Question: This graft is


Question: Not a tumor marker

Ans. d (Alpha-1 antitrypsin). (Ref. Robbins, Pathologic Basis of Disease, 6th/pg.325) Alpha-1 Antitrypsin Blood Levels as Indicator for the Efficacy of Cancer Treatment Ref- Our data came to confirm this suggestion and to strongly conclude that the measurement of a1-AT blood levels during the course of cancer treatment has a valuable clinical significance as an indicator for the efficacy of treatment. Tumor markers Malignancy 1 AFP (5-fetoprotein) - Normally made by fetus. - Hepatocellular carcinomas. - Nonseminomatous germ cell tumors of the testis (e.g., yolk sac tumor). 2 b-hCG - Hydatidiform moles, - Choriocarcinomas, and - Gestational trophoblastic tumors. 3 Inhibin - Granulosa cell tumor 4 CEA - Nonspecific but produced by 70% of colorectal and pancreatic cancers; - Also produced by gastric and breast carcinomas. 5 Ca 125 - Malignant Epithelial ovarian tumors 6 PSA - Ca prostate 7 TRAP (Tartrate-resistant acid phosphatase) - Hairy cell leukemia (a B-cell neoplasm) 8 b2-Macroglobulin - Multiple myeloma 9 VMA - Pheochromocytoma 10 5-HT - Carcinoid tumor 11 5-HIAA - Carcinoid tumor 12 LDH - GCT, seminoma 13 CA-19-9 - Pancreatic adenocarcinoma. 14 Bombesin - Neuroblastoma, lung and gastric cancer. 15 Alkaline phosphatase - Metastases to bone, - Obstructive biliary disease, - Paget's disease of bone. 16 S-100 - Melanoma, neural tumors, astrocytomas.

Tartarate resistant alkaline phosphatase


Question: The most likely diagnosis is

This is a typical presentation of stage IV neuroblastoma, with the primary tumor arising from orie of the paravertebral sympathetic ganglia and metastasizing to bone marrow, cortical bone, and the retro orbital tissues. Histiocytosis X may have a somewhat similar presentation and involve multiple bones, but it usually involves one rather than both orbits; the right flank mass and tumor clumps in the marrow of this patient also are not characteristic" of histiocytosis X. Rhabdomyosarcoma may arise in the orbit but usually is unilateral; the tumor also rarely is associated with systemic metastases at initial diagnosis. Wilms tumor would produce a right renal rather than suprarenal mass and would metastasize to the lungs rather than to bone and bone marrow. Lymphoblastic lymphoma usually arises in the anterior mediastinum or peripheral node's. Even if it were to present with widespread dissemination, abdominal rather than thoracic disease would be unusual and Lymphoblasts rather than tumor clumps would be seen in the marrow.


Question: Hypersensitivity vasculitisis seen most commonly in

HYPERSENSITIVITY VASCULITIS
In hypersensitivity vasuculitis, postcapillaryvenules are the most commonly involved vessels, capillaries and arterioles are involved less frequently.
It is primarily a disease of small vessels.
It is characterized by leukocytoclasis, a term that refers to the nuclear debris remaining from the neutrophils that have infiltrated in and around the vessels during the acute stages.


Question: Age of eruption of Permanent 1st molar

Ans. is 'a- i.e., 6 years Eruption of temporary teeth (Primary' dentition) Tooth Age in range (months) Average age (months) Lower Cl Upper Cl UpplerLI Lower LI I molar Canine II molar 6-8 7-9 7-9 10-12 12-14 17-18 20-30 7 8 8 11 13 17[?]5 25 Eruption of permanent teeth (Secondary dentition) Age in range (years) Average age (years) First Molar Central incisor Lateral incisor First PM Second PM Canine Second Molar Third molar 6-7 7-8 8-9 9-11 10-12 11-12 12-14 17-25 6[?]5 7 8 10 11 11 5 13 17


Question: In the central nervous system (CNS), oligoden¬drocytes share a similar function with

Oligodendrocytes in the central nervous system (CNS) share a similar function with Schwann cells in the peripheral nervous system-synthesis of myelin. Oligodendrocytes are small, round, lymphocyte-size cells that produce and maintain CNS myelin, which is primarily located in the white matter. Certain diseases, such as progressive multifocal leukoencephalopathy, caused by a papovavirus, specifically attack oligodendrocytes and produce demyelination. Oligodendrogliomas are malignant tumors that are derived from oligodendrocytes. However, unlike Schwann cells, oligodendrocytes contribute segments of myelin sheaths to more than one axon.
Gemistocytes are reactive astrocytes that have an eosinophilic cytoplasm. They are commonly seen along the periphery of cerebral infarctions. Some astrocytomas have a gemistocytic appearance.
Astrocytes provide the structural framework for the neurons and are analogous to the fibroblasts in connective tissue. However, scarring in the brain is not associated with collagen synthesis but with filling in the defect with the cellular processes of astrocytes. A cerebral abscess is the only example of CNS repair with collagen, which is derived from the blood vessels.
Microglial cells are derived from monocytes. They are the phagocytic cell of the CNS.
Ependymal cells line the ventricles of the brain and the spinal canal. They do not produce CSF nor are they responsible for reabsorption of CSF, a function relegated to arachnoid cells.


Question: A patient with diarrhea has a fecal smear that is negative for leukocytes. The patient's diarrhea is most likely caused by

The enterotoxigenic strain of Escherichia coli secretes a heat-labile toxin that stimulates adenylate cyclase, producing a cholera-like syndrome that is responsible for the majority of cases of traveler's diarrhea. Because the bowel mucosa is not invaded and there is no toxin-induced damage, the fecal smear is negative for leukocytes. Campylobacter enteritis, shigellosis, typhoid fever, and amebiasis are all invasive, and infected individuals have stools with inflammatory cells. Typhoid fever is unique because the inflammatory cells are not neutrophils, but mononuclear cells.


Question: Folic acid is absorbed from


Question: A child has no criminal responsibility if the age is less than


Question: A child with a constellation of finding including fever, disabling arthritis, rash, and blindness is MOST likely suffering form

A child with a constellation of findings including fever, disabling arthritis, rash, and blindness is most likely suffering from juvenile rheumatoid arthritis (JRA). JRA is characterized by a chronic synovial inflammation of unknown origin; it most commonly affects the knees, but can also manifest in wrists, ankles, and the atlanto-axial joint in the neck. In general, JRA is more common in girls than boys, but this varies with the type of JRA, which can be divided into the following variant subsets: Still disease (20%), polyarticular (40%), and pauciarticular (40%). Still disease most closely resembles an infectious disease, with spiking fever, a centripetal rash, generalized lymphadenopathy, hepatosplenomegaly, transient arthralgias and arthritis, and effusions (pericardial and pleural). The polyarticular variant is associated with destructive arthritis, particularly if the patient tests positive for the rheumatoid factor. The pauciarticular variant features polyarthritis and inflammation of the anterior uveal tract 10%-50%), which predisposes the patient to visual loss and blindness. In most cases of JRA, with the exception of the polyarticular variant, the rheumatoid factor is negative. Anemia and leukocytosis are noted in acute attacks. Aspirin is the major anti-inflammatory agent that is used for treatment. Regarding the other choices in the question:

rheumatic fever features polyarthritis, but it is not destructive
Lyme disease displays many of these findings, but blindness is not a key feature
Henoch-Schoenlein vasculitis has palpable purpura, non-disabling arthritis, but is not associated with blindness
dermatomyositis does not usually involve the joints


Question: The line joining ant. sup iliac spine to ischial tuberosity and passes a greater trochanter

Ans. is 'a' i.e Nelaton's line Maheshwari 3/e p 310(2/e, p299)] Nelaton's line : With the hip in 90 degrees of flexion, a line joining the ASIS and ischial tuberosity passes through the tip of the greater trochanter on that side. In cases of subtrochanteric shortening, the trochanter will be proximal to this line. Shoemaker's line: With the patient lying supine, the line joining AS1S and tip of the greater trochanter is extended on the side of the abdomen on both sides. Normally these lines meet in the middle above the umbilicus. In case one of the greater trochanters has migrated proximally the lines will meet in the opposite side of the abdomen and below the umbilicus. Chiene's line : With the patient lying supine, lines are drawn joining the two AS1S and the two greater trochanters. Normally these make two parallel lines. In case one of the trochanters has moved proximally the lines will converge on that side. Perkin's line : When the cong. Dislocation of the hip is mild in nature, the Perkins lines are drawn to detect it. A horizontal line is drawn through the triradiate cartilage and a vertical line is drawn down from the outer edge of the acetabulum on both sides. The upper femoral epiphyses normally lies medial to the vertical line and below the horizontal line. But in cong. dislocation of hip the epiphyses will lie on the outer aspect of the vertical line and above the horizontal line. Bryant's triangle : The patient lies supine. The tips of the greater trochanter and ASIS on both sides are marked. A perpendicular is dropped from each ASIS on to the bed. From the tip of the greater trochanter, another perpendicular is dropped on to the first one. The tips of the greater trochanter are joined to the ASIS on the respective side. This forms a triangle ABC. The side BC of the triangle measures supra trochanteric shortening of hip.


Question: Maximum refractive index is in ......... component of eye

Ans- C Refractive index of various eye partsa. Cornea-1.376b. Aqueous humor-1.335c. Lenscortex 1.39d. Lens nucleus : 1.41e. Vitreous humor-1.336


Question: Cytosolic cytochrome C plays an important function in

Ans. is 'a' i.e. Apoptosis Apoptosis is a programmed cell death.Mechanism of ApoptosisApoptosis is induced by a cascade of molecular events that may be initiated in distinct ways but culminate in the activation of caspases.Caspases are central to the pathogenesis of apoptosisThe process of apoptosis is divided into two phasesInitiation phase - During this phase caspases become catalytically activeExecution phase - During this phase caspases act to cause cell death.Initiation phase of apoptosisInitiation of apoptosis occurs principally by signals from two distinct but convergent pathwaysExtrinsic or receptor-initiated pathwayIntrinsic or mitochondrial pathwayExtrinsic or death receptor-initiated pathwayThis pathway is initiated by expression of cell surface death receptors on a variety of cells.Death receptors are members of tumor necrosis factor receptor family that contain a cytoplasmic domain involved in protein-protein interactions that are called death domain because it is essential for delivering apoptotic signals (or death signals)The best-known death receptors are the type 1 TNF receptor (TNFRI) and a related protein called Fas (CD95).When the Fas receptors are cross-linked by its ligand it triggers a sequence of events which eventually leads to activation of caspases.This pathway of apoptosis can be inhibited by a protein called FLIP, which can bind to inactive or procaspases but cannot cleave and activate these enzymes.The intrinsic mitochondrial pathwayThis pathway has no role for death receptors.This pathway is the result of increased mitochondrial permeability and the release of proapoptotic molecules in the cytoplasm.Note that antiapoptotic proteins reside in the mitochondrial membrane (Bcl-2 and Bcl-X).When cells are deprived of survival signals or subjected to stress Bcl-2 and Bcl-X are lost from the mitochondrial membrane and are replaced by proapoptotic members of the family such as Bak, Bax, and Bim.This leads to increase in the permeability of the mitochondrial membrane.Due to increased permeability of the mitochondrial membrane, several proteins that can activate the caspase leak out.One of these proteins is cytochrome C, well known for its role in mitochondrial respiration.In the cytoplasm, cytochrome binds to a protein called Apaf-1 (apoptosis-activating factor-1) and the complex activates caspase.* So, the final result of both the pathways that are extrinsic receptor mediated pathway and the intrinsic mitochondrial pathway is the same i.e. activation of the caspase.The execution phase of apoptosisAfter being activated the caspases act on many cellular components.They cleave cytoskeletal and nuclear matrix proteins and thus disrupts the cytoskeleton.They also lead to the breakdown of the nucleus.In the nucleus, the' target of caspase activation includes proteins involved in transcription, DNA replication andDNA repair.


