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Small cuff size will lead to?

a. Falsely increased BP(Ref: Nelson's 20/e p 2164)In older children, a mercury sphygmomanometer with a cuff that covers approximately two-thirds of the upper part of the arm or leg may be used for blood pressure measurement. A cuff that is too small results in falsely high readings, whereas a cuff that is too large records slightly decreased pressure.

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Ulcer with undermined edges is seen in

Tubercular ulcers typically have undermined edges. Reference: Bailey & Love&;s Sho Practices of Surgery 27th Edition, Page no. 78

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Which of the following is NOT associated with elevation of prostatic specific antigen?

Prostatic Intraepithelial Neoplasia ( PIN) is a precancerous condition; not detected by rectal examination, TRUS , or MRI; does not cause rise in PSA level . It is usually identified after TURP for BPH with final histology or by prostatic biopsy.Reference: page1048 SRB&;s manual of surgery 5th edition

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Muscle relaxant used in renal failure :

B i.e. Atracurium

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Gastrinoma a/w

Diarrhoea is due to hypergastrinaemia.It is associated with severe ulcers,not superficial SRB's manual of surgery,5th edition,710.

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CAGE questionnaire is used in:AP 07; MP 09; NEET 13

Ans. Alcohol dependence

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Which of the following is used in exocytosis?

Ans. (a) CaExocytosis is a calcium dependent process where in the cellular contents are moved out of the cell in the form of vesicles (Cell Vomiting)

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Therapeutic blood range of theophylline in microgram per L is:

Theophylline is having a narrow margin of safety so therapeutic drug monitoring is essential If levels increase more than 20mg/L- side effects occurs ESSENTIAL OF MEDICAL PHARMACOLOGY SEVENTH EDITION KD TRIPATHI PGNO.226

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Lift off test is used for which of the following muscles?

Ans. is 'b' i.e., Subscapularis TestMuscle TestedLift off testSubscapularisJobe testSupraspinatusSpeed testBicepsYergason testBicepsBelly press testSubscapularis

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Which of the following is not a structural element of TMJ?

Sigmoid notch (or) mandibular notch forms the sharp upper border of the ramus the condyle and coronoid process.

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Prognostic stage groups in carcinoma breast include all except

Prognostic stage groups include TNM plus grading, and status of biomarkers HER-2, ER, and PR Ref: AJCC 8th edition

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Arrange the following subtypes of schizophrenia, in order of prognosis, with the best prognosis first and the worst prognosis last, 1. Paranoid schizophrenia2. Catatonic schizophrenia3. Simple schizophrenia4. Disorganised schizophrenia

The correct sequence is Catatonic schizophrenia followed by Paranoid schizophrenia followed by Disorganised schizophrenia followed by Simple Schizophrenia Please remember in both DSM-5 and ICD-11, these subtypes have been removed

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Mammalian Mitochondria are involved in all of the following Except

Protein synthesis is a cytoplasmic process.Fatty acid synthesis stas with the production of Acetyl Co-A within the mitochondria. b-oxidation of fatty acid oxidation also occurs in mitochondria. Mitochondrial DNA synthesis occurs within the mitochondria.

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Cross examination of the prosecution witness is done by-

In government prosecutions, cross examination is done by defense lawyer.

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Thickness of oxygen inhibition layer in composite curing is:

When composite is light cured, oxygen in the air causes an interference in the polymerization resulting in the formation of an oxygen inhibition layer on the surface of the composite.The oxygen-inhibited layer is the sticky, resin-rich uncured layer that is left on the surface.Thickness is about 50-500 micrometer. Reference- Sturdevant 6th ed P:237

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Hassall&;s corpuscles are present in

Inderbir Singh's Human Histology Sixth edition Pg 140 The medulla of thymus contains pink staining rounded masses called the corpuscles of Hassal

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Triamterene causes

Inhibitors of renal epithelial Na+ channel Include Triamterene and amiloride. Triamterene:- It is incompletely absorbed orally, paly bound to plasma proteins, largely metabolized in liver to an active metabolite and excreted in urine. Plasma t 1/2 is 4 hours, effect of a single dose lasts 6-8 hours. Side effects:- consist of nausea, dizziness, muscle cramps and rise in blood urea. Impaired glucose tolerance and photosensitivity are repoed, but urate level is not increased. Ref:- kd tripathi; pg num:-590

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Persistent vomiting in G.O.O. causes -a) Hyponatremic hyperchloremia occurb) Hypernatremia without ↓ed Cl- alkalosisc) Hypokalemic metabolic alkalosisd) Paradoxical aciduria

Repetitive vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria) Cause of paradoxical aciduria Initially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions, thus the urine becomes acidic and metabolic alkaline state is further aggravated.

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All are immediate causes of death in burns except

Immediate causes of death in burns Shock Suffocation Injury Delayed causes of death Toxemia Inflammatory complications Ref: TEXTBOOK OF FORENSIC MEDICINE AND TOXICOLOGY KRISHNAN VIJ FIFTH EDITION PAGE 163

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Mucositis is caused by:

Flurouracil is used mainly for solid malignancies,i.e colon, rectum, pancreas, liver, urinary bladder, head, and neck. Genetic deficiency of dihydropyridine dehydrogenase(DPD) leads to Fluorouracil toxicity. Major toxicity is myelosuppression, mucositis, diarrhea, nausea, vomiting, peripheral neuropathy (hand-foot syndrome)also occurs. Other given drugs are anti-cancerous drugs without mucositis. ESSENTIALS OF MEDICAL PHARMACOLOGY-SEVENTH EDITION-K.D TRIPATHI Page; 864

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Complications of therapy with radioactive iodine includes -

Ans. is 'b' i.e. Hypothyroidism

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Uterine souffle :

Ans. is b i.e. Is due to increase in blood flow through the dilated uterine vessels Uterine souffle is a soft blowing systolic murmur The sound is synchronous with maternal pulse It is due to increase in blood flow through the dilated uterine vessels Heard low down at the sides of the uterus, best on the left side It can also be heard in big uterine fibroid. Note Soft blowing murmur synchronous with the fetal hea sound is called Fetal / Funic souffle.

