Download NEET PG 2019 Question Paper with Answers

Download NEET PG (The National Eligibility cum Entrance Test Postgraduate) 2019 Question Paper with Answers

1.Syndromeassociatedwithposterior
inferiorcerebellararterythrombosis:
a)Wallenbergsyndrome
b)Medialmedullarysyndrome
c)Inferioralternatingsyndrome
d)Dejerinesyndrome
CorrectAnswer-A
AnswerA.Wallenbergsyndrome
Wallenbergsyndromeisalsoknownaslateralmedullarysyndrome
ortheposteriorinferiorcerebellararterysyndrome.
Wallenbergdescribedthefirstcasein1895.
Thisneurologicaldisorderisassociatedwithavarietyofsymptoms
thatoccurasaresultofdamagetothelateralsegmentofthe
medullaposteriortotheinferiorolivarynucleus.
Itisthemosttypicalposteriorcirculationischemicstrokesyndrome
inclinicalpractice.
Etiology:
Wallenbergsyndromeiscausedmostcommonlyby
atherothromboticocclusionofthevertebralartery,followedmost
frequentlybytheposteriorinferiorcerebellarartery,andleastoften,
themedullaryarteries.
Hypertensionisthecommonestriskfactorfollowedbysmokingand
diabetes.
Medialmedullarysyndrome,alsoknownasinferioralternating
syndrome,hypoglossalalternatinghemiplegia,loweralternating
hemiplegia,orDejerinesyndrome,isatypeofalternatinghemiplegia

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characterizedbyasetofclinicalfeaturesresultingfromocclusionof
theanteriorspinalartery.

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2.SpaceofDisseisin:
a)Spleen
b)Lymphnode
c)Liver
d)Bone
CorrectAnswer-C
Ans.C.Liver
Theperisinusoidalspace(orspaceofDisse)isalocationintheliver
betweenahepatocyteandasinusoid.
Itcontainsthebloodplasma.
Microvilliofhepatocytesextendintothisspace,allowingproteins
andotherplasmacomponentsfromthesinusoidstobeabsorbedby
thehepatocytes.

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3.WhatareGittercells:
a)Macroglia
b)ModifiedmacrophagesinCNS
c)Astrocytes
d)Oligodendrocytes
CorrectAnswer-B
AnswerB.ModifiedmacrophagesinCNS
Gittercells:
Thesecellsaremacrophagesandbecauseoftheirappearancethey
arecalled"Gittercells".
Theylookthiswaybecausetheyarelipid-laden.
Thesemacrophagesarethoughttobemainlyderivedfrom
circulatingbloodmonocytes,butsomeprobablyoriginatefrom
residentmicroglia.
Anytimethereisparenchymaldamage(e.g.inflammation,
infarction,parasitemigration)thesecellswillphagocytoselipidfrom
degeneratedmyelinandcellulardebris.
Theselipid-ladenmacrophagesmigratetotheperivascularspaces

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andleavetheCNSviathebloodorCSF.

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4.Cholecystocavallineseparates:
a)Right&Leftliverlobe
b)LiverwithGallBladder
c)RightLobeofLiverwithGallBladder
d)LeftLobeofLiverwithGallBladder
CorrectAnswer-A
AnswerA.Right&Leftliverlobe
Functionallobesandsegmentsoftheliver
Thefunctionalrightandleftlobesoftheliverareseparatedbyan
imaginaryplanepassingalongtheflooroffossaforgallbladderand
thegrooveforinferiorvenacava(cholecysto-cavalline).
Ontheanterosuperiorsurfaceoftheliver,theplanepasseslittle
righttotheattachmentoffalciformligament.Thefunctionalrightand
leftlobesoftheliveraremoreorlessofequalsize.

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5.Whichofthefollowingexocrineglandular
ductsarenotobstructedincysticfibrosis:
a)Pancreas
b)Lung
c)Sweatgland
d)Allofabove
CorrectAnswer-C
AnswerC.Sweatgland
MostCFpatientshave3distinctabnormalcharacteristics:
Theductsofthemucus-secretingglandsareobstructedduetoan
increaseinviscosityofthesesecretionsleadingtoglandular
dilatationanddestruction.
CFpatientsarepronetochronicbacterialcolonizationand
infections.
ThesweatglandsarenotobstructedinCFpatientsbecausein
serousglandssuchassweatglandsthereareabnormal
concentrationsofinorganicions,ratherthanglandularobstruction
withthickmucus.
Thequantitativepilocarpineiontophoresissweattestisauniformly
acceptedmethodfordiagnosingCF.Thesweatglandductsmustbe
patentforthistest.
Obstructionofairwaysleadstobronchiectasisandatelectasis;
pancreaticductobstructionleadstopancreatitisandmalabsorption;
andpluggingofbileductsleadstoobstructivejaundice.

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6.BootshapeofheartinTOFisdueto:
a)Leftatrialenlargement
b)Rightatrialenlargement
c)Rightventricularhypertrophy
d)Biventricularhypertrophy
CorrectAnswer-C
AnswerC.Rightventricularhypertrophy
Bootshapedheart.A`boot-shaped'heart("coeurensabot"in
French)isthedescriptiongiventotheappearanceofthehearton
plainfilminsomecasesofTetralogyofFallot.
Itdescribestheappearancesofanupturnedcardiacapexdueto
rightventricularhypertrophyandaconcavepulmonaryarterial
segment.

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7.Whichofthefollowingstructureisnot
derivedfromexternalobliquemuscle:
a)Inguinalligament
b)Lacunarligament
c)Cooperligament
d)LineaSemilunaris
CorrectAnswer-D
AnswerD.LineaSemilunaris
Theexternalobliquemuscle(oftheabdomen)(alsoexternal
abdominalobliquemuscle)isthelargestandtheoutermostofthe
threeflatmusclesofthelateralanteriorabdomen.
Inguinalligament(Poupart'sligament)isthefoldedlowerborderof
externalobliqueaponeurosis
Lacunarligament(Gimbernatligament)isthecrescentshaped
expansionfromthemedialendofinguinalligamentattachedto
pectineallineofpubis.
Pectinealligament(Cooper'sligament)isstrongfibrousband
extendinglaterallyfromthelacunarligamentalongpectineallineof
pubis.Similartolacunarligament,itismadeofexternaloblique
aponeurosis.
Reflectedpartofinguinalligamentextendsfromthelateralcrusof
superficialinguinalringformedbyinguinalligamentupwardstolinea
alba.Itformstheposteriorwallofinguinalcanal.
Thelineasemilunaris(alsosemilunarlineorSpigelianline)isa
curvedtendinousintersectionfoundoneithersideoftherectus
abdominismuscle.

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8.Contralaterallossofpainandtemperature
isduetoinjuryto:
a)Anteriorspinothalamictract
b)Lateralspinothalamictract
c)Fasciculusgracilis
d)Fasciculuscuneatus
CorrectAnswer-B
AnswerB.Lateralspinothalamictract
Damagetolateralspinothalamictractleadstolossofpainand
temperatureontheoppositesideofthebodybelowthelevelof
lesion,sincetheneuronsofthistractcrossestotheoppositesidein
thespinalcord.
Anteriorspinothalamictractcarriescrudetouchandpressure
sensations.Fasciculusgracilisandfasciculuscuneatuscarries
consciousproprioception,finetouch,stereognosisandvibration
sensations.

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

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10.Structurederivedfromfirstpharyngeal
arch:
a)Levatorpalatini
b)Buccinator
c)Stylohyoid
d)Anteriorbellyofdigastric
CorrectAnswer-D
AnswerD.Anteriorbellyofdigastric
MESODERMALDERIVATIVESOFPHARYNGEALARCHES
Muscular
Skeletal
Pharyngealarch
Nerve
contributions
contributions
Maxilla
Zygomaticbone
Partoftemporal
Mylohyoid
andvomer,
Musclesof
sphenoid,
mastication
Mandibular
Ist(also
mandible
Anteriorbellyof
divisionof
called"mandibular
Meckel's
digastric
TrigeminalNerve
arch")
cartilage:-Malleus,
Tensorveli
(V3).
incus
palatini
Anteriorligament
Tensortympani ofmalleus
Sphenomandibular
ligament
Reichert's
cartilage,stapes
Stapedius
(exceptfootplate)
Stylohyoid

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Posteriorbellyof Styloidprocess
IInd(alsocalled
digastric
Stylohyoid
Facial
the"hyoidarch")
Facial
ligament
expression
Smallercornuof
muscles
hyoid
Superiorpartof
bodyofhyoid
Greatercornuof
hyoid
IIIrd
Stylopharyngeus
Glossopharyngeal
Lowerpartofbody
ofhyoid
Cartilageoflarynx
Pharyngeal
exceptarytenoids Superiorlaryngeal
IVth
muscles
superior
branchofVagus
Cricothyroid
parathyroids,
epiglotticcartilage
Recurrent
Intrinsicmuscles Arytenoidcartilage laryngeal
VIth
oflarynx(except oflarynx
nerve(branchof
cricothyroid)
vagus)

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11.Jointinvolvedinmovementofheadfrom
lefttoright.
a)Atlantoaxial
b)Atlantooccipital
c)C2-C3Joint
d)C3-C4Joint
CorrectAnswer-A
AnswerA.Atlantoaxial
Atlanto-occipital(betweenskullandC1)jointpermitsnoddingof
head(aswhenindicatingapprovalorYES)andAtlanto-axialjoint
permitstheheadtobeturnedfromsidetoside(asindicating
disapprovalorNO).

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12.Whatisthenervesupplyof
Submandibulargland:
a)Auriculotemporalnerve
b)Lingualnerve
c)Glossopharyngealnerve
d)Inferioralveolarnerve
CorrectAnswer-B
AnswerB.LingualNerve
Thesubmandibularglandsreceiveautonomicinnervationthrough
parasympatheticandsympatheticfibres,whichdirectlyandindirectly
regulatesalivarysecretionsrespectively.
Parasympathetic
Parasympatheticinnervationoriginatesfromthesuperiorsalivatory
nucleusthroughpre-synapticfibres,whichtravelviathechorda
tympanibranchofthefacialnerve(CNVII).
Thechordatympanithenunifieswiththelingualbranchofthe
mandibularnerve(CNVIII)beforesynapsingatthesubmandibular
ganglionandsuspendingitbytwonervefilaments.
Post-ganglionicinnervationconsistsofsecretomotorfibreswhich
directlyinducetheglandtoproducesecretions,andvasodilator
fibreswhichaccompanyarteriestoincreasebloodsupplytothe
gland.Increasedparasympatheticdrivepromotessalivasecretion.

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Sympathetic
Sympatheticinnervationoriginatesfromthesuperiorcervical
ganglion,wherepost-synapticvasoconstrictivefibrestravelasa
plexusontheinternalandexternalcarotidarteries,facialarteryand
finallythesubmentalarteriestoentereachgland.Increased
sympatheticdrivereducesglandularbloodflowthrough
vasoconstrictionanddecreasesthevolumeofsalivarysecretions,
resultinginamoremucusandenzyme-richsaliva.

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13.Parathyroidglandisimplantedinwhich
muscle?
a)Sartorius
b)Supinator
c)Deltoid
d)Brachioradialis
CorrectAnswer-D
AnswerD.Brachioradialis
Parathyroidsurgery:Autotransplantation
Themostcommonplacesforauto-implantationofparathyroid
glandsarethebrachioradialismuscleandthepresternalregion.
Otherlocationscanalsobeused:thesternocleidomastoid,the
subcutaneoustissueofupperlimbsandabdominalfat.

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14.Rightcoronaryarteryarisesfrom?
a)RightAorticSinus
b)LeftAorticSinus
c)Posteriorcoronarysinus
d)Anteriorcoronarysinus
CorrectAnswer-A
AnswerA.RightAorticSinus
RCAarisesfromanterioraorticsinusakaRightaorticsinus.
LCAarisesfromleftposterioraorticsinus.

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15.Bainbridgerefluxcauses?
a)Bradycardia
b)Increasedcardiacoutput
c)Decreasedvenousreturn
d)Increasedheartrate
CorrectAnswer-D
Ans:D.Increasesheartrate.
BainbridgeReflex:
Positivefeedbackmechanismwithcompensatoryincreaseinheart
rate?Duetoriseinrightatrialpressure.
Commonlyreferredtoas"atrialreflex".
Resultingfromincreasedbloodpressureorincreaseddistensionof
largesystemicveins&rightupperchamberofheart.

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16.Golgitendonorganresponsiblefor?
a)Tension
b)Length
c)Pressure
d)Proprioception
CorrectAnswer-A
Ans:A.Tension.
Differencebetweenfunctionsofmusclespindle&golgitendon
organ:
Musclespindle:
Actsas"Musclelengthdetectors".
Alsodetectsrateofchangeinmusclelength.
Golgitendonorgan:
Actsas"Muscletensiondetectors".
Alsodetectsrateofchangeinmuscletension.
Becauseoflocationofmusclespindle&golgitendonorgan.
Musclespindleareparalleltomusclefibers(extrafusalfibers).
Golgitendonorganinseriestomusclefibers(extrafusalfibers).
Yet,Bothareactivatedbymusclestretch.

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17.Hormonepredominatelysecretedafter14
dayonendometriumis?
a)Progesterone
b)Estrogen
c)LH
d)FSH
CorrectAnswer-A
Ans:A.Progesterone.
Eventsofovariancycle:
Bleedingcontinuesforabout4days.
By5thday,ovarianfollicleissufficientlydeveloped.
Secretesconsiderablequantitiesofestrogen.
Duringpre-ovulatoryphase:
Estrogeninfluencesendometrialproliferativechanges.
Hence,"Preovulatoryphaseofuterinecycle"alsoreferred
"Proliferativephase".
Duringpost-ovulatoryphase:
Endometriumenterssecretoryphase.
Hence,"Postovulatoryphaseofuterinecycle"alsoreferred
"Secretoryphase".
Duetocombinedactionofestrogen&progesterone.
Progesterone:
Moreimportant&responsibleforsecretorychanges.
Peakson21stday.
Endofsecretoryphase:
Estrogen-primedendometrium.
Degenerationofcorpusluteumdeclinesestrogen&progesterone
levels.

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Resultsinwithdrawalbleeding?Menstruation.

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18.Peripheralchemoreceptorsrespondto
hypoxiausingwhichchannel?
a)Calciumchannel
b)Sodiumchannel
c)Potassiumchannel
d)Chloridechannel
CorrectAnswer-C
Ans:C.Potassiumchannel.
Carotidbodiesarecomposedofglomuscells(alsocalledtypeI),
whichareofneuronalphenotypeandcontainavarietyof
neurotransmitters.
Glomuscellsareinfunctionalcontactwiththeafferentnerve
endings.
Glomuscellsareinitialsite(s)ofsensorytransduction.
Hypoxiareleasestransmitter(s)fromglomuscells,whichinturnby
depolarizingthesensorynerveendingleadstoanincreasein
sensorydischarge.
OnehypothesisassumesthataK+-channelproteinisanO2sensor
andthathypoxiadepolarizesglomuscellsbyinhibitingtheK+
channel,leadingtoanincreaseincytosolicCa2+,resultingin
transmitter(s)release.

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19.Withincreaseinagewhichofthe
followingistrueforlungs?
a)Pulmonarycomplianceincreases
b)Residualvolumedecreases
c)Mucocillaryclearanceincreases
d)Fibrousofinterstitiumdreaseses
CorrectAnswer-A
Ans:A.Pulmonarycomplianceincreases
Anatomicalandphysiologicalchangesofrespiratorysystem
withaging:
Anatomical:
Airspacesize:Increased
Compliance:
Chestwallcompliance:Decreased
Lungcompliance:Increasedtounchanged
Totalrespiratorysystemcompliance:Decreased
Musclestrength:
Maximalinspiratorypressure(MIP):Decreased
Transdiaphragmaticpressure(Pdi):Decreased
Maximumvoluntaryventilation(MVV):Decreased
Lungfunction:
FEV1:Decreased
FVC:Decreased
TLC:Unchanged
Vitalcapacity:Decreased
Functionalresidualcapacity:Increased
Residualvolume:Increased
DLCO/VA:Decreased

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Exercisecapacity:
VO2max:Decreased
Deadspaceventilation:Increased
Immunology:
Bronchialfluid:
Neutrophils%:Increased
RatioofCD4+/CD8+cells:Increased
Epithelialliningfluidantioxidants:Decreased.

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20.Functionalresidualvolumeis?
a)Afternormalinspiration
b)Afternormalexpiration
c)Afterforcefulexpiration
d)Afterforcefulinspiration
CorrectAnswer-A
Ans:A.Afternormalinspiration
FunctionalResidualCapacity(FRC)isthevolumeofairpresentin
thelungsattheendofpassiveexpiration.

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21.Polyuriais-
a)70ml/kg
b)60ml/kg
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
d)Determiningtubularsecretion
CorrectAnswer-A
Ans:A.GFR.
Tubuloglomerularfeedback?Twocomponents:
*Afferentarteriolefeedbackmechanism
-Usuallyreferredas"Tubuloglomerularfeedback"
*Efferentarteriolefeedbackmechanism.
Afferentarteriolarfeedbackmechanism:
*Transmitterinvolved?AdenosinecausingCa2+channelopening.
Efferentarteriolarfeedbackmechanism:
*Activatesrenin-angiotensinsystemgeneratingangiotensinII
efferentarterioleconstriction?edGFR.
*Feedbackdependsonjuxtaglomerularapparatus&itsspecialized
cells.
-Maculadensa?Specializedepitheliumofdistaltubuleinclose
contactwithafferentarteriole

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23.Calcitoninlevelsincreasedin
a)Hyperthyroidism
b)Hyperparathyroidism
c)Hypoparathyroidism
d)CushingSyndrome
CorrectAnswer-B
Ans:B.Hyperparathyroidism
Theserumcalcitoninlevelisstronglyincreasedinthistypeof
cancer.Aftersuccessfultotalthyroidectomy,calcitoninisno
longerdetectable.Increasingconcentrationsofcalcitoninafter
therapyindicaterelapseormetastasis.Hyperparathyroidismis
presentin20-30%ofpatientswithmedullarthyroidcarcinoma.

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24.WhenthevaluesofFev1=1.3&FCV=3.9.
Whichofthefollowingdoesthissignify?
a)Normallungfunction
b)Obstructivelungdisease
c)Restrictivelungdisease
d)Both
CorrectAnswer-B
Ans:B.Obstructivelungdisease
Measurementofthebronchodilatorresponseofforcedexpiratory
volumein1second(FEV1)isanimportantmethodinclinical
respiratorymedicine.
Thismeasurementisusedtopredicttheresponsetobronchodilator
treatmentandispartofthediagnosisofCOPDandasthma.
Thebronchodilatorresponseofforcedvitalcapacity(FVC)hasless
clinicalusethanthebronchodilatorresponseofFEV1butmayadd
importantclinicalphysiologicalinformation
AirwayobstructionwasdefinedasFEV1/FVCratiobelowlowerlimit
ofnormal(LLN)beforebronchodilation,andCOPDwasdefinedas
anFEV1/FVCratiobelowLLNafterbronchodilation.

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25.Antegradeperistalsisdueto?
a)Ach
b)Serotonin
c)SubstanceP
d)VIP
CorrectAnswer-D
Ans:D.VIP
Definedasamotorpatternofthegutorganmusculaturethatcan
propelcontentintotheanal(antegradeperistalsis)ororal
(retrogradeperistalsis)direction.
Impulsestravelingoradactivateascendingcontraction:
Neurotransmittershereareacetylcholine,substanceP,and
neurokininA.
Impulsestravelingcaudadactivatedescendingrelaxation:
NeurotransmittershereareVIP,NO,andPACAP(pituitaryadenylyl
cyclaseactivatingpolypeptide).

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26.C-peptideseenin?
a)InPre-proinsulin
b)InProinsulin
c)Asacombinedentitywithinsulinaftersecretion
d)Agastrointestinalproactivemolecul
CorrectAnswer-B
Ans:B.Inproinsulin
Synthesisofinsulin:
Synthesizedaslargerpreprohormone(Pre-proinsulin)enteringER.
Removalof23amino-acidsignalpeptidetakesplace.
Convertedto"Prohormone-Proinsulin".
Proinsulinstructure:
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
d)Chemoreceptors
CorrectAnswer-A
Ans:A.VRG
Medullaryrespiratorygroup:
Principalareasinmedullaoblongataconcernedwithrespiratory
regulation.
Includes,
Dorsalrespiratorygroup(DRG).
Ventralrespiratorygroup(VRG).
Pre-Botzingercomplex.
Peripheralinputs.
Dorsalrespiratorygroup(DRG):
DRGneurons?
Mainlyconcernedwithinspiration.
Descend&terminateonspinalmotorneuronsinnervatingprimary
inspiratorymuscles.
I.e.,Diaphragm&Externalintercostalmuscles.
Ventralrespiratorygroup(VRG):
VRGneurons?
Mainlyconcernedwithforcefulexpiration.
Minimalactivitiesw.r.tinspiration.
Contributestobothexpiration&inspiration.

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28.Slowconductionvelocityisseenwith
whichofthefollowingnervefibers?
a)Preganglionicautonomicnervefibers
b)Postganglionicautonomicnervefibers
c)Motornerves
d)Sympatheticnervefibers
CorrectAnswer-B
Ans:B.Postganglionicautonomicnervefibers
Erlanger&Gasserclassification:
Cfiber?Characteristics:
Diameter?0.2-1.0
Myelination?Unmyelinated
Conduction?0.2-2(minimum)
Functions:
Pain?Slowpain("Protopathic/Secondpain)
Temperature
Pressure
Postganglionicautonomicfibers.
Highsusceptibilityto:Localanesthetics

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29.Testosteronesecretedby,
a)Leydig'scells.
b)Somatotropiccells.
c)Acidophiliccells.
d)Gonadotropiccells
CorrectAnswer-A
Ans:A.Leydig'scells.
Thehypothalamussendsasignaltopituitaryglandtorelease
gonadotrophicsubstances(folliclestimulatinghormoneand
luteinizinghormone).
Luteinizinghormone(LH)stimulatestestosteroneproduction.
Testosteroneisproducedbygonads(byLeydigcellsintestesin
men&byovariesinwomen).

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30.Vasopressinactsthroughwhichchannels
incollectingduct?
a)Aquaporin1
b)Aquaporin2
c)GLUT?
d)GLUT?4
CorrectAnswer-B
Ans:B.Aquaporin2
Principalcellsofcollectingductcontainaregulatedsystemofwater
channelsantidiuretichormone(ADH,alsocalledarginine
vasopressin,AVP).
ADHcontrolspermeabilityofthesecellstowaterbyregulating
insertionofpre-formedwaterchannels(aquaporin-2,AQP2)into
apicalmembrane.

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31.Trueaboutdecorticaterigidity?
a)Removalofcerebralcortexandbasalganglia
b)Flexionoflowerlimbs&extensionofupperlimbs
c)Rigidityislesspronouncedthandecerebraterigidity
d)Noneoftheabove
CorrectAnswer-C
Ans:C.Rigidityislesspronouncedthandecerebraterigidity.
Decorticaterigidity:
Madebyremovingwholecerebralcortexbutleavingbasalganglia
intact.
Characterizedbyflexionofupperextrimitiesatelbow&extensionof
lowerextrimities.
Flexionduetorubrospinaltractexcitationofflexorsinupper
extremities&hyperextensionoflowerextermity.
Decorticateanimaldoesnothaveintensehypertoniaasdecerebrate
animal.
Duetointactbasalgangliaindecorticateanimal.

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32.Zewellgersyndroneisduetoabsenceof
a)Lysosomal
b)Mitochondria
c)Peroxisome
d)Nucleus
CorrectAnswer-C
Answer.C.Peroxisome
Zellwegersyndrome,alsocalledcerebrohepatorenalsyndrome,isa
rarecongenitaldisordercharacterizedbythereductionorabsence
offunctionalperoxisomesinthecellsofanindividual.
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
d)Arginine
CorrectAnswer-D
Answer:D.Arginine
Arginine,asemiessentialorconditionallyessentialaminoacidin
humans,isoneofthemostmetabolicallyversatileaminoacids.
Itservesasaprecursorforthesynthesisofurea,nitricoxide,
polyamines,proline,glutamate,creatine,andagmatine.

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34.Whichofthefollowingisnotthesourceof
cytosolicNADPH?
a)Isocitratedehydrogenase
b)ATPcitratelyase
c)Malicenzyme
d)G6PD
CorrectAnswer-B
Answer.B.ATPcitratelyase
NADPHisacofactorusedinanabolicreactions,suchaslipidand
nucleicacidsynthesis,whichrequireNADPHasareducingagent.
ThemajorsourceofNADPHinanimalsandothernon-
photosyntheticorganismsisthepentosephosphatepathway.
Thekeyenzymesintheseprocessesare:NADP-linkedmalic
enzyme,NADP-linkedisocitratedehydrogenase,NADP-linked
glutamatedehydrogenaseandnicotinamidenucleotide
transhydrogenase.

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35.AllaretrueregardingmitochondrialDNA,
EXCEPT?
a)Doublestranded
b)Inheritedfrommother
c)Highmutationrate
d)Allrespiratoryproteinsaresynthesizedwithinmitochondria
itself
CorrectAnswer-D
Answer.D.Allrespiratoryproteinsaresynthesizedwithin
mitochondriaitself
MtDNAisorganizedasacircular,covalentlyclosed,double-
strandedDNA.
Insexualreproduction,mitochondriaarenormallyinherited
exclusivelyfromthemother;themitochondriainmammaliansperm
areusuallydestroyedbytheeggcellafterfertilization.
MutationsofmitochondrialDNAcanleadtoanumberofillnesses
includingexerciseintoleranceandKearns?Sayresyndrome(KSS),
whichcausesapersontolosefullfunctionofheart,eye,andmuscle
movements.

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36.Whichapolipoproteinisresponsiblefor
Alzeihmersdisease
a)APOE4
b)APOE3
c)APOE2
d)APOE1
CorrectAnswer-A
ANSWER.A.APOE4
ThreecommonpolymorphismsintheAPOEgene,e2,e3,ande4,
resultinsingleaminochangesintheApoEprotein.
Thee4alleleofapolipoproteinE(APOE)isthemajorgeneticrisk
factorforAlzheimer'sdisease(AD).
thedifferentialeffectsofapoEisoformsonA?aggregationand
clearanceplaythemajorroleinADpathogenesis.
Inparticular,APOEe4isassociatedwithincreasedriskforAD,
whereasAPOEe2isassociatedwithdecreasedrisk.

