ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes)

Allindia2005aipgmeaiipganswers,explanationsrefrencesfree Page1of97
ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes)
(ByDrVarunSinghalMDStd.,TopRankerAllIndia2003,4,AllRightsreservedAIPPG).
DiscusscontroversialquestionsinQuestionForum
Q.1Theparvocellularpathwayfromlateralgeniculatenucleustovisualcortexismostsensitive
forthestimulusof:
1.Colorcontrast.
2.Luminancecontrast.
3.Temporalfrequency.
4.Saccadiceyemovements.
AnswerIs1
GANONG,SREVIEWOFPHYSIOLOGYED19Pg-163

Q.2Thefibersfromthecontralateralnasalhemiretinaprojecttothefollowinglayersofthelateral
geniculatenucleus:
1.Layers2,3&5.
2.Layers1,2&6
3.Layers1,4&6
4.Layers4,5&6
Answeris3
GANONG,SREVIEWOFPHYSIOLOGYED19-163

Q.3Allendothelialcellsproducethrombomodulinexceptthosefoundin:
1.Hepaticcirculation.
2.Cutaneouscirculation
3.Cerebralmicrocirculation.
4.Renalcirculation.
Answeris3

Q.4S.A.nodeactsasapacemakeroftheheartbecauseofthefactthatit:
1.Iscapableofgeneratingimpulsesspontaneously.
2.Hasrichsympatheticinnervations.
3.Haspoorcholinergicinnervations.
4.Generatesimpulsesatthehighestrate.
Answeris4
Q.5Thefirstphysiologicalresponsetohighenvironmentaltemperatureis:
1Sweating
2Vasodilation
3Decreasedheatproduction
4Non-shiveringthermogenesis
Answeris2
GANONG,SREVIEWOFPHYSIOLOGYED19Pg-257,599

Q.6Allofthefollowingfactorsnormallyincreasethelengthoftheventricularcardiacmuscle
fibresexcept:
1.Increasedvenoustone.
http://www.aippg.com/allindia2005answers.htm 6/13/2009
2.Increasedtotalbloodvolume.
3.Increasednegativeintrathoracicpressure.
4.Lying-to-standingchangeinposture.
Answeris4

Q.7Thevasodilatationproducedbycarbondioxideismaximuminoneofthefollowing
1.Kidney
2.Brain
3.Liver.
4.Heart.
Answeris2

Q.8Whichoneofthefollowingstatementsregardingwaterreabsorptioninthetubules?
1.ThebulkofwaterreabsorptionoccurssecondarytoNa+reabsorption.
2.Majorityoffacultativereabsorptionoccursinproximaltubule.
3.ObligatoryreabsorptionisADHdependent.
4.20%ofwaterisalwaysreabsorbedirrespectiveofwaterbalance.
Answeris1

Q.9Urinaryconcentratingabilityofthekidneyisincreasedby:
1.ECFvolumecontraction.
2.IncreaseinRBF.
3.Reductionofmedullaryhyperosmolarity
4.IncreaseinGFR.
Answeris1

Q.10Distributionofbloodflowismainlyregulatedbythe:
1Arteries
2Arterioles
3Capillaries
4Venules
Answeris2

Bloodflowinthevesselsprimarilyduetopumpingactionoftheheart
Otherfactorsarediastolicrecoilofwallsofarteries,pumpingactionskeletalmuscleon
veinsandnegativeintrathoracicpressure
RegulationofBloodflowtoeachtissueisdependsonthediameterofthevessels
principallyofarterioles.Resistancetoflowmostlydependsondiameterofarteriolesandtoa
minordegreeontheviscosityoftheblood.Arteriolesarethemajorsiteoftheresistancetoblood
flowandsmallchangeintheircalibercauseslargechangeinthetotalperipheralresistance.

Q.11Inwhichofthefollowingareductioninarterialoxygentensionoccurs?
1.Anaemia.
2.COpoisoning.
3.Moderateexercise
4.Hypoventilation.
Answeris3
Harrisonpricipleofinternalmedicine15thed/209,1502
PaO2isnormalin
AnemicHypoxia
CarbonMonoxideIntoxication
Histotoxichypoxia
AnemicHypoxia
ThereisDeclineintheO2-carryingcapacityoftheblood.
Inanemichypoxia,thePaO2isnormal
CarbonMonoxideIntoxication

CarbonmonoxidepreferentiallydisplacesO2fromhemoglobin,essentiallymakingaportionof
hemoglobinunavailableforbindingtoO2.Inthiscircumstance,carbonmonoxidesaturationis
highandO2saturationislow,eventhoughthedrivingpressureforO2tobindtohemoglobin,
reflectedbyPO2,isnormal.
RespiratoryHypoxia?Themostcommoncauseofrespiratoryhypoxiaisventilation -perfusion
mismatch.Italsocausedbyhypoventilation,anditisthenassociatedwithanelevationofPaCO2
andlowPaO2.
Inmoderateexercises?po2isdecreased(ganong)

Q.12Neuronaldegenerationisseeninallofthefollowingexcept:
1.Crushnerveinjury
2.Fetaldevelopment.
3.Senescence
4.Neuropraxia.
Answeris4
Apley,sorthopedics8thed/230
Maheshwariessentialorthopedics2nded/51(table10.1)
Neuropraxia-isareversiblephysiologicalnerveconductionblockinwhichspontaneouscomplete

recoveryoccursandthereisnochancesofdegeneration.
Axonotmesisdegenerationoccursdistaltothelesionandforafewmmretrograde.Theaxon
disintegratesandisresorbedbyphagocytescalledWALLERIANDEGENERATION.
Infetaldevelopmentdegenerationisbymechanismofapoptosis
Insenescencenervestartsdegeneratebecauseofnouseofnerve.

Q.13WithwhichoneofthefollowingLowermotorneuronlesionsareassociated?
1.Flaccidparalysis.
2.Hyperactivestretchreflex.
3.Spasticity.
4.Muscularincoordination.
Answeris1
Harrisonprincipleofinternalmedicine15thEd/134
LowerMotorNeuronWeakness
Lesionofant.Horncellorcranialnervenuclei.
Flaccidweaknessofmuscle
Lossofdeeptendonreflexes
Fasciculationofmusclefibers
Atrophyofmuscle

Lesionofthecellbodiesofbrainstemmotorcranialnervenucleiandtheanteriorhornofthe
spinalcord.Orfromdysfunctionoftheaxonsoftheseneuronsastheyreachestoskeletalmuscle.
Spasticity Uppermotorneurondisease
Rigidity Extrapyramidaldisorders
Leadpipe"or"plastic"stiffness Rednucleus
Cogwheel Parkinsonsdisease
Paratonia(gegenhalten) Diseaseofthefrontallobes
Flaccidity Lowermotorneuronlesion

Q.14Aspermiaisthetermusedtodescribe:
1.Absenceofsemen.
2.Absenceofsperminejaculate.
3.Absenceofspermmotility.
4.Occurrenceofabnormalsperm.
Answeris1
DORLANDDICTIONARY
ASPERMIAisabsenceofsemen
AZOOSPERMIAmeanabsenceofsperm
OLIGOZOOSPERMIAISlessthan20millonspermpermlofsemen.

Q.15WhichofthefollowingstatementscanberegardedasprimaryactionofInhibin?
1.Itinhibitssecretionofprolactin.
2.Itstimulatessynthesisofestradiol
3.ItstimulatessecretionofTSH.
4.ItinhibitssecretionofFSH.
Answeris4
Harrisonpricipleofinternalmedicine15thed/2157
GANONGREVIEWOFPHYSIOLOGY19THEDITION/127

InhibininhibitsthereleaseofFSHbythehypothalamic-pituitaryunit.
ActivinenhanceFSHsecretionaswellashavinglocaleffectsonovariansteroidogenesis.
FollistatinattenuatestheactionsofActivinandothermembersofthetransforminggrowthfactor
(TGF)family.

Q.16A40yearoldmale,withhistoryofdailyalcoholconsumptionforthelast7years,isbrought
tothehospitalemergencyroomwithacuteonsetofseeingsnakesallaroundhimintheroom,not
recognizingfamilymembers,violentbehaviorandtremulousnessforfewhours.Thereishistory
ofhishavingmissedthealcoholdrinksince2days.Examinationrevealsincreasedblood
pressure,tremors,increasedpsychomotoractivity,fearfulaffect,hallucinatorybehavior,
disorientation,
impairedjudgementandinsight.Heismostlikelytobesufferingfrom:
1.Alcoholichallucinosis.
2.Deliriumtremens.
3.Wernickeencephalopathy.
4.Korsakoffspsychosis.
Answeris2
Harrisonpricipleofinternalmedicine15thed/2565
AllIndiarepeatQof2003

Whenachronicalcoholicstopstakingalcoholthenwithdrawalsymptomsgenerallybeginwithin
5to10hofdecreasingethanolintake,peakinintensityonday2or3,andimprovebyday4or5.
Featuresincludetremorofthehands(shakesorjitters);agitationandanxiety;autonomicnervous
systemoveractivity.Thetermdeliriumtremens(DTs)referstodelirium(mentalconfusionwith
fluctuatinglevelsofconsciousness)alongwithatremor,severeagitation,andautonomicover
activity).Itistobenotedthatonly5to10%ofalcohol -dependentindividualseverexperience
DTs.

Q.17A45yearmalewithahistoryofalcoholdependencepresentswithconfusion,nystagmus
andataxia.Examinationreveals6thcranialnerveweakness.Heismostlikelytobesuffering
from:
1.Korsakoffspsychosis.
2.Wernickesencephalopathy.
3.DeClerambaultsyndrome.
4.Deliriumtremens.
Answeris2
Harrisonprincipleofinternalmedicine15thed/2562
AllIndiarepeatQof2004
Wernicke'sdiseaseisacommonandpreventabledisorderduetoadeficiencyofthiaminevitamin.

Alcoholicsaccountformostofthecasesofit.Thecharacteristicclinicaltriadisthatof
ophthalmoplegia,ataxia,andglobalconfusion.However,onlyone -thirdofpatientsof
Wernicke'sdiseasehavethisclassicclinicaltriad.
Ocularmotorabnormalitiesincludehorizontalnystagmusonlateralgaze,lateralrectuspalsy
(usuallybilateral),conjugategazepalsies,andrarelyptosis.
Thepupilsareusuallyspared,buttheymaybecomemioticwithadvanceddisease.
AtrophyoftheMamillarybodiesisseeninmostchroniccases.

Q.18A25yearoldfemalepresentswith2yearhistoryofrepetitive,irresistiblethoughtsof
contaminationwithdirtassociatedwithrepetitivehandwashing.Shereportsthesethoughtstobe
herownanddistressing;butisnotabletoovercomethemalongwithmedications.Sheismost
likelytobenefitfromwhichofthefollowingtherapies:
1.Exposureandresponseprevention.
2.Systematicdesensitization.
3.Assertivenesstraining.
4.Sensatefocusing.
Answeris1
Newoxfordtextbookofpsychiatry1sted/827-828

Althoughitisarepeatquestion,manyguideshasbeengiventheanswersystemic
desensitizationButaccordingtooxfordthebehavioraltherapyisaseffectiveaspharmacotherapy
inO.C.D.
Recently2neuroimagingstudiesfoundthatpatientwithO.C.D.,whoaresuccessfullytreatedwith
behavioraltherapyshowschangesincerebralmetabolismsimilartothosefoundbysuccessful
treatmentwithS.S.R.I.
TheprinciplebehavioralapproachinO.C.D.isexposureforobsessionandresponseprevention
forvirtual.
Desensitization,thoughtstopping,flooding,implosiontherapyandaversionconditioninghave
alsobeenusedin-patientwithO.C.D.

Q19An18yearoldboycametothePsychiatryOPDwithacomplaintoffeelingchangedfrom
inside.Hedescribedhimselfasfeelingstrangeasifheisdifferentfromhisnormalself.Hewas
verytenseandanxiousyetcouldnotpointouttheprecisechangeinhim.Thisphenomenaisbest
calledas:
1.Delusionalmood.
2.Depersonalization.
3.Autochthonousdelusion.
4.Overvaluedidea.
Answeris2
Neerajahujapsychiatry5thed/113
CharlisGMorrispsychology10thed/522
Essentialfeatureofdepersonalizationisthatpersonsuddenlyfeelschangedordifferentina
strangeway.ThiskindoffeelingisespeciallycommonduringadolescenceandyoungadultE.g.
A20yroldcollegestudentsoughtprofessionalhelpexperiencingepisodesoffeelingoutsideof
himselffor2yr.Atthesetimeshefeltgroggy,dizzy,andpreoccupied.
Delusionmoodandautochthonousdelusionarethefalsebeliefasperdefinition,butthisboy
doesnthavefalsebelief

Q.20Themajordifferencebetweentypicalandatypicalantipsychotics
isthat:
1.Thelattercauseminimalornoincreaseinprolactin.
2.Theformercausetardivedyskinesia.
3.Theformerareaavailableasparenteralpreparation.
4.Thelattercausesubstantialsedation.
Answeris2
K.D.T.Essentialofpharmacologyp396
Atypicalantipsychotic
Clzapine Tardivedyskinesiarase Prolactinlevel
Resperidone Tardivedyskinesiarase prolactionlevel
Olanapine Tardivedyskinesiarase littleinprolactinlevel
SomaindifferencebetweentypicalandatypicalantipsychoticislackofTardivedyskinesiain
atypicalantipsychotic.

Q.21Drymouthduringantidepressanttherapyiscausedbyblockadeof:
1.Muscarinicacetylcholinereceptors.
2.Serotonergicreceptors.
3.Dopaminergicreceptors.
4.GABAreceptors.
Answeris1
K.D.T.Essentialofpharmacologyp410
Anticholinergicsideeffectofantidepressantleadstodrymouthinthepatientsonthesedrugs.
DrymouthisduetotheMuscarinicacetylcholinereceptorantagonismofthesedrugs.

Q.22Allofthefollowingarehallucinogens,except:
1.LSD.
2.Phenylcyclidine.
3.Mescaline
4.Methylphenidate.
Answeris4
Hallucinogen
LSD
Mescaline
Psilocybin
Phenylcyclidine
Peyote

Phenylcyclidineisalsoknownasangeldust.?Methylphenidateisnotahallucinogen.ItisaCNS
stimulantandusedintreatmentofnarcolepsy.

Q.23An18-year-oldstudentcomplainsoflackofinterestinstudiesforlast6months.Hehas
frequentquarrelswithhisparentsandhasfrequentheadaches.Themostappropriateclinical
approachwouldbeto:
1.Leavehimasnormaladolescentproblem.
2.Ruleoutdepression.
3.Ruleoutmigraine.
4.Ruleoutanoppositionaldefiantdisorder.
Answeris1
Adolescenceisaperiodofstormandstress,fraughtwithsuffering,passion,andrebellionagainst
adultauthority(sotheymayhavefrequentquarrelswithhisparents).Between15 -30%of
adolescentstudentdropoutofhighschool,manyregularlyabusedrugs.Sotheproblemofinthis
q.isanormaladolescentproblem.
Thereisnosadnessinmood.Soitexcludesdepression
Frequentquarrelsandlossofinterestinstudiesonly,excludeMigraine.
Oppositionaldefiantdisorder-agegroupis8-12yr.

Q.24Preservationis:
1.Persistentandinappropriaterepletionofthesamethoughts.
2.Whenapatientfeelsverydistressedaboutit.
3.Characteristicofschizophrenia.
4.Characteristicofobsessivecompulsivedisorder(OCD)
Answeris1
Newoxfordtextbookofpsychiatry1sted/63
Neerajahujapsychiatry5thed/13
Perservationisfoundinmanyorganicmentaldisorders,itisnotcharacteristicof
schizophrenia.
Itisdefinedasaninabilitytoshiftfromonethemetoanotherone.Athoughtisretainedlongafter
ithasbecomeinappropriateinthegivencontext.Fore.g.apatientmaygiveacorrectanswerto
thefirstquestion,butrepeatsthesameresponsetoasubsequentlycompletelydifferentquestion.

Q.25Oneofthefollowingusuallydifferentiateshystericalsymptomsfromhypochondriacal
symptoms:
1.Symptomsdonotnormallyreflectunderstandablephysiologicalorpathologicalmechanisms.
2.Physicalsymptomsareprominentwhicharenotexplainedbyorganicfactors.
3.Personalitytraitsaresignificant.
4.Symptomsrunachroniccourse.
Answeris1

Q.26Whichoneofthefollowingistheinvestigationofchoiceforevaluationofsuspected
Perthesdisease?
1)PlainX-ray
2)Ultrasonography(US)
3)ComputedTomography(CT)
4)MagneticResonanceImaging.
Answeris4DahnertRadiologicalreviewmanual,5thEd,Pg -49
Haaga;CT/MRIofwholebody
MRIis90-100sensitiveand85-90%specificfordiagnosisofPerthesdiseaseandavascular
necrosis(Haaga).MRIcandetecttheearliestchangesinsignalintensityoftissues.Edemaseenas
ahigh-signal-intensity(bright)onMRIT2weightedimageasearliestsignofinflammation.
SoitistheinvestigationofchoiceinevaluationofsuspectedPerthe sdisease
IfQuestionwereNextstepinevaluationofpatient,orwhatwillbethefirstinvestigationof
choice?ThenanswerwillbePlainX-ray
PEARLPOINTSaboutLegg-Calve-Perthesdisease-Coxaplana
-Itisidiopathicavascularnecrosisoffemurhead
-Only10%casesarebilateral,
-M:Fratio-5:1,butinbilateralcasesM:Fis2:1
-WhenoccurInadultsitiscalledChandlersdisease
-LossofasterisksignseenonCT/MRI
-Doublelinesign(in80%ofcases)seenonMRI

Q.27.Eisenmengersyndromeischaracterizedbyallexcept:
1.Returnofleftventricleandrightventricletonormalsize.
2.Pulmonaryveinsnotdistended.
3.Pruningofperipheralpulmonaryarteries.
4.Dilatationofcentralpulmonaryarteries.
Answeris1DahnertRadiologicalreviewmanual,5thEd,Pg-627-628
CXRfindingsofEisenmengersyndrome
-Pronounceddilatationofcentralpulmonaryarteries
-Pruningofperipheralpulmonaryarteries
-EnlargedRV+RA
-ReturnofLA+LVtonormalsize
-Normalpulmonaryvein
-Noredistributionofpulmonaryvein(normalvenouspressure).

Q.28InwhichoneofthefollowingconditionstheSialographyiscontraindicated?
1.Ductalcalculus.
2.Chronicparotitis
3.Acuteparotitis
4.Recurrentsialadenitis.
Answeris3LB24TH/728

Mumpsisthemostcommoncauseofacutepainfullparotidswelling,thatpredominantlyaffectthe
children.acutebacterialparotitisismostcommonlycausedbystaph.Aureus.Sialographyis
absolutelycontraindicatedinacuteinfection.

Q.29ThemostcommonsiteofleakinCSFrhinorrheais:
1.Sphenoidsinus.
2.Frontalsinus.
3.Cribriformplate.
4.Tegmentympani.
Answeris3Snellsclinicalanatomy7thEd,Pg-802
Harrisonprincipleofinternalmedicine15thEd

Cribriformplateoftheethmoidbonemaybedamagedinthefracturesofant.cranialfossa.The
patientwillbehavingepistaxisandCSFrhinorrhea.CSFmayalsoleakthroughtheadjacent
sinus.Persistentrhinorrheaandrecurrentmeningitisareindicationsforsurgicalrepairoftorndura
andunderlyingfracture.
Pearlpointsaboutheadinjury.(Baileyandloves24thed/596)

Glialandmacrophagereactionsbeginwithin2daysafterbraincontusionandresultinscarred,
hemosiderin-staineddepressionsonthesurface(plaquesjaunes)afteryears.Thoseareone
sourceofposttraumaticepilepsythatoccursafteryearsoftheheadinjury.
Administrationofprophylacticantibioticinfracturebaseofskullgivesnobenefit.
Evenitcanincreasemorbidityandmortality.
DexamethasonehavingcontroversialroleintreatingraisedI.C.T.in -patientofhead
injury.ButithasadefiniteroleinraisedICTduetootherreason.
Fluidleakingfromnoseandearshouldbescreenedfor? -transferrin(tauprotein)to
confirmtheCSF.
FreshbloodclotandcoagulopathicproteinsgivesmixeddensityonCTcalledSWIRLsign
BlowoutfractureisfractureoforbitalfloorgivesTEARDROPsignonCT.

Q.30Whichofthefollowingisthemostcommonrenalcysticdiseaseininfantsis?
1.Polycystickidney.
2.Simplerenalcyst.
3.Unilateralrenaldysplasia.
4.Calycealcyst.
Answeris3Currentpediatricdiagnosisandtreatment,11thEd,Pg -15;
DahnertRadiologicalreview,5thEd,Pg -928-929

-Mostabdominalmassesinthenewbornareassociatedwiththekidneys(multicysticdysplastic
kidney,hydronephrosis,etc)
-MCDKisPottertypeIIcyst
-Itissecondmostcommoncauseofanabdominalmassinneonate(afterhydronephrosis)
-Itismostcommonformofcysticdiseaseininfants
-U/LMCDKisthemostcommonformofmulticysticdysplastickidney(80 -90%).Lt:Rtratio
2:1
-Nuclearstudies(99m-TcMAG3)preferredoverIVPforevaluationofthefunctionofkidneys,
becauseinfirstmonthoflifetheconcentratingabilityofevennormalneonatalkidneysis
suboptimal.

Q.31Themostcommontypeoftotalanomalouspulmonaryvenousconnectionis:
1.Supracardiac.
2.Infracardiac
3.Mixed.
4.Cardiac.
Answeris1Ref -C.P.D.T;11Ed/557
DahnertRadiologicalreview,5thEd,Pg-603
TAPVCItisclassifiedaccordingtothesiteofentryofpulmonaryveinintotherightoftheheart

Type1(55%)entryintoleftSVCorRtSVC(Supracardiac)
Type2-entryintoRtatriumorcoronary(cardiac)
Type3-entryinportalvein(Infracardiac)
Type4mixed

Q.32Whichoneofthefollowingisthemostcommonlocationofhypertensivebleedinthebrain?
1.Putamen/externalcapsule.
2.Pons.
3.Ventricles.
4.Lobarwhitematter.
Answeris1Harrisonprincipleofinternalmedicine15thed/2386
Intraparenchymalhemorrhageismostcommontypeofintracranialhemorrhage.
Hypertension,trauma,andcerebralamyloidangiopathyareamongtheimp.causes.Advancedage
andheavyalcoholconsumptionalsoincreasetherisk.Cocaineuseisoneofthemostimportant
causesofitintheyoungadults.
ThemostcommonsitesofIntraparenchymalbleedarethebasalganglia(Putamen,thalamus,
andadjacentdeepwhitematter),deepcerebellum,andPons.ThePutamenisthemostcommon
siteforhypertensivehemorrhage

Q.33Whichoneofthefollowingisthemostpreferredroutetoperformcerebralangiography?
1)Transfemoralroute
2)Transmaxillaryroute
3)DirectCarotidPuncture
4)Transbranchialroute.

GraingerandAllisonsDiagnosticRadiology4thed./150
Harrisoninternalmedicine15thed/.
Itispossibletoopacityarteriesinmanyareasofthebodyusingadirectpercutaneousneedle
puncture.

Thecommoncarotidandvertebralarteriescanbepuncturedintheneckusingananterior
approachtoobtainarteriogramsofthecarotidandvertebrobasilarsystems;thesubclavian,
axillaryorbrachialarteriescanbepuncturedforupperlimbarteriography,theabdominalaorta
(highorlow)forlumbar,pelvicandlegarteriography;andthefemoralarteryforsingleleg
studies.
ButnowPercutaneousstudiesintheheadandneckandupperlimbhavebeenlargelysupplanted
bythetransfemoralcathetermethod.
GraingerandAllinsonDiagnosticRadiology4thed.
Harrisoninternalmedicine15thed/.

Q.34Whichoneofthefollowingsofttissuesarcomasfrequently
metastasizestolymphnodes?
1.Fibrosarcoma.
2.Osteosarcoma.
3.EmbryonalRhabdomyosarcoma.
4.Alveolarsoftpartsarcoma.
Answeris3
Sarcomastendtometastasizethroughthebloodratherthanthelymphaticsystem;lymphnode
metastasesoccurin5%ofcases.
Exceptionsare
Synovialandepithelioidsarcomas,
Clear-cellsarcoma(melanomaofthesoftparts),
Angiosarcoma,and
Rhabdomyosarcoma

Wherenodalspreadmaybeseenin17%
Thepulmonaryparenchymaisthemostcommonsiteofmetastasesin
sarcomas.Exceptionsare
Leiomyosarcomas of GIT Liver
Myxoid liposarcomas Seekfattytissue
Clear-cell sarcomas Bones
Alveolar soft part sarcoma CNS
ThehistologicalgradeisthemostimportantprognosticfactorsOFSARCOMAS.
InthetreatmentofsarcomasDoxorubicin(Adriamycinistradename) -basedchemotherapyis
favored(asinLeiomyosarcomas).

Q.35Whichoneofthefollowingradioisotopeisnotusedaspermanentimplant?
1.Iodine-125
2.Palladium-103.
3.Gold-198.
4.Caesium-137.
Regionaltherapyofadvancedcarrier,MichaelT.Lutze.JushuaT.Rubin.Isted/184.
R.C.S.Pointon,TheRadiotherapyofmalignantDisease2nded/7.
Radioisotopesused,aspermanentimplantisknownasbrachytherapy.

Brachytherapysources.Someoftheseradionuclides,e.g.radium -226,areaccompaniedbyan
equilibriumamountofoneormoreradioactivedaughterproducts,whichhavedifferenthalf -lives
andemitdifferentradiations.
Radionuclide Radiation emitted Half-life
Radium-226 Gamma rays Gamma rays
Caesium-137 Gamma rays 30 years
Cobalt-60 Gamma rays 5.26 years
Indium-192 Gamma rays 74 days
Gold-198 Gamma rays 2.7 days
Strontium-90 Beta rays 28.1 years
Yttrium-90 Beta rays 64 hours

-Caesium137sourcearenowmorecommonlyused.
-Gold198isusedforPermanentgoldseedimplant.
-Stronum90-Bone
Yitrium90-Pituitarygland
Iodine125-CNSmetastasis(RUBIN)

Q.36WhichoneofthefollowingtumorsshowscalcificationonCTscan?
1.Ependymoma
2.Meduloblastoma.
3.Meningioma.
4.CNSlymphoma.
Answeris3
Dahnert;Radiologicalreviewmanual5thEd/299
CTfindingsofMeningioma
1.Sharplydemarcatedwellcircumcisedslowlygrowingmass
2.Wideattachmenttoadjacentduramater
3.Corticalbucklingofunderlyingbrain
4.Hyperdense(70-75%duetopsammomatouscalcification)lesiononNECT
5.Calcificationascircular/radialpatternseenonCTin20 -25%cases
6.Hyperostosisofadjacentbone(in18%)
MRI findings Angiography mother in law phenomenon
1 Dural tail sign in 60 % of cases 1 Sunburst or spoke-wheel pattern of vascularity,
2 Hypervascularity 2 Early draining vein

Finepunctuatemultifocalcalcificationoccursin25-50%ofEpendymoma.Butthesearenot
clearlyevidentonCTscan.

D/Dofsuprasellarmasswithcalcification
-Craniopharyngioma(90%havecalcification)
-Meningioma(25%calcifiedasseenonCT)
-Granuloma
-Dermoid/Teratoma
-RarelyhypothalamicGliomaorOpticGlioma

Q.37Thetechniqueemployedinradiotherapytocounteracttheeffectoftumormotiondueto
breathingisknownas:
1.Arctechnique.
2.Modulation.
3.Gating.
4.Shunting.
Answeris3GraingerandAllison s,diagnosticradiology4thed/143Gatedimaging

Whenanymotionofbodyproducesdisturbanceandmotionrelatedartifactinimagesin
Radiologyorduringradiotherapy,thengatingisdonetoreducethemotionrelatedartifacts.

Ifcardiacmotion-ECGgatingdone
Ifrespiratorymotion-Diaphragmaticgatingdone.

Q.38Inwhichofthefollowingdiseases,theoverallsurvivalisincreasedbyscreeningprocedure?
1Prostatecancer.
2Lungcancer.
3Coloncancer.
4Ovariancancer.
Answeris3
Widespreadscreeningforbreast,cervical,andcoloncancerisbeneficialforcertainagegroups
Breast CancerAnnualorbiennialscreeningwith Lung Cancer Screening chest radiographs
mammographyormammographyplusclinicalbreast and sputum cytology has been evaluated as
examinationinwomenovertheageof50saveslives. methods for lung cancer screening. No
reduction in lung cancer mortality has been
found
Colorectal CancerAnnualfecaloccultblood Cervical CancerScreeningwithPapanicolaousmears
testingusinghydratedspecimenscouldreduce decreasescervicalcancermortality.Guidelines
colorectalcancermortalitybyathird.Twocase-control recommendregularPaptestingforallwomenwhoare
studiessuggestthatregularscreeningofpeopleover50 sexuallyactiveorhavereachedtheageof18.The
withsigmoidoscopydecreasesmortality. recommendedintervalforPapscreeningvariesfrom1
to3years

Q.39GammacamerainNuclearMedicineisusedfor:
1Organimaging.
2Measuringtheradioactivity.
3Monitoringthesurfacecontamination.
4RIA.
Answeris2WalterMiller,TextbookofRadiotherapy;Pg-112
GraingerandAllisondiagnosticradiology4thEd/141
Gammacameraisthedevicesusedtoobservethedistributionofanisotopeinanorgan,orina
partofthebody.Itreceivesthegammarayphotonsfrompatientthroughagridofthousandsof
holesdrilledparalleltoeachother.Gammacamerameasurestheradioactivityinbodythenforms
aimage
GAMMACAMERAISUsedfordetectionofradioactivityINBODY.TheM/Cuseddetectoris
scintillationdetector.
Scintillators-whenthesearestruckbyaphotonofX-rayorgammaraytheyscintillate
(releasedasaflashoflight).Ingammacamera -ScintillatorusedismadeuptoNaIcrystal.

