AIPGE 2011: All Questions With Options & References

Discussion in 'NEET 2013 All india Exam' started by Guest, Jan 10, 2011.

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    Q1. Which is a branch from trunk of brachial plexus ?
    1. SupraScapular Nerve
    2. Long Thoracic Nerve
    3. Axillary Nerve
    4. Nerve to Subclavius Muscle

    Answer 1. SUPRASCAPULAR NERVE

    Q2. Autorikshaw run over an 8-year-old, tyre mark over leg is called?
    A. Patterned bruise
    B. Imprint abrasion
    C. Contusion
    D. Pressure bruise
    References : Given below

    Answer is B Imprint abrasion

    Krishan Vij ,Text Book of Forensic Medicine and Toxicology, Principles and Practice, 2008, 4thEdn, Pages 282-283.
    Pressure Abrasions (Crushing Abrasions / Imprint Abrasions): When the impact is vertical to the skin surface, the epidermis gets crushed and pressure type of abrasions result and the imprint of the impacting object may be produced. These may be seen in manual strangulation (abrasions produced by fingernails) and in hanging, where the weave of the ligature material may be reproduced.
    Patterned Abrasions: Patterned abrasions occur when the force is applied at or around right angle to the surface of skin, as already mentioned……The classical example of this is seen in traffic accidents when tyre of a motor car passes over the skin leaving the pattern when the skin has been squeezed into the grooves of the rubber tread.
    Reddy.K.S.N,The Essentials of Forensic Medicine and Toxicology, 2006, 25th Edn, Pages 156-157.
    Patterned bruising is also seen in motor car accidents.
    Answer: Imprint Abrasion is to be preferred as most appropriate alternate to Patterned Bruise, since,
    1. Imprint abrasion and patterned abrasion are the same.
    2. Patterned abrasion (imprint abrasion) is the classical example of tyre mark
    3. Tyre will produce patterned bruise usually, if in association with abrasions

    Q3. Mineralocorticoid receptors are present in all except ( REPEAT )

    1) Hippocampus
    2) Brain
    3) Liver
    4) Kidney

    Answer 3) Liver

    Q4. Which is not autoimmune disease?

    1. SLE
    2. Grave’s Disease
    3. Myasthenia Gravis
    4. Sickle Cell Disease

    Answer 4. Sickle Cell Disease

    Q5. A 40 year female underwent surgery. Post operatively she told the anaesthetist that she was aware of per-operative agents. Individual intraoperative awareness is evaluated by

    1. Bispectral Index
    2.

    Answer 1. Bispectral Index

    Bispectral index (BIS) is one of several recently developed technologies which purport to monitor depth of anesthesia. BIS monitors can replace or supplement Guedel's classification system for determining depth of anesthesia. Titrating anesthetic agents to a specific bispectral index during general anesthesia in adults (and children over 1 year old) allows the anesthetist to adjust the amount of anesthetic agent to the needs of the patient, possibly resulting in a more rapid emergence from anesthesia. Use of the BIS monitor may reduce the incidence of intraoperative awareness in high risk procedures or patients[1] and may also have a role in predicting recovery from severe brain injury

    Q6. Most common cause of death in schizophrenia patient
    1. Homicide
    2. Depression
    3. Suicide
    4. Due to Antipsychotic side effects

    Answer C ) Suicide

    Q7. All are pneumatic bones except
    1) Frontal
    2) Mandible
    3) Ethmoidal
    4) Mastoid

    Answer 2 ) Mandible

    Q8. Clue Cells are found in
    A) Candida
    B) Bacterial Vaginosis
    C) Trichomonas Vaginalis
    D) Chlamydial infection

    B) Bacterial Vaginosis

    Q9. Nerve involved in supracondylar fracture

    1. Radial nerve
    2. Median nerve
    3. Ulnar nerve
    4. Ant int nerve

    Ans- AIIMS CONTROVERSIAL QUESTION

    Q11. Punett Square is used for
    1. Genotype
    2. Collecting datas in one group
    3.
    4.

    1. Genotype
    The Punnett square is a diagram that is used to predict an outcome of a particular cross or breeding experiment. It is named after Reginald C. Punnett, who devised the approach, and is used by biologists to determine the probability of an offspring having a particular genotype.

    Q12. A teenage girl complaints of pain over the knee. The pain increase while starting to stand from sitting position and while walking upstairs. What is the likely diagnosis?

    1. Chondromalacia of patella
    2. Patellar Fracture
    3. Torn Meniscus
    4. Bipartite Patella

    Answer ) 1. Chondromalacia of patella
    Chondromalacia patellae means "soft cartilage under the knee cap," a presumed cause of pain at the front of the knee. This condition often affects young .The pain of chondromalacia patellae is typically felt after prolonged sitting, like for a movie, and so is also called "movie sign" or "theater sign".

    Q13. Blount’s disease is present as

    1. Genu recurvatum
    2. Genu varum
    3. Genu Valgum
    4.
    Answer 3. Genu Valgum

    Blount's Disease is one which affects the bone development of toddlers and older children. Most often, it starts as bow-leggedness which does not improve in a child between two and four years of age.

    DEAR DOCTORS TIBIA VARA is other name for BLOUNT'S DISEASE and it presents as GENU VALGUM

    Radiographic Appearance

    Physiologic bowing typically show flaring and bowing of tibia and femur in a symmetric fashion and is normal in children < 2 years of age (maximal at about 18 mo);
    - physiologic genu valgum, or knock knees, develops next, w/ maximal deformity occurring at 3 years of age;
    - gradual correction to ultimate alignment of slight genu valgum occurs by 9 years of age in the great majority of patients

    Q14. Which is not a neural tumor ?

    1. Ependymoma
    2.Neuroblastoma
    3. Gangliocytoma
    4. Ganglioglioma

    Answer. CONTROVERSIAL As Usual AIIMS ROCKS with dummy Questions

    REF Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. pp. 1406.
    Ganglioglioma is a tumour that arises from ganglion cells in the central nervous system.
    The term "gangliocytoma" is sometimes equated with ganglioglioma. However, it is also sometimes equated with ganglioneuroma. The term "gangliocytoma" is sometimes used to imply that the tumor is entirely neuronal.

    Q15. Cadeveric transplant is done for A/E

    1. blood vessels
    2. liver
    3. lung
    4. bladder

    Answer 4. Bladder

    The major donor organs and tissues are heart, lungs, liver, pancreas, kidneys, eyes, heart valves, skin, bones, bone marrow, connective tissues, middle ear, blood vessels. Therefore one donor can possibly give gift of life to many terminally ill patients who would not survive otherwise.

    Q16. 32 yr male a known hypertensive planned for cholecystectomy . which of following is contraindicated
    1. propofol
    2. ketamine
    3. midazolam
    4.

    ANS 2. Ketamine

    Ketamine causes a rise in intracranial pressure and should not be used in patients who have sustained a recent head injury.
    The blood pressure rises by about 25% (on average the systolic pressure rises by 20-30 mmHg) and the heart rate is increased by about 20% - the overall effect is therefore to increase the workload of the heart.
    The pressure within the eyeball (intra-ocular pressure) rises for a short time following administration.

    All pressures are increased.

    Q17. . One of the drug is contraindicated in Patients with lithium toxicity
    1.diuretics
    2. beta blocker
    3. ccb
    4.

    Answer 1. Diuretics

    Diuretics acting distally to the proximal tubule, such as thiazides and spironolactone, do not directly affect the fractional excretion of lithium (although they may affect serum lithium levels indirectly through their effects on volume status). Reabsorption of lithium is increased and toxicity is more likely in patients who are hyponatremic or volume depleted, both of which are possible consequences of diuretic therapy.

    Q18. Which virus crosses placenta least likely

    1. rubella
    2. herpes simplex
    3. HIV
    4. Hepatitis B

    ANS Hepatitis B

    HBV is a large virus and does not cross the placenta, hence it cannot infect the fetus unless there have been breaks in the maternal-fetal barrier, e.g. via amniocentesis.

    Q19. Which is present in Pentology of fallot :
    1. ASD
    2. VSD
    3. Right Ventricular Hypertrophy
    4. Pulmonary stenosis

    Answer 1. ASD

    Q20. All are true about Nesidioblastosis except ?

    1. Hypoglycemic Episodes are seen
    2. Occurs in adults more than child
    3. Histopathology shows Hyperplasia of Islet cells
    4. Diazoxide is used in treatment

    Answer 2. Occurs in adults more than child

    Nesidioblastosis is hyperinsulinemic hypoglycemia attributed to excessive function of pancreatic beta cells with an abnormal microscopic appearance. The abnormal histologic aspects of the tissue included the presence of islet cell enlargement, islet cell dysplasia, beta cells budding from ductal epithelium, and islets in apposition to ducts.Most common age group 2 – 3 years.
  2. Guest

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    Q21. Epileptogenic

    1. Desflurane
    2. Sevoflurane
    3. Ether
    4. Halothane

    Answer 2. Sevoflurane
    Ref : A practice of anesthesia for infants and children By Charles J. Coté

    Q22. Most common tumor causing superior Vena cava syndrome.

    1. Lymphoma
    2. Small cell carcinoma
    3. Non small cell carcinoma.
    4.

    ANS Small cell Carcinoma

    Nearly 95% of superior vena cava syndrome cases are attributed to cancer, with the most common cause being small cell lung cancer, followed by squamous cell lung cancer, adenocarcinoma of the lung, non-Hodgkin's lymphoma, and large cell lung cancer.

    Q23. Most common tumor causing superior Vena cava syndrome.

    1. Lymphoma
    2. Small cell carcinoma
    3. Non small cell carcinoma.
    4.

    ANS 3. Small cell Carcinoma

    Nearly 95% of superior vena cava syndrome cases are attributed to cancer, with the most common cause being small cell lung cancer, followed by squamous cell lung cancer, adenocarcinoma of the lung, non-Hodgkin's lymphoma, and large cell lung cancer.

    Q23. Not a cause of primary amoenorrhoea

    1. kallman syndrome
    2. turner syndrome
    3. sheehan syndrome
    4. rokitansky syndrome

    Answer 3. sheehan syndrome

    Q24. All are indoor air pollutants except

    1.CO
    2. Chloroflurocarbons
    3. Nitrogen oxide
    4. Mercury

    Answer 3) Nitrogen Oxide

    Q25. Denominator in Maternal Mortality rate
    1. Total Number of Live birth
    2. Total Number of Married Women
    3. Total Number of Birth
    4.

    Answer 1. 1. Total Number of Live birth

    Q26.Contraceptive to be avoided in epilepsy

    1. OCP
    2. Condoms
    3. IUD
    4. Post Coital Pill

    ANSWER 1. OCP

    Confusion Lies Between OCP and POST COITAL PILL .

    But Check this standard reference from

    The morning after pill can be used in women with epilepsy after unprotected sexual intercourse. A higher dose is recommended in patients taking hepatic enzyme inducing drugs
    - 1st dose – Levenorgestrol 1.5mgs (2 tablets)
    - 2nd dose 12 hours later – Levenorgestrol 0.75mgs (1 tablet)

    Q27. People are separated into certain sub groups. People are selected randomly from sub groups. What type of sampling is done?
    1. Random sampling
    2. Stratified Sampling
    3. Quota Sampling
    4.

    Answer 2. Stratified Sampling

    Q28. NARP syndrome is seen in

    1. mitochondrial
    2. glycogen storage
    3. lysosomal
    4. lipid storage

    Answer 1. Mitochondrial Disorder

    Neuropathy, ataxia, and retinitis pigmentosa, is a condition related to changes in mitochondrial DNA.
    Mutations in the MT-ATP6 gene cause neuropathy, ataxia, and retinitis pigmentosa.
    The MT-ATP6 gene is contained in mitochondrial DNA. Mitochondria are structures within cells that convert the energy from food into a form that cells can use. Although most DNA is packaged in chromosomes within the nucleus, mitochondria also have a small amount of their own DNA (known as mitochondrial DNA or mtDNA).

    Q29. Which pass through Jugular foramen ?

    1. Vertebral artery
    2. Hypoglossal Nerve
    3. Internal Carotid artery
    4. Sympathetic chain

    CN IX, X, XI(descending), jugular vein passes through jugular foramen

    Jugular Foramen or Vernet's syndrome is characterized by the paresis of 9th–11th (with or without 12th) cranial nerves together.

    Q30. Necrotizing lymphadenitis is seen in

    1.Kimura disease
    2. kikuchi disease
    3. hodgkin disease
    4. castelman disease

    Answer 2. Kikuchi Disease

    Kikuchi disease ai also called histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease, is an uncommon, idiopathic, generally self-limited cause of lymphadenitis. The most common clinical manifestation of Kikuchi disease is cervical lymphadenopathy. Several viral candidates have been proposed, including cytomegalovirus, Epstein-Barr virus,16 human herpesvirus, varicella-zoster virus, parainfluenza virus, parvovirus B19, and paramyxovirus.
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    Q31. Which is rave drug?

    1. Cannabis
    2. Cocaine
    3. Heroin
    4.

    Answer 2. Cocaine

    Yet another one from AIIMS Board

    "RAVE drugs - MDMA, cocaine, amphetamines and ketamine.
  4. Guest

    Guest Guest

    which is rave drug?

    one of the options was EXTASY, and this should be the answer. its chemical name is MDMA
  5. Guest

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    Superior vena cava syndrome MOST common cause
    a)metastasis
    b)nonsmall cell lung carcinoma
    c)small cell carcinoma

    ANS-B
    William Hunter first described the syndrome in 1757 in a patient with syphilitic aortic aneurysm. In 1954, Schechter reviewed 274 well-documented cases of superior vena cava syndrome (SVCS) reported in the literature; 40% of them were due to syphilitic aneurysms or tuberculous mediastinitis. In more recent times, these infections have gradually decreased as the primary cause of superior vena cava (SVC) obstruction. Lung cancer, particularly adenocarcinoma, is now the underlying process in approximately 70% of the patients with superior vena cava syndrome (SVCS). However, up to 40% of the causes are due to nonmalignant causes.
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    Q. 32. Aprepitant is all except
    1. Agonist at NK1
    2. Crosses Blood Brain Barrier
    3. Ameliorate Nausea Vomiting of chemotherapy
    4. Metabolized by CYP450

    Answer 1. Agonist at NK1

    Aprepitant is an antiemetic chemical compound that belongs to a class of drugs called substance P antagonists (SPA). It mediates its effect by blocking the neurokinin 1 (NK1) receptor.
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    Q. 33. Buprenorphine is a
    1. Partial agonist at MU Receptor
    2. Partial agonist at Kappa Receptor
    3. Full Agonist at Mu Receptor
    4. It is antagonist at Kappa receptor

    Answer 1. . Partial agonist at MU Receptor

    Q. 34. Local Anaesthetic agent with vasoconstrictor is not used in
    1. Spinal
    2. Epidural
    3. Digital finger block
    4. Skin Anaesthesia

    Answer 3. Digital Finger Block

    The toxicity of LA is related to the amount and speed of their absorption into the systemic circulation !
    Vasoconstrictor ingredient (e.g., adrenaline, felypressin) is often added to LA with the aim to reduce the absorption of LA into the systemic circulation.
    Effects of vasoconstrictors:
    - increase in the effect of LA (increased concentration)
    - decrease in the toxicity of LA (decreased absorption)
    - increase in the duration of the effect of LA
    Vasoconstrictors must not be used for producing ring-block of an extremity (e.g. finger or toe) because they may cause prolonged ischaemia and gangrene.

    Q. 35. All are true about Erlotinib except
    1. Used in Non Small Cell Carcinoma
    2. It is a small peptide acting as EGRF antagonist
    3. Food decreases absorption
    4. It causes skin rashes

    Answer 3. Food decreases absorption

    Explanation : Food enhances the oral absorption and bioavailability of erlotinib.
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    Q36. Specific Compliance of lung is decreased by all except

    1. Chronic Bronchitis
    2. Pulmonary fibrosis
    3. Pulmonary Congestion
    4. Decreased Surfactant
    Answer 1. Chronic Bronchitis

    Emphysema / COPD may be associated with an increase in pulmonary compliance due to the loss of alveolar and elastic tissue.

    Q37. Sparrow marks are seen in following condition

    1. gunshot injuries
    2. stab injry of face
    3 vitriolage
    4 windshield glass injury

    Answer 4 windshield glass injury
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    Q. Blount’s disease is a cause of?
    1. Coax vara
    2. Coax magna
    3. Genu valgum
    4. Genu varum

    Ans: 4 it is a typical disorder affecting the postero-medial epiphysis of proximal tibia (due to avascular necrosis) thereby leading to over growth of the lateral epiphysis resulting in agene / tibia vara deformity. It is common in West Indies & Africans.

    Q. 1. Which is a branch from trunk of brachial plexus ?
    1. SupraScapular Nerve
    2. Long Thoracic Nerve
    3. Axillary Nerve
    4. Nerve to Subclavius Muscle

    Answer 1. SUPRASCAPULAR NERVE or NERVE TO SUBCLAVIUS ????

    The nerve to the Subclavius Muscle

    This nerve is from the anterior aspect of the superior trunk, from C5, with occasional additions from C4 and C6.
    It descends posterior to the clavicle and anterior to the brachial plexus to supply the subclavius muscle.

    The Suprascapular Nerve

    This nerve arises from the posterior aspect of the superior trunk, fibres from the ventral rami of C5 and C6 and often C4 (50% of people).
    It supplies the supraspinatus and infraspinatus muscles and the shoulder joint.
    It passes laterally across the posterior triangle of the neck, superior to the brachial plexus and then through the scapular notch.
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    1. Which is a branch from trunk of brachial plexus ?
    1. SupraScapular Nerve
    2. Long Thoracic Nerve
    3. Axillary Nerve
    4. Nerve to Subclavius Muscle
    Answer 1. SUPRASCAPULAR NERVE

    2. Autorikshaw run over an 8-year-old, tyre mark over leg is called?
    A. Patterned bruise
    B. Imprint abrasion
    C. Contusion
    D. Ectopic bruise
    References : Given below
    Answer is B. Imprint abrasion
    Krishan Vij ,Text Book of Forensic Medicine and Toxicology, Principles and Practice, 2008, 4thEdn, Pages 282-283.
    Pressure Abrasions (Crushing Abrasions / Imprint Abrasions): When the impact is vertical to the skin surface, the epidermis gets crushed and pressure type of abrasions result and the imprint of the impacting object may be produced. These may be seen in manual strangulation (abrasions produced by fingernails) and in hanging, where the weave of the ligature material may be reproduced.
    Patterned Abrasions: Patterned abrasions occur when the force is applied at or around right angle to the surface of skin, as already mentioned……The classical example of this is seen in traffic accidents when tyre of a motor car passes over the skin leaving the pattern when the skin has been squeezed into the grooves of the rubber tread.
    Reddy.K.S.N,The Essentials of Forensic Medicine and Toxicology, 2006, 25th Edn, Pages 156-157.
    Patterned bruising is also seen in motor car accidents.
    Answer: Imprint Abrasion is to be preferred as most appropriate alternate to Patterned Bruise, since,
    1. Imprint abrasion and patterned abrasion are the same.
    2. Patterned abrasion (imprint abrasion) is the classical example of tyre mark
    3. Tyre will produce patterned bruise usually, if in association with abrasions

    3. Mineralocorticoid receptors are present in all except ( REPEAT )
    1) Hippocampus
    2) Brain
    3) Liver
    4) Kidney
    Answer 3) Liver

    4. Which is not autoimmune disease?
    1. SLE
    2. Grave’s Disease
    3. Myasthenia Gravis
    4. Sickle Cell Disease
    Answer 4. Sickle Cell Disease

    5. A 40 year female underwent surgery. Post operatively she told the anaesthetist that she was aware of per-operative agents. Individual intraoperative awareness is evaluated by
    1. Bispectral Index
    2.
    Answer 1. Bispectral Index
    Bispectral index (BIS) is one of several recently developed technologies which purport to monitor depth of anesthesia. BIS monitors can replace or supplement Guedel's classification system for determining depth of anesthesia. Titrating anesthetic agents to a specific bispectral index during general anesthesia in adults (and children over 1 year old) allows the anesthetist to adjust the amount of anesthetic agent to the needs of the patient, possibly resulting in a more rapid emergence from anesthesia. Use of the BIS monitor may reduce the incidence of intraoperative awareness in high risk procedures or patients[1] and may also have a role in predicting recovery from severe brain injury

    6. Most common cause of death in schizophrenia patient
    1. Homicide
    2. Depression
    3. Suicide
    4. Due to Antipsychotic side effects
    Answer C ) Suicide

    7. All are pneumatic bones except
    1) Frontal
    2) Mandible
    3) Ethmoidal
    4) Mastoid
    Answer 2 ) Mandible

    8. Clue Cells are found in
    A) Candida
    B) Bacterial Vaginosis
    C) Trichomonas Vaginalis
    D) Chlamydial infection
    B) Bacterial Vaginosis

    9. Nerve involved in supracondylar fracture
    1. Radial nerve
    2. Median nerve
    3. Ulnar nerve
    4. Anterior interosseous nerve
    Answer 4. Anterior interosseous nerve

    10. Pain in ethmoidal disease travels through
    1. Nasociliary Nerve
    2. Lacrimal Nerve
    3. Frontal Nerve

    11. Punett Square is used for
    1. Genotype
    2. Collecting datas in one group
    3.
    4.Inheritance pattern
    1. Genotype
    The Punnett square is a diagram that is used to predict an outcome of a particular cross or breeding experiment. It is named after Reginald C. Punnett, who devised the approach, and is used by biologists to determine the probability of an offspring having a particular genotype.

    12. A teenage girl complaints of pain over the knee. The pain increase while starting to stand from sitting position and while walking upstairs. What is the likely diagnosis?
    1. Chondromalacia of patella
    2. Patellar Fracture
    3. Torn Meniscus
    4. Bipartite Patella
    Answer ) 1. Chondromalacia of patella
    Chondromalacia patellae means "soft cartilage under the knee cap," a presumed cause of pain at the front of the knee. This condition often affects young .The pain of chondromalacia patellae is typically felt after prolonged sitting, like for a movie, and so is also called "movie sign" or "theater sign".

    13. Blount’s disease is present as (Repeat from ADrPlexus Mock series 3 on Dec 30,2010 ) Q.No 107
    1. Genu recurvatum
    2. Genu varum
    3. Genu Valgum
    4.
    Answer 3. Genu Varum

    14. Diet Recommendations all except
    1. Cholesterol intake should be 100 gm/1000 kcal/day
    2. To avoid alcohol consumption
    3. Salt intake should be less than 5gm/day
    4. Saturated fat is about 10% of whole diet
    Answer 4. Saturated fat is about 10% of whole diet

    15. People are separated into certain sub groups. People are selected randomly from sub groups. What type of sampling is done?
    1. Random sampling
    2. Stratified Sampling
    3. Quota Sampling
    4. Cluster Sampling
    Answer 2. Stratified Sampling

    16. Which pass through Foramen Magnum ?
    1. Vertebral artery
    2. Hypoglossal Nerve
    3. Internal Carotid artery
    4. Sympathetic chain
    Answer 1. Vertebral artery
    Spinal roots of CN XI(ascending), brainstem, vertebral arteries.
    Jugular Foramen or Vernet's syndrome is characterized by the paresis of 9th–11th (with or without 12th) cranial nerves together.
    1- HYPOGLOSSAL CANAL - hypoglossal nerve

    2- INTERNAL CAROTID ARTERY - passes thru both carotid canal and foramen lacerum

    3- GREATER PALATINE FORAMEN - anterior palatine nerve

    4- LESSER PALATINE FORAMEN - posterior palatine nerve

    5- NASOPALATINE NERVE - incisive foramen

    6- SUPRA ORBITAL FORAMEN OR NOTCH - supraorbital nerve

    7- SUPRA ORBITAL FISSURE - inferior opthalmic vein

    8- INFRA ORBITAL FORAMEN - infra orbital nerve

    9- ZYGOMATIC NERVE - infra orbital fissure

    10- ZYGOMATICO FACIAL FORAMEN - zygomatico facial branch of the sixth nerve

    11- OPTIC CANAL - central retinal vein

    12 - FORAMEN ROTUNDUM - maxillary division of the trigeminal nerve

    13- FORAMEN OVALE - Mandibular nerve, Accessory meningeal artery, Lesser petrosal nerve and Emissary veins (mnemonic : MALE).

    14- FORAMEN SPINOSUM - middle meningeal artery

    15- JUGULAR FORAMEN - 9 , 10 , 11 th cranial nerves

    16- MASTOID FORAMEN - meningeal branch of occipital artery

    17- TYMPANO MASTOID FISSURE - auricular branch of vagus ( vidian r alderman n )

    18- FACIAL NERVE - stylomastoid foramen

    19- CHORDA TYMPANI NERVE - petro tympanic fissure.

    17. Which is not a neural tumor ?
    1. Ependymoma
    2.Neuroblastoma
    3. Gangliocytoma
    4. Ganglioglioma
    Answer CONTROVERSIAL
    REF Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. pp. 1406.
    Ganglioglioma is a tumour that arises from ganglion cells in the central nervous system.
    The term "gangliocytoma" is sometimes equated with ganglioglioma. However, it is also sometimes equated with ganglioneuroma. The term "gangliocytoma" is sometimes used to imply that the tumor is entirely neuronal.

    18. Which is rave drug?
    1. Cannabis
    2. Cocaine
    3. Heroin
    4. Ecstacy
    Answer 4. Ecstasy
    There are a variety of substances that have been connected with Rave Clubs. This is a brief list of some of the drugs by slang names and some of their effects:
    Ecstasy – Hallucinogen/Stimulant Ecstasy is a synthetic drug that is similar to methamphetamine and the hallucinogen mescaline. Ecstasy can produce a significant increase in heart rate and blood pressure and a sense of alertness. The stimulant effects, which enable users to dance for extended periods, may also lead to dehydration, hypertension, and heart or kidney failure. Ecstasy can cause brain damage. It is one of the most widely used of the club drugs.
    Ephedrine – Stimulant This substance is sold over-the-counter at convenience stores, some food stores, and mail order. It is sold often as ‘Herbal Ecstasy’ and is touted as a ‘safe’ and ‘legal’ form of Ecstasy. Ephedrine is in the Amphetamine family and can cause heart attacks, seizures, agitation, palpitations, and other health problems. Ephedrine is a common weight-loss substance. The FDA has proposed restrictions on ephedrine after it received more than 800 reports of harmful effects to people, among them coronary problems that could put patients at risk for heart attacks, strokes and death.
    Ketamine – Hallucinogen Ketamine is an animal tranquilizer used by vets in pet surgery. Users say the effects of Ketamine are similar to PCP. Ketamine is usually snorted and is frequently used in combination with other drugs like ecstasy, heroin and cocaine. The high lasts anywhere from 30-minutes to about 2-hours. Special K or powdered Ketamine, emerged as a recreational drug in the 1970s and was known as “Vitamin K’ in the underground club scene in the 1980s. It has since resurfaced as “Special K†in the 1990s rave scene.
    GHB – Depressant This substance comes in a liquid form and looks like water and has a salty taste. GHB is used as a “club drug†for effects similar to those of Rohypnol, also known as “date rape drugs.†Coma and seizures can occur following of GHB and when combined with methamphetamine.
    Mixing GHB with alcohol could be a deadly combination. Excessive use of GHB can result in loss of consciousness (G-hole), tremors, irregular and depressed respiration and coma.
    Methcathinone – Stimulant Known on the street as Khat or cat it produces an amphetamine like effect. The drug produces a burst of energy and feeling of invincibility, accompanied by a state of well being and euphoria. Effects include paranoia, hallucinations, nervousness and anxiety. Physical effects can be pounding heart, headaches stomachaches, and shakes. Khat is most often snorted, but may also be injected with a needle or taken orally by mixing with a beverage such as a soft drink.
    LSD – Hallucinogen LSD induces abnormalities in sensory perceptions. Effects are unpredictable depending on the amount taken, on the surroundings in which the drug is used, and on the user’s personality, mood, and expectations. It can be in the form of a tablet, capsule, liquid, or on pieces of blotter paper that have absorbed the drug and is typically taken by mouth. Effects come on within 30 to 90 minutes after taking and can include physical effects of dilated pupils, higher body temperature, increased heart rate and blood pressure, sweating, loss of appetite, sleeplessness, dry mouth, and tremors.
    Magic Mushrooms – Hallucinogen The effects of Mushrooms or “Shrooms†are similar to LSD. They include illusions and hallucinations, distorted perception of time and distance. It is ingested orally in the form of tablets or powder. Trips or episodes can consist of psychosis, convulsions, flashbacks, and possible death.
    Methamphetamine – Stimulant Methamphetamine affects many areas of the central nervous system. The drug is often made in clandestine laboratories from relatively inexpensive over-the-counter ingredients. Diverse groups, including young adults who attend raves, in many regions of the country, are using it. It is available in many forms, and can be smoked, snorted, injected, or orally ingested. Methamphetamine use is associated with serious health consequences, including memory loss, aggression, violence, psychotic behavior, and potential cardiac and neurological damage. Abusers typically are agitated, have excited speech, decreased appetite, and increased physical activity levels.

    19. All are indoor air pollutants except
    1. Radon
    2. Carbon Monoxide
    3. Nitrogen oxide
    4. Mercury
    Answer 3) Nitrogen Oxide

    20. Denominator in Maternal Mortality rate
    1. Total Number of Live birth
    2. Total Number of Married Women
    3. Total Number of Birth
    4.
    Answer 1. 1. Total Number of Live birth

    21. Cadeveric transplant is done for A/E
    1. blood vessels
    2. liver
    3. lung
    4. bladder
    Answer 4. Bladder
    and this is why you have to read prospectus back page with specific links
    The major donor organs and tissues are heart, lungs, liver, pancreas, kidneys, eyes, heart valves, skin, bones, bone marrow, connective tissues, middle ear, blood vessels. Therefore one donor can possibly give gift of life to many terminally ill patients who would not survive otherwise.

    22. Not a cause of primary amoenorrhoea
    1. kallman syndrome
    2. turner syndrome
    3. sheehan syndrome
    4. rokitansky syndrome
    Answer 3. sheehan syndrome

    23. 32 yr male a known hypertensive planned for cholecystectomy . which of following is contraindicated
    1. propofol
    2. ketamine
    3. midazolam
    4.
    ANS 2. Ketamine
    Ketamine causes a rise in intracranial pressure and should not be used in patients who have sustained a recent head injury.
    The blood pressure rises by about 25% (on average the systolic pressure rises by 20-30 mmHg) and the heart rate is increased by about 20% - the overall effect is therefore to increase the workload of the heart.
    The pressure within the eyeball (intra-ocular pressure) rises for a short time following administration.
    All pressures are increased.

    24. One of the drug is contraindicated in Patients with lithium toxicity
    1.diuretics
    2. beta blocker
    3. ccb
    4.
    Answer 1. Diuretics
    Diuretics acting distally to the proximal tubule, such as thiazides and spironolactone, do not directly affect the fractional excretion of lithium (although they may affect serum lithium levels indirectly through their effects on volume status). Reabsorption of lithium is increased and toxicity is more likely in patients who are hyponatremic or volume depleted, both of which are possible consequences of diuretic therapy.

    25. Most common tumor causing superior Vena cava syndrome.
    1. Malignant Lymphoma
    2. Small cell carcinoma
    3. Non small cell carcinoma.
    4.
    ANS Small cell Carcinoma
    Nearly 95% of superior vena cava syndrome cases are attributed to cancer, with the most common cause being small cell lung cancer, followed by squamous cell lung cancer, adenocarcinoma of the lung, non-Hodgkin's lymphoma, and large cell lung cancer.

    26. Which virus crosses placenta least likely ( ADrPlexus Q )
    1. rubella
    2. herpes simplex
    3. HIV
    4. Hepatitis B
    ANS 4. Hepatitis B
    HBV is a large virus and does not cross the placenta, hence it cannot infect the fetus unless there have been breaks in the maternal-fetal barrier, e.g. via amniocentesis.

    27. Deoxygenated Blood is carried in all blood vessels except
    1. umbilical artery
    2. umbilical vein
    3. pulmonary artery
    4. right ventricle
    Answer 2. Umbilical vein

    28. A patient with Solitary kidney having 4 cm solitary exophytic mass in lower pole. Management is
    1.Partial nephrectomy
    2. Radical nephrectmy with dialysis
    3. Radical nephrectomy with immediate renal transplant
    4. Observation
    ANS. Partial nephrectomy

    29. Which is present in Pentology of fallot :
    1. ASD
    2. VSD
    3. Right Ventricular Hypertrophy
    4. Pulmonary stenosis
    Answer 1. ASD

    30. All are true about Nesidioblastosis except ?
    1. Hypoglycemic Episodes are seen
    2. Occurs in adults more than child
    3. Histopathology shows Hyperplasia of Islet cells
    4. Diazoxide is used in treatment
    Answer 2. Occurs in adults more than child
    Nesidioblastosis is hyperinsulinemic hypoglycemia attributed to excessive function of pancreatic beta cells with an abnormal microscopic appearance. The abnormal histologic aspects of the tissue included the presence of islet cell enlargement, islet cell dysplasia, beta cells budding from ductal epithelium, and islets in apposition to ducts.Most common age group 2 – 3 years.

    31. Epileptogenic
    1. Desflurane
    2. Sevoflurane
    3. Ether
    4. Halothane
    Ref : A practice of anesthesia for infants and children By Charles J. Coté
    Answer 2. Sevoflurane

    32. Contraceptive to be avoided in epilepsy
    1. OCP
    2. Condoms
    3. IUD
    4. Post Coital Pill
    ANS. OCP
    The morning after pill can be used in women with epilepsy after unprotected sexual intercourse. A higher dose is recommended in patients taking hepatic enzyme inducing drugs
    - 1st dose – Levenorgestrol 1.5mgs (2 tablets)
    - 2nd dose 12 hours later – Levenorgestrol 0.75mgs (1 tablet)

    33. NARP syndrome is seen in
    1. mitochondrial
    2. glycogen storage
    3. lysosomal
    4. lipid storage
    Answer 1. Mitochondrial Disorder
    Neuropathy, ataxia, and retinitis pigmentosa, is a condition related to changes in mitochondrial DNA.
    Mutations in the MT-ATP6 gene cause neuropathy, ataxia, and retinitis pigmentosa.
    The MT-ATP6 gene is contained in mitochondrial DNA. Mitochondria are structures within cells that convert the energy from food into a form that cells can use. Although most DNA is packaged in chromosomes within the nucleus, mitochondria also have a small amount of their own DNA (known as mitochondrial DNA or mtDNA).

    34. Necrotizing lymphadenitis is seen in
    1. Kimura disease
    2. kikuchi disease
    3. hodgkin disease
    4. castelman disease
    Answer 2. Kikuchi Disease
    Kikuchi disease ai also called histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease, is an uncommon, idiopathic, generally self-limited cause of lymphadenitis. The most common clinical manifestation of Kikuchi disease is cervical lymphadenopathy. Several viral candidates have been proposed, including cytomegalovirus, Epstein-Barr virus,16 human herpesvirus, varicella-zoster virus, parainfluenza virus, parvovirus B19, and paramyxovirus.

