1. Zygote with zona pellucida reaches uterine cavity by : a) 2 days b) 4 days c) 5 days d) 6 days Correct Answer - B 4 days
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1.Zygotewithzonapellucidareachesuterinecavityby:
a)2days
b)4days
c)5days
d)6days
CorrectAnswer-B4days
2.Inspermatogenesis,independentassortmentofpaternalandmaternalchromosomesoccursduring-
a)Primarytosecondaryspermatocyte
b)Spermatogoniatoprimaryspermatocyte
c)Secondaryspermatocytetospermatids
d)Spermatidstospermatozoa
CorrectAnswer-AAnswer-A.PrimarytosecondaryspermatocyteInspermatogenesis,independentassortmentofpaternalandmaternalchromosomesoccursduringmeiosisI,inwhichprimaryspematocyte)to(2n)isconvertedintotwosecondaryspermatocytes(In).
3.Tonguemusclesarederivedfrom
a)Lateralplatemesoderm
b)Occipitalmyotome
c)Intermediatemesoderm
d)Cervicalmyotome
CorrectAnswer-BAns:BOccipitalmyotomeDevelopmentofthetongue:-I.Epithelium:Ant2/3--lingualswellingsof1starchandtuberculumimpar.Post1/3--largedorsalpartofhypobranchialeminence,i.e,3rdarch.Posteriormostpart--smalldorsalpartofthehypobranchialeminence,i.e.4tharch.II.Muscles:Derivedfromoccipitalmyotomesexceptpalatoglossuswhichisderivedfromthe6tharch.
4.Whichofthefollowingisremnantofdistalumbilicalartery?
a)LigamentumTeres
b)SuperiorVescicalartery
c)MedialumbilicalLigament
d)Ligamentumarteriosum
CorrectAnswer-CAns.C.MedialumbilicalLigamentRemnantofumbilicalartery:-
1. Proximalpart:Superiorvesicalartery2. Distalpart:Medialumbilicalligament
5.Allarederivedfromneuralcrestexcept?
a)Adrenalmedulla
b)Pigmentcellinskin
c)Cornealstroma
d)Retinalpigmentedepithelium
CorrectAnswer-DAns.is`d'i.e.,RetinalpigmentedepitheliumDerivativesofneuroectoderm1.Fromneuraltube:CNS(brain,spinalcord),astrocytes,oligodendrocytes,ependymalcells,retina,pinealgland,neurohypophysis(posteriorpituitary),allcranialandspinalmotornerves.2.Fromneuralcrest:Neuralcrestderivativesare:?3.Neuralderivatives*Sensoryneuronsof5th,7th,8th,9th,10thcranialnerveganglia(trigeminal,geniculate,sphenopalatine,submandibular,cochlear,vestibular,oticandvagalparasympatheticganglia).*Sensoryneuronsofspinaldorsalrootganglia.*Sympatheticchaingangliaandplexus(celiac/preaortic/renalganglia,entericplexusinGIT,i.e.AuerbachsandMeissner's)*ParasympatheticgangliaandplexusofGIT.*Schwanncellsofperipheralnerves,satellitecellsofallganglia.*Adrenalmedulla,chromaffincells,parafollicularC-cellsofthyroidgland.*Melanocytesandmelanoblasts.
6.Opticvesicleisderivedfrom-
a)Endoderm
b)Mesoderm
c)Neuroectoderm
d)SurfaceEctoderm
CorrectAnswer-CAnswer-C.NeuroectodermAnoutgrowthfromprosencephalonformsopticvesicle(neuroectodermalstructure).ProximalpartofopticvesiclebecomesconstrictedandelongatedtoformopticstalkGrowingopticvesiclecomesincontactwithsurfaceectodermwhichisthickenedtoformlensplacode.
7.Digeorgesyndromeischaracterizedbyallexcept?
a)Congenitalthymichypoplasia
b)Abnormaldevelopmentofthirdandfourthpouches
c)Hypothyroidism
d)Hypocalcemictetany
CorrectAnswer-CAns.is'c'i.e.,Hypothyroidism
8.
Partofneuraltubefromwhichcorpuscallosumdevelops
a)Basallamina
b)Alarlamina
c)Laminaterminalis
d)Basalplate
CorrectAnswer-CAns.is'c'i.e.,LaminaterminalisThedevelopmentofthecorpuscallosumoccursbetweenthe12thand16-20thweeksofgestation6.Itbeginswiththegenuandthencontinuesposteriorlyalongthebodytothesplenium.Therostrumisthelastparttobeformed.Myelinationofthecorpuscallosumoccursintheoppositedirection,fromthespleniumforwards.Theydevelopfromlaminaterminaliswhichiscranialpartofneuraltubeandlaterliesintheanteriorwallof3'dventricle.Thecorpuscallosum,thelargestofcerebralcommissures,takestheformofanarchoverthethirdventricle.Itconnectstheneocorticesofbothsides.
9.Epithelialliningofurinarybladder?
a)Squamous
b)Transitional
c)Cuboidal
d)Columnar
CorrectAnswer-BAns.is'b'i.e.,TransitionalUrothelium(transitionalepithelium)isfoundinrenalpelvis,calyces,ureter,urinarybladder,proximalpartofurethra.
10.Femaleurethradevelopsfrom-
a)Urogenitalsinus
b)Mesonephricduct
c)Uretericbud
d)MetanephricBlastema
CorrectAnswer-AAns.A.UrogenitalsinusThefemaleurethraismainlyderivedfromtheurogenitalsinuswhiletheurethralplateformsthevestibuleandlabiaminora.
11.AllofthefollowinghelpinformationofIVCexcept-
a)Theposteriorintercardinalanastomosis
b)Terminalportionofrightvitellinevein
c)Segmentofrightcardinalvein
d)Subcardinalsinus
CorrectAnswer-DAns.D.SubcardinalsinusTheinferiorvenacavaiscomposedof(fromcaudaltocranial):
1. Posteriorintercardinalanastomosis.2. Thecaudalportionoftherightsupracardinalvein.3. Therightanastomosisbetweenthesupracardinalandthe
subcardinalveins.4. Asegmentoftherightsubcardinalvein.5. Theanastomosisbetweentherightsubcardinalandrightvitelline
veins.6. Theterminalportionoftherightvitellinevein.
12.Kidneyparenchymaisderivedfrom-
a)Uretericbud
b)Mesonephros
c)Metanephros
d)Paramesonephros
CorrectAnswer-CAns.C.MetanephrosMetanephros:Thissystemwillformthenephronsandparenchymaofthedefinitivekidney.
13.Facialnerveisaderivativeofwhichofthefollowingbranchialarch?
a)Firstarch
b)Secondarch
c)Thirdarch
d)Fourtharch
CorrectAnswer-BFacialnerveisaderivativeofsecondbranchialarch.Musclesoffacialexpressionderivedfromitarebuccinator,auricularis,frontalis,platysma,orbicularisorisandorbicularisoculi.Additionalmusclessuppliedbyitarestapedius,stylohyoid,andposteriorbellyofdigastric.
Branchialarch
Cranialnerve Muscles
Firstmandibular
Trigeminal Musclesofmastication:masseter,temporalis,medialandlateralpterygoid.Additionalmuscles:mylohyoid,anteriorbellyofdigastric,tensortympani,tensorvelipalatini
Third Glossopharyngeal Stylopharyngeus
Fourthandsixth
Superiorlaryngeal,recurrentlaryngealbranchesofvagus
Pharyngealandlaryngealmuscles:cricothyroid,levatorvelipalatini,constrictorsofpharynx,intrinsicmusclesoflarynx
Ref:NeurosciencefortheStudyofCommunicativeDisordersBySubhashChandraBhatnagarpage279.
14.Leptoteneandpachytenearestagesofwhichphasesofmeiosis-
a)ProphaseI
b)MetaphaseI
c)AnaphaseII
d)TelophaseII
CorrectAnswer-AAns.A.ProphaseIMeiosis1isdividedintofollowingphases:-l)Prophase1:Itisfurtherdividedintofollowingstages:-
1. Leptotene2. zygotene3. Pachytene4. Diplotene5. Diakinais
2)Metaphase13)Anaphase14)Telophase1
15.Pelvickidneysareduetoallexcept?
a)Inabilitytoascendduringfetallife
b)Fusionofthelowerpoles
c)Beingblockedbybranchesoftheaorta
d)p53mutation
CorrectAnswer-DAns.D.p53mutationPelvickidneyAfetalpelvickidneyisaconditionthatresultswhenthekidneysfailtoascendtotheirnormalpositionabovethewaistandremaininthepelvisbecausetheyareblockedbybloodvesselsintheaorta.Developingkidneysmayalsofusetogethercausingwhatisknownasa'horseshoekidney"Afetalpelvickidneyorhorseshoekidneyisgenerallydiagnosedbyultrasound(sonogram)examinationbeforebirth.Evaluationofthekidneysispartoftheroutineultrasoundexaminationdonebymanyobstetriciansaspartoftheirprenatalcarearoundthe20sweekofpregnancy.
16.Cryptamagnadevelopsfromwhichpouch?
a)1st
b)2nd
c)3rd
d)4th
CorrectAnswer-BAns.B.2ndMedialsurfaceofeachtonsilhas15-20crypts,thelargestofwhichiscalledIntratonsillarcleftorcryptomagna(whichrepresentspersistenceoftheventralportionofthesecondpharyngealpouch).
17.Whichofthefollowingisatractionepiphysis?
a)DistalRadius
b)Mastoidprocess
c)TibialCondyles
d)CoracoidProcess
CorrectAnswer-BAns.B.Mastoidprocess
18.Allofthefollowingaretrueabouttheliverexcept?
a)ItiscoveredbyGlisson'scapsule
b)StellatecellsarepresentinthespaceofDisse
c)Kupfercellsarethedefensecells
d)Thelobulesintheliverarepentagonal
CorrectAnswer-DAns.D.ThelobulesintheliverarepentagonalLiverhashexagonallobules
19.Hering'scanalispresentin?
a)Spleen
b)Liver
c)Kidney
d)Lung
CorrectAnswer-BAns,B.Liver1hecanalofHeringorintrahepaticbileductulesarepartofoutflowsystemofexocrinebileproductfromtheliver.Theyarefoundbetweenthebilecanaliculiandinterlobularbileductsneartheouteredgeofliverlobule.
20.Herring'sbodiesarepresentin?
a)Parstuberalis
b)Parsintermedia
c)Neurohypophysis
d)Parsterminalis
CorrectAnswer-CAns.C.NeurohypophysisHerringbodiesorneurosecretorybodiesarestructuresfoundintheposteriorpituitary(neurohypophysis).
21.Allofthefollowingaretrueaboutthymusexcept?
a)Thecorticalportionismainlycomposedoflymphocytes
b)ThemedullacontainsHassall'sCorpuscles
c)ItisderivedfromthefourthPharyngealpouch
d)Itundergoesatrophypubertyonwards
CorrectAnswer-CAns.C.ItisderivedfromthefourthPharyngealpouchThethymusisaspecializedprimarylymphoidorganoftheimmunesystem.Withinthethymus,TcellsorTlymphocytesmature.Thethymusislargestandmostactiveduringtheneonatalandpre-adolescentperiods.Bytheearlyteens,thethymusbeginstoatrophyandthymicstromaismostlyreplacedbyadipose(fat)tissueThymusisderivedfromthethirdpharyngealpouch
22.Auerbachsplexusispresentinthe-
a)Colon
b)Esophagus
c)Stomach
d)Alloftheabove
CorrectAnswer-DAlloftheabove
23.Whichofthefollowinglayerisabsentintheesophagusa-
a)Adventitia
b)Serosa
c)Muscularispropria
d)Mucosa
CorrectAnswer-BAns.B.SerosaTheesophagusalsohasanadventitia,butnotaserosa
24.Whichisthemostabundantcartilage-
a)Hyalinecartilage
b)Elasticcartilage
c)Fibrocartilage
d)None
CorrectAnswer-AAns.A.Hyalinecartilage
25.Haustrationsarepresentin-
a)Duodenum
b)Ileum
c)Jejunum
d)Colon
CorrectAnswer-DAns.is'd'i.e.,Colon[RelBDC#/eVol.2p.2661
1. Characteristicsfeaturesoflargeintestine(colon)are:-i)3longitudinalbands,formedbylongitudinalmusclecoat,calledTaeniaecoli.
2. Sacculationorhaustration3. Fatfilledperitonealpouchescalledappendicesepiploicae.
Thesearenotfoundinappendix,caecumandrectum.4. Greaterpartisfixedexceptforappendix,transversecolonand
sigmoidcolon.5. Pyere'spatches(presentinsmallintestine)arenotpresent.
26.Whatistheliningofthelacrimalglandalveoli?
a)Ciliatedcolumnarcells
b)Pyramidalcells
c)Nonkeratinizingsquamousepithelium
d)None
CorrectAnswer-BAns.B.PyramidalcellsAlveolioftheglandarelinedbypyramidalcells,whichshowlightlystainedapicalsecretarygranules.
27.Whattypeofmusclesaremedialtwolumbricals?
a)Unipennate
b)Bipennate
c)Multipennate
d)None
CorrectAnswer-BAns.B.Bipennate
28.Ansanephroniislinedby?
a)Columnar
b)Squamousepithelium
c)Cuboidalandcolumnarepithelium
d)Stratifiedsquamousepithelium
CorrectAnswer-BBi.e.Squamousepithelium
29.Fourcarpalbonesarepresentatwhatage?
a)3years
b)4years
c)5years
d)6years
CorrectAnswer-B4yearsREF:Parikh6'editionpage2.9Between2to6years,thenumberofcarpalbonespresentonXrayrepresentstheapproximateageinyears,asforexample,fourcarpalbones—4years.
30.Whatisthelevelofthespineofscapula?
a)T7
b)TI0
c)T4
d)T2
CorrectAnswer-CAns.C.T4SpineofscapulaisatT3T4level
31.Whichofthefollowingmusclescarriesoutshoulderabductionfrom15to90degrees?
a)Suprapinatus
b)Trapezius
c)Deltoid
d)SerratusAnterior
CorrectAnswer-CAns.C.Deltoid
32.Whichmuscleactingonthethumbhasdualnervesupply?
a)FlexorPollicisLongus
b)FlexorPollicisbrevis
c)AdductorPollicis
d)OpponensPollicis
CorrectAnswer-BAns.B.FlexorPollicisbrevis
33.WhatisWartenberg'ssign?
a)InabilitytomaintainIntrinsicplusposition
b)Inabilitytoadductsmallfingeragainsttheringfinger
c)Inabilitytograspabookbetweenthethumbandindexfinger
d)Inabilitytomovethemiddlefingersideways
CorrectAnswer-BAns,B.InabilitytoadductsmallfingeragainsttheringfingerWartenberg’ssignisinabilitytoadductthesmallfingerinagainsttheringfngerduetoweaknessofpalmarinterosseousmuscles.
34.Sensoryregionoftheulnarnerveis?
a)Tipoflittlefinger
b)Tipofindexfinger
c)1stwebspace
d)Lateralupperaspectofarm
CorrectAnswer-AAns.A.Tipoflittlefinger
35.Pulpoftheindexfingerissuppliedby
a)Mediannerve
b)Radialnerve
c)Ulnarnerve
d)Axillarynerve
CorrectAnswer-AAns,A.Mediannerve
36.Lowradialnerve[justafterspiralgroove]palsydoesnotproduce?
a)Lossofwristextention
b)Lossofelbowextention
c)Lossoffingerextention
d)Lossofthumbextention
CorrectAnswer-BAns.B.LossofelbowextentionLowradialnervepalsyInjuryisafterthespirdgroove.Lowradialnervepalsymaybeoftwotypes:i)TypeI:-Injuryoccursbetweenthespiralgrooveandelbowjoint.Musclesinvolvementis:-
1. Elbowertensors(Triceps,anconeus)arespared.2. Wrist,elbowandfingerextensorsareparalysed.3. Sensorylossinfirstwebspace(ondorsalside)
Ii)TypeII:-Injuryoccursbelowtheelbowjoint.1. Elbowextensors(triceps,anconeus)andwristextensors(ECRL)are
spared.2. Fingerextensors(extensordigitorum,extensordigitiminimi,
extensorindicis)andthumbextensors(extensorpollicisclongus&brevis)areparalysed.
3. Sensorylossinfirstwebspace(ondorsalside).Iflesionislowa)Type1Wristdrop,thumbdropandfingerdrop.Elbowextensionispreserved.Sensorylossoverthedorsumoffirstwebspace.
b)Type2ThumbdropandfingerdropElbowandwristextensionispreservedSensorylossoverthedorsumoffirstwebspace
37.Infraspinousfossaofscapulacontainswhichofthefollowingmuscles?
a)Subscapularis
b)Infraspinatus
c)Teresmajor
d)Supraspinatus
CorrectAnswer-BAns.B.InfraspinatusInfraspinatusattachesmediallytotheinfraspinousfossaofthescapulaandlaterallytothemiddlefacetofthegreatertubercleofthehumerus.
38.Structurepassingdeeptoflexorretinaculumatwrist:
a)Ulnarnerve
b)Mediannerve
c)Radialnerve
d)Ulnarartery
CorrectAnswer-BTheflexorretinaculumstretchesacrossthefrontofthewristandconvertstheconcaveanteriorsurfaceofthehandintoanosteofascialtunnel,thecarpaltunnel,forthepassageof:ThemediannerveFlexortendonsofthethumb(flexorpollicislongus)andfingers(flexordigitorumsuperficialisandprofundus).RadialandtheulnarbursaItisattachedmediallytothepisiformboneandthehookofthehamateandlaterallytothetubercleofthescaphoidandthetrapeziumbones.Theattachmenttothetrapeziumconsistsofsuperficialanddeeppartsandformsasynovial-linedtunnelforpassageofthetendonoftheflexorcarpiradialis.Thelowerborderisattachedtothepalmaraponeurosis.
39.Coracoacromialligamentresistswhichmovements?
a)Upwarddisplacementofhumeralhead
b)Abductionofshoulder
c)Inferiordisplacementofhumerus
d)Externalrotation
CorrectAnswer-AAns.A.UpwarddisplacementofhumeralheadThecoracoacromialligamentisaflattriangularbandthatplaysasupportiverolefortheshoulderjoint.CoracoacromialpreventsUpwarddisplacementofhumeralhead.Ithastwopart,conoid(medial)andtrapezoid(lateral).Theweightoftheupperlimbistransmittedtothemedialtwo-thirdoftheclavicleandthencetotheaxialskeletonthroughthecoraco-clavicularligment.
40.Coracohumeralligamentinsertson?
a)Greatertuberosity
b)Lesserandgreatertuberosities
c)Anatomicalneckofhumerus
d)Bicepetalgroove
CorrectAnswer-BAns.B.LesserandgreatertuberositiesCoracohumeralligament:Anextraarticularligamentonthelateralsurfaceofcoracoidandinsertsintothegreaterandlessertuberosities,spanningthebicipitalgroove.Sectioningofcoracohumeralligamentsproducesanteroinferiorinstability.Representsfoldedthickeningofglenohumeralcapsuleinareaofrotatorintervalbetweensubscapularis&supraspinatus.W/bodyupright&armindependentposition,coracohumeral&MGHLplayimportantrolesinresistinginftranslation.
41.Whatistheactionofanconeus?
a)Primaryelbowextensor
b)AssistsExtensionofelbow
c)Wristextension
d)ThumbAbduction
CorrectAnswer-BAns.B.AssistsExtensionofelbowAnconeus=Itsroleinelbowextensionistrivialinhumans.Itassistsinextensionoftheelbow,wherethetricepsbrachiiistheprincipalagonist,andsupportstheelbowinfullextension.
42.Whichmusclehelpsinclimbingatree?
a)LatissimusDorsi
b)Rhomboideus
c)Trapezius
d)Levatorscapulae
CorrectAnswer-AAns.A.LatissimusDorsiClimbingoftreeishelpedby:
1. LatissimusDorsi2. Pectoralismajor
LatissimusDorsiisalsoknownas"climber'smuscle"or"Treeclimbingmuscle".
43.Posteriorinterosseusarteryisabranchof?
a)Commoninterosseusartery
b)Radialartery
c)Medianartery
d)Brachialartery
CorrectAnswer-AAns.A.CommoninterosseusarteryThecommoninterosseousartery,about1cm.inlength,arisesimmediatelybelowthetuberosityoftheradiusfromtheulnarartery.
44.Whichmuscleprotectsthebrachialplexusincaseofclaviclefractures?
a)Subclavius
b)Supraspinatus
c)Subscapularius
d)TeresMinor
CorrectAnswer-AAns.A.SubclaviusThesubclaviusprotectstheunderlyingbrachialplexusandsubclavianvesselsfromabrokenclavicle.
45.Whichofthefollowingistrueaboutdeeppalmararch?
a)Mainlyformedbytheradialartery
b)Ulnararteryhasnocontributiontoit
c)Itgivesoff5perforatingbranches
d)Itdoesnotanastomosewiththesuperficialpalmararch
CorrectAnswer-AAns.A.MainlyformedbytheradialarteryDeeppalmararchItliesacrossthebaseofmetacarpalbones.Itisformedmainlybyradialarteryandcompletedbyadeepbranchoftheulnarartery.Itsbranchesare:-ThreepalmarmetacarpalarteriesThreeperforatingarteriesRecurrentbranchesThedeeppalmararchliesdeeptotheobliqueheadofadductorpollicis,longflexortendon,andlumbricalmusclesandpassesacrossthebaseofmetacarpalandinterossei.
46.
Whichpartofscapulacanbepalpatedintheinfraclavicularfossa?
a)Coracoidprocess
b)Spineofscapula
c)Inferiorangle
d)Supraspinousfossa
CorrectAnswer-AAns.A.CoracoidprocessThecoracoidprocessisathickcurvedprocessattachedbyabroadbasetotheupperpartoftheneckofthescapula;itrunsatfirstupwardandmedialward;then,becomingsmaller,itchangesitsdirection,andprojectsforwardandlateralward.Itispalpablejustbelowtheclavicle.
47.Flexorcarpiradialisinsertsinto?
a)Baseof5thmetatarsal
b)Baseof2ndand3rdmetacarpal
c)Scaphoidandtrapezium
d)Capitateandhamate
CorrectAnswer-BAns.,B.Baseof2ndand3rdmetacarpalFlexorcarpiradialisOrigin:Medialepicondyleofthehumerus.Insertion:Baseofsecondandthirdmetacarpals.Nervesupply:Mediannerve.Action:Pronatoroftheforearm,weakflexorofelbow.
48.Whatistrueaboutlateraltibialcondyle?
a)Iliotibialtractisattachedtothelateralcondyleoftibia
b)Ligamentumpatellaeinsertsonit
c)Medialcollateralligamentisattachedtoit
d)Semimembranosusisattachedtoit
CorrectAnswer-AAns.A.Iliotibialtractisattachedtothelateralcondyleoftibia*Tibiaisthesecondlongestbone(afterfemur).*Proximalend(upperend)-Proximal(upper)endoftibiaincludesmedialandlateralcondyles,formingtibialplateau.Italsoincludestibialtuberosityandintercondylararea(areabetweenmedialandlateralcondyle).-Distalend*Medialmalleolusgivesattachmenttodeltoidligament(medialcollateralligament)ofankle.
49.WeaknessofextensorHallucislongusisduetowhichnerverootmainly?
a)L5
b)L4
c)S1
d)S2
CorrectAnswer-AAns.A.L5
50.Whichofthefollowingiscommonbetweenthemedialandlateralplantararch?
a)FlexorDigitorumBrevis
b)PlantarFascia
c)SpringLigamnet
d)DeltoidLigament
CorrectAnswer-BAns,B.PlantarFasciaPlantarfasciaactsasatiebeamforbothmedialandlateralplantararches.
51.Whichtendonislodgedinthegrooveonposteriorsurfaceoflateralmalleolus?
a)Peroneuslongus
b)Tibialisanterior
c)Tibialisposterior
d)FlexorHallucisLongus
CorrectAnswer-AAns,A.PeroneuslongusPeroneuslongusendsinalongtendon,whichrunsbehindthelateralmalleolus,inagroovecommontoit.
52.Allofthefollowingaretrueabouttibialisanteriorexcept?
a)Itissuppliedbythesuperficialperonealnerve
b)Itdorsiflexesthefoot
c)Itiscloselyrelatedtotheanteriortibialvessels
d)Itinsertsonthemedialcuneiform
CorrectAnswer-AAns.A.ItissuppliedbythesuperficialperonealnerveTibialisanteriorItissituatedonthelateralsideofthetibia;itisthickandfleshyabove,tendinousbelow.Thetibialisanterioroverlapstheanteriortibialvesselsanddeepperonealnerveintheupperpartoftheleg.
53.Attachmentonposteriorsurfaceofsacrum?
a)MultifidusLumborum
b)Iliacus
c)Coccygeus
d)Piriformis
CorrectAnswer-AAns,A.MultifidusLumborumAttachementsonsacrumA)PosteriorSurfaceMultifiduslumborum–Thedeepestmusclearisingfromthesacrum.SomeofitsfiberscovertheuPpertwosacralforamina.Thismuscleattachestothetransverseprocessesofthesuperiorvertebraeandisthereforeabletohelpstabilizethespine.Erectorspinae–Partlyarisesfromtheposteriorsacrumandthesacrospinousligament.Itisessentialinachievingextensionandlateralbendingoftheheadandvertebralcolumn
54.Structurespassingthroughsacralhiatusare?
a)S4nerveroot
b)S2nerveroot
c)S3nerveroot
d)S5nerveroot
CorrectAnswer-DAns.D.S5nerverootSacralhiatusThesacralhiatuscorrespondstotheposteriorcaudalopeningattheendofthesacralcanal,whichusuallyoccursatthefifthsacralvertebra(S5),attheposteriorsurfaceofthesacrum.
55.Longestcutaneousnerveinbody?
a)Lateralcutaneousnerveofthigh
b)Medialcutaneousnerveofthigh
c)Saphenousnerve
d)Suralnerve
CorrectAnswer-CAns,C.SaphenousnerveThesaphenousbranchofthefemoralnerve(saphenousnerve)isthelongestcutaneousnerve.Itrunswiththegreatsaphenousveininfrontofmedialmalleolusandsuppliestheskinofanteromedialaspectofthelegandmedialborderofthefoot.Thesaphenousnervemaybedamagedinfrontofthemedialmalleolusduringvenesectionofthelongsaphenousvein.Therefore,femoralnervedamagecancausesensorylossovertheareaofthegreatsaphenousveinintheleg.
56.Obliquepoplitealligamentisderivedfrom?
a)Semitendinosus
b)Bicepsfemoris
c)Adductormagnus
d)Semimembranosus
CorrectAnswer-DAns,D.SemimembranosusObliquepoplitealligamentItisanexpansionfromthetendonofsemimembranosusattachmenttointercondylarlineoffemur.Itiscloselyrelatedtopoplitealarteryandispiercedbymiddlegenicularvesselsandnerveandtheterminalpartoftheposteriordivisionoftheobturatornerve.
57.Lateralborderofthefootreceivesitssensorysupplyfrom?
a)Saphenousnerve
b)Suralnerve
c)Deepperonealnerve
d)Sciaticnerve
CorrectAnswer-BAns.B.Suralnerve
58.Allofthefollowingisincludedinchestwallexcept?
a)Ribs
b)ThoracicVertebrae
c)Sternum
d)Lumbarvertebrae
CorrectAnswer-DAns,D.Lumbarvertebrae
59.Respiratorybronchiolesareformedfrom?
a)Principalbronchus
b)Terminalbronchioles
c)TertiaryBronchus
d)Lobarbronchioles
CorrectAnswer-BAns,B.TerminalbronchiolesTerminalbronchioleemnateintorespiratorybronchioles.Repiratorybronchiolesproceedintothealveolarducts,whichimmediatelybranchintoalveolarsacs(alveoli).
60.Segmentofbronchidistaltoprimarybifurcation?
a)Primarybronchi
b)Terminalbronchiole
c)Respiratorybronchiole
d)Sencondarybronchi
CorrectAnswer-AAns.A.Primarybronchi
61.Thecricopharyngealsphincterishowfarfromthecentralincisor?
a)15cm
b)25cm
c)40cm
d)50cm
CorrectAnswer-AAns,A.15cmAtthelevelofT1Overtebra,itspassagethroughesophagealhiatusofdiaphramloweresophagealsphincter-37.5-40cm(f5-f6inches)fromincisor
62.Whichofthefollowingstructuresisrelatedtotheesophagus22.5cmfromtheincisorteeth?
a)Archofaorta
b)Rightprincipalbroncus
c)ThoracicDuct
d)AzygousVein
CorrectAnswer-AAns,A.Archofaorta2dconstrictionisatT4levelwherearchofaortacrossesesophagus.
63.Thoracicductopensintosystemiccirculationat?
a)junctionofSVCandleftbrachiocephalicvein
b)Junctionofleftinternaljugularandleftsubclavianvein
c)Directlyintocoronarysinus
d)Intoazygousvein
CorrectAnswer-BAns.B.JunctionofleftinternaljugularandleftsubclavianveinThoracicductbeginsasacontinuationoftheupperendofthecisternachylinearthelowerborderofT12vertebraandentersthethoraxthroughtheaorticopeningofdiaphragrn(atT12).ItthenascendsthroughtheposteriormediastinumandatT5levelcrossesfromrightsidetotheleftsideandascendsalongleftmarginofoesophagustoentertheneck.AtthelevelofC7vertebrae,archestowardsleftsidetoopenintoleftbrachiocephalicveinattheangleofunionofleftsubclavianandleftinternaljugularveins.
64.Sympatheticsupplyoftheheartisfrom?
a)Vagus
b)Thoracicsympatheticfibres[T1toT5]
c)Lumbarsympatheticfibres
d)Cervicalganglion
CorrectAnswer-BAns,B.Thoracicsympatheticfibres[T1toT5]
65.Whichofthefollowingarecuspsoftheaorticvalves?
a)Left,rightandAnterior
b)Anterior,RightandPosterior
c)Posterior,LeftandRight
d)Anterior,PosteriorandLeft
CorrectAnswer-CAns,C.Posterior,LeftandRightTheaorticvalveisasemilunarvalvewiththreecuspswhichincludeleft,rightandposterior.
66.Whichisthewidow'sarteryinmyocardialinfarction?
a)Leftanteriordescendingartery
b)Rightcoronaryartery
c)Posteriorinterventricularartery
d)Leftcircumflexartery
CorrectAnswer-AAns,A.LeftanteriordescendingarteryTheanteriorinterventricularbranchoftheleftcoronaryartery,(alsoleftanteriordescendingartery(LAD),oranteriordescendingbranch)isabranchoftheleftcoronaryartery.Occlusionofthisarteryisoftencalledthewidow-makerinfarctionandhencethisarteryiscalledawidow’sartery.
67.Whichofthefollowingpassesposteriortothehilumofthelung?
a)Vagus
b)Phrenicnerve
c)SVC
d)Rightatrium
CorrectAnswer-AAns,A.Vagus
68.Whatisthelevelofthepulmonaryvalve?
a)3rdintercostalspace
b)4thcostalcartilage
c)3rdcostalcartilage
d)2ndintercostalspace
CorrectAnswer-CAns,C.3rdcostalcartilage
69.Lowerlimitoftheinferiorborderofthelunginthemidaxillarylineis?
a)6thrib
b)8thrib
c)10thrib
d)12thrib
CorrectAnswer-BAns,B.8thribThelowerlimitoftheinferiorborderofthelungis2ribsabovethereflectionofthepleural.Inthemidaxillarylinethepleurareflectsatthe10thribandhencethelowerlimitofthelungis8thrib.
70.Whichisatypicalintercostalnerve?
a)First
b)Second
c)Third
d)Seventh
CorrectAnswer-CThird"Typicalintercostalnervesaretheonesthatareconfinedtotheirownintercostalspacesinthethoracicwall.Thethird,fourth,fifthandsixthintercostalnervesarethetypicalnerves"
71.Greatcardiacveinliesin?
a)Tricuspidvalve
b)Anteriorinterventricularsulcus
c)Posteriorinterventricularsulcus
d)None
CorrectAnswer-BAns.is'B'i.e.,Anteriorinterventricularsulcus[RefBDC4th/eVol.I,p.251-252;KeithMooreClinicalAnatomyhlth/ep.136-137;Snell'sClinicalAnatomy9th/ep.121](Atrioventricular)sulcus→Greatcardiacvein,coronarysinus,Smallcardiacvein,RCA,LCX.Anteriorinterventricularsulcus→Greatcardiacvein,leftanteriordescending(interventricular)artery.Posteriorinterventricularsulcus→Middlecardiacvein,PosteriorinterventricularbranchofRCA.
72.Apexatofthelungliesatwhatlevel?
a)Abovetheclavicle
b)Belowtheclavicle
c)Attheleveloftheclavicle
d)None
CorrectAnswer-AAns.is'a'i.e.,Abovetheclavicle[RefBDC4thiep.222-228]Apexliesintheinletofthorax,2-5cmabovetheclavicle.Itisrelatedanteriorlytosubclavianarteryandvein.Posteriorlyitisseparatedfromneckoffirstribby(frommedialtolateral)sympathetictrunk,fistposteriorintercostalvein,superiorintercostalartery,andascendingbranchofventralramusof1"thoracicnerve.
73.Diaphragmissuppliedby?
a)Phrenicnerve
b)C2,C3,C4Roots
c)Thoracodorsalnerve
d)Longthoracicnerve
CorrectAnswer-AAns.is'a'i.e.,Phrenicnerve[RefBDC6th/eVolIp.192,fig.12.12]NervesupplyMotor:-Phrenicnerve(C3C4C5).Sensory:-i)centrallybyphrenicnerve.Peripherallybylower6intercostalnerves.
74.Midpointbetweensuprasternalnotchandpubicsymphysespassesthroughwhichplane?
a)Transpyloricplane
b)Transtubercularplane
c)Trnasxiphoidplane
d)None
CorrectAnswer-AAns.is'a'i.e.,Transpyloricplane[RefBDCVol-26th/ep.229]Anteriorabdominalwallisdividedinto9regionswiththehelpoftwoverticalandtwohorizontalplanes.Thehorizontalplanesinclude:-
1. Transpyloricplane(ofAdison):-Itliesmidwaybetweenthesuprasternalnotchandpubicsymphysis.Itpassesanteriorlythroughtipsof9'hcostalcartilageandposteriorlythroughlowerborderofL,vertebra.Organspresentatthislevelarehilumofkidney,pylorusofstomach,beginningofduodenum,neckofpancreas,fundusofgallbladderandoriginofSMA.
2. Transtubercularplane:-ItconnectsthetuberclesofiliaccrestsandpassthroughupperborderofL5vertebra.Thetwoverticalplanesarerightandleftlateralplanespassingthroughmidinguinalpoint(alsocalledasmidinguinalplaneormidclavicularplane).Thenineregionsfromabovedownwadsare-
1. Inmiddle:-Epigastrium,umblical,hypogastrium.2. Onrightside:-Righthypochondrium,rightlumbar,andrightinguinal
(iliac)regions.3. Leftside:-Lefthypochordrium,leftlumbarandleftinguinal(iliac)
regions.
75.Musclelyingbetweenanteriorandmiddlelayerofthoracolumbarfasciais?
a)Psoasmajor
b)QuadratusLumborum
c)Obduratorinternus
d)Externaloblique
CorrectAnswer-BAns.is'b'i.e.,QuadratusLumborum[RefBDC6thleVol.2p.343;Snell9"/ep.695]Quadratuslomborumisenclosedbetweenanteriorandmiddlelayers.Erectorspinae(paraspinalmuscle)isenclosedbetweenmiddleandposteriorlayer.
76.AnteriorRectusSheathjustabovepubicsymphysisisformedby?
a)ExternalObliqueAponeurosis
b)TheaponeurosisofthreemusclesincludingExternalOblique,InternalOblique,andTransversusAbdominis
c)LineaAlba
d)InternalObliqueonly
CorrectAnswer-BAns.is'B'i.e.,AponeurosisofthreemusclesincludingExternalOblique,InternalOblique,andTransversusAbdominisTheanteriorwalljustabovethesymphysispubis(areabelowthearcuateline)→isformedbyaponeurosisofallthreemuscles(externaloblique,internaloblique,transversusabdominis).Threeaponeuroticlayersformingrectussheathofbothsidesinterlacewitheachothertoformatendinousraphe,Lineaalba.Itextendsfromthexiphoidprocesstopubicsymphysis.Lineaalbaisnarrowandindistinctbelowtheumbilicus,astworectilieinclosecontact.Lineaalbabroadensoutabovetheleveloftheumbilicus.
77.Rightsuprarenalveindrainsinto?
a)Inferiorvenacava
b)Rightrenalvein
c)Leftrenalvein
d)AccessoryHemiazygousvein
CorrectAnswer-AAns.is'a'i.e.,InferiorvenacavaArterialsupplyofadrenalglandisbythreearteries:-1.Superiorsuprarenalartery(branchoftheinferiorphrenicartery);2.Middlesuprarenalartery(branchofabdominalaorta);and3.inferiorsuprarenalartery(branchoftherenalartery).Venousdrainageisthroughthesuprarenalveins.Rightsuprarenal(adrenal)veindrainsintoIVCandleftsuprarenalveindrainsintotheleftrenalveinandthenintoIVC.Lymphaticsfromsuprarenalglandsdrainintolateralaortic(para-aortic)nodes.
78.Whichofthefollowingisnotderivedfromtheexternalobliqueaponeurosis?
a)InguinalLigament
b)Lacunarligament
c)LineSemilunaris
d)PectinealLigament
CorrectAnswer-CAns.is'c'i.e.,LineSemilunaris[RefBDC6th/eVol2p.343;Snell91Vep.695]Externaloblique→Inguinal(Pouparts)ligamentLacunarligamentMnemonic:IPLPectineal(cooper's)ligamentSuperficialinguinalringExternalspermaticfasciaInternaloblique→Cremastericfascia&muscleAlongwithtendonoftransversusabdominisformsconjointtendon
79.Stomachissuppliedby?
a)Coeliactrunk
b)Splenicartery
c)Gastroduodenalartery
d)Alloftheabove
CorrectAnswer-DAns.is'd'i.e.,Alloftheabove
80.Whatisthenumberoflayersingreateromentum?
a)1
b)2
c)3
d)4
CorrectAnswer-DThegreateromentumisfoldedbackonitselfandisthereforemadeupoffourlayersofcloselyappliedvisceralperitoneum,whichareseparatedbyvariableamountsofadiposetissue.
81.Stomachwallismainlydrainedbyalllymphnodesexcept?
a)Pyloricnodes
b)Shortgastricvesselnodalgroup
c)Rightgastroepiploicnodes
d)Inguinalnodes
CorrectAnswer-DAns.is'd'i.e.,Inguinalnodes[RefGray'sanatomy20thedition]Thestomachisdrainedbyfourgroupsoflymphnodes:
1. Leftgastricarterialnodalgroup,whichfollowstheleftgastricarteryanddrainintotheceliacnodes.Theydrainthelessercurvatureofthestomachtotheleft.
2. Shortgastricandleftgastroepiploicvesselsnodalgroup.Thelymphaticvesselswhichdraintheleftsideofthegreatercurvatureofthestomachfollowsthesevesselsanddrainintothepancreaticosplenicgroupofnodes.
3. Rightgastroepiploicnodes,whichdraintherighthalfofthegreatercurvatureofstomachasfarasthepylorus
4. Pyloricnodeswhichdrainsthepyloricpartofstomachtothehepatic,pyloricandleftgastricnodes.Allthevesselsenterintotheceliacnode.Fromthesenodestheypassintotheintestinallymphtrunks,whichthenenterthecisternachyliortheabdominalconfluenceoflymphtrunks.Thecisternachylidrainsintothethoracicduct.
82.Alllymphofstomachdrainsinto?
a)Pyloricnodes
b)Shortgastricvesselnodalgroup
c)Rightgastroepiploicnodes
d)Coeliacnodes
CorrectAnswer-DAns.'D'i.e.,CoeliacnodesAllthevesselsenterintotheceliacnode.Fromthesenodes,theypassintotheintestinallymphtrunks,whichthenenterthecisternachyliortheabdominalconfluenceoflymphtrunks.Thecisternachylidrainsintothethoracicduct.
83.Gallbladderisrealtedtowhichsegmentoftheliver?
a)I
b)II
c)III
d)IV
CorrectAnswer-DAns.is'd'i.e.,IV[RefGray's40thlep.1163-1167;Sabiston18th/ep.1584]ThegallbladderliesontheinferiorsurfaceofthelivercloselyrelatedtosegmentIVorthequadratelobe.Anatomicallyliverisdividedintoalargerightlobeandasmallleftlobebylineofattachmentoffalciformligament(anterosuperiorly),fissureforligamentumteres(inferiorly),andfissureforligamentumvenosum(posteriorly).Rightlobeismuchlargerandformsfivesixthofliverandleftlobeformsonlyonesixth.Caudatelobeandquadratelobearepartsofanatomicalrightlobe.Thephysiologicalleftlobeiscomposedof4segmentsdesignatedItoIVandissuppliedbyleftbranchofhepaticartery,leftbranchofportalveinanddrainedbylefthepaticduct.ThephysiologicalrightlobeconsistsofsegmentV,VI,VIIandVIIIandissuppliedbyrighthepaticartery,rightbranchofportalveinanddrainedbyrighthepaticduct.
84.Whichsegmentofliverdrainsonbothsides?
a)I
b)II
c)III
d)IV
CorrectAnswer-AAns.is'A'i.e.,ICaudatelobe(segmentI)Itissituatedontheposteriorsurfaceoftherightlobe.ItisboundedonrightbyagrooveforIVC,onleftbyfissureforligamentumvenosum,andinferiorlybyportahepatis(containinghepaticartery,portalvein,hepaticductbileduct,nerveplexus,andlymphatics).Justbehindtheportahepatis,thecaudatelobeisconnectedtotherestoftherightlobebythecaudateprocess.Thereisasmallroundedelevationtotheleft,calledthepapillaryprocess.Caudatelobeliesinthesuperiorrecessoflessersacandisrelatedtothecruraofthediaphragm,rightinferiorphrenicartery,andcoeliactrunk.Caudatelobe(anatomicalpartoftherightlobe)belongsphysiologicallytobothrightandleftlobesbecauseitreceivesbloodfromtherightandlefthepaticarteries;rightandleftbranchesoftheportalvein,anddrainsbileintoboththerightandlefthepaticduct.Thusitisconsideredasthephysiologicallyindependentlobe.
85.Caudatelobeoftheliver-Trueis?
a)Itreceivesbloodsupplyfrombothrightandlefthepaticarteries
b)ItisSegmentIIoftheliver
c)Itissituatedontheanteriorsurfaceofliver
d)Itliesbetweentheaortaandligamentumvenosum
CorrectAnswer-AAns.is'a'i.e.,Itreceivesbloodsupplyfrombothrightandlefthepaticarteries[RefRameshBabup.249]Caudatetube(segmentI)issituatedonposteriorsurfaceofliverbetweenIVC&ligamentumvenosum.Itreceivesbloodsupplyfromright&leftarteries.
86.Superiorborderofepiploicforamenformedby-
a)Caudatelobe
b)Hepaticartery
c)Bileduct
d)IVC
CorrectAnswer-AAns.is'a'i.e.,CaudatelobeEpiploicforamen(foramenofWinsloworaditustolessersac)isaslit-likeopeningthroughwhichlessersaccommunicateswithgreatersac.ItissituatedatthelevelofT12vertebra.Itsboundariesare:-Anterior:-Rightfreemarginoflesseromentum(containsportalvein,hepaticarteryproperandbileduct).Posterior:-IVC,rightsuprarenalglandandT12vertebra.Superior:-Caudatelobeoftheliver.Inferior:-1stpartoftheduodenumandhorizontalpartofthehepaticartery.
87.InternalanalSphincterisformedby?
a)Puborectalis
b)Circularmusclesfromlowerrectum
c)LongitudinalInvoluntarymuscles
d)None
CorrectAnswer-BAns.is'b'i.e.,Circularmusclesfromlowerrectum[RefBDC4th/eVol.Hp.383;Gray'sAnatomy40thieChapter67]Externalsphincteriscontributedbyfibersfrompuborectalispartoflevatoranimuscle(inuppermostpart);superficialtransverseperinealmusclesanteriorlyandanococcygealrapheposteriorly(inupperthird)andanococcygealligament(inmiddlethird).
88.Allofthefollowingaretrueaboutduodenumexcept?
a)Fourthpartistheshortestpart
b)AmpullaofVateropensthroughthesecondpart
c)Minorduodenalpapillaisinthethirdpart
d)Firstpartappearslikeaduodenalcaponbariumstudies
CorrectAnswer-CAns.is'c'i.e.,Minorduodenalpapillaisinthethirdpart[RefBDC6'1*Vol.2p.259-262]Thirdpart(Horizonalpart):Itis10cm(4inches)long.ItbeginsatinferiorduodenalflexureandpassestowardstheleftinfrontofIVCbehindsuperiormesentericvesselsandrootofmesenterytomeet4thpartofduodenum.
89.Whichofthefollowingisabranchoftheinferiormesentericartery?
a)Sigmoidartery
b)Middlecolicartery
c)Renalartery
d)RightColicartery
CorrectAnswer-AAns.is'a'i.e.,Sigmoidartery[RefBDC6th/eyoi.2p.276]Inferiormesentricarterygivesfollowingbranches?
1. Leftcolicartery2. Sigmoidarteries3. Superiorrectalartery
90.Waldeyer'sfasciaconnects?
a)Rectumtosacrum
b)Rectumtouterus
c)Rectumtolateralwallofpelvis
d)Rectumtobladder
CorrectAnswer-AAns.is'a'i.e.,Rectumtosacrum[RefClinicalanotomy2"dlep.786]Supportofrectuminclude
1. Fasciaofwaldeyer:Itattachesthelowerpartofrectalampullatothesacrum.Itisformedbycondensationofpelvicfasciabehindtherectumandenclosesthesuperiorrectalvesselsandlymphatics.
2. Lateralligamentsoftherectum:Itisformedbycondensationofpelvicfasciaandenclosesmiddlerectalvessels,andbranchesofpelvicplexuses.
3. Rectovesicalfasciaofdenonvilliers:Itextendsfromrectum(behind)totheprostateandseminalvesicleinfront.
4. Pelvicperitoneumandrelatedvascularpedicles.Perinea(bodywithitsmuscles.
91.ContentofAlcock'scanalis?
a)Internalpudendalartery
b)Internaliliacartery
c)Inferiorrectalvein
d)Inferiormesentericvein
CorrectAnswer-AAns.is'a'i.e.,Internalpudendalartery[RefBDC6th/eVol-2p.362]Pudendalcanal(Alcock'scanal)isafascialcanalinthelateralwallofischeorectal(ischeo-anal)fossa,enclosingpudendalnerveandinternalpudendalvessels(arteryandvein).Itisaspacebetweenobturatorfasciaandlunatefascia.Otherbelievethatitisformedbysplittingoftheobturatorfascia.
92.Allofthefollowingorgansareindirectcontactwiththespleenexcept?
a)Duodenum
b)Stomach
c)Leftkidney
d)Colon
CorrectAnswer-AAns.is'a'i.e.,DuodenumGrossmorphologyofthespleenSpleenhastwoends(anteriororlateralandposteriorormedial),threeborders(superior,inferiorandintermediate),twosurfaces(visceralanddiaphragmatic),twoangles(anterobasalangleandposterobasalangle)andhilum.Theanteriorendissupportedbythephrenicocolicligament.Thesuperiorborderischaracteristicallynotchednearitsanteriorend.Thevisceralsurfaceisrelatedtothefundusofstomach(atgastricimpression),leftkidney(atrenalimpression),splenicflexureofthecolon(atcolicimpression)andtailofthepancreas(atpancreaticimpression).Itslowerendisrelatedtothephrenicocolicligament.Thediaphragmaticsurfaceisrelatedtothediaphragm.
93.Glanspenisisacontinuationof-
a)Corpusspongiosum
b)Ischiocavernosus
c)CorporaCavernosa
d)Puborectalis
CorrectAnswer-AAns.is'A'i.e.,CorpusspongiosumThepenisisthemaleorganofcopulation.Thepenishasarootandabody.Therootofthepenisissituatedinthesuperficialperinea!pouch,attachedtotheinferiorsurfaceoftheperinealmembrane.Itconsistsofthreemassesoferectiletissue:thebulbofthepenisandtwocrura.Eachcruscontinuesforwardtobecomethecorpuscavernusum(inthebody)andthebulbistheposteriorendofthecorpusspongiosum(ofthebody).Thebodyofthepenisisthefreeportionofthepenis.Itiscomposedofthreeelongatedmassesoferectiletissues:-rightandleftcorporacavernosa,andmediancorpusspongiosum.Corporacavernosaeareenvelopedbytunicaalbugineaandcorpusspongiosumisalsosurroundedbytunicaalbuginea.Thepenileurethrarunsthroughthewholelengthofthecorpusspongiosumfromthebulbatthebacktotheterminalexpandedpartofthecorpusspongiosum,calledtheglanspenis.
94.Whichmusclecausesopeningoftheupperendofesophagus?
a)Epiglottis
b)Thyropharungeus
c)Stylopharyngeus
d)Cricopharyngeusofinferiorconstrictor
CorrectAnswer-DAns.is'd'i.e.,Cricopharyngeusofinferiorconstrictor[RefHall,ArthurC.Guyton,JohnE.(2005).Textbookofmedicalphysiology(11thed.).Philadelphia:W.B.Saunders.p.782-784.]UpperesophagealsphinctorTheupperesophagealsphinctersurroundstheupperpartoftheesophagus.Itconsistsofskeletalmuscle,butisnotundervoluntarycontrol.Openingoftheupperesophagealsphincteristriggeredbytheswallowingreflex.Theprimarymuscleoftheupperesophagealsphincteristhecricopharyngealpartoftheinferiorpharyngealconstrictor.
95.Posteriorperforationofstomach,collectionofcontentsoccursinwhichpouch?
a)Greatersac
b)Leftsubhepaticandhepatorenalspaces[pouchofMorrison]
c)Omentalbursa
d)Rightsubphrenicspace
CorrectAnswer-CAns.is'B'i.e.,Leftsubhepaticandhepatorenalspaces[pouchofMorrison]Aposteriorgastriculcermayperforateintothelessersac(omentalbursa).Theleakingfluidpassesoutthroughepiploicforamentoreachthehepatorenalpouch.Sometimesinthesecasestheepiploicforamenisclosedbyadhesions.Thenthelessersacbecomesdistended,andcanbedrainedbyatubepassedthroughthelesseromentum.
96.Cremastricmuscleisformedfrom?
a)Fasciafrominternaloblique
b)Fasciafromexternaloblique
c)Fasciafromrectusabdominis
d)Fasciafromtransversusabdominis
CorrectAnswer-AAns.is'a'i.e.,FasciafrominternalobliqueThelayersofscrotumfromoutsidetoinsideare:-
1. Skin2. Dartosmuscle(smoothmusclelayer)continuouswithCollesfascia
ofperineumposteriorlyandScarpa'sfasciaandCamper'sfasciaanteriorly.
3. Theexternalspermaticfascia,extensionfromexternaloblique.4. Thecremastericmuscle,continuouswithfasciafrominternal
oblique.5. Theinternalspermaticfascia,continuouswithfasciafromfascia
transversalis.
97.Kidneyiscoveredbywhatfascia?
a)Sibson'sfascia
b)Buck'sFascia
c)Gerota'sFascia
d)None
CorrectAnswer-CAns.is'c'i.e.,Gerota'sFascia[RefFarlexPartnerMedicalDictionaryFarlex2012]RenalfasciaTherearefourcoveringsaroundthekidney(fromwithinoutwords):-Truecapsule(fibrouscapsule)Itisformedbythecondensationoffibrousstromaofkidney.Falsecapsule(renalfasciaorfasciaofGerota)Itisformedbycondensationofextra-peritonealconnectivetissuearoundkidneyandiscontinuouslaterallywithfasciatransversalis.Falsecapsuleconsistsoftwolayers:anterior"fasciaofToldt"andposterior"fasciaofZuckerkendl".
98.
Narrowestpartofureteris?
a)Brimofthepelvis
b)Crossingbygonadalvessels
c)Vesicouretricjunction
d)Crossingbyductusdeferens
CorrectAnswer-CAns.is'c'i.e.,Vesicouretricjunction[RefCampbellisurology6thlep.2123;Gray'sAnatomyforstudents1"/ep.325]Uretermeasuresabout3mmindiameter,butisconstrictedatfiveplaces
1. Pelviuretericjunction2. Brimoflesserpelvis(atthelevelofbifurcationofcommoniliac
arteryandcrossingofexternaliliacartery3. Pointofcrossingofureterbyductusdeferensorbroadligamentl4. Entryinbladderwall(thisvesicoureteraljunctionisthenarrowest
partofureter)5. Openinginlateralangleoftrigone
99.Whatisthetotallengthofthecolon?
a)1metre
b)1.5metres
c)2metres
d)4metres
CorrectAnswer-BAns.is'b'i.e.,1.5metres[RefBDCVol.IIelep.269-273]Thelargeintestineextendsfromtheileocaecaljunctiontoanus.Itis1.5meterslongandisdividedintocaecum,ascendingcolon,rightcolic(hepatic)flexure,transversecolon,leftcolic(splenic)flexure,descendingcolon,sigmoidcolon,therectumandanalcanal.Transversecolonislongestpart(50cm)andanalcanalshortest(3.8cm).Caecum→6cmSigmoidcolon→37.5cmAscendingcolon-›12.5cmRectum→12cmTransversecolon→50cmAnalcanal→3.8cmDescendingcolon→25cm
100.Submandibularlymphnodesdrainthefollowingareasofthefaceexcept?
a)Medialhalfofeyelids
b)Centralpartoflowerlip
c)Medialpartofcheek
d)Centralpartofforehead
CorrectAnswer-BAns.is'b'i.e.,Centralpartoflowerlip[RefBDCVol.III6th/ep.73]LymphaticdrainageoffaceThefacepossessesthreeareasfromwhichlymphaticdrainageisasfollows:?
1. Upperarea,comparisinggreaterpartofforehead,lateralViofeyelids,conjunctiva,lateralpartofcheekandparotidarea,drainsintopreauricular(superficial)parotidnodes.
2. Middlearea,comprisingcentralpartofforehead,externalnose,upperlip,lateralpartoflowerlip,medialhalvesofeyelids,medialpartofcheek,andgreaterpartoflowerjaw,drainsintosubmandibularnodes.
3. Lowerarea,includingcentralpartoflowerlipandthechin,drainsintosubmentalnodes.
101.Larynxbelowthevocalcordsdraininto?
a)Pretracheallymphnodes
b)Occipitallymphnodes
c)Mediastinalnodes
d)Lymphaticsalongthesuperiorlaryngealvein
CorrectAnswer-AAns.is'a'i.e.,PretracheallymphnodesSupraglotticpart(Abovevocalcord)LymphaticsalongthesuperiorlaryngealveinandnodesadjacenttothethyrohyoidmembraneInfraglotticpart(Belowvocalcord)PretrachealandprelaryngealnodesVocalcordsDevoidoflymphaticsupply
102.Nervesupplytotheangleofthemandibleisby?
a)PosteriorprimaryramiofC2,C3
b)Greaterauricularnerve
c)Maxillarynerve
d)Mandibularnerve
CorrectAnswer-BAns.is'b'i.e.,GreaterauricularnerveTheskinovertheangleofthejaw(mandible)issuppliedbytheanteriordivisionofthegreaterauricularnerve.
103.Nervesupplytothetipofthenoseisfrom?
a)Theophthalmicdivisionofthetrigeminalnerve
b)Greaterauricularnerve
c)Themaxillarydivisionofthetrigeminalnerve
d)Mandibularnerve
CorrectAnswer-AAns.is'a'i.e.,OphthalmicdivisionofthetrigeminalnerveTipofthenoseandlowerpartofthedorsumofthenosearesuppliedbytheexternalnasalbranchoftheophthalmicdivisionofthetrigeminalnerve.
104.Dangerousspaceintheneckisfoundbetween?
a)Buccopharyngealfasciaandalarfascia
b)Prevertebralfasciaandalarfascia
c)BuccopharyngealfasciaandPrevertebralfascia
d)None
CorrectAnswer-BAns.is'b'i.e.,Prevertebralfasciaandalarfascia[Ref"Severesofttissueinfectionsoftheheadandneck:aprimerforcriticalcarephysicians".Lung.187(5):271-9.]Thedangerspaceoralarspace,isaregionoftheneck.Thecommonnameoriginatesfromtheriskthataninfectioninthisspacecanspreaddirectlytothethorax,and,duetobeingaspacecontinuousontheleftandright,canfurthermoreallowinfectiontospreadeasilytoeitherside.Itisboundedsuperiorlybytheskullbase,anteriorlybythealarfasciaandposteriorlybytheprevertebralfascia.Itcomestoanendatthelevelofthediaphragm.Theretropharyngealspaceisfoundanteriortothedangerzone,betweenthealarfasciaandbuccopharyngealfascia
105.Whichmuscleisattachedtothediscofthetemporomandibularjoint?
a)Buccinator
b)Lateralpterygoid
c)Masseter
d)Temporalis
CorrectAnswer-BAns.is'Bi.e.,Lateralpterygoid[RefBDC415/eVol.3p.145;Last'sanatomy11'"/eLateralpterygoidorigin→Upperhead:Infratemporalsurface&crestofgreaterwingofsphenoid.Lowerhead:Lateralsurfaceoflateralpterygoidplate.Nervesupply→PterygoidfoveaonAnteriordivisionoftheneckofman→mandibularnerve.anaudible,Articulardiscandcapsuleoftemporomandibularjoint.Action→Depressesthemandible.Protrusionandsidetosidemovement.
106.Maxillarytuberclegivesattachmentto?
a)Lateralpterygoid
b)Medialpterygoid
c)Temporalis
d)Masseter
CorrectAnswer-BAns.is'b'i.e.,Medialpterygoid[RefBDCVolIII6thlep.116]MedialPterygoidOrigin:Superficialhead:Tuberosityofmaxilla.Deephead:Medialsurfaceoflateralpterygoidplate&pyramidalprocessofpalatinebone.Insertion:Medialsurfaceofanglemandible&adjoiningramus.Nervesupply:BranchfromtrunkofmandibularnerveAction:Elevatesthemandible,Protection&sidetosidemovement.
107.Vidiannerveisalsoknownas?
a)NerveofPterygoidcanal
b)GreaterPetrosalnerve
c)LesserPetrosalnerve
d)GreaterAuricularnerve
CorrectAnswer-AAns.is'a'i.e.,NerveofPterygoidcanalThenerveofthepterygoidcanal(Vidiannerve)isformedbythejunctionofthegreaterpetrosalnerveandthedeeppetrosalnervewithinthepterygoidcanalcontainingthecartilaginoussubstance,whichfillstheforamenlacerum.Itpassesforwardthroughthepterygoidcanalwithitscorrespondingartery(arteryofthepterygoidcanal)andisjoinedbyasmallascendingsphenoidalbranchfromtheoticganglion.Itthenentersthepterygopalatinefossaandjoinstheposteriorangleofthepterygopalatineganglion.
108.Whichofthefollowingnucleibelongtothegeneralvisceralafferentcolumn?
a)Facialnervenucleus
b)Trigeminalnucleus
c)Dorsalnucleusofvagus
d)Nucleusambiguus
CorrectAnswer-CVisceralafferentfibers,alsocalledgeneralvisceralafferentfibers,conveysensationfromthealimentarytract,heart,vessels,andlungsbywayofnervesIXandX.Aspecializedvisceralafferentcomponentisinvolvedwiththesenseoftaste;fiberscarryinggustatoryimpulsesarepresentincranialnervesVII,IX,andX.Thegeneralvisceralafferentcolumnisrepresentedbypartofthedorsalnucleusofthevagusnerve.Ref:WaxmanS.G.(2010).Chapter8.CranialNervesandPathways.InS.G.Waxman(Ed),ClinicalNeuroanatomy,26e.
109.RightRecurrentlaryngealnerveloopsaround?
a)Rightsubclavianartery
b)Rightaxillaryartery
c)RightExternalcarotidartery
d)RightSuperiorthyroidartery
CorrectAnswer-AAns.is'a'i.e.,Rightsubclavianartery[RefLarsen,WilliamJ.(1993).Humanembryology]RecurrentlaryngealnerveOnrightsideitarisesintherootofneckandwindsaroundfirstpartofrightsubclavianartery.Itmaybeanterior(superficial)orposterior(deep)toinferiorthyroidartery.Onleftsideitarisesinthorax(superiormediastinum)andwind'saroundthearchofaortaimmediatelybehindtheattachmentofligamentumarteriosum.Itisusuallyposterior(deep)toinferiorthyroidarteryorbetweenitsbranches.Recurrentlaryngealnervesuppliesallintrinsicmusclesoflarynx(exceptcricothyroid)andmucousmembraneoflarynxbelowvocalfold.Italsogivesbranchestodeepcardiacplexus,trachea,esophagusandinferiorconstrictior.Inferiorthyroidarteryisligatedawayfromglandtoavoidinjurytonerve.Leftnerveismoreliabletodamage.
110.Leftrecurrentlaryngealpassesbetween?
a)Trachea&larynx
b)Trachea&esophagus
c)Esophagusandbronchi
d)Esophagusandaorta
CorrectAnswer-BAns.is'b'i.e.,Trachea&esophagus[RefGray's38th/ep.786]Thepathsoftheleftandrightrecurrentlaryngealnervesveryslightlywiththeleftrecurrentlaryngealnervedividingfromthemainvegusnerveattheleveloftheaorticarch.Theleftrecurrentlaryngealnervethandipsposteriorlyaroundthearoticarchtoassendthroughthesuperiormediastinumtoenterthegroovebetweentheesophagusandtrachea.Therightrecurrentlaryngealnervedividesfromthemainvagusnerveattheleveloftherightsubclavianarterytoenterthesuperiormediastinum.Therightrecurrentlaryngealnervethendipsposteriorlyaroundthesubclavianarterytoassendinthegrovebetweentheesophagusandtrachea.
111.Structurespiercedbytheparotidductareallexcept?
a)Buccopharyngealfascia
b)Buccinatormuscle
c)Buccalfatpad
d)Investinglayerofdeepcervicalfascia
CorrectAnswer-DAns.'d'i.e.,InvestinglayerofdeepcervicalfasciaTheparotidduct(Stenson'sduct)Parotidductemergesfromtheanteriorborderoftheglandandpassesforwardoverthelateralsurfaceofthemasseterandcanbepalpatedatthetenseanteriormarginofthemassetermuscle.Initscourseductpiercesbuccalfatpad,buccopharyngealfasciaandbuccinatormuscle(obliquely)andopensonthemucousmembraneofcheekoppositetoseconduppermolartooth.Whenintraoralpressureisraised(duringblowing)theductiscompressedbetweenthebuccinatorandmucousmembrane,preventinginflationoftheduct.
112.Whichlayerofthescalpisvascular?
a)Pericranium
b)Superficialfascia
c)Skin
d)Aponeurosis
CorrectAnswer-BAns.is'b'i.e.,SuperficialfasciaThescalpisasofttissuethatcoversthecalvariaoftheskull.Itconsistsoffivelayersandcanbememorizedbyamnemonicusingtheinitiallettersoftheword.SCALP:?SkinClosenetworkofconnectivetissue(superficialfascia)Aponeurosis(galeaaponeurotica)withoccipitofrontalismusclesLooseareolar(subaponeurotic)tissuePericranium(outerperiosteumoftheskull)
113.AllofthefollowingpassthroughtheSinusofmorgagniexcept-
a)Auditorytube
b)Levatorvelipalatini
c)Ascendingpalatineartery
d)Stylopharyngeus
CorrectAnswer-DAns.'d'i.e.,StylopharyngeusSinusofMorgagniisthelargegapbetweentheupperconcaveborderofthesuperiorconstrictorandthebaseoftheskull.Thestructurespassingthroughitare:1.Auditorytube2.Levatorvelipalatini3.Ascendingpalatineartery4.Palatinebranchofascendingpharyngealartery
114.Chordatympaniisabranchof?
a)Facialnerve
b)Trigeminalnerve
c)Greaterauricularnerve
d)Externallaryngealnerve
CorrectAnswer-AAns.is'a'i.e.,Facialnerve[Ref:BDC6thleVol3p.371]Branchesoffacialnerve
1. Infallopian(facialcanal):-Greaterpetrosal(greatersuperficialpetrosal)nerve,nervetostapedius,chordatympani.
2. Atitsexitfromstylomastoidforamen:-Posteriorauricular,digastricnerve,stylohyoidnerve.
3. Terminalbranches:-Temporal,zygomatic,buccal,marginalmandibular,andcervical.
115.Chorda-tympanidoesnotcarrywhichfibers?
a)Preganglionicparasympatheticfibersforsublingualglands
b)Preganglionicparasympatheticfibersforsubmandibulargland
c)Preganglionicparasympatheticfibersforparotidgland
d)Tastefibersfromanteriortwothirdoftongue
CorrectAnswer-CAns.is'c'i.e.,PreganglionicparasympatheticfibersforparotidglandChordatympaniisabranchoffacialnervemainlycarryingtastesensationsfromtheanterior2/3rdofthetongueThechordatympanicarriestwotypesofnervefibersfromtheiroriginwiththefacialnervetothelingualnervethatcarriesthemtotheirdestinations:Specialsensoryfibersprovidingtastesensationfromtheanteriortwo-thirdsofthetongue.Preganglionicparasympatheticfiberstothesubmandibularganglion,providingsecretomotorinnervationtotwosalivaryglands:thesubmandibularglandandsublingualglandandtothevesselsofthetongue,whichwhenstimulated,causedilationofbloodvesselsofthetongue.
116.WhichofthefollowingpassthroughtheHypoglossalcanal?
a)Hypoglossalnerve
b)Externaljugularvein
c)Facialnerve
d)Mandibularnerve
CorrectAnswer-AAns.is'a'i.e.,Hypoglossalnerve[RefBDC6th/eVol.3p.18-20]
117.Whichmuscleisantagonisttoorbicularisoculithatisnotsuppliedbyfacialnerve?
a)LevatorPalpebraesuperioris
b)Orbicularisoris
c)Superioroblique
d)Inferioroblique
CorrectAnswer-AAns.is'a'i.e.,LevatorPalpebraesuperiorisOrbicularisoculiclosestheeyeandissuppliedbythefacialnerve.LevatorPalpebraesuperiorisopenstheeyelidandissuppliedbytheoculomotornerve.
118.AllofthefollowingaremainbranchesofTrigeminalnerveexcept?
a)Mandibularnerve
b)Maxillarynerve
c)Ophthalmicnerve
d)Opticnerve
CorrectAnswer-DAns.is'd'i.e.,Opticnerve[RefBDC6th/eVol3p.369]Divisionsoftrigeminalnerve
1. Ophthalmicdivision(Ophthalmicnerve:V1)2. Maxillarydivision(Maxillarynerve:V2)3. Mandibulardivision(Mandibularnerve:V3)
119.Extensionoftheretropharyngealspaceisbetween?
a)Alarfasciaandbuccopharyngealfascia
b)buccopharyngealfasciaandprevertebralfascia
c)AlarfasciaandPrevertebralfascia
d)None
CorrectAnswer-AAns.is'a'i.e.,AlarfasciaandbuccopharyngealfasciaRetropharyngealspaceTheretropharyngealspaceisapotentialspaceoftheheadandneck,boundedbythebuccopharyngealfasciaanteriorlyandthealarfasciaposteriorly.Togetherwiththelateralpharyngealspace,thesespacesaretermedtheparapharyngealspaces.Itcontainstheretropharyngeallymphnodes.Becauseseriousinfectionsofteethcanspreaddownthisspaceintotheposteriormediastinum,itisoftenconfusedwiththedangerspace.Thedangerspaceisactuallybetweenthealarfasciaandtheprevertebralfasciaandextendsfromthecranialbaseabovetothelevelofthediaphragm.Itislimitedabovebythebaseoftheskull,andbelowwherethealarfasciafuseswiththebuccopharyngealfasciaataboutthelevelofT4andthecarina.
120.Delphiannodesare?
a)Prelaryngealnodes
b)Occipitalnodes
c)Coeliacnodes
d)Noneoftheabove
CorrectAnswer-AAns.is'a'i.e.,PrelaryngealnodesTheDelphiannode(prelaryngeal)alongwithparatrachealnodes,pretrachealnodes,perithyroidalnodesmakeuplevelVIcervicallymphnodes,andisnotroutinelyexcisedinradicalneckdissections.Itreceiveslymphfromthethyroidandlarynx.TheDelphiannodegainsitsnamefromtheOracleofDelphi,whoseprophecy,inthiscase,wouldbeofanunpleasantdeathsecondarytolaryngealcancer.Theinvolvementofthisnodecanbearesultofdiffusenodalinvolvementinheadandnecksquamouscellcarcinomaorisolationfromthedirectlymphaticspreadoflaryngealcancerthroughtheanteriorcommissure.Thyroidcarcinomasmayalsoinvolvethisnode.
121.Straightsinusisformedby?
a)InferiorSagittalSinus
b)InternalJugularveins
c)SuperiorSagittalSinus
d)Tranversesinus
CorrectAnswer-AAns.is'a'i.e.,InferiorSagittalSinusThestraightsinus,alsoknownastentorialsinusorthesinusrectus,isanareawithintheskullbeneaththebrainthatreceivesvenousblood.Straightsinusisformedbytheunionoftheinferiorsagittalsinuswiththegreatcerebralvein.Itisconsideredacontinuationoftheinferiorsagittalsinus.Itdrainsintothetransversesinus,mostcommonlyintheleftone.Thestraightsinusissituatedwithintheduramater,wherethefalxcerebrimeetsthemidlineoftentoriumcerebelli.Incross-section,itistriangular,containsafewtransversebandsacrossitsinterior,andincreasesinsizeasitproceedsbackward.
122.Whicharterysuppliestheparacentrallobule?
a)MedialStriateartery
b)CallosoMarginalartery
c)Pericallosalartery
d)Frontopolarartery
CorrectAnswer-BAns.is'b'i.e.,CallosoMarginalartery[RefBDCVol.36th/ep.461,462]CallosomarginalarteryisabranchofanteriorcerebralarterythatsuppliestheparacentrallobulewhichhasaroleincontrolofmicturitionAnteriorcerebralarteryHasfollowingbranches:-
1. Medialstriateartery(recurrentarteryofHeubner):Itsuppliescaudatenucleus(ventralpart),putamen,andanteriorlimbandgenuofinternalcapsule.
2. Fronto-polarartery:Itsuppliesmedialandorbitalsurfacesoffrontallobe.
3. Orbitalbranches:Itsuppliesmedialandorbitalsurfacesoffrontallobe.
4. Calloso-marginalartery:Itsuppliestheparacentrallobuleandpartsofgyruscinguli.
5. Pericallosalartery:Itsuppliesmedialsurfaceofparietallobeandprecuneous.
123.Nucleusofbasalganglia
a)Dentate
b)Thalamus
c)Caudate
d)Rednucleus
CorrectAnswer-CAns:Ci.e.CaudatenucleusThebasalgangliahavefivenucleioneachsideofthebrain.-Caudatenucleus-Putamen-Globuspallidus-Subthalamicnucleus-SubstantianigraThecaudatenucleusandputamencollectivelyformthestriatum.Theputamenandglobuspalliduscollectivelyformthelentiformnucleus.Theglobuspallidusisdividedintoexternalandinternalsegments
124.Mostlateralnucleusofcerebellumis?
a)Dentate
b)Globose
c)Fastigial
d)Emboliform
CorrectAnswer-AAns.is'A'i.e.,DentateTherearefourdeepcerebellarnuclei(fromlateraltomedial):dentate,emboliform,globose,andfastigial.Thegloboseandtheemboliformnucleiaresometimeslumpedtogetherastheinterpositusnucleus.
125.
Superiormarginalgyrusisapartof?
a)Parietallobe
b)Frontallobe
c)Temporallobe
d)Occipitallobe
CorrectAnswer-AAns.is'a'i.e.,ParietallobeThesuperiormarginalgyrusisaportionoftheparietallobe.ThisareaofthebrainisalsoknownasBrodmannarea40basedontheuniversallyusedbrainmapcreatedbyKorbinianBrodmanntodefinethestructuresinthecerebralcortex.
126.
Parsdorsalisisapartof?
a)Cerebrum
b)Cerebellum
c)Pons
d)Thalamus
CorrectAnswer-CAns.is'c'i.e.,Pons[RefFarlexPartnerMedicalDictionaryFarlex2012]ParsDorsalisThepartoftheponsboundedlaterallybythemiddlecerebellarpedunclesandanteriorlybytheventralpartofpons;itiscontinuouswiththetegmentumofthemesencephalonandcontainslongtractssuchasthemedialandlaterallemnisci,cranialnervenuclei,andreticularformatin.
127.Arborvitaeareseenin?
a)Cerebrum
b)Cerebellum
c)Pons
d)Thalamus
CorrectAnswer-BAns.is'b'i.e.,CerebellumThearborvitaeisthecerebellarwhitematter,so-calledforitsbranched,tree-likeappearance.Insomeways,itmoreresemblesafernandispresentinboththecerebellarhemispheres.Itbringssensoryandmotorinformationtoandfromthecerebellum.Thearborvitaeislocateddeepinthecerebellum.Situatedwithinthearborvitaearethedeepcerebellarnuclei;thedentate,globose,emboliformandthefastigialnuclei.Thesefourdifferentstructuresleadtotheefferentprojectionsofthecerebellum.
128.TotalvolumeofCSFis?
a)150ml
b)500ml
c)50ml
d)800ml
CorrectAnswer-AAns.is'a'i.e.,150mlThemajorsourceofCSFisthechoroidalplexusofall4ventricles,mainlyintwolateralventricles.OthersourcesofCSFareependymalcellsoftheventriclesandthebrainitself,viaperivascularspaces.ThetotalvolumeofCSFinanadultisabout125-150ml.TherateofformationofCSFisabout500-550ml/day.ThustheCSFisreplaced3-4timeseveryday.ThewaterypartofCSFissecretedbytransductionbuteachofitsconstitutionsisactivelytransported.Na.issecretedintotheCSFwiththehelpofNa+ATPase.GlucoseentersCSFthroughfacilitateddiffusionmediatedbyGLUT-1.HCO3issecretedwiththehelpofcarbonicanhydrase.
129.Laterallemniscusterminatesinto?
a)Lateralgeniculatebody
b)Superiorcolliculus
c)Inferiorcolliculus
d)Inferiorolivarycomplex
CorrectAnswer-CAnsis'c'i.e.,Inferiorcolliculus[RefBDC6th/eVol..3p.374]
130.Internalcapsule-Allofthefollowingarepartsexcept?
a)Anteriorlimb
b)Sublentiformpart
c)Retrolentiform
d)Prelentiform
CorrectAnswer-DAns.is'd'i.e.,PrelentiformTheinternalcapsuleisdividedfrombeforebackwardsintofollowingparts:AnteriorlimbPosteriorlimbRetrolentiformpartGenuSublentiformpart
131.Substantiaferrugineaisfoundin-
a)Fourthventricle
b)Thalamus
c)Midbrain
d)Thirdventricle
CorrectAnswer-AAns.is'a'i.e.,Fourthventricle[RefMedicalDictionary,2009FarlexandPartners]Itisashallowdepression,ofabluecolorinthefreshbrain,lyinglaterallyinthemostrostralportionoftherhomboidalfossanearthecerebralaqueduct;itliesnearthelateralwallofthefourthventricleandconsistsofabout20,000melanin-pigmentedneuronalcellbodiesthenorepinephrine-containingaxonsofwhichhavearemarkablywidedistributioninthecerebellumaswellasinthehypothalamusandcerebralcortex.Alsocalledaslocuscinereus,locusferrugineus.
132.Infundibulardiverticulumisanextentionof?
a)1stand2thventricles
b)3rdventricle
c)4thventricle
d)None
CorrectAnswer-BAns.is'B'i.e.,3rdventricleThirdventricleisamidlinecavityofdiencephalon.Itisamediancleftbetweentwothalami.Anterosuperiorlyitcommunicateswithlateralventriclethroughtheinterventricularforamen(foramenofMonro).Posteroinferiorlyitcommunicateswithfourthventriclethroughcerebralaqueduct(DuctofSylvius).Therearefourextensions(recesses)ofthirdventricle:(a)Suprapinealrecess,(b)Pinealrecess,(c)Infundibularrecess,and(d)Opticrecess.
133.Whichofthefollowingisacompletesulcusinthebrain?
a)Calcarinesulcus
b)Paracentralsulcus
c)Both
d)None
CorrectAnswer-AAns.is'a'i.e.,CalcarinesulcusThecalcarinesulcus(orcalcarinefissure)isananatomicallandmarklocatedatthecaudalendofthemedialsurfaceofthebrainofhumansandotherprimates.ItsnamecomesfromtheLatin"calcar"meaning"spur".Itisacompletesulcus.Foraccommodationinalimitedspacewithintherigidcranialbox,thecerebralcortexisfoldedintonumerousgyriorconvolutionsseparatedbysulciorfissures.Eventuallythetotalsurfaceareaofthecortexofhumanbrainisincreasedtoabout2200cm2,inwhichonlyaboutonethirdofthecortexisexposedasgyriandtwothirdishiddeninthesulci.
134.Whichofthefollowingisderivedfromtheneuraltubeexcept?
a)Retina
b)Brain
c)Dorsalrootganglia
d)Pinealgland
CorrectAnswer-CAns.is'c'i.e.,Dorsalrootganglia[RefTextbookofhumanembryology-786]Nervoussystemdevelopsfromectoderm(neuroectoderm).Nervoussystemdevelopsfromneuraltubewhichinturndevtlopsbyprocessofneurulation,i.e.formationofneuralplateanditsinfoldingintoneuraltube.
135.Cerebellovestibularfibrespassthrough?
a)Superiorcerebellarpeduncle
b)Middlecerebellarpeduncle
c)Inferiorcerebellarpeduncle
d)None
CorrectAnswer-CAns.is'c'i.e.,Inferiorcerebellarpeduncle[RefBDCVol.III6thlep.405]Inferiorcerebellarpeduncle→
1. Posteriorspinocerebellar2. Cuneocerebellar(posteriorexternalarcuatefibres)3. Olivocerebellar4. Parolivocerebellar5. Reticulocerebellar6. Vestibulocerebellar7. Anteriorexternalarcuatefibres8. Striaemedullares
136.Longspinousprocessisseenin?
a)Cervicalvertebrae
b)ThoracicVertebrae
c)LumbarVertebrae
d)Sacrum
CorrectAnswer-BAns.is'b'i.e.,ThoracicVertebrae[Ref:BDC5th/eVol.3p.40]
137.Movementoccuringatatlanto-axialjoint?
a)Flexion
b)Bending
c)Rotation
d)Nodding
CorrectAnswer-CAns.is'c'i.e.,Rotation[Ref:Clinicalanatomy3rdiep.786]Movmentspermittedatatlanto-occipitaljointare:-Flexionandextension(noddingofhead),and(ii)Lateralflexion(bendingofneck).Movementspermittedatatlanto-axialjointsareside-to-siderotationofhead(lookingtowardsright-or-left).
138.Spinalsegmentalarteryisabranchof?
a)Ascendingspinalartery
b)Basilarartery
c)Posteriorspinalartery
d)Anteriorspinalartery
CorrectAnswer-AAns.is'a'i.e.,Ascendingspinalartery[RefSpinalCordMedicine.DemosMedicalPublishing.]Arterialsupplyofspinalcord
139.Whichofthefollowingisnotapermanentmucosalfold?
a)Heister'svalves
b)Transverserectalfold
c)Plicaecircularis
d)Gastricrugae
CorrectAnswer-DAns.is'd'i.e.,Gastricrugae[RefInderbirSinghHistologyp.240;BDC4th/eVol.Hp.241,245,274,378;Gray's40thlep.1138,1120,1151,1132,1178]Gastricrugaeofstomach,andlongitudinalfoldsinmucosaofupperrectumandcolonaretemporarymucosalfoldsandareobliteratedbydistension.Whereas,plicacircularis(valvesofkerkring)ofsmallintestine,crescenticmucosalfoldsofcysticduct(spiralvalveofHeister),transverse(horizontal)rectalfolds(Houston'svalvesorplicatransversalis)andpermanentlongitudanalrectalcolumnsorfolds(foundin
140.Lipidraftsareseenin?
a)Ribosomes
b)Mitochondria
c)Plasmamembrane
d)ER
CorrectAnswer-CAns.C.Plasmamembrane.*LipidraftsareregionsinplasmamembranethataccumulateCholesterolandglycolipids(glycosphingolipids).-Sothereregionsareslightlythickerthanotherareasofplasmamembrane.-Becausefdistinctmolecularcompositionoflipidrafts,theycanactusmicrocompartmentwithincells,givingthecellanadditionalwaytoorganizepathways.-Involvedintheregulationofsignaltransduction.Typesoflipidrafts:*Planarlipidrafts(noncaveolarorglycolipidrafts)-Continuouswithplaneofcellmembrane(theyarenotinvaginate).Caveolae:*Specializedtypesoflipidraftswhichareflasklikeinvaginationsofplasmamembrane.*Producedwherecaveolinproteinispresentinlipidbilayermembrane.
141.Markerofendoplasmicreticulum?
a)Acidphosphatase
b)Glucose-6-phosphatase
c)Catalase
d)LDH
CorrectAnswer-BAns.B.Glucose-6-phosphatase.OrganelleorfractionMarkersPlasmamembrane-Adenylcyclase,Na+ICATPaseLysosome-AcidphosphataseGolgiapparatus-Galactosyltransferase,GolgimannosidaseII,Sialyltransferase,G1cNActransferase.Endoplasmicreticulum-Glucose-6-phosphatasePeroxisome-Catalase,Urate(uricacid)oxidaseCytosol-LactatedehydrogenaseNucleus-DNARibosome-HighcontentofRNA
142.Followingisafeatureofsimplediffusion?
a)Againstaconcentrationgradient
b)Easyfornon-polarsubstance
c)Moreinthickmembrane
d)Requirescarrierprotein
CorrectAnswer-BAns.B.Easyfornon-polarsubstanceSimplediffusion:Referstodiffusionofmoleculeacrossthemembranefollowingaconcentrationgradientorchemicalgradient,butwithoutthehelpofanycarrierprotein.Factorsinfluencing:A)Rateofdiffusionisdirectlyproportionate:-Concentration(chemical)gradientCross-sectionalareaofthemembranethroughwhichdiffusiontakesplaceLipidsolubilityofthesubstanceB)Rateofdiffusionisinverselyproportionate:-ThicknessofdiffusionmembraneSizeoftheparticleChargeorpolarityofsubstanceSo,simplediffusionisfavoredbysmallsize,lipidsolubilityandabsenceofpolarity(non-polarsubstance)andcharge(neutralmolecule)throughathin,largemembranewheretheconcentrationgradientismore.
143.Mostcommonmechanismfortransportintothecell?
a)Diffusion
b)Primaryactivetransport
c)Antiport
d)Cotransport
CorrectAnswer-AAns.A.Diffusion.(RefPrinciplesofmedicalphysiologyp.3.)Mostimportantandmostcommonmechanismoftransportispassivediffusion.
144.TrueaboutNernstequation?
a)Usedtocalculateequilibriumpotential
b)Calculatedfornon-ionicsolution
c)NernstpotentialforClis-90my
d)Allarecorrect
CorrectAnswer-AAns.A.Usedtocalculateequilibriumpotential.[Ref:Ganong24thlep.9;Principlesofmedicalphysiologyp.8]RMPvalueiscalculatedonbasisofNernstequation.Alsoreferred"Nernstpotential/Equilibriumpotential/DiffusionpotentialofK+.
145.ECFconcentrationof1C.is150meq/LandICFconcentrationofleis5meq/L.WhatistheequilibriumpotentialforK+is?
a)+60mV
b)-60mV
c)-90mV
d)+90mV
CorrectAnswer-CAns.'c'i.e.,-90mVNernstEquation–Canbeusedtofindthecellpotentialatanymomentinduringareactionoratconditionsotherthanstandard-state.
E=cellpotential(V)underspecificconditionsE=cellpotentialatstandard-stateconditions\R=idealgasconstant=8.314J/mol-KT=temperature(kelvin),whichisgenerally25C(298K)n=numberofmolesofelectronstransferredinthebalancedequationF=Faraday'sconstant,thechargeonamoleofelectrons=95,484.56C/mollnQc=thenaturallogofthereactionquotientatthemomentintime.-61150
EK=log=90mV+15
146.Nernnstequationrelatedtoequilibriumpotentialdoesnotdependupon?
a)Concentrationgradient
b)Electricgradient
c)Non-ionicsolution
d)Concentrationofionsintwosolution
CorrectAnswer-CAns.C.Non-ionicsolution[RefGuyton12th/ep.50;Principlesofmedicalphysiologyp.8]Nernstequationisforionicsolution.
147.DuetoDonnan-Gibbseffect?
a)ConcentrationofK.isgreaterinECF
b)ConcentrationofclisgreaterinECF
c)TotalionsaremoreinICF
d)Allaretrue
CorrectAnswer-CAns.C.TotalionsaremoreinICF[RefPrinciplesofmedicalphysiologyp.7]Gibbs-Donnanequilibrium:Themammaliancells(intracellularfluid)containsnon-diffusibleanionlikeproteinsandorganicphosphatewhereasK'andCl-arediffusiblecationandanion,respectively.TheECFcontains1K+andCl-asdiffusiblecationandanionrespectively.DuetoGibbs-Donnanequilibrium:-ConcentraionofCl-isgreaterinICFthanECF(concentrationofdiffusiblecationisgreaterincompartmentwithnon-diffusibleanion).ConcentrationofClisgreaterinECFthanICF.TotalnumberofionsisgreaterinICFthanECF.Alltheseeffectshelptomaintaintheshapeandvolumeofcellsbydistributingdiffusibleionsacrossthemembraneaccordingtophysiologicaldemand.
148.ATPaseiswhichtypeofpump?
a)Secondaryactive
b)Electrogenic
c)Symport
d)Alloftheabove
CorrectAnswer-BAns.B.Electrogenic[RefGanong24th/ep.51,10;Guyton12th/ep.53]Sodium-potassiumpump:*Mostimportantpumpforprimaryactivetransportinbody.*AnElectrogenicpump.*ResponsibleformaintainingNa+&K+conc.differenceacrosscellmembrane.Mechanism:*ICF-HighK+concentration.*ECF-HighNa+concentration.*BothNa+&K+transportedagainstconcentrationgradient.*UsesenergybyhydrolyzingATP;Functions:*PumpcontainsATPaseactivity.*Na+-K+pumpextrudes--3Na+outfromcell.-Pumps2K+intocell.-CouplingratioofNa+-K+pump-3:2.
149.Diffusionrelatedto02transportacrossrespiratorymembraneisanexampleof?
a)Simplediffusion
b)Facilitateddiffusion
c)Activediffusion
d)Osmoticdiffusion
CorrectAnswer-AAns.A.Simplediffusion.[Ref.Ganong25thlep.51&24thlep.53]Simplediffusion-Movementoffats,oxygen,CO,throughlipidportionofmembrane.Facilitateddiffusion-Movementofglucoseandsomeamino-acids.Primaryactivetransport-IonsK+,Na*,Secondaryactivetransport-Glucoseororamino-acidintothecellalongNa`(Sympoftorcotransport)1-1+outofthecellagainstNa+(Antiportorcountertransport).
150.Measurementofintracellularfluidina50yearsoldmaleisdoneby?
a)Dilutionmethod
b)Evansblue
c)D20
d)Indirectly
CorrectAnswer-DAns.D.Indirectly.[RefGanong23th/ep.3-6;Guyton12th/ep.286-288]Mostofthefluidiscalculateddirectlybydilutionmethod,exceptforintracellularfluid(ICF)andinterstitialfluid.Boththesearecalculatedindirectlybycalculatingotherbodyfluids.ICF=Totalbodywatervolume-ECFvolumeInterstitialfluid=ECFvolume-Plasmavolume.
151.Calculationofinterstitialfluidina50yearsoldisdoneby?
a)TBWminusECF
b)ECFminusplasmavolume
c)ICFminusECF
d)TBWminusICF
CorrectAnswer-BAns.B.ECFminusplasmavolume.[RefGanong23th/ep.3-6;Guyton12th/ep.286-288]Mostofthefluidiscalculateddirectlybydilutionmethod,exceptforintracellularfluid(ICF)andinterstitialfluid.Boththesearecalculatedindirectlybycalculatingotherbodyfluids.ICF=Totalbodywatervolume-ECFvolumeInterstitialfluid=ECFvolume-Plasmavolume.
152.Excitabilityofcellsismaximallyaffectedbychangeinconcentrationofwhichion?
a)IC+
b)Na*
c)a-
d)Ca+2
CorrectAnswer-DAns.D.Ca+2[RefPrinciplesofmedicalphysiologyp.801]Effectsofionconcentrationchangeonmembranepotential:*Hypercalcemia-AnincreaseinextracellularCa2+concentrationcanstabilizethemembranebydecreasingexcitability.*Hypocalcemia-Calciumionismembranestabilizers.-AdecreaseinextracellularCa2+concentrationincreasestheexcitabilityofnervebydecreasingtheamountofdepolarizationnecessarytoproducetheactionpotential.-Hyperexcitabilityisseen.
153.Non-specificpainpathwayisfor?
a)Nociceptivepain
b)Neuropathicpain
c)Idiopathicpain
d)Inflammatorypain
CorrectAnswer-CAns.C.Idiopathicpain[RefTextbookofpsychotherapyp.6]Painmaybedividedinto:-Nociceptivepain:Itismusculoskeletalpainthatresultsfrominjuryorinflammatoryordegenerativedisorders,e.g.bonefractureorarthritisorburn.Neuropathicpain:Itisduetodysfunction/damageofnerves,e.g.prolapseintervertebraldisc.Mixedpain:Ithascomponentsofbothnociceptiveandneuropathicpains.Idiopathicorunspecifiedpain:Itispurelypsychologicalinnatureandisthereforecalledpsychogenicpain.
154.Dullvisceralpainiscarriedbywhichtypeofneurons?
a)Agamma
b)Aa
c)Cfibres
d)B
CorrectAnswer-CAns.C.“C”fibers.[RefGanong24th\ep.92&23rdlep.89]Aviscusdoesnothaveanyothersensation(e.g.touch,temperatureetc)exceptpain.Duetosparsedistributionofpainreceptors,visceralpainispoorlylocalized.Visceralpainsensationiscarriedbytype-Cafferentsinthesympatheticsystem(fromthoracicandabdominalviscera)andparasympatheticsystem(frompelvicviscera).
155.'C'fiberscarrysensationsthroughwhichpathway?
a)Posteriorcolumn
b)Anteriorspinothalamictract
c)Lateralspinothalamictract
d)Alloftheabove
CorrectAnswer-CAns.C.Lateralspinothalamictract.[RefGanong23rdiep.648;Goyton12thlep.573].CfiberscarryPain(slowpain)andtemperaturesensation.Thesearecarriedbylateralspinothalamictract.
156.TypesCnervefibersare?
a)Sensory
b)Motor
c)Mixed
d)Anyoftheabove
CorrectAnswer-AAns.A.sensory.TypeCfibers:Postganglionicautonomicfibers.Sensoryfunctionafferenttotemperature&pressure.Nomotorfunction.
157.Warmthsensationiscarriedby?
a)Aafibers
b)A(3fibers
c)Ayfibers
d)ASfibers
CorrectAnswer-AAns.a.Aafibers[RefGanong25"Yep.94&24"lep.92;Principlesofphysiologyp.512]Temperature(warmth/cold)sensationiscarriedbyAδ&Cfibers.
158.Trueaboutmyosin?
a)Thinfilament
b)Coversactivesiteofaction
c)HasATPaseactivity
d)Ca'bindingprotein
CorrectAnswer-CAns.C.HasATPaseactivity[RefGanong241thlep.100,102]Theshorteningofmusclefiberoccursduetoslidingofactinfilamentsonmyosinfilament.However,therearefourmuscleproteinsinvolvedintheprocess:-Actin,Myosin,Tropomyosin,andtroponin.Myosin:Myosinistheproteinthatconstitutesthethickfilaments.Myosinofskeletalmuscleismyosin-II.MyosinparticipatesinthecontractilemechanismandalsoactsasanATPase.
159.Incardiacmuscles,T-tubulesarepresentat?
a)Zlines
b)Alines
c)Ilines
d)A-Ijunction
CorrectAnswer-AAns.A.“Z”lines.[RefPrinciplesofmedicalphysiologyp.794]Thecardiacmusclecellcontainsactin,myosinthesarcotubularsystemandotherorganellesseeninskeletalmuscles.However,theTsystemofcardiacmuscleislocatedatZlinesratherthanatA-Ijunction,whereitislocatedinskeletalmuscles.
160.Inamusclefiberatrest,thelengthoftheIbandis1mmandAbandis1.5mm.Whatisthelengthofthesarcomere
a)0.5mm
b)2.5mm
c)3.5mm
d)5mm
CorrectAnswer-BAns.B.2.5mm.SarcomereistheportionofmyofibrilbetweentwoZlines.Thus,lengthofsarcomereingivenquestion=0.5mm(1/2Iband)+1.5mm(Aband)+0.5mm(1/2Iband)=2.5mm.
161.Whitefibersarepresentinwhichmuscle?
a)Calfmuscles
b)Backmuscles
c)Glutealmuscles
d)Handmuscles
CorrectAnswer-DAns.D.Handmuscles.[RefPrinciplesofmedicalphysiologyp.118]Typeofmusclefibers:Type1(red)ortype2(white).Mostofthemuscleinhumanbodycontainsbothtypesoffibers,i.e.mostmusclesinthebodyhavebothtypesofmotorunits.But,somemuscleshavemoretype1fibers(type1motorunits)thantype2,andvice-versa.Accordingly,skeletalmusclescanbedividedinto:RedmusclesThesemusclescontainmoretype1(red)fibers,thereforeareslowtwitchmusclesandcontainmoremyoglobincontent.Thesearemuscleswhichrequireprolongedcontraction,forexample,muscleswhichhelpinmaintainingposture,i.e.Backmusclesgluteusmuscles(atbackofhip)andcalfmuscles.White(pale)musclesThesemusclescontainmoretype2(white)fibersandarefasttwitchmuscles.Thesearemuscleswhichhelprapidcontractionsandfinermovements.ExamplesareHandmusclesandextraocularmuscles.
162.Functionofmusclespindleis?
a)Movementofalimb
b)Muscletonemaintenance
c)Goalorientedmusclecontraction
d)Alloftheabove
CorrectAnswer-BAns.B.Muscletonemaintenance[RefUnderstandingofmedicalphysiologyp.138]Ifaskeletalmuscleisstretched,itrespondbycontracting.Inotherwords,ifamuscleisstretched,ittendstobecomeshorterandmorestiff,therebyresistingstretch.Thisisbecauseofreceptorsensitivetostretchwithinthemuscle.Stretchreceptorwithinamuscleiscalled"musclespindles".Stretchreflexhastwoprincipalfunctions:1)TomaintainmuscletoneToneisatendencyofamuscletoresistbeingstretched.Muscletoneisnotonlyimportantformaintainingposturebutalsofacilitateslocomotionandmakesallvoluntarymovementsmooth.2)Tomakemusclesrespondtostretchandrelease.
163.Afferentsforstretchreflexesarecarriedbywhichfibers?
a)Aa
b)Ay
c)TypeB
d)TypeC
CorrectAnswer-AAns.A.Aa[RefGanong24th/ep.229]Sensoryinnervation(afferent)ofmusclespindle:Twotypesofsensorynervefibers(afferent)originatefromtheintrafusalfibers:Annulospiral(Primary)endingarewoundaroundthecentralregionofbothnuclearbagfiberandnuclearchainfiber.TheseareAα(orIα)fibers.Flower-spray(Secondary)endingsinnervatetheperipheralparts(ends)ofnuclearchainfiber.TheseareAβor(orII)fibers.
164.Spinalcordhashowmanysynapsesingolgitendonreflex?
a)1
b)2
c)3
d)4
CorrectAnswer-BAns.B.2[Ref:Principlesofmedicalphysiologyp.786]Strechreflexthroughmusclespindle→MonosynapticGolgitendonreflex→Bisynaptic.
165.Inversestretchreflexisa?
a)Monosynapticreflex
b)Bisynapticreflex
c)Polysynapticreflex
d)Nonsynapticreflex
CorrectAnswer-BAns.B.Bisynapticreflex[RefPrinciplesofmedicalphysiology3rd/ep.786]Golgitendonreflex(inversestretchreflex)isbisynapticreflex.
166.Facilitatorypresynapticneurotransmitteris?
a)GABA
b)Glycine
c)Glutamate
d)Aspartate
CorrectAnswer-C:DAns.is'c>d'i.e.,Glutamate>Aspartate[RefUnderstandingofmedicalphysiology1"/ep.412]Glutamateisthechiefexcitatoryneurotransmitterinthebrainandspinalcord.Aspartateseemstobethechiefexcitatoryneurotransmitterofcorticalpyramidalcells.
167.
Nissl'sgranulesarefoundinwhichpartofnervecell-
a)Axonhillock
b)Axons
c)NodeofRanvier
d)Body
CorrectAnswer-DAns.D.Body[RefChaudhri7h/ePrinciplesofmedicalphysiology-7]NisslBodies(Nisslgranuleortigroidbody):Nisslbodiesarelargegranularbodyfoundinneuron.Presentalloverthesoma(body),exceptingaxonhillockandtheyextendtosomeextentinthedendrites,butnotwithintheaxon.Thesegranulesareroughendoplasmicreticulumwithfreeribosomesandarethesiteofproteinsynthesis.Theyarethoughttobeinvolvedinthesynthesisofneurotransmittersuchasacetylcholine.Nisslbodiesarebasophilicgranules.Chromatolysis(disappearanceofNisslbodies)isanimportanthistologicalsignofneuronalinjury.Whenthedemandoftheproteinsynthesisisgreatthenisslgranulesoverworkandmanyaltogetherdisappear(chromatolysis).
168.Stereociliaarefoundin?
a)Eye
b)Nose
c)Tongue
d)Epididymis
CorrectAnswer-DAns.D.Epididymis*Stereociliaarefoundinthreeplaces-Haircellsofinnerear-Epididymis-Ductusdeferens.
169.Stereociliaarepresentin?
a)Tastebuds
b)Haircells
c)Retina
d)Nose
CorrectAnswer-BAns.B.Haircells.[RefGanong25th/ep.202]Haircellshaveacommonstructure.ThetallesthaircelliscalledasKinociliumandtheprogressivelyshorterhaircellsarecalledasStereocilia.Thesehaircellsareconnectedtogetherbytiplinkswhichhasmechanicallysensitivecationchannels.
170.CSFpressureisincreasedinallexcept-
a)Forcedinspiration
b)Coughing
c)Valsalvamanoeuvre
d)Crying
CorrectAnswer-AAns.A.Forcedinspiration.[RefEssentialofmedicalphysiologyp.950]Eventslikecoughing,valsalvamanoeuvre,andcryingincreasethepressurebydecreasingabsorption.CompressionofIJV(internaljugularvein)alsoraisestheCSFpressure.
171.CSFispresentinwhichspace?
a)Centralcanalofspinalcord
b)Ventriclesofbrain
c)Subarachnoidspace
d)Alloftheabove
CorrectAnswer-DAns.D.Alloftheabove.[RefGanong24th/ep.603;Principlesofmedicalphysiologyp.293]*Cerebrospinalfluid(CSF)isaclear,colorless,almostproteinfreefiltrate(transduate)ofblood.*Itispresent,-Aroundthebrain(insubarachnoidspace)andinsidethebrain(initsventricles).-Aroundthespinalcord(insubarachnoidspace)andinsidethespinalcord(initscentralcanal).
172.FunctionofGhrelin?
a)Stimulatewaterabsorption
b)Increaseappatite
c)Regulationoftemperature
d)Stimulatelipogenesis
CorrectAnswer-BAns.B.Increaseappatite[RefClinicalendocrinologyp.48;Ganong24th/ep.487]*Ghrelinisapeptidesecretedbyoxynticcellsingastricfundusthatarecharacterizedbyround,compact,electron-densesecretorygranules.*Ghrelinpromotesfoodintake,i.e.,stimulateappetite(orexigenic).*Increaseswithanorexia.*Inhuman,ghrelininduceslipolysis.*Ghrelinisreleasedfromthestomachinfastingstate.-Increaseshungerbyinhibitingtheventromedialhypothalamus(satietycenter).-StimulatesGHsecretions.
173.Locationofvisualcortex?
a)Precentralgyrus
b)Postcentralgyrus
c)Sylvianfissure
d)Calcarinesulcus
CorrectAnswer-DAns.D.Calcarinesulcus[RefPrinciplesofmedicalphysiologyp.531]Theoccipitallobeisthevisualprocessingcenterofbraincontainingmostoftheanatomicalregionofvisualcortex.Primaryvisualareaisbrodmannarea17(alsocalledVI)onmedialsideofoccipitallobeincalcarinesulcus.Itisalsocalledasstriateareaorstriatecortexbecauseitcanbeidentifiedbyalargestripeofmyelin,thestriaofgennari.
174.Parvocellularpathwayforvisionisconcernedwith?
a)Finedetailsofobject
b)Movementsofobject
c)Flickeringfeatures
d)Depthofvision
CorrectAnswer-AAns.A.Finedetailsofobject[RefGanong24th/ep.190]Parvocellularpathway(arisesfromlayer3,4,5,6ofLGB).Axonsfromparvocellularterminateinlayer4ofthevisualcortex.Parvocellularpathwaycarriessignalsforcolorvision,texture,shapeandfinerdetails.
175.Sweatglandsaresuppliedbyallexcept?
a)Cholinergicneurons
b)Sympatheticneurons
c)Adrenergicneurons
d)C-fibers
CorrectAnswer-CAns.C.Adrenergicneurons[RefUnderstandingofmedicalphysiologyp.786]Nervesupplyofsweatglandisuniqueinthatitissympatheticbutcholinergic(mostothersympatheticsitesarenoradrenergic).Post-ganglionicsympatheticfibersareType-Cfibers.
176.Gustatorypathwayinvolveswhichnerve?
a)Facial
b)Glossopharyngeal
c)Vagus
d)Alloftheabove
CorrectAnswer-DAns.D.Alloftheabove[RefPrinciplesofmedicalphysiologyp.87]Fibersinnervatingtastebudsarebranchesofcranialnerves,i.e.,branchesoffacial,glassopharyngeal,andvagusnerves.Thetastebudsintheanteriortwo-thirdsofthetongueareinnervatedbylingualbranchesofthefacialnerve.Thetastebudsintheposteriorthirdofthetongueareinnervatedbyglossopharyngealnerve.Tastereceptorsinthepharyngealpartoftongueandonthehardpalate,softpalate,andepiglottisareinnervatedbyfibersofthevagusnerve.
177.Functionofcerebellum?
a)Regulationoftone
b)Coordinationofeyemovement
c)Planning&initiationofmovement
d)Alloftheabove
CorrectAnswer-DAns.D.AlloftheaboveFunctionsofthecerebellum:Regulationoftone,postureandequilibrium.Smootheningandcoordinationofvoluntarymovements.Themostimportantfunctionandthebestknownfunctionofcerebellumiscoordinationofmovements.CoordinationofeyemovementsPlanningandinitiationofmovementsLearningoffrequentlyperformedvoluntarymovements.Timingandcomparison:Thecerebellumisbelievedtobeatimingdevicethattimesthedurationofagonisticmuscleactivityandlatencyofantagonisticactivity,Sothatanymovementishaltedatthecorrectpoint.
178.Whichofthefollowingisnotametabotropicreceptorforserotonin?
a)5HT,A
b)5HT,13
c)5HT2A
d)5HT3
CorrectAnswer-DAns.D.5HT3[Ref:Ganong32p.139;Principlesofmedicalphysiologyp.786]Metabotropicreceptors:AreG-proteincoupledreceptorswhichactthroughsecondmessenger.Serotoninincluded:Withtheexceptionofthe5-HT3receptor,aligandgatedionchannel,allother5-HTreceptors.
179.Twopointdiscriminationismainlyafunctionofwhichtouchreceptors?
a)Merkel'sdisc
b)Ruffini'sendorgan
c)Pacciniancorpuscle
d)Meissner'scorpuscle
CorrectAnswer-AAns.A.Merkel'sdisc[RefPrinciplesofmedicalphysiologyp.647]Tactile(touch)receptorsFortouch(superficaltouch):-Meissner'scorpuscle(detecttextureofsurface,i.e.roughorsmooth),Merkel'sdisc(detecttwopointdiscrimination).
180.Whichofthefollowingdefinesvitalcapacity?
a)Airinlungafternormalexpiration
b)Maximumairthatcanbeexpiratedafternormalinspiration
c)Maximumairthatcanbeexpiratedaftermaximuminspiration
d)Maximumairinlungafterendofmaximalinspiration
CorrectAnswer-CAns.C.MaximumairthatcanbeexpiratedaftermaximuminspirationVitalcapacity(VC):4700ml.Amountofairthatcanbeexhaledwithmaximumeffortaftermaximuminspiration(ERV+TV+IRV).Usedtoassessstrengthofthoracicmusclesaswellaspulmonaryfunction.
181.Functionalresidualcapacityinnormaladultis?
a)500ml
b)1200ml
c)2400ml
d)3200ml
CorrectAnswer-CAns.C.2400ml[Ref:Ganong24th/ep.629-631]Volumeofairinthelungsattheendofanormalexpiration.Inotherwords,FRC=ERV+RV.About2400ml.
182.Whatismaximumvoluntaryventilation?
a)Amountofairexpiredinonemunuteatrest
b)Maximumamountofairthatcanbeinspiredandexpiredinoneminute
c)Maximumamountofairthatcanbeinspiredperbreath
d)Maximumamountofairremaininginlungafterforcedexpiration
CorrectAnswer-BAns.B.Maximumamountofairthatcanbeinspiredandexpiredinoneminute[RefGuyton12th/ep.472,473;Ganong24th/ep.633]Maximumvoluntaryventilation(MVV):Itisthemaximumamountofairthatcanbemovedintoandoutofthelungsin1minutebyvoluntaryeffort.About125-170L/min.
183.TrueaboutCarboxyhemoglobin?
a)Takeup02veryquickly
b)Causeshistotoxichypoxia
c)CausesleftshiftofHb-02dissociationcurve
d)Allaretrue
CorrectAnswer-CAns.C.CausesleftshiftofHb-02dissociationcurve[RefUnderstandingofmedicalphysiologyp.173].COHbcannottakeup02;liberatesCOveryslowlyandshiftsdissociationcurveofremainingHbO,toleft,decreasingtheamountof02released.COpoisoningcausesanemichypoxiabecausetheamountofHbthatcancarryO2,isreducedbutthetotalHbamountofbloodisunaffectedbyCO.
184.WhatisthedifferencebetweenHb-0dissociationcurveandHb-COcurve?
a)COshiftsthecurvetoleft
b)COhasmoreaffinitytoHb
c)Co-Hbcurveissimilarto02-Hbcurve
d)Allaretrue
CorrectAnswer-DAns.D.Allaretrue[RefUnderstandingsofmedicalphysiologyp.786]COHbcannottakeup02;liberatesCOveryslowlyandshiftsdissociationcurveofremainingHb02toleft,decreasingtheamountofO2,released.TheaffinityofHbforCOis200-250timesitsaffinityfor02.SoCO-Hbdissociationcurveisalmostidenticalto02Hbdissociationcurveexceptthatpartialpressureareatalevelof1/250.
185.NottrueaboutBohreffect?
a)Decreaseaffinityof02byincreasePCO,
b)LeftshiftofHb-02dissociationcurve
c)ItisduetoH*
d)Allaretrue
CorrectAnswer-BAns.B.LeftshiftofHb-02dissociationcurve[RefGanong24th/ep.644,Understandingofmedicalphysiologyp.789]Bohreffect:IncreaseinPCO2decreasesthe02affinitytohemoglobinandshiftstheoxygendissociationcurvetoright;itiscalledBohreffect.TheeffectofraisedPCO2ismediatedbyincreaseinhydrogenionconcentration.Hydrogenionsshiftthecurvebybindingwithhemoglobin.Deoxygenatedhemoglobin(Deoxyhemoglobin)bindsII'moreactivelythandoesoxygentatedhemoglobin(oxyhemoglobin).Ionsbindtodeoxyhemoglobinandreducetheaccessibilityofoxygentohaemgroups.Thatiswhyinthepresenceofmorehydrogenions,lessoxygencancombineswithhemoglobinatagivenP02andtheoxygendissociationcurveshiftsrightward.
186.Whichofthefollowingexplainsuptakeof0,infetalcirculation?
a)Bohr'seffect
b)Halden'seffect
c)HigheraffinityofHbFfor0,
d)Noneoftheabove
CorrectAnswer-CAns.C.HigheraffinityofHbFfor0,[RefSmith'sanaesthesia3rdlep.77]Fetalhemoglobin'sgreateraffinityforoxygenimprovesoxygenuptakeattheplacenta.Agreateraffinityforoxygenisanadvantageforuptakeattheplacenta.
187.Whichofthefollowingexplainsdeliveryof02infetalcirculation?
a)Bohr'seffect
b)Halden'seffect
c)HigheraffinityofHbFfor02
d)Noneoftheabove
CorrectAnswer-AAns.A.Bohr'seffectUptakeof0,atplacenta→DuetohighaffinityofHbFfor02Deliveryof02attissuelevel→DuetoBohreffect.
188.Trueof02-Hbdissociationcurve?
a)Straightlinecurve
b)100%saturatedatP02of100mmHg
c)Cooperativebinding
d)Hbmoleculecancarry6moleculesof0,
CorrectAnswer-CAns.C.CooperativebindingMolecularbasis:"Duetophenomenon"CooperativebindingofOxygentohemoglobin".Stepsinvolved:Hemoglobin,atetramerFourO2moleculesbinds1Hbmolecule.1stO2moleculebondswithgreatestdifficulty.IncreasesaffinitytonextO2molecule.
189.Whichincreasesaffinityofhemoglobinfor0,-
a)Acidosis
b)Hyperthermia
c)HighpH
d)HighPCO2
CorrectAnswer-CAns.C.HighpHConditionsassociatedwithincreasedaffinityofhemoglobinforoxygen:HighpH.DecreasedH+ionconcentration(alkalosis).ReducedPCO2Reducedbodytemperature.Reduced2,3-bisphosphoglycerate(2,3-BPG)/2,3-diphosphoglycerate(DPG)Fetalhemoglobin.COpoisoning.
190.Incomparisontohemoglobin,effectofmyoglobinonBohreffect?
a)Increased
b)Decreased
c)Same
d)NoBohreffect
CorrectAnswer-DAns.D.NoBohreffect[RefPrinciplesofmedicalphysiologyp.711]Myoglobin:Singlepolypeptidechain.Humanmyoglobincontains152aminoacidswithamolecularweightof17,500.Hemeisattachedto92"dhistidinresidue.Onemoleculeofmyoglobincancombinewithonemoleculeofoxygen.MyoglobinhashigheraffinitytooxygenthanthatofHb.MyoglobinhashighoxygenaffinitywhileBohreffect,cooperativeeffectand2,3-diphosphoglycerateeffectcanabsent.
191.FunctionofchlorideshiftinRBCs?
a)RightshiftofHb-O,curve
b)LeftshiftofHb-02curve
c)TransportofCO2
d)Diffusionof02inalveoli
CorrectAnswer-CAns.C.TransportofCO2[RefGanong24th/ep.644;Principlesofmedicalphysiologyp.819]TransportofCO2:*Carbondioxideistransportedinbloodasplasmabicarbonate.*Redbloodcells(RBCs)playamajorroleinthemechanismbecauseRBCscontaintheenzymecarbonicanhydrasethatcatalyzesthereactionCO2+H20=HCO3+H.*HencewhenCO2diffusesintotheRBC,itreactschemicallywithwatertogenerateHCO3.*TheH+ionsaremoppedupbyhemoglobin,whichisanexcellentbuffer.*Thisenablesthereactiontoproceedintheforwarddirection.*TheHCO3-ionsgenerateddiffuseoutintotheplasmainexchangeforClionsthatdiffuseintoRBCssimultaneously.*ThemovementofchlorideionsintoRBCiscalledChlorideshift.-TheaboveeventsresultsinanincreaseintotalnumberionsinsidetheRBC,whichincreasesitsosmolarity.-Asaresult,waterenterstheRBCthroughosmosis.
192.Closingvolumeisrelatedtowhichofthefollowing?
a)Tidalvolume
b)Residualvolume
c)Vitalcapacity
d)None
CorrectAnswer-BAns.B.Residualvolume[RefPrinciplesofmedicalphysiologyp.240,241]Theclosingvolumeisthepointatwhichdynamiccompressionoftheairwaysbegins,especiallyduringforcedexpiration.Lower(dependent)partsofthelungshaslessertransmuralpressure,thereforetheybegintocloseearly.Therefore,closingvolumeisthelungvolumeaboveresidualvolumeatwhichairwayinthelower,dependentpartsofthelungsbegintocloseoff.Closingcapacityisthelungvolume(includingresidualvolume)atwhichairwaysinthelower,dependentpartsofthelungsbegintocloseoff,i.e.,Closingcapacity=closingvolume+residualvolume.Closingcapacityandvolumearetestedforsmallairwayfunction.Criticalclosingvolumeistheminimumvolumeandpressureofgasnecessarytopreventsmallairwaycollapse.Itissomewhatnearresidualvolume.
193.Centralchemoreceptorsarenotstimulatedby?
a)TPCO2
b)TEl'inCSF
c)Hypoxia
d)Allstimulate
CorrectAnswer-CAns.C.Hypoxia[RefGanong25th/ep.658]Centralchemoreceptors:Locatedinachemosensitiveareaontheventralsurfaceofthemedullaneartheexitoftheninthandtenthcranialnerves.Theprimarystimulusforthecentralchemoreceptorsisanincreaseinthehydrogenionconcentration.Stimulationofcentralchemoreceptorsbyincreasedhydrogenionconcentrationleadstoexcitationoftherespiratoryneurons,therebyproducinganincreaseintherateanddepthofrespiration.CentralchemoreceptorsaredirectlystimulatedbyanincreaseinH*concentrationinCSFandbraininerstitialtissue,whichisbroughtaboutbychangeinarterialPCO2(PaCO2).Notstimulatedbyhypoxia;ratherlikeanyothercells,theyaredepressedbyhypoxia.
194.Chemicalregulationofrespirationisnotaffectedby?
a)P02
b)PCO2
c)pH
d)MeanBP
CorrectAnswer-DAns.D.MeanBP[RefPrinciplesofmedicalphysiology;Ganong24th/ep.662-663]ChemicalRegulationCentralchemoreceptors:TFPConcentrationinCSF(1,pHofCSF);TPCO,ofblood.Peripheralchemoreceptors:LP02,TPACO2,acidosis(4pH)
195.Trueabouthighaltitudeacclimatization?
a)Leftshift0102-Hbcurve
b)DecreasedRBCcount
c)Hypoventilation
d)Increasederythropoietin
CorrectAnswer-DAns.D.Increasederythropoietin[RefGanong24th/ep.650,651&23'/ep.617-619;Guyton12ip.529,530]Acclimatization:Importalcompensatorymechanismsathighaltitudeare:-Hyperventilation:-CausesCO2washout,.1.,PCO2andrespiratoryalkalosis.Increased2,3DPG:-Rightwardshiftof02-Hbdissociationcurve.PolycythemiaandincreasedHb:-Duetoincreasederythropoietinreleasewhichcausesabsolutepolycythemiawithincreasedredcellmass.Others:-Increasedrenalexcretionofalkali(HCO3-),increasedtissuevascularity,increasedoxidativemetabolism,Increaseddiffusioncapacityoflung,increasedmyoglobin.
196.Respiratoryexchangeofgasesisstratedfrom?
a)Branchi
b)Alveoli
c)Bronchiole
d)Tissuelevel
CorrectAnswer-BAns.B.Alveoli[RefGanong25th/ep.639-640]Externalrespiration:Itconsistsofexchangeofgases(02andCO2)inthealveoli.Thereisdiffusionof02fromalveolarairintopulmonarycapillarybloodanddiffusionofCO2intooppositedirection.
197.Distendingcapacityoflungismaximumat?
a)Apex
b)Base
c)Midregion
d)Posteriorlobe
CorrectAnswer-AAns.A.Apex[RefUnderstandingsofmedicalphysiologyp.791]"Theairspacesattheapicesofthelungstendtoberelativelydistended,duetoweightofthelungseffectivelydraggingitselfdownwards,puttingtractionontheupperpartofthelungandstretchingtheapicalairspacesopen."
198.Actionpotentialincardiacmusclesisduetowhichions?
a)K*
b)Na*
c)Ca'
d)CI?
CorrectAnswer-A:B:CAns.b>a&cNa+,K+andCa+,allareinvolvedinfullcycleofactionpotentialincardiacmuscle.But,themainphase(phase0ordepolarization)isduetoNa+ions.Phase0(phaseofrapiddepolarization)→openingoffastsodiumchannelswithNa*influx.Phase1(initialphaseofrapidrepolarization)-4closureoffastsodiumchannels.Phase2(plateuphase)→openingofvoltagegatedslowCa**channelswithcalciuminflux.Phase3(finalrepolarization)→openingofK*channelswithefflux.Phase4-4Restingmembranepotential.
199.HeartsoundoccuringjustbeforeclosureofAV?
a)S1
b)S2
c)S3
d)S4
CorrectAnswer-DAns.D.S4[RefCECILp.212]S4occursjustbefore1stheartsound(1stheartsoundisduetoclosureofAVvalve,i.e.mitral&tricuspidvalve).
200.Baroreceptorsarerelatedtowhichvessels?
a)Internalcarotidartery
b)Externalcarotidartery
c)Subclavianartery
d)Brachiocephalictrunk
CorrectAnswer-AAns.A.Internalcarotidartery[RefGanong24thlep.590,591;Principlesofmedicalphysiologyp.791]Baroreceptorsaremechanoreceptorsthatarelocatedintheadventiaofcarotidarteryandaorta,atspecializedlocationscalledsinuses.
201.EffectofpositiveG?
a)Increasedcerebralarterialpressure
b)Increasedvenousreturn
c)Decreasedcardiacoutput
d)Increasedpressureinlowerlimb
CorrectAnswer-CAns.C.Decreasedcardiacoutput[RefGanong25thiep.576,24thlep.607-608,Principlesofmedicalphysiologyp.632]EffectsofpositiveG:ThrowingofbloodinthelowerpartIncreasedlowerlimbvenouspressureDecreasedcerebralarterialpressureDecreased,venousreturnDecreased,cardiacoutputGray-outandBlack-out.
202.Whichofthefollowingcauseincreaseinpulmonaryarterialpressure?
a)Histamine
b)Hypoxia
c)ANP
d)PGI2
CorrectAnswer-BAns.B.Hypoxia[RefGanong24th/ep.637]Hypoxiacausesvasoconstrictioninpulmonarybloodvesselscausingincreaseinpulmonaryarterialpressure.Effectofvariousstimulationsonpulmonaryvessels:Vasoconstriction:alpha-adrenergicThromboxane-A2AngiotensinIILTC4,LTD4EndothelinsHypoxiaHypercapnia
203.Mostimportantcerebralvasodilator?
a)H+
b)Na+
c)Cal+
d)None
CorrectAnswer-AAns.A.H+
[RefR.K.Marya3rdiep.156]ThemainmetabolicfactorresponsibleforthevasodilatationassociatedwithcerebralactivityistheCO2producedbytheactivatedneurons.IncreaseinbloodPCO2alsoproducescerebralvasodilatation.ThevasodilatoryeffectofCO2isindirectandismediatedbyformationoflocalH+whichhasadirectvasodilatoryeffectoncerebralbloodvessels.AfallinbloodPO,producescerebralvasodilatationandanincreaseinbloodPO,producescerebralvasoconstriction.
204.Reninsecretionisdecreasedby?
a)Sympatheticstimulation
b)Prostacycline[PGI2]
c)Naclindistaltubules
d)Hypotension
CorrectAnswer-CAns.C.Naclindistaltubules[RefGanong241thlep.674,670]Principalregulatorsofreninsecretion:Thejuxtaglomerularcellsthemselvesarethesensorsoftheafferentarteriolarpressure.LoweredpressurestimulatereninreleaseIncreasedNaC1indistaltubulesissensedbymaculadensaandthesignalistransmittedtoJGcells.ThisresultsindecreasedReninrelease.OppositeoccurswhendecreasedNaC1isdeliveredindistaltubule,i.e.,increasedreninrelease.Adenosineisprobablythemediatorofsignal.TheJGcellsareinnervatedbysympatheticfibers.Theyreleaserenininresponsetosympatheticdischarge,andbycirculatingcatecholamines.Prostacycline(PGI2)stimulatesreninsecretionthroughadirectaction.
205.Trueaboutfunctionofdistalconvolutedtubule?
a)ReabsorbeNa*byNal(+2c1-channel
b)ReabsorbeIC'byNei('channel
c)WaterreabsorptionbyADH
d)Allarecorrect
CorrectAnswer-CAns.C.WaterreabsorptionbyADHOver-allimpactofreabsorptioninearlydistaltubuleistodiluteurinebyremovingsolutes.Latesegmentofdistaltubuleisfunctionallysimilartocorticalcollectingduct.Principal(P)cellsreabsorbsodium&waterfromlumen(ByADH&secretepotassiumintolumen.Intercalated(I)cellsreabsorbpotassium&secretehydrogenintolumen.Cl-isreabsorbedintolatedistaltubule.
206.FunctionofLaciscellsinnephron?
a)H+secretion
b)Na+reabsorption
c)Reninsecretion
d)Regulationofvasoconstriction/vasodilatationofarterioles
CorrectAnswer-DAns.D.Regulationofvasoconstriction/vasodilatationofarterioles[RefPrinciplesofmedicalphysiologyp.412]Juxtaglomerular/Extraglomerularmesangialcells(Laciscells)formingconnectionviaactinandmicrotubuleswhichallowforselectivevasoconstriction/vasodilationoftherenalafferentandefferentarterioleswithmesangialcellcontraction.Note:Laciscellsalsocontainsomerenin.ButReninismainlysecretedbyjuxtaglomerularcells.
207.Plasmainulinofapersonis4mg/mlandurineflowrateis20ml/min.WhatwillbeGFRifurineinulinis50mg/ml?
a)125ml/min
b)250ml/min
c)500ml/min
d)1000ml/min
CorrectAnswer-BAns.B.250ml/min[RefGanong23rdlep.678,679]GFR–UrineinulinxUrineflowGFR=–250ml/min.
208.Trueaboutaquaporinsareallexcept?
a)Protein
b)Aquaporin-1inPCT
c)Aquaporin-2inloopofHenle
d)Aquaporin-2inCD
CorrectAnswer-CAns.C.Aquaporin-2inloopofHenle[RefGanong24thiep.683-690]AquaporinsareproteinchannelswhichhelpinrapiddiffusionofwaterProximaltublesandthindescendinglimbofloopofHenle→aquaporin-1,whichisindependentofADH.Latedistaltubuleandcollectingduct→aquaporin-2,dependentonADH.
209. MaximumfatabsorptioninGItractoccursin?
a)Duodenum
b)Jejunum
c)Ileum
d)Calcium
CorrectAnswer-BAns.B.JejunumAfterfatdigestion,fattyacidsandmonoglyceridesareabsorbedinsmallintestineespeciallyinthejejunumandsomeamountalsoinileum.Insidetheenterocyte,fattyacidsandmonoglyceridesagainformtriglycerides.Thesetriglyceridesareincorporatedintochylomicronsandtransportedtolymphaticsandfromtheretobloodvessels.
210.Iftheileumisexcised,whatwillincreaseinstool?
a)Bilesalts
b)Bileacids
c)Iron
d)Calcium
CorrectAnswer-AAns.A.BilesaltsBile(Majorconstituentbilesalts)isabsorbedinterminalileum.Ironandcalciumareabsorbedinduodenum.
211. Whichofthefollowingactsas"Gatekeeper"intheGIT?
a)Na+-aminoacidcotransporter
b)Na+K+ATPass
c)Calciumchannel
d)Ne-glucosecotransporter
CorrectAnswer-CAns.C.Calciumchannel[Refwww.ncbi.nlm.nih.gov]Epithelialcalciumchannels(ECaCs)actas'gatekeeper'fortransepithelialCa"transport.PrimetargetforhormonalcontrolofactiveCa(2+)fluxfromtheurinespaceorintestinallumentothebloodcompartment.ThisreviewcoversthedistinctivepropertiesofthesehighlyCa(2+)-selectivechannelsandhighlightstheimplicationsforourunderstandingoftheprocessoftransepithelialCa(2+)transport.
212.TrueaboutbasicrhythmofGIT?
a)Fluctuatebetween-65and-40mV
b)Initiatedbyzymogencells
c)Pacemakercellsarepresentinproximalstomach
d)Alloftheabove
CorrectAnswer-AAns.A.Fluctuatebetween-65and-40mV[RefPrinciplesofmedicalphysiologyp.915]Thesmoothmusclecellsofgastrointestinaltracthasspontaneousrhythmicfluctuationsinmembranepotentialbetweenabout-65and-45mV.Thisiscalledbasicelectricalrhythm(BER).ThisBERisinitiatedbypacemakercellscalledintersititialcellsofCajal.
213.Dailyfecalurobilinogenexcretioninhealthyadults?
a)20-40gm
b)40-280gm
c)20-40mg
d)40-280mg
CorrectAnswer-DAns.D.40-280mg[Ref:Principlesofmedicalphysiologyp.212]Thenormaldailyexcretionofurobilinogeninthefecesrangesfrom40to280mg,averaging150mg.Atotaldailyexcretionof140mgofurobilinogenwouldrepresentthecatabolismof3.99gramsofhemoglobin.
214.Maximumdailydegradationofhemoglobininnormaladults?
a)2gm
b)4gm
c)6gm
d)8gm
CorrectAnswer-DAns.D.8gmAtotaldailyexcretionof140mgofurobilinogenwouldrepresentthecatabolismof3.99gramsofhemoglobin.Normalmaximumurobilinogeninfecesis280mg,i.e.8gramsofhemoglobincatabolism.
215.cAMPactivates?
a)Proteinkinase'A'
b)Proteinkinase'C'
c)Nucleartranscription
d)Phospholipare
CorrectAnswer-AAns.A.Proteinkinase'A'Hormonesactingthroughadenylylcyclase(AC):Corticotropinreleasinghormone(CRH),FSH,LH,TSH,ACTH(corticotropin),ADH,Vasopressin(V2receptors),Parathormone,Catecholamine)e.g.,adrenaline(mostactions),Glucagon,hCG,Calcitonin,Somatostatin,acetylcholine(M2),Dopamine(1),AngiotensinII(epithelialcells),GABA-B,Histamine(H2).
216.Mechanismofactionof5-areductase?
a)BreakageofC4C5doublebond
b)BreakageofC-Nbond
c)Breakageofamidebond
d)BreakageofN-Nbond
CorrectAnswer-AAns.A.BreakageofC4C5doublebond5-alphareductasecausesreduction(breakge)ofC4-05doublebond(A4.5)withthehelpofNADHasacofactor.Itconverts(reduces)testosteronetodihdrotestosterone.
217.Glucosetransporteraffectedindiabetesmellitus?
a)GLUT-2
b)GLUT-5
c)GLUT-4
d)SGLT-2
CorrectAnswer-CAns.C.GLUT-4[RefPrinciplesofmedicalphysiologyp.790]GLUT-4isresponsibleforfacilitatingthetransportofglucoseintothecellsinresponsetoinsulin.Forthisreason,mutationinGLUT-4havebeenassociatedwithtype2diabetes.TheGLUT-4geneislocatedonshortarmofchromosome17(17p13).
218.Geneforinsulinresponsiveglucosetransporterislocatedonchromosome?
a)7
b)21
c)17
d)13
CorrectAnswer-CAns.C.17[RefPrinciplesofmedicalphysiologyp.790]GLUT-4isresponsibleforfacilitatingthetransportofglucoseintothecellsinresponsetoinsulin.Forthisreason,mutationinGLUT-4havebeenassociatedwithtype2diabetes.TheGLUT-4geneislocatedonshortarmofchromosome17(17p13).
219.TrueaboutACTHandcortisol[corticosteroid]secretion?
a)Maximumsecretionintheevening
b)ACTHhasnegativefeed-backcontrol
c)ACTHhasmajoreffectonmineralocorticoidsecretion
d)ACTHisderivedfromPOMC
CorrectAnswer-B:DAns.B&D.ACTHhasnegativefeed-backcontrol(D)ACTHisderivedfromPOMC[RefUnderstandingsofmedicalphysiologyp.539]ACTHisderivedfromprecursormoleculepro-opiomelanocortin(POMC).ACTHstimulatestheadrenalcortextoincreasethesynthesisandreleaseofglucocorticoids.Atnormalphysiologicalconcentration,theeffectofACTHonsecretionofmineralocorticoid(aldosterone)andandrogenisminimal.However,athigherconcentrationsynthesisandreleaseofthesehormonecanalsoincrease.ThesecretionofACTHissubjectedtonegativefeedback(inhibition)byglucocorticoids.ACTHsecretionshowsdiurnal(circadian)rhythmwithminimumsecretionateveningandmaximumsecretionatearlymorning.
220.Secretionofcortisolishighestat?
a)Mid-night
b)Earlymorning
c)Afternoon
d)Evening
CorrectAnswer-BAns.B.Earlymorning[RefTextbookofclinicalendocrinologyp.78]ThesecretionofACTHandconsequentlythatofcortisolfollowsacircadianrhythmduetohypothalamic(Suprachiasmaticnucleus)control.ACTHsecretionisminimumduringnightandmaximumearlyinthemorning(6-8am).
221.Allaretrueregardingintracellularreceptors,except?
a)Actbyregulatinggeneexpression
b)Fastestactingreceptors
c)Glucocorticoidreceptors
d)DNAcontainshormoneresponsiveelements
CorrectAnswer-BAns.B.Fastestactingreceptors[RefGanong24thlep.406;Harper28th/ep.4281]Thisisslowestactingtranductionmechanismbecauseproteinsynthesistakessometime.
222.HormonewhichaffectsIC*ionconcentration?
a)GH
b)Thyroxine
c)Insulin
d)Estrogen
CorrectAnswer-CAns.C.Insulin[RefGuytonIlth/ep.710]InsulinlowersserumIC'concentrationi.e.,causeshypokalemia.ThehypokalemicactionofinsulinisduetostimulationofK+intakebythecellsmainlyinmuscleandadiposetissue.InsulinincreasestheactivityofNa+-K.ATPaseincellmembrane,sothatmoreK+ispumpedintocells.
223.Tissuefactoractivates?
a)Intrinsicpathway
b)Contactpathway
c)Invitropathway
d)Invivopathway
CorrectAnswer-DAns.D.Invivopathway[RefGanong23thiep.5.31-53.5]Bloodcoagulationpathwaysaredividedinto:-Intrinsicpathway(contactpathway):Itislargelyan'invitro'pathwayandisactivatedwhenfactorXII(Hagemanfactororcontactfactor)comesincontactwithnegativelychargedsurface,e.g.glass,kaolinetc.Extrinsicpathway:Itislargelyaninvivopathwayisactivatedbytissuefactor(thromboplastin)atthesiteoftissueinjury.
224.Tissefactoractivates?
a)Preaccelerin
b)Hagemanfacter
c)Labilefacter
d)Prothrombin
CorrectAnswer-AAns.A.Preaccelerin[RefGanong23rdlep.531-535]Preaccelerin(factorVII)isactivatedtofactorVilabytissuefactor.TissuefactoristhecofactorforbothfactorVIIandVila.
225.
Maximumstorageofmagnesiumoccursinwhichpartofbody?
a)Adiposetissue
b)Skeletalmuscles
c)Blood
d)Bone
CorrectAnswer-DAns.D.Bone[RefPrinciplesofmedicalphysiologyp.114]Anadultcontainsapproximately25gramsofmagnesium.About60%ofthemagnesiumispresentinbone,ofwhich30%isexchangeableandfunctionsasareservoirtostabilizetheserumconcentration.About20%ispresentisskeletalmuscles,19%inothersofttissuesandlessthan1%inECF.
226.
Phosphate/phosphorusispresentinwhichpartofcell?
a)Cellmembrane
b)DNA
c)RNA
d)Alloftheabove
CorrectAnswer-DAns.D.Alloftheabove[RefPrinciplesofmedicalphysiology/ep.116]PhosphorusisacomponentofDNA,RNA,ATPandalsothephospholipidsthatformallcellmembranes.NearlyeverycellularprocessthatusesenergyobtainsitintheformofATP.Thus,itisanessentialelementforalllivingcellsandimportantforenergyutilizationinthebody.
227.Exercisemediatedincreaseinmuscularbloodflowismediatedbywhichsympatheticfibers
a)Adrenergic
b)Noradrenergic
c)Dopaminergic
d)Cholinergic
CorrectAnswer-DAns.D.CholinergicAnexerciseisaformofstress,andlikemoststresses,isaccompaniedbysympatheticoveractivity.Skeletalmuscleshavebothsympatheticnoradrenergicvasoconstrictorfibersandsympatheticcholinergicvasodilatorfibers.Vasoconstrictornervefibersactmainlyonveins.Venoconstrictionimprovesvenousreturnandhelpsinimprovingcardiacoutput.Ontheotherhand,sympatheticcholinergicfibers,whichareuniquetoskeletalmuscles,bringaboutarteriolardilatationandtherebyincreasemusclebloodflow.
228. Prematureejaculationoccursinwhichphaseofsexualcycle?
a)Excitementphase
b)Plateuphase
c)Orgasmicphase
d)Resolution
CorrectAnswer-CAns.C.Orgasmicphase[RefOxfordtextbookofpsychiatryp.227]Orgasmphase:PrematureejaculationoccursinthisphaseReflexivemusclecontractionoccursinpelvisItistheshortestphaseandlastsonlyafewseconds
229. Erectionofpenisoccursinwhichphaseofsexualcycle?
a)Excitementphase
b)Plateuphase
c)Orgasmicphase
d)Resolution
CorrectAnswer-AAns.A.ExcitementphaseRefOxfordtextbookofpsychiatryp.227]ExcitementphaseThereisincreasedphysiologicalexcitementsuchashighBPandheartrate.Thereiserectionofpenis(inmales)andswellingofclitoris&labiaminora(infemales).Testesswell,scrotumtightensThereisvaginallubrication
230.Shortestphaseofsexualcycle?
a)Excitementphase
b)Plateuphase
c)Orgasmicphase
d)Resolution
CorrectAnswer-CAns.C.Orgasmicphase[RefOxfordtextbookofpsychiatryp.227]Orgasmphase:PrematureejaculationoccursinthisphaseReflexivemusclecontractionoccursinpelvisItistheshortestphaseandlastsonlyafewseconds
231.InhibitionofNa*ATPaseleadsto?
a)DecreasedNa*inthecell
b)IncreasedCa'inthecell
c)IncreasedK*inthecell
d)IncreasedCl-inthecell
CorrectAnswer-BAns.B.IncreasedCa'inthecell[RefPrinciplesofmedicalphysiology3rdlep.786]3Na+/1Ca+exchanger(Sodium/Calciumexchangepump):Itmoves3Na+intothecellinexchangeoneCa+goingout
232.Hypercoagulablefactoris?
a)ProteinC
b)ProteinS
c)FactorVLeiden
d)AntithrombinIII
CorrectAnswer-CAns.C.FactorVLeiden[RefTextbookofclinicalhematologyp.786]FactorVLeidenisthemostcommoninheritedhypercoagulablestate.Occurswhenaspecificmutationinaproteinthatismoreresistanttobeturnedoff,leadingtoanincreasedriskofthrombosis.
233.Apnea-hypopneaindexisusedfor?
a)Emphysema
b)Asthma
c)Hyalinemembranedisease
d)Obstructivesleepapnea[OSAI
CorrectAnswer-DAns.D.Obstructivesleepapnea[OSAI[RefHarvarded]ApneaHypopneaIndex(AHI)TheAHIisthenumberofapneasorhypopneasrecordedduringthestudyperhourofsleep.Itisgenerallyexpressedasthenumberofeventsperhour.BasedontheAHI,theseverityofOSAisclassifiedasfollows:None/Minimal:AHI<5perhourMild:AHI5,but<15perhourModerate:AHI15,but<30perhourSevere:AHI30perhour.
234.Trueaboutheterophilicreceptors?
a)InvolvedinbindingofGHtocellmembrane
b)Bindtosameligand/hormone
c)Involvedincelladhesion
d)Allarecorrect
CorrectAnswer-CAns.C.Involvedincelladhesion[RefTextbookofclinicalpathologyp.1132]Cell-cellandcell-tissue-interactionsoccurthroughfollowingtypesofreceptors:Homophilic&heterophilicreceptors.Heterophilicreceptors:Thesereceptorsrecognizedistinctligands(calledadhesionepitopes)ofopposingcellmembranesortissue(called"lockandkeybonds"or"links").
235.Thirdorderneuronsofsensationsfromfacearisein?
a)Medulla
b)Spinalnucleusoftrigeminal
c)Thalamus
d)Brainstem
CorrectAnswer-CAns.C.ThalamusGeneralsensationsfromthefacearecarriedbytrigeminalnerve.FromVPMnucleusofthalamus,thirdorderneuronsprojecttopostcentralgyrus(primarysensorycortex).
236.Somaticefferentofwhicharisefrommedulla?
a)Oculomotor
b)Trochlear
c)Abducent
d)Hypoglossal
CorrectAnswer-DAns.D.HypoglossalGeneralsomaticefferent(motor)nucleiofHypoglossalnucleus:Itliesinmedullaandthroughhypoglossalnervesuppliesmusclesoftongue,exceptpalatoglossus.
237.Actiniswhichtypeofprotein?
a)Fibrous
b)Globular
c)Both
d)None
CorrectAnswer-CAns.C.Both[RefPrinciplesofmedicalphysiologyp.731]Therearetwotypesofactinfilaments:F-actin→FibrousproteinG-actin→Globularprotein
238.NAD+Actsasacoenzymefor?
a)Xanthineoxidase
b)L-aminoacidoxidase
c)Succinatedehydrogenase
d)Malatedehydrogenase
CorrectAnswer-DAns.'D'MalatedehydrogenaseNAD-linkeddehydrogenasesPyruvatedehydrogenase,isocitratedehydrogenase,malatedehydrogenase,a-ketoglutaratedehydrogenase,glutamatedehydrogenase,glyceraldehyde-3-Pdehydrogenase,lactatedehydrogenase,13-hydroxyacylCoAdehydrogenase,glycerol3-Pdehydrogenase(cytoplasmic).NADP*-linkeddehydrogenasesGlucose-6-Pdehydrogenase,6-Phosphogluconatedehydrogenase,3-ketoacylreductase,Enoylreductase,gulonatedehydrogenase.FAD-linkeddehydrogenasesSuccinatedehydrogenase,fattyacylCoAdehydrogenase,glycerol-3Pdehydrogenase(mitochondrial).
239.Enzymeinvolvedinthetransferofhydrogenionis
a)Hydratase
b)Oxidase
c)Peroxidase
d)Dehydrogenase
CorrectAnswer-B:DAns.is'b'i.e.,Oxidase&'d'i.e.,Dehydrogenase[RefHarper30th/ep.198;Vasudevan5th/ep.210]Enzymeinvolvedinoxidation-reactionare:?CauseremovalofhydrogenDehydrogenases:UseNADorFADasacceptorOxidases:Useoxgenasacceptor,AddoxygenOxygenases
240.Whichofthefollowingisaconstitutiveenzyme?
a)Hexokinase
b)Glucokinase
c)pgalactosidase
d)Cyclooxygenase-2
CorrectAnswer-AAns.is'a'i.e.,Hexokinase
241.Sequenceofcomplexesintheelectrontransportchainis-
a)NADHdehydrogenase→Q→Cytochromebc1→Cytochromeaa3→O,
b)NADHdehydrogenase→Q→Cytochromeaa3→Cytochromebcl→O,
c)NADHdehydrogenase→Cytochromeaa3→Q→Cytochromebcl→O,
d)NADHdehydrogenase→Cytochromebcl→Q→Cytochromeaa3→O,
CorrectAnswer-AAns.is'a'i.e.,NADHdehydrogenase→Q→Cytochromebcl→Cytochromeaa3→02Electrontransportchainismadeupof5stationarycomplexesand2mobilecomplexes
242.Regardingenergyproductionbytheelectrontransportchain,whichistrue?
a)Thecomplexesarearrangedinadecreasingorderofredoxpotential
b)Thecomplexesarearrangedinadecreasingorderofabilitytogetreduced
c)Thecomplexesarearrangedinadecreasingorderofstateofoxidation
d)Thecomplexesarearrangedinadecreasingorderofenergylevel
CorrectAnswer-DAns.is'd'i.e.,Thecomplexesarearrangedinadecreasingorderofenergylevel[RefEssentialofbiochemistryp.712]ETChelpinATPgenerationItisexplainedbyMitchell'schemiosmotictheory.Accordingtothistheory,thecomplexesarearrangedinanincreasingorderofredoxpotential.Redoxpotentialisameasureofabilitytogetreduced.Sothecomplexesarearrangedinanincreasingorderofabilitytogetreduced.Asmoreasubstanceisoxidisedhigherwillbetheabilitytogetreduced,thecomplexesarearrangedinanincreasingorderofstateofoxidation.Asstateofoxidationisinverselyproportionaltoenergylevel,thecomplexesarearrangedinadecreasingorderofenergylevel.So,whenelectronsmovefromonecomplextoanother,itmeanselectronsmovefromacomplexofhighenergytoacomplexoflowenergyandthatliberatesenergy.Thisenergyisusedforpumpinghydrogenionsfromthemitochondrialmatrixtojustoutsidetheinnermitochondrialmembrane.Afterhydrogenionsaccumulateoutside
theinnermitochondrialmembrane,hydrogenionsgothroughFOComponentofATPsynthase.