Question: Pollicization is best described as

• Reconstruction of thumb is called pollicization. Typically this Consists of surgically migrating the index finger to
the position of the thumb
• During pollicization the index finger metacarpal bone is cut and the finger is rotated approximately 120—160 degrees and replaced at the base of the hand at the usual position of the thumb
• The arteries and veins are left attached.
Amputated digits should be well washed with saline and wrapped in STERILE GAUZE soaked in STERILE SALINE or RL and put in STERILE plastic bag & put in an CONTAINER with ICE(digits should not be in direct contact with ICE).
TRANSPORT :   room temperature 6 hrs and at 4 deg C for 12 hrs
The vessels SHOULD NOT be clamped but SECURED with pressure DRESSING only.


Question: Lamina cribrosa is not present in

Morning glory syndrome is a mesodermal defect in which there is peripapillary defect along with absence of lamina cribrosa.


Question: Lymphnodes not involved in CA endometrium is

Ans-C Inferior mesenteric Lymphatics from the uterus do not drain inferior mesenteric nodesLymphatic drainage of uterus -Upper lymphatics - Aortic & superficial inguinal nodes* (from fundus)Middle lymphatics - Ext. iliac nodes* (from body)Lower lymphatics - Ext. iliac nodes, internal iliac nodes* (from cervix)


Question: Hormone Therapy indicated in menopausal women

Ref. DC Dutta's Textbook of Obstetrics. Pg 890

INDICATIONS OF HORMONAL THERAPY

Relief of menopausal symptoms like hot flushes, senile vaginitis, mood swings, decreased libido, memory loss, irritability, increased risk of CAD
Prevention of osteoporosis
To maintain the quality of life in menopausal years


Question: This scalpel works on the principle of

Harmonic scalpel works on the principle of high energy ultrasonic waves (megahertz). Harmonic scalpel is used in liver resections and laparoscopic surgery.


Question: As per MCI regulations, a medical practitioner should maintain the records of in patients for a minimum period of

(Refer: Rajesh Bardale - Principles of Forensic medicine & Toxicology, 1st edition, pg no: 32)
Every physician shall maintain the medical records pertaining to his / her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India


Question: C/F of complicated cataract A/E

Ans: (B) Opacity along sutures Ref.: A.K. Khurana 6th ed. /194-95 * Complicated cataract : Cataract secondary to some intraocular disease which may be: # Anterior cortical in anterior segmental lesion as glaucoma, acute iritis, or, # Posterior cortical in posterior segmental lesion as uveitis, RD, pigmentary retinal dystrophy. * The second type of complicated cataract presents with posterior cortical bread crumb appearance/ polychromatic lusture or rainbow cataract. * Bread crumbs appearance is Pathognomonic of posterior cataract. * Opacity usually commence in posterior cortex and spread axially and NOT along sutures. * Vision is much impaired even in early stage, owing to the position of the opacity near the nodal point of the eye.


Question: In full term neonates, the ductus arteriosus closure is mainly due to

(Low pressure O2): Ref 45-Dutta 6th (394-Ghai 7th) Changes of the fetal circulation at birth 1. Closure of the umbilical arteries: Functional closure is almost instaneous preventing even slight amount of the fetal blood to drain out. Actual obliteration takes about 2-3 months. The distal parts from the lateral umbilical ligaments and the proximal parts remain open as superior vesical arteries. 2. Closure of umbilical vein: - The obliteration occurs a little latter than the arteries, After obliteration, the umbilical vein forms the ligamentum teres and the ductus venosus becomes ligamentum venosum 3. Closure of the ductus arteriosus - Within few hours of respiration, the muscle wall of the ductus arteriosus contracts probably in response to rising oxygen tension of the blood flowing through the duct. The effects of the variation of the O2 tension on the ductus arteriosus are thought to be mediated through the action of prostaglandins. Prostaglandin antagonists given to the mother may lead to the premature closure of the ductus arteriosus. Whereas functional closure of the ductus may occur soon after the establishment of pulmonary circulation, the anatomical obliteration takes about 1-3 months and becomes ligamentum arteriosum 4. Closure of the foramen ovale: - This is caused by an increased pressure of the left atrium combined with a decreased pressure on the right atrium. Functional closure occurs soon after birth but anatomical closure occurs in about 1 year time. Within one or two hours following birth ,the cardiac output is estimated to be a bout 500 ml per minute, and the heart rate varies from 120 -140 per minute * During foetal life, patency of the ductus arteriosus appears to be maintained by the combined relaxant effects of low oxygen tension and endogenously produced prostaglandins (PGE2), In full term neonates the oxygen is the most important factor controlling ductual closure (1480- Nelson 17th) Ref 2 - PATHOPHYSIOLOGY The DA is derived from the distal dorsal sixth aortic arch and is completely formed by the eighth week of gestation.6 Its role is to shunt the blood from the nonfunctional fetal lung through its connection between the main pulmonary artery and the proximal descending aorta. This right-to-left shunt allows the blood with a relatively low oxygen concentration to be carried from the right ventricle through the descending aorta and eventually to the placenta, where gas exchange will occur. Before birth, approximately 90% of right ventricular output flows through the DA. Figure 1 illustrates the role of the DA in redirecting fetal circulation in comparison to neonatal circulation.15 Premature closure in the fetus is associated with significant morbidities, including right-sided heart failure, which may result in fetal hydrops.6 Normally, the DA closes within 24-72 hours after a full-term birth; if after 72 hours the ductus fails to close, a diagnosis of persistent PDA may be made.1,16 Figure 1. Left-The ductus arteriosus is an essential component of fetal circulation. It functions by shunting blood away from the nonfunctional fetal lung and into the systemic circulation through the aorta. Right-After birth, decreases in PGE2 and oxygen tension contribute to the closure of the ductus Arteriosus, allowing gas exchange to occur in the newly functioning lungs rather than the now absent placenta. Blue = oxygen-poor blood; Red = oxygen-rich blood; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle. The paradoxical patent ductus arteriosus. J Clin Invest 166:2863-2866 by Ivey KN, and Srivastava D. Copyright 2006 by J Clin Invest. Reproduced with permission of J Clin Invest via Copyright Clearance Center. The patency of the DA is primarily controlled by low fetal oxygen tension and the circulation of prostanoids produced from the metabolism of arachidonic acid by COX, with PGE2 producing the most profound ductal relaxation among the prostanoids.16,17 Smooth muscle relaxation of the DA results from the activation of the G-coupled prostaglandin receptor EP4 by PGE2. Following the activation of prostaglandin receptor EP4, a cascade of events ensues, which includes the accumulation of cyclic adenosine monophosphate, increased protein kinase A, and finally, decreased myosin light chain kinase, leading to vasodilation and ultimately DA patency.15 The preterm ductus is especially sensitive to the vasodilatory effects of prostaglandins, contributing to the failure of ductal closure.18 In term infants, as birth approaches, decreased sensitivity of the DA to prostaglandins and decreased circulating levels of PGE2 contribute to DA closure.19 Within 24-72 hours after a full-term birth, the DA closes as a result of increased oxygen tension and decreased circulating PGE2 and prostacyclins (PGI2). As oxygen tension increases, smooth muscle voltage-dependent potassium channels are inhibited. Through this inhibition, an influx of calcium contributes to ductal constriction. This oxygen-induced constriction fails in preterm infants potentially due to immaturity of oxygen-sensing receptors.20 Levels of circulating PGE2 and PGI2 are decreased as a result of increased metabolism in the newly functioning lung, as well as the removal of the placental source. The decreased circulating levels of these potent vasodilators allow the DA to constrict. These factors collectively contribute to smooth muscle constriction, leading to ischemic hypoxia of the inner muscle wall of the DA. As the ductus constricts, the luminal area is diminished, resulting in a thickened vessel wall and obstructed flow through the vasa vasorum, the essential capillary network nourishing the outer cells of the vessel. This causes an increased distance of diffusion for oxygen and nutrients, including glucose, glycogen, and adenosine triphosphate (ATP), which results in nutritional deficit and oxygen starvation, leading to cell death.21 Ductal constriction in preterm infants is not sufficiently profound. Consequently, preterm infants are resistant to smooth muscle hypoxia, which is paramount in triggering the cell death and remodeling required for permanent closure of the DA.22 Inhibition of prostaglandin and nitric oxide resulting from tissue hypoxia is not as extensive in the preterm neonate in comparison to the term infant, further contributing to resistance to DA closure in the preterm infant.23 The main provider of nutrients to the DA is the lumen; however, the vasa vasorum is also a substantial provider to the outer wall of the ductus. The vasa vasorum grows toward the lumen and extends 400-500 mm from the outer wall of the ductus. The distance between the lumen and the vasa vasorum (40-500 mm) is referred to as the avascular zone and represents the maximum distance allowable for effective nutrient diffusion. In full-term infants, this avascular zone is expanded beyond the effective diffusion distance, therefore contributing to cell death. In preterm infants, the avascular zone does not sufficiently expand, resulting in cell survival and maintenance of ductal patency.24 If the levels of circulating PGE2 and other prostaglandins are decreased through COX inhibition, closure is facilitated. The abovementioned differences between ductal vessel wall thickness of the fetus, term neonate, and preterm neonate are illustrated in Figure 2.16 In response to the nutritional deficit and ischemic hypoxia, vascular endothelial growth factor and transforming growth factor beta (both of which contribute to endothelial proliferation), in combination with other inflammatory mediators, contribute to the remodeling of the DA into the non-contractile ligament commonly referred to as the ligamentum arteriosum.16,24 Figure 2. Comparison of fetal and both the premature and full-term newborn ductus arteriosus. The avascular zone in the preterm ductus (bottom row) does not sufficiently expand beyond the effective diffusion distance after birth (bottom right). Hermes-deSantis et al.16 Reprinted by permission from Macmillan Publishers Ltd: J Perinatol 26: s14-s18, copyright 2006.


Question: Median weight of 100 children was 16 kgs. The standard deviation was 8.calculate the percentage coefficient of variance.

Coefficient of Variation (COV)

COV = SD × 100

Mean or Median
Is SD expressed as percentage of mean OR median.

CV = SD / MEAN × 100 = 8/16 × 100 = 50%


Question: The action potential of the the sinoatrial node

The action potential of the sinoatrial node and atrioventricular node results from the opening of the slow Ca2+ channels and the influx of Ca2+(some Na+ may also enter through these slow Ca2+channels). An action potential is elicited when the membrane potential reaches threshold. Spontaneous depolarization is an intrinsic property of nodal tissue and can occur in the absence of nerves. The low resting potential results in a small action potential that propagates slowly. The rapid Na+ channels are inactivated in nodal tissue. An increase in the conductance to K+ would hyperpolarize the membrane.

