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MHC restriction is a pa of all except aEUR'

Autoimmune disorder

3D

Autoimmune disorder Major histocompatibility complex : Major histocompatibility complex, also called the human leucocyte antigen (HLA) complex is a 4 megahase region on chromosome 6. This region is densely packed with genes. These genes encodes two major proteins or antigens i.e., MHC I & MHC II. These proteins play an impoant role in the differentiation of foreign cells from host cell. Presence of these proteins is necessary for identification of host cells. Identification of the cells is impoant for immune responses. If the cell is recognised as self, the immune system will not mount an immune response against it. How does MHC helps in this ??? Cells continuously display small pieces of their own internal protein, carrying them, outsie the cell membrane where the immune system can see them. These peptides are just pieces of the normal proteins found inside the cell. These peptides are held together at the cell surface by major histocompatibility complex, which holds these peptides together for the immune system to examine them. Each persons immune system is customized early in life to ignore these peptides, so healthy cells are not able to trigger the immune system and they are left alone. But if any virus or other microorganism is multiplying inside the cell, the peptides synthesized by it also is displayed on the surface. The MHC displays these unusual (foreign) protein on the surface of the cell. The immune system is triggered because of these peptides, staing, a series of event that will eventually lead to killing of the cell containing foreign peptide. MHC is also the cause of tissue rejection during skin grafts and organ grafts. This is how the MHC protein got its name; the term histocompatibility refers to the difficulty of finding compatible grafts between a donor and a patient. Each person has their own collection of MHC molecules. If you graft a piece of skin that has a different collection of MHC types they will trigger the immune system to destroy the cell. So a compatible donor is needed such as a relative who has a similar collection of MHC molecules. MHC is also active against cancer Cancer cells, like normal cells, display pieces of their own protein on their surface. So if any of these proteins carries recognizable cancer mutations, this provides a signal to the immune system that something is wrong and the cell is killed. MHC plays role in activation of T helper cells (Th) MHC class II molecules are present on the membranes of dendritic cells, macrophages. These cell function as antigen presenting cell during immune response. They capture the antigen and present it to T helper cells. In response, the T helper cells secrete cytokines that stimulate B cell proliferation and antibody production. The impoant point about T helper cells is that they respond to only those antigens which have been presented to them by cells that have host matching MHC complex on the presenting cell. In general the antigen presenting cell .first phagocytoses the protein antigen and cleaves it to peptides in the lysosomes. These peptides are then extruded and attached to the presenting cell's surface MHC complex. T helper cells first, make sure, that these MHC class II molecules are host's own MHC and then responds appropriately. So, we can say that receptor on the T helper cell is thus responsive to the combination of antigen and host matching MHC complex on the presenting cell. Helper / inducer T cells (CD4)---) MHC class II restriction - Suppressor T cells (CD8) MHC class I restriction Cytolytic cytotoxic T cells (CD8) MHC class I restriction (Kills viral infected cells, tumor cells, facilitates graft rejection)

Pathology

None

During cardiac imaging the phase of minimum motion of hea is:

Mid diastole

3D

D i.e. Mid diastole- During cardiac imaging (such as MRI, CT, electron beam tomography), mid diastolic phase (or diastasis) of cardiac cycle is usually (but not always) associated with lowest (minimum) mean motion of hea.Q- Optimum phase (i.e. with minimum cardiac motion) for cardiac and coronary vessel imaging is mid-diastole (diastasis) at low or intermediate hea rates; but is variable and may occur in late systole at high hea rates.Cardiac Motion and Imaging- Radiological imaging by CT and MRI can detect coronary aery disease in early stage. However, the use of these tools to cardiac imaging is severely limited because of motion aifacts produced by constantly in motion hea completing an entire cycle of contraction and relaxation in about 1 second.- So radiological cardiac imaging requires a 'window' of minimum cardiac motion to reduce motion aifacts and achieve meaningful images. The phase of minimum cardiac motion is although variable and depends on several factors especially hea rate and the chamber (i.e. right /left - atrium or ventricle) to be specifically imaged. However, the phase of minimum cardiac motion (= optimum phase for cardiac & coronary vessel imaging).

Physiology

None

Mandibular nerve does not supply:?

Buccinator

0A

A. i.e. Buccinator

Anatomy

None

A 68-year-old man is admitted to the coronary care unit with an acute myocardial infarction. His postinfarction course is marked by congestive hea failure and intermittent hypotension. On the fouh day in hospital, he develops severe midabdominal pain. On physical examination, blood pressure is 90/60 mm Hg and pulse is 110 beats per minute and regular; the abdomen is soft with mild generalized tenderness and distention. Bowel sounds are hypoactive; stool Hematest is positive. Which of the following is the most appropriate next step in this patient's management?

Angiography

2C

In the absence of peritoneal signs, angiography is the diagnostic test of choice for acute mesenteric ischemia. Patients with peritoneal signs should undergo emergent laparotomy. Acute mesenteric ischemia may be difficult to diagnose. The condition should be suspected in patients with either systemic manifestations of aeriosclerotic vascular disease or low cardiac-output states associated with a sudden development of abdominal pain that is out of propoion to the physical findings. Because of the risk of progression to small-bowel infarction, acute mesenteric ischemia is an emergency and timely diagnosis is essential. Although patients may have lactic acidosis or leukocytosis, these are late findings. Abdominal films are generally unhelpful and may show a nonspecific ileus pattern. Since the pathology involves the small bowel, a barium enema is not indicated. Upper gastrointestinal series and ultrasonography are also of limited value. CT scanning is a good initial test, but should still be followed by angiography in a patient with clinically suspected acute mesenteric ischemia, even in the absence of findings on the CT scan. In addition to establishing the diagnosis in this stable patient, angiography may also assist with operative planning and elucidation of the etiology of the acute mesenteric ischemia. The cause may be embolic occlusion or thrombosis of the superior mesenteric aery, primary mesenteric venous occlusion, or nonocclusive mesenteric ischemia secondary to low-cardiac output states. A moality of 50% to 75% is repoed. The majority of affected patients are at high operative risk, but early diagnosis followed by revascularization or resectional surgery or both are the only hope for survival. Celiotomy must be performed once the diagnosis of aerial occlusion or bowel infarction has been made. Initial treatment of nonocclusive mesenteric ischemia includes measures to increase cardiac output and blood pressure. Laparotomy should be performed if peritoneal signs develop

Anaesthesia

Preoperative assessment and monitoring in anaesthesia

Drugs undergoing acetylation include all except:

Metoclopramide

1B

Ans. B. MetoclopramideAcetylation by N-acetyl transferases (NAT)e.g, S - SulfonamidesH - HydralazineI - IsoniazidP - Procainamide, PASD - DapsoneC - Clonazepam, Caffeine

Pharmacology

General Pharmacology

A group of expes discussing a topic in front of the audience without any specific order. This mode of communication is known as: September 2008

Panel discussion

0A

Ans. A: Panel discussion In panel discussion there is a chairman/moderator and 4-8 speakers. Each speaker prepares separately, the other speakers hear one another for the time at the session itself. Panel discussions, however, differ from team presentations. Their purpose is different. In a team presentation, the group presents agreed-upon views; in a panel discussion, the purpose is to present different views. Also in a team presentations, usually speakers stand as they speak; in panel discussions, usually speakers sit the whole time. Technically, a panel discussion consists of questions and answers only, and a symposium consists of a series of prepared speeches, followed by questions and answers. The chairman/ moderator must monitor time and manage questions. If each paicipant is making a speech for a set period of time, he should signal the speakers at the one minute to go mark and at the stop mark. If a speakers goes more than one or two minute he can stop them to gave the equal rights to each speakers. The chairman/ moderator must be a biased person; he is neither in our nor against the topic. At the end the compare should summarize the discussion and thank the panel members.

Social & Preventive Medicine

None

Starvation and diabetes mellitus can lead on to ketoacidosis which of the following features is in our of ketoacidosis due to diabetes mellitus.