243.Electrontransportchainallaretrueexcept
a)Complexesarearrangedinanincreasingorderofredoxpotential;
b)MitochondrialGlycerolphosphatedehydrogenasesendsitselectrondirectlytoQ
c)l0HydrogenionsaretranslocatedwhenNADHentersintoanelectrontransportchain
d)7HydrogenionsaretranslocatedwhenFADH2electronsgetintoelectrontransportchain.
CorrectAnswer-DAns.is'd'i.e.,7HydrogenionsaretranslocatedwhenFADH2electronsgetintoelectrontransportchainNADHelectronsgetintoelectrontransportchainthroughcomplexI.EnergydifferencebetweenNADHandQisinsuchawaythatwhenelectronsmovefromcomplexItoQ,4hydrogenionsgettranslocated.Similarly4ionsgettranslocatedwhenelectronsmovefromQtocomplexIIIand21-1'ionsgettranslocatedwhenelectronsmovefromcomplexIIItoIV.Sototally101-1+ionsgettranslocatedwhenelectronsfromNADHgetintoelectrontransportchain.ComplexVorATPsynthasecomplexworksinsuchawaythatwhen10H*ionsgothroughF0component,1ATPisgenerated.Sowhen10Hydrogenionsaretranslocated,2.5ATPscanbegenerated.FADH,electronsgetintoelectrontransportchainthrougheithercomplexIIortheydirectlygetintoQ,ineithercase,noenergyisliberated.Nohydrogenionsaretranslocated.Whenelectronsmove
fromQtoComplexIII,4hydrogenionsandwhenelectronsmovefromIIItoIV2hydrogenionsaretranslocated.Sototally6hydrogenionsaretranslocatedwhenFADH2getsintoelectrontransportchain.ATPsynthasecomplexgenerates1ATPforevery4hydrogenionstranslocatedthroughF,component.Sofor6hydrogenions,itis1.5ATP
244.Atractilosideactas?
a)Uncoupler
b)Inhibitorofoxidativephosphorylation
c)InhibitorofcomplexIofETC
d)InhibitorofcomplexIIIofETC
CorrectAnswer-BAns.is'b'i.e.,InhibitorofoxidativephosphorylationInhibitorsofelectrontransportchain?Inhibitorsofrespiratorychainmaybedividedintothreegroups:?1.InhibitorsofelectrontransportchainproperTheseinhibitorsinhibittheflowofelectronsthroughtherespiratorychain.Thisoccursatfollowingsites.ComplexI(NADHtoCoQ)isinhibitedby:-Barbiturates(amobarbital),PiericidinA(anantibiotic),rotenone(aninsectiside),chlorpromazine(atranquilizer),andguanethidine(anntihypertensive).TheseinhibitorsblockthetransferofreducingequivalentsfromFeSproteintoCoQ.ComplexIIisinhibitedby:-CarboxinandTTFAinhibittransferofelectonfromFADH2toCoQ,whereasmalanatecompetitivelyinhibitfromsuccinatetocomplexII.ComplexIII(CytochromebtocytochromeCI)isinhibitedby:-Dimercaprol,antimycinA,BAL(Britishantilewisite),Naphthyloquinone.TheseinhibitorsblockthetransferofelectronsfromcytochromebtocytochromeComplexIV(cytochromeCoxidase)isinhibitedby:-Carbonmonoxide,CN-,H2Sandazide(N3-).Theseinhibitorsblockthetransferofelectronsfromcytochromeaa3tomolecularoxygenandthereforecantotallyarrestcellularrespiration.2.Inhibitorsofoxidativephosphorylation
ThesecompoundsdirectlyinhibitphosphorylationofADPtoATP.OligomycininhibitsFocomponentofF0F,ATPase.Atractilosideinhibitstranslocase,atransportproteinthattransportsADPintomitochondriaforphosphorylationintoATP.3.UncouplesAsthenamesuggests,thesecompondsblockthecoupelingofoxidationwithphosphorylation.ThesecompoundsallowthetransferofreducingequivalentsinrespiratorychainbutpreventthephosphorylationofADPtoATPbyuncouplingthelinkagebetweenETCandphosphorylation.Thustheenergyinsteadofbeingtrappedbyphosphorylationisdissipatedasheat.Uncouplersmaybe:-
1. Natural:-Thermogenin,thyroxine2. Synthetic:-2,4-dinitrophenol(2,4-DNP),2,4-dinitrocresol(2,4-
DNC),andCCCP(chlorocarbonylcyanidephenylhydrazone).
245.Whichofthefollowingistherespiratorycentreofcell?
a)Mitochondria
b)Microsome
c)Lysosome
d)Nucleus
CorrectAnswer-AAns.is'a'i.e.,MitochondriaAsmitochondriaharbourstheelectrontransportchain.Inelectrontransportchain,theelectronsfromNADHandFADH2aretransferredthroughthevariouscomplexestofinallyOxygen.Oxygenisthenconvertedtowater.ThiswayallfuelsgetoxidisedtoCarbondioxide.Inotherwordsinmiotochondria,OxygenisutilisedandCarbondioxidegenerationissupported.Henceitiscalledastherespiratorycentreofthecell.
246.Celluloseisbiochemically-
a)β(1,4)Lglucose
b)?,(14)Dglucose
c)β(1,4)Dglucose
d)?(1,4)Lglucose
CorrectAnswer-AAns.is'a'i.e.,β(1,4)LglucoseCelluloseisacomponentofcellwall.Celluloseisastructuralhomopolysaccharidemadeupofglucosemoleculeslinkedby13(1,4)linkages.Humanscannotdigestcellulosebecausehumandigestiveenzymescannotbreak43(1,4)linkagespresentinoligosaccharidesandpolysaccharides.Thisiswhyvegetariandietisconsideredtoprovidefibretothediet.
247.DandLisomerismis-
a)Opticalisomerism
b)Functionalisomerism
c)Epimerism
d)Enantiomerism
CorrectAnswer-DAns.isd.i.e.,EnantiomerismEnantiomerismisatypeofstereoisomerisminwhichtwomoleculeshavethesamemolecularformulaandthesamestructuralformulabuttheydifferinspatialorientationwithrespecttoallthecarbonatomsandtheyarenamedbasedontheorientationinthepenultimatecarbonatom.Inthepenultimatecarbonatom,ifOHisontherightside,itisDform,ifOHisontheleftside,itisLform.TheothernameforenantiomerismisRacemism.
248.Whichamongthefollowingglucosetransporterpresentinbetacells?
a)GLUT1
b)GLUT2
c)GLUT3
d)GLUT4
CorrectAnswer-BGLUT2istheglucosetransporterpresentinthebetacellsandlivercells.IthasahighKmforglucose.Henceentryofglucoseisdirectlyproportionaltotheglucoselevel.Itisaninsul;inindependenttransport.GLUT3ispresentinbrainandGLUT4meditesinsulindependenttransportofglucoseintomuscleandadiposetissue.Ref:MurrayR.K.,GrannerD.K.(2011).Chapter40.Membranes:Structure&Function.InD.A.Bender,K.M.Botham,P.A.Weil,P.J.Kennelly,R.K.Murray,V.W.Rodwell(Eds),Harper'sIllustratedBiochemistry,29e.
249.Allofthefollowingareconvertedtocr-ketoglutarateoncatabolismexcept-
a)Glutamate
b)Histidine
c)Proline
d)Glycine
CorrectAnswer-DAns.is'd'i.e.,Glycine[RefHarper30th/ep.162,250/ep.166,167]
250.Glucogenicaminoacidsgiverisetoallofthefollowingintermediatesofcitricacidcycleexcept-
a)Isocitrate
b)cketoglutarate
c)SuccinylCoA
d)Fumarates
CorrectAnswer-AAns.is'a'i.e.,Isocitrate
251.WhatistheprecursorofprolineinKrebscycle?
a)Oxaloacetate
b)cketoglutarate
c)SuccinylCoA
d)Fumarates
CorrectAnswer-BAns.is'b'i.e.,cketoglutarate[RefEssentialsofBiochemistryp.232;Harper29`'/ep.ProlineisanalphaaminoacidwithapyrrolidineringItisanonpolariminoacidwithNHasoneofitsfunctionalgroupsItdisruptsahelixItisanonessentialaminoacidandissynthesizedfromanon-essentialaminoacidglutamateGlutamateinthepresenceofyglutamatekinasegetsconvertedtoglutamate5phosphate,whichinthepresenceofyglutamatedehydrogenasegetsconvertedtoyglutamatesemialdehyde.yglutamatesemialdehydespontaneouslycyclisestoformypyrrolinecarboxylatewhichinthepresenceofreductaseformsproline
252.usedincitricacidcycleareallexcept-
a)NAD
b)FAD
c)NADP
d)GDP
CorrectAnswer-CAns.C.NADPEnzyme ReducingequivalentATPIsocitratedehydrogenase 1NADH 2.5alphaketoglutaratedehydrogenase1NADH 2.5SuccinylCoA ATP/GTP 1Succinatedehydrogenase FADH2 1.5Malatedehydrogenase NADH 2.5 total 10
253.Allofthefollowingstepsactassourcesofenergyincitricacidcycleexcept-
a)Citratesynthase
b)Isocitratedehydrogenase
c)SuccinylThiokinase
d)SuccinateDehydrogenase
CorrectAnswer-AAns.is'a'i.e.,Citratesynthase
254.Trueaboutglucokinaseis-
a)Itispresentinallcells
b)Itisaconstitutiveenzyme
c)Ithasahighkm
d)Itisinhibitedbyglucose6phosphate
CorrectAnswer-CAns.is'c'i.e.,IthasahighkmS.No. Property Hexokinase Glucokinase
1 Location Allcells LiverandPancreatic(3cells
2 Affinity High Low3 Km Low High
4 Inhibitionbyglucose6phosphate Yes No
5 InductionbyInsulin No(Constitutiveenzyme)
Yes(InducibleEnzyme)
255.Allofthefollowingaretrueaboutlactateutilisationinliverexcept-
a)TotalnetnumberofATPformedbecauseofcori'scycleis6
b)Cori'scycleshiftsthemetabolicburdenfrommuscletoliver
c)Cori'scyclecannotbesustainedindefinitelybecauseitisenergeticallyunfavourable
d)Cori'scycleislinkedtoglycogensynthesisinmuscle
CorrectAnswer-AAns.is'a'i.e.,TotalnetnumberofATPformedbecauseofcoil'scycleis6CORI'SCYCLEMuscleusesamoleculeofglucosethroughanaerobicglycolysisandgets2ATPs.Inthisprocess,glucosebecomestwomoleculesoflactate.The2lactatemoleculesthroughcirculationreachliver.Inliver,thetwomoleculesoflactateareutilisedthroughgluconeogenesistoformaglucosemoleculeattheexpenseof6ATPs.Theglucoseformedinliverreachesmuscleandisutilisedforagainanaerobicglycolysisifthemuscleisstillexercising.Incasemuscleisdonewithexercising,theglucosewhichreachesthemusclefromliverisusedforglycogensynthesis.
256.Whichofthefollowingistrueabouteffectofinsulinandglucagonongluconeogenesis?
a)Insulinfavourstheformationoffructose2,6bisphosphate
b)Fructose2,6bisphosphateisaninhibitorofglycolysis
c)Insulinactsthroughakinase
d)GlucagonstimulatesPFK.2activityofthetandemenzyme
CorrectAnswer-AAns.is'a'i.e.,Insulinfavourstheformationoffructose2,6bisphosphateGlycolysisandgluconeogenesisarereversalofeachother.Hencethetwopathwaysshouldberegulatedinsuchawaythatwhenonepathwayisactive,theotheronehastobeinactive.Otherwisetheywillendupinfutilecycles.
257.Keyenzymeofgluconeogenesisareallexcept?
a)Pyruvatecarboxylase
b)PEPcarboxykinase
c)Pyruvatekinase
d)Glucose-6-phosphatase
CorrectAnswer-CAns.is'c'i.e.,PyruvatekinaseMitochondrialpyruvatecarboxylasecatalyzesthecarboxylationofPyruvatetoOxaloacetate,ItisanATP-requiringreaction,Biotinisthecoenzyme.PhosphoenolpyruvateCarboxykinase:Catalyzesthedecarboxylationandphosphorylationofoxaloacetatetophosphoenolpyruvate(PEPCK)(Cytosol)usingGTPasthephosphatedonor.Theconversionofglucose-6-phosphatetoglucoseiscatalyzedbyglucose6-phosphatase
258.Inglycogensynthesistheactiveformofglucoseusedis-
a)Glucose6phosphate
b)GlucoseIphosphate
c)UDPglucose
d)UTPglucose
CorrectAnswer-CAns.is'c'i.e.,UDPglucoseGlycogensynthesisoccursinliverandSkeletalMuscleUDPglucoseistheactiveformofglucosewhichgetsaddedtothegrowingglycogenThenumberofhighenergyphosphatesrequiredforattachingaglucosemoleculetogrowingglycogenis3TheratelimitingenzymeofglycogensynthesisisglycogensynthaseGlycogensynthasegetsactivatedbydephosphorylationGlycogensynthaseattachesglucoseresiduesonebyonealongastraightchain,linkedbya(1,4)linkages.Thiscontinuesuntil11to13residuesareattachedinastraightchain.Atbranchpointsinglycogen,a(1,6)linkagesshouldbeformed.
259.UDPglucoseisnotusedin?
a)Uronicacidpathway
b)Glycogensynthesis
c)Galactosemetabolism
d)HMPshunt
CorrectAnswer-DAns.is'd'i.e.,HMPshuntUDP-glucoseisderivedfromglucose-6-phosphateviaglucose-l-phosphate.ThemajorfateofUDP-glucoseisthesynthesisofglycogen.OtherusesofUDP-glucoseare-1.Inuronicacid(glucoronicacid)cycletogenerateUDPglucuronate.2.Galactosemetabolism3.Glycosylationofproteins,lipidsandproteoglycans.
260.Neonatalhypoglycaemiawhichdoesnotrespondtocounterregulatoryhormoneadministrationisdiagnosticof-
a)Her'sdisease
b)Cori'sdisease
c)Anderson'sdisease
d)VonGierke'sdisease
CorrectAnswer-DAns.is'd'i.e.,VonGierke'sdiseaseGlycogenstoragedisorderspresentingwithhypoglycaemiaareTypeI(VonGierke'sdisease),TypeIII(Cori'sdiseaseorForbe'sdisease),TypeVI(Her'sdisease),TypeIX(FanconiBickelsyndrome)TheonlyGlycogenstoragedisorderwhichpresentsashypoglycaemianotrespondingtocounterregulatoryhormoneadministrationisVonGierke'sdiseaseMuscleinvolvementisnotafeatureofTypeI(VonGierke'sdisease),TypeIV(Andersoendisease),TypeVI(Her'sdisease),TypeIX(FanconiBickelsyndrome)AndersendiseaseorTypeIVistheonlyglycogenstoragediseasewhichpresentswithneitherhypoglycaemianorwithmuscleinvolvement.Itpresentsashepatomegalyandcirrhosis
261.Whichofthefollowingisaserineprotease
a)Chymotrypsin
b)Pepsin
c)Carboxypeptidase
d)Caspases
CorrectAnswer-AAns.is'a'i.e.,ChymotrypsinlRef:Chatterjee7h/ep.4j5-361*ThetermProteaseisusedtorepresentthegroupofenzymesthatcatalyzethecleavageofpeptidebondsinproteinsandpeptidemoleculeswiththeparticipationofwaterasco-reactant.Insimplewords,proteasescatalyzethecleavageofpeptidebondsbyhydrolysis(additionofwaterSerineproteases:-*Thesepossesacriticalserineresidueattheactivesite.-Exampleofserineproteasesaretrypsin,chymotrypsin,elastase,andthrombin.*Serineproteasesareinhibitedbydisopropylphosphofluridatewhichbindscovalentlytoserineresidue.-Theactivesiteofserineproteasescontainthreecriticalaminoacidsserine,histidineandaspartate.Theseresiduesareoftenreferredtoascatalytictriad
262.Essentialfattyacidsareexcept:
a)Arachidonicacid
b)Linoleicacid
c)Palmiticacid
d)Linolenicacid
CorrectAnswer-ATheessentialfattyacidsarepolyunsaturatedfattyacids,linoleicacid(18:26)andlinolenicacid(18:33).
Arachidonicacid(20:46)isderivedfromdietarylinoleicacidandispresentprimarilyinmembranephospholipids.
Importantderivativesoflinolenicacidareeicosapentaenoicacid(20:63)anddocosahexaenoicacid(DHA,22:63)foundinhumanmilkandbrainlipids.Palmiticacidisacommonsaturatedfattyacid.Arachidonicacid(20C:ro6)isnotnutritionallyessentialbecausechainelongasesystemcanconvertlinoleicacid(l8C:<o6)intoArachidonicacid(20C:o6).Soarachidonicacidisconsideredasconditionallyessential,becauseithastobesuppliedinthedietiflinoleicacidisnotsupplemented.Ref:BothamK.M.,MayesP.A.(2011).Chapter23.BiosynthesisofFattyAcids&Eicosanoids.InD.A.Bender,K.M.Botham,P.A.Weil,P.J.Kennelly,R.K.Murray,V.W.Rodwell(Eds),Harper'sIllustratedBiochemistry,29e.
263.Whichofthefollowingisatransfattyacid?
a)Oleicacid
b)Elaidicacid
c)Stearicacid
d)Arachidonicacid
CorrectAnswer-BAns.is'b'i.e.,Elaidicacid[RefHarper30"/ep.213]Therearetwotypesoffattyacids:SaturatedUnsaturatedCis-transisomerismisforunsaturatedfattyacids.Stearicacidisasaturatedfattyacid(Nocis-transisomerism)Onlyimportantunsaturatedtrans-fattyacidisElaidicacid(trans-9-octadecenoic)
264.ActivatorsofAcetylCoAcarboxylaseareallexcept
a)AcylcoA
b)Citrate
c)Glutamate
d)Dicarboxylicacid
CorrectAnswer-AAns.is'a'i.e.,AcylCoA[RefHarper29thlep.217,220]AllostericmodulationofacetylCoAcarboxylase
1. Activaters:Citrate(tricarboxylicacid);glutamate(dicarboxylicaminoacid)&otherdicarboxylicacids;ATP
2. Inhibitors:AcylCoA
265.Arachidonicacidoxidationinvolveshowmanycyclesofbetaoxidation?
a)l0
b)20
c)9
d)8
CorrectAnswer-CAns.is'c'i.e.,9NumberofacetylCoAformedin(3-oxidationoffattyacids=Numberofcarbonatoms/2.Numberofcyclesof(beta-oxidationrequired-Noofcarbon/2(-1)Hencearachidonicacidwith20carbonatomsundergoespoxidationtoform10acetylCoAbygoingthrough(20/2)-1cyclesi.e.,9cycles.
266.Allaretrueaboutbetaoxidationoffattyacidsexcept-
a)CarnitineacyltransferaseIistheratelimitingenzymeoffattyacidoxidation
b)CarnitineacyltransferaseIisstimulatedbyAcylCoA
c)CarnitineAcyltransferaseIisstimulatedbymalonylCoA
d)CarnitineAcyltransferaseIdefectcausesadecreaseinacylcarnitinelevels
CorrectAnswer-CAns.is'c'i.e.,CarnitineAcyltransferaseIisstimulatedbymalonylCoAAsCATIistheratelimitingenzymeoffattyacidoxidation,itssubstrateisacylCoA.Asweknowthatallenzymesgetstimulatedbytheirsubstrates,acylCoAstimulatesCATI.MalonylCoAisaproductofacetylCoAcarboxylase(ACC).ACCistheratelimitingenzymeoffattyacidsynthesis,ananabolicpathway.So,malonylCoAisanintermediateofanabolicpathway.Henceitisasignalofhighenergy(Anabolismhappensonlyinhighenergystatus).Whentheenergyisalreadyhigh,wedonotwantfattyacidstobefurtheroxidised.Wewantfattyacidstobeonlystored.So,malonylCoA,asignalofhighenergyinhibitsCATI.Inshort,anythingwhichsignalslowenergystimulatesfattyacidoxidation(CATI).So,ADP,NAD,FAD,Glucagon,AcylCoAstimulatefattyacidoxidationAnythingwhichsignalhighenergyinhibitfattyacidoxidation.So,ATP,NADH,FADH2,InsulinandmalonylCoAinhibitfattyacidoxidation.Fattyacidoxidationdefectspresentasnonketotichypoglycaemia,
hyperammonemia,dicarboxylicaciduria.Andallfattyacidoxidationdefectsalsopresentwithincreaseinacylcarnitinelevels.OneexceptionisCATIdefect.InCATIdefect,asacylCoAisnotconvertedtoacylCarnitine,freecarnitinelevelsarehighandacylcarnitinelevelsarelow.
267.AIIaretrueaboutbetaoxidationoffatsacidsexcept-
a)Occursinmitochondria
b)Occursinperoxisome
c)Resultsinhydrogenperoxidegeneration
d)Fattyacidoxidationdefectspresentwithketosis
CorrectAnswer-DAns.is'd'i.e.,FattyacidoxidationdefectspresentwithketosisFattyacidoxidationdefectcausesnon-ketotichypoglycemia.Fattyacidoxidationhappensinmitochondriaandinperoxisomes.Thedifferencebetweenmitochondrialoxidationandperoxisomaloxidationisthatinmitochondria,whenthe13carbonatomisoxidised,thehydrogenatomsareremoved.ThosehydrogenatomsareusedforreducingNADandFADtoformNADHandFADH2.NADHandFADH2enterintoelectrontransportchaintoformATP.Inperoxisome,thehydrogenatomremovedfrom(3carbonatomisusedtoreduce02formingF1202.Onlybecause11202isformedinperoxisomeby(betaoxidationtheorganismiscalledso)
268.WhichofthefollowingistrueaboutBetaoxidationoffattyacids?
a)Stearicacidonoxidationprovides106ATPs
b)OddchainfattyacidoxidationprovidesonlypropionylcoA
c)Fattyacidoxidationdefectscausehypoglycemia
d)Ketonebodiesareformedbyincompleteoxidationoffattyacidduringstarvationtoincreaseenergyproduction
CorrectAnswer-CAns.is'c'i.e.,FattyacidoxidationdefectscausehypoglycaemiaDefectinfattyacidoxidationcauseshypoglycemia.AboutotheroptionsStearicacidoxidationproduces122ATPs.Evenchainfattyacidsare(3-oxidizedtoacetylCoA.Oddchainfattyacidsarealso(3-oxidizednormallybutthelaststepproducesa3-carbonpropionylCoAalongwithanacetylCoA(insteadof2moleculesacetylCoAthatoccursinevenchainfattyacids).Ketonebodyformation(ketogenesis)occurswhenthereisahighrateoffattyacidoxidationinliverwhichprovidesexcessiveacetylCoA,substrateforketogenesis.Whenketonebodiesareformed,aswecan'texpectthe10ATPswhichwegetfromeveryacetylCoAthroughcitricacidcycle,theformulaforenergeticsofincompleteoxidationoffattyacidsis:
269.WhichofthefollowingistrueaboutpropertiesofVLDL/LDL-
a)Inelectrophoresis,VLDLmigratesmorecathodalthanLDL
b)LDLisformedfromliver
c)LDLisformedfromChylomicron
d)VLDLremnantsreachextrahepatictissues
CorrectAnswer-BAns.is'b'i.e.,LDLisformedfromliverLipoproteinelectrophoresisofafastingsampleshowsthreebands-HDL,VLDL,LDLinthatorderfromanodetocathode.VLDLissynthesizedinliverthatcontainshightriglyceride,ChE,cholesterol,phospholipidandApoB-100.(VLDLparticlesresemblechylomicronesincompositionexceptthatVLDLcontainsApoB-100insteadofApoB-48).VLDLparticlesaresecretedintheplasmaandaswithchylomicron,ApoEandApoCaretransferredfromHDLtoVLDL.NowVLDLcontainsApoB-100,ApoEandApoC.Inplasma,triglyceridesofVLDLarehydrolysedbysamelipoproteinlipase(seeabove)andapoCistransferredtoHDLandtheremmantsarecalledIDL.40-60%ofIDLisremovedbyliverviaLDLreceptormediatedendocytosis,thisprocessrequireApoEwhichactsasligandforLDLreceptors.RemainingIDLisremodeledbyhepatic(liver)lipasewhichhydrolyzesmoretriglyceridetoformLDLthatcontainsmaximumcholesterol.70%ofLDLisremovedbyliverviaLDLreceptorand30%isutilizedbyperipheraltissuesasasourceofcholesterol.
270.Reversecholesteroltransport-allaretrueexcept-
a)Transportofcholesterolfromextrahepatictissuestoliver
b)ATPBindingCassetteTransporterproteinisinvolvedintheconversionofHDL3toHDL2
c)LecithinCholesterolAcylTransferasehelpsintheconversionofSpheroidalHDLtoDiscoidalHDL
d)CholesterolEsterTransferProteinhelpsinincreasingHDLlevel
CorrectAnswer-DAns.is'd'i.e.,CholesterolEsterTransferProteinhelpsinincreasingHDLlevelReverseCholesterolTransportisthetransportofCholesterolesterandphospholipidfromextrahepatictissuestoliver.HDLisreleasedbybothliverandintestinalcells.Inboththecases,theyarereleasedasdiscoidalHDLApoAlactivatesLecithinCholesterolAcylTransferaseanditconvertsdiscoidalHDLtoSpheroidalHDL(HDL3)HDL3activatesABC1(ATPBindingCasetteTransporter1)tocollectcholesterolandphospholipidsfromextrahepatictissuemembranes.ThiswayHDL3sizeincreasesanddensitydecreases.HenceitformsHDL2.ThisHDL2reacheslivertoemptyitscontentsintoliver.Onthewaytoliver,ifHDL2encountersIDL,CholesterolEsterTransferProtein(CETP)transfersChoelsterolesterfromHDL2toIDL,convertingIDLtoLDL.HenceCETPdecreasesHDLlevelandincreasesLDLlevel.
271.Progesteronesynthesisrequires-
a)LDL
b)VLDL
c)HDL
d)Chylomicron
CorrectAnswer-CAns.is'c'i.e.,HDLGranulosacellsusefollicularfluidHDLasasourceofcholesterolforthesynthesisofprogesterone.UndertheinfluenceofLH,corpuslutealcellstakeupcholesterolfromfollicularfluidHDLandconvertcholesterolintoprogesterone.
272.Siteofsmallchainfattyacidabsorptionis-
a)Ileum
b)Duodenum
c)Ascendingcolon
d)Rectum
CorrectAnswer-CAns.is'c'i.e.,AscendingcolonShortchainfattyacids(SCFA)arefattyacidswith2to6carbonatoms.Theyarethemajorend-productsofthemicrobialdigestionofcarbohydratesinthealimentarycanal.Theseshortchainfattyacids,butyrateparticularlyisimportantforcolonhealthbecauseitistheprimaryenergysourceforcoloniccellsandhasanti-carcinogenicaswellasanti-inflammatorypropertiesthatareimportantforkeepingcoloncellshealthy.Butyrateinhibitsthegrowthandproliferationoftumorcelllinesinvitro,inducesdifferentiationoftumorcells,producingaphenotypesimilartothatofthenormalmaturecell,andinducesapoptosisorprogrammedcelldeathofhumancolorectalcancercellsThehighestconcentrationsareobservedinthelargeintestine(caecumandcolon)ofallthemammals.Humancaecumandproximalcolonhavehighluminalconcentrationsoforganicnutrients(non-starchpolysaccharidesfromplantcellwalls,andproteinsnotabsorbedbythesmallintestine)whichmaintainhighbacterialgrowthrates.Againstthisfermentativebackground,antiperistalsisensuresretentionandthoroughmixingoffaecesintheproximalcolon,whichisthesiteofmaximalSCFAproduction.SCFAabsorptionisconcentrationdependentandoccurs
mostreadilyintheproximalcolon(Includescecum,ascendingcolonandtransversecolon).
273.HMGCoAisprecursorofallexcept-
a)Ubiquinone
b)Dolichol
c)Bilepigments
d)Ketonebody
CorrectAnswer-CAns.is'c'i.e.,Bilepigments3-Hydroxy3methylglutarylCoAorHMGCoAisformedfromacetylCoA.
274.Refsum'sdiseaseisduetodeficiencyofwhichofthefollowingenzyme?
a)Malonatedehydrogease
b)Thiophorase
c)Succinatethiokinase
d)Phytanicalphaoxidase
CorrectAnswer-DDi.e.PhytanicalphaoxidaseRefsum'sdiseaseisarareautosomalrecessivedisordercausedbydeficiencyofphytanicaoxides(Nelson)/a?hydroxylase(Lippincot)/PhytanoylCoAhydroxylase(Lehninger)resultsinaccumulationofphytanicacidduetoitsdecreaseda-oxidation(i.e.hydroxnlationatacarbonbyfattyacidahydroxylase)
275.Whatistheparameterthatisusedtoassesslipidperoxidation?
a)Malondialdehyde
b)CRP
c)hsCRP
d)Carboxymethyllysine
CorrectAnswer-AAns.is'a'i.e.,MalondialdehydeROScanbeproducedbyeitherbreakageofcovalentbond,additionofelectronstoamoleculeorremovalofhydrogenbyotherradicals.Theyaregenerallyhighlyreactivespeciesandtypicallyactaselectrophilicspeciesoroxidantagents.Themostimportantradicalsorpro-oxidantmoleculesinvolvedindiseaseprocessesaresuperoxide(02-),hydroxylradical(OH),hydrogenperoxide(H202)andcertainoxidesofnitrogen,likenitricoxide(NO)andperoxynitrite(ONOO-)2Sinceitiscomplexmeasuringfreeradicalsdirectlyinvivo,itisnecessarytocarryoutthequantificationofcellularcomponentswhichcanreactwiththesefreeradicals,suchasproteins,DNAandmainlylipids.Oncelipidperoxidesareunstablecompounds,theytendtodegraderapidlyinavarietyofsubproducts.MDA(Malondialdehyde)isoneofthemostknownsecondaryproductsoflipidperoxidation,anditcanbeusedasamarkerofcellmembraneinjury.MDAisathree-carbon,low-molecularweightaldehydeformedbycyclizationofaldehydeswhichhaveunsaturationinaor13positionsSeveralmethodshavebeendevelopedtoassessMDA,including
quantitativemethodsusingspectrophotometryorfluorimetricdetection,highperformanceliquidchromatography(HPLC),gaschromatographyandimmunologicaltechniquesOthermarkersofoxidativestressincludeconjugateddienes,ethaneandpentanegases,isoprostanesand4-HNE(4-hydroxy2-nonenal)
276.Allaretrueaboutketonebodiesexcept?
a)Acetoacetateisprimaryketonebody
b)Synthesizedinmitochondria
c)Synthesizedinliver
d)HMGCoAreductaseistherate-limitingenzyme
CorrectAnswer-DAns.is'd'i.e.,HMGCoAreductaseistherate-limitingenzyme
277.AllarefeaturesofAbetalipoproteinemia,EXCEPT:
a)Plasmalevelsofcholesterolandtriglycerideareextremelylow
b)Manifestinearlychildhoodwithdiarrhea
c)Progressivepigmentedretinopathyseen
d)Neurologicalmanifestationasataxiainfirstdecade
CorrectAnswer-DPlasmalevelsofcholesterolandtriglycerideareextremelylowinthisdisorder,andchylomicrons.Abetalipoproteinemiausuallypresentsinearlychildhoodwithdiarrheaandfailuretothrive.
Theneurologicalmanifestationslikedecreaseddistallowerextremityvibratoryandproprioceptivesense,dysmetria,ataxia,andthedevelopmentofaspasticgait,oftenbythethirdorfourthdecade.
Patientsalsodevelopaprogressivepigmentedretinopathypresentingwithdecreasednightandcolorvision.
Ref:HarrisonsPrinciplesofInternalMedicine,18thEdition,Page3153
278.Aminoacidinsynthesisofneurotransmitter
a)Glutamate
b)Proline
c)Cysteine
d)Alanine
CorrectAnswer-AAns.is'a'i.e.,GlutamateAminoacid NeurotransmitterGlutamate Glutamate&GABAGlycine GlycinePhenylalanine&TyrosineDopamine,Norepinephrine&EpinephrineTryptophan Serotonin
279.MaximumbufferingcapacityofabufferismaximumatpH
a)Lessthanpka
b)Morethanpka
c)Equaltopka
d)Hasnorelationwithpka
CorrectAnswer-CAns.is'c'i.e.,Equaltopka[RefHarper30th/ep.21&29'11ep.20,21,18;Vasudevan6thiep.22,23]MaximalbufferingcapacityoccursatpHequaltopkaofbuffer.Therefore,toworkasabestbufferatphysiologicalpHaminoacidshouldhavepkavalueclosetophysiologicalpH(7.4).Aminoacidscanhavebufferingactionduetothreeionizablegroups:-a-carboxylgroup:-Differentaminoacidshavepkavalueofa-carboxylgroupbetween3.5-4.So,carboxylgroupofaminoacidshasmaximumbufferingcapacitybetweenpH3.5-4.a-aminogroup:-Differentaminoacidshavepkavalueofa-aminogroupbetween8.0-9.0.Thus,a-aminogrouphasmaximumbufferingcapacitybetweenpH8.0-9.0.Specialionizablegroup(insomeaminoacids):-Amongspecialionizablegroupofaminoacids,imidazolegroupofhistidinehaspkavalue6.5-7.4,whichisclosesttophysiologicalpH.Hence,histidine(duetoimidazolegroup)hasmaximumbufferingcapacityatphysiologialpH.
280.Essentialamino-aciddeficiencyaffectnitrogenbalanceby
a)Increasingproteindegradation
b)Decreasingproteindegradation
c)Decreasingproteinsynthesis
d)Increasingproteinsynthesis
CorrectAnswer-CAns.is'c'i.e.,Decreasingproteinsynthesis[RefPrinciplesofmedicalBiochemistryp.464]Nitrogenbalanceisthedifferencebetweeningestednitrogenandexcretednitrogen.Nitrogenbalance=Ningested-NexcretedBecausedietaryproteinsareanimportantsourceofnitrogen,nitrogenbalanceisanimportantindexofproteinandaminoacidmetabolism.Inhealthyadults,nitrogenbalanceiszero,i.e.astateofnitrogenequlibriumexists,wherenitrogenintakeisequaltonitrogenexcretion.Negativenitrogenbalance(excretionexceedsintake)indietaryproteindeficiencyInadult,evenofproteinstarved,atleast30-40gmofaminoacidsaredegradedeachday;thisamountdefinestheminimumdietaryrequirment.Ifdietarysupplydropsbelowthislimit,anegativenitrogenbalanceoccursandthebodyproteinislost.Essentialaminoaciddeficiencyhasthesameeffectbecauserelativedeficiency.
281.Creatinineisformedfrom:
a)Arginine
b)Lysine
c)Leucine
d)Histamine
CorrectAnswer-AGlycine,arginineandmethionineallparticipateincreatinebiosynthesis
282.Acidicaminoacidsare-
a)Asparagine
b)Arginine
c)None
d)Lysine
CorrectAnswer-AProlineisauniqueaminoacidandhasanimminogroup(=NH)insteadofanamino(NH2)groupfoundinotheraminoacid.Methionine&Cysteinearesulfurcontainingaminoacids.Thepropertyofphotochromicity(i.e.absorbanceofultravioletlightat250-290nmesp280nm)isseenwitharomaticaminoacid(tryptophan>tyrosine>phenylalanine).Hydrophobic(nonpolar)aminoacidshavenochargeontheirRgrouporsidechain.Aliphatic(egmethyl,methylene,thioether&imino)sidechainsandaromaticsidechainsarenonpolar.Somethyl(CH3)sidechainofalanine;propyl(C3H7)sidechainofvaline;butyl(C4H9)sidechainofleuicine&isoleucine;thioethersidechainofmethionine;andiminogroup/pyrrolidinecontainingsidechainofprolinearenonpolar.Methyl(CH3)sidechainofalanineisnonpolar.Serine,threonine,tyrosinecontaininghydroxylgroupandcysteinecontainingsulfhydrylgroup,arepolaraminoacidswithneutral/uncharged/nonionicsidechain.Positivelychargedbasicamino(NH3+)groupsidechainofhistidine,arginineandlysine;andnegativelyacidiccarboxyl(COO-)sidechainofasparticacidandglutamicacidispolar.
283.Functionoftyrosinaseis
a)Synthesisofnorepinephrine
b)Synthesisofdopamine
c)Synthesisofmelanin
d)Alloftheabove
CorrectAnswer-CAns.is'c'i.e.,Synthesisofmelanin[RefHarper29th/ep.288-290]Note-TyrosinehydroxylaseandtyrosinasecatalyzestheconversionoftyrosinetoDopa,butbotharedefferentenzymes.Tyrosinehydroxylaseisinvolvedincatecholaminessynthesisinadrenalmedullaandsympatheticganglia,whereastyrosinaseisinvolvedinmelaninsynthesisinmelanoblastsofskin.
284.Cofactorfordopaminehydroxylase?
a)Fe
b)Mg
c)Mn
d)Cu
CorrectAnswer-DDopamine8-hydroxylaseisa'copper'containingmonooxygenasethatrequiresascorbicacidandmolecularoxygen.Itcatalyzestheformationofnorepinephrine.
285.Ratelimitingenzymeincatecholaminesynthesis?
a)Dopadecarboxylase
b)N-methyltransferase
c)Dopaminehydroxylase
d)Tyrosinehydroxylase
CorrectAnswer-DAns.is'd'i.e.,Tyrosinehydroxylase
286.Enzymewhichactsonaspartate
a)SerumGlutamatePyruvateTransaminase(SGPT)
b)SerumGlutamateOxaloacetateTransaminase(SGOT)
c)Ornithinetranscarbmaylase(OTC)
d)Argininosuccinatelyase(ASL)
CorrectAnswer-BAns.is'b'i.e.,SerumGlutamateOxaloacetateTransaminase(SGOT)SGPTcatalaysesthetransaminationbetweenAlanineandaKetoglutarate.Alanine+aKetoglutaratePyruvate+GlutamateItisinnowayrelatedtoaspartate.SGOTcatalysesthetransaminationbetweenAspartateandaKetoglutarate
287.TrueaboutglutamatedehydrogenaseisA/E
a)Livermitochondrialenzyme
b)UsebothNAD*orNADP+coenzyme
c)InhibitedbyADP&activatedbyGTP
d)Reversibleoxidativedeamination
CorrectAnswer-CCi.e.InhibitedbyADP&activatedbyGTPDuringfirstfewdaysoffasting,thereisrapidbreakdownofmuscleprotein,providingaminoacids(alanine&glutaminemainly)thatareusedbyliverforgluconeognesisQ.Inthefastingstate,theoutputofalaninefromskeletonmuscleisinfarexcessofitsconcentrationinthemuscleproteinsthatarebeingcatabolized.Becauseitisalsoformedbytransaminationofpyruvateproducedbyglycolysisofmuscleglycogen.Alanineisexportedtotheliver,whereitistransaminatedbacktopyruvate,whichservesasasubstrateforgluconeogenesisQ.
288.Allostericstimulatorofglutamatedehydrogenaseis
a)ATP
b)GTP
c)PalmitoylCoA
d)Leucine
CorrectAnswer-DAns.is'd'i.e.,LeucineGLDHisallostericallystimulatedbyADP,GDP,leucine,valineandisoleucine.ItisinhibitedbyATP,GTP,palmitoylCoAandZinc.
289.Whichofthefollowingisabiologicallyimportanttripeptide?
a)Thyrotropinreleasinghormone
b)Thyroidstimulatinghormone
c)Gonadotropinreleasinghormone
d)FollicleStimulatinghormone
CorrectAnswer-AAns.is'a'i.e.,ThyrotropinreleasinghormoneTripeptideisapeptidewith3aminoacidsand2peptidelinkages.Biologicallyimportanttripeptidesincludeglutathione,TRH(ThyrotropinReleasingHormone)andmelanostatin.TSHisaglycoproteinnotapeptide.Itismadeupoftwosubunits-aand(Iasubunitisapolypeptidewithabout92aminoacids.ItisastructuralanalogueofasubunitofFSH.LHandHCG.Bsubunitisapolypeptidemadeupof118aminoacids.GnRH(GonadotropinreleasingHormone)isadecapeptidewith10aminocids.FSHisaglycoproteinwithtwosubunits-aandp.asubunitisapolypeptidewithabout96aminoacids.ItisastructuralanalogueofasubunitofTSH.LHandHCG.psubunitisapolypeptidemadeupof111aminoacids.
290.CarbamoylPhosphatesynthetaseI[CPSI]trueis
a)Itispresentincytoplasm
b)Itisinvolvedinpyrimidinesynthesis
c)N-AcetylGlutamateisanallostericstimulatorofCPSI
d)GlutamineistheaminogroupdonorforCPSI
CorrectAnswer-CAns.is'c'i.e.,N-AcetylGlutamateisanallostericstimulatorofCPSIPROPERTYCPS-I CPS-IIPathway Ureacycle PyrimidinesynthesisSubcellularlocation Mitochondria Cytoplasm
AminoGroupdonor
Ammonia Glutamine
Allostericregulation
StimulatedbyN-AcetylGlutamate(NAG)
Inhibitedbytheproducts-pyrimidinenucleotides,Uridine,Cytidine&Thymidine
291.CarbamoylphosphatesynthetaseIis:
a)Lysosolicenzyme
b)Cytosolicenzyme
c)Mitochondrialenzyme
d)Alloftheabove
CorrectAnswer-CMitochondrialcarbamoylphosphatesynthetaseIisanenzymethatcatalyzesareactionthatproducescarbamoylphosphate.ThisenzymecatalyzesthereactionofATPandbicarbonatetoproducecarbonylphosphateandADP.CarbonylphosphatereactswithammoniatogivecarbamateCytosoliccarbamoylphosphatesynthetaseIIusesglutamineratherthanammoniaasthenitrogendonorandfunctionsinpyrimidinesynthesis.
292.HHHsyndromeisduetodefectin?
a)Tryptophanmetabolism
b)Histidinetransporter
c)BranchedchainAAmetabolism
d)Ornithinetransporter
CorrectAnswer-DAns.is'd'i.e.,Ornithinetransporter[RefTextbookofclinicalpaediatricsp.496]Hyperornithinaemia,hyperammonaemia,homocitrullinuria(HHH)syndromeisanautosomalrecessivedisorderofornithinetransportcausedbymutationsingeneSLC25A15encodingtheornithinetransorterprotein(ORNT1).Thereisdefectiveactivityoftheornithinetransporteracrossthemitochondrialmembrane,whichcausesafunctionaldeficiencyoftwomitochondrialenzymes:Ornithinetranscarbomylase:Whichcatalysesthecondensationofornithineandcarbamoylphosphatetocitrulline.Ornithine-8-aminotransferase(OAT):Whichmetabolizestheornithineto.'-pyrroline-5-carboxylateandultimatelyglutamateandproline.Ornithineaccumulatesinthecytoplasmanditsdeficiencyinmitochondriacausesasecondaryureacycledisorderandhyperammonemia.Carbamoylphosphateaccumulatesandundergoesallternatemetabolismtoform:
1. Homocitrulline-Excretedinurine2. Oroticacid3. Plasma
293.Allofthefollowingcandetermineproteinstructureexcept
a)Edman'sSequencing
b)Xraycrystallography
c)Opticalrotatorydispersion
d)Spectrophotometry
CorrectAnswer-DAns.is'd'i.e.,SpectrophotometryMethodsusedforstudyingprimarystructure:A)Sanger'ssequencingSanger'sreagentis(1fluro2,4Dinitrobenzene)B)Edman'sSequencingEdman'sreagentisPhenylisothiocyanateC)ReverseSequencingIthastobesupplementedbyMassSpectrometryMethodsusedforstudyingsecondarystructure:
1. OpticalRotatoryDispersion2. OcularDichorism
Methodsusedforstudyingtertiarystructure:1. X-rayCrystallography2. UVspectroscopy3. NMRspectroscopy
294.Edman'sreagentisusedfor
a)DNAsequencing
b)Proteinsequencing
c)ProteinDenaturation
d)DNAdenaturation
CorrectAnswer-BAns.is'b'i.e.,ProteinsequencingEdman'sreagentisPhenylisothiocyanate.PhenylisothiocyanateisusedforsequencingproteinsPhenylisothiocyanatebindstoaaminogroups.Inaprotein,onlyaminoterminalaminoacid'saaminogroupwillbefree.HencewhenPhenylisothiocyanateisaddedtoapeptidewhichisadsorbedontoaglassfibrecoatedwithapolymer,inthepresenceof12%trimethylamine,itreactswiththeaminegroupofNterminalaminoacid.Byacidhydrolysis,thefirstaminoacidiscleavedfromthepolypeptidechainandtheaminoacidisidentifiedbychromatography.Thecycleiscontinued.Thisway50aminoacidscanbesequenced.
295.Mostabundantaminoacidinbrainis
a)Glutamate
b)Aspartate
c)Glutamine
d)Asparagine
CorrectAnswer-AAns.is'a'i.e.,GlutamateGlutamateisthemostabundantfreealphaaminoacidfoundinBrain.Itisanacidicpolaraminoacid.Itisthepredominantexcitatoryneurotransmitterofbrain.ItissynthesisedinbrainfromglutamineandaKetoglutarate.Glutamateisreleasedfrompresynapticexcitatoryneuronsinacalciumdependentmanner.Glutamateactsonbothinotropicandmetabotropicreceptors.Inotropicreceptorsofglutamateinclude:KainatereceptorsAMPAreceptorsNMDAreceptors
296.Cystinehashowmanymoleculesofcysteine?
a)1
b)2
c)3
d)4
CorrectAnswer-BAns.is'b'i.e.,2CysteineisasulphurcontainingaminoacidItisapolarbutunchargedaminoacidCysteinewithasulfhydrylgroupcangetoxidisedandformsadimer(2)calledascystine.Cysteineacquiresitspolarnatureonlybyvirtueofitssulfhydrylgroup.
297.Vitamingiveninhomocysteinuriaareallexcept
a)VitaminB6
b)VitaminB12
c)Folate
d)Thiamine
CorrectAnswer-DAns.is'd'i.e.,ThiamineMajorfateofhomocysteineisthatitgetsconvertedintocysteineinthepresenceofcystathionineIsynthase.Cystathioninepsynthaseisdependentonpyridoxalphosphate.Hencedefectofcystathioninepsynthasecanresultinhomocysteinuria.Thisiscalledasclassicalhomocysteinuria.ThisconditionrespondstoB6administration,astheenzymecystathionepsynthaseisdependentonB6.Minorfateofhomocysteineisthatitgetsconvertedintomethionineinthepresenceofmethioninesynthase.Methioninesynthaseisdependentonmethylcobalamine(coenzymeformofVitaminB12).MethylgroupdonorformethylcobalamineismethylTHFA.Homocysteinuriaisalsocausedbydefectofmethioninesynthase.AsthisenzymeisdependentonVitaminB12andTHFA,homocysteinuriarespondstoB12andTHFAadministration
298.Glutathioneisusedtodetoxifywhichfreeradical?
a)Hydrogenperoxide
b)Superoxide
c)Peroxylradical
d)SingletOxygen
CorrectAnswer-AAns.is'a'i.e.,HydrogenperoxideGlutathioneisatripeptide.ItisgammaglutamylcysteinylglycineItisdenotedasGSH-becauseithascysteinewithasulphydrylgroupItisusedtodetoxifyhydrogenperoxideandlipidperoxidesinthepresenceofglutathioneperoxidase.Glutathionecanalsodetoxifyperoxylradical.Peroxylradicalcannotgetreducedbyenzymaticreactions.TheygetdetoxifiedbyantioxidantslikevitaminEandGlutathioneSingletoxygengetsdetoxifiedprincipallybypolyphenolantioxidantsSuperoxideradicalsaredetoxifiedbySuperoxidedismutase(SOD)usingZincaselectronacceptorordonor(SomeclassesofSODsuseironorNickelaselectronacceptorordonor)
299.Matchenzymewiththediseasecausedduetoitsdeficiency-Enzyme Disease
FumarylacetoacetateTyrosinetransaminaseTyrosinaseAlkaptonuria
A.TyrosinemiaTypeIIhydroxylaseB.HomogentisateOxidaseC.TyrosinemiaTypeID-Albinism
a)I→D,2→C,3→A,4→B
b)I→A,2→C,3→D,4→B
c)1→C,2→D,3→A,4→B
d)l→C,2→A,3→D,4→B
CorrectAnswer-DAns.is'd'i.e.,1-pC,2→A,3→D,4→B[RefHarper29th/ep.289]
300.Whichofthefollowinghastwoaminogroups-
a)Glycine
b)Arginine
c)Lysine
d)Asparagine
CorrectAnswer-BHistidinehastwoiminogroups.Lysinehasoneaminogroup.Argininehastwoaminogroups
301.Alternatefuelforbrainis
a)Glucose
b)Ketonebodies
c)Fattyacid
d)Aminoacid
CorrectAnswer-BAns.is'b'i.e.,KetonebodiesThereisnostoredfuelinbrain,butitutilizes60%oftotalenergyunderrestingconditions.Glucoseisvirtuallythesolefuelforthebrain,exceptinprolongedstarvingwhenketonebodiesarethemajorsource.Fattyacidsdonotserveasfuelforthebrain,becausetheyareboundtoalbumininplasma;hencecannotcrosstheblood-brainbarrier.
302.Pyruvatecanbeasubstrateofallexcept
a)LactateDehydrogenase
b)Malicenzyme
c)Aspartatetransaminase
d)Alaninetransaminase
CorrectAnswer-CAns.is'c'i.e.,AspartatetransaminaseThereareseveralpathwaysintowhichpyruvatecanenter.Thepathwaychoseninagiventissuedependsonitsstateofoxygenationandprevailingmetabolicconditions,asdescribedbelow:OxidativedecarboxylationtoacetylCoAIntissuesthatareadequatelyperfusedwithoxygen(i.e.,underaerobicconditions),pyruvateundergoesoxidativedecarboxylationtoformacetylCoA,whichisfurthercatabolizedtoCO2andH20viacitricacidcycle(Krebscycle).ThisreactionservesasabridgebetweenglycolysisandKreb'scycle.Thus,pyruvateservesasthesourceofsubstrateoffirstreactionofTCA(Citricacidcycle),i.e.,acetylCoA.
303.Gasreleasedfromoligosaccharidemetabolismbyintestinalbacteriais
a)Carbondioxide
b)Sulphurdioxide
c)Nitricoxide
d)Methane
CorrectAnswer-DAns.is'd'i.e.,MethaneSomefooditemsarehighinindigestibleoligosaccharides.Eg,transgalactooligosaccharides,fructooligosaccharides(Inulin)Sincetheseoligosaccharidesdonotgetdigestedinthesmallintestine,theyreachthelargeintestine.Largeintestinalmicroorganismsbreakdowntheseoligosaccharidestoformshortchainfattyacidslikepropionate,butyrate.Theseshortchainfattyacidsarefoundtobetrophictointestinalmucosa.Ithasanti-inflammatoryeffectstoo.Hencethesearefoundtoprotectintestinalmalignancy.Thisisthebasisofprebioticsbeingsupplementedtopeoplewithintestinalinflammatorydisordersandtomaintainintestinalflora.Butthedownsideoftheseindigestibleoligosaccharidesisthat,whenmicroorganismsactontheseoligiosaccharides,theyresultingasproduction.Thegasesproducedincludestheusualhydrogen,nitrogenandcarbondioxide.Apartfromthatwhenoligosaccharidesareacteduponbymicroorganisms,itresultsinmethaneproduction.Thismethaneisfoundtohavethebloatingandflatulenceeffect.
304.Whichvitaminisrequiredforconversionofserinetoglycine?
a)VitC
b)B12
c)Pyridoxine
d)Thiamine
CorrectAnswer-CAns.is'c'i.e.,Pyridoxine[RefHarper290/ep.267-268]GlycineisanonessentialaminoacidsynthesizedfromanothernonessentialaminoacidserineSerineinthepresenceofSerinehydroxylmethyltransferase(SHMT)getsconvertedtoglycine.SHMTisapyridoxinedependentenzyme.ThisstepusestetrahydrofolateascoenzymeanditgetsconvertedtoN5,N10methyleneTHFA,whichthenactsas1carbondonorandhelpsintheconversionofuridinetothymidine.
305.Headacheandpapilledemaarefeaturesoftoxicityofwhichvitamin?
a)VitaminA
b)VitaminD
c)VitaminC
d)VitaminE
CorrectAnswer-AAns.is'a'i.e.,VitaminAHypervitaminosisACausedbyconsumptionoffoodrichinvitaminAlikefishorliver(notbyexcessiveintakeofcarotenoidsastheconversionofcarotenetovitaminAisregulated).Mechanismoftoxicity:Suppressesosteoblastsandstimulatesosteoclasts.Highretinolconcentrationsstimulatelysosomalenzymereleaseandcauselocaltissuedamage.Featuresincludeanorexia,irritability,headache,skinpeeling,vomiting.Headache,vomitingandpapilledemaarefoundtobecausedbyincreaseinintracranialtension.Hencethisconditioniscalledaspseudotumourcerebri.AsvitaminAstimulatesosteoclasts,hypercalcemia,bonyprojections,pathologicalfracturesarealsoobservedasfeatures.
306.Whichofthefollowingisteratogenic:
a)Folate
b)Cyanocobalamin
c)VitaminA
d)VitaminC
CorrectAnswer-CAns.C:VitaminAPharmacologicaldosesofvitaminAareteratogenicandinpregnancythedailydosemustnotexceed6000-8000IU.SyntheticanaloguesofvitaminA:*Tretinoin*Isotretinoin*Etretinate*Acetretin*TeratogenicdrugsDrugsandmedications:*TobaccoCaffeine*Drinkingalcohol(ethanol)(fetalalcoholspectrumdisorder),*Isotretinoin(13-cis-retinoicacid)*Temazepam*Nitrazepam*Aminopterinormethotrexate*AndrogenichormonesBusulfan*Captopril,enalapril*Coumarin*Cyclophosphamide*Diethylstilbestrol*Phenytoin(diphenylhydantoin)
Lithium*Methimazole*Penicillamine*Tetracyclines*Thalidomide*Trimethadione*Flusilazole*ValproicacidEnvironmentalchemicals:*Polycyclicaromatichydrocarbons(polynucleararomatichydrocarbons)*Polychlorinatedbiphenyls(PCBs)*Polychlorinateddibenzodioxinsa.k.adioxin,*OrganicmercuryIonizingradiation:*Atomicweaponsfallout(Iodine-131,uranium)*BackgroundradiationDiagnosticx-rays*RadiationtherapyInfections:*Cytomegalovirus*Herpesvirus*ParvovirusB19*Rubellavirus(Germanmeasles)*Syphilis*ToxoplasmosisAneasywaytoremembermaternalinfectionsisTORCH:Toxoplasmosis,Otheragents,Rubella,CMVandHSV.Metabolicimbalance:*AlcoholismDiabetes*Folicaciddeficiency*Iodinedeficiency*Hyperthermia
307.Alcoholismleadstodeficiencyofwhichvitamin?
a)VitaminA
b)VitaminB1
c)VitaminD
d)VitaminB6
CorrectAnswer-BAns.is'b'i.e.,VitaminB1Ofallthemicronutrients,thiaminewillbethefirstmicronutrienttobecomedeficient.Reasonis,apartfromthepersonmissinghismixedbalanceddiet,alcoholisalsofoundtointerferewiththiamineabsorption.Thethirdreasonrelatedtothiaminedeficiencyinachronicalcoholicisthatalcoholinterfereswithmagnesiumabsorption.Magnesiumisnecessaryforactivationofthiaminetoitscoenzymeformthiaminepyrophosphateinthepresenceofthiaminekinase.
308.VitaminB12isrequiredforallofthefollowingexcept?
a)Conversionofhomocysteinetomethionine
b)Conversionofhomocysteinetocysteine
c)ConversionofpropionylcoAtosuccinylCoA
d)ConversionofmethylTHFAtoTHFA
CorrectAnswer-BAns.is'b'i.e.,ConversionofhomocysteinetocysteineActiveformofvitaminB12aremethylcobalamineanddeoxyadenosylcobalamine.FollowingreactionsrequirevitaminB12coenzyme:i)IsomerizationofmethylmalonylCoAtosuccinylCoA:Inthisreaction,activeformofvitaminB12isdeoxyadenosylcobalamine.Propionyl-CoAisproducedascatabolicendproductofsomealipathicaminoacidsand(3-oxidationofoddchainfattyacids.PropionylCoAisthenconvertedtosuccinylCoAthroughmethylmalonyl-CoA.Thusmethylmalonyl-CoAisaccumulatedandexcretedinurineasmethylmalonicacid(methylmalonate)invitaminB12deficiency,i.e.methylmalonicaciduria.ii)ConversionofhomocysteintomethionineInthisreaction,activeformismethylcobalamine.Thisistheonlyreactionwhichrequiresbothvitamin812(asmethylcobalamine)andfolicacid(asN5-methyl-114-folate).Thereactioniscatalyzedbytheenzymecobalamin-dependentmethioninesynthasealsocalled5-methyltetrahydrofolate-
homocysteinemethyltransferase.
309.Whichofthefollowingvitaminsissignificantlysynthesisedingutbyintestinalflora?
a)Folate
b)B12
c)Biotin
d)B6
CorrectAnswer-A:B:CAns.is'c>'b'&'a'i.e.,Biotin>B12&FolateThoughvitaminsaresupposedtobeessentialmicronutrientswhicharesupposedtobesuppliedinthediet,somevitaminslikeVitaminDandNiacinareendogenouslysynthesised.VitaminD3orcholecalciferolissynthesisedintheskinepidermiswhenUVlightactson7dehydrocholesterolwhichispresentinthemalphigianlayer.UVlightopensuponeoftheringsofcholesterol,convertingcholesterolintoasecosteroidwhichischolecalciferol.Cholecalciferolreachesliver.Inliveritishydroxylatedat25thpositionby25ahydroxylasetoform25hydroxycholecalciferol25hydroxycholecalciferolreachesthekidney.Itishydroxylatedat1stpositionby1ahydroxylasetoform1,25dihydroxycholecalciferol,theactiveformofvitaminD.Niacin'sactivecoenzymeformsNADandNADParesynthesisedendogenouslyfromaminoacidtryptophanApartfromthesetwovitaminssynthesisedbyhumanmetabolicpathways,therearevitaminslikeBiotin,VitaminKwhicharesynthesisedtosignificantamountinlargeintestinebyintestinalmicroorganisms.ResearchhasidentifiedsynthesisoffolateandB12
aswellinlargeintestine.Thoughtheyaresynthesisedinlargeintestine,asallwatersolublevitaminsgetabsorbedinsmallintestine,onlyendogenouslysynthesisedBiotinandVitaminKarefoundtocontributesignificantlytometabolicpathways.ThatiswhybiotinandvitaminKdeficienciesarerelativelyrare.
310.Chainbreakingantioxidantsareallexcept-
a)Tocopherol
b)Ascorbicacid
c)Polyphenolicflavinols
d)Superoxidedismutase
CorrectAnswer-DAns.is'd'i.e.,SuperoxidedismutaseChainbreakingantioxidantsaremoleculeswhichcandonateanelectronoracceptelectronfromunstableintermediatesoflipidperoxidationconvertingthemintostableintermediates.TheyareoftwotwotypesLipidphasechainbreakingantioxidantAqueousphasechainbreakingantioxidantLipidphasechainbreakingantioxidantThemostimportantlipidphasechainbreakingantioxidantisatocopherol.atocopherolreactswithperoxylradicaltoformtocopheroxylradicalwithexcesschargeassociatedwithextraelectronbeingdistributedalongthechromanering.AqueousphasechainbreakingantioxidantThemostimportantchainbreakingantioxidantofthistypeisascorbicacidorvitaminC.Itcanscavengemanysuperoxideradicals.Mostimportantlyithelpsbyregeneratingtocopherolafteritisoxidisedduringtheprocessofreducingperoxylradicals.ApartfromvitaminCwehaveagroupofpolyphenolflavinolslikeepitachingallatewhichcanreduceoxidantspeciesinaqueousphase.Thesearepresentingreenteaandsomeantioxidantsupplements
Superoxidedismutaseisanantioxidantenzymewhichhelpsindetoxifyingsuperoxidestoformmolecularoxygenandhydrogenperoxide.Itisnotachainbreakingantioxidant
311.Whichofthefollowingelementsisknowntoinfluencethebody'sabilitytohandleoxidativestress?
a)Fluride
b)Iron
c)Copper
d)Selenium
CorrectAnswer-DAns.is'd'i.e.,Selenium[Ref:PankajNaikp.382]Theactivityoftheantioxidantenzymesdependsonsupplyofminerals:?*Manganese*Zinc*Copper*Selenium-Manganese,copperandzincarerequiredfortheactivityofsuperoxidedismutase.-Seleniumisrequiredfortheactivityofglutathioneperoxidase.
312.VitaminB12deficiencycausesallexcept?
a)Homocysteinuria
b)Methylmalonicaciduria
c)Subacutecombineddegeneration
d)Epinephrineexcess
CorrectAnswer-DAns.is'd'i.e.,Epinephrineexcess[RefDineshPuri3rdlep.381]DeficiencyofvitaminB12causesPerniciousanemia,megaloblasticanemia(secondarytofunctionalfolatedeficiencyduetofolatetrap),methylmalonicaciduriaduetoaccumulationofmethylmalonyl-CoA,andneuropathy,likesubacutecombineddegeneration(SACD)anddemyelination.Theremayhomocysteinuriaasmethioninesynthase,amethylcobalaminedependentenzyme,isdefective.
313.Deficiencyofwhichvitaminduringpregnancypredisposestomeningomyelocele?
a)Folicacid
b)Biotin
c)Pyridoxine
d)Thiamine
CorrectAnswer-AAns.is'a'i.e.,FolicacidFolicaciddeficiencyinpregnancypredisposedtoNTD(e.g.myelomeningocele,meningocele,spinabifida).
314.RichestsourceofvitaminB12?
a)Meat
b)Greenleafyvegetables
c)Cornoil
d)Sunfloweroil
CorrectAnswer-AAns.is'a'i.e.,MeatVitaminB12isnaturallyfoundinanimalproducts,includingfish,meat,poultry,eggs,milk,andmilkproducts.VitaminB12isgenerallynotpresentinplantfoods,butfortifiedbreakfastcerealsareareadilyavailablesourceofvitaminB12withhighbioavailabilityforvegetarians.RichsourceofvitaminB12→Beef,liver,andchicken.Fishandshellfishsuchastrout,salmon,tunafish,andclams.Fortifiedbreakfastcereal.Low-fatmilk,yogurt,andcheese.Eggs.
315.RegardingNADandNADP,trueis?
a)Precursoristyrosine
b)MalicenzymeisanNADdependentenzyme
c)Highleucinecausesniacindeficiency
d)Niacindeficiencycausescutaneousvasodilatation
CorrectAnswer-CAns.is'c'i.e.,HighleucinecausesniacindeficiencyNADandNADParenicotinicacidderivativeswhichissynthesizedfromtryptophan(nottyrosin)MalicenzymeisNADPdependentenzyme(notNADdependent)Excessofleucineinhibitstheconversionoftryptophanintoniacinandcausespellagra.NiacindeficiencycausesPellagra.PellagracharacterisedbythethreeDs-Diarrhoea,DermatitisandDementiaiscausedbyniacinorvitaminB3deficiency.
316.AntistressVitaminis?
a)VitaminB1
b)VitaminB2
c)VitaminB3
d)VitaminB5
CorrectAnswer-DAns.is'd'i.e.,VitaminB5VitaminB5orpantothenicacidiscalledasanantistressvitaminasitisfoundtohaveanimpactoncortisolreleaseandisfoundtosupportourimmunesystem.
317.TrueaboutPurinesynthesis?
a)GlutamineistheaminogroupdonorforN9
b)PRPPsynthetaseistheratelimitingenzymeofpurinesynthesis
c)THFAisnecessaryforformingC6ofpurinering
d)GMPisthefirstnucleotidetobeformedduringpurinesynthesis
CorrectAnswer-AAns.is'a'i.e.,GlutamineistheaminogroupdonorforN9Inpurinenucleotidesynthesis,firstRibose5phosphateisactivatedbyPRPPsynthetasetoformPRPP.ThisPRPPgetsattachedtoN9(sourceisglutamine)inthepresenceofPRPPglutamineamidotransferase.Thisistheratelimitingenzymeofpurinesynthesis.PRPPsynthetaseisacommonenzymeofpyrimidinenucleotidesynthesisandofniacinadeninedinucleotidesynthesis.AsPRPPsynthetaseisnotcommittedforPurinenucleotidesynthesis,itcannotbeconsideredastheratelimitingenzymeofpurinesynthesis.Inpurinesynthesis,Inosinemonophosphate(IMP)isfirstformedIMPonaminationwithAspartategivesrisetoAMPinthepresenceofadenylosuccinatesynthetase.ThisstepneedsGTPasasourceofenergyIMPondehydrogenationbyIMPdehydrogenasefollowedbyaminationwithglutaminewillgiverisetoGMP.ThisstepusedATPasasourceofenergy
318.Trueaboutpyrimidinecatabolismis?
a)Itisasourceofuricacid
b)βaminoisobutyrateisgenerated
c)Unlikeothercatabolicpathways,itdoesnotgenerateintermediatesofcitricacidcycle
d)Increasedpyrimidinecatabolismcausesdecreasedsynthesisofcarnosine
CorrectAnswer-BAns.is'b'i.e.,βaminoisobutyrateisgeneratedInpyrimidinecatabolism,firstcytidineandthymidineareconvertedtouridinebydeaminationanddemethylationrespectively.Uridineinthepresenceofphosphorylasegetsconvertedintouracil.UracilundergoeshydrogenationinthepresenceofdihydrouracildehydrogenasetoformdihydrouracilDihydrouracilhydrataseopenstheringofdihydrouraciltoformalinearstructure
319.RegardingFISHallaretrueexcept?
a)Usedtodetectcopynumbervariations
b)Usedtodetectbalancedtranslocations
c)Requiresoligonucleotides
d)RequiresDNApolymerase
CorrectAnswer-DAns.is'd'i.e.,RequiresDNApolymeraseFluoroscentinSituHybridisationisacytogenetictechniqueusedtodetectchromosomalabnormalities.ThistechniqueusesfluorescentlylabelledoligonucleotidesorDNAprobes.Theseprobesbindtospecificsequencesofachromosome.Attachedtotheprobesarereporterfluorescentdyeswhichunderfluorescencemicroscopyconfirmthepresenceorabsenceofaparticularchromosomalaberration.InFISH,thetargetisthenuclearDNAofeitherinterphasecellsorofmetaphasechromosomesaffixedtoamicroscopeslide.Whenaspecificprobeisadded,itannealstoitscomplementarysequenceintheaffixedDNA.Astheprobeislabelledwithareportermoleculeitisvisualizedbyfluorescencemicroscopy
320.AllofthefollowingaretrueaboutNucleicAcidSequenceBasedAmplificationexcept?
a)ItisaspecificamplificationofRNA
b)ItisareplacementforreversetranscriptasePCR
c)Denaturationiscarriedoutat94°C
d)ItrequiresReversetranscriptase.
CorrectAnswer-CAns.is'c'i.e.,Denaturationiscarriedoutat94°CNucleicAcidSequenceBasedAmplification(NASBA)orIsothermalRNAamplificationisareplacementforReversetranscriptasePCR(RT-PCR).BothNASBAandRT-PCRareusedforamplifyingdesiredorspecificRNAfragments.InRT-PCR,firstthedesiredRNAisconvertedtodsDNAusingreversetranscriptaseandthenthedsDNAisamplifiedusingPCRtechnique
321.Thelinkagewhichlinksindividualnucleotidesinapolynucleotidechainis-
a)pN-Glycosidiclinkage
b)aN-glycosidiclinkage
c)3'5'Phosphodiesterlinkage
d)5'3'Phosphodiesterlinkages
CorrectAnswer-CAns.is'c'i.e.,3'5'PhosphodiesterlinkageNucleoside N-glycosidicbondbetweenpentosesugar
andnitrogenousbase.Nucleotide(monophasphatenucleatide)
Posphoesterlinkage(notphosphodiester)betweennucleosideandphosphategrp.
Diphosphate&polyphosphatenucleotides
Acidanhydridelinkagebetweenmonophosphate&otherphosphategrp
Polynucleotidechain 3'5'phosphodiesterlinkagebetween3'hydroxylgroupnucleotidewith5'phosphategroupofnextnucleotide.
322.Bondformationbetweenribosesugarandnitrogenis?
a)Acidanhydridelinkage
b)Phosphodiesterlinkage
c)Phosphoesterlinkage
d)Glycosidiclinkage
CorrectAnswer-DAns.is'd'i.e.,GlycosidiclinkagePentosesugar(riboseordeoxyribose)islinkedtoanitrogenousbase(purineorpyrimidine)viacovalentN-glycosidicbondtoformnucleoside
323.Ataxiatelangiectasiaiscausedbyadefectof?
a)BaseExcisionRepair
b)NucleotideExcisionrepair
c)Mismatchrepair
d)dsDNAbreakrepair
CorrectAnswer-DAns.is'd'i.e.,dsDNAbreakrepairDNArepair DefectassociatedMismatchrepair HereditaryNonpolyposisColonCancerNucleotideExcisionRepair
Xerodermapigmentosa,Cockaynesyndrome
DoubleStrandedDNABreak
AtaxiaTelangiectasia,Bloom'ssyndrome,
Repair Fanconi'sanemia
324.Jumpinggenesare?
a)Moderatelyrepetitivesequences
b)Highlyrepetitivesequences
c)Satellitesequences
d)Simplesegmentrepeatsequences
CorrectAnswer-AAns.is'a'i.e.,Moderatelyrepetitivesequences
325.Molecularmimicryisestablishedinthepresenceof?
a)Cysteine
b)Alanine
c)Glycine
d)Tryptophan
CorrectAnswer-AAns.is'a'i.e.,CysteineMolecularmimicryiscausedbystructuralhomologyorsimilaritybetweenforeignantigensandself-antigens.AsaresultofstructuralsimilarityaTcellorBcellactivatedagainstaforeignantigencrossreactswithself-antigenandcausesautoimmunity.Molecularmimicrydoesnotalwaysexpectasequencesimilaritytogetinitiated.ItisfoundtobeinducedevenwhentheselfantigensandexogenousantigenssharethesamebindingmotifwithMHC(MajorHistocompatibilityComplex).Thisbindingmotifsimilarityismoreoftenfoundinthepresenceofcysteine(formsdisulphidebridges),arginineorlysine(formhydrogenbonds)inthebindingsiteofantigens.
326.DNAfragmentsareseparatedby?
a)Ultracentrifugation
b)Agarosegelelectrophoresis
c)Paperchromatography
d)Highpressureliquidchromatography
CorrectAnswer-BAns.is'b'i.e.,Agarosegelelectrophoresis[RefEssentialsofbiochemistryp.756]DNAiscutintolargefragments,usingrestrictionenzymes.Thesefragmentsarethenseparatedbygelelectrophoresis(eitheragaroseorpolyacrylamidegelelectrophoresis).
327.Lefthandedhelixisseenin-
a)BDNA
b)ADNA
c)ZDNA
d)FDNA
CorrectAnswer-CAns.is'c'i.e.,ZDNABasedonquartenarystructureofDNAmanyconformationsarepossibleoutofthecommonthreeformsare–BDNA,ADNAandZDNA.ZDNAItisfoundinthoseregionsofchromosomeswhicharerichinGCsequencesItisalefthandedhelixEveryfullturnhas12basepairing.
328.AminoacyltRNAgetsattachedtowhichsiteofribosome?
a)Psiteof40sribosome
b)Asiteof60sribosome
c)Asiteof40sribosome
d)Psiteof60sribosome
CorrectAnswer-BAns.is'b'i.e.,Asiteof60sribosomeTranslationisaprocessbywhichnucleotidebasesofmRNAgettranslatedasaminoacidsequencesofpolypeptidechain.Ittakespartinfreeribosome.FreeribosomereadsthemRNAfrom5'endto3'end.ItreadsthecodonsofmRNAonebyone.DependinguponthecodonthatispresentinmRNA,ribosomeiscapableofattachingacomplementaryanticodoncontainingtRNA.ThistRNAcarriesacorrespondingaminoacid.Thiswaythepolypeptidechaingrowsfromaminoterminalendtocarboxyterminalend.Eukaryoticribosomeisa80sunit.Itdissociatesinto40sand60ssubunits.60ssubunitcontainsPsiteandAsite.Whenribosomeentersintochainelongation,onthePsiteof60s,isattachedtheAUGcodonofmRNA,towhichinitiationmethioninetRNAisattachedandAsiteisfree
329.Okazakifragmentsareformedduring?
a)Transcription
b)Translation
c)DNAreplication
d)None
CorrectAnswer-CAns.is'c'i.e.,DNAreplication
330.Splicingisaprocessof?
a)Activationofprotein
b)Removalofintrons
c)Synthesisofprotein
d)ReplicationofDNA
CorrectAnswer-BInmolecularbiologyandgenetics,splicingisamodificationofanRNAaftertranscription,inwhichintronsareremovedandexonsarejoined.ThisisneededforthetypicaleukaryoticmessengerRNAbeforeitcanbeusedtoproduceacorrectproteinthroughtranslation.Formanyeukaryoticintrons,splicingisdoneinaseriesofreactionswhicharecatalyzedbythespliceosomeacomplexofsmallnuclearribonucleoproteins(snRNAs),buttherearealsoself-splicingintrons.
331.Proteinsarestoredas?
a)Structuralproteins
b)Functionalproteins
c)Fats
d)Lysosomalenzymes
CorrectAnswer-CAns.is'c'i.e.,FatsThereisnostorageformofproteinHencetheaminoacidsformedbybreakdownofproteinsundergocatabolismDuringcatabolism,mostoftheaminoacidsgiveofftheiraminogroupsandthenthecarbonskeletonundergoescatabolismOncatabolism,thecarbonskeletonofaminoacidsgiverisetoglycolyticintermediateorcitricacidcycleintermediates.
332.Flowcytometryisdoneon
a)Polycythemia
b)Thrombocytosis
c)Basophil
d)Lymphocytes
CorrectAnswer-DAns.d.Lymphocytes"Flowcytometrycanrapidlyandquantitativelymeasureseveralindividualcellcharacteristics,suchasmembraneantigensandtheDNAcontentoftumorcells.FlowcytometryhasalsoprovedusefulintheidentificationandclassificationoftumorsarisingfromTandBlymphocytesandfrommononuclear-phagocyticcells."-Robbins8/ep324
333.TrueabouttRNA?
a)80%oftotalRNA
b)Contains50-60nucleotides
c)CCAsequenceistranscribed
d)LongestRNA
CorrectAnswer-C"TheCCAtailisaCCAsequenceat3'endofthetRNAmolecule.Inprokaryotes,CCAsequenceistranscribed.Ineukaryotes,theCCAsequenceisaddedduringprocessing"."tRNAisthesmallestofthreemajorspeciesofRNAs"—DineshpuritRNAcomprises15%oftotalRNAinthecell.Itcontains73-93nucleotideresidue.
334.MostcommonlyusedvectorforDNAcloning?
a)Plasmid
b)Virus
c)Cosmid
d)Phage
CorrectAnswer-AAns:A.PlasmidAcloningvectorisacarrierDNAmoleculetowhichhumanDNAfragmentisattached.Normally,foreignDNAfragmentscannotself-replicatewithinhostcell.Therefore,theyarejoinedtoavectorDNA,thatcanreplicatewithinhostcell.Thefivemajortypesofcloningvectorsusedare-*Plasmids*Viralvectors/Bacteriophages*Cosmids*BacterialArtificialChromosomes(BACs)*Yeastartificialchromosomes(YACs)
335.ChimericDNAtrueareallexcept?
a)FormedbylinkingDNAfragmentsofunrelatedgenome
b)StickyendproducingrestrictionendonucleasesfavourformationofchimericDNA
c)Theydon'trequireDNAligases
d)TheorganismharbouringachimericDNAhasfeaturesofthemselvesandthepropertiesoftheinsert
CorrectAnswer-CAns.is'c'i.e.,Theydon'trequireDNAligasesChimericDNAorrecombinantDNAisformedbylinkingDNAfragmentsoftwounrelatedgenome.ItisastepinvolvedinrecombinantDNAtechnology.ItisdonetointroduceafavourablequalityintoanorganismlikeabilitytoproduceinsulinbyE.Coli(DonebylinkinginsulincDNAintoavectorandintroducingtherecombinantvectororchimericDNAintoE.Coli)orinsectresistanceincrops(donemyintroducingthegenefragmentcapableofproducingBacillusthurengiensis)intoTiplasmidandintroducingthechimericDNAorrecombinantDNAintogrowingplants).
336.Whatistheroleofcataboliteactivatorprotein(CAP)inLACoperon?
a)Positiveregulator
b)Negativeregulator
c)Attenuation
d)Constitutiveexpression
CorrectAnswer-ACataboliteactivatorprotein,CAPisanactivatorrequiredforhighleveltranscriptionofthelacoperon.CAPproteinexertspositivecontrolandlacrepressorexertsnegativecontrol.WhatisanOperon?Inprokaryotes,thegenescodingforproteinsinvolvedinaparticularmetabolicpathwayareoftensequentiallyarranged-togetheronthechromosomealongwithasinglepromoterorregulatoryregion.Thisentireclusteristermedasanoperon,foreg,thelacoperon(codingproteinsformetabolismoflactose)ortrpoperon(codingproteinsneededforthesynthesisoftryptophan).Lacoperon:LacoperoncontainslacZ,lacYandlacAgenesencodingbetagalactosidase,galactosepermeaseandthiogalactosidetransacetylaseandisprecedbyanoperator(O)siteandpromoter(P)site.TheoperonistranscribedbyRNApolymerasetoproduceasinglepolycistronicmRNAthatistranslatedtoproduceallthreeenzymeswhichareinvolvedinlactosemetabolism.
337.LacYinLacOperoncodesfor?
a)BGalactosidase
b)GalactosidePermease
c)ThiogalactosideTransacetylase
d)Repressor
CorrectAnswer-BAns.is'b'i.e.,GalactosidePermeaseThesecodefor3proteinsthatareinvolvedincatabolismoflactose.Thesegenesare'Z'gene(codesforP-galactosidase),'Y'gene(codesforgalactosidepermease),and'A'gene(codesforthiogalactosidetransacetylase).
338.UbiquitinProteasomepathwayisusedfordegradationof?
a)Extracellularlonglivedproteins
b)Intracellularlonglivedproteins
c)Intracellularshortlivedproteins
d)Extracellularshortlivedproteins
CorrectAnswer-CAns.is'c'i.e.,IntracellularshortlivedproteinsExtracellularproteinsandintracellularlonglivedproteinsgetdegradedinlysosomeswiththehelpofcathepsinIntracellularshortlivedproteinsgetlabelledwithubiquitinoncetheirlifespangetsover.
339.SmallRNAsare?
a)Between200and500bpsinlength
b)Codedbysmallexons
c)Amodeofregulationofgeneexpression
d)Alwaysendogenouslysynthesised
CorrectAnswer-CAns.is'c'i.e.,AmodeofregulationofgeneexpressionSmallRNAsarelessthan200nucleotidesinlength.Theyarecodedbyintronicsequencesofgenes.TheyhelpinregulationofgeneexpressionthroughGENESILENCINGmechanismThemiRNAgenesequenceslocatedwithinintronicsequencesaretranscribedbyRNApolymeraseIIItoformPri-miRNA.Pri-miRNAisprocessedbymicroprocessorcomplextoformastemloopstructure,Pre-miRNA.
340.Allofthefollowingaretrueaboutcollagenstructureexcept-
a)Collagenissecretedbyfibroblastsasprocollagen
b)LysyloxidaseisdependentonVitaminC
c)Hydroxylysineundergoesglycosylation
d)Glycineisthemostabundantaminoacidofcollagen
CorrectAnswer-BAns.is'b'i.e.,LysyloxidaseisdependentonVitaminCCollagenisthemostabundantproteininthebody.Collagenisatriplehelix.Itismadeupof3polypeptidechains-Eachpolypeptidechainhasabout1000aminoacids.Itismadeupofrepetitiveunitsof(Gly-X-Y),whereXandYaremostcommonlyprolineandhydroxyproline.Hence33%ofaminoacidresiduesofcollagenisglycine-themostabundantaminoacidofcollagen.Collagenissynthesisedasprocollagenbyfibroblastsintracellularly.AftertranslationofmRNAofcollageninribosomes,thepolypeptidechainsundergoposttranslationalmodificationsintheformofhydroxylationandglycosylation.
341.Themostabundantaminoacidofcollagenis-
a)Glycine
b)Proline
c)Lysine
d)Tryptophan
CorrectAnswer-AAns.is'a'i.e.,Glycine
342.Foldsincollagenaredueto-
a)Glycine
b)Proline
c)Hydroxyproline
d)Lysine
CorrectAnswer-A:BAns.is`b>a'i.e.,Proline>Glycine[RefEssentialsofbiochemistyp.868]Twoaminoacidsareinvolvedinproducingfoldsincollagen:prolineandglycine.Inordertoformatriple-helixapolypeptidechain(a-chain)mustcontainglycineaseverythirdresidueinthesequence.Thisisbecauseonlytheglycineissmallenoughtobeaccommodatedinthelimitedspaceavailabledownthecentralcoreofthetriplehelix.Eachturnofpolypeptidechain(a-chain)containsthreeaminoacidresidues,andglycine(Gly)ispresentateverythirdposition.Thusglycineconstitutes33%ofthetotalaminoacidresidues.Therepeatingaminoacidresidues,representedas(Gly-X-Y)n,isanabsoluterequirementforformationoftriplehelix.XandYcanbeanyaminoacids,butmostofthetimeXisproline(10%ofthetotalaminoacidresidues)andmostofthetimeYishydroxyproline.Otherimportantaminoacidsfoundincollagenarelysineandhydroxylysine.
343.Hemesynthesisrequires
a)Ferrousiron
b)Glycine
c)SucchylCoA
d)All
CorrectAnswer-D
344.Hemeiswhichporphyrin?
a)TypeI
b)TypeII
c)TypeIII
d)TypeIV
CorrectAnswer-CAns.is'c'i.e.,TypeIII
345.Gerhardt'stestisusedtodetect?
a)Reducingsugar
b)Ketonebody
c)Protein
d)Blood
CorrectAnswer-BAns.is'b'i.e.,KetonebodyGerhardt'stestisatestusedtodetectacetoacetateinurine(acetoneand(3hydroxybutyratedonotanswerthistest).ReagentsusedforGerhardt'stestincludeConcentratednitricacidand10%Ferricchloride
346.GeneticallymediatedVLDLoverproductionisafeatureofallexcept?
a)Familialcombinedhyperlipidemia
b)Hypoapobetalipoproteinemia
c)Familialdyslipidemichypertension
d)LDLsubclassB
CorrectAnswer-BAns.is'b'i.e.,Hypoapobetalipoproteinemia[RefEssentialsofBiochemistryp.712]FamilialcombinedhyperlipidemiaorTypelibFamilialhyperlipoproteinemiaischaracterisedbygeneticallydeterminedoverproductionoftriglyceriderichVLDL(VLDL1)andsmalldenseLDLparticles.Itisthemostcommonlyinheriteddisorder.PleaserememberAcquiredcombinedhyperlipidemiawithsamefeaturesiscausedbymetabolicsyndromeorinsulinresistance.Hyperapobetalipoproteinemiaischaracterizedbyanincreasednumberofsmall,denseLDLparticlesandanelevatedLDL-BlevelwithnormalorborderlinehighLDL-Clevels.PatientswithHyperapobetalipoproteinemiamayhavenormalorhightriglycerides.Hyperapobetalipoproteinemiahasbeenfoundtobethemostcommonphenotype(34%)associatedwithprematureCAD;HyperapobetalipoproteinemiawithhypertriglyceridemiaisfoundtobeevenmorestronglyassociatedwithCADthanHyperapobetalipoproteinemiawithnormaltriglycerides.
347.Abetalipoproteinemiaaffects?
a)Retinalpigmentepithelium
b)Opticnerve
c)Occipitalcortex
d)Bipolarneurons
CorrectAnswer-AAns.is'a'i.e.,RetinalpigmentepitheliumAbetalipoproteinemiaorBassen-KornzweigsyndromeiscausedbyadefectofMicrosomalTriglycerideTransferProtein(MTTP).Inabetalipoproteinemia,bothchylomicronandVLDLformationgetaffected.Asaresult,fatabsorptionisaffectedandtheaffectedchildpresentswithsteatorrheainthefirstfewmonthsoflife.Allfatsolublevitaminabsorptionalsogetaffected.HenceVitaminA,D,EandKdeficiencyisexpected,howeverVitaminEdeficiencyisfoundtohaveprofoundeffects.VitaminEdeficiencypresentsasretinitispigmentosaandsubacutecombineddegeneration.Otherfeaturesofabetalipoproteinemiaareacanthocytes(starshapedRBCsinperipheralsmearcausedbecausethelipidcompositionofRBCmembranegetsaffected),hypocholesterolemia.TreatmentinvolvesvitaminEadministration.
348.Syntheticoxygencarrieris?
a)2,4dinitrophenol
b)Chloflurocarbon
c)Perflurocarbon
d)1fluro2,4dinitrophenol
CorrectAnswer-BAns.is'b'i.e.,ChloflurocarbonBlooddopingisaformoffraudulentincreaseintheoxygencarryingcapacityofaperson,widelyusedtoimprovetheaerobiccapacityofathletesThisisdonebyvariousmethodsAutologousbloodtransfusionHomologousbloodtransfusionErythropoietinorContinuousErythropoietinReceptorActivator
349.Pepsinogenisactivatedby?
a)Enterokinase
b)Enteropeptidase
c)H+
d)Trypsin
CorrectAnswer-CAns.isci.e.,H+
Pepsinissecretedbychiefcellsofstomachinaninactive(zymogen)formcalledpepsinogen.Acid(IF)inlumenofstomachconvertspepsinogentoactivepepsin.Pepsinonceformedalsoattackspepsinogenproducingmorepepsinmoleculesbyautocatalysis.
350.Whichofthefollowingaccumulatesinmaplesyrupurinedisease
a)Leucine
b)Valine
c)Isoleucine
d)All
CorrectAnswer-DAns.is`d'i.e.,AllMaplesyrupurinedisease(MSUD)orbranched-chainketoaciduria*Itisaninbornerrorofmetabolismofbranched-chainaminoacidsvaline,leucineandisoleucine.*Itisduetodeficiencyofanenzymethatcatalyzesthesecondreactionintheseaminoacidsmetabolismi.e.branchedchain-aketoaciddehydrogenasewhichcatalyzesthedecarboxylationofbranched-chainaminoacids.*Asaresult,thebranched-chainaminoacids,leucine,isoleucineandvaline,andtheira-ketoacidsaccumulateintheblood,urine,andCSF.*Thereisacharacteristicmaplesyrupodourtotheurine.*Inmaplesyrupurinediseasethereistheexcretionofbranched-chainaminoacids(isoleucine,leucine,valine)andtheirketoacids(α-ketoβ-methylvalerate,α-ketoisocaproate,α-ketoisovalerate)intheurine.
351.Hemeissynthesizedfrom?
a)Lysine+succinylCoA
b)Glycine+succinylCoA
c)Arginine+MalonylCoA
d)Glycine+MalonylCoA
CorrectAnswer-BAns.B.Glycine+succinylCoAOrganelle:PartlycytoplasmicandpartlymitochondrialStartingmaterials:SuccinylCoAandGlycine
352.Glycemicindexisdefinedas:
a)Glucosecontrolinlast3months
b)Measureofthechangeinthebloodglucosefollowingingestionofproteins
c)Measureofthechangeinthebloodglucosefollowingingestionofcarbohydrate
d)Measureofthechangeinthebloodglucosefollowingingestionoffats.
CorrectAnswer-CTheGlycemicindex(GI)ofacarbohydratecontainingfoodisameasureofthechangeinthebloodglucosefollowingitsingestion
353.TrueaboutcoproporphyrinIandcoproporphyrinIIIis-
a)CoproporphyrinIisexcretedinurine
b)CoproporphyrinIIIisexcretedinbile
c)InDubinJohnsonSyndrome,CoproporphyrinIinurineis80%ofthetotalcoproporphyrin
d)InDubinJohnsonSyndrome,totalcoproporphyrinlevelsiselevated
CorrectAnswer-CAns.is'c'i.e.,InDubinJohnsonSyndrome,CoproporphyrinIinurineis80%ofthetotalcoproporphyrinCoproporphyrinsareintermediatesofhemesynthesisNormallycoproporphyrinIisexcretedinbileandislostinfecesCoproporphyrinIIIisexcretedinurineHenceinnormalurineCoproporphyrinIis25%oftotalcoproporphyrinlevelsinurineDubinJohsonsyndrome,isaformofconjugatedhyperbilirubinemiaandiscausedbyadefectofMultiDrugResistantProtein2(MRP-2),whichisresponsibleforsecretingbilecomponents(conjugatedbilepigments)fromhepatocytesintobiliarycanaliculi.Inthisdisorder,theratioofCoproporphyrinI:CoproporphyrinIIIisreversedandcoproporhyrinIismorethan80%ofthetotalCoproporphyrinlevels.Butthetotalcoproporphyrinlevelsisnormal.PossiblemechanismisCoproporphyrinIissecretedintobilethroughMRP-2.
354.VitaminAdeficiencyleadstometaplasiaof?
a)Squamousepithelium
b)Columnarepithelium
c)Both
d)None
CorrectAnswer-AAnswer-A.SquamousmetaplasiaItoccursmostfrequentlyinrespiratorytractasaresultofchronicirritationbycigarettesmoking.Thecolumnarepitheliumisreplacedbysquamousepithelium.Thissquamousmetaplasiarepresentsanattemptbythehosttorepairorprepareanepithelialtissuethathasbeendamagedbyenvironmentaltoxicantswithamoreresistanttissue.Squamousmetaplasiaisalsoencounteredinotherlocationsuchaspancreaticduct(VitAdeficiency,stonesinpancreaticduct),gallbladder(gallstones),urinarybladder(bladdercalculi,Schistosomiasis),andinendocervix.Thoughthemetaplasiaisreversible,iftheinfluencesthatpredisposetometaplasiaispersistent,malignanttransformationmayoccurinmetaplasticepithelium.
355.Physiologicalhyperplasiaandhypertrophyareseensimultaneouslyin-
a)Uterusinpregnancy
b)Skeletalmuscleinatheleteas
c)Breastatpuberty
d)aandc
CorrectAnswer-DAns.is'a>c'i.e.,Uterusinpregnancy>BreastatpubertyPhysiologicalhypertrophyandhyperplasia*Examplesofphysiologicallyincreasedgrowthoftissuesinclude:--Skeletalmusclehypertrophyinatheletes,bothintheskeletalmuscleoflimbs(asaresponsetoincreasedmuscleactivity)andinleftventricleofheart(asaresponsetosustainedoutflowresistance).-Hyperplasiaofbonemarrowcellsproducingredbloodcellsinindividualslivingathighaltitude;thisisstimulatedbyincreasedproductionoftheerythropoietin.-Hyperplasiaofbreastatpuberty,andinpregnancyandlactation,undertheinfluenceofestrogen,progesterone,prolactinandhumanplacentallactogen.-Hypertrophyandhyperplasiaofuterinesmoothmuscleinpregnancy,stimulatedbyestrogen.-Thyroidhyperplasiaasaconsequenceoftheincreasedmetabolicdemandofpubertyandpregnancy.Foroption'c'-"Hormonalhyperplasiaiswellillustratedbytheproliferationoftheglandularepitheliumofthefemalebreastatpubertyandduringpregnancy,usuallyaccompaniedbyenlargement(hypertrophy)oftheglandularepithelialcell"-*However,IamnotsureaboutthisstatementofRobbin's,asno
*However,IamnotsureaboutthisstatementofRobbin's,asnoothertextbookhasmentionedthatbreastatpubertyundergobothhyperplasiaandhypertrophy.
356.Exampleofcoagulativenecrosisis-
a)Acutetubularnecrosis
b)Stroke
c)Malignanthypertension
d)Acutepancreatitis
CorrectAnswer-AAnswer-A.AcutetubularnecrosisThecausesofcoagulativenecrosisare:
1. Coagulativenecrosisismostfrequentlycausedbysuddencessationofbloodflow(ischemia)insolidorganssuchasheart(MI),Kidney(ATN),Liver,adrenalgland,spleen.Amongstsolidorgansbrainistheonlyexception,i.e.,itistheonlysolidorganinwhichischemialeadstoliquefactivenecrosisandnotcoagulativenecrosis.
2. Toxicproductsofcertainbacteria,asincalfdiphtheria,necrophorusenteritisandotherformsnecrobacillosis.
3. Certainlocallyactingpoisons,e.g.,mercuricchloride.4. Mildburns(thermalinjury),whetherproducedbyheat,electricity,or
x-rays.5. Zenker'sdegenerationnecrosisofmuscle.Itoccursintyphoid.
Rectusanddiaphragmaretheusualmusclesaffected
357.Dystrophiccalcificationisseenin?
a)Milkalkalisyndrome
b)Atheromatousplaque
c)Hyperparathyroidism
d)VitaminAintoxication
CorrectAnswer-BAns.is'b'i.e.,AtheromatousplaqueDystrophiccalcification*Whenpathologicalcalcificationtakesplaceindead,dyingordegeneratedtissue,itiscalleddystrophiccalcification.oCalciummetabolismisnotalteredandserumcalciumlevelisnormal.Dystrophiccalcificationindeadtissues1.Incaseousnecrosisoftuberculosis(mostcommonwhichmaybeinlymphnodes)2.Chronicabscessinliquifactivenecrosis3.Fungalgranuloma4.Infarct5.Thrombi6.Haematomas7.Deadparasites-Cystecercosis/ToxoplasmaHydatid/Schistosoma8.Infatnecrosisofbreast&othertissues
Dystrophiccalcificationindegeneratedtissues
1. Atheromatousplague2. Monkeberg'ssclerosis3. Psommamabodies4. Densoldscars5. Seniledegenratedchangessuch
asincostalcartilage,tracheal,bronchialrings,Pinealglandinbrain.
6. Heartvalvesdamagedbyrheumaticfever.
Howdoescalcificationoccursinthesesitewithnormalserumcalcium?*Calcificationofdeadanddyingcellsandtissuesisacommonfindinginhumanpathologicconditions.*Denaturedproteinsindeadorirreversibledamagedtissuespreferentiallybindphosphateions.*Phosphateionsreactwithcalciumionstoformaprecipitateorcalciumphosphate.*Thus,necrotictissueservesasacalciumsink.
358.Whatisthefirstsignofinjury?
a)Mitochondrialdysfunction
b)Membranedamage
c)DiminishedATP
d)Releaseoflysosomalenzymes
CorrectAnswer-AAnswer-A.Mitochondrialdysfunctionhypoxiaisthemostcommoncauseofcellinjury.OxygenisanimportantrequirementofmitochondriafortheformationofATP;therefore,hypoxiawillresultintheearliestinvolvementofmitochondriaresultingindecreasedformationofATP.DiminishedATPconstitutesthecriticalmechanismofthecellularinjurywhichleadsto:a.IntracellularaccumulationofCa+2b.Mitochondrialdysfunctionc.Membranedamaged.Releaseoflysosomal(hydrolytic)enzymes
359.Blebsarefoundinwhichtypeofinjury?
a)Reversible
b)Irreversible
c)Both
d)None
CorrectAnswer-AAnswer-A.ReversiblePathologicalfeaturesofreversiblecellinjuryare:Cellularswelling(earliest);lossofmicrovilli;cytoplasmicmembraneblebs;ERswelling;Myelinefigures;detachmentofribosomefromER;cytoplasmic(lipid)vacuole;clumpingofchromatin.
360.Hydropicchangeisdueto-
a)Accumulationofwaterintracellularly
b)Fataccumulationintracellularly
c)Lysozymedegeneration
d)Glycogenaccumulationintracellularly
CorrectAnswer-AAnswer-A>AccumulationofwaterintracellularyHydropicchange(abominoiddegeneration,hydropicdegeneration,parenchymatousdegeneration,cloudyswelling)ofacellisdegenerativechange,inwhichthecellsswellduetoinjurytothemembraneaffectingIonictransfer,causingthecytoplasmtoappearcloudyandwatertoaccumulatebetweenthecells,withresultantSwellingofthetissue.Cellularswelling(hydropicchange)istheearliestchangeincellinjury(reversible).
361.Nucleiarearrangedatthecellperipheryinwhichtypeofcell?
a)Langhansgiantcell
b)Merkelcells
c)NKcells
d)Neutrophils
CorrectAnswer-AAnswer-A.LanghansgiantcellPeripheralnucleiareseeninLanghanstypegiantcellsLanghansgiantcellsarelargecellsfoundingranulomatousconditions.Theyareformedbythefusionofepithelioidcells(macrophages)andcontainnucleiarrangedinahorseshoe-shapedpatterninthecellperiphery.Thesecellscontain3-5nuclei.Nucleiarearrangedaroundtheperipheryintheformofahorseshoe.Thesecellsmayalsoactasprecursorsofforeignbodygiantcells.ThesecellsareseeninTB&sarcoidosis.
362.NottrueaboutVEGFis-
a)Highlyspecificforendothelium
b)Hypoxiapotentiatesitsexpression
c)Inhibitsangiogenesis
d)Helpsintumormetastasis
CorrectAnswer-CAnswer-C.InhibitsangiogenesisVascularendothelialgrowthfactor(VEGF)isapotentangiogenicfactorandwasfirstdescribedasanessentialgrowthfactorforvascularendothelialcells.VEGFisup-regulatedinmanytumorsanditscontributiontotumorangiogenesisiswelldefined.Inadditiontoendothelialcells,VEGFreceptorsareexpressedonnumerousnon-endothelialcellsincludingtumorcells.Bindstoendo-specificreceptorsFlt-1andFlk-1(ofthetyrosinekinasefamily).ExpressionofVEGFpotentiatedbyhypoxiaandinactivationofp53.ThetwomostimportantangiogenicfactorsinatumorareVEGFandbasicfibroblastgrowthfactor(bFGF),thushelpingintumormetastasis.
363.Endothelialmoleculeinvolvedinrollingis-
a)ICAM1
b)VCAM1
c)CD31
d)CD34
CorrectAnswer-DAnswer-D.CD34Endothelialmolecule-MajorRoleP-selectin-RollingE-selectin-RollingandadhesionGlyCam-1,CD34-RollingICAM-1(Immunoglobulinfamily)-Adhesion,arrest,transmigrationVCAM-1(Immunoglobulinfamily)-AdhesionPECAM-1(CD-31)-Diapedesis(transmigration)
364.Acutephasereactantsarestimulatedby-
a)IL-6
b)IL-1
c)TNF-a
d)Alloftheabove
CorrectAnswer-DAnswer-D.AlloftheaboveInresponsetoinjury,localinflammatorycells(neutrophilgranulocytesandmacrophages)secreteanumberofcytokinesintothebloodstream,mostnotableofwhicharetheinterleukinsIL6andIL8,andTNFa.Theliverrespondsbyproducingalargenumberofacute-phasereactants.
365.Vasodilatationfollowingendothelialdamageisdueto?
a)Histamine
b)IL-2
c)TGF-3
d)FGF
CorrectAnswer-AAnswer-A.HistamineVasodilatation:-Histamine,prostaglandins(PGD2,PGE2),prostacyclins,serotonin,Nitricoxide,bradykinin
366.Lymphotactiniswhichtypeofchemokine?
a)C
b)C-C
c)C-X-C
d)C-X3-C
CorrectAnswer-CAnswer-C.C-X-CC-chemokines:-Theyarespecificforlymphocytes,e.g.lymphotactin.
367.Primarygranulescontainwhichenzyme?
a)Myeloperoxidase
b)Hydrolases
c)Lactoferrin
d)PhospholipaseA2
CorrectAnswer-AAnswer-A.MyeloperoxidaseMyeloperoxidaseLysozymeAcidhydrolasesElasasesNonspecificcollegenaseBacterialpermeabilityproteinDefensin(BPI)CathepsinGPhospholipaseA2
368.Activecompoundsecretedbyneutrophillsagainstpathogenisknownas?
a)Majorbasicprotein
b)Myeloperoxidase
c)Hydrolase
d)Proteoglycans
CorrectAnswer-BAnswer-B.MyeloperoxidaseTheazurophilicgranulesofneutrophilscontaintheenzymemyeloperoxidase(MPO),whichInthepresenceofahalidesuchasCl-,convertesH202tohypochlorite(HoC1).
369.Peroxidaseenzymefoundinneutrophillsisusedfor-
a)Macrophageactivation
b)Chemotacticagent
c)Microbialkilling
d)Vasodilatation
CorrectAnswer-CAnswer-C.MicrobialkillingPeroxidase(myeloperoxidase)isinvolvedinphagocytosis(microbialkilling).
370.Whichoneofthefollowingstatementsiscorrectregardingchronicgranulomatousdisease?
a)Itisanautosomaldominantdisease
b)Itischaracterizedbyabnormalbacterialphagocytosis
c)Recurrentstreptococcalinfectionsareusualinthisdisease
d)Nitrobluetetrazoliumtestisusefulforscreening
CorrectAnswer-DAns.is'd'i.e.,NitrobluetetrazoliumtestisusefulforscreeningLeukocytesfromthepatientsofchronicgranulomatousdiseasefailtoreducenitrobluetetrazolium(NBT)duringphagocytosis.Thispropertyhasbeenusedasascreeningmethod(NBTtest)forthediagnosisofchronicgranulomatousdisease.Chronicgranulomatousdisease(CGD)Itisagroupofdisordersofgranulocyteandmonocyteoxidativemetabolism.InheritanceX-linked(Mostcommon)AutosomalrecessivePhagocytosisisnormalbutleukocytesdonotundergodegranulationfollowingphagocytosis.ThediminishedH202productionappearstobethemajorreasonfordefectivebactericidaldefect.MutationinthegenesforthefourproteinsthatassembleattheplasmamembraneaccountforallpatientswithCGD:Twoproteinsformtheheterodimercytochromeb-558intheplasmamembrane.
TwootherproteinsinteractwithcytochromeaftercellactivationtoformNADPHoxidaserequiredforHydrogenperoxideproduction.Thebacteriainvolvedinrecurrentinfectionsarecatalasepositivepyogenicpathogenssuchasstaphylococciandcoliforms.Catalasenegativepathogenssuchasstreptococciandpneumococciarehandlednormally.Thereisexcessiveinflammationwithgranulomasformation.
371.Mostcommoncauseofchronicgranulomatousdiseaseinchildrenis:
a)Myeloperoxidasedeficiency
b)Defectivephagocytosis
c)DefectiveH2O2production
d)Job'sdisease
CorrectAnswer-CAnswerisC(DefectiveH2O2production)Chronicgranulomatousdiseaseisa'disorder'ofmicrobialkilling'characterizedbydecreasedabilityofneutrophilstoproduceH4)-QChronicgranulomatousdiseaseisa'disorder'ofmicrobialkilling'characterizedbydecreasedabilityofneutrophilstoproduceH,O2.QPatients,herebecomesusceptibletodiseasecausedbyorganismsthatproduce`catalase',whichdestroysthesmallamountofH2O,presentinthesecellsandleadstofailureofbacterialkilling.Thediseaseiscalledso,becausegranulomas,areformedinvarioustissues,asasecondlinedefenceagainstorganisms,thatnormallywouldberemovedbytheacuteinflammatoryresponse.Manifestations:Recurrentinfectionswithwhichcatalase+vePyogenicbacteriae.g.staph/coliforms.Q
-catalasenegativebacteriae.g.streptococcus,Pneumococcusareoftenhandlednormally.Q
Normalhumoralimmuneresponse?butDefectivekillingprocess:LeucocytesareunabletokillbacteriaafterphagocytosisthemajorreasonbeingdecreasedproductionofH-O2.Q
Screeningmethod:NBTtest:Nitroblueretrazoliumdyeisnotreducedbyneutrophilsinvitro.
372.Delayedumbilicalcorddetachmentleukocytosisisseenin?
a)Leukocyteadhesiondeficiency
b)Chronicgranulomatousdisease
c)Severecombinedimmunodeficiency
d)Noneoftheabove
CorrectAnswer-AAnswer-A.LeukocyteadhesiondeficiencyLeukocyteadhesiondeficiencytype1isadisorderthatcausestheimmunesystemtomalfunction,resultinginaformofimmunodeficiencyOneofthefirstsignsofleukocyteadhesiondeficiencytype1isadelayinthedetachmentoftheumbilicalcordstumpafterbirth.Innewborns,thestumpnormallyfallsoffwithinthefirsttwoweeksoflife;but,ininfantswithleukocyteadhesiondeficiencytype1,thisseparationusuallyoccursthreeweeksorlater.Also,affectedinfantsoftenhaveinflammationoftheumbilicalcordstump(omphalitis)duetoabacterialinfection.It'sduetotheabsenceofCD18antigenthat'snecessaryfortheformationofintegrins,thesubstancesthatareresponsibleforthesecondstepofleukocytemigration:adhesion.Becausetheleukocytescannotefficientlyreachthesiteofinsult,theycannotengulftheoffendingsubstance,andnopuswillbeevident.Also,asacompensatorymechanism,theremaybeexcessiveleukocytosis.
373.Decreaseinplasmaosmoticpressureiscauseofedemain?
a)CHF
b)DVT
c)Nephroticsyndrome
d)None
CorrectAnswer-CAnswer-C.NephroticsyndromeDecreasedplasmaosmoticpressureofcapillaries:Itcausesdecreasesininwarddrivingforce.ItresultsfromHypoproteinemia.Whentotalplasmaproteinisbelow5gm/dl(normal6-8gm/d1)oralbuminisbelow2.5gm/dl(normal3.5-5gm/dl)edematakesplace.Conditionscausinghypoproteinemiaarenephroticsyndrome,livercirrhosis,proteinlosingenteropathy,andPEM.
374.Normaltimetakenforscarformationafterinjuryis?
a)2weeks
b)3weeks
c)4weeks
d)5weeks
CorrectAnswer-CAnswer-C.4weeksImmediatelyafterincision:Incisionisfilledwithbloodclotcontainingfibinandbloodcells(including),dehydrationofsurfaceclotformsscabonsurface.Within24hours:Neutrophilsappearatthemarginofwound,whichisfilledwithbloodclot.24-48hours:Epithelialcellsmovefromwoundedgesandfuseinthemidlinebeneaththesurfacescab,producingacontinuousbutthinepitheliumlayerthatclosesthewound.Day3:Neutrophilsarereplacedbymacrophages,granulationtissueappears,collagenfibersarepresentinthemarginbutdonotbridgetheincision.Day5:Abundantgranulationtissue,maximumneovascularization,abundantcollagenwhichbridgestheincision,theepidermisrecoversitsnormalthickness.2ndweek:Diappearanceofleukocytesandedema,presenceoffibroblasts(derivedfromlocalmesenchyme)andmaximumcollagen.Endof1month:Thereisscarwhichismadeupofcellularconnectivetissuedevoidofinflammatoryinfiltratecoverednowbyintactepidermis.ThereisreplacementofcollagentypeIIIwithcollagentypeI.
collagentypeI.
375.Whichtypeofhealingoccursinanincisionalwoundwithinfection?
a)Primary
b)Delayedprimary
c)Secondary
d)Tertiary
CorrectAnswer-CAnswer-C.SecondaryItsproducedbysharpcuttinginstruments-knife,razor,blade,swords,chopper,axeetc.Secondaryhealingoccursinanincisionalwoundwithinfection.
376.Allofthefollowingcelltypesundergocelldivision,EXCEPT:
a)Pericyte
b)Cardiacmusclecell
c)Smoothmusclecell
d)Satellitecellofskeletalmuscle
CorrectAnswer-BMyocytecelldivisioninthehumanheartceasesafewweeksafterbirth.Thereafter,enlargementoftheheartisasaresultofcellhypertrophyorthelayingdownofcollagenintheextracellularspace.DNAturnoverisalmostundetectableexceptinpathologicstates.Approximately20%ofmyocytesinthehumanhearthavetwonuclei,sothatcellseparation,ratherthanmitosis,couldbringaboutasmallincreaseinthetotalcellnumber.Ref:FrancisG.S.,TangW.,WalshR.A.(2011).Chapter26.PathophysiologyofHeartFailure.InV.Fuster,R.A.Walsh,R.A.Harrington(Eds),Hurst'sTheHeart,13e.
377.Geneforembryogenicstemcellis-
a)Oct-4
b)Nanog
c)GJAI
d)Alloftheabove
CorrectAnswer-DAnswer-D.AlloftheaboveAcommonsubsetof92geneswasidentifiedthatincludedNanog,GTCM-1,connexin43(GJA1),oct-4,andTDGF1(cripto)."
378.Complementmediatedhypersensitivityreactionis?
a)Type-1hypersensitivity
b)Type-2hypersensitivity
c)Type-4hypersensitivity
d)None
CorrectAnswer-BAnswer-B.Type-2hypersensitivityTypeIIreactions(Antibodymediated)→InvolveimmunoglobulinGorImmunoglobulinMboundtocellsurfaceantigen,withsubsequentcomplementfixation.
379.T-cellmediateddiseaseis?
a)Asthma
b)Myastheniagravis
c)SLE
d)Sarcoidosis
CorrectAnswer-DAnswer-D.SarcoidosisTypeI(IgEmediated)EczemaHayfeverAsthmaAtopyUrticariaAnaphylacticshockAcutedermatitisTheobaldsmithphenomenonPrausnitzKusnter(PK)reactionCasonistestSchultz-DalephenomenonTypeII(IgG,IgMandcomplementmediated)BloodtransfusionreactionsErythroblastosisfetalisAutoimmunehemolyticanemiaorthrombocytopeniaoragrnulocytosis4PemphigusvulgarisGoodpasturesyndromeBullouspemphigoidPerniciousanemia
AcuterheumaticfeverDiabetesmellitusGravesdiseaseMyastheniagravisTypeIII(IgG,IgM,complementandleucocytemediated)Local-ArthusreactionSystemic-serumsicknessSchicktestPolyarteritisnodosa(PAN)RheumatoidarthritisSLEAcuteviralhepatitisPenicillaminetoxicityHyperacutegraftrejection
380.Type4hypersensitivityreactiontoTBantigenissimilartowhichofthefollowing?
a)Serumsickness
b)Asthma
c)Myastheniagravis
d)Temporalarteritis
CorrectAnswer-DAnswer-D.TemporalarteritisTypeIV(T-Cellmediated)TuberculintestLepromintestSarcoidosisTuberculosisContactdermatitisGranulomatousinflammationTypeIleprareactionPatchtestTemporalarteritisJonesmotereaction(cutaneousbasophilicHSN)GraftrejectionFairleystestFrie'stest
381.NonIgEmediatedanaphylacticreactionincludes-
a)IgG
b)IgM
c)Compliments
d)Alloftheabove
CorrectAnswer-DAnswer-D.AlloftheaboveCytotoxicreactionscanalsocauseanaphylaxis,viacomplementactivation.Antibodies(IgGandIgM)againstredbloodcells,asoccursinamismatchedbloodtransfusionreaction,activatecomplement.Thisreactioncausesagglutinationandlysisofredbloodcellsandperturbationofmastcellsresultinginanaphylaxis
382.TrueaboutMHC-classII-
a)Notinvolvedininnateimmunity
b)CytotoxicT-cellinvolved
c)Presentinnucleatedcells
d)All
CorrectAnswer-AAns.is'a'i.e.,NOTinvolvedininnateimmunityoMHCIandIIarepartofadaptiveimmunity.AmajorfunctionoftheMHCmoleculeistopresenttheantigentoTcellthatispartofadaptiveimmunity.CytotoxicTcellsareMHC-classIrestricted.MHCclassIIcomplexisfoundonlyoncellsoftheimmunesystem(classIisfoundonallnucleatedcellsandplatelets.)TheantigensbindingwithMHCIImoleculearepresentedtoCD4+Tcells.Asdiscussedearlier,helperTcells/CD4TcellsareMHCII-restricted.BcellshavebothMHCclassIandIIcomplexes.
383.MHC1isinvolvedin?
a)Tumorlysis
b)Mixedleukocytereaction
c)Autoimmunediseasesusceptibility
d)Alloftheabove
CorrectAnswer-AAnswer-A.TumorlysisMHCclassImoleculesarepresentonallnucleatedcells,allvirus-infectedcellscanbedetectedandeliminatedbyCD8+CytotoxicTlymphocytes.MHCclassIisresponsibleforgraftrejectionandcell-mediatedcytolysisofviralinfectedortumorcells.
384.CD4isassociatedwithHLA?
a)HLA1
b)HLA2
c)HLA3
d)Alloftheabove
CorrectAnswer-BAnswer-B.HLA2MHC-IIrecognizesexogenousantigen(extracellularmicrobes,solubleproteins)andpresentittoCD4helperTcells(MHC-IIrestricted).MHCclassIpresentantigentocytotoxicCD-8Tcells(MHC-Irestricted).
385.Memorycellsare:September2004
a)Basophils
b)Eosinophils
c)Lymphocytes
d)Neutrophils
CorrectAnswer-CAns.Ci.e.Lymphocytes
386.WhichofthefollowinginterleukinissecretedbyThelper2cells?
a)IL11
b)IL7
c)IL1
d)IL13
CorrectAnswer-DAns.is'd'i.e.,IL13A)Thelper-1(TF,')secretes4IL-2andinterferon-yB)Thelper-2(T02)secretes->IL-4,IL-5,IL-6,IL-13
387.AllaretrueaboutTolllikereceptorsexcept?
a)Recognizemicrobialmolecules
b)Activationofimmunesystem
c)Regulationofcalciumchannel
d)Activationoftranscriptionfactors
CorrectAnswer-CAnswer-C.RegulationofcalciumchannelToll-likereceptors(TLRs)aremicrobialsensorsthatarenamedforthefoundingmembercalledToll,whichwasdiscoveredinDrosophila.TherearetenmammalianTLRs,whichrecognizeproductsofbacteria(suchasendotoxinandbacterialDNA),viruses(suchasdouble-strandedRNA),andotherpathogens(Fig.2–3,A).TLRsarelocatedinplasmamembranesandendosomes,sotheycandetectextracellularandingestedmicrobes.Theyarecomplementedbycytoplasmicandmembranemolecules,fromseveralotherfamilies,thatalsorecognizemicrobialproducts.TLRsandtheotherreceptorsrecognizeproductsofdifferenttypesofmicrobesandthusprovidedefenseagainstessentiallyallclassesofinfectiouspathogens.Recognitionofmicrobesbythesereceptorsactivatestranscriptionfactorsthatstimulatetheproductionofseveralsecretedandmembraneproteins.Theseproteinsincludemediatorsofinflammation,antiviralcytokines(interferons),andproteinsthatpromotelymphocyteactivationandevenmorepotentimmuneresponses.
388.Tolllikereceptorsareseenon?
a)Macrophages
b)Naturalkillercells
c)Endothelialcells
d)Alloftheabove
CorrectAnswer-DAnswer-D.AlloftheaboveTheToll-likereceptorsarernembraneproteinsthatrecognizeavarietyofmicrobe-derivedmoleculesandstimulateinnateimmuneresponsesagainstthemicrobes.TheToll-likereceptorsareexpressedonmanydifferentcelltypesthatparticipateininnateimmuneresponsesincluding,macrophages,dendriticcells,neutrophils,NKscells,mucosalepithelialcellsandendothelialcells.
389.ThemostcommonorgantobeinvolvedintheacutephaseofGraftvshostdiseaseis?
a)Bonemarrow
b)Skin
c)Liver
d)Gut
CorrectAnswer-BAnswer-B.SkinAcuteGraftvshostdisease(occurringdaystoweeksaftertransplantation)causesepithelialcellnecrosisinthreeprincipaltargetorgans:liver,skin,andgut.Destructionofsmallbileductsgivesrisetojaundice,andmucosalulcerationofthegutresultsinbloodydiarrhea.Cutaneousinvolvementismanifestedbyageneralized(maculopapular)rash.Histologicalfindingsare-
1. Perivascularmononuclearinfiltrates.2. Vacuolardegradationofdermo-epidermaljunction.3. Dyskeratoticcellsoreosinophilicbodiesintheepidermis.4. Epidermolysis.5. Denudationofepidermis(separationoftheepidermisfromthe
dermis).
390.NormalvalueofCD4:CD8ratiois-
a)0.5
b)1
c)1.5
d)2
CorrectAnswer-DAnswer-D.2AnormalCD4/CD8ratiois2.0,withCD4lymphocytesequaltoorgreaterthan400/mm3andCD8lymphocytesequalto200to800/mm3.
391.Morethan90%patientsofCRESTsyndromewiththelimitedcutaneousformofthisdisordermakewhichofthefollowingautoantibodies?
a)Anti-centromere
b)Anti-DNAtopoisomerasel
c)Anti-double-strandedDNA
d)Anti-Golgi
CorrectAnswer-AAllformsofsclerodermaarethoughttohaveastrongautoimmunecomponent,andglucocorticoidsandazathioprineareusedtosuppresstheinflammatorycomplicationsofscleroderma.(Otherdrugsthatcanbeusedintherapyincludepenicillamine,whichinhibitscollagencross-linking,NSAIDSforpain,andACEinhibitorstoprotectthekidneyifhypertensionorrenaldamageoccurs).Theanti-centromereantibodyisquitespecificforCRESTsyndrome(96%ofcases),andisonlyseeninaminorityofpatientswithdiffusescleroderma(mainlythosewithRaynaud'sphenomenon)andrarelyinsystemiclupuserythematosusandmixedconnectivetissuedisease.Alsoknow:Anti-DNAtopoisomeraseI,alsocalledanti-Scl-70occurscommonly(64-75%)indiffuse
scleroderma,butonlyrarelyinCRESTsyndrome.
Anti-double-strandedDNAisfairlyspecificforsystemiclupuserythematosus,althoughitonlyoccursin50-60%oflupuscases.
Anti-GolgiantibodiesareseenmostofteninsystemiclupuserythematosusandSjögrensyndrome.Ref:HellmannD.B.,ImbodenJr.J.B.(2013).Chapter20.Musculoskeletal&ImmunologicDisorders.InM.A.Papadakis,S.J.McPhee,M.W.Rabow(Eds),CURRENTMedicalDiagnosis&Treatment2013.
392.AntiJo-1antibodiesareafeatureassociatedwith?
a)SLE
b)Systemicsclerosis
c)Polymyositis
d)Rheumatoidarthritis
CorrectAnswer-CAnswer-C.PolymyositisAnti-Jo-1antibodyisamyositisspecificautoantibodymostcommonlyfoundinpatientswithidiopathicinflammatorymyopathies(UM).
393.HLAmarkerassociatedwithdiabetesmellitustype1is-
a)B7
b)DR4
c)DQ3
d)DQ4
CorrectAnswer-BAnswer-B.DR4HLAassociatedwithDM1areDR3,DR4,DR8,DQ8.
394.Expressionofageneisknownas?
a)Genotype
b)Phenotype
c)Genome
d)Morphology
CorrectAnswer-BAnswer-B.PhenotypeThegenotype(Thegeneticmakeupofanindividual)ofanorganismistheinheritedmapitcarrieswithinitsgeneticcode.Thegenotypeisthepart(DNAsequence)ofthegeneticmakeupofacell.Genotypeisoneofthreefactorsthatdeterminephenotype,theothertwobeinginheritedepigeneticfactors,andnon-inheritedenvironmentalfactors.
395.Group-Dchromosomeis?
a)Chromosome3
b)Chromosome6
c)Chromosome12
d)Chromosome15
CorrectAnswer-DAnswer-D.Chromosome1513-15-SixchromosomesslightlysmallerthantheCgroupwiththekinetochoresinanearterminalposition.
396.Acuteintermittentporphyriaisassociatedwithwhichtypeofinheritance?
a)Autosomaldominant
b)Autosomalrecessive
c)X-linkeddominant
d)X-linkedrecessive
CorrectAnswer-AAnswer-A.AutosomaldominantMetabolicFamilialhypercho-lesterolemiaAcuteintermittentporphyria
397.Inheritanceassociatedwithcongenitaladrenalhyperplasia-
a)AR
b)AD
c)XR
d)XD
CorrectAnswer-AAnswer-A.AREndocrine-CongenitaladrenalhyperplasiaAlbinism
398.InheritanceassociatedwithfragileX-syndromeis-
a)Autosomaldominant
b)Autosomalrecessive
c)X-linkeddominant
d)X-linkedrecessive
CorrectAnswer-CAnswer-C.X-linkeddominant'None>c'i.e.,X-linkeddominantTheunstabletripletistransmittedinanX-linkedinheritancebuttheprobabilitiesofdifferentphenotypesarefarfromtraditionalX-linkedinheritance.
399.HOXgeneisassociatedwith
a)Cranio-caudaldevelopment
b)Braindevelopment
c)Teethformation
d)Alloftheabove
CorrectAnswer-AAnswer-A.Cranio-caudaldevelopmentHOXgenes(asubsetofhomeoticgenes)areagroupofrelatedgenesthatcontrolthebodyplanofanembryoalongthecranio¬caudal(head-tail)axis.
400.ChromosomeforABOgeneis?
a)9q
b)10p
c)11q
d)12p
CorrectAnswer-AAnswer-A.9qTheABOgene(Histo-bloodgroupABOsystemtransferaseenzyme)residesonchromosome9attheband9q34.2.Histo-bloodgroupABOsystemtransferaseisanenzymewithglycosyltransferaseactivity,whichisencodedbytheABOgeneinhumans.Itisubiquitouslyexpressedinmanytissuesandcelltypes.
401.Barrbodyisfoundinthefollowingphaseofthecellcycle:
a)Interphase
b)Metaphase
c)GIphase
d)Telophase
CorrectAnswer-AAi.e.InterphaseTheinactiveXcanbeseenintheinterphasenucleusasadarklystainingsmallmassincontactwiththenuclearmembraneknownastheBarrbodyorXchromatin.BarrbodyistheinactivatedXchromosome.Innondividinginterphasecellsitremainstightlycoiledandcanbeseenasadarkstainingbodywithinthenucleus.
402.Trinucleotidesequenceassociatedwithspino-cerebellarataxiais?
a)CTG
b)CUG
c)GGG
d)CAG
CorrectAnswer-DAnswer-D.CAGHuntington'sdisease(CAGrepeat),Spinocerebellarataxia(CAGrepeat),Friedreichataxia(GAArepeat),Fragile-X-syndrome(GGGorGCCrepeat),Dystrophiamyotonica(CTG/CUGrepeat)
403.CA-125is?
a)Mucinglycoprotein
b)Carcinomatransmigrationantigen
c)Mucopolysaccharide
d)Lipid
CorrectAnswer-AAnswer-A.Mucinglycoprotein*CA-125,whichstandsfor“CancerAntigen125”alsoknownasmucin16orMUC16isaproteinthatinhumansisencodedbytheMUC16whichisamemberofthemucinfamilyglycoproteins.*Itisfoundinhighamountsinthebloodofpatientswithovariancancer.*CA-125isproducedonthesurfaceofcellsandisreleasedinthebloodstream.*Itisamongthebloodteststhatmaybeorderedbyadoctorifovariancancerissuspected.*CA-125isalsoelevatedincancersofendometrium,cervix,fallopiantubes,pancreas,breast,lungandcolon.*Non-neoplasticconditionscausingelevationofCA-125arepregnancy,menstruation,endometriosis,PID,abdominalTB,peritonitisanduterinefibroid.*referencerange:CA125is0-35units/mL(0-35kU/L).
404.ElevatedCA-125areseenin-
a)AbdominalTB
b)Cacervix
c)Endometriosis
d)All
CorrectAnswer-DAns.is'a'i.e.,AbdominalTB;'b'i.e.,Cacervix;'c'i.e.,EndometriosisElevatedlevelofCA-125isseenin*EpithelialovarianCancer*Nonovariantumors:-Cancersofendometrium,cervix,fallopiantubes,pancreas,breast,lungandcolon.*Nonmalignantconditions:-Pregnancy,mensturation,peritonitis,endometriosis,pelvicinflammatorydisease(abdominalTB)anduterinefibroids.
405.Li-fraumanisyndromeoccursduetomutationingene?
a)p53
b)p16
c)p41
d)p12
CorrectAnswer-AAnswer-A.p53Li-Fraumenisyndromeisduetogermlinemutationinp-53gene.
406.FollowinggeneticcounsellinginafamilyforFamilialpolyposiscoli(FPC)nextscreeningtestis
a)Flexiblesigmoidoscopy
b)Colonoscopy
c)Occultbloodinstools
d)APCgene
CorrectAnswer-DAns.is'd'i.e.APCgeneSchwartzwrites-"Flexiblesigmoidoscopyoffirst-degreerelativesofFAP(Familialadenomatouspolyposis)patientsbeginningatage10to15yearshasbeenthetraditionalmainstayofscreening.Todayfollowinggeneticcounselling,APCgenetestingmaybeusedtoscreenfamilymembersprovidinganAPCmutationhasbeenidentifiedinafamilymember."Familialadenomatouspolyposis(FAP)isadominantlyinheritedcoloncancersyndromeduetogermlinemutationsintheadenomatouspolyposiscoli(APC)tumorsuppressorgeneonchromosome5.Patientswiththissyndromedevelophundredstothousandsofadenomasinthecolonwhichifleftuntreatedwilleventuallydevelopintocoloncancer.EachoftheFAPadenomashaslostthenormalremainingalleleofAPCgenebuthasnotyetaccumulatedtherequiredadditionalmutationstogeneratefullymalignantcells.Induecourseoftimemanyoftheseadenomasacquirefurthergeneticabnormalitiesanddevelopintofullymalignantcancers.APCgeneisthusconsideredto
beagatekeeperforcolontumorigenesis.ThedetectionofAPCgenemutationinfamilymembersofaFAPpatienthelpsinmakingadefinitivediagnosisbeforethedevelopmentofpolyps.
407.Mostcommontumorsuppressorgeneinvolvedincancergenesisis?
a)Rb
b)p53
c)p16
d)p73
CorrectAnswer-BAnswer-B.p53p-53isthemostcommontargetforgeneticalterationinhumantumors;Alittleover50%ofhumantumorscontainmutationinthisgene.
408.Allarepre-malignantconditionsexcept-
a)Anaplasia
b)Metaplasia
c)Hamartoma
d)Dysplasia
CorrectAnswer-CAprecancerousconditionisaconditionorlesioninvolvingabnormalcellsthatareassociatedwithanincreasedriskofdevelopingintocancer.Clinically,precancerousconditionsencompassavarietyofconditionsorlesionswithanincreasedriskofdevelopingintocancer.Dysplasiaisabroadtermthatreferstotheabnormaldevelopmentofcellswithintissuesororgans.Itcanleadtoawiderangeofconditionsthatinvolveenlargedtissueorpre-cancerouscells.Anaplasiaisaconditionofcellswithpoorcellulardifferentiation,losingthemorphologicalcharacteristicsofmaturecellsandtheirorientationconcerningeachotherandtoendothelialcells.Thetermalsoreferstoagroupofmorphologicalchangesinacell(nuclearpleomorphism,alterednuclear-cytoplasmicratio,presenceofnucleoli,highproliferationindex)thatpointtoapossiblemalignanttransformation.Suchlossofstructuraldifferentiationisespeciallyseeninmost,butnotall,malignantneoplasms.Ahamartomaisabenign(noncancerous)tumorlikemalformationmadeupofanabnormalmixtureofcellsandtissuesfoundinareasofthebodywheregrowthoccurs.Itisconsideredadevelopmentalerrorandcanoccuratseveralsites.consideringtheabovetermshamartomaisnotaprecancerouscondition
409.Softwoodexposureleadsto-
a)Nasaladenocarcinoma
b)Skincancer
c)Livercancer
d)Bladdercancer
CorrectAnswer-AAnswer-A.Nasaladenocarcinoma"Thereislittledoubtthatexposuretohardwooddusts(especiallythatofbeech6,oak)inthefurnitureindustry,aswellassomedomesticsoftwoodoutsidetheindustry,isassociatedwithsino-nasalcancers.Amongtheneoplasias,nasaladenocarcinomaisthecancermostcommonlyfoundinwoodworkers."
410.Atwhichcellcyclecheckpointisthecellcyclehaltedifthecell'sDNAisdamaged?
a)GI-S
b)S-G2
c)G2-M
d)GO-GI
CorrectAnswer-A:CAnswer-(A)GI-S(C)G2-MTheSphaseisthepointofnoreturninthecellcycle,andbeforethecellmakesthefinalcommitmenttoreplicate,theG,/ScheckpointchecksforDNAdamage.IfDNAdamageispresent,theDNArepairmachineryandmechanismsthatarrestthecellcycleareputinmotion.ThiscausesdelayatGiScheckpoint.ThischeckpointinusedfortherepairoftheDNAwhichisdamagedafteritsreplication
411.Malignancyassociatedwithhypercalcemia:
a)Breastcancer
b)Smallcelllungcancer
c)Non-smalllungcancer
d)Prostatecancer
e)Multiplemyeloma
CorrectAnswer-A:C:D:EAnswer-A,BreastcancerC,Non-smalllungcancerD,ProstatecancerE,MultiplemyelomaLungcarcinoma,breastcarcinoma,andmultlplemyelomaaccountformorethan50%ofallcasesofmalignancy-associatedhypercalcemia.Gastrointestinaltumarsandprostatecarcinomaarelesscommoncausesofhypercalcemia.
412.AFPisraisedin-
a)Yolksactumor
b)Seminoma
c)Teratoma
d)aandc
CorrectAnswer-DAns.is'a'i.e.,Yolksactumor;'c'i.e.,teratomaAFPisaglycoproteinsynthesizednormallyearlyinfetallifebyyolksac,fetalliverandfetalGIT.Itisstructurallyandgeneticallyrelatedtoalbumin.AFPisraisedinlivercancer(hepatocellularcarcinoma),lungcarcinoma,pancreaticcarcinoma,coloncarcinoma,andnon‐seminomagermcelltumoroftestis/ovary(yolksactumor/endodermalsinustumor,embryonalcarcinoma,teratoma).
413.Immunohistochemicalmarkerforsentinelnodebiopsyforbreastcarcinomais?
a)Cytokeratin
b)Vimentin
c)Calretinin
d)CD45
CorrectAnswer-AAnswer-A.CytokeratinCytokeratin-Carcinoma
414.Scavengerreceptorsarefor?
a)OxidizedLDL
b)ReducedLDL
c)HDL
d)VLDL
CorrectAnswer-AAnswer-A.OxidizedLDLOxidizedLDLhasfollowingeffects
1. Ingestedbymacrophagesthroughthescavengerreceptor,distinctfromLDLreceptors,thusformingfoamcells.
2. Increasesmonocyteaccumulationinlesions.3. Stimulatesreleaseofgrowthfactorsandcytokines.4. Iscytotoxictosmoothmusclecellsandendothelialcells
415.Causesofconstrictivepericarditisis/are?
a)T.B.
b)SLE
c)Brucellosis
d)aandb
CorrectAnswer-DAns.is'a'i.e.,T.B.;b'i.e.,SLECausesofconstrictivepericarditis*Tuberculosis(mostcommoncause)*Pericardialmalignancies(especiallybreast,lung)*Post-viralpericarditis(especiallyhemorrhagic)*Drugs(e.g.Hydralazine,Procainamide,minoxidil,phenytoin)*Bacterial(purulent)pericarditis*Trauma/post-cardiacsurgery→haemopericardium*Fungalpericarditis(Histoplasmosis)*Connectivetissuedisorders(e.g.SLE,RA,Sarcoidosis)*Parasiticpericarditis(toxoplasmosis,trichonosis)*Dresslersyndrome*Mediastinalradiotherapy*Renalfailure
416.Characteristichistopathologicalfeatureofrheumaticheartfailureis-
a)Aschoff'snodule
b)McCallumnpatch
c)Bread&butterpericarditis
d)Shaggyvegetation
CorrectAnswer-AAnswer-A.Aschoff'snoduleMicroscopically,Aschoffbodiesareareasofinflammationoftheconnectivetissueoftheheart,orfocalinterstitialinflammation.FullydevelopedAschoffbodiesaregranulomatousstructuresconsistingoffibrinoidchange,lymphocyticinfiltration,occasionalplasmacells,andcharacteristicallyabnormalmacrophagessurroundingnecroticcenters.Someofthesemacrophagesmayfusetoformmultinucleatedgiantcells.OthersmaybecomeAnitschkowcellsor"caterpillarcells,"sonamedbecauseoftheappearanceoftheirchromatin.MyocardiuminvolvementresultsinmyocarditiswithAschoffbodies.Endocardiuminvolvementleadstotheformationofsmallwartyprojections(verrucae)alongthelineofclosureofvalvularleaflets,mostlyonthemitralvalve.Theyarepathognomicfocioffibrinoidnecrosisfoundinmanysites,mostoftenthemyocardium.Initially,theyaresurroundedbylymphocytes,macrophages,andafewplasmacells,buttheyareslowlyreplacedbyafibrousscar.Aschoffbodiesarefoundinallthethreelayersoftheheart,theleastchanceinthepericardium.
417.Prostheticvalvesarepredisposedto-
a)Thromboembolism
b)Infection
c)Hemolysis
d)Alloftheabove
CorrectAnswer-DAnswer-D.AlloftheaboveThrombo-emboliceventsBleedingProstheticheartvalveobstructionorstenosisProstheticheartvalveregurgitation(valvularandparavalvular)InfectiveendocarditisHemolyticanemiaPatient-prosthesismismatch.
418.Mostfrequenttimeperiodbetweenmyocardialinfarctionandsubsequentmyocardialruptureis-
a)3-4days
b)4-8days
c)1-3weeks
d)3-6weeks
CorrectAnswer-AAnswer-A.3-4daysMyocardialrupturemayoccuralmostanytimeduring3weeksafteracutemyocardialinfarction,butismostcommonbetweenthefirstandfourthdays,whentheinfractedwallisweakest.
419.Infarctsinvolvingwhichportionofthemyocardiumcauseaneurysmasapost-MIcomplication-
a)Subendocardial
b)Anteriortransmural
c)Posteriortransmural
d)Inferiorwall
CorrectAnswer-DAnswer.D.InferiorwallLeftventricularaneurysmformation:Leftventricularapicalaneurysmformationusuallyoccursfollowingantero-apicalmyocardialinfarction,afterLADocclusion.Thisweakeningoftheapicalwallresultsinanoutpouchingor“dyskinesis”oftheapexoftheheartduringsystole.
420.Inpatientswithhypertrophiccardiomyopathymaximummutationsarefoundinwhichgene:
a).β-myosinheavychain
b)Elastin
c).α-tropomyosin
d)TroponinT
CorrectAnswer-Aβ-MyosinheavychainMutationsingeneforβ-Mysoinheavychainareassociatedwith40%ofthefamilieswithhypertrophiccardiomyopathy.TroponinTmutations-15%ofthefamiliesα-tropomyosinmutations~5%ofthefamilies
421.Mutationinproteinassociatedwithrestrictivecardiomyopathy?
a)Myosinregulatoryproteins
b)Myosinbindingprotein-C
c)TroponinI
d)Tropomyosin
CorrectAnswer-CAnswer-C.TroponinIRCM-associatedmutationshavebeenreportedinfourgenesthatencodekeysarcomericproteins/myofilaments
1. MYH7gene-13-Myosinheavychain2. TNNI3gene-CardiactroponinItype33. TNNT2gene-CardiactroponinTtype24. ACTCgene-a-actin
MutationsintheTNNI3geneareoneofthemajorcausesofthiscondition.TheTNNI3geneprovidesinstructionsformakingaproteincalledcardiactroponinI,whichisfoundsolelyintheheart.CardiactroponinIisoneofthreeproteinsthatmakeupthetroponinproteincomplex,whichhelpsregulatetensing(contraction)andrelaxationoftheheartmuscle.TNNI3genemutationsassociatedwithfamilialrestrictivecardiomyopathyresultintheproductionofadefectivecardiactroponinIprotein.Thealteredproteindisruptsthefunctionofthetroponinproteincomplexanddoesnotallowtheheartmuscletofullyrelax.Asaresult,notenoughbloodenterstheventricles,leadingtoabuildupintheatriaandlungs.Theabnormalheartrelaxationandbloodflowisresponsibleformanyofthesignsandsymptomsoffamilial
restrictivecardiomyopathy.
422.Takayasuarteritismainlyaffects?
a)Pulmonaryartery
b)Celiacartery
c)Subclavianartery
d)SMA
CorrectAnswer-CAnswerisC(SubclavianArtery):SubclavianarteryisthesinglemostcommonarteryinvolvedinTakayasuarteritis.Takayasuarteritis:MostcommonsitesaffectedTakayasuarteritistypicallyinvolvesmediumandlargesizedarteriesIthasastrongpredilectionfortheaorticarchanditsbranches.TheinvolvementofthemajorbranchesoftheaortaismuchmoremarkedattheiroriginthandistallyThemostcommonlyaffectedarteriesasseenbyarteriographyinorderoffrequencyCoronary(<10%)Vertebral(35%)Coeliacaxis(18%)Pulmonary(10-40%)SuperiorMesenteric(18%)Iliac(17%)Subclavian(93%)CommonCarotid(58%)AbdominalAorta(47%)Renal(38%)
423.Strawberrygumsareseenin
a)Goodpasteur'ssyndrome
b)Classicpolyarteritisnodosa
c)Wegener'sgranulomatosis
d)Kawasakisyndrome
CorrectAnswer-CAnswer-C.Wegener'sgranulomatosisStrawberrygumsareseeninWegner'sgranulomatosis.StrawberrytongueisseeninKawasakidisease.
424.Strawberrygingivitisseenin
a)Myelocyticinfiltration
b)Phenytointoxicity
c)Wegnergranulomatosis
d)Klipelrenaunaysyndrome
CorrectAnswer-CWegener'sgranulomatosis[Ref:IADVLTextbookofDermatology3r9ep.695]Wegener'sgranulomatosisisknowntocauseoralmucosallesions."Strawberrygingivitisischaracteristicorallesionassociatedwithwegener'sgranulomatosis".Straberrygingivitisclinicallypresentswith:?'Swollenerythematousgumsclinicallyresemblingoverripestrawberries"Histologicallystrawberrygingivitisischaracterizedby
425.Heinzbodiesareremovedby?
a)Macrophages
b)Lymphocytes
c)Neutrophils
d)Fibroblasts
CorrectAnswer-AAnswer-A.Macrophages*TheunstablehemoglobinsarethosehemoglobinvariantsthatundergodenaturationandprecipitationwithintheredcellsasHeinzbodies.*Theygiverisetowhatisknownascongenitalnon-spherocytichemolyticanemiaorcongenitalHeinzbodyhemolyticanemia.*Thesedisordershaveeitherautosomaldominantinheritanceordevelopfromspontaneousmutations.*Theunstablehemoglobinsarisefromeitherasingleaminoacidsubstitutionintheglobinchainorduetodeletionofoneormoreaminoacidswithintheβ-globinchainsothatthefirmbondingofthehaemgroupwithinthemoleculeisdisturbedleadingtotheformationofmethemoglobinandprecipitationofglobinchainsasHeinzbodies.*Heinzbodiesarenotseenafterthefirstoneortwodayssincetheyareremovedbythespleen,leadingtotheformationof‘bitecells’andfragmentedredcells.*Macrophagesdetecttheantigenandremovethedamagedportionsofthecell,itsdamagedmembrane,andthedenaturedhemoglobin.*Theseareassociatedclinicallywithcongenitalhemolyticanemia,G6PDdeficiency,hemolyticanemiasecondarytodrugssuchas
phenacetin,somehemoglobinopathies(thalassemia),andaftersplenectomy.
426.NotafeatureofG-6PDdeficiency?
a)Intravascularhemolysis
b)Oxidativestress
c)Membranedefect
d)Bitecells
CorrectAnswer-CAnswer-C.Membranedefect*Amongthedefectsinhexosemonophosphateshunt,themostcommonisG6PDdeficiency.*G6PDgeneislocatedontheXchromosomeanditsdeficiencyis,therefore,asex(X)-linkedtraitaffectingmales,whilethefemalesarecarriersandareasymptomatic.*PATHOGENESIS:Normally,redbloodcellsarewellprotectedagainstoxidantstressbecauseofanadequategenerationofreducedglutathioneviathehexosemonophosphateshunt.*IndividualswithinheriteddeficiencyofG6PD,anenzymerequiredforhexosemonophosphateshuntforglucosemetabolism,failtodevelopadequatelevelsofreducedglutathioneintheirredcells.*Theclinicalmanifestationsarethoseofacutehemolyticanemiawithinhoursofexposuretooxidantstress.*Thehemolysisis,however,self-limitingeveniftheexposuretotheoxidantiscontinuedsinceitaffectstheolderredcellsonly.