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Investigation of choice in bronchiectasis is

HRCT chest is more specific for bronchiectasis and is the imaging modality of choice for confirming the diagnosis.CT findings include airway dilation(detected as parallel "tram tracks" or as the "signet-ring sign"-a cross sectional area of the airway with a diameter at least 1.5 times that of the adjacent vessel),lack of bronchial tapering(including the presence of tubular structures within 1 cm from the pleural surface.),bronchial wall thickening in dilated airways,inspissated secretions (eg.,the " tree-in-bud" pattern ),or cysts emanating from the bronchial wall(especially pronounced in cystic bronchiectasis.) Reference:Harrison's medicine-18th edition,page no:2143.

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False about hepatic adenoma-

Ans. is 'c' i.e., Older females o Hepatic adenomas are benign solid neoplasms of liver.MC seen in younger females (20-40 years of age)Usually solitaryRisk factor - Prior/current use of estrogens (OCP)o Clinical FeaturesPatients usually present with upper abdominal pain.Physical examinated is usually unrevealing,o Microscopic FeaturesCords of congested or Fat laden hepatocvtes-absent biliary ductules or normal liver architecture,o DiagnosisCT Scan - Well circumscribed heterogenous mass showing early enhancement during arterial phase.MRI Scan - Hyperintense on T, weighted image and enhance early after gadolinium injection,o Isotope Scan - Hepatoma appears cold.o ComplicationsRupture with intraperitoneal bleeding.Malignant transformation (rare) - to HCCo TreatmentHepatic artery embolisation.Resection.

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Renal threshold for serum glucose level-

Ans. is 'b' i.e., 200 mg/dl * The transport maximum for glucose is 375 mg/min whereas the filtered load of glucose is only 125 mg/min.* Therefore, in normal conditions 100% of glucose is reabsorbed in proximal tubules.* When plasma glucose concentration is 100 mg/dl the filtered load is at its normal level, 125 mg/min, there is no loss of glucose in the urine.* However, when the plasma concentration of glucose rises above about 200 mg/dl, increasing the filtered load about 250 mg/min, a small amount of glucose begins to appear in the urine.* This point is termed as threshold for glucose.* Note that this appearance of glucose in the urine occurs before the transport maximum is reached.* The reason for the difference between threshold and transport maximum is that not all nephron have same transport maimum for glucose, and some of the nephron therefore begin to excrete glucose before others have reached their transport maximum.* The overall transport maximum for the kidneys, which is normally about 375 mg/min, is reached when all nephrons have reached their maximal capacity to reabsorb glucose.* That means, above filtered load of 250 mg/min of glucose, some glucose will appear in the urine (threshold level), whereas above filtered load of 375 mg/min, all the glucose will be excreted because all the nephrons have reached to their transport maximum.* Thus, Renal threshold for glucosei) At plasma levels - 200 mg/dlii) At filtered load - 250 mg/min

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A 9-year-old boy diagnosed as uncomplicated pulmonary tuberculosis. He is put on isoniazid, rifampin, and ethambutol at home after initial treatment given at hospital. Which is accurate statement for this scenario?

Prophylaxis with INH is always advisable for family members and close contacts in active cases. None of the drugs prescribed is associated with nephrotoxicity. Polyahralgia is a side effect of pyrazinamide that's not given in this case. Routine LFTs should be done in younger patients if INH plus rifampin given in higher doses. Ocular Function test should be done before staing ethambutol.

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Functional unit of muscle:

Functional unit of muscle is : sarcomere It is the pa of myofibril present between two succsive z lines. Ref: Guyton and Hall textbook of medical physiology 12th edition, page number:86,87

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Cause of exudative retinal detachment are:

Ans. All

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A 47-year-old man suddenly develops high fever and hypotension. He has a generalized erythematous macular rash, and over the next day, develops gangrene of his left leg. Which of the following is the most likely organism?

Streptococcus group A can cause a toxic shock-like syndrome, and has been increasing in frequency in North America. Streptococcal toxic shock-like syndrome was so named because of its similarity to staphylococcal toxic shock syndrome. The illness includes fever, hypotension, renal impairment, and the respiratory distress syndrome. It is usually caused by strains that produce exotoxin. It may be associated with localized infection as well; the most common associated infection is a soft tissue infection such as necrotizing fasciitis. The mortality is high (up to 30%), usually secondary to shock and respiratory failure. The rapid progression of the disease and its high mortality demand early recognition and aggressive treatment. Management includes fluid resuscitation, pressor agents, mechanical ventilation, antibodies, and, if necrotizing fasciitis is present, surgical debridement.

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Which of the following is the most common cause of emergency depament visit related to LSD and its related substances?

The most frequent acute medical emergency associated with LSD use is a panic episode (the "bad trip"), which may persist up to 24 h.A trip is a period of intoxication from a hallucinogenic drug, such as lysergic acid (LSD) or magic mushrooms (psilocybin). It is called a trip because perceptions of the world change so dramatically, it can feel as if a trip to a strange, new land is taken. Unpleasant experience of hallucinogen intoxication is known as a bad trip.Harrison 19e pg: Cocaine and Other Commonly Abused Drugs

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Bilateral destruction of auditory cortex in man causes

(C) Deficiency in interpretation of sounds # Lesion of auditory cortex leads to loss of recognition of total patterns with loss of analysis of properties of sound and sound localisation.> Thus lesion of auditory cortex leads to defect in interpretation of sounds.

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The following infection resembles malignancy -

Ans. is 4b' i.e., E. multilocularis o The chief character of E. multilocularis cyst is its tendency to proliferate, thereby resembling a neoplasm.Hydatid disease of liver is caused byo Echinococcus granulosuso Echinococcus multiloculariso Echinococcus vogeli- Unilocular cystic lesions- Multi locular alveolar hydatid cyst- Polycystic hydatid disease.

