1.

True about inferior oblique muscle:

a) Supplied by inferior division of 3rd CN

b) Primary eye action-Extorsion, abduction & depression

c) The muscle pass below inferior rectus

d) Origin from lacrimal bone

e) Nerve enters the muscle from ocular surface

Correct Answer - A:C

Ans. (A) Supplied by inferior division of 3rd CN (C) The muscle
pass below inferior rectus
It originates from orbital plate of maxilla lateral to the orifice of
nasolacrimal duct.
It is the only muscle to take origin from front of the orbit. Other recti
muscle take origin from annulus of zinn.
Occulomotor nerve in orbit: The larger, lower division divides into 3
branches for the medial rectus, the inferior rectus 6 the inferior
oblique. All branches enter the muscle on their ocular surfaces
except that for the IO which enters its posterior border'
2. True about Submandibular gland duct
obstruction by stone:
a) Presents as a mass below body of mandible

b) Stone in Wharton duct can be palpated below mucous

membrane of floor of mouth

c) Starts pain just after starting a meal

d) Pain carried by glossopharyngeal nerve

e) All the above

Correct Answer - E
Ans. e. All the above
The submandibular salivary gland is a common site of calculus
formation.
The presence of a tense swelling below the body of the mandible,
which is greatest before or during a meal and is reduced in size or
absent between meals, is diagnostic of the condition.
Examination of the floor of the mouth will reveal absence of ejection
of saliva from the orifice of the duct of the affected gland.
Frequently, the stone can be palpated in the duct, which lies below
the mucous membrane of the floor of the mouth'
All the 3 pairs of salivary glands are supplied by efferent
(Parasympathetic & sympathetic) & afferent nerves (chorda tympani-
br. of VII nerve & IX nerw). Afferent fibers carry pain impulse from
salivary gland
3. True about palatine tonsil:
a) Crypts is lined by squamous epithelium

b) Supplied by IX CN

c) Tongue depressor is used for examination

d) Arterial supply is by tonsillar ascending branch of grater

palatine artery

e) Present in oropharynx

Correct Answer - [Link]

Ans. (A) Crypts is lined by squamous epithelium; (B) Supplied
by IX CN; (C) Tongue depressor is used for examination; (E)
Present in oropharynx
Palatine tonsil
The Palatine tonsils are two prominent masses situated one on
either side between the glossopalatine and pharyngopalatine
arches.
Each tonsil consists fundamentally of an aggregation of lymphoid
tissue underlying the mucous membrane between the palatine
arches.
In the child the tonsils are relatively (and frequently absolutely)
larger than in the adult
The follicles of the tonsil are lined by a continuation of the mucous
membrane of the pharynx, covered with stratified squamous
epithelium
Arteries supplying the tonsil are the:
Dorsalis linguae from the lingual
The ascending palatine and tonsillar from the external maxillary
The ascending pharyngeal from the external carotid
The descending palatine branch of the internal maxillary
A twig from the small meningeal.
The veins end in the tonsillar plexus, on the lateral side of the tonsil
The nerves are derived from the sphenopalatine ganglion, and from
the glossopharyngeal.
4. True about articular cartilage:
a) In zone l chondrocytes are smaller

b) Zone 2 contains articular cartilage progenitor cells

c) Zone 3 contains calcified cartilage

d) Zone 4 contain calcified cartilage

e) Chondrocytes are active cell

Correct Answer - [Link]

Ans.(A) In zone l chondrocytes are smaller; (C) Zone 3 contains
calcified cartilage; (E) Chondrocytes are active cell
There are four zones (layers) of articular cartilage from the articular
surface to subchondral bone.
1. Superficial zone (Zone-1)
It is the thinnest zone.
It consists of two layers : (i) A sheet of densly packed collagen with
little polysaccharide and to cells, covers the joint surface, and (ii)
flattened el ipsoid-shaped chondrocytes, with their major axis
parallel to joint surface.
2. Transition zone (Zone2)
Composition is intermediate between superficial zone and middle
zone.
[Link] zone or radial zone or deep zone (Zone-3)
The chondrocytes are spheroidal in shape with their major axis
perpendicular to joint surface.
Chondrocytes are most active synthetically in this zone.
This zone contains the largest diameter collagen fibrils, the highest
concentration ofproteoglycans and the lowest concentration of
water.
4. Calcified cartilage zone (Zone-4)
It separates the middle zone from subchondral bone.
The cells are small with small amount of endoplasmic reticulum and
golgi apparatus with very little metabolic
5. True about innervation of parotid gland:
a) Postganglionic parasympathetic fibre secretomotor

b) Preganglionic parasympathetic fibre relay in Otic ganglion

c) Preganglionic parasympathetic nerve begin in inferior petrosal

nucleus

d) Sympathetic nerve are vasomotor

e) Postganglionic parasympathetic fibres pass through the

glossopharyngeal nerve

Correct Answer - [Link]

Ans: a. Postganglionic parasympathetic fibre secretomotor. b.
Preganglionic parasympathetic fibre relay in Otic ganglion. d.
Sympathetic nerve are vasomotor.
Development:
Parotid gland is the first salivary gland to appear, in early 6' week.
It is ectodermal in origin and develops from the buccal epithelium
just lateral to the angle of mouth
Structures emerging from parotid
The following structures emerge from the parotid gland:
Anterior border:
Parotid duct
3 Terminal branches of facial nerve:
The zygomatic and buccal branches: toward the temporal region,
eyelids and cheek, respectively.
Mandibular branch : Run along the body of the mandibletowards the
mouth
Apex:
5th terminal branch of facial nerve: Cervical branch continues into
the neck (to platysma).
Anterior & posterior divisions of retromandibular vein
Posterior border:
Posterior auricular nerve
Posterior auricular artery
Posterior auricular vein
Along base:
superficial temporal artery
temporal branch of facial nerve
Auriculotemporal nerve
STRUCTURES WITHIN GLAND:
Arteries:
External carotid artery enters through posteromedial surface
Maxillary artery
Superficial temporal vessel
Posterior auricular artery
Veins:
The retromandibular veins
Facial Nerve
Parotid Duct (Stenson’s duct)
The duct turns opens into the vestibule of the mouth (gingivo- buccal
vestibule) opposite the crown of the upper 2nd molar tooth
Nerve supply:
PARASYMPATHETIC:auriculo temporal nerve
SYMPTHETIC SUPPLY- plexus around the external carotid artery.
SENSORY NERVES: auriculotemporal nerve, except for parotid
fascia & overlying skin which are innervated by Great auricular
nerve (C2, C3).
6. Which of the following muscle is supplied
by median nerve :
a) Oppenenspollocis

b) Adductor pollicis

c) Lateral half of the Flexor digitorumprofundus

d) Superficial head of flexor pollicis brevis

e) Deep part of flexorpollicis brevis

Correct Answer - [Link]

Ans. a. Oppenenspollocis; c. Lateral half of the Flexor
digitorumprofundus; d. Superficial head of flexor pollicis
brevis
There are four short muscles of thumb (pollex), they are abductor
pollicis brevis, opponenspollicis, flexor pollicis brevis and adductor
pollicis. The first three of these muscles form the thenar eminence.
All these muscles are supplied by median nerve except for adductor
pollicis which is innervated by ulnar nerve.
7. True about abduction at shoulder joint:
a) Supraspinatus initiates abduction

b) Serratus anterior & trapezius also help in abduction

c) Multipennate deltoid clavicular fiber is main abductor

d) Axillary nerve injury has no effect on abduction

e) Musculotendinous cuff stabilizes shoulder joint

Correct Answer - [Link]

Ans. (a) Supraspinatus initiates abduction (b) Serratus anterior
& trapezius also help in abduction (e) Musculotendinous cuff
stabilizes shoulder joint.
MOVEMENTS OF SHOULDER JOINT
Movement in every direction (Flexion, extension, abduction,
adduction, rotation, circumduction)
Spinal Cord regulating Shoulder movements (C5, C6, C7 & C8)
Flexion, Abduction, & lateral rotation (C5, C6,).
Extension, Adduction, & Medial rotation is (C6, C7, C8)
Movements that take place during abduction of shoulder are
axial rotation of humerus at acroclavicular joint ,elevation of
humerus& movement at clavicular end of sternoclavicular joint.
PLANE HUMERAL RANGE
TYPE OF AXIS OF MUSCLES FACTOR
OF HEAD OF
MOVEMENT MOTION INVOLVED LIMITING
MOTION GLIDING MOTION
Total-0-
165º or
-Inferior
175º
glenohumera
Full
ligament
internal
-Tightness of
 internal
-Tightness of
Inferiorly rotation of
Frontal Saggital Deltoid, the inferior
Abduction in glenoid humerus0-
plane axis Supraspinatus joint
cavity 60º
capsule of
Full
the
external
gleno-
rotation of
humeral joint
humerus0-
90º
8. Organ which have no lymphatic supply:
a) Eyeball

b) Brain

c) Liver

d) Kidney

e) Spinal cord

Correct Answer - [Link]

Ans. a. Eyeball; b. Brain & e. Spinal cord
Lymph capillaries are absent from the cellular structures like brain,
spinal cord, splenic pulp, bone morrow, articulate cartilage,
epidermis, hair, nail & cornea.
Lymphatic vessel are found in all tissue & organ of body except the
central nervous system, eyeball, internal ear, epidermis of the skin,
cartilage & bone.
9. Which of the following statement(s) is/are
true about sphincters of body:
a) Lower 5 cm of oesophageal act as oesophageal sphincter & it is
not morphologically different from other portion of oesophagus

b) Oesophageal & pyloric sphincter remains in topically contracted

state

c) Pre-capillary sphincter is present in b/w metarteriole & capillary

d) Pudendal nerve supplies the sphincter urethrae

e) Sphincter of oddi lies at junction of duodenum & CBD

Correct Answer - [Link]

Ans. b. Oesophageal & pyloric sphincter remains in topically
contracted state; c. Pre-capillary sphincter is present in b/w
metarteriole & capillary; d. Pudendal nerve supplies the
sphincter urethrae ; e. Sphincter of oddi lies at junction of
duodenum & CBD
The common bile duct enters the duodenum at duodenum papilla.
Its orifice is surrounded by the sphincter of Oddi 6 it usually unites
with the main pancreatic duct just before entering the duodenum
At the lower end of the esophagus, extending upward about 3 cm
above its junction with stomach, it is broad lower esophageal
sphincter.
Lower oesophageal sphincter, a specialize zone of circular smooth
muscle surrounding the oesophagus at its transit through the
diaphragm and for much of its short abdominal floor
At the point where each true capillary originates from a metarteriole,
a smooth muscle fiber usually encircles the capillary. This is called,
the precapillary sphincter. This sphincter can open & close the
entrance to the capillary
Pyloric sphincter remain slightly tonically contracted almost all the
time. Despite normal tonic contraction of the pyloric sphincter, the
pylorus usually is open enough for water & other fluids to empty from
the stomach into the duodenum with ease.
10. Muscle(s), which form the floor of pelvic
floor:
a) Obturator internus

b) Piriformis

c) Puborectalis

d) Pubococcygeus

e) Ischiococcygeus

Correct Answer - [Link]

Ans. c. Puborectalis; d. Pubococcygeus; e. Ischiococcygeus
The pelvic floor is formed by the large levator ani (with parts
including the pubococcygeus, puborectalis, and iliococcygeus) and
the much smaller coccygeus.
11. True about Atlanto-axial joint:
a) Vertebral artery pass through grove on arch of atlas vertebrae
to foramen magnum

b) Permits flexion & extension

c) Permit side to side movement of head

d) Permits flexion only

e) Permits rotation

Correct Answer - [Link]

Ans. a. Vertebral artery pass through grove on arch of atlas
vertebrae to foramen magnum;c. Permit side to side movement
of head ; e. Permits rotation
There are 3 atlantoaxial articulations- two lateral atlantoaxial joints
b/w the lateral masses of Cl & C2 vertebrae & one median
atlantoaxial joint b/w the dens of C2 & the anterior arch transverse
ligament of the atlas
Movement(mainly rotation) at all three atlantoaxial joints permits the
head to be turned from side to side, as occurs when rotating the
head to indicate disapproval(the 'NO' movement)
The most important factors maintaining stability are the ligaments, of
which the transverse atlantal ligament is the strongest.
The alar ligaments are weaker
12. All are true about CSF except:
a) Total volume is 250 ml

b) Pressure is 60-180 mm of H2O

c) Formed from choroid plexus of 3rd ventricle

d) Formed from choroid plexus of lateral ventricle

e) None of the above

Correct Answer - A
Ans.a. Total volume is 250 ml
The major source of CSF is the choroidal plexus of all 4 ventricles,
mainly in two lateral ventricles.
Other sources of CSF are ependymal cells of the ventricles and the
brain itself, via perivascular spaces.
The total volume of CSF in an adult is about 125-150 ml.
The rate of formation of CSF is about 500-550 ml/day. Thus the CSF
is replaced 3-4 times every day.
CSF pH is 7.33
112 mm H20 is the average normal CSF pressure
13. Which of the following play most
important role in memory:
a) Synaptic network

b) Electric conduction network

c) Conductivity circuit

d) Conductivity network

e) None

Correct Answer - A
Ans: a. Synaptic Net.
[Ref: Ganong 25th/283-88; Guyton 12th/ 67; A K Jain 6th/1039-40]
Synaptic network s single best answer "Long-term memory involves
changes in the structure of neurons including growth of new
processes and synapses.
So, to the extent that you remember anything about this material on
memory tomorrow, or next week, or next year, it will be because
structural changes in synapses are beginning in your brains.
14. Cyanide poisoning block K influx & Na
efflux. But ATP reverse this effect. So true
statement(s) related to mechanism of
action of cyanide is/are:
a) K influx & Na efflux is regulated by Na-K ATPase enzyme

b) K influx & Na efflux is regulated by Na-K pump

c) ATP provide energy for this channel

d) Na-K ATPase channel is ATP independent

e) None

Correct Answer - [Link]

Ans: a. K influx & Na Efflux Is Regulated By Na-K-ATpase
Enzyme b. K influx & Na Efflux Is Regulated By Na-K pump c.
ATP provides energy for this channel.
[Ref: Reddy 32nd/595; Katzung 13th/1010; Guyton 12th/ 357; A K
Jain 6th/459; Harrison 19th/262e-7]
Cyanide:
Directly poisons the last step in the mitochondrial electron transport
chain, cytochrome a3, which results in a shutdown of cellular energy
production.
This poisoning results from cyanide high affinity for certain metals,
notably Co and Fe+++. Cytochrome a3 contains Fe+++, to which
CN- binds.
Cyanide Poisoning:
It inhibits the action of cytochrome oxidase, carbonic anhydrase &
probably of other enzyme system.
It blocks the final step of oxidative phosphorylation & prevents the
formation of ATP & its use as an energy source.
15. True about Carbon monoxide poisoning:
a) CO has 100 times more affinity than 02 for Hb

b) Cause right side shifting of 02 dissociation curve

c) Oxygen-haemoglobin saturation curve becomes hyper​bolic

shape

d) Pulse oximetry can accurately detect level of CO

e) 10-15% level of CO normally may occur in healthy non​smoker

Correct Answer - C
Ans: c. Orygen-haemoglobin saturation saturation Curve
Becomes Hyperbolic Shape
[Ref Ganong 25th/650-51; Guyton 12th/352; A K Jain 6th/ 431;
httpst/pedclerk. bsd. uchicago. edu/page/ (www. nebi. Nlm. nih.
gov)
Carbon-monoxide-poisoning:
Carbon monoxide shifts the oxygen-haemoglobin saturation curve to
the left and changes it to a more hyperbolic shape.
Less oxygen is available for the tissues.
plasma level of carboxyhemoglobin is normally quite low.
At baseline, levels up to 3 percent ,nay be seen in nonsmokers,
while smokers may have levels up to 10-15 % percent.
Left shift of O2-Hb dissociation curve occur in - CO poisoning HbF,
myoglobin eb decrease in body temperature.
CO has about 240 times the affinity of O2for Hb; this means that CO
will combine with the same amount of Hb as 02 when the CO partial
pressure is 240 times lower.
16. Dead space is increased in:
a) Positive pressure ventilation

b) Extension of neck

c) Anticholinergic drug

d) Endotracheal tube intubation

e) Emphysema

Correct Answer - [Link]

Ans: a. Positive pressure ventilation b. Extension of neck c.
Anti Cholinergic drug e. Emphysema
Ref Ajay Yadav 5th/4-5; Ganong 25th/632-33; Guyton323; A Klain
6th/421
Anatomical Dead Space Increased in:
OId age
Neck extension
jaw protrusion
Bronchodilators
Increasing lung volume (more in inspiration)
Atropine(cause bronchodilation)
Anaesthesia mask, circuits
Intermittent positive pressure ventilation (IppV) & positive end
expiratory pressure( PEEP )
Alveolar Dead Space increased by:
Lung pathologies affecting diffusion at capillary membrane like
interstitial lung disease, pulmonary embolism, pulmonary edema &
ARDS
General anaesthesia
IPPV
PEEP
HYPotension
17. Which of the following is true about
cardiac innervation:
a) T1 -T5 is sympathetic supply

b) Inferior & superior cervical ganglia not involve in innervation

c) Parasympathetic supply is from vagus nerve

d) Great cardiac nerve arise from superior cervical ganglia

e) Inferior cervical ganglia gives off Inferior cardiac nerve

Correct Answer - A:E

Ans: a. T1-T5 is sympathetic e. Inferior cervical ganglia gives
off inferior cardiac nerve
[Ref: BDC 6th/ Vol. I 267;Grayb 40th/982; Guyton 12th/178; A K lain
6th/ 324]
Cardiac Innervation
The cervical ganglia are paravertebral ganglia of the sympathetic
nervous system.
The cervical ganglion has three paravertebral ganglia.
Superior cervical ganglion (largest) - adjacent to C2 & C3
Middle cervical ganglion (the smallest) - adjacent to C6; target:
heart,neck.
Inferior cervical ganglion. The inferior ganglion may be fused with
the first thoracic ganglion to form a single structure, the stellate
ganglion adjacent to C7.
The middle cardiac nerve (great cardiac nerve), the largest of the
three cardiac nerves, arises from the middle cervical ganglion.
Nerves emerging from chemical sympathetic ganglia contribute to
the cardiac plexus.
SymPathetic supply: T 1 to T 5 spinal segments.
Sympathetic preganglionic fibres pass into the symPathetic trunk to
superion middle & inferior cardiac ganglion
Sympathetic postganglionic fibres passes via superior middle &
inferior cardiac sympathetic nerves
Parasympathetic supply to heart is via two vagus nerves with their
cell bodies located in the medulla in the nucleus ambiguus.
18. True about cortisol level in blood plasma:
a) Morning concentration is 17-18nmol/d1

b) Morning concentration is 5-23 pg/dL

c) Evening concentration is almost half of morning concen​tration

d) Evening concentration is 5-23 [Link]/dL

e) None

Correct Answer - B:C

Ans: b. Morning concentration is 5-23 microg/dL c. Evening
concentration is almost Half Of Morning Concentration
Evening concentration is almost half of morning concentration (a/c
below reference values).
Cortisol concentration at 8. 00 am in morning 5-20 mcg/dL (140-550
nmol/L).
19. Saccadicc eye movement is controlled by:
a) Parietal lobe

b) Prefrontal lobe

c) Temporal lobe

d) Frontal cortex

e) Occipital lobe

Correct Answer - D
Ans: d. Frontal cortex
[Ref Ganong 25th/189, 195-96; Guyton 12tlt/786; A K Jain 1115-16]
Normally saccadic movements are voluntary but can be aroused by
peripheral visual or auditory stimuli by stimulation of frontal eye
fields(area 8).
Thus these movements are programmed in the frontal cortex.
The bilateral frontal eye fields in this part of the cortex are concerned
with the control of saccades, and an area just anterior to these fields
is concerned with vergence and the near response.
20. True about normal ECG:
a) Normal PR interval is 0.12-0.20 s

b) PR internal correspondence initiation of P wave to initia​tion of R

wave

c) QT internal correspondence initiation of Q wave to initia​tion of T

wave

d) Normal QRS interval < 0.12 s

e) Normal QTc interval

Correct Answer - A:D

Ans: a. Normal PR interval is 0.12-0.20 s d. Normal QRS interval
[Ref: Ganong 25th/524; Guyton 12th/179-80; ECG made Easy by
Hamptot 4th/6-71]
The PR interval is measured from the beginning of P wave to the
beginning of QRS complex.
A QTc interval longer than 0. 45 s is likely to be abnormal.
Normal QRS interval duration is no greater than 0. 12s.
QT interval is a measure of the time between the start of the Qwave
and the end of the T wave in the heart's electrical cycle.
21. Which of the following is/are true about
SIADH:
a) Desmopressin is used for treatment

b) Vasopressin level is inappropriately high

c) Plasma osmolality is higher than urine osmolality

d) Ted Osmolality of urine

e) Ted Osmolality of plasma

Correct Answer - B:D

Ans: b. Vasopressin level is inappropriately High d. Ted
Osmolality of urine
[Ref Harrison 19th/2280; Ganong 25th/698; A K Jain 6th/ 673-74]
Desmopressin is very useful in the management of diabetes
insipidus.
Syndrome of Inappropriate Antidiuretic Hormone
The syndrome of "inappropriate' hypersecretion of antidiuretic
hormone (SIADH) occurs when vasopressin is inappropriately high
relative to serum osmolality.
Vasopressin is responsible not only for dilutional hyponatremia
(serum sodium < 135 mmol/L) but also for loss of salt in the urine
when water retention is sufficient to expand the ECF volume,
reducing aldosterone secretion
Features:
Hyposmolality
Increased urine osmolality
Urine osmolality becomes higher than plasma osmolality
Urinary Na+ exceeds 20 mEq/L
22. Which of the following feature(s) is/are
suggestive of ne​hogrnic DI in comparison
to central DI :
a) Desmopressin nasal spray restore urine output to normal level

b) Basal vasopressin level > 1 pg/ml

c) Normal posterior pituitary bright spot is not visible on MRI scan

d) Change in water loss during fluid deprivation test

e) None

Correct Answer - B
Ans: b. Basal vasopressin level > 1 pg/ml
[Ref Ganong 25th/698; Guyton 12th/488-89; A K Jain 6th/674]
Failure to Produce ADH: "Central" Diabetes Insipidus.
The treatment for central diabetes insipidus is administration of a
synthetic analog of ADH, desmopressin, which acts selectively on
V2 receptors to increase water permeability in the late distal and
collecting tubules.
Desmopressin can be given by injection, as a nasal spray, or orally,
and it rapidly restores urine output toward normal.
The polyuria anil polydipsia of nephrogenic DI are not affected by
treatment *ith standard doses of DDAVP.
23. All are Urea cycle enzymes except:
a) Ornithine transcarbamylase

b) Carbamoyl-phosphate synthetase I

c) Argininosuccinase

d) Citrulline synthase

e) Argininosuccinic acid synthetase

Correct Answer - D
Answer: (D) Citrulline synthase [Ref Harper 30th/290-96,
29th/274-88; Lippincott
24. Non-polar amino acids are:
a) Proline

b) Lysine

c) Isoleucine

d) Arginine

e) Asparginine

Correct Answer - A:C

Ans: a. Proline c. Isoleucine [Ref Harper 30th/16-22; Lippincott
6th/1-9; Satyanarayan 4th/ 48]
Acidic and Polar side chains Aspartic Acid→ Glutamic Acid
Basic and Polar side chains→ Arginine, Lysine, Histidine
Uncharged & Polar side chains→ Asparginine, Glutamine, Serine,
Threonine, Tyrosine
Non Polar Amino Acids with Non Polar side chains→ Glycine,
Alanine, Valine, Leucine, Isoleucine, Proline.
25. True about squalene:
a) Present in subhuman primate only

b) It is one of the major carbohydrates of body

c) It involves in the synthesis of cholesterol

d) It involves in the synthesis of steroids

e) None

Correct Answer - C:D

Ans: (C) It involves in synthesis of cholesterol, (D) It involves in
synthesis of steroids
Squalene is a hydrocarbon and a triterpene, and is a natural and
vital part of the synthesis of all plant and animal sterols, including
cholesterol, steroid hormones, and vitamin D in the human body.
Squalene is used in cosmetics, and more recently as an
immunologic adjuvant in vaccines.
It is a natural 30-carbon organic compound originally obtained for
commercial purposes primarily from shark liver oil (hence its name),
although plant sources (primarily vegetable oils) are now used as
well, including amaranth seed, rice bran, wheat germ, and olives.
Squalene and omega 2 fatty acid has unlike omega 3 fish oils more
complete and effective chemical groups.
26. Molecular weight of protein can be
determined/estimated by:
a) SDS-PAGE

b) Gel filtration chromatography

c) Agarose gel electrophoresis

d) Ultracentrifugation

e) FRET microscopy

Correct Answer - [Link]

Ans: (A) SDS-PAGE (B) Gel filtration chromatography (D)
Ultracentrifugation [Ref Harper 30th/28; Shinde 7th/772-74;
Satyanarayan 4th/ 725, 60; Vasudevan 5th/482-851
"SDS-PAGE is commonly used for molecular weight determination
of proteins" (Vasudevan 5th/482)
"SDS-PAGE is a popular technique for determination of molecular
weight of proteins" (Satyanarayan 4th/ 725)
" Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-
PAGE) is a reliable method for determining the molecular
weight (MW) of an unknown protein".
"The gel filtration chromatography technique is used for "Separation
of protein molecules, purification of proteins & molecular weight
determinations" Ultra centrifugation is an indispensable tool for the
isolation of subcellular organelles, proteins, & nucleic acids. In
addition, this technique is also employed in determination of
molecular weight of macromolecules\
27. Gel used in RNA electrophoresis:
a) Agarose gel

b) Polyacrylamide plain gel

c) Polyacrylamide SDS (Sodium dodecyl sulphate) impreg​nated

Polyacrylamide gel

d) A & C

e) None

Correct Answer - A
Ans: a. Agarose gel
Separation of RNA in agarose gels is used for a number of different
purposes, including Northern blots to monitor RNA expression
levels, checking RNA integrity and size selection of RNA for cloning
experiments.
Separation of RNA based on fragment length requires conditions
that are different from DNA analysis.
The most frequently used denaturants for RNA agarose gel
electrophoresis are formaldehyde, formaldehyde/formamide, and
glyoxal plus DMSO.
The most efficient RNA denaturant is methylmercury hydroxide.
Because of the hazards associated with this denaturant, it is the
least used system for RNA
28. Which of following releases/provide
energy:
a) Conversion of ADP to ATP

b) Breaking of high energy bond to low energy bond

c) Conversion of pyruvate to lactate

d) Electrical gradient across inner & outer side of mitochon​dria]

membrane

e) Passage of e- through FAD in electron transport chain

Correct Answer - [Link]

