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First class judicial magistrate can give punishment upto

Ans. is 'b' i.e., 3 years Powers of Magistrate's (Sec. 29 CrPC)ClassImprisonmentFineChief judicial magistrateUpto 7 yearsAny amount1st class magistrateUpto 3 years5000 Rs.2nd class magistrateUpto 1 years1000 Rs.

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Which statement is false about allosteric regulation?

Allosteric regulation is usually the mode of regulation for the first step in reaction pathways. Allosteric modulators can be activators or inhibitors.They bind non-covalently at allosteric/regulatory site. By binding at allosteric site, they induce changes in the active site, where substrate binds and they modulate the binding of substrate. Binding of dissociable ligands (allosteric regulation) achieve regulation of enzymic activity within seconds

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Most common part of spine affected by Rheumatoid arthritis is?

Ans. (c) Cervical spineRef.'.MR Imaging of the Spine and Spinal Cord by DetlevUhlenbrock p-375, Orthopedic surgery essentials- Spine by Christopher M. Bono, Steven R. Garfin p-188

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In treatment of osteosarcoma, all of the following are used EXCEPT:

Methotrexate (Mtx): It is one of the oldest and highly efficacious antineoplastic drugs; inhibits dihydrofolate reductase (DHFRase)-blocking the conversion of dihydrofolic acid (DHFA) to tetrahydrofolic acid (THFA) which is an essential coenzyme required for one carbon transfer reactions in de novo purine synthesis and amino acid interconversions. The inhibition is pseudoirreversible because Mtx has 50,000 times higher affinity for the enzyme than the normal substrate. Methotrexate is apparently curative in choriocarcinoma: 15-30 mg/ day for 5 days orally or 2G-40 mg/m2 BSA i.m. or i.v. twice weekly. It is highly effective in maintaining remission in children with acute leukaemias, but not good for inducing remission: 2.5-15 mg/day. It is also useful in other malignancies, rheumatoid ahritis, psoriasis and as immunosuppressant.The use of folinic acid rescue has permitted much higher doses of Mtx and has enlarged its scope to many difficult-to-treat neoplasms. USES: 1)NEOPLASMS 2)MENINGEAL LEUKEMIA 3)OSTEOSARCOMA 4)RHEUMATOID AHRITIS 5)PSORIASIS 6)BREAST CANCER 7)HEAD AND NECK CANCER 8)MYCOSIS FUNGOIDES Cyclophosphamide: It is inactive as such: produces few acute effects and is not locally damaging. Transformation into active metabolites (aldophosphamide, phosphoramidemustard) occurs in the liver, and a wide range of anti tumour actions is exeed. It has prominent immunosuppressant propey. Thus, it is one of the most popular anticancer drugs. It is less damaging to platelets, but alopecia and cystitis (due to another metabolite acrolein) are prominent. Chloramphenicol retards the metabolism of cyclophosphamide. USES: 1)MALIGNANT DISEASES 2)NEPHROTIC SYNDROME 3)JUVENILE IDIOPATHIC AHRITIS 4)LUPUS NEPHRITIS 5)BREAST CANCER 6)NON HODGKIN LYMPHOMA 7)SYSTEMIC SCLEROSIS Vincristine ( oncovin) :It is a rapidly acting drug, very useful for inducing remission in childhood acute leukaemia, but is not good for maintenance therapy. Other indications are lymphosarcoma, Hodgkin&;s disease, Wilms&; tumour, Ewing&;s sarcoma and carcinoma lung. Prominent adverse effects are peripheral neuropathy and alopecia. Bone marrow depression is minimal. USES: Acute Leukemia 1.4 mg/m2 IV qWeek Combination Therapy Cancers Hodgkin&;s Disease, Non Hodgkin&;s Malignant Lymphomas, Rhabdomyosarcoma, Neuroblastoma, and Wilm&;s Tumor Consult dose modifications in multi-drug regimens Uveal Melanoma (Orphan) Indicated for metastatic uveal melanoma Orphan indication sponsor Hana Biosciences, Inc; 7000 Shoreline Cou; Suite 370; South San Francisco, CA 94080 Renal Impairment Dose adjustment not necessary Hepatic Impairment Decrease dose 50% if direct bilirubin >3 mg/dL Monitor: CBC Other Indications & Uses ALL, AML, CML, Hodgkin&;s disease, NHL, neuroblastoma, sarcomas, small cell lung cancer, Wilms&; tumor, brain tumors Off-label: breast cancer, idiopathic thrombocytopenic purpura, Kaposi&;s sarcoma, bladder cancer Daunorubicin (Rubidomycin), Doxorubicin These are antitumour antibiotics with quite similar chemical structures. However, utility of daunorubicin is limited to acute leukaemia (in which it is highly active) while doxorubicin, in addition, is effective in many solid tumours. Effective in Cancers such as: Cancer of breast, ovary, prostate, stomach, thyroid; small cell cancer of lung, liver; squamous cell cancer of head and neck; multiple myeloma, Hodgkin&;s disease, lymphomas, ALL, AML 60-75 mg/m2 IV q21Days 60 mg/m2 IV q14Days O 40-60 mg/m2 IV q21-28Days OR 20 mg/m2/dose qweek Hepatocellular Carcinoma (Orphan) Orphan indication sponsor Delcath Systems, Inc; Rockefeller Center, 23rd Floor; New York, NY 10020 Renal Impairment Dose adjustment not necessary Hepatic Impairment Serum bilirubin <1.2 mg/dL: Dose adjustment not necessary Serum bilirubin 1.2-3 mg/dL : Give 50% dose Serum bilirubin: 3.1-5 mg/dL : Give 25% dose Severe hepatic impairment: Contraindicated Administration Limit lifetime cumulative dose to <550 mg/m2 to reduce risk of cardiotox Monitor: CBC, cardiac function, LFTs REFERENCE:ESSENTIALS OF MEDICAL PHARMACOLOGY(K.D.TRIPATHI,SIXTH EDITION, PAGE NO:822,823,825.826) reference.medscape.com

