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PGIMER ENTRANCE EXAM

MAY 2012

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1. Most commonly used cylinder in anaesthesia machine is:

A. A

B. B

C. D

D. E

E. F

Ans: D(E)

[Ref:Ajay Yadav 1st/ 20-21 ; Miller 7th/ 675 ; Lee 13th/ 84-85 ]

Most commonly used cylinder in anaesthesia machine is E

“Cylinder: Smallest size available is AA and biggest is H. Commonly used cylinders

on anaesthesia machine are of type E”- Ajay Yadav 1st/ 20

“Anesthesia workstations have E-cylinders for use when a pipeline supply source is

not available or the pipeline system fails”- Miller 7th/ 675

2. Feature of malignant hyperthermia includes:

A. Tachycardia

B. Hypotension

C. Excessive sweating

D. ↓ed ETCO2

E. ↓ed O2 saturation

Ans: ACE

[Ref:Ajay Yadav 1st/101-02 ; Miller 7th/ 1187-89 ; Lee 13th/ 353 ; Morgan's clinical

aneasthesia 4th/945-950; Wylie's Anaesthesia 7th/365, 367]

“Clinical feature: Hypoxia, cyanosis,tachycardia, hypertension & cardiac arrhythmia”-

Ajay Yadav 1st/102

“Falling SpO2 despite increase in FiO2; cyanosis”-C.Y.Lee 2006/840

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“Cardiovascular instability with labile B.P”- C.Y.Lee 2006/840

“Unexpected change in B.P”- Lee 13th/ 353

Signs of malignant hyperthermia Lee, Wylie's

Hyperthermia : fever, sweating

3. Common Eye lid tumors are:

A. Squamous cell carcinoma

B. Sebaceous gland carcinoma

C. Malignant melanoma

D. Basal cell carcinoma

E. Malignant germ cell tumor

Ans:ABCD

[Ref: Khurana 4th/359; Parson 20th/439-40 ]

Malignant tumours of eyelid: Commonly observed tumours include squamous cell

carcinoma, basal cell carcinoma, malignant melanoma and sebaceous gland

adenocarcinoma.

4. True about Sympathetic ophthalmitis :

A. Occur after trauma and surgery

B. Injured eye is exciting eye

C. Occur in opposite eye any time

D. B/l non-suppurative uveitis occur

Ans:ABD

[Ref: Khurana 4th/413 ; Parson 20th/374-76 ]

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“Sympathizing (sound) eye. It is usually involved after 4-8 weeks of injury in the other

eye, rarely earlier. Earliest reported case is after 9 days of injury. Most of the cases

occur within the first year. However, delayed and very late cases are also reported”-

Khurana 4th/413 ; Parson 20th/375

5. True about Retinoblastoma:

A. It is most common primary intraocular tumor of childhood

B. It is most common secondary intraocular tumor of childhood

C. Seen in young & middle-age adult

D. Most commonly seen in children

Ans:AD

[Ref: Khurana 4th/ 280-83 ; Parson 20th/357-58 ]

“Retinoblastoma is the most common primary ocular tumor of childhood. About 90%

cases are diagnosed by age 3-4 yrs & 98% by 5 yrs”-O.P.Ghai 7th/594

“The tumor is confined to infants & very young children & is frequently congenital,

although it may remain quiescent or pass unnoticed until the fifth or sixth year of life

or sometime even later”- Parson 20th/357

It is the most common intraocular tumour of childhood occurring 1 in 20,000 live

births.

6. Spirometry measures :-

A. Tidal volume

B. TLC

C. ERV

D. FRC

E. IRV

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Ans: A(Tidal..),C(ERV) &E(IRV)

[Ref: Harrison 18th/ ; Guyton 11th/ 476; Ajay Yadav 1st/7-8 Lee 13th/ 762 ]

“Spirometry measures: tidal volume, inspiratory reserve volume, inspiratory capacity,

expiratory reserve volume & vital capacity. It can not measure residual volume(RV),

so any lung volume requiring RV can not be measured i.e Functional residual

capacity(FRC) & Total lung volume(TLV)”- Ajay Yadav 1st/7-8

7. Which of the following score is/are not included in mild mental

retardation:

A. 85

B. 50

C. 45

D. 75

E. 65

Ans: ACD

[Ref:Park 21st/536; Niraj Ahuja 6th/169-72;Kaplan 10th/1139]

Degrees of Severity of Mental Retardation Kaplan 10th/1139-40

• Mild mental retardation (IQ range, 50 to 70) represents approximately 85

percent of persons with mental retardation.

• Moderate mental retardation (IQ range, 35-50)

• Severe mental retardation (IQ range, 20-35)

8. All have effects on oxygen-hemoglobin dissociation curve except:

A. 2,3-DPG

B. CO2 pressure

C. Cl- concentration

D.Acidosis

E.Temperature

Ans:C

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[Ganong 22th/667-669; Guyton 11th/507; Chatterjea & Shinde 7th/149; Harrison

17th/636, Lehninger 4th/173 Kumar & Clark 4th/357 6th/430]

9.Drug that increases QT interval :

A. Haloperidol

B. Fexofenadine

C. Amiodarone

D. Ebastine

E. Sotatol

Ans:CDE

[Ref: KDT 6th/510,495,428-29]

“Fexofenadine does not prolong QTc interval”- KDT 6th/158

Haloperidol also not mentioned as cause of QT prolongation

10. Positive benzidine test is/are seen in :

A. Hemoglobin

B. Myoglobin

C. Porphobilinogen

D. Glucose

E. Bilirubin

Ans: A & B

[Ref : Harrison 16th / 608;P.J.Mehta 15th/404; Reddy 27th/394]

11. Polar amino acids are :

A. Serine

B. Tryptophan

C. Tyrosine

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D. Valine

E. Lysine

Ans:A(Serine),C(Tyrosine) & E(Lysine)

12. Ectopia lentis is/are seen in :

A. Marfan syndrome

B. Homocystinuria

C. DM

D. Hypertension

E. Sulfite oxidase deficiency

Ans:ABE

[Ref: Khurana 4th/ 202-03,3rd / 210; Parson 20th/506]

13.False statement regarding diabetic retinopathy :

A. Flame shaped haemorrahges

B. Arteriovenous nipping

C. Neovascularisation

D. Hard exudates

E. Exudative macular edema

Ans: B

[Ref: Khurana 4th/260-62; Parson 20th/294-98]

“Arterio venous nipping is found in hypertensive retinopathy”- Khurana 4th/258

14. True about Parathyroid hormone :

A. It is steroid

B. Stimulate 1,25 D3 formation

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C. Inhibits Ca+2 absorption from the intestines

D. Increases the resorption of bone

Ans:BD

[Ref: Ganong 23nd/367-70 ; Guyton 11th/986-988 ]

• Parathyroid hormone (PTH) is the peptide hormone (10 amino acids)

• PTH also increases renal synthesis of 1,25(OH)2D3

15. Second messengers is/are :-

A. Mg+2

B. P04-3

C. cAMP

D. Ca+2

E. Cl- ion

Ans:CD

[Ref: Ganong 23nd/446-48; Guyton 11th/912-15; Harper27/445; KDT6th/231-32]

Types of secondary messenger molecules

• Hydrophobic molecules: water-insoluble molecules, like diacylglycerol, and

phosphatidylinositols

• Hydrophilic molecules: water-soluble molecules, like cAMP, cGMP, IP3, and

Ca2+

• Gases: nitric oxide (NO), carbon monoxide (CO) and hydrogen sulphide

(H2S)

16. Central cyanosis not occurs when total Hb and reduced Hb level is

respectively (in gm%) :

A. 10.9 & 4.1

B. 10.9 & 5.1

C. 10.9& 6.1

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D. 8.9 & 4.1

E. 8.9 & 6.1

Ans:AD

[Ref: Ganong 23nd/ CMDT 06/222; A.K.Jain 5th/482; Guyton 11th/531; Harrison

17th/230-31; Nelson 18th/2033; P.J.Mehta 15th/15]

B Majority of textbooks favour cutoff limit of 5gm% reduced Hb(not 4gm%)

B So answer would be A & D (i.e option involving <5gm% reduced Hb- cyanosis

not occur)

“Cyanosis is due to increased amount of reduced Hb (>5mg%)Q in capillary blood”-

P.J.Mehta 15th/15

“In severe anaemia where Hb is less than 5 gm%, even if all the Hb is reduced in the

capillaries, it will be less than the critical level of 5 gm% & cyanosis does not occur”-

P.J.Mehta 15th/18

“In general, definite cyanosis appears whenever the arterial blood contain more than

5 gms of deoxygenated Hb in each 100 ml of blood”- Guyton 11th/531

“Cyanosis is due to increased amount of reduced Hb (>5mg%)Q in capillary blood”-P

A.K.Jain 5th/482 & CMDT 06/222

“In general, cyanosis becomes apparent when the concentration of reduced

hemoglobin in capillary blood exceeds 40 g/L (4 g/dL)Q”- Harrison 17th/230

17. In findings of SIADH includes:

A. ↑ Urine Na+

B. ↑ S. Na+

C. ↑ Urine osmolality

D. ↑Serum osmolality

E. Postural hypotention

Ans:AC

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[Ref: A.K.Jain 5th/698;Harrison 18th/2908-10;Williams Textbook of Endocrinology,

11th ed.]

Postural hypotention does not occur in SIADH as it is euvolemic hypoosmolality

Feature of SIADH A.K.Jain 5th/698

• ↑ urinary excretion of Na+, Hypernatriuria & hyponatremia

• ↑ Urine osmolality( become higher than plasma osmolality

18. Incorrect statement about Small cell Ca of lung:

A. Not associated with smoking

B. Surgery is treatment of choice

C. Associated with paraneoplastic syndrome

D. Most patients have distant metastases on diagnosis

E. Contain neurosecretory granules

Ans: AB

[Ref: Harrison 18th/737-745 ; Robbins 8th/758-63 ; CMDT 06/ 267 ]

Small cell Ca of lung(SCLC)

• Eighty-five percent of patients with lung cancer of all histologic types are

current or former cigarette smokers(Squamous> Small cell ca> adenocarcinoma)

• Most common variety associated with paraneoplastic syndrome

• Highly malignant tumor with least 5-yr survival rate

• Electron microscopy shows dense-core neurosecretory granules 100 nm in

diameter in two thirds of cases.

19. Features seen in Menke’s disease:

A. Increased serum Cu

B. Decreased circulating ceruloplasmin

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C. Hypopigmented & brittle hair

D. Mental retardation

E. Failure of thrive

Ans: BCDE

[Ref: Harrison 18th/ 604; Nelson 18th/2730]

“Menkes kinky hair syndrome is an X-linked metabolic disturbance of copper

metabolism characterized by mental retardation, hypocupremia, and decreased

circulating ceruloplasmin”- Harrison 18th/ 604

• It is characterized by sparse and coarse hair, growth failure, and deterioration

of the nervous system. Onset of Menkes syndrome typically begins during infancy.

Signs and symptoms of this disorder include weak muscle tone (hypotonia), sagging

facial features, seizures, mental retardation, and developmental delay. The patients

have brittle hair and metaphysealwidening.

20. Clubbing is /are seen in :

A. Mesothelioma

B. Bronchial asthma

C. Idiopathic pulmonary fibrosis

D. TB

E. Sarcoidosis

Ans: ACDE

[Ref: Harrison 18th/ 279,289-90; Robbins 8th/ ; P.J.M 15th/14;CMDT 06/ 221-22 ]

“Clubbing is seen in chronic interstitial lung diseases(Idiopathic pulmonary fibrosis).