Q.40Att=0thereare6x1023radioactiveatomsofasubstance,whichdecaywithadisintegration
constant()equalto0.01/sec.Whatwouldbetheinitialdecayrate?
16x1023
26x1022
36x1021
46x1020
Answeris3
GraingerandAllisons.Diagnosticradiology4thed/140.
Radioactivedecay-
-dN1
=-
dtN
=isdecayconstant
dN
=isdecayrate.Itdt=isfromstarting(dt=T 2-T1)
dtitT1is0thandt=t
WhenT1is0-itiscalledinitialdecaydN=iscalledinitialdecayrate.
t
SoinitialdecayroledN=-XN=.001x6x10 23
=10 -2x6x10 23

21 istheanswer
=6x10
-Initialdecayrate=radioactiveatomsinitiallyxdisintegrationconstant
=6x10(23)x.01
=6x10(21)

Q.41An18-year-oldboycomestotheeyecasualtywithhistoryofinjurywithatennisball.On
examinationthereisnoperforationbutthereishyphaema.Themostlikelysourceofthebloodis
1Irisvessels.
2Circulusiridismajor.
3Circulusiridisminor.
4Shortposteriorciliaryvessels.
Answeris2Parsondiseaseofeye19thed/16,407
CirculusArteriosusmajorsituatedalongthebaseofirisintheciliarybody.
Circulusarteriosusminoralongpapillarymargin
Aconcussioninjurytoiris,especiallyangleresectionleadstohemorrhageintheant.
Chambercalledhyphaema.

Q.42A25-year-oldmalegiveshistoryofsuddenpainlesslossofvisioninoneeyeforthepast
2weeks.Thereisnohistoryoftrauma.Onexaminationtheanteriorsegmentisnormalbutthereis
nofundalglow.Whichoneofthefollowingisthemostlikelycause?
1Vitreoushaemorrhage.
2Opticatrophy.
3Developmentalcataract.
4Acuteattackofangleclosureglaucoma.
Answeris1
Parsondiseaseofeye19thed/360
A.K.Khuranaophthalmology2nded/11
Opticatrophy Painlessbutgraduallossofvision
Developmentalcataract Painlessbutgraduallossofvision
Acuteattackofangleclosureglaucoma Painful,suddenlossofvision
Vitreoushemorrhage Painless,suddenonsetfallinvision
Q.43Themotherofaoneandahalfyearoldchildgiveshistoryofawhitereflexfromoneeyefor
thepast1month.Oncomputedtomographyscanoftheorbitthereiscalcificationseenwithinthe
globe.Themostlikelydiagnosisis:
1Congenitalcataract.
2Retinoblastoma.
3Endophthalmitis.
4Coatsofdisease.
Answeris2
WolfgangDahnertRadiologyReviewManual5thed/345
KanskisClinicalOphthalmologyPg-338.
-Leukocoria(whitepapillaryreflex)ismostcommonsign(inabout60%ofcases).
-Strabismus-2ndmostcommonsign(20%ofcases).
-AnteriorsegmentinvasionbyRetinoblastomaisararepresentation,ifitoccurs,isseeninolder
childrenwithanaverageage>6yrs.
-Metastasisseentotheregionallymphnodesandbrain.
-USGdetectthepresenceofcalcificationatcalculatestumordimension
- CT can alsodetectcalcification; alsodetectgrossinvolvementofopticnerve,orbital andCNS
extension.
-MRIismoreusefulforopticnerveevaluation.

Q.44Enlargedcornealnervesmaybeseeninallofthefollowingexcept:
1Keratoconus.
2Herpessimplexkeratitis.
3Leprosy.
4Neurofibromatosis.
AnswerIs2
Ref.GraysonsDiseasesoftheCornea,4thEdpg-50
Cornealnervesmaybeseeninnormaleyesasfinebranchingwhitelines.
That originates at the limbus in the mid stroma and become more anterior centrally. Corneal
nervesarevisualizedmoreclearlywhentheyarethickened.
-Causesofthickenedcornealnervesare
Fuchsdystrophy
Keratoconus
Neurofibromatosis
Refsumsdisease
IchthyosisLeprosy
Congenitalglaucoma
MultipleEndocrineneoplasia
UseofCannabisSativa
Aging

Q.45UndertheWHOVision2020programme,theSAFEstrategyisadoptedforwhichofthe
followingdiseases?
1Trachoma.
2Glaucoma.
3Diabeticretinopathy.
4Onchocerciasis.
Answeris1(trachoma)
WHOMANNUALOFOPHTH.
Itisarepeatquestion
GET2020(globaleliminationofglaucoma) waslaunched underleadership of W.H.O.in 1997.
ThroughthistheprimaryhealthcareapproachesarebasedonevidencebasedSAFEstrategy.
Ssurgery
Aantibiotic
Ffacialcleanness
Eenvironmentalchanges

Q.46TypeIhypersensitivityismediatedbywhichofthefollowingimmunoglobulins?
1IgA.
2IgG.
3IgM.
4IgE.
Answeris4H15TH/1827

TypeIImmediateReactionHypersensitivity
1Firstexposuresensitizeshost
2MacrophagesandBcellspresentepitopestoTh2cells,whichproduceinterleukin(IL) -4
3IL-4causesclassswitchtoIgE
4MastcellsandbasophilsbindIgEtohigh -affinityreceptors
5IgEcross-linkinginitiatesgranulerelease
These granules contain histamine, heparin, and proteases that induce edema, increased mucus
secretion,andsmoothmusclecontraction;thisistheimmediatereactionthatoccurs

Q.47Hornerssyndromeischaracterizedbyallofthefollowingexcept:
1Miosis.
2Enophthalmos
3Ptosis.
4Cycloplegia
Answeris4H15TH/564

Sympathetic nerve paralysis leads to Horner's syndrome (enophthalmos, ptosis, miosis, and
ipsilateral loss of sweating and loss of ciliospinal reflex). Triad of Horner's syndrome? miosis
with ipsilateral ptosis and anhidrosis constitutes Horner's syndrome, although anhidrosis is an
inconstantfeature.Twootherfeaturesarelossofciliospinalreflexandenophthalmos.Butthese
don,tconstitutethepartoftriad.Cycloplegiaisnotafeatureofit.

Q.48Thesuperiorobliquemuscleissuppliedby:
13rdcranialnerve.
24thcranialnerve.
35thcranialnerve.
46thcranialnerve.
Answeris2
TrochlearNerve
Thefourthcranialnerveoriginatesinthemidbrain,justcaudaltotheoculomotorNervecomplex.
Onlynervethatexitthebrainstemdorsallyandcrosstoinnervatethe
Contralateralsuperioroblique.
Theprincipalactionsofthismusclearetodepressandtointorttheglobe.Palsy
Thereforeresultsinhypertropiaandexcyclotorsion."Headtilttest"isa
cardinaldiagnosticfeature.

Note?Trochlearnerveislongestintracranialnerve.While10thnerveislongestcranialnerve.
Abducentisnotthelongestintracranialnervebutitismostcommonnerveinvolvedinraised
I.C.T.andgivespseudolocalisingsign(Duttasanatomy).

Q.49WhichofthefollowingstatementistrueregardingAcanthamoebakeratitis?
1Fortheisolationofthecausativeagent,cornealscrapingshouldbe
culturedonanutrientagarplate.
2Thecausativeagent,Acanthamoebaisahelminthwhosenormal
habitatissoil.
3KeratitisduetoAcanthamoebaisnotseeninthe
immunocompromisedhost.
4Acanthamoebadoesnotdependuponahumanhostforthe
completionofitslifecycle.
Answeris4

Free-livingamebasareAcanthamoeba,Naegleria,andBalamuthiaaredistributedthroughoutthe
worldandhavebeenisolatedfromawidevarietyoffreshandbrackishwater.Theydontneedof
ahumanhostforthecompletionofitslifecycle.
Riskfactorsfortheirinfection
Lymphoproliferative Chemotherapy
disordersGlucocorticoidtherapy Lupuserythematosus
AIDS Useofhomemadesaline
Wearingoflenseswhileswimming Inadequatedisinfections.
PEARLPOINTS
CultureisdoneonnonnutrientagarplatesseededwithEscherichiacoli.
Fluorescein-labeledantiserumisavailableforthedetectionofprotozoainbiopsyspecimens.
Examinationofthecerebrospinalfluidfortrophozoitesmaybediagnosticallyhelpful,butlumbar
puncturemaybecontraindicatedbecauseofincreasedintracerebralpressure.
The persistence of Legionella pneumophila in water supplies may be attributable to chronic
infectionoftheseamebas,particularlyNaegleria.
The characteristic clinical sign is an annular, Para central corneal ring representing a corneal
abscess.

Q.50A30-year-oldmanhas6/5visioneacheye,unaided.Hiscycloplegicretinoscopyis+1.0D
sph.at1meterdistance.Hiscomplaintsareblurringofnewsprintat30cm.thatclearsupinabout
twominutes.Themostprobablediagnosisis:
1Hypermetropia.
2Presbyopia.
3Accommodativeinertia.
4Cycloplegia.
Answeris3
GunterK.VonNoorden,Binocularvisionandocularmortality6thed/86.
A blurred retinal image is the stimulus to accommodation. Then accommodation starts and
completed with in few seconds. In accommodation inertia - accommodation is slow to come in
actionbutPersonultimatelyaccommodates,ittakesfewminutestofullyaccommodate.
AccommodationisofthereciprocaloftheFixationdistance.Thusiffixationdistanceis1met
-accommodationis1D.
If1/2meter-2D.
If1/3meter-3D.

Q.51Contactlenswearisproventohavedeleteriouseffectsonthecornealphysiologywhichof
thefollowingstatementsisincorrectinconnectionwithcontactlenswear?
1Thelevelofglucoseavailabilityinthecornealepitheliumisreduced.
2Thereisareductioninhemidesmosomedensity.
3ThereisincreasedproductionofCO2intheepithelium.
4Thereisareductioninglucoseutilizationbycornealepithelium
Answeris4
GraysonDiseaseofCornea4thed./25.

Effectofcontactlenswearonepithelialmetabolism.
A.Normalstate.Mostoftheoxygendiffusesthroughthetearsfromtheatmosphere;glucoseis
supplied by the aqueous humor; carbon dioxide is released into the atmosphere; lactate diffuses
intotheaqueoushumor.
B, During polymethylmethacrylate lens wear, oxygen supply and carbon dioxide release are
impaired and must occur through passage of tears beneath the lens. As a result of hypoxia,
glucosedemandandlactateproductionareincreased.
C, During hydrophilic contact lens wear, oxygen supply is improved because some oxygen can
passthroughthelens,butglucosedemandandlactateproductionareincreasedmoderately.
D, With highly oxygen-permeable rigid contact lenses, oxygen supply, glucose demand, and
lactateproductionarenearnormal.
1)Duringhypoxia.

Glucoseutilizationbyanaerobiosis(soincreasedutilizationbecauseofblockinkreb,scycle.)

lactateaccumulateanditincreasesosmoticsoluteload

It leads to stromal edema and reduction in hemidesmosome activity.
Q.52Lumbarsympathectomyisofvalueinthemanagementof:
1Intermittentclaudication.
2Distalischemiaaffectingtheskinofthetoes.
3ArteriovenousFistula.
4Backpain.
Answeris2
H.GeorgeBurkitt/CliveRGQuick,Essentialsurgery,problem,diagnosis
andmanagement3rded/459

Bloodflowinskinincontrolledbysympatheticnervoussystembutnotinmuscle(specially
duringexercise).Claudicationisduetomuscleischemiaduringexercisewhilerestpainisdueto
skinischemia.Sorestpaininskinmaysometimeberelievedbysympatheticblockadebut
claudicationisneverrelieved.SoclaudicationiscontraindicationfortheSympathectomy
Sympathectomyisofnovalueinintermittentclaudication,asitdoesnotinfluencemuscleblood
flow.Itissuccessfulinearlyrestpain.Itmayalsobehelpfulinhealingulcerwheremoderate
ischemiaispresentincombinationwithsomeotherfactorsuchaschronicvenousinsufficiency.
PEARLSPOINTS
Lumbarsympathectomydonewithextraperitonealapproach.
Chemicalsympathectomydonewith6%aqueousphenol.
Medicalsympathectomy-MethylDopa.

1Intermittentclaudicationiscontraindicationforsympathectomy,
2Restpainisanindication
3A.Vfistulatreatedwithsurgery.noroleofsympathectomyisthere
4Backpain(radicularnerveblockcanbedone),sopainrelieved
5Sympathectomydilatationofarteriesoccur-soeffectiveindistalischemiaaffectingtheskin&
toes
Indicationofsympathectomy
1.Restpain
2.Causalgia
3.Hyperhydrosis
4.DefinitetreatmentofcongenitalprolongedQTsyndrome

Q.53Abloodstaineddischargefromthenippleindicatesoneofthefollowing:
1Breastabscess.
2Fibroadenoma.
3DuctPapilloma.
4FatNecrosisofBreast.
Answeris3LB24TH/828Essentialsurgery/3rdEd
Nippledischarge
Milky Pregnancyorhyperprolactinaemia
Clear Physiological
Green Perimenopausal,ductectasia,fibroadenoticcyst
Blood-stained Possiblecarcinomaorintraductpapilloma.

RecentinversionSuggestsafibrosingunderlyinglesionsuchascarcinomaormammaryduct
ectasis.
Eczema(rashinvolvingnippleorareola,orboth)ifunilateral,thisistheclassicsignofPaget s
diseaseofthenipple,apresentationofbreastcancer.
Ductpapillomasbenignhyperplasticlesionsratherthanneoplasmsandarenotpremalignant.Duct
papillomaspresentwithnipplebleedingorablood-staineddischarge.Thedifferentialdiagnosis
thusincludesintraductcarcinomaandinfiltratingcarcinomawhichmustbeexcluded.
DuctographymayconfirmthepresenceofaductPapilloma(Fig.39.23).Ductpapillomasare
usuallytreatedbysurgicalexcisionoftheaffectedsegmentofbreast(microdochectomy).The
affectedsegmentisidentifiedduringoperationbypassingaprobeintotheductfromwhereblood
canbeexpressed.

Q.54Theearliestmanifestationofincreasedintracranialpressurefollowingheadinjuryis:
a.Ipsilateralpapillarydilation.
b.Contralateralpapillarydilatation.
c.Alteredmentalstatus.
d.Hemiparesis.
Answeris3
Baileyandloves24thed/610
Essentialsurgery3RDED/pg138
Thesefindingareinserialeventsofmanifestationofraisedintracranialtension
Observation Observation
Conscious level (Glasgow come Falling score
scale) Dilatation,lossoflightreactionor
Pupil size and light response developing asymmetry
Respiratory pattern and rate Irregularity, slowing or reduced depth ofbreathing.
Developing neurological signs Focal signs point to localized intracranial damage. Falling
Pulse rate pulse rate (late sign)
Blood pressure Rising blood pressure (late sign)

Q.55InwhichofthefollowingconditionsSplenectomyisnotuseful?
1Hereditaryspherocytosis.
2Porphyria.
3Thalassemia.
4Sicklecelldiseasewithlargespleen.
Answeris2
Harrisonprincipleofinternalmedicine15thed/670,672,673
HEREDITARYSPHEROCYTOSIS
Themajorclinicalfeaturesofhereditaryspherocytosisareanemia,splenomegaly,and
jaundice.Splenectomyreliablycorrectstheanemia,althoughtheRBCdefectanditsconsequent
morphologypersist.Theoperativeriskislow.RBCsurvivalafterSplenectomyisnormalor
nearly
ItshouldbenotedthatCholecystectomyshouldnotbeperformedwithoutSplenectomyinany
patientofhemolyticanemia,asintrahepaticgallstonesmayresult.
Splenectomyinchildrenshouldbepostponeduntilage4,ifpossible,tominimizetheriskof
severeinfectionswithgram-positiveencapsulatedorganisms.Polyvalentpneumococcalvaccine
shouldbeadministeredatleast2weeksbeforesplenectomy.

THALLESSIMIA
In-patientofthallessimiaSplenectomyisrequirediftheannualtransfusionrequirement,volume
ofRBCsperkilogrambodyweightperyearincreasesby50%.
SICKLECELLANEMIA
Insicklecellanemiarepeatedmicroinfarctionintissuesoccurduetosickling.Thus,thespleenis
frequentlyinfarctedwithinthefirst18to36monthsoflifecalledautosplenectomy,causing
susceptibilitytoinfection,particularlyfrompneumococci.Acutevenousobstructionofthespleen
(splenicsequestrationcrisisleadstocongestivesplenomegaly),arareoccurrenceinearly
childhood,mayrequireemergencytransfusionand/orsplenectomytopreventtrappingofthe
entirearterialoutputintheobstructedspleen.
Q.56Thefollowingisidealforthetreatmentwithinjectionofsclerosingagents.
1Externalhemorrhoids.
2Internalhemorrhoids.
3Prolapsedhemorrhoids.
4Strangulatedhemorrhoids.
Answeris2
CMDT2004/619,
BaileyandLovesSurgery24thed/1257.
Thereis3degreeofhemorrhoidsaccordingtoposition.
Istdegree Bleedonly,notprolapsed(internal)
2nddegree Prolapsed but will reduce spontaneously or can be reduced
digitallyandwillremainreduced
3rd degree Continuouslyremainprolapsed.
StageI&II Injectionsclerotherapyorrubberbanding
StageIII Hemorrhoidectomy.
MaterialcommonlyusedofinjectionsclerotherapyisPhenol,Almondoil,
Iodoquinone,Aceticacidcannotbeusedbecauseitisaveryweaksclerosingagent.

StageII -spontaneouslyreduced
2 nddegree
isfurtherStageIII -ISmanuallyreduced.
dividedin

Q.57Inwhichofthefollowinglocations.Carcinoidtumorismostcommon?
1Esophagus.
2Stomach.
3Smallbowel.
4Appendix.
Answeris4

AccordingtoHarrisontheileumisthemostcommonsiteofcarcinoid.Butallotherbooks
(Robbins7thed,Schwartzsurgery,Dahnertradiology,Margulisgastrointestinalradiology,
Sabistonsurgery,Devita,scancers,CSDTetc.)stillsaythatAppendixisthemostcommonsite
forcarcinoid.Soinmyopinionanswerwillbeappendix.

Q.58Pancreatitis,pituitarytumorandphaeochromocytomamaybeassociatedwith:
1Medullarycarcinomaofthyroid.
2Papillarycarcinomaofthyroid.
3Anaplasticcarcinomaofthyroid.
4Follicularcarcinomaofthyroid.
Answeris1
MEN1Wermer's Parathyroidadenoma
syndrome Pituitary
Pancreaticisletcellstumors(Gastrinoma)
MEN2A MTC0Parathyroidadenoma
Sipplesyndrome Phaeochromocytoma
MEN2B0MucosalNeuromasyndrome Phaeochromocytoma
MucosalNeuroma
Intestinalganglioneuromatosis
Marfanoidfeatures
OnlythyroidtumorassociatedwithMENsyndromeisMTC(Medullarycarcinomaofthyroid.)
MEN1gene,locatedonchromosome11q13,
Mutationsofthe-RETproto-oncogenehavebeenidentifiedin93to95%ofpatientswithMEN
2,butitislocatedon10thchromosome.

Q.59ardenerssyndromeisararehereditarydisorderinvolvingthecolon.Itischaracterizedby:
1Polyposiscolon,cancerthyroid,skinstumors.
2Polyposisinjejunum,pituitaryadenomaandskintumors.
3Polyposiscolon,osteomas,epidermalinclusioncystsandfibroustumorsintheskin.
4Polyposisofgastrointestinaltract,cholangiocarcinomaandskintumors.
Answeris3
Gardner'ssyndrome. Osteomas,Epidermalinclusioncyst,
Retinalfreckle,MesentericDesmoid
Ampullarycancers,Polyposiscoli
Turcot's syndrome. CNSGlioma,Polyposiscoli
Q.60Themostcommoncancer,affectingIndianurbanwomeninDelhi,MumbaiandChennai,is:
1CervicalCancer.
2OvarianCancer.
3Breastcancer.
4UterineCancer.
Answeris3
-K.PurkP.S.M,17thed/PG.287,Table2.
OverallM/CCancerinIndiaisC.A.Cervix.
M/CCancerofruralarea-C.A.cervix.
M/CcancerinUrbanarea-C.A.Breast.
M/CCancerofmaleinIndia-ofC.A.oforodigestivetract.
InDelhiandMumbai-C.A.Breastismostcommoncancer

Q.61Allofthefollowingaretrueforpatientsofulcerativecolitisassociatedwithprimary
sclerosingcholangitis(PSC),except:
1Theymaydevelopbiliarycirrhosis.
2Mayhaveraisedalkalinephosphatase.
3Increasedriskofhilarcholangiocarcinoma.
4PSCrevertsafteratotalcolectomy.
Answeris4
CMDT2004/604Robbins7thEd/915Harrison16thEd/1784
Primarysclerosingcholangitis(PSC)ischaracterizedbybothintrahepaticandextrahepaticbile
ductinflammationandfibrosis,frequentlyleadingtosecondarybiliarycirrhosisandhepatic
failure.About1to5%ofpatientswithIBDhavePSC,but50to75%ofpatientswithPSChave
IBD.itcanberecognizedafterthediagnosisofIBDandPSCcanbedetectedearlierorevenyears
afterproctocolectomy.Duringacuteattackpatientshaveraisedlevelofalkalinephosphatase.
Patientswiththisentityareathigherriskofdevelopingcholangiocarcinoma.

Importantpointaboutulcerativecolitisincontrastwithcrohnsdisease
1RiskofcarcinomaissignificantlyhigherinU.C.thanC.D.
2Toxicmegacolondevelopsin<2%ofcasesofU.C.,itcanalsooccurinC.D.
3SteroidisnotusedasamaintenancetherapyinthetreatmentofU.C.
4P-ANCA-veandASCA+vehasa95%positivepredictivevalueand92%
SpecificityfordiagnosisofC.D.
5P-ANCA+veandASCA-vehasa88%PPVand98%specificityfor
DiagnosisofU.C.

Q.62Whichoneofthefollowingisnotafeatureofliverhistologyinnon -cirrhoticportalfibrosis
(NCPF)?
1Fibrosisinandaroundtheportaltracts.
2Thrombosisofthemediumandsmallportalveinbranches.
3Nonspecificinflammatorycellinfiltratesintheportaltracts.
4Bridgingfibrosis.
Answeris4
SchiffsDiseasesofliver8thed/406
Robbinspathology/Andersonspathology
DahnertRadiologicalreviewmanual5thed/682

BANTIsyndrome=NONCIRRHOTICPORTALFIBROSIS=Hepatorenal
Sclerosis=IdiopathicportalHTN.
Itischaracterizedbysplenomegaly,hypersplenism;portalHTN,butthereisnofeatureof
cirrhosisandofliverfailure.SothereareabsenceofAscites,encephalopathy,othersignsofliver
failureandBridgingfibrosis,whichisthecharacteristichistologicalfindingofcirrhoticliver.So
theComplicationofdiseasewelltoleratedandisnotassociatedwiththedismalprognosisof
varicealbleedingincirrhoticpatient.Itischaracterizedbygastroesophagealvaricealhemorrhage
inayoungpatientwithprominentsplenomegaly.

POSTULATEDETIOLOGIES
Arsenicexposure Malaria
Ch.bacterialinfection Immunologicderangements
Geneticpredisposition
HISTOPATHOLOGY
-Mainlesiondescribedasanobliterativeportalvenopathyofliver withpatchy
Segmentalsubendothelialthickeningofintrahepaticportalveins.
-Thrombusformationwithvariableobliterationorrecanalization.
-Scarringandfibrosisofportaltract.
-Fibrosisprominentinextrahepaticportalveinanditsintrahepaticbranches.
-Liversurfacemayappearsnodularbutitisnevercirrhotic
-Wideningandfibrosisofspaceofdisse
-Capillarizationofsinusoids
-Non-specificinflammatorycellinportaltractsleadstofibroticreaction.
-NCPFCommoninIndia+Japan.
-Malepredominanceseenwithmeanage25-35yr
-DifferenceinJapaneseandIndian-
Allpatienthasincreaseportalandsplenicpressure.Japanesehaveelevatedhepatovenousportal
gradient(HVPG),whileIndianmayhavenormalorincreaseHVPG
Japanesearelikelytohave10-20yrolderandshowsfemalepredominance.
-Imagingmodalityofchoice-splenoportographywithhelpofDoppler(Dopplerflowmetry).
-Bestinvestigationis-liverbiopsy.

Q.63Themostcommoncomplicationseeninhiatusherniais:
1Oesophagitis.
2Aspirationpneumonitis.
3Volvulus.
4Esophagealstricture.
Answeris1
RobbinsPathologicbasisofdisease7ED/802
DahnertRadiologicalreviewmanual5thed/p832.
RefluxOesophagitisisfrequentlyseeninassociationwithslidinghernias
AssociationofHiatushernia
RefluxOesophagitis(25%) Duodenalulcer(20%)
Diverticulosis(25%) Gallstones(18%).

Q.64PatientsofRectovaginalfistulashouldbeinitiallytreatedwith:
1Colostomy.
2Primaryrepair.
3Colporrhaphy.
4Anteriorresection.
Answeris2
MaggotsAbdominalSurgeryEd./p.2147-49
PriortosurgeryofRectovaginalfistula,acomplete3 -daymechanicalandantibioticbowel
preparationshouldbeperformedandcolonmustbecompletelyemptied,cleansedandsterilized
priortosurgery.Whenallsignsofinfectionhaveresolved,noevidenceoffistulitisisthere,and
freshgranulationtissueispresent,theprimaryrepaircanbeperformed.
Eveninrecurrentfistulasorfistulasafterpelvicirradiation,theyrecommendaMartiusgraft
techniqueforrepair.Soeveninrecurrentconditiontheydoesnotperformthecolostomyinitially.
Whetherornottoperformadivertingcolostomy?TherePreferenceisnottoperformacolostomy
inindividualsundergoingtheirfirstrepairwithaMartiusgraft.
-Colporrhaphydoneinprolapseduterus
-AnteriorresectiondoneinC.A.rectum.

Q.65Ayoungwomanmetwithanaccidentandhadmildquadriparesis.HerlateralX -raycervical
spinerevealedC5-C6fracturedislocation.Whichofthefollowingisthebestlineofmanagement?
1Immediateanteriordecompression.
2Cervicaltractionfollowedbyinstrumentfixation.
3Hardcervicalcollarandbedrest.
4Cervicallaminectomy.
Answeris2
ChapmansOrthopedicSurgery3rded/3699
ApleysOrthopedics8thed/654
MaheshwariOrthopedics

TREATMENTofFracturedislocationatlowercervicalspine(belowC3spine)
Thedisplacementmustbereducedasamatterofurgency.
Skulltractionisused,itisstartedwith5kgandincreasingitstepwisebysimilaramountupto
30kg.
Ifclosedtreatmentwithtractionupto2/3ofbodyweightor65pounds(Whicheverisless)is
unabletoachieveadequatereduction,operativeinterventionisrequired.
Ifreductionfails-Posterioropenreductionandfusionisdone.

Q.66Whichofthefollowingcathetermaterialsismostsuitedforlong -termuseis?
1Latex.
2Silicone.
3Rubber.
4Polyurethane.
Answeris2
Essentialsurgery,problems,diagnosisandmanagementH.George
Burkitt/CliveR.G.Quick3rded/393
Witheithertypeofcatheterization(urethralorsuprapubic),themajorproblemsarecatheter
blockageandinfection.Catheterrapidlybecomesblockedbyepithelialdebrisorbygradual
accretionofcalculus.Modernsiliconeorsilicone-coatedlongtermcathetersarebetterinthis
respectbutmustalsobechangedregularly(every3month s10-12wks).

Q.67Themainsiteofbicarbonatereabsorptionis:
1Proximalconvolutedtubule.
2Distalconvolutedtubule.
3Corticalcollectingduct.
4Medullarycollectingduct.
Answeris1
AlsoseeQ8
ReclamationoffilteredHCO3?takesplacelargelyintheproximaltubule(80 -90%)and,under
normalcircumstances,isvirtuallycompletebelowacriticalplasmaHCO3?concentration.The
thresholdconcentration,whichisnormallyabout26mmol/L,inhuman,isidenticaltothe
concentrationofHCO3?inplasma.Asaconsequence,HCO3?wastageistotallyprevented
normally.

