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This post was last modified on 30 July 2021

1.Upwardmovementofthethyroidglandis
preventeddueto?
a)Berryligament
b)Pretrachealfascia
c)Sternothyroidmuscle

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d)Thyrohyoidmembrane
CorrectAnswer-B
Ans:B.Pretrachealfascia
Thethyroidglandiscoveredbyathinfibrouscapsule,whichhasan
innerandanouterlayer.Theinnerlayerextrudesintotheglandand

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formstheseptumthatdividesthethyroidtissueintomicroscopic
lobules.
Theouterlayeriscontinuouswiththepretrachealfascia,attaching
theglandtothecricoidandthyroidcartilagesviaathickeningofthe
fasciatoformtheposteriorsuspensoryligamentofthethyroidgland

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alsoknownasBerry'sligament.Thiscausesthethyroidtomoveup
anddownwiththemovementofthesecartilageswhenswallowing
occurs.
Gray'sAnatomy:TheAnatomicalBasisofClinicalPractice,41e
,Pageno470

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2.Thereasonforthelongleftrecurrent
laryngealnerveisduetothepersistenceof
whicharchartery?

a)3rdarch
b)4tharch

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c)5tharch
d)2ndarch
CorrectAnswer-B
Ans:B.4tharch
LeftRLNwindsaroundthearchofaorta

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Archofaortaisderivedfromthe4tharch
LangmansMedicalEmbryology13thedition(Pageno88,239)

3.Ligationofthehepaticarterywillimpair
bloodsupplyin
a)RightgastricandRightgastroepiploicartery

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b)RightgastricandLeftgastricartery
c)Rightgastroepiploicandshortgastricvessels
d)Rightgastricandshortgastricvessels
CorrectAnswer-A
Ans:A.RightgastricandRightgastroepiploicartery

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Therightgastricarteryisabranchofthecommonhepaticartery
Therightgastroepiploicarteryisabranchofthegastroduodenal
arterywhichisabranchofthecommonhepaticartery
Theleftgastricarteryisabranchoftheceliactrunk
Shortgastricvesselsarisefromthesplenicartery

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Gray'sAnatomy:TheAnatomicalBasisofClinicalPractice,41st
Edition(Pagenos1116and1117)


4.Wolffianductremnantinfemaleis
a)PouchofDouglas
b)Uterovesicalpouch

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c)Gartner'scyst
d)Broadligament
CorrectAnswer-C
Ans:C.Gartner'scyst
Gartner'scysts,sometimesincorrectlyreferredtoasvaginal

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inclusioncysts,arethemostcommonbenigncysticlesionsofthe
vagina.
Theyrepresentembryologicalremnantsofthecaudalendofthe
mesonephric(Wolffian)duct.
Gartner'sductsarefoundinabout25%ofadultwomen.Almostone

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percentoftheseductsevolveintoGartner'sductcyst.
Ref:AcaseofGartner'scystofvagina,J.AnesthCritcare
OpenAccess,2017,00259.


5.Nervesupplyoftheextraocularmusclesis
constitutedbyallexcept

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a)Ophthalmicnerve
b)Oculomotornerve
c)Trochlearnerve
d)Abducentnerve
CorrectAnswer-A

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Ans:A.Ophthalmicnerve
Lateralrectusissuppliedby6thcranialnerve(abducentnerve)
Superiorrectusissuppliedby4thcranialnerve(trochlearnerve)
Alloftheremainingextraocularmusclesaresuppliedbythe
oculomotornerve.Theophthalmicnerveisabranchofthe

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trigeminalnerveandispurelysensoryinnature.
BDC7thedition,volume3,pgno.215.

6.Claudicationduetopoplitealfemoral
incompetenceisprimarilyseenin
a)Thigh

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b)Calf
c)Buttocks
d)Feet
CorrectAnswer-B
Ans:B.Calf

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Calf
AortaandCommonIliac-Buttocks
FemoralArtery-Thigh
Superficialfemoralartery-Calfandpoplitealartery
PosteriortibialArtery-Feet

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BDC7thedition,volume2,pageno137.

7.Whichmuscleisparalyzedifthereis
hyperextensionofmetacarpophalangeal
jointandflexionoftheinterphalangeal
joint?

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a)Extensordigitorum
b)Interosseiandlumbricals
c)Adductorpollicis
d)Pronatorquadratusmuscle
CorrectAnswer-B

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Ans:B.Interosseiandlumbricals
Hyperextensionofmetacarpophalangealjointandflexionofthe
interphalangealjointisduetopalsyoflumbricalsandinterossei
muscles.
TheactionofLumbricals:FlexionofMCP,ExtensionofIPjoint

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TheactionofPalmarinterossei:Adductionoffingers
TheactionofDorsalinterossei:Abductionoffingers
Ref:BDC,7thedition,volume1,pgno.163.

8.Tumouroftheuncinateprocessofthe
pancreaswillcompresswhichartery

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a)Portalvein
b)Superiormesentericartery
c)Inferiormesentericartery
d)Commonhepaticartery
CorrectAnswer-B

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Ans:B.Superiormesentericartery
Thesuperiormesentericarterypassesanteriortotheuncinate
process
Posteriorly,theuncinateprocessisrelatedtoaorta.
Ref:BDC,7thedition,vol2,page-328.

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9.Aboymetwithamotorbikeaccident.CT
brainshowsinjurytotheposteriorendof
thesuperiortemporalgyrus.Heislikelyto
sufferfrom

a)Fluentaphasia

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b)Non-fluentaphasia
c)Conductionaphasia
d)Noneoftheabove
CorrectAnswer-A
Ans:A.Fluentaphasia

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Fluentaphasia
LesionsintheposteriorportionoftheleftSTGwereassociatedwith
thelossoftheabilitytocomprehendandproducespokenwords
whicharecalledas"fluentaphasia"
BDC7thedition,volume4,pageno129.

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10.A65-year-oldladypresentswitha
vascularinjurytotheinferiorfrontal
gyrus.Whichfunctionalareawould
mostlybeaffected

a)Visual

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b)Auditoryss
c)Wernicke
d)Motorspeech
CorrectAnswer-D
Ans:D.Motorspeech

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Motorspeechdefectisalsocalledapraxiaofspeech.
InjurytotheBroca'sarea/leftinferiorfrontalgyruscausesmotor
speechdefect.
BDC7thedition,volume4,pageno129.

11.Whereisthehighestoxygen

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concentrationpresentsinfetalcirculation
a)SVC
b)IVC
c)Rightventricle
d)Aorta

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CorrectAnswer-B
Ans:B.IVC
Highlyoxygenatedblood
fromtheplacentaiscarriedtothe
fetusbytheumbilicalvein,whichisshuntedtotheinferiorvena
cava.

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NelsonTextbookofPediatrics20thEdition(Pageno2161)

12.WhenthevalueofV/qisinfinity,it
means?
a)NoO2goesfromalveolitobloodandnoco2goesfromblood
toalveoli

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b)Deadspace
c)ThePO2ofalveolarairis159mmHgandPCO2is40mmHg
d)PartialpressureofO2andCO2areequal
CorrectAnswer-B
Ans:B.Deadspace

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Deadspace
Anareawithventilationbutnoperfusion.
*V/Qundefined,thoughapproachinginfinity.
InterpretationsofV/Qratiovalues:
*Valueis0.8

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-Ventilation-Perfusionmatching
*IfV/Qis>0.8?
-Thismeansmoreventilationthanperfusion.
*IfV/Qis<0.8?
-V/Qmismatch

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Ref:ArvindArorareviewbookofphysiology(p.240-241)

13.Proteoglycanpresentintheglomerular
basementmembraneis?
a)Keratansulphate1
b)Keratansulphate2

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c)Heparansulphate
d)Chondroitinsulphate
CorrectAnswer-C
Ans:c.Heparansulphate
Theglomerularmembrane(orthefiltrationbarrier)isthefiltration

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surfacethroughwhichthefluidisfilteredoutfromtheblood.
Theglomerularmembrane(filtrationbarrier)comprises:
*Theglomerularcapillaryendothelium.
*Thebasementmembrane(basallamina).
*TheBowman'svisceralepithelium(podocytes).

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*Importantconstituentsofglomerularmembraneinclude,
-Laminin
-Type4collagen
-Nidogen
-Proteoglycans-(Heparansulphate)

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Ref:ArvindArorareviewbookofphysiology(p.371-372)

14.35yroldfemalewaswatchingTVforlong
hourswithhandsunderherhead.She
complainsoftinglingsensationoverher
arm.Whichtypeofnervefibersismost

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likelytobeaffected?

a)Fibers
b)B-fibers
c)C-Fibers
d)Sympatheticnervefibers

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CorrectAnswer-A
Ans:A.Fibers
A-
Features:
Functions:

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High
delta Diameter-
Pain-
susceptibleto
1-5

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-"Fast/Epicritic/First"pain. Pressure
Myelination-
-Sincefibersarerelatively
Somemyelination fast
Conduction-5-30 Temperature

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Pressure
Touch
Ref:ArvindArorareviewbookofphysiology(p.58-59)

15.Thereflexinwhichthereisinhibitionof
gastricemptyingwhenthereisacidand

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hypertonicsolutionintheduodenum?

a)Enterogastric
b)Gastroileal
c)Gastrocolic
d)Myenteric

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CorrectAnswer-A
Ans:A.Enterogastric
Theenterogastricreflexisoneofthethreeextrinsicreflexesofthe
gastrointestinaltract,theothertwobeingthegastroilealreflexand
thegastrocolicreflex.

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Theenterogastricreflexisstimulatedbyduodenaldistension.Itcan
alsobestimulatedbyapHof3-4intheduodenumandbyapHof
1.5inthestomach.
Themainneuralinfluenceingastricemptyingisthoughttobe
mediatedviaaninhibitorymechanismreferredtoasthe

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enterogastricreflex.Fats,fattyacids,soaps,proteindigestive
products,acids,andhypertonicsolutionsinthesmallintestineinhibit
motility.
Ref:https://www.gastrojournal.org/article/S0016-5085(75)80295-
2/pdf

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16.Inmultiplesclerosis,slowconductionof
motorandthesensorypathwaysisdue
to?

a)DefectinthenodeofRanvier
b)Lossofmyelinsheath

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c)Leakingofsodiumchannels
d)Leakingcalciumchannels
CorrectAnswer-B
Ans:B.Lossofmyelinsheath
MultipleSclerosis(MS)isadisablingprogressiveneurological

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disorder
ThepathophysiologyofMSresultsindisruptionorlossofaxonal
myelininthecentralnervoussystem(CNS),leadingtotheformation
ofscartissue(sclerosis).
Demyelinationproducesalterationsinsaltatoryconduction,slowed

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conductionvelocity,andapredispositiontoconductionblock
Ref:https://www.physiology.org/doi/pdf/10.1152/japplphysiol.00460.2010

17.Whichofthefollowingclottingfactorinapatienton
Warfarintherapy,wouldhavedecreasedgamma
carboxyglutamateresidue?

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a)Factor2
b)Factor11
c)Tissuefactor
d)Factor5
CorrectAnswer-A

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Ans:A.Factor2
VitaminKisacofactorfortheenzymaticconversionofglutamicacid
(Glu)residuestogamma-carboxyglutamicacid(GLA)invitaminK-
dependentproteins,viatheendoplasmicreticulumresidentvitamin
K-dependentgamma-glutamylcarboxylase.

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Thiscarboxylaseactivityisfoundinessentiallyallmammalian
tissues,anditsreactionproduct,Gla,hasbeenobservedinboth
vertebratesandinvertebrates;bothplayanimportantbiologicalrole
inproteinfunction.
VitaminK?dependentclottingfactordeficiency(VKCFD)isarare

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autosomalrecessivebleedingdisorderthatoftenpresentswith
severehemorrhageduringinfancy.
Arareinheritedformofdefective-carboxylationresultinginthe
earlyonsetofbleedingwasfirstdescribedbyMcMillanandRoberts
in1966andsubsequentlyhasbeentermedvitaminK?dependent

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clottingfactordeficiency
(VKCFD).
CombineddeficiencyofvitaminK?dependentclottingfactorsII,VII,
IX,andX(andproteinsC,S,andZ)isusuallyanacquiredclinical
problem,oftenresultingfromliverdisease,malabsorption,or
warfarinoverdose.

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Patientsplasmashowedlessthan3%activityoffactorsII,VII,IX,
andX.

18.Bloodstoredincitrate-phosphate-dextroseisbetterfor
hypoxicpatientsthanacidic-citrate-dextrosebecause?
a)IthaslessP50

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b)Itislessacidic
c)Thefallin2,3DPGisless
d)Noneoftheabove
CorrectAnswer-C
Ans:C.Thefallin2,3DPGisless

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TheinfusionofACDbloodcausedP50and2,3-DPGconcentration
todecreasesignificantly.
Theinfusionofbloodstoredincitratephosphatedextrose(CPD)did
notsignificantlyincreasetheoxygenaffinity.
Tocompensatefortheincreasedoxygenaffinity,theremustbea

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riseincardiacoutputormorelikelyadecreaseinvenousPO2.
ThetransfusionofCPDblood,therefore,ismorefavorableinterms
ofoxygensupply,particularlyinpatientswhohavehadcardiac
surgery.

19.Whichofthefollowingisreferredtoasthe"Windowofthe

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limbicsystem"?
a)Hypothalamus
b)Amygdala
c)Hippocampus
d)Thalamus

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CorrectAnswer-B
Ans.Bi.e.Amygdala.
*Theamygdalahasbeencalledthe"window"throughwhichthe
limbicsystemseestheplaceofthepersonintheworld.
*Theamygdalareceivesneuronalsignalsfromallportionsofthe

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limbiccortex,aswellasfromtheneocortexofthetemporal,parietal,
andoccipitallobes,especiallyfromtheauditoryandvisual
associationareas.

20.Cerebralbloodflowisregulatedbyall
except:

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a)Bloodpressure
b)ArterialPCO2
c)Potassiumions
d)A&C
CorrectAnswer-D

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Ans.A&C.i.e.Bloodpressure&Potassiumions
Thetotalcerebralbloodflowisheldconstantinfaceofconsiderable
changesinthesystemicbloodpressure(60-150mmHg)".-
Principlesofmedicalphysiology.
"Cerebralbloodflowisnotaffectedoverafairlywidevariationin

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arterialbloodpressure".-RKMarya.
Regulationofcerebralbloodflow:
l)Autoregulation:-Duetotheinherentpropertyofbloodvessels,
explainedbymyogenictheory.
2)Metabolicregulation:CBFvariesdirectlywithmetabolicactivity.

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FactorsaffectingregulationarePCO2,PO2,K+,andadenosine.
AmongthisPCO2isthemostimportantone.
3)Sympatheticinnervation:-Importantonlyincaseswithvery
severeelevationofBBe.g.inverystrenuousexercises.
4)Intracranialpressure:-ByCushingreflex.

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5)Others:Bloodviscosity.

21.Hepcidininhibits?
a)Absorptionofcobalamine
b)Transferofironintoenterocytes
c)Folicacidsynthesis

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d)Respiratoryoxidase
CorrectAnswer-B
Ans.is'b'i.e.,Transferofironintoenterocytes
Hepcidinisanironmetabolismregulatoryhormonethatinhibitsiron
absorption(transferofironintoenterocytes).

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Ascorbicacid(vitaminC)formssolublecomplexeswithiron
andreducesironfromtheferrictotheferrousstate,
therebyenhancingironabsorption.
Tannins,presentintea,forminsolublecomplexeswithiron
andloweritsabsorption.

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22.Whichofthefollowingtechniqueisused
tostudycurrentflowacrossasingleion
channel?

a)Patchclamp

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b)Voltageclamp
c)lontophoresis
d)Galvanometry
CorrectAnswer-A
Ans.a.Patch-clamp

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Patch-clampisatechniquetorecordioncurrentflowthrough
asingleproteinchannel.
Thepatch-clamptechniqueisalaboratorytechniquein
electrophysiology,thatallowsthestudyofsingleormultiple
ionschannelsincells.

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Thetechniquecanbeappliedtoawidevarietyofcellsbutis
especiallyusefulinthestudyofexcitablecellssuchasneurons,
cardiomyocytes,musclefibers,andpancreaticbetacells.
Itcanalsobeappliedtothestudyofbacterialionchannels
especiallypreparedgiantspheroplasts.

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Inthepatch-clampexperiment,asmallpipetteiscarefully
maneuveredtosealoffaportionofacellmembrane.Thepipette
hasanelectrodebathedinanappropriatesolutionthatallowsforthe
recordingofelectricalchangesthroughanyporeinthemembrane.

23.A4-year-oldboyofafirst-degree

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consanguineouscouplewasnotedbythe
parentstohavedarkeningoftheurineto
analmostblackcolorwhenitwasleft
standing.Hehasanormalsibling,and
therearenoothermedicalproblems.

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Growthanddevelopmenttodateare
normal.Whichofthefollowingismost
likelytobeelevatedinthispatient?

a)Methylmalonate
b)Homogentisate

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c)Phenylpyruvate
d)-Ketoisovalerate
CorrectAnswer-B
Ans:B.Homogentisate.
*Alkaptonuriaisararemetabolicdiseaseinvolvingadeficiencyin

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homogentisicacidoxidase,andthesubsequentaccumulationof
homogentisicacidintheurine,whichturnsdarkuponstanding.
*Theelevationof
methylmalonate(duetomethylmalonylCoAmutasedeficiency),
Phenylpyruvate(duetophenylalaninehydroxylasedeficiency),

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-ketoisovalerate(duetobranched-chain-ketoacid
dehydrogenasedeficiency),
Homocysteine(duetocystathionine-synthasedeficiency)
*Alloftheseareinconsistentwithahealthychildwithadarkeningof

theurine.

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*Reflippincott'sIllustratedreviews,5thedition,AminoAcid
DegradationandSynthesis,Pg276.

24.Whichofthefollowingistrueabout
differentstructuresofprotein?
a)Secondarystructureisthethree-dimensionalstructureof

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protein
b)Secondarystructureisstabilizedbydisulfidebonds
c)Primary,secondaryandtertiarystructuresdestroyedduring
denaturation
d)Secondaryandtertiarystructuredependsonthesequenceof

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aminoacids
CorrectAnswer-D
Ans:D.Secondaryandtertiarystructuredependsonthe
sequenceofaminoacids
Explanation

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Proteinsarearrangedinanyofthefollowingfourstructures
viz:
*Primary
Thesequenceofaminoacidsinaproteiniscalledtheprimary
structureoftheprotein.chain

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*Secondary
-Thepolypeptidebackbonedoesnotassumearandomthree-
dimensionalstructure,butinsteadgenerallyformsregular
arrangementsofaminoacidsthatarelocatedneartoeachotherin
thelinearsequence.The-helix,-sheet,and-bend(-turn)are

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examplesofsecondarystructuresfrequentlyencounteredin
proteins.
*Tertiary
-Itreferstothethree-dimensionalarrangementofapolypeptide
chainthathasassumeditssecondarystructure.Disulfidebonds

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betweencysteineresiduesmaystabilizethetertiarystructure.
Proteindenaturationresultsintheunfoldinganddisorganizationof
theprotein'ssecondaryandtertiarystructures,whicharenot
accompaniedbyhydrolysisofpeptidebonds
*Quaternary

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-Thequaternarystructurerequiresmorethanonepolypeptide
chain.Thesechainsassociatethroughnoncovalentinteractions.
Reflippincott'sIllustratedreviews,5thedition,Structureof
Protein,Pg13


25.Theinsulinglucagonratiodecreased.The

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enzymeisactiveatthistime?
a)Glucokinase
b)Hexokinase
c)Phosphofructokinase
d)Glucose6phosphatase

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CorrectAnswer-D
Ans.D.Glucose6phosphatase
Explanation
Lowinsulin:glucagonratio(IGR)stimulatesmobilizationofstored
nutrients,increasesglycogenolysisandgluconeogenesis,and

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promotesthebreakdownofadiposetissueintofreefattyacidsand
glycerol.
DecreasesInsulin/glucagonratioshowsthefastingstage.
Glucokinase,Hexokinase,andphosphofructokinaseareglycolytic.
Onlygluconeogenicisglucose6phosphatase.

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Ref-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801814

26.Ochronosisisduetotheaccumulation
of?
a)Homogentisicacid
b)Homogentisicacid

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c)Xanthurenate
d)Glyoxylate
CorrectAnswer-A
Ans:A.Homogentisicacid
Alkaptonuriaisanautosomalrecessiveconditionduetothe

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deficiencyofhomogentisate1,2dioxidase.Thisresultsinthe
excretionofhomogentisicacidinurine.iscompatiblewithafairly
normallife.
Theonlyabnormalityistheblackeningofurineonstanding.
Homogentisicacidisoxidizedbypolyphenoloxidaseto

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benzoquinoneacetate.Itisthenpolymerizedtoblackcolored
alkaptonbodies.
Bythe3rdor4thdecadeoflife,thepatientmaydevelopochronosis
(depositionofalkaptonbodiesinintervertebraldiscs,cartilagesof
nose,pinnaoftheear).Blackpigmentsaredepositedoverthe

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connectivetissuesincludingjointcavitiestoproducearthritis.
Nospecifictreatmentisrequired.Butminimalproteinintakewith
phenylalaninelessthan500mg/dayisrecommended.
Ref-DMVasudevan-Textbookofbiochemistryformedicalstudents,
6thedn,AromaticAminoAcids,andAminoAcidurias,pg208.

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27.Bilirubininserumcanbemeasuredby
a)VandenBerghreaction
b)Ehrlich'sReaction
c)Schlesinger'sReaction
d)Fouchet'sReaction

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CorrectAnswer-A
Ans:A.VandenBerghreaction
BilirubinismostcommonlydeterminedbythevandenBergh
reaction,inwhichdiazotizedsulfanilicacidreactswithbilirubinto
formredazodipyrroles

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Thesearemeasuredcolorimetrically.Inaqueoussolution,thewater-
soluble,conjugatedbilirubinreactsrapidlywiththereagent(within
oneminute),andissaidtobe"direct-reacting."Theunconjugated
bilirubin,whichismuchlesssolubleinaqueoussolution,reacts
moreslowly.

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However,whenthereactioniscarriedoutinmethanol,both
conjugatedandunconjugatedbilirubinaresolubleandreactwiththe
reagent,providingthetotalbilirubinvalue.The"indirect-reacting"
bilirubin,whichcorrespondstotheunconjugatedbilirubin,is
obtainedbysubtractingthedirect-reactingbilirubinfromthetotal

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bilirubin
Note:Innormalplasma,onlyabout4%ofthetotalbilirubinis
conjugatedordirect-reacting,becausemostaresecretedintobile.
Ref-Lippincott'sIllustratedreviews,5thedition,Conversionofamino
acidsinspecializedproducts,Pg285.

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28.IfasampleofDNAifadenineis28%what
willbetheamountofCytosinepresent
a)23%
b)25%
c)46%

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d)22%
CorrectAnswer-D
Ans:D.22%
ThebasesofonestrandofDNAarepairedwiththebasesofthe
secondstrandsothatadenineisalwayspairedwiththymineand

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cytosineisalwayspairedwithguanine.Therefore,one
polynucleotidechainoftheDNAdoublehelixisalwaysthe
complementoftheother.Giventhesequenceofbasesonone
chain,thesequenceofbasesonthecomplementarychaincanbe
determined.

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Note:ThespecificbasepairinginDNAleadstotheChargaffRule:
InanysampleofdsDNA,theamountofadenineequalstheamount
ofthymine,theamountofguanineequalstheamountofcytosine,
andthetotalamountofpurinesequalsthetotalamountof
pyrimidines.

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Thebasepairsareheldtogetherbyhydrogenbonds:twobetweenA
andTandthreebetweenGandC(Figure29.5).Thesehydrogen
bonds,plusthehydrophobicinteractionsbetweenthestacked
bases,stabilizethestructureofthedoublehelix.
Ref-lippincott'sIllustratedreviews,5thedition,thestructureofDNA,

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pg397

29.Whichofthefollowingvitaminathigher
dosescausescystoidmacularedema-
a)VitA
b)VitD

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c)VitE
d)Niacin
CorrectAnswer-D
Ans:D.Niacin
Cystoidmacularedema(CME)isaconditionthatinvolvesthe

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macula,causingpainlessvisionloss.
Niacin(nicotinicacid,vitaminB3,vitaminPP),onecomponentofthe
dietarysupplementtakenbythepatient,isavitaminpreparation
usuallyusedforthetreatmentoflipiddisorders
Fraunfelderetal.reportedthat3gormoreperdayofnicotinicacid

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couldcausemanyocularsideeffectssuchasblurredvision,eyelid
edema,toxicamblyopia,proptosis,lossofeyelashesoreyebrow,
superficialpunctatekeratitis,andcystoidmacularedema,which
representsthemostseriousocularcomplications.Alltheseadverse
effectsarereversiblewithdiscontinuationofniacintherapy

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Ref-CaseReportsinOphthalmologicalMedicine,Volume2013,
ArticleID713061,5page

30.TruestatementregardingHuntington's
choreais
a)Thereisalossoffunctiontypeofmutation

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b)Itisanautosomalrecessive
c)Itisatrinucleotiderepeatexpansiontypeofdisorder
d)IncreasednumberofCAArepeats
CorrectAnswer-C
Ans:C.Itisatrinucleotiderepeatexpansiontypeofdisorder

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Huntington'schoreaisanautosomaldominantdisorderwithan
increasednumberofCAGrepeats.Clinicallymanifestedas
involuntaryjerkymovements,mooddisturbancesandfinallysevere
dementia.
Ref-Langebiochemistryandgeneticsflashcards,Huntington's

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disease,pg161

31.AdditionofwhichAminoAcidwill
increaseUVabsorption
a)Tryptophan
b)Leucine

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c)Proline
d)Arginine
CorrectAnswer-A
Ans:A.Tryptophan
AminoAcidAbsorbUVLight

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AminoAcidsthatabsorb250-290nm(Maximumat280nm)UVlight
aretryptophan,phenylalanine,tyrosine.
ThemaximumabsorptionofUVlightisbytryptophan.
Asitabsorbsultravioletlightabouttentimesmoreefficientlythan
phenylalanineortyrosine,tryptophanmakesthemajorcontribution

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totheabilityofmostproteinstoabsorblightintheregionof280nm.
TryptophanandtyrosineabsorbUVatapproximately280nrn.
UVabsorptionspectroscopyisutilizedtomeasureprotein
concentration.TheabsorptionspectrumofaproteinintheUV
wavelengthrangeistheresultofabsorptionoflightbythearomatic

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aminoacids(250-320nm),thedisulfidebonds(250-300nm)andthe
carbonylgroupofthepeptidebond(190-210).
Remember
AromaticAminoAcidsabsorbUVLights
Aminoacidsarecolourlessbecausetheydonotabsorbvisible

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light.
Ref-Rebeccajames-selfassessmentandreviewofbiochemistry,
3rdedn,Chemistry,andMetabolismofAminoAcids,Pg7

32.V-RichestsourceofvitaminB12?
a)Meat

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b)Greenleafyvegetables
c)Cornoil
d)Sunfloweroil
CorrectAnswer-A
Ans:A.Meat

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*VitaminB12isnaturallyfoundinanimalproducts,includingfish,
meat,poultry,eggs,milk,andmilkproducts.
*Synonymsarecobalamin,extrinsicfactor(EF)ofCastleandanti
perniciousanemiafactor.VitaminB12iswater-soluble,heatstable
andredincolor.Itissatisfiedbyanyofthefollowinggroups:

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cyanide,hydroxyl,adenosylormethyl.
*Cyanocobalamin-Oralpreparationsareinthisform.
*Hydroxycobalamin-Injectablepreparationsareinthisform.
*Adenosylcobalamin-Thisisthemajorstorageform,seeninthe
liver.

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*Methylcobalamin-Thisisthemajorformseeninbloodcirculation
aswellasinthecytoplasmofcells.
*VitaminB12isgenerallynotpresentinplantfoods,butfortified
breakfastcerealsareareadilyavailablesourceofvitaminB12with
highbioavailabilityforvegetarians.

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*RichsourceofvitaminB12
-Beef,liver,andchicken.
-Fishandshellfishsuchastrout,salmon,tunafish,andclams.
-Fortifiedbreakfastcereal.
-Low-fatmilk,yogurt,andcheese.

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-Eggs.

Ref-DMVasudevan-Textbookofbiochemistryformedical
students,6thedn,Nutrition,pg404.

33.Whichaminoacidisusedtosynthesize
Nitricoxide?

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a)Glycine
b)Arginine
c)Tyrosine
d)Threonine
CorrectAnswer-B

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Ans:B.Arginine
Nitricoxideisformedfromargininebytheenzymenitricoxide
synthase(NOS).Itcontainsheme,FAD,FMN,NADPH,and
tetrahydrobiopterin.
Nitricoxidehasaveryshorthalf-life(3-4seconds).NOcombines

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withoxygentoformNO2.Thesenitritesareexcretedthroughurine.
Reactingwithhemoglobin,NOisconvertedtoNO3;andnitratesare
alsoexcretedintheurine.TheverylowquantityofNOisexpelled
throughthelung.
Arginineisahighlybasic,semi-essentialaminoacid.Itisglucogenic

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innature.

34.TrueAboutNoncompetitiveantagonist-
a)Kmremainssame,Vmaxdecreases
b)Kmremainssame,Vmaxdecreases
c)Kmdecreases,Vmaxincreases

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d)Kmincreases,Vmaxincreases
CorrectAnswer-A
Ans:A.Kmremainssame,Vmaxdecreases
Noncompetitiveinhibitionoccurswhentheinhibitorandsubstrate
bindatdifferentsitesontheenzyme.Thenoncompetitiveinhibitor

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canbindeitherthefreeenzymeortheEScomplex,thereby
preventingthereactionfromoccurring.
EffectonVmax:Noncompetitiveinhibitioncannotbeovercomeby
increasingtheconcentrationofthesubstrate.Thus,noncompetitive
inhibitorsdecreasetheapparentVmaxofthereaction.

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EffectonKm:Noncompetitiveinhibitorsdonotinterferewiththe
bindingofsubstratetoenzyme.Thus,theenzymeshowsthesame
Kminthepresenceorabsenceofthenon-competitiveinhibitor.
EffectonLineweaver-Burkplot:Noncompetitiveinhibitionisreadily
differentiatedfromcompetitiveinhibitionbyplotting1/voversus1/[S]

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andnotingthattheapparentVmaxdecreasesinthepresenceofa
non-competitiveinhibitor,whereasKmisunchanged
Ref-lippincott'sIllustratedreviews,5thedition,InhibitionofEnzyme
Activity,pg61.

35.Wernersyndromeassociatedwith

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prematureagingiscausedduetoadefect
inwhichofthefollowing?

a)Telomerase
b)Caspase
c)DNAtopoisomerase

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d)DNAhelicase
CorrectAnswer-D
Ans:D.DNAhelicase
Wernersyndromeisahumanautosomalrecessivedisorderthat
displayssymptomsofprematureaging,includingearlygrayingand

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thinningofhair,wrinklingandulcerationofskin,atherosclerosis,
osteoporosis,andcataracts.
Inaddition,Wernersyndromepatientsexhibitanincreased
incidenceofdiabetesmellitustype2,hypertension,andarehighly
disposedtotheemergenceofbenignandmalignantneoplasms.

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WernersyndromecausedbymutationoftheWRNgene,amember
oftheRecQDNAhelicasefamily.
Ref-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237395/

36.Whichofthefollowingdietaryfiberis
insolubleinwater?

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a)Pectin
b)Lignin
c)Hemicellulose
d)Cellulose
CorrectAnswer-B

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Ans:B.Lignin
Theunavailableorindigestiblecarbohydratesinthedietarecalled
dietaryfiber.
Dietaryfiberisnecessarytomaintainthenormalmotilityofthe
gastrointestinaltract.Theyarechiefly-

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Cellulose-Retainswaterinfeces,promotesperistalsis,increases
bowelaction
Lignin-Antioxidant,increasesbileacidexcretion,
hypocholesterolemic.
Pectins-PartiallyAbsorbwater,slowsesterifiedgastricemptying,

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bindsbileacids,increasestheirexcretion
Hemi-cellulose-Retainswaterinfeces,cellulose,increasesbileacid
anduronicacidexcretion.
Ref-DMVasudevan-Textbookofbiochemistryformedical
students,6thedn,EnergyMetabolismandNutrition.Pg435.