Increase in glucagon/insulin ratio, increased CAMP and increased blood glucose

0A

A i.e. Increase in glucagons/ insulin ratio, increased C- AMP & increased blood sugar.In diabetes little glucose is oxidized as fuel, except by the brain. The rest of tissues burn a large amount of fat, paicularly the liver where the amount of acetyl COA formed from fatty acids exceeds the capacity of the tricarboxylic acid cycle to oxidize it. The excess acetyl COA is conveed to ketone bodies l/t ketonemia, ketonuria & ketoacidosisDiabetics not only have a defect in the tissue utilization of glucose but also appears to be metabolically poised to produce maximum amount of glucose from amino acids (gluconeogenesis) and to prevent glucose from being utilized to to form fat. (fat synthesis)Insulin is decreased & glucagons is increased 1/t Dglucagon/ insulin ratioQ. Glucagon acts elevation in C- AMPQ

Biochemistry

None

ARDS true?

Lung compliance decreased

1B

ARDS is a clinical syndrome of severe dyspnoea of rapid onset, hypoxaemia and diffuse pulmonary infiltrates leading to respiratory failure.ARDS is characterised by Po2/Fio2(inspiratory O2 fraction)<200 mmHg.There will be no hypercapnia, so the patient will have type 1 respiratory failure. There will be a stiff-lung syndrome with collapse and decreased compliance of the lungs due to loss of surfactant.

Medicine

None

Hypeension is seen with all except-

Levodopa

3D

Ans. is d i.e., Levodopa Drug causing hypeension Cocaine MAO inhibitors Oral contraceptives Clonidine withdrawl Tricyclic antidepressants Cyclosporine Glucocoicoids Rofecoxib (NSAID) Erythropoietin Valdecoxib (NSAID) Sympathomimetics

Pharmacology

None

Beta 2 agonist used in rescue therapy in acute respiratory conditions are all except?

Ketotifen

3D

Ans. is 'd' i.e., Ketotifen Formoterol, Salbutomol and bambuterol are p 2 agonists. o Ketotifen is a mast cell stabilizer.

Pharmacology

None

The post mortem report in case of death in police custody should be recorded as

Video recording

1B

Ans. b (Video recording). (Ref. Parikh, FMT, 5th ed., 130)Installation of video camera in jail and recording of postmortem in case of death in police custody is according to human rights.

Forensic Medicine

Law & Medicine, Identification, Autopsy & Burn

Reversible loss of polarity with abnormality in size and shape of cells is known as?

Dysplasia

2C

Dysplasia is reversible Anaplasia is irreversible

Pathology

None

During autopsy for virology study which agent is used for storing tissue: NEET 14

50% glycerine

3D

Ans. 50% glycerine

Forensic Medicine

None

The protective bacterium in the normal vagina is:

Lactobacillus

1B

Vagina has inhabitant bacteria called as Doderleins bacteria which is a lactobaccilli, and converts the glycogen present in vaginal epithelium into lactic acid. Thus, pH of the vagina is acidic The pH of the vagina in an adult woman is 4 -5.5 with an average of 4.5. The pH of vagina varies with age — for further details see preceding text.

Gynaecology & Obstetrics

None

Bence jones proteinuria is derived from?

Light chain globulins

1B

Ans. (b) Light chain globulins(Ref: R 9th/pg 598-602)Excretion of light chains in the urine has been referred to as Bence Jones proteinuria.Light chains includes k and l (kappa and lambda)

Pathology

Misc. (W.B.C)

Which of the following drugs used to treat type II diabetes mellitus causes weight loss:

Metformin

0A

None

Pharmacology

None

Pradhan mantra swasthya suraksha yojana was launched in:

2006

1B

Pradhan mantra swasthya suraksha yojana was approved in 2006 with the objective of correcting imbalances in availability of affordable teiary level healthcare in the country. Ref: National Health Programmes in India, J.Kishore, 10th edition pg: 84

Social & Preventive Medicine

None

Which of the following measures sensitivity: September 2011

True positives

1B

Ans. B: True positives Sensitivity denotes true positives

Social & Preventive Medicine

None

Caput succedaneum in a newborn is: Karnataka 07

Collection of sero-sanguineous fluid in the scalp

1B

Ans. Collection of sero-sanguineous fluid in the scalp

Forensic Medicine

None

Zero order kinetics is seen in all except

Methotrexate

3D

Zero order kinetics is seen in high dose of salicylates,ethanol and phenytoin. Ref-KDT 6/e p31

Anatomy

General anatomy

In a normal healthy person the arterial oxygen is considered satisfactory if SPO2 is more than

90

2C

Ans. c (90) (Ref H-17th/l590-91; pg. A-15)In a normal healthy person the arterial oxygen is considered satisfactory if SP02 is more than 90.Arterial O2 tensionPaO212.7 +- 0.7 kPa (95 +- 5 mm Hg)Arterial CO2 tensionPaCO25.3 +- 0.3 kPa (40 +- 2 mm Hg)Arterial O2 saturationSaO20.97 +- 0.02 (97 +- 2%)Arterial blood pHpH7.40 +- 0.02Arterial bicarbonateHCO3-24 + 2 mEq/LBase excessBE0 +- 2 mEq/LDiffusing capacity for carbon monoxide (single breath)DLCO0.42 mL CO/s/mm Hg (25 mL CO/min/mm Hg)Dead space volumeVD2 mL/kg body wtPhysio dead space; dead space-tidal vol ratioVD/VTKnow at rest & exercise(a) Rest < 35% VT(b) Exercise < 20% VTAlveolar-arterial difference for O2P(A -a) O2< 2.7 kPa (20 mm Hg)Educational Point# Alveolar hypoventilation exists by definition when arterial PC02 (PaC02) increases above the normal range of 37-43 mm Hg, but in clinically important hypoventilation syndromes PaC02 is generally in the range of 50-80 mm Hg.# A decrease in the Anion Gap can be due to:- an increase in unmeasured cations;- the addition to the blood of abnormal cations, such as lithium (lithium intoxication) or cationic immunoglobulins (plasma cell dyscrasias);- a reduction in the major plasma anion albumin concentration (nephrotic syndrome); (A fall in serum albumin by 1 g/dL from the normal value decreases the anion gap by 2.5 mEq/L).- a decrease in the effective anionic charge on albumin by acidosis; or- hyperviscosity and severe hyperlipidemia.

Medicine

Respiratory

A 40-year-old man presents with 5 days of productive cough and fever. Pseudomonas aeruginosa is isolated from a pulmonary abscess. CBC shows an acute effect characterized by marked leukocytosis (50,000/mL) and the differential count reveals shift to left in granulocytes. Which of the following terms best describes these hematologic findings?

Leukemoid reaction

0A

Circulating levels of leukocytes and their precursors may occasionally reach very high levels (>50,000 WBC/mL). These extreme elevations are sometimes called leukemoid reactions because they are similar to the white cell counts observed in leukemia, from which they must be distinguished. The leukocytosis occurs initially because of accelerated release of granulocytes from the bone marrow (caused by cytokines, including TNF and IL-1) There is a rise in the number of both mature and immature neutrophils in the blood, referred to as a shift to the left. In contrast to bacterial infections, viral infections (including infectious mononucleosis) are characterized by lymphocytosis Parasitic infestations and ceain allergic reactions cause eosinophilia, an increase in the number of circulating eosinophils. Leukopenia is defined as an absolute decrease in the circulating WBC count.

Pathology

Basic Concepts and Vascular changes of Acute Inflammation

A patient present with dysphagia of 4 weeks duration. Now he is able to swallow liquid food only. Which of the following is the one investigation to be done:

Upper GI endoscopy is to be done

1B

Answer is B (Upper GI endoscopy is to be done) The patient is presenting with new onset dysphagia for solids alone (able to swallow liquids). This suggests dysphagia due to mechanical obstruction (carcinoma, stricture, web) which is best diagnosed by endoscopy. Note: Barium swallow is the recommended initial investigation Endoscopy is the investigation of choice.

