatedwithabraintumororheadinjuryand

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typicallyaresingle,deepulcersthatarepronetoperforation.
Itisagastriculcerassociatedwithelevatedintracranialpressure.It
isalsocalledvonRokitansky?Cushingsyndrome.
ThemechanismofdevelopmentofCushingulcersisthoughttobe
duetodirectstimulationofvagalnucleiasaresultofincreased

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intracranialpressure.Braintumors,traumaticheadinjury,andother
intracranialprocessesincludinginfections,cancauseincreased
intracranialpressureandleadtooverstimulationofthevagusnerve.

186.Gaslessabdomenseenin-
a)Ulcerativecolitis

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b)Acutepancreatitis
c)Intussusception
d)Necrotisingenterocolitis
CorrectAnswer-B
Answer-B(acutepancreatitis)

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Commoncausesinclude:

Inadult:
-Highobstruction.
-Ascites.
-Acutepancreatitisduetoexcessvomiting.

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-Fluidfilledintestine.
-Largeabdominalmass.
ACUTEPANCREATITIS-radiologysigns
renalhalosign
gaslessabdomen

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groundglassappearance
coloncutoffsign
sentinelloop


187.Bidextrousgripisseenatwhatage?
a)4months

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b)5months
c)6months
d)7months
CorrectAnswer-A
Ans.A.4months

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FINEMOTORMILESTONES:

Age
Milestone
4months Bidextrousreach
6months Unidextrousreach

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9months Immaturepincergrasp
12months Maturepincergrasp
Imitatesscribbling,towerof2
15months blocks
18months Scribbles,towerof3blocks

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Towerof6blocks,vertical&
2years
circularstroke
3years
Towerof9blocks,copiescircle

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4years
Copiescross,bridgewithblocks
5years
Copiestriangle


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188.Whichvaccinetobegiveneveryyear?
a)HepatitisA
b)HepatitisB
c)Influenza
d)Chickenpox

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CorrectAnswer-C
Ans.C.Influenza
Influenza(Flu):Thefluvaccineisrecommendedeveryyearfor
children6monthsandolder:
Kidsyoungerthan9whogetthefluvaccineforthefirsttime(orwho

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haveonlyhadonedosebeforeJuly2017)willgetitintwoseparate
dosesatleastamonthapart.
Thoseyoungerthan9whohavehadatleasttwodosesofflu
vaccinepreviously(inthesameordifferentseasons)willonlyneed
onedose.

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Kidsolderthan9onlyneedonedose.
Thevaccineisgivenbyinjectionwithaneedle(theflushot)orby
nasalspray.Theflushotispreferredforchildrenofallagesbecause
ithasbeenshowntobesafeandeffective.Althoughthenasalspray
wasnotusedinrecentyears,achangedversionofitisnow

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recommended(forthe2018?2019fluseason)forkidswhomay
otherwisenotgetaflushot.Thenasalsprayisonlyforhealthy
peopleages2through49.Peoplewithweakenedimmunesystems
orsomehealthconditions(suchasasthma)andpregnantwomen
shouldnotgetthenasalsprayvaccine.

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189.APGARscore3at1minuteindicates:
a)Mildlydepressed
b)Furtherresuscitationnotneeded
c)Severelydepressed
d)Normal

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CorrectAnswer-C
Ans.C.Severelydepressed
APGARCRITERIA:

Component
Scoreof

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Scoreof1
Scoreof2
of
0
backronym

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blueat
nocyanosis
blueor
extremities
bodyand

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Skincolor
paleall
Appearance
bodypink
extremities

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over
(acrocyanosis) pink
<100beatsper >100beats
Pulserate
absent

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Pulse
minute
perminute
no
grimaceon

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Reflex
response suctionor
cryon
irritability
Grimace

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to
aggressive
stimulation
grimace
stimulation stimulation

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flexedarms
andlegsthat
Activity
none
someflexion

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Activity
resist
extension
Respiratory
weak,irregular, strong,robust

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absent
Respiration
effort
gasping
cry

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INTERPRETATION:
Thetestisgenerallydoneat1and5minutesafterbirthandmaybe
repeatedlaterifthescoreisandremainslow.
Scores7andabovearegenerallynormal
Score4to6,fairlylow

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Score:3andbelowaregenerallyregardedascriticallylowand
causeforimmediateresuscitativeefforts.

190.SevereacutemalnutritionasperWHO
criteria-
a)Weightforagelessthanmedianplus?2SD

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b)Weightforheightlessthanmedianplus2SD
c)Weightforagelessthanmedianplus3SD
d)Weightforheightlessthanmedianminus-3SD
CorrectAnswer-D
Ans.D.Weightforheightlessthanmedianminus-3SD

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Severeacutemalnutritionisdefinedbyaverylowweightforheight
(below-3zscoresofthemedianWHOgrowthstandards),byvisible
severewasting,orbythepresenceofnutritionaloedema.
WorldHealthOrganization(WHO)classificationofnutritionalstatus
ofinfantsandchildren:

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Nutritionalstatus
Age:birthto5years
Weight-for-length/heightorBMI-for-age>3
Obese
standarddeviations(SD)ofthemedian

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Weight-for-length/heightorBMI-for-age>2SD
Overweight
and3SDofthemedian
Moderately
Weight-for-age

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underweight
Severely
Weight-for-age
underweight
Weight-for-length/heightorBMI-for-age?2SD

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Moderateacute
and?3SDofthemedian,ormid-upperarm
malnutrition
circumference115mmand
Severeacute

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Weight-for-length/heightorBMI-for-age
malnutrition
Moderatelystunted

Moderatelystunted Length/height-for-age?2SDand?3SDof
(moderatechronic themedian

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malnutrition)
Severelystunted
(severechronic
Length/height-for-age
malnutrition)

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Weight-for-length/height?2SDand?3SDof
Moderatelywasted themedian
Severelywasted
Weight-for-length/height

191.Wheretolookforpre-ductalO2

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saturationinPDAina3minuteborn
infant?

a)FetalleftUpperlimb
b)Fetalleftlowerlimb
c)FetalrightUpperlimb

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d)Fetalrightlowerlimb
CorrectAnswer-C
Ans.C.FetalrightUpperlimb
Asimplerwaytodetectthisright-to-leftshuntingistousetwopulse
oximetersandmeasurepreductalandpostductalSpO2.Inone

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studyitwasfoundthatarterialsaturationintherightarm(preductal)
ofatleast3%abovethelowerlimb(postductal)isevidenceofright-
to-leftductalshunting.

192.TrueaboutFragileXsyndromeis-
a)TriplenucleotideCAGSequencemutation

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b)10%Femalecarriersmentallyretarded
c)MaleshaveIQ20-40
d)Gainoffunctionmutation
CorrectAnswer-C
Ans.C.MaleshaveIQ20-40

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FragileXSyndrome
FragileXsyndromeisassociatedwithafragilesiteonchromosome
X(Xq29.3)
TriplenucleotideCGGSequencemutation
About20%ofwomenwhoarecarriersforthefragileXpremutation

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areaffectedbyfragileX-relatedprimaryovarianinsufficiency.
IndividualswithFXSmaypresentanywhereonacontinuumfrom
learningdisabilitiesinthecontextofanormalintelligencequotient
(IQ)tosevereintellectualdisability,withanaverageIQof40in
maleswhohavecompletesilencingoftheFMR1gene.

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Fragilesitesareregionsofchromosomesthatshowatendencyto
separationbreakageorattenuationtinderparticulargrowth
conditions.
Inheritance
InheritancedoesnotfollowtheusualMendeliansinglegenepatterns

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ItisduetoAllelicexpansion.
ClinicalManifestations:
Themainclinicalmanifestationsare:
1.MentalRetardation
Infactitisthecommonestcauseofmentalretardationinmales.

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2.Macroorchidism.


3.Characteristicfacialappearancewith:
Longface
Largeprominentears

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ProminentJaw

193.Footdropiscausedbyinjurytowhich
nerveinvolvement:
a)Femoralnerve
b)Tibialnerve

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c)Commonperonealnerve
d)Sciaticnerve
CorrectAnswer-C
AnswerC)CommonPeronealNerve
Footdrop,
sometimescalleddropfoot,isageneraltermfor

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difficultyliftingthefrontpartofthefoot.
Causes
Footdropiscausedbyweaknessorparalysisofthemuscles
involvedinliftingthefrontpartofthefoot.
Causesoffootdropmightinclude:

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1. Nerveinjury.Themostcommoncauseoffootdropiscompression
ofanerveinyourlegthatcontrolsthemusclesinvolvedinliftingthe
foot(peronealnerve).Thisnervecanalsobeinjuredduringhipor
kneereplacementsurgery,whichmaycausefootdrop.
2. Anerverootinjury--"pinchednerve"--inthespinecanalso

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causefootdrop.Peoplewhohavediabetesaremoresusceptibleto
nervedisorders,whichareassociatedwithfootdrop.
3. Muscleornervedisorders.Variousformsofmusculardystrophy,
aninheriteddiseasethatcausesprogressivemuscleweakness,can
contributetofootdrop.Socanotherdisorders,suchaspolioor

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Charcot-Marie-Toothdisease.
4. Brainandspinalcorddisorders.Disordersthataffectthespinal
cordorbrain--suchasamyotrophiclateralsclerosis(ALS),multiple
sclerosisorstroke--maycausefootdrop.


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194.

Whichpartofscaphoidfractureismost
susceptibletoavascularnecrosis?

a)Distal1/3rd
b)Middle1/3rd

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c)Proximal1/3rd
d)ScaphoidTubercle
CorrectAnswer-C
Answer.C.Proximal1/3rd
Scaphoidfractures(i.e.fracturesthroughthescaphoidbone)are

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common,insomeinstancescanbedifficulttodiagnose,andcan
resultinsignificantfunctionalimpairment.
Epidemiology
Scaphoidfracturesaccountfor70-80%ofallcarpalbonefractures.
Althoughtheyoccuressentiallyatanyage,adolescentsandyoung

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adultsaremostcommonlyaffected.
Olderpatientsfallinginasimilarmanneraremorelikelytosustaina
distalradialfracture(usuallyaCollesfracture).
ClinicalPresentation
Classicallytherecanbepaininanatomicalsnuffboxwhichisthought

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tohaveasensitivityof~90%andaspecificity~40%
Fracturescanoccuressentiallyanywherealongthescaphoid,but
distributionisnoteven:
1. waistofscaphoid:70-80%
2. proximalpole:20%

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3. distalpole(orso-calledscaphoidtubercle):10%



195.Pott'spuffytumor:
a)Subperiostealabscessoffrontalbone
b)Subperiostealabscessofethmoidbone

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c)Mucoceleoffrontalbone
d)Mucoceleofethmoidbone
CorrectAnswer-A
Answer.A.Subperiostealabscessoffrontalbone
Pott'spuffytumor,firstdescribedbySirPercivallPottin1760,isa

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rareclinicalentitycharacterizedbysubperiostealabscess
associatedwithosteomyelitis.
Itischaracterizedbyanosteomyelitisofthefrontalbone,either
directorthroughhaematogenousspread.
Thisresultsinaswellingontheforehead,hencethename.