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37.AccordingtoNCEP-ATPIII,whichamong
thefollowinghavenotbeenincludedin
metabolicsyndrome?

a)HighLDL
b)Hypertriglyceridemia

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c)CentralObesity
d)Hypertension
CorrectAnswer-A
Answer-A.HighLDL
Metabolicsyndromereferstotheco-occurrenceofseveralknown

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cardiovascularriskfactors,includinginsulinresistance,obesity,
atherogenicdyslipidemia,andhypertension.Theseconditionsare
interrelatedandshareunderlyingmediators,mechanisms,and
pathways.
CriteriafortheDiagnosisofMetabolicSyndrome

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Elevatedwaistcircumference:(Formen>90cmandforwomen,>80
cm).
Elevatedtriglycerides:>150mg/dL
ReducedHDL("good")cholesterol:Formen,<40mg/dL;forwomen,
<50mg/dL

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Elevatedbloodpressure:>130/85mmHg
Elevatedfastingglucose:>100mg/dL
Insulinresistance(hyperinsulinemia)
Additionalparametersinclude:coagulationabnormalities,
hyperuricemia,microalbuminurianon-alcoholicsteatohepatitis

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(NASH)andincreasedCRP.
Diagnosisismade,ifany3outofthe5criteriagivenabove.

Ref-DMVasudevan-Textbookofbiochemistryformedical
students,6thedn,Clinical,andAppliedBiochemistry,pg286

38.Whichofthefollowingisthebasisforthe

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intestine-specificexpressionof
apoproteinB-48?

a)DNArearrangementandloss
b)DNArearrangementandloss
c)RNAalternativesplicing

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d)RNAediting
CorrectAnswer-D
Ans:D.RNAediting.
TheproductionofapoB-48intheintestineandapoB-100inliveris
theresultofRNAeditingintheintestine,whereasensecodonis

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changedtoanonsensecodonbypost-transcriptionaldeaminationof
CtoU.DNArearrangementandtransposition,aswellasRNA
interferenceandalternatesplicing,doaltergeneexpression,butare
notthebasisofapoB-48tissue-specificproduction.
Reference-Lippincott'sIllustratedReviews:Biochemistry,5th

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edition,RegulationofGeneExpression,Pg464.

39.A30-year-oldmalecamewithcomplaints
ofswellingaroundthekneejoint.
Histopathologicalexaminationofthe
swellingdemonstratedmanygiantcells

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interspersedwithmononuclearcells.
Whatistheprobablediagnosis

a)Osteosarcoma
b)Ewing'ssarcoma
c)Giantcelltumour

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d)Chondrosarcoma
CorrectAnswer-C
Correctans:C
GCTsarelargeandred-brownandoftenshowcysticdegeneration.
Theyarecomposedofuniformovalmononuclearcellsandscattered

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osteoclast-typegiantcellscontaining100ormorenuclei.
Mitoticfiguresaretypicallyfrequent.
Necrosis,hemorrhage,andreactiveboneformationalsoare
commonlypresent.
RefRobbin'sbasicsofpathology9theditionpageno.781

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40.30yearsoldcamewithcomplaintsofeasy
fatigability,exertionaldyspnea,and
weightloss.Shealsocomplainsof
frequentfalls.physicalexamination
revealedtherewasabilateraldecreasein

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vibrationsense.Herhemoglobinlevels
were8.2g%.Shewastreatedwithfolate.
Heranemiaimprovedbutneurological
symptomsworsened.Whichofthe
followingisthemostprobablereasonfor

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hercondition?

a)Folatenotabsorbed
b)Unmaskedpyridoxinedeficiency
c)DeficiencyoffolatereductaseinCNS
d)FolatetherapycausedrapiduseofVitB12storesaggravating

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symptoms
CorrectAnswer-D
Ans:D.FolatetherapycausedrapiduseofVitB12stores
aggravatingsymptoms
VitaminB12isrequiredfortherecyclingoftetrahydrofolate,theform

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offolatethatisneededforDNAsynthesis.
Inkeepingwiththisrelationship,theanemiaofvitaminB12
deficiencyisreversedwiththeadministrationoffolate.Bycontrast,
folateadministrationdoesnotpreventandmay,infact,worsenthe

neurologicsymptoms

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41.A45-year-oldmanwhoisachronic
smokercametotheclinicwitha
complaintofcough.Thephysician
examinesthepatientandtakesabiopsy,

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thepictureinthebiopsywasasthe
descriptionbelow.Whichofthefollowing
cellularchangeshashappenedtothis
patient?

a)Hyperplasia

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b)Dysplasia
c)Metaplasia
d)CIN3
CorrectAnswer-B
Ans:C.Metaplasia

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Metaplasiaisareversiblechangeinwhichoneadultcelltype
(epithelialormesenchymal)isreplacedbyanotheradultcelltype.

(epithelialormesenchymal)isreplacedbyanotheradultcelltype.
squamousmetaplasiaoftherespiratoryepitheliumoftencoexists
withlungcancerscomposedofmalignantsquamouscells.

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cigarettesmokinginitiallycausessquamousmetaplasia,
Ref:Robbin'sbasicsofpathology9theditionpageno.5

42.A30-year-oldwomanpresentswith
thyroidswelling.Oninvestigations,her
TSHlevelsarefoundtobeelevated.

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Postoperativereportsshowed
lymphocyticinfiltrationandhurthlecells.
Amostprobablediagnosisis?

a)Gravesdisease
b)Hashimoto'sthyroiditis

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c)Follicularcarcinoma
d)Medullarycarcinomathyroid
CorrectAnswer-B
Ans:B.Hashimoto'sthyroiditis
Hashimotothyroiditisisthemostcommoncauseofhypothyroidism

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whichischaracterizedbygradualthyroidfailuresecondarytothe
autoimmunedestructionofthethyroidgland.
Itismostprevalentbetweentheagesof45and65yearsandis
morecommoninwomenthaninmen,ultimatelyleadingtoavarying
degreeoffibrosisandthyroidenlargement.

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ThethyroidusuallyisdiffuselyandsymmetricallyenlargedThecut
surfaceispaleandgray-taninappearance,andthetissueisfirm
andsomewhatfriable.
Microscopicexaminationrevealsthewidespreadinfiltrationofthe
parenchymabyamononuclearinflammatoryinfiltratecontaining

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smalllymphocytes,plasmacells,andwell-developedgerminal
centers
.
Thethyroidfolliclesareatrophicandarelinedinmanyareasby

epithelialcellsdistinguishedbythepresenceofabundant
eosinophilic,granularcytoplasm,termedHurthle,oroxyphilcells.

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43.Whichofthefollowingwillbeseenon
cardiacbiopsyofapatientwhohadapost
MIreperfusioninjury?

a)Wavinessoffibres
b)Eosinophiliccontractionbands

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c)Neutrophilsincardiaccells
d)Swellingofcells
CorrectAnswer-B
Ans:B.Eosinophiliccontractionbands
Microscopically,irreversiblydamagedmyocytessubjectto

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reperfusionshowcontractionbandnecrosis;
Inthispathologicprocess,intenseeosinophilicbandsof
hypercontractedsarcomeresarecreatedbyaninfluxofcalcium
acrossplasmamembranesthatenhancesactin-myosin
interactions.

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44.Lossoffootprocessisclassicalincase
of?
a)Membranousglomerulitis
b)Segmentalglomerulosclerosis
c)IgAnephropathy

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d)Diabeticnephropathy
CorrectAnswer-B
Ans:B.Segmentalglomerulosclerosis
Focalsegmentalglomerulosclerosis(FSGS)ischaracterizedby
sclerosis,hyalinosis,adhesions/synechiaeformation,resultingin

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segmentalobliterationofglomerularcapillaries.OnEM,footprocess
effacementisthepredominantfindingwithoutsignificantbasement
membraneabnormalities.Immunofluorescenceshowsstainingfor
IgMandC3inscleroticareas.Juxtamedullarynephronsareaffected
firstandhenceinadequatesamplingmaymissfocallesions.

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https://www.ncbi.nlm.nih.gov/books/NBK532272/

45.Whichofthefollowingfactorsplaya
majorroleintheinitiationofthrombus
formation?

a)Vasoconstriction

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b)Coagulationcascadeactivation
c)Plateletsactivation
d)Endothelialinjury
CorrectAnswer-D
Ans:D.Endothelialinjury

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Thethreeprimaryabnormalitiesthatleadtothrombusformation
(calledVirchow'striad)are
(1)endothelialinjury,
(2)stasisorturbulentbloodflow,and
(3)hypercoagulabilityoftheblood.

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Ref:
robbins9theditionchapter4

46.A33-year-oldmanpresentswitha5-week
historyofcalfpain,swelling,andlow-
gradefever.Serumlevelsofcreatinine
kinaseareelevated.Amusclebiopsy

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revealsnumerouseosinophilsalsoshe
hadperipheralbloodeosinophilia.Which
ofthefollowinginterleukinsisprimarily
responsiblefortheincreasein
eosinophilsinthispatient?

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a)IL2
b)IL4
c)IL1
d)IL6
CorrectAnswer-B

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Ans:B.IL4

47.WhichofthefollowingistrueaboutPAN?
a)Microscopyshowsfibrinoidnecrosisinlargearteries
b)ANCAispositive
c)30%ofpeoplehaveHbsAgpositive

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d)Patienthavehypogammaglobulinemia
CorrectAnswer-C
Ans:C.30%ofpeoplehaveHbsAgpositive
Polyarteritisnodosa(PAN)isanecrotizingvasculitisinvolvingsmall
andmedium-sizedmusculararteriesofmultipleorgansandtissues.

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Thediseaseoccursmorecommonlyinadultmalesthanfemales.
Mostcommonlyaffectedorgans,indescendingorderoffrequencyof
involvement,arethekidneys,heart,gastrointestinaltract,kidneys,
andmuscle.
Theconditionresultsfromimmunologicresponsetoanidentifiable

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antigenthatmaybebacteria(e.g.streptococci,staphylococci,
mycobacteria),viruses(e.g.hepatitisBvirus,influenzavirus,CMV),
malarialparasite,certaindrugs,andchemicals.
ThereisnoassociationwithANCA,[7]butabout30%ofpeoplewith
PANhavechronichepatitisBanddepositscontainingHBsAg-

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HBsAbcomplexesinaffectedbloodvessels,indicatinganimmune
complex-mediatedcauseinthatsubset.InfectionwiththeHepatitis
CvirusandHIVareoccasionallydiscoveredinpeopleaffectedby
PAN.
Leukocytoclasticvasculitis,characterizedbyfibrinoidnecrosiswith

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neutrophilicinfiltrateinthevesselwall.Manyoftheneutrophilsare
fragmented.Thisformisfoundinvasculitiscausedbydepositsof
immunecomplexes.

48.A23-year-oldmalepresentedwitha
historyoffatigueandtiredness.On

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investigation,hewasfoundtohaveHb
valuesof9gm%,MCVof101FL.
peripheralsmearexaminationshowed
microcyticRBCandhypersegmented
neutrophils.Whichismostprobable

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etiology

a)Leadpoisoning
b)Irondeficiencyanemia
c)Chronicalcoholism
d)Hemolyticanemia

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CorrectAnswer-A
Ans:A.Leadpoisoning
Findings
MicrocyticAnemia-IronDeficiency
HypersegmentedNeutrophils-B12andFolicAcidDeficiency

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Young&NoH/oOfAlcoholConsumption[Patientcamewitha
historyofFatigueandTiredness]-ChronicAlcoholismcanberuled
out
HemolyticAnemia-maydemonstrateredbloodcellfragments
calledschistocytes,redbloodcellsthatlooklikespheres

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(spherocytes),and/orredbloodcellsmissingsmallpieces(bite
cells).Anincreasednumberofnewlymaderedbloodcells
(reticulocytes)mayalsobeasignofbonemarrowcompensationfor
anemia.

anemia.

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SoMostProbableAnswerwouldbeLeadPoisoning[Tiredness&
Fatigue]

49.Whatisthemainfeatureofchemotaxisas
observedinwhitebloodcells?
a)Increasedrandommovementofneutrophils

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b)Increasedadhesivenesstointima
c)Increasedphagocytosis
d)Unidirectionallocomotionofneutrophils
CorrectAnswer-D
Ans:D.Unidirectionallocomotionofneutrophils

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Chemotaxisisdefinedasaunidirectionalmovementofleukocytes
uptoaconcentrationgradientofchemotacticmolecules.All
granulocytes,monocytesandtoalesserextentlymphocytes
respondtochemotacticstimuliwithvaryingratesofspeed.
Chemoattractantsareexogenousorendogenous.Exogenous

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agentsarebacterialproducts.Endogenousmediatorsare:
ComponentsofcomplementpathwayC5a
ProductsoflipoxygenasepathwayLTB4
Cytokinesparticularlythoseofchemokinefamilies.

50.Whichofthefollowinganticancerdrugs

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arecompetitiveinhibitorsoftyrosine
kinase?

a)Imatinibandsunitinib
b)Letrozole
c)Bicalutamide

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d)Fulvestrant
CorrectAnswer-A
Ans.is'a'i.e.,Imatinibandsunitinib
Moleculartargetedagents
Tyrosinekinaseinhibitors

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CompetitiveinhibitorsImatinib,Nilotinib,Sunitinib,Dasatinib,
Erlotinib,Gefitinib,Lapatinib,Sorafenib(Rememberallendwith
'nib').
MonoclonalantibodiesCetuximab,panitumumab.
HER2/neu(ERBB2)inhibitorsMonoclonalantibody-Trastuzumab.

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TargetedantibodyGemtuzumab(antiCD-33),Rituximab(anti-
CD20),Alemtuzumab(antiCD-52).
Vascularendothelialgrowthfactor(VEGF)inhibitorMonoclonal
antibody-Bevacizumab.
ProteosomeinhibitorsBortezomib.

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HistonedeacetylaseinhibitorVorinostat
DNA-methyltransferaseinhibitor5-azacytidine,2-deoxy-5
azacytidine.
All-trans-retinoicacid.
Biologicalresponsemodifier-RecombinantIL-2(aldesleukin,

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denileukin).


51.Whichisnotaprokineticagent?
a)Dopamineantagonist
b)5HT4agonist
c)Macrolides

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d)Diphenylmethane
CorrectAnswer-D
Ans:D.Diphenylmethane
Prokineticdrugs
:
Thesearedrugsthatpromotegastrointestinaltransitandspeed

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gastricemptyingbyenhancingcoordinatedpropulsivemotility.
Thisexcludestraditionalcholinomimeticsandanti-ChEswhich
producetonicandlargelyuncoordinatedcontraction.
Drugsincluded:
Metoclopramide,

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Domperidone,
Cisapride,
Mosapride,
Itopride
Ref:K.D.Tripathi7thEdition.Page663-665

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52.Whichofthefollowingdrugsactby
inhibitingDNAreplication?
a)6Mercaptopurine
b)ActinomycinD
c)MitomycinC

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d)Asparaginase
CorrectAnswer-A
Ans:A.6Mercaptopurine
6-MercaptopurineactsbyinhibitingDNAreplication.
Antimetabolites:

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TheseareanaloguesrelatedtothenormalcomponentsofDNAorof
coenzymesinvolvedinthenucleicacidsynthesis.
Theycompetitivelyinhibittheutilizationofthenormalsubstrateor
getthemselvesincorporatedformingdysfunctionalmacromolecules.
Includes:

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Folateantagonist-Methotrexate(Mtx)
Purineantagonist-6-Mercaptopurine(6-MP)
Pyrimidineantagonist-5-Fluorouracil(5-FU)
Purineantagonists
Mercaptopurine(6-MP)andthioguanine(6-TG).

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Thesearehighlyeffectiveantineoplasticdrugs.
Aftersynthesisinthebodytothecorrespondingmono
ribonucleotides,theyinhibittheconversionofinosine
monophosphatetoadenineandguaninenucleotidesthatarethe
buildingblocksforRNAandDNA.

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Thereisalsofeedbackinhibitionofdenovopurinesynthesis.
TheyalsogetincorporatedintoRNAandDNAwhichare
dysfunctional.

Ref:K.D.Tripathi7thEdition.Page.858,862?863

53.DOCforOnychomycosis?

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a)Terbinafine
b)Fluconazole
c)Nystatin
d)Itraconazole
CorrectAnswer-A

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Ans:A.Terbinafine
Onychomycosis(afungalinfectionofthenail,usuallycausedbya
dermatophyte).
Onychomycosisismoredifficulttotreatthanmostdermatophytosis
becauseoftheinherentslowgrowthofthenail.

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Olderantifungalagents(ketoconazoleandgriseofulvin)are
unsuitableforonychomycosisbecauseoftheirrelativelypoor
efficacyandpotentialadverseeffects.
Threerecentlydevelopedantimycoticagents(fluconazole,
itraconazole,andterbinafine)offerhighcureratesandgoodsafety

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profiles.
Ref:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88888/

54.Theophyllinebywhatmechanismcauses
diuresis?
a)PDE3inhibition

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b)PDE4inhibition
c)Beta2agonistaction
d)AdenosineA1receptorantagonism
CorrectAnswer-D
Ans:D.AdenosineA1receptorantagonism

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Themildlydiureticactionsofbothmethylxanthinesaremainlythe
resultofinhibitionoftubularfluidreabsorptionalongtherenal
proximaltubule.
Basedupontheuseofspecificadenosinereceptorantagonistsand
theobservationofacompletelossofdiuresisinmicewithtargeted

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deletionoftheA1ARgene,transportinhibitionbymethylxanthinesis
mediatedmainlybyantagonismofadenosineA1receptors(A1AR)
intheproximaltubule.
Methylxanthinesareweakrenalvasodilators,andtheyactas
competitiveantagonistsagainstadenosine-inducedpreglomerular

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vasoconstriction.
Caffeineandtheophyllinestimulatethesecretionofreninby
inhibitionofadenosinereceptorsandremovalofthegeneral
inhibitorybrakefunctionofendogenousadenosine.
Sinceenhancedintrarenaladenosinelevelsleadtoreduced

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glomerularfiltrationrateinseveralpathologicalconditions
theophyllinehasbeentestedforitstherapeuticpotentialintherenal
impairmentfollowingtheadministrationofnephrotoxicsubstances
suchasradiocontrastmedia,cisplatin,calcineurininhibitorsor
followingischemia-reperfusioninjury.

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Ref:https://www.ncbi.nlm.nih.gov/pubmed/20859805

55.Whichofthefollowingantimicrobials
shouldnotbegiventoachronic
asthmaticpatientmanagedon
theophyllinetherapy?

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a)Erythromycin
b)Amoxicillin
c)Cefotaxime
d)Cotrimoxazole
CorrectAnswer-A

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Ans:A.Erythromycin
Drugswhichinhibittheophyllinemetabolismandincreaseitsplasma
levelareErythromycin,Ciprofloxacin,Cimetidine,Oral
contraceptives,Allopurinol;
Thedoseshouldbereducedto2/3.

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Ref:K.D.Tripathi7thEdition.Page.226-227

56.DOCofprophylaxisformotionsickness?
a)Promethazine
b)Prochlorperazine
c)Metoclopramide

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d)Itopride
CorrectAnswer-A
Ans:A.Promethazine
Motionsickness:

Antiemeticswiththeanticholinergic-antihistaminepropertyarethe

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firstchoicedrugsformotionsickness.
Antidopaminergicandanti-HT3drugsarelesseffective.
Allanti-motionsicknessdrugsactbetterwhentaken?1hour
beforecommencingthejourney.
Oncesicknesshasstarted,itismoredifficulttocontrol;higher

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doses/parenteraladministrationmaybeneeded.
DrugsIncluded:
Promethazine,diphenhydramine,dimenhydrinate:
Thesedrugsaffordprotectionofmotionsicknessfor4?6hours.
Promethazinetheoclate:

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Thissaltofpromethazinehasbeenspeciallypromotedasan
antiemetic,buttheactiondoesnotappeartobesignificantly
differentfrompromethazineHCl.

57.Whichofthefollowingantihypertensive
drugisavoidedinpatientswithhigh

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serumuricacidlevels?

a)Hydrochlorothiazide
b)Enalapril
c)Prazosin
d)Atenolol

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CorrectAnswer-A
Ans:A.Hydrochlorothiazide
Long-termuseofhigherdosethiazidesinhypertensionhascaused
ariseinblooduratelevels.
Ref:K.D.Tripathi7thEdition.Page.585

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58.Mechanismofresistancetopenicillinsvia
beta-lactamaseis
a)Alteredpenicillin-bindingproteins
b)Drugefflux
c)Breaksdrugstructure

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d)Alterationin50Sribosomestructure
CorrectAnswer-C
Ans:C.Breaksdrugstructure
-lactamasesareproducedbystaphylococci,Haemophilus,
gonococci,etc.whichinactivatepenicillinG.

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The-lactamasesmaybepresentinlowquantitybutstrategically
locatedperiplasmically(asingram-negativebacteria)sothatthe
drugisinactivatedsoonafterentry,ormaybeelaboratedinlarge
quantities(bygram-positivebacteria)todiffuseintothemediumand
destroythedrugbeforeentry.

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Beta-lactamantibioticssharethestructuralfeatureofabeta-lactam
ring.
Thisfeatureisresponsiblefortheinhibitionofbacterialcellwall
synthesis.
Thetargetmoleculesarepeptidoglycancross-linkingenzymes(e.g.

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transpeptidasesandcarboxypeptidases)whichcanbindbeta-lactam
antibiotics(penicillin-bindingproteins,PBP).
Bacterialcelldeathisinitiatedbybeta-lactamantibiotic-triggered
releaseofautolyticenzymes.
Incontrasttogram-positivebacteria(absenceofanouter

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membrane),theantibiotichastopenetratethroughporinsofthe
outermembraneofgram-negativebacteriabeforetouchingPBP's.
Bacterialresistancetobeta-lactamantibioticsincludesmodification

ofporins(permeabilitybarrier)andoftargets(lowaffinityofPBP's
forthedrug),productionofinactivatingenzymes(beta-lactamases)

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andinhibitionofreleaseofautolyticenzymes.
Ref:K.D.Tripathi7thEdition.Page.717?720
ncbi.nlm.nih.gov/pubmed/8314292


59.Apatientonlithiumtherapydeveloped
hypertension.HewasstartedonThiazide

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forhypertension.Afterafewdays,he
developedcoarsetremorsandother
symptomssuggestiveoflithiumtoxicity.
Whatistheprobablemechanismof
interaction?

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a)Thiazideincreasesthetubularreabsorptionoflithium
b)Thiazideinhibitsthemetabolismoflithium
c)Thiazidesactasanaddonthedrugtolithium
d)Alloftheabove
CorrectAnswer-A

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Ans:A.Thiazideincreasesthetubularabsorptionoflithium
DrugInteraction:
Diuretics+Lithium=Decreasedexcretion--riseinLi+level-
toxicity;
Diuretics(thiazide,furosemide)bycausingNa+losstopromote

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proximaltubularreabsorptionofNa+aswellasLi+plasma
levelsoflithiumrise.Potassium-sparingdiureticscausemilderLi+
retention.
Management:Reducedoseoflithiumandmonitorlevel.
Ref:K.D.Tripathi7thEdition.Page.449,932

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60.Whichdrugactsviathetyrosinekinase
receptor?
a)Insulin
b)TSH
c)LH

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d)MSH
CorrectAnswer-A
Ans:A.Insulin
Insulinactsonspecificreceptorslocatedonthecellmembraneof
practicallyeverycell,buttheirdensitydependsonthecelltype:liver

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andfatcellsareveryrich.
Theinsulinreceptorisareceptortyrosinekinase(RTK)whichisa
heterotetramericglycoproteinconsistingof2extracellularand2
transmembranesubunitslinkedtogetherbydisulfidebonds.
Ref:K.D.Tripathi7thEdition.Page.261

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61.Pegloticaseisusedforthetreatmentofan
Ankylosingspondylosis
a)ReactiveArthritis
b)CPPD

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c)Chronictophaceousgout
d)RefractoryRheumatoidarthritis
CorrectAnswer-C
Ans:C.Chronictophaceousgout
Pegloticase:

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Pegloticaseisamedicationforthetreatmentofthesevere,
treatmentofrefractorychronicgout.
Itisathird-linetreatmentinthoseinwhomothertreatmentsarenot
tolerated.
RefGoutandothercrystalarthropathiesbyRobertTerkettaud]

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62.Fluoroquinolonecontraindicatedinliver
diseaseis
a)Levofloxacin
b)Pefloxacin
c)Ofloxacin

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d)Lomefloxacin
CorrectAnswer-B
Ans:B.Pefloxacin
Pefloxacinhaslongert?:accumulatesonrepeateddosing
achievingplasmaconcentrationstwiceashighasafterasingle

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dose.
Becauseofthis,itiseffectiveinmanysystemicinfectionsaswell.
Thedoseofpefloxacinneedstobereducedinliverdisease,butnot
inrenalinsufficiency.
Ref:K.D.Tripathi7thEdition.Page.713

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63.Atahighaltitudeof3000m,aperson
complainsofbreathlessness.Allofthe
followingcanbeusedforthe
managementofthispersonexcept?

a)Intravenousdigoxin

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b)Oxygensupplementation
c)Immediatedescent
d)Acetazolamide
CorrectAnswer-A
Ans:A.Intravenousdigoxin

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ManagementofAMSfollowsthreeaxioms:a)furtherascentshould
beavoideduntilthesymptomshaveresolved,b)patientswithno
responsetomedicaltreatmentshoulddescendtoaloweraltitude
andc)ifandwhenHACOissuspected,patientsshouldurgently
descendtoaloweraltitude.

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Descentandsupplementaryoxygenarethetreatmentsofchoice
andforsevereillness,thecombinationprovidesoptimaltherapy.
Remarkably,adescentofonly500to1000musuallyleadsto
resolutionofacutemountainsicknesswhilehigh-altitudecerebral
edema(HACO)mayrequirefurtherdescent.Simulateddescentwith

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portablehyperbaricchambers,nowcommonlyavailableinremote
locations,arealsoeffective.
Medicaltherapybecomescrucialwhenthedescentisnot
immediatelypossible.
Ref:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923381/#!po=31.2500

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64.ApatientwithdiabetesandCOPD
developedpostoperativeurinary
retention.Whichofthefollowingdrugs
canbeusedforshorttermtreatmentto
relievethesymptomsofthisperson?

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a)Bethanechol
b)Methacholine
c)Terazosin
d)Tamsulosin
CorrectAnswer-A

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Ans:A.Bethanechol
Bethanechol
isapreferreddruginthetreatmentofpostpartum
andpostoperativenonobstructiveurinaryretention,anditalso
cancounteractbladderdysfunctionoftenseenwithphenothiazines
andtricyclicantidepressants.

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Itcanaffordsymptomaticreliefincongenitalmegacolonand
gastroesophagealrefluxbutisrarelyusedforthese.
Ref:https://www.pdr.net/drug-summary/Urecholine-
bethanechol-chloride-801,
K.D.Tripathi7thEdition.Page.104

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65.Drugofchoiceforinvasiveaspergillosis
is
a)Posaconazole
b)Voriconazole
c)LiposomalAMB

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d)Caspofungin
CorrectAnswer-B
Ans:B.Voriconazole
ThepreferredtreatmentofprimaryIAisvoriconazole,whichhas
beenfoundtobesuperiortoamphotericinB.

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Azolesinterferewiththesynthesisofergosterolfoundinthefungal
cellmembrane,whereaspolyenes--suchasamphotericinB--
interferewithergosterolfunction.
Anechinocandinthatdisruptsfungalcellwallsynthesis?
caspofungin--anditraconazolehavebeenapprovedforsalvage

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therapyofIA.
Ref:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200583/

66.Whichofthefollowingdrugsactsby
inhibitingthetranscriptionofDNAto
RNA?

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a)Rifampicin
b)Nitrofurantoin
c)Ciprofloxacin
d)Novobiocin
CorrectAnswer-A

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Ans:A.Rifampicin
OverallinhibitionofRNAsynthesisbyrifampiciniscausedbya
destabilizingeffectonthebindingoftheintermediate
oligonucleotidestotheactiveenzyme-DNAcomplex.
RifampicinitselfcanonlyinteractspecificallywithRNApolymerase

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iftheenzymeisfreeorinabinarycomplexwithDNA.
Ref:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC327649/

67.Apatientwasrecentlystartedon
Fluphenazine.Afewweekslater,he
developedtremors,rigidity,bradykinesia,

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andexcessivesalivation.Thefirstlineof
managementforthispatientis

a)Selegiline
b)Trihexyphenidyl
c)Pramipexole

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d)Amantadine
CorrectAnswer-B
Ans:B.Trihexyphenidyl
*Fluphenazinemayblocktheeffectsofagentsusedtotreat
Parkinson'sdiseasesuchaslevodopa/carbidopa.

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*Trihexyphenidylisanantispasmodicdrugthatexertsadirect
inhibitoryeffectontheparasympatheticnervoussystem.
-Italsohasarelaxingeffectonsmoothmuscle.
-ItisindicatedinallformsofParkinsonism.
*Trihexyphenidylworksasananticholinergicandisusedforthe

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treatmentoftremors,spasms,stiffness,andweakmusclecontrol
seeninpatientswithParkinson'sdisease.
-Itcanalsobeusedforthepreventionortreatmentofsimilar
muscularconditionswhicharecausedbycertaincentralnervous
system(CNS)drugssuchasfluphenazine,haloperidol,

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chlorpromazine.
Ref:https://www.ncbi.nlm.nih.gov/books/NBK519488/,https://www.ncbi.nlm.nih.gov/books/NBK519488/

68.Apersonwasgivenamusclerelaxantthat
competitivelyblocksnicotinicreceptors.
Whichofthefollowingdrugsisusedfor

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reversalofmusclerelaxationafter
surgery?

a)Neostigmine
b)Carbachol
c)Succinylcholine

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d)Physostigmine
CorrectAnswer-A
Ans:A.Neostigmine
Neostigmine
hasbeentraditionallyusedastheagentofchoice
toreverseNeuromuscularBlockade(NMB)aftermuscleparalysis

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duringgeneralanesthesia.
Anticholinesterases(neostigmine)aregenerallyusedtoreversethe
effectsofneuromuscularblockingagents.
Ref:https://www.hindawi.com/journals/cria/2017/8197035/

69.Zero-orderkineticsisotherwiseknownassaturationkinetics.Itisindependent

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of:
a)Plasmaconcentration
b)Clearance
c)Volumeofdistribution
d)Halflife

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CorrectAnswer-A
Ans.A.Plasmaconcentration
Inzero-orderkineticsorsaturationkinetics,eliminationmechanisms
becomesaturatedandunabletoprocessmoredrugswhendrug
concentrationsrise.

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Consequently,fordrugsthatareeliminatedbyzero-order
kinetics,aconstantamountofdrugiseliminatedperunittime
regardlessofdrugplasmaconcentration.


70.Whichofthefollowinganticancerdrugs
arecompetitiveinhibitorsoftyrosine

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kinase?

a)Imatinibandsunitinib
b)Letrozole
c)Bicalutamide
d)Fulvestrant

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CorrectAnswer-A
Ans.is'a'i.e.,Imatinibandsunitinib
Moleculartargetedagents
Tyrosinekinaseinhibitors
CompetitiveinhibitorsImatinib,Nilotinib,Sunitinib,Dasatinib,

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Erlotinib,Gefitinib,Lapatinib,Sorafenib(Rememberallendwith
'nib').
MonoclonalantibodiesCetuximab,panitumumab.
HER2/neu(ERBB2)inhibitorsMonoclonalantibody-Trastuzumab.
TargetedantibodyGemtuzumab(antiCD-33),Rituximab(anti-

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CD20),Alemtuzumab(antiCD-52).
Vascularendothelialgrowthfactor(VEGF)inhibitorMonoclonal
antibody-Bevacizumab.
ProteosomeinhibitorsBortezomib.
HistonedeacetylaseinhibitorVorinostat

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DNA-methyltransferaseinhibitor5-azacytidine,2-deoxy-5
azacytidine
All-trans-retinoicacid.
Biologicalresponsemodifier-RecombinantIL-2(aldesleukin,
denileukin)

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71.Whichofthefollowingisthelawonchild
sexualabuseinIndia?
a)ChildSexualAbusePreventionAct
b)ProtectionOfChildrenfromSexualOffencesAct(POCSO)
c)ChildWelfareAct

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d)SexualOffencesAct
CorrectAnswer-B
Ans:B.POSCOAct
TheProtectionofChildrenfromSexualOffences(POSCO)Act,
2012,2019

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ItisapplicabletothewholeofIndia.
Itdefinesachildasanypersonbelowtheageof18yearsand
providesprotectiontoallchildren
OffencescoveredundertheAct:
PenetrativeSexualAssault

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AggravatedPenetrativeSexualAssault
SexualAssault
AggravatedSexualAssault
SexualHarassmentoftheChild
UseofChildforPornographicPurposes

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72.PunishmentofperjurycomesunderIPC
section?
a)IPC191
b)IPC192
c)IPC193

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

d)IPC197
CorrectAnswer-C
Ans:C.IPC193
Definespunishmentforfabricatingfalseevidence
Thewitnessisliabletobeprosecutedforperjury,andthe

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

imprisonmentmayextenduptosevenyears.
193IPC:punishmentforfalseevidence,(punishmentforperjury):
imprisonmentupto7yearsandalsoliableforfine
I91IPC:Givingfalseevidence(perjury)underoath.
I92IPC:Fabricatingfalseevidence(perjury)

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THEESSENTIALSOFFORENSICMEDICINEANDTOXICOLOGY
-Dr.K.S.NARAYANREDDY33rdedition-pg-13

73.Whencivilnegligenceisbroughtup
againstadoctor,theonusofprooflies
upon-

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

a)Judicialfirst-degreemagistrate
b)Policenotbelowthelevelofsub-inspector
c)Doctor
d)Patient
CorrectAnswer-D

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

Ans:D.Patient
"Generallyspeaking,itisforthepatientinanactionfornegligenceto
establishtheguiltofthedoctor,whoseinnocenceisotherwise
assumed."-Parikh
However,incaseswheretheruleofresipsaloquiturisapplied,the

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

patientneednotprovenegligence.Resipsoloquiturmeansthat"the
thingorfactspeaksforitself."Thepatienthastomerelystatewhat
accordingtohimwastheactofnegligence.
Civilnegligence
Whenapatient(orhisrelative,incaseofpatient'sdeath)filessuitin

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acivilcourttogetcompensationfromhisdoctorfortheinjuryor
deathofthepatientduetodoctor'snegligence.
Adoctorfilesacivilsuittogetfeesfromhispatient,whorefusesto
payallegingnegligence.
Notethat?