---

37.HyperammonaemiainhibitTCAcycleby
depleting?
a)succinate
b)aketoglutarate
c)malate
d)fumarate
CorrectAnswer-B
Answer:B.aketoglutarate
Theureacycleandthecitricacidcycleareindependentcyclesbut
arelinked.
Todetoxifyammoniainhyperammonemia,moreglutamateis
required.Thisglutamateisformedfromc-ketoglutarate.
a-ketoglutarate?Transamination?glutamate+NH4+?glutamine.
Thusexcessivea?ketoglutarateisconsumedleadingtodecrease
availabilityofa?ketoglutarateforTCAcycle

---

38.whichaminoacidisusedtosynthesise
Nitricoxide?
a)glycine
b)arginine
c)tyrosine
d)threonine
CorrectAnswer-B
ANSWER:B.Arginine
Nitricoxideisproducedbyagroupofenzymescallednitricoxide
synthases.Theseenzymesconvertarginineintocitrulline,producing
NOintheprocess.OxygenandNADPHarenecessaryco-factors.
threedistinctgenesencodeNOSisozymes:neuronal(nNOSor
NOS-1),cytokine-inducible(iNOSorNOS-2)andendothelial(eNOS
orNOS-3)

---

39.Menkesdiseaseisassociatedwithwhich
enzymedeficiency.
a)lysyloxidase
b)Methioninesynthase
c)Glutamylaminopeptidase
d)Lysylhydroxylase
CorrectAnswer-A
Answers:A.lysyloxidase
Oneoftheenzymes,lysyloxidase,requirescopperforproper
function.Thisenzymecross-linkstropocollagenintostrongcollagen
fibrils.
Menkesdisease(MNK),alsoknownasMenkessyndrome,isanX-
linkedrecessivedisordercausedbymutationsingenescodingfor
thecopper-transportproteinATP7A,leadingtocopperdeficiency.
Thedecreasedsupplyofcoppercanreducetheactivityofnumerous
copper-containingenzymes.
Thesearenecessaryforthestructureandfunctionofbone,skin,
hair,bloodvesselsandthenervoussystemsuchaslysyloxidase.

---

40.LCATdeficiencyincreasesthefollowing
a)HDL
b)LDL
c)VLDL
d)Chylomicron
CorrectAnswer-A
Answer:A.HDL
Lecithincholesterolacyltransferasedeficiency(LCATdeficiency)isa
disorderoflipoproteinmetabolism.
AdeficiencyofLCATcausesaccumulationofunesterified
cholesterolincertainbodytissues.Cholesteroleffluxesfromcellsas
freecholesterolandistransportedinHDLasesterifiedcholesterol.
LCATistheenzymethatesterifiesthefreecholesterolonHDLto
cholesterolesterandallowsthematurationofHDL.
LCATistheenzymethatesterifiesthefreecholesterolonHDLto
cholesterolesterandallowsthematurationofHDL.LCATdeficiency
doesnotallowforHDLmaturationresultinginitsrapidcatabolismof
circulatingapoA-1andapoA-2.TheremainingformofHDL
resemblesnascentHDL.

---

41.A25yearoldalcoholicpresentedwith
edema,hypertension,ocular
disturbance,andchangesinmentalstate
wasobserved,diagnosisofhighoutput
cardiacfailurewasmadewithWetBeri
Beri,thisisduetodeficiencyof?
a)VitB3
b)VitB6
c)VitB9
d)VitB1
CorrectAnswer-D
Answer:D.VitB1
Wetberiberiisthetermusedforthiaminedeficiencywith
cardiovascularinvolvement.
Inthefirststage,peripheralvasodilationoccurs,leadingtoahigh
cardiacoutputstate.Thisleadstosaltandwaterretentionmediated
throughtherenin-angiotensin-aldosteronesysteminthekidneys.
Amorerapidformofwetberiberiistermedacutefulminant
cardiovascularberiberi,orShoshinberiberi.
Thepredominantinjuryistotheheart,andrapiddeterioration
followstheinabilityoftheheartmuscletosatisfythebody's
demandsbecauseofitsowninjury.
Inthiscase,edemamaynotbepresent.Instead,cyanosisofthe
handsandfeet,tachycardia,distendedneckveins,restlessness,
andanxietyoccur.

---

42.GlutamineisIncreaseinCSF,bloodand
urine,thisisduetodeficiencyof
a)CPS-I
b)Arginase
c)OTC
d)Argininosuccinatesynthetase
CorrectAnswer-A
Answer:A.CPS-I
CPSIdeficiencyisoneoftheproximalureacycledefectsandisdue
toacompleteorpartialdeficiencyofthemitochondrialenzyme
carbamylphosphatesynthetaseI(CPSI)whichproducescarbamyl
phosphatefromammonia,ATP,andHCO3.
CarbamoylphosphatesynthetaseI(CPS1orCPSI)transfersan
ammoniamoleculefromglutamineorglutamatetoamoleculeof
bicarbonatethathasbeenphosphorylatedbyamoleculeofATP.
Theresultingcarbamateisthenphosphorylatedwithanother
moleculeofATP.Theresultingmoleculeofcarbamoylphosphate
leavestheenzyme.
CPS-Iistheratelimiting(pacemaker)enzymethispathway.
CPS-IisactiveonlyinthepresenceofN-AcetylGlutamate,an
allostericactivator.

---

43.Trueabouttype1diabetesmellitus
a)Decreasedproteincatabolism
b)DecreasedhepaticGlucoseoutput
c)Increasedlipolysis
d)Increaseglucoseuptake
CorrectAnswer-C
Answer:C.Increasedlipolysis
Uncontrolledinsulin-dependentdiabetesmellitus(typeIdiabetes)
involvesdecreasedglucoseutilization,withhyperglycemia,and
increasedfattyacidoxidation.
Increasedfattyacidoxidationleadstoexcessiveproductionof
acetoaceticand3-hydroxybutyricacidsandofacetone,whichare
knownasketonebodies.
2.Acetoaceticand3-hydroxybutyricacidsdissociateatbodypHand
releaseHleadingtoametabolicacidosis.
LCATistheenzymethatesterifiesthefreecholesterolonHDLto
cholesterolesterandallowsthematurationofHDL.
LCATdeficiencydoesnotallowforHDLmaturationresultinginits
rapidcatabolismofcirculatingapoA-1andapoA-2.Theremaining
formofHDLresemblesnascentHDL.

---

44.ProteinwhichisnotsynthesisedInliveris
a)Phaseprotein
b)Immunoglobulins
c)Albumin
d)Plasmahormone
CorrectAnswer-B
Answer:B.Immunoglobulins
Theliverservesseveralmetabolicfunctionswithinthebody
includingproteinsynthesisandmetabolism.Theliverisresponsible
foranarrayofproteins.
Immunoglobulinsaresynthesisedinplasmacellswhicharebelieved
tobeendproductsofthedifferentiationofcellscalledB-
lymphocytes.
Theliverplaysacrucialroleintheproductionofnearlyallplasma
proteins(albumin,alpha-1-acidglycoprotein,majorityofcoagulation
cascade,andfibrinolyticpathways).
Notableexceptionsinclude:globulins,factorIII,IV,VIII.
Proteinsproducedbytheliver:proteinS,proteinC,proteinZ,
plasminogenactivatorinhibitor,antithrombinIII.VitaminK
dependentproteinssynthesizedbytheliverinclude:FactorsII,VII,
IX,andX,proteinSandC.

---

45.typeofcholesterolpresentingallstones?
a)Amorphouscholesterolmonohydrate.
b)Amorphouscholesteroldihydrate.
c)CrystallineCholesteroldihydrate.
d)Crystallinecholesterolmonohydrate.
CorrectAnswer-D
Answer:D.Crystallinecholesterolmonohydrate.
Gallstonesarehardeneddepositsofdigestivefluidthatcanformin
yourgallbladder.
Themostcommontypeofgallstone,calledacholesterolgallstone,
oftenappearsyellowincolor.Thesegallstonesarecomposed
mainlyofundissolvedcholesterol.
Precipitationofsolidcholesterolcrystalsfromsupersaturatedbile
hasanessentialroleincholesterolgallstoneformation.
Gallstonesarecomposedprincipallyofcholesterolmonohydrate
crystals(cholesterolstones)ortheacidsaltofcalciumbilirubinate
(pigmentstones).
Whenbileisconcentratedinthegallbladder,itcanbecome
supersaturatedwiththesesubstances,whichthenprecipitatefrom
thesolutionasmicroscopiccrystals.Thecrystalsaretrappedin
gallbladdermucus,producinggallbladdersludge.

---

46.collagenpresentinskinis
a)TypeII
b)TypeI
c)TypeIII
d)TypeIV
CorrectAnswer-B
Answer:B.TypeI
Collagenisaproteinthatispartofcartilage,bone,andothertissues
inanimalsandhumans.
Asthemaincomponentofconnectivetissue,itisthemostabundant
proteininmammals.
Collagenconsistsofaminoacidswoundtogethertoformtriple-
heliceslofelongatedfibrils.Itis,mostly,foundinfibroustissues
suchastendons,ligaments,andskin.
Sofar,28typesofcollagenhavebeenidentifiedanddescribed.
Thefivemostcommontypesare:
TypeI:skin,tendon,vasculature,organs,bone(maincomponentof
theorganicpartofbone)
TypeII:cartilage(maincollagenouscomponentofcartilage)
TypeIII:reticulate(maincomponentofreticularfibers),commonly
foundalongsidetypeI.
TypeIV:formsbasallamina,theepithelium-secretedlayerofthe
basementmembrane.
TypeV:cellsurfaces,hair,andplacenta

---

47.whichofthefollowingisnotRibozyme?
a)PloyApolymerase
b)Ribonuclease
c)Transpeptidase
d)PeptidylTransferase
CorrectAnswer-A
Answer:A.PloyApolymerase
Polyadenylationistheadditionofapoly(A)tailtoamessengerRNA.
Thepoly(A)tailconsistsofmultipleadenosinemonophosphates;in
otherwords,itisastretchofRNAthathasonlyadeninebases.
polyadenylationispartoftheprocessthatproducesmature
messengerRNA(mRNA)fortranslation.It,therefore,formspartof
thelargerprocessofgeneexpression.

---

48.Type-Ihyperlipoproteinemiais
characterizedby
a)ElevatedLDL
b)ElevatedHDL
c)Elevatedchylomicrons
d)Elevatedlipoproteinlipase
CorrectAnswer-C
AnswerC.Elevatedchylomicrons
Lipoproteinlipasedeficiency(TypeIhyperlipoproteinemia)results
inincreasedlevelofchylomicrones.
Lipoproteinlipasedeficiencyisageneticdisorderinwhichaperson
hasadefectivegeneforlipoproteinlipase,whichleadstoveryhigh
triglycerides,whichinturncausesstomachpainanddepositsoffat
undertheskin,andwhichcanleadtoproblemswiththepancreas
andliver,whichinturncanleadtodiabetes.
Thedisorderonlyoccursifachildacquiresthedefectivegenefrom
bothparents(itisautosomalrecessive).Itismanagedbyrestricting
fatindiettolessthan20g/day.
Thediseaseoftenpresentsininfancywithcolickypain,failureto
thrive,andothersymptomsandsignsofthechylomicronemia
syndrome.
Theconditionhasalsobeencalledfamilialchylomicronemia
syndrome,chylomicronemia,chylomicronemiasyndrome.and
hyperlipoproteinemtypeIa.

---

49.InKreb'scycleandUreacyclethelinking
aminoacidis
a)Fumarate
b)Alanine
c)Arginine
d)Aspartate
CorrectAnswer-D
Answer:D.Aspartate
Aspartatehelpsincondensationwithcitrullinetoformargino
succinicacid.
ArginosuccinicacidundergoesalyticreactiontoformArginineand
fumarate.
oxaloacetate,theketoacidobtainedfromaspartateisintermediate
ofTCAcycle.
HenceaspartateisacommonintermediateofTCAcyclethrough
oxaloacetateandureacycle(directly)

---

50.VitaminAisstoredin
a)CellsofIto
b)Hepatocyte
c)Endothelialcell
d)Kupffercell
CorrectAnswer-A
AnswerA?CellsofIto
HSCs(hepaticstellatecells)(alsocalledvitaminA-storingcells,
lipocytes,interstitialcells,fat-storingcellsorItocells)existinthe
spacebetweenparenchymalcellsandliversinusoidalendothelial
cellsofthehepaticlobuleandstore50-80%ofvitaminAinthe
wholebodyasretinylpalmitateinlipiddropletsinthecytoplasm.

---

51.Glanzmannthrombastheniaisdueto
a)DecreasedGpIb
b)DecreasedGpIIb/IIIa
c)Anti-GpIIb/IIIaantibodies
d)InhibitionordeficiencyofADAMTS13
CorrectAnswer-B
Ans.is.b.DecreasedGpIIb/IIIa
Glanzmannthrombastheniaisanautosomalrecessivedisorder.
ThereisafailureofprimaryplateletaggregationwithADPor
collagenduetoinheriteddeficiencyoftwoplateletsmembrane
glycoproteins.
ItiscausedduetodeficiencyofglycoproteinIIb-IIIa.

---

52.Apoptoticgeneis-
a)Bax
b)Bcl2
c)Bclx
d)Mcl
CorrectAnswer-B
Answer-B.Bcl2
RegulationisprimarilybytheBcl-2familyofgeneslocatedon
chromosome18.
Somemembersofthisfamilylikebak,bid,bin,Bcl-xs(toremember,
Sforstimulatingapoptosis)stimulateapoptosiswhereasotherslike
Bcl-2,Bcl-xl(toremember,Lforlowerapoptosis),etcinhibit
apoptosis.
Genefamiliessuchascaspases,inhibitorofapoptosisproteins,B
celllymphoma(Bcl)-2familyofgenes,tumornecrosisfactor(TNF)
receptorgenesuperfamily,orp53geneareinvolved,and/or
collaborateintheprocessofapoptosis.

---

53.Alphaoneantitrypsinworksby
a)inhibitionoftrypsin
b)inhibitionoftrypsinogen
c)inhibitionofelastase
d)inhibitionofchymotrypsin
CorrectAnswer-C
Answer-C(inhibitionofelastase)
Explanation-Alpha-1antitrypsin(A1AT)isproducedintheliver,and
oneofitsfunctionsistoprotectthelungsfromneutrophilelastase,
anenzymethatcandisruptconnectivetissue.

---

54.Whichoneofthefollowingisan
autosomalrecessivedisorder?
a)Albinism
b)Huntington'ssyndrome
c)Marfan'ssyndrome
d)Neurofibromatosis-1
CorrectAnswer-A
Answer-A.Albinism
Explanation-Albinismiscausedbymutationsinoneofseveral
genes,andmosttypesareinheritedinanautosomalrecessive
manner.

---

55.FishmouthappearanceofvalveinRHDis
dueto-
a)Ruptureofvalve
b)Calcification&fibrosis
c)Hypertrophyofventricularwall
d)Noneoftheabove
CorrectAnswer-B
Answer-B.Calcification&fibrosis
Inrheumaticheartdisease,anautoimmuneattackonthemitral
valveproducesthickeningofthevalveleaflets.Themitralvalveis
oftendescribedashavinga"fish-mouth"appearance.

---

56.Follicularlymphomapositivity?
a)Bcl-1
b)Bcl-6
c)Bcl-2
d)Noneoftheabove
CorrectAnswer-C
Answer-C.Bcl-2
Atranslocationbetweenchromosome14and18resultsinthe
overexpressionofthebcl-2gene.Asthebcl-2proteinisnormally
involvedinpreventingapoptosis,cellswithanoverexpressionofthis
proteinarebasicallyimmortal.Thebcl-2geneisnormallyfoundon
chromosome18,andthetranslocationmovesthegeneneartothe
siteoftheimmunoglobulinheavychainenhancerelementon
chromosome14.

---

57.whatisthehistologicaldifference
betweentheminUlcerativecolitis&
Crohn'sdisease?
a)Diffusedistributionofpseudopolyps
b)Mucosaledema
c)Cryptabscess
d)Lymphoidaggregatesinthemucosa
CorrectAnswer-C
differencesbetweenulcerativecolitisandCrohn'sdiseaseareas
follows:
ulcerativecolitis
Crohnsdisease
commonsite ileocolitiswithrectalsparing
procolitis,rectum
protective
Smoking
nofactors
factor
Appendicectomy
antibioticduringthefirst
commonrisk
antibioticduringthefirst
yearoflife,turner
factors
yearoflife,turnersyndrome
syndrome
-Methyldopa,Wiskott?
riskfactor
OCP,Smoking
AldrichSyndrome,
Tcellinvolved
TH1
TH2
Earliest
Erythematousmucosa
macroscopic
AphthousUlcer
withafinegranular
finding
surface
Wallinvolved
Transmural
mucosa&submucosa
Pseudopolyp
lesscommon
mostcommon
typeofulcer
serpentine
Collar-buttonulcers
cobblestone
present
notpresent

---

cobblestone
present
notpresent
appearance
skinlesions
seen
notseen
Creepingfat
seen
notseen
non-caseatinggranuloma
Granuloma
notseen
seen
classical-perinatal
Fistula
notseen
(enterocutaneous)
strictures
common
notcommon
Toxic
notseen
seen
megacolon
Cryptabscess
and
lessmarked
moremarked
destruction
Rosethorn
seen
notseen
appearance
Pyloricmetaplasiaisa
metaplasia
panethcellmetaplasia
clinicalmarker
Renalcalculi
calciumoxalate
notpresent
uveitis,migratory
polyarthritis,sacroiliitis,
ankylosing
Extraintestinal
spondylitis,erythema
SimilartoCrohndisease
manifestations nodosum,clubbing,Primary
sclerosing
cholangitis
Named
TrueLoveWitt's
criteriato
--------
criteria-UC
assess
theseverity

---

58.Whatisthecauseofintracorpuscular
defectsinhemolysis?
a)Uremicsyndrome
b)PCH
c)PNH
d)Portalhypertension
CorrectAnswer-C
Answer-C.PNH

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59.Typeofnecrosisseeninbloodvessels
duetoimmunereactions-
a)Coagulation
b)Liquefaction
c)Fibrinoid
d)None
CorrectAnswer-C
Answer-C(Fibrinoid)
Insmallvesselvasculitis,fibrinplugsfrequentlyoccurinthevessel
lumen,butthetermfibrinoidisusuallyusedtorefertomaterial
outsidethelumenofavessel.Fibrinoidnecrosisalsooccursinthe
wallsofarteriolesinmalignanthypertension.

---

60.Inapatientwithlipoproteinlipase
deficiency,whichofthefollowingis
increasedfollowingafattymeal?
a)Chylomicron
b)LDL
c)HDL
d)Apo-A
CorrectAnswer-A
Answer-A.Chylomicron
Lipoproteinlipasedeficiency(TypeIhyperlipoproteinemia):isarare,
autosomalrecessivedisordercausedbyadeficiencyoflipoprotein
lipase.Resultinginfastingchylomicronemiaand
hypertriglycerolemia.Thereisslowclearanceofchylomicronsand
VLDL.LowlevelsofLDLandHDL.Thereisnoincreasedriskof
coronarydisease.

---

61.InWilson'sdisease,thereislessurinary
excretionof-
a)Phosphorus
b)Methyl-Histidine
c)Phosphotyrosine
d)Serine
CorrectAnswer-B
Answer-B.Methyl-Histidine
EssentialsofDiagnosis&TypicalFeaturesofWilsondisease:
Acuteorchronicliverdisease
Deterioratingneurologicstatus
Kayser-Fleischerrings
Elevatedlivercopper
Abnormalitiesinlevelsofceruloplasminandserumandurine
copper.

---

62.WhatisthefunctionofIL1?
a)Enhanceshematopoiesis
b)Stimulatesmastcells
c)Hasantiviralproperties
d)Endogenouspyrogen
CorrectAnswer-D
Answer-D(Endogenouspyrogen)
wasformerlyknownaslymphocyte-activatingfactor(LAF).
augmentstheactivityofmanycelltypes,especiallyTcells.
isanendogenouspyrogen(EP).
inducesanincreaseinacutephasereactants.
isaheat-stableandpH-stablepeptidewithamolecularweightof
17.5kd.
occursintwoforms:IL-1?andIL-1?.

---

63.CEAPscoreindicates-
a)Atrialdisorders
b)Venousdisorder
c)Neurologicaldisorde
d)Traumadisorder
CorrectAnswer-B
Answer-B.(Venousdisorder)
ComprehensiveClassificationSystemforChronicVenousDisorders
(CEAP)
CEAPclassificationofchronic
Clinicalclassification
venousdisease
C3
Edema
C4a
Pigmentationoreczema
Lipodermatosclerosisor
C4b
athrophieblanche
C5
Healedvenousulcer

---

64.IL-1activatedby-
a)Capsase1
b)Capsase3
c)Capsase8
d)Capsase5
CorrectAnswer-A
Answer-A(Capsase1)
ThetwoinflammatorycytokinesactivatedbyCaspase-1are
excretedfromthecelltofurtherinducetheinflammatoryresponsein
neighboringcells.

---

65.Parotidmassmixedconsistency
a)Pleomorphicadenoma
b)Sebaceouscyst
c)Dermoidcyst
d)All
CorrectAnswer-A
Answer-A(Pleomorphicadenoma)
Itisalsoknownas"Mixedtumor,salivaryglandtype",whichrefers
toitsdualoriginfromepithelialandmyoepithelialelementsas
opposedtoitspleomorphicappearance.

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66.Krabbe'sdiseaseis-
a)DeficiencyofBeta-galactosylcermidase
b)Deficiencyofarylsulphatase
c)Alphagalactosidase
d)Acidlipase
CorrectAnswer-A
Answer-A(DeficiencyofBeta-galactosylcermidase)
KrabbediseaseiscausedbymutationsintheGALCgenelocated
onchromosome14(14q31),whichisinheritedinanautosomal
recessivemanner.MutationsintheGALCgenecauseadeficiency
ofanenzymecalledgalactosylceramidase.

---

67.Whatisthechoiceoftreatmentfor
idiopathicthrombocytopeniapurpura
(ITP)?
a)Bloodtransfusion
b)Spontaneousrecovery
c)IVinfusion
d)Splenectomy
CorrectAnswer-D
Answer-D(Splenectomy)
BeneficialeffectsofsplenectomyinchronicITPareduetoboth
removalofthemajorsiteofplatelet
destructionandthemajorsourceofautoantibodysynthesis.

---

68.Fluoroquinoloneswithmaximum
bioavailabilityis?
a)Moxifloxacin.
b)Gatifloxacin.
c)Levofloxacin
d)Ciprofloxacin
CorrectAnswer-C
Ans.C.Levofloxacin.
Pharmacokineticsoffluoroquinolones:
Goodoralbioavailability(exceptnorfloxacin).
Levofloxacin-100%bioavailability.
Multivalentcationsinterferewithabsorption(liketetracycline).

---

69.Mechanismofactionofbuspironeis?

a)5HT1Apartialagonism.
b)5HT1Bantagonism.
c)5HT1Bpartialagonism.
d)5HT2Cantagonism.
CorrectAnswer-A
Ans.A.HT1Apartialagonism
5HT1A:
*Presynapticautoreceptor.
*Modulatesserotoninrelease.
Partial5HT1Aagonists:
*Buspirone,isapirone,gepirone.
*Usefulasanti-anxietydrug.

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70.Whichstatementbestdescribes
mechanismofactionofazole?
a)Synthesisofergosterol
b)Thymidylatesynthase
c)TargetingBeta-1,3?glucan
d)Disruptionofcellwall.
CorrectAnswer-A
Ans.A.Synthesisofergosterol
Inhibitionof14a-lanosteroldemethylase,akeyenzymeinergosterol
biosynthesis?resultingindepletionofergosterol&accumulationof
toxic14a-methylatedsterolsinmembranesofsusceptibleyeast
species?Destructionoffungus.

---

71.Whichisthefollowingisorallyactive
directXainhibitor?
a)Rivaroxaban
b)Agrataban
c)Dabigatran
d)Bilverudin
CorrectAnswer-A
Ans.a.Rivaroxaban
Rivaroxaban,apixaban&edoxabanarefactorXainhibitors.
Dabigatranetexilateisdirectthrombininhibitor.

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72.Whichamongthefollowingismost
probablereasonforpreferenceof
Cisatracuriumoveratracurium?

a)Decreasedhistaminerelease
b)Increasedhistaminerelease
c)DuetoeliminationbyHofmannelimination
d)IncreasedCNStoxicity
CorrectAnswer-A
Ans.A.Decreasedhistaminerelease
Cisatracurium:
*UndergoesHofmannelimination.
*Doesnotprovokehistaminerelease?Hence,preferredover
atracurium.
*Noeffectonheartrate/BP/nilautonomiceffect.
*Produceslesslaudanosinethanatracurium?Hence,lessCNS
toxicity(seizures).

---

73.Whichofthefollowingdrugisusedin
SIADH?
a)Tolvapatan
b)Desmopressin
c)Vwbfactor
d)Terlipressin
CorrectAnswer-A
Ans.A.Tolvaptan
Tolvaptan:
*Vasopressinantagonists.
*OrallyactivenonpeptideselectiveV2receptorantagonist.
*MetabolizedbyCYP3A4?Notgiventopatientsreceivingthis
isoenzymeinhibitor.
*Givenoncedaily.
*t?:6?8hours.
Actions:
*Increasesfreewaterclearancebykidney(aquaretic).
*CorrectslowerplasmaNa+levels.
Uses:
*Usefulforhyponatremiatreatment.
*HyponatremiacausedbyCHF,cirrhosisofliverorsyndromeof
inappropriateADHsecretion(SIADH).
Sideeffect:
*Thirst&drymouth(mostfrequent).
*Fever,G.I.upset&hyperglycaemia.

---

74.DrugactingonK+channelsincludewhich
ofthefollowing?
a)Spironolacton
b)Amiloride.
c)Nicorandil
d)Methyldopa
CorrectAnswer-C
Ans.C.Nicorandil
Nicorandil:
Cardioprotectivepotassiumchannelopener.
Causesischemicpreconditioning&coronarydilation?Byactivating
myocardialATPsensitiveK+channels.
AlsopossessesNO-releasingproperty.
Usefulinangina.

