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

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

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

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

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RNA primer is synthesized by -

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

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

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

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

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

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Yoke muscle pair is

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

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Causes of restrictive cardiomyopathy are -

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

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

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

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

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

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HIV can -

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

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Heamorrhagic external otitis media is caused by

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

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

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

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Most dangerous paicles causing pneumoconiosis are of size

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

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

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

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

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

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Which of the following does not cause Insulin release-

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

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

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

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The following is the least useful investigation in multiple myeloma :

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

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

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

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

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

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index finger infection spreads to -

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

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All are clinical features of chalcosis except

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

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Bidextrous grip is seen at what age?

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

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

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

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

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

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For Status epilepticus, treatment of choice is: September 2012

Ans. D i.e. Lorazepam

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All are subjective tests for audiometry except:

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

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Tonic neck relfex is lost in lesion of -

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

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

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

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Name of mumps vaccine is

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

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Sacro-Iliac joint involvement is common in which condition?

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

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Infertility issues with leiomyoma can be addressed by

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

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

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

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

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

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Alcohol dependence is seen which of the following phase

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

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CAMP acts through:

A i.e., Activation of protein kinase

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

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

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The diameter of Tricuspid orifice is

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

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Most common cause of hirsutism in a teenage girl:

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

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CSF is stored at:Kerala 11

Ans. 4degC

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Gastrosplenic ligament is derived from?

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

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

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

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Crossing over, true is;

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

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Bloom Richardson grading -

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

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Which among the following is FALSE about congenital toxoplasmosis?

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

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Superior suprarenal aery originates from:

Inferior phrenic aery

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Most common cause of Papillary necrosis is

Major causes of Papillary Necrosis1. Analgesic nephropathy2. Sickle cell nephropathy3. Diabetes with UTI4. Prolonged NSAID use Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 340; Tubulointerstitial Diseases of the Kidney

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Alzheimer's disease is associated with: September 2012

Ans. C i.e. Dementia Alzheimer's dementia Coical (NOT subcoical) dementia, Progressive, Associated with Apo E gene, Neurofibrillary tangles are seen and Donepezil is used in management

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Essential amino acids are all except:

10 amino acid are essential - T - Threonine V -VALINE P- Phenylalanine A- Arginine T- Tryptophan M- Methionine I -Isoleucine L -Leucine L - Lysine 2 amino acid are semi essential -Arginine and histidine can be synthesized by adults and not by growing children

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What is tuberculoma?

Tuberculosis may also involve the bone of the maxilla or mandible. One common mode of entry for the microorganisms is into an area of periapical inflammation by way of the blood stream; an anachoretic effect. It is conceivable also that these microorganisms may enter the periapical tissues by direct immigration through the pulp chamber and root canal of a tooth with an open cavity. The lesion produced is essentially a tuberculous periapical granuloma or tuberculoma. These lesions were usually painful and sometimes involve a considerable amount of bone by relatively rapid extension. Ref: Shafer's textbook of oral pathology 7th edition page 321-322

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Clinical features of rheumatic fever are all except-

Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:146-147 Rheumatic Fever Acute, recurrent, inflammatory disease, mainly of children (aged 5-15 years), typically occurring 1-5 weeks after group A streptococcal infection. Pathophysiology 1. Cross reactivity of host antistreptococcal antibodies to cardiac antigens 2. Microbe initiated autoimmune reactivity. Jones Criteria for Diagnosis of Rheumatic Fever Major Criteria Carditis Pancarditis, seen in 50-60% of patients, develops within the first 2 weeks of rheumatic fever. Pericarditis is evidenced by presence of a pericardial rub, myocarditis by tachycardia, soft S1, presence of S3 and CCF and endocarditis by the presence of Carey-Coombs' murmur (mitral diastolic murmur). Ahritis (60-75%) Flitting and fleeting type of polyahritis involving large joints with no residual deformity is seen in 60-75% of patients and occurs early in rheumatic fever. Jaccod's ahritis: Ulnar detion of 4th and 5th finger with flexion at metacarpophalangeal joints is the only residual deformity seen in rheumatic polyahritis. Subcutaneous Nodules Non-tender nodules are seen over bony prominences like elbows, shin, occiput, spine in 3-5% of patients and occur 3-6 weeks after onset of rheumatic fever. Patients who have subcutaneous nodules almost always have carditis. Erythema Marginatum (< 5% and evanescent) Macular lesions with an erythematous rim and central clearing in a bathing suit distribution are seen in < 5% of patients and occur early in rheumatic fever. Chorea (Sydenham's Chorea) (2-30%) A neurological disorder with rapid, involuntary and purposeless non-repetitive movements with a self limiting course of 2-6 weeks is more common in females and is a late manifestation of rheumatic fever. Minor Criteria Clinical 1. Fever 2. Ahralgia 3. Previous history of rheumatic fever or rheumatic hea disease. Laboratory 1. Acute phase reactants (leucocytosis, raised ESR, C-reactive protein) 2. Prolonged PR interval in ECG (> 0.2 sec). WHO Criteria Jones major and pa of the minor criteria except prior history of rheumatic fever/rheumatic hea disease and C-reactive protein. Essential Criteria Evidence for recent streptococcal infection as evidenced by: 1. Increase in ASO titre a. > 333 Todd units (in children) b. > 250 Todd units (in adults). 2. Positive throat culture for streptococcal infection. 3. Recent history of scarlet fever. Two major (or) one major and two minor criteria, in the presence of essential criteria, is required to diagnose Acute Rheumatic Fever. A Positive Rheumatic Fever history is usually elicited in only 50% of patient with Rheumatic Hea Disease. Valve Involvement in Rheumatic Hea Disease Mitral valve alone 50% Aoic valve alone 15-20% Mitral and Aoic valves together 35-40% Mitral, Aoic and Tricuspid valves 2-3% Pulmonary valve is viually never involved. In RHD, mitral valve is most commonly involved followed by involvement of the aoic valve as the pressure gradient across the mitral valve is the greatest, followed by that across the aoic valve. So, the mitral valve is more susceptible to develop pathological changes than the aoic valve.

