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    (1) What type of fracture of this?

    (a.) Bennetts fracture

    (b.) Rolandos fracture

    (c.) Fractures of the metacarpals

    (d.) Fractures of the phalanges

    (1) Ans: a.

    Exp. Bennetts fracture

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    Intraarticular Fractures of the First Metacarpal Base(A). An intraarticular fracture at the base of the first metacarpal with radial and

    proximal displacement is a Bennett's fracture (B). A comminuted intraarticular fracture at the base of the first metacarpal is a

    Rolando's fracture (C).

    It is an oblique intra-articular fracture of the base of the first metacarpal with subluxation or dislocation of the metacarpal. It is

    sustained as a result of a longitudinal force applied to the thumb.

    Treatment: Accurate reduction and restoration of the smooth joint surface is important. This is because, being an intra-articular

    fracture, if not reduced accurately, it will lead to incongruity of the articular surfaces. This would increase the chances of developing

    osteoarthritis. The following methods of treatment are used:

    a. Closed reduction and percutaneous K-wire fixation under an image intensifier, is a good technique. K-wire is used and

    incorporated in a plaster cast.b. Open reduction and internal fixation with a K-wire or a screw may be necessary in some cases.

    (2.) What type of traction is this?

    (a.) Gallows (b.) Bryants

    (c.) Russells (d.) Bucks

    (2.) Ans: c.

    Exp. Russells

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    It is a type of traction that is used for trochanteric fractures.

    (3.) What is the diagnosis?

    (a.) Optic nerve sheath meningioma

    (b.) Optic nerve glioma

    (c.) Caroticocavernous fistula

    (d.) Cavernous hemangioma

    (3.) Ans: a.

    Exp. Optic nerve sheath meningioma

    Optic nerve sheath meningioma with classic tram tract appearance on T1 weighted contrast enhanced MRI.

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    Optic nerve meningiomas account from approximately a third of all optic nerve neoplasms; optic nerve gliomas are the most

    common entity. Unlike optic nerve gliomaswhich occur primarily in children, optic nerve meningiomas are usually seen in adults

    (mean age at presentation 40 years), however up to 25% present in children, in which case they tend to be more aggressive

    Similar to meningiomaselsewhere there is a female predilection

    The vast majority of cases are sporadic, although patients with neurofibromatosis type II(NF2) are at increased risk.

    On axial or oblique sagittal imaging the enhancing tumour surrounding the non-enhancing optic nerveresults in the so-called tram-

    track sign. This is most evident in tumours with tubular growth pattern.

    (4.) What is most probable age of this child?

    (a.) 7 months

    (b.) 10 months

    (c.) 13 months

    (d.) 15 months

    (4.) Ans: b.

    Exp. 10 months

    Diagonal localization of the sources of sound occurs at 10 months

    (5.) The below given abnormality is seen in which condition?

    (a.) Fanconi anemia

    (b.) Dyskeratosis congenita

    (c.) Ehler Danlos syndrome

    (d.) Pseudo hypoparathyroid

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    (5.) Ans: a.

    Exp. Fanconi anemia

    This is radial ray defects seen in Fanconi anemia. It present in a wide spectrum they include absent or hypoplastic thumbs. The

    thenar hypoplasia may be missed unless carefully examined.

    (6.) The cells shown in the figure with arrow is found in which condition?

    (a.) Thalassemia (b.) CRF

    (c.) B12 deficiency (d.) Aplastic anemia

    (6.) Ans: b.

    Exp. CRF

    The red blood cells in uremia may acquire numerous, regularly spaced, small spiny projections. Such cells, called burr cells or

    echinocytes, are readily distinguishable from irregularly spiculated acanthocytes or spur cells.

    (7.) The . Given in picture may help to manage a shoulder dystocia during vaginal delivery-

    (a.) Woods' screw maneuver

    (b.) Zavanelli maneuver

    (c.) McRoberts maneuver

    (d.) None

    (7.) Ans: c.Exp. McRoberts maneuver

    The McRoberts maneuver is named after William A. McRoberts, Jr. It is employed in case of shoulder dystocia during childbirth and

    involves hyperflexing the mother's legs tightly to her abdomen. It is effective due to the increased mobility at the sacroiliac joint

    during pregnancy, allowing rotation of the pelvis and facilitating the release of the fetal shoulder. If this maneuver does not succeed,

    an assistant applies pressure on the lower abdomen (suprapubic pressure), and the delivered head is also gently pulled. The

    technique is effective in about 42% of cases.