---

75.Imipenem,anewerantibioticwithabroad
antibacterialspectrum,iscoadministered
withcilastatin.Whichofthefollowingis
thebestreasonforthesame?
a)CombinationofantibioticsissynergisticagainstPseudomonas
specie
b)Cilastatinaidsgastrointestinalabsorptionofactivemoiety,
imipenem
c)Cilastatininhibitsbeta=lactamaseenzymedestroyingimipenem
d)Cilastatininhibitsanenzymeinkidneydestroyingimipenem
CorrectAnswer-D
Ans.D.Cilastatininhibitsanenzymeinkidneydestroying
imipenem
Imipenem-cilastatin0.5gi.v.6hourly(max4g/day).
Effectiveinserioushospital-acquiredrespiratory,urinary,abdominal,
pelvic,skin&softtissueinfectionsincludingneutropenic,cancer&
AIDSpatients.
ForPs.aeruginosainfections,itshouldbecombinedwith
gentamicin.

---

76.DOCforsmokingcessation?
a)Acamprosate
b)Varenicline
c)Thalidomide
d)Tryptophan
CorrectAnswer-B
Ans.B.Varenicline(IfBupropionisnotanoption)
Anti-smokingdrugs:
Bupropion(alongwithVarenicline&Nicotinereplacementtherapy)
isaUSFDAapprovedfirst-lineagentforpharmacotherapyin
smokingcessation.
Varenicline:
Effectiveagentsforsmokingcessation.
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
CorrectAnswer-A
Ans.A.Trimethoprimandsulfamethoxazolecombination.
CombinationoftrimethoprimwithsulfamethoxazoleisDOCfor
cyclosporiasis&Isosporiasis(Protozoalinfection).

---

78.Mechanismofactionofcurarelikedrugs?
a)BlocksAChsynthesis
b)BlocksAChreceptors
c)Persistentdepolarization
d)AgonisticwithAchreceptors
CorrectAnswer-B
Ans.B.BlocksAChreceptors
Tubocurarine,Cisatracurium,Rocuronium:Competitiveantagonistat
nAChreceptorsmainlyatNMjunction.
d-tubocurarine:
Obsoleteclinicalusage.
PrototypeNMblocker.
Longeractingisoquinolinederivative.
MOA:Actspredominantlyatnicotinicreceptorsiteblockingtheir
receptors?Bycompetingwithacetylcholine(competitive
antagonism).

---

79.Adrugwithhighplasmabindingprotein
propertyhaswhichofthefollowing
properties?
a)LessGFR
b)Lessdruginteraction
c)Highervolumeofdistribution
d)Lesstubularsecretion
CorrectAnswer-A
Ans.A.LesserGFR
Onlyfreedrugscanbefilteredthroughglomerulus.
Hence,PPBdecreasesGFR.
Tubularsecretionisanenergyrequiringcarriermediatedactive
transport.
hence,PPBdonotinterferewithtubularsecretion.

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80.MechanismofactionofOseltamivir?
a)Proteinsynthesisinhibitor
b)Thymidylatesynthetaseinhibitor
c)Neuraminidaseinhibitor
d)Pyrimidineanalogs.
CorrectAnswer-C
Ans.C.Neuraminidaseinhibitor
Neuraminidaseinhibitors:
Analogsofsialicacid.
InterfereswithreleaseofprogenyinfluenzaA&Bvirusfrominfected
hostcells.
Competitively&reversiblyinteractwithactiveenzymesite?>
resultinginclumpingofnewlyreleasedinfluenzavirionstoeach
other&tomembraneofinfectedcell.

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81.Trueaboutcolchicinesis/are?
a)Actsbyneutrophilrecruitment
b)Causesmetaphasearrest
c)Usefulinurate-loweringtherapy
d)Alloftheabove
CorrectAnswer-D
Ans.D.Alloftheabove.
Colchicine:
MOA:
Actsbyinhibitinggranulocytemigrationintoinflamedjoint.
Depolymerizationofmicrotubulesleadstoneutrophilrecruitmentto
inflamedtissue?Alteringneutrophilmotility.
Decreasessecretionofchemotacticfactors&superoxideanionsby
activatedneutrophils.
Causesmetaphasearrest.
Mostcommon&doselimitingtoxicity:
Diarrhea.
Alsocausekidneydamage,myopathy&bonemarrowdepression.
Indications:
Asarate-loweringtherapy(dailycolchicines)suppressingattacks
precipitatedbyabruptserumuricacidchanges.

---

82.Whichofthefollowingdrugisalpha2
agonist?
a)Apraclonidine
b)Timolol
c)PGanalogues
d)Verampamil
CorrectAnswer-A
Ans.A.Apraclonidine
Apraclonidine?Selectivealpha2agonist.
Usefulinglaucoma.
Alphaagonists(Brimonidineandapraclonidine)arecontraindicated
inhypertensivecrisis.
Dipivefrinisaprodrugwhichisconvertedintoepinephrineinsidettre
eyeUall,socansafelybeusedinhypertension.

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83.DrugtodifferentiateMyastheniagravis
fromcholinergiccrisis?
a)Pyridostgmine
b)Edrophonium
c)Methacholine
d)Clonidine
CorrectAnswer-B
Ans.B.Edrophomium.
Edrophonium?Usedasadiagnostictestformyasthenia.
Steps:
2mgdoseinjectedintravenously.
Ifnoreactionoccursafter45seconds,anadditional8mg
administered.
Ifthepatienthasmyastheniagravis,animprovementinmuscle
strengthlastingforabout5minutesusuallyobserved.

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84.ConversionofNorepinephrineto
epinephrineismainlyby?
a)S-adenosylmethionine
b)Arginine
c)Phenylalanine
d)Dehydrogenease
CorrectAnswer-A
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
d)Meropenem
CorrectAnswer-A
Ans.A.Imipenem.
Imipenem:
Carbapenemgrp.ofdrugs.
Maximumtendencytocauseseizures.

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86.DOCfordiphtheriacarrierstateis?
a)Penicillin
b)Antitoxin
c)PenicillinOrerythromycin
d)Ciprofloxacin
CorrectAnswer-C
Ans.C.Penicillinorerythromycin
Contactsshouldreceiveantibiotics.
BenzathinepenicillinG(600,000unitsforpersonsyoungerthan6
yearsoldand1,200,000unitsforthose6yearsoldandolder)
Oralerythromycin(40mg/kg/dayforchildrenand1g/dayforadults)
for7-to10-daycourse.
Identifiedcarriersincommunityalsoreceiveantibiotics.
Maintainclosesurveillanceandbeginantitoxinatthefirstsignsof
illness.

---

87.

---

HealthyHumanvolunteerspartofwhich
clinicaltrialphase?
a)Phase1
b)Phase0
c)Phase3
d)Phase4
CorrectAnswer-A
Ans:A,Phase1.
PhaseIofclinicaltrialishumanpharmacologyandsafety.
PhaseIinvolvesnormalhumanvolunteers.

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88.DOCforscorpionstingbiteis?
a)EDTA
b)Neostigmine
c)N-acetylcysteine
d)Prazosin
CorrectAnswer-D
Ans:d.Prazosin
DOCforpoisoningduetostingofscorpion?Prazosin.
Prazosin:
Analpha-blocker.
Managementofscorpionstingbite:
DependingupontheseverityofScorpionpoisoning:
Immunotherapy-(dosedependingonantivenomtiter)
Prazosin
Midazolam
Aspirin

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89.MOAofTeduglutideinshortbowel
syndrome?
a)GLP-2inhibitor
b)HT1ainhibitor
c)GLP-1analogs
d)C-peptideanalogs
CorrectAnswer-A
Ans.A.GLP-2inhibitor
Glucagon-likepeptide-2(GLP-2)?Importantintestinotrophicgrowth
factor&mediatorofintestinaladaptation.
FDAapprovedteduglutide(Gattex--NPS)totreatshortbowel
syndromeinadultpatientsrequiringadditionalnutritionfromI.V.
parenteralnutrition.
Effectivelyimprovesfluidabsorption.

---

90.DOCforchemotherapyinducedvomiting
is?
a)Graneseteron
b)Prazosin
c)Clonidine
d)Dimenhydrinate
CorrectAnswer-A
Ans.A.Granisetron.
Granisetron:
Serotonin5-HT3receptorantagonist.
Usedasanantiemetictreatingnausea&vomitingfollowing
chemotherapy&radiotherapy.
Maineffect:
Reducesvagusnerveactivity(VagusN.activatesvomitingcenterin
medullaoblongata).

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91.Whatistheadvantageoffixeddose
combinationofdrugs.
a)Increasesefficacyofdrug
b)Decreasesadverseeffects
c)Patientcomplianceimproved
d)Alloftheabove
CorrectAnswer-D
Ans.D.Alloftheabove
AdvantagesofFDC:
Safeandeffective.
Reduces"pillburden"?Enhancingoveralltreatmentoutcome.
Increasesefficiency.
Reduceincidenceofadversedrugeffects.
Improvespatientcompliance.
Offerslowcost(comparedtoindividualcomponentsofactive
ingredients).

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92.DOCfordigitalisisinducedcentro-chilar
tachycardia?
a)Lidocaine
b)Reducingdosageofdigoxinitself,reversesthecondition
c)Verapamil
d)Betablockers
CorrectAnswer-A
Ans.A.Lidocaine
Digitalistoxicity:
Features:
Generallyunwell&lethargy.
Nausea&vomiting.
Confusion.
Yellow-greenvision.
Arrhythmias(e.g.AVblock,bradycardia)
Dizziness.
Precipitatingfactors:
Renaldisease
Hypokalaemia
Hypomagnesemia
Hypoalbuminemia
Hypothermia
Hypothyroidism
Hypercalcemia.
Hypernatremia
Acidosis.
Myocardialischaemia.
PartialAVblock.

---

Drugs:
Amiodarone.
Quinidine.
Verapamil.
Spironolactone.
Furosemide.
Hydrochlorothiazide-CompetewithDCTsecretion,hence
reducingexcretion.
Management:
Digibind.
Correctventriculararrhythmiabylignocaine.
Bradyarrhythmiasbypropanolol.
Atrialtachyarrhythmiasbyatropine.
Phenytoin.
MonitorK+

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93.AntiretroviraltherapyistobegiveninHIV
infectedpatientsirrespectiveofpresence
ofsymptomsifCD4countislessthan?
a)100
b)150
c)200
d)350
CorrectAnswer-C
Ans.C.200
OfferARTtosymptomaticpatientsiftheCD4countis200?350
cells/mm3
ConsiderARTforasymptomaticpatientswithCD4countbetween
200-350cells/mm3andmonitorcloselyfornewsymptoms.
IftheCD4countis200?250cells/mm3,physicianscanconsider
repeatingtheCD4testin4weeksinasymptomaticpatients.
Thisistoruleoutthepossibilityofa20%marginoferrorin
laboratoryresults.
PatientsshouldstartARTbeforetheCD4countdropsbelow200
cells/mm3
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
b)Neutropenia
c)Malaria
d)Filarial
CorrectAnswer-B
Ans.is.B.Neutropenia
Filgrastimisarecombinanthumangranulocytecolonystimulating
factor(G-CSF)whichisa175-aminoacidglyco-protein.
Itdiffersfromthenaturalgranulocytestimulatingfactorduetoits
lackinglycosylationandthepresenceofanextraN-terminal
methionine.Ithasprovedtobeeffectiveinthetreatmentofsevere
neutropenia.
Ref:GoodmanandGilman'sThePharmacologicalBasisof
Therapeutics,11thEdition,Pages1429-32;Immunopharmacology
ByManzoorM.Khan,Pages49-50

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95.Trueabouttreatmentofearlybreast
carcinoma?
a)Aromataseinhibitorsarereplacingtamoxifeninpremenopausal
women
b)Postmastectomyradiationtherapyisgivenwhen4ormore
lymphnodesarepositive
c)Tamoxifenisnotusefulinpost-menopausalwomen
d)Inpremenopausalwomen,multidrugchemotherapyisgivenin
selectedpatients
CorrectAnswer-B
Ans.B.Postmastectomyradiationtherapyisgivenwhen4or
morelymphnodesarepositive
Tamoxifen:
Effectiveinbothpre&postmenopausalwomen(ifhormonereceptor
positive)
DOCinpremenopausalwomen
Aromataseinhibitors:
Provenmorebeneficialthantamoxifeninpostmenopausalwomen.
MOA:
Byloweringestrogeninpost-menopausalwomenwithhormone-
receptor-positivebreastcancer.
Inpost-menopausalwomen,mostofbody'sestrogenisfrom
androgen.
Aromataseinhibitorsinhibitsaromataseenzyme?blocking
androgenintoestrogen?loweringestrogenproducedoutside
ovaries.
Uses:
1stlinetherapyinpostmenopausalwomen,adjuvantsettingor

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secondaryagentafter1to2yearsofadjuvanttamoxifentherapy.
Advantages:
Reducedincidenceofendometrialcancer.
Adverseeffects:
Bonemineraldensityalteration-?osteoporosis&increasedfractures
inpostmenopausalwomen.
Otheroptions:
Inpremenopausalwomenwithanyformofadjuvantsystemic
therapyshouldreceivemultidrugchemotherapy.

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96.ApatientofRAistakingmethotrexate,
steroidsandNSAIDssince4monthsbut
activityofdiseaseprogressionissame.
Whatshouldbethenextprobablestep?
a)StartmonotherapywithantiTNFalphadrugs
b)Continuemethotrexateandsteroids
c)Stoporalmethotrexateandstartparenteralmethotrexate
d)Addsulfasalazine
CorrectAnswer-D
Ans.D.Addsulfasalazine

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97.IVMannitolisusedfortreatmentof
a)Acutecongestiveglaucoma
b)Pulmonaryedema
c)Acuterenalfailure
d)CHF
CorrectAnswer-A
Ans.A.Acutecongestiveglaucoma.
Mannitolmaybeusedtoreduceintraocularpressurewhengiven
intravenously.

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98.Variationinsensitivityofresponseto
differentdosesofadrugindifferent
individualisobtainedfrom?
a)Doseresponsecurve
b)Therapeuticindex
c)Bioavailability
d)Phase1clinicaltrials
CorrectAnswer-A
Ans.A.Doseresponsecurve
Thedose?responserelationship,orexposure?responserelationship,
describesthechangeineffectonanorganismcausedbydiffering
levelsofexposuretoastressorafteracertainexposuretime,ortoa
food.
Appliestoindividuals,ortopopulations.

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99.Whichoneoffollowingisfunctionsof
PGI2?
a)Inhibitsplateletaggregation
b)Isavasodilator
c)IspyrogeniclikePGE2
d)Alloftheabove
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
CorrectAnswer-D
Answer:D.skinsubcutaneousfat
Theclinicalentityofdeglovinginjurymeansthattheskinhasbeen
lost,butthemusculoskeletalunitisintact,andhence,the
movementsoftheparthavebeenpreserved.
Degloving,alsocalledavulsion,isatypeofsevereinjurythat
happenswhenthetoplayersofyourskinandtissuearerippedfrom
theunderlyingmuscle,connectivetissue,orbone.Itcanaffectany
bodypart,butit'smorecommoninthelegs
Dependingontheanglethatthetirepullasacrosstheextremity,the
skinandsubcutaneoustissuemaybepulledorshearedoffon
leadingedgeofextremity.

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101.Sexualperversions(Exhibitionism)is
undersection
a)Section290
b)Section294
c)Section230
d)Section291
CorrectAnswer-B
Answer:B.Section294
EXHIBITIONISM:sexualgratificationbyexposingone'sgenitalia.
Punishableundersec294I.P.C.withimprisonmentupto3monthsor
fine

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102.1staffectedinrigormortis
a)Eyelids
b)Myocardium
c)Jaw
d)Neck
CorrectAnswer-B
Answer-B.Myocardium
stateofthemusclesinadeadbodywhentheybecomestifforrigid
withsomedegreeofshortening.
Allmusclesofbodyareinvolvedi.e.voluntaryorinvoluntary.
However,itdoesnotstartinallmusclessimultaneously(nysten's
rule).
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
c)Sec197
d)Sec190
CorrectAnswer-A
AnswerA.Sec193
Definespunishmentforfabricatingfalseevidence
Thewitnessisliabletobeprosecutedforperjury,andthe
imprisonmentmayextenduptosevenyears.
193IPC:punishmentforfalseevidence,(punishmentforperjury):
imprisonmentupto7years+hne
IgIIpC:(i)Givingfalseevidence(perjury)underoath.
I92IPC:Fabricatingfalseevidence(perjury)

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104.Gastriclavageisnotcontraindicated
afteringestionofwhichacid.
a)HCL
b)H2SO4
c)Carbolicacid
d)Nitricacid
CorrectAnswer-C
Answer-C.CarbolicAcid
Theonlyobsolutecontraindicationiscorrosivepoisoningi.e
alkalis,mineralacid,vegetableacidandorganicacids(except
carbolicacid).
Carbolicacidistheonlycorrosiveinwhichgastriclavagecanbe
used.
Gastriclavagemustbedone(exceptwhencontraindicated)
irrespectiveofwhethervomitinghasoccuredornot,toprevent
aspirationofcontent.
Carbolicacidistheonlycorrosiveinwhichgastriclavageisnot
contraindicated.

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105.Visceraintoxicologystoredin
a)Glycerine
b)Rectifiedspirit
c)Formalism
d)Saturatedsaltsolution
CorrectAnswer-D
Answer-D.Saturatedsaltsolution
Toxicologicalvisceraispreservedinasaturatedsolutionof
commonsalt(sodiumchloride).
Fortoxicologicalanalysis,visceraisneverpreservedinalcohol,
formalin,orbilesalt.
Infact,formalindenaturesproteinsandchemicaitoxinsandwould
interferewiththedetectionofpoisonsduringchemicalanalysis'

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106.Twoidenticaltwinswillnothavesame
a)Fingerprints
b)DNAcopies
c)Iriscolor
d)Bloodgroup
CorrectAnswer-A
Answer:A.Fingerprints
IdenticaltwinshavethesameDNA,buttheirfingerprints
(dactylography)arestilldiferentandtheydonotchange.
Thesecanbeeasilyusedtodifferentiatebetweenanidenticalset
oftwins.
IdenticaltwinshavethesamesetofDNA,thereforeDNA
fingerprintingcannotdifferentiatethem.

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107.InAllegedhistoryofgunshot
injury.thereisburning,blackening,
tattooingaroundthewoundDirtcollar,
theinjuryis
a)Closeshotentrywound
b)Closeshotexitwound
c)Distantshotentrywound
d)distantshotexitwound
CorrectAnswer-A
Answer:A.Closeshotentrywound
Buring,blackening,tattooingaroundthewoundarefeaturesof
closeshotentry.
Andmayoccurincontactshotwhenmuzzleendisnotpressed
firmly.

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

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108.AchildishavingBatteredbaby
syndromehowwillyouidentify
a)Stabwound
b)Gunshotwound
c)Bruiseofdifferentages
d)Noneofthese
CorrectAnswer-C
Ans-C.Bruiseofdifferentages
Abatteredchildisonewhohasreceivedrepetitivephysicalinjuries
asaresultofnon-accidentalviolenceproducedbyaparentora
guardian.
multiplebruisepresentoverbody,Lacerationoftheoralmucosa,
Parentsgivevaguehistoryofaccidenttobethecauseofthe
injuries.
ItisalsocalledCaffeysyndrome,Caffey-Kempesyndrome,
maltreatmentsyndromeorParent-infanttraumaticstresssyndrome
Theinjuriesmaybecausedbyhand,foot,teeth,stick,belt,shoe,
hotwater,lightedcigarette,hotfryingpanoranyhouseholdarticle
Accidentalinjuriestypicallyinvolvebonyprominences[head
(forehead,occipitalorparietalregion),nose,chin,palm,elbows,
kneesandshin],matchthehistorygivenbytheparentsandare
keepingwiththedevelopmentofthechild

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109.Apatientishavinggastrointestinal
problemsincludingabdominalpainand
distension,bloodyormucus-filled
diarrhea,andtenesmus,withrectal
prolapse,Astool,ovaandparasites
examrevealsthepresenceoftypical
Barrel-shapedeggs,possiblecausative
agentis?
a)Campylobacter
b)Clostridiumdifficile
c)Giardialamblia
d)Trichuris
CorrectAnswer-D
Answer:D.Trichuris
whipwormcancausegastrointestinalproblems,suchasabdominal
pain,diarrhea,mucousorbloodystoolsweightloss,painful
urination,andweakness.
Rectalprolapseisahallmark,albeitrare,symptomofaheavyT.
trichiurainfectionthatoccursinchildrenmorefrequentlythanadults.
Whenrectalprolapseoccurs,wormscanoftenbeidentifiedonthe
edematousrectum.
Inawhipworminfection,therectumlosesitsinternalsupport
becausethewormsburytheirthinheadsintotheintestinallining,
looseningtheelasticepitheliumandweakeningthesurrounding
muscles.

---

---

110.Contactisolationisdonefor
a)MRSA
b)Mumps
c)Diphtheria
d)Asthama
CorrectAnswer-C
Answer:C.Diphtheria
AtypeofbacteriacalledCorynebacteriumdiphtheriaecauses
diphtheria.
Theconditionistypicallyspreadthroughperson-to-personcontactor
throughcontactwithobjectsthathavethebacteriaonthem,suchas
acuporusedtissue.
Evenifaninfectedpersondoesn'tshowanysignsorsymptomsof
diphtheria,they'restillabletotransmitthebacterialinfectionforup
tosixweeksaftertheinitialinfection
Thebacteriamostcommonlyinfectyournoseandthroat.Once
you'reinfected,thebacteriareleasedangeroussubstancescalled
toxins.Thetoxinsspreadthroughyourbloodstreamandoftencause
athick,graycoatinginnose,throat,lungs.

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111.Achildissufferingfromrecurrent
chronicinfectionswithencapsulated
bacteriaisduetodeficiencyofsubclass
.
a)IgG1
b)IgG2
c)IgG3
d)IgG4
CorrectAnswer-B
Answer:B.IgG2
IgG2antibodiesarepredominantlyagainstthepolysaccharide
(complexsugar)coating(capsule)ofcertaindisease-producing
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
CorrectAnswer-C
Answer:C.Co-trimoxazole
Themostcommonantibioticthatisprescribedisco-trimoxazole
(trimethoprimsulfamethoxazole),morecommonlyknownasBactrim,
Septra,orCotrim.
ForImmunocompetenthostsPreferedregimen:Trimethoprim-
sulfamethoxazole160mg/800mgPObidfor7-10days..

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113.CoxsackievirusA16causes
a)Yellowfever
b)Hand-foot-mouthdisease
c)Rockymountainspottedfever
d)Encephalomyocarditis
CorrectAnswer-B
Answer:B.Hand-foot-mouthdisease
Hand,FootandMouthDisease(HFMD)iscausedbycoxsackieA-
16
ThevirusesthatcauseHFMDarespreadthroughclosepersonal
contact,throughtheairfromcoughingandthefecesofaninfected
person.
CoxsackievirusA16isthemostcommoncause,andenterovirus71
isthesecond-mostcommoncause.Otherstrainsofcoxsackievirus
andenteroviruscanalsoberesponsible.
Ittypicallybeginswithafeverandfeelinggenerallyunwell.Thisis
followedadayortwolaterbyflatdiscoloredspotsorbumpsthat
mayblister,onthehands,feetandmouthandoccasionallybuttocks
andgroin.

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114.Pneumocystisjeroviciis:
a)AssociatedwithCMV
b)Diagnosisisbysputummicroscopy
c)Seenonlyinimmunocompromisedpatients
d)Alwaysassociatedwithpneumatocele
CorrectAnswer-B
Answer:B.Diagnosisisbysputummicroscopy
Humanisolateof.Pneumocystiswhichisassociatedwithsevere
pneumoniainimmunocompromisedstateparticularlyAIDS.
P.jeroviciisanextracellularpathogen.Growthinthelungis
limitedtosurfactantlayerabovealveolarepithelium.
Serologicevidencesuggestthatmostindividualsareinfectedin
earlychildhood(thusoption"c"iswrong)butthepneumoniais
seenonlyinimmunocompromisedstate.
Diagnosisismadebydetectionoforganisminproperspecimen
Sputum:Quickandnoninvasive.
Broncho-alaeolarlaoage(BAL)fluid:Mainstayofpneumocystis
diagnosis.
Transbronchialbiopsy:IfdiagnosiscannotbemadebyBAL.

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115.Allaretrueaboutcongenital
ToxoplasmosisEXCEPT
a)Chorioretinitis
b)Conjunctivitis
c)Hydrocephalus
d)Cerebralcalcification
CorrectAnswer-B
AnswerB.Conjunctivitis
Occursonlywhenmothergetsprimarytoxoplasmosisinfection
whetherclinicalorasymptomaticduringpregnancyor<6months
beforeconception(i.e.noriskifacquired>6monthsbefore
conception).
Asgestationalageisincreased,riskoftransmissiontofetus
increased,i.e.max.in3rdtrimesterwhile
severityoffetaldamageisdecreased,i.e.infantisusually
asymptomaticifinfectiontransmitin3rdtrimester.
Chorioretinitisisusuallytreatedwithacombinationofcorticosteroids
andantibiotics.
Itcauses:hydrocephalous,diffusecerebral
calcification,hepatosplenomegaly,mentalretardation
myocarditis,lymphadenitis,microencephaly,myocarditis,
chorioretinitis,multiorganfailure,Pneumonitis

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116.trueaboutTRIADcongenitalrubella
syndrome
a)PDA,cataractanddeafnessisseen
b)Hepatosplenomegaly,mentalretardation,deafness
c)Chorioretinitis,multiorganfailure,pneumonitis
d)Noneofthese
CorrectAnswer-A
Answer:A.PDA,cataractanddeafnessisseen
Congenitalrubellasyndrome(CRS)canoccurinadevelopingfetus
ofapregnantwomanwhohascontractedrubella,usuallyinthefirst
trimester.Ifinfectionoccurs0?28daysbeforeconception,theinfant
hasa43%riskofbeingaffected.
Infectionin2ndtrimester?maybedeafnessonly.
>6wks?nomajorabnormalities
Diagnosis:Isolationofvirusincellculturesofthroatsamples,urine
orothersecretions.
DetectionofIgMinsingleserumsampleshortlyafterbirth.
PersistanceofRubellaIgGantibodiesserumbeyond1yearor
risingantibodytiteranytimeduringinfancyinanunvaccinatedchild

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117.Discdiffusionmethodisalsoknownas
a)KirbyBauer
b)VDRL
c)Darkfieldmicroscopy
d)Noneofthese
CorrectAnswer-A
Answer:A.KirbyBauer
Thediskdiffusiontest,oragardiffusiontest,orKirby?Bauertest
(disc-diffusionantibioticsusceptibilitytest,disc-diffusionantibiotic
sensitivitytest,KBtest),isatestoftheantibioticsensitivityof
bacteria.
Itusesantibioticdiscstotesttheextenttowhichbacteriaare
affectedbythoseantibiotics.Inthistest,waferscontaining
antibioticsareplacedonanagarplatewherebacteriahavebeen
placed,andtheplateislefttoincubate.
Ifanantibioticstopsthebacteriafromgrowingorkillsthebacteria,
therewillbeanareaaroundthewaferwherethebacteriahavenot
grownenoughtobevisible.Thisiscalledazoneofinhibition

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118.Rubellavirusbelongstowhichfamily?

a)Rheovirus
b)Togavirus
c)Picornavirus
d)Orthomyxo
CorrectAnswer-B
And.B.Togavirus
Rubellavirus(RuV)isthepathogenicagentofthediseaserubella,
andisthecauseofcongenitalrubellasyndromewheninfection
occursduringthefirstweeksofpregnancy.
RubellavirusistheonlymemberofthegenusRubivirusand
belongstothefamilyofTogaviridae,whosememberscommonly
haveagenomeofsingle-strandedRNAofpositivepolaritywhichis
enclosedbyanicosahedralcapsid.