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Theinfectioncanalsospreadinwards,leadingtoanintracranial
abscess.
Pott'spuffytumorcanbeassociatedwithcorticalveinthrombosis,
epiduralabscess,subduralempyema,andbrainabscess.


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196.Scissorgaitisseeninwhichofthe
followingcondition:
a)Polio
b)Cerebralpalsy

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c)Hyperbilirubinemia
d)Hyponatremia
CorrectAnswer-B
Answer.B.Cerebralpalsy
Scissorgaitisaformofgaitabnormalityprimarilyassociatedwith

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spasticcerebralpalsy.
Thatconditionandotherslikeitareassociatedwithanuppermotor
neuronlesion.


197.Whichstatementisincorrectaboutthe

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pathologyshownintheimage:
a)Tumorarisefromepiphysealtometaphysealregion
b)Tumorhasdistinctmargin
c)Eccentriclesion
d)Chemotherapyisthetreatmentofchoice

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CorrectAnswer-D
Answer.D.Chemotherapyisthetreatmentofchoice
GivenimageisofGiantcelltumor
Giantcelltumorsofbone,
alsoknownasosteoclastomas,are
relativelycommonbonetumorsandareusuallybenign.

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Theytypicallyarisefromthemetaphysisoflongbones,extend
intotheepiphysisadjacenttothejointsurface,
andhavea
narrowzoneoftransition.
Classicappearance

Therearefourcharacteristicradiographicfeatureswhenagiantcell

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tumorislocatedinalongbone:
occursonlywithaclosedgrowthplate
abutsarticularsurface:84-99%comewithin1cmofthearticular
surface1
well-definedwithnon-scleroticmargin(though

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eccentric:iflargethismaybedifficulttoassess
Treatment
Classically,treatmentiswithcurettageandpackingwithbonechips
orpolymethylmethacrylate(PMMA).


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198.Whatshouldbethemostlikelydiagnosis
ofthis65yearoldladypresentswith
backacheandfollowingradiographof
thespineshowninimage?

a)Osteoporosis

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b)Spondylolisthesis
c)Spondylolysis
d)Discitis
CorrectAnswer-B
Answer.B.Spondylolisthesis

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Spondylolisthesisissubluxationoflumbarvertebrae,usually
occurringduringadolescence.
Itusuallyresultsfromacongenitaldefectintheparsinterarticularis
(spondylolysis).


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Spondylolisthesisisusuallyfixed(ie,permanentandlimitedin
degree).ItusuallyinvolvestheL3-L4,L4-L5,orL5-S1vertebrae.
Spondylolisthesisoftenoccursinadolescentsoryoungadultswho
areathletesandwhohavehadonlyminimaltrauma;thecauseisa
lumbarvertebraweakenedbyacongenitaldefectinthepars

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interarticularis(spondylolysis).
Thisdefectcaneasilyleadtofractures;separationofthefracture
fragmentscausesthesubluxation.Spondylolisthesiscanalsooccur
withminimaltraumainpatientswhoare>60andhave
osteoarthritis.

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Ifmildtomoderate(subluxationof=50%),spondylolisthesis,
particularlyintheyoung,maycauselittleornopain.
Spondylolisthesiscanpredisposetolaterdevelopmentofspinal
stenosis.
Ifduetomajortrauma,spondylolisthesiscancausespinalcord

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compressionorotherneurologicdeficits;thesedeficitsrarelyoccur.
[Thisx-rayshowsstage1spondylolisthesisofL5onS1.The
blackarrowshowstheposteriorborderofL5,whichsubluxes
anteriortoS1.Theredarrowpointstothespondylolysis
(congenitaldefectintheparsinterarticularis
).]

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Spondylolisthesisisstagedaccordingtothepercentageofvertebral
bodylengththatonevertebrasubluxesovertheadjacentvertebra:
StageI:0to25%
StageII:25to50%
StageIII:50to75%

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StageIV:75to100%
Spondylolisthesisisevidentonplainlumbarx-rays.Thelateralview
isusuallyusedforstaging.Flexionandextensionviewsmaybe
donetocheckforinstability.
Treatment

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Usuallysymptomatic.
Physicaltherapywithlumbarstabilizationexercisesmaybehelpful.

199.Whichofthefollowingattitudewillbeseeninapatientwithposterior
dislocationofhip?
a)Flexion,Abduction,Internalrotation

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b)Flexion,Adduction,Internalrotation
c)Flexion,Abduction,Externalrotation
d)Flexion,Adduction,Externalrotation
CorrectAnswer-B
Dislocationsareusuallyposterior,andoccasionallyanterior,orcentralthroughthe

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acetabulum.
Posteriordislocation:Hipisflexed,adducted,andinternallyrotated,andlegisshortened.
Anteriordislocation:Hipisflexed,abducted,andexternallyrotated,andlegisshortened.
Centraldislocation:Trochanterisdisplacedmedially.Onemaybeabletofeeltheheadof
femurrectally.Thereisnoshortening.

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200.TrueaboutTenosynovitisoffinger?
a)Fingersheldinmildextension/Extensiondeformityatthe
involvedfingers.
b)Tenosynovitisoflittlefingerwillspreadtothumbratherthanring
finger.

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c)Withinvolvementoflittlefingertheinfectioncanspreadtothe
indexfinger.
d)Treatmentisconservative.
CorrectAnswer-B
Ans.B.Tenosynovitisoflittlefingerwillspreadtothumbratherthan

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ringfinger
Infectionofthesynovialsheaththatsurroundstheflexortendon
Infectionfromtheflexortendonsheathofthethumbcanalsoextend
alongtheradialbursatothespaceofParonaandthenintotheulnar
bursaandtheflexortendonsheathofthelittlefinger--andvice

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versa--leadingtoa"horseshoe"abscess.
Horseshoeabscess:
Maydevelopfromspreadpyogenicflexortenosynovitis,ofmany
individualshaveaconnectionbetweenthesheathsofthethumband
littlefingersatthelevelofthewrist

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201.Mostcommonjointinvolvedinseptic
arthritis:
a)Knee
b)Hip
c)Shoulder

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d)Elbow
CorrectAnswer-A
Answer.A.Knee
Septicarthritis(Acutesuppurativearthritis)
Septicarthritisreferstopyogenicinfectionofajoint,i.e.,infectionof

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ajointbypyogenicorganism(bacteria).
Thejointcanbecomeinfectedby:?
1. Hematogenousspreadfromadistantsite(mostcommonroute).
2. Directinvasionthroughapenetratingwound,intraarticularinjection,
arthroscopy.

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3. Directspreadfromadjacentosteomyelitisespeciallyinjointswhere
Metaphysisisintraarticulare.g.,hipandshoulder.
Clinicalfeatures
Diseaseismorecommoninchildren.
Kneejointisthemostcommonlyaffectedjoint.

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Otherjointwhichareaffectedarehip,shoulderandelbow.Thechild
istoxicwithfever,tachycardia,tachypnea.
Thereisseverepain,swelling,andrednessoverthejoint.
Movementsareseverelyrestrictedandthejointisheldinthe
positionofease.Weightbearingonlimbisnotpossible.

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202.Painfularcsyndromepainisfeltduring?
a)Midabduction
b)Initialabduction
c)Fullrangeofabduction
d)Overheadabduction

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CorrectAnswer-A
Answer.A.Midabduction
PAINFULARCSYNDROME
OtherNames
Impingementsyndrome

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Supraspinatussyndrome
Swimmer'ssyndrome
Thrower'sshoulder
Clinicalsyndromecharacterizedbypainintheshoulderduringan
arcofmovementbetween60?and120?ofabduction.

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Etiology:
1. Minortearsofthesupraspinatustendon
2. Supraspinatustendinitis

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3. Calcificationofsupraspinatustendon
4. Subacromialbursitis
5. Fractureofthegreatertuberosity
6. Increaseinbulkofthecontentsinthesubacromialspace,seenin
inflammationoftherotatorcuff

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203.Whichofthefollowingisfalseas
physiologicalchangeinpregnancy?
a)Increasecardiacoutput
b)Increasetotalprotein
c)Increaseresidualvolume

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d)IncreaseGFR
CorrectAnswer-C
Ans.C.Increaseresidualvolume
Therespiratoryrateisessentiallyunchanged,buttidalvolumeand
restingminuteventilationincreasesignificantlyaspregnancy

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advances.
Thefunctionalresidualcapacityandtheresidualvolumeare
decreasedasaconsequenceoftheelevateddiaphragm.

204.Overtgestationaldiabetesisdefinedas
bloodglucosemorethan_?

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a)>200mg/dl
b)>126mg/dl
c)>100mg/dl
d)>180mg/dl
CorrectAnswer-B

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Ans.B.>126mg/dl
Iffastingis92-125mg/dlitisdiagnosedasGDMandifitis=126
mg/dlitisdesignatedasovertDiabetes

205.MgSO4havenoroleinpreventionof-
a)Seizuresinseverepre-eclampsia

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b)Recurrentseizuresineclampsia
c)RDSinprematurebaby
d)Bradycardia
CorrectAnswer-C
Ans.C.RDSinprematurebaby

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Indicatedtopreventseizuresassociatedwithpre-eclampsia,andfor
controlofseizureswitheclampsia.
Magnesiumsulfate(MgSO4)iscommonlyusedasananticonvulsant
fortoxemiaandasatocolyticagentforprematurelaborduringthe
lasthalfofpregnancy.

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ToxicityofI/Vmagnesiumsulfateincludescardiacarrhythmias,
muscularparalysis,respiratorydepressionandCNSdepressionin
motheraswellastheneonate.

206.Greenfrothyvaginaldischargeis
producedby?

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a)Herpessimplex
b)Candidaalbicans
c)Trichomonasvaginalis
d)Normalvaginalflora
CorrectAnswer-C

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Ans.C.Trichomonasvaginalis
Trichomoniasis?
Itisasexuallytransmitteddisease
Itisalmostentirelyadiseaseofchild-bearingage
Thevaginaldischargeisfrothy,slightlygreenincolourandprofuse.

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Therearemultiplepunctatestrawberryspotsonthevaginalvault
andportiovaginalisofcervix.Diagnosis:Cultureis98%reliable

207.Whichofthefollowingisanabsolute
CONTRAINDICATIONtoOCPuse:
a)Chronicrenaldisease

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b)DVT
c)Diabetesmellitus
d)Historyofamenorrhea
CorrectAnswer-B
Ans.B.DVT

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Contraindicationstocombinedoralcontraceptives
Theyaregenerallyacceptedtobecontraindicatedinwomenwith
pre-existingcardiovasculardisease,inwomenwhohaveafamilial
tendencytoformbloodclots/thrombosis(suchasfamilialfactorV
Leiden),womenwithsevereobesityand/orhypercholesterolemia

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(highcholesterollevel),andinsmokersoverage40.
COCParealsocontraindicatedforwomenwithlivertumors,hepatic
adenomaorseverecirrhosisoftheliver,andforthosewithknownor
suspectedbreastcancer.

208.Whichofthefollowingstatementis

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correctaboutacutefattyliverof
pregnancy?

a)Occursin1in1000pregnancy
b)Mostlyseeninlasttrimester
c)Commoniffemalefetusispresent

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d)Maybeassociatedwithdecreaseduricacid
CorrectAnswer-B
Ans.B.Mostlyseeninlasttrimester
Acutefattyliverofpregnancyisusuallyseeninobesewoman.
Itismorecommonlyseeninwomancarryingamalefoetus.

