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d7450178-fea3-4e61-ae85-7a091965340d

Nesidioblastoma is due to hyperplasia of?

Alpha cell

Beta cell

Acinus

D cells

1b

single

Ans. is 'b' i.e., Beta cell Nesidioblastoma is due to hyperplasia of B cell of panceatic islets.

Pathology

4d9ce514-0813-474c-a6d2-56362d9c6085

In the treatment of undiagnosed megaloblastic anemia, vitamin B12 and folic acid should be given together because :

Vitamin B12 acts as a cofactor for dihydrofolate reductase

Folic acid alone causes improvement of anemic symptoms but neurological dysfunction continues.

Vitamin B12, deficiency may result in methylfolate trap

Folic acid is required for conversion of methylmalonyl CoA to succinyl CoA.

1b

single

Vitamin B12 is required for conversion of methionine to homocysteine and for the formation of succinyl CoA from methylmalonyl CoA. Deficiency of vitamin B12 results in megaloblastic anemia, GI manifestations and neurological abnormalities (due to demyelination). Folic acid alone will correct the symptoms of megaloblastic anemia but it does not prevent neurological abnormali­ties, which continue to proceed. Neurological abnormalities manifest initially in the form of loss of posterior column sensations (vibration, proprioception etc.), but later on, can result in subacute combined degeneration of the spinal cord.

Pharmacology

458abb54-dab4-47fc-92a6-1b60eb688554

Shape memory in NiTi is because of stress induced form

Austenite to martensite

Martensite to austenite

Ferrite to austenite

Austenite to ferrite

0a

single

Dental

d75c1716-d29c-4c93-94d6-59fdb41a1ce5

Most common cause of neonatal meningitis –

Staphylococcus

E. coli

H. influenze

Pneumococcus

1b

single

E. coli & streptococcus agalactie (group B streptococci) are the two most common cause of neonatal sepsis and meningitis

Pediatrics

4bf5714d-d064-4fc7-aaa1-2353848261ca

Adduction of thumb occurs at:

Inter carpal joint

MCP joint

Carpometacarpal joint

Inter phalangeal joint

2c

single

C i.e. Carpometacarpal joint 1st carpometacarpal joint (cmj) is the only cmj with seperate joint cavity so the movements are much free. Flexion- extension (in the plane of palm), adduction - abduction (at right angles to the plane of palm), opposition & circumduction, movements of thumbQ take place at 1st CM Joint.

Anatomy

bedc6844-c0a6-4c77-bf1a-a2a041b9f0c3

Meniere's disease is characterised by:

Conductive hearing loss and tinnitus

Vertigo, ear discharge, tinnitus and headache

Vertigo, tinnitus, hearing loss and headache

Vertigo, tinnitus and hearing loss

3d

single

Meniere's disease is due to raised endolymphatic pressure and clinically presents with vertigo, tinnitus, sensorineural hearing loss and sense of aural fullness. Vertigo can be accompanied by nausea and vomiting. Choice (a) is excluded due to conductive loss, (b) due to headache and ear discharge, and (c) due to headache. Presence of headache with vertigo and tinnitus may be a feature of neurological disorder.

ENT

Ear

ed8739e7-b49e-4cf7-bc0e-6b329ed7cbee

Influenza virus causes new epidemic by (3-5 yrs) -

Antigenic drift

Antigenic shift

Cyclic trends

Mosaicsm

1b

single

Antigenic variations in Influenza Antigenic shift Antigenic drift Occurs due to Genetic recombination/reassoment / Rearrangement Point mutation Nature Sudden Gradual / insidious May lead to Epidemics/ pandemics Sporadic cases Ref: Park 25th edition Pgno : 166-172

Social & Preventive Medicine

Communicable diseases

5902176a-db11-4351-9e92-d47a4439ccb6

All of the following are causes of pneumoperitoneum except -

Perforated peptic ulcer

Laproscopic Procedure

Perforated Appendix

Hirschsprung's Disease

3d

multi

Ans. is 'd' i.e., Hirschsprung's Disease o Gas under left hemidiaphragm is due to fundal gas, a normal finding. When gas is present under right hemidiaphragm also it's due to pneumoperitoneum.Causes of Pneumoperitoneum1. Perforation of GI tract# Peptic ulcer# Inflamamtion (diverticulitis, appendicitis, toxic megacolon, necrotizing enterocolitis)# Infarction# Malignant neoplasm# Obstruction# Pneumatosis cystoides rupture# Iatrogenic-endoscopy2. Iatrogenic# Surgery, peritoneal dialysis, drainage catheters, biopsies3. Penetrating abdominal injury.4. Through female genital tracta. Spontaneousb. Iatrogenic# Iatrogenic perforation of uterus or vagina# Culdocentesis# Tubal patency test5. Gas forming peritonitis6. Pneumothorax with pleuroperitoneal fistula

Surgery

Peritoneal Disorders - Peritonitis

e2db43c7-424f-4ced-b5a9-ddf04146e656

Hypercalcemia related to malignancy is seen in which of the following cancers?