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A dense persistent nephrogram may be seen in all of the following except:

B i.e. Systemic hypeension

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Most common type of mesentric cyst is

Chelolymphalic cyst : It is commonest type of mesentric cyst. It has congenital misplaced lymphatic tissue.

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According to WHO, membranous glomerulonephritis seen in SLE, is -

Ans. is 'd' i.e., Class V

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All the following can be used to grow human viruses except?

The virus needs cellular components for there growth

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When a child is not able to perform the following motor functions such as skipping, walking on heels, hopping in place or going forwards in tandem gati, his motor development is considered to be below ?

Ans. is 'b' i.e., 4 years o A child hops on one foot by 4 years and skips by 5 years. o As this child can not hop, the age of this child is less than 4 years.

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The alveoli are filled with exudate. The air is displaced, converting the lung into a solid organ. This description suggests-

• ‘Bacterial invasion of the lung parenchyma causes the alveoli to be filled with an inflammatory exudate, thus causing consolidation (“solidification”) of the pulmonary tissue’…..Robbins definition of pneumonia

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Antoni A & Antoni B Pattern's are seen in

Schwannoma *Distinctive histologic patterns seen within the peripheral nerve sheath tumor Schwan noma include the Antoni A and Antoni B regions oThese are the classic microscopic appearances of a schwannoma, which is benign. oNote the more cellular "Antoni A" pattern on the left with palisading nuclei surrounding pink areas (Verocay bodies). On the right is the "Antoni B" pattern with a looser stroma, fewer cells, and myxoid change. oNotice the whirly swirly pattern and how the cell nuclei are closely bunched together ... almost as if they're forming a fence (Verocay bodies). oSchwannomas are benign spindle cell tumors that occur along the edges of peripheral nerves.They can usually be removed without damaging the nerve itself.

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Incised wound which is not a feature ?

Ans. is 'c' i.e., Margins are inveed Margins are eveed, clear, and clean cut.

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Which one of the following is a malignant bone tumour?

(C) Chondrosarcoma # MALIGNANT PRIMARY BONE TUMORS include osteosarcoma, chondrosarcoma, Ewing's sarcoma, malignant fibrous histiocytoma, fibrosarcoma, and other sarcoma types. Multiple myeloma is a hematologic cancer which also frequently presents as one or more bone tumors.# CLASSIFICATION of BONE TUMOURS:> Cartilage tumors Osteochondroma: Chondromas Enchondroma Periosteal chondroma Chondroblastoma Chondromyxoid fibroma Chondrosarcoma Dedifferentiated Mesenchymal Clear cell Periosteal> Osteogenic tumors: Osteoid osteoma (B), Osteoblastoma> Fibrogenic tumors: Desmoplastic fibroma of bone, Fibrosarcoma of bone> Fibrohistiocytic tumors: Histiocytoma of bone> Ewing sarcoma/Primitive neuroectodermal tumor> Giant cell tumors: Giant cell tumor> Notochordal tumors: Chordoma> Vascular tumors: Haemangioma and related lesions, Angiosarcoma> Myogenic, lipogenic, neural and epithelial tumors: Leiomyosarcoma of bone, Lipoma of bone, Adamantinoma and osteofibrous dysplasia> Tumors of undefined neoplastic nature: Aneurysmal bone cyst Simple bone cyst; Fibrous dysplasia (B); Langerhans cell histiocytosis (LCH)

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New born term baby born by vaginal delivers' had respiratory' distress, grunt, with scaphoid abdomen -Most probable diagnosis is -

Ans. is 'b' i.e., Diaphragmatic hernia o Diaphragmatic Hernia is defined as a communication between abdominal & thoracic cavities with or without abdominalContents in thorax.MC Bochdalek type.More common on left (85%)30% of CDH have associated anomalesCardiac anomalis is MC anomalis.In cardiac (Hypoplastic left heart syndrome most common).o X ray showing multiple gas locales within the lower left chest, the majority of the rest of the left lung opacified. The left hemidiaphragm can not be seen. The mediastinum and the heart are deviated to the contralateral right side.

