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PHYSIOLOGY 1. True about Nuclear bag fibers a) Sense dynamic length of muscle b) Involved in reciprocal innervation c) Alpha motor neuron stimulation d) Senses muscle tension

Answer: Sense dynamic length of muscle Explanation:

Intrafusal fibers are a second category of muscle fibers found specifically within muscle spindles.■

Intrafusal fibers are classified as nuclear bag fibers containing many nuclei in a dilated central area and nuclear chain fibers lacking definitive bag. There are two subtypes of the nuclear bag fibers, dynamic and static.

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Two types of sensory (afferent) nerves innervate intrafusal fibers:■

Group Ia afferent nerves innervate both nuclear bag fibers and nuclear chain fibers, and transmit information regarding the rate of change in muscle length (Dynamic response).

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Group II afferent nerves mainly innervate nuclear chain fibers and do not innervate the dynamic nuclear bag fibers.

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The steady state activity of group Ia and II afferent provide information on steady state length of muscle (Static response)

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2. Human blood testis barrier a) Tight junction between Sertoli cells b) Absence of germ cells causes immune reaction c) Formed before spermatogenesis d)

Answer: Tight junction between Sertoli cells Explanation:

Tight junction between adjacent Sertoli cells near the basal lamina form a blood-testis barrier.■

Blood-testis barrier prevents many large molecules from passing from the Interstial tissue and the part of tubule near basal lamina (Basal compartment) to the region near tubular lumen (Ad-luminal compartment) and the lumen.

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3. Receptor of joint capsule and ligaments is a) Slow adapting b) Fast adapting c) Different to slow and fast adapting d) Non-adapting

Answer: Slow adapting Explanation: The receptors detect mechanical deformation within the capsule and ligaments:

There are four types of sensory endings that make up joint receptors; free nerve endings, Golgi type endings, ruffini endings, and paciniform endings.

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Slowly adapting receptors: Free nerve endings, Golgi type endings and ruffini endings■

Fast adapting receptors: Paciniform endings■

The rapidly adapting receptors produce generator potentials and action potential discharges that follow the time-varying waveform of pressure changes produced by a vibrating stimulus.

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In contrast, the slowing adapting receptors produce generator potentials and action potential dischargesthat are sustained and unable to mimic the time-varying pattern of the stimulus.

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Consequently, the responses of rapidly adapting 1° afferents are best suited for representing time varying (e.g., vibrating or moving) stimuli, whereas slowly adapting 1° afferents better represent static stimuli (e.g., sustained pressure).

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ANATOMY 1, Which does not supply medulla? a) Anterior spinal artery b) Posterior spinal artery c) Posterior inferior cerebellar artery d) Superior cerebellar artery

Answer: Superior cerebellar artery Explanation: Four main arteries supply the medulla oblongata 1. Anterior spinal artery 2. Posterior spinal artery 3. Posterior inferior cerebellar artery 4. Bulbar branches of the vertebral artery

2. All extra-ocular muscles supplied by ipsi-lateral oculomotor complex nuclei except a) Inferior rectus b) Medial rectus c) Superior rectus d) Inferior oblique

Answer: Superior rectus Explanation: Extra-ocular Muscle Efferents Three cranial motor nuclei provide efferent control of the extra-ocular muscles. Activation of the motor neurons produces contraction of the innervated muscle.

The abducens nucleus sends its axons in the abducens (VI cranial) nerve controls the lateral rectus of the ipsi-lateral eye.

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The trochlear nucleus sends its axons in the trochlear (IV cranial) nerve controls the superior oblique of the contra-lateral eye.

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The oculomotor complex contains nuclei that send axons in the oculomotor (III cranial) nerve control the superior levator in the eyelid of both eyes extra-ocular muscles, which include the medial rectus of the ipsi-lateral eye, inferior oblique of the ipsi-lateral eye inferior rectus of the ipsi-lateral eye  and superior rectus of the contra-lateral eye.