Multiple myeloma

Lung carcinoma

Carcinoma breast

All the above

3d

multi

Answer- D. All the aboveMalignancy related-Solid tumor with metastasis/ paraneoplastic syndromeCarcinoma breast/ Lung/ Kidney etcHematological: Multiple myeloma/Lymphoma/LeukemiaAluminum intoxicationMilk Alkali syndrome

Medicine

6bbbf172-d18c-45d0-a8b8-7cceec89e76f

Which of the following is not used for procuring criminal aboion

Ripe fruit of papaya

Saffron

Seeds of carrot

Unripe fruit of pineapple

0a

single

Drugs having poisonous effects on body causing aboion:- Unripe fruit of papaya Saffron Seeds of carrot Unripe fruit of pineapple juice of calotropis juice of plumbago

Forensic Medicine

Impotency, Virginity, pregnancy & aboion

69a7ae52-ed34-44f4-9dae-36cfeeb51762

Chromosome associated with ADPKD

14 and 16

14 and 13

16 and 14

16 and 14

2c

single

ADPKD Cytogenetic defect Chromosome 16 (85%): ADPKD-1 & Chromosome 4 (15%): ADPKD-2 ARPKD Cytogenetic defect Chromosome 6 Ref: HARSH MOHAN TEXTBOOK OF PATHOLOGY 6th ed. pg no: 659

Pathology

Urinary tract

752ef035-386a-4803-af5a-af7a5dc9357d

Best treatment of 3 weeks old, fracture shaft femur with nonunion is -

Bone graft with internal fixation

External fixation

Internal fixation only

Prosthesis

0a

single

Orthopaedics

c7da2a2c-7246-4829-b9fe-2eebace385b5

Down’s cephalometric analysis of a patient reveals a high mandibular plane angle. Which of the following landmarks are used for the construction of the mandibular plane in this analysis?

Go-Me

Go-Gn

Tangent to the lower most border of the mandible

Me-antegonial notch

0a

single

Tweed and Ricketts- straight line tangent to the lower most border of the mandible. Downs- line joining Gonion to menton. Steiner- line joining Gonion to gnathion. Bimler’s line- line joining menton to antegonial notch. Ref: Radiographic cephalometry:Jacobson A

Dental

be55a293-5c65-47c1-aa9f-4464e19fc88c

Which is not true of malaria Eradication programmea) Started in 1953b) Modified plan started in 1970c) Incidence was 2 million cases in 1958d) Incidence decreased to 50,000 in 1961

ab

a

ad

bc

0a

multi

National anti-malaria Programme The Programme began initially as National Malaria control Programme in 1953. Because of the spectacular success achieved in the control of malaria, the control programme, was converted into an eradication programe in 1958 with the object of eradicating malaria once and for all from the country. The programme went on well for sometimes. The incidence of malaria declined from 75 million cases and 8 lakhs death in 1953 to about 1-2 million cases and no death in 1972. But thereafter the programme suffered serious set backs. There was a sharp increase in malaria incidence, in 1976, there were 6.47 million cases with 59 deaths. The Govt of India in 1977 evolved a "Modified plan of operation" based on "effective control" rather than eradication. The plan has since been implemented and the incidence of malaria began to decline. However, there was gradual, increased in falciparum malaria incidence. Hence a programme for containment of P.falciparum was also launched within the NMEP. Note : Option 'c & d' were given in 19th/e. of Park : - "The incidence of malaria had declined sharply from 75 million cases in 1953 to 2 million cases in 1958". "The annual incidence of malaria cases in India escalated from 50000 in 1961, to a Peak of 6.4 million cases in 1976". Strategic Action plan for malaria control in India (2007-2012) Malaria control is now incorporated into the health service delivery programmes under the umbrella of NRHM. The strategies of National malaria control programme are as follows : - Malaria Control strategies The strategies for prevention and control of malaria and its transmission are-: 1. Surveillance and case management Case detection (passive and active). Early diagnosis and complete treatment. Sentinel surveillance. 2. Integrated vector management (IVM) Indoor residual spray (IRS). Insecticide treated bed nets (ITNs)/ Long Lasting Insecticidal Nets (LLINs). Antilarval measures including source reduction. 3. Epidemic preparadness and early response 4. Supportive interventions Capacity building  Behaviour change communication (BCC) Intersectoral collaboration Monitoring and evaluation Operational research and applied field research. Goals for strategic Plan 2007-2012 The main national goals for malaria control are given below : - At least 50 percent reduction in mortality due to malaria by the year 2010, as per National Health Policy document 2002. At least 80 percent of those suffering from malaria get correct, affordable and appropriate treatment within 24 hours of reporting to the health system, by the year 2012. At least 80 percent of those at high risk of malaria get protected by effective preventive measures such as ITNs/LLINs or IRS by 2012.

Social & Preventive Medicine

1605273f-c03c-4cca-8f11-1b7adb6c0da3

Which is a immunological marker of type I diabetes?

Anti-endothelial antibody

GAD

Anti-saccharomyces antibody

None of the above

1b

multi

Ans. B. GADImmunologic markers in type 1 DM:a. Islet cell autoantibodies (ICAs)b. Antibody to insulin (IAA)c. Glutamic acid decarboxylase, (GAD)d. Tyrosine phosphatase (IA-2 & IA- 2B)e. Beta cell specific zing transporter (ZnT - 8)

Medicine

Miscellaneous

7a3e858b-da32-43eb-835f-f15bead42175

Katayama fever is seen in

Schistosoma Mansoni

Schistosoma japonicum

S. haematobium

S. mekongi

0a

single

S. mansoni more likely to cause Katayama fever than Japonicum.

Microbiology

643fe851-9433-4240-9612-c3af9411b71e

A year 6 old child with IQ of 50. Which of the following can the child do -

Identify colours

Read a sentence

Ride a bicycle

Copy a triangle

0a

single

Ans. is 'a' i.e. Identify colours IQ is defined by as the mental age divided by the chronological age multiplied by 100. So a child 6 years of age with an IQ of 50%, means that his mental age is that of a 3 year old child. Thus we have to look for the developmental milestones of a 3 year old child. o At 3 years of age, a child can identify two colours. o A 3 year old child can speak a small sentence but he cannot read a sentence. o At 3 years, a child can ride a tricycle (not a bicycle). o A child copies a triangle at 5 years of age.