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Evenifadoctorisnegligent,apatientisnotentitledtoany
compensationifnodamagehasoccurred.
Anerrorindiagnosisortreatmentisnotnegligenceprovidedproper
careandskillhasbeenexercised.

Contributorynegligenceisnotadefenseincriminal

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negligence.(Contributorynegligenceisanynegligenceonthepart
ofthepatientorhisattendant,whichalongwiththedoctor's
negligence,contributedtotheinjury)
CriminalnegligencecasesaredealtwithunderI.P.C.section304A.

74.Relativesofapatienttoldduring

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

postmortemexaminationthattheperson
hadatattoo-whichwasnowinvisible.
Howtoidentify?

a)ExaminetheLymphnode
b)Spectrophotometer

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c)Ordinarylight
d)X-ray
CorrectAnswer-A
Answer-A-ExaminetheLymphnode
Tattoomarksarepermanentwhendyepenetratesthedermis.

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

Infraredphotographymakesoldtattoosreadilyvisible.
Afadedtattoomarkbecomesvisiblebytheuseofultravioletlamp4
orrubbingthepartandexaminingwithamagnifyinglens.
Marksarerecognizedevenindecomposedbodies(Aret)whenthe
epidermisisremoved.Lymphnodesnearthetattoomarkshow

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pigmentdeposition.

75.TrueabouthymeninChildrapeis-
a)Hymeneasilytearsbecauseitisthin
b)Hymeneasilytearsbecauseitisinthefront
c)Hymenhardlytearsbecauseitishighlyelastic

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

d)Hymenhardlytearsbecauseitissituateddeep
CorrectAnswer-D
Answer-D-Hymenhardlytearsbecauseitissituateddeep
Thehymenmaynotruptureafterrapeif:
Penetrationwasnotfull

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Thehymenistough,fleshyandelastic
Inayoungchild,fullpenetrationmaynotoccur
GautamBiswasReviewofforensicmedicine&Toxicology2/e;pg-
332
https://www.who.int/violence_injury_prevention/resources/publications/en/guidelines_chap7.pdf

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76.Magnan'ssymptomsarerelatedto
a)Cocainepoisoning
b)Cannabis
c)Cannabis
d)Alcohol

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

CorrectAnswer-A
Answer:A.Cocainepoisoning
Magnan'ssignorSymptomisaclinicalsigninwhichpeople
withcocaineaddictionexperienceparaesthesiawhichfeelslikea
constantlymovingforeignbodies,(cocainebugs)suchasfinesand

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

orpowder,undertheskin.Itisthemosttactilehallucination.
Degenerationofthecentralnervoussystemoccurs,andthepatient
maysufferfromhallucinations,convulsions,delirium,andinsanity.
Magnan'ssymptomorcocainebugsischaracteristic,inwhichthere
isafeelingasifgrainsofsandarelyingundertheskinorsome

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smallinsectsarecreepingontheskingivingrisetoitchingsensation
(formication,tactilehallucination)withresultantexcoriation,leading
toirregularscratchesandulcers.
THEESSENTIALSOFFORENSICMEDICINEANDTOXICOLOGY
ByDr.K.S.NARAYANREDDY33/e-pg-603

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77.ParentsoftheChildcomplainsof
assaultedbyoneoftheirrelativesand
analpaininachild,Oninvestigationtest
showsyellowiodinecrystalswithpicric
acid-whatisthenameofthetest?

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

a)Florencetest
b)Barberio'stest
c)Acidphosphatasetest
d)CreatinePhosphokinase
CorrectAnswer-B

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

Answer:B.Barberio'stest
Itdetectsspermin(secretedbytheprostate)andusesanaqueous
oralcoholicsolutionofpicricacid.
Asaturatedaqueousoralcoholicsolutionofpicricacid,whenadded
tothespermaticfluid,producesyellowneedle-shapedrhombic

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

crystalsofsperminepicrate.Thereactionprobablydependsonthe
presenceofprostaticsecretion.
TheAcidPhosphataseTest:Theprostaticsecretionelementof
seminalfluidcontains500to1000timesgreateracidphosphatase
thananyotherbodyfluid.Humanredcells,semenofhigherapes,

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andjuiceofcauliflowerhaveacidphosphataselevelsimilartothatof
humansemen
THEESSENTIALSOFFORENSICMEDICINEANDTOXICOLOGY
ByDr.K.S.NARAYANREDDY33/e-pg-434


78.TheMagistratecandetainthemaximum

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numberofdaysforamentallyillperson
aspermentalhealthcareis

a)30days
b)90days
c)50days

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d)100days
CorrectAnswer-A
Ans:A.30days
*IftheMagistrateissatisfiedthatitisnecessarytodetainthe
allegedmentallyillpersoninapsychiatrichospital,hepassesa

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ReceptionOrder(orderforadmissionanddetention),whichisvalid
for30days.Ifheisnotsatisfied,hemayrefusetheapplication,
givinghisreasonsinwriting,acopyofwhichissuppliedtothe
applicant.
*AdmissionUnderSpecialCircumstance

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-Amentallyillpersonmaynotbeabletoexpresshiswillingness
foradmissionasavoluntarypatient,Suchpersoncanbeadmittedin
apsychiatrichospital(psychiatricnursinghome)foraperiodof90
daysifanapplicationismadebyarelativesandfriends

79.Vectorforzikavirusis-

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a)Aedes
b)Culex
c)Anopheles
d)Noneofthese
CorrectAnswer-A

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

Ans:A.Aedes
Zikavirusdisease
iscausedbytheZikavirus,whichisspreadto
peopleprimarilythroughthebiteofaninfectedmosquito(Aedes
aegyptiandAedesalbopictus).Theviruscanalso
betransmittedthroughsex.

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

Thesearethesamemosquitoesthatspreaddengueand
chikungunyaviruses.
Amosquitogetsinfectedwithaviruswhenitbitesaninfected
personduringtheperiodoftimewhentheviruscanbefoundinthe
person'sblood,typicallyonlythroughthefirstweekofinfection.

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

MedicalMicrobiologyandImmunology14/e-pg;395

80.AllaretrueregardingJapanese
encephalitisexcept?
a)Causedbyflavivirus
b)Humansaredead-endhosts

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c)Transmittedbyculex
d)Cattlesareamplifierhosts
CorrectAnswer-D
Ans.is'd'i.e.,Cattlesareamplifierhosts
Japaneseencephalitis

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CausedbyagroupBarbovirus(flavivirus)
ItisaZoonoticdiseaseieinfectingmainlyanimalsandincidentally
man.
Insouth,epidemicshaveoccuredinKarnataka,Andhrapredesh,
TamilNadu,andKerala.

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Human,cattle,andhorsesaredead-endhostsasthedisease
manifestsasfatalencephalitis.
Pigsactasanamplifyinghostandhaveaveryimportantroleinthe
epidemiologyofthedisease.
Infectioninswineisasymptomatic,exceptinpregnantsows,when

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

abortionandfetalabnormalitiesarecommonsequelae.
ThemostimportantvectorisCulextritaeniorhynchus,whichfeeds
oncattleinpreferencetohumans.
ThenaturalhostsoftheJapaneseencephalitisvirusarebirds,not
humans.

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InNovember2011,theJapaneseencephalitisviruswasreported
inCulexbitaeniorhynchusinSouthKorea

81.Allofthefollowingis/arehaving
superantigenPropertyExcept
a)Vibriocholera

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b)Streptococcalpyrogenic
c)Staphylococcalenterotoxins
d)Noneofthese
CorrectAnswer-A
Answer-A-VibrioCholera

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SAgsareproducedbysomepathogenicvirusesandbacteriamost
likelyasadefensemechanismagainsttheimmunesystem.
Toxicshocksyndrometoxin(TSST-1),epidermolytictoxinandother
staphylococcalenterotoxinaresuperantigens.
ThesesuperantigenscanbindMHCmoleculesoutsidethepeptide-

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bindingcleft.
Consequently,superantigencanactivateupto10%ofT-cellsina
nonspecificmannerwhichinturnleadstothereleaseoflarge
quantitiesofcytokines.
Jawetz27/e-pg-135

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82.TypeAbioterrorismAgent-
a)Chikungunya
b)Anthrax
c)Hendra
d)Influenza

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CorrectAnswer-B
Answer-B-Anthrax
CategoryAagents-consistsoftheagentsthatareconsideredthe
highestrisk
IncludedamongCategoryBagentsisonethatcouldconceivably

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threatenwaterandfoodsafety.
CategoryCincludespathogensthatareconsideredemerging
infectiousdiseasethreatsandwhichcouldbeengineeredformass
dissemination.
CategoryA

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CategoryB
CategoryC
Anthrax
Caliciviruses
AntimicrobialResistance

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Botulism
Chikungunya
Hendra
Dengue
Cholera

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Influenza(highlypathogenicstrains)
Ebola
E.coliO157:H7 MERS
Hantavirus HepatitisA
Nipah

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Lassa
Ricintoxin
Prions
Marburg
Salmonella

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Rabies
Plague
Typhusfever
SARS
Smallpox Yellowfever

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Tick-Borneencephalitis
Tularemia Zika
Tuberculosis
Jawetz27/e-pg-417


83.CulturemediausedforE.coli0157:H7is

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a)SMAC
b)WilsonandBlairmedium
c)PotassiumtelluriteinMcleod'smedium
d)Deoxycholatecitrateagar(DCA)
CorrectAnswer-A

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

Answer-A-SMAC
Anenterohemorrhagicbacterialstrain,E.coliO157:H7infectsthe
alimentarytractandinducesabdominalcrampswithhemorrhagic
diarrhea.TransmissionofE.coliO157:H7occursviathefecal-oral
routeafterconsumptionofcontaminated,undercookedliquidsand

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foods.
MacConkey-SorbitolChromoSelectAgar(SMAC)isrecommended
forselectiveisolationofEscherichiacoli0157:H7fromfoodand
animalfeedingstuffs.
MacConkeySorbitolAgarisbasedontheformulationdescribedby

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

RappaportandHenigh.Themediumcontainssorbitolinsteadof
lactoseanditisrecommendedforthedetectionofenteropathogenic
strainsofE.coli0157:H7whichfermentslactosebutdoesnot
fermentsorbitolandhenceproducecolorlesscolonies.
SorbitolfermentingstrainsofE.coliproducepink-redcolonies.The

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redcolorisduetotheproductionofacidfromsorbitol,absorptionof
neutralredandasubsequentcolourchangeofthedyewhenthepH
ofthemediumfallsbelow6.8.
https://www.sigmaaldrich.com/analytical-
chromatography/microbiology/microbiology-products.html?

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TablePage=18297647

84.DonovanosisisCausedBy-
a)H.ducreyi
b)Leishmaniadonovani
c)K.granulomatis

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d)Treponemapallidum
CorrectAnswer-C
Answer-C-K.Granulomatis
Donovanosisisasexuallytransmittedgenitalulcerdisease.

Thebacteriumthatcausesdonovanosis(Klebsiella

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granulomatis)infectstheskinaroundthegenitals,groinoranal
areaandcausesulcersanddestructionoftheskin.


85.FungalInfectionwhichisacquiredby
traumaticinoculationis?
a)Sporothrix

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b)Blastomycosis
c)Coccidioides
d)Paracoccidioides
CorrectAnswer-A
Answer-A-Sporothrix

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Sporothrixschenckiiisathermallydimorphicfungusthatliveson
vegetation.Itisassociatedwithavarietyofplants,grasses,trees,
sphagnummoss,rosebushes,andotherhorticulturalplants.
TheconidiaorhyphalfragmentsofS.schenckiiareintroducedinto
theskinbytrauma.

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Followingatraumaticintroductionintotheskin,S.schenckiicauses
sporotrichosis,achronicgranulomatousinfection.
Thismanifestationmimicschroniccavitarytuberculosisandtendsto
occurinpatientswithimpairedcell-mediatedimmunity.
Jawetz27/e-pg-670

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86.Whichofthefollowingisnotinvolvedin
urethritis
a)Trichomonas
b)H.ducreyi
c)Chlamydia

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d)Gonococcus
CorrectAnswer-B
Answer-B-H.ducreyi
Bacteriathatcommonlycauseurethritistoinclude:
E.coliandotherbacteriapresentinthestool

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Gonococcus,whichissexuallytransmittedandcausesgonorrhea.
Chlamydiatrachomatis,whichissexuallytransmittedand
causeschlamydia.
Theherpessimplexvirus(HSV-1andHSV-2)canalsocause
urethritis.Trichomonasisanothercauseofurethritis

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-https://www.webmd.com/a-to-z-guides/urethritis-symptoms-
causes-treatments#1;Jawetz27/e-pg-746


87.Apatientcomplainsaboutnausea,
vomitingandstomachcrampsafter
attendingasocialgatheringparty,which

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causativeorganismislikelyresponsible
forFoodPoisoningwithin3hours.

a)Staphylococcusaureus
b)Salmonella
c)Clostridiumbotulinum

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d)Clostridiumperfringens
CorrectAnswer-A
Answer-A-Staphylococcusaureus
Staphfoodpoisoningischaracterizedbyasuddenstartofnausea,
vomiting,andstomachcramps.Mostpeoplealsohavediarrhea.

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Symptomsusuallydevelopwithin30minutesto6hoursaftereating
ordrinkinganitemcontainingStaphtoxinandlastnolongerthan1
day.Severeillnessisrare.
Theillnesscannotbepassedfromonepersontoanother.
https://www.cdc.gov/foodsafety/diseases/staphylococcal.html

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88.A46-year-oldwomanwithHIVcomplains
severepersistentdiarrhea,Histological
Investigationwasperformed,Identifythe
organismcausingdiarrheainHIVPatient.

a)Cryptosporidium

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b)Staphylococcusaureus
c)Salmonella
d)Clostridiumbotulinum
CorrectAnswer-A
Answer-A-Cryptosporidium

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*TheoriginofinfectiousdiarrheainpatientswithAIDScanbe
dividedinto2generalcategories:thatcausedbycommon
pathogensandthatcausedbyopportunisticpathogens.
*ThemostcommoninfectiousorganismscausingAIDS-related
diarrheainclude

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-Cytomegalovirus(CMV)
-TheparasitesCryptosporidium,
-Microsporidia
-Giardialamblia
*AndthebacteriumMycobacteriumavium-intracellulare(MAC).

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*Otherbacteriaandparasitesthatcausediarrhealsymptomsin
otherwisehealthypeoplemaycausemoresevere,prolongedor
recurrentdiarrheainpeoplewithHIVorAIDS
https://aidsinfo.nih.gov/news/175/aids-related-diarrhea

89.OrganismCausingLGV

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a)Chlamydiatrachomatis
b)Neisseriagonorrhoeae
c)Treponemapallidum
d)Haemophilusducreyi
CorrectAnswer-A

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

Answer-A-Chlamydiatrachomatis
Lymphogranulomavenereum(LGV)isalong-term(chronic)
infectionofthelymphaticsystem.
Itiscausedbyanyofthe3differenttypes(serovars)ofthe
bacteriaChlamydiatrachomatis.

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Thebacteriaarespreadbysexualcontact.Theinfectionisnot
causedbythesamebacteriathatcausegenitalchlamydia.
Chlamydiatrachomatiscauseseye(conjunctivitis,trachoma),
respiratory(pneumonia),andgenitaltract(urethritis,
lymphogranulomavenereum)infections.

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DiagnosismadewiththenucleicacidtestforC.trachomatis,LGV
serovarsdiagnosedserologically.
LangeReviewofMedicalMicrobiology&Immunology14/e208

90.Whichinterleukinresponsiblefor
producingIgEfromBcells

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a)IL1
b)IL3
c)IL4
d)BothB&C
CorrectAnswer-C

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Answer-C,IL4
IgEisproducedbyplasmacellslocatedinlymphnodesdrainingthe
siteofantigenentryorlocally,atthesitesofallergicreactions,by
plasmacellsderivedfromgerminalcentersdevelopingwithinthe
inflamedtissue.

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IgEantibodyproductionrequiresTH2cellsthatproduceinterleukin-4
(IL-4)andIL-13anditcanbeinhibitedbyTH1cellsthatproduce
interferon-(IFN-).
https://www.ncbi.nlm.nih.gov/books/NBK27117/

91.HbsAgisbasedonwhichprinciple

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

a)Immunochromatographyassays
b)Chemiluminescence
c)ELISA
d)Immunofluorescence
CorrectAnswer-A

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

Answer-A-Immunochromatographyassays
HBVchroniccarriersarethoseinwhomHBsAgpersistsformore
than6monthsinthepresenceofHBeAgoranti-HBe.HBsAgmay
persistforyearsafterthelossofHBeAg.Themostusefuldetection
methodsareenzyme-linkedImmunosorbentassayforHBV

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antigensandantibodiesandPCRforviralDNA-Jawetz27/epg-
504
Serologicalassaysdetectthehostimmuneresponse(antibodiesto
HCV)oraviralantigen(HBsAg,HCVcAg).Theyarebasedonthe
immunoassayprincipleandareavailableintheformofrapid

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diagnostictests(RDTs)orlaboratory-basedenzymeimmunoassays
(EIAs),chemiluminescenceimmunoassays(CLIAs)and
electrochemiluminescenceimmunoassays(ECLs).-
https://www.ncbi.nlm.nih.gov/books/NBK442281/


92.NosocomialInfectionoccurswithin?

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a)A-48
b)B.72
c)C.24
d)D.50
CorrectAnswer-A

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

Answer-A-48hours
Ahospital-acquiredinfection(HAI),alsoknownasanosocomial
infection,isaninfectionthatisacquiredinahospitalorotherhealth
carefacility.
Nosocomialinfectionscanbedefinedasthoseoccurringwithin48

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hoursofhospitaladmissionorwithin3daysofdischargeor30days
ofoperation.
Somewellknownnosocomialinfectionsinclude:
ventilator-associatedpneumonia,
Methicillin-resistantStaphylococcusaureus,

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Candidaalbicans,
Acinetobacterbaumannii,
Clostridiumdifficile,
Tuberculosis,
Urinarytractinfection,Vancomycin-resistantEnterococcus,and

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Legionnaires'disease.
https://www.ncbi.nlm.nih.gov/books/NBK441857/

93.Whichofthefollowingcellcomponents
producedbyNeisseriagonorrhoeaeis
responsibleforattachmenttohostcells?

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

a)Lipooligosaccharide
b)Pili(fimbriae)
c)IgA1protease
d)Outermembraneporinprotein
CorrectAnswer-B

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

Answer-B-Pili(fimbriae)
Piliarehair-likeappendagesthatextenduptoseveralmicrometers
fromthegonococcalsurface.Theyenhanceattachmenttohostcells
andresistancetophagocytosis.Theyaremadeupofstackedpilin
proteins.

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Theaminoterminalofthepilinmolecule,whichcontainsahigh
percentageofhydrophobicaminoacids,isconserved.Theamino
acidsequencenearthemidportionofthemoleculealsois
conserved;thisportionofthemoleculeservesinanattachmentto
hostcellsandislessprominentintheimmuneresponse.

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Theaminoacidsequencenearthecarboxyl-terminalishighly
variable;thisportionofthemoleculeismostprominentinthe
immuneresponse.ThepilinsofalmostallstrainsofN.gonorrhea
areantigenicallydifferent,andasinglestraincanmakemany
antigenicallydistinctformsofpilin

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Jawetz27/e-pg-282

94.Wherewillyouputchemicalliquid
biomedicalwaste
a)White
b)Yellow

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c)Blue
d)Red
CorrectAnswer-B
Ans.Byellow
Chemicalwasteiscategorizedintotheyellowcategory.the

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hazardouschemicalandcytotoxicwasteisayellowcategorywitha
specialsignof"CYTOTOXIC"waste.
Anotherliquidwasteasbodysecretionsiscategorizedintothe
yellowcategoryofbiomedicalwasteguidelines,2016
Park'sPSM24thed.Pageno.831

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


95.Maximumworkhoursforaperson
includingovertimeunderthefactoriesact:
a)48
b)50
c)60

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d)100
CorrectAnswer-C
Ans:C.60hours.
Factoriesactpermitsworkfor48hoursperweekwith2hoursof
overtimeeveryday.

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makingitapproximately60hoursofmaximumworkasperthe
factoriesactofIndia
Park'sPSM24thed.Pageno.852

96.Thevaccinetobegivenafterdisaster
a)vaccinationagainsttyphoid

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

b)vaccinationagainstcholera
c)vaccinationagainsttyphoidandcholera
d)vaccinationagainsttetanus
CorrectAnswer-D
Ans.D.vaccinationagainsttetanus.

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

Themajorconcernforanyoneexposedtounsanitaryconditionsis
thattheyshouldbeuptodatewiththetetanus-containingvaccine
becauseiftheyareinjured(asiscommonindisastersettings)the
injuryislikelytobecontaminated.
Routinelyrecommendedvaccinesarerecommendedforevacuees,

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justliketheyareforeveryoneelse.
Choleraandtyphoidvaccinedonothaveanyevidenceformass
vaccinationduetothelowlevelofexposureandprevention
TetanusandHepBvaccineisrequired.

97.WhatistheMONICAproject?

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a)Multinationalmonitoringoftrendsanddeterminantsin
CardiovascularDisease
b)Multinationaloftrendsanddeterminantsincerebrovascular
disease
c)Multinationalmonitoringoftrendsanddeterminantsindiabetes

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

d)Multinationalmonitoringoftrendsanddeterminantsin
congenitalheartdisease
CorrectAnswer-A
Ans:A.Multinationalmonitoringoftrendsanddeterminantsin
CardiovascularDisease

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

TheWHOhascompletedaprojectknownasMONICA"
(multinationalmonitoringoftrendsanddeterminantsin
cardiovasculardiseases)"toelucidatethisissue.
Forty-onecentersin26countrieswereparticipatinginthisproject,
whichwasplannedtocontinuefora10yearperiodendingin1994.

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

Park'sPSM24thed.Pageno.385

98.Extendedsicknessbenefitfor
tuberculosisundertheESIActis:
a)91days
b)1-year

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

c)2years
d)4years
CorrectAnswer-C
Ans.C.2years
EXTENDEDSICKNESSBENEFIT:
Inadditionto91daysof

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sicknessbenefitinsuredpersonssufferingfromcertainlong-term
diseasesareentitledtoExtendedSicknessBenefitasshownbelow,
foramaximumperiodoftwoyears.
ExtendedSicknessBenefitwitheffectfrom1.1.2000ispayable,in
thecasewheretheinsuredpersonhasbeenincontinuous

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

employmentfor2yearsTuberculosis
Park'sPSM24thed.Pageno.854

99.Apersonreports4hoursafterhavinga
cleanwoundwithoutlaceration.Hehad
takenTT10yearsbefore.thenextstepin

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

managementis:

a)FullcourseTetanusvaccinetobegiven
b)FulldoseTTwithTIG
c)Single-doseTT
d)Noneedforanyvaccine

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

CorrectAnswer-C
Ans.C.Single-doseTT
Apatientwithwoundlessthan6hoursoldifclean,non-penetrating
andwithnegligibletissuedamageifhadacompletecourseoftoxoid
oraboosterdosemorethan10yearsago(categoryC)shouldbe

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

treatedwithToxoid1dose.
Park'sPSM24thed.Pageno.331

100.RecentInfluenzaPandemicwasdueto:
a)H1N1
b)H5N1

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c)H7N7
d)H3N2
CorrectAnswer-A
Ans.A.H1N1
H1N1?swineflu?causethemajorfluPandemic(1918and2009)

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H5N1?avianinfluenza.maycausesporadicoutbreaksor
epidemics.Itisassociatedwithhighmortality.

101.MissionIndradhanushisfor:
a)Non-communicablediseases
b)Universalimmunization

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

c)Familyplanning
d)Safewaterandsanitation
CorrectAnswer-B
Ans.B.Universalimmunization
TheMinistryofHealth&FamilyWelfarehaslaunched"Mission

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

IndraDhanush",depictingsevencoloursoftherainbowinDecember
2014,tofullyimmunizemorethan89lakhchildrenwhoareeither
unvaccinatedorpartiallyvaccinated;thosethathavenotbeen
coveredduringtheroundsofroutineimmunizationforvarious
reasons.

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

Theywillbefullyimmunizedagainstsevenlife-threateningvaccine-
preventablediseaseswhichincludediphtheria,whoopingcough,
tetanus,polio,tuberculosis,measles,andhepatitis-B.
Inaddition,vaccinationagainstJapaneseEncephalitisand
HaemophilusinfluenzatypeBwillbeprovidedinselected

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districts/statesofthecountry.
Pregnantwomenwillalsobeimmunizedagainsttetanus.
Ref.Park'sPSM24thed.Page462

102.Astudyhadanormaldistributionwith
themedianvalueas200andstandard

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deviation20.68%willfallbetween

a)160-240
b)170-230
c)180-220
d)190-210

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

CorrectAnswer-C
Ans.C.180-220
Asthemedianvalueis200andthestandarddeviationis20,the
normaldistributionis:
68%ofthepopulationwillhavevaluesbetween?median+/-1SD=

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

220+/-20=180-220
95%ofthepopulationwillhavevaluesbetween?median+/-2SD=
220+/-40=160-240
Note:intheMCQ,asthedatashowsanormaldistribution,the
medianwillbeequaltomeanandthemode.

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

Park'sPSMEd.24thpageno.885

103.Whichofthefollowingisa
technique/methodbasedonbehavioural
sciences

a)Managementbyobjectives

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

b)Networkanalysis
c)Systemsanalysis
d)Decisionmaking
CorrectAnswer-A
Ans.A.Managementbyobjectives

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

Themethodsbasedonbehaviouralsciencesinclude
organizationaldesign
personalmanagement
Managementbyobjectives
informationsystems

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

communication
TheQuantitativemethodsinclude:
cost-benefitanalysis
cost-effectiveanalysis
input-outputanalysis

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networkanalysisasPERTandCPM
Planningprogrammingbudgetingsystems
decisionmaking
Ref:Park's25ed,PAgeno.934

104.Asperthesustainabledevelopment

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

goals,ThetargetforMMRistoachieve
maternaldeathsof

a)<70/Laclivebirths
b)<100/laclivebirths
c)<7/1000livebirths

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d)<10/1000livebirths
CorrectAnswer-A
Ans:A.<70/Laclivebirths
By2030,reducetheglobalmaternalmortalityratiotolessthan70
per100,000livebirths.

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

Park'sPSM24thed.Pageno.28Table:4

105.Thebestmethodforroutinemonitoring
ofairpollution
a)Sulphurdioxide,smoke,andparticulatematter
b)Sulphurdioxide,Hydrogensulphide,carbonmonoxide

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

c)Carbondioxide,hydrogensulphide,lead
d)Sulphurdioxide,Leadandparticulatematter
CorrectAnswer-D
Ans.DSulphurdioxide,Leadandparticulatematter
Airqualityindexconsistsof:

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

Particulatematter(lessthan2.5micrometersand10micrometer?
PM2.5andPM10)
Nitrogendioxide(NO2)
Sulphurdioxide(SO2)
Carbonmonoxide(CO)

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

Ozone(O3)
Ammonia(NH3)
Lead(Pb)
Reference:https://pib.gov.in/newsite/PrintRelease.aspx?
relid=110654

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


106.Thevariationindataiscomparedwith
anotherdatasetby:
a)Variance
b)Coefficientofvariation
c)Thestandarderrorofmean

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

d)Standarddeviation
CorrectAnswer-B
Ans.B.Coefficientofvariation
Variance:IsthesquareofSDwhichtellsaboutthestandard
deviation

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

Coefficientofvariation:Itmayhelpbycomparingthevariationsin
thedataset
Thestandarderrorofthemean:Itistocomparethemeansofthe
datasetswhichhaveadifferentsamplesize,centraltendency,and
standarddeviations

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

Standarddeviation:Itisthedeviationofvaluesfromthemean
Ref.FundamentalsofBiostatistics-7thEdition(Pg20,21)

107.Inwhichofthefollowingmethodsof
managementisthebenefitmeasuredin
naturalunits?

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

a)Programbudgetingsystem
b)Networkanalysis
c)Cost-effectiveanalysis
d)Cost-benefitanalysis
CorrectAnswer-C

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

Ans.C.Cost-effectiveAnalysis
Incost-effectiveanalysis(CEA),benefitsaremeasuredinnatural
unitsoftheoutcomesoftheprograms(life-yearsgained,cases
prevented,etc.)andthecostsaremeasuredinmonetaryunits.
ThemostcomprehensiveindicatorofCEAisQuality-AdjustedLife

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

Years(QALYs).
Park'sPSM24thed.Pageno.908


108.Thedifferencebetweentheincidencein
theexposedandnon-exposedgroupis

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bestgivenby:

a)Relativerisk
b)Attributablerisk
c)Populationattributablerisk
d)Oddsratio

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

CorrectAnswer-B
Ans.BAttributableRisk
AttributableRisk
AttributableRiskisthedifferenceinincidenceratesorproportionsof
diseaseordeathbetweenanexposedandnon-exposedgroup.

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Itisexpressedinpercentageandgivestheextenttowhichthe
diseasecanbeattributedtotheexposureinacohortstudy.
Reference:Park25thEdition,pageno:86


109.Ifonevariableisgiventhenyoucanfind
anothervariableby

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a)Coefficientofvariation
b)Coefficientofcorrelation
c)Coefficientofregression
d)Coefficientofdetermination
CorrectAnswer-C

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Ans.C.Coefficientofregression
Thecoefficientofcorrelationtellsaboutthestrengthofassociation
butnotaboutquantity.Ontheotherhand,thecoefficientof
regressionisusedforquantification.
Ifwewishtoknowinanindividualcasethevalueofonevariable,

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knowingthevalueoftheother,wecalculatewhatisknownasthe
regressioncoefficientofonemeasurementtotheother.Itis
customarytodenotetheindependentvariablebyxandthe
dependentvariablebyy.

110.Prospectivescreeningisdoneincase

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of?
a)Neonateforthyroiddiseases
b)Immigrantscreening
c)Papsmearfor45-yearfemale
d)Diabetesmellitusfor40-yearmale

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CorrectAnswer-B
Ans.B.ImmigrantScreening
Screeningofimmigrantstoacountryisanexampleofprospective
screening.
Prospectivescreening:

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Peoplescreenedforothersbenefit
Theessentialpurposeiscasedetection
Requestedforscreeningfordiseasecontrol;specificrequestfrom
theauthority

111.Aresearcherwantedtoprovethe

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relationbetweenCOPDandsmoking.He
collectedpatientsrecordsfrom
governmenthospitalsandrecordsof
cigarettesalesfromthefinanceand
taxationdepartment.Thisisanexample

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ofwhichstudydesign:

a)Cross-sectional
b)Posologicalstudy
c)Ecologicalstudy
d)Operationsresearch

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CorrectAnswer-C
Ans.C.Ecologicalstudydesign
Thisisanexampleofanecologicalstudy.
AnecologicalstudyisatypeofObservationalstudywhere
informationiscollectedonagroup(orpopulation)ratherthanon

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individualmembersandthenanalyzed.
Heretheassociationbetweenasummarymeasureofsaleof
cigarettes(riskfactor)andasummarymeasureofthenumberof
casesofCOPD(outcome)isstudied.

112.Astudywasdonetoassessmalnutrition

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amongyoungchildren.100childrenwere
selectedeachfromruralandurban
areas.Outofthese,30amongruraland
20amongurbanwerefoundtobe
malnourished.whichofthefollowing

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statisticaltestisusedtocomparethe
datasets?

a)Pairedt-test
b)Chi-square
c)Thestandarderrorofmean

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d)ANOVA
CorrectAnswer-B
Ans.B.Chi-squaretest
Chi-square(x2)Testoffersanalternatemethodoftestingthe
significanceofthedifferencebetweentwoproportions.Ithasthe

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advantagethatitcanalsobeusedwhenmorethantwogroupsare
tobecompared.
Park'sPSM24thed.Pageno.889

113.Theactivedisinfectantpropertyof
bleachingpowderisdueto:

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a)Chlorine
b)Hypochloricacid
c)Hypochlorousacid
d)Chloramines
CorrectAnswer-C

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Ans.C.Hypochlorousacid
Hypochlorousacidisthemosteffectiveformofchlorineforwater
disinfection.
Theactivecomponentofbleachingpowder,CaOCl2,is
hypochlorousacid.