Medicine

None

Inhalation of fungal spores can cause primary lung infections. Of the following organisms, which one is most likely to be associated with this mode of transmission?

C. immitis

0A

C. albicans and Candida tropicalis are opportunistic fungi, and as part of the normal flora are not transmitted by inhalation. C. immitis is a dimorphic fungus and inhalation of the spores transmits the infection. Sprothrix is also a dimorphic fungus but its portal of entry is cutaneous. Trychophyton is a dermatophyte and one of the causes of athlete's foot.

Microbiology

Mycology

Fleeting skin lesions are often present in patients with:

Viral hepatitis B

0A

Fleeting skin lesions are often presents in patients with hepatitis B. Ref: Schiff's diseases of liver, Edition -11, Page - 3.

Medicine

None

In which of the following locations, Carcinoid tumor is most common

Appendix

3D

carcinoid tumour commonly occurs in appendix(45%),ileum(25%),rectum(15%).other sites are(15%)other pas of GIT ,bronchus, and testis SRB,5th,877.

Surgery

Head and neck

S100 is a marker used in the diagnosis of all Except

Basal cell cancer

3D

Acidic protein, 100% Soluble in ammonium sulfate at neutral pH (derivation of name) S100 protein family is multigenic group of nonubiquitous cytoplasmic EF-hand Ca2+-binding proteins, sharing significant structural similarities at both genomic and protein levels; S100 protein family has 24 known human members each coded by a separate gene; at least 19 on chromosome 1q21 Helps regulate cell contraction, motility, growth, differentiation, cell cycle progression, transcription and secretion Structurally similar to calmodulin

Pathology

General pathology

A Patient who is on antihypertensive drug develops a dry cough. Which of the following drug might be responsible for the condition:

ACE inhibitors

1B

The angiotensin-converting enzyme normally helps in conversion of angiotensin I to angiotensin II, which acts as a vasoconstrictor in case of hypovolemia. In addition to that, ACE also helps in the breakdown of bradykinin. When ACE inhibitors (captopril) are given, it inhibits ACE and in addition inhibits the breakdown of bradykinin also, which leads to accumulation of bradykinin level in the body. This increased level of bradykinin presents with a Dry cough, rashes, urticaria and angioedema.

Pharmacology

None

Mad Cow disease (Spongiform disease) occurs due to

C J virus

0A

Mad cow disease or bovine spongiform encephalopathy i.e. Caused by “prions” “PRIONS” are unconventional transmissible agents, proteinaceous in nature.” Diseases caused by prions are Kuru Creutzfeldt Jakob Disease. Gerstmann Straussler Scheinker Syndrome Fatal Familial Insomnia. Scrapie Of Sheep Transmissible Encephalopathy of Mink. Bovine Spongiform Encephalopathy (Mad Cow Disease)

Microbiology

None

Schwann cells are derived from:

Neural crest cells

0A

None

Surgery

None

A patient on lithium therapy was found to be hypeensive also. Which of the following antihypeensive drugs is contraindicated in a patient on lithium therapy in order to prevent toxicity?

Diuretics

3D

Diuretics (thiazide, furosemide) by causing Na+ loss promote proximal tubular reabsorption of Na+ as well as Li+ --plasma levels of lithium rise. ref : KD Tripati 8th ed.

Pharmacology

Central Nervous system

In marasmus, which of the following is not seen?

Edema

0A

Edema is a feature of Kwashiorkor, not seen in marasmus. Kwashiorkor Marasmus Edema Present absent appetite poor Voracious appetite CNS involvement apathy Active child Hepatomegaly seen Not seen Skin and hair changes More common Less common

Pediatrics

FMGE 2019

A 23-year-old woman presents with a rubbery, freely movable 2-cm mass in the upper outer quadrant of the left breast. A biopsy of this lesion would most likely histologically reveal

A mixture of fibrous tissue and ducts

1B

The most common benign neoplasm of the breast is fibroadenoma, which typically occurs in the upper outer quadrant of the breast in women between the ages of 20 and 35. These lesions originate from the terminal duct lobular unit and histologically reveal a mixture of fibrous connective tissue and ducts. Clinically, fibroadenomas are rubbery, freely movable, oval nodules that usually measure 2 to 4 cm in diameter. Numerous neutrophils are seen in acute bacterial infection of the breast (acute mastitis), which is usually seen in the postpaum lactating or involuting breast. Dilation of the breast ducts (ectasia) with inspissation of breast secretions is characteristic of mammary duct ectasia, which is common in elderly women. If large numbers of plasma cells are also present, the lesion is called plasma cell mastitis. Fat necrosis of the breast, associated with traumatic injury, is characterized by necrotic fat surrounded by lipid-laden macrophages and a neutrophilic infiltration. Fibroadenoma Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition

Pathology

miscellaneous

Most common pa of larynx involved in TB ?

Posterior

1B

Ans. is 'b' i.e., Posterior Essential otolaryngology 2"d/e p. 1139] Disease affects the posterior third of larynx more commonly than anterior pa. The pas affected in descending order of frequency are :- i) Interarytenoid fold, ii) Ventricular band, iii) Vocal cords, iv) Epiglottis.

ENT

None

Pyogenic granuloma is associated with

Ulcerative colitis

2C

Pyogenic granuloma is a misnomer as there is no granuloma. It is a benign vascular lesion that bleeds easily on trauma. It is associated with Inflammatory Bowel disease (Ulcerative colitis > Crohn's disease).

Dental

None

Epithelial rests of Malassez are found in

Periodontal Ligament

2C

None

Dental

None

Muscle relaxant used in renal failure -

Atracurium

1B

As Atracurium and Cis-atracurium are inactivated by Hoffman's elimination, they are the muscle relaxants of choice for both liver and renal failure.

Anaesthesia

Muscle relaxants

Ramachandran is on the surgical ward with non-seminomatous tumor of testis and more than 4 retroperitoneal lymph nodes involved. You are the resident who is making a decision about fuher management. The treatment include all of the following, except:

Radiotherapy

3D

Inguinal orchiectomy with high ligation of the cord at the internal ring is the initial management of testicular tumour. Multi Agent chemotherapy and followed by surgical resection is one modality of treatment. Ref: Bailey & Love, 25th Edition, Page 1269.

Surgery

None

A 34-year-old female has a history of intermittent episodes of severe abdominal pain. She has had multiple abdominal surgeries and exploratory procedures with no abnormal findings. Her urine appears dark during an attack and gets even darker if exposed to sunlight. The attacks seem to peak after she takes erythromycin, because of her penicillin allergy. This patient most likely has difficulty in synthesizing which one of the following?

Heme

0A

The patient has acute intermittent porphyria, which is a defect in one of the early steps leading to heme synthesis. The buildup of the intermediate that cannot continue along the pathway leads to the dark urine, and it turns darker when ultraviolet (UV) light interacts with the conjugated double bonds in the molecule. Erythromycin is metabolized through an induced P450 system, which requires increased heme synthesis. This leads to metabolite buildup to the level where the abdominal pain appears. The defect in heme synthesis does not affect creatine phosphate, cysteine, thymine, or methionine levels.

Biochemistry

Proteins and Amino Acids

Most common type of hypospadias is: September 2011

Glandular

0A

Ans. A: Glandular Glandular hypospadias is common and does not usually require treatment Hypospadias: The external meatus opens on the underside of the penis or the perineum, and the inferior aspect of the prepuce is poorly developed (hooded prepuce) Meatal stenosis occurs Bifid scrotum 6 - 10 months of age is the best time for surgery

Surgery

None

In a subclan aery block at outer border of 1st rib, all of the following aeries help in maintaining the circulation to upper limb, EXCEPT?