Reuslts from the activation of rapid Na+ channels

Results from opening of the slow Ca2+ channels

Is equivalent in height and conduction velocity to that of the atrial muscle

Results from an increase in conductance to K+


Question: Incidence of mucocele is lowest in

Paranasal sinus mucocelesmost commonly occur in the third or fourth decades of life with a slight male predilection.
The frontal sinus is most commonly affected followed by the ethmoid sinuses, with reports suggesting 70–90 % of mucoceles occur in these locations.
Ten percent of mucoceles occur in the maxillary sinus and the sphenoid sinus is involved rarely


Question: The permissible concentration of fluorides in drinking water is

Ans. C 0.5 - 0.8 (Ref. Park's textbook of PSM - 22nd/pg. 467, 597) ENDEMIC FLUOROSIS # The permissible concentration of fluorides in drinking water is 0.5 to 0.8 mg/L. # Where drinking water contains excessive amounts of fluorine (3-5 mg/L), endemic fluorosis has been observed. # Certain parts of the country, e.g., Andhra Pradesh, Punjab, Haryana, Karnataka, Kerala, and TN are known for it. # Dental Fluorosis: Ingested during the years of tooth calcification essentially during the first 7 years of life by "mottling of dental enamel", which has been reported at levels above 1.5 mg/L intake. Mottling is best seen on the incisors of the upper jaw. # Skeletal Fluorosis/ Genu valgum: Lifetime daily intake of 3.0-6.0 mg/L or more. # Prevention: Changing the water source. # Nalgonda technique for defluoridation of water. The presence of following chemicals in excess of prescribed limits may constitute ground for rejection of the water as a source of public water supply: # Inorganic constituents: - Arsenic: recommended maximum limit of the concentration is 0.01 mg/L. - Cadmium 0.003 mg/L maximum limit. - Chromium - Cyanide: maximum limit 0.07 mg/L. - Fluoride should not be more than 1.5 mg/L - Lead - Mercury: 0.001 mg/L minimum upper limit. Bacterial plate count on yeast extract agar after incubation at 22degC for 7 days might serve as the best general-purpose indicator of microbiological quality. - Selenium - Nitrite and Nitrate: When nitrate level in drinking water exceeds 50 mg/L, methemoglobinemia may occur; most susceptible are bottle-fed infants of less than 3 months. Nitrate is a good indicator of past contamination. # Organic constituents - Polynuclear aromatic hydrocarbons - Pesticides


Question: Dequervain's tenosynovitis is a stenosing tenosynovitis of the

Dequervain's tenosynovitis is a stenosing tenosynovitis of the first extensor compartment at the wrist comprising the tendons of extensor pollicis brevis and Abductor pollicis longus.


Question: The superior vesical arteries are direct branches of the

The umbilical artery is a branch of the internal iliac artery. In the fetus, the umbilical artery passes over the bladder and continues up the anterior body wall to the umbilical cord and out to the placenta. As it passes the bladder, it gives rise to the superior vesical arteries. After birth, the part of the artery distal to the bladder becomes fibrous, but the proximal part remains patent and continues to supply the bladder.


Question: Alopecia, Hyper pigmentation, Hypogonadism characteristic for deficiency of

The essential feature of Zinc deficiency.

A distinctive rash most often around the eyes, nose, mouth, anus and distal parts called

Acrodermatitis Enteropathica.

Growth retardation in children.

Impaired wound healing

Hypogonadism with diminished reproductive capacity.

Anorexia often accompanied by diarrhoea

Depressed mental function.

Other important disease

Selenium deficiency causes Keshan disease. Copper deficiency causes Menke's disease.


Question: A patient sustains a knife wound through the right fourth intercostals space, 2 cm to the right of the sternum. The area most likely penetrated by the knife is the

The right border of the heart is approximately 1 to 2 cm to the right of the right border of the sternum; therefore, the knife probably did not hit the heart. The middle lobe of the right lung extends from the level of the fourth costochondral junction to the level of the fifth intercostal space. The middle lobe is most likely at the level of the fourth intercostal space.


Question: Electrolyte abnormalties are caused by (PGI June 2009)

Ans : D (Al (OH) E (Hydrochlor-thiazide) 0.9% Nad. KCI & j\aHC03 are used in the treatment of electrolyte disturbances."Hypokalemia is the most significant problem with use of thiazides(e.g., hydrochlorothiazide) & high ceiling diuretics therapy.lt can be prevented & treated by High dietary K+ intake, supplements of KCI (24-72mEq/day)or by concurrent use of K+ sparing diuretics"- KDT 6th 7566NaCI: Hypertonic saline & normal saline is used in the treatment of hyponatremia'' (H17th/279)NaHC03: It is used in the treatment of metabolic acidosis (HI 7th/290)Al(OH)3: Aluminium hydroxide gel is used as an antacid to neutralize gastric acid. It binds with phosphate in the intestine & prevents its absorption - hypophosphatemia occurs on regular use (KDT 6th/635)


Question: Condyloma accuminatum caused most commonly by human papilloma virus (HPV) types of


Question: This disease is

Osteochondrosis of the tarsal navicular (Kohler's disease) is characterised by aseptic necrosis of the Navicular bone causing a painful limp in a child usually 4-10 years of age.


Question: Best treatment of old fracture is

Nonunion fracture shaft femur requires open reduction and rigid internal fixation with either intramedullary nail or DC plating and bone grafting.

Open reduction and internal fixation and bone grafting.


Question: The classical flexion and rotation deformities at hip and knee joints, as a sequela of poliomyelitis, are due to the contracture of.

Ans. is 'a' i.e., Tension fascia lata The flexion and rotation deformities at the hip and knee joint in poliomyelitis are due to iliotibial band contracture.As the iliotibial band is a direct extension of tensor facial lata muscle its pull on the hip and knee joint are actually due to contracture of the tensor facialata muscle.The common deformities seen in polio are-At hip - Flexion abduction and external rotationAt knee - Flexion, genu valgum and triple deformity At foot - Talipes equinovarusAlso, rememberThe test required for iliotibial band contracture - Ober's test *


Question: In myocardial infarction the infarct acquires hyperemic rim with an yellow centre at

3 – 7 days Findings
Gross examination at border
Softening yellow-tan center Histopathology
(light microscopy)
Beginning of disintegration of dead muscle fibers
Necrosis of neutrophils
Beginning of macrophageremoval of dead cells at border


Question: Fluidity buffer present in cell membrane is

Membrane fluidity
Membrane fluidity changes with temperature Transition temperature (Tm)
“More is the Tm,less is the fluidity”
Cholesterol-Fluidity buffer
Saturated FAs
increase Tm and decrease fluidity Unsaturated FAs
decrease Tm and increase fluidity


Question: Serum ca& fetoprotein level is elevated in


Question: Extramammary paget’s is seen in

Ref. Robbins Pathology. 9th edition. Page. 999
Extramammary Paget's disease (EMPD), also extramammary Paget disease, is a rare, slow-growing,  usually noninvasive intraepithelial (in the skin) adenocarcinoma outside the mammary gland and  includes Paget's disease of the vulva and the extremely rare Paget's disease of the penis.


Question: The immunoglobulin mediates ADCC

IgG Antibody
o     Half life(23d),
o     High Serum concerntration (GAMDE) ,
Responsible for-
o     Precipitation,
o     neutralization,
o     NK cell (ADCC)
o  Classical complement
Appear late, indicates past / chronic infection


Question: In Corynebacterium diphtheria

• Diphtheria acts by its toxin and invasion is not seen.
• Elekc gel precipitation test is done for determination of pathogenicity of diphtheria.
• Metachromatic granules are seen also called as Babes earnest granules. Bacteriophages (extra-chromosomal) are responsible for toxigenicity by phage conversion.

Toxigenicity is mediated by chromosomal change


Question: Percentage of Blasts in AML

Ans.(c) 20%Ref: Nelson 18th ed. ch. 495* The characteristic feature of AML is that >20% of bone marrow cells on bone marrow aspiration or biopsy touch preparations constitute a fairly homogeneous population of blast cells, with features similar to those that characterize early differentiation states of the myeloid-monocyte-megakaryocyte series of blood cells. The most common classification of the subtypes of AML is the FAB system.French-American-British (FAB) Classification of Acute Myelogenous LeukemiaSUBTYPECOMMON NAMEMlAcute myeloblastic leukemia without maturationM2Acute myeloblastic leukemia with maturationM3Acute promyeloblastic leukemiaM4Acute myelomonocytic leukemiaM5Acute monocytic leukemiaM6ErythroleukemiaM7Acute megakaryocytic leukemia


Question: A 5 year old male child has multiple hyper pigmented macules over the trunk, on rubbing the lesion with the rounded end of a pen. He developed urticarial wheal, confined to the border of the lesion. The most likely diagnosis is

Urticaria is characterized by large, irregularly shaped pruritic, erythematous wheels

Special forms of urticaria have special features (Dermographism, cholinergic urticaria, solar urticaria, or cold uritcaria)
Most incidents are acute and self-limited over a period of 1-2 weeks
Chronic urticaria (episodes lasting> 6 weeks) may have an autoimmune basis
The most common immunologic mechanism is hypersensitivity mediated by IgE, seen for most patients with acute urticaria
The morphology of the lesions may vary over a period of minutes to hours, resulting in geographic or bizarre, pattern, true urticaria last less than 24 hours and often only 2-4 hours.
The most common cause of acute urticaria are foods, viral infections and medications Diagnosis - In vivo allergy skin testing and in vitro RAST testing
Determination of serum tryptase (Increased in anaphylaxis, systemic mastocytosis, non IgE mediated disease ("anaphylactoid reaction")
ACE inhibitors and Angiotensin II receptors antagonist therapy is contraindicated.

Urticaria pigmentosa (mastocytosis) - consists of multiple irregularly shaped hyperpigmented macule which may present on the trunk and extremities.

Stroking the skin through the lesion with a blunt instrument elicits the classical "triple response of Lewis" called Darier's sign

Treatment - Avoides taking drugs of Aspirin, NSAID', drugs, morphine, codeine, procaine, thiamine, polymyxin B and alcohol.                .

The main stay of treatment is initially includes HI antihistamines (Hydroxyzine, cyproheptadine, Loratadine
Doxepin (TCA) - very effective in chronic urticaria.

Urticarial vasculitis may be seen as part of serum sickness, associated with fever and arthralgia.


Question: Osgood schlatters disease is associated with osteochondritis of

Types of Osteobchondritis and Nomenclature


Question: The following structure is transmitted via foramen ovale


Question: In Bartters syndrome there is defect in

Ref. Guyton. 13th edition. Page. 1103
Na+--K+--2Cl- transporter
This is an electro neutral transport resulting in the reabsorption of about 25% of the filtered sodium, chloride, and potassium.

The luminal membrane contains a K+ channel (Figure VIII-4-4), allowing diffusion of this ion back into lumen (recall that the concentration of K+ inside cells is very high compared to the extracellular concentration).

This back diffusion of K+ into the lumen creates a positive luminal potential, which in turn, promotes calcium and magnesium reabsorption (about 25% of FL) via a paracellular pathway (primarily). This positive luminal potential also causes sodium reabsorption via a paracellular pathway.

Bartter’s syndrome

It is a genetic mutation resulting in diminished function of the Na+--K+--2Cl- transporter in Ascending loop of Henle
This leads to a low volume state, which causes an increase in renin and aldosterone (know as a secondary hyperaldosteronism).
Patients exhibit hypokalemia, alkalosis, and elevated urine calcium.


Question: 20 year old patient presents with hypokalemia, alkalosis with normal blood pressure and no edema. the diagnosis is

It is characterized by hypokalemia , alkalosis, high rennin level and hypercalciuria , but with normal blood pressure and no edema.
This is due to mutation Na-k-cl co transporter gene , usually begins in childhood.