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3. All of the following glands have secreto-motor supply by facial nerve except a) Nasal gland b) Lacrimal gland c) Submandibular gland d) Parotid gland

Answer: Parotid gland Explanation: Facial nerve: Secreto-motor to all glands in head EXCEPT Parotid Parotid gland: Parasympathetic secreto-motor supply arises from the glosso-pharyngeal nerve. The nerves reach the gland via the tympanic branch, the lesser petrosal nerve, the otic ganglion, and the Auriculo-temporal nerve. Submandibular gland and Sublingual Gland: Parasympathetic secreto-motor supply is from the facial nerve via the chorda tympani, and the submandibular ganglion. The postganglionic fibers pass directly to the gland. Nasal gland and lacrimal gland: Parasympathetic secreto-motor supply is from the facial nerve via greater petrosal nerve.

4. Not content of meso-rectal fascia a) Para rectal node b) Inferior rectal veins c) Superior rectal veins d) Inferior mesenteric plexus

Answer: Inferior rectal veins Explanation:

Meso-rectum is enclosed by meso-rectal fascia which is derived from the visceral peritoneum, and is also known as visceral fascia of meso-rectum, fascia propria of rectum or pre-sacral wing of hypo-gastric sheath

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Upper rectum is derived from the embryological hind gut and it is surrounded by meso-rectum and its contents namely superior rectal artery and its branches, superior rectal vein and tributaries, lymphatic vessels and nodes along superior rectal artery, branches from inferior mesenteric plexus to innervate rectum and loose adipose connective tissue down to the level of levator ani.

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5. Bucco-pharyngeal membrane made up of a) Endoderm b) Ectoderm c) Endoderm, mesoderm d) Ectoderm and endoderm

Answer: Ectoderm and endoderm Explanation:

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The bucco-pharyngeal membrane forms the external upper membrane limit (cranial end) of the early gastrointestinal tract (GIT).

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This membrane region first develops in the tri-laminar embryo (week 3) during gastrulation.■

The “membrane” quality comes from being composed of only ectoderm and endoderm, without a middle layer of mesoderm.

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6. A/E innervated by trigeminal nerve: a) Lateral pterygoid b) Medial pterygoid c) Stylo-hyoid d) Tensor veli palati

Answer: Stylo-hyoid Explanation: The trigeminal nerve is the largest and most complex of the 12 cranial nerves (CNs). It supplies sensations to the face, mucous membranes, and other structures of the head. It is the motor nerve for the muscles of mastication and contains propriaceptive fibers. Components and Peripheral Distribution of CN V

Afferent general somatic: Sensory branches of the ophthalmic, maxillary, and mandibular nerves to skin, mucous membranes of the face and head

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Efferent special visceral: Branches to Temporalis, Masseter, pterygoid, mylohyoid, tensor tympani, and palati

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Afferent propriaceptive: Sensory endings in muscles of mastication■

BIOCHEMISTRY 1. Which vitamin deficiency causes circum-corneal vascularization? a) Thiamine b) Riboflavin c) Vit E d) Vit C

Answer: Riboflavin Explanation: Manifestations of riboflavin: Glossitis Magenta color tongue Cheilosis Angular stomatitis Circum-corneal vascularization Proliferation of bulbar conjunctival capillaries

2. Enzyme replacement therapy is given successfully in a) Fabry’s disease b) Gaucher disease c) Sanfilippo syndrome d) Pompe disease