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119.Whichofthefollowinginfection
resembleserythroblastosis?
a)EBV
b)CMV
c)HSV
d)STAPHYLOCOCCUS
CorrectAnswer-B
ANSWER:B.CMV
Cytomegalovirusinfectionisacommonherpesvirusinfectionwitha
widerangeofsymptoms:fromnosymptomstofeverandfatigue
(resemblinginfectiousmononucleosis)
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
CorrectAnswer-A
Answer:A.VDRL
ExaminationofCSFforpleocytosis,increaseproteinconcentration,
VDRLreactivity.
ApositiveCSFVDRLmakesthediagnosisofneurosyphilis.
Ifbothtesti.e.VDRLandFTA-ABSIgM(specific)testare
positiveintheinfantthencongenitalsyphilisshouldbestrongly
suspectedandthechildshouldbetreated.
Apositivetestconfirmsneurosyphilisbutanegativeresultdoesnot
ruleoutneurosyphilis.DuetothelowsensitivityoftheCSFVDRL,
fluorescenttreponemalantibodyabsorptiontest(FTA-ABS)canbe
usedtosupplementVDRL.

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121.Flaskshapedulcersinintestinecaused
by
a)Giardialamblia
b)Entamoebahistolytica
c)Helicobacterpylori(H.pylori)
d)E.vermicularis
CorrectAnswer-B
AnswerB.Entamoebahistolytica
Diseaseoccurswhenamoebacomesincontactwiththecellslining
theintestine.
Itthensecretesthesamesubstancesitusestodigestbacteria,
whichincludeenzymesthatdestroycellmembranesandproteins.
Thisprocesscanleadtopenetrationanddigestionofhuman
tissues,resultingfirstinflask-shapedulcerationsintheintestine.
Entamoebahistolyticaingeststhedestroyedcellsbyphagocytosis
andisoftenseenwithredbloodcells(aprocessknownas
erythrophagocytosis)insidewhenviewedinstoolsamples

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122.Whattypeofculturemediaisusedfor
Ligionella?
a)(BCYE)agarmedia
b)MacConkeyagar
c)Baird?Parkeragar
d)Sabouraud'sagar
CorrectAnswer-A
Answer:A.(BCYE)agarmedia
BCYEisselectiveforcertainGram-negativebacteria,especially
Legionellapneumophila.
Theorganismsarenutritionallyfastidious,non-sporeforming,
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
CorrectAnswer-C
Ans:C.Mucicarminestain
Mucicarminestainprovidesspecificstainingofpolysaccharidecell
wallinC.neoformans.
Thisislimitedtomicroorganismswithacellwallthatiscomposed,at
leastinpart,ofapolysaccharidecomponent.

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124.A36yrsoldmalepatientc/,ocoughcold
fever/rustysputum/sputumnegfortb
,h/ooftravelinchina&eatencrab,
Nametheinfection
a)Paragonimuswestermani
b)Faciolahepatica
c)Fasciolopsisbuski
d)Entamoebahistolytica
CorrectAnswer-A
Ans:A.Paragonimuswestermani(lungfluke).
Duringinvasionandmigrationoftheflukes,diarrhea,abdominal
pain,fever,cough,urticaria,hepatosplenomegaly,pulmonary
abnormalities,andeosinophiliamaydevelop.
Unembryonatedeggsarepassedinthesputumofahuman.
Duringthechronicphase,thelungsaredamagedmost,butother
organsmaybeinvolved.
TheclinicalpictureresemblesandisoftenconfusedwithTB.
Praziquantelisthetreatmentofchoice.

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125.Microbiologicaltestfordiagnosing
leptospirainfection?
a)Coldagglutination
b)Standardagglutination
c)Microscopicagglutinationtest(MAT)
d)Noneofthese
CorrectAnswer-C
Answer:C.Microscopicagglutinationtest(MAT)
Dark-fieldmicroscopyorbyimmunofluorescenceorlightmicroscopy
afterappropriatestainingused
Microscoplcagglutinationtest[MAT](GoldStandard)also
Macroscopicagglutlnationtest
Differentialdiagnosislistforleptospirosisisverylargeduetodiverse
symptoms.

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126.Greencolouroftriageisforwhich
patient?
a)Lowpriority
b)Morbidity
c)Ambulatory
d)Highpriority
CorrectAnswer-C
Ans.C.Ambulatory
Triage
Whenthequantityandseverityofinjuriesoverwhelmtheoperative
capacityofhealthfacilities,adifferentapproachtomedicaltreatment
mustbeadopted.
Theusualprincipleoffirstcome,firsttreated",isnotfollowedin
massemergencies.
Triageconsistsofrapidlyclassifyingtheinjuredandthelikelihoodof
theirsurvivalwithpromptmedicalintervention.
Higherpriorityisgrantedtovictimswhoseimmediateorlong-term
prognosiscanbedramaticallyaffectedbysimpleintensivecare.
Moribundpatientswhorequireagreatdealofattention,with
questionablebenefithavethelowestpriority.
Themostcommontriageclassificationsystemusedinternationalis
fourcolourcodesystem.
Red
Highprioritytreatmentortransfer
Yellow Mediumpriority
Green Ambulatorypatients
Black
Deadormoribundpatients

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127.ConcurrentlistofIndianConstitution
includeswhichofthefollowing?
a)Internationalimmigrationruleforquarantine
b)Preventionofextensionofcommunicablediseasefromoneunit
toanother
c)Minesandoilfieldworkersrules
d)Establishmentandmaintenanceofdrugstandards
CorrectAnswer-B
Ans.B.Preventionofextensionofcommunicablediseasefromone
unittoanother
ThefunctionsoftheUnionHealthMinistryaresetoutintheseventh
scheduleofArticle246oftheconstitutionofIndiaunderthreelists.
1. UnionList
2. ConcurrentList
3. Statelist
The52itemscurrentlyontheConcurrentlistare:
1.Criminallaw,includingallmattersincludedintheIndianPenal
Code
2.Criminalprocedure,includingallmattersincludedintheCodeof
CriminalProcedure.
3.Preventivedetentionforreasonsconnectedwiththesecurityofa
State,themaintenanceofpublicorder,orthemaintenanceof
suppliesandservicesessentialtothecommunity;personssubjected
tosuchdetention.
4.RemovalfromoneStatetoanotherStateofprisoners,accused
personsandpersonssubjectedtopreventivedetentionforreasons
specifiedinEntry3ofthislist.
5.Marriageanddivorce;infantsandminors;adoption;wills,

---

intestacyandsuccession;jointfamilyandpartition;allmattersin
respectofwhichpartiesinjudicialproceedingswereimmediately
beforethecommencementofthisConstitutionsubjecttotheir
personallaw.
6.Transferofpropertyotherthanagriculturalland;registrationof
deedsanddocuments.
7.Contractsincludingpartnership,agency,contractsofcarriage,
andotherspecialformsofcontracts,butnotincludingcontracts
relatingtoagriculturalland.
8.Actionablewrongs
9.Bankruptcyandinsolvency.
10.TrustandTrustees.
11.Administrators?generalandofficialtrustees.
11-A.Administrationofjustice;constitutionandOrganisationofall
courts,excepttheSupremeCourtandtheHighCourts.
12.Evidenceandoaths;recognitionoflaws,publicactsandrecords,
andjudicialproceedings.
13.Civilprocedure,includingallmattersincludedintheCodeofCivil
ProcedureatthecommencementofthisConstitution,limitationand
arbitration.
14.Contemptofcourt,butnotincludingcontemptoftheSupreme
Court.
15.Vagrancy;nomadicandmigratorytribes.
16.Lunacyandmentaldeficiency,includingplacesforthereception
ortreatmentoflunaticsandmentaldeficients.
17.Preventionofcrueltytoanimals.
17-A.Forests.
17-B.Protectionofwildanimalsandbirds.
18.Adulterationoffoodstuffsandothergoods.
19.Drugsandpoisons,subjecttotheprovisionsofEntry59ofListI
withrespecttoopium.
20.Economicandsocialplanning.
20-A.Populationcontrolandfamilyplanning.
21.Commercialandindustrialmonopolies,combinesandtrusts.
22.Tradeunions;industrialandlabourdisputes.
23.Socialsecurityandsocialinsurance;employmentand
unemployment.

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24.Welfareoflabourincludingconditionsofwork,providentfunds,
employers'liability,workmen'scompensation,invalidityandoldage
pensionsandmaternitybenefits.
25.Education,includingtechnicaleducation,medicaleducationand
universities,subjecttotheprovisionsofEntries63,64,65and66of
ListI;vocationalandtechnicaltrainingoflabour.
26.Legal,medicalandotherprofessions.
27.Reliefandrehabilitationofpersonsdisplacedfromtheiroriginal
placeofresidencebyreasonofthesettingupoftheDominionsof
IndiaandPakistan.
28.Charitiesandcharitableinstitutions,charitableandreligious
endowmentsandreligiousinstitutions.
29.PreventionoftheextensionfromoneStatetoanotherof
infectiousorcontagiousdiseasesorpestsaffectingmen,animalsor
plants.
30.Vitalstatisticsincludingregistrationofbirthsanddeaths.
31.Portsotherthanthosedeclaredbyorunderlawmadeby
Parliamentorexistinglawtobemajorports.
32.Shippingandnavigationoninlandwaterwaysasregards
mechanicallypropelledvessels,andtheruleoftheroadonsuch
waterways,andthecarriageofpassengersandgoodsoninland
waterwayssubjecttotheprovisionsofListIwithrespecttonational
waterways.
33.Tradeandcommercein,andtheproduction,supplyand
distributionof,-
(a)theproductsofanyindustrywherethecontrolofsuchindustryby
theUnionisdeclaredbyParliamentbylawtobeexpedientinthe
publicinterest,andimportedgoodsofthesamekindassuch
products
(b)foodstuffs,includingedibleoilseedsandoils
(c)cattlefodder,includingoilcakesandotherconcentrates
(d)rawcotton,whetherginnedornotginned,andcottonseed;and
(e)rawjute.
33-A.Weightsandmeasuresexceptestablishmentofstandards.
34.Pricecontrol.
35.Mechanicallypropelledvehiclesincludingtheprinciplesonwhich
taxesonsuchvehiclesaretobelevied.

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36.Factories.
37.Boilers.
38.Electricity.
39.Newspapers,booksandprintingpresses.
40.Archaeologicalsitesandremainsotherthanthosedeclaredby
orunderlawmadebyParliamenttobeofnationalimportance.
41.Custody,managementanddisposalofproperty(including
agriculturalland)declaredbylawtobeevacueeproperty.
42.Acquisitionandrequisitioningofproperty.
43.RecoveryinaStateofclaimsinrespectoftaxesandotherpublic
demands,includingarrearsofland-revenueandsumsrecoverable
assucharrears,arisingoutsidethatState.
44.Stampdutiesotherthandutiesorfeescollectedbymeansof
judicialstamps,butnotincludingratesofstampduty.
45.Inquiriesandstatisticsforthepurposesofanyofthematters
specifiedinListIIorListIII.
46.Jurisdictionandpowersofallcourts,excepttheSupremeCourt,
withrespecttoanyofthemattersinthisList.
47.FeesinrespectofanyofthemattersinthisList,butnot
includingfeestakeninanycourt.

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128.Lastpointwherereproductiveandchild
healthprogrammeareinclude:
a)Sub-centre
b)Anganwadi
c)District
d)Taluka
CorrectAnswer-C
Ans.C.District
ThevariousactivitiesofReproductiveandchildHealthProgramme
(RCH)arctargetedatthedistrictlevel.
"TheRCHprogrammeisbasedonadiiThrentialapproach.Inputsin
allthedistrictshavenotbeenkeptuniform.
Whilethecarecomponentarethesameforalldistricts,theweaker
districtswillgetmoresupportandsophisticatedfacilitiesare
proposedforrelativelyadvanceddistricts.Onthebasisofcrudebirth
rateandfemaleliteracyrate?allthedistrictshavebeendividedinto
threecategories`A,B,&C'Allthedistrictswillbecoveredina
phasedmanneroveraperiodofthreeyears."

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129.Healthcenterinremotestareafor
planningandmanagementofschemes:
a)Anganwadi
b)Blockcentre
c)Sub-centre
d)PHC
CorrectAnswer-C
Ans.C.Sub-centre
TheSub-Centreisthemostperipheralandfirstcontactpoint
betweentheprimaryhealthcaresystemandthecommunity.Sub-
Centresareassignedtasksrelatingtointerpersonalcommunication
inordertobringaboutbehavioralchangeandprovideservicesin
relationtomaternalandchildhealth,familywelfare,nutrition,
immunization,diarrhoeacontrolandcontrolofcommunicable
diseasesprogrammes.
TheSub-Centresareprovidedwithbasicdrugsforminorailments
neededfortakingcareofessentialhealthneedsofmen,womenand
children.

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130.Diagnosticpowerofatesttocorrectly
diagnoseadiseaseis-
a)Negativepredictivevalue
b)Positivepredictivevalue
c)Sensitivity
d)Specificity
CorrectAnswer-B
Ans.B.Positivepredictivevalue
Positivepredictivevalueistheabilityofatesttocorrectlydiagnose
theproportionofcasesinwhichpersonswithapositivescreening
testresulthavethediseaseinquestion.
Negativepredictivevalueistheproportionofcasesinwhichpeople
withnegativetestresultdonothavethediseaseinquestion.
Sensitivityisdefinedastheabilityofthetesttoidentifycorrectlyall
thosewhohavethedisease,i.e.truepositive.
Specificityisdefinedastheabilityofthetesttoidentifycorrectly
thosewhodonothavethedisease,i.e.truenegative.

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131.Paradoxicalcarriersare-
a)Apersonwhoacquiresthemicroorganismduetohiscontact
withthepatient.
b)Apersonwhoacquiresthemicroorganismanothercarrier.
c)Apersonwhoisclinicallyrecoveredfromaninfectiousdisease
butstillcapableoftransmittingtheinfectiousagenttoothers.
d)None
CorrectAnswer-B
Ans.B.Apersonwhoacquiresthemicroorganismanothercarrier.
Paradoxicalcarrieraredefinedaspersonwhoacquiresthe
microorganismanothercarrier.

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132.AccordingtoIMNCI,ababyof6month
age,criteriaforfastbreathingismore
than_____/min
a)60
b)50
c)40
d)30
CorrectAnswer-B
Ans.B.50
Asthechildrengetolder,theirbreathingrateslowsdown.
Therefore,thecut-offpointhasfastbreathingwilldependontheage
ofthechild.oFastbreathingispresentwhentherespiratoryrateis
:?
Childlessthan2monthsofage:60breathsperminute
Childaged2monthsupto12months:50breathsperminute
Childaged12monthsupto5years:40breathsperminute

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133.Allofthefollowingareexamplesof
Dietaryfibreexcept-
a)Pectin
b)Lignin
c)Cellulose
d)Gums
CorrectAnswer-D
Ans.D.Gums
Dietaryfibreconsistsofunabsorbablecellwallandother
constituentsofvegetablefoodlikecellulose,lignin,hemicellulose,
gums,pectins,glycoproteinsandotherpolysaccharides.
Dietaryfibreabsorbswaterintheintestine,swells,increasebulkof
stoodbyincreasingwatercontentoffaecesandsoftenit,decreases
transittimebyfacilitatingcolonictransit.
"Thepresenceoffibreshortensthetransittimesandincreasesthe
stoolbulk"
Dietaryfibreisoftwotypes:
1. Solublefibres:Itabsorbsupto15timesitsweightinwaterasit
movesthroughGIT,producingsofterstools.Itsgoodsourcesare
oat,flaxseeds,peas,beans,apple,citrusfruits,carrots,barleyand
psyllium.
2. Insolublefibre:Itpromotesmovementofmaterialthroughdigestive
systemandincreasesstoolbulk.It'sgoodsourcesarewheatflour,
wheatbran,nutsandvegetables.

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134.Crossproductratioisdeterminedby
whichstudy?
a)Casecontrol
b)Cohort
c)Crosssectional
d)RCT
CorrectAnswer-A
Ans.A.Casecontrolstudy
Crossproductratio:
Riskincasecontrolstudyiscalculatedbyoddsratio(crossproduct
ratio).

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135.Inanormalcurvewhatistheareathat
comesunder1standarddeviation-
a)50%
b)68%
c)95%
d)100%
CorrectAnswer-B
Ans.B.68%
1SDincludes68%ofvalues
2SDincludes95%ofvalues
3SDincludes99.7%ofvalues

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136.2yearoldboyofweight12kgwith
vitaminAdeficiencywhatisoraldoseof
vitaminA
a)50,000I.U
b)1lakhI.U.
c)1.5lakhI.U
d)2lakhI.U
CorrectAnswer-D
Ans.D.2lakhI.U
Treatment:
Oraltherapy:TheoralregimenofvitaminAis200,000IUondayof
presentation,nextday,and2-4weekslater.
Childrenlessthan1yearofageorlessthan8kgshouldreceivehalf
thedoseoftheabovedose.Repeat200,000IUevery6monthsup
to6yearsofagetopreventrecurrence.
Parenteraltherapy:Ifthepatienthasseveredisease,isunableto
takeoralfeeds,orhasmalabsorption,thepreferabledoseis
100,000IUofvitaminAgivenintramuscularly.
ChildrenwithseveremeaslesshouldalsoreceivevitaminAasthey
areverylikelytobebenefitedfromsuchtherapybothintermsof
savingsightandreducingcasefatality.
Prevention
ProphylaxisconsistsofperiodicadministrationofVitaminA
supplements.WHOrecommendedschedule,whichis
universallyrecommendedisasfollows:
Infants6?12monthsoldandanyolderchildrenweighinglessthan8
kg?100,000IUorallyevery3?6months

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

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137.Notapersonalprotectiveequipment
a)Goggles
b)Badgesfordetectingradiation
c)Gloves
d)Labcoat
CorrectAnswer-B
Ans.B.Badgesfordetectingradiation

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138.Confoundingfactorisdefinedas

a)Factorassociatedwithboththeexposureandthediseaseand
isdistributedunequallyinstudyandcontrolgroups.
b)Factorassociatedwithexposureonlyandisdistributed
unequallyinstudyandcontrolgroups.
c)Factorassociatedwithboththeexposureandthediseaseand
isdistributedequallyinstudyandcontrolgroups
d)Factorassociatedwiththediseaseandisdistributedequallyin
studyandcontrolgroups.
CorrectAnswer-A
Ans.A.Factorassociatedwithboththeexposureandthedisease
andisdistributedunequallyinstudyandcontrolgroups.
Epidemiologicalstudiessearchforthecausesofdiseases,basedon
associationswithvariousriskfactorsthataremeasuredinthestudy.
Inadditiontotheexposuresthatthestudyisinvestigating,theremay
beotherfactorsthatareassociatedwiththeexposureandarealso
riskfactorsforthedisease.Iftheprevalenceoftheseotherfactors
differsbetweengroupsbeingcompared,theywilldistortthe
observedassociationbetweenthediseaseandexposureunder
study.Suchvariablesmaypartiallyorcompletelyaccountforany
apparentassociationbetweenanexposurevariableanddisease.
Thesedistortingfactorsarecalledconfoundingfactorsorvariables.
ThusaConfoundingfactorisdefinedasonewhichisassociated
withboththeexposureandthediseaseandisdistributedunequally
instudyandcontrolgroups.Itisitselfarisk.factor.forthedisease.

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139.Thesignificanceofdifferencebetween
proportionscanalsobetestedby-
a).`t'test
b)Chisquaretest
c)ANOVA
d)Correlationandregression
CorrectAnswer-B
Ans.B.Chisquaretest
Chi-Squaretestoffersamethodoftestingthesignificanceof
differencebetweentheproportions.
Itsadvantageliesinthefactthatitcanalsobeusedwhenmorethan
twogroupsaretobecompared.
Byusingthistest,wecanfindoutifthedifferencebetweentwo
proportionsorratioshasoccurredbychance.Thesteps
involvedare-
1. Testingthenullhypothesis.
2. Applyingchi-squaretest.
3. Calculatingthedegreeoffreedom.
4. Comparingwithprobabilitytables.

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140.PairedTtestisdefinedas-
a)Testusedtoassessquantitativeobservationsbeforeandafter
anintervention
b)Testthatisusedwhentheobservationareintheformof
proportions(forqualitativedata)
c)Testappliedwhenseparateobservationsaremadeon
individualsoftwoseparategroups,andtheseneedtobe
compared
d)None
CorrectAnswer-A
Ans.A.Testusedtoassessquantitativeobservationsbeforeand
afteranintervention
Pairedt-tests
Thepairedt-testisusedtocomparethevaluesofmeansfromtwo
relatedsamples,forexampleina`beforeandafter'scenario.
Thedifferencebetweenthemeansofthesamplesisunlikelytobe
equaltozero(duetosamplingvariation)andthehypothesistestis
designedtoanswerthequestion"Istheobserveddifference
sufficientlylargeenoughtoindicatethatthealternativehypothesisis
true".
Theanswercomesintheformofaprobability?thep-value.

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141.Bestrepresentativeofincidenceof
diseaseindifferenttimeline-
a)Histogram
b)Linediagram
c)Scattereddiagram
d)Bardiagram
CorrectAnswer-B
Ans.B.Linediagram
Linediagramsareusedtoshowthetrendofeventswithpassageof
time.
Itisusedtoshowthetrendofeventswithpassageoftimeand
showshowthefrequencyofaparticulareventorvariablevaryover
time.

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142.Fortrenchtypeofsanitaryfillingthe
amountoflandrequiredfor2meterdeep
trenchfor10000populationis-
a)1acre
b)2acre
c)3acre
d)4acre
CorrectAnswer-A
Ans.A.1acre
GeneralWHOGuidelinesforShallowTrenchesis3-5Metrefor100
People.SoAbout300-500MeterofShallowTrenchesfor10,000
People.
Alsothereshouldbeaperimeterof30maroundthetrench.
Now1Acre=4046SqMeter[200mX200m]
HenceAnsweris1Acre.

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143.Riskofgeneticdiseases
inconsanguineousmarriagebetween
firstcousins?
a)1-2%
b)4-8%
c)8-10%
d)12-14%
CorrectAnswer-B
Ans.B.4-8%
Consanguinityisamarriagebetweenrelativesandhasvarious
degrees.Closelyrelatedindividualshaveahigherchanceof
carryingthesameallelesthanthoselesscloselyrelatedand
thereforechildrenfromconsanguineousmarriagesaremore
frequentlyhomozygousforvariousallelesthanthosefromnon-
consanguineousunions.
Generallyspeaking,frequencyofcongenitalmalformationsamong
newbornsoffirstcousinunionsisabout2timesthefrequency
amongthegeneralpopulation.Inotherwordsinsteadofarateof2-
3%ofbirthdefectsinthegeneralpopulation,therisktofirstcousin
couplesisaround4-6%.

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144.Whichisnotaepidemiological
indicator?
a)ABER
b)Annualparasiteindex
c)Annualfalciparumincidence
d)NoneoftheAbove
CorrectAnswer-A
Answer?A.ABER
ABERorAnnualBloodExaminationRateisnotanepidemiological
indicatorbutanindicatorofoperationalefficiencyofMalariaControl
Programme.

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145.Doseofdiphtheriaantitoxinis-
a)1000to5000IU
b)10000to100000IU
c)1000to2000IU
d)None
CorrectAnswer-B
Ans.B.10000to100000IU
DATmanufacturedbyInstitutoButantanisasterile,transparent
(clear)serumsolutionsuppliedin10mLampoulescontaining
10,000IUeach.
DATmustbestoredintherefrigeratorat2?8?C(36?46?F).
DONOTFREEZE.Onceanampouleisopened,theDATserum
solutionshouldbeusedimmediately.

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146.VerticaltransmissionofHIVishighest
with-
a)Electivecaesareansection
b)HighviralRNAload
c)Breastfeeding
d)Termdelivery
CorrectAnswer-B
Ans.B.HighviralRNAload
Vaginalandemergencycaesareansectiondeliveries,prematurity,
andlowCD4cellcountweremoststronglyassociatedwithinfant,s
infectionstatusinunivariateanalyses.
Childrendeliveredvaginallyorbyemergencycaesareansection
weremorelikelytobeinfectedthanthosedeliveredbyelective
caesareansection,withareductioninriskof79%associatedwith
thelatter(P<0.001).
Similarly,infantsdeliveredbefore37weeksweremorethantwiceas
likelytobeinfectedthaninfantswhowerenotpremature.
Caesareansectionbeforeonsetoflabourandruptureofmembranes
approximatelyhalvestheriskofmother-to-childtransmission.
Transmissionrate:
Duringpregnancy:5?10%
Duringlabouranddelivery:10?15%
Duringbreastfeeding:5?20%
Overallwithoutbreastfeeding:15?25%
Overallwithbreastfeedingtosixmonths:20?35%
Overallwithbreastfeedingto18?24months:30?45%

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147.Themostcommonsiteofthebranchial
cystis:
a)Posteriorborderofsternocleidomastoid
b)Anteriorborderofsternocleidomastoid
c)Digastricmuscle
d)Omohyoidmuscle
CorrectAnswer-B
Answer.B.Anteriorborderofsternocleidomastoid
Abranchialcleftcyst(BCC)commonlypresentsasasolitary,
painlessmassintheneckofachildoryoungadult.
Theyaremostcommonlylocatedalongtheanteriorborderandthe
upperthirdofthesternocleidomastoidmuscleintheanteriortriangle
oftheneck.

