AIIMS MAY 2010: QUESTIONS WITH EXPLANATION

Discussion in 'AIIMS Nov 2013' started by Guest, May 10, 2010.

  1. Guest

    Guest Guest

    Q1.CHANG CLASSIFICATION

    RETINOBLASTOMA
    EWINGS SARCOMA
    MEDULLOBLASTOMA
    OSTEOSARCOMA

    ANS--MEDULLOBLASTOMA
    Risk group stratification is continuing to evolve but is currently based on 3 principal features, including age, extent of postoperative residual disease, and the metastasis stage (M stage) derived from the Chang classification staging system. The M stage classification is as follows:

    M0 - No gross subarachnoid or hematogenous metastasis
    M1 - Microscopic tumor cells found in CSF
    M2 - Gross nodular seeding in cerebellum, cerebral subarachnoid space, or in the third or fourth ventricles
    M3 - Gross nodular seeding in spinal subarachnoid space
    M4 - Extraneuraxial metastasis.

    Q2. berry aneurysms - cause
    a. degeneration of internal elastic lamina
    b. degeneration of media / muscle cell layer
    c. deposition of mucoid material in media
    d. low grade inflammation of vessel wall

    ANS--degeneration of media / muscle cell layer
    Most saccular or intracranial berry aneurysms were once thought to be congenital in origin, arising from focal defects in the media and gradually developing over a period of years as arterial pressure first weakens and subsequently balloons out the vessel wall.
    Recent studies have found scant evidence for congenital, developmental, or inherited weakness of the arterial wall. Although genetic conditions are associated with increased risk of aneurysm development (see Associated conditions), most intracranial aneurysms probably result from hemodynamically induced degenerative vascular injury. The occurrence, growth, thrombosis, and even rupture of intracranial saccular aneurysms can be explained by abnormal hemodynamic shear stresses on the walls of large cerebral arteries, particularly at bifurcation points.

    Less common causes of saccular aneurysms include trauma, infection, tumor, drug abuse (cocaine), and high-flow states associated with AVMs or fistulae.

    Q3. Which of the following retinal diseases is transmitted as Autosomal dominant disorder:
    a) Best disease
    b) Gyrate atrophy
    c) LMB

    Answer: (A). Best disease (vitelliform macular degeneration) is a rare autosomal dominant disorder (Chr. 11q13), with macular degeneration presenting as “yellow egg yolk†like appearance of macula due to lipofuschin accumilation. ERG shows reduced ‘C’ wave.Gyrate atrophy is ornithine tranferase deficiency.Autosomal recessive inheritance Chr 10q.

    Q4. which of the following organs will be affected maximally by the effects of a blast (bomb blast?!?)?
    a. lung
    b. liver
    c. skeletal tissue
    d. nervous system

    ANS. LUNG
    The fatal injury constellation included skull fracture (55%,) blast lung (47%,) ear drum (tympanum) rupture (45%,) and liver laceration (34%.) Interestingly, brain damage frequently occurred without skull fracture. Survivor’s injuries included fractures (18%,) burns (15%,) and concussions (15%.) Blast lung is a severe form of pulmonary contusion (lung “bruiseâ€) where lacerated, crushed lung tissue fills with blood and cannot exchange oxygen.

    Q5. Leprosy affects all of the following except
    a. uterus
    b eyes
    c. ovaries
    d. nerves

    ANS:UTERUS
    LEPROSY AFFECTS ALL ABOVE AMONG THIS RAREST IS UTERUS

    Q6. The capacity of a [bleep] to cause maximum destruction lies in its
    a. size
    b. shape
    c. weight
    d. velocity

    ANS--VELOCITY

    The damage which is created by a projectile is caused by three different mechanisms. The first is laceration and crushing which is the sole method by which low-velocity handguns cause damage to tissue. Higher velocity weapons will stretch the tissue in the wake of the [bleep], forming what is called a temporary cavity as well as the smaller permanent cavity as can be seen in the next couple of slides. A controversial subject is that of shock waves which are present and travel ahead of the [bleep] which last a few microseconds. It was once theorized that these shock waves could cause damage to the tissues; however, this has been refuted in recent studies. The temporary cavity is created by stretching forces in a vacuum in the wake of a [bleep], and the volume of this cavity is proportional to the energy which is transferred, with a maximum diameter being measured at 10 to 40 times the [bleep] diameter. This temporary cavity will actually collapse and reform repeatedly with a diminishing amplitude until it settles down to what will be the permanent cavity. This entire process only lasts one to five milliseconds and, as can be seen in this picture, these are the exact same weight and caliber [bleep]—a .30-caliber [bleep] fired into a block of gelatin. Picture A, on the left, was fired at 1,000 feet per second; and picture B was fired at 2,800 feet per second. You can see the substantial increase in the diameter of the temporary cavity and hence more tissue destruction by higher velocity projectiles. The permanent cavity is the visible track of the [bleep] through the tissue. It is primarily made up of tissue which is crushed by direct contact with the [bleep], and the diameter of the permanent cavity is variable depending on the behavior of the [bleep] as well as the anatomic characteristics of the tissues traversed. Whether the [bleep] yaws once it enters the tissue will increase the diameter of the permanent cavity.

    Q7. Lice TRANSMITS a/e?
    a. Q fever
    b. trench fever
    c. epidemic typhus
    d. relapsing fever

    ANS --Q FEVER
    The human body louse, Pediculus humanus humanus, is the primary vector which transmits the bacterial agents of louse-borne relapsing fever, trench fever, and epidemic typhus.

    Q8. 8. Coagulative necrosis is seen in
    a. TB
    b. sarcoidosis
    c. gangrene
    d. cryptococcal infECTION

    ANS:GANGRENE
    Gangrene is a form of necrosis of tissue with superadded putrefaction.This is a type of coagulative necrosis that occurs due to ischaemia(e.g. in bowel, limb etc.).
    Gangrene is classified into 3 types -
    1. Dry gangrene
    2. Wet gangrene
    3. Gas gangrene


    9.Not an indicator of fecal contamination
    a. E.coli
    b. streptococcus
    c. staphylococcus
    d. cl. perfringens

    ANS:STAPHYLOCOCCUS

    Indicator organisms are used to measure potential fecal contamination of environmental samples. The presence of coliform bacteria, such as E. coli, in surface water is a common indicator of fecal contamination. Coliform bacteria in water samples may be quantified using the most probable number (MPN) method, a probabilistic test which assumes cultivable bacteria meet certain growth and biochemical criteria. If preliminary tests suggest that coliform bacteria are present at numbers in excess of an established cut-off (the Coliform Index), fecal contamination is suspected and confirmatory assays such as the Eijckman test are conducted.[citation needed]

    Coliform bacteria selected as indicators of fecal contamination must not persist in the environment for long periods of time following efflux from the intestine, and their presence must be closely correlated with contamination by other fecal organisms. Indicator organisms need not be pathogenic.[1]

    Non-coliform bacteria, such as Streptococcus bovis and certain clostridia may also be used as an index of fecal contamination

    BACTERIAL INDICATORS OF FECAL CONTAMINATION
    Coliform bacteria, particularly the fecal subgroup have been used for fifty years as an indicator of fecal contamination in fresh waters for known point sources such as sewage treatment plants. It is now known that the use of the Coliform group as indicators of the presence of feces-derived pathogenic bacteria and viruses has shortcomings which can make them untrustworthy indicators in a variety of situations. They exhibit rapid die-off in marine waters and are adversely affected by sunlight and other environmental factors. They enter the water from sewage, liveaboard boats, septic tanks, storm drains and runoff as well as from non-human mammal and bird feces.

    False positives for fecal conform may be caused by a variety of different organisms including Klebsiella and nonfecal coliform. In addition, colifonns have been isolated from pristine areas and may survive and multiply in tropical envirorunents. Thus, the reliability of fecal coliform as an indicator of fecal contamination has been questioned in tropical waters.

    Fecal Streptococci are also inadequate indicators in marine waters and the use of fecal coliforni/fecal streptococci ratios to differentiate human and non-human sources is highly suspect, due to variable die off rates of the two groups. Bacteria of the genus Aeromonas behave similarly to E. coli in polluted waters, but deactivate more rapidly in seawater. The Bifidobactena, Canipylobacteria, Pseudomonas and Salmonella groups seem to offer no advantages over the colifonns and indicators of fecal contamination.

    Bacteria of the genus Staphylococcus survive in sea water and may provide an index of the health risks of swimming in polluted waters, but the group also includes species not associated with fecal pollution. Species of Bacteroides and their phage have the potential to serve as indicators of recent fecal contamination, and may be specific to humans.


    Q10. Most specefic marker for myeloid series
    a. CD 117
    b. CD 99
    c. CD 45
    d. CD 34

    ANS:CD34

    In tumors, CD34 is found in alveolar soft part sarcoma, preB-ALL (positive in 75%), AML (40%), AML-M7


    Q11. Best prognostic indicator for head injured pts?
    a. GCS
    b. ct findings
    c. age of the pt
    d. ... ??

    ANS:GCS


    Q12. Boy with blunt abd trauma - h/o pelvic fracture .. has passed only few drops of blood per meatus and no urine in the past 8 hrs.. bladder is palpable.. which of the following is correct?
    a. anuria d/t haemorhagic shock
    b. urethral injury
    c. ureteral rupture leading to extravasation of urine in retroperitoneum?
    d. bladder rupture


    ANS:URETHRAL INJURY

    IN OPTION C & D BLADDER WILL NOT BE OPALPABLE

    IN OPTION A THERE EILL NOT BE BLOOD PER MEATUS

    13.Drug causing oligospermia

    a. leflunamide
    b. d-penicillinamine
    c. METHOTREXATE
    d. BLEOMYCIN

    ANS:LEFLUNOMIDE


    Q14. MOST COMMON form of substance abuse in india
    a. tobacco
    b. alcohol
    c. cannabis
    d. opioids

    ANS:CANNABIS


    Q15. APPENDICES EPIPLOICAE are present in
    a. caecum
    b. appendix
    c. sigmoid colon
    d. rectum

    ANS:SIGMOID COLON

    The epiploic appendices (or appendices epiploicae, or epiploic appendages, or appendix epiploica, or omental appendices) are small pouches of the peritoneum filled with fat and situated along the colon and upper part of the rectum.

    They are chiefly appended to the transverse and sigmoid parts of the colon, however, their function is unknown.

    The appendages can become inflamed, a benign but painful process known as epiploic appendagitis which can mimic acute appendicitis and other conditions.


    16.All are causes of primary amenorrhea except
    a. rokitansky syn
    b. sheehan's syn
    c. kallman's syn
    d. turner's syn

    ANS:SHEEHAN SYNDROME

    Causes
    Most girls begin menstruating between ages 9 and 18, with an average around 12 years old. Primary amenorrhea is not considered to have occurred until a girl is beyond age 16, if she has undergone other normal changes that occur during puberty. Primary amenorrhea may occur with or without other signs of puberty.

    There are many possible causes of primary amenorrhea:

    Adrenogenital syndrome
    Chromosomal abnormalities such as Turner syndrome or Sawyer syndrome
    Congenital heart disease (cyanotic)
    Congenital adrenal hyperplasia
    Craniopharyngioma
    Chronic (long-term) illnesses
    Cushing's disease
    Cystic fibrosis
    Extreme weight loss
    Genital abnormalities present since birth (absence of the uterus or vagina, vaginal septum, cervical stenosis, imperforate hymen)
    Gonadal dysgenesis
    Hypoglycemia
    Hypothyroidism and hyperthyroidism
    Hypogonadotropic hypogonadism
    Hyperprolactinemia
    Malnutrition
    Obesity
    Prader-Willi syndrome
    Pregnancy
    Polycystic ovarian disease
    Testicular feminization
    True hermaphroditism
    Tumors of the pituitary or adrenal glands
    Tumors of the ovaries


    17.Thalidomide is used in all of the following except
    a. HIV associated peripheral neuropathy
    b. HIV associated mouth ulcers
    c. behcets disease
    d. ENL

    ANS:HIV ASSOCIATED PERIPHERAL NEUROPATHY

    Thalidomide is currently being used or investigated as a treatment for the following dermatological conditions:

    Erythema nodosum leprosum
    Prurigo nodularis
    Actinic prurigo
    Cutaneous lupus erythematosus
    Pyoderma gangrenosum
    Behcet disease
    HIV associated apthous ulcers
    Actinic prurigo
    Erythema multiforme
    [bleep] pemphigoid
    Cutaneous sarcoidosis
    Jessner lymphocytic infiltration
    Pompholyx
    Scleroderma
    Severe urticaria


    Q18. Commonly seen with congenital hypertrophic pyloric stenosis
    a. hyperchloremic metabolic alkalosis
    b. hypochloremic metabolic alkalosis
    c. hyperkalemic metabolic acidosis
    d hypokalemic metabolic acidosis

    ANS:Hypochloremic metabolic alkalosis

    Hypertrophic pyloric stenosis (HPS) is commonly encountered in pediatric practice. The typical infant presents with nonbilious projectile vomiting and dehydration (with hypochloremic metabolic alkalosis) if the diagnosis is delayed. HPS accounts for one third of nonbilious vomiting occurrences in infants and is the most common reason for laparotomy before age 1 year.

    Mutations in this gene are associated with gastrointestinal stromal tumors, mast cell disease, chronic myelogenous leukemia, and piebaldism. Multiple transcript variants encoding different isoforms have been found for this gene.

    Cluster of differentiation (CD) molecules are markers on the cell surface, as recognized by specific sets of antibodies, used to identify the cell type, stage of differentiation and activity of a cell. CD117 is an important cell surface marker used to identify certain types of hematopoietic (blood) progenitors in the bone marrow. To be specific, hematopoietic stem cells (HSC), multipotent progenitors (MPP), and common myeloid progenitors (CMP) express high levels of CD117. Common lymphoid progenitors (CLP) expresses low surface levels of CD117.

    CD117 also identifies the earliest thymocyte progenitors in the thymus. To be specific, early T lineage progenitors (ETP/DN1) and DN2 thymocytes express high levels of c-Kit.

    In addition, mast cells, melanocytes in the skin, and interstitial cells of Cajal in the digestive tract express CD117.

    CD117 is also a marker for mouse prostate stem cells.


    Q19. Hyperextensibility with NORMAL elastic recoil
    a. Ehlers Danlos syn
    b. cutis laxa
    c. scleroderma
    d.

    ans.Ehler danlos syndrome


    Q20. Which of the following is a pulsatile tumor?
    a. Osteosarcoma
    b. chondrosarcoma
    c. osteoclastoma
    d. ewings sarcoma

    ANS:OSTEOCLASTOMA


    Q21. 25 yr old male with fever, malaise.. and erythematous nodules over the shin (?)
    diagnosis is
    a. erythema nodosum
    b. hensen's disease
    c. weber-christian disease
    d. urticarial vasculitis

    ANS.WEBER CHRISTIAN DISEASE

    Weber-Christian disease is a skin condition that features recurring inflammation in the fat layer of the skin. The involved areas of skin manifest as recurrent crops of erythematous, sometimes tender, edematous subcutaneous nodules. The lesions are symmetric in distribution, and the pages and lower legs are affected most frequently. Malaise, fever, and arthralgias frequently occur. Nausea, vomiting, abdominal pain, weight loss, and hepatomegaly may also occur. Because its etiology is unknown, Weber-Christian disease is often referred to as idiopathic lobular panniculitis.

    Q22. The function of 8th cranial nerve is related to
    a. smell
    b. taste
    c. touch
    d. balance


    ANS:BALANCE


    Q23. Amyloidosis .. most reliable investigation
    a. rectal biopsy .. has to be the answer??!
    b. ct scan
    c. colonoscopy
    d...

    ANS:RECTAL BIOPSY


    Q24. pain insensitive structure in brain is
    a. falx cerebri
    b. dural venous sinuses
    c. choroid plexus
    d. middle meningeal a.

    ANS:CHOROID PLEXUS

    • Choroid plexus (D) is not a pain producing structure.
    • Much of the brain parenchyma, ventricular ependyma, pial veins and choroids plexus are not pain-producing structures.
    • Few cranial structures are pain producing – The scalp, middle meningeal artery (B), dural sinuses (A), falx cerebri (C) and proximal segments of large pial arteries.
    • The key structures involved in primary headache are few and the large intracranial vessels and durameter innervated by the trigeminal nerve.


    Q25. infant wid congestive cardiac failure.. bulging fontanelle with a bruit which can be auscultated.. CT shows midline lesion with dilated lateral ventricles.. diagnosis is..??
    a. vein of galen malformation
    b. arachnoid cyst
    c. teratoma
    d. ... ???

    VEIN OF GALEN MALFORMATION

    Q26. Portal flow is decreased to lowest in :-
    Halothane
    Ether
    Enflurane
    Isoflurane

    ANS :ISOFLURANE

    Q27. Savlon contains:-
    Cetrimide + chlorhexidine
    Cetrimide + chlorhexidine + butyl alcohol
    Cetrimide + butyl alcohol
    CETRIMIDE + CETAVLON

    ANS:In India Savlon is an antiseptic liquid marketed by Johnson & Johnson. It contains I.P. 1.5% v/v Chlorhexidine Gluconate Solution and B.P. Strong cetrimide solution eq. to Cetrimide I.P. 3.0% w/v.

    Q28. capacitation of sperm occurs in?

    1. uterus.
    2. epididymis.
    3. vas deferen
    4.?

    ans. uterus

    Q29. Eukaryotic plasma membrane is made of al except?

    1. carbohydrates
    2. lecithin
    3. triglycerides
    4. cholesterol

    ans. triglycerides

    Q30. which of the following doesnt affect free radicals in the lens?

    1. vit a
    2. vit c
    3. vit e
    4. catalase.

    ans. vit a
  2. Guest

    Guest Guest

    28.Capacitation of sperm occurs in

    uterus
    epididymis
    seminal vesicle
    vas deferens

    ANS:UTERUS

    Capacitation is the penultimate step in the maturation of mammalian spermatozoa and is required to render them competent to fertilize an oocyte. This step is a biochemical event; the sperm move normally and look mature prior to capacitation. In vivo this step typically occurs after ejaculation, in the female reproductive tract. In vitro, capacitation can occur in sperm that have either undergone ejaculation or have been extracted from the epididymis.

    By secreting sterol binding albumin, lipoproteins, proteolytic and glycosidasic enzymes such as heparin, the uterus aids in the steps of capacitation.

    Non-mammalian spermatozoa do not require this capacitation step and are ready to fertilize an oocyte immediately after release from the male. After this capacitation the sperm must undergo activation involving the acrosome reaction.

    The best investigation for temporal bone injuries
    a. CT scan
    b. angio
    c. plain film
    d. MRI

    ANS:CT SCAN

    for bony temporal bone – CT
    for inner ear- MRI
    for facial nerve- MRI


    30.MOTORcyclists fracture is..

    a. Ring fracture
    b. Comminuted fracture of the vault..
    c. Skull base divided into two halves - anterior n posterior
    d. Subdural haemoorhage


    ans:Skull base divided into two halves - anterior n posterior

    Ring or Foramen fractures: (a) It is fissured fracture of the skull which encircles the skull in such a manner that the anterior third is separated at its junction with the middle and posterior third (b) fracture line runs at about 3-5 cm outside the foramen magnum at the back and sides of the skull and passes forwards through the middle ears an roof of the nose due to which the skull is separated from the spine.

    Comminuted fractures: In this skull fracture variety, the bone is broken into multiple pieces, e.g. RSA, fall from a height on a hard surface, and from blows by weapons with a large striking surface, kick by an animal, bullet injury, resembles a spider’s web or mosaic.

    Subdural Hemorrhage:
    1. It is common in childhood or old age.
    2. Occurs in subdural space between the durameter and arachnoid due to rupture of bridging or communicating veins, inferior cerebral veins, and cortical veins, i.e. source of blood is venous or capillary, not arterial.
    3. Found in alcoholics old persons and in children.
    4. Death may occur if the hemorrhage > 50 ml.

    31.Infant with repeated vomiting, diarrhea, failure to thrive hepatosplenomegaly CT shows adrenal gland calcification

    adrenal
    h'ge
    cushings
    wolmans syndrome

    ANS:WOLMANS SYNDROME


    Infants may be normal and active at birth but quickly develop progressive mental deterioration, hepatosplenomegaly (an enlarged liver (hepatomegaly) combined with an enlarged spleen (splenomegaly), intrabdominal adenopathy, distended abdomen, gastrointestinal problems including steatorrhea (excessive amounts of fats in the stools), jaundice, anemia, vomiting and calcium deposits in the adrenal glands. The overall clinical picture is an infant who appears ill and fails to thrive.

    The key imaging findings are enlarged adrenal glands, with punctate calcifications, and a preserved shape. The calcification may be limited to the cortex of the gland. This may be a pathognomonic sign. The liver and spleen are enlarged, especially the liver. The liver demonstrates low density on CT, due to fatty infiltration. There may be enlarged, low-density mesenteric and retroperitoneal lymph nodes.
  3. Navjyot.

    Navjyot. Guest

    CIN-3 35 YEAR PARA -3 LADY..TREATMENT OF CHOICE IS :-
    A) CRYO
    B)LEEP
    C)CONISATION
    D)HYSTERECTOMY

    Ans:LEEP

    32.Prostate cancer most sensitive detection is:-
    a) per rectal ex
    b) DRE + PSA ..
    C)pSA
    D) MRI COIL INSIDE RECTUM

    ANS;DRE+PSA

    33 Anterior ethmoidal nerve supplies A/E
    a) Ant part of internal nose
    b) ethmoid sinus
    c) maxillary sinus
    d) sphenoid sinus

    Ans d) sphenoid sinus

    34.classified on basis of Scale very satisfied, satisfied,unsatisfied....

    1.ordinal
    2.nominal
    3.range
    4.interval

    ANS:ORDINAL SCALE
    An ordinal scale is a measurement scale that assigns values to objects based on their ranking with respect to one another. For example, a doctor might use a scale of 0-10 to indicate degree of improvement in some condition, from 0 (no improvement) to 10 (disappearance of the condition). While you know that a 4 is better than a 2, there is no implication that a 4 is twice as good as a 2. Nor is the improvement from 2 to 4 necessarily the same "amount" of improvement as the improvement from 6 to 8. All we know is that there are 11 categories, with 1 being better than 0, 2 being better than 1, etc.

    35.Splicing activity present in
    a. mRNA
    b. tRNA
    c. snRNA
    d. rRNA

    ANS:sn RNA

    In molecular biology, splicing is a modification of an RNA after transcription, in which introns are removed and exons are joined. This is needed for the typical eukaryotic messenger RNA before it can be used to produce a correct protein through translation. For many eukaryotic introns, splicing is done in a series of reactions which are catalyzed by the spliceosome, a complex of small nuclear ribonucleoproteins (snRNPs), but there are also self-splicing introns.

    36.Most important organelle involved in apoptosis
    a. mitochondria
    b. nucleus
    c. golgi bodies
    d. ER

    ANS:NUCLEUS

    37.60 yr old chronic smoker comes with gross painless hematuria of one day duration .. whats th next appropriate investigation?
    a. xray KUB
    b. USG KUB
    c. urine - routine, microscopy
    d. urine cytology for malignant cells

    ANS:URINE CYTOLOGY FOR MALIGNANT CELLS

    38.Woman with placenta praevia - bleeds - what is most likely to occur after delivery?
    a. lack of menstrual cycles
    b. galactorhea
    c. Diabetes insipidus
    d....??

    ANS:LACK OF MENSTRUAL CYCLES

    SECONDARY AMEONORRHOEA

    39.x ray feature of fibrous dysplasia..

    1.ground glass appearance
    2.calcification
    3.cortical thickening
    4.

    ANS:GROUND GLASS APPERENCE
    Image shows homogeneous loss of the normal trabecular pattern in the shaft of the humerus, with a ground-glass appearance caused by fibrous dysplasia.

    40.Peutz-jeghers polyps present in
    a.rectum
    b.colon
    c.small intestine
    d.appendix

    ANS:SMALL INTESTINE(JEJUNUM)


    41.Intrinsic factor of castle found in :

    A.liver
    B.chief cells of stomach
    C.parietal cells of stomach
    D.???

    ANS:pARIETAL CELLS OF STOMACH


    42.Middle aged female with h/o menorrhagia can be treated by all wth some evdence based wala funda except
    1.etamsylate
    2.tranexaminic acid
    3.ocp
    4.progesteron therapy on days 5-25

    ANS:ETHAMSYLATE

    43.Vit A prophylaxis
    a) Specific protection
    b) Health promotion
    c) Secondary
    d) Primordial


    ANS:SPECIFIC PROTECTION


    Concept of Prevention
    Primordial prevention (Prevention of emergence of risk factors): main intervention is through individual and mass education
    Primary Prevention – (Best method of prevention): brought about by – Health promotion and Specific protection

    The well known interventions in this area are:
    Health promotion by:
    a. Heath education
    b. Environmental modification
    c. Nutritional intervention
    d. Lifestyle and behavioural changes

    Specific Protection by:
    a. Immunization
    b. Use of specific nutrients, e.g. Vit A, Fe and Folic acid tablets, etc.
    c. Chemoprophylaxis
    d. Protection against occupational hazards
    e. Avoidance from allergens
    f. Protection from carcinogens
    g. Control of consumer product quality

    Secondary prevention – Early diagnosis and Disease treatment
    Tertiary prevention – Disability limitation and Rehabilitation

    44.Two siblings with osteogenesis imperfecta.. but their parents are normal.. cause/mechanism of inheritance

    anticipation
    genomic imprinting
    germ cell line mosaicisM
    new mutation

    ANS:GERM LINE MOSAICISM

    45.All cause retraction of scapula except?

    a. Rhomboides major
    b. rhomboides minor
    c. trapezius
    d.levator scapulae

    ans:levator scapulae

    46.which of these is not an opioid agonist
    a. heroin
    b. ketamine
    c. methadone.
    d. morphine

    ANS:KETAMINE

    47.Not used in pulmonary hypertension
    a.ccb
    b.endothelin receptor antagonist
    c. alpha blocker
    d.prostacyclines

    ANS:ALPHA BLOCKER
  4. Navjyot.

    Navjyot. Guest

    48.Zollinger elison syndrome drug used is:-

    a) Proton pump inhibitor
    b) Antihistaminics
    c) Dopamine blockers
    d)

    ANS:pPI

    50.Hallmark of acute inflammation?
    1. Vasoconstriction
    2. Stasis
    3. Vasoldilatn and increase in permeability
    4.leucocyte marginaton

    ANS:VASODILATION AND INCREASE IN PERMEABLITY

    51.Hepatomegaly is not the important feature of:- a) Nieman pick disease
    b) Glycogen storage diseases
    c) Hurler Disease
    d) hepatic porphyrias

    ANS:HEPATIC PORPHYRIAS

    52.COELIAC PLEXUS??
    a. Ant lat and around the aorta
    b. post medial and around the aorta
    c. ant medial to lumbar symp chain
    d. post lat to lumbar symp chain

    ANS:ANTEROMEDIAL TO LUMBAR SYMPATHETIC CHAIN

    53.h/o Unilateral progressive proptosis for many years...swelling is increased on bending forward and compressible....USG shows retrobulbar echogenicity

    1) Orbital varix.
    2) Orbital A-V fisula.
    3) Neurofibromatosis.
    4) orbital encephalocele

    ANS.ORBITAL VARIX

    54.Ext laryngeal memb A/E

    cricothyroid
    thyrohyoid
    cricotracheal
    hyoepiglotic

    ANS:CRICOTHYROID

    55.pentology of fallot

    tof + asd

    56.A woman developed acute pain in the right pain. Synovial fluid aspiration showed CPPD crystals. Which of the following tests should be done further for evaluation?
    a. ANA
    b. RF
    c. TSH
    d. ?