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Theneonateisatriskoffattyinfiltrationofliver.
ItMorecommonlyoccursin3rdtrimester.
ItMaybeassociatedwith?uricacid.

209.Femalewith41wkgestationconfirmed
byradiologicalinvestigation,verysure

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ofherLMP,nouterinecontractions,no
effacementandnodilatation.What
shouldnotbedone?

a)Intracervicalfoley's
b)PGE1tab

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c)PGE2gel
d)PGF2alpha
CorrectAnswer-D
Ans.D.PGF2alpha
PgF2alphaisauterinerelaxantsoitcan'tbeusedininductionof

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labour.

210.Doubledeciduasignisseenduring-
a)1Sttrimester
b)2ndearlytrimester
c)2ndlatetrimester

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d)3rdtrimester
CorrectAnswer-A
Ans.A.1sttrimester
Thedoubledecidualsacsign(DDSS)isausefulfeatureonearly
pregnancyultrasoundtoconfirmanearlyintrauterinepregnancy

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(IUP)whentheyolksacorembryoisstillnotvisualized.
The"DoubleDecidualSign",firstdescribedbyNybergandco-
workersconsistsoftwoechogenicringssurroundingthehypoechoic
gestationalsac.
Theinnerringrepresentsthechorion,embryonicdiscanddecidua

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capsularis.
Theouterringrepresentsthedeciduaparietalis.

211.60yearwomancomeswith3rddegree
uterineprolapse.Whatwillbethe
management?

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a)Vaginalhysterectomywithpelvicfloorrepair
b)Pelvicfloorrepair
c)Sacrospinousfixation
d)Pessary
CorrectAnswer-A

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Ans.A.Vaginalhysterectomywithpelvicfloorrepair
Uterineprolapsesurgeryisperformedtoremovetheuterusand
repairtheweaktissue.Uterineprolapsefrequentlyoccursin
postmenopausalwomenwho'vehadoneormorevaginaldeliveries.
Saggingofthepelvicmuscleswhichleadstouterineprolapse

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canoccur:
Ifsupportivetissuesaredamagedduringpregnancyanddelivery
Duetoestrogenloss
Asaresultofstrainingrepeatedlyovertheyears(chroniccough,
constipationetc.)

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Duetogravitationaleffects
Dependingonfactorslikeageofthewoman,desireforbecoming
pregnantandtheoverallstateofawoman'shealth,thetreatment
planisdecided.
Herethewomanisofoldage(nongestational)andhave3rddegree

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ofprolapse.SobestmanagementofchoicewillbeVaginal
hysterectomywithpelvicfloorrepair.

212.Day20ofmenstrualcyclefallsunder
whichphase?
a)Menstrualphase

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b)Follicularphase
c)Ovulationphase
d)Lutealphase
CorrectAnswer-D
Ans.D.Lutealphase

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TheentiredurationofaMenstrualcyclecanbedividedinto
fourmainphases:

1. Menstrualphase(Fromday1to5)
2. Follicularphase(Fromday1to13)
3. Ovulationphase(Day14)

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4. Lutealphase(Fromday15to28)

213.Chromosomenumberofpartial
hydatidiformmoleis-
a)46XX
b)45XO

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c)46XXY
d)69XXX
CorrectAnswer-D
Ans.D.69XX
Apartialhydatidiformmoleisatriploidpregnancywith69insteadof

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46chromosomesandanotherstrangecomplicationofthe
reproductiveprocess.
Partialhydatidiformmolecanbeidentifiedbyultrasoundshowing
placentatissue,somehygromatouscysts,somefetaloddities,but
noclearfetusstructure.

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Ultrasoundisstrictlyanindicator.Afterspontaneousabortionor
dilationandcurettage,tissueneedstobeexaminedbypathology
andcytogeneticsneedstobedetermined.
Ifatriploidkaryotypeisdeterminedas69,XXX,69XXY,or69XYY
[6],thenapartialmolecanbeconfirmed.

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214.Vulvaratrophyanditchingaretreated
by-
a)Estrogenointment
b)Antihistamines

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c)Tamoxifen
d)None
CorrectAnswer-A
Ans.A.Estrogensointment
Atrophicvaginitis,themedicaltermforthiscondition,occursasa

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resultofdeteriorationofthevaginaltissue.
It'sacommonconditioninpostmenopausalwomenbecauseas
estrogenlevelsdrop,thetissuethatlinesthevaginabecomes
thinnerandmoreeasilydamaged.
Womenwithatrophicvaginitismayalsoexperiencevaginalitching,

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burning,frequenturination,orvaginaldischarge.
Womencantreatthisconditiontopicallywithestrogencreams,
tablets(Vagifem),oranestrogen-releasingringplacedinthevagina
(Estring).
Oralestrogen,availablewithadoctor'sprescription,willalsorestore

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vaginaltissue.
Vaginallubricantsofferanalternativeforwomenwaryofusing
estrogen.
MoisturizerssuchasReplens,Astroglide,andLubrincanreduce
symptomsandmakesexualintercoursemorecomfortable.

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215.Prematureejaculationisapartofwhichphaseof
sexualdisorders?
a)Excitementphase
b)Plateauphase
c)Orgasmphase

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d)Refractoryphase
CorrectAnswer-C
Ans.C.Orgasmphase
Themalesexualresponseisdescribedasasequenceofphases
including4stages:sexualdesire,arousal,orgasm(ejaculation)and

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resolution.
Themalesexualdysfunctionusuallyoccursinoneormoreof
thethreefirststagesofthesexualresponsecycle,including:
Dysfunctionsofsexualdesire(e.g.hypoactivesexualdesire)
Arousal(e.g.erectiledysfunction)

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Orgasm/ejaculation(e.g.prematureejaculation,retardedejaculation
orinabilitytoejaculate).
Prematureejaculationoccursduetotherapidevolutionofthetwo
firststagesofthesexualresponsecycleandisnotnecessarily
relatedtostrongsexualarousalorchangesinerection.

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PrematureEjaculationseemstobeaneurobiologicalproblemthatis
relatedtolowserotoninlevelsinthoseregionsofthecentralnervous
systemthatregulateejaculation(brainandspinalcord).


216.NuchaltranslucencyinUSGcanbe

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detectedat_____weeksofgestation.
a)11-13weeks
b)18-20weeks
c)8-10weeks
d)20-22weeks

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CorrectAnswer-A
Ans.A.11-13weeks
Nuchaltranslucencyisthenormalfluid-filledsubcutaneousspace
identifiedatthebackofthefetalneckduringthelatefirsttrimester
andearlysecondtrimester(11.3-13.6weeks).

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217.Firstlineoftreatmentofmastitisina
lactatingmotheris-
a)Dicloxacillin
b)Cefazolin
c)Ceftriaxone

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d)Ampicillin
CorrectAnswer-A
Ans.A.Dicloxacillin
Thebetalactamase-resistantpenicillinshavebeenrecommendedin
thetreatmentofmastitis.Theseincludecloxacillin,dicloxacillin,or

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flucloxacillin.
Becausepenicillinsareacidic,theyarepoorlyconcentratedin
humanmilk,whichisalsoacid.
Therefore,cloxacillinanditscongenerstendtotreatcellulitiswell,
buttheyarelesseffectiveineradicatingadenitis,themostlikely

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precursorofbreastabscess.
Whenpatientsareallergictopenicillins,cephalexinorclindamycin
maybethealternativetoerythromycin.
Combinationlikeco-amoxiclavshouldbeavoidedbecauseoffearof
inducingMRSA

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218.Patientwithrecurrentabortion
diagnosedtohaveantiphospholipid
syndrome.Whatwillbethetreatment?

a)Aspirinonly
b)Aspirin+LowmolecularweightHeparin

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c)Aspirin+LowmolecularweightHeparin+Prednisolone
d)NoTreatment
CorrectAnswer-B
Ans.B.Aspirin+LowmolecularweightHeparin
Therecommendedtreatmentforwomenwithrecurrentpregnancy

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lossassociatedwithantiphospholipidsyndromeincludescombined
AspirinandHeparintherapy.
InpregnantSLEpatientswithAntiphospholipidantibodiesandprior
fetalloss,treatmentwithheparin(standardorlow?molecular-
weight)pluslowdoseaspirinhasbeenshowninprospective

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controlledtrialstoincreasesignificantlytheproportionoflivebirths.
Combinedaspirinandheparintherapyhasproveneffectivenessand
isthepreferredtreatmentforwomenwithrecurrentpregnancyloss
associatedwithantiphospholipidsyndrome.

219.GestationalTrophoblasticneoplasm

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doesnotinclude-
a)Choriocarcinoma
b)Placentalsitetrophoblastictumour
c)Invasivemole
d)Partialmole

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CorrectAnswer-D
Ans.D.PartialMole
Themaintypesofgestationaltrophoblasticdiseasesare:
Hydatidiformmole(completeorpartial)
Invasivemole

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Choriocarcinoma
Placental-sitetrophoblastictumor
Epithelioidtrophoblastictumor
Note:Inthegivenbestoptionbestanswercanbepartialaspartial
hydatidiformmoleisnotcompletelymentionedinit.

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220.Whichvaccineiscontraindicatedin
pregnancy:
a)Chickenpox
b)Rabies
c)Tettoxoid

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d)HepatitisB
CorrectAnswer-A
Ans.A.Chickenpox
Asaruleofthumbthevaccinationwithliveviralorbacterialvaccine
iscontraindicatedinpregnancy.

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Theimportantonesare:?
Measles
Mumps
Poliomyelitis
Rubella

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Yellowfever
Varicella
BCG

221.45yearsfemalewith3months
menorrhagia.USGshowing2cm

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submucosalfibroid.Treatmentoptions.

a)Ocpfor3months
b)Progesteronefor3months
c)Endometrialsampling
d)Hysterectomy

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CorrectAnswer-D
Ans.D.Hysterectomy
YOUNGWOMEN
OLDERWOMEN
Contraceptiondesired

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CombinedOCPs
Contraception
Ruleoutcancer&uterine
Progestogensandother
notdesirable

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pathology
hormones
Mirena
Normaluterus
Uterine

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Progestogens
Effective Fails
(DUB)
pathology
Ethamsylate,

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Minimal
Progestogens
NSAIDs
invasive
andothers

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Estrogen
Continue surgery
?Noresponse
Tranexamicfor for6?9 Hysterectomy Hysterectomy Surgery
3?4months

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months with
withremovalof
GnRH3?4
conservation
ovariesafter50

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months
ofovaries
years
Removalofanintrauterinecontraceptivedeviceifmedicaltherapy
fails.

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Myomectomy/hysterectomyforuterinefibroids.

Wedgeresection/hysterectomyforadenomyosisoftheuterus.
Dilatationandcurettagewithbloodtransfusionistheprimary
treatmentofpubertymenorrhagiawithlowHb%
Multipara,hypertensivewomanwithmenorrhagiashouldbetreated

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withMIRENA
Hysterectomywithorwithoutremovaloftheadnexaaccordingtothe
ageandtheindividualneedsofthepatient.