Pediatrics

61a13162-16b4-4521-b597-9b53ae63198a

Histogram is used to describe-

Quantitative data of a group of patients

Qualitative data of a group of patients

Data collected on nominal scale

Data collected on ordinal scale

0a

single

<p> Histogram is used to describe quantitative data of a group of patients. Histogram is graphical presentation for. &;Continuous quantitative data&;. Reference: Simple Biostatistics by Indeayan & Indrayan,1st edition,pg no:104 and Methods in Biostatistics by Mahajan,6 th edition,pg no.20, K . Park,23rd edition, pg no.844-846. <\p>

Social & Preventive Medicine

Biostatistics

0601d64a-a8b5-4f4b-9661-96473d2e3491

True about calcium in kidney is

Most reabsorption occurs in DCT

Major regulating factor is parathormone

Parathormone decreases calcium absorption

Increased plasma phosphate decreases calcium resorption

1b

multi

Parathormone secreted by parathyroid glands regulates the blood calcium level. Ref: guyton and hall textbook of medical physiology 12 edition page number: 495,496,497

Physiology

Renal physiology

139da2fe-c084-4dc1-8411-917ba7cdd4a0

All are causing hypothyroidism except:

PAS

Captopril

Lithium

Amiodarone

1b

multi

Pharmacology

4335c286-5b22-4903-965f-ae8d00461e4b

All are cluster B personality disorders except?

Antisocial

Narcissistic

Avoidant

Borderline

2c

multi

Ans. is 'c' i.e., Avoidant Personality disorders1. Clustor A (Odd. and Eccentric): Paranoid, Schizoid, Schizotypal.2. Clustor B (Dramatic, Emotional and Erratic) : Antisocial (Dissocial), Flistrionic, Narcissistic, Borderline.3. Clustor C (Anxious and fearful): Anxious (avoidant), Dependent, obsessive - compulsive (anankastic).

Psychiatry

Personality Disorders

a5cf35e9-25b1-44fb-8061-6bd6542be144

Chancre redux is a clinical feature of

Early relapsing syphilis

Late syphilis

Chancroid

Recurrent herpes simplex infection

0a

single

Chancre- primary lesion in syphilis (hard chancre)Chancre redux is the relapse of the chancre lesions in the early stage of syphilisSecondary syphilis-Cutaneous lesionsRoseolarsyphilidePapularsyphilidePsoriasiform lesion CondylomataMalignant syphilidePalm & sole lesion ( Coppery red lesion )Mucosal lesions Mucous patches Snail track ulcers Lymphadenopathy Generalized symmetrical rubbery lymphadenopathy Systemic involvement Periostitis, Ahritis Iridocyclitis, Uveitis, ChorioretinitisNephritic syndrome Late or teiary syphilis- cardiovascular lesions and tabes dorsalis seen(Ref: Ananthanarayan 9th edition, p372)

Pathology

All India exam

9b7faeb7-2787-4280-9ac1-744d9f9872c7

All of the following are features of prematurity in a neonate, except –

No creases on sole

Abundant lanugo

Thick ear cartilage

Empty scrotum

2c

multi

The ears in a premature neonate are soft and flat with ear cartilage being deficient and plant (and not thick) Features of prematurity in a Neonate : Baby is small in size usually less than 47 cm long. Head is relatively large, sutures are widely separated and fontanelle are large The face is small and buccal pad of fat is minimal Skin is thin and pinkish and appears shiny due to generalized edema. Skin is covered with abundant lanugo and there is little vernix caseosa. Subcutaneous fat is reduced The breast nodule is less than 5 mm wide The ears are soft and flat with ear cartilage being deficient and plant Testes are not descended into the scrotal sac. (Empty scrotum) Scrotal sac is poorly pigmented and has fewer rugosities. In females labia majora appears widely separated, exposing the labia minora and the clitoris. Deep creases are not well developed in the sole. (There may be a single deep crease over the anterior one-third of the sole)  Neonatal reflexes such as Moro, Suckling & Swallowing are sluggish. There is hypotonia with a poor recoil of the flexed forearm when extended.

Pediatrics

09950045-18b9-4112-97c1-3783c52160f6

Features of systemic sclerosis include all of the following, Except:

Calcinosis

Sclerodactyly

Hyperpigmentation (Melanin deposition)

More common in young patients

3d

multi

Answer is D (More common in young patients): Systemic sclerosis is primarily a disease of adults and the mean age of presentation is around 50 years. Systemic sclerosis is not a disease of young individuals The mean age of presentation of systemic sclerosis is 50 years -- Current Diagnosis & Treatment in Rheumatology 2nd/228 The peak incidence of systemic sclerosis is 50-60 years -- Robbins 7th/239 The most common age of onset in the range of 30-50 years -- Harrison 171h/2097 Systemic sclerosis is more common in women Like other connective tissue disorders systemic sclerosis shows a female predominance- Harrison 17th/2097 Systemic sclerosis is primarily a disease of women (female to male ratio is 3: I) -- Robbin,s Systemic sclerosis may present with Calcinosis, Sclerodactyly and hyperpiamentation The skin of extremities and trunk may be darkly pigmented. Diffuse tanning in the absence of sun exposure may be a very early manifestation of skin involvement -- Harrisons Calcinosis and sclerodactyly are pa of the 'Crest syndrome' in limited systemic sclerosis CREST syndrome C Calcinosis R Raynauld's E Esophageal dysmotility S Sclerodactyly T Telengactasia

Medicine

7fcc3279-2cbb-4b54-bb55-af59d8b7f426

The most recent direct filling gold which produces the hardest surface on condensation is

Mat gold

Encapsulated powered gold

Mat gold alloyed with calcium and wrapped in gold foil

Platinized gold

2c

multi

Mat gold made of electrolytic precipitate from gold, which is alloyed with a trace amount of calcium, can yield a further increase in hardness by dispersion strengthening without affecting the handling properties.