Ans: (B) Breaking of high... (D) Electrical gradient across ... (E)
Passage of e- through FAD....
In absence of 0xygen pyruvate is reduced to lactic acid (without
producing ATP). In anaerobic glycolysis, pyruvate acts as a
temporary H-store.
It dehydrogenation (oxidizes), the reduced NADH + H+ back to
oxidized NAD+, so that glycolysis can continue even in the absence
of 02. In presence of 02, lactic acid can be oxidized into pyruvic acid
again.
Electron transport is coupled to the phosphorylation of ADP by the
transport ("pumping") of protons (H+) across the inner mitochondrial
membrane from the matrix to the inter membrane space at
Complexes I, III, and IV.
This process creates an electrical gradient (with more positive
charges on the outside of the membrane than on the inside) and a
pH gradient (the outside of the membrane is at a lower pH than the
inside).
The energy generated by this proton gradient is sufficient to drive
ATP synthesis. Thus, the proton gradient serves as the common
intermediate that couples oxidation to phosphorylation.
29. Which of the following is feature(s) of
diabetic ketoacidosis:
a) Decreased triglyceride level

b) Increased fatty acid level

c) TLipoprotein

d) Decreased ketone bodies

e) High Anion gap acidosis

Correct Answer - [Link]

Ans: (B) Increased fatty acid level (C) TLipoprotein (E) High
Anion gap acidosis [Ref Harper 30th/ 231; Lippincott 6th/339,
345; Satyanarayan 4th/481, 682; Harrison 19th/2417-18]
DKA is characterized by hyperglycemia, ketosis, and metabolic
acidosis (increased anion gap) along with a number of secondary
metabolic derangements, Leukocytosis, hypertriglyceridemia, and
hyperlipoprotein​emia are commonly found as well
Increased lactic acid production also contributes to the acidosis. The
increased free fatty acids increase triglyceride and VLDL production.
VLDL clearance is also reduced because the activity of insulin-
sensitive lipoprotein lipase in muscle and fat is decreased.
Hypertriglyceridemia may be severe enough to cause pancreatitis.
Reduced insulin levels, in combination with elevations in
catecholamines and growth hormone, increase lipolysis and the
release of free fatty acids. Normally, these free fatty acids are
converted to triglycerides or very-low-density lipoprotein (VLDL) in
the liver.
30. Which of the following is/are true about
pH of solution:
a) Absolute concentration of acid & salt

b) Relative concentration of acid & salt in solution

c) Increase of temperature increases pH

d) A rise in H+ concentration decreases pH

e) None

Correct Answer - B:D

Ans: (B) Relative concentration..., (D) A rise in H* concentra​‐
tion....
"When pH measured at room temperature there is no direct
correlation between pH and temperature.
A rise in H+ concentration decreases pH while a fall in H+
concentration increases pH. The reverse is true for OH-
concentration
The ratio of salt to acid concentration- Actual concentrations of salt a
acid in a buffer solution may be varying widely, with no change in
pH, so long as the ratio of the concentrations remains the same
31. True statement(s) about Magnetic-
activated cell sorting:
a) It is a method to separate specific cell from complex mixture

b) Fluorescent dyes are uses

c) Antibody-coated magnetic nanoparticles are used

d) Antibodies used are specific for certain cell surface markers

e) Magnetic field is applied

Correct Answer - [Link]

Ans: (A) It is a method..., (C) Antibody-coated magnetic..., (D)
Antibodies used are..., (E) Magnetic field is appli...
MACS, is a procedure developed by Miltenyi Biotec to separate cells
from complex mixtures using antibody-coated magnetic nano
particles.
The antibodies are specific for certain cell surface markers, either
expressed on your population of interest (positive selection), or
expressed on undesired cell types (negative selection).
After adding the antibody-coated beads to the cell mixture and
incubating, the suspension is added to a special single-use
separation column affixed to a magnet, to which the beads stick,
while unlabeled cells flow through.
32. Silver staining is done for:
a) DNA

b) RNA

c) Karyotyping analysis

d) Protein

e) Collagen

Correct Answer - [Link]

Answer- (A) DNA (B) RNA (C) Karyotyping analysis (D) Protein
(E) Collagen
Silver staining is a highly sensitive method for detecting proteins and
nucleic acids (dsDNA & RNA) in polyacrylamide slab gels.
Silver staining is the use of silver to selectively alter the appearance
of a target in microscopy of histological sections; in temperature
gradient gel electrophoresis; and in polyacrylamide gels.
Silver staining is the most sensitive method for permanent staining
of proteins or nucleic acids in polyacrylamide gels.
Histological characterization: Silver staining aids the visualization of
targets of interest, namely intracellular and extracellular cellular
components such as DNA and proteins, such as type III collagen
and reticulin fibres by the deposition of metallic silver particles on the
targets of interest.
33. Non-coding RNA is/are:
a) miRNA

b) Si RNA

c) tRNA

d) mRNA

e) rRNA

Correct Answer - [Link]

Ans: a. miRN..., b. Si RNA..., c. tRNA..., e. rRNA..., [Ref Harper
30th/394-95, 368; en. wikipedia. org; Lippincott 6th/417]
All eukaryotic cells have two major classes of RNA, the protein
coding RNAs, or messenger RNAs (mRNAs), and two forms of
abundant non-protein coding RNAs delineated on the basis of size:
the large ribosomal RNAs (rRNA) and long noncoding RNAs
(lncRNAs) and small noncoding RNAs transfer RNAs (tRNA), the
small nuclear RNAs (snRNAs) and the micro and silencing RNAs
(miRNAs and siRNAs).
The mRNAs, rRNAs and tRNAs are directly involved in protein
synthesis while the other RNAs are participate in either mRNA
splicing (SnRNAs) or modulation of gene expression by altering
mRNA function (mi/SiRNAs) and/or expression (lncRNAs). These
RNA differ in their diversity, stability, and abundance in cells
34. Polymerase III synthesizes:
a) Fragment 28S of rRNA

b) Fragment 23S of rRNA

c) Fragment 5 S of rRNA

d) tRNA

e) mRNA

Correct Answer - C:D

Ans: c. and d [Ref Harper 30th/395-98; Lippincott 428]
"RNA polymerase III synthesizes tRNA, 5S rRNA, and some snRNA

and snoRNA" (Lippincott 428)

35. Two strands of DNA is/are held by:
a) Glycosidic bond

b) Hydrogen bond

c) Covalent bond

d) Ionic bond

e) Van der waal force

Correct Answer - B
Answer( b) hydrogen bond [Ref Harper 30th/359; Lippincott
6th/396-97; Satyanarayan 4th/75]
The two strands are held together by hydrogen bond formed
by complementary base pairs" (Satyanarayan 4th/75)
"The base pairs are held together by hydrogen bonds: two between
A and T and three between G and C. These hydrogen bonds, plus
the hydrophobic interactions between the stacked bases, stabilize
the structure of the double helix.
36. Which of the following is/are true about
Translation:
a) N-formyl methionine is first amino acid in prokaryotes

b) Uses energy in form of GMP

c) Elongation factor EF-1 & EF-2 used in prokaryotes

d) Elongation factor P is used in eukaryotic organism

e) Three initiation factors are required in prokaryotes

Correct Answer - A:E

Ans: a. N-formylmethionine..., e. Three initiation [Ref Harper
30th/419-23; Lippincott 6th/438-42; Satyanarayan 4th/554-60]
In eukaryotes, the first amino acid incorporated is methionine (AUG
codon). But in prokaryotes, the same codon attracts N-formyl
methionine, which is the first amino acid" (Vasudevan 5th/432)
"Elongation factor P is a prokaryotic protein translation

factor required for efficient peptide bond synthesis on 70S

ribosomes from fMet-tRNAf Met. It probably functions indirectly by
altering the affinity of the ribosome for aminoacyl-tRNA, thus
increasing their reactivity as acceptors for peptidyl Steps in Protein
Synthesis
In prokaryotes, three initiation factors are known (IF-1, IF-2, and IF-
3), whereas in eukaryotes, there are over ten (designated eIF to
indicate eukaryotic origin). Eukaryotes also require ATP for initiation.
37. Nucleic acid amplification techniques are:
a) PCR

b) Real time PCR

c) DNA Cloning

d) Next generation DNA sequencing

e) None

Correct Answer - A:B

Ans: a. PCR ..., b. Real time ....[Ref Harper 30th/458; Robbins
9th/180; Lippincott 6th/479;Harrison 19th/ 150e-7; [Link]
springer. corn]
Real-time PCR automates the laborious process of amplifica​tion by
quantitating reaction products for each sample in every
Cycle.
There are several methods for amplification (copying) of small
numbers of molecules of nucleic acid to readily detectable levels.
These NAATs include PCR, LCR, strand displacement amplification,
and self-sustaining sequence replication.
The amplified nucleic acid can be detected after the reaction is
complete or (in real-time detection) as amplification proceeds. The
sensitivity of NAATs is far greater than that of traditional assay
methods such as culture.
38. Second messenger is/are:
a) Ca2+

b) DNA

c) Histone

d) cDNA

e) None

Correct Answer - A
Ans: a. Ca2+ [Ref Harper 30th/501, 91-92, 179, 343; Lippincott
6th/94-951
Nucleotides, such as cyclic adenosine mono-phosphate (cAMP) and
cyclic guanosine monophosphate (cGMP), serve as second
messengers in signal transduction pathways.
Two of the most widely recognized second messenger systems are
the calciumlphosphatidy linositol system, and the adenylyl cyclase
system, which is particularly important in regulating the pathways of
intermediary metabolism.
39. True about genetic code:
a) Follow Mendelian law

b) It is total number of chromosome in the body

c) It is nucleotide sequence which codes for amino acids

d) It codes for DNA

e) None

Correct Answer - C
Ans: [Link] is nucleotide sequence which codes for amino acids
Mendelian Genetics is widely regarded as the cornerstone of
classical genetics. It is a set of primary beliefs relating to the
transmission of hereditary characteristics from parent organisms to
their offspring
The genetic code is a dictionary that identifies the correspondence
between a sequence of nucleotide bases and a sequence of amino
acids.
The Nucleotide Sequence of an mRNA Molecule Consists of a
Series of Codons That Specify the Amino Acid Sequence of the
Encoded Protein
40. Restriction endonuclease cleaves:
a) dsDNA

b) RNA

c) Histone

d) Protein

e) ssDNA

Correct Answer - A
Ans: a. dsDNA
Restriction endonucleases (restriction enzymes), which
cleave double-stranded (ds) DNA into smaller, more manageable
fragments, has opened the way for DNA analysis"
Restriction enzyme (RE or Restriction Endonuclease) is an enzyme
that cleave double-stranded DNAQ at specific recognition nucleotide
known as restriction sitesQ
The cut DNA fragments by RE may have sticky ends (cohesive
ends)° or blunts ends° depending on the mechanism used by
enzyme
DNA fragments with sticky ends are particularly useful for
recombinant DNA experiments (hybrid or chimeric DNA molecules)
Restriction enzyme is named according to the organism from which
it was isolated
41. Phospholipase A2 act on:
a) Phosphoglyceric acid

b) Phosphate

c) Ca+

d) Phosphatidyl-inositol

e) None

Correct Answer - D
Ans: d. Phosphatidyl-inositol
Phospholipases hydrolyze the phosphodiester bonds of
phosphoglycerides, with each enzyme cleaving the phos​pholipid at a
specific site.
Phospholipases release molecules that can serve as messengers
(for example, DAG and IP3), or that are the substrates for synthesis
of messengers (for example, arachidonic acid.
Phospholipases are responsible not only for degrading
phospholipids, but also for "remodeling" them. For example,
phospholipases Al and A2 remove specific fatty acids from
membrane-bound phospholipids; these can be replaced with
alternative fatty acids using fatty acyl CoA transferase.
42. Enzyme used in DNA repair is/are:
a) DNA gyrase

b) DNA polymerase

c) Restriction endonuclease

d) DNA ligase

e) None

Correct Answer - B:D

Ans: b. DNA poly..., d. DNA (Ref Harper 30th/382, 389-92;
Lippincott 6th/ 411-131
When the strand containing the mismatch is identified, an
endonuclease nicks the strand and the mismatched nucleotide(s)
is/are removed by an exonuclease.
Additional nucleotides at the 5'- and 3'-ends of the mismatch are
also removed. The gap left by removal of the nucleotides is filled,
using the sister strand as a template, by a DNA polymerase.
The 3'-hydroxyl of the newly synthesized DNA is joined to the 5'-
phosphate of the remaining stretch of the original DNA strand by
DNA ligase
43. Nucleosome contains:
a) DNA

b) RNA

c) Chromatin

d) Histone

e) None

Correct Answer - A:D

Ans: a. DNA d. Histone [Ref Harper 30th/371-72; Lippincott 6th/
409]
Histones are highly alkaline proteins found in eukaryotic cell nuclei
that package and order the DNA into structural units called
nucleosomes.
They are the chief protein components of chromatin, acting as
spools around which DNA winds, and playing a role in gene
regulation.
When the histone octamer is mixed with purified dsDNA under
appropriate ionic conditions, the same x-ray diffraction pattern is
formed as that observed in freshly isolated chromatin. Biochemical
and electron microscopic studies confirm the existence of
reconstituted nucleosomes.
In the nucleosome, the DNA is super coiled in a left handed helix
over the surface of the disk-shaped histone octamer
44. Serotonin, a mediator of inflammation in
our body, is secreted /released by:
a) Leukocytes

b) Endothelial cell

c) Mast cell

d) Platelet

e) Macrophage

Correct Answer - D
Answer- D. Platelet
Serotonin :It is found in the intestinal mucosa, brain tissue &
platelets.
Release of serotonin (and histamine) from platelets is stimulated
when platelets aggregate after contact with collagen, thrombin,
adenosine diphosphate (ADP), and antigen-antibody complexes.
45. Autosomal recessive disease(s) is/are :
a) Sickle cell anaemia

b) Phenylketonuria

c) Tuberous scelerosis

d) Familial polyposis coli

e) Marfan syndrome

Correct Answer - A:B

Answer- (A) Sickle cell anaemia (B) Phenylketonuria
1. Metabolic-
Cystic fibrosis
Phenylketonuria
Galactosemia
Homocystinuria
Wilson disease
Hemochromatosis
2. Hematopoietic
Sickle cell anemia
Thalassemias
3. Endocrine
Congenital adrenal hyperplasia
4. Skeletal
Ehlers-Danlos syndrome
5. Nervous
Friedreich ataxia
Spinal muscular atrophy
46. Which of the following is/are features(s) of
lewy body dementia:
a) Plaque containing beta-amyloid peptide

b) Deposition of a-synuclein protein

c) Often resistant to standard treatment

d) Common in elderly

e) Risk of falling may present

Correct Answer - [Link]

Answer- (B) Deposition of a-synuclein protein (C) Often
resistant to standard treatment (D) Common in elderly (E) Risk
of falling may present
Alpha- synuclein containing Lewy bodies occur in the brainstem,
midbrain, olfactory bulb, and neocortex.
This is a neuro degenerative disorder clinically characterized by
dementia and signs of Parkinson's disease.
Common in elderly.
The DLB clinical syndrome is characterized by visual hallucinations,
parkinsonism, fluctuating alertness, falls.
47. True about Alzheimer's disease:
a) More common in older age

b) Impairment of the ability to remember new information

c) Mainly affects long term memory

d) General cognitive behavior impaired in prodromal phase

e) Atrophy of frontal & parietal lobe

Correct Answer - [Link]

Answer- (A) More common in older age (B) Impairment of the
ability to remember new information (D) General cognitive
behavior impaired in prodromal phase (E) Atrophy of frontal &
parietal lobe
Alzheimer's disease (AD) is a slowly progressive disease of the
brain that is characterized by impairment of memory.
Alzheimer's disease is Common in 5th and 6th decade.
Early Stage-
This is considered as a mild/early stage and the duration period is 2-
4 years.
Frequent recent memory loss.
Writing and using objects become difficult and depression and
apathy can occur.
Second stage-
This is considered as a middle/moderate stage and the duration is 2-
10 years.
Dementia of Alzheimer's type is associated with Depressive
symptoms, Delusions ,Apraxia and aphasia.
Pervasive and persistent memory loss impacts life across settings.
Moderate stage-
Increased memory loss and confusion.
Last stage-
This is considered as the severe stage and the duration is 1-3 years.
Extreme problems with mood, behavioral problems, hallucinations,
and delirium.
48. True about Hypersensitivity pneumonitis:
a) Occurs due to inorganic antigen

b) Increased CD8+ T cells in bronchoalveolar lavage

c) Manifests mainly as an occupational and environment disease

d) For severe acute cases, oral steroids is given for 3-4 weeks

e) Interstitial inflammatory infiltrate is seen in lung

Correct Answer - [Link]

Answer- (B) Increased CD8+ T cells in bronchoalveolar lavage
(C) Manifests mainly as an occupational and environment
disease (D) For severe acute cases, oral steroids is given for 3-
4 weeks (E) Interstitial inflammatory infiltrate is seen in lung
It is manifested mainly as an occupational disease, in which
exposure to inhaled organic agents leads to acute and eventually
chronic pulmonary disease.
Bronchoalveolar lavage specimens also consistently demonstrate
increased numbers of both CD4+ and CDB+ T lymphocytes.
Histology shows evidence of an interstitial inflammatory infiItrate in
the lung.
In acute cases, prednisolone should be given for 3-4weeks, starting
with an oral dose of 40 mg per day.
49. RS cell having same immunophenotyping
are present in which subtypes of
Hodgkin's lymphoma:
a) Nodular sclerosis

b) Lymphocyte predominant

c) Lymphocyte rich

d) Mixed cellularity

e) Lymphocyte depletion

Correct Answer - [Link]

Answer- (A) Nodular sclerosis (C) Lymphocyte rich (D) Mixed
cellularity (E) Lymphocyte depletion
In the first four subtypes- nodular sclerosis, mixed cellularity,
lymphocyte-rich, and lymphocyte cells.
50. True about Lyonisation of X chromosome:
a) Inactivation of X chromosome only in somatic cell

b) Inactivation of X chromosome only in germ cell

c) Inactivation of X chromosome in somatic & germ cell both

d) Maximun number of Barr body is equal to X chromosome

e) All

Correct Answer - A
Answer- A. Inactivation of X chromosome only in somatic cell
In female, one of two X-chromosome (either paternal or maternal) is
inactivated during embryogenesis as stated in Lyon hypothesis.
This inactivation is passed to all the somatic cell while the germ cells
in the female remain unaffected.
51. Two most common cancer in Indian
woman is:
a) Carcinoma breast

b) Carcinoma cervix

c) Carcinoma colon

d) Carcinoma stomach

e) Carcinoma lung

Correct Answer - A:B

Answer- (A) Carcinoma breast (B) Carcinoma cervix
In women, cancer breast, cervix uteri, colorectum, ovary, lip & oral
cavity.
52. Which of the following is paraganglioma:
a) Adrenal Pheochromocytoma

b) Extra-adrenal Pheochromocytoma

c) Carotid body tumour

d) Carcinoid tumour

e) Glomus tympanicum

Correct Answer - [Link]

Answer- (B) Extra-adrenal Pheochromocytoma (C) Carotid body
tumour (E) Glomus tympanicum
Pheochromocytorna is a chromaffin-cell neoplasm that can arise an
adrenal (adrenal medulla) or extraadrenal tumor.
Extraadrenal pheochromocytoma is also referred to as
paraganglioma.
The carotid body tumor is a prototype of a parasympathetic
paraganglioma.
Glomus tympanicum: Most common tumour in middle ear.
53. Feature(s) of XIII factor deficiency is/are:
a) Delayed wound closure

b) Clot solubility tests are abnormal

c) TaPTT

d) TPT

e) TBT

Correct Answer - A:B

Answer- A,Delayed wound closure B,Clot solubility tests are
abnormal
It characteristically leads to delayed bleeding that occurs hours to
days after a hemostatic challenge.
Clot solubility tests are abnormal.
54. Which of the following statement(s) is/are
correct except:
a) Increased PT in extrinsic pathways

b) Increased aPTT in instrinsic pathways

c) If platelet count is > 1.5 lac/microL, then normal homeo-stasis

present

d) BT is decreased in platelet abnormality

e) None

Correct Answer - D
Aswer- D. BT is decreased in platelet abnormality
Hemostasis is spontaneous arrest of bleeding by physiological
Process.
Prothrombin time (PT):
This assay tests the extrinsic and common coagulation pathways.
Partial thromboplastin time (PTT):
This assay tests the intrinsic and common clotting pathway.
Prolongation generally indicates a defect in platelet numbers or
function.
55. True about Dentigerous cyst:
a) Arises in relation to unerupted teeth

b) It most commonly encroaches maxillary antrum

c) Mandibular third molar is common site

d) Common in mandible

e) All

Correct Answer - [Link]

Answer- A,Arises in relation to unerupted teeth C,Mandibular
third molar is common site D,Common in mandible
Common in lower jaw (mandible) in women 30-40 years.
It occurs in relation to unerupted, permanent, molar tooth, most
commonly the upper or lower third molar.
56. Prognostic factors for carcinoma
esophagus is/are:
a) Depth of invasion

b) Lymph node status

c) Tumour grading

d) Stage of the disease

e) All

Correct Answer - E
Answer- E, All
Stage The most reliable prognostic facfor for esophageal cancer is
the stage of the tumour at the time of diagnosis.
Tumour size
Lymph nodes status
Cancer has spread to distant organs
Cancer that remains after surgery
Tumour grade
57. True about surgical jaundice:
a) Increase of serum bilirubin

b) Increase acid phosphatase

c) Increase alkaline phosphatase

d) Urine bilirubin is absent

e) Stool sterocobilinogen absent

Correct Answer - [Link]

Answer- A,Increase of serum bilirubin C,Increase alkaline
phosphatase E,Stool sterocobilinogen absent
Obstructive jaundice-
1. Biluribin
Direct & Indirect- increased
2. Urine bilirubin- increased
3. Serum albumin- generally unchanged
4. Alkaline phosphatase- Increased
5. Sterocobilinogen- absent
58. Which of the following marker favours
diagnosis of preinvasive & invasive
cervical cancer:
a) Ki67

b) Oncoprotein E6

c) p16INK4, cyclin E, and Ki-67

d) Oncoprotein E8

e) None

Correct Answer - [Link]

Answer- A,Ki67 B,Oncoprotein E6 C,p16INK4, cyclin E, and Ki-
67
The expression of E7 determines the inactivation of pRb with a
consequent increase of free E2F in the cell, leading to both an
increase of cyclin-dependent kinase inhibitor pl6 (p16INK4a) and
aberrant proliferation (marked by increased levels of Ki-67
expression).
59. Which of the following marker/mutation
is/are seen in papillary carcinoma of
thyroid:
a) Synaptophysin

b) RET/PTC

c) P53

d) NTRK1

e) RAS

Correct Answer - [Link]

Answer- B,RET/PTC D,NTRK1 E,RAS
Genetic Alterations in Thyroid Neoplasia-
RET/PTC
BRAF
TRK
RAS
60. Which of the following is/are true about
pregabalin:
a) Approved drug for diabetic neuropathy

b) Approved for treatment of generalized tonic clonic seizure

c) Peripheral edema is side effect

d) Somnolence is side effect

e) Approved for use in Partial seizure

Correct Answer - [Link]

Ans. a. Approved drug For Diabetic neuropathy; c. Peripheral
edema is side effect; d. Somnolence is side effect; e. Approved
for use in partial seizures.
[Ref KDT 7th/419; Katzung 13th/4M, 419; Harrison tgth/2682;
Pharmacology by Satoskar 24th 139)
Pregabalin side-effect includes: Cognitive changes, sedation &
peripheral edema.
GABA analog.
Anti seizure activity and for its analgesic property.
Approved for use in neuropathic pain, including painful diabetic
peripheral neuropathy, post herpetic neuralgia & complex regional
pain syndrome.
Toxicity included- Somnolence, dizziness, ataxia
61. Drug(s) used for overactive bladder:
a) Oxybutinin

b) Tolterodine

c) Mirabegron

d) Onabotulinum toxin A

e) Pirenzepine

Correct Answer - [Link]

Ans . a. Oxybutynin; b. Tolterodine; c. Mirabegron; D.
Onabotulinum toxin A
[R4 KDf 7th/117-18; Katzung 13th/ 127-28; Rang & Date 8th/366;
Pharmacology by Satoskar 24th/ 3OS - 07]
Overactive Bladder:
Antimuscarinic drugs such as Oxybutynin, Flavoxate, tolterodine &
trospium are used for both neurogenic & non- neurogenic overactive
bladder.
Sollfenacin & darifenacin are the new drugs(M3 antagonist) for use
in overactive bladder.
Mirabegron is beta-3 adrenergic agonist used for overactive bladder.
Onabotulinum toxin A is used as single intradetrusor injection, to
treat overactive bladder.
62. All are true about warfarin except:
a) Act through inhibition of coagulation factor IX

b) Protamine sulphate reverses its action

c) Monitoring is done through INR

d) Target of INR with warfarin is generally 2-3

e) Skin necrosis is usually occur in 3-10 days of initiation of

warfarin

Correct Answer - B
Ans: b. Protamine sulphate reverses its action.
[Ref KDT 7th/620-24; Katzung 13th/ 590-92; Rang & Dale Sth/ 30q
Pharmacology by Satoskar 24th/ jN-301]
Warfarin induced skin necrosis is a rare complication characterized
by the appearance of skin lesion 3-10 days after initiation of
treatment.
Dose of warfarin adjusted to give an INR of 2-4, the precise target
depending on the clinical situation.
The reference range for prothrombin time is usually around 12-13
seconds and the INn in absence of anticoagulation therapy is 0. 8-1.
2
Warfarin: Dose regulation is done by prothrombin time & INR
(Heparin/aPTT/clotting time.
Antagonist is Vit K (c. f Heparin- Protamine sulphate).
63. True about M/A of doxorubicin:
a) Intercalate b/w DNA strands

b) Inhibition of DNA polymerase

c) Inhibition of RNA polymerase

d) Inhibition of topoisomerase II

e) Inhibition of protein synthesis

Correct Answer - A:D

Ans. A. Intercalate b/w DNA strands; D. Inhibition Of
Topoisomerase II
[Ref: KDT 7th/867; Katzung 13th/932'j5; G 6 G 1lth/1358;
Pharmacology by Satoskar 24th/ 835)
Doxorubicin: It acts as a non-specific inhibitor of topoisomerase- II,
thus interfering with DNA replication.
64. Anticholinergic drug side-effect includes:
a) Constipation

b) Urinary retention

c) Mydriasis

d) Hypothermia

e) Blurring of vision

Correct Answer - [Link]