    35. A tennis player gets hurt by a ball in his eye, he complaints of decreased vision? what may be the cause for the condition?
    1 optic neuritis
    2 pars planitis
    3 . Avulsion of the Vitreous base
    4 . equatorial edema
    Shall Discuss Most Probable 3. Avulsion of the Vitreous base
    Chapter 12 BLUNT INJURY OF THE EYE
    Blunt injuries: the eye wall does not have a full thickness wound. Open globe or penetrating injuries: the eye wall has a full thickness wound. A blunt force causes a globe rupture and a sharp object causes a laceration at the site of impact. Lacerations may be penetrating with a single entrance wound, or a perforating with an entrance and exit wound.
    Symptoms and signs suggestive of globe rupture include pain, deceased visual acuity (a normal visual acuity is rarely present in a globe rupture), extensive subconjunctival haemorrhage (often involving 360 degrees of bulbar conjuctiva), a deep or shallow anterior chamber, hyphaema, low IOP (however IOP can be normal or high), irregular pupil, iridodialysis, cyclodialysis, lens subluxation, commotio retinae, retinal tears, vitreous haemorrhages, obvious corneal or scleral lacerations or intraocular contents may be outside the orbit.
    Direct blows to the eye transmit energy to the adjacent tissues as they produce compression,
    shearing, and tensile strains. The resultant great shearing forces are usually strongest at the posterior border of the vitreous base, and a linear tear of the retina may result. If traction is strongest at the anterior border of the vitreous base, the nonpigmented ciliary epithelium is torn. Strong traction at both the anterior and posterior borders may produce vitreous base avulsion, which is pathognomic of ocular

    36. Aprepitant is all except
    1. Agonist at Neurokinin receptor
    2. Crosses Blood Brain Barrier
    3. Ameliorate Nausea Vomiting of chemotherapy
    4. Metabolized by CYP450
    Answer 1. Agonist at NK1
    Aprepitant is an antiemetic chemical compound that belongs to a class of drugs called substance P antagonists (SPA). It mediates its effect by blocking the neurokinin 1 (NK1) receptor.

    37. Buprenorphine is a
    1. Partial agonist at MU Receptor
    2. Partial agonist at Kappa Receptor
    3. Full Agonist at Mu Receptor
    4. It is antagonist at Kappa receptor
    Answer 1. . Partial agonist at MU Receptor

    38. Local Anaesthetic agent with vasoconstrictor is not used in
    1. Spinal
    2. Epidural
    3. Digital finger block
    4. Skin Anaesthesia
    Answer 3. Digital Finger Block
    The toxicity of LA is related to the amount and speed of their absorption into the systemic circulation !
    Vasoconstrictor ingredient (e.g., adrenaline, felypressin) is often added to LA with the aim to reduce the absorption of LA into the systemic circulation.
    Effects of vasoconstrictors:
    - increase in the effect of LA (increased concentration)
    - decrease in the toxicity of LA (decreased absorption)
    - increase in the duration of the effect of LA
    Vasoconstrictors must not be used for producing ring-block of an extremity (e.g. finger or toe) because they may cause prolonged ischaemia and gangrene.

    39. All are true about Erlotinib except
    1. Used in Non Small Cell Carcinoma
    2. It is a small peptide acting as EGRF antagonist
    3. Food decreases absorption
    4. It causes skin rashes
    Answer 3. Food decreases absorption
    Explanation : Food enhances the oral absorption and bioavailability of erlotinib.

    40. Sparrow marks are seen in following condition
    1. gunshot injuries
    2. stab injry of face
    3 vitriolage
    4 windshield glass injury
    Answer 4 windshield glass injury

    41. All are supplied by the anterior division of Mandibular nerve except:
    1. lateral pterygoid
    2. medial pterygoid
    3. temporalis
    4. masseter
    Answer 2: medial pterygoid
    The nerve to medial pterygoid is a direct branch of the mandibular trunk.

    42. 39. All of the following decrease bone resorption in osteoporosis except?
    1.Alendronate
    2.Etidronate
    3.Strontium
    4.Teriparatide
    Answer 4. Teriparatide
    Teriparatide increases both bone formation and bone resorption

    43. Onodi Cells & Haller Cells are associated with the following structures respectively?
    1.Optic Nerve & Orbital floor
    2.OPTIC NERVE & INTERAL CAROTID ARTERY
    3.ICA & optic Nerve
    4.ORBITAL FLOOR & ICA
    Answer 1. OPTIC NERVE & ORBITAL FLOOR

    44. Posterior relations of head of pancreas are all except
    1) Common Bile Duct
    2) duodenum first part
    3) Aorta
    4) IVC
    Answer 2. Duodenum First part
    Posterior Surface.—The posterior surface is in relation with the inferior vena cava, the common bile duct, the renal veins, the right crus of the diaphragm, and the aorta.

    45. About yaws all are true except
    1. caused by t. pertenue
    2. transmitted non-venerally
    3. Secondary yaw can involve bones
    4. Last stages involve heart & nerves
    Answer 4. Last stages involve heart & nerves
    Yaws, like syphilis, has been classified into the following 4 stages:
    Primary stage: The initial yaws lesion develops at the inoculation site.
    Secondary stage: Widespread dissemination of treponemes results in multiple skin lesions similar to the primary yaws lesion.
    Latent stage: Symptoms are usually absent, but skin lesions can relapse.
    Tertiary stage: Bone, joint, and soft tissue deformities may occur.

    46. Mifepristone is used in
    1. Hydatiform Mole
    2. Abortion
    3. Ectopic
    4.
    Answer 2. Abortion
    Medical abortion using mifepristone plus prostaglandin is the most effective method of abortion at gestations of less than 7 weeks. Mifepristone is contraindicated in the presence of an intrauterine device (IUD), as well as with ectopic pregnancy, adrenal failure, hemorrhagic disorders, inherited porphyria, and anticoagulant or long-term corticosteroid therapy.

    47. Patient had cicatrical alopecia with grey pigmentation around hair follicles.What will you look for?
    1. Whitish lesion in the buccal mucosa
    2. Nail dystrophy
    3. Arthritis
    4. Discoid Plaques in the face
    Answer 1. Whitish lesion in the buccal mucosa

    48. How to differentiate ASD from VSD in X-ray
    1. Enlarged Left atrium
    2. Pulmonary congestion
    3. Aortic shadow
    Answer 1. Enlarged Left atrium

    49. Specific Compliance of lung is decreased by all except
    1. Chronic Bronchitis
    2. Pulmonary fibrosis
    3. Pulmonary Congestion
    4. Decreased Surfactant
    Answer 1. Chronic Bronchitis
    Emphysema / COPD may be associated with an increase in pulmonary compliance due to the loss of alveolar and elastic tissue

    50. All are features of digitalis toxicity except
    1. Ventricular Bigeminy
    2. Regularisation of AF
    3. Delayed conduction across AV
    4. Biventricular tachycardia
    Answer CONTROVERSIAL AIIMS. HELP US WITH OPTIONS
    Digoxin toxicity is especially suggested by paroxysmal atrial tachycardia with AV block and accelerated junctional rhythm in the presence of atrial fibrillation, so-called “regularization of atrial fibrillation. Prolonged PR intervals (greater than 0.20 second) may represent a conduction delay through the atria or AV junction due to digitalis toxicity or heart block.Bidirectional ventricular tachycardia is particularly characteristic of severe digitalis toxicity. The combination of increased (atrial) arrhythmogenesis and inhibited atrio-ventricular conduction (for example paroxysmal atrial tachycardia with A-V block - so-called "PAT with block") is said to be pathognomonic (i.e. diagnostic) of digoxin toxicity.

    51. A patient was started haloperidol for schizophrenia before four days. Now the patient complaints of severe spasm of neck on one sidefor the past 2 hours. what is the likely diagnosis?
    1. akathisia
    2. Acute dystonia
    3. malignant hyperthermia
    4. tardive dyskinesia.
    Answer: 2. Acute dystonia

    52. Diaphragm develops from all except
    1.pleuroperitoneal membrane
    2.septum transversum
    3.musculature of dorsal wall
    4.cervical somites
    Answer: 4.cervical somites

    53. Sterile pyuria is seen in
    1.chronic pyelonephritis
    2.wilmsâ€s tumour
    3.tuberculosis
    4.cystitis
    Answer: tuberculosis

    54. Haematological syndromes is seen in radiation doses of
    1.5 rad
    2.100 rad
    3. 200 rad
    4.
    Answer: 3. 200
    The hematologic syndrome is associated with radiation doses in the range of 150 to 600 rad (1 .5 to 6 Gy).

    55. Best test to identify metastatic bone lesion is
    1.ct scan
    2.mri
    3.bone scan
    4.x ray
    Answer. Bone scan

    56. Which is the commonly used fixative in histopathological specimen
    1.glutaraldehyde
    2.formaldehyde
    3.alcohol
    4.picric acid
    Answer: 2.formaldehyde
    The most common fixative for light microscopy is 10% neutral buffered formalin (4% formaldehyde in phosphate buffered saline).

    57. All are given in total parenteral nutrition except
    1.carbohydrates
    2.fat
    3.fibre
    4.micronutrients
    Answer:fibre

    58. About parvovirus B19 all are true except
    1. spread by respiratory route
    2.has affinity for erythrocyte p antigen
    3.causes transient aplastic crisis
    4.about only 10%of cases it crosses the placenta
    Answer: Ref Harrison 17th edition p 1116/1117 , Greenwood microbiology 6th e p 452
    The risk of transplacental infection is 30%

    59. In patients receiving isoniazid theraphy which of the following micronutrients to be supplemented
    1. Vitamin B12
    2. pyridoxine
    3.
    4.
    Answer.pyridoxine

    60. Which of the following is used to diagnose intraoperative myocardial infarction
    1.
    2.
    3.transesophagial echocardiogram
    4.ecg
    Answer: Please Help us with correct options

    71 pt with solitary kidney hving 4 cm exophytic mass in lower pole. best management
    partial nephrectomy
    rdical nephrctmy with dialysis
    radical witth immediate renal transplant
    observation

    72 NARP syndrome is seen in
    mitochondrial
    glycogen storage
    lysosomal
    lipid storage

    73 hallmark of acute inflammation ??
    vasoconstriction
    stasis
    vasodilation and increase in permeability
    leucocytic margination

    74 ONODI CELLS & HALLER CELLS are associated with the following structures respectively?
    a.OPTIC NERVE & ORBITAL FLOOR
    b.OPTIC NERVE & INTERAL CAROTID ARTERY
    c.INTERNAL CAROTID ARTERY& OPTIC NERVE
    d.ORBITAL FLOOR & INTERNAL CAROTID ARTERY

    75 amp b causes def of
    na
    ca
    k
    mg

    76 injury to common peronel n all except ??
    loss of senstion over sole
    foot drop
    injury to neck of fibula
    loss of dorsiflex of toe

    77 Nerve involved most commonly in supracondylar fracture
    Radial nerve
    Median nerve
    Ulnar nerve
    Ant int nerve

    78 definitive airway a/e:
    nasotracheal tube
    orotracheal tube
    lma
    cricothyroidectomy

    76 not a cause of primary amoenorrhoea
    kallman syndrome
    turner syndrome
    sheehan syndrome
    rokitansky syndrome

    79 a 65 yrs old lady presenting wth swollen n painful knee...having grade III osteoarthritic changes..wats the best management for her
    1.conservative
    2.arthroscopic washing
    3.partial knee replacement
    4.total knee replacement

    80 which is the integrase inhibitor used in treatment of hiv??
    raltegrase
    indinavir
    lopinavir

    81 A 6 year old child presents with pain in hip in femoral triangle region. X-ray does not reveal any abnormality. What is the next step?
    A. USG
    B. MRI
    C. Aspiration
    D. Traction

    82 Pasteurised milk is tested mostl commonly by:

    a. phosphatase test
    b. coliform test
    c. catalase test


    84 Anaesthetic agent with vasoconstrictor C/I in:
    a. finger block
    b. spinal block
    c. epidural block
    d. regional Anaesthesia

    85 a rickshaw runover thigh of child ..tyre marks over thigh represents ??
    patterned bruise
    imprint abrasion
    ectopic abrasion

    86 prophylaxis of migraine a/e
    propranolol
    flunarizine
    topiramate
    levacetarem

    87 early sign of magnesium toxicity
    1.depression of deep tendon reflexes
    2.respiratory depression
    3.cardiac arrest
    4.decrease urine output

    88 all are actions of muscarinic antagonist except.
    a. decreses gastric secretion
    b. prolongs a-v conduction
    c. decreses resp secretions
    d.contraction of radial muscles of iris

    89 all are seen in argyl robertson pupil except.
    near reflex normal
    direct reflex absent
    consensual reflex normal
    vision normal

    89 Branch of trunk of brachial plexus
    a. suprascalpur
    b. long thoracic n
    c.ant. Thoracic
    d. nerve to sub clavius.

    90 tolerance in opioids develops to all except
    miosis
    analgesia
    euphoria
    ??

    91 diaphragm develops from a/e:
    septum transversum
    dorsal mesocardium
    pleuroperitoneal membrane
    cervical myotomes
    2 ecg is poor in detecting ischaemia in areas supplied by
    lad
    lt circumflex
    lca
    rca

    93 The primary action of NO in git is?
    A. Vasodilatation
    B. Vasoconstriction
    C. GI smooth muscle relaxation
    D. Secretomotor

    94 Which is not seen in digoxin toxicity?
    A. Biventricular tachycardia
    B. Proxysmal atrial tachycardia with ectopics
    C. Ventricular bigeminy
    D. Regularisation of AF

    95 Which of the following does not cause indoor air pollution?
    A. CO
    B. Nitrogen dioxide
    C. Radon
    D. Mercury vapor

    96 All are true about pheochromacytoma except?
    A. 90% are malignant
    B. 95% occur in the abdomen
    C. They secrete catecholamines
    D. They arise from sympathetic ganglions

    Q 97 Most important and hazardous agent that can be used in bioterrorism:
    A. Plague
    B. Small pox
    C. TB
    D. Clostridium botulinum

    [snip] True about epidural opioids are all except?
    A. Acts on dorsal horn cell
    B. Itching
    C. Nausea & vomiting
    D. Respiratory depression

    Q99 Most common site of stricture formation after TURP?
    A. Navicullar foss
    B. Bulb
    C. Prostatic membranous urethra
    D. Bladder neck

    Q100 Intraoperative myocardial infarction is best diagnosed by:
    A. ECG
    B. Invasive arterial pressure
    C. Central venous pressure
    D. Trans esophageal echocardiogram

    Q101 Pseudoisomorphic phenomenon seen in
    A. Psoriasis
    B. Lichen planus
    C. Vitiligo
    D. Plane warts

    1 02 ova albumin antigen was injected into a rabbit. What antibody will it produce initially?
    A. IgG
    B. IgM
    C. IgE
    D. IgD

    103 a 50 yr lady has history of sprained ankle 2 months back followed by recovery. She now complains of severe pain in that ankle with inability to flex that foot. Physician notes edema and shiny skin in local examination. What is the probable diagnosis:
    a. Fibromyalgia
    b. Complex regional pain syndrome 1
    c. Complex regi...

    104 About yaws all are true except:
    A. Caused by Treponema pertenue
    B. Transmitted non-venerally
    C. Secondary yaws can involve bones
    D. Last stages involve heart and nerves

    105 Weight gain in pregnancy is related to all except?
    A. Ethnicity
    B. Smoking
    C. Socioeconomic status
    D. Pre conceptional weight

    106 Which virus among the following is least likely to cross placenta?
    A. Rubella
    B. Herpes simplex
    C. HIV
    D. HBV

    107 A fire breaks out during laser vocal cord surgery. What is not to be done?
    A. Pouring sterile water
    B. Removing endotracheal tube
    C. 100% oxygen after discontinuing anesthetic gases
    D. Treatment with steroid & antibiotic

    108 A patient with history of discharge from right ear for past 1 year presented with severe ear ache. The discharge was cultured and the organism was found to be gram positive cocci. The least likely cause is?
    A. Psuedomonas
    B. Streptococcus pneumoniae
    C. Staphylococcus
    D. Haemophilus influenzae

    109 Which among the following is the most common tumour associated with neurofibromatosis in a child?
    A. Juvenile myelomonocytic leukemia
    B. Acute lymphoblastic leukemia
    C. Acute monocytic leukemia
    D. Acute myeloid leukemia

    110 Common carotid artery is palpated at which site?
    A. Upper border of cricoid cartilage
    B. Upper border of thyroid cartilage
    C. Hyoid bone
    D. ???

    111 A 5 year old boy while having dinner suddenly becomes aphonic and is brought to the casulty for the complaint of respiratory difficulty. What should be the appropriate management?
    A. Cricothyroidotomy
    B. Emergency tracheostomy
    C. Humidified oxygen
    D. Heimlich maneuver

    112 Which among the following is the most common fungal infection seen in immuno competent patients?
    A. Aspergillus
    B. Candida
    C. Cryptococcus
    D. Mucor

    113 A teenaged girl complains of pain in knee on climbing stairs and on getting up after sitting for a long time. What is the probable diagnosis?
    A. Chondromalacia
    B. Plica syndrome
    C. Bipartite patella
    D. Patello-femoral osteoarthritis

    114 cause of premature death in schizophrenia?
    a)homicide
    b)suicide
    c)toxicity of antipsychotic drug
    d)hospital acquired infection

    115 Which of the following is not an adverse effect of thalidomide?
    A. Diarrhoea
    B. Teratogenicity
    C. DVT
    D. Peripheral neuropathy

    116 Superior vena caval syndrome is most commonly caused by?
    A. Lymphoma
    B. Small cell lung ca
    C. Non small cell lung ca
    D. Secondary tumours

    117 Which of the following is a contraindication for medical treatment in gallstones?
    A. Radio opaque stones
    B. Radiolucent stones
    C. Normal functioning gall bladder
    D. Small stones

    18 lines of blashchko --
    lymphatic
    blood vessel
    nerve
    line of development

    119 deoxy blood flow thru a/e:
    umbilical a
    umbilical vein
    pulm a
    right ventricle

    120 best test for hcg ?
    radioimmunoassay
    elisa
    latex test

    121 aortic knuckle shadow on pa x ray..obliterated by consolidation of which portion of lung?
    upper lingula
    lower lingula
    apex of lower lobe
    post part ofupper lobe

    122 Tetracycline used in prophylaxis of ?
    cholera
    brucellosis
    leptospirosis

    123 basal matabolic closely associated with ?
    a.lean body mass
    b.body surface area
    c.body mass index
    d.

    124 maximal water absorption of water in git?
    a jejunum
    b colon
    c ileum
    d ??

    125 pentology of fallot has which one of following extra entities:
    a. asd
    b. vsd
    c. rvh
    d. pulmonary stenosis

    126 free radicals in cells produced by a/e
    glut peroxidase
    NO synthase
    superoxide dismutase

    127 all of done in management of shoulder dystocia except
    a. fundal pressure
    b. suprapubic press
    c. mc roberts
    d. woods

    128 Which one of the following is not neuron tumour
    a.ependymoma
    b.gangliocytoma
    c.ganglioglioma
    d.??

    129 In L5 root involvement, which among the following is not affected?
    A. Thigh adduction
    B. Knee flexion
    C. Knee extension
    D.great Toe extension

    Q130 Which among the following is not a cause of fasting hypoglycemia?
    A. Glucagon excess
    B. Glucose 6 phospatase deficiency
    C. Ureamia
    D. Glycogen synthase deficiency

    131 McKeon's theory on reduced prevalence of TB?
    A. Increased awareness and knowledge
    B. Medical advancement
    C. Behavioural modification
    D. Social and environmental factor

    132 A child presents with abdominal pain only during passage of stools. No other symptoms like vomiting or blood in stools. There are no signs of intestinal obstruction. Most probable diagnosis is?
    A. Rectal polyp
    B. Intusseception
    C. Meckels diverticulum
    D. NEC

    Q133 A man presents with a maculopapular rash. He gives a history of previous painless rash. Infection is due to?
    A. Treponema pallidum
    B. Chlamydia
    C. Calymmatobacterium granulomatis
    D. Haemophilus ducreyi

    Q134 Meglitinides - all are true except:
    a. decreases post parendial hyperglycemia
    b. hypoglycemia less common than sulfonylureas
    c. it decreases insulin resistance
    d. it acts by releasing insulin

    Q135 Cleavage of which complement is involved in both -classical and alternate pathway a. C1
    b. C2
    c. C3
    d. C4

    Q136 what is not asso. with mestruation..?
    1. hormone
    2. vaginal cytology
    3. estrus profile
    4. cervical changes

    Q137 best treatment option for genuine stress incontinence?
    a. burch colposuspenssion
    b. kelly's
    c. sling operation
    d.free vaginal tapping

    Q138 Xanthogranulomatous inflammation all are true except ?
    A. presence of foamy macrophage
    B. presence of tuberculous infection
    C. multinucleatd giant cell
    D. yellow nodule

    Q139 Posterior relations of head of pancreas are all except?
    A. Common bile duct
    B. First part of duodenum
    C. right crus of diaphragm
    D. Inferior vena cava

    140 All are true about blood coagulation except.
    1 factor 10 in doth intrinsic and extrinsic
    2 extrinsic is activated by contact with plasma and -fly charged protein ans
    3 calcium is very important ion for coagulation
    4 intrinsic can be activated in vitro.

    Q141 Late onset endophthalmitis after intraocular lens implantation caused by
    a)staph epidrmidis
    b)pseudomonas
    c) strptococcus pyogenes
    propionibacter acne

    142 Which of the following is not a contraindication for pregnancy?
    A. WPW syndrome
    B. Pulmonary hypertension
    C. Eisenmenger syndrome
    D. Marfan syndrome with aortic root dilatation

    Q143 which one of the following is a cardio protective fattyacid
    a.stearic,
    b.palmitic
    c.oleic
    d.w3 fatty acids

    Q144 Which one of the following is not seen in floor of 3rd ventricle
    a.optic stalk
    b.mammilary body
    C.occulomotor nerve
    d.infundibulum

    145 Which among the following not a component of hypogastric sheth?
    A. Broad ligament
    B. Transverse cervical ligament
    C. lateral ligament
    d.??

    146 Child brought to casualty with reports of violent shaking by parents. Most likely injury?
    A. Long bone #
    B. Ruptured spleen
    C.subdural hematoma
    D.skull bone #

    147 arthropod transmitted virus diseases not found in india
    1.west nile fever
    2.dengue
    3.yellow fever
    4.

    148 open neural tube defects detected by increase in which of the following –

    acetylcholinesterase
    pseudocholinestrase
    AFP

    149 Which of the following is true abt HDI A/E?
    a) LIFE EXPECTANCY AT BIRTH
    b) LIFE EXPECTANCY AT 1 YEAR
    c) EDUCATION
    d) GDP in us $

    150 most potent activator of T cells?
    1. B cells
    2. follicular dendritic cells
    3. mature dendritic cells
    4. macrophages

    151 Following abt Phagocytosis all true A/e
    a.<0.5 mcm
    b.>0.5 mcm
    c.Phagosome+lysosome=phagolysosome
    d. d.amoeba n other unicellular org make their living out of it


    152 APL Ab syndrome which Ab seen?
    a.beta 1 microglobulin
    b.ANA
    c. anti centromere
    d.

    153 poor prognostic factor for ALL?
    a.hyperdiploidy
    b.t(9;22) t(4;11)
    c.2-8 yrs
    d.tlc <50000

    154 Pearson's skewness coefficients
    a.(Mean-median)/sd
    b.Median-mean/sd
    c.Sd/mean-median
    d.Sd/median-mean

    155 scarring alopecia with perifollicular greying .wth mucous mem n facial rashes /annular plaques?
    1.d l e
    2.lichen planus
    3.psorisis
    4.

    156 With delirium tremens,not seen:
    a.visual hallucination
    b.unconsciousness
    c.coarse tremors
    d.opthalmoplegia

    157 A patient wth intestinal infection 7 days later presented with amoebic liver abscess..5cmX5cmX6cm deep liver abscess on right side Rx of choice
    a.Mz and antibiotics is choice
    b.Repeated aspiration and antibiotics
    c.Surgical drainage is best for above mentioned patient wth antibiotics
    d.Resection of liver

    158 drug of choice for central Diab insipidus?
    a.desmopressin
    b.leuprolide
    c.thiazide

    159 first structure to b fixed after Amputation is
    a.Bone fixing
    b.arterial repair
    c.venous repair
    d.nerve repair

    160 fallopian tube immotility seen in:
    a.churg strauss syndr
    b.kartaganers syndr
    c.noonans syndr
    d.turner syndrome

    161 Epileptic potential is present in
    A. Desflurane
    B. Halothane
    C. Sevoflurane
    D. Ether

    162 which one is known as signature fracture?
    1.depressed skull fracture
    2.penetrating fracture
    3.counter coup
    4. # along the suture line

    163 A 7 yr old child with craniopharyngioma got cranial surgery done following which pituitary got damaged.which hormone shld b replaced first-
    1.hydrocort
    2.thyroxine
    3.growth hormone
    4.

    164 A 45 yr old lady presented with dub & usg finding of 8mm endometrium.which is next best investigation to conclude diagnosis?
    1.endometrial histopathology
    2.hysterectomy
    3.ocp
    4.follow up

    Q165 Which one of the following is earliest to be diagnosed by USG?
    a.anencephaly
    b.prosencephaly
    c.meningocele
    d.spina bifida

    166 .A 5 yr ol child presented wth ballooning of perpuce while micturationperpuce adhesion were there.whts the best treatment for him
    a.adhesiolysis and dilatation
    b.circumscision
    c.dorsal slit
    d.conservative


    167 False about HDL?
    a.can oxidise LDL
    b.decreased levels fail to clear LDL
    c.best predictor for CAD
    d

    168 A poison Illuminous, translucent, waxy
    1. Yellow phosphorus
    2.arsenic
    3.thalium
    4.?

    170 Gene for expession of protein.yield max production of enzyme.is ensured by introduction of following gene by virus
    a.Promoter gene
    b.Initiator signal
    c.transln and transcription termination signal
    d.

    171 Body plethysmography pressure findings when pt breathes aginst closed glottis in lungs n recordings respectively
    1.bothdecreased
    2.both increased
    3.lungs increases n recording decreased
    4.in boxincrease lung decrease

    172. cartilage for growth plate is:
    a.fibrous
    b.prim cartilagenous
    c.sec cartilagenous
    d.plane jt

    173 Not a predisposer for atherosclerotic plaque formation?
    a.ApoE
    b.alpha-macroglobulin
    c.oxidised LDL
    d.?


    174. 7 mo child with cough ending in spasm.which is best way to sample?
    a.Nasophayngeal swab
    b.Cough sputum culture
    c.tracheal aspirate
    d.??

    175 Unilateral undescended testis . ideal age of operation
    a.6 months
    b.12 months
    c.24 months
    d.36 months


    176Following are true Carbohydrate antigen
    a.Memory
    b.poly clonal response
    c.?
    d. t cell stimulation


    177 Aflatoxin produced by which of the fungal species?
    a.aspergillus flavus
    b.aspergillus niger
    c. candida
    d??

    178 A 3.8 kg baby of a diabetic mother developed seizure 16 hr after birth ...
    1.hypoglycemia
    2.hypocalcemia
    3. intraventricular hemorrhage
    4. ??

    179 girl presenting with occipital headache assoc wid ataxia vertigo.also similar complaints in mother ?
    a.vestibular neuronitis
    b.basillar migraine
    c.
    d.
    180 18yr male with hemetemesis & melena and splenomegaly ....
    1.NCPF
    2.CIRRHOSIS
    3.MALARIA with dic
    4.extra hepatic portal venous obstruction

    181 Pregnancy induced cholestasis marker... is
    a.Bilirubin
    b.Bile salts
    c.Sgot or sgpt
    d.Alp

    182 ph 7.5 pco2 30.po2 102 is partially ,compensated by
    met acidosis
    met alkalosis
    resp acidosis
    resp alkalosis

    183 pulmonary toxicity is seen with
    1. bleomycin
    2.cisplatin
    3.methotrexate
    4.actinomycin d

    184 A female wid depressed mood,loss of appetite n no interest in surrounding wid insomnia specially wid time lag in iniating n wakes up 1 hr early for 1 yr aftr her husband death is diagnosed as a case of depression..most appropiate treatment
    a.start wid a SSRI
    b.two antideprassant combined therapy
    c.no treatmnt as
    D start antidepressant according to side affect profile

    Q185 A pt comes with history of unresponsive fever n cough. xray pneumonia, gram positiv and partially acid fast branchin filaments 'grows on sheep blood agar'
    1.actinomycosis
    2.nocardiosis
    3.aspergillus
    4.

    186 not a disorder of protein misfolding?
    1.alzeimer
    2.TB
    3.cystic fibrosis
    4.cjd

    Q187 70yr old with intemittent jerks of recent origin, EEG showing b/L periodic spikes, diagnosis?
    a)Hepes simplex encephalitis
    b)Lewy body dementia
    c)Alzheimer's
    d)CJD

    Q188 15 DAYS old baby comes with ca: 5 po4 :9 pth 30 (n=10-60) & seizures
    1.psuedo hypo para thyroid
    2.Vit d def
    3.Hyperparathyroidism
    4.HIE

    Q189 most common cause of meningoencephalitis in children
    1.hsv
    2.enterovirus
    3.mumps
    4.listeria

    q is pulm compliance decreased in all except
    A)pulm congestion
    B)pulm fibrosis
    C)decreased surfactant
    D)chronic bronchitis

    191 all of the following true abt erlotinib except
    1. tyrosine kinase inhibitor
    2. food delays its absorption
    3. rashes s/e
    4. used in non small cell ca lung when not responded to other chemotherapeutic agents

    192 People are separated into certain sub groups. People are selected randomly from sub groups. What type of sampling is done?
    1. Random sampling
    2. Stratified Sampling
    3.cluster sampling
    4.systemic sampling

    Q194 capsule virulence in a/e -
    1.nisseria memingitis
    2.pneumococcus
    3.bordetella pertussis
    4.streptococcus

    Q195 superior oblique palsy-
    a.horizontal and down
    b.horizontal and up
    c.vertical and dwn
    d.vertical and up

    Q196 muscle of dorsal aorta develops frm
    a.paraxial
    b.intermediate
    c.lateral plate
    d.

    197 Uretheral Crest is seen in
    a. bulbar urtehera
    b. prostatic urethera
    c. membranous urethera

    198 Site not affected in posterior cerebral artery infarct is?
    A. Midbrain
    B. Pons
    C. Thalamus
    D. Cortex

    199 Visceral larva migrans seen in
    1.strongyloides
    2.ancylostoma
    3.toxocara canis

    200. psammoma bodies seen in all except
    1.follicular ca thyroin
    2.papillary ca thyroid
    3.cystadenoca
    4.meningioma

    201 Denominator in Maternal Mortality rate
    1. Total Number of Live birth
    2. Total Number of Married Women
    3. Total Number of Birth
    4.

    202 a tennis player gets hurt by a ball, he complaints of decreased vision.what may be finding s/o this trauma
    1 optic neuritis
    2 pars planitis
    3 vitrious detachment/ avulsion
    4 equatorial edema

    203 A 35 year old female has proximal weakness of muscles, repeated ptosis and east fatiguability. The best test to diagnose her condition is:
    1) Muscle biopsy
    2) CPK
    3) Edrophonium test
    4) EMG

    204 For Pcod all r true except
    1 high lh/fsh
    2 high dheas
    3 very high prolactin
    4 raised lh
    205 most imp prognostic factor in Cong Dia Hernia

    a.pulmonary ht
    b.timing of surgery
    c.size

    206 dental numbering is done by all except
    a.FDI two digit system
    b.anatomic n diagramatic charting
    c.pamer notation
    d.??

    207 Sterile Pyuria present in...
    a.Tb
    b. Chronic hydronephrosis??
    c. Wilm's tumour
    d. Neuroblastoma

    208 parvovirus b19 a/e
    a.<10 % transmitted by blood/placenta
    b.Resp route
    c.its a dna virus
    d.affects erythroid progenitor cells

    209 a mother with 33weeks gestation with sle. drugs not to be administered
    1. sulfadiazine
    2. hydroxychloroquine
    3.prednisolone
    4.methotrexate

    209 mifepristone used in

    a.molar
    b.threatened abortion
    c.fibroid
    Ectopic pregnancy

    210 hematuria in 55 yr old man for past 5 years.. 5 episodes lasting for 4 -5 days.wat will b next best inv to come to diagnosis?
    a.urine exam nd microscopy
    b.x ray kub
    c.abdominal usg
    d.

    211 during TURP surgeon takes care to dissect above verumontenum so as not to injure the
    1.external urethral sphincter
    2.urethral crest
    3.prostatic utricle
    4.? d is sphincter vesicae

    212 least common cause of ambiguous genitalia in female child---
    a.placental steroid sulfatase
    b.fetal aromatase
    c.wt4 mutation
    d.cah

    213 medical treatment for variceal bleed
    a.octreotide
    b.pantaprazole
    c.
    d.
    214 lady 25 yr old presents with high tsh and low t4 .which is most common cause for her illness
    1.hashimotos
    2.graves
    3. pit macroadenoma
    4. pseudohypothyroidism...

    215 vit k carboxylates
    1.aspartate
    2.glutamate
    3.
    4.
    216 false about C.diphtheriae:
    a.toxin producn chromosome mediated
    b.org cnfd by toxin production
    c? toxic to heart and neuron
    d?

    217 stab injury with omentum protrusion in umbilical area ,vitals stable.immediate next step
    1.fast
    2.laparotomy
    3.suturing with wound exploration
    4.cect

    218 The shaded area in graph (showing diabetic cut off n diabetic n non diabetic distribution) is
    a] true +ve
    b] true –ve
    c] false +ve
    d] false –ve

    219 man with maculopapular rash with prev h/o painless rash n genital painless ulcer.diagn is:
    a.treponema pallidum
    b.chlamydia
    c.c.granulomatis
    d.H.ducreyi

    220 false about strep pneumoniae?
    a.capsule aids in infection
    b.commonest cause of o.media and pneumonia
    c. least likely cause of meningitis
    d.bile sensitive

    221 a schizophrenic pt started on haloperidol since 2 days comes with c/o torticollis,orofaciolingual movements. what is the diagnosis
    1. acute dystonia
    2.tardive dyskinesia
    3.parkinsonism
    4.akithisia

    222 no carrier state is seen in?
    1.measels
    2.typhoid
    3. diptheria.
    4.polio

    223 Pt. wt hypothyrodism wt IHD . Wt's d Rx ?
    1.low dose of levothyroxin
    2. normal dose
    3.no levothyroxin
    4.thyroid extract

    224 a primigravida in 1st trimester had sputum positive 4 afb..treatment
    a) deferred to 2nd trimester
    b) cat1
    c)cat2
    d)cat3

    225 A patient had head injury with opening of eyes with stimulation to pain, inappropriate words, and moving limbs what is the score:
    a. 10
    b. 8
    c. 12
    d. 14

    226 Which of the following is true?

    a. Acetylcholinesterase inhibited by malathion can be reversed with increasing levels of acetylcholinesterase
    b. Sulphonilamide inhibits folate reductase irrevesibly.
    c. flouoroacetate competetively inhibits aconitase
    ethenol inhibit aldehd dehydrogenase when used in methanol poisoning

    227 Secondary hemorrhage after how many days of tonsillectomy?
    1: 24 hrs
    2: 6 days
    3: 12 days
    4:12 hrs
    228 Aprepitant is all except
    1. Agonist at NK1
    2. Crosses Blood Brain Barrier
    3. Ameliorate Nausea Vomiting of chemotherapy
    4. Metabolized by CYP450

    229 Buprenorphine is a

    1. Partial agonist at MU Receptor
    2. Partial agonist at Kappa Receptor
    3. Full Agonist at Mu Receptor
    ... antagonist at mu..