Dental

7a42e433-7d17-48db-ba2f-20d482eb2fac

A child presented in the casualty with fever, unconscious & papilloedema. What next to the done –

Intubation

Oxygenation

CT scan

All of these

3d

multi

Pediatrics

1cdc8583-73ea-4c09-b994-5f9270a2153f

True about severe barbiturate poisoning except -

Hypothermia

Hypertension

Coma

Non-reactive pupil

1b

multi

There is fall in BP (hypotension).

Forensic Medicine

d402662c-d8a6-4754-83e7-f21d3cb92a5d

Most common neoplasm of appendix is

Pseudomyxoma peritonei

Adenocarcinoma

Carcinoid

Lymphoma

2c

single

Carcinoid tumours arise in argentaffin tissue (Kulchitsky cells of the crypts of Lieberkuhn) and are most common in the vermiform appendix.The tumour can occur in any pa of the appendix, but it is frequently found in the distal third.Ref: Bailey & Love&;s Sho Practice of Surgery

Surgery

G.I.T

cdad3b2a-5ecd-4fc1-8ddc-904ff742b987

Contraindication of Coitus interruptus is:

Erectile dysfunction

Perimenopausal age

Premature ejaculation

Illiterate male paner

2c

single

Withdrawal method or coitus interruptus means the discharge of semen outside the female genitalia at the end of intercourse. Premature ejaculation is the only contraindication. The advantages of the withdrawal method are that it (a) involves no expense, (b) needs no medical supervision, (c) requires no prior preparation, and (d) causes no definite harm. The main drawbacks are the lack of full sexual satisfaction and the relatively higher failure rate.

Gynaecology & Obstetrics

Contraceptives

60d19f8b-1618-4954-ab7f-1b41041f52e0

Inversion and eversion occurs at which joint

Subtalar and midtarsal

Calcaneo navicular

Midtarsal

Calcaneocuboid only

0a

single

A. i.e. Subtalar & mid tarsal joint

Anatomy

c9b5b13a-7631-4442-9e06-08d747523399

Hypermability of joint and hyperelasticity is seen in -

Marfan syndrome

Ehlers danlos syndrome

Fragile X-syndrome

Angelman syndrome

1b

single

Ans. is `b' i.e., Ehlers Danlos syndromeEhlers Danlos syndrome (EDS)o EDS comprises a clinically and genetically heterogenous group of disorders that result from some defect in the synthesis or structure of collegen and characterized by hyperelasticity of skin and hypermobile joints.Several types of EDS have been described based on the extent to which the skin, joints and other tissues are involved, mode of inheritence and biochemical analysis. Type I - severe- II Type mild Classic EDS --> Involvement of both joints & skin. Type III - Hypermobile EDS --> Joints > skin Type IV - Vascular EDS --> Vascular and intestinal intAolvement. Type V --> Similar to classic Type VI - Occular scliotic EDS --> Eye and spine involvement. Type VII - Dermatosparactic EDS --> Dysmorphic features Type VIII --> Perodontal EDS --> Dental involvement.o EDS shows all patterns of mendelian inheritance ?Type I, II, III, IV, VII A & B, VIII Autosomal dominant.Type IV & VII C ----> Autosomal recessiveType V X-linked recessive.o Clinical manifestations 1. SkinSkin is hyperextensible --* Rubber man syndrome.o Patient can develop cigarette - paper scar.o There is easly bruisability.Jointso There is ligament laxity and hypermobility of joint ---> Patient can bend thumb back to touch farearm. o Dislocation of hip or other joints may occur.OthersMitral valve prolapse pn classic (type I) EDSDiaphragmatic herniao Rupture of colon and large aeries -k In vascular (type IV) EDS.o Rupture of cornea and retinal detachmento Kyphoscoliosis In ocular-scoliotic (type VI) EDS.o Blue sclerao Absorptive periodontosis with premature loss of teeth -4 In periodontic (type VIII) EDS.

Pathology

3198e931-1948-4692-9939-dca95f052d97

Burnt rope smell is due to poisoning of ?

Cannabis

Chloral hydrate

Bhang

Charas

0a

single

Ans. is 'a' i.e., Cannabis Odors associated with poisoning Garlik like : Phosphorus, arsenic, zinc phosphide, aluminium phosphide (celphos), arsine gas, tellurium, parathion, malathion, arsenic. Rotten eggs : Hydrogen sulphide, mercaptans, disulphiram. Fishy or musty : Zinc phosphide. o Bitter almonds : Cyanide, HCN. Acrid : Paraldehyde, chloral hydrate. o Burnt rope : Cannabis. Kerosene like : Kerosene and organophosphates. Phenolic smell : Carbolic acid.