    (8.) The following abnormality an angiography is seen in which condition?

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    (a.) Takayasu

    (b.) Giant cell arteritis

    (c.) PAN

    (d.) Wageners granulomatosis

    (8.) Ans: A.

    Exp. Takayasu

    RAS occur in Takayasus and atherosclerosis.

    Angiogram illustrating high-grade renal artery stenosis affecting the left kidney. This lesion is often part of widespread

    atherosclerosis and sometimes is an extension of aortic plaque. This lesion develops in older individuals with preexisting

    atherosclerotic risk factors.

    (9.) What is your diagnosis?

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    (a.) Intestinal perforation

    (b.) Toxic megacolon

    (c.) Volvulus

    (d.) Gastric dilatation

    (9.) Ans: c.Exp. Volvulus

    Sigmoid volvulus with the characteristic radiologic appearance of a "bent inner tube."

    10. What is your diagnosis of the following peripheral smear?

    A. Sickle cell anemia

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    B. Iron deficiency anemia

    C. Hemolytic anemia

    D. Thalassemia

    10. Ans. C. Hemolytic anemia

    Fragmentation hemolysis

    1. Microangiopathic hemolytic anemia (MAHA) is a microangiopathic subgroup of hemolytic anemia (loss of red blood cells

    through destruction) caused by factors in the small blood vessels.

    2. It is identified by the finding of anemia, schistocytes & fragmented RBCs on microscopy of the blood film.

    Presentation1.

    In diseases such as hemolytic uremic syndrome, disseminated intravascular coagulation, thrombotic thrombocytopenic

    purpura, and malignant hypertension, the endothelial layer of small vessels is damaged with resulting fibrin deposition and

    platelet aggregation.

    2. As red blood cells travel through these damaged vessels, they are fragmented resulting in intravascular hemolysis.

    3. The resulting schistocytes (red cell fragments) are also increasingly targeted for destruction by the reticuloendothelia

    system in the spleen, due to their narrow passage through obstructed vessel lumina.

    4. It is seen in systemic lupus erythematosus because the immune complex aggregates with platelets, which creates

    intravascular thrombi. Microangiopathic hemolytic anemia is also seen with cancer

    11. What is the diagnosis of the patient having following condition?

    (A). Herpes zoster (B). Herpes simplex

    (C). Pemphigus (D). Molluscum contagiosum

    11. Ans. (D). Molluscum contagiosum

    a. Molluscum contagiosum is a cutaneous poxvirus infection characterized by multiple umbilicated flesh-colored or

    hypopigmented papules.

    b. Molluscum contagiosum lesions are flesh-colored, dome-shaped, and pearly in appearance. They are often 15 millimeters

    in diameter, with a dimpled center.

    c. They are generally not painful, but they may itch or become irritated

    d. In a process called autoinoculation, the virus may spread to neighboring skin areas.

    e. Children are particularly susceptible to autoinoculation, and may have widespread clusters of lesions.

    12. What is the osmolarity at point X in the diagram below if ADH is present?

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    A) Hypertonic

    B) Hypotonic

    C) Isotonic

    D) Hypertonic if aldosterone is also present

    12. The answer is A. hypertonic

    If ADH is present CD becomes permeable to water via Aquaporin 2 and cause water reabsorption resulting in hypertonic fluid in CD

    and also hypertonic urine. In absence of ADH i.e DI, there would be hypotonic fluid.

    13. In the figure below, The tip of probe passes into the opening of which vessel?

    A. Left coronary artery B. Left marginal artery

    C. Right coronary artery D. Right marginal artery

    13. Ans. C) Right coronary artery

    The specimen is a superior view of the cadaver heart showing the two great vessels of heart in direct view. The ascending aorta

    (held by the forceps) is seen on the right side of the pulmonary trunk

    The right coronary artery (RCA) originates above the right cusp of the aortic valve. It travels down the right atrioventricular groove,

    towards the crux of the heart.