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Lowering of the following parameter indicates acute malnutrition:

Low weight for height: This is also known as nutritional wasting or emaciation which is an indicator of acute malnutrition. It is associated with an increased risk of moality and morbidity. A child who is less than 70% of the expected weight-for-height is classed as severely wasted. Ref: Park's Textbook of Preventive and Social Medicine, p019th edition, Page 434.

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Visible range of electromagnetic spectrum of human eye

Electromagnetic radiation of wavelengths approx. 400nm to 700nm, elicits a retinal response in human eye.

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A 20-year-old man presents with dysuria, urgency, and urethral discharge. Physical examination shows suppurative urethritis, with redness and swelling at the urethral meatus. Which of the following is the most likely etiology of urethritis in this patient?

Urethritis is the most common manifestation of sexually transmitted diseases in men, in whom it typically presents with urethral discharge. Both gonococcal and nongonococcal urethritis have an acute onset and are related to recent sexual intercourse. The infection manifests with urethral discharge, typically purulent and greenish yellow. Symptoms include pain or tingling at the meatus of the urethra and pain on micturition (dysuria). Redness and swelling of the urethral meatus are usually seen in both sexes. In gonococcal urethritis, the urethral discharge contains N. gonorrhoeae, which can be identified microscopically in smears of the urethral exudates. The other choices do not present with urethral suppurative discharge.Diagnosis: Gonorrhea, urethritis

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Cholesterol present in LDL

On accumulation in the cell inhibits replenishment of LDL receptors If LDL cholesterol is increased inside the cell, it down regulates LDL receptors so that further uptake is inhibited. HDL cholesterol is the cholesterol that is removed from peripheral tissues; LDL cholesterol represents the cholesterol which is to be delivered to peripheral tissues. LDL binds to LDL receptors and whole LDL particle is endocytosed by receptor mediated endocytosis via clathrin-coated pits (not by diffusion:- diffusion and endocytosis are different processes). Intracellular cholesterol activates intracellular enzyme acyl-CoA cholesterol acyl transferase (ACAT).

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Which of the following drug does not act on neuromuscular junction?

Ans. (B) Dantrolene(Ref: Katzung 13th/e p467-468)Dantrolene is a directly acting muscle relaxant. It does not act at neuromuscular junction Neuromuscular blockersDepolarisingNon-depolarisingSChTubocurarineAtracuriumCis-atracuriumMivacuriumPancuroniumVecuroniumPipecuronium

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Pernicious anemia associated with -

Ans. is 'a' i.e., Gastric Pathology Anemias of Vitamin B12 Deficiency: Pernicious Anemiao Pernicious anemia is a specific form of megaloblastic anemia caused bv an autoimmune gastritis that impairs the production of intrinsic factor, which is required for vitamin B12 uptake from the g ut.o Histologically, there is a chronic atrophic gastriti smarked by loss of parietal cells, prominent infiltrate of lymphocytes and plasma cells, and megaloblastic changes in mucosal cells.

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Feature of shock lung is?

Lungs due to dual blood supply are generally not affected by hypovolaemic shock but in septic shock, the morphologic changes in lungs are quite prominent termed as 'shock lung'.Grossly, the lungs are heavy and wet. Microscopically, changes in ARDS are seen. The changes include congestion, interstitial & alveolar edema, interstitial lymphocytic infiltrate, alveolar hyaline membranes, thickening and fibrosis of alveolar septa, and fibrin and platelet thrombi in the pulmonary microvasculature.,i.e.,diffuse alveolar damage. Reference: Textbook of pathology-Harsh Mohan,6th edition,page no:113 and Harrison

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Preferred imaging modality for choanal atresia is-

Ans. is 'b' i.e., CT SCAN CT SCAN in choanal atresiao CT SCAN in coronal and saggital projections provides a thorough evaluation of choanal atresia and adjescent structures.o The axial views supply fundamental information including site of obstruction, composition of atretic plate and unilateral or bilateral involvement,o Thus CT SCAN is the preferred imaging modality.