Superior thoracic aery

1B

A rich anastomosis exists around the scapula between branches of subclan aery (first pa) and the axillary aery (third pa). This anastomosis provides a collateral circulation through which blood can flow to the limb when the distal pa of subclan aery or the proximal pa of axillary aery is blocked. Scapular anastomoses occur between the following branches of proximal subclan and distal axillary aery: Branches of Subclan aery: Thyrocervical trunk, Suprascapular and Deep branch of transverse cervical.Branches of Axillary aery: Subscapular, Posterior circumflex humeral and Thoracoacromial aeires.

Anatomy

None

Lymphatics of suprarenal gland drain into lymph nodes -

Para-aortic

1B

Suprarenal glands drain into para-aortic nodes.

Anatomy

None

All of the following can be involved in an injury to the head of the fibula, EXCEPT:

Tibial nerve

3D

The common peroneal nerve is extremely vulnerable to injury as it winds around the neck of the fibula. At this site, it is exposed to direct trauma or is involved in fractures of the upper pa of the fibula. While passing behind the head of the fibula, it winds laterally around the neck of the bone, pierces peroneus longus muscle, and divides into two terminal branches: the superficial peroneal nerve and deep peroneal nerve (anterior tibial nerve). Injury to common peroneal nerve causes foot drop.Ref: Clinical Anatomy By Regions By Richard S. Snell, 9th edition, Page 485.

Anatomy

None

Pain felt between great toe and 2nd toe is due to involvement of which nerve root -

L5

0A

First web space of foot is supplied by deep peroneal nerve (L5)

Anatomy

None

Which of the following is non-competitive inhibitor of intestinal alkaline phosphatase?

L-Phenylalanine

3D

Ans. d (L-Phenylalanine) (Ref. Biochemistry by Vasudevan, 4th ed., 57; 5th ed., 55-56)ALKALINE PHOSPHATASE# The pH optimum for the enzyme reaction is between 9 and 10.# It is activated by magnesium and manganese.# Zinc is a constituent ion of ALR# It is produced by osteoblasts of bone, and is associated with the calcification process.# It is localised in cell membranes (ecto-enzyme), and is associated with transport mechanisms in liver, kidney and intestinal mucosa.# For estimation, sodium phenyl phosphate is used as the substrate, pH is adjusted to 9.9, serum sample is added as the source of ALP and incubated.# Normal serum value of ALP is 40-125 U/L.# Raised Levels:Mild increasepregnancy.Moderate (2-3 times) increaseIn infective hepatitis, alcoholic hepatitis or hepatocellular carcinoma, Hodgkin's lymphoma, congestive cardiac failure or ulcerative colitis.Very high levels of ALP (10-12 times)In extrahepatic obstruction (obstructive jaundice) or cholestasis.Drastically high levels of ALP (10-25 times)Bone diseases where osteoblastic activity is enhanced such as Paget's disease, rickets, osteomalacia, osteoblastoma, metastatic carcinoma of bone, and hyperparathyroidism.Iso-enzymes of Alkaline Phosphatase# Alpha-1 ALP moves in alpha-1 position, it is synthesized by epithelial cells of biliary canaliculi. It is about 10% of total activity and is increased in obstructive jaundice and to some extent in metastatic carcinoma of liver.# Alpha-2 heat labile ALP is stable at 56degC; but loses its activity when kept at 65degC for 30 minutes. It is produced by hepatic cells. Therefore, exaggerated alpha-2 band suggests hepatitis. This liver iso-enzyme forms about 25% of total ALP.# Alpha-2 heat stable ALP will not be destroyed at 65degC, but is inhibited by phenylalanine. It is of placental origin, which is found in blood in normal pregnancy. An iso-enzyme closely resembling the placental form is characteristically seen in circulation in about 15% cases of carcinoma of lung, liver and gut and named as Regan iso-enzyme (after the first patient in whom it was detected) or carcinoplacental iso-enzyme. Chronic heavy smoking also increases Regan iso-enzyme level in blood. Normal level is only 1% of the total ALP.# Pre-beta ALP is of bone origin and elevated levels are seen in bone diseases. This is most heat labile (destroyed at 56degC, 10 min). Wheat germ lectin will precipitate bone isoenzyme. This constitutes about 50% of normal ALP activity.# Gamma-ALP is inhibited by phenylalanine and originates from intestinal cells. It is increased in ulcerative colitis. About 10% of plasma ALP are of intestinal variety.# Leucocyte alkaline phosphatase (LAP) is significantly decreased in chronic myeloid leukemia. It is increased in lymphomas and leukemoid reactions.ALANINE AMINO TRANSFERASE (ALT)# It is also called as serum glutamate pyruvate transaminase (SGPT).# The enzyme needs pyridoxal phosphate as co-enzyme.# Normal serum level of AL T for male is 13^4-0 U/L and for female is 10-28 U/L.# Very high values (100 to 1000 U/L) are seen in acute hepatitis, either toxic or viral in origin.# Both ALT and AST levels are increased in liver disease, but ALT > AST.# Moderate increase (25 to 100 U/L) may be seen in chronic liver diseases such as cirrhosis, Hepatoma.# A sudden fall in ALT level in cases of hepatitis is very bad prognostic sign.NUCLEOTIDE PHOSPHATASE# It is also known as 5' nucleotidase.# It is a marker enzyme for plasma membranes and is seen as an ecto-enzyme (enzyme present on the cell membrane).# Serum samples contain both ALP and NTP.# These are distinguished by Nickel ions which inhibit NTP but not ALP.- Normal NTP level in serum is 2-10 IU/L. It is moderately increased in hepatitis and highly elevated in biliary obstruction.# Unlike ALP, the level is unrelated with osteoblastic activity and therefore unaffected by bone disease.GAMMA GLUTAMYL TRANSFERASE (GGT)# The old name was gamma glutamyl transpeptidase.# It can transfer gamma glutamyl residues to substrate.# In the body it is used in the synthesis of glutathione.# It is seen in liver, kidney, pancreas, intestinal cells and prostate gland.

Biochemistry

Enzymes

Mondors disease is:

Thrombophlebitis of superficial veins of breast

3D

Ans: D (Thrombophlebitis of superficial veins of breast) Ref: Bailey dt Love's Short Practice of Surgery, 25th Edition,833-4Explanation:Mondor's diseaseThrombophlebitis of the superficial veins of the breast and anterior chest wallCan also involve armCauseIdiopathicClinical featuresThrombosed subcutaneous vessel , usually attached to the skin - pathognomonic feature.When the skin over the breast is stretched by raising the arm. a narrow, shallow subcutaneous groove alongside the cord becomes apparent.Differential DiagnosesLymphatic permeation from occult carcinomaManagementConservativeRestriction of arm movements is advised.Resolv es within few months without any complicationAssociation with breast carcinoma is Coincidental

Surgery

Miscellaneous (Breast)

Treatment of Choice in Sleep Apnea Syndrome:

Continuous positive pressure ventilation.

0A

(A) Continuous positive pressure ventilation# Sleep apnea: Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. Each episode, called an apnea, lasts long enough so that one or more breaths are missed, and such episodes occur repeatedly throughout sleep.> The standard definition of any apneic event includes a minimum 10 second interval between breaths, with either a neurological arousal (a 3-second or greater shift in EEG frequency, measured at C3, C4, O1, or O2), a blood oxygen desaturation of 3-4deg/: or greater, or both arousal and desaturation. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, or a "Sleep Study".> Treatment: The most common treatment and arguably the most consistently effective treatment for sleep apnea is the use of a continuous positive airway pressure (CPAP) device, which 'splints' the patient's airway open during sleep by means of a flow of pressurized air into the throat. However the CPAP machine only assists inhaling whereas a BiPAP machine assists with both inhaling and exhaling, and is used in more severe cases. Medications like Acetazolamide lower blood pH and encourage respiration. Low doses of oxygen are also used as a treatment for hypoxia but are discouraged due to side effects.