Answer: Gaucher disease Explanation: Gaucher disease: Gaucher disease is a lipid storage disease characterized by the deposition of glucocerebroside in cells of the macrophage-monocyte system. The disorder results from the deficiency of a specific lysosomal hydrolase, glucocerebrosidase. Enzyme replacement therapy (ERT) for type 1 Gaucher disease is now available. Most patients receive the recombinant enzyme. This preparation is highly effective in reversing the visceral and hematologic manifestations of Gaucher disease. Fabry disease: Fabry disease is an X-linked lysosomal disorder that leads to excessive deposition of neutral glycosphingolipids in the vascular endothelium of several organs and in epithelial and smooth muscle cells. Deficiency of alpha-galactosidase-A activity leads to lysosomal accumulation of glycosphingolipids, predominantly the cerebroside trihexosides. Two enzymes, agalsidase-alpha and agalsidase-beta reportedly help in normalizing renal function, cardiac function, and cerebro-vascular flow. Pompe disease: In some glycogen storage disorders, clinical trials have successfully used treatment involving replacement of the enzymes that are deficient or not working normally. For example, in glycogen storage disorder type II (Pompe disease), this treatment has been shown to help reverse the heart problems and muscle weakness that can occur. For the infantile form of Pompe disease, a recombinant enzyme replacement was approved by the FDA. Sanfilippo syndrome: Sanfilippo syndrome or Mucopolysaccharidosis III (MPS-III) is a rare autosomal recessive lysosomal storage disease. It is caused by a deficiency in one of the enzymes needed to break down the glycosaminoglycan heparan sulfate (which is found in the extra-cellular matrix and on cell surface glyco-proteins).

No treatment for the underlying cause is available. Medical treatment is supportive and is directed toward improving the patient’s quality of life.

3. Final electron goes to In ETC a) 02 b) Cytochrome a c) Cytochrome b1 d) FADH2

Answer: O2 Explanation: The most common of final electron acceptors is molecular oxygen, O2, which combines with the spent electrons of cellular respiration, along with protons, to generate what is known as metabolic water.

4. Not intermediate product of TCA cycle is a) Alpha KG b) Citric acid c) Acetyl co-A d) Succinyl co-A

Answer: Acetyl co-A Explanation: Intermediate products of TCA cycle: Citrate→ Iso-citrate → Alpha keto-glutarate→ Succinyl co-A → Succinate→ Fumarate → Malate → Oxalo-acetate

FORENSIC SCIENCE 1. Cannabis is most commonly abused substance in India. Which form is not used in India as cannabis product? a) Ganja b) Charas c) Bhang d) Afeem

Answer: Afeem Explanation: Charas, ganja and bhang are obtained from the same plant called ‘cannabis sativa’. Charas: It’s a resin extract from the top leaves and unfertilized flower of the young female plant of cannabis sativa. Ganja: Like charas, it is made of the top leaves and unfertilized flower of young female plant. The resin is not extracted like charas. Leaves and flowers are dried and smoked in cigarettes, chillums and pipes. Bhang: Large green leaves and flowering shoots of mainly the male plant but female too. Afeem: A bitter, yellowish-brown, strongly addictive narcotic drug prepared from the dried juice of unripe pods of the opium poppy and containing alkaloids such as morphine, codeine, and papaverine.

2. Viper bite a) Musculo-toxic b) Neuro-toxic c) Histotoxic d) Vasculotoxic

Answer: Vasculotoxic Explanation:

Neurotoxins: Alfa-neurotoxins are a large group of postsynaptic toxins. Alfa -neurotoxins also attack cholinergic neurons. They mimic the shape of the acetylcholine molecule and therefore fit into the receptors → they block the ACh flow → feeling of numbness and paralysis. Snake examples: king cobra, sea snakes, many-banded krait and cobras

1.

Cardiotoxins are components that are specifically toxic to the heart. They bind to particular sites on the surface of muscle cells and cause depolarization and prevent muscle contraction. These toxins may cause the heart to beat irregularly or stop beating, causing death. Snake example: mambas, and some cobra species

2.

Hemotoxins cause hemolysis, the destruction of red blood cells (erythrocytes), or induce blood coagulation (clotting). Snake example: most vipers and many cobra species.

3.

3. Active component of a white oleander a) Nerina b) Nicotine c) Abrine d) Pilocarpine

Answer: Explanation: Abrus precatorius- Abrins Oleander: Oleandrin and nerioside, which are cardenolide glycosides Nerine: A plant genus in the family Liliaceae which causes poisoning when eaten by cattle. The toxic agent is lycorine, which causes salivation, vomiting and diarrhea.