222.Inlowovarianreserve,antimullerian
hormonelevelwillbe:

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a)<1
b)1-4
c)>7
d)>10
CorrectAnswer-A

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Ans.A.<1
AMHandovarianreserve
AMHof1.0hasverypoorovarianreserve
ThecentralconceptforthemeasurementofbloodlevelsofAMHto
determineovarianreserveisthis:womenwithlowerAMHlevels

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havealowerovarianreservethanwomenwithhighAMHlevels.
AMHiscurrentlybeingusedbyfertilityspecialiststohelppredict
womenwhomayrespondpoorlytofertilitymedicationsandin
general,coupleswhoarelesslikelytobesuccessfulwithfertility
treatment.

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223.Presentingdiameteroffullflexedhead:
a)Suboccipito-bregmaticdiameter
b)Suboccipito-frontaldiameter
c)Occipito-frontaldiameter
d)Occipito-posteriorposition

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CorrectAnswer-A
Ans.A.Suboccipito-bregmaticdiameter
Suboccipito-bregmaticdiameter:
Thediameterisfromsuboccipitalregiontocentreofthebregma.
Diameter=9.5cm

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Fetalheadcircumferenceissmallest(32cm)
Headwellflexed
Flexedvertexpresentation
Suboccipito-frontaldiameter:
Diametercalculatedfromprominenceatmidfrontalbonetothe

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under-surfaceoftheoccipitalbonewhereitjoinsneck
Thediameteris10.5cm
Vertexispartiallydeflexed.
Resultsinoccipito-posteriorposition.
Occipito-frontaldiameter:

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Diameterextendsfromtheprominentpointofmid-frontalbonetothe
mostprominentpointofoccipitalbone
Thediameter=11.5cm
Fetalheadcircumference~34.5cm
Vertexisdeflexed

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AssociatedwithDirectoccipito-posteriorposition.
Occipito-posteriorposition:
Itisavertexpresentationinwhichtheocciputisplacedposteriorly.



224.Whatisthedoseofulipristalacetate?

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a)300mg
b)30mg
c)300?g
d)30?g
CorrectAnswer-B

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Ans.B.30mg
Ulipristal(Ella)isaprogesteroneagonist/antagonistmarketedfor
emergencycontraception.Itisavailablebyprescriptiononly.Its
mechanismofactionvariesbasedontimeofadministration.When
takenbeforeovulation,ulipristaldelaysorinhibitsovulation.

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Administrationintheearlylutealphasemaydecreaseendometrial
thicknessandaffectimplantationofafertilizedegg.
Ulipristalislabeledforuseasanemergencycontraceptivefollowing
unprotectedsexualintercourseorcontraceptivefailure.
Onetablet(30-mgtablet)takenassoonaspossible,within120

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hours(fivedays)ofunprotectedsexualintercourseorcontraceptive
failure.

225.Themajorcontributionoftheamniotic
fluidafter20weeksofgestation:
a)Ultrafiltrateandmaternalplasma

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b)Fetalurine
c)Fetallungfluid
d)Fetalskin
CorrectAnswer-B
Ans.B.Fetalurine

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Therearetwoprimarysourcesofamnioticfluid:fetalurineandthe
lungliquid.
Afterabout20weeks,fetalurinemakesupmostofthefluid.

226.PGF2alphamaximumdoseinPPHis-
a)2000?g

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b)200?g
c)2mg
d)20mg
CorrectAnswer-C
Ans.C.2mg

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DrugdosesformanagementofPPH:
15-MethylprostaglandinF2a:
Doseandroute:IM:0.25mg
Continuingdose:0.25mgevery15minutes
Maximumdose:8doses(Total2mg)

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Precautions/contraindications:Asthma

227.Allaretrueaboutskinexcept:
a)Bothdermis&ectodermarederivedfromectoderm
b)Skinaccountsfortotalof15%ofbodyweight
c)Mostofthecellsinskinarekeratinocytesderivedfrom

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ectoderm
d)Dermisismadeupoftype1andtype3collagenin3:2ratio
CorrectAnswer-A
Ans:A.Bothdermis&ectodermarederivedfromectoderm.
Truefact:Dermisderivedfrommesodermandepidermisfrom

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ectoderm.

228.Anaestheticgaswithmaximum
respiratoryirritation
a)Halothane
b)Enflurane

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c)Desflurane
d)Sevoflurane
CorrectAnswer-C
Ans:C.Desflurane
Desfluraneandisofuranewhenusedforinductioncauserespiratory

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irritationduetotheirpungentsmellleadingtobreathholdingand
coughing.
Halothaneandsevofluranedonotcausesucheffects.

229.IVadministrationofwhichanesthetic
drugismostpainfulamongthe

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following?

a)Methohexital
b)Ketamine
c)Propofol
d)Etomidate

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CorrectAnswer-C
Ans:c.Propofol
Propofolpreparation:
Oil-based
preparation(soybeanoil,egglecithin&glycerol).
Hence,painoninjection&rarelythrombophlebitis.

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230.Whichofthefollowingisnot
cardiodepressive?
a)Propofol
b)Thiopentone
c)Ketamine

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d)Etomidate
CorrectAnswer-D
Ans:D.Etomidate
Majoradvantageofetomidate:
Cardiovascularstabilityafterinduction.

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Effectsofetomidateinductiondose:
Negligibleincreaseinheartrate.
Littledecreaseinbloodpressure/cardiacoutput.
Littleeffectoncoronaryperfusionpressure,whilereducing
myocardialO2consumption.

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231.Whichofthefollowingisthemost
commonmethodusedtoknowdepth
ofanaesthesia?

a)BIS
b)Oesophagealcontractility

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c)Depressedresponses
d)Hypotension
CorrectAnswer-A
Ans:A.BIS
Bispectralindex:

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*1stscientificallyvalidated&commerciallyavailablemonitorto
checkdepthofanaesthesia.
*Utilizesmanyparameters(EEGsignals,eyeblinks)tocalculate
depthscore.
Adequatedepth:

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*Scoreof45-60.
Fullyawakestate:
*Scoreof100
Completelysilentbrain:0.

232.MRP2associatedwithwhichofthe

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following?
a)Rotorsyndrome
b)Dubin-Johnsonsyndrome
c)Crigler-Najjarsyndrome
d)Gilbertsyndrome

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CorrectAnswer-B
Ans:B.Dubin-Johnsonsyndrome.
Dubin-Johnsonsyndrome:
Anautosomalrecessivedisorder.
Causedbygenemutationresponsibleforhumancanalicular

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multispecificorganicaniontransporter(cMOAT)protein/also
referred"multidrugresistanceprotein2(MRP2)"orABCC2.

233.Whichofthefollowingiswatersoluble
contrast?
a)Barium

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b)Iodine
c)Bromium
d)Calcium
CorrectAnswer-B
Answer-B.Iodine

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Radiocontrastagentsaretypicallyiodine,barium-sulphateor
gadoliniumbasedcompounds.

234.Solitarylyticlesionsseenin
a)Atherosclerosis
b)Multiplemyeloma

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c)Mitralstenosis
d)Osteoblast
CorrectAnswer-B
Answer-B.Multiplemyeloma
F:fibrousdysplasia(FD)orfibrouscorticaldefect(FCD)

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O:osteoblastoma
G:giantcelltumor(GCT)
M:metastasis(es)/myeloma
A:aneurysmalbonecyst(ABC)
C:chondroblastomaorchondromyxoidfibroma

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H:hyperparathyroidism(browntumor)
I:infection(osteomyelitis)
N:non-ossifyingfibroma(NOF)
E:enchondromaoreosinophilicgranuloma(EG)
S:simple(unicameral)bonecyst

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235.Nottrueaboutsomnambulismamong
thefollowingis?
a)Sleepwalking.
b)Patientconsciousnessispreserved.
c)Disorderofsleeparousal.

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d)Lowlevelmotorskill/functionispresent
CorrectAnswer-D
Ans:D.Lowlevelmotorskill/functionispresent.
Sleepwalking(somnambulism):
Thepatientsmaycarryoutarangeofactivitiesforwhichhedoesn't

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haveanymemorylateron.
Itmayincludeleavingthebedandwalkingaboutandalsoactivities
likedressing,movingaroundorevendriving.

236.Confusionassessmentscaleusedfor
whichofthefollowing?

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a)Schizophrenia
b)Delirium
c)Dementia
d)Depression
CorrectAnswer-B

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Ans:B.Delirium
ConfusionAssessmentMethod(CAM),awidely-usedinstrument
anddiagnosticalgorithmforidentificationofdelirium.
TheCAMinstrumentassessesthepresence,severity,and
fluctuationof9deliriumfeatures:

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Acuteonset
Inattention
Disorganizedthinking
Alteredlevelofconsciousness
Disorientation

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Memoryimpairment
Perceptualdisturbances
Psychomotoragitationorretardation
Alteredsleep-wakecycle.
TheCAMdiagnosticalgorithmisbasedonfourcardinal

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featuresofdelirium:
Acuteonsetandfluctuatingcourse
Inattention
Disorganizedthinking
Alteredlevelofconsciousness.

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237.Whichofthefollowingisthepoor
prognosticfactorforOCD?
a)Magicalthinking
b)Dirtcontamination
c)Pathologicaldoubt

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d)Hoarding
CorrectAnswer-B
Ans:B.Dirtcontamination.
OCD-Clinicalfeatures&symptoms:
Contamination
?Mostcommonobsession.

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Obsessionofcontaminationcompulsiveavoidingofcontaminated
objectsexcessivecleaning-->inabilitytoleavetherehomes(due
togermsfear,shame&disgustfromfeces,urine,dust&germs).
Pathologicaldoubt?2ndmostcommon.
Obsessionofdoubtcompulsivecheckingmostdangerof

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violenceforgettingtoturnoffthestove,ornotlockingthe
door,somepatientcantravelbackhomeseveraltimes.
Obsessionofself-doubtfeelingguiltyaboutissues
Intrusivethoughts?3rdmostcommon.
Intrusiveobsessionalthoughtswithoutcompulsion(repetitive

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sexualoraggressiveacts,patientsobsessedoftherethoughts,
maythinkthattheysupposetoreportthemtothepoliceorto
makeaconfessiontothepriest.
Symmetry?4thmostcommon.
Needforsymmetryofprecisioncompulsionofslowness,patient

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cantakeanhourtoeatamealorshavetheirfaces.

238.Testbasedontheprincipleofsuspect's
reaction,ifhewitnessesaneventthen
hebehavesinacertainwayis?

a)Narcoanalysis

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b)Brainmapping
c)Truthserumtesting
d)Polygraph
CorrectAnswer-D
Ans:D.Polygraph

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239.Intensedepression&miserywithoutany
causeis?
a)Melancholia
b)Majordepressivedisorder
c)Mania

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d)Schizophrenia
CorrectAnswer-A
Ans:A.Melancholia

240.Whichofthefollowingisnottrue
regardingdelusionaldisorder?

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a)Heldwithabsoluteconviction
b)Usuallyfalse
c)Notamenabletoreasoning
d)Occursatearlyage
CorrectAnswer-D

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Ans:D.Occursatearlyage.
Delusionaldisordermayaccountfor1?2%ofadmissionstoinpatient
psychiatrichospitals.
Ageatonsetrangesfrom18?90years,withameanageof40years


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241.Identifytheconditionshownintheimage
below.
a)Intertrigo
b)Heatrash
c)Eczema

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d)Impetigo
CorrectAnswer-A
Ans.A.Intertrigo
ImageshowsIntertrigorashonthebackofa4montholdbaby's
neck.

