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A patient with psoriasis was staed on systemic steroids. After stopping the treatment, the patient developed generalized pustules all over the body.The cause is most likely to be - A. Bacterial infection B. Erythrodermic Psoriasis C. Drug induced reaction D. Pustular psoriasis [<SEP>] The right answer is: D. Pustular psoriasis Explanation: Patient of psoriasis on withdrawal of systemic steroids leads to: 1)Pustular Psoriasis: - Multiple sterile pustules develop on whole body(including palms & soles) k/a sterile as there is no infection, only infiltration present. -If generalised k/a Von Zumbusch disease. - Other provocating factors include Infection, Pregnancy and Hypocalcaemia associated with hypoparathyroidism. 2) Erythrodermic psoriasis >90% body surface area shows redness/inflamed or/- scaling Systemic steroids are contraindicated in psoriasis as, on withdrawal it causes pustular psoriasis except inpregnancy where they are drug of choice

Cholesteatoma is seen in: A. ASOM B. CSOM C. Secretory Otitis media D. Otosclerosis [<SEP>] The right answer is: B. CSOM Explanation: (b) CSOM(Ref. Cummings, 6th ed., 2141)Cholesteatoma formation is characteristic of unsafe CSOM.The other mentioned options are not associated with cholesteatoma.

Which of the following indicates anticipated difficult bag mask ventilation A. Age >30 yrs B. BMI >20 C. Beard D. None of the above [<SEP>] The right answer is: C. Beard Explanation: Predicting difficulty in mask ventilation Mask ventilation is the most basic, and arguably most impoant, skill in airway management. Patients who have been identified as having DMV, or who are predicted to be difficult, are, or potentially are, at the highest risk in airway management. It is this facet of management that should influence our decision-making the most, potentially with consideration given to awake techniques. DMV can also be suggestive of difficulty in subsequent laryngoscopy. DMV occurs in up to 5% of patients, and there are several factors that are known to be predictive of this. An early study highlighted five independent factors Mnemonic OBESE to be used. Fuher study of DMV added modified Mallampati class of 3 or 4, limited jaw protrusion, and the male sex. Neck irradiation is the most significant predictor of impossible mask ventilation, defined as an inability to achieve gas exchange despite the use of adjuncts, multiple providers, and neuromuscular block, as it causes development of fibrotic non-compliant tissue affecting the airway. BMI itself is not a very useful predictor, although it can be a marker for potential oxygenation issues (due to reduced FRC) and increased aspiration risk. In predicting DA, the actual distribution of body fat should be considered, with fat deposition in the parapharyngeal tissues increasing airway collapsibility, predisposing to OSA. This is seen more in android pattern obesity with distribution of adipose tissue around the trunk, upper body, and neck. The increased fat deposits in neck tissue can fuher narrow the airway. OSA, snoring without apnoea, and increasing neck circumference, above 40 cm, are associated with DMV. The probability of DMV increases with increasing neck circumference. Age >55 BMI > 26 (obesity) Beard Lack of teeth(edentulous) History of snoring (OSA) Neck circumference (>17 inches in men and > 16cm in women) Thyromental distance Large tongue facial and neck deformity Cervical spine disease or previous cervical spine surgery

Enzyme replacement therapy is used for- A. Gaucher's disease B. Krabbe's disease C. Metachromatic leukodystrophy D. Tay Sach's disease [<SEP>] The right answer is: A. Gaucher's disease Explanation: Ans. is 'a' i.e., Gaucher's disease * Alglucerase (ceredase) is used in the treatment of Gaucher's disease.* Enzyme replacement therapy (ERT) is also available for Fabry's disease, Type I, Type II and Type VI Mucoploysaccharidosis, Pompe's disease and ADA deficiency

Organism that causes emphysematous cholecystitis is: A. Salmonella typhi B. Cytomegalovirus C. Clostridium perfringens D. Bacteroides [<SEP>] The right answer is: C. Clostridium perfringens Explanation: Ref: Harrison's 18th editionExplanation:Emphysematous CholecystitisIt is thought to begin with acute cholecystitis (calculous or acalculous) followed by ischemia or gangrene of the gallbladder wall and infection by gas-producing organisms.Bacteria most frequently cultured in this setting includeAnaerobes, such as C. welchii or C. perfringensAerobes, such as E. coli.This condition occurs most frequently in elderly men and in patients with diabetes mellitus.The clinical manifestations are essentially indistinguishable from those of nongaseous cholecystitis.The diagnosis is usually made on plain abdominal film by finding gas within the gallbladder lumen, dissecting within the gallbladder w all to form a gaseous ring, or in the pericholecvstic tissues.The morbidity and mortality rates with emphysematous cholecystitis are considerable.Prompt surgical intervention coupled with appropriate antibiotics is mandatory.

Most common site for extra mammary Paget&;s disease is A. Vulva B. Vagina C. Penis D. Anus [<SEP>] The right answer is: A. Vulva Explanation: .It is superficial manifestation of an intraductal carcinoma. The malignancy spreads within the duct up to the skin of the nipple and down into the substance of the breast. It mimics eczema of nipple and areola.most commonly extra mammary manifestations of paget&;s disease is seen in the vulva. * Paget's disease of penis (Erythroplasia of Querat is persistent rawness of glans penis). ref:SRB&;s manual of surgery,ed 3,pg no 1009,473

Inferior Rib notching is seen in all except? A. Coarctation of aoa B. Classical blalock tausing operation C. SVC obstruction D. Neurofibromatosis [<SEP>] The right answer is: D. Neurofibromatosis Explanation: Answer is D (Neurofibromatosis) Neurofibromatosis is associated with superior rib notching Inferior rib notching is characteristically seen in coarctation of Aoa and may also be seen in Superior vena cava obstruction and a Blalock-Taussig shunt operation Rib-Signs in Coarctation of aoa: Inferior rib notching is characteristic, and is believed to be due to pressure erosion by intercostal aeries. Inferior rib notching takes several years to develop and is rarely seen before the age of 8 years.e '3' signemay be seen due to enlargement of left subclan aery above the coarctation Usually spares fist two ribse where intercostal aeries arise from costocervical trunk which is proximal to the usual site of CA. Mostly commonly affected ribs are the 4th to 8th ribs. Usually bilateral but asymmetrical.

Which is false regarding cryptococcus neoformans? A. Grows at 5degC and 37degC B. It has 4 serotypes C. Urease negative D. Causes superficial skin infection [<SEP>] The right answer is: C. Urease negative Explanation: Ans. is 'c' i e., Urease negative Cryptococcus neoformans is distinguished from other non-pathogenic crvptococci by ? - Ability to grow at 37degC Lack of fermentative ability - Ability to hydrolyze urease (urease positive) - Formation of brown pigment on niger seed agar - Ability to assimilate inositol Ability to produce phenole oxidase.

Histopathological finding of gluten hypersensitivity is? A. Crypt hyperplasia B. Increase in thickness of the mucosa C. Distal intestine involvement D. Villous hypertrophy [<SEP>] The right answer is: A. Crypt hyperplasia Explanation: Ans. is 'a' i.e., Crypt hyperplasia Histopathological findings of gluten sensitivity enteropathy* Villous atrophy and Crypt hyperplasia with decrease in villus: crypt ratio.* Loss of microvilli brush border.* Inflammatory cells are present in lamina propria : plasma cells, macrophages, lymphocytes, eosinophils and mast cells.* One of the characteristic feature is that overall mucosal thickness remains same (as villous atrophy is compensated by crypt hyperplasia).* Mainly proximal intestine is involved.