427.Gallstonesinhemolyticanaemiaare-
a)Pigment
b)Mixed
c)Cholesterol
d)Anytype
CorrectAnswer-AAns.is'a'i.e.,Pigment
428.HypercoagulabilityduetodefectivefactorVgeneiscalled:
a)Lisbonmutation
b)Leidenmutation
c)Antiphospholipidsyndrome
d)Induciblethrombocytopeniasyndrome
CorrectAnswer-BAnswerisB(Leidenmutation)HypercoagulabilityduetodefectiveFactorVgeneiscalled'Leidenmutation'andisnamedafterthecityinwhichitwasdescribed.FactorVLeidenFactorVLeidenisavariant(mutated)ofnormalclottingfactorVanddiffersfromnormalclottingfactorVbyasinglenucleotide.WhileFactorVLeideniscompletelynormalintermsofitsabilitytopreventbleeding,theoneaminoaciddifferencemakesFactorVLeidenresistanttobeingdegradedbyactivatedproteinCandproteinS.ConsequentlyfactorVLeidenpersistsinthecirculationlongerandcontributestoformationofbloodclots.FactorVLeidenmutationisthemostcommonunderlyinggeneticcauseofthrombophilia(venousthrombosis)FactorVLeidenmutationposesalifelongriskofdeepvenousthrombosis.
429.Cryoprecipitatecontains:March2009
a)FactorII
b)FactorV
c)FactorVIII
d)FactorIX
CorrectAnswer-CAns.C:FactorVIIICryoprecipitateispreparedfromplasmaandcontainsfibrinogen,vonWillebrandfactor,factorVIII,factorXIIIandfibronectin.Cryoprecipitateistheonlyadequatefibrinogenconcentrateavailableforintravenoususe.Cryoprecipitateisindicatedforbleedingorimmediatelypriortoaninvasiveprocedureinpatientswithsignificanthypofibrinogenemia(CryoprecipitateshouldnotbeusedforpatientswithvonWillebranddiseaseorHemophiliaA(FactorVIIIdeficiency).ItisnotusuallygivenforFactorXIIIdeficiency,astherearevirus-inactivatedconcentratesofthisproteinavailable.Cryoprecipitateissometimesusefulifplateletdysfunctionassociatedwithrenalfailuredoesnotrespondtodialysis.
430.Whichofthefollowingisapro-coagulant?
a)Thrombomodulin
b)ProteinC
c)ProteinS
d)Thrombin
CorrectAnswer-DAnswer-D.ThrombinVariousfactorsinvolvedincoagulationcascodesarefactorI(fibrinogen);factorII(prothrombin);factorIII(thromboplastinortissuefactor);factorIV(calciumionsorCa");factorV(labilefactor);factorVI(accclerin);factorVII(stablefactororpreaccelerin);factorVIII(antihemophilicfactor);factorIX(christmasfactor);factorX(stuart-prowerfactor);factorXI(plasmathromboplastinantecedentorPTA);factorXII(Hagemanfactor);factorXIII(fibrinstabilizingfactororLakiLorandfactor);HMWK(highmolecularweightkinogen);prekallikrein;kallikrein;andplateletphospholipids.
431.Whichtestisusedforbothintrinsicandcommonclottingpathways?
a)Thrombintime
b)Partialthromboplastintime
c)Ristocetinagglutinationtest
d)FDPs
CorrectAnswer-BAnswer-B.Partialthromboplastintime1)Partialthromboplastintime(PTT):Itteststheintrinsicandcommoncoagulationpathways.So,aprolongedPTTcanresultsfromdeficiencyoffactorV,VIII(factorVIIIc,Vonwillebrandfactor),IX,X,XI,XII,prothrombinorfibrinogen.
432.MaximumlifeoftransfusedRBCsis
a)110-120days
b)80-100days
c)60-80days
d)50-60days
CorrectAnswer-BAnswer-B.80-100daysNormalaveragelifespanofredbloodcellsinadultsisabout120days,whereasthatoftransfusedRBCsisabout50-60days"AfteranRBCtransfusion,themeanpotentiallifespanofRBCis85dayswithameanhalflifeof43±11days.
433. HemolyticUremicSyndromeischaracterizedby?
a)Microangiopathichaemolyticanaemia
b)PositiveCoomb'stest
c)Thrombocytopenia
d)aandc
CorrectAnswer-DAnsis'a'i.e.,Microangiopathichemolyticanemia;'c'i.e.,ThromhocytopeniaHemolyticuremicsyndrome*Hemolyticuremicsyndromeischaracterizedbythetriadof:-Anemia(microangiopathichemolyticanemia).-Renalfailure(microangiopathyofkidneyinvolvingglomerularcapillariesandarterioles).-Thrombocytopenia(duetoplateletconsumption).*Hemolyticuremicsyndromeismostcommonischildrenunder2yearsofage.*Itusuallyfollowsanepisodeofacutegastroenterities,oftentriggeredbyEcoli.*Theprodromeisusuallyofabdominalpain,diarrhoeaandvomiting.*Shortlythereafter,signsandsymptomsofacutehemolyticanemia,thrombocytopeniaandacuterenalfailureensue.oSometimesneurologicalfindingsalsooccur.(ButusuallyabsentanddifferentiateHUSfromTTP.)oRarelyHUSmayfollowrespiratorytractinfection.Etiology*Gastrointestinalinfectionininfantswiththefollowingorganism:
*Ecoli,Shigelladysenteriae,StreptococouuspneumoniaeHematologicalfindingsinacaseofmicroangiopathichemolyticanemia:*Presenceofschistocytes(fragmentedredcells).Thisisthehallmarkofmicroangiopathichemolyticanemia.oNeutrophilleukocytosis.*Thrombocytopenia.*Hemoglobinuriaismildtomoderatewithhemosiderinuria.*Bloodureaandserumcreatininelevelsarehigh.*PTandAPTTnormal.*ElevatedserumLDH
434.Allaretrueaboutthromboticthrombocytopenicpurpuraexcept?
a)Microangiopathichemolyticanemia
b)Thrombocytopenia
c)Normalcomplementlevel
d)Grosslyabnormalcoagulationtests
CorrectAnswer-DAns:D.Grosslyabnormalcoagulationtest[Ref:Robbin's7m/ep.1010]*Thromboticthrombocytopenicpurpura(TTP)ischaracterizedbythepresenceofwidespreadthrombosisthroughoutthemicrocirculation.*Theuniquecharacteristicofthesethrombiisthattheyareprimarilycomposedofplateletsowithverylittle.fibrininit.*TheconsumptionofplateletleadstothrombocytopeniaandthepresenceofintravascularthrombicausesmicroangiopathichemolyticanemiaQandwidespreadorgandysfunction.*YoumusthavenoticedthatTTPandDICsharesomanysimilarfeaturessuchas4icrovascularocculsionandmicroangiopathichemolyticanemia,Buttheyarepathologicallydistinct.InTTP*Activationofcoagulationcascadeisnotofprimaryimportance.Thethrombipresentareessentiallyplateletthrombi,henceresultsoflaboratorytestsofcoagulationsuchasPTandPTTareusuallynormal.InD.I.C.*ThemaindefectisactivationofcoagulationsystemthereforePT
andPTTareabnormal.*PatientswithTTParedeficientinanenzymecalledADAMTSB.ThisenzymeisalsoknownasvWfinetalloprotease.*Thisenzymenormallydegradesveryhighmolecularweightmultimersofvon-Willebrand.factor.Intheabsenceofthisenzyme,thesemultimersofvWFaccumulateinplasmaandundersomecircumstancespromoteplateletmacroaggregate.formationthroughoutthemicrocirculationleadingtosymptomsofTTP.*Thromboticthrombocytopenicpurpuraisathromboticmicroangiopathy.*TheotherdisorderswhichisincludedinthisgroupincludeH.U.S.*Thediseasesarecharacterizedbywidespreadthrombosisinmicrocirculation.*ThevesselswhichareinvolvedareterminalarteriolesQandcapillaries.*Thesevesselshavethrombi.*ThecharacteristicofthisthrombusisthatitisprimarilyaplateletthrombusQi.e.thethrombiiscomposedmainlyofplateletsandvonWilebrandfactorwithverylittlefibrininit.Pathogenesis*PatientswithTTParedeficientinanenzymecalledADAMTSBQ.(ThisenzymeisalsoknownasvWfnielalloproteaSe.)*Thisenzymenormallydegradesveryhighmolecularweightmultimersofvon-Willebrand.factor.Intheabsenceofthisenzyme,thesemultimersofvWFaccumulateinplasmaandundersomecircumstancespromoteplateletmacroaggregateformationthroughoutthemicrocirculationleadingtosymptomsofTTP.*Plateletassociatedimmunoglobulin(IgG)andcomplementlevelsarenormalinT.T.P.
435.LeftsideshiftinArneth'scountisseenin?
a)Megaloblasticanemia
b)Septicemia
c)TB
d)Liverdisease
CorrectAnswer-CAnswer-C.TBShifttoleft(hyperactivebonemarrow)Individualswhohavealargerpercentageofneutrophillswithfewerlobes(mainlyNI&N2)havealeftshiftwhichcanbeindicativeofdiseaseprocessessuchasinfections(pyogenicandTB),malignanttumors,hemolyticcrises,myocardialinfarction,acidosis,irradiationetc.
436.Mostcommonheavychaindiseaseis
a)Franklindisease
b)Seligmanndisease
c)Muheavychaindisease
d)Waldenstromcryoglobulinemia
CorrectAnswer-BAns.is'b'i.e.,SeligmannDisease(Alphaheavychaindisease)Therearefourforms:*Alphachaindisease(Seligmann'sdisease)-mostcommontype*Gammachaindisease(Franklin'sdisease)*Muchaindisease*Deltachaindisease
437.Dutcherbodiesareseenin?
a)Brain
b)Liver
c)Spleen
d)Bonemarrow
CorrectAnswer-DAnswer-D.BonemarrowDutcherbodies,whichareattributedtoimmunoglobulinfilledcytoplasminvaginatingintothenucleuscreatingtheappearanceofanintranuclearinclusion.DutcherbodiesaredescribedasintranuclearinclusionsinpatientswithWaldenstrom’smacroglobulinemia.Theinclusionsarepositiveonaperiodicacid-Schiffreactionandwerepresentinthecytoplasmaswellasthenucleus.Theyidentifiedtheinclusionsasglycoproteinandpostulatedthattheymightbechemicallyidenticaltothemacroglobulinintheplasma.
438.Gammagandybodiesareseeninallexcept?
a)Cirrhosiswithportalhypertension
b)Chronicmyeloidleukemia
c)Sicklecellanemia
d)Thalassemia
CorrectAnswer-DAns.is'd'i.e.,ThalassemiaGandy-Gammabodiesarefocioffibrosiscontainingironandcalciumsaltsdepositsonconnectivetissueandelasticfibres.Gandy-Gammabodiesareseenincongestivesplenomegalye.g.,insicklecellanemia,CMLandlivercirrhosis.
439.AllofthefollowingstatementsaboutBurkitt'slymphomaaretrue,Except:
a)Bcelllymphoma
b)8,14translocation
c)Canpresentasanabdominalmass
d)Radiotherapyisthetreatmentofchoice
CorrectAnswer-DAnswerisD(Radiotherapyisthetreatmentofchoice)ThetreatmentofchoiceforBurkitt'sLymphomaischemotherapyandnotRadiotherapy.'Burkitt'slymphomarespondswelltoshorttermhighdosechemotherapy.TreatmentofBurkitt'slymphomainbothchildrenandadultsshouldbeginwithin48hoursofdiagnosisandinvolvestheuseofintensivecombinationchemotherapyregimens'–HarrisonsBurkitt'sLymphomaisaBcelllymphomaBurkitt'sLymphomaaretumorsofmatureBcells–Robbins7th/677t(8;14)translocationisthemostcommontranslocationinBurkitt'sLymphomaBurkitt'slymphomasareassociatedwithtranslocationofthec-MYCgeneonchromosome8.Translocationt(8;14)t(8;22)t(2;8)Burkitt'sLymphomamaypresentwithanabdominalmassMostBurkitt'sLymphomapresentsatextranodalsitesbutmaypresentwithlymphadenopathyExtranodalsitesofinvolvementincludethemandibleandabdominalviscera`Burkitt'sLymphomasmaypresentwithperipherallymphadenopathy
oranintraabdominalmass'–HarrisonCNSinvolvementisfrequentThediseaseisrapidlyprogressiveandhasapropensitytometastasizetoCNS,prophylactictherapytoCNSisthereforemandatory.Burkitt'sLymphomaisthemostrapidlyprogressivehumantumor
440.Oncogeneassociatedwithburkitt'slymphomais:
a)BCL-1,IgH
b)BCL-2,IgH
c)C-MYC
d)ALK
CorrectAnswer-C
Disease CytogeneticAbnormality Oncogene
Mantlecelllymphoma t(11;14)(q13;q32) BCL-1,IgH
Follicularlymphoma t(14;18)(q32;q21) BCL-2,IgH
Diffuselargecelllymphoma t(3;-)(q27;-)t(17;-)(p13;-)
BCL-6p53
Burkitt'slymphoma,Burkitt'sleukemia
t(8;-)(q24;-) C-MYC
CD30+Anaplasticlargecelllymphoma
t(2;5)(p23;q35) ALK
Lymphoplasmacytoidlymphoma t(9;14)(p13;q32) PAX5,IgH
Ref:Harrison,E-18,P-921
441.CagAgeneisassociatedwith
a)Hepatocellularcarcinoma
b)Esophagealcarcinoma
c)MALTlymphoma
d)Lungcarcinoma
CorrectAnswer-CAnswer-C.MALTlymphomaCagA,Agenethatcodesforanimmunodominantantigen,ispresentonlyinHelicobacterpyloristrainsthatareassociatedwithsevereformsofthegastroduodenaldisease(typeIstrains).Helicobacterpyloriisamicroaerophilicspiral-shapedlophotrichousGram-negativebacteriumthatcolonizesthegastriclumenofprimates,includinghumans.HpyloriwasidentifiedasthecauseofchronicactivegastritisandpepticulcerdiseaseinhumansandisconsideredtobeariskfactorforthedevelopmentofgastricadenocarcinomaandMALTlymphoma
442.Richter’ssyndromereferstowhichofthefollowingmalignanttransformation?
a)CLLevolvingintoaggressivelymphoma
b)HairycellleukemiaevolvingtoAML
c)BlastcrisisinCML
d)SplenicinfiltrationinNHL
CorrectAnswer-AAns.A.CLLevolvingintoaggressivelymphomaRichter'stransformationorRichter'ssyndromeisacomplicationofBcellchroniclymphocyticleukemia(CLL)orhairycellleukemia(HCL)inwhichtheleukemiachangesintoafast-growingdiffuselargeBcelllymphoma.
443.Basophillicleucocytosisoccursin-
a)AML
b)ALL
c)CML
d)CLL
CorrectAnswer-CAns.is'c'i.e.,CML
444.TEL-AML1fusionisassociatedwith?
a)CLL
b)CML
c)ALL
d)AML
CorrectAnswer-CAnswer-C.ALLTEL-AML1genefusionisthemostcommongeneticalterationinchildhoodacutelymphoblasticleukemia.Itiscreatedbybalancedtranslocationt(12:21).CytogeneticabnormalitiesassociatedwithALLaregainoffunctionmutationinNOTCH-1geneinT-cellALL.
445.Granulomatouslungdiseaseiscausedby?
a)Hypersensitivitypneumonitis
b)Sarcoma
c)Bronchogeniccarcinoma
d)Bronchogeniccyst
CorrectAnswer-AAnswer-A.HypersensitivitypneumonitisGranulomatouslungdiseasereferstoabroadgroupofinfectiousandwellasnoninfectiousconditionscharacterizedbytheformationofgranulomas.Infectious:Mycobacterial(TB&Non-TB);Fungalinfection(cryptococcus,Histoplasma,Blastomycosis,Coccidioidomycosis,Aspergillosis);ParasiticInfections.Non-infectious:Sarcoidosis;Wegnergranulomatosis;ChurgStrausssyndrome;Chronicgranulomatousdisease;Hypersensitivitypneumonitis;RA;ChronicAspirationPneumonitis;LangerhansCellHistiocytosis;substances(TalcGranulomatosis,Berylliosis)
446.Terminalstageofpneumoniais
a)Congestion
b)Redhepatization
c)Grayhepatization
d)Resolution
CorrectAnswer-DAns.is'd'i.e.,ResolutionIntheusualcourseofpneumonia,finalstageisresolution.However,insomeneglectedcasesfollowingcomplicationsmaydevelop-AbscessformationPleuraleffusion,pleuritisEmpyemaBecteremicdisseminationBrainabscess,endocarditis,meningitis,Organizationsupurrativearthritis.PathologicalchangesofbacterialpneumoniaA.LobarpneumoniaLargeconfluentareaofthelungorentirelobesareconsolidated.Thelowerlobesareaffectedmostcommonly.Therearefourstagesoftheinflammatoryresponse(Laennec'sstages)?1.Stageofcongestion(initialphase)Theaffectedlobeisenlarged,heavy,darkredandcongested.Cutsurfaceexudesblood-stainedfrothyfluid.Thereisdilatationandcongestionofalveolarcapillaries.Therearefewneutrophilsandnumerousbacteriainthealveolarfluid.2.Stageofredhepatization(earlyconsolidation)Thetermhepatizationreferstoliver-likeconsistencyoftheaffected
lobeoncutsection.Theaffectedlobeisredandfirm.Theedemafluidofprecedingstageisreplacedbystrandsoffibrin.Thereismarkedcellularexudateofneutrophilswithextravasationofredcells.3.Stageofgrayhepatizatioa(lateconsolidation)Theaffectedlobeisgrayishbrown,firmanddry.Thefibrinstrandaredenseandmorenumerous.Thereisprogressivedisintigrationofredcellsandneutrophils.Themacrophagesbegintoappearintheexudate.Theorganismsarelessnumerousandappearasdegeneratedforms.4.ResolutionThepreviouslysolidandfibrinousconstituentisliquefiedbyenzymaticaction.Granularandfragmentedstrandsoffibrininthealveolarspacesareseenduetoprogressiveenzymaticdigestion.Thereisprogressiveremovaloffluidcontentaswellascellularexudatefromtheairspaces,resultinginrestorationofnormallungparenchymawithareation.B.BronchopneumoniaPatchyareasofredorgreyconsolidation,moreoftenmultilobarandfrequentlybilateralandbasal(lowerzones)becauseoftendencyofsecretionstogravitateintolowerlobes..Thereissuppurativeexudate,consistingchieflyneutrophils,fillingbronchi,bronchiolesandadjacentalveolarspaces.Alveolarseptathickenduetocongestedcapillariesandleucocyticinfiltration.
447.Pinkpuffersareassociatedwith?
a)Emphysema
b)Chronicbronchitis
c)Pneumonia
d)Bronchiectasis
CorrectAnswer-AAnswer-A.EmphysemaA"pinkpuffer"isapersonwhereemphysemaistheprimaryunderlyingpathologyInemphysema,notonlythereislesssurfaceareaforgasexchange,thereisalsolessvascularbedforgasexchange..Thebodythenhastocompensatebyhyperventilation(the"puffer").Havelesshypoxemia(comparedtobluebloaters)andappeartohavea"pink"complexionandhence"pinkpuffer".
448.Mostcommoncancerfoundincoalmineworkers
a)Analcanal
b)Testicular
c)Lung
d)Liver
CorrectAnswer-CAnswer-C.LungAmongcoalworkerpneumoconiosispatientsstandardincidenceratioofvariousimportantcarcinomas:ovary(2.0)>esophagus(1.76)Lung>(1.45)>Stomach(1.42)>Liver(1.18)>kidney(1.06)>prostate(1.02)>colorectal(1.00)>urinarybladder(0.91)>head&neck(0.87)
449.Inallergicbronchopulmonaryaspergillosis,thelocationoflesionsis
a)Pleura
b)Bronchiandbronchioles
c)Alveoli
d)Alloftheabove
CorrectAnswer-BAnswer-B.BronchiandbronchiolesAllergicbronchopulmonaryaspergillosis(ABPA)isaconditioncharacterizedbyahypersensitivityresponsetotheAspergillus(mostcommonlyAspergillusfumigatus).AnallergicbronchopulmonaryaspergillosisisaformoflungdiseasethatoccursinsomepeoplewhoareallergictoAspergillus.WithABPA,thisallergicreactioncausestheimmunesystemtooverreacttoAspergillusleadingtolunginflammation.ABPAcausesbronchospasm(tighteningofairwaymuscles)andmucusbuildupresultingincoughing,breathingdifficultyandairwayobstruction.italsocausesairwayinflammation,leadingtobronchiectasis—aconditionmarkedbyabnormaldilationofthebronchiandbronchioles.
450.Deficiencyofp53mutationismaximuminwhichlungcarcinoma?
a)Smallcellcarcinoma
b)Squamouscellcarcinoma
c)Adenocarcinoma
d)Lymphoma
CorrectAnswer-BAnswer-B.Squamouscellcarcinoma-MYCandRB-smallcellcancerRASandp16-non-smallcellcancerp53-bothsmallandnon-smallcell,buthighestinsquamouscellcarcinomaK-RAS–adenocarcinoma
451.Metastasistolungscomemostcommonlyfrom
a)Breastcarcinoma
b)Braincarcinoma
c)Bonecarcinoma
d)Melanoma
CorrectAnswer-AAnswer-A.BreastcarcinomaMetastatictumortolungoriginatefromcarcinomainthebreast,colon,stomach,pancreas,kidney,prostate,liver,thyroid,adrenal,malegenitaltractandfemalegenitaltract.
452.Whichtypeofparaneoplasticsyndromeismostcommonlyassociatedwithlungcarcinoma?
a)SIADH
b)Gynaecomastia
c)Acanthosisnigricans
d)Hypocalcaemia
CorrectAnswer-AAnswer-A.SIADHSIADHisthemostcommonparaneoplasticsyndromeassociatedwithlungcarcinomaasSmallcellcarcinomaisthemostcommontypeoflungcancerassociatedwithectopichormoneproductionandparaneoplasticsyndromeandADH(CausingSIADH),ACTH(Causingcushingsyndrome)productionarepredominantlyassociatedsmallcellcarcinoma.
453.Mostcommoncauseofchylothoraxis?
a)Trauma
b)Lymphoma
c)Left-sidedheartfailure
d)Infections
CorrectAnswer-BAnswer-B.LymphomaChylothoraxisapleuralcollectionofamilkylymphaticfluidcontainingmicroglobulesoflipid.Itresultsfromlymphformedinthedigestivesystemcalledchyleaccumulatinginthepleuralcavityduetoeitherdisruptionorobstructionofthethoracicduct.Thetotalvolumeoffluidmaynotbelarge,butchylothoraxisalwayssignificantbecauseitimpliesobstructionofthemajorlymphducts,usuallybyintrathoraciccancerlikeprimaryorsecondarymediastinalneoplasm,suchaslymphoma.
454.TrueStatementaboutsilicosis-
a)Producespleuralplaque
b)Associatedwithtuberculosis
c)Lowerlobeinfiltration
d)All
CorrectAnswer-BAns.is'b'i.e.,AssociatedwithtuberculosisSilicosis3Silicosisisalungdiseasecausedbyinhalationofcrystallinesilicondioxide(silica).*Currently,itisthemostprevalentoccupationaldiseaseintheworld.*Silicosisisaslowlyprogressivedisease,usuallypresentingafterdecadesofexposureasslowlyprogressivenodularfibrosingpneumoconiosis.*Silicaoccursinbothcrystallineandamorphousformsbutcrystallineformsaremuchmorefibrogenic.Thecrystallineformarequartz,crystobalite.*Silicosisischaracterizedinitsearlystagesbynodulesintheupperzonesofthelung.Asthediseaseprogressesthesenodulesmaycoalesceintohardcollagenousscars.*Fibroticlesionsoccurinthehilarlymphnodeandpleura.Sometimesthinsheetsofcalcificationoccurinthelymphnodesandareseenradiographicallyaseegshellcalcificationi.e.(calciumsurroundingazonelackingcalcification.*Itthediseasecontinuestoprogress,expansionandcoalescenceoflesionsproduceprogressivemassivefibrosis.oHistologicallythelesionsofsilicosisconsistsofconcentriclayersofhyalinized
collagensurroundedbyadensecapsuleofmorecondensedcollagen.*Examinationofthenodulesbypolarizedmicroscopyrevealsthebirefringentsilicaparticles.*SilicosisisassociatedwithanincreasedsusceptibilitytoT.B.Itispostulatedthatsilicosisresultsindepressionofcellmediatedimmunityandthecrystallinesilicamayinhibittheabilityofpulmonarymacrophagestokillphagocytosedmycobacteria.*Nodulesofsilicotuberculosisoftendisplayacentralzoneofcaseation.
455.Mostcommontypeofpneumoconiosis,associatedwithTBis?
a)Silicosis
b)Bysinosis
c)Asbestosis
d)Baggassosis
CorrectAnswer-AAnswer-A.SilicosisSilicosisisassociatedwithincreasedsusceptibilitytoT.B.Itispostulatedthatsilicosisresultsinadepressionofcell-mediatedimmunity,andcrystallinesilicamayinhibittheabilityofpulmonarymacrophagestokillphagocytosedmycobacteria.Nodulesofsilicotuberculosisoftencontainacentralzoneofcaseation.
456.Onpolarisingmicroscopy,refractilebodyinthecentreofgranulomaisseenin?
a)Sarcoidosis
b)Silicosis
c)Tuberculosis
d)Asbestosis
CorrectAnswer-BAnswer-B.SilicosisHistologicallythelesionsofsilicosisconsistofconcentriclayersofhyalinizedcollagensurroundedbyadensecapsuleofmorecondensedcollagen.Examinationofthenodulesbypolarizedmicroscopyrevealsthebirefringentsilicaparticles.
457.Anthracosisisduetoinhalationof-
a)Coaldust
b)Asbestos
c)Silicadust
d)Beryliumdust
CorrectAnswer-AAns.is'a'i.e.,CoaldustCoalworker'spneumoconiosis(Blacklung)Blacklungdisease,alsoknownascoalworker'spneumoconiosis(CWP),iscausedbylongexposuretocoaldust.oCoalworker'spneumoconiosishasfollowingspectrum.1.Asymptomaticanthracosis*Inhaledcarbanpigmentisengulfedbyalveolarorinterstitialmacrophages,whichthenaccumulateintheconnectivetissuealongthelymphatics.*Patientiscompletelyasymptomatic.2.Simplecoalworker'spneumoconiosis*Characterizedbycoalmacules(composedofcarbonladenmacrophages)andcoalnodules(carbonladenmacrophages+collegen).*Theupperlobesandupperzonesofthelowerlobesareinvolved.*Theyarelocatedprimarilyadjacenttorespiratorybronchioles,thesiteofinitialdustaccumulation.*Centriacinaremphysemamaydevelop.3.Complicatedcoalworker'spneumoconiosis*Requiresmanyyearstodevelop.*Characterizedbyintenselyblackenedmultiplescarlargerthan2cms.oThisisalsoknownasProgressivemassivefibrosis.
Remember*InCWPandsilicosisupperzonesoflungareinvolvedinitially.oInasbestosislowerlungfieldsareinvolvedinitially.
458.Chronicbronchitisisassociatedwith?
a)Increaseinnumberofglandswithoutanychangeinsize
b)Bronchiolitisobliterans
c)DecreaseinReidindex
d)Onlylargeairwaysareinvolved
CorrectAnswer-BAnswer-B.BronchiolitisobliteransTheearliestfeatureofchronicbronchitisishypersecretionofmucusinthelargerairways,associatedwithhypertrophyofsubmucosalglandoftracheaandbronchi.Later,smallairways(smallbronchiandbronchioles)arealsoinvolvedandshowgobletcellhyperplasia,andintraluminalandperibronchialfibrosis.Inmostseverecases,theremaybeoblitrationoflumenduetofibrosis→Bronchiolitisobliterans.
459.Histopathologyshowinglargecellswithplantlikeapperancewithperinuclearhaloisseeninwhichtypeofrenalcellcarcinoma?
a)Onchocytoma
b)Granularcellcarcinoma
c)Angiosarcoma
d)Chromophobic
CorrectAnswer-DAns.is'd'i.e.,ChromophobicHistopathologicalfindingsofperinuclearhaloandplantcellappearanceareseeninchromophobecellcarcinomaofRCC.Electronmicroscopicfindingconsistingofnumerous150-300nmmicrovesiclesisthesinglemostdistinctiveanddefiningfeatureofchromophobecellca.
460.TrueaboutRCCis?
a)Mostcommonsiteislowerlobeofkidney
b)Mostcommonvarietyispapillarytype
c)Invasionofrenalveinismorecommonthanrenalartery
d)Mostcommonsiteofmetastasisislymphnodes
CorrectAnswer-CAnswer-C.InvasionofrenalveinismorecommonthanrenalarteryRenalcellcarcinomaisthemostcommonmalignanttumorofkidney.Itoccursusuallyin6thand7thdecadeoflife.Thereismalepreponderance.ImportantriskfactorsforRCCaresmoking(mostsignificant),obesity,hypertension,asbestosexposure,estrogentherapy,CRF,tuberoussclerosisandfamilialconditions(VonHippel-Lindausyndrome).RCCisanadenocarcinomaandmostcommonlyarisesfromupperpole.TheoneofthestrikingcharacteristicsofRCCistoinvaderenalveinandisassociatedwithpoorprognosis.
461.Strawberrygallbladderisseenin
a)Cholesterosis
b)Primarysclerosingcholangitis
c)Cholestasis
d)Primarybilliarycirrhosis
CorrectAnswer-AAnswer-A.CholesterosisInCholesterosis,therearedepositsofcholesterolintheepithelialcellsandinthesubmucosalmacrophages.Thisgivesappearanceofmultiplesmallyellowspotsonaredhyperplasticmuscosa,thestraberrygallbladder.
462.Whatisresponsibleforregenerationoflivercells?
a)HGF
b)VEGF
c)TGF-13
d)IFN-y
CorrectAnswer-AAnswer-A.HGFHepatocytegrowthfactor(HGF/scatterfactor)levelsrisetohighlevelssoonafterpartialhepatectomy.Thisistheonlyfactortestedthatactsbyitselfasapotentmitogenforisolatedhepatocytesculturedinvitro.Thisfactorisalsoofcriticalimportanceindevelopmentoftheliver,astargetdeletionsofitsgeneleadtofetaldeathduetohepaticinsufficiency.
463.Bridgingnecrosisischaracteristicallyseenin:
a)Acutehepatitis
b)Chronichepatitis
c)Bothoftheabove
d)Noneoftheabove
CorrectAnswer-CAns:C.BothoftheaboveBridgingnecrosisisamoresevereformofhepatocellularinjuryinacuteviralhepatitisandmayprogresstofulminanthepatitisorchronichepatitis.Bridgingnecrosisischaracterizedbybandsofnecrosislinkingportaltractstocentralhepaticveins,onecentralhepaticveintoanother,oraportaltracttoanothertract.Inseverecasesofacutehepatitis,confluentnecrosisofhepatocytesmayleadtobridgingnecrosisconnectingportal-to-portal,central-to-central,orportal-to-centralregionsofadjacentlobules.Hepatocyteswellingandregenerationcompresssinusoids,andthemoreorlessradialarrayofhepatocyteplatesaroundterminalhepaticveinsarelost.Bridgingfibrosisisanimportantcomponentofsevereexamplesofchronicviralhepatitisandsteatohepatitis.
464.Thezonalnecrosismostcommonlyaffectedinchronicpassivehepaticcongestionis?
a)Central
b)Peripheral
c)Midzonal
d)None
CorrectAnswer-AAnswer-A.CentralCentrilobularhemorrhagicnecrosisiscausedbychronicpassivecongestion(CPC)duetorightheartfailure.
465.Normallysquamo-columnarjunctionisusuallylocatedat
a)Distal2-3cmsofesophagus
b)Proximal2-3cmsofstomach
c)Inesophagusmorethan3cmsproximaltoGEJ
d)Noneoftheabove
CorrectAnswer-BAnswer-A.Distal2-3cmsofesophagusProximalextensionofthesquamocolumnarjunctionbeyondthedistal2-3cmsofoesphagusisabnormalandissuggestiveofBarrett'sesophagus.
466.Carcinomaassociatedmostcommonlywithupperonethirdofesophagusis
a)Adenocarcinoma
b)SquamouscellCarcinoma
c)Adeno-squamousCarcinoma
d)Leiomyosarcoma
CorrectAnswer-BAnswer-B.SquamouscellCarcinomaSquamouscellcarcinomaisthemostcommontypeofesophagealcarcinomaworldwideandinIndia.Itusuallyoccursinmiddle1/3rd(motcommon)andupper1/3'ofesophagus.Somemayalsoariseinlower1/3
467.Autoimmunegastritisisassociatedwithdeficiencyofvitamin?
a)A
b)B12
c)C
d)D
CorrectAnswer-BAnswer-B.B12Inautoimmunegastritis,twoimportantautoantibodiescausingdamageareanti-parietalcellantibodies(mostcommon)andantibodiesagainstintrinsicfactor;anti-IF(mostspecific).VitaminB-12deficiencyandperniciousanemia:DuetodeficiencyofIFcells(secretedbyparietalcells)aswellasdamageofIFbyanti-IFantibodies.
468.Bloodgroupmostcommonlyassociatedwithgastriccarcinomais?
a)BloodGroup0
b)BloodgroupA
c)BloodgroupAB
d)BloodgroupB
CorrectAnswer-BAnswer-B.BloodgroupAGeneticfactors:BloodgroupA,Hereditarynonpolyposiscoloncancersyndrome(HNPCC)andFamilialgastriccancersyndrome(E-cadherinmutation).
469.Whichdiseaseisdiagnosedbyjejunalbiopsy?
a)Celiacdisease
b)Intestinallymphoma
c)Argentaffinomaofintestine
d)Tropicalsprue
CorrectAnswer-BAnswer-B.Intestinallymphomathejejunalbiopsyisusefulinthediagnosisofthefollowingdisorders:IntestinallymphomaIntestinallymphangiectasiaEosinophilicgastroenteritisAmyloidosisCrohn'sdiseaseInfectionbyoneormoremicroorganismsMastocytosisWhipple'sdisease
470.commonestbenigntumoroftheesophagus?
a)Leiomyoma
b)Papilloma
c)Adenoma
d)Hemangioma
CorrectAnswer-AAnsisa.i.e.Leiomyoma"Leiomyomasconstitutemorethan50%ofbenignesophagealtumors"-Schwartz
471.Totalcolonicaganglionosisisavariantof?
a)Crohn'sdisease
b)Ulcerativecolitis
c)Hirschsprung'sdisease
d)Tropicalsprue
CorrectAnswer-CAnswer-C.Hirschsprung'sdiseaseHirschprungdisease(Congenitalaganglonicmegacolon)iscausedbydefectivemigrationofneuralcrestintothemesodermallayerofgut.Thereisaganglionosis(absenceofganglions)inaportionofintestinaltract.IntestinalsegmentlacksbothMeissnersubmucosalandAuerbachmyentericplexuses.
472.APCgeneisinvolvedin?
a)Colorectalcarcinoma
b)Gastriccarcinoma
c)Gastriclymphoma
d)Esophagealadenocarcinoma
CorrectAnswer-AAnswer-A.ColorectalcarcinomaTheAPCproteinisanegativeregulatorthatcontrolsbeta-cateninconcentrationsandinteractswithE-cadherin,whichareinvolvedincelladhesion.MutationsintheAPCgenemayresultincolorectalcancer
473.Vitamindeficiencyassociatedwithcysticfibrosisis
a)K
b)B6
c)C
d)B12
CorrectAnswer-DAnswer-D.B12Patientswithcysticfibrosis(CF)areatriskofdevelopingdeficienciesoffat-solublevitamins(A,D,E,andK)becauseofpancreaticinsufficiency,hepatobiliarydisease,orboth.
474.FalseaboutPatterson-Kelly-Brownsyndromeis?
a)Anemia
b)Esophagealwebs
c)Glossitis
d)Riskfactorforadenocarcinoma
CorrectAnswer-DAnswer-D.RiskfactorforadenocarcinomaPlummer-Vinsonsyndrome(PVS)(Paterson-Brown-Kellysyndromeorsideropenicdysphagia),ischaracterizedbydifficultyinswallowing,irondeficiencyanemia,glossitis,chielosis,andesophagealwebs.
475.Mostcommonsiteforcarcinomapharynxinfemalessufferingfromplummervinsonsyndromeis
a)Postcricoidregion
b)Posteriorwall
c)Lateralwall
d)Pyriformisfossa
CorrectAnswer-AAns.is'a'i.e.,PostcricoidPlummer-VinsonsyndromePlummer-Vinsonsyndrome,alsoknownasBrown-Kelly-Patersonsyndromeorsederopenicdysphagia,seeninmiddleagededentulouswomen.TheplummerVinsionPatersonBrownKellySyndromeischaracterizedby:-DysphagiaChronicirondeficiencyanemiaAtrophicoralmucosaandglossitisBrittle,spoon-shapedfingernails(Koilonychia)Thecauseofdysphagiaisusuallyacervicalesophagealweb,butabnormalpharyngealandesophagealmotilitymayplayarole.Thesyndromecharactersticallyoccursinmiddleagededentulous(withoutteeth)women.Itisapremalignantlesion.Approximately10%ofpatientdevelopsquamouscellCaofesophagus,oralcavityorthehypopharynx.Asiron-deficiencyanemiaisacommonfinding,itisalsoknownassideropenicdysphagia.
Carcinomadevelopsinpost-cricoidregion.
476.Commonestcarcinomathatcancausesplenicmetastasisiswhichofthefollowing?
a)Ca.Pancreas
b)Ca.Stomach
c)Ca.Ovary
d)Ca.Cervix
CorrectAnswer-CAlthoughisolatedmetastasistospleenisrare,studiesfoundthemostcommonprimaryneoplasmswithsplenicmetastasistobegynecologic(61%),withmajoritybeingovarian,colorectal(15%),lung(9%),andstomach(4%).Ref:CTandMRIoftheAbdomenandPelvis:ATeachingFileeditedbyPabloR.Ros,KoenraadJ.Mortele,2006,Page218.
477.Phlegmonousgastritisoccursdueto?
a)H.pylori
b)E.coli
c)C.jejuni
d)Cl.Tetani
CorrectAnswer-BAnswer-B.E.coliMostcasesofphlegmonousgastritisareduetoalpha-hemolyticstreptococci,althoughpneumococci,staphylococci,Escherichiacoli,andrarely,ProteusVulgarisandClostridiumwelchiicanbethecausativeorganisms.
478.Collarbuttonulcerisfoundin?
a)Ulcerativecolitis
b)Crohn'sdisease
c)Shigella
d)Alloftheabove
CorrectAnswer-DAnswer-D.Alloftheabove"Collarbuttonulcers",aradiologicalsign,aremanifestationsofinflammatoryprocesseswithinthebowel.Collarbuttonulcershavealsobeenobservedinthesettingofotherinflammatorybowelprocesses,suchasCrohn'sdisease,ischemiccolitis,andshigellosis.
479.WhichofthefollowingwouldbethebestmorphologicalfeaturetodistinguishulcerativecolitisfromCrohn'sdisease?
a)Diffusedistributionsofpseudopolyps
b)Mucosaledema
c)Cryptabscesses
d)Lymphoidaggregatesinthemucosa
CorrectAnswer-APseudopolypsaremorecommonlyfoundinulcerativecolitisthanCrohn'sdisease.Thesearediscreteareasresultingfromsurvivingislandsofmucosaorheapedupgranulationtissue.Sinceinulcerativecolitisthereisdiffusemucosalinflammationthesepseudopolypsare
diffuselydistributed.DistinguishingfeaturesbetweenUlcerativecolitisandCrohn'sdisease:
Ulcerativecolitis Crohn’sdisease
Rectalinvolvement Yes Variable
Distribution Diffuse Segmentalordiffuse
Terminalileum Backwashileitis Thickenedandstenosis
Serosa Normal Creepingfat
Mucosa Hemorrhagic Cobblestoneandlinearulcers
Pseudopolyps Frequent Lesscommon
Strictures No Common
Fistulas No Common
Lymphoidhyperplasia Infrequent Common
Cryptabscess Extensive Focal
Ref:PediatricInflammatoryBowelDiseaseByPetarMamulapage227.
480.Penilecarcinomaisusually?
a)Squamouscellcarcinoma
b)Basalcellcarcinoma
c)Adenocarcinoma
d)Smallcellcarcinoma
CorrectAnswer-AAnswer-A.SquamouscellcarcinomaMostofpenilecancersaresquamouscellcarcinomaandariseonglansorinnersurfaceofprepuce.
481.Stainusedforstainingthenucleusis?
a)Safranin
b)Fastgreen
c)Hematoxylin
d)Erythrosine
CorrectAnswer-CAnswer-C.HematoxylinHematoxylinstainsthecellnucleusandotheracidicstructures(suchasRNA-richportionsofthecytoplasmandthematrixofhyalinecartilage)blue,whileeosinstainscytoplasm,connectivetissueandotherextracellularsubstancespinkorred.
482.Allareassociatedwithdiabeticgangreneexcept?
a)Wetgangrene
b)Drygangrene
c)Gasgangrene
d)Fournier'sgangrene
CorrectAnswer-CAnswer-C.GasgangreneItisabacterialinfectionthatproducesgaswithintissues.ItcanbecausedbyClostridium,mostcommonlyalphatoxinproducingClostridiumperfringens,orvariousnon-clostridialspecies.
483.Choroidmetastasisisassociatedmostcommonlywith?
a)Gastriccarcinoma
b)Renalcarcinoma
c)Braintumor
d)Bonetumor
CorrectAnswer-BAnswer-B.RenalcarcinomaTumorsmostlikelytometastasizetothechoroidplexusarerenalcellcarcinomaandlungcancer.Othertumorswithdocumentedspreadtothechoroidplexusincludecolon,gastric,breast,thyroid,andbladdercancers,melanomaandlymphoma.
484.WhichofthefollowingstatementsaboutthepathologyinAlzheimer'sdiseaseisnottrue:
a)NeuriticPlaquesareformedofamyloidprotein
b)Neurofibrillarytangles(NFT)aremadeoftauprotein
c)NFTsappearextracellularlybeforeintracellularappearance
d)NumberofNFTscorrelateswithdementia
CorrectAnswer-CAnswerisC(NFTsappearextracellularlybeforeintracellularappearance):NFTsaretypicallyseenintracellularlywithinthesomaandproximaldendritesofneurons.NeurofibrillaryTangles(NFTs)areintracellularaccumulationsofhyperphosphorylated'tau'proteins.NeurofibrillaryTanglesareIntracellularAccumulationsNeurofibrillaryTanglesareintracellularaccumulationsofhyperphosphorylatedmicrotubulebindingprotein'tau'.Pairedhelicalfilamentsoftauprotein(NFTs)formintracellularlywithinthesomaandproximaldendritesofneurons.Thesecytoskeletalproteintangles(NFTs),initiallyimpedecellularmetabolismandaxosplasmictransportleadingtoimpairedsynapticfunctionandeventuallytoneuronaldeath.Theseneurofibrillatytanglesmaybeseenasextracellulartanglesafterdegenerationoftheneuronasevidenceoftheneuronalcell'sdemiseNeurofibrillaryTanglesareintracellularaccumulationsthatmayappearextracellularlyalterdegenerationofneuron(neuronaldeath)
HistopathologicalHallmarksofAlzheimer'sDiseaseAmyloidPlaques(Extracellular)
AmyloidNeuriticPlaquesareformedbyextracellularaccumulationofbetaamyloiddepositswithintheneutropil'Neuritic'or'Senile'I3-amyloidplaquesareanearlyhistopathologicalsignofAlzheimer'sdisease(thatoccurrarelyinhealthysubjects)Theamyloid13-proteinaccumulatedinsingleneuriticplaquesistoxictosurroundingstructuresandadjacentneurons.Clinicopathologicalstudieshaveshownthatamy/aidburdendoesnotdirectlycorrelatewithseverityordurationofdementia.
NeurofibrillaryTangles(Intracellular)Neurofibrillarytanglesarcformedbyintracellularaccumulationofhyperphosphorylatedmicrotubulebindingprotein'tau'.NFT'soccurinmanyneurodegenerativediseasesand/oragroupofdiseasescalledlaupathies'.TheseincludeFrontotemporaldementia,Pick'sdiseaseetc.Thecooccuranceoffi-amyloidplaqueswithNFT'ssuggestsadiagnosisofAD.TheNFT'saretoxictotheneuronsandneuronswithNFT'seventuallydieanddegenerateleavingaresidual`ghosttangle',intheextracellularspaceremindingofthepyramidalcellbodyinwhichitwasinitiallyformed.ClinicopathologicalstudieshaveshownthatdementiacorrelatesmorestronglywithNFT'sthanwithsenileplaques(3-amyloid)
485.Metastasistothyroidcomesfromwhichprimarysiteofmalignancy?
a)Liver
b)Testis
c)Prostate
d)Kidney
CorrectAnswer-DAnswer-D.KidneyMostcommonprimarysitesarekidney,breast,lung,uterus,andmelanoma.
486.WhichofthefollowingisthemostcommonmutationinEwing'ssarcoma-
a)TranslocationX:18
b)Translocation11;22
c)ActivativemutationofG5a,p,surfaceprotein
d)MissensemutationinEXTI
CorrectAnswer-BAns.is'b'i.e.,Translocation11;22Ewing'ssarcomaistypicallycharachterizedbyatranslocationt(11;22)(q24;q12)inupto90%ofpatients.
487.Leastdesmoplasticbreastcarcinomais
a)Ductal
b)Lobular
c)Tubular
d)Medullary
CorrectAnswer-BAnswer-B.Lobular"Invasivelobularcarcinomahasatendencytospreaddiffuselyorbetweenthecollagenfibersofthebreastandproducesdesmoplasticresponse"
488.Markerforneuroblastomaamongthefollowingis?
a)NMP22
b)ChromograninA
c)LDH
d)32microglobulin
CorrectAnswer-BAnswer-B.ChromograninANeuroendocrinemarkersofneuroblastoma:-i)CD-56ii)Chromogranin-Aiii)Synaptophysin
489.Thymichyperplasiaisseenin?
a)Thymoma
b)Thymiclymphoma
c)Myastheniagravis
d)Scleroderma
CorrectAnswer-CAns.is'c'i.e.,MystheniagravisThymichvperplasiaThetermthymichyperplasiausuallyappliestotheappearanceofB-cellgerminalcenterswithinthethymus,afindingthatisreferredtoasthymicfollicularhyperplasia.SuchB-cellfolliclesarepresentinonlysmallnumbersinthenormalthymus.Itcanoccurinanumberofchronicinflammatoryandimmunologicstates,butitismostfrequentlyencounteredinmyastheniagravis(65%to75%ofcases).SimilarthymicchangesaresometimesencounteredinGravesdisease,systemiclupuserythematosus,scleroderma,rheumatoidarthritis,andotherautoimmunedisorders.
490.InEndometrialcarcinoma,whichofthefollowingtumorsuppressorgeneoccurs?
a)P53
b)Rb
c)PTEN
d)APC
CorrectAnswer-CPTENisatumorsuppressorgenewhichisimplicatedinthecausationofendometrialandprostatecarcinoma.
491.Foldingdefectisassociatedwithwhichdisease
a)Parkinson'sdisease
b)Marfansyndrome
c)Acuteintermittentporphyria
d)Wermersyndrome
CorrectAnswer-AAnswer-A.Parkinson'sdiseaseDefectiveproteinfoldingdisorders(DPFDs)areagroupofdiverseneurologicalandsystemicdiseasesinwhichthehallmarkpathologicaleventisthemisfolding,aggregationandaccumulationofaproteinindifferentorgans,inducingcellularapoptosis,tissuedamageandorgandysfunction.IncludesAlzheimer'sdisease,transmissiblespongiformencephalopathies,serpin-deficiencydisorders,sicklecellanemia,Huntington'sdisease,diabetestypeII,amyotrophiclateralsclerosis,Parkinson'sdisease,dialysis-relatedamyloidosis,spinocerebellarataxias,secondaryorreactiveamyloidosis,cysticfibrosisandpriondiseases.
492.Stainusedfortubulinis
a)Lunastain
b)Cajalstain
c)SiRstain
d)Masson'strichrome
CorrectAnswer-CAnswer-C.SiRstainfluorescentstains(SiR-ActinandSiR-Tubulin)arecellpermeablecompoundswhichstainF-actinandmicrotubules,respectively.
493.X-linkedadrenoleukodystrophyis
a)Fattyaciddisorder
b)Lysosomalstoragedisorder
c)Mucoplysaccharridoses
d)Glycogendefectdisorder
CorrectAnswer-AAnswer-A.FattyaciddisorderX-linkedadrenoleukodystrophy(ALD/X-ALD)isadiseaseiscausedbymutationsinABCD1,agenelocatedontheXchromosome,thatcodesforALD,aperoxisomalmembranetransporterprotein.
494.ChromosomeforMEN2geneis
a)11q13
b)13q11
c)10811.2
d)11q10-2
CorrectAnswer-CAnswer-C.10811.2Multipleendocrineneoplasiatype1MEN111813Multipleendocrineneoplasiatype2aRET10811.2
495.Hobnailappearanceisseenin
a)Clearcellcarcinoma
b)Endodermalsinustumor
c)HCC
d)Choriocarcinoma
CorrectAnswer-AAnswer-A.ClearcellcarcinomaHobnailcellisacellwithacharacteristicappearance,includingabulbousnucleusandnuclearprojectionsintothecytoplasm.Hobnailcellsarefoundinclearcellovarianadenocarcinoma,collectingductcarcinoma,andinend-stagecirrhosis
496.Sphenoiddysplasiaisseenin?
a)NF-1
b)Tuberoussclerosis
c)Sturge-Webersyndrome
d)Creutzfeldt-Jakobdisease
CorrectAnswer-AAnswer-A.NF-1NF-1isdiagnosediftwooffollowingsevensarepresent:
1. Sixormorecafe-au-laitmacules:>5mminprepubertalageand>15mminpostpubertalage.
2. Axillaryoringuinalfreckling.3. TwoormoreLischnodules(hamartomasoniris).4. Twoormoreneurofibromaoroneplexiformneurofibroma.5. Adistinctiveosseouslesion:Sphenoiddysplasiaorcorticalthinning
oflongbones.6. Opticglioma.7. AfirstdegreerelativewithNF-1.
497.InacaseofDysgerminomaofovaryoneofthefollowingtumormarkersislikelytoberaised:
a)SerumHCG
b)Serumalphafetoprotein
c)Serumlacticdehydrogenase
d)Seruminhibin
CorrectAnswer-CAns.isci.e.Serumlacticdehydrogenasehoweverplacentalalkalinephosphateandlactatedehydrogenasearecommonlyproducedbydysgerminomasandmaybeusefulinmonitoringthedisease."
498.Mostcommonsiteforectopicthyroidtissueis?
a)Ovaries
b)Lingual
c)Infrontofhyoidbone
d)Stomach
CorrectAnswer-BAnswer-B.LingualByfarthemostcommonlocationisnearitsembryologicaloriginattheforamencaecum,resultinginalingualthyroid.Thisaccountsfor90%ofallcasesofectopicthyroids.
499.Salivaryschintigraphyisusefulin?
a)Monomorphicadenoma
b)Pleomorphicadenoma
c)Sialidinitis
d)Sjogrensyndrome
CorrectAnswer-DAnswer-D.SjogrensyndromeTechnitiumpertechnetatescans(Salivaryscintigraphy)teststhesize,shapeandfunctionofthesalivaryglands.Itisuseful.
1. Tohelpdeterminethecauseofsalivaryglandswelling(e.g.bacteriaorvirus).
2. Todetectablockageofthesalivaryducts.3. Todetectagrowthinthesalivaryglands(e.g.Warthin'sTumour).4. TohelpdiagnoseabnormalmouthdrynessasSjogren'sSyndrome.
500.Trilateralretinoblastomais?
a)BilateralRetinoblastomaplusmedulloblastoma
b)Bilateralretinoblastomapluspineoblastoma
c)Bilateralretinoblastomaplusneuroblastoma
d)Bilateralretinoblastomaplusependymoma
CorrectAnswer-BAnswer-B.BilateralretinoblastomapluspineoblastomaTrilateralretinoblastoma(TRb)referstothecombinationofretinoblastoma(usuallybilateral)andpineoblastoma.Thisrelationshiphighlightsthecloserelationshipbetweenthesehighlyaggressivesmallroundbluecelltumors.
501.Mostcommoncancertooccurinorgantransplantpatientis?
a)Squamouscellcarcinoma
b)Melanoma
c)Lungcancer
d)Colorectalcancer
CorrectAnswer-AAnswer-A.SquamouscellcarcinomamostcommontumorsaftertransplantNonmelanomaskincancer(SCC>BCC)(mostcommon)NHL(2ndmostcommon)LungcarcinomaKaposi'ssarcomaHCCCervicalcarcinoma
502.Hydroxylionsaredestroyedinthebodyby?
a)VitaminC
b)VitaminA
c)VitaminK
d)VitaminD
CorrectAnswer-AAnswer-A.VitaminC"VitaminCandotherwatersolublecompounds,suchasuricacid,thiolsincludingglutathioneanddihydrolipoicacidandpossiblyothersubstancessuchasmetallothionein,servetodefendagainsthydroxylradicals.VitaminE,incontrast,islesseffectiveineliminatinghydroxylradicals.
503.WhichofthefollowingdrugsisnotaninhibitorofP-glycoprotein?
a)Quinidine
b)Erythromycin
c)Verapamil
d)Phenobarbitone
CorrectAnswer-DAns.D.Phenobarbitone[RefKDT7Vep.15]P-glycoprotein:Productofmultidrugresistance1gene(ABCB1).Importantroleinpharmacokineticsofdrugs.AnATP-bindingcassette(ABC)transporterandisanimportantfactortolimitmembranepermeabilityinseveraltissuesand/oreliminationpathwaysintourine(renaltubles)andbile(liver).SomedrugsaresubstrateforbothCYP3A4andP-gp.Examples:CCBs:Verapamil,diltiazamAnticancerdrugs:Etoposide,daunorubicin,doxorubicin,paclitaxel,vincrisitineAntimicrobials:HIVprotoeaseinhibitors(indinavir,ritonavir),erythromycin,ketoconazoleImmunosuppressants:Cyclosporine,tacrolimus,sirolimus.Other:Digoxin,fexofenadine,loperamide.
504.Liposomedrugdeliverysystemisusedforallexcept?
a)Vincristine
b)AmphotericinB
c)Hyoscine
d)Amikacin
CorrectAnswer-CAns.C.HyoscineImportantdrugswithliposomedeliverysystems:Anticancerdrugs→Donorubicin,Daunorubicin,vincristine,camptothecin,methotrexate,cisplatin,mitoxantraneAntifungal→AmphotericinB,NystatinAntibiotics→Amikacin,Ampicillin,ciprofloxacin,Ribavirin,Ganciclovir,chloroquineOthers→IL-2,cyclosporin
505.Tachyphylaxisisseenwithwhichofthefollowingdrugs?
a)Pethidine
b)Ephedrine
c)Phenoxybenzamine
d)Phentolamine
CorrectAnswer-BAns.B.Ephedrine[RefKDT7th/ep.70&6th/ep.68;Laurence50/ep.448;Katzung11`"/ep.32]Tachyphylaxis:*Rapidlydiminishingresponsetorepeatedadministrationofadrug.Tachyphylaxismayoccurdueto:*Down-regulationofreceptors-Whentissuesarecontinuouslyexposedtoanagonist,thenumberofreceptorsdecreases(down-regulation).-Itoccursinasthmaticswhouse132-agonistbronchodilatorsexcessively.*Depletionofstoredneurotransmitter-Itisparticularlycommonwithindirectlyactingsympathomimeticsdrugs,e.g.amphetamine,tyramineandephedrine.-Itisduetodepletionofreleasablepoolofnoradrenalinefromadrenergicnerveterminals.
506.Synergesticactionisshownbythefollowingdrugcombinationsexcept?
a)Glibenclamideandmetformin
b)Enalaprilandhydrochlorthiazide
c)Levodopaandcarbidopa
d)Hydrochlorthiazideandtriamterene
CorrectAnswer-DAns.D.Hydrochlorthiazideandtriamterene[RefKDTp.56]SYNERGISM:Whentheactionofonedrugisfacilitatedorincreasedbytheother,theyaresaidtobesynergistic.Inasynergisticpair,boththedrugscanhaveactioninthesamedirectionorgivenaloneonemaybeinactivebutstillenhancetheactionoftheotherwhengiventogether.Additivedrugcombination:Aspirin+paracetamol-Asanalgesic/antipyreticNitrousoxide+halothane-AsgeneralanestheticAmlodipine+atenolol-AsantihypertensiveEphedrine+theophylline-Asbronchodilator
507.Oxidationinbiotransformationis?
a)Functionalizationreaction
b)Conjugationreaction
c)Syntheticreaction
d)Felsonreaction
CorrectAnswer-AAns.A.Functionalizationreaction[Ref:KDT7th/ep.22,23]Biotransformationincludes2typesofreaction:PhaseI/Nonsynthetic/functionalizationreaction:Oxidation,reduction,hydrolysis,cyclization,decyclization.PhaseH/synthetic/conjugationreactions:Acetylation,glutathioneconjugation,glucoronideconjugation(glucuranization),glycineconjugation,methylation,sulfateconjugation(sulfuranation),nucleotidesynthesis.
508.Oxybutyninactsby?
a)Adrenergicreceptorantagonist
b)Muscarinicrece8ptorantagonist
c)Histaminicantagonist
d)Serotonergicantagonist
CorrectAnswer-BAns.B.Muscarinicrece8ptorantagonist[RefKDT7thlep.113,117]Oxybutynin:Thisrecentlyintroducedantimuscarinic(muscarinicreceptorantagonist)hashighaffinityforreceptorsurinarybladderandsalivaryglandswithadditionalsmoothmusclerelaxantandlocalanestheticproperties.ItisrelativelyselectiveforM1/M3subtypesthanforM2.
509.WhichofthefollowingdrugcrossesBBB?
a)Glycopyrrolate
b)Neostigmine
c)Physostigmine
d)Alloftheabove
CorrectAnswer-CAns.C.Physostigmine[RefKDTp.07,117]Physostigmine-RapidlyabsorbedfromGITandparenteralsites,penetratescorneafreelyandcrossesBBB(bloodbrainbarrier).Neostigmine-Itisaquarternaryammoniumcompoundwhichispoorlyabsorbedorallywithpoorcornealpenetrationanddoesn'tcrossBBB.Glycopyrrolate-Itisapotentandrapidlyactinganti-muscariniclackingcentraleffectsandisusedasapre-anaestheticmedication.
510.Whichofthefollowingisnottrueabouttheactionofanticholinergicdrugs?
a)AtropineisaCNSdepressant
b)Atropinecausesmydriasis,abolitionoflightreflexandcycloplegia
c)Atropinecausesbronchoconstriction
d)Atropinecanincreasethechancesofhyperthermiainchildren
CorrectAnswer-A:CAns.A.AtropineisaCNSdepressant&C.Atropinecausesbronchoconstriction[RefKDT7iVep.113,114]Actionsofanticholinergicdrugs:Theseareoppositeofparasympathetic(cholinergic)system.AtropinehasanoverallCNSstimulantaction.Stimulatesmedullarycentres-vagal,respiratory,vasomotor.Depressesvestibularexcitationandhasantimotionsicknessproperty.AbbrevatesrefractoryperiodofA-VnodeandfacilitatesA-Vconduction,PRintervalisshortened.DoesnothaveanyconsistentormarkedeffectonBP.UsedinarrhythmiaslikeAVblockanddigitalisinducedarrhythmia.Causesmydriasisduetocontractionofcircularmuscles(constrictorpupillae),abolitionoflightreflexandcycloplegia(paralysisofaccomodation).Increasesintraoculartension→Contraindicatedinglaucoma.Causesbronchodilatationandreducedairwayresistance,especiallyinCOPDandasthmapatients.Relaxesurinarybladder,urinaryretentionmay
occur→contraindicatedinbenignprostatehypertrophy.Decreasessweat,salivary,tracheobronchialandlacrimalsecretion.Decreasessecretionofacid,pepsinandmucusinthestomach.
511.Advantageofglycopyrolateoveratropineis?
a)Itisanaturalalkaloid
b)ItlacksCNSpenetration
c)CanbeusedinOPCpoisoning
d)Ismorepotent
CorrectAnswer-BAns.B.ItlacksCNSpenetration[RefKDT7thiep.117]Glycopyrrolate:Quarternarysyntheticcompound,whichispotentandrapidlyactingantimuscariniclackingCNSpenetrationandcentraleffects.Almostexclusivelyusedinpreanaestheticmedication.
512.Oximesareineffectiveinwhichofthefollowingpoisoning:?
a)Organophosphatepoisoning
b)Amanitaphylloidespoisoning
c)Carbamatepoisoning
d)Dhaturapoisoning
CorrectAnswer-CAns.C.Carbamatepoisoning[RefKDT7th/ep.111&6t/ep.105;Katzung11thiep.121]Oximes[Pralidoxime2-PAM,obidoximeanddiacetyl-monoxime(DAM)]areusedinorganophosphatepoisoning.Oximesactsbyreactivatingcholinesteraseenzyme.IneffectiveinCarbamatespoisoning.Pralidoximeiscontraindicatedincarbamatespoisoning,becausenotonlyitdoesnotreactivatecarbamylatedenzyme,ithasweakanti-chEactivityofitsown.Mostcommonlyusedcholinesterasereactivater.
513.Whichofthefollowingisanexampleofirreversiblecarbamate?
a)Ambenonium
b)Galantamine
c)Propoxur
d)Rivastigmine
CorrectAnswer-CAns.C.PropoxurIrreversiblecarbamate:CarbarylPropoxur
514.38yroldpatientwithhighriskofcoronaryarterydiseaseriskhashypertention,whichofthefollowingantihypertensivedrugswillbesuitableasafirstlinetreatmentforthispatient?
a)ACEinhibitors
b)Calciumchannelblockers
c)Betaadrenergicblockers
d)Diuretics
CorrectAnswer-AAns.A.ACEinhibitorsPatientisrelativelyyounghypertensive(38yrs)withhighriskofcoronaryarterydisease,ACEinhibitors/Angiotensinreceptorblockeristhesuitablefirstlinetherapyformanagementofhypertentioninsuchpatients.
515.WhichofthefollowingisNOTasideeffectofamiodarone?
a)Pulmonaryfibrosis
b)Cornealmicrodeposits
c)Photosensitivity
d)Tachycardia
CorrectAnswer-DAns.D.Tachycardia[Ref:KDT7"Vep.534]Amiodaroneisabroadspectrumanti-arrhythmicdrugwhichbelongstoclassIIIoftheanti-arrhythmicdrugs.Followingaretheadverseeffects-FallinBP,bradycardiaandmyocardialdepressionoccursoni.v.injection.
516.Asideeffectofloopdiureticsisusedin?
a)Post-surgerycare
b)Chronicanemia
c)Bloodtransfusion
d)Oncology/cancer
CorrectAnswer-DAns.D.Oncology/cancerFurosemideandotherloopdiureticscausehypocalcemiabyincreasingCa2+excretion.Forthesamereasontheyareusedintumorinducedhypercalcemiatoreduceserumcalciumlevel.
517.Whyadenosinehasashorthalflife?
a)Spontaneoushydrolysis
b)Uptakeinsubcutaneoustissue
c)UptakeinRBCandendothelialcells
d)Renalexcretion
CorrectAnswer-CAns.C.UptakeinRBCandendothelialcells[RefKDT6thIep.518;Katzung11thiep.244]AdenosineistheDOCforP.S.V.T.Administeredbyrapidi.v.injectioneitherasfreebaseorasATP.Actionisveryrapid-terminatesmorethan90%episodesofPSVTwithin30sec.Adenosineisveryshortacting(t.inblood-10sec)duetouptakeintoRBCsandendothelialcells.
518.Mechanismofactionofnicorandilis?
a)K*channelblocker
b)I('channelopener
c)Na'channelblocker
d)Cl-channelblocker
CorrectAnswer-BAns.B.I('channelopener[Ref:KDT7th/ep.540,552]NicorandilThisdualmechanismanti-anginadrugthatactivatesATPsensitiveK+channels(potassiumchannelopener)therebyhyperpolarizingvascularsmoothmuscle.
519.WhichofthefollowingantiarrhythmicdrugscandevelopLongQTsyndrome?
a)Ibutilide
b)Dofetilide
c)Sotalol
d)Alltheabove
CorrectAnswer-DAns.D.AlltheaboveProarrhythmicManifestationsofMostFrequentlyUsedAntiarrhythmicAgents:AmiodarroneDigoxinDisopyramideDofetilideDronedaroneFlecainidesPropafenoneQuinidineSotalol
520.Whichofthefollowingisnottrueaboutthemechanismofactionofdigitalis?
a)ItbindstotheintracellularfaceofNa'ATPaseenzyme
b)ThereisriseinintracellularNa'
c)Ithaspositiveionotropicaction
d)Digitalisactionisindependentofcardiacinnervation
CorrectAnswer-AAns.A.ItbindstotheintracellularfaceofNa'ATPaseenzyme[RefKDT7th/ep.496]Digitalismechanismofaction:Digitalisincreasestheforceofcontractionbyadirectactionindependentoftheinnervation.BindstotheextracellularfaceoftheNa+K+ATPaseandinhibitstheenzymecausingriseintheintracellularlevelsofNa+.TheraisedNa+inturninhibitstheNa+Ca2+exchangerandcausesriseinintracellularCa+.ThisraisedintracellularCa2+isresponsibleforthepositiveionotropiceffect.Thus,digitalisincreasesthecardiaccontractabilityandforceofcontraction.
521.Whichdruginhibitsbothcyclooxygenaseandlipooxygenase?
a)Aspirin
b)Indomethacin
c)Imidazole
d)BW755
CorrectAnswer-DAns.D.BW755[RefBiochemistryofeyebyElaineR.Bermanp.165]Drug-BW755Enzymeinhibited-Cyclooxygenaseandlipoxygenase
522.Drugactingon5HT4receptoris?
a)Loxiglumide
b)Renzapride
c)Atractiloside
d)Metoclopromide
CorrectAnswer-BAns.B.Renzapride[RefKDT7th/ep.174]Renzapride:Renzaprideisacisapridecongenerwhichisaprokineticdruganditincreasesthegastrointestinalmotilitybyactingon5HT4receptors.Renzaprideisstillmoreselectivefor5HT4thancisapride.Italsohaslesserpropensitytocausecardiacarrhythmias.
523.Drugofchoiceforabortingtheacuteattackofmigraineis?
a)NSAIDslikeindomethacin
b)Opioidslikemorphine
c)Triptanslikesumatriptan
d)Glucocorticoids
CorrectAnswer-CAns.C.Triptanslikesumatriptan[RefKDT7th/eP.179]Treatmentandprophylaxisofmigraine:*Forabortinganacuteattackofmigraine,sumatriptan(oranyothertriptan)isthedrugofchoice.-OtherdrugsusedfortreatmentareNSAIDs,ergofamineanddihydroergotamine,andintranasalbutorphanol.*ForProphylaxis,Beta-blocker(propranolol)isthedrugofchoice.-Otherdrugsusedforprophylaxisaretricyclicantidepressants(amitriptyline),calciumchannelblockers(cinnarizine,verapamil),serotonineantagonists(methysergide,cyproheptadine),MAOinhibitors,andanticonvulsants(valproate,topiramate,gabapentine),fluxetin,onabotulinumtoxineA,pepaverineandphenalzine.
524.Rasburicaseisananalogueof?
a)Xanthineoxidase
b)IMPdehydrogenase
c)AdenosineDeaminase
d)UrateOxidase
CorrectAnswer-DAns.D.UrateOxidaseRasburicaseisarecombinantversionofurateoxidase.ThecDNAofUrateoxidaseisobtainedfromAspergillusflavusandisintroducedintoSachhromycescervicae.Itisusedforreducinguratelevels.
525.Adverseeffectofmethysergideis?
a)Metabolicsyndrome
b)Endocardialfibrosis
c)Peyronie'ssyndrome
d)Drymouth
CorrectAnswer-BAns.B.Endocardialfibrosis[RefKDT7th/ep.174]MethysergideChemicallyrelatedtoergotalkaloidswhichantagonizesactionof5HTonsmoothmusclesincludingthatofbloodvessels.MechanismofactionPotent5HT2A/2CantagonistwithNoaadrenergicordopaminergicaction.Uses:Migraineprophylaxis,carcinoidsyndromeandpostgastrectomydumpingsyndrome.AdverseeffectsAbdominal,pulmonaryorendocardialfibrosisisproducedwithprolongeduse.
526.Contraindicationforthetriptansiswhichofthefollowing?
a)Ischemicheartdisease
b)Epilepsy
c)Hepaticfailure
d)Alloftheabove
CorrectAnswer-DAns.D.Alloftheabove[RefKDT7th/ep.179]TriptansTheseare5-HTIDABreceptoragonists.AlltriptanscancausecoronaryvasospasmandarecontraindiatedinIHD.Othercontraindicationsarehypertension,epilepsy,hepaticorrenalimpairmentandduringpregnancy.Themostimportantadverseeffectsarefeelingofchestpressure,tightnessandpainwhichmaybeaccompaniedbyarrhythmiaandMIandappeartobeduetocoronaryvasospasm.
527.Advantageofformoteroloversalmeterolis?
a)Itcanbeusedforprophylaxisinasthmatics
b)Ithasgotafasteronsetofaction
c)Itisashortactingbeta2agonist
d)Italsohasbeta1agonisticaction
CorrectAnswer-BAns.B.Ithasgotafasteronsetofaction[RefKDT7Vep.224;GoodmanGillman11thiep.720]FormoterolItisalongactingselective132agonistwhichacts12hourswheninhaled.Incomparisontosaletetrolithasfasteronsetofactionandisusedonaregularmorning-eveningscheduleforroundtheclockbronchodilatation.Dose:12-24pginhalationtwicedaily.
528.UseofPGF2aanaloguesiscontraindicatedin?
a)Postpartumharmorrhage
b)Glaucoma
c)Bronchialasthma
d)Priapism
CorrectAnswer-CAns.C.Bronchialasthma[RefKDT7th/ep.185,189]ProstaglandinF2a]PGF2aanaloguesaresmoothmuscleconstrictorwhichbringaboutcontractionofsmoothmusclesPGF2aanaloguelikecarboprostisusedforpostpartumhaemorrhagePGF2aanalogueslikelatanoprosthasbeenusedforglaucomaandisafirstlinedrugforopenangleglaucoma.Itiscontraindicatedinbronchialasthmaasitcausesbronchialmusclecontraction.
529.MechanismofactionofTeriparatideis?
a)RecombinantPTH[rPTH]
b)Recombinantcalcitonin
c)Recombinantinsulin
d)Recombinantprolactin
CorrectAnswer-AAns.A.RecombinantPTH[rPTH]TeriparatideThisisrecombinantpreparationof1-34moleculesofaminoterminalofhumanPTH.Itduplicatesalltheactionsoflong(1-84)PTH.Diagnosticuse:Todifferentiatepseudofromtruehypoparathyroidism:teriparatideisgiveniv:ifplasmacalciumlevelfailstorise,thenitispseudohypoparathyroidism.
530.Anti-inflammatoryactionsofcorticosteroidsaremediatedby?
a)Byinhibitingangiogenesis
b)Byinhibitingbreakdownofphospholipids
c)Byincreasingvascularity
d)Byincreasinggranulationtissueformation
CorrectAnswer-BAns.B.Byinhibitingbreakdownofphospholipids[RefKDT7thiep.279]GlucocorticoidsinterfereatseveralstepsintheinflammatoryresponsebutthemostimportantoverallmechanismappearstobelimitationofrecruitmentofinflammatorycellsatthelocalsiteandproductionofproinflammatorymediatorslikePCs,LTs,PAFthroughinhibitionofphospholipaseA.
531.Whichofthefollowingisnotaninhalationalsteroids?
a)Beclomethasone
b)Betamethasone
c)Budesonide
d)Fluticasoneacetonide
CorrectAnswer-BAns.B.Betamethasone[RefKDT7Vep.290]Corticosteroidmaybeusedasinhaledorsystemicdrugsinasthma.InhaledsteroidsTheseareglucocorticoidswithhightopicalandlowsystemicactivity.Commonlyuseddrugsarebeclomethasome,budesonide,fluticasoneandciclesonide.Inhaledsteroidsarethemosteffectiveanti-inflammatoryagentsusedinasthma.
532.Whichofthefollowingantithyroidmedicationshadthemaximumchancesofcausingagranulocytosis?
a)Carbimazole
b)Clotrimazole
c)Propylthiouracil
d)Methimazole
CorrectAnswer-CAns.C.Propylthiouracil[RefKDT7h/ep.253]Propylthiouracilhasgotmaximumchanceofcausingagranulocytosis.Itismostlyreversible.
533.Mifepristoneactsonwhichreceptor?
a)TypeAprogesteronereceptor
b)Estrogenreceptor
c)LHreceptor
d)Thyroidreceptor
CorrectAnswer-AAns.A.TypeAprogesteronereceptor[RefKDT7hlep.319,320]MifepristoneItisapotent,19-norsteroid.Ithasanti-progestational,significantanti-glucocorticoidandanti-androgenicactivity.MifepristoneisapartialagonistandcompetitiveantagonistatbothAandBformsofprogesteronereceptor(PR)Intheabsenceofprogesterone(anovulatorycyclesaftermenopause)itexertsweakprogestionalactivityandinducespredecidualchanges.
534.Pegvisomantis?
a)Somatostatinantagonist
b)Somatotropinantagonist
c)GHreceptorantagonist
d)GHreceptoragonist
CorrectAnswer-CAns.C.GHreceptorantagonist[RefKDT7th/ep.238]PegvisomantThispolyethyleneglycolcomplexedmutantGH.ItbindstoGHreceptorbutdoesnottriggersignaltransductionandactsasaGHreceptorantagonist.
535.Drugusedformedicalmanagementofacromegalyduetosmallpituitarytumorsis?
a)Fulvestrant
b)Pegvisomant
c)Vigabatrin
d)Cabergoline
CorrectAnswer-BAns.B.Pegvisomant[RefKDT7h/ep.238]Pegvisomant:ThispolyethyleneglycolcomplexedmutantGH.ItbindstoGHreceptorbutdoesnottriggersignaltransductionandactsasaGHreceptorantagonist.Approvedfortreatmentofacromegalyduetosmallpituitaryadenomas.
536.Tiboloneisa?
a)Naturalsteroidalestrogen
b)Naturalnon-steroidalestrogen
c)Syntheticsteroidalestrogen
d)Syntheticnon-steroidalestrogen
CorrectAnswer-CAns.C.Syntheticsteroidalestrogen[RefKDT7Vep.306,311]SyntheticestrogensSteroidal→Ethinylestradiol,mestranol,tibolone.Nonsteroidal→Diethylstilbestrol,hexestrol,dienestrol.
537.Tiboloneisusedfor?
a)Fibroids
b)Endometriosis
c)Hormonereplacementtherapy
d)Anovulatoryinfertility
CorrectAnswer-CAns.C.Hormonereplacementtherapy[RefKDT7thiep.306,311]TiboloneItisa19-norsteroiddevelopedspecificallytobeusedforhormonereplacementtherapy,whichcombinesestrogenicandprogestationalpropertieswithweakandrogenicactivity.Inadoseof2.5mgdaily,itsuppressesmenopausalsymptomsandloweretheraisedGnlevels.Noendometrialstimulationhasbeennoted.Urogenitalatrophy,psychologicalsymptoms,libidoandosteoporosisareimprovedsimilartootherformsofHRT.IncreaseinbreastcancerriskappearstobelessthanwithcombinedHRT.Weightgain,increasedfacialhair,andoccasionalvaginalspottingmaybenoted.
538.Danazolactsthrough:?
a)IncreasesreleaseofGn
b)Increasesinsulinrelease
c)InhibitionofreleaseofGn
d)Inhibitionofinsulinrelease
CorrectAnswer-CAns.C.InhibitionofreleaseofGn[RefKDT7th/ep.301]DanazoleIthasweakandrogenic,anabolicandprogestationalactivity.Themostprominentactionissuppressionofgonadotropin(FSH/LH)frompituitary.
539.MechanismofactionofVogliboseis:?
a)pgalactosidaseinhibitor
b)3lactaseinhibitor
c)aglucosidaseinhibitor
d)3glucosidaseinhibitor
CorrectAnswer-CAns.C.aglucosidaseinhibitor[RefKDT7th/ep.277]VogliboseItisaglucosidaseinhibitorwhichpreventsbreakdownofcomplexcarbohydratesintosimplersugarslikeglucose.
540.Metyrosineactsbyinhibiting?
a)PhenolethanolamineNmethylTransferase
b)PhenylalanineHydroxylase
c)TyrosineHydroxylase
d)Tyrosinase
CorrectAnswer-CAns.C.TyrosineHydroxylaseMetyrosineisaMethylL-tyrosineItisacompetitiveinhibitorofTyrosineHydroxylaseTyrosinehydroxylaseistheenzymewhichconvertsTyrosinetoDihydroxyphenylalanine(DOPA).Itistheratelimitingenzymeofcatecholaminesynthesis.
541.Whichofthefollowingoralhypoglycaemicdrugshasthelongestt1/2?
a)Gliclazide
b)Glimepiride
c)Chlorpropamide
d)Tolbutamide
CorrectAnswer-CAns.C.Chlorpropamide[RefKDT6thlep.268]Tolbutamideisshortestactingsulfonylurea.Chlorpropamideislongestactingsulfonylureaandlongestactingoralhypoglycemic.Nateglinideisshortestactingoralhypoglycemic.Tolbutamide,becauseofshorterdurationofaction,issaferinelderlyandinthosepronetohypoglycemia.
542.Allofthefollowingareusesofoctreotideexcept:?
a)Secretorydiarrhea
b)Acromegaly
c)Hepaticencephalopathy
d)Bleedingesophagealvarices
CorrectAnswer-CAns.C.Hepaticencephalopathy[RefKDT7tVep.238]Octreotideisasyntheticoctapeptidesurrogateofsomatostatinwhichis40timesmorepotentinsuppressingGHandprolactinsecretion.Itisalsoaweakinhibitorofinsulinsecretion.Uses:AcromegalySecretorydiarrheaassociatedwithcarcinoids,AIDS,cancerchemotherapyordiabetes.
543.Whichofthefollowingpairsiscorrect?
a)Glibenclamide-Na'ATPblocker
b)Biguanides-AMPKinaseactivation
c)Vildagliptin-SGLT2inhibitor
d)Voglibose-DPP4inhibitor
CorrectAnswer-BAns.B.Biguanides-AMPKinaseactivation[RefKatzung11th/ep.741]BiguanideactsasanAMP-activatedproteinkinase(AMPK)activator.ActivationofAMPKhasahighnumberofpotentiallyantiatheroscleroticeffects,includingreducinginflammatorycelladhesiontobloodvesselendothelium&reducinglipidaccumulation.
544.Mechanismofactionofsulfonylureasis?
a)NaATPchannelblocker
b)KATPchannelblocker
c)CIATPchannelblocker
d)CaATPchannelblocker
CorrectAnswer-BAns.B.KATPchannelblocker[RefKDT7th/ep.270,274]Sulfonylureasprovokeabriskreleaseofinsulinfrompancreas.Theyactonthesocalled"Sulfonylureareceptors"(SUR1)onpancreatic(beta-cellmembrane-causedepolarizationbyreducingconductanceofATPsensitiveK.channels.ThisenhancesinfluxofCa'2--degranulation.Theydonotcausehypoglycemiainpancreatectomizedanimalsandtype1diabetes(Presenceofatleast30%offunctional[3-cellsinessentialfortheiraction).Aminoractionreducingglucagonsecretionbyincreasinginsulinandsomatostatinreleasehasbeendemonstrated.
545.NasallyactingGnRHanalogueis?
a)Goserelin
b)Triptorelin
c)Nafarelin
d)Leuprolide
CorrectAnswer-CAns.C.Nafarelin[RefKDT7thiep.242]GnRHanaloguesareusedbySCroute,howevernafarilinandbusurelincanbeusedasintranasalspray.GnRHanaloguescancausehotflushes,lossoflibidoandosteoporosis.
546.Whichofthefollowingis/aresideeffect/sofgrowthhormoneadministration?
a)Painatinjectionsite
b)Glucoseintolerance
c)Hypothyroidism
d)Alltheabove
CorrectAnswer-DAns.D.Alltheabove[RefKDT&hiep.234]AdverseeffectsofgrowthhormoneSomatropinandsomatremarerecombinantGHanalogues.Somatremhasanadditionalmethionineresidueandismoreimmunogenicthansomatropin,butallergicreactionsorresistancetotreatmentarenotaproblem.Painatinjectionsiteandlipodystrophycanoccur.Glucoseintolerance,hypothyroidism(duetounmaskingofTSHdeficiency),saltandwaterretention,handstiffiress,myalgias,headachearethepossibleadverseeffectsRiseinintracranialtensionoccursinfewcases.
547.WhichofthefollowingdrugshaltsmacrovascularaswellasmicrovasculareffectsofDM?
a)Acarbose
b)Biguanides
c)Meglitinide
d)Algaliptin
CorrectAnswer-BAns.B.Biguanides[RefKDTTh/ep.276]Biguanides]*Biguanideslikemetforminarethe1stlinedrugsforthetreatmentofType2DM,whichactsbyAMPKactivation.*AdvantagesofBiguanidesareasfollows,-Nonhypoglycemic.-Promotesweightloss.-PreventsmacroaswellasmicrovascularcomplicationsofDM.
548.Whichofthefollowingarenaturallyoccurringopioid?
a)Diacetylmorphine
b)Ethylmorphine
c)Morphine
d)Pholcodeine
CorrectAnswer-CAns.C.Morphine[RefKDT7"/ep.474]Classificationofopioids:Naturallyoccurringopiumalkaloids:-Morphine,codeineSemisyntheticopiates:-Diacetylmorphine(heroin),pholcodeineandethylmorphine.Syntheticopioids:-Pethidine(Meperidine),fentanyl,methadone,dextropropoxyphene,tramadol.
549.Mostpotentopioidis?
a)Butorphanol
b)Pentazocine
c)Sulfentanyl
d)Hdrocodone
CorrectAnswer-CAns.C.Sulfentanyl[RefKDTp.476]Theorderofpotencyofopioids:Sufentanil>Fentanyl>Buprenorphine>Hydromorphone,Oxymorphone>Butorphanol>Levorphenol>Oxycodone>Hydrocodone>Nalbuphine,morphine,Methadone>Pentazocine>codeine>Mepridine(Pethidine)>Propoxyphane.
550.Allofthefollowingpairsarecorrectexcept?
a)Peripheraldecarboxylaseinhibitor-Benserazide
b)MAO-Binhibitor-Clorgyline
c)COMTinhibitor-Entacapone
d)Dopaminefacilitation-Amantadine
CorrectAnswer-BAns.B.MAO-Binhibitor-Clorgyline[Ref:KDTThlep.439&&lep.439;Katzung11th/ep.513]Note:ClorgylineisaMAOAinhibitornotMAOB.
551.Whichofthefollowingisusedforthepatientonantiparkinsonianmedicationlevodopa+carbidopa,butpatientshowingmarkedon-offeffect?
a)Bromocriptine
b)Amatidine
c)Selegeline
d)Rimonabant
CorrectAnswer-CAns.C.Selegeline[Ref:Harrison18th/ep.3326,3327]Ifthereiswearingoff(on-offeffect)COMTinhibitororMAO-Binhibitor(selegiline)isadded
552.Whichofthefollowingisnottrueaboutbenzodiazepines?
a)Canproduceataxia
b)HasGABAfacilitatorybutnoGABAmimeticaction
c)REM,andStage3and4sleepisincreased
d)Producesmusclerelaxationbyactiononmedulla
CorrectAnswer-CAns.C.REM,andStage3and4sleepisincreasedRef:KDT6th/ep.394&5th/ep.317,363]Mechanismofactionofbenzodiazepines(BZDs):Musclerelaxationisproducedbyactiononmedulla.Ataxiaisduetoactiononcerebellum.BZDsactsonGABAAreceptors.EffectonCNS:Incontrasttobarbiturates,BZDsarenotgeneraldepressant,butexertrelativelyselectiveanxiolytic,hypnotic,musclerelaxantandanticonvulsanteffects.TheantianxietyactionofBZDsisnotdependentontheirsedativeproperty-withchronicadministrationreliefofanxietyismaintained,butdrowsinesswanesoffduetodevelopmentoftolerance.Stage2sleepisincreased,whileREM,Stage3&4sleeparedecreased.
553.Whichofthefollowingisnottrueaboutbarbiturate?
a)ShowsGABAmimeticaction
b)ShowsGABAfacilitatoryaction
c)ItcandepressvoltagegatedNa.-andIC'channelsathighconcentrations
d)LimbicsystemismostsensitivetothedepressiveactionofbarbituratestoCNS
CorrectAnswer-DAns.D.LimbicsystemismostsensitivetothedepressiveactionofbarbituratestoCNS[RefKDT7th/ep.399&6th/ep.391]ActiononCNS:BarbituratesactprimarilyattheGABA-BZDreceptor-ClchannelcomplexandpotentiateGABAergicinhibitionbyincreasingthelifetimeofCl-channelopeningcausedbyGABA(ContrastbenzodiazepineswhichenhancefrequencyofCIchannelopening)-GABAfacilitatoryaction.BarbituratesdepressallareasofCNS,butthereticularactivatingsystemismostsensitive.
554.Whichofthefollowingcanbeusedinthemanagementoftardivedyskinesia?
a)Cessationofantipsychoticmedication
b)Baclofen
c)Tetrabenazine
d)Alltheabove
CorrectAnswer-DAns.D.Alltheabove[RefKDT7th/ep.445,Harrisons18th/ep.3333]TardiveDyskinesia:Commonestofthetardivesyndromesandistypicallycomposedofchoreformmovementsinvolvingthemouth,lips,andtongue.Atypicalantipsychotics(e.g.,clozapine,risperidone,olanzapine,quetiapine,ziprasidone,andaripiprazole)areassociatedwithasignificantlylowerriskofTDincomparisontotraditionalantipsychotics.Treatmentprimarilyconsistsofstoppingtheoffendingagent.Ifthepatientisreceivingatraditionalantipsychoticandwithdrawalisnotpossible,replacementwithanatypicalantipsychoticshouldbetried.Inrefractorycases,catecholaminedepleterssuchastetrabenazinemaybehelpful.Tetrabenazinecanbeassociatedwithdosedependentsedationandorthostatichypotension.Otherapproachesincludebaclofen(40-80mg/d),clonazepam(1-8mg/d),orvalproicacid(750-3000mg/d).
555.Temazepamissuperiortodiazepamin?
a)Longerdurationofaction
b)Safelyusedinliverfailure
c)Noactivemetaboliterequired.
d)Highhepaticmetabolism
CorrectAnswer-B:CAns.B.Safelyusedinliverfailure&C.Noactivemetaboliterequired.[RefKDT7'/ep.405]TemazepamIntermediateactingbenzodiazepine.Itsmetabolismisindependentofliverandhence,canbesafelygiveninpatientswithhepaticfailure.Temazepamdoesnothaveanactivemetabolitelikediazepam[Note:Diazepamisconvertedtoanactivemetabolite`desmethyldiazepam'(oxazepam)].
556.Drugcontraindicatedinabsenceseizuresis
a)Lamotrigine
b)Clonazepam
c)Tiagabine
d)Ethosuximide
CorrectAnswer-CAns.C.TiagabineCarbamazepine,vigabatrin,andtiagabinearecontraindicatedinthetreatmentofabsenceseizures,irrespectiveofcauseandseverity.
557.Mechanismofactionoftianeptinis:?
a)Increase5HTuptake
b)Decrease5HTuptake
c)IncreaseDAuptake
d)DecreaseDAuptake
CorrectAnswer-AAns.A.Increase5HTuptake[RefKDT7th/ep.447]TianeptinAtypicalanti-depressantIncreases5HTuptakeandisneithersedativenorstimulant.Shownefficacyinanxio-depressivestates,particularlywithpsychosomaticsymptoms,aswellasendogenousdepression.Sideeffectsinclude:drymouth,epigastricpain,flatulence,drowsiness/insomnia,tremorandthebodyache.
558.VenalafaxineisanFDAapproveddrugforthetreatmentof?
a)Majordepression
b)Generalisedanxietydisorder
c)Panicdisorder
d)Alltheabove
CorrectAnswer-DAns.D.Alltheabove[RefMedicalbasisofpsychiatarybySHossein,p.79]VenlafaxineItisserotoninandnoradrenalinereuptakeinhibitors(SNRI),butincontrasttoolderTCAsitdoesnotinteractwithcholinergic,adrenergic,histaminergicreceptorsanddoesnothavesedativeproperty.Itisfasteracting(otherfasteractingantidepressantsarebupropionandmirtazapine).ItraisestheBP(allotherantidepressantscausehypotension).ItisFDAapprovedforuseinmajordepression,generalizedanxietydisorder,andpanicdisorder.
559.FDAapproveddrugforrefractoryschizophrenia?
a)Amoxapine
b)Haloperidol
c)Clozapine
d)Penfluridol
CorrectAnswer-CAns.C.Clozapine[RefKDTriep.441]ClozapineisFDAapproveddrugforresistantschizophreniaItreducestheriskofsucidalbehaviorinyoungerpatientswithschizophrenia.
560.Trueaboutanti-Parkinsondruglevodopais:?
a)Levodopaisanactivemetaboliteofdopamine.
b)About50%ofadministeredlevodopaisperipherallyconvertedtocarbidopa.
c)About2%oftheadministeredlevodopacrossesbloodbrainbarrier.
d)Levodopahasnoroleinhepaticcoma.
CorrectAnswer-CAns.C.About2%oftheadministeredlevodopacrossesbloodbrainbarrier.[RefKDT7th/ep.426]Levodopa:Levodopaisinactivebyitself,butistheimmediateprecursoroftheneurotransmitterdopamine.95%oftheoraldoseisdecarboxylatedintheperipheraltissues.About1-2%oftheadministeredlevodopacrossesthebloodbrainbarriertoreachthebrain,whichistakenupbythesurvivingdopaminergicneuronsandconvertedtodopamine.ThestimulationofexcitatoryDIaswellastheinhibitoryD2receptorsinstriatumachievesthesameneteffectofsmootheningmovementsandreducingmuscletone.Itproducesanon-specific'awakening'effectinthehepaticcoma.
561.Whichofthefollowingistrueaboutziprasidone?
a)Profoundextrapyramidalsymptoms
b)Causesweightloss
c)Hasanti-depressantproperties
d)Safeincardiacpatients.
CorrectAnswer-CAns.C.Hasanti-depressantproperties[RefKDT7th/ep.442]Ziprasidone:Atypicalanti-psychoticIthasa5H1+5HT2+D2blockingactivitywithantagonismat5HT1Dandagonistat5HT1A.Beingatypicalitisfreefromextrapyramidalsideeffects(EPS)andhasgotgoodanxiolyticandantidepressantproperties.ItcausesmildweightgainandhyperglycemiaandcausesQTcprolongationandseriouscardiacarrhythmias.
562.Whichofthefollowingnephrotoxicdrugsshouldbecompletelyavoidedinrenalfailure?
a)Doxycycline
b)Talampicillin
c)Nitrofurantoin
d)Nalidixicacid
CorrectAnswer-B:C:DAns.B,TalampicillinC.Nitrofurantoin&D.NalidixicacidDrugstobeavoidedinrenalpatients:CephalothinTalampicillinNalidixicacidTetracyclines(exceptdoxycyline)Nitrofurantoin
563.ThetypicalmaintencedoseofLeveteracetamis?
a)10-20mg/Kg/day
b)20-30mg/Kg/day
c)30-40mg/Kg/day
d)40-50mg/Kg/day
CorrectAnswer-CAns.C.30-40mg/Kg/day[RefKDT7hlep.420]LevetiracetamUniqueanti-convulsantwhichhasshownefficacyinrefractorypartialseizureswithorwithoutgeneralization.Dosage:Therecommendedstartingdoseis10mg/Kg/daygiventwicedaily.Thedosagecanbeincreasedweeklyorbiweeklyby10mg/Kg/day.Thetypicalmaintenancedoseis30-40mg/Kg/day.
564.Botulinumtoxinisusedintreatmentof?
a)Axillaryhyperhidrosis
b)Blepharospasm
c)Cervicaldystonia
d)Alloftheabove
CorrectAnswer-DAns.D.Alloftheabove[RefKDT7th/ep.99]BotulinumtoxinAandBarehighlypotentexotoxinsproducedbyClostridiumbotulinumwhichcauses`botulinum'byinhibitingAchrelease.Itisusedintreatmentofblepharospasm,spasticcerebralpalsy,strabismus,spasmodictorticollis,nystagmus,hemifacialspasm,axillaryhyperhidrosis,spasticcerebralpalsywhichisduetocholinergicexcess.Ithasalsobeenusedforfacialwrinkles.
565.WhichofthefollowingantipsychoticsshowpartialD2agonistactivity?
a)Aripiprazole
b)Clozapine
c)Quetiapine
d)Ziprasidone
CorrectAnswer-AAns.A.Aripiprazole[RefGoodman6Gillman1p.464,465,466;Katzung11"'/ep.495]Aripiprazole:OnlyantipsychoticwithD2agonisticactivity.(allothersareD2antagonists).LongestactingItalsohas5HT1Aagonisticand5HT2antagonisticactivity-Alsoknownasdopamine-serotininestabilizer.Itisleastsedatingantipsychoticcancauseinsomnia.
566.Whichdrugisgiveninthepainduetodiabeticneuropathy?
a)Lamotrigine
b)Navalproate
c)Gabapentin
d)Morphine
CorrectAnswer-CAns.C.Gabapentin[RefKDT7th/ep.409]GabapentinThisislipophilicGABAderivatve.GabapentinenhancesGABAreleasebutitselfdoesnotactasaagonistattheGABAAreceptor.ItcrossestothebrainandenhancesGABAreleasebutdoesnotactasagonistatGABAAreceptor.Gabapentinisconsideredtobeafirstlinedrugforpainduetodiabeticneuropathyandpostherpeticneuralgia.UsesGTCSandpartialseizuresPainduetodiabeticneuropathyPostherpeticneuralgiaProphalaxisofmigraine
567.Topicalantifungalofchoiceforaspergillusinfectionofeyeis?
a)Miconazole
b)Clotrimazole
c)Econazole
d)Fluconazole
CorrectAnswer-BAns.B.Clotrimazole[RefKhuranaOphthalmology4th/ep.422]Clotrimazole:FungistaticandiseffectiveagainstCandida,Aspergillusandmanyothers.Its1percentsuspensioniseffectivetopicallyandisthetreatmentofchoiceinAspergillusinfectionsoftheeye.
568.Whichofthefollowingisatopicalantifungalagent?
a)Benzylbenzoate
b)Brimetenide
c)Butenafine
d)Posconazole
CorrectAnswer-CAns.C.Butenafine[RefKDT7thiep.796]Butenafine:Butenafineisabenzylaminecongeneroftheterbinafine,whichactsbyinhibitingtheenzymesqualeneepoxidase.Usedonlytopicallyfortreatmentofdermatophytosis.Efficacyintineacruris/corporis/pedisissimilartothatofterbenafine.
569.Fastestactingantimalarialdrugis?
a)Chloroquine
b)Quinine
c)Mefloquine
d)Artether
CorrectAnswer-DAns.D.Artether[RefHarrisons18th/ep.26-2]Artemisininderivatives:Artesunate,artemether,arteether,andtheparentcompoundartemisininaresesquiterpenelactonesderivedfromthewormwoodplantArtemisiaannua.Thesearethefastestactingerythrocyticschizontocide.
570.WhichofthefollowingincreasesAmphoterecinBinducednephrotoxicity?
a)Vancomycin
b)Cyclosporin
c)Acyclovir
d)Alltheabove
CorrectAnswer-DAns.D.Alltheabove[RefKatzung11th/ep.836]"Aminoglycosides.vancomycin,cyclosporineerothernephrotoxicdrugsenhancerenalimpairmentcausedbyAMB"RiskfactorsforamphotericinBinducednephrotoxicityFollowingriskfactorsincreasethechancesofnephrotoxicitycausedbyamphotericin:Concomitantuseofdiuretics.Abnormalbaselinerenalfunction(kidneydiseases)Dehydration(volumedepletion):-Itisakeyfactorfortherenaltoleranceofallthepotentialnephrotoxicdrugs.Therefore,allpatientsshouldreceive1-2litersofisotonicsalinepriortoamphotericinBinfusion.Concomitantuseofnephrotoxicdrugs:-Aminoglycosides,vancomycin,cyclosporine,tacrolimus(FK-506),acyclovir,NSAIDS,radio-contrastagentsHigheraveragedailydoseofamphotericinB.
571.ErythromycinisusedinthetreatmentofwhichGITdisorder?
a)Bacillarydysentery
b)Amoebicdysentery
c)Diabeticgastroparesis
d)Ulcerativecolitis
CorrectAnswer-CAns.C.Diabeticgastroparesis[RefKDT7h/ep.753]Erythromycin:Macrolideantibiotic.Erythromycinstimulatesmotilin(anuppergastrointestinalpeptidehormone)receptorsintheGITwhichinducesgastriccontractions,hastensgastricemptyingandpromotesintestinalmotilitywithoutsignificanteffectoncolonicmotility.Ithasbeenoccasionallyusedtoaffordshorttermsymptomaticreliefindiabeticgastroparesis,however,undesirablealterationofgutfloralimitsitsuse.
572.WhichmacrolideisactiveagainstMycobateriumleprae?
a)Azithromycin
b)Roxithromycin
c)Clarithromycin
d)Framycetin
CorrectAnswer-CAns.C.Clarithromycin[RefKDT7th/ep.754,780,Harrisons18thiep.1364-65]Clarithromycinisanewermacrolide,whichiseffectiveagainstMAC(Mycobacteriumaviumcomplex),atypicalmycobacteriaandMycobacteriumleprae.
573.Ivermectinisthedrugofchoiceforwhichofthefollowinginfections?
a)Trichuriasis
b)Onchocerciasis
c)Loiasis
d)Trichinosis
CorrectAnswer-BAns.B.Onchocerciasis[RefKDT7h/ep.853]Ivermectin:ExtremelypotentsemisyntheticderivativeofnematodalprincipalobtainedfromStreptomycesavermitilis.DOCforsingledosetreatmentofonchocerciasisandstrongyloidosis.Onlyoraldrugeffectiveagainstscabiesandpediculosis.ActsbyglutamategatedCI-channelwhichcausestonicparalysisinnematodes.
574.Whichofthefollowingcausesretinalpigmentation?
a)Quinine
b)Chloroquine
c)Mefloquine
d)Atovaquone
CorrectAnswer-BAns.B.Chloroquine[RefKDT7thiep.823]Chloroquine:1stlineantimalarialdrug,whichisanerythrocyticschizonticide.However,itsprolongeduseofhighdoses(asinDLE,rheumatoidarthritis)maycauselossofvisionduetoretinaldamageintheformofretinalpigmentation.Causecornealdepositsandaffectvisionandarereversibleondiscontinuation.Lossofhearing,rashes,photoallergy,myopathy,grayingofhairmayoccur.
575.MechanismofactionofLinezolidis:?
a)Inhibits30Sribosomesubunitof50Sribosome
b)Inhibits23Sribosomesubunitof50Sribosome
c)Inhibits5Sribosomesubunitof50Sribosome
d)Inhibits5PS.ribosomesubunitof50Sribosome
CorrectAnswer-BAns.B.Inhibits23Sribosomesubunitof50Sribosome[RefKDT7111ep.758]Linezolid:An`oxazoledianones'usefulintreatmentofMRSAandsomeVRSAstrainsItactsbyinhibitingbacterialproteinsynthesisbybindingto23Sfractionof50Sribosome.BindingofthelinezoliddistortsthetRNAbindingsiteoverlappingboth50Sand30Sribosomalsubunitsandstopstheproteinsynthesis.Itisapredominantlybacteriostaticdrug.
576.Whichofthefollowingisnottrueaboutlevamisole?
a)Itisthelevoisomeroftetramisole
b)Ithasimmunomodulatoraction
c)Itcankillstrongyloideslarvaeandadultworms
d)Itisusedagainstascariasisandancyclostomiasis
CorrectAnswer-CAns.C.Itcankillstrongyloideslarvaeandadultworms[RefKDT7ffilep.852]Levamisole,Tetramisole:Tetramisolewasdevelopedinthelate1960s.Itisrecemic;itslevoisomer(levamisole)wasfoundtobemoreactiveandispreferrednow.Bothareactiveagainstmanynematodes,butuseisrestrictedtoascariasisandancylostomiasis,becauseactiononotherwormsispoor.Strongyloideslarvaearekilled,butadultwormsarenotsensitive.Thegangliainwormsarestimulatedcausingtonicparalysisandexpulsionofliveworms.Interferencewithcarbohydratemetabolism(inhibitionoffumaratereductase)mayalsobecontributing.Levamisoleisanimmunomodulatoraswell.LevamisolerestoresdepressedTcellfunction.Itwasonceusedasadiseasemodifyingdruginrheumatoidarthritisandasanadjunctinmalignancies,aphthousulcers,recurrentherpesbutrepeateddosesproducereactionsandnowithasbeenwithdrawn.
577.Whichofthefollowingisasideeffectofclofazimine?
a)Reddishblackskindiscoloration
b)Hemolyticanaemia
c)Flulikesyndrome
d)Axillaryfreckling
CorrectAnswer-AAns.A.Reddishblackskindiscoloration[RefKDT7thlep.781,782]Clofazamine:1stlineanti-leproticdrugDyewithleprostaticandanti-inflammatoryproperties.Getsaccumulatedinmacrophagesandgetsdepositedinmanytissues.Includingsubcutaneousfatasneedleshapedcrystalsresponsibleforreddishblackskindiscoloration.Discolorationofskin,hairandbodysecretionsmayoccur.Conjunctivalpigmentationmayalsooccur.
578.MechanismofactionofNiclosamideis:?
a)Inhibitionofsubstratelevelphosphorylation
b)Inhibitionofoxidativephosphorylation
c)Inhibitionofprotoneffluxpumps
d)Increaseproductionoffreeradicals
CorrectAnswer-BAns.B.Inhibitionofoxidativephosphorylation[RefKDT7th/ep.854]NiclosamideactsbyinhibitingoxidativephosphorylationinmitochondriaandbyinterferingwithanaerobicgenerationofATP.Itismainlyactiveagainstcestodes-T.solium,T.saginata,DiphyllobothriumlatumandH.nana.
579.Forsystemicmycosisfluconazoleispreferredoverketoconazolebecauseof-
a)Greaterefficacy
b)Longert1/2
c)Lessersideeffects
d)Alltheabove
CorrectAnswer-DAns.D.Alltheabove[RefKDT&lep.761]ImidazolesandTriazoles:Thesearepresentlythemostextensivelyusedantifungaldrugs.Fourimidazolesareentirelytopical,whileketoconazoleisusedbothorallyandtopically.Twotriazolesfluconazoleanditraconazolehavelargelyreplacedketoconazoleforsystemicmycosisbecauseofgreaterefficacy,Longert1/2,fewersideeffectsanddruginteractions.Theimidazolesandtriazoleshavebroadspectrumantifungalactivitycoveringdermatophytes,Candida,otherfungiinvolvedindeepmycosis(exceptmucor),Nocardia,somegrampositiveandanaerobicbacteria,e.g.Staph.aureus,Strep.faecalis,Bac.fragilisandLeishmania.Themechanismofactionofimidazolesandtriazolesisthesame.TheyinhibitthefungalcytochromeP450enzymelanosterol14-demethylase'andthusimpairergosterolsynthesisleadingtoacascadeofmembraneabnormalitiesinthefungus.ThelowerhosttoxicityoftriazolescomparedtoimidazoleshascorrelatedwiththeirloweraffinityformammalianCYP450enzymesandlesserpropensitytoinhibitmammaliansterolsynthesis.
However,becausetheyareactiveagainstcertainbacteriaaswell(whichdonothaveergosterol),othermechanismsofactionalsoappeartobeinvolved.
580.INHhepatotoxicityisduetowhichcompound?
a)INHacetylhydrazine
b)INHsulfhydrazine
c)INHmethylhydrazine
d)Alloftheabove
CorrectAnswer-AAns.A.INHacetylhydrazine[RefKDT7thlep.767]INHisextensivelymetabolizedinliver,mostimportantpathwaybeingN-acetylationbyNATZ.TherateofINHacetylationshowsgeneticvariationwithsomebeingFastacetylators-30to40%patients.Slowacetylators-60to70%patients.Isoniazidinducedperipheralneuritisismorecommoninslowacetylators.HepatotoxicminormetaboliteisproducedbyCYP2E1fromacetylhydrazine.
581.WhatistheeffectofcoadministrationofrifampicinandritonavirinpatientssufferingfromAIDS?
a)AreaUnderCurvedecreasedby15%
b)AreaUnderCurvedecreasedby35%
c)AreaUnderCurveincreasedby15%
d)AreaUnderCurveincreasedby35%
CorrectAnswer-BAns.B.AreaUnderCurvedecreasedby35%[RefKucers:theuseofantibiotics6thednbyMLindsayGraysonp.1598]Coadministrationofritonavirwithrifampicin:Recommendationistousethecombinationwithcaution.Areaundercurvedecreasedby35%ThereisnochangeinrifampicinconcentrationItisrecommendedtomonitortheantiretroviralactivityofritonavir
582.Drugofchoiceforsurgicalprophylaxisis:?
a)Cefaclor
b)Ceftizoxime
c)Cefazolin
d)Cefoperazone
CorrectAnswer-CAns.C.Cefazolin[RefKDT7th/ep.726]Cefazolinistheprototype1stgenerationcephalosporinthatisactiveagainstPnGsensitiveorganismsiestreptowcce,gonococciandgroup.Itisthepreferredparenteralfirstgenerationcephalosporinforsurgicalpeophylaxis.
583.Vapiprostisa?
a)Thromboxanereceptorantagonist
b)Thromboxanesynthetaseantagonist
c)PGE1analogue
d)PGI2analogue
CorrectAnswer-AAns.A.Thromboxanereceptorantagonist[RefInternetncbiarticle]Vapiprost:Novelcongener,whichisarecentlydevelopedthromboxanereceptorantagonist.Itpreventsplateletaggregation,preventsthrombusformationandtherebypreventingvesselocclusion.ItisusuallyusedalongwithrtPAlikealteplase,renecteplase,tenecteplase.
584.Treatmentofclopidogreltoxicitycanbedonewith?
a)Wholehumanblood
b)Platelettransfusion
c)vWftransfusion
d)rFVIIainfusion
CorrectAnswer-DAns.D.rFVIIainfusionrFVIIa(RecombinantfactorVila)hasbeenshowntorestorethrombingenerationinclopidogreltreatedbloodsamples,andshortenthrombingenerationlagtimeinpatientswhohadbeentreatedwithaspirinandclopidogrel,andinbloodsamplestreatedwithclopidogrel'sactivemetabolite.Thustheycanbeusedforthemanagementofclopidogreltoxicityinducedbleedingi.e.canbeusedtoreversetheeffectsofclopidogrel.
585.Whyisclopidogrelpreferredoverticlopidine?
a)Lowerincidenceofneutropeniaandthrombocytopenia
b)Lowerincidenceofdyslipidemia
c)Lowerincidenceofhyperglycemia
d)Lowerincidenceofposturalhypotention
CorrectAnswer-AAns.A.Lowerincidenceofneutropeniaandthrombocytopenia[RefKDT6thiep.610]Clopidogrel:Thisnewercongenerofticlopidinehassimilarmechanismofaction,abilitytoinhibitplateletfunctionandtherapeuticefficacy,butappearstobesaferandbettertolerated(CLASSICSstudy).Clopidogrelissaferthanticlopidineasitislessassociatedwithhematologicaldyscrasiasthanuseofticlopidine.Alowerfrequencyofneutropenia,thrombocytopeniaandotherbonemarrowtoxicitycomparedtoticlopidinehasbeenrecorded.Theclopidogrelasaspirininpatientsatriskofischaemicevents(CAPRIE)trialhasfoundclopidogrelrecipientstohaveaslightlylowerannualriskofprimaryischaemiceventsthanaspirinrecipients.
586.Whichofthefollowingantilipidemicdrugisasterolabsorptioninhibitor?
a)Gemfibrozil
b)Simvastatin
c)Nicotinicacid
d)Ezetimibe
CorrectAnswer-DAns.D.Ezetimibe[RefKDT7th/ep.635]3ClassificationofantihyperlipidemicdrugsHMGCoAreductaseinhibitor:Statins:Lovastatin,Simvstatin,Pravastatin,Atorvastatin,RosuvastatinBileacidsequestrantsResins:Colestipol,CholestyramineLPLactivator/PPARalphaactivator-Clofibrate,gemfibrozil,fenofibrate.Sterolabsorptioninhibitor-EzetimibeLipolysis&TGsynthesisinhibitor-Nicotinicacid
587.MechanismofactionofTorcetrapribis?
a)Bileacidsequestrant
b)Sterolabsorptioninhibitor
c)Lipoproteinlipaseactivator
d)CETPinhibitors
CorrectAnswer-DAns.D.CETPinhibitors[Ref:KDT7hlep.641]CETPInhibitors:CETP,i.e.,Cholesterylestertransferproteinsinhibitorsareclassofcholesterolloweringagents.CETPfacilitatesexchangeofCHEwithT4betweenHDLandchylomicrons,VLDLandLDLwhichplaysanimportantroleinthedisposalofHDLassociatedCH.ExamplesofCETPinhibitors:Torcetrapib&AnacetrapibClinicaltrialshavebeenperformedandtorcetrapibwasfoundtoincreaseoccurrenceofcardiovasculareventslikeangina,MI,heartfailureanddeath.
588.MostpotentH2antagonistis:?
a)Ranitidine
b)Cimetidine
c)Famotidine
d)Nizatidine
CorrectAnswer-CAns.C.Famotidine[RefKDT7h/ep.650&6thlep.629;Katzung1lthlep.1070]H2-receptorantagonistsDrugsinthisgrouparecimetidine,ranitidine,famotidine,roxatidine,nizatidineandloxatidine.FamotidineisthemostpotentH2blocker.FamotidinehassomeinverseagonisticactiononH2receptors.AllH2-blockersarecompetitiveblockersexceptfamotidine(competitive-noncompetitive)andloxatidine(noncompetitive).H2blockersareusuallygivenfor6-8weeks.
589.Notanadverseeffectofcimetidine?
a)Confusionalstate,restlessness
b)Gynecomastia
c)Drymouth
d)Decreasedprolactinlevels
CorrectAnswer-DAns.D.Decreasedprolactinlevels[Ref:KDT7h/ep.650]Cimetidine:H2blockerwhichhasbeenreplacedbynewcongenersduetoitsmanyadverseeffects.Followingareitsadverseeffects:Welltoleratedbymostpatients:adverseeffectsoccurin<5%.Thesearegenerallymild.Headache,dizziness,bowelupset,drymouth,rashes.CNSeffectslikeconfusionalstate,restlessness,convulsionsandcomahaveoccurredinfrequentlyinelderlypatients,inthosewithrenalimpairment,especiallywithlargedosesinfused
590.Useofmetoclopramidebeyondweeksincreasesthechancesoftardivedyskinesia?
a)8
b)12
c)16
d)20
CorrectAnswer-BAns.B.12[RefPharmacologyandphysiologyforanesthesiabyHughE.Hemmingsp.511]FDAhasissuedablackboxwarningformetoclopramide,giventhehighiskofdevelopingtardivedyskinesiaifmetoclopramideuseextendsbeyond12weeks.
591.ThetwomoleculesofAminosalicylatecoupledviaazobondform?
a)Mesalazine
b)Olsalazine
c)Balsalazine
d)Sulfasalazine
CorrectAnswer-BAns.B.Olsalazine[RefKDT7h/ep.684]Olsalazine–2moleculesofaminosalicylate(ASA)coupledbyazobonds.Balsalzine5ASAlinkedto4–aminobenzoyl-(3alanine.Sulfasalazine5ASAlinkedtosulfapyridinebyazobond.Mesalazine:-pHcoatedtabletof5ASA
592.Naturalanticancerdrugis?
a)Paclitaxel
b)Methotrexate
c)Cyclophosphomide
d)Alloftheabove
CorrectAnswer-AAns.A.Paclitaxel[RefGoodman&Gilman11th/ep.1350-1354;Katzung1p.949]Antimitoticdrugsofnatural(plant)sources.VincristineVindesinePaclitaxelVinblastineVinorelbineDacetaxelOthernaturalanticancerdrugsareEpipodophyllotoxins(Etoposide)BleomycinAnthracyclins(Doxorubicin,daunorubicin)CamptothecinsMitomycin'C'Actinomycin'D'
593.Drugactingon'S'phaseofcycle?
a)Chlorambucil
b)Methotrexate
c)Vincristine
d)Paclitaxel
CorrectAnswer-BAns.B.Methotrexate[RefKDT7"lep.823]CellcyclespecificTheykillactivelycyclingcellandtheirsiteofactionisconfinedtoonephaseofthecellcycle.Drugscausingcellcyclespecificinhibitionaregivenbelow:G,phase:VinblastineSphase:Mtx,cytarabine,6-TG,6-MP,Hydroxyurea,mitomycinG2phase:Bleomycin,etoposide,Daunorubicin,TopotecanMphase:Vincristine,vinblastine,paclitaxel,dacetaxel,Ixabepilone,Estramustine.
594.Mechanismofactionofaprepitantis?
a)RANKligandinhibitor
b)MMDAantagonist
c)NK1receptorantagonist
d)5HT3antagonist
CorrectAnswer-CAns.C.NK1receptorantagonist[RefGoodman&Gillman's11`"/ep.1005]AprepitantAprepitantisanantiemeticsubstancethatbelongstoaclassofdrugscalledsubstancePantagonists.Thecompoundmediatesitseffectbyblockingtheneurokinin1(NK1)receptor.Aprepitantcrossesthebloodbrainbarrier.Aprepitantisusedforchemotherapyinducednausea&vomiting(CINV),andpost-operativenausea&vomiting(PONY).Afterabsorptionaprepitantisboundextensivelytoplasmaproteins(>95%);itismetabolizedavidly,primarilybyhepaticCYP3A4andisexcretedinthestools.
595.UseofHAARTisassociatedwithhepatotoxicityapproximatelywhatpercentageofpatients?
a)10%
b)20%
c)30%
d)40%
CorrectAnswer-AAns.A.10%[RefHarrisons18th/ep.2566]HighlyActiveAntiretroviralTherapy(HAART):Combinationantiretroviraltherapy(cART),alsoreferredtoashighlyactiveantiretroviraltherapy(HAART),isthecornerstoneofmanagementofpatientswithHIVinfection.Indirecthyperbilirubinemia,resultingfromdirectinhibitionofbilirubinconjugatingactivitybyUDP-glucuronosyltransferase,usuallywithoutelevationofaminotransferaseoralkalinephosphataseactivities,occursin-10%ofpatientstreatedwiththeproteaseinhibitorindinavir.
596.Bendamustineisusefulforthemanagementof?
a)Chroniclymphoidleukemia
b)Coloncarcinoma
c)Breastcarcinoma
d)Renalcarcinoma
CorrectAnswer-AAns.A.Chroniclymphoidleukemia[RefHematologyBasicprinciplesandpracticebyRonaldHoffman,p.819]BendamustineItisachemotherapymedicationusedinthetreatmentofchroniclymphocyticleukemia(CLL),multiplemyeloma,andnon-Hodgkin'slymphoma.ItworksbyinterferingwiththefunctionofDNAandRNA
597.Abraxaneisa:?
a)Albuminbounddocetaxel
b)Globulinbounddocetaxel
c)Albuminboundpaclitaxel
d)Globulinboundpaclitaxel
CorrectAnswer-CAns.C.Albuminboundpaclitaxel[RefKatzung11thlep.1235]Abraxaneisanovelalbuminboundpaclitaxelwhichhasgotlesserpropensitytocausehypersensitivityreactionsthanpaclitaxel.Abraxaneisuseinthetreatmentoftheadvancedmetastaticbreastcarcinomapatients.Paclitaxelactsbyinhibitingmicrotubulinpolymerizationandinhibitsdivisionofmetastaticcells.
598.AbataceptbindstoonTcellsurface
a)CDII
b)CD20
c)CD22
d)CD28
CorrectAnswer-DAns.D.CD28[RefKatzung11th/ep.634]AbataceptItisafusionproteinthatcombinestheextracellulardomainofthemoleculeCTLA4(CD154)withtheFcportionofahumanimmunoglobulin.ItinterferewiththeinteractionsbetweenantigenpresentingcellsandTlymphocytes.Therefore,itaffectsearlystagesinthepathogeniccascadeofeventinRA.CTLA4hashighaffinityforCD28,whenabataceptbindstoCD28onTcellsurface,itpreventsthesecondsignalfrombeingdelivered,thusturningdowntheTcellresponse.
599.Cardiotmdcityisthesideeffectof:?
a)Bleomycin
b)Topotecan
c)Rubidomycin
d)Procarbazine
CorrectAnswer-CAns.C.Rubidomycin[RefKDT7th/ep.826]AnthracyclineinducedcardiotoxicityRubidomycinanddoxorubicinaretheanthracyclineanti-tumorantibioticsTheyhavecardiotoxicityasaadverseeffect.ThiscanmanifesteitheracutelywithECGchanges,arrhythmiasandhypotension,whicharereversible,orbedelayedlikeCHF.
600.Tocilizumabactsasanantagonistatwhichreeptor-
a)ILI
b)IL2
c)IL6
d)TNF
CorrectAnswer-CAns.C.IL6[RefHarrisons18thiednp.2750]TocilizumabisahumanizedmonoclonalantibodydirectedagainstthemembraneandsolubleformsoftheIL-6receptor.IL-6isaproinflammatorycytokineimplicatedinthepathogenesisofRA,withdetrimentaleffectsonbothjointinflammationanddamage.IL-6bindingtoitsreceptoractivatesintracellularsignalingpathwaysthataffecttheacutephaseresponse,cytokineproduction,andosteoclastactivation.
601.MechanismofactionofBasiliximabis?
a)TNFainhibitor
b)IL1antagonist
c)IL2antagonist
d)IL6antagonist
CorrectAnswer-CAns.C.IL2antagonist[RefKDT7`/ep.878,884]BasiliximabandDaclizumabTheyarehighlyhumanizedchimericmonoclonalantiCD25antibodywhichbindstoandactsasIL2receptorantagonist.CombinedwithotherimmunosuppressantslikeazathioprineandMMFtopreventrenalandothertransplantrejectionreactions.Plasmat1/2ofDaclizumabisaround3weekswhichismuchlongerthanBasiliximab.
602.Estramustineisacombinationof?
a)Estradiol+normustine
b)Estriol+normustine
c)Estriol+mechloroethamine
d)Estriol+cyclophosphamide
CorrectAnswer-AAns.A.Estradiol+normustine[RefKDT7thiep.858,866]EstramustineComplexofestradiolandnitrogenmustardnormustinewhichhasweakestrogenicbutnoalkalytingproperty.Itbindstoptubulinandinterfereswithitsorganizationofmicrotubulesexertinganti-mitoticaction.
603.Pemetrexedisindicatedforuseinwhichofthefollowing?
a)Mesoepithelioma
b)Nonsmallcelllungcarcinoma
c)Ewingssarcoma
d)Osteosarcoma
CorrectAnswer-A:BAns.A.Mesoepithelioma&B.Nonsmallcelllungcarcinoma[Ref:KDT7th/ep.858,863]Pemetrexedisanewercongenerofmethotrexatewhichprimarilytargetstheenzymethymidylatesynthase.Uses:Incombinationwithcisplatin,pemetrexedisapprovedfortreatmentofmesoepitheliomaandnonsmallcelllungcarcinoma.
604.Whichofthefollowingisnottrueaboutpurineantagonists?
a)Azathioprineisusedasimmunosuppresant
b)Drugsareactivatedbyhypoxanthineguaninephosphoribosyltransferase[HGPRTase]
c)FludoribineisthedrugofchoiceforCLL
d)Cladarabineisdegradedbyadenosinedeaminase
CorrectAnswer-DAns.D.Cladarabineisdegradedbyadenosinedeaminase[RefKatzungIlth/ep.948]Purineantagonists6-mercaptopurine(6-MP),6-thioguanine,fludarabineandcladarabinearepurineanaloguesthatareusedincancerchemotherapy.CladarabineistheDOCforHairycellleukemiaasitisresistanttodegradationbyadenosinederminase.
605.Panitumumabisusedforwhichcancer?
a)Coloncancer
b)Lungcancer
c)Breastcancer
d)Osteoclastoma
CorrectAnswer-AAns.A.Coloncancer[RefHarrisons18thiep.677]PanitumumabItisamonoclonalantibodyagainstEGFreceptor.Itisusedformanagementof(Colorectal)coloncancer.
606.Cetuximabisusedtotreat?
a)Adamantinoma
b)BasalcellCa
c)ColorectalCa
d)Crohn'sdisease
CorrectAnswer-CAns.C.ColorectalCa[RefKDT7th/ep.870,Harrisons18thiep.677]CetuximabCetuximabisEGF(Epithelialgrowthfactor)receptorantibody,whichpreventscellgrowth,proliferationandmetastasis.ItisapprovedforHeadneckandfacesquamouscellCaasadjuvantwithcisplatin.ItisalsousedforEGFreceptor+vecolorectalCa.
607.Whichofthefollowingisnotanadverseeffectofcyclophosphamide?
a)Hemorrhagiccystitis
b)Infertility
c)Bonemarrowsuppression
d)Diabetesinsipidus
CorrectAnswer-DAns.D.Diabetesinsipidus[RefHarrison17e/ep.521;Goodman&Gilman11th/ep.1326;Katzung11tVep.941]ToxicityofCyclophosphamideBonemarrowsuppression(relativeplateletsparing)PulmonarytoxicityCardiac(athigherdoses)CystitisInfertilityGIToxicityAlopeciaTeratogenesis
608.Adverseeffectoftheimatinibareallexcept?
a)Periorbitaledema
b)Myalgia
c)Pleuraleffusion
d)Arthralgia
CorrectAnswer-DAns.D.Arthralgia[RefKDT7th/ep.870]Imatinibisatyrosinekinaseinhibitor,whichinhibitsPDGF(Plateletderivedgrowthfactor)receptoraswell.Uses:
1. CML-Chronicmyeloidleukemia2. DOCforc-kit+veGIST(GastrointestinalStromalTumor)
Adverseeffects:Abdominalpain,vomiting,fluidretention,pleuraleffusion,periorbitaledema,myalgia,liverdamageandCHF.
609.Defectindiscriminatingbluegreenvisionisduetowhichdrug:?
a)Alprostadil
b)Primaquine
c)Sildenafil
d)Primaquine
CorrectAnswer-CAns.C.Sildenafil[RefKDT7thlep.303-304]Sildenafil(Viagra)actstoincreasecGMPbyinhibitingitsbreakdownbyphosphodiesteraseisoform5(PDE-5).Recommendedthatatleast6hourspassbetweenuseofanitrateandtheingestionofsildenafil.Sildenafilalsohaseffectsoncolorvision,causingdifficultyinblue-greendiscrimination.TwosimilarPDE-5inhibitors,tadalafilandvardenafil,areavailable.
610.Racecadotrilisusedfor?
a)Chronicdiarrhea
b)Acutesecretorydiarrhea
c)Chronicconstipation
d)Diabeticgastroparesis
CorrectAnswer-BAns.B.Acutesecretorydiarrhea[Ref:KDT7th/ep.686]Racecadotrilisrapidlyconvertedtothiorphan,anenkephalinaseinhibitorwhichpreventsthedegradationofencephalin(ENK)whicharemainly8opioidreceptoragonists.Itdecreasesintestinalhypersecretionwithoutaffectingmotilityandusedforshorttermtreatmentofacutesecretorydiarrhea.
611.Trueabouttrienteneis:
a)Itisthedrugoffirstchoiceinwilsonsdisease
b)Itismorepotentcuriureticagentthanpenicillamine
c)Trientinetherapycancauseirondeficiency
d)Trientinecannotbegivenorally
CorrectAnswer-CAns.C.Trientinetherapycancauseirondeficiency[RefHarrisons18thiep.3189]PenicillamineVstrientineinwilsondiseasePenicillamineisthedrugofchoicefortreatmentofwilson'sdisease.However,thedrugproducesundesirablesideeffectsandinsomepatientsbecomeintolerable.Trientineisindicatedespeciallyinpatientswhoareintoleranttopenicillamine.Trientineislesspotentcupriureticagentthanpenicillamine.Trientineisorallyeffectiveandshortacting.Trientinemaycauseirondeficiency;thiscanbeovercomewithshortcourseofirontherapybutironandtrientineshouldnotbeingestedwithin2hoursofeachother.
612.Whichofthefollowingdrugsisassociatedwithpriapism?
a)Hydralazine
b)Prazocin
c)Resperidone
d)Alltheabove
CorrectAnswer-DAns.D.AlltheaboveDrugsthatmaycausepriapism:AnticoagulantsHaloperidolhydralazineNifedipineOlanzapinePapaverinePhenothiazinesPhentolaminePrazosinRisperidoneTrazodone
613.WhichofthefollowingisaCl-channelactivator?
a)Lubriprostone
b)Nefazodone
c)Varenioline
d)Valethamate
CorrectAnswer-AAns.A.Lubriprostone[RefHarrisons18th/ep.2500]ChlorideChannelActivatorsLubiprostoneisabicyclicfattyacidthatstimulateschloridechannelsintheapicalmembraneofintestinalepithelialcells.Chloridesecretioninducespassivemovementofsodiumandwaterintothebowellumenandimprovesbowelfunction.LubiprostoneisanewclassofcompoundsfortreatmentofchronicconstipationwithorwithoutIBS.
614.WhichdrugisusedinthetreatmentofTypeItyrosinemia?
a)Nitisinone
b)Alogliptin
c)Pemoline
d)Milrinone
CorrectAnswer-AAns.A.Nitisinone[RefNelson20'Vep.641]Adietlowinphenylalanineandtyrosinecanslowbutdoesnothalttheprogressionofthecondition.Thetreatmentofchoiceisnitisinone,whichinhibitstyrosinedegradationat4-HPPD.Thistreatmentpreventsacutehepaticandneurologiccrises.Althoughnitisinonestopsorgreatlyslowsdiseaseprogression,somepretreatmentliverdamageisnotreversible.
615.Modafinilisadrugusedinwhichofthefollowingconditions?
a)Prematureejaculation
b)Premenstrualsyndrome
c)Shiftworkdisorder
d)Erectiledysfunction
CorrectAnswer-CAns.C.Shiftworkdisorder[RefKDT7th/ep.487]ModafinilItisanewerpsychostimulantpopularwithnightshift(callcentre)workersandpeoplewhowanttoimprovealertnessandkeepawake.Itisclaimedtoincreaseattentionspan,andimproveaccuracycompromisedbyfatigueandsleepiness.Theapprovedindicationsarenarcolepsy,sleepapneasyndromeandshiftworkdisorder.
616.Acamprostateisusedfor?
a)Alcoholabstinence
b)Nicotineabstinence
c)Opioidabstinence
d)Cocaineabstinence
CorrectAnswer-AAns.A.Alcoholabstinence[RefKDT7th/ep.393]AcamprosateisaweakNMDAreceptorantagonistwithmodestGABAAreceptoragonisticactivityusedformaintenanceofalcoholabstinence.Ithasalsobeenfoundtoreducerelapseofdrinkingbehavior.Itisstartedimmediatelyafteralcoholwithdrawalandgivenatadoseof666mg2-3timesaday.Loosemotionisthemostcommonsideeffect.
617.Ifawomanisassaultedbyherhusbandthenheischargedunder:FMGE11
a)Sec.498-AIPC
b)Sec.304-AIPC
c)Sec.304-BIPC
d)Sec.504IPC
CorrectAnswer-AAns.Sec.498-AIPC
618.
PunishmentforcriminalabortionforthewomenwhogivesconsentandtheperformerarecoveredunderIPCsection?
a)312
b)313
c)314
d)315
CorrectAnswer-AAns.is'a'i.e.,312Punishmentforperformingcriminalabortionwiththeconsentofwomen;bothforthewomenandperformerisincludedinIPCSection312.
619.
AdulteryisdescribedunderwhichsectionofIPC?
a)314
b)375
c)497
d)504
CorrectAnswer-CAns.isc'i.e.,497[RefWomenandtheLawp.167]Section497ofIPCsays,"Whoeverhassexualintercoursewithapersonwhoisandwhomheknowsorhasreasontobelievetobethewifeofanotherman,withouttheconsentorconnivanceofthatman,suchsexualintercoursenotamountingtheoffenceofrape,isguiltyoftheoffenceofadulteryandshallbepunished.
620.
UseofdangerousweaponisrelatedtowhichsectionofIPC?
a)304
b)319
c)322
d)324
CorrectAnswer-DAns.is'D'i.e.,324319IPC:Defineshurt.320IPC:Definesgrievoushurt.321IPC:Voluntarilycausinghurt.322IPC:Voluntarilycausinggrievoushurt.323IPC:Punishmentforvoluntarilycausinghurt(noprovocation,nodangerousweapon)(1yearsimprisonment).324IPC:Punishmentforvoluntarilycausinghurtbydangerousweapon(3yearsimprisonment±fine).325IPC:Punishmentforvoluntarilycausinggrievoushurt(noprovocation,nodangerousweapon)(7yearsimprisonment±fine).
621.
GrievoushurtcomesunderwhichsectionofIPC?
a)Section319
b)Section320
c)Section324
d)Section326
CorrectAnswer-BSection320REF:TextbookofForensicMedicineandToxicologybyNageshKumarRaoPage259Section320:GrievoushurtThefollowingkindsofhurtonlyaredesignatedas"grievous"
1. Emasculation2. Permanentprivationofthesightofeithereye3. Permanentprivationofthehearingofeitherear4. Privationofanymemberorjoint5. Destructionorpermanentimpairingofthepowersofanymemberor
joint6. Permanentdisfigurationoftheheadorface7. Fractureordislocationofaboneortooth8. Anyhurtwhichendangerslifeorwhichcausesthesufferertobe
duringthespaceoftwentydaysinseverebodilypain,orunabletofollowhisordinarypursuits.
622.
OutragingmodestyofwomeniswhichsectionofIPC?
a)375
b)354
c)195
d)304
CorrectAnswer-BAns.is'b'i.e.,354[RefReddy26th/ep.365]Rapeandothersexualoffencesandassault228IPC:Prohibitsdisclosureofidentityofrapevictim.375IPC:Definingrape.376IPC:Punishmentforrape(7yearstolifeimprisonment±fine).376-AIPC:Punishmentformaritalrape(2yearsimprisonment±fine).377IPC:Unnaturalsexualoffences(10yearstolifeimprisonment±fine).354IPC:Assaultorcriminalforcetowomanwithintenttooutragehermodesty.366-AIPC:Procurationofminorgirlforillicitintercourse.351IPC:Definesassault.352-358IPC:Punishmentforcausingassault.509IPC:Word,gestureoractintendedtoinsultthemodestyofawomen
623.
Section89IPCisfor?
a)Criminalresponsibilityofinsane
b)Criminalresponsibilityofachild
c)Criminalresponsibilityofdrunkenperson
d)Ageforconsent
CorrectAnswer-BAns.is'i.e.,Criminalresponsibilityofachild89IPC:Achildunder12yearsofagecannotbegivenvalidconsenttosufferanyharmwhichcanoccurfromanactdoneingoodfaithforthebenefitofthechild,e.g.,consentforsurgery.Theonlyguardiancangivesuchconsent.Anactisdoneingoodfaithforthebenefitofachildorinsaneperson,byorbyconsentoftheguardian.Nothingwhichisdoneingoodfaithforthebenefitofapersonundertwelveyearsofage,orofunsoundmind,byorbyconsent,eitherexpressorimplied,oftheguardianorotherpersonhavinglawfulchargeofthatperson,isanoffencebecauseofanyharmwhichitmaycause,orbeintendedbythedoertocauseorbeknownbythedoertobelikelytocausetothatperson
624.Apersonisdeclareddeadifhe/sheisnotfoundfor
a)7years
b)10years
c)14years
d)21years
CorrectAnswer-AAns.is'a'i.e.,7years[RefCivilLaw,Section108MA]TheIndianEvidenceAct,undersection108provides7yearsfromthedatewhenceapersonisdeclaredtobemissingandhis
625.
AdulterationofdrugisunderwhichsectionofIPC
a)271
b)272
c)273
d)274
CorrectAnswer-DAns.is'd'i.e.,274[RefSafetyManagementofHospitalsp.315;PrinciplesofFMT,Bardalep.18]LawrelatedtoAdulteration:-IndianPenalCode:?Section272→AdulterationofFoodorDrinkIntendedforSaleImprisonmentfor6months,Fine-Rs.1000Section273→SaleofNoxiousFoodorDrinkImprisonemntfor6months,fine-Rs.1000Section274→AdulterationofDrugsSection275→SaleofaduletrateddrugsSection276→SaleofdrugsasadifferentdrugorpreparationSection277→Foulingwaterofpublicspringorreservoir
626.MinimumageforgivingconsentfororgandonationinIndiais?
a)16years
b)18years
c)21years
d)Noagelimit
CorrectAnswer-BAlegalageof18yearshasbeensettoconsentforterminationofpregnancy(MTPAct1971),donationofbloodanddonationoforgans(TransplantationofHumanOrganAct1994).
AsperTransplantationofHumanOrgansAct1994"donor"meansanyperson,notlessthaneighteenyearsofage,whovoluntarilyauthorizestheremovalofanyofhisorgansfortherapeuticpurposesundersubsection(1)orsub-section(2)ofsection3.ParentsorGuardiansconsentwillberequiredforanyindividualbelow18yearswishingtodonateanorgan.
627.Firstcarpalbonetoappearis?
a)Trapezium
b)Capitate
c)Pisiform
d)Lunate
CorrectAnswer-BAns.is'B'i.e.,Capitate[RefReddy'sEssentials26th/ep.63]Theossificationcentresincarpalbonesappearasfollows:nCapitate 1year nHamate 2yearsnTriquitrum 3years nLunate 4yearsnScaphoidandtrapezoid5years nTrapezium6yearsnPisiform 11years
628.Fourcarpalbonesarepresentatwhatage:DNB09
a)3years
b)4years
c)5years
d)6years
CorrectAnswer-BAns.4years
629.Ossificationcentreofscaphoidappearsat
a)1-6months
b)1to2years
c)2to4years
d)4to6years
CorrectAnswer-DAnswer-D.4to6years
630.Holographwillisdefinedas
a)Doctordictatesandwrittenbyrelatives
b)Testatoriswritteninhisownhandwriting
c)Testatorisdictatedandwrittenbyrelatives
d)Testatorisdictatedandwrittenbydoctor
CorrectAnswer-BAns.is'b'i.e.,Testatoriswritteninhisownhandwriting[RefSKSinghal4th/ep.314]Holographwillisonewhichiswrittenbythetestatorinhisownhandwritting.Testamentarycapacityisdefinedasthecapacityofapersontomakeavalidwill.
631.Subpubicangleis:
a)<65°
b)65-75°
c)85°
d)110-120°
CorrectAnswer-C85°
632.Obtuseangleofmandibleisseenin
a)Infancy
b)Adulthood
c)AdultMale
d)AdultFemale
CorrectAnswer-AAns.is'a'i.e.,Infancy[RefParikh6thlep.2.30]Feature Infancy Adult OldageAngleofmandible
Obtuseangle
Rightangle Obtuseangle
Mentalforamenopening
Nearlowerborder
Midwayb/wupper
Looksapparentlynearertheofbody&lowerborderupperborderd/tlossofteeth
633.Sizeofthefetusis20mm,thenbytheruleofHasse’s,whatisthegestationalageofthefetus?
a)2weeks
b)4weeks
c)6weeks
d)8weeks
CorrectAnswer-CAns.is'c'i.e.,6weeksHess'srule(Haase'srule):Itisaroughmethodforcalculatingtheageoffetusbymeasuringthelengthfromcrowntoheel.Upto5thmonthofgestation,lengthofthefoetusincmissquareofthemonthofgestationandbeyond5months,lengthincmis5timesthemonthofgestation.Lengthincm=(monthofpregnancy)→upto5monthsLengthincm=monthofpregnancy→after5monthsInthisquestion:Lengthincm=(monthofpregnancy)22=(monthofpregnancy)→(Note:20mm=2cm)Monthofpregnancy=14monthsor6weeks.
634.Firstincisortoeruptis
a)Lowercentral
b)Uppercentral
c)Lowerlateral
d)Upperlateral
CorrectAnswer-AAns.is'a'i.e.,Lowercentral[RefReddy30thiep.60]Firsttemporarytoothtoupper(inprimarydentition)islowercentralincisorsandlasttemporarytoothtoeruptis2ndmolar.Thesequenceoferuptionislowercentralincisor>uppercentralincisor>upperlateralincisor>lowerlateralincisor>I"molar>Canine>molar.Thereforeeurptionoftemporaryteethiscompletedbyeruptionof2"°molarat25months(2years).Firstpermanenttoothtoerupt(insecondarydentition)is1"molarandlasttoeruptis3rdmolar.Thesequenceoferuptionis1"molar>centralincisor>lateralincisor>1"premolar>2"premolar>canine>2"molar>3rdmolar.Eruptionofpermanentteethiscompletedbyeruptionof3rdmolarbetween17-25years.
635.Ababyhasstatedtogethisfirstmilkteeth.Hisageisapproximately:
a)3months
b)6months
c)9months
d)12months
CorrectAnswer-BMostbabieshavetheirfirstprimary(milk)teetheruptatage6monthofageandfirstsecondaryteetheruptatage6years.
Theteethintheupperjaweruptearlierthanthoseinthelowerjaw,exceptforlowercentralincisors.Thelowercentralincisorsappear,commonly,betweentheagesof5and8months.Theuppercentralincisorsappearamonthlaterandthelateralincisorsusuallywithinthenextthreemonths.Thefirstmolarteethappeararoundtheageof12-15months,precedingtheeruptionofcanineteethby6months,whichappearbetweentheageof18and21months.Thesecondmolarsareoutattheageof21to24months.
Note:Permanentteetheruptionisinthefollowingorder:1stmolar-6years;centralandlateralincisors-6-8years;caninesandpremolars-9-12years;secondmolars-12years;thirdmolars-18yearsorlater.
Ref:GhaiEssentialPediatricsbyOPGhai,6thedition,Page6;NelsonTextbookofPaediatrics17theditionpage18&37
636.X-rayofchoiceforagedetectionataround16-17yearsofage
a)Elbow
b)Wrist
c)Shoulder
d)Pelvis
CorrectAnswer-BAns.is'b'i.e.,Wrist[RefParikh6th/ep.2.10]Site Age(inyears) Female MaleElbow 13-14 15-16Wrist 16-17 18-19Shoulder 17-18 19-20Crestofilium18-19 20-21
637.Rigormortisoccursdueto:September2008
a)Muscleofthebodybegantorelax
b)Capillo-venousdistensioninthemostdependentbodyparts
c)Muscleofthebodybegantostiffen
d)Mummificationofthebodytissues
CorrectAnswer-CAns.C:MuscleofthebodybegantostiffenAfewhoursafterthedeath,thejointsofthebodystiffenandbecomelockedinplace.Thisstiffeningiscalledrigormortis.Dependingontemperatureandotherconditions,rigormortislastsapproximately24-48hoursinwinterand18-36hoursinsummer.Thephenomenoniscausedbytheskeletalmusclespartiallycontracting.Themusclesareunabletorelax,sothejointsbecomefixedinplaceRigormortiscanbeusedtohelpestimatetimeofdeath.Theonsetofrigormortismayrangefrom1-2hours,dependingonfactorsincludingtemperature(rapidcoolingofabodycaninhibitrigormortis,butitoccursuponthawing).Maximumstiffnessisreachedaround12-24hourspostmortem.Itfirststartsininvoluntarymuscles(myocardium)Eyelids,neckandjawmusclesareaffectedfirst,withtherigorthenspreadingtootherpartsofthebody.Thejointsarestiffbutaftersometimegeneraltissuedecayandleakingoflysosomalintracellulardigestiveenzymeswillcausethemusclestorelax.
638.Postmortemlividityisnotseenin?
a)Drowninginwell
b)Drowninginafastflowingriver
c)Postmortemsubmersion
d)Drowninginchlorinatedswimmingpool
CorrectAnswer-BAns.is'b'i.e.,Drowninginafastflowingriver[RefParikh6th/ep.3.10]
639.Postmortemstaininggetsfixedafter:
a)2-3hrs.
b)3-4hrs.
c)5-6hrs..
d)7-8hours
CorrectAnswer-DDi.e.7-8hours
640.Suggilationisduetowhichofthefollowing?
a)Gravityleadingtopoolingofblood
b)Escapeofbloodfrommicrovasculature
c)Moleculardeathleadingtostiffeningofmuscles
d)Autolysisofenzymes
CorrectAnswer-AAns.is'a'i.e.,Gravityleadingtopoolingofblood[RefReddy30th/ep.141]Gravityleadingtopoolingofblood→SuggilationMoleculardeathleadingtostiffeningofmuscles→RigorMortisAutolysisofenzymes→Putrefaction
641.Earliestsignoffetaldeath-
a)Spaldingsign
b)Robert'ssign
c)Ballsign
d)Adipocereformation
CorrectAnswer-BAns.is'b'i.e.,Robert'ssign[RefParikh6thlep.5.75,5.76&4th/ep.268]Robertsign(gasingreatvessels)→12hSpaldingsign(overlappingofskullbones)→1weekBlair-Hartley/Ballsign(hyperflexion/hyperextension→3-4weeksofspinewithovercrowdingofribs
642.Firstsignofmacerationis
a)Robert'ssign
b)Skinslippage
c)Spaldingsign
d)Greenishdiscolorationofbody
CorrectAnswer-BAns.is'b'i.e.,Skinslippage[RefParikh6"Vep.5.75;SKParikh4th/ep.268]Macerationisaprocessofasepticautolysis.Itoccurswhenadeadfetusremainsintheuterusfor3-4dayssurroundedbyliquoramniibutwithexclusionofair.Skinslippageistheearliestsign(occurswithin12hours).