    ANS:TSH

    57.Antigen antibody precipitation is maximally seen in which of the following?
    a. Excess of antibody
    b. Excess of antigen
    c. Equivalence of antibody and antigen
    d. Antigen-Hapten Interaction

    ANS:Equivalence of antibody and antigen
    58.Which of the following is not used to diagnose Leptospirosis?

    a. Microscopic agglutination test
    b. Dark field microscopy
    c. Macroscopic agglutination test
    d. Weil-felix reaction

    ANS:WEIL FELIX REACTION

    59.Sputum positive pregnant in 1st trimester?

    1. no treament.
    2. start cat 1.
    3. start cat 2.
    4.start cat 3.

    ANS:start cat1.

    60.Eukaryotic plasma membrane is made of al except?

    1. carbohydrates
    2. lecithin
    3. triglycerides
    4. cholesterol

    ans. triglycerides

    61.which of the following doesnt affect free radicals in the lens?

    1. vit a
    2. vit c
    3. vit e
    4. catalase.

    ANS:VIT A

    62.Anterior ethmoidal nerve supplies A/E
    a) Ant part of internal nose
    b) ethmoid sinus
    c) maxillary sinus
    d) ant dura near cribrifrm plate

    ANS:MAXILLARY SINUS

    63.OBSESSIVE COMPULSIVE DISORDER DOC:
    A) IMIPRAMINE
    B)ALPRAZOLAM
    C)BZDs
    D)Fluoxetine

    ANS:FLUOXETINE

    64. Sickle cell anemia 26 yrs old boy the following should not be used
    a) IV Regioanal analgesia
    b)BRachial plexus supraclavicular app bloc
    c) brachial plexus axillary approach
    d)brachial plexus

    ANS:INTRAVENOUS REGIONAL ANESTHESIA

    65.Post glenohumeral instability
    a) Crank test
    b) Fulcrum
    c) Jerk test
    d) sulcus test

    ANS:JERK TEST

    66.Most diagnostic of rabies:-
    a) Negri bodies
    b) Gaurneiri bodies
    c)cowdry A
    d)cowdry B

    ANS:NEGRI BODIES

    Q.In intrahepatic cholestasis,termination of pregnancy should be done at-
    a.34 weeks
    b.36 weeks
    c.38 weeks
    d.40 weeks

    ANS:36 WKS

    On diagnosis, most doctors prescribe Ursodeoxycholic Acid. Some will prescribe Cholestyramine. While there is no cure for ICP, and no way to guarantee a successful outcome, studies have shown a slightly better fetal and maternal outcome from administration of Ursodeoxycholic Acid, whereas Cholestyramine appears to only relieve itching.If additional blood tests to check clotting function identify a problem, giving Vitamin K may help avoid the risk of hemorrhage at delivery.Delivery by 35-37 completed weeks is considered crucial to fetal outcome though it does not completely eliminate the risks associated with the condition.


    68.Meralgia parasthetica is due to involvement of:-
    a) Sural nerve
    b) Med cutaneous nerve of thigh
    c) Lateral cutaneous nerve of thigh
    d) Peroneal n

    ANS:LATERAL CUTANEOUS NERVE OF THIGH


    69.FASTEST DECREASE IN K LEVELS IS BY:-

    CALCIUM GLUCONATE
    INSULIN + GLUCOSE
    K RESINS
    NA HCO3

    ANS:INSULIN AND GLUCOSE


    70.maltese cross

    a.cryptococcus
    b.blastomycosis
    c.candida
    d.

    ANS:CRYPTOCOCCUS
  5. Navjyot.

    Navjyot. Guest

    71.INCISED WOULDS ON GENITALIA ON POST MORTEM-

    A) HOMICIDAL
    B) SELF INFLICTED
    C) POST MORTEM
    D) ACCIDENTAL

    ANS:HOMICIDAL

    Q.An alert 6month old baby presents with diarrhoea and vomiting.Systolic blood pressure of 80mm Hg.He appears pale with a heart rate of 180/min and cold and mottled extremities.His capillary refilling time is 4 seconds.Diagnosis-
    a.compensated shock due to hypovolemia
    b.decompensated shock due to supraventricular tachycardia
    c.compensated shock due to svt
    d.decompensated shock due to hypovolemia

    72.Gestational diabetes mellitus.. what is NOT usually seen
    a. past h/o macrosomic baby
    b. malformations
    c. obesity
    d. polyhydramnios

    ANS:pAST H/O MACROSOMIC BABY

    ITS NOR MUST TO HAVE A PAST HISTORY FOR GDM FOR A MOTHER WITH DM ALREADY BEFORE PREGNANCY WE CAN CONSIDER THIS WAT SAY

    73.A healthy young athlete sitting at table with knee at 90 degree flexion. He fully extends it. what will happen?

    a. Movement of tibial tuberosity twds lat border of patella

    b. Movement of tibial tuberosity twds medial border of patella

    c. Movement of tibial tuberosity twds centre of patella

    d. NO CHANGE

    ANS:Movement of tibial tuberosity twds medial border of patella

    74.Carcinogenesis in colon implicates all of the following genes except

    APC
    k-ras
    beta-catenin
    mismatch repair genes

    ANS:BETA CATENIN

    75.A 57yr old woman comes wid b/l progressive weakness of both lower limbs, spasticity present
    on MRI mass enhancing dorsal intradural lesion present .. (rest of da description dont remember.. someone pls help) .. diagnosis
    a. intradural lipoma
    b. meningioma
    c. neuroenteric cyst
    d. ...

    ANS:MENINGIOMA

    76.GIRL eating binges with purgings...
    a.aneroxia nervosa
    b.bulimia nervosa...
    c.binge eating ds
    d.

    ANS:BULIMIA NERVOSA

    77.NORMAL ROLE OF MICRO RNA

    GENE REG
    'RNA SPLICING
    INITIATION OF TRANSL
    DNA CHANGES

    ANS:SPLICING

    78.ACETYL CO A CAN B CONVERTED INTO ALL EXCEPT??
    GLUCOSE
    FATTY ACIDS
    CHOL
    KB

    ANS:GLUCOSE

    79)Incidence can be calculated from?
    a) case control study
    b) cross sectional study
    c) prospective study
    d) retrospective study
    ans: c - prospective study

    80) All are features of prostatic urethra except
    a)trapezoid in shape
    b)presence of veromontanum
    c) opening of prostatic ducts
    d) relation to urethral crest
    ans: trapezoid in shape ( on transverse section it is semilunar/crescentic in shape)

    Child showing dec conc. normal milestones delayed speech.....
    a)Autism
    b)ADHD
    C)Specific devopmental...
    d)...?

    Most common cns tumor to mets extracanially is?
    medulloblastoma
    glioblastoma multiforme
    choroid plexus carcinoma
    ???
    ans: medulloblastoma
    MC mets to bone..

    Q. which is not supplied by pelvic splanhnic nerves?
    a. Rectum.
    b. urinary bladder.
    c. appendix.
    d. uterus.
    Ans. c. appendix.

    Q. True about spinocerebellar tract is
    a. planning n programming.
    b. smoothens and coordinates movement.
    c. learning induced by change in vestibulocular reflex.
    d. equillibrium.
    Ans. smoothens and coordinates movement.

    Q86. Best indicator of ovarian resserve is ?
    a. FSH
    b. estradiol
    c. LH
    d. FSH/LH ratio
    Ans. FSH. (repeat qs 4m nov'2008)

    Q87. Somatomedin mediates:
    a. lipolysis
    b. decreased rate of glucose uptake by cells.
    c. deposition of chondroitin sulphate.
    d. gluconeogenesis.
    Ans. c. deposition of chondroitin sulphate..
  6. Navjyot.

    Navjyot. Guest

    what is NOT a primary cutaneous disorder?
    a. lichen planus
    b. psoriasis
    c. bowen's disease
    d. reiters disease
    ANS:REITER DISEASE

    condition where normal delivery not alowed?
    monozygotic monochorionic
    dizygotic with 1st cephalic 2nd breach,,,
    mento anterior
    extended breech

    ANS:MONOZYGOTIC MONOCHORIONIC


    best indicator for ovarian reserve
    a)LH
    B)FSH
    c)FSH/LH
    d)ESTRADIOL

    ANS:FSH

    MOST SENSITIVE INDICATOR OF PEDIATRIC BLOOD VOLUME????
    CARDIAC OUTPUT
    HEART RATE
    STROKE VOLUME
    PRELOAD

    ANS:HEART RATE

    A 3yr old boy with normal dev.milestones with delayed speech & difficulty in concentration & communication ,not making frnd. most probable dg is
    1.sp.learning disability
    2.autism
    3.mental retardation
    4.ADHD

    ANS:AUTISM

    A 65 yrs old man...h/o of back pain since 3 months....ESR 55....syndesmophytes presentin dorsal spine.minimal dec chest expansion.dx?
    a.ankylosing spondilitis
    b.degenerative osteoarthritis of spine
    c.ankylosing hyperosteosis
    d.lumber canal stenosis

    ANS:ANKY;OSING SPONDYLITIS

    female comin wth lip swellin sign of edema, abdominal pain..wat is characteristic of given cond

    c1 h def
    c5 esterase def

    ANS:C5 DEFECIENCY

    a middle aged male with an ulcerative granulomata on his glans - wright giemsa stained specimen shows 1-2 rounded structures vacuolated within macrophages.. ??
    what is the causative organism?
    a. chlamydia trachomatis
    b. calymmatobacterium granulomatis
    c. h. ducreyi
    d. neisseria gonorrhoea

    ANS:NEISSERIA

    maethaemoglobinemia caused by?
    a. procaine
    b. prilocaine
    c.......
    d........

    ANS:pRILOCAINE

    All of the following r true bout sickle cell anemia except
    a. single nucleotide change leads to a change from glutamate to valine
    b. a single base pair change leads to RFLP
    c. deoxygenated Hb leads to the exposure of sticky end.. due to replacement of non polar residue by polar residue
    d. offers protection to malaria in heterozygotes

    ANS:deoxygenated Hb leads to the exposure of sticky end.. due to replacement of non polar residue by polar residue

    INDIAN REFERENCE MALE WEIGHT

    50KG
    55KG
    60KG
    65KG

    ANS:60 KG
  7. Navjyot.

    Navjyot. Guest

    giant cell arteritis a/e
    a. sudden b/l blindness
    b. mostly affects elderly
    c. mostly women
    d. aggrevated by heat

    ANS:AGGRAVATED BY HEAT

    IN BLUNT ABDOMEN TRAUMA THE INCISION IS BEST DONE THROUGH
    A. MIDLINE ALWAYS
    B.TRANSVERSE ALWAYS
    C.DEPENDS ON ORGAN INVOLVED
    D.DEPENDS ON THE SEVERITY OF HEMORRHAGE

    ANS:ALWAYS MIDLINE

    Vision 2020..right to sight.a/e..
    1) Trachoma.
    2) Onchocerciasis.
    3) Epidemic conjunctivitis.
    4) Cataract

    ANS:EPIDEMIC CONJUCTIVITIS

    Which of the following is not pre-malignant:-

    a) Familial adenomatous polyposis
    b) Juvenile Polyposis syndrome
    c) Adenoma
    d) Juvenile Polyp

    ANS:JUVENILE POLYP

    Which of the following is not true regarding Aedes mosquito?
    a. It bites repeatedly
    b. It transmits dengue
    c. Eggs cannot survive for more than one week without water
    d. Incubation period in mosquito is 7-8 days

    ANS: Eggs cannot survive for more than one week without water

    False positives are increased in which of the following?
    a. Low prevalence
    b. High prevalence
    c. High sensitivity
    d. High specificity

    ANS:LOW PREVALENCE

    Which of the following is not true regarding surveillance of water pollution?
    a. Multiple tube method is used
    b. (?)
    c. Sodium thiosulfate is used to neutralize chlorine
    d. Presence of Clostridium spores indicates recent contamination

    ANS:presence of Clostridium spores indicates recent contamination

    Incidence can be calculated from
    a. Cross sectional study
    b. Case control study
    c. Prospective study
    d. Retrospective study

    ANS:pROSPECTIVE STUDY


    Which of the following is not true about Crude Birth Rate?
    a. It is a measure of fertility
    b. It is actually a ratio
    c. It is independent of the age structure of the population
    d. Numerator does not include still births

    ANS:ITS ACTUALLY A RATIO

    Although Crude birth rate does not take age into considerations, birth rates are affected by the age-structure of the population.

    A ratio is the number of observations in a group with a given characteristic divided by the number of observations without the given characteristic. A ratio is always defined as a part divided by another part.

    Which is the most efficacious vaccine?
    a. Measles
    b. DPT
    c. TT
    d. Polio

    ANS:MEASLES

    The best way to dispose off mercury is
    a. Safe collection and reuse
    b. Controlled combustion
    c. Treatment with acid
    d. Deep burial

    ANS:EITHER A OR C

    According to the WHO the STEPS approach is used for surveillance of which of the following?
    a. Risk factors for communicable diseases
    b. Risk factors for non communicable diseases
    c. Mortality of non communicable diseases
    d. Mortality of communicable diseases

    ANS:RISK FACTOR OF NON COMMINICABLE DISEASES

    All of the following can be used to treat heroin dependence except
    a. Disulfiram
    b. Buprenorphine
    c. Clonidine
    d. Lofexidine

    ANS:DISULFIRAM

    Strawberry gingiva is seen in which of the following?
    a. Wegener’s Granulomatosis
    b. Monocytic leukemia
    c. Phenytoin gum hypertrophy
    d. ?

    Answer:Wegener’s Granulomatosis

    REF:Rook’s Textbook of Dermatology,
    Oral ulcers are the second most common mucocutaneous sign of WG, and it has been suggested that ‘strawberry’ gingival hyperplasia is pathognomonic.
  8. kishan.

    kishan. Guest

    Which of the following drugs should not be used in a pregnant woman of > 35 weeks gestation?
    a. Methotrexate
    b. Sulfasalazine
    c. Prednisolone
    d. Chloroquine

    ANS:METHOREXATE

    All of the following genes are implicated in colon carcinoma except
    a. APC
    b. k-ras
    c. beta-catenin
    d. mismatch repair genes

    ANS:BETA CATENIN
    There appear to be at least three different pathways driving carcinogenesis: chromosomal instability, microsatellite instability (MSI), and CpG island methylation. In the chromosomal instability pathway, early mutations include inherited or acquired changes in the tumor suppressor gene, APC, located on the long arm of chromosome 5, and mutations in the K-ras proto-oncogene. Later genetic events include changes in the deleted in colon cancer mutation (DCC) gene on 18q, and mutation of the tumor suppressor gene p53 on chromosome 17p. Genetic mutations that occur in inherited colorectal cancer following the chromosomal instability pathway include those of the APC gene in familial adenomatous polyposis. The accumulation of genetic alterations with structural and copy number abnormalities in numerous chromosomes eventually leads to phenotypic alterations in the colorectal epithelium and are associated with the development of adenomas that sometimes progress to invasive carcinoma with eventual metastases. In the microsatellite instability pathway, alterations in genes for a variety of DNA mismatch repair enzymes occur in the inherited form (hereditary nonpolyposis colorectal cancer syndrome/Warthin-Lynch syndrome), and silencing of one of these genes (hMLH1) by methylation in the sporadic form. Mismatch repair deficiency leads to numerous mutations in genes that have repeated nucleotide sequences (microsatellites) and in individual nucleotides (mutator phenotype), but chromosomal alterations are uncommon. In the CpG island methylation pathway epigenetic hypermethylation of DNA occurs, leading to suppression of gene expression by methylation in promoters. The perturbations affect expression of important regulatory proteins controlling cell morphology, growth, and adhesion. Hypomethylation of intronic DNA accompanies hypermethylation. Abnormalities of more than one of the three recognized pathways are often evident in colorectal cancers, as CpG island methylation can occur in concert with both the chromosomal instability pathway and the microsatellite instability pathway.

    Which of the following is the best intestinal absorption test?
    a. Quantitative stool fat estimation
    b. D Xylose test
    c. PABA
    d. Schilling test

    ANS:XYLOSE ABSORPTION TEST

    CYP3A INHIBITION IS CAUSED BU ALL EXCEPT
    A) SAQUINAVIR
    B) RITONAVIR
    C) erythromycin
    D) itraconazole

    ANS:SAQUINAVIR

    Which of the following is an early complication of ileostomy?
    a. Necrosis
    b. Obstruction
    c. Diarrhea
    d. Prolapse

    ANS:NECROSIS

    Following are the early stomal complications mentioned in Sabiston Surgery, 18th edition
    Poor location
    Retraction (may also develop as late complication)
    Ischemic necrosis
    Detachment
    Abscess formation (may also develop as late complication)
    Opening wrong end
    Excoriation
    Dermatitis (may also develop as late complication)
    High output (may also develop as late complication

    Which of the following doesnt affect free radicals in the lens?
    1. vit a
    2. vit c
    3. vit e
    4. catalase.

    ANS:VIT A

    Cryoglobulinema with ankle arthritis.polyclonal monoclonal cryoglobulinemia..and other findings of systemic involv??
    a)Hepatitis a
    b)Hepatitis b
    c)hepatitis c
    d)ebv

    ans:hepatitis b

    PANETH CELLS have..
    a. high zinc content
    b. numerous lysozyme granules
    c. rich RER
    d.foamy cells

    QUESTION SHOULD BE A/E

    THEN ANS:FOAMY CELLS

    hyopomagnesemia caused by
    a.furosemide
    b.digoxin
    c.aminoglycoside
    d.cisplatin

    ANS:FUROSEMIDE

    Contraceptive of choice in lactating female...

    a. lactational amemorrohea
    b. barrier contraceptives
    c. progesterone only pill
    d. OCP

    ANS:LACTATIONAL AMENNORHOEA

    Wilm's tumour is associated with a/e

    a. aniridia
    b. hemihypertrophy
    c. hypertension
    d. polycystic kidney

    ans:polycystic kidney

    Global warming,Which is true among the following?
    1. CO2 Is the major gas responsible for the greenhouse effect
    2. Kyoto declaration: 20% emission cut
    3. CFCs do not harm the stratosphere ozone layer
    4. ??
    ANS: CO2 Is the major gas responsible for the greenhouse effect

    Temporal arteritis all are true except
    a. sudden b/l blindness
    b. mostly affects elderly
    c. mostly women
    d .aggravated by heat
    ANS:AGGRAVATED BY HEAT

    68 yr old male havin swollen knee n pain. coming to clinic AHLLBACKc stage 2.wat is moost appropriate treatment?
    a. arthroscopic washing
    b. total knee replacement
    c. conservative
    d.high tibial ostotomy
    ANS:ARTHROSCOPIC WASHING

    Pregnant lady with cervical lypmphadenopathy, prescribed spiramycin, non compliant...baby has intracerebral calcification?
    a.Toxoplasmosis
    b.cytomegalovirus
    c) cryptococcus
    d) ?
    ANS:TOXOPLASMOSIS

    Morgagni hernia?
    a. ant rt hernia
    b.ant left
    c.post rt
    d.post left
    ANS:ANTERIOR RIGHT

    Which of the following drugs should not be used in a pregnant woman of > 35 weeks gestation?
    a. Methotrexate
    b. Sulfasalazine
    c. Prednisolone
    d. Chloroquine

    ANS:METHOREXATE
    Actually this question was that the pregnant female was having SLE..and which of the above drugs cant e used....ans s/b sulfasalazine.

    Thyroid malignancy cant b diagnosed by
    1. hypoehogenicity
    2.hyperechogenicity
    3.microcalcifications
    4.irregular margins
    ANS:HYPERECHOGENICITY

    a pt with head trauma extrnl marks prsnt invst small hemorrhages

    a difuse axonal injury
    b multipal infarcts
    ans a ??

    psammoma bodes not seen in
    1.papillary ca thyroid
    2.follicular ca thyroid
    3.meningioma
    4.serous cystadenoca ovary

    ANS:FOLLICULAR CA
  9. Guest

    Guest Guest

    Contraceptive of choice in lactating female...

    a. lactational amemorrohea
    b. barrier contraceptives
    c. progesterone only pill
    d. OCP

    ANS:LACTATIONAL AMENNORHOEA

    NON HORMONAL SHOULD BE USED SO EITHER A OR B

    ACORDING TO BELOW REFERENCE ITS LACTATIONAL AMENNORHOEA

    Breastfeeding infertility
    For women who meet the criteria (listed below), LAM is 98% - 99.5% effective during the first six months postpartum
    Breastfeeding must be the infant’s only (or almost only) source of nutrition. Feeding formula, pumping instead of nursing[2], and feeding solids all reduce the effectiveness of LAM.
    The infant must breastfeed at least every four hours during the day and at least every six hours at night.
    The infant must be less than six months old.
    The mother must not have had a period after 56 days post-partum (when determining fertility, bleeding prior to 56 days post-partum can be ignored).
    Ecological breastfeeding
    Ecological breastfeeding is a stricter form of LAM developed by Sheila Kippley, one of the founders of the Couple to Couple League. Studies have shown it has a 1% failure rate in the first six months postpartum, and a 6% failure rate before the woman’s first postpartum menstruation

    Contraceptive efficacy of barrier methods.

    Pregnancy Rate (%)

    Condoms---14 - 16
    Spermicide--22 - 26
    Diaphragm--17 - 19
    (Rhythm/NFP)--6 - 20
    (No method)--~ 40
    (Oral contraception)--4 - 6
    (IUDs)--1 - 4-
    (Sterilization)-- 0.1 - 0.5
  10. kishan.

    kishan. Guest

    Ovarian pathology referred to
    1) Gluteal region.
    2) Ant thigh
    3) Medial part of thigh.
    4) Back

    AND:MEDIAL PART OF THIGH

    SMOKING CAUSES CA OF ALL EXCEPT

    LARYNX
    EOSOPHAGUS
    NASOPHARYNX
    ?

    Endolymph in inner ear produced by?
    1) Phalangeal cells.
    2) Stria vascularis
    3) lamina spiralis ossea
    4) ?
    ANS:STRIA VASCULARIS

    Infection from inner er spreads to meninges through
    1) Cochlear aqueduct
    2) Vestibular aqueduct
    3) endolymphatic duct/sac.
    4) Hyrtle's fissure

    ANS:COCHLEAR AQUEDUCT

    Dose-limiting toxicity of (anticancer chemotherapy)...
    1) gastrointestinal toxicity
    2) Myelosupression
    3 NEUROTOXICITY
    4.NEPHROTOXICITY

    MYELOSUPPRESION OR GI TOXICITY

    SYNOVIAL FLUID A/E
    A) TYPE A SYNOVIAL CELLS SECRETE FLUID
    B) NON NEWTONIAN LIQUID
    C) HYALURONIC ACID
    D) ?

    ANS:TYPE A SYNOVIAL CELLS SECRETE FLUID

    All are important causes of childhood blindness in India except?
    1) Malnutrition.
    2) Glaucoma.
    3) Ophthalmia neonatorum
    4) Congenital dacryocystitis

    ANS:CONGENITAL DACROCYSTITIS

    Which is not an alkylating agent?
    1. 5-FU
    2. Melphalan
    3. CYCLOPHOSPHAMIDE
    4.CARMUSTINE

    ANS:5FU

    Which of the following does not cause malabsorptn?
    1. Ascaris ANS
    2. Giardia
    3. Capilliria philippensis
    4. STRONGYLOIDES STERCOBILIGENS

    ANS:ASCARIS

    Chemotaxis is?
    1. Unidirectional increase in movement
    2. Random movement increase
    3. ??
    ANS:UNIDIRECTIONAL INCREASE IN MOVEMENT

    Caspases are involveed in ?
    1. Organogenesis
    2. Hydropic degeneration
    3. ??

    ANS:ORGANOGENESIS

    ALL CAN INCREASE APPETITE EXCEPT
    A)MSH
    B)MELANOCYTE CONCENTRATING HORMONE
    C)NEUROPEPTIDE Y
    D)

    ANS:MELANIN STIMULATING HORMONE

    Not true abt impending eissenmenger?
    1.increasing intensity of tricuspid n pulmonary murmur
    2.increased intensity P2
    3.appearance of graham steel murmur
    4.was single S2

    ANS:SINGLE S2????

    All are true about Left ventricular failure except:-
    a) Pulmonary oligemia
    b) Kerley B lines
    c) redistribution to apices
    d)

    ANS:pULMONARY OLIGAEMIA

    Sister mary joseph nodule :-

    a) Pancreatic cancer
    b) Ovarian cancer
    c) Gastric cancer
    d) Colon cancer

    ANS: GASTRIC CA

    A female infant with normal milestones,Normal BP, and no abnormal genitalia,glucose-30mg/l there is hyperpigmentation only the cause could be:-

    a) INSULINOMA
    b) Familial glucocorticoid deficiency
    c) Cushing Synd
    d)

    ANS:FAMILIAL GLUCOCORTICOID DEFECIENCY

    Hashimoto does not feature?
    1.follicular degeneration
    2.lymphoid,,,,
    3. orphan annie eye,,
    4.
    ANS: ORPHAN ANNIE EYE NUCLEUS

    73.coagulative necrosis is seen in
    TB
    gangrene
    cryptococcal
    sarcoidosis

    74.Amyloidosis .. most reliable investigation
    a. rectal biopsy ans
    b. ct scan
    c. colonoscopy
    d...

    .The afferent of 8th cranial nerve is related to
    a. smell
    b. taste
    c. touch
    d. balance ans

    A healthy young athlete sitting at table with knee at 90 degree flexion. He fully extends it. what will happen?
    a. Movement of tibial tuberosity twds lat border of patella
    b. Movement of tibial tuberosity twds medial border of patella
    c. Movement of tibial tuberosity twds centre of patella
    d.......

    .pain insensitive structure in brain is
    a. falx cerebri
    b. dural venous sinuses
    c. choroid plexus ans??
    d. middle meningeal a.

    Carcinogenesis in colon implicates all of the following genes except
    APC
    k-ras
    beta-catenin
    mismatch repair genes
  11. kiyria.

    kiyria. Guest

    Hypersensitivity vasculitis affects?
    1.post capillary venules
    2.capillaries
    3.arterioles medium sized vessels

    ANS:pOST CAPILLARY VENULES

    ideal age for orchiopexy ?
    1-2 YRS
    5 YRS
    NEONATES

    ANS:1-2 YRS

    True about acute rheumatic carditis is?
    1.troponin i increased
    2.replacing valve will cure chf
    3.necrosis and inflamation in biopsy
    4.decreased contractility

    ANS:NECROSIS AND INFLAMMATION ON BIOPSY

    Most specific test for syphylis?
    1.vdrl
    2.rpr
    3.fta abs
    4.kahn test

    ANS FTA ABS

    Insulin plays important role in A/E
    1.Glycogenesis
    2.lipogenesis
    3.glycolysis
    4.ketogenesis

    ANS:KETOGENESIS

    hyperglycemia/insulin not needed
    a liver
    b brain
    c rbc
    ans liver ??

    Which cranial nerve does not carry parasympathetic outflow from brain?
    1.4rth
    2.7th
    3.9th
    4. 3RD

    ANS: 4TH TROCHLEAR

    All of the followings are features of prostatic urethra except

    1.trapezoid shaped on cross section
    2.opening of prostatic glands
    3. prostatic utricle
    4. verumontam

    ANS: TRAPEZOID SHAPE

    Mineral salt n d bone...
    a hydroxyapatitie,
    b calcium carbonate
    c CACL2
    d ?