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Which has lowest incubation period

Ans. (b) InfluenzaRef: K. Park 23rd ed. /153DISEASECAUSATIVE ORGANISMINCUBATION PERIODMUMPSRNA Myxo Virus14 to 21 daysINFLUENZAOrthomyxo Virus18 to 72 hoursMEASLES (RUBEOLA)RNA Para myxo Virus10 to 14 daysCHICKEN POXHuman Herpes Virus 314 to 16 days

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Dimorphic fungus:

Ans. b. Histoplasma

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Irreversible injury is due to

Irreversible Injury: Defect in membrane function in general, and plasma membrane in particular, is the most important event in irreversible cell injury in ischaemia. Oxygen deprivation causes shift of calcium from mitochondria and endoplasmic reticulum into the cytosol. Increased level of calcium in the cytosol activates endogenous phospholipases from ischaemic tissue which degrade membrane phospholipids progressively which are the main constituent of the lipid bilayer membrane. An alternate hypothesis is decreased replacement-synthesis of membrane phospholipids due to reduced ATP. Myelin figures & cellular swelling are the changes seen in Reversible cell injury.

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Diffusion hypoxia is seen with which drug:

Ans. A. Nitrous oxideDiffusion hypoxia is side effect seen with nitrous oxide. It is seen when suddenly N2 O is stopped while recovering from anaesthesia. It can be prevented by supplying 100 percent O2 to the patient.

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Best management of open fracture is:

Ans: A (Debridement) Ref: Campbell's Operative Orthopaedics, 11th editionExplanation:Management of Open FracturesThree components of open fracture management are:o Aggressive wound debridement.o Definitive fracture stabilization with internal or external fixation; and o Delayed wound closure.Of these wound debridement is the first and most important step to avoid infection.Tscherne Classification of Open Fracture Management into Four Eras:The era of life preservation / preantiseptic era: Until 20th century.The era of limb preservation: During World War I and World Warll.The era of infection avoidance: Until the mid-1960s when antibiotic came into use.The era of functional preservation: At present; management consists of aggressive wound debridement, definitive fracture stabilization with internal or external fixation, and delayed wound closure.Gustilo, Burgess, Tscherne and AO-ASIF group recommendations for open fractures:1.Treat open fractures as emergencies.2.Perform a thorough initial evaluation to diagnose life-threatening and limb-threatening injuries.3.Begin appropriate antibiotic therapy in emergency department and continue treatment for 2 to 3 days only.4.Immediately debride the wound of contaminated and devitalized tissue, copiously irrigate, and repeat debridement within 24 to 72 hours.5.Stabilize the fracture with the method determined at initial evaluation.6.Leave the wound open (Controversial).7.Perform early autogenous cancellous bone grafting.8.Rehabilitate the involved extremity aggressively.Modified Gustilo-Anderson Classification for Open FracturesType I open fractures: Clean wound less than 1 cm long.Type II open fractures: Laceration more than 1 cm long, no extensive soft-tissue damage, skin flaps or avulsions.Type IMA open fractures: Extensive soft-tissue lacerations or flaps, but maintain adequate soft-tissue coverage of bone, or they result from high-energy trauma regardless of the size of the wound. Includes segmental or severely comminuted fractures, even those with 1 cm lacerations.Type NIB open fractures: Extensive soft-tissue loss with periosteal stripping and bony exposure; usually massively contaminated.Type MIC open fractures: Open fractures with an arterial injury that requires repair regardless of the size of the soft-tissue wound.

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Which of the following cells Contain organelles needed for the secretion of a proteinaceous product

Pancreatic acini - The secretory elements of the exocrine pancreas are long and tubular (but they are usually described as acini as they appear rounded or oval in sections). Their lumen is small. Secretory Cells - The cells lining the alveoli appear triangular in section, and have spherical nuclei located basally. In sections stained with haematoxylin and eosin the cytoplasm is highly basophilic (blue) paicularly in the basal pa. With suitable fixation and staining numerous secretory (or zymogen) granules can be demonstrated in the cytoplasm, specially in the apical pa of the cell. These granules are eosinophilic. They decrease considerably after the cell has poured out its secretion. With the EM the cells lining the alveoli show features that are typical of secretory cells. Their basal cytoplasm is packed with rough endoplasmic reticulum (this being responsible for the basophilia of this region). A well developed Golgi complex is present in the supranuclear pa of the cell. Numerous secretory granules (membrane bound, and filled with enzymes) occupy the greater pa of the cytoplasm (except the most basal pa). REF: Inderbir Singh's Textbook of Human Histology, seventh edition, pg.no., 298,299, 300.

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What is the narrowest pa of the respiratory tract in children?