Forensic Medicine

690af9ee-b416-478e-8631-41269c5f5168

Which organ does not utilise ketone bodies:

Liver

Brain

Skeletal muscles

Cardiac muscles

0a

single

A i.e. Liver

Biochemistry

136372f9-8a5c-45a6-81cb-5b03ceddcde0

The following drug is effective in treatment of ptyriasis versicolor -

Ketoconazole

Metronidazole

Griseofulvin

Chloroquine

0a

single

Ans. is 'a' i.e., Ketoconazole Pityriasis versicolor (Tinea versicolor!o Tinea versicolor is a misnomer as it is not caused by dermatophyte; Pityriasis versicolor is more appropriate term. It is caused by a nondermatophyte fungus called Pityrosporum ovale (Malasezia furfur). It usually affects young adults.Clinical featureso There are multiple small scaly hypopigmented macules (macules may be hyperpigmented also). Scaling is furfuraceous or rice powder like. Macules start around the hair follicles and then merge with each other to form large areas. Affects trunk and shoulders (mainly chest and back). There may be loosening of scales with finger nails - Coupled onle or stroke of nail. Lesions are recurrent in nature (may reappear after treatment).Diagnosis of P.versicoloro Examination of scales in 10% KOH shows short hyphae and round spores (Sphagetti and meatball appearance). Wood's lamp shows apple green fluorescence (blue-green fluorescence). Skin surface biopsy - A cyanoacrylate adhesive (crazy glue) is used to remove the layer of stratum comeum on glass slide and then stained with PAS reagent.Treatment of P.versicolorSystemic agents : - Systemic azoles provide a convenient therapeutic option. Drugs used are ketoconazole, Fluconazole or intraconazole.Topical antifungals :- Topical antifungals used are : -Azoles - Clotrimazole, econazole, Miconazole, Ketoconazole.Others - Selenium Sulfide, Sodium thiosulphate, Whitfield's ointment (3% salicylic acid + 6% Benzoic acid).

Skin

Papulosquamous Disorders

d2aa3e65-6b12-45e9-93f6-8e4b6235bdc7

Vision 2020 "The right to sight" includes all except

Trachoma

Epidemic conjunctivitis

Cataract

Onchocerciasis

1b

multi

Epidemic conjunctivitis Vision 2020 : The Right to Sight, is a global initiative launched by WHO in Geneva in 1999 in coalition with Task force of International NGOs' Globally, WHO has identified 5 major blinding eye conditions, for immediate attention : i) Cataract ii) Childhood blindness iii) Trachoma iv) Refractive errors and low vision v) Onchocerciasis (River blindness) The Government of India has adopted 'Vision 2020: Right to Sight' under 'National Programme for Control of Blindness' in 2001. Target diseases identified for intervention under 'Vision 2020' initiatives in India are : i) Cataract ii) Childhood blindness iii) Trachoma iv) Refractive errors and low vision v) Corneal blindness vi) Diabetic retinopathy vii) Glaucoma Objective of Vision 2020 - is to eliminate avoidable blindness by the year 2020 and reduce the global burden of blindness.

Social & Preventive Medicine

2440ad1d-e846-4644-bbe3-5b4fc1c07d56

All of the following statements are true about congenital rubella except-

It is diagnosed when the infant has IgM antibodies at bih

It is diagnosed when Ig G antibodies persist for more than 6 months

M.C. congenital defects are deafness, cardiac malformation and cataract

Infection after 16 weeks of gestation result in major congenital defects

3d

multi

. <p>congenital rubella syndrome:- Refers to infants born with defects secondary to intrauterine infection or who manifest symptoms or signs of intrauterine infection sometime after bih. Congenital infection is considered to have occurred if the infant has IgM antibodies sholy after bih.( as IgM antibodies do not cross placenta,their presence indicate they must have been synthesised by the infant inutero) or if IgG antibodies persist for more than 6 months. At bih virus is easily detected in pharyngeal secretion,multiple organs, CSF ,urine and rectal swabs. Rubella infection inhibits cell division. The classic triad- deafness,cardiac malformation and cataract. Other defects include glaucoma, retinopathy, microcephalus, cerebral palsy, intrauterine growth retardation,hepatosplenomegaly, mental and motor retardation. These defects occuring singly/in combination is known as " congenital rubella syndrome ". Congenital rubella- chronic infection Acquired rubella- acute infection. The gestational age at which maternal infection occurs is a major determinant for extend of foetal infection. 1. First trimester- most disastrous as the organs are developing. Infection during this period results in abnormalities in 85% cases. 2. Second trimester- 16% cases. 3. After 20 weeks- bih defects uncommon. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.151}</p>

Social & Preventive Medicine

Communicable diseases

935cddd3-fa9e-4773-a8d2-acffbe59fb40

Black malarial pigment is seen in: September 2009

P.vivax

P.falciparum

P.nialariae

P.ovlae

1b

single

Ans. B: P.falciparum In well-stained preparations the nuclei of the parasites are always stained red and the cytoplasm blue. The presence of malaria pigment is very characteristic of the older stages of Plasmodium sp. P. falciparum often contains a single black dot. P. vivax often contains countless fine golden yellow/brown specks of malaria pigment. In P. ovale and P. malariae the pigment inclusions are many and brownish black. Countless fine red spots in the red blood cell (Schiiffner's dots) can be seen in P. vivax and P. ovale (the more mature the parasite, the more dots). In P. ovale the dots are sometimes called James's dots. Sometimes a few flecks can be observed in P. falciparum (Maurer's dots or clefts). P. malariae almost never exhibits dots (Ziemann's dots). The visibility of these dots depends to a great extent on the acidity (pH) with which the thin slide preparation is stained (slightly alkaline: pH = 8 is best). The acidity is impoant because blood smears are usually stained for haematological tests with a slightly acid pH.

Microbiology

dd186c10-e165-4a1d-99bc-dcd0dd82ce74

The given karyotype is seen in which of the following syndrome?

Angelman syndrome

Fragile x syndrome

Turner syndrome

Cri du chat syndrome

3d

single

Cri du chat syndrome is caused by a deletion of the end of the sho (p) arm of chromosome 5. (5P- syndrome)Symptoms include characteristic cat-like cry of affected children, epicanthus, severe intellectual disability, low set ears.