    ANSWER:HYDROXYAPPATITE

    Which one favours both bone formation n reduces bone resorption

    STRONTIUM RANEOLATE
    PTH
    BISPHOSPHONATES

    ANS:STRONTIUM RANEOLATE

    which of the following metastasize outside cns?
    glioblastoma multiforme
    medulloblastoma ans
    ependymoblastoma
    choroid plexus tumour

    Which is not supplied by pelvic splanchic nerve?
    A. Appendix
    B. Rectum
    C.Uterus
    D. Urinary Bladder

    ANS:APPENDIX
  12. kiyria.

    kiyria. Guest

    True abt spinocerebellar tract?
    A. Eqilibium.
    B. Smoothens and coordinates movement.
    C. Learning induced by changes in vestibular reflexes
    D. Planning and Programming.

    ANS:Smoothens and coordinates movement.

    Naltrexone is used in
    a. treat withdrawal symptoms
    b. overdose
    c.prevenention of relapse
    d.

    ANS: PREVENTION OF RELAPSE

    which component of eye has max refractive index
    a.ant surface of lens
    b.post surface of lens
    c.centre of lens ans
    D. CORNEA

    ANS:CENTRE OF LENS

    csf rhinorhea most common from
    a frontal sinus
    b ethmoid sinus
    ans b

    the aorta, celiac axis, proximal superior mesenteric artery (SMA), and left renal arteries can be exposed with
    a left medial visceral rotation right medial visceral rotation

    ANS:LEFT MEDIAL ROTATION

    TRUE ABT ATHEROSCLEROSIS??

    A)SEVERITY MORE IF THORACIC AORTA IS INVOLVED
    B)VEINS LESIONS EQUALS IN NUMBERS LIKE ARTERIES
    C)UNSAT FAT REDUCE RISK OF ATHEROSCLEROSIS
    D)CHOLESTROL HAS NO EFFECT

    ANS:VEINS LESIONS EQUALS IN NUMBERS LIKE ARTERIES ?

    Infant wid RR 48 HR 180 cool extremities .. and capillary refill time 4 secs which of the following is correct?
    a. early (compensated) shock d/t hypovolemia
    b. early compensated shock d/t supraventricular tachycardia
    c. late decompensated shock d/t hypovolemia
    d. late decompensated shock d/t svt

    ANS:early (compensated) shock d/t hypovolemia

    Graphical representation of frequency with continuous graph
    1.polygon
    2.histogram
    3.bar graph
    4?

    ANS:HISTOGRAM

    Barret’s esophagus is diagnosed by which of the following?
    a. Intestinal metaplasia
    b. Intestinal dysplasia
    c. Columnar metaplasia
    d. Columnar dysplasia

    Answer: Intestinal metaplasia
  13. kiyria.

    kiyria. Guest

    MC CSF RHINORRHOEA?

    ETHMOIDAL CELL
    SPHENOID CELLS
    FRONTAL
    TEGMEN TYMPANI

    ANS:ETHMOIDAL CELL

    Superior middle alveolar is branch of
    a) palatine branch of maxillary
    b) nasal branch of maxillary
    c) inf alveolar branch
    d)mandibular

    ANS?
    The middle superior alveolar nerve is a nerve that drops from the infraorbital portion of the maxillary nerve to supply the sinus mucosa, the roots of the maxillary premolars, and the mesiobuccal root of the first maxillary molar. It is not always present; and in the majority of cases it is non existent with the posterior superior alveolar nerve innervating the premolars and molars alone.

    Hypocalcaemia true A/E

    1.digital tingling
    2.perioral numbness
    3.decreased reflexes
    4.laxity of skin

    ANS: DECREASED REFLEXES

    Proteus infecn ... stone

    1.cystein
    2.triple phosphate
    3.struvite
    4

    ANS:triple phosphate

    histrectomy done but some extra sites involved tt
    a chemo
    b radio
    c chemoradio

    HEMOCHROMATOSIS TRUE

    a) Heterogenous
    b) Complete penetrance
    c) Female more tham male
    d) Phlebotomy is of no use

    ANS:HETEROGENOUS

    40 yr female with hyperpigmamntation, benedict in urine +ve, Brown black supernatant, & calcification IV disc
    a. Alkaptonuria
    b. Tyrosenemia II
    c. PKU
    d. Arginossuccinemia

    ANS:ALKAPTONURIA

    Lyme disease A/E
    a. I. burdogferic causes lcal invasion & produces proinflammtory cytokines
    b. occur when Active Humoral immunity depressed
    c. PMNs in CSF seen in memingela involvement
    d. IgA antibodies specific for intrathecal is diagnsostic

    ANS:IGA ANTIBODIES SPECIFIC FOR INTRATHECAL DIAGNOSTIC

    Streptococcus AE
    a. Streptolysin o is active in reduce state
    b. Streptokinase produce by srotyep ACG
    c. Streptodrnase acton DNA
    d. Pyrotoxin A plasmid mediated

    ANS:pYROTOXIN A PLAMID MEDIATED

    Which of the following is not true about Toxoplasma infection?
    a. Best way to diagnose fetal infection is cord blood IgM
    b. IgA antibodies are more sensitive than IgM
    c. Dye test is the gold standard to detect IgG
    d. Avidity testing must be done for IgG and IgM antibodies

    ANS:Best way to diagnose fetal infection is cord blood IgM

    Methods to obtain fetal blood, such as periumbilical fetal blood sampling, have been largely abandoned because of the rate of false-negative prenatal diagnoses, the risk involved for the fetus, and the delay in obtaining definitive results with conventional parasitologic tests. Prenatal diagnosis of congenital toxoplasmosis presently is based on ultrasonography and amniocentesis. PCR on amniotic fluid for the detection of T. gondii–specific DNA performed at 18 weeks of gestation or later is more sensitive, more rapid, and safer than conventional diagnostic procedures involving fetal blood sampling. In cases in which the approximate date of onset of infection is known, it has been suggested that amniocentesis be performed no earlier than 4 weeks thereafter, with the preferable time for amniocentesis being 17 to 21 weeks.

    A 35 yr old lady comes with primary infertility. There is a mass palpable and her CA-125 levels are 90 units. What's most probable diagnosis?
    a. Ca Ovary
    b. borderline ca Ovary
    c. tuberculosis
    d. endometrioma

    ANS:TUBERCULOSIS

    Infertility may be the only presentation in Pelvic tuberculosis. Mass may be discovered in physical examination. CA-125 levels are elevated.

    Infertility is not presenting feature of ovarian carcinoma.

    Endometrioma (chocolate cysts) are associated with endometriosis. Infertility, pelvic pain and dyspareunia are the symptoms. In the absence of these three together, tuberculosis is the most appropriate answer.
  14. kiyria.

    kiyria. Guest

    ideal age for orchiopexy ?
    1-2 YRS
    5 YRS
    NEONATES

    ANS:1-2 YRS


    why not neonates?


    MANAGEMENT

    Bilateral undescended testes
    First intersex (females with adrenal hyperplasia) should be ruled out. If the boy is less than 9 years old and he has bilateral undescended testes, hormonal work-up is needed. This work-up may lead to a diagnosis of bilateral anorchia which means the testes never formed on either side.

    If the hormonal work-up is normal, an HCG stimulation test is applied and testosterone is subsequently measured. Patients with bilateral anorchia will not make testosterone in response to HCG.

    Retractile testis
    This is a normal variant
    This phenomenon usually disappears by 13 years of age

    General thoughts:

    Reasons to treat the undescended testicle

    Most pediatric urologists recommend orchiopexy by 1 to 1.5 years of age or earlier. There is evidence that early damage to the germ cells that produce sperm begins at this age. Other reasons to treat are psychological reasons and placement of testicle in postion more amenable to physical examination to pick up testis cancer. The most effective treatment is surgery, which can be performed as an outpatient.

    Pharmacotherapy has the advantages of avoiding anesthesia and being minimally invasive. HCG (human chorionic gonadotopin) is the drug of choice. Hcg is hought to stimulate Leydig cells of testicle to produce male hormones. The precise mechanism of action is unknown. Injections of HCG are given several times per week over several weeks. This can produce descent in some children. However, the success rates have been reported to be as low as10%. Unfortunately the results of hormone treatment have diminshed success in children less than two years of age.

    Usually a maximum 5 week course is undertaken. Patients failing hormonal therapy should undergo surgical treatment



    Surgical therapy
    Surgery is immediately performed on ectopic testes, cryptorchids with coexisting hernias, and boys at pubertal age. When a testis is felt in the groin area we usually explore the area through a small incision. made in the skin above the scrotum called the inguinal region. Most undescended testes are associated with a hernia that must be repaired. After this is done, the testis is brought down into the scrotum and anchored in a space created in the scrotum (orchiopexy). Both Incisions (in the inguinal region and scrotum) are closed with absorbable sutures.

    Concealed Laparoscopic Orchiopexy
    Laparoscopy can be used to localize nonpalpable, undescended testes. The laparoscopy is performed first to find out if the testicle is located in the abdomen or if it is congenitally absent.

    If the testis is low in the abdomen, an orchidopexy is performed laparoscopically. A laparoscope is inserted through a small umbilical opening to locate the non-palpable testis. If the testis is healthy, a second instrument is placed through a small opening in the scrotum to move the testicle into its natural postion. Sometimes the testicle is located too high in the abdominal cavity to reach in a one step operation. In this setting, the testicle will be freed of it previous blood supply and placed in a location such that it can be brought down with a second operation. The second stage is performed in 6 months.
  15. kiyria.

    kiyria. Guest

    Q18.Hyperextensibility with NORMAL elastic recoil
    a. Ehlers Danlos syn
    b. cutis laxa
    c. scleroderma
    d.

    ans.Ehler danlos syndrome
    Skin
    Hyperextensibility

    Cutaneous hyperextensibility (stretchy skin) characterises all types of EDS, except for the Vascular Type (type lV), which has noticeably translucent skin with visible veins. When skin is over-stretched it still retains normal elastic recoil and snaps back once released. This is best tested at the neck, elbows, or knees.

    Cutaneous fragility
    Easy splitting of the skin is particularly common in Classical Type. Gaping, 'fish-mouth' or 'cigarette paper' scars follow minimal trauma over sites of bony prominence and areas prone to trauma such as the forehead, chin, elbows, knees, and shins.

    Epicanthic folds
    These are additional symmetrical folds of skin at the inner aspects of the eyes producing apparent broadening of the nose.

    Molluscoid pseudotumours
    These are firm, fibrous lumps measuring up to 2 - 3 cm which develop over pressure points such as the elbows and knees.

    Spheroids

    Approximately one third of affected individuals describe small, firm nodules like 'ball-bearings' just beneath the skin (sub cutis). These consist of fibrotic and calcified fat which overlay bony areas such as the shins.

    Piezogenic papules
    These small, soft, skin-coloured lumps appear on the side of the heel when standing and disappear when the foot is elevated. Although usually symptom-less they can occasionally be painful.

    Varicose veins
    These are more common in many types of EDS, than in the general population.

    Q20.Which of the following is a pulsatile tumor?
    a. Osteosarcoma
    b. chondrosarcoma
    c. osteoclastoma
    d. ewings sarcoma
    ANS:OSTEOSARCOMA

    Primary tumors that may present as pulsating lesions :
    - Telengiectatic Osteogenic sarcoma
    - Angioendothelioma/Angiosarcoma of bone
    - Aneurysmal bone cyst
    - Giant cell tumor (rarely)

    Secondaries/Metastases that may present as pulsating lesions :
    - Metastasis from Renal cell carcinoma
    - Metastasis from Thyroid carcinoma

    Q21.25 yr old male with fever, malaise.. and erythematous nodules over the shin (?)diagnosis is
    a. erythema nodosum
    b. hensen's disease
    c. weber-christian disease
    d. urticarial vasculitis

    ANS.WEBER CHRISTIAN DISEASE
    Weber-Christian disease is a skin condition that features recurring inflammation in the fat layer of the skin. The involved areas of skin manifest as recurrent crops of erythematous, sometimes tender, edematous subcutaneous nodules. The lesions are symmetric in distribution, and the pages and lower legs are affected most frequently. Malaise, fever, and arthralgias frequently occur. Nausea, vomiting, abdominal pain, weight loss, and hepatomegaly may also occur. Because its etiology is unknown, Weber-Christian disease is often referred to as idiopathic lobular panniculitis.

    Q22.The function of 8th cranial nerve is related to
    a. smell
    b. taste
    c. touch
    d. balance
    ANS:BALANCE
  16. kiyria.

    kiyria. Guest

    Q23:Amyloidosis .. most reliable investigation
    a. rectal biopsy .. has to be the answer??!
    b. ct scan
    c. colonoscopy
    d...

    ANS:RECTAL BIOPSY
    Investigations
    Biopsy is the definitive investigation for amyloidosis. Fine-needle fat-pad biopsy and rectal biopsy have both been hailed as the investigation of choice, each giving positive results in 80-90 percent of cases. Skin biopsy is also a useful investigation, with the possibility of providing definitive diagnosis. The biopsy may be of involved or uninvolved skin, as both provide high-yield results for diagnosis. Where other tissues are involved, they may also be used to stain for amyloid, including liver or spleen biopsy, carpal tunnel tissue, nail or scalp biopsy.

    Q24.pain insensitive structure in brain is
    a. falx cerebri
    b. dural venous sinuses
    c. choroid plexus
    d. middle meningeal a.

    ANS:CHOROID PLEXUS
    • Choroid plexus (D) is not a pain producing structure.
    • Much of the brain parenchyma, ventricular ependyma, pial veins and choroids plexus are not pain-producing structures.
    • Few cranial structures are pain producing – The scalp, middle meningeal artery (B), dural sinuses (A), falx cerebri (C) and proximal segments of large pial arteries.
    • The key structures involved in primary headache are few and the large intracranial vessels and durameter innervated by the trigeminal nerve.

    Q25.Infant wid congestive cardiac failure.. bulging fontanelle with a bruit which can be auscultated.. CT shows midline lesion with dilated lateral ventricles.. diagnosis is..??
    a. vein of galen malformation
    b. arachnoid cyst
    c. teratoma
    d. ... ???

    ANS:VEIN OF GALEN MALFORMATION
    The vein of Galen is located under the cerebral hemispheres and drains the anterior and central regions of the brain into the sinuses of the posterior cerebral fossa. The vein of Galen aneurysmal malformation is a choroidal type of arteriovenous malformation involving the vein of Galen forerunner and is distinct from an arteriovenous malformation with venous drainage into a dilated, but already formed, vein of Galen.

    Aneurysmal malformations of the vein of Galen (VGAM) typically result in high-output congestive heart failure or may present with developmental delay, hydrocephalus, and seizures

    Vein of Galen malformation (VGAM) results from an aneurysmal malformation with an arteriovenous shunting of blood. The congenital malformation develops during weeks 6-11 of fetal development as a persistent embryonic prosencephalic vein of Markowski; thus, VGAM is actually a misnomer. The vein of Markowski actually drains into the vein of Galen.

    VGAM usually causes high-output heart failure in the newborn resulting from the decreased resistance and high blood flow in the lesion. Associated findings include cerebral ischemic changes such as strokes or steal phenomena that result in progressive hemiparesis. Hemorrhage from the malformation can occur, although this is not a common finding. Finally, the malformation may result in mass effects, causing progressive neurological impairment. Alternatively, the malformation may cause obstruction of the cerebrospinal fluid (CSF) outflow and result in hydrocephalus.2

    Physical
    Congestive heart failure
    Neonates may present with tachypnea, respiratory distress, and cyanosis.
    They often require ventilatory support and institution of aggressive management of heart failure.
    Hydrocephalus
    Hydrocephalus may be the presenting feature in older infants.
    A cause should be sought in neonates with macrocephaly.
    Infants may have hydrocephalus, in which case prominent scalp veins or "sunset" eye findings are noted.
    Developmental delay: Signs of hydrocephalus and congestive heart failure should be looked for in infants with developmental delay.
    In early childhood, symptoms include headache, convulsive seizures, hydrocephalus, and cardiac failure.
    Causes
    Although any vessel may be affected, the vein of Galen is the most frequently affected. Congenital malformation develops during weeks 6-11 of fetal development as a persistent embryonic prosencephalic vein of Markowski.

    Q26.Portal flow is decreased to lowest in :-
    Halothane
    Ether
    Enflurane
    Isoflurane

    ANS:HALOTHANE

    Inhalational anesthetics produce differential effects on hepatic blood flow and oxygenation that may impact hepatocellular function and drug clearance. In this investigation, the effects of sevoflurane on hepatic blood flow and oxygenation were compared with those of enflurane, halothane, and isoflurane Each pt randomly received enflurane, halothane, isoflurane, and sevoflurane, each at 1.0, 1.5, and 2.0 MAC concentrations. Mean arterial blood pressure and cardiac output decreased in a dose-dependent fashion during all four anesthetics studied. Heart rate increased compared to control during enflurane, isoflurane, and sevoflurane anesthesia and did not change during halothane anesthesia. Hepatic arterial blood flow and portal venous blood flow were measured by chronically implanted electromagnetic flow probes. Hepatic O2 delivery and consumption were calculated after hepatic arterial, portal venous, and hepatic venous blood gas analysis. Hepatic arterial blood flow was maintained with sevoflurane and isoflurane. Halothane and enflurane reduced hepatic arterial blood flow during all anesthetic levels compared to control (P less than 0.05), with marked reductions occurring with 1.5 and 2.0 MAC halothane concomitant with an increase in hepatic arterial vascular resistance. Portal venous blood flow was reduced with isoflurane and sevoflurane at 1.5 and 2.0 MAC. A somewhat greater reduction in portal venous blood flow occurred during 2.0 MAC sevoflurane (P less than 0.05 compared to control and 1.0 MAC values for sevoflurane). Enflurane reduced portal venous blood flow at 1.0, 1.5, and 2.0 MAC compared to control. Halothane produced the greatest reduction in portal venous blood flow (P less than 0.05 compared to sevoflurane)

    Q27.Savlon contains:-
    Cetrimide + chlorhexidine
    Cetrimide + chlorhexidine + butyl alcohol
    Cetrimide + butyl alcohol
    CETRIMIDE + CETAVLON

    ANS:Cetrimide + chlorhexidine
    ANS:In India Savlon is an antiseptic liquid marketed by Johnson & Johnson. It contains I.P. 1.5% v/v Chlorhexidine Gluconate Solution and B.P. Strong cetrimide solution eq. to Cetrimide I.P. 3.0% w/v

    Q28.Sputum positive pregnant in 1st trimester?
    1. no treament.
    2. start cat 1.
    3. start cat 2.
    4.start cat 3.
    ans:start cat1.

    Q29.capacitation of sperm occurs in?
    1. uterus.
    2. epididymis.
    3. vas deferen
    4.?

    ans. uterus
    Capacitation is the penultimate step in the maturation of mammalian spermatozoa and is required to render them competent to fertilize an oocyte. This step is a biochemical event; the sperm move normally and look mature prior to capacitation. In vivo this step typically occurs after ejaculation, in the female reproductive tract. In vitro, capacitation can occur in sperm that have either undergone ejaculation or have been extracted from the epididymis.

    By secreting sterol binding albumin, lipoproteins, proteolytic and glycosidasic enzymes such as heparin, the uterus aids in the steps of capacitation.

    Non-mammalian spermatozoa do not require this capacitation step and are ready to fertilize an oocyte immediately after release from the male. After this capacitation the sperm must undergo activation involving the acrosome reaction.

    Q30.Eukaryotic plasma membrane is made of al except?
    1. carbohydrates
    2. lecithin
    3. triglycerides
    4. cholesterol
    ans. triglycerides

    Q31.Which of the following doesnt affect free radicals in the lens?
    1. vit a
    2. vit c
    3. vit e
    4. catalase.
    ans. vit a

    Q32.The best investigation for temporal bone injuries
    a. CT scan
    b. angio
    c. plain film
    d. MRI

    ANS:CT SCAN
    for bony temporal bone – CT
    for inner ear- MRI
    for facial nerve- MRI

    Q33.MOTORcyclists fracture is..
    a. Ring fracture
    b. Comminuted fracture of the vault..
    c. Skull base divided into two halves - anterior n posterior
    d. Subdural haemoorhage

    ans:Skull base divided into two halves - anterior n posterior

    Ring or Foramen fractures: (a) It is fissured fracture of the skull which encircles the skull in such a manner that the anterior third is separated at its junction with the middle and posterior third (b) fracture line runs at about 3-5 cm outside the foramen magnum at the back and sides of the skull and passes forwards through the middle ears an roof of the nose due to which the skull is separated from the spine.

    Comminuted fractures: In this skull fracture variety, the bone is broken into multiple pieces, e.g. RSA, fall from a height on a hard surface, and from blows by weapons with a large striking surface, kick by an animal, bullet injury, resembles a spider’s web or mosaic.

    Subdural Hemorrhage:
    1. It is common in childhood or old age.
    2. Occurs in subdural space between the durameter and arachnoid due to rupture of bridging or communicating veins, inferior cerebral veins, and cortical veins, i.e. source of blood is venous or capillary, not arterial.
    3. Found in alcoholics old persons and in children.
    4. Death may occur if the hemorrhage > 50 ml.

    Q34.Infant with repeated vomiting, diarrhea, failure to thrive hepatosplenomegaly CT shows adrenal gland calcification
    adrenal
    h'ge
    cushings
    wolmans syndrome

    ANS:WOLMANS SYNDROME
    Infants may be normal and active at birth but quickly develop progressive mental deterioration, hepatosplenomegaly (an enlarged liver (hepatomegaly) combined with an enlarged spleen (splenomegaly), intrabdominal adenopathy, distended abdomen, gastrointestinal problems including steatorrhea (excessive amounts of fats in the stools), jaundice, anemia, vomiting and calcium deposits in the adrenal glands. The overall clinical picture is an infant who appears ill and fails to thrive.

    The key imaging findings are enlarged adrenal glands, with punctate calcifications, and a preserved shape. The calcification may be limited to the cortex of the gland. This may be a pathognomonic sign. The liver and spleen are enlarged, especially the liver. The liver demonstrates low density on CT, due to fatty infiltration. There may be enlarged, low-density mesenteric and retroperitoneal lymph nodes

    Q.35.CIN-3 35 YEAR PARA -3 LADY..TREATMENT OF CHOICE IS :-
    A) CRYO
    B)LEEP
    C)CONISATION
    D)HYSTERECTOMY
    Ans:LEEP

    Q36.Prostate cancer most sensitive detection is:-
    a) per rectal ex
    b) DRE + PSA ..
    C)pSA
    D) MRI COIL INSIDE RECTUM
    ANS;DRE+PSA

    Q.37.Anterior ethmoidal nerve supplies A/E
    a) Ant part of internal nose
    b) ethmoid sinus
    c) maxillary sinus
    d) sphenoid sinus
    ANS:MAXILLARY SINUS

    Q38.classified on basis of Scale very satisfied, satisfied,unsatisfied....
    1.ordinal
    2.nominal
    3.range
    4.interval

    ANS:ORDINAL SCALE
    An ordinal scale is a measurement scale that assigns values to objects based on their ranking with respect to one another. For example, a doctor might use a scale of 0-10 to indicate degree of improvement in some condition, from 0 (no improvement) to 10 (disappearance of the condition). While you know that a 4 is better than a 2, there is no implication that a 4 is twice as good as a 2. Nor is the improvement from 2 to 4 necessarily the same "amount" of improvement as the improvement from 6 to 8. All we know is that there are 11 categories, with 1 being better than 0, 2 being better than 1, etc.

    Q39.Splicing activity present in
    a. mRNA
    b. tRNA
    c. snRNA
    d. rRNA

    ANS:sn RNA
    In molecular biology, splicing is a modification of an RNA after transcription, in which introns are removed and exons are joined. This is needed for the typical eukaryotic messenger RNA before it can be used to produce a correct protein through translation. For many eukaryotic introns, splicing is done in a series of reactions which are catalyzed by the spliceosome, a complex of small nuclear ribonucleoproteins (snRNPs), but there are also self-splicing introns

    Q40.60 yr old chronic smoker comes with gross painless hematuria of one day duration .. whats th next appropriate investigation?
    a. xray KUB
    b. USG KUB
    c. urine - routine, microscopy
    d. urine cytology for malignant cells
    ANS:URINE CYTOLOGY FOR MALIGNANT CELLS

    Q41.Most important organelle involved in apoptosis
    a. mitochondria
    b. nucleus
    c. golgi bodies
    d. ER
    ANS:MITOCHONDRIA

    Q42.Woman with placenta praevia - bleeds - what is most likely to occur after delivery?
    a. lack of menstrual cycles
    b. galactorhea
    c. Diabetes insipidus
    d....??
    ANS:LACK OF MENSTRUAL CYCLES

    Q43.x ray feature of fibrous dysplasia..

    1.ground glass appearance
    2.calcification
    3.cortical thickening
    4.

    ANS:GROUND GLASS APPERENCE
    Image shows homogeneous loss of the normal trabecular pattern in the shaft of the humerus, with a ground-glass appearance caused by fibrous dysplasia.

