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Which of the following condition is necessary prerequisite for this change? A. Rupture of membranes B. Scanty liquor amnii C. Adequate liquor amnii D. Air inside the uterine cavity [<SEP>] The right answer is: C. Adequate liquor amnii Explanation: Ans. (C). Adequate liquor amniiThe photograph shows maceration, a sign of intrauterine death.Conditions favoring maceration: Intact membranes; adequate liquor amnii & NO air.

Savita is 32 weeks pregnant presents in causality and diagnosed as a case of APH. Vitals are unstable with BP 80/60 which of the following is next step in M/n A. Careful observation B. Blood transfusion C. Medical induction of labour D. Immediate cesarean section [<SEP>] The right answer is: B. Blood transfusion Explanation: Ans. is b i.e. Blood transfusion

All are true about Cancer breast, except: A. Affected sibling is a risk factor B. Paget's disease of nipple is intraductal type of CA C. Common in aged nulliparous D. Increased incidence with prolonged breast feeding [<SEP>] The right answer is: D. Increased incidence with prolonged breast feeding Explanation: Ans. (d) Increased incidence with prolonged breast feeding* Paget's Disease is a superficial manifest of an underlying Intra ductal carcinoma breast

Which of the following vitamin reduces the risk of insulin resistance, obesity, and the metabolic syndrome? A. Vitamin A B. Vitamin C C. Vitamin D D. Vitamin B12 [<SEP>] The right answer is: C. Vitamin D Explanation: Higher Intakes of Vitamin D May Be Beneficial There is evidence that Vitamin D intake considerably higher than that required to maintain calcium homeostasis reduce the risk of insulin resistance, obesity, and the metabolic syndrome, as well as various cancers. There is growing evidence that higher vitamin D status is protective against various cancers, including prostate and colorectal cancer, and also against prediabetes and the metabolic syndrome. Desirable levels of intake may be considerably higher than current reference intakes, and ceainly could not be met from unfoified foods. While increased sunlight exposure would meet the need, it carries the risk of developing skin cancer. Reference: Harper; 30th edition; Page no: 552, 553

The following drugs have significant drug interactions with digoxin except: A. Cholestyramine B. Thiazide diuretics C. Quinidine D. Amlodipine [<SEP>] The right answer is: D. Amlodipine Explanation: Ref:KDT 6/e p499 Cholestyramine inhibits itestinal absorption of digoxin. Thiazides result in hypokalemia and thus make precipitate digitalis toxicity by pharmacodynamic interaction. Quinidine and verampil reduces the exceion of digoxin and does make precipitate toxicity (pharmacokinetic interaction)

Antiboiotic Prophylaxis for infective endocarditis is indicated in: A. Isolated secundum ASD B. Mitral valve prolapse without regurgitation C. Prior coronary aery bypass graft D. Coarctation of aoa [<SEP>] The right answer is: D. Coarctation of aoa Explanation: Answer is D (Coarctation of Aoa) Coarctation of Aoa is a high risk cardiac lesion fior the development of infective endocarditis and an indication fir antibiotic prophyloxis.

Adder Head" appearance is found in: A. X-ray B. USG C. IVP D. CT [<SEP>] The right answer is: C. IVP Explanation: VP

Ortolani's test is done for A. Congenial dislocation of the knee joints B. Congenital dislocation of the hip joints C. Congenital dislocation of the shoulder joints D. Congenital dislocation of the elbow joints [<SEP>] The right answer is: B. Congenital dislocation of the hip joints Explanation: B. i.e. (Congenital dislocation of hip joints) (410 - Apley 8th)Important Tests**Ortolani's and Barlow's test Galeazzi test (604 CDT 4th)Congenital dislocation of hip joints** Apprehension testRecurrent dislocation of shoulder joints* Bryant's Call ways Hamilton ruler testHamilton ruler testAnterior dislocation of shoulder joints* **Pivot-shift testAnterior cruciate ligament* Lachman testAnterior cruciate ligament* Drawer testCruciate ligament (Ant & Post)* **Mc-Murray's testMeniscus injury* Appley's grinding testMeniscus injury* **Thomas testHip flexion deformity* ** Ankle joint has LEAST chances for recurrent dislocations

A 50 year old female patient complains of difficulty in swallowing. Patient gives h/o multiple diagnostic CT-scans of the head and neck region. This patient may be predominantly susceptible to which of the following? A. Medullary thyroid carcinoma B. Follicular thyroid carcinoma C. Anaplastic thyroid carcinoma D. Papillary thyroid carcinoma [<SEP>] The right answer is: D. Papillary thyroid carcinoma Explanation: The incidence of thyroid carcinomas, predominantly papillary thyroid carcinomas, increases in humans after radiation exposure. There is strong dependence on age at exposure—susceptibility to radiation-induced thyroid cancer is higher in children than adults. There is little evidence for a dose response for individuals exposed during adulthood. Females are 2 to 3 times more susceptible than males to radiogenic and spontaneous thyroid cancers. Reference: White and Pharoah, Oral radiology, ed 8th, pg-92

Which of the following may be seen in second degree Hea block (select three options): A. Change in QRS complex morphology B. Atrial rate more than ventricular rate C. Prolonged conduction time D. All of the above [<SEP>] The right answer is: D. All of the above Explanation: Answer is A, B, and C Second degree AV block (Type I and /or Type II) may be associated with prolonged conduction time (prolonged PR interval), Atrial rate more than ventricular rate and change in QRS complex morphology (Tipe II). Name Rhythm Rate (beats/minute) P waves (lead II) PR Interval QRS complex First-degree atrio- ventricular (AV) block Regular That of underlying sinus rhythm; both atrial and ventricular rates will be the same Sinus origin: one P wave to each QRS complex Prolonged (more than 0.20 second); remains constant Normal (0.10 second or less) Second-degree AV Atrial: regular Atrial: that of Sinus origin Varies; progressively Normal (0.10 block, Mobitz I Ventricular: irregular underlying sinus rhythm lengthens until a P wave isn't conducted second or less) Ventricular: depends on number of impulses conducted through AV node: will he less than atrial rate (P wave occurs without the QRS cmplex); a pause follows the dropped QRS complex Second-degree AV Atrial: regular Atrial: that of Sinus origin: two or Normal or Normal if block at block, Mobitz II ventricular: usually underlying sinus three P waves prolonged; remains level of bundle of regular, but may be rhythm (sometimes more) constant His; irregular if Ventricular: depends before each QRS conductions ratios vary on number of Impulses conducted through AV node; will be less than atrial rate complex bundle branches Third-degree AV block Atrial: regular Atrial: that of Sinus P waves with Varies greatly Normal if block at Ventricular: regular underlying sinus rhythm Ventricular:40 to 60 if paced by AV junction; 30 to 40 (sometimes less) if paced by ventricles; will be less than atrial rate no constant relationship to the QRS complex; P waves found hidden in QRS complexes and T waves level of AV node or bundle of His; wide if block in bundle branches No constant Relationship between P wave and QRS complex is a feature of Third degree or complete hea block. One P wave to each QRS complex is a feature of First degree block

An ill 16 days old baby girl is brought to the emergency. On examination pallor and dyspnoea present with a respiratory rate of 85 per minute. Her HR is 200 bpm, hea sounds are distant and a gallop is heard. X-ray showed cardiomegaly. An echocardiogram shows dilated ventricles and dilation of the left atrium. An ECG shows ventricular depolarization complexes that have low voltage. Which of the following is the most likely diagnosis? A. CHF B. Glycogen storage disease C. Pericarditis D. Aberrant left coronary aery arising from pulmonary aery [<SEP>] The right answer is: A. CHF Explanation: In CHF pallor, dyspnoea, tachypnoea, tachycardia and cardiomegaly are common regardless of the cause.The most common causes of CHF in children include myocarditis caused by adenovirus and coxsackievirus B.The echocardiogram shows ventricular and left atrial dilatation as well as poor ventricular function. With glycogen storage disease of the hea muscle thickening would be expected. With pericarditis- pericardial effusion is seen. On ECG, the voltages of the ventricular complexes seen with aberrant origin of the left coronary aery are not diminished, and a pattern of myocardial infarction can be seen. *

In inversion of the foot, the sole will face: A. Upwards B. Downwards C. Laterally D. Medially [<SEP>] The right answer is: D. Medially Explanation: Ans: d (Medially) Ref: BDC, Vol. II, 4th ed, p. 155; Kieth L. Moore, 4th ed, p. 638Inversion is the movement in which the medial border of the foot is elevated, so that the sole faces medially.Eversion is the movement in which the lateral border of the foot is elevated. So that the sole faces laterally.Joints of the foot and the Movements taking place there:JOINTTYPE OF JOINTMOVEMENTSAnkle jointHinge jointPlantar flexion, dorsiflexionSubtalar joint (talocalcaneal)Plane synovialInversion, eversionT alocalcaneonavicularBall and socketGliding and rotator movementsCalcaneocuboidPlane synovialInversion, EversionTarsometatarsalPlane synovialGliding or slidingIntermetatarsalPlane synovialLittle movement possibleMetatarsophalangealCondylarFlexion, extension, adduction, abduction and circumductionInterphalangealHinge varietyFlexion, Extension

Where does the "knot" is put in the neck during judicial hanging? A. The back of the neck B. Under angle of jaw C. Below the chin D. Choice of hangman [<SEP>] The right answer is: B. Under angle of jaw Explanation: In judicial hanging, a rope to allow a drop of five to seven metres according to the weight, build and age of the person, is looped round the neck, with the knot under the angle of the jaw. This causes fracture-dislocation usually at the level of the second and third, or third and fouh cervical veebrae. Ref: The essentials of forensic medicine and toxicology by Dr K S Narayan Reddy, 27th edition, Page 306.