643.Whichisthebesttemperatureforputrefaction?
a)-10degreesC
b)0degreesC
c)30degreesC
d)50degreesC
CorrectAnswer-CAns.is'c'i.e.,30degreesC[RefReddy30th/ep.150]Putrefactionisthelaststageinresolutionofbodyfromtheinorganictoorganicstateandisacertainsignofdeath.Theputrefactionisdueto:Autolysis:Theenzymesofthebody,breakdownthedeadbodycausingproteolysis,lipolysisandglycolysis.Bacterialenzymes:Aerobicandanaerobicbacteriapresentinsmallintestine(e.g.C.welchii,staphylococcus,E.colietc.)releaseenzymes(especillylipaseandlecithinase),whichactonbodytocausebreakdown.Threeconditionsarenecessoryforputrefaction:(i)warmth(10-45°),(ii)moisture(humidity)and(iii)air.Ifairisabsent,adipocereformation(saponification)occurs,andintheabsenceofmoisture,mummificationoccurs.
644.AccordingtoCasper'sdictum,decompositionisthefastestwhenthebodyisinwhichofthefollowing?
a)Air
b)Water
c)Earth
d)Soil
CorrectAnswer-AAns.is'a'i.e.,Air[RefReddy30thiep.155]Itistheeffectofmedium(inwhichbodylies)onrateofputrefaction.Casper'sdictumstatesthatabodydecomposesinairtwiceasrapidlyasinwaterandeighttimesasrapidlyinearth.
645.Enzymeresponsibleforpostmortemhemolysisis
a)Hemolysin
b)Lecithinase
c)Lipoproteinase
d)Protease
CorrectAnswer-BAns.is'b'i.e.,Lecithinase[RefTextbookofFMTbyVij5th/ep.89]Bacteriaproducealargevarietyofenzymesthatactoncarbohydrates,proteinsandfatsandbreakdownthevarioustissues.Oneofthemostimportantenzymesisthelecithinase'producedbytheClostridiumwelchii,whichhydrolysesthelecithinpresentinallthecellmembranesincludingbloodcellsandthusisresponsibleforproducinghemolysisofbloodpostmortem.Thisenzymealsohelpsinpostmortemhydrolysisandhydrogenationofbodyfat.
646.Mummificationisenhancedby?
a)Moistandhotair
b)Moistandcoolair
c)Dryandhotair
d)Dryandcoolair
CorrectAnswer-CAns.is'c'i.e.,DryandhotairMummificationItisamodificationofputrefaction,whichoccursintheabsenceofmoisture.Thatiswhenthereisexcessairandwarmthbutnomoisture(humidity),i.e.hotdryandwindyclimate,mummificationtakesplaceinplaceofnormalputrefaction.Thusmummificationoccursindeserts,especiallyinsummerandalsoinbodiesburiedinshallowgraveinsandysoil.Mummificationischaracterizedbydessicationordryingofthedeadbody.Thereisdrying,dehydrationandshrivelingofdeadbody.Itproceedsfromexteriortointerior.Thereforefirsttobeinvolvedisskin,especiallyofexposedbodypartslikelips,nosetip,hands(fingers)andfeet(toes).Theskinisshrunken,contracted,dry,brittle,leathery,strechedacrossbonyprominencesandrustybrowntoblackincolor.Internalvisceraalsodryup,darkenincolorandblendwitheachothertoformasinglemass.Bodyemitssmelllikerottencheese.Facialfeaturesandinjuriesarewellpreserved,thusidentificationofbodyandcauseofdeathcanbedetermined(likeadipocereformation).Timerequiredformummificationvariesbetween3months-2years.Ifproperlypreserved,amummifiedbodycanremainforyears.Chronicarsenicorantimonypoisoningfavormummification.
Medicolegalimportance:(i)Identificationofbody(facialfeaturesarepreserved),(ii)causeofdeath(injurymarksarepreserved),(iii)timesincedeathcanbeestimated.
647.Postmortemwoundbestdiffersfromtheantemortemwoundby:
a)Gapsonincising
b)Noclots
c)Absenceoferythemaandcellularchanges
d)All
CorrectAnswer-CCi.e.Absenceoferythema&cellularchange
648.Pugilisticattitudeischaracteristicallyseenin?
a)Burns
b)Drowning
c)Electrocution
d)Hanging
CorrectAnswer-AAns.is'a'i.e.,Burns
649.Treatmentofchoiceforstabinjurycaecum?
a)Caecostomy
b)Ileo-transverseanastomosis
c)Transversecolostomy
d)Sigmoidcolostomy
CorrectAnswer-BAns.is'b'i.e.,ileo-transverseanastomosisStabandlow-velocityinjuriestothecolonwithminimalcontaminationandhemodynamicalstabilitycanbemanagedbyprimaryrepairmechanismslikeileotransverseanastomosis.
650.Gunpowderonbodyandclothingcanbevisualizedby?
a)HarrisonandGilroytest
b)Neutronactivationanalysis
c)Dermalnitratetest
d)Alloftheabove
CorrectAnswer-DAns.is'd'i.e.,Alloftheabove[RefParikhelep.4.39]Testsusedinfirearmdischarge:Basedondetectionofnitrate:Dermalnitrite(Paraffin)test.Basedondetectionofheavymetal:HarrisonandGilroytest,neutronactivationanalysis,Atomicobsorptionspectroscopy,andflamelessatomicabsorptionspectroscopy.
651.Bulletfixedfromagunisnotreleased.Itisejectedoutwithsubsequentshot.Suchabulletiscalledas
a)Tandembullet
b)Dum-dumbullet
c)Inceridiarybullet
d)Tumblingbullet
CorrectAnswer-AAns.is'a'i.e.,Tandembullet[RefSKSinghal4thlep.188]Varietiesofbulletsare:-i)Incendiary(igniting)bullet:Thetipofbulletcontainsselfignitingmateriale.g.bariumnitrateandpowderedaluminiumandmagnesium(inthepast,phosphoruswasused),sothatitcatchesfireonhittingthetarget.Itisusedtocausefireinusuallyinflammabletargetslikefueltanks(ofaircraftsetc).ii)Explosivebullet:Thetipcontainsadetonatororleadazide,sothatthebulletexplodesonhittingthetarget.iii)Dum-dumbullet(expandingbullet):ItisajacketedbulletwithisnosetipchiseledorcutoffItisdesignedtoincreaseindiameterandexpanduponstrikingthetarget,thusproducinglargerdiameterwoundsoflimitedpenetration.iv)Tandembullet(Piggeytailbullet):Itiscalledone-behind-otherbulletbecausetwobulletsareejectedoneaftertheother,whenfirstbulletfailedtoleavetheburrelandisejectedbysubsequentlyfiredbullet.Therefore,bothenterbodythroughsameenterancewound(some
times,theymayenterthroughdifferententries),butthewoundsofexitarealwaystwo.
652.Whichofthefollowingcausesmaximumdamage?
a)Tandem
b)Dumdum
c)Souvenir
d)Piggy
CorrectAnswer-BAns.is'b'i.e.,Dumdum[RefSKSinghale/ep.188]Expandingbullets,alsoknownashollow-pointbulletsor"dum-dums",aredesignedto"mushroom"uponenteringatargetinordertostopitfromleavingthebody.Comparedtoregularbullets,orfullmetaljackammunition,expandingbulletsareintendedtocausemaximumtissuedamage.
653.Abulletpackedwithjacketandopensatabaseiscalled
a)Dumdumbullet
b)Tandembullet
c)Duplexbullet
d)Souvenirbullet
CorrectAnswer-AAns.is'a'i.e.,Dumdumbullet[RefParikhp.4.33]
654.Ricochetbulletis
a)Bulletproducingakeyholeentrywound
b)Bulletwithnosetipchiseledoff
c)Deviationinthedirectionorpathofbullet
d)Bulletcontainingignitingmaterial
CorrectAnswer-CAns.is'c'i.e.,Deviationinthedirectionorpathofbullet[RefReddy30th/ep.211]Ricochettingofbulletisdefinedasdeviationinthedirectionorpathofbulletbecauseofstrikingofbullettoanintermediaryobject.
655.Compoundusedasprimerinweaponis
a)Potassiumchlorate
b)Sulphur
c)Potassiumnitrate
d)Nitrocellulose
CorrectAnswer-AAns.is'a'i.e.,Potassiumchlorate[RefParikh6th/ep.4.29]Cartridge(round)Cartridgeistheammunitionusedinfirearms.Cartridgeconsistsof(i)Cartridgecase,(ii)Propellant(gunpowder),(iii)Projectile(missile)and(iv)Wads(onlyinshotguns.).1)CartridgecaseItistheoutershellorcoveringofthecartridge.Inshotgunitiscylinderical.Baseisofbrassandrestofitisofcardboardorplastic.Inrifledweapons,itistaperingandwholeofitismadeofbrassorsteel.Centerofbasehaspercussioncap(detonatorcap)whichhassensitivecomposition,i.e.primer,consistingofpotassiumchlorate,antimonysulphide,mercuryfulminate,bariumnitrite,leadperoxideortetrazene.Inallweapons,afterfiring,thecartridgecaseremainsinthebarrelanditistobetakenoutmanually(shotgun,revolvers,rifle)oritisejectedoutautomatically,e.g.inpistals.2)Propellent(gunpowder)Itpropelstheprojectile(missile)forward.Itiscomposedofblackpowderorsmokelesspowderintheformofgrains,pellets,thincylindricalcordsorflakes.Itsignitionresultsinformationofexpandinghotgasesunderpressurewhich(gaspressure)propels
theprojectile(missile)byprovidingitnecessarymuzzlevelocityandstrikingenergy.Theclassicalgunpowderisknownasblackpowder,consistsofcharcol(15%),Sulphur(10%),andpotassiumnitrate(75%).Dependingonfineness,theblackgunpowderisdesignatedasFG,FFG,FFFG.etc.(F=fineness).Pyrodexisanothergunpowderwithsamecomponents,butwithdifferentratios.Blackgunpowderproducessmoke,i.e.Itissmokeproducingpowder.Smokelesspowder,inadditiontoblackpowder,hasnitrocellulose(singlebase),ornitrocelluloseplusnitroglycerine(doublebase),ornitrocelluloseplusnitroglycerineplusnitroguanidine(triplebase).Semismokelesspowderhas80%blackpowderand20%smokeless
656.Destructivepowerofbulletisdeterminedbyallexcept
a)Velocityofbullet
b)Weightofbullet
c)Shapeofbullet
d)Kineticenergy
CorrectAnswer-CAns.is'c'i.e.,Shapeofbullet[RefReddy29thlep.194]Tissuedamage(ordestructivepowerofbullet)isdependentonstriking(kinetic)energyofbullet,whichisproportionaltoitsmassandsquareofvelocity(KE='/2mv2).Somodernbulletsaredesignedtohavesmallermassallowingtransportationoflargeamountofammunitionandhighvelocity,asvelocityismoreimportantdeterminantindestructivepowerofbullet.
657.HeatRuptureischaracterizedby:
a)Regularmargins
b)Irregularmargins
c)Rupturedbloodvessels
d)RupturedRedBloodcells/clottedblood
CorrectAnswer-BBi.e.Irregularmargins
658.Sexualstimulationobtainedthroughsomeinanimateobjectisknownas:September2003
a)Transvestism
b)Fetichism
c)Voyeurism
d)Zoophilia
CorrectAnswer-BAns.Bi.e.Fetichism
659.Transvestismis:
a)Wearingclothesofoppositesex
b)Touchingonesownprivatepartstoothers
c)Desireforsexualintercoursewithdeadbodies
d)Orgasmfromvisualisationpartofthebodyofawoman
CorrectAnswer-AAi.e.Wearingclothesofoppositesex
660.Whichofthefollowingismeantbytheterm‘SinofGomorrah’?
a)Oralsex
b)Analsex
c)Bestiality
d)Lesbianism
CorrectAnswer-AOralsexisalsocalledcoitusperosorSinofGomorrahorbuccalcoitus.AccordingtoBiblethesinwascommoninatowncalled:Gomorrah,sothename.ItisincludedinUnnaturalsexualoffencesAct(S.377IPC).Ref:TheEssentialsofForensicMedicineandToxicologybyDr.K.S.NarayanReddy,27thedition,Page365.
661.Voyeurismis?
a)Sexualgratificationbywatchingtheactofsexualintercourse
b)Useofsuchobjectsforsexualgratification
c)Sexualgratificationisbyselfpain
d)Sexualgratificationbyrubbingprivatepart
CorrectAnswer-AAns.is'a'i.e.,Sexualgratificationbywatchingtheactofsexualintercourse[RefReddy30th/ep.395]Voyeurism(Scoptophilia,Peepingtom):Sexualgratificationisobtainedbylookingatthesexualorgansofotherpersons,watchingtheactofsexualintercourse,orwitnessingundressingbyawoman.
662.Whichofthefollowingisthetestdonetoconfirmlivebornfetusafterfetaldeath?
a)Mirrortest
b)Breslau'stest
c)Magnustest
d)Paraffintest
CorrectAnswer-BAns.is'b'i.e.,Breslau'stest[RefSKSinghal4thlep.271]TestsusedininfanticidePloucquet'stest:Weightoflungismeasuredinrelationtobodywieght.Beforebirthweightoflungis1/70ofbodyweightandafterrespirationitbecomes1/35ofbodyweightduetoincreasedbloodflowinlungbeds.StatictestorFodere'stest:Theaverageweightofbothlungsbeforerespirationis30-40gmandafterrespirationis60-70cm.Hydrostatictest(Raygat'stest,1"lifetest):Thegravityofanon-respiredlungis1040-1050andofarespiredlungis940-950,so,afterrespirationlungfloatsonwater(specificgravityofwateris1000).Breslau'ssecondlifetest:Itassumesthatalivebornchildwouldrespireandtherefore,wouldalsoswallowsomeairintothestomachandbowel.Hencetheyfloatonwater.Thistestisfalselypositiveinputrefaction(duetoputrefiedgases)orincasesofattemptedartificialrespiration.Werdin'stest:Beforebirthmiddleearcontainsgelatinousembryonictissuewhichisreplacedbyairafterrespiration.
663.Bansdolaisaformofstrangulationby:NEET14
a)Ligature
b)Hands
c)Woodensticks
d)Bendofelbow
CorrectAnswer-CAns.C.WoodensticksDependinguponthemethodusedtoconstricttheneck,strangulationcanbedividedinto:Ligaturestrangulation:*Neckiscompressedbyaligatureofwhichusuallymultipleroundsaregivenandnoknotistied.Throttling(manualstrangulation):*Neckiscompressedbyoneorbothhands.*Whenneckiscompressedbytwopalms,itisknownaspalmarstrangulation.Bansdola:*Compressionofneckwithoneortwowoodensticksorbamboo.Garrotting:*Itiscompressionofneckbyaropethrownfrombehind.Spanishwindlassisatypeofgarrotting,whichusedtobetheofficialmodeofexecutioninspain.Inthis,anironcoloraroundtheneckwastightenedbyascrewforstrangulation.Mugging(chokehold):*Itiscompressionofneckbyforearmorinthebendofelbow.
Strangulationbyknee/foot:*Inthis,neckiscompressedbykneeorfoot.
664.Followingismostsuggestiveofantemortemhanging:DNB09
a)Salivarydribbling
b)Congestionoflungs
c)Ligaturemarks
d)Petechialhemorrhages
CorrectAnswer-AAns.Salivarydribbling
665.Acouplewaslockedupinaroomwithfirearound.Allofthefollowingaretheprobableimmediatecausesofdeathinsuchcircumstanceexcept:-
a)Cyanideintoxication
b)Suffocation
c)Sepsis
d)Fatembolism
CorrectAnswer-CAns.is'c'i.e.,Sepsis[RefReddy29'/ep.287;Parikh6thlep.4.153]CausesofdeathinburnsCausesofdeathinburnsmaybedividedinto:A)Causesofimmediatedeath:Theseare(1)neurogenicshock(primaryshock),(2)hypovolaemicshock(secondaryshock),(3)suffocation,duetoinhaledCO,CO2,(4)cyanideintoxication,(5)fatembolism,(6)cerebralorpulmonaryedema,and(7)accidentalinjuriesduringburn.B)Causesofdelayeddeath:Theseare:(1)renalfailure(acutetubularnecrosis),(2)infections(sepsis,gangrene,tetanus)and(3)centrilobularnecrosisofliver.
666.Puremotorpalsyseeninpoisoningof
a)Leadpoisoning
b)Arsenicpoisoning
c)Cocainepoisoning
d)Cannabispoisoning
CorrectAnswer-AAns.is'A'i.e.,LeadpoisoningTheperipheralneuropathyofleadtoxicityisapuremotorneuropathyaffectingtheupperlimbsmorethanthelowerlimbs,presentingassymmetricorasymmetricwristdrop.Theweaknessmayalsoinvolveothermusclegroupsofthedistalupperextremities,theinvolvementoflowerextremities,includingisolatedfootdrop,alsomayoccur.
667.Trueaboutstrychninepoisoningis:
a)Allmusclesaffectedatthesametime
b)Shouldergirdleaffectedfirst
c)Pelvicgirdleaffectedfirst
d)Noneoftheabove
CorrectAnswer-AAi.e.Allmusclesaffectedatsametime
668.Wrongaboutdhaturaseedsis?
a)Kidneyshaped
b)Odourless
c)Yellowbrown
d)Convexsmoothsurface
CorrectAnswer-DAns.is'd'i.e.,Convexsmoothsurface[RefPilley4th/ep.207;GautamBiswas2"d/ep.496]FeaturesofDhaturaseesare:-
1. Large&thick2. Odourlers3. Kidney-shaped4. Laterallycompressedanddoubleedgedatconvexborder(not
smooth)5. Yellowiskbrown6. Bitter
669.Trueaboutacidpoisoningis
a)Greatestdamageisalongthelessercurvature
b)Corrosivescausevaporizationoftissues
c)Vitriolagemeansingestionofacidinemptystomach
d)Highestchanceofperforationiswithnitricacid
CorrectAnswer-AAns.is'a'i.e.,GreatestdamageisalongthelessercurvatureMagenstrasseisthetermappliedtothepathwayacidicagentsfollowinstomach.Thepathwayofacidsandalkalisinfoodfilledstomachstartsalongthelessercurvatureofthestomachandleadstothepylorus,whichexplainsthelocationofgreatestdamageinfoodfilledstomach.Stomachwithoutfoodhavesignificantinjuryinthelowerhalfoftwothirdsandmayhavesparingoffundus.Mechanismofaction:-Corrosivesfix,destroyanderodethesurfacewithwhichtheycomeincontact.Theymainlyactlocallyby:HygroscopicextractionofwaterfromtissuesCoagulationofproteinsandConversionofhaemoglobinintohematin.Titriolage'isthrowingofanycorrosiveonanotherperson.Eyesareaffectedmostcommonly.Itcomesundersector320IPS.Therearehighestchancesofperforationofstomachwith11,SO4,amongallmineralacids.
670.
Highestcontentofcannabisisfoundinwhichpartoftheplant?
a)Root
b)Resin
c)Seed
d)Stem
CorrectAnswer-BAns.is`b'i.e.,Resin[RefReddy26th/ep.528]Cannabis,alsoknownasmarijuana,isobtainedfromtheIndianHempplantorcannabisindica(Cannabissativa).TheactiveprinciplesofCannabisarecontainedinitsresin.Allpartsoftheplant,maleorfemale,containtheactivematerial,exceptstem,rootandseeds.Theprincipalconstituentoftheresinarecannabinol,whichhasnoaction.Cannabidiolisalsoinert,butonexposuretoheat,itispartlyconvertedtotheveryactiveisomerictetrahydrocannabinols(THC).
671.AllofthefollowingareCNSstimulantsexcept?
a)Amphetamines
b)Benzodiazepines
c)Cocaine
d)Methylphenidate
CorrectAnswer-BAns.is'b'i.e.,BenzodiazepinesCNSstimulantsareamphetamine,methylphenidate,atomoxetine,modafinil,cocaine,pemolineandcaffeine.
672.Nuxvomicaseedscontain2alkaloids,strychnineand:
a)Hyoscine
b)Hyoscyamine
c)Brucine
d)Atropine
CorrectAnswer-CCi.e.Brucine
673.Aseasnakeis:
a)Neurotoxic
b)Hemotoxic
c)Musculotoxic
d)Alloftheabove
CorrectAnswer-CCi.e.Musculotoxic
674.'ColdTurkey'termisusedtodenotewhichofthefollowing?
a)Consumptionofheroin
b)Abruptcessationofheroin
c)Gradualwithdrawalofheroin
d)Placetowithdrawadruginagroup
CorrectAnswer-BAns.is'b'i.e.,Abruptcessationofheroin[RefQuittingSmokingforLifep.18]'ColdTurkey'meansabruptandcompletecessationoftakingadrugtowhichoneisaddiced.Alcoholisnottheonlydrugwherebyquittingcoldturkeyposesadangertothepatient.Peoplewhoareaddictedtoopiates(heroin,methadone,morphine,Suboxone,andevenprescriptionbenzodiazepines)areatimmenseriskiftheytrytostoptheirdrugintakewithoutaplan.
675.Allaretrueofopioidwithdrawal,except:NIMHANS10;PGI14
a)Yawning
b)Hallucinations
c)Lacrimation
d)Piloerection
CorrectAnswer-BAns.Hallucinations
676.Smokystoolisseeninwhichpoisoning?
a)Phosphorus
b)Arsenic
c)Lead
d)Zinc
CorrectAnswer-AAns.is'a'i.e.,Phosphorus[RefModernMedicalToxicologybyPillayp.68]Acutepoisoningofphosphorus:?Breathsmellsofgarlic.Vomitusandstoolsmaybeluminousinthedark.Smokystoolsyndrome:-Faintfumesmayemanatefromthestools.Manifestationsofliverdamage-tenderhepatomegaly,jaundicewhichmayprogresstoanolivegreenhue,flappingtremorofhands(asterixis),mousyodourtothebreath(foetorhepaticus).
677.Gigantinisactiveprincipleof
a)PlumbagoRosea
b)Calotropis
c)RicinusCommunis
d)P.Zeylanica
CorrectAnswer-BAns.is'b'i.e.,Calotropis[RefConciseTextbookofFMT-Sharmap.250]Calotropisgigantea-4containsactiveprinciplenamedgigantin.Whencut,stemandleavesoftheplantexrudeanacridmilkyjuice.Whenthisjuiceisallowedtostandorheated,serumisexudedleavingbehindwhiteclot.Theserumcontainstheactiveprinciplenamedgigantinwhichisverytoxic.
678.Whichofthefollowingistrueaboutcocainemetabolitetest
a)Measurebenzoylecgoninelevels
b)Usedtodiagnosecocaineuse
c)Treatmentofcocaineoverdose
d)Alloftheabove
CorrectAnswer-DAns.is'd'i.e.,Alloftheabove[RefCodeofFederalRegulationsp.174]Cocaineandcocainemetabolitetestsystem:Acocaineandcocainemetabolitetestsystemisadeviceintendedtomeasurecocaineandacocainemetabolite(benzoylecgoonine)inserum,plasma,andurine.Measurementsobtainedbythisdeviceareusedinthediagnosisandtreatmentofcocaineuseoroverdose.
679.Activeingredientofmarkingnutis?
a)Semecarpol
b)Crotin
c)Abrin
d)None
CorrectAnswer-AAns.is'a'i.e.,SemecarpolSemicarpusanacardiumormarkingnutorbhilawanItsseedareheartshaped,conicalandblackwithacridoilyjuicewhichisbrownishbutturnsblackonexposuretoair.Activeprinciplesaresemecarpolandbhilawanol.Juiceappliedtoskinproducesirritation,painfulblistersfollowedbyitchingandeczema.Thereforeitisusedtoproduceartificialbruises.Itisalsousedbywashermantomarkclothes.
680.WhoisthefatherofmodernMicrobiology?
a)Metchnikoff
b)LordLister
c)LouisPasteur
d)RobertKoch
CorrectAnswer-CFatherofModernMicrobiology:LouisPasteur.FatherofMedicalMicrobiology:RobertKoch.FatherofPathology:RudolphVirchow.
681.WhichofthefollowingstatementregardingcelldivisionisNOTTRUE?
a)Produceshaploidnumberofchromosomes
b)Producessamenumberofchromosomes
c)Produces2cells
d)Noneoftheabove
CorrectAnswer-AMitosisisanucleardivisioninwhichdaughtercellsreceivethesamenumberofchromosomesasthatofparentcell.Thedaughtercellsresultingfrommitosisareidenticaltoeachotherandalsototheparentcellinthequantityandqualityofgeneticmaterial.
Mitosis:Itistheprocessthatfacilitatesequalpartitioningofreplicatedchromosomesintotwo
identicalgroups.
Asaresultofthistwonewdaughtercellsarisefromoneoriginalcell.
Allthecellscreatedthroughmitosisaregeneticallyidenticaltooneanotherandtothecell
fromwheretheycame.
Themainpurposeofmitosisineukaryoticcellsaregrowthoftheindividual,repairoftissue
andasexualreproduction.
682.Allofthefollowingareimportantmechanismsofgenetransferinbacteria,except?
a)Lateralgenetransfer
b)Conjugation
c)Verticalgenetransfer
d)Horizontalgenetransfer
CorrectAnswer-CAns.is'c'i.e.,VerticalgenetransferGenetransferGenetransferreferstotheprocessofgeneticmaterial(e.g.DNA)beingsentandreceivedamongtwoorganisms-*Donorsendsandrecipientreceivesthegeneticmaterial.Therearetwoprocessesofgenetransfer:?1.Horizontalgenetransfer(HGT)orlateralgenetransferHorizontalgenetransferistheprocessbywhichgeneticmaterialispassedbetweentwodifferentorganism,i.e.organismofdifferentspecies.Therecipientisnottheoffspringofdonor.Themostimportantexampleisgenetransferbetweenthebacteria.Theprocessesofhorizontalgenetransferinbacteriaare:-
1. Transduction2. Transformation3. Conjugation
2.VerticalgenetransferVerticalgenetransferistheprocessoftransferringgeneticmaterialtoorganismofsamespecies,i.e.donorrecievesgeneticmaterial
fromitsancestor,e.g.itsparentoraspeciesfromwhichitevolved.Therefore,thedonorwillhavethesamegeneralmakeupastheparents.Verticalgenetransferis"amixoftwoparents",i.e.whentwoorganismsmate,theirgenesareverticallytransferedtotheirspawn.Thisprocessisnotimportantinbacteria.
683.Naturalmethodofhorizontalgenetransferamongbacteriaincludes-
a)Electroporation
b)Transduction
c)Transformation
d)bandc
CorrectAnswer-DAns.is'b'i.e.,Transduction;'c'i.e.,TransformationGenetransferGenetransferreferstotheprocessofgeneticmaterial(e.g.DNA)beingsentandreceivedamongtwoorganisms--->Donorsendsandrecipientreceivesthegeneticmaterial.Therearetwoprocessesofgenetransfer:?1)Horizontalgenetransfer(HGT)orlateralgenetransferHorizontalgenetransferistheprocessbywhichgeneticmaterialispassedbetweentwodifferentorganism,i.e.organismofdifferentspecies.Therecipientisnottheoffspringofdonor.Themostimportantexampleisgenetransferbetweenthebacteria.Theprocessesofhorizontalgenetransferinbacteriaare:-
1. Transduction2. Transformation3. Conjugation
2)VerticalgenetransferVerticalgenetransferistheprocessoftransferringgeneticmaterialtoorganismofsamespecies,i.e.donorrecievesgeneticmaterialfromitsancestor,e.g.itsparentoraspeciesfromwhichitevolved.Therefore,thedonorwillhavethesamegeneralmakeupasthe
parents.Verticalgenetransferis"amixoftwoparents",i.e.whentwoorganismsmate,theirgenesareverticallytransferedtotheirspawn.Thisprocessisnotimportantinbacteria.
684.Allculturemediaareusedforantibioticsusceptibilityexcept-
a)Tetrathionate-F
b)Bloodagar
c)Chocolateagar
d)Muller-Hintonagar
CorrectAnswer-AAns.is'a'i.e.,Tetrathionate-F*TheKirby-Bauerdiskdiffusionmethodisoneofthemostwidelypracticedantimicrobialsusceptibilitytests(AST).*Itisaffectedbymanyfactorsamongwhicharethemediaused.*Mueller-Hintonagar(MHA)isthestandardmediumrecommendedinguidelines.*Mueller-Hintonhasafewpropertiesthatmakeitexcellentforantibioticuse....-Starchisknowntoabsorbtoxinsreleasedfrombacteria,sothattheycannotinterferewiththeantibiotics.-Second,itisalooseagar.Thisallowsforbetterdiffusionoftheantibioticsthanmostotherplates.
685.Loeffer'sserumisanexampleof
a)Basalmedium
b)Simplemedium
c)Complexmedium
d)Enrichmentmedium
CorrectAnswer-CAns.is'c'i.e.,Complexmedium[RefAnanthanarayan8th/e.p.140]Loeffler'smediumisanenrichedmedium→Atypeofspecial(complex)medium.
686.Tocreateanaerobiosiswhichorganismisused
a)Micrococcus
b)Clostridium
c)B.anthracis
d)Corynebacterium
CorrectAnswer-AAns.is'a'i.e.,MicrococcusObligateaerobicmicrococcusisusedtocreateanaerobiccondition(anaerobiosis).Themicrococcusandtheanaerobicorganismtobecultivatedarebothinoculatedintothesameliquidmedium.DuringincubationtheMicrococcusgraduallyutilizesthefreeoxygencreatingconditionsfavorableforthegrowthofanaerobe.Afteranaerobiosisisachieved,themicrococcusdies(duetolackofoxygen)leavingtheanaerobeinpureculture.
687.Savloncontains
a)Cetrimide+Chlorhexidine
b)Cetrimide+Chlorhexidine+butylalcohol
c)Cetrimide+butylalcohol
d)Cetrimide+Cetavlon
CorrectAnswer-AAns:A.Cetrimide+chlorhexidine[RefKDTpharmacology6/e,p861,860;Park20/e,p117]Savloncontains-Chlorhexidinegluconate(hibitane)+Cetrimide(cetavlon)invariouspercentagesSavlonliquidantiseptic-chlorhexidinegluconate1.5%+cetrimide3%Savloncream-chlorhexidineHC10.1%+cetrimide0.5%Savlonhospitalconcentrate-chlorhexidinegluconate7.5%+cetrimide15%Otherantisepticanddisinfectantsofimportance:Betadine-povidone(polyvinylpyrrolidone)iodineDettol-chloroxylenol4.8%in9%terpinol&13%alcoholDakin'ssolution-Dilutedsodiumhypochloritesolutionbufferedwithboricacid.Availablechlorineis0.5%.Eusol-Solutionofchlorinatedlime(1.25%)+boricacid(L25%)0.4%availablechlorineDakin'ssolution&Eusoldissolvepus&necrotictissueinadditiontobeinggermicidal.Sousedincleaningofinfectedwound.
688.WhichofthefollowingisamethodofPasteurization
a)Vatmethod
b)Pasteurmethod
c)Billingmethod
d)Flashmethod
CorrectAnswer-A:DAns.is'a&d'i.e.,Vatmethod&Flashmethod[RefPark23ra/ep.655]Pasteurizationisdonetodestroythepathogensinmilk.Itkillsnearly90%ofbacteriainmilk,includingmoreheatresistanttubercularbacilliandQ-feverorganism.However,thermoduricbacteriaandsporesarenotkilled.Therearefollowingmethodsofpasteurization:?A)Holdermethod(Vatmethod)Milkiskeptat63-66°Cfor30minutesandthenrapidlycooledto5°C.B)Hightemperatureshorttime(HTST)methodItisalsocalledFlashmethod.Milkisheatedto72°Cfor15secondsandthenrapidlycooledto4°C.Itisnowthemostwidelyusedmethod.C)Ultra-hightemperature(UHT)methodMilkisrapidlyheatedintwostagesto125°Cforfewseconds,2"dstagebeingunderpressure.Itisthenrapidlycooled.Method RemarksHolder/VatMethod
Forsmallandruralcommunities
HTST(flash) Mostwidelyused,forlarge
HTST(flash)Method
Mostwidelyused,forlargequantities
UHTMethod Heatingin2stages2'dstageunderpressure
689.TemperatureusedinTyndallizaton
a)40°C
b)60°C
c)80°C
d)100°C
CorrectAnswer-DAns.is'd'i.e.,100°C[RefAnanthanarayan9thiep.31&triep.33]Tyndallization(intermittentsterilization)Mediacontainingsugarorgelatinaresterilizedbyheatingat100°Cfor20minutesonthreesuccessivedays.Firstexposurekillsallvegetativebacteria.Sporesgerminateandarekilledonsubsequentexposures
690.Laproscopeissterilizedby?
a)2%formalin
b)2%glutaraldehyde
c)Autoclaving
d)Boiling
CorrectAnswer-BAns.is'b'i.e.,2%glutaraldehydeAllendoscopes(e.g.laproscope)aresterilizedby2%glutaraldehyde(cidex).
691.Sterilizationofculturemediacontainingserumisby:
a)Autoclaving
b)Microporefilter
c)Gammaradiation
d)Gammaradiation
CorrectAnswer-AAns.(a)Autoclaving
692.Nutrientagarheatedat80°Cusedfor
a)Sporegermination
b)Togrowmesophilicbacteria
c)Togrowthermophilicbacteria
d)Forclostridiumisolation
CorrectAnswer-A:DAns.is'a'>'d'i.e.,Sporegermination>ForclostridiumisolationHeatingfor20minutesat80degreescentigradedestroysvegetativecellsandactivatesthesporesforgermination.Thismethodcanbeusedtocultivateanaerobicspore-formingorganisms(e.g.clostridium)Aboutoptionsa&cMicroorganismscanbegroupedintobroad(butnotveryprecise)categories,accordingtotheirtemperaturerangesforgrowth.Psychrophiles(cold-loving)cangrowat0°C,andsomeevenaslowas-10°C;theirupperlimitisoftenabout25°C.Mesophllesgrowinthemoderatetemperaturerange,fromabout20°C(orlower)to45°C.Thermophilesareheat-loving,withanoptimumgrowthtemperatureof50°ormore,amaximumofupto70°Cormore,andaminimumofabout20°C.Hyperthermophileshaveanoptimumabove75°Candthuscangrowatthehighesttemperaturestoleratedbyanyorganism.AnextremeexampleisthegenusPyrodictium,foundongeothermallyheatedareasoftheseabed.Ithasatemperatureminimumof82°,anoptimumof105°andagrowthmaximumof110°C.
693.Involutionalformareseeninwhichphaseofbacterialgrowth
a)Lagphase
b)Logphase
c)Stationaryphase
d)Deathphase
CorrectAnswer-DAns.is'd'i.e.,Deathphase[RefAnanthanarayan94Vep.22]Bacterialgrowthisthedivisionofonebacteriumintotwodaughtercellsinaprocesscalledbinaryfission.Providingnomutationaleventoccurs,theresultingdaughtercellsaregeneticallyidenticaltotheoriginalcell.Hence"Localdoubling"ofthebacterialpopulationoccurs.Bacteriahaveadistinctpatternofgrowthwhenabacteriumisseededintoasuitableliquidmediumandincubated,itsgrowthfollowsadefinitecourse.
694.Partialacidfastorganismis
a)M.tuberculosis
b)M.Bovis
c)Nocardia
d)None
CorrectAnswer-CAns.is'c'i.e.,Nocardia[RefConciseReviewofmicrobiologyp.13]Portialacidfastmeans,organismwhichisshowslessaffinityforprimarystain,thuslessconcentratedH2So4(insteadof20%H2So4)isusedfordecolorizationofprimarystain(Carbolfuschin).PartialacidfastbacteriaareMleprae(5%H,SO4),andNocardia(0.5%H2SO4)
695.Resolvingpowerofelectronmicroscope
a)1-5mm
b)1-5um
c)1-5nm
d)1-5A°
CorrectAnswer-DAns.is'd'i.e.,1-5Ae[RefEssentialsofmedicalmicrobiology]
696.Classificationofstaphylococcusisbasedon-
a)Catalasetest
b)Coagulasetest
c)Mannitolfermentation
d)Optochinsensitivity
CorrectAnswer-BAns.is'b'i.e.,CoagulasetestMedicallyimportantstaphylococcithatcausehumandiseasearedividedintotwogroups:?Coagulasepositive:Staphylococcusaureus.Coagulase-negative:Staphylococcusepidermidis,Staphylococcushaemolyticus,Staphylococcussaprophyticus.
697.Ironhelpsinvirulenceofwhichorganism
a)Streptococcuspyogenes
b)Pneumococcus
c)Staphylococcusaureus
d)Pseudomonas
CorrectAnswer-CAns.is'c'i.e.,StaphylococcusaureusStaphylococcusaureuscausesasignificantamountofhumanmorbidityandmortality.TheabilityofS.aureustocausediseaseisdependentuponitsacquisitionofironfromthehost.S.aureuscanobtainironfromvarioussourcesduringinfection,includinghaemandtransferrin.Themostabundantironsourceinhumansishaemironboundbyhaemoglobincontainedwithinerythrocytes.S.aureusisknowntolyreerythrocytesthroughsecretionofpore-formingtoxins,providingaccesstohosthaemoglobin.Proteinsoftheiron-regulatedsurfacedeterminant(Isd)systembindhosthemoproteins,removethehaemcofactor,andshuttlehaemintothecytoplasmforuseasanutrientironsource.DeletionofIsdsystemcomponentsdecreasesstaphylococcalvirulence,underscoringtheimportanceofhaemironacquisitionduringinfection.Inadditiontohaem,S.aureuscanutilizetransferrinironthroughthesecretionofsiderophores.Severalstaphylococcalsiderophoreshavebeendescribed,someofwhichhavedefinedrolesduringthepathogenesisofstaphylococcal
infections.
698.Allaretrueaboutlisteriaexcept:
a)Grampositive
b)PALCAMagarisusedforisolation
c)Characteristictumblingmotilityat37°C
d)Umbrellashapedgrowth
CorrectAnswer-CAns.is.'c'i.e.,Characteristictumblingmotilityat37°CL.monocytogenesisagram-positive'coccobacillus'(coccoidrod)withatendencytooccurinchains.Peritrichousflagellaareproducedbythebacillusoptimallyat20-30°Cbutonlyscantilyornotatallat37°CCulturemediausedforisolationarebloodagar,chocolateagar,andPALCAMagar.Itgrowsonordinarymediawithinatemperaturerangeof1°to45°C.Mostcasesofhumandiseasearecausedbyserotypes1/2a,1/2band4b.Theorganismcanbefoundasapartofthegastrointestinalflorainhealthyindividuals.HumandiseaseduetoL.monocytogenesgenerallyoccursinthesettingofpregnancyorimmunosuppression.
699.DOCforlisteriameningitis-
a)Ampicillin
b)Cefotaxime
c)Cefotriaxone
d)Ciprofloxacin
CorrectAnswer-AAnswer-A.AmpicillinTheantibioticofchoiceforlisteriainfectionisampicillinorpenicillinG.
700.WhichofthefollowingisnotmechanismforresistancetoMRSA-
a)Resistanceischromosomallymediated
b)ProducedmainlybyalterationinPBPs
c)MRSAresistanceisabsolutelybeta-lactamaseindependent
d)Intrinsicresistanceisknown
CorrectAnswer-CAns.is'c'i.e.,MRSAresistanceisabsolutelybeta-lactamhhaseindependent
701.Wool-Sorterdiseaseiscausedby
a)Pseudomonas
b)Bacillusanthracis
c)Vibrioparahemolyticus
d)Spirillusminor
CorrectAnswer-BAns.is'b'i.e.,Bacillusanthracis[RefHarrison19(h/ep.261;Ananthnarayan/ep.246]BacillusAnthracisisthecausativeorganismofanthrax.Inhuman,anthraxoccursinfollowingforms?Cutaneousanthrax(Hideporter'sdisease)Itisthemostcommonformofanthrax.Itisapainlesslesionandiscalledcharbonormalignantpustule.Itgenerallyresolvesspontaneously,but10-20%ofuntreatedpatientsmaydevelopfatalsepticemia.Pulmonaryanthrax(Woolsorter'sdisease)Itfollowsinhalationofdustfrominfectedwool.Itpresentsashemorrhagicpneumonia.Intestinalanthraxisrarestform.
702.Allaretrueaboutcutaneousanthraxexcept?
a)Extremelypainful
b)Thewholeareaiscongestedandedematous
c)Centralcrustationwithblackeschar
d)Satellitenodulearoundinguinalregion
CorrectAnswer-AAns.is'a'i.e.,ExtremelypainfulCutaneousanthraxispainless.
703.CapsuleofBacillusanthracisisformedof:
a)Polysaccharide
b)Lipopolysaccharide
c)Polypeptide
d)Longchainfattyacids
CorrectAnswer-CAns.is.'c'i.e.Polypeptide
704.Fishyodourisfoundongrowthofwhichorganism
a)Proteus
b)Pseudomonas
c)Yersiniapseudotuberculosis
d)Yersiniapestis
CorrectAnswer-AAns.is'a'i.e.,ProteusProteusispartofthenormalfloraofthehumangastrointestinaltract.Itcanalsobefoundfree-livinginwaterandsoil.Whenthisorganism,however,enterstheurinarytract,wounds,orthelungsitcanbecomepathogenicCultureofproteusbacillihasacharacteristicputrefactiveodordescribedas'fishyorseminal".Rottencookedfishyodor:Proteusmirabilisproducesaverydistinctfishyodor.OnSalmonella-Shigella(SS)agar,Proteususuallysmellslike“rottencookedfish”.
705.ConfirmatorytestforSyphilisis:September2010March2013
a)VDRL
b)Rapidplasmareagintest
c)FT-ABS
d)Alloftheabove
CorrectAnswer-CAns.C:FT-ABST.pallidumcannotbegrowninvitroDiagnostictestsforsyphilis:Testsincludeserologictestsforsyphilis(STS),whichconsistofscreening(reaginic)andconfirmatory(treponemal)tests,anddarkfieldmicroscopy.Reaginictestsuselipidantigens(cardiolipinfrombovinehearts)todetectreagin(humanantibodiesthatbindtolipids).TheVenerealDiseaseResearchLaboratory(VDRL)andrapidplasmareagin(RPR)testsaresensitive,simple,andinexpensivereaginicteststhatareusedforscreeningbutarenotspecificforsyphilis.Resultsmaybepresentedqualitatively(e.g.,reactive,weaklyreactive,borderline,ornonreactive)andquantitativelyastiters(e.g.,positiveat1:16dilution).Manydisordersotherthantreponemalinfections(e.g.,SLE,antiphospholipidantibodysyndromes)canproduceapositive(biologicallyfalse-positive)reagintestresult.CSFreaginictestsarereasonablysensitiveforearlydiseasebutlesssoforlateneurosyphilis.CSFreagintestscanbeusedtodiagnoseneurosyphilisortomonitorresponsetotreatmentbymeasuringantibodytiters.Treponemaltestsdetectantitreponemalantibodiesqualitatively
andareveryspecificforsyphilis.Theyincludethefollowing:Fluorescenttreponemalantibodyabsorption(FTA-ABS)testMicrohemagglutinationassayforantibodiestoT.pallidum(MHA-TP)T.pallidumhemagglutinationassay(TPHA)
706.Rapiddetectionofmeningococalmeningitisis
a)Bloodculture
b)CSFculture
c)PCR
d)None
CorrectAnswer-CAns.is'c'i.e.,PCR[RefBasicinmicrobiologyp.719]"PCRassaycanbeperformedrapidlywithaturnaroundtimeof2hourfromintiationofDNAextractiontotheissuingofreports".LaboratorydiagnosisofmeningococciSpecimensusedareCSF(forcases),nasopharyngealswab(forcarrier),blood(inmeningococcemia&earlymeningitis),andpetechiallesions(inmeningococcemia).Bestspecimenforcase4CSF(bylumbarpuncture).Bestspecimenforcarrier4Naspharyngealswab.
707.Presumptivediagnosisofmeningococcalmeningitisismadeearliestby-
a)CSFculture
b)PCR
c)Latexagglutination
d)CFT
CorrectAnswer-CAns.is'c'i.e.,Latexagglutination[RefEssentialsofmedicalmicrobiologyr3d/ep.412]IncombinationwithaclinicalpictureCSFexaminationconsistentwithbacterialmeningitis,apresumptivediagnosisofbacterialmeningitiscausedbyN.meningitidis,S.pneumoniae,orH.influenzaecanbymadeafterperformingaGramstainoftheCSFsedimentorbydetectionofspecificantigensintheCSFbyalatexagglutinationtestorusingRDTs.Positiveresultsforanyofthesetestscanrapidlyprovideevidenceofinfectionevenifculturesfailtogrow.PCRandCSFcultureareusedfordefinitivediagnosis(notpresumptivediagnosis)
708.Legionnairediseaseiscausedby?
a)Motilegrampositive
b)Motilegramnegative
c)Non-motilegrampositive
d)Non-motilegramnegative
CorrectAnswer-BAns.is'b'i.e.,Motilegram-negativeLegionellaisagram-negative,non-capsulatedcoccobacilluswhichismotilebypolarorsubpolarFlagella.Legionellacausesthefollowinginfections:A)PulmonaryinfectionsTherearetwotypesofpulmonaryinfections:-1.PontiacFever:Itisself-limitingflu-likeillnesswithincubationperiod24-48hours.Thereisnopneumonia.2.LegionnairesDisease:Itisatypicalpneumoniawithanincubationperiodof2-l0days.Itischaracterizedbycough.chestpain,hemoptysis,high-gradefever,diarrhoea,confusion,'relativebradycardiaandhyponatremia'.Iftheonsetofsymptomsoccurswithin10daysofdischargefromthehospital,nosocomiallegionnaire'sdiseaseshouldbesuspected.ExtrapulmonaryinfectionsThemostcommonsiteofinfectionistheheart(myocarditis/pericarditis/endocarditis).
709.Pontiacfeveriscausedby:
a)Legionella
b)Listeria
c)Scrubtyphus
d)Leptospira
e)Rickettsia
CorrectAnswer-AAns.(a)LegionellaPontiacfeverisamildnonfatalinfluenzalikeillnesscausedbyLegionellapneumophila.Pontiacfexc,AnacuteselflimitingfluelikeillnesswithIPof24-48hoursMalaise,fatigueandmyalgiaarethemostfrequentpresentingsymptomsPneumoniadoesn'tdevelop.Completerecoverytakesplace,withoutantibiotictherapy.Diagnosisisestablishedbyantibodydetection.
710.Sewerswabsaretakentodetect
a)Typhoidcasesincommunity
b)Choleracasesincommunity
c)Typhoidcarriersincommunity
d)Choleracarriersincommunity
CorrectAnswer-CAns.is'c'i.e.,Typhoidcarriersincommunity[RefTextbookofpracticalMicrobiologyp.721]TyphoidcarriersaredetectedbySewer-swabmethod'.Theuseofsewerswabsenablespremisestobescreenedforthepossibilityoftheexistenceofasalmonellaproblemmorequicklyandmoreeasilythanbytheexaminationofmanyend-of-linesamples.Intheeventofsalmonellaebeingfound,areturnvisitcanbepaidanddetailedsamplestakentoattempttodefectthesourceofcontamination.
711.Speciesofshigellacausingarthritis
a)Shdysenteriae-1
b)Shsonnei
c)Shflexneri
d)Shboydii
CorrectAnswer-CAns.is'c'i.e.,Shflexneri[RefHarrison18th/ep.945]Shigellaishighlycommunicable.Theinfectivedoseforshigellaisless.Itcanbeaslowas10-100bacillibecausetheysurvivegastricaciditybetterthanotherenterobacteriae.Shigellaeproducefollwingclinicalfeatures.1)Intestinal:Theseare:-Dysentery:MostcommoncauseisShdyenteriaetypel.Diarrhea:UsuallybyShSonnei.2)Extraintestinal:Thesearehemolyticuremicsyndrome(causedbyShdysenteriae-I),arthritis(Shflexneri),seizures(Shflexneri),pneumoniaandReitersyndrome(inHLAB27association).
712.Griffthclassificationisbaseon
a)'C'-carbohydrate
b)M,T,Rantigens
c)Typeofhemolysis
d)0,requirment
CorrectAnswer-BAns.is'b'i.e.,M,T,Rantigens[RefAnanthanarayan9th/ep.209,210]Group'A'strep.arefurthersubdividedintotypesbasedontheprotein(M,TandR)antigenspresentonthecellsurface(Griffithtyping).About80typesofstr.pyogeneshavebeenrecognized.
713.Howdoeschlamydiadifferfromotherusualbacteria?
a)Lackcellwall
b)Cannotgrowincellfreeculturemedia
c)Containsinclusionbody
d)Noneoftheabove
CorrectAnswer-CAns.is'c'i.e.,ContainsinclusionbodyChlamydiaproducesbasophilic(intracytoplasmic)inclusionbodiesininfectedcellsincontrasttoeosinophilicinclusionbodiesproducedbymostvirusesandhencetheyaresometimesreferredtoasBasophilicviruses.UniquepropertiesofchlamydiaeareChlamydiaisanobligateintracellularparasite.ThismeanstheycansurviveonlybyestablishigresidenceinsideanimalcellsTheyneedtheirhost'sATPasanenergysourcefortheirowncellularactivity.TheyareenergyparasitesusingacellmembranetransportsystemthatusesATPfromthehostsystemandgivesoutADP.Thisobligateintracellularexistencemakesitimpossibletoculturetheseorganismsonnonlivingartificialmedia.Duetotheirsmallsizeandfailuretogrowincell-freemediatheywereconsideredtobeviruses.ChlamydiaegrowsinculturesofavarietyofeukaryoticcelllinesMcCoyorHeLacells.ItmaybenecessarytotreatcellswithpolyanioniccompoundssuchasDEAD-dextrantoreducetheelectrostaticbarriertoinfection.Antimetabolitesuchascycloheximideisaddedtofavourcompetitionforhostcellaminoacidpools.Alltypesof
chlamydiaeproliferateinembryonatedeggsparticularyintheyolksac.Thespecialfeaturesinstructureandchemicalcompositionofchlamydiaeare:
1. Theoutercellwallresemblesthecellwallofgramnegativebacteria2. Ithasarelativelyhighlipidcontent3. Itisrigidbutitdoesnotcontaintypicalbacterialpeptidoglycan;
perhapsitcontainatetrapeptidelinkedmatrix.4. NAcetylmuramicacidalsoappearstobeabsentfromchlamydiae
cellwall.
714.Similaritybetweenchlamydiaandvirusis
a)Filterablethroughfilter
b)Abilitytogrowincellfreemedia
c)ContainsbothDNAandRNA
d)Alloftheabove
CorrectAnswer-AAns.is'a'i.e.,Filterablethroughfilter[RefTextbookofmicrobiologybyParijap.418]Chlamydiaewerethoughttobevirusesbecause(likeviruses)they:Passthrough0.45ymfilters.Areobligateintracellularparasite-cannotbegrownincellfreemedia.
715.Chlamydiatrachomatisinfectioncommonlycauses:March2004
a)Infertility
b)Postcoitalbleeding
c)Amenorrhoea
d)Malignancy
CorrectAnswer-AAns.Ai.e.Infertility
716.Whichtestcannotdifferentiateendemicandepidemictyphus
a)Weil-Felixreaction
b)Complementfixationtest
c)Immunofluorescence
d)Radioprecipitation
CorrectAnswer-AAns.is'a'i.e.,Weil-FelixreactionBothepidemictyphusandendemictyphusarepositiveforOX-19antigen→ThusWeilFelixreactioncannotdifferentiatebetweenthetwo.Weil-FelixreactionThisreactionisanagglutinationtestinwhichseraaretestedforagglutininsto0antigensofcertainnonmotileproteusstrainsOX-19,OX-2andOX-K.Thebasisofthetestisthesharingofanalkali-stablecarbohydrateantigenbysomerickettsiaeandbycertainstrainsofproteus,P.vulgarisOX-19andOX-2andP.mirabilisOX-K.Thetestisusuallydoneasatubeagglutination,thoughrapidslideagglutinationmethodshavebeenemployedforscreening.
717.E.colisubtypesaredividedonthebasisof
a)Lactosefermentation
b)Virulenceproperties
c)Somatic0antigen
d)Maltosefermentation
CorrectAnswer-BAns.is'b'i.e.,Virulenceproperties[Refenwikipedia.org]EntericE.coli(EC)areclassifiedonthebasisofserologicalcharacteristicsandvirulenceproperties:?EnteropathogenicE.coli(EnteroadherentEcoli)EnterohemorrhagicE.coliorverotoxigenicE.coliEnterotoxigenicE.coliEnteroaggregativeE.coliEnteroinvasiveE.coli
718.A20yearoldmanpresentedwithabdominalpain,vomitingandbloodydiarrhea,hisstoolsamplegrewEscherichiacoliinpureculture.WhichofthefollowingserotypeofE.coliisthecausativeagentofhemorrhagiccolitis?
a)O157:H7
b)O159:H7
c)O107:H7
d)O55:H7
CorrectAnswer-AEnterohemorrhagicE.coliO157:H7istheserotypeofE.colicausinghemorrhagiccolitis.
Itisassociatedwiththeingestionofundercookedhamburger,sprouts,unpasteurizedmilkorjuice.EHECproducesashigatoxinandcancausecolitisafteranincubationperiodof3-5days.Ittypicallyproduceswaterydiarrheathatprogresstobloodydiarrheaafterafewhourstofewdays.Fatigue,abdominalpain,nauseaandvomitingareassociatedcomplaints.
Mechanismofenterohemorrhagiccolitisappearstobevascularendothelialdamagethatleadstoplateletaggregationandinitiationofthecoagulationcascade.Thisinturn,leadstoischemiaofthe
colonandresultsinhemorrhagiccolitis.
Ref:MayoClinicGastroenterologyandHepatologyBoardReviewByStephenHauser,4thEdition,Page197
719.ELISAtestforvirulenceantigenisusedforwhichtypeofEcoli
a)ETEC
b)EIEC
c)EHEC
d)EAEC
CorrectAnswer-BAns.is'b'i.e.,EIEC[RefAnanthnarayan9th/ep.279]ForlaboratorydiagnosisofEIEC,theSerenytestusedtobeemployed(thatis,instillationofsuspensionoffreshlyisolatedEIECorshigellaintotheeyesofguineapigsleadstomucopurulentconjunctivitiesandseverekeratitis).Micemaybeusedinsteadofguineapigs.CellpenetrationofHeLaorHEP-2cellsincultureisamorehumanediagnostictest.Thisabilitytopenetratecellsisdeterminedbyalargeplasmid,detectionofwhichcanalsobeadiagnostictest.Theplasmidcodesforoutermembraneantigenscalledthe'virulencemarkerantigens'(VMA)whichcanbedetectedbytheELISA(VMAELISA)test.
720.E.coliinfectionoccurinwhichenzymedefect
a)Lactase
b)Pyruvatekinase
c)Pepsin
d)Trypsin
CorrectAnswer-BAns.is'b'i.e.,Pyruvatekinase[RefHardcoremicrobiology&immunologybyBenjaminWSearsp.133]Opportunisticinfectionsisimmunodeficiencyduetodefectinmyeloidcellsare:-StaphaureusKlebsiellaPneumococcusE.coliNeisseriaCandidaConditionscausingdefectinmyeloidcellsare:?ChronicgranulomatousdiseaseChediak-HigashisyndromeG6PDandpyruvatekinasedeficiencyMyeloperoxidasedeficiency
721.Culturemediacontainingpotassiumtellurite
a)TCBSmedium
b)Monsurmedium
c)BYCEmedium
d)MullerHintonagar
CorrectAnswer-BAns.is'b'i.e.,Monsurmedium[RefFundamentalprinciplesofbacteriologyp.129]Monsur'sGTTAmediumisMonsur'sgelatintourocholatetrypticasetelluriteagar.SelectivemediaforvibriocholaraeTCBSmedium(pH8.6):Thismediumcontainsthiosulfate,citrate,bilesalts,sucrose,andbromothymolblue(indicator).V.choleraeproduceslarge,yellowconvexcoloniesonthismedium.Thisisduetofermentationofsucrosebythebacteria,leadingtoproductionofacid.AccumulationofacidreducespHofthemedium,andsothecolorofthebromothymolblueindicatorbecomesyellow,thusmakingV.choleraecoloniesyellow.Nonsucrose-fermentingV.parahaemolyricusproducesbluegreencolonies.Monsur'sGTTAmedium(pH8.5):HighpHofthemediumandpresenceofpotassiumtelluriteinthismediuminhibitsmostofGrampositivebacteriaandentericbacteriawithexceptionofproteusspecies.Hence,theGTTAmediumisusedforisolationofV.choleraeandothervibriosfromfeces.V.choleraeproducessmalltranslucentcolonieswithgrayishblackcencerandaturbidhaloafter24hoursofincubation.Thecoloniesbecomelarger(3-4mminsize)afteraprolongedincubationof48hours.
AlkalineBSA(pH8.2):ThisisanotherselectivemediumusedforV.cholerae.ThecoloniesonBSAaresimilartothoseonnutrientagar.
722.Borreliacauseswhichofthefollowing
a)Weil'sdisease
b)Bejels
c)Vincentangina
d)Yaws
CorrectAnswer-CAns.is'c'i.e.,VincentanginaThreeimportantdiseasescausedbyBorreliaeare:?Lymedisease:CausedbyB.burgdorferiRelapsingfever:CausedbyB.recurrentis,Bduttoni,B.hermsii,B.Parkeri,B.turicatae,B.persica,B.hispanica.Vincent'sangina:CausedbyB.vincenti.
723.Whichofthefollowingismostactiveagainstslowlydividingtubercularbacilli?
a)Isoniazid
b)Rifampicin
c)Streptomycin
d)Ethambutol
CorrectAnswer-BAns.is'b'i.e.,Rifampicin
724.GenerationtimeforMtuberculosis
a)10-15min
b)10-15hours
c)10-15days
d)5-10days
CorrectAnswer-BAns.is'b'i.e.,10-15hours[RefAnanthanarayan8th/ep.365]Generationtimeofleprabacillus→412-13daysGenerationtimeoftuberclebacillus→14hoursGenerationtimeofcoliformbacilli→20minutes
725.Gonococcihasaffinityfor:
a)Columnarepithelium
b)Glandularepithelium
c)Stratifiedsqamousepithelium
d)Squamousepithelium
CorrectAnswer-AColumnarepithelium
726.WhichofthefollowingagentsismostcommonlyassociatedwithrecurrentmeningitisduetoCSFleaks?
a)Meningococci
b)Pneumococci
c)HemophilusInfluenza
d)E.Coli
CorrectAnswer-BIntracranialCSFleakscausebacterialmeningitis,about80%arecausedbyS.Pneumoniae.Othercausativeorganismsaremeningococcus,HemophilusspeciesandS.aurues.
Ref:ClinicalPediatricNeurologyByRonaldB.David,Page217
727.Trueaboutvibriocholeraeis-
a)Diseasemorecommoninwoman
b)Classicalvibrioprotectagainstdevelopmentof0-139Torismilderthanclassical
c)El-Torismilderthanclassical
d)All
CorrectAnswer-CEl-Torismilderthanclassical
728.Diphtheriatoxin'smechanismofactionis:September2009
a)Inhibitingglucosesynthesis
b)Inhibitingproteinsynthesis
c)Promotingacetylcholinerelease
d)AlteringcyclicGMPlevels
CorrectAnswer-BAns.B:InhibitingproteinsynthesisThediphtheriatoxincausesthedeatheucaryoticcellsandtissuesbyinhibitionofproteinsynthesisinthecells.Althoughthetoxinisresponsibleforthelethalsymptomsofthedisease,thevirulenceofC.diphtheriaecannotbeattributedtotoxigenicityalone,sinceadistinctinvasivephaseapparentlyprecedestoxigenesis.
729.Stalactitegrowthingheebrothisduetothefollowingorganism?
a)Y.pestis
b)T.palladium
c)H.influenzae
d)C.diphtheriae
CorrectAnswer-ACulturalcharacteristicsofYersiniapestis:1.Whengrowninaflaskofbrothwithoil/gheefloatedontop(gheebroth)acharacteristicgrowthoccurswhichhangsdownintothebrothfromthesurface,resemblingstalactite.2.Onnutrientagar,coloniesaresmall,delicate,transparentdiscs,becomingopaqueoncontinuedincubation.3.Onbloodagarcoloniesaredarkbrownduetoabsorptionoftheheminpigment.4.OnMacConkeyagarcolourlesscoloniesareformed.5.Inbrothaflocculentgrowthoccursatthebottomandalongthesidesofthetube.
Ref:TextbookofMicrobiologyAnanthanarayanan,8thedition
730.Cystwithscolexandhooksisseenin
a)T.saginatu
b)Fishtapeworm
c)Echinococcus
d)H.diminuta
CorrectAnswer-CAns.is'c'i.e.,Echinococcus[Ref:Clinicalparasitology3rd/ep.315]Firstonemustunderstandthemeaningofscolex.Scolexispear-shapedorknoblikeheadofcystodes(tapeworms).Scolexiscoveredwithsuckersandhooks:-
1. Taeniasolium:Scolexcontainsfoursuckersandrostellarhooks(rostellumwithhooks).
2. Taeniasaginata:Scolexcontainsfoursuckersbutnohooks/rostellum(hookless).
3. H.Nana:Scolexcontainsfoursuckersandrostellumofhooks.4. H.diminuta:Scolexcontainsfoursuckersbutnohooks(hookless).5. Echinococcus:Scolexcontainssuckersandrostellumofhooks.6. Diphyllobothriumlotus:Scolexhastwoelongatedsuckinggrooves
(insteadofsuckers).Therearenohooks(hookless).
731.E.coliisdifferentiatedbyEhistolyticabypresenceof
a)Veryactivemovement
b)Thinnuclearmembrane
c)Cystwith1-4nuclei
d)Bluntpseudopodia
CorrectAnswer-DAns.is'd'i.e.,Bluntpseudopodia[Ref:Essentialsofmedicalparasitologyp.37]
732.Pulmonaryeosinophiliaisfoundininfectionwith?
a)Babesia
b)Malaria
c)Strongyloides
d)Trypanosoma
CorrectAnswer-CAns.is'c'i.e.,Strongyloides[RefHarrison18th/ep.2120&17th/ep.1610]AscarisStrongyloidesstercoralisAncylostoma(hookworm)WuchereriabancroftiorW.malayiToxocara
733.AdherenceofE.histolyticatocolonicmucosaismediatedby?
a)Fibronectin
b)Lectin
c)Collagen
d)Fucose
CorrectAnswer-BAns.is'b'i.e.,Lectin[Refwww.pathologyoutlines.com]PathophysiologyofE.histolyticainfectionCystareingestedfromfecallycontaminatedfoodorwater,sexualtransmissionalsooccurs.Excystationto8motiletrophozoitesoccursinthesmallintestineThecystsareresistanttogastricacid(andchlorineinwatersupplies).Trophozoitesarepotentiallyinvasiveandmultiplybybinaryfission.Inanestimated20%ofinfectionsinvasionintothewallofthecolonwithtissuedestructionoccurs.AdherencetocolonicmucosaismediatedbyalectinonE.histolytics'ssurface.TheparasitetheninducesapoptosisofepithelialcellsthroughachannelformingporeproteinE.histolyticaingestsremnantcells.Sometrophozoitesundergoencystationthroughsignallingpathwayscompletingthecycle.
734.Calabarswellingisproducedby?
a)Onchocercavolvulus
b)Loaloa
c)Burgiamalayi
d)Wuchereriabancrofti
CorrectAnswer-BAns.is'b'i.e.,Loa-LoaLoiasisLoiasisiscausedbyL.Loa(theAfricaneyeworm)Habitatofadultwormsissubcutaneousconnectivetissueofman;ofteninthesub-conjuctivaltissueoftheeye.Thewormpassesitslifecycleintwohosts:1)Man&2)Chrysops(Mangoordeerflies)C/Fs→Asymptomaticmicrofilaremia,Calabar(fugitive)swelling-subcutaneousswelling,Nephropathy,Encephalopathy(rare),CardiomyopathyCalabarswellingisduetohypersensitivityreactiontotheadultworm.
735.
PromastigoteformofLeishmaniaisfoundinwhichpartofsandfly:March2005
a)Lymphnode
b)GIT
c)Spleen
d)Bonemarrow
CorrectAnswer-BAns.B:GIT
736.WhichstageofLeishmaniaisfoundinspleenaspirateofpatient?
a)Amastigote�
b)Promastigote
c)Epimastigote��
d)Trypomastigote
CorrectAnswer-AAns.is'a'i.e.,Amastigote�[RefEssentialsofparasitology�p.�122]Amastigoteforms,alsoknownasLeishmaniadonovanibodies,arefoundintracellularlyintissueslikeliver,spleenandbonemarrow.ApositivebonemarroworspleenaspirationforL.donovanibodiesprovidesconfirmationofdiagnosis.
737.Maurer'sdotsareseeninwhichspeciesofplasmodium?
a)Povale
b)Pvivax
c)Pfalciparum
d)Pmalariae
CorrectAnswer-CAns.is'c'i.e.,P.falciparum[RefChatterjee12th/ep.79-80]P.vivax→ Schuffner'sdotP.malariae→ Ziemann'sstippling,P.falciparum→Maurer'sdotP.ovale→ Schuffner'sdot
738.Cholangiocarcinomaiscausedby:
a)Giardialamblia
b)Clonorchisinfestation
c)Paragonimusinfestation
d)Ascarisinfestation
CorrectAnswer-BAns.b.Clonorchisinfestation
739.Intermediatehostisnotrequiredforwhichparasite-
a)Toxoplasma
b)Schistosoma
c)Ancylostoma
d)Fishtapeworm
CorrectAnswer-CAns.is'c'i.e.,Ancylostoma[RefRajeshKarykartep.7]Thesequentialstagesingrowth,developmentandmultiplicationconstituteitslifecycle
740.Capsidofviralstructureis:
a)Extracellularinfectiousparticle
b)Proteincoataroundnucleicacid
c)Enveloparoundavirus
d)Noneoftheabove
CorrectAnswer-BAns.b.Proteincoataroundnucleicacid
741.SmallestDNAvirusis?
a)Herpesvirus
b)Adenovirus
c)Parvovirus
d)Poxvirus
CorrectAnswer-CAns.is'c'i.e.ParvovirusSmallestvirus(alsosmallestDNAvirus)→Parvovirus.Largestvirus(alsolargestDNAvirus)→Poxvirus.SmallestRNAvirus→PicornavirusLargestRNAvirus→Paramyxoviridae.
742.Allvirusesareassociatedwithspecificinclusionbody,except?
a)CMV
b)Malluscumcontagiosum
c)EBV
d)Yellowfever
CorrectAnswer-CAns.is'c'i.e.,EBV[RefEssentialsofmedicalmicrobiologyp.791]
743.Handfootmouthdiseaseiscausedby?
a)Enterovirus-70
b)Coxsackie-Avirus
c)Coxsackie-Bvirus
d)Enterovirus
CorrectAnswer-BAns.is'b'i.e.,Coxsackie-Avirus[RefGreenwoodle/ep.459;Ananthanarayan9th/ep.491]TherearetwotypesofCoxsackieviruses:
1. CoxsackieA(Seotypes1to24):Theycauseasepticmeningitis(especiallyA7andA9),Herpangina,febrileillness,acutehemorrhagicconjucntivitis(byA24),and'Hand-foot-mouthdisease'.
2. CoxsackieB(Sterotypes1to6):Theycauseasepticmeningitis(allserotypes),neonataldisease,Bornholmdisease(plurodyniaorepidemicmyalgia),myocarditis,hepatitis,pancreatitis&DM(serotypeB4),andpneumonia.
744.Rashofchickenpoxcanbedifferentiatedfromtherashofsmallpoxbyallexcept?
a)Pleomorphic
b)Centripetal
c)Deep-seated
d)Unilocular
CorrectAnswer-CAns.is'c'i.e.,Deep-seatedRashofchickenpoxissuperficial(notdeepseated).
745.HSV-2(Herpessimplex)causes?
a)Oralulcers
b)Genitalulcers
c)U.T.I.
d)Pharyngitis
CorrectAnswer-BAns.is'b'i.e.,Genitalulcer
746.HSV-2causeslatentinfectioninwhichnerveplexus/ganglia?
a)Trigeminalganglion
b)Oticganglion
c)Sacralganglion
d)Ciliaryganglion
CorrectAnswer-CAns.is'c'i.e.,Sacralganglion[RefEssentialsofmedicalmicrobiology3'/ep.1215]SiteoflatencyHSV-1→Trigeminalganglion.HSV-2→Sacralganglion.
747.WhichofthefollowingisHepadnavirus?
a)HAV��
b)HBV
c)HCV
d)HDV
CorrectAnswer-BAns.is'b'i.e.,HBV�[RefAnanthnarayan9th/ep.549&8thlep.545]
748.Coreantigen[HBOinHBVisenclodedbywhichgene?
a)S
b)C
c)P
d)X
CorrectAnswer-BAns.is`b'i.e.,C[RefAnanthanarayan9th/ep.544]ThegenomeofHBVismadeofcircularDNA,butitisunusualbecausetheDNAisnotfullydoublestranded->oneofthestrandsisincompleteandotheriscomplete4partiallydoublestrandedDNA.Therearefourknowngenesencodedbygenome-'C',X','P','S'.Pgeneisthelargestgene..X-genecodesforHBxAg,whichcantransactivatethetranscriptionofcellularandviralgenesandmaycontributetocarcinogenesis.HBxAganditsantibodyarepresentinpatientswithseverechronichepatitisandhepatocellularcarcinoma.
749.TrueaboutCMVareallexcept?
a)Mostcommoncauseofpost-transpinatationinfection
b)Mostcommoncauseoftransplacentalinfection
c)Anon-envelopedDNAvirus
d)Producesintranuclearinclusions
CorrectAnswer-CAns.is'c'i.e.,Anon-envelopedDNAvirusCMVisanenvelopedDNAvirus,belongstoHerpesviridae.
750.RespiratorySyncytialVirus(RSV)causesall,EXCEPT:
a)Coryzainkids
b)ARDS
c)Bronchitis
d)Commoncold
CorrectAnswer-BRSVinfectionleadstoawidespectrumofrespiratoryillnesses.Ininfantsitcancausepneumonia,bronchiolitis,andtracheobronchitis.Inthisagegroup,illnessbeginsmostfrequentlywithrhinorrhea,low-gradefever,oftenaccompaniedbycoughandwheezing.Inadults,themostcommonsymptomsarecommoncold,withrhinorrhea,sorethroat,andcough.Itcauseseverepneumoniainelderly.Sinusitis,otitismedia,andworseningofchronicobstructiveandreactiveairwaydiseasearealsoassociatedwithRSVinfection.Ref:Harrison’sPrinciplesofInternalMedicine,18thEdition,Chapter186
751.Rota-teqoralvaccineforrotaviruscontains?
a)2reassortedrotaviruses
b)3reassortedrotaviruses
c)4reassortedrotaviruses
d)5reassortedrotaviruses
CorrectAnswer-DAns.is'd'i.e.,5reassortedrotaviruses[RefEssentialofmedicalmicrobiologyp.932]Rota-virusvaccineTheRotavirusvaccinesarelive-attenuatedvaccinesgivenorally.Twonewvaccinesarenowinuse-
1. RV5oralpentavalentvaccine(Rotateq)containsfivereassortantrotavirusesdevelopedfrom5humanstrainsonbovinerotavirusbackground[ThesefivestrainsareGI,G2,G3,G4andP(8)]
2. RV1monovalentvaccine(Rotarix)containsoneliveattenuatedrotavirusstrain[thestrainisP1A(8)GI]TheadministrationofRotarix(2doses)andRotaTeq(3doses)needstobecompletedby32weeksofagetominimizeanypotentialriskofintussusception.Thefirstlicensedrotavirusvaccine,aRhesusmonkeyrotavirus-basedtetravalenthumanreassortantvaccine(Rotashield),waswithdrawnafterthisliveoralvaccinewasassociatedwithdevelopmentofintestinalintussusception.
752.WhatissimilarbetweenrotavirusandNorwalkvirus?
a)Bothbelongtosamefamily
b)Bothhavesegmentedgenome
c)BothhavesinglestrandedRNA
d)Botharecausesofviralgastroenteritis
CorrectAnswer-DAns.is'd'i.e.,Botharecausesofviralgastroenteritis[RefEssentialsofMicrobiologyp.497]Rotavirusbelongstoreoviridae→doublestrandedsegmentedRNA.Norwalkvirusbelongstocalciviridae→SinglestrandednonsegmentedRNA.BothRotavirusandNorwalkvirusarecausesofviralgastroenteritis
753.Zikaviruscauses?
a)Hepatitis
b)Myocarditis
c)Conjunctivitis
d)Noneofthese
CorrectAnswer-CAns.is'c'i.e.,ConjunctivitisZikavirus(ZIKV)isaflavivirusrelatedtoyellowfevervirus.ItistransmittedbyAedesmosquito.Zikavirusdisease(Zika)isadiseasecausedbytheZikavirus,whichisspreadtopeopleprimarilythroughthebiteofaninfected
754.Ebolavirusbelongsto?
a)Picornaviridae
b)Togaviridae
c)Flaviviridae
d)Filoviridae
CorrectAnswer-DAns.is'd'i.e.,Filoviridae
755.Poliovirusisshedinstoolupto-
a)6weeks
b)8weeks
c)10weeks
d)12weeks
CorrectAnswer-DAns.is'd'i.e.,12weeksInthefaces,thevirusisexcretedcommonlyfor2to3weeks,sometimesaslongas3to4months.
756.Trueaboutrhabdoviridaeareallexcept?
a)Includesvesculostomatitisvirus
b)Rabiesvirusisinactivatedbyformalin
c)RabiesvirusisnegativesensedoublestrandedRNAvirus
d)Alloftheabovecorrect
CorrectAnswer-CAns.is'c'i.e.,RabiesvirusisnegativesensedoublestrandedRNAvirusRhabdoviridaecontainstwogenera:?
1. Vesiculoviruses:Vesculostomatitisvirus,chandipuravirus.2. Lyssavirus:Rabiesvirus.
RabiesvirusItisaneneveloped,RNA(negativesensessRNA)virus.IthasRNAdependentRNApolymerase.Itisabulletshapedvirus.Rabiesvirusissensitivetoethanol,iodinepreparations,soap,quaternaryammoniumcompound,detergentsandlipidsolvents(likeether,chloroform).Itisinactivatedbyphenol,beta-propiolactone(BPL),formalin,Sunlight,UVirradiation,andbyheat.Rabiesisprimarilyazoonoticdiseaseofwarm-bloodedanimals,particularlycarnivoroussuchasdogs,Cats,Jackalsandwolves.Itistransmittedtomanusuallybybitesorlicksofrabidanimals.Itisthecommunicablediseasewhichisalwaysfatal.Itisdeadendinfectioninman.
757.Negribodiesarecharacteristicof:September2008,March2013
a)Tetanus
b)Rabies
c)Polio
d)AIDS
CorrectAnswer-BAns.B:RabiesSincefirstdescribedbyNegriin1903,thepresenceoftheNegribodiesarepracticallypathognomicforrabiesandareanimportantdiagnosticfinding.Negribodiesarediscrete,intracytoplasmic,deeplyeosinophilicinclusionsthatmeasureseveralmicronsindiameter.Inabout75%ofcasesofrabiesthesecanbeseenonhematoxylinandeosinstainedsections.Theyoccurinneuronsofthebrainstem,particularlythoseinthehippocampus,andinthePurkinjecellsofthecerebellum.UltrastructuralstudieshaveshownthatNegribodyconsistsofamassofnucleocapsidssurroundedbyviralparticlesbuddingfromintracytoplasmicmembranes.Thosebodiescanbeseeninaxons,anditisinthiswaythatvirusspreadsfromthecentralnervoussystemtomanyorgansofthebody.BecauseNegribodiesareusuallyseeninintactneurons,theyarefoundawayfromtheinflammatory,nonspecificlesions.Rabiesviralantigenscanbedemonstratedininfectedcellsbymeansoffluorescentantibodytechnique.AntigenscanbeshowntobepresentincellsintheabsenceofNegribodies,andhencethistechniqueismuchmoresensitivethanthe
bodies,andhencethistechniqueismuchmoresensitivethanthesearchofsectionsofbrainforthepathognomoniccytoplasmicinclusions.
758.CCR5mutationisrelatedtowhichcondition?
a)ResistancetoHIVinfection
b)SusceptibilitytoHIVinfection
c)ResistancetoHBVinfection
d)SusceptibilitytoHBVinfection
CorrectAnswer-AAns.is'a'i.e.,ResistancetoHIVinfection[Refwww.lumenlearning.com]Inrecentyears,scientificinteresthasbeenpiquedbythediscoveryofafewindividualsfromnorthernEuropewhoareresistanttoHIVinfectionin1998,AmericangeneticistStephenJ.O'BrienattheNationalInstitutesofHealth(NIH)andcolleaguespublishedtheresultoftheirgeneticanalysisofmorethan4,000individuals.TheseindicatedthatmanyindividualsofEurasiandescent(upto14%insomeethnicgroups)haveadeletionmutation,calledCCR5delta32,inthegeneencodingCCR5isacoreceptorfoundonthesurfaceofTcellsthatisnecessaryformanystrainsofthevirustoenterthehostcell.ThemutationleadstotheproductionofareceptortowhichHIVcannoteffectivelybindandthusblocksviralpeoplehomozygousforthismutationhavegreatlyreducedsusceptibilitytoHIVinfection,andthosewhoareheterozygoushavesomeprotectionfrominfectionaswell.
759.A52-year-oldmalewithHIVpresentswithprofuse,waterydiarrheaof5days’duration.Abiopsyofthesmallintestineisshownhere.Whatisthemostlikelycauseofthispatient’ssymptoms?
a)Cryptosporidium.
b)Giardia.
c)Acanthamoeba.
d)Histoplasma.
CorrectAnswer-AThecausativeorganisminthiscaseiscryptosporidium,ateenytinyprotozoan.Cryptosporidiummainlyaffectschildren,inwhomitcauseseitherself-limitedorpersistentdiarrhea.ItalsoaffectspatientswithAIDS,inwhomitcausessevere,chronicdiarrhea.Theorganismishighlyinfectious,andisspreadbyfecal-oraltransmission.
Diagnosismaybemadeonacid-fastexaminationofthestool,inwhichcryptosporidialoocystsarevisibleasround,red-stainingstructures.Histologicexamination,whichisusuallynotnecessaryfordiagnosis,showstinyroundorganismsprojectingfromthebrushborder,asseeninthephotomicrographabove.Treatmentinvolvesantiparasitictherapyandnutritionalsupport.
760.BloodydiarrheainHIVinfectedpatientismostlydueto?
a)Cryptosporidium
b)Isospora
c)CMV
d)Salmonella
CorrectAnswer-CAns.is'c'i.e.,CMV[Refwww.medscape.com]ThemostcommonoftheopportunisticinfectionsthatcausediarrheainpatientswithAIDSareCMVinfection,cryptosporidiosis,microsporidiosis,andMACinfection.CMVinfectionisthemostcommonopportunisticviralinfectionintheGItractofHIV-infectedpatientsandcancauseproblemsfromthemouthtotheanus.Itmostfrequentlycausesacolitisassociatedwithfever,crampyabdominalpain,andfrequent(oftenbloody)stools.
761.Sabouraud'sdextrose[glucose]agarisusedforisolationof-
a)Pseudomonas
b)B.Antracis
c)Fungi
d)Ancylostome
CorrectAnswer-CAns.is'c'i.e.,Fungi[RefGreenwood10/ep.570;Ananthanarayan8th/ep.601]Culturemediausedinmycologyare:
1. Sabouraud'sglucoseagar(mostcommon)2. Czapek-Doxmedium3. Cornmealagar
762.Neurotropicfungusis/are-
a)Cryptococcusneoformans
b)Histoplasmosis
c)Trichophyton
d)aandb
CorrectAnswer-DAns.is'a'i.e.,Cryptococcusneoformans;'b'i.e.,HistoplasmosisFungiinfectingthebrainareCryptococcusneoformansBlastomycesdermatitidisCoccidioidesimmitisAspergillussp.Candidasp.SporothrixschenckiiHistoplasmacapsulatum
763.Hairperforationtestispositiveininfectionwith?
a)Trichophyton
b)Microsporum
c)Epidermophyton
d)Alloftheabove
CorrectAnswer-AAns.is'a'i.e.,TrichophytonHairperforationtest.Thehairperforationtestconsistsofinoculatingcoloniesofanorganismintoadishcontainingasmallamountofwater,afewdropsofyeastextractsolutionandsomehumanhair.Thedishisincubatedat300Candafter7days,someofthehairaretakenandarekeptonaslidewithacoverslipandareobservedunderamicroscope.Thetestisconsideredpositiveifthehairhasdeep,narrowwedgeshapedperforationinit..Hairperforationtestisdonetodistinguishbetweenisolatesofdermatophytes,particularlytrichophytonmentagrophytesanditsvariants.
764.Ectothrixiscausedby?
a)Ttansurans
b)Tviolaceum
c)Microsporumcanis
d)Alloftheabove
CorrectAnswer-CAns.is'c'i.e.,Microsporumcanis[Ref:Greenwood16thiep.574]Tineacapitisisdermatophyticinfectionofscalpandscalphair.Occurscommonlyinchildren.Itisuncommoninadults(incontrast,T.crusis,T.manuumandT.unguiumarecommoninadults).Causedbygeneratrichophytonormicrosporum.Asepidermophytondoesnotaffectthehair,EpidermophytondoesnotcauseT.capitis.TwomostcommonspeciescausingT-CapitisareM.canis&T.tonsurans.Tineacapitismaybetwotypes.
1. EndothrixInvasionofhairshaftbyfungus.ItiscausedbyT.tonsurans(MC),T.violaceum,T.schoenleinii.
2. EctothrixFungalinvasionisrestrictedtotheoutermostcuticleofhair.ItiscausedbyM.canis(MC),M.audouini,T.mentagrophytes.AsectothrixisthecommonesttypeofT.capitis,MicrosporumcanisisthemostcommoncauseofT.Capitis
765.Aspergillusfumigatusisdifferentiatedbyotherfungiby?
a)Showingseptatehyphae
b)Growat45°C
c)Causerespiratorytractinfection
d)Mostcommonendemicmycosis
CorrectAnswer-BAns.is'b'i.e.,Growat45°C[RefHarrison19thiep.1346;Ananthanarayan8th/ep.613]Aspergillusisamouldwithseptatebranchinghyphae.AbilityofA.fumigatustogrowat45°Chelpstodistinguishitfromotherspecies.Modeoftransmission-InhalationofAspergillusspores(Conidia)intolungs.Thecommonesthumandiseasecausedbyaspergillusisotomycosis.Aspergillusinfectioninneutropenicpatientischaracterizedbyhyphalinvasionofbloodvessels,thrombosis,necrosisandhemorrhagicinfarction
766.Chlamydosporeisformedby?
a)Candidaalbicans
b)Candidapscitasi
c)Histoplasma
d)Cryptococcus
CorrectAnswer-AAns.is'a'i.e.,Candidaalbicans[RefAnanthanarayan8thlep.607-608]Allcandidaspeciespathogenicforhumansarealsoencounteredascommensalsofhumans,particularlyinthemouth,stoolandvagina.Theygrowrapidlyonsimplemediaasovalbuddingcellsat25°to37°C.Intissue,bothyeastsandpseudohyphaearepresent.Candidaalbicansisdifferentiatedbyothercandida:Itformstruehyphae(mycelia)orgermtubeswhengrowninserum.Itformsthickwalledlargesporescalledchlamydosporeswhengrownincornmealagar.Itisdimorphic.
767.Trueaboutcryptococcusareallexcept
a)Primarilyinfectslung
b)Ureasenegative
c)India-inkisused
d)Allaretrue
CorrectAnswer-BAns.is`bi.e.,UreasenegativeCRYPTOCOCCUSNEOFORMANSTheonlypathogenicyeastFourcapsularserotypes-A,B,CandDIthaspolysaccharidecapsuleMostinfectionsinimmunocompromizedpatientsarecausedbyserotypeA.PigeondroppingscommonlycontainsserotypeAandD.EucalyptustreecontainserotypeB.Itisureasepositive.ModeoftransmissionByinhalationofthefungusintothelung(mostcommon)Throughskinormucosa(sometimes).
768.Pneumocystisjeroviciis:
a)AssociatedwithCMV
b)Diagnosisisbysputummicroscopy
c)Seenonlyinimmunocompromisedpatients
d)Alwaysassociatedwithpneumatocele
CorrectAnswer-BAnswer:B.DiagnosisisbysputummicroscopyHumanisolateof.PneumocystiswhichisassociatedwithseverepneumoniainimmunocompromisedstateparticularlyAIDS.P.jeroviciisanextracellularpathogen.Growthinthelungislimitedtosurfactantlayerabovealveolarepithelium.Serologicevidencesuggestthatmostindividualsareinfectedinearlychildhood(thusoption“c”iswrong)butthepneumoniaisseenonlyinimmunocompromisedstate.DiagnosisismadebydetectionoforganisminproperspecimenSputum:Quickandnoninvasive.Broncho-alaeolarlaoage(BAL)fluid:Mainstayofpneumocystisdiagnosis.Transbronchialbiopsy:IfdiagnosiscannotbemadebyBAL.
769.Pneumocystiscariniiisdiagnosedby-
a)Sputumexaminationfortrophozoitesandcystundermicroscope
b)Culture
c)Positiveserology
d)Growthonartificialmedia
CorrectAnswer-AAns.is'a'i.e.,Sputumexaminationfortrophozoitesandcystundermicroscope
770.A60yearsoldfarmerhasdevelopedswellingonthesoleoffootwithdischargingyellowgranules.Thediagnosisis-
a)Fungalmycetoma
b)Eumycetoma
c)Actinomycosis
d)Candidiasis
CorrectAnswer-CAns.is'c'i.e.,ActinomycosisMycetomaIsalocalizedchronicgranulomatousinvolvementofthesubcutaneousanddeepertissues,commonlyaffectingthefootandlessoftenthehandandotherparts.Presentingasasubcutaneousswellingwithmultipledischargingsinuses.Sinusesdischargeseropurulentfluidcontaininggranules.Thesegranulesaremicrocoloniesoftheetiologicalagents.Mycetomacanbecausedbybothfungusandbacteria
771.Lipophilicfungusis?
a)Malasseziafurfur
b)Candida
c)Cryptococcus
d)Histoplasma
CorrectAnswer-AAns.is'a'i.e.,Malasseziafurfur[RefPrinciplesofmedicalmicrobiologyp.781]Malasseziafurfur(Pityrosporumovale)isalipopphilicfungusthatisfoundinareasofthebodythatarerichinsebaceousglands.Thisfunguscausestineaversicolor(pityriasisversicolor).
772.NottrueaboutsporothrixSchenckii?
a)Dimorphicfungus
b)Asteroidbodies
c)Copperpennybodies
d)Commoningardners
CorrectAnswer-CAns.is'c'i.e.,Copperpennybodies[RefHarrison19th/ep.1353]Copperpennybodiesareseeninchromoblastomycosis.SporothrixSchenckiiSporothrixSchenckiiisadimorphicfungus.Theorganism(sporothrixschenckii)areusuallydescribedastiny,cigar-shapedbodies,3-5micronsinlength,whichbearfromonetothreesmallovalbudsateitherorbothpales.Occasionallyalargerasteroidbodymaybeseen.BecauseS.schenckiinaturallyfoundinsoil,hay,sphagnummoss,andplants,itusuallyaffectsfarmers,gardeners,andagriculturalworkers.Thisfungaldiseaseusuallyaffectstheskinalthoughrareformscanaffectthelungs,joints,bonesandCNS.Fungusentersthroughsmallcutsandabrasionsintheskintocausetheinfection.Becauserosescanspreadthedisease,itisoneofafewdiseasesreferredtoasrose-thornorrosegardener'sdisease.
773.Antibodyspecificityisdueto?
a)AminoacidsequenceatHchain
b)AminoacidsequenceatLchain
c)Aminoacidatcarboxyterminal
d)Aminoacidsequenceattheaminoterminal
CorrectAnswer-A:B:DAns.is'd>a&b'i.e.,Aminoacidsequenceataminoterminal>AminoacidsequenceatHchain&AminoacidsequenceatLchain[RefReadbelow]Antibodyspecificityisduetovariabilityoftheaminoacidsequencesatthevariableunit(ataminoterminal)ofbothHandLchains(notonlyHorLchains).
774.Antibodydiversityisdueto-
a)Generearrangement
b)Genetranslocation
c)Antigenicvariation
d)aandc
CorrectAnswer-DAns.is'a'i.e.,Generearrangement;'c'i.e.,Antigenicvariation
775.Specificityofantibodyisdependenton?
a)Fcportion
b)Fabregion
c)Carboxyterminal
d)Alloftheabove
CorrectAnswer-BAns.is'b'i.e.,Fabregion[Ref:Harrison19th/ep.372;Ananthanarayan9thiep.100]TheinfiniterangeoftheantibodyspecificityofimmunoglobulinsdependsonthevariabilityoftheaminoacidsequencesatthevariableunitsofHandLchains.VariableregionispresentonFabregion.
776.Mosteffectiveantibodyforprecipitation?
a)IgM
b)IgG
c)IgA
d)IgD
CorrectAnswer-BAns.is'b'i.e.,IgG[RefHarrison19th/ep.372&18th/ep.2674;Ananthanarayan9thiep.98&8th/ep.98]IgMismoreeffectivethanIgGfor:
1. Immunehemolysis2. Opsonization3. Complementfixationbyclassicalpathway4. Bacterialagglutination
IgGismoreeffectivethanIgMfor:1. Neutralizationoftoxins&viruses2. Precipitationreactions.
777.ComplementFixationtestis:September2005
a)VIDAL
b)Coombstest
c)Wassermannreaction
d)VDRL
CorrectAnswer-CAns.C:WassermannreactionThecomplementfixationtest(CFT)wasextensivelyusedinsyphilisserologyafterbeingintroducedbyWassermanin1906.However,thereisnowatrendtoreplacetheCFTwiththesimpleflocculationtests.AlthoughCFTisconsideredtobearelativelysimpletest,itisaveryexactingprocedurebecause5variablesareinvolved.Inessencethetestconsistsoftwoantigen-antibodyreactions,oneofwhichistheindicatorsystem.Thefirstreaction,betweenaknownvirusantigenandaspecificantibodytakesplaceinthepresenceofapredeterminedamountofcomplement.Thecomplementisremovedor"fixed"bytheantigen-antibodycomplex.Thesecondantigen-antibodyreactionconsistsofreactingsheepRBCwithhaemolysin.Whenthisindicatorsystemisaddedtothereactants,thesensitizedRBCswillonlylyseinthepresenceoffreecomplement.TheantigensusedforCFTtendtobegroupantigensratherthantype-specificantigens.InorderfortheCFTtobesetupcorrectly,theoptimalconcentrationofhaemolyticserum,complement,andantigenshouldbedeterminedbytitration.TheWassermanntestisnolongerinuse.
778.Apatientispresentingwithrecurrentstaphylococcalinfection,kyphoscoliosisandtypicalfaces.Thepatientissufferingfrom?
a)IgAdeficiency
b)HyperIgEsyndrome
c)Commonvariableimmunodeficiency
d)Burton'sAgammaglobulinemia
CorrectAnswer-BAns.is'b'i.e.,HyperIgEsyndromeJob'ssyndrome(Hyper-IgEsyndrome)Job'ssyndrome,alsocalledHyper-IgEsyndromeorHyperimmunoglobulinEsyndrome,isanautosomaldominantdisorderduetomutationsinSignalTransducerandActivatorofTranscription-3(STAT-3).Thereisdefectinphagocytosis.IgElevelsareelevated.Otherimmunoglobulinsarenormal.Clinicalmanifestationsincludestaphylococcalcoldabscess,otitismedia,recurrentsinopulmonaryandskininfections,andcavitarypneumoniawithpneumatoceles.Besideinfections,otherfindingsarecharacteristicfacieswithbroodnose,osteoporosis,kyphoscoliosis,cerebral.
779.18yearsoldgirlpresentswithwaterydiarrhea.Mostlikelycausativeagent-
a)Rotavirus
b)V.cholerae
c)Salmonella
d)Shigella
CorrectAnswer-BAns.is'b'i.e.,V.choleraeAmongstthegivenoptionsRotavirusandV.choleraecausewaterydiarrhea.Acutewaterydiarrhainchildrenisusuallybacterialinorigin,mostcommonlyduetoenterotoxigenicE.coli(ETEC).Vcholeraeisalsoacommoncause.Rotavirusisthemostcommoncauseofdiarrheaininfantandchildren(thepatientinquestionisadult).
780.Swimmingpoolconjunctivitisiscausedby
a)Chlamydiatrachomatis
b)Adenovirustype8
c)Adenovirustype8
d)Gonococcus
CorrectAnswer-AAns.,Chlamydiatrachomatis
781.A30yearsoldmaleishavingprpductivecoughwithdysnea.Bloodgasanalysisshowslowpa02.Chestx-rayisshowingreticulonodularpattern.Thecausativeagentis?
a)Staphaureus
b)Pneumococcus
c)P.jerovecii
d)Pseudomonas
CorrectAnswer-CAns.is'c'i.e.,P.jerovecii[RefReadbelow]Reticulo-nodularshadowisseenininterstitialpneumonia.AmongthegivenoptionsPjeroveciiisacauseofinterstitialpneumonia.Otherthreeoptionsarecausesofairspacepneumonia."PneumocystisCariniipneumoniaproducesadiffuse,symmetric,fine-to-mediumreticulonodularpattern".
782.Mostcommonorganismgrowninurinecultureofpregnantwomanwithasymptomaticbacteriuria?
a)Proteus
b)E.coli
c)Staphaureus
d)Pseudomonas
CorrectAnswer-BAns.is'b'i.e.,E.coliAsymptomaticbacteriuriaisthepresenceofbacteriainavoidedurinesampleandiscausedbybacterialcolonizationoftheurinarytract.Itaffectsabout5to10percentofbothsexuallyactiveandpregnantwomen.Asymptomaticbacteriuriaislessprevalentinmen.Asthenameindicates,asymptomaticbacteriuriadoesnotcausesymptoms.Theconditionsimplyreferstothedetectionofbacteriainaurinesample.Nonetheless,thereisgoodreasontobeconcernedaboutthisinfection,particularlyifyouarepregnant,becauseitcanleadtoasymptomaticupperurinarytractinfection(namely,pyelonephritis),whichcancomplicatepregnancy.Bacteriaaretypicallyintroducedintotheurinarytractduringintercourseorwhenwipingafterabowelmovement.ThebacteriumE.coliisresponsibleforatleast75to80percentofasymptomaticbacteriuria.Klebsiellapneumoniea,Proteusspecies,staphylococcalspecies,enterococci,andgroupBstreptococcicanalsoestablishcolonization.
783.
Apaitentoperatedfortransurethralresectionofprostate[TURP]developsUTI.Theorganismmostcommonlygrownonculturewillbe-
a)Proteus
b)E.coli
c)Pseudomonas
d)Listeria
CorrectAnswer-BAns.is'b'i.e.,E.coli[Refwww.jcam.com]MostcommonorganismcausingUTIaftertransurethralprostectomyisEcoli.
784.Cellulitissurroundingdiabeticulcerismostlycausedby?
a)Streptococcuspyogenes
b)Staphylococcus
c)Mixedorganisms
d)Pseudomonas
CorrectAnswer-CAns.is'c'i.e.,Mixedorganisms[RefEssentialsofmedicalmicrobilogyp.712]"Amixtureofgram-positivecocciandgram-negativeacrobesandanaerobesisoftenimplicatedincellulitissurroundingdiabeticanddecubitusulcers".
785.Candidiasofpenisis?
a)Thrush
b)Leukoplakia
c)Balanitis
d)None
CorrectAnswer-CAns.is'c'i.e.,Balanitis[RefEssentialsofmedicalmicrobiologyp.712]Candidalinfectionsareidentifiedbytheirlocationonthebodyasfollows:Axillae,underpendulousbreasts,groin,interglutealfolds:intertrigo.Glanspenis:balanitisFollicularpustules:candidalfolliculitisNailfolds:candidalparonychiaMouthandtongue:oralcnadidiasis(thrush)Areaincludedunderdiaper-diaperdermatitis
786.Non-parasiticeosinophiliaiscausedbyinfectionwith-
a)Staphylococcus
b)Ehrlischia
c)Coccidioidomycosis
d)Candidiasis
CorrectAnswer-CAns.is'c'i.e.,Coccidioidomycosis[RefDiagnostichematologyp.332]"Oneoftheveryfewnon-parasiticinfectionsthatregularlycauseeosinophiliaisCoccidioidomycosis,afungalinfection.atypicalpneumonia
787.Atypicalpneumoniacanbecausedbythefollowingmicrobialagentsexcept?
a)Mycoplasmapneumoniae.
b)Legionellapemmophila
c)HumanCoronavirus
d)Klebsiellapneumoniae
CorrectAnswer-DAnswerisD(Kleibsellapneumonia):CausesofAtypicalpneumonias.1.Mycoplasmapneumonias2.Viralpneumonias-Influenza-RSV-Adenovirus-Rhinovirus-Rubeola-Varicilla-Coronavirus3.Chlamydiapneumonia4.Coxiellabumetti5.Pneumocystiscarinii6.LegionellaCoronavirusisaninfrequentcauseofpneumonia.SARSassociatedcoronavirus(SARS-CoV)causedepidemicofpneumoniafromNov2002toJuly2003-Harrison
788.Healthindexcharacteristicsareallexcept?
a)Validity
b)Reliability
c)Affordability
d)Feasibility
CorrectAnswer-CAns.is'c'i.e.,AffordabilityTherehasbeensomeconfusionoverterminology:healthindicatorascomparedtohealthindex(plural:indicesorindexes).Ithasbeensuggestedthatinrelationtohealthtrends,thetermindicatoristobepreferredtoindex,whereashealthindexisgenerallyconsideredtobeanamalgamationofhealthindicators(56).CharacteristicsofindicatorsIndicatorshavebeengivenscientificrespectability:forexampleidealindicators.Shouldbevalid,i.e.,theyshouldactuallymeasurewhattheyaresupposedtomeasure;Shouldbereliableandobjective,i.e.,theanswersshouldbethesameifmeasuredbydifferentpeopleinsimilarcircumstances.Shouldbesensitive,i.e.,theyshouldbesensitivetochangesinthesituationconcerned.Shouldbespecific,i.e.,theyshouldreflectchangesonlyinthesituationconcerned,Shouldbefeasible,i.e.,theyshouldhavetheabilitytoobtaindataneeded,and;Shouldberelevant,i.e.,theyshouldcontributetotheunderstanding
ofthephenomenonofinterest.
789.Trueforepidemiologicaltriad
a)Time,place,person
b)Agent,host,environment
c)Disease,prevention,treatment
d)Agent,man,disease
CorrectAnswer-BAns:Bi.e.Agent,host,environmentEpidemiologicaltriadTheoccurrenceandmanifestationsofanydisease,whethercommunicableornoncommunicable,aredeterminedbytheinteractionofthefollowingthreefactors.
1. Theagent2. Thehost3. Theenvironment
Thesethreefactorstogetherconstitutetheepidemiologicaltriad.Merepresenceofthesefactorsdoesnotcausedisease,theinteractionofthesethreeisrequiredforthecausationofadisease.
790.PQLIis
a)Objectivecomponentoflevelofliving
b)Subjectivecomponentoflevelofliving
c)Objectivecomponentofqualityoflife
d)Subjectivecomponentofqualityoflife
CorrectAnswer-DAns.is'd'i.e.,SubjectivecomponentofqualityoflifeSubjectivecomponentThesubjectivecomponentofwellbeingisqualityoflife.Theleveloflivingandstandardoflivingareobjectivecriteriaofwellbeing,whilethequalityoflifecomprisestheindividual'ssubjectiveevaluationofthese.Therecentdefinitionofqualityoflifeisasfollows"acompositemeasureofphysicalmentalandsocialwellbeingasperceivedbyeachindividualorgroupofindividuals."WHOdefinitionisasfollows"theconditionofliferesultingfromthecombinationoftheeffectsofthecompleterangeoffactorssuchasthosedetermininghealth,happiness,education,etc."Theindexforqualityoflifeis"Physicalqualityoflifeindex(PQLI)".ThePQLIisanattempttomeasurethequalityoflifeorwell-beingofacountry.Physicalqualityoflifeindexconsolidatesthreeindicators:-LiteracyrateInfantmortalityrateLifeexpectancyatage1year(LEI)PQLIrangesfrom0to100.PQLIinIndiais65.
791.Onlydiseasewhichiseradicatedworldwide?
a)Smallpox
b)Polio
c)Diphtheria
d)Measles
CorrectAnswer-AAns.is'a'i.e.,SmallpoxEradicationimpliesterminationofalltransmissionofinfectionbyexterminationofinfectiousagent.Itisanabsoluteprocess,i.e.allornonephenomenon.Itliterallymeans"tearingoutbyroots".Eradicationisa"globalterm"usedonlycessationofinfectionfromthewholeworld.Smallpoxistheonlydiseasethathasbeeneradicated.OtherdiseaseswhicharecandidatesforglobaleradicationPolio,measles,dracunculiasis,diphtheria.
792.Endemicdiseaseisdefinedas-
a)Diseaseoccuringregularlyinexpectedfrequency
b)Diseaseoccuringirregularly
c)Diseaseoccuringinexcessofexpectedfreqency
d)Diseaseaffectingalargepopulation
CorrectAnswer-AAns.is'a'i.e.,Diseaseoccuringregularlyinexpectedfrequency[RefPark23"/ep.93&22"/ep.89]Sporadic→Diseaseoccuringirregularlyfromtimetotime.Endemic→Diseaseoccuringregularlyinexpectedfrequency.Epidemic→Diseaseoccuringinexcessofexpectedfrequency.Pandemic→Epidemicaffectingalargeproportionofpopulationoverawidegeographicarea.
793.Medianincubationperiodis?
a)Maximumtimefromexposuretodevelopmentofsymptomsinallcases
b)Minimumtimefromexposuretodevelopmentofsymptomsinallcases
c)Timefromexposuretodevelopmentin50%ofcases
d)Noneoftheabove
CorrectAnswer-CAns.is'c'i.e.,Timefromexposuretodevelopmentin50%ofcasesIncubationperiodisthetimeintervalbetweeninvasionbyaninfectiousagentandappearnaceofthefirstsignandsymptom.'Medianincubationperiod'isthetimerequiredfor50%casestooccurfollowingexposure.
794.Standpipeinruraloreasisanexampleofwhichprincipleofprimaryhealthcare?
a)Equitabledistribution
b)Communityporticipation
c)Intersectoralcoordination
d)Appropriatetechnology
CorrectAnswer-CAns.is'c'i.e.,Inter-sectoralcoordination[RefPrimaryheathcareonline;Park23'/ep.742]Publicworks,eg.ensuringanadequatesupplyofsafewater(Standpipe)andbasicsanitation,comesunderinter-sectoralcoordination(multi-sectoralapproach).IntersectoralcoordinationTheprimaryhealthcareisnotprovidedbyhealthsectoralone.Itinvolvesallotherrelatedsectorsofnationalandcommunitydevelopment,inparticularagriculture,animalhusbandry,food,industry,education,housing,publicworks(e.g.anadequatesupplyofsafewaterandbasicsanitation),communicationandothersectors.
795.Secondaryattackrateisameasureof-
a)Communicability
b)Lethality
c)Strengthofassociation
d)None
CorrectAnswer-AAns.is'a'i.e.,CommunicabilitySARisanimportantmeasureofcommunicability.Highersecondaryattackratemeans,morenumbersofsusceptiblecontactsaredevelopingthediseaseafterexposuretoprimarycase.So,highertheSARhigheristhecommunicability(infectiousness)ofdisease.Onetermrelatedtosecondaryattackrateisattackrateandrequiresspecificmentionhere(Hasbeenexplainedinbriefpreviously)AttackRate:Whennewcasesoccurrapidlyoverashortperiodoftimeinawelldefinedpopulationtheattackrateisused.oItisusuallyexpressedasapercentage.newcasesoccuringduringashortperiodoftimeAttackRate=________________________________________________________________x100populationatriskatthebeginningofthetimeperionTheattackrateisalsocalledcumulativeincidencerate.Itdiffersfromtheconventionalincidencerateinthatittendstodescribediseaseoreventsthataffectalargerproportionofthepopulationofinterest.
interest.Attackrateisusedwhen"populationisexposedtoriskforalimitedperiodoftime,Suchasepidemic."Attackrateeffectstheextentofepidemic.AttackratevssecondaryattackrateAttackrateincludesnewcasesduringaspecificperiodoftime(whichisusuallyshort)anditincludesallthecasesduringthatperiod,i.e.primaryaswellassecondarycases.Ontheotherhandsecondaryattackrateincludesnewcaseswhichdevelopwithintherangeofincubationperiodafterexposuretoprimarycase,i.e.itincludesonlysecondarycase(notprimarycases).
796.Apopulationof50childrenishaving10immunizedagainstchickenpox.5childrendevelopedchickenpoxonmarch2017.Other28childrendevelopedchickenpoxwithinnext2weekwhatistheSARofchickenpox?
a)60%
b)70%
c)80%
d)90%
CorrectAnswer-CAns.is'c'i.e.,80%[Ref:ParkMllep.105-107&23ra/ep.100]Primarycasesinthequestion→5(developingchickenpoxonsameday)Immunechildren→10Susceptiblecontacts→Totalchildren-(Primarycases+immunizedchildren)=50-(5+10)=35No.ofsusceptibledevelopingdesease=28Noofsusceptibledevelopingdiseasex100=80%Totalnumberofsusceptiblesx
797.Denominatorinunder-5proportionalmortalityrate?
a)Numberofdeathunder5yearsofage
b)Mid-yearunder-5population
c)Totaldeaths
d)Mid-yearpopulation
CorrectAnswer-CAns.is'c'i.e.,Totaldeaths
798.Berkesonianbiasisatypeof?
a)Admissionratebias
b)Intervieverbias
c)Informationbias
d)Recallbias
CorrectAnswer-AAns.is'a'i.e.,Admissionratebias[Ref:Park24thlep.78-79]BerkesonianbiasBerksonianbiasresultsfromthegreaterprobabilityofhospitaladmissionforpeoplewithtwoormorediseasethanforpeoplewithonedisease.So,itisalsoknownasadmissionratebias.
799.Trueabouticebergofdisease?
a)Clinicianisconcernedwithhiddenportionoficeberg
b)Tipoftheicebergrepresentclinicalcases
c)Tetanusisclassicalexample
d)ScreeningisdoneforTipoftheiceberg
CorrectAnswer-BAns.is'b'i.e.,TipoftheicebergrepresentclinicalcasesIcebergofdisease*Diseaseinacommunitymaybecomparedwithaniceberg.*Thefloatingtipoftheicebergrepresentswhatthephysicianseesinthecommunity,i.e.clinicalcases(Diagnosedcase,symptomaticcaseoftheclinicallyapparentcase).*Thevastsubmergedportionoftheicebergrepresentsthehiddenmassofdisease,i.e.latent,inapparent,presymptomaticandundiagnosedcasesandcarriersinthecommunity.-The"waterline"representsthedemarcationbetweenapparentandinapparentdisease.-Anepidemiologistisconcernedwiththehiddenportionoftheicebergwhereastheclinicianisconcernedwiththetipoftheiceberg.-ScreeningisdoneforaHiddenportionoftheicebergwhereasdiagnosisisdoneforthetipoftheiceberg.*TheicebergphenomenonofdiseaseisnotshownbyRabies,Tetanus,Rubella,andMeasles.*Theclinicianconcernedonlywiththetipoficeberg,i.esymptomaticcasesthatareseeninclinicaltreatment,thiscanresultininaccurateviewofthenatureandcausesofadiseaseresultsbecausetheminorityofthecasesarestudied(hiddencases:-
submergedportionoficebergisnotstudied)-->Clinician'sFallacy.
800.Liveinfluenzavaccineisgivenbywhichroute?
a)Intradermal
b)Subcutaneous
c)Intramuscular
d)Intranasal
CorrectAnswer-DAns.is'd'i.e.,Intranasal[RefPark24thiep.168]Theroutesofimportantvaccinesare:?Subcutaneous:Measles,rubella,killedinfluenza,killedcholera,IPV,yellowfever.Intramuscular:Mumps,killedinfluenza,typhoidVi-polysaccharide,DPT(deepintramuscular),rabies,IPV.iii)Intradermal:BCG,rabies.Nasal:Liveinfluenza.Oral:OPV,oralcholera,oraltyphoid(typhoral).
801.Whichofthefollowingistrue?
a)Twolivevaccinesshouldnotbegiventogether
b)Liveandkilledvaccineshouldnotbegiventogether
c)Immunoglobolinshouldnotbegivenforatleast6weekswhenalivevaccineisadministered
d)Livevaccineshouldnotbegivenfor12weeksifimmunoglobinhasbeengiven
CorrectAnswer-DAns.is'd'i.e.,Livevaccineshouldnotbegivenfor12weeksifimmunoglobinhasbeengiven.Twolivevaccinescanbegivensimultaneously,buttheyshouldbegivenatdifferentsites.Otherwisetheyshouldbegivenatanintervalofatleast3weeks(ifadministeredatsamesite).Liveandkilledvaccinecanbegiventogether.Livevaccinesshouldnotnormallybegivenfor12weeksafteraninjectionofnormalhumanIgandifalivevaccinehasalreadybeengiven,HumanIginjectionshouldbedeferredfor2weeks.
802.HALEisusedtomeasure
a)Disabilityadjustedlifeexpectancy
b)Healthylifeexpectancy
c)Qualityadjustedlifeexpectancy
d)Expectancyfreeofdisability
CorrectAnswer-BAns.is'b'i.e.,HealthylifeexpectancyHealth-Adjustedlifeexpectancy(HALE)HALEistheindicatorusedtomeasureahealthylifeexpectancy.HALEisbasedonthelifeexpectancyatbirthbutincludesanadjustmentfortimespentinpoorhealth.Itistheequivalentnumberofyearsinfullhealththatanewborncanexpecttolivebasedoncurrentratesofillhealthandmortality.
803.Duringinvestigationofanepidemic,theareaisdeclaredfreeofepidemicwhen?
a)Twicetheincubationperiodofthediseasesinceoccurrenceofthelastcase
b)Thricetheincubationperiodofthediseasesinceoccurrenceofthelastcase
c)Thelongestincubationperiodforthedisease
d)Incubationperiodforthediseaseplustwostandarddeviations
CorrectAnswer-AAns.is'a'i.e.,Twicetheincubationperiodofthediseasesinceoccurrenceofthelastcase[RefPark22"d/ep.123]Therearefollowingstepsintheinvestigationofanepidemic:?
1. Verificationofdiagnosis:Thisisthefirststepininvestigationofanepidemic.
2. Confirmationofexistenceofanepidemic:Bycomparingwithdiseasefrequenciesduringsameperiodinpreviousyears.
3. Definingthepopulationatrisk.4. Rapidsearchforallcasesandtheircharacteristics:Searchfornew
casesiscarriedouteveryday,tilltheareaisdeclaredfreeofepidemic;thisperiodisusuallytakenas"twicetheincubationperiodofthediseasesincetheoccuranceoflastcase".
5. Dataanalysis.6. Formulationofhypothesis.
804.Specificcontentinmalariavaccineis?
a)Gametocyticprotein
b)Polysaccharidesheath
c)Sporozoiteprotein
d)Lipoproteinenvelop
CorrectAnswer-CAns.is'c'i.e.,Sporozoiteprotein[RefInternet]Circumsporozoiteprotein(CSP)isasecretedproteinofthesporozoitestageofthemalariaparasite(plasmodiumsp)andtheantigenictargetofRTS,S,apre-erythrocyticmalariavaccinecurrentlyundergoingclinicaltrails.Theamino-acidsequenceofCSPconsistsofanimmunodominantcentralrepeatregionflankedbyconservedmotifsattheN-andC-terminithatareimplicatedinproteinprocessingastheparasitetravelsfromthemosquitotothemammalianvector.ThestructureandfunctionofCSPishighlyconservedacrossthevariousstrainsofmalariathatinfecthumansnon-humanprimatesandrodents.ItcanfirstbedetectedinlargequantitiesassporozoitesareformingwithinoocystsresidingthemidgutwallsofinfectedmosquitoesUponegressionfrommatureoocysts,sporozoitsbeginmigratingtothesalivaryglands,andCSPisknowntobeanimportantmediatorofthisprocess.AdditionallyCSPisinvolvedinhepatocytebindinginthemammalianhost.HeretheN-terminusandcentralrepeatregioninitiallyfacilateparasitebinding.Oncethehepatocytesurfaceproteolyticcleavageatregion1oftheN-terminusexposestheadhesivedomianoftheC-terminus,therebyprimingtheparasitesforinvasionoftheliver.
805.Roleofmagnesium[Mg]inOPV?
a)Adjuvant
b)Preservative
c)Stabilizar
d)Antiinfective
CorrectAnswer-CAns.is'c'i.e.,Stabilizer[Refwww.who.int]"PolioSabin(oral)vaccineisamagnesiumchloridestabilizedpreparationofliveattenuatedpoliovirusesofsabinstrainstype1,2,er3"StabilizersTheseareusedtoconfirmproductqualityorstability.Examplesarepotassiumorsodiumsalts,lactose,humanserumalbumin,gelatinandbovineserumalbumin
806.Thedifferencebetweendescriptiveandanalyticstudies?
a)Descriptivestudiesareusedtotesthypothesis
b)Analyticstudiesareusedtoformulateahypothesis
c)Descriptivestudiesarefirstphaseinepidemiology
d)Analyticstudiesobservedistributionofdisease
CorrectAnswer-CAns.is'c'i.e.,Descriptivestudiesarefirstphaseinepidemiology[RefPark24thiep.67-75]Descriptivestudiesarefirstphaseofanepidemiologicalinvestigation.Thesestudiesareconcernedwithobservingthedistrubutionofdiseaseintime,placeandperson.Descriptivestudiesareusedtoformulateeitologicalhypothesis.Analyticalstudiesarethesecondmajortypeofepidemiologicalstudies(afterdescriptivestudies).Itcontrasttodescriptivestudiesthatlookatentirepopulation,inanalyticstudies,thesubjectofinterestistheindividualwithinthepopulation(exceptinecologicalstudy).Theobjectisnottoformulate,buttotesthypothesis.Inexperimentalstudies,epidemiologistactivelyintervenetochangeadiseasedeterminantorprogressionofdisease.Experimentalstudiesareusedfortestinghypothesis.
807.Strengthofassociationofoutcomeandriskfactorismeasuredby?
a)Relativerisk
b)Attributablerisk
c)Populationattributablerisk
d)Noneoftheabove
CorrectAnswer-AAns.is'a'i.e.,Relativerisk[Ref:Park24`Vep.83]Relativeriskisadirectmeasureofthestrengthofassociationbetweensuspectedcauseandeffect.Forexamplearelativeriskof2meansthattheincidencerateis2timeshigherintheexposedgroupascomparedwithunexposed->i.e.,a100%increaseinrisk.Ontheotherhand,attributableriskindicatestheextentwhichisattributedbyriskfactor(exposure)todisease.Forexampleattributableriskof90%means90percentofdiseaseamongexposedisduetoexposuretoriskfactor.Insimplewords:?Relativeriskindicatestheincreasedpercentageofriskofdevelopingadisease,ifpersonisexposedtoriskfactor.Attributableriskindicatesthepercentageofdiseasewhichisattributedbyriskfactoramongtheexposed.Relativeriskisabetterindexthanisattributableriskforassessingtheetiologicalroleofafactorindisease.
808.ImportantmeasureforNationalhealthpolicy?
a)Relativerisk
b)Oddsratio
c)Incidence
d)Attributablerisk
CorrectAnswer-DAns.is'd'i.e.,Attributablerisk[RefPark24th/ep.83]RelativeriskVsAttributableriskRelativeriskisadirectmeasureofthestrengthofassociationbetweensuspectedcauseandeffect.Forexamplearelativeriskof2meansthattheincidencerateis2timeshigherintheexposedgroupascomparedwithunexposed-i.e.,a100%increaseinrisk.Ontheotherhand,attributableriskindicatestheextentwhichisattributedbyriskfactor(exposure)todisease.Forexampleattributableriskof90%means90percentofdiseaseamongexposedisduetoexposuretoriskfactor.Insimplewords:-Relativeriskindicatestheincreasedpercentageofriskofdevelopingadisease,ifpersonisexposedtoriskfactor.Attributableriskindicatesthepercentageofdiseasewhichisattributedbyriskfactoramongtheexposed.Relativeriskisabetterindexthanisattributableriskforassessingtheetiologicalroleofafactorindisease.Ontheotherhand,attributableriskgivesabetterideathandoesrelativeriskoftheimpactofsuccessfulpreventiveorpublichealthprogrammemighthaveinreducingtheproblem.Thatmeansattributableriskreflectthepublichealthimportancebetterthan
relativerisk.
809.Astudythatgivestheprevalenceofdelusionintheelderlyatagivenpointoftime?
a)Case-controlstudy
b)Cohortstudy
c)Cross-sectionalstudy
d)Ecologicalstudy
CorrectAnswer-CAns.is'c'i.e.,Cross-sectionalstudyCross-sectionalstudiesAcross-sectionalstudyisthesimplestformofanobservationalstudy.Itisalsoknownasaprevalencestudy.Itisbasedonasingleexaminationofacross-sectionofthepopulationatonepointoftime.Theresultsofthisexaminationcanbeprojectedonthewholepopulation.Thecross-sectionalstudytellsaboutthedistributionofadiseaseratherthanitsetiology.Cross-sectionalstudiescanbethoughtofasprovidingasnapshotofthefrequencyandcharacteristicofadiseaseinapopulationataparticularpointintime.Across-sectionalstudyismoreusefulforchronicdisease,asthepopulationisstudiedatonce,nofollow-upisrequired.
810.100individualsarediagnosedwithlungcancerinapopulationof100000.Outof100patients,80weresmokersand20000weresmokersintotalspopulation.WhatisPAR?
a)60
b)75
c)80
d)90
CorrectAnswer-BAns.is'b'i.e.,75[RefPark241thlep.83]Inthegivenquestion:Incidenceintotalpopulation=100per1lacNumberofexposed=20000(Allexposed)Numberofnon-exposed=80000(100000-20000)Non-exposedhavinglungcancer=20(outof100patients80weresmoker.Thus20arenoneexposed)Incidenceamongnon-exposed=20per80000or25per100000
811. Recallbiasismostcommonlyassociatedwithwhichstudydesign-
a)Casecontrolstudy
b)Cohortstudy
c)Cohortcasecontrolstudy
d)Cross-sectionalstudy
CorrectAnswer-AAns.is'a'i.e.,CasecontrolStudyRecallbias(Memorybias):Thistypeofbiasmayoccurwhencasesandcontrolsareaskedtorecallcertainevents,andsubjectsinonegrouparemorelikelytoremembertheeventthanthoseintheothergroup.Forexamplepeopletakeaspirincommonlyandformanyreasons,butpatientsdiagnosedashavingpepticulcerdiseasemayrecalltheingestionofaspiriningreateraccuracythanthosewithoutG1problems.AlsopatientswhohavehadanMIaremorelikelytorecallandremembercertainhabits(likeeatinghabit)withgreateraccuracythanthosewhohavenothadanMI.
812.Trueaboutstandardizationareallexcept?
a)Mostcommonlyusedforagedifferences
b)Directstandardizationisusedwhenpopulationislarge
c)Agespecificratesarerequiredinindirectstandardization
d)Allarecorrect
CorrectAnswer-CAns.is'c'i.e.,Agespecificratesarerequiredinindirectstandardization[Ref:Park23"/ep.58]IndirectstandardizationWhenthepopulationissmall(oroutcomeisrare)thenumberofeventsobservedcanbesmall.Inthatcircumstance,indirectstandardizedmethodscanbeusedtoproduceastandardizedmortalityrate(SMR)orastandardizedincidencerate(SIR).Inindirectstandardization,onecomputesthenumberofevents(mortality)thatwouldhavebeenexpectediftheeventrates(mortalityrate)fromthestandardpopulationhadappliedinthestudypopulation,i.e.agespecificratesofstandardpopulationareappliedtostudypopulation(oppositetodirectstandardization).Studypopulationisusedtoprovideagespecificdeathrates.Withineachagestratum,onemultipliestheagespecificrateofstandardpopulationbythenumberofpeopleinthestudypopulationtodeterminethenumberofcasesthatwouldhaveexpectedifthatweretherateinthestudygroupTheseexpectednumbersareaddedupacrossallagegroupsanddividedintotheobservednumbertoyieldtheSMR.Advantageofindirectstandardizationisthatagespecificratesof
studypopulationarenotrequired.
813.Standardizationismostimportantfor?
a)Sexdistribution
b)Agedistribution
c)Diseasedistribution
d)Noneoftheabove
CorrectAnswer-BAns.is'b'i.e.,Agedistribution[RefPark23ralep.58]Standardizationismostcommonlyusedforage.Astandardizateddeathrate(ASDR)isthebestmortalityindicator.'Crudedeathrate'istobestandardizedforageforcomparisonoftwopopulation,asagecompositionisdifferent.
814.Standardizeddeathratesareusedbecausehealth?
a)Forvalidcomparisomoftwogroupsofdifferenthealthdeterminants
b)Calculationsaremoreaccurate
c)Toavoidselectionbias
d)Alloftheabove
CorrectAnswer-AAns.is'a'i.e.,Forvalidcomparisonoftwogroupsofdifferenthealthdeterminants[RefPark23rd/ep.58]Standardization(oradjustment)ofratesisusedtounablethevalidcomparisonofgroupsthatdifferregardinganimportanthealthdeterminant(mostcommonlyage).Forexample,ifwewanttocomparethedeathratesoftwodifferentpopulationswithdifferentagecomposition,thecrudedeathrateisnotrightyardstickbecauseratesareonlycomparableifthepopulationsuponwhichtheyarebasedarecomparable.
815.Trueaboutcohortstudy
a)Descriptivestudy
b)Incidencestudy
c)Proceedsfromeffecttocause
d)Allarecorrect
CorrectAnswer-BAcohortstudyisatypeofanalyticobservationalstudyCohortstudyproceedsforwardfromcausetoeffect,i.e.,thediseasehasnotoccurredinsubjects(Incontrasttocase-controlstudywhichproceedsbackwardfromeffecttocause).ItisalsoknownasProspectivestudy,longitudinalstudy,Incidencestudy,forward-lookingstudy.Thefeaturesofcohortstudiesare:Thecohortsareidentifiedbeforetheappearanceofthediseaseunderinvestigation.Thestudygroups,sodefined,areobservedoversometimetodeterminethefrequencyofdiseaseamongthem.Thestudyproceedsforwardfromcausetoeffect.
816.Allaretrueaboutnaturalexperiments,except?
a)Researcherhasnocontrolovertheallocationofsubjects
b)Jameslindexperimentisanexample
c)IncludesRandomizedcontrolledtrials[RCTs]
d)Allarecorrect
CorrectAnswer-CAns.is'c'i.e.,IncludesRandomizedcontrolledtrials[RCTs][RefModernepidemiologyp.397]Naturalexperimentsarethoseinwhichexposuretotheeventorinterventionofinteresthasnotbeenmanipulatedbyresearcher.Theindividualsexposedtotheexperimentalandcontrolconditionsaredeterminedbynatureorbyotherfactorsoutsidethecontroloftheinvestigators.Whenanaturallyoccurringeventorsituationisexploitedbyaresearchertohelpansweraresearchquestion,itiscalledanaturalexperiment.Theresearcherhaslittleornocontroloverthesituationthatisbeingobserved.AgoodexampleofnaturalexperimentisonebyJamesLindin1747onthepreventionofscurvyamongsailors.Hecomparedtheeffectsofdifferentacidicsubstances,rangingfromvinegartocidr,ongrupsofafflictedsailors,andfoundthatthegroupwhofromvinegartocidr,ongroupsofafflictedsailors,andfoundthatthegroupwhoweregivenorangesandlemonshadlargelyrecoveredfromscurvyafter6days.OtherimportantexampleisJohnSnow'snaturalexperimentoncholeralinkedwithcontaminatedwater.RCTisnotnaturalexperimentasresearcherallocatetheindividualsinstudyandcontrolgroupbyrandomization.
instudyandcontrolgroupbyrandomization.
817.Inastudyapatientdoesnotknowthenatureofdrug[whetheraplaceboorcurativedrug]heistaking.Theresearcherknowsthedrugtypetobegiventotheindividualsinstudy.Typesofblindinginthisstudyis?
a)Single
b)Double
c)Triple
d)Combineddouble/triple
CorrectAnswer-AAns.is'a'i.e.,Single[RefPark24'1*p.78]SingleblindingDoubleblindingTripleblinding
StudysubjectsarenotawareofthetreatmenttheyarereceivingStudysubjectsaswellasinvestigatorarenotawareofthetreatmentstudysubjectsarereceivingStudysubjects,investigatoraswellasanalyzerarenotawareofthetreatmcstudysubjectsarereceiving
818.WhichPassiveimmunityisalsoprovidedthroughcolostrumandbreastmilk?
a)IgG
b)IgA
c)IgE
d)IgM
CorrectAnswer-BAns.B.IgAPassiveimmunityisalsoprovidedthroughcolostrumandbreastmilk,whichcontainIgAantibodiesthataretransferredtothegutoftheinfant,providinglocalprotectionagainstdisease-causingbacteriaandvirusesuntilthenewborncansynthesizeitsownantibodies.ProtectionmediatedbyIgAisdependentonthelengthoftimethataninfantisbreastfed,whichisoneofthereasonstheWorldHealthOrganizationrecommendsbreastfeedingforatleastthefirsttwoyearsoflife.
819.Midyearpopulationisestimatedon?
a)1stMarch
b)1stJuly
c)1stApril
d)15thAugust
CorrectAnswer-BAns.is'b'i.e.,1StJuly[RefPark22"/ep.58&21"/ep.52]Denominatorincrudedeathrateismidyearpopulation,whichisestimatedonfirstofJulyofanyear.
820.Meningococcalvaccinecontains?
a)50mcgofpolysccharideofeachstrain
b)100mcgofpolysccharideofeachstrain
c)1000mcgofpolysccharideofeachstrain
d)5000mcgofpolysccharideofeachstrain
CorrectAnswer-AAns.is'a'i.e.,50mcgofpolysaccharideofeachstrain[RefPark24th/ep.176]VaccinesareavailableforgroupA,C,YandW-125.ThereisnogroupBvaccineavailableatpresent.Vaccinesarepreparedfromcapsularpolysaccharide.Bivalent(A,C),trivalent(A,C,W135),andtetravalent(A,C,W135,Y)vaccinesareavailable.Thevaccinescontain50mcgofpolysaccharideofeachindividualstrain.
821.Howmanydosesofmonovalentmeningococcal'C'vaccineisgiveninInfants?
a)One
b)Two
c)Three
d)Four
CorrectAnswer-BAns.is'b'i.e.,Two[RefPark24th/ep.176]MonovalentMenAconjugatevaccineshouldbegivenasasingledosetoindividuals1-29yearsofage.FormonovalentMenCconjugatevaccine,onesingleintramusculardoseisrecommendedforchildrenaged>12months,teenagersandadults.Children2-11monthsofagerequire2doseadministrationatanintervalofatleast2monthsandaboosterabout1yearthereather.Quadrivalentvaccinesareadministeredasasingledosetoindividualsaged2years.
822.Secondaryattackrateofmumps:?
a)75%
b)85%
c)95%
d)<50%
CorrectAnswer-BAns.is'b'i.e.,85%[RefPark23'/ep.147&22"d/ep.139-140]SARofsomeimportantinfectiousdiseasesMeasles 80%Rubella 90-95%Chickenpox 90%Pertussis 90%Mumps 86%
823.IsolationperiodofTB?
a)2daysaftertreatment
b)1weekaftertreatment
c)2weeksaftertreatment
d)3weeksaftertreatment
CorrectAnswer-DAns.is'd'i.e.,3weeksaftertreatment[RefPark24th/ep.129]PeriodofisolationrecommendedTuberculosis(sputum+)→2weeksadult,6weekspaediatric.
824.Sensitivityofascreeningtesttellsabout
a)Percentageofdiseasepeopleamongthosewithapositivetest
b)Percentageofdiseasepeopleamongthosewithanegativetest
c)Percentageofhealthypeopleamongthosewithanegativetest
d)Percentageofhealthypeopleamongthosewithapositivetest
CorrectAnswer-AAns.is'a'i.e.,PercentageofdiseasepeopleamongthosewithapositivetestSensitivity:Abilityofascreeningtesttoidentifycorrectlyallthosewhohavethedisease(Cases).Specificity:Abilityofascreeningtesttoidentifycorrectlyallthosewhodon'thavethedisease(healthy).Positivepredictivevalue(PPV):Abilityofascreeningtesttoidentifycorrectlyallthosewhohavethedisease,outofallthosewhotestpositiveonascreeningtest.Negativepredictivevalue(NPV):Abilityofascreeningtesttoidentifycorrectlyallthosewhodon'thavethedisease,outofallthosewhotestnegativeonascreeningtest.Whenascreeningtestisusedtodiagnoseadisease,thetestoutcomecanbepositive(diseased)ornegative(healthy),whiletheactualhealthstatusofthepersonmaybedifferent.Inthatsetting:Truepositive→Diseasedpeoplecorrectlydiagnosedasdiseased.Falsepositive→Healthypeoplewronglyidentifiedasdiseased.Truenegative→Healthypeoplecorrectlyidentifiedashealthy.Falsenegative→Diseasedpeoplewronglyidentifiedashealthy.
825.Ifeffectivetreatmentforadiseaseisintroducedinacommunity,whatwillbetheeffectonincidence[I]andprevalence[P]?
a)NochangeinP&I
b)BothP&Iwilldecrease
c)Pwilldecrease&Iwillincrease
d)Pwilldecrease&Iwillremainsthesame
CorrectAnswer-DAns.is'd'i.e.,Pwilldecrease&Iwillremainsthesame[RefPark24th/ep.66&23rdiep.62]Neweffectivetreatmentwillcurethepatientandtherebydecreasethedurationofdisease.So,neweffectivetreatmentwillaffectthedurationofdisease.Incidencemeasurestherateatwhichnewcasesareoccurringinapopulation,Itisnotinfluencedbyduration.So,neweffectivetreatmentwillhavenoeffectonincidence.Ontheotherhand,prevalencewilldecreaseduetodecreaseindurationofdisease.
826.Ascreeningtesthassensitivityof90%andspecificityof99%.Theprevalenceofdiseaseunderinvestigationis5per1000population.WhatisthePPVofthegivenscreeningtest?
a)10
b)70
c)33
d)99
CorrectAnswer-CAns.is'c'i.e.,33[RefPark23rd/ep.139&22"dlep.132;Hopefieldbiostatistics4thlep.49]Positivepredictivevalueisrelatedtosensitivityspecificityandprevalence.ThisrelationshipisrepresentedbyBaye'stheorem:-
827.BestindicatorforspreadofTBinacommunity?
a)Annualinfectionrate
b)Prevalenceofinfection
c)Caserate
d)Incidenceofnewcases
CorrectAnswer-AAns.is'a'i.e.,Annualinfectionrate[RefPark24thlep.191-195&23'/ep.177]Thefollowingepidemiological-indicesareusedintuberculosisproblemmeasurementandprogrammestrategy1.PrevalenceofinfectionItisthepercentageofindividualsshowingpositivetuberculintest.2.Incidenceofinfection(Annualinfectionrate)ItisthepercentageofpopulationunderstudywhowillbenewlyinfectedbyM.tuberculosisamongthenon-infectedoftheprecedingsurveyduringthecourseofoneyear.Itexpressestheattackingforceoftuberculosisandisalsoknownastuberculinconversionindexi.e.percentegeofnewpeoplebecomingtuberculinpositive.Indevelopingcountries,every1%ofannualinfectionrateissaidtocorrespondto50newcasesofsmearpositivepulmonaryTB,peryear,for100000generalpopulation.ItisthebestindicatorforevalutionofTBproblemanditstrend.InIndia,annualinfectionrate/tuberculinconversionindexis1.7%.3.PrevalenceofdiseaseorcaserateItisthepercentageofindividualswhosesputumispositivefortuberclebacillionmicroscopicexamination.
Itisthebestavailablepracticalindextoestimatethenumberofinfectiouscasesorcaseloadinacommunity.4.IncidenceofnewcasesItisthepercentageofnewTBcases(confirmedbybacteriologicalexamination)per1000populationoccurringduringoneyear.5.PrevalenceofsuspectedcasesThisisbasedonX-rayexaminationofchest.6.PrevalenceofdrugresistantcasesItistheprevalenceofpatientexcretingtuberclebacilliresistanttoanti-tuberculardrugs.7.MortalityrateThenumberofdeathsfromtuberculosiseveryyearper1,000population.
828.FordiagnosisofTB,Sputummicroscopyhas?
a)Highsensitivity&highspecificity
b)Highsensitivity&lowspecificity
c)Lowsensitivity&highspecificity
d)Lowsensitivity&lowspecificity
CorrectAnswer-DAns.is'd'i.e.,Lowsensitivity&lowspecificityMostrapidmethodofdiagnosisforTBSputummicroscopy.But,sputummicroscopyhaslowsensitivityandspecificity.MostreliablemethodfordiagnosisofTB->Cultureoftubercularbacilli.
829.Varicellazostervirusinfectionismorelikelytooccurinwhichofthefollowingmonth?
a)March
b)August
c)October
d)November
CorrectAnswer-AAns.is'a'i.e.,March[Ref:CECILVol.1,p.1840]"Varicellaoccursmostcommonlyduringthelatewinterandspringmonths,thepeakbeingaboutinMarch"
830.Mostcommoninfluenzaviruscausingdisease?
a)TypeA
b)TypeB
c)TypeC
d)TypeD
CorrectAnswer-AAns.is'a'i.e.,TypeA[RefPark24th/ep.163-166]Therearethreeviralsubtypes:TypeA(causesallpandemicsandmostepidemics);typeB;andtypeC(notcirculatingcurrently).Currentlytheinfluenzavirusescirculatingintheworldare:H,N,oftypeA(causesswineflu);H2N2oftypeA;H3N2oftypeA;H5N,oftypeA(causesbirdfluoravianinfluenza);117N9oftypeA(causedepidemicofavianinfluenzainChinain2013);andtypeB.Influenzashowscyclictrendwithepidemicoccuringevery2-3yearsincaseofinfluenza-Aandevery4-7yearsincaseofinfluenza-B.Pandemicsarecausedbyonlyinfluenza-Aevery10-15years.Influenzaaffectsallagesandbothsexes.Sourceofinfectionofinfluenzaisaclinicalcaseorsubclinicalcase.Majorreservoirofinfluenzavirusexistsinanimalandbirds.
831.MammalianreservoirforR.prowazekii?
a)Rodents
b)Dog
c)Cattle
d)Humans
CorrectAnswer-DAns.is'd'i.e.,Humans[RefPark24th/ep.316,319]
Disease Agent Insectvector
Mammalianreservoir
Typhusgroupa)Epidemictyphusb)Murinetyphus(Endemictyphus)c)Scrubtyphus
R.prowazekiiR.typhiR.Tsutsugamushi
LouseFleaMite
HumansRodentsRodents
832.Rotavirusvaccinedosesshouldnotbeinitiatedbeyondwhichagetopreventcomplications:
a)6weeks
b)10weeks
c)12weeks
d)32weeks
CorrectAnswer-C
Twoliveattenuatedoralrotavirusvaccineshavebeenlicensedforuserotateqandrotarix.Thefirstdoseofthesevaccinesshouldbegivennolaterthan12weeks.Incaseofrotarix,vaccinationmustbecompletedby24weeks.Incaseofrotate,lastdoseofvaccineshouldbeadministeredby32weeks.Riskofintussusceptionsincreaseiffirstdoseisadministeredbeyond12weeks.Ref:Park21stedition,page205.
833.MinimumacceptedintervalbetweentwodosesofDPTvaccine?
a)2weeks
b)4weeks
c)6weeks
d)8weeks
CorrectAnswer-BAns.is'b'i.e.,4weeks[RefPark24th/ep.172]Totalthreedosesaregiveninprimarlyimmunizationwithanintervalof4weeksbetweenthreedoses.Firstboosterisgivenat16-24monthswithsecondboosterat5-6years.DPT,→6weeksofageDPT,→10weeksofageDPT,→14weeksofageDPTim,,→16-24monthsofageterDPTB→5yearsofage
834.Post-exposureprophylaxisisindicatedin?
a)HBV
b)Rabies
c)Diphtheria
d)All
CorrectAnswer-DAns.is'a'i.e.,HBV;'b'i.e.,Rabies;'c'i.e.,DiphtheriaReadthequestioncarefully,examinarisaskingaboutpostexposureprophylaxis(notpost-exposureimmunization).oInpreviousexplanation,Ihaveexplainedthediseasesforwhichpost-exposureprophylaxisisdonebyimmunization(vaccineorimmunoglobulinorboth).Insomediseasespost-exposureprophylaxisisdonebydrugs,i.e.,post-exposurechemoprophylaxis:-HIV→AntiretroviraltherapyHerpes→FamciclovirDiphtheriaMiningococcalmeningitis
835.Healthycarrierisseenin?
a)Measles
b)Rubella
c)Meningococcalmeningits
d)Influanza
CorrectAnswer-CAns.is'c'i.e.,Meningococcalmeningitis[RefPark24th/ep.103-106&23"1/ep.95,96]TemporarycarrierTemporarycarriersshedtheinfectiousagentforshortperiodoftime.ThiscategorymayincludeIncubatorycarriers:
Measles,mumps,polio,pertussis(whoopingcough),influenza,diphtheria,HepatitisB.
Convalescentcarriers:
Typhoid,cholera,diphtheria,Pertussis(whoopingcough),dysentery.
Healthycarriers:
Polio,Cholera,meningococcalmeningitis,Salmonellosis,diphtheria
ChroniccarrierChorniccarriersexcretetheinfectiousagentforindefiniteperiod.Examples:Typhoid,hepatitisB,dysentery,malaria,gonorrhoea,cerebrospinalmenigitis,Diphtheria.
836.Infectivityofconvalescentcarrierofcholeralastsfor?
a)1-5days
b)1-2weeks
c)2-3weeks
d)4-5weeks
CorrectAnswer-CAns.is'c'i.e.,2-3weeksTherearefollowingtypesofcarrierincholera:Incubatory:Shedvibriosonlyinthebriefincubationperiodof1-5days.Convalescent:Shedvibriosfor2-3weeks.Healthyorcontactcarrier:Hashadsubclinicalinfectionandshedvibriosforlessthan10days.Chroniccarriers:Canshedvibriosformonthsoryearsandmayhavepersistentinfectioningallbladder
837.Diagnosisoffilariasisisconfirmedmostcommonly?
a)Clinicalfeatures
b)Detectionofmicrofilariae
c)PCR
d)Seralogicaltest
CorrectAnswer-BAns.is'b'i.e.,Detectionofmicrofilariae[RefEssentialsofclinicalmicrobiology-188]Detectionofmicrofilariae(MOThemostcommonlyusedmethodfordiagnosisoffilariasisisdetectionofmicrofilariaeinbloodsmear.ThebloodcollectionshouldbedoneatnightbecauseofnocturnalperiodicityofmicrofilariaeThemicrofilariaeofW.bancroftiandB.malayioccuringinIndiadisplayanocturnalperiodicity,i.e.,theyappearinlargenumberatnightandretreatfromthebloodstreamduringtheday.Thisisabiologicaladaptationtothenocturnalbitinghabitsofvectormosquitoes.Themaximumdensityofmicrofilariaeinbloodisreportedbetween10pmand2am.Whenthesleepinghabitsofthehostarealtered,areversalinperiodicityhasbeenobserved.Thickfilmismostcommonlyusedmethodfordetectionofmicrofilariae.Concentrationtechniquebymembranefilterconcentration(MFC)methodisthemostsensitivemethodwhichcandetectlowdensityofmicrofilariaeinblood.
838.Maximumspreadofmalariaoccursinwhichmonth?
a)March-April
b)January-February
c)April-May
d)September-October
CorrectAnswer-DAns.is'd'i.e.,September-October[RefPark24th/ep.272-276]MalariaisaprotozoaldiseasecausedbyinfectionwithparasiteofgenusplasmodiumandtransmittedtomanbycertainspeciesofinfectedfemaleAnophelinemosquito.Definitivehost-Mosquito(sexuallifecycle).IntermediatehostMan(Asexualcycle).SeasonInIndiamaximumprevalenceisfromJulytoNovember.Reservoir-WithpossibleexceptionofchimpanzeesintropicalAfrica,whichmaycarrytheinfectionwithP.malariae,nootheranimalreservoirisknowntoexist.Manharbouringsexualforms(gametocytes)istheonlyreservoir.Extrinsicincubationperiod(inmosquito)10to20days.Itistheperiodoftimerequiredforthedevelopmentofparasitefromgametocytetosporozoitestage(infectivestagetoman)inthebodyofmosquito.