Apparent mineral ocorticoid excess syndrome


Question: In ca ovary inguinal lymph nodes are involved in stage

FIGO revised the staging of carcinoma ovary in January 2014 and according to the new staging inguinal LN involvement is stage IV b.


Question: In a study in the UK, an association was found between the sale of antiarrhythmic drug and an increase in deaths due to asthma. This is an example of

Ans. is 'a' i.e. Ecological study Repeat May 08 www. ucel ac. uk. rlos/specs/rlo_observational_study. doc; http.//cancersupportivecare. com/epidemiology.html] For explanation see May 08


Question: Cell organelle affected in Wolman’s Disease is

Characteristics of Lysosomes

Discovered by Christian de Duve
Contains acid hydrolases,acid lipases,collagenase
ATP-dependent proton pumps in the membrane maintain an acidic environment (pH 4.0–5.0)

Lysosomal Diseases
Tay-Sachs disease
Hexosamidase A
Gaucher’s disease
Beta galactocerebrosidase
I-cell disease
Absent mannose-6-phosphate tag


Question: Anemia of chronic disease is characterised by

(Ref: Robbins 8/e p662)

Anemia of chronic disease- Impaired red cell production associated with any chronic diseases that would be infectious/inflammatory/neoplastic.
Chronic diseases produce a cytokine “IL-6” that increases the production of hepcidin from liver.  Hepcidin inhibits ferroportin function in macrophages and reduces the transfer of iron from storage pool to developing erythroid precursors in bone marrow.
So the patient develop anemia irrespective of increased amount of iron in macrophages.
Laboratory findings- Increased ferritin (storage iron), Low serum iron  and reduced total iron binding capacity.
Whereas in iron deficiency anemia, the patient will have decreased ferritin, lowserum iron and high iron binding capacity.


Question: The operative procedure is known as "microfracture" is done for the

Ans. is 'd' i.e. Osteochondral defect of the femurRef. Various internet sites (www.orthopedics.hss.edu, www.kneeguru.co.uk)Microfracture is an arthroscopic procedure used to treat osteochondral defects (damaged areas of articular cartilage of the knee)


Question: Indicator for outbreak of Plague epidemic is

“Cheopis index : It is an average no of X.cheopis per rat. It is a specific flea index. If this index is more than 1, it is regarded as indicative of potential explosiveness of the situation, should a plague outbreak occur”


Question: A patient presented with a 1 x 1.5 cms growth on the lateral border of the tongue. The treatment indicated would be.

Ans- B Interstitial brachytherapy Ref- Although this study is retrospective, the results are noteworthy, considering its long follow up and the description of results in terms of LCR, toxicities, and functional outcome. Our study recommends treating patients with brachytherapy alone in T1 stage and demonstrates the need for addressing nodal region either by neck dissection or nodal irradiation in T2 stage patients. The highlight of the study is that it establishes the need for dose escalation (from the doses used in the study) in both T1 and T2 stage tumors when using interstitial brachytherapy either as sole modality or as a boost.


Question: Number of permanent teeth in a 8 year old child


Question: Optic tract fibers project to thesuperior colliculi for

Optic tract fibers project to the

Superior colliculifor reflex gazes
Pretectal areafor the light reflex
Suprachiasmatic nucleusof theanterior hypothalamus for generation of circadian rhythms.


Question: Autoimmune thyroiditis can be confirmed in a patient by

Once hypothyroidism is diagnosed by clinical features, TSH and free T4 measurements, etiology can be confirmed by measuring the presence of autoantibody—particularly thyroid peroxidase (TPO), which is present in 90 to 95% of patients with autoimmune hypothyroidism. Biopsy by fine needle aspirate can confirm the diagnosis but is not necessary in most cases.


Question: A 10 years child has unilateral nasal obstruction epistaxis, swelling over the cheek, the diagnosis is

Ans. is 'c' i.e.Angiofibroma Angiofibroma ( Nasopharyngeal fibroma)Age group: the 2nd decade of life.Sex: Predominantly males ( almost exclusively males)*The site of origin*: posterior part of the nasal cavity close to the margin of sphenopalatine foramen.*Growth: From its site of origin the tumor grows into the nasal cavity, nasopharynx - pterygopalatine fossa - pterygomaxillary fossa - infratemporal fossa & checkClinical features :Profuse and recurrent epistasis ( MC presentation)*Progressive nasal obstruction*Conductive hearing loss and serous otitis media d/t obstruction of auditory tubeBroadening of nasal bridge*Proptosis*Swelling of cheek, * infratemporal fossaInvolvement of 2nd, 3rd, 4th, 6th C.N


Question: The investigative method of choice for confirmation of H.pylori eradication is

In summary, it is not necessary to perform endoscopy to diagnose H. pylori. Serology is the test of choice for initial diagnosis when endoscopy is not required. If, however, endoscopy is to be performed, the rapid urease assay and histology are both excellent options, but the cost advantage lies with the rapid urease assay. After treatment, the urea breath test is the method of choice but again should not be performed until 4 weeks after therapy ends. If the breath test is unavailable, endoscopy may be performed in selected patients such as those with bleeding ulcers or other complications of their PUD.


Question: Gleason's classification used for

(Carcinoma Prostate) (699- Basic robbins 8th)GLEASON - SYSTEM - Gleason grade has proved to correlate reasonably well with both the anatomic stage of prostatic carcinoma and the prognosis* Pancreatic cancer probably arise from precursor lesion (Pan INs) developing by a progressive accumulation of characteristic mutations of oncogenes (eg K-RAS) and tumor suppressor genes (eg P16, P53 and SMA D4)* Breast cancer - the majority are in the BRCA-1 and BRCA2 genes, less commonly in P53, PTEN or ATM genes


Question: The lineage specific marker for B cells is

Lineage specific B cell marker is CD 19. However on IHC the best marker is CD 20. CD 21 is the receptor for EBV


Question: In postpartum patients, the blood volumes become normal after nonpregnant state is


Question: The effect of progesterone on lipids

While part of the administered progestogen is metabolized to oestrogen, it is also partly metabolized to testosterone. If administered to a patient during pregnancy, some progestogens have virilizing effect upon a female fetus. Lipid metabolism decreases HDL but increases low-density lipoprotein. Thus, it is harmful to the heart.
It improves the immune response


Question: Fistula formation due to the below etiology  occurs within

Vesicovaginal fistula: In obstructed labor, the bladder becomes an abdominal organ and due to compression of urethra between presenting part and pubic symphysis, patient fails to empty bladder. The bladder wall gets traumatized which may lead to bloodstained urine, a common finding in obstructed labor. The bases of the bladder and urethra which are nipped in between presenting part and pubic symphysis may undergo pressure necrosis. The devitalized tissue becomes infected and later on may slough off around the 3rd to 5th day of puerperium resulting in genitourinary fistula which is a remote complication (does not present on the day of injury as in perineal tear).
Causes:

Obstetric cause—97% obstructed labor is the prime cause, and bladder neck is the most common site;
Gynecological operations—anterior colporrhaphy, total hysterectomy, or Wertheim’s operation, sling operation.


Question: Florence test for seminal stains tests for the presence of

(Refer: Rajesh Bardale - Principles of Forensic medicine & Toxicology, 1st edition, pg no: 401)


Question: The drug of choice of hypertensive uveitis is

Latanoprost is a PG F2 analogue and should not be given in patents of uveitis
Cholinergic drugs like Pilocarpine are also contraindicated in Ocular inflammation
Dipivefrin- (diphenylephrine) - sympathomimetic drugs (Adrenergic drugs)
Mechanism of action
1. Increase aqueous out flow results by virtue of both alpha and beta receptor stimulation
2. Decreased aqueous humour production occurs due to stimulation of alpha - receptors in the ciliary body


Question: Less sedating anti emetic used in motion sickness and vertigo

Meclizine and cyclizine are often used in preventing motion sickness and for short-term treatment of vertigo because they are less sedating than diphenhydramine and promethazine.
Promethazine also causes antiemetic activity and is available as a suppository or for injection. Chlorpheniramine and brompheniramine, which are less sedating than diphenhydramine and promethazine, are often used alone or in combination with decongestants for allergies and colds. Cyproheptadine has antiserotonin activiry and may be useful in treating patients with carcinoid tUmor, where it blocks the effects of serotonin and histamine on smooth muscle. Aztemizole, loratadine, and terfenadine are nonsedating antihistamines that do not cross the blood-brain barrier.


Question: Most common malignant brain tumor

Ans. B Glioblastoma multiforme Ref: Sabiston.Page 1371 The following data should be remembered for brain tumors- Most common malignant Brain tumor: Secondaries > Gliomas > Meningiomas > Astrocytomas.


Question: Hatter's shake is seen in

Ans. is 'b' i.e., Mercury poisoning * Metallic mercury (para or quick silver) is not poisonous on ingestion, as it is not absorbed. But its vapours are poisonous. Mercuric compounds being soluble are more poisonous than mercurous compounds. Mercuric chloride (HgCl2), also called corrosive sublimate or perchloride of mercury, is most poisons salt of mercury.* Acute poisoning presents with syncope, convulsions general instability and nephrotoxicity (proximal tubular). The mouth, tongue and fauces become corroded and appears grayish white.* Signs and symptoms of chronic mercury poisoning are :1) Excessive salivation, metallic taste, loosening of teeth, and blue black lining on gums (similar to lead poisoning).2) Diphtheria like membranous colitis and dysentery.3) Anorexia, insomnia, sweating, nausea, irritability and photophobia.4) Special features are : i) Mercuria lentis: Brownish deposition of mercury on anterior lens capsule.ii) Tremors : There are moderately coarse, intentional tremors starting in fingers and hands, and legs. They are also called Danbury tremors or hatter's shake or glass blower's shake. In severe form, patient becomes unable to dress, write or walk, i.e. concussion mercurialis (shaking palsy).iii) Erethism (neuropsychiatric changes): The personality disturbance is characterized by shyness, irritability, tremors, loss of memory and insomnia. There may be depression, delusion, hallucination and MDP (mad hatter).iv) Acrodynia (Pink disease): This is idiosyncratic hypersensitivity reaction with a generalized pinkish rash described as 5P : pinkish, puffy, painful, paraesthesia hands and peeling of skin.v) Minimata disease: It is due to organic mercury poisoning due to eating fish poisoned by mercury.vi) Membranous glomerulopathy.


Question: Transport medium for Streptococcus will be

Transport media: used to transport the specimen from collection place to laboratory. Transport media mainly used to avoid multiplication of commensals in the particular sample.

Stuart (charcoal swab), Amies medium -Gonococcus o Pikes - Streptococcus
Venkatraman Ramakrishnan medium, autoclaved sea water, Alkaline salt water- Vibrio
Buffered glycerol saline–Typhoid bacilli o Carry Blair medium–Enteric pathogen


Question: Usual presentation of cauda equina syndrome is

Conus medullaris syndrome is usually sudden and bilateral whereas cauda equina is grdual and unilateral.


Question: Best monitoring of progress of labor is done by


Question: Adenocarcinoma of ethmoid sinus associated with

Ans. is 'a' i.e Woodworkers Workers of wood industry develop - Adenocarcinomas of ethmoid & other nasal sinusesWorkers of Nickle refining industry - Sq. cell Ca & anaplastic Ca of nasal sinuses.