It does not normally accompany asthma or COPD;when seen in later, commitant

lung cancer should be suspected. It is observed less often in small cell cancer than

in other histological types”- CMDT 06/ 222

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•“Clubbing may be hereditary, idiopathic, or acquired and associated with a variety of

disorders, including cyanotic congenital heart disease, infective endocarditis, and a

variety of pulmonary conditions (among them primary and metastatic lung cancer,

bronchiectasis,asbestosis, sarcoidosis, lung abscess, cystic fibrosis,tuberculosis and

mesothelioma), as well as with some gastrointestinal diseases (including

inflammatory bowel disease and hepatic cirrhosis).”- Harrison 18th/ 290

21. Correct combinations are :

A. Apnoea = Airway blockage or no air entry through nasal aperture for ≥10

s sec

B. Hypopneas = ≥10 s events in which there is continued breathing but the

ventilation is reduced by at least 50% from the previous baseline during sleep

C. Snoring occur from obstruction of lower airway

D. Apnoea index- no of apnoeic episode/hr

E. Apnoea-Hypocapnia index > 10 indicates mild obstruction

Ans: ABDE

[Ref: Harrison 18th/ 2186; Guyton 11th/522-23; CMDT 06/1080,305-06 ]

• Obstructive sleep apnoea & Snoring are caused by blockage of the upper

airway- Guyton 11th/522

• Apneas are defined in adults as breathing pauses lasting ≥10 s and

hypopneas as ≥10 s events in which there is continued breathing but the ventilation

is reduced by at least 50% from the previous baseline during sleep. As a syndrome,

OSAHS is the association of a clinical picture with specific abnormalities on testing;

asymptomatic individuals with abnormal breathing during sleep should not be labeled

as having OSAHS.

• The apnea–hypopnea index (AHI) is an index of sleep apnea severity

thacombines apneas and hypopneas.

• The AHI, as with the separate apnea index and hypopnea index, is calculated

by dividing the number of events by the number of hours of sleep. (AHI values are

typically categorized as<5= Normal; 5–15/hr = mild; 15–30/hr = moderate; and >

30/h = severe.)

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22. Causes of secretory diarrhea is/are:

A. V. cholera

B. Laxatives

C. Excess Phenolphthalein intake

D. Ulcerative colitis

E. Pancreatic exocrine insufficiency

Ans: ABC

[Ref: Harrison 18th/313 ; Robbins 8th/832; Harrison 17th/249, 814; Manual of

Gastroenterology 4th/184; CMDT 09/496-97]

Ulcerative colitis causes inflammatory diarrhoea whereas Pancreatic exocrine

insufficiency Steatorrheal diarrhoea

23. CRF can differentiated from ARF by presence of :

A. Anemia in CRF

B. Small size kidney

C. Hyperphosphatemia

D. Hyperkalemia

E. Peripheral neuropathy

Ans: Ans: B(Small Kidneys) E( Peripheral neuropathy)

[Ref: Harrison 18th/ ;Harrison 17th/1761-1770 ; CMDT 09 / 797-807]

“Anaemia , metabolic acidosis, hyperphosphatemia, hypocalcemia & hyperkalemia

can occur with both acute & chronic renal failure”- CMDT 06 / 908

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CRF : CMDT 09 / 797-807 : states

• Bilateral small kidneys in ultrasound are diagnosticQ.

• Peripheral neuropathiesQ manifest themselves as sensorimotor

polyneuropathies (stocking and glove distribution) and isolated or multiple isolated

mononeuropathies.

24. Feature of acute rheumatic fever includes:

A. Carey coombs murmur

B. Pancarditis

C. Always cause residual jt disease

D. Chorea

E. Group A Streptococcal infection

Ans:ABDE

[Ref: Robbins 7th/593-94; Harrison 18th/2752-55; Harrison’s 17th/2093-94;Ghai

7th/381-82,6th / 382]

“There is no residual damage to the joint”- Ghai 7th/381

“During acute RF, diffuse inflammation and Aschoff bodies may be found in any of

the three layers of the heart—pericardium, myocardium, or endocardium—hence the

lesion is called a pancarditis.”- Robbins 7th/593

25. 100 gram of dates contains:

A. Iron 7.3 gram

B. Vit C: 100 mg

C. Calorie: 317

D. Carotene:44 µg

E. Calcium 10 mg

Ans: ACD

TABLE 20(Park 21st): Nutritive value of some common fruits (per 100g of edible

portion)

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Date : 317 Calories; Calcium(120 mg); Iron(7.3mg); Carotene (44 µg); Vit. C 3 mg

26. Alkylating agents is/are:

A. Methotrexate

B. Busulfan

C. Doxorubicin

D. Daunorubicin

E. Chlorambucil

Ans:BE

[Ref : K.D.T. 6th/819-20; Katzung 10th/887-88; Goodman & Gilman 11th/1335-36]

1. Alkylating agents

Nitrogen mustard : Chlorambucil

Alkyl sulfonate BusulfanQ

27. Isolation is beneficial in :

A. Diphtheria

B. Measles

C. Typhoid

D. TB

E. Cholera

Ans: A (Diphtheria); B (Measles); C (Typhoid); D (T.B.);& E (Cholera)

[Ref:Park 21th / 111]

According to table ( Park 21th / 111), isolation is recommended in all diseases

given in option although its benefits is controversial in someQ

28. Ganciclovir true is :

A. Inhibits human DNA polymerase

B. Used in CMV

C. Used in HSV

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D. Active against Kaposi's sarcoma-associated herpesvirus

Ans:All

[Ref: KDT 6th/770-71 ;Katzung 10th/ 795-96]

Action Inhibits cytomegalovirus (CMV) and other virus replication by competitive

inhibition of viral DNA polymerases and direct incorporation into viral DNA.

“Ganciclovir has in vitro activity against CMV, HSV, VZV, EBV, HHV-6, and KSHV

(Kaposi's sarcoma-associated herpesvirus). Its activity against CMV is up to 100

times greater than that of acyclovir”-Katzung 10th/ 796

29. True statement(s) is/are:

A. Hemicholinium leads to increased storage of Ach

B. Botulinum blocks Ach release

C. Tyramine inhibit release of NA

D. Imipramine is NA & 5-HT reuptake inhibitor

E. Black widow spider toxin induces massive release of Ach

Ans:BDE

[Ref : K.D.T. 6th/93 ; Katzung 10th/ 78,80,90 ]

Two toxins interfere with cholinergic transmission by affecting release: botulinus

toxin inhibits release, while black widow spider toxin induces massive release &

depletion”- K.D.T. 6th/93

“Tyramine is a indirectly acting sympathomimetics, acts on the adrenergic neurons to

release NA, which then acts on the adrenoreceptors”- K.D.T. 6th/120

“Hemicholinium-3 (HC3), also known as hemicholine, is a drug which blocks the

reuptake of choline by the high-affinitycholine transporter (ChT; encoded in humans

by the gene SLC5A7) at the presynapse. The reuptake of choline is the rate limiting

step in the synthesis of acetylcholine; hence, hemicholinium-3 decreases the

synthesis of acetylcholine. It is therefore classified as an indirect acetylcholine

antagonist .Acetylcholine is synthesized from choline and a donated acetyl group

from acetyl-CoA, by the action of choline acetyltransferase (ChAT)”- Katzung 10th/

78

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30.Which of the following is/are not calcium-channel blocking agent(s):

A. Verapamil

B. Propranolol

C. Carvedilol

D. Nicardipine

E. Nebivolol

Ans:BCE

[Ref : K.D.T. 6th/ 137 ; Katzung 10th/ 175]

“Nebivolol : It is a selective β1 blocker & also acts as a NO donor”- K.D.T. 6th/142

“Carvedilol is a β1 + β2+ α blocker”- K.D.T. 6th/143

31. Which of the following Drug-receptor pair correctly matched:

A. Buspirone : 5HT-1 agonist

B. Granisetrine 5HT-2 antagonists

C. Cisapride 5 HT-3 agonist

D. Methysergide-5 HT-4 antagonist

E. Imipramine :TNF-α inhibitor

Ans: A

[Ref : K.D.T. 6th/167 ; Katzung 10th/272]

“Methysergide is a potent 5HT-2A/2C antagonist with tissue specific agonistic

actions as well, but is non-selec tive –act on 5HT-1 receptor also”- K.D.T. 6th/167

“Methysergide have partial agonist effects at 5-HT2 vascular receptors”- Katzung

10th/272

“Imipramine inhibit monoamine reuptake & interact with a variety of receptors viz.

muscarinic, α adrenergic, histamine H1, 5-HT1, 5-HT2 &occasionally dopamine D2”-

K.D.T. 6th/441

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“Buspirone, a 5-HT1A agonist, has received wide attention for its usefulness as an

effective nonbenzodiazepine anxiolytic”- K.D.T. 6th/163

“Cisapride is a 5-HT4 agonist as well as weak 5-HT3 antagonist”- K.D.T. 6th/645

“Granisetron is a 5-HT3-receptor antagonists”-K.D.T. 6th/647

“TNF-α inhibitors are: infliximab adalimumab, certolizumab and golimumab

32. Acute hepatitis ‘B’ can be diagnosed by :

A. HBsAg

B. IgM anti-HBc Ab

C. HBeAg

D. IgG anti-HBc Ab

E. Core antigen

Ans: A (HBsAg); B (IgM...)& C (HBeAg)

[Ref : Park 21th/193-194;Harrison 17th / 1933-34;Ananthanarayan 8th/543]

HBcAg is called as core antigen.It is not demonstrable in circulation because it is

enclosed within the HBsAg coat, but its antibody, anti-HBc appears in serum a week

or two after the appearance of HBsAg”- Ananthanarayan 8th/543

“HBsAg is the first biomarker to appear in blood after infection.HBeAg appears in

blood concurrently with HBsAg or soon afterwards”- Ananthanarayan 8th/543

33. Vaccines NOT contraindicated in pregnancy :

A. Measles

B. Varicella

C. Mumps

D. Rabies

E. Hepatitis

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Ans: D (Rabies); E (Hepatitis)

[Ref: Park 21th/98]

Live vaccineS are C/I in pregnancy

34. Screening is effective in :

A. Carcinoma lung

B. Carcinoma prostate

C. Carcinoma ovary

D. Carcinoma breast

E. Carcinoma cervix

Ans : B (Carcinoma pros.) &D(Carcinoma b..)& E (Carcinoma Cervix)

[Ref: Harrison 18th/660-63,17th/490-91; Park 21st/356-572]

Screening is not helpful in Ca lung, Ca ovaries and Ca endometrium

“Effective screening have been developed for cervical cancer, breast cancer & oral

cancerQ”- Park 21st/356

•Prostate Ca: DRE and PSA estimationQ detects carcinoma in early resectable

stage. Hence decreases mortality

35. Disease infectious before onset of symptoms:

A. Hepatitis B

B. Measles

C. Mumps

D. Cholera

Ans: A (Hepatitis B); B (Measles); & C (Mumps)

[Ref: Park21th/91]

“As a rule, infectious diseases are not communicable during the incubation period,

but there are exceptions, as for example, measles, chickenpox, whooping cough or

hepatitis A Q are communicable during the later part of the incubation period”- Park

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21th/94

Park21th/91: Writes: INCUBATORY CARRIERS: Measles, mumps, polio, pertussis,

influenza, diphtheria and hepatitis B

36. Endemic ascites is caused by :

A. Argimone mexicana seeds

B.Junjhunia seeds

C.Argot poisoning

D.Fusarium toxin

E. Aflatoxin

Ans: B (Jhunjhunia seeds)

[Ref: Park 21th/607-8]

Endemic ascites: On chemical analysis Jhunjhunia seeds were found to contain

pyrrolizidine alkaloids which are causative agent for Endemic ascites- Park 21th/608

37. True about HPV vaccination :

A. Given in woman of age group 25-40 years

B. Primary immunization consists of 2 dose

C. Efficacy >70% for cervical cancer

D. Two types of vaccine are available in the market

E. Protect against HPV 16 & 18

Ans: C (Efficacy..), D (Two types..) & E (Protect..) [Ref:Harrison 18th/1484-

85;Harrison 17th/1119;Internet]

“The ACIP recommends routine vaccination of females 11-12 years of age with 3

intramuscular dose; the second & third dose should be given 2 & 6 months after the

first”- CMDT 09/1173

“ACIP of the Centers for Disease Control and Prevention has recommended that

HPV vaccination be routinely offered to girls and young women 9–26 years of age”-

Harrison 18th/1484-85

“The quadrivalent vaccine has also been licenced in US for use in male(9-26 yr of

age) for prevention of anogenital warts”- Harrison 18th/1485

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38. Teratogenic drug(s) is/are:

A. Phenytoin

B. Methotrexate

C. Folic acid

D. Ampicillin

E. Enalapril

Ans:ABE

[Ref:;KDT 6th/84-85, 909-910; Drug in Pregnancy & Lactation by G.Briggs 6th/339]

“A recent report indicates 2.7 fold higher malformation rate in fetuses exposed to