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Thedisinfectingactionofchlorineismainlyduetohypochlorous
acid,andtoasmallextentduetothehypochloriteions.
Park'sPSM24thed.Pageno.138

114.Motherdoesnottransmitwhatantibody
tothebaby?

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a)Polio
b)Diphtheria
c)Diphtheria
d)Tetanus
CorrectAnswer-A

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Ans.A.Polio
Whengivenduringpregnancy,theTdapvaccineboostsantibodies
inthemother,whicharetransferredtoherdevelopingbaby.Early
third-trimesteradministrationoptimizesneonatalantibodylevels.
Ref.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168293/pdf/ciu327.pdf

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1)


115.Voluntaryadmissioncanbedone
maximumuptohowmuchtime
accordingtoMHA2017

a)48hrs

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b)7Days
c)30Days
d)90Days
CorrectAnswer-D
Ans.D.90Days

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Ifadmissionrequiresmorethan30daysorreadmissionwithin7
days(section90),theyshouldbeexaminedbytwopsychiatristsand
canbeadmittedforamaximumperiodof90daysiftheysatisfy
normsasperthissectionoftheactandhavetoinformtheboardfor
permission,takingaccountofADandconsentshouldbereviewed

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fortnightlyalongwithplanningforcommunity-basedtreatment.
http://www.amhonline.org/article.asp?issn=2589-
9171;year=2018;volume=19;issue=1;spage=9;epage=14;aulast=Neredumilli


116.Bloodbagsaredisposedofin
a)Yellowbag

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b)Blackbag
c)Redbag
d)Whitebag
CorrectAnswer-C
Ans:C.Redbag

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Theblackbagisusedforcollectingdrywastematerialwhichisnot
infectious.
Materialslikepaper,plastics,cardboardboxes,andotherdrywaste
generatedinthehospitalofficeorinthewardsaredisposedofin
thisbag.

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Thisisnotbiomedicalwaste.
Theredbagisusedforthedisposalofplasticscollectedfrom
operationtheaters,ICUsandwards.
Theyellowbagisusedforhighlyinfectiousitemslikeapathological
waste,humananatomicalwastesuchasbodyparts,amputated

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parts/organs,tumors,placentas,abortedordeadfetuses,blood-
soakedcottonbandages,animaltissues,organs,carcasses,etc.
BlueorWhiteopaquebagisusedforcollectingthesegregated
metalsharpssuchasneedles,blades,saws,scalpels,andglass
pieces.

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RefPark23'/ep.793-794]

117.AbsolutecontraindicationforIUD(Intra
UterineContraceptiveDevice)areall
except?

a)Pregnancy

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b)Undiagnosedvaginalbleeding
c)Pelvicinflammatorydisease
d)Uterinemalformation
CorrectAnswer-D
Ans.is'di.e.,Uterinemalformation

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Contraindications
ABSOLUTE:
Suspectedpregnancy
Pelvicinflammatorydisease
Vaginalbleedingofundiagnosedetiology

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Cancerofthecervix,uterusoradnexaandotherpelvictumours
Previousectopicpregnancy
RELATIVE:
Anaemia
Menorrhagia

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HistoryofPID(PelvicInflammatoryDisease)sincelastpregnancy
Purulentcervicaldischarge
Distortionsoftheuterinecavityduetocongenitalmalformations,
fibroid
Unmotivatedperson

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118.Whichofthefollowingiswater-related
disease
a)Yellowfever
b)Scabies
c)Cholera

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d)Dysentery
CorrectAnswer-A
Ans.is'a'i.e.,Yellowfever
*Watercancausediseasenotonlybydrinkingbutalsobyvarious
othermodes,directlyorindirectly.

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*Dependinguponthetypeoftransmission,thediseasesare
classified.
*PublicHealthClassificationofWaterbornediseases
*Waterbornediseases:Occurduetodrinkingcontaminatedwater,
transmittedbythefaeco-oralroute.Examples:Typhoid,Cholera.

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Dysentery,ViralHepatitisA
*Waterwasheddiseases:Includeinfectionsoftheouterbody
surfacewhichoccurduetoinadequateuseofwaterorimproper
hygiene.Examples:Scabies,Trachoma,Typhus,Bacillary
dysentery,Amoebicdysentery

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*Water-baseddiseases:Referstoinfectionstransmittedthroughan
aquaticinvertebrateanimal.Examples:Schistosomiasis.
Dracunculiasis(Guineawormdisease)
*Water-relateddiseases(Waterbreedingdiseases):Areinfections
spreadbyinsectsthatdependonwater.Examples:Malaria,

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Filariasis,Dengue,Yellowfever,Onchocerciasis

119.InVision2020,thetargetforSecondary
Sevicecenterisforhowmuch
population?

a)10000

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b)50000
c)1lac
d)5lac
CorrectAnswer-D
Ansis'd'i.e.5lac

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Vision2020:TheRighttoSight,isaglobalinitiativelaunchedby
WHOin1999inabroadcoalitionwitha'TaskForceofInternational
Non-GovernmentalOrganisations(NGOs)'tocombatthegigantic
problemofblindnessintheworld.
Theobjectiveistoeliminateavoidableblindnessbytheyear2020

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andtoreducetheglobalburdenofblindness.Thegovernmentof
Indiahasadopted'Vision2020:RighttoSight'undertheNational
ProgrammeforControlofBlindness.
BasedontherecommendationsofWHO,thereisaneedtodevelop
theinfrastructurepyramidwhichincludes

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I.PrimarylevelVisionCentres
Thereisaneedtodevelop20000visioncenters,
AnEachwithoneOphthalmicAssistantorequivalent(Community-
basedMLOP),Coveringapopulationof50000.
2.ServiceCentres.

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Thereisaneedtodevelop2000servicecentersatthe
secondarylevel.
Eachwithtwoophthalmologistsand8paramedics(Hospital-based

MLOP),andoneeyecaremanager,Coveringapopulationof5lacs.
3.TrainingCentres

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Thereisaneedtodevelop200'TrainingCentres'forthetrainingof
Ophthalmologists,Coveringapopulationof50lacs.
4.CentreofExcellence(COE)
Thereisaneedtodevelop20COEwithwelldevelopedallsub-
specialtiesofOphthalmology,Coveringapopulationof5crores.

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120.CA-125isamarkerforthescreeningof
ovariancancer.Tocharacterizethistest,
histopathologicalconfirmationofovarian
cancerwasdoneinacohortofpatients.
60/100womenwhotestedpositivefor

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thistesthadovariancancerand20/100
womenwhotestednegativehadovarian
cancer.Whatisthenegativepredictive
valueofthistest?

a)20/100

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b)40/100
c)60/100
d)80/100
CorrectAnswer-D
Ans:D.80/100

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Negativepredictivevalue(NPV):Abilityofascreeningtesttoidentify
correctlyallthosewhodon'thavethedisease,outofallthosewho
testnegativeonascreeningtest.


NegativePredictiveValue(NPV)=Numberoftrue

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negatives/(Numberoftruenegatives+numberoffalsenegatives).
Diseasepresent Diseaseabsent
TestPositive 60(a:TP)
40(b:FP)
TestNegative 20(c:FN)

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80(d:TN)
Total
80
120
Truenegatives=80

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Totalnegatives=100
Negativepredictivevalue=80/100=80%.

121.Screeningisnotusefulinwhich
carcinoma
a)Carcinomaprostate

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b)Carcinomacolon
c)Carcinomabreast
d)Testiculartumor
CorrectAnswer-D
Ans:D.Testiculartumor

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Screeningisnotusefulintesticulartumors.
ScreeningRecommendationsforAsymptomaticSubjects:
Breast
:
Self-examination.
Clinicalexamination.

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Mammography.
MRI.
Cervical:
Paptest(cytology).
HPVtest

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Colorectal:
Sigmoidoscopy
Fecaloccultbloodtesting(FOBT)
Colonoscopy
FecalDNAtesting

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Fecalimmunochemicaltesting(FIT)
CTcolonography
Lung:
Low-dosecomputedtomography
(CT)scan

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OvarianCA:
CAmarker-125
Transvaginalultrasound
Prostate:
Prostate-specificantigen(PSA)

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Digitalrectalexamination(DRE)
Skin:
Completeskinexamination

122.Admissionratebiasis?
a)Reportingbias

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b)Responsebias
c)Berkesonianbias
d)None
CorrectAnswer-C
Ans.is'c'i.e.,Berkesonianbias

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Selectionbias
Selectionbiasisdistortionthatresultsfromtheprocedureusedto
selectsubjectsandfromfactorsthatinfluencestudyparticipation.
Groupstobecomparedaredifferentiallysusceptibletotheoutcome
evenbeforetheexperimentalmaneuverisperformed.

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Selectionbiasmaybeofthefollowingtypes.
1.Surveillance/detectionbias
Apotentialartifactinepidemiologicdatacausedbytheuseofa
particulardiagnostictechniqueortypeofequipment.
Forexample,cancerratesmayvaryindifferentregionsorperiods,

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notbecauseofanactualdifferenceintheincidenceofdiseasebut
becauseofdifferentdiagnostictechnologies.
Ifthediagnostictestisbeingusedinoneregionismoresensitive
thanotherregions,thecancerrateswillbehighinthatregioneven
withouttheexistenceofanactualdifference.

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2.Neymansurvivalbias(Incidence-Prevalencebias)
Thistypeofbiasisduetomissingfatalcases,mildcasesorcases
ofshorterdurationfromthestudy.
Forexample,inastudyofbreastcancer,wecanchoosetwo
differenttypesofcases:?

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IncidentcasesAllbreastcancerpatientsnewlydiagnosedduring

agiventime.
PrevalentcasesAllbreastcancerpatientswhoarealiveduringa
giventimeframe.
Thesecanleadtodifferentresultsbecausetheprobabilityoffinding

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acaseinagiventimeframeisrelatedtomortalityrisk.Those
patientswhohayamildformofthediseaseandsurvivefora
relativelylongtimehaveagoodchanceofbeingaroundonthedate
ofdatacollection.Thosepatientswhodiequicklyareunlikelytobe
aroundonthatdate.

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3.Referralbiasorvolunteerbias
Volunteerorreferralbiasoccursbecausepeoplewhovolunteerto
participateinastudy(orwhoarereferredtoit)areoftendifferent
thannon-volunteers/non-referral.
Thisbiasusuallyfavoursthetreatmentgroup,asvolunteerstendto

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bemoremotivatedandconcernedabouttherehealth.
4.Responsebias
Thisoccurswhenthosewhorespondtoasurveydifferinimportant
waysfromthosewhodonotrespond.
Thisbiascanworkineitherdirection,i.e.,ifbiasoccurs,whenthose

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whodonotrespondtoasurveydifferinimportantwaysfromthose
whorespond,itiscallednonrespondentbias.
5.Berkesonianbias
Berkesonianbiasresultsfromthegreaterprobabilityofhospital
admissionforpeoplewithtwoormorediseasesthanforpeoplewith

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onedisease.So,itisalsoknownasadmissionratebias.
Forexample,Ifbreastcanceristheexposureofinterest(diseases
areoftentreatedasexposuresinhospital-basedcase-control
studies)andmeningiomaisthecasediseasethenpeoplewithboth
breastcancerandmeningiomacouldbehospitalizedforeither

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breastcancerormeningiomaorboth.
However,peoplewithonlybreastcancerorwiththeonly
meningiomacouldbehospitalizedbecauseofoneofthese
diseases.
Therefore,agreaterproportionofpeopleinthecommunitywithboth

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breastcancerandmeningiomawouldbeadmittedtothehospital
thanpeoplewithmeningiomaonly.
So,Berkesonianbiasoccurswhenbothexposure(e.g.,breast

cancerintheaboveexample)anddisease(e.g.,meningiomain
aboveexample)affecttheselection

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123.Stimulationoftheexternalauditorycanal
leadstocoughduetowhichnerve
a)AuricularbranchVagus
b)Greaterauricularnerve
c)Auriculotemporalnerve

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d)FacialNerve
CorrectAnswer-A
Ans:A.AuricularbranchVagusnerve.
>AuricularbranchofVagus(Arnold'snerve)
andFacialnerve
continuesinwardstosupplytheposteriorwallandflooroftheEAC.

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>Thecoughresponsecausedwhilestimulatingtheearcanalis
mediatedbythevaguswhichalsosuppliesthelarynx.
(Re/.Shambaugh,6thed.,page45)

124.

wideningofthecartilaginouspartoftheextra

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auditorycanalcalled.

a)Otoplasty
b)Myringoplasty
c)Tympanoplasty
d)Meatoplasty

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CorrectAnswer-D
Ans.(d)Meatoplasty.
Meatoplasty
isanoperativetechniquetowidenthelateral
cartilaginouspartoftheexternalauditorycanal.
Otoplasty-isaproceduretochangetheshape,positionorsizeof

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theears.
Myringoplasty-closureoftheperforationofparstensaofthe
tympanicmembrane
Tympanoplasty-surgicaltechniquetorepairadefectinthe
tympanicmembranewiththeplacementofagraft,eithermedialor

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lateraltothetympanicmembraneannulus
ref:https://vula.uct.ac.za/access/content/group/ba5fb1bd-be95-
48e5-81be-586fbaeba29d/Meatoplasty.pdf


125.TubercularOtitismediaischaracterized
byallexcept

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a)Painfulotorrhea
b)Multipleperforations
c)Palegranulations
d)Foul-smellingeardischarge
CorrectAnswer-A

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

Ans.A.Painfulotorrhea.
>Tuberculosisofmiddleearisacomparativelyrareentityusually
seeninassociationwithorsecondarytopulmonarytuberculosis,the
infectionreachesthemiddleearthroughtheeustachiantube
>Itischaracterizedbypainlessotorrhoeawhichfailstorespondto

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theusualantimicrobialtreatment
>patientwithevidenceoftubercleinfectionelsewherefollowedby
multipletympanicmembraneperforations,abundantgranulation
tissue,andbonenecrosis,preauricularlymphnodeenlargement
https://www.ncbi.nlm.nih.gov/pubmed/21522113

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126.Partialandfullclosuredonein
a)Atrophicrhinitis
b)Allergicrhinitis
c)Vasomotorrhinitis
d)Occupationalrhinitis

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CorrectAnswer-A
Ans.A.Atrophicrhinitis
ATROPHICRHINITIS
>Itisaformofchronicrhinitisassociatedwithatrophyof
nasalmucosa,mucousglands,nerves,andvessels.

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>Itcanbeprimaryorsecondary.
>Thesurgicaloptionsaimtoreducethesizeoftheroomy
cavitiestopreventtheexposuretodryingeffectsofair
andcrustsformationandthushelpregenerationofnasalmucosa.
Fullclosure-Young'soperation

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Partialclosure-Modifiedyoung'soperation.
(Ref.Cummings,6thed.,695)

127.OccipitomentalviewofPNSX-raycalled
as
a)Caldwellview

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b)Waterview
c)Townview
d)Pineview
CorrectAnswer-B
Answer:b.Waterview

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OccipitomentalviewofPNSX-raycalledasWaterview

128.Whatcausesshiftingfluid?
a)ExudativeRetinaldetachment
b)TractionalRetinalDetachment
c)Rhegmatogenousretinaldetachment

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d)Retinodialysis
CorrectAnswer-A
Ans.a.ExudativeRetinaldetachment.
>Inexudativeretinaldetachment,thesubretinalfluidmaybe
confinedtoalocalizedarea,usuallytheposteriorpole,ormay

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extendtotheperiphery,evenformingbullousretinaldetachment.
>Thecharacteristicfeatureofasignificantexudativeretinal
detachmentisthepresenceofshiftingsubretinalfluid.

>Thefluidshiftstothemostdependentlocationwhenpatients
changebodyposition.

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

https://clinicalgate.com/nonrhegmatogenous-retinal-detachment/

129.Conjunctivalinjection,pharyngeal
injection,polymorphicrash,cervical
lymphadenopathycanbeseenin

a)Kawasakisyndrome

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b)Measles
c)Thrombocytopenia
d)Mumps
CorrectAnswer-A
Ans:a.Kawasakisyndrome.

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

>Kawasakidiseaseisageneralizedvasculitisthataffectsmedium-
sizedarteries.
>Itischaracterizedbysystemicinflammationthatmanifestsas
persistentfever,erythemaofthemucousmembranes,bilateral
nonexudativeconjunctivitis,rash,swellingandrednessofthehands

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andfeet,andcervicallymphadenopathy
Ref:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034467/

130.IncongruousHomonymoushemianopia
withWernicke'shemianopiapupilisseen
withthelesionof

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

a)Opticradiation
b)Lateralgeniculatebody
c)Optictract
d)Anterioroccipitalcortex
CorrectAnswer-C

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

Ans:c.Optictract
>AnterioroptictractlesionproducesIncongruousHomonymous
hemianopia,decreasedvisualacuity,afferentpupil
defect(Wernicke'shemianopiapupil)andatrophyofopticdiscswith
characteristicBow-tieatrophyarecontralateral.

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

>AcompleteHomonymoushemianopiaresultsfromposterioroptic
tractlesions.
Ref:https://books.google.co.in/books?
id=bDpI9n4q3e0C&pg=PA376&lpg=PA376&dq=Incongruous+Homonymous+hemianopia+with+Wernicke%27s+hemianopic+pupil&source=bl&ots=36lTWDpqEI&sig=ACfU3U1mJNezirKF_11Ku5xpqqmWX6mdQw&hl=en&sa=X&ved=2ahUKEwio2-
fCi_bmAhUoxzgGHf56An8Q6AEwFXoECAoQAQ#v=onepage&q=Incongruous%20Homonymous%20hemianopia%20with%20Wernicke's%20hemianopic%20pupil&f=false

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


131.Thepatientcamewithproptosis,
restrictionofeyemovements,andwas
Euthyroid.Whatcouldthisbefrom?

a)OrbitalCellulitis
b)OrbitalLymphoma

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c)Orbitalpseudotumor
d)Thyroidophthalmopathy
CorrectAnswer-C
Ans:C.Orbitalpseudotumor
>Proptosisandrestrictedeyemovementismostcommonly

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

associatedwiththyroidophthalmopathy
>ButinquestionaskedisEuthyroid.
>So,thebestoptiontoselectisOrbitalpseudotumor(Idiopathic
orbitalinflammatorysyndrome)
Ref.ComprehensiveOphthalmologybyAKKhurana-6th

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EditionPageno335


132.Prerequisiteforsympathetic
ophthalmitis
a)Penetratinginjurytotheeye
b)Bluntoculartumor

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

c)Chemicalinjury
d)Urinarytractinfection
CorrectAnswer-A
Ans:a.Penetratinginjurytotheeye.
>Sympatheticophthalmiaisararetypeofuveitisthatcausessmall

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abnormalclumpsofcells(granulomas)toform.
>Thisdisorderoccursintheuninjuredeyeafterapenetratinginjury
(suchaswhenapencil,pen,orstickpuncturestheeye)orsurgery
totheother(injured)eye.
Ref:https://www.msdmanuals.com/en-in/home/eye-disorders/uveitis-

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and-related-disorders/sympathetic-ophthalmia.

133.Photostresstesttodifferentiate
a)Lensandcornea
b)ThemaculaandOpticnervediseases
c)Cataractandglaucoma

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

d)Retinalandvitreousdiseases
CorrectAnswer-B
Ans:b.ThemaculaandOpticnervediseases.
>Todistinguishopticnerveconductiondefectsfromthe
maculardiseaseinpatients
withotherwiseunexplainedlossof

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

centralvisionwefirstdeterminedthebestvisualacuitywith
correctionatdistanceinunilateraldefects.
>Thenormaleyewastestedfirstandphotostressedforten
seconds
bylookingatanordinarypenlightheld2to3cmfromthe
eye.

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

>ThetimerequiredtoreadthreelettersonthreeSnellentestlines
justlargerthanthebestacuitywasusedastheendpoint.
>Recoverytimewillbeprolongedwithmaculopathy.
>Prolongedrecoverytimewillnotbeobservedinpatientswho
haveopticnervedisease.

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

https://www.ncbi.nlm.nih.gov/pubmed/836667

134.Whichlayerofcorneahelpsinthe
hydrationofstromaofcornea
a)Endothelium
b)Epithelium

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c)Descemetmembrane
d)Stroma
CorrectAnswer-A
Ans:a.Endothelium
>Thecornealendotheliumisresponsibleformaintainingthe

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

hydrationofthecornea.
>Thisisthrougha"Pump-Leak"mechanismwheretheactive
transportpropertiesoftheendotheliumrepresentthe"Pump"and
thestromalswellingpressurerepresentsthe"Leak"
Ref:https://www.researchgate.net/publication/51238307_Molecular_Mechanisms_Underlying_the_Corneal_Endothelial_Pump

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135.A65oldmalewithahistoryof
hypertensionanddiabetes,presentsto
theOPDwithcomplaintsofdiplopiaand
squint.Onexamination,thesecondary
deviationismorethantheprimary

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deviation.Whichofthefollowingismost
likelydiagnosis

a)concomitantsquint
b)paralyticsquint
c)Restrictivesquint

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d)Pseudosquint
CorrectAnswer-B
Ans:b.paralyticsquint.
>Paralyticorincomitantsquintoccurswhenthereisanacquired
defectofthemovementofaneye.

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>Thesquint(anddoublevision)ismaximallydemonstratedby
lookinginthedirectionofactionoftheweakenedmuscle.
>ParalyticsquintsoccurduetodiseaseoftheIII,IVandVIcranial
nerves.
Ref:https://www.gponline.com/basics-

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strabismus/ophthalmology/article/1055827

136.Esotropiaiscommonin
a)Myopia
b)Hypermetropia
c)Emmetropia

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d)Astigmatism
CorrectAnswer-B
And:B.Hypermetropia
>Patientswithrefractiveesotropiaaretypicallyfarsighted
(hyperopic).

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>Thismeansthattheeyesmustworkhardertoseeclearly,
particularlywhentheobjectofregardisupclose.
https://aapos.org/glossary/accommodative-esotropia

137.Anextrarowofciliaposteriortothegrey
line

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a)Distichiasis
b)Tylosis
c)Madarosis
d)Trichiasis
CorrectAnswer-A

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And:a.Distichiasis
>Distichiasisisararedisorderdefinedastheabnormalgrowthof
lashesfromtheorificesofthemeibomianglandsontheposterior
lamellaofthetarsalplate.
Ref:https://emedicine.medscape.com/article/1212908-overview

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138.Thepatientcamewithunilateral
ProptosisandbilateralAbducentnerve
palsy.Thiscouldbefrom

a)Cavernoussinus
b)Orbitalcellulitis

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c)Orbitalpseudotumor
d)Orbitallymphoma
CorrectAnswer-A
Ans:a.Cavernoussinus
>Proptosisisinitiallyseenunilaterallyultimatelybecomesbilateral.

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>6thcranialnerve(Abducent)passesthroughthecavernous
sinus.soincavernoussinusthrombosisbilateralabducenspalsyis
seen.
Parson'sDiseasesoftheEye-Ed.22Pg497

139.Thecharacteristicfindingoffungal

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ulcers?
a)Satellitelesions
b)Dendriticulcer
c)Ringabscess
d)Whitehypopyon

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CorrectAnswer-A
And.a.Satellitelesions
>Fungalkeratitisorkeratomycosisreferstoaninfectiveprocessof
thecorneacausedbyanyofthemultiplepathologicfungicapableof
invadingtheocularsurface.

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>whentheepithelialintegrityisbrokeneitherduetotraumaorocular
surfacediseaseandtheorganismgainsaccessintothetissueand
proliferates.
>Multifocalstromalinfiltratesor"satellitelesions"havebeen
consideredacharacteristicfeatureoffungalkeratitis.

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Ref:https://eyewiki.aao.org/Fungal_Keratitis

140.Adrugusedinapatientwithincreased
IOPandopticdiscchanges,ciliary
congestionfordecreaseIOPactsby
increasinguveoscleraloutflowis

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

a)Latanoprost
b)Pilocarpine
c)Dorzolamide
d)Timolol
CorrectAnswer-A

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

Ans:a.Latanoprost
>LatanoprostselectivelystimulatestheprostaglandinF2alpha
receptorandthisresultsinadecreasedintraocularpressure(IOP)
viatheincreasedoutflowofaqueoushumor,whichisoften
implicatedincasesofelevatedintraocularpressure.

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Ref:https://www.google.com/url?
sa=t&source=web&rct=j&url=https://www.drugbank.ca/drugs/DB00654&ved=2ahUKEwicmYHW5PjmAhU94HMBHZG6ADcQFjANegQIAxAB&usg=AOvVaw34z-
Nz08_cOFzeYemAzeWf&cshid=1578651404060

141.ApatientdiagnosedwithRheumatoid
arthritiswasonmedications.After2

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years,hedevelopedablurringvisionand
wasfoundtohavecornealopacity.
Whichdrugismostlikelytocausethis?

a)Sulfasalazine
b)Chloroquine

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c)Methotrexate
d)Leflunomide
CorrectAnswer-B
Ans:B.Chloroquine
Inlong-termchloroquinetherapyOcularcomplicationswere

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observed
>Thistherapyisusuallyusedinpatientswithrheumatoidarthritis,
lupuserythematosus,sarcoidosis,discoidlupus,andotherchronic
"collagendisease".
>Retinalchanges,cornealopacifications,blurringofvisionaresome

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complicationsseeninlongtermuseofChloroquine.
Ref:https://www.ncbi.nlm.nih.gov/pubmed/1427503

142.Nutcrackeresophagus,thecorrect
statementis
a)Thereisextremelyforcefulperistalticactivityleadingto

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episodesofchestpainanddysphagia
b)Thereisnomedicalt/tavailable
c)TypeofoesophagealMalignancy
d)None
CorrectAnswer-A

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Ans:A.Thereisextremelyforcefulperistalticactivityleadingto
episodesofchestpainanddysphagia
NutCrackerOesophagusisahypermotilitydisorderwithhigh
amplitudeperistalsis.Itisaconditioninwhichextremelyforceful
peristalticactivityleadstoepisodicchestpainanddysphagia.

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Treatmentiswithnitratesornifedipine.
Ref.davidsonsprinciplesandpractice23rdeditionpageno.795

143.Whichofthefollowingcriteriaisusedto
assesstheprognosisoftheliver
conditionasrepresentedinthepicture

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below?

a)Childpughscore
b)Milanscore
c)Meldscore
d)Alvaradoscore

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CorrectAnswer-A
Ans:A.Childpughscore
theliverconditionasrepresentedinthepictureabovedemonstrates
livercirrhosis.
Child-Pughscore(ortheChild?Turcotte?PughscoreorChild

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Criteria)isusedtoassesstheprognosisofchronicliverdisease,
mainlycirrhosis.
Itisnowusedtodeterminetheprognosis,aswellastherequired
strengthoftreatmentandthenecessityoflivertransplantation.
Factor

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1
2points
3points
point
Totalbilirubin

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<34 34-50
>50
(mol/L)
Serumalbumin >35 28-35
<28

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(g/L)
PTINR
<1.7 1.71-2.30
>2.30
Ascites

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None Mild
Moderateto
Severe
Hepatic
None GradeI-II(orsuppressed

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GradeIII-IV(or

Hepatic
None GradeI-II(orsuppressed
GradeIII-IV(or
encephalopathy

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withmedication)
refractory)
Interpretation:
Points Class Oneyearsurvival Two-yearsurvival
5?6

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

A
100%
85%
7?9
B

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81%
57%
10?15 C
45%
35%

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144.Suddenonsetheadachewithneck
rigidity?
a)Intraparenchymalhemorrhage
b)Sah
c)Meningitis

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d)Noneoftheabove
CorrectAnswer-B
Ans:b.Sah
suddenonsetofasevereheadache(oftendescribedas"theworst
headacheofmylife")

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nauseaandvomiting
stiffneck
sensitivitytolight(photophobia)
blurredordoublevision
lossofconsciousness

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seizures

145.Vegetationinmitralvalveseeninwhich
condition
a)Libmansacks
b)Infectiveendocarditis

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c)NBTE
d)Rheumaticfever
CorrectAnswer-B
Ans:B.Infectiveendocarditis
Infectiveendocarditisischaracterizedbylesions,knownas

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vegetations,whichisamassofplatelets,fibrin,microcoloniesof
microorganisms,andscantinflammatorycells.Inthesubacuteform
ofinfectiveendocarditis,thevegetationmayalsoincludeacenterof
granulomatoustissue,whichmaybefibrosedorcalcified.

146.Waterhammerpulseisseenin

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a)Aorticregurgitation
b)Mitralstenosis
c)Aorticstenosis
d)Leftventricularfailure
CorrectAnswer-A

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Ans:A.Aorticregurgitation
Waterhammerpulse

Itisalargeboundingpulse,associatedwithanincreasedstroke
volumeoftheleftventricleandadecreaseintheperipheral
resistance,leadingtowidepulsepressure.

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Thepulsestrikesthepalpatingfingerwitharapid,forcedjerkand
quicklydisappears.
Itisbestfeltintheradialarterywiththepatient'sarmelevated.
Itisseeninaorticregurgitation.


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147.Whatwillyoudowhen3yrsoldchild
parentscometophcwithfever,cough
since5dayswithchestindrawing
presentundermnciclassification

a)Giveantipyreticsonly

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b)Giveantibioticsandfollowup
c)Referurgentlytotertiarycare
d)Giveantibioticsandrefertotertiarycare
CorrectAnswer-D
Ans:D.Giveantibioticsandrefertotertiarycare

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148.Whatpoisonwillyoudetectinskeleton
evenafteremaciation
a)Lead
b)Arsenic
c)Mercury

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d)Cadmium
CorrectAnswer-B
Ans:B.Arsenic
Arsenic
canbedetectedeveninconflagratedhumanbones.Hence,
itispossibletodetectpoisoningbyarsenicevenwhenthebodyhas

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beenburntforalongtime.
FMT2ndeditionPageno.184

149.Ph7.2,HCO3-(10or12),pco2-35,
metabolicacidosisdueto
a)K+excretionbythekidney

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b)Co2expirationbylungs
c)H+excretionbythekidney
d)Hco3lossbykidney
CorrectAnswer-D
Ans:D.Hco3lossbykidney

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Inthequestion,pHisdecreased(acidosis)&pCO2isdecreased
(Normal=40-45mmHg).
AdecreasedpCO2willtrytoincreasepH,henceitmustbea
secondarycompensatingmechanism.
So,theprimarymechanismcausingtheacid-baseimbalancemust

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beadecreaseinserumbicarbonateconcentrationi.e.metabolic
acidosis.

150.ImpairedfunctionofAquaporinresultsin
a)Liddelsyndrome
b)NephrogenicDI

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c)Cysticfibrosis
d)Bartersyndrome
CorrectAnswer-B
Ans:B.NephrogenicDI
Aquaporins,alsocalledwaterchannels,areintegralmembrane

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proteinsfromalargerfamilyofmajorintrinsicproteinsthat
formporesinthemembraneofbiologicalcells,mainlyfacilitatingthe
transportofwaterbetweencells.
Geneticdefectsinvolvingaquaporingeneshavebeenassociated
withseveralhumandiseasesincludingnephrogenicdiabetes

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insipidusandneuromyelitisoptica.

151.Mostseriouscomplicationofmeaslesis:
September2008
a)Croup
b)Meningo-encephalitis

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

c)Otitismedia
d)Pneumonia
CorrectAnswer-B
Ans.B:Meningo-encephalitis
Measlesisahighlycommunicableacutedisease.Itisalsoknownas

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rubeolaandismarkedbyprodromalfever,cough,coryza,
conjunctivitis,andpathognomonicenanthem(i.e.,Koplikspots),
followedbyanerythematousmaculopapularrashonthethirdto
seventhday.
Infectionconferslife-longimmunity.

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Ageneralizedimmunosuppressionthatfollowsacutemeasles
frequentlypredisposespatientstobacterialotitismediaand
bronchopneumonia.
Inapproximately0.1%ofcases,measlescausesacutemeningo-
encephalitis,whichisthemostseriouscomplication.Subacute

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sclerosingpanencephalitis(SSPE)isararechronicdegenerative
diseasethatoccursseveralyearsaftermeaslesinfection.