Q.68Whichofthefollowingisthemosttroublesomesourceofbleedingduringaradicalretro
pubicprostatectomy?
1Dorsalvenouscomplex.
2Inferiorvesicalpedicle.
3Superiorvesicalpedicle.
4Seminalvesicularartery.
Answeris1
GlennsUrologicsurgery5thed/277
MichaelJ.Drdler,Surgicalmanagementofurologicaldisease,AnanatomicapproachIsted/PG
654.
Therearetwodorsalvenousplexusaroundtheprostate.Superficialdorsalveinisdividedand
thensutureddirectly.Butthedeepdorsalveincomplexrunsparalleltotheurethraattheapexof
prostateandthenfansoutovertheanteriorofprostate.Wefeelthatitisimportanttocontrolthese
vesselspreemptivelyratherthansimplytoincisethemandplacesuturesafterward.
AMc--Dougalclampisusefulforthispurpose.

Santorinisplexusprovidesthemajorsourceofvenousdrainageoftheprostate.Thisplexuslies
ontheanteriorsurfaceoftheprostateinthepuboprostaticspace.Thedeepdorsalveinofthepenis
anditstributariesarethemajorcontributorstotheplexus.Duringretropubicprostatectomythis
vesselshouldbecontrolledseparately(1)beforecapsulotomyincasesofsimpleretropubic
proceduresand(2)beforeopeningendopelvicfasciaanddividingpuboprostaticligamentsin
casesofradicalprostatectomy.

Q.69Themostcommoncauseofrenalscarringina3yearoldchildis:
1Trauma.
2Tuberculosis.
3Vesicoureteralrefluxinducedpyelonephritis.
4Interstitialnephritis.
Answeris3
Dahnertradiologicalreviewmanual5thed/p983,946
VESICOURETERICREFLUX-(Congenitalreflux=Primaryreflux)
9-10%ofnormalCaucasianbabies
1.4%ofschoolgirls
30%ofchildrenwithafirstepisodeofUTI
Refluxnephropathyalsocalledchronicatrophicpyelonephritis.Itleadstothescarringofkidney.
Scarformationoccursonlyuptoage4years.VesicoureteralrefluxinducedPyelonephritisismost
commoncauseofrenalscarringinchildren.

Q.70Themostsensitiveimagingmodalityfordiagnosinguretericstonesinapatientwithacute
colicis:
1X-rayKUBregion
2Ultrasonogram
3non-contrastsCTscanoftheabdomen.
4ContrastenhancedCTscanoftheabdomen.
Answeris3
DahnertRadiologicalreviewmanual5thed/P981-982
M/ctypeofcalculusisCalciumstone
M/ctypeofcalculusisCalciumstone
Calciumstone -75%
Struvitestone -15%
Calciumphosphate -5%
AllareradioopaqueUricacid -5%
Cystine -1%
Radiolucentstone -Uricacid
Xanthine
Matrixstone
Q.71Whichoneofthefollowingisnotusedastumormarkerintesticulartumors?
1AFP.
2LDH.
3HCG.
4CEA.
Answeris4
Baileyandlovessurgery23rded/1280
Harrisonprincipleofinternalmedicine15thed/chapter90
Theserumlactatedehydrogenase(LDH)levelservesasanadditionalmarkerofallGCTsof
testis,butitisnotasspecificaseitherAFPorHCG.LDHlevelsareincreasedin50to60%
patientswithmetastaticnonseminomaandinupto80%ofpatientswithadvancedseminoma.
Whileplasmacarcinoembryonicantigen(CEA)levelpredictseventualtumorrecurrencein
coloniccarcinoma.

Q.72Whichoneofthefollowingisthecommoncauseofcongenital
Hydrocephalusis?
1Craniosynostosis.
2Intrauterinemeningitis
3Aqueductalstenosis
4MalformationsofgreatveinofGalen.
Answeris3
Dahnertradiologicalreviewmanual5thedi/291
CongenitalHydrocephalus
1-M/ccauseisaqueductstenosis(43%)
2-2ndcommonestiscommunicatinghydrocephalus(38%).
3-OnUSGassessmentisdifficultpriorto20wksGA,asventriclesordinarily
Constitutesalargeportionofcranialvault.
4-OnUSG-danglingchoroidplexussignisseen.
5-CAUSESOFINFANTILEHYDROCEPHALUS
Aqueductalstenosis Dandy-Walkersyndrome
VeinofGalenaneurysm Tumor
Postinfectious Hemorrhage
Superiorvenacavaobstruction ChoroidplexusPapilloma
ChiariIImalformation

Q.73Inachild,non-functioningkidneyisbestdiagnosedby:
1Ultrasonography.
2IVU.
3DTPARenogram.
4Creatinineclearance.
Answeris3
GraingerandAllinson,DiagnosticRadiology3rded/115
UrinaryTractimaginginPediatricsagegroup
Atwo-partevaluationofthekidneyisnowcommonplace;renalmorphologyisassessedwith
ultrasoundandrenalfunctionbyradionuclidestudy.Bothcongenitalandacquiredconditionsmay
resultinreducedrenalfunction,andradionuclideimagingissuperiortoexcretoryurographyin
providinginformation.Intheneonatalperiod,thisconjointimagingtechniqueisexcellentin
evaluatingcysticdysplasticconditions,obstructiveuropathies,andrenovasculardisturbances.
Renalscintigraphyandultrasonographycomplementeachother.
Renalfunctionandthestatusofthecollectingsystemcanbeassessedbyagentswhicharefiltered
bytheglomeruli-likeradiographiccontrastmedia-99mTcdiethylene-triaminepentaaceticacid
(DTPA)-orsecretedbytherenaltubules-iodine-131(131I-)labelledortho-iodohippurate(OIH),
99mTcmercaptoacetyltriglycine(MAG3).Anagentwhichbindsinthecortexisusedtoassess
functioningrenalparenchyma:99mTcdimercaptosuccinicacid(DMSA).Bycombiningfeatures
ofboththeabovegroups,9mTcglycoheptonate(GH)ispartiallyclearedbyfiltration(85%)and
partiallyboundtoproximalrenaltubules(15%).

Q.74Themostcommonmalignantneoplasmofinfancyis:
1MalignantTeratoma.
2Neuroblastoma.
3Wilmstumor.
4Hepatoblastoma.
Answeris2
Dahnertradiologicalreviewmanual5thed/932-933
GraingerandAllinson,diagnosticradiology,5thed/1757
Neuroblastomaisthemostcommonsolidabdominalmassofinfancy(12.3%ofallperinatal
neoplasm).Itconstitutes3rdM/Cmalignanttumorofinfancy(afterleukemia>CNStumor).But
Neuroblastomais2ndM/Ctumorofchildhood(Wilmstumorisfirst)
-SiteofmetastasisinNeuroblastoma-bone(60%)>L.N.(42%)>orbit>liver(15%)<
intracranial.
-Syndromeassociatedwithmetastasisofneuroblastoma-
1)Hutchinsonsyndrome
2)Peppersyndrome
3)Blueberrymuffinsyndrome.

Q.75ThemostcommonpresentationofachildwithWilm stumoris:
1Anasymptomaticabdominalmass.
2Hematuria.
3Hypertension.
4Hemoptysisduetopulmonarysecondary.
Answeris1
GraingerandAllinson,diagnosticradiology,5thed/1760
Dahnertradiologicalreviewmanual5thed/984-85
-Wilmstumor-(Nephroblastoma)
- Clinical presentation - Rules of 10s
Asymptomatic palpable abdominal mass 10% Unfavorable histology
(90%) 10% Bilateral0 10% Vascular invasion
HTN in 25% due to rennin 10% Calcification
Pain abdomen (25%) 10% Pulmonary metastasis at presentation
Low-grade fever (15%)
10%tumoris-phaeochromocytoma
10%ruleisalsoseeninCraniopharyngiomaofbrain.
PEARLPOINTS
-D/dfromNeuroblastomaisveryimp.NotethatinNeuroblastomathereis
Encasement/elevationofaortawhileWilmstumorhaveinvasionproperly.
-Neuroblastomashowsstippledregularcalcificationwhilecurvilinear
CalcificationisseeninWilmstumor.

Q.76Thelaryngealmaskairwayusedforsecuringtheairwayofapatientinallofthefollowing
conditionsexcept:
1Inadifficultintubation.
2Incardiopulmonaryresuscitation.
3Inachildundergoinganelectiveroutineeyesurgery.
4Inapatientwithalargetumorintheoralcavity.
Answeris4
ClinicalanesthesiologyLange-Appleton3rd/P-65
Thelaryngealmaskairwayprovidesanalternativetoventilationthrougha
FacemaskorETT.
ContraindicationtoLMA
-Patientwithpharyngealpathology(e.g.abscess)
-Patientwithpharyngealobstruction.(Largetumor)
-Fullstomach(e.g.pregnancy,hiatushernia)
-Lowpulmonarycompliance(e.g.obesity)requiringpeakinspiratory
Pressuregreaterthan20cmH2O.

Q.77Thefollowingareusedfortreatmentofpostoperativenauseaandvomitingfollowingsquint
surgeryinchildrenexcept:
1Ketamine.
2Ondansetron.
3Propofol.
6Dexamethasone.
Langeclinicalanaesthesiology3rdEd,pg-940
Postoperativenausea&vomiting

1)Increasedincidenceofnauseahasbeenreportedwith -
.followingopiods.N2Oanaesthesia
.afterlaparoscopy.afterstrabismussurgery

2)Highestincidenceappearstobeinyoungwomen,studiessuggestthatnauseaismorecommon
duringmenstruation.
3)Propofolanaesthesiadecreasestheincidenceofpostoperativenauseaandvomiting.
4)Intravenousdroperidolandmetoclopramidealsodecreasespostoperativenausea.
5)Drugsusedinpostoperativenausea.
5HT3antagonists(ondansetron,granisetronanddolasetron)areextremelyeffective.Nodystonia
andNodysphoriaoccurwithuseoftheseagent.
Ondansetronmaybemoreeffectivethanotheragentinchildren.
Dexamethasonewhencombinedwithanotherantiemeticisespeciallyeffectiveforrefractory
nauseaandvomiting.
Lowdosepropofolhasbeenreportedtobeeffectiveforpostoperativenauseaandvomiting.

Q.78WhichoneofthefollowinganaestheticagentscausesariseintheIntracranialpressure:
1Sevoflurane.
2Thiopentonesodium.
3Lignocaine.
4Propofol.
Answeris(1)Sevoflurane-
Similartoisofluraneanddesflurane,sevofluranecausesslightincreaseincerebralbloodflow
andintracranialpressureatnormocarbia.
HighconcentrationofSevoflurane(>1.5MAC)mayimpairautoregulationofC.B.LF.andthus
allowingadropinC.B.F.duringihemorrhagichypotension.ThiseffectonCBFisless
pronounced
thanisoflurane.
Propertyofsevoflurane-.nonpurgentandrapidincreaseinalveolaranestheticconcentration
makeserofluraneanexcellentchoiceforsmoothandrapidinhalationinductioninpediatricor
adultpatient.
Contraindicationofserofluraneare
1)Severehypovolemia2)Susceptibilitytomalignanthyperthermia3)intracranialhypertension.

Q.79Thefollowingmodesofventilationmaybeusedforweaningoffpatientsfrommechanical
ventilationexcept:
1ControlledMechanicalventilation(CMV).
2Synchronizedintermittentmandatoryventilation(SIMV).
3Pressuresupportventilation(PSV).
4Assist-controlventilation(ACV).

PointsaboutVentilatorymodes-
CMV-Controlledmodeventeilation
AC-Assistcontrol.
IMV-Intermittentmandatoryventilation
SIMV-Synchronizedintermittentmandatoryventilation.
PSV-Pressuresupportventilation
PCV-PressureControlVentilation
MMV-Mandatoryminuteventilation
IRV-InverseI:Eratioventilation
APRV-Airwaypressurereleaseventilation
HFJV-Highfrequencyjetventilation.
Themodesthatdontallowspontaneousventilation
CMV
PCV
PC -IRV
Theweaningmodesare
IMV
SIMV
PSV
ACcanalsobeusedduringweaningbutCMVisneverusedasweaningmode.

Q.80ThemostcommonpathogensresponsiblefornosocomialpneumoniasintheICUare:
1Grampositiveorganisms.
2Gramnegativeorganisms.
3Mycoplasma.
4Virusinfections.
Nosocomialpneumoniasareusuallycausedbygramnegativeorganisms,andareleadingcauseof
deathinmanyICUs
GIbacterialovergrowth

Translocationintotheportalcirculation

RetrogradecolonizationoftheupperairwaysfromGItract

Aspiration
Mostnosocomialinfectionarisefromendogenousbacterialflora
Urinarytractaccountsforupto35-40%ofnosocomialinfection
Urinaryinfareusuallyduegramnegativebacteriaandassociatedwithindwellingcatheter
Woundinfare2ndmostcommoncause,25-30%
Pneumoniaaccountsforanother,20-25%
Intravascularcatheterinfareresponsiblefor5 -10%ofICUinf
Hencetheansweris2

Q.81ALowerSegmentCaesareanSection(LSCS)canbecarriedoutunderallthefollowing
techniquesofanaesthesiaexcept:
1Generalanaesthesia.
2Spinalanaesthesia.
3Caudalanaesthesia.
4CombinedSpinalEpiduralanaesthesia.

Langeclinicalanaesthesiology3rdEd,p-828.
Anasthesiaforcesareansection-
-80%areperformesunderregionalansthesia
40%spinal
40%epidural
-EpiduralanasthesiaispreferredoverspinalanasthesiabecauseofmoregradualdecreaseinB.P.
-Continuousepiduralanasthesiaalsoallowsbettercontrolthesensorylevel.
-CSEanasthesiaitiscalledcombinedspinalepiduralanasthesia.
Itcombinesbenefitofbothtypeofanasthesia.
1.rapidandreliableandintenseblockofspinalanasthesia.
2.flexibilityofepiduralcatheter.
-Advantageofgeneralanasthesia.
1.rapid,reliable.
2.controlofairway&ventilation.
3.potentiallylesshypotension.
Importantfacts:
1.CesareansectionrequiresaT4sensorylevel.
2.Measurestopreventhypotensionduringspinalanastheasia.
-1500-2000mlbolusofRingerlactateinjectionpriortoblock(crystalloidarenoteffective).
-phenylephrineifhypotensionoccurs.
-ephedrinepriortoblock.
-trendlenbergposition
3.Epiduralanasthesiaismostsatisfactorywhenanepiduralcatheterisused.
4.Epiduralmorphine,5mg,attheendofsurgeryprovidesgoodtoexcellentpainrelief
post-operatively.

Q.82Themostappropriatecircuitforventilatingaspontaneouslybreathinginfantduring
anaesthesiais:
e.JacksonReesmodificationofAyresTPiece.
f.MaplesonAorMagillscircuit.
g.MaplesonCorWaterstoandfrocanister.
h.Bainscircuit.

Langeclinicalanaesthesiology3rdEd,pg

Q.83Theabnormalpreoperativepulmonaryfunctiontestinapatientwithseverekyphoscoliosis
includes:
i.IncreasedRV/TLC.
j.ReducedFEV1/FVC
k.ReducedFEV25-75
l.IncreasedFRC.
m.

Q.84Whichoneofthefollowingdrugshasbeenshowntoofferprotectionfromgastricaspiration
syndromeinapatientwithsymptomsofreflux?
1Ondansetron.
2Metoclopramide.
3Sodiumcitrate.
4Atropine.

Langeclinicalanaesthesiology3rdEd,p830
Prophylaxisagainstaspirationpneumonia:
1.30mlof.3Msodiumcitrate30 -445minpriortoinductiongivenroutinely.
2.Patientwithriskfactorslikemorbidobesity,gastro -esophagealreflux,potentiallydifficult
airway,emergentdeliveryshouldalsoreceiveRanitidineand/or
Metoclopramide.
3.Highriskpatient-40mgomeprazoleinnightismosteffective.
4.anticholenergiclikeGlycopyrrolate(.1mg)reducetheriskofaspirationonlytheoretically.

Q.85Whichoneofthefollowingistrueofadrenalsuppressionduetosteroidtherapy?
1Itisnotassociatedwithatrophyoftheadrenalglands.
2Itdoesnotoccurinpatientsreceivinginhaledsteroids.
3Itshouldbeexpectedinanyonereceiving>5mg.PrednisoloneDaily
4Followingcessation,thestressresponsenormalizesafter8weeks.
Answeris3

Q.86Thecarpaltunnelcontainsallofthefollowingimportantstructuresexcept:
1MedianNerve.
2Flexorpollicislongus.
3Flexorcarpiradialis.
4Flexordigitorumsuperficialis.
Answeris3
B.D.Chaurasiavol.ii3rdEdpg -99

Q.87Thefemoralringisboundedbythefollowingstructuresexcept:
1Femoralvein
2Inguinalligament.
3Femoralartery.
4Lacunarsligament.
Answeris3
B.D.Chaurasiavol.ii3rdEdpg -44-45
Femoralveinmakesthelateralwalloffemoralring.Femoralarterylieslateraltothe
femoralveinsohowcanitmakeboundaryoffemoralring.

Q.88Allofthefollowingstatementsregardingvasdeferencearetrueexcept:
1Theterminalpartisdilatedtoformampulla.
2ItcrossesureterintheregionofIschialspine.
3Itpasseslateraltoinferiorepigastricarteryatdeepinguinalring.
4Itisseparatedfromthebaseofbladderbytheperitoneum.
Answeris4
Thebaseofbladderisnotcoveredbytheperitoneumsohowcanitseparatetheureterfromthe
baseofbladderbytheperitoneum.

Q.89Thefollowingstatementsconcerningchordatympaninervearetrueexceptthatit:
1Carriessecretomotorfiberstoslubmandibulargland.
2Joinslingualnerveininfratemporalfossa.
3Isabranchoffacialnerve.
4Containspostganglionicparasympatheticfibers.
Answeris4
B.D.Chaurasiavol.III3rdEdpg -113
ItCarriessecretomotorfiberstoslubmandibulargland,whicharepreganglionic
parasympatheticfibersnotpostganglionicparasympathetic
ItshouldbenotedthatanymajornerveinbodycannotContainspostganglionicparasympathetic
fibers.Becauseparasympatheticganglialieintheeffectororganitself,sohowisitpossible?

Q.90Awomanwithinfertilityreceivesanovarytransplantfromhersisterwhoisanidentical
Twin.Whattypeofgraftitis?
1Xenograft.
2Autograft.
3Allograft.
4Isograft.
Answeris4
PanikarmicrobiologyPG164
TYPES OF GRAFTS
Allograft: Transplant from one individual to another with a different genetic make - up,
within the same species, e.g. kidney transplant from one person to any other
(except an identical twin).
Isograft or Transplant between genetically identical, monozygotic twins, or between
Syngeneic graft members of an inbred strain of animals.
Autograft Transplant from one site to another on the same individual, e.g. transplanting
a blood vessel from the leg to the heart during cardiac bypass surgery. This
type of transplant does not require immunosuppressive therapy.
Xenograft Transplant across species barriers, e.g., transplanting a heart from a baboon
to a human. Have a very poor prognosis because of the presence of cross -
species reactive antibodies that will induce hyperacute rejection.

Q.91Thetypeofjointbetweenthesacrumandthecoccyxisa:
1Symphysis.
2Synostosis.
3Synchondrosis.
4Syndesmosis.
Answeris1

Q.92TheProstaticurethraischaracterizedbyallofthefollowingfeatures,exceptthatit:
1Itisthewidestandmostdilatablepart
2Presentsaconcavityposteriorly
3Liesclosertoanteriorsurfaceofprostate.
4ReceivesProstaticductulesalongitsposteriorwall.
Answeris2
B.D.ChaurasiaVol.2/Page308
Moore&Dalley,Clinicallyorientedanatomy4thEdPg363

PROSTATICURETHRA
1Semi-lunarontransversesectionwithitsconvexitydirectedforwards.
2Widestandmostdilatablepartofthemaleurethra.
3ReceiveProstaticductulesalongitsposteriorwall.
4Formsagentlecurve,thatisconcaveanteriorly
5Liesclosertoanteriorsurfaceofprostate.
6ProstaticsinusesliesonsideofProstaticutricleandeachsinusPresentstheopeningofabout
20-30Prostaticglands
7SlitlikeopeningofejaculatoryductonorjustwithintheorificetotheProstaticutricle
-Themembranouspartisstarshaped(stellate)anditisleastdilatablepartofthemale
urethra.
-Thespongypartisintheformofatransverseslit.
-Externalurethralorificeisintheformofaverticalslit.

Q.93Allofthefollowingareasarecommonlyinvolvedsitesinpelvicfractureexcept:
1Pubicrami.
2Alaeofileum.
3Acetabula.
4Ischialtuberosities.
Answeris4
Moore&DalleyClinicallyorientedanatomy4thEdPG338

Pelvicfracturescanresultfrom-directtraumatothepelvicbonesasinautomobileaccidentsor
causedbyforcestransmittedtothesebonesfromthelowerlimbsduringfallonfeetTheareasof
fracturesin?ingorderoffrequencyare
1Pubicrami
2Acetabula(ortheareaimmediatelysurroundingthem
3Regionofsacroiliacjoint
4Alaeofileum
Thesearetheweakareasofthepelvis

Q.94Thefollowinggroupoflymphnodesreceiveslymphaticsfromtheuterusexcept:
1Externaliliac.
2Internaliliac.
3Superficialinguinal.
4Deepinguinal.
Answeris4
B.D.ChaurasiaVol.IIpage319.
Lymphatic drainage of uterus
Fundus and upper part of body Aortic nodes partly to the superficial inguinal
nodes along the round ligament of the uterus
Cervix - External iliac, internal iliac and sacral nodes.
Middle lymphatics and lower part External iliac nodes

Q.95Allofthefollowingphysiologicalprocessesoccurduringthegrowthattheepiphysealplate
except:
1Proliferationandhypertrophy.
2Calcificationandossification.
3Vasculogenesisanderosion.
4Replacementofredbonemarrowwithyellowmarrow.
Answeris4
Tortora&Grabowski,PrinciplesofAnatomy&Physiology9thEd,Pg168 -170
Theepiphysealplateisalayerofhyalinecartilageinthemetaphysicofagrowingbonethat
consistsoffourzones
Resting Zone No function in bone growth, they anchor the epiphyseal plate to the bone of
epiphysis
Proliferating Zone The chondrocytes divide to replace those that die at the diaphyseal side of
epiphyseal plate
Hypertrophic Zone The chondrocytes are even larger. The lengthening of the diaphysis is the
result of cell division in the zone of proliferating cartilage and the maturation
of the cells in the zone of Hypertrophic cartilage
Calcified Zone Consists mostly of dead chondrocytes because the matrix around them has
calcified. This calcified cartilage is dissolved by osteoclastic erosion and
increased vascularisation. This area is invaded by osteoblasts and
capillaries from the diaphysis

Q.96BenignProstatichypertrophyresultsinobstructionoftheurinarytract.Thespecific
conditionisassociatedwithenlargementofthe:
1Entireprostategland.
2Laterallobes.
3Medianlobe.
4Posteriorlobes.
Answeris3
Moore&DalleyClinicallyorientedanatomy4thEdPg-369

Middlelobe(medianlobe)oftenenlargesinthemostpeoplesandobstructstheinternalurethral
orifice;themorethePersonstrains,themoretheProstateoccludetheurethraenlargementofthis
lobegiverisetosymptomofbladderoutflowobstructioneveninabsenceofProstatic
enlargement.

Q.97Inanadultmale,onperrectalexamination,thefollowingstructurescanbefeltanteriorly
except:
1Internaliliaclymphnodes.
2Bulbofthepenis.
3Prostate.
4Seminalvesiclewhenenlarged.
Answeris1
Moore&DaleysClinicallyOrientedAnatomy4thEd,Pg-388
Manystructuresrelatedtotheantero-inferiorpartoftherectummaybepalpatedthroughitswalls
onperrectalexamination.Theseare-
-Prostate&seminalvesiclesinmales
-Cervixinfemales
-Inbothsexes,pelvicsurfaceofsacrum&coccyx,Ischialspace&tuberositiesmayalsobe
palpated
-Bulbofpenisspeciallywhenurethraiscatheterized.
-EnlargedinternaliliacLNfeltonlateralwall,pathologicalthickeningoftheUreters
swellinginischiorectalfossa,orischiorectalabscessandabnormalcontentsinrecto -vesicalpouch
inmale&recto-uterinepouchinfemales
-Tendernessofinflamedappendixcanalsobedetectedperrectallyincaseofpelvicappendix.

Q.98Whiledoingthoracocentesis,itisadvisabletointroduceneedlealong:
1Upperborderoftherib.
2lowerborderoftherib.
3Inthecenteroftheinter-costalspace.
4Inanteriorpartofinter-costalspace.
Answeris1
ClinicallyorientedanatomyKeithL.Moore4thedi/87.
InThoracocentesis,toavoiddamagetotheinter-costalnerveandvessels,theneedleis
insertedsuperiortotherib,inplaneofmidaxillary sline,Highenoughtoavoidthe
collateralbranches.Itisnotinsertedalonglowerborderofribbecauseneuro -vascularbundlelies
there.

TRIANGLEOFSAFETY
Anteriorborderoflatissimusdorsi
TheposteriorborderofthePectoralismajorand
Thesuperiorborderofthefifthrib

Q.99.VirusmediatedtransferofhostDNAfromonecelltoanotherisknownas:
1.Transduction.
2.Transformation.
3.Transcription.
4.Integration.
Answeris1
Panikarmicrobiology6thEdPG51-53
Harrisonprincipleofinternalmedicine15thed/chapter69Table69 -3
Twomajorclassesofvectorsareusedfortransferringnucleicacidsintocellsforthepurposesof
genetherapy:viralandnon-viralvectors.Viralvectorshavebeengeneticallyengineeredsothat
thevirusestransferexogenous(therapeutic)nucleicacidsintocellsthroughaprocesscalled
transduction.

Q.100Barrbodyisfoundinthefollowingphaseofthecellcycle:
1.Interphase.
2.Metaphase.
3.GIphase
4.Telophase.
Answeris1

Q.101Thetypeofhemoglobinthathasleastaffinityfor2,3 -Diphosphoglycerate(2,3-DPG)or
(2,3-BPG)is:
1.HgA.
2.HgF.
3.HgB.
4.HgA2.
Answeris2
LippincottillustratedBiochemistry/pg33.
Underphysiologicconditions,HbFhasahigheraffinityforoxygenthandoesHbA,owingto
HbFsbindingonlyweaklyto2,3-BPG.(Note:They-globinchainsofHbFlacksomeofthe
positivelychargedaminoacidsfoundinthe-globinchainsthatareresponsibleforbinding2,3 -
BPG].Because2,3-BPGservestoreducetheaffinityofhemoglobinforoxygen,theweaker
interactionbetween2,3-BPGandHbFresultsinahigheroxygenaffinityforHbFrelativetoHbA
Form Chain composition Fraction ofTotal hemoglobin
HbA 2 2 90%
HbF 2 y 2 < 2%
HbA2 2 2 2-5%
HbA 1c 22-glucose 3-9%
(Note:The-chainsinthesehemoglobinsareidentical)

Q.102Cellularandflagellarmovementiscarriedoutbyallofthefollowingexcept:
1Intermediatefilaments.
2Actin.
3Tubulin.
4Myosin.
Answeris1
GanongPhysiology20ed/14
1Thecytoskeletonismadeupprimarilyofmicrotubules,intermediatefilamentsand
microfilaments.
2Microtubulesareadynamicportionofthecellskeleton.Theyprovidethetracksfortransportof
vesicles,organellessuchassecretorygranules,andmitochondriafromonepartofthecellto
another.Microtubulesaremadeupof2lobularproteinsubunits -and-tubulin.
3Intermediatefilamentsformflexiblescaffoldingforthecellandhelpitresistexternalpressureit
dosenothelpinanymovementinorofthecell.
Molecular motors
Microtubulebase Kinesinanddyne
Actinbased Myosin
Somicrotubule,actinandmyosinfunctionsasmolecularmotor(in
movementofcell<flagella<cilia)

Q.103Hemeisconvertedtobilirubinmainlyin:
1Kidney.
2Liver.
3Spleen.
4Bonemarrow.
Answeris3
Harrison16thed/239
SequenceofHemecatabolisandbilirubin
Spleen>Liver(OtherReticuloendothelialcells)

Geneticorfunctionaldeficiencyoftheglucuronyltransferasesystem
UNCONJUGATEDANDTOTALBILIRUBININCREASES
.Crigler-Najjersyndrome.
.Gilbertsyndrome
.Physiologicaljaundiceinnewbornespeciallyprematureinfants

Q.104Anexampleofatumorsuppressorgeneis:
1myc
2fos
3ras
4Rb
Answeris4
Harrison15thed/chapter81
Love&Bailey24thed/214
Somee.g.ofTumorSuppressorgeneinvolvedinhumantumorigenesis
Gene Chromosome Cancer type
APC 5q 21 Colon
P53 17P13 App. 50% of all cancer
RB1 13q14 Retinoblastoma, lung, breast, prostate
SMAD4 18q21 Pancreatic
WT1 11P13 Wilms tumor
VHL 3P25 Kidney, phaeochromocytoma
Ras,fos&mycallareoncogene
Q.105HIVcanbedetectedandconfirmedby:
1PolymeraseChainReaction(PCR)
2ReverseTranscriptase-PCR
3RealtimePCR
4MimicPCR.
Answeris1
Long&ProbersPediatricsinfectiousdiseases2ndEdPG677,
Samtersimmunologicaldiseases5thEd,Vol-1Pg438

PCRismostoftenusedtofindpro -viralDNAwithinthechromosomesofinfectedmononuclear
cells.ViralRNA,whichrepresentsviralreplication,canalsobedetectedbyPCR.Thepolymerase
chainreactionforthedetectionofHIVDNAorRNAisextremelysensitivetestthatcandetectas
fewasonecopyofviralDNAorRNAin10cells.
HIVDNAPCRisrelativelyrapiddiagnosticassaytestcanbeperformedwithin24hrsusing
anticoagulatedwholeblood.
Reversetranscriptase-PCRisusedforthequantitativeevaluationofHIVRNAwithinthe
plasmafortheprognosispointofview.
Viralcultureandp24antigendetectionarealsoquantitativevirologicassayusedfordisease
progressionandresponsetotherapy.
ThegoldstandardforthedeterminationofHIVisculture.
Hence answer is 1.
PCRamplificationoftheHIVproviralDNAprovidestheabilitytodetectHIVatearlierstagesof
infection,becausetheviralnucleicacidispresentimmediatelyuponexposure.
ReversetranscriptasePCR(RT-PCR)-isamodifiedversionofPCRinwhichC-DNAproduced
fromanRNAsampleusingreversetranscriptaseisamplified.RT -PCRisusedtomeasurethe
quantityofHIV(anRNAvirus),circulatingintheblood(viralload)whenmonitoringthe
responsetodrugsorthestatusofinfectionin-patientwithHIVinfection.