Psychiatry

Miscellaneous

Rectal polyp most commonly presents as

Bleeding

1B

.LOWER GI BLEED- * Bleeding in the GIT below the level of the ligament of Treitz. * Normal faecal blood loss is 1.2 ml/day. A loss more than 10 ml/day is significant.* Angiodysplasia. * Diveicular disease - commonest cause in Western countries. * Tumours of colon or small bowel. * Anorectal diseases--Haemorrhoids, fissure in ano. * Ulcerative colitis * Crohn's disease. * Colorectal polyps; rectal carcinomas. * Intussusception ref:SRB&;s manual of surgery,ed 3,pg no 925.

Surgery

G.I.T

Ulipristal acetate is a/an:

Selective progesterone receptor modulator

3D

Ans. is d, i.e. Selective progesterone receptor modulatorRef: Harrison's Principles of Internal medicine 19th/ed, p2391Ulipristal acetate (trade name Ella One in the European Union, Ella in the US for contraception, and Esmya for uterine fibroid) is a selective progesterone receptor modulator (SPRM).PharmacodynamicsAs an SPRM, ulipristal acetate has partial agonistic as well as antagonistic effects on the progesterone receptor. It also binds to the glucocorticoid receptor, but is only a weak anti-glucocorticoid relative to mifepristone, and has no relevant affinity to the estrogen, androgen and mineralocorticoid receptors. Phase II clinical trials suggest that the mechanism might consist of blocking or delaying ovulation and of delaying the maturation of the endometrium.Medical Uses* Emergency contraception: For emergency contraception, a 30mg tablet is used within 120 hours (5 days) after an unprotected intercourse or contraceptive failure. It has been shown to prevent about 60% of expected, pregnancies, and prevents more pregnancies than emergency contraception with levonorgestrel.* Treatment of uterine fibroids: Ulipristal acetate is used for preoperative treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age in a daily dose of a 5mg tablet. Treatment of uterine fibroids with ulipristal acetate for 13 weeks effectively controlled excessive bleeding due to uterine fibroids and reduced the size of the fibroids.InteractionsUlipristal acetate is metabolized by CYP3A4 in vitro. Ulipristal acetate is likely to interact with substrates of CYP3A4, like rifampicin, phenytoin, St John's wort, carbamazepine or ritonavir. Therefore, concomitant use with these agents is not recommended. It might also interact with hormonal contraceptives and progestogens such as levonorgestrel and other substrates of the progesterone receptor, as well as with glucocorticoids.Adverse EffectsCommon side effects include abdominal pain and temporary menstrual irregularity or disruption. Headache and nausea were observed under long-term administration (12 weeks), but not after a single dose.ContraindicationsUlipristal acetate should not be taken by women with severe liver diseases because of its CYP-mediated metabolism. It has not been studied in women under the age of 18.Pregnancy: Unlike levonorgestrel, and like mifepristone, ulipristal acetate is embryotoxic in animal studies. Before taking the drug, a pregnancy must be excluded.

Gynaecology & Obstetrics

Physiology & Histology

A patient presented with ahritis and purpura. Laboratory examination showed monoclonal and polyclonal cryoglobulins. Histopathology showed deposits of cryoglobulins around the vessels. The patient should be tested for which of the following ?

HCV

1B

Hepatitis C This is caused by an RNA flavivirus. Acute symptomatic infection with hepatitis C is rare. Most individuals are unaware of when they became infected and are identified only when they develop chronic liver disease. Eighty per cent of individuals exposed to the virus become chronically infected and late spontaneous viral clearance is rare. There is no active or passive protection against hepatitis C virus (HCV). Hepatitis C infection is usually identified in asymptomatic individuals screened because they have risk factors for infection, such as previous injecting drug use , or have incidentally been found to have abnormal liver blood tests. Although most people remain asymptomatic until progression to cirrhosis occurs, fatigue can complicate chronic infection and is unrelated to the degree of liver damage. Hepatitis C is the most common cause of what used to be known as 'non-A, non-B hepatitis'. If hepatitis C infection is left untreated, progression from chronic hepatitis to cirrhosis occurs over 20-40 years. Risk factors for progression include male gender, immunosuppression (such as co-infection with HIV), prothrombotic states and heavy alcohol misuse. Not everyone with hepatitis C infection will necessarily develop cirrhosis but approximately 20% do so within 20 years. Once cirrhosis has developed, the 5- and 10-year survival rates are 95% and 81%, respectively. One-quaer of people with cirrhosis will develop complications within 10 years and, once complications such as ascites develop, the 5-year survival is around 50%. Once cirrhosis is present, 2-5% per year will develop primary hepatocellular carcinoma. Ref Davidson edition23rd pg877

Medicine

G.I.T

All of the following structures passes through the Alcock canal, EXCEPT:

Obturator internus muscle

3D

Alcock canal or pudendal canal stas from the lesser sciatic notch and runs forward on the medial surface of the ischial tuberosity up to the pubic arch where it is continuous with the deep perineal pouch. Contents of the pudendal canal are:Pudendal nervePudendal aery and veinWithin the canal pudendal nerve give rise to following branches:Perineal nerveDorsal nerve of penis or clitorisRef: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 38. Anatomy.

Anatomy

None

Marfans Syndrome affecting eyes, skeletal system, and the cardiovascular system is caued by the mutation in the gene

Fibrillin 1

0A

Marfan Syndrome Is Caused by Mutations in the Gene for Fibrillin-1. It is inherited as an autosomal dominant trait. It affects the eyes (eg, causing dislocation of the lens, known as ectopia lentis), the skeletal system (most patients are tall and exhibit long digits and hyperextensibility of the joints), and the cardiovascular system (eg, causing weakness of the aoic media, leading to dilation of the ascending aoa). Abraham Lincoln may have had this condition. Most cases are caused by mutations in the gene (on chromosome 15) for fibrillin-1.Mutations in the fibrillin-1 gene have also been identified as the cause of acromicric dysplasia and geleophysic dysplasia, which are characterized by sho stature, skin thickening, and stiff joints. Congenital contractural arachnodactyly is associated with a mutation in the gene for fibrillin-2.Ref: Harper&;s Biochemistry; 30th edition; Chapter 50; The Extracellular Matrix

Biochemistry

miscellaneous

RNA primer is synthesized by -

DNA primase

2C

Ans. is 'c' i.e., DNA primase ProteinFunctionDNA polymerasesDeoxynucleotide polymerizationHelicasesProcessive unwinding of DNATopoisomerasesRelieve torsional strain that results from helicase-induced unwindingDNA primaseInitiates synthesis of RNA primersSingle-strand binding proteinsPrevent premature reannealling of dsDNADNA ligaseSeals the single strand nick between the nascent chain and Okazaki fragments on lagging strand

Biochemistry

Transcription

Biochemical analytes measured in the triple test are all the following Except

Inhibin A

3D

Second-Trimester ScreeningPregnancies with fetal Down syndrome are characterized by lower maternal serum AFP levels--approximately 0.7 MoM, higher hCG levels--approximately 2.0 MoM, and lower unconjugated estriol levels--approximately 0.8 MoM. This triple test can detect 61 to 70 percent of Down syndrome.Levels of all three markers are decreased in the setting of trisomy 18.Ref: William&;s Obstetrics; 24th edition; Chapter 14

Gynaecology & Obstetrics

Diagnosis in obstetrics

A preterm baby is born with synchronised upper chest movement, minimal nasal flare, expiratory grunting heard by the stethoscope, but has no chest or xiphoid retractions. The Silverman score is:

2

1B

The Silverman Anderson retraction score of respiratory distress syndrome (RDS): Upper chest Lower chest Xiphoid retraction Nares dilatation Expiratory grunt Grade 0 Synchronised No retraction None None None Grade 1 Lag on inspiration Just visible Just visible Minimal By stethoscope Grade 2 See-saw Marked Marked Marked Without stethoscope Mild RDS: Score 1-3 Moderate RDS: 4-7 Severe RDS: 7-10 Ref: Advances in Pediatrics by Dutta By Jaypee Brothers, Medical Publishers, 2007, Page 89.