The narrowest pa of the adult airway is the vocal cords In children, the narrowest pa is the cricoid cailage located in the subglottic area of the larynx. Ref: Internet

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Soil may act as a reservoir for all except-

The reservoir of infection of brucellosis: Main reservoirs of human infection are cattle, sheep, goats, swine, buffaloes, horse and dogs Cross infection can occur between animal species  The animals may remain infected for life.

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Which inhalational agent is best uterine relaxant?

ANSWER: (A) HalothaneREF: Synopsis of Anaesthesia p.168Best uterine relaxant is halothane followed by ether

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High or low fistula in ano are divided by which of the following

Anorectal ring is formed by internal anal spincter, external anal spincter and puborectalis muscle.

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The following statements concerning the abdominal part of the sympathetic trunk are not true except:

The abdominal portion of the sympathetic trunk is situated in front of the vertebral column, along the medial margin of the Psoas major. It consists usually of four lumbar ganglia, connected together by interganglionic cords. It is continuous above with the thoracic portion beneath the medial lumbocostal arch, and below with the pelvic portion behind the common iliac artery. The ganglia are of small size, and placed much nearer the median line than are the thoracic ganglia. Gray rami communicantes pass from all the ganglia to the lumbar spinal nerves. The first and second, and sometimes the third, lumbar nerves send white rami communicantes to the corresponding ganglia. The rami communicantes are of considerable length, and accompany the lumbar arteries around the sides of the bodies of the vertebrae, passing beneath the fibrous arches from which some of the fibers of the Psoas major arise.

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A 75-year-old man is found by his internist to have an asymptomatic carotid bruit. The best initial diagnostic examination would be

Doppler ultrasonography (duplex) has become the best initial test for screening patients with carotid disease. It has become a highly accurate test, often obviating the need for carotid arteriography prior to carotid endarterectomy. Carotid arteriography remains the "gold standard" when quantifying the degree of carotid stenosis, but it is usually performed after noninvasive testing suggests significant stenosis. Spiral CT angiography is a new noninvasive modality that has been used to evaluate many segments of the vascular tree, but as yet its accuracy does not approach that of standard arteriography and it would certainly not be used in the initial evaluation of a patient with an asymptomatic bruit. Magnetic resonance arteriography (MRA) is also a relatively new modality that has enjoyed moderate success in the investigation of carotid disease. Although not quite as accurate as standard arteriography, it has been used in conjunction with the duplex as a complementary study. Once again, because of its cost, MRA would not be used as the primary screening modality. Transcranial Doppler studies are used to assess the intracranial vasculature.

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A 46-year-old man presents with diffuse chest pain at rest and recent history of cough, fever and rhinor - rhea lasting for 3 days.

Ans. (a) Acute pericarditis.The tracing reveals sinus rhythm at approximately 75 beats/ min. The PR interval is prolonged to 200 milliseconds consistent with borderline first-degree AV block. The QRS axis and intervals are normal.ST elevations with concave upward morphology are seen in I and aVL, II and aVF, and V2 through V6. No Q waves are present. Furthermore, subtle PR-segment depression is seen in leads I and II. The differential diagnosis for ST-segment elevation includes, among other things, acute myocardial infarction, pericarditis, and left ventricular aneurysm. In this case, the upward concavity of the ST segment, the PR-segment depression, the lack of Q waves, and the diffuse nature of the ST-segment elevation in more than one coronary artery distribution make pericarditis the likely etiology. Patients with pericarditis will complain of chest pain, typically described as sharp and pleuritic. Radiation is to the trapezius ridge. The pain is improved with sitting up and leaning forward and worsened by leaning backward.

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Minimum alveolar concentration (MAC) of an anesthetic agent means it produces lack of reflex response to skin incision in____ of subjects.

Ans. b (50%). (Ref. Shorttext book, Anaesthesia, 2nd ed., 54-55)Anesthetic potency of volatile anesthetics is measured by MAC. MAC represents the alveolar concentration of an anesthetic (at one atmosphere) that prevents movement in 50 percent of the subjects in response to pain.MINIMUM ALVEOLAR CONCENTRATION (MAC) - MAC = 1/ potency of drug# For determination of MAC in humans, the usual stimulus used is surgical skin incision.# It represents after a short time the partial pressure of the anesthetic in the central nervous system (CNS) and it is therefore the most useful index of anesthetic potency.# MAC is age-dependent, being lowest in newborns, reaching a peak in infants, and then decreasing progressively with increasing age.# The MAC can also be altered following administration of opioids.# As a rule of thumb, the addition of every one percent of alveolar nitrous oxide to another inhalation anesthetic will decrease in the MAC of that gas about one percent.# Increases in MAC result from hyperthermia and hypernatremia.# Decreases in MAC can result from hypothermia, hyponatremia, pregnancy, hypotension, and drugs such as lithium, lidocaine, opioids, and alpha2 agonists.Minimum alveolar concentration of inhaled anesthetics in 100% oxygen:- Halothane 0.74 percent- Enflurane 1.68 percent- Isoflurane 1.15 percent- Desflurane 6.3 percent- Sevoflurane 2.0 percent- Nitrous oxide 104 percent Factors increasing MACFactors decreasing MACDrugs decreasing MAC1) Hyperthermia2) MAO inhibitors3) Hypernatremia4) Alcohol abuse (chronic)1) Hyperthermia2) Hypoxia3) Metabolic acidosis4) Pregnancy5) Alcohol abuse (acute).1) Opiods, Pancuronium2) Propofol, Ketamine3) Benzodiazepines4) Barbiturates, Lidocaine5) Clonidine.