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A 1 year old child is brought to you with delayed milestones. On examination you note that the child is very fair with hypopigmented hair and blue eye. He has also got eczemas. The child was also very irritable. What is your diagnosis?

This child is suffering from Phenylketonuria. Here there is inability to conve phenylalanine to tyrosine due to phenylalanine hydroxylase deficiency. The decreased pigmentation in this condition is due to reduced melanin formation. The treatment is a diet low in phenylalanine with tyrosine supplementation. Delay in initiation of treatment will lead to mental retardation. Ref: Essential revision notes for MRCP by Philip A Kalra, Edition 3, Page - 322 ; Harrison, Edition 17, Page - 2470

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Incomplete closure of palpebral apeure is called: March 2004

Ans. A i.e. Lagophthalmos

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Galactokinesis means :

Ejection of milk

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Serological testing of patient shows HBsAg, IgM Anti-HBc and HBeAg positive . The patient has-

HBs Ag is the first marker appear in the blood after infection. Anti HBc is the earliest antibody seen in blood. HBeAg indicates infectivity REF:MICROBIOLOGY ANANTHA NARAYANAN NINTH EDITION PAGE.546&547

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All of the following are seen in GH deficiency except?

From late in the first year until mid-teens, poor growth and/ or shoness is the hallmark of childhood GH deficiency. It tends to be accompanied by delayed physical maturation so that bone maturation and pubey may be delayed by several years. Severe GH deficiency in early childhood also results in slower muscular development, so that gross motor milestones may be delayed. Some severely GH-deficient children have recognizable, cherubic facial features characterized by maxillary hypoplasia and forehead prominence. These children have a high pitched voice and are stunted. GH deficiency is associated with hypoglycemia. In contrast gigantism or acromegaly is associated with impaired glucose tolerance.

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Hydatidiform - mole, characterized histologically by

(Hydropic degeneration of the villous storma): Ref: 193-97, 201-DHYDATIDIFORM MOLE (Vesicular mole) - It is an abnormal condition of placenta where there are partly degenerative and partly proliferative changes in the young chorionic villi.* It is best regarded as a benign neoplasm of the chorion with malignant potential* Vaginal bleeding is the commonest presentation (90%) "white currant in red currant juice"* Expulsion of grape like vesicles (rich in HCG) per vaginum is diagnostic of vesicular mole* Histology shows - hydropic degeneration of the villous stroma with absence of blood vessels and trophoblastic proliferationRISK FACTORS FOR MALIGNANT CHANGE* Patient above the age of 40 irrespective of parity* Patients having previous 3 or more births irrespective of age. Age is more important than the parity* Initial serum hCG > 100,000 mIU/ml* Uterine size >20 weeks* Previous history of molar pregnancy* Large (> 6 cm) thecaleutin cystsImportant features of complete and Partial molesFEATURESCOMPLETE (CLASSIC) MOLEINCOMPLETE* Embryo/fetusAbsentPresent* Hydropic degeneration of villiPronounced and diffusedVariable and focal* Trophoblast hyperplasia * Uterine sizeDiffuseFocal* Theca leutin cystsMore than the date (30 - 60%)Less than the date* KaryotypeCommon (25 - 50%)Uncommon* phCG46 XX (85%) Paternal in originTriploid (90%) diploid (10%)* Classic clinical symptomsHigh (> 50, 000)CommonSlight elevation (< 50,000)Rare* Risk of persistent gestational trophoblastic neoplasia (GTN)20%<5%

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The nerve impulse which leads to initiation of smooth muscle contraction

Ans. (a) Cause opening of the calcium channel which leads to increase in Ca2+ contraction(Ref: Ganong, 25th ed/p.116)The never impulse which leads to initiation of smooth muscle contraction Cause opening of the calcium channel which leads to increase in Ca2+ contraction

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In a family, the father has widely spaced eyes, increased facial hair and deafness. One of the three children has deafness with similar facial features. The mother is normal. Which one of the following is most likely pattern of inheritance in this case?

A i.e. Autosomal dominant (most likely) Waardenburg's Syndrome (WS) is a rare autosomal dominant syndrome characterized by pigmentary disturbances (skin, hair, iris), sensorineural hearing loss, and other developmental anomalies such as dystopia canthorum (widely spaced eyes) and blepharophimosis. The syndrome that closest matches the features provided in the question is Waardeburg syndrome type-I. This is inherited as an autosomal dominant fashion and hence is the answer of exclusion. As the question does not provide us with details as to the sex of the three children, a sex linked inheritance pattern cannot be worked out. Also the combined presentation of an affected father, unaffected mother and one affected child among three children is possible with both an autosomal dominant and an autosomal recessive inheritance pattern. In absence of any more details, the answer to this question cannot be deduced through the exploration of various permutations and combinations. How both autosomal dominant and autosomal recessive inheritance can be responsible for the above combination: Autosomal Dominant Autosomal recessive (A-affected allele and a normal allele) If the disease is transmitted in an Autosomal Dominant then :Father (affected) will be either 'AA' or 'Aa' Mother (unaffected) will be 'aa' If father is AA and mother aa, the offsprings will be 1. aA - 100% affected If father is Aa and mother aa, the offsprings will Aa - 50% affected aa - 50% not affected The scenario in the above question therefore is possible autosomal dominant inheritance if father is Aa and mother is aa (A'-affected allele and 'a' normal allele) If the disease is transmitted in an Autosomal recessive form :Father (affected) will be 'AA' Mother (unaffected) may be 'aa' or 'Aa' If father is AA and mother aa, the offsprings will be 1. aA - 100% not affected, (but carriers) If father is AA and mother Aa, the offsprings will be Aa - 50% not affected, carrier AA - 50% affected The scenario in the above question therefore is possible with autosomal recessive inheritance if father is aa and mother is Aa

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All of the following statements about Heparin are true, except:

Heparin inhibits the production of aldosterone. It thus lead to severe Hyperkalemia and not hypokalemia as mentioned in the choice above. Ref: Harrison's Textbook of Internal Medicine, 16th edition, Page 1261; K D Tripathi Textbook of Pharmacology, 5th Edition, Pages 561-63

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Tigroid white matter on MRI is seen in?