Question: The most common metabolic abnormality pre¬disposing patients to renal stone formation is

The most common metabolic abnormality predisposing patients to renal stone formation is hypercalciuria. Calcium oxalate and calcium phosphate stones are the two most common stones. Hypercalciuria combined with decreased fluid intake is frequently associated with stone formation; thus, adequate hydration is important in the treatment of stones.
Hyperuricemia can contribute to stone formation, but uric acid stones are not as common as calcium stones and most people with hyperuricemia do not have stones. Distal renal tubular acidosis can lead to calcium phosphate stones, but this disorder is not as common as stone formation in hypercalciuria. Increased urine volume and increased urine citrate concentration would both decrease the incidence of stones. In adequate concentrations, citrate binds to calcium and renders it unavailable for stone formation.


Question:
Sarcomeresare the fundamental contractile unit of skeletal muscle and are characterized by their highly ordered appearance under a polarizing light microscope
Thick filaments in the A bandare composed primarily of the protein myosin.

Each myosin moleculeis composed of

Sarcomeresare the fundamental contractile unit of skeletal muscle and are characterized by their highly ordered appearance under a polarizing light microscope
Thick filaments
Thick filaments in the A band are composed primarily of the protein myosin. Each myosin molecule is composed of six monomers: two protein strands intertwined in a helical arrangement (termed heavy chains) and four smaller, globular proteins (termed myosin light chains).
Thin filaments
Thin filaments are composed of three primary proteins: actin, tropomyosin, and troponin


Question: Endodermal sinus tumor is associated with

Ans-A i.e. Schiller Duval body Endodermal sinus tumor (yolk sac tumor)This tumor is rare but it is the second most common malignant tumor of germ cell origin.It is thought to be derived from differentiation of malignant germ cells towards extraembryonic yolk sac structure.Similar to the yolk sac the tumor is rich is a fetoprotein and antitrypsin.9 The characteristic histological feature of yolk sal tumor is Schuller Duval body.Schiller Duval body is a glomerulus like structure composed of central blood vessel enveloped by germ cells within a space lined by germ cells. Also, know Call Exner bodyReinke's crystalSignet ring cellsHobnail cellsPsammoma bodies-----Granulosa cell tumorHills a cell tumorKrukenberg tumorClear cell carcinomaPapillary serous cystadenoma of the ovary.


Question: Bloody discharge from the nipple is most commonly due to

Ans C Duct papilloma Ref: Bailey & Love's short practice of surgery 25th ed Causes of nipple discharge Blood Green Single duct Duct papilloma Ductal carcinoma Duct ectasia Duct ectasia Serous Fibrocystic disease Duct ectasia Multiple ducts Ductal carcinoma Duct ectasia Fibrocystic disease


Question: Test discovered by this scientist is a type of

WIDAL Fernand Isidore discovered widal test.


Question: A neonate with Down syndrome is having bilious vomiting

Ans. (a) Duodenal atresia Ref - The image shows the presence of double bubble appearance suggestive of diagnosis of duodenal atresia. About 8% of children with Down syndrome are born with duodenal atresia which presents with bilious vomiting.

Congenital hypertrophic pyloric stenosis


Question: Two live vaccines the minimum duration between injections should be

Directly from CDC guidelines

The timing and spacing of vaccine doses are two of the most important issues in the appropriate use of vaccines.

If the live vaccine is given first, it is necessary to wait at least 2 weeks (i.e., an incubation period) before giving the antibody. If the interval between the vaccine and antibody is less than 2 weeks, the recipient should be tested for immunity or the vaccine dose should be repeated.
If live parenteral (injected) vaccines (MMR, MMRV, varicella, zoster, and yellow fever) and live intranasal influenza vaccine (LAIV) are not administered at the same visit, they should be separated by at least 4 weeks.
An exception to this recommendation is yellow fever vaccine administered less than 4 weeks after single-antigen measles vaccine.


Question: Rain drop skull appearance is seen

Ref. Grainger and Allison's Diagnostic Radiology. Page. 409

MULTIPLE MYELOMA –RAIN DROP APPERANCE /PUNCHED OUT LESIONS IN THE SKULL
Imp radiological features –

Expansile osteolytic lesions associated with soft tissue masses
Diffuse osteolysis or generalised osteoporosis
Periosteal new bone formation is characteristically absent
Spine –diffuse lytic lesions


Question: A chronic alcoholic patient on high carbohydrate diet develops a deficiency of

(Manganese) (410-H) (449-H17th) Deficiencies of manganese have been reported to result in bone demineralization, poor growth, ataxia, disturbances in carbohydrate and lipid metabolism and convulsion Deficiency and Toxicities of Metals Element Deficiency Toxicity Boron No-biologic function determined Developmental defects, male sterility, testicular atrophy Copper Anemia, growth retardation, defective keratinization and pigmentation of hair, hypothermia, degenerative changes in aortic elastin, osteopenia, mental deterioration. Hepatic failure, tremor, mental deterioration, hemolytic anemia, renal dysfunction Chromium Impaired glucose tolerance* Occupational renal failure dermatitis, pulmonary cancers. Manganese Impaired growth and skeletal development, reproduction, lipid and carbohydrate metabolism: upper body rash General:- Neurotoxicity, Parkinson like symptoms. Occupational:- Encephalitis like syndrome, Parkinson like syndrome, psychosis pneumoconiosis. Molybdenum Severe Neurologic abnormalities Reproductive and fetal abnormalities Selenium Cardiomyopathy, heart failure, striated muscle degeneration General:- Alopecia, abnormal nails, emotional lability, peripheral neuropathy, lassitude, garlic odor to breath, dermatitis. Occupational:- Lung and nasal carcinoma, liver necrosis, pulmonary inflammation.


Question: Peripheral nerve regenerates at a rate of

The axonal regeneration proceeds slowly at rate of 1-2 mm/day in human.


Question: Establishment of fetoplacental circulation seen at

Ref. DC Dutta's Textbook of Obstetrics. Pg 36

Implantation of 12-16 cell stage occurs in the endometrium on the anterior and posterior wall of the body near the fundus on the 6th day following fertilization.

Then the deeper penetration of the human blastocyst is called interstitial implantation, which happens by approx. 13th day after fertilization
The fetal circulation is established by 21st days after fertilization


Question: The most common type of Rhabdomyosarcoma is

Rhabdomyosarcoma, the most common soft-tissue sarcoma of childhood and adolescence, usually appears before age 20. It may arise in any anatomic location, but most occur in the head and neck or genitourinary tract, where there is little if any skeletal muscle as a normal constituent. Rhabdomyosarcoma is histologically sub classified into embryonal, alveolar, and pleomorphic variants. The rhabdomyoblast—the diagnostic cell in all types—contains eccentric eosinophilic granular cytoplasm rich in thick and thin filaments. Rhabdomyoblasts may be round or elongate; the latter are known as tadpole or strap cells, and may contain cross-striations visible by light microscopy.
Embryonal rhabdomyosarcoma is the most common type, accounting for 60% of rhabdomyosarcomas. It includes the sarcoma botryoides as well as spindle cell and anaplasticvariants. The tumor occurs in children younger than 10 years of age and typically arises in the nasal cavity, orbit, middle ear, prostate, and paratesticular region. This variant of rhabdomyosarcoma commonly has parental isodisomy of chromosome 11p15.5, which leads to overexpression of the imprinted IGFII gene. The sarcoma botryoides subtype develops in the walls of hollow, mucosal-lined structures, such as the nasopharynx, common bile duct, bladder, and vagina. Where the tumors abut the mucosa of an organ, they form a submucosal zone of hypercellularity called the cambium layer.


Question: Serum amyloid associated protein, found in

(Chronic inflammatory states) (84 - HM) (159 - R) (168- Basic pathology 8th)* AA amyloid fibril proteins are typically deposited in the setting of chronic inflammary states & traumatic conditions they derive from a larger serum precursor synthesized in the liver called SAA {Serum amyloid associated) protein* b- amyloid protein found in Alzheimer's disease


Question: Bullous pemphigoidis characterized by

Bullous pemphigoid ischaracterized by non acantholytic blisters on trunk and limbs. .
It is characterized by a negative Nikolsky’s sign, so B is incorrect.
Blisters of bullous pemphigoid are tense and not at all easily ruptured, so C is incorrect.
Typical tense blisters of BP come on red/ urticarial base in elderly population


Question: Earliest manifestation of megaloblastic anemia is

(Ref: Harrison 18/e p866, 17/e p645-646, Tejinder Singh 2/e p54-61)

Peripheral blood picture

Bone marrow picture

Macrocytosis (↑ MCV, MCH. Normal MCHC)
Peripheral smear

           Macroovalocytes
           Few nucleated RBCs
           Evidence of dyserythropoiesis like-

Basophilic stippling
Cabot ring
Howell- Jolly bodies

↓ Hb
↓ Hematocrit
Reticulocyte count – Normal or mild decrease
White cells- Leucopenia
Hypersegmented neutrophils/ Macropolycytes- First manifestation
↓ Platelets
Pancytopenia (10-20%)

   Lab investigations:

Serum iron, ferritin - ↑ in pure VitB12/ Folate defect
Serum bilirubin & LDH ↑- due to hemolytic component
Schillings test: Used to assess status of intrinsic factor (IF) & Vit B12 to distinguish pernicious anemia from other causes of Vit.B12  deficiency.

Moderate- marked hypercellularity
Erythroid hyperplasia
M:E ratio reversal
Erthropoiesis- Megaloblastic
Giant metamyelocytes
Mildly reduced megakaryocytes
BM iron moderately increased in pure Vit B12/ Folate defects.


Question: Neurotransmitter employed by rods and cones is


Question: A 40 year old patient has a dry eye and reduced nasal secretions. On routine examination CNS system was normal. The location of a lesion might be in the

The sphenopalatine ganglion (or pterygopalatine ganglion) is a parasympathetic ganglion found in the pterygopalatine fossa.
It takes care of several glands like LNP – lacrimal, nasal & palatine glands
The pterygopalatine ganglion (ganglion of Meckel), the largest of the parasympathetic ganglia associated with the branches of the trigeminal (maxillary branch) nerve, is deeply placed in the pterygopalatine fossa, close to the sphenopalatine foramen.


Question: Mc benign epithelial ovarian tumor is

Serous cystadenoma and cystadenocarcinoma
Serous cystadenoma and cystadenocarcinoma are amongst the most common of cystic ovarian neoplasms, accounting about 50% of all ovarian tumours; of these, 60-70% are benign, 15% borderline and 20-25% are malignant.


Question: The membrane attack complex formed by the complement cascade is

Activation of the complement cascade by the classical or alternative pathway leads to the cleavage of complement fragments and the formation of active enzymatic complexes. The C5b fragment aggregates with complement proteins C6, C7, CS, and C9, resulting in the polymerization of the final product, known as the “membrane-attack complex” (MAC). MAC lyses cells by inserting into the plasma membrane and destroying the permeability barrier.

Formed only in the classical complement pathway.


Question: The appearance of the colon on a barium enema is seen in


Question: Following features seen are characteristic  of


Question: Nerve element of brachial arch are developed from

Ref. Gray’s anatomy.  41st edition. Page. 449.
Topic, Subtopic – Brachial arch, embryology
Branchial or pharyngeal arches are masses of mesoderm covered by ectoderm and lined by endoderm. Within these masses, muscular and skeletal components develop, as well as aortic arches and nerve networks. The arches are separated by grooves, visible on the surface of the embryo as pharyngeal clefts and in the interior as the pharyngeal pouches

In the human embryo, the arches are first seen during the 4th week of development.
They appear as a series of outpouchings of mesoderm on both sides of developing pharynx.