    Q44.Peutz-jeghers polyps present in
    a.rectum
    b.colon
    c.jejunum
    d.appendix

    ANS:SMALL INTESTINE(JEJUNUM)

    Q45.Intrinsic factor of castle found in :
    A.liver
    B.chief cells of stomach
    C.parietal cells of stomach
    D.???
    ANS:pARIETAL CELLS OF STOMACH

    Q46.Middle aged female with h/o menorrhagia can be treated by all except
    1.etamsylate
    2.tranexaminic acid
    3.ocp
    4.progesteron therapy on days 5-25
    ANS:ETHAMSYLATE

    Q47.Vit A prophylaxis
    a) Specific protection
    b) Health promotion
    c) Secondary
    d) Primordial

    ANS:SPECIFIC PROTECTION
    Concept of Prevention
    Primordial prevention (Prevention of emergence of risk factors): main intervention is through individual and mass education
    Primary Prevention – (Best method of prevention): brought about by – Health promotion and Specific protection

    The well known interventions in this area are:
    Health promotion by:
    a. Heath education
    b. Environmental modification
    c. Nutritional intervention
    d. Lifestyle and behavioural changes

    Specific Protection by:
    a. Immunization
    b. Use of specific nutrients, e.g. Vit A, Fe and Folic acid tablets, etc.
    c. Chemoprophylaxis
    d. Protection against occupational hazards
    e. Avoidance from allergens
    f. Protection from carcinogens
    g. Control of consumer product quality

    Secondary prevention – Early diagnosis and Disease treatment
    Tertiary prevention – Disability limitation and Rehabilitation

    Q48.Two siblings with osteogenesis imperfecta.. but their parents are normal.. cause/mechanism of inheritance

    anticipation
    genomic imprinting
    germ cell line mosaicism
    new mutation

    ANS:GERM LINE MOSAICISM

    Q49.which of these is not an opioid agonist
    a. heroin
    b. ketamine
    c. methadone.
    d. morphine
    ANS:KETAMINE

    Q50.All cause retraction of scapula except?

    a. Rhomboides major
    b. rhomboides minor
    c. trapezius
    d.levator scapulae

    ans:levator scapulae
  17. kiyria.

    kiyria. Guest

    Q51.Not used in pulmonary hypertension
    a.ccb
    b.endothelin receptor antagonist
    c. alpha blocker
    d.prostacyclines
    ANS:ALPHA BLOCKER

    Q52.Zollinger elison syndrome drug used is:-
    a) Proton pump inhibitor
    b) Antihistaminics
    c) Dopamine blockers
    d)
    ANS:pPI

    Q53.Hallmark of acute inflammation?
    1. Vasoconstriction
    2. Stasis
    3. Vasoldilatn and increase in permeability
    4.leucocyte marginaton
    ANS:VASODILATION AND INCREASE IN PERMEABLITY

    Q54.Hepatomegaly is not the important feature of:-
    a) Nieman pick disease
    b) Glycogen storage diseases
    c) Hurler Disease
    d) hepatic porphyrias
    ANS:HEPATIC PORPHYRIAS

    Q55.H/o Unilateral progressive proptosis for many years...swelling is increased on bending forward and compressible....USG shows retrobulbar echogenicity

    1) Orbital varix.
    2) Orbital A-V fisula.
    3) Neurofibromatosis.
    4) orbital encephalocele
    ANS.ORBITAL VARIX

    Q56.Ext laryngeal memb A/E

    cricothyroid
    thyrohyoid
    cricotracheal
    hyoepiglotic
    ANS:CRICOTHYROID

    Q58.A woman developed acute pain in the right pain. Synovial fluid aspiration showed CPPD crystals. Which of the following tests should be done further for evaluation?
    a. ANA
    b. RF
    c. TSH
    d. CPK

    ANS:TSH

    Labs
    Arthrocentesis for Synovial Fluid exam
    CPPD crystals on Polarized Microscopy
    General studies for CPPD Deposition Disease
    Serum Calcium
    Serum Magnesium
    Serum Phosphorus
    Alkaline Phosphatase
    Thyroid Stimulating Hormone (TSH)
    Serum Ferritin
    Pseudogout attack
    Complete Blood Count
    Leukocytosis up to 15,000 per mm3
    Erythrocyte Sedimentation Rate (ESR) increased
    Pseudo-Rheumatoid
    Erythrocyte Sedimentation Rate (ESR) elevated
    Rheumatoid Factor may be positive at low titer

    Q59.Antigen antibody precipitation is maximally seen in which of the following?

    a. Excess of antibody
    b. Excess of antigen
    c. Equivalence of antibody and antigen
    d. Antigen-Hapten Interaction

    ANS:Equivalence of antibody and antigen


    Q60.Which of the following is not used to diagnose Leptospirosis?

    a. Microscopic agglutination test
    b. Dark field microscopy
    c. Macroscopic agglutination test
    d. Weil-felix reaction

    ANS:WEIL FELIX REACTION

    Diagnosis

    Kidney tissue, using a silver staining technique, revealing the presence of Leptospira bacteriaOn infection the microorganism can be found in blood for the first 7 to 10 days (invoking serologically identifiable reactions) and then moving to the kidneys. After 7 to 10 days the microorganism can be found in fresh urine. Hence, early diagnostic efforts include testing a serum or blood sample serologically with a panel of different strains. It is also possible to culture the microorganism from blood, serum, fresh urine and possibly fresh kidney biopsy. Kidney function tests (Blood Urea Nitrogen and creatinine) as well as blood tests for liver functions are performed. The latter reveal a moderate elevation of transaminases. Brief elevations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) levels are relatively mild. These levels may be normal, even in children with jaundice. Diagnosis of leptospirosis is confirmed with tests such as Enzyme-Linked Immunosorbent Assay (ELISA) and PCR. Serological testing, the MAT (microscopic agglutination test), is considered the gold standard in diagnosing leptospirosis. As a large panel of different leptospira need to be subcultured frequently, which is both laborious and expensive, it is underused, mainly in developing countries.

    Differential diagnosis list for leptospirosis is very large due to diverse symptomatics. For forms with middle to high severity, the list includes dengue fever and other hemorrhagic fevers, hepatitis of various etiologies, viral meningitis, malaria and typhoid fever. Light forms should be distinguished from influenza and other related viral diseases. Specific tests are a must for proper diagnosis of leptospirosis. Under circumstances of limited access (e.g., developing countries) to specific diagnostic means, close attention must be paid to anamnesis of the patient. Factors like certain dwelling areas, seasonality, contact with stagnant contaminated water (Bathing swimming, working on flooded meadows, etc) and/or rodents in the medical history support the leptospirosis hypothesis and serve as indications for specific tests (if available).

    Leptospira can be cultured in Ellinghausen-McCullough-Johnson-Harris medium, which is incubated at 28 to 30 °C. The median time to positivity is three weeks with a maximum of 3 months. This makes culture techniques useless for diagnostic purposes, but is commonly used in research.

    Q61.OBSESSIVE COMPULSIVE DISORDER DOC:
    A) IMIPRAMINE
    B)ALPRAZOLAM
    C)BZDs
    D)Fluoxetine

    ANS:FLUOXETINE

    Medications as treatment include selective serotonin reuptake inhibitors (SSRIs) such as paroxetine, sertraline, fluoxetine, escitalopram, and fluvoxamine and the tricyclic antidepressants, in particular clomipramine. SSRIs prevent excess serotonin from being pumped back into the original neuron that released it. Instead, serotonin can then bind to the receptor sites of nearby neurons and send chemical messages or signals that can help regulate the excessive anxiety and obsessive thoughts. In some treatment-resistant cases, a combination of clomipramine and an SSRI has shown to be effective even when neither drug on its own has been efficacious.

    Q62. Sickle cell anemia 26 yrs old boy the following should not be used
    a) IV Regioanal analgesia
    b)BRachial plexus supraclavicular app bloc
    c) brachial plexus axillary approach
    d)brachial plexus

    ANS:INTRAVENOUS REGIONAL ANESTHESIA

    Bier Block (Intravenous Regional Anesthesia) History August Bier introduced this block in 1908. Early methods included the use of two separate tourniquets and procaine was the local anesthetic of choice. Initial popularity waned and it fell into disuse as new methods were found for anesthetizing the upper extremities. In 1963, Holmes popularized the Bier Block. The basic idea behind the Bier block is to exsanguinate the extremity, apply an arterial tourniquet to isolate it from circulation, and inject local anesthetic into the extremities venous system, inducing anesthesia.

    Indications The Bier block is a suitable technique for the following:  Surgical procedures involving the arm below the elbow (open procedures or closed reductions) Surgical procedures involving the leg below the knee (open procedures or closed reductions) Surgical procedures that will be completed within 40-60 minutes

    Advantages & Disadvantages of the Bier block

    Advantages include the following: Easy to administer Low incidence of block failure Safe technique when used appropriately Rapid onset and recovery Muscle relaxation for the surgeon

    Disadvantages include the following:

    Should be used for only short procedures Patient may experience tourniquet pain after 20-30 minutes Sudden cardiovascular collapse or seizures may occur if local anesthetic is released into the circulation too early.

    Contraindications

    Patients with the following conditions: Reynaud’s disease Homozygous sickle cell disease Crush injuries Young children Unreliable or inadequate tourniquets.

    Q63.Post glenohumeral instability
    a) Crank test
    b) Fulcrum
    c) Jerk test
    d) sulcus test

    ANS:JERK TEST
    Tests for Instability:
    - sulcus sign: (for multidirectional instability)
    - a gap between the humeral head and undersurface of the acromion;
    - appears when the longitudinal traction is placed on the humeral shaft w/ arm at side while in a seated position;
    - the sulcus sign is felt to be pathognomonic of multidirectional instability;
    - upto 1 cm of displacement may be normal, where as displacement of 3 cm is severe;

    - exam for anterior instability:
    - rotatory stress test:
    - for determining presence of Bankart Lesion:
    - posterior instability:
    - jerk test: pt's arm is abducted to 90 deg and internally rotated;
    - the examiner axilly loads the humerus while the arm is moved horizontally across the body
    - the left hand stabilizes the scapula;
    - look for a sudden jerk as the humeral head slides off the back of glenoid;
    - ref:
    - Painful jerk test: a predictor of success in nonoperative treatment of posteroinferior instability of the shoulder.
    - Capsulolabral augmentation for the the management of posteroinferior instability of the shoulder. - SLAP tear:
    - speed's test:
    - used to examine the proximal tendon of the long head of the biceps
    - forward flex the shoulder (60 deg) against resistance while maintaining the elbow in extension and the forearm in supination
    - tenderness in the bicipital groove in dicates bicipital tendinitis
    - obrien's test
    - shoulder is held in 90 degrees of forward flexion, 30 to 45 degrees of horizontal adduction and maximal internal rotation;
    - grab the patient's wrist and resists the patient's attempt to horizontally adduct and forward flex the shoulder
    - ref:

    Q64.Most diagnostic of rabies:-

    a) Negri bodies
    b) Gaurneiri bodies
    c)cowdry A
    d)cowdry B
    ANS:NEGRI BODIES

    Q65.In intrahepatic cholestasis,termination of pregnancy should be done at-
    a.34 weeks
    b.36 weeks
    c.38 weeks
    d.40 weeks

    ANS:36 WKS

    On diagnosis, most doctors prescribe Ursodeoxycholic Acid. Some will prescribe Cholestyramine. While there is no cure for ICP, and no way to guarantee a successful outcome, studies have shown a slightly better fetal and maternal outcome from administration of Ursodeoxycholic Acid, whereas Cholestyramine appears to only relieve itching.If additional blood tests to check clotting function identify a problem, giving Vitamin K may help avoid the risk of hemorrhage at delivery.Delivery by 35-37 completed weeks is considered crucial to fetal outcome though it does not completely eliminate the risks associated with the conditi

    Q66.Meralgia parasthetica is due to involvement of:-

    a) Sural nerve
    b) Med cutaneous nerve of thigh
    c) Lateral cutaneous nerve of thigh
    d) Peroneal n

    ANS:LATERAL CUTANEOUS NERVE OF THIGH

    Q67.FASTEST DECREASE IN K LEVELS IS BY:-

    CALCIUM GLUCONATE
    INSULIN + GLUCOSE
    K RESINS
    NA HCO3

    ANS:INSULIN AND GLUCOSE

    Q68.maltese cross

    a.cryptococcus
    b.blastomycosis
    c.candida
    d.

    ANS:CRYPTOCOCCUS

    Q69.INCISED WOULDS ON GENITALIA ON POST MORTEM-

    A) HOMICIDAL
    B) SELF INFLICTED
    C) POST MORTEM
    D) ACCIDENTAL

    ANS:HOMICIDAL

    Q70.Gestational diabetes mellitus.. what is NOT usually seen
    a. past h/o macrosomic baby
    b. malformations
    c. obesity
    d. polyhydramnios

    ANS:MALFORMATIONS

    Barret’s esophagus is diagnosed by which of the following?
    a. Intestinal metaplasia
    b. Intestinal dysplasia
    c. Columnar metaplasia
    d. Columnar dysplasia


    Answer: Intestinal metaplasia



    The metaplasia of esophageal squamous epithelium to columnar epithelium (Barrett's esophagus) is a complication of severe reflux esophagitis, and it is a risk factor for esophageal adenocarcinoma (Chap. 87). Metaplastic columnar epithelium develops during healing of erosive esophagitis with continued acid reflux because columnar epithelium is more resistant to acid-pepsin damage than is squamous epithelium. The metaplastic epithelium is a mosaic of different epithelial types, including goblet cells and columnar cells, which have features of both secretory and absorptive cells. Finding intestinal metaplasia with goblet cells in the esophagus is diagnostic of Barrett's esophagus; this type of mucosa is thought to be at risk of cancer. Barrett's esophagus is arbitrarily divided into long-segment (>2–3 cm) and short-segment (<2–3 cm) groups; long-segment disease is diagnosed in about 1.5% and short-segment disease in 10–15% of the GERD population

    73.A healthy young athlete sitting at table with knee at 90 degree flexion. He fully extends it. what will happen?

    a. Movement of tibial tuberosity twds lat border of patella

    b. Movement of tibial tuberosity twds medial border of patella

    c. Movement of tibial tuberosity twds centre of patella

    d. NO CHANGE

    ANS:Movement of tibial tuberosity twds medial border of patella

    Q73.A 57yr old woman comes wid b/l progressive weakness of both lower limbs, spasticity present on MRI mass enhancing dorsal intradural lesion present diagnosis

    a. intradural lipoma
    b. meningioma
    c. neuroenteric cyst
    d. ...

    ANS:MENINGIOMA

    Q75.GIRL eating binges with purgings...

    a.aneroxia nervosa
    b.bulimia nervosa...
    c.binge eating ds
    d.

    ANS:BULIMIA NERVOSA

    Q76.NORMAL ROLE OF MICRO RNA

    GENE REG
    'RNA SPLICING
    INITIATION OF TRANSL
    DNA CHANGES

    ANS:SPLICING

    Q77.ACETYL CO A CAN B CONVERTED INTO ALL EXCEPT??
    GLUCOSE
    FATTY ACIDS
    CHOL
    KB

    ANS:GLUCOSE

    Q78.Incidence can be calculated from?

    a) case control study
    b) cross sectional study
    c) prospective study
    d) retrospective study

    ans: c - prospective study

    Q79.All are features of prostatic urethra except

    a)trapezoid in shape
    b)presence of veromontanum
    c) opening of prostatic ducts
    d) relation to urethral crest

    ans: trapezoid in shape

    Q.80.Child showing dec conc. normal milestones delayed speech.....
    a)Autism
    b)ADHD
    C)Specific devopmental...
    d)...?

    ANS:AUTISM

    Q81. which is not supplied by pelvic splanhnic nerves?

    a. Rectum.
    b. urinary bladder.
    c. appendix.
    d. uterus.

    ANS:APPENDIX

    Q82. True about spinocerebellar tract is

    a. planning n programming.
    b. smoothens and coordinates movement.
    c. learning induced by change in vestibulocular reflex.
    d. equillibrium.

    Ans. smoothens and coordinates movement.

    Q83. Best indicator of ovarian resserve is ?

    a. FSH
    b. estradiol
    c. LH
    d. FSH/LH ratio

    Ans. FSH

    Q84. Somatomedin mediates:

    a. lipolysis
    b. decreased rate of glucose uptake by cells.
    c. deposition of chondroitin sulphate.
    d. gluconeogenesis.

    Ans. c. deposition of chondroitin sulphate

    Q85.what is NOT a primary cutaneous disorder?
    a. lichen planus
    b. psoriasis
    c. bowen's disease
    d. reiters disease

    ANS:REITER DISEASE

    Q86.Condition where normal delivery not alowed?

    monozygotic monochorionic
    dizygotic with 1st cephalic 2nd breach,,,
    mento anterior
    extended breech

    ANS:MONOZYGOTIC MONOCHORIONIC

    Q86.MOST SENSITIVE INDICATOR OF PEDIATRIC BLOOD VOLUME?

    CARDIAC OUTPUT
    HEART RATE
    STROKE VOLUME
    PRELOAD

    ANS:HEART RATE

    Q88.A 65 yrs old man...h/o of back pain since 3 months....ESR 55....syndesmophytes presentin dorsal spine.minimal dec chest expansion.dx?
    a.ankylosing spondilitis
    b.degenerative osteoarthritis of spine
    c.ankylosing hyperosteosis
    d.lumber canal stenosis

    ANS:ANKYLOSING SPONDYLITIS

    Q89.female comin wth lip swellin sign of edema, abdominal pain..wat is characteristic of given condition

    c1 def
    c5 def

    ANS:C1 ESTERASE DEFECIENCY

    Q90.A middle aged male with an ulcerative granulomata on his glans - wright giemsa stained specimen shows 1-2 rounded structures vacuolated within macrophages.. ?
    what is the causative organism?
    a. chlamydia trachomatis
    b. calymmatobacterium granulomatis
    c. h. ducreyi
    d. neisseria gonorrhoea

    ANS:NEISSERIA

    Q91.Methaemoglobinemia caused by?
    a. procaine
    b. prilocaine
    c.......
    d........
    ANS:pRILOCAINE

    Q92.All of the following r true bout sickle cell anemia except

    a. single nucleotide change leads to a change from glutamate to valine
    b. a single base pair change leads to RFLP
    c. deoxygenated Hb leads to the exposure of sticky end.. due to replacement of non polar residue by polar residue
    d. offers protection to malaria in heterozygotes

    ANS:deoxygenated Hb leads to the exposure of sticky end..

    Q93.INDIAN REFERENCE MALE WEIGHT

    50KG
    55KG
    60KG
    65KG

    ANS:60 KG

    Q94.CAUSE OF SPIDER NAEVI

    ESTROGEN

    Q95.CONTINOUS FREQUENCY DISTRIBUTION REPRESENTED BY

    ANS:HISTOGRAM

    Q96.Caspases are involved in
    a. Organogenesis
    b. Hydropic degeneration
    c.
    d.

    Ans:Organogenesis

    Q97.Giant cell arteritis a/e
    a. sudden b/l blindness
    b. mostly affects elderly
    c. mostly women
    d. aggrevated by heat

    ANS:AGGRAVATED BY HEAT

    Criteria for diagnosis

    The American College of Rheumatology criteria (1990) for the diagnosis of GCA are as follows2,24 :

    Age at onset of 50 years
    New headache
    Abnormalities of the temporal arteries
    Erythrocyte sedimentation rate (ESR) of 50 mm/h
    Positive results of a temporal artery biopsy (vasculitis characterized by a predominance of mononuclear infiltrates or granulomas, usually with multinucleated giant cells)

    Women are 2-4 times more likely to have GCA than men.

    Ophthalmic history
    The most dramatic symptom of GCA, visual loss, results directly from the inflammation of the medium- and large-sized cranial vessels.32,33,34,35,36,37,38,39,40,41,42 Around 50% of patients with GCA eventually experience visual symptoms (eg, transient visual blurring, diplopia, eye pain, sudden vision loss). Transient repeated episodes of blurred vision are usually reversible, but sudden loss of vision is an ominous sign and is almost always permanent. Vision loss incidence, either partial or complete, is variably reported to be 10-60%.
    The most common cause of vision loss is anterior ischemic optic neuropathy (AION). This results from ischemia of the optic nerve head, supplied mainly by the posterior ciliary arteries. Most AION is nonarteritic (87-91%) in nature. A history of sudden painless loss of vision frequently accompanies the patient with AION.

    Q 98. IN BLUNT ABDOMEN TRAUMA THE INCISION IS BEST DONE THROUGH

    A. MIDLINE ALWAYS
    B.TRANSVERSE ALWAYS
    C.DEPENDS ON ORGAN INVOLVED
    D.DEPENDS ON THE SEVERITY OF HEMORRHAGE

    ANS:ALWAYS MIDLINE

    Q99.Vision 2020..right to sight.a/e..

    1) Trachoma.
    2) Onchocerciasis.
    3) Epidemic conjunctivitis.
    4) Cataract

    ANS:EPIDEMIC CONJUCTIVITIS

    Q100.Which of the following is not pre-malignant:-

    a) Familial adenomatous polyposis
    b) Juvenile Polyposis syndrome
    c) Adenoma
    d) Juvenile Polyp

    ANS:JUVENILE POLYP
  18. kiyria.

    kiyria. Guest

    Q101.Which of the following is not true regarding Aedes mosquito?

    a. It bites repeatedly
    b. It transmits dengue
    c. Eggs cannot survive for more than one week without water
    d. Incubation period in mosquito is 7-8 days

    ANS: Eggs cannot survive for more than one week without water

    Q102.False positives are increased in which of the following?

    a. Low prevalence
    b. High prevalence
    c. High sensitivity
    d. High specificity
    ANS:LOW PREVALENCE

    Q103.Which of the following is not true regarding surveillance of water pollution?
    a. Multiple tube method is used
    b. (?)
    c. Sodium thiosulfate is used to neutralize chlorine
    d. Presence of Clostridium spores indicates recent contamination
    ANS:presence of Clostridium spores indicates recent contamination

    Q105.Which of the following is not true about Crude Birth Rate?

    a. It is a measure of fertility
    b. It is actually a ratio
    c. It is independent of the age structure of the population
    d. Numerator does not include still births

    ANS:ITS ACTUALLY A RATIO

    Although Crude birth rate does not take age into considerations, birth rates are affected by the age-structure of the population.

    A ratio is the number of observations in a group with a given characteristic divided by the number of observations without the given characteristic. A ratio is always defined as a part divided by another part.

    Q105.Which is the most efficacious vaccine?

    a. Measles
    b. DPT
    c. TT
    d. Polio

    ANS:MEASLES

    Q106.According to the WHO the STEPS approach is used for surveillance of which of the following?

    a. Risk factors for communicable diseases
    b. Risk factors for non communicable diseases
    c. Mortality of non communicable diseases
    d. Mortality of communicable diseases
    ANS:RISK FACTOR OF NON COMMINICABLE DISEASES

    Q107.All of the following can be used to treat heroin dependence except

    a. Disulfiram
    b. Buprenorphine
    c. Clonidine
    d. Lofexidine
    ANS:DISULFIRAM

    Q108.Strawberry gingiva is seen in which of the following?

    a. Wegener’s Granulomatosis
    b. Monocytic leukemia
    c. Phenytoin gum hypertrophy
    d. ?

    Answer:Wegener’s Granulomatosis

    REF:Rook’s Textbook of Dermatology,
    Oral ulcers are the second most common mucocutaneous sign of WG, and it has been suggested that ‘strawberry’ gingival hyperplasia is pathognomonic

    Q109.The best way to dispose off mercury is

    a. Safe collection and reuse
    b. Controlled combustion
    c. Treatment with acid
    d. Deep burial

    ANS:SAFE COLLECTION AND REUSE

    Q110.All of the following genes are implicated in colon carcinoma except

    a. APC
    b. k-ras
    c. beta-catenin
    d. mismatch repair genes

    ANS:BETA CATENIN

    There appear to be at least three different pathways driving carcinogenesis: chromosomal instability, microsatellite instability (MSI), and CpG island methylation. In the chromosomal instability pathway, early mutations include inherited or acquired changes in the tumor suppressor gene, APC, located on the long arm of chromosome 5, and mutations in the K-ras proto-oncogene. Later genetic events include changes in the deleted in colon cancer mutation (DCC) gene on 18q, and mutation of the tumor suppressor gene p53 on chromosome 17p. Genetic mutations that occur in inherited colorectal cancer following the alterations in genes for a variety of DNA mismatch repair enzymes occur in the inherited form (hereditary nonpolyposis colorectal cancer syndrome/Warthin-Lynch syndrome), and silencing of one of these genes (hMLH1) by methylation in the sporadic form. Mismatch repair deficiency leads to numerous mutations in genes that have repeated nucleotide sequences (microsatellites) and in individual nucleotides (mutator phenotype), chromosomal instability pathway include those of the APC gene in familial adenomatous polyposis. The accumulation of genetic alterations with structural and copy number abnormalities in numerous chromosomes eventually leads to phenotypic alterations in the colorectal epithelium and are associated with the development of adenomas that sometimes progress to invasive carcinoma with eventual metastases. In the microsatellite instability pathway, but chromosomal alterations are uncommon. In the CpG island methylation pathway epigenetic hypermethylation of DNA occurs, leading to suppression of gene expression by methylation in promoters. The perturbations affect expression of important regulatory proteins controlling cell morphology, growth, and adhesion. Hypomethylation of intronic DNA accompanies hypermethylation. Abnormalities of more than one of the three recognized pathways are often evident in colorectal cancers, as CpG island methylation can occur in concert with both the chromosomal instability pathway and the microsatellite instability pathway.

    Q111.Which of the following is the best intestinal absorption test?

    a. Quantitative stool fat estimation
    b. D Xyulose test
    c. PABA
    d. Schilling test
    ANS:XYULOSE ABSORPTION TEST

    Q111.Which of the following is the best intestinal absorption test?

    a. Quantitative stool fat estimation
    b. D Xyulose test
    c. PABA
    d. Schilling test
    ANS:XYULOSE ABSORPTION TEST

    Q113.Which of the following is an early complication of ileostomy?

    a. Necrosis
    b. Obstruction
    c. Diarrhea
    d. Prolapse

    ANS:NECROSIS

    Following are the early stomal complications mentioned in Sabiston Surgery, 18th edition
    Poor location
    Retraction (may also develop as late complication)
    Ischemic necrosis
    Detachment
    Abscess formation (may also develop as late complication)
    Opening wrong end
    Excoriation
    Dermatitis (may also develop as late complication)
    High output (may also develop as late complication

    Q114.Cryoglobulinema with ankle arthritis.polyclonal monoclonal cryoglobulinemia..and other findings of systemic involv?
    a)Hepatitis a
    b)Hepatitis b
    c)hepatitis c
    d)ebv
    ans:hepatitis C

    Q115.Hyopomagnesemia caused by

    a.furosemide
    b.digoxin
    c.aminoglycoside
    d.cisplatin

    ANS:FUROSEMIDE

    Q116.Wilm's tumour is associated with a/e
    a. aniridia
    b. hemihypertrophy
    c. hypertension
    d. polycystic kidney

    ans:polycystic kidney

    Q117.Global warming,Which is true among the following?

    1. CO2 Is the major gas responsible for the greenhouse effect
    2. Kyoto declaration: 20% emission cut
    3. CFCs do not harm the stratosphere ozone layer
    4. ??
    ANS: CO2 Is the major gas responsible for the greenhouse effect

    Q118.68 yr old male havin swollen knee n pain. coming to clinic AHLBACKc stage 2.wat is moost appropriate treatment?

    a. arthroscopic washing
    b. total knee replacement
    c. conservative
    d.high tibial ostotomy
    ANS:ARTHROSCOPIC WASHING

    Q119.Pregnant lady with cervical lypmphadenopathy, prescribed spiramycin, non compliant...baby has intracerebral calcification?

    a.Toxoplasmosis
    b.cytomegalovirus
    c) cryptococcus
    d) ?
    ANS:TOXOPLASMOSIS

    Q120.Morgagni hernia?

    a. ant rt hernia
    b.ant left
    c.post rt
    d.post left
    ANS:ANTERIOR RIGHT

    Q121.Which of the following drugs should not be used in a pregnant woman of > 35 weeks gestation?

    a. Methotrexate
    b. Sulfasalazine
    c. Prednisolone
    d. Chloroquine
    ANS:METHOREXATE

    Q122.Thyroid malignancy cant b diagnosed by

    1. hypoehogenicity
    2.hyperechogenicity
    3.microcalcifications
    4.irregular margins
    ANS:HYPERECHOGENICITY

    Q123.Psammoma bodes not seen in

    1.papillary ca thyroid
    2.follicular ca thyroid
    3.meningioma
    4.serous cystadenoca ovary
    ANS:FOLLICULAR CA

    Q124.Ovarian pathology referred to

    1) Gluteal region.
    2) Ant thigh
    3) Medial part of thigh.
    4) Back
    ANS:MEDIAL PART OF THIGH

    Q125.Endolymph in inner ear produced by?