Ans: A. Constipation. B. Urinary retention C. Mydriasis E.
Blurring of vision
[Ref: KDT 7th/120;G dz G 11th/194; Katzung 13th/ 129; Rang &
Dale \th/ 164-65; Pharmacology by Satoskar 24th/301).
Body temperature is frequently elevated.
Unfortunately, children, especially infants, are very sensitive to
hyperthermic effects of atropine.
Constipation & urinary retention(precipitation especially in elderly)
can occur with atropine
Difficulty in swallowing, dry mouth, ferer, dry-flushed & hot skin,
difficulty in micturition, Mydriasis, photophobia, blurring of near
vision, palpitations, dreadful visual hallucination, ataxia, delirium,
psychotic behavior, weak & rapid pulse, hypotension,
cardiovascular collapse with respiratory depression, convulsion &
coma.
65. Which of the following is/are true about
benefits of Sus​tained release formulation
of drugs:
a) Decreased incidence and/or intensity of undesired effects

b) Increases potency of the drug

c) Release of drug is less influenced by pH

d) Prolong drug effect

e) Decreased frequency of administration

Correct Answer - [Link]

Ans A. Decreased Incidence and/or Intensity of undesired
effects; c. Release Of Drug Is Less Influenced By pH; D.
Prolong drug effect; E. Decreased Frequency of administration.
[Ref: KDf 7th/35; G 6'G 11th/5; Pharmacology by Satoskar 24th/7;
[Link] pharmatutor. org/articles/review-sustained-release-
dosage' forms).
Sustained release implies slow release of the drug over a time
period.
It may or may not be controlled release
Advantages of sustained release dosage forms:
Control of drug therapy is achieved.
Rate and extent of drug absorption can be modified
Frequency of drug administration is reduced.
Patient compliance can be improved.
Drug administration can be made convenient
Maximizing the availability of drug with minimum dose.
The safety margin of high potency drug can be increased.
66. True about drug-response curve(DRC):
a) Steepest in middle portion of the DRC

b) Inverted U shaped curve may be for some drug

c) Rectangular hyperbola- when plotted in logarithmic scale

d) Sigmoid shape- when plotted in logarithm is used

e) Enables comparison of potency of drugs

Correct Answer - [Link]

Ans. (A) Steepest in middle portion of the DRC (B) Inverted U
shaped curve may be for some drug (C) Rectangular hyperbola-
when plotted in logarithmic scale (E) Enables comparison of
potency of drugs
Dose-Response Relationship:
Rectangular hyperbola.
Sigmoidal curve in dose -response relationship: the steepest portion
in the middle-wiki.
DRC is used to measure- drug potency, drug efficacy & drug safety-
slideshare.
Some drugs cause low-dose stimulation and high-dose inhibition of
response.
These U-shaped relationships for some receptor systems are said to
display hormesis.
Several drug-receptor systems can display this property e.g.,
prostaglandins, endothelin, and purinergic and serotonergic
agonists, among others), which is likely to be at the root of drug
toxicity.
67. True about organophosphorus poisoning:
a) Atropine is best for early treatment & maintenance

b) Pralidoxime is important for restoring neuromuscular

transmission

c) Phenytoin is the primary drug used for seizure control

d) Mydriasis present

e) Pralidoxime & atropine works synergistically

Correct Answer - [Link]

Ans. (A) Atropine is best for early treatment & maintenance
(B) Pralidoxime is important for restoring neuromuscular
transmission (E) Pralidoxime & atropine works synergistically
[Ref Reddy 32nd/495-97;G & G ltth/21};KDT 7th/111: 1 3th/979-80;
Pharmacology by Satoskar 24th/ 297]
OrganophosPhorus Poisoning:
AII case of Anti-ChE poisoning must be promptly given atropine 2
mg i. V repeated every 10 min till dryness & other signs of
atropinization appear.
Continued treatment with maintenance doses may be required for 1-
2 weeks
The use of oximes in organophosphate poisoning is secondary to
that of atropine. Moreven the clinical benefit of oximes is highly
variable.
Control of convulsions with judicious use of diazepam.
Ocular manifestations include marked miosis' ocular pain'
conjunctival congestion, diminished vision, ciliary spasm, And brow
ache.
Atropine in sufficient dosage effectively antagonizes the actions at
muscarinic receptor sites, and to a moderate extent at peripheral
ganglionic and central sites
68. Which of the following drug(s) act by
inhibiting protein synthesis by attaching
to 50 S ribosome:
a) Tetracycline

b) Ampicillin

c) Isoniazid

d) Imipramine

e) Ethionamide

Correct Answer - B:C

Ans. (B) Ampicillin (C) Isoniazid
[KDT 7th/734,768; Katzung 13th/789]
Tetracyclines bind to 30S ribosome & inhibit aminoacyl RNA
attachment to the A site
Erythromycin & clindamycin bind to 50S ribosome & hinder
translocation of the elongated peptide chain back from A site to P
site. Peptide synthesis may be prematurely Terminated.
ChloramPhenicol binds to 50S subunit' It interfere with peptide bond
formation & transfer of peptide chain from P site
Aminoglycosides bind to several sites at 30S & 50S subunits- freeze
initiation, interfere with polysome formation & cause misreading of
mRNA code
69. OCP efficacy decreases with concurrent
administration of which of the following
drug(s):
a) Phenytoin

b) Ampicillin

c) Isoniazid

d) Imipramine

e) Ethionamide

Correct Answer - A:B

Ans. (A) Phenytoin (B) Ampicillin
[Ref KDT 7th/ 326; Katzung 13th/712; Rang & DaIe 9th/ 434:
Pharmacology by Satoskar 24th/ 967).
Contraceptive failure may occur with concurrent administration
of:
Enzyme inducer: Phenytoin, phenobarbital, primidone,
carbamazepine, rifampin, ritonavir - Metabolism of estrogenic &
progestational component is increased.
Tetracyclines-ampicillin.
Deconjugation of estrogens secreted in bile fails to occur their
enterohepatic circulation is interrupted → blood level fal
70. All are true about tamoxifene except:
a) Used as adjuvant therapy in estrogen receptor positive breast
cancer

b) Approved for the primary prophylaxis of breast cancer in high

risk woman

c) No effect on uterus

d) Pro-estrogen effect on bone

e) Cause endometrial Ca

Correct Answer - [Link]

Ans. (A) Used as adjuvant therapy in estrogen receptor positive
breast cancer (C) No effect on uterus (D) Pro-estrogen effect on
bone (E) Cause endometrial Ca
[Ref; KDT 7th/101'02; Katzung 13th/ 106]
NM is located in neuromuscular junction 6 cause depolarization of
muscle end Plate
NN located on autonomic ganglia, adrenal medulla & CNS
Most smooth muscles & glands have M2 6 M3 subtypes; M3
Predominates.
Ach is a major neurotransmitter at autonomic, somatic as well as
central sites. Release of Ach from nerve terminal help in synaptic
transmission
71. Which of following true regarding
acetylcholine receptors:
a) M2 receptor- heart

b) MI receptor- smooth muscle

c) NM receptor is present on neuromuscular junction

d) Synaptic junction-Ach is transmitter

e) NN located on adrenal medulla

Correct Answer - [Link]

Ans. (A) M2 receptor- heart (C) NM receptor is present on
neuromuscular junction (D) Synaptic junction-Ach is
transmitter (E) NN located on adrenal medulla
[Ref; KDT 7th/101'02; Katzung 13th/ 106]
NM is located in neuromuscular junction 6 cause depolarization of
muscle end Plate
NN located on autonomic ganglia, adrenal medulla & CNS
Most smooth muscles & glands have M2 6 M3 subtypes; M3
Predominates.
Ach is a major neurotransmitter at autonomic, somatic as well as
central sites. Release of Ach from nerve terminal help in synaptic
transmission
72. Which of the following drug(s) comes in
risk category B of FDA teratogenic risk
categories for pregnancy:
a) Phenytoin

b) Resperidone

c) Olanazapine

d) Clozapine

e) Arpirazole

Correct Answer - D
Ans. D. Clozapine
[Ref: KDT 7th/90; Katzung 13th/1018; Rang 6 Dale 8th/700;
Pharmacology by Satoskar 24th/ 1 122; [Link] bulletin-
oxford journal]
Category A:
No risk to fetus in human studies
Levothyroxine
Potassium
Supplementation
MgSO4
Category B
Animal studies show no risk
Human studies are lacking
Penicillins
Cephalosporins
Macrolides
Brimonidine
Category C
Animal studies show Positive teratogenic risk
Human studies are not available
Albuterol
Zidovudine
CCB
Morphine
Atropine
Category D
Human and animal studies show positive teratogenic risk
Can be used in pregnancy because of benefits greater than risk
might be acceptable.
Corticosteroids
Azathioprine
Carbamazepine
Valproate
Methotrexate
Lithium
Category X
Human and animal studies show positive teratogenic risk
Absolutely contraindicated in pregnancy because of risk greater than
benefits.
Thalidomide
isotretinoin
Fluoroquinolones
Tetracyclines
Chloramphenicol
Warfarin
ACE inhibitors
73. Which of the following is true regarding
ropinirole wrt L-dopa :
a) Cognitive symptom improves

b) Lower incidence of hallucination

c) Cause excessive sleepiness

d) More effective in the treatment of patients who have developed

on/off phenomena

e) Provide neuroprotective effect

Correct Answer - [Link]

Ans. C,Cause excessive sleepiness D,More effective in the
treatment of patients who have developed on/off phenomena
E,Provide neuroprotective effect
[Ref: KDT 7th/430-31; G & G 535-j8;Katzung 13th/478; Rang 6 Date
8th/494-95; Pharmacology by Satoskar 24th/237
All the dopamine agonists in larger doses can coute tevere
neuropsychiatric adverse effects.
Ropinirole & Pramipexole
Selective D2/D1 receptor agonists
Better tolerated dt do not show the fluctuations in efficacy associated
with levodopa.
They do, however, cause somnolence 6 sometimes hallucinations
(recent evidence suggests that they may predispose to compulsive
behaviours, such as excessive gambling, overeating 6 sexual
excess, related to the reward functions of dopamine
A disadvantage of current dopamine agonists is their short plasma
half Life(6-8 hr), requiring 3 times daily dosage though slow release
once daily formulations are now available
Trial have found them to afford symptom relief comparable to
levodopa.
Some trials have noted lower incidence of dyskinesias 6 motor
fluctuations among Patients treated with these drugs than dose
treated with levodopa
It is longer acting than levodopa.
High incidence of hallucination & sleepiness
74. True about methanol poisoning:
a) Gastric decontamination is helpful

b) Formate & formaldehyde are active metabolite

c) Taking with Ethanol cause more toxicity

d) Fomipezole a specific antagonist, is given for treatment

e) Cause high anion gap acidosis

Correct Answer - [Link]

Ans. A,Gastric decontamination is helpfu B,Formate &
formaldehyde are active metabolite D,Fomipezole a specific
antagonist, is given for treatment E,Cause high anion gap
acidosis
[Ref: KDT 7th/ 394-96; Katzung 13th/393; Pharmacology by
Satoskar 24th/ 9s-96).
Treatment of Methyl Alcohol
Fomepizole, an alcohol dehydrogenase inhibitor, is approved for the
treatment of ethylene glycol poisoning and methanol poisoning.
Ethanol used intravenously as treatment for methanol poisoning.
Methanol concentrations higher than 50 mg/dl are thought to be an
absolute indication for hemodialysis and treatment with fomepizole
or ethanol, although formate blood levels are a better indication of
clinical pathology.
Hospitalisation, nursing care
Gastric lavage, activated charcoal
Treatment of acidosis/hypoglycemia
Inhibition of methanol metabolism- Giving ethyl alcohol dt fomepizole
(a specific inhibitor of alcohol dehydrogenase & drug of choice for
methanol poisoning)
Promote metabolic degradation of formate: folinic acid together with
folic acid
Diuretics, urine alkalinisation
Hemodialysis in severe case
Maintenance of nutrition
75. S/E of Bevacizumab includes:
a) Hypertension

b) Hemoptysis

c) Malena

d) Cerebellar stroke

e) Not cause gastrointestinal perforation

Correct Answer - [Link]

Ans. A,Hypertension B,Hemoptysis C,Malena D,Cerebellar
stroke
[Ref: KDT 7th/871: Katzung 13th/ 937-38; Rang & Dale 8th/;
Pharmacology by Satoskar 24th/840).
S/E of Bevacizumab:
Hypertension
Arterial thromboembolism-heart attack 6 stroke
Vessel injury 6 haemorrhages
Heart failure
Proteinuria
Gastrointestinal perforation
Healing defect
76. TNF-a Inhibitors are used for :
a) Ulcerative colitis

b) Crohn's disease

c) Rheumatoid arthritis

d) Psoariasis

e) Lichen planus

Correct Answer - [Link]

Ans. A,Ulcerative colitis B,Crohn's disease C,Rheumatoid
arthritis D,Psoariasis
[Ref Hanison 19th/1961;Neena Khanna 5th/58, 68;CMDT 2016/641;
KDT 7th/883-84).
TNF-alpha Inhibitors: Use
Etanercept -Rheumatoid arthritis, severe/refractory ankylosing
spondylitis, plaque psoriasis, polyarticular idiopathic juvenile arthritis.
Infliximab- refractory rheumatoid arthritis, ankylosing spondylitis,
psoriasis, fistulating Crohn's disease, ulcerative colitis
Adalimumab- Use as like infliximab
Certolizumab - Crohn's disease
Golimumab - ulcerative colitis Psoriasis: Treatment includes TNF
blockers like etanercept, infliximab.
77. Antibiotic of choice for
Stenotrophomonas maltophilia in​fection
is:
a) Ampicillin

b) Trimethoprim-sulfamethoxazole (TMP-SMX)

c) Penicillin

d) Ciprofloxacin

e) None

Correct Answer - B
Ans: b. Trimethoprim-sulfamethoxazole (TMP-SMX)
78. Which of the following is/are paraphilia:
a) Pedophilia

b) Sodomy

c) Frotteurism

d) Voyeurism

e) Exhibitionism

Correct Answer - [Link]

Ans: A. Pedophilia [Link] D. Voyeurism E. Exhibitionism
[Ref Synopsis of Psychiatry by Kaplon dr Saddock llth/593-97;
Reddy 32nd/ 411; Neeraj Ahuja 7th/124-26; Parikh 7th/ 411-12J
Paraphilias or perversions are sexual stimuli or acts that are
deviations from normal sexual behaviors, but are necessary for
some persons to experience arousal and orgasm.
According to the Diagnostic and Statistical Manual of Mental
Disorders, fifth edition (DSM-5), the term paraphilic disorder is
reserved for those cases in which a sexually deviant fantasy or
impulse has been expressed behaviorally.
Individuals with paraphilic interests can experience sexual pleasure,
but they are inhibited from responding to stimuli that are normally
considered erotic. The paraphiliac person's sexuality is mainly
restricted to specific deviant stimuli or acts.
DSM-5 lists pedophilia, frotteurism, voyeurism, exhi​bitionism, sexual
sadism, sexual masochism, fetishism, and transvestism with explicit
diagnostic criteria because of their threat to others and/or because
they are relatively common paraphilias. There are many other
paraphilias that may be diagnosed
79. Which of the following joint is best
predictor of age of 16-17 year by X-ray:
a) Knee

b) Elbow

c) Hip

d) Wrist

e) Ankle

Correct Answer - D:E

Ans: (D) Wrist (E) Ankle [Ref Reddy 32nd/78, 77, 74; Parikh 7th/
61-63]
For estimation of age: Take X-ray
6-12 years Elbow joint, Wrist joint, 6 yr- center for lower end of
ulna (A); medial epicondyle of the humerus (A)
9 years: Olecranon (A)
9 to 11 years: Trochela of humerus (A)
10th to 11th year: Pisiform (A)
11th year: Lateral epicondyle of humerus (A)
13 to 16 years: X-ray of pelvis elbow joint &pelvis (13thyr -separate
centers in triradiate cartilage of acetabulum (A)
12 to 14 years: Lesser trochanter of femur (A)
14th year: Crest of ilium (A), fusion of medial epicondyle of
humerus, lateral epicondyle with trochlea
15th year: fusion of triradiate cartilage of acetabulum
16-17 year: wrist
Crest of ilium: 18-19.
Ischeal tuberostty,clavicle(inner end): 21-22(F), 23-24(M)
80. Which of the following is/are feature(s) of
human hair:
a) Medullary index: <0.3

b) Cortex is thin

c) Cortex is thick

d) Medulla-narrow

e) Medulla-wider

Correct Answer - [Link]

Ans: a. Medullary index..., c. Cortex is thick..., d. Medulla​nar....
[Ref Reddy 32nd/91; Parikh 7th/ 499]
Trait Human Hair Animal hair
Character Fine & thin Coarse & thick
Cuticular scales are
Cuticle Cuticular scales are
very
large & have step-
short, broad, thin &
like or
irregularly annular wavy projections
Thin, rarely more
Cortex Thick, well -striated
than
& 4 to 10 times as twice as broad as
broad as medulla medulla
Varies considerably,
Medulla usually narrow, discontinuous, Continuous & wider
fragmented or entirely absent
Mostly present in the
Pigment Evenly distributed
medulla
 medulla
Specific for different
Precipitin Specific for human
animals
Medullary index
(Diameter of Below 0.3 Above 0.5
medulla/
Diameter of
shaft)
81. Which of the following is true
statement(s)about exhumation?
a) Police can order for exhumation

b) Executive magistrate can order for exhumation

c) Postmortem can not be done on exhumated body

d) Cr PC 176(4) is related to enquiry of exhumated body

e) CrPC 174 is related to enquiry of exhumated body

Correct Answer - B:D

Ans: b. Executive magistrate..., d. Cr PC 176 (4) is related...
[Ref Reddy 32nd/ 128-29; Parikh 7th/133-34]
It is digging out of an already buried body legally from the grave
There is no time limit for exhumation in India
Autopsies are performed on exhumed bodies:
(1) In criminal cases, such as homicide, suspected homicide
disguised as suicide or other types of death, suspicious poisoning,
death as a result of criminal abortion & criminal negligence;
(2) In civil cases, such as accidental death claim, insurance,
workmen's compensation claim, liability for professional negligence,
survivorship & inheritance claims or disputed identity
Authorisation: The body is exhumated only when, there is a written
order from the executive magistrate. The body can he exhumated by
any government doctor
The body is exhumated under the supervision of a medical officer &
magistrate in the presence of a police officer
Whenever practicable, the magistrate should inform the relatives of
the deceased & allow them to remain present at the enquiry (176 (4)
Cr. P. C)
82. True about cadaveric spasm:
a) Same mechanism as rigor mortis

b) Mechanism is unknown

c) Also k/a instantaneous rigor

d) Occur only in cold environment

e) Can be seen in some drowning case

Correct Answer - [Link]

Ans: b. Mechanism..., c. Also 1c/a..., e. Can be seen....
Cadaveric Spasm (Cataleptic Rigidity or Instantaneous Rigor) is a
rare condition. In this, the muscles that were contracted during life
become stiff and rigid immediately after death without passing into
the stage of primary relaxation, and its Mechanism is unknown
It occurs especially in cases of sudden death, excitement, fear,
severe pain, exhaustion, cerebral haemorrhage, injury to the
nervous system, firearm wound of the head, drowning, convulsant
poisons (such as strychnine) .
83. Cause(s) of Opisthotonus is/are:
a) Cocaine

b) Strychnos Nux Vomica seed

c) Strychnine

d) Codeine

e) Curare

Correct Answer - B:C

Ans: B. Strychnos Nux Vomica seed C. Strychnine
Strychnine (alkaloid from seeds of strychnosnux-vomica) cause
opisthotonus (Parikh 7th/639-40)
"Strychnine : The convulsions are most marked in antigravity
muscles, so that the body typically arches in hyperextension
(opisthotonus)" (Reddy 32nd/581)
Causes of Opisthotonus: Arnold-Chiari syndrome, Meningitis,
Brain tumor, Gaucher disease, Growth hormone deficiency
(occasionally), Glutaricaciduria and organic acidemias (forms of
chemical poisoning).
84. Which of the following is NOT rape:
a) Sexual intercourse with wife, of age below 15 year, with
consent

b) Sexual intercourse with wife, of age 16 year, with consent

c) Sexual intercourse with a girl below 18 years of age, with

consent

d) Sexual intercourse with a girl of 18 year with consent

e) Sexual intercourse with wife who is living separately from

him under a decree of separation, or any custom or usage
with her consent

Correct Answer - [Link]

Ans: b. Sexual intercourse with..., d. Sexual intercourse with a
girl..., e. Sexual intercourse with wife who is living ...... [Ref
Reddy 32nd/ 392-95; Parikh 7th/389-911
Rape: The Criminal Law (Amendment) Bill, 2013 (5.375, I.P.C)
Acc to Gazette Notification of GOI regarding Criminal Law
(amendendment) Act, 2013 released on 2 april, 2013, 1t is age 15
year .
Exception to S. 375, I.P.C: Sexual intercourse or sexual acts by
a man with his own wife, the wife not being under 15 years.
There is controversial reference regarding age of wife, either 16 or
15 year in Reddy (old & new ed.) & Parikh.
With her consent, when the man knows that he is not her husband
and that her consent is given because she believes that he is
another man to whom she is or believes herself to be lawfully
married.
With her consent when, at the time of giving such consent, by
reason of unsoundness of mind or intoxication or the administration
by him personally or through another of any stupefying or
unwholesome Substance, she is unable to understand the nature
and consequences of that to which she gives consent.
With or without her consent, when she is under eighteen years of
age.
When she is unable to communicate consent
85. In which of the following condition(s),
children are prone to fungal & viral
infection:
a) Thymic aplasia

b) Agammaglobulinemia

c) Lymphocytopenia

d) Severe combined immune deficiencies (SCID)

e) Chediak-Higashi syndrome

Correct Answer - [Link]

Ans: (A) Thymic aplasia (C) Lymphocytopenia (D) Severe
combined immune deficiencies (SCID)
[Ref Harrison 19th/2104-08; Ananthanarayan 9th/171-76; Jawetz
27th/146-47; Greenwood 16th/148J
T cell disorders affect both cell-mediated and humoral immunity
making the patient susceptible to viral, protozoal and fungal
infections. Viral infections such as those by cytomegalovirus and
attenuated measles in the vaccine can be fatal in these patients.
Lymphocytopenia is most often due to AIDS or undernutrition, but it
also may be inherited or caused by various infections, drugs, or
autoimmune disorders. Patients have recurrent viral, fungal, or
parasitic infections.
Hypogammaglobulinemia leads to recurrent bacterial in​fections.
Viral & fungal infections are controlled by cell-mediated immunity,
which is normal in hypogammaglobulinemic individual.
86. Which of the following is type 3
hypersensitivity reaction (immune
complex disease):
a) SLE

b) Diabetes Mellitus I

c) Goodpasteur syndrome

d) Multiple sclerosis

e) Bronchial asthma

Correct Answer - A
Ans: a. SLE
[Ref Ananthanarayan 9th/162-67; Robbins 9th/201; lawetz 27th/145​‐
46; Greenwood 16th/144]
Type 3 Hypersensitivity reaction (Immune complex disease)
Ananthanarayan 9th/162, It is two types-arthus reaction & serum
sickness.
the damage is caused by antigen-antibody complexes. These may
precipitate in & around small blood vessels causing damage to cells
secondarily, or on membranes, interfering with their function .
87. Which of the following infection has
incubation period
a) Brucella

b) Gonorrhoea

c) Syphilis

d) HBV

e) Leishmaniasis

Correct Answer - [Link]

Ans: (A) Bruce...,(B) Gonorrho..., (C) Syphilis
[Ref Harrison 19th/1134, 194e-2, 1005; Ananthanarayan 9th/341 .1]
Brucella: The incubation period is usually about 10-30 days, but
may be sometimes be very prolonged" (Ananthanarayan 9th/341)
"Brucella: The incubation period varies from 1 week to several
months, and the onset of fever and other symptoms may be abrupt
or insidious" (Harrison 19th/194e-2)
Syphilis: Clinical disease sets in after an incubation period of about
a month(range 10-90 days)" (Ananthanarayan 9th/372)
"Syphilis: The median incubation period in humans (-21 days)
suggests an average inoculum of 500-1000 infectious organisms for
naturally acquired disease; the incubation period rarely exceeds 6
weeks.
Gonococcal infection in men: Acute urethritis is the most common
clinical manifestation of gonorrhea in male patients. The usual
incubation period after exposure is 2-7 days, although the interval
can be longer & some men remain asymptomatic (Harrison
19th/1005)
88. Stain used for Mycobacterium
tuberculosis is/are:
a) Ziehl-Neelsen technique of staining

b) Auramine-rhodamine stain

c) Gomori methenamine silver stain

d) Kinyoun stain

e) Gram staining

Correct Answer - [Link]