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Confirmatory test for syphilis is-rpt qun

rpt qun

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The placenta secretes a hormone that is utilized in the early detection of pregnancy. This hormone is:

The synthesis and secretion of hCG begins about day 6 of pregnancy, presumably from the trophoblast cells. Pregnancy tests utilize the measurement of hCG for detection of the embryo. Endothelial growth factor (EGF) is synthesized by the cytotrophoblast cells in the early placenta, then is synthesized by the syncytiotrophoblast cells later (6-8 week old placenta). EGF maintains the trophoblast. Relaxin is synthesized by decidual cells at the time of paurition and acts to "soften" the cervix and pelvic ligaments. IGF act similarly to EGF by stimulating differentiation of the cytotrophoblast cells. HCS is synthesized by syncytiotrophoblast cells and will promote general growth. It is essential in the stimulation of mammary duct proliferation in development of the breast during pregnancy. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 22. Reproductive Development & Function of the Female Reproductive System. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.

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Ulceration of the vulva is commonly seen in all except

Ans. is a, i.e. Bacterial vaginosisRef: Dutta Gynae 6th/ed, p262Vulval ulcersVulval ulcers are predominantly due to sexually transmitted diseases. Rarely, it may be due to non-specific causes.Malignant ulcer is also rare. The various etiological factors related to vulval ulcers are given in the below Table.Ulcers of the VulvaSTD relatedIdiopathicTuberculosisMalignancySystemic disease related or dermatoses* Syphilis* Herpes genitalis* Chancroid* Granuloma inguinale* Lymphogran-uloma venereumBehget's diseaseAphthous ulcersLipschutz ulcersTubercularPrimay* Squamous cell carcinoma* Malignant melanoma* Basal cell carcinomaSecondary* Leukemia* Choriocarcinoma* Lupus erythematosus* Crohn's disease* Lichen planus* Lichen sclerosus* Sjogren's syndromeNote: Lipschutz ulcer: The lesion affects mainly the labia minora and introitus. In acute state, there may be constitutional upset with lymphadenopathy. The causative agent may be Epstein-Barr virus. Treatment is with antiseptic lotions and ointment.

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Thalidomide can be used in all of the followingconditions except?

HIV associated peripheral neuropathy

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In children with classical galactosemia all are true except:

E. coli sepsis is common and the onset often precedes the diagnosis of galactosemia Elimination of galactose reverse growth failure, cataract, renal and hepatic dysfunction Galactokinase deficiency -> accumulation of galactose and galactitol Duae variant- a single amino acid substitution, has 50% of normal enzyme activity- asymptomatic

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When a person changes position from standing to lying down, following change is seen:

B i.e. Venous return to hea increases immediately In standing posture, 300- 500m1 of blood pools in venous capacitance vessels of lower extremities, which is immediately returned towards heaQ on assuming lying down posture. Cardiovascular system Onlying On standing - Stroke volume - Cardiac output - Venous return - Central blood pool Increase Decrease - Central venous pressure - Aerial BP - Abdominal & limb flow - Hea rate - Peripheral venous pooling - Total peripheral resistance Decrease Increase - Abdominal & limb resistance - Small vein pressure

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Metrorrhagia is

The term intermenstrual bleeding is updated nomenclature for metrorrhagia.