    230 blood chimerism is maintained by??
    a) monochorionin dizygotic
    b)dichorionic dizygotic
    c) vaninshin twins
    d) singleton preganancy
    231 crp stands for??
    1.capsular polysaccharide in pneumococcus
    2.
    3.
    4.
    232 features of bstructive azoospermia??
    1.high fsh high testosterone
    2.low fsh high testosterone
    3.normal fsh normal testosterone
    4.

    233 principle mediator of apoptosis?
    1.nucleus
    2.lysosome
    3.mitochondria
    4.?

    234 regarding Leptospirosis.true is
    a.rats only reservoir
    b.fluroquinolones r doc
    c.person to person transmission
    d. oro fecal transmission

    235 5 year old child and burned are of the size of palm is equal to
    1. 1%
    2. 5%
    3. 10%
    4.

    236 Q:All are true about ranalozine except?
    a)causes hypotension
    b)1st line antianginal
    c)hyoglycemic
    D?

    237 true abt sodium fluoride in treatment of otosclerosis?
    1.inhibits osteblastic activity
    2.used in active phase of otosclerosis when schwartz sign positive
    3. has proteolytic activity(bone enzymes)
    4.
    238 wat is true abt ranula
    1.epulis
    2.swelling in floor of mouth
    3.
    4.
    239 A 6 week old male infant was brought in a state of dehydration and shock . Na levels were low 124 k levels 7 meq per l , hyper pigmentation present with normal genitalia . Diagnosis ?
    1.Congenital adrenal hyperplasia
    2.adrenal hmg n shock
    3.Acute gastroenteritis with dehydration
    4.

    240 In pseudohyperparathyroidism what is true ?
    1.Gain of function mutation
    2.Decreased conversion of gtp to gmp
    3.Decreased inositol tri phosph production
    4.no response due to increase c amp

    241 all true except selective estrogen receptor downregulator (serd), fulvestrant
    1. Used for breast cancer
    2. is selective oestrogen antagonist
    3. Is slower acting, safer, more effective than SERM
    ‎4.given as once a month dose

    242 which drug not used to control bleeding while delivery of a woman with heart disease ?
    1.methylergometrime
    2.carboprost
    3.syntocin
    4.misoprostol

    243 not a autoimmune disease outta following??
    1.sle
    2.myasthenia fravis
    3.sickle cell disease
    4.graves disease

    244 treatment wth INH leads to deficiency of ?
    1.thiamine
    2.niacin
    3.pyridoxine
    4.pantothenic acid

    245 surgeon removes a part of liver to the left of falciform legiment. which segment the surgeon has removed
    1. 1 & 4a
    2. 2 & 3
    3. 1 & 4b
    4.
    246 diminished kidney function which is done

    1.N acetylcysteine
    2.fenoldopam
    3.low osmolar contrast
    ...
    247 a patient had running nost and pain over medical aspect of eye foll that the patient developed, chemosis,protosis,diplopia of right eye on abduction with congestion of optic disc. what is the prbable diagnosis?
    1.acute ethmoidal sinusitis
    2.orbital cellulitis
    3.cavernous sinus thrombosis
    4.orbital apex syndrome

    248 which one of the folloeing not used in diagnosis of insulinoma ?
    1.fasting glucose test
    2. d xylose
    3. c peptide levels
    4. insulin /glucose ratio

    249 A young lady presents with fever , dysuria and pain abdomen . Uncomplicated acute cystitis was diagnosed . Which of these is false ?
    1.Nitrate test positive
    2.e coli ct was < 10 power 3
    3.1 pus cell per 7 field
    4.1 bacilli per field

    250 pt with malaria, given primaquine develops hemolysis, diagnosis?
    1.g 6 pd def
    2.glucose 6 phosphate
    3.
    4.

    251. Best investigation for bone metastases?
    a.MRI
    b.CT
    c.bone scan
    d. x ray

    252. CT least accurate for:
    a. 1 cm of aneurysm in hepatic artery
    b.1 cm of lymph node inpara-aortic region
    c.1 cm of pancreas mass in tail
  11. Guest

    Guest Guest

    251 anaesthesia avoided in sickle cell patient...
    a. iv anaesthesia
    b. regional anaes

    252 Pregnancy induced cholestasis marker... is
    a. Bilirubin
    b. Bile salts
    c. Sgot/sgpt
    d. Alp

    253 pt with b/l central loss of vision, normal retinogram.no systemic features. no history of similar complaints in any family members.
    which condition?
    a) best's disease
    b) stargardt's disease
    c) Retinitis pigmentosa
    d) macualr hole

    254 poor prognostic factor for ALL?
    a.hyperdiploidy
    b.t(9;22).....ans
    c.2-8 yrs
    d.?

    255 commonest cause for b/l proptosis in children?
    a.cavernous haemangioma
    b.rhabdomyosarcoma
    c,d?

    256 most reliable radiological sign of pulmonary hypertension-----
    a. descending branch of right pulmonary artery > 16mm
    b. desc of lt pul a. >16mm
    c. lt. Pul a. >16 mm
    d. pul a. >16mm

    257 primi in labour with uterine contractions since last 10 hrs,cx not effaced?;next step?
    a.sedate n observe
    b.syntocin induction
    c.c.s.
    d.?

    258 earliest to be diagnosed by USG?
    a.anencephaly
    b.prosencephaly
    c.meningocele
    d.

    259 An amoebic liver abscess..5cm-5cm Rx of choice
    a. Mz amd antibiotics is choice
    b. Repeated aspiration and antibio
    c. Surgical drainage
    d. Resection of liver

    260 perpuce adhasion 2yr child.rx
    a. adhesiolysis and dilatation
    b. circumscision
    c. dorsal slit

    261 all true except:
    a.human anatomical waste disposed in yellow bag
    b.red bag contents can be source of contamination
    c.black bag for incineration ash
    d.blue bag contents always disposed in secure landfill

    262 not a c/i for pregnancy - wpw syndrome

    263 no carrier state – measels

    264 man with maculopapular rash with prev h/o painless rash.diagn is:
    a.treponema pallidum
    b.chlamydia
    .C.granulomatis
    d.H.ducreyi

    265 false about strep pneumoniae?
    a.capsule aids in infection
    b.commonest cause of o.media and pneumonia
    c.??

    266 Amputation 1st done is
    a. Bone fixing

    267 mineralocorticoid receptor not present in
    a.liver
    b.colon
    c.hippocampus
    d.kidney

    268 pasteurised milk is tested mostly by:
    a.phosphatase test
    b.coliform test

    269 d/o/c for central Diab insipidus?
    a.vasopressin
    b.leuprolide
    c.thiazide

    270 fallopian tube immotility seen in:
    a.churg strauss syndr
    b.kartaganer;s
    c.?d.?

    271 child got cranial sx done ... pituitary got damaged.. which hormone shld b replaced first-
    hydrocort
    thyroxine
    growth hormone

    272 delirium tremens,not seen:
    a.visual hallucination
    b.unconsciousness
    c.coarse tremors
    a. opthalmoplegia

    273 pnt with low Ca,high phosphorus,raised PTH..inv not to be done:
    a.urine microscopy
    b.PTH levels
    c.vit D levels
    d.??

    274 miglitinides all are true except
    1decreases post parendial hyperglycemia
    2 hypoglycemia less than sulfonylurease
    3 it decreases insulin resistance ans it's (thiazolidinedions acts as insulin sensitizer)
    4 it acts by releasing insulin (yes just like sulfonylurease but less hypoglycemia)

    275 Pearson's skewness coefficients
    a. (Mean-median)/sd
    b. Median-mean/sd
    c. Sd/mean-median
    d. Sd/median-mean

    276.Question about contrast used in imaging
    Test dose to be given

    277.Test for milk
    phospatase test
    indole test

    278.child with seizure within 16hrs of birth
    hypoglycemia
    hypocalcemia

    279. Gun powder can
    UV lightANS
    IR light
  12. Guest

    Guest Guest

    A 5 year old boy while having dinner suddenly becomes aphonic and is brought to the casulty for the complaint of respiratory difficulty. what should be the next appropriate treatment:-
    1) cricothyroidotomy
    2) emergency tracheostomy
    3) humidified oxygen
    4) Hemlich maneouvre

    Ans is Emergency tracheostomy

    heimlich's maneuver is not tried in partial or incomplete obstruction as it can cause complete obstruction.
    Cricothyrotomy is performed as an intervention of choice in complete obstruction and when there are no or minimal surgical instruments available.

    Emergency tracheostomy followed by removal of foriegn body by direct laryngoscopy is the procedure to be followed.

    there is no point of doing tracheostomy if the thing can be managed with lessor invasive procedure

    "Chocking" redirects here. For the mechanical tool, see Wheel chock.
    For the act of compressing someone's neck, see Strangling. For other uses, see Choke.
    Choking
    Classification and external resources
    ICD-10 F41.0, R06.8, T17, W78-W80
    ICD-9 784.9, 933.1
    MeSH D000402

    Choking is the mechanical obstruction of the flow of air from the environment into the lungs. Choking prevents breathing, and can be partial or complete, with partial choking allowing some, although inadequate, flow of air into the lungs. Prolonged or complete choking results in asphyxia which leads to anoxia and is potentially fatal. Oxygen stores in the blood and lungs keep the victim alive for several minutes after breathing is stopped completely.

    Choking can be caused by:

    * Physical obstruction of the airway by a foreign body.
    * Respiratory diseases that involve obstruction of the airway.
    * Compression of the laryngopharynx, larynx or trachea in strangulation.

    Contents

    * 1 Choking in non-humans
    * 2 Foreign objects
    * 3 Symptoms and clinical signs
    * 4 Treatment
    o 4.1 Encouraging the victim to cough
    o 4.2 Back slaps
    o 4.3 Abdominal thrusts
    + 4.3.1 Self treatment with abdominal thrusts
    o 4.4 Modified chest thrusts
    o 4.5 Finger sweeping
    o 4.6 Direct vision removal
    * 5 CPR
    * 6 Notable victims
    * 7 Other uses of abdominal thrusts
    * 8 References
    * 9 External links

    Choking in non-humans
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    Foreign objects

    The type of choking most commonly recognised as such by the public is the lodging of foreign objects (also known as foreign bodies, but consisting of any object which comes from outside the body itself, including food, toys or household objects) in the airway.

    This type of choking is often suffered by small children, who are unable to appreciate the hazard inherent in putting small objects in their mouth. In adults, it mostly occurs whilst the patient is eating. In one study, peanuts were the most common obstruction.

    Symptoms and clinical signs

    * The person cannot speak or cry out, or has great difficulty and limited ability to do so.
    * Breathing, if possible, is labored, producing gasping or wheezing.
    * The person has a violent and largely involuntary cough, gurgle, or vomiting noise, though more serious choking victims will have a limited (if any) ability to produce these symptoms since they require at least some air movement.
    * The person desperately clutches his or her throat or mouth, or attempts to induce vomiting by putting their fingers down their throat.
    * If breathing is not restored, the person's face turns blue (cyanosis) from lack of oxygen.
    * The person does any or all of the above, and if breathing is not restored, then becomes unconscious.

    Treatment

    Choking can be treated with a number of different procedures, with both basic techniques available for first aiders and more advanced techniques available for health professionals.

    Many members of the public associate abdominal thrusts, also known as the Heimlich Maneuver with the correct procedure for choking, which is partly due to the widespread use of this technique in movies, which in turn was based on the widespread adoption of this technique in the United States at the time.

    Most modern protocols (including those of the American Heart Association and the American Red Cross, who changed policy in 2006[5] from recommending only abdominal thrusts) involve several stages, designed to apply increasingly more pressure.

    The key stages in most modern protocols include:
    Encouraging the victim to cough

    This stage was introduced in many protocols as it was found that many people were too quick to undertake potentially dangerous interventions, such as abdominal thrusts, for items which could have been dislodged without intervention. Also, if the choking is caused by an irritating substance rather than an obstructing one, and if conscious, the patient should be allowed to drink water on their own to try to clear the throat. Since the airway is already closed, there is very little danger of water entering the lungs. Coughing is normal after most of the irritant has cleared, and at this point the patient will probably refuse any additional water for a short time.
    Back slaps

    The majority of protocols now advocate the use of hard blows with the heel of the hand on the upper back of the victim. The number to be used varies by training organization, but is usually between five and twenty.

    The back slap is designed to use percussion to create pressure behind the blockage, assisting the patient in dislodging the article. In some cases the physical vibration of the action may also be enough to cause movement of the article sufficient to allow clearance of the airway.

    Almost all protocols give back slaps as a technique to be used prior to the consideration of potentially damaging interventions such as abdominal thrusts, but Henry Heimlich, noted for promulgating abdominal thrusts, wrote in a letter to the New York Times that back slaps were proven to cause death by lodging foreign objects in to the windpipe.

    The findings of a 1982 Yale study by Day, DuBois, and Crelin that "persuaded the American Heart Association to stop recommending back blows for dealing with choking...was partially funded by Heimlich's own foundation." According to Roger White MD of the Mayo Clinic and American Heart Association (AHA), "There was never any science here. Heimlich overpowered science all along the way with his slick tactics and intimidation, and everyone, including us at the AHA, caved in."

    Abdominal thrusts
    A demonstration of abdominal thrusts

    Abdominal thrusts, also known as the Heimlich Maneuver (after Henry Heimlich, who first described the procedure in a June 1974 informal article entitled "Pop Goes the Cafe Coronary", published in the journal Emergency Medicine). Edward A. Patrick, MD, PhD, an associate of Heimlich, has claimed to be the uncredited co-developer of the procedure. Heimlich has objected to the name "abdominal thrusts" on the grounds that the vagueness of the term "abdomen" could cause the rescuer to exert force at the wrong site.

    Performing abdominal thrusts involves a rescuer standing behind a patient and using their hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it. This amounts to an artificial cough.

    Due to the forceful nature of the procedure, even when done correctly it can injure the person on whom it is performed. Bruising to the abdomen is highly likely and more serious injuries can occur, including fracture of the xiphoid process or ribs.

    In some areas, such as Australia, authorities believe that there is not enough scientific evidence to support the use of Abdominal thrusts and their use is not recommended in first aid.

    Self treatment with abdominal thrusts

    A person may also perform abdominal thrusts on themselves by using a fixed object such as a railing or the back of a chair to apply pressure where a rescuer's hands would normally do so. As with other forms of the procedure, it is possible that internal injuries may result.
    [edit] Modified chest thrusts

    A modified version of the technique is sometimes taught for use with pregnant and/or obese patients. The rescuer places their hand in the center of the chest to compress, rather than in the abdomen.

    Finger sweeping

    The American Medical Association advocates sweeping the fingers across the back of the throat to attempt to dislodge airway obstructions, once the choking victim becomes unconscious

    Some protocols advocate the use of the rescuer's finger to 'sweep' foreign objects away once they have reached the mouth.[citation needed] However, many modern protocols recommend against the use of the finger sweep as if the patient is conscious, they will be able to remove the foreign object themselves, or if they are unconscious the rescuer should simply place them in the recovery position (where the object should fall out due to gravity). There is also a risk of causing further damage (for instance inducing vomiting) by using a finger sweep technique.

    Direct vision removal

    The advanced medical procedure to remove such objects is inspection of the airway with a laryngoscope or bronchoscope, and removal of the object under direct vision, followed by CPR if the patient does not start breathing on their own. Severe cases where there is an inability to remove the object may require cricothyrotomy.

    CPR

    In most protocols, once the patient has become unconscious, the emphasis switches to performing CPR, involving both chest compressions and artificial respiration. These actions are often enough to dislodge the item sufficiently for air to pass it, allowing gaseous exchange in the lungs.

    Notable victims

    * United States President George W. Bush survived choking on a pretzel on January 13, 2002, receiving major media coverage.
    * Jimmie Foxx, a famous Major League Baseball player, died by choking on a bone.
    * Tennessee Williams, the playwright, died after choking on a bottle cap.
    * An urban legend states that obese singer Mama Cass choked to death on a ham sandwich. This was borne out of a quickly discarded speculation by the coroner, who noted a partly eaten ham sandwich and figured she may have choked to death. In fact, she died of a heart condition, often wrongly referred to in the media as heart failure but specified on her death certificate as fatty myocardial degeneration.
    * The Queen Mother was admitted to a UK Hospital for an operation in May 1993 after choking on a fish bone.

    Other uses of abdominal thrusts

    Dr. Heimlich also advocates the use of the technique as a treatment for drowning and asthma attacks, but Heimlich's promotion to use the maneuver to treat these conditions resulted in marginal acceptance. Criticism of these uses has been the subject of numerous print and television reports which resulted from an internet and media campaign by his son, Peter M. Heimlich, who alleges that in August 1974 his father published the first of a series of fraudulent case reports in order to promote the use of abdominal thrusts for near-drowning rescue.
  13. Guest

    Guest Guest

    A 35 year old female has proximal weakness of muscles, repeated ptosis and east fatiguability. The best test to diagnose her condition is:
    1) Muscle biopsy
    2) CPK
    3) Edrophonium test
    4) EMG
    Answer: Edrophonium test.
    Explanation: Muscle biops, EMG and CPK are primarily used for diagnosis of inflammatory myopathies e.g. polymyositis, inclusion body myositis. Here the clinical picture is clearly of MG, which most common presentataion is extraocular muscle palsies. Plus inflammtory myopathies usually spare extraocular muscles. BUT proximal muscle weakness is included in the syndrome of myapthic muscle weakness. Anyways, I think what they wanted is to focus on how to distinguish between MG and inflammatory myopathies using a single test and not a diagnostic test. So the answer is Edrophonium which will help us to clarify it in a split second( figuratively) Edrophonium Positive=MG, negative, test further for myopathies.


    What are the methods for diagnosing Myasthenia Gravis and how long do they take to perform?

    The initial diagnostic exam for Myasthenia Gravis includes the following:

    * Evaluation begins with examination by a neurologist. 1 hour.
    * " Tensilon test. (A Tensilon test is positive in many patients who have MG, but may actually be negative in 20-30% patients with MG diagnosed by other methods.) 15-30 minutes in the physician's office.
    * Acetylcholine receptor antibodies (a blood test). Acetylcholine receptor antibodies are positive in 90% of patients with general myasthenia. The results usually take a week to return from the laboratory.
    * EMG (electromyogram) is a test to determine the electrical response from the muscle after stimulation of the nerve. 1 hour.

    ans: EMG

    An additional test is:

    * Single-fiber EMG. This test is only performed at specialized centers. The exam itself takes 1-3 hours to perform. A single fiber EMG is considered the best test, being positive in 95-99% of MG patients.

    In rare patients all these tests are normal, but examination by a neurologist suggest Myasthenia Gravis. If the disease is mild or purely ocular (symptoms of the eye muscles), then the tests are more frequently negative then in the case of the generalized disease.
  14. Guest

    Guest Guest

    Q: which is NOT a definite airway
    a. nasotracheal tube
    b. orotracheal tube
    c. LMA......ANS
    d. cricothyroidtomy..

    Ref:
    A definitive airway can be: an endotracheal tube, an nasotracheal tube, or a surgical airway (cricothroidotomy).

    The need for a definitive airway is based upon a number of clinical findings:
    the presence of apnea
    inability to maintain a patent airway by less invasive means
    need to protect the lower airway from aspiration of blood or vomitus
    impending or potential airway compromise (following inhalational injury, facial fractures, retroparygeal hematoma or sustained seizure activity)
    presence of a closed head injury requiring assisted ventilation
    inability to maintain adequate oxygenation by face mask oxygen supplementation
    any patient with a Glasgow coma score of 8 or less
  15. Guest

    Guest Guest

    17. Which is not a neural tumor ?
    1. Ependymoma
    2. Neuroblastoma
    3. Gangliocytoma
    4. Ganglioglioma
    Answer CONTROVERSIAL (cant ans be neuroblastoma,neuroendocrine tumor)

    Neuroblastoma is the most common extracranial solid cancer in childhood and the most common cancer in infancy, with an annual incidence of about 650 new cases per year in the US. Close to 50 percent of neuroblastoma cases occur in children younger than two years old. It is a neuroendocrine tumor, arising from any neural crest element of the sympathetic nervous system or SNS.

    REF Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. pp. 1406.
    Ganglioglioma is a tumour that arises from ganglion cells in the central nervous system.
    The term "gangliocytoma" is sometimes equated with ganglioglioma. However, it is also sometimes equated with ganglioneuroma. The term "gangliocytoma" is sometimes used to imply that the tumor is entirely neuronal.
  16. Guest

    Guest Guest

    Q-Epileptic potential is present in
    A. Desflurane
    B. Halothane
    C. Sevoflurane
    D. Ether
    Best Ans-Sevoflurane

    • SEVOFLURANE, ISOFLURANE, ENFLURANE Have epileptic potential.

    • "ISOLATED EPILEPTIFORM PATTERNS SOMETIMES CAN BE SEEN DURING INTERSUPPRESSION ACTIVITY AT 1.5 TO 2 MAC ISOFLURANE. SEVOFLURANE CAUSES SIMILAR DOSE-DEPENDENT EEG EFFECTS. EQUI-MAC CONCENTRATIONS OF SEVOFLURANE AND ISOFLURANE CAUSE SIMILAR EEG CHANGES.
    • EPILEPTIFORM ACTIVITY HAS BEEN INDUCED BY ADMINISTRATION OF SEVOFLURANE IN PATIENTS WITHOUT EPILEPSY, AND SEIZURE ACTIVITY ON EEG, BUT NOT CLINICAL SEIZURE ACTIVITY, HAS BEEN REPORTED IN PEDIATRIC PATIENTS WITH A HISTORY OF EPILEPSY DURING INDUCTION OF ANESTHESIA WITH SEVOFLURANE.
    • DESPITE THESE OBSERVATIONS, SEVOFLURANE, SIMILAR TO OTHER INHALATION AGENTS, IS NOT SUITABLE FOR USE DURING ELECTROCORTICOGRAPHY FOR LOCALIZATION OF SEIZURE FOCI.
    • EEG PATTERNS SEEN WITH ENFLURANE ARE SIMILAR TO THE PATTERNS SEEN WITH ISOFLURANE EXCEPT THAT EPILEPTIFORM ACTIVITY IS CONSIDERABLY MORE PROMINENT.
    • At 2 to 3 MAC, burst suppression is seen, but virtually all intersuppression activity consists of large spike/wave pattern discharges. Hyperventilation with high concentrations of enflurane increases the length of suppression, decreases the duration of bursts, but increases the amplitude and main frequency component of the intersuppression epileptiform activity. Frank EEG seizures also may occur with enflurane that produce the same cerebral metabolic effects as pentylenetetrazol, a known convulsant.
    • Halothane also produces EEG patterns similar to those of isoflurane, but dosages of halothane that would produce burst suppression in the EEG (3 to 4 MAC) are associated with profound cardiovascular toxicity.
    • Desflurane produces EEG changes similar in nature to equi-MAC concentrations of isoflurane. In limited clinical studies,
    • THERE HAS BEEN NO EVIDENCE OF EPILEPTIFORM ACTIVITY WITH DESFLURANE, DESPITE HYPERVENTILATION AND 1.6 MAC DOSAGE,[219] AND DESFLURANE HAS BEEN USED AS A TREATMENT OF REFRACTORY STATUS EPILEPTICUS.

    • “SEIZURES OCCUR DURING INDUCTION OF ANESTHESIA WITH HIGH CONCENTRATIONS OF SEVOFLURANE IN CHILDREN, INCLUDING THOSE WITHOUT A RECOGNIZED SEIZURE DIATHESIS.
    • IN TWO HEALTHY HUMAN SUBJECTS, EEG BURST SUPPRESSION WITH 2 MAC SEVOFLURANE WAS ACCOMPANIED BY EPILEPTIFORM DISCHARGES THAT WERE OBSERVED DURING EEG MONITORING.
    • These discharges were associated with a significant increase in CBF, thus demonstrating that flow-metabolism coupling was preserved. In patients with temporal lobe epilepsy, administration of 1.5 MAC sevoflurane elicited widespread paroxysmal interictal EEG activity. Of note was the observation that paroxysmal activity was not restricted to the ictal focus and that the administration of sevoflurane was not of any assistance in localization of the epileptogenic region of the brain.
    • The development of tonic-clonic movements indicative of seizure activity has also been reported in otherwise healthy patients on emergence from sevoflurane anesthesia. In all of the reported cases of seizure activity attributable to sevoflurane anesthesia, untoward sequelae have not been documented. These reports highlight sevoflurane's ability, albeit small, to evoke epileptiform activity, and accordingly, the use of sevoflurane in patients with epilepsy should be undertaken with appropriate caution.â€
    ----------------- Miller's Anesthesia

    • “Potential for cerebral toxicity has been studied for sevoflurane as compared to halothane. At
    • normal CO2 and blood pressure no evidence of sevoflurane toxicity exists.

    • With extreme hyperventilation to decrease cerebral blood flow by half, brain lactate levels increase, but significantly less than with halothane. There are conflicting data as to whether sevoflurane has a proconvulsant effect.
    • High, long-lasting concentrations of sevoflurane (1.5 to 2.0 MAC), a sudden increase in cerebral sevoflurane concentrations, and hypocapnia can trigger EEG abnormalities that often are associated with increases in heart rate in both adults and
    • children. This has raised the question as to the appropriateness of sevoflurane in patients with epilepsy.â€

    • “Sevoflurane has the potential for toxicity, since it can be converted to toxic agents; however, the concentration of these agents is normally below
    • the toxic threshold. Sevoflurane has been shown to be a useful alternative to halothane for
    • p ediatric induction, however there are reports of epileptiform discharges in patients given sevoflurane at induction doses (1.5 to 2 MAC).â€
    ---------- Barash, Paul G.; Cullen, Bruce F.; Stoelting, Robert K.
    Clinical Anesthesia, 5th Edition
    Lippincott Williams & Wilkins

    Drug issues
    The following anaesthetic and allied drugs should be used with caution in epileptics:
    -----oxford anasthesia
  17. Guest

    Guest Guest

    1. Most common nerve injured in supracondylar fracture humerus?
    a. Median
    b. Radial
    c. Ulnar
    d. Anterior interosseus nerve
    Ans: D
    The Mnemonic for the order of nerves injured in Supracondylar fracture is AMRU
    That is:
    Ant . Interosseus Nerve> Median > Radial >Ulnar

    2. Earliest symptom of GERD in an infant is?
    A. Respiratory distress answer
    B. Upper GI bleed
    C. regurgitation
    D.obstruction

    Ans: C REGURGITATION....
    Reference from Nelson Pediatrics
    Infantile reflux manifests more often with regurgitation (especially postprandially), signs of esophagitis (irritability, arching, choking, gagging, feeding aversion), and resulting failure to thrive; symptoms resolve spontaneously in the majority by 12–24 mo. Older children, in contrast, may have regurgitation during the preschool years; complaints of abdominal and chest pain supervene in later childhood and adolescence. Occasional children present with neck contortions (arching, turning of head) designated Sandifer syndrome. The respiratory presentations are also age dependent: GERD in infants may manifest as obstructive apnea or as stridor or lower airway disease in which reflux complicates primary airway disease such as laryngomalacia or bronchopulmonary dysplasia. Otitis media, sinusitis, lymphoid hyperplasia, hoarseness, vocal cord nodules, and laryngeal edema have all been associated with GERD. In contrast, airway manifestations in older children are more frequently related to asthma or to otolaryngologic disease such as laryngitis or sinusitis.

    3. Basal metabolic rate is closely associated with?
    A. Lean body mass
    B. Body surface area
    C. Body mass index
    D. Body weight
    Ans: A Lean Body mass (REPEAT...shall not spend much time on repeats)

    4. A girl presented with recurrent occipital headache associated with ataxia and vertigo. Mother also has similar complaints. Most probable diagnosis is?
    A. Vestibular neuronitis
    B. Basillar migraine
    C. TIA
    D. –
    Ans: b Basilar migraine(REPEAT)

    5. Drug of choice for central Diabetes Insipidus is?
    a. Desmopressin
    b. Leuperolide
    c. Thiazide diuretics
    d. –
    Ans: A Desmopressin
    Reference: Harrispn 17th ed
    The signs and symptoms of uncomplicated pituitary DI can be eliminated completely by treatment with desmopressin (DDAVP), a synthetic analogue of AVP (Fig. 334-1). It acts selectively at V2 receptors to increase urine concentration and decrease urine flow in a dose-dependent manner (Fig. 334-4). It is also more resistant to degradation than AVP and has a three- to fourfold longer duration of action. Desmopressin (DDAVP) can be given by IV or SC injection, nasal inhalation, or oral tablet.

    6. A 32 year old mountaineer has a hematocrit of 70%. What is the possible explanation?
    A. Polycythemia with relative dehydration
    B. High altitude cerebral oedema
    C. High altitude pulmonary oedema
    D. Hemodilution

    Ans.A Polycythemia and relative dehydration

    Reference:Harrison 17th ed
    Polycythemia can be spurious (related to a decrease in plasma volume; Gaisbock's syndrome), primary, or secondary in origin. The secondary causes are all associated with increases in EPO levels: either a physiologically adapted appropriate elevation based on tissue hypoxia (lung disease, high altitude, CO poisoning, high-affinity hemoglobinopathy) or an abnormal overproduction (renal cysts, renal artery stenosis, tumors with ectopic EPO production). A rare familial form of polycythemia is associated with normal EPO levels but hyperresponsive EPO receptors due to mutations

    7. Tetracycline is used in the prophylaxis of which of the following diseases?
    a. Cholera
    b. Brucellosis
    c. Leptospirosis
    d. Meningitis
    Ans: a Cholera
    Reference:Goodman Gilman and Harrison 17th ed
    Doxycycline (300 mg as a single dose) is effective in reducing stool volume and eradicating Vibrio cholerae from the stool within 48 hours. Antimicrobial agents, however, are not substitutes for fluid and electrolyte replacement in this disease. In addition, some strains of V. cholerae are resistant to tetracyclines.

    8. A 7 month old child has bouts of cough ending with a whoop. What is the best way to confirm the diagnosis?
    A. Nasophayngeal swab
    B. Cough plate culture
    C. Tracheal aspirate
    D. –

    Ans: a Nasopharyngeal swab
    Harrison 17th ed

    The diagnosis is Pertusis and we have to find the best specimen to confirm the diagnosis.

    Culture of nasopharyngeal secretions remains the gold standard of diagnosis, although DNA detection by polymerase chain reaction (PCR) is replacing culture in many laboratories because of increased sensitivity and quicker results. The best specimen is collected by nasopharyngeal aspiration, in which a fine flexible plastic catheter attached to a 10-mL syringe is passed into the nasopharynx and withdrawn while gentle suction is applied.

    9. Aflatoxin is produced by?
    A. Aspergillus flavus
    B. Aspergillus niger
    C. Candida
    D. –

    Ans: a Aspergillus Flavus

    MYCOTOXINS
    Many fungi produce poisonous substances called mycotoxins that can cause acute or chronic intoxication and damage. The mycotoxins are secondary metabolites, and their effects are not dependent on fungal infection or viability. A variety of mycotoxins are produced by mushrooms (eg, amanita species), and their ingestion results in a dose-related disease called mycetismus. Cooking has little effect on the potency of these toxins, which may cause severe or fatal damage to the liver and kidney. Other fungi produce mutagenic and carcinogenic compounds that can be extremely toxic for experimental animals. One of the most potent is aflatoxin, which is elaborated by Aspergillus flavus and related molds and is a frequent contaminant of peanuts, corn, grains, and other foods.

    10. Most important prognostic factor in congenital diaphragmatic hernia?
    A. Pulmonary hypertension
    B. Timing of surgery
    C. Size of defect
    D. –

    Ans: A Pulmonary hypertension

    Reference: Nelson 18th ed

    Overall survival of live-born infants is 67%. The incidence of spontaneous fetal demise with CDH diagnosis is 7–10%. Relative predictors of a poor prognosis include an associated major anomaly, symptoms before 24 hr of age, severe pulmonary hypoplasia, herniation to the contralateral lung, and the need for ECMO.
    Serious sequelae include pulmonary function changes, neurodevelopmental delays, and growth retardation. Pulmonary problems continue to be a source of morbidity for long-term survivors of CDH. Children receiving CDH repair studied at 6–11 yr of age demonstrate significant decreases in forced expiratory flow at 50% of vital capacity and decreased peak expiratory flow. Both obstructive and restrictive patterns can occur. Those without severe pulmonary hypertension and barotrauma do the best. Those at highest risk include children who required ECMO and patch repair, but the data clearly show that non-ECMO CDH survivors also require frequent attention to pulmonary issues. At discharge, up to 20% of infants require oxygen, but only 1–2% require it past 1 yr of age.
  18. Guest

    Guest Guest

    11. A surgeon removed the part of liver to the left of the falciform ligament. Which segments have been removed?
    A. 1 & 4a
    B. 2 & 3
    C. 1 & 4b
    D. 5 & 6
    Ans: B 2 & 3(REPEAT)

    Reference: Sabiston 18th ed
    Resection of segments II and III is a commonly performed sublobar resection and is often referred to as a left lateral segmentectomy and left lateral sectionectomy or left lobectomy.Left lobe is that part of liver to the left of the falciform ligament.

    12. Punnett square is used for
    a. Finding genotype of offspring
    b. Statistical analysis
    c. –
    d. –

    Ans:a Finding the genotype of the offspring
    Reference: The Tennessee Gateway Science
    Punnett square is a Diagram used to identify possible combinations of recessive and dominant alleles in OFFSPRING.To create a punnette square divide a suare into 4 parts and write the letters that represent the alleles of one parent on top of the suare and the alleles of the other parent on the side of the square..Just like we make a 2X2 table for statistics questions.Combine the allele of one parent with the other and work out the 4 possible combinations.The punnett square does not give the exact information about the offspring but instead gives the probability.

    13. Cavitation is seen in?
    A. Mycolplasma pneumonia
    B. Tuberculous pneumonia
    C. Streptococcal pneumonia
    D.Staphylococcus pneumonia

    Ans: D Staphylococcal Pneumonia(REPEAT)

    14. In PSUDOHYPOPARATHYROIDISM true is?(NEED FINETUNING OF STEM)
    a. Decreased cAMP
    b. Decreased IP3
    c. Increased gtpas activity/Gain of function mutation in GTPase
    d.---

    Ans:a Decreased cAMP

    Reference: Harrisson 17th ed
    Individuals with Pseudohypoparathyroidism 1, the most common of the disorders, show a deficient urinary cyclic AMP response to administration of exogenous PTH. Patients with PHP-I are divided into type a, with AHO and reduced amounts of Gs in in vitro assays with erythrocytes, and type b, lacking AHO and with normal amounts of Gs in erythrocytes. There is a third type (PHP-Ic, reported in a few patients) that differs from PHP-Ia only in having normal erythrocyte levels of Gs despite having AHO, hypocalcemia, and decreased urinary cyclic AMP responses to PTH (presumably with a post-Gs defect in adenyl cyclase stimulation).
    Difference between follicular carcinoma and follicular adenoma is?
    A. Vascular invasion
    B. Mitosis
    C. Nuclear pleomorphism
    D. Tubule formation
    Ans: a Vacular invasion (REPEAT)

    15. Antidepressant drug that can be used in nocturnal eneuresis?
    A. Imipramine
    B. Fluoxamine
    C.
    D.
    Ans: A Imipramine
    Reference: Kaplan Saddock Psychiatry
    Imipramine (Tofranil) is efficacious and has been approved for use in treating childhood enuresis, primarily on a short-term basis. Initially, up to 30 percent of patients with enuresis stay dry, and up to 85 percent wet less frequently than before treatment. The success often does not last, however, and tolerance can develop after 6 weeks of therapy. Once the drug is discontinued, relapse and enuresis at former frequencies usually occur within a few months. The drug's adverse effects, which include cardiotoxicity, are also a serious problem.