Ans: a. Ziehl-Neelsen techni..., b. Auramine-rhodamine sta..., d.
Kinyoun stain
[Ref Harrison 19th/1113; Ananthanarayan 9th/346-48; Lippincott
Microbiology 3rd/ 21; Jawetz 27th/38; Text Book of Diagnostic
microbiology by Connie R. Mohan 3rd/691;Greenwood 16th/15]
When stained with carbol fuchsin by Ziehl-Neelsen method or by
fluorescent dyes(Auramine 0, Rhodamine), mycobacterium
tuberculosis reist decolourisation by 20% sulphuric acid & are
therefore called acid fast.
Ziehl-Neelsen method d phenol-auramine procedures are methods
of great practical importance in the diagnosis of mycobacterial
diseases" .
The Kinyoun method, or Kinyoun stain, is an acid-fast procedure
used to stain any species of the genus Mycobacterium and Nocardia
species. It involves the application of a primary stain (carbol
fuchsin), a decolorizer (acid-alcohol), and a counter stain (methylene
blue)"
89. Food borne diseases are:
a) Japanese encephalitis

b) Hemophilia

c) HBV

d) Botulism

e) Typhoid fever

Correct Answer - D:E

Ans: d. Botuli..., e. Typhoid ...,[Ref Park 23rd/657]
The term" food-borne disease" is defined as: "A disease, usually
either infectious or toxic in nature, caused by agents that enter the
body through the ingestion of food." With the catering systems, food-
borne diseases are on the increase throughout the world.
Due to toxins produced by certain bacteria LIKE Botulism,
Staphylococcus poisonS
Bacterial diseases:- Typhoid,fever, Paratyphoid fever,
salmonellosis, staphylococcal intoxication, C. perfringens,
Shigellosis brucellosis etc.
90. Which of the following is NOT lysine
positive non-fermen​tor:
a) Burkholderia pseudomallei

b) Burkhomelia mallei

c) Burkholderia cepacia

d) Stenotrophomonas maltophilia

e) Pseudomonas aeruginosa

Correct Answer - [Link]

Ans: a. Burkholderia..., b. Burkhomelia..., e. Pseudomonas Aeru
......
The Burkholderia cepacia complex (BCC) and Stenotrophomonas
maltophilia are closely related groups of non fermenting gram-
negative bacilli (NFGNBs) having a similar spectrum of infections
ranging from superficial to deep-seated and disseminated infections.
Identification of these lysine decarboxylase-positive NFGNBs lags
behind in most Indian laboratories. A simplified identification scheme
was devised for these two pathogens that allowed us to isolate them
with an increasing frequency at our tertiary care institute.
91. A person is suffering from acquired
immunodeficiency disease(AIDS) & visited
the zoo. After some days, he is com​‐
plaining of headache & cough. He has
also have some neuro​logical symptoms.
On staining of CSF sample, it shows cap​‐
sulated yeast. Likely infection is:
a) Histoplasma

b) Aspergillus

c) Cryptococcus

d) Blastomycosis

e) Coccidioidomycosis

Correct Answer - C
Ans: C, Cryptococcus
Like CNS disease, pulmonary cryptococcosis can follow an indolent
course, and the majority of cases probably do not come to clinical
attention.
Pulmonary cryptococcosis can be associated with antecedent
diseases such as malignancy, diabetes, and tuberculosis.
Cryptococcus Infection can be acquired by inhalation of
desiccated yeasts(or basidiospores) from feces of pigeon or other
birds
Direct microscopic examination of India ink-stained wet films of
material from lesions reveals capsulated, budding yeast cells; the
capsule are prominent in the India ink preparatio
92. Normal flora of Oral cavity is/are except:
a) Veillonella

b) Anerobic micrococci

c) Geotrichum

d) Gemella

e) Yersinia

Correct Answer - [Link]

Ans: a. Veillone..., b. Anerobic microc..., c. Geotrich..., d.
Gemell.
More than 700 bacterial species or phylotypes, of which over 50%
have not been cultivated, have been detected in the oral cavity.
The mouth contains a plethora of organisms- pigmented & non-
pigmented micrococci; some of which are aerobic, gram positive,
aerobic, spore bearing bacilli, coliforms, proteus & lactobacilli
The gum pocket b/w the teeths, & the crypts of the nostrils have a
wide spectrum of anaerobic flora- anerobic micro-cocci,
microaerophilic & anaerobic streptococci, vibrios, fusiform bacilli,
corynebactrium species, actinomyces, lep​tothrix, mycoplasma,
Neisseria eb• bacteriodes are all found in varying extents. Among
fungi, candida er geotrichum have been reported.
93. Gold standard diagnostic test for
babeiosis is:
a) Peripheral blood smear examination

b) Blood Culture

c) PCR

d) ELISA

e) Indirect fluorescent antibody (IFA) test

Correct Answer - A
Ans: a. Peripheral blood smear ...,
[Ref Harrison 19th/1385-86; Paniker Parasitology 7th/85;Chatterjee
Parasitology 13th/137; Lippincott Microbiology 3rd/225; Jawetz
27th/708; Greenwood 16th/599]
Microscopic examination of stained blood smear is gold standard
test for babesiosis"
A specific diagnosis usually is established by microscopic
examination of Giemsa-stained thin blood smears. Babesia
trophozoites appear round, pear-shaped, or ameboid.
The ring form is most common and lacks the central brownish
deposit (hemozoin) typical of Plasmodium falciparum trophozoites.
Other distinguishing features are the absence of schizonts and
gametocytes and the occasional presence of tetrads ("Maltese
cross").
If parasites cannot be identified by microscopy and the disease is
still suspected, amplification of the babesial 18S rRNA gene by
polymerase chain reaction (PCR) is recommended. Quantitative
PCR has greatly lowered the threshold for detection of B. microti
DNA
94. True about listeria monocytogens
infection:
a) Common in pregnant women

b) Common in elderly

c) Common in children

d) Common in newborns

e) Ampicillin is drug of choice

Correct Answer - [Link]

Ans: a. Common in pregnant..., b. Common in elderly...,d.
Common in newborns..., e. Ampicillin.
[Ref Harrison 19th/982-84; Ananthanarayan 9th/395-96;
Lippincott Microbiology 3rd/ 98; Jawetz 27th/ 197-98;
Greenwood 16th/195-96]
Listeria infections are most common in pregnant women, fetuses
and newborns, and in immunocompromised individuals, such as
older adults and patients receiving corticosteroids" (Lippincott
Microbiology 3rd/ 98).
The disease affects pregnant women, newborns, adults with
weakened immune systems, and the elderly,
Listeria monocytogenes is a food-borne pathogen that can cause
serious infections.
Meningitis in older adults (especially with parenchymal brain
involvement or subcortical brain abscess) should trigger
consideration of L. monocytogenes infection.
95. True about Japanese encephalitis:
a) Most severe epidemic spread occured in 2006

b) Main vector in India is culex tritaeniorhynchus

c) Spread by aedes mosquito

d) India still not able to develop vaccine indigenously

e) Pigs are amplifier host

Correct Answer - B:E

Ans: (B) Main vector in India is culex tritaeniorhynchus (E) Pigs
are amplifier host
[Ref Park 23rd/284-87;Harrison 19th/1315; Ananthanarayan
9th/520​22, 519]
During 2006, there was a large outbreak of chikungunya in India,
with 1. 39 million officially reported cases spread over 16 states;
attack rates were estimated at 45% in some areas"
The virus is particularly common in areas where irrigated rice fields
attract the natural avian vertebrate hosts and provide abundant
breeding sites for mosquitoes such as Culex tritaeniorhynchus,
which transmit the virus to humans.
Additional amplification by pigs, which suffer abortion, and horses,
which develop encephalitis, may be significant as well. Vaccination
of these additional amplifying hosts may reduce the transmission of
the virus.
96. Not AIDS defining cancer:
a) Anal carcioma

b) Hodgkin's lymphoma

c) Cervial cancer

d) Non -Hodgkins lymphoma

e) Kaposi carcinoma

Correct Answer - A:B

Ans: (A) Anal carcioma (B) Hodgkin's lymphoma
[Ref Harrison 19th/1268; Ananthanarayan 9th/576-77; Lippincott
Microbiology 3rd/ 302]
The neoplastic diseases considered to be AIDS defining conditions
are Kaposi's sarcoma, non-Hodgkin's lymphoma, and invasive
cervical carcinoma.
In addition, there is also an increase in the incidence of a variety of
non-AIDS-defining malignancies including Hodgkin's disease;
multiple myelotna; leukemia; melanotna;and cervical, brain,
testicular, oral, lung, gastric, liver, renal, and anal cancers.
97. True about Plasmodium falciparum:
a) Increased size of infected RBC

b) Crescentric shaped gametocyte

c) Delicate ring present

d) Small & multiple rings common

e) Erythrocyte preference- old cells

Correct Answer - [Link]

Ans: (B) Crescentric shaped gametocyte (C) Delicate ring
present (D) Small & multiple rings common
[Ref Harrison 19th/1369; Parasitology by Chatterjee 13th/103;
Parasi​tolgy by Paniker 7th/75]
Ring stage- delicate, small, double chromatin, multiple rings
common, Accole forms found
Macrogametocyte- Crescentric, deep blue cytoplasm, large diffuse
nucleus
The mature gametocytes are round in shape, except in P,
falciparum, in which they are crescent-shaped
Schizont: Fills two-third of red blood cell which is not enlarged-
Chatterjee 13th/103
Infected erythrocyte- Normal size, Maurer's cleft, sometimes
basophilic stippling
Erythrocyte preference- young erythrocyte, but can infect all stages
98. Which of the following statement is/are
true about Giardia:
a) Cause bloody diarrhorea

b) Invasive to GI mucosa

c) More common in hypogammaglobulinemic person

d) Less common in achlorohydria

e) Metronidazole is effective in treatment

Correct Answer - C:E

Ans: (C) More common in hypogammaglobulinemic person (E)
Metronidazole is effective in treatment [Ref Parasitology by
Chatterjee 13th/47-48;Parasitolgy by Paniker 7th/32-33;Harrison
19th/1406]
Metronidazole, trimidazole, furazoilidone have been found to be
effective for giardiasis
G. lamblia is typically seen within the crypts of duodenal & jejunal
mucosa. It does not invade the tissue, but remains tightly adhered to
intestinal epithelium by means of the sucking disc
Te person having agammaglobulinemia, malnourished persons are
more susceptible to giardiasis
99. In which organism can be isolated:
a) CSF specimen of tetanus infection

b) CSF specimen of listeria monocytogenes

c) From valves in rheumatic valvulitis

d) From myocardium in diphtheric myocarditis

e) Meningococcal rash

Correct Answer - B:E

Ans: (B) CSF specimen of listeria
monocytogenes (E) Meningococcal rash
L. monocytogenes : The diagnosis is typically made by culture of
blood, cerebrospinal fluid (CSF), or amniotic fluid. L. monocytogenes
may be confused with "diphtheroids" or pneumococci in gram-
stained CSF or may be gram-variable and confused with
Haemophilus spp.
Petechial lesion: Meningococci may sometimes be demonstrated in
petechial lesions by microscopy & culture.
100. True about cytomegalovirus -
a) Characteristic owl eye appearance

b) Type 5 Human herpesvirus type

c) Lymphocyte enlargement

d) Cause congenital infection

e) Lymphoproliferative

Correct Answer - [Link]

Ans: a. Characteristic..., b. Type 5 Human..., d. Cause
congenital ....
[Ref Harrison 19th/1190-91; Ananthanarayan 9th/473-74; Jawetz
27th/470-74]
It is cytomegalic (not lymphoproliferative, which occur in HHV4, 6 &
7)
Characterized by enlargement of infected cells
Congenital infection- Intrauterine infection leads to fetal death or
cytomegalic inclusion disease of newborn which is often fatal
101. Which of the following is/are true about
Mycoplasma pneumonia infection
except:
a) Causes many extrapulmonary manifestations

b) Cold agglutinin titer is not increased

c) Cause atypical pneumonia

d) Paucity of respiratory signs on physical examination

e) Cough is typically productive

Correct Answer - B:E

Ans: b. Cold agglutinin..., e. Cough is typically
Cold hemagglutinins for group 0 human erythrocyte appear in about
50% of untreated patients, in rising titer, with the maximum reached
in the third or fourth week after onset.
A titer of 1:64 or more supports the diagnosis of M. pneumoniae
infection.
The cough is typically nonproductive, but some patients produce
sputum. Headache, malaise, chills, and fever are noted in the
majority of patients.
102. True about enteroviruses:
a) In 1999, wild polio virus 2 was eradicated from world

b) Vaccine associated paralytic poliomyelitis(VAPP) most

frequently caused by serotype 1 vaccine

c) Bivalent OPV contains type 1 & type 3 strain

d) Primary course of OPV consists of only 1 dose

e) Coxasackie A7 & enterovirus type 71 causes aseptic meningitis

Correct Answer - [Link]

Ans: (A) In 1999, wild polio virus 2 was eradicated from world
(C) Bivalent OPV contains type 1 & type 3 strain (D) Primary
course of OPV consists of only 1 dose (E) Coxasackie A7 &
enterovirus type 71 causes aseptic meningitis
[Ref Park 23rd/ 202-09; Harrison 19th/1289-91; Ananthanarayan
9th/485]
Of the 3 strains of wild poliovirus, wild poliovirus type 2 was
eradicated in 1999 & case numbers of type 3 are down to the
lowest-ever levels with the last case reported in Nov 2012 from
Nigeria.
The WHO programme on immunization(EPI) & the national
immunization programme in India recommended a primary course of
3 doses of OPV at one-month intervals, commencing the first dose
when infant is 6 weeks old.
Poliovirus type 1 is responsible for most epidemics of paralytic
poliomyelitis. Type 3 also causes epidemics to a lesser extent. .
Type 2 usually causes inapparent infections in western countries but
in India paralysis due to type 2 is quite common"
 GROUP SEROTYPE
Poliovirus 1-3
Coxsackie virus A 1-22 AND 24
Coxsackie virus B 1-6
s
Echovirus 1-9, 11-27,
29-34
Numbered (EV) 68-78
echovirus
103. True about chickengunya fever:
a) Caused by single stranded RNA arbovirus

b) Excruiting arthralgia in peripheral joints

c) Antiviral therapy is very effective

d) Absolute lymphocytosis is present

e) Vector is aedes mosquitoes

Correct Answer - [Link]

Ans: (A) Caused by single stranded RNA
arbovirus (B) Excruiting arthralgia in peripheral
joints (E) Vector is aedes mosquitoes.[Ref Harrison 19th/13j3;
park 23ril/289; Ananthanarayan gth/440,519; Jawetz 27th/ 548.
Chickengunya: Blood counts may be normal, or patients may have
leukopenia with relative lymphocytosis.
The vector is Aedes aegypti, It is caused by arbovirus (Family-
Togaviridae, Genus- Al?phavirus) (Ananthanarayan 9th/517)
The Chikungunya virus by single stranded RNA virus?
Chikungunya is a local word meaning doubling up owing to
excruciating joint pains
There is no specific treatment & usually self limiting. Analgesics &
antipyretics along with fluid supplementation are recommended to
manage infection & relieve fever, joint pains & swelling. Drugs like
aspirin & steroids should be avoided
104. True about Zika virus:
a) Sexually transmitted

b) 50% infected person develop symptoms

c) Effective therapy available

d) Transmitted by Aedes vector

e) Transmission in utero

Correct Answer - [Link]

Ans: a. Sexually transmitted d. Transmitted by Aedes vector e.
Transmission in utero[Ref Harrison 19th/1314;
It is spread mostly by the bite of an infected Aedes species
mosquitoes (A. aegypti and A. albopictus). These mosquitoes are
aggressive daytime biters.
It can be passed from a pregnant woman to her fetus. Infection
during pregnancy can cause certain birth defects.
It can be passed through sex from a person who has Zika to his or
her partners. It can be passed through sex, even if the infected
person does not have symptoms at the time.
The majority of people infected with Zika virus do not display any
symptoms
105. Biosafety level 4 infection includes:
a) Hantavirus

b) Nile virus

c) Ebola virus

d) Crimean-Congo HF

e) Lyssa Fever

Correct Answer - [Link]

Ans: c. Ebola virus d. Crimean-Congo HF e. Lyssa Fever [Ref
Harrison 19th/1323, 1328; consteril. corn/biosafety-levels;
thecere​brallounge. wordpress. corn]
Filoviruses (includes three genera: Cueva virus, Ebola virus, and
Marburg virus) are categorized as World Health Organization (WHO)
Risk Group 4 Pathogens.
Biosafety Level 4- Hemorrhagic fevers, Marburg virus, Ebola
virus, Lassa virus, Smallpox
106. Serological test is/are useful in diagnosis
of which of the following disease:
a) Typhoid

b) Q fever

c) Acanthamoeba infection

d) Scrub typhus

e) Brucellosis

Correct Answer - [Link]

Ans: a. Typhoid b. Q fever d. Scrub typhus
The diagnosis of Q fever is based mainly on serological tests, such
as microagglutination, complement fixation, immunofluorescence &
ELISA.
Serological tests: There are not used for early diagnosis of rickettsia!
diseases(including Q fever, scrub typhus), from a treatment
perspective, but to confirm the diagnosis for epidemiological
investigations.
Scrub typhus: Serological assay (indirect fluorescent antibody,
indirect immunoperoxidae & enzyme immunoassays), are mainstays
of laboratory diagnosis.
Tube agglutination is routinely used for serological diagnosis of
typhoid, brucellosis & typhus fever.
107. All are true about gas gangrene except:
a) Type 1 gangrene is fournier's gangrene

b) Devitalized tissue predispose to gas gangrene

c) High 02 tension in tissue is important precondition

d) a -toxin is main cause of the toxaemia associated with gas

gangrene

e) Mainly caused by C. perfringens

Correct Answer - E
Ans: E. Mainly caused by C. perfringens[Ref Harrison 19th/990-
95; Ananthanarayan 9th/257-59; Jawetz 27th/186-87;Greenwood
16th /231-35]
C. perfringens in association with mixed aerobic and anaerobic
microbes can cause aggressive life-threatening type I necrotizing
fasciitis or Fournier's gangrene.
Predisposing host factors include debility, old age & diabetes
a -toxin is generally considered to be the main cause of the
toxaemia associated with gas gangrene
"a-toxin: This is the most important toxin biologically & is responsible
for profound toxaemia of gas gangrene"
108. Which are transmitted by Dog:
a) Echinococcus granulosus

b) Toxocara Canis

c) Echinococcus multiocularis

d) Toxoplasma Gondii

e) None

Correct Answer - A:C

Ans: A. Echinococcus granulosus C. Echinococcus
multiocularis" [Ref Park 23rd/ 3}4;Hanison 1 9th/ 1 432, 1 67
e- 1 : Chatterjee Parasitology 1 3th/ 1 59; CMDT 20 16/
12801.
Alveolar echinococcosis (AE) is caused by infection with the larval
stage of Echinococcus multilocularis. The adult tapeworm is
normally found in foxes, coyotes, and dogs. Infection with the larval
stages is transmitted to people through ingestion of food or water
contaminated with tapeworm eggs.
Toxocara canis: Human infection is by ingestion of eggs, which are
shed in feces of dog.
Toxoplasma gondii: Man acquires infection by ingestion of
contaminated food and water containing sporulated oocyst (from cat)
or by ingestion of undercooked meat containing tissue cysts"
109. Follow up is not required in which of
the following study:
a) Prospective study

b) Retrospective study

c) Cross-sectional study

d) Longitudinal study

e) Cohort study

Correct Answer - B:C

Ans: b. Retrospective study, c. Cross-sectional study. [Ref Park
23rd/ 62, 69; Community
Cohort (Known by a variety of names- prospective study,
longitudinal study, incidence study & forward looking study) is follow
up study with individual as unit of study (Park 23rd/ 62, 75) Case
control studies, often called retrospective studies:
No attrition problems, because case control studies do not require
follow-up of individual into the future .
Cross-sectional studies (Also k/a prevalence study) is single
examination (so no follow up) of a cross-section of population at one
point in time- the results of which can be projected on the whole
population .
Longitudinal studies: Observations are repeated in the same
population over a prolonged period of time by means of follow-up
examinations .
110. Special protection includes:
a) Personalitydevelopment

b) lmmunization against specific disease

c) Specific nutritional diet

d) Protection from occupational hazard

e) Environmental modification

Correct Answer - [Link]

Ans: b. Immunization against..., c. Specific nutritional diet..., d.
Protection from occupational
Specific Protection
Immunization
Use of specific nutrients
Chemoprophylaxis
Protection against occupational hazards
Protection against accident
Protection from carcinogens
Avoidance of allergens
The control of specific hazards in the general environment e.g., air
pollution, noise control
Control of consumer product quality & safety of foods, drugs,
cosmetics etc
111. True about Civil registration system in
India:
a) Dual record system

b) Deficient

c) Head of institution or officer-in charge is responsible for

registration

d) Birth & Death both are registered

e) Cause of death is recorded

Correct Answer - [Link]

Ans: b. Deficie..., c. Head of institution..., d. Birth & Death
both..., e. Cause of death
The registration system in India tended to be very unreliable, the
data being grossly deficient in regards to accuracy, timeliness,
completeness & coverage. This is because of illiteracy, ignorance,
lack of concern, & motivation
The central births & Death Registration Act, 1969 fixes the
responsibility for reporting births & deaths. While the public (e.g,
parents, relatives) are to report events occurring in their households,
the heads of hospital, nursing homes, hotels, jails or dharmashalas
are to report events occurring in such institutions to be concerning
registrar
The time limit for registering the events of birth & that of deaths is 21
days uniformly all over India. In case of default a late fee can be
imposed.
112. True about silicosis all except:
a) Caused by exposure of silica oxide

b) Severe exposure- whole lung lavage may helpful in

alleviat_ing symptoms

c) Fibrosis of upper lung

d) Fibrotic change can be reversed after stopping exposure

e) More risk ofTB & lung cancer.

Correct Answer - D
Ans: d -Fibrotic change can be reversed after stopping
exposure
Silicosis is progressive & what is more important is that silicotics are
prone to tuberculosis
There is no effective treatment for silicosis. Fibrotic changes that
have already taken place cannot be reversed
Nodular fibrosis, more frequent in apex & posterior border (upper
part of lung) (c.f in asbestosis fibrosis in lower half of lung)
Silicotics are more prone to develop pulmonary tuberculosis (but in
recent year there is doubt whether silicotics really develop T.B.)
For acute silicosis, bronchoalveolar lavage may alleviate symptoms,
but does not decrease overall mortality.
113. Which of the following is/are true
about use of Bar diagram:
a) Comparison of 2 categorial data which are not-additive

b) Comparison of 2 categorial data which are proportional

percentage contribution of categories

c) Pie chart is used for comparison of 2 categorial data which are

proportional percentage contribution of categories

d) Comparison of magnitude of different frequencies in dis​crete

data

e) Comparison of continuous data

Correct Answer - [Link]

Ans: a. Comparison..., c. Pie chart is..., d. Comparison of
magnitude
Bar Diagram
Length of bar represents frequency of a character
Popular er easy method
Used for comparison of magnitude of different frequencies in
discrete data
Spacing b/w any two bars should be nearly equal to half of the width
of the bar
3 Type- simple, proportionate & multiple.
CategoriesQuantity to be Appropriate diagram
on x-axis represented on y-axis*
Continuous Additive Pie if proportional contribution
(frequency or of the categories is to be
percentage), represented, otherwise
histogram
 histogram
Line for depiction of trend,
otherwise bar
Addictive (frequency or
Discrete or Pie if proportional percentage
percentage),
categorical contribution of the categories
is to be represented,
(number, rate or ratio)
otherwise bar
bar
114. Benefit of vertical health programme
includes:
a) More focus on efficiencY

b) More rapid results

c) Dedicated worker always available

d) Many programs can run at one time

e) Effective way of maximizing the impact of the available

resources

Correct Answer - [Link]

Ans: a. More focus..., b. More rapid..., c. Dedicated worker..., e.
Effective way of.
Vertical programmes are "so called because they are direct​ed,
supervised, and executed, either wholly or to a great extent, by a
specialized service using dedicated health workers"
In contrast, an integrated programme is "the process of bringing
together common functions within and between organizations to
solve common problems, developing a commitment to shared vision
and goals and using common technologies and resources to achieve
these goals"
Vertical programmes (also known as stand-alone, categorical or
free-standing programmes or the vertical approach) refer to
instances where "the solution of a given health problem [is
addressed] through the application of specific measures through
single-purpose machinery"
115. True about Reinke's oedema:
a) Usually unilateral

b) Common in smoker

c) Corticosteroid is mainstay of treatment

d) Involve whole of membranous part of the vocal cords

e) Patient has low pitch voice

Correct Answer - [Link]

Answer- B,Common in smoker D,Involve whole of membranous
part of the vocal cords E,Patient has low pitch voice
It is bilateral symmetrical swelling of the whole of membranous part
of the vocal cords.
This is due to oedema of the subepithelial space (Reinket space)
ofthe vocal cords.
Etiology-
Heavy smoking,
Chronic sinusitis &
Laryngopharyngeal reflex
C/F-
Patient uses false cords for voice production & this gives him a low-
pitched & rough voice.
Treatment-
Decortication of the vocal cords i.e., removal of strip of epithelium, is
done first on one side & 3-4 weeks alter on the other.
116. Feature(s) of Scheibe's syndrome is/are:
a) Semicircular canal fistula

b) Abnormality in bony labyrinth

c) Dysplasia of cochlea

d) Middle ear anaomaly

e) All

Correct Answer - C
Answer- C. Dysplasia of cochlea
It is most common inner ear anomaly.
Dysplasia is seen in the cochlea & saccule; hence also called
cochleosaccular dysplasia.
It is inherited as an autosomal recessive nonsyndromic trait.
117. True about nasopharyngeal carcinoma:
a) Level 4 cervical lymph node not involved

b) Radiotherapy is treatment of choice

c) Also c/a Guangdong tumour

d) May associated with U/L otitis media

e) Associated with EBV

Correct Answer - [Link]