The tigroid pattern/ leopard skin sign occurs on MRI head is seen in Pelizaeus-merzbacher disease, due to creation of islands of perivascular myelin due patchy myelin deficiency. It is a rare hypomyelination syndrome caused by mutation in proteolipid protein, PLP 1 gene at chromosome Xq22. Child will show slow psychomotor development with nystagmus(pendular eye movements), hypotonia, extrapyramidal symptoms and spasticity. Tigroid pattern is also seen in metachromatic leucodystrophy.

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Which of the following is the Nysten's law

In rigor mois, all muscles of body, both voluntary and involuntary are involved. Externally it first appears in the eye lids, then lower jaw, muscles of the face, neck upper limbs and lastly lower limbs. This descending pattern or proximodistal progression is called Nysten's law. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 26

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If a drug is active against the pre-erythrocytic stage of the malarial parasite it will be useful as a:

If a drug is active against the pre-erythrocytic stage of the malarial parasite it will be useful as a Causal prophylactic. Stage killed Clinical Use Pre-erythrocytic Causal Prophylaxis Erythrocytic Clinical cure Suppressive Prophylaxis Exo-erythrocytic Radical cure Gametocytic Prevention of transmission

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All are true statement about tracheostomy and larynx in children except:

Infant's larynx differs from adult in:It is situated high up (C2 - C4).Q (in adults = C3 - C6)Of equal size in both sixes (in adults it is larger in males)Larynx is funnel shapedThe narrowest pa of the infantile larynx is the junction of subglottic larynx with trachea and this is because cricoid cailage is very smallEpiglottis is omega shaped, soft, large and patulous.Laryngeal cailages are soft and collapse easilySho trachea and sho neck.Vocal cords are angled and lie at level of C4Trachea bifurcates at level of T2Thyroid cailage is flat. The cricothyroid and thyrohyoid spaces are narrow.Tracheostomy in Infants and Children Trachea of infants and children is soft and compressible and its identification may become difficult and the surgeon may easily displace it and go deep or lateral to it injuring recurrent laryngeal nerve or even the carotid.During positioning, do not extend too much as this pulls structures from chest into the neck and thus injury may occur to pleura, innominate vessels and thymus or the tracheostomy opening may be made twoo low near suprasternal notchTracheostomy in Infants and Children The incision is a sho transverse one, midway between lower border of thyroid cailage and the suprasternal notch. The neck must be well extended.A incision is made through two tracheal rings, preferably the third or fouh.

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Drug NOT used in pulmonary hypeension is?

alpha blockers Pulmonary hypeension General management Diuretic therapy may be useful as it relieves pulmonary edema. Anticoagulant therapy is advocated for all patients. Specific management Calcium channel blockers Patients who have substantial reductions in pulmonary aerial pressure in response to sho acting vasodilators at the time of cardiac catheterization should he initially treated with calcium channel blockers. Endothelin receptor antagonist Bostenan is a non-selective endothelium receptor antagonist, is an approved t/t ,for patients who are NYHA .functional classes III and IV. Phosphodiesterase-5 inhibitors Slidenafil is used for patients who are NYHA functional classes II and Prostacyclins Iloprost is a prostacyclin analogue used in PAH patients who are NYHA functional classes III and IV. Pulmonary circulation is unique in that it accommodates a blood flow that is almost equal to that of all the other organs of body but still maintains low pressure. The factors responsible for low pressure in pulmonary circulation (even with large volume of blood) are:- - Larger diameter of pulmonary vessels due to thin wall of pulmonary aery and aerioles.

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Which of the following is a good prognostic factor in ALL:

Answer is D (Hyperdiploidy): Hyperdiploidy is associated with a good prognosis Hyperdiploidy is associated with a good prognosis Patients with hyperdiploidy (>50 chromosomes) or DNA index > 0.16 have a ourable prognosis - Age < 2 years has a poor prognosis Patients who are very young (< 2 years) and older patients (> 10 years) tend to have a worse prognosis- lthough most textbooks use the criteria of Age < 1 year to define a poor prognostic factor, Age < 2 year has been mentioned as a poor prognostic factor in ceain textbooks including Hoffman's Hematology (4th/1158) Since Hyperdiploidy provided amongst the option is an established good prognostic factor, this is selected as the single best answer of choice. High WBC count is associated with a poor prognosis Initial leukocyte count at diagnosis has proved to be an impoant prognostic factor in viually every ALL study. Different studies (textbooks) quote different values for the initial WBC count that is associated with a poor prognosis but uniformly a high WBC count carries a poor prognosis. Different text books Favourable WBC count Unourable WBC count Wintrobe's Hematology < 10,000 > 20,000 Hoffman Hematology < 50,000 > 50,000 Manual of Clinical oncology <30,000 >30,000 Inference Low WBC count High WBC count Male sex is associated with a poor prognosis 'Female patients have a rare ourable prognosis'

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A 28 year old labourer, 3 yrs back presented with penile ulcer which was not treated. Later he presented with neurological symptoms for which he got treated. Which is the test to monitor response to treatment?

This is a case of neurosyphilis. A positive nontreponemal CSF serologic test result (CSF VDRL) establishes the diagnosis of neurosyphilis (and an increased cell count in response to the spirochete documents the presence of active disease). In VDRL test, the inactivated serum is mixed with cardiolipin antigen on a special slide & rotated for 4 minutes. Cardiolipin remains as uniform crystals in normal serum but it forms visible clumps on combining with regain antibody. The reaction is read under low power microscope. By testing serial dilutions, the antibody titre can be estimated. The results are repoed as reactive, weak by reactive / not reactive. The VDRL test can be used for testing CSF also, but not plasma. A number of modification of VDRL test have been developed, of which the Rapid Plasma Reagin (RPR) is the most popular. In RPR test. VDRL antigen containing carbon paicles which make the result more clear cut & evident to the naked eye The RPR test is done with unheated serum / plasma but is not suitable for testing CSF. Ref: Ananthanarayanan & Paniker's textbook of microbiology Ed 8 Pg - 375; Klausner J.D., Hook III E.W. (2007). Chapter 20. Neurosyphilis. In J.D. Klausner, E.W. Hook III (Eds), CURRENT Diagnosis & Treatment of Sexually Transmitted Diseases.