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Intertrigoiscausedbywarmmoistfoldsofskinrepeatedlyrubbing
together.
Theaffectedareamaybecomeblisteredorinfectedwithbacteriaor
fungi.
Intertrigoisacommonconditioninbabiesandistreatedwithnappy

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creamandkeepingtheaffectedareacleananddry.


242.IdentifytheinfectionfromthechestX-
rayofapatientwithlow-gradefever?
a)ILD

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b)Bronchopneumonia
c)MiliaryTB
d)Consolidation
CorrectAnswer-C
Answer-C.MilitaryTB

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Miliarytuberculosisisduetohematogenousdisseminationof
tuberclebacilli.
Thisisduetothehematogenousspreadofinfectionandmaybe
seeninbothprimaryandpost-primarydisease.
Atfirst,thechestradiographmaybenormalbutthensmall,discrete

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nodules,1-2mmindiameter,becomeapparent,evenlydistributed
throughoutbothlungs.Thesemayenlargeandcoalescebutwith

adequatetreatment,theyslowlyresolve.
Denseopacitiesoccurwithcalcificationandmetallicdustdisease


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243.Identifytheconditiongiveninthe
image?
a)Atrialfibrillar
b)Atrialflutter
c)Ventriculartachycardia

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d)SVT
CorrectAnswer-C
Answer-C(Ventriculartachycardia)
MonomorphicVT
Regularrhythm.

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Originatesfromasinglefocuswithintheventricles.
ProducesuniformQRScomplexeswithineachlead--eachQRSis
identical(exceptforfusion/capturebeats).


244.Apatientpresentedwithhistoryof

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diplopiaandrestrictedeyemovements.
AclinicalimageandCTimageisshown
below.Whatwillbethediagnosis?

a)Le-fortfracture
b)Fracturemaxilla

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c)Fracturezygomatic
d)Blowoutfracture
CorrectAnswer-D
Answer-D(Blowoutfracture)
Anorbitalblowoutfractureisatraumaticdeformityoftheorbitalfloor

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ormedialwall,typicallyresultingfromimpactofabluntobjectlarger
thantheorbitalaperture,oreyesocket.


245.Identifytheradiologicalprocedure
shownbelow?

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a)Bariummealfollowthrough
b)Bariumenema
c)Enteroclysis
d)Proctography
CorrectAnswer-A

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Answer-A(Bariummealfollow-through)
*Asmallbowelfollow-throughisasinglecontraststudy(oral
contrast,eitherbariumorwater-solublecontrast).
*ItisoftenperformedafteranupperGIfluoroscopystudy,asthe
contrastcolumnmovesfromthestomachandduodenumtothe

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smallbowel.
*Mostsmallbowelcontrastexaminationsperformedasapartofan

upperGIseries-bariummealandfollow-through.
*Thesmallbowelfollow-throughcanbeusefulforevaluationof:
-strictures

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-obstruction
-diverticula
-masses
-extraluminaltethering
-abnormalmotility

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246.Identifytheconditioninthebelow
image?
a)Lacunarinfarct
b)Embolicinfarct

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c)Thromboticinfarct
d)Intracerebralhemorrhage
CorrectAnswer-A
Answer-A.Lacunarinfarct
ThisimageshowsaCTscanofalacunarinfarct.

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Occlusionofalargerperforatingvesselcausesalacunarinfarct.
Acutely,lacunarinfarctsareoftenroundedwithahazyoutlineand
mayfluctuateinsizeinthesubacutephase--mostoftenenlarging.
Whenmature,however,theybecomesharplydelineated,shrinkin
size--typicallylessthan1.5cmdiameter--andcavity-like.

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ThegliotichyperintenserimofamaturelacuneonFLAIR
differentiatesitfromaperivascularspace.
IOCforHyperacuteInfarctMRI[bestsequence?DWI]
Acute/hyperacuteinfarctsshowrestricteddiffusion



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247.Achildwithhistoryoffever,
photosensitivity,rashsparingnasolabial
foldpresentstoOP.Identifythe
condition?

a)SLE

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b)Polymorphouslighteruption
c)Discoidlupus
d)Skintuberculosis
CorrectAnswer-A
Ans:A.SLE.

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Clinicalpresentation:
Mostcommonrashisphotosensitive,raisederythematous
malarrash.
55-85%developatsomepointindisease
DiscoidLupusErythematosus(DLE):15-30%circular,scaly

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hyperpigmentedlesionswitherythematousrim,atrophiccenter
--canbedisfiguring
Mouth/vaginal/nasalulcers
Alopecia:maybediffuseorpatchy.Occurs50%.



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248.Patientpresentswithpuritiesofinter
digitsoflefthandasshownintheimage.
Identifythecondition?

a)Sarcoptesscabis
b)Dermatitisherpetiformis

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c)Xeroticdermatitis
d)Erythemamultiforme
CorrectAnswer-A
Ans:A.Sarcoptesscabis
Scabiesisanintenselypruriticskinconditioncausedbyinfestation

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withthemicroscopicmiteSarcoptesscabiei.
Sarcoptesscabieivarhominis,andistransmittedfrompersonto
personbyskin-to-skincontact.
Sarcoptesscabieimite:


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Burrowedintotheepidermis,themite,itsfecesandovalaidby
femalesseemtocausetheirritationthatleadstoitchingand
secondaryinfectionfromscratching.
Scabieslikewarmplaces,suchasskinfolds,betweenthefingers,
underfingernails,oraroundthebuttockorbreastcreases.Theycan

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alsohideunderwatchstraps,braceletsorrings.


249.Identifythecondition.Thisischildwith
asthmaticmother.
a)Atopicdermatitis

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b)SLE
c)Erythema
d)TEN
CorrectAnswer-A
Ans:A.Atopicdermatitis

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Atopicdermatitis(eczema)isatypeofinflammationoftheskin
(dermatitis)resultinginitchy,red,swollen,andcrackedskin.
Alsoknownas"atopiceczema".
Longlasting(chronic)&tendstoflareperiodically.
Commoninchildren(canoccuratanyage).

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Usuallystartsininfancyorearlychildhood.
Childrenwithfamilyhistoryofatopicdermatitis,asthmaorhayfever
aremorelikelytodevelopatopicdermatitis.


250.Identifytheconditionshowninthe

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image?
a)Sebaceouscyst
b)Alopeciaareta
c)Trichotillomania
d)Tineacapitis

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CorrectAnswer-B
Ans:B.Alopeciaareta
Alopeciaareataisanautoimmunedisordercharacterizedby
transient,non-scarringhairlossandpreservationofthehairfollicle.
Hairlosscantakemanyformsrangingfromlossinwell-defined

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patchestodiffuseortotalhairloss,whichcanaffectallhairbearing
sites.
Patchyalopeciaaffectingthescalpisthemostcommontype.


251.Identifytheconditionintheimage?

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a)Leukoderma
b)Piebaldism
c)Vitiligo
d)DLE
CorrectAnswer-A

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Ans:A.Leukoderma
Leukodermaisaskindiseasethatcauseslossofskinpigmentation
(melanin)thatleadstoskinwhitening.
Thewhitepatchesontheskinaretermedasleukoderma.
Whentheconditiongetssevere,thespotscoveralmostallpartsof

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thebodyincludingscalp,faceandthegenitals.


252.Whichofthefollowingregardingthe
conditiondepictedintheimage?
a)Maybeanindicationofskinmalignancy

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b)Hypopigmentation
c)MaybeassociatedwithInsulinresistantdiabetesmellitus
d)Commonlyoccursinleanandthin.
CorrectAnswer-C
Ans:C.MaybeassociatedwithInsulinresistantdiabetesmellitus

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Acanthosisnigricansisassociatedwithobesityandinsulin
resistanceinmajorityofthepatients.
Acanthosisisdiffuseepidermalhyperplasia(thickeningoftheskin).
ImpliesincreasedthicknessoftheMalpighianlayer(stratumbasale
andstratumspinosum).

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Occursprimarilyinflexuralareasasvelvetyhyperpigmentation.
Commonlyseeninaxilla.
Maybeareflectionofendocrinopathysuchasacromegaly,
cushing'ssyndrome,polycysticovariansyndrome&GIT
malignancy.

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253.Thecausativeorganismforthecondition
depictedinimageis?
a)Staphylococci
b)Candidalinfection

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c)Streptococcus
d)Actinomycetes
CorrectAnswer-A
Ans:A.Staphylococcus.
Impetigo:

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LesionsofcommonorsuperficialimpetigomaycontaingroupA?-
hemolyticstreptococci,Saureus,orboth.
Mostcommonskininfectioninchildren.
Highlycontagious.
Lesionsinbullous(staphylococcal)impetigo:

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CausedbySaureus.
Aresuperficial,thin-walled&bullous.
Onruptures-->resultsinthin,transparent,varnish-likecrust

appears.
Distinguishedfromstuck-oncrustofcommonimpetigo.

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Isdistinctiveappearanceofbullousimpetigo.
Duetolocalactionofepidermolytictoxin(exfoliation).


254.Identifytheconditionasshown:
a)Brodieabscess

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b)Osteoidosteoma
c)Intracorticalhemangioma
d)Chondromyxoidfibroma
CorrectAnswer-A
Answer.A.Brodieabscess

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Brodieabscessisanintraosseousabscessrelatedtoafocusof
subacutepyogenicosteomyelitis.
Unfortunately,thereisnoreliablewayradiographicallytoexcludea
focusofosteomyelitis.
Ithasaproteanradiographicappearanceandcanoccuratany

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locationandinapatientofanyage.
Itmightormightnotbeexpansile,haveascleroticornonsclerotic
border,orhaveassociatedperiostitis.

Epidemiology
Typicallythesepresentinchildrenwithunfusedepiphysealplates,

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morefrequentlyinboys.
Location
Ithasapredilectionforends(metaphysis)oftubularbones:
1. proximal/distaltibialmetaphysis(mostcommon)
2. carpalandtarsalbones

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3. Rarelytraversingtheopengrowthplate;epiphysis(inchildrenand
infants).
Radiographicfeatures
Plainradiograph
lyticlesionofteninanovalconfigurationthatisorientedalongthe

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longaxisofthebone
surroundedbyathickdenserimofreactivesclerosisthatfades
imperceptiblyintosurroundingbone
lucenttortuouschannelextendingtowardgrowthplatepriorto
physealclosure(pathognomonic)

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periostealnew-boneformation+/-adjacentsoft-tissueswelling


255.14yroldchildwithNaiveRheumatoid
Arthritispatientasshowninimage.
Whatshouldbethecorrecttreatmentof

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givencondition:

a)DMARDwithshortcourseofSteroids
b)OnlyNSAID'S
c)DMARDafterinitial3monthsofNSAID'S
d)MonotherapywithTNFdrugs

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CorrectAnswer-A
MonotherapywithTNFdrugs
AnswerA.DMARDwithSteroids
GivenconditionisRheumatoidArthritis

Rheumatoidarthritis(RA)isachronicautoimmunemultisystemic

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inflammatorydiseasewhichaffectsmanyorgansbutpredominantly
attacksthesynovialtissuesandjoints.
Clinicalfeatures:
Itoccursbetweentheageof20to50years.
Womenareaffectedabout3timesmorecommonlythanmen.