Pediatrics

None

Bacteriostatic antitubercular drug among the following is :

Ethambutol

3D

None

Pharmacology

None

Yoke muscle pair is

Rt LR and Lt MR

2C

Right lateral rectus and left medial rectus. Yolk muscles are pair of muscles one from eye which contracts simultaneously during version movement.

Ophthalmology

None

Causes of restrictive cardiomyopathy are -

All of the above

3D

Restrictive cardiomyopathy is characterised by a primary decrease in ventricular compliance , resulting in impaired ventricular filling during diastole. Restrictive cardiomyopathy can be idiopathic or associated with systemic disease that also happen to affect the myocardium for example radiation fibrosis, amyloidosis, sarcoidosis, or products of inborn errors of metabolism Robbins 9 th edition page no. 401

Pathology

Cardiovascular system

3-year-old child comes in ER with Hv'o vomiting, loose watery motion for 3 days, on examination, the child was drowsy, sunken eye. Hypothermia and skin pinch take time to revert back, diagnosis

Severe dehydration

3D

on  A child with severe dehydration will have at least two of the following four signs: sensorium is abnormally sleepy or lethargic, sunken eyes, drinking poorly or not at all, and a very slow skin pinch. A child with some signs of dehydraon will have two of the following: restlessness or irritability, sunken eyes, drinking eagerly or slow skin pinch. A child with either one or none of these signs is classified as having no signs of death

Pediatrics

None

A 50 years old lady presented with lump in the left breast, which has developed suddenly in weeks. Perimenstrual symptoms are present. No associated family history. On examination, the lump is well circumscribed, fluctuant, 1.5 cm oval in shape. Most likely diagnosis:

Breast cyst

0A

Fibroadenoma - it occurs in 2nd to 3rd decade of life Galactocele - it occurs in 3rd to 4th decade of life. Breast cancer - there is no associated family history and lump has developed suddenly hence breast cancer is ruled out. Breast cyst - it occurs in 5th to 6th decade of life. Examination revealed fluctuant lesion which point towards breast cyst. - Often multiple, may be bilateral & can mimic malignancy. Typically present suddenly - Diagnosis can be confirmed by aspiration and / or ultrasound.

Surgery

Breast

HIV can -

Cross blood brain barrier

0A

it can cross blood brain barrier and cause cns infection REF:ANANTHANARAYANAN TEXT BOOK OF MICROBIOLOGY 9EDITION PGNO.576

Microbiology

Virology

Heamorrhagic external otitis media is caused by

Influenza

0A

Otitis externa haemorrhagica It is characterized by for mation of haemorrhagic bullae on the tympanic membrane and deep meatus. It is probably viral in origin and may be seen in influenza epidemics. The condition causes severe pain in the ear and blood-stained discharge when the bullae rupture. Treatment: with analgesics is directed to give relief from pain. Antibiotics are given for secondary infection of the ear canal, or middle ear if the bulla has ruptured into the middle ear. Ref:- Dhingra; pg num:-52

ENT

Ear

A 7 year old male patient presents to the clinic for routine dental examination and has history of frequent snacking and sugary beverages. Intraoral examination shows multiple pit and fissure caries and subsurface enamel porosity manifesting as milky white opacity. Tactile probing should not be used in this case because of all of the following EXCEPT?

It may induce spontaneous bleeding

3D

Traditionally, dentists have relied upon a visual-tactile radiographic  procedure  for  the detection  of  dental caries. This procedure involves the visual identification of demineralized  areas  (typically  white  spots)  or  suspicious pits or fissures and the use of the dental explorer to determine the  presence of a  loss of continuity  or breaks in the enamel and to assess the softness or resilience of the enamel. Caries lesions located on interproximal tooth surfaces  have  generally  been  detected  with  the  use  of  bitewing radiographs. These procedures have been used routinely in virtually every dental office in the United States for the past 50 years. Tactile probing with an explorer is no longer used for caries detection in most European countries, and this protocol has now been adopted by many U.S. dental schools. The primary concerns that led to the discontinuation of the probing procedure were as follows: 1. The  insertion  of  the  explorer  into  the  suspected lesion inevitably disrupts the surface layer covering very early lesions, thereby eliminating the possibility for remineralization of the decalcified area;  2. The probing of lesions and suspected lesions results in the transport of  cariogenic  bacteria  from  one area  to another;  and   3. Frank lesions requiring restoration are generally apparent visually  without  the  need  for  probing.

Dental

None

Most dangerous paicles causing pneumoconiosis are of size

A. 1-5 micron

0A

In pneumoconiosis, the most dangerous paicles range from 1-5 micron in diameter, because they may reach the terminal small airway and settle in there lining notes The solubility and cytotoxicity of paicles ,modify the nature of pulmonary response

Anatomy

Respiratory system

Calculate the deficit for a 60 kg person,with Hb - 5 g/dl add 1000 mg for iron stores.

2500

1B

Iron deficit = Bodyweight(kg) x 2.3 x (15 - Hb) + 1000       = 60 x 2.3 x (15 - 5) + 1000       = 2380 (close to 2500)

Medicine

None

Which of the following is not a cause of glomerular proteinuria?

Multiple myeloma

2C

Multiple myeloma is characterized by tubular proteinuria. The Bence Jones proteins induce tubular damage Increased beta-2-microglobulin levels in urine is an prognostic indicator of Multiple myeloma Diabetes Mellitus and amyloidosis lead to damage to basement membrane of the kidney leading to glomerular proteinuria in form of albuminuria Nil Lesion is also called as minimal change disease and presents as glomerular cause of proteinuria leading to nephrotic presentation . Multiple Myeloma: SPEP will demonstrate a sharp peak ("church spire" orM band) in the gamma globulin region as shown below:

Medicine

Nephrology

Which of the following does not cause Insulin release-

Rosiglitazone

0A

Ans. is 'a' i.e., Rosiglitazone o Oral hypoglycemic drugs may be divided into two groups. 1. Group 1 These drugs reduce plasma glucose by stimulating insulin production, therefore called insulin secretogogues. Hypoglycemia is a well known side effect. Examples are: i) Sulfonylureas: first generation (chlorpropamide, tobutamide); second generation (Glimipiride, glyburide, glipizide, gliclazide). ii) Megalitinnide/D-phenylalanine analogues: Nateglinide, Rapaglinide. 2. Group 2 These drugs reduce blood glucose without stimulating insulin production, therefore are insulin nonsecretogogues. These durgs do not cuase hypoglycemia when used alone and can cause hypoglycemia, only when used with other oral hypoglycemics. Examples are: i) Biguanides: Metformin, Phenformin ii) Thiazolidinediones: Rosiglitazone, Pioglitazone, Troglitazone. iii) alpha-glucosidase inhibitors: Acarbose, miglital.

Pharmacology

None

Which of the following endocrine tumors is most commonly seen in MEN I ?

Gastrinoma

1B

In MEN 1 : * Gastrinoma (>50%) * Insulinoma (10-30%) * Glucagonoma (<3%) * Somatotrophinoma (25%) Reference : page 2336 Harrison's Principles of Internal Medicine 19th edition

Medicine

Endocrinology

The following is the least useful investigation in multiple myeloma :

Bone scan

2C

Answer is C (Bone scan) Bone scans are least useful for diagnosis of Multiple Myeloma. Cytokines secreted by myeloma cells suppress osteoblastic activity therefore typically no increased uptake is observed. In multiple myeloma the osteohlastic response to bone destruction is negligible. The bone scan therefore is often normal or may show areas of decreased uptake (photopenia).It has been found to be less useful in diagnosis than plain radiography. Ig protein /24 hour is a major ciriteria for diagnosis " align="left" height="133" width="100"> Note : Serum M component is most commonly IgG Q (IgG (53%), IgA (25%), IgD (I%) Bence Jones proteins are light chain protein only Q.