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148.Inspiratorystridorisfoundinwhatkind
oflesions:
a)Supraglottic
b)Subglottic
c)Tracheal
d)Bronchus
CorrectAnswer-A
AnswerA.Supraglottic
Generally,aninspiratorystridorsuggestsairwayobstructionabove
theglottis.
Whileanexpiratorystridorisindicativeofobstructioninthelower
trachea.
Abiphasicstridorsuggestsaglotticorsubglotticlesion.

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149.InRetinitispigmentosadecreasedlevel
of?
a)Arachidonic
b)Trielonic
c)Thromboxane
d)Docosahexanoicacid
CorrectAnswer-D
Answer.D.Docosahexanoicacid

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150.Whatisagainsttherulecorrectionin
astigmatism:
a)-1.25cyl90
b)-2spherical180
c)-3cyl180
d)+2cyl180
CorrectAnswer-A:D
TypesofregularastigmatismDependingupontheaxisandthe
anglebetweenthetwoprincipalmeridia,regularastigmatismcanbe
classifiedintothefollowingtypes:
1.With-the-ruleastigmatism.Inthistypethetwoprincipalmeridia
areplacedatrightanglestooneanotherbuttheverticalmeridianis
morecurvedthanthehorizontal.Thus,correctionofthisastigmatism
willrequiretheconcavecylindersat180??20?orconvexcylindrical
lensat90??20?.Thisiscalled'with-the-rule'astigmatism,because
similarastigmaticconditionexistsnormally(theverticalmeridianis
normallyrendered0.25Dmoreconvexthanthehorizontalmeridian
bythepressureofeyelids).
2.Against-the-ruleastigmatismreferstoanastigmaticconditionin
whichthehorizontalmeridianismorecurvedthanthevertical
meridian.Therefore,correctionofthisastigmatismwillrequirethe
presciptionofconvexcylindricallensat180??20?orconcave
cylindricallensat90??20?axis.
***WEHAVETOMUGTHISUP:Aplusat90,orminusat180
accountsfor"withtheruleastigmatism***

---

151.Morbidfearofdarknessknownas:
a)Claustrophobia
b)Xenophobia
c)Mysophobia
d)Nyctophobia
CorrectAnswer-D
Answer.D.Nyctophobia
Nyctophobiaisanextremefearofnightordarknessthatcancause
intensesymptomsofanxietyanddepression.
Afearbecomesaphobiawhenit'sexcessive,irrational,orimpacts
yourday-to-daylife.
Claustrophobiaisaformofanxietydisorder,inwhichanirrational
fearofhavingnoescapeorbeingclosed-incanleadtoapanic
attack.
xenophobia.:fearandhatredofstrangersorforeignersorof
anythingthatisstrangeorforeign.
Mysophobia,alsoknownasverminophobia,germophobia,
germaphobia,bacillophobiaandbacteriophobia,isapathological
fearofcontaminationandgerms.

---

152.Achildhasptosisandpoorlevator
function.Whatsurgerywillyoudo?
a)Levatormuscleresection
b)Mullerectomy
c)FasanellaServatsurgery
d)Frontalissuspensionsurgery
CorrectAnswer-D
AnswerD.Frontalissuspensionsurgery
Mullermuscleresectionsaretypicallyusedforrepairofminimal
ptosis(2mm)andaregenerallyconsideredsuperiortothe
Fasanella-Servatprocedure(tarsoconjunctivalmullerectomy)in
maintainingeyelidcontourandpreservingthetarsus.
Whenlevatorfunctionispoor,thesurgeonshouldconsiderutilizing
theaccessoryelevatorsoftheeyelidinptosisrepair.Thistypeof
surgeryismostcommonlyrequiredincongenitalptosiswithpoor
levatorfunctionorinvariousformsofneurogenicptosiswithpoor
levatorfunction.
Frontalissuspensionsurgeryperformedwhenlevatorfunctionispoor
orabsent,theeyelidissuspendeddirectlyfromthefrontalismuscle
sothatmovementofthebrowisefficientlytransmittedtotheeyelid.
Thus,thepatientisabletoelevatetheeyelidbyusingthefrontalis
muscletoliftthebrow.Frontalissuspensioncanbeperformed
transcutaneouslyortransconjunctivally.Thissurgeryconnectsthe
eyelidtothebrowwithaslingmaterialandutilizesthepowerofthe
frontalismuscletoelevatethepoorlyfunctioningeyelid.

---

153.Whichdrugcausesocularhypotension
withapneainaninfant?
a)Latanoprost
b)Timolol
c)Brimonidine
d)Dorzolamide
CorrectAnswer-C
Answer.C.Brimonidine
Brimonidineisarelativelyselectivealpha-agonist,whichreduces
intraocularpressure(IOP)bydecreasingaqueousproductionand
increasinguveoscleraloutflow.
Brimonidinepassesthroughtheblood-brainbarrier,potentially
causingcentralnervoussystem(CNS)toxicity.
Therehavebeenreportsofbradycardia,hypotension,hypothermia,
hypotonia,andapneaininfantsaftertopicalbrimonidine.

---

154.Chemotherapyagentsfor
retinoblastoma:
a)vincristine,carboplatinandetoposide
b)vinblastine,etoposideandbleomycin
c)vinblastine,vincristineandetoposide
d)vinblastine,vincristineandcisplatin
CorrectAnswer-A
Answer.A.Vincristine,carboplatinandetoposide
ChemotherapyforRetinoblastoma
Chemotherapy(chemo)istheuseofanti-cancerdrugstotreat
cancer.
Chemocanbegivenindifferentwaystotreatretinoblastoma.
Someofthechemodrugsusedtotreatretinoblastomainclude:
1. Carboplatin
2. Cisplatin
3. Vincristine
4. Etoposide
5. Cyclophosphamide
6. Topotecan
7. Doxorubicin
Mostoften,2or3drugsaregivenatthesametime.
Astandardcombinationiscarboplatin,vincristine,andetoposide,
althoughforverysmalltumors,onlycarboplatinandvincristinemay
beenough.
Otherdrugsmightbeusedifthesearenoteffective.

---

155.Drugusedinacutecongestiveglaucoma
are:
a)Atropine
b)Pilocarpine
c)Acetazolamide
d)BothB&C
CorrectAnswer-D
Answer.D.BothPilocarpine&Acetazolamide
Managementofangleclosureglaucoma
Acutecongestiveglaucomaalsoisknownasacuteangleclosure
glaucoma.
ImmediatemedicaltherapyinacuteACconsistsofcommencing
IOP-loweringeyemedicationssuchastopical?-blocker,a2-agonist
andevenprostaglandinanaloguesassoonaspossible.
OncetheIOPissufficientlyreducedtoallowirisreperfusion,
pilocarpineisinstilledtoinducemiosisinanattempttowidenthe
anteriorchamberanglesandreestablishaqueousoutflow.
Mydriaticdrugssuchasatropine,cyclopentolate,tropicamideand
phenylephrineareprecipitatingfactorforangleclosureglaucoma,so
notused(contraindicated)initstreatment.

---

156.WhichistheMostcommonocular
findinginmyastheniagravis?
a)Ptosis
b)Lagophthalmos
c)Proptosis
d)Enophthalmos
CorrectAnswer-A
Answer.A.Ptosis
Inmorethanhalfthepeoplewhodevelopmyastheniagravis,
theirfirstsignsandsymptomsinvolveeyeproblems,suchas:
1. Droopingofoneorbotheyelids(ptosis).
2. Doublevision(diplopia),whichmaybehorizontalorvertical,and
improvesorresolveswhenoneeyeisclosed.

---

157.Esotropiaisusuallyassociatedwith:
a)Myopia
b)Hypermetropia
c)Astigmatism
d)Presbyopia
CorrectAnswer-B
Ans.B.Hypermetropia
Accommodativeesotropiaisoneofthemostcommontypesof
strabismusinchildhood.
Theincidenceisestimatedat2%ofthepopulation.
Itisusuallyfoundinpatientswithmoderateamountsofhyperopia.
Asthepatientaccommodatesorfocusestheeyes,theeyes
converge.

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158.Whichwallofheartenlargementcanbe
seenonbariumswallowinpatientwith
mitralstenosis-
a)Leftatrium
b)Rightatrium
c)Leftventricle
d)Rightventricle
CorrectAnswer-D
Answer.D.Rightventricle
Mitralstenosisisassociatedwithrightventricularhypertrophy.
LeftventriculardiastolicpressureisnormalinisolatedMS.
Mitralstenosis:Features
leftatrialpressureisincreased
pulmonaryarterialpressureisincreased
Increasedrightventricularafterloadimpedestheemptyingofthis
chamberandRightventricularenddiastolicpressureandvolume
increase.
Rightventricularhypertrophyoccurs.

---

159.Whichofthefollowingstatementsistrue
aboutthebundleofkent?
a)Abnormalpathwaybetweentwoatria
b)Itismuscularornodalpathwaybetweentheatriaandventricle
inWPWsyndrome
c)ItisslowerthantheAVnodalpathway
d)None
CorrectAnswer-B
Answer.B.Itismuscularornodalpathwaybetweentheatria
andventricleinWPWsyndrome
TheWolff-Parkinson-Whitesyndromeisdefinedbythecombination
ofanatrioventricularpre-excitation(bundleofKent)andparoxysmal
supraventriculartachycardias.Thediagnosisofatrioventricularpre-
excitationinsinusrhythmisestablishedontheassociationbetween
ashortPRinterval,awideQRS,adeltawave,anormalterminal
QRSportionandfrequentrepolarizationdisorders.

---

160.Deepvenousthrombosiswhichis
incorrect?
a)Clinicalassessmenthighlyreliable
b)Mostlybilateral
c)Mostcommonclinicallypresentsaspainandtendernessincalf
d)Somecasesmaydirectlypresentaspulmonary
thromboembolism
CorrectAnswer-B
Answer.B.Mostlybilateral
Wellsscoreorcriteria:(possiblescore-2to9)
Activecancer(treatmentwithinlast6monthsorpalliative):+1point
Calfswelling=3cmcomparedtoasymptomaticcalf(measured10
cmbelowtibialtuberosity):+1point
Swollenunilateralsuperficialveins(non-varicose,insymptomatic
leg):+1point
Unilateralpittingedema(insymptomaticleg):+1point
PreviousdocumentedDVT:+1point
Swellingofentireleg:+1point
Localizedtendernessalongthedeepvenoussystem:+1point
Paralysis,paresis,orrecentcastimmobilizationoflowerextremities:
+1point
Recentlybedridden=3days,ormajorsurgeryrequiringregionalor
generalanestheticinthepast12weeks:+1point
Alternativediagnosisatleastaslikely:-2points

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161.Punchedoutulcerinesophagusisseen
in
a)herpes
b)cmv
c)Oesophagitis
d)candida
CorrectAnswer-C
Answer.C.Oesophagitis
Itislikelytopresentwithasingle,largeshallowlinearulceras
opposedtothemultiplevesicular/"punched-out"ulcersseenin
herpesesophagitis.

---

162.Typeofsensationlostonsamesideof
BrownSequardsyndrome-
a)Pain
b)Touch
c)Proprioception
d)Temperature
CorrectAnswer-C
Answer.C.Proprioception
Damagetoonehalfofthespinalcord,resultinginparalysisandloss
ofproprioceptiononthesame(oripsilateral)sideastheinjuryor
lesion,andlossofpainandtemperaturesensationontheopposite
(orcontralateral)sideasthelesion.

---

163.Achondroplasiashowswhichtype
inheritance-
a)XLR
b)XLD
c)Autosomalrecessive
d)Autosomaldominant
CorrectAnswer-D
Answer.D.Autosomaldominant
Achondroplasiaisinheritedinanautosomaldominantpattern,
whichmeansonecopyofthealteredgeneineachcellissufficientto
causethedisorder.

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164.MELDscoreincludes
a)Serumcreatinine
b)Transaminase
c)Albumin
d)Alkalinephosphatase
CorrectAnswer-A
Answer.A.Serumcreatinine
TheModelforEnd-stageLiverDisease(MELD)isaprospectively
developedandvalidatedchronicliverdiseaseseverityscoring
systemthatusesapatient'slaboratoryvaluesfor?
LiSerumbilirubin
Serumcreatinine
Theinternationalnormalizedratio(INR)forprothrombintimeto
predictthreemonthsurvival.
Patientswithcirrhosis,andincreasingMELDscoreisassociated
withincreasingseverityofhepaticdysfunctionandincreasedthree-
monthmortalityrisk.
Givenitsaccuracyinpredictingshort-termsurvivalamongpatients
withcirrhosis,MELDwasadoptedbytheUnitednetworkfororgan
sharing(UNOS)in2002forprioritizationorpatientsawaitingliver
transplantationintheUnitedstates.

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165.Infarctsinvolvingwhichportionofthe
myocardiumcauseaneurysmasapost-
MIcomplication-
a)Subendocardial
b)Anteriortransmural
c)Posteriortransmural
d)Inferiorwall
CorrectAnswer-D
Answer.D.Inferiorwall
Leftventricularaneurysmformation:
Leftventricularapicalaneurysmformationusuallyoccursfollowing
antero-apicalmyocardialinfarction,afterLADocclusion.
Thisweakeningoftheapicalwallresultsinanoutpouchingor
"dyskinesis"oftheapexoftheheartduringsystole.

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166.Riskfactorsforalzheimer'sdisease
include-
a)Klinefeltersyndrome
b)LowBP
c)Down'ssyndrome
d)None
CorrectAnswer-C
Answer.C.Down'ssyndrome
PeoplewithDownsyndromearebornwithanextracopyof
chromosome21,whichcarriestheAPPgene.Thisgeneproducesa
specificproteincalledamyloidprecursorprotein(APP)withage
thesegetaccumulatedinthebraincellandaffectsthefunctioningof
thebrainleadingtoalzheimer'sdementia.

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167.Afemalepatientof26years,presents
withoralulcers,photosensitivityand
skinmalarrashinfacesparingthe
nasolabialfoldsofbothside.
a)Sturgewebersyndrome
b)SLE
c)Dermatitis
d)Psoriasis
CorrectAnswer-B
Answer-B(SLE)
Commonsymptomsincludepainfulandswollenjoints,fever,chest
pain,hairloss,mouthulcers,swollenlymphnodes,feelingtired,and
aredrashwhichismostcommonlyontheface.

---

168.Mostcharacteristiccardiovasculardefect
seeninRubella-
a)Pulmonaryarterystenosis
b)Coarctationofaorta
c)Ankylosisspondylitis
d)Rheumaticfever
CorrectAnswer-A
Answer.A.Pulmonaryarterystenosis
Theclassictriadforcongenitalrubellasyndromeis:
Sensorineuraldeafness(58%ofpatients)
Eyeabnormalities?especiallyretinopathy,cataract,and
microphthalmiaCongenitalheartdisease?especiallypulmonary
arterystenosisandpatentductusarteriosus.

---

169.OsbornJwavesisseenin-
a)Hypothermia
b)Hyperkalemia
c)Hypocalemia
d)Hypokalemia
CorrectAnswer-A
Answer.A.Hypothermia
Causepeoplesufferingfromhypothermiawithatemperatureofless
than32?C(90?F).

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170.Alcoholicshowswhichtypeof
cardiomyopathy-
a)Hypercardiomyopathy
b)Dilatedcardiomyopathy
c)Pericarditis
d)Myocarditis
CorrectAnswer-B
Answer.B.Dilatedcardiomyopathy
Alcoholiccardiomyopathyisadiseaseinwhichthechroniclong-
termabuseofalcohol(i.e.,ethanol)leadstoheartfailure.Alcoholic
cardiomyopathyisatypeofdilatedcardiomyopathy.

---

171.WhichisnotrelatedtoHIV
a)PrimaryCNSlymphoma
b)Tertiarysyphilis
c)Oesophagealcandidasis
d)None
CorrectAnswer-B
Answer.B.Tertiarysyphilis
TertiarySyphilishasnorelationtoHIVstatusandprimarilybasedon
thedurationoftheinfectionandcomplicationsofSyphilis.

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172.Essentialmajorbloodculturecriteriafor
infectiveendocarditis.
a)Singlepositivecultureofhacek
b)Singlepositivecultureofcoxiella
c)Singlepositivecultureofcornybacterium
d)Botha&b
CorrectAnswer-A
Answer.A.SinglepositivecultureofHACEK

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173.Respiratorycentresarestimulatedby
a)Oxygen
b)Lacticacid
c)Carbondioxide
d)Calcium
CorrectAnswer-C
Answer.C.Carbondioxide
Thebody'srespiratorycenterinthemedullaisnormallystimulated
byanincreasedconcentrationofcarbondioxide,andtoalesser
extent,bydecreasedlevelsofoxygeninarterialblood.Stimulation
oftherespiratorycentercausesanincreaseintherateanddepthof
breathing,thusblowingoffexcesscarbondioxideandreducing
bloodacidity.

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174.Whichmurmurincreasesonstanding?
a)HOCM
b)MR
c)MS
d)VSD
CorrectAnswer-A
Answer.A.HOCM
MurmurwillgetsofterwithValsalvaorstandingfromsquatting
becauselessbloodisbeingejectedthroughtheaorticvalve.Rapid
squattingfromastandingpositionforcesincreasedvenousreturn
andwouldhavetheoppositeeffectofValsalvaorrapidstanding.

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175.Mostcommonindicationforliver
transplantinchildren-
a)Biliaryatresia
b)Cirrhosis
c)Hepatitis
d)Drugreactions
CorrectAnswer-A
Answer-A(Biliaryatresia)
Indicationsforlivertransplantationininfantsandchildreninclude
acuteliverfailure(ALF),chronicliverfailurewithpruritus,
complicationsofcholestasisandfailuretothrive.Inyoungchildren,
themostcommonliverdiseaseleadingtotransplantationisbiliary
atresia

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176.Mostcommontypeofgallstoneis-
a)Mixedstones
b)Purecholesterolstones
c)Pigmentstones
d)Calciumbilirubinate
CorrectAnswer-A
Answer-A
Mixed-Between4%and20%ofstonesaremixed.
Pigment-Between2%and30%ofstonesarebilirubinstones.
Cholesterol-Between35%and90%ofstonesarecholesterol
stones.
Themostcommontypeofgallstoneswasmixedcholesteroltype
gallstoneswith67.5%followedbyblackpigmentandbrownpigment
typesas23.83%and5.89%,respectively.
Mixedstonesare90%common.Itcontainscholesterol,calcium
saltsofphosphatecarbonate,palmitate,proteins,andaremultiple
faceted.

---

177.Serpiginousulcerdistalesophagus-
a)CMV
b)Herpes
c)Pill
d)Corrosive
CorrectAnswer-A
Answer-A(CMV)
CMVclassicallycausesserpiginousulcersinthedistalesophagus
thatmaycoalescetoformgiantulcers.

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178.Omphaloceleiscausedby?
a)Duplicationsofintestinalloops
b)Abnormalrotationoftheintestinalloop
c)Failureofguttoreturntothebodycavityfromitsphysiological
herniation
d)Reversedrotationoftheintestinalloop
CorrectAnswer-C
Answer-C(Failureofguttoreturntothebodycavityfromits
physiologicalherniation)
Failureofguttoreturntothebodycavityfromitsphysiological
herniation.Exomphalos(omphalocele)isherniationofabdominal
viscerathroughanenlargedumbilicalring.Theviscera,whichmay
includeliver,smallandlargeintestines,stomach,spleen,orbladder,
arecoveredbyamnion.Theoriginofomphaloceleisafailureofthe
boweltoreturntothebodycavityfromitsphysiologicalherniation
duringthe6thto10thweeks.

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179.Dohlmanprocedurefor-
a)Meckel'sdiverticulum
b)Zenker'sdiverticulum
c)Dermatomyositis
d)Menetrier'sdisease
CorrectAnswer-B
Answer-B(Zenker'sdiverticulum)
Thetreatmentofpharyngealpouches(Zenker'sDiverticulum)may
bebyeitheropensurgicalorendoscopictechniques.The
endoscopicDohlman'sprocedureisanidealtechniqueinthe
elderly.

---

180.Ifamotherisdonatingkidneytoherson
isanexample-
a)Isograft
b)Allograft
c)Autograft
d)Xenograft
CorrectAnswer-B
Answer-B(Allograft)
Allograft?Graftingbetweentwonon-identicalmemberofsame
speciesbutnotsamegenotypes.Itincludesthetransplantationof
heart,kidney,lungetc,fromamemberswhodonatetheirorgans.
Anti?rejectiondrugsorimmunosuppressantneedtobetakento
preventthebodyfromrejectingatransplantedorgan.
Mosthumantissueandorgantransplantsareallografts.

---

181.Uvulavesicaeisproducedbywhich
prostatelobe?
a)Anteriorlobe
b)Postlobe
c)Medianlobe
d)Laterallobe
CorrectAnswer-C
Answer-C(medianlobe)
Themucousmembraneimmediatelybehindtheinternalurethral
orificepresentsaslightelevation,theuvulaofurinarybladder,
causedbythemedianlobeoftheprostate.
Itisoftenenlargedinbenignprostatichypertrophy.

---

182.TrueaboutBarrett'sesophagusareallof
thefollowingexcept:
a)Causesadenocarcinoma
b)Patientisusuallyasymptomatic
c)Histologyofthelesionshowsmucussecretinggobletcells
d)Chronicgastroesophagealrefluxisapredisposingfactor
CorrectAnswer-A
Answer-
Barrettesophagusisapremalignantconditionthatinvolvesthe
distalesophagusandappearstoberelatedtochronic
gastroesophagealreflux(GORD).
Thereismetaplasticchangeintheliningmucosaofesophagus.
PatientisusuallyasymptomaticinacaseofBarrett'sEsophagus.
HistologyofthelesioninacaseofBarrett'sesophagusshows
mucussecretinggobletcells.
DiagnosisofBarrett'sesophagusismadebydemonstrationof
columnarmucosa,whichonhistopathologyshowsIntestinaltypeof
metaplasia
ChronicrefluxisacasueofBarrett'sEsophagus.

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183.Parathyroidautoimplantationtakesplace
inwhichofthemuscle?
a)Biceps
b)Triceps
c)Brachioradialis
d)Sartorius
CorrectAnswer-C
Answer-C(Brachioradialis)
Atotalparathyroidectomywithaforearmautograftinvolvesremoval
ofallparathyroidtissueintheneck,withreimplantationofasmall
amountofmorcellatedtissuewithinapocketformedinthe
brachioradialismuscle.

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184.Bell'spalsyisassociatedwiththelesion
inwhichofthenerve?
a)11thcranialnerve
b)7thcranialnerve
c)9thcranialnerve
d)3rdcranialnerve
CorrectAnswer-B
Answer-B(7thcranialnerve)
Bell'spalsyoccursduetoamalfunctionofthefacialnerve(VII
cranialnerve),whichcontrolsthemusclesoftheface.Facialpalsyis
typifiedbyinabilitytocontrolmovementinthemusclesoffacial
expression.

---

185.Cushingulcerisseenincaseof-
a)Burns
b)Headinjury
c)Cellnecrosis
d)Stress
CorrectAnswer-B
Answer-B(Headinjury)
Cushingulcersareassociatedwithabraintumororheadinjuryand
typicallyaresingle,deepulcersthatarepronetoperforation.
Itisagastriculcerassociatedwithelevatedintracranialpressure.It
isalsocalledvonRokitansky?Cushingsyndrome.
ThemechanismofdevelopmentofCushingulcersisthoughttobe
duetodirectstimulationofvagalnucleiasaresultofincreased
intracranialpressure.Braintumors,traumaticheadinjury,andother
intracranialprocessesincludinginfections,cancauseincreased
intracranialpressureandleadtooverstimulationofthevagusnerve.

---

186.Gaslessabdomenseenin-
a)Ulcerativecolitis
b)Acutepancreatitis
c)Intussusception
d)Necrotisingenterocolitis
CorrectAnswer-B
Answer-B(acutepancreatitis)
Commoncausesinclude:
Inadult:
-Highobstruction.
-Ascites.
-Acutepancreatitisduetoexcessvomiting.
-Fluidfilledintestine.
-Largeabdominalmass.
ACUTEPANCREATITIS-radiologysigns
renalhalosign
gaslessabdomen
groundglassappearance
coloncutoffsign
sentinelloop

---

187.Bidextrousgripisseenatwhatage?
a)4months
b)5months
c)6months
d)7months
CorrectAnswer-A
Ans.A.4months
FINEMOTORMILESTONES:
Age
Milestone
4months Bidextrousreach
6months Unidextrousreach
9months Immaturepincergrasp
12months Maturepincergrasp
Imitatesscribbling,towerof2
15months blocks
18months Scribbles,towerof3blocks
Towerof6blocks,vertical&
2years
circularstroke
3years
Towerof9blocks,copiescircle
4years
Copiescross,bridgewithblocks
5years
Copiestriangle

---

---

188.Whichvaccinetobegiveneveryyear?
a)HepatitisA
b)HepatitisB
c)Influenza
d)Chickenpox
CorrectAnswer-C
Ans.C.Influenza
Influenza(Flu):Thefluvaccineisrecommendedeveryyearfor
children6monthsandolder:
Kidsyoungerthan9whogetthefluvaccineforthefirsttime(orwho
haveonlyhadonedosebeforeJuly2017)willgetitintwoseparate
dosesatleastamonthapart.
Thoseyoungerthan9whohavehadatleasttwodosesofflu
vaccinepreviously(inthesameordifferentseasons)willonlyneed
onedose.
Kidsolderthan9onlyneedonedose.
Thevaccineisgivenbyinjectionwithaneedle(theflushot)orby
nasalspray.Theflushotispreferredforchildrenofallagesbecause
ithasbeenshowntobesafeandeffective.Althoughthenasalspray
wasnotusedinrecentyears,achangedversionofitisnow
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
CorrectAnswer-C
Ans.C.Severelydepressed
APGARCRITERIA:
Component
Scoreof
Scoreof1
Scoreof2
of
0
backronym
blueat
nocyanosis
blueor
extremities
bodyand
Skincolor
paleall
Appearance
bodypink
extremities
over
(acrocyanosis) pink
<100beatsper >100beats
Pulserate
absent
Pulse
minute
perminute
no
grimaceon
Reflex
response suctionor
cryon
irritability
Grimace
to
aggressive
stimulation
grimace
stimulation stimulation
flexedarms
andlegsthat
Activity
none
someflexion
Activity
resist
extension
Respiratory
weak,irregular, strong,robust
absent
Respiration
effort
gasping
cry

---

INTERPRETATION:
Thetestisgenerallydoneat1and5minutesafterbirthandmaybe
repeatedlaterifthescoreisandremainslow.
Scores7andabovearegenerallynormal
Score4to6,fairlylow
Score:3andbelowaregenerallyregardedascriticallylowand
causeforimmediateresuscitativeefforts.