    1) Phalangeal cells.
    2) Stria vascularis
    3) lamina spiralis ossea
    4) ?
    ANS:STRIA VASCULARIS
  19. kim.

    kim. Guest

    AIIMS MAY 2010: All 200 Quetions with Answers

    1.CHANG CLASSIFICATION

    RETINOBLASTOMA
    EWINGS SARCOMA
    MEDULLOBLASTOMA
    OSTEOSARCOMA


    ANS--MEDULLOBLASTOMA

    2.berry aneurysms - cause
    a. degeneration of internal elastic lamina
    b. degeneration of media / muscle cell layer
    c. deposition of mucoid material in media
    d. low grade inflammation of vessel wall

    ANS:DEGENERATION OF INTERNAL ELASTIC LAMINA

    Q3.Which of the following retinal diseases is transmitted as Autosomal dominant disorder:
    a) Best disease
    b) Gyrate atrophy
    c) LMB
    d)macular

    ANS:BEST DISEASE

    4.Leprosy affects all of the following except
    a. uterus
    b eyes
    c. ovaries
    d. nerves

    ANS:UTERUS

    5.which of the following organs will be affected maximally by the effects of a blast (bomb blast?
    a. lung
    b. liver
    c. skeletal tissue
    d. nervous system

    ANS:LUNG

    6.The capacity of a b ullet to cause maximum destruction lies in its
    a. size
    b. shape
    c. weight
    d. velocity

    ANS--VELOCITY

    7..Lice TRANSMITS a/e?

    a. Q fever
    b. trench fever
    c. epidemic typhus
    d. relapsing fever

    ANS --Q FEVER


    8. Coagulative necrosis is seen in
    a. TB
    b. sarcoidosis
    c. gangrene
    d. cryptococcal infection

    ANS: gangrene

    9.Not an indicator of fecal contamination
    a. E.coli
    b. streptococcus
    c. staphylococcus
    d. cl. perfringens

    ANS:staphylococccus

    10.Most specefic marker for myeloid series

    a. CD 117
    b. CD 99
    c. CD 45
    d. CD 34
    ANS: CD 117


    11.Best prognostic indicator for head injured pts?
    a. GCS
    b. ct findings
    c. age of the pt
    d.history


    ANS:GCS


    12.Boy with blunt abd trauma - h/o pelvic fracture .. has passed only few drops of blood per meatus and no urine in the past 8 hrs.. bladder is palpable.. which of the following is correct?
    a. anuria d/t haemorhagic shock
    b. urethral injury
    c. ureteral rupture leading to extravasation of urine in retroperitoneum?
    d. bladder rupture


    ANS:URETHRAL INJURY


    13.Drug causing oligospermia

    a. leflunamide
    b. d-penicillinamine
    c. METHOTREXATE
    d. BLEOMYCIN


    ANS:methotrexate

    14.MOST COMMON form of substance abuse in india
    a. tobacco
    b. alcohol
    c. cannabis
    d. opioids

    ANS:TOBACCO

    15.APPENDICES EPIPLOICAE are present in
    a. caecum
    b. appendix
    c. sigmoid colon
    d. rectum

    ANS:SIGMOID COLON

    16.16.All are causes of primary amenorrhea except
    a. rokitansky syn
    b. sheehan's syn
    c. kallman's syn
    d. turner's syn


    ANS:SHEEHAN SYNDROME


    17.Thalidomide is used in all of the following except
    a. HIV associated peripheral neuropathy
    b. HIV associated mouth ulcers
    c. behcets disease
    d. ENL


    ANS:HIV ASSOCIATED PERIPHERAL NEUROPATHY

    18.Commonly seen with congenital hypertrophic pyloric stenosis
    a. hyperkalemic metabolic alkalosis
    b. hypokalemic metabolic alkalosis
    c. hyperkalemic metabolic acidosis
    d hypokalemic metabolic acidosis

    ANS:Hypokalemic metabolic alkalosis

    19.Hyperextensibility with NORMAL elastic recoil
    a. Ehlers Danlos syn
    b. cutis laxa
    c. scleroderma
    d. pseudoxanthoma elasticum

    ANS:EHLER DANLOS SYNDROME


    20.Which of the following is a pulsatile tumor?
    a. Osteosarcoma
    b. chondrosarcoma
    c. osteoclastoma
    d. ewings sarcoma


    ANS:Osteosarcoma

    21.25 yr old male with fever, malaise.. and erythematous nodules over the shin (?)
    diagnosis is
    a. erythema nodosum
    b. hensen's disease
    c. weber-christian disease
    d. urticarial vasculitis

    ANS:WEBER CHRISTIAN DISEASE
    22.The function of 8th cranial nerve is related to
    a. smell
    b. taste
    c. touch
    d. balance


    ANS:BALANCE

    23.Amyloidosis .. most reliable investigation
    a. rectal biopsy .. has to be the answer??!
    b. ct scan
    c. colonoscopy
    d...


    ANS:RECTAL BIOPSY


    24.pain insensitive structure in brain is
    a. falx cerebri
    b. dural venous sinuses
    c. choroid plexus
    d. middle meningeal a.


    ANS:CHOROID PLEXUS

    25.infant wid congestive cardiac failure.. bulging fontanelle with a bruit which can be auscultated.. CT shows midline lesion with dilated lateral ventricles.. diagnosis is..??
    a. vein of galen malformation
    b. arachnoid cyst
    c. teratoma
    d. ... ???

    ANS:VEIN OF GALEN MALFORMATION

    26.Portal flow is decreased to lowest in :-
    Halothane
    Ether
    Enflurane
    Isoflurane


    ANS :HALOTHANE

    27.Savlon contains:-
    Cetrimide + chlorhexidine
    Cetrimide + chlorhexidine + butyl alcohol
    Cetrimide + butyl alcohol
    CETRIMIDE + CETAVLON

    ANS:Cetrimide +chlorhexidine

    28.sputum positive pregnant in 1st trimester?

    1. no treament.
    2. start cat 1.
    3. start cat 2.
    4.start cat 3.

    ANS:Start cat1.

    29.capacitation of sperm occurs in?

    1. uterus.
    2. epididymis.
    3. vas deferen
    4.seminiferous tubules

    ANS:Uterus

    30.Eukaryotic plasma membrane is made of al except?

    1. carbohydrates
    2. lecithin
    3. triglycerides
    4. cholesterol

    ANS:Triglycerides

    31.which of the following doesnt affect free radicals in the lens?

    1. vit a
    2. vit c
    3. vit e
    4. catalase.

    ANS:Vit a

    32.The best investigation for temporal bone injuries
    a. CT scan
    b. angio
    c. plain film
    d. MRI

    ANS:CT SCAN

    32.MOTORcyclists fracture is..

    a. Ring fracture
    b. Comminuted fracture of the vault..
    c. Skull base divided into two halves - anterior n posterior
    d. Subdural haemoorhage


    ANS:Skull base divided into two halves - anterior n posterior

    33.Infant with repeated vomiting, diarrhea, failure to thrive hepatosplenomegaly CT shows adrenal gland calcification

    adrenal
    h'ge
    cushings
    wolmans syndrome

    ANS:WOLMANS SYNDROME

    34.CIN-3 35 YEAR PARA -3+0 LADY..TREATMENT OF CHOICE IS :-
    A) CRYO
    B)LEEP
    C)CONISATION
    D)HYSTERECTOMY


    Ans:LEEP

    35.Prostate cancer most sensitive detection is:-
    a) per rectal ex
    b) DRE + PSA ..
    C)pSA
    D) MRI COIL INSIDE RECTUM

    ANS;DRE+PSA

    36.33 Anterior ethmoidal nerve supplies A/E
    a) Ant part of internal nose
    b) ethmoid sinus
    c) maxillary sinus
    d) ant dura near cribrifrm plate

    ANS:Maxillary sinus

    37.Vit A prophylaxis
    a) Specific protection
    b) Health promotion
    c) Secondary
    d) Primordial

    ANS:Specific protection

    38.OCD D.OC. -
    A) IMIPRAMINE
    B)ALPRAZOLAM
    C)BZDs
    D)Fluoxetine

    ANS:Fluoxetine

    39.60 yr old male with total painless gross hematuria .Inv of choice to know the cause of hematuria would be
    a) USG
    B)KUB XRAY
    C)URINE routine n microscopy
    D)URINE FOR MALIGNANT CELLS

    ANS:URINE FOR MALIGNANT CELLS

    40.Cryoglobulinema wala ques..wth ankle arthritis.polyclonal monoclonal cryoglobulinemia..and other findings of systemic involv??
    a)Hep a
    b) Hep b
    c) hep c
    d) ebv

    ANS:HEPATITIS C

    41. Sickle cell anemia 26 yrs old boy the following should not be used
    a) IV Regioanal analgesia
    b)BRachial plexus supraclavicular app bloc
    c) brachial plexus axillary approach
    d)brachial plexus

    ANS:IVRA

    42.Post glenohumeral instability
    a) Crank test
    b) Fulcrum
    c) Jerk test
    d) sulcus

    ANS:JERK TEST

    43.Most diagnostic of rabies:-
    a) Negri bodies
    b) Gaurneiri bodies
    c)cowdry A
    d) cowdry B

    ans neigri bodies

    44.Meralgia parasthetica is due to involvement of:-
    a) Sural nerve
    b) Med cutaneous nerve of thigh
    c) Lateral cutaneous nerve of thigh
    d) Peroneal n

    ans lateral cut n of thigh

    45.CYP3A INHIBITION IS CAUSED BU ALL EXCEPT
    A) SAQUINAVIR
    B) RITONAVIR
    C) erythromycin
    D) itraconazole

    ans saquinavir

    46.woman with placenta praevia - bleeds - what is most likely to occur after delivery?
    a. lack of menstrual cycles
    b. galactorhea
    c. Diabetes insipidus
    d....??

    ans:lack of menstrual cycles OR DI PLS CLEAR

    47.FASTEST DECREASE IN K LEVELS IS BY:-
    CALCIUM GLUCONATE
    INSULIN + GLUCOSE
    K RESINS
    NA HCO3

    ans.insulin +glucose OR ????????

    48.PANETH CELLS have..
    a. high zinc content
    b. numerous lysozyme granules
    c. rich RER
    d.foamy cells

    ANS:??????????

    49.maltese cross question .. ???
    a.cryptococcus
    b.blastomycosis
    c.candida
    D.
    ans cryptococcus

    50.INCISED WOULDS ON GENITALIA ON POST MORTEM-
    A) HOMICIDAL
    B) SELF INFLICTED
    C) POST MORTEM
    D) ACCIDENTAL

    ans homicidal

    51Gestational diabetes mellitus.. what is NOT usually seen
    a. past h/o macrosomic baby
    b. malformations
    c. obesity
    d. polyhydramnios

    ANS:A OR B IS PAST H/O MACROSOMIA MUST IN GDM?

    52.A 35 yr old lady comes with primary infertility. There is a mass palpable and her CA-125 levels ar 90 ..... (units). What's most probable diagnosis?

    a. Ca Ovary
    b. borderline ca Ovary
    c. tuberculosis
    d. endometrioma

    ANS:TB

    53.two siblings with osteogenesis imperfecta.. but their parents are normal.. cause/mechanism of inheritance
    a. anticipation
    b. genomic imprinting
    c. germ cell line mosaicism
    d. NEW MUTATION

    ANS...GERM LINE MOSACISM>NEW MUTATION .

    54.MOST important form of substance abuse in india
    a. tobacco
    b. alcohol
    c. cannabis
    d. opioids

    ANS TOBACCO.

    55.A healthy young athlete sitting at table with knee at 90 degree flexion. He fully extends it. what will happen?
    a. Movement of tibial tuberosity twds lat border of patella
    b. Movement of tibial tuberosity twds medial border of patella
    c. Movement of tibial tuberosity twds centre of patella
    d. NO CHANGE

    ANS : Movement of tibial tuberosity twds medial border of patella

    56.Carcinogenesis in colon implicates all of the following genes except
    APC
    k-ras
    beta-catenin
    mismatch repair genes

    ANS BETA CATENIN
    57.30yr old woman comes wid b/l progressive weakness of both lower limbs, spasticity present on MRI mass enhancing dorsal intradural lesion present , diagnosis
    a. intradural lipoma
    b. meningioma
    c. neuroenteric cyst
    d. ...

    ANS MENINGIOMA

    58.treatment for bells palsy coming on third day....

    steroid + acyclovir..
    STEROID ONLY
    Steroid with vit b12
    Steroid +acyclovir+vitamin

    ANS STEROID +ACYCLOVIR

    59. GIRL eating binges with purgings...
    a.aneroxia nervosa
    b.bulimia nervosa...
    c.binge eating ds

    ANS bulimianervosa

    61.SPLICING FUNC OF??
    M RNA
    SN RNA
    R RNA
    T RNA

    ANS.SN RNA......

    62.AFTER OVERNITE FASTING.GLU TRANSPORTED REDUC IN

    BRAIN CELL
    RBC
    LIVER
    ADIPOSE TISSUE

    ANS ADIPOSE TISSUE


    63.ACETYL CO A CAN B CONVERTED INTO ALL EXCEPT??
    GLUCOSE
    FATTY ACIDS
    CHOL
    KB

    ANS GLUCOSE

    64.GAP BETWEEN DNA JOINED BY??

    HELICASE
    LIGASE
    TOPOISOMERASE
    PHOSPHORYLASE

    ANS LIGASE


    65.hyopomagnesemia
    a. furosemide ANS
    b.digoxin
    c.aminoglycoside
    d.cisplatin

    ANS FRUSOMIDE

    66.whch of these is not an opioid agonist
    a. heroin
    b. ketamine
    c. methadone.
    d.CODIENE

    ANS KETAMINE.


    67. contaceptive of choice in lactating female...

    a. lactational amemorr
    b. barrier
    c. proget onlt pill
    d. OCP

    ANS LACT AMENORRHOEA


    68.wilm's tumour is associated c a/e

    a. aniridia
    b. hemihypertrophy
    c. htn
    d. polycystic kidney

    ANS POLYCYSTIC KIDNEY

    69.STEPS
    A.prevalance of non communicable ds
    B-prevalance of risk factor of non communicable ds
    C-assesment of t/t of non communicable ds

    ANS PREV OF RISK FACTORS

    70.true about crude BIRTH rate?

    a. Its a good measure of fertility
    b. Its actually a ratio not a rate
    c. it independent of age of population
    d. NUMERATOR doesn't inc still births

    ANS :ITS RATIO NOT RATE

    71. all cause retraction of scapula except?

    a. Rhomboides major
    b. rhomboides minor
    c. trapezius
    d. LEV SCAPULAE

    ANSWER... LEVATOR SCAPULAE

    72. Xanthogranulomatous inflammation .. all are true except

    a. assoc with tb
    b. giant cells present
    c. yellow nodules present in organ
    d. cholesterol laden macrophages present

    ANS ASSOC WTH TB

    73.peutz-jeghers polyps present in
    a.rectum
    b.colon
    c.small intestine
    d.appendix

    ANS JEJUNUM

    74.most important organelle involved in apoptosis
    a. mitochondria
    b. nucleus
    c. golgi bodies
    d. ER

    ANS MITOCHONDRIA

    75.Lady undergoes total radical hysterectomy for Stage Ib Ca Cx. It is found that Ca extends to lower body of uterus and Upper (vaginal wall???). What next?

    a. chemo
    b. radio
    c. chemoradio
    d. follow up

    ANS CHEMORADIATION

    76.CHOLESTASIS IN PREG... delivery at
    a. 34 wks
    b. 36
    c.38
    d.40

    ANS:36 WKS

    77.global warming....
    Which is true among the foll?
    1. CO2 Is the major gas responsible for the greenhouse effect
    2. Kyoto declaration: 20% emission cut
    3. CFCs do not harm the stratosphere ozone layer
    4. ??

    ANS CO2 MAJOR GAS....

    78.Temporal arteritis all are true except
    a. sudden b/l blindness
    b. mostly affects elderly
    c. mostly women
    d .aggrav by heat

    ANS AGGRAVATED BY HEAT

    79.68 yr old male havin swollen knee n pain. coming to clinic AHLLBACKc stage 2.wat is moost appropriate treatment?
    a. arthroscopic washing ANSWER
    b. total knee replacement
    c. conservative
    d.high tibial ostotomy

    ANS ARTHROSCOPIC WASHING

    80.pregnant lady with cervical lypmphadenopathy, prescribed spiramycin, non compliant...baby has intracerebral calcification?
    a.Toxoplasmosis
    b.cytomegalovirus
    c) cryptococcus
    d)

    ANS TOXOPLASMOSIS


    81.morgagni hernia?
    a. ant rt hernia
    b.ant left
    c.post rt
    d.post left

    ANS ANTERIOR RIGHT

    82.35 weeks pregnant lady withsle, which drug cant b used??
    1. methotrexate
    2.sulfasalazine
    3.prednisolone
    4.chloroquine.

    ANS METHOTREXATE

    83thyroid malignancy cant b diagnosed by
    1. hypoehogenicity
    2.hyperechogenicity
    3.microcalcifications
    4.irregular margins

    ANS HYPERECHOGENICITY

    84 psammoma bodes not seen in
    1.papillary ca thyroid
    2.follicular ca thyroid <--ans
    3.meningioma
    4.serous cystadenoca ovary

    ANS FOLLICULAR CA

    85.COELIAC PLEXUS??
    a. Ant lat and around the aorta--answer
    b. post medial and around the aorta
    c. ant medial to lumbar symp chain
    d. post lat to lumbar symp chain

    ANS ANT LAT TO AORTA

    86.Ovarian pathology referred to
    1) Gluteal region.
    2) Ant thigh
    3) Medial part of thigh.
    4)?????

    ANS MEDIAL PART OF THIGH

    87.Endolymph in inner ear produced by?
    1) Phalangeal cells.
    2) Stria vascularis.
    3) lamina spiralis ossea
    4)????

    ANS STRIA VASCULARIS

    88.Infection from inner er spreads to meninges through
    1) Cochlear aqueduct
    2) Vestibular aqueduct
    3) endolymphatic duct/sac.
    4) Hyrtle's fissure

    ANS COCHLEAR AQUEDUCT

    89.Dose-limiting toxicity of (anticancer chemotherapy)...
    1) gastrointestinal toxicity
    2) Myelosupression
    3 NEUROTOXICITY
    4.NEPHROTOXICITY

    ANS MYELOSUPRESSION. OR GI TOXICITY

    90.Sterilization by irradiation is used in all except?
    1)artificial tissue graft
    2)bone graft
    3)endoscope
    4)suture

    ANS :

    91. strawberry gingiva?
    -monocytic leukemia
    -wegeners
    -phenytoin
    -????

    ANS WEGNERS GRANULOMATOSIS

    92.not used in pulmonary hypertension
    a.ccb
    b.endothelin receptor antagonist
    c. alpha blocker
    d.prostacyclines

    ANS ALPHA BLOCKER

    93.female wid knee pain..showin CPPD..next inv?
    -RF
    -TSH
    -CPK
    -ANA

    ANS TSH

    94.IN BLUNT ABDOMEN TRAUMA THE INCISION IS BEST DONE THROUGH
    A. MIDLINE ALWAYS ANSWER RPT
    B.TRANSVERSE ALWAYS
    C.DEPENDS ON ORGAN INVOLVED
    D.DEPENDS ON THE SEVERITY OF HEMORRHAGE

    ANS MIDLINE ALWAYS

    95.best indicator for ovarian reserve
    a)LH
    B)FSH ANSWER RPT
    c)FSH/LH
    d)ESTRADIOL

    ANS FSH

    96SYNOVIAL FLUID A/E
    A) TYPE A SYNOVIAL CELLS SECRETE FLUID ANSWER RPT
    B) NON NEWTONIAN LIQUID
    C) HYALURONIC ACID
    D)

    ANS A

    97.All are important causes of childhood blindness in India except?
    1) Malnutrition.
    2) Glaucoma.
    3) Ophthalmia neonatorum
    4) Congenital dacryocystitis

    ANS CONG DACROCYSTITIS

    9 8)Vision 2020..right to sight... A/E
    1) Trachoma.
    2) Onchocerciasis.
    3) Epidemic conjunctivitis.
    4) Cataract

    ANS EPIDEMIC CONJUCTIVITIS

    99.DIGITALIS TOXICITY ENHANCED BY ALL EXCEPT:-
    A.RENAL FAILURE
    B.HYPERKALEMIA
    C.HYPERCALCEMIA
    D.HYPOMAGNESEMIA

    ANS HYPER KALEMIA

    100.Which is not an alkylating agent?
    1. 5-FU
    2. Melphalan
    3. CYCLOPHOSPHAMIDE
    4.CARMUSTINE

    ANS 5 FU

    101. What is not used for treatment of heroin dependence ?
    1. Disulfiram
    2. Buprenorphine
    3. Clonidine
    4.LOXFEXIDINE

    ANS DISULFIRAM

    102.Which of the following does not cause malabsorptn?
    1. Ascaris
    2. Giardia
    3. Capilliria philippensis
    4. STRONGYLOIDES STERCOBILIGENS

    ANS ASCARIS

    103 Vaccine with maximum efficacy?
    1. Measles
    2. DPT
    3. TT
    4. ??

    ANS MEASLES

    104 .Mercury disposal?
    1. Collect carefully and reuse
    2. deep burial
    3. MIX WITH ACID
    4.

    ANS COLLET CAREFULLY N RE USE

    105Hallmark of acute inflammation?
    1. Vasoconstriction
    2. Stasis
    3. Vasoldilatn and increase in permeability
    4. ??

    ANS VASODILATION AND PERMEABILITY

    106.Chemotaxis is?
    1. Unidirectional increase in movement
    2. Random movement increase
    3. ??

    ANS UNIDIRECTIONAL INCREASE IN MOVEMENT

    107. Caspases are involveed in ?
    1. Organogenesis
    2. Hydropic degeneration
    3. ??

    ANS: ORGANOGENESIS

    108.ALL CAN INCREASE APPETITE EXCEPT
    A)MSH
    B)MELANOCYTE CONCENTRATING HORMONE
    C)NEUROPEPTIDE Y
    D)

    ANS : MSH

    109.not true abt impending eissenmenger???
    -increasing intensity of tricuspid n pulmonary murmur
    -increased intensity P2
    -appearance of graham steel murmur
    -was single S2

    ANS:GRAHAM STEEL MURMUR????

    110. All are true about Left ventricular failure except:-
    a) Pulmonary oligemia
    b) Kerley B lines
    c) redistribution to apices
    d)

    ANS PULMONARY OLIGAEMIA

    111.Sister mary joseph nodule :-

    a) Pancreatic cancer
    b) Ovarian cancer
    c) Gastric cancer
    d) Colon cancer

    ANS GASTRIC CA
    112. A female infant with normal milestones,Normal BP, and no abnormal genitalia,glucose-30mg/l there is hyperpigmentation only the cause could be:-

    a) INSULINOMA
    b) Familial glucocorticoid deficiency
    c) Cushing Synd
    d)

    ANS:FAMILIAL GLUCOCORICOID DEFECIENCY

    113.Hepatomegaly is not the important feature of:-

    a) Nieman pick disease
    b) Glycogen storage diseases
    c) Hurler Disease
    d) HEP PORPHYRIA

    ANS: HEPATIC PORPHYRIA

    114.Zollinger elison syndrome drug used is:-

    a) Proton pump inhibitor
    b) Antihistaminics
    c) Dopamine blockers
    d) RANITIDINE

    ANS PPI

    115.The following drug causes dry mouth/warm skin ,tachycardia, mydriasis :-

    a) Anticholinergics
    b) Sympathomimmetic
    c) Cholinergic Drugs
    d) alpha blocker

    ANS :

    116.134.which of the following metastasize outside cns?

    glioblastoma multiforme
    medulloblastoma
    ependymoblastoma
    choroid plexus tumour

    ANS MEDULLOBLASTOMA

    117.hashimoto does not cause?
    follicular degeneration
    lymphoid,,,,
    annie eye,,

    ANS ORPHAN ANNIE EYE

    118.Which of the following is not pre-malignant:-

    a) Familial adenomatous polyposis
    b) Juvenile Polyposis
    c) Adenoma
    d) Juvenile PolyP

    ANS D JUV POLYP

    119.carcinoma not due tio smoking?
    ca oesophagus
    ca larynx
    ca bladder
    ca nasopharynx

    ANS :

    120.hypersensitivity vasculitis affects?
    post capillary venules
    capillaries
    arterioles medium sized vessels

    ANS POST CAP VENULES

    121.true about acute rheumatic carditis is?
    trop i increased
    replacing valve will cure chf
    necrosis and inflamation in biopsy
    DEC CONTRACTILITY
    ANS NECROSIS AND INFLAMMATION ON BIOPSY

    122.a middle aged male with an ulcerative granulomata on his glans - wright giemsa stained specimen shows 1-2 rounded structures vacuolated within macrophages.. ??
    what is the causative organism? & the size of the bodies were 1-3 micron
    a. chlamydia trachomatis
    b. calymmatobacterium granulomatis
    c.
    d.Neisseria gonorrheae

    ANS:

    123.what is the wt.of a reference indian man?
    1.50kg
    2.55kg
    3.60kg
    4.65kg

    ANS 60 KG

    124.ideal age for orchiopexy ?
    1-2 YRS
    5 YRS
    NEONATES

    ans. 1-2 yrs

    125.most specific test for syphylis?
    1.vdrl
    2.rpr
    3.fta abs
    4.kahn test

    ANS FTA ABS

    126.insulin plays important role in A/E
    1.Glycogenesis
    2.lipogenesis
    3.glycolysis
    4.ketogenesis

    ANS KETOGENESIS

    127.Which cranial nv does not carry parasympathetic outflow from brain?
    1.4rth
    2.7th
    3.9th
    4. 3RD

    ANS 4TH
    128.A 3yr old boy with normal dev.milestones with delayed speech & difficulty in concentration & communication ,not making frnd. most probable dg is
    1.sp.learning disability
    2.autism
    3.mental retardation
    4.ADHD

    ANS AUTISM

    129.All of the followings are features of prostatic urethra except

    1.trapezoid shaped on cross section
    2.opening of prostatic glands
    3. PROS UTRICLE
    4. verumontam

    ANS TRAPEZOID SHAPE

    130.mineral salt n d bone...
    hydroxyapatitie,
    calcium carbonate
    c CACL2
    d?

    ANS HYDROXYAPPATITE

    131.which one favours both bone formation n reduces bone resorption
    STRONTIUM RANEOLATE
    PTH
    BISPHOSPHONATES

    ANS: STRONTIUM RANEOLATE

    132.x ray feature of fibrous dysplasia..

    1.ground glass appearance
    2.calcification
    3.cortical thickening
    4.

    ANS GROUND GLASS APPEARENCE

    133.IN ageing-
    1.increasd cross linkage f collagen
    2INCREASED SUPER OXIDE DISMUTASE
    3.?
    4.incresd tissue damage d/t free radical injury

    ANS ACCUM OF FREE RADICAL INJURY.....

    134.Which is not supplied by pelvic splanchic nerve?
    A. Appendix
    B. Rectum
    C.Uterus
    D. Urinary Bladder

    ANS APPENDIX

    135.True abt spinocerebellar tract?
    A. Eqilibium.
    B. Smoothens and coordinates movement.
    C. Learning induced by changes in vestibular reflexes
    D. Planning and Programming.

    ANS Smoothens and coordinates movement.


    136.A Middle aged female with h/o menorrhagia can be treated by all except
    1.etamsylate
    2.tranexaminic acid
    3.ocp
    4.progesteron therapy on days 5-25

    ANS:ETHAMSYLATE

    137.Intrinsic factor of castle found in :

    A.liver
    B.chief cells of stomach
    C.parietal cells of stomach ANS
    D.???

    ANS PARIETAL CELL

    138.HIV PT... ACID FAST CYST IN STOOL
    A)ISOSPORA
    B)MICROBALEI
    C)
    D)GIARDIASIS

    ANS ISOSPORA

    139.naltrexone is used in
    a. treat withdrawal symptoms
    b. overdose
    c.prevens relapse ans

    ANS PREV OF RELAPSE

    140.the aorta, celiac axis, proximal superior mesenteric artery (SMA), and left renal arteries can be exposed with
    a left medial visceral rotation ans
    right medial visceral rotation

    ANS LEFT MEDIAL RT

    141.which component of eye has max refractive index
    a.ant surface of lens
    b.post surface of lens
    c.centre of lens ans
    D. CORNEA

    ANS CENTRE OF LENS

    142.which of the following is not true
    a.clostridium spores indicate recent contamination ans
    b.sod thiosulphate added to neutralise cl

    ANS A

    142.The afferent of 8th cranial nerve is related to
    a. smell
    b. taste
    c. touch
    d. balance

    ANS BALANCE

    143.a male was brought unconscious with external injuries.CT shows no midline shift but basal cisterns were full with multiple small heamorrhages diagnosis
    a.brain contusion
    b.diffuse axonal injury
    c.subdural haemorrhage
    d.multiple infarc
    ANS DIFFUSE AXONAL INJURY

    144.Ext laryngeal memb A/E

    cricothyroid
    thyrohyoid
    cricotracheal
    hyoepiglotic


    ANS:CRICOTHYROID OR HYOEPIGLOTTIC ??