InWesternblotGP120,p55,gp41andp24antigentakenandantibodiesagainstthesedetected.
TheProbeantibodyusedinitis125I-goatantihumanIg.

Q.106Whichoneofthefollowingmoleculesisusedforcellsignaling?
1CO2.
2O2.
3NO.
4N2.
Answeris3
GanongPhysiology20thed/109
NITRICOXIDE
1alsocalledEDRF(endotheliumderivedrelaxingfactor)
2Itactsbyactivatingguanylcyclasebydirectbinding.(NotGproteinmediatedaction,likeother
transmitters).ForsignalingitdonotrequireGprotein,Itdirectlydiffusesincell.
3SynthesizedfromL-argininbyactionofNOsynthaserequiresNADPH.
NOsynthaseisalsocalledNADPHdiaphorase(NDP).

Carbonmonoxide(CO)isanothergasthatisprobablyatransmitterinbrain.
-SignaltransductionbyusingcGMPpathway-ANFandNO.
-Tyrosinekinaseactivityofreceptorseenin
Insulin EGF
PDGF IGF

107Allofthefollowinghormoneshavecellsurfacereceptorsexcept:
1Adrenalin.
2GrowthHormone.
3Insulin.
4Thyroxin.
Answeris4
HarparBiochemistry26thed/138
Lipidsolublehormones(steroidsandthyroidhormone)
1)TheirReceptorsareinsidethecell.
2)Hormone-receptorcomplexbindstohormoneresponseelements(HRE,ofenhancergene)in
DNA.
3)Controlofgeneexpressionrequireshour
E.g.-Steroids
Calcitriol
Thyroxines
Retinoicacid
Whileinsulin,adrenalin,growthhormoneandother(alotofproteinhormone)arewater -soluble
andtheydonotcrosscellmembrane.Theirreceptorsareinthecellmembrane.
ThyroidhormonesentercellsandT3bindstothyroidreceptor,whicharepresentinthenuclei.

108Fluoride,usedinthecollectionofbloodsamplesforglucoseestimation,inhibitsthe
enzyme:
1Glucokinase.
2Hexokinase.
3Enolase.
4Glucose-6-phosphatase.
Answeris3
108.PG232
Dehydrationof2-PhosphoglyceratetoPhosphoenolpyruvate

Enolaseisahomodimerthatisinhibitedbyfluoride,withformationofthemagnesium
fluorophosphatescomplexattheactivesite.Thispropertyoffluorideisusedtoinhibit
glycolysisinbloodspecimensobtainedformeasurementofglucoseconcentration.Intheabsence
offluoride(oranyotherantiglycolyticagent),thebloodglucoseconcentrationdecreasesastabout
10mg/dLperhourat25oC.Therateofdecreaseismorerapidinbloodfromnewborninfants
owingtotheincreasedmetabolicactivityoftheerythrocytesandinleukemiapatientsbecauseof
thelargernumbersofleukocytes.
Neuron -specificandnon-neuron-specificenolaseisoenzymeshavebeenusedasmarkers
todistinguishneuronsfromnonneuronalcells(e.g.,glialcellsthatarephysicallyand
metabolicallysupportivecellsofneurons)byimmunocytochemicaltechniques.Neuron -specific
enolaseisextremelystableandresistanttoanumberofinvitrotreatments(e.g.,hightemperature,
urea,chloride)thatinactivateotherenolases.

Q.109Inthesmallintestine,choleratoxinactsby:
1ADP-ribosylationoftheGregulatoryprotein.
2Inhibitionofadenylcyclase.
3ActivationofGTPase.
4ActiveabsorptionofNaCl.
Answeris1
RAnanthanarayanPanikarMicrobiology5thed/286
A1Fragmentofcholeratoxincausesprolongedactivationofcellularadenylatecyclaseand
accumulationofc-AMP,leadingtooutpouringoflargequantitiesofwaterandelectrolytesinto
thesmallintestinallumen,andtheconsequentwaterydiarrhea.

PEARLPOINTS
CertainbacterialexotoxinsareenzymeandtheyattachtoADP-riboseresidueofNADtoG
subunit.ThisactivityisK/AADPribosylation.SomeoncogenicmutationleadstoADP
ribosylationofsomeprotein(geneproduct)
Cholera toxin Ribosylation of Gs d diarrhoea of cholera
E.coli Gs Travelers diarrhoea
Pertusis toxin Gi Pertusis
p21Gs-Colon,lung,breast,bladdertumor
ras(GSP)-Pituitarytumors,adenomas,endocrineovarian

Q.110Thefollowingisnotafeatureofmalignanttransformationbyculturedcells:
1Increasedcelldensity.
2Increasedrequirementforgrowthfactors.
3Alterationsofcytoskeletalstructures.
4Lossofanchorage.
Answeris2
MolecularcellbiologLodish,Berk4thedi/1058

Thecells,whichcontinuetogrowwhenthenormalcellshavebecomequiescent,have
undergonetransformationandarecalledtotransformedcell.Propertiesoftransformedcell -
similartothatofmalignantcellitiscalledmalignanttransformationofculturedcell.

1Changeincellmorphology
2Abilitytogrowunattachedtoabasallaminaorotherextracellularmatrixcalledlossof
anchorage)
3LossofActinmicrofilament
4Reducedrequirementforgrowthfactor.
5Secretionofplasminogenactivator.

Q.111Osteoclastsareinhibitedby:
1Parathyroidhormone.
2Calcitonin.
31,25-dihydroxycholecalciferol.
4Tumornecrosisfactor.
Answeris2
FactorsinhibitOsteoclastsare-
CalcitoninTGF?
EstrogenIFN?
PGE2
Factorinhibitsosteoblast-onlyCorticosteroids.

Note-Parathyroidexcessleadstolossofcalciumfrombonebyactivatingosteoclastbutits
receptorisnotonosteoclast.Itsreceptoronosteoblast-itactivatestheosteoclast.

Q.112Theprotectiveeffectsofbreastmilkareknowntobeassociatedwith:
1IgMantibodies.
2Lysozyme.
3Mastcells.
4IgAantibodies.
Answeris4
Forfar&ArneilsTextbookofPediatrics4thEd,Pg-364

Macrophagesandnon-specificimmunefactorssuchaslactoperoxidase,unsaturatedlactoferrin
and
Lysozymearebactericidal.LipasekillsGiardialambliaandentamoebaandmanygangliosides
andlipidsareviricidal.NeverthelessspecificpassiveimmunityconferredbysecretoryIgAis
possiblyofgreaterimportance.Itconferspassiveimmunitytothebabyandexertsitsprotective
actionbypreventingbacterialcontacttoepithelialcellsurfaces,thuspreventinggastrointestinal
infections

Q.113Asimplebacterialtestformutageniccarcinogensis:
1Amestest.
2Redoxtest.
3Bacteriophage.
4Genesplicing.
Answeris1
RobbinsPathology6thed/307 -308
ThemutagenicpotentialisinvestigatedbymostcommonlyusingtheAmestest.Thistestusesthe
abilityofachemicaltoinducemutationinthebacteriumSalmonellatyphimurium.70 -90%of
knowchemicalcarcinogensscorespositiveintheAmestest.
?Bacteriophagesarevirusesthatareresponsiblefortransduction.
?GenesplicingisthegeneticdefectresponsibleforBThalassemia.Mutationinsplicesitesaffects
theaccuracyofintronremovalfromhetero -nuclearRNA(hnRNA)during
posttranscriptionalprocessing.
Mutationinsplicesitenowwelldocumentedin
BThalassemia
Gauchersdiseaseand
Tay-Sachsdisease.

Q.114ThepredominantisozymeofLDHincardiacmuscleis:
1LD-1.
2LD-2
3LD-3
4LD-5.
Answeris1MBB4TH/233
HarshMohanPathology3rded./349
HarpersBiochemistry26thed/57
LDLH-1ismyocardialspecificisozyme;estimationofratioofLDH -1/LDH-2above1is
reasonablyhelpfulinmakingadiagnosisofMI.
TABLE13.3
SerumLDHIsoenzymePatternsinVariousDisorders*
Isoenzyme Pattern Disorder

ElevationofLDH-1and Myocardialinfarction
LDH-2,frequently Renalcorticalinfarction
PerniciousanemiaHemolysisMuscular
LDH-1>LDH-2
dystrophy(laterstages)
ElevationofLDH-5 Liverdisease
SkeletalmuscledamageSomecancers
Someneoplasticdiseasesfrequently
ElevationofLDH-3
Lymphoproliferative
LDH-3>LDH-2 disordersPlatelet-relateddisorders
ElevationofLDH-2 Pulmonaryinfarction
andLDH-3
Allisoenzymeselevated Widespreadtissueinjury
*NormaldistributionLDH-1<LDH-2>LDH-3>LDH-4<=>LDH-5

Q.115.BothVitaminKandCareinvolvedin:
1Thesynthesisofclottingfactors.
2Posttranslationalmodifications.
3Antioxidantmechanisms.
4Themicrosomalhydroxylationreactions.
Answeris2
HarparBiochemistry26thed/495,487

Vit.CleadstoposttranslationalmodificationofCollagen.Itleadstohydroxylationof
prolineresiduesattheYpositioninprocollagenchainsastheypassthroughtheRER.
Vit.KleadstocarboxylationofthecoagulationfactorII,VII,IXandX,aswellasthe
anticoagulantproteinCandS.ItdoescarboxylationofGlutamicacidresidue.ThisVit.K
dependentCarboxylationisacotranslationalmodification/posttranslationalmodification.

Q.116Enzymesthatmoveamoleculargroupfromonemoleculetoanotherareknownas:
1.Ligases.
2.Oxido-reductases.
3.Transferases.
4.Dipeptidases.
Answeris3MBB4TH/86
HarperBiochemistry26thed/50
TABLE8.3Sixmajorclassesofenzymes
Class Type of reaction Example
1. Oxidoreductases Oxidation-reduction Lactate dehydrogenase
Nucleosidemonophosphatekinas
2. Transferases Group transfer
(NMP kinase)
Hydrolysis reaction (transfer of Chymotrypsin

3. Hydrolases
functional groups to water)
4. Lyases Addition or removal of groups to double bonds Fumarase
5. Isomerases Isomerization (intramolecular group transfer) Triose phosphate Isomerases
Ligation of two substrates at theexpense of ATP
6. Ligases Aminoacyl-tRNA synthetase
hydrolysis
Q.117Themembraneprotein,clathrinisinvolvedin:
1Cellmotility.
2Receptor-mediatedendocytosis.
3Exocytosis.
4Cellshape.
Answeris2MBB4TH/186
HarpersBiochemistry26thed/420,429117./185-187
Clathrinisamajorcomponentofcoatedvesicle.Clathrinanditstightlyboundlightchainsformsflexiblelatti
leadingtoscaffoldingofthesurroundingvesicle.
Clathrincoatedvesiclehaveanimportantroleinreceptormediatedendocytosisinadditiontoroleinintracellul
transport.
LDHreceptorinternalizationisagoodexampleofclathrincoatedreceptormediated
endocytosis.

Q.118Ahighlyionizeddrug:
1Isexcretedmainlybythekidney.
2Cancrosstheplacentalbarriereasily.
3Iswellabsorbedfromtheintestine.
4Accumulatesinthecellularlipids.
Answeris1
K.D.T.medicalpharmacology5thed/26
Lipid soluble drugs filtered at the glomerulus back diffuses in the tubules because 99% of glomerular filtrate
reabsorbed,butnonlipidsolubleandhighlyionizeddrugsareunabletodoso.Thusrateofexcretionofsuchdrug
areparallelstogfr(orCreatinineclearance).Soahighlyionizeddrugmainlyexcretedbykidney.
Whilelipidsolubledrugscancrosscellmembranedirectly.Sothesedrugscancrosstheplacentalbarriereasil
andwellabsorbedfromintestine.Lastlylipidsolubledrugsaccumulateinthelipidtissues.

Q.119Theaminoacidresiduehavinganiminosidechainis:
1Lysine.
2Histidine.
3Tyrosine.
4Proline.
Answeris4MBB4TH/21
LippincottillustratedbiochemistryPG -4
ProlineistheA.A.thathasaniminosidechain.Prolineisasecondaryaminewhosepresenceinaproteindisrup
normalsecondarystructure.
Proline contains a secondary amine group, called an imine, instead of a primary amine group. For this reaso
proline is called an imino acid. This compound has a rotationally constrained rigid-ring structure. As a resu
prolylresiduesinapolypeptideintroducerestrictionsonthefoldingofchains.Incollagen,theprincipalprotein
human connective tissue, certain prolyl residues are hydroxylated. The hydroxylation occurs during prote
synthesisandrequiresascorbicacid(vitaminC)asacofactor.

Q.120CO2isprimarilytransportedinthearterialbloodas:
1DissolvedCO2.
2Carbonicacid.
3Carbamino-hemoglobin.
4Bicarbonate.
Answeris4GanongPhysiology20thed./648
-Thereis49mlofCO2ineachdeciliterofarterialblood.
-2.6mlisdissolved.
-2.6mlasCarbaminocompound
-43.8mlisasinHCO-3
SoCO2isprimarilytransportedinthearterialbloodasBicarbonate.

Q.121EndemicDiseasemeansthatadisease:
1Occursclearlyinexcessofnormalexpectancy.
2Isconstantlypresentinagivenpopulationgroup.
3Exhibitsseasonalpattern.
4Isprevalentamonganimals.
Answeris2KPARK -P.S.M17thed/82.
Endemic disease Constant presence of a disease or infection with in a given
geographic area or population group, without importation from
outside.

Epidemic Disease occurs clearly in excess of normal expectancy is called
Pandemic Epidemic affecting a large population or crossing the boundaries of
nations

Q.122Whichoneofthefollowingisagoodindexoftheseverityofanacutedisease?
1Causespecificdeathrate.
2Casefatalityrate.
3Standardizedmortalityratio.
4Fiveyearsurvival
Answeris2KPARK -PSM17thed/49(repeat)

Casefatalityraterepresentsthekillingpowerofadisease.Itissimplytheratioofdeathstocases.
SoItisarationotthetruerate.Casefatalityrateiscloselyrelatedtovirulence.
Total No. Of death d/t a particular disease X
100 =C.F.R Total No. Of cases d/t the same disease

Q123Whichoneofthefollowingstatementsaboutinfluenceofsmokingonriskofcoronaryheart
disease(CHD)isnottrue?
1InfluenceofsmokingisindependentofotherriskfactorsforCHD
2InfluenceofsmokingisonlyadditivetootherriskfactorsforCHD
3InfluenceofsmokingissynergistictootherriskfactorsforCHD
4Influenceofsmokingisdirectlyrelatedtonumberofcigarettessmokedperday.
Answeris2KPARKPSM17thed/275

-ThedegreeofriskofdevelopingCHOisdirectlyrelatedtothenumberofcigarettessmokedper
day.
-CigarettesFiltersareprobablynotprotective.
-Thereisevidencethattheinfluenceofsmokingisnotonlyindependentof,butalsosynergistic
withotherriskfactorssuchasHTNandelevatedserumcholesterol.Sochoice2iswrong.

Q.124Antibiotictreatmentofchoicefortreatingcholerainanadultisasingledoseof:
1Tetracycline.
2Co-trimoxazole.
3Doxycycline.
4Furazolidone.
Answeris3K.ParkP.S.M.17thed./173.Table9.124
Antibioticsusedinthetreatmentofcholera
AntibioticsChildrenAdults
Doxycyclineonce -300mg
Tetracycline12.5mg/kg500mg
4timesadayfor3days
Trimethroprim(TMP)TMP5mg/kgandTMP160mg
sulfamethoxazole(SMX)SMX25mg/kgSMX800mg
twiceadayfor3days

1)Erythromycinandchloramphenicolmayalsobeusedwhennoneoftheotherrecommended
antibioticsareavailable,orwhenVibrioCholerae01isresistanttothelatter.
2)Doxycyclineistheantibioticofchoiceforadults(exceptingpregnantwomen),sinceasingle
dosesuffices.
3)TMP-SMXistheantibioticofchoiceforchildren.Tetracyclineisequallyeffective,butisnot
availableeverywhereinpaediatricform.
4)Furazolidoneistheantibioticofchoiceforpregnantwomen.

Q.125AllofthefollowingstatementsaretrueaboutCongenitalRubellaexcept:
1ItisdiagnosedwhentheinfanthasIgMantibodiesatbirth.
2ItisdiagnosedwhenIgGantibodiespersistformorethan6months.
3Mostcommoncongenitaldefectsaredeafness,cardiacmalformationsandcataract.
4Infectionafter16weeksofgestationresultsinmajorcongenitaldefects.

- The first trimester of pregnancy is the most disastrous time for the foetus as the organs are
developing.
-Classicaltriadispatentductusarteriosus,cataractanddeafness
-Infectionin2ndtrimestermaycausedeafness,butthoseinfectedafter16weekssuffernomajor
abnormalities.
-Congenitalrubellaisdiagnosedbytheisolationofrubellavirusand/orthedetectionofIgM
antibodiesinasingleserumsample,and/orthedocumentationofeitherthepersistenceof
rubella antibodies in serum beyond 1 year of age/more than 6 month or a rising antibody titer
anytimeduringinfancyinanunvaccinatedchild

Q.126Therecommendeddailyenergyintakeofanadultwomanwithheavyworkis:
11800.
22100.
32300.
42900.
Answeris4 KPARKPSM17thed/432

Q.127Allofthefollowingmethodsareantilarvalmeasuresexcept:
1Intermittentirrigation.
2Parisgreen.
3Gambusiaaffinis.
4Malathion.
Answeris4KPARKPSM17thed/546 -547
-Anti-larvalmeasure
a)Environmentalcontrol-Sourcereductionbyintermittentirrigation,Fillinganddrainage.
Thesemethodsgenerallyproducepermanentresults.
b)Chemicalcontrol-commonlyusedlarvicidesare
1)Mineraloils
2)Parisgreen(Copperacetoarsenite)
3)Syntheticinsecticides
Fenthion,chlorpyrifosandabatearethemosteffectivelarvicides.
(malathionisnotmucheffective,c)Biologicalcontrol-Gambusiaaffinis
Lebisterreticulates(Barbadosmillions)Soprobableanswerismalathion.

Q.128AllofthefollowingaretrueabouttheHerdImmunityforinfectiousdiseasesexcept:
1Itreferstogroupprotectionbeyondwhatisaffordedbytheprotectionofimmunized
individuals.
2Itislikelytobemoreforinfectionsthatdonothaveasub -clinicalphase.
3Itisaffectedbythepresenceanddistributionofalternativeanimalhosts.
4Inthecaseoftetanusitdoesnotprotecttheindividual.

Elements,whichcontributetheherdimmunity,are
1)Occurrenceofclinicalandsubclinicalinfectioninherd
2)Immunisationofherd
3)Herdstructure.
Herd structure is never constant; it is affected by the presence and distribution of alternative
animalhosts.
-InthecaseofTetanus,howeverherdimmunitydoesnotprotecttheindividual.
-Herdimmunityimpliesgroupprotectionbeyondthataffordedbytheprotectionofimmunizedin
dividuals.
Soonlychoiceisleft(2)thatistheanswerbecauseHerdimmunitywillbelessforinfectionsthat
donothaveasubclinicalphase.

Q.129 The best indicator for monitoring the impact of Iodine Deficiency Disorders control
programmeis:
1Prevalenceofgoiteramongschoolchildren.
2Urinaryiodinelevelsamongpregnantwomen.
3NeonatalHypothyroidism.
4Iodinelevelinsoil.

Iodinemonitoring
Countries implementing control programmes require a network of laboratories for iodine
monitoringandsurveillance.Theselaboratoriesareessentialfora)iodineexcretiondetermination
b) determination of iodine in water, soil and food as part of epidemiological studies, and c)
determinationofiodineinsaltforqualitycontrol.
Neonatalhypothyroidismisasensitivepointertoenvironmentaliodinedeficiencyandcanthusbe
aneffectiveindicatorformonitoringtheimpactofaprogramme.

Q.130Whatisthecolor-codingofbaginhospitalstodisposeoffhumananatomicalwastessuch
asbodyparts?
1Yellow.
2Black.
3Red.
4Blue.
ScheduleIseetable14.1
ScheduleIIseetable14.2

Q.131WHOdefinesadolescentagebetween:
110-19yearsofage
210-14yearsofage
310-25yearsofage
49-14yearsofage
Answeris1K.ParkP.S.M17thed/99
O.P.Ghaiessentialofpediatric
WHOEPISchedule-
- The adolescent age group 10-19 year represents an important additional target group for
immunization.

Q.132Inavillagehavingpopulationof1000,wefoundpatientswithcertaindisease.Theresults
ofasnewdiagnostictestonthatdiseaseareasfollows.
Testresult Disease
Present Absent
+ 180 400
- 20 400
Whatisthepercentprevalenceofdisease?
1.0.20.
2.2.
3.18.
4.20.
Answeris4
-Populationis1000.
-Totalno.Havediseased.Person 180+20=200
-Soprevalenceis200per1000ofpopulation
But%prevalenceis200x100
1000
=20%

Q.133Thefollowingtestsareusedtochecktheefficiencyofpasteurizationofmilkexcept:
1Phosphatasetest.
2Standardplatecount.
3Coliformcount.
4Methylenebluereductiontest.

Testsofpasteurizedmilkare
1)Phosphatasetest
2)Standardplatecount
3)Coliformcount
Mostofcountriesinthewestenforcealimitof30000bacterialcountpermlofpasteurizedmilk.
ThestandardinmostcountriesisthatColiformsbeabsentin1mlofmilk.Presenceof
Coliforminpasteurizedmilkisanindicationeitherofimproperpasteurizationorpost
pasteurizationcontamination.

Q.134WhatwillbetheBMIofamalewhoseweightis89kgandheightis172cm:
127.
230.
333.
436.
(1)Bodymassindex(Queteletsindex)=Weight(kg)/Height(m)
89/1.72x1.72=30
(2)Brocaindex=Height(cm)minus100

Forexample,ifapersonsheightis160cm.
hisidealweightis(160-100)=60kg
Thebodymassindex(BMI)andtheBrocaindexarewidelyused.
Skinfold thickness, it is a rapid and non-invasive method for assessing body fat. Several
varietiesofcalipers(e.g.Harpendenskincalipers)areavailableforthepurpose.Themeasurement
may be taken at all the four sites - mid-triceps, biceps, subscapular and suprailiac regions. The
sumofthemeasurementsshouldbelessthan40mminboysand50mmingirls.

Q.135ThemostcommonsideeffectofIUDinsertionis:
1Bleeding.
2Pain.
3Pelvicinfection.
4Ectopicpregnancy.
SIDE-EFFECTSANDCOMPLICATIONS
1. BleedingThe commonest complaint of women fitted with an IUD (inert or medicated) is
increasedvaginalbleeding.
Painissecondmajorsideeffect,leadingtoIUDremoval.Itismostcommonsideeffectwhich
increasestheremovalrate.
Othercomplications-
1)PID2)ectopicpregnancy3)uterineperforation.
ThepainduetoIUCDisusuallydisappearbythethirdmonth.
TheriskofPIDishighestinfirstfewmonthsafterIUDinsertion.
Perforationd/tIUCDoccurmorefrequentlywheninsertionsareperformedbetween48hrand6
weekspostpartum.
IUCDispostcoitalcontraceptiveofchoice.
Highestriskofectopicpregnancyseenwithprogestasert.

Q.136ForthetreatmentofcaseofclassIIIdogbite,allofthefollowingarecorrectexcept:
1GiveImmunoglobulinsforpassiveimmunity.
2GiveARV.
3Immediatelystitchwoundunderantibioticcoverage.
4Immediatelywashwoundwithsoapandwater.

Combinedadministrationofasingledoseofantirabiesserumwithacourseofvaccine,together
withlocaltreatmentofthewoundisthebestspecificprophylactictreatmentafterexposureofman
torabies.
Purpose of local treatment is to remove as much virus as possible from the site of inoculation
beforeitcanbeabsorbedonnerveendings.Localtreatmentofwoundsisofmaximalvaluewhen
appliedimmediatelyafterexposure(withinminutesifpossible)butitshouldnotbeneglectedif
severalhoursordayshaveelapsed.
Immediateflushingandwashingthewoundpreferablyunderarunningtap,foratleast5minutes
isofparamountimportanceinthepreventionofhumanrabies.

Residual virus remains in the wound (s), after cleansing, should be inactivated by
irrigation with virucidal agents - either alcohol (400-700 ml/litre), tincture or 0.01% aqueous
solutionofiodineorpovidoneiodine.Quaternaryammoniumcompounds(e.g.savlon,cetavlon)
are no longer recommended (3,7). Cauterization with carbolic acid or nitric acid is no longer
recommendedasitleavesverybadscars.
Bitewoundsshouldnotbeimmediatelysuturedtopreventadditionaltraumawhichmay
helpspreadthevirusintodeepertissues.Ifsuturingisnecessary,itshouldbedone24-48hours
later.

Q.137A2-year-oldfemalechildwasbroughttoaPHCwithahistoryofcoughandfeverfor4
dayswithinabilitytodrinkforlast12hours.Onexamination,thechildwashavingweightof5kg
andrespiratoryrateof45/minutewithfever.Thechildwillbeclassifiedassufferingfrom:
1Veryseveredisease.
2SeverePneumonia.
3Pneumonia.
4NoPneumonia.
Answeris3
KPARKPSM17thed/137
Management of pneumonia in a child aged 2 months upto 5 years
SIGNS Chestindrawing(if Nochestindrawingbutfast Nochestindrawing
alsorecurrent breathing Nofastbreathing(Less
wheezing,godirectly (50perminuteormoreif than50perminuteif
totreatwheezing child2months-upto12 child2monthsupto5
months, years).
40perminuteormoreif
child12monthsupto5
years
CLASSIFY SEVERE PNEUMONIA NOPNEUMONIA
AS PNEUMONIA COUGHORCOLD
The child in the question is 2 year old. So he/she will not be classified as per classification of
young infant. He will be classified as per classification of pneumonia for child aged 2 months
upto5yrs

Q.138Theinformationtechnologyhasrevolutionizedtheworldofmedicalsciences.Inwhichof
thefollowingyeartheinformationTechnologyActwaspassedbytheGovernmentofIndia?
11998
22000.
32001.
42003.
Answeris2
InformationTechnologyAct,2000(NO.21OF2000)(9THOFJUNE,2000)

Q.139TransplantationofHumanOrgansActwaspassedbyGovernmentofIndiain;
11996.
21993.
31998.
41994.
Answeris4
WWW.Indianlawinfo.com

Q.140Whichoneofthefollowingisnotsourceofmanager spower.
1Reward.
2Coercive
3Legitimate.
4Efferent.
Answeris4

Q.141Thestandardnormaldistribution:
1Isskewedtotheleft.
2Hasmean=1.0
3Hasstandarddeviation=0.0
4Hasvariance=1.0.
Answeris3
KPARKPSM17thed/613

-Standardnormalcurveissmooth,bellshaped,perfectlysymmetricalcurve,basedonainfinitely
largenumberofserration.
-Thetotalareaofthecurveis1;itsmeaniszero;anditsstandarddeviationis1.
-Themean,medianandmodeallcoincideaccordingtoHighyieldstatistics.
Variance=(S.D.)2
SoifS.D.is1thanvariancewillalsobe1
Thustheansweris4.

Q.142ThePEFRofagroupof11yearoldgirlsfollowanormaldistributionwithmean3001/min
andstandarddeviation20l/min.
1About95%ofthegirlshavePEFRbetween260and340l/min.
2Thegirlshavehealthylungs.
3About5%ofgirlshavePEFRbelow260l/min.
4AllthePEFRmustbelessthan340l/min.
Answeris1
KPARKPSM17thed/613
-AreabetweenoneS.Ooneithersideofmean(x-?16)willincludeapproximately68%ofthe
valueinthedistribution.
-2S.D.=95%ofthevalue
-3S.D.-99.7%ofthevalue
Inthequestion-
(x-)-Mean300L/min
S.D.=20L/min
1.S.D.=20
2.SD.=40
So68%ofthegroupwillbeintherangeof(x -?20).
300?20-280to320about95%ofthegirlswillhavePEFRinbetween(x?40) -300?40=260to
340L/min
So5%ofgirlswillhavePEFRbeloweither260L/minorabove340L/min(2.5%below260and
2.5%above340)
-Choice2&4aretotallywrong.