4. In which poisoning, Burnt Rope odor is present a) Hydrogen sulphide b) Cyanide c) Nitrobenzene d) Cannabis

Answer: Cannabis Explanation: Rotten eggs odor: Hydrogen sulphide Garlic odor: Arsenic poisoning Fishy odor: Zn phosphide poisoning Burnt rope odor: Cannabis Bitter almond odor: Cyanide poisoning

PATHOLOGY 1. Verocay body is seen in a) Meningioma b) Glioma c) Schwannoma d) Hemangioma

Answer: Schwannoma Explanation:

Schwannoma is also known as neurilemoma. Encapsulated biphasic nerve sheath tumor derived from Schwann cells.

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Biphasic: compact hyper-cellular Antoni A areas and myxoid hypo-cellular Antoni B areas. Small tumors may be all Antoni A.

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Cells are narrow, elongate and wavy with tapered ends interspersed with collagen fibers■

Nuclear palisading around fibrillary process (Verocay bodies) are often seen in cellular areas■

Large irregularly spaced vessels are most prominent in Antoni B areas■

2. Rossets are not seen in: a) Retinoblastoma b) Medulloblastoma c) PNET d) Neuro-cysticercosis

Answer: Neuro-cysticercosis Explanation: Rosettes are little round groupings of cells found in tumors. They usually consist of cells in a spoke-wheel or halo arrangement surrounding a central, acellular region. Homer Wright rosette: 1. This rosette is typically seen in neuroblastoma, Medulloblastoma, and primitive neuroectodermal tumors (PNETs). 2. It consists of a halo of tumor cells surrounding a central region containing neuropil (hence its association with tumors of neuronal origin). Flexner-Wintersteiner Rosette: 1. This rosette is characteristic of retinoblastomas. It consists of tumor cells surrounding a central lumen that contains cytoplasmic extensions from the tumor cells. True Ependymal Rosette: 1. This rosette is seen in ependymoma and consists of tumor cells surrounding an empty lumen. Peri-vascular Pseudo-rosette: 1. This rosette consists of tumor cells collected around a blood vessel. It’s called a pseudo-rosette because the central structure isn’t part of the tumor. 2. These rosettes are common in ependymomas, but also see in medulloblastoma, PNET, central neurocytomas, and glioblastomas.

3. Not example of uni-parental disomy a) Angelman syndrome b) Prader-Willi syndrome c) Bloom syndrome d) Silver Russell syndrome

Answer: Bloom syndrome Explanation:

Bloom syndrome (congenital telangiectatic erythema) is a rare autosomal recessive disorder characterized by telangiectases and photosensitivity, growth deficiency of prenatal onset, variable degrees of immunodeficiency, and increased susceptibility to neoplasms of many sites and types.

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Uni-parental disomy (UPD) occurs when a person receives two copies of a chromosome or of part of a chromosome, from one parent and no copies from the other parent.

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The most well-known conditions: Prader-Willi syndrome (UPD 15) Angelman syndrome (UPD 15) Beckwith-Wiedemann syndrome

Russell-Silver syndrome (UPD 7) Transient neonatal diabetes (UPD 6) UPD of chromosome 14

4. Morphogenetic and mitogen both is feature of a) IGF b) FGF c) PDGF d) BMPR

Answer: IGF Explanation:

The IGF’s (insulin-like growth factors) are mitogenic, stimulating the fetal metabolism and coordinating the feto-placental metabolism. IGF-II regulates early embryonic development while IGF-I is responsible for the growth of the newborn.

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IGF-I signaling is an important mitogenic and morphogenetic regulator in hair follicle biology.■

MICROBIOLOGY/ PARASITOLOGY  1. When was HIV virus discovered? a) 1983 b) 1976 c) 1969 d) 1992

Answer: 1983 Explanation:

AIDS was first clinically observed in 1981 in the United States. The initial cases were a cluster of injection drug users and gay men with no known cause of impaired immunity who showed symptoms of Pneumocystis carinii pneumonia (PCP), a rare opportunistic infection that was known to occur in people with very compromised immune systems.

