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Mother of a 10 year old male child is concerned that he appears smaller than other boys of his age. Intraoral examination reveals that the patient is in his mixed dentition stage. Permanent incisors and 1st molars are found to be present. Mandibular permanent canines are erupting and maxillary deciduous molars are present. Physical growth status of a child may vary from the chronologic age in many children, but it correlates well with skeletal age. Which is the best radiographic analysis to ascertain the skeletal age of this patient?

FISH MAN'S SKELETAL MATURITY INDICATORS Keonord S Fishman proposed a system for evaluation for skeletal maturation in 1982, Fishman made use of four anatomical sites located on the thumb, third finger, fifth finger and radius.  Note: Witt’s and Steiner’s analysis are cephalometric analysis and not a method to analyze skeletal age.  Demirjian’s system is a method of analysing dental age and not skeletal age.

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Which of the following investigation is not necessary for investigating optic neuritis?

USG B scan is not useful for evaluating optic neuritis. MRI head and orbit is needed for evaluation of optic neuritis to rule out MS. ESR- |sed in infectious causes of optic neuritis. Visual fields are used for follow up and extent of vision loss. OCT (Optical coherence tomography)- used to see amount of optic nerve edema.

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Risk of congenital heart disease in first degree relative is

Ans. b (2 to 6%). (Ref. Nelson, Textbook of Paediatrics, 18th/pg. 1878)Congenital heart disease occurs in# 0.5 to 0.8% of live births.# 3 to 4 % of stillboms.# 10 to 25% of abortuses.# 2% of premature infants (except PDA)# 0.8% of normal population.# 2-6% after birth of a child with CHD or if parent affected.# 20-30% when 2 first-degree relatives have congenital heart disease.NOTE: Most congenital defects are well tolerated in the fetus because of the parallel nature of the fetal circulation. Even the most severe cardiac defects (hypoplastic left heart syndrome) can usually be well compensated for by the fetal circulation. It is only after birth when the fetal pathways (ductus arteriosus and foramen ovale) are closed that the full hemodynamic impact of an anatomic abnormality becomes apparent. One notable exception is the case of severe regurgitant lesions, most commonly of the tricuspid valve. In these lesions (Ebstein anomaly), the parallel fetal circulation cannot compensate for the volume load imposed on the right side of the heart. In utero heart failure, often with fetal pleural and pericardial effusions, and generalized ascites (nonimmune hydrops fetalis) may occur.

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Cerebral malaria most commonly attends infection with which of the following

Cerebral malaria involves the clinical manifestations of Plasmodium falciparum malaria that induce changes in mental status and coma and is accompanied by fever. Without treatment, cerebral malaria is fatal in 24-72 hours and the moality ratio is between 25 to 50 percent. The common histopathologic finding is the sequestration of parasitized and nonparasitized red blood cells in cerebral capillaries and venules. Ref:- Baveja

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Fever occurs due to -

Ans. is 'a' i.e., IL1 Pyrogeneso Pyrogenes are substances that cause fever.o Pyrogens may be exogenous or endogenous* Exogenous- Bacterial toxins* Endogenous- IL0-l,TNF-a, IL-6, Interferons, Cilioiy's neurotropic factoro These pyrogenes increase the level of PGE2 in the hypothalamus that elevates the thermoregulatory set point and causes fever.

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The extraction of upper first molars may be indicated:

Key concept: Any teeth which is having poor prognosis is indicated for extraction.

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Rhinosporidiosis is caused by which of the following?

Rhinosporidiosis is caused by Rhinosporidium seeberi. This organism was previously considered to be a fungus. It is now identified to be an aquatic protistan protozoa parasite belonging to the class Mesomycetzoea. ( Ref Scott Brown, 8th edition, VOL 1, Pg no. 208 )

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Calcinosis universalis occurs in –

Calcinosis universalis is the diffue deposition of calcium salts in the skin, subcutaneous tissue and sometimes in connective tissue. It occurs in Juvenile Dermatomyositis.

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Fetal stage starts at:

Fetal Growth Periods

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Which of the following belongs to antifibrinolytic drugs

Antifibrinolytic drugs promote blood clotting by preventing blood clots from breaking down. Some examples of antifibrinolytic drugs are aprotinin, tranexamic acid (TXA), epsilon-aminocaproic acid and aminomethylbenzoic acid. Doctors sometimes give these drugs to patients having surgery to prevent blood loss. Ref: KD Tripathi 8th ed.

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Longest acting L.A. – a) Bupivacaineb) Tetracainec) Xylocained) Procaine

Dibucaine is the longest acting LA (duration is 2.5-3.5 hours). Amongst the given options tetracaine & bupivacaine are longest acting (both have duration of 2-3 hours). Decreasing order of duration :- Dibucaine (longest acting) > Bupivacaine = Tetracaine = Ropivacaine = Etidocaine > Prilocaine = Lignocaine = Mepivacaine = Cocaine > Procaine > chlorprocaine.

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Which of the following drugs should be given in sustained release oral dosage form?

Sustained release preparation are used for prolonged duration of action of drug . So, used when drug has sho half life and when we require the action of drug for longer duration. Anti-hypeensive drug are used for lifelong. So, sustained release preparations are required. Anti-arrhythmic drugs used in treatment of PSVT are not to be used as sustained release preparation as we need action for only a sho duration. Anti-inflammatory drug with the half life of 24 hrs is already acting for long duration we don't need sustained release preparation. Hypnotic drug with a half life of 2hrs will work for 5-6 hrs. So, no need of sustained release preparation.