Q.143TheeventsAandBaremutuallyexclusive,so:
1Prob(AorB)=Prob(A)+Prob(B).
2Prob(AandB)=Prob(A),Prob(B).
3Prob(A)=Prob(B).
4Prob(A+Prob(B)=1.
Answeris

Q.144TotalCholesterollevel=a+b(calorieintake)+c(physicalactivity)+d(bodymassindex);
isanexampleof:
1Simplelinearregression.
2Simplecurvilinearregression
3Multiplelinearregression.
4Multiplelogisticregression.
Answeris

Q.145TheHblevelinhealthywomenhasmean13.5g/dlandstandarddeviation1.5g/dl,whatis
theZscoreforawomanwithHblevel15.0g/dl.
19.0.
210.0.
32.0.
41.0.
Answeris2
KPARKPSM17thed/613
Z=(X-X)
{
X-Singlevalueofaobject=15g/dl
X-=Mean=13.5g/dl
{=Standarddeviation=1.5g/dL

SoZ=15-13.5/1.5=1.5/1.5=1
Answer-is(4).

Q.146Thediagnosticpowerofatesttocorrectlyexcludethediseaseisreflectedby:
1Sensitivity.
2Specificity.
3Positivepredictivity.
4Negativepredictivity.
Answeris4

Q.147Infantmortalitydoesnotinclude:
1Earlyneonatalmortality.
2Perinatalmortality.
3Postneonatalmortality
4Lateneonatalmortality.
Answeris2
KPARKPSM17thed/392

Numberofdeathsofchildren
Lessthan1yearofageinayear
IMR=-------------------- ------------x100
Numberoflivebirthsinthesameyear

PERINATALMORTALITYRATE
Ascurrentlydefined,thetermperinatalmortalityincludesbothlatefoetaldeaths
(stillbirths)and earlyneonataldeaths.TheEighthRevisionoftheInternationalClassificationof
Diseases (ICD) defined the perinatal period as lasting from the 28th week of gestation to the
seventhdayafterbirth.TheNinthRevision(1975)ofICDaddedthat:
wellestablishedvitalrecordsofstillbirthsisasfollows:
Latefoetaldeaths(28weeksgestationandmore)
+earlyneonataldeaths(firstweek)inoneyear
PMR=--------------------------------------------------- x1000
Livebirthsinthesameyear

For international comparisons, Late foetal and early neonatal deaths weighing over 1000g at
birthexpressedasaratioper1000livebirthsweighingover1000gatbirth .Itiscalculatedas:
Latefoetalandearlyneonatal
deathsweighingover1000gatbirth
Perinatal
mortality=----------------------------------------- x1000
rateTotallivebirthsweighingover1000g
atbirth.

Q.148Acardiologistfoundahighlysignificantcorrelationcoefficient(r=0.90,p=0.01)
betweenthesystolicbloodpressurevaluesandserumcholesterolvaluesofthepatientsattending
hisclinic.Whichofthefollowingstatementsisawronginterpretationofthecorrelation
coefficientobserved?
1Sincethereisahighcorrelation,themagnitudesofboththemeasurementsarelikelytobeclose
toeachother.
2ApatientwithahighlevelofsystolicBPisalsolikelytohaveahighlevelofserum
cholesterol.
3ApatientwithalowlevelofsystolicBPisalsolikelytohavealowlevelofserum
cholesterol.
4About80%ofthevariationinsystolicbloodpressureamonghispatientscanbeexplainedby
theirserumcholesterolvaluesandviceaversa

Q.149Allofthefollowingdrugsareeffectiveinthetreatmentofpityriasisversicolorexcept:
1Seleniumsulphide.
2Ketoconazole.
3Griseofulvin.
4Clotrimazole.
Answeris3
HarrisonsInternalMedicine15thEd
TREAETMENT
Solutionscontainingsulfur,salicylicacid,orseleniumsulfidewillcleartheinfectionif
useddailyforaweekandthenintermittentlythereafter.Treatmentwithasingle400-mgdoseof
ketaconazole(otherazoles)isalsoeffective.Ketoconazoleisusedforsystemictreatmentand
Seliniummiconazoleandclotrimazoleforlocalapplication.
Griseofulvin is the drug ofchoice for dermatophyte infections requiring systemic therapy. BUT
ITISNOTEFFECTIVEINTINEAVERSICOLORTINEAVERSICOLOR
Causedbyanon-dermatophytedimorphicfungus
Anormalinhabitantoftheskin
YeastformPityrosporumorbicularedoesnotleadsthedisease
Hyphalformcausescharacteristiclesionsofdisease
Thetypicallesionsconsistofovalscalymacules,papules,andpatchesconcentratedonthechest,
shoulders,andbackbutonlyrarelyonthefaceordistalextremities.
Ondarkskin,theyoftenappearashypopigmentedareas,
Hypopigmentationisd/tazelicacid
Diseaserareinchildren.
AKOHpreparationfromscalinglesionswilldemonstrateaconfluenceofshorthyphaeandround
spores(so-calledspaghettiandmeatballs).
-PityriasisAlbacanbedifferentiatedbymorecommoninvolvementoffaceandchildren.
-Indeterminateleprosycanbedifferentiatedbyabsenceofscaling,presenceof
anaesthesia (if present) and epidural atrophy and patient belonging to high leprosy prevalence
state.

Q.150A36-year-oldfactoryworkerdevelopeditchy,annularscalyplaquesinbothgroins.
Application of a corticosteroid ointment led to temporary relief but the plaques continued to
extendattheperiphery.Themostlikelydiagnosisis:
1Erythemaannularecentrifugum.
2Granulomaannulare.
3Annularlichenplanus.
4Tineacruris.
Answeris4
When Tinea is wrongly treated with steroid, lesions get more profuse and itching is less. It is
called Tinea incognito. While corticosteroid is used in treatment of all three condition except
tinea.

Q.151 A 16-year-old boy presented with asymptomatic, multiple, erythematous, annular lesions
with a collarettes of scales at the periphery of the lesions present on the trunk. The most likely
diagnosisis:
1Pityriasisversicolor.
2Pityriasisalba.
3Pityriasisrosea.
4Pityriasisrubrapilaris.
Answeris3

PITYRIASISROSEA
Pityriasis rosea (PR) is a papulosquamous eruption of unknown etiology that occurs more
commonlyinthespringandfall.Itsfirstmanifestationisthedevelopmentofa2-to6-cmannular
lesion (the herald patch). This is followed in a few days to a few weeks by the appearance of
manysmallerannularorpapularlesionswithapredilectiontooccuronthetrunk.Thelesionsare
generallyoval,withtheirlongaxisparalleltotheskin-foldlines.Individuallesionsmayrangein
colorfromredtobrownandhaveatrailingscale.
PR shares many clinical features with the eruption of secondary syphilis, but palm and sole
lesionsareextremelyrareinPRandcommoninsecondarysyphilis.
Treatment is generally directed at alleviating pruritus and consists of oral antihistamines,
midpotencytopicalglucocorticoids,and,insomecases,theuseofUV -Bphototherapy.

P.Versicolour Predominanttrunkinvolvementwithbrown,scalymacules
P.Rosea Predominanttrunkinvolvementwitherythematousannularlesionswithperipheral
finebranlikescales
P.RubraPilaris There is predominant face and scalp involvement with late involvement of whole
body
-Orangeyhueerythema
-ThickenedPalmswithyellowishdiscoloration
-Folliculareruption.

Q.152TheonlydefiniteindicationforgivingsystemicCorticosteroidsinpustularpsoriasisis:
1Psoriaticerythrodermawithpregnancy.
2Psoriasisinapatientwithalcoholiccirrhosis.
3Moderatearthritis.
4Extensivelesions.
Answeris1
Rook/Wilkinson/EBLING,Textbookofdermatology6thedition/1631,1643
RoleofsystemicsteroidinPsoriasis-
SystemicsteroidshouldnotbeusedintheroutinecareofPsoriasis.Theydohaveroleinthe
managementofpersistent,otherwiseuncontrollable,erythroderma,whichiscausingmetabolic
complicationandinfulminatinggeneralizedpustularpsoriasisofthevonZumbuschtypeifother
drugsarecontraindicated.
-GeneralizedPustularPsoriasisofpregnancy(Impetigoherpetiformis)
FulminatingdiseaseinpregnancyisbesttreatedwithIVPrednisolone,thedrugwhichcarriesthe
leasthazardforthefetus.
- Methotrexate, retinoids, PUVA or combination therapy may be needed after delivery to allow
weaningoffthesteroid.

Q.153 A 40-year-old woman presents with a 2-year history of erythematous papulopustular
lesionsontheconvexitiesoftheface.Thereisabackgroundoferythemaandtelangiectasia.The
mostlikelydiagnosisinthepatientis:
1Acnevulgaris.
2Rossacea.
3Systemiclupuserythematosus.
4Polymorphiclighteruption.
Answeris2
ACNEROSACEA
Individuals with rosacea initially demonstrate a pronounced flushing reaction. This may be in
responsetoheat,emotionalstimuli,alcohol,hotdrinks,orspicyfoods.Asthediseaseprogresses,
theflushpersistslongerandlongerandmayeventuallybecomepermanent.Papules,pustules,and
telangiectases can become superimposed on the persistent flush. Rosacea of very long standing
mayleadtoconnectivetissueovergrowth,particularlyofthenose(rhinophyma).
Ocularproblemsarepotentiallysightthreateningandwarrantophthalmologicevaluation.
Itistreatedeffectivelywithoraltetracyclineindosesrangingfrom250to1000mg/d.Topical
metronidazoleorsodiumsulfacetamidehasalsobeenshowntobeeffective.Theuseof
low-potency, nonfluorinated topical glucocorticoids, particularly after cool soaks, is helpful in
alleviatingfacialerythema.
NOTE-Fluorinated topical glucocorticoids should be avoided since chronic use of these
preparationsmayactuallyelicitrosacea.
ACNEVULGARIS
Theclinicalhallmarkofacnevulgarisisthecomedone,whichmaybeclosed(whitehead)oropen
(blackhead). Closed comedones appear as 1- to 2-mm pebbly white papules, which are
accentuated
whentheskinisstretched.Theyaretheprecursorsofinflammatorylesionsofacnevulgaris.

Q.154 An 8-year-old boy from Bihar presents with a 6 months history of an illdefined,
hypopigmentedslightlyatrophicmaculeontheface.Themostlikelydiagnosisis:
1Pityriasisalba.
2Indeterminateleprosy.
3Morphoca.
4Calciumdeficiency.
Answeris
-PityriasisAlbacanbedifferentiatedbymorecommoninvolvementoffaceandchildren.
-Indeterminateleprosycanbedifferentiatedbyabsenceofscaling,presenceofanaesthesia(if
present)andepiduralatrophyandpatientbelongingtohighleprosyprevalencestate.

Q.155 A 27-year old sexually active male develops a vesiculobullous lesion on the glans soon
after taking tablet paracetamol for fever. The lesion healed with hyperpigmentation. The most
likelydiagnosisis:
1Behcetssyndrome.
2Herpesgenitalis.
3Fixeddrugeruption.
4Pemphigusvulgaris.
Answeris3
HarrisonsInternalMedicine15thEd/
FIXEDDRUGREACTIONS
Thesereactionsarecharacterizedbyoneormoresharplydemarcated,erythematouslesionsin
whichhyperpigmentationresultsafterresolutionoftheacuteinflammation;withrechallenge,the
lesionrecursinthesame(i.e.,"fixed")location.Lesionsofteninvolvethelips,hands,legs,face,
genitalia,andoralmucosaandcauseburning.Mostpatientshavemultiplelesions.Patch
testing is useful to establish the etiology. Fixed drug eruptions have been associated with
phenolphthalein, sulfonamides, tetracyclines, phenylbutazone, NSAIDs, and barbiturates.
Although cross-sensitivity appears to occur between different tetracycline compounds, cross-
sensitivitywasnotelicitedwhendifferentsulfonamidecompoundswereadministeredtopatients
aspartofprovocationtesting.
BEHCET'SSYNDROME-isaclinicopathologicentitycharacterizedbyrecurrentepisodesoforal
andgenitalulcers,iritis,andcutaneouslesions

Q.156Inafirearminjury,thereisburning,blackening,toattooingaroundthewound,alongwith
cherryredcolourofthesurroundingtissuesandiscruciateinshape,theinjuryis:
1Closeshotentry.
2Closecontactexit.
3Contactshotentry.
4Distantshotentry.
Answeris3
Parikh1996edi/p-280,Modi22nded./354,Reddy2000ed/181,`83,185
Contact wound make - cruciform entrance wound, may be larger than exist.
Flame/burning/scorchingareproducedby-Revolvers/pistolswhentheyaregenerallywithinrange
ofabout2-3inch.
Ifafirearmisdischargedverycloseorinactualcontact,thesubcutaneoustissueoveranareaof
20f 3 inches round the wound of entrance are lacerated and the surrounding skin is usually
scorched and blackened by smoke and tattooed with unburnt grains of gun power or smokeless
propellantpowder.
Henceansweriscontactshotentry(3).

Q.157Inmethyl alcohol poisoning there is CNS depression,cardiac depression and optic nerve
atrophy.Theseeffectsareproduceddueto:
1Formaldehydeandformicacid
2Acetaldehyde.
3Pyridine.
4Aceticacid.
Answeris1
Modi22nded/320ofToxicology(SectionII)
SYMPTOMSOFMETHYLALCOHOLPOISONING
Dilatedpupil,visualdisturbances,photophobia,concentricdeminutionofvisualfieldsforcolour
and form, followed by partial or total blindness due to retrobulbar neuritis resulting from a
specifictoxiceffectofformaldehydeonretinalcells.
Henceansweris(1).

Q.158Inchronicarsenicpoisoningthefollowingsamplescanbesentforlaboratoryexamination,
except:
1Nailclippings.
2Hairsamples.
3Bonebiopsy.
4Bloodsample.
Answeris4
ModitoxicologySectionII22nded./126,129.Reddy2000edToxicology

Depositionofarsenicinchronicarsenicpoisoning
Greatestconcentrationfoundinhairsandnailswhereitisstoredpermanently.
Itsdepositioninhairsbeginsin15daysafteradministration.
Arsenicalsofoundinhumantissues.Inwhichthelivercontainlargestamount.Bonesandteeth
comenext.Theamountfoundinbloodisnegligible.
Inchronicpoisoningarsenicisalsofoundinbrain,spinalcord.Infatalresults,occurringfrom
salvarsanpoisoning,itisinterestingtonotethatarsenicisnotfoundinthebrainornervoustissue.
Henceanswerisblood(4).

Q.159Whichofthefollowingstatementsisnotcorrectregardingdiatom?
1Diatomsareaquaticunicellularplant.
2Diatomshasanextracellularcostcomposedofmagnesium.
3Aciddigestiontechniqueisusedtoextractdiatoms.
4Presence of diatoms inthe femoralbonemarrow is an indicationof antemortem inhalationof
water.
Answeris2
Modi22ndeditionSectionI/289,290.Parikh1996ed/217 -218

DIATOMTEST
Findingofdiatomsbymicroscopicexaminationoftissuelikebrain,liverorbonemarrowfrom
thefemurorhumerusafteraciddigestionisihelpfulinconfirmingdeathfromdrowning.
Diatomsaretinyunicellularalgae(aquaticplant).
Theymaybefanshaped(Stellate),ribbonlikeandseensinglyoringroups.
Theyhavehardsiliceous(notmagnesium),almostindestructibleoutercovering(frustules).
Adiatomshowschromatophobesbeforeaciddigestion.
Aciddigestiondonewithstrongnitricoxideandheatingittillaclearfluidisobtained.
Sincediatomsresistputrefaction,thediatomtestisparticularlyvaluablewheredecompositionis
advanced.
Diatomtestisnegativeindeadbodiesthrowninwaterandindrydrowning.
Answeris-(2).

Q.160InIndia,magistrateinquestisdoneinthefollowingcasesexcept:
1Exhumationcases.
2Dowrydeathswithin5yearsofmarriage.
3Murdercases
4Deathofapersoninpolicecustody.
Answeris3
Parikh1996ed./386,10).Reddy2000ed/5

-MAGISTRATESINQUEST-
1) Admission of a mentally ill person in a Psychiatric hospital or a Psychiatric nursing home
undercertainprovisionofthementalhealthact,1987.
2)Deathofaconvictinjail.
3)Deathofapersoninpolicecustodyorduringpoliceinterrogationorasaresultofpolicefiring.
4)Exhumationcases.

Dowrydeathundersection176(1)(CrPC)Providesinquestbyexecutivemagistrateandsection
174(3)(CrPC)providesasfollow:when
1)Caseinvolvessuicidebyawomanwithinsevenyearsofhermarriage.
2)Thecaserelatestothedeathofawomanwithin7yearsofhermarriageinanycircumstances
raisingareasonablesuspicion.
3)Thecasesrelatetothedeathofawomanwithin7yearsofhermarriageandanyrelativeofthe
womanhasmadearequestinthisbehalf,thepoliceofficerwillforwardthebodyforautopsyto
thenearestM.O.
Henceansweris(3).

Q.161Atautopsy,thecyanidepoisoningcasewillsowthefollowingfeatures,except:
1Characteristicbitterlemonsmell.
2Congestedorgans.
3Theskinmaybepinkishorcherryredincolor.
4Erosionandhemorrhagesinesophagusandstomach.
Answeris1
ModitoxicologysectionII22nded./470,471,473.Reddy2000ed/530

HYDROCYANICPOISONING-
Itoccursincombinationwithleavesofcherrylaurel,inbitteralmonds,intheKernelsof
commoncherry,plum,apricot,peachandotherstonefruits,theordinarybambooshoots,andin
certainoilseeds.
Theseplantscontaincrystallineglucoside,K/Aamygdalin,whichinthepresenceofwaterand
naturalenzymeemulsion-hydrolysedinHCN+glucoseandbenzolhyde.
FirstsymptomisbitteralmondodourofHCN(Notbitterlemon).
KCNhavestrongalkalineeffectandihasacorrosiveeffectonmucousmembrane.
Postmortemstainingofbrightcherryredcolorduetocyanmethaemoglobin.
Mucousmembraneofstomachandduodenumisoftenredandcongested.

Henceanswer(1).

Q.162ThemostreliablecriteriainGustafsonsmethodofidentificationis:
1Cementumapposition.
2Transparencyofroot.
3Attrition.
4Rootresorption.
Answeris2
APURBANANDY1996edition/P-63.Reddy2000ed/58

ESTIMATIONOFAGEFROMTEETHINELDERLYSUBJECTS:
DonebyGustafsonsformula(basedonageinganddecayingchangesinteeth).
Thereare6criterias
AttritionSecondarydentineCementumapposition
PeriodontosisRootresorptionTransparencyofroot

OnlyattritionandPeriodontosiscanbeusedinlivingsubjectsbecauseforexaminationofother
changes,teethhavetobeextractedoutoftheirsockets.
Ofallabovethecriteria,transparencyofrootdoneisthesinglemostimportantone.
Ratingofcementumappositionismostdifficulttoassess.
Importantquestionhavebeenaskedfrequentlyaboutteeth

Years TotalNo.Ofteeth
2-5yr 20
At6yr 21-24duetoeruptionoffirstpermanentmolars
7-12yr Remains24
12-14yr 25-28duetoeruptionof2 ndpermanentmolars.
14-17yr Remains28
17-25yr 29-32duetoeruptionof3 rdpermanentmolars
Q.163Theminimumageatwhichanindividualisresponsibleforhiscriminalactis:
17years
212years
316years
421years
Answeris1
Parikh1996edi/47.Reddy2000ed/60
Undersection82IPC,achildundertheageofsevenisincapableofcommittinganoffence.
Thisisbecausethatachildofthattenderagecannothaveaguiltymindorcriminalintentionwith
whichtheactisdone.
UnderSection83IPC,achild>7yrand,<12yrinIndiaispresumedtobecapableof
committinganoffenceifhehasobtainedsufficientmaturityofunderstandingtojudgethenature
andconsequencesofhisconductonthatoccasion.Thelawpresumessuchmaturityinachildof
thatageunlessthecontraryisprovedbythedefence.
Undersection89IPC-Achild<12yrcannotgivevalidconsenttosufferanyharmwhichcan
occurfromanactdoneingoodfaithandforitsbenefitseg.consentforanoperation.
Undersection87IPC?Aperson<18yrcannotgivevalidconsent,wheatherexpressorimplied,
tosufferanyharmwhichmayresultfromanactnotintendedornotknowntocausedeathor
grievoushurt,eg.consentforawrestlingcontest.
Answeris(1).

Q.164Themostreliablemethodofidentificationofanindividualis:
1Dactylography.
2Scars.
3Anthropometry.
4Handwriting.
Answeris1
Parikh1996ed./53.Reddy2000ed/70
Dactylographydependsonridgesandgroves,overfingersandthumbsitmakes
absoluteidentificationpossible.
Answeris(1).

Q.165Themostcommonpatternoffingerprintis:
1Arch.
2Loop.
3Whorl.
4Composite.
Answeris2
Parikh1996ed/53.Reddy2000ed/70
Loops67%,
Whorls -25%,
Arches -6-7%,and
Composites1 -2%
Answeris(2).

Q.166A30yearsoldmalepatientpresentswithcomplaintsofweaknessinrightupperandboth
lowerlimbsforlast4months.Hedevelopeddigitalinfarctsinvolving2ndand3rdfingersonright
sideand5thfingeronleftside.Onexamination,BPwas160/140mmHg,allperipheralpulses
werepalpableandtherewasasymmetricalneuropathy.InvestigationsshowedaHb -12gm,TLC-
12000Cumm,Platelets4,30,000,ESR-49mm.UrineexaminationshowedproteinuriaandRBC
-10-15/hpfwithnocasts.Whichofthefollowingisthemostlikelydiagnosis.
1Polyarteritisnodosa.
2Systemiclupuserythematosus.
3Wegenersgranulomatosis.
4Mixedcryoglobulinemia.
Answeris1H15TH/1592,1966

Q.167Whichofthefollowinginfestationleadstomalabsorption?
1Giardialamblia.
2Ascarislumbricoides.
3NecaterAmericana.
4Ancylostomaduodenale.
Answeris1H15TH/1678

Giardiaremainsapathogenoftheproximalsmallbowelanddoesnotdisseminate
hematogenously.Giardiainfectionsarecommoninbothdevelopedanddevelopingcountries.
Becausecystsare,person-to-persontransmissionoccurswherefecalhygieneispoor.Although
trophozoitesadheretotheepithelium,theydonotcauseinvasiveorlocallydestructivealterations.
Thelactoseintoleranceandsignificantmalabsorptionthatdevelopinaminorityofinfectedadults
andchildren.Inafewcasesusuallyinchronicallyinfected,symptomaticpatientsthe
histopathologicfindings(includingflattenedvilli)andtheclinicalmanifestationsresemblethose
oftropicalsprueandgluten-sensitiveenteropathy.DiseasemanifestationsofGiardiasisrange
fromasymptomaticcarriagetofulminantdiarrheaandmalabsorption.However,diseasecanbe
severe,resultinginmalabsorption,weightloss,growth
retardation,dehydration,and(inrarecases)death

PEARLPOINTS
GiardiasiscanbelifethreateninginpatientswithHYPOGAMMAGLOBULINEMIA
MetronidazoleisDOC

Q.168Allofthefollowingcancauseosteoporosis,except.
1Hyperparathyroidism.
2Steroiduse.
3Fluorosis.
4Thyrotoxicosis.
Answeris3H15TH/2229
Hyperparathyroidismleadstoincreasedboneresorptionsoleadingtotheosteoporosis.
Glucocorticoidsareacommoncauseofmedication-inducedosteoporosis
Excessivethyroidhormonecanaccelerateboneremodelingandresultinbonelossandleadsto
osteoporosis.
Fluorosisleadstoincreasedbonedensitysohowitcanleadtotheosteoporosis.

Q.169Serumangiotensinconvertingenzymemayberaisedinalloffollowing,except:
1Sarcoidosis.
2Silicosis.
3Berylliosis
4Bronchogeniccarcinoma.
Answeris4
OxfordMedicine3rdEdvol.2,Pg-2832
ConsistentlyelevatedserumACE(angiotensinconvertingenzyme)levelsareappreciablyhigher
foundin

Pulmonarycondition Nonpulmonarycondition
Sarcoidosis Alcoholicliverdisease
Gauchers Hyperthyroidism
Silicosis Diabetesmellitus
Berylliosis
Atypicalmycobacteriuminfection
-SerialserumACEmeasurementscanbehelpfulinmonitoringdiseaseactivityasitscorrelate
withchestradiographandclinicalcondition.

Q.170Hypercalcemiaassociatedwithmalignancyismostoftenmediatedby:
1Parathyroidhormone(PTH)
2Parathyroidhormonerelatedprotein(PTHrP).
3Interleukin-6(IL-6)
4Calcitonin.
Answeris2H15TH/646
Parathormone-relatedprotein(PTHrP)producedbytumorshasacentralroleasamediatorof
hypercalcemiaincancer.PTHrPactsviathePTHhormonereceptorsonosteoblastsandrenal
tubularcellstostimulateboneresorptionandrenalcalciumconservation.
ElevatedplasmaPTHrPlevelsarealsofoundinmosthypercalcemicpatientswithbone
metastases.Transforminggrowthfactors,cytokines(interleukin1and6),andotherunknown
factorscouldplayacontributoryrole.
Inlymphoma,avitaminD-relatedproductofthetumormayalsoincreasecalcium
absorptioninthegut.

Q.171AllofthefollowingarethecausesofrelativePolycythemiaexcept:
1Dehydration.
2Denguehemorrhagicfever.
3Gaisbocksyndrome.
4Highaltitude.
Answeris4H15TH/353
Polycythemiacanbeofthreetypes

1 Spurious (related to a decrease in Gaisbock'ssyndrome
plasmavolume) Dehydrationleadstodecreasedplasmavolume
Dengue-increasedvascularpermeabilityto
Waterleadstodecreasedplasmavolume
2Primary, PolycythemiaVera
3Secondary(Associatedwithincreases Lungdisease
in EPO levels. physiologically adapted High altitude
responsetotissuehypoxia COpoisoning
High-affinityhemoglobinopathy
ArarefamilialformofPolycythemiaisassociatedwithnormalEPOlevelsbutmutations
producinghyperresponsiveEPOreceptors.

Q.172AllofthefollowingmaycauseSTsegmentelevationonEKG,except:
1Earlyrepolarizationvariant.
2Constrictivepericarditis.
3Ventricularaneurysm.
4Prinzmetalsangina.
Answeris2H15TH/1268,1367
Reversibletransmuralischemia,forexample,duetocoronaryvasospasm(Prinzmetal'svariant
angina),maycausetransientST-segmentelevationswithoutdevelopmentofQwavesST-segment
elevationsthatpersistforseveralweeksormoreafteraQ -waveinfarctusuallycorrelatewitha
severeunderlyingwallmotiondisorder(akineticordyskineticzone),althoughnotnecessarilybut
canbeduetoafrankventricularaneurysm
VentricularaneurysmleadstopersistentelevationoftheSTsegmentafterMI.
ST-segmentelevationssimulatingischemiamayoccurwithacutepericarditisormyocarditis,or
asanormalvariant("earlyrepolarization"pattern)

Q.1735-Nucleotidaseactivityisincreasedin;
1Bonediseases.
2Prostatecancer.
3Chronicrenalfailure.
4Cholestaticdisorders.
Answeris4H15TH/1713

Alkalinephosphatase Morespecific Locatedinornearthebilecanalicularmembraneof
hepatocytes
5-nucleotidase Morespecific SameasAlkalinephosphatase
Gamma glutamyl transpeptidase Lessspecific Located in the endoplasmic reticulum and in bile
(GGT ductepithelialcells

EnzymesraisedinCholestasis threeenzymes
Due to more diffuse localization in the liver, GGT elevation in serum is less specific for
Cholestasisthanareelevationsofalkalinephosphataseor5-nucleotidase.VeryhighlevelofGGT
isspeciallyseeninrelationwithalcoholicliverdisease.

Q.174NormalCSFglucoselevelinanormoglycemicadultis:
120-40mg/dl
240-70mg/dl
370-90mg/dl
490-110mg/dl
Answeris2H15TH/APPENDIXTABLEA -3

Q.175Bartshydropsfetalisislethalbecause:
1HbBartscannotbindoxygen.
2Theexcess?-globinforminsolubleprecipitates.
3HbBartscannotreleaseoxygentofetaltissues.
4Microcyticredcellsbecometrappedintheplacenta.
Answeris3H15TH/672

Thehomozygousstateforthe?-thalassemia-1(hydropsfetalis)causestotalabsenceof
?-globin synthesis. No physiologically useful hemoglobin is produced beyond the embryonic
stage.
Excess?-globinformstetramerscalledHbBart's(?4),whichhasanextraordinarilyhighoxygen
affinity.ItdeliversalmostnoO2tofetaltissues,causingtissueasphyxia,edema(hydropsfetalis),
congestiveheartfailure,anddeathinutero.