    17. A female patient presented with depressed mood, loss of appetite and no interest in surroundings. There is associated insomnia. The onset of depression was preceeded by a history of business loss and immediately soon after it she developed the followiung symptoms for the past 1yr . True is?
    A. No treatment is necessary as it is due to business loss
    B. SSRI is the most efficacious of the available drugs
    C. Start SSRI treatment based on side effect profile
    D. Combination therapy of 2 anti depressant drugs

    Ans:C Treatment is started based on the side effect profile

    Reference:Kaplan and Saddock

    Initial Medication Selection
    The available antidepressants do not differ in overall efficacy, speed of response, or long-term effectiveness. Antidepressants, however, do differ in their pharmacology, drug drug interactions, short- and long-term side effects, likelihood of discontinuation symptoms, and ease of dose adjustment. Failure to tolerate or to respond to one medication does not imply that other medications will also fail. Selection of the initial treatment depends on the chronicity of the condition, course of illness (a recurrent or chronic course is associated with increased likelihood of subsequent depressive symptoms without treatment), family history of illness and treatment response, symptom severity, concurrent general medical or other psychiatric conditions, prior treatment responses to other acute phase treatments, potential drug drug interactions, and patient preference. In general, approximately 45 to 60 percent of all outpatients with uncomplicated (i.e., minimal psychiatric and general medical comorbidity), nonchronic, nonpsychotic major depressive disorder who begin treatment with medication respond (i.e., achieve at least a 50 percent reduction in baseline symptoms); however, only 35 to 50 percent achieve remission (i.e., the virtual absence of depressive symptoms).

    18. An Infant is brought to casualty with reports of violent shaking by parents. Most characteristic injury is?
    A. Long bone fracture answer
    B. Ruptured spleen
    C. Subdural hematoma
    D. Skull bone fracture

    Ans: Subdural hematoma

    Reference: Forensic Medicine By Reddy

    Under the Topic Battered Baby syndrome Reddy talks about SUBDURAL HEMATOMA being the MOST CHARACTERISTIC FEATURE of violent shaking of an infant by the Parent...Its called INFANTILE WHIPLASH SYNDROME....In Battered baby syndrome multiple Long bone fractures at various stages of healing may be seen and not in infantile whiplash syndrome..

    19. Gun powder on clothing can be visualized by?
    A. Magnifying lens
    B. UV rays
    C. Infrared rays
    D. Dye
    Ans: B UV Rays (REPEAT)

    20. Capsular antibody protection is seen in all except?
    A. Neisseria meningitidis
    B. Pneumococcus
    C. Bordetella pertussis
    D. Haemophilus influenza

    Ans: C Bordetella pertusis

    Reference: Harrison 17th ed
    B. pertussis produces a wide array of toxins and biologically active products that are important in its pathogenesis and in immunity. Most of these virulence factors are under the control of a single genetic locus that regulates their production, resulting in antigenic modulation and phase variation. Although these processes occur both in vitro and in vivo, their importance in the pathobiology of the organism is unknown; they may play a role in intracellular persistence and person-to-person spread. The organism's most important virulence factor is pertussis toxin, which is composed of a B oligomer–binding subunit and an enzymatically active A protomer that ADP-ribosylates a guanine nucleotide-binding regulatory protein (G protein) in target cells, producing a variety of biologic effects. Pertussis toxin has important mitogenic activity, affects the circulation of lymphocytes, and serves as an adhesin for bacterial binding to respiratory ciliated cells. Other important virulence factors and adhesins are filamentous hemagglutinin, a component of the cell wall, and pertactin, an outer-membrane protein. Fimbriae, bacterial appendages that play a role in bacterial attachment, are the major antigens against which agglutinating antibodies are directed. These agglutinating antibodies have historically been the primary means of serotyping B. pertussis strains. Other virulence factors include tracheal cytotoxin, which causes respiratory epithelial damage; adenylate cyclase toxin, which impairs host immune-cell function; dermonecrotic toxin, which may contribute to respiratory mucosal damage; and lipooligosaccharide, which has properties similar to those of other gram-negative bacterial endotoxins.
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    21. Signature fracture refers to?
    A. Depressed skull fracture
    B. Suture displacement fracture
    C. Contrecoup injury
    D. Fracture at foramen magnum
    Ans: Depressed fracture (REPEAT) I don’t think the question needs an explanation

    22. Which among the following is most frequently seen in anti phospholipid antibody syndrome?(Pls CORRECT Q)
    A. Beta 2 microglobulin antibody
    B. Anti nuclear antibody
    C. Anti centromere antibody
    D. Anti beta 2 glycoprotein antibody

    Ans: D Anti beta 2 GP Ab
    The antiphospholipid antibody syndrome (APS) may be defined as the occurrence of arterial or venous thrombosis or recurrent miscarriage in association with laboratory evidence of persistent antiphospholipid antibody. The antibody may manifest itself as either a lupus anticoagulant detected by clotting tests or an anticardiolipin antibody (ACA) detected by immunoassay. The syndrome may be associated with an autoimmune disorder, especially SLE (secondary), or may occur independently of other autoimmune disorders (primary). A large proportion of antiphospholipid antibodies are actually directed against complexes of phospholipid with protein, most notably beta-2-glycoprotein I. The ACA immunoassay detects both these clinically significant antibodies and antibodies directed purely against cardiolipin and not beta-2-glycoprotein I. The latter antibodies are transient, and are often associated with infection but not thrombosis. A positive anti-b2 GPI assay is evidence in favor of APS, once persistence is demonstrated by repeating the assay after eight weeks.

    23. What factor is responsible for deciding whether an antibody will remain membrane bound or get secreted?
    A. RNA splicing
    B. Class switching
    C. Differential RNA processing
    D. Allelic exclusion
    Ans: C Differential RNA Processing(REPEAT)

    24. Blood Chimerism is associated with?
    A. Monochorionic monoamniotic twins
    B. Monochorionic diamniotic twins
    C. Singleton pregnancy
    D. Vanishing twin

    Ans: B Monochorionic diamniotic twins (no doubt if these were the options)
    Explanation: Reference:
    “ Journal Ref: Blood Chimerism in a Dizygotic Dichorionic Pregnancyâ€

    “Blood chimerism in monochorionic twins conceived by induced ovulation: Case reportâ€
    Journal says “ Blood chimerism “is more common in monochorionic dizygotic(MCDZ)twins and rare in dichorionic twins
    “Cases in which a monochorionic placenta occurs in a twin pregnancy,vascular anstomosis is well described and can lead to blood chimerism as well as twin twin transfusion syndrome.In contrast interplacental vascular communications occur only with very rare exceptions in a dichorionic placentaâ€

    25. In expectant management of placenta praevia, all are done except?
    A. Cervical encirclage
    B. Anti D
    C. Corticosteroids
    D. Blood transfusion
    Ans: a Cervical encirclage
    Reference: Williams Obstetrics
    The treatment of classical cervical incompetence is cerclage. The operation is performed to surgically reinforce
    the weak cervix by some type of purse-string suturing. Bleeding, uterine contractions, or ruptured membranes are usually contraindications for cerclage.

    26. Which drug is not used during delivery in a woman with rheumatic heart disease ?
    A. Methylergometrine
    B. Carboprost
    C. Syntocin
    D. Misoprostol
    Ans: A Methylergometrine(REPEAT)

    27. Which is not an autoimmune disease?
    A. SLE
    B. Grave's disease
    C. Myasthenia gravis
    D. Sickle cell disease
    Ans: D Sickle Cell Disease(I don’t think an explanation is needed..Sickle cell ds is a hemoglobinopathy and not an autoimmune ds)

    28. All are true regarding selective estrogen receptor downregulator (SERD),fulvestrant except?
    A. Used for breast cancer
    B. Is a selective oestrogen antagonist
    C. Is slower acting, safer, LESS effective than SERM
    D. Given as once a month im dose
    Ans: C Its slower acting and less efficacious than SERM
    Reference:This Question has been taken line to line from Goodman Gilman Pharmacology as u will see below:
    Fulvestrant
    Fulvestrant (FASLODEX) is the first FDA approved agent in the new class of estrogen-receptor downregulators, which were hypothesized to have an improved safety profile, faster onset, and longer duration of action than the SERMs due to their pure ER antagonist activity (Robertson, 2002). Fulvestrant was approved in 2002 for postmenopausal women with hormone receptor-positive metastatic breast cancer that has progressed despite antiestrogen therapy.
    Mechanism of Action
    Fulvestrant is a steroidal antiestrogen that binds to the ER with an affinity more than 100 times that of tamoxifen, inhibits its dimerization, and increases its degradation.
    Preclinical studies suggest that as a consequence of this ER "downregulation," ER-mediated transcription is abolished, completely suppressing the expression of estrogen-dependent genes (Howell et al., 2004b). This difference in the activity of fulvestrant likely explains why fulvestrant demonstrates efficacy against tamoxifen-resistant breast cancer.
    However, the hypothesis that fulvestrant provides more effective antiestrogen activity than tamoxifen was not confirmed by a clinical trial comparing fulvestrant (250 mg intramuscularly monthly) with tamoxifen (20 mg orally daily) as first-line therapy in metastatic breast cancer (Howell et al., 2004a).
    Absorption, Fate, and Excretion
    Maximum plasma concentrations are reached about 7 days after intramuscular administration of fulvestrant and are maintained over a period of 1 month. The plasma half-life is approximately 40 days. Steady-state concentrations are reached after 3 to 6 monthly injections. There is extensive and rapid distribution, predominantly to the extravascular compartment.
    Various pathways, similar to those of steroid metabolism including oxidation, aromatic hydroxylation, and conjugation, extensively metabolize fulvestrant. CYP3A4 appears to be the only CYP isoenzyme involved in the oxidation of fulvestrant. Several preclinical and clinical studies have confirmed that fulvestrant is not subject to CYP3A4 interactions that might affect the safety or efficacy of the drug. The putative metabolites possess no estrogenic activity and only the 17-keto compound demonstrates a level of antiestrogenic activity about 4.5 times less than that of fulvestrant. The major route of excretion is via the feces, with less than 1% being excreted in the urine (Robertson and Harrison, 2004).
    Therapeutic Uses
    Fulvestrant typically is administered as a 250-mg intramuscular injection at monthly intervals. It is used in postmenopausal women as antiestrogen therapy of hormone receptor-positive metastatic breast cancer after progression on first-line antiestrogen therapy such as tamoxifen (Strasser-Weippl and Goss, 2004). Fulvestrant is at least as effective in this setting as the third-generation aromatase inhibitor anastrozole.
    Fulvestrant 250 mg (administered as a once-monthly 5-ml intramuscular injection) also has been compared with tamoxifen 20 mg (orally once daily) in a trial of postmenopausal women with ER-positive and/or progesterone receptor (PR)-positive or ER/PR-unknown metastatic breast cancer who had not previously received endocrine or chemotherapy. There was no difference between fulvestrant and tamoxifen in time to disease progression in either the entire study population or the subset of patients with ER- and/or PR-positive disease. Observed differences in other efficacy endpoints favored tamoxifen, and fulvestrant equivalence was not demonstrated (Vergote and Robertson, 2004). The long time to steady-state plasma levels for fulvestrant has brought into question the results of existing studies, and trials are in progress to test the relative efficacy of giving an initial loading dose followed by regular monthly injections.
    Clinical Toxicity
    Fulvestrant generally is well tolerated with the most common adverse events being nausea, asthenia, pain, vasodilation (hot flushes), and headache. Injection site reactions, seen in about 7% of patients, are reduced by giving the injection slowly. In the study comparing anastrozole and fulvestrant, quality-of-life outcome measures were maintained over time with no significant difference between the drugs.

    29. A farmer developed a swelling in the inguinal region which later ulcerated. What stain can be used to detect bipolar stained organisms?
    A. Albert's stain
    B. Waysons stain
    C. Ziehl neelsen stain
    D. Nigrosin stain
    Ans: B Wayson stain(REPEAT)

    30. An 8 year old boy completed 8 out of 10 day course of cefaclor. Now he developed a generalized erythmatic rash which is mildly pruritic and lymphadenopathy. Diagnosis is?
    A. Kawasaki disease
    B. Type 3 hypersensitivity
    C. Anaphylaxis
    D. Infectious mononucleosis
    Ans: B Type 3 Hypersensitivity(REPEAT)
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    31. Rave drug is?
    A. Cannabis
    B. Cocaine
    C. Heroin
    D. Amphetamine
    Ans: D Amphetamine(MDMA)
    MDMA is also called Rave drug and ecstasy

    32. How to differentiate ASD from VSD in X-ray?
    A. Enlarged Left atrium
    B. Normal left atrium
    C. Pulmonary congestion
    D. Aortic shadow
    Ans: B Normal LA size
    LA remains normal in ASD despite volume overload since it can decompress through 2 outlets that is into RA and into LV.So LA enlargement is not seen in ASD wheras it is seen in VSD

    33. Regarding an imbecile, all are true except?
    A. IQ is 50-60 B. Intellectual capacity equivalent to a child of 3-7 years of age
    C. Not able to take care of themselves
    D. Condition is congenital or acquired at an early age
    Ans: A IQ is 50-60
    Reference: Kaplan and saddock

    Q Range Classification
    70-80 Borderline deficiency
    50-69 Moron
    20-49 Imbecile
    below 20 Idiot

    34. Which is not true regarding diet modification recommended in high cardiovascular risk group?
    A. Cholesterol less then 100 mg/1000kcal/day
    B. Avoid alcohol
    C. Fat intake 10% of total calories
    D. Salt limitation to less than 5 gm
    Ans: C Fat intake <10% of total calories
    Reference: American Heart association 2006 guidelines
    These guidelines confirm the options 1/2/4...regarding option 3....it is the saturated fat content which should be less that 10%.the total fat intake should be less than 30% of the overall calorie intake.
    IF THE OPTION 3 WAS....Saturated Fat intake less than 10% then the answer shall become Avoid alcohol...as AHA guidelines say upto 2-3 drink per day is fine....

    35. Maintenance dose of which of the following drugs is used worldwide for opioid dependence?
    A. Naltrexone
    B. Methadone
    C. lmipramine
    D. Disulfiram
    Ans: B Methadone
    Reference: Kaplan and saddock
    Methadone is a synthetic narcotic (an opioid) that substitutes for heroin and can be taken orally. When given to addicts to replace their usual substance of abuse, the drug suppresses withdrawal symptoms. A daily dosage of 20 to 80 mg suffices to stabilize a patient, although daily doses of up to 120 mg have been used. The duration of action for methadone exceeds 24 hours; thus, once-daily dosing is adequate. Methadone maintenance is continued until the patient can be withdrawn from methadone, which itself causes dependence. An abstinence syndrome occurs with methadone withdrawal, but patients are detoxified from methadone more easily than from heroin. Clonidine (0.1 to 0.3 mg three to four times a day) is usually given during the detoxification period.
    Methadone maintenance has several advantages. First, it frees persons with opioid dependence from using injectable heroin and, thus, reduces the chance of spreading HIV through contaminated needles. Second, methadone produces minimal euphoria and rarely causes drowsiness or depression when taken for a long time. Third, methadone allows patients to engage in gainful employment instead of criminal activity. The major disadvantage of methadone use is that patients remain dependent on a narcotic.

    36. Best test/Gold standard test for assesing HCG function/action?
    A. Radioimmunoassay
    B. ELISA
    C. Latex test
    D. Bioassay
    Ans: D Bioassay(OPEN TO SCRUTINY......CHALLENGING REFERENCES INVITED)
    Though Radioimmunoassay is more sensitive than Bioassay for quatifying an antigen ,Bioassay only can asses an harmone both quantitatively and qualitatively....THE Question SPECIFICALLY asked about the BEST TEST OF FUNCTION which can be assessed by BIOASSAY and not Radioimmunoassay.

    37. Vitamin K is involved in the posttranswerlational modification of?
    A. Glutamate
    B. Aspartate
    C. --
    D. –
    Ans: A Glutamate(REPEAT)

    38. Spinal anaesthesia is given at which level?
    A. L1-2
    B. L2-4
    C. S1
    D. Midline thoracic segments
    Ans: B L2-4
    Reference: Miller anesthesia(Procedureconsult)
    • Spinal anesthetics have their effects at the spinal cord, which originates at the foramen magnum of the skull and the brainstem and extends caudally to the conus medullaris. The distal termination varies from about the level of the 3rd lumbar vertebrae (L3) in infants to the lower border of L1 in adults. The spinal cord is surrounded by three membranes (from central to peripheral): the pia mater, arachnoid mater, and dura mater. It is believed that the arachnoid mater is responsible for up to 90% of the resistance to drug migration in and out of the CSF. Inside the subarachnoid space are the CSF, spinal nerves, a network of trabeculae between the two membranes, and blood vessels supplying the spinal cord. Although the spinal cord ends at about L1 in adults, the subarachnoid space continues to about the second sacral vertebrae (S2).
    • Posterior to the epidural space is the ligamentum flavum, which extends from the foramen magnum to the sacral hiatus. Immediately posterior to the ligamentum flavum are the lamina and spinous processes of the vertebral bodies or the interspinous ligaments. Posterior to these structures is the supraspinous ligament, which joins the vertebral spines.
    • Anatomic landmarks most important to performance of spinal anesthesia are the iliac crests, the midline of the back, and the vertebral spinous processes. Palpation of the midline of the back identifies the spinous processes and vertebral interspaces in most patients but may be difficult in obese patients. A line drawn between the upper borders of the iliac crests across the midline of the back identifies the approximate level of L4 or the L4-L5 interspace.
    • Spinal anesthesia is usually performed at the level of the L3 or L4 vertebrae in the adult patient, because the spinal needle is introduced below the level at which the spinal cord ends.

    39. a child presented with mild fever little breathlessness..... was treated and she improved over 4 days and later deteriorated again with fever and more breathlessness. x ray showed hyperlucency. diagnosis?
    1.bronchiolitis obliterans
    2.alveolar proteinosois
    3.bronchitis 4. AsthmA
    Ans: a bronchiolitis obliterans(REPEAT)

    40. Which of the following passes through foramen magnum?
    A. Internal Carotid Artery
    B. Sympathetic chain
    C. Hypoglossal Nerve
    D. Vertebral Artery
    Ans: D Vertebral artery(REPEAT)
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    41. McKeon's theory on reduced prevalence of TB?
    A. Increased awareness and knowledge
    B. Medical advancement answer
    C. Behavioural modification
    D. Social and environmental factor
    Ans: D Social and environmental factor
    Reference:†McKeown and the Idea That Social Conditions Are Fundamental Causes of Disease Bruce G. Link, PhD and Jo C. Phelan, PhD “
    THE MCKEOWN THESIS STATES that the enormous increase in population and dramatic improvements in health that humans have experienced over the past 2 centuries owe more to changes in broad economic and social conditions than to specific medical advances or public health initiatives.1 The thesis gives center stage to social conditions as root causes of the health of populations. On the basis of new data and numerous revisitations, however, Colgrove2 tells us that the thesis has been “overturned†and the theory “discredited.†Whither, then, the idea that social conditions require prominence in any complete understanding of the health of populations? When we turn away from “the thesis,†do we accept an “antithesis†asserting that the role of social conditions is insignificant?

    42. Which among the following is not a cause of fasting hypoglycemia?
    A. Glucagon excess
    B. Glucose 6 phospatase deficiency
    C. Ureamia
    D. Glycogen synthase deficiency
    Ans: A Glucagon excess
    Explanation: Glucose 6 phosphatase def leads to inability to mobilize glucose and hence can cause
    Glycogen synthase def leads to glycogen deficiency and hence during fasting patient goes hypo
    In uremia liver metabolism is hampered and hence hypo is possible
    In glucagon excess there is HYPERglycemia and hence the answer.

    43. Mineralocorticoid receptor is not present in?
    A. Liver
    B. Colon
    C. Hippocampus
    D. Kidney
    Ans:Liver(REPEAT)

    44. Prolonged treatment with INH leads to deficiency of?
    A. Pyridoxine
    B. Thiamine
    C. Pantothenic acid
    D. Niacin
    Ans: A Pyridoxine
    Reference: Harrison 17th ed table of vitamins
    Vitamin B6
    Defeciency symptoms: Seborrhea, glossitis convulsions, neuropathy, depression, confusion, microcytic anemia RDA:<0.2 mg Factors contributing to deficiency:Alcoholism, isoniazid

    45. Which is the most reliable objective sign of identifying pulmonary plethora in chest X-ray?
    A. Diameter of the main pulmonay artery >16mm
    B. Diameter of the lt pulmonay artery >16mm
    C. Diameter of the decending Rt pulmonay artery >16mm
    D. Diameter of the decending Lt pulmonay artery >16mm
    Ans: C(REPEAT)

    46. Necrotizing lymphadenitis is seen in?
    A. Kimura disease
    B. Kikuchi disease
    C. Hodgkin disease
    D. Castelma
    Ans: B Kikuchi disease (a type of Modified REPEAT)
    Reference:Harrison 17th ed and eMEDICINE
    Kikuchi disease, also called histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease
    The most common clinical manifestation of Kikuchi disease is cervical lymphadenopathy
    Kimura disease is a chronic inflammatory disorder of unknown etiology that most commonly presents as painless, unilateral cervical lymphadenopathy or subcutaneous masses in the head or neck region. The disorder received its current name in 1948, when Kimura et al2 noted the vascular component and referred to it as an "unusual granulation combined with hyperplastic changes in lymphoid tissue."
    Lymph-Node Tuberculosis (Tuberculous Lymphadenitis) from Harrison 17th ed:
    The most common presentation of extrapulmonary tuberculosis (>40% of cases in the United States in recent series), lymph-node disease is particularly frequent among HIV-infected patients. In the United States, children and women (particularly non-Caucasians) also seem to be especially susceptible. Once caused mainly by M. bovis, tuberculous lymphadenitis is today due largely to M. tuberculosis. Lymph-node tuberculosis presents as painless swelling of the lymph nodes, most commonly at posterior cervical and supraclavicular sites (a condition historically referred to as scrofula). Lymph nodes are usually discrete and nontender in early disease but may be inflamed and have a fistulous tract draining caseous material. Associated pulmonary disease is seen in >40% of cases. Systemic symptoms are usually limited to HIV-infected patients. The diagnosis is established only by fine-needle aspiration or surgical biopsy. AFB are seen in up to 50% of cases, cultures are positive in 70–80%, and histologic examination shows granulomatous lesions. Among HIV-infected patients, granulomas usually are not seen. Differential diagnosis includes a variety of infectious conditions, neoplastic diseases such as lymphomas or metastatic carcinomas, and rare disorders like Kikuchi disease (necrotizing histiocytic lymphadenitis), Kimura's disease, and Castleman's disease.

    47. NARP syndrome is seen in?
    A. Mitochondrial function disorder
    B. Glycogen storage disorder
    C. Lysosomal storage disorder
    D. Lipid storage disorder
    Ans: A Mitochondrial disorder(REPEAT)

    48. A 65 yrs old lady presented with a swollen and painful knee. On examination, she was found to have grade III osteoarthritic changes. What is the “BEST COURSE OF ACTION†?
    A. Conservative management
    B. Arthroscopic washing
    C. Partial knee replacement
    D. Total knee replacement
    Ans: D Total knee replacement
    THIS QUESTION IS NOT A REPEAT FROM MAY AIIMS....
    This question has been adequately discussed in the institute classes and the answer is TKR....Whatever be the case they are asking the BEST course of action and so no point in going for a conservative approach...

    49. Causes of primary amenorrhoea are all except?
    A. Rokintasky syndrome
    B. Kallaman syndrome
    C. Sheehan syndrome D.Turner syndrome
    Ans: C Sheehan syndrome(REPEAT)

    50. Integrase inhibitor approved for treatment of HIV is?
    A. Raltegravir
    B. Indinavir
    C. Lopinavir
    D. Elvitegravir
    Ans: A Raltegravir
    Reference: Pasting a net reference since the texts don’t have thedrug....anyway Ralteravir and maraviroc are given in Sparsh Pharmac
    Raltegravir (MK-0518, brand name Isentress) is an antiretroviral drug produced by Merck & Co., used to treat HIV infection. It received approval by theU.S. Food and Drug Administration (FDA) in October 2007, the first of a new class of HIV drugs, the integrase inhibitors, to receive such approval.
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    51. Deoxygenated blood is not seen in
    a. Pulmonary artery
    b. Umbilical artery
    c. Umbilical vein
    d. Renal vein
    Ans: C Umbilical vein(No explanation needed)

    52. All of the following are pneumatic bones except?
    A. Frontal
    B. Ethmoid
    C. Mandible
    D. Maxilla
    Ans: C Mandible (No explanation needed)

    53. Which of the following is not a contraindication for pregnancy?
    A. WPW syndrome
    B. Pulmonary hypertension
    C. Eisenmenger syndrome
    D. Marfan syndrome with aortic root dilatation
    Ans: A WPW syndrome(REPEAT)

    54. Which of the following antihypertensive drugs is contraindicated in a patient on Lithium in order to prevent toxicity?
    A. Clonidine
    B. Beta blockers
    C. Calcium channel blockers
    D. Diuretics
    Ans: D Diuretics
    Reference: goodman and gilman
    Most of the renal tubular reabsorption of Li+ occurs in the proximal tubule. Nevertheless, Li+ retention can be increased by any diuretic that leads to depletion of Na+, particularly the thiazides (see Chapter 28) (Siegel et al., 1998). Renal excretion can be increased by administration of osmotic diuretics, acetazolamide, or aminophylline, although they are of little help in the management of Li+ intoxication. Triamterene may increase excretion of Li+, suggesting that some reabsorption of the ion may occur in the distal nephron. However, spironolactone does not increase the excretion of Li+. Some nonsteroidal antiinflammatory agents can facilitate renal proximal tubular resorption of Li+ and thereby increase concentrations in plasma to toxic levels

    55. Superior vena caval syndrome is most commonly caused by?
    A. Lymphoma
    B. Small cell lung ca
    C. Non small cell lung ca
    D. Secondary tumours
    Ans: B Small cell carcinoma(REPEAT)

    56. Which of the following is not an adverse effect of thalidomide?
    A. Diarrhoea
    B. Teratogenicity
    C. DVT
    D. Peripheral neuropathy
    Ans: A Diarrhea
    Reference: Goodman and Gilman
    The most common adverse effects reported in cancer patients are sedation and constipation (Franks et al., 2004), while the most serious one is treatment-emergent peripheral sensory neuropathy, which occurs in 10% to 30% of patients with MM or other malignancies in a dose- and time-dependent manner (Richardson et al., 2004). Thalidomide-related neuropathy is an asymmetric, painful, peripheral paresthesia with sensory loss, commonly presenting with numbness of toes and feet, muscle cramps, weakness, signs of pyramidal tract involvement, and carpal tunnel syndrome. The incidence of peripheral neuropathy increases with higher cumulative doses of thalidomide, especially in elderly patients. Although clinical improvement typically occurs upon prompt drug discontinuation, long-standing residual sensory loss can occur. Particular caution should be applied in cancer patients with preexisting neuropathy (e.g., related to diabetes) or prior exposure to drugs that can cause peripheral neuropathy (e.g., vinca alkaloids or bortezomib), especially since there has been little progress in defining effective strategies to alleviate neuropathic symptoms. An increasing incidence of thromboembolic events in thalidomide-treated patients has been reported, but mostly in the context of thalidomide combinations with other drugs, including steroids and particularly anthracycline-based chemotherapy (Zangari et al., 2001), and with very low incidence with single-agent thalidomide treatment.

    57. Blount’s disease is:
    A. Genu valgum
    B. Genu varum
    C. Genu recurvatum
    D. Menisceal injury
    Ans: B Genu varum
    Reference:eMEDICINE(don’t have the orthobook with me right now)
    Blount disease is an uncommon growth disorder characterized by disordered ossification of the medial aspect of the proximal tibial physis, epiphysis, and metaphysis. This progressive deformity is manifested by varus angulation and internal rotation of the tibia in the proximal metaphyseal region immediately below the knee

    58. A teenaged girl complains of pain in knee on climbing stairs and on getting up after sitting for a long time. What is the probable diagnosis?
    A. Chondromalacia patellae
    B. Plica syndrome
    C. Bipartite patella
    D. Patello-femoral osteoarthritis
    Ans: A Chondromalacia patellae
    Reference: Current Orthopedic Diagnosis and management.
    Bilateral knee pain and stiffness in a teenage girl is suggestive of a few conditions of which Chondromalacia patellae is one.

    59. Which of the following is not included in parenteral nutrition?
    A. Fat
    B. Carbohydrate
    C. Fibre
    D. Micronutrients
    Ans: C Fibre

    60. Sparrow marks are seen in?
    A. Gunshot injuries
    B. Stab injury of face
    C. Vitriolage
    D. Windshield glass injury
    Ans: D Winshield glass injury
    Reference: Forensic pathology by David.J.Williams
    “The occupants of the first row seats in a motor vehicle accident may demonstrate facial injuries due to contact with windshield glass called sparrow’s foot.”
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    61. Amphotericin B causes deficiency of?
    A. Na
    B. Ca
    C. K
    D. Mg
    Ans: C Potassium
    Reference: Goodman and Gilman
    Renal tubular acidosis and renal wasting of K+ and Mg2+ also may be seen during and for several weeks after therapy. Supplemental K+ is required in one-third of patients on prolonged therapy.

    62. All are seen in injury to common peroneal nerve except?
    A. Loss of sensation over sole
    B. Foot drop
    C. Injury to neck of fibula
    D. Loss of dorsiflexion of toe
    Ans: A loss of sensation over the sole(No explanation needed)

    63. Cause of premature death in schizophrenia?
    A. Homicide
    B. Suicide
    C. Toxicity of antipsychotic drug
    D. Hospital acquired infection
    Ans:B Suicide
    Reference:Kaplan and saddock(A STAIGHT LINE TO LINE FROM THE TEXT)
    Suicide

    Suicide is the single leading cause of premature death among people with schizophrenia. Suicide attempts are made by 20 to 50 percent of the patients, with long-term rates of suicide estimated to be 10 to 13 percent. These numbers reflect an approximately 20-fold increase over the suicide rate in the general population. Often, suicide in schizophrenia seems to occur “out of the blue,†without prior warnings or expressions of verbal intent. The most important factor is the presence of a major depressive episode. Epidemiological studies indicate that up to 80 percent of schizophrenia patients may have a major depressive episode at some time in their lives. Some data suggest that those patients with the best prognosis (few negative symptoms, preservation of capacity to experience affects, better abstract thinking) can paradoxically also be at highest risk for suicide. The profile of the patient at greatest risk is a young man

    64. Epileptic potential is present in
    A. Desflurane
    B. Halothane
    C. Sevoflurane
    D. Ether
    Ans: Sevoflurane(No explanation needed)

    65. Which of the following anesthetic drugs is contraindicated in a patient with hypertension?
    A. Ketamine
    B. Propofol
    C. Etomidate
    D. Diazepam
    Ans: Ketamine(Ketamine is known to increase the BP...no explanation needed)

    66. All of the following decrease bone resorption in osteoporosis except?
    A. Alendronate
    B. Etidronate
    C. Strontium
    D. Teriparatide

    Ans: D Teripartide
    Reference: Goodman and Gilman
    Parathyroid Hormone (PTH)
    Continuous administration of PTH or high circulating PTH levels achieved in primary hyperparathyroidism causes bone demineralization and osteopenia. However, intermittent PTH administration promotes bone growth. Selye first described the anabolic action of PTH some 80 years ago, but this observation was largely ignored and generally forgotten. Beginning in the 1970s, studies focused on the anabolic action of PTH, culminating with FDA approval of synthetic human 34-amino-acid amino-terminal PTH fragment [hPTH(1–34), teriparatide] for use in treating severe osteoporosis (Hodsman et al., 2005). Full-length PTH(1–84) is likely to be approved in the near future; its benefits over PTH(1–34) are unclear.

    Absorption, Fate, and Excretion
    Pharmacokinetics and systemic actions of teriparatide on mineral metabolism are the same as for PTH. Teriparatide is administered by once-daily subcutaneous injection of 20 g into the thigh or abdomen. With this regimen, serum PTH concentrations peak at 30 minutes after the injection and decline to undetectable concentrations within 3 hours, whereas the serum calcium concentration peaks at 4 to 6 hours after administration. Based on aggregate data from different dosing regimens, teriparatide bioavailability averages 95%. Teriparatide clearance averages 62 L/hour in women and 94 L/hour in men, which exceeds normal liver plasma flow, consistent with both hepatic and extrahepatic PTH removal. The serum half-life of teriparatide is approximately 1 hour when administered subcutaneously versus 5 minutes when administered intravenously. The longer half-life following subcutaneous administration reflects the time required for absorption from the injection site. The elimination of PTH(1–34) and full-length PTH proceeds by nonspecific enzymatic mechanisms in the liver, followed by renal excretion.

    Clinical Effects
    In postmenopausal women with osteoporosis, teriparatide increases BMD and reduces the risk of vertebral and nonvertebral fractures. Several laboratories have examined the effects of intermittent PTH on BMD in patients with osteoporosis. In these studies, teriparatide increased axial bone mineral, although initial reports of effects on cortical bone were disappointing. Coadministration of hPTH(1–34) with estrogen or synthetic androgen led to impressive gains in vertebral bone mass or trabecular bone. However, in some early studies there was only maintenance or even loss of cortical bone. Vitamin D insufficiency in patients at baseline or pharmacokinetic differences involving bioavailability or circulating half-life may have contributed to observed differences on cortical bone. The most comprehensive studies to date established the value of daily hPTH(1–34) administration on total BMD, with significant elevations of BMD in lumbar spine and femoral neck and with significant reductions of vertebral and nonvertebral fracture risk in osteoporotic women (Neer et al., 2001) and men (Finkelstein et al., 2003).
    Candidates for teriparatide treatment include women who have a history of osteoporotic fracture, who have multiple risk factors for fracture, or who failed or are intolerant of previous osteoporosis therapy.

    Adverse Effects
    In rats, teriparatide increased the incidence of bone tumors, including osteosarcoma (Vahle et al., 2004). The clinical relevance of this finding is unclear, especially since patients with primary hyperparathyroidism have considerably higher elevations of serum PTH without a greater incidence of osteosarcoma. Nonetheless, teriparatide should not be used in patients who are at increased baseline risk for osteosarcoma (including those with Paget's disease of bone, unexplained elevations of alkaline phosphatase, open epiphyses, or prior radiation therapy involving the skeleton). Full-length PTH(1–84), which is in clinical trials, has not been associated with osteosarcomas. Other adverse effects have included exacerbation of nephrolithiasis and elevation of serum uric acid levels.