Seal finger and whale finger are associated with - A. Listeria B. Erysipelothrix C. Corynebacterium D. Treponema [<SEP>] The right answer is: B. Erysipelothrix Explanation: Ans. is 'b' i.e., Erysipelothrix

Which of the following muscle acts as unlocker of knee? A. Gracilis B. Popliteus C. Saorius D. Biceps femoris [<SEP>] The right answer is: B. Popliteus Explanation: Popliteus rotates the tibia medially on the femur or, when the tibia is fixed, rotates the femur laterally on the tibia. At the beginning of flexion of the fully extended knee, lateral femoral rotation by popliteus muscle unlocks the joint.Must know:Locking of knee joint is due to the the action of quadriceps femoris, that brings about medial rotation of femur on tibia in later stages of extension. Ref: Snells, Clinical anatomy, 7th Edition, Page 650.

A 60 yr old chronic smoker presents with painless gross hematuria of 1 day duration. Which is the investigation of choice to know the cause of hematuria? A. USG B. X-ray KUB C. Urine routine D. Urine microscopy for malignant cytology cells [<SEP>] The right answer is: D. Urine microscopy for malignant cytology cells Explanation: A chronic smoker with painless gross hematuria should be suspected as having bladder cancer. The most common form of bladder cancer is transitional cell carcinoma (TCC). Tobacco use, followed by occupational exposure to various carcinogenic materials such as automobile exhaust or industrial solvents are the most frequent risk factors. Hematuria is the presenting symptom in 85-90% of patients with bladder cancer. It may be gross or microscopic, intermittent rather than constant. Exfoliated cells from both normal and neoplastic urothelium can be readily identified in voided urine. Ref: Scher H.I., Motzer R.J. (2012). Chapter 94. Bladder and Renal Cell Carcinomas. 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.

The most sensitive method for detecting cervical Chlamydia trachomatis infection is: A. Direct fluorescent antibody test B. Enzyme immunoassay C. Polymerase chain reaction D. Culture on irradiated McConkey cells [<SEP>] The right answer is: C. Polymerase chain reaction Explanation: Ans. is 'c' i.e., Polymerase chain reactionRef: Harrison, 17th/e, p. 1074,19th/e, p. 1165 and Ananthanarayan, 9th/e, p. 415Amplification assays such as ligase chain reaction and polymerase chain reaction are the most sensitive chlamydial diagnostic method.Other methods are:(a) Cell culture: Sensitivity (60-80%).(b) Direct immunofluorescent antibody test: Sensitivity 70-80% and quite specific.(c) ELISA: 60-80%.

Congestive hea failure in an infant is characterized by all except A. Pedal edema B. Tachypnea C. Sweating D. Poor weight gain [<SEP>] The right answer is: A. Pedal edema Explanation: Congestive Cardiac Failure in InfantsSymptomsSignsuFeeding difficultyuTakes less volume per feeduDiaphoretic while suckinguForehead sweating.uSuck-rest-suck cycle.uPoor weight gainuPeriorbital edema uClothes no longer fituIncreasing cloth sizeuRapid breathing/nasal flaring/cyanosis/chest retractions.uTachycardia.uHepatomegaly.uOccasionally Splenomegaly.uPeriorbital edemauEdema in flanks. uDependent edema (Refer: Nelson's Textbook of Paediatrics, 19thedition, pg no:1530)

Congenital hydrocele is best treated by A. Eversion of sac B. Excision of sac C. Lord's procedure D. Herniotomy [<SEP>] The right answer is: D. Herniotomy Explanation: Congenital hydrocele is best treated with herniotomy if they do not resolve spontaneously. Established acquired hydrocele often have thick walls. They are treated by subtotal excision of the sac. If the sac is small, thin walled and contains clear fluid, Lord's operation is done. Jaboulay's operation where the sac is eveed with placement of testis in a pouch created by dissection in the fascial planes of the scrotum, is an alternative. Reference : page 1328 Bailey and Love's sho practice of surgery 25th edition and page 1072 SRB's manual of surgery 5th edition

Rate limiting step in cholesterol synthesis is catalysed by which of the following enzyme? A. HMG CoA synthetase B. HMG CoA reductase C. Thiokinase D. Mevalonate kinase [<SEP>] The right answer is: B. HMG CoA reductase Explanation: Conversion of HMG CoA to mevalonate by HMG CoA reductase is the rate limiting step in the synthesis of cholesterol. Cholesterol is an allosteric inhibitor of HMG CoA reductase Statin drugs acts as competitive inhibitors with mevalonate for binding to HMG CoA reductase. Insulin ors the active form of HMG CoA reductase and increases cholesterol synthesis. Glucagon ours the inactive form and decreases cholesterol synthesis. Ref: Biochemistry By John W. Pelley, page 89.

Vaccine administered by following route is A. Typhoral live B. H1n1 killed C. H1n1 live D. Yellow fever live [<SEP>] The right answer is: C. H1n1 live Explanation: Hlnl live (Intranasal route)

Coloured urine is not seen in : A. Quinine B. Rifampcin C. Nitrofurantoin D. Pyridium [<SEP>] The right answer is: A. Quinine Explanation: Answer is A (Quinine) Quinine is not associated with discoloured urine.

Schizophrenia is treated by A. Anti depressants B. Anti psychotics C. Anti epileptics D. Mood stabilizers [<SEP>] The right answer is: B. Anti psychotics Explanation: Ans. is 'b' i.e., Anti psychotics

Fries test is used in the diagnosis of: A. Gonorrhoea B. Herpes C. Chanchroid D. Granuloma venereum [<SEP>] The right answer is: D. Granuloma venereum Explanation: Granuloma venereum

A 45-year-old woman complains of severe headaches and difficulty in swallowing. Over the past 6 months, she has noticed small, red lesions around her mouth as well as thickening of her skin. The patient has "stone facies" on physical examination. Which of the following antigens is the most common and most specific target of autoantibody in patients with this disease? A. C-ANCA (anti-proteinase-3) B. Double-stranded DNA C. P-ANCA (anti-myeloperoxidase) D. Scl-70 (anti-topoisomerase I) [<SEP>] The right answer is: D. Scl-70 (anti-topoisomerase I) Explanation: Scleroderma (refer to the image below) Autoimmune disease of connective tissue. Antinuclear antibodies are common but are usually present in a lower titer than in patients with SLE. Antibodies viually specific for scleroderma include:- Nucleolar autoantibodies (primarily against RNA polymerase) Antibodies to Scl-70, a non-histone nuclear protein topoisomerase; Anticentromere antibodies (associated with the "CREST" variant of the disease). The Scl-70 autoantibody is most common and specific for the diffuse form of scleroderma and is seen in 70% of patients. -Autoantibodies to double-stranded DNA (choice B) are seen in patients with SLE. -Autoantibodies to SS-A/SS-B are seen in patients with Sjogren syndrome. (Fig: A fibroblastic focus is present at the arrows.) Diagnosis: Scleroderma

Grave's ophthalmopathy mostly presents as September 2010 A. Proptosis B. Ptosis C. Reduced intraocular tension D. Increased power of convergence [<SEP>] The right answer is: A. Proptosis Explanation: Ans. A: Proptosis Graves' ophthalmopathy (also known as thyroid eye disease (TED), dysthyroid/thyroid-associated orbitopathy (TAO), Graves' orbitopathy) is an autoimmune inflammatory disorder affecting the orbit around the eye, characterized by upper eyelid retraction, swelling (edema), redness (erythema), conjunctivitis, reduce dpower convergence and bulging eyes (proptosis).

Flipped LDH indicating Myocardial Infarction is represented by: A. LDH-1> LDH-2 B. LDH-2 > LDH-1 C. LDH-4 > LDH-5 D. LDH-5 > LDH-4 [<SEP>] The right answer is: A. LDH-1> LDH-2 Explanation: When LDH-1 is greater than LDH-2, it is referred to as flipped LDH and is indicative of MI. LDH-1 isoenzyme is found primarily in hea muscle and is lesser in concentration than the LDH-2 Isoenzyme which is primarily found in RBC. When the concentration of LDH-1 is observed to be greater than LDH2. It is referred to as flipped LDH and is indicative of Myocardial infarction. LDH has five isoenzymes: LDH-1 LDH-1 is found primarily in hea muscle 17% to 27% LDH-2 LDH-2 is primarily found in Red blood cells 27% to 37% LDH-3 LDH-3 is highest in the lung 18% to 25% LDH-4 LDH-4 is highest in the kidney, placenta, and pancreas 3% to 8% LDH-5 LDH-5 is highest in the liver and skeletal muscle 0% to 5% The LDH test helps determine the location of tissue damage. Thus in Normal ratios LDH-1 is less than LDH-2 and LDH-5 is less than LDH-4. When LDH-1 is greater than LDH-2: It is referred to as flipped LDH. It is indicative of MI. When your LDH-5 is greater than your LDH-4: It could mean damage to the liver or liver disease. This includes cirrhosis and hepatitis. Ref: Harrisons 19th edition

Blood supply of stomach is/are: A. Left gastric aery B. Sho gastric aery C. Lt gastroepiploic aery D. All [<SEP>] The right answer is: D. All Explanation: A. i.e. Left gastric aery; B. i.e. Sho gastric aery; C. i.e. Left gastroepiploic aery

Which of the following ultrasound finding has the highest association with aneuploidy? A. Choroid plexus cyst B. Nuchal translucency C. Cystic hygroma D. Single umbilical aery [<SEP>] The right answer is: C. Cystic hygroma Explanation: All the above mentioned are ultrasound findings associated with increased risk of aneuploidy although the highest association is seen with cystic hygroma Nuchal translucency and cystic hygroma are both measured in the first trimesterTrisomy 21 is the most common aneuploidy associated with increased NT and cystic hygroma While monosomy X presents as second-trimester hygroma.