Q.176Clusterheadacheischaracterizedbyall,except:
1Affectspredominantlyfemales.
2Unilateralheadache.
3Onsettypicallyin20-50yearsoflife.
4Associatedwithconjunctivalcongestion.
Answeris21H15TH/78
CLUSTER HEADACHE RAEDER'S SYNDROME, HISTAMINE CEPHALALGIA, AND
SPHENOPALATINENEURALGIA
0.Episodic type is most common and is characterized by one to three short-lived attacks of
periorbitalpainperdayovera4-to8-weekperiod,followedbyapain-freeintervalthataverages
1year.
0.Menareaffectedseventoeighttimesmoreoftenthanwomen;
0.Hereditaryfactorsareusuallyabsent.
0. Although the onset is generally between ages 20 and 50, it may occur as early as the first
decadeoflife.
Clinical Features
Pain Periorbitalpainbeginswithoutwarning
Excruciatinginintensityandisdeep
Reachesacrescendowithin5min
Nonfluctuating,andexplosive
Strictlyunilateralandusuallyaffectsthesameside
insubsequentmonths
Attackslastfrom30minto2h
Associated Homolaterallacrimation
symptoms Reddeningoftheeye
Nasalstuffiness
Lidptosis,and
Nausea.
PEARLPOINTS

Theclustersyndromeisthusclinically,genetically,andtherapeuticallydifferentfrommigraine.
Alcoholprovokesattacksinabout70%ofpatientsbutceasestobeprovocativewhenthebout
remits;thison-offvulnerabilitytoalcoholispathognomonicofclusterheadache.
Onlyrarelydofoodsoremotionalfactorsprecipitatepain,incontrasttomigraine.
Propranololandamitriptylinearelargelyineffective.Lithiumisbeneficialforclusterheadache
andineffectiveinmigraine.

TREATMENT
Themostsatisfactorytreatmentistheadministrationofdrugstopreventclusterattacksuntilthe
boutisover.
Effectiveprophylacticdrugsare
prednisone,lithium,methysergide,ergotamine,sodiumvalproate,andverapamil.
Lithium (600 to 900 mg daily) appears to be particularly useful for the chronic form of the
disorder.
ergotamineismosteffectivewhengiven1to2hbeforeanexpectedattack
Fortheattacksthemselves,oxygeninhalation(9L/minviaaloosemask)isthemosteffective
modality.

Q.177Themostsensitivetestforthediagnosisofmyastheniagravisis:
1ElevatedserumAch-receptorbindingantibodies.
2Repetitivenervestimulationtest.
3Positiveedrophoniumtest.
4Measurementofjitterbysinglefibreelectromyography.
Oxfordtextbookofmedicine/disorderofneuromuscularjuncton/pg1169

For practical purposes, the presence of anti-AchR antibodies is confirmatory and no further
diagnosticinvestigationsarerequired.Itisthe mostspecifictestforM.G.butitisnotthemost
sensitive test. In seronegative patients, electromyography and the intravenous edrophonium
(Tensilon) test are helpful edrophonium test. The test is therefore likely to be of most use in
patientswithpurelyocularsymptomsandsigns.False-negativeandfalse-positiveresultsarenot
uncommon.

The conventional electromyographic measure for diagnosing myasthenia gravis is the
demonstrationofadecrementalresponseofthecompoundmuscleactionpotentialinresponseto
repetitive nerve stimulation at 3 Hz. More sensitive, but not specific and only available in
specialist centres, is the presence of increased jitter and blocking, as assessed by single-fibre
electromyography.

Table1Ionchannelsresponsibleforthedifferentclinicaldisorders
IonchannelClinicaldisorder
AcetylcholinereceptorMyastheniagravis
Voltage-gatedcalciumchannelLambert -Eatonmyasthenicsyndrome
Voltage-gatedpotassiumchannelAcquiredneuromyotonia

Q.178VitaminB12deficiencycangiverisetoallofithefollowing,except:
1Myelopathy.
2Opticatrophy.
3Peripheralneuropathy.
4Myopathy.
Answeris4H15TH/2432
SUBACUTECOMBINEDDEGENERATION(VITAMINB12DEFICIENCY)

Siteofinvolvement Symptoms
Myelopathy (involvement of the posterior and -Parasthesiasinthehandsandfeet
lateraltracts) -Early loss of vibration and position sensation-
Progressiveataxicweakness
Peripheralneuropathy -Lossofdeeptendonreflexes
Opticatrophy -Lossofvision
Opticatrophyandirritabilityandothermentalchangesmaybeprominentinadvancedcases
andonoccasionarethepresentingsymptoms(megaloblasticadness).
ThediagnosisisconfirmedbythefindingofalowserumB12concentration,elevatedlevelsof
homocysteine(homocysteinemia),methylmalonyluria,andapositiveSchillingtest

Q.179EEGisusuallyabnormalinallofthefollowing,except.
1Subacutesclerosingpanencephalitis.
2Locked-instate.
3CreutzfoldtJackobdisease
4Hepaticencephalopathy.
Answeris2H15TH/2491,1765,2333

SSPEisararechronicprogressivedemyelinatingdiseaseoftheCNSassociatedwithmeasles
virus.Mostpatientsgiveahistoryofprimarymeaslesinfectionatanearlyage(2years),witha
latentintervalof6to8yearsbythedevelopmentofaprogressiveneurologicdisorder.
Creutzfeldt-Jakobdisease(CJD)isadegenerativediseaseofthecentralnervoussystem(CNS)
thatiscausedprions.CJDtypicallypresentswithdementiaandmyoclonus,andisrelentlessly
progressive,usuallyresultsindeathwithinayearofonset
SSPE Characteristicperiodicpatternwithburstsevery3to8sofhigh-voltage,
sharpslowwaves,followedbyperiodsofattenuated("flat")background
CJD Advanced cases shows repetitive, high voltage, triphasic, and
polyphasicsharpdischarges
Stereotypedperiodicburstsof<200msduration,occurringevery1to2
s,makesthediagnosisofCJDverylikely
Hepaticenceph. Grade I TO III shows triphasic waves while grade IV shows delta
activity.
PEARLPOINTS
EEGchangesareproducedbyabnormalityofcerebralcortex.Locked -instateisapontinelesion
(liesdeepinposteriorcranialfossa),sohowitcanproducetheEEGchanges.
Q.180Allofthefollowingareneurologicchannelopathiesexcept:
1Hypokalemicperiodicparalysis.
2Episodicataxiatype1.
3Familialhemiplegicmigraine.
4SpinocerebellarataxiaI.
Answeris4H15TH/74,2345,2409
Hypo K.P.P. Voltage-sensitive, skeletal muscular calcium channel,
FHM P/Q type calcium channel subunit expressed only in the central
nervous system
Episodic AtaxiaTypes1 Potassium channel
Type2 a1A voltage-dependentcalciumchannelsubunit
TheSCA1geneproduct,calledataxin-1,isanovelproteinofunknownfunction

Q.181AccordingtotheGlasgowComaScale(GCS),averbalscoreof1indicates:
1Noresponse.
2Inappropriatewords.
3Incomprehensiblesounds.
4Disorientedresponse.
Answeris1H15TH/2440
Glasgow coma scale
Clinical observation Score
Eyeopening
Spontaneous4
Toverbalcommand3
Topain2
None1
Motorresponse
Obeyscommands6
Localisespain5
Flexionwithdrawaltopain4
Abnormalflexion(decorticate)3
Extensiontopain(decerebrate)2
None1
Verbalresponse
Orientated5
Confusedconversation4
Inappropriatewords3
Incomprehensiblewords2
None1

Q.182Whichofthefollowingisnotaneuroparasite?
1Taeniasolium.
2Acanthamoeba.
3Naegleria.
4Trichinellaspiralis.
Answeris4H15TH/1231,1202,1249
Cysticercoidscanbefoundanywhereinthebody,mostcommonlyinthebrainandtheskeletal
muscle.ItiscausedbyTaeniasolium.
AcanthamoebaspeciescausesGranulomatousAmebicEncephalitis
PrimaryamebicmeningoencephalitiscausedbyNaegleriafowlerifollowstheaspirationofwater
contaminatedwithtrophozoites
TrichinellosisdevelopsaftertheingestionofmeatcontainingcystsofTrichinella.While
mostinfectionsaremildandasymptomatic,heavyinfectionscancausesevereenteritis,
periorbitaledema,myositis,and(infrequently)death.ButCNSinvolvementisnotseen.

Q.183A50yearoldman,analcoholicandasmokerpresentswitha3hourhistoryofsevere
retrosternalchestpainandincreasingshortnessofbreath.Hestartedhavingthispainwhileeating,
whichwasconstantandradiatedtothebackandinterscapularregion.Hewasaknown
hypertensive.Onexamination,hewascoldandclammywithaheartrateof130/min.andaBPof
80/40mmHg.JVPwasnormal.Allperipheralpulseswerepresentandequal.Breathsoundswere
decreasedattheleftlungbaseandchestX-rayshowedleftpleuraleffusion.

Whichoneofthefollowingisthemostlikelydiagnosis?
1Acuteaorticdissection.
2Acutemyocardialinfarction.
3Ruptureoftheesophagus.
4Acutepulmonaryembolism.
Answeris4H15TH/1432

Thefactorsthatpredisposetoaorticdissectioninclude
systemichypertension,acoexistingconditionin70%ofpatients,
peakincidenceisinthesixthandseventhdecades.
Menaremoreaffectedthanwomenbyaratioof2:1.
Thepainmaybelocalizedtothefront(retrosternal)orbackofthechest,oftenthe
interscapularregion,andtypicallymigrateswithpropagationofthedissectiontotheback.Other
symptomsincludesyncope,dyspnea,andweakness.
Physicalfindingsmayincludehypertensionorhypotension,lossofpulses,orfeeblepulses.
chestx-rayoftenrevealsawidenedsuperiormediastinum.Apleuraleffusion(usually
left-sided)alsomaybepresent.Thiseffusionistypicallyserosanguinousandnotindicativeof
ruptureunlessaccompaniedbyhypotensionandfallinghematocrit.

Q.184Whichofthefollowingisacauseofreversibledementia?
1Subacutecombineddegeneration.
2Picksdisease.
3Creutzfeldt-Jakobdisease.
4Alzheimersdisease.
Answeris1H15TH/

Q.185WhichoneofthefollowingdrugsisTopoisomerase1inhibitor?.
1Doxorubicin.
2Irinotecan.
3Etoposide.
4Vincristine.
Answeris2H15TH/536

Q.186Studythefollowingcarefully:
Readthepedigree.Inheritancepatternofthediseaseinthefamilyis:
1Autosomalrecessivetype.
2Autosomaldominanttype.
3XLinkeddominanttype.
4Xlinkedrecessivetype.

Q.187Palpablepurpuracouldoccurinthefollowingconditions,except:
1Thrombocytopenia.
2Small-vesselvasculitis.
3Disseminatedgonococcalinfection.
4Acutemeningococcemia.

Q.188A59yearoldmanwithseveremyxomatousmitralregurgitationisasymptomatic,witha
leftventricularejectionfractionof45%andanend -systolicdiameterindexof2.9cm/m2.The
mostappropriatetreatmentis:
1Mitralvalverepairofreplacement.
2Notreatment.
3ACEinhibitortherapy.
4Digoxinanddiuretictherapy.

Q.189Thegoldstandardforthediagnosisofosteoporosisis:
1DualenergyX-rayabsorptiometry.
2SingleenergyX-rayabsorptiometry.
3Ultrasound.
4Quantitativecomputedtomography.

Q.190Nevirapineisa:
1Proteaseinhibitor.
2Nucleosidereversetranscriptaseinhibitor.
3Non-nucleosidereversetranscriptaseinhibitor.
4Fusioninhibitor.

Q.191WithreferencetoinfectionswithEscherichiacolithefollowingaretrueexcept:
1EnteroaggregativeE.coliisassociatedwithPersistentdiarrhoea.
2EnterohemorrhagicE.colicancausehaemolyticuraemicsyndrome.
3EnteroinvasiveE.coliproducesadiseasesimilartosalmonellosis.
4EnterotoxigenicE.coliisacommoncauseoftravelers diarrhoea.

Q.192Thefollowingstatementsaretrueregardingmelioidosisexcept:
1ItiscausedbyBurkholderiamallei.
2Theagentisagramnegativeaerobicbacteria.
3Bipolarstainingoftheaetiologicalagentisseenwithmethylenebluestain.
4Themostcommonformofmelioidosisispulmonaryinfection.

Q.193Thefollowingbacteriaaremostoftenassociatedwithacuteneonatalmeningitisexcept:
1Escherichiacoli.
2Streptococcusagalactiae.
3Neisseriameningitides.
4Listeriamonocytogenes.

Q.194AllofthefollowingVibriosp.arehalophilic,except:
1V.cholerae.
2V.parahaemolyticus.
3V.alginolyticus.
4V.fluvialis.

Allmembersofthegenusarehighlymotile,facultativelyanaerobic,curvedgram -negativerods
withoneormorepolarflagella.ExceptforV.choleraeandV.mimicus,allrequiresaltforgrowth
("halophilicvibrios").

Q.195Allofthefollowingorganismsareknowntosurviveintracellularlyexcept:
1Neisseriameningitides.
2Salmonellatyphi.
3Streptococcuspyogenes.
4Legionellapneumophila.

Q.196ThecapsuleofCryptococcusneoformansinaCSFsampleisbestseenby
1Gramsstain.
2Indiainkpreparation.
3Giemsastain.
4Methanamine-Silverstain.

Q.197InVonHippel-LindauSyndrome,theretinalvasculartumoursareoftenassociatedwith
intracranialhemangioblastoma.Whichoneofthefollowingregionsisassociatedwithsuch
vascularabnormalitiesinthissyndrome?
1Opticradiation.
2Optictract.
3Cerebellum.
4Pulvinar.

Q.198Virusescanbeisolatedfromclinicalsamplesbycultivationinthefollowingexcept:
1Tissueculture.
2Embryonatedeggs.
3Animals.
4Chemicallydefinedmedia.

Ananthnarayan,sTextbookofmicrobiology,

Q.199Itistrueregardingthenormalmicrobialflorapresentontheskinandmucousmembranes
that:
1Itcannotbeeradicatedbyantimicrobialagents
2ItisabsentinthestomachduetotheacidicpH.
3Itestablishesinthebodyonlyaftertheneonatalperiod.
4Theflorainthesmallbronchiissimilartothatofthetrachea.

Q.200Anarmyjawanpostedinaremoteforestareahadfeverandheadache.Hisfeverwas104F
andpulsewas70permin.Hehadanerythematouslesionofabout1cmonthelegsurroundedby
smallvesicles,alongwithgeneralizedlymphadenopathyatthetimeofpresentationtothereferral
hospital.HisbloodsamplewascollectedtoperformserologyforthediagnosisofRickettsial
disease.WhichoneofthefollowingresultsinWeil-felixreactionwillbediagnosticinthis
clinicalsetting:
1HighOX-2
2HighOX-19.
3HighOX-K.
4HighOX-19andOX-2.
Answeris3PANICKAR6TH/
Thisisacaseofscrubtyphuswithclassicalclinicalpresentaqtion.Theclassiccasedescription
includesanescharatthesiteofchiggerfeeding,regionallymphadenopathy,andamaculopapular
rash.Afteranincubationperiodof6to21days(usually8to10days),theonsetofdiseaseis
characterizedbyfever,headache,myalgia,cough,andgastrointestinalsymptoms.Severecases
typicallyincludeprominentencephalitisandinterstitialpneumoniaaskeyfeaturesofvascular
injury.Scrubtyphusisfoundinenvironmentsthatharbortheinfectedchiggers,particularlyareas
ofheavyscrubvegetationwheretheforestisregrowingafterbeingclearedandalongriverbanks.
OnWeil-felixreactionscrubtyphusshows
OX-K OX-2 OX-19
+++ - -
Q.201Adenosinedeaminase(enzyme)deficiencyisassociatedwith:
1Severecombinedimmunodeficiency(SCID).
2X-linkedagammaglobulinemia.
3Transienthypogammaglobulinemiaofinfance.
4Chronicgranulomatousdisease.
Answeris1R7th/201
Severecombinedimmunodeficiency(SCID)isinheritedasbothautosomalrecessiveandX -
linkedrecessiveform.AutosomalrecessiveformofSCIDcharacterizedbyseverelymphopenia,
thefailureinTandBcelldevelopment.ItisduetomutationsintheRAG -1orRAG-2genes.
AbouthalfofpatientswithautosomalrecessiveSCIDaredeficientinanenzymeinvolvedin
purinemetabolism,adenosinedeaminase(ADA),duetomutationsintheADAgene.

Q.202Whichofthefollowingviralinfectionsistransmittedbytick.
1Japaneseencephalitis.
2Denguefever.
3Kyasanurforestdisease(KFD).
4Yellowfever.

Answeris3KParkP.S.M.17thed/543.
Hardtick Softtick
Ticktyphus Qfever
Viralencephalitis Relapsingfever
Viralfevers(KFD)
Tularemia
Tickaralysis
Humanbabesiosis
Q.203Atypicalpneumoniacanbecausedbythefollowingmicrobialagentsexcept?
1Mycoplasmapneumoniae.
2Legionellapemmophila.
3HumanCoronavirus.
4Klebsiellapneumoniae.
Answeris4RobbinsPathology7ed/747

CommonCausesofCommunityacquiredatypicalpneumoniaare.
1)Mycoplasmapneumoniae 4) Viruses (RSV, Parainfluenza, influenza A &

B,adenovirus,SARS).
2) Chlamydia spp (Pneumoniae, Psittaci,
trachomatis) SARSiscausebyhumancoronavirus.
3)Coxiellaburnetti(Qfever)
4)Legionellapemmophila
Q.204TheserumconcentrationofwhichofthefollowinghumanIgGsubclassismaximum?
1IgG1.
2IgG2.
3IgG3.
4IgG4.
Answeris4H16THED/1922.AN6THED/81
IgGcomprisesapproximately75to85%oftotalserumimmunoglobulin.ThefourIgG
subclassesarenumberedinorderoftheirlevelinserum,IgG1beingfoundingreatestamounts
andIgG4theleast.

IgG165% IgG38%
IgG223% IgG44%
Q.205Chlamydiatrachomatisisassociatedwiththefollowingexcept:
1Endemictrachoma.
2Inclusionconjunctivitis.
3Lymphogranulomavenereum.
4Communityacquiredpneumonia.
Answeris4H16THED/1531
DiseasecausedbyChlamydiatrachomatis

Pneumonia, primarily in children and young Recurrentrespiratoryinfectionsinolderadults
adults,
AsthmaandSarcoidosis
Atheroscleroticcardiovasculardisease
Sexually transmitted and perinatally acquired
TrachomaA,B,Ba,andCserovars infections.DthroughK

Lymphogranuloma venereum (LGV) and Inclusion conjunctivitis in young adult and
hemorrhagicproctocolitis.L1,L2,andL 3 children

Q.206ThefollowingstatementsaretrueregardingClostridiumperfringensexcept:
1Itisthecommonestcauseofgasgangrene.
2Itisnormallypresentinhumanfaeces.
3TheprincipaltoxinofC.perfringensisthealphatoxin.
4GasgangreneproducingstrainsofC.perfringensproduceheatresistantspores.
Answeris4PANICKAR6TH/230

Clostridiaarepresentinthenormalcolonicfloraatconcentrationsof109to1010pergram.C.
ramosumisthemostcommonandisfollowedinfrequencybyC.perfringensincolonizing
clostridium.Whilemostcommoncolonizingorganismsincolonarebacteriods.
C.perfringensisthemostcommonoftheclostridialspeciesisolatedfromtissueinfections
(gasgangrene)andbacteremias.
C.perfringensisassociatedwithfoodpoisoning(typeA)andenteritisnecroticans(typeC).
C.perfringenspossessesatleast17possiblevirulencefactors.Thisspecieshasbeendividedinto
fivetypes(AthroughE)onthebasisoffourmajorlethaltoxins:?,?,?,and?.The?toxinisa
phospholipaseC(lecithinase)thatsplitslecithinintophosphorylcholineanddiglyceride.Thisisa
majortoxinandassociatedwithgasgangrene.GasgangreneproducingstrainsofC.perfringens
produceheatlabilesporesandgetdestroyedwithboiling

207ThemostcommonorganismamongstthefollowingthatcausesacutemeningitisinanAIDS
patientsis:
1Streptococcuspneumoniae.
2Streptococcusagalactiae.
3Cryptococcusneoformans.
4Listeriamonocytogenes..
Answeris3Harrison16th/1116

TheAIDSdementiacomplex,orHIVencephalopathy,isconsideredanAIDS -definingillness.
AIDS
dementiacomplexiscommonestCNSdisorderinAIDSpatient.
AmongthemorefrequentopportunisticdiseasesthatinvolvetheCNSaretoxoplasmosis,
cryptococcosis,progressivemultifocalleukoencephalopathy,andprimaryCNSlymphoma.
ToxoplasmosisisthemostcommonopportunisticinfectionofCNSinAIDSpatients.Itisthe
most
commoncauseofchrioretinitisinthesepatient,whileCMVisthemostcommoncauseofretinitis
inAIDS.
C.neoformansistheleadinginfectiouscauseofmeningitisinpatientswithAIDS.Itisthe
initialAIDS-definingillnessinapproximately2%ofpatientsandgenerallyoccursinpatients
withCD4+Tcellcounts<100/uL.Cryptococcalmeningitisisparticularlycommoninpatients
with
AIDSinAfrica.

Q.208Abacterialdiseasethathasbeenassociatedwiththe3 Rsi.e.,rats,ricefields,andrainfall
is:
1Leptospirosis.
2Plague.
3Melioidosis.
4Rodent-bitefever.
Answeris1KParkP.S.M.17thP(222)

Leptospirosisisazoonosiswithaworldwidedistribution.Waterisanimportantvehicleintheir
transmission.Epidemicsofleptospirosismayresultfromexposuretofloodwaterscontaminated
byurinefrominfectedanimals
Leptrospiraareexcretedinurineofinfectedanimalsforalongtime.Rats,miceandvoles
particularlyR.novergicusandMusmusculusareReservoirs.
Humaninfectionisusuallycausedbyoccupationalexposuretotheurineofinfectedanimals,eg
agriculturalandlivestockfarmers,workerinricefields.
Leisuretimeactivitiessuchasswimmingandfishingalsocarryrisks.
Leptospirashedinurineandcansurviveforweeksinsoilandwaterheavyrainfallcanleadsto
highlevelofcontaminationofsoilofthatarea.Potentialcontaminationofwateroccurs.

Q.209AchildwasdiagnosedtobesufferingfromdiarrhoeaduetoCompylobacterjejuni.Which
ofthefollowingwillbethecorrectenvironmentalconditionsofincubationofthecultureplatesof
thestoolsample:
1Temperatureof42oCandmicro-aerophilic.
2Temperatureof42oCand10%carbondioxide.
3Temperatureof37oCandmicro-aerophilic.
4Temperatureof37oCand10%carbondioxide.
Answeris1DavidGreenwood,Medical,Microbiology16thedition/288

CampylobacterareSmallspiralGramnegativewithsingleflagellumatoneorbothpole.Theyare

usuallysensitivetoO2andsuperoxide,yetO2isessentialforgrowth,somicro -aerophilic
conditionmustbeprovidedfortheircultivation.Compylobacterjejunigrowbestat42 -43oC.
Note,othercampylobactorlikeenteritisgrowsbestat37oCtemp.

Q.210WhichoneofthefollowingstatementsistrueregardingChlamydiapneumoniae:
1Fifteenserovarshavebeenidentifiedashumanpathogens.
2Modeoftransmissionisbytheairbornebirdexcreta.
3Thecytoplasmicinclusionspresentinthesputumspecimenarerich
inglycogen.
4Thegroupspecificantigenisresponsibleforitheproductionofcomplementfixingantibodies.
Answeris4Brooksmedicalmicrobiology,23ed/chapter28.
Chlamydiapneumoniaeprducestheglycogennegetiveinclusionbodiesthataremuchlikeof
Chlamydiapsittaciandaresulfonamide-resistant.Onlyoneserovrarhasdiscovered.Serology
usingtheMicroimmunofluroscenttestisthebmostsensitvemethodforthedetectionof
Chlamydia
pneumoniaeinfection.Thistestisthespeciesspecificnotthecomplementfixingantibody
detectionbycomplementfixationtest.Becausethecomplementfixingantibodiesareagainstthe
groupspecificantigensodetectionoftheseantibodiesarenotspeciesspecific.
ModeoftransmissionisbytheairbornebirdexcretaisseeninCh.Psittaci.

Q.211Whichofthefollowingultrasoundmarkerisassociatedwithgreatestincreasedriskfor
Trisomy21infetus:
1Echogenicfociinheart.
2Hyperechogenicbowel.
3Choroidplexuscysts.
4Nuchaledema.
AnswerisWilliams/p988
RiskassociatedwithDownsyndrome.

1)Nuchalfold?6mm-38%
2)Femurlength-34%
3)BPD/FL-22%
4)Hyperechogenicbowel-11%
5)Choroidplexuscyst-0%

Q.212ThehighestincidenceofGestationalTrophoblasticDiseaseisin:
1Australia.
2Asia.
3NorthAmerica.
4WesternEurope.
Answeris2H16th/588,Dutta5TH/206

Gestationalchoriocarcinomaaccountsfor<1%offemalegynecologicmalignancies.IntheUnited
States,theincidenceisabout1per1000pregnancies;inAsia,2per1000pregnancies.The
spectrumofdiseaserangesfrombenignhydatidiformmoletotrophoblasticmalignancy
(placental-sitetrophoblastictumorandchoriocarcinoma).
Apriorhistoryofmolarpregnancyisalsoariskfactor.Priorhistoryofhydatidiformmoleisa
riskfactorforchoriocarcinoma.

Q.213Thesmallestdiameterofthetruepelvisis:
1Interspinousdiameter.
2Diagonalconjugate.
3Trueconjugate.
4Intertuberousdiameter.

Answeris2Dutta5TH/p90

Interspinousdiameteristhesmallestdiameterofthetruepelvis.Itisapproximately

Q.214Themostcommonpuregermcelltumoroftheovaryis:
1Choriocarcinoma.
2Dysgerminoma.
3Embryonalcelltumor.
4MalignantTeratoma.
Answeris2DahnertRadiologicalreviewmanual5thedi/1046.
COGDT9TH/chapter49
Malignantgermcelltumorofovarycomprises7%oftumor.

(a)Matureteratomy(10%)=theonlybenignvarietyanditismixedtumor
(b)dysgerminoma(1.9%)
(c)immatureTeratoma(MalignantTeratoma)(1.3%)
(d)Endodermalsinustumor(1%)
(e)Malignantmixedgermcelltumor(.7%)
(f)Choriocarcinoma(.1%)
(g)Embryonalcarcinoma(.1%)

Q.215Infantsofdiabeticmotherarelikelytohavethefollowingcardiacanomaly:
1Coarctationofaorta.
2Fallotstetrology
3Ebsteinsanomaly.
4Transpositionofgreatarteries.
Answeris2Famarof&Martin sNeonatal-
PerinatalMedicine7thEdvol-1,Pg-282.

ThecongenitalanomalymostspecificforpregnantwomanwithDMiscaudaldysplasia(sacral
agenesis),whichoccurs200-400timesmoreoftenindiabeticwomen.)Thislesion(sacral
agenesis)ismostspecificbutnotmorecommonthanNeuraltubedefectandCongenital
heartdefects.
MalformationsofCNSthataremorecommonindecreasingfrequencyare
-Neuraltubedefect(openmyelomeningocoele)
-Anencephaly
-Holoprocencephaly

RiskofCardiacmalformationsuchasTGAandVSDareincreased5fold.TGAisthemost
commoncongenitalcardiacanomalyindiabeticinfants.

Q.216Whichoneofthefollowingistheidealcontraceptiveforapatientwithheartdisease?
1IUCD.
2Depoprovera.
3Diaphragm.
4Oralcontraceptivepills.
Answeris2Dutta/p296

Barriermethodofcontraceptive(condom)istheidealcontraceptive -onlybarriermethodgivenin
choiceisdiaphragm.

Q.217ThekaryotypeofapatientwithAndrogenInsensitivitySyndromeis:
146xx.
246xy.
347xxy.
445x0.
Answeris2Robbins7th/181,SHAWS13TH/105
HARRISON15th/chapter-338

Completetesticularfeminization(alsocalledcompleteandrogeninsensitivity)isacommon
formofmalepseudohermaphroditism;Itisthethirdmostcommoncauseofprimaryamenorrhea
after
gonadaldysgenesis(Turnersyndrome)andcongenitalabsenceofthevagina
(Mayer-Rokitansky-Kuster-Hausersyndrome).Thekaryotypeis46,XY,andthemutationisX -
linked.
Reifensteinsyndrome(alsocalledpartialandrogeninsensitivity)isthetermappliedtoformsof
incompletemalepseudohermaphroditism

Q.218Thefollowingdrugisnothelpfulinthetreatmentofectopicpregnancy:
1Methotrexate.
2Misoprostol.
3Actinomycin-D.
4RU486.
Answeris2Williams 21st/898
Novak sGynecology13thed/530
Methotrexateisaantineoplasticdrugthatactsasafolicacidantagonistandhighlyeffective
againstrapidlyproliferatingtrophoblast.singledosetreatmentiseasiertoadministerandmonitor
thanvariabledosemethotrexatetherapy,butiti8sassociatedwithhighfailurerate.Aaippg.co
mpaperIncaseoffailureseconddoseofmethotrexateisgiven.
Afive-daycourseofintravenousactinomycinresultsincopleteresolutionofanectopic
pregnancyevenincaseofmethotrexatefailure.
RU486(Mifepristone)combinedwithmethotrexateissafeandeffectivetreatmentwithout
obvioussideeffects.Drugsuseddirectinjectionsare
Methotrexate ProstagladinsF 2E2
Hyperosmolarglucose KCL
MisoprostolisProstagladinsE1analouge.Itisnotusedinectopicpregnancy.