Answer- A,Level 4 cervical lymph node not
involved B,Radiotherapy is treatment of choice C,Also c/a
Guangdong tumour D,May associated with U/L otitis
media E,Associated with EBV
It is mostly seen in fifth to seventh decades.
Males are three times more prone than female.
Epstein-Barr virus is closely associated with nasopharyngeal
carcinoma.
Due to obstruction of Eustachian tube, there is conductive hearing
loss, serous or suppurative otitis media.
Radiotherapy: It is treatment of choice for nasopharyngeal
carcinoma.
118. True about tubercular otitis media are all
except?
a) Spreads through eustachian tube

b) Causes painless ear discharge

c) May cause multiple perforations

d) Usually affects both ears

e) None

Correct Answer - D
Answer- D. Usually affects both ears
Tuberculosis of middle ear is a comparatively rare entity usually
seen in association with or secondary to pulmonary tuberculosis,
infection reaches the middle ear through eustachian tube.
Clinical features
Generally, tuberculosis of middle ear is unilateral.
It is characterized by painless otorrhoea which fails to respond to the
usual antimicrobial treatment. There is painless watery otorrhea.
Single or multiple perforation of tympanic membrane.
119. Evidence based therapy of Bell's palsy
include(s):
a) Facial nerve massage

b) Facial nerve stimulation

c) Steroid

d) Acyclovir

e) All

Correct Answer - C
Answer- C. Steroid
1. Medical treatment
Prednisolone (steroid) is the drug of choice and is started at initial
visit. Initiation of therapy during first 24 hours of symptom confers a
higher likelihood of recovery.
Antiviral therapy (Acyclovir) is a newer adjunct in treating acute
facial palsy of viral origin (both Bell's palsy and Ramsay hunt
syndrome).
Most surgeons these days advocate combination of steroids and
antiviral drugs.
120. A person has vertigo without CNS
involvement. Causes is/ are:
a) Perilymph fistula

b) Otolithiasis

c) Vestibular neuritis

d) Meniere's disease

e) Multiple sclerosis

Correct Answer - [Link]

Answer- A,Perilymph fistula B,Otolithiasis C,Vestibular
neuritis D,Meniere's disease
Peripheral (Lesions of end organs vestibular nerve)
Meniere's disease
Benign paroxysmal positional
vertigo
Vestibular neronitis
Labyrinthitis
Vestibulotoxic drugs
Head trauma
Perilymph fistula
Syphilis
Acoustic neuroma
121. Cause(s) of in Mydriasis:
a) Organophosphorus poisoning

b) Homer syndrome

c) Oculomotor nerve palsy

d) Parasympathetic stimulation

e) All

Correct Answer - C
Answer- C. Oculomotor nerve palsy
Carbolic acid, Chloral hydrate, Organophosphorus, Morphine
(opiate) and 'New Horn' i.e. neurosyphilis/tabes dorsalis (spinal
miosis or small, irregular Argyll Robertson pupil) and Horner's
syndrome, Oculomotor nerve palsy.
Atropine and cocaine cause mydriasis.
122. True about primary open angle
glaucoma:
a) Also k/a Chronic simple glaucoma

b) Hypermeteropeas are more predisposed

c) Polygenic inheritance

d) Laser iridotomy is used for treatment

e) Fundus examination reveals large cup

Correct Answer - [Link]

Answer- (A) Also k/a Chronic simple glaucoma (C) Polygenic
inheritance (E) Fundus examination reveals large cup
Also known as chronic simple glaucoma of adult onset and is
typically characterized by slowly progressive raised intraocular
pressure.
Associated with characteristic optic disc cupping and specific visual
field defects.
Pathogenesis-
Heredity: POAG has a polygenic inheritance.
Age- elderly between 5th and 7th decades.
Myopes are more predisposed than the normals.
Diabetics have a higher prevalence of POAG.
POAG is more in hyPertensives.
C/F
patients usually complain of frequent changes in presbyopic glasses.
Patients develop delayed dark adaptation.
Fundus examination show large cup. (0.6 or more)
Laser iridotomy is used for treatment of primary angle closure
glaucoma.
123. Cloudy cornea is/are seen:
a) Klinefelter syndrome

b) Turner syndrome

c) Megalocornea

d) Mucopolysaccharidosis

e) All

Correct Answer - D
Answer- D. Mucopolysaccharidosis
S-Sclerocornea
T-Trauma
U-Ulcer
M- Mucopolysaccharidosis
P-Peter anomaly
ED- Congenital hereditary endothelial dystrophy
124. Ectopia lentis is associated with all
except -
a) Homocystinuria

b) Weil - Marchesani syndrome

c) Marfan syndrome

d) Cockayne syndrome

e) Osteogenesis imperfecta

Correct Answer - D:E

Answer- (D) Cockayne syndrome (E) Osteogenesis imperfecta
More common:
Marfan syndrome
Homocystinuria
Weil-Marchesani syndrome
Sulfite oxidase deficiency
Hyperlysinemia
125. Not feature of Fuch's
heterochromiciridocyclitis:
a) White nodules on the anterior surface of the iris

b) Koppeprecipitates present at back of cornea

c) Granulomatous type of low grade anterior uveitis

d) Topical corticosteroids are used for treatment

e) All

Correct Answer - C
Answer- C. Granulomatous type of low grade anterior uveitis
Fuchs' heterochromiciridocyclitis is a chronic nongranulornatous
type of low grade anterior uveitis.
The disease is characterised by:
Heterochromia of iris,
Diffuse stromal iris atrophy,
Fine KPs at back of cornea,
Faint aqueous flare,
Absence of posterior synechiae
Topical corticosteroids are all that is required.
126. True about iris:
a) Eye colour is due to relative number of melanocytes

b) Stroma is responsible for pigmentation

c) Sphincter pupillae is supplied by parasympathetic fibres

d) Dilator pupillae is supplied by sympathetic fibres

e) Stroma is covered on its anterior surface by two layers of

pigmented epithelium

Correct Answer - [Link]

Answer- A,Eye colour is due to relative number of
melanocytes B,Stroma is responsible for
pigmentation C,Sphincter pupillae is supplied by
parasympathetic fibres E,Stroma is covered on its anterior
surface by two layers of pigmented epithelium
Eye color is determined by the relative number of melanocyte in the
stroma and of course the density of melanin granules produced.
Iris is composed of a stroma cantaining branched connective tissue
cells, usually pigmented but largely unpigmented in blue irides.
The stroma is covered on its posterior surface by two layers of
pigmented epithelium.
The iris is richly supplied by sensory nerve fibres derived from the
trigeminal nerve.
The sphincter pupillae is supplied by parasympathetic autonomous
secretomotor nerve fibres derived from the oculomotor nerve, while
the motor fibres of the dilator muscle arc defived from the cervical
sympathetic chain.
127. Which of the following is/are not the
feature(s) of corneal ulcer due to herpes
virus:
a) Rose Bengal staining of margin of ulcer

b) Decreased corneal sensitivity

c) Fluorescein staining of floor of the ulcer

d) Ring infiltration

e) All

Correct Answer - [Link]

Answer- A,Rose Bengal staining of margin of
ulcer B,Decreased corneal sensitivity C,Fluorescein staining of
floor of the ulcer
"Dendritic ulcer base stains with fluorescein & the margins with rose
Bengal.
Fluorescein installation illuminated by blue light shows up corneal
ulceration at an early stage.
The cornea is relatively insensitive. In severe forms, dendritic ulcers
develop.
128. All are true about chronic fatigue
syndrome except:
a) For diagnosis, duration of fatigue should be atleast 6 month

b) Impaired memory and concentration may present

c) Fatigue relieved by rest

d) Physical examination shows no abnormalities

e) Cognitive behavioral therapy is useful for treatment

Correct Answer - C
Answer- C. Fatigue relieved by rest
Fatigue lasts for at least 6 months
Fatigue is of new or definite onset.
Fatigue is not the result of an organic disease or ofcontinuing
exertion
Fatigue is not alleviated by rest.
Fatigue symptoms are soar throat, tender cervical or axilary lymph
nodes, muscle pain, pain in several joints, headaches, malaise
129. All are true about primary aldosteronism
except:
a) One of the most common cause of secondary hypertension

b) Hyperkalemia

c) Sodium retention

d) Ratio of plasma aldosterone to plasma renin activity (PA/ PRA)

is a useful screening test

e) Tetany may occur

Correct Answer - B
Answer- B. Hyperkalemia
Primary hyperaldosteronism is one of the most common cause of
secondary hypertension.
Excessive levels of aldosterone cause sodium retention and
potassium excretion, with resultant hypertension and hypokalemia.
Hypokalemia can cause weakness, parethesias, visual disturbances
and tetany.
The diagnosis of primary hyperaldosteronism is confirmed by the
elvated level of aldostetone and depressed levels of renin in the
circulation (low PRA).
The ratio of plasma aldosterone to plasma renin activity (PA/PRA) is
a useful screening test.
130. All are true about acute pericarditis
except:
a) Pain radiate to left shoulder & arm

b) Widespread elevation of the ST segments, often with upward

concavity & then return to baseline

c) Pain relieved by lying supine & intensified by sitting up and

leaning forward

d) Corticosteroid relieves symptoms

e) High-pitched scratching or crunching noise may heard in

auscultation

Correct Answer - C
Answer- C. Pain relieved by lying supine & intensified by sitting
up and leaning forward
The characteristic pain of pericarditis is retrosternal, radiates to the
shoulders and neck (retrosternal, and left precoridal).
Characteristically, pericaridial pain may be relieved by sitting up and
leaning forward and is intensified by lying supine.
A pericardial friction rub is a high-pitched superficial scratching or
crunching noise, produced by movement of the inflamed
pericardium.
There are four stages of ECG changes in the evolution of acute
pericarditis.
In stage 1, there is widespread elevation of the ST segments, often
with upward concavity, involving two or three standard limb leads
and V2 to V6, with reciprocal depressions only in aVR and
sometimes V1, as well as depression of the PR segment Usually
there are no significant changes in QRS complexes.
In stage 2, after several days, the ST segments return to normal,
and only then, or even later, do the T waves become inverted (stage
3).
Ultimately, weeks or months after the onset of acute pericarditis, the
ECG returns to normal in stage 4.
The pain is usually relieved by aspirin.
131. Malignancy associated with
hypercalcemia:
a) Breast cancer

b) Small cell lung cancer

c) Non-small lung cancer

d) Prostate cancer

e) Multiple myeloma

Correct Answer - [Link]

Answer- A,Breast cancer C,Non-small lung cancer D,Prostate
cancer E,Multiple myeloma
Lung carcinoma, breast carcinoma, and multlple myeloma account
for more than 50% of all cases of malignancy-associated
hypercalcemia.
Gastrointestinal tumars and prostate carcinoma are less common
causes of hypercalcemia.
132. Which of the following markers suggest
likely primary cancer in carcinoma of
unknown primary(CUP):
a) CK7 is found in tumors of the lung, ovary, endometrium &
breast

b) CK20+/CDX-2 +/CK7–, suggestive of lower gastrointestinal

cancer

c) Calretin & WT-1 for melanoma

d) Chromogranin, synaptophysin & CD56 are marker of

neuroendocrine prrimary

e) None

Correct Answer - [Link]

Answer- A,CK7 is found in tumors of the lung, ovary,
endometrium & breast B,CK20+/CDX-2 +/CK7–, suggestive of
lower gastrointestinal cancer D,Chromogranin, synaptophysin
& CD56 are marker of neuroendocrine prrimary
CK7, CK20, thrombomodulin- Urothelial
CK7, CK20, CDX-2, carcinoembryonic antigen (CEA)- intestinal
Calretinin, WT-1- Mesothelioma
Chromogranin, synaptophysin, CD56- Neuroendocrine
133. Which is true about thrombolysis in
acute ischemic stroke:
a) Most effective if used within 3 hour

b) Contraindicated in h/o prior intracranial haemorrahage

c) Use of heparin within 48 hr is not a contraindication

d) Contraindicated if platelets <100, 000per microliter

e) All

Correct Answer - [Link]

Answer- A,Most effective if used within 3
hour B,Contraindicated in h/o prior intracranial
haemorrahage D,Contraindicated if platelets <100, 000per
microliter
Intravenous thrombolysis with recombinant tissue plasminogen
activator (rt-PA) increases the risk of haemorrhagic transformation of
the cerebral infarct with potentially fatal results. However, if it is
given within 4.5 hours of symptom onset to catefully selected
patients, the haemorrhagic risk is offset by an improvement in
overall outcome.
134. High anion gap metabolic acidosis is/are
present in:
a) Asthma

b) COPD with CO2 retention

c) Poorly controlled diabetes

d) Renal tubular acidosis

e) All

Correct Answer - C
Answer- C. Poorly controlled diabetes
Ketoacidosis
Diabetic
Alcoholic
Starvation
135. True about McCune-Albright syndrome:
a) Occur in children & during puberty

b) Precocious puberty in female

c) Involve long bone of limb

d) Associated with hypothyroidism

e) All

Correct Answer - [Link]

Answer- A,Occur in children & during puberty B,Precocious
puberty in female C,Involve long bone of limb
McCune-Albright syndrome (MAS) is characterized by the triad of
polyostotic fibrous dysplasia, cafe au lait skin pigmentation, and
peripheral precocious puberty.
Albright syndrome is precocious sexual development, which occurs
most often in girls.
The average age at onset in affected girls is about 3 yr and puberty.
136. Increased portal vein pressure & normal
hepatic vein pressure can be seen in all
except:
a) Alcoholic cirhhosis

b) Alcholoic hepatitis

c) Budd Chairi syndrome

d) Portal vein thrombosis

e) Inferior vena cava obstruction

Correct Answer - C:E

Answer- C,Budd Chairi syndrome E,Inferior vena cava
obstruction
"Budd-Chiari syndrome (Obstruction of hepatic veins at any site from
efferent vein of the lobule to the entry of the IVC into right atrium.
Posthepatic- Budd-Chiari syndrome, Inferior vena caval webs
137. Which of the following statement(s)
is/are regarding American Heart
Association(AHA) Guideline-2015 for
cardiopulmonary resuscitation(CPR) &
Emergency cardiovascular care(ECC):
a) Chest compression: ventilation Compression ventilation ratio
without advanced airway – rate 30:2 irrespective of rescuer &
age of patient

b) Compression rate- at least 100/min

c) Failure to achieve an ETCO2 of 10 mm Hg by waveform

capnography after 20 minutes of resuscitation has been
associated with an extremely poor chance of return of
spontaneous circulation(ROSC)

d) Limit interruptions in chest compressions to less than 10

seconds

e) None

Correct Answer - C:D

Answer- C,Failure to achieve an ETCO2 of 10 mm Hg by
waveform capnography after 20 minutes of resuscitation has
been associated with an extremely poor chance of return of
spontaneous circulation(ROSC) D,Limit interruptions in chest
compressions to less than 10 seconds
Compression rate is modified to a range of l00 to 120/min.
Compression ventilation ratio without advanced airway- 1 or 2
rescuers 30: 2
Failure to achieve an ETCO2 of I0 mm Hg by waveform
capnography after 20 minutes of resuscitation has been associated
with an extremely poor chance of ROSC and survival.
The clarified recommendatio-n for cfrest compression depth for
adults is atleast 2 inches (S cm) but not greater than 2.4 inches (6
cm) .
138. True about multiple sclerosis:
a) Corticosteroids are used in acute attack

b) Intravenous Immunoglobulin is effective mode of treat¬ment

c) IFN a- used in recurrence

d) IFN-P- used in recurrence

e) Plasmapheresis may be used in severe relapses

Correct Answer - [Link]

Answer- (A) Corticosteroids are used in acute attack (D) IFN-P-
used in recurrence (E) Plasmapheresis may be used in severe
relapses
Main drugs used for treating multiple sclerosis include Interferon-β
1a
Frequency of relapses in multiple sclerosis patient is decreased by
beta-interferon/glatiramer.
Newer drug approved for relapse in multiple sclerosis patients is
Fingolimod.
Glucocorticoids are used to manage either first attacks or acute
exacerbations.
Natalizumab is a monoclonal antibody against α4 subunit of α4β1
integrin on lymphocytes, useful in treating multiple sclerosis.
It reduces the relapse rate when given intravenously once monthly.
139. Extrathyroid feature of hypothyroidism
includes:
a) Pretibial myxedema

b) Carpal tunnel syndrome

c) Bradycardia

d) Thyroid acropathy

e) Peripheral edema

Correct Answer - [Link]

Answer- (B) Carpal tunnel syndrome (C) Bradycardia
(E) Peripheral edema
Common symptoms are- Weight gain, Fatigue, Dry skin and hair,
Menorrhagia, Hoarseness, coldness
CVS- Bradycardia, Myxoedema, hypertension
Nervous system- Carpal tunnel syndrome,
Facial features- purplish lips, malar flush, periorbital oedema
Yellowing of skin occurs due to accumulation of increase carotene.
140. Which of the following is true about
medication overuse headache:
a) Not associated with triptanuse

b) Restriction of analgesics should be done

c) Opioid is mainly responsible

d) Preventive therapy should be encouraged after stopping/

reducing analgesic

e) None

Correct Answer - [Link]

Answer- (B) Restriction of analgesics should be done
(C) Opioid is mainly responsible (D) Preventive therapy should
be encouraged after stopping/ reducing analgesic
medications that are the most common culprits are compound
analgesia (particularly codeine and other opiate containing
preparations) and triptans, and MOH is usually associated with use
on more than 10-15 days per month.
Management is by withdrawal of the responsible analgesics
Migraine prophylactics may be helpful in reducing the rebound
headaches.
141. Which of the following is/are feature(s) of
acute interstitial nephritis:
a) Eosinophiluria

b) Peripheral eosinophilia

c) WBC cast

d) Gross haematuria

e) Significant proteinuria

Correct Answer - [Link]

Answer- (A) Eosinophiluria (B) Peripheral eosinophilia (C) WBC
cast
Peripheral eosinophilia can occur, especially with drug induced.
Microscopic hematuria is invariably present.
Urinalysis can reveal white blood cell, granular or hyaline cast.
The presence of urine eosinophils is neither sensitive or specific.
Proteinuria can be a feature, particularly in NSAIDS-induced
interstitial nephritis.
142. Feature(s) of Bulbar palsy is/are:
a) Dysphagia

b) Absent jaw jerk

c) Absent gag reflex

d) Tongue atrophy

e) Tongue wasting & fasciculations

Correct Answer - [Link]

Answer- (A) Dysphagia (B) Absent jaw jerk (C) Absent gag
reflex (D) Tongue atrophy (E) Tongue wasting & fasciculations
Paralysis or loss of function supplied by cranial nerve arising from
bulb (old name of medulla oblongata).
Affected CN are 9, 10, 11 & l2th.
Tongue-flaccid, wasted, fasciculation may be present.
Involvement of IX & X CN: Nasal twang, nasal regurgitation, hoarse
voice, dysphagia, loss of sensation over pl/3 tongue,
weak cough, absent gag reflex & weak cough reflex.
In u/l lesion, there is never a complete paralysis of deglutition or of
articulation.
143. All are true about hepatorenal syndrome
except:
a) Creatinine level raised

b) Albumin infusion given

c) Liver transplantation improves renal functions

d) May occur in cirrhosis

e) Low dose dopamine infusion is very effective

Correct Answer - E
Answer- E. Low dose dopamine infusion is very effective
The hepatorenal syndrome (HRS) is a form of functional renal failure
without renal pathology that occurs in about 10% of patients with
advanced cirrhosis or acute liver failure.
There are marked disturbances in thc arterial renal circulation in
Patients with HRS.
TyPe I HRS- a significant reduction in creatinine clearance within 1-2
weeks of presentation.
Type 2 HRS- an elevation of serum creatinine level.
HRS is often seen in patients with refractory ascites.
Treatment-
dopamine or prostaglandin analogues were used as renal
vasodilating medications.
Patients are treated with midodrine, an alpha-agonist, along with
octreotide and intravenous albumin.
The best theragy for HRS is liver transplantation.
144. Which of the following is/are used for
assessment of carbohydrate
malabsorption:
a) Schilling test

b) Steatorrhoea

c) D-xylose test

d) Glucose test

e) Urine test

Correct Answer - C
Answer- C. D-xylose test
D-xylose absorption test is the most commonly employed test for
carbohydrate absorption - Harrison
An endoscopic mucosal biopsy is the more specific test and is now
considered essential.
D-xylose is a carbohydrate that is absorbed almost exclusively in the
proximal small bowel without the help of pancreatic enzymes. A
positive D-xylose test indicates malabsorption due to intestinal
mucosal disease and thus be used as a test for assessment of
mucosal function.
145. True about Swan-Ganz catheter:
a) Measures right atrial pressure

b) Measures left ventricular filling pressure

c) Measure PCWP

d) Inserted through left subclavian vein

e) Inserted directly in Right atrium

Correct Answer - [Link]

Answer- (A) Measures right atrial pressure (B) Measures left
ventricular filling pressure (C) Measure PCWP (D) Inserted
through left subclavian vein
Continuous cardiac output monitoring.
Central temPerature monitoring
Measurement of pulmonary artery pressure (can also measure RA
and RV pressures during insertion)
Measurement of mixed venous saturations
Estimation of diastolic filling of left heart (normal PCWP 2-12mmHg)
146. Treatment of acute Hyperleukocytosis
includes:
a) Hydroxyurea

b) Isotretinoin

c) Leukapheresis

d) Vincristine

e) All

Correct Answer - [Link]

Answer- (A) Hydroxyurea (C) Leukapheresis (D) Vincristine
Leukapheresis is the treatment of choice.
In patients with AML, hydroxyurea should be started.
In ALL patients, higher than 200, 000/mm3 patients may be treated
with vinctistine, steroids, or both.
147. Feature(s) of 3rd degree burn is/are:
a) Blister formation

b) Very painful

c) No spontaneous healing

d) Dry eschar formation

e) Thrombosed vessels can be seen under the skin

Correct Answer - [Link]

Answer- C,No spontaneous healing D,Dry eschar
formation E,Thrombosed vessels can be seen under the skin
Entire thickness of skin destroyed (into fat)
Any color (white, black, red, brown), dry, less painful (dermal plexus
of nerves destroyed)
Heal by contraction and scar deposition (no epithelium left in middle
of wound)
Full-thickness Burns (3 degree BURN)- thrombosed vessels can be
seen under the skin.
148. True about Babcock forcep:
a) Teeth at end

b) Serration at end

c) Triangular orifice in blades

d) Used for soft delicate tubular structure

e) Curved forcep

Correct Answer - C:D

Answer- C,Triangular orifice in blades D,Used for soft delicate
tubular structure
An instrument with a ratchet & a triangular erpansion with
fenestrations at the operating end
It does not have any teeth
This instrument can be used to hold intestine, thyroid gland,
mesoappendix, uterine tube etc.
149. Gas used in creating pneumoperitonem :
a) Water

b) CO2

c) 02

d) Air

e) CO

Correct Answer - [Link]

Answer-B,CO2 C,02 D,Air
Gases used for pneumoperitoneum include carbon dioxide (CO2),
air, oxygen, nitrous oxide (N20), argon, helium and mixtures of these
gases.
150. CO2 is used in laproscopy for creating
pneumoperitoneum in place of air
because:
a) Less absorption from peritoneal surface

b) Fast clearance from body

c) Less solubility in blood

d) Electrocauteryis safe to use

e) Less risk of gas embolism

Correct Answer - [Link]

Answer- B,Fast clearance from body D,Electrocauteryis safe to
use E,Less risk of gas embolism
CO2 gas insufflation is preferred by most laparoscopists because it
has a high diffusion coefficient and is a normal metabolic end
product rapidly cleared from the body.
Also, CO2 is highly soluble in blood and tissues and does not
support combustion.
The risk of gas embolism is lowest with CO2.
Cardiac arrhythmias can occur with CO2 pneumoperitoneum.
151. Acute haemorrhagic pancreatitis
produce which of the following sign:
a) Cullen sign

b) Rovsing sign

c) Psoas sign

d) Grey Turner sign

e) Kehr sign

Correct Answer - A:D

Answer- A,Cullen sign D,Grey Turner sign
Bleeding into the fascial plane scan produce bluish discolouration of
the flanks (Grey Turner's sign) or umbilicus (Cullen's sign).
152. True regarding urinary catheterization
with 16 French size:
a) It is the suitable size to use in adult female

b) It can cause UTI in long term use

c) Used in management of urethral obstruction

d) Diameter is 4 mm

e) Sterile technique must be used for insertion

Correct Answer - [Link]

Answer- A,It is the suitable size to use in adult female B,It can
cause UTI in long term use C,Used in management of urethral
obstruction E,Sterile technique must be used for insertion
Foley's catheter is sterilized by gamma radiation. Usually Foley's
catheter is kept for 7 days.
Size:
Adults— 16 F
Children— 8 F or 10 F
Obstruction of the urethra by an anatomical condition that ,makes it
dfficult for one to urinate: prostate hypertrophy,
prostate cancer, or narrowing of the urethra.
153. Which of the following is/are true about
obstructive uropathy:
a) Stricture in ureter is cause

b) Stone in ureter is cause

c) RTA type 4 can occur

d) Absence of hydronephrosis on USG rule out obstructive

uropathy

e) When obstruction is above the level of the bladder, bilateral

hydroureter and hydronephrosis occurs

Correct Answer - [Link]

Answer- A,Stricture in ureter is cause B,Stone in ureter is
cause C,RTA type 4 can occur
Any obstruction at or distal to the bladder neck may lead to back
pressure affecting both kidneys.
Obstruction at or proximal to the ureteral orifice leads to unilateral
damage.
Partial obstruction leads to gradual progressive muscular
hypertrophy followed by dilation, decompensation and
hydronephrotic changes.
Acquired urinary tract obstruction may be due to inflammatory or
traumatic urethral strictures, ureteral or pelvic stones.
154. True about branchial fistula:
a) External opening near the anterior border of
sternocleido¬mastoid

b) External opening at junction of upper & middle third of

sternocleidomastoid muscle

c) Develop due to persistence of 2ndbranchial cleft

d) Open in oropharynx

e) Move with swallowing

Correct Answer - [Link]

Answer- A,External opening near the anterior border of
sternocleido¬mastoid C,Develop due to persistence of
2ndbranchial cleft D,Open in oropharynx
This is always congenital & occurs due to persistent 2nd branchial
cleft.
The external orifice is nearly always situated in the lower third of the
neck near the anterior border of the sternocleidomastoid.
The patient may complain of a dimple, discharging mucus & the
dimple becomes more obvious when the patient is asked to swallow.
155. True about 1st degree haemorrhoid:
a) Painless bleeding

b) Malaenae occur

c) Constipation may be present

d) Prolapse on defaecation

e) Never prolapse

Correct Answer - [Link]