Medicine

None

Most common organism causing ventilator associated pneumonia -

Pseudomonas

2C

None

Microbiology

None

A 2-week-old baby is irritable and feeding poorly. On physical examination, the infant is irritable, diaphoretic, tachypneic and tachycardic. There is circumoral cyanosis, which is not alleted by nasal oxygen. A systolic thrill and holosystolic murmur are heard along the left sternal border. An echocardiogram reveals a hea defect in which the aoa and pulmonary aery form a single vessel that overrides a ventricular septal defect. What is the appropriate diagnosis?

Truncus aeriosus

3D

Truncus aeriosus refers to a common trunk for the origin of the aoa, pulmonary aeries and coronary aeries. It results from absent or incomplete paitioning of the truncus aeriosus by the spiral septum during development. Most infants with persistent truncus aeriosus have torrential pulmonary blood flow, which leads to hea failure. None of the other choices are distinguished by a single vessel that carries blood from the hea.

Pathology

Cardiac disorders

prophylaxis for Pneumocystis carinii is indicated in HIV positive patents When CD4 count is-

< 200 cells / mm3

1B

Low CD4 count correlated with risk of PCP (p < 0.0001); 79% had CD4 counts less than 100/microl and 95% had CD4 counts less than 200/microl. Bacterial pneumonia has been linked to several HIV-related factors, including CD4 counts, having an uncontrolled viral load, and not being on antiretroviral therapy. HIV-positive people with a weak immune system, paicularly a CD4 count below 200 cells/mm3, are at greatest risk. Ref Harrison20th edition pg 1107

Medicine

Infection

index finger infection spreads to -

Thenar space

0A

Ans. is 'a' i.e., Thenar space o Thenar space communicates w'ith the index finger while the mid palmar space communicates with the middle, ring and little fingers.o Thus infection of index finger leads to thenar space infection while the infection of middle, ring or little finger leads to mid palmar space infection.FeaturesMidpalmar spaceThenar space1. ShapeTriangular.Triangular2. SituationUnder the inner half of the hollow of the palm.Under the outer half of the hollow of the3. ExtentProximalDistalDistal margin of the flexor retinaculum.Distal palmar crease.Distal margin of the flexor retinaculum.Proximal transverse palmar crease.4, CommunicationsProximalDistalForearm space.Fascial sheaths of the 3rd and 4th lumbricals; occasionally 2nd.Fascial sheath of th first lumbrical, occasionally 2nd.5. BoundariesAnteriorPosteriori) Flexor tendons of 3rd, 4th. and 5th fingersii) 2nd, 3rd and 4th lumbricalsiii) Palmar aponeurosisFascia covering interossei and metacarpals.Intermediate palmar septumi) Short muscles of thumb.ii) Flexor tendons of the index finger.iii) First Lumbricalsiv) Palmar aponeurosis.Transverse head of adductor pollicis.Laterali) Tendon of flexor pollicis longus with radial bursa.ii) Lateral palmar septum.Intermediate palmar septum.MedialMedial palmar septum6. DrainageIncision in either the 3rd or 4th web space.Incision in the first web. posteriorly.

Orthopaedics

Management In Orthopedics

Acute appendicitis is best diagnosed by -

Physical examination

1B

None

Medicine

None

All are clinical features of chalcosis except

Dalen- fuch's nodules.

3D

Dalen - fuch's nodules are formed due to proliferation of the pigment epithelium ----- sympathetic ophthalmitis.

Ophthalmology

None

Bidextrous grip is seen at what age?

4 months

0A

Ans. A. 4 monthsFINE MOTOR MILESTONES: AgeMilestone4 monthsBidextrous reach6 monthsUnidextrous reach9 monthsImmature pincer grasp12monthsMature pincer grasp15monthsImitates scribbling, tower of 2 blocks18monthsScribbles, tower of 3 blocks2 yearsTower of 6 blocks, veical & circular stroke3 yearsTower of 9 blocks, copies circle4 yearsCopies cross, bridge with blocks5 yearsCopies triangle

Pediatrics

None

A victim of Tsunami has difficulty in overcoming the experience. She still recollects the happening in dreams and thoughts. The most likely diagnosis is

Post traumatic stress disorder

0A

PTSD is characterised by recurrent and intrusive recollections of the stressful event, either in flashbacks (images, thoughts, or perceptions) and/or in dreams. There is an associated sense of re-experiencing of the stressful event. There is marked avoidance of the events or situations that arouse recollections of the stressful event, along with marked symptoms of anxiety and increased arousal. The other impoant clinical features of PTSD include paial amnesia for some aspects of the stressful event, feeling of numbness, and anhedonia (inability to experience pleasure). Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 112

Psychiatry

Anxiety disorders stress disorders and grief

A tumor has the following characteristic retrobulbar location within the muscle cone, well defined capsule, presents with slowly progressive proptosis, easily resectable, occurs most commonly in the 2nd to 4th decade. Most likely diagnosis is -

Cavernous hemangioma

1B

Ref: Clinical ophthalmology 5th/e p.670 *Cavernous hemangioma is the most common benign, intraconal tumor in adults. *Hemangiopericytoma is also retrobulbar intraconal lesion found in adults but is a rare tumor. Moreover owing to its tendency to invade the adjacent tissues, its margins are less distinct than cavernous hemangioma. *Rest 2 options i.e. Dermoid and Capillary hemangioma are primarily extraconal lesions.

Ophthalmology

Diseases of orbit, Lids and lacrimal apparatus

For Status epilepticus, treatment of choice is: September 2012

Lorazepam

3D

Ans. D i.e. Lorazepam

Medicine

None

All are subjective tests for audiometry except:

Impedance audiometry

1B

(b) Impedance audiometry(Ref. Scott Brown, 6th ed., Vol 2; 2/12/1)Impedance audiometry is an objective test. It does not require the cooperation of patient.Other objective audiometry tests are; OAEs, Electrocochleography and BERA

ENT

Hearing Loss

The mesial surface of the crown is almost parallel to long axis and the root of a:

Mandibular canine

3D

None

Dental

None

Tonic neck relfex is lost in lesion of -

Medulla

2C

Ans. is 'c' i.e., Medulla

Physiology

None

More than 90% patients of CREST syndrome with the limited cutaneous form of this disorder make which of the following autoantibodies?

Anti-centromere

0A

All forms of scleroderma are thought to have a strong autoimmune component, and glucocoicoids and azathioprine are used to suppress the inflammatory complications of scleroderma. (Other drugs that can be used in therapy include penicillamine, which inhibits collagen cross-linking, NSAIDS for pain, and ACE inhibitors to protect the kidney if hypeension or renal damage occurs). The anti-centromere antibody is quite specific for CREST syndrome (96% of cases), and is only seen in a minority of patients with diffuse scleroderma (mainly those with Raynaud's phenomenon) and rarely in systemic lupus erythematosus and mixed connective tissue disease.Also know:Anti-DNA topoisomerase I , also called anti-Scl-70 occurs commonly (64-75%) in diffuse scleroderma, but only rarely in CREST syndrome.Anti-double-stranded DNA is fairly specific for systemic lupus erythematosus, although it only occurs in 50-60% of lupus cases.Anti-Golgi antibodies are seen most often in systemic lupus erythematosus and Sjogren syndrome. Ref: Hellmann D.B., Imboden Jr. J.B. (2013). Chapter 20. Musculoskeletal & Immunologic Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow (Eds),CURRENT Medical Diagnosis & Treatment 2013.

Pathology

None

Name of mumps vaccine is

Jeryl Lynn

0A

Widely used live attenuated mumps vaccine include the jeryl Lynn, RIT 4385, Leningrad-3, L-Zagreb and Urable strains. The current mumps strain (jeryl Lynn) has the lowest associated incidence of post-vaccine aseptic meningitis.