219Thebestperiodofgestationtocarryoutchorionvillousbiopsyforprenataldiagnosisis?
18-10weeks
210-12weeks
312-14weeks
414-16weeks
Answeris2Dutta5th/p113
Williams21st/ch.37
Chorionicvillussamplingisthesecondmostcommonprocedureforgeneticprenataldiagnosis.It
isroutinelyperformedatabout10to12weeksofgestation,itallowsforanearlierdetectionof
abnormalitiesandasaferpregnancytermination,becausethereisanincreasedassociationoflimb
defects(Oromandibulodigitaldysplasia)whentheprocedureisperformedbeforethe9thweek.
Soitisnotdonebeforethe9thweek.

Q.220Whichoneofthefollowingbiochemicalparametersisthemostsensitivetodetectopen
spinabifida?
1Maternalserumalphafetoprotein.
2Amnioticfluidalphafetoprotein.
3Amnioticfluidacetylcholinesterase.
4Amnioticfluidglucohexaminase.

Answeris3Rodecks&Whittle s
FetalMedicine,.Pg -377
Whenamnioticfluidacetylcholinesterase(AchE)measurementisavailablefordiagnostic
purposes,nearlyallofthefalsepositiveamnioticfluidAFPmeasurementscouldbeidentified.So
itisthemostsensitivetestfordetectionofopenspinabifida.ElevationofAmnioticfluid
alphafetoproteinlevelwithoutincreasedacetylcholinesterasecanbeduetootheretiologyor
frombloodcontamination.

Q.221.Riskofpretermdeliveryisincreasedifcervicallengthis:
1.2.5cm.
2.3.0cm.
3.3.5cm.
4.4.0cm.
Answeris1Williams21st/701
Pretermbirth,FUCHS2ndedition/30 -31
Meancervicallengthat24weekswas35mm,andthosewomenwithprogressivelyshorter
cervicesexperiencedincreasedratesofpretermbirth.
Whenthecervicallengthmeasuredbyvaginalultrasoundwaslessthan50thpercentile(<37
mm),riskofpretermdeliverywasincreased3.7fold.
Ifmanualmeasuredcervixwasshorterthanthe50thpercentile(18mm),prematurebirthwas
increased2.9fold.

Q.222.DiagnosisofbetaThalassemiaisestablishedby:
1.NESTROFTTest.
2.HbA1Cestimation.
3.Hbelectrophoresis.
4.Targetcellsinperipheralsmear.

Q.223.Allaretheriskfactorsassociatedwithmacrosomiaexcept:
1.Maternalobesity.
2.ProlongedPregnancy.
3.Previouslargeinfant.
4.ShortStature.
Answeris4Williams21st/759

Factorsthatfavorthelikelihoodoflargefetus
1)Obesity5)Malefetus
2)Multiparity6)Previousinfant>4kg
3)Prolongedgestation7)Raceandethnicity
4)Maternalage.

Q.224.Whichofthefollowingstatementsisincorrectinrelationtopregnantwomenwith
epilepsy?
1.Therateofcongenitalmalformationisincreasedintheoffspringofwomenwithepilepsy.
2.Seizurefrequencyincreasesinapproximately70%ofwomen.
3.Breastfeedingissafewithmostanticonvulsants.
4.Folicacidsupplementationmayreducetheriskofneuraltubedefect.
Answeris2Williams21st/1408 -1409

Duringpregnancyincreasedseizurefrequencyseenin35%,whiledecreasedfrequencyin15%
andnochangein50%.WomentakingantiepilepticdrugsshouldreceivetheFolicacid
supplementationasmostoftheseagentsdepletethisnutrient.Folicacidsupplementationreduces
theriskofneuraltubedefect.Therateofcongenitalmalformationisincreasedintheoffspringof
womenwithepilepsyevenwhenpatientisnottakingtheantiepileptics.

Q.225.Allarethecausesofintrauterinegrowthretardationexcept:
1.Anemia.
2.Pregnancyinducedhypertension.
3.Maternalheartdisease.
4.Gestationaldiabetes.
Answeris4Williams21st/751 -752,Dutta5th/499
MaternalconditionscommonlyassociatedwithI.U.G.R.
1)Renaldisease
2)Vasculardiseaselikeeclampsia,pre-eclampsiaetc.
3)Chronichypoxia
4)Maternalanaemia
5)Placentalinsufficiency
6)Multiplepregnancy
7)Antiphospholipidantibodysyndrome.

Pre-eclampsia,heartdisease,malnutritionmaybelifethreateningandimportantcauseoffetal
growthretardation.
Note-DiabeticmotherihaveriskofmacrosomiainplaceofI.U.G.R

Q.226.Misoprostolhasbeenfoundtobeeffectiveinallofthefollowingexcept:
1.Missedabortion.
2.Inductionoflabour.
3.Menorrhagia.
4.Preventionofpost-partumhemorrhage(PPH).

Q.227.Allofthefollowingappeartodecreasehotflushesinmenopausalwomenexcept:
1.Androgens.
2.Raloxifene.
3.Isoflavones.
4.Tibotone.
Answeris2CMDT2004/1140
Androgendeficiencycontributestohotflushes;lossoflibidoandsexualhair,muscleatrophy,
andosteoporosis,selectedwomenmaybetreatedwithlowdosemethyltestosterone.Androgen
shouldnotbegiventowomenwithliverdisease;duringpregnancyorbreast -feeding.
Raloxifenealternativetoestrogeninpostmenopausalwomentopreventosteoporosis.Butitdoes
notreducehotflushes,vaginaldryness,skinwrinkling,orbreastatrophy.Whileitcanleadtohot
flushesasasideeffect.
Raloxifeneincreasesriskofvenousthromboembolism.
Tibolonehavemixedestrogenic,progestogenicandweakandrogenicactivity,itreducesthe
climacteric-relatedcomplication.
Isoflavons-arephytoestrogen(soyphytoestrogenoccursnasturally)
-BindweaklytoE.R.?butstronglytoE.R.B.
-DailyintakeofSoyproteinsreduceshotflushesbyabout45%within12
weeks.

Q.228.InacaseofDysgerminomaofovaryoneofthefollowingtumormarkersislikelytobe
raised:
1.SerumHCG.
2.Serumalphafetoprotein.
3.Serumlacticdehydrogenase.
4.Seruminhibin.
MalcolmCoppleson,
GynecologicAnsweris3Oncology2nded/918 -921.
Lipincott-Rovenpublication,S-JeanEmans,Marc
R-Pediatricandadolescentgynecology4thed./575.

Dysgerminomaismostcommonmalignantgermcelltumoroftheovary,representing2%ofall
ovarianmalignancies.
LDH,PLAP,andCA125maybeelevatedandinsomeinstancescanserveastumormarker.
LDHinparticularhasbeensuccessfulinpredictingrecurrenceintesticularseminomaand
dysgerminoma.
LDHiselevatedinsomepatientwithdysgerminoma,andthelevelsandtheisoenzymepattern
(LDH-1andLDH-2)maybeusefulinsuggestingthediagnosispreoperatively.

Q.229.Useofoneofthefollowingvaccinationisabsolutelycontraindicatedinpregnancy:
1.Hepatitis-B.
2.Cholera.
3.Rabies.
4.Yellowfever.

Q.230.ThemostcommoncauseofsecondaryamenorrhoeainIndiais:
1.Endometrialtuberculosis.
2.Prematureovarianfailure.
3.Potycysticovariansyndrome.
4.Sheehanssyndrome.

Q.231.InKlippel-Feilsyndrome,thepatienthasallofthefollowingclinicalfeaturesexcept:
1.Lowhairline.
2.BilaterealNeckwebbing.
3.Bilateralshortnessofsternomastoidmuscles.
4.Grosslimitationsofneckmovements.

Q.232.Themostcommonsequelaeoftuberculousspondylitisinanadolescentis:
1.FibrousAnkylosis.
2.Bony-Ankylosis.
3.Pathologicaldislocation.
4.Chronicosteomyelitis.

Q.233.InRadionuclideimagingthemostusefulradiopharmaceuticalforskeletalimagingis:
1.Gallium67(67Ga).
2.Technetium-sulphur-colloid(99mTc-Sc).
3.Technetium-99m(99mTc).
4.Technetium-99mlinkedtoMethylenedisphosphonate(99mTc-MDP).

Q.234.Heberdensarthropathyaffects:
1.Lumbarspine.
2.Symmetricallylargejoints.
3.Sacroiliacjoints.
4.Distalinterphalangealjoints.

Q.235.Subtrochantericfracturesoffemurcanbetreatedbyallofthefollowingmethodsexcept:
1.SkeletaltractiononThomassplint.
2.SmithPetersenNail.
3.Condylarbladeplate.
4.Endersnail.

Q235.Ref-Chapmansorthopaedicsurgery3rdEd,Pg655-660

-Lockedmedullarynailswereusedforclosednailingofproximalfemoralfractures.Allclosed
adultsubtrochanticfracturesbelowtheleveloflessertrochantercanbesafelynailedwithfirst
generationnail,regardlessofthefracturepatternordegreeofcommunition
-Endersnailhasparticularadvantageinunusualsituationswherethesofttissuesaroundthehip
precludetheuseofanydevicethatentersforhip,andender snailcanbeinsertedthroughthe
knee
-Condylarbladeplateisusedforanatomicreductionandstablefixationofallfragments

Q.235.ApleysOrthopedics8thed/694
Chapmansorthopedicsurgery3rded/653.

Treatmentofsubtrochantericfracture
Openreductionandinternalfixationistreatmentofchoice.
Compression(Dynamic)Hipscrewandplateissatisfactory.
Intramedullarynailareequallygoodforstablization
Devicesusedinsubtrachentericfractureare-
1)Lockednail(interlockingnail)-Altanailtechniqueisreamedlockedintramedullarynailing.
2)Zickelsnail
3)Endernail
4)95obladeplate.
5)95odynamiccondylarscrew.
Therehasbeennearlyacompleteeliminationofnonoperativetreatmentinadultandincreasein
operativetreatmentofsub-trochantericfracture.

Answeris(1).

Q.236.Allofthefollowingaretrueaboutfractureoftheatlasvertebra,except:
1.Jeffersonfractureisthemostcommontype.
2.Quadriplegiaisseenin80%cases.
3.Atlantooccipitalfusionmaysometimesbeneeded.
4.CTscansshouldbedonefordiagnosis.
236.ApleysOrthopedics8thed/650.

Fractureatlas-
Jeffersonfracture.
Usuallynoneurologicaldeficit.
Fractureseenonopenmouthview.
CTscanisparticularlyhelpful.
Undisplacedfracture-Treatedwithsemi-rigidcollarorhalovastuntilfractureunite.
Ifsidewayspreadingoflatestmass(>7mmonopenmouthview)orrupturedtransverse
ligament
orunstableinjury-treatedwithholocastforseveralweeks.
IfpersistinginstabilityonX-ray-aPosteriorC1-2(atlantoaxial)arthrodesisis
considered.
Fractureofatlasareassociatedwithinjuryelsewhereincervicalspineinupto50%ofcases.
Odontoidfractureandhangmansfractureshouldbeexcluded.

CAMPBELLSoperativeOrthopedics9thed/2722
ChapmansOrthopaedicSurgery3rded/3674-77.

-TheinitialdescriptionofC1archwasgivenbyJefferson(sofractureC1archinwholecanbe
saidJeffersonfracture).ButtypicalJeffersonfractureistypeIIIfracture,whichhaving
fractureofbothanteriorandposteriorarchofatlas.Itiscalledtheburstfracture(Jefferson
fracture),whichischaracterizedby4fracture -2inposteriorarchand2inanteriorarch.
-HowevermostcommoninjuryistypeIfracturewhichisisolatedposteriorarchfracture.
-Itisresultfromthehyperextension-axialloadinginjury.
-SecondM/cfractureislateralmassfracture.
-TypicalJeferrsonfractureis3rdm/cfracture.

Henceonlycorrectchoiceis(4).

Butbestanswerofthisquestionis(2),becauseneurologicaldeficitisseeninatlantoaxial
dislocation(evenifitisalsosevere.

Q.237.A30yearoldmanhadroadtrafficaccidentandsustainedfractureoffemur.Twodays
laterhedevelopedsuddenbreathlessness.Themostprobablecausecanbe:
1.Pneumonia.
2.Congestiveheartfailure.
3.Bronchialasthma.
4.FatEmbolism.

Q.238.A45yearoldwasgivensteroidsafterrenaltransplant.After2yearshehaddifficultyin
walkingandpaininbothhips.Whichoneofthefollowingismostlikelycause?
1.PrimaryOsteoarthritis.
2.Avascularnecrosis.
3.Tuberculosis.
4.Aluminumtoxicity.

Q.239.Allofthefollowingarebranchesoftheexternalcarotidarteryexcept:
1.Superiorthyroidartery.
2.AnteriorEthmoidalartery.
3.Occipitalartery.
4.Posteriorauricularartery.

239.B.D.ChaurusiyaHeadandNecked./p103and87

BranchesofexternalcarotidA
(A)Anterior-Sup.thyroid,lingualandfacial
(B)Posterior-occipital,post.auricular
Medial-ascendingpharyngeal
(d)Terminal-MaxillaryandsuperficialtemporalA

-AnteriorethmoidalAisbranchofophthalmicA,thisisbranchofinteriorcarotidA.

Q.240.AllaretrueforGradenigo ssyndromeexcept:
1.Itisassociatedwithconductivehearingloss.
2.Itiscausedbyanabscessinthepetrousapex.
3.ItleadstoinvolvementoftheCranialnervesVandVI.
4.Itischaracterizedbyretro-orbitalpain.

Q240.Ref-DiseasesofEar,Nose&Throat,3rdEd,PLDhingra,Pg -103
GradenigoSyndromeistheclassicalpresentationofpetrositis&consistsoftriadof
a.Externalrectuspalsy(vinervepalsy)
b.Deepseatedearorretro-orbitalpain(vthnerveinvolvement)
c.Persistenteardischarge-iepetrositis
Hencetheansweris1
Q240.Ref-DiseasesofEar,Nose&Throat.3rdedition,P.L.DhingraGradenigo ssyndromeisthe

classicalpresentationofpetrositis&consistsoftriadof:
1.Externalrectuspalsy(VIthnervepalsy)
2.Deep-seatedearorretro-orbitalpain(Vthnerveinvolvement).
3.Persistenteardischarge-whichpointstopetrosistis.

Q.241.Themostcommonandearliestmanifestationofcarcinomaoftheglottisis:
1.Hoarseness.
2.Haemoptysis.
3.Cervicallymphnodes.
4.Stridor.
241.Dahnertsradiologicalreviewmanual5thedition/382.

-GlotticC.AismostcommontypeofC.A.larynx.
-Earliestsymptomishoarseness.
-M/CsymptomishoarsenessinC.A.Glottis.
-Supraglotticcarcinomaisdetectedlateduetominimalsymptomatology.

Answer-(1).

Q.242.Abbey-Estlanderflapisusedinthereconstructionof:
1.Buccalmucosa.
2.Lip.
3.Tongue.
4.Palate.

Q.243.Androphoniacanbecorrectedbydoing:
1.Type1Thyroplasty.
2.Type2Thyroplasty.
3.Type3Thyroplasty.
4.Type4Thyroplasty.

Q243.RefENT,Head&NeckSur22ndEd-Vol-3,Pgs2072,2089-90.
Isshikicategorizedlaryngealphonosurgeryintofourtypesbasedon
Functionalalterationofvocalfolds
-medialdisplacement(type-1thyroplasty)
-lateraldisplacement(type-2)
-shorteningorrelaxation(type-3)
-elongationortensioningprocedures(type-4)
-lentheningprocedure(type-4)havebeenadvocatedforvocalfoldbowing
resultingfromagingortrauma,post-surgicaldefects,androphonia&gendertransformation

-type3foradductorspasmodicdysphonia,mutationalfalcetto&gendertransformation.

Ans-D

Q.244.Inwhichoneofthefollowingperineuralinvasioninheadandneckcancerismost
commonlyseen?
1.Adenocarcinoma.
2.Adenoidcysticcarcinoma.
3.BasalCellAdenoma.
4.Squamouscellcarcinoma.

244.Robbin/sPathology
Dahnertradiologicalreviewmanual5theds/369

-AdenoidcysticC.A.(Cylindroma)
40-70yragegroup,M=F
-Mostcommonmalignantneoplasmsofminorsalivarygland
(HardPalateiscommonestsite)
-Thistumorhavepropensityforperineuralspreadalongfacialnerve.

Q.245.UseofSeigelsspeculumduringexaminationoftheearprovidesallexcept:
1.Magnification.
2.Assessmentofmovementofithetympanicmembrane.
3.Removalofforeignbodyfromtheear.
4.Asapplicatorforthepowderedantibioticofear.

TextbookofENTbyMohd.Maqbool10thed/26

-Speculumconsistsofa10diopterlensandasidetobeconnectedwitharubberbulb.
-Anairtightsystemisproducedincanalandpressureisincreasedbybulb.
-Speculumisusefulforthefollowingreason -
1)Itgivesamagnifiedviewofthemembrane
2)Itishelpfultoassessthemobilityofthemembrane.
3)Thespeculumisusedtoelicitthefistulasign.
4)Byvaryingthepressure,dischargethroughtheperforationcanbesuckedoutaswellas
medicationcanbeputintothemiddleear.

Henceansweris(3).

Q.246.Bloodspecimenforneonatalthyroidscreeningisobtainedon:
1.Cordblood.
2.24hoursafterbirth.

Q.247.Achildwithrecurrenturinarytractinfectionsismostlikelytoshow:
1.Posteriorurethralvalves.
2.Vesicouretericreflux.
3.Neurogenicbladder.
4.Renalanduretericcalculi.

Q.248.Theappropriateapproachtoaneonatepresentingwithvaginalbleedingonday4oflifeis:
1.AdministrationofvitaminK.
2.Investigationforbleedingdisorder.
3.Nospecifictherapy.
4.Administrationof10ml/kgoffreshfrozenplasmaover4hours.
O.P.GhaiPediatrics5thed./125

Answeris(3)
Menstruallikebleedingmayoccurfrom3rdto7thdayoflifethisisattributedto
transplacentalpassageofhormonesandestrogenwithdrawalafterbirth,notherapyisrequired.

Q.249.Whichoneofthefollowingdrugsisusedforfetaltherapyofcongenitaladrenal
hyperplasia?
1.Hydrocortisone.
2.Prednisolone.
3.Fludrocortisone.
4.Dexamethasone.

249.-Fetalmedicine,CharlesH.RodeckIsted./831.
-Topreventthebirthofvirilizedfemales,Evansetal.Firstadministereddexamethasoneata
doseof.25mgq.i.d.toamotherknowntobeariskofCAH.
-Itiscurrentlyrecommendedtostartthetherapyat7thweeksofgestation.
FimaLifschiz-Pediatricendocrinology3rded/315.
-Pxwithdexamethasonewasrecentlyemployedinpregnanciesatriskfor21 -
hydroxilasedeficiency.
-Thecurrentrecommendationistotreatthemotherwithapregnancyatriskfor
21-OHdeficiencywithdexamethasoneinadoseof.5mgTDSassoonas
pregnancyisrecognized.

Q.250.Thecoagulationprofileina13-yearoldgirlwithMenorrhagiahavingvonWillebrands
diseaseis:
1.IsolatedprolongedPTTwithanormalPT.
2.IsolatedprolongedPTwithanormalPTT.
3.ProlongationofbothPTandPTT.
4.Prolongationofthrombintime.

Q.251.AllofthefollowingaretrueaboutmanifestationsofvitaminEdeficiencyexcept:
1.Hemolyticanemia.
2.Posteriorcolumnabnormalities.
3.Cerebellarataxia.
4.Autonomicdysfunction.

Q.252.Differentialexpressionofsamegenedependingonparentoforiginisreferredtoas:
1.Genomicimprinting.
2.Mosaicism.
3.Anticipation.
4.Nonpenetrance.

Q.253.Thechancesofhavinganunaffectedbaby,whenbothparentshaveachondroplasia,are:
1.0%.
2.25%.
3.50%.
4.100%.

Q.254.Allofthefollowingtherapiesmayberequiredina1 -hour-oldinfantwithseverebirth
asphyxiaexcept:
1.Glucose.
2.Dexamethasone.
3.Calciumgluconate.
4.Normalsaline.

254.O.P.Ghai,EssentialofPediatrics5thed/153.

1)Maintaintemperature
2)ProvideO2/ventilationasrequired.
3)EnsurenormalB.P:Volumeexpanders,dopamine,dobutamine.
4)Acidosis,hypoglycemia,hypocalcemianeedscorrection
5)Treatseizures.

Dexamethasonehasnoroleinresuscitationofasphyxiatednewborn.

Whenasphyxiaoccursprenatallythenhighlevelofcirculatingsteroidsalreadyleadstolung
maturation.

Q.255.Themostcommonleukocytoclasticvasculitisaffectingchildrenis:
1.Takayasudisease.
2.Mucocutaneouslymphnodesyndrome(Kawasakidisease)
3.HenochSchonelinpurpura.
4.Polyarteritisnodosa.

255.AndersonPathology10thed./1433

-Smallvesselvasculitis-K/aleukocytoclasticvasculitis.
-TheincidenceofHenoch-SchonleinPurpuraPeaksaround5yrofageandismostcommon
typeof
vasculitisofchildren.
-d/dofleukocytoclasticvasculitis-
1)H.S.P.
2)Microscopicpolyangitis
3)Cryoglobulinemicvasculitis
4)Wegenersgranulomatosis
5)Churgstrausssyndrome
6)Druginducedvasculitis
7)Neisseriainducedvasculitis.
accordingtoHarrison15thed.?
-AnaphylactoidPurpura=Henoch-Schonleinpurpura.

Q.256.Afouryearoldboywasadmittedwithahistoryofabdominalpainandfeverfortwo
months,maculopapularrashfortendays,anddrycough,dyspneaandwheezingforthreedays.
Onexamination,liverandspleenwereenlarged4cmand3cmrespectivelybelowthecostal
margins.
Hishemoglobinwas10.0g/dl,plateletcount37x109/L,whichincluded80%eosinophils.Bone
marrowexaminationrevealedacellularmarrowcomprising45%blastsand34%eosinophilsand
eosinophilicprecursors.Theblastsstainednegativeformyeloperoxidaseandnon -specificesterase
andwerepositiveforCD19,CD10,CD22andCD20.

Whichoneofthefollowingstatementsinnottrueaboutthisdisease?
1.Eosinophilsarenotpartofitheneoplasticclone.
2.t(5:14)rearrangementmaybedetectedinblasts.
3.Peripheralbloodeosinophiliamaynormalizewithchemotherapy.
4.Inv(16)isoftendetectedintheblastsandtheeosinophils.

256.WilliamsHematology6thed/1056,1051.
CD19,CD10,CD22andCD20aremarkerofbcellorigin.soitisalymphoidleukemianot
myeloid
one.

Q.257.Kidneybiopsyfromachildwithhemolyticuremicsyndromecharacteristicallymostlikely
presentsfeaturesof:
1.Thromboticmicroangiopathy.
2.Proliferativeglomerulonephritis.
3.Focalsegmentalglomerulosclerosis.
4.Minimalchangedisease.

Q.258.TheclassificationproposedbytheInternationalLymphomaStudyGroupfornon -
Hodgkinslymphomaisknownas:

1.Kielclassification.
2.REALclassification.
3.WHOclassification.
4.Rappaportclassification.
258.Williamshematology6thed/1208

-In1993theInternationalLymphomaStudyGroupbeganayearlongefforttoestablishanew
classificationtheREALclassification(RevisedEuropean-Americanlymphoma).

Q.259.Oneoftheintestinalenzymesthatisgenerallydeficientinchildrenfollowinganattackof
severeinfectiousenteritisis:
1.Lactase.
2.Trypsin.
3.Lipase.
4.Amylase.

Q.260.Anewbornpresentedwithbloatedabdomenshortlyafterbirthwithpassingofless
meconium.Afull-thicknessbiopsyoftherectumwascarriedout.Whichoneofthefollowing
rectalbiopsyfindingsismostlikelytobepresent?
1.Fibrosisofsubmucosal.
2.Hyalinisationofthemuscularcoat.
3.Thickenedmuscularispropria.
4.Lackofganglioncells.

Q.261.Allofthefollowingfeaturesareseenintheviralpneumoniaexcept:
1.Presenceofinterstitialinflammation.
2.Predominanceofalveolarexudates.
3.Bronchiolitis.
4.Multinucleategiantcellsinthebronchiolarwall.

261.PathologicbasisofdiseasesRobbinsed./751.
Thetermatypicalpneumoniadenotesthemoderateamountofsputum,nophysicalfindingof
consolidation,onlymoderateelevationofW.B.C.lackofalveolarexudate(answer).

Morphologyofatypicalpneumonia-
-Predominantinterstitialnatureofinflammatoryreaction.
-Superimposedbacterialinfectioncausesulcerativebronchitisandbronchiolitis.
-Epithelialgiantcellswithintranuclearorintra -cytoplasmicinclusionmaybepresentin
cytomegalicinclusiondiseases,othervirusesproducecytopathicchanges.

Henceansweris(2).

Q.262.Aschoffsnodulesareseenin:
1.Subacutebacterialendocarditis.
2.Libman-Sacksendocarditis.
3.Rheumaticcarditis.
4.Non-bacterialthromboticendocarditis.

262.Path.Robbins/593

Aschoffbodies-Theseconsistoffociofswolleneosinophiliccollagensurroundedby
lymphocytes(PrimarilyTcells),occasionalplasmacells,andplumpmacrophagescalled
Antischkowcells(PathognomonicforRF).Thesedisposedinacentral,slender,wavyribbon
(hencethedesignationCaterpillarcells.
Someofthelargermacrophagesbecomesmultinucleatedtoformaschoffgiantcells.

AnswerRheumaticcarditis.

Q.263.Pulmonarysurfactantissecretedby:
1.TypeIpneumocytes.
2.TypeIIpneumocytes.
3.Claracells.
4.Bronchialepithelialcells.
263.Robbin/713.
Alveolarepithelium-containsacontinuouslayerof2principalcelltypes:
Flattened,plateliketypeIpneumocytecovering95%ofsurface.
TypeII-Globular,only5%ofsurfacearea.
Theyarethesourceofpulmonarysurfactant.Surfactantcontainedinosmiophiliclamellarbodies.

Q.264.Whichoneofthefollowingconditionscommonlypredisposestocoloniccarcinoma?
1.Ulcerativecolitis.
2.Crohnsdisease.
3.Diverticulardisease.
4.Ischaemiccolitis.
264.Robbins/848.
-incidenceofcancerofgitinpatientswithlongstandingprogressiveC.D,withafivetosix -
foldincreasedriskovernormalpopulation.HowervertheriskofcancerinCrohn sdiseaseis
considerablylessthaninpatientswithchronicU.C.
Henceansweris(1).
Ulcerativecolitis
Importantpointtoberemembered-
-CryptabscessseeninU.C.
-LeadpipeappearanceofColon-U.C
Q.265.Fibrinoidnecrosismaybeobservedinallofthefollowing,except:
1.Malignanthypertension.
2.Polyarteritisnodosa.
3.Diabeticglomerulosclerosis.
4.Aschoffsnodule.
265.Robbins593,594,1008,539
-Themyocardialinvolvement-Myocarditis-takestheformofscatteredAschoffbodies,often
perivascular.Concomitantinvolvementoftheendocardiumandtheleftsidedvalvesby
inflammatoryfocitypicallyresultinfibrinoidnecrosiswithinCuspsoralongthecord.

-Morphologyofmalignanthypertensioninkidney-
-Fleabittenappearance
-Fibrinoidnecrosisofarterioles
-Onionskinningofintima.
-MorphologyofPolyarteritisnodosa(PAN)
-transmuralinflammationofarterialwall
-fibrinoidnecrosis
-fibrousthickeningofvesselwall
Henceansweris(3).

Q.266.Allofthefollowingstatementsaretrueregardingreversiblecellinjury,except:
1.Formationofamorphousdensitiesinthemitochondrialmatrix.
2.Diminishedgenerationofadenosinetriphosphate(ATP).
3.Formationofblebsintheplasmamembrane.
4.Detachmentofribosomesfromthegranularendoplasmicreticulum.
266.Robbins/19

-Persistentorexcessiveinjurycausesirreversibleinjury.
1)Extensivedamageofcellularmembrane
2)Swellingofliposomes
3)VacuolizationofmitochondriawithreducedcapacitytogenerateATP.

Note-amorphousdensityinmitochondrialmatrixisafeatureofreversibleinjury.
Henceansweris(3).

Q.267.Whichofthefollowingstatementspertainingtoleukemiaiscorrect?
1.Blastsofacutemyeloidleukemiaaretypicallysudanblacknegative.
2.Blastsofacutelymphoblasticleukemiaaretypicallymyeloperoxidasepositive.
3.Lowleucocytealkalinephosphatasescoreischaracteristicallyseeninblasticphaseofchronic
myeloidleukemia.
4.Tartarateresistantacidphosphatasepositivityistypicallyseeninhairycellleukemia.

.267.WiernikNeoplasticdiseaseofblood3rded/68.
-ThemostconsistentanddiagnosticabnormalityofgranulocytesinCMLisloworabsentL.A.P.
TheL.A.PiselevatedinPolycythemiaveraandmyeloidmetoplasia.