Answer- A,Painless bleeding C,Constipation may be
present E,Never prolapse
Four Degrees of Haemorrhoids
First degree: bleed only, no prolapse
Second degree: prolapse, but reduce spontaneously
Third degree: prolapse and have to be manually reduced
Fourth degree: permanently prolapsed
156. Which of the following examination is
done in supine position:
a) Tredelenburg position

b) ReverseTredelenburg position

c) Sims position

d) Jack knife position

e) Lloyd-Davies position

Correct Answer - [Link]

Answer- A,Tredelenburg position B,ReverseTredelenburg
position E,Lloyd-Davies position
"Tredelenburg position: Lithotomy with head down
Reverse Tredelenburg position: The patient is supine on the
operating table with the table tilted up 15" at the head end to reduce
venous engorgement.
"Most commonly, the patient is examined in the left lateral (Sims)
positior with the buttocks overlying the edge of the examination
couch and with the axis of the torso crossing, rather than parallel
with, the edge of the couch.
The prone jackknife or knee-elbow positions may be used.
Lloyd-Davies Position: It is also known as the Trendelenburg
position with legs apart.
157. True about lip carcinoma:
a) Common in smoker

b) More common in lower lip

c) More common in upper lip

d) Always painful to touch

e) Distant metastasis is late

Correct Answer - [Link]

Answer- A,Common in smoker B,More common in lower
lip E,Distant metastasis is late
Lower lip is more often involved
lncidence of oral cancer is six times more in smoker than non-
smoker
Site of predilection is b/w the midline & commissure of the lip
Mostly, it is squamous cell carcinoma, often seen in males in the age
group of40-70 years
L, N metastases develop late. Submental & submandibular nodes
are the first to be involved; other deep cervical nodes may also get
involved later.
158. True about mediastinal teratoma:
a) Most common tumour of anterior mediastinum

b) Most common germ cell tumour of mediastinum

c) More commonly occurs in anterior mediastinum

d) Contain teeth, skin, hair, cartilage and bone

e) Histologically graded as differentiated & undifferentiated

Correct Answer - [Link]

Answer- B,Most common germ cell tumour of
mediastinum C,More commonly occurs in anterior
mediastinum D,Contain teeth, skin, hair, cartilage and
bone E,Histologically graded as differentiated &
undifferentiated
Most common malignancy in young men between age 15 and 35
years.
Primary mediastinal germ cell tumors (including teratomas,
seminomas, and nonseminomatous malignant germ cell tumors) are
a heterogeneous group of benign and malignant neoplasms.
Teratomas are the most common type of mediastinal germ cell
tumors.
They contain two or three embryonic layers that may include teeth,
skin, hair (ectodermal), cartilage and bone (mesodermal), or
bronchial, intestinal, or pancreatic tissue (endodermal).
Mediastinal Teratomas may either be-
Mature: Well differentiated
Immature: Poorly differentiated
With malignant transformation
159. True about inguinal hernia in children:
a) Occur due to persistence of processus vaginalis

b) Defect in abdominal may present

c) Most common variety is direct type

d) Difficult to reduce non-operatively

e) More common in girls

Correct Answer - [Link]

Answer- A,Occur due to persistence of processus
vaginalis B,Defect in abdominal may present D,Difficult to
reduce non-operatively
In children, if inguinal (indirect) hernia is present in one side, then
processus vaginalis is intact on other side.
Males are affected about six times more often than females.
Indirect inguinal hernia- Can occur in any age from childhood to
adult.
Inguinal hernia results from a failure of closure of the processus
vaginalis.
160. True regarding testicular tumour:
a) For stage I seminoma- orchidectomy alone used for treatment

b) For stage I seminoma- orchidectomy + radiotherapy used for

treatment

c) Stage I non-seminomatous germ cell tumour-orchidectmy

+radiotherapy used for treatment

d) Staging is important for planning management

e) i3HCG & AFP may be used as marker the response of

treatment

Correct Answer - [Link]

Answer- B,For stage I seminoma- orchidectomy + radiotherapy
used for treatment D,Staging is important for planning
management E,i3HCG & AFP may be used as marker the
response of treatment
Testicular Tumour: Staging
Stage I: The tumour is confined to the testis;
Stage II: Nodal disease is present but is confined nodes below the
diaphragm;
Stage III: Nodal disease is present above the diaphragm;
Stage IV: Nonlymphatic metastatic dise
In confirmed cases, staging is an essential step in planning
treatment.
HCG & NSGCTs when raised, these markers are used to monitor
the response to treatment.
161. Feature(s) of Fournier's gangrene:
a) Necrotizing fasciitis of the male genitalia and perineum

b) Diabetes is risk factor

c) Urgent wide surgical excision of the dead and infected tissue is

essential

d) Testis need to be removed in all cases

e) None

Correct Answer - [Link]

Answer- A,Necrotizing fasciitis of the male genitalia and
perineum B,Diabetes is risk factor C,Urgent wide surgical
excision of the dead and infected tissue is essential
Fournier's gangrene is a necrotizing fasctitis of the male genitalia
and perineum that can be rapidly progressing and fatal if not treated
promptly.
Risk factors-
urethral
strictures,
perirectal abscesses,
poor perineal hygiene,
diabetes,
cancer,
human immunodeficiency virus (HIV)
Clinical features-
Clinical signs include fevers, perineal and scrotal pain.
Cellulitis, eschars, necrosis, flaking skin, and crepitus may all be
observed.
Treatment-
Urgent wide surgical excision of the dead and infected tissue is
essential.
162. Which of the following is/are feature(s) of
enlarged kidney:
a) Ballotable

b) Upper border can be reached

c) Shift to paracolic gutter on compression

d) Do not move with respiration

e) Dull on percussion on renal angle

Correct Answer - A:E

Answer- A,Ballotable E,Dull on percussion on renal angle
It is a reniform swelling
lt moves very slightly uith respiration as it comes down a little at the
height of inspiration.
lt is ballottable
A sickening sensation is often felt during manipulation
A hand can be easily insinucted b/w the upper pole of swelling & the
costal margin
Percussion will rewal resonont note in front of a kidney swelling as
coils of intestine & colon will always be in front ofthe kidney.
163. Hypoparathyroidism can occur in:
a) After thyroid surgery

b) Digeorge syndrome

c) Radical resection of head & neck cancer

d) MEN I

e) All

Correct Answer - [Link]

Answer- A,After thyroid surgery B,Digeorge
syndrome C,Radical resection of head & neck cancer
Genetic disorders (eg: DeGeorge syndrome)
. Abnormal parathyroid gland development
. Abnormal PTH synthesis
o Activating mutations of calcium sensing receptor (autosomal
dominant hypocalcemia or sporadic isolated hypoparathyroidism)
. Post-surgical (thyroidectomn parathyroidectomn radical neck
dissection)
o Autoimmune polyglandular syndrome
164. True about breast cyst:
a) Mostly seen in premenopausal period

b) Most common in young woman

c) Usually unilateral

d) Yellowish-greenish discharge

e) Adhere to underlying skin

Correct Answer - [Link]

Answer- A,Mostly seen in premenopausal period C,Usually
unilateral D,Yellowish-greenish discharge
Classically seen in perimenopausal women mostly in last decade of
reproductive life.
50% of cysts are multiple or recurrent.
Cyst fluid can be straw, colored, opaque, or dark green and may
contain fleck of debris.
Diagnosis can be confirmed by aspiration and/or ultrasound.
165. Fibrocystic disease differ from
fibroadenoma by having:
a) Pain shift with cycle

b) Freely mobile

c) Usually bilateral

d) Firm & rubbery

e) Well demarcated border

Correct Answer - A:C

Answer- A,Pain shift with cycle C,Usually bilateral
Painful, often multiple, usually bilateral masses in the breast.
Rapid fructuation in the size of the masses is common.
Frequently, pain occurs or increases and size increases during
premenstrual phase of cycle.
These lesions are always associated with benign changes in the
breast epithelium.
The microscopic findings of fibrocystic condition indude cyst (gross
and microscopic), papillomatosis, adenosis, fibrosis, and ductal
epithelial hyperplasia.
Clinical features-
Pain or tenderness often calls attention to the mass.
Discharge from the nipple.
Discomfort occurs or is increased during the pemenstrual phase of
the cycle.
Fibroadenoma-
Peak age of incidence is at 20 year
Present with painless lump
It is smooth, round bordered, firm to hard in consistency & freely
mobile within the breast (so called breast mouse)
166. Test for incompetent valve done by:
a) Cough impulse test

b) Trendelenburg

c) Percussation wave travel in retrograde direction along varicose

vein

d) Percussation wave travel in orthograde direction along varicose

vein

e) All

Correct Answer - [Link]

Answer- A,Cough impulse
test B,Trendelenburg C,Percussation wave travel in retrograde
direction along varicose vein
Cough impulse test: saphenoofemoral incompetence
Trendelenburg I: saphenofemoral incompetence
Trendelenburg II: Perforator incompetence
Multiple tourniquet test: Site of perforator incompetence
Schwartz test: Superficial column of blood
167. Which of the following is/are true about
renal carcinoma of T3a stage:
a) Involve Gerota fascia

b) Involve perinephric fat

c) Renal vein involvement

d) Inferior vena cava involvement

e) Size >10 cm

Correct Answer - [Link]

Answer- B,Involve perinephric fat C,Renal vein involvement
E,Size >10 cm
168. True about extracorporeal shock wave
lithotripsy (ECWL):
a) C/I in pregnancy

b) Less satisfactory for hard stones

c) Stone is breaked into small pieces which comes out with urine

d) Safer in coagulopathy

e) Endoscopic retrieval is sometimes used for impacted stone

fragment produced by lithotripsy

Correct Answer - [Link]

Answer- A,C/I in pregnancy B,Less satisfactory for hard
stones C,Stone is breaked into small pieces which comes out
with urine E,Endoscopic retrieval is sometimes used for
impacted stone fragment produced by lithotripsy
Crystalline stones disintegrate under the impact of shock waves
produced by the ESWL machine.
Ureteric colic is common after ESWL.
The principal complication of ESWL is infection.
"Pregnant women [Link] with large abdominal aortic
aneurysms or uncorrectable bleeding disorders should not be
treated with ESWL.
169. True about carcinoma gall bladder:
a) Increased bilirubin level is contraindication for surgery

b) Palliative treatment is for advanced disease

c) Metastatic recurrence is common in liver

d) When gall bladder wall is involved, extended cholecystectomy

is done

e) Surgery should be done in all cases

Correct Answer - [Link]

Answer- (B) Palliative treatment is for advanced disease
(C) Metastatic recurrence is common in liver (D) When gall
bladder wall is involved, extended cholecystectomy is done
If GB cancer is found at cholecystectomy & if mucosa alone is
involved, then cholecystectomy is sufficient
If GB wall is involved, then extended cholecystectomy is done
Radiation has very small benefit. Chemotherapy also has been tried.
5-FU, mitomycin C, doxorubicin are drugs used
Prognosis is very poor. Aggressive surgery & complete clearance
give best results.
Surgery remains the only curative option for gallbladder cancer.
170. True about paramedian incision:
a) It is made below umbilicus

b) Better in obese person

c) Cause abdominal hernia

d) Cut anterior surface of rectus sheath

e) Cut posterior surface of rectus sheath

Correct Answer - [Link]

Answer- (C) Cause abdominal hernia (D) Cut anterior surface of
rectus sheath (E) Cut posterior surface of rectus sheath
Use: provides laterality to the midline incision, allowing lateral
structures such as the kidney, adrenals and spleen to be accessed.
Location: about 2-5 cm to the left or right of the midline incision.
lncision is over the medial aspect of the transverse convexity of the
rectus.
Layers of the abdominal wall skin, fascia (camper's and scarpa's)
and the anterior rectus sheath are incised.
Incisions in anterior and posterior shecti is seperated by muscle
which acts as a buttress, therefore closure and more secure.
171. All are true about full thickness rectal
prolapse except:
a) Elderly are at risk

b) Common in children

c) More common in female

d) sensation of incomplete evacuation

e) May associated with a weak pelvic floor

Correct Answer - B
Answer- B. Common in children
Common ln elderly women who are multipara
ConstiPation is important feature
Tenesmus common
Some degree of incontinence of faeces & flatus is always present.
 172. Which of the following is/are feature(s) of
Keloid:
a) Collagen fibers are randomly arranged

b) Type IV collagen dominates

c) Lesion with healthy margin removed

d) Steroid is very useful

e) Goes beyond margin of wound

Correct Answer - [Link]

Answer- (B) Type IV collagen dominates (D) Steroid is very
useful (E) Goes beyond margin of wound
Scars are often described as being atrophic, hypertrophic and
keloid.
A hypertrophic scar is defined as excessive scar tissue that does not
extend beyond the boundary of the original incision or wound.
A keloid scar is defined as excessive scar tisste that extends beyond
the bounilaries of the originat incision or wound .
IgE antibody is least commonly seen in keloid.
eloids grow on particular sites, these are ?
1. Central chests (probably most common, not sure)
2. Back
3. Shoulder
4. Earlobes
Etiology of keloid-
Key factors: Surgery burns, vaccinations
Elevated levels of growth factor (more of type .8, collagen)
Laceration or abrasion
Over the sternum (incision)
Inheritance and injection
Deep pigmented skin
Histology of both hypertrophic and keloid scars-
Excess collagen with hypervascularity
keloids where there is more type III collagen.
Hypertrophic scars improve spontaneously with time, whereas keloid
scars do not.
keloid scars have thicker, more abundant collagen bundles.
Treatment-
Intralesional injection of steroid (Triamcinolone acetate) is now
recommended as the first line of t/t for keloid.
173. True about Congenital hypertrophic
pyloric stenosis:
a) Shortening of pyloric canal on barium contrast imaging

b) Elongation of pyloric canal on barium contrast imaging

c) Narrowing of pyloric canal on barium contrast imaging

d) Thickened pyloric muscle on USG

e) Child should be given normal saline with KC1

Correct Answer - [Link]

Answer- (B) Elongation of pyloric canal on barium contrast
imaging (C) Narrowing of pyloric canal on barium contrast
imaging (D) Thickened pyloric muscle on USG (E) Child should
be given normal saline with KC1
Imaging confirmation is sought by most clinician to differentiate from
gastroesophageal reflex
Precaution: Empty stomach via nasogastric tube before study &
Remove contrast at end
Elongation & narrowing ofpyloric canal
String sign=passing of small barium streak through elongated pyloric
channel (most specific sign)
Double/triple track sign: crowding of mucosal folds in pyloric channel
174. In comparison to ulcerative colitis, which
of the following is/are feature(s) of
crohn's disease:
a) Transmural inflammation

b) More common in smoker

c) More pANCA positivity

d) TNF-alpha inhibitor role only in CD

e) All

Correct Answer - [Link]

Answer- (A) Transmural inflammation (B) More common in
smoker (D) TNF-alpha inhibitor role only in CD
Can affect any part of GIT, but me sites – terminal ileum, ileocecal
valve, and caecum.
Etiology-
Smoking is a strong risk factor
OCPs and Appendicectomy increase risk
Morphology-
Skip lesions
Thick bowel wall
Strictures common
Transmural inflammation
Non caseating granulomas
Moderate pseudopolyps
Deep, knife- like ulcers
Fibrosis, serositis- Marked
Investigations-
70% ASCA +ve (anti Saccharomyces cerevisiae Ab) 10% pANCA
positive
Treatment
Anti-TNF therapy (Infliximab, adalimumab, certolizumab) -first-line
agents to induce remission in moderate to severe disease and to
maintain remission
175. True about paralytic ileus:
a) Postoperative ileus primarily affects the stomach and colon

b) Mostly resolve after 24-72 hours

c) Return of function occurs in the following order: stomach, large

bowel and small bowel.

d) If opioid is used as postoperative analgesia, then chance

increases

e) Is an anticipated complications of abdominal operations

Correct Answer - [Link]

Answer- (A) Postoperative ileus primarily affects the stomach
and colon (B) Mostly resolve after 24-72 hours (D) If opioid is
used as postoperative analgesia, then chance increases (E) Is
an anticipated complications of abdominal operations
Etiology
Post operative
A degree of ileus usually occurs after any abdominal procedure
Self-limiting (24-72 hours)
May be prolonged in Hypoproteinemia or metabolic abnormality
Intra-abdominal inflammation (peritonitis, abscess, retroperitoneal
hemorrhage)
Reflex ileus: following fractures of spine/ribs, retroperitoneal
hemorrhage or application of a plaster jacket
Metabolic & electrolyte derangements (uremia, hypokalemia,
hyponatremia, hypo and hypomagnesemia, diabetic coma,
hypoparathyroidism, hypothyroidism)
Drugs (opiates, psychotropic agents, anticholinergic agents, calcium
channel blockers)
Return of function of the intestine occurs in the following order: small
bowel, large bowel and then stomach
Paralytic ileus, also called pseudo-obstruction, is one of the major
causes of intestinal obstruction in infants and children.
176. Acinic cell carcinoma is/are found in:
a) Breast

b) Parotid

c) Lacrimal gland

d) Pancrease

e) Minor salivary gland

Correct Answer - [Link]

Answer- (B) Parotid (D) Pancrease (E) Minor salivary gland
Major Salivary Glands (including parotid)
Minor Salivary Glands
Acinar cell caricinoma are malignant epithelial neoplasm (of
pancrease )
177. Which are Radio-opaque stones:
a) Pure uric acid

b) Cysteine

c) Phosphate

d) Oxalate

e) Impure uric acid

Correct Answer - [Link]

Answer- (B) Cysteine (D) Oxalate (E) Impure uric acid
Renal Calculus-
Oxalate stones
Phosphate calculus- struvite
Uric acid and urate calculi
Cystine calculus
178. True about lymphangiomacircum
scriptum:
a) Compressible swelling

b) Often contain clear fluid

c) Groups of vesicles are found on skin

d) May present at birth or shortly after birth

e) None

Correct Answer - [Link]

Answer- (B) Often contain clear fluid (C) Groups of vesicles are
found on skin (D) May present at birth or shortly after birth
This tyPe Presents as circumscribed lesion which appears as small
vaicle or small blister or slightly elevated skin patch
The size varies from 0.5 to 4 mm in diameter
A large area of skin may be involved on the inner side of the thigh,
buttock on the shoulder or in the axilla
The whole lesion is soft & sPongY
Fluctuation, fluid thrill & translucency test are always positive. The
swelling is not compressible
The margins of the swelling are indistinct
The skin vesicles contain clear fluid
It is usually prominent at puberty and may often start bleeding.
179. Sacral-teratoma/sacrococcygeal
teratoma is a derivative of -
a) Primitive streak

b) Ectoderm

c) Hypoblasts

d) Cranial neuropore

e) None

Correct Answer - A
Answer- A. Primitive streak
Gastrulation & Hensen’s node:
In 2nd week - Gastrulation occurs → Establishes 3rd germ layer
(mesoderm).
Gastrulation begins with primitive streak formation in caudal region
of epiblast.
Primitive node or Hensen's node or primitive knot:
Thickening formed at cranial end of primitive streak.
Sacrococcygeal formation:
Failure of Hensen's node to regress can lead to sacrococcygeal
formation.
Incomplete primitive streak regression → leaves caudal remnant →
Sacrococcygeal teratoma.
Arise from residual to totipotential cell rests (Hensen's node).
Sacrococcygeal teratoma demonstrates tissue derived from all three
cell layers.
Contain varying proportions of mature & immature elements.
180. True about central venous
catheterization:
a) Catheter may be placed through subclavian vein

b) If the CVP is low in the presence of a low MAP or cardiac

output, then fluid resuscitation is necessary

c) Can be used for gaining venous access in patient with poor

peripheral veins

d) Subclavian vein route is safest in term of complications

e) All

Correct Answer - [Link]

Answer- (A) Catheter may be placed through subclavian vein
(B) If the CVP is low in the presence of a low MAP or cardiac
output, then fluid resuscitation is necessary (C) Can be used
for gaining venous access in patient with poor peripheral veins
Used for monitoring of CVE administration of fluid to treat
hypovolemia & shock, infusion of caustic drug & total Parenteral
nutrition, asPiration of emboli, insertion of transcutaneous pacing
leads & gaining venous access in patient with poor peripheral veins.
CVP or right atrial pressure (RAP) is monitored using a catheter
inserted via either the internal jugular or the subclavian vein.
The CVP may help in assessing the need for intravascular fluid
replacemant.
181. True about care of polytrauma patient:
a) CT scan of whole body can be done to exclude injuries

b) Long spinal cord injury support is given if spinal cord injury is

suspected

c) Triage of injuries with colour coding like red, yellow, green &
black can be done in case of mass casualty

d) Initial fluid management is done as early as possible

e) None

Correct Answer - [Link]

Answer- (A) CT scan of whole body can be done to exclude
injuries (B) Long spinal cord injury support is given if spinal
cord injury is suspected (C) Triage of injuries with colour
coding like red, yellow, green & black can be done in case of
mass casualty (D) Initial fluid management is done as early as
possible
Because of CT, an increasing amount of both blunt & penetrating
trauma has been safely managed nonoperatively.
'The availability of high resolution multislice scanners, promoting the
development of protocols in some centers that call for early
intergration of complete body (i.e. head, cervical mspine, chest,
abdomen & pelvis) CT scanning of selected trauma patient.
Intravenous line is critical for intravenous volume resuscitation.
Triage system involves a color-coding scheme using red, yellow,
green, white, and black tags: Red indicates high priority treatment or
transfer, yellow signals medium priority, green indicates ambulatory
patients & black for dead or moribund.
182. Which of the following is true about
suture technique:
a) Subcuticular suture is used where cosmetic appearance is
important

b) Vertical mattress causes cause prominent stitch mark scars

c) Horizontal mattress is used for fragile skin

d) Vertical mattress is used for fragile skin

e) None

Correct Answer - [Link]

Answer- (A) Subcuticular suture is used where cosmetic
appearance is important (B) Vertical mattress causes cause
prominent stitch mark scars (C) Horizontal mattress is used for
fragile skin
The horizontal mattress stitch is a suture technique used to close
wounds.
This makes it ideal for holding together fragile skin.
Vertical mattress suture are that it provides closure for both deep
and superficial layers, and also allows perfect eversion and vertical
opposition of the superficial skin edges.
Subcuticular suture technique is used in skin where a cosmetic
appearance is important arrd where the skin edges may be
approximated easily.
183. Corticosteroids are useful in which of the
following paediatrics disease:
a) TB meningitis

b) Endobronchial TB

c) Spinaventosa

d) Acute tuberculous pericardial effusion

e) Severe miliary tuberculosis

Correct Answer - [Link]

Ans. (A) TB meningitis; b. Endobronchial TB; (D) Acute
tuberculous pericardial effusion; (E) Severe miliary
tuberculosis
Corticosteroids use in paediatrics:
These are useful in the treatment of some children with tuberculosis
disease.
Corticosteroids decrease mortality rates and long-term neurologic
sequelae in some Patients with tuberculous meningitis by reducing
vasculitis, inflammation, and, ultimately, intracranial pressure.
Short courses of corticosteroids :Endobronchial tuberculosis that
causes respiratory distress, localized emphysema, or segmental
pulmonary lesions.
Relieve symptoms and constriction associated with acute
tuberculous pericardial effusion.
Dramatic improvement in symptoms of tuberculous pleural effusion
and shift of the mediastinum.
Severe miliary tuberculosis have dramatic improvement with
corticosteroid therapy if the inflammatory reaction is so severe that
alveolocapillary block is present.
184. Eosinophilia in children is/are present in:
a) Allergic rhinitis

b) Echinococcosis

c) Rheumatoid arthritis

d) Infectious mononucleosis

e) Wiskott-Aldrich syndrome

Correct Answer - [Link]

Ans. (A) Allergic rhinitis; (B) Echinococcosis; (C) Rheumatoid
arthritis; (E) Wiskott-Aldrich syndrome
Common causes of eosinophilia:
Acute:
Allergic disorder: Asthma, atopic dermatitis, urticaria. drug
hypersensitivity, pemphigoid
Parasitic infestation: Toxocara, ascaris, amebiasis, strongyloidiasis,
filarial, toxoplasmosis, trichinosia, schistosomiasis, malaria, scabies
Fungal infections: Bronchopulmonary aspergillosis, coccidiomycosis
Malignancy: Hodgkin lymphoma, T cell lymphoma, acute
myelogenous leukaemia, myeloproliferative syndrome
Hypereosinophilic syndrome
Chronic:
Allergic disorders: Pemphigus, dermatitis herpetiformis
Autoimmune disorders: Inflammatory bowel disease, rheumatoid
arthritis, Myeloproliferative syndrome, hypereosinophilic syndrome
,Loeffler syndrome.
Immunodeficiency syndromes: Hyper IgE, Wiskott Aldrich syndrome;
Omenn syndrome; graft versus host reaction
Miscellaneous: Thrombocytopenia with absent radii; renal allograft
rejection; Addison disease
185. Syndrome not associated with childhood
leukaemia:
a) Edward syndrome

b) Fanconi syndrome

c) Diamond-Black anaemia

d) Patau syndrome

e) Kostmann syndrome

Correct Answer - A:D

Ans. (A) Edward syndrome; (D) Patau syndrome
Risk factors for Childhood Leukemia
Down syndrome
Shwachman-Diamond syndrome
Kostmann syndrome
Li-Fraumeni syndrome
Fanconi syndrome
Bloom syndrome .
Klinefelter syndrome
Turner syndrome
Neurofibromatosis type I
Ataxia-telangiectasia
Severe combined immune deficiency
Paroxysmal nocturnal haemoglobinuria
186. A child has vitamin D deficiency rickets.
Which of the following is/are correct
regarding biochemical changes:
a) ↑ Alkaline phosphatase

b) ↑ serum calcium

c) ↑ parathyroid hormone

d) ↑ phosphate

e) ↑ 25-(OH)D3

Correct Answer - A:C

Ans. (A) ↑ Alkaline phosphatase ; (C) ↑ parathyroid hormone
BIOCHEMICAL REACTIONS:
Serum calcium: normal or low
Serum phosphate: low
Alkaline phosphatase: high
Hypophosphatasia shows low level of alk. phosphatase
PTH: High
Hypophophatemia
187. True about fetal alcohol syndrome:
a) Increased birth weight

b) Normal fine motor development

c) Normal social skill development

d) Facial abnormalities

e) Intelligence subnormal

Correct Answer - D:E

Ans.(D) Facial abnormalities ; (E) Intelligence subnormal
Fetal alcohol syndrome
High level of alcohol ingestion in pregnancy can cause damage to
fetus, known as fetal alcohol syndrome.
The harmful effects may be due to alcohol itself or due to one of its
breakdown products. Some evidence suggests that alcohol
may impair placental transfer of essential amino acids and zinc, both
necessary for protein synthesis, which may account for IUGR.
Characteristics of fetal alcohol syndrome include : ?
IUGR (not large proportionate body)
Microcephaly
Congenital heart defects (ASD, VSD)
Mental retardation
Facial abnormalities → Short palpebral fissures, epicanthal folds,
maxillary hypoplasia, micrognathia, low set ears, smooth philtrum,
thin smooth upper lip.
Minor joint anomalies
Hyperkinetic movements
188. Feature(s) of congenital rubella
syndrome include:
a) Cataract

b) ASD

c) Deafness

d) Patent ductus arteriosus

e) All the above

Correct Answer - [Link]