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70 year old man has abdominal pain with mass inabdomen. Angiography reveals aneurysm of aoa. Mostlikely cause is:

. Atherosclerosis

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Which of the following is false regarding neonatal resuscitation?

1. T - tube delivers free flow oxygen - TRUE 2. Self - inflating bag should not be used without reservoir - FALSE - can be used but FiO2 will be less. 3. Self - inflating bag can deliver free flow oxygen - TRUE 4. Flow inflating bag delivers free flow oxygen - TRUE

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The most impoant prognostic factor of Wilms tumor-

Robbins basic pathology 10th edition page no 290. Wilms tumor or nephroblastoma is the most common primary tumor of the kidney in children. On microscopic examination, Wilms tumors are characterized by recognizable attempts to recapitulate different stages of nephrogenesis. The pattern of anaplastic cells within the primary tumor has impoant implications for prognosis.

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The relationship of mean height of two group of children is best studied by-

.

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Advantage of brachytherapy – a) Non-invasiveb) Less radiation hazard to normal tissuec) Max.radiation to diseased tissued) Can be given in all malignanciese) Doesn't require trained personnel

As the radiotherapy source is placed directly in contact with tumor, maximum radiation exposure occurs to tumor tissue with relative sparing of adjacent normal tissue. Brachytherapy is invasive and requires trained personnel. Brachytherapy can be used in most (not all) of the malignancies where radiotherapy is the component of treatment.

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Acyl carnitine functions in:

Ans: a (Transport of long....) Ref: Vasudevan, 4th ed, p. 129The long chain fatty acyl CoA cannot pass through the inner mitochondrial membrane. There fore a transporter, carnitine is involved in transfer of fatty acids.Beta oxidation:Beta oxidation is absent in brain and erythrocytes (because erythrocytes lack mitochondria and fatty acids do not cross BBB).Carnitine acyl transferase -1 is inhibited by Malonyl CoA.Clinical correlate:Carnitine acyl transferase(CAT) deficiency (myopathic form)Although all tissues contain CAT most common form of genetic deficiency is myopathic form and due to a defect in muscle specific CAT gene.Features:Muscle aches, red urineRhabdomyolysis, myoglobinuriaProvoked by exerciseIncreased by high fat; low carbohydrate dietMuscle biopsy: increased muscle triglyceride in cytoplasmTreatment: Cease muscle activity, give glucose.

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Fatal period in sulphuric acid poisoning is :

C i.e. 12 -16 hours

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Most common method of anterior capsulotomy in phacoemulsification

Answer- C. CapsulorhexisThe most commonly used technique for anterior capsulotomy during phacoemulsification is continuous curvilinear capsulorhexis (CCC).

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A 26 year old female patients presents to emegency with history of consuming hair dye paraphenylenediamine . What shall be the expected outcome in such patient ?

Hair dye poisoning(Paraphenylenediamine ): Cost-effective alternative to Organophosphate poisoning Readily available to masses. Clinical manifestations are Angioedema leading to dysphasia and respiratory distress, Rhabdomyolysis, Intravascular hemolysis, Acute renal failure and hepatic necrosis. Myocarditis or fatal arrhythmia may also occur in PPD poisoning. Mainstay of management is early recognition and suppoive measures as there is no specific antidote

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Generally, radiotherapy should not be used for treating benign conditions. The only possible exception being:

Ans. B. Extensive pigmented villonodular synovitisPVNS is commonly seen around knee. Synovial inflammation occurs due to cholesterol and pigment deposition. Radiotherapy may alleviate this disease. Else one has to go with synovectomy. Malignant transformation is reported but very rare.SYNOVIAL SARCOMA is a soft tissue tumor that does not have synovial origin despite its name. It is a rare but aggressive tumor that arises from tendon sheaths or joint capsules where there are multipotent stem cell rests that differentiate into mesenchymal as well as epithelial structures, hence a BIPHASIC TUMOR. It is characterized by Ctrl (X;18). Excision is the treatment of choice.

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Blockade of nerve conduction by a local anaesthetic is characterized by -

Ans. is 'b' i.e., Need to cross the cell membrane to produce the block Penetration of axonal membrane by L.A. o Local anaesthetics are weak bases and are used in the form of acid salts (usually HCL). o They penetrate the axoplasmic membrane in unionized form (unionize molecules are lipid soluble and diffusible). o Inside axon they becomes ionized and act from inside of Na+ channel. Sodium bicarbonate speeds the onset of action of LAs by increasing the unionized form (weak bases are unionized at alkaline pH). About other option Stimulated fibers are blocked rapidly (not resting fibers) Smaller fibers are more sensitive than larger o LA does not effect resting membrane potential as it does not block the Na+ channel in resting state (see above explanantion). LA inhibits depolarization as it prolonges the inactive state and prolongs the refractory period.