    145.Antigen antibody precipitation is maximally seen in which of the following?
    a. Excess of antibody
    b. Excess of antigen
    c. Equivalence of antibody and antigen
    d. Antigen-Hapten Interaction

    ANS:Equivalence of antibody and antigen

    146.Which of the following is not used to diagnose Leptospirosis?

    a. Microscopic agglutination test
    b. Dark field microscopy
    c. Macroscopic agglutination test
    d. Weil-felix reaction

    ANS:WEIL FELIX REACTION

    147.pentology of fallot

    tof + asd

    148.classified on basis of Scale very satisfied, satisfied,unsatisfied....

    1.ordinal
    2.nominal
    3.range
    4.interval

    ANS:ORDINAL SCALE

    149.h/o Unilateral progressive proptosis for many years...swelling is increased on bending forward and compressible....USG shows retrobulbar echogenicity

    1) Orbital varix.
    2) Orbital A-V fisula.
    3) Neurofibromatosis.
    4) orbital encephalocele


    ANS.ORBITAL VARIX

    150.iNCIDENCE OF DISEASE IS BEST DETECTED BY
    A) CASE CONTROL STUDY
    B)RETROSPECTIVE
    C)PROSPECTIVE
    D) CROSS SECTIONAL

    ANS PROSPECTIVE

    151 TRUE ABT ATHEROSCLEROSIS??

    A)SEVERITY MORE IF THORACIC AORTA IS INVOLVED
    B)VEINS LESIONS EQUALS IN NUMBERS LIKE ARTERIES
    C)UNSAT FAT REDUCE RISK OF ATHEROSCLEROSIS
    D)CHOLESTROL HAS NO EFFECT

    ANS :
    152 maethaemoglobinemia caused by?
    a. procaine
    b. prilocaine ANS
    c LIDOCAINE
    d BUPI

    ANS PRILOCAINE
    153What is true about clomiphine?

    a. Enclomiphene is anestrogenic
    b. preg rate 3 TIMES AS COMPARE TO placebo
    c. Causes inc in PREGNANCY RATE in RCT of oligospermic men
    d. TWIN PREG 5 TO 6%

    ANS:
    154.All of the following r true bout sickle cell anemia except
    a. single nucleotide change leads to a change from glutamate to valine
    b. a single base pair change leads to RFLP
    c. deoxygenated Hb leads to the exposure of sticky end.. due to replacement of polar residue by NON- polar residue?
    d. offers protection to malaria in heterozygotes

    ANS : deoxygenated Hb leads to the exposure of sticky end.. due to replacement of polar residue by NON- polar residue

    155.Infant wid RR 48 HR 180 cool extremities .. and capillary refill time 4 secs which of the following is correct?
    a. early (compensated) shock d/t hypovolemia
    b. early compensated shock d/t supraventricular tachycardia
    c. late decompensated shock d/t hypovolemia
    d. late decompensated shock d/t svt

    ANS:EARLY COMPENSATED SHOCK DUE TO HYPOVOLEMIA

    156Graphical representation of frequency with continuous graph
    1.polygon
    2.histogram
    3.bar graph
    4.........

    ANS HISTOGRAM

    157female comin wth lip swellin sign of edema, abdominal pain..wat is characteristic of given cond

    c1 h def
    c5 def
    .....
    .....

    ANS C1 DEF

    158Cow's milk
    ans contains 80% whey protein is false
    has less glucose
    has more Na n K


    ANS WHEY PROT IN COWS MILK.

    159.Barret’s esophagus is diagnosed by which of the following?
    a. Squomous metaplasia
    b. Intestinal dysplasia
    c. Columnar metaplasia
    d. Columnar dysplasia
    Answer: Squamous metaplasia

    160.which of the following is not a primary skin disease..
    a. psoriasis
    b. lichen planus
    c. reiters disease..

    ANS REITERS



    162.Cause of spider nevi
    a.estrogen
    b.testosterone
    c.hepatotoxins
    d.fsh

    ANS ESTROGEN

    162sup middle alveolar branch of
    a) palatine branch of maxillary
    b) nasal branch of maxillary
    c) inf alveolar branch
    d)mandibular

    ANS :

    163 65 yrs old man with H/o of back pain since 3 months. ESR is raised syndesmophytes present.diagnosis is :-

    a.ankylosing spondilitis
    b.degenerative osteoarthritis of spine
    c.ankylosing hyperosteosis
    d.lumber canal stenosis.

    ANS:ANKYLOSING SPONDYLITIS

    164All are true about eisenmenger except:-

    a) peripheral pulmonary vein pruning
    b) Normalisation of size of left ventricle and right ventricle
    c)
    d)

    ANS :

    165.MC CSF RHINORRHOEA???

    ETHMOIDAL CELL
    SPHENOID
    FRONTAL
    TEGMEN TYMPANI

    ANS: ETHMOIDAL CELL

    166sternomastoid Tm...... A/E ALWAYS BREACH

    167hypocalcaemia true A/E
    A.digital tingling
    B.perioral numbness
    C.decreased reflexes
    D.

    ANS DEC REFLEXES

    168proteus infecn ... stone
    cystein
    triple phosphate
    3
    4
    ANS triple phophate.....

    169.TRUE ABT ARBO VIRUS?

    OTHER OPTIONS
    KFD FIRST IN WB
    .....
    .....

    ANS:CHIKUNGUNYA BY AEDES AGEYPTI

    170indicator of long term malnutrition...
    HT AND WT
    MID ARM CICUMFERENCE
    HEAD CIRCUMFERENCE
    ?
    ANS:HT NAD WEIGHT

    171lepromin test A/E

    DIAG TEST

    172.HEMOCHROMATOSIS CORRECT IS
    a)Heterogenous
    b) Complete penetrance
    c) Female more tham male
    d) Phlebotomy is of no use
    ANS: HETEROGENOUS

    173somatomedin ...?? deposition of chondroitin sulphate ????

    174.SLE QUES ABT SENSTIVITY N SP??

    ANS

    175follicular adenoma n carcinoma can b diff?

    vascular invasion

    176,Thalidomide is used in all of the following except
    a. HIV associated peripheral neuropathy
    b. HIV associated mouth ulcers
    c. behcets disease
    d. ENL

    ANS A

    177young man back from leisure trip..has some painful joint... foriegn body sensation in eyes...

    ans : reiter's


    178.40 yr female with hyperpigmamntation, benedict in urine +ve, Brown black supernatant, & calcification IV disc
    a. Alkaptonuria
    b. Tyrosenemia II
    c. PKU
    d. Arginossuccinemia

    ANS:ALKAPTUNORIA
    179.2 COUNTRIES COMPARISION ON DEATH RATE STANDARDIZATION (GMAX RXPG) REQ BECAUSE-
    A) AGE DISTRIBUTION
    B)GENDER DISTRIBUTION
    C)ENVIRONMENTAL FACTORS

    ANS AGE DISTRIBUTION

    180 CD4 TH1 cell all EXCEPT
    a. Opsonization
    b. Memory B cell
    c. Antibody formation
    d. CTL
    ANS:ANTIBODY FORMATION?

    181.Early complication of ileostomy
    a. Obstruction
    b. Collapse
    c. Necrosis
    d. Diarrhea

    ANS:NECROSIS

    182. Indicator of Intravascular volume indicator in neonate- Repeat
    a. HR
    b. Stroke volume
    c. CO
    d. Preload

    ANS:HR

    183.False positivity increases when....
    A.HIGH SPECIFICITY
    B.HIGH SENSITIVITY
    C.HIGH PREVALENCE
    D.LOW PREVALENCE
    ANS:HIGH SPECIFICITY
    184.pharmacovigilence ?
    a. Drug safety
    b. Unethicaltrade of drug
    c. Pharmacy students
    d. Drug efficacy

    ANSWER :DRUG SAFETY

    185.INSULIN FAST ADM CAUSES
    A.HYPONATREMIA
    B.HYPERCLCEMIA
    C.HYPOKALEMIA
    D.HYPERKALEMIA

    ANSWER HYPOKALEMIA

    186.Exercise blood flow to excercising muscle is increase because of
    a. Local metabolites
    B.SYMPATHETIC ACTIVITY
    C OPENING POTENTIAL CHANNELS

    ANSWER LOCAL METABOLITES

    187. Lyme disease AE
    a. I. burdogferic causes lcal invasion & produces proinflammtory cytokines
    b. occur when Active Humoral immunity depressed
    c. PMNs in CSF seen in memingela involvement
    d. IgA antibodies specific for intrathecal is diagnsostic

    ANS:D

    188.true abt fap a/e
    a.ar
    b.screenin wth colonoscopy
    c.
    d.

    ANS:

    189. Streptococcus AE
    a. Streptolysin o is active in reduce state
    b. Streptokinase produce by srotyep ACG
    c. Streptodrnase acton DNA
    d. Pyrotoxin A plasmid amediated

    ANS D

    190.water pollution-all true except-
    1.multiple tubes used.
    2.thiosulphate used to neutralise chlorine.
    3.clostridial spores suggest recent infection.
    4.

    ANS: CLOSTRIDIUM RECENT INF
    191.Condition where normal delivery not alowed?
    a.monozygot dizygotic with 1st cephalic,,,
    b.mento anterior
    c.monozygo mono chorionic

    ANS MONOZYGO MONOCHORIONIC

    193.branchial sinuses.??a/e
    a.arise frm 2nd arch

    FOLLOWING STATEMENTS TRUE ABT DIAG TEST OF TOXOPLASMOSIS??

    IGA MOST SPECIFIC FOE FETAL INF
    FOR TESTING IGG DYE TEST GOLD STNDARD
    IGM MORE SP THAN IGG IS SPECIFIC FOR FETAL CORD BLD
    AVIDITY SOME THIN CANT RECALL PROPERLY

    195HYALURONIC ACID FOUND IN
    A)VITREOS HUMOR

    196.ABSORBTIVE POWER OF SMALL INTESTINE TESTED BY?
    A.PABA
    B.D XYLULOSE
    C
    D

    ANSWER ...D XYLULOSE

    197.NOT SEEN IN HIV AFFECTING VESSELS ANSWER IS
    a) AORTIC ANEURYSM
    B.Tamponade
    c. CHF
    d. Arterial emboli recurrent


    198Which of the following is not true regarding Aedes mosquito?
    a. It bites repeatedly
    b. It transmits dengue .
    c. Eggs cannot survive for more than one week without water
    d. Incubation peRIOD 7-8 DAYS

    199.NEURAL TUBE DEFECT—ACETYLCHOLINEESTERASE
    200. Sterilization by irradiation is done in all of the following except
    a. Artificial tissue grafts
    b. Bone grafts
    c. Endoscopes
    d. Sutures


    201.CHLORINE--HORROCKS APPARATUS
  20. kiyria.

    kiyria. Guest

    Q. All of the following are CD4 T cell functions except
    a. Cytotoxicity
    b. Antibody formation
    c. Opsonization
    d. Memory cells

    ans:cytotoxicity

    The principle functions of Th1 cells are to activate macrophages to kill microorganisms and to induce B cells to make subclasses of immunoglobulin (Ig) G antibodies that are very effective at opsonizing extracellular pathogens for uptake by phagocytic cells. In addition, Th1 cells are the major helper T cells involved in delayed-type hypersensitivity. The cytokines elaborated by Th1 cells stimulate macrophage Fc receptor expression, phagocytosis, and antigen presentation, enhancing the capacity of macrophages to kill intracellular pathogens. Th2 cells, on the other hand, initiate the antibody response to antigen by activating naive antigen-specific B cells to produce IgM antibodies and subsequently stimulate the production of switched immunoglobulin isotypes, including IgA, IgE, and neutralizing and/or weakly opsonizing subtypes of IgG. In addition to stimulating the production of IgE antibodies, the cytokines made by Th2 cells induce differentiation of mast cells and eosinophils. Although these effects may contribute to development of allergy, these responses may be protective in helminth infections

    Q. Which of the following is true about Clomiphene citrate
    a. Enclomiphene is anti-estrogenic
    b. Clomiphene citrate as compared to placebo increases pregnancy rate three fold
    c. Risk of twin pregnancy is 5-6%
    d. In RCT it increases pregnancy rate in those with oligospermia

    ans:a

    Clomiphene citrate is a triphenylethylene; its two isomers, zuclomiphene (cis-clomiphene) and enclomiphene (trans-clomiphene), are a weak estrogen agonist and a potent antagonist, respectively. The risk of twins is mentioned as 5-8%,It has been shown to increase fertility rate in males with oligospermia
  21. kiyria.

    kiyria. Guest

    Which of the following is not true regarding Aedes mosquito?
    a. It bites repeatedly
    b. It transmits dengue .
    c. Eggs cannot survive for more than one week without water
    d. Incubation peRIOD 7-8 DAYS

    ans:c

    The CDC traveler's page on preventing dengue fever suggests using mosquito repellents that contain DEET (N, N-diethylmetatoluamide, between 20% to 30% concentration, but not more). It also suggests the following:

    The mosquito usually bites at dusk and dawn but may bite at any time during the day – especially indoors, in shady areas, or when the weather is cloudy."CDC".

    The mosquito's preferred breeding areas are in areas of stagnant water, such as flower vases, uncovered barrels, buckets, and discarded tires, but the most dangerous areas are wet shower floors and toilet tanks, as they allow the mosquitos to breed in the residence. Research has shown that certain chemicals emanating from bacteria in water containers stimulate the female mosquitoes to lay their eggs. They are particularly motivated to lay eggs in water containers that have the correct amounts of specific fatty acids associated with bacteria involved in the degradation of leaves and other organic matter in water. The chemicals associated with the microbial stew are far more stimulating to discerning female mosquitoes than plain or filtered water in which the bacteria once lived.
    Wear long-sleeved clothing and long trousers when outdoors during the day and evening.
    Spray permethrin or DEET repellents on clothing, as mosquitos may bite through thin clothing.
    Use mosquito netting over the bed if the bedroom is not air conditioned or screened. For additional protection, treat the mosquito netting with the insecticide permethrin.
    Spray permethrin or a similar insecticide in the bedroom before retiring.
    Although the lifespan of an adult Aedes Aegypti is between two to four weeks depending on conditions, Aedes aegypti's eggs can be viable for over a year in a dry state, which allows the mosquito to re-emerge after a cold winter or dry spell

    Hyaluronic acid is derived from hyalos (Greek for vitreous) and uronic acid because it was first isolated from the vitreous humour and possesses a high uronic acid content.

    The term hyaluronate refers to the conjugate base of hyaluronic acid. Because the molecule typically exists in vivo in its polyanionic form, it is most commonly referred to as hyaluronan.

    D-xylose Absorption Test
    The D-xylose absorption test measures the level of D-xylose, a type of sugar, in a blood or urine sample. This test is done to help diagnose problems that prevent the small intestine from absorbing nutrients in food.

    D-xylose is normally easily absorbed by the intestines. When problems with absorption occur, D-xylose is not absorbed by the intestines, and its level in blood and urine is low.

    Why It Is Done
    A test for D-xylose is done to:

    Check to see if malabsorption syndrome is causing symptoms, such as chronic diarrhea, weight loss, and weakness. A person with malabsorption syndrome is unable to absorb nutrients, vitamins, and minerals from the intestinal tract into the bloodstream.
    Find the cause of a child's failure to gain weight, especially when the child seems to be eating enough food.
    How To Prepare
    For 24 hours before a D-xylose test, do not eat foods high in pentose, a sugar similar to D-xylose. These foods include fruits, jams, jellies, and pastries.

    Medicines such as aspirin and indomethacin can interfere with the results of a D-xylose test. For this reason, your doctor may instruct you to temporarily stop these medicines before the test.

    Do not eat or drink anything except water for 8 to 12 hours before having this test. Children younger than 9 years old should not eat or drink anything except water for 4 hours before the test.

    Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).

    How It Is Done
    The amount of D-xylose in urine and blood samples is measured before and after you drink a D-xylose solution. To begin the test, a sample of your first urine of the day and a sample of your blood is collected.

    Next you will drink a D-xylose solution. For adults, a blood sample is usually taken 2 hours after drinking the solution. For children, a blood sample may be taken 1 hour after drinking the solution. Another blood sample may be drawn 5 hours after drinking the solution.

    You will need to collect all of the urine you produce for 5 hours after drinking the sugar solution. Sometimes urine is collected for 24 hours after drinking the sugar solution.
  22. kiyria.

    kiyria. Guest

    MoMo(Monochorionic Monoamniotic)

    Fortunately, modern technology allows doctors to observe babies in the womb, and monitor the situation. High resolution ultrasounds, doppler imaging and non-stress tests help to assess symptoms and identify potential cord problems. Cord entanglement and compression are generally a slow process, so parents and medical caregivers have time to make decisions. Some situations will require such close monitoring that the expectant mother must remain hospitalized.

    There is no approved treatment or procedure to fix the situation. The only resolution is delivery of the babies. Virtually all MoMo babies are born prematurely. Doctors have to balance the risks of the babies' condition in the womb versus the consequences of prematurity. If cord compression occurs early in the pregnancy, the babies may not be able to survive. Some doctors elect to schedule delivery of MoMo babies at 32, 34 or 36 weeks, believing that the womb environment is simply too dangerous past that point in time. Sometimes steroids may be administered to boost the babies' lung development and improve their chances of surviving outside the womb.

    A cesarean section is mandated for MoMo babies to avoid cord prolapse, a situation that occurs when the second babies cord is expelled as the first baby is delivered.
  23. kiyria.

    kiyria. Guest

    CD117 is a specific marker for AML arising de novo or in association with myelodysplastic syndromes. Overall, we found CD117 expression in 69% of myeloid leukemic processes (AML, MDS-AML, and CML myeloid blast crisis). Others have reported CD117 expression by flow cytometric analysis in 23% to 91% of AML cases. Our findings are in agreement with the largest studies that found CD117 in 63% to 67% of AML cases.
    We found no CD117 expression in ALL. Other studies have found rare examples of expression in ALL, more frequently those of T-lineage than of B-lineage. Our study included 7 cases of T-ALL. Although the number of cases of TALL studied was small, one should consider the possibility that the anti-CD117 clone might account for a difference in specificity. Notably, studies that reported positive staining in occasional T-ALL used the antibody clones LC-KIT (Lander Diagnostico, Madrid, Spain)6 and YB5.B8 (Immunotech, Marseille, France). In studies of messenger RNA (mRNA) expression, Nishii et al21 found c-kit mRNA in 4 of 12 cases of T-ALL. However, Wang et al found no c-kit mRNA in 3 cases of T-ALL studied, and Lerner and colleagues23 also found no c-kit mRNA in 1 case of T-ALL.
    Usefulness of CD117, CD13, and CD33 for Discriminating Acute Myeloid From Acute Lymphoid Leukemia CD13 and/ CD117 CD13 CD33 or CD33
    Specificity (%) 100 86 74 67
    Sensitivity (%) 69 84 86 99
    Positive predictive value (%) 100 92 87 86
    Negative predictive value (%) 62 72 72 97

    CD117 Expression in Acute Myelogenous Leukemia Subtypes*
    FAB Class No. of Cases No. (%) of CD117+ Cases
    M0 5 4 (80)
    M1 10 6 (60)
    M2 21 19 (90)
    M3 4 2 (50)
    M4 7 5 (71)
    M5a 2 0 (0)
    M5b 5 1 (20)
    M7 2 1 (50)
    * According to the French-American-British (FAB) classification.
    Hans et al / CD117 IN ACUTE LEUKEMIA
    Although CD117 has a high specificity, it is not as sensitive as CD13 or CD33 for detecting myeloid leukemic processes. Approximately 30% of acute myeloid leukemia did not stain with anti-CD117. Although 99% of acute myeloid leukemias were positive for CD13 and/or CD33 in our series, the myeloid specificity of CD13 and/or CD33 is much lower than that of CD117. However, through careful morphologic review and the use of a comprehensive immunophenotyping panel and cytochemical stains, we found that myeloid lineage assignment could be established in all instances without the use of CD117. Furthermore, according to the findings in a German cooperative study9 and the Children’s Cancer Group, CD117 status seems to lack prognostic significance in AML.
    CD117 expression does not seem to be a reliable predictor of FAB AML subtype. In the present study, the highest frequency of CD117 expression was found in the AML M2 category (90% positive). In addition, 80% of cases in the AML M0 group had CD117 expression. In contrast, we found no CD117 in AML M5a, and only 20% of cases of M5b expressed this antigen. The total number of M5 cases in our study was small, however, precluding firm conclusions.
    Previous studies have reported a range of CD117 expression in AML M5 varying from 0% to 69%. The 2 largest series documented CD117 expression in 21.2%9 and 32.8%10 of AML M5. Few studies have specifically compared M5a with M5b with regard to CD117 protein expression or mRNA expression23; these studies indicate that CD117 expression occurs frequently in M5a but is unusual in M5b. The surface antigen density of CD117 is generally low in AML, as the fluorescence intensity is typically dim by flow cytometric methods. This may account, in part, for the broad range of reported CD117 expression in acute myeloid leukemias. In the present study, only 1 of the 68 positive cases had a mean fluorescence intensity greater than 1 decade log above the negative control. To optimize detection sensitivity in these circumstances, a PE conjugate is preferable to an FITC conjugate of the antibody.
    Anti-CD117 (clone 95C3) seems to be a specific marker for myeloid lineage in acute leukemia. However, addition of this marker to our routine acute leukemia immunophenotyping panel added no significant diagnostic benefit. It may be a useful adjunct in difficult cases, but it does not seem to add much in the usual case of acute leukemia. Others using a different anti-CD117 clone, YB5.B8, have drawn similar conclusions.
  24. kiyria.

    kiyria. Guest

    PATHOGENESIS OF BERRYANEURYSM... The congenital theory of the etiology of intracranial berry aneurysms has been widely accepted for manyyears. Review of the supporting evidence indicates that it is not based on sound scientific data but on unscientific and unsubstantiated allegations. There is no evidence of a congenital, developmental, or inherited weakness of the vessel wall. The most plausible explanation is that the aneurysms are acquired degenerative lesions — the effect of hemodynamic stress. The mural atrophy leading to aneurysmal dilatation is an acquired lesion which can be produced experimentally by hemodynamics alone. Hypertension and connective tissue disorders associated with acquired loss of tensile strength of the connective tissues are not essential: they appear to be aggravating rather than causal factors. Occlusion of one or more feeding vessels may enhance the possibility of aneurysm formation at large arterial forks subjected to the augmented hemodynamic stress associated with collateral flow.
  25. kim.

    kim. Guest

    INSULIN FAST ADM CAUSES
    A.HYPONATREMIA
    B.HYPERCLCEMIA
    C.HYPOKALEMIA
    D.HYPERKALEMIA


    ans:hypokalemia

    Basically, insulin reduces serum K+ from ECF to ICF mainly because insulin increases the activity of the famous sodium-potassium pump. However, this is only a temporary fix and monitoring for the hypokalemic/hypoglycemic effects would be necessary. You would have to give glucose with the insulin as part of the regimen. It depends on whether the person has an actual total body excess of K+ or the K+ has moved from ICF to ECF as to how well this will work and for how long.

    Causes of movement from ICF to ECF would be tissue damage, acidosis, hyperuricemia, and uncontrolled DM.

    Causes of excess total body K+ would be too much potassium foods, salt substitutes, transfusions of whole blood or PRBCs, and decreased K+ excretion from the kidneys due to K+ sparing diuretics, renal failure, or Addison's disease
  26. kim.

    kim. Guest

    The STEPwise approach to NCD risk factor surveillance

    STEPs is a sequential process of gathering comparable and sustainable NCD risk factor information at the country-level. By using the same standardised questions and protocols, all countries can develop surveillance systems containing quality information about NCD risk factors in their unique settings. This information can, in turn, be used to plan for and implement currently available interventions to address the disease patterns caused by these risk factors.

    The STEPS approach is based on the concept that NCD surveillance systems need to be simple, focussing on a minimum number of risk factors that predict disease - before placing too much emphasis on costly disease registers which are difficult to sustain long-term.

    A tool for surveillance of risk factors, WHO STEPS, has been developed to help low and middle income countries get started. It is based on collection of standardized data from representative populations of specified sample size to ensure comparability over time and across locations.

    Step 1 gathers information on risk factors that can be obtained from the general population by questionnaire. This includes information on socio-demographic features, tobacco use, alcohol consumption, physical inactivity, and fruit/vegetable intake.

    Step 2 includes objective data by simple physical measurements needed to examine risk factors that are physiologic attributes of the human body. These are height, weight, and waist circumference (for obesity) and blood pressure.

    Step 3 carries the objective measurements of physiologic attributes one step further with the inclusion of blood samples for measuring lipid and glucose levels.

    Measuring NCD risk factors in this manner provides a flexible system that can be useful in a variety of country settings. Questionnaire-based measurements (Step 1) may be all that is feasible in low resource settings, while physiological measurements (Steps 2 and 3) may provide the impetus for health programme modification in higher resource settings or countries with specific surveillance needs (i.e. high prevalence of diabetes type 2). Countries can determine which additional set of questions are appropriate to their needs and what can be accomplished in the context of an on-going surveillance system.

    STEPS is now being planned or implemented in 33 countries in WHO's south east Asian region, western pacific region, African region and eastern Mediterranean region. WHO/HQ is offering technical support in order to ensure quality control and enhance the comparability of data collection. More countries will be added in consultation with regional and country offices of WHO. Some 40 countries will be in some phase of STEPS implementation by the end of 2003.
  27. kim.

    kim. Guest

    Pharmacovigilence ?
    a. Drug safety
    b. Unethicaltrade of drug
    c. Pharmacy students
    d. Drug efficacy

    ans:drug safety

    Pharmacovigilance (sometimes abbreviated PV or PVG) is the pharmacological science relating to the detection, assessment, understanding and prevention of adverse effects, particularly long term and short term side effects of medicines. Generally speaking, pharmacovigilance is the science of collecting, monitoring, researching, assessing and evaluating information from healthcare providers and patients on the adverse effects of medications, biological products, herbalism and traditional medicines with a view to:

    identifying new information about hazards associated with medicines
    preventing harm to patients.
    The etymological roots are: pharmakon (Greek), “drug;” and vigilare (Latin), “to keep awake or alert, to keep watch.”

    Pharmacovigilance is particularly concerned with adverse drug reactions, or ADRs, which are officially described as: "A response to a drug which is noxious and unintended, and which occurs at doses normally used… for the prophylaxis, diagnosis or therapy of disease, or for the modification of physiological function

    40 yr female with hyperpigmamntation, benedict in urine +ve, Brown black supernatant, & calcification IV disc
    a. Alkaptonuria
    b. Tyrosenemia II
    c. PKU
    d. Arginossuccinemia

    ans:alkaptunoria

    Alkaptonuria is often asymptomatic, but the sclera of the eyes may be pigmented (often only at a later age)[1], and the skin may be darkened in sun-exposed areas and around sweat glands; sweat may be coloured brown. Urine may turn brown if collected and left exposed to open air, especially when left standing for a period of time. Kidney stones and stone formation in the prostate (in men) are common and may occur in more than a quarter of cases.

    The main symptoms of alkaptonuria are due to the accumulation of homogentisic acid in tissues. In the joints this leads to cartilage damage, specifically in the spine, leading to low back pain at a young age in most cases. Cartilage damage may also occur in the hip and shoulder. Joint replacement surgery (hip and shoulder) is often necessary at a relatively young age.