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Followingpresentationsarecommon:
a)Anacute,symmetricalpolyarthritis:
Painandstiffnessinmultiplejoints(atleastfour)
Symptomsofarticularinflammation.
Thejointsaffectedmostcommonlyarethemetacarpo-phalangeal

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joints,particularlythatoftheindexfinger.
Otherjointsaffectedcommonlyare(giveninTable):
Common
?MPjointsofhand
?PIPjointsoffingers

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?Wrists,knees,elbows,ankles
?Hipjoint
Lesscommon
?Temporomandibularjoint
?Atlantoaxialjoint

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Uncommon
?Facetjointsofcervicalspine
Onexamination:
Swollenboggyjointsasaresultofintra-articulareffusion,synovial
hypertrophyandoedemaoftheperiarticularstructures.

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Thejointsmaybedeformed.
DeformitiesinRheumatoidarthritis
Hand
?Ulnardriftofthehand
?Boutonnieredeformity

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?Swanneckdeformity
Elbow
?Flexiondeformity
?Early?flexiondeformity
Knee

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Late?triple*subluxation
Ankle
?Equinusdeformity
Foot
?Halluxvalgus,Hammertoe,etc.

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Treatmentandprognosis
TreatmentofRAisaimedatimprovingthesymptomsandslowing
diseaseprogression.
Therapyiswithacombinationofcorticosteroids,non-steroidalanti-

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inflammatorydrugs(NSAIDs),diseasemodifyinganti-rheumatic
drugs(DMARDs),andTNFantagonists(e.g.etanercept).


256.In34weeksgestationtheweightofbaby
was3kg.Thechildshowsfollowing

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featuresmayindicateassociated
condition?

a)Anemia
b)Diabetes
c)APH

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d)None
CorrectAnswer-B
Ans.B.Diabetes
Macrosomiaisthetermusedtodescribealargefetus.
MacrosomiaisassociatedwithGestationaldiabetesandMaternal

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obesity
Therecommendeddefinitionisfetal(neonatal)weightexceeding
twostandarddeviationsorabove90thcentilefortheappropriate
normalpopulation.
AccordingtoACOG:birthweightof>4500gmiscalledas

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macrosomia.
InIndiancontextBirthweightof>4000gmiscalledasmacrosomia.

257.


30yearoldwomanwithcomplaintof

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dysmenorrhoea,dyspareuniawithchronic
pelvicpainundergoeshysterectomy.From
thecutsectionofhysterectomyspecimen
belowidentifythecondition.

a)Adenomyosis

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b)Fibroids
c)Leiomyoma
d)Endometriosis
CorrectAnswer-A
Ans.A.Adenomyosis

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Crosssectionthroughthewallofahysterectomyspecimenofa30-
year-oldwomanwhoreportedchronicpelvicpainandabnormal
uterinebleeding.Theendometrialsurfaceisatthetopoftheimage,
andtheserosaisatthebottom.
Adenomyosisiswherethetissuefromtheliningofwombpenetrates

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intothemuscle.

Adenomyosiscanbediffuseorfocal.theultimatemanagementof
adenomyosisishysterectomy.


258.Identifythetypeofplacentapraeviaas

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showninthepicturebelow?
a)I.
b)II.
c)III.
d)IV.

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CorrectAnswer-B
Ans.B.II




259.Afemalepatientpresentedwith

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recurrentUrinarytractinfections.
Imagingshowsthefollowingpicture.
Whatcanbethemostprobable
diagnosis?

a)DuplicationofUreter

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b)CongenitalMegaureter
c)Ureterocele
d)UrinaryStones
CorrectAnswer-C

Ans.C.Ureterocele

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Plainradiographshowsnocalcificationalongtheurinarytract.Post
intravenouscontrastradiographshowsdilatationoftheleftdistal
uretershowinga"cobra'shead"appearanceand"radiolucenthalo"
effect.FindingsrepresentintravesicalUreteroceleofleftureter.
Ureterocelerepresentsabnormaldilatationofthedistalureteric

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segment.Ureterocelemaybeassociatedwitheitherasingleora
duplexureter.Uretericduplicationispresentinabout75%casesof
ureteroceles.Ureterocelehasafemalepredilection.
Ureterocelecanbefurtherclassifiedintosimpleandectopictypes.


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260.Identifythetriangleintheimagebelow-
a)Koch'striangle
b)Gastrinomatriangle
c)Hesselbach'striangle
d)Sherren'striangle

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CorrectAnswer-B
Answer-B(Gastrinomatriangle)
Explanation-
Thegastrinomatriangle,alsoknownasPassaro'striangle.
Thetriangleisformedbyjoiningthefollowingthreepoints:

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superiorly:confluenceofthecysticandcommonbileducts
inferiorly:junctionofthesecondandthirdportionsoftheduodenum
medially:junctionoftheneckandbodyofthepancreas


261.Identifytheinstrument-

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a)Bladeno.15
b)Bladeno.10
c)Bladeno.11
d)Blade12
CorrectAnswer-C

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Answer-C(Surgicalblade11)
Explanation-
TheNo.11isalsousedforothersmallincisionsforexamplewhen
insertingalaparoscopicport,veinandarterycentrallines,opening
theaortaandremovingcalcificationsintheaorticormitralvalves.

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262.Identifythetypeofknotintheimage-
a)Grannyknot
b)Surgeon'sknot
c)Reefknot

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d)None
CorrectAnswer-A
Answer-A(Granny'sknot)
Thegrannyknotisabindingknot,usedtosecurearopeorline
aroundanobject.

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263.IdentifytheconditionintheECG?
a)Atrialfibrillation
b)Arrhythmia
c)Atrialflutter

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d)Cardiomyopathy
CorrectAnswer-C
Answer.C.Atrialflutter
Atrialflutter
(AFl)isacardiacdysrhythmiacharacterizedbyrapid
andregulardepolarizationoftheatriathatappearsasasawtooth

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patternontheelectrocardiogram(ECG)andiscategorizedintotype
I(typical)andtypeII(atypical)AFl.


264.Apatientisaknowncaseofacute
pancreatitisdevelopsbreathlessness,

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bilateralbasalcrepitationonday4and
chestradiographyasshownintheimage
below.Whatwillbethediagnosis?

a)Bilateralpneumonia
b)ARDS

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c)CarcinogenicPE
d)Collapse

CorrectAnswer-B
Answer-b.ARDS
Acuterespiratorydistresssyndrome
(ARDS)istypeof

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respiratoryfailurecharacterizedbyrapidonsetofwidespread
inflammationinthelungs.
Bilateralopacitiesonchestimaging(chestradiographorCT)not
explainedbyotherlungpathology(e.g.effusion,lobar/lungcollapse,
ornodule.

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265.Identifytheimagewiththediagnosis?
a)VT
b)PSVT
c)AT

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d)Ventricularfibrillation
CorrectAnswer-B
Answer.B.PSVT
Supraventriculartachycardia(SVT).
Supraventriculartachycardia
isanabnormallyfastheartbeatthatoriginatessomewhereabovethe

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ventricles.It'scausedbyabnormalcircuitryintheheartthatis
usuallypresentatbirthandcreatesaloopofoverlappingsignals.


266.Apatientcameinemergencywithsevere
abdominalpainpulse112/minuteand

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systolicBP80mm/HgwiththechestX-
rayshownbelow.Whatwillbethenext
appropriatesteptobetakenforthe
patient?

a)Exploratorylaprotomy

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b)SalineWashofstomach
c)Intercostaltubedrainage
d)None
CorrectAnswer-A
Answer.A.Exploratorylaparotomy

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AboveX-rayshowsairunderleftdiaphragm(pneumoperitoneum)
whichindicateshollowviscousperforationwithpartialintrathoracic

positionedstomach.
Thispatientwillrequireemergencyexploratorylaparotomy.
Thisisoneofthecommonestsurgicalemergencies.

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267.Truestatementaboutgivenconditionof
eyeexcept:
a)Arisefromanypartofconjunctiva
b)CancauseAstigmatism

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c)Surgeryistreatmentofchoice
d)UVexposureisriskfactor
CorrectAnswer-A
Answer.A.Arisefromanypartofconjunctiva
GivenconditionisPterygium

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Pterygiumisanon-cancerous(non-neoplastic)growthof
conjunctiva.
Characterizedbyawing-shapedfoldofconjunctivauponthecornea
fromeithersidewithintheinterpalpebralfissure.
Pterygiumisalwayssituatedinthepalpebralaperture.

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PathologicallyPterygiumisadegenerative&hyperplasticcondition

ofconjunctiva.
Thesubconjunctivaltissueundergoeselastoticdegeneration&
proliferatesasvascularisedgranulationtissueundertheepithelium,
whichultimatelyencroachesthecornea.

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Thecornealepithelium,Bowman'slayer&stromaaredestroyed.
Etiology&Clinicalfeatures
Morecommoninpeoplewithexcessoutdoorexposuretosunlight
(UVrays)dry,heat,highwind&abundanceofdust.
Clinically,presentsasatriangularfoldofconjunctivaencroaching

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thecorneaintheareaofpalpebralaperture,usuallyonthenasal
side.
Otherfindingsarestocker'sline(depositionofiron).
Pterygiumisanasymptomaticconditionintheearlystages,except
forcosmeticintolerance.

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Visualdisturbanceorcornealastigmatismmayoccur.
Visualdisturbancesareduetoencroachmentofpterygiumon
pupillaryareaorcornealastigmatism.
Occasionallydiplopiamayoccurduetolimitationofocular
movements.

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Treatment
Asymptomaticpterygiumwhichisnotprogressiveisbestleftalone.
Surgicalexcisionistheonlysatisfactorytreatment.


268.Followingtestisusedtodiagnosewhich

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ocularconditionasshowninimage:
a)Strabismus
b)Heterophoria
c)BothA&B
d)Noneoftheabove

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CorrectAnswer-C
Ans:C.BothA&B
Givenimageiscover-uncovertest
Thecover-uncovertesttodiagnosevarioustypesoftropias,whichis
amedicaltermforstrabismus.

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Thesinglecovertestisatestisusedtodetermineifthereisa
heterotropiaortropia,whichismanifeststrabismusormisalignment
thatisalwayspresent.
Thefirsteyeiscoveredforapproximately1-2seconds.Asthiseye
iscovered,theuncoveredeyeisobservedforanyshiftinfixation.

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Thecross-covertestoralternatingcovertestisusuallyemployedto
detectheterophoria.
Oneeyeiscovered,andthenthecoverismovedimmediatelyover
totheothereye.Withheterophoria,whenthecoverismovedtothe
othereye,theeyethathasjustbeenuncoveredcanbeseento

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movefromadeviatedpoint.
Thedifferencebetweenheterotropiaandheterophoriacanbeeasily
understoodasfollows.
Withheterotropia,acorrectingmovementoftheeyecanbedetected
alreadybythesimplecovertest;withheterophoria,suchcorrecting

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movementonlytakesplaceinthecross-covertest.
Peoplewithheterophoriacancreateandmaintainbinocularfusion
throughvergence,andthecross-covertestpurposelybreaksthis
fusion,makingthelatentmisalignmentvisible.