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In 1983, two separate research groups led by Robert Gallo and Luc Montagnier independently declared that a novel retrovirus may have been infecting AIDS patients, and published their findings in the same issue of the journal Science.

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2. Malaria recrudescence is- a) Resistant to treatment b) Relapse of infection c) Relapse in vivax and ovale d) Re-appearance of asexual stage parasitaemia after treatment.

Answer: Re-appearance of asexual stage parasitaemia after treatment Explanation:

In infections involving P. vivax and P. ovale there may be persistent hypnozoites in the liver. They are responsible for relapses of those species for periods of up to 8 or 9 years.

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The term for recurrence of infection with other species, P. falciparum, P. malariae and P. knowlesi, which lack hypnozoites, is “recrudescence”, meaning that the infection has recurred from persistent blood stages of the malaria parasite.

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There are several studies to prove that recurrent P. falciparum infection is caused by recrudescence of chloroquine resistant parasites.

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“Recrudescence” can also occur with P. vivax and P. ovale infections when such parasites have also persisted in the blood.

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Recrudescence can be due to (1) incomplete or inadequate treatment as a result of drug resistance or improper choice of medication, (2) an antigenic variation, and (3) multiple infections by different strains.

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3. Both DNA and RNA found in a) Bacteria b) Prion c) Viriod d) Plasmid

Answer: Bacteria Explanation:

A plasmid is a small, circular, double-stranded DNA molecule that is distinct from a cell’s chromosomal DNA. Plasmids naturally exist in bacterial cells, and they also occur in some eukaryotes.

1.

Viroids are plant pathogens that consist of a short stretch of highly complementary, circular, single-stranded RNA.

2.

A prion is an infectious agent composed of protein in a mis-folded form. Prion diseases or transmissible spongiform encephalopathies (TSEs) are a family of rare progressive neurodegenerative disorders that affect both humans and animals.

3.

PHARMACOLOGY 1. Which of the following anti-Parkinson drug may cause peripheral vasospasm? a) Ropinirole

b) Amantadine c) Bromocriptine d) Carbidopa

Answer: Bromocriptine Explanation:

Bromocriptine is a dopamine receptors agonist that may cause peripheral vasospasm. It is contraindicated in patients with peripheral vascular disease.

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Ropinirole directly stimulate the dopamine receptors but it doesn’t cause vasospasm.■

Amantadine and Carbidopa do not act directly act on dopamine receptors.■

2. Lithium should be stopped how many days before surgery a) 1 b) 2 c) 3 d) 4

Answer: 2 days Explanation:

Lithium is used to treat bipolar affective disorders. It may potentiate the effect of depolarizing and competitive neuromuscular blocking agents. The clearance of lithium can be reduced and its toxicity increased by factors that cause negative fluid balance, negative sodium balance, and decreased glomerular filtration rate.

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Lithium should be discontinued 2-3 days before major surgery and resumed when renal function and electrolyte levels are stable.

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If serum levels are not in a toxic range, renal function is normal, and fluid electrolyte status is stable, lithium can be continued before minor surgery.

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3. ATT side effects as hypothyroidism a) INH b) Pyrazinamide c) Ethionamide d) Streptomycin

Answer: Ethionamide Explanation:

Ethionamide is second-line anti-tuberculosis medication. Ethionamide is administered at a dose of 15–20 mg/kg/day (maximum 1 g/day) once or twice/day.

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Ethionamide use is most commonly limited by gastrointestinal intolerance. Taking ethionamide at bedtime or with food may improve tolerance.

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Hypothyroidism is an important adverse event; therefore, thyroidstimulating hormone levels should be measured at baseline and monthly while patients are receiving therapy.