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Zinc dose in 8 months infants

Ans. is 'd' i.e., 20 mg/kg x 14 days

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A patient with Ca endometrium has > 50% myometrial invasion and vaginal metastasis. Pelvic and retroperitoneal lymph nodes are not involved. Peritoneal seedings are +ve. The stage is:

FIGO Surgical Staging of Carcinoma of the Corpus Uteri: Stage I Stage Ia - Tumor limited to endometrium Stage Ib - Invasion to less than one-half the myometrium Stage Ic - Invasion to more than one-half the myometrium Stage II Stage IIa - Endocervical glandular involvement only Stage IIb - Cervical stromal invasion Stage III Stage IIIa - Tumor invades serosa and/or adnexa, and/or positive peritoneal cytology Stage IIIb - Vaginal metastases Stage IIIc - Metastases to pelvic and/or paraaoic lymph nodes Stage IV Stage IVa - Tumor invades bladder and/or bowel mucosa Stage IVb - Distant metastases including intra-abdominal and/or inguinal lymph nodes Ref: Dorigo O., Goodman A. (2007). Chapter 51. Premalignant & Malignant Disorders of the Uterine Corpus. In A.H. DeCherney, L. Nathan (Eds),CURRENT Diagnosis & Treatment Obstetrics & Gynecology, 10e.

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Underwater autopsy of the hea is done in cases of: DNB 09

Ans. Air embolism

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Which of the following has highest potential to cause metabolic syndrome?

Metabolic complication like weight gain, hyperlipidemia and precipitation of diabetes is a major limitation. Other given drugs donot cause metabolic syndrome. Ref KD TRIPATI 8TH ED.

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Duchnne's muscular dystrophy -

Ans. is 'b' i.e., X-linked recessive o Duchnne & Becker's muscular dystrophy are X-linked recessive.

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Vector for Zika virus disease is:

Zika virus is a mosquito- borne flavivirus which is transmitted through the bite of infected Aedes Aegypti. Transmission from an infected pregnant mother to her baby during pregnancy or around the time of bih is also a possibility. Zika Virus Zika virus is a mosquito-borne Flavivirus Caused by Zika virus which belongs to the genre Flavivirus. Zika virus is diagnosed through PCR (polymerase chain reaction) and virus isolation from blood samples.

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Commonest cause of non engagement at term, in primi is:

In primi's the most common cause of non engagement at term is deflexed head or occipitoposterior position followed by cephalopelvic dispropoion. Ref: Datta Obs 9e pg 330.

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Aberrant thyroid tissue may be found in all except:

Usually there are 3 places where aberrant thyroid tissues may be formed: i) Lingual thyroid. ii) Thyroglossal ectopic thyroid. iii) Struma Ovarii Struma Ovarii is an ovarian teratoma in which thyroid tissue may be present. It is malignant.

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Hemiballismus is due to lesion in?

Ans. (b) Contralateral subthalamic lesionRef: Harrison 19th ed. / 2623LesionManifestation* Caudate nucleusContralateral chorea* Globus pallidusContralateral atheotosis* Sub-thalamic nucleusContralateral hemiballismus* CerebellumIpsilateral intentional tremors* Internal capsuleContra-lateral hemiplegia with hemi- anesthesia* Ventral ponsLocked in syndrome

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Which one of the following is used in Cardiovascular imaging?

Multidetector CT: It has cone shaped beam of X-ray Multiple slices of detectors and useful in Cardiovascular imaging. Multi-detector CT is paicularly suitable for imaging of the chest, hea and vessels. It is also useful for imaging of trauma patients.

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Insulin is essential for entry of glucose in which of the following tissue:

Ans. (c) Skeletal musclesRef: Harper's Biochemistry, 30 ed. pg. 191-192th* Insulin increases the number and activity of GLUT 4 receptor. Thereby facilitating the entry of glucose in tissues having GLUT4 receptor.* Tissues with abundant GLUT4 receptor are: Skeletal muscles, Heart and Adipose tissue* Thus among the given choices, skeletal muscle is the one which required for entry of glucose.GLUT receptors, their location and functionReceptorLocation on tissueFunctionGLUT 1Brain, kidney, colon, placenta, RBC, retinaGlucose uptakeGLUT 2Liver, pancreatic beta cell, small intestine, KidneyRapid uptake or release of glucoseGLUT 3Brain, kidney and placentaGlucose uptakeGLUT 4Heart, skeletal muscles, adipose tissueInsulin-stimulated glucose uptakeGLUT 5Small intestineAbsorption of glucoseGLUT 6Spleen, leukocyte-GLUT 7Liver, endoplasmic reticulumGlucose transporter in endoplasmic reticulum