152.ThemostcommoncauseofdeathinSLE
inchildren
a)Lupusnephritis

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b)Lupuscerebritis
c)Libmansacksendocarditis
d)Anemiaandinfections
CorrectAnswer-A
Ans:A.Lupusnephritis

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MajorcausesofdeathinpediatricSLEinclude:

1. Renaldisease(lupusnephritis)
2. Severediseaseflare
3. Infections

153.ApatienthavingmultipleGallstonesand

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shows8mmdilationand4stonesin
CBD,besttreatmentmodalitiesare?

a)Cholecystectomywithcholedocholithotomyatthesamesetting
b)ESWL
c)CholecystectomyandwaitforERCP

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d)All
CorrectAnswer-A
Ans:A.Cholecystectomywithcholedocholithotomydoneatthe
samesitting
ManagementofsuspectedorprovenCBDstonesassociatedwith

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gallbladderstones
Forgallstones-laparoscopiccholecystectomyistheprocedureof
choice.
ForCBDstonestwothingscanbedone:
1)Ifthesurgeonisexperiencedinlaparoscopictechniquesof

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CBDstoneremovalthenbothcholecystectomyand
choledocholithotomyaredoneinthesamesitting.
CBDstonesarefirstconfirmedbyanintraoperativecholangiogram
thenthestonesareremovedlaparoscopicallyviathecysticductor
bycholedochotomy.

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2)Ifthesurgeonisnotexperiencedwithlaparoscopicmethodsof
CBDstoneremoval,preoperativeendoscopicsphincterotomywith
stoneremovalandlaterlaparoscopiccholecystectomyisdone.
Laparoscopiccholecystectomywithcholedocholithotomyinthe
samesittingisthepreferredtechnique(providedthesurgeonis

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experienced)

Butonemustkeepinmindherethat
"forelderly,poor-riskpatientswithgallstonesandCBDstones,some
haverecommendedERCPandsphincterotomyasthesole
treatment,leavinggallbladderandstonesinsitu".-Maingot's10/e

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Usuallythegallstonesinthesepatientsremainasymptomaticandif
theneedarisescanbemanagedbycholecystectomy

154.Pulmonaryplethoraisseenwithall
except:
a)TGS

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b)Ebsteinanomalies
c)Hypoplasticleftheartsyndrome
d)Doubleoutletrightventricle
CorrectAnswer-B
Ans:B.Ebsteinanomalies

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Pulmonaryplethoraisseenin
TOF
TA
Ebstein'sanomaly
Pulmonaryatresia

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155.20yearsoldmanpresentedwiththe
complaintofswellingofthewristforthe
lasttwoyears.histopathological
examinationshowedspindle-shaped
cellsandverocaybodieswhatisthe

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diagnosis?

a)Lipoma
b)Dermoidcyst
c)Neurofibroma
d)Schwannoma

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CorrectAnswer-D
Ans:D.Schwannoma
spindlecellsandverocaybodiesareseeninschwannoma
isatumorofthetissuethatcoversnerves,calledthenervesheath.
ThesetumorsdevelopfromatypeofcellcalledaSchwanncell,

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whichgivesthemtheirname.Schwannomasareoftennot
cancerous(benign).
Themostcommontypeofschwannomaisvestibularschwannoma.
Itaffectsthenerveresponsibleforbalance(alsocalledthevestibular
nerve).Itcancauseinnereardeafnessbecausethehearingand

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balancenerveruntogether,andasthetumorgrowsitdamagesthe
hearingnerve(cochlearnerve).Becauseofthisdoctorusedtocall
themacousticneuromas.
Microscopically,thetumoriscomposedoffibrocellularbundles
formingthewhorledpattern.

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Thereareareasofdenseandcompactcellularity(AntoniA

pattern)alternatingwithlooseacellularareas(AntoniB
pattern).AreasofAntoniApatternshowpalisadednuclei
calledVerocaybodies.
Nervefibersareusuallyfoundstretchedoverthecapsulebutnot

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withinthetumor.
Areasofdegenerationcontainhaemosiderinandlipid-laden
macrophages.
SchwanncellscharacteristicallyexpressS-100protein.
Aschwannomararelyeverbecomesmalignant.

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156.Hemodynamicallyunstablepatientwith
SVT
a)IVIBUTILIDE
b)IVDILTIAZEM

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c)CARDIOVERSION
d)Ivbeta-blockers
CorrectAnswer-C
Ans:C.CARDIOVERSION


157.AFemalepatientwasonlithiumfor

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bipolardisorderfor6months.shefasted
forsomedaysduetoreligiouscondition
andlaterpresentedwith
seizures,tremors,confusionand
weakness.Whatinvestigationshaveto

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bedonetodiagnosehercondition

a)serumelectrolytes
b)serumlithium
c)ECG
d)MRI

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CorrectAnswer-B
Ans:B.serumlithium
Becauseofitseffectsonmultiplebodysystems,includingbutnot
limitedtorenal,hematologic,andthyroidsystems,appropriate
baselinestudiesmustprecedethestartoflithiumtherapy.

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Theminimalteststobedoneincludeserumcreatinine,electrolytes,
thyroidfunctiontests,andacompletebloodcountwithdifferential.
Additionally,becauseofitscardiaceffect,anECGisindicated.Any
womanthoughttobepregnantshouldhaveapregnancytest.
Ref:NurcombeB.(2008).Chapter12.DiagnosticFormulation,

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TreatmentPlanning,andModesofTreatmentinChildrenand
Adolescents.InM.H.Ebert,P.T.Loosen,B.Nurcombe,J.F.
Leckman(Eds),CURRENTDiagnosis&Treatment:Psychiatry,2e.

158.Lithiumcauses:
a)Hypokalemia

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b)Hyperkalemia
c)Hypocalcemia
d)Hypercalcemia
CorrectAnswer-A
Ans:A.Hypokalemia

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Sideeffectsoflithium

1. Neurological:-Tremoristhecommonestsideeffectoflithium.Other
CNSsideeffectsaregiddiness,ataxia,motorincoordination,
hyperreflexia,mentalconfusion,nystagmus.
2. Renal:-Nephrogenicdiabetesinsipiduswithpolyuria&polydipsia.

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AmilorideistheDOCforLithiuminducednephrogenicDI.
3. Cardiovascular:-Effectsaresimilartohypokalemia.Themost
commonECGchangeisTwavedepression.
4. Endocrine:-Goitre,hypothyroidism
5. GIT:-Nausea,vomiting,diarrhea,metallictest,abdominalpain.

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6. Dermatological:-Acneiformeruptions,papulareruption,
exacerbationofpsoriasis.
7. Teratogenicity:-Ebstein'sanomalyinthefetus.

159.A50-year-oldmanpresentswith
paresthesia.HB-6.8g/dl.Peripheral

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smearshowsmacrocytosisand
neutrophilswithhypersegmented
nuclei.endoscopyrevealsatrophic
gastritis.amostprobablediagnosisis

a)Folatedeficiency

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b)VitaminB12deficiency
c)Riboflavindeficiency
d)Irondeficiency
CorrectAnswer-B
Ans:B.VitaminB12deficiency

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Macrocytosisandhypersegmentedneutrophilsonperipheralsmear,
poorabsorption(Atrophicgastritis)suggestthediagnosisofB12
deficiency.
Thepresenceofanemia(Hb=6gm%)Macrocytosis(MCV=104)and
decreasedvitaminB12levels(B12=60pg/ml)suggestsadiagnosis

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ofmegaloblasticanemiaduetovitaminB12deficiency.
Thepatientinquestionthushasmacrocyticanemiaduetovitamin
B12deficiency.

160.Alltransretinoicacidisusedinthe
treatmentoftumourassociatedwith

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

a)BCR-ABL
b)PML-RARA
c)CMYC
d)CEBPA
CorrectAnswer-B

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

Ans:B.PML-RARA
All-transretinoicacid(ATRA)isanactivemetaboliteofvitaminA
underthefamilyretinoid.
Retinoids,throughtheircognatenuclearreceptors,exertpotent
effectsoncellgrowth,differentiationandapoptosis,andhave

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significantpromiseforcancertherapyandchemoprevention.
DifferentiationtherapywithATRAhasmarkedamajoradvanceand
becomethefirstchoicedruginthetreatmentofacutepromyelocytic
leukemia(APL).
All-transretinoicAcidisusedinthetreatmentforAcute

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PromyelocyticLeukemia(PML)

161.RenaltubularacidosiswithABGvalue
pH=7.24P02=80;PaCO2=36Na=131;
HCO3=14Cl=90;BE=-13Glucose=
135aboveABGpicturesuggest?

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

a)Respiratoryacidosis
b)Respiratoryalkalosis
c)Metabolicacidosis
d)Metabolicalkalosis
CorrectAnswer-C

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

Ans:C.Metabolicacidosis
ThegivenvalueshavelowpH,andlowHCo3Indicatemetabolic
acidosis
PCO2inlowernormalrange(normalvalue35-45mm/hg)

162.Patientwithpulmonaryfibrosis.Which

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antiarrhythmicdrugshouldnotbegiven
a)Amiodarone
b)Flecainide
c)Ivibutilide
d)lidocaine

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CorrectAnswer-A
Ans:A.Amiodarone
Amiodaroneanditsmetabolitescanproducelungdamagedirectly
byacytotoxiceffectandindirectlybyanimmunologicalreaction.
ThelatterissupportedbythefindingofcytotoxicTcellsin

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bronchoalveolarlavage(BAL)fluidfrompatientswithdiagnosed
APT.AmiodaronemayinducetheproductionoftoxicO2radicals,
whichcandirectlydamagecells

163.A42-year-oldpatientwithobstructive
jaundice.Alp,Ggt,haptoglobinall

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increased.Themostlikelycauseis:

a)Alcohol
b)Lead
c)Chronicrf
d)Noneoftheabove

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CorrectAnswer-A
Ans:A.Alcohol
Anindicatorthatshouldmaketheclinicianhighlysuspiciousof
alcohol-relatedliverinjuryisAST:ALTratioof2:1ormore.
Gamma-glutamyltransferase(GGT)isanothersensitivebutnon-

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

specificmarkerforthehepaticinjurywhichcannotbeusedsolelyto
diagnosealcohol-relatedhepaticinsult.
LevelsofGGTgreaterthantwicethenormalvaluesinadditionto
AST:ALTratio>2stronglyindicatealcohol-inducedliverinjuryas
well.

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164.ThedifferentiatingfeaturebetweenIBS
andorganicGIdiseaseis:
a)Diarrhea
b)Stoolcalprotectin
c)Painabdomen

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

d)Mucusinstools
CorrectAnswer-B
Ans:B.Stoolcalprotectin
BothorganicIBDandnon-organicfunctionaldisorderslikeIBS
exhibitverysimilarsymptomsresearchershaveidentifiedseveral

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

stool-basedbiomarkerstodifferentiatebetweenIBDandIBS.These
becomeespeciallycrucialwhentakingthenextsteptowards
decidinghowtomanagethedisease(e.g.therapeuticintervention,
etc.).Thosebiomarkersincludethefollowing:
Calprotectin

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Alpha-1Antitrypsin
Lysozyme
SecretoryIgA
Albumin

165.Atienthasfatigue.Butnotgaining

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weight.Bodywaswarm.Investigation
willshow:

a)LowTSHwithmoret3ort4
b)HighTSHwithnormalt3ort4
c)HighTSHwitheuthyroid

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d)Increaseduptakeoft3,butdecreaset4
CorrectAnswer-A
Ans:A.LowTSHwithmoret3ort4

166.WarminginFrostfrostbiteshouldbe
doneatwhattemperature:

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

a)37degree
b)42degree
c)44degree
d)46degree
CorrectAnswer-A

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

Ans:A.37degree
Attemperaturebelowfreezing(dry-coldcondition)frostbiteoccurs
thetissuefreeze&icecrystalsforminbetweenthecells
Affectedpartshouldbewarmedusingwaterat44?isunder
Criticism,Warmingshouldlastabout20minutesatatime,Intakeof

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hotfluidspromotesgeneralrewarming

167.Whichofthefollowingisnotseenin
Pituitaryapoplexy
a)Headache
b)Hypertension

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c)Hypotension
d)Vomiting
CorrectAnswer-C
Ans:C.Hypotension
FollowingareseeninPituitaryapoplexy

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Severehypoglycemia
Severeheadache(usuallyretro-orbital)
Impairedconsciousness
Fever
Visualdisturbances(visualfielddefect,visualacuity)

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Ophthalmoplegia(ocularparesis)Causingdiplopia
Hypotension&shock
Nausea/vomiting
Meningealsign

168.Lossofpain/temperaturesensationon

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ipsilateralface&C/Lbodydueto
thrombosisin

a)PICA
b)Posteriorcerebellarartery
c)Superiorcerebellarartery

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d)Noneoftheabove
CorrectAnswer-A
Ans:A.PICA
.Mostcasesresultfromipsilateralvertebralarteryocclusion;
occlusionoftheposteriorinferiorcerebellararteryisresponsiblefor

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

it.
VesselocclusionthatresultsinLateralMedullarysyndrome:
Vertebral(mostcommon)
Posteriorinferiorcerebellar(2ndmostcommon)
Superior,middleorInferiorlateralmedullaryarteries

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Lateralmedullarysyndrome(Wallenbergsyndrome):
Vertigo
Numbnessofipsilateralfaceandcontralaterallimbs
Diplopia
Dysphagia

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Dysarthria
Ataxia
Hoarseness

169.AllfoundinLVFexcept
a)Lungoligemia

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b)Kerleyblines
c)Rales
d)Pedaledema
CorrectAnswer-A
Ans:A.Lungoligemia

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ChestX-rayFeaturesofLeftventricularfailure:
Cardiomegaly
Kerleylines
Prominentupperlobeveins
Bat'swingsshadow

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Pleuraleffusion
KerleyBlineisduetointerstitialedema.
Prominentrightdescendingpulmonaryarteryisseeninacute
pulmonaryembolism.

170.Allofthefollowingshowlowglucosein

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pleuralfluid,EXCEPT-
a)Empyema
b)Malignantpleuraleffusion
c)Rheumatoidarthritis
d)Dressler'ssyndrome

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CorrectAnswer-D
AnswerisD(Dressler'sSyndrome):
Dresslersyndromeisasecondaryformofpericarditisthatoccurs
inthesettingofinjurytotheheartorthepericardium(theouterlining
oftheheart).Itconsistsoffever,pleuriticpain,pericarditisand/or

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pericardialeffusion.
Thediseaseconsistsofpersistentlow-gradefever,chest
pain(usuallypleuritic),pericarditisand/orpericardialeffusion.The
symptomstendtooccur2?3weeksaftermyocardialinfarctionbut
canalsobedelayedafewmonths.Ittendstosubsideinafewdays,

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andveryrarelyleadstopericardialtamponade.ElevatedESRisan
objectivebutnonspecificlaboratoryfinding.
Dressler'sSyndromeisnotassociatedwithlowglucoseinpleural
fluid.
RheumatoidArthritis,MalignancyandEmpyema(Bacterial

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infections)areallestablishedcausesofpleuraleffusionwithlow
glucose.
Pleuraleffusionwithlowglucose(<60mg/c11)
1. Malignancy
2. Bacterialinfections

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3. Rheumatoidpleuritis

171.A25yearsoldladywithahistoryoffever
for1monthpresentswithheadacheand
ataxia.Brainimagingshowsdilated
ventriclesandsignificantbasal

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exudates.Whichofthefollowingwillbe
themostlikelyCSFfinding:

a)Lymphocytosis,LowGlucose,Highprotein
b)Lymphocytosis,NormalGlucose,Highprotein
c)Lymphocytosis,LowGlucose,Normalprotein

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d)Neutrophilia,Lowglucose,LowProtein
CorrectAnswer-A
Ans:A.(Lymphocytosis,LowGlucose,Highprotein)
Presenceofsignificantbasalexudates,togetherwithdilated
ventricles(hydrocephalus)inayoungfemalewith

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aprolongedhistoryoffeverandheadachesuggestsadiagnosisof
TubercularMeningitis.
TubercularMeningitisischaracterizedbyLymphocyticPleocytosis,
LowGlucoseandHighProteinwithintheCSF.
ThepathologicalhallmarkofTubercularMeningitisisthe

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predominantinvolvementofbasalcisternsthatareobservedbythe
presenceofbasalinflammatorytissueexudate.

172.Whichofthefollowingdrugcanbegiven
inpatientsofprimarypulmonary
hypertension?

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a)Icatibant
b)Bosentan
c)Labetolol
d)Sodiumnitroprusside
CorrectAnswer-B

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Answer-B.Bosentan
TreatmentforPrimarypulmonaryhypertension:
CALCIUMCHANNELBLOCKERS:
Patientswhorespondtoshort-actingvasodilatorsatthetimeof
cardiaccatheterizationshouldbetreatedwithcalciumchannel

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blockers.
Theendothelinreceptorantagonistsbosentanandambrisentanare
approvedtreatmentsofPAH
Bosentaniscontraindicatedinpatientswhoareoncyclosporineor
glyburideconcurrently.

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173.ApatientarrivedinERfollowinganRTA
withhypotension,respiratorydistress
andsubcutaneousemphysemawithno
entryofairononeside.Whatwillbethe
bestmanagement?

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a)Needledecompressionin5thintercostalspaceinthe
midaxillaryline
b)ContinuePPV
c)ShifttoICUandincubate
d)SecureIVlineandstartfluidresuscitationafterinsertionofthe

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wide-boreIVline
CorrectAnswer-A
Ans-A.Needledecompressionin5thintercostalspaceinthe
midaxillaryline
Atensionpneumothoraxdevelopswhena'one-wayvalve'airleak

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occurseitherfromthelungorthroughthechestwall.
Airissuckedintothethoraciccavitywithoutanymeansofescape,
completelycollapsingthencompressingtheaffectedlung.
Etiology-
Themostcommoncausesarepenetratingchesttrauma,bluntchest

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traumawithparenchymallunginjuryandairleakthatdidnot
spontaneouslyclose,iatrogeniclunginjury(e.g.duetocentral
venepuncture)andmechanicalpositivepressureventilation.
C/F-
Thepatientisincreasinglyrestlesswithtachypnoea,dyspnoeaand

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distendedneckveins

Treatment-
Treatmentconsistsofimmediatedecompression,initiallybyrapid
insertionofalarge-borecannulaintothesecondintercostalspacein
themidclavicularlineoftheaffectedside,thenfollowedbyinsertion

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ofachesttubethroughthefifthintercostalspaceintheanterior
axillaryline.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg367,920


174.TreatmentofRenalcellcarcinomaof

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lessthan4cmwillbe-
a)Partialnephrectomy
b)Radicalnephrectomy
c)Radicalnephrectomy+postoperativeradiotherapy
d)Radicalnephrectomy+chemotherapy

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CorrectAnswer-A
Ans:A.Partialnephrectomy
Partialnephrectomyisnowbeingusedasprimarysurgicaltherapy
forpatientswithatumorlessthan4cminsize.EarlierRadical
nephrectomywasthetreatmentofchoicefortumorsofanysize.

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Classicradicalnephrectomyconsistsofremovalofthekidney,
perirenalfat,adrenalgland,andregionallymphnodes.MoststageI
andstageIItumors.
Partialnephrectomy-isindicatedforpatientswithaT1tumor
(accordingtotheUICCTNMstagingsystem)andanormal

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contralateralkidney.
Interventionshouldbeconsideredforgrowthto>3-4cmorby
>O.5cmperyear.


StageT1aN0M0

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Partialnephrectomyrecommended.Thiscanbedonevia
open/laparoscopic/roboticprocedures
StageT1bN0M0
PN(open/laparoscopic/robotic)incaseswheretechnicallyfeasible
LaparoscopicRNshouldbeofferedifaPNisnotfeasible

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OpenRNiflaparoscopicsurgeryisnotpossible.
StageT2N0M0
RN?open/laparoscopic/robotic
PN?open/laparoscopic/robotic
StageT3

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RN?open,laparoscopicorrobotic-assisted
Resectionofvascularthrombosiswhenapplicable(usuallyopen)
Resectionofallgrossdiseaseincludinghilarorretroperitoneal
extension
PNmaybeattemptedinhighlyselectedcasesbyexperienced

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surgeons
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg1420
https://www.researchgate.net/publication/263933944_Surgical_management_of_renal_cell_carcinoma_Canadian_Kidney_Cancer_Forum_Consensus


175.WhichisnotseeninAsepsisscore-

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a)Erythema
b)Induration
c)Serousdischarge
d)Purulentexudate
CorrectAnswer-B

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Answer-B.Induration
Criterion
Points
Additionaltreatment
0

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Antibioticsforwoundinfection
10
Drainageofpusunderlocalanaesthesia
5
Debridementofwoundundergeneral

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10
anaesthesia
Serousdischarge
Daily0-5
Erythema

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Daily0-5
Purulentexudate
Daily0-10
Separationofdeeptissues
Daily0-10

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Isolationofbacteriafromwound
10
Stayasinpatientprolongedover14days
5
asresultofoundinfection

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Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg48


176.Esophagealmanometrywasperformed-
itrevealedpanesophagealpressurization
withdistalcontractileintegrityas

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>450mmHgpressureinthebody.What
willbethediagnosis?

a)Type1achalasia
b)Type2achalasia
c)Type3achalasia

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d)Jackhammeresophagus
CorrectAnswer-C
Ans:C.Type3achalasia
TypeIachalasia(classicachalasia)-
ElevatedmedianIRP(>15mmHg),100%failedperistalsis(DCl

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<100mmHg.s.cm)
PrematurecontractionswithDCIvalues<450mmHg.s.cmsatisfy
criteriaforfailedperistalsis
TypeIIachalasia(withesophagealcompression)-
ElevatedmedianIRP(>15mmHg),100%failedperistalsis,

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panesophageal
pressurisationwith>20%ofswallows.
Contractionsmaybemaskedbyoesophagealpressurizationand
DCIshouldnotbecalculated.
Typelllachalasia(spasticachalasia)

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ElevatedmedianIRP(>15mmHg),nonormalperistalsis,premature
(spastic)
contractionswithDCI>450mmHg.s.cmwith>20%ofswallows

Maybemixedwithpanesophagealpressurization
'Diffuseesophagealspasm'andjackhammer(nutcracker)

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esophagus
-
Spasticpressuresonmanometryof400-500mmHgmarked
hypertrophyofthecircularmuscleandacorkscrewesophaguson
bariumswallow.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition

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

publishedin2018Pg1096,1099


177.Whatwillbetheappropriate
managementforAbdominalaortic
aneurysm-

a)Monitortillsizereaches55mm

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b)Immediatesurgery
c)USGmonitoringtill>70mmasymptomatic
d)Notreatment
CorrectAnswer-A
Answer-A.Monitortillsizereaches55mm

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Anasymptomaticabdominalaorticaneurysm
inanotherwisefit
patientshouldbeconsideredforrepairif>55mmindiameter
(measuredbyultrasonography).
Regularultrasonographicassessmentisindicatedforasymptomatic
aneurysms<55mmindiameter.

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75%ofaneurysmsaresuitableforendovascular(minimallyinvasive)
repair,usuallyviathefemoralarteriesinthegroin.
Rupturedabdominalaorticaneurysmisasurgicalemergency.
SymptomaticAAA-
Anoperationisusuallyindicatedinpatientswhoareotherwise

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reasonablyfit.Painmaybeawarningsignofstretchingofthe
aneurysmsacandimminentrupture;surgeryshouldbeperformed
assoonaspossible(usuallyonthenextavailableoperatinglist).
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg961

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178.WhatistheTstageofa2.5cmlung
carcinoma,notinvolvingthepleura?
a)T1a
b)T2

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c)T1b
d)T1c
CorrectAnswer-D
Ans:D.T1c
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition

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publishedin2018Pg927

179.In,theprimarysurveywhichisnot
included-
a)CECTtolookforbleeding
b)Exposureofthewholebody

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c)ABC
d)RecordingBP
CorrectAnswer-A
Answer?A.CECTtolookforbleeding
Theprimarysurveyaimstoidentifyandmanagethemost

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immediatelylife-threateningpathologiesfirstandfollowscABCDE.
1.c-Exsanguinatingexternalhemorrhage
2.A-airwaywithcervicalspinecontrol
3.B-Breathing&ventilation
4.C-Circulation&hemorrhage

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5.D-Disability
6.E-Exposure
Anassessmentofthehemodynamicstatusshouldbemadeto
identifyshockedpatients:theskinmaybepale,coolandsweaty,the
pulserateraisedtoover100perminuteandthebloodpressure

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low.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg323


180.MClocationofgastrinomainMEN-1
syndrome?

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

a)Duodenum
b)Jejunum
c)Pancreas
d)Ileum
CorrectAnswer-A

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

Answer-A.Duodenum
PETsoccurinaround50-60VoofMEN1patients.
Themostcommonfunctionaltumourisgastrinomainduodenum
followedbyinsulinoma.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition

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

publishedin2018Pg856


181.Patientshaveprecancerouslesionswith
abdominalswellingandinguinalnodes
areseen.Onexamination,
lymphadenopathywasfound.Themost

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probablecarcinomarelatedtothis
conditionwillbe?

a)capenis
b)CaTestis
c)caprostate

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d)cabladder
CorrectAnswer-A
Answer-A.capenis
Cancerpenisspreadstoinguinalnodes.
Amass,pruritusordischargeiscommon.Advancedtumoursmay

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

causefecalincontinencebytheinvasionofthesphincters.
Analcanaltumoursarepalpableandirregularinduratedtender
ulceration.Sphincterinvolvementmaybeevident.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg1371

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


182.Amanunderalcoholintoxicationhad
fallenintoamanholeandhadaperineal
injurywithswollenscrotumandupper
thighalongwithbloodatmeatus.The
patientishavingdifficultypassingurine

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aswell.Whatwillbetheinjury
associatedduetothistrauma?

a)Bladderrupture
b)Penilefracture
c)Bulbarurethra

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

d)Membranousurethra
CorrectAnswer-C
Answer-C.Bulbarurethra
Thereisahistoryofablowtotheperineum,usuallyduetoafall
astrideinjury.Thebulbarurethraiscrushedupwardsontothepubic

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

bone,typicallywithsignificantbruising.
Cyclingaccidents,loosemanholecoversandgymnasiumaccidents
astridethebeamaccountforanumberofcases.C/F
Thesignsofarupturedbulbarurethraareperinealbruisingand
hematoma,typicallywithabutterflydistribution.Thereisusually

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

bleedingfromtheurethralmeatusandretentionofurineisalso
typicallypresent.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg1479,1480


183.Patientwithahistoryofcarcinoma

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bladderpresentingwithdyspnoeawith
clinicalsignsofDVTandtachycardia.
Theriskforthepatienttodevelop
Pulmonaryembolismaccordingto
WELL'sscore

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

a)High
b)Medium
c)Low
d)Cannotcommentwithoutd-dimervalues
CorrectAnswer-B

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

Ans.B.Medium
Wellscriteria
Score
High
>6.0

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

Moderate
2.0to6.0
Low
<2.0
ModifiedWellscriteria Score

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

PElikely
>4.0
PEunlikely
<or=4.0
ModifiedWellsCriteriaforDVT

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

Variable
Score
Lowerlimbtraumaorsurgeryorimmobilisationin
1
plastercast

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


Bedriddenfor>3daysorsurgeryinthelast4weeks
1
Tendernessalongthelineoffemoralorpoplitealveins
1
Entirelimbswollen

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

1
Calf>3cmlargercircumferencethantheotherside
1
10cmbelowthetibialtuberosity
1

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

Pittingedema
1
Dilatedcollateralsuperficialveins(notvaricoseveins)
1
PreviousDVT

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

1
Malignancy(includingtreatmentupto6monthsago)
1
Intravenousdrugabuse
3

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

AlternativediagnosismorelikelythanDVT
-2
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg988


184.After4monthsofrenaltransplantation,a

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

patientcanlikelytodevelopwhich
infection-

a)EBV
b)CMV
c)Candida

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

d)Histoplasma
CorrectAnswer-B
Answer-B.CMV
Causesofallograftdysfunction

1.Early

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

Primarynon-function(irreversibleischaemicdamage)
Delayedfunction(reversibleischaemicinjury)
Hyperacuteandacuterejection
Arterialorvenousthrombosisofthegraftvessels
Drugtoxicity(e.g.calcineurininhibitortoxicity)

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

Infection(e.9.cytomegalovirusdiseaseingraft
Mechanicalobstruction(ureter/commonbileduct)
2.Late
Chronicrejection
Arterialstenosis

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

Recurrenceoforiginaldiseaseinthegraft(glomerulonephritis,
hepatitisC)
Mechanicalobstruction(ureter,commonbileduct)
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg1551

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


185.Thepatientispresentwithfecal
peritonitisandduringlaparotomy,a
diverticularperforationisseen.Which
stageisclassifiedaccordingto
Hinchey'sstage?

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

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

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

Answer-D.4
Hincheyclassificationofcomplicateddiverticulitis.

1. GradeIMesentericorpericolicabscess
2. GradellPelvicabscess
3. GradelllPurulentperitonitis

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

4. GradelVFaecalperitonitis
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg1274


186.Ayoungmanmetwithamotorbike
accidentandhadinjuriestoileumand

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

jejunum.Thereforetheentireileumand
partialjejunumwereresected.Whichof
thefollowingwouldthepatientsuffer
from

a)VitaminB12deficiency

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

b)Atrophicgastritis
c)Constipation
d)None
CorrectAnswer-A
Answer-A.VitaminB12deficiency

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

TheileumistheonlysiteofabsorptionofvitaminB12andbilesalts.
Bilesaltsareessentialfortheabsorptionoffatsandfat-soluble
vitamins.
Followingresectionoftheileum,thelossofbilesaltsincreasesand
isnotmetbyanincreaseinsynthesis.

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

Thejejunumistheprincipalsitefordigestionandabsorptionoffluid,
electrolytes,iron,folate,fat,proteinandcarbohydrate,butthe
absorptionofbilesaltsandvitaminB12onlyoccursintheterminal
ileum,wheretherearespecifictransporters.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition

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

publishedin2018Pg283,1241


187.Apatientafteraheavymealcomeswith
epigastricpain.Onexamination
tendernessandrigidityintheupper
abdomen.X-rayshowing

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

pneumomediastinum.Whatcanbethe
cause-

a)Spontaneousesophagealrupture
b)Penetratingforeignbodyinjurytoesophagus
c)Perforatedpepticulcer

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

d)Ruptureofemphysematousbulla
CorrectAnswer-A
Answer-A.Spontaneousesophagealrupture
Thisisaclinicalcaseofspontaneousesophagealrupture/
Boerhaave'ssyndrome

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

Theclinicalhistoryisusuallyofseverepaininthechestorupper
abdomenafteramealoraboutofdrinking.
Mackler'striad,whichconsistsof(1)vomitingfollowedby(2)chest
painand(3)subcutaneousemphysemaduetoanesophageal
rupture.

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

Achestradiographisoftenconfirmedwithairinthemediastinum,
pleuraorperitoneum.
InvestigationsChestX-ray--showspneumomdiastinum(`V'signof
Naclerio).
MRI/CTchest.

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

Totalcount.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition

publishedin2018Pg1073
SriramBhatM,SRB'sManualofSurgery,4theditionpublished
in2013,Pg856

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


188.Transplantationbetweenidenticaltwins-
a)Isograft
b)Allograft
c)Autograft
d)Xenograft

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

CorrectAnswer-A
Answer-A.Isograft
Graft:Itisthetransferoftissuefromoneareatoanotherwithoutits
bloodsupplyornervesupply.
Autograft:Itistissuetransferredfromonelocationtoanotheronthe

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

samepatient.
Isograft:Itistissuetransferbetweentwogeneticallyidentical
individuals,i.e.betweentwoidenticaltwins.
Allograft:Itistissuetransferbetweentwogeneticallydifferent
members,e.g.kidneytransplantation(Humantohuman)

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

(Homograft).
Xenograft:Itistissuetransferfromadonorofonespeciestoa
recipientofanotherspecies(Heterograft).


189.Thoracoscore,whatisnotthe

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

component
a)ASACLASSIFICATIONS
b)SURGERYPRIORITIES
c)Performancestatus
d)Expectedcomplicationspost-surgery

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

CorrectAnswer-B
Answer-B.SURGERYPRIORITIES
TheThoracoscoreisthemostwidelyusedmodeltoassesstherisk
ofoperativemortalityinthoracicpatients

Ref-BaileyandLove,Shortpracticeofsurgery,27thedition

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

publishedin2018Pg915


190.Retrosternalgoiterwhichistrue?
a)AllpatientsshouldundergoCTchest
b)Allpatientsrequireamediansternotomy
c)itreceivesbloodsupplyfromthoracicvessels

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

d)Majorityofretrosternalgoitresshouldbeoperatedimmediately
CorrectAnswer-A
Answer-A.AllpatientsshouldundergoCTchest
Retrosternalgoitretendstoarisefromtheslowgrowthofa
multinodularglanddownintothemediastinum.

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

Itgetsitsbloodsupplyfromthemediastinumitself,notfromthe
neck.
Investigations
AchestX-rayshowsasofttissueshadowunderthesternum.
Aradioactiveiodinestudyisdiagnostic.