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Effective red cell diameter

Answer: (C) Thalassemia minor anemia may present with normal RBC diameter (265-68-Hrshmohon 7th) (630= Rabbins- basis disease)Red blood cell distribution width (RDW or RCDW) is a measure of the variation of red blood cell (RBC) volume that is reported as part of a standard complete blood count. Usually red blood cells are a standard size of about 6-8 pm in diameter. Certain disorders, however, cause a significant variation in cell size. Higher RDW values indicate greater variation in size. Normal reference range in human red blood cells is 11.5-14.5%. If anemia is observed, RDW test results are often used together with mean corpuscular volume (MCV) results to determine the possible causes of the anemia. It is mainly used to differentiate an anemia of mixed causes from an anemia of a single cause. Deficiencies of Vitamin Bl2 orfolate produce a macrocytic anemia (large cell anemia) in which the RDW is elevated in roughly two- thirds of all cases; however, a varied size distribution of red blood cells is a hallmark of iron deficiency anemia, and as such shows an increased RDW in virtually all cases. In the case of a mixed iron and B!2 deficiency, there will normally be a mix of both large cells and small cells, causing the RDW to be elevated. An elevated RDW (red blood cells of unequal sizes) is known as anisocytosis. An elevation in the RDW is not characteristic of all anemias; anemia of chronic disease,hereditary spherocytosis, acute blood loss, aplastic anemia (anemia resulting from an inability of the bone marrow to produce red blood cells), and certain hereditary hemoglobinopathies (including some cases of thalassemia minor) all may present with a normal RDW* The human erythrocyte is a biconcave disc, 7-2 pm in diameter, and has a thickness of 2-4 pm at the periphery and 1 mm in the centre* More than 90% of the weight of erythrocytes consists of haemoglobin. The life span of red cell is 120 +- 30 day.* Range of normal red cell count in health in 5.5 +- 1.0 x1012/L in men and 4.8 +- l.0x 1012/l in women* Packed cell volume (PCV) or haematocrit- 0.47 + 0.07L/L (40-54%) in men- 0.42 +- 0.05 L/L (37-47%) in women* Reticulocyte count (%)0.5-l .5* Red cell distribution width-11.5-14.51. Mean corpuscular volume (MCV) =PCV in L/LRBC Count/L Normal value is 85 +- 8fl (77-93 fl)2. Mean corpuscular haemoglobin (MCH) =Hb/LRBC Count/L Normal range is 29.5 +2.5pg (27-32 Pg)3. Mean corpuscular haemoglobin concentration (MCHC) =Hb /dlPCV in L/LNormal value is 32.5 +2.5 g/dl (30-35 g/dl)* The size of the RBC is measured by MCV. MCHC is independent of red cell count and size *** Monocyte is the largest mature leucocyte in peripheral blood* Flow cytometry is done on - Lymphocytes* The anticoagulant used in Wintrobe ESR- Double oxalate1. Alkaline phosphatase is specific to Neutrophils cells2. Acid phasphatase is found in all hematopoitic cells but the highest levels are found in macrophages and osteoclasts (Monocytes)* Anticoagalant of choice for coagulation test is 3.2% sodium citrate *** Potassium oxalate + sodium fluoride is anticoagulant used in collection of blood sugar.Increases Leucocyte Alkaline phosphateDecreased Leucocyte Alkaline phosphate* Infections* Leukamoid reactions* Polycythemia- vera* Paroxysmal nocturnal hemoglobinuria (PNH)* CMLBlood group A is associated with1. Carcinoma stomach, cervix salivary gland pancreas2. Pernicious anemia3. Thrombosis in OCP users

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The most impoant indication for surgical repair of a Bicornuate Uterus is -

The most impoant indication for surgical repair of a Bicornuate Uterus is Recurrent aboions Recurrent aboions occur due to - Decreased space for embryo to grow and Relatively less blood supply

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Maternal moality rate is -

Park&;s textbook of preventive and social medicine 23rd edition. * Maternal moality rate is the no of maternal deaths in a given period per 100,000 women of reproductive age during the same time period.

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Colour of crystals in positive Florence test is -

Ref:The essential of forensic medicine and toxicology Dr.K.S NARAYAN REDDY 32nd edition pg no 415 the stain is estracted by 10% HCL and a drop is placed on a glass slide and allow to dry a cover slip is place dover this , and a drop of florence solution(KI,iodide and water) this allowed to run under the cover slip .if the semen is present, dark brown crystals of choline iodide appeared immediately , they are rhombic or needle shaped crystals resembling haemin but are larger, arranged in clusters,rossettes, crosses etc... Choline orginate from the seminal vessicles,the test is not a proof of seminal fluid but only of presence of some vegetables or animal substances . a negative reaction is proof that the stain is not seminal

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Factor Xa is necessary for conversion of prothrombin to thrombin

Ans. (c) As part of both extrinsic and intrinsic pathways(Ref: Robbins 9th/pg 118-119; 8th/pg 119)Activated factor IX along with factor VIIIa (Intrinsic pathway) & factor VIIa (extrinsic pathway), converge to activate Factor X to Xa is necessary for conversion of prothrombin to thrombin (common pathway)

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True about Rotameter –

As the gas flows through the rotameter, bobbin rises and the upper end of bobbin determines the flow rate. Rotameter works on variable area (variable orifice) and constant pressure principle (not variable pressure). Causes of inaccurate reading in rotameter are :- Static electricity, Dirt inside the tube, Non-vertical tube, back pressure by ventilator, Defect in top sealing washer.

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What is an ideal method to prevent aspiration pneumonia?