The neural crest are bilaterally paired strips of cells arising in the ectoderm at the margins of the neural tube. These cells migrate to many different locations and differentiate into many cell types within the embryo.


Question: Specific cell surface proteins, such as alkaline phosphatase, and lipoprotein lipase, are anchored to the cell membrane. This anchoring is accomplished by covalent binding through an oligosaccharide bridge to component of the cell membrane. This component is

Phosphatidylinositol derivatives play several distinct roles in the cell membrane, one of which is that they anchor several cell surface proteins. Cell surface proteins bound to phosphatidylinositol are also found in several parasitic protozoa. By altering these proteins, these protozoa can change their antigenic properties and avoid immunosurveillance. Being attached via a telatively long chain to the membrane via phosphatidylinositol, rather than being a part of the membrane itself, allows these proteins lateral movement on the cell surface. The proteins can be cleaved from the membrane by the action of phospholipase C. The other compounds listed are also phospholipids, but they do not anchor proteins in the membrane.


Question: Bacillary angiomatosis is caused by

Henselae causes bacillary angiomatosis, a condition resembling Kaposi’s sarcoma in patients with AIDS. The skin, lymph nodes or liver and spleen are primarily involved in this condition. The bacteria also cause sub acute bacterial endocarditis.


Question: Vomiting on the first day of birth is caused by

Infant may vomit mucus, occasionally blood streaked in the first few hour after birth, if may be due to irritation of the gastric mucosa by material swallowed during delivery.
• A large number of normal babies vomit on first day due to irritation of stomach by swallowed amniotic fluid
• Vomiting from esophageal obstruction occurs with the first feeding
• Vomiting due to obstruction of the small intestine usually begins on the 1st day of life and is frequent persistent, usual, non projectile, copious, and unless the obstruction is above the ampulla of vater, bile- stained.
• Vomiting of pyloric stenosis may begin any time after birth but does not assume its characteristic pattern before the 2nd, 3rd week


Question: The local anesthetic with the longest duration of action is

Longest acting, most potent and most toxic local anesthetic is dibucaine.
Chlorprocaine is the shortest acting local anesthetic.


Question: Ocular symptom of Von Recklinghausen disease is

• NF-1 is the most common phakomatosis, affecting 1:4000 individuals, and presents in childhood.
• The gene locus is on 17q11.

Deformed anterior chamber with reduced angle of AC


Question: Commonest site of the foreign body lies in

(Subtarsal sulcus): Ref: 370-73-P, 402-408-KH Intra ocular foreign bodies Chip of iron and steel (90%) are commonest foreign body Mechanical effects - In general these include comeal or/and scleral perforation, hyphaema, iris hole, rupture of the lens and traumatic cataract, vitreous haemorrhage and/or degeneration, choroidal perforation, haemorrhage and inflammation, retinal hole haemorrhage, oedeama and detachment. Extraocular foreign bodies: Small foreign body impact on the comeal or conjuctival surface (674-K) * Adhere to the superior palpebral conunctiva in the subtarsal sulcus and abrade the cornea with every blink. A pathognomic pattern of linear comeal abrasion may be seen. A subtarsal foreign body is easily missed unless the upper lid is everted. * Ascend and lodge in the superior conjucntival fornix and produce chronic conjunctivitis * Impact in the bulbar conjunctiva * Impact in the comeal epithelium or stroma to a depth proportional to the velocity of the foreign body * A very high velocity foreign body may penetrate the cornea or sclera and lodge intraocularly.


Question: Minimum effective dose of oestrogen in OCP’s is

Combined oral pills
Combined oral pills contain a mixture of ethinyloestradiol (EE2) in a dose of 20 to 30 μg and an orally active progestogen which is a 19-norsteroid. Mala-D contains 0.5 mg of d-norgestrel and Mala-N contains 1 mg norethisterone; these are available free of cost in India. The tablets are taken starting on the second day of the cycle for 21 days. A new course of tablets should be commenced 7 days after the cessation of the previous course. They should be taken at a fixed time of the day, preferably after a meal.


Question: Loss of insight is seen in

Ans. is 'D' SchizophreniaLoss of insight is seen in Psychotic disorders which includeSchizophrenia*Mood disorders (Mania, Depression, MDP) *Delusional disorder*


Question: The following feature is most commonly seen in

Parakeratasis is appearance of nuclei in the stratum corneum, which is normally nonnucleated cell layer. It can be a result of incomplete differentiation in keratinocytes or of reduced transit time. Clinically parakeratosis manifests as scaling, which is typical of papulosquamous disorders.
Actinic keratosis shows atypical pleomorphic keratinocytes in the basal layer, over which acanthosis, hyperkeratosis, and parakeratosis are also found.
Seborrheic keratosis is characterized by uniform basaloid cells, keratin cysts, and a large number of melanocytes.


Question:
Diagnostic test for group A streptococcal
erythroderma is


Question:
Steroids hormones exert their effects
by binding to

Steroid hormones cross the cell membrane and bind to specific receptors within the cell. These receptors are transcription factors that are active only in the presence of particular hormones. The hormone-transcription factor complex binds to steroid hormone responsive elements in DNA to influence transcription from steroid-sensitive genes. Thyroid hormone, retinoic acid, and 1,25-dihydroxycholecalciferol exert their effects in a similar way.


Question: The daily extra calories in the second and third trimester of pregnancy is

Ans- C Extra calories required in pregnancy during 1st trimester is 150 kcals and 2nd trimester and 3rd trimester is 350 kcals


Question: Ganciclovir is used in the treatment of

Ans. is 'b' i.e., Cytomegalovirus Ganciclovir is an antiherpetic antiviral drug. It is active against all Herpetic viruses such as - H. simplex H. Zoster E.B. virus Cytomega lo virus However it is more active against CMV. Because: - Concentration of active inhibitor ganciclovir triphosphate is much higher inside CMV infected cells. Plasma t1/2 of ganciclovir is 2-4 hrs but that inside CMV is > 24 hrs. Because systemic toxicity of Ganciclovir is very high, its use is restricted to CMV infections in immunocompromised patient.


Question: Ochronosis is due to chronic exposure to

(Refer: Rajesh Bardale - Principles of Forensic medicine & Toxicology, 1st edition, pg no: 440)
Carbolic aci


Question: Investigation of choice to assess cardiotoxicity of anthracycline drugs is

The best noninvasive method to study the LVEF (left ventricular ejection fraction) is Multiple Gated (MUGA or gated blood pool imaging) radioneuclide scan using Stannous pyrophosphate to label RBC’s and 9mTC pertechnetate for imaging. Altered Ejection Fraction is a contraindication for anthracycline drugs. However Echocardiogram is the investigation of choice because of its wider availability, simpler and reasonable accuracy in determining LVEF. The best investigation is myocardial biopsy.


Question: Noninvasive prenatal testing (NIPT)

Ref. The Short Textbook of Obstetrics. Page. 778

NON INVASIVE PRENATAL TESTING

Targeted ultrasonography
Fetal blood cells in maternal blood
Double marker and triple screening
Maternal serum estriol

INVASIVE PRENATAL TESTING

Amniocentesis
Chronic villus sampling
Cordocentesis

Maternal serum for evaluation of Down’s syndrome

Amniocentesis for evaluation of fetal chromosomal anomalies


Question: Special visceral efferent doesn’t involve

Ref. Gray’s anatomy.  41st edition. Page.  982
All of the spinal nerves contain both sensory and motor functions and can be organized on the basis of the functional components of each nerve.

General Somatic Afferent (GSA) fibers are related to receptors for pain temperture and mechanical receptors in the skin, muscles and joints
General Visceral Afferent (GVA) fibers are related to receptors in visceral structures
General Visceral Efferent (GVE) fibers are preganglionic autonomic fibers
General Somatic Efferent (GSE) fibers innervate skeletal muscle (these are axons of alpha and gamma motor neurons)


Question: Hypokalemic paralysis is side effect of

Its use as a male contraceptive was discovered in China. Gossypol is a yellow pigment isolated from cottonseed oil. It is administered orally 10 to 20 mg daily for 3 months and thereafter 20 mg twice weekly. The action is directly on the seminiferous tubules inhibiting spermatogenesis without altering FSH and LH levels. The side effects such as weakness, hypokalaemia and permanent sterility in 20% cases limit its use.


Question: Test done for Mycobacterium tuberculosis based on CMI is

Ref. Textbook of Microbiology and Immunology BY Parija. Page. 350

IGRA
IGRAs measure a person’s immune reactivity to M. tuberculosis. White blood cells from most persons that have been infected with M. tuberculosis will release interferon-gamma (IFN-g) when mixed with antigens (substances that can produce an immune response) derived from M. tuberculosis.
Types of IGRA

QuantiFERON TB Gold In-Tube test (QFT-GIT);
T-SPOT.TB test (T-Spot)


Question: Traveller’s diarrhea is caused due to

Persons from developed countries visiting endemic areas often suffer from ETEC diarrhea—a condition known as Traveler’s diarrhea.


Question: The most common sequelae of tuberculous spondylitis in an adolescent is

Fibrous ankylosis is seen in healed tubercular joints. Bony ankylosis is seen in healed tubercular spine.


Question: Number of Milk teeth are


Question: A factory worker presents with excessive salivation, blue line on gums, tremors, disturbed personality, insomnia and loss of appetite. Diagnosis

(Refer: Rajesh Bardale - Principles of Forensic medicine & Toxicology, 1st edition, pg no: 458)
Mercury poisoning:

Chronic Poisoning:  Otherwise called as ‘Hydrargyrism’.
MC poisonous salt of mercury is Chloride
Classic Triad:Gingivitis, Salivation and Tremors.
Signs & Symptoms:

Blue lines on gums
Tremors (Danbury tremors) which starts in hands and then progresses to other parts of the body. When generalized, it is called as ‘Hatter’s Shake’, glassblowers shakes
Most severe form called as ‘Concussio mercurialis’ where no activity is possible.
‘Mercurial Erethism’ which occurs in worker of mirror industry where there is development of psychological symptoms
‘Mercuria lentis’ is a peculiar eye change where brownish deposit of mercury seen on anterior lens capsule and this is due to exposure to mercury vapor. It has no effects on visual acuity
Acrodynia ( Pink disease)
Idiosyncratic hypersensitivity reaction, seen in children
Generalized erythematous, eczematous papular type of lesions mostly in hands & feet, accompanied by thickening & peeling of the skin.

Dimercaprol (BAL) is used in treatment of mercury poisoning.


Question: The operative procedure known as “micro fracture” is done for the

Microfracture is an orthopedic procedure used to treat osteochondral defects (damaged areas of articular cartilage of
the knee).


Question: Painful ulcers over genitalia are caused by

Ans. c (Chancroid). (Ref. Ananthnarayan, 6th /326, Harrison, Medicine, 15th/1004)Painful ulcer on the penis is due to Haemophilus ducreyi or chancroid or soft chancre.Differential diagnosis of ulcers on genitalia is.Herpes simplex Organisms causing an ulcer on genitaliaCommentsChancroid# It is acute onset, painful ulcer, preceded by vesiculopustule, causes multiple ulcers, with a soft base, tender, bleeding ulcer, the floor of ulcer is formed by the slough, with undermined edges, purulent & profuse discharge surr by the inflammatory skin, & progresses fast.# Caused by Haemophilus ducreyii. Smear shows Gram-negative bacilli in chains.Granuloma inguinale# Caused by Calymmatobacterium granulomatis,Primary syphilis (Condyloma lata)# Treponema pallidum. (Hard chancre)Herpes simplex


Question: Japanese encephalitis vaccine in the routine schedule is as follows

First dose at 9-12 months followed by booster at 16-24 months

Three doses 1 month apart followed by a booster if needed

Three doses with the second dose 1 month and 3rd dose 6 months after the first dose


Question: Combination chemotherapy ( ABV )with daunorubicin , bleomycin , vincristine is used in

It is used in Kaposi’s sarcoma. Intraleisional danorubicin and vinblastine, radiation treatment, placitaxel, interferon alpha are also used.