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Avascular necrosis may be seen in all of the following, except

Common Site of Avascular necrosisCauseHead and femurFracture neck femur (Subcapital)Posterior dislocation of hipProximal pole of scaphoidFracture through waist of scaphoidBody of talusFracture neck of talusProximal pole of lunateLunate dislocation*Other sites of common AVN are Distal medial condyle, Humeral head, Capitellum, and Metatarsal heads*In the early stages, bone scintigraphy and MRI are the diagnostic modalities of choice.*Non ohopedic causes of AVN - Sclera, Caisson's disease, Lupus erythematosus, Radiation and Alcohol (Refer: Apley's system of Ohopedics and Fracture, 8th edition, pg no: 91-103, 436-439)

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Which antiepileptic drug is least secreted in breast milk -

Ans. is 'b' i.e., Clonazepam DrugBreast milk to plasma concentrationCarbamazepine0-69Clonazepam033Ethosuximide0-94Gabapentin0-7-1-3Lamotrigine0-057-1-47Phenobarbitone0-4-0-6Phenytoin018-0-45Primidone0-72Topiramate0-86-1-1Valproate0-42Zonisamide0-93

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Therapeutic drug monitoring is done for all of the following drugs Except

TDM is not done for most commonly used drugs or safe drugs like paracetamol, diclofenac done for antiepileptic drugs, immunosuppressants, anticancer drugs, lithium Phenytoin- antiepileptic, cyclosporin, tacrolimus- immunosuppressants in the options not done for antihypeensives and BP can be measured clinically and easily REF KD Tripathi 8th ed

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The following methods can be used to detect the point mutation in the beta globin gene that causes sickle cell anemia, EXCEPT:

Point mutation involves the replacement of a single base nucleotide with another nucleotide of the gene. Point mutations in the beta globin gene can be identified by analysing the DNA. Nohern blot is a technique used in studying the RNA and hence the answer of exclusion. Ref: Introduction to Biotechnology By Thieman William, 2nd Edition, Pages 71, 78, 81, 82

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Cranial irradiation is also indicated in the treatment of which variety of lung cancer?

Small cell lung cancers or oat cell carcinomas, exhibits aggressive behavior, with rapid growth, early spread to distant sites, exquisite sensitivity to chemotherapy and radiation, and frequent association with distinct paraneoplastic syndromes. Surgery usually plays no role in its management. Widespread metastases occur early in the course of the disease, with common spread to the mediastinal lymph nodes, liver, bones, adrenal glands, and brain. Management of limited-stage small cell lung cancer involves combination chemotherapy, usually with a platinum-containing regimen, and thoracic radiation therapy. If the patient achieves a complete remission, he or she would be offered prophylactic cranial irradiation.

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The disease most likely to result In presents of emotional contact is

The poal of entry of measles virus is through the respiratory tract or conjunctivae following contact with large droplets or small-droplet aerosols in which the virus is suspended. Reference: Nelson textbook of pediatrics 19th edition.Page 1070

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All of the following are signs of chronic liver failure, Except:

Answer is D (Subcutaneous nodules): Subcutaneous nodules are generally not seen as stigmata of chronic liver disease. Chronic Liver Disease manifests with loss of subcutaneous fatty tissue resulting in paper thin skin with marked folds (paper-money skin).

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Immediate management of a child with foreign body inhalation is -

Ans. is 'b' i.e., Bronchoscopy Treatment of aspirated foreign body A) Treatment of foreign body in upper respiratory tract. o If obstruction is complete --> Immediate intervention. o If obstruction is paial --> Patients should allow to use their own cough reflex to extrude the foreign body --> If it fails than intervention should be done. o Method of removal of foreign body : - 1)If child is younger than 1 year --> Child should be placed face down over the rescuir's arm with head positioned below trunk. Five measured back blows are delivered rapidly between the scapula. If obstruction persists, the infant should be rolled over and five rapid chest compressions should be performed. This sequence is repeated until the obstruction is relieved. 2) If child is elder than 1 year ---> Abdominal thursts (Heimlich maneuver) should be performed. B) Treatment of foreign body in lower respiratory tract. o The treatment of choice is prompt endoscopic (bronchoscopic) removal of foreign body.

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Slipped capital femoral epiphysis is seen most commonly in which age group -

Slipped capital femoral epiphysis (SCFE) occurs during adolescent rapid growth period when epiphysis plate is weak & the capital epiphysis is displaced down & back. * Etiology : age - 10-17years of age Sex- male : female - 5:2 Location: left hip is involved in 58% of the cases *stages 1. Preslipping stage 2.chronic slipping stage 3.stage of fixed deformity *Radiographic changes - *early change : marginal blurring of the proximal metaphysis , lower margin of metaphysis is included within the acetabulum normally but excluded in the early epiphyseal slip, Trethovan &;s line : line drawn along the superior margin of the neck , transects the epiphysis normally , but will be above it in slip, depth of epiphysis is reduced , there is a step between metaphysis & epiphysis. *Late changes : trethovan&;s sign is present , head is atrophic , neck shaft angle is less than 90 degree , new bone formation is seen at the anterior superior pa of neck , joint space is clear , shenton&;s line is broken. * CT scan is very useful in assessing degree of slips. Classification of slipping - mild(51%), moderate(22%), severe slipping (17%) REF:Essential ohopedics, John Ebenezer, 4th edition, pg.no.416

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All are true about vitamin E except ?

Ans. is 'c' i.e., Water soluble vitamin Vitamin E is a fat soluble vitamin (not water soluble). All other options are correct.

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Contents of the suboccipital triangle are formed by all of the following structures, EXCEPT:

The contents of the suboccipital triangle are veebral aery, suboccipital nerve and greater occipital nerve.The suboccipital triangle is the area in the suboccipital region between the rectus capitis posterior major and the obliquus capitis superior and inferior muscles. It is covered by a layer of dense fibro-fatty tissue, deep to the semispinalis capitis muscle. Its floor is formed by the posterior occipitoatlantal membrane and the posterior arch of the C1 veebrae. The suboccipital muscles are:Obliquus capitis superior muscleObliquus capitis inferior muscleRectus capitis posterior major muscleRectus capitis posterior minor muscleRef: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 1. Back.