Ans: A (Cuffed endotracheal tube) Ref: Bailey, 24th ed, p. 46; Ajay Yadav, p. 101A cuffed endotracheal tube is used to:1. Facilitate artificial airway ventilation or surgery around face or airway.2. Protection of lung if there is a risk of pulmonary aspiration.Predisposing factors for aspiration:1. Full stomach-- single, most important factor.2. | Level of consciousness.3. Conditions which reduce the tone of LES:Pregnancy (acid aspiration in late pregnancy- Mendelson syndrome)Abdominal tumorsObesity, hiatus herniaPresence of nasogastric tubeDrugs-Atropine, glycopyrrolate, opioids, thiopentone.4. Conditions delaying gastric emptyingDiabetes, hypothyroidism, pain, anxiety, anticholinergics, opium.Management:Prevention:Management - full stomach patients:1. Empty stomach2. H2blockers- to reduce acid production.3. Metoclopramide4. Neutralisation of gastric contents by antacids1. Regional anesthesia is preferred2. Awake intubation3. Rapid sequence intubation- Sellick maneuver

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A mutation that results in a value replacement for glutamic acid at position 6 of the B chain of hemoglobin 5 hinders normal hemoglobin function and results in sickle-cell anemia when the patient is homozygous for this mutation. This is an example of which of the following types of mutation?

Missense mutations are those in which a single base change (point mutation) results in a codon that encodes for a different amino acid residue. The effects of these types of mutations can range from very minor or even undetectable to major, depending on the impoance of the altered residue to protein folding and function. Nonsense mutations are also point mutations in which the affected codon is altered to a stop (nonsense) codon, resulting hi a truncated protein. Frame shift mutations are due to one or two base "pair inseions or deletions such that the reading frame is altered. These mutations generally lead to truncated proteins as well, since in most protein coding regions the unused reading frames contain numerous stop codons.

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Which of the following vessel does not cross the midline of the body:

The left gonadal vein drains into the left renal vein which crosses the midline to join inferior vena cava. All the other options (Left renal vein, left brachiocephalic vein and hemiazygous vein) cross the midline.Ref: Human Anatomy, B D Chaurasia, 4th Edition, Volume 2, Chapter 24, Page 297, 307, 316; Clinical Anatomy by Systems, Richard S. Snell, 2007 Edition, Page 166, 167, 840.

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Daily maintenance fluid for a child weighing 24 kg is:

Fluid requirement in a child in this child weighing 24 kg is:1540 mL. For first 10 kg: 100ml/kg For next 10 kg : 50ml/kg For each kg. above 20 : 20 ml/kg (1-10 kg) 100 x 10 = 1000 mL (11-20 kg) 50 x 10 = 500 mL; For next 4 kg (21-24 kg) 20 x 4= 80 mL

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OCP protects against all EXCEPT: September2012

Ans. A i.e. Hepatic adenoma OCP's administration may result in hepatic adenoma. Oral contraceptive pills Protects against: - Uterine Ca, - Ovarian Ca, - RA, - Endometriosis etc.

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In a chronic alcoholic, all the following may be seen in the liver except -

Alcoholic liver disease There are three distinct forms of liver disease - 1. Hepatic steatosis (fatty liver) 2. Alcoholic hepatitis (a) Acute alcoholic hepatitis      Focal necrosis      Cholestasis      Mallory hyaline bodies (b) Chronic hepatitis 3. Alcoholic cirrhosis

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Ring sideroblasts, with iron laden occurs in

i.e. (Mitochondria) : (301-Harsh Mohan 6th ) (625-Robbins & Cotran-Pathologic basis of disease 8th)Ringed sideroblasts is characteristic of sideroblastic anemia /Myelodysplastic SyndromeRinged sideroblast in which haem synthesis is disturbed as occurs in sideroblastic anaemiasRinged sideroblasts containing numerous large granules, often forming a complete or partial ring around the nucleus. These ringed arrangement of these granules is due to presence of iron laden mitochondria around the nucleus

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Signal from Baroreceptors goes to -