---

190.SevereacutemalnutritionasperWHO
criteria-
a)Weightforagelessthanmedianplus?2SD
b)Weightforheightlessthanmedianplus2SD
c)Weightforagelessthanmedianplus3SD
d)Weightforheightlessthanmedianminus-3SD
CorrectAnswer-D
Ans.D.Weightforheightlessthanmedianminus-3SD
Severeacutemalnutritionisdefinedbyaverylowweightforheight
(below-3zscoresofthemedianWHOgrowthstandards),byvisible
severewasting,orbythepresenceofnutritionaloedema.
WorldHealthOrganization(WHO)classificationofnutritionalstatus
ofinfantsandchildren:
Nutritionalstatus
Age:birthto5years
Weight-for-length/heightorBMI-for-age>3
Obese
standarddeviations(SD)ofthemedian
Weight-for-length/heightorBMI-for-age>2SD
Overweight
and3SDofthemedian
Moderately
Weight-for-age
underweight
Severely
Weight-for-age
underweight
Weight-for-length/heightorBMI-for-age?2SD
Moderateacute
and?3SDofthemedian,ormid-upperarm
malnutrition
circumference115mmand
Severeacute
Weight-for-length/heightorBMI-for-age
malnutrition
Moderatelystunted

---

Moderatelystunted Length/height-for-age?2SDand?3SDof
(moderatechronic themedian
malnutrition)
Severelystunted
(severechronic
Length/height-for-age
malnutrition)
Weight-for-length/height?2SDand?3SDof
Moderatelywasted themedian
Severelywasted
Weight-for-length/height

---

191.Wheretolookforpre-ductalO2
saturationinPDAina3minuteborn
infant?
a)FetalleftUpperlimb
b)Fetalleftlowerlimb
c)FetalrightUpperlimb
d)Fetalrightlowerlimb
CorrectAnswer-C
Ans.C.FetalrightUpperlimb
Asimplerwaytodetectthisright-to-leftshuntingistousetwopulse
oximetersandmeasurepreductalandpostductalSpO2.Inone
studyitwasfoundthatarterialsaturationintherightarm(preductal)
ofatleast3%abovethelowerlimb(postductal)isevidenceofright-
to-leftductalshunting.

---

192.TrueaboutFragileXsyndromeis-
a)TriplenucleotideCAGSequencemutation
b)10%Femalecarriersmentallyretarded
c)MaleshaveIQ20-40
d)Gainoffunctionmutation
CorrectAnswer-C
Ans.C.MaleshaveIQ20-40
FragileXSyndrome
FragileXsyndromeisassociatedwithafragilesiteonchromosome
X(Xq29.3)
TriplenucleotideCGGSequencemutation
About20%ofwomenwhoarecarriersforthefragileXpremutation
areaffectedbyfragileX-relatedprimaryovarianinsufficiency.
IndividualswithFXSmaypresentanywhereonacontinuumfrom
learningdisabilitiesinthecontextofanormalintelligencequotient
(IQ)tosevereintellectualdisability,withanaverageIQof40in
maleswhohavecompletesilencingoftheFMR1gene.
Fragilesitesareregionsofchromosomesthatshowatendencyto
separationbreakageorattenuationtinderparticulargrowth
conditions.
Inheritance
InheritancedoesnotfollowtheusualMendeliansinglegenepatterns
ItisduetoAllelicexpansion.
ClinicalManifestations:
Themainclinicalmanifestationsare:
1.MentalRetardation
Infactitisthecommonestcauseofmentalretardationinmales.
2.Macroorchidism.

---

3.Characteristicfacialappearancewith:
Longface
Largeprominentears
ProminentJaw

---

193.Footdropiscausedbyinjurytowhich
nerveinvolvement:
a)Femoralnerve
b)Tibialnerve
c)Commonperonealnerve
d)Sciaticnerve
CorrectAnswer-C
AnswerC)CommonPeronealNerve
Footdrop,sometimescalleddropfoot,isageneraltermfor
difficultyliftingthefrontpartofthefoot.
Causes
Footdropiscausedbyweaknessorparalysisofthemuscles
involvedinliftingthefrontpartofthefoot.
Causesoffootdropmightinclude:
1. Nerveinjury.Themostcommoncauseoffootdropiscompression
ofanerveinyourlegthatcontrolsthemusclesinvolvedinliftingthe
foot(peronealnerve).Thisnervecanalsobeinjuredduringhipor
kneereplacementsurgery,whichmaycausefootdrop.
2. Anerverootinjury--"pinchednerve"--inthespinecanalso
causefootdrop.Peoplewhohavediabetesaremoresusceptibleto
nervedisorders,whichareassociatedwithfootdrop.
3. Muscleornervedisorders.Variousformsofmusculardystrophy,
aninheriteddiseasethatcausesprogressivemuscleweakness,can
contributetofootdrop.Socanotherdisorders,suchaspolioor
Charcot-Marie-Toothdisease.
4. Brainandspinalcorddisorders.Disordersthataffectthespinal
cordorbrain--suchasamyotrophiclateralsclerosis(ALS),multiple
sclerosisorstroke--maycausefootdrop.

---

---

194.

---

Whichpartofscaphoidfractureismost
susceptibletoavascularnecrosis?
a)Distal1/3rd
b)Middle1/3rd
c)Proximal1/3rd
d)ScaphoidTubercle
CorrectAnswer-C
Answer.C.Proximal1/3rd
Scaphoidfractures(i.e.fracturesthroughthescaphoidbone)are
common,insomeinstancescanbedifficulttodiagnose,andcan
resultinsignificantfunctionalimpairment.
Epidemiology
Scaphoidfracturesaccountfor70-80%ofallcarpalbonefractures.
Althoughtheyoccuressentiallyatanyage,adolescentsandyoung
adultsaremostcommonlyaffected.
Olderpatientsfallinginasimilarmanneraremorelikelytosustaina
distalradialfracture(usuallyaCollesfracture).
ClinicalPresentation
Classicallytherecanbepaininanatomicalsnuffboxwhichisthought
tohaveasensitivityof~90%andaspecificity~40%
Fracturescanoccuressentiallyanywherealongthescaphoid,but
distributionisnoteven:
1. waistofscaphoid:70-80%
2. proximalpole:20%
3. distalpole(orso-calledscaphoidtubercle):10%

---

---

195.Pott'spuffytumor:
a)Subperiostealabscessoffrontalbone
b)Subperiostealabscessofethmoidbone
c)Mucoceleoffrontalbone
d)Mucoceleofethmoidbone
CorrectAnswer-A
Answer.A.Subperiostealabscessoffrontalbone
Pott'spuffytumor,firstdescribedbySirPercivallPottin1760,isa
rareclinicalentitycharacterizedbysubperiostealabscess
associatedwithosteomyelitis.
Itischaracterizedbyanosteomyelitisofthefrontalbone,either
directorthroughhaematogenousspread.
Thisresultsinaswellingontheforehead,hencethename.
Theinfectioncanalsospreadinwards,leadingtoanintracranial
abscess.
Pott'spuffytumorcanbeassociatedwithcorticalveinthrombosis,
epiduralabscess,subduralempyema,andbrainabscess.

---

---

196.Scissorgaitisseeninwhichofthe
followingcondition:
a)Polio
b)Cerebralpalsy
c)Hyperbilirubinemia
d)Hyponatremia
CorrectAnswer-B
Answer.B.Cerebralpalsy
Scissorgaitisaformofgaitabnormalityprimarilyassociatedwith
spasticcerebralpalsy.
Thatconditionandotherslikeitareassociatedwithanuppermotor
neuronlesion.

---

197.Whichstatementisincorrectaboutthe
pathologyshownintheimage:
a)Tumorarisefromepiphysealtometaphysealregion
b)Tumorhasdistinctmargin
c)Eccentriclesion
d)Chemotherapyisthetreatmentofchoice
CorrectAnswer-D
Answer.D.Chemotherapyisthetreatmentofchoice
GivenimageisofGiantcelltumor
Giantcelltumorsofbone,alsoknownasosteoclastomas,are
relativelycommonbonetumorsandareusuallybenign.
Theytypicallyarisefromthemetaphysisoflongbones,extend
intotheepiphysisadjacenttothejointsurface,andhavea
narrowzoneoftransition.
Classicappearance

---

Therearefourcharacteristicradiographicfeatureswhenagiantcell
tumorislocatedinalongbone:
occursonlywithaclosedgrowthplate
abutsarticularsurface:84-99%comewithin1cmofthearticular
surface1
well-definedwithnon-scleroticmargin(though
eccentric:iflargethismaybedifficulttoassess
Treatment
Classically,treatmentiswithcurettageandpackingwithbonechips
orpolymethylmethacrylate(PMMA).

---

198.Whatshouldbethemostlikelydiagnosis
ofthis65yearoldladypresentswith
backacheandfollowingradiographof
thespineshowninimage?
a)Osteoporosis
b)Spondylolisthesis
c)Spondylolysis
d)Discitis
CorrectAnswer-B
Answer.B.Spondylolisthesis
Spondylolisthesisissubluxationoflumbarvertebrae,usually
occurringduringadolescence.
Itusuallyresultsfromacongenitaldefectintheparsinterarticularis
(spondylolysis).

---

Spondylolisthesisisusuallyfixed(ie,permanentandlimitedin
degree).ItusuallyinvolvestheL3-L4,L4-L5,orL5-S1vertebrae.
Spondylolisthesisoftenoccursinadolescentsoryoungadultswho
areathletesandwhohavehadonlyminimaltrauma;thecauseisa
lumbarvertebraweakenedbyacongenitaldefectinthepars
interarticularis(spondylolysis).
Thisdefectcaneasilyleadtofractures;separationofthefracture
fragmentscausesthesubluxation.Spondylolisthesiscanalsooccur
withminimaltraumainpatientswhoare>60andhave
osteoarthritis.
Ifmildtomoderate(subluxationof=50%),spondylolisthesis,
particularlyintheyoung,maycauselittleornopain.
Spondylolisthesiscanpredisposetolaterdevelopmentofspinal
stenosis.
Ifduetomajortrauma,spondylolisthesiscancausespinalcord
compressionorotherneurologicdeficits;thesedeficitsrarelyoccur.
[Thisx-rayshowsstage1spondylolisthesisofL5onS1.The
blackarrowshowstheposteriorborderofL5,whichsubluxes
anteriortoS1.Theredarrowpointstothespondylolysis
(congenitaldefectintheparsinterarticularis).]

---

Spondylolisthesisisstagedaccordingtothepercentageofvertebral
bodylengththatonevertebrasubluxesovertheadjacentvertebra:
StageI:0to25%
StageII:25to50%
StageIII:50to75%
StageIV:75to100%
Spondylolisthesisisevidentonplainlumbarx-rays.Thelateralview
isusuallyusedforstaging.Flexionandextensionviewsmaybe
donetocheckforinstability.
Treatment
Usuallysymptomatic.
Physicaltherapywithlumbarstabilizationexercisesmaybehelpful.

---

199.Whichofthefollowingattitudewillbeseeninapatientwithposterior
dislocationofhip?
a)Flexion,Abduction,Internalrotation
b)Flexion,Adduction,Internalrotation
c)Flexion,Abduction,Externalrotation
d)Flexion,Adduction,Externalrotation
CorrectAnswer-B
Dislocationsareusuallyposterior,andoccasionallyanterior,orcentralthroughthe
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.
c)Withinvolvementoflittlefingertheinfectioncanspreadtothe
indexfinger.
d)Treatmentisconservative.
CorrectAnswer-B
Ans.B.Tenosynovitisoflittlefingerwillspreadtothumbratherthan
ringfinger
Infectionofthesynovialsheaththatsurroundstheflexortendon
Infectionfromtheflexortendonsheathofthethumbcanalsoextend
alongtheradialbursatothespaceofParonaandthenintotheulnar
bursaandtheflexortendonsheathofthelittlefinger--andvice
versa--leadingtoa"horseshoe"abscess.
Horseshoeabscess:
Maydevelopfromspreadpyogenicflexortenosynovitis,ofmany
individualshaveaconnectionbetweenthesheathsofthethumband
littlefingersatthelevelofthewrist

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201.Mostcommonjointinvolvedinseptic
arthritis:
a)Knee
b)Hip
c)Shoulder
d)Elbow
CorrectAnswer-A
Answer.A.Knee
Septicarthritis(Acutesuppurativearthritis)
Septicarthritisreferstopyogenicinfectionofajoint,i.e.,infectionof
ajointbypyogenicorganism(bacteria).
Thejointcanbecomeinfectedby:?
1. Hematogenousspreadfromadistantsite(mostcommonroute).
2. Directinvasionthroughapenetratingwound,intraarticularinjection,
arthroscopy.
3. Directspreadfromadjacentosteomyelitisespeciallyinjointswhere
Metaphysisisintraarticulare.g.,hipandshoulder.
Clinicalfeatures
Diseaseismorecommoninchildren.
Kneejointisthemostcommonlyaffectedjoint.
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
CorrectAnswer-A
Answer.A.Midabduction
PAINFULARCSYNDROME
OtherNames
Impingementsyndrome
Supraspinatussyndrome
Swimmer'ssyndrome
Thrower'sshoulder
Clinicalsyndromecharacterizedbypainintheshoulderduringan
arcofmovementbetween60?and120?ofabduction.

---

Etiology:
1. Minortearsofthesupraspinatustendon
2. Supraspinatustendinitis
3. Calcificationofsupraspinatustendon
4. Subacromialbursitis
5. Fractureofthegreatertuberosity
6. Increaseinbulkofthecontentsinthesubacromialspace,seenin
inflammationoftherotatorcuff

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203.Whichofthefollowingisfalseas
physiologicalchangeinpregnancy?
a)Increasecardiacoutput
b)Increasetotalprotein
c)Increaseresidualvolume
d)IncreaseGFR
CorrectAnswer-C
Ans.C.Increaseresidualvolume
Therespiratoryrateisessentiallyunchanged,buttidalvolumeand
restingminuteventilationincreasesignificantlyaspregnancy
advances.
Thefunctionalresidualcapacityandtheresidualvolumeare
decreasedasaconsequenceoftheelevateddiaphragm.

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204.Overtgestationaldiabetesisdefinedas
bloodglucosemorethan_?
a)>200mg/dl
b)>126mg/dl
c)>100mg/dl
d)>180mg/dl
CorrectAnswer-B
Ans.B.>126mg/dl
Iffastingis92-125mg/dlitisdiagnosedasGDMandifitis=126
mg/dlitisdesignatedasovertDiabetes

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205.MgSO4havenoroleinpreventionof-
a)Seizuresinseverepre-eclampsia
b)Recurrentseizuresineclampsia
c)RDSinprematurebaby
d)Bradycardia
CorrectAnswer-C
Ans.C.RDSinprematurebaby
Indicatedtopreventseizuresassociatedwithpre-eclampsia,andfor
controlofseizureswitheclampsia.
Magnesiumsulfate(MgSO4)iscommonlyusedasananticonvulsant
fortoxemiaandasatocolyticagentforprematurelaborduringthe
lasthalfofpregnancy.
ToxicityofI/Vmagnesiumsulfateincludescardiacarrhythmias,
muscularparalysis,respiratorydepressionandCNSdepressionin
motheraswellastheneonate.

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206.Greenfrothyvaginaldischargeis
producedby?
a)Herpessimplex
b)Candidaalbicans
c)Trichomonasvaginalis
d)Normalvaginalflora
CorrectAnswer-C
Ans.C.Trichomonasvaginalis
Trichomoniasis?
Itisasexuallytransmitteddisease
Itisalmostentirelyadiseaseofchild-bearingage
Thevaginaldischargeisfrothy,slightlygreenincolourandprofuse.
Therearemultiplepunctatestrawberryspotsonthevaginalvault
andportiovaginalisofcervix.Diagnosis:Cultureis98%reliable

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207.Whichofthefollowingisanabsolute
CONTRAINDICATIONtoOCPuse:
a)Chronicrenaldisease
b)DVT
c)Diabetesmellitus
d)Historyofamenorrhea
CorrectAnswer-B
Ans.B.DVT
Contraindicationstocombinedoralcontraceptives
Theyaregenerallyacceptedtobecontraindicatedinwomenwith
pre-existingcardiovasculardisease,inwomenwhohaveafamilial
tendencytoformbloodclots/thrombosis(suchasfamilialfactorV
Leiden),womenwithsevereobesityand/orhypercholesterolemia
(highcholesterollevel),andinsmokersoverage40.
COCParealsocontraindicatedforwomenwithlivertumors,hepatic
adenomaorseverecirrhosisoftheliver,andforthosewithknownor
suspectedbreastcancer.

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208.Whichofthefollowingstatementis
correctaboutacutefattyliverof
pregnancy?
a)Occursin1in1000pregnancy
b)Mostlyseeninlasttrimester
c)Commoniffemalefetusispresent
d)Maybeassociatedwithdecreaseduricacid
CorrectAnswer-B
Ans.B.Mostlyseeninlasttrimester
Acutefattyliverofpregnancyisusuallyseeninobesewoman.
Itismorecommonlyseeninwomancarryingamalefoetus.
Theneonateisatriskoffattyinfiltrationofliver.
ItMorecommonlyoccursin3rdtrimester.
ItMaybeassociatedwith?uricacid.

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209.Femalewith41wkgestationconfirmed
byradiologicalinvestigation,verysure
ofherLMP,nouterinecontractions,no
effacementandnodilatation.What
shouldnotbedone?
a)Intracervicalfoley's
b)PGE1tab
c)PGE2gel
d)PGF2alpha
CorrectAnswer-D
Ans.D.PGF2alpha
PgF2alphaisauterinerelaxantsoitcan'tbeusedininductionof
labour.

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210.Doubledeciduasignisseenduring-
a)1Sttrimester
b)2ndearlytrimester
c)2ndlatetrimester
d)3rdtrimester
CorrectAnswer-A
Ans.A.1sttrimester
Thedoubledecidualsacsign(DDSS)isausefulfeatureonearly
pregnancyultrasoundtoconfirmanearlyintrauterinepregnancy
(IUP)whentheyolksacorembryoisstillnotvisualized.
The"DoubleDecidualSign",firstdescribedbyNybergandco-
workersconsistsoftwoechogenicringssurroundingthehypoechoic
gestationalsac.
Theinnerringrepresentsthechorion,embryonicdiscanddecidua
capsularis.
Theouterringrepresentsthedeciduaparietalis.

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211.60yearwomancomeswith3rddegree
uterineprolapse.Whatwillbethe
management?
a)Vaginalhysterectomywithpelvicfloorrepair
b)Pelvicfloorrepair
c)Sacrospinousfixation
d)Pessary
CorrectAnswer-A
Ans.A.Vaginalhysterectomywithpelvicfloorrepair
Uterineprolapsesurgeryisperformedtoremovetheuterusand
repairtheweaktissue.Uterineprolapsefrequentlyoccursin
postmenopausalwomenwho'vehadoneormorevaginaldeliveries.
Saggingofthepelvicmuscleswhichleadstouterineprolapse
canoccur:
Ifsupportivetissuesaredamagedduringpregnancyanddelivery
Duetoestrogenloss
Asaresultofstrainingrepeatedlyovertheyears(chroniccough,
constipationetc.)
Duetogravitationaleffects
Dependingonfactorslikeageofthewoman,desireforbecoming
pregnantandtheoverallstateofawoman'shealth,thetreatment
planisdecided.
Herethewomanisofoldage(nongestational)andhave3rddegree
ofprolapse.SobestmanagementofchoicewillbeVaginal
hysterectomywithpelvicfloorrepair.

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212.Day20ofmenstrualcyclefallsunder
whichphase?
a)Menstrualphase
b)Follicularphase
c)Ovulationphase
d)Lutealphase
CorrectAnswer-D
Ans.D.Lutealphase
TheentiredurationofaMenstrualcyclecanbedividedinto
fourmainphases:
1. Menstrualphase(Fromday1to5)
2. Follicularphase(Fromday1to13)
3. Ovulationphase(Day14)
4. Lutealphase(Fromday15to28)

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213.Chromosomenumberofpartial
hydatidiformmoleis-
a)46XX
b)45XO
c)46XXY
d)69XXX
CorrectAnswer-D
Ans.D.69XX
Apartialhydatidiformmoleisatriploidpregnancywith69insteadof
46chromosomesandanotherstrangecomplicationofthe
reproductiveprocess.
Partialhydatidiformmolecanbeidentifiedbyultrasoundshowing
placentatissue,somehygromatouscysts,somefetaloddities,but
noclearfetusstructure.
Ultrasoundisstrictlyanindicator.Afterspontaneousabortionor
dilationandcurettage,tissueneedstobeexaminedbypathology
andcytogeneticsneedstobedetermined.
Ifatriploidkaryotypeisdeterminedas69,XXX,69XXY,or69XYY
[6],thenapartialmolecanbeconfirmed.

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---

214.Vulvaratrophyanditchingaretreated
by-
a)Estrogenointment
b)Antihistamines
c)Tamoxifen
d)None
CorrectAnswer-A
Ans.A.Estrogensointment
Atrophicvaginitis,themedicaltermforthiscondition,occursasa
resultofdeteriorationofthevaginaltissue.
It'sacommonconditioninpostmenopausalwomenbecauseas
estrogenlevelsdrop,thetissuethatlinesthevaginabecomes
thinnerandmoreeasilydamaged.
Womenwithatrophicvaginitismayalsoexperiencevaginalitching,
burning,frequenturination,orvaginaldischarge.
Womencantreatthisconditiontopicallywithestrogencreams,
tablets(Vagifem),oranestrogen-releasingringplacedinthevagina
(Estring).
Oralestrogen,availablewithadoctor'sprescription,willalsorestore
vaginaltissue.
Vaginallubricantsofferanalternativeforwomenwaryofusing
estrogen.
MoisturizerssuchasReplens,Astroglide,andLubrincanreduce
symptomsandmakesexualintercoursemorecomfortable.

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215.Prematureejaculationisapartofwhichphaseof
sexualdisorders?
a)Excitementphase
b)Plateauphase
c)Orgasmphase
d)Refractoryphase
CorrectAnswer-C
Ans.C.Orgasmphase
Themalesexualresponseisdescribedasasequenceofphases
including4stages:sexualdesire,arousal,orgasm(ejaculation)and
resolution.
Themalesexualdysfunctionusuallyoccursinoneormoreof
thethreefirststagesofthesexualresponsecycle,including:
Dysfunctionsofsexualdesire(e.g.hypoactivesexualdesire)
Arousal(e.g.erectiledysfunction)
Orgasm/ejaculation(e.g.prematureejaculation,retardedejaculation
orinabilitytoejaculate).
Prematureejaculationoccursduetotherapidevolutionofthetwo
firststagesofthesexualresponsecycleandisnotnecessarily
relatedtostrongsexualarousalorchangesinerection.
PrematureEjaculationseemstobeaneurobiologicalproblemthatis
relatedtolowserotoninlevelsinthoseregionsofthecentralnervous
systemthatregulateejaculation(brainandspinalcord).

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216.NuchaltranslucencyinUSGcanbe
detectedat_____weeksofgestation.
a)11-13weeks
b)18-20weeks
c)8-10weeks
d)20-22weeks
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
d)Ampicillin
CorrectAnswer-A
Ans.A.Dicloxacillin
Thebetalactamase-resistantpenicillinshavebeenrecommendedin
thetreatmentofmastitis.Theseincludecloxacillin,dicloxacillin,or
flucloxacillin.
Becausepenicillinsareacidic,theyarepoorlyconcentratedin
humanmilk,whichisalsoacid.
Therefore,cloxacillinanditscongenerstendtotreatcellulitiswell,
buttheyarelesseffectiveineradicatingadenitis,themostlikely
precursorofbreastabscess.
Whenpatientsareallergictopenicillins,cephalexinorclindamycin
maybethealternativetoerythromycin.
Combinationlikeco-amoxiclavshouldbeavoidedbecauseoffearof
inducingMRSA

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218.Patientwithrecurrentabortion
diagnosedtohaveantiphospholipid
syndrome.Whatwillbethetreatment?
a)Aspirinonly
b)Aspirin+LowmolecularweightHeparin
c)Aspirin+LowmolecularweightHeparin+Prednisolone
d)NoTreatment
CorrectAnswer-B
Ans.B.Aspirin+LowmolecularweightHeparin
Therecommendedtreatmentforwomenwithrecurrentpregnancy
lossassociatedwithantiphospholipidsyndromeincludescombined
AspirinandHeparintherapy.
InpregnantSLEpatientswithAntiphospholipidantibodiesandprior
fetalloss,treatmentwithheparin(standardorlow?molecular-
weight)pluslowdoseaspirinhasbeenshowninprospective
controlledtrialstoincreasesignificantlytheproportionoflivebirths.
Combinedaspirinandheparintherapyhasproveneffectivenessand
isthepreferredtreatmentforwomenwithrecurrentpregnancyloss
associatedwithantiphospholipidsyndrome.

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219.GestationalTrophoblasticneoplasm
doesnotinclude-
a)Choriocarcinoma
b)Placentalsitetrophoblastictumour
c)Invasivemole
d)Partialmole
CorrectAnswer-D
Ans.D.PartialMole
Themaintypesofgestationaltrophoblasticdiseasesare:
Hydatidiformmole(completeorpartial)
Invasivemole
Choriocarcinoma
Placental-sitetrophoblastictumor
Epithelioidtrophoblastictumor
Note:Inthegivenbestoptionbestanswercanbepartialaspartial
hydatidiformmoleisnotcompletelymentionedinit.

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220.Whichvaccineiscontraindicatedin
pregnancy:
a)Chickenpox
b)Rabies
c)Tettoxoid
d)HepatitisB
CorrectAnswer-A
Ans.A.Chickenpox
Asaruleofthumbthevaccinationwithliveviralorbacterialvaccine
iscontraindicatedinpregnancy.
Theimportantonesare:?
Measles
Mumps
Poliomyelitis
Rubella
Yellowfever
Varicella
BCG

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221.45yearsfemalewith3months
menorrhagia.USGshowing2cm
submucosalfibroid.Treatmentoptions.
a)Ocpfor3months
b)Progesteronefor3months
c)Endometrialsampling
d)Hysterectomy
CorrectAnswer-D
Ans.D.Hysterectomy
YOUNGWOMEN
OLDERWOMEN
Contraceptiondesired
CombinedOCPs
Contraception
Ruleoutcancer&uterine
Progestogensandother
notdesirable
pathology
hormones
Mirena
Normaluterus
Uterine
Progestogens
Effective Fails
(DUB)
pathology
Ethamsylate,
Minimal
Progestogens
NSAIDs
invasive
andothers
Estrogen
Continue surgery
?Noresponse
Tranexamicfor for6?9 Hysterectomy Hysterectomy Surgery
3?4months
months with
withremovalof
GnRH3?4
conservation
ovariesafter50
months
ofovaries
years
Removalofanintrauterinecontraceptivedeviceifmedicaltherapy
fails.
Myomectomy/hysterectomyforuterinefibroids.