    67. 26-Ondoni cells and Haller cells are associated with the following structures respectively?
    A. Optic nerve and Orbital floor answer
    B. Optic nerve and Internal carotid artery
    C. Internal carotid artery and Optic nerve
    D. Orbital floor and Internal carotid artery
    Ans: Optic nerve and Orbital floor(REPEAT)

    68. 27-Pain sensation from the ethmoid sinus is carried by :
    A. Frontal nerve
    B. Lacrimal nerve
    C. Nasociliary nerve
    D. Infraorbital nerve
    Ans: C Nasociliary nerve which divides into the ethmoidal branches to supply the ethmoidal sinus

    69. 28-Which among the following is not used to treat alcohol dependence?
    A. Flumazenil
    B. Acamprosate
    C. Naltrexone
    D. Disulfiram
    Ans: A Flumazenil(a MODIFIED REPEAT......last time this question came with Diazepam in the options)

    70. A 40yr old patient has a single kidney with an exophytic mass of 4 cm size at it’s lower pole. Which among the following is the best course of action?
    A. Partial nephrectomy
    B. Radical nephrectomy with dialysis
    C. Radical nephrectomy with immediate renal transwerplant
    D. Observation

    Ans: A Partial nephrectomy since it is the current method of choice for tumors less than or equal to 4cm and at poles.
  24. Guest

    Guest Guest

    71. 29-Which among the following is the most common fungal infection seen in immuno competent patients?
    A. Aspergillus
    B. Candida
    C. Cryptococcus
    D. Mucor

    Ans: A Aspergillus
    Reference: Harrison 17th ed
    The required size of the infecting inoculum is uncertain; however, only intense exposures (e.g., during construction work, handling of moldy bark or hay, or composting) are sufficient to cause disease in healthy immunocompetent individuals.
    An increasing incidence of invasive aspergillosis in medical intensive care units suggests that, in patients who are not immunocompromised, temporary abrogation of protective responses as a result of glucocorticoid use or a general anti-inflammatory state is a significant risk factor.

    72. All are seen in Argyl Robertson pupil except?
    A. Near reflex normal
    B. Direct reflex absent
    C. Consensual reflex normal
    D. Vision normal

    Ans: C Consensual reflex is normal
    Argyll Robertson pupil
    This is caused by neurosyphilis and is characterised by the
    following:
    • Involvement is usually bilateral but asymmetrical
    • The pupils arc small and irregular.
    • Light-near dissociation. • The pupils are very difficult to dilate.

    73. A 5 year old boy while having dinner suddenly becomes aphonic and is brought to the casulty for the complaint of respiratory distress. What should be the appropriate management?
    A. Cricothyroidotomy
    B. Emergency tracheostomy
    C. Humidified oxygen
    D. Heimlich maneuver

    Ans: D Heimlich manoeveure(please read the explanation carefully)

    This is the AHA guidelines for management of any conscious choking patient....The question in the exam had a conscious,aphonic patient in respiratory distress...Now how to manage.....Most of the discussions in the forum give other answer feeling that Heimlich has to be performed at the site only...lets C the guidelines and find the answer...

    1. Recognise signs of choking
    2. Call for help
    3. Use Heimlich manoeveure until the patient recovers OR LOSES CONSCIOSNESS
    4. Place the victim in a supine position ..open the mouth and perform a finger sweep
    5. Open the airway and attempt to ventilate
    6. If unsuccessful give upto 5 heimlich manoeveures
    7. Repeat 5 and 6
    8. If expert has arrived he has to perform a laryngoscopy and try to remove the foreign body if not already removed
    9. FAILING ALL ATTEMPTS ONLY CRICOTHYOTOMY SHOULD BE PERFORMED.

    74. Which among the following is a branch from the trunk of brachial plexus?
    A. Subscapular nerve
    B. Long thoracic nerve
    C. Anterior thoracic nerve
    D. Nerve to subclavius

    Ans:D Nerve to subclavius.......If suprascapular nerve was not at all there in the options....so the answer is clear....

    75. Orthotolidine test is used for detecting:
    A. Chlorine
    B. Nitrites
    C. Nitrates
    D. Ammonia
    Ans: A Chlorine(No explanation needed)

    76. Which among the following is the most common tumour associated with neurofibromatosis in a child?
    A. Juvenile myelomonocytic leukemia
    B.Acute lymphoblastic leukemia
    C. Acute monocytic leukemia
    D. Acute myeloid leukemia

    Ans: Juvenile myelomonocytic leukemia
    Reference: Nelson 18th ed
    Juvenile Chronic Myelogenous Leukemia
    Juvenile chronic myelogenous leukemia (JCML), also known as juvenile myelomonocytic leukemia, is a clonal proliferation of hematopoietic stem cells that typically affects children <2 yr of age. Patients with this disease do not have the Philadelphia chromosome that is characteristic of CML. Patients with JCML present with rashes, lymphadenopathy, and splenomegaly. Analysis of the peripheral blood often shows an elevated leukocyte count and also may show thrombocytopenia and the presence of erythroblasts. The bone marrow shows a myelodysplastic pattern, with blasts accounting for <30% of cells. No distinctive cytogenetic abnormalities are seen. JCML is rare, constituting <2% of all cases of childhood leukemia. Therapeutic reports are largely anecdotal. Patients with neurofibromatosis type 1 have a predilection for this type of leukemia. Stem cell transplantation offers the best opportunity for cure, but much less so than for classic CML.

    77. Diaphragm develops from all except:
    A. Septum transwerversum
    B. Dorsal mesocardium
    C. Pleuroperitoneal membrane
    D. Cervical myotomes

    Ans: D Cervical myotomes
    Reference: Langman Embryology gives text confirming the options A/D ....now regarding options B and D is the confusion....Langman says the nerve supply alone develops from the level of the cervical myotomes but not the diaphragm....so i prefer the answer cervical myotomes> dorsal mesocardium

    78. Erythema nodosum is seen in all except:
    A. Pregnancy
    B. Tuberculosis
    C. SLE
    D. Chronic pancreatitis

    Ans: D Chronic pancreatitis
    Causes
    Currently, the most common cause of erythema nodosum is streptococcal infection in children and streptococcal infection and sarcoidosis in adults.3 Numerous other causes have been reported.4 The causes reported most often in the literature are as follows:
    • Bacterial infections: Streptococcal infections are one of the most common causes of erythema nodosum. Tuberculosis was an important cause in the past, but it has decreased dramatically as a cause for erythema nodosum; however, it still must be excluded, especially in developing countries.5,6 Yersinia enterocolitica is a gram-negative bacillus that causes acute diarrhea and abdominal pain; it is a common cause of erythema nodosum in France and Finland.7,8,9 Mycoplasma pneumoniae infection may cause erythema nodosum. Erythema nodosum leprosum clinically resembles erythema nodosum, but the histologic picture is that of leukocytoclastic vasculitis. Lymphogranuloma venereum may cause erythema nodosum. Salmonella infection may cause erythema nodosum. Campylobacter infection may cause erythema nodosum.
    • Fungal infections: Coccidioidomycosis (San Joaquin Valley fever) is the most common cause of erythema nodosum in the American Southwest. In approximately 4% of males and 10% of females, the primary fungal infection (which may be asymptomatic or involve symptoms of upper respiratory infection) is followed by the development of erythema nodosum. Lesions appear 3 days to 3 weeks after the end of the fever caused by the fungal infection. Histoplasmosis may cause erythema nodosum. Blastomycosis may cause erythema nodosum.
    • Drugs: Sulfonamides and halide agents are an important cause of erythema nodosum. Drugs more recently described to cause erythema nodosum include gold and sulfonylureas. Oral contraceptive pills are implicated in an increasing number of reports.
    • Enteropathies: Ulcerative colitis and Crohn disease may trigger erythema nodosum. Erythema nodosum associated with enteropathies correlates with flares of the disease. The mean duration of chronic ulcerative colitis before the onset of erythema nodosum is 5 years, and erythema nodosum is controlled with adequate therapy of the colitis. Erythema nodosum is the most frequent dermatologic symptom ininflammatory bowel diseases, and it is strongly associated with Crohn disease.10
    • Hodgkin disease and lymphoma: Erythema nodosum associated with non-Hodgkin lymphoma may precede the diagnosis of lymphoma by months. Reports of erythema nodosum preceding the onset of acute myelogenous leukemia have been published.11
    • Sarcoidosis: The most common cutaneous manifestation of sarcoidosis is erythema nodosum. A characteristic form of acute sarcoidosis involves the association of erythema nodosum, hilar lymphadenopathy, fever, arthritis, and uveitis, which has been termed Löfgren syndrome. This presentation has a good prognosis, with complete resolution within several months in most patients. HLA-DRB1*03 is associated with Löfgren syndrome. Most DRB1*03-positive patients have resolution of their symptoms within 2 years; however, nearly half of DRB1*03-negative patients have an unremitting course.12
    • Behçet disease (associated with erythema nodosum)
    • Pregnancy: Some patients develop erythema nodosum during pregnancy, most frequently during the second trimester. Repeated episodes occur with subsequent pregnancies or with the use of oral contraceptives.

    79. Posterior relations of head of pancreas are all except?
    A. Common bile duct
    B. First part of duodenum
    C. Aorta
    D. Inferior vena cava
    Ans: B First part of Duodenum(NO Explanation needed)

    80. Multiple sebaceous cysts seen in:
    A. Gardner’s syndrome
    B. Turcot syndrome
    C. Muir Torre syndrome
    D. Cowden syndrome
    Ans:C Muir torre syndrome
    Reference:Sabiston 18th ed table in chapter of GI neoplasia
    Muir-Torre variant: sebaceous adenomas, keratoacanthomas, sebaceous epitheliomas, and basal cell epitheliomas

    81. Which among the following is the hallmark of acute inflammation?
    A. Vasoconstriction
    B. Stasis
    C. Vasodilation and increase in permeability
    D. Leukocyte margination
    Ans: C Vasodilatation and increased vascular permeability(REPEAT)
  25. Guest

    Guest Guest

    82. True about epidural opioids are all except?
    A. Acts on dorsal horn substantia gelatinosa
    B. Can cause Itching
    C. Function of the intestines are not affected
    D. Can cause respiratory depression

    Ans: C Function of the intestine is not affected

    Reference: Pharmacology By KATZUNG(THE QUESTION HAS BEEN TAKEN LINE TO LINE FROM TEXT---READ BELOW)

    Because of their direct action on the superficial neurons of the spinal cord dorsal horn, opioids can also be used as regional analgesics by administration into the epidural or subarachnoid spaces of the spinal column. A number of studies have demonstrated that long-lasting analgesia with minimal adverse effects can be achieved by epidural administration of 3–5 mg of morphine, followed by slow infusion through a catheter placed in the epidural space. It was initially assumed that the epidural application of opioids might selectively produce analgesia without impairment of motor, autonomic, or sensory functions other than pain. However, respiratory depression can occur after the drug is injected into the epidural space and may require reversal with naloxone. Effects such as pruritus and nausea and vomiting are common after epidural and subarachnoid administration of opioids and may also be reversed with naloxone if necessary. Currently, the epidural route is favored because adverse effects are less common.
  26. Guest

    Guest Guest

    81. Which among the following is the hallmark of acute inflammation?
    A. Vasoconstriction
    B. Stasis
    C. Vasodilation and increase in permeability
    D. Leukocyte margination
    Ans: C Vasodilatation and increased vascular permeability(REPEAT)

    82.True about epidural opioids are all except?
    A. Acts on dorsal horn substantia gelatinosa
    B. Can cause Itching
    C. Function of the intestines are not affected
    D. Can cause respiratory depression

    Ans: C Function of the intestine is not affected

    Reference: Pharmacology By KATZUNG(THE QUESTION HAS BEEN TAKEN LINE TO LINE FROM TEXT---READ BELOW)

    Because of their direct action on the superficial neurons of the spinal cord dorsal horn, opioids can also be used as regional analgesics by administration into the epidural or subarachnoid spaces of the spinal column. A number of studies have demonstrated that long-lasting analgesia with minimal adverse effects can be achieved by epidural administration of 3–5 mg of morphine, followed by slow infusion through a catheter placed in the epidural space. It was initially assumed that the epidural application of opioids might selectively produce analgesia without impairment of motor, autonomic, or sensory functions other than pain. However, respiratory depression can occur after the drug is injected into the epidural space and may require reversal with naloxone. Effects such as pruritus and nausea and vomiting are common after epidural and subarachnoid administration of opioids and may also be reversed with naloxone if necessary. Currently, the epidural route is favored because adverse effects are less common.

    82. Which among the following does not cause hyperpyrexia?
    A. MAOI
    B. Alcohol
    C. atropine
    D. Amphetamine
    Ans: B Alcohol
    Reference:Harisson 17th ed
    Alcohol(ethanol) causes hypothermia and not hyperthermia

    83. All are true about neuronal tumors except?
    A. 90% are malignant
    B. 95% occur in the abdomen
    C. They secrete catecholamines
    D. They arise from sympathetic ganglions

    Ans: A 90% are malignant...as per the rule of 10...only 10% are malignant
    Reference:Harrison 17th ed
    Epidemiology
    Pheochromocytoma is estimated to occur in 2–8 out of 1 million persons per year, and about 0.1% of hypertensive patients harbor a pheochromocytoma. Autopsy series reveal prevalence figures of 0.2%. The mean age at diagnosis is about 40 years, although the tumors can occur from early childhood until late in life. The "rule of tens" for pheochromocytomas states that about 10% are bilateral, 10% are extraadrenal, and 10% are malignant. However, these percentages are higher in the inherited syndromes.

    84. Campylobacter jejuni false is-(contributions from Dr.confident)

    a.commonest cause of campylobacteriosis
    b.polutry source of infection
    c.humans are reservoir
    d.associated with GBS

    Answer:C humans are the only reservoir[REPEAT AIIMS09]

    85. Which of the following does not cause indoor air pollution? (dr.confident contribution)
    A. CO
    B. Nitrogen dioxide
    C. Radon
    D. Mercury vapor


    86. Most important and potential agent that can be used in bioterrorism:
    A. Plague
    B. Small pox
    C. TB
    D. Clostridium botulinum

    YET TO SOLVE

    88. Most common site of obstruction after TURP?
    A. Navicullar foss
    B. Bulb
    C. Prostatic membranous urethra
    D. Bladder neck

    YET TO SOLVE

    89. Intraoperative myocardial infarction is best diagnosed by:
    A. ECG
    B. Invasive arterial pressure
    C. Central venous pressure
    D. Transwer esophageal echo

    Ans:D TEE(REPEAT) Reference awaited

    90. Pseudoisomorphic phenomenon seen in
    A. Psoriasis
    B. Lichen planus
    C. Vitiligo
    D. Plane warts

    Ans:D Plane warts(reference awiated)
    91. Campylobacter jejuni false is-

    a.commonest cause of campylobacteriosis
    b.polutry source of infection
    c.humans are reservoir
    d.associated with GBS

    ans : C. as animals are reservoirs of Camplyobacter

    92. Some antigen was injected into a rabbit. What antibody will it produce initially?
    A. IgG
    B. IgM
    C. IgE
    D. IgD
    Ans: B IgM(IS this question any trick or just a question asking for the primary immune respose)

    91. A fire breaks out during laser vocal cord surgery. What is not to be done?
    A. Pouring sterile water into the oral cavity
    B. Removing endotracheal tube
    C. 100% oxygen after discontinuing anesthetic gases
    D. Treatment with steroid & antibiotic
    Ans:
    Reference: Could not get a Text reference....a journal paper on Management of Airway fire during Microlaryngeal surgery provides some light
    Managing fire

    Remove source of fire and extinguish with water
    Stop ventilation,†turn off O2 “
    Mask ventilate with air, “then 100% O2 once fire is extinguishedâ€
    Laryngoscopy and rigid bronchoscopy to remove debris
    Lavage and fibreoptic bronchoscopy if indicated by airway injury
    Common pattern is worst injury at the surgical site and little distal injury
    If severe injury
    “Maintain ventilationâ€
    Consider low tracheostomy
    “IV corticosteroids may be helpfulâ€
    CXR, ABG with co-oximetry for smoke inhalation assessment

    Option B is correct...
    Option A not sure...
    Option C is TRICKY......we should Discontinue the oxygen first that itself will extinguish the fire....once the fire is gone then ventilate with 100% O2....
    OptionD is correct

    Answer should be A/C depends on the exact wordings of the option C

    Current answer: C

    92. Some antigen was injected into a rabbit. What antibody will it produce initially?
    A. IgG
    B. IgM…………….answer
    C. IgE
    D. IgD

    93. Which insect among the following is not resistant to DDT?
    A. Musca domestica
    B. Phlebotomus…………..answer
    C. Culex
    D. Anopheles stephensi

    94. Which virus among the following is least likely to cross placenta?
    A. Rubella
    B. Herpes simplex……………………
    C. HIV
    D. HBV

    95. About yaws all are true except:
    A. Caused by Treponema pertenue
    B. Transwermitted non-venerally
    C. Secondary yaws can involve bones
    D. Last stages involve heart and nerves
    Ans: D Late stages involve heart and nerves
    Reference:Harrison 17th ed
    Yaws
    Also known as pian, framboesia, or bouba, yaws is caused by T. pallidum subspecies pertenue and is characterized by the development of one or several primary lesions ("mother yaw"), which is followed by
  27. Guest

    Guest Guest

    86. Most important and potential agent that can be used in bioterrorism:
    A. Plague
    B. Small pox
    C. TB
    D. Clostridium botulinum

    Botulinum Toxin as a Bioweapon

    In a bioterrorist attack, botulinum toxin would likely be dispersed as an aerosol or as contamination of a food supply. While contamination of a water supply is possible, it is likely that any toxin would be rapidly inactivated by the chlorine used to purify drinking water. Similarly, toxin can be inactivated by heating any food to >85°C for >5 min. Without external facilitation, the environmental decay rate is estimated at 1% per minute, and thus the time interval between weapon release and ingestion or inhalation needs to be rather short. The Japanese biologic warfare group, Unit 731, is reported to have conducted experiments on botulism poisoning in prisoners in the 1930s. The United States and the Soviet Union both acknowledged producing botulinum toxin, and there is some evidence that the Soviet Union attempted to create recombinant bacteria containing the gene for botulinum toxin. In records submitted to the United Nations, Iraq admitted to having produced 19,000 L of concentrated toxin—enough toxin to kill the entire population of the world three times over. By many accounts, botulinum toxin was the primary focus of the pre-1991 Iraqi bioweapons program. In addition to these examples of state-supported research into the use of botulinum toxin as a bioweapon, the Aum Shrinrikyo cult unsuccessfully attempted on a least three occasions to disperse botulism toxin into the civilian population of Tokyo.

    Smallpox

    Variola Virus as a Bioweapon

    Given that most of the world's population was vaccinated against smallpox, variola virus would not have been considered a good candidate as a bioweapon 30 years ago. However, with the cessation of immunization programs in the United States in 1972 and throughout the world in 1980 due to the successful global eradication of smallpox, close to 50% of the U.S. population is fully susceptible to smallpox today. Given its infectious nature and the 10–30% mortality in unimmunized individuals, the deliberate spread of this virus could have a devastating effect on our society and unleash a previously conquered deadly disease. It is estimated that an initial infection of 50–100 persons in a first-generation of cases could expand by a factor of 10–20 with each succeeding generation in the absence of any effective containment measures. While the likely implementation of an effective public health response makes this scenario unlikely, it does illustrate the potential damage and disruption that can result from a smallpox outbreak.

    In 1980, the World Health Organization (WHO) recommended that all immunization programs be terminated; that representative samples of variola virus be transferred to two locations: one at the CDC in Atlanta, GA, in the United States and the other at the Institute of Virus Preparations in the Soviet Union; and that all other stocks of smallpox be destroyed. Several years later, it was recommended that these two authorized collections be destroyed. However, these latter recommendations were placed on hold in the wake of increased concerns on the use of variola virus as a biologic weapon and thus the need to maintain an active program of defensive research. Many of these concerns were based upon allegations made by former Soviet officials that extensive programs had been in place in that country for the production and weaponization of large quantities of smallpox virus. The dismantling of these programs with the fall of the Soviet Union and the subsequent weakening of security measures led to fears that stocks of V. major may have made their way to other countries or terrorist organizations. In addition, accounts that efforts had been taken to produce recombinant strains of Variola that would be more virulent and more contagious than the wild-type virus have led to an increase in the need to be vigilant for the reemergence of this often fatal infectious disease.

    90. Pseudoisomorphic phenomenon seen in
    A. Psoriasis ………answer
    B. Lichen planus
    C. Vitiligo
    D. Plane warts
    Ans: D Plane warts(Reference by Dr.saini)
    pseudoisomorhic phenomenon "is here .. ckeck this out ..

    "Boyd and Neldner have classified all reported cases of Koebner phenomenon into four different groups:

    1. True isomorphic phenomenon: There appear to be three disease processes that display the true isomorphic response of Koebner: psoriasis, lichen planus and vitiligo;
    2. Pseudoisomorphic phenomenon: The Koebner phenomenon seen in infectious diseases, e.g. warts, molluscum contagiosum and pyoderma gangrenosum;

    another reference ..

    "ROXBURGS" 17TH EDITION

    it says .. on pg 21 & 130 ... the conditions causing isomorphic phenomenon ...
    1) psoriasis
    2)lichen planus
    3)DLE

    another is from wikipedia ....
    but he has complicated the things .. yet in the last sentence he says the truth abt the plane warts .. see this too ..

    "Koebner phenomenonFrom Wikipedia, the free encyclopedia Heinrich Köbner (1838-1904)

    The Koebner phenomenon, also called the "Koebner response" or the "isomorphic response", refers to skin lesions appearing on lines of trauma.

    The Koebner phenomenon may result from either a linear exposure or irritation. Conditions demonstrating linear lesions after a linear exposure to a causative agent include: molluscum contagiosum, warts and toxicodendron dermatitis (a dermatitis caused by a genus of plants including poison ivy).

    Warts and molluscum contagiosum lesions can be spread in linear patterns by self-scratching ("auto-inoculation"). Toxicodendron dermatitis lesions are often linear from brushing up against the plant.

    Causes of the Koebner phenomenon that are secondary to scratching rather than an infective or chemical cause include vitiligo, psoriasis, lichen planus, lichen nitidus, pityriasis rubra pilaris, and keratosis follicularis (Darier disease).

    The Koebner phenomenon describes skin lesions which appear at the site of injury. It is seen in:
    Psoriasis
    Pityriasis rubra pilaris
    Lichen planus
    Lichen nitidus
    Vitiligo
    Lichen sclerosus
    Elastosis perforans serpiginosa
    warts
  28. Guest

    Guest Guest

    101. Which of the following is the most probable diagnosis in a patient with loss of central vision and a normal ERG with no family history?
    A. Best's disease
    B. Stargardt's disease
    C. Retinitis pigmentosa
    D. Macular hole
    Ans:B Stargardt disease
    Clincal ophthalmology by Vaughan
    Both Eale’s and Stargrdt’s can manifest with loss of central vision and normal ERG....but stargerdt is most common and it is autosomal recessive wheras Eales is AD and less common...

    102. Renal calculi associated with proteus infection is:
    A. Uric acid
    B. Triple phosphate
    C. Calcium oxlalate
    D. Xanthine
    Ans:B Triple phosphate(REPEAT)

    103. The primary action of NO in git is?
    A. Vasodilatation
    B. Vasoconstriction
    C. GI smooth muscle inhibition
    D. Secretomotor
    Ans:C GI smooth muscle inhibition(REPEAT)
  29. Guest

    Guest Guest

    Q-A schizophrenic patient started on haloperidol 2 days back, comes
    with complaints of torticollis and orofaciolingual movements. What is the
    diagnosis?
    A. Acute dystonia
    B. Tardive dyskinesia
    C. Parkinsonism
    D. Akathisia

    Ans-acute dystonia.
    Ref-


    ACUTE DYSTONIC REACTION
    Acute reaction following exposure to antipsychotic medication with sustained, often painful muscular spasms, producing twisted abnormal postures, OFTEN WITHIN DAYS OF THERAPY initiation.


    TARDIVE DYSKINESIA
    LATE ONSET (MONTHS, YEARS, MEAN = 7 YEARS) involuntary, repetitive, purposeless movements, occurring with long-term antipsychotic treatment (although also has been reported in untreated patients with schizophrenia).


    ANTIPSYCHOTIC-INDUCED PARKINSONISM
    A frequent adverse effect found in full form in at least 20% of patients treated with antipsychotic medication. Generally OCCURS WITHIN FOUR WEEKS OF TREATMENT and is a major cause of noncompliance
    ---------------Oxford American Handbook of Psychiatry, 1st Edition



    MOTOR SIDE EFFECTS OF ANTIPSYCHOTIC DRUGS
    • Parkinsonian: Tremor, rigidity, bradykinesia, festinant gait, rigid posture

    • DYSTONIAS: TONGUE PROTRUSION, OPHISTHOTONUS, SPASMODIC TORTICOLLIS, OCULOGYRIC CRISIS

    • Akathisia: Movement, restlessness

    • Tardive : Abnormal involuntary movements of face, limbs, respiratory muscles.
    dyskinesia
    ----------------------“Psychiatry for General Practitionersâ€


    “DYSTONIAS are brief or prolonged contractions of muscles that result in obviously abnormal movements or postures, including oculogyric crises, TONGUE PROTRUSION, trismus, TORTICOLLIS, laryngeal “pharyngeal dystonias, and dystonic postures of the limbs and trunk.
    Other dystonias include blepharospasm and glossopharyngeal dystonia; the latter results in dysarthria, dysphagia, and even difficulty in breathing, which can cause cyanosis.
    Children are particularly likely to evidence opisthotonos, scoliosis, lordosis, and writhing movements.
    Dystonia can be painful and frightening and often results in noncompliance with future drug treatment regimensâ€.


    “AKATHISIA is subjective feelings OF RESTLESSNESS, OBJECTIVE SIGNS OF RESTLESSNESS, OR BOTH. Examples include a sense of anxiety, inability to relax, jitteriness, pacing, rocking motions while sitting, and rapid alternation of sitting and standingâ€.

    --------Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition
  30. Guest

    Guest Guest

    Q-Mifepristone is used in?
    A. Molar pregnancy
    B. Threatened abortion
    C. Fibroid
    D. Ectopic pregnancy

    Ans-fibroid>>>>ectopic pregnancy

    Ref-
    ECTOPIC PREGNANCY-
    “Medical therapy is preferred by most, if feasible. Only methotrexate has been extensively studied as an alternative to surgical therapy.
    Other agents that have been used include prostaglandins and MIFEPRISTONE, as well as potassium chloride or hyperosmolar glucose injected into the ectopic mass.â€


    “Mifepristone Plus Methotrexate
    It seems logical that the addition of 600 mg of mifepristone orally to single-dose methotrexate might improve efficacy and result in faster resolution of the unruptured ectopic pregnancy .
    IN A RANDOMIZED TRIAL OF 212 CASES, HOWEVER, ROZENBERG AND CO-WORKERS (2003) DOCUMENTED NO DIFFERENCES IN SUCCESS RATESâ€.
    ---------------------------------------------------------------------------------------------------------------
    “ANTIPROGESTINS for FIBROIDS
    Mifepristone, also known as RU486, is the most widely available antiprogestin for treatment of leiomyomas(FIBROID). It has proved effective in decreasing leiomyoma volume and clinical symptoms.
    “MIFEPRISTONE DIMINISHES LEIOMYOMA VOLUME BY APPROXIMATELY HALF.
    (Eisinger, 2003; Murphy, 1993). In their review, Steinauer and colleagues (2004) found that although there was not a consistent correlation between increasing mifepristone dose and leiomyoma response, increasing duration of treatment did correlate with tumor shrinkage during 3- to 6-month trials. They also reported that MIFEPRISTONE WAS EFFECTIVE IN IMPROVING SYMPTOMS.
    Of those treated, 91 percent developed amenorrhea, 75 percent reported improved pain relief, and 70 percent had fewer pressure symptoms. In a comparison of leuprolide acetate treatment and MIFEPRISTONE THERAPY, REINSCH AND ASSOCIATES (1994) SHOWED COMPARABLE DECREASES IN UTERINE VOLUME, YET MIFEPRISTONE WAS BETTER TOLERATED.â€
    --------- Williams Gynecology ,The McGraw-Hill Companies

    -------------------------------------------------------------------------------------

    “Salpingocentesis is a technique in which agents such as KCL, METHOTREXATE, PROSTAGLANDINS, AND HYPEROSMOLAR GLUCOSE are injected into the ectopic pregnancy transvaginally using ultrasonographic guidance, transcervical tubal cannulization, or laparoscopy. Agents injected under ultrasonographic guidance have included METHOTREXATE (166,167,168,169,170), KCl (171), combined methotrexate and KCl (172), and prostaglandin E2 (173). The potential advantages of salpingocentesis include a one-time injection with the potential avoidance of systemic side effects. Reproductive function after this form of treatment has not been reported. Because of the limited experience, this treatment cannot be recommended until there is further study.
    Agents injected into the amniotic sac at laparoscopy have included prostaglandin F2a (174), hyperosmolar glucose (175), and methotrexate (176). This method has the obvious disadvantage of requiring laparoscopy, but it can be used if laparoscopy has been performed. Other agents reported for the treatment of ectopic pregnancy include RU-486 (177) and anti-hCG antibody (178).â€
    ------------------- Berek & Novak's Gynecology, 14th Edition

    THEY DON’T MENTION MIFEPRISTONE AT ALL HERE IN NOVAKS GYNEC.

    Also mifepristone has not been mentioned as treatment for ectopic pregnancy in
    Danforth's Obstetrics and Gynecology, 10th Edition
  31. Guest

    Guest Guest

    Q-Most important prognostic factor in congenital diaphragmatic hernia?
    A. Pulmonary hypertension
    B. Timing of surgery
    C. Size of defect
    D. Gestational age
    Ans-Pulmonary hypertension
    Ref-

    “Many newborns with CDH have respiratory failure within minutes of birth, and urgent stabilization is mandatory to reverse hypoxia, hypercarbia, and metabolic acidosis. Prompt and aggressive preoperative care is essential . This generally includes mechanical ventilation with 100% oxygen, sedation with narcotics, muscle paralysis, controlled alkalosis with hyperventilation and intravenous sodium bicarbonate, and vasopressors. Permissive hypercarbia and gentle ventilation have proven effective in a number of centers “Regardless of the mode of therapy, THE GOAL IS TO REVERSE THE BABY'S PERSISTENT PULMONARY HYPERTENSION WITH RIGHT-TO-LEFT SHUNTING OF OXYGEN-POOR BLOOD ACROSS THE OPEN FORAMEN OVALE AND THE DUCTUS ARTERIOSUS.
    Some infants do not improve despite aggressive therapy, and many centers use ECMO before hernia repair to stabilize these desperately ill infants (65,66). Venovenous or venoarterial bypass is used, depending on the infant's hemodynamic stability.

    BYPASS IS CONTINUED UNTIL THE PULMONARY HYPERTENSION IS REVERSED AND LUNG FUNCTION IS IMPROVED.”
    -------------------Avery's Neonatology, 6th Edition

    “The failure of normal division of airway structures at the pseudoglandular stage may lead to PULMONARY HYPOPLASIA or sequestration, cystic adenomatoid malformation, and, crucially, failure of the pleuro-peritoneal membrane to close, which MAY RESULT IN CONGENITAL DIAPHRAGMATIC HERNIA”
    ----------------------Neonatal Emergencies, McGraw-Hill Companies


    “The high mortality and morbidity in CDH is mainly attributed to PULMONARY HYPOPLASIA and PERSISTENT PULMONARY HYPERTENSION.”

    “Pulmonary morbidity, including PULMONARY HYPOPLASIa, BRONCHOPULMONARY DYSPLASIA, PERSISTANT PULMONARY HYPERTENSION, REACTIVE AIRWAY DISEASE, AND LIMITED POSTNATAL ALVEOLAR GROWTH, is the most common and signifi cant problem in CDH infants surviving beyond the neonatal period”
    --------------------- Pediatric Surgery
    Diagnosis and Management,springer
  32. Guest

    Guest Guest

    Q- All of the following are true about erlotinib except?
    A. Tyrosine kinase inhibitor
    B. Food delays its absorption
    C. Rashes can occur
    D. Used in non small cell lung cancer when there is no response to other chemotherapeutic agents

    Ans-Food delays its absorption.

    Ref-


    • “Erlotinib (TARCEVA; [N-(3-ethynylphenyl)-6,7-bis(2-methoxyethoxy)-4-quinazolinamine]) is a human HER1/EGFR TYROSINE KINASE INHIBITORâ€


    • “ERLOTINIB IS ~60% ABSORBED AFTER ORAL ADMINISTRATION AND ITS BIOAVAILABILITY IS INCREASED TO ALMOST 100% BY FOODâ€

    • “It is indicated for treatment of patients with LOCALLY ADVANCED OR METASTATIC NON–SMALL CELL LUNG CANCER.â€

    “The most common adverse reactions in patients receiving erlotinib were DIARRHEA AND RASHâ€
    --------------------- Goodman & Gilman’s Manual of
    Pharmacology and Therapeutics


    Drug:Erlotinib

    Mechanism of Action:Inhibits EGFR TYROSINE KINASE leading to inhibition of EGFR signaling

    Clinical Applications:NON-SMALL CELL LUNG CANCER, PANCREATIC CANCER

    Acute Toxicity:DIARRHEA

    Delayed Toxicity:SKIN RASH, diarrhea, anorexia, interstitial lung disease

    --------------------- Basic & Clinical Pharmacology, 11th Edition

    Bertram G. Katzung
  33. Guest

    Guest Guest

    Q- Main blood supply of neck of femur?
    A. Lateral circumflex femoral
    B. Medial circumflex femoral
    C. Profunda femoris
    D. Popliteal artery

    Ans-medial circumflex femoral>Lateral circumflex femoral

    Ref-

    “The circumflex femoral arteries encircle the uppermost shaft of the femur and anastomose with each other and other arteries, supplying the thigh muscles and the superior (proximal) end of the femur.
    THE MEDIAL CIRCUMFLEX FEMORAL ARTERY IS ESPECIALLY IMPORTANT BECAUSE IT SUPPLIES MOST OF THE BLOOD TO THE HEAD AND NECK OF THE FEMUR VIA ITS BRANCHES, THE POSTERIOR RETINACULAR ARTERIES. The retinacular arteries are often torn when the femoral neck is fractured or the hip joint is dislocated.


    The LATERAL CIRCUMFLEX FEMORAL ARTERY, LESS ABLE TO SUPPLY THE FEMORAL HEAD AND NECK AS IT PASSES LATERALLY ACROSS THE THICKEST PART OF THE JOINT CAPSULE OF THE HIP JOINT, MAINLY SUPPLIES MUSCLES ON THE LATERAL SIDE OF THE THIGH.”
    -------------------Clinically Oriented Anatomy, Keith L. Moore

    “The blood supply of the femoral head is derived from an arterial ring around the neck, just outside the attachment of the fibrous capsule, constituted by the MEDIAL AND LATERAL CIRCUMFLEX FEMORAL ARTERIES WITH MINOR CONTRIBUTIONS FROM THE SUPERIOR AND INFERIOR GLUTEAL VESSELS”

    “Observations on developmental patterns of blood supply in late fetal and early postnatal periods have revealed that
    ALTHOUGH MEDIAL AND LATERAL CIRCUMFLEX FEMORAL ARTERIES AT FIRST CONTRIBUTE EQUALLY, TWO MAJOR BRANCHES OF THE MEDIAL PROVIDE THE FINAL SUPPLY, BOTH POSTERIOR TO THE NECK.