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Common Facial vein is formed by the union of

The scalp on each side of the midline is drained by five veins. The veins of the scalp accompany the arteries and have similar names. These are as follows: Supratrochlear and supraorbital veins: They join each other at the medial angle of the eye to form the angular vein, which continues downwards as the facial vein behind the facial artery. Superficial temporal vein: It descends in front of tragus to enter the parotid gland where it joins the maxillary vein to form the retromandibular vein, which terminates by dividing into anterior and posterior divisions. The anterior division unites with the facial vein to form common facial vein, which drains into the internal jugular vein. Posterior auricular vein: It descends behind the auricle and  unites with the posterior division of the retromandibular vein to form the external jugular vein, which drains into the subclavian vein. Occipital vein: It terminates in the suboccipital venous plexus.

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Branches of brachial aery are all EXCEPT:-

Radial collateral aery is anterior descending branch of the profunda brachii aery, not a direct branch of brachial aery.

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During which phase of the cell cycle the cellular content of DNA is doubled -

There are two resting phases and two active phases in the cycle. Resting phases → G1 & G2 Active phases S-phase (synthetic phase) - As the name suggests, synthesis of new DNA takes place, i.e. doubling of DNA occurs. M-phase (mitotic phase) - Mitosis takes place and the daughter cells receive one copy of DNA. In this phase, cell number is doubled.

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Pancreatic pseudocyst most commonly occurs after ?

Ans. is 'b' i.e. Pancreatitis Most common cause of pancreatic pseudocyst is Pancreatitis (90%) The second most common cause is trauma (10%). Pseudocysts are seen in both acute and chronic pancreatitis.

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Disability adjusted life year (DALY) is a measure of ?

Ans. is 'b' i.e., Effectiveness of treatment Disability - adjusted life year (DALY) DALY is a measure of :- The burden of disease in a defined population The effectiveness of interventions It expresses years lost to premature death and years lived with disability adjusted for the severity of the disability. That means, DALY measures both moality and disability together (in contrast to sullivan's index which is related to disability only). One DALY is one lost year of healthy life. DALY combines following : - Years of lost life (YLL). Years lost to disability (YLD) DALY = YLL + YLD Japanese life expectancy statistics are used as a standard for measuring premature death, as Japanese have the longest life expectancy. Health - adjusted life expectancy (HALE) HALE is the indicator used to measure healthy life expectancy. HALE is based on the life expectancy at bih but includes an adjustment for time spent in poor health. It is the equivalent number of years in full health that a newborn can expect to live based on current rates of ill health and moality.

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A drug X is secreted through renal tubules, tubular secretion of this drug can be confirmed if renal clearance of drug X is:

* After filtration from glomerulus, a drug may undergo two processes (tubular reabsorption and tubular secretion) before going out from the body i.e. renal clearance *Suppose 100 mg of a drug is filtered by glomerulus and the renal clearance is 150 mg, it means 50 mg is coming from somewhere else, i.e. tubular secretion must be present. However, we cannot say that reabsorption is not occuring because if 20 mg is reabsorbed and 70 mg is secreted, same thing can happen. * Suppose, 100 mg of a drug is filtered but renal clearance is 50 mg. Therefore, 50 mg must have gone somewhere i.e. tubular reabsorption must be occurring. Again, we cannot say that tubular secretion is not present.

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A 28-year-old woman presented with high-grade fever, cough, diarrhea and mental confusion for 4 days. X-ray chest revealed bilateral pneumonitis. Search for etiology will most likely reveal?

The clinical profile of fever, cough and X-ray revealing bilateral pneumonitis and presence of diarrhea and confusion indicates the presence of Atypical pneumonia. The organism causing atypical pneumonia out of the given choices is Legionella pneumophila Confusion can be explained by hyponatremia due to SIADH. The clinical manifestations of Legionnaires' disease are usually more severe than those of most "atypical" pneumonias. Clinical Clues Suggestive of Legionnaires' Disease Diarrhea High fever (>40degC; >104degF) Numerous neutrophils but no organisms revealed by Gram's staining of respiratory secretions Hyponatremia (serum sodium level <131 mg/dL) Failure to respond to b-lactam drugs (penicillins or cephalosporins) and aminoglycoside antibiotics Occurrence of illness in an area where potable water supply is known to be contaminated with Legionella Onset of symptoms within 10 days after discharge from the hospital (hospital-acquired legionellosis manifesting after discharge or transfer)

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Not true about microtubules is/are:

D i.e. GTP not required

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Which of the following statements is FALSE regarding vincristine

Vincristine is a vinca alkaloid. It is used for the induction of remission in ALL. It is a marrow sparing drug but causes peripheral neuropathy, alopecia and SIADH as adverse effects.

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Which of the following not a prion associated disease -

scrapie,CJD&Kuru are prion disease REF:ANATHANARAYANAN MICROBIOLOGY NINTH EDITION PAGE.557

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Systemic inflammatory response syndrome, false is

Answer- A. HypoglycemiaIt is an inflammatory state affecting the whole bodn frequently a response of the immune system to infection, but not necessarily so.When two or more of these criteria are met with or without evidence of infection -Body temperature less than 36 c greater than 38 CHea rate greater than 90 beats per minuteTachypneaWhite blood cell count less than 4000 cells/mm3HyperglycemiaAltered mental state

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Neuraminidase inhibitor ?

Ans. is 'a' i.e., Oseltamivir Oseltamivir acts by inhibiting influenza virus neuraminidase enzyme which is needed for release of progeny virions from the infected cell.