ACE inhibitors(e.g Enalapril) in first trimester. ACE inhibitors must be stopped when

women conceives”- KDT 6th/484

“Prophylactic folic acid administration is given during pregnancy to reduce the risk of

neural tube defect”- KDT 6th/592

39. Drug that increases QT interval :

A. Haloperidol

B. Fexofenadine

C. Amiodarone

D. Ebastine

E. Sotatol

Ans:CDE

[Ref: KDT 6th/510,495,428-29]

“Fexofenadine does not prolong QTc interval”- KDT 6th/158

Drugs that prolong Q-T interval

Antiarrhythmics QuinidineQ, procainamideQ, disopyramide, propafenone,

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AmiodaroneQ, Sotalol

Antimicrobial Quinine, mefloquine, artemisinin, halofantrine, sparfloxacin, gatifloxacin

Antihistaminic TerfenadineQ, astemizole, ebastine

Antidepressants Amitryptyline & other tricyclics

Antipsychotics Thioidazine, risperidone, Ziprasidone(Katzung 10th/463)

Prokinetics CisaprideQ

40. Anti MRSA drugs are :

A. Linezolid

B. Vancomycin

C. Daptinomycin

D. Cefepime

E. Piperacillin-tazobactam

Ans: ABC

[Ref: clinicalpharmacy.ucsf.edu/idmp/whatsnew/dapto_monograph.htm ;Harrison

18th/2134 ;KDT6th/700,708,732,734; G & G 11th/1132; Jawetz, Melnick, &

Adelberg's Medical Microbiology, 24th Edition]

Piperacillin-tazobactam: spectrum include b-lactamase-producing strains of S aureus

as well as some b-lactamase-producing gram-negative bacteria”- Katzung 10th/741

“Cefepime (fourth-generation cephalosporin): It has good activity against P

aeruginosa, Enterobacteriaceae, S aureus, and S pneumoniae.”- Katzung 10th/741

“The drug of choice for these organism is vancomycinQ/linezolidQ, but ciprofloxacin

can also be used. ImipenemQ, DalfopristinQ/Quinupristin, Mupirocin, Teicoplanin are

also effective against MRSA”- KDT 6th/708,732,733,734

“Daptomycin is a newly-approved antibacterial agent, highly resistant species

(MRSA, VISA, VRSA, VRE”-

clinicalpharmacy.ucsf.edu/idmp/whatsnew/dapto_monograph.htm

“Daptomycin : Its spectrum of activity is similar to that of vancomycin except that it is

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more rapidly bactericidal in vitro and it is active against vancomycin-resistant strains

of enterococci and vancomycin-intermediate and -resistant strains of S aureus”-

Katzung 10th/741

41.MOA of verapamial is:

A. Inhibition of Ca+2 channel

B. Inhibition of Na+ channel

C. Inhibition of K+ channel

D. Block membrane repolarisation

E. Membrane stabilisation

Ans:A

[Ref: KDT 6th/ 511,517-18 ; Katzung 10th/ 221-23 ]

Classification of antiarrhythmic drugs: four classes

1. Class 1 action is sodium channel blockade(Membrane stabilizing drugs):

2. Class 2 action is sympatholytic. Drugs with this action reduce b-adrenergic activity

in the heart.

3. Class 3 action is manifest by prolongation of the APD. Most drugs with this action

block the rapid component of the delayed rectifier potassium current, IKr.

4. Class 4 action is blockade of the cardiac calcium current. This action slows

conduction in regions where the action potential upstroke is calcium dependent, eg,

the sinoatrial and atrioventricular nodes.

Class IV agents act by blocking voltage-sensitive calcium channels. Class IV drugs

slow conduction in the SA and AV nodes where action potential propagation

depends on slow inward Ca2+ current, slowing the heart and terminating SVT by

causing partial AV block. They shorten the plateau of the action potential and reduce

the force of contraction. Reduced Ca2+ entry reduces after-depolarisation and thus

suppresses premature ectopic beats.

42. Phenytoin causes:

A. Pure red cell aplasia

24

B. Megaloblastic anaemia

C. Aplastic anaemia

D. Hemolytic anaemia

E. Thrombocytopenia

Ans:All

[Ref : K.D.T. 6th/ 404-05 ; A to Z Drug Facts 2003 by David S. Tatro ;Goodman &

Gilman 11th/335 ]

Adverse Reactions of of Phenytoin A to Z Drug Facts 2003 by David S. Tatro

HEMATOLOGICAL: Thrombocytopenia; leukopenia; granulocytopenia;

agranulocytosis; pancytopenia; macrocytosis; megaloblastic anemia; eosinophilia;

monocytosis; leukocytosis; simple anemia; hemolytic anemia; aplastic anemia.

“Phenytoin: Hematological reactions include neutropenia and leucopenia, or more

rarely, red-cell aplasia, agranulocytosis, and thrombocytopenia. Lymphadenopathy is

associated with reduced immunoglobulin A (IgA) production.Hypoprothrombinemia

and hemorrhage have occurred in the newborns of mothers who received phenytoin

during pregnancy; vitamin K is effective treatment or prophylaxis”- Goodman &

Gilman 11th/335

43. Morphological feature of rosacea includes:

A. Papules

B. Pustules

C. Vesicles

D. Telangiectasia

E. Comedones

Ans: ABDE

[Ref: Neena Khanna 3rd/ 104 ; Harrison 18th/404;Roxburg 17th/162-63 ]

Vescicles not mentioned as feature in any above textbooks

“Acne rosacea or rosacea: It is characterized by the presence of erythema,

telangiectases, and superficial pustules , but is not associated with the presence of

comedones. Often, individuals with rosacea initially demonstrate a pronounced

flushing reaction. As the disease progresses, the flush persists longer and longer

and may eventually become permanent. Papules, pustules, and telangiectases can

25

become superimposed on the persistent flush”- Harrison 18th/404

44. Intra epidermal blisters are seen in :

A. Bullous pemphigoid

B. Pemphigus folliaceous

C. Dermatitis herpeteformis

D. Hailey Hailey disease

E. Bullous impetigo

Ans:B (Pemphigus..) D (Hailey..)

[Ref: Pathology of Skin by Farmer & Hood 2nd/235,237,655 Neena Khanna 3rd/62-

65,67,1th/52;Roxburg 17th/255,82]

“Hailey Hailey disease(Benign familial pemphigus): It is a Intra epidermal bullous

disorder & present as flaccid vesicle, crusted erosion & circinate plaques

onerythematous base. Usually worse in summertime”- Neena Khanna

3rd/67;Roxburg 17th/255

Bullous ImpetigoQ is subcorneal disorder while Dermatitis herpeteformis, Bullous

SLE & Bullous pemphigoid are Dermo-epidermal (Subepidermal) lesionsQ

“Pemphigus group of diseases are intra-epidermal bullous disorderQ”- Neena

Khanna 1th/52

45. Wood’s lamp examination is used in diagnosis of:

A. Erythrasma

B. Lichen planus

C. Psoriasis

D. P. veriscolor

E. T.capitis

Ans: ADE

Wood’s lamp examination is not done in diagnosis of Psoriasis & Lichen planus

[Ref: Neena Khanna 3rd/13,209 ; Harrison 18th/ 394 ; Rooks Textbook of

26

Dermatology 7th/ 5.11-5.14;Roxburg 17th/38,41]

46. Drugs used in scabies are all except :

A. Crotamiton

B. Permethrin

C. Gamma-benzene hexachloride(BHC)

D. Tacrolimus

E. Benzyl benzoate

Ans:D

[Ref: Neena Khanna 3rd/297; Harrison 18th/3577;KDT 6th/863-64]

Tacrolimus is a calcineurin inhibitor(immunomodulator) used in atopic dermatitis,

vitiligo & rosacea”- Neena Khanna 3rd/345

“Scabicides used are: Permethrin creamQ (5%), Gamma benzene hexachloride(G-

BHC1%), Crotamiton (10%), Benzyl benzoate (25%) & Ivermectin (single oral dose

200 µg/kg)”- Neena Khanna 3rd/297

47. Cutaneous T.B includes:

A. Lupus vulgaris

B. Scrofuloderma

C. Lichen planus

D. Lupus erythematosus

E. Lupus pernio

Ans: AB

[Ref: Neena Khanna 3rd/ 217 ; Harrison 18th/ 1349 ; Behl 7th/202;Rook’s

Dermatology 7th/28.10-28.30]

“Lupus erythematosus includes SLE(systemic lupus erythematosus, DLE & SCLE”-

Neena Khanna 3rd/ 186

“Lupus pernio is found in sarcoidosis. Microscopically, it resembles lupus vulgaris.

27

Biopsy shows granulomatous infiltration”- Harrison 18th/ 2808

“Cutaneous manifestations of tuberculosis include primary infection due to direct

inoculation, abscesses and chronic ulcers, scrofuloderma, lupus vulgaris (a

smoldering disease with nodules, plaques, and fissures), miliary lesions, and

erythema nodosum”- Harrison 18th/ 1349

48. Painful genital ulcer is/are seen in :

A. Chancroid

B. Lymphogranuloma Venereum

C. Primary syphilis

D. Herpes

E. G ranuloma inguinale

Ans: AD

[Ref :Neena Khanna 3rd/ 259-270; Ananthnarayan 8th/420; Harrison

18th/1108,17th/831-32]

“Primary syphilis cause Hunterian chancre(painless)”- Neena Khanna 3rd/259

“Lymphogranuloma Venereum:Primary lesion is a small painless papulovesicualar

lesion appearing on external genitalia”- Ananthnarayan 8th/420

“Granuloma inguinale begins as a painless papule on the genitalia, which leads to a

slowly progressive, autoinoculable ulcer”- Ananthnarayan 8th/396

49. Laparoscopy is /are C/I in :

A. Pregnancy

B. Distension of intestine

C. Severe cardio-pulmonary disease

D. Peritonitis

E. Inguinal hernia

Ans:ABCD

28

[Ref : L & B 25th/247-49 ;Washington Manual of Surgery 5th/642-43 ; Maingot's

Abdominal Operations; Mastery of Surgery 5th/ 1116

“Massive abdominal distention may result in an increased risk of iatrogenic bowel

injury”- Washington Manual of Surgery 5th/643

Pregnancy is a relative C/I

“C/I for Laparoscopy are relative & includes uncorrectable coagulation defects,

severe congestive heart failure, respiratory insufficiency, suspected acute & diffuse

peritonitis & presence of distended bowel”- emedicine.medscape.com/ article

50. Predisposing factors for Varicose vein includes :

A. Incompetent valve b/w superficial and deep vein

B. Deep vein thrombosis

C. Buerger’s disease

D. Female sex Hormone

E. Family history

Ans:ABDE

[Ref : L & B 25th/ 927,923-24 ; S.Das Textbook of Surgery 5th/205-06;Sabiston

18th/2006 ;CSDT 11th/873;Manipal Surgery 3rd/103 ]

“Very often, the valve at saphenofemoral junction is incompetent/absent. The valves

can also be absent where the superficial vein join the deep vein”- Manipal Surgery

3rd/103

Buerger’s disease(thromboangitis obliterans) is occlusive diseases of small &

medium sized arteries”- L & B 25th/ 923

Although Buerger’s disease can cause migratory thrombophlebitis of superficial &

deep vein, but it is not mentioned as a cause of varicose vein in any above textbooks

51. Biopsy in Hirschsprung’s disease can be taken from :

A. 4 cm above the dentate line

B. 4 cm below dentate line

29

C. 6 cm below dentate line

D. At the level of dentate line

E. Anywhere feasible- site not important

Ans:A(Single best option)

[Ref : Sabiston 18th/2065 ; CSDT11th/1321 ; Nelson 18th/1565-67; S.Das Textbook

of Surgery 5th/1035-36]

“Biopsy should be taken atleast 2 cm above the dentate line”- S.Das Textbook of

Surgery 5th/1036

“Rectal biopsy:It is important to obtain the sample at least 2 cm above the dentate

line”-Sabiston 18th/2065

“Rectal suction biopsies are the procedure of choiceQ & should be performed no

closer than 2cm to the dentate line to avoid the normal area of hypoganglionosis at

the anal verge”-Nelson 18th/1566

“The definitive diagnosis of Hirschsprung's disease is made by rectal biopsy.