Burst supression pattern on EEG is typically seen in: A. Anoxic encephalopathy B. Absence seizures C. SSPE D. Herpes simplex encephalitis [<SEP>] The right answer is: A. Anoxic encephalopathy Explanation: Ref: Ref: Harrisons 18/e p e-45 chapter  As the depth of coma increases, the EEG becomes nonreactive and may show a burst-suppression pattern, with bursts of mixed-frequency activity separated by intervals of relative cerebral inactivity. In other instances there is a reduction in amplitude of the EEG until eventually activity cannot be detected. Such electrocerebral silence does not necessarily reflect irreversible brain damage, because it may occur in hypothermic patients or with drug overdose. The prognosis of electrocerebral silence, when recorded using an adequate technique, depends upon the clinical context in which it is found. In patients with severe cerebral anoxia, for example, electrocerebral silence in a technically satisfactory record implies that useful cognitive recovery will not occur.

To feel comfoable and cool in a factory the conrrected effective temperature ( in degree Farenheit) should be - A. Less tha 69 B. Between 69 and 76 C. Between 77 and 80 D. Between 81 and 82 [<SEP>] The right answer is: B. Between 69 and 76 Explanation: Comfo zones: In deg C of corrected effective temperature Pleasant and cool 20 Comfoable and cool 20-25 (69-76F) Comfoable 25- 27 (77-80F) Hot and uncomfoable 27-28 Extremely hot 28+ Intolerably hot 30+. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 792

Test used for factor VIII deficiency identification is- A. PT B. APTT C. D dimer D. FDP [<SEP>] The right answer is: B. APTT Explanation: Ans. is 'b' i.e., APTT o Factor VIII is a part of the intrinsic pathway of coagulation. The test used to identity1 the defects in the intrinsic and common pathways of coagulation is PTT. Thus prolonged PTT is a feature of patient with factor VIII deficiency.o Patients with hemophilia have deficiency of factor VIII that results in prolonged PTT.o Tests used to evaluate different aspects of hemostasis.Bleeding timeo It is not a test for coagulation rathers it tests the ability of the vessels to vasoconstrict and the platelets to form a hemostatic plug.o It is the time taken for a standardized skin puncture to stop bleeding,o Normal reference value is between 2-9 minutes.o Prolongation generally indicates the defect in platelet number or function.Prothrombin time (PT)o This assay tests the extrinsic and common coagulation pathway.o So, a Prolonged PT can result from deficiency of factor V, VII. X, prothrombin or fibrinogen.Partial thromboplastin time (PTT)o This assay tests the intrinsic and common coagulation pathways.o So, a prolonged PTT. can results from the deficiency of factor V, VHI, IX, X, XI, XII, prothrombin or fibrinogen.Thrombin timeo It is the time taken for clotting to occur when thrombin is added to the plasma,o It tests the conversion of fibrinogen to fibrin and depends on adequate fibrinogen level,o Prolonged thrombin time results from decreased level of fibrinogen.Defective coagulation pathwayPTAPTTExtrinsicIntrinsicCommonIncreasedNormalIncreasedNormalIncreasedIncreased

A 19 year old female presents with pain in the neck for 5 days. She is not able to wear tie for her job because of neck pain. H/O fatigue and lethargy for 10 days. She had flu like symptoms 20 days ago which resolved spontaneously. BP 110/80 mmHg, Pulse 48/min. Extremities are cold and dry. Neck is very tender. ECG normal. TSH is elevated. ESR 30 mm/hr. Next appropriate step A. Atropine injection B. Levothyroxine administration C. Aspirin D. Increase iodine intake in food [<SEP>] The right answer is: C. Aspirin Explanation: Answer: c) Aspirin (SCHWARTZ 19TH ED, P-1525; SABISTON 19TH ED, P-895)Granulomatous or Subacute or De Quervain's thyroiditisMost commonly occurs in 30- 40 year-old womenStrong association with the HLA-B35Fever with Sudden or gradual onset of neck painH/o preceding URI; Viral etiologyGland - enlarged, tender, firmClassically progresses through four stages: Hyperthyroid-Euthyroid-Hypothyroid-EuthyroidA few patients develop recurrent diseaseEarly stages: | ESR, Tg, T4, and T3 levels are elevated, TSH decreasedDuring Hypothyroid stage: elevated TSHLow radio-iodine uptakeFNAC - multinucleated giant cells of an epithelioid foreign body type and aggregates of lymphocytes activated macrophages, and plasma cellsSelf-limiting diseaseAspirin and NSAIDs are used for pain reliefPrednisolone for severe casesShort-term thyroid replacement may be needed and may shorten the duration of symptoms

Headache, apathy and deteriorating level of consciousness occurring weeks after head injury suggests; A. Chronic subdral haematoma. B. Pontine hemorrhage C. Continuing cerebral. D. Depressed skull fracture. [<SEP>] The right answer is: A. Chronic subdral haematoma. Explanation: Chronic subdral haematoma

A 27-year female wearing high heels stumbled and sustained inversion injury at ankle. Which ligament is most likely to be injured in the given case? A. A B. B C. C D. D [<SEP>] The right answer is: A. A Explanation: Ans. A. (A)A. Anterior Talofibular ligamentAnkle sprains: Usually caused by the falls from height or twists of ankle. When the plantar-flexed foot is excessively inverted, the anterior and posterior talofibular and calcaneofibular ligaments are stretched and torn. The anterior talofibular ligament is most commonly torn.

Asymmetric tonic neck reflex (ATNR) disappears at ______ A. 6 months B. 5 months C. 9 months D. 8 months [<SEP>] The right answer is: A. 6 months Explanation: Asymmetric tonic reflex (ATNR) diappears by 6-7 months postnatally The tonic neck reflex is produced by manually rotating the infant&;s head to 1 side and observing for the characteristic fencing posture (extension of the arm on the side to which the face is rotated and flexion of the conralateral arm) An obligatory tonic neck response, in which the infant becomes "stuck" in the fencing posture, is always abnormal and implies a CNS disorder Ref: Nelson 21st edition pgno: 3059

Ligament teres is a remnant of ? A. Ductus aeriosus B. Umbilical aery C. Umbilical vein D. Ductus venosus [<SEP>] The right answer is: C. Umbilical vein Explanation: Umbilical vein

Sho structured primi gravida has height less then A. 140 cm B. 145 cm C. 150 cm D. 135 cm [<SEP>] The right answer is: A. 140 cm Explanation: 140 cm

Which of the following is the most specific and sensitive screening test for renovascular hypeension? A. HRCT B. CT Angiography C. Captopril enhanced radionucleotide scan D. Doppler ultrasound of renal aeries [<SEP>] The right answer is: B. CT Angiography Explanation: Hypeension due to an occlusive lesion of a renal aery is renovascular hypeensionIn the initial stages, the mechanism of hypeension generally is related to activation of the renin-angiotensin system. Obstruction of the renal aery leads to decreased renal perfusion pressure, thereby stimulating renin secretion. Over time, possibly as a consequence of secondary renal damage, this form of hypeension may become less renin-dependent.As a screening test, renal blood flow may be evaluated with a radionuclide -ohoiodohippurate (OIH) scan, or glomerular filtration rate may be evaluated with a - diethylenetriamine pentaacetic acid (DTPA) scan before and after a single dose of captopril (or another ACE inhibitor).Contrast aeriography remains the "gold standard" for evaluation and identification of renal aery lesions.Harrison 19e pg: 1618

Role of egg lecithin in propofol formulation is? A. Acts as emulsifying agent B. Acts as preservative C. Acts as carrier vehicle D. Acts as antibacterial [<SEP>] The right answer is: A. Acts as emulsifying agent Explanation: Propofol is an insoluble drug that requires a lipid vehicle for emulsification. Current formulations of propofol use a soybean oil as the oil phase and egg lecithin as the emulsifying agent.