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Presence of spiral grooves in the barrel of weapon is referred to as:

Ans. (A). RiflingShotgunRifled gunCHOKING:* The terminal few cms (7-10) is constricted in shot guns.* Reduces the pelletsdispersionQ* Increases the explosive forces of the pellets.* Increases the velocity of the pellets.RIFLING:* Interior of bore has spiral grooves which run parallel to each other, but twisted spirally from breech to muzzle end.* These grooves are called 'rifling'* Imparts Spinning motion to the bulletQ* Greater power of penetration.* Straight trajectory* Increases accuracy & rangeFully choked shotgun - Least dispersion of pelletsUnchoked shotgun - Maximum dispersionQ of pellets. Paradox gun: A smooth bore gun with small terminal part rifled.Bullets that impart great tissue destruction:Soft nosed bullet that flatten on impactDum Dum bulletBullets that fragment (frangible bullet)Bullets that mushroom on impact

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Duhamel procedure is done for -

Ans. is 'a' i.e., Hirschsprung's disease * Surgery in Hirschsprung's disease aims to remove the aganglionic segment and 'pull-through' ganglionic bowel to the anus (e.g. Swenson, Duhamel, Soave and transanal procedures) and can be done in a single stage or in several stages after first establishing a proximal stoma in normally innervated bowel.

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Post coital test showing non motile sperms in the cervical smear and Motile sperms from the posterior fornix suggests :

Ans. is a i.e. Immunological defect Post coital test is a test for evaluation of the potential role of cervical factor in infeility. The couple is advised intercourse close to ovulation time, in the early hours of morning (preferably) The woman presents herself at the clinic within 2 hours after the intercourse. The mucus is aspirated from the cervical canal and posterior fornix (acts as control) and spread over a glass slide. Result : 10-50 motile Sperms with progressive movement/ HPF in cervical mucus seen Cervical factor ruled out Less than 10 sperms / HPF Need for proper semen analysis to see oligospermia Sperms immotile in mucus aspirated from cervical canal and motile in specimen from posterior fornix or Rotatory/ shaky movement seen in sperms aspirated from cervical canal Immunological defect

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Which of the following is a first-generation Cephalosporin used for surgical prophylaxis?

First-Generation Cephalosporins: include - Cefazolin, Cephalexin, Cephradine, Cefadroxil, Cephalothin and Cephapirin Cefazolin is good for skin preparation as it is active against skin infections from S.pyogenes and MRSA. It is administered Intramuscular or Intravenous (i.e Parenteral drug).It is a drug of choice for surgical prophylaxis.Cefazolin does not penetrate the CNS and cannot be used to treat meningitis. Cefazolin is better tolerated than Antistaphylococcal Penicillins, and it has been shown to be effective for serious Staphylococcal infections e.g Bacteremia. Oral First generation drugs may be used for the treatment of urinary tract infections and Staphylococcal or Streptococcal infections, including cellulitis or soft tissue abscess.

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"Birbeck granules" are seen in

"Tennis racket" shaped Birbeck granules are seen in Langerhan cells, which are antigen presenting cells present in epidermis.

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For each extra-articular manifestation of RA, select the most likely diagnosis.Associated with increased frequency of infections.

Felty syndrome consists of chronic RA, splenomegaly, and neutropenia. The increased frequency of infections is due to both decreased number and function of neutrophils.

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Bakers cyst is a type of:

Baker's cyst:- It is a pulsion diveiculum of knee joint.- It usually found in the posterior aspect of the knee joint.- It is associated with medial meniscal injury.

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Most common cranial nerve involved in ophthalmoplegic migraine is:

Ans. III nerve

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Position of wrist in cast of colle's fracture is:

A . i.e. Palmar detion & pronation

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Neonate triangular cord sign on USG is seen in -

Ans. is 'b' i.e., Biliary atresiao Triangular cord sign is seen in biliary ateria due to fibrosis.

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Surgery for elective hemicolectomy for carcinoma colon is described as -

Ans. is 'b' i.e., Clean contaminated

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Concentration of adrenaline used with lidocaine is?

(334) 1 in 200000 REF: Miller 6th ed p. 589 USES AND DOSES OF ADRENALINE: USE DOSE Anaphylaxis SC or IM injection is 0.3-0.5 mg 1:1,000 Croup Racemic adrenaline is a 1:1 mixture of the dextrototary (d) and levorotatory (1) isomers of adrenaline Local anesthetics 1 in 200000

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Patient on treatment on carbidopa + levodopa for 10 yrs now has weaning off effect. What should be added to restore action -

Ans. is 'a' i.e., Tolcapone o Both entacapone and tolcapone enhance and prolong the therapeutic effect of levodopa-carbidopa in advanced and fluctuating parkinsons disease. They may be used to smoothen off the 'wearing off', increase 'on' time and decrease loff' time, improve activities of daily living and allow levodopa dose to be reduced,o Treatment of on - off phenomenon in parkinsonism:Add one or two additional doses of levodopa.Continuous delivery of levodopa in duodenum.Avoid proteins in diet.Controlled release oral levodopa.'' peripheral decarboxylase inhibitor.Use of subcutaneous apomorphine.

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A 33-year-old man has never been vaccinated for hepatitis B. Serologic tests reveal negative hepatitis B surface antigen (HBsAg) and positive antibody to surface antigen. Which of the following conditions does this serologic pattern best fit with?

The antibody can be demonstrated in 80-90% of patients, usually late in convalescence, and indicates relative or absolute immunity. In contrast, HBsAg occurs very early and disappears in < 6 months. Persistence of HBsAg indicates chronic infection. The pattern in this patient is also seen postvaccination, and perhaps as a consequence of remote infection.

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Which of the following is seen in cystic fibrosis?

b. Elevated sweat chloride levels(Ref: Nelson's 20/e p 2100)Because the function of sweat gland duct cells is to absorb rather than secrete chloride, salt is not retrieved from the isotonic primary sweat as it is transported to the skin surface; chloride and sodium levels are consequently elevated. So sweat chloride is usually 60mEq/L in cystic fibrosis.

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All of the following are true for retinopathy of prematurity except:

Ans. Occurs in premature infants due to late crying

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The diagnosis of diabetes mellitus is ceain in which of the following situations?