Samples of mucosa and submucosa are obtained at 1 cm, 2 cm, and 3 cm from the

dentate line”-Schwartz 8th

52. True about Keloid:

A. Seen in caucasians

B. Treatment is excision and grafting

C. Grows beyond margin

D. Precancerous lesion leading to cancer

E. Everted margin

Ans:BC

[Ref : L & B 25th/ 30,598-99, 24th/93 ; Sabiston 18th/206-07 ; CSDT11th/ 1243 ;

Scwartz 8th/ ]

“Coloured races are particularly liable to keloid formation. Negroes are commonly

affected”- S.Das Textbook of Surgery 5th/123

“Shaving away the excess scar tissue & then resurfacing the area by a thin skin

30

graft, though advocated by a few surgeon to give encouraging results, yet such

treatment has never produced good result by large”- S.Das Textbook of Surgery

5th/123

“Everted edge(rolled out) is a characteristic feature of squamous cell Ca or ulcerated

adenocarcinoma”- S.Das Textbook of Surgery 5th/125

53. Breast conservative surgery is not done in :

A. Scleroderma

B. Multicentric lesion

C. 1st & 2nd trimester Pregnancy

D. Diffuse microscopic calcification

E. Fixity of tumor to chest wall

Ans: All

[Ref: Sabiston 18th/877; S.Das 5th/727; L & B 25th/843, 24th / 841; Devita 7th/1437;

CSDT 11th/330; Mastery of Surgery, 5th Edition]

“Clinically detectable multifocality is a relative contraindication to breast-conserving

surgery, as is fixation to the chest wall or skin or involvement of the nipple or

overlying skin.”- CSDT 11th/330

Contraindications for BCS:

1. Multicentric breast cancer.

2. Diffuse malignant looking micro calcifications on mammogram

5. Collagen vascular disease.

6. Early pregnancy.

54.Irreversible step(s) in glycolysis is/are:

A. Enolase

B. Phosphofructokinase

C. Pyruvate kinase

D. Glyceradehyde -3-phosphate dehydrogenase

31

E. Hexokinase

Ans:BCE

[Ref: Vasudevan 5th/85-88;Harper 28th/158; Chatterjea & Shinde 7th/306-09 ]

Phosphofructokinase catalyse conversion of Fructose – 6-P to F-1,6-bi-P

(Irreversible) Q- Chatterjea & Shinde 7th/308

Enolase catalyse conversion of 2-phosphoglycerate to phosphoenol

pyruvate(Reversible)- Vasudevan 5th/87

Pyruvate kinase catalyse conversion of phosphoenol pyruvate to

pyruvate(Irreversible) -Chatterjea & Shinde 7th/310

Glyceraldehyde-3-phosphate-dehydrogenase catalyse conversion of

Glyceraldehyde-3-p to 1,3-biphosphoglycerate-(Reversible) Q- Chatterjea & Shinde

7th/306

55. High energy phosphate compound is/are :

A. ATP

B. Creatine phosphate

C. Glucose- 1- phosphate

D. Glycerol -3-phosphate

E. ADP

Ans:AB

[Ref;Harper 28th/94; Vasudevan 5th/228; Satyanarayan 3rd/222-23 ]

Classification of high-energy compounds

There are at least 5 groups of high-energy compounds

1. Pyrophosphates e.g. ATP.

2. Acyl phosphates e.g. 1, 3-bisphosphoglycerate.

3. Enol phosphates e.g. phosphoenolpyruvate.

4. Thioesters e.g. acetyl CoA.

5. Phosphagens e.g. phosphocreatine

56. Which of the following enzyme is not involved in Urea cycle :

32

A. Glutamate dehydrogenase

B. Argininosucinate synthetase

C. α- KG dehydorogenase

D. Isocitrate dehydrogenase

E. Fumarase

Ans: ACDE

[Ref ; Harrison 18th/3216,3219;17th/2472-74; Harper 28th/243;Shinde 7th/450-51]

“α- KG dehydorogenase, fumarase & Isocitrate dehydrogenase are enzymes of

TCA(citric acid cycle”- Shinde 7th/317

Glutamate dehydrogenase catalyses the formation of glutamate & ammonia in

mitochondria. It provide ammonia for Carbamoyl phosphate synthase(1st step of

urea cycle- so Glutamate dehydrogenase is not part of urea cycle

57. Protein separation based on mass / molecular weight (size) is/are done in

all EXCEPT :

A. Ultrafiltration

B. Electrophoresis

C. 2D gel electrophoresis

D. Gel Filtration chromatography

E. Centrifugation

Ans:B

[Ref : Harper 28th/24,37-38;Satyanarayan 3rd/59; Lippincott 4th/21;

www.ncbi.nlm.nih.gov › NCBI › LiteratureQ 25 June 2009;Harper27th/21-25;Protein

purification Handbook: laboratory Manual Chapter II;NMS Biochemistry 4th/19-23;

Shinde 7th/90; Vasudevan 5th/481-90]

Centrifugation: masses or densities

Ultrafiltration: concentrates a protein solution using selective permeable membranes.

The function of the membrane is to let the water and small molecules pass through

while retaining the protein.

33

Electrophoresis Separates Molecules according to Their Charge:Mass Ratio

SDS-PAGE: The proteins in SDS-PAGE are separated on the sole basis of their

size.

Two-Dimensional Gel Electrophoresis: Electrophoresis of all cellular proteins through

an SDS gel can separate proteins having relatively large differences in molecular

weight

58. Which is/are not transport proteins :

A. Transferrin

B. Collagen

C. Ceruloplasmin

D. Hb

E. Albumin

Ans:B

[Ref: Harper 28th/569,271 ;Satyanarayan 3rd/184;Vasudevan 5th/241 ]

“Hemoglobin is largely responsible for the transport of oxygen from the lungs to

tissue. It also helps to transport CO2 from the tissues to the lungs”- Harper 28th/197

“Transport protein: Hb, the transporter of oxygen is a tetrameric protein”- Vasudevan

5th/28

“Structural protein: Collagen is the most abundant protein in mammals & the main

fibrous component of skin, bone, tendon, cartilage & teeth”- Vasudevan 5th/28

59. Selenium deficiency causes:

A. Dermatitis

B. Cardiomyopathy

C. Diarrhoea

D. Alopecia

E. Gonadal atrophy

34

Ans:B

[Ref: Harrison 18th/604,595; Shinde 7th/ 594;Satyanarayan 3rd/422:Vasudevan

5th/329 ]

Gonadal atrophy, alopecia, dermatitis & diarrhoea are the feature of zinc deficiency”-

Harrison 18th/595(table)

Alopecia, dermatitis & diarrhea are feature of selenium toxicity”- Satyanarayan

3rd/422

60.Copper containing enzymes is/are :

A. Superoxide dismutase

B. Cytochrome oxidase

C. Myeloperoxidase

D. Tyrosinase

E. Amine oxidase

Ans:ABDE

[Ref: Harper 28th/ 573 ]

Myeloperoxidase (MPO) is a peroxidase enzyme. It is a lysosomal protein stored in

azurophilic granules of the neutrophil. MPO has a heme pigment.

61. Gestational diabetes mellitus more likely occurs in:

A. Morbid obesity

B. Previous h/o GDM

C. Family history of GDM

D. Advanced age

E. H/o pregnancy losses

Ans: All

[Ref : Dutta’s Obstetrics 6th/284-286 ;William’s Obstetrics 23rd/1109; CDTOG

10th/ch-18 ]

35

The potential candidates for GDM are Dutta’s Textbook of Obstetrics 6th/284

a) Positive family history of diabetes (parents or sibling). Family history should

include uncles, aunts and grand parents

b) Having a previous birth of and overweight baby of 4kg or more

c) Previous stillbirth with pancreatic islet hyperplasia revealed on autopsy

d) Unexplained perinatal lossQ

e) Presence of polyhydramnios or recurrent vaginal candidiasis in present

pregnancy

f) Persistent glycosuria

g) Age over 30 Q

h) ObesityQ

i) Ethnic group (East Asian, Pacific island ancestry)

62. Maneuver used in shoulder dystocia is/are:

A. Lovset maneuver

B. Woods corkscrew maneuver

C. Ritzen maneuver

D. Mauriceau-Smellie-Veit technique

E. McRoberts maneuver

Ans: B (Woods..); E (Mc Roberts..)

[Ref : Dutta’s Obstetrics 6th/407-408, 384 ;William’s Obstetrics 23rd/ ]

“Mauriceau-Smellie-Veit technique is used in delivery of after-coming head in

assisted breech delivery”- Dutta’s Obstetrics 6th/382

Lovset maneuver is used in bringing down arm in breech deliver”- Dutta’s Obstetrics

6th/387

“Ritzen maneuver: It is assisted delivery of head in normal labour”- Dutta’s Obstetrics

6th/138

Mc Roberts maneuver & Wood’s maneuver Q are used in Shoulder dystocia-

Dutta Obstetrics 6th / 407-408

36

63. True statement related to Hormonal replacement therapy :

A. ↓ed chance of hip fracture

B. ↓ed Breast cancer

C. ↓ed Colon Ca

D. ↓ed Endometrial Ca

E. ↑ed risk of DVT

Ans: A(↓ed ..), C (↓ed Colon..); E (↑ed risk . .)

[Ref : Shaw’s Gynae 14th/57-59 ;Dutta Gynaecology 5th/59-60; CDTOG 10th/ch-59

;Novak’s 14th/1334-35 ]

Benefits of Hormonal replacement therapy Dutta Gynaecology 5th/59

• Decreased risk in vertebral & hip fracture(25-50%)

• Reduction in colorectal cancer(20%)

Risk of Hormonal replacement therapy Dutta Gynaecology 5th/60

• ↑Endometrial Ca

• ↑Breast Ca

• ↑Venous thromboembolism(DVT)

64. Risk factor for ectopic pregnancy is/are:

A. Tubal sterilization

B. Infertility

C. IUCD use

D. OCP

E. Multiparity

Ans: A (Tubal..); B (Infertility); C (IUCD)

[Ref: Q 202 Nov 2009;Shaw's 14th/208; Dutta’s Obstetrics 6th/179-80;William’s

37

Obstetrics 23th/239]

65. Criteria for severe pre- eclampsia includes all except:

A. Fetal growth restriction

B. Prematurity

C. Proteinuria

D. Oliguria

E. Pulmonary edema

Ans: None (all are correct)

[Ref : Dutta’s Obstetrics 6th/226-228 ;William’s Obstetrics 23rd/ 708 ; CDTOG

10th/ch-19 ]

“Fetal hazard in severe pre- eclampsia :Intrauterine death, IUGR, asphyxia &

prematurity’- Dutta’s Obstetrics 6th/228

66. Risk factor for Acute PID includes:

A. Advanced age

B. OCP use

C. IUCD users

D. Previous h/o PID

E. ↑ no of sexual partner

Ans: C (IUCD); D (Previous..); E (↑ no. of..)