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Useful diagnostic studies in the evaluation of upper-extremity pain include all of the following, EXCEPT:

Pain in the upper extremity may be of musculoskeletal or neurologic origin. Compression of the nerves supplying the upper extremity can occur at various levels from the spinal cord all the way down to the fingers. Cervical spine x-ray is helpful for detecting bony abnormalities, which may cause nerve compression. Pancoast's tumor, which can be demonstrated on chest x-ray, may be responsible for pain. Neural conduction studies of the median nerve may disclose the presence of carpal tunnel syndrome as the cause of pain. Finkelstein's test produces pain in patients with de Quervain's disease. The test is performed by asking the patient to grab his own thumb with the other fingers of the same hand and then move the wrist in the ulnar direction. If pain is elicited, then the test is positive. Adson's test is very helpful in detecting the presence or absence of collateral circulation between the radial and ulnar aeries and is not diagnostic for pain. Ref: Rapp J.H., MacTagga J. (2010). Chapter 34. Aeries. In G.M. Dohey (Ed),CURRENT Diagnosis & Treatment: Surgery, 13e.

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Sperm acquires motility in ?

Ans. is 'c' i.e., Epididymis Spermatozoa leaving the testis (seminiferous ubules) are not fully mobile. They continue their maturation and acquire their mobility during their passage through epididymis. From epididymis they come to vas deference, distal end of which also receives the secretions of seminal vesicle, and continues as the ejeculatory duct. The ejeculatory duct joins the prostatic urethra. Once ejeculated into the the female, vaginal secretions improve the motility and feilizing ability of sperms. Fuher exposure to secretions of female genital tract (in uterus and/or fallopian tube) fuher improves the mobility and feilizing ability of the sperms. The beneficial effects of stay in the female genital tract are collectively called capacitation, from the isthmus, capacitated sperms move rapidly to the ampullas, where feilization takes place.

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Management of Osteoradionecrosis would be:

Treatment of osteoradionecrosis at the present time is unsatisfactory. Decortication with sequestrectomy and hyperbaric oxygen with antibiotics have been used with limited success because of poor healing after surgery. Conservative approaches with the aim to maintain the integrity of the lower border of the mandible, keeping the site free of infection and the patient free of pain, may in the long-term prove more successful. The risk for osteoradionecrosis is greater in the presence of odontogenic or periodontal disease and in individuals with poor oral hygiene or ill-fitting dentures. Patients should be referred for dental care before undergoing a course of radiation therapy to minimize radiation caries and osteoradionecrosis. Radiation caries can be minimized by restoring all carious lesions before radiation therapy and initiating preventive techniques of good oral hygiene and daily topical fluoride.

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Which of the following maternal complication during pregnancy result in giving bih to a large baby?

Maternal development of gestational diabetes result in fetal macrosomia. The pathophysiology of fetal macrosomia is not very clear but it seems clear that fetal hyperinsulinemia is one driving force. The insulin like growth factor, as well as fibroblast growth factor, also are involved, so a hyperinsulinemic state with increased levels of some growth factors, with increased expression of GLUT proteins in syncytiotrophoblast, may promote excessive fetal growth. It could also be due to elevated levels of maternal free fatty acid which leads to its increased transfer to the fetus accelerating triglyceride synthesis and resulting in adiposity. Ref: Williams Obstetrics 22nd Edition, Page 59, 689 ; Textbook of Obstetrics By D. C Dutta, 6th Edition, Page 286-7

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Mallory's hyaline is seen in ?

Ans is 'c' i.e., Indian childhood cirrhosis

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Farmers lung is caused by -

Ans. is 'a' i.e., Micromonospore faenia Spores of some thermophilic actinomycetes such as faenia and Saccharomonsporia species may induce allergic alveolitis leading to COPD,farmer's lung.

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Mr. Ramesh a business man has taken multiple bank loans from a nationalized bank and unable to make payments. He has been brought for psychiatric evaluation as recently he has been denying any memory of taking loans from the bank. Interestingly, all other memory functioning is pretty intact. This is suggestive of:

Dissociative Amnesia: Commonest clinical type of dissociative disorder. Occurs mostly in adolescent and young adults. Severe psychological trauma, the patient temporarily and unconsciously shuts down the memory of the traumatic event Circumscribed loss of traumatic memory is seen in these individuals The other memories are intact and this cannot be explained by normal forgetting Treatment: Suppoive psychotherapy Identify trauma related cognitive distoions and help the individual cope with adaptive behaviours Drug assisted interview could be beneficial to elicit information- abreaction

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A 55-year-old man is admitted to the hospital for an iliofemoral bypass. The operation is performed successfully and the blood flow between the iliac and femoral arteries is restored. During rehabilitation which of the following arteries should be palpated to monitor good circulation of the lower limb?