Ans. is C Nucleus of tractus solitarius o Baroreceptors are mechanoreceptors that are located in the adventia of carotid artery and aorta, at specialized locations called sinuses. Carotid sinus is a little bulge at the root of internal carotid artery, located just above the bifurcation of the common carotid artery. It is innerv ated by the sinus nerve, a branch of glossopharyngeal (IX cranial) nerve. Aortic arch (aortic sinus) also contains mechenoreceptors (stretch receptors) which are similar to carotid sinus receptors. However, their afferent nerve fibers travel in the aortic nerve, a branch of Vagus (X cranial) nerve. o The sinus nerve (from carotid sinus) and aortic nerve/vagal fibers (from aortic sinus) are together called 'Sino- aortic nerves'. They, together, are also refered to as 'Buffer nerves' because they are the afferents of cardiovascular reflexes that buffer abrupt changes in blood pressure. o Baroreceptors are highly sensitive to any change in mean blood pressure. Sinoaortic nerves (buffer nerves) normally discharge rhythmically, synchronous with the pressure fluctuation during systole and diastole. They respond to BP changes between 70 mm Hg and 150 mm Hg. When BP rises, baroreceptors are stimulated and their afferents (through sinoaortic nerves) stimulate nucleus of tractus solitarus (NTS) which inturn inhibits the pressor area of VMC, i.e., Rostral ventrolateral medula (RVLM). This results in decreased sympathetic outflow and therefore decreases in vasomotor tone and vasodilation. Vasodilation brings down the BP. Thereby helping hemostasis. Activated NTS also stimulates nucleus ambiguous (cardioinhibitory center) of medulla, which increases parasympathetic (vagal) output, through vagus, that decreases heart rate. Reduction in heart rate reduces the cardiac output, which also reduces BP. Baroreceptor stimulation also weekly inhibits respiration, o When BP falls, for instance while changing the posture from lying down to standing, reverse change takes place. When a person stands up, his blood is pooled in the veins of lowrer limbs by the effect of gravity. Central venous pressure and venous return decrease, which causes a fall in stroke volume. Hence the systolic BP falls. As a result, the discharge rate of baroreceptors decreases leading to a decrease in the inhibitory' influence on the pressor area of VMC. Hence vasomotor tone increases, leading to vasoconstriction, and consequently an increase in BP. Simultaneously, the nucleus ambiguous of the vagus is also inhibited, increasing the heart rate and consequently stroke volume and eventually BP. Thus fall in BP due to change of posture is very brief (Transient).

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Intrinsic factor of castle is secreted by which of the following cells in gastric glands

The stomach also adds a significant volume of digestive juices to the meal. Like salivary secretion, the stomach actually readies itself to receive the meal before it is actually taken in, during the so-called cephalic phase that can be influenced by food preferences. The gastric secretions arise from glands in the wall of the stomach that drain into its lumen, and also from the surface cells that secrete primarily mucus and bicarbonate to protect the stomach from digesting itself, as well as substances known as trefoil peptides that stabilize the mucus-bicarbonate layer. The glandular secretions of the stomach differ in different regions of the organ. The most characteristic secretions derive from the glands in the fundus or body of the stomach. These contain two distinctive cell types from which the gastric secretions arise: the parietal cells, which secrete hydrochloric acid and intrinsic factor; and the chief cells, which produce pepsinogens and gastric lipase. The acid secreted by parietal cells serves to sterilize the meal and also to begin the hydrolysis of dietary macromolecules. Intrinsic factor is impoant for the later absorption ofvitamin B12 or cobalamin. Pepsinogen is the precursor of pepsin, which initiates protein digestion. Lipase similarly begins the digestion of dietary fats.REF: GANONG&;S REVIEW OF MEDICAL PHYSIOLOGY, KIM BARRETT, HEDDWEN BROOKS, SCOTT BOITANO, SUSAN BARMANTWENTY THIRD EDITIONPAGE NO:432

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Which is not echogenic while doing ultrasonography-

Bile and urine are least echogenic. Bone, gas, and organ boundaries are most echogenic.

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Features of mycotic aneurysm are all except

Mycotic aneursm is commonly saccular.

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Microvesicular fatty liver is caused by -

Ans. is 'b' i.e., Valproate Steatosiso Accumulation of triglyceride fat droplets within the heaptocytes is known as steatosis or fatty liver. It may be of two types -1. Microvesicular steatosis - Multiple tiny droplets accumulate that do not displace the nucleus.2. Macrovasicular steatosis - A single large droplet accumulates that displaces the nucleus.Causes of steatosisMicrovesicularMacrovesicularo Reye's syndromeo Acute fatty liver of pregnancyo Jamaican vomiting sicknesso Drugs - valproic acid, tetracycline, nucleoside analogueo Wolman's diseaseo Lysosomal acid lipase deficiencyo Congenital defects of urea cycle enzymeso Early stage of alcoholic cirrhosiso Chronic viral hepatitiso Alcoholic liver diseaseo DM - insulin resistanceo Lipodystrophyo PEM, starvationo Dysbetalipoproteinemiao TPN, Jejunoileal bypasso Inflammatory bowel diseaseo Syndrome x (obesity, DM, hypertriglyceridemia)o Drugs - CCBs, synthetic estrogens, nucleoside analogues

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Child protection scheme is under which ministry -

Ans. is 'c' i.e., Ministry of women and child developmento In 2006 the Ministry' of Women and Child Development (MWCD) proposed adoption of Integrated Child Protection Scheme (ICPS).o In 2009 the central government take the scheme its approval and has begun the extensive task of providing children with a protective and safe environment to develop and florish.o The purpose of the scheme is to provide for children in difficult circumstances, as well as to reduce the risks and vulnerabilities children have in various situations and actions that lead to abuse, neglect, exploitation, abandonment and separation of children.