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The recent treatment of sho bridle passable stricture of urethra in the penile and bulbous urethra is

Endoscopic (internal) urethrotomy Internal urethrotomy is performed using the optical urethrotome. The stricture is cut under visual control using a knife passed through the sheath of a rigid urethroscope. The stricture is usually cut at the 12 o'clock position, taking care not to cut too deeply into the vascular spaces of the corpus spongiosum that surrounds the urethra. It is possible to get lost when trying to cut a way through a very tight stricture, and this is especially true when there are false passages because of previous dilatation attempts. Accordingly, a guidewire should be passed through to the bladder prior to incision of the stricture in order to establish the true lumen of the urethra. Following urethrotomy a catheter should be left in situ for 1-3 days afterwards. A single urethrotomy seems to give a permanent cure of an uncomplicated stricture in about 50% of patients. Success rates are highest when the stricture is sho and when it is present within the bulbar urethra. In contrast, failure rates are highest in long strictures, strictures within the penile urethra and in recurrent strictures. The main complications are infection and bleeding. Ref: Bailey and love 27th edition Pgno : 1484

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CD8 antigen is present on

CD4 antigen is present on t helper cells Cd8 antigen on T suppressor cells CD8 cells recognize MHC class I antigens Ref: Textbook of Microbiology Baveja 5th ed Pg 135

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Hemolytic disease of newborn is least common with which blood group female -

Ans. is 'c' i.e., OABO incompatibility has a protective effect to the development of Rh sensitization and thus the development of hemolytic disease of newborn

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Primary spermatocytes, chromoso me is -

Ans. is 'c' i.e., 46-XY Secondary spermatocyte (Haploid -23)-Spermatid(Haploid-23)Spermatogonia - Primary spermatocyteDiploid-46)(Diploid-46)Secondary spermatocyte (Haploid-23)-Spermatid(Haploid-23)

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Chlamydia Trachomatis, false is

Ans. is 'a' i.e. Elementary body is metabolically active Chlamydiae is a gram negative bacteria that are obligate intracellular parasitesThey require the host's ATP as an energy source for their own metabolism. They have a cell membrane transport system that takes on ATP from the host cell and then return backs an ADP. This is called ATP/ADP translocator. Chlamydia life cycleThe chlamydia life cycle is complex as the bacteria exists in two forms (biphasic)Elementary bodyIt is a metabolically inert (does not divide), dense, round, small (300 nm) infectious particle.The outer membrane has extensive disulfide bond cross-linkages that confer stability for extracellular existence.It is an infectious particle that spreads from host to host.Initial body (also called reticulate body)Once inside a host cell the elementary body inhibits phagosome lysosome fusion and grows in size to 1000 nm.Its RNA content increases and binary fission occurs forming the initial body, (initial body)Although the initial body synthesizes its own DNA, RNA and proteins, it requires ATP from the host.Also know * Chlamydia trachomatis has affinity for columnar cells.

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All of the following statements are true, except

Optic C is true for libman - sacks endocarditis seen in SLE. Refer the byte "Vegetations in Endocarditis".

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Migraine prophylaxis includes:

Trick: Very Volatile Pharma Agent For Migraine Prophylaxis V  →  Verapamil V  →  Valproate P  →  Pizotifen A  →  Amitryptiline F  →  Flunarizine M  →  Methylsergide P  →  Propranolol

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Ritgen maneuver is done in

Ritgen manuever is done for delivery of head in normal labor to allow controlled delivery of head. When the head distends the vulva and perineum enough to open the vaginal introitus to a diameter of 5cn of more , a towel is drapled ,gloved hand may be used to exe forward pressure on the chin of fetus through the perineum just in front of coccyx. Concurrently the other hand exes pressure superiorly against occiput. This ours nect extension so that the head is delivered with its smallest diameter passing through the introitus and over perineum

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One year old male child presented with poor urinary stream since bih. The investigation of choice for evaluation is -

Ans. is 'a' i.e., Voiding cystourethrography o Poor urinary stream since bih suggests urinary tract obstruction (usually infravesical). o Most common cause of urinary tract obstruction in a male child is posterior urethral valve. o And the best diagnostic method for posterior urethral valve is voiding cystourethrogram.

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A 6 year old mentally retarded male child patient presents with hepatosplenomegaly, coarse facial features, corneal clouding, large tongue, prominent forehead, joint stiffness, short stature and skeletal dysplasia. What is the enzyme deficient in this patient?

Mucopolysaccharidosis-I H (Hurler’s Disease): Biochemical defect: Homozygous or double heterozygous nonsense mutation of IDUA gene on Chromosome 4p encoding α-L-Iduronidase. Clinical features of MPS I H (Hurler’s Disease): Progressive disorder with multiple organ and tissue involvement that results in premature death, usually by 10 years of age. An infant with Hurler’s syndrome appears normal at birth, but inguinal hernias are often present. Diagnosis is usually made between 6 and 24 month of age. Hepatosplenomegaly, coarse facial features, corneal clouding, large tongue, prominent forehead, joint stiffness, short stature and skeletal dysplasia are seen. Acute cardiomyopathy has been found in some infants < 1 year of age. Most patients have recurrent upper respiratory tract and ear infections, noisy breathing and persistent copious nasal discharge. Valvular heart disease with incompetence, notably of the mitral and aortic valves, regularly develops, as dose coronary artery narrowing. Obstructive airway disease, notably during sleep, may necessitate trachotomy. Obstructive airway disease, respiratory infection and cardiac complications are the common causes of death.  Key Concept: Hurler's disease is due to α-L- Iduronidase enzyme deficiency due to homozygous or double heterozygous nonsense mutation of IDUA gene on Chromosome 4p encoding α-L-Iduronidase. Reference- Harper’s illustrated biochemistry. 30th edition page no: 179

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Muscle which is not there in a modiolus:

Modiolus is a point where eight muscles meet at the ANGLE OF MOUTH 1. Depressor anguli oris (or) triangularis 2. Levator anguli oris or caninus 3. Risorius 4. Orbicularis oris 5. Buccinator 6. Zygomaticus major 7. Quadratus labii superioris 8. Quadratus labii inferioris

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SAFE strategy for Trachoma includes all of the following except:

A i.e. Screening

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Dissection of which aery is seen in pregnancy -

Answer is 'b' i.e. Aoa

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All of the follow ing are diaphyseal tumors except-

Ans. is 'd' i.e., Aneurysmal bone cyst Sites of tumorsEpiphyseal tumorsMetaphyseal legionsDianhvseai lesionso Chondroblastomao Giant cell tumor (osteoclastoma)o Clear cell chondrosarcomao Osteogenic sarcomao Unicameral (simple) bone cysto Aneuiysmal bone cysto Fibrous cortical defecto Chondrosarcomao Osteochondromao Enchondromao Osteoblastomao Ewring sarcomao Lymphomaso Fibrous dysplasiao Adamantinomao Histiocytosiso Osteoid osteomao Chondromyxoid fibromao Fibrosarcomao Fibrous cortical defecto Non ossifying fibroma

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Which of the following acts as an antagonist to NMDA receptor?