A 63 year old man presents with a triad of angina, syncope and congestive hea failure. Which of the following valvular hea lesion can be suspected- A. antral stenosis B. Tricuspid regurgitation C. Aoic stenosis D. Aoic regurgitation [<SEP>] The right answer is: C. Aoic stenosis Explanation: Even severe AS may exist for many years without producing any symptoms because of the ability of the hyperophied LV to generate the elevated intraventricular pressures required to maintain a normal stroke volume. Most patients with pure or predominant AS have gradually increasing obstruction over years, but do not become symptomatic until the sixth to eighth decades. Exeional dyspnea, angina pectoris, and syncope are the three cardinal symptoms. Dyspnea results primarily from elevation of the pulmonary capillary pressure caused by elevations of LV diastolic pressures secondary to reduced left ventricular compliance and impaired relaxation. Angina pectoris usually develops somewhat later and reflects an imbalance between the augmented myocardial oxygen requirements and reduced oxygen availability. Exeional syncope may result from a decline in aerial pressure caused by vasodilation in the exercising muscles and inadequate vasoconstriction in nonexercising muscles in the face of a fixed CO, or from a sudden fall in CO produced by an arrhythmia. ( Harrison&;s principle of internal medicine,18th edition,pg no.1939 )

An athelete presented with red coloured urine after 2 days of history of severe exeion. The most probable cause is? A. Hemoglobinuria B. Hemosiderinuria C. Hematuria D. Myoglobinuria [<SEP>] The right answer is: D. Myoglobinuria Explanation: Myoglobinuria REF: Harrison's Internal Medicine 17th edition chapter 382, Physiology and pathology of the urine by john dixon p. 49 Red color urine may be due to hemoglobin or myoglobin. In the question clue is given that patient is an athlete who competed in an event which lead to sternous exercise and hence increased myoglobin in the urine. "The states of energy deficiency cause activity-related muscle breakdown accompanied by myoglobinuria, appearing as light-brown- to dark-brown-colored urine"

Which of the following is released from hypothalamus? A. Orexin B. Cortisol releasing hormone C. Neuropeptide D. Ghrelin [<SEP>] The right answer is: B. Cortisol releasing hormone Explanation: There are 6 established hypothalamic releasing and inhibiting hormones : Corticotropin-releasing hormone (CRH), Thyrotropin releasing hormone (TRH), Growth hormone releasing hormone (GRH), Growth  hormone inhibiting hormone (GIH), Luteinizing hormone releasing hormone (LHRH) and Prolactin inhibiting hormone(PIH).

Vestibulo-Ocular Reflex Mediated by: A. Flocculonodular Lobe B. Vermal portion of Spinocerebel 1 um C. Neocerebellum D. Paravermal region of Spinocerebellum [<SEP>] The right answer is: A. Flocculonodular Lobe Explanation: Ans:A (Flocculonodular Lobe) Ref: Pal GK. Cerbellurn. In: Textbook of Medical Physiology. Ahuja Publishing House. 2007: 116: 871.Explanation:Functional Division of CerebellumVestibulo cerebellum/Arch-cerebellum (Flocculonodular lobe)Connections with vestibular apparatusConcerned with equilibrium and learning induced changes in vesiihulo-occular reflexSpino cerebellumVermis - controls muscle movements of axial bodyIntermediate zone - controls muscle movements of limbsCerbrocerbellum (Ponto cerebellum/Neo cerbellurn) Overall planning programming of motor activities

Which statement best describes the cranial fossa? A. The middle cranial fossa contains the cribriform plate. B. The anterior cranial fossa contains the pituitary gland. C. The middle cranial fossa is floored by the sphenoid and temporal bones. D. The internal acoustic meatus lies in the middle cranial fossa. [<SEP>] The right answer is: C. The middle cranial fossa is floored by the sphenoid and temporal bones. Explanation: The floor of the middle cranial fossa is made up of the body and greater wing of the sphenoid as well as the squamous temporal bone. The cribriform plate forms pa of the floor of the anterior cranial fossa The middle cranial fossa contains the pituitary gland. The internal acoustic meatus lies in the posterior cranial fossa.

Which of the following vitamin enhances intestinal absorption of calcium? A. Vitamin D B. Vitamin K C. Vitamin B1 D. Vitamin B2 [<SEP>] The right answer is: A. Vitamin D Explanation: Vitamin Functions Deficiency Disease D Maintenance of calcium balance Enhances intestinal absorption of Ca2+ and mobilizes bone mineral Regulation of gene expression and cell differentiation Rickets = poor mineralization of bone Osteomalacia = bone demineralization Reference: Harper; 30th edition; Page no: 550

Which of these is the most impoant indication for Strassmans Metroplasty done for a bicornuate uterus? A. Infeility B. Menorrhagia C. Repeated early pregnancy losses D. Associated vaginal atresia [<SEP>] The right answer is: C. Repeated early pregnancy losses Explanation: Habitual aboion is the most impoant indication for surgical treatment of women who have a double uterus. The aboion rate in women who have a double uterus is to three times greater than that of the general population. Best diagnosis of the condition is made by laparohysteroscopy. Strassmans Metroplasty

A 2-year-old child had burns on buttocks, both legs, face, neck and singeing of hair. Total surface area burnt: JIPMER 14 A. 27% B. 37% C. 45% D. 55% [<SEP>] The right answer is: B. 37% Explanation: Ans. 37%

Which test helps to differentiate between concomitant squint and paralytic squint A. Cover - uncover test B. Alternate covertest C. Direct cover test D. None of the above [<SEP>] The right answer is: B. Alternate covertest Explanation: This procedure causes breakdown of binocular fusion mechanism thus helpful to differentiate.

Best disinfectant of cholera stool is- A. Bleaching powder B. Cresol C. Phenol D. Lime [<SEP>] The right answer is: B. Cresol Explanation: Cresol is an excellent coal-tar disinfectant. It is 3 to 10 times as powerful as phenol, yet no more toxic. Cresol is best used in 5 to 20 percent strength for disinfection of farces and urine. Cresol is an all-purpose general disinfectant. (refer pgno :128 park 23 rd edition)

Black eye is a type of - A. Patterend abrasion B. Ectopic abrasion C. Ectopic bruise D. Friction abrasion [<SEP>] The right answer is: C. Ectopic bruise Explanation: The synopsis of forensic medicine & toxicology ; Dr k.s.narayan reddy ; 28th edition ; Pg .no . 107 Black eye is the most common example for ectopic bruising or percolated contusion .

In a patient with a type of familial dyslipidemias he presented with palmar Xanthomas and he ias at increased risk of atherosclerosis and CAD.In Lipid profile there was elevation of triacylglycerols and cholesterol.And the IDL and chylomicrons were elevated.What is the pathophysiology of the condition? A. LDL deficiency B. VLDL overproduction C. Apo C-2 deficiency D. Apo E deficiency [<SEP>] The right answer is: D. Apo E deficiency Explanation: Reference: Harpers illustrated biochemistry 30th edition page 275

Endolymphatic duct drains into : A. Subdural space B. External space C. Subarachnoid space D. Succulus [<SEP>] The right answer is: A. Subdural space Explanation: Ans:A.)Subdural Perilymph drains into subarachnoid space through the aqueduct of cochlea... Endolymph is absorbed in subdural space.

Usually associated with parvovirus B19 infection in those with hereditary spherocytosis- A. Mild to moderate splenomegaly B. Aplastic crisis C. Gallstones D. Hemolytic crisis [<SEP>] The right answer is: B. Aplastic crisis Explanation: Ans. is 'b' i.e., Aplastic crisis o Parvovirus B19 selectively infects erythroidprecursors and is the most common aetiological agent that induces aplastic crisis in patients with hereditary spherocytosis (and other Hemolytic disorders).Transient aplastic crisiso Persons with decreased erythrocytes caused by conditions such as iron deficiency anemia, human immunodeficiency virus sickle cell disease, spherocytosis or thalassemia are at risk of transient aplastic crisis if infected with parvovirus B19.o The virus causes a cessation of erythrocyte production,o Parvovirus infection may be the first manifestation in HS.o It begins with reticulocytosis and thrombocytosis.

A patient with cushinoid features presents with hemoptysis; he shows no response to dexamethasone suppression test; most likely diagnosis here is: A. Adrenal hyperplasia B. Adrenal adenoma C. Ca lung with ectopic ACTH production D. Pituitary microadenoma [<SEP>] The right answer is: C. Ca lung with ectopic ACTH production Explanation: Answer is C (Ca lung with ectopic ACTH production); Lack of suppression to dexamethasone challenge (ACTH producing tumor) and presence of hemoptysis (Carcinoma lung) in a patient with Cushinoid features suggests a diagnosis of Carcinoma lung with ectopic ACTH secretion. As a method of diagnostic workup of any patient with suspected Cushings we screen the patient with plasma coisol levels at 8:00 a.m. in the morning. Those with increased coisol levels are subjected to a dexamethasone supression test. In the given question there is lack of suppression to dexamethasone challenge so option (d) is out. Out of the choices remaining the presence of hemoptysis points towards the diagnosis of carcinoma lung with ectopic ACTH.

Symptomatic treatment is not required in withdrawal of: A. Cannabis B. Morphine C. Alcohol D. Cocaine [<SEP>] The right answer is: A. Cannabis Explanation: Since cannabis causes very mild withdrawal symptoms hence, no symptomatic treatment is required. LSD and other hallucinations also do not cause any withdrawal symptoms .

Following death of a person, what happens to potassium level in the vitreous. A. Potassium level falls B. Potassium level increases C. Remains unchanged D. It depends on cause of death [<SEP>] The right answer is: B. Potassium level increases Explanation: Potassium concentration raises at the rate of 0.17-0.25 mmol per hour following death. It helps in determination of time since death.