839.Nottrueaboutdiphtheriavaccine?
a)Canbegivenaspentavalentvaccine
b)ForinfantDPTisthevaccineofchoice
c)Firstdoseisgivenat6weeksofage
d)allofthese
CorrectAnswer-DAns.is'DAllofthese,[RefPark24thiep.172]Diphtheriavaccineisatoxoid.ItisgivenastrivalentvaccineDPT-PreparationofchoiceforimmunizationofinfantFirstdoseisgivenat6weeksofagePentavalentvaccineprovidesprotectiontoachildfrom5lifethreateningdisease-diphtheria,pertussis,tetanus,hepatitisBandhaemophilusinfluenzatypeb(Hib).Givingpentavalentvaccinereducesthenumberofprickstoachild.Whenused,itreplacesHepatitisBandDPTprimaryvaccinationscheduleat6,10and14weeksintheimmunizationprogramme,exceptthatthebirthdoseofhepatitisBandboosterdosesofDPTarecontinued.
840.Whichvaccineisusedtopreventdeathfrompneumoniainchildren?
a)Measlesvaccine
b)Rubellavaccine
c)Chickenpoxvaccine
d)Influenzaviralvaccine
CorrectAnswer-AAns.is'a'i.e.,Measlesvaccine[RefPark24th/ep.182]Threevaccineshavepotentialofreducingdeathfrompneumonia:-MeaslesvaccineHIBvaccine(HaemophilusinfluenzeetypeB)PneumococcalvaccineThesevaccinesworktoreducetheincidenceofbacterialpneumonia.
841.Antiboioticofchoiceforseverepneumoniain1yearallchild?
a)Cotrimoxazole
b)Ciprofloxacin
c)Benzylpenicillin
d)Tetracycline
CorrectAnswer-CAns.is'c'i.e.,Benzylpenicillin[RefPark24`h/ep.181,182]Antibioticsofchoicefortreatmentofacuterespiratoryinfectionsinchildrenaged2months-5years
1. Nopneumonia(Coughorcold)→Noantibiotic2. Pneumonia(notsevere)-scotrimoxazole3. Severepneumonia-Benzylpenicillinorampicillinor
chloramphenicol4. Veryseveredisease4Chloramphenicol
Antibioticsofchoicefortreatmentofacuterespiratoryinfectionsininfantsyoungerthan2months
1. Nopneumonia(Coughorcold)4Noantibiotic2. Allpneumonia(severeornotsevere)4(Benzylpenicillinor
ampicillin)plusgentamycin.
842. Reconstitutedmeaslesvaccineshouldbeusedwithin-
a)1hour
b)3hour
c)6hour
d)12hour
CorrectAnswer-AAns.is'a'i.e.,1hour"Thereconstitutedvaccineshouldbekeptoniceandusedwithinonehour".—ParkMeaslesvaccine:Type:Liveattenuated,lyophilized(Freezedried)vaccine,Measlesvaccineisliveattenuated,lypholized(Freezdried)vaccine.StrainsofvirususedtopreparevaccineareEdmonstonZagrebstrain(mostcommon),SchwartzstrainandMoratenstrain.Itisgivensubcutaneouslyintomiddleone-thirdofantero-lateralaspectofthigh.Itisgivenattheageof9months(agecanbelowereredto6monthsinepidemics&malnutrition)andisrepeatedat16-24monthsofage.Ithasprotectiveefficacy(sero-conversion)of95%.Vaccinationprovidelifelongimmunity.Incubationperiodofvaccineinducedmeaslesis7days.Inpost-exposureprophylaxis,measlesvaccineshouldbegivenwithin2-3daysofexposure.Incubationperiodofmeaslesvirusis10days.Incubationperiodofliveattenuatedmeaslesvirusoflivevaccineis7days.Thus,ifthevaccineisgivenwithin2-3daysofexposure,thereplicationofvaccinevirustakespreferenceoverreplicationofwildvirus.
Diluentusedformeaslesvaccinereconstitutionisdistilledwaterorsterilewater.Reconstitutedvaccineshouldbeusedwithin1hour.Usualtemperatureforcoldchainstorageis+2to+8°C.
843.ColorofboxcontainingdrugsfortreatmentofcategoryIofTB-
a)Red
b)Blue
c)Yellow
d)Green
CorrectAnswer-AAns.is'a'i.e.,Red[RefPark24th/ep.199]
844.MajorreservoirofKFD?
a)Human
b)Squirrels
c)Cattle
d)Monkey
CorrectAnswer-BAns.is'b'i.e.,SquirrelsKFD,alsoknownas'monkeydisease'isahemorrhagicfevercausedbyflavivirusbelongingtogroup-Barbovirus.DiseaseiscommoninfourdistrictsofKarnataka:Shimoga,NorthKannda,SouthKanadaandChikamagaloor.KFDwasfirstrecognizedin1957inShimogadistrictofKarnataka.MajorvectorfortransmissionofKFDishardtick(HaemophysalisspinigeraandH.turtura).But,softtickcanalsotransmitthedisease,especiallyoutsidetheIndia.Ratsandsquirrelsarethemajorreservoir.Monkeyactsasamplifyinghostandmanisincidentaldead-endhost,thereisnoman-to-mantransmission.
845.ThresholdlevelofherdimmunityforPertussisis?
a)80%
b)70%
c)90%
d)50%
CorrectAnswer-CAns.is'c'i.e.,90%HerdimmunityItisthelevelofresistanceofacommunityorgroupofpeopletoaparticulardisease.Itoccurswhenthevaccinationofaportionofthepopulation(orherd)providesprotectiontounprotected(non?vaccinated)individuals.AdvantageofherdimmunityItisnotnecessarytoachieve100%immunizationtocontroladiseasebyprovidingherdimmunity.Whenacertainpercentageofpopulation,isvaccinated,thespreadofdiseaseiseffectivelystopped.Thiscriticalpercentageisreferredtoasherdimmunitythreshold.DiseaseHerdimmunitythreshodDiphtheria→85%Measles→83-94%Mumps→75-86%Pertussis→92-94%Polio→80-86%Rubella→80-85%Smallpox→83-85%
846.Whatisthecommonestformofplague?
a)Bubonicplague
b)Pneumonicplague
c)Septicaemicplague
d)Hemorrhagicplague
CorrectAnswer-AThecommonestformofplagueisbubonicplague.Pneumonicplagueoccursinlessthan5%ofpatients.
Septicaemicplagueoccursrarelyexceptforaccidentallaboratoryinfections.Ref:Park21stedition,page270.
847.MostcommonsourceofDiphtheria
a)Case
b)Carrier
c)Both
d)None
CorrectAnswer-BAns.is'b'i.e.,CarrierDiphtheriaisanacuteinfectiousdiseasecausedbytoxigenicstrainsofcorynebacteriumdiphtheriae.Sourceofinfectioncasesorcarriers;carriersarecommonsourcesofinfection,theirratioisestimatedtobe95carriersfor5clinicalcases.Infectiveperiod→14-28daysfromtheonsetofdisease.Agegroup→1to5yearsSex→BothsexesIncubationperiod→2-6days
848.WHOVISION2020initiativeincludes?
a)Cornealulcer
b)Trachomablindness
c)Diabeticretinopathy
d)VernalkeratoConjunctivitis
CorrectAnswer-BAns.is'b'i.e.,TrachomablindnessAftertherealizationthatunlessblindnesscontroleffortsareintensified,theprevalenceofblindnesswilldoubleby2020AD,theWHOalongwithanInternationalPartnershipcommitteelaunchedtheVision2020Initiativein1995.Thediseasesidentifiedforglobaleliminationinclude:?
1. Cataractblindness2. Trachomablindnessandtransmission3. Onchocerciasis4. Avoidablecausesofchildhoodblindness5. Refractiveerrorsandlowvision
Indianvisionof2020includesthefollowingsevendiseases.1. Cataractblindness2. Glaucoma3. Trachomablindnessandtransmission4. Diabeticretinopathy5. Childhoodblindness6. Cornealblindness7. Refractiveerrorsandlowvision
849.PrevalenceofRHDinIndiain5-15yearsagegroup?
a)1-2per1000
b)5-7per1000
c)10-12per1000
d)13-15per1000
CorrectAnswer-BAns.is'b'i.e.,5-7per1000[RefPark24th/ep.397]InIndia,RHDisprevalentintherangeof5-7perthousandin5-15yearsagegroupandthereareabout1millionRHDcasesinIndia.RHDconstitutes20-30%ofhospitaladmissionsduetoCVDinIndia.Streptococcalinfectionsareverycommonespeciallyinchildrenlivinginunder-privilegedconditions,andRFisreportedtooccurin1-3percentofthoseinfections.
850.JaiVigyanMissionmodeprojectinIndiaisfor?
a)Measles
b)TB
c)Rheumaticfever
d)STD
CorrectAnswer-CAns.is'c'i.e.,Rheumaticfever[RefPark24tVep.397]JaiVigyanMissionModeprojectonCommunityControlofRF/RHDinIndiaisbeingcarriedoutwithfourmaincomponents,viz.tostudytheepidemiologyofstreptococcalsorethroats,establishregistriesforRFandRHD,vaccinedevelopmentforstreptococcalinfectionandconductingadvancedstudiesonpathologicalaspectsofRFandRHD.
851.WhichdoesnothaveLivebirthsasdenominator?
a)Infantmortalityrate
b)Neonatalmortalityrate
c)Childmortalityrate
d)Childdeathrate
CorrectAnswer-DAns.is'd'i.e.,Childdeathrate[RefPark24thlep.608-612]CDR=No.ofdeathsofchildrenaged1-4years/TotalNo.ofchildrenaged1-4years.
852.Dualrecordsystemisusefulforestimationof?
a)Literacy
b)Fertility
c)Populationdensity
d)Sexratio
CorrectAnswer-BAns.is'b'i.e.,Fertility[RefPark24th/ep.878]Sampleregistrationsystem(SRS),initiatedinmid1960sprovidesreliableestimatesofbirth(fertility)anddeath(mortality)ratesatstateandnationallevels.Itisadualrecordsystem,consistingofcontinuousenumerationofbirthanddeathbyanenumeratorandanindependentsurveyevery6monthsbyaninvestigatorsupervisor.MainobjectiveofSRSistoprovidereliableestimatesofbirthrate,deathrateandinfantmortalityrateatthenaturaldivisionlevelforruralareasandatstatelevelforurbanareas.Infantmortalityrateisthedecisiveindicatorforestimationofsamplesizeatnaturaldivision.SampledesignforSRSisuni-stagestratifiedsimplerandomsample.SRSnowcoversentirecountry.
853.Whichofthefollowingisfalseaboutintra-uterinedevices(IUDs)?
a)MultiloadCu-375isathirdgenerationintra-uterinedevice(IUD)
b)Copperdevicesareeffectiveaspost-coitalcontraceptives
c)LNG-20(Mirena)hasaneffectivelifeof5years
d)PregnancyratesofLippesLoopandTCu-200aresimilar
CorrectAnswer-AMultioadCu-375isanewercopperintra-uterinedevice(IUD).ThecopperdevicescomprisethesecondgenerationIUDs.Thenon-medicatedorinertdevicesarethefirstgenerationIUDsandthehormone-releasingdevicesarethethirdgenerationIUDsRef:Park’sTextbookOfPreventiveAndSocialMedicine,ByK.Park,19thEdition,Pages393-395.
854.Perinatalmortalityrateincludewhichofthefollowing?
a)Abortions+Stillbirthearlyneonataldeaths
b)Stillbirth+earlyneonataldeaths
c)Abortions+earlyneonataldeaths
d)Deathsupto42dysafterbirth
CorrectAnswer-BAns.isb'i.e.,Stillbirth+earlyneonataldeath
855.Poorman'sironsourceis?
a)Almond
b)Grapes
c)Soya
d)Jaggery
CorrectAnswer-DAns.is'd'i.e.,Jaggery[RefPark24th/ep.661&23rd/ep.623]Therearetwomajorformsofiron:?1)Haem-ironItisbetterabsorbedbutislessimportantsourceofironinIndiandiet.Itismainlyfoundinfoodsofanimalorigin,e.g.liver,meat,poultryandfish.2)Non-haemironItispoorlyabsorbedbutistheimportantsourceofironinIndiandiet.Itismainlyfoundinfoodsofvegetableorigin,e.g.cereales,greenleafyvetetables,legumes,nuts,oilseeds,juggery,anddriedfruits.Amongdryfruits,cashewnuthasmaximumiron(9%)followedbyalmonds(7%),andpistachos(7%).Ironofmilkislowinallmammalianspecies.Jaggeryisconsideredaspoorman'sironsource.Itcontainsagoodamountofironalongwithvitamin-A.
856.An70kgfarmerisconsuming56gramsproteins,275gramscarbohydrateand60gramslipids.Heconsuming?
a)Lesscalories
b)Morecalories
c)Adequatecalories
d)Connotbecommented
CorrectAnswer-AAns.is'a'i.e.,Lesscalories[RefReadbelow]Proteinandcarbohydratebothprovide4calpergramandfatprovides9calpergram.Thusthefarmeristaking(calorKcalperday)=(56x4)+(275x4)+(60x9)=1864
857.Forevery100kilocalories,vitaminB,requiredis-
a)0.05mg
b)0.5mg
c)5.0mg
d)1.0gn
CorrectAnswer-AAns.is‘a'i.e.,0.05rugThiamineisrequired0.5mgper1000K.calofenergyintake,i.e.,0.05mgper100Kcal.
858.Gomezclassificationisbasedon?
a)Weightretardation
b)Heightretardation
c)Midarmcircumference
d)Stunting
CorrectAnswer-AAns.is'a'i.e.,Weightretardation
859.Kanawatiindexisusedfor?
a)Airpopulation
b)PEM
c)Obesitydefinition
d)Infectivity
CorrectAnswer-BAns.is'b'i.e.,PEMKanawatiindexisusedtoclassifyproteinenergymalnutrition(PEM).
860.Humanmilkwithrespecttocowmilkhas-
a)Lessfat
b)Lessprotein
c)Lesscarbohydrate
d)aandb
CorrectAnswer-DAns.is'a'i.e.,Lessfat;`b'LessproteinHumanmilkhaslessfat,lessprotein,morecarbohydratesandlesscalcium,incomparisontocowmilk.Humanmilkhaslesssodium,potassiumandchloride.However,thesesubstancesareincorrectamount(thoughless)inhumanmilk.Salts(meq/L)Cow'smilk HumanmilkSodium 25(toomuch)6.5(correctamount)Chloride 29(toomuch)12(correctamount)Potassium 35(toomuch)14(correctamount)
861.MostcommonnutritionalprobleminIndia?
a)Lowbirthweight
b)Fluorosis
c)Irandeficiencyanemia
d)VitaminAdeficiency
CorrectAnswer-CAns.is'c'i.e.,Irondeficiencyanemia[RefPark24thlep.677,661-667]ThemajornutritionalprobleminIndiaare:
1. Lowbirthweight2. Iodinedeficiencydisorders(IDD)3. Proteinenergymalnutrition4. Endemicfluorosis5. VitaminAdeficiency6. Lathyrism7. Irondeficiencyanemia
Irondeficiencyanemiaisthemostwidspreadamongthese.
862.Pulsesaredeficientin?
a)Methionirfe
b)Lysine
c)Threonine
d)All
CorrectAnswer-AAns.is'a'i.e.,Methionine[Ref:Park23'/ep.628&21"/ep.578]Someaminoacidsaredeficientinaparticularfood,calledlimitingaminoacids.Forexample,cerealsandwheataredeficientinthreonineandlysine,pulsesaremainlydeficientinmethionineandcysteine,andmaizeisdeficientintryptophanandlysine.Supplementaryactionofproteins:Iftwoormorefooditemseatentogether,theirproteinssupplementthedeficientaminoacidofeachother.Forexamplecerealsaredeficientinthreonineandlysine,whereaspulsesaredeficientinmethionineandcystein.Ifbotharetakentogether,theirproteinscomplementeachotherandprovideamorebalancedandcompleteproteinintake.
863.DailyironrequirementinhealthyIndianmaleis-
a)35mg
b)17mg
c)10mg
d)5mg
CorrectAnswer-BAns.is'bi.e.,17mg
Group Ironabsorbed/day(mg)
Recommendedintake
Adultmale 0.84 17Adultfemale(mensturating) 1.65 21
Pregnantwoman 2.80(extra1.15)35(extra14mg/day)
Lactatingwoman(0-6months) 1.65 21
Infant(6-12months) 0.7 SAdolescentboys(13-15years) 1.6 32
Adolescentgirls(13-15years) 1.36 27
864.Notaprimaryairpollutant?
a)SO2
b)CO,
c)Ozon
d)VOCs
CorrectAnswer-CAns.is'c'i.e.,Ozone[RefPark24tVep.770]Airpollutionistheintroductionofchemicalsparticulatematter,orbiologicalmaterialintotheatmospherethatcauseharmordiscomforttohumansorotherlivingorganisms,ordamagesthenaturalenvironment.Anairpollutantisknownasasubstanceintheairthatcancauseharmtohumansandthe-environment.
865.Numberofholesinmosquitonet[persq.inch]?
a)50
b)150
c)100
d)200
CorrectAnswer-BAns.is'b'i.e.,150[RefPark24th/ep.810&23'/ep.773]Thebestpatternofmosquitonetistherectangularnet.Thereshouldnotbeasinglerentinthenet.TheSizeofopeningsinthenetisofutmostimportance,thesizeshouldnotexceed0.0475inchinanydiameter.Thenumberofholesinonesquareinchinusually150.
866.Inmalariacontrol,insecticideusedforinsectisidetreatedbednets(ITBN)-
a)Deltamethrin
b)Malathion
c)Lindone
d)Fenitrothion
CorrectAnswer-AAns.is'a'i.e.,DeltamethrinInsecticideTreatedBedNets(ITBN)Programme(esp.deltamethrin)hasresultedinsignificantdeclineinmalariaincidenceandAPI
1. Averagedeclineinanophelinemosquitodensity-68%2. Averagedeclineincuicinemosquitodensity-50%3. ChemicalsusedinITBNProgramme:Syntheticpyretheroids
Deltamethrin:2.5%indosageof25mg/m21. Cyfluthrin:5%indosageof50mg/m22. Otherinsecticidesused:Permethrin,Lambdacyhalothrin,
Etofenprox,CypermethrinEffectivenessofpyrethroids:For6-12months(Retreatmentevery6months)Long-lastinginsecticidalmosquitonets(LLINs):Alsousepyrethroidinsecticides,andachemicalbinderthatallowsthenetstobewashed>20times,allowingusefor>3years.
867.Testforcoliformcount?
a)Eijkmantest
b)Casoni'stest
c)Nitratetest
d)Ureasetest
CorrectAnswer-AAns.is'a'i.e.,EijkmantestAdleranalysingpresumptivecoliformcount,EcolicountiscofirmedbyothertestslikeEijkmanttestandindoleproduction.
868.Notacontactpoison:MAHE14
a)Pyrethrum
b)Parisgreen
c)Rotenone
d)Eucalyptusoil
CorrectAnswer-AAns.is.A.Pyrethrum
869.Whichofthefollowingisnotaindoorairpollutant?
a)Carbonmonoxide
b)Nitrousoxide
c)Radon
d)Mercury
CorrectAnswer-DAns.is'di.e.,MercuryIndoorairpollutionreferstochemical.biologicalandphysicalcontaminationofindoorair,i.e.thepollutionofairwithinandaroundbuildingandstructures.Asmostofthepeoplework,study,eat,drinkandsleepinenclosedenvironments(i.e.indoor)whereaircirculationmayberestricted—>Mostpeoplespendlargeportionoftimeindoors,asmuchas80-90%oftheirlives.Therefore,morepeoplesufferfromindoorairpollutionthanoutdoorpollution.
BasicInformationonPollutantsandSourcesofIndoorAirPollutionAsbestosBiologicalPollutantsCarbonMonoxide(CO)Formaldehyde/PressedWoodProductsLead(Pb)NitrogenDioxide(NO2)PesticidesRadon(Rn)IndoorParticulateMatterSecondhandSmoke/EnvironmentalTobaccoSmokeStoves,Heaters,FireplacesandChimneysVolatileOrganicCompounds(VOCs)
870.Thesourceofendogenousradiationis
a)Radon
b)Potassium
c)Thorium
d)Uranium
CorrectAnswer-BAns.is'b'i.e..PotassiumoRadiationispartofman'senvironment.
871.RangeofflightofAedesmosquitois?
a)1km
b)Lessthan100m
c)400m
d)10kms
CorrectAnswer-BAns.is'b'i.e.,Lessthan100m[RefPark23'/ep.771&22"d/ep.715]Aedesdonotflyoverlongdistances;usuallylessthan100metres(110yards).Anopheles→3-5KmsCulex→11KmsAedes→100m
872.Inpositivelyskeweddeviation?
a)Mean=Median=Mode
b)Mean>Medians>Mode
c)Mode>Median>Mean
d)Noneoftheabove
CorrectAnswer-BAns.is'b'i.e.,Mean>Medians>Mode
873.Chi-squaretestisfor?
a)StandarderrorofMean
b)StandarderrorofProportion
c)Standarderrorofdifferencebetween2Means
d)StandarderrorofdifferencebetweenProportions
CorrectAnswer-DAns.is'd'i.e.,StandarderrorofdifferencebetweenProportionsChi-squaretestmeasuresthesignificanceofdifferencebetweentwoproportionsbytesting,whethertheobservedfrequenciesdiffersignificantlyfromtheexpectedfrequencies.
874.Whichofthefollowingdefinesmovementacrossscioeconomicstatus.
a)Socialequality
b)Socialupliftment
c)Socialmobility
d)Socialinsurance
CorrectAnswer-CAns.is'c'i.e.,SocialMobility[RefPark23'lep.688&22"d/ep.639]Socialmobilityisthedegreetowhichanindividual'sfamilyorgroup'ssocialstatuscanchangethroughoutthecourseoftheirlifethroughasystemofsocialhierarechy,i.e.Socialmobilityreferstomovementofindividuals/familiesacrossdifferentsocioeconomiclevels.
875.Allarenon-parametrictestsexcept-
a)Chi-squaretest
b)Signtest
c)Fisherexacttest
d)Studentt-test
CorrectAnswer-DAns.is'd'i.e.,Studentt-test
876.ThenumberofAnganwadiworkerssupervisedbyaMukhyasevikais:
a)10
b)15
c)25
d)30
CorrectAnswer-CMukhyaSevikaisamiddlelevelsupervisor.Shesupervises20to25Anganwadiworkers.Sheisrequiredtobeagraduateinsocialworkorhomescienceorarelatedfield.Sheistrainedforthreemonths.Ref:HealthpoliciesandprogrammesinIndia,D.K.Taneja11theditionpage:312
877.WhichofthefollowinghasresponsibilityofdatacollectionforactivemalariasurveillanceatPHClevel?
a)DHO[DistrictHealthOfficer]
b)MPW[Multipurposeworker]
c)MO-PHC[MedicalOfficer-PHC]
d)DMO[DistrictMedicalOfficer]
CorrectAnswer-CAns.is'c'i.e.,MO-PHC[MedicalOfficer-PHC][RefPark24"/ep.433]"TheMedicalOfficer-PHChastheoverallresponsibilityforsurveillanceandlaboratoryservices,andalsosupervicesthespray".
878.WhichofthefollowingconditionsmustbefulfilledforaPHCtobecomeafirstreferralunit?
a)4-6beds
b)15workers
c)Emergencyobstericcare
d)Basiclaboratoryservices
CorrectAnswer-CAns.is'c'i.e.,Emergencyobstericcare[RefTextbookofIndianHealthcare-728]Criticaldeterminantsofafirstfeferralunit24-hourdeliveryservicesincludingnormalandassisteddeliveriesEmergencyobstetriccareincludingsurgicalinterventionslikecaesareansectionsandothermedicalinterventions,New-borncare,Emergencycareofsickchildren,Fullrangeoffamilyplanningservicesincludinglaproscopicservices,Safeabortionservices,TreatmentofSTI/RTI,Bloodstoragefacility,Essentiallaboratoryservices,Referral(transport)services.
879.Acculturationis?
a)Traige
b)Culturalchangesduetosocialisation
c)Attitude
d)Belief
CorrectAnswer-BAns.is'b'i.e.,CulturalchangesduetosocialisationAcculturationisaprocessofsocial,psychological,andculturalchangethatstemsfromthebalancingoftwocultureswhileadaptingtotheprevailingcultureofthesociety.Acculturationisaprocessinwhichanindividualadopts,acquiresandadjuststoanewculturalenvironment.
880.TheICDSschemeissponsoredby
a)Ministryofhealth&familywelfare
b)MinistryofSocialwelfare
c)Ministryofeducation
d)None
CorrectAnswer-BAns.is'b'i.e.,Ministryofsocialwelfare
881.TrueaboutNPCDCSisall,EXCEPT:
a)Separatecentreforstroke,DM
b)Implementationinsome5statesover10district
c)CHChasfacilitiesfordiagnosisandtreatmentofCVD,Diabetes
d)Daycarefacilitiesareavailableatsubcentre
CorrectAnswer-CTheNPCDCSprogramhastwocomponentsviz.(i)Cancer&(ii)Diabetes,CVDs&stroke.Thesetwocomponentshavebeenintegratedatdifferentlevelsasfaraspossibleforoptimalutilizationoftheresource.TheactivitiesatState,District,CHCandSubCentrelevelhavebeenplannedundertheprogrammeandwillbecloselymonitoredthroughNCDcellatdifferentlevels.Thestrategiesproposedwillbeimplementedin20,000SubCentresand700CommunityHealthCentrein100Districtsacross21Statesduring2010-12Earlydiagnosisofdiabetes,CVDs,StrokeandCancerisdoneatDistrictHospital,notatCHC.Ref:NPCDCSOperationalGuidelines,DGHS,GOI,Page6;http:/health.bih.nic.in/Docs/Guidelines-NPCDCS.pdf.
882.InternationalRedCrosswasfoundedby:
a)HenryDunant
b)JohnDRockfeller
c)MarieCurie
d)Noneoftheabove
CorrectAnswer-ATheRedCrossisanon-politicalinternationalhumanitarianorganisationfoundedbySwissbusinessmanHenryDunant.Ref:Park21steditionpage:858.
883.JaiVigyanNationalMissionisfor?
a)Adolescentgirlshealth
b)Mother&childhealth[MCH]
c)Science&technology
d)Childlabourprevention
CorrectAnswer-CAns.is'c'i.e.,Science&technology[RefInformationp.1997-98]TheUnionMinisterforhumanresourceDevelopment,Dr.MurliManoharJoshi,hassaidthatscientificInstitutionswouldtakeup21importantdevelopmentprojectsaspartoftheJaiVigyanNationalMissionwithfocusonscienceandtechnology.Theseprojectswouldbeinareassuchasfoodsecurity,energyconservations,healthcare,disastermanagementandbio-diversity.ScientificandRandDinstitutionswouldtakeuponeprojectin1999.Alltheprojectswouldbegivengreenchanneltreatmentwithproceduresrelaxedhesaidwhileparticipatingattheannualsessionsofthe86t5IndianScienceCongressinChennalonJan.3.TheministersaidhehaddirectedthedepartmentofBio-technologytoinstitute10awardseveryyearforoutstandingyoungscientistsinbiosciences.Thiswouldencouragehighqualityresearchofexcellenceandrelevance.Asachievingexcellencewasdependentininnovativetalentswhichinturnneededidentificationandnurturingfromanearlyage,anewschemetoselectunder18youngstersofoutstandingtalentandtoprovidethemwithnecessaryambienceandopportunitiesforharnessingtheirtalentandbeeninstituted.
884.ColoredkitforSTDtreatmentiswhichtypeofapproach?
a)Preventive
b)Symptomatic
c)Syndromic
d)Rehabilitative
CorrectAnswer-CAns.is'c'i.e.,Syndromic[RefPark23'/e.p.332-336]In1988,WorldHealthOrganizationintroducedtheconceptofSyndromicmanagement'.Insyndromicmanagement,diagnosisandtreatmentisnotbasedonspecificdiseasesidentifiedbytestingbutratheronsyndromes,whichisagroupofclinicalfindings.Treatmentisgenerallygivenforalloratleastmostcommonlyseendiseasesororganismsthatcouldcausethatsyndrome.Pre-packedcolourcodedSTI/RTIkitshavebeenprovidedforfreesupplytoalldesignatedSTI/RTIclinics.Kit1→Grey,forurethraldischarge,ano-rectaldischarge,cervicitis.Kit2→Green,forvaginitisKit3→White,forgenitalulcersKit4→Blue,forgenitalulcersKit5→Red,forgenitalulcersKit6→Yellow,forlowerabdominalpainKit7→Black,forscortalswelling.
885.InRNTCPmicroscopiccenterisrecommendedforhowmuchpopulation?
a)5000
b)10000
c)50000
d)100000
CorrectAnswer-DAns.is'd'i.e.,100000TheRNTCPdesignated'Microscopycentre'isestablishedfor100000populationinplanes(50000inhillyandmoutainareas).Forevery5microscopycenters(500000population),thereisoneSeniorTBlaboratorysupervisor(STLS).STLSrechecksallpositiveslidesand10%ofallnegativeslides.Sputummicroscopicexaminationduringcasefindingisdoneindesignatedmiroscopycenters.Onetuberculosisunitisestablishedfor500000populationinplanes(250000populationinhilly/tribalareas).Thereisonestatedrugstore(SDS)forevery50millionpopulation.
886.PERTiswhichtypeofmanagementtechnique?
a)Basedonbehavioralscience
b)Qualitative
c)Quantitative
d)Noneoftheabove
CorrectAnswer-CAns.is'c'i.e.,QuantitativeManagementinhumanorganizationactivityissimplytheactofgettingpeopletogethertoaccomplishdesiredgoalsandobjectives.Therearetwomajortypesofmethodsofmanagement.
1. Methodsbasedonbehaviouralsciences.2. Quantitativemethods.
887.WhichofthefollowingisSocraticmethodofcommunication?
a)Lectures
b)Groupdiscussion
c)Groupdiscussion
d)Massmedia
CorrectAnswer-BAns.is'b'i.e.,Groupdiscussion[RefPark24thlep.892Two-waycommunication(socraticmethod)Itismethodofcommunicationinwhichboththecommunicatorandtheaudiencetakepartandtheinformationistransferredinbothdirection.Examples→Groupdiscussion,Paneldiscussion,symposium,workshop,conferences.
888.Worldheartdayiscelebratedon?
a)29thSeptember
b)28thSeptember
c)8thSeptember
d)1stDecember
CorrectAnswer-AAns.is'a'i.e.,29thSeptember[RefInternet]29thSeptember→Worldheartday28thSeptember→Worldrabiesday8thSeptember→WorldliteracydayPhDecember→WorldAIDSday
889.MinimumfloorspacerecommendedforworkeraccordingtoFactoriesAct?
a)1000Cuft
b)500Cuft
c)200Cuft
d)100Cuft
CorrectAnswer-BAns.is'b'i.e.,500Cuft[RefPark24th/ep.852]ThefirstIndianFactoriesactdatesasforbackas1881.Theactwasrevisedandamendedseveraltimes,thelatesbeingthefactories(Amendment)act,1987.Followingstandardsarerecommended
1. Aminimumof500Cuftofspaceforeachworker(nottakingintoaccountspacemorethan14feetabovethegrouplevel).
2. Forfactoriesinstalledbeforethe1948Act,aminimumof350Cuftofspaceperworker.
3. Asafetyofficerineveryfactorywherein1000orworkersareemployed
4. Awelfareofficerineveryfactorywherein500ormoreworkersareemployed.
5. Acanteenwhereinmorethan250ormoreworkersareemployed.6. Crecheswhereinmorethan30womenworkersareemployed.
890.Safetyofficerisrecommendedwherefactoryhashowmanyworkers[InfactoryAct]?
a)250ormore
b)500ormore
c)1000ormore
d)2000ormore
CorrectAnswer-CAns.is'c'i.e.,1000ormore[RefPark24th/ep.852]Followingstandardsarerecommended:
1. Aminimumof500Cuftofspaceforeachworker(nottakingintoaccountspacemorethan14feetabovethegrouplevel).
2. Forfactoriesinstalledbeforethe1948Act,aminimumof350Cuftofspaceperworker.
3. Asafetyofficerineveryfactorywherein1000orworkersareemployed
4. Awelfareofficerineveryfactorywherein500ormoreworkersareemployed.
5. Acanteenwhereinmorethan250ormoreworkersareemployed.6. Crecheswhereinmorethan30womenworkersareemployed
891.Category4biomedicalwasteinclude?
a)Humananatomicalwaste
b)Animalwaste
c)Cytotoxicdrug
d)Wastesharps
CorrectAnswer-DAns.is'd'i.e.,Wastesharps[RefPark23"1/ep.793-794]BMWsinIndiaaremanagedunder'BiomedicalWasteManagementandHandlingRules1998'withexercisingpowers6,8,25ofEnvironmentalProtectionAct1986(underMinistryofEnvironmentandForests).Schedulesare:-
1. ScheduleI:CategoriesofBMW,theirtreatmentanddisposal.2. ScheduleII:ColorcodingandtypeofcontainerforBMWdisposal.3. ScheduleIII:LabelsforBMWcontainers/bags.4. ScheduleIV:LabelsfortransportofBMWcontainers/bags.5. ScheduleV:StandardsfortreatmentanddisposalofBMW.6. CategoryNo.7→Solid(wastegeneratedfromdisposalitemsother
thanthewastesharpssuchastubings,catheters,intravenoussetsetc.)
892.OneofthefollowingisnottrueofInternationalClassificationofDisease-
a)Itisrevisedoncein10years
b)ItwasdevisedbyUNICEF
c)The10threvisionconsistsof21majorchapters
d)ItisacceptedforNationalandInternationaluse
CorrectAnswer-BAns.is'b'i.e.,ItwasdevisedbyUNICEFICDwasdevisedbyWHO.
893.Tensortympaniisattachedat?
a)Malleus
b)Incus
c)Stapes
d)Tympanicmembrane
CorrectAnswer-AAns.is'a'i.e.,Malleus[RefGray'sAnatomy38thlep.485]Tympaniccavityhastwomuscles:
894.Themaxillarysinusopensintomiddlemeatusatthelevelof:
a)Hiatussemilunaris
b)Bullaethmoidalis
c)Infundibulum
d)Noneoftheabove
CorrectAnswer-AThemaxillarysinusisthelargestoftheparanasalsinusesandislocatedinthemaxilla,lateraltothenasalcavityandinferiortotheorbit.Themaxillarysinusopensintotheposterioraspectofthehiatussemilunarisinthemiddlemeatus.Theinfraorbitalnerve(CNV-2)primarilyinnervatesthemaxillarysinus.
895.Vesiclesonexternalearareseenin
a)Otitisexterna
b)Malignantotitisexterna
c)Herpeszoster
d)Clearcellcarcinoma
CorrectAnswer-CAns.is'c'i.e.,Herpeszoster[RefHeadandNeckSurgicalPathologyp.53]RamsayHuntsyndromeItislowermotorneurontypeoffacialpalsyduetoVaricella(herpes)zoster.Painisoftenaprominentfeatureandvesiclesareseenintheipsilateralear,onthehardpalateand/oronanteriortwothirdoftongue.Itmayinvolveothercranialnerves-V,VIII,IXandXandcervicalbranches(C2,C3&C4)thathaveanastomoticcommunicationswithfacialnerve.Thisresultsinfeatureslike:AnaesthesiaoffaceGiddinessHearingimpairmentalongwithVIInervepalsy.
896.Firstlinetreatmentformildretractionpocketintheearis
a)Observation
b)Antibiotics
c)Tympanostomytube
d)Surgicalexcision
CorrectAnswer-BAns.is'b'i.e.,Antibiotics[RefConqueringOtitismediabyCharlesBluestonep.95]RetractionpocketItmustbetreatedbyanotolaryngologist.1)AntibioticsAmildretractionpocketthatispresentinafluid-filledmiddleearcanfirstbetreatedwithantibiotics.2)TympanostomyIfantibioticsdoesnotwork,atympanostomytubeisusuallyinserted,andinmostcases,theeardrumwillreturntonormal.Iftheretractionpocketisverydeep,atubeshouldbeinserted,bypassingtheantibiotictreatment.3)SurgicalexcisionIftheretractionpocketstilldoesnotgoaway,thedeformedeardrumshouldbeoperatedontopreventacholesteatomafromdeveloping.Onceacholesteatomadevelops,surgeryistheonlywaytoremoveit.
897.Cauliflowerearseenin:
a)Hematomaoftheauricle
b)Carcinomaoftheauricle
c)Fungalinfectionoftheauricle
d)Congenitaldeformity
CorrectAnswer-ACauliflowerear(boxer'sear,wrestler'sear)isanacquireddeformityoftheouterear.Inthisinjury,theearcanshrivelupandfoldinonitselfandappearpale,givingitacauliflower-likeappearance,hencethetermcauliflowerear.Wrestlers,boxersandmartialartistsinparticulararesusceptibletothistypeofinjury.Whentheearisstruckandabloodclotdevelopsundertheskin,ortheskinisshearedfromthecartilage,theconnectionoftheskintothecartilageisdisrupted.
898.Inelectrocochleography:
a)Itmeasuresmiddleearlatency
b)Outerhaircellsaremainlyresponsibleforcochlearmi‐crophonicsandsummationpotential
c)Summationpotentialisacompoundofsynchronusauditorynervepotential
d)TotalAPrepresentsendocochlearreceptorpotentialtoanexternalauditorystimulus
CorrectAnswer-BAns.is.B.Outerhaircellsaremainlyresponsibleforcochlearmicrophonicsandsummationpotential
899.Whichfractureofthepetrousbonewillcausefacialnervepalsy:
a)Longitudinalfractures
b)Transversefractures
c)Mastoid
d)Facialnerveinjuryisalwayscomplete
CorrectAnswer-BAns.is.B.Transversefractures
900.OssicleM/CinvolvedinCSOM:
a)Stapes
b)Longprocessofincus
c)Headofmalleus
d)Handleofmalleus
CorrectAnswer-BAns.is.B.Longprocessofincus
901.MacEwan'striangleisthelandmarkfor:
a)Maxillarysinus
b)Mastoidantrum
c)Frontalsinus
d)None
CorrectAnswer-BAns.is.B.Mastoidantrum
902.Cristaeareseenin?
a)Utricle
b)Saccule
c)Semicircularcanal
d)Otolithmembrane
CorrectAnswer-CAns.is'c'i.e.,Semicircularcanal[RefDhingraSth/ep.16]VestibularapparatusThevestibularapparatuswithintheinnereardetectsheadmotionandpositionandtransducesthisinformationtoaneuralsignal.
903.Functionofsacculeis?
a)Linearacceleration
b)Angularacceleration
c)Sensespositionofhead
d)Rotationalmovement
CorrectAnswer-A:CAns.is'a'i.e.,Linearacceleration&'c'i.e.,Sensespositionofhead
904.EarliestagefordoingBERAis?
a)Inutero-beforebirth
b)Atbirth
c)3months
d)6months
CorrectAnswer-BAns.is'b'i.e.,Atbirth[RefLoganTurner10thlep.254;PLDhingra4th/ep.28]"Worldwidescreeningislargelyperformedinnewbornnurserywiththefirstscreeningtestperformedfrombirthuntil10daysofage"
905.Mostcommonmalignancyofmiddleearis
a)Glomustumor
b)Squamouscellcarcinoma
c)Adenocarcinoma
d)Sarcoma
CorrectAnswer-BAns.is'b'i.e.,Squamouscellcarcinoma[RefTextbookofENTbyRakeshShrivastav2"/ep.67]Squamouscellcarcinomaisthemostcommonmalignanttumorofthemiddleear.Otherformsofmalignancylikeadenocarcinomaandsarcomaarerare.
906.Mostcommonbenigntumorofearcanalis
a)Osteomas
b)Sebaceousadenoma
c)Papilloma
d)Ceruminoma
CorrectAnswer-AAns.is'a'i.e.,Osteomas[RefDhingra6thlep.107;BansalENTp.160;EncyclopediaofImaging,Baertp.1318]Osteomas/exostoses→mostcommonbenigntumorsoftheexternalauditorycanal.Squamouscellcarcinomas→Mostcommonmalignanttumorsoftheexternalauditorycanal.
907.Diplacusisis
a)Hearingsoundwithdiminishedintensity
b)Hearingsoundsoftwodifferenttones
c)Hearingextremelyloudsound
d)Perceivinglightonproductionofsound
CorrectAnswer-BAns.is'b'i.e.,Hearingsoundsoftwodifferenttones[RefTulilst/ep.114]Monauraldiplacusis:-Inmonauraldiplacusis,alistenerhearstwotoneswhenasingletoneispresentedtoasingleear,i.e.oneearhearstwodifferenttoneswhenpresentedone.Binauraldiplacusis:-Inbinauraldiplacusis,alistenerhearstwodifferenttonesinright&leftearwhenasingletoneispresentedtobothears.Bothmonoauralandbinauraldiplacusisarecausedbyinhomogenitiesinthecochleathatalsogiverisetospontaneousotoacousticemissions.
908.WhichsemicircularcanalismostcommonlyinvolvedinBPPV?
a)Horizontal
b)Posterior
c)Superior
d)Alloftheabove
CorrectAnswer-BAns.is'b'i.e.,Posterior[RefDhingraSth/ep.51]BPPVisthoughttobecausedbydisplacementofotoconia(mineralcrystals)fromthevestibuleofinnerearintothesemicircularcanals.Theposteriorsemicircularcanalismostcommonlyinvolved,thoughsuperiorandhorizontalcanalscanalcanalsobeaffected.OtoconiaorearrocksaresmallcrystalsofcalciumcarbonatederivedstructureintheutriclewhichmigrateintosemicircularcanalsandcauseBPPV.Whilesacculesalsocontainsotoconia,theyarenotabletomigrateintothesemicircularcanals.
909.Mostcommonossicleaffectedduetotrauma-
a)Malleus
b)Incus
c)Stapes
d)Allaffectedsimilarly
CorrectAnswer-BAns.is'b'i.e,Incus[RefHearing:PracticalGuidebyTysomep.96]"Significantheadinjuryordirecttraumatothemiddleearcanresultinsubluxationofoneormoreoftheossicles,theincusbeingthemostcommonlyaffected
910.Thresholdofhearinginayoungnormaladultis?
a)0dB
b)10dB
c)20dB
d)30dB
CorrectAnswer-AAns.is'a'i.e.,0dB[RdDhingra4n/ep.21]AudiometriczeroThresholdofhearing,i.e.Thefaintestintensitywhichanormalhealthypersoncanhearwillvaryfrompersontoperson.TheInternationalStandardsOrganisation(ISO)adoptedastandardforthis,whichisrepresentedasthezerolevelontheaudiometer(0dB).AccordingtoISO,audiometriczeroisthemeanvalueofminimalaudibleintensityinagroupofnormallyhearinghealthyyoungadults.
911.Gradenigo'ssyndromeinvolvesallofthefollowingcranialnerves,EXCEPT:
a)IV
b)V
c)VI
d)VII
CorrectAnswer-AAns.A.IVGradenigo’ssyndromeischaracterizedbyfacialpain,particularlyinthefirstdivisionofthetrigeminalnerveanddiplopiaduetosixthcranialnervepalsy.Itisassociatedwithdiseaseattheapexofthepetroustemporalbonewheretheabducensnerveiscloselyrelatedtothetrigeminalnerve.Facialnervepalsyanddeafness(VIIInervepalsy)isalsoconsideredtobeapartofthissyndrome.Causesincludes:Inflammation(petrositis,possiblyspreadingfromalocalinfectionsuchasotitisormastoiditis)Tumors(cholesteatoma,chordoma,meningioma,nasopharyngealcarcinoma,metastaticdisease)Skullbasefracture
912.Singaporeearis
a)Hypertrophyofsweatglands
b)Hypertrophyofsebaceousglands
c)Otitisexterna
d)Excoriationofexternalearskin
CorrectAnswer-CAns.is'c'i.e,Otitisexterna[RefClinicalENT5th/ep.223]ExcessivemoistureisanimportantpredisposingfactorforotitisexternaasexcessivemoistureelevatesthepHandremovesprotectivecerumen.Therefore,humidityandhotclimatepredisposetootitisexterna.Henceotitisexternaisalsoknownas:-
1. Singaporeear(whereclimateishotandhumid)2. Swimmer'sear3. Telephonist'sear(telephonistswhorequireinsertsintheirearhave
excessivemoistureduetosweating).
913.Allofthefollowingaretrueaboutmalignantotitisexternaexcept:
a)ESRisusedforfollowupaftertreatment
b)Granulationtissuesareseenonsuperiorwalloftheexternalauditorycanal
c)Severehearinglossisthechiefpresentingcomplaint
d)Pseudomonasisthemostcommoncause
CorrectAnswer-CAns.c.SeverehearinglossisthechiefpresentingcomplaintSeverehearinglossisnotthechiefpresentingcomplaintmalignantotitisexterna.MalignantOtitisExterna:Characterizedbygranulationtissueinexternalauditorycanalatthejunctionofboneandcartilage.MCorganismzPseudomonasaeruginosaESRisraised,usedforfollowupoftreatment
914.Adiabeticpatientpresentswithfoulsmellingeardischarge,feverandseverepainintheear.Onexaminationthereisthickyellowcoloureddischargefromtheearandgranulationtissueinthecanal.Whichofthefollowingistheappropriatemanagementforthispatient?
a)Surgicaldebridement
b)Antibiotictherapy
c)Cryotherapy
d)Laserremovalofgranulationtissue
CorrectAnswer-BAns.is'b'i.e.,Antibiotictherapy[RefDhingra6th/ep.52]Thepatientdescribedinthequestionmostlikelyhasmalignantotitisexterna.Sothetreatmentofchoiceisanti-pseudomonalantibiotics.Extensivesurgicaldebridementonceanimportantpartofthetreatmentisnowrarelyneeded
915.Topodiagnosisoffacialnervehasallthetestsexcept
a)Schirmertest
b)Bingtest
c)Tastetest
d)Salivaryflowtest
CorrectAnswer-BAns.is'b'i.e.,Bingtest[RefDhingra6th/ep.98]Thefollowingtestsareusefulinfindingthesiteoflesioninparalysisoflowermotorneuron.
1. Schirmertest:Itcompareslacrimationofthetwosides.Astripoffilterpaperishookedinthelowerfornixofeacheyeandtheamountofwettingofstripmeasured.Decreasedlacrimationindicateslesionproximaltothegeniculategan-glionasthesecretomotorfibrestolacrimalglandleaveatthegeniculateganglionviagreatersuperficialpetrosalnerve.
2. Stapedialreflex:Stapedialreflexislostinlesionsabovethenervetostapedius.Itistestedbytympanometry.
3. Tastetest:Itcanbemeasuredbyadropofsaltorsugarsolutionplacedononesideoftheprotrudedtongue,orbyelectrogustometry.Impairmentoftasteindicateslesionabovethechordatympani.
4. Submandibularsalivaryflowtest:Italsomeasuresfunc-tionofchordatympani.PolythenetubesarepassedintobothWhartonductsanddropsofsalivacountedduringoneminuteperiod.Decreasedsalivationshowsinjuryabovethechorda.
916.Whichofthefollowingisthefunctionoftensortympanimuscle?
a)Dampenveryloudsound
b)Tensestympanicmembrane
c)Tensespharyngotympanictube
d)Preventnoisetraumatotheinnerear
CorrectAnswer-BAns.is'b'i.e.,Tensestympanicmembrane[RefDhingra6"/ep.8]Normalopeningoftheeustachiantubeequalizesatmosphericpressureinthemiddleear;closingoftheEustachiantubeprotectsthemiddleearfromunwantedpressurefluctuationsandloudsounds.Themusclesoftheeustachiantubesystemhelptoopenandclosethetube,thusallowingittoperformitsfunction.Themusclesare:?
1. Tensorvelipalatini(tensorpalatini):-Contractionofthismuscleduringswallowing,yawningandsneezingopensthetube.Defectivefunctionofthismuscleincleftpalateresultsineustachiantubedysfunction.
2. Tensortympani:-Tensonisesthetympanicmembrane.3. Levatorvelipalatini:-Sometimes,italsohelpstoopenthetube,
howeveritisusuallyconsideredasavelopharyngealvalvemuscleonly.
4. Salpingopharyngeus:-Itsfunctionalsignificanceisquestionable.
917.Trueaboutserousotitismediaareallexcept?
a)Alsocalledglueear
b)Affectschoolgoingchildren
c)TypeCtympanogram
d)Fluidinmiddleear
CorrectAnswer-CAns.is`c'i.e.,TypeCtympanogramSerousotitismediaSerousotitismedia(SOM)hasmanysynonyms:Serousotitismedia,otitismediawitheffusion,glueear,non-suppurativeotitismedia,mucoidotitismedia,silentotitismedia.SOMisaninsidiousconditioninwhichthereisthickorstickynon-purulentfluidbehindtheeardruminthemiddleear,butthereisnoearinfection,i.e.,effusionofmiddleearwithoutinfection.Fluidinthemiddleearissterile.SOMoccursmostcommonlyinschoolgoingchildrenandSOMisthecommonestcauseofchildhoodhearingloss.Etiopathogenesis1.EustachiantubedysfunctionEustachiantubedysfunction,coupledwithrecurrentupperrespiratorytractinfectionisthemostimportantfactorinthedevelopmentofSOM.Normallyeustachiantubehelpstodrainfluidstopreventthemfrombuildingupintheear.InEustachiantubedysfunction,itisunabletodrainthefluid.FollowingcancauseEustachiantubeblock:-
1. Respiratorytractinfection:-Adenoid,rhinitis,tonsillitis,sinusitis.2. Allergies3. Benignandmalignanttumorofnasopharynx.
2.UnresolvedotitismediaInadequateantibiotictherapyinacutesuppurativeotitismediamayinactivateinfectionbutfailstoresolveitcompletely.Lowgradeinfectionlingersonandactsasstimulusformucosatosecretemorefluid.ClinicalfeaturesUnlikechildrenwithanearinfection(ASOM),childrenwithSOMdonotactsick.oTheonlypresentingsymptommaybehearinglosswithfullnessinear.OtoscopicfindingofSOMAirbubblesonthesurfaceofeardrumFluidbehindtheeardrum.Dullnessoftheeardrumwhenalightisused,withlossoflightreflex.oEardrummayappearyellow,greyorbluishincolour.RetractedeardrumwithdecreasedmobilityTympanometryshowstypeBtympanogram.
918.Pinkreflexthroughintacttympanicmembraneinactiveotosclerosisisknownas
a)Schwabach'ssign
b)Schwartzsign
c)Lyre'ssign
d)Chvostek'ssign
CorrectAnswer-BAns.is'b'i.e.,Schwartzsign[RefDhingra5th/ep.98;Currentotolaryngology2nd/ep.674]Areddishhue/Flammingopinkmaybeseenonthepromontoryandovalwindownicheowingtotheprominentvascularityassociatedwithanotospongioticfocus.Thisisk/aSchwartzsign.Schwartzsignisapinkreflex,seenthroughintacttympanicmembrane,intheareaofovalwindow.Itindicatesactiveotosclerosisusuallyduringpregnancy.Lyre'ssignissplayingapartofinternalandexternalcarotidarteriesonangiogramincasesofcarotidbodytumouroftheneck.Chvostek'ssignseeninhypocalcaemiaasaftertotalthyroidectomywhereparathyroidshavealsobeenremoved.Tappingoverthedistributionoffacialnerveproducesatwitch.
919.SADEclassificationclassifies
a)Retractionoftympanicmembrane
b)ExtensionofGlomustumor
c)Mortalityafterheartdiseaseduringpregnancy
d)ExtentofCSFrhinorrhea
CorrectAnswer-AAns.is'a'i.e.,Retractionoftympanicmembrane[RefBasicClinicalRadiobiology5th/ep.942]Sade'sclassificationofretractionoftheparstensaofthetympanicmembranedefinedtwotypesofretractionandclassifiedeachonanordinalscale:?1.Atelectasis,definedasdiffuse'retractionofthetympanicmembranetowardsthepromontorium'.2.Retractionpocket,definedasfocal'retractionoftheparstensatowardsorintotheattic'
920.A10yearoldchildpresentswithnonfoulpurulentsmellingdischarge,whichispainless.Patientreportsthatheisabletohearbetterinthepresenceofdischargethanwhentheearisdry.Themostprobablediagnosisis
a)CSOM
b)Serousotitismedia
c)Cholesteatoma
d)Mastoiditis
CorrectAnswer-AAns.is'a'i.e.,CSOM[RefDhingra6th/ep.68]ClinicalfeaturesofCSOMProfusemucopurulantdischargewhichisnotfoulsmelling,i.e.,nonfoulsmellingdischarge.Hearingloss(conductivetype).Ifsensorineuralcomponentalsooccurs(i.e.,mixedtype),itarousesthesuspicianoftoxicdeafness.Sometimes,patientreportsaparadoxicaleffect,i.e.,hearsbetterinthepresenceofdischargethanwhentheearisdry.Thisisduetoroundwindowshieldingeffectproducedbydischargewhichhelpstomaintainphasedifferential.Thereisnopain,ifitoccursitisduetoassociatedotitisexternanotduetootitismedia.Sincetheinfectedareaisopenatbothends,dischargedoesnotaccumulateinthemiddleearcavity.Ossicularchainismostlyuninvolved,ifinvolvedonlylongprocessof
incusisinvolved.
921.Treatmentofcentralsafeperforationoftympanicmembraneincludesallexcept
a)Auraltoilet
b)Eardrops
c)Avulsionofauralpolyp
d)Myringoplasty
CorrectAnswer-CAns.is'c'i.e.,Avulsionofauralpolyp[RefDhingra6thlep.72]Anauralpolypshouldneverbeavulsedasitmaybearisingfromthestapes,facialnerveorhorizontalcanalandthusleadtofacialparalysisorlabyrinthitis.TreatmentTheaimistocontrolinfectionandeliminateeardischargeandatalaterstagetocorrectthehearinglossbysurgicalmeans.
1. Auraltoilet:Removealldischargeanddebrisfromtheear.Itcanbedonebydrymoppingwithabsorbentcottonbuds,suctionclearanceundermicroscopeorirrigation(notforcefulsyringing)withsterilenormalsaline.Earmustbedriedafterirrigation.
2. Eardrops:Antibioticeardropscontainingneomycin,polymyxin,chloromycetinorgentamicinareused.Theyarecombinedwithsteroids,whichhavelocalantiinflammatoryeffect.
3. Systemicantibiotics:Theyareusefulinacuteexacerbationofchronicallyinfectedear,otherwiseroleofsystemicantibioticsinthetreatmentofCSOMislimited.
4. Precautions:Patientsareinstructedtokeepwateroutoftheearduringbathing,swimmingandhairwash.Rubberinsertscanbeused.Hardnoseblowingcanalsopushtheinfectionfromnasopharynxtomiddleearandshouldbeavoided.
5. Treatmentofcontributorycauses:Attentionshouldbepaidtotreatconcomitantlyinfectedtonsils,adenoids,maxillaryantrumandnasalallergy.
6. Surgicaltreatment:Auralpolyporgranulations,ifpresent,shouldberemovedbeforelocaltreatmentwithantibiotics.Itwillfacilitateeartoiletandpermiteardropstobeusedeffectively.
7. Reconstructivesurgery:Onceearisdry,myringoplastywithorwithoutossicularreconstructioncanbedonetorestorehearing.Closureofperforationwillalsocheckrepeatedinfectionfromtheexternalcanal.
922.Korner'sseptumisseenin?
a)Petrosquamoussuture
b)Temporosquamoussuture
c)Petromastoidsuture
d)Frontozygomaticsuture
CorrectAnswer-AMastoiddevelopsfromsquamousandpetrousbone.Korner'sseptumispersistenceofpetrosquamoussutureintheformofabonyplate.Korner'sseptumissurgicallyimportantasitmaycausedifficultyinlocatingtheantrumandthedeeper(ells,andthusleadtoincompleteremovalofdiseaseatmastoidectomy.MastoidantrumcannotbereachedunlesstheKornersseptumhasbeenremoved.
923.Aggernasiis
a)Mucosalflapcoveringthenasolacrimalduct
b)Openingofthesinuses
c)Depressioninfrontofmiddleturbinate
d)Elevationanteriortomiddleturbinate
CorrectAnswer-DAns.is'd'i.e.,Elevationanteriortomiddleturbinate[RefDhingra5thiep.150;Tuli1"/ep.135]Atriumisashallowdepressioninfrontofthemiddleturbinate.Aggernasiisanelevationjustanteriortotheattachementofmiddleturbinate.
924.Quadrungularseptumisseeninwhichofthefollowing?
a)Larynx
b)Nose
c)Cranium
d)Palate
CorrectAnswer-BAns.is'b'i.e.,Nose[RefDhingra5th/ep.150]"Cartilageoftheseptum,alsoknownasthequandragularcartilagebecauseitisroughlyquadrilateralinshape-separatesthenostrils".
925.Nasalvestibuleis
a)Lateralpartofnasalcavity
b)Antero-inferiorpartofnasalcavity
c)Supero-medialpartofnose
d)Posteriorapertureofnose
CorrectAnswer-BAns.is'b'i.e.,Antero-inferiorpartofnasalcavity[RefOtolaryngologyBasicScience&ClinicalReviewbyVanDeWaterp.462]Internalnosehasfollowingparts:Nasalcavityproper:-Internalnoseisdividedintorightandleftnasalcavitiesbynasalseptum.Eachnasalcavitycommunicateswiththeexteriorthroughnarisornostrilsandwithnasopharynxthroughposteriornasalapertureorposteriornaresorchoana.Vestibuleofnose:-Anteriorandinferiorpartofthenasalcavityislinedbyskinandiscalledvestibuleofnose.Itcontainssebaceousglands,hairfolliclesandthehaircalledvibrissae.
926.Whichofthefollowingtermsisusedtodescribethemostprominentpointofnasaltip?
a)Pronasale
b)Alare
c)Nasion
d)Columellaapex
CorrectAnswer-AAns.is'a'i.e.,Pronasale[RefHandbookofanthropometry:Physicalmeasuresofhumanforminhealthanddiseases,byVictorR.Preedy,p.922]Pronasale:Mostprominentpointonthenasaltip.Alare:Thepointwherethenasalblade(Alanasi)extendsthefarthestout.Columellaapex:Themostanteriororthehighestpointonthecolumellacrestattheapexofthenostril.Nasion:Thepointinthemidlineofboththeanatomicnoseandthenasoanterioralsuture
927.Epistaxisafterligatingexternalcarotidarteryisduetowhichvessel?
a)Anteriorethmoidalartery
b)Superiorlabialartery
c)Sphenopalatineartery
d)Greaterpalatineartery
CorrectAnswer-AAns.is'a'i.e.,Anteriorethmoidalartery[RefDhingra5thiep.190]Sinceexternalcarotidarteryisligated,thebleedingcomesfrombranchesoftheinternalcarotidartery.Anteriorethmoidalartery,abranchofophthalmicartery,whichisabranchofinternalcarotidartery,isaconstituentofthebloodsupplyoftheLittle'sareaofthenasalseptum.Bloodsupplyofnasalseptumi)InternalcarotidsystemAnteriorethmoidalarteryBranchesofophthalmicarteryPosteriorethmoidalarteryii)ExternalCarotidSystemSphenopalatineartery(branchofmaxillaryartery)givesnasopalatineandposteriormedialnasalbranches.Septalbranchofgreaterpalatineartery(Br.ofmaxillaryartery).Septalbranchofsuperiorlabialartery(Br.offacialartery)
928.Killian'spolypisa/an
a)Antrochoanalpolyp
b)Ethmoidalpolyp
c)Frontalpolyp
d)Maxillarypolyp
CorrectAnswer-AAns.is'a'i.e.,Antrochoanalpolyp[RefDhingra5th/ep.186;Essentialotolaryngology2"1/ep.660]Nasalpolypsareoftwotypes:?Antrochoanal:-Thisisusuallysolitaryandarisesfrommaxillarysinusandgrowsbackwardinthenosetowardsthechoana(incontrasttoethmoidalpolypswhichtendtogrowforward).TheAntrochoanalpolypwasfirstdescribedbyGustainkillians,thereforethenamegiventoitwaskillian'spolyp.Ethmoidal:-Thesearemultiple,bilateralandarisefrometmoidalsinusesandtendtoprotrudeforwards.
929.Whichofthefollowingisthepredisposingfactorforethmoidalcarcinoma
a)Smoking
b)Alcohol
c)Chronicinfection
d)Alloftheabove
CorrectAnswer-AAns.is'a'i.e.,Smoking[RefDiseasesofENTbyBansalp.363]Riskfactorsforsquamouscellcarcinomaoftheparanasalsinuses:-Smoking,Mustardgas,Nickelandchromiumplatingindustry,IsopropyloilLeatherindustry,Wooddustexposure(adenocarcinomaofethmoid),Polycyclicvolatilehydrocarbons
930.Mostcommonsinuspredisposedtomalignancywhichofthefollowing?
a)Ethmoid
b)Maxillary
c)Frontal
d)Sphenoid
CorrectAnswer-BAns.is'b'i.e.,Maxillary[RefDhingra5thiep.219]Themajorityofparanasalsinusmalignancies(50-80%)originatewithinthemaxillarysinusantrum.Sinusesandvariousconditionsinwhichsinusesareaffectedindescendingorderoffrequency
931.Mostcommonbenigntumorofparanasalsinuses?
a)Papilloma
b)Osteoma
c)Warts
d)Fibroma
CorrectAnswer-BAns.is'b'i.e.,Osteoma[RefLoganTurner8`h/ep.89]Osteomaofthefrontalsinus-Mostcommonbenigntumourarisinginthenasalsinuses.Theosteomaarisesfromthefloorofthefrontalsinusnearthemidline.
932.Rhinolithcancause
a)Nasalobstruction
b)Epistaxis
c)Epiphora
d)Alloftheabove
CorrectAnswer-DArhinolithisacalculuspresentinthenasalcavity.Thewordisderivedfromtherootsrhino-and-lith,literallymeaning"nosestone".Arhinolithusuallyformsaroundthenucleusofasmallexogenousforeignbody,bloodclotorsecretionbyslowdepositionofcalciumandmagnesiumsalts.Overaperiodoftime,theygrowintolargeirregularmassesthatfillthenasalcavity.Theymaycausepressurenecrosisofthenasalseptumorlateralwallofnoseleadingtonasalobstruction,epistaxis,headache,sinusitisandepiphora.
933.WhatisaRhinolith:
a)Foreignbodyinnose
b)Stoneinnose
c)Depositionofcalciumaroundforeignbodyinnose
d)Misnomer
CorrectAnswer-CRhinolithsarecalcareousmasseswhichresultduetodepositionofsalts-likecalciumandmagnesiumcarbonatesandphosphatesaroundthenucleusofaforeignbody.
934.Treatmentofnasalbonefractureincludesallexcept
a)Hematomadrainage
b)Topicalvasoconstrictor
c)Closedreduction
d)Immediaterhinoplasty
CorrectAnswer-DAns.is'd'i.e.,Immediaterhinoplasty[RefScottBrown7th/ep.1612]TreatmentofnasalinjuriesAfterensuringpatencyofairway,adequateventilationandoverallstabilityofpatient,attentiontothenasalinjuriesshouldbegiven.Standardtherapyistoperformclosedreductionoropenreducationbetween3and7days,andupto2weeks.Thisisbecause:Mostofthepatients(-70-80%)donotrequireanyactivetreatment,asmanydonothaveanasalfractureandthosethatdo,thefractureisnotdisplaced.Softtissueswellingcanproducethemisleadingappearanceofadeformitywhichdisapearsastheswellingsubsides.Suchpatientsrequireonlyreassurance&topicalvasoconstrictorstoalleviatecongestionandobstructivesymptoms.Are-examinationshouldbecarriedoutafter5days,ifthereisuncertainityabouttheneedforreduction.Alargenumberofpatientswillhaveapreexistingnasaldeformitycausedbyapreviousincident.Patientsthatfallinthiscategoryareadvisedtoconsideraformalrhinoplastywheneverythinghassettleddownsomemonthslater.Immediatesurgicalinterventioninacutephaseisindicated:?Severedeformity:-Septalhematomacausingnasalobstruction
935.Allofthefollowingaretrueaboutparapharyngealabscessexcept?
a)Mastoidprocessdividesthespaceintoanteriorandposterior
b)Alsoknownaspharyngomaxillaryspaceinfection
c)Tonsilispushedmedially
d)Occursaftertoothextraction
CorrectAnswer-AAns.is'a'i.e.,Mastoidprocessdividesthespaceintoanteriorandposterior[RefDhingraV/ep.281]Styloidprocessandthemusclesattachedtoitdividetheparapharyngealspaceintoanteriorandposteriorcompartments,notmastoidprocess.
936.Trismusinparapharyngealabscessisduetospasmof:
a)Massetermuscle
b)Medialpterygoid
c)Lateralpterygoid
d)Temporalis
CorrectAnswer-BStyloidprocessdividesthepharynxintoanteriorandposteriorcompartment.Trismusoccursininfectionofanteriorcompartmentwhereastorticollis(duetospasmofparavertebralmuscles)occursintheinfectionofposteriorcompartment.
937.Regardingadenoidstrueis/are:
a)Thereisfailuretothrive
b)Mouthbreathingisseen
c)CTscanshouldbedonetoassesssize
d)aandb
CorrectAnswer-DHigharchedpalateandmouthbreathingarefeaturesofhypertrophiedadenoidswhichleadstoadenoidfaciesInadenoidsasaconsequenceofrecurrentnasalobstructionandURTI,childdevelopsfailuretothriveSizeofadenoidsmaywellbeassessedusinglateralradiographofnasopharynx,andCTscanisnotnecessaryAdenoids,alsoknownasnasopharyngealtonsils,aresubepithelialcollectionoflymphoidtissueatthejunctionofroofandposteriorwallofnasopharynx.
938.Liningepitheliumofvocalcordis
a)Stratifiedsquamousepithelium
b)Nonstratifiedsquamousepithelium
c)Ciliatedcolumnarepithelium
d)Nonciliatedcolumnarepithelium
CorrectAnswer-AAns.is'a'i.e.,Stratifiedsquamousepithelium[RefDhingraViep.300]Vocalcordsalongwiththeupperpartofthevestibuleistheonlypartoflaryngealmucousmembranewhichislinedbyepitheliumofstratifiedsquamoustype.Elsewhereinthelarynxepitheliumofthemucousmembraneisciliatedcolumnartype.
939.SelectcorrectstatementsaboutCalarynx:
a)GlotticCaisthemostcommon
b)Supraglotticcahasbestprognosis
c)LymphaticspreadisthemostcommoninsubglotticCa
d)All
CorrectAnswer-AAns.is.A.GlotticCaisthemostcommon
940.WhichofthefollowingsitesofCalarynxhasthebestprognosis?
a)Glottic
b)Supraglottis
c)Subgottis
d)Allhavepoorprognosis
CorrectAnswer-AAns.is'a'i.e.,Glottic[RefDhingra5th/ep.326]Laryngealcarcinoma:-Cancer PrognosisGlottis GoodSupraglottisPoorSubglottis Worst
941.Laserusedintrachealneoplasmis
a)Argon
b)KTP-532
c)CO2
d)Nd-YAG
CorrectAnswer-CAns.is'c'i.e.,CO2[RefDhingra5th/ep.315]FourtypesoflaseraregenerallyusedinENTsurgery:ArgonKTP-532(Potassiumtitanylphosphate);Nd:YAG(Neodyminum-yttriumaluminiumgarnet);CO2Thecarbondioxide(CO)laseristhemostcommonlaserusedfortrachealneoplasm.
942.MostcommonsiteofdistantmetastasisfromCalarynx
a)Lymphnodes
b)Lung
c)Brain
d)Bone
CorrectAnswer-BAns.is'b'i.e.,Lung[RefClinicalOtorhinolaryngologyyd/el).931]Distantmetastasisisseenmuchlessfrequently.Themostcommonlyaffectedsitesfordistantmetastasesarelungs(66%);bone(22%),liver(10%),mediastinumandbonemarrow.
943.AllthefollowingaretrueaboutLaryngealcarcinomaexcept:
a)Morecommoninfemales
b)Commoninpatientsover40yearsofage
c)Afterlaryngectomy,esophagealvoicecanbeused
d)bandc
CorrectAnswer-ACancerLarynxMostcommonhistologicaltypeoflaryngealCa-Squamouscellcarcinoma(seenin90%cases)Itismorecommoninmales.Male:Femaleratiois4:1Mostcommonage=60-70years.
944.ApatientpresentswithCalarynxinvolvingleftfalsecord,leftarytenoidandleftaryepiglotticfoldwithbilateralmobiletruecords.Thetreatmentofchoiceinthispatientiswhichofthefollowing?
a)Verticalhemilarygectomy
b)Horizontalpartialhemilaryngectomy
c)Totallaryngectomy
d)Radiotherapyfollowedbychemotherapy
CorrectAnswer-BAns.is'b'i.e.,Horizontalpartialhemilaryngectomy[RefDhingra4th/ep.284]Involvementofunilateralfalsecord,aryepiglotticfoldsandarytenoidswithmobilecordsuggestssupraglotticcancerinT2stage(morethanonesubsitesofsupraglottisareinvolved).
945.Inrecurrentlaryngealnervepalsywhichmusclekeepsvocalcordinmedianposition?
a)Posteriorcricoarytenoid
b)Cricothyroid
c)Vocalis
d)Alloftheabove
CorrectAnswer-BAns.is'b'i.e.,Cricothyroid[RefDhingra5th/ep.300]RecurrentlaryngealnerveparalysisRecurrentlaryngealnervesupplies:?
1. Allintrinsicmusclesofthelarynxexceptcricothyroid.2. Sensorysupplytolarynxbelowvocalcords.
So,paralysisofrecurrentlaryngealnervecauses:?1. Paralysisofallintrinsicmusclesincludingalladductors(exceptfor
cricothyroid)andallabductors.2. Anaesthesiabelowthelevelofvocalcord.
Though,thereisparalysisofbothadductors(exceptcricothyroid)andabductors,themanifestationsaremainlyduetoparalysisofabductors.
946.
Esophagusisconstrictedat4anatomiclocations.Narrowestpartofesophagusliesatwhichofthefollowingconstriction?
a)Atthelevelofcricopharyngealsphincter
b)Atthecrossingofaorticarch
c)Atthecrossingofleftbronchus
d)Atthelevelofopeninginthediaphragm
CorrectAnswer-ANarrowestpartofesophagusisatitscommencementatthecricopharyngealsphincterwhichis15cmfromtheincisorteeth.
Othersitesofesophaguswhereitisslightlyconstrictedincludes:Crossingbytheaorticarchwhichis22cmfromtheteeth.
Crossingbytheleftprincipalbronchuswhichis27cmfromtheteeth
Attheopeninginthediaphragmwhichis38cmfromtheteeth
947.
Foodparticlesmostlygetobstructedinwhichpartofesophagus-
a)Cricopharyngealsphincter
b)Crossingofarchofaorta
c)Cardiacend
d)Noneoftheabove
CorrectAnswer-AAns.is'a'i.e,Cricopharyngealsphincter[Ref:Dhingra6thiep.349]Byfarthecommonestsiteisatorjustbelowthecricopharyngealsphincter.Flatobjectslikecoinsareheldupatthesphincterwhileothersareheldintheupperoesophagusjustbelowthesphincterduetopoorperistalsis.
948.Trueregardingtractiondiverticuliofesophagusisallexcept
a)Doesnotemptycompletely
b)Triangularappearance
c)Containsalllayers
d)Maintainselasticrecoil
CorrectAnswer-AAns.is'a'i.e.,Doesnotemptycompletely[RefTheEsophagusbyRichterp.143]
TypeLayersLocationAssociatedShapeEmptying
TractionDiverticulaTruediverticulaLinedbyalllayersMidesophagusScarringfromTBorhistoplasmosisinvolvingperihilarorsubcarinallymphnodesTriangularortentedTendstoemptycontents
PulsionDiverticulaFalsediverticulaUsusallyonlymucosaloutpouchingsDistalesophagusAssociatedwithdysmotilityRoundedoutpouchingsDonotemptycompletelyEpiphrenicdiverticula,Zenker'sdiverticula
949.Simplemastoidectomyisdonein:
a)Acutemastoiditis
b)Cholesteatoma
c)Coalescentmastoiditis
d)Localizedchronicotitismedia
CorrectAnswer-CAns.is.C.Coalescentmastoiditis
950.Radicalmastoidectomyisdonefor:
a)ASOM
b)CSOM
c)Atticoantralcholesteotoma
d)Acutemastoiditis
CorrectAnswer-CAns.is.C.Atticoantralcholesteotoma
951.Sluder'sneuralgiaisalsocalledas
a)Anteriorethmoidalsyndrome
b)Posteriorethmoidalsyndrome
c)Trottersyndrome
d)Lermoyezsyndrome
CorrectAnswer-AAns.is'a'i.e.,Anteriorethmoidalsyndrome[RefDhingra6th/ep.450]Sluder'sneuralgiaItisalsocalledanteriorethmoidalsyndrome.Itissaidtooriginatefromthemiddleturbinatepressingonthenasalseptum.Itischaracterizedbypainaroundthebridgeofthenoseradiatingintoforehead.TreatmentAnatomicalcorrectionrelievesthepain.
952.Styloidprocessisderivedfrom?
a)1starch
b)2ndarch
c)3rdarch
d)4tharch
CorrectAnswer-BStyloidprocessisderivedfrom2ndpharyngealarch.
953.Mostcommoncauseofsinger'snoduleis?
a)Infection
b)Allergy
c)Vocalabuse
d)None
CorrectAnswer-CAns.is'c'i.e.,VocalabuseVocalnodule(singer'sorscreamer'snodule)Vocalnodulearebenignnoneoplasticgrowthonfreeedgeofboththevocalcordsatthejunctionofanterior1/3withposterior2/3.Thisareaisparticularlyvulnerabletotraumaasthisistheareaofmaximumvibrationofthecord.Themajorcauseisvoiceabuse,thereforeitismostcommonlyseeninsingers,actors,teachers,andhowkers.Hoarsenessisthemostcommonsymptom.Vocalfatigueandpaininneckonprolongedphonationareothersymptoms.TreatmentEarlycasesofvocalnodulescanbetreatedconservativelybyeducatingthepatientinproperuseofvoice.Manynodulesespeciallyinchildren,disappearwiththistreatment.Surgeryisrequiredforlargenodulesorlongstandingnodulesinadults.Microscopic(micorlaryngoscopic)excisionisthetreatmentofchoice.
954.Mostcommontumoroforopharynxis
a)Squamouscellcarcinoma
b)Adenocarcinoma
c)Melanoma
d)Salivaryglandtumors
CorrectAnswer-AAns.is'a'i.e.,Squamouscellcarcinoma[RefAbeloff'sClinicalOncology6"lep.1059]90–95%oftumorsintheoropharynxaresquamouscellcarcinomas,whereasothersareminorsalivaryglandtumors,melanomas.Themostcommonmanifestingsymptomsareanontenderneckmass,dysphagia,otalgia,ora"hotpotato"voice.
955.Investigationofchoicefordiagnosingsubmandibularglandductstonesis
a)Ultrasound
b)X-rayoffloorofmouth
c)Sialography
d)Sialoendoscopy
CorrectAnswer-AAns.is'a'i.e.,Ultrasound[RefChurchill'spocketbookofsurgeryp.133]InvestigationsforsalivaryglandstonesUltrasoundistheinvestigationofchoice–asitpermitsassessmentofthegland,ductsystemandcalculuswhichusuallyhasanacousticshadow.'Floorofmouth'radiographicviewforsubmandibularcalculiinWharton'sductwhereultrasoundfindingsareequivocalorunavailable.Ifnostoneisseen,considersialography.Sialoendoscopyisincreasinglyusedinthediagnosisandtreatmentofsalivaryglandoutflowobstructiveconditions.
956.DeafnessinacaseofPaget'sdiseaseisdueto
a)Retractionpockets
b)Otitis
c)Eightnerveinvolvement
d)Endolymphatichydrops
CorrectAnswer-CAns.is'c'i.e.,Eightnerveinvolvement[ReferNeurologyconsult5"/ep.866]Cranialnervecompressionistheusualcauseofdeafness.ComplicationsofPaget'sdiseaseFollowingcomplicationscanoccurinPaget'sdisease:-
1. Fracture:Arecommoninweightbearingbones2. Cranialnervecompression:-Maycauseimpairedvision,facial
palsy,trigeminalneuralgiaordeafness.3. Otosclerosis:-AnothercauseofdeafnessinPaget'sdisease.4. Spinalcanalstenosisandnerverootcompression5. Highoutputcardiacfailure6. Osteoarthritis:ofHipandknee7. Rarelyosteosarcoma
957.Membraneincisedduringhemilaryngectomyis
a)Thyrohyoid
b)Cricothyroid
c)Aryepiglottic
d)Infralaryngeal
CorrectAnswer-BAns.is'b'i.e.,Cricothyroid[RefDhingraelep.310]IndicationsandcontaindicationsIdealforbulkylesionsofthemembranoustruevocalcordNormalorslightlyimpairedvocalcordmobilityNoinvolvementofthesupraglottis
958.Snellen'schartisusedtotest:
a)Vision
b)Refraction
c)Presbyopia
d)Colourblindness
CorrectAnswer-AAns.Vision
959.InSnellen'schart,eyesubtendsanangleofhowmanyminuteswithlettersonSnellen'schart?
a)1minofarc
b)5minofarc
c)10minofarc
d)15minofarc
CorrectAnswer-BAns.is'b'i.e.,5minofarcIndications:Toprovideabaselinerecordingofvisualacuity(VA)ToaidexaminationanddiagnosisofeyediseaseorrefractiveerrorFormedico-legalreasonsEquipment:Multi-letterSnellenchartEorCSnellenchartorachartwithillustrationsforpatientswhocannotreadorspeakPlainoccluder(notessential)PinholeoccluderTorchorflashlightPatient'sdocumentationProcedure:Atthegivendistance,eachlettersubtendsanangleof5minatthenodalpointoftheeyeSnellenchartisusedfordistantvision.Thepatientshouldreadthechartatadistanceof6m.Principle:
ltconsistsoflettersarrangedinlines,withprogressivelydiminishingsize.Eachlettersubtendsanangleof5minutesatthenodalpointofaneyewhenviewedfromitsrespectivedistanceEachletterissoconstructedthatthewidth(ofeachstroke)subtendsanangleof1minute=MAR.
Interpretation:Normalvisualacuityforfaris6/5Bestvisualacuityforfaris6/3MinimumrecordableVAonSnellen'schartis1/60.Snellen'schart:
960.Placidodiscisusedfordiagnosingwhichofthefollowingcondition?
a)Uveitis
b)Keratoconus
c)Retinoblastoma
d)Retinaldetachment
CorrectAnswer-BPlacidodiscexaminationisusedtodiagnosekeratoconus.Inacaseofkeratoconus,placidodiscexaminationshowsirregularitiesofthecircles.
Placido’skeratoscopicdisc:Itisadiscpaintedwithalternatingblackandwhitecircles.Itmaybeusedtoassessthesmoothnessandcurvatureofcornealsurface.Normally,onlookingthroughtheholeinthecenterofdiscauniformsharpimageofthecircleisseenonthecornea.Distortionofthecirclesoccurwhenirregularitiesarepresentonthecornealsurface.
Ref:ComprehensiveOphthalmologyByAKKhurana,4thedn,page119
961.Listersperimeterisusedfor
a)KineticVisualfieldtesting
b)StaticVisualfieldtesting
c)Bothkineticandstaticvisualtesting
d)Noneofthese
CorrectAnswer-AAns.is'a'i.e.,KineticVisualfieldtesting[RefKanski's8th/echapter10,p.325]Staticperimetry:Amethodofassessingfields,usuallyautomated,inwhichthelocationofastimulusremainsfixed,withintensityincreaseduntilitisseenbythesubject(thresholdisreached)ordecreaseduntilitisnolongerdetected.Kinetic(dynamic)perimetryisnowmuchlesscommonlyperformedthanstaticperimetry.Astimulusofconstantintensityismovedfromanon-seeingareatoaseeingareaatastandardizedspeeduntilitisperceived,andthepointofperceptionisrecordedonachart;pointsfromdifferentmeridiaarejoinedtoplotanisopterforthatstimulusintensity.Stimuliofdifferentintensitiesareusedtoproduceacontourmapofthevisualfield.Kineticperimetrycanbeperformedbymeansofamanual(Goldmann)oranautomatedperimeterifthelatterisequippedwithanappropriatesoftwareprogram.
962.WhatisthetypeofGoldmantonometry?
a)ApplanationTonometry
b)Dynamiccountourtonometry
c)Reboundtonometry
d)Impressiontonometry
CorrectAnswer-AAns.is'a'i.e.,ApplanationTonometry[RefAnatomy&physiologyofeye2"1/ep.79]Measurementofintraocularpressure(10P)MeasurementofIOPisdoneby:?A)Manometry:-ItistheonlydirectmeasureofIOP.B)Tonometry:-ItisanindirectmethodofmeasurementofIOP.Followingtypesoftonometersarethere:-
1. Indentation(impression)tonometer:-Thesearethemostcommonlyusedtonometers.ExampleisSchiotztonometer.
2. ApplanationtonometerGoldmannapplanationtonometeristhemostaccuratetonometer.Othertypesofapplanationtonometersareperkin'stonometer,pneumatictonometer,air-pufftonometer,Pulseairtonometer,Tonopen
963.Spasmofaccommodationmimics
a)Myopia
b)Hypermetropia
c)Amblyopia
d)Presbiopia
CorrectAnswer-AAns.is'a'i.e.,Myopia[RefKhuranailth/ep.42]PseudomyopiaSpasmofaccommodationoccursduetoexcessivecontractionoftheciliarymuscles.Thismakesthezonuleslooseandhencethelensbecomesmoreconvex.Thisleadstotheimagebeformedinfrontoftheretinatherebtmimickingmyopia.Thisiscalledpseudomyopia.
964.Subretinalhaemorrhageatthemaculainmyopiaisknownas?
a)Lacquercracks
b)FosterFuchsspot
c)Staphyloma
d)Macularretinoschisis
CorrectAnswer-BAns.is'b'i.e.,FosterfuchsspotDegenerativemyopia:Refractiveerrormayincreaseupto20-25Dwithdegenerativechangesineye.Temporalmyopiccrescentisafeatureofpathological/degenerativemyopia.Itisawhitecrescentatthetemporalborderofthedisc.Someofthemosttypicalfeaturesofdegenerativemyopiaare:VitreousliquefactionandposteriorvitreousdetachmentPeripapillaryatrophyappearingastemporalchoroidalorscleralcrescentsorringsaroundtheopticdiscLatticedegenerationintheperipheralretinaTiltingormalinsertionoftheopticdisc,usuallyassociatedwithmyopicconusThinningoftheretinalpigmentepitheliumwithresultingatrophicappearanceofthefundusEctasiaofthescleraposteriorly(posteriorstaphyloma)BreaksinBruch’smembraneandchoriocapillaris,resultinginlinesacrossthefunduscalled“lacquercracks”FosterFuch’sspotinthemaculararea.
965.Dispersiveprismfunctionsfor
a)Splittinglightintodifferentwavelengths
b)Reflectinglight
c)Polarizinglight
d)None
CorrectAnswer-AAns.is'a'i.e.,Splittinglightintodifferentwavelengths[Ref"TheDiscoveryoftheSpectrumofLight".]"Prismsmaybeusedforpolarisingandreflectinglightbutdispersiveprismslikethecommonlyusedtriangularprismsplitthelightintodifferentcoloursbasedonwavelengths"Inoptics,aprismisatransparentopticalelementwithflat,polishedsurfacesthatrefractlight.Atleasttwooftheflatsurfacesmusthaveananglebetweenthem.Theexactanglesbetweenthesurfacesdependontheapplication.Thetraditionalgeometricalshapeisthatofatriangularprismwithatriangularbaseandrectangularsides.Lightchangesspeedasitmovesfromonemediumtoanother(forexample,fromairintotheglassoftheprism).Thisspeedchangecausesthelighttoberefractedandtoenterthenewmediumatadifferentangle(Huygensprinciple).Thedegreeofbendingofthelight'spathdependsontheanglethattheincidentbeamoflightmakeswiththesurface,andontheratiobetweentherefractiveindicesofthetwomedia(Snell'slaw).Therefractiveindexofmanymaterials(suchasglass)varieswiththewavelengthorcolorofthelightused,aphenomenonknownasdispersion.Thiscauseslightofdifferentcolorstoberefracteddifferentlyandtoleavetheprismatdifferentangles,creatinganeffectsimilartoarainbow.
966.Gobletcellsareseenin-
a)Cornea
b)Conjunctiva
c)Retina
d)Vitreous
CorrectAnswer-BAnswerB.ConjunctivaGobletcellswithintheconjunctivalepitheliumarespecializedcellsthatsecretemucinsontothesurfaceoftheeye.HistologyofconjunctivaTheepitheliumisnon-keratinizingandaroundfivecell-layersdeep.Mucin-secretinggobletcellsarelocatedwithintheepithelium,andtheyaremostdenseinferonasally(nasal>inferior)andinthefornices.Thestroma(substantiapropria)consistsofrichlyvascularized,looseconnectivetissue.TheaccessorylacrimalglandsofKrauseandWolfringarelocateddeepwithinthestroma.Conjunctiva-associatedlymphoidtissue(CALT)iscriticalintheinitiationandregulationofocularsurfaceimmuneresponses.
967.Schwalbe'sringcorrespondsto:
a)Cornealendothelium
b)Descemet'smembrane
c)Schlemm'scanal
d)Ciliarybody
CorrectAnswer-BAns.Descemet'smembrane
968.Cornealepithelialrepairincludesallofthefollowingphasesexcept
a)Cellproliferation
b)Cellmigration
c)Celladhesion
d)Cellfusion
CorrectAnswer-DAns.is'd'i.e.,Cellfusion[RefCornealEpithelialwoundhealing:BJO1994,78;401-408]CornealepithelialrepairTheprocessesinvolvedinthehealingofcornealepithelialwoundscanbedividedintothreedistinctcomponents:cellmigration,cellproliferation,andcelladhesion.Allthreecomponentsarepartofacontinuousprocessbutthecontributionofeachcanvarydependingonthesizeanddepthofthewoundandnatureofinjury.
969.Conjunctivalstainingisdonebyallexcept
a)Fluoroscein
b)Indiaink
c)RoseBengal
d)Lissamine
CorrectAnswer-BAns.is'b'i.e.,Indiaink[RefCanJOphthalmol.2015Aug;50(4):273-7.doi:10.1016/j.jcjo.2015.05.007.]Commondyesusedforconjunctivalstaining:RoseBengal,FluorosceinandLissamine.
970.Treatmentofmooren'sulceris?
a)Cornealgraft
b)Immunosuppressives
c)Topicalsteroids
d)Alloftheabove
CorrectAnswer-DAlloftheaboveREF:Khurana4thedp.110MOOREN'SULCER:Severeinflammatoryperipheralulcerativekeratitis,chronicserpigenousorrodentulcerTreatment:1.Topicalcorticosteroids2.Immunosuppressiveswithsystemicsteroids,e.g.cyclosporine3.Softcontactlens4.Lamellarorfullthicknesscornealgrafting
971.Pseudogerontoxonisseenin
a)Vernalkeratopathy
b)Choroidalmelanoma
c)Trachoma
d)Retinoblastoma
CorrectAnswer-AAns.is'a'i.e.,Vernalkeratopathy[RefKanski8'1*Chap.5,p.138]
972.A50yearoldmalepresentswithcicatricialentopionofupperandlowereyelid.Oneversionofuppereyelid,linearconjunctivalscars-Arltlineareseen.Whatisthediagnosis?
a)Trachoma
b)Springcatarrah
c)Ligneousconjunctivitis
d)Parinaudoculoglandularsyndrome
CorrectAnswer-AAns.is'a'i.e.,Trachoma[RefKanski8th/eChap.5,p.138]Arltlineisafeatureoftrachoma.SignsofTrachomaConjunctivalsigns:-Congestion,conjunctivalfollicles(boiledsagograinlike),Papillaryhyperplasia,conjunctivalscarring(Arlesline),concretion.Cornealsigns:-Superficialkeratitis,Herbertfollicles,Pannus,Cornealulcer,Herbertpits,Cornealopacity.
973.Painisoutofproportiontosignsinwhichcornealulcer?
a)Herpessimplexkeratits
b)Acanthamoebakeratitis
c)Fungalkeratitis
d)Pneumococcalkeratitis
CorrectAnswer-BAns.is'b'i.e.,Acanthamoebakeratitis[RefKanski8thleChap.6,p.197]Inhuman,acanthamoebacauses:-(i)Keratitis;(ii)Granulomatousencephalitis,(iii)FulminantmeningoencephalitisPatientpresentswithveryseverepain(whichisoutofproportiontothedegreeofclinicalsigns),watering,photophobia,blurredvisionandblepherospasm.Onexamination,followingcharacteristicfeaturesareseen:?
1. Initiallesions(Epitheliallesions):-InitiallytheAcanthamoebakeratitisshowstypicalreticularpatternduetoradialkeratoneuritis(Radialperineuritis).Atthisstageitiscommonlymistakenforherpessimplexkeratitisbecauseofpseudodentriticepitheliallesion(dentriticulcermorphology).
2. Advancedcases(Stromalinvolvement):-Overaperiodofweeksstromalsignsdevelopwithcentralorparacentralringshapedlesionwithstromalinfiltrateandanoverlyingepithelialdefect,ultimatelypresentingasringabscess.Theremayberadialperineuritis,Wessely(inflammatory)ringandhypopyon.
974.Whichofthefollowingisnotafeatureoffungalcornealulcer?
a)Fixedhypopyon
b)Ulcerwithsloughingmargins
c)Symptomsaremorepronouncedthansigns
d)FungalhyphaeareseenonKOHmount
CorrectAnswer-CAns.c.Symptomsaremorepronouncedthansigns
975.Oblateellipsoidappearanceofcorneaisseeninwhichofthefollowingconditions?
a)PostmyopicLASIKsurgery
b)Withtheruleastigmatism
c)Bi-obliqueastigmatism
d)Obliqueastigmatism
CorrectAnswer-AAns.is'a'i.e.,PostmyopicLASIKsurgery[RefQualityofvision:EssentialOpticsforthecataractandrefractivesurgeon,chap.3,p.30]Thecorneaisathreedimensionalprolateellipsoid,likeabulletoratulip.Itissteeperinthecentreandflatterintheperiphery.AfterrefractivesurgerieslikemyopicLASIK,corneaisconvertedtooblateellipsoid,whichissteeperintheperipheryandflatterinthecentre.
976.WhichofthefollowingGlycosaminoglycansarenotpresentincornea
a)Keratinsulfate
b)Chondroitinsulfate
c)Chondroitin
d)Heparinsulfate
CorrectAnswer-DAns.is'd'i.e.,Heparinsulfate[RefKhuranaAnatomyandPhysiologyofEyes,?die,chapter2,p.26)GAGs(Glycosaminoglycans)orsocalledacid-mucopolysaccharidesrepresent4-4.5%ofthedryweightofthecornea.CorneacontainsthreemajorGAGfractionsnamely:Keratansulfate(50%),chondroitinsulfate(25%)andchondroitin(25%)-presentexclusivelyincornea.TheGAGarepresentintheinterfibrillarspaceofthecornealstromaandaccountforthe`stromalswellingpressure'(normal-60mmHg)ie.Itstendencytoimbibewaterandthusplaysanimportantroleinthemaintenanceofcornealhydrationlevelandtransparency.AnabnormalaccumulationofGAGoccursinthecornealstromaofthepatientsaffectedbytheinbornerrorsofGAGmetabolismknownasmucopolysaccharidosis.
977.Irondepositionlineatedgeofpterygiumoncornealepitheliumisknownas?
a)Stocker'sline
b)KFRing
c)Fleischerring
d)Ferrysline
CorrectAnswer-AAns.is'a'i.e.,Stocker'sline[Ref:Khurana4'5/ep.80;Parson21"/ep.181;Yanoff&DuckerOphthalmologyydlep
978.Geneforeyemorphogenesis
a)Pax-6
b)BMP-4
c)HOX-D13
d)HOX-A13
CorrectAnswer-AAns.is'a'i.e.,Pax-6ThePax-6genelocusisatranscriptionfactorforvariousgenesandgrowthfactorsinvolvedineyeformation.Pax-6isamastercontrolgeneforeyemorphogenesisandencodesforPairedboxproteinPax-6(alsocalledaniridiatypeIIproteinoroculorhombin).
979.Thepercentageofatropinepresentinatropinedropsascycloplegicis:
a)0.5%
b)1%
c)4%
d)2%
CorrectAnswer-B1%
980.Whichorderneuronisopticnerveinthevisualpathway?
a)Firstorder
b)Secondorder
c)Thirdorder
d)Noneofthese
CorrectAnswer-BAns.is'b'i.e.,Secondorder[RefKhurana4th/ep.286-289;Concisetextbookofphysiology2"/ep.336]Sensoryorgans→Photoreceptors(Rods&cones)Neuronsoffirstorder→Axonofbipolarcells(inRetina)Neuronsofsecondorder→Axonsofganglioniccell(Retinai.e.,Opticdisc,Opticnerve,Opticchiasma,optictracts)Neuronsofthirdorder→Axonsfromnervecellsinlateralgeniculatebody(opticradiation)
981.Purkinjeimagetestisusedin
a)Keratomoter
b)Retinoscopy
c)Opticalcoherencetomography
d)Pachymeter
CorrectAnswer-DAns.is'd'i.e.,Pachymeter[RefElkington'sclinicaloptics3rd/echapter14,p.207]Pachymetryisthemeasurementofcornealthickness.Pachymetersemployeitheropticalorultrasoundprinciples.OpticalpachymetersusethePurkinje-Sansonimagesformedbytheanteriorandposteriorsurfacesofthecornea(imagesIandII)tomeasurecornealthickness,andthePurkinje-Sansonimagesformedbytheposteriorsurfaceofthecorneaandtheanteriorsurfaceofthelens(imagesIIandIII)tomeasurethedepthoftheanteriorchamber.
982.
Whichofthefollowingisnotapartofuveal
a)Iris
b)Ciliarybody
c)Choroid
d)Retina
CorrectAnswer-DAns.is'd'i.e.,Retina[RefKhurana's2"/eChap.3,p.44]Uvealtissueconstitutesthemiddlevascularcoatoftheeyeball(Innercoatisretinaandoutercoatiscornea&sclera).Fromanteriortoposterioritcanbedividedintothreeparts:-Iris,ciliarybodyandchoroid.Irisandanteriorpart(2mm)ofciliarybody(parsplicata)areconsideredasanterioruvealtissues.Posteriorpart(4mm)ofciliarybody(parsplana)andadjacentchoroidareconsideredasintermediateuvealtissue.Choroidisconsideredasposterioruvealtissue.Theentireuvealtractisdevelopmentally,structurallyandfunctionallyoneindividualstructure.
983.AllexceptonearetrueforScleromalaciaperforans
a)Itisnoninflammatoryscleritis
b)Itaffectsonlymales
c)Perforationoftheglobeisextremelyrare
d)Visionisunaffected
CorrectAnswer-BAns.is'b'i.e.,Itaffectsonlymales[RefKanski'sClinicalOphthalmology8"Vechapter8,p.259]ScleromalaciaperforansScleromalaciaperforans(5%ofscleritis)isaspecifictypeofprogressivescleralthinningwithoutinflammationthattypicallyaffectselderlywomenwithlongstandingrheumatoidarthritis,buthasalsobeendescribedinassociationwithothersystemicdisorders.Despitethenomenclature,perforationoftheglobeisextremelyrareasintegrityismaintainedbyathinlayeroffibroustissue.Differentialdiagnosisisfromtheinnocuousscleralhyalineplaqueandsenilescleromalacia.
984.TransportofAscorbicacidtolensisdonebywhichofthefollowing?
a)Myoinositol
b)Choline
c)Taurine
d)Na-KATPase
CorrectAnswer-DThelensepitheliumistheprincipalsiteofenergyproductionofthelensthatisusedfortransportofinorganicionsandaminoacidsbyanactiveprocessinvolvingNaandKactivatedATPase.Ref:HistopathologyofPreclinicalToxicityStudies:InterpretationandRelevance...ByPeterGreaves,PeterGreaves(M.B.,Ch.B.),2007,Page896;TransportofvitaminCinthelens,CurrEyeRes.1987Jul;6(7):885-96;Adler'sPhysiologyoftheeye10thEdition,Page131;AscorbicacidandtheEye,AmJClinNutr1991;54:1198S-1202S.
985.Bluedotcataractiscausedby
a)Diabetes
b)Wilson'sdisease
c)Atopicdermatitis
d)Chalcosis
CorrectAnswer-CAns.is'c'i.e.,Atopicdermatitis[RefParson's21"/ep.259]Bluedotcorticalcataractiscausedbymyotonicdystrophyandatopicdermatitis.
986.Whichofthefollowingiscomplicationofprolongeduseofcorticosteroideyedrops?
a)PosteriorSubcapsularcataract
b)Nuclearcataract
c)Capsularcataract
d)Corticalcataract
CorrectAnswer-AAns.is'a'i.e.,PosteriorSubcapsularcataractCausesofposteriorsubcapsularcataract:Myotoicdystrophy Down'ssyndromeIonizingradiationWilson'sdisease Corticosteroids GalactosemiaDM Busulfan SenilecataractInfrared/heatcataract Chloroquine Trauma(glass-blower'sorglassworker)Atopicdermatitis
987.Falseabouttreatmentofcataractinchildrenis
a)ECCEisthetreatmentofchoice
b)Incaseofbilateralcataractimparingvisionsurgerymustbedoneby4-6weeksofage
c)Lensectomyisnotoneofthemethodsofextracapsularextraction
d)Intraocularlensimplantationmustbedoneonlyafter2yearsofage
CorrectAnswer-CAns.is'c'i.e.,Lensectomyisnotoneofthemethodsofextracapsularextraction[RefTextbookofpediatriccataractsurgeryp.194]Thecriticalperiodfordevelopingthefixationreflexinbothunilateralandbilateralvisualdeprivationdisordersisbetween2-4monthsofage.Anycataractdenseenoughtoimpairvisionmustbedealtwithbeforethisageandtheearliestpossibletimeispreferred.
988.Whatisthenewadvanceincataractsurgery?
a)FemtosecondLaser
b)NeodymiumLaser
c)NanosecondLaser
d)PicosecondLaser
CorrectAnswer-AAns.is'a'i.e.,Femtosecondlaser[RefFemtosecondlaser-assistedcataractsurgery:KendallE.Donaldson,RosaBraga-Mele,FlorenceCabot,fortheASCRSRefractiveCataractSurgerySubcommittee]Femtosecondlaser-assistedcataractsurgeryprovidessurgeonsanexcitingnewoptiontopotentiallyimprovepatientoutcomesandsafety.Inthissurgeryafemtosecondlaserisusedforvariousstepslikelensfragmentationandcapsulotomy.Althoughtheresultshavebeengoodthetechnologyiscurrentlyveryexpensive.
989.Whichofthefollowingstepisnotdoneduringphacoemulsificationsurgeryforcataract?
a)Irrigationanddrainageofcortex
b)Continuouscurvilinearcapsulorrhexis
c)FoldableIOLimplantation
d)Sclerocornealtunnel
CorrectAnswer-DAns.is'd'i.e.,Sclerocornealtunnel[RefPhacoemulsificationbyvajpayee]Thestepsinphacoemulsificationinclude:(i)Corneoscleralincision,(ii)Continuouscurvilinearcapsulorrhexis,(iii)Hydrodissectionandhydrodelineation,(iv)Emulsificationandaspirationofnucleusandthencortex,(v)FoldableIOLimplantationinposteriorchamber.
990.Phacoemulsificationuses
a)Highfrequencysoundwaves
b)Infraredwaves
c)Ultravioletrays
d)Noneofthese
CorrectAnswer-AAns.is'a'i.e.,Highfrequencysoundwaves[RefKanski's8th/echapter9,p.281]InPhacoemulsification,lensnucleusisemulsifiedusinghighfrequencysoundwaves.
991.Postoperativecomplicationsofcataractareallexcept?
a)Aftercataract
b)Endophthalmitis
c)Glaucoma
d)Scleritis
CorrectAnswer-DAns.is'd'i.e.,Scleritis[RefOphthalmologybyDuker2"d/ep.484]Therearesomanycomplicationsofcataractsurgery,Hereareonlyimportantones:?Aftercataract(opacificationofcapsule)RetinaldetachmentVitreousprolapse&lossNeovascularglaucomaCystoidmacularedemaAnterioruveitis(iridocyclitis)EndophthalmitisIrisprolapseAphakicglaucomaStriakeratopathy&PseudophakicbullouskeratopathyFibrous&endothelialgrowthCornealendothelialdamage
992.Whichofthefollowingisthemostimportantfactorinthepreventionoftheendophthalmitisincataractsurgery?
a)Preoperativepreparationwithpovidoneiodine
b)Oneweekantibiotictherapypriortosurgery
c)Trimmingofeyelashes
d)Useofintravitrealantibiotics
CorrectAnswer-AAns.Preoperativepreparationwithpovidoneiodine
993.Hemeralopiaisseenin
a)Retinaldetachment
b)Retinitispigmentosa
c)Opticneuritis
d)Subcapsularcataract
CorrectAnswer-DAns.is'd'i.e.,Subcapsularcataract[RefKanski8th/eChap.9,p.270]Hemeralopiaistheinabilitytoseeclearlyinbrightlight(alsoknownasdayblindness)andistheexactoppositeofnyctalopia(nightblindness).SubcapsularcataractAnteriorsubcapsularcataractliesdirectlyunderthelenscapsuleandisassociatedwithfibrousmetaplasiaofthelensepithelium.Posteriorsubcapsularopacityliesjustinfrontoftheposteriorcapsuleandhasagranularorplaque-likeappearanceonobliqueslitlampbiomicroscopy,buttypicallyappearsblackandvacuolatedonretroillumination;thevacuolesareswollenmigratorylensepithelialcells(bladderorWedl),similartothosecommonlyseenpostoperativelyinposteriorcapsularopacification.Duetoitslocationatthenodalpointoftheeye,aposteriorsubcapsularopacityoftenhasaparticularlyprofoundeffectonvision.Patientsarecharacteristicallytroubledbyglare,forinstancefromtheheadlightsofoncomingcars,andsymptomsareincreasedbymiosis,suchasoccursduringnearvisualactivityandinbrightsunlight(dayblindness).
994.Achildhasgotacongenitalcataractinvolvingthevisualaxiswhichwasdetectedbytheparentsrightatbirth.Thischildshouldbeoperated:
a)Immediately
b)At2monthsofage
c)At1yearofagewhentheglobebecomesnormalsized
d)After4yearswhenentireocularandorbitalgrowthbecomesnormal
CorrectAnswer-AAns.A[Immediately]Congenitalcataract-Timingofsurgery
1. Bilateraldense-cataractrequiresearlysurgery(i.e.by6weeksofage)topreventthedevelopmentofstimulusdeprivationamblyopia
2. Bilateralpartial-cataractmaynotrequiresurgeryuntillaterifatall,incasesofdoubt,itmaybeprudenttodefersurgerymonitorlensopacity,andvisualfunctionandintervenelaterifvisiondeteriorates.
3. Unilateraldense-cataractmeritsurgentsurgery(withindays)followedbyaggressiveanti-amblyopiatherapythecataractisdetectedafter16weeksofagethensurgerycanbedelayedlittlebecauseamblyopiaisrefractory4.Partialunilateral-cataractcanusuallybeobservedortreatednonsurgicallywithpupillarydilatationandpossiblypart-timecontralateralocclusiontopreventamblyopia"Thecriticalperiodofdevelopingthefixationreflexesinbothunilateralandbilateralvisualdeprivationdisordersisbetween2and4monthsofage,anycataractdenseenoughtoimpairvisionmustbedealtwithbeforethis
ageandtheearliestpossibletimeispreferred"
995.Whichofthefollowingisagooddyeisusedforlensincataractsurgery?
a)TrypanBlue
b)Fluoroscein
c)Indiaink
d)None
CorrectAnswer-AAns.is'ATrypanbluedyeforanteriorsegmentsurgeriesTrypanbluehasbeenusedasanadjunctforimprovingvisualizationoftheanteriorcapsuleduringphacoemulsificationofmaturewhitecataractsforthepastfewyears.Surgeonshavelonguseddyeslikeindocyaninegreen,fluorescein,andtrypanbluetostaintheanteriorcapsuleinordertofacilitatethesurgicalprocedure.studiescomparingthese3dyeshaveconcludedthattrypanblueprovidessignificantlymoreintensivestainingoftheanteriorlenscapsulethantheothersTrypanblueiseasiertousethanindocyaninegreen,becauseitcomesinapremixedsolution,anditisavailableatamoreeconomicalprice.
996.Whichofthefollowingisalayerbetweenchoroidandretina?
a)Bruch'smembrane
b)Descemet'smembrane
c)Photoreceptors
d)Ganglioncelllayer
CorrectAnswer-AAns.is'a'i.e.,Bruch'smembrane[RefParson's21"/ep.321]Bruch'smembraneistheinnermostlayerofthechoroid.Itisalsocalledthevitreouslamina,becauseofitsglassymicroscopicappearance.Itis2-4thick.Itliesbetweenchoroidandtheretina.
997.100dayglaucomaiscausedby
a)CRVO
b)CRAO
c)Buphthalmos
d)Agerelatedmaculardegeneration
CorrectAnswer-AAns.is'a'i.e.,CRVO100-dayglaucomaistypicallyseeninIschemicCRVO.Followingcentralretinalveinocclusion,flame-shapedhaemorrhagesdevelopinthenervefiberlayeroftheretina,especiallyaroundtheopticdisc,asaresultofthehighintravascularpressurethatdilatestheveinsandcollateralvessels.Edemaoftheopticdiscandretinaoccurbecauseofimpairedabsorptionofinterstitialfluid.Visionisgenerallypoorbutmayrecoversurprisinglywell,consideringtheseverityofthefunduscopicchanges.Intractableclosed-angleglaucoma,withseverepainandrepeatedhaemorrhages,commonlyoccurs2to3monthsaftercentralretinalveinocclusion(100-dayglaucoma';'thromboticglaucoma'),owingtoneovascularizationoftheirisandadhesionsbetweentheirisandtheanteriorchamberangle(peripheralanteriorsynechiae).
998.KeethWagnerclassificationisfor
a)Hypertensiveretinopathy
b)Diabeticmaculpathy
c)CRVO
d)CRAO
CorrectAnswer-AAns.is'a'i.e.,Hypertensiveretinopathy[RefRobartW.Schrier8"/ep.1377]
999.Allareseeninnon-proliferativediabeticretinopathyexcept?
a)Microaneurysm
b)Neovascularization
c)Hardexudates
d)Macularedema
CorrectAnswer-BAns.is'b'i.e.,NeovascularizationClassificationofDiabeticretinopathyNonproliferative ProliferativeBackgroundretinopathy
1. Microaneurysm2. Dotandblothemorrhage(deep
hemorrhage)3. Hardexudate4. Macularedema
B)Preproliferativeretinopathy
1. Cotton-woolspots(softexudates)
2. Venousbeading3. Extensivehemorrhage4. lntraretinalintravascularabn
ormalities(IRMA
Neovasculorizationofthedisc(NVD)
1. Neovasculaizationelsewhereintheretina(NVE)
2. Viffeoushemorrhage3. Fibrovascularproliferation4. Trsctionretinsldetachment5. Irissurfaceneovascularization
(rubeosisiridisorneovascularglaacoma)
1000.Allofthefollowingarethecausesofexudativeretinaldetachmentexcept:
a)Retinopathyoftoxaemiaofpregnancy
b)Retinopathyofprematurity
c)ExudativeretinopathyofCoats
d)Sympatheticophthalmia
CorrectAnswer-BAns.Retinopathyofprematurity
1001.Inwhichofthefollowing,intraocularpressureisveryhighandinflammationisminimum?
a)Glaucomatocycliccrisis
b)Acuteiridocyclitis
c)Hypetensiveuveitis
d)Angleclosureglaucoma
CorrectAnswer-AAns.is'a'i.e.,Glaucomatocycliccrisis[RefKhurana4th/ep.160]GlaumatocycliccrisisGlamatocycliticcrisis(Posner-Schlossmansyndrome)isaunilateralrecurrentnon-granulomatousiritisthatisassociatedwithanelevatedocularpressureduringtheattacks.Thisself-limitingconditiontendstooccurinpersonsduringthethirdtosixthdecadeandthevisualfields,theopticnervehead,andanteriorchamberanglearenormal.Amildinflammatoryreactionisveryrarelypresentasevidencedbyafewkeraticprecipitatesontheposteriorsurfaceofthecornea.Thecauseoftheglaucomaremainsunknown,butatrabeculitisissuspected.Manypatients(55%)subsequentlydevelopopenangleglaucoma
1002.CellbodiesofMuller'sCellsarepresentinwhichlayerofretina?
a)Innerlimitingmembrane
b)Outernuclearlayer
c)Retinalpigmentepithelium
d)Ganglioncelllayer
CorrectAnswer-AAns.is'a'i.e.,Innerlimitingmembrane[RefHistologyoftheEye,editedbyWilliamKrause,Dept.PathologyandAnatomicalscience,UniversityofMissouriSchoolofMedicine]Innerlimitingmembrane-basementmembraneelaboratedbyMullercells.Nervefibrelayer-axonsoftheganglioncellnuclei(notethatathinlayerofMullercellfootplatesexistsbetweenthislayerandtheinnerlimitingmembrane).Ganglioncelllayer-containsnucleiofganglioncells,theaxonsofwhichbecometheopticnervefibresformessagesandsomedisplacedamacrinecells.Innerplexiformlayer-containsthesynapsebetweenthebipolarcellaxonsandthedendritesoftheganglionandamacrinecells.Innernuclearlayer-containsthenucleiandsurroundingcellbodies(perikarya)oftheamacrinecells,bipolarcellsandhorizontalcells.Outerplexiformlayer-projectionsofrodsandconesendingintherodspheruleandconepedicle,respectively.Thesemakesynapseswithdendritesofbipolarcells.Inthemacularregion,thisisknownastheFiberlayerofHenle.Outernuclearlayer-cellbodiesofrodsandcones.Externallimitingmembrane-layerthatseparatestheinnersegment
portionsofthephotoreceptorsfromtheircellnucleus.Layerofrodsandcones-layerofrodcellsandconecells.Retinalpigmentepithelium-singlelayerofcuboidalcells.Thisisclosesttothechoroid.
1003.Retinaltearsseenmostcommonlyseenin?
a)Primaryretinaldetachment
b)Secondaryretinaldetachment
c)Tractionalretinaldetachment
d)Exudativeretinaldetachment
CorrectAnswer-AAns.is'a'i.e.,PrimaryretinaldetachmentRetinaldetachmentisadisorderofeyeinwhichretinapeelsawayfromitsunderlyinglayerofsupporttissue.Usuallythereisseparationbetweentheneuroepithelium(neurosensoryepithelium)andthepigmentedlayer.Theretinalseparationisdividedinto:
1. Primary:-Rheugmatogenousretinaldetachment.2. Secondary:-Tractionalretinaldetachmentandexudativeretinal
detachment.RhegmatogeneousretinaldetachmentThisisthecommonesttypeofretinaldetachment.Thisisduetoaretinalbreak/tear/holewhichallowstheliquidvitreoustoseepsintothesubretinalspaceandseparatesthesensoryretinafromthepigmentaryepithelium.Predisposingfactorsinclude:(i)Myopia,(ii)Previousintraocularsurgery:cataractextraction,(aphakia)orpseudoaphakia);(iii)Trauma;(iv)Retinaldegeneration(Latticedegeneration;Snailtrackdegeneration,Senileordegenerativeretinoschisis.TractionalretinaldetachmentItisduetopullingontheretinausuallyfromfibro-vascularbandinthevitreouscavity,i.e.,vitroretinalband.
Exudativeretinaldetachment(solidretinaldetachment)Itoccursduetotheretinabeingpushedawaybyaccumulationoffluidoraneoplasmbeneaththeretina.Thistypeofdetachmentiscausedbyinflammatorydisordersorbytumors.
1004.Anelderlymalewithheartdiseasepresentswithsuddenlossofvisioninoneeye;examinationrevealscherryredspot;diagnosisis:
a)Centralretinalveinocclusion
b)Centralretinalarteryocclusion
c)Amaurosisfugax
d)Acuteischemicopticneuritis
CorrectAnswer-BBi.e.CentralRetinalArteryOcclusionCentralretinalarteryocclusioncharacteristicallypresentswithsuddenpainlesslossofvision,cherryredspot&cattle-truckappearanceQ(ofretinalveinsusually).Sourceofembolifromcarotidartery&heartdisease,andthrombusfromarteriosclerosisalongwithhypertension&arteritisarepredisposingfactors.
1005.Whichofthefollowingistrueaboutsignsofangleinclosureglaucomaexcept
a)Verticalsemidialtedpuil
b)Edematouscornea
c)Multipleirisnodules
d)Edematousandhyperemicopticdisc
CorrectAnswer-CAns.is'c'i.e.,Multipleirisnodules[RefParson's21"/ep.290]ClinicalfeaturesofangleclosureglaucomaConjunctivaischemosedandcongested(bothconjunctival&ciliaryvesselsarecongested).CorneaisoedematousandinsensitiveAnteriorchamberisveryshallow&withaqueousflareAngleofanteriorchamberisclosed(ongonioscopy)IrisisdiscolouredPupilissemidilated,verticallyovalandfixed.Itisnonreactivetobothlightandaccommodation.IOPismarkedlyraised(40-70mmHg)Opticdiscisoedematous&hyperemicFelloweyeshowsshallowanteriorchamberandanarrowangle.
1006.Whichofthefollowingisfalsestatementaboutvitreous?
a)Anatomically,vitreousispresentinanteriorsegment
b)Vitreouslargelycontainwaterandhyaluronicacid
c)Strongestattachmentofvitreousbaseisatoraserrata
d)Vitreousisattachedanteriorlytothelens
CorrectAnswer-AAns.is'a'i.e.,Anatomically,vitreousispresentinanteriorsegment[RefKanski8thieChap.17,p.722]Vitreousispresentinposteriorsegmentofeye.Vitreoushumorisajellylikefluidliquidthatfillsmost(80%)oftheeye(fromthelensback,i.e.,intheposteriorsegment).Thevitreousconsistslargelyofwater(99%),anetworkofcollagenfibrils,largemoleculesofhyaluronicacid,peripheralcells(hyalocytes),andmucopolysaccharides,formingagel-likematerial.Thereisapotentialspacebetweenvitreousandretina,calledsubhyaloidspace.Asweage,vitreouschangesfromageltoaliquidandgraduallyshrinksseparatingfromtheretina.Thisiswhenpeoplestartseeingfloaters(blackspotsinfrontoftheeye).
1007.Phacodonesisisseeninallexcept
a)Traumaticinjurytotheeye
b)Hypermaturecataract
c)Pseudoexfoliation
d)Diabetesmellitus
CorrectAnswer-DAns.is'd'i.e.,Diabetesmellitus[RefKanski8thiep.300]Phacodonesisisthetremulousnessorvibrationofthelenswitheyemovement.Itisseenin:
1. Trauma2. Pseudoexfoliationsyndrome3. Hypermaturecataract4. Ectopialentis
1008.Onsetofstereopsisoccursattheageof:
a)3to5months
b)1to2years
c)5years
d)7years
CorrectAnswer-AAns.3to5months
1009.Homonymoushemianopiatypeofvisualfielddefectisseeninallexcept?
a)Lateralgeniculatebody
b)Totalopticradiation
c)Optictract
d)Opticchaisma
CorrectAnswer-DAns.is'd'i.e.,Opticchaisma
1010.Normalvisionwithabsenceofdirect&consensuallightreflex,whichnerveisinvolved?
a)Optic
b)Oculomotor
c)Trigeminal
d)Abducens
CorrectAnswer-BAns.is'b'i.e.,OculomotorThisquestioncanbesolvedbysimplebasicknowledge:-Amongthegivenoptionsonlyoiticnerveandocculomotornewesarerelatedtolightreflex'aInopticnerveinjuryvisionisalsoimpaired(visionisnormalinthequestion)'nThusanswerisoculomotornerveWhenlightisshonetoone(e.g.left)eye.leftopticnervecaniesafferentimpulsetobrainandfrombrainefferentimpulsetoipsiplateral(left)eyecomesthroughipsilateral(left)occulomotornerye(fordirectlightreflex)andefferentforcontralatcral(right)eyecomesthroughcontralateral(right)occulmotornerveforconsensuallightreflex'Whenlightisshonetoother(right)eyc,rightopticnervecarriesafferentimpulsetobrainandfrombrain,efferentimpulsetorighteye(fordirectlightreflex)comesthroughrightocculmotornerveandeffcrentfbrlefteye(forconsensuallightreflex)comesthroughleftocculomotornerve'So:-OpticneweisresponsibtefordirectlightreJlexinipsilateraleyeand
consensuallightreflexforcontralateraleye.(lnaboveexample,afferentforrightsideddirectandleftsidedconsensuallightreflexisthroughrightopticnerve;andatl-erentforleftsideddirectandrightsidedconsensuallightreflexisthroughleftopticnerve)'Occulomotornerveisresponsiblefordirectandconsensuallightreflexinthesameeye'(lnaboveexample'efferentforrightsideddirectasrvellasconsensuallightreflexisthroughrightocculmotornerveandef'ferentforleftsideddirectaswellasconsensuallightreflexisthroughleftocculomotornerve)'Incompleteopticnervelesionofoneside(Amaurosislightreflexortotalafferentpupillaryfect)TheipsilateraldirectreflexislostTheipsilateralconscnsualreflexisintactThecontralateraldirectreflexisintactThecontralateralconsensualreflexislostInocculomotornervelesionofoneside(efferentpupillarydefectTheipsilateraldirectreflexislostTheipsilateralconsensualreflexislostThecontralateraldirectreflexisintactThecontralateralconsensualreflexisintact
1011.Whichofthefollowingistrueaboutdivergentsquint
a)Itisalsocalledexotropia
b)Itismorecommonthanconvergentsquint
c)Itisafeatureof6thnervepalsy
d)Allofthefollowing
CorrectAnswer-AAns.is'a'i.e.,Itisalsocalledexotropia[RefPediatricstrabismus4th/ep.218-224]Divergentsquintisalsocalledasexotropia.Itlesscommonthanconvergentsquint(esotropia).6thnervepalsycausesconvergentsquint.
1012.Crossedeyefixationispositivein-
a)Esotropia
b)Exotropia
c)Hypertropia
d)Hypotropia
CorrectAnswer-AAns.is'a'i.e.,Esotropia[RefInternet]Crossfixationistheuseoftherighteyetoviewtheleftvisualfieldandtheuseofthelefteyetoviewtherightvisualfield.Thisbehaviorisverycommoninchildrenwithinfantileesotropia.Crossfixationoftencausestheappearanceofnotlookingdirectlyatatargetandparentsoftenwonderifvisionisreduced.
1013.Partialptosisisoculomotornerveinjuryisduetointact-
a)Supplyfromoppositeoculomotornerve
b)Sympatheticinnervation
c)Parasympatheticinnervation
d)Actionoforbicularisoculi
CorrectAnswer-BAns.is'b'i.e.,Sympatheticinnervation[RefTextbookofophthalmicreconstructivesurgeriesp.786]Motornervesupplyoflidisthroughthreesources:?
1. Facialnervesupplyingorbicularisoculi,(closingoflid)2. Oculomotorsupplyinglevatorpalpebraesuperioris;3. Sympatheticfibressupplyingmuller'smuscle.4. BothLPSandMullermusclefunctiontoretractthelid,henceonly
partialptosisisseeninoculomotornervepalsy.
1014.Painfuleyemovementisafeatureof:
a)Iridocyclitis
b)Papilledema
c)Cornealulcer
d)Vernalcatarrh
CorrectAnswer-AAnterioruveitis,alsoknownasiridocyclitisandiritis,istheinflammationoftheirisandanteriorchamber.Anywherefromtwo-thirdsto90%ofuveitiscasesareanteriorinlocation.Injection,photophobia,pain,andblurredvisionusuallyaccompanyiritis(anterioruveitisoriridocyclitis).Ref:BravermanR.S.(2012).Chapter16.Eye.InW.W.Hay,Jr.,M.J.Levin,R.R.Deterding,J.J.Ross,J.M.Sondheimer(Eds),CURRENTDiagnosis&Treatment:Pediatrics,21e.
1015.Retinoblastomasshowallofthefollowingexcept
a)Smallroundcells
b)Necrosis
c)PseudorosettesandFleurettes
d)None
CorrectAnswer-DAns.'d'isNone(Allareseen)[RefKhurana4thiep.281]HistologyofretinoblastomasThetumorarisesfromsmallroundcellswithlargenuclei,i.e.,itisatumorofagroupcalledsmallroundbluecelltumors.MicroscopicfeaturesofawelldifferentiatedtumorincludeFlexnerwintersteinerrosettes(specificforretinoblastoma),HomerWrightrosettes,pseudorosettesandfleurettesformation.
1016.Whichofthefollowingismostcommonvisualdefectinpapilloedema
a)Amourosisfugax
b)Homonymoushemianopia
c)Homonymousquadrantopia
d)Glare
CorrectAnswer-AAns.is'a'i.e.,Amourosisfugax[RefClinicalopthalmology2"d%p.349,350]InitiallythesymptomsofpapilloedemaareduetoincreasedICT,e.g.headache,nausea,projectilevomitingandpapilloedema.Visionisnormalinitially.In25%ofpatientsvisualsymptomsoccuronlyinadvancedseverepapilloedema,whenopticatrophysetsin.Typically,thereisrecurringbriefepisodes(transient)ofvisualobscurations(Amaurosisfugax)lastinglessthen30seconds,inwhichvisionturnsgreyorblacks,sometimesdecribedasifaveilhasfallenovertheeyes.Thesymptomsusuallyaffectbotheyesatonceaspapilloedemaisbilateral.Centralvisionisaffectedlateinthedisease.Initiallythereisenlargementofblindspotandprogressivecontractionofthevisualfield(visualfieldbecomessmaller).Completeblindnesssetsineventually.Thus,characteristicallythereisgraduallyprogressivepainlesslossofvision
1017.Whatisthetreatmentofmeibomianitis?
a)Cleansingthelidedges
b)Applicationofmoistheat
c)Localantibiotics
d)Alloftheabove
CorrectAnswer-DAns.is'd'i.e.,Alloftheabove[RefFosterCS.Theeyeinskinandmucousmembranedisorders.In:TasmanW,JaegerEA,eds.Duane'sOphthalmology.15thed.Philadelphia,Pa:LippincottWilliams&Wilkins;2009:chap27]MeibomianitisMeibomianitisisinflammationofthemeibomianglands,agroupofoil-releasing(sebaceous)glandsintheeyelids.CausesAnyconditionthatincreasestheoilysecretionsofthemeibomianglandswillallowexcessoilstobuildupontheedgesoftheeyelids.Thisallowsfortheexcessgrowthofbacteriathatarenormallypresentontheskin.Theseproblemscanbecausedbyallergies,hormonechangesduringadolescence,orskinconditionssuchasrosaceaandacne.Meibomianitisisoftenassociatedwithblepharitis,whichcancauseabuildupofadandruff-likesubstanceatthebaseoftheeyelashes.Insomepeoplewithmeibomianitis,theglandswillbepluggedsothatthereislessoilbeingmadeforthenormaltearfilm.Thesepeopleoftenhavesymptomsofdryeye.
1018.Blowoutfractureoforbitleadstofracturein
a)Floor
b)PosteriorMedialwall
c)Lateralwall
d)Roofoftheorbit
CorrectAnswer-BAns:B1.Ablowoutfractureoftheorbitalflooristypicallycausedbyasuddenincreaseinorbitalpressurebyastrikingobjectwhichisgreaterthan5cmindiameter,greaterthantheoritalsindiametersuchasafistortennisball.2.Thefracturemostfrequentlyinvolvestheflooroftheorbitalongthethinbonecoveringtheinfraorbitalcanal.3.Thefloorconsistsofthreebones:Zygomatic,MaxillaryandPalatine.4.Theposteromedialportionofthemaxillaryboneisrelativelyweakandmaybeinvolvedina‘blowout’fracture.5.FractureoftheRoofoftheorbitknownas‘blowin’fractures.6.Mostmedialwallorbitalfracturesareassociatedwithfloorfracture
1019.Mostcommonsiteofbasalcellcarcinomaoftheeyeis
a)Eyelid
b)Conjunctiva
c)Cornea
d)Lacrimalapparatus
CorrectAnswer-AAns.is'a'i.e.,Eyelid[RefRenuJogi4th/ep.420;Khurana4th/ep.360]Basalcellcarcinomaisthecommonestmalignanttumorofthelids(90%)usuallyseeninelderlypeople.Itislocallymalignantandinvolvesmostcommonlylowerlid(50%)followedbymedia!canthus(25%),upperlid(10-15%)andoutercanthus."Basalcellcarcinomaisseeninthelowerlidneartheinnercanthususually
1020.Vitrectomyshouldbeconsideredifthevitreoushaemorrhageisnotabsorbedwithin:
a)1month
b)3months
c)6months
d)2months
CorrectAnswer-BAns.3months
1021.Ankyloblepheronisdefinedas
a)Adhesionofthelidtotheeyeballs
b)Adhesionofthelidmarginstoeachother
c)Inturnedeyelash
d)Inflammationofthelidmargin
CorrectAnswer-BAnsis'b'i.e.,Adhesionofthelidmarginstoeachother[Ref:Kanski8thlep.52]DisordersoftheeyelidsBlepharitis:-Chronicinflammationoflidmargin.Blephritisacarica:InflammationoflidmargincausedbyDemodexfolliculorum.Madarosis:-Lossofeyelashes.Trichiasis:-Misdirectedeyelasheswhichrubagainsttheeyeballinnormalpositionoflidmargin.Distichiasis:-anabnormalextrarowofciliatakingplaceofmeibomianglands.Entropion:-Inwardrollingorinturningoflidmargin.Ectropion:-Outrollingoroutwardturningoflidmargin.Symblepharon:-Adhesionofthelidstoeyeball.Ankyloblepharon:-Adhesionofmarginsoftwoeyelids.BlepharophimosisPalpebralfissureappearstobecontractedattheoutercanthus.Lagophthalmos:-Incompleteclosureofthepalpebralaperturewheneyesareshut.Tylosis:-Thickeningoflidmargin.Basalcellcarcinoma:-MostcommonmalignanttumorofeyelidClobomaoflid:-Triangulargapinnasalsideofupperlid
1022.Theglobeisdisplacedtowhichsideinlacrimalglandtumour?
a)Inferotemporal
b)Inferonasal
c)Superotemoral
d)Nasal
CorrectAnswer-BAns.is'b'i.e.,Inferonasal[RefBernardiniFP,DevotoMH,CroxattoJO.Epithelialtumorsofthelacrimalgland:anupdate.CurrOpinOphthalmol2008;19:409-13]Alllacrimalglandtumorstypicallysharethefollowingsymptoms:facialasymmetryduetodisplacementoftheglobe,diplopia,ptosis,limitedocularmotility,andenlargementofthelacrimalgland.Epitheliallesionstendtodevelopmostlyintheorbitallobeofthelacrimalglandandareprincipallyunilateral.Theinitialsignisusuallyinferiorandnasaldisplacementoftheglobeandproptosis,duetothesuperotemporallocationofthelacrimalglandintheanterioraspectoftheorbit.
1023.'D'shapedpupilisseenin
a)Glaucoma
b)Dislocationoflens
c)Iridodialysis
d)Iridocyclitis
CorrectAnswer-CAns.is'c'i.e.,Iridodialysis[RefKhurana4thiep.404]Iridodialysisisdetachmentofirisfromitsrootattheciliarybody.ItresultsinDshapedpupilandalackbiconvexareaseenattheperiphery.
1024.Investigationofchoiceforopticneuritisis?
a)MRIBrainandorbit
b)CtscanBrainandorbit
c)Vitreousbiopsy
d)Electooculogram
CorrectAnswer-AAns.is'a'i.e.,MRIBrainandorbit[RefKanski8th/eChap.19,p.784]MagneticResonanceImaging(MRI)isfarmoresuperiorforthestudyofsofttissueandthus,formostneuro-ophthalmicconditions,MRIistheinvestigationofchoice.
1025.Enophthalmosisseenin?
a)Blowoutfractureoforbitwall
b)Hyperthyroidism
c)RadiationInjuries
d)Diabetesmellitus
CorrectAnswer-AAns.is'a'i.e.,BlowoutfractureoforbitwallEnophthalmosisseeninblowoutfractureoforbitwall.
1026.Ocularfindingsindiabetesareallexcept-
a)Retinopathy
b)Earlysenilecataract
c)Neovascularglaucoma
d)Blepharophimosis
CorrectAnswer-DAns.is'd'i.e.,Blepharophimosis[RefKanski's8`Vechapter13,p.520]
1027.Mucinlayertearflilmdeficiencyoccursin:
a)Keratoconjunctivitissicca
b)Lacrimalglandremoval
c)Canalicularblock
d)Herpetickeratitis
CorrectAnswer-AAi.eKeratoconjunctivitissicca
1028.Whichofthefollowingisalongtermsideeffectofphakic10Ls
a)Chronicglaucoma
b)Retinaldetachment
c)Opticneuritis
d)None
CorrectAnswer-AAns.is'a'i.e.,Chronicglaucoma[RefChenLI,etal.Metaanalysisofcataractdevelopmentafterphakicintraocularlenssurgery.JCataractRefractSurg2008;34:1181-200.]Phakicintraocularlenses(pIOLs)areartificiallensesthatareinsertedeitherontopoftheirisorinbetweentheirisandthenaturallens.Theyareusedtotreatrefractiveerrorwithoutremovingcorneatissueorthelens.LongtermrisksofphakicIOLSChronicintraocularpressureelevationcanproduceindolentvisiondamagefromangleclosureglaucoma.Thesurgicalprocedureitselfalsoinducessomeendothelialcelldamageandiftheprostheticisincloseproximitytothecornea,chroniclosscouldbeinduced.Finally,chronicinflammationorprosthetic-lenstouchcaninducecataractformation
1029.Mostcommonprotozoancausingkeratitisis
a)Plasmodium
b)Acanthamoeba
c)Toxoplasma
d)W.bancrofti
CorrectAnswer-BAns.is`b'i.e.,Acanthamoeba[RefKanski8th/ep.197]"Acanthamoebakeratitisisthemostcommonkeratitiscausedbyaprotozoanespeciallyincontactlensusers".
1030.Smokersarepronetowhichlunginfection
a)Mycobacteriumtuberculosis
b)Pneumonia
c)Influenza
d)Alltheabove
CorrectAnswer-DAnswer-D.Alltheabove
1031.SomepatientswithsevereformofIdiopathicinfantilehypercalcemia,presntwithphenotypicfeaturessimilartowhichofthefollowing?
a)Williamssyndrome
b)Potterssyndrome
c)Angelmansyndrome
d)VHLsyndrome
CorrectAnswer-AAnswer-A.WilliamssyndromeInthesevereform,PrenatalandpostnatalgrowthfailurearecommonandnumberofphenotypicfeaturesofWilliamssyndromeareobservedinsomeofthepatientsincludecardiovascularabnormalities(usuallysupravalvularaorticstenoisandperipheralpulmonicstenosis),latepsychomotordevelopment,selectivementaldeficiency,acharacteristicunusualfaciesandshortstature.Theserumcalciumlevelsrangebetween12-19mg/dL.
1032.Whichliverdisease/sis/areassociatedwithductopenia?
a)Chronicgraftrejection
b)Hepaticsarcoidosis
c)Paraneoplasticsyndromerelatedtohodgkinslymphoma
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveLossofbileductsfromtheportaltractsisreferredtoasductopenia.Ductopeniaismostcommonlyseenrelatedtochronicallograftrejectionandincludesdrugrelatedinjury,primarybinarycirrhosis,primarysclerosingcholangitis,chronicgraft-vs-hostdisease,hepaticsarcoidosis,paraneoplasticsyndromerelatedtoHodgkindisease,andsyndromicpaucityofbileducts(Alagillesyndrome).
1033.1to2mmhaemorrhagesinskinareknownas:
a)Microbleed
b)Petechiae
c)Purpura
d)Noneoftheabove
CorrectAnswer-BMinute1-to2-mmhemorrhagesintoskin,mucousmembranes,orserosalsurfacesarecalledpetechiae.Thesearemostcommonlyassociatedwithlocallyincreasedintravascularpressure,lowplateletcounts(thrombocytopenia),ordefectiveplateletfunction(asinuremia).Ref:Robbins8theditionChapter4.
1034.Whichofthefollowingisnottrueaboutmetabolicsyndrome?
a)ItisalsocalledSyndromeX
b)Acanthosisandsignsofhyperandrogenismmaybeseen
c)TypeAhasautoantibodiesagainsttheinsulinreceptor
d)Insulinresistanceincreasestheriskoftype2DMinpatientswithPCOS
CorrectAnswer-CAnswer-C.TypeAhasautoantibodiesagainsttheinsulinreceptorItisaninsulinresistanceconditionwhichcomprisesaspectrumofdisorders,withhyperglycemiarepresentingoneofthemostreadilydiagnosedfeatures.Themetabolicsyndrome,theinsulinresistancesyndrome,orsyndromeXaretermsusedtodescribeaconstellationofmetabolicderangementsthatincludesinsulinresistance,hypertension,dyslipidemia(decreasedHDLandelevatedtriglycerides),centralorvisceralobesity,type2diabetesorIGT/IFG,andacceleratedcardio-vasculardisease.Acanthosisnigricansandsignsofhyperandrogenism(hirsutism,acne,andoligomenorrheainwomen)arealsocommonphysicalfeatures.Twodistinctsyndromes-
1. typeA,whichaffectsyoungwomenandischaracterizedbyseverehyperinsulinemia,obesity,andfeaturesofhyperandrogenism;andtypeAinsulinresistancesyndromehaveanundefineddefectintheinsulin-signalingpathway.
2. typeB,whichaffectsmiddle-agedwomenandischaracterizedby
severehyperinsulinemia,featuresofhyperandrogenism,andautoimmunedisorders.
1035.MetabolicsyndromediagnosisinmenbasedonNCEPATPIIIcriteriaincludesthefollowingexcept
a)Abdominalobesity>40inches
b)HDL<50mg/dL
c)BP>/=130/85mmHg
d)Fastingglucoe>110mg/dL
CorrectAnswer-BAnswer-B.HDL<50mg/dL
1036.Waterhammerpulseseenin
a)>Aorticstenosis
b)>Aorticregurgitation
c)>AorticstenosisandAorticregurgitation
d)>Mitralregurgitation
CorrectAnswer-BAorticregurgitation[Ref.Harrison17h/ep1476&166/ep1400Kundu,bedsideclinicsinmedicine]WaterhammerpulseItisalargeboundingpulse,associatedwithincreasedstrokevolumeoftheleftventricleanddecreaseintheperipheralresistance,leadingtoawidepulsepressure.Thepulsestrikesthepalpatingfingerwitharapid,forcefidjerkandquicklydisappears.Itisbestfeltintheradialarterywiththepatientsarmelevated.ItisseeninAorticregurgitation.PathophysiologyofwaterhammerpulseInAorticregurgitationthestrokevolumeishigh,sothesystolicpressureishighandthisisresponsibleforsharpriseinthepulse.Thestrokevolumeishighbecausetheleftventriclegetsbloodfromtwosourcesduringthediastolei.e.bloodleakingfromtheAortaandtheblooditreceivesfromleftatria.ThecollapseoccursbecauseDiastolicleakofbloodintotheleftventriclefromtheAortaRapidrunofftotheperipheryasaresultoflowsystemicvascularresistance(theincreasedcardiacoutputstimulatesthebaroreceptorsintheaorticarchandtheresultisreflexvasodilatationoftheperipheralvesselsintowhichthebloodflowsrapidly).
Wiryarearmselevatedintheexamination?Whenthearmisraisedthereisfallofbloodcolumnresultinginvasodilationandthushelpstoreducethediastolicpressuremore,sothepulsepressurewidens.ItmaybesothatthearterypalpatedbecomesmoreinthelineofAortaafterelevationofthearmandthusallowsthedirectsystolicejectionanddiastolicbackwardflow.
1037.FALSEstatementregardingtheECGinacutepericarditisis:
a)TwaveinversiondevelopbeforeSTelevationsreturntobaseline
b)GlobalSTsegmentelevationisseeninearlypericarditis
c)Sinustachycardiaisacommonfinding
d)PRsegmentdepressionispresentinmajorityofpatients
CorrectAnswer-ATwaveinversiondevelopafterSTelevationsreturntobaseline.
TherearefourstagesofECGchangesintheevolutionofacutepericarditis.Instage1,thereiswidespreadelevationoftheSTsegments,oftenwithupwardconcavity,involvingtwoorthreestandardlimbleadsandV2toV6,withreciprocaldepressionsonlyinaVRandsometimesV1,aswellasdepressionofthePRsegmentUsuallytherearenosignificantchangesinQRScomplexes.Instage2,afterseveraldays,theSTsegmentsreturntonormal,andonlythen,orevenlater,dotheTwavesbecomeinverted(stage3).Ultimately,weeksormonthsaftertheonsetofacutepericarditis,theECGreturnstonormalinstage4.
Ref:Harrisonsprinciplesofinternalmedicine,18thedition,Page:1971
1038.Ejectionclickofpulmonarystenosisisbetterheardin
a)Inspiration
b)Expiration
c)Patientbendingforward
d)Patientlyinginleftlateralposition
CorrectAnswer-BAnswer-B.ExpirationItemanatesfromastenoticpulmonaryvalveoradilatedpulmonaryartery.Itsmostcharacteristicfeatureistodisappearorbecomemarkedlysofterwithinspirationi.e.itisbetterheardinexpiration.Itislocalizedto2ndand3rdintercostalspaces.Theymayalsobepresentinpatientswithpulmonaryhypertentionortheoneswithdilatedpulmonaryartery.
1039.ReciprocalchangesinECGinpatientswithinferiorwallmyocardialinfarctionareseeninwhichleads
a)I
b)II
c)III
d)aVF
CorrectAnswer-AAnswer-A.I
1040.Allarefeaturesofaorticstenosisexcept
a)Congestiveheartfailureduetosystolicordiastolicdysfunction
b)Presenceofejectionsystolicmurmur
c)Presenceofpulsustardus
d)Pressureintheaortaisthesameasinleftventricle
CorrectAnswer-DAnswer-D.PressureintheaortaisthesameasinleftventricleClinicalFindings-SystolicejectionmurmurCarotidpulsusparvusettardusDiminishedaorticcomponentof2ndheartsoundSuddendeathinseverestenosisafterexerciseClassicaltriad-AnginaSyncopeShortnessofbreath(heartfailure)
1041.Whichofthefollowingisnottrueaboutbicuspidaorticvalve?
a)Usuallyundetectedinearlylife
b)Itismorecommoninfemalesthaninmales
c)Post-stenoticdilatationofascendingaortacanbeseen
d)Diagnosisismadebyechocardiography
CorrectAnswer-BAnswer-B.ItismorecommoninfemalesthaninmalesThecongenitalbicuspidaorticvalve,whichmayinitiallybefunctionallynormal,isoneofthemostcommoncongenitalmalformationsoftheheartandmaygoundetectedinearlylife.Morefrequentinmales(3:1)Diagnosisismadebyechocardiography,whichrevealsthemorphologyoftheaorticvalveandaorticrootandquantitatesseverityofstenosisorregurgitation.Theascendingaortaisoftendilated,misnamed"poststenotic"dilatation;thisisduetohistologicabnormalitiesoftheaorticmediasimilartothoseinMarfan'ssyndromeandmayresultinaorticdissection.
1042.Whichofthefollowinghemodynamicchangesisnotevidentincardiactamponadeduringdiastole?
a)Rightatrialandventricularcollapse
b)AbsentywaveonJVP
c)Biphasicvenousreturn
d)Elevatedpericardialpressure
CorrectAnswer-CAnswer-C.BiphasicvenousreturnDuringthediastolethepericardialpressureremainselevated.ItisgreaterthantheintracavitarypressurethusthereisnofillingduringthediastoleTheabsenceofvenousreturnduringthediastoleleadstoabsenceof"y"wavesontheJ.V.P.andthe"diastoliccollapse"oftherightatriaandventricle.
1043.Majorcriteriaforinfectiveendocarditisincludewhichofthefollowing
a)Injectiondruguser
b)Fever
c)Oslersnodes
d)Typicalorganismofinfectiveendocarditisisolatedfromtwoseparatebloodcultures
CorrectAnswer-DAnswer-D.Typicalorganismofinfectiveendocarditisisolatedfromtwoseparatebloodcultures
1044.WhichofthefollowingECGfeaturesarenotseeninpatientswithventriculartachycardias?
a)BizzareQRScomplexes
b)PresenceofAVdissociation[fusionbeats]
c)ProlongeddurationofQRScomplexes
d)Ppulmonale
CorrectAnswer-DAnswer-D.PpulmonaleAVdissociation(atrialcapture,fusionbeats)QRSduration>140msforRBBBtypeV1morphology,VI>160msforLBBBtypeVImorphologyFrontalplaneaxis-900to1800DelayedactivationduringinitialphaseoftheQRScomplexLBBBpattern-RwaveinV1,V,>40msRBBBpattern-onsetofRwavetonadirofS>100msBizarreQRSpatternthatdoesnotmimictypicalRBBBorLBBBQRScomplex.ConcordanceofQRScomplexinallprecordialleadsRSordominantSinV6forRBBBVTQwaveinV6withLBBBQRSpatternMonophasicRorbiphasicqRofR/SinV,withRBBBpattern
1045.Cerebro-occulo-genitalsyndromehasthefollowingfeaturesexcept
a)Microcephaly
b)Shortstature
c)Agenesisofcorpuscallosum
d)Flaccidquadriplegia
CorrectAnswer-DAnswer-D.FlaccidquadriplegiaCerebro-occulo-genitalsyndromeisassociatedwithmicrocephaly,shortstature,microophthalmia,agenesisofcorpuscallosum,hypospadiasandspasticquadriplegia.