Ketamine is a general anesthetic agent which acts by blocking excitatory NMDA type of glutamate receptors.

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Which does not contribute to Enterobillary Fistula ?

Ans. is 'c' i.e. Gastric ulcer

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Atomoxetine is used for ?

Ans. is 'b' i.e., ADHD Atomoxetine it is selective norepinephrine reuptake inhibitor and is approved for use in ADHD. It is indicated in children > 6 years and in adults with concentration and attention problems. Atomoxetine absorbed orally, hydroxylated by CYP2D6 and excreted in urine, mainly as glucuronide. While majority of individuals are extensive metabolizers (EM), few are poor metabolizers (PM) due to polymorphism of CYP2D6. Inhibitors of CYP2D6 like fluoxetine, paroxetine, quinidine increase concentration and toxicity of atomoxetine. It should not be given with MAO inhibitors and is contraindicated in glaucoma.

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Which drug can be administered through all routes?

Ref: Katzung 11th ed. p. 542Explanation:Most opioid analgesics are well absorbed when given by subcutaneous, intramuscular, and oral routes.Rectal suppositories of morphine and hydromorphone have been used when oral and parenteral routes are undesirable.The transderma I patch provides stable blood levels of drug and better pain control while avoiding the need for repeated parenteral injections.Fentanyl has been the most successful opioid in transdermal application and is indicated for the management of persistent unremitting pain.The intranasal route avoids repeated parenteral drug injections and the first-pass metabolism of orally administered drugs.Butorphanol is the only opioid currently available in the USA in a nasal formulation. Butorphanol has shown greater analgesia in women.Another alternative to parenteral administration is the buccal transmucosal route, which uses a fentanyl citrate lozenge or a "lollipop'' mounted on a stick.

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Charcot's/neuropathic joint are most commonly seen in

.

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Most variable absorption is seen with which route?

Ans. is 'a' i.e., Oral Oral administration of drugs is safe, convenient and economical, but has the potential for the most variable absorption pattern. Clinical pharmacology Routes of drug administration Drugs are administered by various routes. Different routes have different characteristics, so that the route of administration may have a profound effect upon the speed and efficiency with which the drugs act. The routes of drug administration may be: i) Local route ii) Systemic route Local route - Drug is administered at the site of lesion. Systemic route - Drug is administered through systemic routes is intended to be absorbed into the blood stream and distributed all over, including the site of action, through circulation.

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Pain during injection occurs with all Except

Ketamine is the only intravenous inducing agent that does not cause pain on injectionAgentPain on iv injectionThiopentoneMethohexitonePropofolEtomidateKetamine+/0++++++0

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Which variety of AML is associated with good prognosis -

Ans. is 'b' i.e., M3 Prognostic factors in AMLGood PrognosisBad Prognosiso Age < 40 yearso Age < 2 years or > 55 yearso M2, M3, M4 forms of AMLo M0, M6, M7 FORMS OF AMLo Blast cell with Auer rodso Complex karyotypeso TLC <25x109/Lo TLC> 100 x 109/Lo t (15;17), t (8;21), inv 16o Deletions 5q, 7q (Monosomy 5 or 7)o Leukemia without preceeding MDSo AML with preceding MDS or anticancer drug exposure

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Muscle not having dual nerve supply

Anterior belly of digastric is supplied by the trigeminal nerve and posterior belly by facial nerve Spinal accesory nerve and c3,c4 nerves supply Trapezius Ischial pa of sciatic nerve and the obturator nerve supply adductor magnus Ref: Gray's 39e/p112-127

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Clinical features of T.B. Spine are AJE -

There is weight loss (not gain). The presenting complains are : - Back pain : Commonest and earliest symptom. Initially, pain occurs on the sudden movement of the spine. The stiffness of back : Is also an early symptom and occur along with pain. Visible deformity: Gibbus or Kyphosis Localized swelling : Due to cold abscess   Paraplagia : In neglected cases Constitutional symptoms : Evening fever, loss of appetite, night sweat, loss of weight. On examination, following findings may be seen : - Decreased range of motion. Local tenderness : Over the spinous process of an affected vertebra. Deformity : - Cervical spine : - Straight neck with loss of cervical lordosis. Thoracic : - Gibbus/kyphosis Lumbar : - Loss of lumbar lordosis        iv) Para-vertebral swelling : - Cold abscess

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Inheritance pattern of ABO blood group system and HLA system

"The genes that determine the A and B phenotypes are found on chromosome 9p and are expressed in a Mendelian codominant manner."

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Paroxymal sneezing on getting up early in morning from bed is associated with ?

Vasomotor Rhinitis It is a non allergic rhinitis clinically simulating nasal allergy. Symptoms Paroxysmal sneezing : Bouts of sneezing sta just after getting out of the bed in the morning. Excessive rhinorrhoea : This accompanies sneezing and may be the only predominant symptom. It is profuse and watery and may even wet several handkerchiefs. The nose may drip when the patient leans forward, and this may need to be differentiated from CSF rhinorrhoea. Nasal obstruction : This alternates from side to side. Usually more marked at night. It is the dependent side of nose which is often blocked when lying on one side. Postnasal drip.

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A young male patient presented with UTI. On urine examination pus cells were found but no organisms. Which method would be best for culture?

Sterile pyuria -caused by Chlamydia , ureaplasma and mycoplasma. McCoy culture is used for Chlamydia. Thayer Main - Neisseria gonorrhea. L J medium - Mycobacterium tuberculosis Levinthal medium - Hemophilus

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In the life cycle of malaria parasite, the definitive host is -

Life history of plasmodium The malaria parasite undergoes 2 cycles of development the human cycle (asexual cycle) and the mosquito cycle (sexual cycle). Man is the intermediate host and mosquito the definitive host Ref: Park 25th edition Pgno : 281-285

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What is this study?