Ans. (A) Cataract; (C) Deafness; (D) Patent ductus arteriosus
Congenital rubella syndrome (CRS) can occur in a developing fetus
of a pregnant woman who has contracted rubella, usually in the first
trimester.
Triad shows:PDA, cataract and deafnes
If infection occurs 0–28 days before conception, the infant has a
43% risk of being affected.
Infection in 2nd trimester – may be deafness only.
>6 wks – no major abnormalities
Diagnosis: Isolation of virus in cell cultures of throat samples, urine
or other secretions.
Detection of IgM in single serum sample shortly after birth.
Persistence of Rubella IgG antibodies serum beyond 1 year or
rising antibody titre anytime during infancy in an unvaccinated child
189. A 4.2 kgs baby born to uncontrolled
diabetic mother. The following condition
will not occur in the baby:
a) Hypercalcemia

b) Hypoglycemia

c) Hyperbilirubinemia

d) Polycythaemia

e) Cardiovascular defects

Correct Answer - A
Ans. (A) Hypercalcemia
Neonatal Complication :
Hypoglycaemia
Respiratorydistress syndrome
Hyperbilirubinemia
Hypocalcemia
Hypomagnesemia .
Polycythemia
Cardiomyopathy
190. True about caput succedaneum -
a) Oedematous swelling of scalp

b) Margins are clearly defined

c) Swelling resolve spontaneously after few days ofbirth

d) Swelling remains for three months

e) Maximum size at birth

Correct Answer - [Link]

Ans. (A) Oedematous swelling of scalp; (C) Swelling resolve
spontaneously after few days of birth; (E) Maximum size at
birth
Caput succedaneum is a diffuse, sometimes ecchymoticedematous
swelling of the soft tissues of the scalp involving the area Presenting
during vertex delivery.
It may extend across the midline and across suture lines.
The edemadisappears within the lstfew days of life.
Molding of the head and overriding of the parietal bones are
frequently associatedand become more evident aftercaput has
receded; they disappear during the lst weeks oflife
Analogous swelling, discoloration, and distortion ofthe face are seen
in face Presentations.
191. A child has fever with redness of cheek.
The causative organism forthis condition
is:
a) Herpes virus

b) Parvovirus B-19

c) Adenovirus

d) Rubella

e) Roseola

Correct Answer - B
Ans. (B) Parvovirus B-19
Exanthema infectiosum:
The characteristic rash first appears as erythematous flushing on the
face in a slapped cheek appearance (red cheek).
The most common manifestation of parvovirus B19 is erythema
infectiosum, also known as fifth disease, which is a benign, self-
limited exanthematous illness of childhood.
It was the 5th in a classification scheme of common childhood
exanthems.
The preceding 4 exanthems were measles, scarlet fever, rubella,
and Filatov-Dukes disease (an atypical scarlet fever), with roseola
infantum as the "sixth disease
192. True about minimal change disease -
a) Hypertension is commonly present

b) Most common cause of nephrotic syndrome in adults

c) High dose steroids results in remission in most cases

d) Commonly progress to chronic renal failure

e) Reversible loss of podocyte function

Correct Answer - C:E

Answer- (C) High dose steroids results in remission in most
cases (E) Reversible loss of podocyte function
Minimal change disease:
Also k/a lipoid nephrosa, foot process disease & Nil deposit disease
The disease sometimes follows a respiratory infection or routine
prophylactic immunization'
The onset may be preceded by an upper respiratory infection, atopic
allergy or immunisation.
The disease characteristically respond to steroid therapy
The benign disorder is characterized by diffuse effacement of foot
processes of visceral epithelial cell (podocytes).
most frequent cause of nephrotic syndrome in children
The visceral epithelial changes are completely reversible afrer
corticosteroid therapy, concomitant with remission of the proteinuria.
There is commonly no hypertension or hematuria.
The appearance of acute renal failure in adults.
193. Which of the following true about new-
born&children:
a) Erythropoietin level is more in preterm than term

b) Erythropoietin given to preterm only in some special cases

c) Erythropoietin given to Preterm can cause complication

d) a & b

e) None of the above

Correct Answer - B:C

Ans. (B) Erythropoietin given to preterm only in some special
cases; (C) Erythropoietin given to Preterm can cause
complication
Most infants with birthweight of <1Kg RBC transfusions. A key
reason why the nadir haemoglobin values of premature infants are
lower than those of term infants is the former group’s relatively
diminished plasma EPO level in responseto anaemia.
Preterm infants exhibit a sluggish EPO response to falling
haematocrit values.
Low plasma EPO level provide rationale the use of recombinant
EPO in the treatment of anemia of prematurity.
Proper doses of EPO and iron effectively stimulate neonatal
erythropoiesis. However, the efficacy of EPO therapy to substantially
diminish the needfar RBC transfusion has not been
convincinglydemonstrate, particularly far sick, extremely premature
neonates, and recombinant EPO has not been widely accepted as
treatment for anemia of prematurity.
ln rare cases, some preparations of EPO have been associated with
the development of anti-EPO antibodies that result in severeanemia.
194. In which condition(s), urethral opening is
never at tip of glans penis:
a) Epispadias

b) Hypospadias

c) Urethral stricture

d) Bladder exstrophy

e) All of the above

Correct Answer - [Link]

Ans. a. Epispadias ; b. Hypospadias ; d. Bladder exstrophy
Hypospadias
A congenital disorder of the urethra where the urinary opening is not
at the usual location on the head of the penis. It is the second-most
common birth abnormality of the male reproductive system, affecting
about one of every 250 males at birth.
EPISPADIAS
An epispadias is a rare type of congenital malformation in which the
urethra opens on the dorsum (the upper aspect) of the penis. It is
often part of the condition termed Epispadias-exstrophy of the
bladder. Epispadias is a mild form of bladder exstrophy, and in
severe cases, exstrophy and epispadias coexist.
195. Ingestion of which of the following
mimics scurvy in child:
a) Magnesium

b) Potassium iodide

c) Arsenic

d) Iron

e) Copper

Correct Answer - A
Ans. a. Magnesium
Hypermagnesemia is most probable answer because it also cause
paralysis
Hypermagnesemia inhibits acetylcholine release at the
neuromuscular junction, producing hypotonia, hyporeflexia, and
weakness; paralysis occurs at high concentrations. The
neuromuscular
196. True about boutonniere deformity:
a) Flexion of proximal interphalangeal joint & hyperextension of
distal interphalangeal joint

b) Hyperextension of proximal interphalangeal joint & flexion of

distal interphalangeal joint

c) Flexion at proximal interphalangeal & extension at

metacarpophalangeal joint

d) Flexion deformity of the proximal interphalangeal joint occur

due to tear in central slip of extensor tendon

e) May occur in rheumatoid arthritis

Correct Answer - [Link]

Ans. a. Flexion of proximal interphalangeal joint &
hyperextension of distal interphalangeal joint; d. Flexion
deformity of the proximal interphalangeal joint occur due to
tear in central slip of extensor tendon ; e. May occur in
rheumatoid arthritis
Boutonniere deformity is a deformed position of the fingers or toes,
in which the joint nearest the knuckle (the proximal interphalangeal
joint, or PIP) is permanently bent toward the palm while the farthest
joint (the distal interphalangeal joint, or DIP) is bent back away (PIP
flexion with DIP hyperextension).
It can be caused by a cut on the top of the finger, which can sever
the central slip (tendon) from its attachment to the bone. The tear
looks like a buttonhole ("boutonnière" in French). In some cases, the
bone actually can pop through the opening.
Boutonnière deformities may also be caused by arthritis.
197. True about ankylosing spondylitis:
a) Romanus lesion may be found

b) If left untreated, spine fusion may occur

c) Predilection of the joints of the axial skeleton

d) Bony erosions do not occur

e) all

Correct Answer - [Link]

Ans. a. Romanus lesion may be found ;b. If left untreated, spine
fusion may occur; c. Predilection of the joints of the axial
skeleton
Ankylosing spondylitis (marie-strumpell disease)
Ankylosing spondylitis is a chronic progressive inflammatory disease
of the sacroiliac joints and the axial skeleton.
rototype of seronegative (absence of rheumatoid factor)
spondyloarthropathies.
Inflammatory disorder of unknown cause.
Usually begins in the second or third decade with a median age of
23, in 5% symptoms begin after 40.
Male to female ratio is 2-3 : 1
Strong correlation with HLA-B270-95% of case
9s are positive for HLA - B27.
Joints involved in ankylosing spondylitis
Ankylosing spondylitis primarily affects axial skeleton.
The disease usually begins in the sacro-iliac joints and usually
extends upwards to involve the lumbar, thoracic, and often cervical
spine.
In the worst cases the hips or shoulders are also affected. Hip joint
is the most commonly affected peripheral joint.
Rarely knee (Ebenzar 4th/e 593) and ankle (Apley's 9thle 67) are
also involved. Pathology
Enthesitis i.e. inflammation of the insertion points of tendons,
ligaments or joint capsule on bone is one of the hallmarks of this
entity of disease.
Primarily affects axial (spinal) skeleton and sacroiliitis is often the
earliest manifestation of A.S..
Involvement of costovertebral joints frequently occur, leading to
diminished chest expansion (normal _ 5 cm)
Peripheral joints e.g. shoulders, and hips are also involved in 1/3rd
patients.
Extraarticular manifestations like acute anterior uveitis (in 5%); rarely
aortic valve disease, carditis and pulmonary fibrosis also occur.
Pathological changes proceed in three stages?
Inflammation with granulation tissue formation and erosion of
adjacent bone.
Fibrosis of granulation tissue
Ossification of the fibrous tissue, leading to ankylosis of the joint.
Radiological features of ankylosing spondylitis
Radiographic evidence of sacroiliac joint is the most consistent
finding in ankylosing spondylitis and is crucial for diagnosis. The
findings are :-
Sclerosis of the articulating surfaces of SI joints
Widening of the sacroiliac joint space
Bony ankylosis of the sacroiliac joints
Calcification of the sacroiliac ligament and sacro-tuberous ligaments
Evidence of enthesopathy - calcification at the attachment of the
muscles, tendons and ligaments, particularly around the pelvis and
around the heel.
X-ray of lumbar spine may show :-
Squaring of vertebrae : The normal anterior concavity of the
vertebral body is lost because of calcification of the anterior
longitudinal ligament.
ft Loss of the lumbar lordosis.
Bridging `osteophytes' (syndesmophytes)
Bamboo spine appearance
198. True about giant cell sarcoma?
a) Most common age group affected is 20-40year

b) Proximal femur is most common site affected

c) Pulmonary metastasis occur in <3% of cases

d) A locally aggressive tumor

e) May involve sacrum

Correct Answer - [Link]

Ans. a. Most common age group affected is 20-40year ; c.
Pulmonary metastasis occur in <3% of cases; d. A locally
aggressive tumor; e. May involve sacrum
GCT :
It perhaps represents the most aggressive benign tumor and
threatens the true definition of a benign cancer because benign
pulmonary metastasis develop in approximately 1% to 2% of giant
cell tumors.
CLINICAL FEATURES
The tumour is seen commonly in the age group of 20-40 years i.e.,
after epiphyseal fusion.
The bones affected commonly are those around the knee i.e., lower-
end of the femur and upper-end of the tibia.
Lower-end of the radius is another common site.
The tumour is located at the epiphysis.
It often reaches almost up to the joint surface.
Common presenting complaints are swelling and vague pain.
Sometimes, the patient, unaware of the lesion, presents for the first
time with a pathological fracture through the lesion.
199. Which of the following is/are true about
simple bone cyst:
a) Most commonly occur in adult

b) Commonest site is the upper end of the humerus

c) Cortex may be thin

d) Cause pathological fracture

e) No risk of recurrence after removal

Correct Answer - [Link]

Ans. b. Commonest site is the upper end of the humerus c.
Cortex may be thin d. Cause pathological fracture
Simple Bone Cyst (Also k/a Solitary or Unicameral Cyst)
lt appear during childhood, in metaphysis in one of the long bones &
most commonly ln proximal humerus or femur .
lt is not a tumour , it tend to heal spontaneously .
It is seldom seen in adult
This condition is usually discovered after a pathological fracture or
as an incidental finding on X-ray .
X-ray shows a well demarcated radiolucent area in the metaphysis
often extending up to the physeal plate; the cortex nay be thinned &
the bone expanded
Treatment depends on whether the cyst is symptomatic, actively
growing or involved in a fracture
200. True about Colle's fracture:
a) Occur at distal end of radius, about 2 cm from distal articular
surface

b) Fracture also involves radiocarpal joint

c) Fracture also involves proximal radioulnar joint

d) Cause ulnar deviation

e) Common in women

Correct Answer - A:E

Ans. a. Occur at distal end of radius, about 2 cm from distal
articular surface; e. Common in women
Colle's Fracture :
This is a Fracture at the distal end of the radius, at its
corticocancellous junction (about 2 cm from the distal articular
surface), in adults, with typical displacement .
It nearly always results from a fall on an out-stretched hand c It is
commonest fracture in people above forty years
Particularly common in women because of postmenopausal
osteoporosis .
Displacement- dorsal displacement, dorsal tilt (most characteristic),
lateral displacement, dorsal tilt, supination & impaction of fragments
Complication: Dinner fork deformity & Subluxation of the inferior
radio-ulnar joint (distal radiocarpal joint)
It is most common of all fracture in older people.
201. For assessing the injury of meniscus of
knee joint, which of the following test
is/are done:
a) Apley's test

b) Lachmann test

c) McMurray's test

d) Thessaly test

e) Hamilton ruler test

Correct Answer - [Link]

Ans. a. Apley's test ; c. McMurray's test; d. Thessaly test
Tests for Meniscal Injuries –
Apley's grinding test: for meniscus injury
McMurray's test- This classic test for a torn meniscus is seldom used
now that the diagnosis can easily be made by MRI. A positive test is
helpful but not pathognomonic a negative test does not exclude a
tear .
Thessaly test: This test has shown a high diagnostic accuracy rate
at the level of 95% in detecting meniscal tears
202. A 70 year old lady got compression
fracture of L1 vertebra. There is no
neurological deficit to this patient. What
advise will you give for this Patient:
a) Vitamin D supplementation

b) Do MRI scan

c) Go for screw fixation of L1 vertebra

d) To take Dexamethasone

e) To take Alendronate

Correct Answer - A:E

Ans. a. Vitamin D supplementation; e. To take Alendronate
It is a case of osteoporotic fracture of lumbar spine
Treatment can be divided into medical & preventive .
Medical:
High protein diet, androgen, estrogen, Vitamin D, fluoride,
alendronate, calcitonin, teripratide, denosumab & strontium (both are
antiresorptive agent) .
Orthopaedic treatment: Exercise & Bracing (ASH brace or Taylor
brace)
203. Which of the following indicates high
risk choriocarcinoma:
a) Initial serum hCG> 40,000 m IU/mL

b) Prior chemotherapy failure

c) Following term pregnancy

d) Metastasis limited to lung and vagina

e) Long duration of disease

Correct Answer - [Link]

Ans. a. Initial serum hCG> 40,000 m IU/mL; b. Prior
chemotherapy failure; c. Following term pregnancy e. Long
duration of disease
High risk factors which indicates the development of
choriocarcinoma at the time of diagnosis of a hydatidiform
mole are:
Maternal age more than 40 years
Excessive uterine enlargement
Serum hCG levels more than 100,000mIU/ml
Theca lutein cysts greater than 6 cm in diameter
Toxemia, hyperthyroidism and coagulopathy
Trophoblastic embolization
Previously treated choriocarcinoma
204. True about mature ovarian teratoma:
a) Recurrence is common after excision

b) Contain hair Teeth, bone & cartilage

c) Mostly benign

d) May be bilateral

e) Torsion is common complication

Correct Answer - [Link]

Ans. b. Contain hair Teeth, bone & cartilage; c. Mostly benign;
d. May be bilateral; e. Torsion is common complication
Teratoma are divided into three categories-
Mature (benign) e.g. dermoid
Immature (essentially malignant), e.g. solid teratoma & monodermal
or highly specialized e.g. stroma ovarii"
Dermoid Cyst:
Of all cystic tumours of the ovary 5-10% are dermoid .
It constitute 97% of all ovarian teratoma .
It contains sebaceous material & hair & the wall is lined in part by
squamous epithelium which contains hair follicle & sebaceous
glands
Teeth, bone, cartilage, thyroid tissue & bronchial mucus membrane
are often found in the wall
Dermoid cysts are innocent ovarian tumours but epidermoid
carcinoma occur in l.7% & sarcomatous change have been
described
Dermoids are bilateral in 12-15%
Torsion is most common (15-20%) & rupture is an uncommon ( 1%)
complication
205. Poor prognostic factors for heart disease
in pregnancy is/are:
a) EF 30 mm Hg by echocardiography

b) Prior cardiac failure, arrhythmia or transient ischemic attack

c) Aortic valve area<1.5 cm2

d) Class III and Class IV NYHA patients

e) Peak LV outflow tract gradient >30 mm Hg by

echocardiography

Correct Answer - [Link]

Ans. b. Prior cardiac failure, arrhythmia or transient ischemic
attack; c. Aortic valve area<1.5 cm2; d. Class III and Class IV
NYHA patients; e. Peak LV outflow tract gradient >30 mm Hg by
echocardiography
Heart diseases in which pregnancy with poor prognosis:
Marfan syndrome
Aortic disease with dilatation of > 50mm with bicuspid aortic valve.
Coarctation of aorta
Eisenmenger syndrome
Severe fixed obstructive lesions ( aortic stenosis, mitral stenosis,
pulmonic stenosis, hypertrophic obstructive cardiomyopathy)
NYHA class 3 & 4 heart diseases (severe systemic ventricular
dysfunction/CHF)
Ejection fraction < 30-40%
Previous peripartum cardiomyopathy with any residual impairment of
LV function
Pulmonary arterial hypertension of any cause
Severe cyanosis
206. True about abdominal hysterectomy:
a) Preferred for prolapse in postmenopausal woman

b) Ureter injury can be avoided by opening the retroperitoneum &

identifying ureter

c) Postoperative complications are less than vaginal hysterectomy

d) Preferred in obese patient

e) Enables wide exploration of abdomen

Correct Answer - B:E

Ans. b. Ureter injury can be avoided by opening the
retroperitoneum & identifying ureter; e. Enables wide
exploration of abdomen
Abdominal Hysterectomy (AH)
Required for endometriosis and large fibroids
Results in greatest mean blood loss
Injury to ureter is one of the most formidable complication of
hysterectomy. Most ureteral injuries can be avoided by opening the
retroperitoneum to directly identifying the ureter
Has the highest incidence of febrile morbidity
Posterior wall of abdominal wound infection (obviously)
Longest hospitalisation
Enables wide exploration of abdomen
And slowest to recover
Factors suggesting preferred route:
Significant uterine enlargement
Inadequate transvaginal access
Adnexal pathology & fixation
Obliteration of pouch of Douglas(endometriosis)
207. True about Copper containing IUCD:
a) Increased copper level in milk

b) Increased risk of ectopic pregnancy

c) Increased bleeding in menstruation with pain

d) Provide protection against PID

e) Irregular menses

Correct Answer - [Link]

Ans. b. Increased risk of ectopic pregnancy; c. Increased
bleeding in menstruation with pain; e. Irregular menses
Copper containing IUCD acts locally in uterus, so no affect on
Cu level in milk
Complication of IUCD:
Dysmenorrhoea
Menstrual dysfunction: prolonged & heavy bleeding
PID: 2-10 times greater among IUD users .
Should pregnancy occur with a device in situ, there is risk of ectopic
pregnancy (0.02%)
208. True about Progestogen only pill:
a) It is taken daily on the same time

b) Higher failure rate than COC

c) Fertility return to normal after discontinuation without any delay

d) Suited for lactating women lactating women

e) Ectopic pregnancy risk are same as COC

Correct Answer - [Link]

Ans. a. It is taken daily on the same time ; b. Higher failure rate
than COC; d. Suited for lactating women lactating women
Progestogen only Pill (POP) /Minipil
Does not have some major side effects of combined pills & well
suited for lactating women; some progestogens, in fact, increase
milk secretion .
Side-effect: weight gain, irregular menstrual bleeding, depression,
breast cancer, thromboembolism .
Advantage: Lactating women, women over 35 years, those with
focal migraine, those intolerant to estrogen or oestrogen
contraindicated, diabetic, hypertensive, sickle cell anaemia
As regards to return of fertility, faster than COC users
Contraindication: C/I to POP are previous are previous ectopic
pregnancy, ovarian cyst, breast & genital cancer, abnormal vaginal
bleeding active liver & arterial disease, porphyria, liver tumour.
209. Markers of malignant ovarian tumour
is/are:
a) Inhibin

b) Beta human chorionic gonadotropin

c) Alpha fetoprotein (AFP)

d) Pax7

e) NB/70K

Correct Answer - [Link]

Ans. a. Inhibin; b. Beta human chorionic gonadotropin; c. Alpha
fetoprotein (AFP); e. NB/70K
Tumour Marker in Epithelial Ovarian Cancer :
CA-125: screening of epithelial cancer ofovary
Macrophage colony stimulating factor (M-CSF)
OVXI
HER-2/Neu
Inhibin
hCG :ovarian choriocarcinoma
BRCAI & BRCA2 (Serous carcinoma)
MLHI, MSH2 & MSH6 (HNPCC associated ovarian cancer)
AFP, hCG & CEA-Germ cell tumour
Tumour marker- for embryonal carcinoma (AFB hCG)
Endodermal sinus tumour (AFP)
Choriocarcinoma (hCG)
Germ cell tumor-AFP, hCG, NB/70K, placental alkaline phosphatase
& lactate dehydrogenase.
210. A 30-year lady delivered a baby. Which of
the following statement(s) is not true
about postpartum contraception:
a) OCP is not given because it can causes venous thrombosis &
have adverse impact on milk production

b) POP is contraceptive of choice for lactating women

c) POP should be started after 6 week

d) LNG-IUD is good in lactating women

e) For non-lactating women, ovulation not occurs until 12 week

Correct Answer - E
Ans. e. For non-lactating women, ovulation not occurs until 12
week
Non-lactating (Postpartum): Contraceptive practice should be started
after 3 week. Pill is good; IUD is equally effective alternative
POP is safe in lactating women & can be started 6 weeks onwards.
LNG is safer than desogestrel & gestagen from thrombosis point of
view.
Intramuscular & progestogen implant can be prescribed 6 week after
deliver
IUCD insertion within 10 min of expulsion of placenta or within 24 hr
of delivery is proved safe & effective
COC are contraindicated in the puerperium, both because of its
adverse on milk secretion in a lactating women & increased risk of
thromboembolic episode. COC can be prescribed to a nonlactating
woman 3 weeks after delivery.
211. True about placenta accreta:
a) Incidence is about 1 in 2500 Pregnancy

b) Incidence increased in last decade

c) Absence of decidua basalis

d) Fibrinoid layer deficient

e) More common in primi

Correct Answer - [Link]

Ans. b. Incidence increased in last decade; c. Absence of
decidua basalis; d. Fibrinoid layer deficient
In placenta accreta decidua basalis is absent and placental villi are
attached to the myometrium.
Risk factors:
Patients with a history of uterine surgery are at greatest risk of
developing an accreta.
In fact, those with a prior cesarean section carry a 25% risk.
placenta previa in the presence of a uterine scar
Others - prior uterine surgery, endometrial ablation, Asherman
syndrome, uterine leiomyomata,
212. True about low grade squamous
intraepithelial lesions:
a) Confined to the lower 1/3 of the epithelium of cervix

b) All cases are treated by cryotherapy

c) 30% progress to invasive cancer in 10 years

d) It is kept under observation with PAP smear or HPV DNA tests

e) None of the above

Correct Answer - A:D

Ans.(A) Confined to the lower 1/3 of the epithelium of cervix &
(d) It is kept under observation with PAP smear or HPV DNA
tests
CIN-I (Low grade squamous intraepithelial lesions): It is often seen
with inflammatory conditions like trichomoniasis & HP & is reversible
following treatment.
The undifferentiated cells are confined to the lower 1/3 of the
epithelium.
Women with CIN I, confirmed on biopsy is kept under observation
with pap smear follow up at 6 months or HPV DNA tests at 12
month. If both tests are negative routine recall (screening) is done. If
these tests are Persistent then treat it as HSIL
 213. True about endometriosis:
a) Laparoscopy is gold standard for diagnosis

b) COC is used to relieve mild Pain

c) GnRH antagonist is used to relieve severe pain

d) Can be managed expectantly in asymptomatic cases

e) None of the above

Correct Answer - [Link]

Ans. (A)Laparoscopy is gold standard for diagnosis; (B). COC is
used to relieve mild Pain; (D) Can be managed expectantly in
asymptomatic cases
Friends this is the most often asked question on endometriosis. It is
worth while to know a few details on this topic.
Empirical treatment : is for pain presumed to be due to
endometriosis. (in absence of definitive diagnosis) and includes :—
Counselling
1. Analgesia
2. Nutritional therapy
3. Progestin or OCP's
Analgesia : Studies have shown NSAID's except niflumic acid are
more effective in chronic pain relief due to endometriosis or
dysmenorrhea suspected to be due to endometriosis.
Hormonal medical treatment :
Basis of management : Since estrogen is known to stimulate the
growth of endometriosis, hormonal therapy has been designed to
suppress estrogen synthesis, thereby inducing atrophy of ectopic
endometrial implants or interrupting the cycle of stimulation and
bleeding.
Indication : — Mild pelvic endometriosis in young women.°
Treatment of residual and recurrent disease following conservative
surgery.
214. Which is true regarding premenstrual
dysphoric disorder (PMDD):
a) Severe depressed mood

b) Pain ceases at onset of menses

c) Depression may continue after menstrual period

d) Antidepressant is given for treatment

e) Pain ceases after menses is over

Correct Answer - [Link]