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Indication for surgery in a case of adrenal incidentaloma

Ref: Bailey&;s 26thE pg: 780. Treatment of Incidentaloma: Any non-functioning adrenal tumour greater than 4 cm in diameter and smaller tumours that increase in size over time should undergo surgical resection. Non-functioning tumours smaller than 4 cm should be followed-up after 6, 12 and 24 months by MRI and hormonal evaluation.

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In case control study of buccal carcinoma-

Case control studies often retrospective studies are a common first approach to test causal hypothesis. In recent years case control study has emerged as a permanent method of epidemiological investigation. Both exposure and outcome has occurred before the study. Study proceeds backwards from effect to cause. It uses a control or comparison group to suppo or refute an inference (refer pgno:71 park 23 rd edition)

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Nephrotic syndrome is characterised by

Ans. is 'a' i.e., Proteinuria; 'b' i.e., Hyperlpidemia; 'c' i.e., Oedema Pathophvsiologv of nephrotic syndrome Proteinuria o The most impoant feature of nephrotic syndrome is massive proteinuria (>3.5 gm/day) o Proteinuria results from altered permeability of glomerular filtration barrier for protein. o The largest propoion of protein lost in the urine is albumin but globulins are also excreted in some diseases. The ratio of low to high molecular weight proteins in urine in various cases of syndrome is a manifestation of the selectivity of proteinuria. A highly selective proteinuria consists mostly of low molecular weight proteins, i.e. albumin & transferrin, where as apoorly selective proteinuria consists of higher molecular weight globulin in addition to albumin. Edema o Proteinuria leads to hypoalbuminemia that results in decreased colloid osmotic pressure edema. Hyperlipidemia o Increased synthesis of lipoproteins by liver. o Decreased catabolism of lipids. o There is increased cholesterol, triglycerides VLDL, and LDL. Lipiduria o Hyperlipidemia results in lipiduria due to excessive leakiness of glomerular filtration barrier.

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All the following are the risk factors for cervical cancer except

There are numerous risk factors for cervical cancer: Young age at first intercourse (younger than 16 years), Multiple sexual paners, Cigarette smoking, race, High parity, Low socioeconomic status, and Chronic immune suppression. Reference: Novak's gynaecology; 14th edition; Chapter 35; Uterine cancer

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Person preoccupied by worries about ill health is :

A i.e. Hypochondriasis

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Terminal branches of facial nerve are all, EXCEPT:

The facial nerve crosses lateral to the styloid process and penetrates the parotid gland. In the parotid gland, the nerve divides at the pes anserinus into 2 major divisions; ie, the superiorly directed temporal-facial and the inferiorly directed cervicofacial branches. After the main point of division, 5 major branches of the facial nerve exist, as follows:Temporal (ie, frontal)ZygomaticBuccalMarginalCervical

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Which of the following is orexigenic?

Ghrelin: Anorexigenic and somatotrophic signal from the stomach Akio Inui1 About the author top of page Abstract Ghrelin, an endogenous ligand for the growth hormone secretagogue receptor, is synthesized principally in the stomach and is released in response to fasting. Ghrelin is structurally related to motilin and, together, they represent a novel family of gut-brain regulatory peptides. In addition to having a powerful effect on the secretion of growth hormone, ghrelin stimulates energy production and signals directly to the hypothalamic regulatory nuclei that control energy homeostasis. The study of ghrelin has extended our understanding of how growth is controlled and has shown that the stomach is an impoant component of this system.

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Metformin is NOT effective in lowering of blood sugar level in which of the following patients?

(Ref:KDT 6/e p269) Metformin is the drug of choice for the treatment of obese diabetic patients, as it causes weight loss. It does not cause release of insulin, therefore less chances of hypoglycemia.

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You are conducting a survey in your village and the person you are interviewing is a 32 year old post graduate working as a clerk. His total family income is 20,000 Rs per month. According to Kuppuswamy's socio economic status scale, he belongs to:

Kuppuswamy's socio economic status scale takes into account education, occupation and monthly family income. Since he is a post graduate he gets 6 points for education. His job as a clerk gives him 5 points and a monthly family income of 20000 Rs gives him 12 points which gives him a total of 23 points and so he belongs to upper middle socioeconomic class. Socio economic status Total score Upper socio economic status 26 - 29 Upper middle socioeconomic status 16 - 25 Lower middle socioeconomic status 11 - 15 Upper lower socioeconomic status 5 - 10 Lower socioeconomic status <5 Ref: Park, Edition 21, Page 639

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True regarding the development of ear:

A i.e. Eustachian tube opens at the level of inferior turbinate; B i.e. Pinna develops from the cleft of arch; C i.e. Growth of inner ear completed by 4th monthEustachian tube connects tympanic cavity with nasopharynx. It is about 36cm long in adults and runs downwards, forwards & medially at an angle of 45deg with horizontal from bony tympanic end to slit like pharyngeal end. Tympanic end is in the anterior wall of middle ear, just above the level of floor. While nasopharyngeal end is situated in the lateral wall about 1 -1.25 cm behind the posterior end of inferiro turbinateQ

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Gastric irritation is least with following NSA1D: (PGI June 2008)

Ans. B (Acetaminophen) "Gastric mucosal damageQ: Gastric pain, mucosal erosion/ ulceration and blood loss are produced by all MSAIDs to varying extents: relative gastric toxicity is a major consideration in the choice of MSAIDs. Paracetamol", a very weak inhibitor of COX is practically free of gastric toxicity and selective (misoprosto) administered concurrently with NSAIDsanatgonise their gastric toxicity"- KDT 6th/186Aspirin is acetylsalicylic acid KDT 6th/187

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The concetration of potassium in microgram in ORS is-

Ans. is 'b' i.e., 20 meq

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Abnormal mousy/mushy odour of urine is associated with

Ans. a (Phenylketonuria) (Ref. Harrison's Internal Medicine 17th/Ch. 358)Inborn errors of amino acid metabolism associated with abnormal odourInborn error of metabolismUrine odorGlutaric acidemia (type II)Sweaty feet, acridHawkinsinuriaSwimming poolIsovaleric acidemiaSweaty feet, acridMaple syrup urine diseaseMaple syrup/Burnt sugarHypermethioninemiaBoiled cabbageMultiple carboxylase deficiencyTomcat urineOasthouse urine diseaseHops-likePhenylketonuriaMousy or mustyTrimethylaminuriaRotting fishTyrosinemiaBoiled cabbage, rancid butterTHE HYPERPHENYLALANINEMIAS# result from impaired conversion of phenylalanine to tyrosine.# The most common and clinically important is phenylketonuria (frequency 1:10,000), which is an autosomal recessive disorder characterized by an | concentration of phenylalanine and its by-products in body fluids and by severe mental retardation if untreated in infancy.# It results from | activity of phenylalanine hydroxylase (phenylketonuria type I).# The accumulation of phenylalanine inhibits the transport of other amino acids required for protein or neurotransmitter synthesis, reduces synthesis and increases degradation of myelin, and leads to inadequate formation of norepinephrine and serotonin.# Phenylalanine is a competitive inhibitor of tyrosinase, a key enzyme in the pathway of melanin synthesis, and ac- counts for the hypopigmentation of hair and skin.# Untreated children with classic phenylketonuria are normal at birth but fail to attain early developmental milestones, develop microcephaly, and demonstrate progressive impairment of cerebral function.# Hyperactivity, seizures, and severe mental retardation are major clinical problems later in life.# EEG abnormalities; "mousy" odor of skin, hair, and urine (due to phenylacetate accumulation); and a tendency to hypopigmentation and eczema are devastating clinical picture.# In contrast, affected children who are detected and treated at birth show none of these abnormalities.Treatment# To prevent mental retardation, diagnosis and initiation of dietary treatment of classic phenylketonuria must occur before the child is 3 weeks of age.# Dietary phenylalanine restriction is usually instituted if blood phenylalanine levels are >250 pmol/L (4 mg/dL).# Treatment consists of a special diet low in phenylalanine and supplemented with tyrosine, since tyrosine becomes an essential amino acid in phenylalanine hydroxylase deficiency.# With therapy, plasma phenylalanine cone should be maintained between 120 and 360 pmol/L (2 and 6 mg/dL).# Dietary restriction should be continued and monitored indefinitely..# Pregnancy risks can be minimized by continuing lifelong phenylalanine-restricted diets and assuring strict phenylalanine restriction 2 months prior to conception and throughout gestation.ConditionEnzyme DefectClinical FindingsInheritance1. Phenylketonuria type IPhenylalanine hydroxylaseMental retardation, microcephaly, hypopig- mented skin and hairs, eczema, "mousy" odorAR2. Phenylketonuria type IIDihydropteridine reductaseMental retardation, hypotonia, spasticity, myoclonusAR3. Phenylketonuria type III6-Pyruvoyl- tetrahydropterin synthaseDystonia, neurologic deterioration, seizures, mental retardationAR4. GTP cyclohydrolase I deficiencyGTP cyclohydrolase IMental retardation, seizures, dystonia, temperature instabilityAR5. Carbinolamine dehydratase deficiencyPterin-4-carbinolamine dehydrataseTransient hyperphenylalaninemia (benign)AR

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