Under transplantation of humans organs act, the punishment for the doctor involved is A. < 1 year B. < 2 years C. 2-5 years D. > 5 years [<SEP>] The right answer is: C. 2-5 years Explanation: The Transplantation of Human Organs Act 1994, amended in 2011, and 2012 Chapter VI and VII deals with the trial and punishment of offences under this act. Under this act, doctors involved will be punished for a period of 2-5yrs. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr. PC IGNATIUS PAGE NO: 389

Staphylococcus aureus does not cause which of the following skin infection: A. Ecthyma gangrenosum B. Bullous impetigo C. Botryomycosis D. Cellulitis [<SEP>] The right answer is: A. Ecthyma gangrenosum Explanation: Ans. is. a. Ecthyma gangrenosum

A young lady with symptoms of hypehyroidism with elevated T4 and TSH levels. On examination, patient was not experiencing Tachycardia or excessive sweating.Fuher examination reveals bitemporal hemianopia. Next step of management A. Sta beta blockers immediately B. Conservative management sufficient C. Sta antithyroid drugs and wait for symptoms to resolve. D. Sta antithyroid drugs and do urgent MRI [<SEP>] The right answer is: D. Sta antithyroid drugs and do urgent MRI Explanation: Hypehyroidism with elevated levels of T4 and TSH levels and bitemporal hemianopia is highly suggestive of TSH secreting adenoma. Urgent MRI should be done to confirm the diagnosis of TSH secreting pituitary adenoma along with antithyroid drugs. Thyrotropin-secreting pituitary tumors (TSH-omas) are a rare cause of hypehyroidism and account for less than 1% of all pituitary adenomas. - Origin - anterior pituitary- MC cause of hyper pituitarism - Pituitary adenoma C/F Functional (Secreting) Non-Functional (Non-Secreting)Early Presentation due to physiologic Delayed presentation (Big enough toeffect cause neurological deficit) | Bitemporal Hemianopia Seen on 3rd / 4th Decade- M = F- MC type of pituitary adenoma is Prolactinoma IOC for diagnosis - MRIOther work-up done Full Endocrinologic ProfileFormal visual field testing TreatmentBromocriptine (Dopamine agonist) -Prolactinoma- Shrink prolactinoma in 6 to 8 weeks- Growth hormone security tumors - shrinkage occur < 20% Pts | Agent Octreotide | GH level in 70% Pts , | Tumor volume in 30% Indications of Sx in pituitary adenoma- GH Secreting tumors- Primarily Cushing Disease- Adenoma causing acute visual deterioration- Non-Prolactin secreting macroadenoma causing symptoms by mass effect Surgical ApproachIntranasal Trans-Sphenoidal , Sub labial Indications of Radiosurgery in pituitary adenoma- Used as primary therapy- Adjuvant therapy after subtotal resection- Recurrent disease

Statuary rape is - A. Less than 15 years B. Less than 16 years C. Less than 18 years D. Less than 20 years [<SEP>] The right answer is: C. Less than 18 years Explanation: Ref:Textbook of Forensic medicine and toxicology (V.V.Pillay) 17th edition, page no.388 Minimum age at which female can give consent for sex by what age is 18 years. As per Sec.375IPC unlawful sexual intercourse by man with a woman with or without her consent when she is under 18 years of age. The criminal law (Amendment) Act,2013 has increased the previous recomended age of consent from 16 to 18 years, which means any sexual activity irespective of presence of consent with a woman below the age of 18 will constitute statutory rape.

A patient on amiodarone is diagnosed to have cornea verticillata. What should be management – A. Stop the drug B. Penetrating keratoplasty C. Lamellar keratoplasty D. Observation [<SEP>] The right answer is: A. Stop the drug Explanation: Cornea Verticillata This is a whorl-like opacity in the corneal epithelium seen in patients on long-term treatment with medication such as amiodarone, chloroquine, phenothiazines and indomethacin. It is also seen in patients with Fabry disease and its carrier state. The condition is generally asymptomatic, harmless and reversible on stopping the drug. The whorl-like pattern shows the direction of migration of corneal epithelial cells. Occasionally the condition had been known to cause glare and surface discomfort which response to topical lubricants.

Most aggressive lung CA: A. Squamous cell CA B. Adenocarcinoma C. Small cell lung CA D. Large cell CA [<SEP>] The right answer is: C. Small cell lung CA Explanation: Ans. (c) Small cell lung CARef: Robbings 9th ed./ 717* Small cell carcinoma is a highly malignant tumor with a strong relationship to cigarette smoking.* Around 1% occurs in nonsmokers.* They are the most aggressive of lung tumors, metastasizing widely and are always fatal.

Chemoprophylaxis is indicated for all except- A. Typhoid B. Meningococcal meningitis C. Cholera D. Plague [<SEP>] The right answer is: A. Typhoid Explanation: Chemoprophylaxis There is no role of Chemoprophylaxis in Typhoid. For chemoprophylaxis in meningococcal meningitis, Rifampicin, Ciprofloxacin & Ceftriaxone is used. Tetracycline is used in Cholera and Plague.

In pontaic fever, which antigen is seen in urine? A. Lipopolysaccharide-1 B. Lipopolysaccharide-2 C. Lipopolysaccharide-4 D. Lipopolysaccharide-6 [<SEP>] The right answer is: A. Lipopolysaccharide-1 Explanation: Ans. is 'a' i.e., Lipopolysaccharide-1 Legionella are classified into serogroup on the basis ofgroup specific lipopolysaccharide (somatic antigen or 'O' antigen). Legionella pneumophila sero-group-1 (LP-1) is the most common infecting organism. Urine test detect LP-1.

Mediastinal lymph node calcification is seen in which one of the following- A. Metastatic neoplasm B. Lymphoma C. Sarcoidosis D. Bronchiectasis [<SEP>] The right answer is: C. Sarcoidosis Explanation: Ref:Robbins Basic Pathology (9th Edition),page no.478,479 Sarcoidosis Although sarcoidosis is considered here as an example of a restrictive lung disease, it is impoant to note that sarcoidosis is a multisystem disease of unknown etiology characterized by noncaseating granulomas in many tissues and organs. MORPHOLOGY The diagnostic histopathologic feature of sarcoidosis is the noncaseating epithelioid granuloma, irrespective of the organ involved. This is a discrete, compact collection of epithelioid cells rimmed by an outer zone of largely CD4+ T cells. The epithelioid cells are derived from macrophages and are characterized by abundant eosinophilic cytoplasm and vesicular nuclei. It is not uncommon to see intermixed multinucleate giant cells formed by fusion of macrophages. A thin layer of laminated fibroblasts is present peripheral to the granuloma; over time, these proliferate and lay down collagen that replaces the entire granuloma with a hyalinized scar. Two other microscopic features are sometimes seen in the granulomas: (1) Schaumann bodies, laminated concretions composed of calcium and proteins; and (2) asteroid bodies, stellate inclusions enclosed within giant cells. Their presence is not required for diagnosis of sarcoidosis--they also may occur in granulomas of other origins. Rarely, foci of central necrosis may be present in sarcoid granulomas, suggesting an infectious process. Caseation necrosis typical of tuberculosis is absent The lungs are involved at some stage of the disease in 90% of patients. The granulomas predominantly involve the interstitium rather than air spaces, with some tendency to localize in the connective tissue around bronchioles and pulmonary venules and in the pleura ("lymphangitic" distribution). The bronchoalveolar lavage fluid contains abundant CD4+ T cells. In 5% to 15% of patients, the granulomas eventually are replaced by diffuse interstitial fibrosis, resulting in a so-called honeycomb lung. Intrathoracic hilar and paratracheal lymph nodes are enlarged and calcification in 75% to 90% of patients, while a third present with peripheral lymphadenopathy. The nodes are characteristically painless and have a firm, rubbery texture. Unlike in tuberculosis, lymph nodes in sarcoidosis are "nonmatted" (nonadherent) and do not ulcerate.

"Candle-wax spots" in the retina are present in A. Sarcoidosis B. Toxoplasmosis C. Syphilis D. Tuberculosis [<SEP>] The right answer is: A. Sarcoidosis Explanation: (A) Sarcoidosis # OCULAR MANIFESTATIONS OF SARCOIDOSIS:> Anterior segment: Conjunctival involvement has been reported in patients with ocular sarcoidosis.> Sarcoidosis granulomas are solitary, yellow "millet-seed" nodules.> Anterior uveitis occurs in 22%- 70% of patients with ocular sarcoidosis, and is usually granulomatous & chronic.> Iris nodules have been reported in up to 12.5% of patients with sarcoidosis associated uveitis.> Exacerbations of granulomatous uveitis are often associated with an appearance of fresh iris or fundus nodules.> Posterior synechiae, cataract and glaucoma are common complications.> Corneal band keratopathy develops in a few patients and is usually associated with hypercalcemia.> Posterior segment: The most common manifestations at the posterior segment are vitritis, intermediate uveitis, panuveitis, posterior uveitis, retinal vasculitis & optic nerve involvement. Other manifestations include choroidal nodules & exudative retinal detachment.> Overall, patients with chronic posterior uveitis and panuveitis have significantly more complications than do patients with anterior uveitis.> "Candle wax drippings" and "punched-out" lesions can be seen in patients with uveitis secondary to sarcoidosis.