Question: Mediator of acute inflammation not derived from cell is (D. REPEAT Feb 2014)

Ans: C (Kinins) Ref: Harsh Mohan, Textbook of Pathology, 6th edition, pg 136-37Explanation:Chemical Mediators of InflammationAka permeability factors or endogenous mediators of increased vascular permeability.They are broadly classified into 2 groups:Mediators released by ceils.Mediators originating from plasma.Chemical Mediators of Acute InflammationA. Cell-Derived MediatorsVasoactive aminesHistamine5-hydroxytryptamineNeuropeptidesArachidonic acid metabolites (Eicosanoids)Metabolites via cyclo-oxygenase pathwayProstaglandinsThromboxane A2ProstacyclinResolvinsMetabolites via lipo-oxygenase pathway5-HETELeukotrienesLipoxinsLysosomal components (from PM Ns, macrophages)Platelet activating factor (PAF)CytokinesIL-1TNF-aTNF-bIFN-gChemokinesFree radicalsOxygen metabolitesNitric oxideB. Plasma-Derived Mediators (Plasma Proteases) Products of:The Kin in the system.The Clotting system.The Fibrinolytic system.The Complement system.


Question: Mapleson’s classification of anesthetic breathing system

The Mapleson D may be described as a co-axial modification of the basic T-piece system, developed to facilitate scavenging of waste anaesthetic gases.
Circuit

Describes the T-piece system as requiring a fresh gas flow rate of 1.5 – 2 times the minute volume


Question: A large volume of gas is seen at sub diaphragm level in x ray presentation diagnosis is

A. i.e. (Peritoneal perforation) (994-B & L 25th) Radiological Findings * Peritoneal perforation (Peritonitis) - Erect chest x-ray shows free air under the diaphragm (perforated viscus * Presence of dilated gas-filled loops of bowel or show free gas. * Intestinal obstruction - multiple gas-fluid levels** are most important criteria, ladder-like pattern * Paralytic ileus - shows gas -filled loop of intestine with multiple fluid levels * Intussusception - shows an absence of caecal gas shadow and increased gas shadows in the small intestine


Question: HIV treatment in pregnancy

Ref. DC Dutta's Textbook of Obstetrics. Pg 352

Regardless of HIV viral load and CD4 count, all HIV infected pregnant women should be offered antiretroviral therapy (ART) after diagnosis till lifelong to reduce perinatal transmission

ART should focus on reduction of perinatal transmission and treatment of maternal HIV disease.
It reduces perinatal transmission by several mechanisms , including lowering maternal antepartum viral load and pre exposure and post exposure prophylaxis of the infant.
Therefore, for prevention of perinatal transmission of HIV ,combined antepartum, intrapartum, and infant antiretroviral prophylaxis is recommended .


Question: Colchicine mechanism of action in acute gout

Ref. KDT. Page. 214
It does not inhibit the synthesis or promote the excretion of uric acid. – Direct lines from Tripathi, guides may lead you wrong. But they don’t have an effect

Colchicine MOA
The first two points is how it acts in acute Gout

Colchicine does not affect phagocytosis of urate crystals but inhibits release of the glycoprotein and the subsequent events.
By binding to fibrillar protein tubulin, it inhibits granulocyte migration into the inflamed joint and thus interrupts the vicious cycle.
Antimitotic: causes metaphase arrest by binding to microtubules of mitotic spindle.
Increases gut motility through neural mechanisms

Inhibition of release of chemotactic factors

Binding to tubulin and inhibition of leucocyte migration


Question: Flame cells are seen in

Multiple myeloma usually presents as destructive plasma cell tumors (plasmacytomas) involving the axial skeleton. Relatively normal-appearing plasma cells, plasma blasts with vesicular nuclear chromatin and a prominent single nucleolus, or bizarre, multinucleated cells may predominate. Other cytologic variants stem from the dysregulated synthesis and secretion of Ig, which often leads to intracellular accumulation of intact or partially degraded protein. Such variants include flame cells with fiery red cytoplasm, Mott cells with multiple grapelike cytoplasmic droplets, and cells containing a variety of other inclusions, including fibrils, crystalline rods, and globules. The globular inclusions are referred to as Russell bodies (if cytoplasmic) or Dutcher bodies (if nuclear). In advanced disease, plasma cell infiltrates may be present in the spleen, liver, kidneys, lungs, lymph nodes, and other soft tissues.


Question: Mucopolysaccharides are

Mucopolysaccharides (commonly known as glycosaminoglycans) are heteropolysaccharides composed of sugar derivatives (mainly amino sugars and uronic acids). The important mucopolysaccharides include hyaluronic acid, heparin, chondroitin sulfate, dermatan sulfate and keratan sulfate.
Hyaluronic acid is the ground substance of synovial fluid of joints. It serves as lubricants and shock absorbent in joints.


Question: The only reliable means of diagnosing acute cardiac rejection before substantial myocardial damage has occurred is

Of the major complications, allograft rejection is the primary problem requiring surveillance; scheduled endomyocardial biopsy is the only reliable means of diagnosing acute cardiac rejection before substantial myocardial damage has occurred and at a stage that is reversible in the majority of instances. Rejection is characterized by interstitial lymphocytic inflammation that, in its more advanced stages, damages adjacent myocytes; the histology resembles myocarditis. When myocardial injury is not extensive, the “rejection episode” is usually either self-limited or successfully reversed by increased immunosuppressive therapy. Advanced rejection may be irreversible and fatal if it is not promptly treated.


Question: Carotid body containsislands of two types of cells, type I and type II cells, surrounded by fenestrated sinusoidal capillaries. Type I cells are excited byhypoxia, and the principal transmitter appears to be

Carotid & Aortic Bodies
There is a carotid body near the carotid bifurcation on each side, and there are usually two or more aortic bodies near the arch of the aorta .
Each carotid and aortic body (glomus) contains islands of two types of cells, type I and type II cells, surrounded by fenestrated sinusoidal capillaries.
Type I cells
The type I or glomus cells are closely associated with cup-like endings of the afferent nerves.
The glomus cells resemble adrenal chromaffin cells and have dense-core granules containing catecholamines that are released upon exposure to hypoxia and cyanide .
The cells are excited byhypoxia, and the principal transmitter appears to be dopamine, which excites the nerve endings by way of D2 receptors.
Type II cells
The type II cells are glia-like, and each surrounds four to six type I cells. Their function is probably sustentacular.


Question: The primary pathophysiologic problem in in idiopathic pulmonary fibrosis is believed to be

Bronchoalveolar lavage in patients with idiopathic pulmonary fibrosis, a chronic inflammatory disorder of the lower respiratory tract characterized by dyspnea and reticulonodular infiltrates on chest radiography, discloses an abundance of alveolar macrophages. Probably related to locally generated immune complexes, alveolar macro phages become activated and then produce several mediators that recruit and induce fibroblast proliferation, which causes secondary damage. Macrophage-derived mediators believed to be important in this process include fibronectin, a 200-kDa dimeric glycoprotein that interacts with connective tissue matrix as well as specific receptors on fibroblasts, and platelet-derived growth factor, whose chain is encoded by the c-sis protooncogene. Platelet-derived growth factor is believed to play an important role in recruiting fibroblasts to the site of inflammation. Macrophages also producechemotaxins such, as leukotriene 84 and interleukin 8, which attract neutrophils and eosinophils into the region.

Microorganism mediated activation of pulmonary neutrophils

Immune complex mediated activation of alveolar macrophages

Direct immune complex mediated pulmonary interstitial damage


Question: Excitatory post synaptic potential is due to

EPSP (Excitatory post synaptic potential) -
1. Definition: the increase in voltage above the normal resting potential — that is to a less negative value — is called
EPSP because if this potential rises high enough, it will elicit on action potential in the neuron, thus exciting it.
    EPSP is due to depolarization.
2. Production à rapid influx of Na+ to the interior neutralised part of the negativity of RMP à RMP ed from - 65 to      - 45 my à EPSP à excite the neuron.


Question: For spinal anesthesia lignocaine is used as

Lignocaine is used as 5% (heavy) for spinal anesthesia.


Question: In a population of 5000, on 1st January, total cases of myopia were 500. Till 31st December, 90 new cases were found. Calculate the incidence of myopia PER 100.


Question: The test having the fastest lab processing time for karyo type assessment is

Amniocentesis, cordocentesis, cystic hygroma aspiration, and chorionic villus samplingare techniques of obtaining fetal tissues that are amenable to cytogenetic analysis.
Amniotic fluid cellsrequire tissue culture to obtain adequate cell numbers for analysis.
Chorionic villi can be harvested directlyfor extremely rapid diagnosis or can be cultured for higher banding (increased detail).


Question: Speech discrimination score, lowest in

D. i.e. (Acoustic neuroma) (137 - Maqbool)SPEECH DISCRIMINATION SCORE (speech recognition or word recognition score) - tested at 30 to 40 dB, SLUSES1. It determines the extent of discrimination difficulty2. It aids in the diagnosis of the site of pathology in the auditory system eg poor in acoustic neuroma. The normal in conductive deafness3. It assists in rehabilitative measures like the fitting of a hearing aid***Hitzelberg sign seen in Acoustic neuromaVOCAL INDEX - is the relationship between hearing loss for speech and whispered voice* Small in conductive deafness and high in perceptive deafness* Laryngeal pseudosulcus is seen in - Laryngophrayngeal reflux**


Question: Riehl’s melanosis involves

Riehl’s melanosis (pigmented contact dermatitis) involves face and neck


Question: Lymphatic Drainage of the Maxillary Sinus goes first to

Through the posterior pathway, the lymphatics from the maxillary and ethmoid sinuses drain into the retropharyngeal lymph nodes


Question: Steroids hormones exert their effects by binding to

Steroid hormones cross the cell membrane and bind to specific receptors within the cell. These receptors are transcription factors that are active only in the presence of particular hormones. The hormone-transcription factor complex binds to steroid hormone responsive elements in DNA to influence transcription from steroid-sensitive genes. Thyroid hormone, retinoic acid, and 1,25-dihydroxycholecalciferol exert their effects in a similar way.


Question: Umbilical artery is a branch of

Anterior division of internal iliac artery

A part of Umbilical artery persists as superior vesical artery and remaining artery becomes obliterated forming medial umbilical ligament.

Posterior division of internal iliac artery


Question: A 6 years child has foreign body in trachea .Best initial management is

Ans. is 'a' i.e.Heimlich's maneuver The best option here is Heimlich's maneuver."Heimlich man oeuvre: stand behind the person and place your arms around his lower chest and give four abdominal thrusts. The residual air in the lungs may dislodge the foreign body providing some airway. "Heimlich's maneuveris actually performed for laryngeal foreign bodies and not for tracheal or bronchial foreign bodies.Heimlich's is performed for completed obstruction and should not be tried in partial obstructions (for fear of causing total obstruction )If Hemlocks m fails then cricothyrotomy or emergency tracheostomy is done.Once the emergency is over, foreign body can be removed by direct laryngoscopy or by laryngofissure (if body is impacted )Tracheal & Bronchial foreign bodiesEmergency removal is not indicated in these ( unless there is airway obstruction or they are of vegetable matter eg seeds likely to swell up)Removed by bronchoscopy with full preparation and under GA.Rigid bronchoscope is used.