    The SUPPLY FROM THE LATERAL CIRCUMFLEX ARTERY DIMINISHES AND THE ARTERIAL RING IS INTERRUPTED”
    -------------------------- Gray's Anatomy, 40th Edition


    Q-Sterile pyuria is present in?
    A. Renal tuberculosis
    B. Chronic hydronephrosis
    C. Wilm's tumour
    D. Neuroblastoma
    Ans-renal TB

    Ref-

    TUBERCULOSIS OF THE KIDNEY, URETER, AND BLADDER

    “The patient usually complains of frequent painless micturition.
    Urgency is uncommon. The urine is classically characterized by a STERILE PYURIA;
    however, up to 20% of patients do not have any leukocytes in the urine ( Gow, 1976 ).
    Commonly, the symptoms are intermittent.
    Overt hematuria is present in only 10% of patients, but microscopic hematuria is present in up to 50%.”
    ------------------ Campbell-Walsh Urology, 9th ed.
  34. Guest

    Guest Guest

    Q-Diaphragm develops from all except:
    A. Septum transversum
    B. Dorsal mesocardium
    C. Pleuroperitoneal membrane
    D. Cervical myotomes

    Ans-dorsal mesocardium(which is not equal to dorsal mesentry)

    Ref-

    “The diaphragm divides the body cavity into the thoracic and peritoneal cavities.
    It develops from four components:
    (a) SEPTUM TRANSVERSUM (central tendon),
    (b) PLEUROPERITONEAL MEMBRANES,
    (c) dorsal mesentery of the esophagus, and
    (d) MUSCULAR COMPONENTS FROM SOMITES AT CERVICAL LEVELS THREE TO FIVE (C3-5) OF THE BODY WALL.

    Since the septum transversum is located initially opposite cervical segments three to five and since muscle cells for the diaphragm originate from somites at these segments, the phrenic nerve also arises from these segments of the spinal cord (C3, 4, and 5 keep the diaphragm alive!). diaphragmatic hernias involving a defect of the pleuroperitoneal membrane on the left side occur frequently.”
    ------------------- 11th edition of Langman's Medical Embryology
  35. Guest

    Guest Guest

    Q Which is NOT SEEN in digoxin toxicity?
    A. Biventricular tachycardia
    B. Paroxysmal atrial tachycardia
    C. Ventricular bigeminy
    D. Regularisation of AF

    Ans- NONE>>>Biventricular tachycardia??

    (from refrences given below digoxin causes bidirectional ventricular tachycardia and not biventricular tachycardia)
    Regarding B,C,D there is definitive proof that they are seen in digitalis toxicity.

    Ref-

    “At THERAPEUTIC DOSES, digoxin decreases automaticity at the AV node, PROLONGING THE EFFECTIVE REFRACTORY PERIOD OF AV NODAL TISSUE and slowing conduction velocity through the node.
    These combined vagotonic and electrophysiologic properties UNDERLIE THE USE OF DIGOXIN IN THE TREATMENT OF PATIENTS WITH ATRIAL FIBRILLATION AND RAPID VENTRICULAR RESPONSE RATES; both the decreased automaticity of AV nodal tissue and the decreased conduction velocity through the node increase the degree of AV block, and thereby decrease the ventricular response rate.”

    In contrast to its effects at the AV node, digoxin enhances automaticity of the infranodal (His–Purkinje) conduction system. These divergent effects at the AV node and His– Purkinje system explain the characteristic electrophysiologic disturbance of complete heart block with accelerated junctional or accelerated idioventricular escape rhythm (REFERRED TO AS “REGULARIZED” ATRIAL FIBRILLATION) in patients with DIGOXIN TOXICITY”.

    ---------------------- Principles of Pharmacology: The Pathophysiologic Basis of Drug Therapy, David E. Golan

    “THE MOST COMMON CARDIAC MANIFESTATIONS OF DIGITALIS TOXICITY INCLUDE
    • atrioventricular junctional rhythm,
    • premature ventricular depolarizations,
    • bigeminal rhythm, and
    • second-degree atrioventricular blockade. However, it is claimed that digitalis can cause virtually any arrhythmia.”

    ----------- Basic & Clinical Pharmacology, 11th Edition

    Bertram G. Katzung, Susan B. Masters, Anthony J. Trevor

    “WHILE DIGITALIS INTOXICATION CAN CAUSE VIRTUALLY ANY ARRHYTHMIA, arrhythmias that should raise a strong suspicion of digitalis intoxication are those in which DAD-RELATED TACHYCARDIAS occur along with impairment of sinus node or AV nodal function. ATRIAL TACHYCARDIA WITH AV BLOCK IS CLASSIC, BUT VENTRICULAR BIGEMINY (SINUS BEATS ALTERNATING WITH BEATS OF VENTRICULAR ORIGIN),

    “BIDIRECTIONAL” VENTRICULAR TACHYCARDIA, AV JUNCTIONAL TACHYCARDIAS, AND VARIOUS DEGREES OF AV BLOCK ALSO CAN OCCUR.
    With severe intoxication (e.g., with suicidal ingestion), severe hyperkalemia owing to poisoning of Na,K–ATPase and profound bradyarrhythmias are seen. In patients with elevated serum digitalis levels, the risk of precipitating ventricular fibrillation by DC cardioversion probably is increased; in those with therapeutic blood levels, DC cardioversion can be used safely.”
    -------------------------------- Goodman & Gilman’s Manual of Pharmacology and Therapeutics”


    “Digoxin Toxicity.
    “ Among the more common electrophysiological manifestations are
    • Ectopic beats of AV junctional or ventricular origin,
    • First-degree AV block,
    • AN EXCESSIVELY SLOW VENTRICULAR RATE RESPONSE TO ATRIAL FIBRILLATION, or an
    • accelerated AV junctional pacemaker.

    These often require only a dosage adjustment and appropriate monitoring. Sinus bradycardia, sinoatrial arrest or exit block, and second- or third-degree AV conduction delay usually respond to atropine, although temporary ventricular pacing may be necessary. Potassium administration should be considered for patients with evidence of increased AV junctional or ventricular automaticity, even when the serum K+ is in the normal range, unless high-grade AV block also is present. Lidocaine or phenytoin, which have minimal effects on AV conduction, may be used for the treatment of worsening ventricular arrhythmias that threaten hemodynamic compromise (see Chapter 34). Electrical cardioversion carries an increased risk of inducing severe rhythm disturbances in patients with overt digitalis toxicity and should be used with particular caution. Note, too, that inhibition of the Na+,K+-ATPase activity of skeletal muscle can cause hyperkalemia.
    --------------------------- Goodman_Gillman_11th Ed

    “A new method for quantifying ventricular regularization during atrial fibrillation.
    Ware JH, Tecklenberg PL, Miller M, Raff MS, Grauer L, Goldstein RE.

    Atrial fibrillation (AF) characteristically results in random variation of the intervals between successive ventricular depolarizations. However, when a patient with AF is treated with excessive amounts of digitalis, regular junctional rhythms may occur.
    THE DETECTION OF "REGULARIZATION" OF THE VENTRICULAR RHYTHM IN PATIENTS WITH AF MAY SIGNAL EARLY DIGITALIS TOXICITY”
  36. Guest

    Guest Guest

    Questions 91-110:

    91. Campylobacter jejuni false is-

    a.commonest cause of campylobacteriosis
    b.polutry source of infection
    c.humans are reservoir
    d.associated with GBS

    ans : C. as animals are reservoirs of Camplyobacter

    91. A fire breaks out during laser vocal cord surgery. What is not to be done?
    A. Pouring sterile water into the oral cavity
    B. Removing endotracheal tube
    C. 100% oxygen after discontinuing anesthetic gases
    D. Treatment with steroid & antibiotic
    Ans:
    Reference: Could not get a Text reference....a journal paper on Management of Airway fire during Microlaryngeal surgery provides some light
    Managing fire

    Remove source of fire and extinguish with water
    Stop ventilation,†turn off O2 “
    Mask ventilate with air, “then 100% O2 once fire is extinguishedâ€
    Laryngoscopy and rigid bronchoscopy to remove debris
    Lavage and fibreoptic bronchoscopy if indicated by airway injury
    Common pattern is worst injury at the surgical site and little distal injury
    If severe injury
    “Maintain ventilationâ€
    Consider low tracheostomy
    “IV corticosteroids may be helpfulâ€
    CXR, ABG with co-oximetry for smoke inhalation assessment

    Option B is correct...
    Option A not sure...
    Option C is TRICKY......we should Discontinue the oxygen first that itself will extinguish the fire....once the fire is gone then ventilate with 100% O2....
    OptionD is correct

    Answer should be A/C depends on the exact wordings of the option C

    92. Some antigen was injected into a rabbit. What antibody will it produce initially?
    A. IgG
    B. IgM
    C. IgE
    D. IgD
    Ans: B IgM(IS this question any trick or just a question asking for the primary immune respose)

    93. Which insect among the following is not resistant to DDT?
    A. Musca domestica
    B. Phlebotomus…………..answer
    C. Culex
    D. Anopheles stephensi

    94. Which virus among the following is least likely to cross placenta?
    A. Rubella
    B. Herpes simplex
    C. HIV
    D. HBV

    95. About yaws all are true except:
    A. Caused by Treponema pertenue
    B. Transwermitted non-venerally
    C. Secondary yaws can involve bones
    D. Last stages involve heart and nerves
    Ans: D Late stages involve heart and nerves
    Reference:Harrison 17th ed
    Yaws
    Also known as pian, framboesia, or bouba, yaws is caused by T. pallidum subspecies pertenue and is characterized by the development of one or several primary lesions ("mother yaw"), which is followed by the appearance of multiple disseminated skin lesions. All early skin lesions are infectious and may persist for many months; cutaneous relapses are common during the first 5 years. Late manifestations, affecting 10% of untreated persons, are destructive and can involve skin, bone, and joints.
    The infection is transmitted by direct contact with infectious lesions, often during play or group sleeping, and may be enhanced by disruption of the skin by insect bites or abrasions. After an average of 3–4 weeks, the first lesion begins as a papule—usually on an extremity—and then enlarges (particularly during moist warm weather) to become papillomatous or "raspberry-like" (thus the name "framboesia") (Fig. 163-2). Regional lymphadenopathy develops, and the lesion usually heals within 6 months; dissemination is thought to occur during the early weeks of infection. A generalized secondary eruption, accompanied by generalized lymphadenopathy, appears either concurrent with or following the primary lesion, may take several forms (macular, papular, or papillomatous), and may become secondarily infected with other bacteria. Painful papillomatous lesions on the soles of the feet result in a painful crablike gait ("crab yaws"), and periostitis may result in nocturnal bone pain and polydactylitis.

    Late yaws is manifested by gummas of the skin and long bone, hyperkeratoses of the palms and soles, osteitis and periostitis, and hydrarthrosis. The late gummatous lesions are characteristically extensive. Destruction of the nose, maxilla, palate, and pharynx is termed gangosa and is similar to the destructive lesions seen in leprosy and leishmaniasis.

    96. Weight gain in pregnancy is related to all except?
    A. Ethnicity
    B. Smoking
    C. Socioeconomic status
    D. Pre conceptional weight
    Ans: B Smoking (REPEAT)

    97. A 3.8 kg baby of a diabetic mother developed seizures 16 hours after birth. Most probable cause is?
    A. Hypoglycemia
    B. Hypocalcemia
    C. Birth asphyxia
    D. Intra ventricular hemorrhage

    Ans: A Hypoglycemia(REPEAT)

    [98]. Regarding PCOD, all are true except?
    A. High LH/FSH
    B. High DHEAS
    C. Very high prolactin
    D. Raised LH
    Ans: C Very high prolactin(REPEAT)

    99. Which anesthetic modality is to be avoided in sickle cell disease?
    A. General anesthesia
    B. Brachial plexus block
    C. IV regional anesthesia
    D. Spinal
    Ans: C IV regional anesthesia(REPEAT)

    100. Best marker for intrahepatic cholestasis of pregnancy is?
    A. Bile salts
    B. Bile acid
    C. Bilirubin
    D. Alkaline phosphatise
    Ans: B Bile acids(REPEAT)

    101. Which of the following is the most probable diagnosis in a patient with loss of central vision and a normal ERG with no family history?
    A. Best's disease
    B. Stargardt's disease
    C. Retinitis pigmentosa
    D. Macular hole
    Ans:B Stargardt disease
    Clincal ophthalmology by Vaughan
    Both Eale’s and Stargrdt’s can manifest with loss of central vision and normal ERG....but stargerdt is most common and it is autosomal recessive wheras Eales is AD and less common...

    102. Renal calculi associated with proteus infection is:
    A. Uric acid
    B. Triple phosphate
    C. Calcium oxlalate
    D. Xanthine
    Ans:B Triple phosphate(REPEAT)

    103. The primary action of NO in git is?
    A. Vasodilatation
    B. Vasoconstriction
    C. GI smooth muscle inhibition
    D. Secretomotor
    Ans:C GI smooth muscle inhibition(REPEAT)

    104. A 40 year old female underwent surgery. Post operatively she told the anaesthetist that she was aware of per-operative events. Individual intraoperative awareness is evaluated by (to prevent such instances from occurring)?
    A. Pulse oximetry
    B. Colour doppler
    C. Bispectral index
    D. End tidal CO2
    Ans:C BIS
    Refernce: Quantitative EEG, event-related potentials and neurotherapy
    By Juri Kropotov
    Bispectral index is used to asses the depth of anesthesia.Its a good measure of brain activites in sleep wakefulness cycle.

    105. All of the following helps in generating oxygen burst for killing bacteria within neurophils except?
    A. Superoxide dismutase
    B. Oxidase
    C. Peroxidase
    D. Glutathione peroxidise
    Ans: A Superoxide dismutase and Glutathione peroxidise(OPEN FOR DISCUSSION)
    Reference: Robbins pathos 8th ed
    A series of enzymes acts as free radical–scavenging systems and breaks down H2O2 and o2. .[21,][23] These enzymes are lo-cated near the sites of generation of the oxidants and include the following:
    1. Catalase, present in peroxisomes, decomposes H2O2 (2H2O2 ➙ O2 + 2H2O).
    2. Superoxide dismutases (SOD) are found in many cell types and convert O2 to H2O2 (2O2. + 2H ➙ H2O2 + O2). This group includes both manganese–SOD which is localized in mitochondria, and copper-zinc–SOD, which is found in the cytosol.
    3. Glutathione peroxidase also protects against injury by catalyzing free radical breakdown (H2O2 + 2GSH ➙ GSSG [glutathione homodimer] + 2H2O, or 2OH + 2GSH ➙ GSSG + 2H2O). The intracellular ratio of oxidized glutathione (GSSG) to reduced glutathione (GSH) is a reflection of the oxidative state of the cell and is an important indicator of the cell's ability to detoxify ROS.

    106. Most common cause of meningoencephalitis in children?
    A. HSV
    B. Enterovirus
    C. Mumps
    D. Listeria
    Ans:B Enterovirus(REPEAT)

    107. Principle orgenelle involved in the execution of apoptosis is?
    A. Nucleus
    B. Lysosome
    C. Mitochondria
    D. Endoplasmic reticulum

    Answer:C Mitochondria(REPEAT)

    108. Feature of obstructive azoospermia is?
    A. High FSH, high testosterone
    B. Low FSH, high testosterone
    C. High FSH, low testosterone
    D. Normal FSH, normal testosteron

    Ans:D NORMAL Testosterone and FSH(REPEAT)

    109. ‎'C' in C reactive protein stands for:
    A. Capsular polysaccharide in pneumococcus
    B. Concanavalin-a
    C. Calretinin
    D. Cellular

    Ans:A Capsular polysaccharide of pneumococcus(REPEAT)

    110. Buprenorphine is?
    A. Partial agonist at Mu Receptor
    B. Partial agonist at Kappa Receptor
    C. Full Agonist at Mu Receptor
    D. Antagonist at Kappa receptor

    Ans:A Partial agonist of mu receptor
    Reference: Goodman and Gilman
    Buprenorphine appears to be a partial receptor agonist. Depending on the dose, buprenorphine may cause symptoms of abstinence in patients who have been receiving receptor agonists for several weeks. It antagonizes the respiratory depression produced by anesthetic doses of fentanyl about as well as does naloxone without completely reversing opioid pain relief (Boysen et al., 1988). Although respiratory depression has not been a major problem, it is not clear whether there is a ceiling for this effect (as seen with nalbuphine and pentazocine). The respiratory depression and other effects of buprenorphine can be prevented by prior administration of naloxone, but they are not readily reversed by high doses of naloxone once the effects have been produced. This suggests that buprenorphine dissociates very slowly from opioid receptors. The half-life for dissociation from the receptor is 166 minutes for buprenorphine, as opposed to 7 minutes for fentanyl (Boas and Villiger, 1985). Therefore, plasma levels of buprenorphine may not parallel clinical effects. Cardiovascular and other side effects (e.g., sedation, nausea, vomiting, dizziness, sweating, and headache) appear to be similar to those of morphine-like opioids.
  37. Guest

    Guest Guest

    111.All are true about aprepitant except?
    A. Agonist at NK1
    B. Crosses blood brain barrier
    C. Ameliorates nausea and vomiting of chemotherapy
    D. Metabolized by CYP450

    Ans:A Agonist at NK1 Receptor
    Reference:Katzung Pharmacology
    Neurokinin 1 (NK1) receptor antagonists have antiemetic properties that are mediated through central blockade in the area postrema. Aprepitant is a highly selective NK1 receptor antagonist that crosses the blood-brain barrier and occupies brain NK1 receptors. It has no affinity for serotonin, dopamine, or corticosteroid receptors.

    112. Time of occurrence of secondary hemorrhage after tonsillectomy?
    A. 24 hrs
    B. 6 days
    C. 12 days
    D. 12 hrs

    Ans: 6 Days(No reference needed)

    113. A patient with head injury on examination revealed eye opening in response to pain, inappropriate words and pain localisation. Calculate GCS?
    a. 10
    b. 8
    c. 12
    d. 14

    Ans: A 10(GCS—no referencs needed)

    114. A primigravida in 1st trimester had sputum positive for acid fast bacillus. What is the preferred treatment?
    A. Treatment deferred till 2nd trimester
    B. Category 1 DOTS
    C. Category 2 DOTS
    D. Category 3 DOTS
    Ans:B Category 1 DOTS(REPEAT)

    117. What will you give to treat hypothyroidism in a patient with ischemic heart disease?
    A. Low dose of levothyroxine
    B. Normal dose of levothyroxine
    C. Do not give levothyroxine
    D. Thyroid extract ???

    118. Carrier state is not important in transmission of:
    A. Measles
    B. Typhoid
    C. Polio
    D. Diphtheria

    Ans:A Measlers(REPEAT)

    119. A schizophrenic patient started on haloperidol 2 days back, comes with complaints of torticollis and orofaciolingual movements. What is the diagnosis?
    A. Acute dystonia
    B. Tardive dyskinesia
    C. Parkinsonism
    D. Akathisia
    Ans:A Acute Dystonia
    Reference:Kaplan and saddok
    Neuroleptic-Induced Acute Dystonia
    Diagnosis, Signs, and Symptoms
    Dystonias are brief or prolonged contractions of muscles that result in obviously abnormal movements or postures, including oculogyric crises, tongue protrusion, trismus, torticollis, laryngeal–pharyngeal dystonias, and dystonic postures of the limbs and trunk. Other dystonias include blepharospasm and glossopharyngeal dystonia; the latter results in dysarthria, dysphagia, and even difficulty in breathing, which can cause cyanosis. Children are particularly likely to evidence opisthotonos, scoliosis, lordosis, and writhing movements. Dystonia can be painful and frightening and often results in noncompliance with future drug treatment regimens.
    Epidemiology
    The development of dystonic symptoms is characterized by their early onset during the course of treatment with neuroleptics and their high incidence in men, in patients younger than age 30 years, and in patients given high dosages of high-potency medications.
    Etiology
    Although it is most common with intramuscular doses of high-potency antipsychotics, dystonia can occur with any antipsychotic. The mechanism of action is thought to be dopaminergic hyperactivity in the basal ganglia that occurs when central nervous system (CNS) levels of the antipsychotic drug begin to fall between doses.

    120. All are true about parvovirus b19 except?
    A. <10 % spread by transplacental route
    B. Spread by respiratory route
    C. It is a DNA virus
    D. Affects erythroid progenitor cells
    Ans:A <10% spread by transplacental route(REPEAT)

    121. Sterile pyuria is present in?
    A. Renal tuberculosis
    B. Chronic hydronephrosis
    C. Wilm's tumour
    D. Neuroblastoma
    Ans:A Sterile pyuria(REPEAT)

    122. A 35 year old female has proximal weakness of muscles, ptosis and easy fatiguability. The best test to diagnose her condition is:
    A. Muscle biopsy
    B. CPK
    C. Edrophonium test
    D. EMG

    Ans:C Edrophonium test(REPEAT)

    123. Denominator in Maternal Mortality Rate?
    A. Total number of live births
    B. Total number of married women
    C. Total number of births
    D. Midyear population
    Ans:A Total live births(REPEAT)

    124. Psammoma bodies are seen in all except?
    A. Follicular carcinoma thyroid
    B. Papillary carcinoma thyroid
    C. Cystadenocarcinoma
    D. Meningioma

    Ans:A Follicular carcinoma thyroid(REPEAT)

    125. Visceral larva migranswer is seen in?
    A. Strongyloides
    B. Ancylostoma
    C. Toxocara canis
    D. Visceral leishmaniasis

    Ans:A Toxocara canis(no explanation needed)
    Reference:Jawetz microbiology

    126. Urethral crest is situated in:
    A. Prostatic urethra
    B. Membranous urethra
    C. Penile urethra
    D. Bulbar urethra
    Ans:A Prostatic urethra(no explanation needed)

    127. People were separated into relevant 5 sub groups. People were selected randomly from these sub groups. What type of sampling was done?
    A. Simple random sampling
    B. Stratified Sampling
    C. Cluster sampling
    D. Systematic sampling

    Ans:Stratified sampling

    128. All of the following are true about erlotinib except?
    A. Tyrosine kinase inhibitor
    B. Food delays its absorption
    C. Rashes can occur
    D. Used in non small cell lung cancer when there is no response to other chemotherapeutic agents

    Ans:B Food delays absorption
    Reference:Goodman and Gilman
    Absorption, Fate, and Excretion
    Erlotinib is about 60% absorbed after oral administration and its bioavailability is substantially increased to almost 100% by food. Peak plasma levels occur 4 hours after an oral dose. Following absorption, erlotinib is approximately 93% protein-bound to albumin and alpha1-acid glycoprotein. Its half-life is ~36 hours. Erlotinib is metabolized primarily by CYP3A4 and to a lesser extent by CYP1A2 and CYP1A1.

    129. What will you give to treat hypothyroidism in a patient with ischemic heart disease?
    A. Low dose of levothyroxine
    B. Normal dose of levothyroxine
    C. Do not give levothyroxine
    D. Thyroid extract

    Ans:A Low dose of levothyroxine(OPEN FOR DISCUSSION)

    Reference---BRAUNWALD'sPRINCIPLES OF CARDIOLOGY

    SUBCLINICAL HYPOTHYROIDISM

    Subclinical hypothyroidism defined as a TSH above the upper range of the reference population (usually >5 mIU/ml) is seen in up to 9 percent of unselected populations, and clearly prevalence increases with advancing age. In contrast to younger patients in whom there is a strong female predilection, in older populations, this difference is lost. Subclinical hypothyroidism alters lipid metabolism, atherosclerosis, cardiac contractility, and systemic vascular resistance. Cholesterol levels rise in parallel with increments in TSH elevations starting at 5 mIU/liter. A large study of women in Rotterdam showed that atherosclerosis and myocardial infarction increased with odds ratios of 1.7 and 2.3 in subclinical hypothyroid women, respectively. Interestingly, the presence of antithyroid antibodies as a measure of autoimmune thyroid disease indicated heightened risk. Restoration of serum TSH to normal after thyroid hormone replacement improved lipid levels, lowered systemic vascular resistance, and improved cardiac contractility. Patients with subclinical hypothyroidism have prolonged isovolumic relaxation times, whereas systolic contractile function does not change (see Fig. 81-6 ). Replacement with l-thyroxine sodium at a mean dose of 68 mg per day (range 50 to 100 mg per day) restored isovolumic relaxation times to normal and when compared with the same patients before therapy, systemic vascular resistance declined and systolic function significantly improved. A variety of studies have indicated that the changes in systemic vascular resistance result from alterations in endothelium-dependent vasodilation. Taken together, it seems appropriate to recommend thyroid hormone replacement for all patients with subclinical hypothyroidism from a cardiovascular perspective. The lack of untoward cardiac effects observed when serum TSH levels normalize indicate that the potential benefits far outweigh the risks of treatment.

    130. Mifepristone is used in?
    A. Molar pregnancy
    B. Threatened abortion
    C. Fibroid
    D. Ectopic pregnancy…
    Ans:Fibroid
    Reference:Goodman and Gilman
    Therapeutic Uses and Prospects
    Mifepristone (MIFEPREX), in combination with misoprostol or other prostaglandins (see below), is available for the termination of early pregnancy. When mifepristone is used to produce a medical abortion, a prostaglandin is given 48 hours after the anti-progestin to further increase myometrial contractions and ensure expulsion of the detached blastocyst. Intramuscular sulprostone, intravaginal gemeprost, and oral misoprostol have been used. The success rate with such regimens is >90% among women with pregnancies of 49 days duration or less. The most severe untoward effect is vaginal bleeding, which most often lasts from 8 to 17 days, but is only rarely (0.1% of patients) severe enough to require blood transfusions. High percentages of women also have experienced abdominal pain and uterine cramps, nausea, vomiting, and diarrhea due to the prostaglandin. Women receiving chronic glucocorticoid therapy should not be given mifepristone because of its anti-glucocorticoid activity, and the drug should be used very cautiously in women who are anemic or receiving anticoagulants. Women over 35 years old with cardiovascular risk factors should not be given sulprostone because of possible heart failure (Christin-Maitre et al., 2000).
    Other investigational or potential uses for mifepristone that are under development include the induction of labor after fetal death; the induction of labor at the end of the third trimester; treatment of endometriosis, leiomyomas, breast cancer, and meningiomas; and as a postcoital or luteal-phase contraceptive (Spitz and Chwalisz, 2000). A major concern about long-term use is the possibility of unopposed estrogenic effects, but this concern could be allayed by further development of selective progesterone-receptor modulators.
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    131. A 55 year old man presents with history of 5 episodes of hematuria each lasting for about 4-5 days associated with clots in the past 5 years. What will be the best investigation to arrive at a diagnosis?
    A. Urine examination and microscopy
    B. X-ray KUB
    C. Abdominal USG
    D. DTPA scan
    Ans: Before going to the answer let us split the question and see the explanation:
    55yr old man –possibility of carcinomas , BPH and sometimes cystic diseases of the kidney as well
    Intermittent hematuria with CLOTS lasting for 4-5 days each—should be a sizable bleed with stagnation
    Past 5 yrs history—really a long process...unlikely a malignancy.

    132. A graph of Normal blood sugar level curve and Diabetic blood sugar level curve was shown. An area was seen overlapping towards the normal gycemic curve. A point at 120 mg/dl was shown too. Question : What does that area represent?
    A. True positive
    B. False positive
    C. True negative
    D. False negative

    Ans:D False negative

    If anyone has a contradiction we can get the diagram on the thread and then argue

    133. Which among the following not used in diagnosis of insulinoma?
    A. Fasting glucose test
    B. Xylulose test
    3. C peptide levels
    4. Insulin / glucose ratio

    Ans:B xylose test
    which is for intestinal function..anyway here is sabiston reference for completion sake..
    The pathognomonic finding is an inappropriately high (>5 mU/mL) level of serum insulin during symptomatic hypoglycemia. A possible mechanism for this high level of insulin in the face of hypoglycemia may be overexpression of the insulin splice variant. A diagnostic ratio of blood insulin (in microunits per milliliter) to glucose (in milligrams per deciliter) of greater than 0.4 or C peptide levels higher than 2 nmol/L have proved valuable in diagnosis. The best way to induce hypoglycemia is with fasting: two thirds of patients will experience hypoglycemic symptoms in 24 hours, and nearly all other patients experience symptoms by 72 hours of fasting. Provocative tests, usually involving tolbutamide or glucagon, have been used, but they may cause dangerously profound hypoglycemia and are not generally necessary. Because cerebrocytes metabolize only glucose, prolonged profound hypoglycemia may cause permanent brain damage. Clinicians need to be alert to this problem when attempting to induce hypoglycemia by fasting. Most important, preoperative fasting orders must be accompanied by IV administration of glucose.

    134. All are true about Nesidioblastosis except ?
    A. Hypoglycemic episodes are seen
    B. Occurs in adults more than children
    C. Histopathology shows hyperplasia of islet cells
    D. Diazoxide is used for treatment

    Ans:B Occurs in adults more than children


    The disorder later was called persistent hyperinsulinemic hypoglycemia of infancy (PHHI)
    n PHHI, the histologic abnormalities in pancreatic structure are heterogeneous but can be grouped into 2 broad categories: (1) focal adenomatous hyperplasia (found in one fourth to one third of cases) and (2) a diffuse abnormality of the islets
    Diazoxide (Hyperstat [IV], Proglycem [PO]) is an antihypertensive agent that relaxes smooth muscle in the peripheral arterioles.
    • Diazoxide is related to the thiazide class of drugs but has no diuretic action. It promotes opening of the potassium adenosine triphosphate (ATP) channel, which inhibits pancreatic secretion of insulin, stimulates glucose release from the liver, and stimulates catecholamine release. (This effect is opposite that of the sulfonylurea drugs used in diabetes mellitus, which close the ATP channel.)
    • Diazoxide causes sodium and water retention and should be used cautiously in patients with congestive heart failure or poor cardiac reserve. Hypertrichosis, coarsening of the facies, decreased serum immunoglobulin G levels, and hyperosmolar nonketotic comas have been reported with diazoxide, especially with long-term use.
    • Patients should be monitored for hypotension while using diazoxide, especially during intravenous (IV) administration, because blood pressure may drop rapidly. Usually, oral diazoxide is used for the treatment of hypoglycemia.
    • Some authors recommend using chlorothiazide in conjunction with diazoxide for a synergistic effect. Chlorothiazide activates a different potassium channel, and its diuretic action helps counteract the salt and water retention associated with diazoxide therapy.

    135. Gold standard test for diagnosis of laryngopharyngeal reflux?
    A. 24 hr double probe pH monitoring
    B. Flexible endoscopy
    C. Barium swallow
    D. Laryngoscopy
    Ans: A 24hr double probe pH monitoring
    Reference:Sabiston 18th ed
    The gold standard for diagnosing and quantifying acid reflux is the 24-hour pH test.[3] The study is performed by placing a thin catheter containing one or more solid-state electrodes in the esophagus. The electrodes are spaced 5 to 10 cm apart and are capable of sensing fluctuations in the pH between 2 and 7. The electrodes are connected to a data recorder that the patient wears for the period of observation. There is a digital clock displayed on the recorder. When the patient has an event (e.g., heartburn, chest pain, eructation), he or she is to record the event in a diary, noting the time on the recorder ( Fig. 42-5 ).

    136. Acoustic neuroma involves
    A. Superior vestibular division of 8th cranial nerve
    B. Auditory part of 8th cranial nerve
    C. 7th cranial nerve
    d. Inferior vestibular division of 8th cranial nerve
    Ans: D Inferior vestibular nerve(CONFUSING QUESTION OF THE DECADE—let us not waste time discussing which is the answer...we shall assume we made a mistake in this question no matter what option u have marked!!---AIIMS only knows the answer)

    137. A patient had running nose and pain over medical aspect of eye being treated with decongestants for many days. He later developed chemosis,protosis and diplopia on abduction of right eye with congestion of optic disc. What is the probable diagnosis?
    A. Acute ethmoidal sinusitis
    B. Orbital cellulitis
    C. Cavernous sinus thrombosis
    D. Orbital apex syndrome
    Ans:C Cavernous sinus thrombosis(REPEAT)

    138. An anesthesia resident was giving spinal anaesthesia when the patient had sudden aphonia and loss of consciousness. What could have happened?
    A. Total spinal
    B. Partial spinal
    C. Vaso vagal attack
    D. Intra vessel injection
    Ans:A Total spinal(REPEAT)

    139. Urea cycle occurs in:
    A. Liver
    B. G.I.T.
    C. Spleen
    D. Kidney
    Ans:A Liver

    140. Right isomerism is?
    A. Asplenia
    B. Two spleens
    C. One spleen
    D. Polysplenia
    Ans:A Asplenia
    Right isomerism is also called asplenia syndrome

    141. Definitive airway is all except?
    A. Nasotracheal tube
    B. Orotracheal tube
    C. LMA(Laryngeal mask airway)
    D. Cricothyroidotom
    Ans: c LMA
    Reference:

    142. A primigravida at 37 weeks of gestation with loss of engagement. Cervix 1cm dilated. 10 uterine contractions per hour. What is management?
    A. Sedate the patient and wait
    B. LSCS
    C. Amniotomy
    D. Induction with membrane rupture

    Ans:A Sedate the patient and wait (REPEAT)
    143. Regarding anterior choroidal artery syndrome, all are true except?
    A. Hemipareisis
    B. Hemisensory loss,
    C. Involvement of anterior limb of internal capsule
    D. Homonymous hemianopia
    Ans:C Invovement of anterior limb of internal capsule
    Reference:eMEDICINE and KEITH & MOORE CLINICAL ANATOMY
    Posterior limb of internal capsule is supplied by the anterior choroidal artery

    Anterior choroidal artery territory stroke features:
    • Hemiparesis
    • Hemianesthesia
    • Homonymous hemianopia

    144. A 15 day old baby came with history of seizures. Blood tests revealed Ca 5mg/dl, PO4 9mg/dl, PTH 30pg/ml (n=10-60). What is the most probable diagnosis?
    A. Pseudohypoparathyroidism
    B. Vitamin D deficiency
    C. Hyperparathyroidism
    4. HIE

    Ans:A Pseudohypoparathyroidism

    145. Thiamine deficiency causes decreased energy production because?
    A. It is required for the process of transweramination
    B. It is a co-factor in oxidative reduction
    C. It is a co-enzyme for transwerketolase in pentose phosphate pathway
    D. It is a co-enzyme for pyruvate dehydrogenase & alpha ketoglutarate dehydrogenase
    Ans:D It is a co-enzyme for pyruvate dehydrogenase & alpha ketoglutarate dehydrogenase
    Since kreb’s cycle is the main energy source for cell...it will be worst Hit in a thiamine deficient state...

    142. A primigravida at 37 weeks of gestation with loss of effacement. Cervix 1cm dilated. 10 uterine contractions per hour. What is management?
    A. Sedate the patient and wait
    B. LSCS
    C. Amniotomy
    D. Induction with membrane rupture

    Ans: A

    148. ‎18 year old male presents with hemetemesis, melena and splenomegaly. What is the probable initial diagnosis?
    A. NCPF
    B. Cirrhosis
    C. Malaria with DIC
    D. Extra hepatic portal venous obstruction
    Ans:A NCPF(REPEAT)

    149. Following are true about carbohydrate antigen except?
    A. Memory
    B. Poly clonal response
    C. Poor immunogenicity
    D. T cell independent immunity

    Ans:A Memory(REPEAT)

    150. Ideal age for surgery in unilateral undescended testis is?
    A. 6 months
    B. 12 months
    C. 24 months
    D. 36 months
    Ans:A 6 months(adequately discussed in past.........wrongly given in guides...........reference—campbell urology,Elsevier urologic surgery,pediatric urology,nelson paediatrics)
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    151. A 45 year old lady presented with DUB & USG finding of 8mm thick endometrium. What is the next step?
    A. Endometrial histopathology
    B. Hysterectomy
    C. OCP
    D. Follow up
    Ans”Endometrial histopathology(REPEAT)

    152. Fallopian tube immotility is seen in?
    A. Churg strauss syndrome
    B. Kartagener's syndrome
    C. Noonan syndrome
    D. Turner syndrome
    Ans:B Karteagener syndrome(REPEAT)

    153. First structure to be fixed after amputation is?
    A. Bone fixing
    B. Arterial repair
    C. Venous repair
    D. Nerve repair
    Ans:A Bone fixing

    154. Poor prognostic factor for ALL is?
    A. Hyperdiploidy
    B. t(9;22) t(4;11)
    C. 2-8 yrs of age
    D. TLC < 50000
    Ans:B . t(9;22) t(4;11)

    155. Most potent activator of T cells?
    A. B cells
    B. Follicular dendritic cells
    C. Mature dendritic cells
    D. Macrophages
    Ans:C Mature dendritic cells(REPEAT)

    156.Methods of producing monoclonal antibodies are all except? (dr.confident)
    A. Attaching inactive viral particle on cell membrane
    B. Adding ethylene glycol
    C. Applying a small electric current
    D. Reducing the viscosity of the membrane

    Ans:D Reducing the viscosity of the membrane(unless proved otherwise)
    Reference:Methods in enzymology

    157. Aortic knuckle shadow on PA CXR, obliterated by consolidation of which portion of lung?
    upper lingula
    lower lingula
    apex of lower lobe
    posterior part of upper lobe

    Answer- Posterior part of upper lobe.