Pathology

General pathology

ca4d9cae-829a-4754-bc29-849fc5cf037f

A 40-year-old male with h/o progressive dysphagia for liquid has dilated esophagus on barium meal. Most likely cause is

Achalasia cardia

Cancer at cardia

Ca esophagus

Carcinoma gastric fundus

0a

single

Achalasia cardia * All of the above mentioned condition except Achalasia cardia occur around 60 years of age. Features for differentiation between achalasia cardia and carcinoma esophagus: Achalasiacardia Carcinomaesophagus a. Around30-40 yearsofage a. Presentationafter60yearsofage b. No dysphagiafor solids b. Dysphagiafor solidspresent c. Dysphagiaforliquidspresent c. Dysphagiaforliquidsonlyat verylatestages

Surgery

406f665c-7bd8-400e-ab4b-e6d2c594677e

Secondary glaucoma in early stage of herpes zoster ophthalmlcus occurs due to

Trabeculitis

Hypersecretion of aqueous humour

Haemorrhagic hypopyon

lridocyclitis

0a

single

HERPES ZOSTER OPHTHALMICUS Ocular lesions: Ocular complications usually appear at the subsidence of skin eruptions and may present as a combination of two or more of the following lesions: 1. Conjunctivitis: It is one of the most common complication of herpes zoster. It may occur as mucopurulent conjunctivitis with petechial haemorrhages or acute follicular conjunctivitis with regional lymphadenopathy. Sometimes, severe necrotizing membranous inflammation may be seen. 2. Zoster keratitis: May precede the neuralgia or skin lesions. 3. Episcleritis and scleritis: These usually appear at the onset of the rash but are frequently concealed by the overlying conjunctivitis. 4. Iridocyclitis: It is of a frequent occurrence and may or may not be associated with keratitis. There may be associated hypopyon and hyphaema (acute haemorrhagic uveitis). 5. Acute retinal necrosis: 6. Anterior segment necrosis and phthisis bulbi. 7. Secondary glaucoma: It may occur due to trabeculitis in early stages and synechial angle closure in late stages. Ref:- A K KHURANA; pg num:-104,105

Ophthalmology

Cornea and sclera

35eb64d6-b677-448e-91e6-0c8fc5f38245

First class judicial magistrate can give punishment upto

1 year

3 years

7 years

10 years

1b

single

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

Forensic Medicine

Law & Medicine, Identification, Autopsy & Burn

5b34f81a-448c-4f49-8e47-c1485e4bca1f

Which statement is false about allosteric regulation?

It is usually the mode of regulation for the last step in reaction pathways

Cellular response is faster with allosteric control than by controlling enzyme concentration in the cell

The regulation usually is impoant to the conservation of energy and materials in cells

Allosteric modulators bind non-covalently at sites other than the active site and induce conformational changes in the enzyme

0a

multi

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

Biochemistry

Enzyme regulation

73d55fe4-5a19-4b07-8f05-9f667bbad96f

Most common part of spine affected by Rheumatoid arthritis is?

Lumbar spine

Thoracic spine

Cervical spine

Sacrum

2c

single

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

Orthopaedics

Rheumatoid Arthritis

f506c73c-a879-4631-aaf9-6520806974ef

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

High dose methotrexate

Cyclophosphamide

Vincristine

Doxorubicin

2c

multi

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

Pharmacology

Chemotherapy

91afa9b6-2c8a-4492-b2fb-1d677929c0d2

Lowering of the following parameter indicates acute malnutrition:

Weight for age

Weight for height

Height for age

BMI

1b

single

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

Pediatrics

59332a64-0ef2-409e-b7e1-bc6295509b74

Visible range of electromagnetic spectrum of human eye

370 - 740 nm

740- 1140 nm

200 - 370 nm

200 - 370 nm

0a

single

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

Physiology

b806c08d-02ae-45d6-a4a8-a2b8d4396fe2

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

Borrelia recurrentis

Chlamydia trachomatis

Haemophilus ducreyi

Neisseria gonorrhoeae

3d

single

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

Pathology

Male Genital Tract

b085b90f-c2bb-4097-92d9-5e7b16109741

Cholesterol present in LDL

Represents primarily cholesterol that is being removed from peripheral cells

Binds to a receptor and diffuses across the cell membrane

On accumulation in the cell inhibits replenishment of LDL receptors

When enters a cell, suppresses activity of acyl-CoA; cholesterol acytransferase ACAT

2c

single

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

Biochemistry

3027ec04-d7c7-4dd4-bbb0-4510348e2aea

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

Succinylcholine

Dantrolene

Vecuronium

Mivacurium

1b

single

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

Pharmacology

Anaesthesia

534b13db-974e-4b83-a926-f1e6b2359928

Pernicious anemia associated with -

Gastric pathology

Renal pathology

Esophageal pathology

Oral pathology

0a

single

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

Pathology

Iron Deficiency and Megaloblastic Anemia

b8acf03f-00d6-4724-aaab-27f03cca5d3c

Feature of shock lung is?