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

CTscan/MRIisusefulandallpatientsshouldundergoit.
Surgicalremovalofretrosternalthyroidisdone.(TOC)
Commonlyitcanberemovedthroughanincisionintheneck.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg810

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

SriramBhatM,SRB'sManualofSurgery,4theditionpublished
in2013,Pg498


191.TrueforKing'sCriteriawithacute
fulminantliverfailureexcept-
a)Age

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

b)Jaundice<7days
c)Serumbilirubin>17.5mg/dl
d)INR>3.5
CorrectAnswer-B
Answer-B.Jaundice<7days

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

King'sCollegecriteriaforlivertransplantationinAHF.

APAP-associatedAHF-
pH?<?7.3
or
INR?>?6.5,serumcreatinine>3.4mg/dl,andgradeIII-IV

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

encephalopathy
AllothercausesofAHF
INR>6.5
Or
Threeofthefollowingvariables:

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

1.Age40years
2.ThecauseisnonA,nonBhepatitisoridiosyncraticdrugreaction
3.Durationofjaundicebeforeencephalopathy>7days
4.INR?>?3.5
5.Serumbilirubin>17.5mg/dl

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

APAP,acetaminophen;INR,internationalnormalizedratio.

192.Apatientwhowaspostedforelective
inguinalherniasurgeryhashistoryMIfor
whichheunderwentCABG.Whatwill
youdoinpreoperativeassessment?

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

a)History+c/e+routinelabs+angiographytolookforstent
patency
b)History+c/e+routinelabs
c)History+c/e+routinelabs+stresstest
d)History+c/e+routinelabs+V/Qscan

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

CorrectAnswer-C
Answer-C.History+c/e+routinelabs+stresstest
InthegivenscenariothepatienthadundergoneCABGnotan
angioplasty,sothefirstoptionisruledout.
Withroutinelabtests,thestresstestshouldbeincludedtocheckthe

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

cardiacfunctionaspreoperativeassessment

193.Historyoftraumawithastabinjuryto
therightlowerchestwithlowBPandlow
pulserate.ItcanbeimprovedwithIV
fluidsandafterresuscitationinthe

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

traumacenterpatient'sBPbecomes
normal.AchestX-rayshowedclearlung
fields.Whatwillbethenextstep-

a)EFAST
b)Keepimmediatechesttube

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

c)CECTabdomen
d)CECTchest
CorrectAnswer-A
Answer-A.EFAST
Investigationsaredrivenbythecardiovascularstatusofthepatient.

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

Intorsotrauma,thebestandmostsensitivemodalityisaCTscan
withintravenouscontrastforbluntinjuryifthepatientisstable.
Routineinvestigationintheemergencydepartmentofinjurytothe
chestisbasedonclinicalexamination,supplementedbychest
radiography.

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Ultrasoundcanbeusedtodifferentiatebetweencontusionandthe
actualpresenceofblood.
Extendedfocusedassessmentwithsonarfortrauma(eFAST)is
becomingthemostcommoninvestigation.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition

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

publishedin2018Pg366,372


194.Inapatientwithparathyroidadenoma,
howdoweconfirmtheremovalofthe
correctglandaftersurgery?

a)50%reductioninPTHafter10mins

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b)50%reductioninPTHafter5mins
c)25%reductioninPTHafter10mins
d)25%reductioninPTHafter5mins
CorrectAnswer-A
Answer-A.50%reductioninPTHafter10mins

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

Miamicriteria
TheIOPTHvaluesatbaseline(pre-incisionandpreexcision)andat
5and10minutesafterparathyroidectomywerereviewedaccording
totheMiamicriterion(>50%dropfromhighestbaselineIOPTHlevel
at10minutesafterexcision),criterion1(>50%dropfrompre-

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

incisionIOPTHlevelat10minutes),criterion2(>50%dropfromthe
highestbaselineIOPTHlevelat10minutesandfinalIOPTHlevel
withinthereferencerange),criterion3(>50%dropfromthehighest
baselineIOPTHlevelat10minutesandfinalIOPTHlevellessthan
thepre-incisionvalue),criterion4(>50%dropfromthehighest

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

baselineIOPTHlevelat5minutes),andcriterion5(>50%dropfrom
preexcisionIOPTHlevelat10minutes).
Ref-https://www.ncbi.nlm.nih.gov/pubmed/16702520

195.Flapcommonlyusedinbreast
reconstructionis?

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a)DIEPbasedondeepinferiorepigastricvessels
b)TRAMbasedonsuperiorglutealvessels
c)Glutealflapbasedonthoracodorsalartery
d)Latissimusdorsiflapbasedontheinferiorepigastricartery
CorrectAnswer-A

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

Answer-A.DIEPbasedondeepinferiorepigastricvessels
DIEPflap(basedondeepinferiorepigastricvessels)
TRAMflapbasedonItiseithersuperiorpediclebasedonthe
superiorepigastricvesselsorinferiorpediclebasedontheinferior
epigastricvessels.

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

Latissimusdorsimuscle/myocutaneousflapItisbasedonthe
thoracodorsalartery,abranchofthesubscapularartery
Superiorglutealflapbasedonsuperiorglutealvessels.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg879

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SriramBhatM,SRB'sManualofSurgery,4theditionpublished
in2013,Pg350,594


196.A30-year-oldmanispresentedwith
crampingglutealpainafterwalking
500m.Whichisthevesselinvolved

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duringthis?

a)Arterialdiseasewithaortoiliacinvolvement
b)Arterialdiseasewithfemoralarteryinvolvement
c)Femoralvenousinsufficiency
d)None

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

CorrectAnswer-A
Answer-A.Arterialdiseasewithaortoiliacinvolvement
Themusclegroupaffectedbyclaudicationisclassicallyone
anatomicallevelbelowthelevelofarterialdiseaseandisusuallyfelt
inthecalfbecausethesuperficialfemoralarteryisthemost

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

commonlyaffectedartery(70%ofcases).
Aorto-iliacdisease(30%ofcases)maycausethighorbuttock
claudication.Buttockclaudicationinassociationwithsexual
impotenceresultingfromarterialinsufficiencyiseponymouslycalled
Leriche'ssyndrome.Itisveryrare.

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Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg943


197.Whichisthemostcommonpancreatic
endocrineneoplasm?
a)Insulinoma

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b)Gastrinoma
c)VIPoma
d)Glucagonoma
CorrectAnswer-A
Answer-A.Insulinoma

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Insulinoma(70-80%)>Nonfunctionaltumours(30-35%)>
gastrinoma(20-25%)

198.Anelderlymanwithalong-standing
moleoverthefacewhichisincreasingin
sizeandshowingirregularborders.What

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willbethediagnosis?

a)Superficialspreadingmelanoma
b)Lentigomaligna
c)Acralmelanoma
d)Nodularmelanoma

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

CorrectAnswer-A
Answer-A.Superficialspreadingmelanoma
Superficialspreadingmelanoma

Thisisthemostcommonpresentation(70%)usuallyarisinginapre-
existentnaevusafterseveralyearsofslowchange,followedby

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rapidgrowthintheprecedingmonthsbeforepresentation.
Nodularmelanoma(NM)Nodularmelanomaaccountsforl5%olall
MM.
Typicallyappearasblue/blackpapules,l-2cmindiameter,and
becausetheylackthehorizontalgrowthphase.

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Lentigomalignamelanoma-
Presentsasaslow-growing,variegatedbrownmaculeontheface,
neckorhandsoftheelderly.
Acrallentiginousmelanoma(ALM)ALMaffectsthesolesoffeet
andpalmsofhands.

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Itusuallypresentsasaflat,irregularmaculeinlaterlife.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg610


199.Whichparameterconclusivelyrulesout
malnutrition?

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

a)Edema
b)Leanbodymass
c)Skinfoldthickness
d)NormalECFvolume
CorrectAnswer-B

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

Ans.B.Leanbodymass
Measuringweightandheightisthemostcommonwayofassessing
malnutritioninagivenpopulation.Suchuseofmeasurementsof
dimensionsofthehumanbodyisknownasanthropometry.
Anthropometryisawidelyused,inexpensiveandnoninvasive

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

measureofthegeneralnutritionalstatusofanindividualora
populationgroup.Thethreecommonlyusedanthropometricindices
are:
-Weight-for-Age{WFA).
-Length-for-AgeorHeight-For-Age(HFA).

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-Weight-for-LengthorWeight-for-Height{WFH).
PEMreducesgrowthinchildren
Energyexpenditureinexcessofconsumptionleadstometabolizing
nutritionreservesintheformofstoredbodyfat.
Leanbodymassintheformofmuscleandevenorgantissuewill

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

alsobeconsumedifPEMpersists.itservesasareliableindicator
forPEM
Weightlossaccompaniestheinitialstagesofinadequateenergy
intakebut,ifprolonged,isfollowedbywasting,calledinitssevere
clinicalform,marasmus.

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Inchildren,PEMdelaysorpermanentlystuntsgrowthandincreases

morbidityandmortality.
Ref.ParkPSMed.24thPageno.677

200.A2yearsbabywith6.7kg,Hb%-6mg/dl
totalprotein3mg/dL,lowalbuminwith

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distendedstomachbutnoproteinuria.
Whatwillbethediagnosis?

a)Marasmus
b)Kwashiorkor
c)Indianchildhoodcirrhosis

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d)None
CorrectAnswer-B
Ans.B.Kwashiorkor
Kwashiorkorisaformofsevereacutemalnutrition(SAM)
characterizedbyedemaandapathy.

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Edemaismostlikelytoappearfirstonthefeetandtheninthelower
legs.Itcandevelopintogeneralizededemaaffectingthehands,
arms,andface.
Moonface
Skinchangesincludedepigmentationofskin,dermatoses,dark,

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crackedpeelingpatches(flakypaintdermatosis)withpaleskin
underneaththatiseasilyinfected.
Hairissparse,easilypulledout,andmayturnreddish.
Flagsign:alternatingbandsofhypopigmentedandnormal
pigmentedareasonthehairstrand

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Theliverisoftenenlargedwithfat(fattyLiver).
Thechildrenaremiserableandapatheticandoftenrefusetoeat.
Musclewastingandgrowthfailureareseen.
Villousatrophyofsmallintestineanddiarrhea.


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NelsonTextbookofPediatrics20thEditionPage:301

201.InRDSinachild,whichcellsarefound
defective?
a)Type1pneumocytes
b)Type2pneumocytes

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

c)Bronchialepithelium
d)None
CorrectAnswer-B
Ans.B.Type2pneumocytes
TypeIcellsformthealveolarwallwhiletheTypeIIcellssynthesize

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andsecretesurfactantDPCC.
ThedefectinthebiosynthesisofDipalmitoylphosphatidylcholine
(DPPC),alsoknownasdipalmitoyllecithinleadstoRespiratory
distresssyndrome.
Ref.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880575/

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202.Causeofgreenish-blackstoolina
neonate-
a)Meconium
b)Biliverdin
c)Bilirubin

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d)Urochrome
CorrectAnswer-B
Ans.B.Biliverdin
Fetalbowelcontentsconsistofvariousproductsofsecretion,such
asglycerophospholipidsfromthelung,desquamatedfetalcells,

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lanugo,scalphair,andvernix.Italsocontainsundigesteddebris
fromtheswallowedamnionicfluid.Thedarkgreenish-blackis
causedbypigments,especiallybiliverdin.
Ref.WilliamsObstetricsEd.24thPageno.141

203.Atermbabyonbreastfeedingwith

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bilirubin14mg/dLwhichofthefollowing
istrue?

a)Exchangetransfusion
b)Continuetobreastfeed
c)Phototherapy

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d)None
CorrectAnswer-B
Ans.B.Continuetobreastfeed
Comparedwithformula-fednewborns,breastfedinfantsarethreeto
sixtimesmorelikelytoexperiencemoderatejaundice(totalserum

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

bilirubinlevelabove12mgperdL)orseverejaundice(totalserum
bilirubinlevelabove15mgperdL.
Inabreastfednewbornwithearly-onsethyperbilirubinemia,the
frequencyoffeedingsneedstobeincreasedtomorethan10per
day.Iftheinfanthasadeclineinweightgain,delayedstooling,and

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

continuedpoorcaloricintake,formulasupplementationmaybe
necessary,butbreastfeedingshouldbecontinuedtomaintainbreast
milkproduction.
Phototherapyusuallynotrecommendedwhenthetotalserum
bilirubinlevelisbelow15mgperdL.

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

Ref:https://www.aafp.org/afp/2002/0215/p599.html

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

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

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

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

205.APGARscore3at1minuteindicates:
a)Mildlydepressed
b)Furtherresuscitationnotneeded

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c)Severelydepressed
d)Normal
CorrectAnswer-C
Ans.C.Severelydepressed
APGARCRITERIA:

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Component
Scoreof
Scoreof1
Scoreof2
of

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0
backronym
blueat
nocyanosis
blueor

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

extremities
bodyand
Skincolor
paleall
Appearance

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

bodypink
extremities
over
(acrocyanosis) pink
<100beatsper >100beats

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Pulserate
absent
Pulse
minute
perminute

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no
grimaceon
Reflex
response suctionor
cryon

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

irritability
Grimace
to
aggressive
stimulation

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grimace
stimulation stimulation
flexedarms
andlegsthat
Activity

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none
someflexion
Activity
resist
extension

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Respiratory
weak,irregular, strong,robust
absent
Respiration
effort

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gasping
cry

INTERPRETATION:
Thetestisgenerallydoneat1and5minutesafterbirthandmaybe
repeatedlaterifthescoreisandremainslow.

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Scores7andabovearegenerallynormal
Score4to6,fairlylow
Score:3andbelowaregenerallyregardedascriticallylowand
causeforimmediateresuscitativeefforts.

206.Awomandevelopedpainandcrawling

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sensationonherlegsatnight.Clinical
historyofrestlesslegsyndrome.Drugof
choice?.

a)Pramipexole
b)Gabapentin

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c)VitaminB12
d)Irontablets
CorrectAnswer-A
Ans.apramipexole
Restlesslegsyndrome:

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

Subjectivesensation"creepy-crawly"feelinginthelimbs,and
irresistibleurgetomovethelegswhenatrestorwhiletryingtofall
asleep.
Whentheindividualislyinginbedandrelaxing,heorsheis
disturbedbythesesensations.

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Thenheorshemovesthelegsandagaintriestofallasleep.
Thiscyclesometimescontinuesforhoursandresultsinprofound
insomnia.
Treatment:
Thedopaminergicagonists'pramipexoleandropiniroleareFDA

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approvedandrepresentthetreatmentsofchoice.
Ref.KaplanandSadock'sSynopsisofPsychiatry-11thEdition
(Pageno559)


207.HistoryofArthritisinvolving1stMCP
joint,otherPIP&DIPjoints,spareswrist

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andankle.Whatcouldbethediagnosis

a)Osteoarthritis
b)Rheumatoidarthritis
c)Psoriaticarthritis
d)Gout

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

CorrectAnswer-A
Ans:a.Osteoarthritis
>Thedistalinterphalangeal(DIP)jointisactuallythemostcommon
locationonthebodyforosteoarthritis(OA).
>Thefrequencyofhandarthritis,OAattheDIPjointoccursin

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

approximately58%ofindividuals.
>ThesymptomsofOAattheDIPjointcommonlyincludepainand
changestothesizeandshapeofthejoint.
https://www.3pointproducts.com/blog/health-arthritis-finger-
and-toe-conditions/dip-joint-osteoarthritis-how-to-treat-this-

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common-form-of-arthritis


208.12yroldChildadmittedtoICUwithblunt
traumaandfemurfracture-Pao260%
despite100%o2andrebreathermask,
CXRshowslungfieldsclearbutthe

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patientremainsconfused.Whatismost
likelythediagnosis-

a)Pulmonarycontusion.
b)Fatembolismsyndrome.
c)Hypovolaemicshock.

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

d)Pulmonaryembolism.
CorrectAnswer-B
Ans:b.Fatembolism.
Inthispatient,basedonthecasepresentationthereisRespiratory
Systeminvolvedaspao2is60,andCNSinvolvementasheisina

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confusedstate.
>So,thediagnosishereisFatembolismsyndrome.
>Embolizedfatwithincapillarybedscausedirecttissuedamageas
wellasinduceasystemicinflammatoryresponseresultingin
pulmonary,cutaneous,neurological,andretinalsymptoms.

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

>Gurd'sclinicaldescriptionoftheFESrenewedinterestinstudying
thissyndrome
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665122/

209.A4yroldchildwhileplayingsuddenly
spunaroundhiselbowfromherservant

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maid'shandandnowcontinuously
cryingnotallowinganyonetotouchhis
elbow.Heiskeepinghiselbowextended
.whatismostlikelythediagnosis-

a)Radialheadfracture

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

b)Pulledelbow
c)supracondylarfracture
d)Elbowdislocation
CorrectAnswer-B
Ans:b.Pulledelbow

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

>Pulledelbow,alsocallednursemaid'selbow,isaradialhead
subluxationcausedbyaxialtractionorasuddenpulloftheextended
pronatedarm,anditisaverycommonphenomenon.
>Inthiscaseofpulledelbow,thechildusuallyavoidsmovingthe
affectedarm,holdingitclosetohisorherbody,withoutconsiderable

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

pain,andnoobviousswellingordeformitycanbeseen.
>Whileafractureshouldbeexcluded,thepulledelbowcanusually
beidentifiedbasedonthispresentation.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999240/

210.Asexuallyactivefemalewiththeprofuse

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frothyfoul-smellingdischargewith
intenseitching.Strawberrycervix
revealedonexamination.Whatwillbe
thediagnosis?

a)Trichomonasvaginalis

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

b)Bacterialvaginosis
c)Candidiasis
d)None
CorrectAnswer-A
Answer:a.Trichomonasvaginalis

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

Trichomonasvaginitis:
ClinicalFeatures:
Thereissuddenprofuseandoffensivevaginaldischargeoften
datingfromthelastmenstruation.
Irritationanditchingofvaryingdegreeswithinandaroundthe

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

introitusarecommon.
Thereisthepresenceofurinarysymptomssuchasdysuriaand
frequencyofmicturition.
Theremaybehistoryofprevioussimilarattacks
OnExamination:

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

Thereisthin,greenish-yellowandfrothyoffensivedischargeper
vaginum.
Thevulvaisinflamedwithevidencesofpruritus.
Vaginalexaminationmaybepainful.Thevaginalwallsbecomered
andinflamedwithmultiplepunctatehemorrhagicspots.Similarspots

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arealsofoundoverthemucosaoftheportiovaginalispartofthe
cervixonspeculumexaminationgivingtheappearanceof
`strawberry'
Ref:DuttaGynaecology6theditionPageno.163-164

211.33yroldfemalewithheavymenstrual

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bleedingfor6monthscomestothe
gynaecologyOPD.Onexamination,no
abnormalitywasseen.USGalso
appearednormal.Thepatientwastried
tobemanagedonnon-hormonal

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treatmentbutitfailed.Whatwillbethe
nextmanagementstep?

a)Hormonaltherapy
b)Endometrialsampling
c)Hysterectomy

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

d)Hysterectomy
CorrectAnswer-B
Ans.B.Endometrialsampling
BeforestartingHormonaltherapyendometrialsamplingisdoneasif
hormonaltherapyprecedessamplingthesamplingresultswillbe

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

altered.
AsalreadymentionedinquestiontheUSGandclinicalexamination
shownoabnormalityhencethediagnosiscan'tbemadeonthatso
fordiagnosisweneedtodoendometrialsamplingandseethe
hormonalpattern.Thenwecanproceedwithhormonaltherapy.

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

Ref.DuttaGynaecologyed.6thpageno.120

212.Postmenopausalwomen1stlineofdrug
forosteoporosisis-
a)OCP
b)Bisphosphonates

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

c)Raloxifene
d)Strontium
CorrectAnswer-B
Ans.is.B.Bisphosphonates
Firstlineofmanagementofosteoporosis?Bisphosphonates

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females.
Alendronate,etidronate,pamidronate,andIbandronateare
bisphosphonateswhichinhibitboneresorption,andarevery
effectiveforbothosteoporosispreventionandtreatment.
Uses:

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

Firstlinedrugsfortreatingpostmenopausalosteoporosis
Paget'sdisease
Osteolyticbonemetastasis.
Raloxifene:Itisaselectiveestrogenreceptormodulatorwhichis
alsousefulinmanagementofosteoporosisbutitisahormonal

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

preparation.

213.Prolactinsecretedmaximumat-
a)24hrsafterdelivery
b)REM
c)2hrsrunning

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d)24hourafterOvulation
CorrectAnswer-A
Ans.A.24hrsafterdelivery
Prolactinismaximum24hrsafterdelivery.
Prolactinsecretionalsoincreasesduringstrenuousexerciseand

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sleep(NREM).
24hrsafterovulationestrogenhasanegativefeedbackeffecton
prolactinwhichdecreasesthelevelofprolactin.

214.Allareusedforpostcoitalcontraception
except-

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

a)CuT
b)Ru486
c)Highdoseestrogen
d)Danazol
CorrectAnswer-D

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

Ans.D.Danazol
EMERGENCYCONTRACEPTIVES:

Drug
Dose
PREGNANCY

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

RATE

Levonorgestrel
0.75mgstatand
0?1
after12hours

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

Ethinylestradiol50?g+
2tabstatand2after 0?2
norgestrel0.25mg
12hours
Ethinylestradiol

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

2.5mgBd?5days
0?0.6
Mifepristone
100mgsingledose
0?0.6

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

CopperIuds(Goldstandard)
Insertionwithin5
0?0.1
days
(RU486Mifepristone)

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

30mgPO
0?1
(ulipristalacetate)
Ref:DUTTAGYNAECOLOGYED.6THPAGENO.492

215.Apatientdeliveredathomewitha

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completeperinealtearcametothe
hospitalafter2weeks.What
managementwillyouprefer?

a)Immediaterepair
b)Repair3weekspost-delivery

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

c)Repair6weekspost-delivery
d)Repair3monthspost-delivery
CorrectAnswer-D
Ans.D.Repair3monthspost-delivery
Therecenttearsshouldberepairedimmediatelyfollowingthe

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

deliveryoftheplacenta.Thisreducesthechanceofinfectionand
minimizesbloodloss.
Incasesofdelaybeyond24hours,therepairistobewithheld.
Antibioticsshouldbestartedtopreventinfection.
Thecompletetearshouldberepairedafter3monthsifdelayed

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

beyond24hours.
Incaseofanydoubttothegrade3rd-degreetear,itisadvisableto
classifytoahigherdegreeratherthanalowerdegree.
Ref.ObsDutta24theditionPageno.490

216.InModernobstetrics,forsensitizedRh-

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negativemotherwhatshouldbedoneto
evaluatetheconditionofthemother?

a)MCAdopplerpeaksystolicvolume
b)Fetalblood
c)Amniocentesis

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

d)Biophysicalprofile
CorrectAnswer-A
Ans.A.MCAdopplerpeaksystolicvolume
Dopplerultrasound:SerialDopplerstudyofthemiddlecerebral
artery(MCA)-peaksystolicvelocity(PSV)isthemainstaytoassess

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

fetalanemia.Avalue>1.5multiplesofthemedian(MOMs)forthe
correspondinggestationalage,predictsmoderatetoseverefetal
anemia.
Thisvalue(between24weeksand35weeksofgestation),isan
indicationforcordocentesisandfetaltransfusion

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MostcentershavereplacedserialamniocentesiswithserialMCA
Dopplerstudies.
Ref.OBstetricsDuttaed.8thpg.391

217.A7weekspregnantladyhas1accidental
exposuretox-ray.Whichofthefollowing

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shouldbedone?

a)Continuepregnancy
b)Terminatepregnancy
c)Chromosomeanalysis
d)Preinvasivediagnostictesting

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CorrectAnswer-A
Ans.A.Continuepregnancy
ExposuretoX-rayhasaverylowrangeofradsoingivencase
scenarioPregnancywillbecontinued.
Exposure>15radduringthesecondandthirdtrimesteror>5radin

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thefirsttrimesterneedspatientcounseling.Electiveterminationof
pregnancymaybeconsidered.
Ref.OBSDutta8theditionPageno.740
William'sObs24theditionPageno.931Tableno46-5


218.A32-year-oldwomancomplainsof

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amenorrheasincethedeliveryofababy
15monthspreviously,despitethefact
thatshedidnotbreastfeedherbaby.The
deliverywascomplicatedbyexcessive
hemorrhagethatrequiredatransfusion

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of2.5litersofblood.Shehasalsobeen
fatiguedandhasgainedanadditional
4.5Kgsincethebabywasborn.
Laboratorydatashowthefollowing:
SerumLH<1IU/L(normal,4-24IU/L)

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Serumestradiol5pg/mL(normal,20-
100pg/mL)
SerumTSH0.1mU/L(normal,0.5-5
mU/L)
SerumGH3ng/mL(normal,<5ng/mL)

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SerumACTH28pg/mL(normal,10-50
pg/mL)
Serumprolactin2ng/mL(normal,
Injectionof500gofTRHfailedto
producetheexpectedriseinbothserum

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TSHandprolactin.Whichofthe
followingdiagnosesmostlikelyexplains
thefindingsinthispatient?

a)Hashimoto'sthyroiditis
b)Isolatedgonadotropindeficiency

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b)Isolatedgonadotropindeficiency
c)Primaryamenorrhea
d)Sheehan'ssyndrome
CorrectAnswer-D
Ans.D.Sheehan'ssyndrome

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Sheehan'ssyndrome
Itishypopituitarismduetoischemicdamagetothepituitaryresulting
fromexcessivehemorrhageduringparturition.
Thepituitaryisenlargedduringpregnancy;itismoremetabolically
active,andmoresusceptibletohypoxemia.

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Furthermore,thebloodvesselsinthepituitarymaybemore
susceptibletovasospasmbecauseofthehighestrogen.
Inabout30%ofwomenwhohemorrhageexcessivelyduring
parturition,somedegreeofhypopituitarismeventuallybecomes
manifest.

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Thesymptomsdependonhowmuchofthepituitaryisdamagedand
whatcelltypesaredestroyed.Thepatientdescribedaboveexhibited
persistentamenorrheaafterthedeliveryofherinfant.
Thisisduetothedestructionofpituitarygonadotrophsand
diminishedsecretionofgonadotropins(LH).

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Therealsoappearstohavebeensignificantdestructionof
lactotrophssinceTRHinjectionfailedtoinduceanincreasein
prolactin.
Hadthewomenattemptedtobreastfeedherinfant,afailureto
lactatemostlylikelywouldhaveoccurred.

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Thiscaseisalsocharacterizedbysecondaryhypothyroidism.
ThelowTSHandfailuretorespondtoTRHinjectionare
confirmatory.
CorticotrophsappeartohavebeensparedsinceplasmaACTHis
normal.

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Itisnotclearwhethersomatotrophsweredamaged.
FurthertestingwouldbeneededtoseeifGHreserveisdiminished.

Ref.WilliamObs.ed.24thpageno.798,1163
DuttaGynaecology6thed.Pageno.465


219.Meiosisoccursin

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a)Adultovary
b)Prepubertaltestis
c)Atbirthinovary
d)All
CorrectAnswer-A

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Ans.is.A.Adultovary
Meiosis1iscompletedatpubertyhenceanswerisadultovary
Totalnumberofoocytesat20weeksofintrauterinelifeisabout6?7
million.Atbirth,thetotalnumberofprimordialfolliclesisestimatedto
beabout2million.Theprimaryoocytesdonotfinishthefirstmeiotic

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divisionuntilpubertyisreached.
Spermatogenesisoccursatpubertysoitcannothappenin
prepubertaltestis.

220.DCDAtwins,38wks,firsttwinbreech
motherhasBP140/96,1+proteinuria

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what'sthemanagement

a)ImmediateLSCS
b)Inductionat40weeks
c)Immediateinductionanddelivery
d)Inductionifsignsofpreeclampsia

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CorrectAnswer-A
ANS.A.ImmediateLSCS
CASEDISCUSSION:
ThepatienthasmildpreeclampsiawithBP140/96,soTOPis37
weeks.

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Thispatientis38weekssoimmediateterminationofpregnancyis
required.
ThefirsttwinisbreechsothemodeofdeliveryisLSCShencethe
answerisA.
INDICATIONSOFCESAREANSECTION:

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Theindicationsarebroadlydividedinto:
Obstetric

Placentaprevia
Preeclampsia
Previouscesareansection

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Cordprolapseofthefirstbaby
Abnormaluterinecontractions
Contractedpelvis.
Fortwins:
Boththefetusesoreventhefirstfetuswithnoncephalic(breechor

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transverse)presentation
Twinswithcomplications:IUGR,conjoinedtwins
Monoamniotictwins
MonochorionictwinswithTTTS
Thecollisionofboththeheadsatbrimpreventingengagementof

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eitherhead.
Ref.OBSDutta8thedPageno.244

221.A36-weekoldpregnantladywith
previoustwindelivery.Whatisthe
Ovarianscore?

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a)G2P1
b)G2P2
c)G3P2
d)G3P3
CorrectAnswer-A

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

ANS.A.G2P1
Gravidaincludesallconfirmedpregnancies.Eachpregnancyisonly
countedonetime,evenifthepregnancywasmultiplegestations,
suchastwinsortriplets
Parityreflectsthetotalnumberofbirthsafter20weeks,notthetotal

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numberofinfantsborn.
Ref.OBSDutta8thedPageno.107

222.Misoprostolusedintheinductionof
labourisananalogueofwhichofthe
followingtypeofprostaglandin?

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

a)PGE1
b)PGE2
c)PGI2
d)PGF2alpha
CorrectAnswer-A

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CorrectAns:A.PGE1
MisoprostolisamethylesterofPGE1.
IndicationsofMisoprostol:

Itisusedforcervicalripening.
Transvaginallyitisusedforinductionoflabour.

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UsesofProstaglandinsinObstetrics:
Inductionofabortion
Terminationofmolarpregnancy
Inductionoflabour
Cervicalripeningpriortoinductionoflabour

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Accelerationoflabour
Managementofatonicpostpartumhemorrhage
Medicalmanagementoftubalectopicpregnancy

223.Inearlypregnancyclinicalsignsof
feelingthecervixandthebodyofbulky

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uterusseparatedbecauseofsoftened
isthmusat6-8weeksofgestation:

a)Goodell'ssign
b)Chadwick'ssign
c)Piskacek'ssign

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d)Hegar'ssign
CorrectAnswer-D
CorrectAns:D.Hegar'ssign
At6to8weeksmenstrualage,thefirmcervixcontrastswiththenow
softerfundusandthecompressibleinterposedsoftenedisthmus

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--Hegarsign

224.13yroldchildvisitgynaecologyOPD
withacomplaintofnotattaining
menarchewithkaryotype46XX.On
examination,clitoromegalyisseen.

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Whichenzymeismostlikelytobe
deficientintheabovecondition?

a)21alpha-hydroxylase
b)11beta-hydroxylase
c)17alpha-hydroxylase

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d)3beta-hydroxysteroiddehydrogenase
CorrectAnswer-A
Ans.A.21alpha-hydroxylase
TheconditiondescribedaboverepresentstheCongenitaladrenal
hyperplasia.

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"Morethan90%ofCAHcasesarecausedby21-hydroxylase
deficiency"
Congenitaladrenalhyperplasia:
Itisduetoaninbornerrorofadrenalsteroidmetabolism,commonly
dueto21-hydroxylase(95%)andrarelydueto11-hydroxylaseor3

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hydroxysteroiddehydrogenasedeficiency.
Clinicalpresentation
Anambiguityofsexatbirth
Hirsutismandamenorrheamaybethepresentingfeaturesaround
pubertyinamilderform.

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Thekaryotypeis46,XX.
Ref.DuttaGynaecologyed.6thpageno.440


225.Amotherbroughther16-year-old
daughtertoGynaecologyOPDwitha
complaintofnotattendingmenarche.

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ShegivesH/Ocyclicabdominalpain.On
furtherexaminationmidline,abdominal
swellingseen.Perrectalexamination
revealsabulgingmassinthevagina.
Whichofthefollowingcanbemost

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commonlyseen?

a)Imperforatehymen
b)Transvaginalseptum
c)Vaginalagenesis
d)MRKH

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CorrectAnswer-A
Ans.A.Imperforatehymen
Accordingtotheclinicalcase,patientssufferfromprimary
amenorrheaandcryptomenorrhea(cyclicabdominalpain).
Thegirlisagedabout14?16years.

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Thechiefcomplaintsareperiodiclowerabdominalpain,whichmay
becontinuous,primaryamenorrheaandurinarysymptoms,suchas
frequency,dysuriaorevenretentionofurine.
Infact,insignificantcases,thepresentingfeaturemaybethe
retentionofurine.Thecauseofretentionisduetotheelongationof

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theurethra.
Anabdominalexaminationrevealsasuprapubicswelling,whichmay

beuterineorfullbladder.Priorcatheterizationrevealsthetruestate.
Vulvalinspectionrevealsatensebulgingmembraneofbluish
coloration

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Ref.DuttaGynaecologyed.6thpageno.42

226.Whichofthefollowingisnotan
estrogen-dependentpubertalchange?
a)Hairgrowth
b)Menstruation

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c)VaginalCornification
d)Cervicalmucus
CorrectAnswer-B
Ans.B.Menstruation
Pubarcheordevelopmentofaxillaryandpubichairisdueto

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testosterone(inboththesexes).
Pubertyinfemales:
Involvesthebeginningofmenstrualcycles(menarche),breast
development(thelarche),andanincreaseinadrenalandrogen
secretion(adrenarche).