---

Wedgeresection/hysterectomyforadenomyosisoftheuterus.
Dilatationandcurettagewithbloodtransfusionistheprimary
treatmentofpubertymenorrhagiawithlowHb%
Multipara,hypertensivewomanwithmenorrhagiashouldbetreated
withMIRENA
Hysterectomywithorwithoutremovaloftheadnexaaccordingtothe
ageandtheindividualneedsofthepatient.

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222.Inlowovarianreserve,antimullerian
hormonelevelwillbe:
a)<1
b)1-4
c)>7
d)>10
CorrectAnswer-A
Ans.A.<1
AMHandovarianreserve
AMHof1.0hasverypoorovarianreserve
ThecentralconceptforthemeasurementofbloodlevelsofAMHto
determineovarianreserveisthis:womenwithlowerAMHlevels
havealowerovarianreservethanwomenwithhighAMHlevels.
AMHiscurrentlybeingusedbyfertilityspecialiststohelppredict
womenwhomayrespondpoorlytofertilitymedicationsandin
general,coupleswhoarelesslikelytobesuccessfulwithfertility
treatment.

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223.Presentingdiameteroffullflexedhead:
a)Suboccipito-bregmaticdiameter
b)Suboccipito-frontaldiameter
c)Occipito-frontaldiameter
d)Occipito-posteriorposition
CorrectAnswer-A
Ans.A.Suboccipito-bregmaticdiameter
Suboccipito-bregmaticdiameter:
Thediameterisfromsuboccipitalregiontocentreofthebregma.
Diameter=9.5cm
Fetalheadcircumferenceissmallest(32cm)
Headwellflexed
Flexedvertexpresentation
Suboccipito-frontaldiameter:
Diametercalculatedfromprominenceatmidfrontalbonetothe
under-surfaceoftheoccipitalbonewhereitjoinsneck
Thediameteris10.5cm
Vertexispartiallydeflexed.
Resultsinoccipito-posteriorposition.
Occipito-frontaldiameter:
Diameterextendsfromtheprominentpointofmid-frontalbonetothe
mostprominentpointofoccipitalbone
Thediameter=11.5cm
Fetalheadcircumference~34.5cm
Vertexisdeflexed
AssociatedwithDirectoccipito-posteriorposition.
Occipito-posteriorposition:
Itisavertexpresentationinwhichtheocciputisplacedposteriorly.

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---

224.Whatisthedoseofulipristalacetate?
a)300mg
b)30mg
c)300?g
d)30?g
CorrectAnswer-B
Ans.B.30mg
Ulipristal(Ella)isaprogesteroneagonist/antagonistmarketedfor
emergencycontraception.Itisavailablebyprescriptiononly.Its
mechanismofactionvariesbasedontimeofadministration.When
takenbeforeovulation,ulipristaldelaysorinhibitsovulation.
Administrationintheearlylutealphasemaydecreaseendometrial
thicknessandaffectimplantationofafertilizedegg.
Ulipristalislabeledforuseasanemergencycontraceptivefollowing
unprotectedsexualintercourseorcontraceptivefailure.
Onetablet(30-mgtablet)takenassoonaspossible,within120
hours(fivedays)ofunprotectedsexualintercourseorcontraceptive
failure.

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225.Themajorcontributionoftheamniotic
fluidafter20weeksofgestation:
a)Ultrafiltrateandmaternalplasma
b)Fetalurine
c)Fetallungfluid
d)Fetalskin
CorrectAnswer-B
Ans.B.Fetalurine
Therearetwoprimarysourcesofamnioticfluid:fetalurineandthe
lungliquid.
Afterabout20weeks,fetalurinemakesupmostofthefluid.

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226.PGF2alphamaximumdoseinPPHis-
a)2000?g
b)200?g
c)2mg
d)20mg
CorrectAnswer-C
Ans.C.2mg
DrugdosesformanagementofPPH:
15-MethylprostaglandinF2a:
Doseandroute:IM:0.25mg
Continuingdose:0.25mgevery15minutes
Maximumdose:8doses(Total2mg)
Precautions/contraindications:Asthma

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227.Allaretrueaboutskinexcept:
a)Bothdermis&ectodermarederivedfromectoderm
b)Skinaccountsfortotalof15%ofbodyweight
c)Mostofthecellsinskinarekeratinocytesderivedfrom
ectoderm
d)Dermisismadeupoftype1andtype3collagenin3:2ratio
CorrectAnswer-A
Ans:A.Bothdermis&ectodermarederivedfromectoderm.
Truefact:Dermisderivedfrommesodermandepidermisfrom
ectoderm.

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228.Anaestheticgaswithmaximum
respiratoryirritation
a)Halothane
b)Enflurane
c)Desflurane
d)Sevoflurane
CorrectAnswer-C
Ans:C.Desflurane
Desfluraneandisofuranewhenusedforinductioncauserespiratory
irritationduetotheirpungentsmellleadingtobreathholdingand
coughing.
Halothaneandsevofluranedonotcausesucheffects.

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229.IVadministrationofwhichanesthetic
drugismostpainfulamongthe
following?
a)Methohexital
b)Ketamine
c)Propofol
d)Etomidate
CorrectAnswer-C
Ans:c.Propofol
Propofolpreparation:
Oil-basedpreparation(soybeanoil,egglecithin&glycerol).
Hence,painoninjection&rarelythrombophlebitis.

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230.Whichofthefollowingisnot
cardiodepressive?
a)Propofol
b)Thiopentone
c)Ketamine
d)Etomidate
CorrectAnswer-D
Ans:D.Etomidate
Majoradvantageofetomidate:
Cardiovascularstabilityafterinduction.
Effectsofetomidateinductiondose:
Negligibleincreaseinheartrate.
Littledecreaseinbloodpressure/cardiacoutput.
Littleeffectoncoronaryperfusionpressure,whilereducing
myocardialO2consumption.

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231.Whichofthefollowingisthemost
commonmethodusedtoknowdepth
ofanaesthesia?
a)BIS
b)Oesophagealcontractility
c)Depressedresponses
d)Hypotension
CorrectAnswer-A
Ans:A.BIS
Bispectralindex:
*1stscientificallyvalidated&commerciallyavailablemonitorto
checkdepthofanaesthesia.
*Utilizesmanyparameters(EEGsignals,eyeblinks)tocalculate
depthscore.
Adequatedepth:
*Scoreof45-60.
Fullyawakestate:
*Scoreof100
Completelysilentbrain:0.

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232.MRP2associatedwithwhichofthe
following?
a)Rotorsyndrome
b)Dubin-Johnsonsyndrome
c)Crigler-Najjarsyndrome
d)Gilbertsyndrome
CorrectAnswer-B
Ans:B.Dubin-Johnsonsyndrome.
Dubin-Johnsonsyndrome:
Anautosomalrecessivedisorder.
Causedbygenemutationresponsibleforhumancanalicular
multispecificorganicaniontransporter(cMOAT)protein/also
referred"multidrugresistanceprotein2(MRP2)"orABCC2.

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233.Whichofthefollowingiswatersoluble
contrast?
a)Barium
b)Iodine
c)Bromium
d)Calcium
CorrectAnswer-B
Answer-B.Iodine
Radiocontrastagentsaretypicallyiodine,barium-sulphateor
gadoliniumbasedcompounds.

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234.Solitarylyticlesionsseenin
a)Atherosclerosis
b)Multiplemyeloma
c)Mitralstenosis
d)Osteoblast
CorrectAnswer-B
Answer-B.Multiplemyeloma
F:fibrousdysplasia(FD)orfibrouscorticaldefect(FCD)
O:osteoblastoma
G:giantcelltumor(GCT)
M:metastasis(es)/myeloma
A:aneurysmalbonecyst(ABC)
C:chondroblastomaorchondromyxoidfibroma
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.
d)Lowlevelmotorskill/functionispresent
CorrectAnswer-D
Ans:D.Lowlevelmotorskill/functionispresent.
Sleepwalking(somnambulism):
Thepatientsmaycarryoutarangeofactivitiesforwhichhedoesn't
haveanymemorylateron.
Itmayincludeleavingthebedandwalkingaboutandalsoactivities
likedressing,movingaroundorevendriving.

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236.Confusionassessmentscaleusedfor
whichofthefollowing?
a)Schizophrenia
b)Delirium
c)Dementia
d)Depression
CorrectAnswer-B
Ans:B.Delirium
ConfusionAssessmentMethod(CAM),awidely-usedinstrument
anddiagnosticalgorithmforidentificationofdelirium.
TheCAMinstrumentassessesthepresence,severity,and
fluctuationof9deliriumfeatures:
Acuteonset
Inattention
Disorganizedthinking
Alteredlevelofconsciousness
Disorientation
Memoryimpairment
Perceptualdisturbances
Psychomotoragitationorretardation
Alteredsleep-wakecycle.
TheCAMdiagnosticalgorithmisbasedonfourcardinal
featuresofdelirium:
Acuteonsetandfluctuatingcourse
Inattention
Disorganizedthinking
Alteredlevelofconsciousness.

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237.Whichofthefollowingisthepoor
prognosticfactorforOCD?
a)Magicalthinking
b)Dirtcontamination
c)Pathologicaldoubt
d)Hoarding
CorrectAnswer-B
Ans:B.Dirtcontamination.
OCD-Clinicalfeatures&symptoms:
Contamination?Mostcommonobsession.
Obsessionofcontaminationcompulsiveavoidingofcontaminated
objectsexcessivecleaning-->inabilitytoleavetherehomes(due
togermsfear,shame&disgustfromfeces,urine,dust&germs).
Pathologicaldoubt?2ndmostcommon.
Obsessionofdoubtcompulsivecheckingmostdangerof
violenceforgettingtoturnoffthestove,ornotlockingthe
door,somepatientcantravelbackhomeseveraltimes.
Obsessionofself-doubtfeelingguiltyaboutissues
Intrusivethoughts?3rdmostcommon.
Intrusiveobsessionalthoughtswithoutcompulsion(repetitive
sexualoraggressiveacts,patientsobsessedoftherethoughts,
maythinkthattheysupposetoreportthemtothepoliceorto
makeaconfessiontothepriest.
Symmetry?4thmostcommon.
Needforsymmetryofprecisioncompulsionofslowness,patient
cantakeanhourtoeatamealorshavetheirfaces.

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238.Testbasedontheprincipleofsuspect's
reaction,ifhewitnessesaneventthen
hebehavesinacertainwayis?
a)Narcoanalysis
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
d)Schizophrenia
CorrectAnswer-A
Ans:A.Melancholia

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240.Whichofthefollowingisnottrue
regardingdelusionaldisorder?
a)Heldwithabsoluteconviction
b)Usuallyfalse
c)Notamenabletoreasoning
d)Occursatearlyage
CorrectAnswer-D
Ans:D.Occursatearlyage.
Delusionaldisordermayaccountfor1?2%ofadmissionstoinpatient
psychiatrichospitals.
Ageatonsetrangesfrom18?90years,withameanageof40years

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241.Identifytheconditionshownintheimage
below.
a)Intertrigo
b)Heatrash
c)Eczema
d)Impetigo
CorrectAnswer-A
Ans.A.Intertrigo
ImageshowsIntertrigorashonthebackofa4montholdbaby's
neck.
Intertrigoiscausedbywarmmoistfoldsofskinrepeatedlyrubbing
together.
Theaffectedareamaybecomeblisteredorinfectedwithbacteriaor
fungi.
Intertrigoisacommonconditioninbabiesandistreatedwithnappy

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creamandkeepingtheaffectedareacleananddry.

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242.IdentifytheinfectionfromthechestX-
rayofapatientwithlow-gradefever?
a)ILD
b)Bronchopneumonia
c)MiliaryTB
d)Consolidation
CorrectAnswer-C
Answer-C.MilitaryTB
Miliarytuberculosisisduetohematogenousdisseminationof
tuberclebacilli.
Thisisduetothehematogenousspreadofinfectionandmaybe
seeninbothprimaryandpost-primarydisease.
Atfirst,thechestradiographmaybenormalbutthensmall,discrete
nodules,1-2mmindiameter,becomeapparent,evenlydistributed
throughoutbothlungs.Thesemayenlargeandcoalescebutwith

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adequatetreatment,theyslowlyresolve.
Denseopacitiesoccurwithcalcificationandmetallicdustdisease

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243.Identifytheconditiongiveninthe
image?
a)Atrialfibrillar
b)Atrialflutter
c)Ventriculartachycardia
d)SVT
CorrectAnswer-C
Answer-C(Ventriculartachycardia)
MonomorphicVT
Regularrhythm.
Originatesfromasinglefocuswithintheventricles.
ProducesuniformQRScomplexeswithineachlead--eachQRSis
identical(exceptforfusion/capturebeats).

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244.Apatientpresentedwithhistoryof
diplopiaandrestrictedeyemovements.
AclinicalimageandCTimageisshown
below.Whatwillbethediagnosis?
a)Le-fortfracture
b)Fracturemaxilla
c)Fracturezygomatic
d)Blowoutfracture
CorrectAnswer-D
Answer-D(Blowoutfracture)
Anorbitalblowoutfractureisatraumaticdeformityoftheorbitalfloor
ormedialwall,typicallyresultingfromimpactofabluntobjectlarger
thantheorbitalaperture,oreyesocket.

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245.Identifytheradiologicalprocedure
shownbelow?
a)Bariummealfollowthrough
b)Bariumenema
c)Enteroclysis
d)Proctography
CorrectAnswer-A
Answer-A(Bariummealfollow-through)
*Asmallbowelfollow-throughisasinglecontraststudy(oral
contrast,eitherbariumorwater-solublecontrast).
*ItisoftenperformedafteranupperGIfluoroscopystudy,asthe
contrastcolumnmovesfromthestomachandduodenumtothe
smallbowel.
*Mostsmallbowelcontrastexaminationsperformedasapartofan

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upperGIseries-bariummealandfollow-through.
*Thesmallbowelfollow-throughcanbeusefulforevaluationof:
-strictures
-obstruction
-diverticula
-masses
-extraluminaltethering
-abnormalmotility

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246.Identifytheconditioninthebelow
image?
a)Lacunarinfarct
b)Embolicinfarct
c)Thromboticinfarct
d)Intracerebralhemorrhage
CorrectAnswer-A
Answer-A.Lacunarinfarct
ThisimageshowsaCTscanofalacunarinfarct.
Occlusionofalargerperforatingvesselcausesalacunarinfarct.
Acutely,lacunarinfarctsareoftenroundedwithahazyoutlineand
mayfluctuateinsizeinthesubacutephase--mostoftenenlarging.
Whenmature,however,theybecomesharplydelineated,shrinkin
size--typicallylessthan1.5cmdiameter--andcavity-like.
ThegliotichyperintenserimofamaturelacuneonFLAIR
differentiatesitfromaperivascularspace.
IOCforHyperacuteInfarctMRI[bestsequence?DWI]
Acute/hyperacuteinfarctsshowrestricteddiffusion

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247.Achildwithhistoryoffever,
photosensitivity,rashsparingnasolabial
foldpresentstoOP.Identifythe
condition?
a)SLE
b)Polymorphouslighteruption
c)Discoidlupus
d)Skintuberculosis
CorrectAnswer-A
Ans:A.SLE.
Clinicalpresentation:
Mostcommonrashisphotosensitive,raisederythematous
malarrash.
55-85%developatsomepointindisease
DiscoidLupusErythematosus(DLE):15-30%circular,scaly
hyperpigmentedlesionswitherythematousrim,atrophiccenter
--canbedisfiguring
Mouth/vaginal/nasalulcers
Alopecia:maybediffuseorpatchy.Occurs50%.

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---

248.Patientpresentswithpuritiesofinter
digitsoflefthandasshownintheimage.
Identifythecondition?
a)Sarcoptesscabis
b)Dermatitisherpetiformis
c)Xeroticdermatitis
d)Erythemamultiforme
CorrectAnswer-A
Ans:A.Sarcoptesscabis
Scabiesisanintenselypruriticskinconditioncausedbyinfestation
withthemicroscopicmiteSarcoptesscabiei.
Sarcoptesscabieivarhominis,andistransmittedfrompersonto
personbyskin-to-skincontact.
Sarcoptesscabieimite:

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

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249.Identifythecondition.Thisischildwith
asthmaticmother.
a)Atopicdermatitis
b)SLE
c)Erythema
d)TEN
CorrectAnswer-A
Ans:A.Atopicdermatitis
Atopicdermatitis(eczema)isatypeofinflammationoftheskin
(dermatitis)resultinginitchy,red,swollen,andcrackedskin.
Alsoknownas"atopiceczema".
Longlasting(chronic)&tendstoflareperiodically.
Commoninchildren(canoccuratanyage).
Usuallystartsininfancyorearlychildhood.
Childrenwithfamilyhistoryofatopicdermatitis,asthmaorhayfever
aremorelikelytodevelopatopicdermatitis.

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250.Identifytheconditionshowninthe
image?
a)Sebaceouscyst
b)Alopeciaareta
c)Trichotillomania
d)Tineacapitis
CorrectAnswer-B
Ans:B.Alopeciaareta
Alopeciaareataisanautoimmunedisordercharacterizedby
transient,non-scarringhairlossandpreservationofthehairfollicle.
Hairlosscantakemanyformsrangingfromlossinwell-defined
patchestodiffuseortotalhairloss,whichcanaffectallhairbearing
sites.
Patchyalopeciaaffectingthescalpisthemostcommontype.

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251.Identifytheconditionintheimage?
a)Leukoderma
b)Piebaldism
c)Vitiligo
d)DLE
CorrectAnswer-A
Ans:A.Leukoderma
Leukodermaisaskindiseasethatcauseslossofskinpigmentation
(melanin)thatleadstoskinwhitening.
Thewhitepatchesontheskinaretermedasleukoderma.
Whentheconditiongetssevere,thespotscoveralmostallpartsof
thebodyincludingscalp,faceandthegenitals.

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252.Whichofthefollowingregardingthe
conditiondepictedintheimage?
a)Maybeanindicationofskinmalignancy
b)Hypopigmentation
c)MaybeassociatedwithInsulinresistantdiabetesmellitus
d)Commonlyoccursinleanandthin.
CorrectAnswer-C
Ans:C.MaybeassociatedwithInsulinresistantdiabetesmellitus
Acanthosisnigricansisassociatedwithobesityandinsulin
resistanceinmajorityofthepatients.
Acanthosisisdiffuseepidermalhyperplasia(thickeningoftheskin).
ImpliesincreasedthicknessoftheMalpighianlayer(stratumbasale
andstratumspinosum).
Occursprimarilyinflexuralareasasvelvetyhyperpigmentation.
Commonlyseeninaxilla.
Maybeareflectionofendocrinopathysuchasacromegaly,
cushing'ssyndrome,polycysticovariansyndrome&GIT
malignancy.

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253.Thecausativeorganismforthecondition
depictedinimageis?
a)Staphylococci
b)Candidalinfection
c)Streptococcus
d)Actinomycetes
CorrectAnswer-A
Ans:A.Staphylococcus.
Impetigo:
LesionsofcommonorsuperficialimpetigomaycontaingroupA?-
hemolyticstreptococci,Saureus,orboth.
Mostcommonskininfectioninchildren.
Highlycontagious.
Lesionsinbullous(staphylococcal)impetigo:
CausedbySaureus.
Aresuperficial,thin-walled&bullous.
Onruptures-->resultsinthin,transparent,varnish-likecrust

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appears.
Distinguishedfromstuck-oncrustofcommonimpetigo.
Isdistinctiveappearanceofbullousimpetigo.
Duetolocalactionofepidermolytictoxin(exfoliation).

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254.Identifytheconditionasshown:
a)Brodieabscess
b)Osteoidosteoma
c)Intracorticalhemangioma
d)Chondromyxoidfibroma
CorrectAnswer-A
Answer.A.Brodieabscess
Brodieabscessisanintraosseousabscessrelatedtoafocusof
subacutepyogenicosteomyelitis.
Unfortunately,thereisnoreliablewayradiographicallytoexcludea
focusofosteomyelitis.
Ithasaproteanradiographicappearanceandcanoccuratany
locationandinapatientofanyage.
Itmightormightnotbeexpansile,haveascleroticornonsclerotic
border,orhaveassociatedperiostitis.

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Epidemiology
Typicallythesepresentinchildrenwithunfusedepiphysealplates,
morefrequentlyinboys.
Location
Ithasapredilectionforends(metaphysis)oftubularbones:
1. proximal/distaltibialmetaphysis(mostcommon)
2. carpalandtarsalbones
3. Rarelytraversingtheopengrowthplate;epiphysis(inchildrenand
infants).
Radiographicfeatures
Plainradiograph
lyticlesionofteninanovalconfigurationthatisorientedalongthe
longaxisofthebone
surroundedbyathickdenserimofreactivesclerosisthatfades
imperceptiblyintosurroundingbone
lucenttortuouschannelextendingtowardgrowthplatepriorto
physealclosure(pathognomonic)
periostealnew-boneformation+/-adjacentsoft-tissueswelling

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255.14yroldchildwithNaiveRheumatoid
Arthritispatientasshowninimage.
Whatshouldbethecorrecttreatmentof
givencondition:
a)DMARDwithshortcourseofSteroids
b)OnlyNSAID'S
c)DMARDafterinitial3monthsofNSAID'S
d)MonotherapywithTNFdrugs
CorrectAnswer-A
MonotherapywithTNFdrugs
AnswerA.DMARDwithSteroids
GivenconditionisRheumatoidArthritis

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Rheumatoidarthritis(RA)isachronicautoimmunemultisystemic
inflammatorydiseasewhichaffectsmanyorgansbutpredominantly
attacksthesynovialtissuesandjoints.
Clinicalfeatures:
Itoccursbetweentheageof20to50years.
Womenareaffectedabout3timesmorecommonlythanmen.
Followingpresentationsarecommon:
a)Anacute,symmetricalpolyarthritis:
Painandstiffnessinmultiplejoints(atleastfour)
Symptomsofarticularinflammation.
Thejointsaffectedmostcommonlyarethemetacarpo-phalangeal
joints,particularlythatoftheindexfinger.
Otherjointsaffectedcommonlyare(giveninTable):
Common
?MPjointsofhand
?PIPjointsoffingers
?Wrists,knees,elbows,ankles
?Hipjoint
Lesscommon
?Temporomandibularjoint
?Atlantoaxialjoint
Uncommon
?Facetjointsofcervicalspine
Onexamination:
Swollenboggyjointsasaresultofintra-articulareffusion,synovial
hypertrophyandoedemaoftheperiarticularstructures.
Thejointsmaybedeformed.
DeformitiesinRheumatoidarthritis
Hand
?Ulnardriftofthehand
?Boutonnieredeformity
?Swanneckdeformity
Elbow
?Flexiondeformity
?Early?flexiondeformity
Knee
Late?triple*subluxation
Ankle
?Equinusdeformity
Foot
?Halluxvalgus,Hammertoe,etc.

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Treatmentandprognosis
TreatmentofRAisaimedatimprovingthesymptomsandslowing
diseaseprogression.
Therapyiswithacombinationofcorticosteroids,non-steroidalanti-
inflammatorydrugs(NSAIDs),diseasemodifyinganti-rheumatic
drugs(DMARDs),andTNFantagonists(e.g.etanercept).

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256.In34weeksgestationtheweightofbaby
was3kg.Thechildshowsfollowing
featuresmayindicateassociated
condition?
a)Anemia
b)Diabetes
c)APH
d)None
CorrectAnswer-B
Ans.B.Diabetes
Macrosomiaisthetermusedtodescribealargefetus.
MacrosomiaisassociatedwithGestationaldiabetesandMaternal
obesity
Therecommendeddefinitionisfetal(neonatal)weightexceeding
twostandarddeviationsorabove90thcentilefortheappropriate
normalpopulation.
AccordingtoACOG:birthweightof>4500gmiscalledas
macrosomia.
InIndiancontextBirthweightof>4000gmiscalledasmacrosomia.

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257.

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30yearoldwomanwithcomplaintof
dysmenorrhoea,dyspareuniawithchronic
pelvicpainundergoeshysterectomy.From
thecutsectionofhysterectomyspecimen
belowidentifythecondition.
a)Adenomyosis
b)Fibroids
c)Leiomyoma
d)Endometriosis
CorrectAnswer-A
Ans.A.Adenomyosis
Crosssectionthroughthewallofahysterectomyspecimenofa30-
year-oldwomanwhoreportedchronicpelvicpainandabnormal
uterinebleeding.Theendometrialsurfaceisatthetopoftheimage,
andtheserosaisatthebottom.
Adenomyosisiswherethetissuefromtheliningofwombpenetrates
intothemuscle.

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Adenomyosiscanbediffuseorfocal.theultimatemanagementof
adenomyosisishysterectomy.

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258.Identifythetypeofplacentapraeviaas
showninthepicturebelow?
a)I.
b)II.
c)III.
d)IV.
CorrectAnswer-B
Ans.B.II

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259.Afemalepatientpresentedwith
recurrentUrinarytractinfections.
Imagingshowsthefollowingpicture.
Whatcanbethemostprobable
diagnosis?
a)DuplicationofUreter
b)CongenitalMegaureter
c)Ureterocele
d)UrinaryStones
CorrectAnswer-C

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Ans.C.Ureterocele
Plainradiographshowsnocalcificationalongtheurinarytract.Post
intravenouscontrastradiographshowsdilatationoftheleftdistal
uretershowinga"cobra'shead"appearanceand"radiolucenthalo"
effect.FindingsrepresentintravesicalUreteroceleofleftureter.
Ureterocelerepresentsabnormaldilatationofthedistalureteric
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
CorrectAnswer-B
Answer-B(Gastrinomatriangle)
Explanation-
Thegastrinomatriangle,alsoknownasPassaro'striangle.
Thetriangleisformedbyjoiningthefollowingthreepoints:
superiorly:confluenceofthecysticandcommonbileducts
inferiorly:junctionofthesecondandthirdportionsoftheduodenum
medially:junctionoftheneckandbodyofthepancreas

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261.Identifytheinstrument-
a)Bladeno.15
b)Bladeno.10
c)Bladeno.11
d)Blade12
CorrectAnswer-C
Answer-C(Surgicalblade11)
Explanation-
TheNo.11isalsousedforothersmallincisionsforexamplewhen
insertingalaparoscopicport,veinandarterycentrallines,opening
theaortaandremovingcalcificationsintheaorticormitralvalves.