Diffuse alveolar damage

Usual interstitial pneumonitis

Organizing pneumonia

Bronchilolitis

0a

single

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

Medicine

Respiratory system

bcbed6b8-b61f-4f77-be75-1baad68c67f5

Preferred imaging modality for choanal atresia is-

X ray

CT SCAN

MRI

PET SCAN

1b

single

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

ENT

Congenital Anomalies of Nose and PNS

86316afb-7b14-41bf-895d-733352a96e8d

Which has lowest incubation period

Mumps

Influenza

Measles

Chicken pox

1b

single

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

Social & Preventive Medicine

Influenza

d5b316b7-1f9b-44c4-96e9-caf8081350fe

Dimorphic fungus:

Candida

Histoplasma

Rhizopus

Mucor

1b

single

Ans. b. Histoplasma

Microbiology

f8e8a40b-5f29-40f9-a7b1-b6e7cdeb1574

Irreversible injury is due to

Decrease in ATP

Defective membrane function

Myelin figures

Cellular swelling

1b

single

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

Pathology

2f895602-6f58-41c1-bc23-328fc55431a7

Diffusion hypoxia is seen with which drug:

Nitrous oxide

Ketamine

Theophylline

Halothane

0a

single

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

Pharmacology

Anaesthesia

29043d0b-e9f0-4908-b521-d9fb686b10e8

Best management of open fracture is:

Debridement

External fixation

Internal fixation

Tourniquet

0a

single

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

Orthopaedics

Management In Orthopedics

d76eef9d-f13b-4171-b71e-8b11a5752c84

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

Pyramidal cells of the pancreatic acini

Chief cells of the stomach

Serous-Secreting cells of the parotid gland

Fibroblast

0a

single

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

Anatomy

General anatomy

39fbfd57-438a-4da6-a37b-d4e9c6699716

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

Glottis

Subglottic area

Trachea

Carina

1b

single

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

Surgery

Head and neck

8e36c89a-ae3a-4b3c-862b-cdea6d58c3a9

Soil may act as a reservoir for all except-

Tetanus

Anthrax

Brucellosis

Coccidioidomycosis

2c

multi

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

Social & Preventive Medicine

e61e85c2-4093-4cc0-bae8-178da7ab1396

Which inhalational agent is best uterine relaxant?

Halo thane

Isoflurane

Sevofiurane

Desflurane

0a

single

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

Anaesthesia

Obstetric Anesthesia

d7364b35-cd96-4795-a35f-1438bb1e56c0

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

Anorectal ring

Anal canal

External anal spincter

Dentate line

0a

single

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

Surgery

939cc43e-68d3-4cc0-a450-146b92b9f257

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

It enters the abdomen behind the lateral arcuate ligament

The trunk passes in 6 segmentally arranged ganglia

All the ganglia receive white rami communicantes

Gray rami communicantes are given off to the lumbar spinal nerves

3d

multi

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

Unknown

8724d418-0226-4f08-a6e2-472acc9fde19

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

Transcranial Doppler studies

Doppler ultrasonography (duplex)

Spiral CT angiography

Arch aortogram with selective carotid artery injections

1b

single

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

Surgery

Arterial Disorders

405b7c79-b6ac-4407-977c-e5595bba56c4

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

Acute pericarditis

Constrictive pericarditis

Takotsubo-cardiomyopathy

Cor pulmonale

0a

single

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

Medicine

Electrocardiography

f0a888cd-816b-4fa3-bdd6-87c2e839129f

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

25%

50%

75%

100%

1b

single

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

Anaesthesia

Fundamental Concepts

2499af53-81c9-4589-b624-3c2b9961693d

Zinc dose in 8 months infants

10 mg/kg x 10 days

20 mg/kg x 10 days

10 mg/kg x 14 days

20 mg/kg x 14 days

3d

single

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

Pediatrics

664cb622-1721-4127-9d1f-11fc03f8afb4

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

IIIa

IIIb

IIIc1

IIIc2

1b

single

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

Gynaecology & Obstetrics

e6c9d28c-5e93-4b8f-b5d2-60203976ef5b

True statement about phase 2 clinical trials is:

Large number of healthy volunteers are studied

Used to determine maximum tolerated dose

Used to determine efficacy

Used to determine toxicity

2c

multi

Pharmacology

490b6a35-f5b6-42fc-9f2a-f4784b2cda1a

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

Myocardial infarction

Pulmonary embolism

Air embolism

Pneumothorax

2c

single

Ans. Air embolism

Forensic Medicine

d564e744-5604-4dad-af50-92879a977416

What is the effect of doubling the diameter of a cantilever spring?

Strength increases by 4 times, Springiness increases by 8 times

Strength decreases by 4 times, Springiness decreases by 8 times

Strength decreases by 8 times, Springiness increases by 16 times

Strength increases by 8 times, Springiness decreases by 16 times

3d

single

Dental

203f7cd2-2c38-4fe2-85eb-d8683f81673a

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

Clozapine

Risperidone

Quetiapine

Aripiprazole

0a

single

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

Pharmacology

Central Nervous system

f2dbbf8d-5472-4ba1-ab50-7b05dbfe132b

The maximum dosage of local anesthetic agent like lidocaine must be reduced when used in combination with a CNS and/respiratory depressant because, it may result in:

Seizures

Coma

Death

All of the above

3d

multi

Surgery

14f81df2-fce4-4563-a99e-6ef7244dce10

Duchnne's muscular dystrophy -

X-linked dominant

X - linked recessive

Autosomal dominant

Autosomal recessive

1b

single

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

Pediatrics

10722c5d-4bce-486c-af0f-36abf6b7b96f

Vector for Zika virus disease is:

Anopheles stephensi

Phelebotomus

Aedes Aegypti

Culex

2c

multi

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

Social & Preventive Medicine

NEET Jan 2020

8839fa58-63ef-4dba-8c27-1c4417d327e6

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

CPD

Hydramnios

Brow presentation

Breech

0a

single

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

Anatomy

General obstetrics

99ba7da7-e3c0-41c4-af51-ce019e0347d6

Aberrant thyroid tissue may be found in all except:

Lingual thyroid

Thyroglossal ectopic thyroid

Struma ovarii

None

3d

multi

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

Surgery

a9e7551f-ef33-4f03-95b5-dd734229baed

Side effects of zidovudine-

Headache

Myalgia

Granulocytopenia

Rashes

2c

single

Medicine

fbcc366e-424d-435f-89e3-28f44d5aba13

Hemiballismus is due to lesion in?