The number of doses recommended for oral Ty21a typhoid vaccine is: A. 14 B. 5 C. 3 D. 1 [<SEP>] The right answer is: C. 3 Explanation: The Ty21a vaccine is licensed for use in individuals > 5 years. A three dose regimen is recommended. Vaccine is administered on alternate days: 0n days 1, 3 and 5. Ref: Park 21st edition, page 215.

The drug used in petit mal seizures and has a narrow spectrum of antiepileptic activity is A. Lamotrigine B. Ethosuximide C. Phenytoin D. Primidone [<SEP>] The right answer is: B. Ethosuximide Explanation: Ethosuximide and valproate are the drugs of choice for absence seizures and are more effective than lamotrigineReference: Katzung Pharmacology; 12th edition; Page no: 418

Which test is not useful in a patient with history of Syncopal attack? A. Electrophysiological testing B. Tilt Table testing C. PET Scan D. Holter monitoring [<SEP>] The right answer is: C. PET Scan Explanation: Answer is C (PET Scan) : PET scan has- not been mentioned as a test to investigate syncope in Harrisons text. It is the single best answer of exclusion. Electrophysiological tests and 24 hour ECG Holter monitoring are indicated in patients where history suggests a cardiac disease. Upright tilt table testing is indicated for suspected neurogenic / vasodepressor syncope in patients with normal history / examination. Invasive Cardiac Electrophysiologic testing : provides diagnostic and prognostic information regarding Sinus Node function, AV conduction and Supraventricular and Ventricular arrhythmia. Holter monitor : provides 24 - 48 hours monitoring of ECG rhythm on an outpatient basis and is indicated for detection of conduction abnormalities. Upright tilt table testing : Is a test for vasodepressor / neurogenic syncope in patients with normal history / examination. In susceptible patients upright tilt at an angle between 60deg to 80deg for 30 to 60 minutes induces a vasovagal episode. Indications for Table Tilt test include : Recurrent syncope - Single syncope episode that caused injury - Single syncope event in high risk setting (pilot, commercial vehicle driver) Syncope The choice of diagnostic test should be guided by the history and physical examination For All patients Serum electrolytes Glucose Haematocrit

Magic syndrome is seen in: A. Behcet disease B. Aphthous major C. Herpetiform D. Bloom syndrome [<SEP>] The right answer is: A. Behcet disease Explanation: “MAGIC syndrome” (Mouth and Genital ulcers with Inflamed Cartilage) has been proposed to describe patients with clinical features of both relapsing polychondritis and Behcet disease.

Acute hemorrhagic conjunctivitis is caused by ? A. Enterovirus 70 B. Adenovirus C. Poliovirus D. Hepadnavirus [<SEP>] The right answer is: A. Enterovirus 70 Explanation: Ans. is 'a' i.e., Enterovirus 70 Acute hemorrhagic conjunctivitis (AHC) may be caused by adenoviruses, but two enteroviruses, enterovirus 70 and coxsackie A24 variant, are the major causes.

In a 24 year old man weight of the upper limb is transmitted to the axial skeleton by: A. Coracoacromial ligament B. Coracoclavicular ligament C. Costoclavicular ligament D. Coracohumeral ligament [<SEP>] The right answer is: B. Coracoclavicular ligament Explanation: The axial skeleton shapes the longitudinal axis of the human body. Coracoclavicular ligament suspends the scapula from the lower one third of the clavicle and forms a strong bond between them. The weight of the upper limb is transmitted to the axial skeleton through this ligament. A fracture of the clavicle, medial to the attachment of this ligament leads to drooping of upper limb. Ref: TB of Anatomy and Physiology PR Ashalatha, 1st Ed, Page 110

Primary health care was proposed in 1978 at: A. Alma ata B. New York C. Geneva D. Delhi [<SEP>] The right answer is: A. Alma ata Explanation: Answer: A. Alma ata. (Ref Park's Textbook of PSM 22nd/Pg.832)The new approach to health care came into existence in 1978 following an international conference at Alma Ata (USSR).The Alma-Ata conference defines the primary health care as follows: Primary health care is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and the country can afford.Millennium Development Summit was held in New York in 2000 where MDG are formulated.World Health Assembly is held in Geneva, which is a head quarter of WHO.Note: The term "comprehensive health care" (womb to tomb) was first used by Bhore committee in 1946.

Gene involved in Cowden syndrome is A. P53 B. PTEN C. RB D. Ras [<SEP>] The right answer is: B. PTEN Explanation: (B) PTENo"Phosphatase and Tensin'' homolog (PTEN) - protein in humans encoded by the PTEN gene. Gene mutations promotes development of cancers.[?]Cowden's disease/Multiple Hamartoma Syndrome:-Part of PTEN hamartoma tumor syndrome-An autosomal dominant syndrome-Trichilemmomas - Numerous tumors of hair follicles in face-Multiple hamartomatous polyps in GI tract, Lipomas, Granulomas-Very high risk of breast, Follicular endometrail carcinoma & thyroid carcinomaoTreatment: Bilateral mastectomies recommended-Contraindicated are mammography & other radiation exposure of breast tissue.-Mean age at presentation <10 years-Very high risk of breast, follicular carcinoma of thyroid & Endometrial carcinomaoPTEN (phosphatase and tensin homologue) is a membrane-associated phosphatase encoded by a gene on chromosome 10q23 that is mutated in Cowden syndrome, an autosomal dominant disorder marked by frequent benign growths, such as skin appendage tumors, and an increased incidence of epithelial cancers, particularly of the breast, endometrium, and thyroid.oPTEN acts as a tumor suppressor by serving as a brake on the PI3K/AKT arm of the receptor tyrosine kinase pathway.oPTEN gene function is lost in many cancers through deletion, deleterious point mutations, or epigenetic silencing.SELECTED TUMOR SUPPRESSOR GENES & ASSOCIATED FAMILIAL SYNDROMES & CANCERS, SORTED BY CANCER HALLMARKS*Gene (Protein)Familial SyndromesAssociated CancersInhibitors of Mitogenic Signaling PathwaysAPC (Adenomatous polyposis coli protein)Familial colonic polyps and carcinomasCarcinomas of stomach, colon, pancreas; melanoma*. NF1 (Neurofibromin-1)Neurofibromatosis type 1 (neurofibromas and malignant peripheral nerve sheath tumors)Neuroblastoma, juvenile myeloid leukemia*. NF2 (Merlin)Neurofibromatosis type 2 (acoustic schwannoma and meningioma)Schwannoma, meningioma*. PTCH (Patched)Gorlin syndrome (basal cell carcinoma, medulloblastoma, several benign tumors)Basal cell carcinoma, medulloblastoma*. PTEN (Phosphatase and tension homologue)Cowden syndrome (variety of benign skin, GI, and CNS growths; breast, endometrial, and thyroid carcinoma)Diverse cancers, particularly carcinomas and lymphoid tumors*. SMAD2, SMAD4 (SMAD2, SMAD4)Juvenile polyposisFrequently mutated (along with other components of TGFb signaling pathway) in colonic & pancreatic CaInhibitors of Ceil Cycle Progression*. RB Retinoblastoma (RB) proteinFamilial retinoblastoma syndrome (retinoblastoma, osteosarcoma, other sarcomas)Retinoblastoma; osteosarcoma carcinomas of breast, colon, lung*. CDKN2A p16/INK4a & pU/ARFFamilial melanomaPancreatic, breast, and esophageal carcinoma, melanoma, certain leukemiasInhibitors of "Pro-growth" Programs of Metabolism and Angiogenesis*. VHL (Von Hippel Lindau (VHL) protein)Von Hippel Lindau syndrome (cerebellar hemangioblastoma, retinal angioma, renal cell carcinoma)Renal cell carcinoma*. STK11 (Liver kinase B1 (LKB1) or STK11)Peutz-Jeghers syndrome (GI polyps, GI cancers, pancreatic carcinoma and other carcinomas)Diverse carcinomas (5%-20% of cases, depending on type)*. SDHB, SDHD (Succinate dehydrogenase complex subunits B & D)Familial paraganglioma, familial pheochromocytomaParaganglioma

Supraventricular crest lies between- A. Pulmonary orifice and atrioventricular orifice B. Atrioventricular orifice and fossa ovalis C. SVC and right atrium D. Right an dleft coronary artery [<SEP>] The right answer is: A. Pulmonary orifice and atrioventricular orifice Explanation: Ans. is 'a' i.e., Pulmonary orifice and atrioventricular orifice Interior of right ventricle* It is anteroinferior chamber and projects to the left of right atrium. It is in contact with the sternum.* It is divided into -i) Rough inflowing part (ventricle proper)# It is developed from right half of primitive ventricle.# Its interior is rough due to the presence of muscular ridges known as trabeculae carneae, which are more prominent in apical region.# Trabeculae carneae are of 3 types: -1. Ridges - Linear elevations.Supraventricular crest - a ridge present between the pulmonary and atrioventricular orifices, extends downwards in the posterior wall of the infundibulum.2. Bridges -'Muscular elevations with fixed ends on ventricular walls, the center being free.Septomarginal trabecula: It is a specialized bridge which extends from the right of ventricularseptum to the base of anterior papillary muscle. It contains the right branch of atrioventricular bundle.3. Papillary muscles are conical projections of muscle fiber bundles. Their base is attached to the ventricular wall and the apex is attached to the chordae tendinae, which are further attached to the cusps of atrioventricular (AV) valves. There are three papillary muscles in the right and two in the left ventricle. They regulate closure of atrioventricular valves.ii) Smooth outflowing part (infundibulum or conus arteriosus)# Smooth outflowing part develops from mid portion of bulbus cordis and surrounds pulmonary valveSupraventricular crest (crista supraventriculars) or infundibuloventricular crest separates tricuspid (AV) orifice and pulmonary orifice, i.e. inlet and outlet parts.