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262.Identifythetypeofknotintheimage-
a)Grannyknot
b)Surgeon'sknot
c)Reefknot
d)None
CorrectAnswer-A
Answer-A(Granny'sknot)
Thegrannyknotisabindingknot,usedtosecurearopeorline
aroundanobject.

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263.IdentifytheconditionintheECG?
a)Atrialfibrillation
b)Arrhythmia
c)Atrialflutter
d)Cardiomyopathy
CorrectAnswer-C
Answer.C.Atrialflutter
Atrialflutter(AFl)isacardiacdysrhythmiacharacterizedbyrapid
andregulardepolarizationoftheatriathatappearsasasawtooth
patternontheelectrocardiogram(ECG)andiscategorizedintotype
I(typical)andtypeII(atypical)AFl.

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264.Apatientisaknowncaseofacute
pancreatitisdevelopsbreathlessness,
bilateralbasalcrepitationonday4and
chestradiographyasshownintheimage
below.Whatwillbethediagnosis?
a)Bilateralpneumonia
b)ARDS
c)CarcinogenicPE
d)Collapse

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CorrectAnswer-B
Answer-b.ARDS
Acuterespiratorydistresssyndrome(ARDS)istypeof
respiratoryfailurecharacterizedbyrapidonsetofwidespread
inflammationinthelungs.
Bilateralopacitiesonchestimaging(chestradiographorCT)not
explainedbyotherlungpathology(e.g.effusion,lobar/lungcollapse,
ornodule.

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265.Identifytheimagewiththediagnosis?
a)VT
b)PSVT
c)AT
d)Ventricularfibrillation
CorrectAnswer-B
Answer.B.PSVT
Supraventriculartachycardia(SVT).Supraventriculartachycardia
isanabnormallyfastheartbeatthatoriginatessomewhereabovethe
ventricles.It'scausedbyabnormalcircuitryintheheartthatis
usuallypresentatbirthandcreatesaloopofoverlappingsignals.

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266.Apatientcameinemergencywithsevere
abdominalpainpulse112/minuteand
systolicBP80mm/HgwiththechestX-
rayshownbelow.Whatwillbethenext
appropriatesteptobetakenforthe
patient?
a)Exploratorylaprotomy
b)SalineWashofstomach
c)Intercostaltubedrainage
d)None
CorrectAnswer-A
Answer.A.Exploratorylaparotomy
AboveX-rayshowsairunderleftdiaphragm(pneumoperitoneum)
whichindicateshollowviscousperforationwithpartialintrathoracic

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positionedstomach.
Thispatientwillrequireemergencyexploratorylaparotomy.
Thisisoneofthecommonestsurgicalemergencies.

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267.Truestatementaboutgivenconditionof
eyeexcept:
a)Arisefromanypartofconjunctiva
b)CancauseAstigmatism
c)Surgeryistreatmentofchoice
d)UVexposureisriskfactor
CorrectAnswer-A
Answer.A.Arisefromanypartofconjunctiva
GivenconditionisPterygium
Pterygiumisanon-cancerous(non-neoplastic)growthof
conjunctiva.
Characterizedbyawing-shapedfoldofconjunctivauponthecornea
fromeithersidewithintheinterpalpebralfissure.
Pterygiumisalwayssituatedinthepalpebralaperture.
PathologicallyPterygiumisadegenerative&hyperplasticcondition

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ofconjunctiva.
Thesubconjunctivaltissueundergoeselastoticdegeneration&
proliferatesasvascularisedgranulationtissueundertheepithelium,
whichultimatelyencroachesthecornea.
Thecornealepithelium,Bowman'slayer&stromaaredestroyed.
Etiology&Clinicalfeatures
Morecommoninpeoplewithexcessoutdoorexposuretosunlight
(UVrays)dry,heat,highwind&abundanceofdust.
Clinically,presentsasatriangularfoldofconjunctivaencroaching
thecorneaintheareaofpalpebralaperture,usuallyonthenasal
side.
Otherfindingsarestocker'sline(depositionofiron).
Pterygiumisanasymptomaticconditionintheearlystages,except
forcosmeticintolerance.
Visualdisturbanceorcornealastigmatismmayoccur.
Visualdisturbancesareduetoencroachmentofpterygiumon
pupillaryareaorcornealastigmatism.
Occasionallydiplopiamayoccurduetolimitationofocular
movements.
Treatment
Asymptomaticpterygiumwhichisnotprogressiveisbestleftalone.
Surgicalexcisionistheonlysatisfactorytreatment.

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268.Followingtestisusedtodiagnosewhich
ocularconditionasshowninimage:
a)Strabismus
b)Heterophoria
c)BothA&B
d)Noneoftheabove
CorrectAnswer-C
Ans:C.BothA&B
Givenimageiscover-uncovertest
Thecover-uncovertesttodiagnosevarioustypesoftropias,whichis
amedicaltermforstrabismus.
Thesinglecovertestisatestisusedtodetermineifthereisa
heterotropiaortropia,whichismanifeststrabismusormisalignment
thatisalwayspresent.
Thefirsteyeiscoveredforapproximately1-2seconds.Asthiseye
iscovered,theuncoveredeyeisobservedforanyshiftinfixation.

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Thecross-covertestoralternatingcovertestisusuallyemployedto
detectheterophoria.
Oneeyeiscovered,andthenthecoverismovedimmediatelyover
totheothereye.Withheterophoria,whenthecoverismovedtothe
othereye,theeyethathasjustbeenuncoveredcanbeseento
movefromadeviatedpoint.
Thedifferencebetweenheterotropiaandheterophoriacanbeeasily
understoodasfollows.
Withheterotropia,acorrectingmovementoftheeyecanbedetected
alreadybythesimplecovertest;withheterophoria,suchcorrecting
movementonlytakesplaceinthecross-covertest.
Peoplewithheterophoriacancreateandmaintainbinocularfusion
throughvergence,andthecross-covertestpurposelybreaksthis
fusion,makingthelatentmisalignmentvisible.

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269.Namethemanoeuvreshowninthe
image:
a)Brandtdaroff
b)Epley
c)Foster
d)Semont
CorrectAnswer-B
Answer.B.Epley
TheEpleymaneuverisanexerciseyoucandoathometorelieve
dizzinesscausedbybenignparoxysmalpositionalvertigo(BPPV).
BPPViscausedbyaproblemwiththeinnerear.Calciumcrystals
calledcanalithscanendupinthesemicircularcanals.

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270.Identifytheconditionofthegivenimage:
a)Acquiredcholesteatoma
b)Congenitalcholesteatoma
c)Ruptureoftympanicmembrane
d)Keratosisobturans
CorrectAnswer-D
Answer.D.Keratosisobturans
GivenimageisKeratosisobturans,otoscopeview.
Thisisarareconditionoftheearcanalwithageneralisedfailureof
migrationofthenormalcanalskin.
Theskinaccumulatesandtheunderlyingboneisresorbed.
Herethereisadeepwideningoftheearcanalwithexposureofthe
circularannulusattheedgeofthetympanicmembrane(eardrum,
centre).
Thejugularvein(purple)canbeseenthroughtheremainingtissue

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ontheflooroftheearcanal.
Theeardrumisrelativelyunaffectedhere.

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271.CTimageofleftmaxillawithhistoryof
allergicrhinitis?
a)Groundglassappearance
b)Doubledensities
c)Honeycomb
d)OnionPeelAppearance
CorrectAnswer-B
Answer:B.DoubleDensitises
Allergicfungalsinusitisisthemostcommonformoffungal
sinusitisandiscommoninwarmandhumidclimates.Onimaging,it
usuallypresentsasopacificationandexpansionofmultiple
paranasalsinuses,unilaterallyorbilaterally,withcontentthatis
centrallyhyperdenseonCT

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Themajorityofsinusesshownearcompleteopacification.On
unenhancedCT,thesinusesaretypicallyopacifiedbycentrally
(oftenserpiginous7)hyperdensematerialwithaperipheralrimof
hypodensemucosa.
Approximately40%ofpatientsmayhaveeachofthefollowing
features4:
expansionofaninvolvedsinus
remodellingandthinningofthebonesinuswalls
erosionofthesinuswall

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272.Identifytheinstrument:
a)Maddoxrod
b)Maddoxwing
c)Maddoxglass
d)Redglasses
CorrectAnswer-A
AnswerA)Maddoxrod
TheMaddoxrodtestcanbeusedtosubjectivelydetectand
measurealatent,manifest,horizontalorverticalstrabismusfornear
anddistance.
Thetestisbasedontheprincipleofdiplopicprojection
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
c)Malignancy
d)Tracheomalacia
CorrectAnswer-B
-Laryngealpapillomatosis,orrecurrentrespiratorypapillomatosis
(RRP),isthemostfrequentbenigntumorofthelarynx.
-Itiscausedbythehumanpapillomavirus(HPV)types6and11.It
isalsothesecondmostcommoncauseofhoarsenessinchildren.
-Laryngealpapillomasarelocatedprimarilyinthelarynxonthevocal
cordmarginsandepiglottis.
-Tumorsarebenignbutpresentobstructiveproblemsbecauseof
theirlocalizationinthevocalcordsorothersites
-Atpresentation,papillomasareusuallypresentononeorboth

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vocalcordswiththeanteriorcommissure,supraglottis,or
subglottisalsocommonlyaffect

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274.ApatientgivesH/ohoarsenessinvoice
&presentingwithclinicalconditionas
shownintheimage.Identifythelesion:
a)Membranoustonsillitis
b)Folliculartonsillitis
c)Diphtheria
d)Aphthousulcer
CorrectAnswer-C
-Diphtheriaisaseriousbacterialinfectionthatusuallyaffectsthe
mucousmembranesofyournoseandthroat.
-DiphtheriaiscausedbythebacteriumCorynebacterium
diphtheriae.
-Diphtheriasignsandsymptomsusuallybegintwotofivedaysafter
apersonbecomesinfectedandmayinclude:

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Athick,greymembranecoveringyourthroatandtonsils
sorethroatandhoarseness
Swollenglands(enlargedlymphnodes)inyourneck
Difficultybreathingorrapidbreathing
Nasaldischarge
Feverandchills
Malaise.

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275.Apatientpresentedwiththefollowing
pictureofTympanicMembrane.Most
Probablediagnosis(markedwitharrow):
a)TubercularOtitisMedia
b)SyphiliticOtitisMedia
c)Pseudomonasinfection
d)FungalOtitisMedia
CorrectAnswer-A
Answer.A.TubercularOtitisMedia
TuberculousOtitisMediaWhereperforationsaremultipleandare
associatedwithotorrhea,atuberculosisofthemiddleearshouldbe
suspected.
Theseperforationsresultfrombreakingdownoftubercles.
Inthegivenimage,Tympanicmembraneshowingmultiple

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perforations
Infectionreachesthemiddleearthrougheustachiantube.
Theraremodesofinfectionarethroughhematogenousspread
fromtubercularfocusinlung,tonsils,cervicallymphnodes;ordueto
ingestionofinfectedcow'smilk.
Itusuallyaffectschildrenandyoungadults.

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276.Whichmethodisusedtostudythe
followingtimeline?
a)CohortStudy
b)Crosssectionalstudy
c)RandomizedControlTrials
d)InterventionalStudies
CorrectAnswer-A
Ans.A.CohortStudy
TheimagerepresentstheNaturalhistoryofdiseasethatrefersto
theprogressionofadiseaseprocessinanindividualovertime,in
theabsenceoftreatment.
Thetimelineshowsthestateofsusceptibility,exposure,the
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
Gram-positiveculture,Identifythe
image:
a)Streptococcuspneumoniae
b)Staphylococcus
c)Propionibacterium
d)Mycobacterium
CorrectAnswer-A
Answer:A.Streptococcuspneumoniae
Streptococcuspneumoniae(pneumococcus)isaGram-positive
bacteriumthatisresponsibleforthemajorityofcommunity-acquired
pneumonia
S.pneumoniaeisalpha-hemolytic,meaningthatitcanbreakdown
redbloodcellsthroughtheproductionofhydrogenperoxide(H2O2).

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TheproductionofH2O2bythebacterialinfectioncanalsocause
damagetoDNA,andkillcellswithinthelungs.
Pneumococcalpneumoniacausesfeverandchills,coughs,difficulty
breathing,andchestpain.Iftheinfectionspreadstothebrainand
spinalcord,itcancausepneumococcalmeningitis,

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278.12Identifythepicture
a)Herpeszosterpic
b)Smallpox
c)Chickenpox
d)Atopicdermatitis
CorrectAnswer-A
Answer:A.Herpeszosterpic
Shingles,alsoknownasherpeszoster,isaviraldisease
characterizedbyapainfulskinrashwithblistersinalocalizedarea.
Shinglesisduetoareactivationofvaricellazostervirus(VZV)within
aperson'sbody.
ThediseasechickenpoxiscausedbytheinitialinfectionwithVZV.
Oncechickenpoxhasresolved,thevirusmayremaininactivein
nervecells.
Whenitreactivates,ittravelsfromthenervebodytotheendingsin
theskin,producingblisters.Riskfactorsforreactivationincludeold
age,poorimmunefunction.

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---

279.Identifytheimage
a)Malaria
b)Plague
c)Japaneseencephalitis
d)Paragonimus
CorrectAnswer-C
Answer;C.Japaneseencephalitis
Japaneseencephalitis(JE)isaninfectionofthebraincausedbythe
Japaneseencephalitisvirus(JEV).
JEVisgenerallyspreadbymosquitoes,specificallythoseofthe
Culextype.Pigsandwildbirdsserveasareservoirforthevirus.
symptomsmayincludeheadache,vomiting,fever,confusion,and
seizures.

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280.Whatisthecauseofdeathaccordingto
thebelowdeathcertificate
a)BreastCancer
b)Secondaries
c)CerebralHemorrhage
d)AlloftheAbove
CorrectAnswer-D
Ans.D.AlloftheAbove
AlltheThreearecauseofdeathastheyareindescribingthe
sequenceofeventsindeaths.

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281.Identifythebloodgroupingprocess
donehere.
Slidegivenwith:ABnoclumps,
ClumpinginO&Noclumpsincontrol.
Whichgroupdoesthissignify?
a)A-ve
b)B+ve
c)O+ve
d)Rhgroup
CorrectAnswer-D
Ans:D.Rhgroup
*Dantigen?
-Mostimportantbloodgroupantigeninroutinebloodbanking.
-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
d)Septoopticdysplasia
CorrectAnswer-A
AnswerA.Callosaldysgenesis
Givenimageisshowingracingcarsign
Racingcarsign(callosaldysgenesis)
Theracingcarsignreferstowidelyspacedlateralventriclesdueto
agenesisofthecorpuscallosumwithinterveningProbstbundles.
AppearancesonaxialMRIorCTarereminiscentofaFormulaOne
carseenfromabove,withthetyresrepresentedbythewidely-

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spacedfrontalhorns,andthedilatedtrigones(colpocephaly).

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283.Whichnervesuppliestotheareamarked
as`AreaB'intheimage:
a)Ulnarnerve
b)Mediannerve
c)Radialnerve
d)Posteriorinterosseousnerve
CorrectAnswer-C
AnswerC.Radialnerve
Thesuperficialterminalbranchoftheradialnerveispurely
cutaneousandsupplieslateralhalfofthedorsumofthehand,andto
theproximalpartsofthedorsalsurfacesofthethumb,theindex
finger,andlateralhalfofthemiddlefinger.

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284.Whichofthefollowingisnotaboundary
ofgivenimage:
a)Commonhepaticduct
b)Cysticduct
c)Inferiorsurfaceoftheliver.
d)Gallbladder
CorrectAnswer-D
AnswerD.Gallbladder
CALOT'STRIANGLE
*Calot'striangle(cystohepatictriangle)isasmallanatomicalspace
intheabdomen.
*Itislocatedattheportahepatisoftheliver?wherethehepatic
ductsandneurovascularstructuresenter/exittheliver.
*Thebordersareasfollows:
-Medial?commonhepaticduct.
-Inferior?cysticduct.
-Superior?inferiorsurfaceoftheliver.

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*TheabovedifferfromtheoriginaldescriptionofCalot'strianglein
1891?wherethecysticarteryisgivenasthesuperiorborderofthe
triangle.
*Themoderndefinitiongivesamoreconsistentborder(thecystic
arteryhasconsiderablevariationinitsanatomicalcourseand
origin).

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285.Markedareainthegivenimageis
suppliedbywhichdermatome?
a)T8
b)T9
c)T10
d)T11
CorrectAnswer-C
AnswerC.T10
Importantdermatome&anatomicallandmarks
Followingisalistofspinalnervesandpointsthatare
characteristicallybelongingtothedermatomeofeachnerve.
*C2?Atleastonecmlateraltotheoccipitalprotuberanceatthe
baseoftheskull.Alternately,apointatleast3cmbehindtheear.
*C3?Inthesupraclavicularfossa,atthemidclavicularline.

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*C4?Overtheacromioclavicularjoint.
*C5?Onthelateral(radial)sideoftheantecubitalfossa,just
proximallytotheelbow.
*C6?Onthedorsalsurfaceoftheproximalphalanxofthethumb.
*C7?Onthedorsalsurfaceoftheproximalphalanxofthemiddle
finger.
*C8?Onthedorsalsurfaceoftheproximalphalanxofthelittle
finger.
*T1?Onthemedial(ulnar)sideoftheantecubitalfossa,just
proximallytothemedialepicondyleofthehumerus.
*T2?Attheapexoftheaxilla.
*T3?Intersectionofthemidclavicularlineandthethirdintercostal
space
*T4?Intersectionofthemidclavicularlineandthefourthintercostal
space,locatedatthelevelofthenipples.
*T5?Intersectionofthemidclavicularlineandthefifthintercostal
space,horizontallylocatedmidwaybetweenthelevelofthenipples
andthelevelofthexiphoidprocess.
*T6?Intersectionofthemidclavicularlineandthehorizontallevel
ofthexiphoidprocess.
*T7?Intersectionofthemidclavicularlineandthehorizontallevel
atonequarterthedistancebetweenthelevelofthexiphoidprocess
andtheleveloftheumbilicus.
*T8?Intersectionofthemidclavicularlineandthehorizontallevel
atonehalfthedistancebetweenthelevelofthexiphoidprocessand
theleveloftheumbilicus.
*T9?Intersectionofthemidclavicularlineandthehorizontallevel
atthreequartersofthedistancebetweenthelevelofthexiphoid
processandtheleveloftheumbilicus.
*T10?Intersectionofthemidclavicularline,atthehorizontallevel
oftheumbilicus.
*T11?Intersectionofthemidclavicularline,atthehorizontallevel
midwaybetweentheleveloftheumbilicusandtheinguinal
ligament.
*T12?Intersectionofthemidclavicularlineandthemidpointofthe
inguinalligament.
*L1?MidwaybetweenthekeysensorypointsforT12andL2.

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*L2?Ontheanteriormedialthigh,atthemidpointofaline
connectingthemidpointoftheinguinalligamentandthemedial
epicondyleofthefemur.
*L3?Atthemedialepicondyleofthefemur.
*L4?Overthemedialmalleolus.
*L5?Onthedorsumofthefootatthethirdmetatarsophalangeal
joint.
*S1?Onthelateralaspectofthecalcaneus.
*S2?Atthemidpointofthepoplitealfossa.
*S3?Overthetuberosityoftheischiumorinfraglutealfold
*S4andS5?Intheperianalarea,lessthanonecmlateraltothe
mucocutaneouszone

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286.Identifythetypeofthefibremarkedin
theimageofinternalcapsule:
a)Projectionfibres
b)Shortassociationfibres
c)Longassociationfibres
d)Commissuralfibres
CorrectAnswer-A
AnswerA.Projectionfibres
Internalcapsule
Areaofwhitematterinthebrainthatseparatesthecaudatenucleus
andthethalamusfromtheputamenandtheglobuspallidus.
Theinternalcapsulecontainsbothascendinganddescending
axons.
Itconsistsofaxonalfibresthatrunbetweenthecerebralcortexand

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thepyramidsofthemedulla.
Components
TheinternalcapsuleisV-shapedwhencuttransversely
(horizontally).
Whencuthorizontally:
thebendintheViscalledthegenu
Anteriorlimboftheinternalcapsule.
theposteriorlimborcrusposteriusisthepartbehindthegenu,
betweenthethalamusandlenticularnucleus.
theretrolenticularportioniscaudaltothelenticularnucleusand
carriesoptictractsincludingthegeniculocalcarineradiations.
thesublenticularportionisbeneaththelenticularnucleusandare
tractsinvolvedintheauditorypathwayfrommedialgeniculate
nucleustotheprimaryauditorycortex(BrodmannArea41).
Grossmotorstrengthisimpairedwithischemiaoftheinternal
capsule.

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---

287.Identifythestructuremarkedbyared
arrowinthegivenimage:
a)Greatveinofgalen
b)Pinealgland
c)Fornix
d)Falxcerebri
CorrectAnswer-C
AnswerC.Fornix
Thefornixisthemainefferentsystemofthehippocampusandan
importantpartofthelimbicsystem.
Itisoneofthecommissuralfibersconnectingthecerebral
hemispheres.
Grossanatomy
RoughlyC-shaped,thefornixextendsfromthehippocampusto

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themammillarybodiesofthehypothalamusandtheanteriornuclei
ofthethalamus.
Itisacurvilinearbundleofwhitematterfibersthatbeginsasagroup
ofmyelinatedfiberscalledthealveus.
Thealveusjoinstoformthefimbriaofthehippocampus.
Thefimbriaofeachhippocampusthickensandthensplitsofffrom
thehippocampustoformthecrus(leg)ofthefornix.
Thefornixiscomposedoffourparts:
crura:bestseenatthespleniumofthecorpuscallosumatthelevel
ofthesuperiorcolliculusoncoronalimages
commissure:connectsthecrura
body:fromthemergingofthecrura,providesoneoftwomajorpaths
throughwhichthehippocampuscommunicatewitheachother
columns(anteriorpillars):curvesanteriorlyanddivesintothe
hypothalamus(mammillarybodies)

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288.WhatistheNerveSupplyofmarked
structureinthegivenimage:
a)Anteriorinterosseousnerve
b)Posteriorinterosseousnerve
c)Ulnarnerve
d)Mediannerve
CorrectAnswer-D
AnswerD.Mediannerve
Thestructureindicatedisthefirstlumbricalmuscleofthehand.
*Thelumbricalsbelongtotheintrinsicgroupofmuscleswhichact
onthehand.
*Theintrinsicmusclesincludethefollowingmuscles/groups:
-Thenargroup(actonthumb)
-Hypothenargroup(actonlittlefinger)

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-Adductorpollicis
-Lumbricals
-Interosseousmuscles
-Palmarisbrevis
*Alltheintrinsicmusclesofthehand,exceptthethenarmuscles
andthelateraltwolumbricalmuscles,areinnervatedbythedeep
branchoftheulnarnerve.
*Thethenarmusclesandthelateraltwolumbricalmusclesare
innervatedbythemediannerve.
*AusefulmnemonicforrememberingthisisMEATLOAF."MEAT"
referstotheMediannerve,andLOAFreferstothemuscleswhichit
innervates:Lateraltwolumbricals,Opponenspollicis,Abductor
pollicisbrevis,Flexorpollicisbrevis

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289.Identifythemarkedstructureinthe
image:
a)Cerebrum
b)Brainstem
c)Corpuscallosum
d)Cerebellum
CorrectAnswer-D
AnswerD.Cerebellum

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Thecerebellum,whichstandsfor"littlebrain",isastructureofthe
centralnervoussystem.Ithasanimportantroleinmotorcontrol,
withcerebellardysfunctionoftenpresentingwithmotorsigns.
Thecerebellumislocatedatthebackofthebrain,immediately
inferiortotheoccipitalandtemporallobes,andwithintheposterior
cranialfossa.
Itisseparatedfromtheselobesbythetentoriumcerebelli,atough
layerofduramater.
Itliesatthesamelevelofandposteriortothepons,fromwhichitis
separatedbythefourthventricle.

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290.NerveinjuredinFrey'ssyndromeis:
a)AuriculotemporalNerve
b)Greatauricularnerve
c)LingualNerve
d)Inferioralveolarnerve
CorrectAnswer-A
AnswerA.AuriculotemporalNerve
Frey'ssyndrome(alsoknownasBaillargersyndrome,Dupuy's
syndrome,auriculotemporalsyndrome,orFrey-Baillargersyndrome)
isarareneurologicaldisorderresultingfromdamagetoornearthe
parotidglandsresponsibleformakingsaliva,andfromdamageto
theauriculotemporalnerveoftenfromsurgery.

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291.Whichnervepassesthroughthemarked
forameninthegivenimage:
a)Lingualnerve
b)Mandibularnerve
c)Chordatympaninerve
d)Inferioralveolarnerve
CorrectAnswer-D
AnswerD.Inferioralveolarnerve
MarkedareaisMandibularforamen,
Mandibularforamen?openingonthemedialsurfaceoftheramus;
passagewayfortheinferioralveolarnerveandartery,whichsupply
thelowerteeth.

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---

292.Identifythemarkedmuscle`A'inthe
diagram:
a)Brachioradialis
b)Extensorcarpiradialislongus
c)Flexorcarpiradialis
d)Extensorcarpiulnaris
CorrectAnswer-B
AnswerB.Extensorcarpiradialislongus
Theextensorcarpiradialislongusmuscleemergesfromthelateral
epicondyleofthehumerusandthedistalpartofthe
supraepicondylarrim;itstendonentersonthedorsalsideofthe

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baseofmetacarpalII.
Inproximalareas,itisdeeptothebrachioradialismuscle.
Thewristisexpandedandabductedbytheextensorcarpiradialis
longusmuscle.
Nervesupply
Itisinnervatedbytheradialnerve
Action
Extensorandabductorofhandatwrist

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293.Whichofthefollowingnailfindingsis
seenintheconditionshownbelow?
a)Pterygium
b)Pigmentation
c)Pitting
d)Ridges
CorrectAnswer-C
Answer.C.Pitting
Nailpittingmayshowupasshallowordeepholesinyournails.
invalidquestionid

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