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Estradiolinducesthedevelopmentofsecondarysexcharacteristics,
includingthebreastsandreproductivetract,andincreasedfatinthe
hips.
Estrogensalsoregulatethegrowthspurtatpuberty,vaginal
cornification,andcervicalmucusproduction,induceclosureofthe

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epiphyses,haveapositiveeffectinmaintainingboneformation,and
canantagonizethedegradingactionsofparathyroidhormoneon
bone.
Reference:RhoadesandTanner'sMedicalPhysiology,2ndedition
(Pageno:680)

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227.A22-year-oldprimigravidavisitsANC
OPDwith20weeksPOG.Onexamination
uterineheightrevealsa16-week
size.USGshowsreducedliquor.What
willbethediagnosis?

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a)Renalagenesis
b)Fetalanemia
c)Barter'ssyndrome
d)Liddlesyndrome
CorrectAnswer-A

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Ans.A.Renalagenesis
Thequestionstatesreducedliquorthatmeansoligohydramniosis
seen.
Oligohydramniosisdefinedasanamnioticfluidindexof5cmor
less.

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Itisalmostalwayspresentwhenthereiseitherobstructionofthe
fetalurinarytractorrenalagenesis.
WilliamsObstetricsed24thpage237

228.MostcommonsiteforFertilizationis-
a)Ampulla

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b)Isthmus
c)Intramural
d)Fimbriae
CorrectAnswer-A
Ans.A.Ampulla

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Fertilizationistheprocessoffusionofthespermatozoonwiththe
matureovum.
Itbeginswithspermeggcollisionandendswiththeproductionofa
mononucleatedsinglecellcalledthezygote.
Itsobjectivesare:

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Toinitiatetheembryonicdevelopmentoftheeggand
Torestorethechromosomenumberofthespecies.
Almostalways,fertilizationoccursintheampullarypartoftheuterine
tube.
Reference:DuttaObstetricsed.8thPageno23

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229.Distensionmediausedforhysteroscopy
withbipolarcautery?
a)Glycine
b)NS
c)Co2

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d)Dextran70
CorrectAnswer-B
Ans.B.NS
Thedistendingmediacommonlyusedinhysteroscopyisnormal
saline

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--Theuterinecavityisdistendedwithamediatoseparatethe
uterinewallsandtohaveapanoramicview.Themediausedcould
beeitheragasoraliquid.
Carbondioxide(CO2)--iscommonlyusedfordiagnosticpurposes.
Itissolubleinbloodandissafe.

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Hysteroflatorprovidesagasflowrateofamaximumof100mLper
minuteandamaximumpressureof100mmHg.
Liquidmediaisusedforoperativeprocedures.
Normalsalinecanbeusedissuitableforbipolarcauterybutnot
suitableformonopolarelectrosurgery.Constantflowistobe

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maintainedtoflushtheoperativearea.
Ref.DuttaGynaecologyed.6thpageno.620,624

230.Besttreatmentoptionforseptateuterus-
a)TompkinsMetroplasty
b)Jonesmetroplasty

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c)Strassmannmetroplasty
d)Transcervicalhysteroscopicresectionoftheseptum
CorrectAnswer-D
Ans.D.Transcervicalhysteroscopicresectionoftheseptum
Hysteroscopicmetroplastyismorecommonlydone.

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Resectionoftheseptumcanbedoneeitherbyaresectoscope
orbylaser.
Advantagesare:

1. Highsuccessrate(80?89%),
2. Shorthospitalstay

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3. Reducedpostoperativemorbidity(infectionoradhesions)
4. Subsequentchanceofvaginaldeliveryishighcomparedto
abdominalmetroplastywherethecesareansectionismandatory.
Othermethods:
Abdominalmetroplastycouldbedoneeitherbyexcisingtheseptum

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(Strassman,Jones,andJones)orbyincisingtheseptum
(Tompkins).
Ref.DuttaGynaecologyed.6thpageno.47

231.ApregnantfemalehadMeconium
stainedliquorandunderwentemergency

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LSCS.Afewdayslaterhercondition
deteriorated.USGshowededematous
bowels.What'sthecause?

a)Meconiumperitonitis
b)Paralyticileus

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c)Adhesiveintestinalobstruction
d)Intra-abdominalabscess
CorrectAnswer-B
Ans.B.Paralyticileus
POSTOPERATIVECOMPLICATIONSOFLSCS:

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

Intestinalobstruction:Theobstructionmaybemechanicaldueto
adhesionsorbands,orparalyticileusfollowingperitonitis.
Paralyticileusisanadynamicobstructioninwhichthereisafailure
oftransmissionofperistalticwaves
Clinicalfeatures:

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

Theresultantstasisleadstothefollowing:
Accumulationoffluidandgasinthebowel
Withassociateddistension:markedandtympanitic
Vomiting(effortless)
Absenceofbowelsounds

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Absoluteconstipation
Duttaobstetricsed.8thPageno.678
Bailey&Love'sShortPracticeofSurgery-27thEdition(Page
no1297)


232.18-year-oldgirlpresentswith6months

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ofamenorrheawithh/olow-gradefever,
weightloss,painabdomen,generalized
weaknesses.OnPRexamination,
palpableleft-sidedpelvicmassfelt...
Diagnosisis

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

a)Fibroidwithdegeneration
b)TBpelviswithTuboovarianmass
c)Ectopicpregnancy
d)Granulosacelltumour
CorrectAnswer-B

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

Ans.B.TBpelviswithTuboovarianmass
Thetuberclesbursttopourthecaseousmaterialinsidethelumen
producingtubercularpyosalpinx,whichmayadheretotheovaries
andthesurroundingstructures.
Oftentheinfectionspreadsoutwardsproducingperisalpingitiswith

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exudation,causingdenseadhesionswiththesurroundingstructures
tuberculartubo-ovarianmass.
Clinicaldiagnosticfeatures:
Weakness,low-gradefever,anorexia,anemiaornightsweatsmay
bepresent.

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Infertility:Itmaybeprimaryorsecondary
Chronicpelvicpain
Vaginaldischarge--postcoitalbleedingorablood-stained
discharge.
Constitutionalsymptomssuchaslossofweight,malaise,anorexia,

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pyrexia,andanemiaarepresentintheacutephaseofthedisease.
Menstrualabnormality:Inabout50percent,themenstrualfunctionis
normal.
PresenceofpelvicmasswithnodulesinthepouchofDouglas
palpable

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Ref.GynaecologyDuttaed.6thPageno.139-142

233.AChildisborn,coveredwithathick
membranouscoat,whatcouldbethe
possiblediagnosis?

a)Lamellarichthyosis

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b)X-linkedichthyosis
c)IchthyosisVulgaris
d)Ichthyosisacquista
CorrectAnswer-A
Answer-a.Lamellarichthyosis

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Explanation-Ichthyosisisoneofthemostcommon
genodermatoses.Itischaracterizedbydry(xerotic)scalyskinall
overthebody.Scalesaredull-brown-black.
Thebasicdefectisanimpairmentinthebarrierfunctionofskinand
inabilitytomaintainmoisture.Collodionbabyisthetermusedto

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denotethenewbornbabywithichthyosis;thenewbornbabyis
encasedinathick,shinymembranecoatcalledcollodionandis
seeninLamellarichthyosis
Ref-ArvindAroraskin,6thedition,pageno203

234.Mouthtomouthrespirationprovides

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

whatpercentageofoxygen?
a)10%
b)16%
c)21%
d)100%

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

CorrectAnswer-B
Ans.B.16%
Mouthtomouthbreathingprovides0.8to1.2litersofexhaledairper
breathand16%ofoxygenwhichisenoughtosustainlife.
TheuseofAmbubagandroomairprovides21%O2.

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

TheAmericanHeartAssociationrecommendstidalvolumesof700
to1000mLduringmouth-to-mouthventilation,butsmallertidal
volumesof500mLmaybeofadvantagetodecreasethelikelihood
ofstomachinflation,asmouth-to-mouthventilationgascontainsonly
17%oxygen,but4%carbondioxide.

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235.Cancerpatientundergoesradiotherapy,
pickthetruestatementfor
radiosensitivityoftissues?

a)Rapidlydividingcellsareresistanttoradiation
b)GImucosaisoneofthemostradioresistanttissuesinthebody

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

c)Theintensityofradiationisinverselyproportionaltothesquare
ofdistancefromthesource
d)Smallbloodvesselsareleastresistanttoradiation
CorrectAnswer-C
Answer-C-Theintensityofradiationisinverselyproportional

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tothesquareofdistancefromthesource
Theinversesquarelawdescribestheprincipleofdosereduction
asthedistancefromthesourceincreases.
Thedoseisproportionaltotheinverseofthesquareoftheradius.
Thusifyoudoublethedistanceyoureducethedosebyafactorof

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

four.
Ref-1.ShafieiSA,HasanzadehH,ShafieiSA.Asimple
calculationmethodfordeterminationofequivalentsquarefield.
JMedPhys.2012;37(2):107-11.DOI:10.4103/0971-
6203.94746-FreetextatPubMed-Pubmedcitation

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236.MostcommonDRUGcausing
dependence?
a)Cannabis
b)Cocaine
c)Heroin

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

d)Amphetamine
CorrectAnswer-A
ANS-A.Cannabis
Cannabis-9millionusers,192millionusers(Acc.ToWHODrug
report2018)

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

Heroin(opioidderivative)-2.5lakhusers
Itisestimatedthat275millionpeopleusedillicitdrugs,suchas
cannabis,amphetamines,opioids,andcocaine,in2016which
translatesintoanannualprevalenceofillicitdruguseof5.6%.
Cannabisismostusedwith192millionusers.Some31million

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peoplewhousedrugssufferfromdrugusedisorders.-(WHODrug
report2018)
Ref:ARVINDARORAreviewofpsychiatryp:64,WHODrug
report(2018)


237.MBBSstudentshewaschokingwith

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

dyspnea,chesttightness,anxietyandan
impendingsenseofdoomon
examinationallsystemicconditionswere
foundnormal,thenshewentto
psychiatry.Whatistheprobable

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

diagnosisofthecondition?

a)Panicdisorder
b)Depression
c)Epilepsy
d)Asthma

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

CorrectAnswer-A
ANS-A.Panicdisorder
Panicdisorder-severeanxietywithchoking,chestpainand
palpitations.
Depression-lowmoodandlostinterestinactivities

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

Epilepsy-neurologicaldisorderwithwhole-bodyfatigueandmuscle
spasms
Anasthma-respiratorydisorderassociatedwithsymptomsofcough,
wheezing,etc
Ref:ARVINDARORAreviewofpsychiatryp:131

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238.Apatientwithdepressionwasgiven
Imipraminefor2weeks.Relatives
noticedincreasedexcitement,colourful
clothes,increasedtalking.Whatisthe
nextstepinmanagement?

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

a)AntipsychoticwithImipraminecontinued
b)DiscontinueImipramineandstartValproate
c)ContinueImipraminealone
d)ManagewithValproatealone
CorrectAnswer-A

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

ANS-A.AntipsychoticwithImipraminecontinued
Theconditionfromwhichthepatientaboveissufferingisabipolar
disorderwhichincludesbothdepressionandmania.
Soinordertotreatbothantidepressanti.eimipramineiscontinued
alongwithanantipsychoticsuchasphenothiazines,thioxanthenes,

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

etc.
Antipsychoticorvalproatealonecannotreducethedepressionand
Imipraminealonecannotreducethemania.
Ref:ARVINDARORAreviewofpsychiatryp.no:111

239.APatientfallsdownoftenwith

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

behavioralchangeandenuresis.Whatis
theconditionassociatedwithhim?

a)Frontotemporaldementia
b)Normalpressurehydrocephalus
c)Parkinson'sdisease

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

d)Alzheimer'sdisease
CorrectAnswer-B
Ans-B.Normalpressurehydrocephalus
Frontotemporaldementia-Associatedwithpoorbehavioralcontrol,
decisionmaking,andlanguage.

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

Normal-pressurehydrocephalus-Associatedwithgaitdisturbance,
behaviouralchange,enuresis,anddementia.
Parkinson'sdisease-Associatedwithtremorandmuscularstiffness
Alzheimer'sdisease-Associatedmainlywithmemorylossand
confusion

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

Ref:NormalPressureHydrocephalusByMichaelJ.Fritsch,
UweKehler,UllrichMeierP.16;Oxfordtextbookofneurological
surgerybyAdelHelmyP.94


240.APatientwithdepressivesymptomsfor
6monthsandassociatedwith

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

auditoryhallucinationsfor2weeks.What
istheprobablediagnosisofthe
condition?

a)Psychoticdepression
b)Schizoaffectivedisorder

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

c)Maniadepressiveillness
d)Schizophrenia
CorrectAnswer-A
Ans-A.Psychoticdepression
Psychoticdepression-Depressionalongwithpsychoticsymptoms

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

suchashallucinations,delusions,etc.
Schizoaffectivedisorder-Symptomsofschizophreniaandmood
disturbancesoccurtogether.
Maniadepressiveillness-Maniadepressionalongwithpsychotic
symptoms.

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Schizophreniaincludesallthesymptomsofschizophrenia
Ref:ArvindArorareviewofPsychiatrypage.103


241.Identifythetypeofjointinthegiven
picture

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

a)Syndesmosis
b)Synarthrosis
c)Synovialjoint
d)Symphysis
CorrectAnswer-C

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

Ans:Csynovialjoint
Themarkedstructureisajointbetweenthetransverseprocess
ofvertebraandribs-acostotransversejoint.
Interchondral,Sternocostal,Costovertebral,andCostotransverse
areallplanetypesofsynovialjoints.

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BDC,7thedition,volume1,pg234.


242.Identifythemuscle.Whatisitsnerve
supply
a)Dorsalscapularnerve

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b)Thoracodorsalnerve
c)Spinalaccessorynerve
d)Suprascapularnerve
CorrectAnswer-A
Ans:A.Dorsalscapularnerve

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Markedmuscleislevatorscapulae.ItissuppliedbyC3,C4,andC5
(dorsalscapularnerve)


243.Identifythecartilage
a)Hyalinecartilage

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b)Elasticcartilage
c)Articularcartilage
d)Fibrocartilage
CorrectAnswer-D
Ans:D.Fibrocartilage

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Fibrocartilage
Fibrocartilageischaracterizedbyalargeamountofirregularand
densebundlesofcollagenfibersinthematrix.Itconsistsof
alternatinglayersofcartilagematrixandthickdenselayersoftypeI
collagenfibers.

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Ref.InderbirSingh'sTextbookofHumanHistology-8thEdition
(Pagenos56-59)



244.Identifytheboundariesoftheanatomical
structureintheimage

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a)Extensorpollicislongus
b)Abductorpollicislongus
c)Styloidprocessoftheradius
d)Alloftheabove
CorrectAnswer-D

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Ans:D.Alloftheabove
Themarkedstructureistheanatomicalsnuffbox.
Boundariesare:
Themedialborder(ulnarside)ofthesnuffboxisthetendonofthe
extensorpollicislongus.

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Thelateralborder(radialside)isapairofparallelandintimate
tendonsoftheextensorpollicisbrevisandtheabductorpollicis
longus.
Theproximalborderisformedbythestyloidprocessoftheradius
Thedistalborderisformedbytheapproximateapexofthe

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schematicsnuffboxisoscelestriangle.

Thefloorofthesnuffboxvariesdependingonthepositionofthe
wrist,butboththetrapeziumandprimarilythescaphoidcanbe
palpated.


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245.Identifythecelltypemarkedinthe
cerebellum?
a)Basketcells
b)Granulecells
c)Golgicells

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d)Purkinjecells
CorrectAnswer-D
Ans:D.Purkinjecells
Explanation:



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ThePurkinjecellspresentthemoststrikinghistologicalfeatureof
thecerebellum.
Elaboratedendritesextendintothemolecularlayerfromasingle
subjacentlayerofthesegiantnervecellbodies(calledthePurkinje
layer).

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Onceinthemolecularlayer,thePurkinjecelldendritesbranch
extensivelyinaplaneatrightanglestothetrajectoryoftheparallel
fibers.
Inthisway,eachPurkinjecellisinapositiontoreceiveinputfroma
largenumberofparallelfibers,andeachparallelfibercancontacta

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verylargenumberofPurkinjecells(ontheorderoftensof
thousands).
Ref:https://www.ncbi.nlm.nih.gov/books/NBK10865/


246.Identifythesleepwavemarkedinthe

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EEGduringthesleep-wakecycle?
a)Stage1sleep
b)REMsleep
c)Stage2sleep
d)Stage3sleep

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CorrectAnswer-B
Ans:B.REMsleep
Explanation:
REM/ParadoxicalSleep:
Duetothe"presenceofrapideyemovement"recordedon

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electrooculogram.
Hasparadoxicalelevationofbrainactivity,metabolism&
physiologicalactivity.
"High-amplitudeslowwaves"replacedby"rapid,lowvoltageactivity
&betawave"-

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Duringstage3&4REMsleep.
FeaturesofREMsleep:

1.InEEGrecording:
Beta-wave.
Reappearanceofalphawave.

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Saw-toothwave(lowvoltagefastactivity).
Ponto-genital-occipitalspikes.
Ref:ArvindArorareviewbookofphysiology(p.204-205)


247.Casal'snecklaceisseenindeficiencyof:

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a)VitaminAdeficiency
b)Niacin
c)Irondeficiencyanemia
d)VitaminB12deficiency
CorrectAnswer-B

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Ans:B.Niacin
Thedeficiencyofniacinleadstotheclinicalconditioncalled
pellagra.PellagraisanItalianword,meaning"roughskin".Pellagra
iscausedbythedeficiencyofTryptophanaswellasNiacin.Pellagra
isseenmoreinwomen;thismaybebecausetryptophanmetabolism

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isinhibitedbyestrogenmetabolites.
Thesymptomsofpellagraare:
Dermatitis:Intheearlystages,brightrederythemaoccurs,
especiallyinthefeet,ankles,andface.Increasedpigmentation
aroundtheneckisknownasCasal'snecklace.Thedermatitisis

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precipitatedbyexposuretosunlight
Diarrhea:diarrheamaybemildorseverewithbloodandmucus.
Dementia:Itisfrequentlyseeninchroniccases.
Deliriumiscommoninacutepellagra.Irritability,inabilityto
concentrateandpoormemoryaremorecommoninmildcases.

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Ataxiaandspasticityarealsoseen.
Ref-DMVasudevan-Textbookofbiochemistryformedicalstudents,
6thedn,WaterSolubleVitamins,pg395.


248.AnHivpositivepatientwithaCD4

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COUNTOF300/Cummpresentswith
mucosallesionsinthemouthasshown
inthefigure.onmicroscopybudding
yeastsandpseudohyphaeareseen.A
mostprobablediagnosisis?

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a)Candidiasis
b)Hairyleukoplakia
c)Lichenplanus
d)Diphtheria
CorrectAnswer-A

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CorrectAns:A.Candidiasis
MostcommonopportunisticinfectioninHIViscandidiasis
CandidiasisisafungalinfectionduetoanytypeofCandida.
Whenitaffectsthemouth,itiscommonlycalledthrush.
Signsandsymptomsincludewhitepatchesonthetongueorother

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Signsandsymptomsincludewhitepatchesonthetongueorother
areasofthemouthandthroat.Othersymptomsmayinclude
sorenessandproblemsswallowing.
Whenitaffectsthevagina,itiscommonlycalledayeastinfection.
Signsandsymptomsincludegenitalitching,burning,andsometimes

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awhite"cottagecheese-like"dischargefromthevagina.
Robbin'sbasicsofpathology502,503


249.A25-Year-oldmalepresentedwitha2cm
thyroidnodule.Athyroidectomywas

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done.Thehistologypictureisgiven
below.whatcouldbethediagnosis

a)Papillarycarcinomathyroid
b)Follicularadenoma
c)Gravesdisease

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d)Adenomatousgoitre
CorrectAnswer-A
Ans:A.Papillarycarcinomathyroid
Papillarycarcinomasmaymanifestassolitaryormultifocallesions
withinthethyroid.Insomecases,theymaybewell-circumscribed

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andevenencapsulated;inotherinstances,theyinfiltratethe
adjacentparenchymawithill-definedmargins.
Thelesionsmaycontainareasoffibrosisandcalcificationandoften
arecystic.Oncutsurface,theymayappeargranularandsometimes
containgrosslydiscerniblepapillaryfoci.

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Thedefinitivediagnosisofpapillarycarcinomacanbemadeonly

aftermicroscopicexamination.
Thenucleiofpapillarycarcinomacellscontainveryfinelydispersed
chromatin,whichimpartsanopticallyclearappearance,givingrise
tothedesignationgroundglassor"OrphanAnnieeye"nuclei.in

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cross-sections.
UnlikehyperplasticpapillarylesionsseeninGravesdisease,the
neoplasticpapillaehavedensefibrovascularcores.Concentrically
calcifiedstructurestermedpsammomabodiesoftenarepresent
withinthepapillae.

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Focioflymphaticpermeationbytumorcellsarepresent
Robbin'sbasicsofpathology9theditionpageno.736


250.A5-year-oldchildpresentedwitha
historyofbloodinthestools.On

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examination,therewasapolypoidmass
intherectum,abiopsyofwhichshowed
asbelow.Amostprobablediagnosisis?

a)Villousadenoma
b)Juvenilepolyp

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c)Vascularmalformation
d)Serratedadenoma
CorrectAnswer-B
Ans:B.Juvenilepolyp
Thehistologicalpictureofjuvenilepolyps.Itconsistsof

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pedunculated,smooth-surfaced,reddishlesionsthatarelessthan3
cmindiameteranddisplaycharacteristiccysticspacesoncut
sections.
Microscopicexaminationshowsthespacestobedilatedglands

filledwithmucinandinflammatorydebris

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Robbin'sbasicsofpathology9theditionpageno.592


251.25-year-oldmanpresentsforaroutine
physicalexamination.Thepatientistall
andonexamination,hewasfoundto

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haveanearlydiastolicmurmur.His
familypedigreeisgivenbelow.Whichof
thefollowingisthemodeofinheritance
bywhichthediseaseislikelytobe
transmitted?

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a)AD
b)AR
c)XLR
d)XLD
CorrectAnswer-A

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Ans:A.AD
AutosomalDominant(AD)InheritanceDiseases
?Mutatedgenescanexpressthemselvesinaheterozygousstate.
?Usually,itcausesadefectinthesynthesisofstructuralQornon-
enzymeproteins.

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enzymeproteins.
?Thesehaveavariableonset.
?Thesearecharacterizedbyreducedpenetrance(individualsinherit
thegenebutcanbephenotypicallynormal)andvariable
expressibilityQ(thetraitisseenintheindividualscarryingthe

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mutantgenebutisexpresseddifferentlyamongindividuals,e.g.
patientsofneurofibromatosishavevariantfrombrownishskinspots
tomultipleskintumoursindifferentpatients).


252.A51-year-oldpersoncamewitha

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complaintofhematuria.Onexamination,
hewasnormotensiveandhadpedal
edema.Investigationsrevealedthe
patienthadnoglucosuriaandhada
creatininevalueof9mg%.Renalbiopsy

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isasshownbelowwhichofthefollowing
investigationsoneshoulddotoidentify
theetiologyofthedisease?

a)ANA
b)ANTIGBMantibodies

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c)HIVRNA
d)Urineimmunoelectrophoresis
CorrectAnswer-B
Ans:B.ANTIGBMantibodies
Kidneybiopsy:Immunofluorescencedemonstratedlinearstaining

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withIgG,characteristicofanti-glomerularbasementmembrane
disease
,alsoknownasGoodpasturesyndrome.
Anti?glomerularbasementmembrane(anti-GBM)antibodiesare
seeninGoodpasturesyndrome.Theycauseendothelialcellinjury
resultinginanephriticsyndromewithhematuria.

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Robbins&CotranPathologicBasisofDisease,9edPagenos
912-914



253.A35-year-oldheterosexualpatient
diagnosedwithHIVhadahistoryof

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chronicwaterydiarrhea.Acolonoscopic
biopsyisshownbelow.Amostprobable
diagnosisis?

a)Giardia
b)CMV

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c)Microspora
d)Cryptosporidium
CorrectAnswer-D
Ans:D.Cryptosporidium
DiseasecausedbyinfectionwithCryptosporidiumspecies,a

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protozoalparasite
Traditionallyconsideredacoccidianparasite,butrecentevidence
suggestsitmaybeagregarineparasite
Infectionismostcommonintheterminalileumandproximalcolon
Thediseasealsooccursintheproximalsmallintestine,distalcolon,

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gallbladder,bileducts,andpancreas

gallbladder,bileducts,andpancreas
Inimmunosuppressedpatients,chronicdiarrheaoccursthatisoften
debilitating,acalculouscholecystitis,sclerosingcholangitis,
pancreatitis,biliarystrictures,andrespiratorydiseasemayoccur

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Intissuebiopsies,2-5mbasophilicroundbodiesareseen
protrudingfromtheapexofenterocytes("bluebeads")withinthecell
membrane;highlightwithGiemsastain
Villousatrophy,crypthyperplasia,cryptitisandincreasedmixed
inflammatorycellswithinthelaminapropriamaybeseen

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ref:Bennett:Mandell,Douglas,andBennett'sPrinciplesand
PracticeofInfectiousDiseases,8thEdition
,CDC
-Cryptosporidium



254.An11-yearboypresentedwithcoughfor

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15daysonexaminationhewasfoundto
havecervicallymphadenopathy.lymph
nodeexaminationshowedbelowfinding
whatcouldbethediagnosis

a)Leprosy

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b)Sarcoidosis
c)TB
d)Syphilis
CorrectAnswer-C
Ans:C.TB

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Histologicalpictureshownaboveisoftuberculosis
Tuberculosisisacommunicablechronicgranulomatousdisease
causedbyMycobacteriumtuberculosis.Itusuallyinvolvesthelungs
butmayaffectanyorganortissueinthebody.
Typically,thecentersoftuberculousgranulomasundergocaseous

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necrosis.histologicxamination,sitesofactiveinvolvementare

markedbyacharacteristicgranulomatousinflammatoryreactionthat
formsbothcaseatingandnoncaseatinggranulomaswhichconsistof
epithelioidhistiocytesandmultinucleatedgiantcells.
Robbinsbasicsofpathology9theditionpageno.493

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255.A40yearoldpersonpresentedwith10*8
swellinginaretroperitoneal,biopsyfrom
thelesionisasshownbelow.Molecular
analysisdemonstratedt(12,16).Amost

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probablediagnosisis

a)Myxoidliposarcoma
b)Lipoma
c)Synovialsarcoma
d)Pleomorphicsarcoma

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CorrectAnswer-A
Ans:A.Myxoidliposarcoma
Myxoidliposarcomaisthemostcommonhistologictype.
Itiscomposedofmonomorphic,fusiformorstellatecells
representingprimitivemesenchymalcells,lyingdispersedin

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mucopolysaccharide-richgroundsubstance.
Occasionaltumourgiantcellsmaybepresent.Theprominent

meshworkofcapillariesformingchicken-wirepatternisa
conspicuousfeature
RefRobbin'sbasicsofpathologypageno.792.

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256.47.35-year-oldwomanwithalong
historyofdyspnea,chroniccough,
sputumproduction,andwheezingdies
ofrespiratoryfailurefollowingaboutof

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lobarpneumonia.Shewasnotasmoker
oranalcoholic.Thelungautopsyis
shownintheimage.Whichofthe
followingunderlyingconditionwasmost
likelyassociatedwiththepathologic

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changesshownhere?

a)Mutationindyneinarms
b)Cysticfibrosis
c)Alpha1antitrypsindeficiency
d)Antibodiesagainsttype4collagen

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CorrectAnswer-C

CorrectAnswer-C
Ans:C.Alpha1antitrypsindeficiency
Thephotomicrographaboveisfromapatientwithhereditaryalpha-
1-antitrypsindeficiency.
Alpha-1-antitrypsinisnormallypresentin

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serum,tissuefluidsandmacrophages.It'sabig-timeinhibitorof
proteases(whicharedestructiveenzymessecretedbyneutrophils
duringinflammation).Goodthingtohavearound.
Patientswhoaredeficientinalpha-1-antitrypsinarelessableto
countertheeffectsofproteases,andtheelastictissueinthelungis

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eventuallydestroyed,producingemphysema(irreversible
enlargementoftheairspacesdistaltotheterminalbronchiole).
Inadditiontoemphysema,patientswithalpha-1-antitrypsin
deficiencymaydevelophepatitisandevencirrhosisfrom
accumulationofabnormally-foldedalpha-1-antitrypsinwithin

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hepatocytes.
Theseproteinsarevisibleasbrightlyeosinophilicinclusionswith
regularhematoxylinandeosinstaining.Thediseasevariesinits
presentation;somecasesaresevereatbirth,andothersare
asymptomaticuntillaterlife.Inpatientswithsevereliverdisease,

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livertransplantationisthetreatmentofchoice.


257.GraphshowingthreedrugsA,B&C.
Whichofthefollowingdrugsshownin
thegraphbelowhasthehighest

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potency?

a)DrugA
b)DrugB
c)DrugC
d)BothDrugA&B

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CorrectAnswer-A
Ans:A.DrugA
Thelineontheleftismorepotent.
DrugAismorepotent.
DrugPotency:

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ThepositionofDRConthedoseaxisistheindexofdrugpotency
whichreferstotheamountofdrugneededtoproduceacertain

response.
ADRCpositionedrightwardindicateslowerpotency.
Relativepotencyisoftenmoremeaningfulthanabsolutepotency

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andisgenerallydefinedbycomparingthedose(concentration)of
thetwoagonistsatwhichtheyelicitahalf-maximalresponse(EC50
).
Drugpotencyisclearlyafactorinchoosingthedoseofadrug.
Ref:K.D.Tripathi7thEdition.Page.54?55

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258.InthefollowingX-rayofthewrist,whatis
theexactage-
a)2yrs
b)8yrs

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c)6yrs
d)9yrs
CorrectAnswer-C
Answer-C-6yrs
Assessmentsofskeletalmaturityinpre-pubertalchildrenare

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primarilybasedontheepiphysealsizeofthephalangesasthey
relatetotheadjacentmetaphyses.
Duringthisstageofdevelopment,theossificationcentersforthe
epiphysisincreaseinwidthandthickness,andeventuallyassumea
transversediameteraswideasthemetaphysis

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Moreweightisgiventothesizeoftheepiphysisinthedistal

phalangesthantothatinthemiddlephalanges,andevenlessto
thatintheproximalphalanges.
http://www.chospab.es/biblioteca/DOCUMENTOS/Atlas_of_Hand_Bone_Age.pdf


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259.Identifythephenomena
a)ElectricBurn
b)CrocodileBurn
c)Scalds
d)Putrefaction

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CorrectAnswer-D
Answer-D-Putrefaction
Putrefactionisthedecompositionofthebodycarriedoutbythe
microbialaction.Aftercessationofhemostasis,thenaturalfloraof
thebodymigratesfromtheguttothebloodvesselsandspreadsall

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overthebody.
Externalmicro-organismsenterthebodythroughthealimentary
canal,respiratorytract,andopenwounds.Intheabsenceofbody
defenses/immunemechanisms,themicrobeskeepgrowing,asthey
feedupontheproteinsandcarbohydratesofthebloodandbody

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parts.
Theprincipalbacterialagentcausingputrefactionisthegram-
positive,anaerobic,androd-shapedClostridiumwelchii.
Itreleaseslecithinase,whichcauseshydrolysisoflecithinpresentin
thebloodcells,causingtheirlysis.Putrefactionbeginswithinan

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hourofdeath,butthepeakactivityofthemicrobesoccursaround
the24-hourtimeframe.
https://www.ncbi.nlm.nih.gov/books/NBK539741/


260.IdentifythefollowingImage

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a)Neisseriameningitidis
b)Neisseriacinerea
c)Neisseriagonorrhoeae
d)Neisseriapolysaccharea
CorrectAnswer-A

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Answer-A-Neisseriameningitides
Neisseriameningitidesoftenreferredtoasmeningococcus,isa
Gram-negativebacteriumthatcancausemeningitisandotherforms
ofmeningococcaldiseasesuchasmeningococcemia,life-
threateningsepsis.