[Ref : Shaw’s Gynae 14th/399-404; Dutta’s Gynae 5th/125 ; William’s Gynae 1st/73 ]

“PID is a disease of young women, who are sexually & reproductively active.Two

thirds are restricted to young women of less than 25 years & remaining one-third

limited among 30 years or older”- Dutta’s Gynae 5th/125

38

>>. Risk factor for Acute PID Dutta’s Gynae 5th/125

• Multiple sexual partner

• Absence of contraceptive pill use

• Previous history of acute PID

• IUD users

• Menstruating teenagers

Protection for Acute PID Dutta’s Gynae 5th/125

• Contraceptive methods- Barrier method & Oral steroidal

contraceptives(produce thick mucus plug & decrease in duration of menstruation)

• Women with monogamous partner who had vasectomy

• Pregnancy

• Menopause

• Husband who is azoospermic

67. Left gastric vein drain into:

A. IVC

B. Portal vein

C. Directly into splenic vein

D. Splenic vein through short gastric vein

E. Left gastro-epiploic vein

Ans:B

[Ref: BDC4th/Vol.II 270 ; Snells' Anatomy 8th/ 220]

“The Lt & Rt gastric veins drains directly into the portal vein. The short gastric veins

& the left gastroepiploic veins join the splenic. The right gastroepiploic veins joins the

superior mesenteric vein”- Snells' Anatomy 8th/ 220

68. A person met with Knife injury to face & resultant damage to facial nerve. It

lead to impaired/decreased secretion from:

39

A. Parotid gland

B. Sublingual gland

C. Lacrimal gland

D. Parotid gland, sublingual gland & submandibular gland

E. Submandibular gland

Ans: BCE

[Ref: BDC4th/Vol.III 133, 140,161-61 ; Snells' Anatomy 8th/765 ]

“The parotid gland receives its parasympathetic input from the glossopharyngeal

nerve(CN IX, Auriculotemporal nerve) via the otic ganglion, while the submandibular

and sublingual glands receive their parasympathetic input from the facial nerve (CN

VII) via the submandibular ganglion”- BDC4th/Vol.III 137

“Five terminal branch emerge along the anterior border of the parotid gland”-

BDC4th/Vol.III 137(But not supply)

“Greater petrosal nerve: The post-ganglinic fibres are secretomotor to the lacrimal

gland & the glands of the nose & the palate”- Snells' Anatomy 8th/765

69. Structures injured while resecting the free edge of lesser omentum :

A. Portal vein

B. Hepatic artery proper

C. Hepatic vein

D. Cystic duct

E. Common bile duct

Ans:ABE

[Ref: BDC4th/Vol.II 240-41 ; Snells' Anatomy 8th/249 ; Gray’s 40th/1102 ]

“Right free margin of the lesser omentum contains portal vein, common bile duct,

hepatic artery, portocaval lymph node & lymphatics & the hepatic plexus of nerves

40

ensheathed in a perivascular fibrous capsule”- Gray’s 40th/1102

70. Correct statement about tongue is/are:

A. Facial N. supplies filiform papillae

B. Glossophanygeal nerve supplies cirumvallate papillae

C. The posterior most part of tongue develops from Ist pharyngeal arch

D. Genioglossus is the safety muscle

E. Blood supply is derived from lingual artery

Ans:A(Most probably? could not got direct reference) BDE

[Ref: BDC4th/Vol.III 250-253; Snells' Anatomy 8th/781 ; Gray’s 40th/ 503,507 ]

“Glossophanygeal nerve supplies cirumvallate papillae”- Snells' Anatomy 8th/781

“The posterior most part of tongue develops from 4th pharyngeal arch”-

BDC4th/Vol.III 253

Why genioglossus is called safety muscle of tongue? wiki.answers.com › Biology ›

Human Physiology › Muscular System; Gray’s 40th/ 503

The genioglossus muscle is the muscle of the tongue. it's attached the base of the

tongue to the inside

front of the jaw bone. It pulls the tongue forward. In the people with obstructive sleep

apnea, the genioglossus is more active in holding the airway open at rest. If it

relaxes during sleep, the airway narrows and collapses. as it keeps the airway open

thus saves life, it's called a life saving muscle.

Fliform papillae occurs on anterior part of tongue Gray’s 40th/ 503

Chorda tympani is nerve of taste for A2/3 of the tongue except cirumvallate papillae-

BDC4th/Vol.III 250-253

71. Tibial nerve injury/palsy causes :

A. Dorsiflexion of foot at ankle joint

41

B. Planter flexion of the foot at ankle joint

C. Loss of sensation of dorsum of foot

D. Paralysis of muscles of anterior compartment of leg

E. Loss of sensation over the medial border of foot

Ans:A

[Ref: BDC4th/Vol.II 173,85-86 ; Snells' Anatomy 8th/660 ;Gray’s 40th/1427 ]

“The muscles of anterior compartment of leg are supplied by deep peroneal nerve.

Paralysis of the muscles of anterior compartment of leg results in loss of the power

of dorsiflexion of the foot. As a result the foot is plantar flexed. The condition is called

foot drop”- BDC4th/Vol.II 100

Sensory supply of leg & foot Snells' Anatomy 8th/660

• Common peroneal nerve: anterior & lateral side of leg & dorsum of foot &

toes, including the medial side of the big toe

• Tibial nerve(through sural nerve): lower half of back of leg & lower 1/3 of

lateral area of calf & whole of lateral border of the foot till the tip of little toe

• Saphenous nerve(Branch of femoral nerve): medial area of leg & medial

border of the foot as far as the ball of the big toe

• Posterior cutaneous nerve of thigh: upper half of the central area of calf

Tibial Nerve Injury Snells' Anatomy 8th/660

Motor: All muscle in the back of leg & the soles of the foot are paralyzed. The

opposing muscles dorsiflex the foot at ankle joint & evert the foot at the subtalar &

transverse tarsal joints, an attitude referred to as calcaneovalgus

Sensory: Sensation is lost on the sole of foot; later trophic ulcers develop

72. Breast is/are supplied by :

A. Lateral thoracic artery

B. Internal mammary artery

C. Musculophrenic artery

D. Superior thoracic artery

42

E. Superior epigastric artery

Ans: ABD

[Ref: BDC Vol. I 4th / 41-42,212 ; Snells' Anatomy 8th/427]

Deep Arteries of anterior abdominal wall BDC Vol. II 4th / 204

“Musculophrenic (branch of Internal mammary artery) artery gives branch to the

diaphragm, the anterior abdominal wall & the seventh, eighth & ninth intercostals

spaces as the anterior intercostals arteries”-

“Superior epigastric artery (branch of Internal mammary artery) gives muscular,

cutaneous, anastomatic & hepatic branch”

73. In injury to upper trunk of the brachial plexus following seen:

A. Supination of forearm

B. Pronation of forearm

C. Inability to initiate abduction of shoulder

D. Decreased sensation of medial hand

E. Paralysis of deltoid muscle

Ans: BCE

[Ref : B.D.C. 4th/Vol I 51-54; Snell's Anatomy 8th/ 536-37 ]

Decreased sensation of medial hand occurs in lower trunk injury(Klumpke’s

paralysis)- B.D.C. 4th/Vol I 53

74. Posterior Cutaneous Nerve of thigh supplies skin overlying:

A. Medial aspect of thigh

B. Posteroinferior aspect of buttocks

C. Scrotum

D. Back of thigh

E. Popliteal fossa

43

Ans: All

[Ref : B.D.C. 4th/Vol II 110 ; Snell's Anatomy 8th/ 565-66 ;Gray’s 40th/1384 ]

“Posterior Cutaneous Nerve of thigh supplies skin of back & medial side of thigh, the

popliteal fossa & the proximal part of the back of the leg”- Gray’s 40th/1384

Posterior Cutaneous Nerve of thigh (S1,S2,S3) B.D.C. 4th/Vol II 76

1. A perineal branch which supplies the skin of the posterior two-third of the

scrotum or labium majus

2. Gluteal branch which supply the skin of the posteroinferior quadrant of the

gluteal region

Sensory supply of legB.D.C. 4th/Vol II 110

• Posterior cutaneous nerve of thigh: upper half of the central area of calf

75. Which of the following does not form boundary of femoral ring:

A. Femoral aretry

B. Femoral vein

C. Femoral nerve

D. Lacunar ligament

E. Inguinal ligament

Ans:AC

[Ref: BDC4th/Vol.II 53 ; Snells' Anatomy 8th/ 579]

Femoral ring BDC4th/Vol.II 53 ; Snells' Anatomy 8th/ 579

It is the baseor upper end of the femoral canal.

It is directed upward and is oval in form, its long diameter being directed transversely

and measuring about 1.25 cm.

Boundaries

The femoral ring is bounded as follows:

anteriorly by the inguinal ligament.

posteriorly by the pectineal ligament.

44

medially by the crescentic base of the lacunar ligament.

laterally by the fibrous septum on the medial side of the femoral vein

76. True about anatomy of Fallopian tubes:

A. Length is 20 cm

B. Medial to lateral structures are isthmus, Interstitial part, Ampulla &

Fimbriae

C. Ovary is attached to uterus by Ovarian ligament

D. Uterine artery supplies medial 2/3 of tube

E. Ampulla is largest part

Ans:CDE

[Ref: BDC4th/Vol. II 355-57; Dutta Obs 6th/ 7]

“Uterine artery supplies medial 2/3 & ovarian artery supplies the lateral 1/3 of the

tube”- BDC4th/Vol. II 357

The fallopian tubes stretch from the uterus to the ovaries and measure about 8 to 10

cm (4 to 6 inches) in length. Segments of the fallopian

The fallopian tube is not just a passive pipe or a conduit, but an active organ with its

separate locations performing separate functions. Starting from the ovarian end

(fimbria) and proceeding toward the uterus, these are the:

• Fimbrial segment - faces the ovary

• Infundibular segment(1.25 cm) - funnel shaped segment behind the fimbria

• Ampullary segment(5 cm) - wide middle segment

• Isthmic segment (2.5 cm)- narrow muscular segment near the uterus

• Interstitial segment (1.25cm)- passes through the uterine muscle into the

uterine cavity

77. Blood brain barrier is/are formed by :

45

A. Oligodendrocytes

B. Microglial cell

C. Astrocytes

D. Schwann cell

E. Neuroglial cell

Ans:CE

[Ref: BDC4th/Vol.III386-87 ; Ganong 23rd/572-73;Robbins 7th/1349-50;‘Gray’s

40th/48-49;Guyton 11th/766]

Blood–brain barrier (BBB): made up of BDC4th/Vol.III386-87

1. Vessel wall

2. Arachnoid layer of the perivascular sheath

3. The perivascular space

4. Neuroglia & the ground substance of the brain

“ Some astrocytic processes are directed toward neurons and their processes and

synapses, where they are believed to act as metabolic buffers or detoxifiers,

suppliers of nutrients, and electrical insulators. Others surround capillaries or extend

to the subpial and subependymal zones, where they contribute to barrier functions

controlling the flow of macromolecules between the blood, the CSF, and the brain”-

Robbins 7th/1349-50:

78. During incision & drainage of ischiorectal abscess, which nerve is/are

affected/injured :

A. Superior rectal nerve

B. Inferior rectal nerve

C.Superior gluteal nerve

D.Inferior gluteal nerve

E. Ilioinguinal nerve

46

Ans: B

[Ref: BDC4th/Vol.II 328-29 ,76 ,196 ; Snells' Anatomy 8th/394 ]

Contents of the Ischiorectal fossa -

1. Ischiorectal pad of fat.

2. Inferior rectal nerve and vessels.

3. Posterior scrotal / posterior labial nerve and vessels.

4. Pudendal canal and its contents(pudendal nerve & internal pudendal vessel)

5. Perineal branch of fourth sacral nerve.

6. Perforating cutaneous branch of S2 , S3 nerve .

Ilioinguinal nerve: supply the skin of external genitalia & upper part of the medial side

of the

thigh”- BDC4th/Vol.II 196

79. True statement about Restriction endonuclease :

A. Palindromic sequences observed

B. Protects bacteria from infection by virus

C. Present only in eukaryotes

D. Restrict replication of DNA

Ans:ABD

[Ref:Lippincott 4th/465-66;Harper 28th/388-90,27th / 403; Satyanarayana 3rd / 580]

“A restriction enzyme (or restriction endonuclease) is an enzyme that cuts DNA at

specific recognition nucleotidesequences (with Type II restriction enzymes cutting

double-stranded DNA) known as restriction sites. Such enzymes, found in bacteria

and archaea, are thought to have evolved to provide a defense mechanism against

invading viruses”

“RE can specifically recognize DNA with particular sequence of 4-6 mucleotides and

cleave. The recognition sequences are palindromicQ (i.e., twofold rotational

symmetry”- Lippincott 4th/466

“RE restrict DNA replication”- Satyanarayana 3rd / 579

47

80. Non coding RNAs are :

A. siRNA

B. miRNA

C. tRNA

D. mRNA

E. rRna

. Ans: A (siRNA), B (miRNA), C (tRNA) E (rRna) [Ref: Harper 28th/310;

Lippincott 4th/ 417; .; en.wikipedia.org/wiki/Non-coding_RNA]

81.Technique(s) used detecting for Gene Mutation is/are:

A. RT- PCR

B. Denaturing gradient gel electrophoresis

C. DNA sequencing

D. Restriction fragment polymorphism (RFLP)

E. Single-strand conformational polymorphism

Ans:All

[Ref: Harrison Table 18th/ 508, 17th/406 ; Vasudevan 5th/454-56]

82. MHC II is/are presented by:

A. Macrophage

B. Dendritic cells

C. Lymphocyte

D. Epithelial cell

E. Platelets

Ans: A(Macrophage), B(Dendr..) & C(Lymphocyte)

[Ref: Robbins 7th/203-04;Ananthanarayan 8/132-35; Harrison17/2045-53 ]

“In contrast to class I molecules, the tissue distribution of MHC class II molecules is

48

largely restricted to antigen-presenting cells (macrophages, dendritic cells, and B

cells). Expression of class II molecules can be induced on several other cell types,

however, including endothelial cells and fibroblasts, by the action of IFN-γ”- Robbins

7th/204

83. Which of the following are activators of lymphocyte:

A. CD 79b

B. CD 3

C. CD 28

D. CD 14

E. LCK

Ans : All (A, B, C, D & E)

[Ref : Immunology by David male 7th/107-108, 192-193, 31 kuby Immunology

6th/259]

LCK (Internet)

• Lymphocyte specific tyrosine kinase, lck is critical for lymphocyte

development & activation

• LCK, is one of the eight members of the src family of tyrosine kinase, is

activated after T cell stimulation & is required for T-cell proliferation & IL-2

production.