    158. CT least accurate for:
    a. 1 cm of aneurysm in hepatic artery
    b.1 cm of lymph node in para-aortic region
    c.1 cm of pancreas mass in tail
    d. 1cm gall stone

    answer-d) 1cm gall stones

    159.Best investigation for bone metastases:
    a.MRI
    b.CT
    c.bone scan
    d. x ray

    Answer- c) Bone scan
  40. Guest

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    BONE METASTASIS BEST DETECTED BY..............................................
    Imaging in Bone Metastases
    Author: Wilfred CG Peh, MD, MBBS, FRCP(Glasg), FRCP(Edin), FRCR, Clinical Professor, Faculty of Medicine, National University of Singapore; Senior Consultant Radiologist, Alexandra Hospital, Singapore
    Coauthor(s): Malai Muttarak, MD, Professor of Radiology, Faculty of Medicine, Chiang Mai University, Thailand
    Contributor Information and Disclosures

    Updated: Mar 20, 2008



    TechnetiumTc) bone scintiscanning (ie, radionuclide bone scanning) is widely regarded as the most cost-99m (99m -effective and available whole-body screening test for the assessment of bone metastases. Conventional radiography is the best modality for characterizing lesions that are depicted on bone scintiscans. Combined analysis and reporting of findings on radiographs and99m Tc bone scintiscans improve the diagnostic accuracy in detecting bone metastases and assessing the response to therapy.7,8,9
    Computed tomography (CT) scanning and magnetic resonance imaging (MRI) are useful in evaluating suspicious bone scintiscan findings that appear equivocal on radiographs.10,11,12,13 MRI can also help in detecting metastatic lesions before changes in bone metabolism make the lesions detectable on bone scintiscans.14,15,16 CT scanning is useful in guiding needle biopsy, particularly in vertebral lesions. MRI is helpful in determining the extent of local disease in planning surgery or radiation therapy.
    The first screening test used for the detection of bone metastases depends on the relative availability of MRI and99m Tc bone scintiscanning. The selection will become less of an issue when more MRI units are established and when its cost decreases. Factors such as cost and relatively long imaging times, as well as considerations of patient throughput, are important. MRI is estimated to cost 2-3 times as much as99m Tc bone scintigraphy17,18 ; fluorodeoxyglucose (FDG) positron emission tomography (PET) scanning costs 8 times as much.19,20,21,22,23....................................................................................................... From above ref is..............MRI>Bone scanning?????
  41. Guest

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    BONE METASTASIS BEST DETECTED BY..............................................
    Imaging in Bone Metastases
    Author: Wilfred CG Peh, MD, MBBS, FRCP(Glasg), FRCP(Edin), FRCR, Clinical Professor, Faculty of Medicine, National University of Singapore; Senior Consultant Radiologist, Alexandra Hospital, Singapore
    Coauthor(s): Malai Muttarak, MD, Professor of Radiology, Faculty of Medicine, Chiang Mai University, Thailand
    Contributor Information and Disclosures

    Updated: Mar 20, 2008



    TechnetiumTc) bone scintiscanning (ie, radionuclide bone scanning) is widely regarded as the most cost-99m (99m -effective and available whole-body screening test for the assessment of bone metastases. Conventional radiography is the best modality for characterizing lesions that are depicted on bone scintiscans. Combined analysis and reporting of findings on radiographs and99m Tc bone scintiscans improve the diagnostic accuracy in detecting bone metastases and assessing the response to therapy.7,8,9
    Computed tomography (CT) scanning and magnetic resonance imaging (MRI) are useful in evaluating suspicious bone scintiscan findings that appear equivocal on radiographs.10,11,12,13 MRI can also help in detecting metastatic lesions before changes in bone metabolism make the lesions detectable on bone scintiscans.14,15,16 CT scanning is useful in guiding needle biopsy, particularly in vertebral lesions. MRI is helpful in determining the extent of local disease in planning surgery or radiation therapy.
    The first screening test used for the detection of bone metastases depends on the relative availability of MRI and99m Tc bone scintiscanning. The selection will become less of an issue when more MRI units are established and when its cost decreases. Factors such as cost and relatively long imaging times, as well as considerations of patient throughput, are important. MRI is estimated to cost 2-3 times as much as99m Tc bone scintigraphy17,18 ; fluorodeoxyglucose (FDG) positron emission tomography (PET) scanning costs 8 times as much.19,20,21,22,23....................................................................................................... From above ref is..............MRI>Bone scanning?????
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    160. Compliance is decreased in all except?
    A. Pulmonary congestion
    B. Emphysema
    C. Decreased surfactant
    D. Chronic bronchitis

    Ans:D Chronic bronchitis
    Compliance of the Lungs & Chest Wall
    Compliance is also slightly greater when measured during deflation than when measured during inflation. Consequently, it is more informative to examine the whole pressure–volume curve. The curve is shifted downward and to the right (compliance is decreased) by pulmonary congestion and interstitial pulmonary fibrosis (Figure 35–11). Pulmonary fibrosis is a progressive restrictive airway disease of unknown cause in which there is stiffening and scarring of the lung. The curve is shifted upward and to the left (compliance is increased) in emphysema. It should be noted that compliance is a static measure of lung and chest recoil. The resistance of the lung and chest is the pressure difference required for a unit of air flow; this measurement, which is dynamic rather than static, also takes into account the resistance to air flow in the airways.

    161. A 70yr old presents with intemittent jerks of recent origin, EEG showing bilateral periodic spikes. What is the most probable diagnosis?
    A. Hepes simplex encephalitis
    B. Lewy body dementia
    C. Alzheimer's
    D. CJD
    Ans:D CJD
    Clinical Features
    Nonspecific prodromal symptoms occur in about a third of patients with CJD and may include fatigue, sleep disturbance, weight loss, headache, malaise, and ill-defined pain. Most patients with CJD present with deficits in higher cortical function. These deficits almost always progress over weeks or months to a state of profound dementia characterized by memory loss, impaired judgment, and a decline in virtually all aspects of intellectual function. A few patients present with either visual impairment or cerebellar gait and coordination deficits. Frequently the cerebellar deficits are rapidly followed by progressive dementia. Visual problems often begin with blurred vision and diminished acuity, rapidly followed by dementia.
    Other symptoms and signs include extrapyramidal dysfunction manifested as rigidity, masklike facies, or choreoathetoid movements; pyramidal signs (usually mild); seizures (usually major motor) and, less commonly, hypoesthesia; supranuclear gaze palsy; optic atrophy; and vegetative signs such as changes in weight, temperature, sweating, or menstruation.
    Myoclonus
    Most patients (~90%) with CJD exhibit myoclonus that appears at various times throughout the illness. Unlike other involuntary movements, myoclonus persists during sleep. Startle myoclonus elicited by loud sounds or bright lights is frequent. It is important to stress that myoclonus is neither specific nor confined to CJD. Dementia with myoclonus can also be due to Alzheimer's disease (AD) (Chap. 365), dementia with Lewy bodies (Chap. 365), cryptococcal encephalitis (Chap. 195), or the myoclonic epilepsy disorder Unverricht-Lundborg disease (Chap. 363).
    Clinical Course
    In documented cases of accidental transmission of CJD to humans, an incubation period of 1.5–2.0 years preceded the development of clinical disease. In other cases, incubation periods of up to 30 years have been suggested. Most patients with CJD live 6–12 months after the onset of clinical signs and symptoms, whereas some live for up to 5 years.
    Diagnosis
    The constellation of dementia, myoclonus, and periodic electrical bursts in an afebrile 60-year-old patient generally indicates CJD. Clinical abnormalities in CJD are confined to the CNS. Fever, elevated sedimentation rate, leukocytosis in blood, or a pleocytosis in cerebrospinal fluid (CSF) should alert the physician to another etiology to explain the patient's CNS dysfunction.

    157. Not a disorder of protein misfolding ?
    A. Alzheimer's disease
    B. Tuberculosis
    C. Cystic fibrosis
    D. CJD
    Ans: B TB

    The Cystic Fibrosis Gene: Mutational Spectra and Genotype-Phenotype Correlation.
    Since the CFTR gene was cloned in 1989, more than 1300 disease-associated mutations have been identified. Various mutations can be grouped into six “classes†based on their effect on the CFTR protein:
    • Class I: Defective protein synthesis. These mutations are associated with complete lack of CFTR protein at the apical surface of epithelial cells.
    • Class II: Abnormal protein folding, processing, and trafficking. These mutations result in defective processing of the protein from the endoplasmic reticulum to the Golgi apparatus; the protein does not become fully folded and glycosylated and is instead degraded before it reaches the cell surface. The most common class II mutation is a deletion of three nucleotides coding for phenylalanine at amino acid position 508 (ΔF508). Worldwide, this mutation can be found in approximately 70% of cystic fibrosis patients. Class II mutations are also associated with complete lack of CFTR protein at the apical surface of epithelial cells.
    • Class III: Defective regulation. Mutations in this class prevent activation of CFTR by preventing ATP binding and hydrolysis, an essential prerequisite for ion transport (see above). Thus, there is a normal amount of CFTR on the apical surface, but it is nonfunctional.
    • Class IV: Decreased conductance. These mutations typically occur in the transmembrane domain of CFTR, which forms the ionic pore for chloride transport. There is a normal amount of CFTR at the apical membrane, but with reduced function. This class is usually associated with a milder phenotype.
    • Class V: Reduced abundance. These mutations typically affect intronic splice sites or the CFTR promoter, such that there is a reduced amount of normal protein. As discussed subsequently, class V mutations are also associated with a milder phenotype.
    • Class VI: Altered regulation of separate ion channels. As previously described, CFTR is involved in the regulation of multiple distinct cellular ion channels. Mutations in this class affect the regulatory role of CFTR. In some cases, a given mutation affects the conductance by CFTR as well as regulation of other ion channels. For example, the ΔF508 mutation is both a class II and class VI mutation.

    162. Pulmonary toxicity is seen with?
    A. Bleomycin
    B. Cisplatin
    C. Methotrexate
    D. Actinomycin D
    Ans:A Bleomycin
    Reference: Goodman and Gilman pharmacology
    The most serious adverse reaction to bleomycin is pulmonary toxicity, which begins with a dry cough, fine rales, and diffuse basilar infiltrates on x-ray and may progress to life-threatening pulmonary fibrosis. Radiologic changes may be indistinguishable from interstitial infection or tumor, but may progress to dense fibrosis, cavitation, atelectasis or lobar collapse, or even apparent consolidation. Approximately 5% to 10% of patients receiving bleomycin develop clinically apparent pulmonary toxicity, and about 1% die of this complication.

    163. 92 young male presented with history of fever and a nodule in the leg. Histopathology of the nodule revealed foamy histiocytes and neutrophillic infiltrate in the dermis. Most probable diagnosis is?
    A. Sweet's syndrom
    B. Rosai Dorfman disease
    C. Erythema Nodosum Leprosum
    D.erythema nodosum
    Ans: A Sweet syndrome(REPEAT)

    164. Medical treatment for variceal bleed is by?
    A. Octreotide
    B. Pantaprazole
    C. Desmopressin
    D.—
    Ans: A Octreotide
    Reference: Harrison Principles of Internal Medicine 17th ed
    The medical management of acute variceal hemorrhage includes the use of vasoconstricting agents, usually somatostatin or Octreotide. Vasopressin was used in the past but is no longer commonly used. Balloon tamponade (Sengstaken-Blakemore tube or Minnesota tube) can be used in patients who cannot get endoscopic therapy immediately or who need stabilization prior to endoscopic therapy. Control of bleeding can be achieved in the vast majority of cases; however, bleeding recurs in the majority of patients if definitive endoscopic therapy has not been instituted. Octreotide, a direct splanchnic vasoconstrictor, is given at dosages of 50–100 micg/h by continuous infusion. Endoscopic intervention is employed as first-line treatment to control bleeding acutely. Some endoscopists will use variceal injection therapy (sclerotherapy) as initial therapy, particularly when bleeding is vigorous.

    165. All are true statements regarding use of sodium fluoride in the treatment of otosclerosis except?
    A. It inhibits osteblastic activity
    B. Used in active phase of otosclerosis when schwartz
    C.Nephritis is a contraindication D.It decreases the release of osteolytic enzymes
    Ans:A inhibits osteblastic activity(REPEAT)

    166. A patient who was given primaquin develops hemolysis. Diagnosis is
    A. Glucose 6 phosphate dehydrogenase deficiency
    B. Glucose 6 phosphatase deficiency
    C. --
    D. –

    Ans:A G6PD deficiency

    167. 86 true regarding ranula?
    A. It is also known as epulis
    B. It is a cystic swelling in the floor of mouth
    C. It is a type of thyroglossal cyst
    D. It is a type of mucus retention cyst
    Ans:B It is a cystic swelling in the floor of mouth
    Reference: Robbins pathology 8th ed
    A ranula is histologically identical to a mucocele. However, this term is reserved for mucoceles that arise when the duct of the sublingual gland has been damaged. A ranula can become extremely large and develop into a “plunging ranula†when it dissects its way through the connective tissue stroma connecting the two bellies of the mylohyoid muscle

    168.Which of the following is not an evidence based treatment for menorrhagia?
    A. Ethamsylate
    B.OCP
    C.Tamoxefene
    D. –
    Ans:A Ethamsylate(REPEAT)

    169. A 3.8 kg baby of a diabetic mother developed seizures 16 hours after birth. Most probable cause is?
    A. Hypoglycemia
    B. Hypocalcemia
    C. Birth asphyxia
    D. Intra ventricular hemorrhage
    Ans: A Hypoglycemia(REPEAT)

    170. 74 coarctation of aorta mc asso with
    1.Bicuspid aortic valve
    2.PDA
    3. Aortic stenosis
    4. --
    Ans:A Bicuspid aortic valve(REPEAT)

    171. Anaesthetic agent with vasoconstrictor is contraindicated in?
    A. Finger block
    B. Spinal block
    C. Epidural block
    D. Regional anaesthesia
    Ans:A Finger block(REPEAT)

    172. 63Auto-Rikshaw ran over a child’s thigh, there is a mark of the tyre tracks, it is an
    A. Contact bruise
    B. Patterned bruise
    C. Imprint abrasion
    D. Ectopic bruise
    Ans:C Imprint abrasion(REPEAT)
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    173. Tolerance in opioids develops to all except?
    A. Miosis
    B. Analgesia
    C. Euphoria
    D. Nausea and vomiting
    Ans: A Miosis
    Reference:Katzung Pharmacology
    MIOSIS
    Constriction of the pupils is seen with virtually all opioid agonists. Miosis is a pharmacologic action to which little or no tolerance develops ; thus, it is valuable in the diagnosis of opioid overdose. Even in highly tolerant addicts, miosis is seen. This action, which can be blocked by opioid antagonists, is mediated by parasympathetic pathways, which, in turn, can be blocked by atropine.

    174. The bifurcation of Common carotid artery is palpated at?
    A. Upper border of cricoid cartilage
    B. Upper border of thyroid cartilage
    C. Hyoid bone
    D. Cricothyroid membrane
    Ans:B Upper border of thyroid cartilage
    Reference:Snell’s Anatomy by regions
    Common Carotid Artery
    The right common carotid artery arises from the brachiocephalic artery behind the right sternoclavicular joint (Figs. 11-57 and 11-59). The left artery arises from the arch of the aorta in the superior mediastinum . The common carotid artery runs upward through the neck under cover of the anterior border of the sternocleidomastoid muscle, from the sternoclavicular joint to the upper border of the thyroid cartilage. Here it divides into the external and internal carotid arteries.

    175. Pregnant mother at 35 weeks of gestation. What drug can you not give her for treatment of SLE?
    A. Prednisolone
    B. Methotrexate
    C. Sulfsalazine
    D. Hydroxychloroquine
    Ans:B Methotrexate(REPEAT)

    176. All are true about xanthogranulomatous inflammation except?
    A. Presence of foamy macrophages
    B. Associated with TB
    C. Multinucleated giant cell
    D. Presence of yellow Nodules
    Ans:B Associated with TB(REPEAT)

    177. Clue Cells are seen in :
    A. Bacterial vaginosis
    B. Vaginal candidiasis
    C. Chlamydial vaginosis
    D. Trichomoniasis
    Ans: A Bacterial Vaginosis (REPEAT)

    178. Which complement component is involved in both classical and alternate pathway?
    A. C1
    B. C2
    C. C3
    D. C4
    Ans:C C3(REPEAT)

    179. Which of the following are not associated with menstrual cycle?
    A. Hormonal changes
    B. Vaginal cytology changes
    C. Estrus profile
    D. Endometrial changes
    Ans:C Estrous Profile (REPEAT)

    180. Alkalanization of Urine is done during administration of which of the following chemotherapeutic drugs?
    A. ara-c
    B. Mtx
    C. cisplatin
    D. Ifosfamide
    Ans:A Methotrexate
    Goldfrank's toxicologic emergencies
    By Lewis R. Goldfrank, Neal Flomenbaum
    Urinary alkalinisation with Sodium Bicarbonate is routinely used during high dose Methotrexate cancer chemotherapy.
    Methotrexate is predominantly excreted unchanged in urine.
    It is poorly soluble in acidic urine.
    The solubility and of Mtx can be increased and nephrotoxicity reduced by Sodium bicarbonate administration.

    181. The Progesterone in low dose OCP is? (contributed by dr.PROPRANOLOL)
    A.Norethisterone
    B.Levonegestrol
    C.Desgestrol
    D.—
    Ans: C Desogestrel > B Levonorgestrel
    Reference:Dutta Obstetrics
    Reference:Dutta Obstetrics5th edition pg 465..
    Low dose OCP:
    Femilon(Infar)-desogestrol 0.15mg and Ethinyl estradiol 20mcg

    182. Test of Pasterurized milk is performed by:
    A. Phosphatase test
    B. Coliform test
    C. Catalase test
    D. Methylene blue test
    Ans:A Phosphatase test(REPEAT)

    182. Test of Pasterurized milk is performed by:
    A. Phosphatase test
    B. Coliform test
    C. Catalase test
    D. Methylene blue test
    Ans:A Phosphatase test(REPEAT)

    183. All are true about delirium tremens except?
    A. Visual hallucinations
    B. Coarse tremors
    C. Third Nerve palsy
    D. Altered consciousness
    Ans:C Third Nerve Palsy
    Reference:Kaplan and Sadock Synopsis of Psychiatry
    The essential feature of the syndrome is delirium occurring within 1 week after a person stops drinking or reduces the intake of alcohol. In addition to the symptoms of delirium, the features of alcohol intoxication delirium include autonomic hyperactivity such as tachycardia, diaphoresis, fever, anxiety, insomnia, and hypertension; perceptual distortions, most frequently visual or tactile hallucinations; and fluctuating levels of psychomotor activity, ranging from hyperexcitability to lethargy.

    184. Main site of water absorption is:
    A. Jejunum
    B. Colon
    C. Ileum
    D. Stomach
    Ans:A Jejunum (REPEAT)

    185. Pentalogy of fallot has which one of following extra entities:
    A. ASD
    B. VSD
    C. RVH
    D. Pulmonary stenosis
    Ans:A ASD(REPEAT)

    186. All of the following are done in management of shoulder dystocia except?
    A. Fundal pressure
    B. Suprapubic pressure
    C. McRoberts manoeuvre
    D. Woods manoeuvre
    Ans:A Fundal pressure(REPEAT)

    187. About Human Development Index, all are true except?
    A. Life expectancy at birth
    B. Life expectancy at 1 year of age
    C. Education
    D. GDP
    Ans: B. Life expectancy at 1 year of age(REPEAT)

    188.A 50yr old patient presents with 2 yrs h/o recurrent abdominal pain, radiating to back, relived only by parenteral analgesic. USG & CT confirmed the diagnosis ,appropriate procedure is?
    A.vagotomy with Gastroduodenostomy
    B.vagotomy with antrectomy
    C.whipple procedure
    D.Longitudinal pancreaticojejunostomy

    Ans:D Longitudinal Pacreaticojejunostomy

    The Diagnosis is Chronic Pancreatitis which was medically managed.
    The treatment for it is Puestow’s longitudinal Pancreaticojejunostomy.
    Reference:Sabiston Surgery 18th ed
    Typically, patients with chronic pancreatitis have upper abdominal pain radiating to the back. It can be constant or episodic and triggered by drinking alcohol or eating. Repeated use of heating pads or hot water bottles to treat the chronic pain may result in skin lesions (erythema ab igne) that define the distribution of the pain ( Fig. 55-5 ). Some patients experience no pain.
    For most patients with pain-ful chronic pancreatitis, intermittent or persistent pain remains a major issue, and analgesics of increasing potency are needed.
    The two indications for surgical intervention are pain and concern about the possible presence of cancer. After the diagnosis of chronic pancreatitis has been established, surgical intervention is considered when (1) the pain is severe enough to limit the patient's lifestyle or reduce productivity, and (2) the pain persists despite complete abstinence from alcohol and administration of non-narcotic analgesics.
    Puestow and Gillesby, in 1958, described an operation that involved longitudinally opening the entire duct and then invaginating the opened pancreas into a Roux-en-Y loop of jejunum. This allowed for more complete decompression but still required splenectomy. Later, Partington and Rochelle modified the Puestow procedure by creating a side-to-side anastomosis between the opened duct and jejunum, thus eliminating the need for splenectomy ( Fig. 55-8 ). In appropriately selected patients (i.e., those with large ducts and those with intraductal stones), longitudinal pancreaticojejunostomy, performed according to the Partington and Rochelle modification of the Puestow procedure, has been reported to result in immediate pain relief in more than 80% of patients and long-term pain relief in roughly 60% of patients. More recently, Ho and Frey further modified the procedure by including removal of part of the pancreatic head, thereby marsupializing the duct as it dives deeply in the pancreas to reach the ampulla of Vater. This allows for an even more complete duct decompression and a longer longitudinal pancreaticojejunostomy. Both short- and long-term pain relief appear to be improved, and the procedure can be performed when the duct is only moderately dilated.

    189. A young lady presents with fever , dysuria and pain abdomen . Uncomplicated acute cystitis was diagnosed . Which of these is false ?
    A.Nitrate test positive
    B.e.coli count was < 10 power 3
    C.1 pus cell per 7 field
    D.1 bacilli per field

    Ans: B e.coli count was < 10 power 3(does not satisfy the cut off for significant bacteriuria)

    190. In a 5 year old child the burn area corresponding to thesize of palm is equal to
    A. 1%
    B. 5%
    C. 10%
    D.20%

    Ans:A 1%
    Reference:Nelson Textbook Of Pediatrics 18th ed
    ESTIMATION OF BODY SURFACE AREA FOR A BURN.
    Appropriate burn charts for different childhood age groups should be used to accurately estimate the extent of BSA burned. The volume of fluid needed in resuscitation is calculated from the estimation of the extent and depth of burn surface. Mortality and morbidity also depend on the extent and depth of the burn. The variable growth rate of the head and extremities throughout childhood makes it necessary to use BSA charts, such as that modified by Lund and Brower or the chart used at the Shriners Hospital in Boston. The rule of nines used in adults may be used only in children older than age 14 yr or as a very rough estimate to institute therapy before transfer to a burn center. In small burns of <10% of BSA, the rule of palm may be used, especially in outpatient settings. The area from the wrist crease to the finger crease (the palm) in the child equals 1% of the child's BSA.
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    190. In a 5 year old child the burn area corresponding to thesize of palm is equal to
    A. 1% BSA
    B. 5% BSA
    C. 10% BSA
    D.20% BSA

    Ans:A 1%
    Reference:Nelson Textbook Of Pediatrics 18th ed
    ESTIMATION OF BODY SURFACE AREA FOR A BURN.
    Appropriate burn charts for different childhood age groups should be used to accurately estimate the extent of BSA burned. The volume of fluid needed in resuscitation is calculated from the estimation of the extent and depth of burn surface. Mortality and morbidity also depend on the extent and depth of the burn. The variable growth rate of the head and extremities throughout childhood makes it necessary to use BSA charts, such as that modified by Lund and Brower or the chart used at the Shriners Hospital in Boston. The rule of nines used in adults may be used only in children older than age 14 yr or as a very rough estimate to institute therapy before transfer to a burn center. In small burns of <10% of BSA, the rule of palm may be used, especially in outpatient settings. The area from the wrist crease to the finger crease (the palm) in the child equals 1% of the child's BSA.

    191 What is the type of joint seen in the growth plate?
    A. Fibrous
    B. Primary cartilagenous
    C. Secondary cartilagenous
    D. Plane joint
    Ans:B Primary cartilaginous joint(REPEAT)

    192.The acid base status of a patient is as follows : pH - 7.45, pCO2 - 30 mm of Hg, pO2 - 105 mm of Hg. Patient has partially compensated?
    A. Metabolic acidosis
    B. Metabolic alkalosis
    C. Respiratory acidosis
    D. Respiratory alkalosis
    Ans:D Respiratory alkalosis(No explanation needed)

    193 A female presents with sings of meningitis. CSF shows gram positive bacilli. It is most probably?
    A. Listeria
    B. Haemophilus influenzae
    C. Pneumococcus
    D. Staphylococcus
    Ans:A Listeria

    194.A 50 yr lady has history of sprained ankle 2 months back followed by recovery. She now complains of severe pain in that ankle with inability to flex that foot. Physician notes edema and shiny skin in local examination. What is the probable diagnosis:
    A. Fibromyalgia
    B. Complex regional pain syndrome 1
    C. Complex regional pain syndrome 2
    D. Peripheral neuropathy
    Ans:B Complex regional pain syndrome 1
    Reference:Harrison Principles Of Internal Medicine 17th ed
    The failure to identify a primary role of the ANS in the pathogenesis of these disorders has resulted in a change of nomenclature. Complex regional pain syndrome (CRPS) types I and II are now used in place of reflex sympathetic dystrophy (RSD) and causalgia, respectively.
    CRPS type I is a regional pain syndrome that usually develops after tissue trauma. Examples of associated trauma include myocardial infarction, minor shoulder or limb injury, and stroke. Allodynia (the perception of a nonpainful stimulus as painful), hyperpathia (an exaggerated pain response to a painful stimulus), and spontaneous pain occur. The symptoms are unrelated to the severity of the initial trauma and are not confined to the distribution of a single peripheral nerve. CRPS type II is a regional pain syndrome that develops after injury to a peripheral nerve, usually a major nerve trunk. Spontaneous pain initially develops within the territory of the affected nerve but eventually may spread outside the nerve distribution.
    Pain is the primary clinical feature of CRPS. Vasomotor dysfunction, sudomotor abnormalities, or focal edema may occur alone or in combination but must be present for diagnosis. Limb pain syndromes that do not meet these criteria are best classified as "limb pain—not otherwise specified." In CRPS, localized sweating (increased resting sweat output) and changes in blood flow may produce temperature differences between affected and unaffected limbs.
    CRPS type I (RSD) has classically been divided into three clinical phases but is now considered to be more variable. Phase I consists of pain and swelling in the distal extremity occurring within weeks to 3 months after the precipitating event. The pain is diffuse, spontaneous, and either burning, throbbing, or aching in quality. The involved extremity is warm and edematous, and the joints are tender. Increased sweating and hair growth develop. In phase II (3–6 months after onset), thin, shiny, cool skin appears. After an additional 3–6 months (phase III), atrophy of the skin and subcutaneous tissue plus flexion contractures complete the clinical picture.
    The natural history of typical CRPS may be more benign than reflected in the literature. A variety of surgical and medical treatments have been developed, with conflicting reports of efficacy. Clinical trials suggest that early mobilization with physical therapy or a brief course of glucocorticoids may be helpful for CRPS type I. Other medical treatments include the use of adrenergic blockers, nonsteroidal anti-inflammatory drugs, calcium channel blockers, phenytoin, opioids, and calcitonin. Stellate ganglion blockade is a commonly used invasive therapeutic technique that often provides temporary pain relief, but the efficacy of repetitive blocks is uncertain.

    195.Drug given for bone megakaryocyte stimulation in patient of thrombocytopenia..?
    1.filgastrim
    2.oprevelkin
    3.--
    4.—
    Ans: B Oprelvekin
    Reference:Goodman and Gilman Pharmacology
    Recombinant human interleukin-11 oprelvekin (NEUMEGA) is a bacterially derived, 19,000-dalton polypeptide of 177 amino acids that differs from the native protein only because it lacks the amino terminal proline residue and is not glycosylated. The recombinant protein has a 7-hour half-life after subcutaneous injection. In normal subjects, daily administration of oprelvekin leads to a thrombopoietic response in 5 to 9 days.
    The drug is available in single-use vials containing 5 mg and is administered to patients at 25 to 50 micg/kg per day subcutaneously. Oprelvekin is approved for use in patients undergoing chemotherapy for nonmyeloid malignancies that displayed severe thrombocytopenia (platelet count <20,000/microL) on a prior cycle of the same chemotherapy, and is administered until the platelet count returns to more than 100,000/micL. The major complications of therapy are fluid retention and other associated cardiac symptoms, such as tachycardia, palpitation, edema, and shortness of breath; this is a significant concern in elderly patients and often requires concomitant therapy with diuretics. Fluid retention reverses upon drug discontinuation, but volume status should be carefully monitored in elderly patients, those with a history of heart failure, or those with preexisting fluid collections in the pleura, pericardium, or peritoneal cavity. Also reported are blurred vision, injection-site rash or erythema, and paresthesias.

    196. A man presents with maculopapular rash 2weeks after having a painless genital.Causative organism of the condition is:
    A.treponema pallidum
    B.chlamydia
    C.c.granulomatis
    D.H.ducreyi
    Ans:A Treponema pallidum(Its syphilis—anyway shall upload references later)

    197. A patient with stab injury presents with with omentum protruding in the umbilical area ,vitals stable.The next step in the management of the patient is: (CONTRIBUTED BY dr.lucifer)
    A.FAST
    B.LAPAROTOMY
    C.WOUND EXPLORATION
    D.CECT ABDOMEN
    Ans:C Wound Exploration
    Reference:Sabiston Surgery 18th ed eMEDICINE and Fundamentals of Surgical Practice By Andrew N. Kingsnorth, Aljafri A. Majid

    Abdominal Trauma
    The abdomen is frequently injured after both blunt and penetrating trauma. Approximately 25% of all trauma victims will require abdominal exploration. Clinical evaluation of the abdomen by means of physical examination is inadequate to identify intra-abdominal injuries because of the high number of patients with altered mental status secondary to head trauma, alcohol, or drugs and because of the inaccessibility of the pelvic, upper abdominal, and retroperitoneal organs to palpation. For these reasons, several diagnostic modalities have evolved during the past 3 decades, including diagnostic peritoneal lavage (DPL), ultrasound, CT, and laparoscopy, all of which have advantages, disadvantages, and limitations.
    The development of more modern technology, experience, and invasiveness have been the most important determinants of the use of diagnostic methods for abdominal trauma. In modern trauma centers in the 21st century, better noninvasive technology favors the use of ultrasound and CT in the evaluation of trauma victims.
    Mechanism of Injury
    Blunt trauma secondary to motor vehicle accidents, motorcycle accidents, falls, assaults, and striking of pedestrians remains the most frequent mechanism of abdominal injury. Penetrating abdominal wounds are usually caused by either gunshot or stab wounds and by a significantly smaller number of shotgun wounds.
    Based on the high frequency of intra-abdominal organ injury after gunshot wounds, mandatory abdominal exploration, with the rare exception of tangential and superficial wound trajectories restricted to the right upper quadrant, remains the standard form of management. Stab wounds to the abdomen, however, carry a significantly lower risk of intra-abdominal organ injury than do gunshot wounds, and several studies have recently favored a more selective approach, as opposed to mandatory exploratory laparotomy.
    The impetus for nonoperative management of solid organ injury in stable blunt trauma patients has expanded to penetrating trauma as well. With improved imaging, more stable patients sustaining a single solid organ injury after stab and gunshot wounds to the abdomen will be treated conservatively.
    In children, besides the aforementioned mechanisms of injury, child abuse and trauma secondary to recreational activities such as bicycling, swimming, and roller skating should also be considered.
    Diagnosis
    The history of the traumatic event is particularly important in determining the likelihood of an intra-abdominal organ injury. All possible information should be obtained from the prehospital personnel, including the mechanism of injury, the height of a fall, damage to the interior and exterior of a vehicle in a motor vehicle accident, other deaths at the scene, ejection, vital signs, mental status, the presence of external bleeding, the type of weapon, and other pertinent data.
    On arrival at the hospital, the history and physical examination are usually accurate in determining intra-abdominal injury in an awake and responsive patient, although the limitations of physical examination are significant. Many patients with moderate intra-abdominal bleeding will be in a compensated hemodynamic condition and will not have peritoneal signs. Furthermore, retroperitoneal and pelvic injuries cannot be ruled out on the basis of only physical findings. We believe that an objective abdominal evaluation is necessary and should be performed by any of the available diagnostic modalities, in addition to the physical examination. The test of choice depends on the hemodynamic stability of the patient and the severity of associated injuries.
    Hemodynamically stable patients sustaining blunt trauma are adequately evaluated by abdominal ultrasound or CT, unless other severe injuries take priority and the patient needs to go to the operating room before the objective abdominal evaluation. In such instances, DPL or focused abdominal sonography for trauma (FAST) is usually performed in the operating room to rule out intra-abdominal bleeding requiring immediate surgical exploration.
    Hemodynamically stable blunt trauma patients are evaluated by ultrasound in the resuscitation room, if available, or by DPL to rule out intra-abdominal injuries as the source of blood loss and hypotension.
    Hypotensive patients with isolated penetrating abdominal trauma who are hypotensive or in shock or have peritoneal signs should go to the operating room despite the mechanism of injury. Stab wound victims without peritoneal signs, evisceration, or hypotension benefit from wound exploration and DPL. Gunshot wound victims should generally undergo exploration.