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N.meningitidisisagram-negativeproteobacteriumandmember
ofthebacterialfamilyofNeisseriaceae.
N.meningitidisisafastidiousbacteria,dyingwithinhourson
inanimatesurfaces,andiseitheranencapsulatedor
unencapsulated,aerobicdiplococcuswitha"kidney"or"coffee-

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bean"shape.
Jawetz27/e-pg-287;


261.IdentifytheImage
a)Trichuristrichiura

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b)Ancylostomaduodenale
c)Paragonimus
d)Strongyloides
CorrectAnswer-A
Answer-A-Trichuriasistrichiura

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Itisbrownincolourbeingbile-stained.
Ithasatripleshell,theoutermostlayerofwhichisstainedbrown.
Itisbarrel-shapedandabout50umlongand25umwideinthe
middle,withaprojectingmucusplugateachpolecontainingan
unsegmentedovum

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Theplugsarecolourless.Theeggfloatsinthesaturatedsalt
solution
Jawetz27/e-pg-724


262.Identifytheorganismcausingan

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infectionontheupperarm
a)Tineacorporis
b)Tineacapitis
c)Tineacruris
d)Tineamanus

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CorrectAnswer-A
Answer-A-TineaCorporis.
Dermatophytosisoftheglabrousskincommonlygivesrisetothe
annularlesionsofringworm,withaclearing,scalycentersurrounded
byaredadvancingborderthatmaybedryorvesicular.

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Thedermatophytegrowsonlywithindead,keratinizedtissue,but
fungalmetabolites,enzymes,andantigensdiffusethroughtheviable
layersoftheepidermistocauseerythema,vesicleformation,and
pruritus.
Thelesionsexpandcentrifugallyandactivehyphalgrowthisatthe

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periphery,whichisthemostlikelyregionfromwhichtoobtain
materialfordiagnosis.

Whentheinfectionoccursinthegroinarea,itiscalledTinea
cruris,
orjockitch.
Tineamanusreferstotheringwormofthehandsorfingers.

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Tineacapitisisdermatophytosisorringwormofthescalpandhair
Jawetz27/e-pg-668


263.ImmunoglobulinImageshownbelowis
of-

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a)IgA
b)IgG
c)IgM
d)IgE
CorrectAnswer-A

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

Ans:A.IgA
IgAisthemajorimmunoglobulinresponsibleformucosalimmunity.
ThelevelsofIgAintheserumarelow,consistingofonly10?15%of
totalserumimmunoglobulinspresent.Incontrast,IgAisthe
predominantclassofimmunoglobulinfoundinextravascular

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secretions.
Inserum,IgAissecretedasamonomerresemblingIgG.Inmucous
secretions,IgAisadimerandisreferredtoassecretoryIgA.
ThissecretoryIgAconsistsoftwomonomersthatcontaintwo
additionalpolypeptides:theJchainthatstabilizesthemoleculeand

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asecretorycomponentthatisincorporatedintothesecretoryIgA
whenitistransportedthroughanepithelialcell

Jawetz27/e-pg-138


264.A15yearsoldboypresentedwithfever

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andchillsfor3days.Onexamination,he
wasfoundtohavedelayedskinpinch
timeanddryoralmucosa.Aperipheral
bloodsmearrevealedthefollowing
picture.Identifythepathogeninvolved?

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

a)Babesia
b)Plasmodiumvivax
c)Plasmodiumfalciparum
d)Salmonellatyphi
CorrectAnswer-B

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

Answer-B-Plasmodiumfalciparum
Givenclinicalpresentationsuggestiveofmalaria.
Doubleringsinerythrocytes&banana-shapedgametocytesona
peripheralbloodsmear-TypicalP.falciparuminfection.

peripheralbloodsmear-TypicalP.falciparuminfection.

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Theearlyringformintheerythrocyteisverydelicateandtiny,
measuringonlyone-sixthoftheredcelldiameter.Ringsareoften
seenattachedalongthemarginoftheredcell,theso-calledform
appliqueoraccole.
Binucleaterings(doublechromatin)arecommonresemblingstereo

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headphonesinappearance.Severalringsmaybeseenwithina
singleerythrocyte.
Paniker'sTextbookofMedicalParasitology-8thedition,pg-73;
Jawetz27/e-medicalparasitology-pg-721



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265.Apatientcomplainsaboutpainful
blistersaroundtheangleofmouth
identifythepathogen

a)HerpesLabialis
b)Herpangina

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c)Herpeszoster
d)Epstein-Barr
CorrectAnswer-A
Answer-A-HerpesLabialis
Herpeslabialis
,commonlyknownascoldsores,isatypeof

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infectionbytheherpessimplexvirusthataffectsprimarilythelip.
Symptomstypicallyincludeaburningpainfollowedbysmallblisters
orsores.Thefirstattackmayalsobeaccompaniedbyfever,sore
throat,andenlargedlymphnodes.
Relapsinginfectionsarelimitedtothemucosaofthehardpalateor,

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inolderchildrenandadults,thelips.Thenumberofrelapses
decreasesaftertheageof35years.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2602638/



266.Apatientwiththefollowingfeature

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shownintheimage.Thepatientreports
havinganother3-year-oldsiblingat
home,whoisfullyimmunizedasperthe
immunizationschedule.whatisthebest
measuretopreventdiphtheriainthe

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siblingofthediphtheriacasechild.

a)Givediphtheriatoxoidbooster
b)GiveafullcourseofDPTvaccine
c)Giveprophylacticerythromycin
d)Nothingisrequiredtobedone

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

CorrectAnswer-D
Ans.D.Nothingisrequiredtobedone
Asperthenationalimmunizationprotocol,eachchildreceivesDPT
boosterat16-24
months,andthenat5years.nowasthechildintheMCQis3years

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oldandisimmunizedtodate,thechildmusthavereceivedtheDPT

boosterinjectionjustwithinthelast2years.hencethechildis
protectedandprobablynoaddedimmune-preventionorvaccination
isrecommended.
Page174,25ed.PARK

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267.Themostcommonsiteoforiginofthe
diverticulumofthepharynxseeninthe
bariumswallowgivenbelowis

a)Betweenstylopharyngeusandpalatopharyngeus

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b)Betweenmiddleandinferiorconstrictor
c)Betweeninferiorconstrictorandesophagus
d)Betweenthyropharyngeusandcricopharyngeus
CorrectAnswer-D
Ans:(d)Betweenthyropharyngeusandcricopharyngeus

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

ThegivenpictureisthebariumswallowshowingZenker's
diverticulum.
>Zenkerdiverticulum,apulsiondiverticulumofthehypopharynx,isa
rarelesionthatoccursinelderlypopulations.>Theconditionresults
inaclassicpresentationofsymptoms,withcomplicationsthat

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includeaspirationandpneumonia,andismanagedbyendoscopic
andsurgicalrepair.
Ref.ScottBroTon,Vol3;746

Ref.ScottBroTon,Vol3;746
Ref:https://emedicine.medscape.com/article/836858-overview.

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268.BattlesignimageBluishPurplecolour
behindmastoid?
a)Battlesign
b)Bezoldabscess

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c)BothAandB
d)Noneofthese
CorrectAnswer-A
Ans.(a)Battlesign.
>BattleSign(alsocalledBattle'sSign)isdefinedasbruisingover

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themastoidprocess.Itisretroauricularormastoidecchymosisthat
istypicallytheresultofheadtrauma.
ref:https://www.statpearls.com/kb/viewarticle/18169?
utm_source=pubmed


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269.Thepatientpresentswith,fever,
dysphagia.Imageshowingpushing
tonsil.whatisthediagnosis?

a)Parapharyngealabscess
b)Retropharyngealabscess

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c)Peritonsillarabscess
d)Ludwig'sangina
CorrectAnswer-C
Ans.C.Peritonsillarabscess
Peritonsillarabscess,alsoknownasquinsy,isthelocalized

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collectionofpusinperitonsillarspacebetweenthetonsillarcapsule
andsuperiorconstrictormuscle.
>Thetonsilisfoundpusheddownwardandmedially.
>Theuvulaisswollenandedematousandpushedtotheopposite
side.

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>Thereisabulgeonthesoftpalateandanteriortonsillarpillar.
>Mucousmaybeseenoverlyingthetonsillarregion.

ref:https://www.ncbi.nlm.nih.gov/books/NBK519520/


270.Thispatientgivesahistoryoftoothache

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foroneweek.Whatisthediagnosis:
a)Acuteparotitis
b)Angioneuroticedema
c)Ludwig'sangina
d)Parapharyngealabscess

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

CorrectAnswer-C
Ans.C.Ludwig'sangina
>Thisisaninfectionofthesubmandibularspace,i.e.floorofthe
mouth.
>ThemostcommoncauseofLudwig'sanginaisdentalCaries.

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

>Thesubmandibularspaceisdividedinto2spacesbythe
mylohyoidmuscle(alsoknownastheoraldiaphragm).
>Thespaceabovethemylohyoidisknownassublingualspace.
Heretheinfectionspreadsfrompremolartooth.
>Thespacebelowthemylohyoidisknownassubmaxillaryspace

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laterallyandsubmentalspaceinthecenter.
>Infectiontothisspacefollowscariousmolars.

(Ref.ScottBrown,8thed.,VoI3;628)


271.Themovementislostin:

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a)Thirdnervepalsy
b)Trochlearpalsy
c)Sixthnervepalsy
d)Facialnervepalsy
CorrectAnswer-B

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

Ans:b.Trochlearpalsy
>Thetrochlearnerveisthefourthcranialnerve(CNIV)andoneof
theocularmotornervesthatcontroleyemovement.
>Thetrochlearnerve,whilethesmallestofthecranialnerves,has
thelongestintracranialcourseasitistheonlynervetohaveadorsal

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exitfromthebrainstem.
>Itoriginatesinthemidbrainandextendslaterallyandanteriorlyto
thesuperiorobliquemuscle.
Ref:https://www.ncbi.nlm.nih.gov/books/NBK537244/


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272.Identifytheconditiongivenbelowinthe
image
a)Peutzjeghers
b)Juvenilepolyp
c)Villousadenoma

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d)Hyperplasticpolyp
CorrectAnswer-B
Answer-B.Juvenilepolyp
TheimageshownhereisJuvenilepolyp.
Thisisabrightred,glisteningpedunculatedsphere(cherrytumour),

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

whichisfoundininfantsandchildren.
Itcancausebleeding,orpainifitprolapsesduringdefecation.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg1327



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273.BariumSwallowexaminationisshown.
Whatcanbethemostprobable
diagnosis?

a)EsophagealCa
b)EsophagealRing

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c)EsophagealTear
d)AchalasiaCardia
CorrectAnswer-A
Answer-A.EsophagealCa
TheimageisEsophagealcarcinoma

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Squamouscellcancerandadenocarcinomaarethemostcommon
types.
Theclassicappearanceofamidoesophagealproliferative
squamouscellcarcinoma.
Squamouscellcarcinomaoftheesophagusproducinganirregular

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stricturewithshoulderedmargins.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition

publishedin2018Pg1086


274.Identifytheconditiongivenintheimage

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below?
a)Chroniclymphedema
b)Cushingsyndrome
c)Osteoporosis
d)None

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

CorrectAnswer-A
Answer-A.Chroniclymphedema
Theimageshowsbuffalohumpappearanceofthefootseenin
chroniclymphedema.
Lymphoedemacharacteristicallyinvolvesthefoot.

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

Thecontouroftheankleislostthroughinfillingofthesubmalleolar
depressions,a'buffalohump'formsonthedorsumofthefoot,the
toesappear'square'becauseofconfinementoffootwearandthe
skinonthedorsumofthetoescannotbepinchedbecauseof
subcutaneousfibrosis(Stemmer'ssign).

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Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg998



275.Identifytheconditiongivenbelow-
a)MCUwithBulbarurethralstricture

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b)MCUwithpenilestricture
c)RGUwithmembranousstricture
d)RGUwithprostaticstricture
CorrectAnswer-A
Answer-A.MCUwithBulbarurethralstricture

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Thecommoncausesofurethralstricturesare:
Inflammatory

1. Secondarytourethritis
2. Secondarytobalanitisxeroticaobliterans.(BXO)
Traumatic

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1. Bulbarurethralinjury
2. Pelvicfractureurethraldisruptioninjury
Iatrogenic
1. Secondarytourethralinstrumentationincludingcatheterizationand


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transurethralprostatectomy
2. Secondarytoradicalprostatectomy
3. Secondarytoradiotherapyforprostatecancer
Idiopathic
Ascendingurethrogramshowingurethralstricturesofthebulbar

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urethra.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg1482



276.Whatistheuseoftheinstrumentgiven

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intheimagebelow?
a)Laparoscopicsterilisation
b)Removalofectopicpregnancy
c)Terminationofpregnancy
d)Laparoscopicprocedurestocreatepneumoperitoneum

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

CorrectAnswer-A
Ans.A.Laparoscopicsterilisation
Lapringapplicator:Duringatuballigation,a2cmto3cmsegmentof
thefallopiantubeisdrawninsideanarrowcone-shapedapplicator.
Thesilasticringpreviouslystretchedaroundtheapplicator,isthen

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

releasedontothetuballoop.Oncethesilasticringcontracts,the
fallopiantubeisblocked
Ref.https://www.surgicalinstruments.com/general-lap-bariatric-
instruments/fallopian-ring-applicator-for-tubal-ligation



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277.Identifytheimagebelow:
a)Femalecondom
b)Malecondom
c)Chaaya
d)Today

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CorrectAnswer-A
Ans.A.Femalecondom
Thefemalecondom(Femidom):
Itisapouchmadeofpolyurethanethatlinesthevaginaandalsothe
externalgenitalia.Itis17cminlengthwithoneflexiblepolyurethane

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ringateachend.Theinnerringattheclosedendissmaller
comparedtotheouterring.
Ref.Duttagynaecology6thed.Pageno.476


278.Whatconditionofthemotheris

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associatedwiththefollowingfetal
anomaly?

a)ACEinhibitor
b)GDM
c)PregestationalDM

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

d)Valproate
CorrectAnswer-C
Ans.C.PregestationalDM
TheimageshowsCaudalregressionsyndrome
Thisrareanomalyischaracterizedbytheabsenceofthesacral

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spineandoftenportionsofthelumbarspine.Itisapproximately25
timesmorecommoninpregnancieswithpregestationaldiabetes
Sonographicfindingsincludeaspinethatappearsabnormallyshort,
lacksthenormallumbosacralcurvatureandterminatesabruptly
abovetheleveloftheiliacwings.

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Becausethesacrumdoesnotliebetweentheiliacwings,theyare

abnormallyclosetogetherandmayappear"shield-like."
Theremaybeabnormalpositioningofthelowerextremitiesanda
lackofnormalsofttissuedevelopment.
OBSWILLIAMSed.24pageno.204

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279.Interpretthepartogram.
a)CPD
b)Maternalexhaustion
c)Inadequateuterinecontractions

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d)Ruptureuterus
CorrectAnswer-A
Ans.A.CPD
Patientadmittedat7AM
Cervicaldilatation4cm

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Head:5/5thpalpable
After2hrs
Cervicaldilatation:5cm

Cervicaldilatation:5cm
Head:3/5thpalpable

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After4hrs:11AM
Cervicaldilatation7cm
Head:2/5thpalpable
Cervicaldilatation:Reached10cm
Uterinecontractionisstrongafter4hrsbuttheDescentofthehead

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isstill2/5th(constantafter4hrs)
Diagnosis:Arrestofdescent
Themostcommoncauseofthearrestofdescentiscephalopelvic
disproportion
Ref.https://hetv.org/resources/reproductive-

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

health/impac/Symptoms/Unsatisfactory__progress_labour_S57_S67.html
https://apps.who.int/iris/bitstream/handle/10665/58903/WHO_FHE_MSM_93.8.pdf?
sequence=1



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280.60yrfemalewithahistoryofintermittent
bleedingwithUSGpicshownbelow.
Whatisthediagnosis?

a)Endometrialpolyp
b)Caendometrium

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c)Submucosalfibroid
d)None
CorrectAnswer-A
AnsA.Endometrialpolyp
The3Dimagegivesabetterpictureofalargevesselpassingintoa

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polyp.
Endometrialpolyps:
Endometrialpolypsarelocalizedovergrowthofthebasalstroma
withcentralbloodvesselscoveredbysurfaceendometriummostly
risingfromthefundalarea.

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

Itisimportanttomentionthattheliabilityofpolypstobleedfollows
theirpeculiarstructure.Eachpolyphasacentralfeedingvessel,soft
stromaandbacktobackglandularity.
Onlineref.http://www.gynaecologist4u.com/9.html


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281.WhatwillbetheHysteroscopicfindingin
thegivenimage?
a)BilateralHydrosalpinx
b)Bilateralcornualblock
c)NormalHSG

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d)Bicornuateuterus
CorrectAnswer-A
Ans.A.BilateralHydrosalpinx
TheimageisHysterosalpingogramshowingbilateralhydrosalpinx
(fimbrialblock).

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Hysterosalpingogramshowingradio-opaqueshadowfillingthe
uterinecavity.Thetubesofbothsidesaredistendedwiththeradio-
opaquedye.Thereisnoevidenceofperitonealspillage.



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NORMALHSGSHOWINGSPILLAGE
Hysterosalpingogramshowingbilateralcornualblock.
Hysterosalpingogramshowingbicornuateuterus.
Ref.DCDutta'sTextbookofGynecology6thEditionPageno.

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657-659,661



282.Aladyontreatmentforinfertility
developedascites,abdominalpain&
dyspnea.

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USGofthepatientwasdoneshown
below.Whatwillbethediagnosis?

a)PCOS
b)OHSS
c)Thecaluteincyst

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

d)Mucinouscystadenomas
CorrectAnswer-B
ANS.B.OHSS
Ovarianhyperstimulationsyndrome(OHSS):

Itisaclinicalsymptomcomplexassociatedwithovarian

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

enlargementresultingfromexogenousgonadotropintherapy.
Symptomsmayincludeabdominalpainanddistension,ascites,
gastrointestinalproblems,respiratorycompromise,oliguria,
hemoconcentration,andthromboembolism.
Thesesymptomsmaydevelopduringovulationinductionorinearly

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pregnanciesthatwereconceivedthroughexogenousovarian
stimulation.
REF:DCDutta'sTextbookofGynecology6thEditionPAGENO.
529,530,661



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283.5-yearmalechildpresenttotheclinic
withH/OrecurrentinfectionOn
examinationhewasfoundtohave
rashesshownbelowintheimage.On
routinebloodinvestigation,lowplatelet

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countwasfoundwhatwillbethe
diagnosis?

a)WiskottAldrichsyndrome
b)Job'ssyndrome
c)ChediakHigashisyndrome

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

d)None
CorrectAnswer-A
Ans.A.WiskottAldrichsyndrome
WiskottAldrichsyndrome:Thereisamutationinthegeneencoding
Wiskott-Aldrichsyndromeprotein(WASP),whichislocatedon

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

Xp11.23.TheX-linkeddiseaseischaracterizedby
thrombocytopenia,eczema,andamarkedvulnerabilitytorecurrent

thrombocytopenia,eczema,andamarkedvulnerabilitytorecurrent
infection,resultinginearlydeath.
Plateletsaresmallinsize.

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

ThereisaprogressivelossofTlymphocytesintheperipheralblood
andintheT-cellzones(paracorticalareas)ofthelymphnodes,with
variabledefectsincellularimmunity.
Patientsdonotmakeantibodiestopolysaccharideantigens,andthe
responsetoproteinantigensispoor.TheyarepronetodevelopB-

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celllymphomas.
Robbins&CotranPathologicBasisofDisease,9ed:Pageno
242



284.Thepatientispresentingwiththe

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

deformityofthefingerasshown.ThePIP
isinvolvedbuttheDIPisspared

a)Osteoarthritis
b)Rheumatoidarthritis
c)PsoriaticArthritis

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

d)Ankylosingspondylitis
CorrectAnswer-B
Ans:b.Rheumatoidarthritis
>Swan-neckdeformityofthefingerdescribeshyperextension
atthePIPjointwithflexionoftheDIPjoint

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

>RheumatoidArthritisClinicalPresentation
Ref:https://www.medscape.com/answers/331715-5365/what-is-
a-swan-neck-deformity-of-the-finger-in-rheumatoid-arthritis-ra



285.Whatisthemostlikelydiagnosisgiven

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intheimage-
a)Popeye'ssign
b)Griesingersign
c)Risingsunsign
d)Winnersign

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

CorrectAnswer-A
Ansa.Popeye'ssign
>presentedtotheorthopedicclinicwithalargebulgeonhisright
upperarm.
>Examinationrevealedanobviousdeformityintheanteriormid-

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

upperarmthatmaybecomemoresignificantduringelbowflexion
>ThistypicalfindingonphysicalexaminationisknownasPopeye
signorPopeyedeformity,whichiscausedbybulgingofthebiceps
musclebellyafterruptureofthebicepstendon
https://academic.oup.com/qjmed/article/112/12/931/5487419

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286.Thepatientispresentingwithpain
aroundthebaseofthethumb,tendons
involved-

a)APB&EBL

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

b)APL&EPB
c)APB&EPB
d)APL&EPL
CorrectAnswer-B
Ans:b.APL&EPB

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

>TheconditionexplainedinthepatientisDeQuervain's
Tenosynovitis
>DeQuervain'sTenosynovitisisapainfulinflammationoftendons
onthesideofthewristatthebaseofthethumb.
>Thesetendonsincludetheextensorpollicisbrevis(EPB)andthe

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

abductorpollicislongus(APL).

>Thesemusclesarelocatedonthedorsalsideoftheforearmand
gotothelateralsideofthethumbthroughafibrous-osseoustunnel
madeoftheprocessusstyloideusradiiandtheextensor
retinaculum.

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


retinaculum.
https://www.physio-
pedia.com/De_Quervain%27s_Tenosynovitis
Aclinicalcaseofabnormallengtharms,longfingersandtoes
Ans:Marfansyndrome(Ortho)

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287.Theshownangleintheimageisknown
as
a)Cobb'sangle
b)Bohler'sangle

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

c)Fergusonangle
d)Baumann'sangle
CorrectAnswer-A
Ans:a.Cobb'sangle
>TheimageshowstheScoliosispatterninVertebra.

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

TheCobbAngleisusedasastandardmeasurementtodetermine
andtracktheprogressionofscoliosis.
>Theangleofcurvatureismeasuredbydrawinglinesparalleltothe
upperborderoftheuppervertebralbodyandthelowerborderofthe
lowestvertebraofthestructuralcurve.

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

>Thenerectingperpendicularsfromtheselinestocrosseachother,
theanglebetweentheseperpendicularsbeingthe`angleof
curvature'
>ACobbangleof10degreesisregardedasaminimumangulation

>ACobbangleof10degreesisregardedasaminimumangulation

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

todefineScoliosis.
Ref:https://www.physio-pedia.com/Cobb%27s_angle


288.Whatisthediagnosisof55oldwomen
withachroniclowbackache-

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

a)Osteoporosis
b)Hurler'ssyndrome
c)Paget'sdisease
d)Renalosteodystrophy
CorrectAnswer-A

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

Ans:a.Osteoporosis
>Osteoporosisis,forthemostpart,adiseaseofaging.
>Theolderseniorisathighriskforosteoporosis.
>Theriskforlowbonedensityincreaseswithageandsignificantly
impactsbonestrength.

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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2685234/


289.Identifytheconditionshowninthe
image?
a)IchthyosisVulgaris

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

b)Syndromalichthyosis
c)Leprosy
d)Sarcoidosis
CorrectAnswer-A
Answer-A.IchthyosisVulgaris

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

Ichthyosisisoneofthemostcommongenodermatoses.Itis
characterizedbydry(xerotic)scalyskinalloverthebody.Scalesare
dull-brown-black.Thebasicdefectisanimpairmentinthebarrier
functionofskinandinabilitytomaintainmoisture.
Ichthyosiscanbedividedinto:-

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

1. Inheritedichthyosis(IchthyosisVulgaris,X-linkedIchthyosis,
Lamellarichthyosis,epidermolytichyperkeratosis).
2. Syndromalichthyosis
3. Acquiredichthyosis(Ichthyosisacquisita).
ThemostcommontypeofichthyosisisichthyosisVulgarisinwhich

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

thereisadeficiencyoffilaggrinaproteinfoundinthegranularlayer

thereisadeficiencyoffilaggrinaproteinfoundinthegranularlayer
(stratumgranulosum)
Manydifferentmetaphorshavebeenusedtodescribethe
appearanceandtextureoftheskininvarioustypesandstagesof

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

ichthyosis,e.g.,alligatorskin,Crocodileskin(Sauroderms),Fish
skinandporcupineskin.
Ref-ArvindAroraskin,6thedition,pageno203


290.Thepatientcamewithhistoryofbullae

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

involving>30"A,bodysurfacearea
alongwitherosionsofthelipsandother
mucosaeforthepast7days.Whatisthe
mostprobableunderlyingetiology?

a)Bacterialinfection

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

b)Viralinfection
c)Drugs
d)Malignancy
CorrectAnswer-C
Ans:C.Drugs

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

TypicalofSteven-Johnsonsyndrome&toxicepidermalnecrolysis.
Toxicepidermalnecrolysis(TEN):
Alsoreferredtoas"Lyell'ssyndrome".
Rare,life-threateningskincondition.
Usuallycausedbyadrugreaction.

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



291.Whichofthefollowingdoestheimageof
Capnographbelowdepicts?
a)Duringinspiration
b)Inspirationwithcardiacoscillations

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

c)Duringexpiration
d)spontaneousrespiration
CorrectAnswer-D
Ans.D.spontaneousrespiration
Theimageinthegivenquestionshowsacapnographwithclefts

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

duringphaseIIIwhichindicatesspontaneousbreathingeffortsby
thepatientduringcontrolledmechanicalventilation.Alsoknown
ascurarenotchorcleft.
Ref:https://www.ncbi.nlm.nih.gov/pubmed/24132805
Miller'sAnesthesia8thedition(Pageno.1554)

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292.Identifythedeviceshownintheimage.
a)NasopharyngealAirway
b)EndotrachealTube(Cuffed)
c)GuedelAirway

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

d)LaryngealMaskAirway
CorrectAnswer-D
Ans:D.)LaryngealMaskAirway
Laryngealmaskairway
Atypeofsupraglotticairway.

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

ItisalsoreferredtoasBrainmaskasitwasinventedbyDr.Archies
Brain.
LMAprovidesanairwayintermediatebetweenthefacemaskand
trachealtube
Itisamedicaldevicethatkeepsapatient'sairwayopenduring

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

anaesthesiaorunconsciousness.
TheprincipleofLMAisthatitprovidesaneffectivegas-tightseal
aroundthelaryngealinletwithoutanythinghavingtopassthrough
thevocalcord.
LMAisveryeffectiveinmaintainingapatentairwayinthe

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

spontaneouslybreathingpatient.

Itiscomposedofanairwaytubethatconnectstoanellipticalmask
withacuffwhichisinsertedthroughthepatient'smouth,downthe
windpipe,andoncedeployedformsanairtightsealontoptheglottis
(unliketrachealtubeswhichpassthroughtheglottis)allowinga

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

secureairwaytobemanagedbyahealthcareprovider.
LMAisavailablein8differentsizes
Disadvantage:
OneofthemajordisadvantagesofLMAisthatitssealaround
laryngealinletdoesnotalwayspreventaspiration.

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

Therefore,LMAshouldnotbeusedwherethereisanincreasedrisk
ofaspirationofstomachcontents,e.g.'fullstomachpatient.


293.IdentifytheconditionintheX-raygiven
below-

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

a)TGA
b)TAPVC
c)TOF
d)Ebstein'sanomaly
CorrectAnswer-C

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

Answer-C-TOF
TheimageshownaboveisofTetralogyofFallotcondition.
Classicallythechestradiographdemonstratesa'boot-shaped'heart
withpoorlydevelopedlungvasculature.
Thediagnosisisconfirmedwithechocardiography.

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

Surgerytocorrectthetetralogyisthemainstayoftreatmentandis
usuallycarriedoutat4-6
monthsofage,whenpossible.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg905

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



294.Achestradiographobtainedamalewith
hypertension.Whatwillbethe
diagnosis?

a)TetralogyofFallot

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b)Ebstein'sAnomaly
c)TAPVC
d)CoarctationofAorta
CorrectAnswer-D
Answer-D-CoarctationofAorta

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Thechestradiographclassicallydemonstratesrib-notchingbecause
ofdilatedposteriorintercostalvessels.Theheartisusuallyofnormal
sizeintheolderchildandshowsaclassical'threesign"replacing
thetypicalaorticknuckle.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition

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publishedin2018Pg906



295.Steeplesignisseeninwhichofthe
followingcondition?
a)Acuteepiglottitis

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b)Acutelaryngotracheobronchitis
c)Laryngealpapillomatosis
d)Bilateralabductorparalysis
CorrectAnswer-B
Answer-B-Acutelaryngotracheobronchitis

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TheimagebelowindicatesAcutelaryngotracheobronchitis.
Croupisusuallyofsloweronsetthanacuteepiglottitisandoccurs
mostcommonlyinchildrenunder2yearsofage.
Thechildrenhavebiphasicstridorandareoftenhoarsewitha
typicalbarkingcough.

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Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg743



296.Identifytheradiologicalsigngiven
below-

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a)Diverticulitis
b)Ischaemiccolitis
c)Appendicitis
d)None
CorrectAnswer-B

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Answer-B-Ischaemiccolitis
Single-contrastbariumenemashowsthenarrowingofthe
descendingcolonwithascallopedappearancewithulcerationorthe
classicaloedematous'thumbprinting'signinischaemiccolitis.
Plainfilmsarefrequentlytakenandoftenrevealsplenicflexure

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irregularitywithamuralthickening.
Ref-DavidSutton,TextbookofRadiologyandImaging,Volume
1,Edition7th,Pg653
Basicofradiology,Lange,2ndedition,Pg642



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297.Amiddle-agedmanwithaswellingover
thenecksincechildhoodwiththe
overlyingskinnotintactwhichhadabag
orworm-likeappearancewithablack
spotinthemiddle.Whatwillbethe

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diagnosis?

a)Cirsoidaneurysm
b)Varicocele
c)Plexiformneurofibroma
d)Lymphangioma

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CorrectAnswer-C
Answer-C-Plexiformneurofibroma
PlexiformneurofibromasrepresentanuncommonvariantofNF-1in
whichneurofibromasarisefrommultiplenervesasbulgingand
deformingmassesinvolvingalsoconnectivetissueandskinfolds--

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hencetheclinicaldescriptionoflesionsas"bagsofworms."

Skinexaminationalsorevealedmultipleneurofibromasandcaf?-au-
laitmaculesonthetrunkandarms.
Ref-
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753888/#!po=35.7143

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298.Identifytheradiologicalimagegiven
below-
a)Intussusception
b)Carcinomacolon

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c)Sigmoidvolvulus
d)Sigmoidvolvulus
CorrectAnswer-A
Answer-A-Intussusception
Thisimageshowsintussusception.

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Theclassicpresentationiswithepisodicabdominalpainand
screamingepisodesassociatedwiththepassageofbloodand
mucus('redcurrentjelly').
Theabdominalradiographmaydemonstrateanabsenceofbowel
gasintherightiliacfossawitharoundedsoft-tissuemassa

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crescentofairattheapexofintussusception,orsmall-bowel
obstruction.
Ref-DavidSutton,TextbookofRadiologyandImaging,Volume
1,Edition7th,Pg872



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299.Namethesignseeninthegivenbelow
imagerepresents-
a)Mickeymousesign
b)Stringsign
c)Tillauxsign

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d)Stemmer'ssign
CorrectAnswer-A
Answer-A-Mickeymousesign
TheMickeyMousesignissaidtorepresentthenormalanatomyof
thecommonfemoralartery,commonfemoralveinandgreat

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saphenousveinonultrasoundattheleveljustinferiortotheinguinal
crease.
Reference-Coleridge-SmithP,LabropoulosN,PartschH,Myers
K,NicolaidesA,CavezziA.Duplexultrasoundinvestigationof


theveinsinthechronicvenousdiseaseofthelowerlimbs--UIP

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consensusdocument.PartI.Basicprinciples.Europeanjournal
ofvascularandendovascularsurgery:theofficialjournalofthe
EuropeanSocietyforVascularSurgery.



300.A35-year-oldmalepresentswith

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recurrentepisodesofabdominalpain,
jaundice,andfatigueandunderwent
MRCP.Whatwillbethemostlikely
diagnosis?

a)Primarybiliarycirrhosis

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b)Caroli'sdisease
c)Primarysclerosingcholangitis
d)Orientalcholangitis
CorrectAnswer-C
Answer-C-Primarysclerosingcholangitis

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ThisimageshowsPSC.
MRimagingofthebiliarysystem,especiallyMRCP,hasbecome
moreimportantinbiliaryimaging,includingthedetectionofcalculiof

thegallbladderandbiliarytree.
ThediagnosisofPSCisprincipallybasedonthefindingsat

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cholangiography,inwhichirregular,narrowedbileductsare
demonstratedinboththeintrahepaticandextrahepaticbiliarytree.
Ref-BaileyandLove,Shortpracticeofsurgery,27thedition
publishedin2018Pg1167
Basicofradiology,Lange,2ndedition,Pg313

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