• Inhibition of lck has been a target to prevent lymphocyte activation & acute

rejection

84. Dyeing declaration can be recorded by:

A. Doctor

B. Sister incharge

C. Village headman

D. Executive magistrate

E. Judicial magistrate

49

Ans: All

[Ref: Reddy 27th/ 9; Parikh 6th/ 1.15-1.16 ]

DYING DECLARATION

• If there is time a Magistrate should be called to record the declaration before

recording the statement, the doctor should certify that the person is conscious and

his mental faculties are normal (compos mentis).

• If the condidtion of the vicitim is serious, and there is no time to call a

Magistrate, the doctor should take the declaraton in the presence of two witnesses.

The statement can also be recorded by the village headman, police or any other

person, but its evidential value will be less.

“In a landmark judgment, the division bench comprising Justice M Sasidharan

Nambiar and Justice P Bhavadasan(Kerala High court) ruled that there is no law or

statute that dying declaration should be recorded only by a magistrate. The bench

said that dying declaration recorded by the doctor or anybody with credibility in the

society can be accepted as evidence after analysing its evidentiary value as per

law”- TOI Jul 4, 2012

Dying declaration recorded by police is valid: SC New Delhi, Thu May 17 2012

Indian Express

www.preservearticles.com/.../short-notes-on-the-value-of-dying-decl..

“Dying declaration should be recorded by the executive magistrate and police officer

to record

the dying declaration only if condition of the deceased was so precarious that no

other

alternative was left”

“Under the old CrPC, there was no distinction between the Executive and Judicial

Magistrates; some states still follow the old CrPC, e.g. Nagaland; there, the Collector

is also the head of the judicial branch of the district and can pass sentences,

including capital punishment, under IPC.”

85. Inquest not present in Indian court :

A. Magistrate inquest

50

B. Medical examiner’s system

C. Coroner inquest

D. Police inquest

E. Trial by jury

Ans: BCE

[Ref: Reddy 27th/ 5; Parikh 6th/1.3-1.7 ]

Two types of inquests are held in India: the police inquest & the magistrate’s inquest.

CORONER’S INQUEST : This is type of inquest done in U.K., some States in

U.S.A., and some other countries, but not in India.

MEDICAL EXAMINER’S SYSTEM : This is a type of inquest conducted in most of

the states in the United States of America.

JURY : Trial by jury has been abolished in India.

86. True about Incised looking wound:

A. Type of split laceration wound

B. Avulsion laceration wound with blunt object

C. Produced by blunt object

D. Incised wound

E. Commonly seen on Scalp

Ans: ACE

[Ref: Reddy 27th/ 165-66 ]

Type of Lacerations Reddy 27th/ 165-66

1. Split laceration: with excessive crushing & without excessive crushing (Incised

like or Incised-looking Wounds)

2. Stretch laceration

3. Avulsion(Shearing laceration)

4. Tears

51

5. Cut laceration

87. False statement(s) about postmortem staining is/are:

A. Occur immediately after death

B. Common in dependent part

C. Disappear with rigor mortis

D. Surface elevated

E. Not found in internal organ

. Ans: A (Immedi..), C ( Disappear..),D(Surf..) & E (Not..)

[Ref: Reddy 27th/136-39; Modi’s Medical Jurisprudence & Toxicology 22nd/226]

“PM staining persists until putrefaction sets in”- Reddy 27th/137

““PM staining does not appear elevated above the surface, but has sharply defined

edges”- Modi’s Medical Jurisprudence & Toxicology 23nd/429

88. True about Cadaveric spasm :

A. Seen in voluntary muscle

B. Some particular group of muscles are involved

C. Disappear with Rigor mortis

D. Occur 2-3 hour after death

E. Occur immediately after birth

Ans: ABCE

[Ref: Reddy 27th/143 ; Parikh 6th/3.18-3.19 ]

“Cadaveric spasm: This is usually limited to a single group of voluntary muscles &

frequently involves the hand. Occasionally, the whole body is affected as seen in

soldiers, shot in battle. No other condition simulates cadaveric spasm & it cannot be

produced by any method after death. It passes without interruption into normal rigor

52

mortis & disappears when rigor disappears”- Reddy 27th/143

89. In India law and punishment is in accordance with:

A. Indian panel code

B. Consumer Protection Act

C. Criminal Procedure Code

D. Indian Evidence Act

E. Coroner’s Act

Ans: ABCD

[Ref: Reddy 27th/5 ; Parikh 6th/ 1.5 ]

“Coroner’s Act 1871: in Maharshtra is likely to be repealed soon & the cononer’s

court in Mumbai will then be abolished(It was practice in High Courts of Calcutta and

Bombay)- Parikh 6th/ 1.5

“CORONER’S INQUEST: This is type of inquest done in U.K., some States in

U.S.A., and some other countries, but not in India” - Reddy 27th/5

Legal Procedure Reddy 27th/5,49

• Indian Penal Code(I.P.C) 1860

• Criminal Procedure Code(Cr.P.C) 1973

• Indian Evidence Act(I.E.A) 1872

• Consumer Protection Act(CPA/COPRA)1986 (amended in 2002)

90. As per who protocol, ATT drug C/I in pregnancy :

A. Rifampicin

B. Pyrazinamide

C. Ethambutol

D. Streptomycin

E. INH

53

Ans: D

[Ref: KDT 6th/ 748-49;Park 21st/ 175 ]

T.B Treament during pregnancy Park 21st/ 175

“During pregnancy, streptomycin can cause permanent deafness in the baby, so

ethambutol should be used instead of streptomycin. Isoniazid, rifampicin,

pyrazinamide & ethambutol are safe to use. Second-line drugs such as

fluoroquinolones,ethionamide & protionamide are tertogenic are tertogenic & should

not be used”

T.B Treament during pregnancy KDT 6th/ 748-49

“The WHO & British Thoracic Society consider H, R & Z to be safe to the foetus &

recommended the standard 6 month (2HRZ+4HR) regimen for pregnant women with

T.B. E can be added during late but not early pregnancy. S is contraindicated”

91. A female of 45 years has taken treatment of category I (DOTS) for 6 months, yet

she is AFB positive. According to DOTS, continuation phase of new treatment

regimen should continue for:

A. 4 months

B. 5 months

C. 6 months

D. 7 months

E. 8 months

Ans: B(5 month)

[Ref: KDT 6th/ 747-48; Park 21st/ 173 ]

“Any patient treated with category I or category III who has a positive smear at 5,6,7

months of treatment should be considered a failure & started on Category II

treatment, afresh”- Park 21st/ 173

Category II treatment: 2(HRZES)3 + 1(HRZE)3

Continuation - 5(HRE)3

54

92. Which ATT is/are safe in chronic liver disease patients :

A. INH

B. Rifampicin

C. Pyrazinamide

D. Ethambutol

E. Streptomycin

Ans: DE

[Ref: KDT 6th/ 740-45;Park 21st/ 171;Katzung 10th/773-76]

Three drugs can induce hepatitis: Pyrazinamide, INH and Rifampicin (in decreasing

order of frequency).

“Pyrazinamide is C/I in patients with liver disease”- KDT 6th/ 742

“Rifampin imparts a harmless orange color to urine, sweat, tears, and contact lenses

(soft lenses may be permanently stained). Occasional adverse effects include

rashes, thrombocytopenia, and nephritis. It may cause cholestatic jaundice and

occasionally hepatitis.”- Katzung 10th/774

“Ethionamide is also hepatotoxic. Neurologic symptoms may be alleviated by

pyridoxine”- Katzung 10th/776

“Streptomycin is ototoxic and nephrotoxic”- Katzung 10th/775

93. Larvae which travel through lung during its life cycle :

A. Strongyloides stercoralis

B. Ascaris lumbricoides

C. Necator Americanus

55

D. Trichuris trichiura

E. Wuchereria bancrofti microfilarae

Ans:ABC

[Ref :Panikar 6th/ 159 ]

Trichuris trichiura larva pass trough caecum(not lung)- Panikar 6th/167

Confusion about option E Wuchereria bancrofti microfilarae??

“In Tropical Pulmonary Eosinophilia(occult filariasis), microfilariae and parasite

antigens are rapidly cleared from the bloodstream by the lungs. The clinical

symptoms result from allergic and inflammatory reactions elicited by the cleared

parasites”-Harrison

“Tropical Pulmonary Eosinophilia(occult filariasis): Microfilariae are not usually

detectable in blood, but lung biopsies have shown microfilarae in some cases. It has

been suggested that in these cases, there is failure in the suppression of immune

response to microfilarae antigens, so that microfilarae are filtered out & destroyed in

the lungs, with allergic inflammatory reactions”- Panikar 6th/204

Larvae that pass through lung during its life cycle

• Ascaris lumbricoides Panikar 6th/190

• A.duodenale Panikar 6th/179

• Necator Americanus Panikar 6th/180

• Echinococcus (Lung acts as 2nd filter) Panikar 6th/151

• Schistosoma hematobium(Lung acts as 2nd filter) Panikar 6th/119

• Paragonimus westermani(Lung flukes) Panikar 6th/135

• Strongyloides Stercoralis Panikar 6th/171

94. Arthropod borne disease is/are:

A. Brucellosis

56

B. Lyme disease

C. Borrelia recurrentis

D. Malaria

E. Plague

Ans:BCDE

[Ref : Ananthanarayan 8th/343 ; Park 21st/708]

“Brucellosis is transmitted through ingestion, contact, inhalation or accidental

inoculation”- Ananthanarayan 8th/343

Lyme disease(Borrelia burgdorferi) is transmitted by bite of Ixodid ticks”-

Ananthanarayan 8th/381

95. Tick is a vector for :

A. Crimean Congo fever

B. Rocky Mountain spotted fever

C. Epidemic typhus

D. Endemic typhus

E. Scrub typhus

Ans:AB

[Ref : Ananthanarayan 8th/406; Park 21st/720-21]

Crimean congo fever is transmitted by tick”- Ananthanarayan 8th/514

96. Diseases caused by cat reading is/are:

A. Bartonella hansellae

B. Bartonella bacilliformis

C. Pasteurella multocida

D. Bartonella vinsoni

57

E. Yersinia pestis

Ans:ACE

[Ref : Ananthanarayan 8th/ 324,326,411-12;Harrison 18th/ 1314 ]

B. bacilliformis is transmitted by Sandfly bite- Harrison 18th/ 1314

Bartonella vinsoni sub-species arupensis reservoir :Mice Harrison 18th/ 1314

Bartonella vinsoni sub-species berkhoffii reservoir :Domestic dogs, coyotes, gray

foxes Harrison 18th/ 1314

97. Bacillary Angiomatosis occur due to:

A. Mycoplasma

B. Gardenella

C. Bartonella bacilliformis

D. Hemophilus influenza

E. No relation with any above organism

Ans:E

[Ref : Ananthanarayan 8th/ 411-1;Harrison 18th/ 1314 -19 ]

“Bacillary angiomatosis is caused by B. henselae & B. quintana”- Harrison 18th/

1318

“Bartonellosis, or Carrión's disease, is caused by B. bacilliformis. The disease is

characterized by two distinct phases: (1) an acute febrile hematic phase, known as

Oroya fever; and (2) an eruptive phase manifested by cutaneous lesions, known as

verruga peruana”- Harrison 18th/ 1319

98. Single gene disorder(s) is/are:

A. Colon cancer

58

B. Huntingtions disease

C. DMD

D. β- thalassemia

E. Type II DM

Ans: ABCD

[Ref: Robbins 7th/ 150-160,170,181 ,287 ; Harrison 18th/499-505 ]

Diabetes mellitus II is Multifactorial Disorders

• Single Gene Disorders are of two types: (i) that follow classical mendelian

principles of inheritance &(ii) that follow Nonclassic Inheritance

• Classical Type: Mutations involving single genes typically follow one of three

patterns of inheritance: autosomal dominant, autosomal recessive, and X-linked. The

general rules that govern the transmission of single-gene disorders are well known

and are not repeated here.