    At the origin of the RCA is the conus artery.

    In addition to supplying blood to the right ventricle (RV), the RCA supplies 25% to 35% of the left ventricle (LV).

    In 65% of population, the RCA gives off the posterior interventricular artery (PIVA) right cardiac dominance.

    In 10% of cases, the PIVA is given off by the left circumflex artery left dominance.

    25 % people have co-dominance, where multiple PIVA(s) are found, arising from both the coronary arteries.

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    PIVA is also called as PDA (posterior descending artery). The PDA supplies the inferior wall, ventricular septum, and the

    posteromedial papillary muscle.

    14. What is the your diagnosis of the following examination of the fundus?

    (A) Diabetes retinopathy.

    (B) Optic atrophy

    (C) CRAO

    (D) Retinal detachment

    14. Ans. (D) Retinal detachment

    It is a cause of retinal detachment appears as an elevated sheet of retinal tissue with folds. In this patient the fovea was spared, so

    acuity was normal, but a superior detachment produced an inferior scotoma.

    Retinal Detachment

    This produces symptoms of floaters, flashing lights, and a scotoma in the peripheral visual field corresponding to the detachment. I

    the detachment includes the fovea, there is an afferent pupil defect and the visual acuity is reduced. In most eyes, retina

    detachment starts with a hole, flap, or tear in the peripheral retina (rhegmatogenous retinal detachment). Patients with periphera

    retinal thinning (lattice degeneration) are particularly vulnerable to this process. Once a break has developed in the retina, liquefied

    vitreous is free to enter the subretinal space, separating the retina from the pigment epithelium. The combination of vitreous

    traction on the retinal surface and passage of fluid behind the retina leads inexorably to detachment. Patients with a history of

    myopia, trauma, or prior cataract extraction are at greatest risk for retinal detachment. The diagnosis is confirmed by

    ophthalmoscopic examination of the dilated eye.

    15. What is treatment of choice of the classical sign shown in the fundus photo given below:

    (A) Control of systemic disease

    (B) Laser

    (C) Vitrectomy

    (D) Enucleation

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    15. Ans. (B) Laser

    It is a case of diabetic retinopathy. Best treatment for this is LASER.

    Lasers In Ophthalmology

    Argon laser - It is absorbed by Hemoglobin

    - Used for PDR, neovascular glaucoma, capillary hemangioma

    Nd: YAG laser - For posterior capsulotomy, iridectomies, iridotomies, cutting vitreous bands (vibriolysis)

    Sec. Glaucoma, after cataract, tumors

    Excimer / UV laser - In refractive surgeries like LASIK

    (For T/t of Myopia, Astigmatism and Hypermetropia)Also used for photorefractive keratectomy (in Band Keratoplasty)

    Diode laser - Retinal photocoagulation, for glaucoma drainage

    Argon Laser is used in - RD

    Retinal Vein Occlusion

    Eale's ds

    Lasers used for retinal photocoagulation are---Diode laser, krypton red laser, double frequency Nd: YAG

    16. A 2-year-old child (A) presents with a four-day history of a rash limited to the feet and ankles. The papular rash is both pruritic

    and erythematous. The 3-month-old sibling of this patient (B) has similar lesions also involving the head and neck. Appropriate

    treatment for this condition includes (See Fig)

    (A). Coal-tar soap (B). Permethrin(C). Hydrocortisone cream (D). Emollients

    16. Ans. (A). Coal-tar soap

    When the clinical signs of constricted pupils, bradycardia, and muscle fasciculations are associated with the sudden onset of

    neurologic symptoms, progressive respiratory distress, diaphoresis, diarrhea, and overabundant salivation, a diagnosis of

    organophosphate poisoning should be suspected. Intake of organophosphate agents can occur by ingestion, inhalation, or

    absorption through skin or mucosa. Organophosphates inhibit carboxylic esterase enzymes, including acetylcholinesterase and

    pseudocholinesterase; toxicity depends primarily on the inactivation or inhibition of acetylcholinesterase.