    Valvular heart disease, mainly calcification and regurgitation of the aortic and mitral valves, may occur, and in severe and progressive cases valve replacement may be necessary. Coronary artery disease may be accelerated in alkaptonuria.

    A distinctive characteristic of alkaptonuria is that ear wax exposed to air turns red or black (depending on diet) after several hours because of the accumulation of homogentisic
    Benedict's--by the addition of urine to the reagent. On boiling a brownish yellow precipitate a~ with black supernatant fluid ... to be highly specific for alkaptonuria
  28. kiyria.

    kiyria. Guest

    Vascular invasion. As the WHO Committee stated (23), vascular invasion is a much more reliable sign of malignancy than capsular invasion. The criteria for its recognition, therefore, need to be just as stringent or more so. The vessel should be located within the capsule or immediately outside it (rather than within the tumor itself). It should be of large (i.e., venous rather than capillary) caliber and should have an identifiable wall and endothelial lining. The intravascular cells should have a clear-cut epithelial appearance (sometimes simulated by plump endothelial cells in areas of organizing thrombosis). They should project into the vessel lumen in a thrombus-like fashion, in such a way that they partly or completely obliterate it. Most important, they should be attached at some point to the vessel wall. A cluster of follicular cells found floating in the vascular lumen may be the result of artifactual detachment at surgery or gross examination and should therefore be discounted. Another feature to be regarded as insufficient evidence of vascular invasion is the close intermingling of follicular cells and vessels within the capsule. This may be the result of the labyrinthine configuration of those vessels coupled with the sometimes marked irregularity of the interface between tumor cells and capsule.

    There is some controversy regarding the significance of the endothelial layer sometimes seen over the protruding tumor nests. Some observers consider this evidence that vascular invasion has not yet occurred, arguing that one component of the vessel wall is still present between the tumor cells and the vascular lumen. Others, ourselves included, not only regard its presence as compatible with a diagnosis of vascular invasion but view it as corroborating evidence for this occurrence. It has been suggested that the reason for its presence is analogous to that operating in ordinary thrombi, i.e., an attempt at organization and recanalization.

    Because it is sometimes difficult to decide whether an intracapsular nest of tumor cells is located within a vessel or not, attempts have been made to facilitate this determination with the use of special stains. In general, the results have been disappointing, mostly because of the peculiar nature of the capsular vessels. Despite their large caliber, the walls are partially or sometimes completely devoid of a continuous smooth muscle layer or an elastic lamina $ps(pl. V-A)$pe. As a result, elastic tissue stains, trichrome stains, or immunocytochemical reactions for actin are often of no avail. Immunostains for endothelial cells, such as factor VIII-related antigen and Ulex europaeus agglutinin I have proved more useful $ps(pl. V-B;$pe$ps fig. 55)$pe, but their utility is limited because the results are sometimes completely negative in structures indubitably representing vessels, whether for technical reasons, delayed fixation, or true lack of expression
  29. kiyria.

    kiyria. Guest

    Gamma radiation
    Gamma rays, emitted from cobalt-60, are similar in many ways to microwaves and X-rays. Gamma rays delivered during sterilization break chemical bonds by interacting with the electrons of atomic constituents. And although they are highly effective in killing micro-organisms, they leave no residues nor have sufficient energy to impart radioactivity (Reitz V, 2004) The gamma process is repeatable and easy to use. It does not require high pressures or vacuum.
    Gamma rays are ideally suited for sterilization of disposable items, however, reliable sterilization of solutions,medical instruments, catheters, gloves, and even sealed plastic material can also be achieved (Weil PH, 1986) . Packaging remains intact with gamma processing (Reitz V, 2004) .


    Surgical Care of osteoartrits
    Joint lavage: Closed-needle joint lavage may benefit a small subgroup of patients with osteoarthritis. However, a 2010 meta-analysis of randomized controlled trials of joint lavage for knee osteoarthritis suggests that, at 3 months, joint lavage alone does not significantly relieve pain or improve function. In addition, the combination of joint lavage and intra-articular steroids injection is no more effective than lavage alone. In their review of 6 trials including 855 patients, Avouac et al found that the pooled effect size (ES) of joint lavage versus placebo was not significant for pain intensity (ES = 0.17 [-0.37, 0.71]) or physical function (ES = -0.15 [-0.34, 0.04]). Likewise, the pooled ES of joint lavage combined with steroid injection versus joint lavage alone was not significant for pain intensity (ES = -0.82 [-2.47, 0.82]) or physical function (ES = 0.09 [-0.28, 0.45]).4
    Arthroscopy: Arthroscopy may help patients with osteoarthritis of the knee that in whom imaging reveals specific structural damage (eg, for repairing meniscal tears, removing fragments of torn menisci that are producing symptoms). Overall, arthroscopy is not recommended for nonspecific "cleaning of the knee" in osteoarthritis.
    Osteotomy
    Consider this procedure in patients with a malaligned hip or knee joint.
    The procedure is usually recommended in younger patients with osteoarthritis.
    Osteotomy can lessen the pain, although it can lead to more challenging surgery later if the patient requires arthroplasty.
    Arthroplasty
    Perform this procedure if all other modalities are ineffective and osteotomy is not viable or if a patient cannot perform his or her daily activities despite maximal therapy.
    This procedure alleviates pain and may improve function. Approximately 8-15 years of viability are expected from the joint replacement in the absence of complications.
  30. kiyria.

    kiyria. Guest

    Hereditary juvenile haemochromatosis: a genetically heterogeneous life-threatening iron-storage disease

    Most common form due to mutation in HFE gene, which encode a protein involved in the regulation of iron absorption. The most common mutations are C282Y and H63D. Homozygosity for C282Y or compound heterozygosity for C282Y/H63D are the most common genotypes associated with hemochromatosis. Penetrance is incomplete

    As women regularly lose blood during menstruation, hemochromatosis is less common among females than males

    The Basis of Therapeutic Phlebotomy (TP).
    Hereditary hemochromatosis (HH), a common autosomal recessive disorder of Caucasians, is characterized by iron absorption in homozygotes wich is inappropriately great for the body iron content, and, in may subjects, is typified by progressive iron deposition in the liver, pancreas, heart, and other organs. TP, the first successful therapy for iron overload due to HH, is used to reduce body iron stores to minimal levels, and to maintain this state of iron balance for a lifetime. TP works by removing red blood cells which are rich in iron (200-250 mg of iron per unit of blood; 1 unit = 450-500 ml = "1 pint"). With TP, asymptomatic HH subjects can avoid irreversible tissue injury, and other patients can minimize the progression of symptomatic iron overload. Most HH patients are candidates for TP therapy, regardless of age, although a few, e.g., those with advanced hepatic cirrhosis and portal hypertension, may not tolerate TP well enough to permit "de-ironing". Despite attempts to develop more elegant strategies to remove iron from the body, TP is still the most effective, economical, and safe treatment known for iron overload due to HH. The degree of iron overload is assessed by measurement of the serum ferritin concentrations ([Ftn•) and by analysis of the liver biopsy specimen for iron. In practical terms, HH subjects with serum [Ftn] > 50 ng/ml or with increased liver iron content need TP.
  31. kim.

    kim. Guest

    A patient was brought unconscious to the emergency department with head injury. CT scan showed no midline shift, but the basal cisterns were full with blood and there were multiple small hemorrhages. What is the diagnosis?

    a. Subarachnoid hemorrhage
    b. Subdural hemorrhage
    c. Diffuse axonal injuries
    d. Multiple infarcts

    Diffuse axonal injury (DAI) is one of the most common and devastating types of traumatic brain injury, meaning that damage occurs over a more widespread area than in focal brain injury. DAI, which refers to extensive lesions in white matter tracts, is one of the major causes of unconsciousness and persistent vegetative state after head trauma. It occurs in about half of all cases of severe head trauma and also occurs in moderate and mild brain injury

    The outcome is frequently coma, with over 90% of patients with severe DAI never regaining consciousness.Those who do wake up often remain significantly impaired.

    Nowadays, other authors state that DAI can occur in every degree of severity from (very) mild or moderate to (very) severe. Concussion may be a milder type of diffuse axonal injury

    Unlike brain trauma that occurs due to direct impact and deformation of the brain, DAI is the result of traumatic shearing forces that occur when the head is rapidly accelerated or decelerated, as may occur in auto accidents, falls, and assaults. It usually results from rotational forces or severe deceleration. Vehicle accidents are the most frequent cause of DAI; it can also occur as the result of child abuse such as in shaken baby syndrome.

    The major cause of damage in DAI is the disruption of axons, the neural processes that allow one neuron to communicate with another. Tracts of axons, which appear white due to myelination, are referred to as white matter. Acceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter. Two thirds of DAI lesions occur in areas where grey and white matter meet

    Lesions typically exist in the white matter of brains injured by DAI; these lesions vary in size from about 1–15 mm and are distributed in a characteristic way. DAI most commonly affects white matter in areas including the brain stem, the corpus callosum, and the cerebral hemispheres. The lobes of the brain most likely to be injured are the frontal and temporal lobes. Other common locations for DAI include the white matter in the cerebral cortex, the corpus callosum, the superior cerebral peduncles, basal ganglia, thalamus, and deep hemispheric nuclei. These areas may be more easily damaged because of the difference in density between them and the rest of the brain.

    Histological characteristics
    DAI is characterized by axonal separation, in which the axon is torn at the site of stretch and the part distal to the tear degrades. While it was once thought that the main cause of axonal separation was tearing due to mechanical forces during the trauma, it is now understood that axons are not typically torn upon impact; rather, secondary biochemical cascades, which occur in response to the primary injury (which occurs as the result of mechanical forces at the moment of trauma) and take place hours to days after the initial injury, are largely responsible for the damage to axons.

    Though the processes involved in secondary brain injury are still poorly understood, it is now accepted that stretching of axons during injury causes physical disruption to and proteolytic degradation of the cytoskeleton. It also opens sodium channels in the axolemma, which causes voltage-gated calcium channels to open and Ca2+ to flow into the cell. The intracellular presence of Ca2+ unleashes several different pathways, including activating phospholipases and proteolytic enzymes, damaging mitochondria and the cytoskeleton, and activating secondary messengers, which can lead to separation of the axon and death of the cell.

    Cytoskeleton disruption
    Axons are normally elastic, but when rapidly stretched they become brittle, and the axonal cytoskeleton can be broken. It is thought that integrins connected to the extracellular matrix outside the cell and to the cytoskeleton within it can transmit forces from the matrix to the cytoskeleton and cause the latter to tear when the axon is stretched.

    Misalignment of cytoskeletal elements after stretch injury can lead to tearing of the axon and death of the neuron. Axonal transport continues up to the point of the break in the cytoskeleton, but no further, leading to a buildup of transport products and local swelling at that point. When it becomes large enough, swelling can tear the axon at the site of the break in the cytoskeleton, causing it to draw back toward the cell body and form a bulb. This bulb is called a retraction ball, the hallmark of diffuse axonal injury.

    When the axon is transected, Wallerian degeneration, in which the part of the axon distal to the break degrades, takes place within one to two days after injury. The axolemma disintegrates, myelin breaks down and begins to detach from cells in an anterograde direction (from the body of the cell toward the end of the axon), and nearby cells begin phagocytic activity, engulfing debris.

    Calcium influx
    While sometimes only the cytoskeleton is disturbed, frequently disruption of the axolemma occurs as well, causing the influx of Ca2+ into the cell and unleashing a variety of degrading processes. An increase in Ca2+ and Na+ levels and a drop in K+ levels is found within the axon directly after injury. Possible routes of Ca2+ entry include sodium channels, pores torn in the membrane during stretch, and failure of ATP-dependent transporters due to mechanical blockage or lack of energy. High levels of intracellular Ca2+, the major cause of post-injury cell damage, destroy mitochondria, contribute to the generation of reactive oxygen species and trigger phospholipases and proteolytic enzymes that damage Na+ channels and degrade or alter the cytoskeleton and the axoplasm. Excess Ca2+ can also lead to damage to the blood brain barrier and swelling of the brain.

    One of the proteins activated by the presence of calcium in the cell is calpain, a Ca2+-dependent non-lysosomal protease. About 15 minutes to half an hour after the onset of injury, a process called calpain-mediated spectrin proteolysis, or CMSP, begins to occur. Calpain breaks down a molecule called spectrin, which holds the membrane onto the cytoskeleton, causing the formation of blebs and the breakdown of the cytoskeleton and the membrane, and ultimately the death of the cell. Other molecules that can be degraded by calpains are microtubule subunits, microtubule-associated proteins, and neurofilaments.

    Generally occurring one to six hours into the process of post-stretch injury, the presence of calcium in the cell initiates the caspase cascade, a process in cell injury that usually leads to apoptosis, or "cell suicide".

    Mitochondria, dendrites, and parts of the cytoskeleton damaged in the injury have a limited ability to heal and regenerate, a process which occurs over 2 or more weeks. After the injury, astrocytes can shrink, causing parts of the brain to atrophy
  32. kiran.

    kiran. Guest

    A middle aged man presented with ulcerative granuloma on glans. Wright Giemsa stain showed 1-2 rounded structures in macrophage vacuoles. What is the etiologic agent?
    a. Chlamydia trachomatis
    b. Neisseria gonorrheae
    c. Calymmatobacterium granulomatis
    d. (?)

    ans:calmmatobacterium donovanni(granulomatis)


    Radiographic appearance of fibrous dysplasia is
    a. Ground glass appearance
    b. Calcification
    c. Cortical thickening
    d. Periosteal reaction

    ground glass appearence

    In fibrous dysplasia, the medullary bone is replaced by fibrous tissue, which appears radiolucent on radiographs, with the classically described ground-glass appearance. Trabeculae of woven bone contain fluid-filled cysts that are embedded largely in collagenous fibrous matrix, which contributes to the generalized hazy appearance of the bone.


    Which of the following is not heard in impending Eisenmenger syndrome?
    a. Increased flow murmur across pulmonary and tricuspid valves
    b. Increased intensity of P2
    c. Single S2
    d. Graham Steell murmur

    ans:A

    increased flow murmur across pulmonary and tricuspid occurs in lutembachers syndrome

    Sequence of events in Eisenmenger syndrome
    Congenital left to Right shunt
    Increased flow and pressure in the pulm vasculature
    Pulmonary capillary destruction / scarring and pulmonary arteries thickening and endothelial dysfunction
    Increased pulm artery pressure
    RV hypertrphy (…ischemia / arrhythmia)
    Increased RV pressure à more than LV pressure
    Reversal of shunt from Rt à Lt…… Cyanosis …Polycythemia …..hyperviscosity …. CVA / PE

    Cyanosis
    Clubbing
    Arterial pulses are small in volume
    Jugular venous pulse wave may be A-wave dominant. However, with tricuspid regurgitation, the V wave may be prominent.
    Precordial palpation reveals a right ventricular heave and, frequently, a palpable S2.
    Loud P2
    High-pitched early diastolic murmur of pulmonic insufficiency
    Right-sided fourth heart sound
    Pulmonary ejection click
    A fixed, widely split S2 is characteristic of an ASD pansystolic murmur of tricuspid regurgitation.
    The murmur of ASD or VSD, and the continuous murmur of a PDA disappear when Eisenmenger physiology develops; a short systolic murmur may remain audible
    Respiratory signs include cyanosis and tachypnea. (usu clear lungs)
    Hematologic signs include bruising and bleeding; funduscopic abnormalities related to erythrocytosis include engorged vessels, papilledema, microaneurysms, and blot hemorrhages.
    Abdominal signs include jaundice, right upper quadrant tenderness, and positive Murphy sign (acute cholecystitis).
    Vascular signs include postural hypotension and focal ischaemia (paradoxical embolus).
    Musculoskeletal signs include clubbing, tenderness over the metacarpal or metatarsal joints (hypertrophic osteoarthropathy), and joint effusions.


    Examination reveals:
    Cyanosis, clubbing and plethora
    Right ventricular heave with palpable, loud pulmonary component of the second heart soundLoud second heart sound with a narrow split
    Ejection systolic murmur audible along the left sternal border
    Graham Steell murmur: a diastolic murmur audible along the left sternal border due to functional incompetence of the pulmonary valve in patients with pulmonary hypertension. The Graham Steell murmur is a high-pitched, decrescendo murmur, loudest during inspiration
  33. kiran.

    kiran. Guest

    Methemoglobinemia in children usually results from exposure to oxidizing substances (such as nitrates or nitrites; aniline dyes; or medications, including lidocaine, prilocaine, phenazopyridine hydrochloride [Pyridium], and others) or is the result of inborn errors of metabolism (especially glucose-6-phosphate dehydrogenase [G6PD] deficiency and cytochrome b5 oxidase deficiency) or severe acidosis, which impairs the function of cytochrome b5 oxidase. This is particularly evident in young infants with diarrhea,1 in whom excessive stool bicarbonate loss leads to metabolic acidosis, which exacerbates the relatively immature cytochrome b5 oxidase system.
  34. kim.

    kim. Guest

    Which of the following is not used in the treatment of pulmonary hypertension?
    a. Calcium channel blockers
    b. Alpha blockers
    c. Prostacyclins
    d. Endothelin receptor antagonist

    Some therapies have long been available to treat pulmonary hypertension and are still of value. Fluid retention is common, and adequate diuresis frequently brings about substantial symptomatic improvement. Oxygen supplementation should be provided to hypoxemic patients, either at rest or with exertion or during sleep. Digoxin is often administered for supraventricular arrhythmias or right ventricular dilatation. Based on uncontrolled trials, warfarin anticoagulation is routinely administered to patients with moderate to severe PAH, usually aiming for an INR between 1.5 and 2.5. Phlebotomy has been recommended when the hematocrit exceeds 56, particularly in patients with congenital heart disease. Calcium channel blockers, sometimes in high doses, were considered the most effective pharmacotherapies for pulmonary hypertension prior to the advent of newer specific therapies.[2] Responders to calcium channel blockers, who usually manifest substantial acute vasoreactivity, have an excellent prognosis. Unfortunately, they constitute only 5% to 10% of PAH patients. With the exception of anticoagulation and calcium channel blocker therapy in responders, these therapies should be considered mainly palliative, and although they can be quite useful for ameliorating symptoms, they do not significantly affect the natural history of the disease.

    Newer and more effective pharmacotherapies for PAH are now available, starting with prostacyclins in 1996 and, more recently, endothelin receptor antagonists and phosphodiesterase 5 inhibitors. Randomized controlled trials have demonstrated significant benefits for these therapies, but they all have limitations and must be used judiciously. Relative merits of the different therapies, suggested applications, possible combinations, and newer therapies are discussed below.

    Which of the following is not true about synovial fluid?
    a. Contains Hyaluronic acid
    b. Viscosity is variable
    c. Non-Newtonian fluid
    d. Formed by type A synovial cells

    Synovial fluid is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its yolk-like consistency ("synovial" partially derives from ovum, Latin for egg), the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement.

    The inner membrane of synovial joints is called the synovial membrane and secretes synovial fluid into the joint cavity. This fluid forms a thin layer (roughly 50 μm) at the surface of cartilage and also seeps into microcavities and irregularities in the articular cartilage surface, filling all empty space.[1] The fluid in articular cartilage effectively serves as a synovial fluid reserve. During movement, the synovial fluid held in the cartilage is squeezed out mechanically to maintain a layer of fluid on the cartilage surface (so-called weeping lubrication).

    Composition
    Synovial tissue is sterile and composed of vascularized connective tissue that lacks a basement membrane. Two cells type (type A and type B) are present: Type B produce synovial fluid. Synovial fluid is made of hyaluronic acid and lubricin, proteinases, and collagenases. Synovial fluid exhibits non-Newtonian flow characteristics; the viscosity coefficient is not a constant and the fluid is not linearly viscous. Synovial fluid has Thixotropic characteristics; viscosity decreases and the fluid thins over a period of continued stress.

    Normal synovial fluid contains 3-4 mg/ml hyaluronan (hyaluronic acid), a polymer of disaccharides composed of D-glucuronic acid and D-N-acetylglucosamine joined by alternating beta-1,4 and beta-1,3 glycosidic bonds. Hyaluronan is synthesized by the synovial membrane and secreted into the joint cavity to increase the viscosity and elasticity of articular cartilages and lubricate the surfaces between synovium and cartilage.

    Synovial fluid contains lubricin secreted by synovial cells. It is chiefly responsible for so-called boundary-layer lubrication, which reduces friction between opposing surfaces of cartilage. There is also some evidence that it helps regulate synovial cell growth.

    Its functions are:

    reducing friction by lubricating the joint, absorbing shocks, and supplying oxygen and nutrients to and removing carbon dioxide and metabolic wastes from the chondrocytes within articular cartilage.

    It also contains phagocytic cells that remove microbes and the debris that results from normal wear and tear in the joint.
  35. Guest

    Guest Guest

    CYP3A Inhibitors

    Troleandomycin
    Grapefruit juice
    Antidepressants
    Nefazodone > fluvoxamine (Luvox) > fluoxetine
    (Prozac) > sertraline
    Paroxetine (Paxil)
    Venlafaxine
    Azole antifungals
    Ketoconazole (Nizoral) > itraconazole (Sporanox) > fluconazole (Diflucan)
    Cimetidine (Tagamet)†
    Clarithromycin (Biaxin)
    Diltiazem
    Erythromycin
    Protease inhibitors


    CYP3A Inducers
    Carbamazepine
    Rifampin
    Rifabutin
    Ritonavir
    Dexamethasone
    Phenobarbital
    Phenytoin (Dilantin)

    CYP3A Substrates

    Amitriptyline
    Benzodiazepines
    Alprazolam
    Triazolam
    Midazolam
    Calcium blockers
    Carbamazepine
    Cisapride
    Dexamethasone
    Erythromycin
    Ethinyl estradiol
    Glyburide
    Imipramine
    Ketoconazole
    Lovastatin
    Nefazodone
    Terfenadine
    Astemizole
    Verapamil
    Sertraline
    Testosterone
    Theophylline
    Venlafaxine

    Protease inhibitors
    Ritonavir
    Saquinavir
    Indinavir
    Nelfinavir
  36. kiran.

    kiran. Guest

    Cluster of differentiation (CD) molecules are markers on the cell surface, as recognized by specific sets of antibodies, used to identify the cell type, stage of differentiation and activity of a cell. CD117 is an important cell surface marker used to identify certain types of hematopoietic (blood) progenitors in the bone marrow. To be specific, hematopoietic stem cells (HSC), multipotent progenitors (MPP), and common myeloid progenitors (CMP) express high levels of CD117. Common lymphoid progenitors (CLP) expresses low surface levels of CD117.
    CD117 also identifies the earliest thymocyte progenitors in the thymus. To be specific, early T lineage progenitors (ETP/DN1) and DN2 thymocytes express high levels of c-Kit.

    In addition, mast cells, melanocytes in the skin, and interstitial cells of Cajal in the digestive tract express CD117.

    CD117 is also a marker for mouse prostate stem cells.[


    CD45 is a protein tyrosine phosphatase (PTP) located in hematopoietic cells except ethrocytes and platelets. CD45 is also called the common leukocyte antigen, T220 and B220 in mice. The protein tyrosine kinases constitute a family of receptor-like and cytoplasmic inducing enzymes that catalyze the dephosphorylation of phosphostyrosine residues and are characterized by homologous catalytic domains ( Barford et al. 1994). CD45 is a protein that has several isoforms and the hematopoietic cells express one or more of the isoforms. The specified expression of the CD45 isoforms can be seen in the various stages of differentiation of normal hematopoietic cells ( Virts et al. 1997). CD45 is uniformly distributed in plasma membrane and enrich regions of T cell and B cell contact. In fact, CD45 constitute 10% of the molecules on the surface of expressing cells( Katz 2003 ). Some isoforms of CD45 are CD45RO, CD45RA, and CD45RB. Each CD45 isoforms is distinguished from one another isoform depending on the type of exon the CD45 has or the exons the CD45 does not have. The CD45RA isoform contains the A exon only and the CD45RB has the B exon only whereas the CD45RO has neither the none of the exons: A, B, or C.
  37. kiyria.

    kiyria. Guest

    low prevalence
    high sensitivity test is very sensitive and picks people wit no disease cause its jus so sensitive
    so if a disease is of low prevalence in a population then there r people with disease will be less so sensitive test will pick people with disease but also one witout cause its jus so sensitive so if with 100 people the prevalence of disease is jus 1 the test u conduct to screen may show 3 people have disease 2 false positive
    and on other hand if a disease is 30 people of 100 have disease then it will pick up jus 2 people witout jus 2 FP
    so of case 1: false positive is more
    or case 2: false positive is more
    its case 1: 66% people test positive even when they didnt have the disease
    jus math
    i jus understood it this way

    mitochondria has cytochrome c which leaks out in to the cytoplasm when the cell has to undergo apoptosis which initiates the caspasses cycle
    go to youtube type in apoptosis u have this awesum video of it
    robbins 7thed page 29 2nd column intrinsic pathway

    when fetus is going organogenesis undergoes apoptosis (which is by caspases) fetus has both mullerian and wolfian duct SOX9 gene causes release of mullerian inhibiting substance causing mullerian duct to undergo apoptotic cell death in organogenesis
    robbins 7th edi. page 26 second column 8th line from the top


    81. Barret’s esophagus is diagnosed by which of the following?
    A. Intestinal metaplasia
    b. Intestinal dysplasia
    c. Columnar metaplasia
    d. Columnar dysplasia
    intestinal metaplasia takes place any where but intestines thats why metaplasia
    dysplasia takes place in intestine
    columnar is vague ur trachea bronchus are also columnar short and simple
  38. kiyria.

    kiyria. Guest

    47. All of the following causes inhibition of CYP3A except
    a. Saquinavir
    b. Ritonavir
    c. Itraconazole
    d. Erythromycin


    ANS:SAQUINAVIR

    CYP3A Inhibitors
    Ketoconazole
    Itraconazole
    Fluconazole
    Cimetidine
    Clarithromycin
    Erythromycin
    Troleandomycin
    Grapefruit juice

    FOR RITONAVIR REFERENCE:
    Adding twice-daily ketoconazole (a potent CYP3A inhibitor) to elvitegravir plus ritonavir (another strong CYP3A inhibitor) raised elvitegravir levels only modestly in a study of 18 healthy volunteers [1]. The finding is important because, if both are approved, the integrase inhibitor elvitegravir will probably be coformulated with the Gilead booster GS-9350 (cobicistat), so some people could end up taking two CYP3A inhibitors with elvitegravir. For that reason, the FDA asked Gilead to "study the effect of additional CYP3A inhibition on boosted elvitegravir with a second strong inhibitor like ketoconazole."

    Elvitegravir, Gilead's investigational integrase inhibitor, relies primarily on CYP3A4 for metabolism. As a result, CYP3A4 inhibitors boost elvitegravir concentrations. Ritonavir and cobicistat can raise elvitegravir levels 20-fold. When metabolism by CYP3A4 is blocked, elvitegravir can turn to UGT1A1 or UGTIA3.

    The antifungal ketoconazole was the best known CYP3A inhibitor until development of ritonavir. Therapeutic doses range from 200 to 400 mg once daily, and 200 mg twice daily can be used to study CYP3A inhibition. In planning this study, Gilead learned that ketoconazole is also a UGT1A1 inhibitor. That complicated the trial design because elvitegravir can use UGT1A1 as a secondary metabolism pathway.

    The trial plan called for 18 healthy volunteers to take 150/100 mg of elvitegravir/ritonavir once daily on study days 2 through 11, then to add 200 mg of ketoconazole twice daily on days 12 to 15. To determine whether ketoconazole boosted elvitegravir via inhibition of CYP3A4 or UGT1A1, the investigators also gave 5 mg of midazolam on days 1, 11, and 15 because midazolam is a standard probe of CYP3A4 inhibition.