Retrograde ureterogram demonstrating the collecting system. The radiolucent filling defect in the renal pelvis is caused by radiolucent calculus

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Maximum number of oogonia is seen at

Maximal number of oogonia is achieved at 20th week of gestation.

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All of the following are functions of the spleen EXCEPT ?

Functions of spleen:- 1. Phagocytic function -- when any foreign body invades, macrophages ingest them by phagocytosis & liberate the antigenic products of the organism -- antigens activate the helper T lymphocytes & B lymphocytes 2. Secretion of bactericidal agents -- secrete many bactericidal agents which kill the bacteria I. Superoxide (02-) II. Hydrogen peroxide (H202) III. Hydroxyl ions (OH -) 3. Secretion of interleukins -- IL-1: accelerate maturation & proliferation of specific B lymphocytes & T lymphocytes -- IL-6: cause growth of B lymphocytes -- IL-12: influence the T-helper cells Through the reticuloendothelial system the spleen clears encapsulated bacteria such as pneumococcus and Haemophilus influenzae which are poorly opsonized from the hepatic reticuloendothelial system. In addition to these functions the spleen serves as an extramedullary site for hematopoiesis and plays a functional role in the recycling of iron. While the white pulp of the spleen is impoant in the initiation of the adaptive immune response, material is delivered to the spleen through the blood and not the lymph.

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Sandifer syndrome due to GERD in infants is confused with __________

Infants with GERD presents with anorexia, dysphagia, arching of back during feedings, irritability, hematemesis, anaemia, failure to thrive.other symptoms are chest pain, recurrent pneumonia apnoea, wheezing, stridor, hoarseness, cough, abnormal neck posturing(Sandifer syndrome) Sandifer syndrome is most commonly mistaken for seizures Ref : ESSENTIAL PEDIATRICS,O.P.GHAI, PG NO:253, 7th edition

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Inferior orbital fissure is between which 2 walls of orbit:

Inferior orbital fissure is formed between the greater wing of the sphenoid (lateral wall) and maxilla (Floor)runs posterolaterally It transmits the zygomatic branch of the maxillary nerve and the ascending branches from the pterygopalatine ganglion The infraorbital vessels are found in the inferior orbital fissure and travel down the infraorbital groove into the infraorbital canal and exit through the infraorbital foramen Inferior division of ophthalmic vein passes through the inferior orbital fissure. No. 6 is Inferior Orbital fissure No. 3 is Superior Orbital fissure

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In a family, mother is normal while father has a genetic disease. All their daughters are carriers and sons are normal, what is the pattern of inheritance of disease?

a. X-linked recessive(Ref: Nelson's 20/e p 595, Ghai 8/e p 640)In a X-linked recessive disease; affected male transmits the disorder to all his daughters (carriers)Sons get their X chromosome from their mother & not from their fatherHence sons of a diseased father are unaffected in X-linked diseasesIn an X-linked dominant disorder all the daughters of an affected father would be diseased and not carriers.

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The blood gas parameters: pH 7.58, pCo2 23 mm Hg pO2 300 mm Hg and oxygen saturation 60% are most consistent with-

Answer is B (Ventilatory malfunction) Ventilatory malfunction is the single best answer of exclusion This is consistent with a diagnosis of ventilatory mal function. None of the other three condition satisfy the given parameters of the patients. The answer of exclusion therefore is some form of ventilatory malfunction. In carbon monoxide poisoning ABG analysis would reveal acidosis and nollnal PO2 In voluntary hyperventilation oxygen saturation would be normal. In methyl alcohol poisoning ABG would reveal acidosis and not alkalosis.

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Cause of alpha thalasemia -

Ans. is 'a' i.e., Deletion of alpha genes a thalassemiasAlpha thalassemias are hemoglobin disorders in which the a chain of the hemoglobin is not/partly synthesized. a chains are required for all types of hemoglobin synthesis of all types of hemoglobin i.e.HbA (a2 b2)HbF (a2 g2)* HbA2 (a2d2)

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Which of the following is/are feature of streptococcus agalactiae rather than staphylococcus aureus?

C. Coagulase negativeb hemolysis and bacitracin resistance occur in bothStaphylococcus AureusCoagulase Positive: Ananthanarayan Whf2l0Beta type of hemolyisis on blood agar-Microbiology by Baveja 5th/175"Streptococci- coagulase negative" Ananthanarayan lQ7h/218 "Lancefield group B consists of a single species, S. agalactiae, which is definitively identified with specific antiserum to the group B cell wall-associated carbohydrate antigen. A streptococcal isolate can be classified presumptively as GBS on the basis of biochemical tests, including hydrolysis of sodium hippurate (in which 99% of isolates are positive), hydrolysis of bile esculin (in which 99-100% are negative), bacitracin susceptibility (in which 92% are resistant), and production of CAMP factor (in which 98-100% are positive). CAMP factor is a phospholipase produced by GBS that causes synergistic hemolysis with p lysin produced by certain strains ofS. aureus'-Harrison 19th/969Staphylococci produce catalase, which converts hydrogen peroxide into water and oxygen. The catalase test differentiates the staphylococci, which are positive, from the streptococci, which are negative- Jawetz 27th/205Ananthanarayan 10th/210Species or common nameLancefield groupHemolysisLaboratory testS. pyogenesABetaBacitracin-sensitive, PYR test-positive; Ribose not fermntedS. agalactiaeBBetaCAMP test, Hippurate hydrolysisBacitracin Test microbeonline.com Positive: Streptococcus pyogenes Negative: Streptococcus agalactiaeThe bacitracin test is useful for differentiating b-hemolytic Group A streptococci from b-hemolytic non-Group A streptococci. This is important because most streptococcal diseases are caused by Group A streptococci. The bacitracin test can also be used to differentiate the bacitracin-resistant Staphylococcus from the bacitracin-susceptible Micrococcuswww.austincc.edu

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A neonate diagnosed of having pentalogy of Fallot. She may have the following lesions:

Patients with tetralogy of Fallot have a VSD, RV infundibular stenosis, RVH, and a dilated aoa (in about 50% of patients it overrides the septum). If there is an associated ASD, the complex is referred to as pentalogy of Fallot. Ref: Bashore T.M., Granger C.B., Hranitzky P., Patel M.R. (2013). Chapter 10. Hea Disease. In M.A. Papadakis, S.J. McPhee, M.W. Rabow (Eds), CURRENT Medical Diagnosis & Treatment 2013.