Note-TheLAPtendstoriseduringdruginduceddemissionofCMLandinblasticphase.
-LowLAPalsoseeninP.N.H.
-HighLAPseenin-Polycythemiaveraandmyeloidmetaplasia.
-TRAP(Tartarateresistantacidphosphatasepositivitytypicallyseeninhairlycellleukemia.
-BlastsofAML(notALL)-Myeloperoxidasepositive
-BlastsofALLaresudannegative.
-Anotherfrequentlyaskedimportantquestion-
AcceleratedphaseCML1)Peripheralblast>100,000/mm3
2)Characterizedby
Progressivesplenomegaly.
Basophilia
Plateletcountaberration,includingthrombocytosis.
3)Thisphaseusuallylastfor3-9months.

Q.268.Inwhichofthefollowingconditionsbilateralcontractedkidneysarecharacteristically
seen?
1.Amyloidosis.
2.Diabetesmellitus.
3.Rapidlyprogressive(crescentic)glomerulonephritis.
4.Benignnephrosclerosis.

Q.269.AllofthefollowingCSFfindingsarepresentintuberculousmeningitis,except:
1.Raisedproteinlevels.
2.Lowchloridelevels
3.Cobwebformation.
4.Raisedsugarlevels.
269.O.P.GhaiPediatrics5thed/395

-SugarlevelisnormalordecreasedinT.B.M.itisnotraisedinanybacterialorfungal
meningitis.
-CobwebformationinCSFisfeatureofT.B.M.duetoexcessproteinwithinit.
-Cldecreasedincsf(<600MG/Dl)
Henceansweris(4).

Q.270.Allofthefollowingvascularchangesareobservedinacuteinflammation,except:
1.Vasodilation.
2.Stasisofblood.
3.Increasedvascularpermeability.
4.Decreasedhydrostaticpressure.
270.Robbins/50

Vascularchangesinacuteinflammation-
1)Vasodilationisoneofearliestmanifestation.
2)Itfollowedbyincreasedvascularpermeability
3)Lossoffluidresultinconcentrationofredcellsinsmallvesselsandincreasedviscosityof
blood-bloodflowslower-aconditiontermasstasis.
4)Colloidosmoticpressureisdecreased.
5)Whilehydrostaticpressureisincreased.
Henceansweris(4).

Q.271.ThesubtypeofHodgkinsdisease,whichishistogeneticallydistinctfromalltheother
subtypes,is:
1.Lymphocytepredominant.
2.Nodularsclerosis.
3.Mixedcellularity.
4.Lymphocytedepleted.
271.Robbins/686

NowWHOClassificationrecognizes5subtypeofH.L.Infirst4type(nodularsclerosis,mixed
cellularity,lymphocyterich,andlymphocytedepletion)theReedSternbergCellshaveasimilar
immunophenotype;asthese4areoftenclumpedasclassicalformofH.L.
InlymphocytepredominanceHL,ReedsternbergcellshaveacharacteristicBcell -
immunophenotypedistinctfromthatofitheclassicalHLsubtype.

Henceansweris(1).

Q.272.Inapoptosis,Apaf-1isactivatedbyreleaseofwhichofthefollowingsubstancesfromthe
mitochondria?
1.Bcl-2.
2.Bax.
3.Bcl-XI.
4.CytochromeC.
272.Robbins/30

Cellunderstressordeprivedofsurvivalsignals

ReleaseofBcl-2and/orBcl-xfrommitochondria

Nowincreasedpermeabilityofmitochondria

Cytochrome-CcomesoutofmitochondriabindstoApaF-Iincytosol.

ThisactivatedcomplexactivatetheCaspase-9andapoptosisstarts.
Henceansweris(4).

Q.273.Whichtypeofamyloidosisiscausedbymutationofthetransthyretinprotein?
1.FamilialMediterraneanfever.
2.Familialamyloidoticpolyneuropathy.
3.Dialysisassociatedamyloidosis.
4.Prionproteinassociatedamyloidosis.

Q.274.InfamilialMediterraneanfever,thegeneencodingthefollowingproteinundergoes
mutation:
1.Pyrin.
2.Perforin.
3.Atrialnatriureticfactor.
4.Immunoglobulinlightchain.

Q.275.Whichofthefollowingstatementsisnottrue?
1.PatientswithIgDmyelomamaypresentwithnoevidentM -spikeonserumelectrophoresis.
2.Adiagnosisofplasmacellleukemiacanbemadeifcirculatingperipheralbloodplasmablasts
comprise14%ofperipheralbloodwhitecellsinapatientwithwhitebloodcellcountof11x
109/Landplateletcountof88x109/L.
3.Insmolderingmyelomaplasmacellsconstitute10-30%oftotalbonemarrowcellularity.
4.Inapatientwithmultiplemyeloma,amonoclonallightchainmaybedetectedinbothserum
andurine.
Neoplasticdiseaseofblood3rded/497-498.
PeterH,Wiernip,GeorgeP,Canellos

PLASMACELLLEUKEMIA
Diagnosisismadewhenatypicalplasmacellsinperipheralbloodatleast20%ofthe
differentialcount.

SMOLDERINGMULTIPLEMYELOMA
DiagnosisdependsonpresenceofserumMprotein<30g/L.
<10%atypicalplasmacellsinbonemarrowsmears.
Absentofsymptom,anemiaandskeletallesion.

MONOCLONALGAMMOPATHYOFUNKNOWNSIGNIFICANCE

Circulatingatypicalplasmacellalso<10%.

Definitionofleukemia(my)?>20%ofblastcellmustbethere.

Myelodysplasticsyndrome-alsoK/asmoulderingleukemiabecauseitishavingblastcells<30%

but>10%.SoitisalsoK/apreleukemicleukemia.

Likesmoulderingleukemiathesmoulderingmyelomamayhave10-20%plasmacells.Butiwhen
the
wardleukemiaisused,italwaysmeansthatcellsare>20%ofcirculatingW.B.C.
-Williamshematology6thed/1284?asmallproportionofpatientihavenon -secretorymyeloma
in
whichtheneoplasticcellsdonotproducesignificantamountofmonoclonalimmunoglobulins.

Q.276.In-situDNAnickendlabelingcanquantitate:
1.Fractionofcellsinapoptoticpathways.
2.FractionofcellsinSphase.
3.p53geneproduct.
4.bcr/ablgene.

Q.277.Whichoneofthefollowingserumlevelswouldhelpindistinguishinganacuteliver
diseasefromchronicliverdisease?
1.Aminotransaminase.
2.Alkalinephosphatase.
3.Bilirubin.
4.Albumin.

Serumalbuminissynthesizedexclusivelybyhepatocytes.Serumalbuminhasalonghalf -life:15
to20days,withapproximately4%degradedperday.Becauseofthisslowturnover,theserum
albuminisnotagoodindicatorofacuteormildhepaticdysfunction;onlyminimalchangesinthe
serumalbuminareseeninacuteliverconditionssuchasviralhepatitis,drug -related
hepatoxicity,andobstructivejaundice.Inhepatitis,albuminlevelsbelow3g/dLshouldraisethe
possibilityofchronicliverdisease.
Hypoalbuminemiaismorecommoninchronicliverdisorderssuchascirrhosisandusually
reflectssevereliverdamageanddecreasedalbuminsynthesis.
Oneexceptionisthepatientwithascitesinwhomsynthesismaybenormalorevenincreased,but
levelsarelowbecauseoftheincreasedvolumeofdistribution

Q.278.WhichoneofthefollowingstainsisspecificforAmyloid?
1.PeriodicAcidschif(PAS).
2.Alzerianred.
3.Congored.
4.Von-Kossa.
AndersonsPathology/p.455
Stainingcharacteristicsofamyloid
Stain Appearance of amyloid Diagnostic utility
H&E/HPS* Pink,hyaline,amorphous Nonspecific
Methylvioletorcrystalviolet Metachromasia Nonspecific
ThioflavineTorthioflavineS Secondary fluorescence under Nonspecific but is the most
ultravioletradiation sensitivescreeningtest
SulfatedAlcianblue Blue-green Nonspecific but may be useful as a
screeningtest
Congored Red-green birefringence under Definitivediagnostictest
polarizedlight
Immunohistochemistry using Positiveimmunoreactivity Allows classification of type of
antibodyspecificforfibrilprotein amyloid
*Hematoxylinandeosin/hematoxylin,phloxine,andsaffron

Q.279.Whichoneofthefollowingdiseasescharacteristicallycausesfattychangeinliver?
1.HepatitisBvirusinfection.
2.Wilsonsdisease.
3.HepatitisCvirusinfection.
4.Chronicalcoholism.

Q.280.A48-year-oldwomanwasadmittedwithahistoryofweaknessfortwomonths.On
examination,cervicallymphnodeswerefoundenlargedandspleenwaspalpable2cmbelowithe
costalmargin.Herhemoglobinwas10.5g/dl,plateletcount237x10/Landtotalleukocytecount
40x10/L,whichincluded80%maturelymphoidcellswithcoarseclumpedchromatin.Bone
marrowrevealedanodularlymphoidinfiltrate.Theperipheralbloodlymphoidcellswerepositive
forCD19,CD5,CD20andCD23andwerenegativeforCD79BandFMC -7.

Thehistopathologicalexaminationofithelymphnodeinthispatientwillmostlikelyexhibit
effacementoflymphnodearchitectureby:
1.Apseudofollicularpatternwithproliferationcenters.
2.Amonomorphiclymphoidproliferationwithanodularpattern.
3.Apredominantlyfollicularpattern.
4.Adiffuseproliferationofmediumtolargelymphoidcellswithhighmitoticrate.

Thisisthecaseofchroniclymphocyticleukemia(CLL)CLLandsmalllymphocyticlymphoma
(SLL)-botharemorphologically,phenotypicallyandgenotypicallyindistinguishable,differing
onlyinthedegreeofperipheralbloodlymphocytosis.
ForCLL-peripheralbloodlymphocyteshouldbe>4000/mm3or>40x109/L.

Maturelymphoidcells Ageof50
PanBcellmarkerCD19andCD20 Proliferationcentersseenonhistopathology
smalllymphocyteonhistology
InadditiontoPanBcellmarkertheyhaveTcellmarker(CD23andCD5)onasmallsubsetof
normalBcell.
Prolymphocytegathertogetherfocallytoformlooseaggregates(nottypicalfolliclelikefollicular
lymphoma)(andcellarenotdiffusealso)
(SoaPseudofollicularpatternisseen)

Q.281.Thefollowingdrugshavesignificantdruginteractionwithdigoxin,except.
1.Cholestyramine.
2.Thiazidediuretics.
3.Quinidine.
4.Amlodipine.

Q.282.Oneofthefollowingisnottrueaboutnesiritide:
1.Itisabrainnatriureticpeptideanalogue.
2.Itisusedinacutelydecompensatedheartfailure.
3.Ithassignificantoralabsorption.
4.Ithasashorthalf-life.
Katzung/209,214,Brainnatriureticpeptide(BNP

1.Endogenouspeptidebrainnatriureticpeptide(BNP)hasrecentlybeenapprovedforuseinacute
cardiacfailureasnesiritide.
2.ItincreasecGMPinsmoothmusclecells
3.Shorthalf-lifeofT1/2-18min.
4.Itisadministeredasabolusi.v.Dosefollowedbycontinuousinfusion.
5.Tradename(Natrecor)
6.Onlyparenteralpreparationisavailable.

Q.283.Allofthefollowingconditionsareknowntocausediabetesinsipidusexcept:
1.Multiplesclerosis.
2.Headinjury.
3.Histiocytosis.
4.Viralencephalitis.

Q.284.AntipsychoticdruginducedParkinsonismistreatedby:
1.Anticholinergics.
2.Levodopa.
3.Selegiline.
4.Amantadine.
Katzung/472,473

Druginducedparkinsonismistreated,whennecessary,withconventionalantiparkinsonismdrugs
oftheantimuscarinictypeor,inrarecasewithamantadine.
Akathesiaanddystonia-diphenhydraminemoreusedthanantimuscarinic

Tardivedyskinesia
1.Occurin20-40%oftreatedpatient
2.Lateadverseeffect
3.Difficulttoreverse,sometimeself-limited.
4.Firststepistriedtodiscontinueorreducethecurrentantipsychoticorswitchtooneofthe
neweratypicalagent.
5.2ndstepiseliminatingalldrugswithcentralanticholinergicaction(noteit).
6.Ifbothmeasuresfail,thenadditionofdiazepamindosesashighas30 -40mg/daymayaddto
theimprovementbyenhancingGABAergicactivity.
Q.285.WhichoneofthefollowingisusedintherapyofToxoplasmosis?
1.Artensenuate.
2.Thiacetazone.
3.Ciprofloxacin.
4.Pyrimethamine.

DrugsagainstbothT.gondii
Pyrimethamine trimethoprim azithromycin
clindamycin Chlortetracycline Atovaquone
Pyrimethamineand Inhibittheenzymedihydrofolatereductase
trimethoprim
clindamycin, Inhibitorsofproteinsynthesis
Chlortetracycline,and
azithromycin
Atovaquone Blockspyrimidinesalvage
Atovaquone,whichblockspyrimidinesalvage,hasdemonstratedactivityagainstbothT.gondii
andP.carinii.

Oculartoxoplasmosis Treated for 1 month with pyrimethamine plus either sulfadiazine or
clindamycin
Congenitaltoxoplasmosis Dailyoralpyrimethamineandsulfadiazinefor1year
Immunocompromised Pyrimethamine+sulfadiazine+Leucovorin
Therapywithspiramycin(100mg/kgperday)plusprednisone(1mg/kgperday)hasbeenshown
tobeefficaciousforcongenitalinfection.
Bothpyrimethamineandsulfadiazinecrosstheblood-brainbarrier

Q.286.Thefollowingstatementsregardingfinasteridearetrueexcept:
1.Itisusedinthemedicaltreatmentofbenignprostatichypertrophy(BPH).
2.Impotenceiswelldocumentedafteritsuse.
3.Itblockstheconversionofdihydrotestosteronetotestosterone.
4.Itisa5-?reductaseinhibitor.

Finasterideisacompetitiveinhibitorof5a-reductasetype2.Finasterideblockstheconversionof
testosteronetodihydrotestosterone,theprincipalandrogenintheprostate.Adoseof5mg/d
causesanaveragedecreaseinprostatesizeof~24%,anincreaseinurineflowrates,and,insome,
improvementinsymptoms.
The5a-reductaseinhibitorfinasterideamelioratesymptomsinathirdormoreofpatients,butits
impactismodestandnotapparentformanymonths.Combinedtreatmentwithterazosinhas
provednobetterthantreatmentwithanalphablockeraloneinmostmen.

Q.287.Eternaceptactsbyoneofithefollowingmechanisms:
1.Byblockingtumornecrosisfactor.
2.Byblockingbradykininsynthesis.
3.Byinhibitingcyclo-oxygenase-2.
4.Byblockinglipoxygenase.
Katzung/591TNF blockingagents

1. Alsoinhibitlymphotoxin
2. T4.5days.
3. 50mgs.c.Onceweekdose.
4. Ineffectiveinulcerativecolitis.
5. But also used in scleroderma, Wegeners granulomatosis, giant cell

arteritis, sarcoidosis.
ANOTHERNEWDRUG
LEFLUNOMIDE-ActivemetaboliteA77-1726
Inhibitdihydroorotatedehydrogenase

SodecreasesRNAsynthesis.

ArrestofstimulatedcellsinGIphase

-SoitinhibitsTcellprolifrationandproductionofantibodies.
-Itisaseffectiveasmethotrexateandleflunomideresultedina46.2%responsecomparedwith
19.5%in-patientreceivingmethotrexatealone.

Q.288.Allofthefollowingarethedisadvantagesofanestheticeither,except.
1.Inductionisslow.
2.Irritantnatureofeitherincreasessalivaryandbronchialsecretions.
3.Cauterycannotbeused.
4.Affectsbloodpressureandisliabletoproducearrhythmias.

Q.289.Inunconjugatedhyperbilirubinemia,theriskofkernicterusincreaseswiththeuseof:
1.Ceftriaxone.
2.Phenobaritone.
3.Ampicillin.
4.Sulphonamide

Numberofallergicreactions hematologiccomplications
Maculopapularrashesurticaria Granulocytosis,
Life-threatening reactions such as erythema Hemolyticandmegaloblasticanemia

multiforme, Stevens-Johnson syndrome, and toxic
epidermalnecrolysis Granulocytopenia
TrimethoprimHyperkalemia Renalinsufficiencycausedbycrystaluria
Jaundiceandkernicterusinnewborns Drug fever with serum sickness, hepatic toxicity
(including necrosis), and systemic lupus
erythematosus.
Itisrecommendedthatsulfonamidesnotbeadministeredtothenewbornbecauseofconcernsthat
bilirubinmaybedisplacedfromprotein-bindingsites,withsubsequentjaundiceandkernicterus.
Theseverehypersensitivityreactionsoccurredmostcommonlyaftertreatmentwiththelong -
actingsulfonamides,suchassulfamethoxypyridazine
Photosensitivityreactionsarealsorelativelycommonwithsulfonamides.
Inhighdoses,trimethopriminterfereswiththerenalsecretionofpotassium.Hyperkalemiais
relativelycommonamongHIV-positivepatientsandismostoftenfoundafter7daysof
trimethoprim-sulfamethoxazoletherapyforpneumoniacausedbyPneumocystiscarinii.
Hemolyticanemiaismostcommoninpatientswithglucose-6-phosphatedehydrogenase
deficiencywhotakelong-actingcompounds;trimethoprim-sulfamethoxazolerarelycauses
hemolysisinsuchsubjects.
Renalinsufficiency,causedbycrystalsoftherelativelyinsolubleacetylmetabolite,isobserved
primarilywiththelong-actingsulfonamides.

Q.290.Paralysisof3rd,4th,6thnerveswithinvolvementofophthalmicdivisionof5thnerve,
localizesthelesionto:
1.Cavernoussinus.
2.Apexoforbit.
3.Brainstem.
4.Baseofskull.

Thecavernoussinussyndromeisadistinctiveandlife -threateningdisorder.
Ophthalmicveins Orbitalorfacialpain;orbitalswellingandchemosis
Fever
Oculomotorneuropathy Third,fourth,andsixthcranialnervesinvolvement
Trigeminalneuropathy Ophthalmic(V 1)andoccasionallythemaxillary(V 2)divisions
Mostfrequentcausesare
Cavernoussinusthrombosis,oftensecondarytoinfectionfromorbitalcellulitis(frequently
Staphylococcusaureus),
InSinusitisespeciallywithmucormycosisindiabeticpatients
Duetotheanatomyofthecavernoussinusthesyndromemayextendtobecomebilateral.

Q.291.Allofthefollowingaretopicallyusedsulphonamidesexcept:
1.Sulphacetamide.
2.Sulphadiazine.
3.Silversulphadiazine.
4.Mafenide.

Q.292.Oculogyriccrisisisknowntobeproducedbyallofthefollowingdrugsexcept:
1.Trifluoperazine.
2.Atropine.
3.Perchlorperazine.
4.Perphenazine.
Answeris2ClinicalPharmacologyP.N.Bennett,M.J.Bnrown9thed/384 -85

Acuteextrapyramidalsideeffectsofantipsychoticare
Dystonia-abnormalmovementsofthetangueandfacialmuscleswith
Fixedposturesandspasm,
IncludetorticoliscalledOculogyriccrisis
Andbizarreeyemovement

Henceansweris(2)atropine
Remainingthreearethetypicalantipsychoticthatcausestheacutedystonia.
Fewimportantpointsaboutatypicalantipsychotics
1. Extrapyramidalsideeffectsareseen,notablywithhighdoseofresperidoneandolanzapine.
2. Clozapine and olanzopine are the most likely of ithe atypical agents to cause anticholinergic
(antimuscarinic)sideeffects.
3. Moreweightgainwith-clozapine, olanzopine
4. impairedglucosetolerancemorewithclozapine, olanzapine.
5. Risperidone and amisulpride are as likely as classical antipsychotic to raise prolactin level and
causinggalactorrhea.
6. Mostimportantriskwithclozapine-agranulocytosis(2%ofpatient)
Q.293.Whichofthefollowingdrugsisusefulinprophylaxisofmigrain?
1.Propranolol.
2.Sumatriptan.
3.Domperidone.
4.Ergotamine.

ProphylacticTreatmentofMigrainedrugsarenowavailablethathavethecapacitytostabilize
migraine
propranolol valproate Amitriptyline
timolol methysergide nortriptyline
verapamil phenelzine Isocarbazid
cyproheptadine
PhenelzineisMAOI;therefore,tyramine-containingfoods,decongestants,andmeperidineare
contraindicated.
Methysergidemaycauseretroperitonealorcardiacvalvularfibrosiswhenitisusedformorethan
8months,thusmonitoringisrequiredforpatientsusingthisdrug;theriskofthefibrotic
complicationisabout1:1500andislikelytoreverseafterthedrugisstopped.
Stimulationof5-HT1receptorscanstopanacutemigraineattack.Ergotamineand
dihydroergotaminearenonselectivereceptoragonists,whiletheseriesofdrugsknownastriptans
areselective5-HT1receptoragonists.Avarietyoftriptans(e.g.,naratriptan,rizatriptan,
sumatriptan,zolmitriptan)arenowavailableforthetreatmentofmigraine.
Rizatriptanappearstobethefastestactingandmostefficaciousofthetriptanscurrentlyavailable.
Sumatriptanandzolmitriptanhavesimilarratesofefficacyaswellastimetoonset,whereas
naratriptanistheslowestactingandtheleastefficacious.
Unfortunately,monotherapywithaselectiveoral5 -HT1agonistdoesnotresultinrapid,
consistent,andcompletereliefofmigraineinallpatients.Triptansarenoteffectiveinmigraine
withauraunlessgivenaftertheauraiscompletedandtheheadacheinitiated.Theyareuselessin
prophylaxisofmigrain.Recurrenceofheadacheisamajorlimitationoftriptanuse.

Q.294.Inverseagonistofbenzodiazepinereceptoris:
1.Phenobarbitone.
2.Flumazenil.
3.Beta-carboline.
4.Gabapentin.

Katzung357
BZantagonist Flumazenil
BZinverseagonist Bcarboline
GABAagonist BZitself
Q.295.Thegroupofantibioticswhichpossessadditionalantiinflammatoryand
immunomodulatoryactivitiesis:
1.Tetracyclines.
2.Polypeptideantibiotics.
3.Fluoroquinolones.
4.Macrolides.

Tacrolimus(originallylabeledFK506)isamacrolidelactoneantibioticisolatedfromaJapanese
soilfungus,Streptomycestsukubaensis.Ithasthesamemechanismofactionascyclosporinebut
is10to100timesmorepotent.Theadvantageoftacrolimusareminimizingepisodesofrejection,

reducingtheneedforadditionalglucocorticoiddoses,andreducingthelikelihoodofbacterialand
cytomegalovirusinfection.
Inmosttransplantationcenters,tacrolimushasnowsupplantedcyclosporineforprimary
immunosuppression,andmanycentersrelyonoral,ratherthanintravenous,administrationfrom
theoutset.
Thetoxicityoftacrolimusissimilartothatofcyclosporine;nephrotoxicityandneurotoxicityare
themostcommonlyencounteredadverseeffects,andneurotoxicity(tremor,seizures,
hallucinations,psychoses,coma)ismorelikelyandmoresevereintacrolimus -treatedpatients.
Bothdrugscancausediabetesmellitus,buttacrolimusdoesnotcausehirsutismorgingival
hyperplasia.Becauseofoverlappingtoxicitybetweencyclosporineandtacrolimus,especially
nephrotoxicity,andbecausetacrolimusreducescyclosporineclearance,thesetwodrugsshould
notbeusedtogether.

Q.296.Withwhichofthefollowingtheophyllinehasanantagonisticinteraction?
1.Histaminereceptors.
2.Bradykininreceptors.
3.Adenosinereceptors.
4.Imidazolinereceptors.

MethylxanthinesTheophyllineanditsvarioussaltsaremedium-potencybronchodilatorsthat
workbyincreasingcyclicAMPbytheinhibitionofphosphodiesterase.Theyalsoshows
Adenosinereceptorsantagonisticinteraction.

Q.297.Oneofthefollowingisnotpenicillinasesusceptible.
1.Amoxicillin.
2.PenicillinG.
3.Piperacillin.
4.Cloxacillin.

Bacteriadevelopresistancetob-lactamantibioticsbyavarietyofmechanisms.Mostcommonis
thedestructionofthedrugbyb-lactamases.
-lactamasesproductionisplsmidcontrolled.Theseenzymeshaveahigheraffinityfortheb -
lactamantibiotic.Bindingresultsinhydrolysisoftheb-lactamring.Penicillinsthosearenot
penicillinasesusceptiblearemethicillin,Cloxacillin,naficillinetc.
Asecondmechanismofbacterialresistancetob-lactamantibioticsisanalterationinPBP
(penicillinbindingproteins)targetssothatthePBPshaveamarkedlyreducedaffinityforthe
drug.Whilethisalterationmayoccurbymutationofexistinggenes,theacquisitionofnewPBP
genes(asinstaphylococcalresistancetomethicillin

Q.298.WhichoneofthefollowingisbestassociatedwithLumefantrine?
1.Antimycobacterial.
2.Antifungal.
3.Antimalarial.
4.Antiamoebic.
Answeris3

Artemether-lumefantrineandatovaquone-proguanilarerecentlyintroduced,well-tolerated
antimalarialdrugsusedin3-dayregimens.Theyarebotheffectiveagainstmultidrug-resistant
falciparummalaria.

Q.299.Whichoneofthefollowingdrugsincreasesgastrointestinalmotility?
1.Glycopyrrolate.
2.Atropine.
3.Neostigmine.
4.Fentanyl.
Answeris3

Syntheticopioids,sharingpropertiesofopiumandmorphine,includemeperidine,
propoxyphene,diphenoxylate,fentanyl,buprenorphine,methadone,andpentazocine.Various
opiateeffectsareanalgesia,respiratorydepression,constipation,andeuphoria.Fentanyl(80to
100timesmorepowerfulthanmorphine)isespeciallydangerous.
Atropineblocksthemuscarinicreceptors.Atropinedecreasesgastrointestinaltract
motilityandsecretionandcausesconstipation.Althoughvariousderivativesandcongenersof
atropine(suchaspropantheline,isopropamide,andglycopyrrolate)havebeenadvocatedin
patientswithpepticulcerorwithdiarrhealsyndromes
NeostigmineisCholinesteraseinhibitorsthatenhancetheeffectsofparasympathetic
stimulationandleadstoreversalofintoxicationbyagentswithaanticholinergicaction

Q.300.Whichoneofthefollowingisthefastestactinginhalationalagent?
1.Halothane.
2.Isoflurane.
3.Ether.
4.Sevoflurane.
Answeris4

Sevoflurane-
Similartoisofluraneanddesflurane,sevofluranecausesslightincreaseincerebralbloodflow
andintracranialpressureatnormocarbia.
HighconcentrationofSevoflurane(>1.5MAC)mayimpairautoregulationofC.B.F.andthus
allowingadropinC.B.F.duringihemorrhagichypotension.ThiseffectonCBFisless
pronouncedthanisoflurane.
Propertyofsevoflurane-.nonpurgentandrapidincreaseinalveolaranestheticconcentration
makeserofluraneanexcellentchoiceforsmoothandrapidinhalationinductioninpediatricor
adultpatient
Contraindicationofserofluraneare
2)Severehypovolemia2)Susceptibilitytomalignanthyperthermia3)intracranialhypertension.
Desfluraneisthefastestactingagent.While2ndistheSevoflurane.

2005AIPPG.com,AuthorDrVarunSinghal,Allrightsreservedworldwide
Forums:PGENTRANCEFORUM,UKForums,IELTSforum,USMLEStep1FORUM
PLABIELTSMRCP

ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes)

Uploaded by

Document Informationclick to expand document information

Copyright:

Available Formats

ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes)

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes)

Uploaded by

Copyright:

Available Formats

Allindia2005aipgmeaiipganswers,explanationsrefrencesfree Page1of97

2 Hypervascularity 2 Early draining vein

Isoenzyme Pattern Disorder

Hydrolysis reaction (transfer of Chymotrypsin

Hypo K.P.P. Voltage-sensitive, skeletal muscular calcium channel,

Type2 a1A voltage-dependentcalciumchannelsubunit

1)Mycoplasmapneumoniae 4) Viruses (RSV, Parainfluenza, influenza A &

5. But also used in scleroderma, Wegeners granulomatosis, giant cell

Life-threatening reactions such as erythema Hemolyticandmegaloblasticanemia

You might also like

ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes)

Uploaded by

Document Informationclick to expand document informationppg1

Document Informationclick to expand document information

Copyright:

Available Formats

ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes)

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes)

Uploaded by

Copyright:

Available Formats

Allindia2005aipgmeaiipganswers,explanationsrefrencesfree Page1of97

2 Hypervascularity 2 Early draining vein

Isoenzyme Pattern Disorder

Hydrolysis reaction (transfer of Chymotrypsin

Hypo K.P.P. Voltage-sensitive, skeletal muscular calcium channel,

Type2 a1A voltage-dependentcalciumchannelsubunit

1)Mycoplasmapneumoniae 4) Viruses (RSV, Parainfluenza, influenza A &

5. But also used in scleroderma, Wegeners granulomatosis, giant cell

Life-threatening reactions such as erythema Hemolyticandmegaloblasticanemia

You might also like