Ipsilateral Caudate nucleus

Contralateral sub-thalamic lesion

Contralateral Putamen

Ipsilateral sub-thalamic lesion

1b

multi

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

Medicine

C.N.S.

a8f0881e-d9f2-4bc6-b062-ff212972a974

Which one of the following is used in Cardiovascular imaging?

Second generation CT

Third generation CT

Spiral CT

Multidetector CT

3d

single

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

Radiology

CT SCAN

f0b2de0d-0d45-488b-acad-6cd6b31d57c8

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

Most neurons in cerebral cortex

Renal tubular cells

Skeletal muscles

Mucosa of small intestine

2c

multi

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

Biochemistry

Carbohydrates

3db1546d-2c7e-4286-b0e6-86e353ac6b0d

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

Cervical spine x-rayChest X-ray

Chest X-ray

Neural conduction studies of the median nerve

Adson's test

3d

multi

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

Anatomy

572bf171-1177-4c4b-a84a-3345ed0fd222

Sperm acquires motility in ?

Seminal vesicle

Testes

Epididymis

Ejaculatory duct

2c

single

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

Physiology

0b02f5d1-6583-4ecb-9ed2-0554d9567dab

Management of Osteoradionecrosis would be:

Hyperbaric oxygen

Removal of sequestrum

Fluoride application

All of the above

3d

multi

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

Radiology

6f7305c1-d81a-4a85-ad66-b7adf46e8a38

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

Anaemia

Cardiac disease

Gestational diabetes

Gestational hypeension

2c

single

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

Gynaecology & Obstetrics

00204f64-2f4d-4256-996b-d2c2cc4f5e91

The part of nephron "least permeable to water" is

Proximal tubule

Descending Limb of loop of Henle

Ascending limb of loop of Henle

Collecting tubule

2c

single

Physiology

66dbf8ca-d444-4fb2-bf4f-29a93381d6d5

Mallory's hyaline is seen in ?

Hepatitis C infection

Amoebic liver abscess

Indian childhood cirrhosis

Autoimmune hepatitis

2c

multi

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

Pathology

4b2ab761-ab75-4156-86b8-ad7edff752bc

Farmers lung is caused by -

Micromonospore faenia

Aspergillosis

Histoplasma capsulatam

All of the above

0a

multi

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

Microbiology

41732901-93eb-4ce5-ba9b-c266dd86052e

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

Dissociative amnesia

Dissociative fugue

Dissociative identity disorder

Dissociative autonomic dysfunction

0a

multi

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

Psychiatry

Neurotic, Stress Related and Somatoform Disorders

bf095cef-71d8-457d-820d-9b834258e1c0

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

Anterior tibial

Deep fibular (peroneal)

Deep plantar

Dorsalis pedis

3d

single

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

Anatomy

Lower Extremity

0f26a800-1058-47c2-8694-f495949e101c

The most common malignant neoplasm of infancy is:

Malignant teratoma

Neuroblastoma

Wilms' tumor

Hepatoblastoma

1b

single

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

Pediatrics

6924ca3c-2407-4c1e-bff4-9de5230a1d2a

Chorionic villous sampling done before 10 weeks may result in:

Fetal loss

Fetomaternal hemorrhage

Oromandibular limb defects

Sufficient material not obtained

2c

single

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

Gynaecology & Obstetrics

Diagnosis in Obstetrics

59910ee9-c246-4df5-86bb-872966f42d45

Which one of the following is not associated with a high reticulocyte count ?

Acute bleed

Haemolytic anaemia

Megaloblastic anaemia

Response to treatment in nutrition deficiency anaemia

2c

single

Medicine

12d6c610-9132-43b1-8f58-d5b9cf4ea3b5

Most immunogenic Typhoid antigen

O antigen

H antigen

Vi antigen

Somatic antigen

1b

single

Microbiology

a59f3a04-43fd-49b1-aa8b-5b95c654a4f4

Erenumab was approved by FDA in 2018 for

Phenylketonuria

Migraine

Hypeension

Glycogen storage disorders

1b

single

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

Pharmacology

All India exam

86435dfb-d5b1-45fc-8e69-d466365d7134

Site of maximum bicarbonate absorption-

Proximal convoluted tubule

Distal convoluted tubule

Cortical collecting duct

Medullary collecting duct

0a

single

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

Physiology

Renal Tubular Reabsorption and Secretion

43add3e6-7b59-49b9-bb3e-e0a1acdde142

Mediastinal lymph node calcification is seen in which one of the following ?a) Metastatic neoplasmb) Lymphomac) Sarcoidosisd) Bronchiectasis

a

c

ac

bc

3d

single

Radiology

5be04934-e75c-4b10-9dc0-fa583efb77ed

True statement about PPV is:

It increases with prevalence

It decreases with prevalence

No relation with prevalence

Increases incidence

0a

multi

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

Social & Preventive Medicine

Screening

8e52e363-2ec1-44dc-a2e4-3e5108b3b653

Cephalic index is used for determination of?

Sex

Race

Height

Stature

1b

single

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

Forensic Medicine

Identification - Medicolegal aspects

07f825a3-1f7c-4bc2-a476-e2751656a2f1

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

Thallium

Arsenic

Lead

Copper

0a

multi

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

Medicine