Which of the following is freely filtered by kidney across glomerular capillariesa) Albumin (across glomerular capillaries)b) Globulinc) Creatinined) HCO3 e) Glucose A. cde B. acd C. bde D. ade [<SEP>] The right answer is: A. cde Explanation: Freely filterable substances by glomerulus -        Water -        Na+ -        Cl- -        HCO3- -        Inulin -        Glucose -        Creatinine   -        Free Calcium or phosphate

Antibodies associated with GTCS in SLE : A. Anti neuronal ab B. Anti-Ro ab C. Anti-Sm ab D. None [<SEP>] The right answer is: A. Anti neuronal ab Explanation: Ans.A Anti neuronal ab (Ref: Harrison's Internal medicine 18th/Table 319-1; 17th edition, P. 2076). Autoantibodies in Systemic Lupus Erythematosus (SLE) Antibody Prevalence, % Antigen Recognized Clinical Utility Antinuclear antibodies 98 Multiple nuclear Best screening test; repeated negative tests make SLE unlikely Anti-dsDNA 70 DNA (double-stranded) High titers are SLE-specific and in some patients correlate with disease activity, Anti-Sm 25 Protein complexed to 6 species of nuclear U1 RNA Specific for SLE; no definite clinical correlations; most patients also have anti Anti-RNP 40 Protein complexed to U1 RNA Not specific for SLE; high titers associated with syndromes that have overlap blacks than whites Anti-Ro (SS-A) 30 Protein complexed to hY RNA, primarily 60 kDa and 52 kDa Not specific for SLE; associated with sicca syndrome, predisposes to subacute cutaneous with decreased risk for nephritis Anti-La (SS-B) 10 47-kDa protein complexed to hY RNA Usually associated with anti-Ro; associated with decreased risk for nephritis Antihistone 70 Histones associated with DNA (in the nucleosome, chromatin) More frequent in drug-induced lupus than in SLE Antiphospholipid 50 Phospholipids, 2 glycoproteins 1 cofactor, prothrombin Three tests available ELISAs for cardiolipin and 2G1, sensitive prothrombin Antierythrocyte 60 Erythrocyte membrane Measured as direct Coombs' test; a small proportion develops overt hemolysis Antiplatelet 30 Surface and altered cytoplasmic antigens on platelets Associated with thrombocytopenia but sensitivity and specificity are not good; Antineuronal (includes anti-glutamate receptor) 60 Neuronal and lymphocyte surface antigens In some series a positive test in CSF correlates with active CNS lupus. Antiribosomal P 20 Protein in ribosomes In some series a positive test in serum correlates with depression or psychosis Also remember: Antibody Best screening test for Antibody ANA SLE Anti-Histone Drug-induced lupus Antinuclear antibodies SLE, nonspecific Anti-dsDNA; Anti-Sm Specific for SLE Anti-sm (Nelson's Paediatric Textbook) Marker of CNS lupus Anti-DNA Level of which correlates with disease activity Anti-Ro (SS-A) SACL, neonatal lupus Anti-Ro and Anti-La ie risk of nephritis (protective against nephritis) Antiphospholipid Hematological and Fetal Loss Antiribosomal protein Depression and Psychosis Anti-basement membrane Goodpasture syndrome Anticardiolipin, lupus anticoagulant SLE, antiphospholipid syndrome Anticentromere Limited scleroderma (CREST syndrome) Anti--Scl--70 (anti--DNA topoisomerase 1) Scleroderma (diffuse) Anti--SSA, anti--SSB (anti-Ro, anti--La) Sjogren syndrome Anti--Jo--1, anti--SRP, anti--Mi--2 Polymyositis, dermatomyositis Anti--TSH receptor Graves disease Anti--U1RNP (ribonucleoprotein) Mixed connective tissue disease c-ANCA (PR3-ANCA) Granulomatosis with polyangiitis (Wegener) IgA antiendomysial, IgA anti--tissue transglutaminase Celiac disease p-ANCA (MPO--ANCA) Microscopic polyangiitis, Churg--*JStrauss syndrome Anti--ACh receptor Myasthenia gravis Rheumatoid factor (antibody, most commonly IgM, specific to IgG Fc region), anti--CCP Rheumatoid arthritis Anti--glutamate decarboxylase Type 1 diabetes mellitus Anti--desmoglein Pemphigus vulgaris Anti--hemidesmosome Bullous pemphigoid Antimicrosomal, antithyroglobulin Hashimoto thyroiditis Antimitochondria! 1*< biliary cirrhosis Anti--smooth muscle Autoimmune hepatitis ALSO KNOW: LE cells Neutrophils with LE bodies seen in SLE, RA Penicillamine drug induced Hematoxilin bodies SLE endocarditis (Libmann-Sack) 'Wire-loop' lesions SLE type IV nephritis

Tonsillar fossa is bounded anteriorly by A. Pharyngobasilar fascia B. Palatopharyngeal fold C. Buccopharyngeal fascia D. Palatoglossal fold [<SEP>] The right answer is: D. Palatoglossal fold Explanation: Tonsilar fossa is bounded by Anterior - Palatoglossal fold containing palatoglossal muscle Posterior - Palatopharyngeal fold containing palato pharyngeal muscle Apex - Soft palate, where both arches meet Base - Dorsal surface of posterior one-third of tongue. (Ref: Anatomy of head, neck and brain. Vishram Singh. P 227 )

"Castration anxiety" is seen in which phase of Sigmond Freud's psychosexual stages of development A. Oral B. Anal C. Phallic D. Genital [<SEP>] The right answer is: C. Phallic Explanation: Phallic phase (3-5years): Male child develops Oedipus complex (sexual feeling towards mother) and will be afraid that father may castrate him for this termed as "Castration anxiety".

Shock causes: A. Stagnant hypoxia B. Anemic hypoxia C. Hypoxic hypoxia D. Histotoxic hypoxia [<SEP>] The right answer is: A. Stagnant hypoxia Explanation: Ans: A (Stagnant hypoxia)Ref: Pat GK, Hypoxia and Oxygen Therapy, In: Textbook of Medical Physiology, 2nd ed, Abuja Publishing House 2011: 94: 754-55Explanation:Refer the explanation of previous question

Calcium silicate based material is: A. MTA B. Geristore C. Dieket D. Retroplast [<SEP>] The right answer is: A. MTA Explanation: Mineral trioxide aggregate was developed by Dr Torabinejad in 1993.  It contains tricalcium silicate, dicalcium silicate, tricalcium aluminate, bismuth oxide, calcium sulfate and tetracalcium aluminoferrite. pH of MTA is 12.5. Textbook of Endodontics Nisha Garg 3rd Ed

Which of the following statements about Total Infra–Venous Anaesthesia (TIVA) is true – A. Causes More Renal Toxicity B. Reduces Cerebral Metabolic Rate C. Risk of Malignant Hyperthermia is high D. Inhibits Hypoxic Pulmonary Vasconstriction [<SEP>] The right answer is: B. Reduces Cerebral Metabolic Rate Explanation: Total intravenous anaesthesia refers to a technique in general anaesthesia using a compination of agents given solely by IV route and in the absence of all inhalation agents. TIVA (Total intravenous anaesthesia) is produced by IV propoful. Propofol decreases the cerebral metabolic rate. Propofol does not impair renal function, does not trigger malignant hyperthermia and does not inhibit hypoxic pulmonary vasoconstriction.

In Profound MR, IQ is A. 50-69 B. 35-49 C. 20-34 D. < 20 [<SEP>] The right answer is: D. < 20 Explanation: IQ range for categoriesICD-10DSM-IVMild50-6950-55 to 70Moderate35-4935-40 to 50-55Severe20-3420-25 to 35-40ProfoundBelow 20Below 20-25Reference: Oxford Textbook of Psychiatry; 3rd edition; Chapter 18; Learning Disability

Which of the following iodinated compound is present in a maximum concentration in the thyroid? A. Monoiodotyrosine (MIT) B. Diiodotyrosine (DIT) C. T3 D. Reverse T3 [<SEP>] The right answer is: B. Diiodotyrosine (DIT) Explanation: THYROID HORMONE SYNTHESIS AND SECRETIONThyroid hormones are synthesized in the colloid, near the apical cell membrane of the follicular cells. Catalyzed by the enzyme thyroidal peroxidase, iodide in the thyroid cell is oxidized to iodine.The iodine enters the colloid and is rapidly bound at the 3 position to tyrosine molecules attached to thyroglobulin, forming monoiodotyrosine (MIT).MIT is next iodinated at the 5 position, forming diiodotyrosine (DIT).Two DIT molecules then condense in an oxidative process ("coupling reaction") to form one thyroxine (T4) molecule.Some T3 is probably formed within the thyroid gland by condensation of MIT with DIT. A small amount of reverse T3 (rT3) is also formed.In the normal thyroid, the average distribution of iodinated compounds is 23% MIT, 33% DIT, 35% T4, 7% T3, and 2% reverse T3.