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269.Namethemanoeuvreshowninthe
image:
a)Brandtdaroff
b)Epley
c)Foster

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d)Semont
CorrectAnswer-B
Answer.B.Epley
TheEpleymaneuverisanexerciseyoucandoathometorelieve
dizzinesscausedbybenignparoxysmalpositionalvertigo(BPPV).

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BPPViscausedbyaproblemwiththeinnerear.Calciumcrystals
calledcanalithscanendupinthesemicircularcanals.


270.Identifytheconditionofthegivenimage:
a)Acquiredcholesteatoma

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b)Congenitalcholesteatoma
c)Ruptureoftympanicmembrane
d)Keratosisobturans
CorrectAnswer-D
Answer.D.Keratosisobturans

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GivenimageisKeratosisobturans,otoscopeview.
Thisisarareconditionoftheearcanalwithageneralisedfailureof
migrationofthenormalcanalskin.
Theskinaccumulatesandtheunderlyingboneisresorbed.
Herethereisadeepwideningoftheearcanalwithexposureofthe

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circularannulusattheedgeofthetympanicmembrane(eardrum,
centre).
Thejugularvein(purple)canbeseenthroughtheremainingtissue

ontheflooroftheearcanal.
Theeardrumisrelativelyunaffectedhere.

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271.CTimageofleftmaxillawithhistoryof
allergicrhinitis?
a)Groundglassappearance
b)Doubledensities

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c)Honeycomb
d)OnionPeelAppearance
CorrectAnswer-B
Answer:B.DoubleDensitises
Allergicfungalsinusitisisthemostcommonformoffungal

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sinusitisandiscommoninwarmandhumidclimates.Onimaging,it
usuallypresentsasopacificationandexpansionofmultiple
paranasalsinuses,unilaterallyorbilaterally,withcontentthatis
centrallyhyperdenseonCT

Themajorityofsinusesshownearcompleteopacification.On

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unenhancedCT,thesinusesaretypicallyopacifiedbycentrally
(oftenserpiginous7)hyperdensematerialwithaperipheralrimof
hypodensemucosa.
Approximately40%ofpatientsmayhaveeachofthefollowing
features4:

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expansionofaninvolvedsinus
remodellingandthinningofthebonesinuswalls
erosionofthesinuswall


272.Identifytheinstrument:

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a)Maddoxrod
b)Maddoxwing
c)Maddoxglass
d)Redglasses
CorrectAnswer-A

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AnswerA)Maddoxrod
TheMaddoxrodtestcanbeusedtosubjectivelydetectand
measurealatent,manifest,horizontalorverticalstrabismusfornear
anddistance.
Thetestisbasedontheprincipleofdiplopicprojection

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TheMaddoxrodisahandheldinstrumentcomposedofredparallel
plano-convexcylinderlens,whichrefractslightrayssothatapoint
sourceoflightisseenasalineorstreakoflight.
Duetotheopticalproperties,thestreakoflightisseen
perpendiculartotheaxisofthecylinder.

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TheMaddoxrodtestshouldbeusedincasesof:
Smalltomoderate
Decompensatedphorias.
Acquiredstrabismus(ratherthancongenitalorearly-onset)

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273.Identifythelesionofvocalcordinthe
imagegivenbelow:
a)Reinke'sedema
b)LaryngealPapilloma

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c)Malignancy
d)Tracheomalacia
CorrectAnswer-B
-Laryngealpapillomatosis,orrecurrentrespiratorypapillomatosis
(RRP),isthemostfrequentbenigntumorofthelarynx.

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-Itiscausedbythehumanpapillomavirus(HPV)types6and11.It
isalsothesecondmostcommoncauseofhoarsenessinchildren.
-Laryngealpapillomasarelocatedprimarilyinthelarynxonthevocal
cordmarginsandepiglottis.
-Tumorsarebenignbutpresentobstructiveproblemsbecauseof

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theirlocalizationinthevocalcordsorothersites
-Atpresentation,papillomasareusuallypresentononeorboth

vocalcordswiththeanteriorcommissure,supraglottis,or
subglottisalsocommonlyaffect



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274.ApatientgivesH/ohoarsenessinvoice
&presentingwithclinicalconditionas
shownintheimage.Identifythelesion:

a)Membranoustonsillitis
b)Folliculartonsillitis

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c)Diphtheria
d)Aphthousulcer
CorrectAnswer-C
-Diphtheriaisaseriousbacterialinfectionthatusuallyaffectsthe
mucousmembranesofyournoseandthroat.

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-DiphtheriaiscausedbythebacteriumCorynebacterium
diphtheriae.
-Diphtheriasignsandsymptomsusuallybegintwotofivedaysafter
apersonbecomesinfectedandmayinclude:

Athick,greymembranecoveringyourthroatandtonsils

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sorethroatandhoarseness
Swollenglands(enlargedlymphnodes)inyourneck
Difficultybreathingorrapidbreathing
Nasaldischarge
Feverandchills

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Malaise.


275.Apatientpresentedwiththefollowing
pictureofTympanicMembrane.Most
Probablediagnosis(markedwitharrow):

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a)TubercularOtitisMedia
b)SyphiliticOtitisMedia
c)Pseudomonasinfection
d)FungalOtitisMedia
CorrectAnswer-A

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Answer.A.TubercularOtitisMedia
TuberculousOtitisMediaWhereperforationsaremultipleandare
associatedwithotorrhea,atuberculosisofthemiddleearshouldbe
suspected.
Theseperforationsresultfrombreakingdownoftubercles.

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Inthegivenimage,Tympanicmembraneshowingmultiple

perforations
Infectionreachesthemiddleearthrougheustachiantube.
Theraremodesofinfectionarethroughhematogenousspread
fromtubercularfocusinlung,tonsils,cervicallymphnodes;ordueto

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ingestionofinfectedcow'smilk.
Itusuallyaffectschildrenandyoungadults.


276.Whichmethodisusedtostudythe
followingtimeline?

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a)CohortStudy
b)Crosssectionalstudy
c)RandomizedControlTrials
d)InterventionalStudies
CorrectAnswer-A

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Ans.A.CohortStudy
TheimagerepresentstheNaturalhistoryofdiseasethatrefersto
theprogressionofadiseaseprocessinanindividualovertime,in
theabsenceoftreatment.
Thetimelineshowsthestateofsusceptibility,exposure,the

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subclinicaldiseaseinwhichpathologicchangestakeplace,the
onsetofsymptoms,followedbytheusualtimeofdiagnosis,clinical
disease,followedbyrecovery,disability,ordeath.
Longitudinalstudiesareusedtostudythenaturalhistoryofthe
disease.

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277.A6yearoldboyishavingsymptoms
suchasfeverandchills,cough,rapid
breathing,difficultybreathing,andchest
pain,culturefromasampleshows

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Gram-positiveculture,Identifythe
image:

a)Streptococcuspneumoniae
b)Staphylococcus
c)Propionibacterium

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d)Mycobacterium
CorrectAnswer-A
Answer:A.Streptococcuspneumoniae
Streptococcuspneumoniae(pneumococcus)isaGram-positive
bacteriumthatisresponsibleforthemajorityofcommunity-acquired

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pneumonia
S.pneumoniaeisalpha-hemolytic,meaningthatitcanbreakdown
redbloodcellsthroughtheproductionofhydrogenperoxide(H2O2).

TheproductionofH2O2bythebacterialinfectioncanalsocause
damagetoDNA,andkillcellswithinthelungs.

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Pneumococcalpneumoniacausesfeverandchills,coughs,difficulty
breathing,andchestpain.Iftheinfectionspreadstothebrainand
spinalcord,itcancausepneumococcalmeningitis,


278.12Identifythepicture

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a)Herpeszosterpic
b)Smallpox
c)Chickenpox
d)Atopicdermatitis
CorrectAnswer-A

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Answer:A.Herpeszosterpic
Shingles,alsoknownasherpeszoster,isaviraldisease
characterizedbyapainfulskinrashwithblistersinalocalizedarea.
Shinglesisduetoareactivationofvaricellazostervirus(VZV)within
aperson'sbody.

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ThediseasechickenpoxiscausedbytheinitialinfectionwithVZV.
Oncechickenpoxhasresolved,thevirusmayremaininactivein
nervecells.
Whenitreactivates,ittravelsfromthenervebodytotheendingsin
theskin,producingblisters.Riskfactorsforreactivationincludeold

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age,poorimmunefunction.



279.Identifytheimage
a)Malaria
b)Plague

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c)Japaneseencephalitis
d)Paragonimus
CorrectAnswer-C
Answer;C.Japaneseencephalitis
Japaneseencephalitis(JE)isaninfectionofthebraincausedbythe

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Japaneseencephalitisvirus(JEV).
JEVisgenerallyspreadbymosquitoes,specificallythoseofthe
Culextype.Pigsandwildbirdsserveasareservoirforthevirus.
symptomsmayincludeheadache,vomiting,fever,confusion,and
seizures.

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280.Whatisthecauseofdeathaccordingto
thebelowdeathcertificate
a)BreastCancer
b)Secondaries

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c)CerebralHemorrhage
d)AlloftheAbove
CorrectAnswer-D
Ans.D.AlloftheAbove
AlltheThreearecauseofdeathastheyareindescribingthe

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sequenceofeventsindeaths.


281.Identifythebloodgroupingprocess
donehere.
Slidegivenwith:ABnoclumps,

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ClumpinginO&Noclumpsincontrol.
Whichgroupdoesthissignify?

a)A-ve
b)B+ve
c)O+ve

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d)Rhgroup
CorrectAnswer-D
Ans:D.Rhgroup
*Dantigen?
-Mostimportantbloodgroupantigeninroutinebloodbanking.

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-AntibodiesofRhsystemdonotoccurnaturallyinserum.
-Mostlyasaresultofantigenexposureduringpregnancyor
throughtransfusion.
*PresenceorabsenceofDantigendeterminedbytestingRBC's
withAnti-D.

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-AgglutinationindicatesDpositivetestcells.
-NoagglutinationindicatesDnegativetestcells.
*"WeakD"?UsedtodescribeDantigenformsthatareun-
agglutinateddirectlybyanti-Dreagents


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282.Identifytheconditionasshowninthe
imagegivenbelow:
a)Callosaldysgenesis
b)Dandywalkersyndrome
c)Aicardisyndrome

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d)Septoopticdysplasia
CorrectAnswer-A
AnswerA.Callosaldysgenesis
Givenimageisshowingracingcarsign
Racingcarsign(callosaldysgenesis)

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Theracingcarsignreferstowidelyspacedlateralventriclesdueto
agenesisofthecorpuscallosumwithinterveningProbstbundles.
AppearancesonaxialMRIorCTarereminiscentofaFormulaOne
carseenfromabove,withthetyresrepresentedbythewidely-

spacedfrontalhorns,andthedilatedtrigones(colpocephaly).

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283.Whichnervesuppliestotheareamarked
as`AreaB'intheimage:
a)Ulnarnerve
b)Mediannerve

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c)Radialnerve
d)Posteriorinterosseousnerve
CorrectAnswer-C
AnswerC.Radialnerve
Thesuperficialterminalbranchoftheradialnerveispurely

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cutaneousandsupplieslateralhalfofthedorsumofthehand,andto
theproximalpartsofthedorsalsurfacesofthethumb,theindex
finger,andlateralhalfofthemiddlefinger.