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Methadone is used to treat withdrawal symptoms of: PGI 12; NEET 13

Ans. Heroin

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Carbamoyl phosphate synthase I is used in ?

Ans. is 'c' i.e., Urea cycleCarbamyl phosphate synthase I Urea cycleCarbamyl phosphate synthase II- Pyrimidine synthesis

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Features of Mitral stenosis on X-ray are all EXCEPT:

Lower lobe prominence of veins REF: Sutton's radiology 7th edition page 294 Features of mitral stenosis on X ray: Straightening of hea border (earliest sign ) Lifting of left bronchus Posterior displacement of esophagus Double atrial shadow Alveolar edema Kerly B lines Pulmonary hemosiderosis Cephalisation of upper lobe vessels Moustache sign: Enlargement of main pulmonary aery and periferal pruning

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Medical etiquette is related to

Medical etiquette:- It deals with the conventional laws of couesy observed between members of the medical profession. A doctor should behave with his colleagues as he would have them behave with himself. Medical jurisprudence (juris= law; prudentia = knowledge):- It deals with legal responsibilities of the physician with paicular reference to those arising from physician-patient relationship, such as medical negligence cases, consent, rights and duties of doctors, serious professional misconduct, medical ethics, etc. In sho, it deals with legal aspects of practice of medicine. Ref:- k s narayan reddy; pg num:-01

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Because free ammonia in the blood is toxic to the body, it is transported in which of the following non-toxic forms?

Ans. C. Glutamine and ureaBoth urea and glutamine play an important role in the storage and transport of ammonia in the blood. Histidine, phenylalanine, methionine, and lysine are not involved in ammonia transport.

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Which one of the following structures is pa of the diencephalon?

Diencephalon consist of:- Thalamus Hypothalamus Meta-thalamus-include medial and lateral geniculate body Epi-thalamus-include Pineal body, Habenular trigone and post. commisure Sub-thalamus

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One of the most common complication of iridocyclitis is:

Ans. Secondary glaucoma

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About retinitis pigmentosa, all are true EXCEPT: September 2012

Ans. B i.e. Central scotoma Retinitis pigmentosa Feature: Loss of visual acuity Microscopy: Irregular black deposits of clumped pigment in the peripheral retina (Bone spicules)

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Most common carcinoma after burns is:

Squamous cell carcinoma is MC carcinoma in burns. SCC commonly occurs in long standing ( Marjolin's ulcer) , old scar or keloid. Both Marjolin's ulcer & keloid are complications that arise after burns

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Which of the following cells do not act as antigen presenting cells. ?-

Answer is option 1 T cell responses differ from B cell responses in at least two crucial ways. First, T cells are activated by foreign antigen to proliferate and differentiate into effector cells only when the antigen is displayed on the surface of antigen-presenting cells in peripheral lymphoid organs. The T cells respond in this manner because the form of antigen they recognize is different from that recognized by B cells. Whereas B cells recognize intact antigen, T cells recognize fragments of protein antigens that have been paly degraded inside the antigen-presenting cell. The peptide fragments are then carried to the surface of the presenting cell on special molecules called MHC proteins, which present the fragments to T cells. T cells don't act as antigen presenting cells.

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Commonest cause of obstructive hydrocephalus in children

Aqueducts stenosis is most common cause of obstructive hydrocephalus in children. Reference: GHAI Essential pediatrics, 8th edition

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Characteristic feature of acute inflammation is:

. Vasodilatation and increased vascular permeability

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According to FIGO classification the investigation in Carcinoma cervix are all except -

Ans-C

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Most specific marker for neural tube defects is

Both alpha-fetoprotein and acetylcholinesterase in amniotic fluid are markers for neural tube defects. But acetylcholinesterase is the most specific marker. Ref : Dutta book of obstetrics 8th Ed

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The most dreadful complication of Kawasaki disease is

Kawasaki disease is an acute, febrile, usually self-limited illness of infancy and childhood (80% of the patients are younger than 4 years of age) associated with an aeritis of mainly large to medium-sized vessels. Its clinical significance stems from the involvement of coronary aeries. Coronary aeritis can cause aneurysms that rupture or thrombose, resulting in myocardial infarction. (Robbins basic pathology,9th edition,pg no.352)

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Anaplasia is:

Ans. c. Lack of differentiationRef: Robbins and Cotran Pathologic Basis of Disease 9th Ed; Page No-269Cellular ChangesHyperplasia: Increase in number of cells. May be a risk factor for future malignancy (e.g. to endometrial hyperplasia) but not considered premalignant.Hypertrophy: Increase in size of cells.Atrophy: Decrease in tissue mass due to increase in size and/or number of cells. Causes include disuse, denervation, loss of blood supply, loss of hormonal stimulation, poor nutrition.Dysplasia: Disordered, non-neoplastic cell growth. Term used only with epithelial cells. Mild dysplasia is usually reversible; severe dysplasia usually progresses to carcinoma in situ.Metaplasia: Replacement of one cell type by another. Usually due to exposure to an irritant, such as gastric acid or cigarette smoke. Reversible if the irritant is removed but may undergo malignant transformation with persistent insult (e.g. Barrett esophagus - esophageal adenocarcinoma).Neoplasia: Uncontrolled, clonal proliferation of cells. Can be benign or malignant.Anaplasia: Complete lack of differentiation of cells in a malignant neoplasm.Differentiation The degree to which a malignant tumor resembles its tissue of origin:Well-differentiated tumors (often less aggressive) closely resemble their tissue of origin.Poorly differentiated tumors (often more aggressive) look almost nothing like their tissue of origin.