    The study group included 12 men and 6 women with an average age of 27 years (range 19 to 44) and an average weight of 77 kg (range 57 to 97). No one suffered grade 3 or 4 adverse events, and only one person had a grade 2 event--somnolence when taking elvitegravir/ritonavir plus midazolam.

    Adding ketoconazole to elvitegravir/ritonavir moderately increased elvitegravir's maximum concentration (Cmax), area under the curve (AUC), and trough, as indicated by the following geometric mean ratios (GMR) and 90% confidence intervals (CI) for elvitegravir/ritonavir versus elvitegravir/ritonavir/ketoconazole:

    · Cmax: GMR 117%, 90% CI 104 to 133

    · AUC: GMR 148%, 90% CI 136 to 162

    · Trough: GMR 167%, 90% CI 148 to 188

    Comparing midazolam levels when given with elvitegravir/ritonavir versus elvitegravir/ritonavir plus ketoconazole indicated that adding ketoconazole to elvitegravir/ritonavir resulted in only a 1% to 1.5% additional inhibition of CYP3A. Thus ketoconazole must be exerting most of its effect on elvitegravir via UGT1A1 inhibition. Compared with historical controls taking ketoconazole without another CYP3A inhibitor, ketoconazole levels in this study were higher, as they have been in earlier studies of ketoconazole taken with a ritonavir-boosted protease inhibitor.
  39. kiyria.

    kiyria. Guest

    The organelle having important role in apoptosis is
    a. Mitochondria
    b. Golgi body
    c. Endoplasmic reticulum
    d. Nucleus


    mitochondrion, long considered an organelle specific to energy metabolism, is in fact multi-functional and involved in many diseases. Mitochondrial DNA accumulates somatic mutations during aging, the progression of cancer and diabetes. Most cancer cells contain homoplasmic mutations in the mitochondrial genome. Although little is known about the contributions of mutations to carcinogenesis, some mutations in the nuclear genes encoding mitochondrial proteins have been identified as responsible for certain familial cancers. Mitochondria play an essential role in generating the germ line by releasing mitochondrial ribosomal RNAs, by which the germ line transfers the genetic information necessary for life to the next generation. Collaboration between mitochondria and the cytosol occurs in several metabolic pathways. Many enzymes involved in synthesizing uridine, heme and steroids and in the urea cycle are located inside mitochondria. Notably, a reaction involved in the synthesis of UMP is coupled with the energized state of mitochondria. Thus, the synthesis of DNA and RNA should be indirectly coupled with the energized state of mitochondria. Additionally, storing calcium is an important role of mitochondria. Calcium functions as a second messenger in signal transduction, however, it also activates several proteinases or lipases to induce damage. The mitochondrion plays a significant role in necrosis and is a center for apoptosis, determining its initiation, regulation and execution. Thus, the mitochondrion is widely involved in cell proliferation, cell death and disease
  40. smarty.

    smarty. Guest

    Diagnostic Tests
    Leptospirosis can be diagnosed by culture, detection of antigens or nucleic acids, or serology. Serum chemistry values and analysis of the CSF may support the diagnosis. In humans, Leptospira can be isolated from the blood, cerebrospinal fluid or urine. Culture can be difficult and may require up to 13 to 26 weeks. Identification to the species, serogroup and serovar level is done by reference laboratories, using genetic and immunologic techniques. Leptospira spp. can also be identified in clinical samples by immunofluorescnce and immunhistochemical staining, as well as DNA probes and polymerase chain reaction (PCR) techniques.
    Darkfield microscopy can be used but is not specific. Most human cases of leptospirosis are diagnosed by serology. The most commonly used serologic tests are the microscopic agglutination test (MAT, previously known as the agglutination-lysis test) or ELISAs. The MAT test is serogroup but not serovar specific, and can be complicated by cross-reactions. Less commonly used tests include complement fixation, radioimmunoassay, immunofluorescence, counterimmunoelectrophoresis and thin layer immunoassay.
    The macroscopic slide agglutination test may be used for a presumptive diagnosis, but is not specific. A high titer with consistent symptoms is suggestive of an acute case, but a rising titer is necessary for a definitive diagnosis. Few serovarspecific assays are available in human medicine.
  41. smarty.

    smarty. Guest

    The normal esophagus (swallowing tube) is lined by a pinkish-white tissue called squamous epithelium. Some people also have red stomach tissue (normal appearing columnar epithelium) present in the bottom part of the esophagus. Barrett's esophagus is a condition in which the normal squamous epithelium of the esophagus has been replaced by an abnormal red columnar epithelium called specialized intestinal metaplasia. Specialized intestinal metaplasia is red, like normal stomach tissue, but does not look like stomach tissue under the microscope. Therefore, a biopsy (a piece of tissue taken from the esophagus) is needed to diagnose Barrett's esophagus.
  42. smarty.

    smarty. Guest

    Caspases and apoptosis
    The caspases are a family of proteins that are one of the main executors of the apoptotic process. They belong to a group of enzymes known as cysteine proteases and exist within the cell as inactive pro-forms or zymogens. These zymogens can be cleaved to form active enzymes following the induction of apoptosis.

    Induction of apoptosis via death receptors typically results in the activation of an initiator caspase such as caspase 8 or caspase 10. These caspases can then activate other caspases in a cascade. This cascade eventually leads to the activation of the effector caspases, such as caspase 3 and caspase 6. These caspases are responsible for the cleavage of the key cellular proteins, such as cytoskeletal proteins, that leads to the typical morphological changes observed in cells undergoing apoptosis.

    The apoptosome
    There are a number of other mechanisms, aside from activation of the death receptors, through which the caspase cascade can be activated. Granzyme B can be delivered into cells by cytotoxic T lymphocytes and is able to directly activate caspases 3, 7, 8 and 10. The mitochondria are also key regulators of the caspase cascade and apoptosis. Release of cytochrome C from mitochondria can lead to the activation of caspase 9, and then of caspase 3. This effect is mediated through the formation of an apoptosome, a multi-protein complex consisting of cytochrome C, Apaf-1, pro-caspase 9 and ATP.

    Caspases and chromatin breakdown
    One of the hallmarks of apoptosis is the cleavage of chromosomal DNA into nucleosomal units. The caspases play an important role in this process by activating DNases, inhibiting DNA repair enzymes and breaking down structural proteins in the nucleus.

    1) Inactivation of enzymes involved in DNA repair.

    The enzyme poly (ADP-ribose) polymerase, or PARP, was one of the first proteins identified as a substrate for caspases. PARP is involved in repair of DNA damage and functions by catalyzing the synthesis of poly (ADP-ribose) and by binding to DNA strand breaks and modifying nuclear proteins. The ability of PARP to repair DNA damage is prevented following cleavage of PARP by caspase-3.

    2) Breakdown of structural nuclear proteins.

    Lamins are intra-nuclear proteins that maintain the shape of the nucleus and mediate interactions between chromatin and the nuclear membrane. Degradation of lamins by caspase 6 results in the chromatin condensation and nuclear fragmentation commonly observed in apoptotic cells.

    3) Fragmentation of DNA.

    The fragmentation of DNA into nucleosomal units - as seen in DNA laddering assays - is caused by an enzyme known as CAD, or caspase activated DNase. Normally CAD exists as an inactive complex with ICAD (inhibitor of CAD). During apoptosis, ICAD is cleaved by caspases, such as caspase 3, to release CAD. Rapid fragmentation of the nuclear DNA follows.
  43. smarty.

    smarty. Guest

    Q.paneth cells have
    a)high zinc content
    b)numerous lysozyme granules
    c)rich RER
    d)foamy cells


    ANS-B

    REF:HISTOLOGY AND CELL BIOLOGY:EXAMINATION AND BOARD REVIEW

    paneth cells lie in bases of crypts and produce a polysaccharide complex.in addition to RER and golgi complex,they have large acidophilic secretory granules containing lysozyme ,an antibacterial enzyme ,that helps to control intestinal flora

    acidophilic secretory granules containing lysozyme is associated with specific fun of paneth cells and hence the ans

    Paneth cells are found in the intestinal tract. They contain zinc and lysozyme (an enzyme that lyses certain kinds of bacteria) as well as large eosinophilic refractile granules within their apical cytoplasm. Their exact function is unknown but due to the presence of lysozyme it is likely that Paneth cells contribute to host defense. When exposed to bacteria or bacterial antigens, Paneth cells secrete a number lysozymes into the lumen of the crypt, thereby contributing to maintenance of the gastrointestinal barrier.


    Q. berry aneurysm cause
    a)degeneration of internal elastic lamina
    b)degeneration of medial layer
    c)deposition of mucoid material in media

    ANS-A

    REF:pATHOLOGY BY RUBIN AND FARMER

    in berry aneurysm there is poin of congenital muscular weakness.the blood pressure exploit this weakness,eventually the internal elastic membrane degenrates and fragments after which endothelium yields.-->aneurysm
  44. smarty.

    smarty. Guest

    caspases in organogenesis

    Caspases are key mediators in the regulation and execution of apoptosis, a crucial part of the morphogenetic process during limb development. Caspase-8 and -9 are upstream caspases. Caspase-8 mediates the extrinsic pathway of apoptosis triggered by signaling through TNF-R1 family receptors. Caspase-9 is activated during the intrinsic pathway downstream of mitochondria. Caspase-3 is an effector caspase that initiates degradation of the cell in the final stages of apoptosis. Vitamin A is a potent teratogen that causes limb reduction defects in embryos exposed during organogenesis. Previous in vitro studies have shown that exposure of the organogenesis-stage murine limb to vitamin A results in excessive levels of apoptosis. The goal of this work was to characterize the involvement of caspase-3, -8, and -9, as well as cytochrome-c release from the mitochondria, in the apoptotic cascade induced by vitamin A. METHODS: Limb buds from gestational day 12 CD-1 mice were cultured in a chemically defined medium in the absence or presence of vitamin A. Cultures were terminated after 6 days to examine the effect of the drug on gross morphology. Apoptosis was detected by TUNEL staining after culture for 24 hr. Caspase activation was determined by Western blotting and localized by immunohistochemistry of control and treated limbs. The release of cytochrome-c into the cytoplasm was assessed by Western blotting after cell-fractionation. RESULTS: Limbs cultured in the presence of vitamin A showed a dose-dependent growth reduction and dysmorphogenesis of the cartilaginous anlagen. Apoptosis was increased in the interdigital, anterior, and posterior marginal zones and in the apical ectodermal ridge. Western-blotting confirmed the presence of activated caspase-3 that increased with time in culture and vitamin A concentration. Cleaved caspase-3 immunoreactivity colocalized with TUNEL stained limb regions and increased dramatically with increasing drug concentrations. In contrast, procaspase-8 and -9 were not activated. Exposure to high concentrations of vitamin A did, however, increase cytoplasmic cytochrome-c, suggesting mitochondrial involvement. CONCLUSIONS: Caspase-3 is a key effector caspase in the apoptotic pathway induced by Vitamin A. While caspases-8 and -9 are not responsible for the activation of caspase-3 in response to the drug, cytochrome-c release from mitochondria may play an upstream role.
  45. smarty.

    smarty. Guest

    Gestational diabetes, defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy, occurs in about 3% of pregnancies. Risk factors for GDM include obesity, history of miscarriage or fetal death, maternal age of 40 years or more, family history of diabetes, history of prematurity, macrosomia, congenital malformation, polyhydramnios, or excessive weight gain. O’Sullivan and Mahan originally restricted the diagnosis to alterations of glucose tolerance during pregnancy that resolved after birth.<1> Using the oral glucose tolerance test (OGTT), women were shown to be at increased risk of overt adult diabetes later in life.
    Potential flaws in study design (selection bias and confounding) and questions of test validity (reproducibility and obsolescence of blood testing technique) weaken this evidence.
    Two case series have shown elevated perinatal loss rates (6.4% vs. 1.5% and 3.2% vs. 0.95%) among those with abnormal as opposed to normal OGTT results. In neither of these studies was there control for confounding.<2,3> Case series, again not controlling for confounding factors, have reported prevalences of macrosomia among infants born to women with GDM of 12% to 35%.<2-4> GDM is not the only or most important risk factor for macrosomia. In one study with an overall 1 Associate Professor of Family Medicine, University of Montreal, Montreal, Quebec 16 incidence of macrosomia of 1.7 per 1,000 and where confounding was controlled, the relative risk of macrosomia for GDM was 3.0, as compared with 25.8 and 6.4 per 1,000 for obesity and postmaturity respectively. Indeed, only 5% of infants weighing more than 4,500 g were born to women with GDM.<5> However, macrosomia is clearly associated with increased maternal and neonatal death rates, primary cesarean section for cephalopelvic disproportion and non-progression of labour, brachial plexus paralysis and clavicular fractures. In a series of infants with shoulder dystocia in a community hospital, 5.4% of mothers had GDM.<6> There is weak and conflicting evidence regarding the association of GDM with an increased risk of congenital anomalies.Overall, there is evidence of an association between carbohydrate intolerance and adult onset diabetes, macrosomia and perinatal mortality. However, the validity of the initial studies upon which the diagnostic criteria for GDM were established has been questioned.
  46. smarty.

    smarty. Guest

    Diabetes mellitus is the most common medical complication of pregnancy. The Centers for Disease Control and Prevention estimated that 20.8 million persons in the United States had diabetes in 2005. Minority groups are disproportionately affected. Diabetes is undiagnosed in nearly one-third of adults with the condition.

    Preexisting (type 1 or type 2) diabetes mellitus affects approximately 1–3 per 1000 pregnancies. Although preconception care and glycemic control are advised, pregnancy will be the first time many women present for medical care. Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with first recognition during pregnancy. GDM complicates approximately 4% of pregnancies. Women with GDM have an approximately 50% risk of developing type 2 diabetes over the next 10 years. Pregnancy affords a unique opportunity to diagnose or possibly prevent diabetes among women at risk to develop type 2 diabetes later in life.

    Diabetes during pregnancy poses significant risks to the mother and fetus. With poorly controlled diabetes, spontaneous abortion risk is high, and the rate of major congenital anomalies is 6–12% among women with pregestational diabetes. Diabetic ketoacidosis (DKA) is an immediate threat to maternal and fetal life. Fetal death occurs in approximately 10% of pregnant patients with DKA, which is an improvement from rates of 30–50% in the recent past. GDM increases the risk of fetal macrosomia, which is associated with secondary complications such as operative delivery, shoulder dystocia, and birth trauma. There is an increase in neonatal complications, such as hypoglycemia, respiratory distress syndrome (RDS), hypocalcemia, and hyperbilirubinemia.

    Before the introduction of insulin in 1922, diabetic patients often died during the course of their pregnancy. Just 20 years ago, delivery of an unexplained stillbirth from a mother with type 1 diabetes was not uncommon. Today this tragedy is rare, with a reduction in perinatal mortality rate to less than 5%. When diabetic patients receive preconception care, including medical nutrition therapy and insulin therapy as needed to achieve near-normal glycemic goals as well as antepartum fetal surveillance, morbidity and mortality approach that of women with uncomplicated pregnancies. Two decades ago, most diabetics required prolonged hospitalization, but today few require more than a brief hospital stay. This is partly due to the accessibility of self-monitoring of blood glucose level with its concomitant effect on glycemic control.

    Currently, the priorities for diabetes care providers are first to identify and control diabetes prior to conception and second to appropriately screen and treat even mild gestational diabetes during pregnancy.
  47. smarty.

    smarty. Guest

    Diagnostic Criteria for Gestational Diabetes Mellitus

    Risk assessment for GDM is performed at the first prenatal visit in all women who do not already have diagnosed diabetes. Women with risk factors should be screened as soon as feasible. Risk factors include obesity (nonpregnant body mass index 30), prior history of GDM, heavy glycosuria (> 2+), unexplained stillbirth, prior infant with major malformation, and family history of diabetes in a first-degree relative. If results of testing do not demonstrate diabetes, these women should be retested between 24 and 28 weeks' gestation. All women of ordinary or high risk should be screened between 24 and 28 weeks' gestation. In the United States, a 2-step approach usually is taken. The first step is a screening test consisting of a 50-g oral glucose challenge test (GCT). Plasma or serum glucose level is measured 1 hour later. The GCT can be performed at any time of day and without regard to time of prior meal. The sensitivity and specificity of the test are related to the cutoff value designated to be an "abnormal" result. A cutoff value of 140 mg/dL has a sensitivity of approximately 80% and results in progression to definitive testing in 14% of patients; a cutoff value of 130 mg/dL has a sensitivity of 90% and results in definitive testing in 24% of patients. Either cutoff value is acceptable. If the GCT result is 180 mg/dL or more, then the FPG should be obtained the next day, before the 3-hour, 100-g OGTT because many of these women can be diagnosed by FPG alone if the FPG is 95 or more.
  48. smarty.

    smarty. Guest

    EARLY POSTOPERATIVE COMPLICATION OF ILEOSTOMY IS;;
    1NECROSIS;;
    2 OBSTRUCTION;;
    3 DIARRHOEA;;
    4 PROLAPSE

    Early post operative complication of ileostomy includes a serious problem of immediate postoperative diarrhea, with patients losing as much as 3 liters of fluid via the stoma per day, complicating biochemical disturbances due to loss of fluid and electrolytes.

    Post-operative complications of ileostomy

    As with any surgery, complications can develop during, or soon after, having an ileostomy. Possible complications include:

    * excessive bleeding - which can be treated with blood transfusions
    * post-operative infections - which can be treated with antibiotics
    * accidental damage or perforation to nearby tissues or organs - which may require further surgery to repair

    There is a risk that an ileostomy will cause serious complications, such as a heart attack, or stroke, which could potentially be fatal.

    It is difficult to estimate the exact rate of death because estimates can vary depending on the type of ileostomy surgery being performed, and the general health of the person who is having the surgery. Generally, the risk is thought to be small, at less than 1 in 100.

    Obstruction
    Sometimes, the ileostomy does not function for short periods of time. This is not usually a problem. However, if your stoma is not active for more than six hours, and you experience cramps or nausea, you may have an obstruction. In this situation, you should contact your GP or stoma nurse.
    A warm bath may help to relax your abdominal muscles. Do not take a laxative. Foods such as nuts, pineapple, coconut, and corn, are more likely to cause an obstruction.

    Pouchitis
    Pouchitis is when an internal pouch becomes inflamed and is a common complication in people with an ileo-anal, or continent, ileostomy. It is estimated that around 1 in 3 people with an internal pouch will experience at least once episode of pouchitis.The symptoms of pouchitis are similar to digestive conditions such as Crohn’s disease, or ulcerative colitis, and include:

    * diarrhoea, which is often bloody
    * abdominal pains
    * stomach cramps
    * dehydration
    * high temperature (fever) of or above 38C (100.4F)

    Pouchitis can usually be successfully treated with a two-week course of antibiotics.
    Stoma problems

    Some people with an end, loop, or a continent, ileostomy, experience problems related to their stoma. These can include:

    * irritation and inflammation of the skin around the stoma - this can make it difficult to hold the pouch in position
    * narrowing of the stoma (stoma stricture) - which can make it difficult to fit the pouch into the stoma
    * widening of the stoma (stoma prolapse) - again, making it difficult to hold the pouch in place

    Skin irritation can usually be treated with topical treatments, such as a spray, to reduce skin inflammation and irritation.

    A stoma stricture or prolapse may require minor surgery to correct the stoma.

    Valve malfunction
    A common complication of a continent ileostomy is that the valve that is connected to the internal pouch can malfunction due to the valve narrowing, or being pulled out of position. In this circumstance, minor surgery is required to either repair or replace the valve.

    Phantom rectum
    Phantom rectum is a complication that can affect people with ileostomies. The condition is similar to a ‘phantom limb’, where people who have had a limb amputated feel that it is still there.
    People with phantom rectum feel like they need to go to toilet even though they do not have a working colon. This feeling can continue to occur many years after surgery. Some people have found that sitting on a toilet can help relieve the feeling

    Answer is Diarrhoea
  49. smarty.

    smarty. Guest

    which of the following is the best -intestinal absorption test;;
    1quantitative stool fat examination ;;
    2d-xululose test;;
    3paba;;
    4schilling test;;

    Quantitative stool fat examination is the reliable test for the steatorrhoea

    D-xylose absorption is a laboratory test to determine how well the intestines absorb a simple sugar (D-xylose). The test helps determine if nutrients are being properly absorbed.

    PABA is also occasionally used in pill form by sufferers of irritable bowel syndrome to treat its associated gastrointestinal symptoms, and in nutritional epidemiological studies to assess the completeness of 24-hour urine collection for the determination of urinary sodium, potassium, or nitrogen levels.

    The Schilling test is a medical investigation used for patients with vitamin B12 deficiency. The purpose of the test is to determine if the patient has pernicious anemia.

    Answer is D-xylose test.
  50. smarty.

    smarty. Guest

    sterilisation by irradiation is done in all the following, except ;;
    1artificial tissue grafts;;
    2 bone grafts;;
    3endoscopes ;;
    4 sutures;;
    Gamma Radiation Sterilization
    Almost all medical products that are covered in schedule C and C1 are commonly sterilized by gamma radiation. An indicative list of these products is given below:

    * Surgical Disposables : Surgical Sutures, Bandages, Dressings, Gauge pads, Nappies, Delivery Kits etc, which are made of Cotton Wool and Gauge.

    * Metallic Products: Surgical Blades, Needles, Implants, Aluminum Caps, Containers etc.

    * Plastic And Rubber Items: Petri-dish, Centrifuge Tube, Blood Collection Sets, Scalp Vein Sets, Shunt Valves, Rubber Gloves, Contraceptive Devices, Gowns, Wraps Covers, Sheets, etc.

    * Pharmaceuticals: Silver Sulphadiazene Cream, Gelatin Capsule, Bentonite Charcoal, Ergot Powder, Absorbable gelatin, Ophthalmic preparations in paraffin base and oil base, Skin Ointment in Polyethylene glycol base.

    * Ayurvedic: Raw Materials, Herbs, Medicines, Granules.

    * Spices : Whole and in Processed form.

    The Gamma Sterilization Advantage
    Industrial scale sterilization can be done by several techniques such as dry heating, autoclaving (steam' sterilization), gas sterilization (eg. Ethylene oxide sterilization) etc., besides sterilization using gamma rays. But the sterilization using gamma rays has the following advantages:

    * Unlike heat sterilization or steam sterilization, Gamma ray sterilization does not significantly increase the temperature of the products and therefore can be used to sterilize safely even the heat sensitive materials as well as materials in frozen condition.
    * Unlike Ethylene oxide sterilization, gamma sterilization does not leave any harmful residue. In products exposed to gamma rays from Cobalt-60 source at the normally used dose level, there is no danger of radioactivity or toxicity. Radiation processed products does not become radioactive- just as our body do not start emitting X -rays after being X-rayed.
    * Gamma sterilization is performed after packaging of the products in the final containers and does not involve any aseptic handling. Product sterility is retained indefinitely, as long as the packaging is intact
    * Sterilization of products of any shape can be achieved due to the high penetration ability of gamma rays.
    * Gamma ray sterilization is non-polluting, environment friendly process, and since it is a continuous process, the results are more uniform than gas or high temperature sterilization, which are essentially batch processes.

    The process of high-level disinfection, an appropriate standard of treatment for heat-sensitive, semicritical medical instruments (e.g., flexible, fiberoptic endoscopes, bronchoscopes), inactivates all vegetative bacteria, mycobacteria, viruses, fungi, and some bacterial spores. High-level disinfection is accomplished with powerful, sporicidal chemicals (e.g., glutaraldehyde, peracetic acid, and hydrogen peroxide) that are not appropriate for use on housekeeping surfaces. These liquid chemical sterilants/high-level disinfectants are highly toxic. Use of these chemicals for applications other than those indicated in their label instructions (i.e., as immersion chemicals for treating heat-sensitive medical instruments) is not appropriate.

    General Recommendations: Recommendations for Environmental Infection Control in Health-Care Facilities (CDC).
    Endoscopes that enter sterile tissue or a sterile body cavity (i.e., arthroscopes, laproscopes) must be subjected to a sterilization process before each use. This should be steam, ethlyene oxide or Steris® sterilization. If this is not feasible, the endoscopes must at least receive high level disinfection, which consists of a 12 - 20 minute soaking in glutaraldehyde).
    Endoscopes that will not enter into a sterile cavity and will not violate mucous membranes (i.e., endoscopes, bronchoscopes, cystoscopes) must at least receive a 20 minute soaking in glutaraldehyde, peracetic acid, or hydrogen peroxide before each use.
    All parts of the endoscope must be thoroughly and meticulously cleaned with soap, water, and brushes immediately after use to prevent drying of secretions. This is essential before processing because organic and patient material (blood, mucous, etc.) may contain high concentrations of microorganisms. Also, such organic material may inactivate chemical germicides and protect microorganisms from the disinfection or sterilization process. Care must be taken to thoroughly clean all channels.
    Steam sterilization is the most inexpensive and effective method for sterilizing. Steam should be used on endoscopes or endoscope parts when possible. However, check with manufacturer’s manual to ensure they will withstand this type of processing.
    Ethylene oxide gas sterilization is a more complex and expensive process than steam sterilization. It is used for objects that might be damaged by heat or excessive moisture. ETO gas or Steris® sterilization should be used on endoscopes whenever possible.
    When liquid chemicals such as glutaraldehyde, peracetic acid, or hydrogen peroxide are used, the items must be meticulously cleaned with soap and water and thoroughly dried before being placed into the solution. For high level disinfection, the items must be soaked for at least 20 minutes (12 minutes for Cidex OPA®) or for 10 hours for sterility. Following the use of these chemicals, all instruments must be rinsed three times to remove any chemical residue. To rinse disinfected endoscopes and bronchoscopes, use water of the highest quality practical for the system’s engineering and design (e.g., sterile water or bacteriologically-filtered water [water filtered through 0.1–0.2-μm filters]).

    Diffuse ultraviolet radiation is employed to sterilize the inner surfaces of the endoscope instrument lumen. The ultraviolet radiation can be delivered via one or more optical fibers having a light-diffusing assembly coupled thereto. The instrument operates by delivering cytotoxic radiation to the inner lumen surface to sterilize any biological agents
    which may be present within the instrument lumen.

    Development of practical methods for the storage, without significant deterioration, of tissues for clinical use as grafts has created a demand for tissue banks, and with the establishment of these banks new procedures for sterilization and preservation are constantly being investigated.
    With respect to bone there are advantages and disadvantages to each of the several techniques now in use. Currently the most popular method is that of storage at – 20 to – 30 C of bone, obtained under sterile conditions, from amputations, thoracotomies, or other surgical operations.

    Steam sterilization of bone is not recommended by the American Association of Tissue Banks (AATB). Steam sterilization of bone may alter the structural proteins, causing the bone to not function as desired after implantation. The altered nature of steam-sterilized bone is of greatest concern in procedures in which bone strength, such as for weight-bearing purposes, is affected. Steam sterilization of the bone graft has not been validated, and it is not possible to determine whether the bone graft would function as needed. The AATB recommends using irradiation and ethylene oxide to sterilize bone;however, neither process is practical during a surgical procedure if the patient is under anesthesia.

    Tissues used as allografts that are sterilized currently include bone, cartilage, ligaments, tendons, fascias, dura mater, heart valves, vessels, skin and amnion.

    Following intensive studies of the effects of ionizing radiation on the chemical, physical and biological properties of tissue allografts and their
    components, these are now radiation sterilized using a variety of methods and practices.
    All the mentioned options can be sterilised using irradiation
    If the question is specifically Gamma irradiation, then the answer will be endoscopes.

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