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284.Whichofthefollowingisnotaboundary
ofgivenimage:
a)Commonhepaticduct
b)Cysticduct
c)Inferiorsurfaceoftheliver.

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d)Gallbladder
CorrectAnswer-D
AnswerD.Gallbladder
CALOT'STRIANGLE
*Calot'striangle(cystohepatictriangle)isasmallanatomicalspace

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intheabdomen.
*Itislocatedattheportahepatisoftheliver?wherethehepatic
ductsandneurovascularstructuresenter/exittheliver.
*Thebordersareasfollows:
-Medial?commonhepaticduct.

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-Inferior?cysticduct.
-Superior?inferiorsurfaceoftheliver.


*TheabovedifferfromtheoriginaldescriptionofCalot'strianglein
1891?wherethecysticarteryisgivenasthesuperiorborderofthe

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triangle.
*Themoderndefinitiongivesamoreconsistentborder(thecystic
arteryhasconsiderablevariationinitsanatomicalcourseand
origin).


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285.Markedareainthegivenimageis
suppliedbywhichdermatome?
a)T8
b)T9
c)T10

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d)T11
CorrectAnswer-C
AnswerC.T10
Importantdermatome&anatomicallandmarks
Followingisalistofspinalnervesandpointsthatare

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characteristicallybelongingtothedermatomeofeachnerve.
*C2?Atleastonecmlateraltotheoccipitalprotuberanceatthe
baseoftheskull.Alternately,apointatleast3cmbehindtheear.
*C3?Inthesupraclavicularfossa,atthemidclavicularline.

*C4?Overtheacromioclavicularjoint.

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*C5?Onthelateral(radial)sideoftheantecubitalfossa,just
proximallytotheelbow.
*C6?Onthedorsalsurfaceoftheproximalphalanxofthethumb.
*C7?Onthedorsalsurfaceoftheproximalphalanxofthemiddle
finger.

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*C8?Onthedorsalsurfaceoftheproximalphalanxofthelittle
finger.
*T1?Onthemedial(ulnar)sideoftheantecubitalfossa,just
proximallytothemedialepicondyleofthehumerus.
*T2?Attheapexoftheaxilla.

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*T3?Intersectionofthemidclavicularlineandthethirdintercostal
space
*T4?Intersectionofthemidclavicularlineandthefourthintercostal
space,locatedatthelevelofthenipples.
*T5?Intersectionofthemidclavicularlineandthefifthintercostal

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space,horizontallylocatedmidwaybetweenthelevelofthenipples
andthelevelofthexiphoidprocess.
*T6?Intersectionofthemidclavicularlineandthehorizontallevel
ofthexiphoidprocess.
*T7?Intersectionofthemidclavicularlineandthehorizontallevel

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atonequarterthedistancebetweenthelevelofthexiphoidprocess
andtheleveloftheumbilicus.
*T8?Intersectionofthemidclavicularlineandthehorizontallevel
atonehalfthedistancebetweenthelevelofthexiphoidprocessand
theleveloftheumbilicus.

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*T9?Intersectionofthemidclavicularlineandthehorizontallevel
atthreequartersofthedistancebetweenthelevelofthexiphoid
processandtheleveloftheumbilicus.
*T10?Intersectionofthemidclavicularline,atthehorizontallevel
oftheumbilicus.

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*T11?Intersectionofthemidclavicularline,atthehorizontallevel
midwaybetweentheleveloftheumbilicusandtheinguinal
ligament.
*T12?Intersectionofthemidclavicularlineandthemidpointofthe
inguinalligament.

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*L1?MidwaybetweenthekeysensorypointsforT12andL2.


*L2?Ontheanteriormedialthigh,atthemidpointofaline
connectingthemidpointoftheinguinalligamentandthemedial
epicondyleofthefemur.

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*L3?Atthemedialepicondyleofthefemur.
*L4?Overthemedialmalleolus.
*L5?Onthedorsumofthefootatthethirdmetatarsophalangeal
joint.
*S1?Onthelateralaspectofthecalcaneus.

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*S2?Atthemidpointofthepoplitealfossa.
*S3?Overthetuberosityoftheischiumorinfraglutealfold
*S4andS5?Intheperianalarea,lessthanonecmlateraltothe
mucocutaneouszone


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286.Identifythetypeofthefibremarkedin
theimageofinternalcapsule:
a)Projectionfibres
b)Shortassociationfibres
c)Longassociationfibres

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d)Commissuralfibres
CorrectAnswer-A
AnswerA.Projectionfibres
Internalcapsule
Areaofwhitematterinthebrainthatseparatesthecaudatenucleus

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andthethalamusfromtheputamenandtheglobuspallidus.
Theinternalcapsulecontainsbothascendinganddescending
axons.
Itconsistsofaxonalfibresthatrunbetweenthecerebralcortexand


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thepyramidsofthemedulla.
Components
TheinternalcapsuleisV-shapedwhencuttransversely
(horizontally).
Whencuthorizontally:

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thebendintheViscalledthegenu
Anteriorlimboftheinternalcapsule.
theposteriorlimborcrusposteriusisthepartbehindthegenu,
betweenthethalamusandlenticularnucleus.
theretrolenticularportioniscaudaltothelenticularnucleusand

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carriesoptictractsincludingthegeniculocalcarineradiations.
thesublenticularportionisbeneaththelenticularnucleusandare
tractsinvolvedintheauditorypathwayfrommedialgeniculate
nucleustotheprimaryauditorycortex(BrodmannArea41).
Grossmotorstrengthisimpairedwithischemiaoftheinternal

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capsule.




287.Identifythestructuremarkedbyared
arrowinthegivenimage:

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a)Greatveinofgalen
b)Pinealgland
c)Fornix
d)Falxcerebri
CorrectAnswer-C

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AnswerC.Fornix
Thefornixisthemainefferentsystemofthehippocampusandan
importantpartofthelimbicsystem.
Itisoneofthecommissuralfibersconnectingthecerebral
hemispheres.

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Grossanatomy
RoughlyC-shaped,thefornixextendsfromthehippocampusto


themammillarybodiesofthehypothalamusandtheanteriornuclei
ofthethalamus.

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Itisacurvilinearbundleofwhitematterfibersthatbeginsasagroup
ofmyelinatedfiberscalledthealveus.
Thealveusjoinstoformthefimbriaofthehippocampus.
Thefimbriaofeachhippocampusthickensandthensplitsofffrom
thehippocampustoformthecrus(leg)ofthefornix.

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Thefornixiscomposedoffourparts:
crura:bestseenatthespleniumofthecorpuscallosumatthelevel
ofthesuperiorcolliculusoncoronalimages
commissure:connectsthecrura
body:fromthemergingofthecrura,providesoneoftwomajorpaths

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throughwhichthehippocampuscommunicatewitheachother
columns(anteriorpillars):curvesanteriorlyanddivesintothe
hypothalamus(mammillarybodies)


288.WhatistheNerveSupplyofmarked

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structureinthegivenimage:
a)Anteriorinterosseousnerve
b)Posteriorinterosseousnerve
c)Ulnarnerve
d)Mediannerve

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CorrectAnswer-D
AnswerD.Mediannerve
Thestructureindicatedisthefirstlumbricalmuscleofthehand.
*Thelumbricalsbelongtotheintrinsicgroupofmuscleswhichact
onthehand.

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*Theintrinsicmusclesincludethefollowingmuscles/groups:
-Thenargroup(actonthumb)
-Hypothenargroup(actonlittlefinger)

-Adductorpollicis
-Lumbricals

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-Interosseousmuscles
-Palmarisbrevis
*Alltheintrinsicmusclesofthehand,exceptthethenarmuscles
andthelateraltwolumbricalmuscles,areinnervatedbythedeep
branchoftheulnarnerve.

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*Thethenarmusclesandthelateraltwolumbricalmusclesare
innervatedbythemediannerve.
*AusefulmnemonicforrememberingthisisMEATLOAF."MEAT"
referstotheMediannerve,andLOAFreferstothemuscleswhichit
innervates:Lateraltwolumbricals,Opponenspollicis,Abductor

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pollicisbrevis,Flexorpollicisbrevis


289.Identifythemarkedstructureinthe
image:
a)Cerebrum

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b)Brainstem
c)Corpuscallosum
d)Cerebellum
CorrectAnswer-D
AnswerD.Cerebellum

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Thecerebellum,whichstandsfor"littlebrain",isastructureofthe
centralnervoussystem.Ithasanimportantroleinmotorcontrol,
withcerebellardysfunctionoftenpresentingwithmotorsigns.
Thecerebellumislocatedatthebackofthebrain,immediately

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inferiortotheoccipitalandtemporallobes,andwithintheposterior
cranialfossa.
Itisseparatedfromtheselobesbythetentoriumcerebelli,atough
layerofduramater.
Itliesatthesamelevelofandposteriortothepons,fromwhichitis

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separatedbythefourthventricle.


290.NerveinjuredinFrey'ssyndromeis:
a)AuriculotemporalNerve
b)Greatauricularnerve

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c)LingualNerve
d)Inferioralveolarnerve
CorrectAnswer-A
AnswerA.AuriculotemporalNerve
Frey'ssyndrome(alsoknownasBaillargersyndrome,Dupuy's

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syndrome,auriculotemporalsyndrome,orFrey-Baillargersyndrome)
isarareneurologicaldisorderresultingfromdamagetoornearthe
parotidglandsresponsibleformakingsaliva,andfromdamageto
theauriculotemporalnerveoftenfromsurgery.


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291.Whichnervepassesthroughthemarked
forameninthegivenimage:
a)Lingualnerve
b)Mandibularnerve
c)Chordatympaninerve

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d)Inferioralveolarnerve
CorrectAnswer-D
AnswerD.Inferioralveolarnerve
MarkedareaisMandibularforamen,
Mandibularforamen?openingonthemedialsurfaceoftheramus;

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passagewayfortheinferioralveolarnerveandartery,whichsupply
thelowerteeth.




292.Identifythemarkedmuscle`A'inthe

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diagram:
a)Brachioradialis
b)Extensorcarpiradialislongus
c)Flexorcarpiradialis
d)Extensorcarpiulnaris

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CorrectAnswer-B
AnswerB.Extensorcarpiradialislongus
Theextensorcarpiradialislongusmuscleemergesfromthelateral
epicondyleofthehumerusandthedistalpartofthe
supraepicondylarrim;itstendonentersonthedorsalsideofthe

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baseofmetacarpalII.
Inproximalareas,itisdeeptothebrachioradialismuscle.
Thewristisexpandedandabductedbytheextensorcarpiradialis
longusmuscle.

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Nervesupply
Itisinnervatedbytheradialnerve
Action
Extensorandabductorofhandatwrist


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293.Whichofthefollowingnailfindingsis
seenintheconditionshownbelow?
a)Pterygium
b)Pigmentation
c)Pitting

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d)Ridges
CorrectAnswer-C
Answer.C.Pitting
Nailpittingmayshowupasshallowordeepholesinyournails.
invalidquestionid

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