99. Increased Prothrombin time is/are seen in:

A. Pt on oral anticoagulant

B. Pt with liver disease

C. Factor X deficiency

D. Factor VII deficiency

E. Vit. K deficiency

Ans: All

Prothrombin Time (PT) Robbins 7th/649

• This assay tests the extrinsicQ & common coagulation pathways

A prolonged PT can results from deficiency or dysfunction of factor V, factor VII,

factor X, prothrombin or fibrinogen

59

100. Both B and T cell defect presents in :

A. SCID

B. Common Variable immunodeficiency

C. Wiskot-Aldrich syndrome

D. X-linked Agammaglobulinemia

E. Chronic mucocutaneous candidiasis

Ans: AC

[Ref: Ananthanarayan 8th/156]

Combined immunodeficiency(& T cell defect): Nezelof Syndrome, Ataxia

Telangiectasia, Wiskott-Aldrich syndrome & Severe Combined Immunodeficiency

(SCID) Ananthanarayan 8th/156

101. True about Adult polycystic kidney disease :

A. Autosomal dominant pattern of inheritance

B. Most common pattern is One gene mutation

C. Most common pattern is two gene mutation

D. Somatic mutation can also occurs

E. Loss of heterozygosity may occur

Ans:ACDE

[Ref : Harrison 18th/2355-57; CMDT 06/928;Robbins 7th/962-964]

“At least two genes account for this disorder: AD PKD-1 gene on short arm of

chromosome 16 (85-90%) & ADPKD-2 gene on chromosome 4 (10-15%). Other

sporadic cases without these mutations have also been recognized”-CMDT 06/928

Genetic Considerations Harrison 18th/2355

“Over 90% of cases are inherited as an autosomal dominant trait, with the remainder

likely representing spontaneous mutations. Mutations in the PKD-1 gene on

chromosome 16 (ADPKD-1) account for 85% of cases, whereas mutations in the

60

PKD-2 gene on chromosome 4 (ADPKD-2) represent the remainder. A few families

appear to have a defect at a site that is different from either of these loci. Direct

mutation analysis of isolated cysts suggests there is loss of heterozygosity, whereby

a somatic mutation in the normal "wild-type" allele of a small number of tubular

epithelial cells leads to unregulated clonal proliferation of the cells that ultimately

form the cyst lining”

102. Autosomal Dominant pattern of renal cyst is/are seen in:

A. Cystic renal dysplasia

B. Simple renal cyst

C. Adult polycystic kidney disease

D. Medullary cystic kidney disease

E. Acquired renal cyst

Ans: CD

[Ref : Harrison 18th/ 2356, 17th/1797-1799; Robbins 7th/962-964]

“The medullary cystic kidney diseases (MCKD) generally present in young adults.

Two genetic loci have been defined, both with autosomal dominant transmission ”-

Harrison 18th/ 2359

CYSTIC RENAL DYSPLASIA Robbins 7th/962

This sporadic disorder is due to an abnormality in metanephric differentiation

ACQUIRED (DIALYSIS-ASSOCIATED) CYSTIC DISEASE Robbins 7th/966

SIMPLE CYSTS Robbins 7th/966

These occur as multiple or single, usually cortical, cystic spaces that vary widely in

diameter. They are commonly 1 to 5 cm but may reach 10 cm or more in size.

103. Superior vena cava syndrome is/are commonly seen in :

A. Small cell lung carcinoma

B. Squamous cell lung carcinoma

C. Lymphoma

D. Multiple myeloma

61

E. Scleroderma

Ans: ABC

[Ref: Swartz 8th/562;Robbins 7th/ 544,615,762 ; Harrison 18th/ 742,2266-

67,2762;CMDT06/267,302,475 ]

“Superior mediastinal tumors such as adenocarcinoma of lung, lymphoma, thyroid

carcinoma, thymoma, teratom, synovial cell sarcoma or andiosarcoma accounts for

over 80% of cases of SVC syndrome”- CMDT06/475

“Malignant tumors, such as lung cancer, lymphoma, and metastatic tumors, are

responsible for the majority of SVCS cases. With the expanding use of intravascular

devices (e.g., permanent central venous access catheters, pacemaker/defibrillator

leads), the prevalence of benign causes of SVCS is increasing. Lung cancer,

particularly of small cell and squamous cell histologies, accounts for approximately

85% of all cases of malignant origin. In young adults, malignant lymphoma is a

leading cause of SVCS. Hodgkin's lymphoma involves the mediastinum more

commonly than other lymphomas but rarely causes SVCS”- Harrison 18th/ 2266

104. CHARGE in CHARGE syndrome stands for :

A. C-Choanal atresia

B. H-Heart defects

C. A-Atrial septal defect

D. R-Retardation of growth

E. G- gonadal anomalies

Ans:BD

[Ref :O.P.Ghai 337]

CHARGE : The letters stand for-

C- coloboma of the eye,

H- heart defects,

A-atresia of the nasal choanae(i,e choanal atresia),

62

R- retardation of growth and/or development,

G- genital and/or urinary abnormalities(genitourinary defect), and

E- ear abnormalities and deafness.

105. VACTERAL stands for :

A. V-Vestibular anomalies

B. A-Anal anomalies

C. C-cardiac anomalies

D. TE-tracheaoesophageal anomalies

E. R- Rectal anomalies

Ans:BCD

[Ref : L & B 25th/ 579 ;Nelson 18th/1543 ]

VACTERAL stands for L & B 25th/ 579 en.wikipedia.org/wiki/

V - Vertebral anomalies

A - Anal atresia/anus

C - Cardiovascular anomalies

TE - Tracheoesophageal fistula/trachea

R - Renal (Kidney) and/or radial anomalies

L - Limb defects/limb buds

“VATER/VACTERL (vertebral, anorectal, [cardiac], tracheal, esophageal, renal,

radial, [limb]) syndrome”-Nelson 18th/1543

106. In Hypothyroidism following are seen:

A. Menorrhagia

B. Constipation

C. Warm & moist skin

D. Silky hair

63

E. Hirsutism

Ans:ABDE

[Ref : L & B 25th/ 775 ; Harrison 18th/2919-25;Sabiston 18th/ 926 ]

Warm & moist skin occurs in hyperthyroidism

Adult Hypothyroidism L & B 25th/ 775

The signs of thyroid deficiency are:

• bradycardia;

• cold extremities;

• dry skin and hair;

• periorbital puffiness;

• hoarse voice;

• bradykinesis, slow movements;

• delayed relaxation phase of ankle jerks.

The symptoms are:

• tiredness;

• mental lethargy;

• cold intolerance;

• weight gain;

• constipation;

• menstrual disturbance(menorrhagia)

• carpal tunnel syndrome.

107. Skin tags is/are seen in :

A. Pregnancy

B. Obesity

C. Endocrine disorder

D. Lichen planus

E. DLE

64

Ans:ABC

[Ref : Roxburg 17th/ 283; Neena Khanna 3rd/302-03;Harrison 18th/391,412,2487-

88; www.emedicinehealth.com/skin_tags/article]

“Etiology of skin tags is unknown, but skin tags may be: Familial ,Associated with

obesity”- Neena Khanna 3rd/302

People with diabetes and pregnant women tend to be more prone to skin

tags.www.medicalnewstoday.com/articles/67317.php

Skin Tags

• Studies have shown existence of low-risk HPV 6 and 11 in skin tags hinting at a

possible role in its pathogenesis. Acrochorda have been reported to have an

incidence of 46% in the general population. A causal genetic component is thought

to exist.[6] They also are more common in women than men. Rarely, they can be

associated with the Birt-Hogg-Dubé syndrome, Acromegaly and polycystic ovary

syndrome.

• Risk factors - a risk factor is something which increases the likelihood of developing

a condition or disease. For example, obesity significantly raises the risk of

developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

Skin tags are more common in:People who are overweight and obese,Pregnant

women - most likely because of the hormones secreted,Individuals with

diabetes.People with the human papilloma virus (low-risk HPV 6 and 11). & Illegal

steroid use - they interfere with the body and muscles, causing the collagen fibers in

the skin to bond, allowing skin tags to be formed.

108. A 6 yr old child has midline neck cystic swelling. D/D of this condition does NOT

includes:

A. Branchial cyst

B. Thyroglossal cyst

C. Lymphnode enlargement

D. Cystic hygroma

E. Carotid body tumor

65

Ans:ADC

[Ref : S.Das 5th/619;L & B 25th/ 726-29]

Midline cystic swelling: Thyroglossal cyst, enlarged submental LN, Goitre of thyroid

isthmus, Ludwig angina

Lateral Swelling

Carotid triangle: Carotid body tumor, branchial cyst, thyroid swelling

Posterior triangle:Cystic hygroma

109. Catgut is generally prepared from submucosa of :

A. Cat

B. Sheep

C. Human

D. Rabbit

E. Wild boar

Ans:B

[Ref : L & B 25th/ 238 ; Sabiston 18th/271 ; CSDT11th/94 ]

Sheep or cattle: L & B 25th/ 238

Sheep & beef- Sabiston 18th/271

Bovine: CSDT11th/94

110. True bout Typhlitis :

A. Perforation common

66

B. Most common site is ileum

C. CT scan is screening test of choice

D. Bacteria can be isolated from intestine

E. Neutrophil count decreases

Ans: ACDE

[Ref : L & B 25th/ 1211 ;Harrison 18th/1335,2276-77,716 Sabiston 18th/ ; CSDT11th/

750 ; Swartz 8th ]

“Early diagnosis is provided by a high index of suspicion and the use of CT

scanning”

“Abdominal computed tomography (CT) scanning with oral and intravenous contrast

is the preferred examination. The maximum normal colonic wall thickness on CT

scan is 3 mm. When the colon is distended with stool, fluid, or oral contrast, the

normal colonic wall is nearly imperceptible. Pericolonic fat should demonstrate

homogeneous fat attenuation”-

The cecum is almost always affected, and the process often extends into the

ascending colon and terminal ileum

Various bacterial and/or fungal organisms, including gram-negative rods, gram-

positive cocci, anaerobes (eg, Clostridium septicum), and Candida spp, are often

seen infiltrating the bowel wall. Polymicrobial infection is frequent. Only rarely are

inflammatory or leukemic infiltrates identified . Bacteremia or fungemia is also

common, usually with enteric organisms such as Pseudomonas or yeasts such as

Candida

The mortality rate for caecitis can be as high as 40 to 50%, mostly because it is

frequently associated with bowel perforation. Caecitis is diagnosed with a radiograph

CT scan showing thickening of the caecum and "fat stranding"

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111. True about apocrine gland :

A. Secrete odourless hypotonic fluid

B. Provide odour to body

C. Present in axilla & groin

D. Present all over body

E. Suppurative infection of gland cause Hidradenitis suppurativa

Ans: A(?)BCE

[Ref: Neena Khanna 3rd/109,1st/97-98; L & B 25th/1266;Gray’s 40th/153;Nelson

18th/2652]

Not confirmed about hypotonicity!!!

“Bacterial decomposition of apocrine sweat gland accounts for the unpleasant odour

associated with perspiration”- Nelson 18th/2652

“The secretion is initially sterile & odourless, but it undergoes bacterial

decomposition to generate potent odourous, musky compound”- Gray’s 40th/153

In humans, apocrine sweat glands are found only in certain locations of the body: the

axillae (armpits), the areola of the pages , and the genitoanal region. Specialized

types of apocrine sweat glands present on the eyelids are called Moll's glands. Most

of the human body contains eccrine sweat glands. Apocrine sweat glands secrete a

milky, viscous, odourless fluid which only develops a strong odour when it comes

into contact with bacteria on the skin surface.

An important distinction between an eccrine sweat gland and an apocrine sweat

gland structure is that an apocrine sweat gland has a larger lumen. Another

distinction is that apocrine sweat glands secrete a more viscous fluid.

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112. Tube thoracostomy is indicated in :

A. Pneumothorax

B. Hemothorax

C. Surgical emphysema

D. Pneumo-hemothorax

E. Pulmonary contusion

Ans:ABD

[Ref : L & B 25th/ ; Sabiston 18th/ 1666-67,495,1672,1669 ; CSDT11th/ ]

Surgical emphysema (subcutaneous trapped air) is a complication of chest drain

insertion, or sometimes of the pneumothorax itself.