The occurrence of hyperglycemic ketoacidosis or hyperglycemic hyperosmolar coma is diagnostic of diabetes mellitus. Similarly, persistent fasting hyperglycemia , even if it is asymptomatic, has been recommended by the National Diabetes Data Group as a criterion for the diagnosis of diabetes. However, abnormal glucose tolerance-whether after eating or after a standard "glucose tolerance test" -can be caused by many factors (e.g., anxiety, infection or other illness, lack of exercise, or inadequate diet). Similarly, glycosuria may have renal as well as endocrinologic causes. Therefore, these two conditions cannot be considered diagnostic of diabetes. Gestational diabetes is diagnosed in women between the twenty-fouh and twenty-eighth weeks of gestation, first using a 50-g oral glucose load if the I-h glucose level >7.8 mmol/L (140 mg/dL); a 100-g oral glucose test is performed after an overnight fast. Gestational diabetes is initially treated with dietary measures; if the postprandial glucose level remains elevated, insulin therapy is often staed. About 30% of women with gestational diabetes will eventually develop true diabetes mellitus.

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Features of alcohol withdrawl are all EXCEPT: March 2013

Ans. D i.e. Hypersomnolence Alcohol and psychiatry Wernicke's encephalopathy involves: Mammilary bodies Korsakoff's syndrome presents as: - Profound and persistent anterograde amnesia and Confabulation Feature of alcoholic paranoia: Hallucination Questionarrie used: CAGE Alcohol withdrawl: - Visual and tactile hallucination (hangover), - Delirium tremens - MC symptom of alcohol withdrawl; Disorientation, Anxiety, Perceptual defect; Chlordiazepoxide is used for management

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The opercular poion of the cerebral coex that contains Broca's area is which of the following?

Motor speech area of Broca (Brodmann's area 44, 45) occupies the opercular and triangular poions of the inferior frontal gyrus of the dominant hemisphere. Broca's area is formed of two minor gyri, called pars opercularis and pars triangularis, that lie in the posterior end of the inferior frontal gyrus. This area subserves expressive language function.

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Autopsy is known by all names except ?

Ans. is 'c' i.e., Biopsy An autopsy (also known as a post-moem examination, obduction, necropsy, or autopsia cadaverum) is a highly specialized surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause and manner of death and to evaluate any disease or injury that may be present.

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Which of the following has strongest association with osteosarcoma?

Retinoblastoma and osteosarcoma both can occur due to mutation in common gene i.e RB gene. Hence both have strongest association.

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Most useful for sex determination is: Kerala 08

Ans. Pelvis

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Features of shock

In early clinical septic shock, renal function was lower, which was accompanied by renal vasoconstriction, a lower renal oxygen delivery, impaired renal oxygenation, and tubular sodium reabsorption at a high oxygen cost compared with controls decrease or decline in the GFR implies progression of underlying kidney disease or the occurrence of a superimposed insult to the kidneys. This is most commonly due to problems such as dehydration and volume loss. An improvement in the GFR may indicate that the kidneys are recovering some of their function Ref Davidson 23rd edition pg 460

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DOC for listeria meningitis:

Ans. is 'a' i.e., Ampicillin Treatment of listeria infectiono The antibiotic of choice for listeria infection is ampicillin or penicillin G.Antibiotic regimens for listeria infection||||First line regimensPenicillin allergic patientsAlternative drugso Ampicillin or Penicillin is the drug of choiceo Trimethoprim sulphame- thoxazoleo Imipenem and meropenemo Other antibiotic that are less effective# Vancomycin# Erythromycin# Chloramphenicol

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All of the following statements about neuromuscular blockage produced by succinylcholine are true, except:

Succinylcholine is a depolarizing neuromuscular blocker. With succinylcholine no fading is observed after train of four or tetanic stimulation. All four stimulatory responses after TOF stimulation are suppressed to the same extent. REF : Smith and atkenhead 10th ed

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A man is stuck with lathi on the lateral aspect of the head of the fibula. Which of the following can occur as a result of nerve injury

The common peroneal nerve is extremely vulnerable to injury as it winds around the neck of the fibula if that happens, clinical features are:Motor loss-a)The foot drop is due to paralysis of muscles of anterior compament of the leg (dorsiflexors of the foot) {dorsiflexion not possible}.b)Loss of extension of toes due to the paralysis of extensor digitorum longus & extensor hallucis longus.c)Loss of eversion of the foot due to paralysis of peroneus longus & brevis.Sensory loss- Sensory loss on the anterior aspect of the leg & whole of the dorsum of foot except the cleft between the great & second toes, which is supplied by the branch from the deep peroneal nerve.

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Contraception with increased risk of actinomycosis -

Ans. is 'c' i.e., IUCD o Actinomycosis may occur by use of IUCD.Side effects and complications of lUDs1. Bleeding - Most common2. Pain - Second major side effect3. Pelvic infection - PID4. Uterine perforation5. Pregnancy6. Ectopic pregnancy7. Expulsion8. Mortality' - extremely rare

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A six year old male baby presents to a hospital with recurrent gross hematuria for 2 years. There is no h/o burning micturition or pyuria. Urine routine examination demonstrated no pus cells and urine culture was sterile. Serum C3 levels were normal. What is the most probable diagnosis-

Wilms tumor is a rare kidney cancer that is highly treatable. Most kids with Wilms tumor survive and go on to live normal, healthy lives. Also known as nephroblastoma, Wilms tumor can affect both kidneys, but usually develops in just one Wilms' Tumor; Nephroblastoma) Wilms tumor is an embryonal cancer of the kidney composed of blastemal, stromal, and epithelial elements. Genetic abnormalities have been implicated in the pathogenesis, but familial inheritance accounts for only 1 to 2% of cases. Diagnosis is by ultrasonography, abdominal CT, or MRI The AMER1 gene is located on the X chromosome (one of the two sex chromosomes), so when Wilms tumor is caused by mutations in this gene, the condition follows an X-linked dominant pattern Ref Harrison20th edition pg 233

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Diagnosis of carcinoid tumors is done by:

Answer is A (5HIAA): The diagnosis of typical carcinoid tumors is done by measurement of 5HIAA levels. Diagnosis of Carcinoid Tumors (Harrison) The diagnosis of carcinoid syndrome relies on measurement of urinary or plasma serotonin or its metabolites in the urine. Typical carcinoid syndrome (high level of serotonin) is characterized by high levels of 5HIAA. The measurement of 5HIAA is most frequently used for typical carcinoid syndrome. Most physicians' only use urinary 5HIAA levels / excretion rates however plasma and platelets serotonin levels if available provide additional information. Platelet serotonin levels (5-HT) are more sensitive than urinary 5HIAA levels but are not generally available. Atypical carcinoid syndromes (low levels of serotonin) may have normal or minimally elevated 5HIAA levels. In such patient's urinary levels of other tryptophan metabolites such as 5HTP should be measured. Elevated levels of urinary 5 HTP is suggestive of an atypical carcinoid syndrome.