Question: Type of reaction in Type I Lepra reaction is

Type IV delayed Hypersensitivity reaction
Lepra reactions
Type 1 reaction is also called as “Downgrading” or “reversal” reaction
• It occurs in Borderline Leprosy
• It is type “IV delayed Hypersensitivity reaction”.


Question: Sensation of proprioception is transmitted by;

(Refer: Ganong’s Review of Medical Physiology, 24th edition, pg no: 92-94)
Numerical Classification of Sensory Fibres


Question: Poiseuille’s hagen lawis

Poiseuille-Hagen Formula
The relation between the flow in a long narrow tube, the viscosity of the fluid, and the radius of the tube is expressed mathematically in the Poiseuille-Hagen formula:


Question: Perjury under section IPC

C 191. Sec 191 IPC - Perjury (definition of giving false evidence) Sec 193 IPC - Perjury (punishment for giving false evidence) - Upto 7 years (offense is triable by a first class magistrate) Sec 195 CrPC - Prosecution for contempt of lawful authority of public servants, for offenses against public justice and for offenses relating to documents given for evidence For a person to be punished for perjury, a complaint has to be made in writing as per the above section (195 crpc) Sec 340 CrPC - Procedure in cases mentioned in Sec 195 CrPC - When a complaint is received in writing, the procedure of further inquiry and punishment of accused is as per this section. Sec 154 IEA - Hostile witness


Question: Typical appearance of Tumour cells and Macrophages on Histological section indicate

Burkitt lymphoma (Appearance: Starry-sky pattern)


Question: In carcinoma base of tongue pain is referred to ear through

Ans. is 'c' i.e., Glossopharyngeal Referred otalgiao As ear receives nerve supply from Vth (auriculotemporal branch), IXth (tympanic branch) and IXth (auricular branch) cranial nerves; and from C2 (lesser occipital) and C2 and C3 (greater auricular), pain may be referred from these remote areas.Via IXth cranial nerveDental: - Caries tooth, apical abscess, impacted molar, malocclusion.Oral cavity: - Benign or malignant ulcerative lesions of oral cavity or tongue.Temporomandibular joint disorders: - Bruxism, osteoarthritis, recurrent dislocation, ill-fitting denture.Sphenopalatine neuralgiaVia IXth cranial nerveOropharynx : - Acute tonsillitis, peritonsillar abscess, tonsillectomy. Benign or malignant ulcers of soft palate, tonsil and its pillars.Base of tongue: - Tuberculosis or malignancyElongated styloid process.Via Xth cranial cerve : Malignancy or ulcerative lesion of vallecula, epiglottis, larynx or laryngopharynx, oesophagus.Via C2 and C3 spinal nerves : Cervical spondylosis, injuries of cervical spine, caries spine.


Question: Red degeneration of uterine fibroid is mc in

Red degeneration
This complication of uterine myomas develops most frequently during pregnancy, although it is not rare in cases of painful myomas in women over the age of 40. The myoma becomes tense and tender and causes severe abdominal pain with constitutional upset and fever. The tumour itself assumes a peculiar purple red colour and develops a fishy odour. If the tumour is carefully examined, some of the large veins in the capsule and the small vessels in the substance of the tumour will be found thrombosed


Question: CLO test is used for

Ans. is 'a' i.e., H. pylori CLO test is another name for campvlobacter-like organism test :-o Rapid urease test, also known as the CLO test (Campylobacter-like organism test), is a rapid diagnostic test for diagnosis of Helicobacter pylori.o The basis of the test is the ability ofH. pylori to secrete the urease enzyme, which catalyzes the conversion of urea to ammonia and carbon dioxide.o The urease produced by H. pylori hydrolyzes urea to ammonia, which raises the pH of the medium, and changes the color of the specimen from yellow (Negative) to red (Positive).


Question: In combination birth control pills, the contraceptive effect of the estrogenic component is primarily related to

The two estrogenic compounds used in oral contraceptives are ethinyl estradiol and its 3-methyl ether, mestranol.
To become biologically effective, mestranol must be demethylated to ethinyl estradiol, because mestranol does not bind to the estrogenic cytosol receptor.
The degree of conversion of mestranol to ethinyl estradiol varies among individuals; however, it is estimated that ethinyl estradiol is about 1.7 times as potent as the same weight of mestranol.
The estrogenic component of birth control pills was originally added to control irregular endometrial desquamation resulting in undesirable vaginal bleeding.

Conversion of ethinyl estradiol to mestranol

Suppression of luteinizing hormone (LH) secretion

Suppression of follicle-stimulating hormone (FSH) secretion


Question: Trisodium phosphonoformate (foscarnet) is a po¬tent antiviral agent for treating herpes simplex infec¬tions. It works by affecting

Trisodium phosphonoformate (foscarnet) inhibits herpes simplex virus (HSV) replication. Foscarnet is a potent inhibitor of HSV-induced DNA polymerase, and has little effect on known cellular DNA polymerases. Herpesvirus mutants resistant to the drug arise easily.
To a lesser extent, foscarnet also appears to inhibit the polymerase of hepatitis B virus and retroviruses.
Combinations of antivirals, including foscarnet, are currently prescribed to increase the clinical usefulness of the drugs.


Question: Young lady presents with acute abdominal pain and history of 1 1/2 months amenorrhoea on USG examination there is a collection of fluid in the pouch of Douglas and empty uterine cavity. Diagnosis is

Ans-A ectopic pregnancy (Ref Dutta, 6/e, p 186 (5/e, p. 198, 4/e, pl98)).History of amenorrhoea and absence of gestational sac and collection of fluid in the pouch of Douglas leaves no doubt about the diagnosis of ectopic pregnancy.


Question: Uterine bleeding at 12 weeks gestation without any cervical dilationis an indicative of

Bleeding occurs in about 30 to 40%of human gestations before 20 weeks of pregnancy, with about half of these pregnancies ending in spontaneous abortion.
A threatened abortion takes place when this uterine bleeding occurs without any cervical dilation or effacement


Question: Mechanism that does not contribute to counter current multiplier in nephron

Ref. Guyton. 13th edition. Page. 435
Countercurrent multiplication in the kidneys is the process of using energy to generate an osmotic gradient that enables you to reabsorb water from the tubular fluid and produce concentrated urine.

The three segments of the loops of Henle have different characteristics that enable countercurrent multiplication.

The thin descending limb is passively permeable to both water and small solutes such as sodium chloride and urea. The tubular fluid becomes steadily more concentrated or hyperosmotic (compared to blood) as it travels down the thin descending limb of the tubule.
The thin ascending limb is passively permeable to small solutes, but impermeable to water, which means water cannot escape from this part of the loop. The tubular fluid becomes steadily more dilute or hyposmotic as it moves up the ascending limb of the tubule.
The thick ascending limb actively reabsorbs sodium, potassium and chloride. this segment is also impermeable to water, which again means that water cannot escape from this part of the loop. This segment is sometimes called the “diluting segment”

Active transport of sodium and chloride out of thick ascending limb of LOH

Water reabsorption in thin descending limb of LOH

Sodium reabsorption out of thin descending limb of LOH


Question: Wound contraction is primarily mediated by

Myofibroblasts, cells with features intermediate between fibroblasts and smooth muscle cells, appear in the wound 2 to 3 days after injury. Their active contraction decreases the size of the defect.


Question: The definite diagnosis of malignancy in pheochromocytoma is based on

Pheochromocytoma are neoplasms composed of chromaffin cells, which synthesize and release catecholamines and in some instances peptide hormones. It is important to recognize these tumors because they are a rare cause of surgically correctable hypertension. Pheochromocytoma range from small, circumscribed lesions confined to the adrenal to large hemorrhagic masses weighing kilograms. The tumors are composed of polygonal to spindle-shaped chromaffin cells or chief cells, clustered with the sustentacular cells into small nests or alveoli (zellballen) by a rich vascular network. The cytoplasm has a finely granular appearance, best demonstrated with silver stains, due to the presence of granules containing catecholamines. The nuclei are usually round to ovoid, with a stippled “salt and pepper” chromatin that is characteristic of neuroendocrine tumors.
There is no histologic feature that reliably predicts clinical behavior. Several histologic features, such as numbers of mitoses, confluent tumor necrosis, and spindle cell morphology, have been associated with an aggressive behavior and increased risk of metastasis, but these are not entirely reliable. Tumors with “benign” histologic features may metastasize, while bizarrely pleomorphic tumors may remain confined to the adrenal gland. In fact, cellular and nuclear pleomorphism, including the presence of giant cells, and mitotic figures are often seen in benign pheochromocytomas, while cellular monotony is paradoxically associated with an aggressive behavior. Even capsular and vascular invasion may be encountered in benign lesions. Therefore, the definitive diagnosis of malignancy in pheochromocytomas is based exclusively on the presence of metastases. These may involve regional lymph nodes as well as more distant sites, including liver, lung, and bone.


Question: A crisis in a patient with sickle cell disease is most likely to be cause by

A crisis in sickle cell disease occurs when deoxygenated HbS precipitates, deforming (sickling) red blood cells and .blocking capillaries. Variables that increase the proportion ofHbS in the "deoxy" state tend to increase the probability of a crisis by increasing the extent of sickling. The "deoxy" form of hemoglobin is favored by a decrease in pH (acidosis). An increase in pH (alkalosis), increased oxygen concentration, decreased CO2 concentration, and decreased 2,3-bisphosphoglycerate concentration would all favor the" oxy" form of hemoglobin.


Question: "Golden S" sign is seen in

i.e. (Bronchogenic carcinoma with upper lobe collapse): (Internet) Golden S sign is a sign seen on imaging of the chest that suggests a central lung mass or lung collapse. It was first described by Golden in 1925 in association with bronchial carcinoma, but it is also seen in metastatic cancer, enlarged lymph nodes, and collapse of the right upper lobe of the lung. The Golden S sign can be seen on plain radiographs as well as on computed tomography (CT) scans of the chest. The sign is seen in the right lung as a distorted minor fissure, whose lateral aspect is concave inferiorly and whose medial aspect is convex inferiorly. This produces a "reverse S" appearance, responsible for the sign being occasionally called the reverse S sign of Golden Right upper lope collapse around a large central mass. Discussion: The mass prevents the central part of the lobe from losing volume. Because the peripheral lobe collapses and the central portion doen't. It appears convex centrally and concave peripherally. The shape therefore resembles an S or reverse S, and is called the Golden S sign after Golden's description of cases of lobar collapse caused by carcinoma of the lung. Golden S sign - The sign is seen in the right lung as a distorted minor fissure * Floating membrane sign" in liver found in Hydatid disease * Floating water lily sign is seen in Hydatid cysts** Egg Shell Calcifications * Silicosis * Sarcoidosis * Scleroderma * Histoplasmosis * Amyloidosis * Lymphoma following radiotherapy " Popcorn calcification" is pathognomic for Hemartoma on chest X-ray (562-H17th) Pulmonary embolism - X-ray chest findings Hampton's hump As peripheral wedge shaped opacity due to pulmonary infarct Wester mark's sign It is a focal area of oligemia due to vasoconstriction distal to embolus Palla's sign Enlarged right descending pulmonary artery

Bronchogenic carcinoma with lower lobe collapse

Bronchogenic carcinoma in interlobular fissure