Silicosis caused by ? A. Gold B. Coal C. CO D. Silica [<SEP>] The right answer is: D. Silica Explanation: Ans. is 'd' i.e., Silica

Human development index includes - A. Crude death rate B. Life expectancy at one year C. Life expectancy at bih D. All [<SEP>] The right answer is: C. Life expectancy at bih Explanation: Ans. is 'c' i.e., Life expectancy at bih According to 22nd/e of Park, options 'd & e' are not the components of HDI. o Expected years of schooling (not adult literacy rate) and GNI per capita (not GDP) are the components of HDI.

H. capsulatum, a dimorphic fungus, is found in soil heavily contaminated with bird droppings. Which of the following statements best describes the presence of the organism in tissue biopsies? A. Yeasts with broad-based bud B. Single-cell yeasts with pseudohyphae C. Arthrospores D. Oval budding yeasts inside macrophages [<SEP>] The right answer is: D. Oval budding yeasts inside macrophages Explanation: Histoplasma capsulatum is a dimorphic fungus that forms two types of spores: tuberculate macroconidia and microconidia. Inhalation of the microconidia transmits infection. Inhaled spores (microconidia) are engulfed by macrophages and develop into yeast forms. Most infections remain asymptomatic; small granulomatous foci heal by calcification. However, pneumonia can occur. The heterophile antibody test is useful for early diagnosis of infectious mononucleosis. The figure below illustrates the oval budding yeasts.

Budding reproduction in tissue is seen in A. Cryptococcus, candida B. Candida, rhizopus C. Rhizopus, mucor D. Histoplasma, candida [<SEP>] The right answer is: A. Cryptococcus, candida Explanation: Cryptococcus is a yeast, candida is a yeast-like fungus. Both are reproduced by budding Histoplasma is a dimorphic fungus Mucor and Rhizopus are produced by asexual means sporangiospores Reference: Textbook of Microbiology; Baveja; 4th edition

True about polio: A. Paralytic polio is most common B. Spastic paralysis seen C. IM injections and increased muscular activity lead to increased paralysis D. Polio drops in pulse polio immunisation given only in <3 years old children [<SEP>] The right answer is: C. IM injections and increased muscular activity lead to increased paralysis Explanation: False 90-95% of polio infections are asymptomatic False Acute flaccid paralysis is seen in Polio & not spastic paralysis True Risk of paralytic polio is increased by tonsillectomy, strenous physical exercise, tooth extraction,Injection (intramuscular) False OPV drops are given to all children less than 5 yr age in pulse polio immunisation

The retention of dowel in a pin retained crown is increased by A. Increased length, smooth surface and increased taper. B. Increased length, serrated surface and increased taper. C. Increased length, smooth surface and parallel sides. D. Increased length, serrated surface and parallel sides. [<SEP>] The right answer is: D. Increased length, serrated surface and parallel sides. Explanation: Post should be at least 2/3 the root length, parallel sided and serrated for increased retention in the canal

Which of the following drugs can be administered by subcutaneous route? A. Albuterol B. Metaproterenol C. Terbutaline D. Pirbuterol [<SEP>] The right answer is: C. Terbutaline Explanation: terbutaline can be given as s.c (0.25mg) in asthma.

Mycosis fungoides which is not true: A. It is the most common form of cutaneous lymphoma. B. Pautriers microabscess. C. Indolent course and easily amenable to treatment. D. Erythroderma seen and spreads to peripheral. [<SEP>] The right answer is: C. Indolent course and easily amenable to treatment. Explanation: Mycosis Fungoides: Mycosis fungoides is synonymous with Cutaneous T cell lymphoma.

Bacterial pyogenic parotitis affecting the parotid gland is most common after: March 2008 A. Uveo-parotid fever B. Mumps C. Debilitation after major surgery D. After administration of iodine [<SEP>] The right answer is: C. Debilitation after major surgery Explanation: Ans. C: Debilitation after major surgery Acute bacterial parotitis is now infrequent, but its historical impoance. Mumps and bacterial parotitis were differentiated by 1800, but neither was effectively treated. The moality rate for bacterial parotitis was 80%. Before antibiotics and intravenous administration of fluids were available, bacterial parotitis occurred in postoperative patients or other severely ill patients who became dehydrated and contributed to their demise as an incurable sepsis.

Patient diagnosed as squamous cell intraepithelial lesion which of the following has the highest risk for progression to carcinoma; A. Low grade squamous intraepithelial neoplasia B. High grade squamous intraepithelial neoplasia C. Squamous intraepithelial associated with HPV 16 D. Squamous intraepithelial neoplasia associated with HIV [<SEP>] The right answer is: B. High grade squamous intraepithelial neoplasia Explanation: High grade squamous intraepithelial lesion have a propensity to progress and become invasive, therefore need investigations and treatment Ref: Shaw Gynecology 17 e pg 410.

Autosomal recessive polycystic kidney disease features include: A. Can be diagnosed intrauterine B. Proceeds to renal failure till children reaches school going age C. Can be palpated abdominally D. Hypertension doesn't develop until late stages of the disease [<SEP>] The right answer is: A. Can be diagnosed intrauterine Explanation: Ans. A. Can be diagnosed intrauterineExplanationClinical features of ARPKD (Autosomal recessive polycystic kidney disease) are:Classic ARPKD is generally diagnosed in utero or within the neonatal period and characterized by greatly enlarged echogenic kidneys in diseased fetuses. (Option a)Reduced fetal urine production may contribute to oligohydramnios and pulmonary hypoplasia.About 30% of affected neonates die shortly after birth due to respiratory insufficiency. Close to 60% of mortality occurs within the first month of life.In the classic group, most patients are bom with renal insufficiency and ESRD (End stage renal disease). (Option b)However, infants often have a transient improvement in their GFR; death from renal insufficiency at this stage is rare.Some patients are diagnosed after the neonatal stage and form the older group. Morbidity and mortality in this group often involve systemic hypertension, progressive renal insufficiency, and liver manifestations.The hallmarks of ARPKD liver disease are biliary dysgenesis due to a primary ductal plate malformation with associated periportal fibrosis, namely congenital hepatic fibrosis (CHF) and dilatation of intrahepatic bile ducts (Caroli's disease). CHF and Caroli's disease can then lead to portal hypertension exhibiting hepatosplenomegaly, variceal bleeding, and cholangitis.Some patients with the diagnosis of ARPKD at 1 year of age with nephromegaly exhibit slowly declining renal function over 20 years with only minimally enlarged kidneys at ESRD (Option c and e) and markedly atrophic kidneys following renal transplantation.The slow progression of renal disease is likely due to increasing fibrosis rather than the development of cysts.Systemic hypertension is common in all ARPKD patients, even those with normal renal function. (option d)

You are the medical officer in charge of the immunisation programme at a sub-centre and you are informed by the local ASHA worker that one of the children who was immunised has has been dizzy. On fuher investigation it was confirmed that the symptoms were due to anxiety of pain of the injection and not as a result of the vaccine. You would consider the incidence as: A. Vaccine reaction B. Injection reaction C. Programme error D. Coincidental [<SEP>] The right answer is: B. Injection reaction Explanation: The following are the adverse effect following immunisation: Vaccine reaction - Here the event is caused by the inherent propeies of the vaccine when given correctly. Programme error - In this case the event is as a result of error in preparation, handling or administration of the vaccine. Coincidental - The event after immunisation is not caused by the vaccine but by a chance association. Injection reaction - The anxiety of the pain an injection itself may cause hyperventilation, dizziness etc. This is not a result of the vaccine and is called injection reaction. Ref: Park, 21st Edition, Page 103, 107.

Bicipital aponeurosis lies over which structure in cubital fossa:- A. Median cubital vein B. Radial nerve C. Brachial aery D. Anterior interosseous aery [<SEP>] The right answer is: C. Brachial aery Explanation: Bicipital aponeurosis lies superficial to the brachial aery and median nerve. -lies deep to superficial veins. -provides protection for the deeper structures during venepuncture at cubital fossa. -routinely released to decompress the median nerve

Postponing paying attention of conscious impulse or conflict is a mature defence mechanism known as - A. Sublimation B. Suppression C. Humor D. Anticipation [<SEP>] The right answer is: B. Suppression Explanation: Suppression is pushing of unwanted feelings into unconscious which has reached conscious awareness.

The commonest site of perforation during colonoscopy is - A. Caecum B. Hepatic flexure C. Splenic flexure D. Sigmoid colon [<SEP>] The right answer is: D. Sigmoid colon Explanation: • Risks of colonoscopy: Perforation and hemorrhage • MC site of bleeding after colonoscopy: Stalk after polypectomy. • MC site of perforation during colonoscopy: Sigmoid colon • Perforation can be caused by excessive air pressure, tearing of the antimesenteric border of the colon from excessive pressure on colonic loops, and at the sites of electrosurgical applications