Surgical emphysema can form because of poor technique during drain insertion or

because of displacement of the drain such that a side hole near the end of the drain

lies within the subcutaneous tissues.

Surgical emphysema has the clinical characteristic of feeling like 'rice crispies' or

'bubble wrap' on palpation.

“Pulmonary contusion :Management is directed toward maintaining good

oxygenation and adequate pulmonary toilette. Judicious crystalloid infusion is

important to avoid fluid overload and pulmonary edema; however, intravascular

volume depletion should also be avoided to decrease the risk for global ischemia

and multiple organ failure. Patients with persistently low PaO2 who do not respond to

supplemental oxygen, pulmonary toilette, and pain control should be intubated and

mechanically ventilated”- Sabiston 18th/495

A chest tube (chest drain or tube thoracostomy in British medicine or intercostal

drain) is a flexible plastic tube that is inserted through the side of the chest into the

pleural space. It is used to remove air (pneumothorax) or fluid (pleural

effusion,blood, chyle), or pus (empyema) from the intrathoracic space. It is also

known as a Bülau drain or an intercostal catheter

Indications

69

Pneumothorax: accumulation of air in the pleural space

Pleural effusion: accumulation of fluid in the pleural space

Chylothorax: a collection of lymphatic fluid in the pleural space

Empyema: a pyogenic infection of the pleural space

Hemothorax: accumulation of blood in the pleural space

Hydrothorax: accumulation of serous fluid in the pleural space

Postoperative: for example, thoracotomy, oesophagectomy, cardiac surgery

113. Flail chest means fracture of :

A. 2 Ribs on same side

B. 2 Ribs on 2 side

C. 4 Ribs on 2 sides

D. Cervical or first rib on one side

E. Multiple ribs on both side

Ans:CE

[Ref : L & B 25th/ 343 ; Sabiston 18th/ 496 ; Schwartz 8th ; CSDT11th/ ]

“It is usually results from blunt trauma associated with multiple rib fracture i,e three or

more ribs fractured in two or more places”- L & B 25th/ 343

“Flail chest occurs when four or more ribs are fractured in at least two locations.

Paradoxical movement of this free-floating segment of chest wall may occasionally

be sufficient to compromise ventilation. However, it is of greater physiologic

importance that patients with flail chest frequently have an underlying pulmonary

contusion”-Schwartz 8th

Flail Chest

“By definition, a flail chest occurs in the presence of two or more fractures in three or

more consecutive ribs and causes instability of the chest wall; however, it can also

occur after costochondral separation ( Fig. 20-12 ). Flail chest is characterized by

70

paradoxical motion of the chest wall (inward with inspiration and outward with

expiration). Fractures can be located in the anterior, lateral, or posterior chest wall.

Flail chest occurs in 10% to 15% of patients sustaining major chest trauma, and the

chance of having an intrathoracic injury in this situation increases severalfold. Closed

head injury is the most frequently associated extrathoracic injury, and it contributes

to higher morbidity and mortality rates. Isolated flail chest carries a low mortality rate

in younger patients”- Sabiston 18th/ 496

114. Pulsus paradoxus is/are present in all except:

A. Haemorrhagic shock

B. Pulmonary embolism

C. Right ventricular myocardial infarction

D. Cardiac tamponade

E. Severe COPD

Ans: C

[Ref: Harrison 18th/1972]

“Paradoxical pulse occurs not only in cardiac tamponade but also in approximately

one-third of patients with constrictive pericarditis . This physical finding is not

pathognomonic of pericardial disease because it may be observed in some cases of

hypovolemic shock, acute and chronic obstructive airways disease, and pulmonary

embolus”- Harrison 18th/1972

115. Loud S1 is /are present in:

A. MS with pliable valve

B. MS with calcified valve

C. MR

D. AS

E. TR

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Ans: A

[Ref: Harrison 18th/1826;Hurst 12th/261 ;PJM 15th/137]

MS with calcified valve, MR & TR cause soft S1

S1 is normal in AS-O.P.Ghai 7th/418

A loud, late M1 is the hallmark of hemodynamically significant mitral stenosis. When

calcific fixation of the stenotic mitral valve occurs, M1 is soft, and the opening snap is

absent

“AS: The cardiac impulse is heaving and sustained in character, and there may be a

palpable fourth heart sound (S4). An aortic systolic thrill is often present at the base

of the heart. In 80 to 90 percent of adult patients with severe AS, there is an S4

gallop sound, a midsystolic ejection murmur that peaks late in systole, and a single

second heart sound (S2) because A2 and P2 are superimposed or A2 is absent or

soft”- Hurst 12th/261

Intensity of S1

The primary factors determining intensity of S1 are (1) integrity of valve closure, (2)

mobility of the valve, (3) velocity of valve closure, (4) status of ventricular contraction,

(5) transmission characteristics of the thoracic cavity and chest wall, and (6) physical

characteristics of the vibrating structures.

INCOMPLETE QUESTIONS

1. Congenital ear disease classification:

A. Morquis/Marqueate I, II

B. Morquis I, II, III

C. Corp I, II

D. Corp I, II

E. None of above

72

2. Defect in 1st pharyngeal cleft results in :

a.thyroglossal cyst

b.Thyroglossal fistula

c.branchial cyst

d. Loss of sensation from posterior part of tongue

e. Choanal atresia

Ans:

First branchial anomalies

First branchial anomalies represent 1% of all branchial anomalies. Work reports the

following 2 types[1] :

• A type I branchial anomaly is ectodermally derived and is a duplication of the

external auditory canal (EAC). Type I branchial anomalies may manifest posteriorly,

adjacent to the pinna and concha. They may terminate near a bony plate at the level

of the mesotympanum.

• Type II branchial anomalies contain both ectoderm and mesoderm. They are more

common and can originate along the EAC, middle ear cleft, or nasopharynx. Type II

branchial anomalies often manifest with a fistula emanating from the concha, EAC,

or neck, with a tract extending medially and inferiorly to the EAC. They may pass

medial or lateral to the facial nerve and terminate at the level of the anterior border of

the sternocleidomastoid muscle. Often an opening is found in the EAC as well as

below the jaw.

First branchial anomalies do not usually involve the middle ear or tympanic

membrane.

Patients with first branchial anomalies may present with unilateral facial paralysis.

First branchial anomalies may be associated with hemifacial microsomia.

3. Host gene affect disease progression in:

A. Hepatitis B

B. Hepatitis B

C. HCV

73

D. HIV

E. P

4. Significance of Biomarker:

A. P

B. C

C. S

D. I

E. G

Provide options??

Ref: Harper

5. Which antiepilepties promotes growth hormone secretion :

A. Phemytoin

B. Valproate

C. Carbamazepine

D. Phenobarbitone

E. Lacosamide

Lacosamide (INN, formerly known as erlosamide) is a medication developed by UCB

for the adjunctive treatment of partial-onset seizures and diabetic neuropathic pain

marketed under the trade name Vimpat.

6. Drug used for dementia in both disease parkinsonism & Alzeimer’s disease:

A. Donazapril

B. Revastigmine

C. Galantinum

D. Vincosentrin

E. Tacrine

F. Memantine

74

7. Contrast used in MRI :

A. Gadolinium

B. I odine

C. Myodinium

D. Technitium

E. Indium

Ans:A, other?

[Ref ;Bhadury 2nd/177]

The contrast dye used in these MRI Scans is generally gadolinium as complications

are rarer in comparison to the Iodine origin dye used for x-rays and CT scans

8. Hyperdense biconvex feature in CT seen in all except :

A. Subdural hemorrhage

B. Extradural hemorrahage

C. Foreign body

D. Intracerebral hemorrhage

E. Hypertensive hemorrhage

9. Prophylactic cranial irradiation given in :

A. AML

B. ALL

C. Small cell Ca of lung

D. Glioblastoma multiforme

E. NHL

10. True about Imaging in gallbladder:

A. Cirrhosis:anteriorly shift

B. Polysplenia:Left shift

75

C. Never beyond superior surface

D. Wandering of gallbladder

11. Increased density of corticospinal tract in T2 MRI seen in:

A. Astrocytoma

B. Amyotrophic lateral sclerosis

C. Hemochondromatosis

D. Wilson disease

E. Vascular Infarction

Ans: B?

Cortical motor neurone loss and corticospinal tract (CST) degeneration are typical of

amyotrophic lateral sclerosis (ALS). It is a matter of debate whether qualitative

assessment of the CST by MRI is useful in the diagnosis. It is also an open question

whether quantitative determination of the T2 relaxation times can improve its value.

Signal intensity along the CST on 14 consecutive slices was assessed using

arbitrary visual rating on double-echo T2-weighted and proton-density spin-echo

images of 21 patients with ALS and 21 age- and sex-matched controls. T2 was

determined quantitatively. On the T2-weighted images the patients' ratings did not

differ from that of controls. The T2 of patients and controls showed no statistical

difference in any slice. There was no correlation between T2 and patient age,

duration of the disease, or predominant bulbar, lower or upper motor neurone signs.

The only correlation between MRI findings and disease was on the proton-density

images: all cases in which the CST was poorly seen were controls; a clearly high-

signal CST was seen only in the patients. High conspicuity of the CST was thus

specific but not sensitive for the diagnosis of ALS. T2-weighted images and

measurement of T2 were not useful for diagnosis.

76

12. Light bulb appearance in CT scan seen in:

a. pheochromocytoma

b.adrenal adenoma

c.adrenal cortical tumor

d. C

e. M

Ans:

[Ref : www.ajronline.org/content/194/6/1450.full]

MRI: Pheochromocytomas and other paragangliomas classically have a "light bulb"

(very intense)

MRI:Typically hemangiomas are homogeneously hypointense relative to the liver on

T1-weighted and markedly hyperintense (lightbulb sign) on T2-weighted images

relative to the liver

Up to 70% of pheochromocytomas show relatively high signal intensity on T2-

weighted images—a feature classically known as the light bulb sign, which was

originally thought to be characteristic of pheochromocytoma [56, 69]. Currently,

however, that description is not considered accurate, with at least 30% of

pheochromocytomas showing moderate or low T2-weighted signal intensity and

appearing similar to other adrenal diseases

13. Complete mole can be differentiated from partial mole by :

A. P57kip2

B. P53

C. P16inkga

D. P63

77

E. PED

Ans: A

ajcp.ascpjournals.org/content/133/2/196.full

The p57(KIP2) gene ( CDKN1C ) is strongly paternally imprinted and expressed from

the maternal allele. Because Complete Mole lacks a maternal genome, p57(KIP2)

immunostaining is correspondingly absent, whereas hydropic abortuses and partial

mole show positive staining

14. 70 yr female undergoing vaginal hysterectomy. The risk factor for post-op

infection :

A. Old age

B. DM

C. HTN

D. Obesity

E. Bacterial vaginosis

15. X-linked agammaglobinemia :

A. 3

B. 3

C. 19

D. A

E. T

What was exact question??

16. Oncogene tyrosine kinase involves :

78

A. PML-BRCA 1

B. BCR-ABL

C. HAAJ

D. JUN

E. NJKKR,JNP

[Ref: Robbins 7th/ 98-100,296-97]

17. what is true about Kerala in relation to India :

a. high literacy rate

b. high doctor/ population ratio

c. high growth rate

d. older age of marriage

e.

18. A 14 yr child restricted eye movements in all directions, ptosis, fatiguability of

proximal muscle myopathy.What is most useful test diagnosis:

A. C PK

B. E MG

C. Endrophonium test

D. Biopsy

E. D

Chronic progressive external ophthalmoplegia (CPEO), also known as progressive

external ophthalmoplegia (PEO), is a type of eye movement disorder. It is often the

only feature of mitochondrial disease, in which case the term CPEO may be given as

the diagnosis. In other people suffering from mitochondrial disease, CPEO occurs as

part of a syndrome involving more than one part of the body, such as Kearns-Sayre

syndrome. Occasionally CPEO may be caused by conditions other than

mitochondrial diseases.

Diagnosis

It is important to differentiate CPEO from other pathologies that may cause an

79

ophthalmoplegia. There are specific therapies used for these pathologies.

CPEO is diagnosed via muscle biopsy. On examination of muscle fibers stained with

Gömöri trichrome stain, one can see an accumulation of enlarged mitochondria. This

produces a dark red staining of the muscle fibers given the name “ragged red fibers”.

While ragged red fibers are seen in normal aging, amounts in excess of normal

aging give a diagnosis of a mitochondrial myopathy.