1046.Pulsusbiseferians,whichofthefollowingisnottrue
a)Itisseeninaorticregurgitation
b)Itisbetterfeltinperipheralarteries
c)Ithasonepeakinsystoleandoneindiastole
d)Ithastwopeaks
CorrectAnswer-CAnswer-C.IthasonepeakinsystoleandoneindiastoleItischaracterizedbytwosystolicpeaks.Itisseeninpatientsofaorticregurgitation.Thepulsewaveupstrokerisesrapidlyandforcefullyproducingthefirstsystolicpeak(percussionwave).Abriefdeclineinpressureisfollowedbyasmallerandsomewhatslowerrisingpositivepulsewave.Inbisiferianspulsethesecondriseinsystoleisenhancedbyreflectionfromperipheralarteriesthereforeitismoreprominentinperipheralpulse.
1047.ThemostcommonreentranttachycardiaassociatedwithWPWsyndromeis
a)OrthodromicAVreentry
b)AntidromicAVreentry
c)RapidlyconductingAF
d)None
CorrectAnswer-AAnswerisA(OrthodromicAVreentry)123.Themostcommonmacro-reentranttachycardiaassociatedWPWsyndromeisorthodromicAVreentry.Themostcommonmacro-reentranttachycardiaassociatedwithWPWsyndromeisreferredtoasOrthodromicAVreentry'
1048.SquarewaveseeninECGrecordingdenote
a)Atrialdepolarization
b)Ventriculardepolarization
c)Ventricularrepolarization
d)StandardizationofECG
CorrectAnswer-DAnswer-D.StandardizationofECGEachECGmachinehasaprovisionforStandardization(STD)ofCalibration(CAL).Thestandardizationleverreleasesacurrentof1mVtothestylusofECGmachinethatrecordsashiftof10mmontheECGpaper.Thestandardizationcurrentgivesrisetoawavepatterncalledsquarewavepatternasdepictedintheimagebelow.
1049.WhichofthefollowingisnottrueaboutTorsadesdepointes?
a)PresenceofprolongedQTintervalonECG
b)PresenceofpolymorphicQRScomplexes
c)Itisatypeofsupraventriculartachycardia
d)QRScomplexesappeartorotatearoundtheisoelectricbaselineofECG
CorrectAnswer-CAnswer-C.ItisatypeofsupraventriculartachycardiaThesignificanceofthelongQTsyndromeisitsassociationwiththedevelopmentofaspecifictypeofventriculartachycardiacalledTorsadesdepointsorpolymorphicventriculartachycardiaAwidecomplextachyarrythmiawithQRScomplexesofvaryingaxisandmorphologythatappeartorotatearoundtheisoelectricbaseline.
1050.ProlongedQTintervalisseeninallofthefollowingexcept
a)Hypokalemia
b)Hypocalcemia
c)Useofmacrolideantibiotitcs
d)Hypernatremia
CorrectAnswer-DAnswer-D.HypernatremiaMetabolicHypokalemiaHypocalcemiaHypomagnesemia
1051.Followingaretheclinicalsignsofwidenedpulsepressureseeninpatientsofaorticregurgitationexcept
a)Corriganssign
b)DeMussetssign
c)WaterHammerpulse
d)Diastolicmurmur
CorrectAnswer-DAnswer-D.DiastolicmurmurCorrigan’spulse:ArapidandforcefuldistensionofthearterialpulsewithaquickcollapseDeMusset’ssign:Bobbingoftheheadwitheachheartbeat(likeabirdwalking)Muller’ssign:VisiblepulsationsoftheuvulaQuincke’ssign:CapillarypulsationsseenonlightcompressionofthenailbedTraube’ssign:Systolicanddiastolicsoundsheardoverthefemoralartery(“pistolshots”)Duroziez’ssign:GradualpressureoverthefemoralarteryleadstoasystolicanddiastolicbruitHill’ssign:Poplitealsystolicbloodpressureexceedingbrachialsystolicbloodpressureby≥60mmHg(mostsensitivesignforaorticregurgitation)Waterhammerpulse
1052.AllofthefollowingarecharacteristicfeaturesofTricuspidAtresiaexcept-
a)LeftAxisdeviation
b)Rightventricularhypoplasia
c)Pulmonaryvascularityisdiminished
d)SplittingofS2
CorrectAnswer-DAns.is'd'i.e.,SplitingofS2Atresiaofthetricuspidvalveresultsintheabsenceofacommunicationbetweentherightatriumandrightventriclethereforetherightventricleisunderdevelopedtheinflowportionbeingabsent.TheonlyexitforsystemicvenousbloodcomingtotherightatriumisbywayofAtrialSepta!defect.Throughthisthebloodgoestoleftatriumfromwhereitentersleftventricle.Aventricularseptaldefectprovidescommunicationbetweentheleftventricleandtheoutflowportionoftherightventricle.TheleftventriclethereforemaintainboththesystemicaswellasthepulmonarycirculationthusthereishypertrophyoftheleftventriclewhichisreflectedbyleftaxisdeviationinECG.Thepulmonarybloodflowisdependentonthesizeoftheventriculardefect,thesmallertheVSD,thelesserthepulmonarybloodflow.90%patientsofTriscuspidAtresiahavediminishedpulmonarybloodflow.oAuscultatoryfindingincaseofTricuspidAtresiaS1-NormalS2-SingleMurmurgradeIItogradeIII/VI
1053.Episodeofstableanginapectoristypicallylastsfor
a)Lessthan1min
b)2-5mins
c)5-10mins
d)>10mins
CorrectAnswer-BAnswer-B.2-5minsAnginaisusuallycrescendo-decrescendoinnature,typicallylasts2to5min,andcanradiatetoeithershoulderandtobotharms(especiallytheulnarsurfacesoftheforearmandhand).Italsocanariseinorradiatetotheback,interscapularregion,rootoftheneck,jaw,teeth,andepigastrium.Anginaisrarelylocalizedbelowtheumbilicusorabovethemandible.
1054.Levinesignisseenin
a)Stableanginapectoris
b)Acutebronchialasthma
c)Hemolyticanemia
d)Gastroesophagealrefluxdisease
CorrectAnswer-AAnswer-A.StableanginapectorisStableAnginaPectoris:ThisepisodicclinicalsyndromeisduetotransientmyocardialischemiaWhenthepatientisaskedtolocalizethesensation,heorshetypicallyplacesahandoverthesternum,sometimeswithaclenchedfist,toindicateasqueezing,central,substernaldiscomfort(Levine'ssign).
1055.NotTrueaboutPrinzmetal'sangina:
a)Maypresentatrest
b)Occursdueatheroscleroticobstructionofcoronaryarteries
c)Smokingisariskfactor
d)Nitratesareusedfortreatment
CorrectAnswer-BAnswer-B.OccursdueatheroscleroticobstructionofcoronaryarteriesThissyndromeisduetofocalspasmofanepicardialcoronAryartery,leadingtoseveremyocardialischemialeadingtoseveremyocardialischemia.Therightcoronaryarteryisthemostfrequentsite,followedbytheleftanteriordescendingcoronaryartery.Acetylcholinereleasedbytheparasympatheticsystematrestwillsimplycausecontractionofthevascularsmoothmuscle.ItusuallyoccursatrestandisassociatedwithtransientST-segmentelevation.Etiologycigarettesmokers
1056.ThemostcommontoxincausingDilatedCardiomyopathyis:
a)Alcohol
b)Chemotherapeuticagents
c)Heavymetal
d)Occupationalexposure
CorrectAnswer-AAnswerisA(Alcohol)ChronicAlcoholConsumptionisthemostcommoncauseofToxicDilatedCardiomyopathy.Alcoholisthemostcommontoxinimplicatedinchronicdilatedcardiomyopathy'Note:DilatedcardiomyopathyisthemostcommontypeofcardiomyopathyThemostcommoncauseofdilatedcardiomyopathyisIdiopathic(Two-Thirds)AlcoholConsumptionisthemostcommoncauseofToxicDilatedCardiomyopathy
1057.Obstructiveshockcanbeseenin
a)Pulmonaryembolism
b)Tensionpneumothorax
c)Pericardialtamponade
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveCausesintraumapatientsincludepulmonaryembolism,pericardialtamponade,acutecoronarysyndromes,increasedintrathoracicpressureasintensionpneumothorax,positivepressureventilationandexcessivePEEP.
1058.Pharmacologicalstressduringstressmyocardialradionucleotideperfusionimagingcanbeinducedusing
a)Dipyridamole
b)Adenosine
c)Dobutamine
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveDipyridamoleoradenosinecanbegiventocreateacoronary"steal"bytemporarilyincreasingflowinnondiseasedsegmentsofthecoronaryvasculatureattheexpenseofdiseasedsegments.Alternatively,agradedincrementalinfusionofdobutaminemaybeadministeredtoincreaseMVO2.Thedevelopmentofatransientperfusiondefectwithatracersuchasthallium-201or99m-technetiumsestamibiisusedtodetectmyocardialischemia.
1059.Whiletreatingpatientswithmalignanthypertentionthemaximumalloweddecreaseinbloodpressureinthefirst2-6hoursshouldnotexceed%
a)15
b)20
c)25
d)30
CorrectAnswer-CAnswer-C.25HypertensionwithsystolicBP180mmHganddiastolicBP120mmHgisclassifiedas"severehypertension".Severehypertension(180/120)doesnotnecessarilymeanhypertensiveemergencyormalignanthypertension.?PatientswithB.P.180/120mayremainasymptomaticwithoutcausinganycomplications.Theinitialaimoftreatmentinmalignanthypertensionandhypertensiveencephalopathyistolowerdiastolicbloodpressuretoabout100to105mmHgwithinminutesto,two-sixhourswiththemaximumfallinB.P.overthisperiodoftimenotexceeding25%oftheoriginalvalue.
1060.ECGpatternseeninpulmonaryembolismis:September2009,March2013
a)S3Q3T1
b)S1Q1T3
c)S1Q3T3
d)S3Q3T3.
CorrectAnswer-CAns.C:S1Q3T3
1061.Contraindicationforpercutaneousballonmitralvalvotomyincludethefollowingexcept
a)Presenceofpulmonaryhypertension
b)Leftatrialthrombus
c)Severemitralregurgitation
d)Commissuralcalcification
CorrectAnswer-AAnswer-A.PresenceofpulmonaryhypertensionPatientswithvalvularcalcification,thickenedfibroticleafletswithdecreasedmobilityandsubvalvularfusion,haveincidenceofacutecomplicationsandhigherrateofrestenosisonfollowup.Suchpatientsareconsideredacontraindicationfortheprocedure.Othercontraindicationsincludemorethanmoderatemitralregurgitation,presenceofleftatrialthrombi,andcommissuralcalcification.
1062.Mitralvalvereplacementisrecommendedinpatientswith
a)ModerateMSinNYHAclassII
b)ModerateMSinNYHAclassIII
c)SevereMSinNYHAclassII
d)SevereMSinNYHAclassIII
CorrectAnswer-DAnswer-D.SevereMSinNYHAclassIIISincetherearealsolong-termcomplicationsofvalvereplacement,patientsinwhompreoperativeevaluationsuggeststhepossibilitythatMVRmayberequiredshouldbeoperatedononlyiftheyhavesevereMS—i.e.,anorificearea"1cm2—andareinNYHAClassIII,i.e.,symptomaticwithordinaryactivitydespiteoptimalmedicaltherapy".
1063.HOCMiscommoninwhichagegroup?
a)10-30years
b)20-40years
c)30-50years
d)40-60years
CorrectAnswer-BAnswer-B.20-40yearsHypertrophiccardiomyopathyischaracterizedbymarkedleftventricularhypertrophyintheabsenceofothercauses,suchashyper-tensionorvalvedisease.Earliertermedhypertrophicobstructivecardiomyopathy(HOCM)Hypertrophiccardiomyopathyischaracterizedhemodynamicallybydiastolicdysfunction,originallyattributedtothehyper¬trophy,fibrosis,andintraventriculargradientwhenpresent.Hypertrophiccardiomyopathyusuallypresentsbetweentheagesof20and40years.Dyspneaonexertionisthemostcommonpresentingsymptom,reflectingelevatedintracardiacfillingpressures
1064.Preferredveinforcentralvenouscatheterinsertionis
a)Rightinternaljugularvein
b)Leftinternaljugularvein
c)Rightsubclavianvein
d)Rightantecubitalvein
CorrectAnswer-AAnswer-A.RightinternaljugularveinPlacementofthecentralvenouscatheterisindicatedforthemonitoringofthecentralvenouspressureandforprolongeddrugadministrationforparenteralnutrition.Thepreferredsiteforinsertionofcatheterintothesuperiorvenacavaisfrominternaljugularveinoftheneck.Otherusedsitesarefromthesubclavianveinorfromtheperipheralveinintheantecubitalfossa.Commonlyusedveincannulationsitesforcentralvenousaccessinclude:JugularveinExternaljugularveinInternaljugularvein(central,posterior,anteriorapproaches)Subclavianvein(supraclavicular,infraclavicular,axillaryapproaches)FemoralveinBasilicvein
1065.KerleyBlinesseeninmitralstenosiswhentherestingleftatrialpressureexceeds
a)10mmHg
b)20mmHg
c)30mmHg
d)40mmHg
CorrectAnswer-BAnswer-B.20mmHgKerleyBlinesarefine,dense,opaque,horizontallinesthataremostprominentinthelowerandmid-lungfieldsandthatresultfromdistentionofinterlobularseptaeandlymphaticswithedemawhentherestingmeanLApressureexceedsapproximately20mmHg.
1066.Whichofthefollowingisthemostcommonanamolyinpatientswithfanconi'sanemia?
a)Hyperpigmentationofthetrunk,neckandintertriginousareas
b)Absentradiiandthumb
c)Weakradialpulse
d)Presenceofhorseshoekidneys
CorrectAnswer-AAnswer-A.Hyperpigmentationofthetrunk,neckandintertriginousareasFanconianemia(FA)isprimarilyinheritedinanautosomalrecessivemanner(oneuncommonformisX-linkedrecessive).ThemostcommonanomalyinFAishyperpigmentationofthetrunk,neck,andintertriginousareas,aswellascafé-au-laitspotsandvitiligo,aloneorincombination.Anomaliesofthefeet,congenitalhipdislocation,andlegabnormalitiesareseen.
1067.Patientswithwhichofthefollowingconditionsareatgreatestriskofpernio
a)Raynaud'sphenomenon
b)Kawasakidisease
c)HenochSchonlenpurpura
d)HepatitisCinfection
CorrectAnswer-AAnswer-A.Raynaud'sphenomenonThetwomostcommonnonfreezingperipheralcoldinjuriesarechilblain(pernio)andimmersion(trench)foot.Chilblainresultsfromneuronalandendothelialdamageinducedbyrepetitiveexposuretodrycold.Youngfemales,particularlythosewithahistoryofRaynaud'sphenomenon,areatgreatestriskofpernio(chilblain).Persistentvasospasticityandvasculitiscancauseerythema,mildedema,andpruritus.Eventuallyplaques,bluenodules,andulcerationsdevelop
1068.FEVI/FVCisdecreasein:
a)Asthma
b)Kyphosis
c)Scoliosis
d)Fibrosis
CorrectAnswer-AAnswerisA(Asthma):DecreasedFEV1/FVCsuggestsadiagnosisofObstructiveLungDisease.AmongsttheoptionsprovidedAsthmaistheonlyconditionthatleadstoObstructivePatternofLungDiseaseandhenceistheanswerofchoiceKyphosis,ScoliosisandFibrosisareRestrictiveLungDiseasesthatarecharacterizedbyNormalorElevatedFEVI/FVCratios.
1069.WhatisTiffeneau-Pinelliindex?
a)FEV1/FVCratio
b)Bodymassindex
c)Quetletindex
d)Ventilation/Perfusionratio
CorrectAnswer-AAnswer-A.FEV1/FVCratio
1070.Lightscriteriaisusedfor
a)Pleuraleffusions
b)Pericardialeffusions
c)Ascites
d)Increasedintracranialtension
CorrectAnswer-AAnswer-A.PleuraleffusionsLight'scritenaforclassificationofunilateralpleuraleffusionThepleuralfluidisanexudateifoneormoreofthefollowingciteriaaremet.Pleuralfluidproteindividedbyserumprotein>0.5PleuralfluidlacatodehyoctogenaseLDHdividedbyserumLDH>0.6
1071.Commoncauseofdeathinapatientwithchronicbronchieactasisis
a)Rightsidedheartfail
b)Infection
c)Hemoptysis
d)Carcinoma
CorrectAnswer-AAnswer-A.RightsidedheartfailIntodaysworld,rightsidedheartfailureinpatientswithdiffuselongstandingbronchieactasisisacommoncauseofdeathinpatientswithchronicbronchieactasis.Pneumoniaandhemorrhagearelesscommoncausesofdeath.
1072.Leutrieneinhibitorsareusedinasthmafor
a)Monotherapyforacuteattack
b)Add-ontherapyinpatientsnotcontrolledbylowdoseinhaledglucocorticoids
c)Statusasthmaticus
d)Noneoftheabove
CorrectAnswer-BAnswer-B.Add-ontherapyinpatientsnotcontrolledbylowdoseinhaledglucocorticoidsCysteinyl-leukotrienesarepotentbronchoconstrictors,causemicrovascularleakage,andincreaseeosinophilicinflammationthroughtheactivationofcys-LT1-receptors.Lukotrieneinhibitorssuchasmontelukastandzafirlukast,blockcys-LT1-receptorsandprovidemodestclinicalbenefitinasthma.Theyarelesseffectivethaninhaledcorticosteroidsincontrollingasthmaandhavelesseffectonairwayinflammation,butareusefulasanadd-ontherapyinsomepatientsnotcontrolledwithlowdosesofinhaledcorticosteroids.
1073.Apneahypoapneaindexindicatingobstructivesleepapneais-
a)<1
b)2-5
c)5-8
d)>8
CorrectAnswer-AAnswer-A.<1Normalpreschoolandschool-agechildrengenerallyhaveatotalAHIoflessthan1.5(obstructiveAHI<1),andthisisthemostwidelyusedcutoffvalueforObstructiveSleepApneainchildren12yrandbelow;inolderadolescents,theadultcutoffofanAHI5isgenerallyused.
1074.Multipleepisodesofacutechestsyndromeareassociatedwith
a)Asthma
b)Bronchieactasis
c)SLE
d)Sjogrenssyndrome
CorrectAnswer-AAnswer-A.AsthmaPatientpresentswithrecurrentepisodesofacutechestsyndrome.Thecharacteristicsymptomsduringanepisodeofasthmaarewheezing,dyspnea,andcoughing,whicharevariable,bothspontaneouslyandwiththerapy.Prodromalsymptomsmayprecedeanattack,withitchingunderthechin,discomfortbetweenthescapulae,orinexplicablefear(impendingdoom).
1075.Triadofskinlesions,mononeuritismultiplex,eosinophilsseenin
a)Alportssyndrome
b)Churg-Strausssyndrome
c)Cryoglobulinemia
d)Wegenersgranulomatosus
CorrectAnswer-CAnswer-C.CryoglobulinemiaChurg&Straussischaracterizedbyasthma,eosinophilla,extravasculargranulomaformation,vasculitis.ClinicalFeatures-Fever,malaise,anorexia,weightloss.Mononeuritismultiplexisthesecondmostcommonfeatures.Allergicrhinitisandsinusitis.AsthmaPeripheralandtissueeosinophillia,extravascularnecrotizinggranuloma.
1076.Chronicbronchitisissaidtobepresentwhenpatienthaschroniccough
a)3consecutivemonthsinatleasttwoconsecutiveyears
b)2consecutivemonthsfor3consecutiveyears
c)3consecutivemonthsinoneyear
d)1monthinayearfor2consecutiveyears
CorrectAnswer-AAnswer-A.3consecutivemonthsinatleast2consecutiveyears.Cigarettesmokingisthemostimportantriskfactor;airpollutantsalsocontribute.Thedominantpathologicfeaturesaremucushypersecre-tionandpersistentinflammation.Histologicexaminationdemonstratesenlargementofmucous-secretingglands,gobletcellhyperplasia,chronicinflammation,andbronchiolarwallfibrosis.
1077.Brockssyndromeisduetowhichlobeoflung?
a)Rightmiddlelobe
b)Rightlowerlobe
c)Leftupperlobe
d)Leftlowerlobe
CorrectAnswer-AAnswer-A.RightmiddlelobeBrockssyndromeisduetocollapseofrightmiddlelobeoflung.Itisseenasanacutecomplicationofpulmonarytuberculosis.Itoccurssecondarytohilarnodeinvolvement.
1078.PresenceofVelcrocracklesatthelungbaseonauscultationisasignof
a)Scleroderma
b)SystemicLupus
c)WegenersGranulomatosus
d)Polyarteritisnodosa
CorrectAnswer-AAnswer-A.SclerodermaCLINICALFEATURES-Skin-sclerodactyly,Ranaud’sphenomenon,calcinosis,telangiectasia,skinthickening.(inadvancestagefingersbecomeclawlike&facemasklike)Musculoskeletalfeatures-Arthralgia,flexortenosynovitisGIT-oesophagitis,dysphagia,malabsorptionCardiorespiratoryfeatures-pulmonaryfibrosis,pulmonaryhypertensionRenalfeatures-hypertensiverenalcrisisMalignanthypertensionPhysicalexaminationmayreveal"Velcro"cracklesatthelungbases.
1079.FeatureofAcutesevereAsthmaincludeallofthefollowing,Except:
a)Tachycardia>120/min
b)Pulsusparadoxus
c)Respiratoryacidosis
d)Drowsy
CorrectAnswer-AAnswerisA.Tachycardia>120/minDiaphoresisBradycardiaParadoxicalthrocobadominalmovementsPEER<33%HypotensionPulsusparadoxusHypercapneaSilentchest
1080.TypeIVrespiratoryfailureoccursdueto
a)Alveolarflooding
b)InabilitytoeliminateCO2
c)Lungatelactasis
d)Hypoperfusionofrespiratorymuscles
CorrectAnswer-DAnswer-d.HypoperfusionofrespiratorymusclesTypeIVRespiratoryFailure:resultsfromhypoperfusionofrespiratorymusclesinpatientsinshock.Commonlycausedbycardiogenicshock,septicshockandhypovolemicshock.
1081.Type3respiratoryfailureoccursdueto?
a)Post-operativeatelectasis
b)Kyphoscoliosis
c)Flailchest
d)Pulmonaryfibrosis
CorrectAnswer-AAns.is'a'i.e.,Post-operativeatelectasis
1082.Tool/swhichobjectivelyassestheriskofadverseoutcomesinapatientwithpneumoniais/are
a)Pneumoniaseverityindex[PSI]
b)CURB-65criteria
c)ApacheeScore
d)Glasgowscale
CorrectAnswer-A:BAnswer-(A)Pneumoniaseverityindex[PSI](B)CURB-65criteriaToolsthatobjectivelyassesstheriskofadverseoutcomesarethePneumoniaSeverityIndex(PSI),aprognosticmodelusedtoidentifypatientsatlowriskofdying;andtheCURB-65criteria,aseverity-of-illnessscore.TheCURB-65criteriaincludefivevariables:confusion(C);urea>7mmol/L(U);respiratoryrate30/min(R);bloodpressure,systolic"90mmHgordiastolic"60mmHg(B);andage65years(65).
1083.Empyemanecessitansisdefinedassowhen?
a)Pluralempyemaisunderpressure
b)Pleuralempyemahasrupturedintobronchus
c)Pleuralempyemahasrupturedintothepericardium
d)Pleuralempyemaisshowingextensiontothesubcutaneoustissue
CorrectAnswer-DAns.is'd'i.e.,Pleuralempyemaisshowingextensiontothesubcutaneoustissue
1084.InICUsettingpatientssufferingfromwhichrespiratorypathologyareatriskofCO2narcosis?
a)Pneumonia
b)Asthma
c)Emphysema
d)Bronchieactasis
CorrectAnswer-CAnswer-C.EmphysemaHypoventilationsyndromeoccursmostfrequentlyinpatientswithahistoryofchronicCO,retentionwhoarereceivingoxygentherapyforemphysemaorchronicpulmonarydisease.TheelevatedPaco,leadingtoCO,narcosismayhaveadirectanestheticeffect,andcerebralvasodilationfromincreasedPaco,canleadtoincreasedICP
1085.Inspiratorysqueaksarethephysicalexaminationfindingof
a)Bronchiolitis
b)Pulmonaryhypertension
c)Pneumonia
d)Pulmonaryedema
CorrectAnswer-AAnswer-A.BronchiolitisILDassociatedwithinflammationbutarelesslikelytobeheardinthegranulomatouslungdiseases.Cracklesmaybepresentintheabsenceofradiographicabnormalitiesonthechestradiograph.Scatteredlateinspiratoryhigh-pitchedrhonchi—so-calledinspiratorysqueaks—areheardinpatientswithbronchiolitis.Cyanosisandclubbingofthedigitsoccurinsomepatientswithadvanceddisease.
1086.Whichofthefollowingaretheclinicalabnormalitiesofuremia?
a)Hyperphosphatemia
b)Uremicfrost
c)Pepticulcer
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveVolumeexpasion(I)Hyperkalemia(I)Hyponatremia(1)Hyperphosphatemia(I)
1087.WhichtypeofBartter'ssyndromeisassociatedwithmutationsinbarttin?
a)Type1
b)Type2
c)Type3
d)Type4
CorrectAnswer-DAnswer-D.Type4Bartter'ssyndromemayresultfrommutationsaffectinganyoffiveiontransportproteinsintheTAL.Theproteinsaffectedincludetheapicalloopdiuretic-sensitivesodium-potassium-chlorideco-transporterNKCC2(type1),theapicalpotassiumchannelROMK(type2),andthebasolateralchloridechannelC1C-Kb(type3).Bartter'stype4resultsfrommutationsinbarttin,anessentialsubunitofCIC-KaandC1C-Kbthatenablestransportofthechloridechannelstothecellsurface.Barttinisalsoexpressedintheinnerear;thisaccountsforthedeafnessinvariablyassociatedwithBartter'stype4.
1088.Testusedforscreeningforurinarytractinfectionis
a)Nitritetest
b)Nanitroprussidetest
c)PaulBunneltest
d)Fentonstest
CorrectAnswer-AAnswer-A.NitriteTestEffectiveandrapidmethodusedforscreeningurineforthepresenceofbacterialinfection.Testisbasedonthefactthatmostbacteriapresentintheurine,havethecapacitytoreduceurinenitratetonitrite.
1089.Patientwithnephroticsyndromehasdecreasedamountofwhichantibody
a)IgG
b)IgE
c)IgM
d)IgA
CorrectAnswer-AAnswer-A.IgGTheimmunologicalabnormalitiesnotedareverypeculiarIgGantibodyisdecreaseIgEandIgMantibodyincreaseReducedresponsestoPHAandConA(ConcanavalinA)IncreaseofbetamicroglobulinlevelsReducedproductionofIL2IncreasedproductionofvascularpermeabilityandimmunosuppressorfactorsbyCD4TcellsandCD8Tcellsrespectively.
1090.RIFLEcriteriaisusedfordiagnosisof
a)Acutekidneyinjury
b)Acutesplenicinjury
c)Acuteliverinjury
d)Acutebowelinjury
CorrectAnswer-AAnswer-A.AcutekidneyinjuryTheRIFLEcriteria,definesthreesincreasinglevelsofseverityofacutekidneyinjuryonthebasisoftheincreaseinserumcreatinineconcentrationordecreaseinurineoutput.
1091.Whatisoliguria-
a)Excretionoflessthan300m1in24hrs
b)Excretionoflessthan500m1in24hrs
c)Excretionoflessthan300ml.in12hrs
d)Excretionoflessthan100ml.in24hrs
CorrectAnswer-BAns.is'b'i.e.,Excretionoflessthan500mlin24hrs(NotethatBailey&Love25/ep1279(24/ep1300&23/ep1168)writeOliguriatobelessthan300mlin24hrs,butwewouldfollowHarrison&CMDT;NotethatSmith'sUrology17/ep531(16/e,p538)writeitto<400ml/day!!whatanutterconfusion.)
1092.HemodynamicallyimportantlesionsofrenalarterystenosisarepredictedbyrenalarteryvelocitiesmorethanonDopplerultrasound.
a)100cm/s
b)125cm/s
c)150cm/s
d)200cm/s
CorrectAnswer-DAnswer-D.200cm/sRenalarteryvelocitiesbyDopplerultrasoundabove200cm/sgenerallypredicthemodynamicallyimportantlesions(above60%vessellumenocclusion),althoughtreatmenttrialsrequirevelocityabove300cm/stoavoidfalsepositives.Renalresistiveindexhaspredictivevalueregardingtheviabilityofthekidney.Itremainsoperator-andinstitution-dependent.
1093.Gitelman'ssyndromeresemblestheeffectsofwhichofthefollowingdrugs?
a)Thiazide
b)Furosemide
c)Spironolactone
d)Amiloride
CorrectAnswer-AAnswer-A.ThiazideGitelman'ssyndromeisduetomutationsinthethiazide-sensitiveNa-Clco-transporter,NCCT,inthedistalconvolutedtubule(DCT).DefectsinNCCTinGitelman'ssyndromeimpairsodiumandchloridereabsorptionintheDCTandthusresembletheeffectsofthiazidediuretics.Itremainsunclearhowthisdefectleadstoseveremagnesiumwasting.
1094.Autosomalrecessivepolycystickidneydiseaseischaracterisedbythealteredexpressionof:
a)Polycystin
b)Nephrocystin
c)Uromodulin
d)Fibrocystin
CorrectAnswer-DFibrocystin(polyductin)genemutationisseeninautosomalrecessivepolycystickidneydisease.
Note:Polycystinmutationisassociatedwithautosomaldominantpolycystickidneydisease.Nephrocystinisrelatedtonephronophthisis.Uromodulinmutationisseeninmedullarycystickidneydisease.Ref:Harrisonsprinciplesofinternalmedicine,18thedition,Page:2356.
1095.Definitionofcomplicatedurinarytractinfectionis,theinfectionwhichfailtoresolveorrecurwithinweek/sofstandardtherapy.
a)1week
b)2weeks
c)3weeks
d)4weeks
CorrectAnswer-BAnswer-B.2weeksComplicatedurinarytractinfectionsreferstotheinfectionsthatfailtoresolveorrecurwithin2weeksofstandardtherapy.Theseareassociatedwithbacteremiaorsepsisandareassocatedwithperiurethralabscess,obstructionsandpyelonephritis
1096.Apatientpresentswithblunttraumatoabdomen.Oninvestigationspatientisfoundtohavehepaticinjurywhichhasarupturedsubcapsularhematomawithactivebleeding.Whatisthegradeofliverinjury?
a)GradeI
b)GradeII
c)GradeIII
d)GradeIV
CorrectAnswer-CAnswer-C.GradeIII
1097.Excellentpredictorofmortalityandmorbidityinpatientsafterhepatectomyis
a)Serumlactatelevels
b)Serummagnesiumlevel
c)Serumironlevel
d)Serumcopperlevel
CorrectAnswer-AAnswer-A.SerumlactatelevelsHyperlactemiaandhypophosphatemiaarecommonderangementsinpatientsundergoingliverresection.Gluconeogenesiscarriedoutbythelivernormallyconsumes40-60%oflactate.Whentheliverisdamaged,stressedorresected,itproduceslactateratherthanmetabolizingit.Duetotheadditiveeffectsoflactate-containingintravenoussolution,non-lactatecontainingsolutionsarerecommendedforpostoperativeuseafterhepatectomy.
1098.Portalhypertensionissaidtobepresentifportalvenouspressureismorethan:March2010
a)3-5mmHg
b)5-8mmHg
c)10-12mmHg
d)15-20mmHg
CorrectAnswer-CAns.C:10-12mmHgNormalportalpressureisgenerallydefinedbetween5and10mmHg.Portalhypertensionresultswhentheportalpressurerisesto12mmHgorgreaterandcomplicationscanarise,suchasvaricesandascites.Manyconditionsareassociatedwithportalhypertension,ofwhichcirrhosisisthemostcommoncause
1099.AllofthefollowingdrugsmaybeusedinthetreatmentofulcerativecolitisExcept:
a)Corticosteroids
b)Azathioprine
c)Sulfasalazine
d)Methotrexate
CorrectAnswer-DAnswerisD(Methotrexate)Methotrexatehasnotbeenshowntobeeffectivefbrtreatingactiveulcerativecolitisorformaintainingremission.
1100.AsciticfluidSAAG<1.1whatisthediseaseassociatedwith
a)Hepaticfailure
b)Idiopathicportalfibrosis
c)Constrictivepericarditis
d)Peritonealcarcinomatosis
CorrectAnswer-DAnswer-D.PeritonealcarcinomatosisLowalbumingradient(SAAG<1.1g/dL)PeritonealcarcinomatosisPeritonealtuberculosisPancreatitisSerositisNephroticsyndrome
1101.Specificantibodyassociatedwithprimarybiliarycirrhosisis:
a)Anti-myosin
b)Anti-nuclear
c)Anti-mitochondrial
d)Anti-endomysial
CorrectAnswer-CAns.C:Anti-mitochondrialPrimarybiliarycirrhosisisstronglyassociatedwiththepresenceofanti-mitochondrialantibodies(AMA),whicharediagnosticPBC:*AssociatedwithCRESTsyndrome,siccasyndrome,auto-immunethyroiditis,typeIDMandIgAdeficiency*IgGAMAisdetectedinmorethan90%ofpatientswithPBC*90%ofwomenarebetween35-60years*Earliestsymptomispruritis*Eventuallyhepatocellularfailureandportalhypertensiondevelops*Labfindings:-Increasedserumalkalinephosphatase-Increasedserum5-nucleotidaseactivity-Increasedgamma-glutamyltranspeptidase-Serumbilirubinisusuallynormal-Aminotransferaselevelsminimallyincreased-Treatment:Ursodiol
1102.GeneassociatedwiththedevelopmentofPeutz-Jegherssyndromeis
a)STK11
b)PTEN
c)KRAS
d)BRCA1
CorrectAnswer-AAnswer-A.STK11Germlineheterozygousloss-of-functionmutationsinthegeneSTKilarepresentinapproximatelyhalfofindividualswithfamilialPeutz-JegherssyndromeaswellasasubsetofpatientswithsporadicPeutz-Jegherssyndrome.
1103.Whichofthefollowingisnottrueaboutamoebiasis?
a)ALAin10%causesintropics
b)Portalsystemefficientfilter
c)Abscessduetosuppuration
d)Abscesswallgoodforculture
CorrectAnswer-CAns.is'c'i.e.,AbscessduetosuppurationAmebicliverabscessPusinamoebicliverabscessisnotduetosuppuration,butisamixtureofsloughedlivertissueandblood.Itischocolatebrownincolourandthickinconsistency(anchovysaucepus)Inthetropics2-10%oftheindividualsinfectedwithentamoebahistolyticasufferfromhepaticcomplications.Thetrophozoitesarecarriedfromthelargeintestinetotheliverbyportalvein.Intheliverthecapillarysystemactsasefficientfilterandholdstheseparasites.Incaseofamoebicliverabscessthediagnosticaspirationisdonefromtheabscesswallbecausethetrophozoitesareconfinedtotheperiphery.
1104.Righthanddominantpatientpresentswithnormalcomprehensionbutspeakswithshortutterancesofafewwordsatatime,comprisedmostlyofnouns.Whatisthemostprobablelocationofthelesion
a)Leftinferiorfrontalgyrus
b)Rightinferiorfrontalgyrus
c)Leftsuperiortemporalgyrus
d)Rightsuperiortemporalgyrus
CorrectAnswer-AAnswer-A.LeftinferiorfrontalgyrusPatienthasnormalcomprehensionbutspeakswithshortutterancesofafewwordsatatime,comprisedmostlyofnouns.Thesefindingsaresuggestiveofbrocasaphsia.Itisseeninpatientshavingaffectionoftheinferiorfrontalgyrusofthedominanthemisphere.Thepatientisrighthandedsothelefthemisphere,willthedominantone.Thusmostprobablelocationofthelesionisleftinferiorfrontalgyrus.
1105.Pureworddeafnessisassociatedwith
a)Middlecerebralarterystroke
b)Posteriorcerebralarterystroke
c)Vertebralarteryaneurysm
d)Basilararteryaneurysm
CorrectAnswer-AAnswer-A.MiddlecerebralarterystrokeThemostcommoncausesareeitherbilateralorleft-sidedmiddlecerebralartery(MCA)strokesaffectingthesuperiortemporalgyrus.TheneteffectoftheunderlyinglesionistointerrupttheflowofinformationfromtheauditoryassociationcortextoWernicke'sarea.
1106.Globalaphasiaisseendueto
a)Strokesinvolvingentiremiddlecerebralarterydistributioninlefthemisphere
b)Strokesinvolvingentiremiddlecerebralarterydistributioninrighthemisphere
c)Strokesinvolvingentireposteriorcerebralarterydistributioninlefthemisphere
d)Strokesinvolvingentireposteriorcerebralarterydistributioninrighthemisphere
CorrectAnswer-AAnswer-A.StrokesinvolvingentiremiddlecerebralarterydistributioninlefthemisphereThissyndromerepresentsthecombineddysfunctionofBroca'sandWernicke'sareasandusuallyresultsfromstrokesthatinvolvetheentiremiddlecerebralarterydistributioninthelefthemisphere.Relatedsignsincluderighthemiplegia,hemisensoryloss,andhomonymoushemianopia.
1107.LambertEatonsyndrometrueis
a)Itisaparaneoplasticsyndromeassociatedwithsquamouscellcarcinomaoflung
b)IgMantibodiesagainstligandgatedcalciumchannels
c)Thereisincreaseinreleaseofpresynapticacetylcholine
d)Withcontinuousstimulationthereismarkedincreaseinamplitudeofactionpotentials.
CorrectAnswer-DAnswer-D.Withcontinuousstimulationthereismarkedincreaseinamplitudeofactionpotentials.ItisaparaneoplasticsyndromeassociatedwithcancerparticularlysmallcellCaoflung.Itisadisorderofneuromuscularjunctiontransmission(Presynaptic)TheseIgGautoantibodiesagainstthevoltagesensitivecalciumchannelsreducethenumberoffunctioningchannels.Thiscausesdecreaseinreleaseofpresynapticacetylcholine.SymptomsMusclesofthetrunkshouldergirdle,pelvicgirdleandmusclesoflowerextremities(musclesoftheproximallegarethemostcommonlyinvolvedmuscles)Oftenthefirstsymptomsaredifficultyinarisingfromachair,climbingstairsandwalking,theshouldermusclesareaffectedlateron.
1108.WhichisnotseeninAlzheimersdisease
a)Gradualdevelopmentofforgetfulness
b)Defectivevisuospatialorientation
c)Depression
d)Sequenceofneurologicalabnormalitiesfollowsadescribedorder
CorrectAnswer-DAnswer-D.SequenceofneurologicalabnormalitiesfollowsadescribedorderThesequenceofneurologicaldisabilitiesmaynotfollowanydescribedorderandoneoranotherdeficitmaytakepreceedencebutusuallythediseasepreceedesinthefollowingfourobservedpatterns.1)Korsakoffamnesticstate2)Dysnomia3)Visuospatialorientationbecomesdefective4)Paranoiaandotherpersonalitychanges
1109.Whichlobeisaffectedintheearlycourseofalzheimersdisease
a)Frontallobe
b)Parietallobe
c)Medialtemporallobe
d)Lateraltemporallobe
CorrectAnswer-CAnswer-C.MedialtemporallobeStructuresofthemedialtemporallobe,includinghippocampus,entorhinalcortexandamygdala,areinvolvedearlyinthecourseandareusuallyseverelyatrophiedinthelaterstages.
1110.Whichis/aretheusualfirstdeformity/iestobeseeninCMTdisease?
a)Pescavus
b)Clubhand
c)Mannusvalgus
d)Flexiondeformityofknee
CorrectAnswer-AAnswer-A.PescavusCharcot-Marie-Tooth(CMT)diseaseisthemostcommontypeofhereditaryneuropathy.Thereisprogressivemuscleweaknessandatrophythatusuallybeginsinthefirsttwodecadesoflife.Thefirstsignsofthediseaseareusuallypescavus,footdeformitiesandscoliosis.Thereisslowlyprogressiveweaknessandwasting,firstofthefeetandlegsandthenofthehands.ThemostcommonformofCMTistype1,ademyelinatingneuropathywithautosomaldominantinheritance,mappedmostcommonlytotheshortarmofchromosome17.
1111.Huntingtonsdiseaseiscommonlyseeninagegroupbetween
a)15-35years
b)25-45years
c)35-55years
d)45-65years
CorrectAnswer-BAnswer-B.25-45yearsHDisaprogressive,fatal,highlypenetrantautosomaldominantdisordercharacterizedbymotor,behavioral,andcognitivedysfunction.Onsetistypicallybetweentheagesof25and45years(range,3-70years)withaprevalenceof2-8casesper100,000andanaverageageatdeathof60years.Huntigton'sdiseaseischaracterizedbytriadofAutosomaldominantinheritenceChoreoathetosisDementia
1112.WhichcranialnerveisinvolvedinWebersyndrome?
a)II
b)III
c)IV
d)V
CorrectAnswer-BAnswer-B.IIIWeber'ssyndrome-Midbrain-Oculomotornerve-Ipsilateralthird-nervepalsy
1113.Violentabnormalflingingmovementswhichareirregularandaffectingonesidearecalledas-
a)Chorea
b)Athetosis
c)Dystonia
d)Hemiballismus
CorrectAnswer-DAnswer-D.HemiballismusItisdefinedasthedysfunctionintheimplementationofappropriatetargetingandvelocityofintendedmovements,dysfunctionofpostureandabnormalinvoluntarymovement,ortheperformanceofnormalappearingmovementsatinappropriateorunintendedtimes.
1114.Wernickesencephalopathydevelopssecondarytoaccumulationofwhichsubstrate?
a)Glutamate
b)Aspartate
c)Lactate
d)Acetate
CorrectAnswer-AAnswer-A.GlutamateGlutamateaccumulatesowingtoimpairmentofaketoglutamatedehydrogenaseactivityandincombinationwithenergydeficiencymayresultinexcitotoxiccelldamage.
1115.Whichofthefollowingclinicaltestwhenpositivesuggestspresenceofsensoryataxia?
a)Rombergtest
b)Adsontest
c)Stinchfieldtest
d)CrossedSLRtest
CorrectAnswer-AAnswer-A.RombergtestTheRombergtestisatestofthebody'ssenseofpositioning(proprioception),whichrequireshealthyfunctioningofthedorsalcolumnsofthespinalcord.TheRombergtestisusedtoinvestigatethecauseoflossofmotorcoordination(ataxia).ApositiveRombergtestsuggeststhattheataxiaissensoryinnature,thatis,dependingonlossofproprioception.
1116.Toddsparalysisisexperiencefollowingepisodeof
a)Focalseizure
b)Generalisedseizure
c)Aftercorrectionofhyponatremia
d)Aftercorrectionofhypokalemia
CorrectAnswer-AAnswer-A.FocalseizureFocalseizuresarisefromaneuronalnetworkeitherdiscretelylocalizedwithinonecerebralhemisphere.Theroutineinterictal(i.e.,betweenseizures)electroencephalogram(EEG)inpatientswithfocalseizuresisoftennormalormayshowbriefdischargestermedepileptiformspikes,orsharpwaves.Second,patientsmayexperiencealocalizedparesis(Todd'sparalysis)forminutestomanyhoursintheinvolvedregionfollowingtheseizure.
1117.Cerebro-occulo-genitalsyndromehasthefollowingfeaturesexcept
a)Microcephaly
b)Shortstature
c)Agenesisofcorpuscallosum
d)Flaccidquadriplegia
CorrectAnswer-DAnswer-D.FlaccidquadriplegiaCerebro-occulo-genitalsyndromeisassociatedwithmicrocephaly,shortstature,microophthalmia,agenesisofcorpuscallosum,hypospadiasandspasticquadriplegia.
1118.Frontallobesyndromeconsists
a)Euphoria
b)Indifference
c)Irritability
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveEuphoria,indifference,disinhibition,andirritabilityareconsequencesoffrontallobelesions.Theseemotionalandbehaviouraldisturbancesareusuallyreferredtoasfrontallobesyndrome.Otherfeaturesaredecreasedsocialconcern,jocularity,facetiousness,coarseness,hyperkinesia,disinhibition,lossofsocialgraces,inappropriatesexualadvances,sexualexhibitionism,impulsiveness,restlessness,andgrandiosedelusions.
1119.Flappingtremorsarenotseenin
a)CO2toxicity
b)Hypomagnesemia
c)Subarachnoidhemorrhage
d)Carbolicacidpoisoning
CorrectAnswer-DAnswer-D.CarbolicacidpoisoningItisanimportantclinicalsignItisnotpathognomonicofanyconditionbutitgivescluetoseriousunderlyingdiseaseprocess.Flappingtremorisamotordisturbancemarkedbyintermettentlapsesofanassumedpostureasaresultofintermittencyofsustainedcontractionofgroupofmuscles.
1120.Featureswhichdifferentiateseizuresfromsyncopeincludethefollowingexcept
a)Noimmediateprecipitatingfactorslikestress,valsalva,orthostatichypotension
b)Immediatetransitiontounconciousness
c)Presenceofcyanosisandfrothingofmouth
d)Presenceofpremonitorysymptomslikediaphoresisandtunnelingofvision
CorrectAnswer-DAns.D.Presenceofpremonitorysymptomslikediaphoresisandtunnelingofvision
1121.Finetremorsarefoundinwhichdisorder
a)Mercurypoisoning
b)Excesssmoking
c)Hypoglycemia
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveFinetremorsarenotedwhenalimbisheldinanantigravitypostureTheyarenotedinsituationsofcatecholamineexcesssuchasanxietystates,thyrotoxicosis,hypoglycemiaandinalcoholismandexcesssmoking.Theyarealsonotedafteringestionofdrugslikecaffeine,salbutamol,theophylline,amphetamine,tricyclicantidepressants,Lithium,valproate,steroids,andinmercurypoisoning.
1122.Trueaboutelectrophoresisinpatientsofmultiplemyeloma
a)Mcomponentspikeisforthealphaglobulins
b)Monoclonalantibodymustbepresentataconcentrationofatleast10g/L[1.0g/dL]tobeaccuratelyquantitatedbyelectrophoresis
c)McomponentisIgMin53%ofthepatients
d)McomponentisIgAin25%ofthepatients
CorrectAnswer-DAnswer-D.McomponentisIgAin25%ofthepatientsTheimmunoglobulinsmoveheterogeneouslyinanelectricfieldandformabroadpeakinthegammaregion.Theyglobulinregionoftheelectrophoreticpatternisusuallyincreasedintheseraofpatientswithplasmacelltumors.ThereisasharpspikeinthisregioncalledanMcomponent(Mformonoclonal).TheserumMcomponentinmultiplemyelomawillbeIgGin53%ofpatients,IgAin25%,andIgDin1%;20%ofMietitswillhaveonlylightchainsinserumandurine.
1123.Allbutoneistrueforbetathalassemiamajor
a)Growthanddevelopmentisimpaired
b)Redcellcount<4x10'2/L
c)LevelsofHbA2<3.5%
d)Bonemarrowironisdepleted
CorrectAnswer-DAnswer-D.BonemarrowironisdepletedAnaemiaHbgm/dl-<7(severe)IncreasedHbF,HbA2andabsenceofHbA.Severityofdisease++++GrowthanddevelopmentimpairedSplenomegaly++++Skeletalchanges+++ThalassemiafaciesB.M.Iron-decreased
1124.Immunethrombocytopenicpuprpuraassociatedwith
a)HepatitisAinfection
b)HepatitisBinfection
c)HepatitisCinfection
d)HepatitisDinfection
CorrectAnswer-CAnswer-C.HepatitisCinfectionImmunethrombocytopenicpurpura(ITP;alsotermedidiopathicthrombocytopenicpurpura)isanacquireddisorderinwhichthereisimmune-mediateddestructionofplateletsandpossiblyinhibitionofplateletreleasefromthemegakaryocyte.ITPistermedsecondaryifitisassociatedwithanunderlyingdisorder;autoimmunedisorders,particularlysystemiclupuserythematosus(SLE),andinfections,suchasHIVandhepatitisC,arecommoncauses.
1125.WhichofthefollowingisnotacauseofsecondaryIdiopathicthrombocytopenicpurpura?
a)Systemiclupuserythmatosus
b)HepatitisCinfection
c)Rheumatoidarthritis
d)HIVinfection
CorrectAnswer-CAnswer-C.RheumatoidarthritisITPistermedsecondaryifitisassociatedwithanunderlyingdisorder;autoimmunedisorders,particularlysystemiclupuserythematosus(SLE),andinfections,suchasHIVandhepatitisC,arecommoncauses.
1126.Drug/susedinmanagementrelapsedmultiplemyelomais
a)Bortezomib
b)Lenalidomide
c)Doxorubicin
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveThecombinationofbortezomibandliposomaldoxorubicinisactiveinrelapsedmyeloma.Thalidomide,ifnotusedasinitialtherapy,canachieveresponsesinrefractorycases.High-dosemelphalanandstemcelltransplant,ifnotusedearlier,alsohaveactivityinpatientswithrefractorydisease.
1127.TreatmentofchronicphaseofCMLinpregnantwomenis-
a)Imatinib
b)Leukapheresis
c)Spleenectomy
d)Interferontherapy
CorrectAnswer-BAnswer-B.LeukapheresisIntensiveleukapheresismaycontrolthebloodcountsinchronic-phaseCML;however,itisexpensiveandcumbersome.Itisusefulinemergencieswhereleukostasis-relatedcomplicationssuchaspulmonaryfailureorcerebrovascularaccidentsarelikely.SplenectomywasusedinCMLinthepastbecauseofthesuggestionthatevolutiontotheacutephasemightoccurinthespleen.Splenicradiationisusedrarelytoreducethesizeofthespleen.
1128.Whichofthefollowingdrug/scanbeusedforimmediateparenteralanticoagulationinpatientswithvenousthromboembolism?
a)Unfractionedheparin
b)Lowmolecularweightheparin
c)Fondaparinux
d)Alltheabove
CorrectAnswer-DAnswer-D.�AlltheaboveImmediatelyeffectiveanticoagulationisinitiatedwithaparenteraldrug:unfractionatedheparin(UFH),low-molecular-weightheparin(LMWH),orfondaparinux.Oneshoulduseadirectthrombininhibitor�argatroban,lepirudin,orbivalirudin�inpatientswithprovenorsuspectedheparin-inducedthrombocytopenia.Warfarinrequires5-7daystoachieveatherapeuticeffect.
1129.Apatientpresentswithicterus,butthereisnoevidenceofbilirubininurine.Whatisthemostlikelycauseofjaundiceinthispatient?
a)Hemolysis
b)Gallstones
c)Carcinomaheadofpancreas
d)Biliaryatresia
CorrectAnswer-AAnswer-A.HemolysisHemolysisandhyperbilirubinemiaIncreaseddestructionoferythrocytesleadstoincreasedbilirubinturnoverandunconjugatedhyperbilirubinemia;thehyperbilirubinemiaisusuallymodestinthepresenceofnormalliverfunction.Therefore,hemolysisalonecannotresultinasustainedhyperbilirubinemiaofmorethan-68umol/L(4mg/dL).Whenhemolysisistheonlyabnormalityinanotherwisehealthyindividual,theresultisapurelyunconjugatedhyperbilirubinemia.
1130.Trueaboutsideroblasticanemia
a)SeverityofthediseasedependsontheresidualerythroidALAsynthaseactivity
b)Prussianbluestainingsideroblastsareobserved
c)Pyridoxinesupplementationcanbeusedfortreatment
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveXLSAresultsfromthedeficientactivityoftheerythroidformofALA-synthaseandisassociatedwithineffectiveerythropoiesis,weakness,andpallor.Typically,maleswithXLSAdeveloprefractoryhemolyticanemia,pallor,andweaknessduringinfancy.Peripheralbloodsmearsrevealahypochromic,microcyticanemiawithstrikinganisocytosis,poikilocytosis,andpolychromasia;theleukocytesandplateletsappearnormal.AvarietyofPrussianblue-stainingsideroblastsareobserved.Levelsofurinaryporphyrinprecursorsandofbothurinaryandfecalporphyrinsarenormal.
1131.Massivetransfusionisdefinedastransfusionof
a)10/24ormoreredcellproductsinhours.
b)5/12ormoreredcellproductsinhours.
c)10/48ormoreredcellproductsinhours.
d)5/24ormoreredcellproductsinhours.
CorrectAnswer-AAnswer:A10/24ormoreredcellproductsinhours.Variousdefinitionsofmassivebloodtransfusion(MBT)havebeenpublishedinthemedicalliteraturesuchas:Replacementofoneentirebloodvolumewithin24hTransfusionof>10unitsofpackedredbloodcells(PRBCs)in24hTransfusionof>4unitsofPRBCsin1hwhenon-goingneedisforeseeable
1132.WhichisthemostcommoncauseofthrombocytopeniainanICUpatient?
a)Sepsis
b)Bonemarrowfailure
c)ITP
d)Druginduced
CorrectAnswer-AAnswer-A.SepsisThrombocytopeniaisacommonlaboratoryabnormalitythathasbeenassociatedwithadverseoutcomesinICUpatients.Thrombocytopeniaisdefinedasplateletcount<150X103cells/mcL.CommoncausesofthrombocytopeniainICUpatients:SepsisDisseminatedintravascularcoagulationConsumption(eg,majortrauma,cardiopulmonarybypass)Dilution(withmassivetransfusion)MyelosuppressivechemotherapyMechanicalcirculatorysupportdevices(eg,intra-aorticballoonpump)Lesscommonbutimportantcausesofthrombocytopeniathatshouldnotbemissed:Heparin-inducedthrombocytopeniaHemophagocyticsyndromeUncommoncausesofthrombocytopeniathatdevelopduringICUadmissionDrug-inducedthrombocytopenia(otherthanheparinorcytotoxicchemotherapy)
Leukemia,myelodysplasia,aplasticanemia,etc,unlessabnormalitieswerealreadypresentbeforeICUadmission
1133.WhatpercentageofMultiplemyelomapatientshavevertebralinvolvement?
a)22%
b)44%
c)66%
d)88%
CorrectAnswer-CAnswer-C.66%Bonelesionsaremostcommoninthevertebralcolumn.Thefollowingdistributionwasseeninalargeseriesofcases:Vertebralcolumn→66%Ribs-44%Skull→4%Pelvis→28%Femur→28%Clavicle→10%
1134.Multiagentchemotherapyinducesremissioninofthepatientsofacutemyelogenousleukemia
a)65-70
b)75-80
c)85-90
d)95-100
CorrectAnswer-CAnswer-C.�85-90Aggressivemultiagentchemotherapyissuccessfulininducingremissioninapproximately85-90%ofpatients.Prognosticfeatures[t(8;21);t(15;17);inv(16);APL]andimprovedoutcomewithchemotherapy,matchedsiblingstemcelltransplantationisrecommendedonlyafterarelapseMatched-siblingbonemarroworstemcelltransplantationafterremissionachieveslong-termdisease-freesurvivalinabouttwothirdsofpatients.
1135.Incaseofhypothyroidismwhichinvestigationismostinformativeandmostcommonlyused?
a)SerumTSHLevel
b)SerumT3,T4Level
c)SerumCalcitoninassay
d)SerumT3level
CorrectAnswer-AAnsisAieSerumTSHLevel"AnormalTSHLevelexcludesprimary(butnotsecondary)hypothyrodism.IftheTSHiselevatedafreeT4levelisneededtoconfirmthepresenceofclinicalhypothyrodism,butfreeT4isinferiortoTSHwhenusedasascreeningtest,asitwillnotdetectsubclinicalormildhypothyroidism.CirculatingfreeT3levelsarenormalinabout25%ofthepatients,reflectingadaptiveresposetohypothyroidism.T3measurementsarethereforenotindicated."-Harrison"Amongthevariousavailableserumthyroidfunctiontests,TSHisthemostusefultoassessglanddysfunction."?EndocrineSurgeryofHead&Neck,p83.
1136.HbA1ccontrolforhowmuchtime
a)2-3weeks
b)3-6weeks
c)6-8weeks
d)14-18weeks
CorrectAnswer-CAnswer-C.6-8weeksThehalf-lifeofanerythrocyteistypically60days,thelevelofglycatedhemoglobin(HbA1c)reflectsthemeanbloodglucoseconcentrationoverthepreceding6-8weeks.
1137.HbA1Ccriteriaforapatienttobediagnosedwithdiabetesmellitusis
a)>4.5%
b)>5.5%
c)>6.5%
d)>7.5%
CorrectAnswer-CAnswer-C.>6.5%Fastingplasmaglucose>(126mg/dl)Twohourplasmaglucose>(200mg/d1)duringanoralGTTA/C>6.5%
1138.AllareseeninMENIIAsyndromeexcept
a)Medullarycarcinomaofthyroidisseenin100%ofthepatients
b)40-30%patientshavephaeochromocytoms
c)CausedbylossoffunctionmutationinIIRTprotooncogene
d)PrimaryhyperparathyroidismisthemostvariablefeatureofMENIIAsyndrome
CorrectAnswer-CAnswer-C.CausedbylossoffunctionmutationinIIRTprotooncogeneMEN-2AorSipplesyndrome,ischaracterizedbypheochromocytoma,medullarycarcinomaofthethyroid,andparathyroidhyperplasia.Parathyroidhyperplasiaandevidenceofhypercalcemiaorrenalstones.MEN-2AisclinicallyandgeneticallydistinctfromMEN-Iandiscausedbygermlinegain-of-functionmutationsintheRETproto-oncogeneonchromosomel0qll.2.40%to50%havepheochromocytomas.PrimaryhyperparathyroidismisthemostvariablefeatureofMEN2Asyndrome.
1139.Whichofthefollowingisnottrueaboutthedevelopmentofthyroidtumorsinnodulargoiter?
a)Prevalenceofthyroidcarcinomarangesbetween5-15%inthepatientswithmultinodulargoiter
b)Papillarycarcinomaisthemostcommoncarcinomadevelopedinpatientswithnodulargoiter
c)Bothbenignandmalignantneoplasmscanbeseeninpatientswithnodulargoiter
d)TheriskofdevelopmentofcarcinomaisnotcorrelatedwiththelevelofTSH
CorrectAnswer-DAnswer-D.TheriskofdevelopmentofcarcinomaisnotcorrelatedwiththelevelofTSHThyroidtumorsbothbenignandmalignantcanbeseenincolloidgoiterwithbothsolitaryandmultiplenodules.Theprevalenceofthyroidcarcinomarangesfrom5–15%inmultinodulargoiterand8–17%insolitarycolloidnodules.Theprevalenceinhigherinmencomparedtowomenandusuallyoccursinolderagegroup.Themostcommonmalignanttumorarisinginmutinodulargoiterispapillarycarcinoma.Otherlikefollicularcarcinoma,hurthlecellcarcinomaandmedullarycarcinomaarealsoencountered
1140.Tertiaryhyperparathyroidismis-
a)HighPO4levelwithmetastasis
b)SecondaryhyperparathyroidismwithCRF
c)PrimaryhyperparathyroidismwithlowCa"levels
d)Secondaryhyperparathyroidismwithchiefcelladenoma
CorrectAnswer-DAns.is'd'i.e.,SecondaryhyperparathyroidismwithchiefcelladenomaDavidsonstates"InverysmallproportionofcasesofsecondaryhyperparathyroidismcontinuousstimulationoftheparathyroidmayresultinadenomaformationandautonomousPTHsecretion.Thisisknownastertiaryhyperparathyroidism".
1141.Indicationforgivingliothyronineastherapeuticmanagementis
a)Resistantdepression
b)Socialphobia
c)Alzheimersdisease
d)Cataplexy
CorrectAnswer-AAnswer-A.ResistantdepressionItisthesyntheticlevorotatoryisomeroftriiodothyronine(T3).Liothyronineisthemostbroadlyusedthyroidhormonefortreatmentofdepression.Liothyronineisusedtoacceleratetheresponsetotricyclicantidepressantsparticularlyinwomen.Itisknowntoaugmentresponsetoantidepressantsinpatientswithmooddisorders,inthosewhofailedtorespondtoatricyclicantidepressanttrialie.Inpatientswithresistantdepression.
1142.Medicalmanagementofhyperparathyroidismincludeswhichofthefollowing?
a)Bisphosphonates
b)Calcitonin
c)Plicamycin
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveExpansionofintravascularvolume,administrationofloopdiuretics,pharmacotherapywhichreducesosteoclasticboneresorption(likeBisphosphonates,Calcitonin,andPlicamycin)areusefulinthemedicalmanagementofhyperparathyroidism.
1143.Whichofthefollowingcausesofhypercalcemiaisnotassociatedwithhighboneturnover?
a)Hyperthyroidism
b)VitaminAintoxication
c)VitaminDintoxication
d)Thiazides
CorrectAnswer-CAnswer-C.VitaminDintoxicationVitaminDrelatedVitaminDintoxicationIncreased1,25(OH)2Deg.SarcoidosisIdiopathichypercalcemiaofinfancyAssociatedhighboneturnoverHyperthyroidismImmobilizationThiazidesVitaminAintoxication
1144.Fastinghypoglycemiaiscausedbythefollowingexcept
a)Alcoholintake
b)Pentamidinetherapy
c)Renalinsufficiency
d)Chronicpancreatitis
CorrectAnswer-DAnswer-D.ChronicpancreatitisInappropriate(High)InsulinLevelInsulinreactioninpatientswithdiabetes-Thisisthemostcommoncauseofhypoglycemia,duetoanimbalancebetweeninsulinsupplyandinsulinrequirements.Insulinsecretagogueoverdoseintype2diabetespatients-Insulinsecretagoguesareoralhypoglycemicagentsthatworkbystimulatinginsulinreleasefrombetaisletcellsand,herefore,havethepotentialtocausehypoglycemia.Sulfonylureas(themostcommonlyprescribedtypeofthesemedications)areclearedbythekidney,soelderlypatientswithcompromisedrenalfunctionareatriskfordevelopinghypoglycemiawhileontheseagents.Factitioushypoglycemia(selfinducedorinadvertent)AutoimmunehypoglycemiaPentamidine-Pentamidineusedfortreatment/prophylaxisofPCPinpatientswithAIDScancausehypoglycemiabydirectinjurytothebetaisletcellscausinghyperinsulinemia.ExcessInsulinSecretion(Insulinoma)
1145.Diabetesinsipidusissaidtobepresentwhen
a)>30ml/hrurineoutputin24hrsand<260mosml/Losmolarity
b)>40ml/hrurineoutputin24hrsand<280mosml/Losmolarity
c)>50ml/hrurineoutputin24hrsand<300mosml/Losmolarity
d)>60ml/hrurineoutputin24hrsand<320mosml/Losmolarity
CorrectAnswer-CAnswer-C.>50ml/hrurineoutputin24hrsand<300mosml/LosmolarityDecreasedsecretionoractionofargininevasopressinusuallymanifestsasdiabetesinsipidus,asyndromecharacterizedbytheproductionofabnormallylargevolumesofdiluteurine.DImustbedifferentiatedfromotheretiologyofpolyuria.Thetestshouldbestartedinthemorningwithcarefulsupervisiontoavoiddehydration.Bodyweight,plasmaosmolality,serumsodium,andurinevolumeandosmolalityshouldbemeasuredhourly.Thetestshouldbestoppedwhenbodyweightdecreasesby5%orplasmaosmolality/sodiumexceedtheupperlimitofnormal.The24-hoururinevolumeis>50ml/kgbodyweightorurineosmolalityMeasurementofAVPlevelsbeforeandafterfluiddeprivationmaybehelpfultodistinguishcentralandnephrogenicDI.Occasionally,hypertonicsalineinfusionmayberequirediffluiddeprivationdoesnotachievetherequisitelevelofhypertonicdehydration,butthisshouldbeadministeredwithcaution.
1146.Chronicadrenalinsufficiencyiscausedbythefollowingorganismsexcept
a)Mycobacteriumtubercle
b)Histoplasmacapsulatum
c)Coccidioidesimmitis
d)Mycobacteriumbovis
CorrectAnswer-DAnswer-D.MycobacteriumbovisInfections,particularlytuberculosisandthoseproducedbyfungi,causeprimarychronicadrenocorticalinsufficiency.Whenpresent,tuberculousadrenalitisisusuallyassociatedwithactiveinfectioninothersites,particularlyinthelungsandgenitourinaryAIDSsufferersareatriskfordevelopingadrenalinsufficiencyfromseveralinfectious(cytomegalovirus,Mycobacteriumaviumintracellulare)andnoninfectious(Kaposisarcoma)complications.
1147.Whichofthefollowingisnotafeatureofmyxedemacoma?
a)Reducedlevelofconsciousnessandseizureswithotherfeaturesofhypothyroidismisseen
b)Hypoventilationleadingtohypoxiaandhypercapnia
c)Levothyroxinecanbegivenviaintravenousandnasogastricroute
d)Levothyroxineshouldnotbeusedinthemanagement
CorrectAnswer-DAnswer-D.LevothyroxineshouldnotbeusedinthemanagementMyxedemacomaisdefinedasseverehypothyroidismleadingtodecreasedmentalstatus,hypothermia,andothersymptomsofhypothyroidism.Reducedlevelofconsciousness,sometimesassociatedwithseizuresmayalsobeseen.Factorsthatpredisposetomyxedemacomaincludecoldexposure,trauma,infection,andadministrationofnarcotics.Therapyformyxedemacomashouldincludelevothyroxine(500μg)asasingleIVbolusfollowedbydailytreatmentwithlevothyroxine(50–100μg/d),alongwithhydrocortisone(50mgevery6h)forimpairedadrenalreserve,ventilatorysupport,spaceblankets,andtreatmentofprecipitatingfactors.
1148.Acuteadrenalinsufficiencycanpresentas
a)Acuteabdomenwithabdominaltenderness,nausea,vomitingandfever
b)Neurologicdiseasewithdecreasedresponsivenessprogressingtostuporandcoma
c)Hypovolemicshock
d)Alloftheabove
CorrectAnswer-DAnswer-D.AlloftheabovePosturalhypotensionmayprogresstohypovolemicshock.Adrenalinsufficiencymaymimicfeaturesofacuteabdomenwithabdominaltenderness,nausea,vomiting,andfever.Insomecases,theprimarypresentationmayresembleneurologicdisease,withdecreasedresponsiveness,progressingtostuporandcoma.Anadrenalcrisiscanbetriggeredbyanintercurrentillness,surgicalorotherstress,orincreasedglucocorticoidinactivation(e.g.,hyperthyroidism).
1149.ThegoldstandardtestfordiagnosisofInsulinomais:
a)'72hour'fasttest
b)PlasmaGlucoselevels<3mmol/l
c)PlasmaInsulinlevels>6µU/ml
d)C-peptidelevels<50pmol/e
CorrectAnswer-ATheanswerisA('72hour'fasttest):TheGoldstandardtestfordiagnosisofInsulinomaisasupervised'72hourfast'testDiagnosisofinsulinomarequiresdemonstrationofinappropriatelyhighlevelsofplasmaInsulin(andC-peptide)inthepresenceofdocumentedhypoglycemia(Achievedby72-hourfasttest).AbsolutevaluesofInsulinorC-peptidearenotreliableinestablishingadiagnosisunlesshypoglycemiaisdocumentedThe'72hourfasttest'allowsdemonstrationofhypoglycemia,togetherwillelevatedlevelsofInsulinandC-peptideandthusbecomesthemostreliable–goldstandardtestforestablishingadiagnosisofInsulinomaDiagnosisofInsulinoma:'72hourfast'testThediagnosisofInsulinomarequiresthedemonstrationofaninappropriatelyelevatedplasmainsulin(andC-peptide)atthetimeofhypoglycemia.The'72hourfast'testinvolvessupervisedfastingforupto72hoursoruntilhypoglycemiacanbedocumented.Thetestisconsideredpositiveifatanytimewhenbloodglucoselevelsdropto<2.2mmo1/1(40mg/dl),theseruminsulinlevelsarerecordedtobegreaterthan6µU/ml.(andC-peptidelevels>100
pmo1/1)Studiesindicatethat100%ofpatientswithinsulinomawillbedetectedafterasupervised72hourfastandhencethistestisconsideredthegoldstandardtest.First24hours:70-80%ofpatientswithinsulinomacanbedetectedUpto48hours:98%ofpatientswithinsulinomacanbedetectedBy72hours:100%ofpatientswithinsulinomacanhedetected
1150.Hypotonicsolutiongiventocorrect
a)Dehydrationsecondarytodiuretictherapy
b)Diabeticketoacidosis
c)Hyperosmolar,hyperglycemicnonketoticsyndrome
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveHypotonicsolutionhasosmolaritylowerthanseumosmolarity.Whenapatientreceiveshypotonicsolution,fluidshiftsoutofthebloodvesselsandintothecellsandinterstitialspaces,whereosmolarityishigher.Hypotonicsolutionhydratescellswhilereducingfluidinthecirculatorysystem.IndicationsDehydrationsecondarytodiuretictherapy.DiabeticketoacidosisHyperosmolar,hyperglycemicnonketoticsyndromeExamplesofhypotonicsolutions:halfnormalsaline,0.33%sodiumchloride,dextrose2.5%inwater,dextrose2.5%.
1151.Allofthefollowingarecausesofacutehyponatremiaexcept
a)GlycineirrigationinTURP
b)Recentinstitutionofthiazidetherapy
c)MDMAingestion
d)Liquoriceingestion
CorrectAnswer-DAnswer-D.LiquoriceingestioncausesofhyponatremiaIatrogenicPostoperative:premenopausalwomenHypotonicfluidswithcausesof1'vasopressinGlycineirrigation:TURP,uterinesurgeryColonoscopypreparationRecentinstitutionofthiazidesPolydipsiaMDMAingestionExercise-inducedMultifactorial,e.g.,thiazideandpolydipsia
1152.Acutehyponatremiabecomessymptomaticat
a)<135mEq
b)<125mEq
c)<120mEq
d)<110mEq
CorrectAnswer-BAns.is'b'i.e.,<125mEqSerumlevelofsodiumatwhichsymptomsdevelopAcute<125meq/LChronic<120meq/LHyponatremiaiscommonlydefinedasaserumsodium<135mmol/L(<135mEq/L).Neurologicalsymptomsoccuratdifferentlevelsoflowsodium,dependingnotonlyontheabsolutevaluebutalsoontherateoffall.Inpatientswithhyponatremiathatdevelopsoverhours,life-threateningseizuresandcerebraledemamayoccuratvaluesashighas125mmol/L.Incontrast,somepatientswithmorechronichyponatremiathathasslowlydevelopedovermonthstoyearsmaybeasymptomaticevenwithserumlevels<110mmol.AcuteorhvperacutehvponatremiaThehyponatremiadevelopedwithintheprevious24hours,itiscalled"acute."Ifthehyponatremiadevelopedoverjustafewhoursduetoamarkedincreaseinwaterintake(self-inducedwaterintoxication,asmaybeseeninmarathonrunners,psychoticpatients,andusersofecstasy),itiscalled"hyperacute."
ChronichyponatremiaIfitisknownthatthehyponatremiahasbeenpresentfbrmorethan48hours,orifthedurationisunknown(suchasinpatientswhodevelophyponatremiaathome),itiscalled"chronic."MildtomoderatehyponatremiaMildhyponatremiaisusuallydefinedasaserumsodiumconcentrationbetween130and135meq/L.Moderatehyponatremiaisoftendefinedasaserumsodiumconcentrationbetween121and129meq/L.SeverehvponatremiaSeverehyponatremiacanbedefinedasaserumsodiumof120meq/Lorless.SymptomsofhvponatremiaAbsentsymptomsPatientswithhyponatremiaarefrequentlyasymptomatic,particularlyifthehyponatremiaischronicandofmildormoderateseverity(ie,serumsodium>120meq/L).However,suchpatientsmayhavesubclinicalimpairmentsinmentationandgait.MildtomoderatesymptomsMildtomoderatesymptomsofhyponatremiaarerelativelynonspecificandincludeheadache,nausea,vomiting,fatigue,gaitdisturbances,andconfusion.Inpatientswithchronichyponatremia(ie,>48hoursduration),thesefindingsarenotassociatedwithimpendingherniation;however,inpatientswithmoreacutehyponatremia,suchsymptomsshouldbeconsideredominousandmayevolvewithoutwarningtoseizures,respiratoryarrest,andherniation.SeveresymptomsSeveresymptomsofhyponatremiaincludeuSeizuresObtundationComaRespiratoryarrest.
1153.Respiratoryacidosisisrecognizedprimarilybyincreasein
a)Pa02
b)PaCO2
c)HCO3
d)Noneoftheabove
CorrectAnswer-BAnswer-B.PaCO2RespiratoryacidosisoccurswhenthereisaccumulationofCO2duetotypeIIrespiratoryfailure.itcanalsooccurduetoseverepulmonarydisease,respiratorymusclefatigue,orabnormalitiesinventilatorycontrolandisrecognizedbyanincreaseinPaco2anddecreaseinpHThisresultsinariseinthePCO2,withacompensatoryincreaseinplasmabicarbonateconcentration,particularlywhenthedisorderisoflongdurationandthekidneyhasfullydevelopeditscapacityforincreasedacidexcretion
1154.Whichofthefollowingdrugadministrationisnotassociatedwithhypomagnesemia?
a)Cisplatin
b)Valproate
c)Foscarnet
d)Cetuximab
CorrectAnswer-BAnswer-B.ValproateDrugscausinghypomagnesemiaEthanolDiuretics(loop,thiazide,osmotic)CisplatinPentamidine,foscarnetCyclosporineAminoglycosides,amphotericinBCetuximab
1155.DoseofbenzathainepenicillinGtobegiveninpatientsoflatentsyphilisinpatientswithoutpenicillinallergyandnormalCSFfindingsis
a)0.6mUIM/weekfor3weeks
b)1.2mUIM/weekfor3weeks
c)2.4mUIM/weekfor3weeks
d)4.8mUIM/weekfor3weeks
CorrectAnswer-CAnswer-C.2.4mUIM/weekfor3weeksPrimary,secondary,orearlylatent-CSFnormalornotexamined:PenicillinGbenzathine(singledoseof2.4mUIM)CSFabnormal-TreatasneurosyphilisLatelatent(orlatentofuncertainduration),cardiovascular,orbenigntertairy-CSFnormalornotexamined:PenicillinGbenzathine(2.4mUIMweeklyfor3weeks).CSFabnormal:Treatasneurosyphilis
1156.SARSinfectioncasefatalityrateof>50%isobservedinpatientsofwhichagegroup?
a)<20yrs
b)20-40years
c)40-60years
d)>65years
CorrectAnswer-DAnswer-D.>65yearsThecasefatalityratefromSARS-CoVinfectionduringthe2003outbreakwas10-17%.Nopediatricdeathswerereported.Theestimatedcasefatalityrateaccordingtoagevariedfrom<1%forthoseyoungerthan20yearofageto>50%forthoseolderthan65yrofage.
1157.Whichofthefollowingcorroboratestothepresenceofclostridiumdifficleinfectioninpatientstakingantibioticsforanothercause?
a)Diarrhoeaunformedstoolsper12hfor2dayswithnootherrecognizedcause
b)Diarrhoeaunformedstoolsper24hfor2dayswithnootherrecognizedcause
c)Diarrhoeaunformedstoolsper24hfor3dayswithnootherrecognizedcause
d)Diarrhoeaunformedstoolsper24hfor4dayswithnootherrecognizedcause
CorrectAnswer-BAnswer-B.Diarrhoeaunformedstoolsper24hfor2dayswithnootherrecognizedcauseDiarrhoeaunformedstoolsper24hfor2dayswithnootherrecognizedcause.ToxinAorBdetectedinthestoolbyPCRorculture.Pseudomembranesseenincolonbyendoscopy.
1158.Followingarethefeaturesofneuropathyassociatedwithvaricella-zosterinfectionexcept
a)Persistentinfectioninneuronsofsensoryganglia
b)Withreactivationvirustransportedalongnervestoskin
c)Shinglesaredistributedalongmotordermatomes
d)Intranuclearinclusionsarenotfoundinperipheralnervoussystem
CorrectAnswer-CAnswer-C.ShinglesaredistributedalongmotordermatomesVaricella-zosterisoneofthemostcommonviralinfectionsoftheperipheralnervoussystem.Followingchickenpox,alatentinfectionpersistswithinneuronsofsensoryganglia.Ifthevirusisreactivated,sometimesmanyyearslater,itmaybetransportedalongthesensorynervestotheskin.Hereitinfectskeratinocytes,leadingtoapainful,vesicularskineruption(shingles)inadistributionthatfollowssensorydermatomesMostcommonistheinvolvementofthoracicortrigeminalnervedermatomes.
1159.Accordingtothecongenitalrubellasyndromeeradicationprogram,thefirstpriorityforrubellavaccinationisofferedtowhichofthefollowinggroup?
a)Allfemalechildrenatoneyear
b)Allnonpregnantwomen
c)Allnonpregnantwomenofage15to34
d)Alladolescentnonpregnantgirls15to24yearsofage
CorrectAnswer-CThefirstandforemostpriorityhasbeengiventothegroupofallnon-pregnantwomenbetweentheages15and34forrubellavaccination.Theotherthreeoptionsaresuitableagegroups.Ref:Park’sTextbookofPreventiveandSocialMedicine19thedition;pages130-131.
1160.ExtrahepaticManifestationsofHepatitisCincludeallofthefollowingExcept:
a)LichenPlanus
b)CeliacDisease
c)Glomerulonephritis
d)Cryoglobulinemia
CorrectAnswer-BAnswerisB(Celiacdisease)ExtrahepaticmanifestationsinviralhepatitisC:Wepatology'byKuntzAgranulocytosisAplasticanaemiaCornealulcerationCiyoglobillinaemiaDiabetesmellitus(typeI)ErythemaexsudativummultiformeGlomerulonephritisGuillain-BarresyndromeHyperlipasaemiaLichenplanusNon-HodgkinlymphomaPolyarteritisnodosaPolyarthritisPolyneuritisPorphyriacutaneatardaSialadenitisSjogren'ssyndrome/SiccasyndromeThrombocytopenia
Thyroiditis
1161.AllarefeaturesofSIRSexcept-
a)RR>24&Paco2<22mmhg
b)WBC>11or<4
c)Temperature<36and>38
d)PR>90
CorrectAnswer-AAnswer-A.RR>24&Paco2<22mmhg
1162.Whichofthefollowingisnottrueabouttheepididymo¬orchitisofmumps?
a)Itisthemostcommonmanifestationofmumpsinfection
b)Testicularenlargementusuallyresolvesin1week
c)Bilateraltesticularinvolvementseenin10-30%ofcases
d)Sterilityrarelydevelopsinthesepatients
CorrectAnswer-AAnswer-A.ItisthemostcommonmanifestationofmumpsinfectionEpididymo-orchitisisthesecondmostcommonmanifestationofmumps,developingin15–30%ofcasesinpostpubertalmales.–Orchitis,characterizedbyapainful,tender,feverandenlargedtestis,isbilateralin10–30%ofcasesandresolveswithin1week.–Oophoritis(manifestedbylowerabdominalpainandvomiting)occursin~5%ofwomenwithmumps.–Sterilityinmumpsisrare.
1163.Mostcommonnerveaffectedinleprosy
a)Posteriortibial
b)Ulnar
c)Median
d)Facial
CorrectAnswer-AAnswer-A.PosteriortibialLeprosyaffectsperipheralmixednervesandcutaneousnerves.Themostcommonperipheralnervesaffectedintheorderoffrequencyaretheposteriortibial>ulnar>median>lateralpopliteal>facial>radial
1164.Dengueshocksyndromeischaracterizedbythefollowingexcept-
a)Hepatomegaly
b)Pleuraleffusion
c)Thrombocytopenia
d)Decreasedhaemoglobin
CorrectAnswer-DAns.is'd'i.e.,DecreasedhemoglobinDenguehemorrhagicfeverFeverMinororMajorhemorrhgicmanifestationsHepatomegalyThrombocytopenia100,000/mm3HypoalbuminemiaObjectiveevidenceofincreasedcapillarypermeability(hematocrit20%.)Pleuraleffusion(bychestradiograph)[Nelson,17/e,p1093]CriteriaforDengueshocksyndromeItincludesthosefordenguehemorrhagicfeverplus,Hypotensionornarrowpulse.
1165.Thefollowingstatementsaretrueregardingbotulismexcept-
a)Infantbotulismiscausedbyingestionofpreformedtoxin
b)ClostridiumbotulinumA,B,CandFcausehumandisease
c)Thegeneforbotulinumtoxinisencodedbyabacteriophage
d)Clostridiumbarattimaycausebotulism
CorrectAnswer-AAns.is'a'i.e.,InfantbotulismiscausedbyingestionofpreformedtoxinInfantbotulismiscausedbyingestionofspores.Sporesareingestedinfood,getestablishedinthegutandthereproducethetoxin."SevenmaintypesofC.botulinum,designatedA-G,produceantigenicallydistincttoxinswithpharmacologicallyidenticalaction.Alltypescancausehumandisease,buttypeA,BandEaremostcommon".(InHarrison&Ananthanarayan,eighttypesofC.botulinumA,B,CI,C2,D,E,F,Ghavebeenmentioned).Toxinproductioninclostridiumbotulinumappearstobedeterminedbypresenceofbacteriophage(atleastintypeC&D)."Clostridiumbutyricumandclostridiumbarattihavealsobeenfoundtoproducetoxin".-Harrison16th/e843-Anystrainproducingtoxinwillobviouslycausebotulism.
1166.Austriansyndromeiscausedbywhichinfection
a)Staphylococcusaureus
b)Streptococcuspneumoniae
c)Staphylococcusepidermidis
d)Streptococcusviridans
CorrectAnswer-BAnswer-B.StreptococcuspneumoniaeAustriansyndromeisamedicalconditionfirstdescribedbyRobertAustrianin1957.Theclassicaltriadconsistsofpneumonia,endocarditis,andmeningitis,allcausedbyStreptococcuspneumoniae.Itisassociatedwithalcoholism,duetothepresenceofhyposplenia(reducedsplenicfunctioning),andcanbeseeninmalesbetween40and60yearsold.
1167.Factorscontributingtothedevelopmentofcomplicationsinmeaslesarethefollowingexcept-
a)Agegroup5-20years
b)Highercasefatalitywithovercrowding
c)Severemalnutrition
d)Lowerserumretinollevels
CorrectAnswer-AAnswer-A.Agegroup5-20yearsComplicationsofmeaslesarelargelyattributabletothepathogeniceffectsofthevirusontherespiratorytractandimmunesystem.Morbidityandmortalityfrommeaslesaregreatestinpatientsyoungerthan5yrofage(especially<1yrofage)andolderthan20yrofage.
1168.TrueaboutVHLsyndromeis
a)Itisanautosomalrecessivecondition
b)Centralnervoussystemisnotinvolved
c)Regularscreeningforclearcellcarcinomaofkidneysisessential
d)VHLisagrowthpromotergene
CorrectAnswer-CAnswer-C.RegularscreeningforclearcellcarcinomaofkidneysisessentialVonHippel-Lindaudisease(VHL)isarareautosomaldominantdiseasecharacterizedbyabnormalangiogenesiswithbenignandmalignanttumorsthataffectmultipletissues.ThediseaseisinheritedasamutationinonealleleoftheVHLtumor-suppressorgene.Somaticmutationofthenormalalleleleadstoretinalangiomas,centralnervoussystem(CNS)hemangioblastomas,pheochromocytomasandmulticentricclearcellcysts,hemangiomas,andadenomasofthekidney.ThehihriskofrenalcellcarcinomamandatesieriodicsurveillanceusuallearlinadultsbCTorMRI.Routinescreeningandawarenessofthenaturalhistoryoflesionshasenabledrenal-sparingapproachestodiseasemanagement.
1169.Tuberoussclerosisiscausedbymutationsinthefollowingproteins
a)Hamartin
b)Tuberin
c)Merlin
d)Ankyrin
CorrectAnswer-A:BAnswer-A.Hamartin&B.TuberinItiscausedbymutationsineithertheTSC1gene,whichmapstochromosome9q34,andencodesaproteintermedhamartin,ormutationsintheTSC2gene,whichmapstochromosome16p13.3andencodesthetuberinprotein.Hamartinformsacomplexwithtuberin,whichinhibitscellularsignalingthroughthemammaliantargetofrapamycin(mTOR),andactsasanegativeregulatorofthecellcycle.Patientswithtuberoussclerosishaveseizures,mentalretardation,adenomasebaceum(facialangiofibromas),shagreenpatch,hypomelanoticmacules,periungualfibromas,renalangiomyolipomas,andcardiacrhabdomyomas.
1170.Whatcharacteristicfindingoftuberoussclerosisispresentatbirthbutnotlaterinlife?
a)Cardiacrhabdomyosarcoma
b)Facialangiofibroma
c)Periungalfibroma
d)Renalangiomyolipoma
CorrectAnswer-AAnswer-A.CardiacrhabdomyosarcomaPatientswithtuberoussclerosishaveseizures,mentalretardation,adenomasebaceum(facialangiofibromas),shagreenpatch,hypomelanoticmacules,periungualfibromas,renalangiomyolipomas,andcardiacrhabdomyomas.Cardiacrhabdomyosarcomascanbepresentatbirthinupto80%oftheinfantswithtuberoussclerosis.Theseinvoluteinthefirstthreeyearsoflifeandcompletelydisappearbyadulthood
1171.Followingisnottrueaboutepinephrine
a)Haspotentalphaandbetastimulatingproperties
b)Itimprovescoronaryperfusionpressureandmyocardialbloodflow
c)IncreasescerebralbloodflowduringCPR
d)Routineuseofhighdoseepinephrineduringresuscitationisindicated
CorrectAnswer-DAnswer-D.RoutineuseofhighdoseepinephrineduringresuscitationisindicatedEpinephrine(adrenaline)isanendogenouscatecholaminewithpotenta-and11-adrenergicstimulatingproperties.Theadrenergicaction(vasoconstriction)increasessystemicandpulmonaryvascularresistance.TheresultanthigheraorticdiastolicbloodpressureimprovescoronaryperfusionpressureandmyocardialbloodfloweventhoughitreducesglobalcardiacoutputduringCPR.epinephrinealsoincreasescerebralbloodflowdurinooduualiCPRbecauseperipheralvasoconstrictiondirectsagreaterproportionofflowtothecerebralcirculation.However,epinephrinecandecreaselocalcerebralmicrocirculatorybloodflowatatimewhenglobalcerebralflowisincreased.
1172.Ztracktechniquemustbeusedforadministrationof
a)InjectionIronDextrandeepIM
b)InjectionHydroxyzinehydrochloridedeepIM
c)InjectionDepomedroxyprogesteroneiv
d)Injectionerythromycin
CorrectAnswer-A:BAnswer-A.InjectionIronDextrandeepIM&B.InjectionHydroxyzinehydrochloridedeepIMWithintramuscularinjectionsmedicationscanleakupwardintothesubcutaneoustissuescausingstaining,bruisingandsignificantpainforseveralweeksorlongerwithsomemedications.NursesareencouragedtousetheZtracktechnique(causinganeedletrackorpathwayintheshapeofZ)anytimeanintramuscularinjectionisgiven,topreventleakageandassociatedpain.TheZtracktechniquemustbeusedwheneveradeepintramuscularinjectionofirondextran,andotherirritatingsolutionssuchashydroxyzinehydrochlorideandseveralantipsychoticagentsaregiven.
1173.Inmanwhatquantityofethylalcoholconsumeddailyfor>10yearsincreasestherelativeriskofdevelopmentofalcoholicliverdisease
a)20g/d
b)40g/d
c)60g/d
d)80g/d
CorrectAnswer-DAnswer-D.80g/d80g/dayx10+yr.
1174.NotafeatureofWernicke'sKorsakoffSyndrome
a)Ataxia
b)Psychosis
c)Normalpupillaryresponse
d)Opthalmoplegia
CorrectAnswer-CCi.e.Normalpupillaryresponse
1175.WhichofthefollowingantineoplasticagentsisusedinthemanagementofHodgkinslymphoma,nonHodgkinslymphomaandsmallcellcarcinomaoflung?
a)Cisplatin
b)Bleomycin
c)Paclitaxel
d)Doxorubicin
CorrectAnswer-AAnswer-A.CisplatinCisplatinisusedinthemanagementofHodgkinslymphoma,nonHodgkinslymphomaandsmallcellcarcinomaoflung.
1176.Pierrerobinsyndromefollowingistrueexcept
a)Consistsofmicrognathiaandcleftpalate
b)Tongueisofnormalsize
c)Airwayobstructionparticularlyduringexpiration
d)30-50%patientshaveSticklersyndrome
CorrectAnswer-CAnswerC.AirwayobstructionparticularlyduringexpirationPierreRobinsyndromeconsistsofmicrognathiausuallyaccompaniedbyahigharchedorcleftpalate.Thetongueisusuallyofnormalsize,butthefloorofthemouthisforeshortened.Theairpassagescanbecomeobstructed,particularlyoninspiration,usuallyrequiringtreatmenttopreventsuffocation.Theinfantshouldbemaintainedinaproneorpartiallypronepositionsothatthetonguefallsforwardtorelieverespiratoryobstruction.Somepatientsrequiretra-cheostomy.Mandibulardistractionproceduresintheneonatecanimprovemandibularsize,enhancerespiration,andfacilitateoralfeedings.Sufficientspontaneousmandibulargrowthcantakeplacewithinafewmonthstorelievethepotentialairwayobstruction.Oftenthegrowthofthemandibleachievesanormalprofilein4-6year.
1177.Mantlefieldradiationwasusedformanagementof-
a)Hodgkinslymphoma
b)Mantlecelllymphoma
c)Multiplemyeloma
d)Cervicalcarcinoma
CorrectAnswer-AAnswer-A.HodgkinslymphomaMantlefieldradiationisatypeofradiationtreatmentusedforHodgkin'slymphomaTheterm'mantle'isderivedfromthenameofagarment,muchlikeacloak,usedmanyyearsback.Theshapeoftheexposedareatheradiationfieldhascontoursthatresembletheshieldingcloak.Thistypeoflargeradiationfieldisnotcommonlyusedtoday.
1178.Alienlimbsyndromeseenin
a)Postneurosurgicalcases
b)Alzheimersdisease
c)Creutzfeldt-Jakobdisease
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveAlienhandsyndrome(AHS)isaconditioninwhichapersonexperiencestheirlimbsactingseeminglyontheirown,withoutcontrolovertheactions.Thetermisusedforavarietyofclinicalconditionsandmostcommonlyaffectsthelefthand.Alienhandsyndromeisbestdocumentedincaseswhereapersonhashadthetwohemispheresoftheirbrainsurgicallyseparated,aproceduresometimesusedtorelievethesymptomsofextremecasesofepilepsy.Italsooccursinsomecasesafterbrainsurgery,stroke,infection,tumor,aneurysmandspecificdegenerativebrainconditionssuchasAlzheimer'sdiseaseandCreutzfeldt-Jakobdisease.
1179.OsmolarityofMilkF-100is
a)399mOsm/L
b)409mOsm/L
c)419mOsm/L
d)429mOsm/L
CorrectAnswer-CAnswer-C.419mOsm/LUNICEFandWHOpreparedtwoformuladietsbymodificationofthecowsmilk-MilkF-75(starter75kcal/100ml)andF-100(followup100kcal/100ml).
1180.Whichofthefollowingdrugscancauseseizuresexcept?
a)Lithium
b)Phencyclindine
c)INH
d)Ketorolac
CorrectAnswer-DAnswer-D.KetorolacPsychotropicsAntidepressantsAntipsychoticsLithiumDrugsofabuseAmphetamineCocainePhencyclidineMethylphenidateFlumazenil
1181.Riboflavindeficiencycauses
a)Cornealvascularization
b)Anemia
c)Personalitychanges
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveRiboflavindeficiencyismanifestedprincipallybylesionsofthemucocutaneoussurfacesofthemouthandskin.Inadditiontothemucocutaneouslesions,cornealvascularization,anemia,andpersonalitychangeshavebeendescribedwithriboflavindeficiency.
1182.Soretbandinwhichporphyrinsabsorblightlieatwhatwavelengthofthespectrumoflight?
a)200nm
b)300nm
c)400nm
d)500nm
CorrectAnswer-CAnswer-C.400nmDuetothisstructureporphyrinsavidlyabsorblightinaregionnear400nmofthelightspectrum.ThispartofthelightspectrumiscalledtheSoretband.
1183.Whichofthefollowingisnotseenafternervetransection?
a)Morphologicpatternofwalleriandegeneration
b)Myelinovoids
c)Painfulneuroma
d)Neuromaincontinuity
CorrectAnswer-DAnswer-D.NeuromaincontinuityThemorphologichallmarksofaxonalneuropathiesproducedbycuttingaperipheralnerve,resultsinaprototypicalpatternofinjurydescribedasWalleriandegenerationWithinadayofinjury,thedistalaxonsbegintofragmentandtheassociatedmyelinsheathsunravelanddisintegrateintosphericalstructures(myelinovoids).Afailureoftheoutgrowingaxonstofindtheirdistaltargetcanproducea"pseudotumor"termedtraumaticneuroma—anonneoplastichaphazardwhorledproliferationofaxonalprocessesandassociatedSchwanncellsthatresultsinapainfulnodule.
1184.Reactivenitrogenspeciesforkillingofmicrobesaremainlyderivedfrom
a)Elementalnitrogen[N3]
b)NitricOxide[NO]
c)NitrogenDioxide[NO2]
d)NitrousOxide[N20]
CorrectAnswer-BAnswer-B.NitricOxide[NO]Killingofmicrobesisaccomplishedbyreactiveoxygenspecies(ROS,alsocalledreactiveoxygenintermediates)andreactivenitrogenspecies,mainlyderivedfromnitricoxide(NO),andtheseaswellaslysosomalenzymesdestroyphagocytoseddebris.Thisisthefinalstepintheeliminationofinfectiousagentsandnecroticcells.
1185.Duringstateofarousalinmenrelaxationofsmoothmuscleincorpuscavernosumismainlycausedby
a)Acethycholine
b)Nitricoxide
c)Bicarbonateions
d)Calcium
CorrectAnswer-BAnswer-B.NitricoxideErectiledysfunction(ED)referstotheinabilityofmentoattainandmaintainanerectpeniswithsufficientrigiditytoallowsexualintercourse.Nitricoxide(NO)releasedparasympatheticnonadrenergicnoncholinergic(NANC)nervesandvascularendotheliumisthemajortransmittercausingrelaxationofsmoothmuscleincorpuscavernosumandbloodvesselssupplyingit;AChandPGsalsoplayarole.
1186.WhichofthefollowinggenesifaffectedwillsporadicallycauseJuvenilemyeloidleukemia?
a)NF1
b)PTEN
c)APC
d)SMAD2
CorrectAnswer-AAnswer-A.NF1NF1-Neurobiastoma,juvenilemyeloidleukemia
1187.ChronicmanifestationsofAspergillosisarenotevidentinwhichofthefollowingorgans?
a)Skin
b)Brain
c)Lung
d)Eye
CorrectAnswer-DAnswer-D.EyeLung,sinus,brain,skin,heart,
1188.Allofthefollowingaretrueaboutincontinentiapigmenti,except:
a)Ocularinvolvementisseeninalmost100%casesandistypicallyunilateral
b)Avascularityofperipheralretina
c)Primaryskinabnormality
d)X-linkeddominant
CorrectAnswer-AOcularinvolvementisseeninabout20-35percentofthecasesofincontinentiapigmentibutnotin100percentcasesasmentionedintheoption.IncontinentiapigmentiisaX-linked
dominantprimaryskindiseasethatleadstoavascularityoftheretina.Ref:Rook'sTextbookofDermatology7thEdition,Pages39.20-3.22;TheRetinalAtlasByLawrenceA.Yannuzzi,Page38
1189.Oculogyriccrisisisknowntobeproducedbyallofthefollowingdrugsexcept
a)Trifluoperazine
b)Atropine
c)Perchlorperazine
d)Perphenazine
CorrectAnswer-BAnswer-B.AtropineOculogyriccrisisisoneofthemanifestationsseeninacutedystonicreaction(acutemusculardystonia).Othermanifestationsarefacialgrimacing,torticollis,lockedjaw,abnormalcontractionofspinalmuscles(opisthotonus).Itoccurswithin1to5daysofantipsychotictherapy.Trifluperazine,perchlorperazineandperphenazineareantipsychotic
1190.WhichofthefollowingprimarilygovernstheuptakeofTc-99mMDPinbody?
a)Amountofosteogenicactivity
b)Amountofiodineuptake
c)Amountofcalciumuptake
d)Amountofcatecholamineactivity
CorrectAnswer-AAnswer-A.AmountofosteogenicactivityTechnetium99-misacommonlyusedradiopharmaceutical.Technetium99-mmethylenediphosphonate(Tc-99mMDP),desirableforthegammacarmeraimagingisthecommonlyusedform.Tc-99mMDPcanbepreparedfromakitcontaining,sodiumpertechnitate(NaTcO4)vial,MDP,stabilizersandstannousion.
1191.Technitium-99mpertechnetatelabelledmethylenediphosphonateisstructurallysimilarto
a)Calciumphosphate
b)Phosphorus
c)Sodiumbicarbonate
d)Magnesiumsulfate
CorrectAnswer-AAnswer-A.CalciumphosphateTheradionucletideadministeredisTechnitium-99mpertechnetatelabeledmethylenediphosphonateisananalogofcalciumphosphate.
1192.Laproscopicprocedurepatientdevelopsshoulderpaindueto
a)Subphrenicabscess
b)Positionalpainduringsurgery
c)Subdiaphragmaticmigrationofgas
d)Injurytoliver
CorrectAnswer-CAnswer-C.SubdiaphragmaticmigrationofgasOnetypeofpainthatisuniquetolaparoscopyisthepostlaparoscopyshoulderpainduetothephrenicnerveirritationtothediaphragmcausedbytheCO,gasthatremainsintheabdomenattheendoftheprocedure.Whenthepatientsitsup,thegasmovesupwardstothediaphragmandirritatesitleadingtoreferredpainC3-C%.
1193.Apatientcomeswithacomplaintofshoulderpainafterlaparoscopicsurgery.Whatshouldbethenextstepinmanagement?
a)Oralparacetamolfor2-3days
b)USGofshoulderregion
c)Diagnosticshoulderarthroscopy
d)Intraarticularlignocaineinjection
CorrectAnswer-AAnswer-A.Oralparacetamolfor2-3daysShouldertippainThepatientshouldbewarnedaboutthispreoperativelyandtoldthatthepainisreferredfromthediaphragmandnotduetoalocalproblemintheshoulders.Itcanbeatitsworst24hoursaftertheoperation.Itusuallysettleswithin2-3daysandisrelievedbysimpleanalgesics,suchasparacetamol.
1194.Whichofthefollowingshouldbedoneforanacuteonsetpainfulscrotalswellingin12yearsoldmale?
a)Dopplerstethoscopeevaluation
b)Administeranalgesics
c)Advisebedrest
d)Administerantibiotics
CorrectAnswer-AAnswer-A.DopplerstethoscopeevaluationAcuteonsetpainfulscrotalswellingin12yearsoldpreadolescentmaleismostprobablyduetotorsionoftestis.Insuspectedcasesoftorsionoftestisortesticularappendageadopplerstethoscopeshouldbeusedtoevaluatebloodflowtothetesticles.
1195.Earliesthematologicalchangefollowingspleenectomyis
a)Leukocytosisandthrombocytosis
b)PresenceofHeinzbodies
c)EvidenceofHowellJollybodies
d)Poikilocytosis
CorrectAnswer-AAnswer-A.LeukocytosisandthrombocytosisIntheimmediatepostsplenectomyperiod,leukocytosis(upto25,000/4)andthrombocytosis(upto1.106/4)develop,butwithin2-3weeks,bloodcellcountsandsurvivalofeachcelllineageareusuallynormal.
1196.
Followingroadtrafficaccidentpatientsufferspolytraumaandisevaluatedintheemergencysectionofthehospital.Hispulserateis116,respiratoryrateis24,bloodpressureof122/78mmofHgandpatientismildlyanxious.Whatistheapproximatebloodlosspatienthasfollowingtrauma?
a)<750ml
b)750-1500ml
c)1500-2000ml
d)>2000ml
CorrectAnswer-BAnswer-B.750-1500ml
1197.Sebaceouscystoccursoccurinallthefollowinglocationsinbodyexcept
a)Palmsandsoles
b)Axilla
c)Back
d)Pubicarea
CorrectAnswer-AAnswer-A.PalmsandsolesThescalp,scrotum,shoulders,neck,andbackarethecommonsites,buttheycanoccurwherevertherearesebaceousglands.Therearenosebaceousglandsonthepalmsofthehandsandsolesofthefeet,thussebaceouscystsarenotfoundintheselocations.
1198.Cortisollevelsremainelevatedforhowmanyweek/sfollowinghemorrhage?
a)1
b)2
c)3
d)4
CorrectAnswer-AAnswer-A.1Burnpatientshavedemonstratedelevatedcirculatingcortisollevelsforupto4weeks,whilesofttissueinjuryandhemorrhagemaysustainelevatedcortisollevelsforaslongas1week.
1199.Surgicaltreatmentofcongenitalhydrocelerecommendedifitfailstoresolvebywhatage?
a)1year
b)2years
c)3years
d)4years
CorrectAnswer-BAnswer-B.2yearsApatentprocessusvaginalisthatistoonarrowtopreventthedevelopmentofaninguinalherniamayneverthelessallowperitonealfluidtotrackdownaroundthetestistoformacongenitalhydrocele.Themajorityresolvespontaneouslyastheprocessuscontinuestoobliteratebutsurgicalligationisrecommendedinboysolderthan2yearsiftheydonotresolvespontaneously.
1200.Whatpercentageofgallstonesareradioopaque?
a)10-20
b)30-40
c)50-60
d)70-80
CorrectAnswer-AAnswer-A.10-20Cholelithiasisisacommoncauseofepigastricorrightupperquadrantpaininmiddleagedobesefemalepatients.Only15-20%ofthegallstonesareradio-opaque.Gallstonesarethemostcommonbiliarypathology.Itisestimatedthatgallstonesarepresentin10-15%oftheadultpopulationintheUSA.
1201.Percentageofrenalstonesthatareradio-opaque
a)20
b)40
c)60
d)80
CorrectAnswer-DAnswer-D.80RoutineuseofnoncontastCTScanhascompletelyrevolutionizedtoimagingevaluationofrenalstonedisease,nearlycompletelyreplacingplainradigrpahsandXurographyfordiagnosisofacuteureteralobstructionbyrenalstones.Nephrolithiasisreferstothepresenceofcalculiintherenalcollectingsystem.Nearly10%ofthepopulationwillformarenalstoneintheirlifetime.Sufficientcalciumoxalateandphosphateispresentin80%oftherenalcalculiforthemtoberadio-opaqueontheplainradiographs.
1202.Indicationsofthoracotomyinbluntchesttraumaincludeallexcept
a)Initialdrainageof>500mloffreshblood
b)Ruptureofbronchous
c)Continuedbleedingof>200ml/hrfor>/=3hrs
d)Unsuccesfulattemptatdrainageofcardiactamponade
CorrectAnswer-AAnswer-A.Initialdrainageof>500mloffreshbloodContinuedbleedingof>200ml/hrfor>3hrsRuptureofbronchus,aorta,esophagusordiaphragm.Cardiactamponade(ifneedleaspirationunsuccessful).
1203.Visualexaminationisusedasscreeningtestfor
a)Melanoma
b)Breastcancer
c)Thyroidcancer
d)Testicularcancer
CorrectAnswer-AAnswer-A.MelanomaVisualexaminationistheonlyscreeningtestformelanomaorskincancer.Forlesionswithsuspicionofheadandneckmelanoma,dermatologistsvisualexaminationscreeningis89-97%sensitivewith35-75%positivepredictivevalue.
1204.Embolisationoftumorsisdoneusing
a)Polyvinylalcohol
b)Autologousbloodclots
c)Absoluteethanol
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveThefollowingaretheembolicmaterialscommonlyusedfortrans-arterialembolization:GelatinspongeparticlesMicrospheresAutologousbloodclotsPolyvinylalcoholn-butylcyanoacrylateglueAbsoluteethanol
1205.
Definitivesurgeryisapartofwhichstageofdamagecontrolsurgery?
a)I
b)II
c)III
d)IV
CorrectAnswer-DAnswer-D.IVFollowingmajorinjury,protractedsurgeryinthephysiologicallyunstablepatientwiththe'deadlytriad'-thecombinationofhypothermia,acidosisandcoagulopathy'Damagecontrol'or'damagelimitationsurgery'isaconceptthatoriginatedfromnavalarchitecture,wherebyashipwasdesignedtohaveareassealedoffinthecaseofdamage,tolimitflooding.Stages-
1. Patientselection2. Controlofhaemorrhageandcontrolofcontamination3. Resuscitationcontinuedintheintensivecareunit4. Definitivesurgery5. Abdominalclosure
1206.Breastsurgeryisconsideredunderwhatcategoryofcardiacrisk?
a)>10%
b)5-10%
c)1-5%
d)<1%
CorrectAnswer-DAnswer-D.<1%Low(reportedcardiarisk<1%)-EndoscopicproceduresSuperficialproccdureCataractsurgeryBreastsurgeryAmbulatorysurgery
1207.Whatistheorderofdisorientation,whichapersongoesthroughafteraneventoftraumatohead?
a)Firsttime,thenplacefollowedbyperson
b)Firstplace,thentimefollowedbyperson
c)Firstperson,thentimefollowedbyplace
d)Firsttime,thenpersonfollowedbyplace
CorrectAnswer-AAnswer-A.Firsttime,thenplacefollowedbypersonOrientationreferstothecleintsrecognitionofperson,placeandtime-thatisknowingwhoandwhereeorsheisandthecorrectday,dateandyear.Thisiscommonlydocumentedas"orientedX3".Absenceofcorrectinformationaboutperson,placeandtimeisreferredtoasdisortientation.
1208.Whichofthefollowingisthepreferredrouteofaccessfortotalparenteralnutritioninapatientwhorequiresthesamefor<14daysandthereisotherwisenoindicationforuseofcentralcatheter?
a)Internaljugularvein
b)Externaljugularvein
c)Periphaeralvein
d)PICCline
CorrectAnswer-CAnswer-C.PeriphaeralveinAdministrationofparenteralnutritionviaaperipheralvenouscathetershouldbeconsideredforpatientswhoarelikelytoneedshort-termparenteralnutrition(lessthan14days)whohavenoneedforcentralaccessforotherreasons.Careshouldbetakenincatheterchoice,andinattentiontopH,tonicityandlong-termcompatibilityoftheparenteralnutritionformulationsinordertoavoidadministrationorstabilityproblems.
1209.Whichofthefollowingisnottrueaboutuseofgraftinvascularsurgery
a)Autologussaphenousveinachievessuperiorpatencyratestoprostheticmaterialsespeciallyinfemorodistalbypass
b)ThepatencyofthePTFEgraftsmaybeimprovedbyinterpositionofaveincuffatproximalanastomosis
c)Dopplerultrasoundassessmentisthemethodofchoiceforqualityassuaranceoncompletionofoperativeprocedure
d)Intheabsenceofspecificcontraindicationsaspirinshouldbeprescribedforallthepatientsofperipheralvasculardisease
CorrectAnswer-BAnswer-B.ThepatencyofthePTFEgraftsmaybeimprovedbyinterpositionofaveincuffatproximalanastomosisAutologoussaphenousveinachievessuperiorpatencyratestoprostheticmaterials,especiallyinfemorodistalbypass.Insituandreversedveingraftbypassesperformequallywellandthechoiceoftechniqueshouldbebaseduponanatomicalconsiderationsthatarespecifictoindividualpatients.Intheabsenceofsaphenousvein,noconvencingstudiesexisttosuggestthepreferredprostheticalternative.ThepatencyofPTFEgraftsmaybeimprovedbyinterpositionofaveincuffatthedistalanastomosis.Patencyratesassociatedwithpre-cuffedPTFE,graftsarecomparabletothatobtainedfromstandardPTFEgraftswithaninterpositionveincuff.Thereisnojustificationfortheroutineuseofadjuvantdistalarterivenousfistulae.
1210.Intracranialpressureisnotraisedduring
a)Hyperventilation
b)Statusepilepticus
c)Headinjury
d)Subduralhematoma
CorrectAnswer-AAnswer-A.HyperventilationHyperventilationisusedasatreatmentwithraisedintracranialpressure.HyperventilationcausesdecreasedPaCO2whichsubsequentlyleadstoarterialvasoconstrictionthusloweringcerebralbloodflow(CBF),cerebralbloodvolume,andintracranialpressure
1211.Immediatephysiologicalresponsetosuddendecreaseinbloodvolumeis
a)Releaseofepinephrine
b)Shiftoffluidfromintracellulartointerstitialcompartment
c)Releaseofangiotensin
d)Releaseofthyroxine
CorrectAnswer-AAnswer-A.ReleaseofepinephrineThemajorhemodynamicabnormalityinhypovolemicshockisdecreaseinpreload.Theimmediatephysiologicalresponseofthebodytothesuddendecreaseinvolume(preload),isareleaseofcatecholamines(epinephrine,norepinephrine).Thesubsequentincreaseinheartrateandcontractilityhelpmaintaincardiacoutput.
1212.Allofthefollowingareindicationsforbariatricsurgeryexcept-
a)BMI>40kg/m2
b)BMI>35kg/m2withatleastonecomorbidity
c)BMI>30withlongstandingdiabetes
d)Failureofothermethodsofweightloss
CorrectAnswer-CAnswer-C.BMI>30withlongstandingdiabetesIndicationsforbariatricswgeryBMI>40kg/m2BMI>35kg/m2withatleastonecomorbidityPatientathighriskofobesityassociatedmorbidityandmortalityFailureofothermethodsofwightloss
1213.Slipsignisseenin
a)Lipoma
b)Desmoidtumor
c)Sebaceouscyst
d)Hernia
CorrectAnswer-AAnswer-A.LipomaAcharacteristic"slippagesign"maybeelicitedbygentlyslidingthefingersofftheedgeofthetumor.Thetumorwillbefelttoslipoutfromunder,asopposedtoasebaceouscystoranabscessthatistetheredbysurroundinginduration.
1214.Forreimplantationdigitsarestoredin
a)Icepacks
b)Deepfreeze
c)Coldsaline
d)Plasticbagswithice
CorrectAnswer-DAnswer-D.PlasticbagswithiceTheamputatedpartshouldbewrappedinmoistenedgauzeandplacedinasealedplasticbag.Thisbagshouldthenbeplacedinanicewaterbath.Donotusedryiceanddonotallowtheparttocontacticedirectly;frostbitecanoccurintheamputatedpart,whichwilldecreaseitschanceofsurvivalafterreplantation.Bleedingshouldbecontrolledintheproximalstumpbyasminimalameansasnecessary,andthestumpdressedwithanonadherentgauzeandbulkydressing."
1215.Characteristicsitefordevelopmentofvenouslegulcersis
a)Skinofgaiterregion
b)Behindlateralmalleolus
c)Shinoftibia
d)Medialaspectofknee
CorrectAnswer-AAnswer-A.SkinofgaiterregionThevenousulcerofthelegcharacteristicallydevelopsintheskinofthegaiterregion,theareabetweenthemusclesofthecalfandtheankle.ThisistheregionwheremanyoftheCockettperforatorsjointheposteriortibialveintothesurfacevein,knownastheposteriorarchveinThemajorityofulcersdeveloponthemedialsideofthecalfbutulcersassociatedwithlessersaphenousincompetenceoftendeveloponthelateralsideoftheleg.Ulcerscandeveloponanypartofthecalfskininpatientswithpost-thromboticlegs;however,venousulcersrarelyextendontothefootorintotheuppercalfand,ifthereisulcerationatthesesites,otherdiagnosesshouldbeseriouslyconsidered.
1216.Whichofthefollowingistrueaboutthemanagementofvenousulceroflowerlimb?
a)Initialtreatmentisdebridementandsurgery
b)Compressiondressingsshouldideallybeappliedontwiceweeklybasis
c)Antibioticsdonotspeeduptheulcerhealing
d)Biologicaldressingsdonothavepotentialtoimprovehealing
CorrectAnswer-CAnswer-C.AntibioticsdonotspeeduptheulcerhealingPatientsareinitiallytreatedbyacompressionbandagingregimen.Alternativetothesebandagingregimensistoapplyablandabsorbentleak-proofdressingbeneathagraduatedelasticcompressionstocking(classII).BiopsiesareindicatedifmalignancyissuspectedanditisimportanttorememberthataMarjolin'stypeofulcer(asquamouscellorbasalcellcarcinoma)candevelopinachroniclongstandingvenousulcer.Considerationmustbegiventohealingtheulcerbyexcisionandgrafting.Biologicaldressingshavebeendeveloped,includingfetalkeratinocytesandcollagenmeshesPinchgraftsandulcerexcisionwithmeshgraftinghavebeenshowntoprovidegoodearlyhealingwithmoderatelong-termresults
1217.Whichofthefollowingsuturehasmaxtensilestrengthandminimumtissuereaction
a)Poliglecaprone
b)Polypropylene
c)Polygalctine
d)Polydioxanone
CorrectAnswer-BAnswer-B.PolypropylenePolypropylenesuturesarenon-absorbableandprovidepermanentwoundsupport.Polypropylenesuturesarebluecoloredforeasyidentificationduringsurgery.Polypropylenesutureshaveexcellenttensilestrengthandareusedfororthopaedic,plasticandmicrosurgeries,generalclosureandcardiovascularsurgeries
1218.Blunttraumaexploratorylaparotomydonenonexpansileswellingfoundonmesentericborderofintestine,management
a)Resectionandanastomosis
b)Ligation
c)Excisionofswelling
d)None
CorrectAnswer-DAnswer-D.NoneNonExpansileswellingonmesentericborderofintestineisalmostalwaysduetomesentericadenitisanditisanincidentalfinding,hencewarrantingnosurgicalintervention.
1219.InSVCsyndromefornonsmallcellcarcinomaoflungmanagementdone
a)Radiotherapy
b)Immunotherapy
c)Chemotherapy
d)Surgery
CorrectAnswer-AAnswer-A.RadiotherapyInpatientswithSVCSsecondarytonon–small-cellcarcinomaofthelung,radiotherapyistheprimarytreatment.Thelikelihoodofpatientsbenefitingfromsuchtherapyishigh,buttheoverallprognosisofthesepatientsispoorSmallcellcarcinomaoflungpresentingasSVCsyndrome-Combinationofchemotherapyandradiotherapy.NonSmallcellcarcinomaoflungpresentingasSVCsyndrome-Radiotherpyalone.
1220.Hadfieldsoperationisperformedforwhichofthefollowingpathology?
a)Ductectasia
b)Fibroadenoma
c)Mondorsdisease
d)Inflammatorybreastcarcinoma
CorrectAnswer-AAnswer-A.DuctectasiaTREATMENT-StopsmokingHadfield’soperation-excisionofallmajorductsAntibiotics-amoxiclavandmetronidazole
1221.Microdochotomyistreatmentfor
a)Ductectasia
b)Breastabscess
c)Ductpapilloma
d)DCIS
CorrectAnswer-CAnswer-C.DuctpapillomaThefinaldiagnosisismadebyexcisingtheinvolvedduct(Microdochotomy)andanyunderlyingmassifpresentandsubjectingthemforahistopathologicaldiagnosis
1222.Previousraditiontherapyforwhichdiseaseparticularyincreasestheriskofbreastcarcinomadevelopment?
a)Hodgkinslymphoma
b)Mantlecelllymphoma
c)Nasopharyngealcarcinoma
d)Lungcarcinoma
CorrectAnswer-AAnswer-A.HodgkinslymphomaArealprobleminwomenwhohavebeentreatedwithmantleradiotherapyaspartofthemanagementofHodgkin'sdisease,inwhichsignificantdosesofradiationtothebreastarereceived.
1223.Whichofthefollowinghistologicaltypeofbreastcarcinomaworstprognosis?
a)Tubular
b)Colloid
c)Papillary
d)Scirrhous
CorrectAnswer-DAnswer-D.ScirrhousMCtypeofbreastcarcinomaisinvasiveductalcarcinoma(schirrhous).MCformseen(60-75%)Hardlump,whitishyellow,noncapsulated,irregularwithcartilaginousconsistencyRetractionofnipple
1224.52yearsfemalepatientpresentswith4cmdiameterdiagnosedbreastcancerlesionwithipsilateralaxillaryandcontralateralsupraclavicularlymphadenopathy.AsperAJCCsystem,patientbelongstowhichstageofbreastcancer?
a)Ilia
b)None
c)IIIc
d)IV
CorrectAnswer-DAnswer-D.IV
1225.Bestprognosisforcarcinomabreastisseenwithwhichofthefollowing?
a)<1cmsize,nodes-ye,ER/PR+ve,her2/neu-ye
b)<1cmsize,nodes-ye,ER/PR-ye,her2/neu+ve
c)<2cmsize,nodes-ye,ER/PR+ve,her2/neu-ye
d)<2cmsize,nodes-ye,ER/PR-ye,her2/neu+ve
CorrectAnswer-AAnswer-A.<1cmsize,nodes-ye,ER/PR+ve,her2/neu-yeMolecularchangesinthetumorarealsouseful.TumorsthatoverexpresserbB2(HER2/neu)orhaveamutatedp53genehaveaworseprognosis.TumorsthatoverexpresserbB2aremorelikelytorespondtohigherdosesofdoxorubicin-containingregimensandpredictthosetumorsthatwillrespondtoHER2/neuantibodies(trastuzumab)(herceptin)andHER2/neukinaseinhibitors.
1226.Favorableprognosiswith>90%5yearsurvivalrateforcarcinomabreastisseeninwhichofthefollowing?
a)Screendetectedductalcarcinomainsitu
b)Screendetectedlobularcarcinomainsitu
c)Nodenegativetumorwithfavourablehistology
d)Noneoftheabove
CorrectAnswer-AAnswer-A.ScreendetectedductalcarcinomainsituIntraductalcarcinoma(malignantmammaryductalepithelialcells)withoutanyinvasionintobasementmembrane.
1227.Afemaleundergonesurgeryforleftbreastcancer3yrsbacknowdevelopedbluenoduleonsameside
a)Lymphangiosarcoma
b)Recurrence
c)Hemangioma
d)Cellulitis
CorrectAnswer-AAnswer-A.LymphangiosarcomaAngiosarcomaisavasculartumorwhichmayarisedenovointhebreastorasacomplicationoftheradiationtherapy.
1228.Whatpercentageofreductionindyingfrombreastcancercanbeachievedwithannualscreeningafterageof50yrswithmammography?
a)15-20%
b)20-25%
c)25-30%
d)30-35%
CorrectAnswer-CAnswer-C.25-30%Meta-analysisexaminingoutcomesfromeveryrandomizedtrialofmammographyconclusivelyshowsa25-30%reductioninthechanceofdyingfrombreastcancerwithannualscreeningafterage50years.
1229.Whichofthefollowinghormonallevelsinfluencethedevelopmentofbenignbreastdisease?
a)Estrogen
b)Progesterone
c)Lutenizinghormone
d)Testosterone
CorrectAnswer-A:BAnswer-A.Estrogen&B.ProgesteroneEtiology/PathogenesisHormonal:Responsivenessofbreasttissuetomonthlychangesofestrogenandprogesteroneplayanimportantroleinpathogenesisofbenignbreastdisease.Theymayberelatedtoexcesshormonalstimulationorhypersensitivityofbreasttissue.
1230.Whichofthefollowingistrueaboutbreastreconstructionsurgery
a)Easiestreconstructionisdoneusingsilicongelimplant
b)TRAMflapgivesbettercosmeticresultsthanLDflap
c)Radiotherapyinpostopperioddoesnotinfluencetheoutcomeafterbreastreconstruction
d)Nipplereconstructioncannotbeperformedunderlocalanesthesia
CorrectAnswer-AAnswer-A.EasiestreconstructionisdoneusingsilicongelimplantTheeasiesttypeofreconstructionisusingasiliconegelimplantunderthepectoralismajormuscle.Thismaybecombinedwithpriortissueexpansionusinganexpandablesalineprosthesisfirst(oracombineddevice),whichcreatessomeptosisofthenewbreast.Iftheskinatthemastectomysiteispoor(e.g.followingradiotherapy)orifalargervolumeoftissueisrequired,amusculocutaneousflapcanbeconstructedeitherfromthelatissimusdorsimuscle(anLDflap)orusingthetransversusabdominismuscle(aTRAMflapas).Thelattergivesanexcellentcosmeticresultinexperiencedhandsbutisalengthyprocedureandrequirescarefulpatientselection.Itisnowusuallyperformedasafreetransferusingmicrovascularanastomosis,althoughthepedicledTRAMfromthecontralateralsideisstillused.VariationsontheTRAMflaprequiringlessmuscleharvesting,suchastheDIEPflap(basedondeepinferiorepigastricvessels),areincreasinglybeingused.
increasinglybeingused.Impedimentstoimmediatereconstructionincludeinsufficienttheatretimeandalackofexperiencedreconstructivesurgeons.Inaddition,ifapatientislikelytoneedpostoperativeradiotherapythenadelayedreconstructionusingaflapoftengivesabetterresult.Radiotherapyontoaprosthesisoftenleadstoahighincidenceofcapsularcontractureandunacceptableresults.Nipplereconstructionisarelativelysimpleprocedurethatcanbeperformedunderalocalanaesthetic.
1231.Treatmentoflargeomphaloceledefectcanbedoneby
a)Primaryclosure
b)StagedclosureusingPTFEmesh
c)Paintingintactsacdailywithantisepticsolution
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveLargedefectspresentamoresubstantialproblemandfourtechniqueshavebeendescribed:non-operativetherapy,skinflapclosure,stagedclosureandprimaryclosure
1232.WhichofthefollowingisnottrueaboutPateysmastectomy
a)Itisalsocalledmodifiedradicalmastectomy
b)Intercostobrachialnervesareusuallypreserved
c)Alllymphnodesofaxillaareremoved
d)Pectoralismuscleiseitherdividedorretracted
CorrectAnswer-BAnswer-B.IntercostobrachialnervesareusuallypreservedItisalsocalledmodifiedradicalmastectomyandisacommonlyperformedprocedure.Theintercostalbrachialnervesareusuallydividedinthisoperationandthepatientshouldbewarnedaboutsensationchangespostoperatively.Thewoundisdrainedusingawide-boresuctiontube.Earlymobilisationofthearmisencouragedandphysiotherapyhelpsnormalfunctiontoreturnveryquickly
1233.Macroprolactinomaidealtreatmentis
a)Excision
b)Bromocriptine
c)Stereotacticradiosurgery
d)Observation
CorrectAnswer-BAnswer-BBromocriptine(BEC)isgenerallyconsideredtobetheagentofchoiceinthetreatmentofprolactinomabecauseofitslongtrackrecordandsafety.
1234.Initialtreatmentformostpatientofgrowthhormonesecretingpituitaryadenomais
a)Transphenoidalsurgicalresection
b)Somatostatinanalogs
c)GHrectorantagonists
d)Dopamineagonists
CorrectAnswer-AAnswer-A.TransphenoidalsurgicalresectionTranssphenoidalsurgicalresectionbyanexperiencedsurgeonisthepreferredprimarytreatmentforbothmicroadenomas(curerate-70%)andmacroadenomas(<50%cured).
1235.Radioiodinepreferredintreatmentin
a)Youngpatients
b)Pregnancy
c)Recentonsetoftoxicgoiter
d)Postsurgeryforpapillarythyroidcancer
CorrectAnswer-CAnswer-C.RecentonsetoftoxicgoiterThemainindicationsforRAItherapyincludethefollowingconditions
1. Hyperthyroidismdueto:Grave’sdiseaseToxicmultinodulargiotreorHyperfunctioningthyroidnodules
2. Non-toxicmultinodulargoitre3. Thyroidcancer.
1236.Parathyroidadenomasaccountforhowmuchpercentageofpatientswithprimaryhyperpara-thyroidism?
a)50%
b)60%
c)70%
d)80%
CorrectAnswer-DAnswer-D.80%Solitaryadenomas,Asingleabnormalgland,isthecausein-80%ofpatients;theabnormalityintheglandisusuallyabenignneoplasmoradenomaandrarelyaparathyroidcarcinoma.
1237.MCsiteforthyroglossalcystis:
a)Beneaththeforamencaecum
b)Floorofmouth
c)Abovehyoid
d)Subhyoid
CorrectAnswer-DAns.Di.e.SubhyoidSitesofthyroglossalcyst
1. Subhyoid:Themostcommontype2. Atthelevelofthyroidcartilage:2ndcommonsite3. Suprahyoid:Doublechinappearance4. Attheforamencaecum:Rare5. Atthelevelofcricoidcartilage:Rare6. Inthefloorofthemouth
1238.Investigationofchoiceforhepaticmetastasisformstomachcanceris
a)MRI
b)CECT
c)USG
d)HIDA
CorrectAnswer-BAnswer-B.CECTCTistheimagingmodalityofchoiceforevaluatinglivermetastases.Thispreferenceislargelyattributabletotheeffectsofthedualbloodsupplyontheenhancementcharacteristicsofmetastases,ascomparedwithnormalliverparenchyma.
1239.Prognosisofsurgeryforliversecondariesisbestforwhichcancer?
a)Colorectal
b)Neuroendocrine
c)Genitourinary
d)Esophageal
CorrectAnswer-CAnswer-C.GenitourinaryFornoncolorectal,nonneuroendocrinetumors,metastasesfromgenitourinaryprimarieshavethebestprognosisfollowinghepaticmetastatectomy.
1240.IndicatonsoflivertransplantinPCMpoisoningareallexcept
a)SGPTincrease
b)PT/INR
c)Highcreatinine
d)Encephalopathy
CorrectAnswer-AAnswer-A.SGPTincreaseIndicationpoorprognosisandhencenecessitateatransplantinsuchpatients-
1. ArterialpH<7.3(takenbysamplingofbloodfromanartery)2. Allthreeofaninternationalnormalizedratio(INR)ofgreaterthan
6.5,serumcreatinineofgreaterthan300micromolesperlitreandthepresenceofencephalopathy(ofgradeIIIorIV).Thesethreearemarkersofcoagulopathy,kidneyfunctionandmentalstatus.
1241.Milancriteriaisfor
a)SelectingpatientsforLivertransplantation
b)SelectingpatientsforLungtransplantation
c)SelectingpatientsforKidneytransplantation
d)Selectingpatientsforhearttrnasplantation
CorrectAnswer-AAnswer-A.SelectingpatientsforLivertransplantationTheMilancriteriastatethatapatientisselectedfortransplantationwhenheorshehas:
1. Onelesionsmallerthan5cm2. Upto3lesionssmallerthan3cm3. Noextrahepaticmanifestations4. Novascularinvasion
1242.WhatshouldbetheplanofmanagementforapatientforwhomwhileundergoingsimplecholecystectomyT2gallbladdercarcinomaisdiscovered?
a)Resectionof4b-5segement,dissectionoftheN1-2nodesandexcisionofportsites
b)Postoperativeadjuvantchemotherapy
c)Radicalcholecystectomy
d)Whipplesprocedure
CorrectAnswer-AAnswer-A.Resectionof4b-5segement,dissectionoftheN1-2nodesandexcisionofportsitesStageIandII-simplecholecystectomyStageIII–cholecystectomy+adjacenthepaticresection(atleast2cmdepth)+regionallymphadenectomyPoorprognosis
1243.TheGallstonepainisreferredtotheshoulderthroughwhichofthefollowingnerves:
a)C2-C8
b)T1-T4
c)T8-T12
d)C3-05
CorrectAnswer-DAnsis'd'i.e.C3-05Gallstonediseasemayreferpaintotherightshouldertip(k/aKehr'ssign).Thisisbecause,aninflamedgallbladderirritatesthediaphragmwhichissuppliedbythephrenicnerve(C3-05).Thesecervicalnerveroots,alsoprovidesensorysupplytotherightshoulderthroughsupraclavicularnerves.HencethegallbladderpainisreferredtotherightshoulderthroughtheC3-05nerveroots.Kehr'ssignisaclassicexampleofreferredpain:irritationofthediaphragmissignaledbythephrenicnerveaspainintheareaabovethecollarbone.Thisisbecausethesupraclavicularnerveshavethesamecervicalnervesoriginasthephrenicnerve,C3andC4.Boas'signcanalsoindicatestomachandduodenaldisease.WhenthetransverseprocessesofthoracicvertebraeT10-T12arepressedoreffleuragedwiththebottomofthehand,paincanappearatleftofspinousprocesses(instomach'slessercurvatureulcer)oratright(inpyloricorduodenalulcer).Boas'orBoas'ssignishyperaesthesia(increasedoralteredsensitivity)belowtherightscapulacanbeasymptominacutecholecystitis(inflammationofthegallbladder).
cholecystitis(inflammationofthegallbladder).
1244.3cmstoneincysticductneartheampullaofvater,TheMethodofremovalisa
a)Transduodenalapproach
b)Supraduodenalapproach
c)Lithotripsy
d)Chemicaldissolution
CorrectAnswer-AAnswer-A.TransduodenalapproachAccordingtoMaingot's"Themethodsofsurgicaldrainageincludetransduodenalsphincterotomy,choledochoduodenotomy,andcholedochojejunostomy."
1245.Inwhichcondition,medicaltreatmentofgallstoneisindicated-
a)Stoneis<15mmsize
b)Radioopaquestone
c)Calciumbilirubinatestone
d)Nonfunctioninggallbladder
CorrectAnswer-AAnsis'a'isStoneis<15mmsizeMedicaltreatmentsforgallstones,usedaloneorincombination,includethefollowing-Oralbilesalttherapy(ursodeoxycholicacid)(particularlyforx-ray-negativecholesterolgallstonesinpatientswithnormalgallbladderfunction)Extracorporealshockwavelithotripsy(particularlyfornoncalcifiedcholesterolgallstonesinpatientswithnormalgallbladderfunction)Medicalmanagementismoreeffectiveinpatientswithgoodgallbladderfunctionwhohavesmallstones(<1cm)withahighcholesterolcontent.Bilesalttherapymayberequiredformorethan6monthsandhasasuccessrateoflessthan50%.
1246.RegardingCagallbladder-
a)Squamouscellcaisthemostcommon
b)Presentwithjaundice
c)Goodprognosis
d)All
CorrectAnswer-BAnswer(b)PresentswithjaundiceBiliarytractcancerstendtobeslow-growingtumoursthatinvadelocallyandmetastasisetolocallymphnodes.Distantmetastasestotheperitonealcavity,liverandlungdooccur.Jaundiceisthemostcommonpresentingfeature.Abdominalpain,earlysatietyandweightlossarealsocommonlyseen.Onexamination,jaundiceisevident,cachexiaoftennoticeableandapalpablegallbladderispresentiftheobstructionisinthedistalcommonbileduct(Courvoisier'ssign).
1247.WhichofthefollowingisnotaprognosticfactorforAcutePancreatitis
a)SerumAmylase
b)SerumCalcium
c)SerumGlucose
d)SerumAST
CorrectAnswer-AAnswerisA(SerumAmylase):SerumAmylasedoesnotformanycriteriaforprognosisinAcutePancreatitis.Althoughelevatedserumamylaselevelisimportantforestablishingdiagnosisofacutepancreatitis,itplaysnoroleinpredictingprognosisorseverity."Thereappearstobenodefinitecorrelationbetweenseverityofpancreatitisandthedegreeofserumamylaseelevation.After48to72hours,evenwithcontinuingevidenceofpancreatitis,totalserumamylaselevelstendtoreturntonormal."-HarrisonHyperglycemia(Glucose),Hypocalcemia(Calcium)andelevatedserumASTareallpoorprognosticfactorsinaccordancewithRanson'scriteriaaselaboratedinthepreviousquestion.
1248.Mostsensitiveandspecificforacutepancreatitisamongstthefollowingis:September2008
a)S.amylase
b)S.Alaninetransaminase
c)S.lipase
d)C-reactiveprotein
CorrectAnswer-CAns.C:S.lipaseSerummarkersfordiagnosisofacutepancreatitis:Alaninetransaminase-Associatedwithgallstonepancreatitis;threefoldelevationorgreaterinthepresenceofacutepancreatitishasapositivepredictivevalueof95percentindiagnosingacutegallstonepancreatitisAmylaseMostaccuratewhenatleasttwicetheupperlimitofnormal;amylaselevelsandsensitivitydecreasewithtimefromonsetofsymptomsC-reactiveproteinLatemarker;highlevelsassociatedwithpancreaticnecrosisLipaseIncreasedsensitivityinalcohol-inducedpancreatitis;morespecificandsensitivethanamylasefordetectingacutepancreatitisPhospholipaseA2AssociatedwithdevelopmentofpancreaticnecrosisandpulmonaryfailureProcalcitonin
Earlydetectionofseverity;highconcentrationsininfectednecrosisTrypsinogenactivationpeptideEarlymarkerforacutepancreatitisandclosecorrelationtoseverity
1249.Whichenzymeisofdiagnosticimportanceinchronicpancreatitis
a)Amylase
b)Pancreaticpolypeptide
c)Lipase
d)SerumInterleukin6levels
CorrectAnswer-CAnswer-C.LipaseElevatedlipaselevelsaremorespecifictothepancreasthanelevatedamylaselevels.Lipaselevelsremainhighfor12days.Inpatientswithchronicpancreatitis(usuallycausedbyalcoholabuse),lipaselevelsmaybeelevatedinthepresenceofanormalserumamylaselevel.
1250.Mostcommonscreeningtestforacutepancreatitis-
a)Serumamylase
b)Serumlipase
c)Urinetrypsinogen
d)Insulin
CorrectAnswer-CAnswer-C.UrinetrypsinogenRapidmeasurementofurinarytrypsinogen-2levelisusefulintheemergencydepartmentasascreeningtestforacutepancreatitis.
1251.Whichofthefollowingis/aretheimagingcriteriaforunresectablecarcinomaofpancreas?
a)Metastaticspreadtovertebrae
b)Invasioninduodenalwall
c)Irregularincreaseindensityofomentalfat
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveMetastaticspredoutsidethepancreasmakestumorirresectable.Tumorinvasionintoadjacentorganssignificsunresectability.
1252.Drugofchoiceforpalliativetreatmentofpancreaticcarcinoma
a)Erlotinib
b)Gemcitabine
c)Paclitaxel
d)Cyclophosphomide
CorrectAnswer-BAnswer-B.GemcitabineA)Inoperablelocallyadvanceddisease-Gemcitabineisusedathetreatmentofchoiceforthesepatients.B)MetastaticDiseaseGemcitabineisthestandardtreatmentwithamediansurvivalof6monthsanda1-yearsurvivalrateofonly20%.Capecitabine,anoralfluoropyrimidine,hasbeencombinedwithgemcitabine(GEM-CAP)inaphaseIIItrialthatshowedanimprovementinresponserateandprogression-freesurvivaloversingle-agentgemcitabine,butnosurvivalbenefit.
1253.
Modified-KaushWhippleoperationisdevisedtopreservewhichpartofstomach?
a)Fundus
b)Body
c)Lessercurvature
d)Pyloricantrum
CorrectAnswer-DAnswer-D.PyloricantrumThisprocedureisalsocalledpyloruspreservingpancreaticoduodenectomy(PPPDorpp-KaushWhippleprocedure).Itistheprocedureofchoiceformostadenocarcinomasoftheheadofpancreas.Theoriginalpancreato-duodenectomyasproposedbyWhippleincludedresectionofthegastricantrum.TheWhippleprocedureisnowreservedforsituationsinwhichtheentireduodenumhastoberemoved(e.g.inFAP)orwherethetumourencroachesonthefirstpartoftheduodenumorthedistalstomachandaPPPDwouldnotachieveaclearresectionmargin.
1254.Whichofthefollowingcausesofacutepancreatitiscancauserecurrentboutswithoutanyobviouspathology
a)SphincterOddidysfunction
b)Pancreasdivisum
c)Hypertriglyceridemia
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveEtiology-Gallstones(mostcommon)Alcoholabuseisthesecondcauseofacutepancreatitis.Occultdiseaseofthebiliarytreeorpancreaticducts,especiallymicrolithiasis,sludge.HypertriglyceridemiaPancreasdivisumPancreaticcancerSphincterofOddidysfunctionCysticfibrosisDrugs-Steroids,Azathioprine,Valproate,Estrogens,L-Asparaginase,6-mercaptopurine,Sulfonamides,Tetracycline,Anti-retroviralagents,ThiazidediureticsFamilialorgeneticHyperparathyroidismHypercalemiaPostERCPMostcommoncausesinchildren:bluntabdominalinjuries,
multisystemdisease(hemolyticuremicsyndromeandinflammatoryboweldisease)biliarystonesormicrolithiasis(sludging),anddrugtoxicity
1255.Pseudocystpancreasisdevelopedinhowmuchdurationfollowinganattackofacutepancreatitis?
a)Lessthan1week
b)Lessthan2weeks
c)3ormoreweeks
d)4ormoreweeks
CorrectAnswer-DAnswer-D.4ormoreweeksPseudocyststypicallyarisefollowinganattackofmildacutepancreatitis,lieoutsidethepancreas,andrepresentanAPFCthathasnotresolvedandmatured.Formationofapseudocystrequires4weeksormorefromtheonsetofacutepancreatitis.
1256.Cullen'ssignisseenin:March2004
a)Acutecholecystitis
b)Acutehepatitis
c)Acutepancreatitis
d)Bluntinjuryabdomen
CorrectAnswer-CAns.Ci.e.Acutepancreatitis
1257.Howmuchpercentageoftheblunttraumainjuriestospleeninadultsarecurrentlymanagednonoperatively?
a)30%
b)50%
c)80%
d)90%
CorrectAnswer-CAnswer-C.80%Spleenistheintra-abdominalorganmostcommonlyinjuredinablunttraumatotheabdomen.Upto80%ofbluntsplenicinjuriescanbemanagednon-operatively.Itcanbemanagedin2ways:i)Non-operativelyThisisnowtheorderofthedayandcurrently>70%ofadultswithbluntsplenicinjuriesaremanagednon-operatively.Buttheprimaryrequirementforitis-hemodynamicstability.ii)OperativemanagementPatientswhoarehemodynamicallyunstableorarefailingnon-operativemanagement(eg.requirecontinuingtransfusion)shouldundergooperativetreatment.
1258.Mostprevalentsymptominpatientsofleiomyomaofesophagusis
a)Pain
b)Pyrosis
c)Dysphagia
d)Weightloss
CorrectAnswer-CAnswer-C.DysphagiaCLINICALFEATURES-Asymptomatic(<5cm)Dysphagia,painMorecommoninmalesLocation-2/3rdofoesophagus
1259.Followingisnottrueabouttractiondiverticulumofesophagus-
a)Producedduetotheextraluminalforces
b)Itisnotatruediverticulum
c)Theoutpouchingisusuallysmallandconical
d)Maydeveloptracheoesophagealfistula
CorrectAnswer-BAnswer-B.ItisnotatruediverticulumIntractiondiverticulaextraluminalforces(likeinflammed&scarredperibronchial&mediastinallymphnodes)pullthefullthicknessoftheesophagusout,creatingatruediverticula.Tractiondiverticulaaremuchlesscommon.Theyaremostlyaconsequenceofchronicgranulomatousdiseaseaffectingthetracheobronchiallymphnodesduetotuberculosis,atypicalmycobacteriaorhistoplasmosis.Fibrotichealingofthelymphnodesexertstractionontheoesophagealwallandproducesafocaloutpouchingthatisusuallysmallandhasaconicalshape
1260.Whichofthefollowingisfalseaboutzenkersdiverticulum
a)Mostpatientsareabove50yearsofage
b)Itisthemostcommonesophagealdiverticulum
c)Mucosaloutpouchingthroughthekillianstriangle
d)Cervicalwebscanbeassociatedwithzenkersdiverticulumin80%ofthepatients
CorrectAnswer-DAnswer-D.Cervicalwebscanbeassociatedwithzenkersdiverticulumin80%ofthepatientsZenkerdiverticulumoriginatesfromtheposteriorwalloftheesophagusinatriangularareaofweakness,limitedinferiorlybythecricopharyngeusmuscleandsuperiorlybytheinferiorconstrictormuscles(ie,theKilliantriangle).Zenker'sdiverticulum,alsopharyngoesophagealdiverticulum,alsopharyngealpouch,alsohypopharyngealdiverticulum,isadiverticulumofthemucosaofthepharynx,justabovethecricopharyngealmuscle(i.e.abovetheuppersphincteroftheesophagus).Itisapseudodiverticulum(notinvolvingalllayersoftheesophagealwall).Seenin50yearsold.
1261.Dohlmanprocedurefor-
a)Meckel’sdiverticulum
b)Zenker’sdiverticulum
c)Dermatomyositis
d)Menetrier’sdisease
CorrectAnswer-BAnswer-B(Zenker’sdiverticulum)Thetreatmentofpharyngealpouches(Zenker’sDiverticulum)maybebyeitheropensurgicalorendoscopictechniques.TheendoscopicDohlman’sprocedureisanidealtechniqueintheelderly.