Social & Preventive Medicine

Epidemiology

Sacro-Iliac joint involvement is common in which condition?

Ankylosing spondylitis

0A

(A) Ankylosing spondylitis # ANKYLOSING SPONDYLITIS (AS, from Greek ankylos, crooked; spondylos, vertebrae; -itis, inflammation), previously known as Bekhterev's disease, Bekhterev syndrome, and Marie-Strumpell disease, is a chronic inflammatory disease of the axial skeleton with variable involvement of peripheral joints and nonarticular structures. AS is a form of spondyloarthritis, a chronic, inflammatory arthritis where immune mechanisms are thought to have a key role. It mainly affects joints in the spine and the sacroiliac joint in the pelvis, and can cause eventual fusion of the spine.> The typical patient is a young male, aged 20-40; however, the condition also presents in females.> The condition is known to be hereditary. Symptoms of the disease first appear, on average, at age 23 years. These first symptoms are typically chronic pain and stiffness in the middle part of the spine or sometimes the entire spine, often with pain referred to one or other buttock or the back of thigh from the sacroiliac joint.

Orthopaedics

Miscellaneous

Infertility issues with leiomyoma can be addressed by

GnRH agonist

2C

GnRH agonist treatment is approved for treating infertility associated with fibroid uterus.

Gynaecology & Obstetrics

None

An adult male sustained accidental burns and died 1 hour later. Which of the following enzymes will be increased in the burn area?

ATPase

0A

Answer: a) ATPase (KS NARAYAN REDDY 33rd ED P-327)In antemortem burns, skin adjacent to the burnt area will show increase in the following enzymes after certain time intervalEnzymeAge of wounds (hour)ATPases1Esterases1Aminopeptidases2Acid phosphatase4Alkaline phosphatase8

Forensic Medicine

Injuries

Recommended daily dietary requirment of folate (folic acid) in children ?

80-120 mg

0A

Ans. is 'a' i.e., 80-120 mg Recommended daily allowances of folic acid are:- Healthy adults - 200 micro gm.(mcg) Pregnancy - 500 mcg Lactation - 300 mcg Children - 80-120 mcg

Social & Preventive Medicine

None

Alcohol dependence is seen which of the following phase

Oral

0A

Ans. is 'a' i.e. Oral PhasePsychiatric disorders resulting from fixation of regression to this phase* Oral phase (Birth 1 Vx year)* Alcohol dependence or drug dependence* Severe mood disorder* Dependent personality traits and disorders* Schizophrenia* Ana! phase* Obsessive compulsive traits* Obsessive compulsive disorder* Phallic (oedipal) Phase (3-5 years)* Oedipus complex is the primary cause of hysteria and other neurotic symptoms* Latency phase (5-12 years)* Neurotic disorders* Genital phase (12 years onward)* Neurotic disorders

Psychiatry

Substance Abuse

CAMP acts through:

Activation of protein kinase

0A

A i.e., Activation of protein kinase

Physiology

None

A four-fold increase in the titre obtained in Weil- Felix reaction is diagnostic of -

Rickettsial infection

0A

In weil-felix test, host antibodies to various rickettsial species cause agglutination of Proteus bacteria because they cross-react with bacterial cell surface antigens. Reference: Harrison20th edition pg 1011

Medicine

Infection

The diameter of Tricuspid orifice is

4cm

3D

ValveDiameter of OrificePulmonary2.5cmAoic2.5cmMitral3cmTricuspid4cmRef: BD Chaurasia; Volume 1; 6th edition; Table 18.1

Anatomy

Thorax

Most common cause of hirsutism in a teenage girl:

Ovarian disease

0A

As explained earlier PCOD is the most common cause of hirsutism. PCOD most common affects teenage girls (15–25 years). Therefore, In teenage girls most common cause of hirsutism is PCOD.

Gynaecology & Obstetrics

None

CSF is stored at:Kerala 11

4degC

0A

Ans. 4degC

Forensic Medicine

None

Gastrosplenic ligament is derived from?

Dorsal mesogastrium

2C

ANSWER: (C) Dorsal mesogastriumREF: Langman's Medical Embryology 9th edition 293The gastrosplenic ligament (ligamentum gastrosplenicum or gastrolienal ligament) is part of the greater omentum. Embryonically the gastrosplenic ligament is derived from the dorsal mesogastrium. The gastrosplenic ligament is made of peritoneum that connects the greater curvature of stomach with the hilum of the spleen. Contains: Short gastric vessels and left Gastro-Epiploic vessels

Anatomy

Abdomen & Pelvis

A 59-year-old male is found to have a 3.5-cm mass in the right upper lobe of his lung. A biopsy of this mass is diagnosed as a moderately differentiated squamous cell carcinoma. Workup reveals that no bone metastases are present, but laboratory examination reveals that the man's serum calcium levels are 11.5 mg/dL. This patient's paraneoplastic syndrome is most likely the result of ectopic production of

Parathyroid hormone-related peptide

2C

Symptoms not caused by either local or metastatic effects of tumors are called paraneoplastic syndromes. Bronchogenic carcinomas are associated with the development of many different types of paraneoplastic syndromes. These syndromes are usually associated with the secretion of ceain substances by the tumor cells. For example, ectopic secretion of ACTH may produce Cushing's syndrome, while ectopic secretion of antidiuretic hormone (syndrome of inappropriate ADH secretion) may produce hyponatremia. Hypocalcemia may result from the production of calcitonin, while hypercalcemia may result from the production of parathyroid hormone-related peptide (PTHrP), which is a normal substance produced locally by many different types of tissue. PTHrP is distinct from parathyroid hormone (PTH) patients with this type of paraneoplastic syndrome have increased calcium levels and decreased PTH levels. As a result of decreased PTH production, all of the parathyroid glands in these patients are atrophic. Other tumors associated with the production of PTHrP include clear cell carcinomas of the kidney, endometrial adenocarcinomas, and transitional carcinomas of the urinary bladder. Lung cancers are also associated with multiple, migratory venous thromboses. This migratory thrombophlebitis is called Trousseau's sign and is more classically associated with carcinoma of the pancreas. Hyperophic osteoahropathy is a syndrome consisting of periosteal new bone formation with or without digital clubbing and joint effusion. It is most commonly found in association with lung carcinoma, but it also occurs with other types of pulmonary disease. Erythrocytosis is associated with increased erythropoietin levels and some tumors, paicularly renal cell carcinomas, hepatocellular carcinomas, and cerebellar hemangioblastomas. It is not paicularly associated with bronchogenic carcinomas. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition.

Pathology

miscellaneous

Crossing over, true is;

Between non sister chromatids of homologous chromosomes

1B

Crossing over is the exchange of genetic material between non sister chromatids of homologous chromosomes occuring during pachytene stage of prophase I of meiosis.Recombination of genes in the same chromosome is brought about by crossing over. Ref: PRINCIPLES OF GENETICS, By Eldon John Gardner, Michael J. Simmons, D. Peter Snustad, 8th Edition, Page 163

Biochemistry

None

Bloom Richardson grading -

Carcinoma breast

0A

Ans. is 'a' i.e., Carcinoma breasto Bloom Richardson Grading and its variants are used to grade breast cancers.

Pathology

Breast

Which among the following is FALSE about congenital toxoplasmosis?

IgG is diagnostic

2C

Negative IgM with positive IgG indicates past infection. The presence of IgM antibody (which does not cross placenta) in the infant's circulation will diagnose congenital toxoplasmosis. The double sandwich IgA-ELISA is more sensitive than the IgM-ELISA for detecting congenital infection in the fetus and newborn. The methods used to detect IgM are 1)Double sandwich IgM ELISA 2)IgM immunosorbent assay. Ref: Kim K., Kasper L.H. (2012). Chapter 214. Toxoplasma Infections. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.

Microbiology

None

Superior suprarenal aery originates from:

Inferior phrenic aery

2C

Inferior phrenic aery

Anatomy

None