    Fundamentals of Surgical Practice By Andrew N. Kingsnorth, Aljafri A. Majid
    Indications for Operation in Anterior abdominal stab wounds:
    Shock ; Peritonitis and Visceral Protrusion(OMENTUM EXCLUDED)
    In Equivocal cases the investigation of choice is Exploration of wound to find if the peritoneum is breached.

    eMEDICINE reference:
    Abdominal stab wound exploration forms part of a strategy developed by surgeons to allow a more selective approach. In asymptomatic patients with stab wounds to the anterior abdomen, 2 methods are widely used to help determine the need for laparotomy:
    • Abdominal stab wound exploration (Subsequent diagnostic peritoneal lavage [DPL], serial clinical evaluation, or both are used to further assess patients in whom an exploration cannot definitively exclude peritoneal penetration.)
    • Serial clinical evaluation

    198. Site not affected in posterior cerebral artery infarct is?
    A. Midbrain
    B. Pons
    C. Thalamus
    D. Striate Cortex
    Ans:B Pons(will post references soon)

    199. A poison Illuminous, translucent, waxy
    A. Yellow phosphorus
    B. Arsenic
    C. Thalium
    D. ?
    Ans:A Yellow phosphorous

    200 . A pt comes with history of unresponsive fever n cough. xray shows pneumonia,sputum reveals aerobic, gram positive and partially acid fast branching filaments.Causative organism is?
    A. Actinomycosis
    B. Nocardiosis
    C. Aspergillus
    D.—
    Ans:B Nocardiosis
    Reference: Harrison Principles Of Internal Medicine 17th ed:
    Pneumonia, the most common form of nocardial disease in the respiratory tract, is typically subacute; symptoms have usually been present for days or weeks at presentation. The onset is occasionally more acute in immunosuppressed patients. Cough is prominent and produces small amounts of thick, purulent sputum that is not malodorous. Fever, anorexia, weight loss, and malaise are common; dyspnea, pleuritic pain, and hemoptysis are less common. Remissions and exacerbations over several weeks are frequent. Roentgenographic patterns vary, but some are highly suggestive of nocardial pneumonia. Infiltrates vary in size and are typically of at least moderate density. Single or multiple nodules are common , sometimes suggesting tumor metastases. Infiltrates and nodules tend to cavitate (Fig. 155-2). Empyema is present in one-third of cases.
    The first step in diagnosis is examination of sputum or pus for crooked, branching, beaded, gram-positive filaments 1 microm wide and up to 50microm long . Most nocardiae are acid-fast in direct smears if a weak acid is used for decolorization (e.g., in the modified Kinyoun, Ziehl-Neelsen, and Fite-Faraco methods). The organisms often take up silver stains.
    Nocardiae grow relatively slowly; colonies may take up to 2 weeks to appear and may not develop their characteristic appearance for up to 4 weeks. Several blood culture systems support nocardial growth. Yield in manual systems is enhanced when blood cultures are incubated aerobically for up to 4 weeks and when blind subcultures are performed. Nocardial growth is so different from that of more common pathogens that the laboratory should be alerted when nocardiosis is suspected in order to maximize the likelihood of isolation. Since nocardiae are among the few aerobic microorganisms that use paraffin as a carbon source, paraffin baiting can be used to isolate the organisms from mixed cultures.
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    201. Which among the following is the best inotrope drug for use in right heart failure with primary pulmonary hypertension?
    A. Dobutamine
    B. digoxin
    C. Halothane
    D. Milrinone
    Ans:D Milrinone
    Ans:Goodman and Gilman Pharmacology
    Inamrinone and Milrinone
    Parenteral formulations of inamrinone (previous name amrinone) and milrinone have been approved for short-term support of the circulation in advanced heart failure. Both drugs are bipyridine derivatives and relatively selective inhibitors of PDE3, the cyclic GMP–inhibited cyclic AMP PDE.
    These drugs cause direct stimulation of myocardial contractility and acceleration of myocardial relaxation. In addition, they cause balanced arterial and venous dilation with a consequent fall in systemic and pulmonary vascular resistances, and left and right heart filling pressures.
    Cardiac output increases due to the stimulation of myocardial contractility and the decrease in left ventricular afterload.
    As a result of this dual mechanism of action, the increase in cardiac output with milrinone is greater than that seen with nitroprusside at doses that produce comparable reductions of systemic resistance. Conversely, the arterial and venous dilator effects of milrinone are greater than those of dobutamine at doses that produce comparable increases in cardiac output

    202. Which of the following helps in generating oxygen burst for killing bacteria within neurophils ?
    A. Superoxide dismutase
    B. Oxidase
    C. Peroxidase
    D. Glutathione reductase
    Ans:B Oxidase(REPEAT)

    203. Main blood supply of neck of femur?
    A. Lateral circumflex femoral
    B. Medial circumflex femoral
    C. Profunda femoris answer
    D. Popliteal artery
    Ans: B Medial circumflex femoral artery
    Reference:Snell’s Clinical anatomy by regions
    Blood Supply to the Femoral Head and Neck Fractures

    Anatomic knowledge of the blood supply to the femoral head explains why avascular necrosis of the head can occur after fractures of the neck of the femur. In the young, the epiphysis of the head is supplied by a small branch of the obturator artery, which passes to the head along the ligament of the femoral head.

    The upper part of the neck of the femur receives a profuse blood supply from the medial femoral circumflex artery. These branches pierce the capsule and ascend the neck deep to the synovial membrane.

    As long as the epiphyseal cartilage remains, no communication occurs between the two sources of blood. In the adult, after the epiphyseal cartilage disappears, an anastomosis between the two sources of blood supply is established. Fractures of the femoral neck interfere with or completely interrupt the blood supply from the root of the femoral neck to the femoral head. The scant blood flow along the small artery that accompanies the round ligament may be insufficient to sustain the viability of the femoral head, and ischemic necrosis gradually takes place.

    204. All are actions of muscarinic antagonist except?
    A. Decreases gastric secretion
    B. Prolongs a-v conduction
    C. Decreases respiratory secretions
    D. Contraction of radial muscles of iris
    Ans:D Contraction of radial muscles of Iris
    On seeing the Q first it appears as if all 4 options are correct....Anyway cholinergic system contracts circular muscle of iris...an Antimuscarinic agen will block this and this inturn leads to pupilary dilatation....contraction of radial muscles of Iris is a function of sympathetic system.

    205. All are used in the treatment of hot flushes except?
    A. Tamoxifen
    B. Venlafaxine
    C.
    D.
    Ans:A Tamoxifen(REPEAT)

    206. Pearson's skewness coefficient is?
    A. (Mean-median)/SD
    B. Median-mean/SD
    C. SD/mean-median
    D. SD/median-mean
    Ans:A (Mean-median)/SD
    Reference:WIKIPEDIA
    Pearson's skewness coefficients
    Karl Pearson suggested simpler calculations as a measure of skewness: the Pearson mode or first skewness coefficient, defined by
     (mean − mode) / standard deviation,
    as well as Pearson's median or second skewness coefficient, defined by
     3 (mean − median) / standard deviation.

    207. Best treatment option for genuine stress incontinence?
    A. Burch colposuspension
    B. Kelly’s procedure
    C. Sling operation
    D. Tension free vaginal taping
    Ans:A Burch colposuspension
    Reference:Berek and Novak Gynaecology
    In 1997, the American Urological Association convened a clinical guidelines panel to analyze published outcomes data on surgical procedures to treat female stress urinary incontinence and to produce practice recommendations to guide surgical decision–making . The panel concluded that colposuspensions (e.g., Burch, Marshall–Marchetti–Krantz [MMK]) and slings were more effective than transvaginal needle suspensions or anterior repairs for long–term success (48 month cure/dry rates). The median probability estimates for cure/dry rates at 48 months and longer were 84% (95% CI, 79%–88%) for colposuspensions and 83% (95% CI, 75%–88%) for sling procedures, compared with 67% (95% CI, 53%–79%) for transvaginal needle suspensions and 61% (95% CI, 47%–72%) for anterior repairs.

    208. Lines of blaschko are:
    A. Lymphatics
    B. Blood vessel
    C. Nerves
    D. Lines of development
    Ans:D Lines of development
    Reference: Avery's neonatology: pathophysiology & management of the newborn By Gordon B. Avery, Mhairi G. MacDonald, Mary M. K. Seshia, Martha D. Mullett
    “During development, skin and its structures are thought to migrate along the "lines of Blaschko" . Most authorities believe thatBlaschko lines are an expression of epidermal and not dermal migrationâ€

    209. All are true about meglitinides except?
    A. Decreases post parandial hyperglycemia
    B. Hypoglycemia less common than sulfonylureas
    C. It decreases insulin resistance
    D. It acts by releasing insulin .
    Ans:C It decreases Insulin resistance
    INSULIN SECRETAGOGUES: MEGLITINIDES
    The meglitinides are a relatively new class of insulin secretagogues. Repaglinide, the first member of the group, was approved for clinical use in 1998 (Table 41–7). These drugs modulate B-cell insulin release by regulating potassium efflux through the potassium channels previously discussed. There is overlap with the sulfonylureas in their molecular sites of action because the meglitinides have two binding sites in common with the sulfonylureas and one unique binding site.

    Repaglinide has a very fast onset of action, with a peak concentration and peak effect within approximately 1 hour after ingestion, but the duration of action is 5–8 hours. It is hepatically cleared by CYP3A4 with a plasma half-life of 1 hour. Because of its rapid onset, repaglinide is indicated for use in controlling postprandial glucose excursions. The drug should be taken just before each meal in doses of 0.25–4 mg (maximum, 16 mg/d); hypoglycemia is a risk if the meal is delayed or skipped or contains inadequate carbohydrate. This drug should be used cautiously in individuals with renal and hepatic impairment. Repaglinide is approved as monotherapy or in combination with biguanides. There is no sulfur in its structure, so repaglinide may be used in type 2 diabetic individuals with sulfur or sulfonylurea allergy.
    INSULIN SECRETAGOGUE: D-PHENYLALANINE DERIVATIVE
    Nateglinide, a D-phenylalanine derivative, is the latest insulin secretagogue to become clinically available. Nateglinide stimulates very rapid and transient release of insulin from B cells through closure of the ATP-sensitive K+ channel. It also partially restores initial insulin release in response to an intravenous glucose tolerance test. This may be a significant advantage of the drug because type 2 diabetes is associated with loss of this initial insulin response. The restoration of more normal insulin secretion may suppress glucagon release early in the meal and result in less endogenous or hepatic glucose production. Nateglinide may have a special role in the treatment of individuals with isolated postprandial hyperglycemia, but it has minimal effect on overnight or fasting glucose levels. Nateglinide is efficacious when given alone or in combination with nonsecretagogue oral agents (such as metformin). In contrast to other insulin secretagogues, dose titration is not required.
    Nateglinide is ingested just before meals. It is absorbed within 20 minutes after oral administration with a time to peak concentration of less than 1 hour and is hepatically metabolized by CYP2C9 and CYP3A4 with a half-life of 1.5 hours. The overall duration of action is less than 4 hours.
    Nateglinide amplifies the insulin secretory response to a glucose load but has a markedly diminished effect in the presence of normoglycemia. The incidence of hypoglycemia may be the lowest of all the secretagogues, and it has the advantage of being safe in individuals with very reduced renal function.

    210. All are true regarding serotonin syndrome except?
    A. It is not idiosyncratic and unpredictable
    B. Dantrolene is the drug of choice for the condition
    C. --
    D. –
    Ans:B Dantrolene is the drug of choice for the condition
    Reference:WIKIPEDIA
    Management is based primarily on stopping the usage of the precipitating drugs, the administration of serotonin antagonists such as cyproheptadine, and supportive care including the control of agitation, the control of autonomic instability, and the control of hyperthermia.
    Additionally, those who ingest large doses serotonergic agents may benefit from gastrointestinal decontamination with activated charcoal if it can be administered within an hour of overdose.
    The intensity of therapy depends on the severity of symptoms. If the symptoms are mild, treatment may only consist of discontinuation of the offending medication or medications, offering supportive measures, giving benzodiazepines for myoclonus, and waiting for the symptoms to resolve.
    Moderate cases should have all thermal and cardiorespiratory abnormalities corrected and can benefit from serotonin antagonists. The serotonin antagonist cyproheptadine is the recommended initial therapy, although there have been no controlled trials demonstrating its efficacy for serotonin syndrome. Despite the absence of controlled trials, there are a number of case reports detailing apparent improvement after patients have been administered cyproheptadine. Animal experiments also suggest a benefit from serotonin antagonists.
    Cyproheptadine is only available as tablets and therefore can only be administered orally or via a nasogastric tube; it is unlikely to be effective in patients administered activated charcoal and has limited use in severe cases. Additional pharmacological treatment for severe case includes administering atypical antipsychotic drugs with serotonin antagonist activity such as olanzapine. Critically ill patients should receive the above therapies as well as sedation or neuromuscular paralysis. Patient who have autonomic instability such as low blood pressure require treatment with direct-acting sympathomimetics such as epinephrine, norepinephrine, orphenylephrine. Conversely, hypertension or tachycardia can be treated with short-acting antihypertensive drugs such as nitroprusside or esmolol; longer acting drugs such as propranolol should be avoided as they may lead to hypotension and shock.
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    q 211. All of the following are neuronal tumours except?
    A. Gangliocytoma
    B. Ganglioglioma
    C. Neuroblastoma
    D. Ependymoma....ANS

    REF: Robbins's.. Page 1348
    I got hold of old edition thus giving the page number of old edition but yo ucan find it under heading of NEURONAL TUMOURS in robbins.. at present edition that I got hold of is old edition page 1348.. But as I said under heading of NEuronal tumours it says this..

    " Several types of Cns tumors contain mature appearing neurons(ganglion cell these might be complete population(GANGLIOCYTOMa) or sometimes it might be mixed with glial tissue ( GANGLIOGLIOMA).. OTHERS INCLUDE CEREBRAL NEUROBLASTOMA ,CENTRAL NEUROCYTOMA AND DYSEMBRYONIC NEUROEPITHELIAL TUMOR

    212. Orthopnoea in right heart failure develops due to?
    A. Reservoir function of pulmonary veins
    B. Reservoir function of leg veins
    C. --
    D. –-
    Ans:B Reservoir function of leg veins(MANY WILL ARGUE---OPEN FOR DISCUSSION)
    Reference:BRAUNWALD’s PRINCIPLES OF CARDIOLOGY
    ORTHOPNEA:
    Orthopnea is defined as dyspnea that occurs in the recumbent position and is usually a later manifestation of heart failure than exertional dyspnea.
    Orthopnea is generally relieved by sitting upright or by sleeping with additional pillows.
    It results from the redistribution of fluid from the splanchnic circulation and lower extremities into the central circulation during recumbency, with a resultant increase in pulmonary capillary pressures.
    Nocturnal cough is a frequent manifestation of this process, and is a frequently overlooked symptom of heart failure. Although orthopnea is a relatively specific symptom of heart failure, it may occur in pulmonary patients with abdominal obesity or ascites, and in pulmonary patients whose lung mechanics favor an upright posture.

    213. Commonest cause for bilateral proptosis in children?
    A. Cavernous haemangioma
    B. Rhabdomyosarcoma
    C. ALL
    D. AML
    Ans:D AML
    Reference: “Proptosis in children: An Approach”
    http://medind.nic.in/ias/t04/s2/iast04s2p33g.pdf

    The most common causes of Bilateral ptosis in children is granulocytic sarcoma in AML/MDS and metastatic neuroblastoma
    Most common cause of malignant proptosis in children:
    In india—Retinoblastoma
    Western countries-Rhabdomyosarcoma

    214.Most common malignant cause of proptosis in children?
    A. A. Cavernous haemangioma
    B. Rhabdomyosarcoma
    C. ALL
    D. AML
    Ans:B Rhabdomyosarcoma

    215. Blood examination of a patient revealed low calcium, high phosphate and raised PTH. Which of the following investigations need not be done?
    A. Urine microscopy
    B. PTH reassessment
    C. Vitamin D levels
    D. –
    Ans:Urine microscopy(OPEN FOR SCRUTINY)
    The crux is it is not Multiple Myeloma...

    206. OPTIONS UNCLEAR SO 2 VERSIONS HAVE BEEN PUT UP:
    VERSION 1: Pearson's skewness coefficient is?
    A. (Mean-mode)/SD
    B. Mode-mean/SD
    C. SD/mean-mode
    D. SD/mode-mean

    Ans- mean-mode/SD
    VERSION 2: Pearson's skewness coefficient is?
    A. (Mean-median)/SD
    B. Median-mean/SD
    C. SD/mean-median
    D. SD/median-mean
    Ans:A (Mean-median)/SD
    Reference:WIKIPEDIA
    Pearson's skewness coefficients
    Karl Pearson suggested simpler calculations as a measure of skewness: the Pearson mode or first skewness coefficient, defined by
     (mean − mode) / standard deviation,
    as well as Pearson's median or second skewness coefficient,, defined by
     3 (mean − median) / standard deviation.
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    218. about contrast radiography true is (HIGHLY UNCLEAR ON OPTIONS)
    a.3 parts of iodine with 2 parts of solvent
    b.injection into artery is associated with 1/3 times more complication than injection into a vein
    c.Test dose should be performed if a contrast reaction is suspected
    d.—
    Ans:C Test dose should be performed if a contrast reaction is suspected(Logical)

    219. A female with XO genotype and Primary amenorrhoea most likely diagnosis is?
    A. Gonadal dysgenesis
    B. Androgen insensitivity syndrome.
    C. MRKH
    D. –
    Ans:A Gonadal dysgenesis

    220. 1.Cicatrising alopecia with perifolicular blue-gray pathches (??) is most commonly associated with
    a. Nail dystrophy
    b. Whitish lesion in the buccal mucosa
    c. Arthritis
    d. Discoid Plaques in the face
    Ans:???diagnosis---DLE or Lichen Planopilaris
    Open to scrutiny---for now D>A

    221.Transfer of an amino group from an amino acid to an alpha keto acid is done by?
    A. Transaminases
    B. Aminases
    C. Transketoses
    D. –
    Ans:A Transaminases(no references needed)
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    222. True about gastric carcinoma is?
    A. Occult bleeding in stool is not seen
    B. Often associated with achlorhydria/hypochlorhydria
    C. Always squamous cell carcinoma
    D. Radiosensitive
    Ans:B Often associated with achlorhydria/hypochlorhydria
    Reference:Schwartz surgery
    Most patients who are diagnosed with gastric cancer in the United States have advanced stage III or IV disease at the time of diagnosis. The most common symptoms are weight loss and decreased food intake due to anorexia and early satiety. Abdominal pain (usually not severe and often ignored) also is common. Other symptoms include nausea, vomiting, and bloating. Acute GI bleeding is somewhat unusual (5%), but chronic occult blood loss is common and manifests as iron deficiency anemia and heme-positive stool. Dysphagia is common if the tumor involves the cardia of the stomach. Paraneoplastic syndromes such as Trousseau's syndrome (thrombophlebitis), acanthosis nigricans (hyperpigmentation of the axilla and groin), or peripheral neuropathy are rarely present.
    Chronic atrophic gastritis is by far the most common precursor for gastric cancer, particularly the intestinal subtype . The prevalence of atrophic gastritis is higher in older age groups, but it is also common in younger people in areas with a high incidence of gastric cancer. In many patients, it is likely that H. pylori is involved in the pathogenesis of atrophic gastritis. Correa described three distinct patterns of chronic atrophic gastritis: autoimmune (involves the acid-secreting proximal stomach), hypersecretory (involving the distal stomach), and environmental (involving multiple random areas at the junction of the oxyntic and antral mucosa).

    223. A boy gets hit by a tennis ball in the eye following which he has complaints of decreased vision. Which of the following tells that blunt injury is due to the ball.
    1. Optic neuritis
    B. Pars planitis
    C. Vitreous base detachment
    D. Equatorial edema
    Ans: C Vitreous base detachment
    Reference: Vitreoretinal disease: the essentials By Carl D. Regillo, Gary C. Brown, Harry W. Flynn
    “The presence of Vitreous base avulsion is thought to be pathognomonic of blunt ocular traumaâ€

    224. False about C.diphtheriae is?
    A. Toxin production is chromosome mediated
    B. org cnfd by toxin production
    C. Toxic to heart and neurons
    D. –
    Ans:A Toxin production is chromosome mediated

    225. True regarding drug resistance of MRSA? (was a long stem though)
    A. Penicillinase enzyme production
    B. Due to change in penicillin binding receptors
    C. plasmid mediated
    D. Treated with amoxicillin clavulanic acid
    Ans:B Due to change in penicillin binding receptors

    226. Muscular component of dorsal aorta develops from?
    A. Axial mesoderm
    B. Paraxial mesoderm
    C. Intermediate mesoderm
    D. Lateral plate mesoderm
    Ans: D Lateral plate mesoderm
    Reference: DEVELOPMENTAL ORIGIN AND MOLECULAR REGULATION OF VASCULAR SMOOTH MUSCLE CELLS
    Per Wasteson Institute of Biomedicine, Department of Medical Biochemistry and Cell Biology, Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden, 2008
    “Aortic SMCs have been proposed to derive from lateral plate mesoderm. It has further been suggested that induction of SMC differentiation is confined to the ventral side of the aorta and that cells later migrate to the dorsal sideâ€

    227. Dental numbering is done by all except?
    A. FDI two digit system
    B. Anatomic and diagramatic charting
    C. Palmer notation
    D. –
    Ans: Cant arrive at a conclusion without the 4th option since all the above are used

    228. False about pneumococcus is?
    A. Capsule aids in virulence
    B. Commonest cause of otitis media and pneumonia
    C. Meningitis caused by it is milder than other
    D. ---
    Ans:C Meningitis caused by it is milder than other organisms

    229. False regarding Japanese encephalitis is:
    A. Epidemic is 2-3 cases in a village
    B. Mosquito bite is always associated with disease
    C. 70 in infants
    D. Apparent and nonapparent ratio 1:100
    Ans:B Mosquito bite is always associated with disease

    230. True in keto acidosis is..
    A. Decreased HCO3
    B. Increased levels of lactate
    C. --
    D. –
    Ans:A Decreased Hco3

    231. A 6 week old male infant was brought in a state of dehydration and shock. Examination revealed hyper pigmentation over the body with normal external genitalia. Blood tests revealed hypoglycemia, Na - 124 mEq/L and K - 7 mEq/L. What is the probable diagnosis ?
    A. Congenital adrenal hyperplasia¡¬¡¬¡¬¡¬¡¬ answer
    B. Adrenal haemorrhage and shock
    C. Acute gastroenteritis with dehydration
    D. –
    Ans:A CAH(modified REPEAT)

    232. All of the following are true regarding diabetes mellitus except?
    A. Insulin is not used in type 2 diabetes
    B. Sliding scale regimen is used in hospitals
    C. --
    D. –
    Ans:A Insulin is not used in type 2 DM

    233. Which among the following is an early sign of magnesium toxicity?
    A. Loss of deep tendon reflexes
    B. Respiratory depression
    C. Cardiac arrest
    D. Decreased urine output
    Ans:A Loss of DTR

    234. All of the following are affected in low radial nerve palsy except?
    A. Extensor carpi radialis longus
    B. Extensor carpi radialis brevis
    C. Finger extensors
    D. Sensation on dorsum of hand
    Ans:A ECRL(REPEAT)

    235. A man connected to a body plethysmograph exhales against a closed glottis. What will be the finding?
    A. The pressure in both the lungs and the box increases
    B. The pressure in both the lungs and the box decreases
    C. The pressure in the lungs decreases, but that in the box increases
    D. The pressure in the lungs increases, but that in the box decrease
    Ans: D. The pressure in the lungs increases, but that in the box decrease

    236. A patient presents with fever and abdominal pain. Clinical examination reveals hepatomegaly extending 4 finger breadths below the costal margin. USG reveals a 5cm*5cm*4cm hypodense lesion 1cm deep to liver surface. Tests for hydatid disease were -ve. Best course of action is?
    A. Multiple aspirations,antiamebics and antibiotics
    B. Catheter drainage with antiamebics and antibiotics
    C .Hepatectomy(??)
    d.. Medical management with antiamebics and antibiotics
    Ans: B. Catheter drainage with antiamebics and antibiotics
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    237. All are true about blood coagulation except?
    A. Factor 10 in a part of both intrinsic and extrinsic pathway
    B. Extrinsic pathway is activated by contact with plasma and negatively charged proteins
    C. Calcium is very important for coagulation
    D. Intrinsic pathway can be activated in vitro
    Ans: D. Intrinsic pathway can be activated in vitro

    238. Late onset endophthalmitis after lens implantation is caused by?
    A. Staphylococcus epidermidis
    B. Pseudomonas
    C. Streptococcus pyogenes
    D. Propionibacterium acnes

    Ans:D Propionibacterium acnes

    239. All are seen in the floor of 3rd ventricle except?
    A. Infundibulum
    B. Oculomotor nerve
    C. Mammillary body
    D. Optic stalk
    Ans:B Occulomotor nerve

    240. Which among the following is not a component of hypogastric sheath?
    A. Broad ligament
    B. Uterosacral ligament
    C. lateral ligament
    D. Ligament of bladder
    Ans:A Broad ligamnent of uterus ---a peritoneal reflection

    241. A patient presents with signs of pneumonia. The bacterium obtained from sputum was gram positive cocci which grew on sheep agar. What test is used to identify the type of organism?(Question stem incomplete---though it seemed like pneumococcal pneumonia)
    A. Bile solubility
    B. Bacitracin sensitivity
    C. Coagulase test
    D. –
    Ans:A Bile solubility

    242. True about platelet function defect?
    A. Normal platelet count with prolonged bleeding time
    B. Thrombocytosis with prolonged bleeding time
    C. --
    D. --

    Ans: A. Normal platelet count with prolonged bleeding time
    243. After removal of pituitary for craniopharyngioma, first drug given is?
    A.cortisone
    B.GH
    C. --
    D. –
    Ans:A Cortisone(no references though—will have to search)

    244. A 5 year old child presented with ballooning of perpuce while micturition. Perpuce adhesions were present. What is the best treatment for him?
    A. Adhesiolysis and dilatation
    B. Circumcision
    C. Dorsal slit
    D. Conservative

    Ans:B Circumscision

    245. Which of the following process in a vector is used to increase the yield of protein produced in recombinant protein synthesis?
    A. Promoter induction
    B. Genes for protease inhibitors
    C. Translation initiation
    D. Translation and transcription termination
    Ans:A Promoter induction(logically from these options---u need to increase transcription and then only translation---mere increase in translation will not increase protein output...so induce a promoter get more mrna and then more protein via translation---hypothetical explanation----absolutely no references...so subject to change in the light of better evidences)

    246. VERSION 1:
    Which of the following is not associated with atherosclerotic plaque formation?
    A.Plasma ApoE
    B. alpha 2-macroglobulin
    C. Oxidised LDL
    D. Increased homocystiene

    Ans:B alpha 2 macroglobulin
    Reference: Alpha2-antiplasmin is a single-chain glycoprotein serpin synthesized predominantly by the liver. It is the main inhibitor of plasmin in human plasma, forming a 1 : 1 stoichiometric complex with plasmin that inactivates the enzyme. Alpha2-macroglobulin also inhibits plasmin, but at a much slower rate than alpha2-antiplasmin; therefore, alpha2-macroglobulin has questionable importance in the physiological regulation of fibrinolysis
    VERSION 2:
    Increased levels of which of the following is not associated with atherosclerotic plaque formation?

    A.Plasma ApoE
    B. alpha 2-macroglobulin
    C. Oxidised LDL
    D. Increased homocystiene
    Ans:Both A and B

    247. Least common cause of ambiguous genitalia in a female child?
    A. Placental steroid sulfatase deficiency
    B. Fetal aromatase deficiency
    C. WT-4 mutation
    D. CAH
    Ans: A. Placental steroid sulfatase deficiency

    248.A patient presented to the with bluish pigmentation of conjunctiva, mucous membranes, nails. What is the poison:
    A. Mercury
    B. Arsenic
    C. Lead
    D. Silver
    Ans:D Silver
    249.Best marker for open nural tube defect.
    A.Acetylcholinesterase
    B.Pseudocholinesterase
    C.AFP
    D. --

    Ans:A Acetylcholinesterase(REPEAT)
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    Smooth muscle of the dorsal aorta shares a common clonal origin with skeletal muscle of the myotome
    Milan Esner1, Sigolène M. Meilhac1,*, Frédéric Relaix1, Jean-François Nicolas1, Giulio Cossu2,3,4 and
    Margaret E. Buckingham1,†
    We show that cells of the dorsal aorta, an early blood vessel, and of the myotome, the first skeletal muscle to form within the
    somite, derive from a common progenitor in the mouse embryo. This conclusion is based on a retrospective clonal analysis, using a
    nlaacZ reporter targeted to the -cardiac actin gene. A rare intragenic recombination event results in a functional nlacZ sequence,
    giving rise to clones of -galactosidase-positive cells. Periendothelial and vascular smooth muscle cells of the dorsal aorta are the
    main cell types labelled, demonstrating that these are clonally related to the paraxial mesoderm-derived cells of skeletal muscle.Rare endothelial cells are also seen in some clones. In younger clones, arising from a recent recombination event, myotomal
    labelling is predominantly in the hypaxial somite, adjacent to labelled smooth muscle cells in the aorta. Analysis of Pax3GFP/+
    embryos shows that these cells are Pax3 negative but GFP positive, with fluorescent cells in the intervening region between the
    aorta and the somite. This is consistent with the direct migration of smooth muscle precursor cells that had expressed Pax3. These
    results are discussed in terms of the paraxial mesoderm contribution to the aorta and of the mesoangioblast stem cells that derive
    from it.
    INTRODUCTION
    The dorsal aorta in amniotes is an early embryonic blood vessel
    composed of endothelial and smooth muscle cells. It is also the
    source of two classes of mesodermal stem cell, hematopoietic stem
    cells (de Bruijn et al., 2000) and mesoangioblasts (De Angelis et al.,
    1999). The latter are stem cells that express some endothelial
    markers and give rise to a number of mesodermal derivatives,
    including skeletal muscle and smooth muscle (Minasi et al., 2002).
    This raises the possibility of a lineage relationship between these
    muscles and prompted us to investigate the origin of smooth muscle
    cells in the dorsal aorta.
    At embryonic day (E) 8 in the mouse, the initial structure of the
    dorsal aorta is present as two tubes extending under the neural tube
    and notochord, along the anteroposterior axis of the embryo. Fusion
    of the tubes, in the central region of the trunk, takes place
    progressively towards the extremities, to give the single midline
    dorsal aorta. The nascent tube is formed from endothelial cells
    (Drake and Fleming, 2000). Mural cells, expressing smooth muscle
    markers, differentiate under the endothelial cell layer, which faces
    into the lumen. In the avian dorsal aorta, the first mural smooth
    muscle cells appear ventrally (Hungerford et al., 1996). Pericytes are
    a class of mural cell that characteristically lie within the basal lamina
    of the endothelium and constitute the smooth muscle component of
    capillaries, whereas thicker blood vessels, such as the dorsal aorta,
    accumulate additional outer layers of vascular smooth muscle cells
    (Gerhardt and Betsholtz, 2003).
    Smooth muscle is derived from mesoderm, except at certain sites,
    such as in the head and aortic arches, where it originates from the
    neural crest (Le Lievre and Le Douarin, 1975). It is thought that,
    during vascular development, smooth muscle cells are recruited
    from surrounding mesenchyme and induced to differentiate by
    factors produced by the endothelial cells of the vessel (Hirschi et al.,
    1998). However, endothelial and smooth muscle cells may derive
    from a common Flk1-expressing progenitor (Yamashita et al., 2000;
    Ema et al., 2003). Furthermore, labelling experiments have
    suggested that endothelial cells in the dorsal aorta can
    transdifferentiate into smooth muscle (DeRuiter et al., 1997). The
    mesoangioblast stem cells may correspond to an endothelial/pericyte
    intermediate cell type (Cossu and Bianco, 2003).
    Endothelial cells in the dorsal aorta have been shown to derive
    from two distinct mesodermal sources. In both birds and mammals,
    it has been proposed that there may be a common progenitor cell, the
    hemangioblast, derived from splanchnic mesoderm, that gives rise
    to the endothelial cells of the vessel wall and to hematopoetic cells
    (Jaffredo et al., 1998; Nishikawa et al., 1998). Grafting experiments
    in avian embryos have shown that somites give rise to endothelial
    cells in the dorsal aorta; this paraxial mesoderm contribution was
    restricted to a dorsolateral location, whereas the ventral floor was
    colonized by cells derived from splanchnic mesoderm, at the stages
    examined (Pardanaud et al., 1996).
    Somites form from paraxial mesoderm as segmented structures,
    following an anteroposterior developmental gradient, on either side
    of the neural tube, from about E8 in the mouse. Under the influence
    of signals from surrounding tissues, cells in the somite acquire
    different mesodermal identities (Tajbakhsh and Buckingham, 2000).
    Ventrally, mesenchymal cells of the sclerotome will give rise to the
    bone of the vertebral column and ribs. Dorsally the initial epithelial
    structure of the somite is retained as the dermomyotome, which
    gives rise to dorsal derm and to all the skeletal muscles of the body.
    The first skeletal muscle to form is the myotome. Muscle progenitor
    cells delaminate from the dermomyotome and migrate under this
    epithelium where they differentiate. Initially, this process takes place from the epaxial dermomyotome, which is adjacent to the axial
    structures of the neural tube and notochord. Later, cells from the
    other, hypaxial, extremity of the dermomyotome also contribute to
    the myotome. Other muscle progenitor cells migrate out from the
    hypaxial dermomyotome to form, for example, the muscles of the
    limb. Dermomyotomal cells are characterized by the expression of
    Pax3, an important regulator of myogenesis. Endothelial cells are
    also associated with somites, from which they migrate into the body
    and limbs. Somite transplantation experiments in avian embryos
    have shown that angioblasts are derived from all somitic
    compartments (Noden, 1989; Wilting et al., 1995). More recently
    lineage tracking, using retrovirus vectors in the chick embryo, has
    shown that endothelial and skeletal muscle cells in the limb are
    derived from a common progenitor cell, labelled in the hypaxial
    dermomyotome (Kardon et al., 2002). It has been suggested that the
    mesenchymal cells of the avian sclerotome can be recruited to give
    rise to the smooth muscle of blood vessels formed in this region of
    the embryo (Christ et al., 2004).
    In order to examine a possible lineage relationship between cells
    in the dorsal aorta and the skeletal muscle cells of the myotome in
    the mouse embryo, we adopted a genetic approach that permits
    retrospective clonal analysis (Bonnerot and Nicolas, 1993; Nicolas
    et al., 1996). This employs a laacZ reporter that contains a
    duplication of the lacZ coding sequence under the control of
    regulatory sequences directing expression to the tissues of interest.
    In the embryo, a rare intragenic recombination event will remove the
    duplication to give lacZ, which encodes a functional -galactosidase
    (-gal) protein when the gene is expressed. A common progenitor
    cell that has undergone such a recombination event will give rise to
    -gal+ cells that are clonally related. We have used mice in which
    we had targeted the -cardiac actin gene with a nlaacZ reporter
    (Meilhac et al., 2003), in order to carry out such a clonal analysis in
    the myocardium. In addition to the heart, -cardiac actin is also
    expressed in embryonic skeletal muscle and in the dorsal aorta
    (Sassoon et al., 1988).
    The retrospective clonal analysis presented in this paper shows
    that cells in the dorsal aorta and in the myotome have a common
    clonal origin. The properties of the common progenitor cells are
    discussed. Based on the analysis of Pax3GFP/+ mice, we propose that
    GFP-labelled progenitor cells migrate from the somite to the dorsal
    aorta. We also document the spatiotemporal characteristics of clones
    in the dorsal aorta, in terms of cell type and position. Most of them
    are smooth muscle cells, but occasional labelled endothelial cells are
    present in the clones, in keeping with the existence of a common
    vascular progenitor.

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