1262.Trueaboutesophagealcarcinomais
a)Morelethalthanthecolorectalcancers
b)Theseshowanincreasingtrendtowardsthenumberofsquamouscellcarcinomas
c)Smallersizeesophageallesionshavebettersurvival
d)Asymptomaticbenignlesionsshouldbeexcisedimmediately
CorrectAnswer-AAnswer-A.MorelethalthanthecolorectalcancersEtiology:alcoholandsmoking:forsquamouscellcarcinomaandadenocarcinomaachalasiaasbestosisBarrettoesophagus:foradenocarcinomacoeliacdiseaseionisingradiationcausticstricture/lyestricturePlummer-VinsonsyndromeEvenwhendetectedasasmalllesion,esophagealcancerhaspoorsurvivalbecauseoftheabundantesophageallymphaticsleadingtoregionallymphnodemetastases.
1263.Patientcomplainsofintermittentdysphagiawhichisequalbothforsolidsandliquids,whichofthefollowingisthemostprobablediagnosis?
a)Achalasiacardia
b)Esophagealstricture
c)Carcinomaesophagus
d)Diffuseesophagealspasm
CorrectAnswer-DAnswer-D.DiffuseesophagealspasmClinicalfeatures-HypertrophyofcircularmusclesDysphagiaChestpain
1264.Earlyandlatesuspectedinstrumentalperforationofoesophagusshouldfirstbeassessedusing
a)Watersolublecontrastswallow
b)CTScan
c)Dilutebariumswallon
d)MRI
CorrectAnswer-AAnswer-A.WatersolublecontrastswallowIfthisisnegative,adilutebariumswallowshouldbeconsidered.ACTscancanbeusedtoreplaceacontrastswalloworasanadjuncttoaccuratelydelineatespecificfluidcollections.
1265.Downhillesophagusvaricesdevelopasaresultofobstructionofseenin
a)Portalvein
b)Hepaticvein
c)Superiorvenacava
d)Inferiorvenacava
CorrectAnswer-CAnswer-C.SuperiorvenacavaDownhillvaricesareproducedbytheobstructionofthesuperiorvenacava,whichresultsincollateraldrainagefromthehead,neckandupperextremityvenoussystemsintotheveinssurroundingthemidandupperthoracicesophagusandintotheazygousvein.OnCTvaricesappearasenhancingtubularregionsintheperiesophagealregion.Thisdensityisequaltothevenousbloodpool.
1266.Mostcommonimpactedforeignbodyinesophagusinchildrenis
a)Coin
b)Foodproduct
c)Krayon
d)Marble
CorrectAnswer-AAnswer-A.CoinCoinsarethemostcommonlyimpactedforeignbodiesinchildreninesophagusandoropharynxfollowedbythefoodproducts
1267.WhichofthefollowingisnottrueaboutmedicalmanagementofuncomplicatedGERD?
a)PPIsarethemosteffectivedrugtreatmentforGORD
b)Householdmeasureoftiltingthebedisefficatious
c)LongtermPPItherapyincreasesriskofmalignantchanges
d)AdequatedoseofPPIfor8weeksistherecommendedtreatment
CorrectAnswer-CAnswer-C.LongtermPPItherapyincreasesriskofmalignantchangesTreatment-1.Lifestylemodificationwithavoidingorcessationofsmoking,tea/coffee,alcohol.2.Drugs-PPI-antisecretorydrugsAntaacidswithalginateProkinetic-itopride(50mgTID)(Cisaprideandmosapridenotrecommendedasitcausescardiacarrhythmia)LESsphincterisrelaxedbynitrates,atropineandcalciumchannelblocker.3.Mucosaprotectiveagents-sucralfatecolloidalbismuth4.Endotherapy-plexiglassminosphere(PMMA)5.Surgery-antirefluxsurgery
1268.Singledrugregimenforcarcinomaesophaguswhichshowssignificantdecreaseintumorsizein15-20%ofpatientsincorporateswhichdrug?
a)Cisplatin
b)Bleomycin
c)Doxorubicin
d)Vincristine
CorrectAnswer-AAnswer-A.CisplatinSignificantreductionsinthesizeofmeasurabletumormasseshavebeenreportedin15-25%ofpatientsgivensingle-agentcisplatintreatmentandin30-60%ofpatientstreatedwithdrugcombinationsthatincludecisplatin.
1269.MostcommontypeofHiatalherniais
a)Sliding
b)Rolling
c)Mixed
d)Noneoftheabove
CorrectAnswer-AAnswer-A.SlidingThereare4typesofhiatalherniaTypeI:Slidinghernia(mostcommontype-70-80%)TypeII:ParaesophagealorrollingherniaTypeIII:MixedTypeIV:Teseherniasaredistinguishedbythepresenceofotherabdominalviscerawihinthedefecti.e.omentum,transversecolon.
1270.Incorrosiveinjuryofesophaguscorrectstatementisallexcept
a)Alkalisareusuallyingestedinlargervolumes
b)Alkaliscausemoregasticdamagethanacids
c)Alkalisformfibrousscar
d)Acidsformeschar
CorrectAnswer-BAnswer-B.AlkaliscausemoregasticdamagethanacidsIngeneral,alkalisarerelativelyodourlessandtasteless,makingthemmorelikelytobeingestedinlargevolume.Alkaliscauseliquefaction,saponificationoffats,dehydrationandthrombosisofbloodvesselsthatusuallyleadstofibrousscarring.Acidscausecoagulativenecrosiswithescharformation,andthiscoagulantmaylimitpenetrationtodeeperlayersoftheoesophagealwall.Acidsalsocausemoregastricdamagethanalkalisbecauseoftheinductionofintensepylorospasmwithpoolingintheantrum.
1271.Anindividualofage40yrspresentswithdysphagiatobothsolidsandliquidswithsymptomsofregurgitation.Patientalsocomplaintsofchestpainandweightloss.Whichofthefollowingisthepreferredinvestigationfordiagnosisofthispathology?
a)BariumswallowX-ray
b)BariumswallowX-raywithesophagealmanometry
c)BariumswallowX-raywoithesophagealmanometrywithendoscopy
d)Noneoftheabove
CorrectAnswer-BAnswer-B.BariumswallowX-raywithesophagealmanometryBariumswallow-showscucumberoesophagusorbirdsbeakorpenciltipdeformity.Oesophagealmanometry-CharacteristicsofachalasiacardiaHypertensiveLOSAperistalsisinthebodyofoesophagusBariumswallowshowsadilatedesophaguswithtaperingnarrowingintheterminalendofesophagus,describedas‘BIRDBEAK’appearance.
1272.MostaccuratemethodforthediagnosisGastroesophagealRefluxDisease(GERD)is
a)Histologicalstudy
b)Manometry
c)24-hourpHrecordingandelectricalimpedancemeasurement
d)Bariumswallowstudies
e)UpperGIendoscopy
CorrectAnswer-CAnswer-C.24-hourpHrecordingandelectricalimpedancemeasurementThemostsensitivetestfordiagnosisofGERDis24-hambulatorypHmonitoring.Endoscopyisindicatedinpatientswithrefluxsymptomsrefractorytoantisecretorytherapy;inthosewithalarmingsymptomssuchasdysphagia,weightloss,orgastrointestinalbleeding;andinthosewithrecurrentdyspepsiaaftertreatmentthatisnotclearlyduetorefluxonclinicalgroundsalonepHwaslessthan4
1273.Whichofthefollowingtumorsmostcommonlypresentswithuppergastrointestinalbleeding?
a)Primarygastriccancer
b)Esophagealcarcinoma
c)Metastasestostomach
d)Hepaticadenocarcinoma
CorrectAnswer-AAnswer-A.PrimarygastriccancerTumorbleedingaccountsforupto5%ofuppergastrointestinalbleeding(UGIB)cases.
1274.Whichofthefollowingistrueaboutgastriculcerbutnottheduodenalulcer?
a)Painrarelyoccursatnight
b)Melenaismorecommonthanhematemesis
c)Usuallyoccursin40-50yrsofage
d)Painisrelievedwithingestionoffood
CorrectAnswer-AAnswer-A.Painrarelyoccursatnight
1275.Themostcommonlypracticedoperativeprocedureforaperforatedduodenalulceris-
a)Vagotomyandpyloroplasty
b)Vagotomyandantrectomy
c)Vagotomyandperforationclosure
d)Graham'somentumpatchrepair
CorrectAnswer-DAns.is'd'i.e.,Graham'somentumpatchrepair
1276.Nottrueabouthighlyselectivevagotomy-
a)Itisalsoknownparietalcellvagotomy
b)NervesofLatarjetaresacrifised
c)Recurrenceratesarehigherthanvagotomyanddrainageandvagotomyandantrestomy.
d)Entiregastricreservoircapacityispreserved
CorrectAnswer-BAnswer-B.NervesofLatarjetaresacrifisedInHighlyselectivevagotomy(alsoknownasparietalcellvagotomyorproximalgastricvagotomy)thevagalinnervationtotheantrumandpylorus(nervesofLatarjet)arepreserved,onlythevagalsupplytotheproximaltwo-thirdsofstomach(whereessentiallyalltheparietalcellsarelocated)iscut.Thispreservesgastricmotility.
1277.Simplestinvestigationtobeperformedinsuspectedcasesofgastriccanceris-
a)Doublecontrastradiography
b)Plainradiography
c)CTScan
d)Endoscopy
CorrectAnswer-CAnswer-CCtscanInvestigationfordiagnosisofgastriccancer:*UltrasoundandCTscan-Toruleoutsecondariesintheliver.-Tolookforenlargedcoeliacnodes.-Candetectascites-guidedfluidtapandcellcytology.-TodetectKrukenbergtumour(pelvicCT).-Usefulindetectingmetastaticdisease.
1278.Thefeaturesofcrohnsdiseaseareallexcept?
a)Lymphoidhyperplasia
b)Skinlesion
c)Transmuralinvolvement
d)CryptAbscess
CorrectAnswer-AAns.is'a'i.e.,LymphoidhyperplasiaIntermittentmilddiarrhea,fever,abdominalpain(MC)Rightlowerquadrantmass,weightloss,anemiaSometimesmimicsappendicitisorbowelperforationAnalcomplaints(fissure,fistula,abscess)–frequentFat/vitaminmalabsorptionpresentRecurrenceaftersurgerycommonMalignancy(mostcommoncause)+withcoloninvolvementStringsignofKantorisseeninCrohn'sDisease.CreepingfatisafeatureofCrohn'sDisease.
1279.Trueaboutsmallintestinaltumoris-
a)Lymphomasarethemostcommonsmallintestinaltumors
b)Carcinoidsaremorecommonintheduodenumandjejunum
c)Adenomatouspolypsaremorecommonintheterminalileum
d)Riskofdevelopingsmallboweltumorcorrelatespositivelywithcolorectalcancer
CorrectAnswer-DAnswer-D.RiskofdevelopingsmallboweltumorcorrelatespositivelywithcolorectalcancerThesecondmostcommonsmallboweltumoriscarcinoidaccountingfor35%ofallsmallbowelcarcinomas,90%ofwhicharelocatedintheileum.Lymphomasaccountforthethirdmostcommontumorsofthesmallbowel.Adenomatouspolypstendtooccurintheperiampullaryregionandproximaljejunum,closetotheentranceofbileandpancreaticsecretionsintosmallintestine.
1280.Contraindicationforcolostomyplanningareallexcept-
a)Age>60yrs
b)Stomanearskincreasesandbonyprominences
c)Poorlymotivatedpatientforelectivestomy
d)Stomasthroughpreviousscars
CorrectAnswer-AAnswer-A.Age>60yrsThepatientmustbeexplainedtheprocedureandproperlymotivatedfortakingcareofthestomaThestomashouldpreferablybethroughrectusabdominis(topreventprolapseandparastomalhernias)ItshouldbethroughflatsurfaceofabdomenItshouldavoidskincreasesandbonyprominencesItshouldbeawayfrompreviousscars
1281.Colonoscopyisarenotindicatedin-
a)MEN2B
b)FAP
c)HNPCC
d)Cornkitecanadasyndrome
CorrectAnswer-AAnswer-A.MEN2BMEN2Bdoesnotpredisposetocoloncancer.FAP,HNPCC,CronkiteCanadaSyndromepredisposetoColonCancerandhencescreeningwithcolonoscopyisneeded
1282.Criticaldiameterofcaecumwhenperforationisconsideredeminentinpseudo-obstructionis-
a)>7cm
b)>8cm
c)>9cm
d)>10cm
CorrectAnswer-CAnswer-C.>9cmItisdefinedaslargeboweldistentionresultingfromchronicimpairmentofmotility.Thedegreeofcolonicdistentionmaybesevereenoughtocausecaecalperforation.Imminenetperforationofcaecumisconsideredwhenthecaecaldiameterexceedsthecriticaldiameterof9cm(>9cm).
1283.ExceptiontoGoodsalsruleisconsideredwhentheanteriorexternalopeningismoresituatedmorethancmsfromanalmargin-
a)2
b)3
c)4
d)5
CorrectAnswer-BAnswer-B.3Goodsall'sRuleIsusedtodeterminethelocationofinternalopeningAccordingtoit:Fistulaswithexternalopeninganteriortohorizontalimaginarylinedrawnacrossthemidpointofanusconnecttotheinternalopeningbyshortstraighttract.Fistulaswithexternalopeningposteriortothehorizontalline-runacurvilinearcourseandopeninternallyintotheposteriormidline.
1284.Treatmentofchoiceforlowfistulainanois-
a)Fistulotomy
b)Intravenousantibiotics
c)Stagedsurgicalresection
d)Noneoftheabove
CorrectAnswer-AAnswer-A.FistulotomyItisdividedinto2types-high&low,accordingtowhethertheirinternalopeningsisbeloworabovetheanorectalring.Theimportanceofdecidingwhetherafistulaisaloworahightypeisthatalowlevelcanbetreatedbyfistulotomy(openingthetract)withoutcausingdamagetothesphincter.
1285.Stagingofrectalcarcinomaisbestdoneby-
a)CTScan
b)MRI
c)TRUS
d)Alltheabove
CorrectAnswer-BAnswer-B90%ofrectalgrowthscanbefeltbyper-rectalexaminationHigh-resolutionphasedarrayexternalMRIistheinvestigationofchoiceforlocalissuesintheprimarystagingofrectalcancer(bestinvestigationforstaging)aswellasforrestagingafterNACT-RT.ItprovidesthehighestaccuracyforissuesinpretreatmentlocalstagingInvestigationofchoice–rigidsigmoidoscopyandbiopsyToassesslocalspread–TRUS(Endoluminalultrasound)Forlocalstagingandassessmentofproposedcircumferentialresectionmargin–MRI(CTisnotaccurateinlocalstaging)
1286.Rolledupomentumisseenincasesof-
a)Peritonealtuberculosis
b)Peritonealmetastases
c)Perforationperitonitis
d)Malrotationofgut
CorrectAnswer-AAnswer-A.PeritonealtuberculosisTheclassicappearanceofgreyishwhitemilitarynodulesscatteredovertheperitoneum.Inadditionfibrousbandsandadhesionsarecommon.Theomentummaybecomethickenedpresentingasatransverselyplacedmass(rolledupomentum).Clinicallythemostfrequentpresentationoftheperitonealdiseaseisascites.
1287.Pantaloonherniaisalsocalledas-
a)Dualhernia
b)Saddlebaghernia
c)Bochdalekshernia
d)Retrosternalhernia
CorrectAnswer-BAnswer-B.SaddlebagherniaItisalsocalleddualorsaddlebaghernia.Thistypeofherniaconsistsoftwosacsthatstraddletheinferiorepigastricartery,onesacbeingmedialandtheotherlateraltothisvessel.
1288.Whichofthefollowingfamouspersonalitieshadhydroceleassociatedwithhernia,whichprovedtobefatal?
a)EdwardGibbon
b)ThomasEdison
c)MileyWright
d)NeilArmstrong
CorrectAnswer-AAnswer-A.EdwardGibbonEdwardgibbon(1737-1794),englishhistorianhadlargehydrocele.Thehydrocelewasassociatedwithalargescrotalherniawhichprobablywaspunctured.
1289.Incaseoffemalecommonestherniais?
a)Directinguinalhernia
b)Indirectinguinalhernia
c)FemoralHernia
d)Incisionalhernia
CorrectAnswer-BAnsis'b'ieIndirectInguinalherniaInIndirectinguinalherniathecontentsoftheabdomenenterthedeepinguinalringandtraversethewholelengthoftheinguinalcanaltocomeoutthroughthesuperficialinguinalring.Itisthemostcommonofallformsofhernia.Itismostcommonintheyoung(cfadirectherniaismostcommonintheold)Femoralherniasoccurmostcommonlyinwomenbutlowerincidenceoverallthaninguinalhernias.
1290.40yearsmalepresentswithtranslucentscrotalswellinginwhichitispossibletogetabovetheswellingonexamination.Whatisthemostprobablediagnosis?
a)Hydrocele
b)Indirectinguinalhernia
c)Varicocele
d)Sebaceouscyst
CorrectAnswer-AAnswer-A.HydroceleHydrocelesaretypicallytranslucentanditispossibleto'getabovetheswelling'onexaminationofthescrotum.Ahydroceleisanabnormalcollectionofseriousfluidinapartoftheprocessusvaginalis,usuallythetunica.Encystedhydroceleofthecordisasmoothovalswellingnearthespermaticcord,whichisliabletobemistakenforaninguinalhernia.Theswellingmovesdownwardsandbecomeslessmobileifthetestisispulledgentlydownwards
1291.Scrotalswellingnonreduciblebutdisappearswhenthechildwakesupfromsleepismostlikelytobe-
a)Congenitalhydrocele
b)Varicocele
c)Indirectinguinalhernia
d)Noneoftheabove
CorrectAnswer-AAnswer-A.CongenitalhydroceleIncongenitalhydrocelethecommunicationwithperitonealcavityisusuallytoosmalltoallowherniationofintra-abdominalcontents.Usuallyhydroceleisanonreducibleswellingbutcongenitalhydrocelecanpassivelygetdrainedthroughintacttunicsvaginalisduetogravitywhilesleeping.Bothvaricoceleandindirectinguinalherniaarereduciblescotalswelling.SothemostprobableanswerisCongenitalhydrocele
1292.Treatmentofcongenitalhydrocephalusis-
a)Ventriculoperitonealshunt
b)Sterestacticradiosurgery
c)Diuretics
d)Radiotherapy
CorrectAnswer-AAnswer-A.VentriculoperitonealshuntCongenitalHydrocephalus-TreatmentOptions
1. Ventriculoperitonealshunt2. Endoscopicthirdventriculostomy3. Lumbarpuncture(temporarymeasuretillashuntisput)
1293.Trueofumbilicalhernia-
a)Mostcommoncontentislargeintestine
b)Mostoftheumbilicalherniasdisappearspontaneously
c)Malesareaffectedmorethanfemales
d)Uncomplicatedhereniasarerepairedat1yearofagethroughaninfraumbilicalincision.
CorrectAnswer-BAnswer-B.MostoftheumbilicalherniasdisappearspontaneouslyUmbilicalherniadevelopsduetoeitherabsenceofumbilicalfasciaorincompleteclosureofumbilicaldefectininfants.Umbilicalhernia(paraumbilicalhernia)isaprotusionorherniationthroughlineaalbajustaboveorbelowumbilicus.Weakestpartisumbilicalcicatrix.Contentsare-greateromentum,smallintestineandtransversecolon.CLINICALFEATURES-Femalesin5thdecadeSwellinghassmoothsurface,distinctedgesresonantwithdraggingpain.ExpansileimpulseonpatientcoughingSurgicaltreatmentisindicatedifHerniapersistsat2yearsofageorolder.Ifthedefectismorthan2cminsize.Ifitisassociatewithcomplications.Heriorrhaphy(surgeryforrepairofhernia)isdonethroughaninfraumbilicalincision.Defectisclosedwithinterruptedsuturesafterligatingthesac.
1294.A10yearsoldmalepresentsasmoothswellingnearsuperficialinguinalring,whichmovesdownwardswhenthetesticleispulleddownwards.Diagnosis-
a)Inguinalhernia
b)Congenitalhydrocele
c)Encystedhydroceleofthecord
d)Varicocele
CorrectAnswer-CAnswer-C.EncystedhydroceleofthecordAhydrocoeledevelopsinaremnantoftheprocessusvaginalissomewherealongthecourseofthespermaticcord.Thishydrocoelealsotransilluminates,andisknownasanencystedhydrocoeleofthecord.Theswellingmovesdownwardsandbecomeslessmobileifthetestisispulledgentlydownwards.Infemales,amulticystichydrocoeleofthecanalofNucksometimespresentsasaswellinginthegroin.
1295.Physiologicaladhesionsbetweenforeskinandglanspenispersistuntilyearsofage-
a)4
b)5
c)6
d)7
CorrectAnswer-CAnswer-C.6Phimosisisaconditioninwhichtheforeskinofthepeniscannotbepulledbackpasttheglans.Thephysiologicaladhesionsbetweentheforeskinandtheglanspenismaypersistuntil6yearsofageormore,givingthefalseimpressionthattheprepucewillnotretract.
1296.Commonestsiteofhypospadiasis-
a)Justproximaltoglans
b)Inthemeidofpenis
c)Scrotum
d)Perineum
CorrectAnswer-AAnswer-A.JustproximaltoglansHypospadiasisaconditioninwhichtheurethralmeatusopensontheundersideofpenisortheperineum(i.e.ventralsurfaceofpenis)proximaltothetipoftheglanspenis.
1297.Besttimeforsurgeryofhypospadiasisatwhatage-
a)0-4months
b)4-6months
c)6-10months
d)>2years
CorrectAnswer-CAnswer-C.6-10monthsOperationsforhypospadiasisareroutinelyperformedwhenthepatientisbetween6and18monthsofage.Theinfanthasgoodtolerancetosurgeryandanesthesiabytheageof6months.Thechildiswellawareofhisgenitaliaandtoilettrainingbytheageof18months.So,themostsuitableagefortheoperationofhypospadiasisbetween6and18months.Thedegreeofhypospadiasdictatestheneedforrepair.Iftheopeningisglanularorcoronal(85%ofpatients),thepenisisusuallyfunctionalbothformicturitionandprocreationandrepairisdoneprimarilyforcosmeticreasons.Openingsthataremoreproximalontheshaftrequirecorrectiontoallowvoidingwhilestanding,normalerection,andproperspermdepositionduringintercourse.Thecommonestprocedurefordistalhypospadiasisthe‘tubularizedincisedplate’urethroplasty,whiletechniquesthatutilizetheforeskinarecommonlyusedformoreproximalhypospadias.Complicationsofhypospadiassurgery:urethrocutaneousfistula(mostcommon)RecurrenceofchordeeUrethralstricture
MeatalstenosisInfection
1298.Whichoneofthefollowingstatementistrueofundescendedtestis-
a)Usuallydescendsspontaneouslyatpuberty
b)Orchipexytobedoneifnodescentbypuberty
c)Hasahigherincidenceofmalignancy
d)Maintainsnormalspermproduction
CorrectAnswer-CAns.is'c'i.e.,HasahigherincidenceofmalignancyTREATMENT-*Orchidopexydonebefore6monthsofage*Orchidectomy-patientwithincompletedescendedtestisisatrophic,pastpubertyandnormaltestis*Ombredanne’soperationinbilateralcases*HCGorGnRH-cryptorchidismassociatedwithhypogenitalismandobesity*ApproximatelyUDTspontaneouslydescendby3monthsofage*Secondarysexualcharactersticsarenormal
1299.Mostcommonsiteofpenilecarcinomais-
a)Glans
b)Prepuce
c)Shaft
d)Coronalsulcus
CorrectAnswer-AAnswer-A.GlansWhenitoccursontheglanspenis,itisknownaserythroplasiaofQueyratandwhenitoccursontheshaftofthepenisitiscalledBowen'sdisease.Carcinomaofthepenisismosttypicallyasquamouscellcarcinomaarisingintheskinoftheglanspenisortheprepuce.MCorginatesfromglans>sulcus>prepuce>shaft
1300.Whichofthefollowingarethetreatmentoptionsforcystocele?
a)Anteriorcolporrhaphy
b)Transvaginaltape
c)Transobturatortape
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveTraditionally;ananteriorvaginalwallrepair(anteriorcolporrhaphy)wasperformedvaginally;nowreplacedbyvaginallyinsertedtape[transvaginaltape(TVT)ortransobturatortape(TOT)]ormeshslings.
1301.Traditionallyscrotalcarcinomaisassociatedwithwhichofthefollowingoccupations?
a)Chimneysweeps
b)Mulespinners
c)Coalworker
d)Woodworkers
CorrectAnswer-AAnswer-(A)ChimneysweepsCarcinomaofthescrotum.Itistraditionallyrecognizedasanoccupationalhazardforchimneysweepsandmulespinners.ItwasdescribedbyPotts.Itwasthefirstcancerlinkedtooccupationalexposurewhen,in1775,PerivallPottdescribeditinchimneysweepsinEngland.Otheroccupationsthathadapreponderanceofthediseaseincludedpeoplewhoworkedwiththedistillatesofcoalandmenexposedtomineraloil.
1302.Whatisthemainhazardofectopictestis-
a)Impotence
b)Carcinomadevelopment
c)Liabletoinjury
d)Herniadevelopment
CorrectAnswer-CAnswer-C.LiabletoinjuryThemainhazardisliabilitytoinjury.
1303.40yearsoldmalecomplainsofloinpainsince1month.Patient'scomplaintofpainhasseverelyincreasedoverlast2hoursandpainnowradiatesfromloinandtogroinandanteriorthighandpatientiswrithinginbedforcomfort.Whatisthemostprobableetiology?
a)Bladdercalculus
b)Uretericcalculus
c)Vesicouretericreflux
d)Hydronephrosis
CorrectAnswer-BAnswer-B.UretericcalculusThereisapatternofsevereexacerbationonabackgroundofcontinuingpainRadiatestothegroin,penis,scrotumorlabiumasthestoneprogressesdowntheureterTheseverityofpainisnotrelatedtothesizeofthestoneThepainisalmostinvariablyassociatedwithhaematuriaTheremaybefewphysicalsigns
1304.Treatmentofchoiceforbladderstone
a)Transurethrallitholapaxy
b)Percutaneoussuprapubiclitholapaxy
c)Vesicotomyandstoneretrieval
d)Intravenousantibiotics
CorrectAnswer-AAnswer-A.TransurethrallitholapaxyTREATMENT-Atransurethralcystolitholapaxyisthemostcommonprocedureusedtotreatadultswithbladderstones.Smallstone-UltrasoundlithotripsyLargestone-laserlithotripsyLitholapaxy-cystoscopiclithotriteSuprapubiccystolithotomy
1305.Followingarethesign/ssuggestiveofobstructionofurinarytractonCTScan
a)Hyroureter
b)Perinephricstranding
c)Thickeningofthelateroconalfascia
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveNonenhancedCThasbeenacceptedastheimagingmodalityofchoiceintheradiologicevaluationofpatientssuspectedofhavingurolithiasis.CTissuperiortootherimagingmodalitiesinthediagnosticaccuracyandassessmentoftheircharacteristics.Themostdirectsignofureterolithiasisisthestonewithintheureterallumen,withproximalureteraldilatationandnormaldistalcaliber.OtherfavorablesecondarysignsatCTare:Hydroureter,hydronephrosis,perinephricstranding,periureteraledemaandunilateralrenalenlargement.
1306.HarderrenalstonehavinglesssatisfactoryresultswithECWLis-
a)Oxalatestone
b)Phosphatestone
c)Uratestone
d)Cystinestone
CorrectAnswer-DAnswer-D.CystinestoneExtracorporealShockwaveLithotripsy(ECWL):Aurinarycalculushasacrystallinestructure.Bombardedwithshockwavesofsufficientenergyitdisintegratesintofragments.TheclearanceofstonefromthekidneyusingESWLwilldependupontheconsistencyofthestoneanditssite.Mostoxalateandphosphatestonesfragmentwell.
1307.
Radicalnephrectomyinvolvesresectionofthefollowingexcept-
a)Gerotasfascia
b)Ipsilateraladrenalgland
c)Surroundinghilarlymphnodes
d)Proximalpara-aorticlymphnodes
CorrectAnswer-DAnswer-D.Proximalpara-aorticlymphnodesThestandardmanagementforstageIorIItumorsandselectedcasesofstageIIIdiseaseisradicalnephrectomy.ThisprocedureinvolvesenblocremovalofGerota'sfasciaanditscontents,includingthekidney,theipsilateraladrenalgland,andadjacenthilarlymphnodes.
1308.Normalurineflowrateinhealthyadultsinurodynamicstudyis-
a)10ml/sec
b)20ml/sec
c)25ml/sec
d)5ml/sec
CorrectAnswer-BAnswer-B.20ml/secAges14to45--Theaverageflowrateformalesis21mL/sec.Theaverageflowrateforfemalesis18mL/sec.Ages46to65--Theaverageflowrateformalesis12mL/sec.Theaverageflowrateforfemalesis18mL/sec.Ages66to80--Theaverageflowrateformalesis9mL/sec.Theaverageflowrateforfemalesis18mL/sec.
1309.Dermoepidermalburniswhatdegreeofburn-
a)I
b)II
c)III
d)IV
CorrectAnswer-BAnswer-B.IIDermoepidermalburnsareSuperficialIIdegreeburns.
1310.Revascularizationandangiogenesisprocessafterskingraftingisseenafterhowmanydaysaftertheprocedure?
a)4
b)5
c)6
d)7
CorrectAnswer-BAnswer-B.5RevascularizationorangiogenesisAfterapprox5days,revascularizationoccursandthegraftdemonstratesbotharterialinflowandvenousoutflow.
1311.Themostcommonlyusedmyocutaneouspediclegraftforpelvissurgeriescontainsmusclesegmentsfrom-
a)Rectusabdominismuscle
b)Externalobliquemuscle
c)Internalobliquemuscle
d)Transversusabdominismuscle
CorrectAnswer-AAnswer-A.RectusabdominismuscleThemostfrequentlyusedmyocutneouspediclegraftscontain,musclesegmentsfromtherectusabdominismuscleoftheanteriorabdominalwall,gracialismuscleoftheinnerthigh,bulbocavernosusmuscleofthevulva,thetensorfascialatamuscleofthelateralthigh,andgluteusmaximusmuscle.
1312.Kernahen'sstriped'Y'classification,Mainreferencepointis-
a)Incisiveforamen
b)Softpalate
c)Hardpalate
d)Thirdmolar
CorrectAnswer-AAnswer-A.IncisiveforamenKernahen'sstriped'Y'classificationItisusedtoclassifycleftlipandcleftpalateTheincisiveforamenistakenasreferencepoint
1313.LAHSALcodeisusedtorepresentcongenitalmalformationof-
a)Lip
b)Alveolus
c)Hardandsoftpalate
d)Alltheabove
CorrectAnswer-DAnswer-D.Alltheabove
1314.WhatisthemeaningoftheFrenchword"Debridement"
a)UnleashorCutOpen
b)Debulk
c)Sanitize
d)Rehydration
CorrectAnswer-AAnswer-A.UnleashorCutOpenTakenfromtheFrenchmeaningto'unleashorcutopen',debridementhascometomeanmorethansimplythelayingopenoftissues.Itplaysacrucialpartinthemanagementoftrauma.
1315.Cardinalrulefordressingofpressureulceristo-
a)Keepulcertissuedryandsurroundingintacttissuedry
b)Keepulcertissuedryandsurroundingintacttissuemoist
c)Keepulcertissuemoistandsurroundingintacttissuedry
d)Keeptheulcertissuemoistandsurroundingintacttissuemoist
CorrectAnswer-CAnswer-C.KeepulcertissuemoistandsurroundingintacttissuedryAnidealdressingshouldprotectthewound,bebiocompatibleandprovideidealhydration.Thetypeoftheulcerbedandthedesireddressingfunctiondeterminethetypeofdressingneeded.Thecardinalruleistokeeptheulcertissuemoistandthesurroundingintacttissuedry.
1316.Outcomeofburnsdependson-
a)Extentofburns
b)Typeofresuscitationfluid
c)Maintenanceofairway
d)Skingrafting
CorrectAnswer-AAnswer-A.ExtentofburnsThevariousfactorsinfluencingtheoutcomeofburnsare:ExtentofburnsDepthofburnsTimingoffirstEscharectomy(removesdevitalizedtissueandhencesourceofinfection)Ageandmedicalcomorbidities
1317.Allofthefollowingaretrueregardingfluidresuscitationinburnpatientsexcept:
a)Considerintravenousresuscitationinchildrenwithburnsgreaterthan15%TBSA
b)Oralfluidsmustcontainsalts
c)MostpreferredfluidisRinger'slactate
d)Halfofthecalculatedvolumeoffluidshouldbegiveninfirst8hours
CorrectAnswer-AAns.A:Considerintravenousresuscitationinchildrenwithburnsgreaterthan15%TBSAInchildrenwithburnsover10%TBSAandadultswith15%TBS,considertheneedforintravenousfluidresuscitation.Iforalresuscitationistobecommenced,itisimportantthatthewatergivenisnotsaltfree.Preferredfluid:LactatedRinger'sSolution,becauseitis:*Isotonic*Cheap*Easilystored-Resuscitationformulas:Parklandformulamostcommonlyused-Fluidcalculation:4xweightinkgx%TBSAburn-Give1/2ofthatvolumeinthefirst8hours.Giveother1/2innext16hours-TBSA:Totalburnssurfacearea.
1318.Thebesttreatmentforcystichygromais-
a)Surgicalexcision
b)Radiotherapy
c)Sclerotherapy
d)Chemotherapy
CorrectAnswer-AAns.is'a'i.e.,SurgicalExcisionDefinitivetreatmentiscompleteexcisionofthecystatanearlyage.
1319.Apatientafterroadtrafficaccidentpresentedwithtensionpneumothorax.Whatisthefirstlineofmanagement?
a)Insertwideboreneedlein2ndintercostalspace
b)ImmediatechestX-ray
c)CTscanEmergencythoracotomy
d)Emergencythoracotomy
CorrectAnswer-AAnswer-A.Insertwideboreneedlein2ndintercostalspaceFirstlineofmanagementintensionpneumothorax:Insertwideboreneedlein2ndintercostalspace.
1320.Preferredtreatmentfororaltonguecarcinomawhichinfiltratesthelocalcorticalboneis-
a)Subtotalglossectomy
b)Subtotalglossectomy+selectiveneckdissection
c)Subtotalglossectomy+selectiveneckdissection+mandibulectomy
d)Totalglossectomy+selectiveneckdissection+mandibulectomy
CorrectAnswer-CAnswer-C.Subtotalglossectomy+selectiveneckdissection+mandibulectomyThemanagementplanforlocallyadvancedtonguecarcinomasincludessubtotalglossectomy+selectiveneckdissection+mandibulectomy.Advancedtumors(T3andT4)oftenencroachuponthefloorofthemouthand,occasionally,themandible.Inthesecircumstances,aresectionofthetongueandfloorofthemouthandmandibleisrequired.
1321.Forlowerlipcarcinomaof<1cminsize.Thetreatmentofchoicewillbe-
a)Radiation
b)Chemotherapy
c)Excision
d)Radiationandchemotherapy
CorrectAnswer-CAnswer-C.ExcisionSmalltumors(T1&T2)(<2cm)-If1/3rdorlessthan1/3rdlipinvolved-VorW-shapedexcision+primaryclosure.Excisionoflowerlipupto1/3rdcanbesuturedprimarilyin3layers–mucosa,muscle,andskinkeepingvermillionborderinproperapposition.
1322.
UptoLevelIIIlymphnodedissectionisdoneforwhichnodalstatusoforopharyngealcancer?
a)N1
b)N2
c)N3
d)N4
CorrectAnswer-AAnswer-A.N1ManagementofneckNOSelectiveneckdissectionOralCavity atleastlevelsl-lllOropharynxatleastlevelsll-lVN1-N2a-c SelectiveorcomprehensiveneckLevelVl Subglotticlaryngealcancers
1323.Hoarsenessofvoiceinlungcarcinomaisduetoinvasionofwhichstructure?
a)Recurrentlaryngealnerve
b)Internallaryngealnerve
c)Glossopharyngealnerve
d)Vagusnerve
CorrectAnswer-AAnswer-A.RecurrentlaryngealnerveHoarseness-Recurrentlaryngealnerveinvasion
1324.Acrallentiginestypeofmalignantmelanomaoccursin-
a)Face
b)Napeofneck
c)Mucosa
d)Sunexposedareas
CorrectAnswer-CAnswer-C.MucosaAcrallentiginous-LeastcommonwithworstprognosisMCsite-sole,mucosa
1325.Whichofthefollowingprovidesexcellentdetailsaboutthechemodectomas?
a)Xray
b)CTangiography
c)MRI
d)PETSCAN
CorrectAnswer-CAnswer-C.MRIMRIscanningprovidesexcellentdetailinmostcasesofchemodectomas.
1326.Hemorrhagecommonlyseenwithtrivialtraumainelderly-
a)Subduralhemorrhage
b)Extraduralhemorrhage
c)Subarachnoidhemorrhage
d)Intraparenchymalhemorrhage
CorrectAnswer-AAnswer-A.SubduralhemorrhageSubduralhemorrhagefrequentlyoccursinolderadults,afterapparentlytrivialtraumaandisoftenrelatedtoafallinwhichthereisnodirecttraumatothehead.Recurrenttrivialtraumainelderlyisthemostcommoncauseofsubduralhemorrhagedeveloping.
1327.Mostcommonorganinjuredinpenetratinginjuryoftheabdomen:
a)Liver
b)Spleen
c)Smallbowel
d)noneofthese
CorrectAnswer-CAns-C-SmallBowelThemostcommoncauseisastaborgunshot.Themostcommonorgansinjuredarethesmallbowel(50%),largebowel(40%),liver(30%),andintra-abdominalvascular(25%).Whentheinjuryiscloserange,thereismorekineticenergythanthoseinjuriessustainedfromadistance.Eventhoughmostgunshotwoundstypicallyhavealinearprojection,thehigh-energywoundsareassociatedwithunpredictableinjuries.Theremayalsobesecondarymissileinjuriesfromboneorbulletfragments.Stabwoundsthatpenetratetheabdominalwallaredifficulttoassess.
1328.IndicationforsurgicalcompartmentreleaseincompartmentSyndromeinanycompartmentisabsolutepressuregreaterthan?
a)15mmHg
b)20mmHg
c)30mmHg
d)Variesfromcompartmenttocompartment
CorrectAnswer-C30mmHgREF:Withtext"Settingthethresholdforfasciotomyataperfusionpressureof30mmHgcanbeconsideredsafe,butstillmayleadtoovertreatmentifusedroutinely"REF:Evidence-basedOrthopedics-MohitBhandariPage634Differentauthorsconsidersurgicalinterventionif:(REF:TiwariA,HaqAI,MyintF,HamiltonG.Acutecompartmentsyndromes.BrJSurg2002;89:397-412.)
1. AbsoluteICPgreaterthan30mmHg2. DifferencebetweendiastolicpressureandICPgreaterthan30
mmHg3. DifferencebetweenmeanarterialpressureandICPgreaterthan40
mmHg"Intracompartmentalpressuremaybemeasuredbythewickcatheterinpatientssuspectedtohavecompartmentsyndrome.Bysuchmethodapressureof30mmHgormoresustainedfor6-8hoursormoreisalikelyindicationfordecompressivefasciotomy"REF:SkeletalinjuryinthechildbyJohnAnthonyOgdenPage317IntracompartmentalComments
Intracompartmentalpressure
Comments
<15mmHg Normalcompartmentpressureoflowerlimbs
>25mmHg Venousdrainagefromclosedmyofascialspacesisimpaired.
>30mmHg Completevenouscollapse>60mmFig NeuromuscularischemiaREF:Masteryofvascularandendovascularsurgery-GeraldB.Zelenock,ThomasS.Huber,LouisM.MessinaPage507
1329.Achildswallowedawatchbatterycontainingalkalinecontent.Whatnext-
a)ImmediateX-raymeasurements
b)Removesurgicallyimmediately
c)CTabdomen
d)Laxatives
CorrectAnswer-AAnswer-A.ImmediateX-raymeasurementsAlkalinedrycellbatteriescontain:SodiumhydroxidePotassiumhydroxide
1330.Burrholeisdonefor-
a)ChronicSDH
b)EDH
c)SAH
d)Contusion
CorrectAnswer-AAnswer-A.ChronicSDHLiquefiedSDHsarecommonlytreatedwithdrainagethroughoneortwoburrholesplacedoverthethickestaspectsofthehematoma.Manysurgeonsplacefrontalandparietalburrholesthatlatercanbeincorporatedintoafrontotemporoparietalcraniotomy,ifneeded.
1331.Typicalofrectussheathhematomais-
a)Severetenderness
b)Bluishdiscoloration
c)Firmpainfulmass
d)Ecchymosis
CorrectAnswer-CAnswer-C.FirmpainfulmassClinicalfeaturesofrectussheathhematomaA)SymptomsCommonhistoricalfeaturesofrectussheathhematoma(RSH)includeacuteabdominalpain,fever,nausea,andvomiting.B)Signsi)VitalsignsAlow-gradefeveriscommoninrectussheathhematoma.Thehematomacanbelargeenoughtocompromiseintravascularvolume,withresultantsignsofhypovolemicshockincludinghypotension,tachycardia,andtachypnea.ii)AbdominalexaminationTypically,theabdominalexaminationrevealsapalpable,painful,firm,nonpulsatileabdominalmasscorrespondingtotherectussheath.Themassmaybebilobarwithacentralgroove.Themassdoesnotmovewithrespiration.Becausethehematomaisdeeptothesubcutaneoustissueandrectusmuscles,themassisnotalwayspalpable,particularlyinobesepatients.
1332.Percuteneouschemicallumbarsympathectomyispractisedusing-
a)Phenol
b)Ethanol
c)Formalin
d)Aceticacid
CorrectAnswer-AAnswer-A.PhenolChemicalsympathectomyrequirestheinjectionofsmallquantitiesofdiluteaqueousphenolintothelumbarsympatheticchainunderradiographiccontrol.
1333.Whichofthefollowingissparedinlumbarsympathectomy:September2009
a)L1
b)L2
c)L3
d)L4
CorrectAnswer-AAns.A:LlTopreservesexualfunctions,Llispreserved.
1334.Mostcommonlyperformedandacceptablemethodofbariatricsurgeryis:
a)Biliopancreaticdiversion
b)Biliopancreaticdiversionwithilcostomy
c)Laparoscopicgastricbanding
d)Roux-en-Ygastricbypass.
CorrectAnswer-DAns:D.Roux-en-Ygastricbypass.(Ref.Sabiston20/ep1187,19/ep363;Schwartz10/ep1112,9/952;Harrison19/p2398).Roux-en-Ygastricbypass:Mostcommonlyperformed&acceptablemethodofbariatricsurgery.3restrictive-malabsorptivebypassprocedures:Combineelementsofgastricrestriction&selectivemalabsorption.ProceduresincludeRoux-en-Ygastricbypass,biliopancreaticdiversion&biliopancreaticdiversionwithduodenalswitch.Roux-en-Y:Mostcommonlyundertaken&mostacceptedbypassprocedure.Performedwithanopenincisionorbylaparoscopy.
1335.Whichofthefollowingelectrolyteabnormalitiescanbeseenafterbraininjury?
a)Hyponatremia
b)Hyperkalemia
c)Hypomagnesemia
d)Alltheabove
CorrectAnswer-AAnswer-AElectrolyteabnormalitiesoccurin60%ofthepatientswithheadinjury.Patientswithbraininjuryareatahighriskforthedevelopmentofelectrolyteimbalanceincludinghyponatremia,hypocalemia,hypophosphatemiaaswellashypokalemiaand(toalesserdegree)Hypomagnesemia.Sotheappropriateanswerwillbehyponatremia.
1336.Neuroimagingfeaturesofneurocysticercosisareconsideredascriteriafordefinitivediagnosis-
a)Major
b)Minor
c)Probable
d)Absolute
CorrectAnswer-AAnswer-A.MajorEvidenceoflesionshighlysuggestiveofneurocysticercosisonneuroimagingstudiesPositiveserumimmunoblotforthedetectionofanticysticercalantibodiesResolutionofintracranialcysticlesionsaftertherapywithalbendazoleorpraziquantelSpontaneousresolutionofsmallsingleenhancinglesions.
1337.Featuresofmarasmusareallexcept:
a)Absenceofanasarca
b)Increasedappetite
c)Excessivecatabolismofadiposetissueandmuscleprotein
d)UncompensatedphaseofPEM
CorrectAnswer-DAnswer-D.UncompensatedphaseofPEMItisduetoprolongdeficiencyofcaloriesandproteins.Thusthereisexessivecatabolismofadiposetissueandmuscleprotein.Itischaracterizedbygrosswastingofmuscleandsubcutaneoustissuesresultinginemaciationandmarkedstunting.Childmayshowvoraciousappetite.MarasmusrepresentsthecompensatedphaseofPEM.
1338.Allofthefollowingarecausesofpseudoparalysisexcept
a)Osteomyelitis
b)Scurvy
c)Septicarthritis
d)Polio
CorrectAnswer-DAnswer-D.PolioCausesofpseudoparalysis
1. Scurvy(vitaminCdeficiency)2. Osteomyelitis3. Septic(arthritis)4. Congenitalsyphilis
1339.Whichofthefollowingcanleadtoregressionofdevelopmentalmilestones
a)Rett'ssyndrome
b)Autism
c)Neuromusculardiseases
d)Alloftheabove
CorrectAnswer-DAnswer-D.AlloftheaboveThehallmarkofmanydegenerativedisordersisneurologicalregression.Lossofonlylanguageskills–autism–suspected.Regressionofbothlanguageandmotormilestones→Rett'ssyndrome.
1340.AllofthefollowingarefeaturesofRett'ssyndromeexcept
a)Microcephaly
b)Regressionofmilestones
c)Cardiaarrhythmias
d)FocalConvulsions
CorrectAnswer-DAnswer-D.FocalConvulsionsThisisthecharacteristicfeatures,thattheybegintoloosetheiracquiredskills,e.g.,cognitiveandheadgrowthisnormalduringearlyperiodafterwhichthereisanarrestofgrowth.Acquiredmicrocephaly(Declerationofheadgrowthduetosignificantlyreducedbrainweight).Mostchildrendeveloppeculiarsighingrespirationswithintermittentperiodsofapneathatmaybeassociatedwithcyanosis-4Breathholdingspells.
1341.Childwhileplayinghassuddenlossofconsciousnessandappearspale.Thereisnosignificantmedicalhistoryandthechildwasotherwisehealthy.Whichofthefollowingisthemostprobablediagnosis?
a)Attentiondeficithyperkineticdisorder
b)Breathholdingspell
c)Autism
d)Rett'ssyndrome
CorrectAnswer-BAnswer-B.BreathholdingspellPallidform(Pallidspells)Theseareinitiatedbypainfulexperience,e.gfallingandstrikingthehead.Pallidspellsareduetoexcessivecentralparasympetheticactivity.Clinicalfeaturesincludepallor,apnea,lossofconsciousness,hypotonia,seizuresandbradycarda.Treatmentincludessupportandreassuranceofparents.Atropinemaybeusedinrefractorycases
1342.Infantilebodyproportioninadultsisseeninallexcept-
a)Achondroplasia
b)Hypothyroidism
c)Klinefelter'ssyndrome
d)Cretinism
CorrectAnswer-CAnswer-C.Klinefelter'ssyndromeInfantiletypebodyporportionAchondroplasiaJuvenilemyxedema(hypothyroidism)Cretinism
1343.Ifchronologicalage>skeletalagewithnormalgrowthvelocity,thenthefinalheightthatisexpectedtobeachievedis
a)Normal
b)Lessbecauseofsmallbones
c)Morethanexpected
d)Lessbecauseofepiphysealclosureduetoacceleratedgrowthvelocity
CorrectAnswer-AAnswer-A.NormalIfthegrowthvelocityisnormalbutthechronologicalageismorethantheboneage,thenthediagnosisisConstitutionaldelayingrowth.ConstitutionaldelayingrowthItisthemostcommoncauseofshortstatureinmidchildhoodperiodbuttheultimateheightisnormal.Theirbirthweightandheightarenormal.Strongfamilyhistoryofparentshavingshortstatureinchildhoodwithdelayinonsetofpubertyisusuallypresent.
1344.Whichofthefollowingabouthormonelevelsinamalnourishedchildistrue?
a)Increasedinsulinlevels
b)Decreasedcortisollevels
c)Increasedgrowthhormone
d)Alloftheabove
CorrectAnswer-CAnswer-C.IncreasedgrowthhormonechangesinPEMDecreasedinsulinlevelsIncreasedcortisolIncreasedgrowthhormone
1345.A9montholdchildwithrespiratoryrate53/minandpresenceofcoughisclassifiedas:
a)SIRS
b)Respiratorydistress
c)Tachypnoea
d)ARDS
CorrectAnswer-CAnswer-C.TachypnoeaTachypnea(fastbreathing):Fastbreathingisdefinedas:
1. lessthan2monthsofage->60breathsperminute2. Childaged2monthsupto12months-50breathsperminute3. Childaged12monthsupto5years-40breathsperminute
1346.Anewbornafterprolongedlabourisnotbreathingwellandafter30secondsofreceiving100%oxygenbybagandmask,heartrateis88beatspermin,whatisthenextstepinmanagement?
a)Discontinueoxygenandventilation
b)Discontinueoxygen,continueventilation
c)Continueoxygenandventilation
d)Startchestcompressions
CorrectAnswer-CAnswer-C.ContinueoxygenandventilationAftertheinfanthasreceived30secondsofventilationwith100%oxygenbybagandmask,evaluationofheartrateshouldbedone-HR>100→Discontinueventilationifspontaneousrespirationispresent.HR60to100→ContinueventilationBelow60→Continueventilation+chestcompressionsAfter30secondsofchestcompressions,theheartrateischecked.HR<60→Continuechestcompressionandbag&maskventilation+initiatemedications.HR>60→Discontinuechestcompressionbutcontinuebag&maskventilationuntiltheheartrateisabove100.[Ref:O.P.Ghai7th/ep.98]
1347.Howarechestcompressionsgiveninanewborn?
a)Usingpalmonthelowerthirdofsternum
b)Usingtwofingersonthemiddlethirdofsternum
c)Usingthetwothumbsonthelowerthirdofsternum
d)Usingthreefingersonthelowerthirdofsternum
CorrectAnswer-CAnswer-C.UsingthetwothumbsonthelowerthirdofsternumTwo-fingertechniqueThetipsofthemiddlefingerandeithertheindexfingerorringfingerofonehandareusedtocompressthesternum.Theotherhandisusedtosupporttheinfant'sback,unlesstheinfantisonaveryfirmsurface.
1348.Contraindicationofbagandmaskventilationareallofthefollowingexcept:March2009
a)Tracheo-esophagealfistula
b)Hiatushernia
c)Pregnancy
d)Emptystomach
CorrectAnswer-DAns.D:EmptyStomach
Bag-maskventilationcanproducegastricinflationwithcomplications,includingregurgitation,aspiration,andpneumonia.
Conditionspredisposingtoaspirationare:FullstomachpatientsHiatushernia,pregnancyIntestinalobstructionTracheo-esophagealfistulaMeconiumaspirationsyndromeGastricinflationcanelevatethediaphragm,restrictlungmovement,
anddecreaserespiratorysystemcompliance
1349.Graspreflexdevelopsby-
a)20weeks
b)24weeks
c)28weeks
d)32weeks
CorrectAnswer-CAns.is'c'i.e.,28weeksReflex-Ageofappearance32-Ageofdisappearance(afterbirth)
1350.Asymmetrictonicneckreflexdisappearsatwhatage?
a)2months
b)3months
c)6months
d)8months
CorrectAnswer-CAnswer-C.6monthsAssymmetictonicneck-wksofgestation4-6→6-7months
1351.Trueabouttonicneckreflexis
a)Extensionofarmonipsilateralside,flexiononcontralateralside
b)Extensionofarmoncontralateralside,flexiononipsilateralside
c)Extensionofarmsonbothsides
d)Flexionofarmsonbothsides
CorrectAnswer-AAnswer-A.Extensionofarmonipsilateralside,flexiononcontralateralsideThetonicneckreflexisproducedbymanuallyrotatingtheinfant'sheadto1sideandobservingforthecharacteristicfencingposture(extensionofthearmonthesidetowhichthefaceisrotatedandflexionofthecontralateralarm).Anobligatorytonicneckresponse,inwhichtheinfantbecomes"stuck"inthefencingposture,isalwaysabnormalandimpliesaCNSdisorder.
1352.Withdrawalreflexisanexampleofwhichofthefollowing?
a)Monosynapticreflex
b)Polysynapticreflex
c)BothAandBoftheabove
d)Noneoftheabove
CorrectAnswer-BThewithdrawalreflexisatypicalpolysynapticreflexthatoccursinresponsetoausuallypainfulstimulationoftheskinorsubcutaneoustissuesandmuscle.Whenareflexarcconsistsofonlytwoneuronsinananimal(onesensoryneuron,andonemotorneuron),itisdefinedasmonosynaptic.Monosynapticreferstothepresenceofasinglechemicalsynapse.Inthecaseofperipheralmusclereflexes(patellarreflex,achillesreflex),briefstimulationtothemusclespindleresultsincontractionoftheagonistoreffectormuscle.Inpolysynapticreflexpathways,oneormoreinterneuronsconnectafferent(sensory)andefferent(motor)signals.Allbutthemostsimplereflexesarepolysynaptic,allowingprocessingorinhibitionofpolysynapticreflexeswithinthebrain.
Ref:Ganong'sReviewofMedicalPhysiology23rdedition,Chapter9.
1353.Closureofpatentductusarteriosusisstimulatedby?
a)ProstaglandinF2a
b)Cycloxygenase
c)Increasein02tensionatbirth
d)Hypercarbia
CorrectAnswer-CAnswer-C.Increasein02tensionatbirthThemechanismproducingtheinitialconstrictionofductusarteriosusisnotcompletelyunderstood,buttheincreaseinarterial02tensionplaysanimportantrole.Onemorefactorwhichhelpsinclosureoftheductusarteriosusisthedecreaseinconcentrationofprostaglandinsatthetimeofbirth.
1354.FalseaboutPDAis
a)Morecommoninfemales
b)Anatomicalclosuretakes21hoursafterbirth
c)PGEmaintainspatencyofductus
d)Dilatationofascendingaorta
CorrectAnswer-BAnswer-B.Anatomicalclosuretakes21hoursafterbirthPatentductusarteriosusisacommunicationbetweenthepulmonaryarteryandaorta.'Functionalclosure'takesplacewithin15hoursofbirth.'Anatomicclosure'ofductusarteriosusoccurs10-21daysafterbirth.Prostaglandinsmaintainthepatencyofductus.Thepersistenceoffunctionofductusarteriosusbeyond24hoursafterbirthisconsideredasPDAintermneonate,i.e.iffunctionalclosuredoesnottakeplacein24hoursafterbirth,itisconsideredasPDA.
1355.Whichofthefollowingisnotseeninpatentductusarteriosus?
a)Leftatrialhypertrophy
b)Leftventricularenlargement
c)Continuousmurmur
d)AttenuatedSI
CorrectAnswer-DAnswer-D.AttenuatedSIIncreasedflowafterpassingthroughlungreachestheleftatriumandcausesvolumeoverload→Leftatrialdilatationandhypertrophy.Increasedbloodvolumepassesfromleftatriumtoleftventriclethroughmitralvalve,i.e.,increasedflowthroughmitralvalve→AccentuationofS1anddelayeddiastolicmurmur.Leftventriclereceiveslargeramountofbloodthatresultsinvolumeoverload→Leftventricleenlargement.
1356.Whichofthefollowingcongenitalanomaliesleadstoheartfailureatbirth?
a)Totalanomalouspulmonaryvenousconnection
b)Transpositionofgreatarteries
c)Pulmonaryatresia
d)Coarctationofaorta
CorrectAnswer-CAnswer-C.PulmonaryatresiaTimingofCHFincongenitalheartdiseases-Pulmonary,mitralandaorticatresiasHypoplasticleftandrightheartsyndromes,transpositionandmalpositionofgreatateries.
1357.ThefollowingfeaturesaretruefortetralogyofFallot,except-
a)Ventricularseptaldefect
b)Rightventricularhypertrophy
c)Atrialseptaldefect
d)Pulmonarystenosis
CorrectAnswer-CAns.is'c'i.e.,ASDTetralogyofFallot*Theclassicalexampleofcyanoticpatientswithpulmonicstenosisistetralogyoffallot.*TOFisthecommonestcongenitalheartdisease.*ConstituentsofTOFVentricularseptaldefectOverridingordextroposedaortaPulmonicstenosisRightventricularhypertrophy.
1358.Mostimportantprognosticmarkeroftetralogyoffallot
a)VSD
b)Pulmonarystenosis
c)Overridingofaorta
d)Rightventricularhypertrophy
CorrectAnswer-BAnswer-B.PulmonarystenosisTetrologyoffallothas4components:
1. Obstructiontorightventricularoutflow(pulmonarystenosis),2. Amal-alignmenttypeofventricularsepta]defect(VSD),3. Dextropositionoftheaortasothatitoverridestheventricular
septum,and4. Rightventricularhypertrophy
[RefNelson20thlep.2211]
1359.Microcephalyiscommoninchildrenofmotherswithallexcept
a)Alcoholintake
b)Warfarinintake
c)Warfarinintake
d)Varicella
CorrectAnswer-BAnswer-B.WarfarinintakeSecondaryStructuraldefects:Neuraltubedefects(anencephaly,encephalocele).Metabolicdisorders:Rhenylketonuria,citrullinemia,methylmalonicaciduria.Congenitalinfections:Rubella,CMV,HSV,toxoplasmosis,syphilis,varicella.Teratogens:Alcohol,tobacco,cocaine,heroin.Others:Maternaldiabetes,maternalphenylketonuria,hypothyroidism,hypopituitrism,adrenalinsufficiency.
1360.Whichofthefollowingstatementistrueforphysiologicaljaundiceinneonate?
a)Occursinthefirst6hoursofdelivery
b)Neurologicalsequelaearecommon
c)Besttreatedbyphototherapy
d)Startson2nddayoflife
CorrectAnswer-DMostneonatesdevelopvisiblejaundiceduetoelevationofunconjugatedbilirubinconcentrationduringtheirfirstweek.ThiscommonconditioniscalledPhysiologicaljaundice.Itlastsfor5daysinterminfants&7daysinpreterminfants.Itdoesnotrequireanytreatment&disappersspontaneously.Inpathologicaljaundiceclinicaljaundicewillappearinthefirst24hrsoflife.Ref:Nelson,18thEdition,Pages760-761;OPGhai,6thEdition,Pages170-171.
1361.Whatisthecapacityofstomachatbirth
a)5ml
b)25ml
c)50ml
d)100ml
CorrectAnswer-CAnswer-C.50mlDay15-7ml.SizeofcherryDay322-27ml.SizeofwalnutOneweek45-60ml.SizeofanapricotOnemonth80-150ml.Sizeofalargeegg
1362.Colourofstoolsinbreastfednewbornis-
a)Red
b)Green
c)Black
d)Golden
CorrectAnswer-DAnswer-D.GoldenColourofstoolsinneonateMeconium(firststool)ispassedwithin24hours.Afterthatmeconiumstools(blacktarry)canbepassedupto3days.On4th-5thdaystransitionalstools(greenish)arepassed.After5daysregularmilkstools(goldenyellow)arepassed.Thereisgoldendiscolorationofstool.
1363.Trigonocephalyisduetoprematureclosureofwhichsuture?
a)Sagittalsuture
b)Metopicsuture
c)Lambdoidsuture
d)Coronalsuture
CorrectAnswer-BAnswer-B.MetopicsutureTrigonocephal-MetopicsutureKeelshapedforeheadHypotelorismAbnormalitiesofforebrain
1364.Whichofthefollowingisamarkerforneuraltubedefects?
a)↑Phosphatidylesterase
b)↑Pseudocholinesterase
c)↑Acetylcholinesterase
d)↑Butyrylcholinesterase
CorrectAnswer-CNeuraltubedefectsareassociatedwithhighlevelsofAcetylcholinesterase.
Ref:GeneticdisordersandFetus,4thEdition,Page673;IanDonald'sPracticalObstetricProblemByRenuMisra,6thEdition,Page44*Inintraembryoniclife,neuraltubeisopenatbothendandfreelycommunicatewithamnioticcavity.Failureofclosureofneuraltuberesultsinpersistentofthiscommunication.Thisallowsexcretionoffollowingfetalsubstancesintoamnioticcavity?-Alpha-fetoprotein-Acetylcholinesterase*TheseserveasbiochemicalmarkersforNTDsforprenataldiagnosis.
1365.Meconiumileusisassociatedwith:
a)Cysticfibrosis
b)Infantofdiabeticmother
c)Hypothyroidism
d)Noneoftheabove
CorrectAnswer-AInfantswithcysticfibrosishavecharacteristicpancreaticenzymedeficienciesandabnormalchloridesecretionintheintestinethatresultintheproductionofviscous,water-poormeconium.
Meconiumileusoccurswhenthisthick,highlyviscousmeconiumbecomesimpactedintheileumandleadstohigh-gradeintestinalobstruction.Ref:Schwartz’sprincipleofsurgery9thedition,chapter39.
1366.RDAofzincinachild?
a)10mg
b)20mg
c)6-8mg
d)4-5mg
CorrectAnswer-CAns.is'c'i.e.,6-8mgRDAofZincinchildren1-3years—>3mg4-8years-55mg9yearsandabove(male)—>8-11mg9yearsandabove(female)-->8mg
1367.WhichofthefollowingisnotafeatureofMinimalchangedisease?
a)Hypertension
b)Edema
c)Proteinuria
d)Responsivetosteroidtherapy
CorrectAnswer-AAnswer-A.HypertensionMinimalChangeDiseaseisthemostcommoncauseofNephroticsyndromeinchildren.EdemaandSelectiveproteinuriaarefeaturesofnephroticsyndrome.Fevermaybepresentonaccountofincreasedsusceptibilitytoinfection.Minimalchangediseaseprsentswithinsidiousonsetofnephroticsyndromeinchildrenbelow6yearsofage.HypertensionisnotafeatureofnephroticsyndromeandisrareinMinimalchangedisease.Hematuria(afindingofnephriticsyndrome)isalsorare.
1368.Whichofthefollowingdrugsisusefulintheprophylaxisofmigraine?
a)Propranolol
b)Sumatriptan
c)Domperidone
d)Ergotamine
CorrectAnswer-ADrugssuchastopiramate,valproate,propanolol,timolol,candesartan,verapamilandamitryptillineareindicatedinmigraineprophylaxis.
Migraineprophylaxisisindicatedwhenmigraineheadachesoccurmorethantwoorthreetimesamonthorwhenitisassociatedwithsignificantdisability.Afterinitiationoftherapy,itshouldbecontinuedforseveralmonths.Oncethepatientremainsheadachefree,thedoseistaperedandthedrugiseventuallywithdrawn.BotulinumtoxintypeAwasapprovedbytheUSFoodandDrugAdministration(FDA)formigrainepreventioninlate2010.
Ref:CurrentMedicalDiagnosisandtreatment2012,Chapter24
1369.Drugofchoiceforinfantilespasmis?
a)Vigabatrin
b)Adrenocorticotropichormone(ACTH)
c)Ethosuximide
d)Carbamazepine
CorrectAnswer-AAns.'a'i.e.,VigabatrinVigabatrin(drugofchoice),ACTH(2ndchoice)andcorticosteroidsareusedfortreatment.
1370.WhatistherateofCSFformationinchildren?
a)0.3ml/min
b)1ml/min
c)3ml/min
d)20ml/min
CorrectAnswer-AAnswer-A.0.3ml/minTherateofCSFformationinchildrenandadultsis:-0.3to0.4ml/minOR18to20ml/hour
1371.Mostcommoncauseofcranialirradiationinchildrenis
a)SmallcelllungCa
b)ALL
c)AML
d)Craniopharyngioma
CorrectAnswer-BAnswer-B.ALLALLandsmallcelllungCaaretwomajorindicationsforcranialirradiation,evenprophylacticallytopreventbrainmetastasis.Inchildren,ALListhemostcommoncause.
1372.Mostcommoncauseofseverehematemesisinachildis-
a)Portalhypetension
b)Pepticulcer
c)Malloryweisssyndrome
d)Noneoftheabove
CorrectAnswer-AAns.is'a'i.e.,Portalhypertension"Massivehematemesisinachildisalmostalwaysduetovaricealbleeding".Varicealbleedingisduetoportalhypertension.
1373.Whichofthefollowingisnotafeatureofphysiologicalanaemiaofinfancy?
a)Terminfanthemoglobin7gm%
b)Preterminfanthemoglobin7gm%
c)Terminfanthemoglobin9gm%
d)Preterminfanthemoglobin9gm%
CorrectAnswer-AAnswer-A.Terminfanthemoglobin7gm%PhysiologicAnemiaofInfancy
1. Hemoglobindropstolowpointatage6to8weeks2. ErythropoietinnadirdropsHemoglobin3. TermInfants:Hemoglobindropsto9-11g/dl4. PretermInfants:Hemoglobindropsto7-9g/dl
[RefAnemiaininfancy,pediatricinreviewAmericanacademyofpediatrics2012]
1374.Meanhemoglobinina1yearoldchildis
a)18.5g/dl
b)16.5g/d1
c)14g/c11
d)12g/dl
CorrectAnswer-DAnswer-D.12g/dl
Hblevel(g/L) Prevalence(%)
Age(mo) N MeamSE Mildanemia
(Hb<110g/L)ModeratetoSevereanemia(Hb<80g/L)
0-56-1112-2324-60Totel
5688128251523
9.810.0810.0410.1810.09
0.210.170.210.130.09
78.175.363.368.369.3
5.25.811.98.18.3
Hb,hemoglobina.Meansandfrequenciesareweighted.
1375.WhichofthefollowingbiochemicaltestisusedtodiagnoseDubinJohnsonsyndrome?
a)Serumtransaminases
b)Bromsulphaleintest(BSP)
c)Hippuratetest
d)Gammaglutamyltransferaselevel
CorrectAnswer-BBromsulphaleintest(BSP)isthediagnostictestforDubin-JohnsonSyndrome.BiliaryexcretionofnumerousanioniccompoundssuchasBromsulphalein(BSP)iscompromisedinDubin-JohnsonSyndrome(DJS).Inthistest,BSPisadministeredasIVbolusanditsclearancefromplasmaisdetermined.BSPlevelsshowacharacteristicriseinpatientswithDJSafter90minutesofinjection,duetorefluxofconjugatedBSPintothecirculationfromthehepatocyte.Ref:Davidson’sprinciplesandpracticeofMedicine,20thEdition,Chapter23,Page945;Harrison’sPrinciplesofInternalMedicine,16thEdition,Page1821;DigestiveDiseasesandSciencesVol/17numbers6.
1376.Albinismisduetodeficiencyofthefollowingenzyme?
a)Phenylalaninehydroxylase
b)Homogentisicacidoxidase
c)Tyrosinase
d)Decarboxylase
CorrectAnswer-CThemostcommoncauseofalbinismisadefectintyrosinase,theenzymemostresponsibleforthesynthesisofmelanin.Albinismisaninbornerrorduetolackofsynthesisofmelanin.Itisanautosomalrecessivedisorderwithafrequencyof1in20,000.
Ref:TextbookofBiochemistryandHumanBiologybyG.P.Talwar,3rdEd,Page452
1377.Aminoacidmetabolismisimplicatedinwhichdisease?
a)Maplesyrupurinedisease
b)Reye'ssyndrome
c)VonGierke'sdisease
d)McArdle'sdisease
CorrectAnswer-AAnswer-A.MaplesyrupurinediseaseItisduetodeficiencyofenzymethatcatalyzesthesecondreactionintheseaminoacidsmetabolismi.e.branchedchain-aketoaciddehydrogenasewhichcatalysesdecarboxylationofbranchedchainaminoacids.
1378.A3monthsoldchildwasstartedonsupplementalfoodsalongwithbreastmilk.Thechildwasfedwithfruitpulpandsweetenedcereals.Soonthechilddevelopedbloatingofabdomen,vomiting,lethargy,irritability.Oninvestigation,therewashyperbilirunemiaandelevatedtransaminaselevels.Thechildissufferingfromwhichofthefollowingenzymedeficiencies?
a)Fructokinase
b)AldolaseB
c)Galactokinase
d)Galactose-1-phosphateuridyltransferase
CorrectAnswer-BAnswer-B.AldolaseBSymptomsoccurwhenfoodsorformulascontainingthesesugarsareintroducedintothediet.Clinicalmanifestationsresemblegalactosemiaandincludejaundice,hepatomegaly,vomiting,lethargy,irritability,andconvulsions.Laboratoryfindingsincludeaprolongedclottingtime,hypo-albuminemia,elevationofbilirubinandtransaminaselevels,andproximaltubulardysfunction.
1379.EarliestsymptomofTaysachdisease
a)Exaggeratedstartleresponse
b)Bonedeformation
c)Hepatomegaly
d)Excessivebleeding
CorrectAnswer-AAns.is'a'i.e.,Exaggeratedstartleresponse[RefIllustratedmedicalbiochemistryp.330]Tay-SachdiseaseClinicalsymptomsareusuallyevidentinthefirstyearoflifeInitialsignsarenotdramaticandpresentasenfeeblement,spasticityandslowdevelopment.Anexaggeratedstartleresponsetosoundmaybethemostsignificantearlysignofwhichaparentisaware.Otherfeaturesarementalretardation,deteriorationofvisionandearlydeath."Affectedinfantsusuallydevelopnormallyuntil4-5monthsofagewhendecreasedeyecontactandanexaggeratedstartleresponsetonoise(hyperacusis)arenoted."---Nelson.PatientswiththeinfantileformofTay-Sachsdiseasehaveclinicalmanifestationsininfancyincludinglossofmotorskills,increasedstartlereaction,andmacularpallorandretinalcherry-redspots.
1380.Allaretrueaboutsacrococcygealteratomaexcept
a)Notassociatedwithincreasedserummarkers
b)Inmostcasesisnotvisibleexternally
c)Ifassociatedwithhydrops,shouldberesectedantenatally
d)Mostcommontumoroffetus
CorrectAnswer-BAnswer-B.InmostcasesisnotvisibleexternallyUretersmaybepartiallyobstructedresultinginhydro-ureterandhydronephrosis.SacrococcygealTeratoma(SCT)isthemostcommonneoplasminthefetusandnewbornMostcommontumorinfetusandneonatesacrococcygealteratomaMostcommontumorininfancyneuroblastoma.Theyarenotassociatedwithelevatedmarkersunlessmalignancyispresent.Sacrococcygealteratomawithhydrops:-Treatment-Inuteroresectionorcatheterdirectedvesselobliteration
1381.MostcommonsignofLRTI[Lowerrespiratorytractinfection]inchildrenis
a)Chestindrawing
b)Tachypnea
c)Nasalflaring
d)Failuretofeedwell
CorrectAnswer-BAnswer-B.TachypneaTachypneaisthemostconsistentmanifestationofpneumonia.Pneumoniaisaninflammationoftheparenchymaoflungs,andmostlycausedbybacterialorviralinfection.Mostcommoncauseofpaediatricpneumoniaisrespiratorysyncytialvirus(RSV).Othervirusescausingpneumoniaareinfluenzavirus(2"°mostcommonvirus),adenovirus,rhinovirus,andparainfluenzavirus.
1382.Mostcommonintraabdominalsolidorgantumorinchildis?
a)Neuroblastoma
b)Rhabdomyoblastoma
c)Wilm'stumor
d)Hypernephroma
CorrectAnswer-AAns.is'a'i.e.,NeuroblastomaMostcommonabdominalcancerofchildhood.Mostcommoncancerofinfancy.Mostcommonextracranialsolidtumorofchildhood(mostcommonsolidtumorofchildhoodisbraintumor).
1383.Whichofthefollowingisnotasignofseveredehydration?
a)Tachycardia
b)Anuria
c)Increasedthirst
d)Delayedcapillaryrefill[>3sec]
CorrectAnswer-CAnswer-C.IncreasedthirstPeripheralpulseseitherrapidandweakorabsentDecreasedbloodpressureNourineoutputVerysunkeneyesandfontanelNotearsParchedmucousmembraneDelayedelasticity(poorskinturgor)Verydelayedcapillaryrefill(>3sec)ColdandmottledLimpDepressedconsciousness
1384.Whatisthegradeofdehydrationifachilddemonstratesexcessivethirstanddecreasedurineoutput?
a)Nodehydration
b)Milddehydration
c)Moderatedehydration
d)Severedehydration
CorrectAnswer-BAnswer-B.MilddehydrationNormalorincreasedpulseDecreasedurineoutputThirstyNormalphysicalfindings
1385.ContentofNa'inringerlactateismeq/1-
a)154
b)12
c)130
d)144
CorrectAnswer-CAns.is'c'i.e.,130
1. 5%Dextrose/10%DxNil2. N/2saline77meq3. N/5saline30meq4. 3%salime513meq5. Ringerlactate130meq6. IsolyteP.26meq
1386.WhichofthefollowingcannotbeusedtodetectHIVstatusinearlyinfancy?
a)DNA-PCR
b)HIVculture
c)ELISA
d)P-24antigenassay
CorrectAnswer-CAnswer-C.ELISAELISAorWesternblottestarenotasreliableinyounginfants.Inolderinfants(>6months),detectionofanti-HIVIgAantibodiesbyELISAisdiagnostic.Inchildren(>18months)demonstrationofanti-HIVIgGantibodiesbyELISAisused.
1387.Teratologyisastudyof
a)Congenitalheartdefect
b)Congenitalabnormalities
c)Woundsandinjuries
d)Noneoftheabove
CorrectAnswer-BAnswer-B.CongenitalabnormalitiesStudyofCongenitalheartdefectsisapartofthebroadspectrumofcongenitalabnormalities,thestudyofwhichisknownasTeratology
1388.Russellsilversyndromeisassociatedwithwhichofthefollowing?
a)Autosomalinheritance
b)X-linkedinheritance
c)Sporadicgenemutation
d)Uniparentaldisomy
CorrectAnswer-DAnswer-D.UniparentaldisomyAngelmansyndromePraderWillisyndromePseudohypoparathyroidismIbTransientneonataldiabetesmellitusBeckwith-WiedemannsyndromeRussellsilversyndromeWangsyndromeTemplesyndrome
1389.WhichofthefollowingisnotafeatureofDown'ssyndrome?
a)Hypotonia
b)Infections
c)Femaleinfertility
d)EarlyonsetAlzheimer'sdisease
CorrectAnswer-CAnswer-C.FemaleinfertilityGIT:-Analatresia,Duodenalatresia,Hirschsprungdisease,annularpancreas.Increasedincidenceofleukemia(1%).LeukemiascommonareALL(mostcommon),AML(M7-AML)transientmyeloproliferativedisorders,andJuvenilCML.Others:EarlyonsetofAlzheimer'sdisease,Decreasedimmunitywithrecurrentinfections,obesity,DM,Hypothyroidism(mostcommonendocrineabnormality).
1390.WhichofthefollowingisnotafeatureofTurner'ssyndrome?
a)Cubitusvalgus
b)Cryptorchidism
c)Shortfourthmetacarpal
d)Shieldchest
CorrectAnswer-BAnswer-B.CryptorchidismClinicalfeaturesinadolescentsareshortstature,webbedneck,lowposteriorhairline,widelyspacednippleswithbroadchest(shieldchest),hypertelorism,epicanthus,slantedpalpebralfissure,ptosis,micrognathia,cubitusvalgus(increaredcarryingangle),sensorineuralhearingloss,shortfourthmetacarpal,hypothyroidism,streakovaries,andsexualinfantilism.Turnersyndromeisthemostimportantcauseofprimaryamenorrhea.
1391.InTurner'ssyndromewhichofthefollowingisNOTseen:
a)Shortstature
b)Widelyspacednipple
c)Webbedneck
d)Mentalretardation
CorrectAnswer-DAnswerisD(Mentalretardation):MentalretardationisseeninDown&Klinefelter'ssyndromebutnotinTurner'ssyndrome.AllotherfeaturesmentionedasoptionsmaybeseeninTurner'ssyndrome.
1392.WhichofthefollowingistrueregardingTurner'ssyndrome?
a)Cubitusvalgus
b)Autosomaldominant
c)Monosomyofchromosome12
d)Sensorineuralhearingloss
CorrectAnswer-AAnswer-A.CubitusvalgusTurnersyndromeisamonosomyofsexchromosome(notautosomaldominant).CubitusvalgusisafeatureofTurnersyndrome.SNHLisnotafeature.
1393.Singlegenedisorderwhichdoesnotfollowmendelianinheritance-
a)Sicklecellanemia
b)Downsyndrome
c)FragileX-syndrome
d)Retinoblastoma
CorrectAnswer-CAns.is'c'i.e.,FragileX-Synd.Transmissionofcertainsingle-genedisordersdoesnotfollowclassicalmendelianprinciples.Thisgroupofdisordercanbeclassifiedintofollowingcategories?
1. Diseasescausedbytriplet-repeatmutation,e.g.fragile-Xsyndrome,Huntingtondisease,&others.
2. Disorderscausedbymutationinmitochondrialgenes,e.g.laberheriditaryopticneuropathy.
3. Disorderassociatedwithgenomicimprinting.4. Disordersassociatedwithgonadalmosaicism.
1394.Mostcommoncauseofshockinchild
a)Septicshock
b)Hypovolemicshock
c)Cardiogenicshock
d)Anaphylacticshock
CorrectAnswer-BAnswer-B.HypovolemicshockHypovolemiaisthemostcommoncauseofshockinchildren.The2ndmostcommoncause-Septicordistributiveshock.3rdmostcommon-Cardiogenicshock
1395.Whichistheprognosticscoringsystemforheadinjuryinchildren?
a)CCS
b)AUDIT
c)Injuryseverityscore
d)PediatricTraumaScore
CorrectAnswer-AAnswer-A.CCS
Table1:ChildrenComaScore(CCS)<2years"OcularResponse 4 Pursuit3 Extraocularmusclesintactreactivepupils2 FixedpupilsandEOMimpaired1 FixedpupilsandEOMparalyzedVerbalresponse 3 Cries2 Spontaneousrespiration1 ApneicMotorresponses 4 Flexesandextends3 Withdrawsfrompainfulstimuli2 Hypertonic1 FlaccidTotalMax.Score 11TotalMinScore
1396.WhichofthefollowingisacriteriaforclinicalStageIIofAIDSinchildren?
a)Lymphadenopathy
b)Oralcandidiasis
c)Hepatosplenomegaly
d)Oesophagealcandidiasis
CorrectAnswer-CAnswer-C.HepatosplenomegalyClinicalStage2HepatosplenomegalyPapularpruriticeruptionsSeborrhoeicdermatitisExtensivehumanpapillomavirusinfectionExtensivemolluscumcontagiosumFungalnailinfectionsRecurrentoralulcerationsLinealgingivalerythema(LGE)AngularcheilitisParotidenlargementHerpeszoster
1397.Whichofthefollowingisclosedatbirth?
a)Foramenovale
b)Posteriorfontanelle
c)Ductusvenosus
d)Anteriorfontanelle
CorrectAnswer-BAnswer-B.PosteriorfontanellePosteriorfontanellePosteriorfontanellegenerallyclosesby2-4monthsafterbirth.Posteriorfontanelleusuallyclosesbytheageof1-4months.Butsometimeitmaybeossified(closes)atbirth.Thus,itisthebestansweramongthegivenchoices.
1398.Harlequinskinchangeisseenduetomutationofwhichgene?
a)ABCA12
b)FAD
c)Keratin1
d)ALOXE3
CorrectAnswer-AAnswer-A.ABCA12Harlequinichthyosis(HI)iscausedbymutationsintheABCAl2gene.MutationinthegeneleadstodefectivelipidtransportandABCAl2activityisrequiredforthegenerationoflong-chainceramidesthatareessentialforthedevelopmentofthenormalskinbarrier.Itisinheritedbyautosomalrecessivemodeofinheritance.
1399.Ritterdiseaseisadiseasecausedby-
a)Infection
b)Autoimmune
c)Genetic
d)Metabolicdisorder
CorrectAnswer-AAnswer-A.InfectionStaphylococcalscaldedskinsyndromeiscausedpredominantlybyphagegroup2staphylococci,particularlystrains71and55,whicharepresentatlocalizedsitesofinfection.
1400.PinkcolorintheIMNCIchartissuggestiveof
a)Normalzoneofweightforage
b)Undernutrition(Upto-2SD)
c)Severelyunderweightzone(Upto-3SD)
d)Veryseverelyundernourished(Upto-5SD)
CorrectAnswer-CAnswer-C.Severelyunderweightzone(Upto-3SD)Green-NormalzoneofweightforageYellow-Undernutrition(upto-2SD)Pink-Severelyunderweightzone(upto-3SD)
1401.5DHTisnecessaryfordevelopmentofwhichofthefollowing?
a)Externalgenitalia
b)Internalgenitalia
c)Mullerianstructures
d)Wollfianstructures
CorrectAnswer-AAnswer-A.ExternalgenitaliaVirilizationofthewolffianductiscausedbytheactionoftestosteroneitself.MasculinizationoftheurogenitalsinusandexternalgenitalsdependsontheactionofDHT(Dehydrotestosterone)duringthecriticalperiodoffetalmasculinization.
1402.TrueaboutAspergersyndrome:
a)Morecommoningirl
b)Repetitiveactivitypattern
c)Subnormalintelligenceisconsistentfeature
d)Severelanguageimpairmentsischaracteristic
e)All
CorrectAnswer-BAns.b.RepetitiveactivitypatternAspergersyndrome:Itisfourtimesmorelikelytooccurinmalesthaninfemalesandusuallyisfirstdiagnosedinchildrenbetweentheagesof2and6.Thecommoncharacteristicsincludeaverageoraboveaverageintelligence"Thereisnoclinicallysignificantgeneraldelayinspokenorreceptivelanguageorcognitivedevelopment.Self'helpskills,adaptivebehaviour,andcuriosityabouttheenvironmentduringthefirst3yearsshouldbeatalevelconsistentwithnormalintellectualdevelopment
1403.Definitionofchildhoodisunderwhatage?
a)8years
b)10years
c)12years
d)16years
CorrectAnswer-C12yearsREF:NelsonTextbookofPaediatrics17theditiondifferentpagesInfancy 0-1yrToddlerhood 1-3yrEarlychildhood(toddlerhoodandsometimeafterwards) 1-4yr
MiddleChildhood(SchoolAge) 6-12yrPreschool 2-5yrAdolescence(onsetofpubertytomaturity) 12-20yr
Adulthood(fullphysicalandintellectualmaturity)
20-21yronwards
1404.Prevalenceofomphaloceleatbirthis
a)1in100livebirths
b)1in2000livebirths
c)1in4000livebirths
d)1in10,000livebirths
CorrectAnswer-CAnswer-C.1in4000livebirthsIncidenceofomphaloceleat11-14weeksgestation-1in1100pregnancies.Prevalenceatbirth-1in4000-6000livebirths.Thisindicatessuddenmortalitymostlikelyduetoinuterofetaldemisefromassociatedchromosomalanomaliesaswellaselectiveterminationafterthediagnosis
1405.Pectusexcavatumis
a)Protrusionofsternum
b)Sternaldepression
c)Sternalcleft
d)Lateraldisplacementofsternum
CorrectAnswer-BAnswer-B.SternaldepressionPectusexcavatum(funnelchest)ismidlinenarrowingofthoraciccavityduetosternaldepression.Mayoccurinisolationormaybeassociatedwithaconnectivetissuedisorder,MarfanorEhlers-Danlossyndrome.Secondarytochroniclungdisease,neuromusculardisease,ortrauma.
1406.Achildaged7yearshashowmanyteeth
a)15
b)20
c)26
d)32
CorrectAnswer-CAnswer-C.26Permanentteeththatappear:1stmolars:-4Centralincisors:-2Temporaryteeth:-20(sincemolarsaresuperaddedpermanentteethandcentralincisorsarereplaced).Soinall26teeth(Range24to26)-at7yearsofage.
1407.Whatistheageofthechildwhodrawsacircleandbuildstowerof7cubes?
a)1year
b)2years
c)21/2years
d)3years
CorrectAnswer-DAnswer-D.3yearsAge Milestone Age Numberof
cubesoftower12-24 Triestoscribble 12months 2
spontaneouslymonths 3
2years Drawsaverticalorhorizontalline
15months 4
3years Drawsacircle 18months 64years Drawsacross(plus
sign)anddrawsarectangle
21months24months
7
5years Drawsatriangle 30months 9 36months 10
1408.Bywhatageisthemilestoneofclimbingstepswithalternatefeetachieved?
a)2years
b)3years
c)4years
d)5years
CorrectAnswer-BAnswer-B.3yearsWalkindependently-1yearunwell,climbingupstairsandgoingdownstairswithonestepatatime-2yearsRidetricycle;climbingupstairswithalternatefeet-3yearsHopping;goingdownstairswithalternatefeet-4yearsSkipping-5years
1409.Maturefingergripcomesatwhatage?
a)5months
b)7months
c)9months
d)1year
CorrectAnswer-CAnswer-C.9months6months→Dropsoneobjectwhenanotherisoffered7months→Transfersobject&unidextrousapproach9months→-pPincergrasp12—13months→Castingappear,mouthingdisappear15months→Feedshimselfwithcup,slightspillage
1410.Socialsmileisattainedatwhatage?
a)2months
b)5months
c)9months
d)1year
CorrectAnswer-AAnswer-A.2monthsSocialsmiledevelopsat2months.
1411.ArrangethefollowingmilestonesinthecorrectorderoftheirattainmentI.Buildtowerof4cubesII.MakesimplesentencesIII.DrawingacircleIV.Drawingarectangle
a)II→III→IV→I
b)I→II→III→IV
c)II→I→III→IV
d)I→II→IV→III
CorrectAnswer-BAnswer-B.I→II→III→IVTheageofattainmentofthemilestonesis:-Buildsatowerof4cubes→18monthsMakessimplesentences→2yearsDrawingacircle→3yearsDrawingarectangle→4years
1412.Bywhatagecananewbornrecognizemother?
a)2months
b)3months
c)6months
d)7months
CorrectAnswer-BAnswer-B.3monthsHeadcontrolStartscooingRecognizesmotherCanfollowanobjectupto180°Onpullingthechildtosit,headlagspartially(between2-3months).After3monthsheadcontroldevelops.
1413.Whichofthefollowingcanbedonebyan18monthsoldbaby?
a)Makingtowerof9cubes
b)Canuse10wordswithmeaning
c)Ridetricycle
d)Turnpagesofbookoneatatime
CorrectAnswer-BAnswer-B.Canuse10wordswithmeaningAt18months,thechildcanuse10wordswithmeaning.
1414.Vocabularyof1.5yearoldchildis-
a)1-10words
b)10-20words
c)20-30words
d)30-40words
CorrectAnswer-BAns.is'b'i.e.,10-20wordsAt18months,thechildcanuse10wordswithmeaning.Othermilestonesaskedinthequestionareachievedinchildrenolderthan18months:?Makingatowerof9cubes-30monthsTurnpagesofbookoneatatime-2yearsRidetricycle-3years
1415.Achildof5yearscanusesentencesofaroundhowmanywords?
a)6words
b)10words
c)100words
d)250words
CorrectAnswer-BAnswer-B.10wordsAlthoughachildhasavocabularyof250wordsat3years,thechildcanusesentenceof10wordsat5years.
1416.Milestonesachievedbya10monthsoldchildareallexcept-
a)Pincergrasp
b)Wavingbye-bye
c)Standingwithoutsupport
d)Playsapeek-a-boogame
CorrectAnswer-CAnswer-C.StandingwithoutsupportBabystandswithoutsupportby1yearofage.Pincergrasp→9monthsWavingbye-bye→9monthsPlaysapeek-a-boogame→10months
1417.Whatistheageofachildwhocanidentify4coloursanddrawatriangle?
a)21/2years
b)3years
c)4years
d)5years
CorrectAnswer-DAnswer-D.5yearsAchildlearnstodrawatriangleattheageof5years.Identificationoffourcoloursisattainedattheageof4years.
1418.Weightofaninfantdoublesbywhatage?
a)6months
b)1year
c)2years
d)3years
CorrectAnswer-CAnswer-C.2yearsWeightofaninfantdoublesby5monthsandquadruplesby2yearsofage.
1419.Growthofheadcircumferencein1st3monthsoflifeisby
a)2cm
b)3cm
c)5cm
d)10cm
CorrectAnswer-CAnswer-C.5cmHeadcircumferenceismeasuredfromtheoccipitalprotuberancetothesupraorbitalridgeofforeheadwhichisthemaximumoccipitofrontaldiameterofskull.Theheadcircumferenceinuterogrowsby0.5cminfirst2weeks,0.75cmin3rdweekandafterthat1cm/weektillbirth.
1420.Delayederuptionisfailureofteethtoappearby
a)6months
b)13months
c)25months
d)37months
CorrectAnswer-BAnswer-B.13monthsDelayederuptionisusuallyconsideredwhentherearenoteethbyapproximately13monthsofage(mean+3SD).Commoncausesofdelayederuptionofteethinclude:-Idiopathic(Mostcommon).HypothyroidHypoparathyroidFamilial
1421.Breastmilkprotectsfrominfectionsasitcontainsallofthefollowingexcept:
a)IgE
b)Lactoferrin
c)Bifidusfactor
d)PABA
CorrectAnswer-AAnswer-A.IgEBreastmilkcontainsseveralantiinfectivefactors
1. Antibodies-3secretoryIgA,IgM2. Lysozyme3. Antistaphylococcalfactor4. Specificinhibitorysubstancesagainstviralinfections.5. Lactoferrin→InhibitsgrowthofE.coli.6. Bilestimulatedlipase→killsentamoebahistolyticaandGiardia
lamblia.7. Bifidusfactor→InhibitsgrowthofE.coli8. Para-amino-benzoicacid(PABA)→Providesprotectionagainst
malariaix)Phagocyticmacrophagesandlymphoidcells
1422.Whichofthefollowingistrueregardingprematuremilkascomparedtomaturemilk?
a)Lesslactose
b)Lessiron
c)Lessimmunoglobulins
d)Lesssodium
CorrectAnswer-AAnswer-A.LesslactosePretermmilkThemilkofmotherwhodeliversprematurelydiffersfromthemilkofamotherwhodeliversatterm.Pretermmilkcontains:Lesslactose(incomparisontotermmilk).ContainsmoreproteinS,sodium,iron,immunoglobinsandcaloriesastheyareneededbythepretermbaby.
1423.Allofthefollowingaretrueregardingbreastmilkascomparedtocow'smilkexcept
a)Containsmorelactose
b)Moreamountofproteins
c)Lessamountoffatcontent
d)Mineralsandsaltsisless
CorrectAnswer-BAnswer-B.MoreamountofproteinsIncomparisontocowmilk,humanmilkcontainslessamountof:Proteins(1gm/100ml),salts(sodium,chloride,potassium),fat(3.4gm/100ml),andminerals(calcium,phosphate)&more:Lactose(7g/100mlor7%).
1424.Whichofthefollowingisthebestreferenceforgrowthmonitoringinchildren?
a)ICMR
b)NCHS
c)Boston
d)IAP
CorrectAnswer-BAnswer-B.NCHSWHOreferencevalues(NCHSstandards)Thesearemostcommonlyusedandbestavailablereferencevaluesforinternationaluse.ThesevaluesarebasedonthedataassembledbyUnitedStatesNationalCentreforHealthStatistics(NCHS).ClassificationofPEMisbasedonthesestandards
1425.Kwashiorkarisduetodeficiencyof
a)Calories
b)Minerals
c)Vitamins
d)Zinc
CorrectAnswer-AAnswer-A.CaloriesMarasmusandkwashiorkorareduetodeficiencyofproteinsandcalories.Itischaracterizedbyclassical'triad'ofedema(Duetohypoalbuminemia),markedlyretardedgrowthandpsychomotor(mental)changes.
1426.
Whichofthefollowingisthemostmetabolicallyactivepartoflongbone?
a)Epiphysis
b)Metaphysis
c)Diaphysis
d)Physis
CorrectAnswer-DAnswer-D.PhysisThegrowthplate(physis)andtheadjacentterminaldiaphysisrepresentthemostmetabolicallyactivesegmentofthelongbone.Thispartchangesdramaticallyduringdevelopmentandhenceitiscalledthemetaphysis
1427.Iliotibialbandcontractureinpatientsofpoliomyelitiswillleadto
a)Flexionathipandknee
b)Flexionathip,extentionatknee
c)Extentionathipflexionatknee
d)Extentionathipandknee
CorrectAnswer-AAnswer-A.FlexionathipandkneeDeformities:Iliotibialbandcontracturecanleadto:Flexion,abductionandexternalrotationdeformityathip(mostcommon).Flexonandvalgusatlcneeorsometimestripledeformityatknee(flexion,posteriorsubluxationandexternalroutationoftibiaonfemur).Equinovarusatankleandfoot.Lumbarscoliosisandpelvicobliquityatspineandpelvisrespectively.
1428.Jumpersknee
a)Apophysitisofpatellartendonasitinsertsinpatella
b)Apophysitisofpatellartendonasitinsertsintibia
c)Apophysitisofquadricepstendonasitinsertsinpatella
d)Apophysitisofhamstringtendonasitinsertsintibia
CorrectAnswer-AAnswer-A.ApophysitisofpatellartendonasitinsertsinpatellaItisalsocalledPatellartendinitisThisisanapophysitis(inflammation)ofthepatellartendonasitinsertsintothepatella.Itisassociatedwithpain,swellingandcrepitus.
1429.WhichofthefollowingisnottrueaboutGaleazzifracturedislocation?
a)Fractureofdistalthirdofradiusanddislocationofdistalradio-ulnarjoint
b)Resultsfromfallonoutstretchedhand
c)Thedistalendofulnadislocatesvolarlyafterdisruptionofdistalradio-ulnarjoint
d)Radiusisangulatedmediallyandanteriorly
CorrectAnswer-CAnswer-C.Thedistalendofulnadislocatesvolarlyafterdisruptionofdistalradio-ulnarjointFractureofthedistalthirdoftheradiuswithdislocationofthedistalradioulnarjointThisinjuryisthecounterpartoftheMonteggiafracture-dislocation.Itcommonlyresultsfromafallonanoutstretchedhand.Theradiusfractureisangulatedmediallyandanteriorly.Thedistalradioulnarjointisdisrupted,resultingindorsaldislocationofthedistalendoftheulnaMalunionoccursbecauseofdisplacementofthefragment.Itresultsindeformityandlimitationofsupinationandpronation.
1430.InMonteggiafracture,whichistrueaboutulnarfractureandheadofradius
a)Bothulnarfractureandheadofradiusisdisplacedposteriorly
b)Bothulnarfractureandheadofradiusisdisplacedanteriorly
c)Ulnarfracturesisposteriorlyandheadofradiusisdisplacedanteriorly
d)Ulnarfractureisanteriorlyandheadofradiusisdisplacedposteriorly
CorrectAnswer-BAns:Bi.e.Bothulnarfractureandheadofradiusisdisplacedanteriorly*Thisisafractureoftheupper-thirdoftheulnawithdislocationoftheheadoftheradius.Itiscausedbyafallonanoutstretchedhand.Itmayalsoresultfromadirectblowonthebackoftheupperforearm.-Thesefallintotwomaincategoriesdependingupontheangulationoftheulnafracture-extensionandflexiontype.Theextensiontype,isthecommonerofthetwo,wheretheulnafractureangulatesanteriorly(extends)andtheradialheaddislocatesanteriorly.Theflexiontypeiswheretheulnafractureangulatesposteriorly(flexes)andtheradialheaddislocatesposteriorly.
1431.WhichofthefollowingisnottrueaboutJeffersonsfracture?
a)Itisaburstfractureoftheringofatlasvertebra
b)Itisthemostcommontypeofatlasfracture
c)FracturedefinintionisparticularlyclearonCTScanimage
d)Itisassociatedwithinjuryelsewhereinspinein25%ofthecases
CorrectAnswer-DAnswer-D.Itisassociatedwithinjuryelsewhereinspinein25%ofthecasesSuddensevereloadonthetopoftheheadmaycausea'bursting'forcewhichfracturestheringoftheatlas(Jefferson'sfracture).Thusitisatypeofaxialcompressionforce.ItisthemostcommontypeoffractureoftheAtlas.Thereisnoencroachmentontheneuralcanalandusuallynoneurologicaldamage.Withtheexceptionofpainorlossofsensationinthegreateroccipitalnervedistribution,neurologicalsequelaeareuncommonandmorelikelytoberelatedtoassociatedinjuries.Fractureofatlasareassociatedwithinjuryelsewhereincervicalspineinupto50%ofcases;odontoidfracturesandhangman'sfractureinparticularshouldbeexcluded
1432.Whichofthefollowingshouldermovementsis/areweakinpatientsofsupraspinatustear?
a)Abduction
b)Adduction
c)Externalrotation
d)Internalrotation
CorrectAnswer-AAnswer-A.AbductionPatientsmaytearthesupraspinatustendonacutelybyfallingonanoutstretchedarmorliftingaheavyobject.Symptomsarepainalongwithweaknessofabductionandexternalrotationoftheshoulder.Atrophyofthesupraspinatusmusclesdevelops.
1433.Whichofthefollowingisnottrueaboutimpingementsyndrome?
a)Itisthetendinitiscausedbyinflammationoftherotatorcufftendons
b)Supraspinatustendonismostofteninvolved
c)Shoulderabductioninthearcof60-120degreesisparticularlypainful
d)Surgicaldecompressionofthesubacromialspaceisfrequentlyindicated
CorrectAnswer-DAnswer-D.SurgicaldecompressionofthesubacromialspaceisfrequentlyindicatedImpingementsyndrome(painfularesyndrome)ismostcommonlyduetendinitsofsupraspinatuscomponentofrotatorcuffandischaracterizedbypainin60°-120"ofabduction.Treatmentisinitialyconservative.Surgicaldecompressionisrequiredinfailedcases.
1434.VascularsignofNarathisnoticedin
a)Fractureneckoffemur
b)Perthesdisease
c)Posteriordislocationofhip
d)Alloftheabove
CorrectAnswer-CCi.e.PosteriordislocationofhipVascularsignofnarathispositiveinposteriordislocationofhipjoint.Duetoposteriordislocation,thehipjointfallsonthefemoralartery,andthiscausesfeebleorabsentfemoralpulse.
1435.MostdangeroustypeofodontoidfractureasperAndersonandD'Alonzoclassificationanditsrespectivemanagementis
a)TypeI-immobilizationinrigidcollar
b)TypeII-screwfixation
c)TypeIII-halovestimmmobilization
d)TypeIV-opereductioninternalfixation
CorrectAnswer-BAnswer-B.TypeII-screwfixationOdontoidfractureshavebeenclassifiedbyAndersonandD'Alonzo(1974)asfollows:
1. TypeI-Anavulsionfractureofthetipoftheodontoidprocessduetotractionbythealarligaments.Thefractureisstable(abovethetransverseligament)anduniteswithoutdifficulty.
2. TypeII-Afractureatthejunctionoftheodontoidprocessandthebodyoftheaxis.Thisisthemostcommon(andpotentiallythemostdangerous)type.Thefractureisunstableandpronetonon-union.Itrequiresfixationbyscrew.
3. TypeIII-Afracturethroughthebodyoftheaxis.Thefractureisstableandalmostalwaysuniteswithimmobilization.
1436.IncreasedQanglepredisposesto
a)Medialpatellarsubluxation
b)Lateralpatellarsubluxation
c)Superiorpatellarsubluxation
d)Inferiorpatellarsubluxation
CorrectAnswer-BAnswer-B.LateralpatellarsubluxationPatellaralignmentcanbeassessedbymeasuringtheQ-angle(quadricepsangle).Thisistheanglesubtendedbyalinedrawnfromtheanteriorsuperioriliacspinetothecentreofthepatellaandanotherfromthecentreofthepatellatothetibialtubercle.Itnormallyaveragesabout14degreesinmenand17degreesinwomen.Patellofemoralstabilityismaintainedbyacombinationofthearticularsurfacegeometryandsofttissuerestraints.
1437.Seatbeltinjuryis
a)Teardropfracture
b)Wedgefracture
c)Chancefracture
d)Whiplashinjury
CorrectAnswer-CCi.e.ChancefractureAhorizontalfractureofthevertebraextendingfrombodytotheposteriorelement,causedbyastrongdistractionforce
1438.Palpablefemurheadonperrectalexamisafeatureofwhichofthefollowingconditions?
a)Posteriorhipdislocation
b)Anteriorhipdislocation
c)Centralhipdislocation
d)Inferiorhipdislocation
CorrectAnswer-CAnswer-C.CentralhipdislocationIncentralfracture-dislocationofthehipthefemoralheadisdriventhroughthefloor(medialwall)oftheacetabulumtowardsthepelviccavity.Itoccursduetofallontheside,orablowoverthegreatertrochater.
1439.Themostcommoncomplicationofintracapsularfractureneckoffemuris
a)Malunion
b)Osteoarthritis
c)Non-Union
d)Shortening
CorrectAnswer-CCi.e.NonunionBothintracapsularneckfractureandextracapsularfracture(basicervicalandITfracture)havesamedeformities,i.e.externalrotationandshortening.Thesedisplacementsaremoremarkedinextracapsularfractures,becauseinanintracapsularfracture,thecapsuleofthehipjointisattachedtothedistalfragmentandpreventsextremerotationanddisplacementofthedistalfragment(andwithit,thelimb).Inextracapsularfracture,distalfragmentbeingoutsidethecapsuleisdisplacedmoremarkedly.
1440.Poplitealarteryinjuryiscommonlyseeninwhichtypeoftraumatickneedislocation?
a)Anterior
b)Posterior
c)Medial
d)Lateral
CorrectAnswer-BAnswer-B.PosteriorPoplitealarteryinjuryiscommonwithbothanteriorandposteriordislocations.Posteriordislocationsmorelikelytoresultindirectinjuryandevenruptureofpoplitealartery(isolatedtransection).Anteriordislocationscausestretchingofpoplitealarterywhichmayleadtointimaldisruptionandthrombosis(damageisoveralongersegmentofartery).
1441.Kochermanoeuverisusedfor
a)Shoulderreduction
b)Elbowreduction
c)Ankledislocation
d)Kneedislocation
CorrectAnswer-AAnswer-A.ShoulderreductionKocher'smanoeuvre:Thisisthemostcommonlyusedmethod.Thestepsareasfollows:
1. Traction—withtheelbowflexedtoarightanglesteadytractionisappliedalongthelongaxisofthehumerus;
2. Externalrotation—thearmisrotatedexternally;3. Adduction—theexternallyrotatedarmisadductedbycarryingthe
elbowacrossthebodytowardsthemidline;and4. Internalrotation–thearmisrotatedinternallysothatthehandfalls
acrosstotheoppositeshoulder.
1442.Anklesprainduetoforcedinversionofaplantarflexedfootisduetoinjuryto
a)Anteriortalofibularligament
b)Posteriortalofibularligament
c)Calcaneofibularligament
d)Posteriorfibresofdeltoid
CorrectAnswer-AAns.a.Anteriortalofibularligament*Structuresdamagedduetoinversioninjury.-Peronealtendoninjury.-Avulsionfractureoftipoflateralmalleolus.-Avulsionfractureofanterolateralsurfaceoftalus&calcaneum(sustentaculumtali).-Fractureofbaseof5thmetatarsal.-Lateralcollateralligamentinjury(anteriortalofibular>calcaneofibular>posterior-talofibularligament).-Medialmalleolusfracture.
1443.Treatmentofscaphoidfracture
a)Conservative
b)CompressionScrews
c)CompressionPlating
d)Traction
CorrectAnswer-AAnswer-A.ConservativeThetreatmentofascaphoidisessentiallyconservative.Thehandisimmobilizedinascaphoidcastwithwristinlittledorsiflexionandradialdeviation(glassholdingposition).
1444.Allofthefollowingaretrueregardingfractureoflateralcondyleofhumerusexcept
a)Usuallyseenat6-10yearsofage
b)ResultsinGunstockdeformity
c)Cubitusvalgusoccurs
d)Tardyulnarnervepalsyisseen
CorrectAnswer-BAnswer-B.ResultsinGunstockdeformityFractureLateralCondyleHumerus/JupiterfractureItisacommonfractureinchildren.Thelateralcondylar(orcapitular)epiphysisbeginstoossifyduringthefirstyearoflifeandfuseswithshaftat12-16years.Betweentheseagesitmaybeshearedofforavulsedbyforcefultraction.Themaximumchancesofinjuryisbetween6-10years.
1445.Mostcommoncomplicationoffractureoftibia
a)Infection
b)Compartmentsyndrome
c)Delayedunion
d)Vascularinjury
CorrectAnswer-CAnswer-C.DelayedunionThetibiahassomecharacteristicfeatureswhichareresponsiblefordelayedunionornon-unionoftibiafractures.Thedistalthirdoftibiaisparticularlypronefordelayedunionandnonunionbecauseofitsprecariousbloodsupply.
1446.WhichofthefollowingisnottrueaboutACLinjury?
a)Itisacomponentofthe0'Donoghuetriad
b)ACLisintrasynovial
c)ACLisimportantforproprioceptivefunction
d)Anteriordrawertestisthemostsensitivetest
CorrectAnswer-DAnswer-D.AnteriordrawertestisthemostsensitivetestLachman'stestisthemostsensitivetestforanteriorcruciateligamenttears.Itisdonewiththekneeflexedat20degrees.Soitcanbedoneinacuteaswellaschronicinjuries.(becauseinacutecaseswithhemarthrosismoreflexionisusuallynotpossiblesoperforminganteriordrawertestisdifficult).ACLisintrasynovial&hasproprioceptivefunction.
1447.Continuousfixedtractionisprovidedby-
a)Thomassplint
b)BBsplint
c)HamiltonRussel
d)Gallows
CorrectAnswer-AAnswer-A.ThomassplintCombinedtraction-IfaThomas'splintisused,thetapesaretiedtotheendofthesplintandtheentiresplintisthensuspended,asinbalancedtraction
1448.Cobraheadplateisusedfor
a)Hiparthrodesis
b)Kneearthrodesis
c)Elbowarthrodesis
d)Anklearthrodesis
CorrectAnswer-AAnswer-A.HiparthrodesisSpecialimplantsSPnail-plantsDynamichipscrew(DHS)-IntertrochantericfractureCondylarblade-plate-InterochantericfractureT-plate-CondylarfractureoffemurSpoonplatetibia-CondyarfractureoftibiaCobraplate-FractureofloweraendofHiparthrodesis
1449.Lockingcompressionplatingforiscommonlyindicatedinthefollowingfracturetypes
a)Periarticularfractures
b)Transverseorobliquefracturesoflongbones
c)Intertrochantericfractures
d)Fractureoflongbones
CorrectAnswer-AAnswer-A.PeriarticularfracturesLockingcompressionplatesarecommonlyusedinperiarticularfractures
1450.Dunloptractionisatypeoftractionusedinmanagementof
a)Fracturehumerus
b)Fractureradius
c)Fracturefemur
d)FractureTibia
CorrectAnswer-AAnswer-A.FracturehumerusItisusedinmanagementoffracturehumerus.Itisaskintractionappliedtothearmwiththechildsupine.Tractionstrapsareappliedtotheforearmwiththearmsupinated.Acounterweightishungfromtheupperpartofthearmtohelppulltheproximalfragmentofthehumerusposteriorly,toapproximatethedistalfragment.Longitudinaltractionisthenappliedtothesupinatedforearmwiththeelbowflexedtoabout45degrees
1451.Anklereflexisaffectedinprolapsedintervertebraldiscatwhatlevel?
a)L3-L4
b)L4-L5
c)L5-S1
d)S1-S2
CorrectAnswer-CAnswer-C.L5-S1S1root-Weaknessofplantarflexorsofroot-Overlateralsideoffoot
1452.CTEVshoetrueis
a)Itisthesameasnormalshoe
b)Ithasstraightmedialborder
c)Ithasmedicalshoeraise
d)Ithasheelwithextralength
CorrectAnswer-BAnswer-B.IthasstraightmedialborderIthasstraightinner(medial)borderwhichhelpspreventforefootadduction.Ithasoutershoeraisewhichhelpspreventforefootinversion.Thereisnoheelwhichhelpspreventequinus.
1453.Allarefeaturesofinflammatoryarthritisexcept?
a)Morningstiffness
b)X-rayshowingsclerosis
c)ElevatedESR
d)Weightgain
CorrectAnswer-BAnswer-B.X-rayshowingsclerosisX-rayfeatureofinflammatoryarthritisshowsrarefactionwhilex-rayfeaturesinnon-inflammatoryarthritisrevealssclerosis.
1454.Whichofthefollowingisnottrueaboutthetestsforhipinstabilityinneonates?
a)Ortolanistesthastwoparts
b)Theyareperformedat2-3daysofbirth
c)Inortolanistestexaminersfingersrestonthegreatertrochanter
d)Inbarlowstestexaminersthumbisplacedinthegroin
CorrectAnswer-AAnswer-A.OrtolanistesthastwopartsInOrtolani'stest,thebaby'sthighsareheldwiththethumbsmediallyandthefingersrestingonthegreatertrochanters;thehipsareflexedto90degreesandgentlyabducted.Normallythereissmoothabductiontoalmost90degrees.Incongenitaldislocationthemovementisusuallyimpeded,butifpressureisappliedtothegreatertrochanterthereisasoft'clunk'asthedislocationreduces,andthenthehipabductsfully(the'jerkofentry').Ifabductionstopshalfwayandthereisnojerkofentry,theremaybeanirreducibledislocation.
1455.Ortolanitestispositivewhentheexaminerhearsthe?
a)Clunkofentryonabductionandflexionofhip
b)Clunkofentryonextensionandadductionofhip
c)Clickofexitonabductionandflexionofhip
d)Clickofexitonextensionandadductionofhip
CorrectAnswer-AAns.is'a'i.e.,ClunkofentryonabductionandflexionofhipClinicaltestsforCDH/DDHIninfancytwotestsareused.Barlow'stestThistestisdonewithin2-3daysofbirth.Thetesthastwoparts:?
1. Part1:-Infantisinsupinepositionwithhipandkneein90°offlexion,Thehipisslowlyadducted&pushedtodislocatethehipandonecanhearaclunckofexitoffemoralheadoutoftheacetabulum.
2. Part2:-Nowthehipisgentelyabductedandpulledtoreducethehip.Thiswillcause'clunk'indicatingreductionofhip.Itisquiteobviousthatpart1canbedoneonlydislocatablehip;butnotinalreadydislocatedhipastheheadisalreadyoutoftheacetabulum.Ortolani'stestThistestissimilarto2ndpartofBarlow'stest,i.e.slowabductionofhipinflexedpositionofhip&kneetoreducethehip.
1456.Oncogenicosteomalaciaismediatedby
a)Phosphatonin
b)Calcitonin
c)Interleukin2
d)Interleukin6
CorrectAnswer-AAnswer-A.PhosphatoninOncogenicosteomalaciaismediatedbyphosphatoninincertaintumors,particularlyvasculartumourslikehemangiopericytomasandalsofibrohistocyticlesions
1457.WhichofthefollowingistrueaboutCTEV
a)Itismorecommoninfemales
b)Rightfootisusuallymoreaffectedthantheleft
c)Talusisdisplacedmedialandplantarwards
d)Tibiausuallyshowslateraltorsion
CorrectAnswer-CAnswer-C.TalusisdisplacedmedialandplantarwardsCTEVisthecommonestandmostimportantcongenitaldeformityofthefoot.CTEVismorecommonmalesinthaninfemales(malestofemaleratio2.5:1).InhalfofthecasesCTEVisbilateral.Rightandleftfootareaffectedequally.
1458.ThelastdeformitytobecorrectedbyPonseti'smethodforCTEVis-
a)HeelVarus
b)Equinus
c)FootAdduction
d)Cavus
CorrectAnswer-BAnswer-B.EquinusPonseti'stechniqueThisinvolvesfirstcorrectingthecavusdeformirythentheadductionandheelvarusandfinallytheequinusdeformity.ThistechniqueisnowmostlyacceptedtechniqueforCTEVcorrectionasitisbasedonbetterunderstandingofthepathoanatomyofthedeformedfoot.Thesuccessofreductionis90-98Percent.
1459.WhichofthefollowingisnottrueaboutthemanipulationmethodstocorrectCTEV?
a)Involvesserialcastingandbelowkneeplastercasting
b)Inkitesmethoddeformitiesarecorrectedsequentiallyadduction→inversion→equinus
c)Ponseti'stechniquehassuccessrateof90-98%
d)Ponseti'smethodofcorrectioninvolvescavus—>adduction-->heelvarus—>equinus
CorrectAnswer-AAnswer-A.InvolvesserialcastingandbelowkneeplastercastingSerialmanipulationandabovekneeplastercastingisdoneweeklyforthefirst6weeks.Otheroptionsarecorrect.
1460.WhichofthefollowingisthemanagementforneglectedcaseofCTEVinapatient>10yearsofage?
a)Triplearthrodesis
b)Anklearthrodesis
c)Jessfixation
d)Ponseticasting
CorrectAnswer-AAnswer-A.Triplearthrodesis*Alltheserequiresurgicalcorrectionandthesurgerydependsupontheageofthepatient.-<4yearsofage:-Postero-medialsofttissuerelease->4years:-Postero-medialsofttissuereleasewithabonyprocedure:-*4-8years:-Dilwyn-Evansprocedure(PMR+Calcaneo-cuboidfusion)*8-10years:-PMR+Wedgetarsectomy*>10years:-Triplearthrodesis(subtalar,calcaneo-cuboid,andtalonavicularjoints)
1461.Osteoporosisisseeninallthefollowingexcept
a)Thyrotoxicosis
b)Rheumatoidarthritis
c)Hypoparathyroidism
d)Steroidtherapy
CorrectAnswer-CAnswerisC(Hypoparathyroidism):Osteoporosisasassociatedwithlzyperparathyroidism(nothypoparathyroidism).DISEASESASSOCIATEDWITHANINCREASEDRISKOFGENERALIZEDOSTEOPOROSISINADULTS:
HypogonadalStatesNutritionalandgastrointestinaldisorders
TurnerSyndrome MalnutritionKlinefeltersyndrome ParenteralnutritionAnorexianervosa MalabsorptionsyndromesHypothalmicamenorrhea GastrectomyOtherprimaryorsecondaryhypogonadalstates
Severeliverdisease,especiallybiliarycirrhosis
Perniciousanemia
EndocrinedisordersHematologicdisorders/Malignancy
Cushing'ssyndrome Multipledisorders/malignancyHyperparathyroidism Lymphomaandleukemia
Thyrotoxicosis Malignancy-associatedparathyroidhormone-related(PTHrP)
Insulin-dependentdiabetes
Insulin-dependentdiabetesmellitus production
Acromegaly MastocytosisAdrenalinsufficiency Hemophilia ThalassemiaSelectedinherited&Rheumatologicdisorders Miscellaneous
OsteogenesisimperfectaQ ImmobilizationQ
MarfansyndromeQChronicobstructivepulmonarydisease
Hemochromatosis PregnancyandlactationHypophosphatasiaQ ScoliosisGlycogenstoragediseases MultiplesclerosisHomocystinuriaQ SarcoidosisEhlers-Danlossyndrome AmyloidosisPorphyria AlcoholismMenkes'syndrome Epidermolysisbullosa Rheumatoidarthritis DRUGSASSOCIATEDWITHANINCREASEDRISKOFGENERALIZEDOSTEOPOROSISINADULTS:Glucocorticoids2CyclosporineQ
CytotoxicdrugsAnticonvulsantsExcessivealcohol
ExcessivethyroxinAluminiumGonadotropin-releasinghormoneagonistsQ
HeparinLithium
1462.WhichofthefollowingisnottrueaboutSCFE?
a)Malesareaffectedmorefrequently
b)Extensionisrestricted
c)Commonlyoccursduringadolescence
d)Varus,adductionandexternalrotationdeformitiesarepresent
CorrectAnswer-BAnswer-B.ExtensionisrestrictedSCFEistheseparationofproximalfemoralcapitalepiphysis(head)atgrowthplate.SCFEoccursduetoweaknessofgrowthplateandoccursduringadolescentperiod(11-15years)whenthegrowthplateisweakduetoacceleratedgrowth.Malesareaffectedmorefrequentlythanfemales.Movementsarerestrictedparticularlyabductionandinternalrotation.Flexionisalsorestrictedandextensionisincreased.AndthisclinicalfeaturedifferentiatesSCFEwithallotherhippathologiesbecausemostofthehippathologieshaveoppositedeformity,i.e.flexiondeformitywithrestrictedextension.Varus,adductionandexternalrotationdeformitiesarepresent.Externalrotationisincreasedalongwithextension.Whenhipisflexeditgoesintoexternalrotation,i.e.obligatoryexternalrotation.ItisaveryimportantsignofSCFE.Waddlinggaitispresent.Trendelenburg'stestispositive.
1463.Genurecurvatumisseenin-
a)Rheumatoidarthritis
b)Poliomyelitis
c)Rickets
d)Alltheabove
CorrectAnswer-DAnswer-D.Alltheabovea)CongenitalrecurvatumThismaybeduetoabnormalintra-uterineposture;itusuallyrecoversspontaneously.Rarely,grosshyperextensionistheprecursoroftruecongenitaldislocationoftheknee.b)LaxligamentsNormalpeoplewithgeneralizedjointlaxitytendtostandwiththeirkneesbackset.Prolongedtraction,especiallyonaframe,orholdingthekneehyperextendedinplaster,mayoverstretchligaments,leadingtopermanenthyperextensiondeformity.Ligamentsmayalsobecomeoverstretchedfollowingchronicorrecurrentsynovitis(especiallyinrheumatoidarthritis),thehypotoniaofrickets,theflailnessofpoliomyelitisortheinsensitivityofCharcot'sdisease.
1464.Psoriaticarthritismostcommonlyinvolveswhichjoint-
a)Distalinterphalangealjoint
b)Proximalinterphalangealjoint
c)Wristjoint
d)Metacarpophalangealjoint
CorrectAnswer-AAnswer-A.DistalinterphalangealjointTheseinclude:
1. Arthritisofdistalinterphalangeal(DIP)joints2. Assymetricaloligoarthritis:Mostcommonpattern3. SymmetricalpolyarthritissimilartoRA4. Axialinvolvement(sacroiliacandspine)similartoankylosing
spondylitis5. Arthritismultilans
1465.Whichofthefollowingis/arefeature/sofsprengelsdeformity?
a)Elevatedshoulderonaffectedside
b)Smallerthanusualscapula
c)Shortneck
d)Alltheabove
CorrectAnswer-DAnswer-D.AlltheaboveSprengel'sdeformity:Deformityistheonlysymptomanditmaybenoticedatbirth.Theshoulderontheaffectedsideiselevated;thescapulalooksandfeelsabnormallyhigh,smallerthanusualandsomewhatprominent;occasionallybothscapulaeareaffected.
1466.Tinelsignisseenin?
a)Nervedegeneration
b)Nerveregeneration
c)Muscledegeneration
d)Muscleregeneration
CorrectAnswer-BAns.is'b'i.e.,NerveregenerationPathologicalchangesafternerveinjuryAfternerveinjury,nervefirstdegeneratesandthentriestoregenerate.NervedegenerationThepartoftheneuronedistaltothepointofinjuryundergoessecondaryorWalleriandegeneration;theproximalpartundergoesprimaryorretrogradedegenerationuptoasinglenode.NerveregenerationAsregenerationbegins,theaxonalstumpfromtheproximalsegmentbeginstogrowdistally.IftheendoneuraltubewithitscontainedSchwanncellsisintact,theaxonalsproutmayreadilypassalongitsprimarycourseandreinnervatetheend-organ.Therateofrecoveryofaxonis1mmperday.Themusclesnearesttothesiteofinjuryrecoversfirst,followedbyothersasthenervereinnervatesmusclesfromproximaltodistal,theso-calledmotormarch.Whentheskinoverthenerveispercussedgentlyfromdistaltoproximal,thepatientgetsatinglingsensationifthenerveisrecovering.ThisiscalledTinel'ssignandisasignofrecovery.
1467.AllaretrueaboutMarie-strumpelldiseaseexcept:
a)Mostcommonlyinvolvesthesacro-iliacjoints
b)Enhesitisiscommon
c)Morecommoninmales
d)Roentgenogramisthemostsensitiveinvestigation
CorrectAnswer-DAnswer-D.RoentgenogramisthemostsensitiveinvestigationMarie—StrumpelldiseaseisalsoknownasAnkylosingSpondylitisIntheearlydiseaseprocess,plainx-rays(Roentgenogram)maybereadasnormal—>notverysensitive.Ankylosingspondylitisprimarilyaffectsaxialskeleton.Thediseaseusuallybeginsinthesacro-iliacjointsandusuallyextendsupwardstoinvolvethelumbar,thoracic,andoftencervicalspine.Intheworstcasesthehipsorshouldersarealsoaffected.Hipjointisthemostcommonlyaffectedperipheraljoint.Itismorecommoninmales(maletofemaleratio2-3:1)
1468.Mostcommonlylesionassociatedwithpathologicalfractureinhandis-
a)Enchondroma
b)Metastases
c)Osteoidosteoma
d)Osteochondroma
CorrectAnswer-AAnswer-A.EnchondromaInhandpathologicalfracturesaremostcommonlyassociatedwithbenignbonetumors.About23%ofthebonetumorsinhandpresentwithpathologicalfractures.Theaverageageofpresentationis37years.Themostcommonboneaffectedistheproximalphalynx,thefifthraywasinvolvedin44%ofthepatients.Majority(approximately88%)ofthepathologicalfracturesarecausedbyenchondromas.
1469.Mostcommonprimarybonetumourofhandis:
a)Osteoma
b)Osteochondroma
c)Enchondroma
d)Noneoftheabove
CorrectAnswer-CEnchondromasarisefromcartilageandarethemostcommonprimarybonetumorsofthehand.Theselesionsaccountfor>90%ofbonetumorsseeninthehand.
Ref:Schwartz’sprincipleofsurgery9thedition,chapter44.Commonestbonemalignancies->Secondaries(metastases)Commonestprimarymalignanttumor>MultiplemyelomaCommonestprimarymalignanttumorolongbonesOsteosarcomaCommonestbenigntumorofbonne-Osteochondroma(Osteochondromaisnottureneoplasmsinceitsgrowthstopswithcessationofgrowthattheepiphysealplate)Commonesttruebenigntumorofbone->OsteroidosteomaCommonestbenigntumorofhand-Enchondroma
1470.Mostcommonmalignantbonetumor-
a)Osteogenicsarcoma
b)Secondaries
c)Osteoma
d)Enchondroma
CorrectAnswer-BAns.is'b'i.e.,SecondariesoSecondariesaremostcommonmalignantbonetumor.oOsteogenicsarcomaisthemostcommonprimarymalignantbonetumor.oOsteomaismostcommonbenignbonetumor.
1471.Agegroupaffectedbyosteosarcoma-
a)Upto10years
b)10-20years
c)30-40years
d)Olderthan45years
CorrectAnswer-BAnswer-B.10-20yearsOsteogenicsarcomaisthemostcommonprimarymalignanttumorofboneinchildren.Thisispredominantlyatumorofchildhoodoradolescence,occuringmostcommonlyinthe10-25years.Themostcommonsiteofinvolvementismetaphysisoflongbonearoundknee:-Lowerendoffemur(45%)UpperendofTibia(25%)
1472.Whichisintramendullarytumoramongcarcinomaofbone-
a)ClassicalOsteosarcoma
b)Parostealosteosarcoma
c)Periostealosteosarcoma
d)Noneoftheabove
CorrectAnswer-AAnswer-A.ClassicalOsteosarcomaInitsclassic(intramedullary)form,osteosarcomaisahighlymalignanttumorarisingwithintheboneandspreadingrapidlyoutwardstotheperiosteumandsurroundingsofttissue.Thetumormostcommonlybeginsinthemetaphysis.Osteosarcomaarisesfromprimitivebone-formingcells.Tumordestroysthebonestructureandeventuallyburstsintothesurroundingsofttissues.
1473.33yroldfemalepresentswithaslowgrowingbonymassalongthedistalfemurcortexinthemetaphysealregionwithanappreciablegapbetweenthecortexandtumorwithoutanycorticalinvasion.Whatistheusualtreatmentforthesame?
a)Localresection
b)Amputaion
c)Chemotherapy
d)Radiotherapy
CorrectAnswer-AAnswer-A.LocalresectionSlowgrowingbonymassalongthedistalfemurcortexinthemetaphysealregionwithanappreciablegapbetweenthecortexandtumorwithoutanycorticalinvasioninanindividualinthe3rdorLIthdecadeoflifeissuggestiveof-parostealosteosarcoma.Localresectionofthelesionistheusualtreatmentforparostealosteosarcoma.
1474.Firstradiologicalsignforactivetuberculararthritisis-
a)Localizedosteoporosis
b)Sclerosis
c)Jointspacereduction
d)Osteophytes
CorrectAnswer-AAnswer-A.LocalizedosteoporosisIntuberculararthritis,localizedosteoporosisisthefirstradiologicalsignofactivedisease.
1475.Whichofthefollowingisnottrueaboutthemanagementofpottsparaplegia?
a)Chemotherapyisthemainstayofconservativemanagement
b)Paraplegianotimprovingwithconservativetreatmentevenafter3-6monthsisanindicationforoperativeintervention
c)Decompressionviaanterolateralapproachismostpreferred
d)Posteriorfusionandinstrumentationcanbeusedtocorrectthedeformity
CorrectAnswer-CAnswer-C.DecompressionviaanterolateralapproachismostpreferredThefollowingmeasuresareadoptedinthetreatmentofPott'sparaplegia:1)ConservativetreatmentChemotherapy(ATTs)isthemainstayofconservativetreatment.Immobilizationbytraction(incervicalspine)orbrace(indorsalregion).Physiotherapyofparalysedlimb.2)Surgicaltreatment
1. Followingarethemainindicationsforsurgery.2. Failedconservativetreatment:-Paraplegiadoesnotshow
improvementbyconservativetreatmentevenafter3-6months.3. Patientdevelopsparaplegiawhileonconservativetreatment.4. Paraplegiagettingworsedespiteadequateconservativetreatment.5. Indoubtfuldiagnosis.6. Rapidonsetparaplegia7. Recurrenceofparaplegiaafterimprovementinitialy.
OperativeprocedureforPott'sparaplegia
Therearevariousprocedures,themostcommonlyusedprocedureisanteriordecompressionbysurgicaldebridement(removaldead,necrotic&caseousmaterial)followedbyautogenousstrutgrafting.Thelogiciswellunderstood;thecompressionisfromanteriorsidemostofthetimebecausetuberculosisoccursinvertebralbodywhichliesanteriortothespinalcord.So,anteriordecompressionisthebestprocedure.Anteriordecompressioncanbecausedby:
1. Anteriorapproach:-Calledanteriordecompression.Itisthemostpreferredprocedure.
2. Anterolateralapproach:-Calledanterolateraldecompression.Othersurgicalprocedures(otherthananteriordecompression)are:
1. Costo-transversectomy2. Posteriorfusionandinstrumentationtocorrectkyphoticdeformity.3. Laminectomy
1476.Tuberculosisofspinemostcommonlyaffectswhichvertebralsegment?
a)Upperdorsal
b)Lowerdorsal
c)Lumbar
d)Cervical
CorrectAnswer-BAnswer-B.LowerdorsalThespineisthecommonestsiteofboneandjointtuberculosis.ThemostcommonsiteisDorsolumbarregion.Lowerdorsal(thoracic)regionisthemostcommonsegmentinvolvedfollowedbylumbarsegment.Thetuberculosisofspineisalsocalledpott'sdiseaseortubercularspondylytis.
1477.A20yearoldmalepresentswithhistoryofgradualonsetpainandswellinginleftkneesince6months.Nowsincelast1monthpatienthasstartedlimpingwhilewalkingandalsohasflexiondeformityofknee.Ultrasonographyshowspresenceofsynovialthickening.Whatisthemostprobablediagnosis?
a)Tuberculosisofknee
b)Pigmentedvillonodularsynovitis
c)Synovialsarcoma
d)Hemarthrosis
CorrectAnswer-AAnswer-A.TuberculosisofkneeUnilateralmonoarticularkneeinvolvementwithgradualonsetpainswellingandflexiondeformity,withsynovialthickeningismostprobablysuggestiveoftuberculosisofknee.Presentingcomplaints:Thepatient,usuallyintheagegroupof10-25years,presentswithcomplaintsofpainandswellinginthekneeOnExamination:
1. Swelling:Thejointisswollen,whichmaybeduetosynovialhypertrophyoreffusion.
2. Muscleatrophy3. Coldabscess
4. Sinus5. Deformity6. Themovementsatthejointarelimited
1478.X-rayappearanceofsequestrumis-
a)Unnaturalradiodensefragments
b)Osteopenicfragment
c)Fragmentwithhoneycombloculatedappearance
d)Radiolucentareawithspeckledcalcification
CorrectAnswer-AAnswer-A.UnnaturalradiodensefragmentsSequestrumisapieceofdeadbone,surroundedbyinfectedgranulationtissuetryingtoeatthesequestrumaway.Onx-ray,sequestrashowupasunnaturaldensefragments,incontrasttothesurroundingosteopenicbone
1479.Cubitusvalgusdevelopsascomplicationof-
a)Jupitorfracture
b)Smithsfracture
c)Malgaignefracture
d)Staddlefracture
CorrectAnswer-AAnswer-A.JupitorfractureFractureoflateralcondyleofhumerus(Jupitorfracture)
1480.Mostcommonsitefortheosteoporoticvertebralfractureis?
a)Dorsolumbarspine
b)Cervicalspine
c)Lumbosacralspine
d)Dorsalspine
CorrectAnswer-AAns.is'a'i.e.,DorsolumbarspineOsteoporosisisanasymptomaticdisorderunlesscomplications(predominantlyfractures)occur.Mostcommonsymptomofosteoporosisisbackpainsecondarytovertebralcompressionfracture.Dorso-lumbarspineisthemostfrequentsite.Othercommonsitesoffracturearelowerendradius(Colle'sfracture)andfractureneckfemur.Osteoporoticfracture(fragilefractures)are:(i)Fracturevertebrae(mostcommon),(ii)Colle'sfracture,(iii)Fractureneckfemur.Serumcalcium,phosphateandalkalinephosphatasearenormalinosteoporosis.
1481.Apatientpresentswithwristtrauma.Oninvestigationspatientisdiagnosedtohaveasprainedwrist,withoutanyevidenceoffracture.Thereistendernessinanatomicalsnuffbox.Whichligamentiscommonlyinvolved-
a)Scapholunateligament
b)Radialcollateralligament
c)Lunotriquetralligament
d)Ulnarcollateralligament
CorrectAnswer-AAnswer-A.ScapholunateligamentLunateandscapholunateligmante-Tenderinlunatefractureandscapholunatedissociation
1482.Trendelenburgtestispositiveduetoinjurytowhichofthefollowingnerve?
a)Obturator
b)Sciatic
c)SuperiorGluteal
d)InferiorGluteal
CorrectAnswer-CAns.C.SuperiorGlutealApositiveTrendelenburgisrelativelynon-specificandmayindicate:Pain(e.g.duetoosteoarthritisofthehipjoint)Weakhipabductors(gluteusmedius,gluteusminimus)Shortfemoralneck/fractureofneckDislocationorsubluxationofthehipNeuropathyGluteusmediusandminimusaresuppliedbySuperiorGlutealnerve.TrendelenburgtestNormallywhenapersonismadetostandononeleg,thehipabductorsoftheipsilateralsideraisetheoppositeandtheunsupportedsideofthepelvis.Iftheabductormechanismisdefective,theunsupportedsideofthepelvisdropsandthisisknownaspositiveTrendelenburgtest.
1483.Falseaboutosteoarthritisis?
a)Involvessynovialjoints
b)Progressivesofteningofthearticularcartilage
c)Itisaninflammatoryarthritis
d)Marginalosteophytesareproduced
CorrectAnswer-CAns.is'c'i.e.,ItisaninflammatoryarthritisOsteoarthritis(OA)isachronicdisorderofsynovialjointsinwhichthereisprogressivesofteninganddisintegrationofarticularcartilageaccompaniedbynewgrowthofcartilageandboneatthejointmargins(osteophytes),cystformationandsclerosisinthesubchondralbone,mildsynovitisandcapsularfibrosis.Thetermosteoarthritisisamisnomerasitisanon-inflammatorycondition.Therighttermisosteoarthrosisordegenerativejointdisorderbecauseitisadegenerativewear-and-tearprocessoccuringinjoints.
1484.ShentonslineisseeninXrayof-
a)Antero-posteriorpelviswithbothhips
b)Antero-posteriorshoulder
c)Lateralcervicalspine
d)Laterallumbosacralspine
CorrectAnswer-AAnswer-A.Antero-posteriorpelviswithbothhipsWithanormalhipShenton'sline,whichcontinuesfromtheinferiorborderofthefemoralnecktotheinferiorborderofthepubicramus,lookscontinuous;anyinterruptioninthelinesuggestsanabnormalpositionofthefemoralhead.Narrowingofthejoint'space'isasignofarticularcartilageloss,afeatureofbothinflammatoryandnon-inflammatoryarthritis.
1485.Falseaboutosteogenesisimperfectais-
a)Defectivecollagenformation
b)Associatedwithcataractformation
c)Autosomaldominant
d)KnownasBrittlebonedisease
CorrectAnswer-BAnswer-B.AssociatedwithcataractformationOsteogenesisimperfecta,alsoknownasbrittlebonediseaseorLobsteinsyndrome,isahereditaryconditioncharacterizedbyfragilityofbones,deafness,bluesclera,laxityofjointsandtendencytoimprovewithage.Itisadiseaseofdefectivecollagenformation.Therefore,collagen-containingtissuesareaffected,e.g.bone,teeth,skin,tendonsandligaments.Primarydefectinboneisdefectiveosteoidformation.Itisusuallytransmittedasanautosomaldominant,butinaseverevariantofthediseasetheparentsarenormalandafreshgenemutationorautosomalrecessiveinheritanceispostulated.Radiologyshowswormianbonesintheskull.
1486.Mostmobilesegmentofvertebralcolumnis-
a)Cervical
b)Thoracic
c)Lumbar
d)Sacral
CorrectAnswer-AAnswer-A.CervicalThespinalcolumncanbedividedintothreemobile(cervical,thoracic,andlumbarregions)andtwofused(sacrumandcoccyx).Cervicalregion:Itisthemostmobileregionofthespinalcolumnwithrangeofmotionofapproximately80-90degreesofflexion,70degreesofextention,20-45degreesoflateralflexion,andupto90degreesofrotationtobothsides
1487.Chauffeurfractureis-
a)Extra-articularfractureofstyloidprocess
b)Intra-articularfractureofstyloidprocess
c)Intra-articularfractureofbaseof1stmetacarpal
d)Extra-articularfractureofbaseof1stmetacarpal
CorrectAnswer-BAnswer-B.Intra-articularfractureofstyloidprocessAnintra-articularobliquefractureofthestyloidprocessoftheradius.
1488.TreatmentofchoiceinAcutemyositisossificansis:
a)Immobilizationofelbow
b)Shortwavediathermy
c)Passivemovementsofarm
d)Activeexercises
CorrectAnswer-AAi.e.Immobilizationofelbow*Restoftheaffectedpartduringtheperiodwhiletheprocessisactiveisthebasicprincipleoftreatment(TN91).*Nomassageshouldbegiven.*Ifanyphysicaltherapyisgoingon,itshouldbediscontinuedimmediately.*Allpassivemovementsandvigorousexercisemustbestopped.Verygentleexercisemustbestarted.*Indomethacinandradiotherapypreventcalcification.However,radiotherapyshouldbeavoidedinchildren.-Surgicalexcisionisindicatedifmyositisossificansinterfereswithfunction.Itisworthnotingthatsurgicalexcisioniscontraindicatedduringactivephasewhencalcificationmatures.*Surgicalexcision,ifrequired,shouldbedoneonlyaftercompletematurationofossification.
1489.Whatisthetreatmentforpatientwithhypertrophicnonunionwithdeformityatfracturesite?
a)Notreatmentrequired
b)Fixationonly
c)Bonegraftingonly
d)Fixationwithbonegrafting
CorrectAnswer-BAnswer-B.FixationonlyPatientswithhypertrophicnonunionhavesufficientvascularitytohealbutstabilityislackingornormalaxialalignmenthasnotbeenrestored.Thusinacaseofhypertrophicnonunionwithoutdeformity,fixationalonewillprovidestabilityandwillleadtohealing.
1490.Proximaltibialepiphysisfusesat-
a)12-14years
b)14-16years
c)16-18years
d)18-20years
CorrectAnswer-CAnswer-C.16-18yearsThetibiaossifiesfromthreecentres,oneintheshaftandoneineachepiphysis.Ossificationbeginsinmidshaftatabouttheseventhintrauterineweek.Theproximalepiphysialcentreisusuallypresentatbirth:atapproximately10yearsathinanteriorprocessfromthecentredescendstoformthesmoothpartofthetibialtuberosity.
1491.Managementofdisplacednoncomminutedintercondylarhumerusfractureis-
a)Openreductioninternalfixation
b)Aboveelbowplasterslabapplication
c)Olecranonpintraction
d)Externalfixation
CorrectAnswer-AAnswer-A.OpenreductioninternalfixationItdependsuponthedisplacement.Anundisplacedfractureneedssupportinanabove-elbowplasterslabfor3-4weeks,followedbyexercises.Adisplacedfractureistreatedgenerallybyopenreductionandinternalfixation.Incaseswithseverecomminution,olecranonpintractionisgiventoreducethefractureandmaintainthereduction.
1492.MCcauseofPrimaryAmenorrheais?
a)Constitutional/idiopathic
b)RMKHsyndrome
c)Ovariandysgenesis
d)Noneoftheabove
CorrectAnswer-CAns,C.OvariandysgenesisMCcauseofprimaryamenorrheaisovariandysgenesis/Turnersyndrome.
1493.Aninfertilewomanhasbilateraltubalblockatcornuadiagnosedonhysterosalpingography.Nexttreatmentofchoiceis?
a)IVF
b)Laparoscopyandhysteroscopy
c)Tuboplasty
d)Hydrotubation
CorrectAnswer-BAns.B.LaparoscopyandhysteroscopyLaparoscopy(withchromopertubationwithmethylenebluedye):Bestinvestigationfortubalpatency,astubalpatencycanbeconfirmedundervision,andbesides,anypathologycansimultaneouslybecorrectedwithoperativelaparoscoPy.
1494.Fetalkaryotypingcanbedonebyall,EXCEPT?
a)Cordocentesis
b)Amniocentesis
c)CVS
d)Fetalskinbiopsy
CorrectAnswer-DAns.D.FetalskinbiopsyPercutaneousumbilicalbloodsampling(PUBS)isalsoknownascordocentesisisperformedafter16weeks'gestation'underUSGguidanceaneedleisinsertedintoumbilicalvein.Thistechniqueapartfromkaryotypingisalsousefulforevaluatingfetalmetabolismandhematologicabnormalities.
1495.55yearoldladycomplaintsofmassinthevagina,whichisreducible&increasesondefecation.Thediagnosisis?
a)Rectalprolapse
b)Uterineprolapse
c)Cervicalfibroid
d)Vaginalcancer
CorrectAnswer-BAns.B.UterineprolapseProlapseisdefinedasthedisplacementofanorganfromitsnormalanatomicalposition.GenitalprolapseoccursduetoweaknessofthesuPPorts.
1496.Moschowit'ssurgeryisdonefor-
a)Cervicalcancer
b)Fundalfibroids
c)Uterineprolapse
d)Enteroceleprevention
CorrectAnswer-DAns.D.EnterocelepreventionEnteroceleformatiolcanbepreventedbyMoschowit'sorHalban'ssurgeries,inboththePODisobliterated.
1497. Whichofthefollowingisusedinquantifyinghirsutism?
a)Bishopscore
b)Rotterdamcriteria
c)Ferriman-Gallweyscore
d)Alloftheabove
CorrectAnswer-CAns.C.Ferriman-GallweyscoreTheFerriman-Gallweyscoreisamethodofevaluatingandquantifyinghirsutisminwomen.Themethodwasoriginallypublishedinl96lbyD.FerrimanandJ.D.GallweyintheJournalofClinicalEndocrinology.
1498.MCheartdiseaseinpregnancyis?
a)MS
b)AS
c)MR
d)WPWsyndrome
CorrectAnswer-AAns.A.MSMitralstenosisistheMCvalvularheartdiseaseinpregnancy.
1499.Rateofcervicaldilatationinprimigravidais?
a)0.8cm/hour
b)1.2cm/hour
c)1.5cm/hour
d)2cm/hour
CorrectAnswer-AAns.A.0.8cm/hourThenormalrateofcervicaldilatationinactivephaseis1.2cm/hourinprimigravidaeand1.5cm/hourinmultiparae.
1500.Complicationsofpreeclampsiaareallexcept?
a)Postdatism
b)DIC
c)Blindness
d)Noneoftheabove
CorrectAnswer-AAns.A.Postdatism
1501.Whatismonitoredinapatientofpreeclamsia?
a)Uricacid
b)Plateletcount
c)LFT
d)Alloftheabove
CorrectAnswer-DAns.D.Alloftheabove
1502.Notanabsolutecontraindicationformethylergometrineuseis?
a)Eclampsia
b)Heartdisease
c)Rhincompatibility
d)Afterdeliveryoffirstbabyintwinpregnancy
CorrectAnswer-CAns.C.RhincompatibilityMethylergometrine(Methergin)canbeusedinthepreventionandtreatmentofPPH.AbsolutecontraindicationstotheuseofMetherginare:
1. Chronichypertension/preeclampsia/eclampsia2. Heartdiseaseinpregnancy3. Afterthedeliveryofthefirstbabyofthetwins.
1503.Aladywith35weeksofpregnancyisadmittedinviewoffirstepisodeofpainlessboutofbleedingyesterday.OnexaminationHb10g%,BP120/70mmHg,uterusrelaxed,andcephalicfloating.FHSregular.Nextlineofmanagementis?
a)Cesareansection
b)Inductionoflabor
c)Waitandwatch
d)Bloodtransfusion
CorrectAnswer-CAns.C.WaitandwatchThisisacaseofplacentaprevia(painlessbleeding,relaxeduterus,andfloatingheadallpointtoplacentaprevia).Inthiscase,allthecriteriaforconservativemanagementarefulfilledandthereforetheansweriswaitandwatchforfetallungmaturity.