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A 6 years child has foreign body in trachea .Best initial management is

Ans. is 'a' i.e.Heimlich's maneuver The best option here is Heimlich's maneuver."Heimlich man oeuvre: stand behind the person and place your arms around his lower chest and give four abdominal thrusts. The residual air in the lungs may dislodge the foreign body providing some airway. "Heimlich's maneuveris actually performed for laryngeal foreign bodies and not for tracheal or bronchial foreign bodies.Heimlich's is performed for completed obstruction and should not be tried in partial obstructions (for fear of causing total obstruction )If Hemlocks m fails then cricothyrotomy or emergency tracheostomy is done.Once the emergency is over, foreign body can be removed by direct laryngoscopy or by laryngofissure (if body is impacted )Tracheal & Bronchial foreign bodiesEmergency removal is not indicated in these ( unless there is airway obstruction or they are of vegetable matter eg seeds likely to swell up)Removed by bronchoscopy with full preparation and under GA.Rigid bronchoscope is used.

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Stapes develops from:

Malleus and incus are derived from mesoderm of 1" arch. Stapes develops from second arch except its footplate and annular ligament which are derived from the otic capsule.

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Buerger waves (alpha waves) of EEG have the rhythm per sec of -

C i.e. 8-13

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Type of cataract in chalcosis is

Answer- A. Sunflower cataract

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Following are more common in multipara women than primipara woman, EXCEPT:

The incidence of preeclampsia in multiparas is variable but is less than that for primiparas. Risk factors associated with pre-eclampsia: Primigravida (young and elderly) Family history (Hypeension, pre-eclampsia, eclampsia) Placental abnormalities Poor placentation Hyperplacentosis Placental ischemia Molar pregnancy Genetic disorder Immunologic phenomenon New paternity Pre-existing vascular or renal disease Thrombophilias Ref: Textbook of Obstetrics by DC Dutta, 6th edition, Page 222.

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Which category of ICD is associated with schizophrenia

ICD ICD mentions International classification of mental and behavioural disorders this was given by WHO( World health Organisation) ICD is used all over the world except America latest edition of ICD is ICD11 ICD 11 was released in 2018 DSM DSM mentions Diagnostic and Statistical manual of mental disorders this was given by APA( American Psychiatric Assosiation) DSM is used in America latest edition of DSM is DSM 5 ICD 11 was released in 2018 categorisation ofmental disorders in ICD 10 is mentioned below F00-F09 Organic, including symptomatic, mental disorders F10-F19 Mental and behavioural disorders due to psychoactive substance use F20-F29 Schizophrenia, schizotypal and delusional disorders F30-F39 Mood disorders ICD-10 Classification of Mental and Behavioural Disorders, World Health Organization, Geneva, 1992

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Terminal axillary draining lymph nodes -

Ans. is 'd' i.e., Apical o The apical group of axillary lymph node receives lymph from anterior (pectoral), posterior (subscapular), central and lateral (humeral) group of axillary lymph nodes. Hence apical group of lymph node is the terminal group of axillary lymph node.Axillary lymph nodeRelated vesselsAnterior (pectoral)Along lateral thoracic vesselsPosterior (scapular)Along subscapular vesselsLateralMedial to axillary veinApical (terminal or infraclavicular)Along axillary vessels

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True about gastric acid secretion:

A i.e. Secretion decreases with secretin B i.e., H2 blocker prevents relapse C i.e., Total acid output indicates parietal cell mass activity

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All of the swelling moves with deglutition except: March 2012

Ans: C i.e. Branchial cyst Swellings which are adherent to the larynx and trachea moves on swallowing, e.g. thyroid swelling, thyroglossal cyst & subhyoid bursitis. Tuberculous & malignant lymph nodes when they become fixed to the larynx or trachea will also move on deglutition

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Shakir's tape is an example of:

Norms under Appropriate technology: Technology that is scientifically sound. adaptable to local needs. acceptable to those who apply it and those for whom it is used. can be maintained using the locally available resources. - Shakir's tape used to measure mid-arm circumference of child accept all the above norms.

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In pyogenic liver abscess commonest route of spread

"Along with cryptogenic infections, infections from the biliary tree are presently the most common identifiable cause of the hepatic abscess. Biliary obstruction results in bile stasis, with the potential for subsequent bacterial colonization, infection and ascension into the liver. This process is k/a ascending suppurative cholangitis. The nature of biliary obstruction is mostly related to stone disease or malignancy. In Asia, intrahepatic stones and cholangitis (recurrent pyogenic cholangitis) is a common cause, whereas, in the Western world, malignant obstruction is becoming a more predominant factor" Ref : Sabiston 18/e p1485

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Most common cause for acute infantile gastroenteritis is?

ANSWER: (D) Rota virusREF: www.ncbi.nlm.nih.gov, J Clin Microbiol v. 26(12); Dec 1988Though none of the text books specifically mention most common causes of acute infantile gastroenteritis, most of the literature search in pubmed , cochrane and medscape and major text books of pediatrics point to: Viruses are more common causes of gastroenteritits in children. Of the viruses most common is rotavirus.Other viruses implicated are calciviruses, Norwalk, adenovirus.Also E.coli is a major cause of diarrhea in children.Other bacteria are: campylobacterium, yersinia enterocolitica, A. hydrophillia .

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