The dorsalis pedis is the continuation of the anterior tibial artery into the foot, as it passes the distal end of the tibia and the ankle joint. The pulse of the dorsalis pedis can be felt between the tendon of the extensor hallucis longus and the tendon of the extensor digitorum longus to the second toe. A strong pulse is a positive indicator of circulation through the limb. The fibular (peroneal) artery is a branch of the posterior tibial artery and passes in the calf between the flexor hallucis longus and tibialis posterior, making it difficult to palpate. The deep plantar artery, the extension of the first dorsal interosseous or lateral plantar arteries, passes deep to the aponeurotic tissues and central muscles of the foot, making palpation unlikely. The dorsal metatarsal branches of the dorsalis pedis pass under cover of the extensor digitorum longus and brevis tendons. Palpable pulses of the first or other dorsal metatarsal arteries can therefore be difficult to detect.

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The most common malignant neoplasm of infancy is:

Neuroblastoma accounts for 7-10% of pediatric malignancies and is the most common solid neoplasm outside the CNS. Fifty percent of neuroblastomas are diagnosed before age 2 years and 90% before age 5 years. Ref: Kligman, Behrman, Jenson, Stanton (2008), Chapter 498, "Neuroblastoma", In the book, "Nelson's Textbook of Pediatrics", Volume 2, 18th Edition, New Delhi, Page 2137

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Chorionic villous sampling done before 10 weeks may result in:

Ans. is c, i.e. Oromandibular limb defectsRef. Williams Obs. 21/e, p 990; 22/e, p 330, 23/e, p 300"Chorionic villous sampling is usually performed at 10-13 weeks and is associated with several complications but studies suggests that limb reduction and oromandibular limb hypo genesis is more common, if CVS is done before 9 weeks. So, CVS is done after 9 weeks because it is more safe." --Williams Obs. 21/e, p 990"The frequency of oromandibular limb hypogenesis, however was increased after CVS, when the procedure was performed before 9 weeks." --Williams Obs. 22/e, p 330"It was shown that limb reduction defects were associated with CVS performed earlier in gestation--typically around 7 weeks." --Williams 23/e, p 300

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Erenumab was approved by FDA in 2018 for

Erenumab belongs to a new class of drugs known as selective calcitonin gene-related peptide (CGRP) antagonists, which are used for the treatment of acute migraine attacks.

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Site of maximum bicarbonate absorption-

Ans. is 'a' i.e., Proximal convoluted tubule o About 80-90 of filtered HCO3- is absorbed in PCT.o Absorption of HCO3- is indirect, which is due to secretion H+, i.e., secretion of H+ is coupled with absorption of HCO3o Filtered HCO3- reacts with H+ to form H2CO3 which then is dissociated into H2O and CO2.o CO2 diffuses into epithelial cell and generate HCO3- which is then reabsorbed.

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True statement about PPV is:

Ans. (a) It increases with prevalenceRef: K. Park 23rd ed. /140-141# POSITIVE PREDICTIVE VALUE* Ability of screening test to identify correctly all those who have disease out of all those who test positive on a screening test.* It depends upon sensitivity, specificity and prevalence of a disease in a population* PPV of a screening is directly proportional to prevalence of disease* If Prevalence of a disease increases in a population, PPV increase for the screening test.PPV=TP/TP+FP x 100

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Cephalic index is used for determination of?

Ans. (b) RaceRef: Parikh 6th ed. / 2.26, http://en.wikipedia.org/ wiki/Cephalic_index

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Severe painful sensorimotor and autonomic neuropathy along with alopecia may suggest poisoning with:

Severe painful sensorimotor and autonomic neuropathy along with alopecia--thallium Severe painful sensorimotor neuropathy / GI disturbance and Mee's lines--arsenic Wrist or finger extensor weakness / anemia and basophilic stippling of red blood cells--lead Ref: Harrison, Edition-18, Page-3450.

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Cavernous sinus communicates with

Draining channels or communications the cavernous sinus drains: 1.into the transverse sinus through the superior petrosal sinus. 2.into the internal jugular vein through the inferior petrosal sinus and through a plexus around the internal carotid aery. 3. into the pterygoid plexus of veins through the emissary veins passing through the foramen ovals, the foramen lacerum, and the emissary sphenoidal foramen 4. In to the facial vein through the superior ophthalmic vein. 5.the right and left cavernous sinuses communicate with each other through the anterior and posterior intercavernous sinuses and through the basilar plexus of veins. Notes: all these communications are valveless and blood can flow through them in either direction Ref: BDC volume3;Sixth edition pg 195

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In civil negligence, onus of proof lies on:

D i.e. Patient In case of malpractice, punishment is given by civil or criminal couQ (depending on type of negligence). Generally, the innocence of doctor is assumed and in cases where negligence is alleged, the plantiff (complainant, patient) has to establish the guilt. The patient is expected to prove that the defendant (doctor) was negligent; there fore the onus (responsibility) of proof lies on patient. But when the doctrine of res ipsa loquitor (ie thing speaks for itself) is applied such as in case of surgery on wrong patient / side / organ etc, the doctor will have to prove that what has happened is not due to his negligenceQ. This means onus of proof lies on patient in negligence (all civil & most criminal case) except in cases where doctrine of res ipsa loquitor appliesQ. Therapeutic misadventure (mischance / disaster / accident) is death or injury of a patient due to some unintentional act by doctor /nurse /hospitalQ during treatment (therapeutic), diagnosis (diagnostic) or experimental study. It provides defence against neglince because a doctor can't be held responsible for injuries resulting from adverse reaction of drug. However, the doctor must warn patient about possible side effects (eg death during surgery or transfusion). And ignorance of the possibility of reaction to drug prescribed to patient amounts to negligence (ie it is not 100% = absolute defence). At times it is not possible to explain every thing to the patient (who may be scared of procedure). Under such circumstances doctor can reveal the details to any one of close relatives of patient. This is called doctrine of therapeutic privilege. Doctrine of emergency says that doctor can provide the treatment without taking prior consent from a patient who is gravely sick, (critically ill), unconscious, or not able to understand the suggestion, or when mentally ill (IPC section 92). In emergency situation involving children, when their parents are not available, a/t doctrine of locoparentis, consent can be obtained from accompanying person (eg teacher or relative). On ceain occasions, despite all proper care given by doctor during treatment, the patient might suffer severe injuries or permanent deformity. This is k/a medical maloccurance, inevitable act or Act of God. If doctor proves this before cou, it will be an absolute defence against malpractice. Free (charity) treatment of patient does not give doctor immunity (defence) against negligenceQ. Whereas judgemental (diagnostic) error, therapeutic misadventure, medical maloccurance, calculated risk doctrine, contributory negligence (on pa of patient), product liability, and res judicata (complain already tried once in cou) provide defenses to a doctor against charges of negligence. Law does not consider doctrine of contributory negligence & consent in charges of criminal negligence; whereas these provide defence in civil negligence.

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Which aery Supplies the deep cerebellar nuclei

The superior cerebellar aery supplies the superior surface of the cerebellum and the cerebellar nuclei (dentate nucleus)

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True about blood supply of scaphoid-

Ans. is 'c' i.e., Major supply from dorsal surfaceo Major blood supply (70-80%) of scaphoid comes through dorsal surface via dorsal branches of radial artery,o These dorsal vessels enter the scaphoid at or just distal to waist area and supply the proximal pole in retrograde fashion.o Proximal 2/3 rd to 3/4 scaphoid is supplied by these dorsal vesselso 20-30% of blood supply comes through palmar and superficial palmar branches of radial artery,o Distal 1/3 rd or 1/4 th and distal tubercle are supplied by these palmar vessels.

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Straining and dribbling of urine in a male infant with recurrent urinary infection should lead to the suspicion of :

The informations provided in this question are : Straining —> Sign of obstruction Driblling  —>  Sign of obstruction and incomplete bladder emptying. UTI May be due to urinary obstruction. All these suggest the diagnosis of obstructive uropathy, and posterior urethral valve is most common cause of obstructive uropathy.

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Which protein is abundant in our body:

Ans. (a) CollagenRef: Harrisons, 19th ed. pg. 2504* Collagen is the most abundant protein in the body.* Harrisons states: "The first genes cloned for connective tissues were the two genes coding for type I collagen, the most abundant protein in bones, skin, tendons, and several other tissues.

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Myoglobinuria is seen in which type of burns:

Electrical burns may cause extensive muscle necrosis and consequent myoglobinuria and hemoglobinuria, both of which may lead to renal insufficiency.

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Sign of the groove is seen in:

LGV is caused by Chlamydia trachomatis serovars L1, L2 and L3 and occurs in three stages. In the secondary stage or inguinal stage, enlargement of the femoral and inguinal lymph nodes separated by the inguinal ligament produces the 'sign of the groove'/sign of Greenblatt. NOTE: Ramrod /saxophone penis in males and Esthiomene in females occurs in the third stage of LGV. Ref: Sexually Transmitted infections, Bhushan Kumar, 2nd edition, pg 510-511.

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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 -

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

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Cholesteatoma is seen in:

(b) CSOM(Ref. Cummings, 6th ed., 2141)Cholesteatoma formation is characteristic of unsafe CSOM.The other mentioned options are not associated with cholesteatoma.

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Which of the following indicates anticipated difficult bag mask ventilation

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

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Enzyme replacement therapy is used for-

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

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Organism that causes emphysematous cholecystitis is:

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.

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Most common site for extra mammary Paget&;s disease is

.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

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Inferior Rib notching is seen in all except?

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.

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Which is false regarding cryptococcus neoformans?

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.

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Histopathological finding of gluten hypersensitivity is?

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.

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