    Treatment consists of gastric lavage, if the poison has been ingested, or decontamination of the skin, if exposure has been through

    contact. Maintenance of adequate ventilation and fluid and electrolyte balance also is indicated. All symptomatic children should

    receive atropine and, if severely affected, cholinesterase-reactivating oximes as well. Cholinesterase-reactivating oximes quickly

    restore consciousness by inhibiting muscarine- and nicotine-like synaptic actions of acetylcholine. Cholinesterase-reactivating

    oximes include pralidoxime chloride or obidoxime.

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    17. A 1-week-old black infant presents to you for the first time with a large, fairly well-defined, purple lesion over the buttocks

    bilaterally, as shown in the photograph. The lesion is not palpable, and it is not warm or tender. The mother denies trauma and

    reports that the lesion has been present since birth. This otherwise well-appearing infant is growing and developing normally and

    appears normal upon physical examination. The most likely diagnosis in this infant is (See Fig)

    (A). Child abuse

    (B). Mongolian spot

    (C). Subcutaneous fat necrosis

    (D). Vitamin K deficiency

    17. Ans. (B). Mongolian spot (Behrman, 16/e, pp 455, 1970.)

    Mongolian spots are bluish-gray lesions located over the buttocks, lower back, and occasionally, the extensor surfaces of the

    extremities. They are common in blacks, Asians, and Latin Americans. They tend to disappear by 1 to 2 years of age, although those

    on the extremities may not fully resolve. Child abuse is unlikely to present with bruises alone; children frequently present with more

    extensive injuries. Subcutaneous fat necrosis is usually found as a sharply demarcated, hard lesion on the cheeks, buttocks, and

    limbs. The lesion usually is red. Hemophilia and vitamin K deficiency rarely present with subcutaneous lesions as described and are

    more likely to present as a bleeding episode.

    18. If you could histologically examine the spinal cord of a patient who had experienced a viral illness 10 years before in which

    only the neurons of the area shown below in diagram were destroyed, what findings would you expect?

    (See Color Atlas, Figure 10)

    (A) The corticospinal tract would be completely degenerated

    (B) The rubrospinal tract would show an increased number of axons

    (C) The corticospinal tract would be about one-third depleted of axons

    (D) The alpha motor neurons would be atrophic

    18. The answer is C. The corticospinal tract would be about one-third depleted of axons

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    The area damaged is primary motor cortex, area 4. The neurons of the primary motor cortex contribute about one-third of the

    axons that make up the corticospinal tract. Other tracts, such as the rubrospinal, do not sprout additional axons. The alpha moto

    neurons do not atrophy if deprived of corticospinal input.

    19. Which of the following most likely cause of the color photo given below.

    (A)N. gonorrhoeae

    (B) Fungal infection

    (C) Adenovirus

    (D) E. Coli

    19. Ans. A. N. gonorrhoeae

    N. gonorrhoeae causes conjunctivitis, pharyngitis, proctitisor urethritis, prostatitisand orchitis.

    Conjunctivitis is common in neonates(newborns), and silver nitrateor antibiotics are often applied to their eyes as a preventive

    measure against gonorrhoea. Neonatal gonorrheal conjunctivitis is contracted when the infant is exposed to N. gonorrhoeaein

    the birth canal and can lead to corneal scarring or perforation, resulting in blindness in the neonate.

    20. What is your diagnosis of the color photo given below:

    (A) Retinoblastoma

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    (B) Cataract

    (C) PHPV

    (D) Coats disease

    20. Ans. (B) Cataract

    This is the case of congenital cataract.

    Classification of cataract by etiology

    Age-related cataract

    Cortical senile cataract

    Immature senile cataract (IMSC): partially opaque lens, discview hazy Mature senile cataract (MSC): completely opaque lens, no disc view

    Hypermature senile cataract (HMSC): liquefied cortical matter: Morgagnian cataract

    Senile nuclear cataract

    Cataracta brunescens

    Cataracta nigra

    Cataracta rubra

    Congenital cataract

    Sutural cataract

    Lamellar cataract

    Zonular cataract

    Total cataract

    Secondary cataract

    Drug-induced cataract (e.g. corticosteroids)

    Traumatic cataract

    Blunt trauma (capsule usually intact)

    Penetrating trauma (capsular rupture and leakage of lens materialcalls for an emergency surgery for extraction of

    lens and leaked material to minimize further damage)