Ans.(A) Severe depressed mood ;(D) Antidepressant is given
for treatment; (E) Pain ceases after menses is over
Premenstrual syndrome (PMS) & Premenstrual dysphoric disorder
(PMDD)
PMS is often noticed just prior to menstruation (last 7-10 days of the
menstrual cycle)
It should fulfil the following criteria :
No related to any organic lesion
Regularly occurring during the luteal phase of each cycle .
Symptom must be severe enough to disturb the life style of women
or she requires medical help .
Symptom free period during rest of the cycle
When these symptoms disrupt daily functioning they are grouped
under PMDD
More common in women aged 30-35 yr.
It may related to childbirth or a disturbing life event
There are no pelvic findings except features of pelvic congestion .
5% suffer from severe symptoms which influence daily activities
SSRI 6 Noradrenaline Reuptake inhibitors (SNRI) are found to be
very effective
215. True about diagnosis of gestational
diabetes mellitus (GDM):
a) If post prandial sugar >200 mg/dl, then overt diabetes

b) If fasting sugar is 100-120 mg/dl, then overt diabetes

c) If fasting sugar is >126 mg/dl, then overt diabetes

d) If Postprandial sugar is <140 mg/dl , then IGT

e) If fasting sugar is 110-125 mg/dl, then IGT

Correct Answer - [Link]

Ans. (A) If post prandial sugar >200 mg/dl, then overt diabetes ;
(C) If fasting sugar is >126 mg/dl, then overt diabetes;(E)If
fasting sugar is 110-125 mg/dl, then IGT
OVERT DIABETES:
Women with a random plasma glucose level > 200 mg/dL + classic
signs and symptoms such as polydipsia, polyuria, and unexplained
weight loss or a fasting glucose exceeding 125 mg/dL.
The diagnostic cutoff value for overt diabetes is a fasting plasma
glucose of 126 mg/dL or higher.
IGT:
Criteria for diagnosis of impaired glucose tolerance & diabetes
with 75 gm oral glucose:
For fasting Its IGT if > 100&< 126
For 2 hour post glucose its IGT if >140 &<200
216. True about primary amenorrhoea:
a) In Rokitansky-Kuster-Hauser syndrome, FSH is normal

b) In Turner syndrome, FSH is decreased

c) In Kallman syndrome, FSH is increased

d) In Kallman syndrome, LH is reduced

e) None

Correct Answer - A:D

Ans. (A) In Rokitansky-Kuster-Hauser syndrome, FSH is normal
and (D) In Kallman syndrome, LH is reduced
ASSOCIATED CONDITION:
Turner’s syndrome
Congenital adrenal hyperplasia (CAH)
Androgen insensitivity syndrome
Testicular feminizationsyndrome
PCOS
Müllerian agenesis/Utero-vaginal Agenesis/Mayer-Rokitansky-
Kuster-Hauser syndrome
DIAGNOSIS:
Buccal smear and an examination of the polymorphonuclear
leucocytes to determine if chromatin positive (probably XX) or
chromatin negative (probably XO or XY); in other cases a full
chromosome analysis may be needed to exclude mosaicism and
AIS.
Hormonal investigations should include LH, FSH,oestradiol and
testosterone levels.
Ultrasound will help determine the presence, state and size of the
ovaries and any follicular activity.
217. In assisted breech delivery, after coming
head is delivered by:
a) Head delivered spontaneously

b) Pinardmanoeuvre

c) Modified Mauriceau-Smellie-Veit technique

d) Special forcep for deliveringhead is used

e) Prague manoeuvre

Correct Answer - [Link]

Ans. (C) Modified Mauriceau-Smellie-Veittechnique ; (D) Special
forcep for delivering head is used ; (E) Prague manoeuvre
Delivery of the Aftercoming head of Breech
Various method of safe delivery of after coming head
Burns-Marshall method : Forcep delivery (Piper forcep, Das forcep,
Neville Barne’sforcep)
Malar flexion & shoulder traction (modified MauriceauSmellie-Veit
technique)
Arrest of after Coming Head
Burns-Marshall method
Modified Mauriceau-Smellie-Veit technique
Brachtmaneuver
Wigand-Martin maneuver
Praguemaneuver
Forcep application
Duhrssen’sincision
Craniotomy
218. Which of the following is/are
ultrasonographic finding of twins:
a) Type of twin pregnancy can be diagnosed in first trimester

b) Lambda sign indicates dichorionicity

c) T sign suggests monochorionic diamniotic pregnancy

d) Monozygotic twins are more common

e) All

Correct Answer - [Link]

Ans. a. Type of twin pregnancy can be diagnosed in first
trimester; b. Lambda sign indicates dichorionicity; c. T sign
suggests monochorionic diamniotic pregnancy
Sonography
Separate gestational sacs
Confirmation of diagnosis as early as 10th week of pregnancy
Variability of fetuses, vanishing twin in second trimester
Chorionicity (twin peak sign or lamda sign)(10–13 weeks of
gestation)
Thick septum in dichorionic twins at base of the membrane
with triangular projection is known as lambda or twin peak sign
Pregnancy dating, Fetal anomalies
Fetal growth monitoring, Presentation and lie of fetuses
Twin transfusion localization, Amniotic fluid volume
219. Which of the following is/are used in
psoriasis:
a) High dose oral dexamethasone

b) Methotrexate

c) TNF-alpha inhibitor

d) Acitretin

e) Narrow band UVB

Correct Answer - [Link]

Ans. B,Methotrexate C,TNF-alpha inhibitor D,Acitretin
Ref;. Neena Khanna 5th/54-59; Hartison 19th/348; Roxburg
17th/138- 42).
Systemic corticosteroids are only indicated for generalized pustular
psoriasis in pregnancy (impetigo herpetiformis).
Biological response modifiers used to treat psoriasis include: T cell
inhibitors (alefacept, adalimumab, itolizumab).
Oral glucocorticoids should not be used in the treatment of psoriasis
due to the potential for developing life-threatening pustular Psoriasis
when therapy is discontinued.
220. True about skin:
a) Epidermis is highly vascular

b) Melanocyte is derived from neural crest

c) Sebaecous gland- holocrine & absent in palm

d) Apocrine gland presents in axilla & groin

e) Hiraadenitis suppurita is infection of apocrine gland

Correct Answer - [Link]

Ans: B,Melanocyte is derived from neural crest C,Sebaecous
gland- holocrine & absent in palm D,Apocrine gland presents in
axilla & groin & E,Hiraadenitis suppurita is infection of apocrine
gland
[Ref Neena Khanna Sth/ 119, 451-53; Harrison 19th/1099; Roxburgh
tTth/ 4-11; General Anatomy by BD Chaurasia 5th/254-60
Hidradenitis suppurativa (Synonym- apocrine acne): Axillary
apocrine sweat gland infection
Sebaceous glands are holocrine in nature,
The pigment cells (melanocyte) of the skin are derived from neural
crest .
Apocrine sweat glands drains directly into hairfollicles in the axillae &
groins
Sebaceous gland are located throughout the skin except on palms &
soles.
Glands made up of acini of lipid containing cells, which secrete
sebum as a holocrine secretion.
Eccrine sweat glands present all over body, especially on palms,
soles & in axillae. Human have 2-24 million eccrine sweat glands
221. Acneiform eruption is/are side effect of :
a) Tetracycline

b) Phenytoin

c) Isoniazid

d) Steroid

e) Potassium iodide

Correct Answer - [Link]

Ans: B,Phenytoin C,Isoniazid D,Steroid & E,Potassium iodide
[Ref Neena Khanna 5th/125; Harrison 19th/356; Harrison 14th/425;
Roxbug 17th/Ea-55
Drug-induced Acneiform Eruptions:
Steroids (corticosteroids, androgens, anabolic steroids), oral
antieMEtics, anti tubercular drugs, anticonvulsants, halides (iodides.
bromides).
Trunk especially back, face nay be involved.
Lesions are monomorPhic, consisting of papules sometimes pustule
222. Cicatrical alopecia is/are seen in:
a) Lichen planopilaris

b) Discoid lupus erythematous

c) Andogen efflyum

d) Lichen planus

e) Trichotillomania

Correct Answer - [Link]

Ans. [Link] planopilaris B,Discoid lupus erythematous &
D,Lichen planus
[Ref Neena Khanna 5th/141; Hanison 19th/355; Roxburg 17th/ 270]
Thichotillomania (compulsive hair-pulling) is characterized by
noticeable hair loss caused by person! persistent & recurrent failure
to resist impulse to pull out hairs.
Nonscarring alopecia
A. Primary cutaneous disorders
[Link] effluvium
Androgenetic alopecia
Alopecia areata
Tinea capitis
Traumatic alopecia
B. Drugs
C. Systemic diseases
Systemic lupus erythematosus
Secondary syphilis
Hypothyroidism
Hyperthyroidism
Hypopituitarism
Deficiencies of protein, iron, biotin, and zinc
ll. Scarring alopecia
A. Primary cutaneous disorders
Cutaneous lupus (chronic discoid lesions)
Lichen planus
Central centrifugal cicatricial alopecia
Folliculitis decalvans
Linear scleroderma (morphea)
B. Systemic diseases
Discoid lesions in the setting of systemic lupus erythematosus
Sarcoidosis
Cutaneous metastases
223. Wavelength of UVB is :
a) 250-280 nm

b) 280-320 nm

c) 320-400 nm

d) 400-700 nm

e) 100-200 nm

Correct Answer - B
Ans. B. 280-320 nm
The wavelength found most effective in treating skin disease with
phototherapy is UVB with warden gfh of 311 (+- 2nm) (narrow band
UVB, NBUVB).
The wavelengths between 4(N and 7AO nm are visible to the human
eye.
224. Which of the following statement(s)
is/are true about physical urticaria
a) Cholinergic urticarial is precipitated by cold

b) Solar urticaria is skin sign of erythropoietic protoporphyria

c) Dermatographism is an example

d) Cold urticaria is precipitated by emotion

e) None

Correct Answer - B:C

Ans. B,Solar urticaria is skin sign of erythropoietic
protoporphyria & C,Dermatographism is an example
[Ref Neena Khanna Sth/189; Harrison 19th/i6i; Roxburg 17th/74-74
).
Physical Urticarias:
Patients with dermatographism exhibit linear wheals following minor
pressure or scratching of the skin.
Solar urticaria characteristically occurs within minutes of sun
exposure and is a skin sign of one systemic disease.
Cold urticaria is precipitated by exposure to the cold, and therefore
exposed areas are usually affected.
Cholinergic urticaria is precipitated by heat, exercise, emotion and is
characterized by small wheals with relatively large flares.
225. True about tracheostomy:
a) Tracheostomy tube may closed by mucous secretion & crust
formation

b) Copious secretion from tube is always due pulmonary infection

c) X-ray chest should be done for confirmation in every case

d) Improper positioning may lead to fatal haemorrhage

e) Displacing of tube after 2 week is medical emergency

Correct Answer - A:D

Ans. A,Tracheostomy tube may closed by mucous secretion &
crust formation D,Improper positioning may lead to fatal
haemorrhage
Ref Schwartz 9th/ 59- I qhttp:/ /[Link]/ ; p [Link] 6th/
3 I 6 - 20;Ajay Yadav 5th/48-49; Millo Anaesthaia Zth/232& IBit-72
Reintubation in the first 36 hours after tracheostomy Is on
emergency.
Tracheostomy tube should not be disturbed For the first 48-72 hr,
but thereafter the tube is changed daily & cleaned at regular interval.
Recent study do not support obtaining a routine post tracheostomy
chest X-ray.
The most dramatic complication is tracheo-innominate artery fistula
(TIAF).
Palpable tube pulsation suggest impending erosion of an artery,
Tracheal deviation may signal abdomen bleeding
226. True about desflurane:
a) Boiling point is <230C

b) Chemically it is Flourinated methyl ethylether

c) It increases the effect of muscle relaxant

d) Can be given safely to patient susceptible to malignant

hyperthermia

e) More potent than isoflurane

Correct Answer - [Link]

Ans.A,Boiling point is <230C B,Chemically it is Flourinated
methyl ethylether C,It increases the effect of muscle relaxant
[Ref Ajey Yadav Sth/ 82; Morgan Sth/170 & 71)
Desflurane:
Fluorinated methyl ethyl ether
Boiling point is less than 20C.
Produces maximum muscle relaxation among the agents.
5 times less potent than isoflurane.
Loss of potency (the MAC of desflurane is 5 times higher than
isoflurane)
Immune mediated hepatitis a rare occurrence.
has the lowest blood: gas solubility of the potent volatile anesthetics
227. Drug(s) not given as transdermal patch:
a) Fentanyl

b) Diclofenac

c) Morphine

d) Clonidine

e) Buprenorphine

Correct Answer - B:C

Ans.B,Diclofenac & C,Morphine
[Ref: KDT 7th/476
Transdermal fentanyl (Durogesic) has become available for use in
cancer/terminal illness.
Butrans skin patches contain buprenorphine an opioid pain
medication.
Clonidine transdermal delivery (patch) systems have been available
since the 1980
228. Endotracheal intubation is/are assessed
by:
a) Mallampati grading

b) ASA physical status grading

c) Thyromental distance

d) Teeth arrangement

e) None

Correct Answer - [Link]

Ans. A,Mallampati grading C,Thyromental distance & D,Teeth
arrangement
Ref: Manipal Surgery 4th/ 1072-73; Ajay Yadav 5th/53' 124; Morgan
5th/ 312-13
ASA physical status grading is for general health status of patient
(not for assessing intubation)
Assessment of Difficult Intubation:
Mallampati grading: It is done to assess mouth oPening
Thyromental distance (distance b/w thyroid notch to mental
prominence with fully extended neck)
Mentohyoid distance: normal > 5 cm
Assessment of TM joint function: Inter incisor gap (mouth opening)
should be at least 5 cm (2 fingerbreadth)
Neck Movement
229. True about photodynamic therapy of
head & neck cancer:
a) Tumour sensitizer is used

b) Singlet oxygen is produced in tumour cell

c) After therapy, radiosensitizer may remain with tumour cell

d) Hemoporphyrin given as radiosensitizer

e) Photosensitivity is a side-effect after therapy

Correct Answer - [Link]

Ans. A,Tumour sensitizer is used B,Singlet oxygen is produced
in tumour cell C,After therapy, radiosensitizer may remain with
tumour cell & E,Photosensitivity is a side-effect after therapy
Ref Sabiston 236; Ballenger\ Otorhinolaryngology 16th/1324
Photodynamic therapy is a new treatment that allows destruction
of cancer cells and has recently been expanded to the eradication of
metaplastic cells,
It begins with the administration of a target specific photosensitizer
that is eventually concentrated in the target tissue.
The photosensitizing agent is then activated with a wavelength-
specific light energy source,which leads to generation of free
radicals cytotoxic to the target tissue.
Applications reported in the literature include treating early
radiographically detected, non-small cell lung cancer, pancreatic
cancer squamous cell and basal cell carcinoma of the skin, recurrent
superficial bladder cancer, Chest wall involvement from breast
cancer and even chest wall recurrence of breast cancer.
Given systemically, these drugs are preferentially taken up in tumor
cells, rendering them more sensitive to light-mediated cell killing
than their surrounding tissues.
230. Which of the following cell(s) are less
radiosensitive:
a) Osteocyte

b) Erythroblasts

c) Chondrocyte

d) Spermatogonia

e) Lymphocyte

Correct Answer - A:C

Ans. A, Osteocyte& C,Chondrocyte
Ref: Sumer Sethi 6th/174; Radiology & Imaging by Thayalan Ist/310
Most radiosensitive blood cell- Lymphocyte
Least radiosensitive blood cell- platelet
Most radiosensitive tissue of body- Bone marrow
Least radiosensitive tissttc of body -Nervous tissue/brain
High Radiosensitive - Lymphoid organs, bone marrow blood, testes,
ovaries, intestines
Low Radiosensitive - Muscle, brain, spinal cord
231. All are true about gamma knife except:
a) Focussed radiation is delivered to tumor

b) Provide equal exposure to surrounding healthy tissue

c) It is a type of stereotactic surgery

d) Primarily used for small brain tumours

e) Uses Co-60 as source of radiation

Correct Answer - B
Ans. [Link] equal exposure to surrounding healthy tissue
Ref: Sumer Sethi 6th/196-97
Stereotactic RadiosurgerY:
Goal of stereotactic radiosurgery is to deliver enough radiation to
destroy or stop the gtorvfh of a lesion previously defined by
specialized imaging techniques without adversely affecting
surrounding tissue.
Gamma Knife Radiosurgery:
Gamma knife radiosurgery k a type of radiation therapy used to treat
tumors and other abnormalities in the brain.
Close to 200 tiny bearns of radiation on a tumor.
Gamma knife:
The Gamma Knife is an advanced radiation treatment for adults and
children with small to medium brain tumors, abnormal blood vessel
formations called artetiotenotrs malformations, epilepsy, trigeminal
neuralgia, a nerve .ott-ditiott that causes chronic pain, and other
neurological conditions.
The'blades" of the GammaKnife" are the beams of gamma radiation
programmed to target the lesion at the point where they intersect.
Gamma Knife enables patients to undergo a non-invasive form of
brain surgery without surgical risks, a long hospital stay or
subsequent rehabilitation.
232. Gamma radiation is/are produced by:
a) Co-60

b) Caesium-137

c) P-32

d) Iridium-192

e) Strontium-90

Correct Answer - [Link]

Ans. A,Co-60 B,Caesium-137 & D,Iridium-192
[Ref: Sumer Sethi 6th/177, 184; Radiology 6 Imaging by Thayalan
lst/17,278
Radiation emitted - Radionuclide
Gamma rays -
Radium-226
Caesium-137
Cobalt-60
iridium-192
Gold-198
Samarium -153
Beta rays:
Strontium-90
Yttrium-90
Phosphorus-32
Rhenium-188
Combination of gamma and beta rays:
Rhenium-186
iodine-131
233. Precise FNAC can be obtained by using :
a) USG

b) CT

c) Endoscopic USG

d) MRI

e) Plain-Xray

Correct Answer - A
Ans. A. USG
Ref Dahnert Radiology Manual 7th/368;Harshmohan 7th/902-
l3;Robbins 9th/333
Radiological imaging Aids for FNAC:
Non-palpable lesion require some form of localization by radiological
aids for FNAC to be carried out.
Plain X-ray films are usually adequate for lesions within bones & for
some lesions within the chest
FNAC of chest may also be attempted under image amplified
fluoroscopy which allows visualization of needle placement on the
television monitor
CT guidance is also used for lesions within the chest dy Abdomen.
The most versatile radiological aid is ultrasonographic guidance
(USG) which allow direct visualization oF needle placement in real
time & is free from radiation hazards.
It is an extremely valuable aid for FNAC of thyroid nodules, soft
tissue masses, intra-abdominal lesions dt for intrathoracic which
about the chest wall, but no help in deep intrathoracic lesions or in
bony lesions
Precision of USG and CT scan is comparable for guidance in FNAC
from thoracic mass lesions
234. True about signal characteristic of CSF
on MRI & FLAIR:
a) Hyperintense on T1WI

b) Hypointense on TI WI

c) Hyperintense on T2WI

d) FLAIR reduces CSF signal

e) FLAIR increases CSF signal

Correct Answer - [Link]

Ans. B,Hypointense on TI WI C,Hyperintense on T2WI &
D,FLAIR reduces CSF signal
Ref: Sumer Sethi 6th/15; Radiology 6 Imagingby Thayalan Ist/386-
89]
MRI Signal Characteristic
CSF: Hypointense on TIWI, hyperintense on T2W1.
Grey/White matter: Grey matter is grey & white matter s white n
T1W1 & relationship is reversed on T2W1.
The fluid,-attenuated inversion-recovery (FLAIR) uses longer T1
(2400ms) & TR (7000ms) to reduce the signal level of CSF & other
tissue with long Tl relaxation constant.
It reduces CSF signal & other water-bound anatomy in MR image
by using a Tl detected at or near the bounce point of CSF.
FLAIR MRI techniques consist of an inversion recovery pulse to null
the signal from CSF and a long echo time to produce a heavily T2-
weighted sequence.
235. Contrast agent which are not used for CT
scan:
a) Water

b) CO2

c) Barium compounds

d) Iodinated high-osmolality contrast media

e) Polyethylene glycol

Correct Answer - B
Ans. B. CO2
Ref Sumer Sethi 6th/20; Radiology 6 Imaging by Thayalan159;
Dahnert Radiology Manual 7th/1147-48
Radiocontrast agents are a type of medical contrast medium used to
improve the visibility of internal bodily structures in X-ray-based
imaging techniques such as computed tomography (CT),
radiography & fluoroscopy.
Radiocontrast agents are typically iodine or barium compounds.
When an agent improves visibility of an area, it is called "contrast
enhancing
Gadolinium is a key component of the contrast material most often
used in magnetic resonance (MR) exams.
Saline (salt water) and air are also used as contrast materials in
imaging exams.
Barium sulfate contrast media continue to be the preferred agents
for opacification of the gastrointestinal tract for conventional
fluoroscopic examinations
The current use of iodinated water-soluble contrast media is
primarily limited to select situations
Two commercid water-soluble iodinated high-osmolality contrast
media (HOCMs) specifically designed for enteric opacification are in
common use. Gastrografin and, Gastroview
236. True about USG:
a) Uses most commonly frequency of 20-50 MHz for diag​nostic
ultrasound

b) Work on principle of piezoelectric effect

c) Ultrasonic waves only penetrates gas , not liquid

d) Gas filled microbubbles are used as contrast media

e) None

Correct Answer - B:D

Ans. [Link] on principle of piezoelectric effect & [Link] filled
microbubbles are used as contrast media
Ref Sumer Sethi 6th/9-10; Radiology & Imaging by Thayalan 334-
40
Contrast-enhanced Ultrasound (CEUS):
Application of ultrasound contrast medium to traditional medical
sonography.
Commercially available contrast media are gx-filled (air or
perfluorocarbon) microbubbles that are administered intravenously
to the sysfernic circulation.
Microbubbles have a high degree of echogenicity (the ability of an
object to reflect ultrasound waves)
237. True about finding of pleural effusion:
a) CT scan can distinguish between a pleural effusion and a
pleural empyema

b) USG can detect very small amount of fluid

c) X-ray- homogenous opacity with obliteration of CP angle

d) MRI cannot differentiate malignant from benign pleural disease

e) MRI can differentiate malignant from benign pleural dis​ease

Correct Answer - [Link]

Ans., A,CT scan can distinguish between a pleural effusion and
a pleural empyema B,USG can detect very small amount of
fluid C X-ray- homogenous opacity with obliteration of CP
angle& EMRI can differentiate malignant from benign pleural
dis​ease
Ref: Sumer Sethi 6th/49; Dahnert Radiology Manual 7th/ 446; WHO
Manual of Radiographic Interpretation 2002/ 4 I _42
Imaging criteria are:
Homogenous density
Density in dependent portion
Upright: Costophrenic angle in pA view
Lateral yiew: Anterior and posterior portions ofgutter
Lateral decubitus position: Along sides
Supine position: Along posteriorly, giving diffuse haziness on the
side of effusion
Silhouette of upper limit of density
Upper margin high in axilla in pA view (yellow arrows)
Upper margin high anteriorly and posteriorly in lateral view
This is just an illusion
Loss of silhouette: In the images below note lack of identifiable left
diaphragm before and visible diaphragm after clearance of fluid
(Silhouette sign principle)
Mediastinal shift
Pleural Effusion- X-Ray
First 300 ml not visualized on PA yiew
Lateral decubitus views may detect as little as 25 ml
Pleural effusion on CT scan:
CT scanning is excellent at detecting small amounts of fluid and is
also often able to identify underlying intrathoracic causes (e.9.
malignant pleural deposits or primary lung neoplasms) as well as
subdiaphragmatic diseases 1e.g. sub diaphragmatic abscess) .
238. True about schizophrenia:
a) Q-EEG finding is one of diagnostic criteria for schizophre​nia

b) Psychosurgery can be done for some resistant cases

c) Family history of schizophrenia is poor prognosis

d) Depression may be found

e) Onset only after 40 year of age

Correct Answer - [Link]

Ans. B,Psychosurgery can be done for some resistant
cases C,Family history of schizophrenia is poor prognosis &
D,Depression may be found
[Ref: Ahuja 7th/54-68; Synopsis of Psychiatry by Kaplan & Sadock
11th/300-32s
Schizophrenia:
Equally prevalent in males & females.
Onset - Before 25 yrs. Peak age - 10 to 20 yrs (males) & 25 to 35
yrs.(Females)
EEG recording shows decreased alpha activity, increased theta &
delta activity.
Quantitative EEG (qEEG) is the analysis of the digitized EEG, and in
lay terms this sometimes is also called 'Brain Mapping’.
Psychosurgery is not routinely indicated.
When used, the treatment of choice is limbic leucotomy in some
cases with seyere & very prominent depression, anxiety or
obsessional symptoms
239. Which of the following is/are not side-
effect of lithium:
a) Seizure

b) Hyporeflexia

c) Nephrogenic diabetes insipidus

d) Alopecia

e) Tremor

Correct Answer - B
Ans. [Link]
Ref: Synopsis of psychiatry by Kaplan 6 Sadock 11th/985-88; KDT
7th/449; pharmacology by Satoskar 2ith/225
Lithium:
Mild toxicity: GI disturbances, drowsiness, muscular weakness,
alopecia, allergic reaction, blurred vision, glycosuria, polyuria &
weight gain.
Chronic administration: goiter formation, hypothyroidism & ECG
changes
Embryotoxicity: Li is embryotoxic & increases the risk of Ebstein's
anomaly
Hyper-reflexia

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