1504.G3P2L2withprevious2LSCSwithanteriorplacentapreviahasgotaveryhighriskofwhichcomplication?
a)Placentaacreta
b)Vasaprevia
c)Abruption
d)Noneoftheabove
CorrectAnswer-AAns.A.PlacentaacretaThetermplacentaaccretaisusedtodescribeanyplacentalimplantationinwhichthereisabnormallyfirmadherencetotheuterinewall.Theincidenceofplacentaaccreta,increta,andpercretahasincreased,mostlikelybecauseoftheincreasedcesareandeliveryrate.
1505.B-Lynchsutureisappliedon?
a)Cervix
b)Uterus
c)Fallopiantubes
d)Ovaries
CorrectAnswer-BAns.B.UterusDescribedfirstbyChristopher,B-LynchisacompressionsutureplacedonuterusinthemanagementofatonicPPHwhenthemedicalmethodsfail.
1506.A28-year-oldprimigravidawith33weeksofpregnancysuddenlycomplainsofheadache,oliguria,andblurredvision.HerBPis180/110andurinealbuminis+3.Thelineoffurthermanagementis?
a)Waitandwatch
b)LSCS
c)Inductionoflabor
d)Anticonvulsant+antihypertensivetherapy
CorrectAnswer-DAns.D.Anticonvulsant+antihypertensivetherapyThepatientisacaseofseverepreeclampsia,withimpendingeclampsia.Magnesiumsulfateisthedrugofchoiceforeclampsiaandalsoforimpendingeclampsia.
1507.Whichofthefollowingstatementsconcerningabdominalpregnancyiscorrect?
a)Gastrointestinalsymptomsarequiteoftenverysevere
b)Fetalsurvivalisapproximately80%
c)Aggressiveattemptsshouldbemadetoremovetheplacentaatthetimeofinitialsurgery
d)Placentacanbeleftinsituatthetimeofsurgery
CorrectAnswer-DAns.D.PlacentacanbeleftinsituatthetimeofsurgeryAlthoughleavingtheplacentaintheabdomenfollowingsurgicaldeliverypredisposestoriskesofpostoperativeinfections,theriskismuchlessseverethanthehemorrhageassociatedwithattemptsofremovalofplacentaatthetimeofprimarysurgery.
1508.CompletevesicularmoleisassociatedThecaleutincsytsinwhatpercentageofcases?
a)<5
b)5-15
c)20-40
d)60-70
CorrectAnswer-CAns.C.20-40Theca-luteincysts:Inmanycasesofhydatidiformmole,theovariescontainmultipletheca-luteincysts.
1509.Patientwith3monthsamenorrhoea,c/ohyperemesisandvaginalbleedingsinceonemonth.O/E=uterus16weekswithabsentfetalheartsound.Thediagnosisis?
a)Vesicularmole
b)Ectopicpregnancy
c)IUFD
d)Abruptioplacentae
CorrectAnswer-AAns.A.VesicularmoleVesicularmoleisanabnormalconditionofplacentawherethereishydropicdegenerationandproliferativechangesintheyoungchorionicvilli.Itisabenignconditionwithmalignantpotential.Uterinebleedingisalmostuniversalandmayvaryfromspottingtoprofusehemorrhage.ItistheMCpresentingfeature.Thedischargehas'whitecurrantinredcurrantjuice'appearance.
1510.Patientwithchoriocarcinoma&jaundice,treatmentofchoiceis?
a)Methotreaxate
b)ActinomycinD
c)Suctionevacuation
d)Combinationofall
CorrectAnswer-BAns.B.ActinomycinD
1511.EMACOregimeisfor?
a)Cacervix
b)Caendometrium
c)Caovary
d)Choriocarcinoma
CorrectAnswer-DAns.D.Choriocarcinoma
1512.Stagelbcervicalcancerisdiagnosedinayoungwoman.Assumingthatthecancerisconfirmedtothecervixandthatintraoperativebiopsiesarenegative,whichofthefollowingstructurewouldnotberemovedduringtheradicalhysterectomy?
a)Uterosacralanduterovesicalligaments
b)Pelvicnodes
c)Theentireparametriumonbothsidesofthecervix
d)Bothovaries
CorrectAnswer-DAns.D.BothovariesPreservationoftheovariesisgenerallyacceptable,particularlyinyoungerwomen.
1513.Invaginalhysterectomy,thefirstclampincludes:
a)Uterineartery
b)Fallopiantube&roundligament
c)Uterosacralligament
d)Noneoftheabove
CorrectAnswer-CAns.C.UterosacralligamentVaginalhysterectomywithpelvicfloorrepairisdoneforvaginouterineprolapseinperi/postmenopausalwomen.Firstclampincludesuteroscaral&Macenrodt'sligament.Secondclampincludesuterineartery.Thirdclampincludescornualstructures.
1514.Therapeuticconizationisindicatedin?
a)Microinvasivecarcinomacervixstagelal
b)CINIII
c)Unsatisfactorycolposcopywithcervicaldysplasia
d)Cervicalmetaplasia
CorrectAnswer-AAns.A.MicroinvasivecarcinomacervixstagelalInstage1A1,thereisnolymphnodeinvolvement.Therapeuticconizationisthesurgeryofchoiceforstage1A1inyoungpatientswhoaredesirousoffuturechildbearing
1515.CervicalcancerIIIBtreatmentis?
a)Wertheim'soperation
b)Radiotherapy
c)Chemotherapy
d)Chemoradiation
CorrectAnswer-DAns.D.ChemoradiationCisplatinisgivenbeforeRTasaradiosensltizer,hencethepreferredterminologyisCTRT(concurrentchemoandradiotherapyalsoknownaschemoradiation).
1516.Wertheim'shysterectomyisdonefor?
a)1A1cervicalcancer
b)IBcervicalcancer
c)Germcellovariancancer
d)Alloftheabove
CorrectAnswer-BAns.B.IBcervicalcancerStagesofCacervixthatareoperable(radical/Wertheim'shysterectomy)are1A2,IB,andIIA.
1517.RadioisotopeusedinCacervixBrachytherapy?
a)Cobalt
b)Iridium
c)Cesium
d)Alloftheabove
CorrectAnswer-DAns.D.Alloftheabove
1518.Cavulvaspreadstoallexcept?
a)Urethra
b)Deepinguinalnodes
c)Superficialinguinalnodes
d)Paraaorticnodes
CorrectAnswer-DAns.D.ParaaorticnodesModesofspreadofca.vulva
1. Direct:Urethra,Vagina,Rectum,pelvicbones2. Lymphatic:MCrouteofspread.3. Lymphaticsoflabiatosuperficial,thendeepinguinalnodes&then
pelvicnodes4. Hematogenousrouterare&mayoccurinadvancedcases
1519.Whichovariantumourcanpresentwithmenorrhagia?
a)Demoidcyst
b)Epithelialovariancancer
c)Granulosacelltumour
d)Yolksactumour
CorrectAnswer-CAns.C.GranulosacelltumourGranulosacelltumours(orgranulosa-thecacelltumours)aretumoursthatarisefromgranulosacells.Thesetumoursarepartofthesexcordgonadalstromaltumourornon-epithelialgroupoftumours.
1520.Allareriskfactorsforectopicpregnancyexcept?
a)Pasthistory
b)Tuballigationfailure
c)IVF
d)LNGIUCD
CorrectAnswer-DAns.D.LNGIUCDIUCD:ThemoderncopperIIJDdoesnotincreasetherkkofectopicpregnancy.However,thereisarelativeincreaseintubalpregnancy(7timesmore)shouldpregnancyoccurwithIUCDinsitu.Studieshavedemonstratedthatuptol%ofpregnanciesachievedthroughIVForGIFTcanresultinaheterotopicgestation.
1521.A21-year-oldfemalepresentstoemergencywardwith2monthsofamenorrheawithpaininabdomenandshock.BP90/60mmHgandHb6gm%.Urinepregnancytestisfoundpositive.Nextimmediatelineoftreatmentis?
a)Laparotomy
b)IVfluids&crossmatch
c)Medicalmanagement
d)Laparoscopy
CorrectAnswer-BAns.B.IVfluids&crossmatchThisisacaseofrupturedectopicpregnancy.PositiveUrinePregnancyTestindicatesthattheamenorrheaisduetopregnancy.Painandshockinearlypregnancyaremostlyalwaysduetorupturedectopic.
1522.DOCformedicalmanagementofectopicpegnancy?
a)ActinomycinD
b)IntramuscularMethotrexate
c)IntramuscularMethotrexate
d)PGf2alpha
CorrectAnswer-BAns.B.IntramuscularMethotrexate
1523.WhatisnotusedinPCOS?
a)OCpills
b)Cyclicalprogesterones
c)Myoinositol
d)Danazol
CorrectAnswer-DAns.D.DanazolInsulinsensitizersarealsousedtotackleinsulinresisitance.DanazolhasnoroleinPCOS.
1524.Pearlnecklaceappearanceischaracteristicof?
a)Ectopicpregnancy
b)PCOS
c)Endometriosis
d)PID
CorrectAnswer-BAns.B.PCOSUSGfeaturesofpolycysticovariansyndrome(PCOS)Greaterthan12folliclesmeasuringbetween2mmand9mmindiameterlocatedperipherally,resultinginapearlnecklaceappearance.Increasedechogenicityofovarianstromaand/orovarianvolumegreaterthan10ml.
1525.Violinstringadhesion[violentstringsign]isseenin?
a)PCOS
b)Endometriosis
c)Fitz-high-curtissyndrome
d)Rupturedectopicpregnancy
CorrectAnswer-CAns.C.Fitz-high-curtissyndromeLaparoscopyisperformed,thelivercapsulewillappearinflamed,withclassicviolinstringadhesionsintheperietalperitoneumbeneaththediaphragm.Fivepercentto10%ofwomenwithacutePIDdevelopsymptomsofperihepaticinflammation,theFitz-High-Curtissyndrome.
1526.Dysgerminomaspreadsmainlyvia?
a)Hematogenousroute
b)Lymphaticroute
c)Directspread
d)Doesnotspread
CorrectAnswer-BAns.B.LymphaticrouteDysgerminomasarethemostcommonmalignantgermcelltumors,accountingforabout30%to40%ofallovariancancersofgermcellorigin.Inthe25%ofpatientswhopresentwithmetastaticdisease,thetumormostcommonlyspreadsviathelymphatics.
1527.Triadofsymptomsofendometriosisareallexcept?
a)Infertility
b)Dysmenorrhea
c)Dyspareunia
d)Cyclicalhematuria
CorrectAnswer-DAns.D.CyclicalhematuriaEndometriosisisdefinedasthepresenceofnormalfunctionalendometrialmucosa(glandsandstroma)abnormallyimplantedinlocationsotherthantheuterinecavity.ItwasfirstdescribedbyVonRokitanskyAboutonethirdofwomenwithendometriosisremainasymptomatic.
1528.ComplicationofBenignOvarianCystsis?
a)Torsion
b)Intracystichemorrhage
c)Pseudomyxomaperotonei
d)Alloftheabove
CorrectAnswer-DAns.D.Alloftheabove
1529.Level1supportofuterus&vaginais?
a)levatorani
b)Perinealbody
c)Uterosacralligaments
d)Alloftheabove
CorrectAnswer-CAns.C.UterosacralligamentsDelancey’sthreelevelsofpelvic(uterus,vagina)support=Level1:Theuterosacral-cardinalligamentcomplexprovidesattachmentoftheuterusandvaginalvaulttothesacrum.Uterineprolapseoccurswhenthisligamentcomplexbreaksorisattenuated.
1530.MCpresentingsymptomoffibroidis?
a)Menorrhagia
b)Infertility
c)Lump
d)Compression
CorrectAnswer-AAns.A.Menorrhagia
1531.Medicalmanagementoffibroidsiswithallexcept-
a)Progesterone
b)Mifepristone
c)Ulipristalacetate
d)Misoprostol
CorrectAnswer-DAns.D.Misoprostol
1532.Endometriosisis?
a)Endometriumwithinthemyometrium
b)Functionalendometriumoutsidetheuterus
c)Myometriumwithintheendometrium
d)RaresquamousvarietyofCAendometrium
CorrectAnswer-BAns.B.FunctionalendometriumoutsidetheuterusEndometriosisDefinition:Presenceoffunctionalendometriumatplacesotherthanuterus(ectopicendometrialtissue)
1533. Samson'stheoryforDevelopmentofEndometriosisis?
a)Celomicmetaplasia
b)Hematogenousspread
c)Lymphaticspread
d)Retrogrademenstruation
CorrectAnswer-DAns.D.RetrogrademenstruationTheoriesforDevelopmentofEndometriosis
1. Samson'stheoryofretrogrademenstruation:themostaccEptedtheory
2. IvanoffandMeyer:Celomicmetaplasia3. HematogenoussPread4. Lymphaticspread(Halban'stheory)5. Directimplantation.
1534.Examinationofa26yearsoldobeseinfertilefemalereveals.Fixedretroverteduterus&Nodularityoftheuterosacralligaments.Themostlikelydiagnosisis?
a)PCOS
b)Endometriosis
c)Adenomyosis
d)TB
CorrectAnswer-BAns.B.EndometriosisPelvicexaminationofendometriosis:Maybenormalormayrevealthefollowing:FixedretroverteduterusPelvictendernessNodulesinthePODNodularityoftheuterosaoalligamentsUnilateralorbilateraladnexalmassSpeculumexaminationmayrevealbluishnodulesinposteriorfornix.
1535.Investigationofchoiceforendometriosis?
a)USG
b)CA125
c)MRI
d)Laparoscopy
CorrectAnswer-DAns.D.LaparoscopyLaparoscopyistheInvestigationofChoice.
1536.Powderburntlesionseenin?
a)PID
b)PCOS
c)Endometriosis
d)Alloftheabove
CorrectAnswer-CAns.C.EndometriosisLaparoscopyfindingsinendometriosisare:ChocolatecystsBlueberrylesionRed/flamelesionPowderburnsPotsRed/purpleraspberrylesionSubovarianadhesionsMatchstickburntsPotsWhitelesion.
1537.Treatmentofchoiceinpatientwithinfertility&endometriosis?
a)IUI
b)Surgery
c)Danozol
d)Ovulationinduction
CorrectAnswer-BAns.B.SurgerySurgicalManagement
1. Patientswithinfertility:laparoscopicovariancystectomy,adhesiolysis,andelectrocoagulationofendometrioticimplants.
2. Ifthefamilyiscompleteandthepatienthasseverepainormenstrualcomplaints:hysterectomywithbilateralsalpingooophorectomy.GenerallycombinedapproachisadoptedwherelaparoscopicsurgeryisfollowedbyGnRHa.
1538.Surgeryofchoicein42yearoldP3L3withdiffuseendometriosisis?
a)Ovariancystectomy&adhesiolysis
b)Hysterectomy
c)HysterectomywithBSOwithresectionofendometrialimplants
d)Ovariancystectomy&adhesiolysis&resectionofimplants
CorrectAnswer-CAns.C.HysterectomywithBSOwithresectionofendometrialimplantsIfthefamilykcompleteandthepatienthasseverepainormenstrualcomplaints:Hystetectomywithbilateralsalpingo-oophorectomywithresectionofallendometrioticimplants.
1539.ThemostcommonMulleriananomalyis?
a)Mullerianagenesis(RMKH)
b)Unicornuateuterus
c)Bicornuateuterus
d)Septateuterus
CorrectAnswer-DAns.D.SeptateuterusSeptateuterusistheMCMulleriananomaly.
1540.SEAMusedinDUBis?
a)Clomiphene
b)Raloxifene
c)Ormiloxifene
d)Mifepristone
CorrectAnswer-CAns.,C.OrmiloxifeneOrmeloxifeneisathirdgenerationbenzopyranSERMwhichblocksthecytosolreceptorsbyitscompetitivebindingandselectivelyactsonestrogenrecePtorsasagonistandantagonistindifferentreproductivetissues.
1541.ChoiceofadjuvanttreatmentforendometrialcarcinomastageIA,gradeIis?
a)Radiotherapy
b)Chemotherapy
c)Chemotherapyplusradiotherapy
d)Notreatment
CorrectAnswer-DAns.D.NotreatmentManagementofCaendometriumA)Stagel=1:Surgery(totalabdominalhysterectomywithbilateralsalpingo-oophorectomywithlymphnodesampling),followedbyradiotherapy.Onlypatientswithstage1A,grades1and2donotrequirepostoperativeradiotherapy.B)Stage2:Modifiedradicalhysterectomy,bilateralsalpingo-oophorectomywithlymphnodedissection,followedbyradiotherapy.C)Stages3and4:Debulkingsurgeryfollowedbyradiotherapy.
1542.A46-year-oldP3L3complainsofmenorrhagiasince3months.Nextlineofmanagementis?
a)D&C
b)Progesteronex6months
c)OCpillsx6months
d)Hysterectomy
CorrectAnswer-AAns.A.D&CInPatientswithmenorrhagiainperimenopausalagegroup(40+),alwaysmakethediagnosisfirstbeforeproceedingwithanytreatment.Itisnecessarytoruleoutendometrialhyperplasiaandcancerinthisagegroup.Hence,histopathologicalexaminationofendometriumisrequired,andthereforeD6Cshouldbedonefirst.
1543.Simplehyperplasiawithatypiawillprogresstocaendometriumin%ofcases?
a)1-2
b)3-4
c)8-9
d)20
CorrectAnswer-CAns.C.8-9
1544.Grade1Caendometrium,thereispresenceof%nonsqoumaousgrowth?
a)<5
b)6-25
c)25-50
d)>50
CorrectAnswer-AAns.A.<5FIGOGradingofEndometrialCarcinomaHistopathologicdegreeofdifferentiation:Gl:<5%nonsquamousornonmorulargrowthpattern.
1545.Definitivetreatmentofadenomyosisis?
a)OCpills
b)NSAIDS
c)Endometrialablation
d)Hysterectomy
CorrectAnswer-DAns,D.HysterectomyHysterectomyTheonlywaytocompletelycurethisconditionistohaveahysterectomy.
1546.MCcauseforhysterectomyis?
a)Prolapse
b)Fibroids
c)Caendometrium
d)AcutePID
CorrectAnswer-BAns.B.FibroidsAhysterectomyisanoperationtoremovetheuterus.Awomanmayhaveahysterectomyfordifferentreasons,including:Uterinefibroidsthatcausepain,bleeding,orotherproblems.
1547.Prolongedsurgerytimeofvaginalhysterectomywouldleadtodamagetowhichnerve?
a)Obturator
b)Pudendal
c)Peroneal
d)Sural
CorrectAnswer-CAns.C.PeronealMostcommonlyinjuredlowerextremitynerveinpatientsundergoingsurgeryinlithotomypositionisthecommonparonealnerve(LA-S2).
1548.
WhichofthefollowingisnotapartofPID-
a)Endometritis
b)Cervicitis
c)Tuboovarianabcess
d)Peritonitis
CorrectAnswer-BAns.B.CervicitisPIDisaspectrumofinfection&inflammationofuppergenitaltractorgansinvolvinguterus,fallopiantubes,ovaries,pelvicperitoneum¶metrium.Cervicitisisnotincluded.
1549.TriadforclinicaldiagnosisPIDincludesallexcept?
a)Fever
b)Lowerabdominalpain
c)Cervicalmotiontenderness
d)Bilateraladnexaltenderness
CorrectAnswer-AAns.A.FeverDiagrosisofPIDisoftendifficult.The"goldstandard"fordiagnosisreliesonthelaparoscopicappearanceofFallopiantubeinflammationbutcostandlimitedavailabilityofthetechniqueoftenprecludeitsuse.Intheabsenceoflaparoscopy,thetriadoflowerabdominalpain,cervicalmotiontenderness,andbilateraladnexaltendernesshasbeenadvocatedastheminimalcriterionforclinicaldiagnosisofPID.
1550.Acutesalpingitisismostcommonlycausedby?
a)N.gonorrhoeae
b)Chlamydiatrachomatis
c)Mycoplasma
d)Staphylococcus
CorrectAnswer-BAns,B.ChlamydiatrachomatisOptionBisnowadaysslightlymorecommonerthanoptiona)&hencethebestoptiontomarkIfpolymicrobial/mixedinfection,isintheoption,thenthatistheanswer.
1551.Tumormarkerforgermcellmalignancyareallexcept?
a)LDH
b)Alkalinephosphatase
c)AFP
d)CA-125
CorrectAnswer-DAns.D.CA-125
1552.Acutepelvicpaincouldbedueto?
a)Ectopicpregnancy
b)PID
c)Corpusluteumhematoma
d)Alloftheabove
CorrectAnswer-DAns.D.Alloftheabove
1553.Nugentscoreincludesallexcept-
a)Lactobacillus
b)Gardnerella
c)Mobiluncus
d)Gonococcus
CorrectAnswer-DAns.D.GonococcusNugent'scriteriafordiagnosisofbacterialvaginosisManyuseNugent'scriteriatoquantifyorgradebacteriaviaGramstainofvaginalsamples.Inbrief,Nugent'scriteriaevaluated3typesofbacteriaviaGramstain:Lactobacillus,Bacteroides/Gardnerella,andMobiluncus.
1554.Cluecellsareseenin?
a)Bacterialvaginosis
b)Candidiasis
c)Chlamydiasis
d)Trichomoniasis
CorrectAnswer-AAns.A.BacterialvaginosisBacterialvaginosis/vaginitis(BV)isacommonvaginalinfection.Cluecells(vaginalepithelialcellscoveredwithcoccobacilliandthecellsappearasstippledorgranular).CIuecellsarediagnosticofBV.
1555.HSGfindingssuggestiveofgenitalkoch?
a)Beadedtubes
b)Honeycombuterus
c)Golfclubtube
d)Alloftheabove
CorrectAnswer-DAns.D.AlloftheaboveInactivetuberculosis,HSGiscontraindicated.
1556.Apregnantladypresentswithgenitalwarts.Thebestmanagementforheris?
a)Imiquimod
b)Trichloroaceticacid
c)Podophyllin
d)Cryotherapy
CorrectAnswer-DAns,.D.CryotherapyForreasonsunknowngenitalwartsincreaseinsizeandnumberduringpregnancy.Treatmentoptionsduringpregnancyincludecryotherapyandtrichloroaceticacid(TCA).Outofthetwo,cryosurgeryismoreeffectivethanTCAandhenceisprefnred.
1557.28yearoldfemalecomplaintsoffoulsmellingyellowishurethraldischargesince4days.Historyofburningmicturation.Historyofsexualcontactwithmultiplepartners2daysbeforetheonsetofsymptoms.Mostlikelydiagnosisis?
a)Syphilis
b)Chancroid
c)Gonococcalurethritis
d)Non-infectiveurethritis
CorrectAnswer-CAns.C.GonococcalurethritisHistoryoffoulsmellingmucopurulentdischarge,&shortincubationperiodwithhighriskexposureclinchesthediagnosis
1558.Twin-peaksignisseenin?
a)AllMonozygotictwins
b)Monochorionictwins
c)Dichorionictwins
d)Siamesetwins
CorrectAnswer-CAns.C.Dichorionictwins
1559.IncaCervixtreatment,pointAreceives?
a)3000cGy
b)5000cGy
c)7000cGy
d)10,000cGy
CorrectAnswer-CAns.C.7000cGyPointAandPointBareinrelationtoradiotherapyforCaCervix.
1560.Ashermanssyndromeischaracterizedby?
a)Amenorrhea
b)Menorrhagia
c)Polymenorrhea
d)Alloftheabove
CorrectAnswer-AAns.A.AmenorrheaIntra-uterineadhesionsAshermansyndromewasidentifiedin1948asuterinesynechiae.Theseintra-uterineadhesions(IUA)areoftenassociatedwithamenorrheaorinfertility.
1561.GARDASILvaccineisfor-
a)HPV16,18
b)HSV
c)HPV6,11,16,18
d)HepatitisB
CorrectAnswer-CAns.C.HPV6,11,16,18
1562.LNGcontentofMirenais-
a)20gms
b)20mg
c)52gms
d)52mgs
CorrectAnswer-DAns.D.52mgsMirena/LNGIUD/LNG2O/levonova/LNGIUSMirenacontainsatotalof52mglevonorgestrel(LNG).LNGisreleasedintotheuterinecavityatarateofapproximtely20pg/day.
1563.WhichofthefollowingdecreasestheriskofPelvicInflammatoryDisease?
a)CuT
b)Spermicidalagents
c)O.C.pills
d)Todayvaginalsponge
CorrectAnswer-CAns.C.O.C.pillsSeveralstudieshaveshownthatregularO.C.pillusersareprotectedfromPIDstotheextentof50%.
1564.Patientwith45XO,whatHRTtobegiven?
a)Growthhormone+E+P
b)Estrogene
c)NoHRTNeeded
d)HRTonlyafter45years
CorrectAnswer-AAns.A.Growthhormone+E+PGrowthhormone(GH)therapyhasbecomethestandardofcareforgirlswithturnersyndromeandshouldbeconsideredassoonasdecreasedlineargrowthvelocityisapparent.Initialhormonereplacementinvolveslowdoseestrogenmonotherapy.Progestagenreplacementisgenerallyadded1-2yearsafterstartingestrogenoruponbreakthroughbleeding.
1565.Tamoxifendecreasestheriskofwhichcancer?
a)Breast
b)Endometrium
c)Ovary
d)Alloftheabove
CorrectAnswer-AAns.A.BreastTamoxifenhasbeenusedformorethan30yearstotreatpatientswithbreastcancer.Tamoxifenworksagainstbreastcancer,inpart,byinterferingwiththeactivityofestrogen,afemalehormonethatpromotesthegrowthofbreastcancercells.InOctober1998,theU.S.FoodandDrugAdministration(FDA)approvedtheuseoftamoxifentoreducetheincidenceofbreastcancerinwomenatincreasedriskofthedisease.
1566.Raloxifenedecreasestheriskofwhichcancer?
a)Breast
b)Cervix
c)Ovary
d)Alloftheabove
CorrectAnswer-AAns.A.BreastAfteranaverageof81months,raloxifenereducesriskofinvasivebreastcancerbyabout38percentcomparedtotamoxifenreducingbreastcancerbyabout50percent.
1567.Leastfailurerate?
a)CuT
b)MIRENA
c)DMPA
d)O.C.PILLS
CorrectAnswer-BAns.B.MIRENA
1568.Nuvaringcontains?
a)EE+etonogestrel
b)LNG+EE
c)LNG
d)EE+drosperinone
CorrectAnswer-AAns.A.EE+etonogestrelContraceptiveringsNuvaRing:Itisasoftvaginalringthatreleases15microgramEEand120microgramENG,etonogestrel,theactivemetaboliteofdesogestrel,perdayasacontrolleddeliverysystem.
1569.Whichdrugusedforendometriosiscancauseincreaseinhepaticenzyme&adverselipidprofile-
a)0.C.pills
b)GnRhanalogues
c)Bothoftheabove
d)Noneoftheabove
CorrectAnswer-AAns.A.0.C.pillsO.C.pills(progesteronecomponent)area/wincreaseinLDL&decreaseinHDLcholesterolbutestrogenshaveoppositeeffect.Cholestasis&cholestaticjaundiceareoccasionalsideeffectsofO.C.pills.
1570. NorgestimateinOCpillshasthefollowingadvantage?
a)Reducesvenousthrombosis
b)IscheaperthanstandardOCpills
c)Reducesacneandhirsutism
d)Usefulinheartdisease
CorrectAnswer-CAns.C.ReducesacneandhirsutismThreenewerprogestogens,namelydesogestrel,gestodene,andnorgestimatecandecreasetheameanilhirsutismascomparedtoolderprogesterones,whichactuallycancauseoilyskinandacne.
1571.WhichofthefollowingisnotanidealcandidateforIUCDinsertion?
a)PreviousLSCS
b)Lactatingmother
c)AcutePID
d)Alloftheabove
CorrectAnswer-CAns.C.AcutePID
1572.Betamethasonegiventopretermpatientforallexcept?
a)Fetallungmaturity
b)Decreaseintraventricularhemorrhage
c)Preventsperiventricularleukomalacia
d)PreventPPH
CorrectAnswer-DAns.D.PreventPPHSteroids(dexamethasoneorbetamethasone)aregiventoenhancefetallungmaturityandtheyalsodecreasetheincidenceintraventricularhemorrhage.
1573.A32-year-oldfemalewithmildhypertension.Twodaysafternormaldelivery,shedevelopseizures,headache.Noproteinuriawasthere.Onimagingshewasfoundtohaveparasagittalinfarctionandhematoma3x2cm.Themostprobablecauseis?
a)Eclampsia
b)Superiorsagittalsinusthrombosis
c)Pituitaryapoplexy
d)Subarachnoidhemorrhage
CorrectAnswer-BAns.B.SuperiorsagittalsinusthrombosisThevariousetiologiesforduralsinusthrombosisare:
1. Thrombophilia(factorVLeidenmutation,prothrombingenemutation20210,deficienciesofantithrombin,proteinCandproteinS,APLAsyndrome,hyperhomorysteinemia)
2. Pregnancy3. Postpartumstate
1574.Penicillamineuseinpregnancyisassociatedwiththisfetalcomplication?
a)Conradisyndrome
b)Renalanomalies
c)Thymushypolplasia
d)Cutislaxa
CorrectAnswer-DAns.D.CutislaxaPencillamineinterfereswithsynthesisofcollagen&elastin&cancause:elastosisperforansserpiginosaandlocalizedcutislaxa.
1575.Theprostaglandinmostcommonlyusedattermforinductionoflaboris?
a)PGI2
b)PGE1
c)PGE2
d)PGF2a
CorrectAnswer-CAns.C.PGE2PGE2ismostcommonlyusedattermforinductionoflabor.
1576.HCGlevelsatwhichExpectantmanagementofEctopicpregnancycanbedone:
a)10000IU/L
b)1000IU/L
c)2500IU/L
d)5000IU/L
CorrectAnswer-BAns.B.1000IU/LInitialHCGlevels<1000IU/l&subsequentlevelsarefalling.
1577.Outcomesofoccipitoposteriorposition?
a)Deeptransversearrest
b)Occipitosacralarrest
c)Facetopubisdelivery
d)Alloftheabove
CorrectAnswer-DAns,D.Alloftheabove
1578.RMPcanperformMTPinfirsttrimesterifhehasassistedinMTPs-
a)5
b)15
c)25
d)50
CorrectAnswer-CAns,C.25Aregisteredmedicalpractitionershallhaveoneormoreofthefollowingexperienceortrainingingynecologyandobstetricsnamely=Ifhehasassistedaregisteredmedicalpractitionerintheperformanceoftwenty-fivecasesofmedicalterminationofpregnancyofwhichatleastfivehavebeenperformedindependently,
1579.Cryingoffetusinuteroiscalledas?
a)Vagitusuterinus
b)Firstcry
c)Uterovaginalis
d)Vagitusvagina
CorrectAnswer-AAns,A.Vagitusuterinus
1580.Trueaboutcephalhematomais:
a)Crossesthesuturelines
b)Alwayspresentatbirth
c)Ventousedeliveryisariskfactor
d)Alloftheabove
CorrectAnswer-CAns.C.VentousedeliveryisariskfactorTheusualcausesofacephalohematomaareaprolongedsecondstageoflabororinstrumentaldelivery,particularlyventouse.
1581.Innercellmassdifferentiatesinto?
a)Chorion
b)Trophoectoderm
c)Embryo
d)Alloftheabove
CorrectAnswer-CANs.C.EmbryoBlastocystenlarges&thezonapellucidaundergoeslysis,thisiscalledzonahatching.Thecellsontheoutersidebecometrohoectodermwhichdifferentiatesintochorion.Thecellsontheinnersideforminnercellmasswhichdifferentiatesintoembrvo.
1582.Embryoiscalled"fetus"afterhowmanyweekspostfertilization/conception?
a)6
b)8
c)10
d)12
CorrectAnswer-BAns.B.8Embryonicperiodbeginsat3rdweekfollowingovulation/fertilization&extendsupto8weekspostconception(10weeksfromLMP).Fetalperiodbeginsafter8weekspostconception(10weeksfromLMP)&endsindelivery.
1583.Utero-placentalcirculationisestablisheddaysafterfertilization?
a)5
b)10
c)15
d)20
CorrectAnswer-BAns.B.10TheuteroPlacentalcirculationisestablished9-10daysafterfertilization.Fetoplacentalcirculationisestablished2ldayspostfertilization.
1584.Pregnancyiscontraindicatedinallofthefollowingexcept-
a)PrimaryPulmonaryHypertension
b)Eisenmenger'ssyndrome
c)Marfan'swithaorticrootdilation
d)WPWsyndrome
CorrectAnswer-DAns,D.WPWsyndrome
1585.Whichheartdiseasehastheworstprognosis/maximummortalityinpregnancy?
a)MS
b)AS
c)PDA
d)Eisenmenger'ssyndrome
CorrectAnswer-DAns.D.Eisenmenger'ssyndrome
1586.Ovariancyclecanbecorrelatedwithallexcept?
a)Endometrialsampling
b)Vaginalcytology
c)Bloodhormonallevels
d)Estrouscycle
CorrectAnswer-DAns.D.EstrouscycleEstrouscycledoesnotoccurinhumanbeings.
1587.Endometrialbiopsytodetectovulationisdoneonwhichdayofthemenstualcycle?
a)Day8-9
b)Day13-15
c)Day21-23
d)Day3-5
CorrectAnswer-CAns.C.Day21-23EndometrialBiopsy:Rarelydonenowadaysforthepurposeofiletectingovulation.
1588.Theuterinebloodflowattermis-
a)50mL/min
b)100-150mL/min
c)350-375mL/min
d)500-750mL/min
CorrectAnswer-DAns.D.500-750mL/minUteroplacentalbloodflowincreasesprogressivelyduringpregnancyandrangesfrom5N)-800mL/minatterm.
1589.Godell'ssignis?
a)Duskyhueofthevestibule
b)Softeningofthecervix
c)Increasedpulsationsfeltthroughthelateralfornices
d)Regularandrhythmiccontractionsduringbimanualexamination
CorrectAnswer-BAns.B.Softeningofthecervix
1590.Infetus,insulinproductionbeginatweeksofgestation-
a)4-6
b)8-12
c)14-18
d)24-28
CorrectAnswer-BAns.B.8-12Reaching8to10weeksintodevelopment,thepancreasstartsproducinginsulin,glucagon,somatostatin,andpancreaticpolypeptide.
1591.Limbbudappearatwhatweeksofgestation?
a)3
b)4
c)6
d)9
CorrectAnswer-BAns.B.4Theupperextremityisfirstdiscretelyvisibleasabulgeorlimbbudthatdevelopsontheventrolateralwalloftheembryoonday26(4-mmcrown-to-rumplength).
1592.Featuresofnonsevere/mildpreecampsiaareallecxept-
a)DiastolicBP<100mmHg
b)SystolicBP<160mmHg
c)MildIUGR
d)Nopremonitorysymptoms
CorrectAnswer-CAns.,C.MildIUGR
1593.FERNINGisdueto?
a)Estogen&sodiumchloride
b)Progesterone&sodiumchloride
c)HCG
d)Alloftheabove
CorrectAnswer-AAns,A,Estogen&sodiumchlorideCervicalmucusisrelativelyrichinsodiumchloridewhenestrogen(butnotprogesterone)isbeingproduced.
1594.Secondwaveoftrophoblasticinvasionoccursatweeksofgestation?
a)8-11
b)10-12
c)12-15
d)16-20
CorrectAnswer-CAns,C.12-15Thetimingofthedevelopmentoftheuteroplacentalvesselshasbeendescribedinwaves,orstages,overthecourseofgestation.Thefirstwaveoccursbefore12weekspost-fertilizationandconsistsofinvasionandmodificationofthespiralarteriesofthedecidua.Between12and16weekspos-fertilization,thesecondworeoccurs.Thisinvolvesinvasionoftheintramyometrialpartsofthespiralarteries,convertingnarrowlumen,muscularspiralarteriesintodilated,low-resistanceuteroplacentalvessels.
1595.Abstinenceperiodbeforesemenanalysisis?
a)1-2days
b)3-5days
c)5-7days
d)7-9days
CorrectAnswer-BAns.B.3-5daysTheidealspecimenforexaminationisafter3-5daysofabstinence.
1596.Engagingdiameterinfacepresentationis-
a)Suboccipitobregmatic
b)Mentovertical
c)Submentobregmatic
d)Occipitofrontal
CorrectAnswer-CANs,C.Submentobregmatic
1597.Leastlikelytocausedysmenorrhea-
a)Endometriosis
b)Adenomyosis
c)Uterinepolyp
d)Cervicalpolyp
CorrectAnswer-DAns,D.Cervicalpolyp
1598.LHsurgeisdueto?
a)Progesterone
b)Estrogen
c)AMH
d)Alloftheabove
CorrectAnswer-BAns,B.Estrogen3-4daysbeforetheovulation,estrogenlevelcrossesacertainlimit(thresholdlevel).
1599.Menopauseisdefinedas?
a)Presenceofhotflushes
b)Cessationofmensesfor1year
c)Cessationofmensesfor6months
d)Cessationofmensesfor2years
CorrectAnswer-BAns,B.Cessationofmensesfor1yearMenopauseisdefinedasthepermanentcessationofmensesfor7yearandisphysiologicallycorrelatedwiththedeclineinestrogensecretionresultingfromthelossoffollicular/ovarianfunction.
1600.Symptomsofmenopauseareallexcept?
a)Hotflushes
b)Nightsweats
c)Decreaselibido
d)Intermittenthypotension
CorrectAnswer-DAns,D.IntermittenthypotensionHotflushesTheclassicsymPtomassociatedwithestrogendeficiencyisthehotflash,alsoknownashotflushThissymptomisdescribedas'recurrent,transientperiodsofflushing,sweatingandasensationofheat,oftenaccompaniedbypalpations,feelingofanxietyandsometimesfollowedbychills".
1601.MENOPAUSEisdiagnosedby?
a)Estradiol<20pg/ml
b)Progesterone<40ng/dl
c)FSH>40IU/L
d)LH>20IU/L
CorrectAnswer-CAns,C.FSH>40IU/LAspertheAmericanAssociationofclinicalEndocrinologists,thediagnosisofmenopauseisconfirmedbyFSHlevels>40IU/L.
1602.Thevelocityofspermis?
a)1-2cm/hr
b)2-4cm/min
c)1-4mm/min
d)1-4mm/hr
CorrectAnswer-CAns.C.1-4mm/minThevelocityofasperminfluidmediumisusually1-4mm/min.Thisallowsthespermtomovetowardsanovuminordertofertilizeit.
1603.Afterejaculationsemenliquefiesin?
a)10minutes
b)30minutes
c)75minutes
d)120minutes
CorrectAnswer-BAns.B.30minutesFollowingejaculation,thesemenformsagelwhichprovidesprotectionforthespermfromtheacidicenvironmentofthevagina.Thegelisliquefiedwithin20-30minutebyenzymesfromtheprostategland.
1604.Duringpregnancy,truestatementaboutCVSis?
a)Cardiacoutputdecreases
b)Rightaxisdeviation
c)Increaseinleftventricularenddiastolicdiameter
d)Alloftheabove
CorrectAnswer-CAns,C.Increaseinleftventricularenddiastolicdiameter2Decho:Increaseinleftventricularenddiastolicdiameter.Increaseinleftandrightatrialdiameters.
1605.MCsiteofimplantationis?
a)Fallopiantubeamullarypart
b)Fallopiantubeisthmus
c)Fundusofuterus
d)Cornuofuterus
CorrectAnswer-CAns,C.FundusofuterusImplantationoccursintheendometriumontheanteriororposteriorwallofthebodynearthefundusonthesixthdayfollowingfertilization(correspondingtothe20thdayofthemenstrualcycle).
1606.AlphasubunitofhCGissimilarto?
a)FSH
b)LH
c)TSH
d)Alloftheabove
CorrectAnswer-DAns,D.AlloftheaboveHumanchorionicGonadotropin(hcG)isstructurallyrelatedtothreeotherglycoproteinhormonesLH,FSH,andTSH.
1607.Placentalhormonewithhighestcarbohydratecontentis-
a)HCG
b)Humanpregnancyspecificbetaglycoprotein
c)HPL
d)Relaxin
CorrectAnswer-AAns,A.HCGHCGhasthehighestcarbohydratecontentofanyhumanhormone-30%.
1608.Thepelvicinletusuallyisconsideredtobecontractedifitsshortest
anteroposteriordiameterislessthan-
a)12cm
b)10cm
c)8cm
d)14cm
CorrectAnswer-BAns.B.10cmThepelvicinletusuallyisconsideredtobecontractedifitsshortestanteroposteriordiameterislessthan10cmorifthegreatesttransversediameterislessthan12cm
1609.AzoospermiawithnormalFSHwouldindicate?
a)Hypothalamicfailure
b)Testicularfailure
c)Obstructionofvasdefrens
d)Alloftheabove
CorrectAnswer-CAns,C,Obstructionofvasdefrens
1610.Causesofmaleinfertility?
a)Idiopathic
b)Varicocele
c)Yq11microdeletion
d)Alloftheabove
CorrectAnswer-DAns,D.Alloftheabove
1611.Fetalthyroidglandisabletosynthesizehormonesbyweeksofgestation?
a)6-7
b)7-8
c)10-12
d)12-14
CorrectAnswer-CAns,C.10-12Fetalthyroidglandisabletosynthesizehormonesby10-12weeksofgestation.
1612.PoorprognosisinfirsttrimesterUSGis?
a)Nofetalpoleat5weeks
b)Nocardiacactivityat5weeks
c)Nogestationalsacat4weeks
d)Nocardiacactivityat8weeksofgestation
CorrectAnswer-DAns,D.Nocardiacactivityat8weeksofgestationAbsenceofembryowithheartbeat22weeksafterascanthatshowedagestationalsacwithoutayolksac
1613.Allaretrueaboutpostpartumdepressionexcept-
a)Symptomsresolvein10-12days
b)Affectsbothsexes
c)SSRIsareeffective
d)Noneoftheabove
CorrectAnswer-AAns,A.Symptomsresolvein10-12days
1614.NerveinjuredinMcRobertsmaneuveris?
a)Lumbosacraltrunk
b)Obturatornerve
c)Femoralnerve
d)Pudendalnerve
CorrectAnswer-CAns,C.FemoralnerveMcRobertsmaneuveristobedoneincasesofshoulderdystocia.Whenthematernalthighsaremarkedlyflexedandabducted,pressurefromtheoverlyinginguinaliigamentmayleadtofemoralnerveinjury.
1615.Mostconclusiveclinicalsignofpregnancyis?
a)Uterineenlargement
b)Cervicalsoftening
c)Amenorrhea
d)Fetalheatsoundauscultation
CorrectAnswer-DAns.D.FetalheatsoundauscultationFHSauscultationisthemostconclusiveclinicalsignofpregnancy.
1616.CRLwhencardiacactivitycanbedetectedearliestbyTVS-
a)1-4mm
b)1cm
c)6-7mm
d)2-4cm
CorrectAnswer-AAns,A.1-4mmFetalheartbeatcanbedetectedasearlyasjustunder6weeksgestationongoodquality,highfrequencytransvaginalultrasound,asacrownrumplength(CRL)ofaslittleas1-2mm.
1617.Kamla,30yearsold,P2L2with3.2x4.1cmfibroiduterus,complainsofmenorrhagiaandisonsymptomatictreatmentsince6months.Thepatientrefusessurgery.Nextlineofmanagementis?
a)GnRHanalogs
b)Danazol
c)Myomectomy
d)Uterinearteryembolization
CorrectAnswer-DAns,D.UterinearteryembolizationUAEcanbeusedasatherapyforsymptomaticpatientswhorefuseorwanttoavoidsurgery.Afterembolization,thereis60-65%decreaseinsizeoffibroidsoveraperiodof6-9months,andsothepatient'ssymPtomsmaydecreaseordisaPPear.Ifthepatientisstillsymptomaticafter1year,thensurgeryshouldbeconsidered.
1618.Livingligatureoftheuterusis?
a)Endometrium
b)Middlelayerofmyometrium
c)Innerlayerofmyometrium
d)Parametrium
CorrectAnswer-BAns,B.MiddlelayerofmyometriumMiddlecrisscrossfibresactaslivingligatureduringinvolutionoftheuterusandpreventbloodloss.
1619.Inpartogramsrecommendedby'WHO'thedistancebetweenthealertandactionlinesis?
a)1hour
b)2hours
c)4hours
d)5hours
CorrectAnswer-CAns.C.4hoursTheconceptofalertline'and‘actionline’wasintroducedbyPhilpottandCastlein1972.Theactionlinecanbeplacedat2–4hoursintervaltotherightandparalleltoalertline.Inpartogramsrecommendedby'WH0'thedistancebetweenthealertandactionlinesis4hours.
1620.Surgicalexcisionofcorpusluteumbeforeweeksofgestation,resultsinmiscarriage
a)6-7
b)9-11
c)11-12
d)12-14
CorrectAnswer-AAns,A,6-7Surgicalexcisionofcorpusluteum(luteoctomy)before7weeksofgestation,uniformlyprecipitatedanabruptdecreaseinserumprogesteroneconcentrationfollowedbymiscarriage
1621.FactorsresponsiblefordevelopmentofOHSSinclude?
a)Histamine
b)Cytokines
c)VascularEndothelialGrowthFactor
d)Alloftheabove
CorrectAnswer-DAns,D.AlloftheaboveVEGFisconsideredtobethemostimportant.
1622.MVAsyringeisusedfor?
a)FirsttrimesterMTP
b)2ndtrimesterMTP
c)Vacuumdelivery
d)Alloftheabove
CorrectAnswer-AAns,A,FirsttrimesterMTPManualvacuumaspiration(MvA)isasafeandeffectivemethodofabortionthatinvolvesevacuationoftheuterinecontentsbytheuseofahand-heldplasticaspirator.Itisappropriatefortreatmentofincompleteabortionforuterinesizesupto12weeksfromthelastmenstrualperiod(includingmiscarriage,spontaneousabortionandremovalofretainedproductsfromaninducedabortion),first-trimesterMTPandendometrialbiopsy.
1623.Diihrssenincisionistakenon-
a)Fallopiantube
b)Ovary
c)Incompletelydilatedcervix
d)Fullydilatedcervix
CorrectAnswer-CAns,C,IncompletelydilatedcervixOccasionallnespeciallywithsmallpretermfetuses,theincompletelydilatedcervixwillnotallowvaginaldeliveryoftheafter-comingheadofthebreech.Insuchcases,Duhrssenincisionsareusuallynecessary(cutthecervixatl0and2o'clockpositions).
1624.A27-year-oldfemalewithplacentapreviahadseverebleeding.Whatisthemostlikelyoutcomepostdelivery?
a)Galactorrhea
b)Diabetes
c)Absenceofmenstrualcycle
d)Cushingsyndrome
CorrectAnswer-CAns.c.AbsenceofmenstrualcycleSheehansyndrome,alsoknownaspostpartumhypopituitarismorpostpartumpituitarynecrosis,ishypopituitarismcausedbynecrosisduetobloodlossandhypovolemicshockduringandafterchildbirth.MostcommoninitialsymptomsofSheehansyndromeareagalactorrhea(absenceoflactation)underdifficultieswithlactation.Manywomenalsoreportamenorrheaoroligomenorrheaafterdelivery.
1625.Womanhas100mlbloodlossevery30days.Thisiscalledas?
a)Menorrhagia
b)Polymenorrhea
c)Hypomenorrhea
d)Normalmenses
CorrectAnswer-AAns.A.MenorrhagiaNormalbloodlossduringmensesisaround35ml(20-80ml)Bloodlossmorethan80mlismenorrhagia
1626.Menometrorrhagiais?
a)Heavyperiods
b)Intermenstrualbleeding
c)Heavy&irregularbleeding
d)Uterinebleedingoccurringatregularintervalsoflessthan21days
CorrectAnswer-CAns.C.Heavy&irregularbleeding
1627.Prevalenceofbreechpresentationatfulltermis?
a)10%
b)6-7%
c)3-4%
d)1-2%
CorrectAnswer-CAns.C.3-4%
1628.Theshortestconjugateis?
a)Trueconjugate
b)Obstetricconjugate
c)Diagonalconjugate
d)Anatomicalconjugate
CorrectAnswer-BAns.B.ObstetricconjugateObstetricconjugate(10cm)DistancebetweenmidpointofsacralPromontorytotheprominentbonyprojectioninthemidlineoninnersurfaceofsymphysispubis.
1629.Shortesttransversediameteris?
a)BPD
b)Bitemporaldiameter
c)Bimastoiddiameter
d)Allareequalinlength
CorrectAnswer-CAns.C.BimastoiddiameterBimastoiddiameter=7.5cmOccipitofrontaldiameter→11.5cm
1630.Withreferencetofetalheartrate,anonstresstestisconsideredreactivewhen?
a)Twofetalheartrateaccelerationsarenotedin20minutes
b)Onefetalheartrateaccelerationisnotedin20minutes
c)Twofetalheartrateaccelerationsarenotedin10minutes
d)Threefetalheartrateaccelerationsarenotedin30minutes
CorrectAnswer-AAns.A.Twofetalheartrateaccelerationsarenotedin20minutesReactive(Reassuring)NSTTwoormoreaccelerationsof>15beats/minuteabovethebaseline,lastingfor>75secondsarcpresentin20-4Ominutesobservationperiod.
1631.Variabledecelerationisseenin?
a)Headcompression
b)Uteroplacentalinsufficiency
c)Cordcompression
d)Noneoftheabove
CorrectAnswer-CAns,C.CordcompressionVariabledecelerationsareduetocordcompression(oligohydramniosinlabor)
1632.ModifiedBIOPHYSICALPROFILEis?
a)NST+FETALTONE
b)FETALTONE+AFI
c)NST+AFI
d)NST+FETALTONE+AFI
CorrectAnswer-CAns,C.NST+AFIModifiedBPP=NST&AFIBPPhas5components
1633.Iffetusishavinghypoxia,whichoftheBPPparameterwillbeaffectedlast?
a)Fetaltone
b)Fetalbreathingmovement
c)Fetalmovements
d)NST
CorrectAnswer-AAns.A.FetaltoneFirstactivitytoappear,FetalToneatabout7.5-8.5weeks,isalsopresumablythelastactivitytodisappearwithprogressivelyworseninghypoxia.
1634.Testusedtodetectgeneticabnormalityinembryo,beforetransferringittothe
uterusinIVFis?
a)Embryocellbiopsy
b)CVS
c)ICSI
d)Alloftheabove
CorrectAnswer-AAns,A.EmbryocellbiopsyPGD,involvesremovingacellfromanIVFembryototestitforaspecificgeneticcondition(cysticfibrosis'forexample)beforetransferringtheembryototheuterus.
1635.InIVF,embryosaretransferredbacktouterinecavityatcellsstage?
a)2
b)2-4
c)4-8
d)8-16
CorrectAnswer-CAns,C.4-8Typicallyembryosatetransferredatthecleavagestage(Day2or3afteroocyteretrieval).Daythreeembryosatecalledcleavagestageembryosandhaveapproximately4-8cells.
1636.Azoospermicpatientcanbeafatherofachild,bywhichofthefollowing?
a)IUI
b)ZIFT
c)ICSI
d)Notpossible&counselregardingadoption
CorrectAnswer-CAns.C.ICSIPESA=percutaneousepididymalspermaspirationMESA=microscopicepididymalspermaspirationTESA=testicularspermasPirationTESE=testicularspermextraction(testicularbiopsy)
1637.Aprimigravidawith36weeksofpregnancyisinlaborwith3cmdilatationandminimaluterinecontraction.Onruptureofmembranes,freshbleedingisnotedwithlatefetaldecelerationupto50beats/min.ThepatientwastakenforLSCSbutfetuscouldnobesaved.Noabruptioorplacentapreviawasseen.Thelikelydiagnosisis?
a)Placentaprevia
b)Revealedabruptio
c)Circumvallateplacenta
d)Vasaprevia
CorrectAnswer-DAns.D.VasapreviaVasaprevia(l:2500)isarareconditioninwhichfetalbloodvesselsareinfrontofthepresentingpartandcrossthecervix.Theconditionhasahighfetalmortalityrate(50-95%).Thisisattributedtorapidfetalexsanguination,resultingfromthevesselstearingwhenthecervixdilates,membraneruPture.
1638.AllarecomponentsofActiveManagementoftheThirdStageofLaborexcept?
a)Uterotonicagentwithin1minuteofbirth
b)Massageofuterusbeforecontrolcordtraction
c)Controlcordtraction
d)Noneoftheabove
CorrectAnswer-BAns.B.MassageofuterusbeforecontrolcordtractionAdministeranuterotonicdrugatthedeliveryoftheanteriorshoulderorafterwards,withinoneminuteofthebaby'sbirth.BeforeperformingAMTSL,gentlypalpatethewoman'sabdomentoruleoutthepresenceofanotherbaby.Atthispoint,donotmassagetheuterus.PerformcontrolledcordtractionMassagetheuterusimmediately
1639.Withwhichofthefollowingevents,thefetomaternalhaemorrhageriskistheleast?
a)Amniocentesis
b)Cordocentrsis
c)Chorionicvillussampling
d)Abruption
CorrectAnswer-DAns.D.Abruption
1640.Infertilityisdefinedas?
a)Inabilitytoconceiveafter1yearofregularunprotectedintercourse
b)Inabilitytoconceiveafter1yearofmarriage
c)Inabilitytoconceiveafter2yearsofmarriage
d)Inabilitytoconceiveinspiteof2yearsofregularunprotectedintercourse
CorrectAnswer-AANS.A.Inabilitytoconceiveafter1yearofregularunprotectedintercourseInfertilityisdefinedasaninabilitytoconceiveinspiteof1yearofregularunprotectedintercourse
1641.Cordprolapseisleastlikelywith-
a)Transverselie
b)Footlingbreech
c)Oligohydroamnios
d)Floatinghead
CorrectAnswer-CAns.C.OligohydroamniosCordprolapsehasbeendefinedasthedescentoftheumbilicalcordthroughthecervixalongside(occult)orpastthepresentingpart(overt)inthevaginaoroutsidethevulvainthepresenceofrupturedmembranes
1642. IdealtimetodoGlucosechallengetestinpregnancyis?
a)12-16weeks
b)20-24weeks
c)24-28weeks
d)30-34weeks
CorrectAnswer-CAns.C.24-28weeksO'sullivanBloodSugarScreeningTest(GlucoseChallengeTest)Theidealtimetodothistestis24-28weeksofgestation(asinsulinresistanceinpregnancyismaximumat28weeksofgestation)
1643.AfterIUFD,whendoesthemotherdevelopDIC-
a)48hours
b)1-2weeks
c)3-4weeks
d)6weeks
CorrectAnswer-CAns.C.3-4weeksThromboplastinfromthedeadfetuscanenterthematernalsystemandcauseDIC.Thisonlyhappenswhenthedeadfetusisretainedinsidefor3-4weeks.
1644.Folicacidrequiredinfirsttrimesterofnormalpregnancy-
a)100microgram
b)400-500microgram
c)4mg
d)5mg
CorrectAnswer-BAns,B,400-500microgramSomeNTDsareassociatedwithaspecificmutationinthemethylenetetrahydrofolatereductasegene,theadverseeffectsofwhichcanbelargelyovercomebypericonceptionalfolicacidsupplementation.MorethanhalfofNTDscouldbepreventedwithdailyintakeof400microgramoffolicacidthroughoutthepericonceptionalperiod.Awomanwithapriorpregnancycomplicatedbyaneuraltubedefectcanreducethe23%recurrenceriskbymorethan70%ifshetakes4mgoffolicacidforthemonthbeforeconceptionandforthefirsttrimesterofpregnancy.
1645.A30-year-oldis14weekspregnant.Shehadtwopainlessdeliveriesat16weeksearlier.Nextlineofmanagementis?
a)Cervicalencerclage
b)Evaluationfordiabetesmellitusandthyroiddisorders
c)Cervicallengthassessment
d)Tocolytics
CorrectAnswer-CAns,C.CervicallengthassessmentThepatienthadtwopainlessabortionsat16weeksinthepast,somostlyitisacaseofincompetentos.Nextlineofmanagementinthesepatientsisfrequentcervicallengthassessment:clinicallyorbyUSG.Thepatientisevaluatedmorefrequentlyandifthecervixisshort(lessthan2.5cm)thancervicalencerclagehastobedone.Cervicalencerclageisthesurgeryofchoiceforincompetentos,butthesurgeryitselfcanleadtocomplicationssuchasuterinecontractions,abortions,andPROM.Sothesurgeryisonlytobedoneifitisindicated.
1646.Uppertwo-thirdanteriorvaginalwallprolapseis?
a)Cystocele
b)Urethrocele
c)Rectocele
d)Enterocele
CorrectAnswer-AAns.A.Cystocele
1647.EarliestsignafterIUFDis?
a)Overlappingofskullbones
b)Hyperflexionofspine
c)Gasingreatvessel
d)Overcrowdingofribs
CorrectAnswer-CAns.C.GasingreatvesselRobertsign(gasingreatvessels)-12hrsafterdeath.
1648.TrueaboutGartnerscystis?
a)RetentioncystinremnantsofWolffianduct
b)Arisesfrommullerianduct
c)Commonlyarisesfromcervix
d)Impulseoncoughing
CorrectAnswer-AAns,A.RetentioncystinremnantsofWolffianduct
1649.Iftheanalspincterisinjured,itiswhichdegreeofPerinealTear?
a)First
b)Second
c)Third
d)Fourth
CorrectAnswer-CAns,C.ThirdPerinealTearsareclassifiedintofourcategoriesFirst-degreetear:lacerationislimitedtothefourchetteandsuperficialperinealskinorvaginalmucosa.Second-degreetear:lacerationextendsbeyondfourchette,perinealskinandvaginalmucosatoperinealmusclesandfascia,butnottheanalsphincter.Third-degreetear:fourchette,perinealskin,vaginalmucosa,muscles,andanalsphincteraretorn
1650.Iftherectalmucosaisinjured,itiswhichdegreeofPerinealTear?
a)First
b)Second
c)Third
d)Fourth
CorrectAnswer-DAns,D.FourthRectalmucosaltearisfourthdegreetear.
1651.Cryptomenorrheaoccursin?
a)Fibroids
b)PCOS
c)Imperforatehymen
d)Alloftheabove
CorrectAnswer-CAns,C.ImperforatehymenCongenitalImperforatehymen:ItisduetofailureofdisintegrationofthecentralcellsofMullerianeminencethatprojectintourogenitalsinusTransversevaginalsePtumAtresiaofvagina,cervix.
1652.Bestindicatorforovarianreserveis?
a)AMH
b)LH/FSHratio
c)FSH
d)Estradiol
CorrectAnswer-AAns.A.AMHAMHbloodlevelsarethoughttoreflectthesizeoftheremainingeggsupplyor“ovarianreserve"
1653.HPLhasactivitysimilartowhichhormone?
a)Oxytocin
b)Growthhormone
c)Insulin
d)Alloftheabove
CorrectAnswer-BAns.B.GrowthhormoneHumanplacentalactogen(hPL)wasnamedso,becauseofitspotentlactogenic&growthhormonelikebioactivityaswellasimmunochemicalresemblancetohumangrowthhormone'
1654.WhichofthefollowingisnotasofttissuemarkerofDownsyndromeonUSG?
a)IncreaseNT
b)Absentnasalbone
c)Exomphalos
d)Polydactyly
CorrectAnswer-DAns.D.Polydactyly
1655.Inacaseofrecurrentspontaneousabortionthefollowinginvestigationisunwanted?
a)Hysteroscopy
b)Testingforantiphospholipidantibodies
c)TestingforTORCHinfections
d)Thyroidfunctiontests
CorrectAnswer-CAns.C.TestingforTORCHinfectionsTestingforTORCHinfectionsisnowthoughttobeunwarranted.
1656.Dilatation&evacuationisdoneforallecxept?
a)Inevitableabortion
b)Incompleteabortion
c)Threatenedabortion
d)Noneoftheabove
CorrectAnswer-CAns.C.ThreatenedabortionInevitableabortionmeanstheprocessofexpulsionofproductsofconceptionhasbecomeirreversible.Theexpulsionofproductsofconceptionhasnotoccurredbutitisboundtohappenandnothingcanbedonetostopthisprocess.Whentheentireproductsarenotexpelled,partofitisleftinsidetheuterinecavity,itiscalledincompleteabortion.
1657.WHOnormalHbvalueforanonpregnantadultfemaleis?
a)10gm/di
b)11gm/dl
c)12gm/dl
d)13gm/dl
CorrectAnswer-CAns.C.12gm/dl
1658.Whichofthefollowingepidermallayerisdeadlayer?
a)Stratumbasale
b)Stratumspinosum
c)Stratumcorneum
d)Stratumgranulosum
CorrectAnswer-CAns.C.StratumcorneumStratumcorneum(Hornylayer):Thisisthemostsuperficiallayerofepidermisandskin.Cellsarefullykeratinizedandendupasanucleatedeadcells.Therefore,stratumcorneumisdeadlayer.Stratumcorneumislasttodevelop4Thereforeinprematurenewbornitisabsent.
1659.Langerhanscellareseeninwhichlayerofskin?
a)Stratumbasal
b)Stratumcarneum
c)Stratumgranulosum
d)Stratumspinosum
CorrectAnswer-DAns.D.Stratumspinosum[RefVenkataram151/ep.2]LangerhanscellsThesecellsarefoundinstratumspinosumandfunctionasepidermalmacrophages(Antigenpresentingcells).Thesecellscontaincharacteristictennisracquetshapedgranules(Birbeckgranules).
1660.Increaseinthethicknessofthepricklecelllayeroftheepidermisiscalled?
a)Spongiosis
b)Acanthosis
c)Hypergranulosis
d)Hyperkeratosis
CorrectAnswer-BAns.B.Acanthosis[RefRook's7th/ep.7.36]ImportantterminologyrelatedtoepidermallayersSeparationofkeratinocytesduetolossofintracellularbridges-AcantholysisIntracellularedemaofkeratinocytesBallooning
1661.Substancecommoninskinandhairis?
a)Keratin
b)Laminin
c)Nectin
d)Vimentin
CorrectAnswer-AAns.A.Keratin[Ref:IADVL3rd/ep.12]Keratinisafamilyoffibrousstructuralproteins.Keratinistheproteinthatprotectsepithelialcellsfromdamageorstress.Keratinisthekeycomponentofourskin,hairandnails.Itsproteinbuildingblockshaveaminoacidchains,coiled,cross-linkedandclassifiedaseitherhardorsoft.
1662.Whichofthefollowingisamelanisingagent?
a)Methoxsalen
b)Dapsone
c)Minocycline
d)Kojicacid
CorrectAnswer-AAns.A.Methoxsalen[RefInternet&IADVL3'/ep.756]Melanizingagentsaredrugsthatincreasesensitivitytosolarradiationandpromotere-pigmentationofde-pigmentedareasofskin.Melanizingagentssensitizetheskintosunlight.Asaresult,erythema,inflammationandpigmentationoccurs.
1663.Fordycespotsinvolve?
a)Penis
b)Tongue
c)Fingers
d)Nails
CorrectAnswer-AAns.A.Penis[RefIADVL3"1/ep.1779]Fordycespots(FordycegranulesorFordycedisease):Fordyce'sspotrepresentsectopicsebaceousglandsonlips(mostcommonsite)andoralmucosa.Theymayalsoappearonvulvaandpenis,wheretheyarecalledTyson'sgland,i.e.,ectopicsebaceousglandatpenis(prepuce)andvulvaiscalledtyson'sgland.Theseglandshavehistopathologysimilartonormalsebaceousglands,despitetheirectopiclocation.
1664.Mostcommonetiologyoferythemamultiformeis?
a)Idiopathic
b)Drugs
c)HSV
d)TB
CorrectAnswer-AAns.A.Idiopathic[Ref:NeenaKhannaYalep.61,63]ErythemamultiformeMostofthecasesoferythemamultiformeareidiopathic,butamongstthecausativeagentsHerpessimplexvirusisthemostimportantcause.Erythemamultiformeisanacute,oftenselflimitederutptioncharacterizedbyadistinctiveclinicaleruption,thehallmarkofwhichistheTargetlesion(IrislesionorBulle'seyelesion).
1665.Hypopigmentedmaculesarefoundin?
a)Addison'sdisease
b)Porphyria
c)Cutaneousmastocytosis
d)Tuberoussclerosis
CorrectAnswer-DAns.D.Tuberoussclerosis[RefRook's7th/ep.17.37-17,39.58-39.59;Behl10thiep.154]Causesoflocalizedhypopigmentation(Macule/Patch):PrimaryCutaneousdisorders:VitiligoPityriasisversicolorPityriasisalbaPostinflammatoryNevusdepigmentosus(achromicus)NevusanemicusPiebaldismChemicalleukodermaIdiopathicguttateHypomelanosisSystemicdiseases:SclerodermaTuberoussclerosisSarcoidosisCutaneousT-celllymphomaLeprosy(tuberculoid&Indeterminate)OnchocerciasisHypomelanosisofItoIncontinetiapigmenti(StageIV)
Vogt-Koyangi-Haradadisease
1666.Whichofthefollowingdiseaseiscloselyrelatedtoenetropathy?
a)LinearIgAdisease
b)Pemphigusfoliaceous
c)Dermatitisherpetiformis
d)Erythemamultiforme
CorrectAnswer-CAns.C.Dermatitisherpetiformis[Ref:Behl10m/ep.293]DermatitisherpetiformisisadiseaseoftheskincausedbythedepositionofIgAinpapillarydermisandalongtheepidermalbasementmembranezone(Dermoepidermaljunction).Almostallpatientsofdermatitisherpetiformishaveanassociatedglutensensitiveenteropathy.
1667.ResidualHypopigmentationfollowingadrugreaction,isbestknownas?
a)Vitiligo
b)Chemicalleukoderma
c)Postinflammatoryhypomelanosis
d)Piebaldism
CorrectAnswer-CAns.C.Postinflammatoryhypomelanosis[RefIADVL3"1/ep.747-748]Amonggivenoptions,postinflammatoryhypomelanosisisthebestanswer.understandletushavealookatthedefinitionfewimportantterms.Vitiligoisalsoanacquiredconditionwithlossofpigmentationbutmostcasesareidiopathic.Itismainlyconsideredtobeanautoimmunecondition.Precipitatedbyhormonalchanges,acuteemotionaltraumaorstressoranyconditionleadingtoimmuneimbalance.So,anyhypomelanosisresultingafterinflammationisknownaspostinflammatoryhypomelanosis(includingleucoderma).Sometimesboththetermsareusedsynonymously.Whereastheterm'chemicalleucoderma'isusedonlywhenthererepeatedexposure(contact)tosomespecificchemical.Thereforeamonggivenoptions,postinflammatoryhypomelanosisisthebestanswerasdrugreactionisaninflammatoryconditionleadingtoresidualhypopigmentation.
1668.Mostcommonpatternofonychomycosisis?
a)Distalandlateralsubungual
b)Proximalsubungual
c)Whitesuperficial
d)Totaldystrophic
CorrectAnswer-AAns.A.Distalandlateralsubungual[RefIADVL3fli/ep.266]Distalandlateralsubungual:DSOisthemostcommonform(90%)ofonychomycosis.CharacterizedbyinvasionofthenailbedandundersideofthenailplatebeginningatthehyponychiumandmigratesproximallythroughtheunderlyingnailmatrixDSOisusuallycausedbythedermatophyteT.rubrum.Infectionofthetoenailsbeingmuchmorecommonthaninfectionofthefingernails
1669.Whichofthefollowingisnotafeatureofdermatomyositis?
a)'V'sign
b)Holstersign
c)Pokiloderma
d)Groovesign
CorrectAnswer-DAns.D.Groovesign[Ref:Rooks7th/ep.127-38;IADVL3'/ep.1236]Groovesign(adepressionalongthecourseofaveinorbetweenmusclegroups)isseenindeepmorphea.Cutaneoussignsoddermatomyositis
1. Gottron'spapules:lilacorviolaceouspapulesonknucklesanddorsaofhands
2. Gottron'ssign:violaceouserythemawithedemaovershoulders,armsandforearms
3. Heliotropesign:violaceouserythemawithedemaovereyelids,periorbitalregion
4. Poikiloderma:atrophyofskin,hypopigmentation,dialaltedbloodvesselsovertrunk
5. Mechanichand:symmetricalhyperkeratosisonulnaraspectofthumbandradialaspectoffingers
6. Shawlsign:violaceouserythemaextendingfromdorsolateralaspectofhands,forearmsandarmstoshouldersandneck.
7. 'V'sign:violaceouserythemainaVshapeddistributionoveranteriorneckandchest.
8. Holstersign:b/1symmetrical,patchymacularviolaceouserythemadisplayibgareticuloidorlevidoidarrayoverthelateralaspectof
upperthighandhips.9. Calcinosiscutis:calciumdepositsinskin(injuvenilevariant)10. Miscellaneoussigns:Photosensitivity,vasculitis,panniculitis,Nail-
foldtelangiectasia
1670.Notafeatureofcandidalintertrigois?
a)Obesityisariskfactor
b)C.albicansisthemostcommoncausativespecies
c)Centralscaling
d)Satellitelesions
CorrectAnswer-CAns.C.Centralscaling[RefNeenaKhanna's4th/ep.294]CandidalintertrigoInfectionofskinfoldsiscalledcandidalintertrigo.Itischaracterizedbyreddened(erythematous)plaques,withsatellitepustules(peripheralpustules).Theremaybefinescalesatperiphery.Overtheregionscoveredwiththickstratumcorneum,i.e.,toewebsandFingerwebs,thelesionappearasmoist,whitecoloredplaques.Virtuallyanybodyfoldmaybeaffected.Groins,axillae,submammaryfoldsinfemales,toes&fingerwebsarecommonsitesofaffection.Lesionspersistingforalongtimeleadtothedevelopmentofsuperficialpainfulerosionsthattakealongerperiodtoheal.Thisiscalled"erythemaoflacquer.
1671.Scalingisnotfeatureofwhichofthefollowing?
a)Tinea
b)Lichenplanus
c)Herpeszoster
d)Reiter'sdisease
CorrectAnswer-CAns.C.Herpeszoster[RefBeh110th/ep.254-268;NeenaKhanna3"Yep.37]Inherpesthereiscrustingbutnoscaling.Papulo-squamousdisordershavefollowingtwocharacteristics:-Papule(solidelevatedskinlesion<1cms)orplaques(solidelevatedlesion>1cm).ii)Scales(visibleexfoliationoftheskinwhichrepresntsvisiblesheddingofskin)."Papulosquamousdisordersmanifestpapulessurmountedbyscales".
1672.A40yearsoldmalepatientpresentswithmultipleerythematousannularlesionswithperipheralscalesarrangedpredominantlyontrunk.Treatmentofchoiceis?
a)Topicalsteroids
b)Systemicsteroids
c)SystemicAzathioprine
d)Topicalantifungal
CorrectAnswer-AAns.A.Topicalsteroids[Ref:Beh110`Vep.263]PityriasisrubrapilarisClinicalpresentationofthepatientinquestionsuggeststhediagnosisofPRPforwhichtreatmentofchoiceistopicalsteroidsandsalicylicacid.TreatmentLocalizedlesions-Topicalcorticosteroids+Keratolytics(Salicylicacid,urea)Erythroderma-VitaminA,Acitretin(Retinoids),oralmethotrexate.
1673.Woronoff'sringisafeatureof?
a)Psoriasis
b)Lichenplanus
c)Pityriasisrosea
d)Pemphigus
CorrectAnswer-AAns.A.Psoriasis[RefRooks7"Vep.35.1-35.63]ClinicalfeaturesofPsoriasis(psoriasisvulgaris)Psoriasisoccursatallages,mostpatientsareyoungormiddleagedadults.Thetypicallesionisnummularroundplaquewhichhasfollowingcharacteristicfeatures:WelldefinedProfuse,silverywhite,powderyscales(Candledropscales)-Loselyadherentandeasilydrops.Brightrederythmatousbase.PlaqueisoftensurroundedbyahypopigmentedhaloRingofWoronoff.
1674.MostimportantfactorincausationofIngrowntoenailis?
a)Fungalinfection
b)Illfittingshoes
c)Geneticpredisposition
d)Nutritionaldeficiency
CorrectAnswer-BAns.B.IllfittingshoesIll-fittingshoes:Ingrowntoenail(unguisincarnates/onychocryptosis)Itisacommonpainfulconditioninwhichthenailgrowssothatitcutsintooneorbothsidesoftheparonychiumornailbed.Whileingrownnailscanoccurinthenailsofboththehandsandthefeet,theyoccurmostcommonlywiththetoenails.Presentswithpain,tenderness,rednessandswellingalongoneorbothsidesoftheaffectednail.
1675.Whichofthefollowingisnotafeatureoflichenplanus?
a)Pterygium
b)Spontaneoushealing
c)Scarringalopecia
d)Notpremalignant
CorrectAnswer-DAns.D.Notpremalignant[RefBehl/ep.265;Rooks7th/ep.5.13]Veryrarelychroniculcerativelesionsmaydevelopmalignantchanges,i.e.,squamouscellcarcinoma.Clinicalfeaturesoflichenplanus.
1676.Whichofthefollowingisnottrueforscabies?
a)Wristiscommonsiteinchildren
b)Burrowsareintradermallesions
c)Papulesandpustulesareduetohypersensitivitytomite
d)Itchinggeneralized
CorrectAnswer-BAns.B.Burrowsareintradermallesions[RefBehl10th/ep.179]Burrowistheserpentine(S-shaped),threadlikegray-brownlinewhichrepresenttheintraepidermaltunnelcreatedbythemovingfemalemiteinstratumcorneum.BurrowisPathognomicofscabies.Burrowsaredifficulttodemonstrateininfant.Clinicalfeaturesofscabies1.Severeitchingisthemostprominentsymptom,andhasfollowingcharacteristicfeatures:WorseatnightGeneralizedAffectingseveralfamilymembers2.InScabies,severeitchingtypicallyworsenatnight,mostnotablyalongthewebspacesoffingers,wrists,elbows,axillaeandgroinarea-AreasknowascircleofHebra.3.Papulesandpapulovesiclesduetohypersensitivitytomite.4.Pustulescanoccurduetosecondaryinfection.5.Excoriationandscratchmarks.6.Historyofinvolvementoffamilymember
1677.Scabiesiscausedby?
a)Mite
b)Tic
c)Virus
d)Fungus
CorrectAnswer-AAns.A.Mite[RefBehl10thiep.179]ScabiesisanintenslypruriticskininfestationcausedbySarcoptesscabiei,anacarus(mite).Scabiesusuallyaffectschildrenbutcanoccuratanyage.Morecommoninlowsocioeconomicstrataasovercrowdingandpoorhygienefacilitatetransmission.Themostimportantmeansoftransmissionisviadirectcontactwithaninfectedindividual.Scabesisawaterwasheddiseasewhichoccursduetoinadequateuseofwaterorimproperhygiene.
1678.Seleniumsulphideisusedinthetreatmentof?
a)Scabies
b)T.versicolor
c)T.cruris
d)Cutaneousleishmaniasis
CorrectAnswer-BAns.B.T.versicolor[RefHarrison17th/ep.318]Seleniumsulphide(2.5%)indetergentbaseisappliedalloverbodybelowneck(sparingthegenitalia),leftovernightandwashedofnextmorning.Twotothreeapplicationsappliedonceortwiceaweekusuallyclearstheinfection.TreatmentofP.versicolor
1. Systemicagents:-azolessuchasketoconazole,fluconazoleoritraconazole.
2. Topicalagents:3. Azoles-clotrimazole,econazole,miconazole,ketoconazole.4. Others-seleniumsulfide(2.5%),sodiumthiosulphate(20%),
whitfield'sointment(3%Salicylicacid+6%Benzoicacid),zincpyrithione(1%),tolnaftate,ciclopiroxolamine.
1679.Firstgenerationtopicalretinoidis?
a)Retinoicacid
b)Adapalene
c)Tazarotene
d)Acitretin
CorrectAnswer-AAns.A.Retinoicacid[RefComprehensivedermatologicaldrugtherapyp.254&internet]RetinoidsTheretinoidscompriseaclassofchemicalcompoundsthatarevitamersofvitaminAorarechemicallyrelatedtoit.Retinoidshavefounduseinmedicinewheretheyregulateepithelialcellgrowth.Retinoidshavemanyimportantfunctionsthroughoutthebodyincludingrolesinvision,regulationofcellproliferationanddifferentiation,growthofbonetissue,immunefunction,andactivationoftumorsuppressorgenes.
1680.Treatmentforimpetigoincludesallexcept?
a)Topicalmupirocin
b)Systemicerythromycin
c)Topicalgentamycin
d)Systemiccephalosporins
CorrectAnswer-CAns.C.Topicalgentamycin[RefIADVL3rd/ep.235]*"Topicaluseofgentamycinshouldbeavoidedasgentamycinresistancecandevelopanditcanbetransferredbetweendifferentspeciesandstrainsofstaphylococcus."Treatmentofimpetigo*Impetigocontagiosum-Localized4Topicalantibioticslikefusidicacidormupirocin-Extensive-Systemicantibiotics(erythromycingrouptocoverstaphylococcusandstreptococcus).-Ifresponseispoor,oxacillin-Clavulanicacidorcephalexincanbetried.BullousImpetigo*Localized→Topicalfusidicacidormupirocin*Extensive4Systemicantistaphylococcalantibiotics(flucloxacillin,amoxicillin-clavulanicacid,methicillinorerythromycin)
1681.Jockitchiscausedby?
a)Epidermophytonfloccosum
b)Candidaalbicans
c)Trichophytontonsurans
d)Malasseziafurfur
CorrectAnswer-AAns.A.Epidermophytonfloccosum[RefNeenaKhanna3rd/ep.242-244]Tineacruris(Jockitch):ItisalsoknownasDhobi'sitch.Tineacrusisisdermatophyticinfectionofthegroinandadjacentskin.Theclassicalappearanceoftineacrurisisred(erythematous)scalylesionwithclearcentre.Marginsarewelldefinedwithraisedborders.Itchingisveryprominent.Themostcommonsitesofinvolvementaregenitalareaandmedialaspectofupperthigh(Mostcommonsiteofdermatophytosisinmales).Tcrurisusuallyaffectyoungadultmale.InIndiatrichophytonrubrumisthemostcommoncauseandinwesterncountriesepidermophytonfloccosumisthemostcommoncause.
1682.Resorcinolisusedinthetreatmentof?
a)Lichenplanus
b)Acne
c)Vitiligo
d)Scabies
CorrectAnswer-BAns.B.Acne[RefContactandoccupationaldermatologyp.195]Resorcinolisincludedinmanyantisepticandkeratolytictopicalmedications.Usesincludepsoriasis,hidradenitissuppurativa,eczema,acne,seborrhea,corns,calluses,warts,andotherskindisorders.
1683.Hertoghe'ssignisseenin?
a)Atopicdermatitis
b)CutaneousTB
c)Lichenplanus
d)Psoriasis
CorrectAnswer-AAns.A.Atopicdermatitis[RefIndianDermatolOnlineJ.2012Sep-Dec;3(3):159-165.doi:10.4103/2229-5178.101810]TheSignofHertogheorQueenAnne'ssignisathinningorlossoftheouterthirdoftheeyebrows(superciliarymadarosis).Itisaclassicalsignofhypothyroidismoratopicdermatitis.Itcanalsobeseeninleprosy,myxedema,follicularmucinosis,trichotillomania,ectodermaldysplasia,discoidlupuserythematosus,alopeciaareata,syphilis,ulerythemaophryogenes,systemicsclerosisandHIVinfection.
1684.Preferredconcentrationofminoxidilforfemaleandrogeneticalopeciais?
a)2%
b)5%
c)8%
d)10%
CorrectAnswer-AAns.A.2%[RefIADVL3'/ep.891]Infemaleandrogenicalopeciaresultsaresimilarwith2%and5%minoxidilbutsideeffectsaremorewith5%solution.Whereasinmales5%ismoreefficacious.Thereforeinafemalepatient2%minoxidilispreferredwhereasinmales5%solutionisthepreferredchoice.
1685.Normalepidermalturnovertimeis?
a)1week
b)2weeks
c)3weeks
d)4weeks
CorrectAnswer-CAns.C.3weeks[Ref:NeenaKhanna3rdlep.297;Roxburgh's7th/ep.62]TreatmentofscabiesinchildrenTopicalpermethrin(5%cream)isasafeandeffectivescabicideinchildren.Itisrecommendedasafirst-linetherapyforpatientsolderthan2monthsofage.Becausetherearetheoreticalconcernsregardingpercutaneousabsorptionofpermethrinininfantsyoungerthan2monthsofage,guidelinesrecommend7%sulfurpreparationinsteadofpermethrin.
1686.Treatmentofchoiceforscabiesinaninfant<6monthsis?
a)BHC
b)Ivermactin
c)Permathrin
d)Crotomiton
CorrectAnswer-DAns.D.Crotomiton[Ref:NeenaKhanna3rdlep.297]Ivermectinistheonlyoraldrug,availableforscabiestreatment.
1687.Oraltreatmentofchoiceforscabiesis?
a)Albendazole
b)Itraconazole
c)Sulphur
d)Ivermactin
CorrectAnswer-DAns.D.Ivermactin[RefBehl10th/ep.406;NeenaKhanna3rd/ep.50,51]Pityriasisrosea:P.roseaisselflimitingdisease,subsideswith6-12weeks.P.roseaisacommonscalydisorder,occuringusuallyinchildrenandyoungadults(10-35years).Characterizedbyround/ovalpinkbrownpatcheswithasuperficial,centrifugalscale,distributedovertrunkinaChristmastreepattern.Theexactetiologyisnotknown,butitisconsideredtobeaviraldisease;HumanHerpesvirus6(HHV6)andHumanHerpesvirus7(HHV7)mayplayarole.
1688.Pityriasisroseaclearswithin?
a)1-2weeks
b)2-4weeks
c)4-8weeks
d)6-12weeks
CorrectAnswer-BAns.B.2-4weeks[RefBehl10th/ep.406;NeenaKhanna3rd/ep.50,51]Pityriasisrosea:P.roseaisselflimitingdisease,subsideswith6-12weeks.P.roseaisacommonscalydisorder,occuringusuallyinchildrenandyoungadults(10-35years).Characterizedbyround/ovalpinkbrownpatcheswithasuperficial,centrifugalscale,distributedovertrunkinaChristmastreepattern.Theexactetiologyisnotknown,butitisconsideredtobeaviraldisease;HumanHerpesvirus6(HHV6)andHumanHerpesvirus7(HHV7)mayplayarole.ClinicalmanifestationsofP.rosea:Thediseasestartswithanupperrespiratoryprodromeoramildflu.After1-2weeks,annularerythematousplaqueappearsontrunkthatisreferredtoasmotherpatchorheraldpatch.Overthenext1-2weeks,freshpatchappearalloverthetrunk,inaChristmastreeconfigurationorFirtreeConfiguration.
1689.Aknowncaseofdiabetesdevelopsannularorangeskinlesions,whichdisappearafterbiopsy.Thisphenomenonisknownas?
a)Koebner'sphenomenon
b)ReverseKoebner'sphenomenon
c)AsboeHensonsign
d)Isotopicphenomenon
CorrectAnswer-BAns.B.ReverseKoebner'sphenomenon[Refhttps://www.researchgate.net/publication/268343496_Proposed_classification_for_koebner_wolfisotopic_renbok_koebner_nonreaction_isotopic_nonreaction_other_relatedphenomen]Annularorangeskinlesionsinadiabeticindicatetowardsgranulomaannulare.Therehavebeenfewreportsofdisappearanceoflesionsafterbiopsyingranulomaannulare.ThisphenomenonisknownasreverseKoebner'sphenomenon.
1690.Alopeciauniversalisis?
a)Lossofallthescalphair
b)Lossofallbodyhair
c)Losshairatthescalpmargin
d)Malepatternhairloss
CorrectAnswer-BAns.B.Lossofallbodyhair[RefFitzpatrick]Inalopeciaaerata,whenthereistotallossofscalphairitiscalledAlopeciatotalis.WhenthereislossoftotalbodyhairitisreferredasAlopeciauniversalis.Alopeciaalongthescalpmarginiscalledophiasis.Aninverseophiasispattern(sisaphio)iswhenitsparesoccipitalregionandaffectsrestofthescalp.
1691.Treatmentofchoiceforerytherodermicpsoriasisis?
a)Prednisolone
b)Hydroxyurea
c)Acitretin
d)Ciclosporin
CorrectAnswer-CAns.C.Acitretin[Ref:NeenaKhanna3rdlep.46]MethotrexateistheDOCforErythrodermicpsoriasis.Acitretinisanalternative.
1692.Multiplepsoriaticlesionsonhands.Treatmentofchoiceis?
a)NBUVB
b)Systemicmethotrexate
c)Topicalsteroidsandsalicylicacid
d)Systemicsteroids
CorrectAnswer-CAns.C.Topicalsteroidsandsalicylicacid[RefNeenaKhanna3rdlep.46]Preferredtreatmentforlocalizedpsoriasisistopicalcoaltarorshortcontact,dithroanol.Alternativeistopicalsteroids+Salicylicacid.
1693.FalseaboutLanger'slinesis?
a)Remainconstantthroughoutlifetimeofaperson
b)Correspondtothecollagenfibersindermis
c)Incisionalongtheselinesproducesbetterscar
d)Skinalongtheselinesisleastflexible
CorrectAnswer-AAns.A.Remainconstantthroughoutlifetimeofaperson[Ref:IADVLtextbookofdermatology3rdlep.175&Internet]Langer'slinesAlsocalledcleavagelines,isatermusedtodefinethedirectionwithinthehumanskinalongwhichtheskinhastheleastflexibility.Theselinescorrespondtothealignmentofcollagenfiberswithinthedermis.Usually,asurgicalcutiscarriedoutinthedirectionoflanger'slines,andincisionsmadeparalleltolanger'slinesgenerallyhealbetterandproducelessscarring.DirectionalchangesofLanger'slineshavebeenknowntooccurwithinthecourseofaperson'slifetime.Sometimestheexactdirectionoftheselinesareunknown,becauseinsomeregionsofthebodytherearedifferencesbetweendifferentindividuals.
1694.Mostcommontypeofcutaneousmastocytosisis?
a)Solitarymastocytoma
b)Urticariapigmentosa
c)Telangiectasiamaculariseruptivaperstans
d)Diffuseerythrodermic
CorrectAnswer-BAns.B.Urticariapigmentosa[RefIADVLtextbookofdermatology3rdep.146Urticariapigmentosa:(Generalizederuptionofcutaneousmastocytosis(childhoodtype).Itisthemostcommonformofcutaneousmastocytosis.Urticariapigmentosaismostcommoninchildren.Itcanalsooccurinadults.Itisafamilialcutaneousdisordercharacterisedbygeneraliseddistributionofredbrownmacules.Eachlesionrepresentsacollectionofmastcellsinthedermiswithhyperpigmentationofoverlyingepidermis.Themostcharacteristicfeaturesisthattheselesionsurticateonscratching.
1695.Volcanosignisseenin?
a)Leprosy
b)Leishmaniasis
c)Lupusvulgaris
d)DLE
CorrectAnswer-BAns.B.Leishmaniasis[RefIndianDermatolOnlineJ.2012Sep-Dec;3(3):159-165.doi:10.4103/2229-5178.101810]Volcanosign:DescriptivetermforthemorphologicfeatureofOldWorldcutaneousleishmaniasis.Thelesionstartsasasmallnontenderpapule,whichenlargesinsizeandulceratesinthecentre.Theborderofthecrustedulceroftenhasanerythematousrimandiscalledas"Volcanosign".
1696.Treatmentofchoicefororalcandidiasisis?
a)Terbinafin
b)Nystatin
c)Griesofulvin
d)Seleniumsulphide
CorrectAnswer-BAns.B.Nystatin[RefIADVL3rdlep283]TreatmentofcutaneouscandidiasisTopical(TOCforuncomplicatedcases):-nystatinsuspension,clotrimazoletroches,gentionviolet,chlorhexidine,ketoocnazole,amphotericingel.Systemic(reinfection,unresponsive&chroniccases):-oralfluconazole,itraconazoleorketoconazoleareneeded.
1697.Mostcommonmetalresponsibleforcontactdermatitisis?
a)Gold
b)Silver
c)Nickel
d)Mercury
CorrectAnswer-CAns.C.Nickel[RefAndrew'sdiseasesofskinE-bookp99&IADVL3rd/ep.559]Contactdermatitisismainlyoftwotypes:A.IrritantcontactdermatitisDuetodirectirritantactionofthemateriale.g.Solvents,Alkalis,Detergents.Mostcommonsitesarehands&forearms.B.AllergiccontactdermatitisItisduetodelayedhypersensitivity(typeIVhypersensitivity)toaparticularantigeninasensitizedindividual.Themostcommonallergenscausingallergiccontactdermatitisarepollenandmetals:
1. Parthenium(Congressgrass)2. Nickel
1698.Whichofthefollowingistrueaboutxerodermapigmentosa?
a)Autosomaldominant
b)Goodlongtermprognosis
c)Purinedimmers
d)DNArepairdefect
CorrectAnswer-DAns.D.DNArepairdefect[RefRook's4thiep.78.12]XerodermapigmentosaMoleculardefect:ExposuretoUVraysdamagesDNAduetoproductionofconvalentlinkagesbetweenadjacentpyrimidines(pyrimidinedimmers).NormallythedamagedDNAisrepairedbyexcisionandrepair.InxerodermapigmentosatherepairofUVdamagedDNAisdefective.Itisanautosomalrecessivedisorder.
1699.Trueabouterythematoxicumis?
a)Commoninpre-termbaby
b)Lesionscontainmanylymphocytes
c)Canbelifethreateningcondition
d)Occursmainlyinneonatalperiod
CorrectAnswer-DAns.D.Occursmainlyinneonatalperiod[RefIADVL.3rdlep.163]*Erythematoxicumneonatorum(ETN/babyacne/toxicerythemaofthenewborn)-Itisabenign,asymptomaticskinconditionthatischaracterizedbysmall,erythematouspapules,vesicles,and,occasionally,pustules.-Thelesionsareusuallysurroundedbyadistinctivediffuse,blotchy,erythematoushalo-Itismorecommoninbabiesbornatfullterm(between37and40weeksofgestation)comparedwithprematurebabies.-Onlyoccursduringtheneonatalperiod,usuallybetweenday2-5afterbirthandtypicallyresolveswithinfirsttwoweeksoflife.-Thefluidfromerythematoxicumlesionswillshowmanyeosinophils
1700.Nevussimplexcommonlypresentsat?
a)Face
b)Trunk
c)Legs
d)Hand
CorrectAnswer-AAns.A.Face[RefIADVL3rdiep.201]Nevussimplex(Nevusflammeusnuchae/storkbite/Salmonpatch)Itisacongenitalcapillarymalformationpresentsin30percentofnewbornbabies.Astorkbiteisduetodilationofbloodvesselsandmaybecomedarkerwhenthechildcriesorstrains.Theyaremostcommonontheforehead,eyelids,upperlip,betweentheeyebrows,andthebackoftheneck,thesemarksfadeastheinfantgrows.
1701.Inmechanicalventilation,peakpressureininspirationdenotes?
a)Complianceoflung
b)Capacityofinspiratorymuscles
c)Airwayresistance
d)Alloftheabove
CorrectAnswer-CAns.C.Airwayresistance[Ref:Essentialsofanaesthesia-786]PressuresinmechanicalventilationPeakpressurePeakpressureapplieswhenthereisairflowinthecircuit,i.e.,duringinspiration.Peakpressuredeterminesairwayresistance.
1702.Propofolvial,onceopened,shouldbeusedwithin?
a)2hours
b)4hours
c)6hours
d)8hours
CorrectAnswer-CANs.C.6hours[Ref:Lee13th/ep.158-160;Morgan4thlep.200-202]Propofolisoilbasedpreparationcontainingsoybeanoil,egglecithin,andglycerol.Thecolorofsolutionismilkywhite.Solutionshouldbeusedwithin6hoursafteropeningthevialbecausetherehavebeendeathreportsfollowingtheuseofcontaminatedsolutionasegglecithinisagoodmediumforbacterialgrowth.Topreventthisproblemrecentlyavailablepropofolpreparationshavedisodiumedetateorsodiummetabisulfiteasantimicrobialagent.
1703.Relativecontraindicationofneuraxial/regionalanesthesiais?
a)Hypertension
b)Renaldisease
c)Sepsis
d)Diabetes
CorrectAnswer-CAns.C.Sepsis[RefMorgan4th/ep.299]Contraindicationstoneuraxialblock(spinal&epidural)Absolute:-Infectionatthesiteofinjection,patientrefusal,coagulopathyorotherbleedingdisorder,severehypovolemia,increasedICT,severeaorticormitralstenosis.Relative:-Sepsis,unto-operativepatient,pre-existingneurologicaldeficit,demyelinatinglesions,severespinaldeformity,stenoticvalvularheartdisease.
1704.CNSaffectionofalocalanestheticagentleadsto?
a)Convulsion
b)Perioralnumbness
c)Depression
d)Alloftheabove
CorrectAnswer-DAns.D.Alloftheabove[RefMorgan4thlep.270]ManifestationsoflocalanesthetictoxicityEarlysymptoms(Prodrome)Circumoralnumbness,dizziness,tongueparesthesia,restlesness,tinnitus,agitation.CNSsymptoms:-Thesearebiphasici.e.excitation(convulsions,restlessness,agitation&tinnitus),followedbydepression(drowsiness,disorientation,respiratorydepression,unconciousness).Cardiovascularmanifestations:-hypotension,cardiacarrest,coma
1705.Americananestheticassociationsaysthatclopidogrelshouldbewithheldhowmanydaysbeforesurgery?
a)1day
b)1week
c)3weeks
d)4weeks
CorrectAnswer-BAns.B.1week[RefAjayYadav3'/ep.46]Preoperativemodificationsofpre-existingdrugs
Drugswhichcanbestopped Drugswhichcanbecontinuedtillthedayofsurgery
Conventionaldoseaspirin&clopidogrel(antiplatelets)-I Antianginal(exceptaspirin)
weekbeforesurgery AntiepilepticsOralanticoagulants-4daysbefore&switchtoheparin,whichisstopped12hourspriortosurgery
Antihypertensives(exceptAT-IIantagoists)Levodopa
Oralhypoglycemic(metformin)-48hoursbeforeurgery Digitalis
andswitchtoinsulin TCAsAT-IIantagonists(losartan,valsarton)-1dayprior Lowdoseaspirin
Lithium-48-72hoursbeforesurgery
MAOinhibitors-3weeksbeforesurgery
Note:Antiplateletdrugslikeclopidogrelandconventionaldoseofaspirinshouldbestopped7dayspriortosurgery.Butlowdoseaspirincanbecontinuedtillthedayofsurgery.
1706.Whichofthefollowinginhalationalanestheticagentmosteasilycrossesbloodbrainbarrier?
a)Methoxyflurane
b)Sevoflurane
c)Desflurane
d)Nitrousoxide
CorrectAnswer-AAns.A.Methoxyflurane[RefAjayYadav4th/ep.63]Oil:gaspartitioncoefficientmeasuresthelipidsolubilityoftheagentandthereforesolubilityinthefat-richtissuesoftheCNS(abilitytocrossBBB).Methoxyfluranehasmaximumoil:Gaspartitioncoefficient—>Mostlipidsoluble&mosteasilycrossesBBB.1120hasminimumoil:Gaspartitioncoefficient-pLeastlipidsoluble&thereforelikelytocrossBBB.
1707.Whichofthefollowinganestheticagentmostislipidsoluble?
a)Nitrousoxide
b)Methoxyflurane
c)Isoflurane
d)Halothane
CorrectAnswer-BAns.B.MethoxyfluraneOil:gaspartitioncoefficientmeasuresthelipidsolubilityoftheagentandthereforesolubilityinthefat-richtissuesoftheCNS(abilitytocrossBBB).Methoxyfluranehasmaximumoil:Gaspartitioncoefficient—>Mostlipidsoluble&mosteasilycrossesBBB.1120hasminimumoil:Gaspartitioncoefficient-pLeastlipidsoluble&thereforelikelytocrossBBB.
1708.Etomidateisnotusedforlongterminfusionbecause?
a)Resultsinadrenalsuppression
b)Maycausevasospasm
c)Resultsincardiacarrhythmias
d)MaycauseincreaseinICT
CorrectAnswer-AAns.A.Resultsinadrenalsuppression[RefMorgan4th/ep.200]Etomidatesuppressescorticosteroidsynthesisintheadrenalcortexbyreversiblyinhibiting1113-hydroxylase,whichcoverts11-deoxycortisoltocortisolandbyarelativeminoreffecton17a-hydroxylase.Usingacontinuousetomidateinfusionforsedationofcriticallyilltraumapatientsinintensivecareunitshasbeenassociatedwithincreasedmortalityduetoadrenalsuppression.Themortalityofpatientsexposedtoacontinuousinfusionofetomidateformorethan5daysincreasedfrom25%to44%,mainlyduetoinfectiouscausessuchaspneumonia.
1709.Amongthefollowingagents,maximumboilingpointisassociatedwith?
a)Sevoflurane
b)Isofurane
c)Methoxyflurane
d)Desflurane
CorrectAnswer-CAns.C.Methoxyflurane[RefAjayYadav4th/ep.63]Boilingpointofmethoxyfluraneismorethanwater(104°C)
1710.ApatientwithnormalsuccinylcholinemetabolismwillhaveDibucainenumberbetween?
a)20-30
b)40-45
c)50-60
d)70-80
CorrectAnswer-DAns.D.70-80Dibucainnumber:Dibucain(alocalanaesthetic)inhibits80%ofnormalpseudocholinesteraseand20%ofatypical(non-functional)pseudocholinesterase.Thereforenormaldibucainnumberis70-80%.
1711.Benzocaineisusedinwhichtypeofanesthesia?
a)Topical
b)Spinal
c)Epidural
d)Alloftheabove
CorrectAnswer-AAns.A.Topical[RefMorgan4th/ep.270]Benzocaineandcocaineareusedonlyintopicalanesthesia.
1712.Succinylcholineiscontraindicatedin?
a)Hyperkalemia
b)Hypokalemia
c)Hypercalcemia
d)Hypocalcemia
CorrectAnswer-AAns.A.Hyperkalemia[RefMorganPiep.214]Schcancausedangeroushyperkalemiainandiscontraindicatedin:Burn,massivetrauma,crushinjury,Severeintraabdominalinfection(sepsis).
1713."TriangleofPetit"isalandmarkforwhichblock?
a)Spinalblock
b)Bier'sblock
c)TAPblock
d)Epiduralblock
CorrectAnswer-CAns.C.TAPblock[RefMiller'sanesthesiaE-bookp.1735]*Transverseabdominisplane(TAP)block-Itisaperipheralnerveblockdesignedtoanesthetizethenervessupplyingtheanteriorabdominalwall(T6toL1).-ThepointofentryfortheblindTAPblockisthelumbartriangleofPetit.-Thisissituatedbetweenthelowercostalmarginandiliaccrest.-Itisboundanteriorlybytheexternalobliquemuscleandposteriorlybythelatissmisdorsi.
1714.Whatistheintubationdoseofpancuronium?
a)0.1mg/kg
b)1mg/kg
c)10mg/kg
d)20mg/kg
CorrectAnswer-AAns.A.0.1mg/kg
1715.Whichofthefollowingagentisassociatedwithmaximumhistaminerelease?
a)d-Tubocurarine
b)Cisatracurium
c)Pancronium
d)Rocuronium
CorrectAnswer-AAns.A.d-TubocurarineHistaminereleaseiscausedby→D-TC(maximumtendency),succinylcholine,mivacurium,doxacurium,atracurium,tubocurarinecancausebronchoconstriction.
1716.Hypotensionfollowingspinalanesthesiacanbebestpreventedby?
a)Preloadingwithcolloids
b)Usingsmallsizeneedle
c)Preloadingwithcrystalloids
d)Alloftheabove
CorrectAnswer-AAns.A.Preloadingwithcolloids[RefLee13th/ep.509,510;Morgan4th/ep.297]Hypotensionisthemostcommoncomplicationofspinalanesthesia.Itarisesduetoblockingofsympatheticrootfibersandisusuallyaccompaniedbybradycardia(PreganglionicblockofthesympatheticnervestoheartT1-T4)andnausea.Hypotensioncanbepreventedbypreloadingthepatientwithcolloids,Preloadingwithcrystalloiddoesnotpreventhypotensionbecauselargevolumesofcrystalloidsquicklyredistributefromintravasculartoextravascularspace.Beachchairpositionalsopreventshypotension.
1717.Intra-arterialthiopentoneinjectionleadsto?
a)Ischemia
b)Vasodilatation
c)Vomiting
d)Hypertension
CorrectAnswer-AAns.A.Ischemia[RefAjayYadav4th/ep.80;Lee13thiep.155]IschemiaInadvertentintra-arterialinjectionofthiopentoneisaverydreadfulcomplication.Itproducesthrombosis,vasospasm,ischemia,necrosisandfinallygangrene.Thefirstsymptomisburningpain.Thefirstsignisblanchingofthehandduetovasospasm.
1718.SizeofLMAfora15kgchildis?
a)1
b)2
c)3
d)4
CorrectAnswer-BAns.B.2LMAaccordingtopatient’sweightandage:10-20kgs,infants&children
1719.Anestheticagentleadingtobradycardiais?
a)Pancuronium
b)Vecuronium
c)Atracurium
d)Propofol
CorrectAnswer-DAns.D.PropofolBradycardiacausinganestheticagents:SuccinylcholinePropofolOpioidsanesthetics(fentanylanditscongers)
1720.TypeEcircuitisusedfor?
a)Spontaneousventilation
b)Controlledventilation
c)Children
d)Anusedforalloftheaboveindications
CorrectAnswer-CAns.C.Children[RefAjayYadav4th/ep.29,30]Circuitofchoiceforspontaneousventilationinadult-4MaplesonACircuitofchoiceforcontrolledventilationinadultMaplesonD(Baincircuit)Circuitofchoiceforchildren-TypeF,i.e.Jackson-Rees(firstchoice)andtypeE,i.e.Ayre'sTpiece(secondchoice)
1721.PropofolshowsfollowingeffectonEEG?
a)Activation
b)Depression
c)Depressioninlowdosesandactivationinhighdoses
d)Noneoftheabove
CorrectAnswer-BAns.B.DepressionEEGchangesduringanesthesia:EEGDepressioncausedby,Inhalationalagents(1-2MAC)BarbituratesOpioidsEtomidatePropofolHypocapniaMarkedhypercapniaHypothermiaLatehypoxia,ischemia
1722.Pinindexsystemisasafetyfeatureadoptedinanesthesiamachinestoprevent?
a)Incorrectattachmentofanesthesiamachines
b)Incorrectattachmentofanesthesiafacemasks
c)Incorrectinhalationagentdelivery
d)Incorrectgascylinderattachment
CorrectAnswer-DAns.D.Incorrectgascylinderattachment[RefLee13th/ep.85]Pinindexsystem:-Thisisthesafetymechanismsothatonecylindercannotbefittedattheother'sposition.
1723.Anestheticagentofchoiceinasthmapatientis?
a)Thiopentone
b)Methexitone
c)Ketamine
d)Propofol
CorrectAnswer-CAns.C.Ketamine[RefMiller's7"lep.744-746]Ketamineisapotentbronchodilator;thereforeitistheanestheticagentofchoiceinbronchialasthmapatients.Halothaneistheinhalationalagentofchoiceinasthmatics.
1724.Mallampatti'sclassificationisfor?
a)Mobilityofcervicalspine
b)Mobilityofatlantoaxialjoint
c)Assessmentoffreerotationofneckbeforeintubation
d)Inspectionoforalcavitybeforeintubation
CorrectAnswer-DAns.D.Inspectionoforalcavitybeforeintubation[RefMorgan4thiep.113]Mallampatiscore(Mallampatioropharyngealscale):Mallampatigradingisusedtoevaluatethevisibilityoftonsilandtonsillarfossawhichinturnassesstheadequatemouthopeningdependinguponthegrade.IndicationsofMallampatiscoreareOralcavityassessmenttoruleoutdifficultintubation(Inspectionoforalcavitybeforeintubation)&Sleepapneaevaluation.
1725.Thicknessofleadaprontopreventradiation:
a)1mm
b)3mm
c)0.5mm
d)7mm
CorrectAnswer-CAns.C.0.5mm"Itisrecommendedthatforgeneralpurposeradiographytheminimalthicknessofleadequivalentintheprotectiveapparelshouldbe0.5mm."-TextbookofRadiologyPhysicsp.39Leadapronof0.5mmthicknessreduceintensityofscatteredX-raysbyover90%.
1726.Radiationprotectionshieldsaremadeupof:
a)Copper
b)Silver
c)Lead
d)Tin
CorrectAnswer-CAns.Lead
1727.SoapbubbleappearanceonMRIbrainischaracteristicof?
a)Tubercularmeningitis
b)Neurocysticercosis
c)Cryptococcalcysts
d)Ependymoma
CorrectAnswer-CAnswer-C.CryptococcalcystsCryptococcomasT1:lowsignalT2/FLAIR:highsignalT1C+(Gd):variable,rangingfromnoenhancementtoperipheralnodularenhancement.GelatinouspseudocystscausedbyCryptococcustendtogivea"soapbubble"appearanceonMRI.MRIfindingsinneuralcryptococcosis.
1728.T2imageinMRIis-
a)Goodtodetectpathology
b)Goodtodetectanatomy
c)Goodforboth
d)Goodfornone
CorrectAnswer-AAnswer-A.GoodtodetectpathologyManypulse-sequencetechniquesareusedinMRI,butmostclassicareT1andT2weightedimages.Asageneralrule,TI-weightedimagesaregoodforviewinganatomy,andT2weightedimagesaregoodfordetectingpathology.[RefFundamentalsofdiagnosticradiologyp.18]
1729.CSFonMRIappears:
a)HyperintenseonT1weighedimageandhypointenseonT2weighedimage
b)HypointenseonT1weighedimageandhyperintenseonT2weighedimage
c)HyperintenseonT1andT2weighedimages
d)HypointenseonT1andT2weighedimages
CorrectAnswer-BAns.HypointenseonT1weighedimageandhyperintenseonT2weighedimageFluid-Edema,Urine,Bile,CSF-T1weightedsignallow&T2weightedsignalhigh
1730.Keyholesignonultrasoundisseenin-
a)Polycystickidney
b)Hydronephrosis
c)Chronicpyelonephritis
d)Posteriorurethralvalves
CorrectAnswer-DAnswer-D.PosteriorurethralvalvesThekeyholesignisanultrasonographicsignseeninboyswithposteriorurethralvalves.ltreferstotheappearanceoftheproximalurethra(whichisdilated)andassociatedthickwalleddistendedbladderwhichonultrasoundmayresembleakeyhole.
1731.MIBGdoseis-
a)40-80MBq
b)80-100MBq
c)100-120MBq
d)120-150MBq
CorrectAnswer-AAnswer-A.40-80MBqMIBGscanisascintigraphicstudythatusesmetaiodobenzylguanidinelabeledtoIodine-123orIodine-131.Theactivityadministeredtoadultsshouldbe:for131I-mIBG:40-80MBq(1.2-2.2mCi);for123ImIBG:400MBq(10.8mCi).ForminimumandmaximumrecommendedactivitiesinchildrenoneshouldconsulttheGuidelinesforRadioiodinatedMIBGScintigraphyinChildren(minimumactivity20MBqfor123I-mIBGand35MBqfor131I-nIBG;maximumactivity400MBqfor123I-mIBGand80MBqfor131I-mIBG).
1732.Bariummealfollowthroughishelpfulindiagnosing-
a)Colonicstricture
b)Ilealstricture
c)Rectalstricture
d)Esophagealstricture
CorrectAnswer-BAnswer-B.IlealstrictureFollowingabnormalitiesofsmallintestinecanbeidentified:-
1. Malabsorption2. BD(CD&UC)3. Tumorsofsmallintestine4. Smallbowelobstruction5. Intestinalstrtcture
1733.Themaximumpermissiblelevelofoccupationalexposuretoradiationis...peryear-
a)5rad
b)2rad.
c)10rad
d)50rad
CorrectAnswer-AAns.is'a'i.e.,5RadTheamountofradiationreceivedfromouterspaceandbackgroundradiationhasbeenestimatedtobe0.1radayear.Apparently,thisdoesnotatpresentconstituteahazard.Theadditionalpermissibledosefrommanmadesourcesshouldnotexceed5radayear.
1734.Bananaandlemonsignseeninwhichfetalnomalies:
a)Neuraltubedefect
b)Hydropsfetalis
c)Twins
d)IUD
CorrectAnswer-AAns.isai.e.NeuraltubedefectSignsofSpinabifidaonUltrasoundSmallbiparietaldiameter.Ventriculomegaly.Frontalbonescallopingorthesocalledlemonsign.Elongationanddownwarddisplacementofthecerebellum-thesocalledbananasign.Effacementorobliterationofthecisternamegna.
1735.Radiographicsigncharacteristicofpulmonaryedemais-
a)Westermark'ssign
b)Hampton'shump
c)Pallasign
d)Batwingsign
CorrectAnswer-DAnswer-D.BatwingsignAcutepulmonaryedema:-Acutepulmonaryedemaischaracterizedbycentrallylocatedalveolarsign,withhazyorfluffyincreaseddensityinperihilardistribution,creatingabat-wingorangel-wingpaftern.Thereisrelativesparingofthemoreperipheralzonesoflungfields.Airbronchogrambecomeevidentasedemabecomesmoreopaque.
1736.Gammaknifeutilizes-
a)Strontium89
b)1-131
c)Cobalt-60
d)P-32
CorrectAnswer-CAnswer-C.Cobalt-60GammaknifecontainsCobalt-60sourcesofapproximately30curisplacedincirculararrayinaheavilyshieldedunit.Theunitdirectsthegammarirystothetarget.
1737.SnowstormappearanceonchestX-rayisseenin-
a)Anthracosis
b)Byssinosis
c)Silicosis
d)Bagassosis
CorrectAnswer-CAnswer-C.SilicosisSimpleformz-Multiplesmallrounded(nodular)opacitiesinthelungparenchyna(snowstonnappeoraace).Thesenodulestendtobelocatedpredominantlyinthemiddleandupperlungfieldswithrelativesparingoflowerlungfields(ThoughIowerlungfieldscanalsobeinvolvedlaterindiseaseprocess).Thereisbilateralhilarlymphadenopathywithcharacteristiceggshellcalcification.
1738."Drooplilysign"isseenin-
a)"Drooplilysign"isseenin
b)Duplicatedcollectingsystem
c)Chronicpyelonephritis
d)Hypernephroma
CorrectAnswer-BAnswer-B.DuplicatedcollectingsystemThedroopinglilysrgl(droppingflowersign)isaurographicsigninsomepatientswithaduplicatedcollectingsystem.Itreferstotheinferolateraldisplacementoftheopacifiedlowerpolemoietyduetoanobstructed(andunopacified)upperpolemoeity.
1739.Sonographicappearanceofhydatidcystis-
a)Hyperechoicaseptatelesion
b)Hypoechoicaseptatelesion
c)Hyperechoicseptatelesion
d)Hypoechoicseptatelesion
CorrectAnswer-DAnswer-D.HypoechoicseptatelesionTypeI(Simplecyst):-Single(solitary)hnrcechoic/anechoicaseptate(withoutsepta)lesion.Thediagnosisofhydatidcystmaybeconsideredwhenfocalthickeningofwallispresentorwhenhlperechoicspots,duetohydatidsand,appearinthedependentareas.
1740.Roentgenistheunitof:March2010
a)Radioactivity
b)Radiationexposure
c)Absorbeddose
d)Noneoftheabove
CorrectAnswer-BAns.B:RadiationExposureThecurie,namedafterscientistMarieCurie,isaunitofmeasurementusedtomeasurehowradioactiveanobjectis,orhowmuchradiationitproduces.Thisisdonebyexamininghowfastitsatomsdisintegrateandmeasuringtheirdisintegrationpersecond.Roentgen,ontheotherhand,isaradiationunitthatindicateshowmuchradiationispresentintheairofaspecificenvironment.Thisisusedtoshowhowmuchradiationmaybeabsorbedbystandinginaparticularplaceforacertainamountoftime.Oneroentgenofgamma-orX-rayexposureproducesapproximately1rad(0.01gray)tissuedose.Morecommonthanthesetwoaretheradandtherem.Thesetwounitscanmeasureanytypeofionizingradiation,includingalpha,beta,neutron,gammaand"X,"anddealwithhowmuchradiationisabsorbedbyobjects.Radstandsfor"radiationabsorbeddose."Oneradequals100ergs(anenergyunit)absorbedby1gofmaterial.Radsareusedtoshowhowmuchradiationanyobject,
especiallythingslikemetalandstone,hasabsorbed.Rem(doseequivalent)isastrictlybiologicalmeasurement,andstandsfor"roentgenequivalentman,"meaningthatitisthesameessentialmeasurementasaroentgen,onlyappliedtothehumanbody,althoughthisworksonlywithgammaand"X"typesofradiation.Remisusedtodefinelimitsofexposureforpeoplewhoworkinnuclearpowerplants.Remisoftendividedinmilliremsandassignedalengthoftime,suchasmilliremsperhour.Curie/becquerelistheunitofradioactivity.
1741.SIunitofradioactivityis:March2013(c,f)
a)Rem
b)Rad
c)Becuerel
d)Curie
e)None
CorrectAnswer-CAns.Ci.e.BecquerelOldunitofradioactivityisCurieandnewunit(SI)isBecquerel.
1742.SIunitofabsorbeddoseis-
a)Becquerel
b)Columb/cm
c)Gray
d)Sievert[Sv]
CorrectAnswer-CAnswer-C.GrayOldunitofabsorbeddoseisRadandnewunit(SI)isGray.
1743.Stenver'sviewisusedfor-
a)Superiororbitalforamen
b)Inferiororbitalforamen
c)Internalauditorycanal
d)Sellaturcica
CorrectAnswer-CAnswer-C.InternalauditorycanalSkulltrauma(sellaturcica)(pituitaryfossa)-LateralviewInternalauditoryview(bothside)-Stenver'sview
1744.Acutemyocarditisschintigraphyisdonewith-
a)Thallium
b)Technetium
c)Gallium
d)None
CorrectAnswer-CAnswer-C.GalliumGallium-67uptakeisincreasedininflamedmyocardium.Gallium-67citrateinjectedintravenouslybindstotransferrin,anditisincorporatedintothetransferrinreceptorofinflammatorycellsormalignanttumorcells.Gallium-67scintigraphyisusefulforexaminationofheartdiseaseincludingcardiacsarcoidosisandacutemyocarditis
1745.Radiationusedmostcommonlyforpainmanagementduetobonemetastasisis-
a)Co60
b)Iridium192
c)Tritium
d)Tin-117
CorrectAnswer-AAnswer-A.Co60Radiopharmaceuticals(radioactiveisotopes)usedformetastaticbonepainarestrontium(Sr89),Samarium(Sm153),rhenium(Re186),Phosphorus-32andTin-117(Sn-177).
1746.Minimumradiationdosewhichmayleadtooligospermiais-
a)<1Gy
b)2-3Gy
c)7-10Gy
d)15Gy
CorrectAnswer-AAnswer-A.<1GyFractionateddoses0.7-0.9Gyleadtooligospermia/azoospermiabutwithfrequentrecoveryat1-1.5years.Permanentazoospermiamayoccurafterfractionateddosesaslowas1.2Gy,andislikely>2Gy.
1747.HalflifeofTechnetium99is:
a)2hours
b)6hours
c)12hours
d)24hours
CorrectAnswer-BAns.6hoursTc-99-Technitium-6hoursHalflife(tin)ofradium(Ra226)is1602-1626years(longest)Q;Cesium(137Cs)is30yearsQ;Cobalt(60Co)is5.2yearsQ;iridium(1921r)is74.5daysQ;Iodine(P31)is8daysQ;1123is13hoursQ;technitium(Tc99)is6hoursQ;and1132is2.3hoursQ.
1748.Halflifeoftritiumis-
a)10.2years
b)12.3years
c)15.5years
d)20.7years
CorrectAnswer-BAnswer-B.12.3yearsTritium(hydrogen-3)isaradioactiveisotopeofhydrogen.Thenucleusoftritium(sometimescalledatriton)containsoneprotonandtwoneutrons.Whereasthenucleusofprotiumcontainsoneprotonandnoneutrons.Tritiumhasahalf-lifeof12.3years
1749.Stereotacticradiosurgeryisdonefor-
a)Glioblastomamultiforme
b)Medulloblastomaspinalcord
c)Ependymoma
d)AVmalformationofbrain
CorrectAnswer-DAns.is'D'i.e.,AVmalformationofbrainItisalsousedfor-
1. Solitarycerebralmetastasis2. Arteriovenousmalformation3. Smallmeningiomas4. Schwannomas5. Pituitaryadenomas
1750.ABonemarrowtransplantrecipientpatientdevelopedchestinfection.OnHRCT'Treeinbudappearance'isseen.Mostlikelycausativeagentis:
a)Klebsiella
b)Pneumocystis
c)TB
d)RSV
CorrectAnswer-BPneumocystis[Ref:HarrisonI7/ep843;Article'Treeinbudsign'inJournal'Radiology'and'Radiographics7Tree-in-budisasignseeninHRCT,mostcommonlyseenwithendobronchialspreadofTuberculosis,butcanbeseenwithawidevarietyofconditions,mostcommonlyinfections.(Describedaheadindetail).Theoreticallyalltheoptionscancause'Tree-in-bud'sign(althoughKlebsiellahasnotbeenmentionedinthelist).SothenextclueisBonemarrowtransplant.Bonemarrowtransplantcausesatransientstateofimmunologicaldeficiencyleadingtoawidevarietyofopportunisticinfections.Amongthegivenoptions,accordingtothetableandtextofHarrison(17/echapter'InfectionsinTransplantRecipients')PneumocystisandRSVcancausepneumoniaaftertransplant:butPneumocystisisamuchmorecommonthanRSV.CommonSourcesofInfectionsafterHematopoieticSteinCellTransplantation PeriodafterTransplantation
InfectionSite Early(<1Month)
Middle(1-4months) Late(>6Months)
Disseminated Aerobicgram-negative,grain-positivebacteria
NocardiaCandida,Aspergillus
Encapsulatedbacteria(Streptococcuspneumoniae,Haemophilusinfluenzae,Neisseriameningitidis)
Skinandmucousmembranes
HSV- HHV-6 VZV
Lungs Candida,AspergillusHSV
CMV,seasonalrespiratoryvirusesPneumocystisToxoplasma
Pneumocystis
Gastrointestinaltract CMV
Kidney BKvirus,adenovirus BKvirus
Brain HHV-6 Toxoplasma ToxoplasmaJCvirus
Bonemarrow HHV-6 Tree-in-budsignThetree-in-budsignisafindingseenonthin-sectioncomputedtomographicimagesofthelung(HRCT).(NotseenonX-rays)Peripheral,small,centrilobularnodulesareconnectedtolinear,branchingopacitiesthathavemorethanonecontiguousbranchingsite,thusresemblingabuddingor,fruitingtree:thisisknownastree-in-bud-pattern.Itrepresentsdilatedandimpacted(mucusorpus-filled)centrilobularbronchioles.Thepresenceoftree-in-budisindicativeofsmallairwaydisease.
ItismostcommonlyassociatedwithendobronchialspreadofMycobacteriumtuberculosis.Butitcanalsobeseeninalargenumberofconditions.Pulmonaryinfectiousdisordersinvolvingthesmallairwaysarethemostcommoncausesofthetree-in-budsign.Anyinfectiousorganism,includingbacterial,mycobacterial,viral,parasitic,andfungalagents,caninvolvethesmallairwaysandcauseatree-in-budpattern.CausesofTree-in-budappearance
PeripheralairwaydiseaseInfectionBacterialMycobacteriumtuberculosisMavium-intracellularecomplexStaphylococcusaureusHaemophilusinfluenzaeFungalAspergillusPneumocystiscarinii,(renamedPneumocystisjiroveci)ViralCytomegalovirusRespiratorysyncytialvirus
CongenitaldisordersCysticfibrosisKartagenersyndromeIdiopathicdisordersObliterativebronchiolitisDiffusepanbronchiolitisAspirationInhalationToxicfumesandgasesImmunologicdisordersAllergicbronchopulmonaryaspergillosis
ConnectivetissuedisordersRheumatoidarthritisSjo-grensyndromePeripheralpulmonaryvasculardiseaseNeoplasmsPrimarypulmonarylymphomaNeoplasticpulmonaryemboliGastriccancerBreastcancerEwingsarcomaRenalcancer
1751.Safelightinradiographicdarkroomisideallyshouldbeoffollowingcolor-
a)Red
b)Yellow
c)Purple
d)Blue
CorrectAnswer-AAnswer-A.RedRed-Somebluesensitivematerials,mostphototypesettingmaterials,mostblueandmostgreensensitivemedicalx-rayfilms(usedindarkroom).Darkamber-Colornegativepapersandmaterials,panchromaticblackandwhitepapers.Amber-Colornegativepapers,panchromaticblackandwhitepapers
1752.Chainoflakesappearanceisseenin?
a)Chronicpancreatitis
b)Acutepancreatitis
c)Gallstoneileus
d)Sub-acuteintestinalobstruction
CorrectAnswer-AChronicpancreatitisREF:Sutton'sRadiology7theditionvolume1page798,Sabistontextbookofsurgery18thedchapter5Chronicpancreatitisischaracterizedbyirregularitiesofthepancreaticducts,ductalstrictures,andareasofductdilation.Themajoraswellastheside-branchductsmaybeinvolved.Forunexplainedreasons,somepatientswithchronicpancreatitisdevelopdilatedmainpancreaticducts(largeductdisease),whereasothersretainductsofnormalorevensmallerthannormalcaliber(smallductdisease).Somepatientswithchronicpancreatitiscanbeshowntohavemajorductsthathavetheappearanceofa"chainoflakes"ora"stringofpearls"thatistheresultofsegmentsofdilatedductseparatedbyareasofductalstricture
1753.Commonlyusedtypeofradiationinradiotherapyis:
a)Alpharays
b)Betarays
c)Gammarays
d)X-rays
CorrectAnswer-CAns.GammaraysRadioiodinegeneratesbothbetaandgammaraysbutpredominantlybetarays.
1754.ThephotosensitivematerialusedinX-raysfilmsconsistof:
a)Cellulose
b)Silverbromide
c)Zincsulphide
d)Cadmiumtungstate
CorrectAnswer-BAns.SilverbromideAftertheimagehasbeendeveloped,theresultantimageisthenfixedbyafixer(Hypo-sodiumthiosulphate)whichremovesunusedsilverhalide,whichwouldmakethefilmappearmilkyorcloudy.X-rayfilmshouldbedevelopedindarkroom,otherwiselightwillspoilthefilm(x-rayfilmhasphotosensitivesilverbromide).Blueandgreenlightaremostsensitivewhereasyellowandredlightareleast.
1755.Leastpenetratingpoweramongfollowingmentionedraysisin-
a)Alpharays
b)Betarays
c)Gammarays
d)X-ray
CorrectAnswer-AAnswer-A.AlpharaysPenetrationpower:Gammarays>Xrays>Betaparticle>Alphaparticle(orheliumion)Ionizing&damagingpower:Alphaparticle(orheliumion)>Betaparticle>Xray>GammarayAlphaparticles(Heliumnuclei)havehighestionizingpowerbecausetheyhavealargecharge.Alphaparticleshavethehighestdamagingpowerastheyarerelativelyslowandheavy.
1756.Non-ionizingradiationamongthefollowingis-
a)MRI
b)CTScan
c)X-ray
d)Positionemissionscintigraphy
CorrectAnswer-AAnswer-A.MRINon-ionizingradiation-USGMRIThermography(infraredrays)UVraysRadiofrequencywavesMicrowaves
1757.Confabulationis?
a)Astateofconfusionwherepatientisnotabletodescribethedetails
b)Purposefullyfabricatingstoriestoprojectacertainimage
c)Fillinguptogapsbyfabricationtocoverlapsesinmemory
d)Afeelingofstrangenesstofamiliarsituationsorevents.
CorrectAnswer-CAns.C.Fillinguptogapsbyfabricationtocoverlapsesinmemory[RefKaplan&Sadock's10th/ep.275]ConfabulationItisatypeofParamnesia(Distortedorfalsifiedrecallofeventsinrelationtodetailsortheirtemporalrelationships)Unintentionalfillingofgapsofmemorywithmaterialwhichareuntrueandfanciful.
1758.Alcoholwithdrawalisnotassociatedwith?
a)Seizure
b)Amnesia
c)Tremers
d)Delirium
CorrectAnswer-BAns.B.Amnesia[Ref:NirajAhuja6th/ep.41]Amnesiaoccursduringacuteintoxication(notduringwithdrawal).
1759.A40yearoldmarriedmalethinksthatheismultitalentedandisalwaysoverconfident.Heneverlistenstohisfamilyorfriends.Infactwheneveranyonegiveshimanyadvice,hethinksthattheyhavesomemotiveagainsthim.Heisalwayssuspiciousofhiswife.Allthesearefeatureof?
a)Borderlinepersonalitydisorder
b)Schizoidpersonalitydisorder
c)Paranoidpersonalitydisorder
d)Histrionicpersonalitydisorder
CorrectAnswer-CAns.C.Paranoidpersonalitydisorder[RefNamboodiri3rdlep.303;NirajAhujaelep.123]Paranoidpersonalitydisorder:Itischaracterizedbygeneralizedmistrustandsuspiciousnessaboutthemotivesandactionsofothersandatendencytointerpretthemasmalevolent.Thepatientbelievesthat:
1. Othersareexploitingordeceivingtheperson.2. Friendsareuntrustworthyandnotloyal.3. Thespouse/partnerisunfaithful.4. Thereishiddenmeaninginneutralorfriendlyremarks.5. Manypatientshavefeelingofself-importanceandthinktheyare
unusuallytalented.
1760.Characteristicofhistrionicpersonalitydisorderis?
a)Violationofrulesofsociety
b)Attention-seekingbehavior
c)Unstableinterpersonalrelationship
d)Grandiosebehavior
CorrectAnswer-BAns.B.Attention-seekingbehavior[RefNirajAhuja6'"/ep.122]Patientswithhistrionicpersonalitydisorderdisplayexcessiveemotionalityandattention-seekingbehavior.OtheroptionsViolationofrulesofsociety→antisocialpersonalitydisorderUnstableinterpersonalrelationship→borderlinepersonalitydisorderGrandiosebehavior→narcissisticpersonalitydisorder
1761.Personalitytypeseeninschizophreniais?
a)Schizoid
b)Paranoid
c)Borderline
d)Alloftheabove
CorrectAnswer-DAns.D.Alloftheabove[RefNirajAhuja6th/ep.125&Internet]Schizophreniaisassociatedwith3typesofpersonalitydisordersi.e.schizoid,borderlineandparanoid.
1762.Irresistibleurgetodrinkalcoholiscalled?
a)Kleptomania
b)Pyromania
c)Dipsomania
d)Trichotillomania
CorrectAnswer-CAns.C.Dipsomania[RefPeculiaritiesofbehavior]Dipsomaniaischaracterizedbyperiodicboutsofuncontrollablecravingforalcohol.
1763.A39yearsoldmalepatientpresentswithwaxyflexibility,negativismandrigidity.Mostprobablediagnosisis?
a)Excitatorycatatonia
b)Stuporouscatatonia
c)Paranoidschizophrenia
d)None
CorrectAnswer-BAns.B.Stuporouscatatonia[RefNeerajAhuja&hiep.62,63]Stuporous(retarded)catatonia:Characterizedbyextremeretardationofpsychomotorfunction,whichincludesmutism,rigidity,negativism,posturing,echolalia,Echopraxia,Catalepsy(waxyflexibility),ambitendency,gegenhalten,streotypies,stupor,Mannerism,Grimicing,Automaticobedience,andverbigeration.
1764.Mostappropriatetestforchildpsychologisttoevaluatetheintellectualabilityofa3yearoldis?
a)StanfordBinetscale
b)Denverdevelopmentscale
c)Alexander'spassalongtest
d)Rorschachinkblottest
CorrectAnswer-AAns.A.StanfordBinetscale[RefPsychologicaltestingp.101]Stanford-BinetIntelligenceScaleTheStanford-BinetIntelligenceScaleisanindividuallyadministeredstandardizedtestthatmeasuresintelligenceandcognitiveabilitiesinchildrenandadults,fromagetwothroughmatureadulthood.TheStanford-BinetIntelligenceScaleisnowinitsfifthedition(SB5)andwasreleasedin2003.Itisacognitiveabilityandintelligencetestthatisusedtodiagnosedevelopmentalorintellectualdeficienciesinyoungchildren.
1765.Treatmentofchoiceforakathesiais?
a)Phenytoin
b)Propranolol
c)Dantrolene
d)Lithium
CorrectAnswer-BAns.B.Propranolol[RefKaplan&Saddock's10thlep.1020]"Thefirstlinedrugforakathisiaismostcommonlyalpha-blocker".
1766.Cardinalelementofbehaviortherapyis?
a)Modeling
b)Learning
c)Conditioning
d)Guidance
CorrectAnswer-BAns.B.Learning[RefNirajAhuja6'1*p.220]Behaviortherapyisbasedontheassumptionthatallbehaviors(normalorabnormal)arelearningresponse.Normalandabnormalbehaviorsaresubjecttothelawsoflearningandthesamelawscanbeusedtochangethem.Behaviortherapyisbasedontheoriesoflearningandaimsatchangingthemaladaptivebehaviorandsubstitutingitwithadaptivebehavior.
1767.Toleranceisseenin?
a)Alcoholdependentsyndrome
b)Schizophrenia
c)OCD
d)Alloftheabove
CorrectAnswer-AAns.A.Alcoholdependentsyndrome[RefKaplan&Saddock's10thlep.382]AlcoholdependentsyndromeAlcoholdependentsyndromeusesthesamecriteriafordependenceforothersubstances,i.e.,threeormoreofthefollowing:-
1. Tolerance2. Withdrawalsymptoms3. Alcoholistakeninlargeramountorforlongerperiod.4. Persistentdesireorsenseofcompulsiontotakealcohol.5. Agreatdealoftimespenttoobtainalcohol,tousealcoholorto
recoverfromitseffect.6. Neglectofimportantsocial,occupationalandrecreationalactivities.
1768.Treatmentofchoiceforgeneralizedanxietydisorderis?
a)Benzodiazepines
b)Neuroleptics
c)Betablockers
d)Barbiturates
CorrectAnswer-AAns.A.Benzodiazepines[RefHarrison17th/ep.2712;Kaplan&Saddock's10th/ep.626]TreatmentofgeneralizedanxietydisorderBenzodiazepinesarethedrugofchoice.Drugsinthisgrouparediazepam,Lorazepam,Alprazolam,Oxazepam,chlordiazepoxide.
1769.Generalizedanxietydisorderisdiagnosedwhenanxietyandworrycontinuesforatleast?
a)2months
b)4months
c)6months
d)8months
CorrectAnswer-CAns.C.6months[RefHarrison17"/ep.2712;Kaplan&Saddock's10th/ep.626]GENERALIZEDANXIETYDISORDERThisischaracterizedbyexcessiveanxietyandworrywhicharepersistent&generalizedandnotrestrictedtoanyspecificsituationorobject.Excessiveanxietyworryoccurforatleast6months.
1770.Riskfactorforsuicideis?
a)Increasedserotonin
b)Drugabuse
c)Femalesex
d)Marriedperson
CorrectAnswer-BAns.B.Drugabuse[Ref:NirajAhujaelep.236,237;Essentialsofpsychiatry4th/ep.734]Causes/RiskfactorsforsuicidePsychiatricdisorders:-Depression(mostcommon),alcoholism(2ndmc),Drug/Substancedependence,Schizophrenia,Dementia.Physicalillness:-Cancer,AIDS,Multiplesclerosis,Headtrauma.Psychosocialfactors:-Failureinlove,maritaldifficulties,familydispute,illegitimatepregnancy.Biologicalfactors:-DecreaseinserotoninOther-Malesex,Age>40years,Single(Unmarried,divorcedorwidowed),previoussuicideattempt,socialisolation.
1771.A25yearsoldmalec/orecurrentabdominalpainbutbiochemicalassaysandultrasoundabdomenisnormal.Healsocomplainsofconstantheadaches.Hesuddenlycomplainsoflossofvisionofbilateraleyes.Ophthalmologistfindsnothingonexamination.Symptomsaremostprobablydueto
a)Bilateralopticneuritis
b)Posteriorinferiorcerebellararteryinfarct
c)Malingering
d)Factitiousdisorder
CorrectAnswer-DAns.D.FactitiousdisorderFactitiousdisorderItisalsoknownasHospitaladdiction,hospitalhoboes,orProfessionalpatient.ThetermMunchausensyndromeisusedforthosepatientswhorepeatedlysimulateorfakediseases(intentionally)forthesolepurposeofobtainingmedicalattention.Thereisnootherrecognizablemotive(incontrasttomalingering).ThetypicalpresentationofMunchausensyndromeischaracterizedbyarestlessjourneyfromdoctortodoctorandhospitaltohospital,anever-changinglistofcomplaintsandsymptoms.Thepatienttriestomaintainthesickroletoobtainmedicalattention.
Theremaybeevidenceofearliertreatmentusuallysurgicalprocedure,forexample,multiplesurgicalscars(gridironabdomen).
1772.Mostimportantreceptorsinvolvedwithschizophreniaare?
a)GABAA
b)GABA,,
c)DZd
d)5-HT
CorrectAnswer-CAns.C.DZd[RefKaplan&Saddock's10thlep.470]Dopaminehypothesisisthemostacceptedhypothesisforschizophrenia.Thereishyperactivityofdopaminergicsystem.Thishypothesisissupportedby:
1. Amphetamineandcocainewhichreleasedopamineincentralsynapsesinduceschizophrenialikesymptoms;and
2. Antipsychoticdrugscontroltheschizophrenicsymptomsbyblockingdopamine(D2)receptors.
1773.Functionalsomaticdisorderis?
a)Somatizationdisorder
b)Chronicfatiguesyndrome
c)Hypochondriasis
d)Bodydysmorphicdisorder
CorrectAnswer-BAns.B.ChronicfatiguesyndromeFunctionalsomaticsyndromes:Theyarecharacterizedmorebysymptoms,sufferinganddisabilitythanbydiseasespecific,demonstrableabnormalitiesofstructureorfunction,i.e.ThereisreportingofsomaticsymptomsandresultantdisabilityratherthanontheevidenceofunderlyingconventiondiseaseprocessThreemostcommonfunctionalsomaticsyndromesarefibromyalgia,Irritablebowelsyndromeandchronicfatiguesyndrome.
1774.DHATsyndromeis?
a)Passageofbloodinurine
b)Passageofsemeninurine
c)Passageofpusinurine
d)None
CorrectAnswer-BAns.B.Passageofsemeninurine[RefEncyclopediaofmulticulturalpsychologyp.135]Dhatsyndromeisaculture-boundsyndromeprevalentinIndiansubcontinentinwhichmalepatientsreportthattheysufferfromprematureejaculationorimpotence,andbelievethattheyarepassageofsemen(dhat)inurine.Theconditionhasnoknownorganiccause.
1775.SuiciderateinIndiais?
a)10.5/100,000
b)12.5/100,000
c)14.5/100,000
d)18/100,000
CorrectAnswer-AAns.A.10.5/100,000[RefInternet;Indian1Psychiatry.2012Oct-Dec;54(4):304-319.doi:10.4103/0019-5545.104793]Indiaranks43rdindescendingorderofratesofsuicidewitharateof10.6/100,000reportedin2009(WHOsuiciderates).InthemostrecentNationalCrimeRecordsBureau(NCRB;MinistryofHomeAffairs)reporttheratein2010roseto11.4per100,000population.Themale:femalesuicideratiowas1.78inIndiain2008and2009.
1776.Whichofthefollowingisnotacultureboundsyndrome?
a)Amok
b)Latah
c)Dhat
d)Von-Gogh
CorrectAnswer-DAns.D.Von-Gogh[RefNirajAhuja6'/ep.65]Importantculture-boundsyndromesAtaquedenerviosDhatsyndromeKhyalcapGhostsicknessKufungisisaMaladimounNerviosShenjingshuairuoTaijinkyofushoSustoAmokKoroLatahWindigo
1777.A25yearsoldmaleisnothappywithitsgenderandisalwaysindistressduetothis.Hewantstochangesexandhavevagina.Itcomesunder?
a)Transsexualism
b)Dualroletransvestism
c)Genderdysphoria
d)Sexualmaturation
CorrectAnswer-CAns.C.Genderdysphoria[RefEncyclopediaofrelationshipsacrossthelifespanp.191]*Genderdysphoria(formerlyGenderIdentityDisorder)-Itisdefinedbystrong,persistentfeelingsofidentificationwiththeoppositegenderanddiscomfortswithone'sownassignedsexthatresultsinsignificantdistressorimpairment.-Inthesecases,theassignedsexandgenderdonotmatchtheperson'sgenderidentity,andthepersonistransgender.
1778.Scatologiais?
a)Eatingdisorder
b)Sleepdisorder
c)Paraphilia
d)Defensemechanism
CorrectAnswer-CAns.C.Paraphilia[Ref:NirajAhuja6th/ep.133,134]Scatologia,alsocalledCoprolalia,isadeviantsexualpracticeinwhichsexualpleasureisobtainedthroughthecompulsiveuseofobscenelanguage.Theaffectedpersoncommonlysatisfieshisdesiresthroughobscenetelephonecalls,usuallytostrangers.
1779.DrugofchoiceforTourettesyndromeis?
a)Haloperidol
b)Amantidine
c)Propanolol
d)Diazepam
CorrectAnswer-AAns.A.Haloperidol[RefKaplan&Saddock10`Vep.557]Medicationforticsuppression(Tourretesyndrome)Neuroleptics-Pimozide,alongwithhaloperidolandfluphenazinearethemedicationswiththemostprovenefficacyincontrollingtics.
1780.Loadingdoseofdiazepamforalcoholwithdrawalis?
a)80mg
b)50mg
c)40mg
d)20mg
CorrectAnswer-DAns.D.20mgRigid:10mgfourtimesdailyFlexible:10mgevery4-6hoursasneededbasedonsymptomstoamaximumof60mg/dayFrontloading:20mgevery2-4hoursuntilsedationisachieved;then10mgevery4-6hoursasneededtoamaximumof60mg/day
1781. TCAsarecontraindicatedinallofthefollowingexcept?
a)Narrowangleglaucoma
b)Prostatehypertrophy
c)ApatientonMOAinhibitors
d)Impairedrenalfunction
CorrectAnswer-DAns.D.Impairedrenalfunction[RefLippincottp.81]CommonContraindicationsofTCAs
1. Hypersensitivitytothemedicines2. Cardiacconductionabnormalities3. Within14daysofMAOinhibitors4. Urinaryretention5. Narrowangleglaucoma6. Prostateenlargement7. Shouldbeusedcautiouslyinsuicidaltendency,schizophrenia,
seizuredisorders,paranoia,impairedliverfunctions.8. Safetyinnotestablishedinpregnancyandlactation.Not
recommendedforchildrenless12yearsofage.
1782.DOCforschizophrenicpatientwithpoororalabsorptionis?
a)Clozapine
b)Fluphenazine
c)Sulpride
d)Penfluridol
CorrectAnswer-BAns.B.Fluphenazine[Ref:TherAdvPsychopharmacol.2014Oct;4(5):198-219.doi:10.1177/2045125314540297]Long-actinginjectable(LAI)antipsychotics(APs)(LAIAPs)haveprovedeffectiveinschizophreniaandotherseverepsychoticdisordersbecausetheyassurestablebloodlevels,leadingtoareductionoftheriskofrelapse.LAIsbypasstheinitialdeactivatingprocessbyavoidingfirst-passmetabolismintheliver.
1783. Whichofthefollowingisnotasideeffectofquetiapine?
a)Drymouth
b)Hairloss
c)Suddencardiacdeath
d)Dyspepsia
CorrectAnswer-BAns.B.Hairloss[RefGoodman&Gilmanli'Vep.463-466]Quetiapineisanatypicalantipsychoticusedforthetreatmentofschizophrenia,bipolardisorder,andmajordepressivedisorder.VeryCommonLesscommon RareDrymouth Highbloodpressure ProlongedQTinterval
Dizziness Orthostatichypotension Suddencardiacdeath
Headache Highbloodcholesterol Syncope
Somnolence Elevatedserumtriglycerides Diabeticketoacidosis
Nausea Abdominalpain Restlesslegssyndrome
Vomiting Constipation Hyponatraemia,lowbloodsodium.
Increasedappetite Increasedappetite Jaundice
Sorethroat Increasedliverenzymes Pancreatitis
Troublemoving Backache Agranulocytosis
Rapid
Rapidheartbeat Insomnia Seizure
Weakness Fatigue Cardiomyopathy Pain Suicidalideation
Dyspepsia(Indigestion) Priapism
Peripheraledema Neurolepticmalignantsyndrome
Dysphagia TardiveDyskinesia. Weightgain
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