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Which of the following is not an indication ofcotrimoxazole aEUR'

Chancroid Corimoxazole in Typhoid Initially cotrimoxazole was an effective alternative to chloramphenicol. However, in many areas resistant S. typhi have appeared and now it is seldom used. Cotrimoxazole in chancroid Corimoxazole for 7 days is a 3rd choice inexpensive alternative to ceftriaxone, erythromycin or iprofloxacin. Cotrimoxazole It is a combination of sulfonamide (sulfamethoxazole) and trime- thoprim in the ratio of 1 :5. Cotrimoxazole was claimed to be more effective than either of its components individually in treating bacterial infections. Because of its associated greater incidence of adverse effects including allergic responses its widespread use has been restricted in many countries to very specific circumstances where its improved efficacy is demonstracted. Uses of Cotrimoxazole Upper and lower respiratory tract infections - Exacerbations of chronic bronchitis - For otitis media and sinusitis. - It should never be used for streptococcal pharyngitis. Urinary tract infections -Uncomplicated cystitis in non pregnant women. Especially valuable for chronic and recurrent cases. - Prostatitis (cotrimoxazole is concentrated in goodamounts in prostate) Pneumocystic carinii pneumonia -Drug of choice next to pentamidine for the treatment and prophylaxis of pneumonias caused by Pneumocystic Jirovecci (commonly seen in imtnunocompromised patients including those suffering from HIV/AIDS). Other conditions where cotrimoxazole finds its use. -Listeria monocytogens infections - Meliodosis - Shigellosis - Traveller's diarrhoeas (E. coli, Campylobacter, Shigella, Y. enterocolitica) - Prophylaxis of cerebral toxoplasmosis - Whipple's disease - Salmonella (typhoid) initially it was responsive but now resistant strains have emerged. - Chancroid According to K.D.T. - Cotrimoxaxole can be used in both chancroid and typhoid. According to Harrison (18/e) Cotrimoxazole is used in Typhoid but it is not used in chancroid. Antiobiotic therapy in typhoid Empirical Ceftriaxone Azithromycin Fully susceptible Ciprofloxacin Amoxicillin Chloramphenicol Cotritnoxazole Multidrug resistant Ciprofloxacin Ceftriaxonl Azithromycin Nalidixic acid resistant Ceftriaxone Azithromycin High dose ciprofloxacin Treatment of chancroid Ciprofloxacin Ceftriaxone Azithromycin

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Relationship between nerve thickness and conduction velocity of myelinated nerves is:

Fiber diameter (thickness) and conduction velocity relationship:  The relationship is linear  for  myelinated  axons  and  parabolic relation for non­myelinated axons.

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A six-year old boy is schedules for examination of the eye under anaesthesia. The father informed that for the past six months the child is developing progressive weakness of both legs. His elder sibling had died at the age of 14 years. Which drug would you definitely avoid during the anaeshetic management?

A i.e. Succinylcholine Boy is having some myopathy (probably duchenne's). So Sch may lead to life threatening hyperkalemia.

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'hn RNA' is associated with which of the following heamatological condition?

hn RNA is seen in case of splicing defect. It is also seen in spiral muscular atropy.

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Virchow's cells are seen in –

Foam cells containing lepra bacilli are called virchow's cells (lepra cells). These cells are abundant in lepromatous leprosy.

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Following statements are true with respect to glycogen except

Insulin inhibits glycogenolysis by oring the inactivation of glycogen phosphorylase and inhibiting glucose-6-phosphatase. The net effect of all these three mechanisms, blood glucose level is lowered.Ref: DM Vasudevan, 7th edition, page no: 321

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Causes of status epilepticus in a child-

Ans. is 'b' i.e., Hyponatremia Causes of status epilepticus in children o Idiopathic o Drug intoxication o Congenital/Developmental neurological abnormalities o Hypoglycemia o Meningitis, Encephalitis o Hyponatremia o Head trauma o Pyridoxin deficiency

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A female with genital herpes simplex is being treated in the outpatient depament. The doctor teaches her about measures that may prevent herpes recurrences and emphasizes the need for prompt treatment if complications arise. Genital herpes simplex increases the risk of:

A female with genital herpes simplex is at increased risk for cervical cancer. Genital herpes simplex isn't a risk factor for cancer of the ovaries, uterus, or vagina. HPV is the primary neoplastic-initiating event in the vast majority of women with invasive cervical cancer. HPV- 16 and -18 are the types most frequently associated with high-grade dysplasia.

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All are chest X-Ray features suggestive of VSD in a child, EXCEPT:

Chest X-Ray are typically normal in small VSD. In case of large VSD the findings are: 1. Cardiomegaly 2. Pulmonary plethora 3. Increased splaying of the carina with an anlge more than 90 with left main bronchi. 4. Small aoic knob 5. Increased left atrium Ref: Essentials of Pediatric Radiology, Page - 44

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The drug imatinib acts by inhibtion of:

Ans. is 'a' i.e. Tyrosine kinase Chronic myeloid leukemia is characterized by BCR-ABL translocationThe BCR-ABL translocation in chronic myeloid leukemia encodes a tyrosine kinase which is essential for cell proliferation and survivalImatinib (511-571) is a new molecularly targeted drug, which inhibits the tyrosine kinase activity, producing hematological and cytological remission in majority of patients.The treatment of CML has changed with the introduction of imatinib mesylate.The drug is a specifically designed inhibitor of the tyrosine kinase activity of the bcr/abl oncogene.It is well tolerated and results in nearly universal, 98% hematologic control of chronic phase disease.It has now replaced both interferon and hydroxyurea as standard therapy.The addition of either alpha interferon or low dose chemotherapy with cytarabine holds promise for even better results.Adverse effects of imatinibNauseaPeriorbital swellingRashMyalgia

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Pleomorphic adenoma is usually arise from

(Parotid gland) (546-HM) (584-Basic pathology 8th)Pleomorphic adenoma (Mixed salivary tumour) is the commonest tumour in the parotid gland and occurs less often in other major and minor salivary gland, common in females.

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