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Hepatotoxicity can also occur with ethionamide; therefore, baseline liver function tests should be obtained.■

4. Methacholine agonist at a) M2 b) M1 c) M4 d) M3

Answer: M2 Explanation:

Ganglionic and other neural muscarinic receptors (M1) are apparently involved in CNS transmission.■

M3 muscarinic receptors on airway smooth muscle mediate broncho-constriction and pre-synaptic M2 muscarinic receptors inhibit acetylcholine release, causing broncho-dilation.

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Tiotropium, a selective antagonist of M3 receptors has recently been approved for treatment of chronic obstructive pulmonary disease (COPD). One of the advantages tiotropium is that it generally blocks only postsynaptic M3 receptors (that promote broncho-constriction) but does not block pre-synaptic M2 receptors (That cause broncho-dilation).

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Methacholine acts as M2-selective muscarinic receptor agonist to stimulate the parasympathetic nervous system.

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It is most commonly used for diagnosing bronchial hyper-reactivity, using the bronchial challenge test. Through this test, the drug causes broncho-constriction and people with pre-existing airway hyper-reactivity, such as asthmatics, will react to lower doses of drug.

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Agonist of muscarinic receptors: M1-Oxotremorine M2- Methacholine M3- Bethanechol

5. Frusemide acts on which part of loop of Henle? a) Ascending limb b) Descending limb

c) PCT d) DCT

Answer: Ascending limb Explanation: The diuretics are generally divided into four major classes, which are distinguished by the site at which they impair sodium re-absorption:

Loop diuretics act in the thick ascending limb of the loop of Henle■

Thiazide-type diuretics in the distal tubule and connecting segment■

Potassium-sparing diuretics in the aldosterone-sensitive principal cells in the cortical collecting tubule■

Acetazolamide and mannitol act at least in part in the proximal tubule.■

6. Laxative use can lead to- a) Hypo-magnesemia b) Hypo-kalemia c) Hypoglycemia d) Spasm of colon

Answer: Hypo-kalemia Explanation: Laxatives are generally well tolerated and may be considered safe drugs. When taken at much higher than the recommended doses (laxative abuse) some side effects may occur (e.g. hypo-kalemia, metabolic alkalosis, renal tubular damage).

7. Which does not form active metabolites? 0R Which is not a pro-drug? a) Diazepam b) Cyclophosphamide c) Lisinopril d) Fluoxetine

Answer: Lisinopril Explanation:

Captopril and Lisinopril are active drugs and other ACE inhibitors are inactive pro-drugs until metabolized in the liver.

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When hypertension or heart failure fails to respond adequately to a pro-drug ACE inhibitor, we should consider a trial of Captopril or Lisinopril. Liver disease may impair activation of pro-drugs. This may apply to liver congestion due to heart failure or hypertension.

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8. Alpha 2 agonist causes a/e a) Anxiolysis b) Sedation c) Analgesia d) Hyperalgesia

Answer: Hyperalgesia Explanation:

The alpha-2 (α2) adrenergic receptor is a G protein-coupled receptor (GPCR). Catecholamines like nor-epinephrine (nor-adrenaline) and epinephrine (adrenaline) signal through the α2-adrenergic receptor in the central and peripheral nervous systems.

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Alpha-2 agonists provide sedation, analgesia, muscle relaxation and anxiolysis.■

9. Methadone related false statements- a) Used in chronic treatment of pain b) Mu agonist c) Alpha agonist d)

Answer: Alpha agonist Explanation:

Methadone is a synthetic opioid analgesic that is primarily a mu-opioid agonist. It has actions and uses similar to those of morphine.

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It also has a depressant action on the cough center and may be given to control intractable cough associated with terminal lung cancer. 

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Methadone is also used as part of the treatment of dependence on opioid drugs, although prolonged use of methadone itself may result in dependence. 

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Indications: For the treatment of dry cough, drug withdrawal syndrome, opioid type drug dependence, and pain

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10. All true about midazolam except- a) Antero-grade amnesia b) Retrograde amnesia

c) Tachyphylaxis seen in patients receiving large doses d) Less Cardiovascular risk in comparison to propofol

Answer: Retrograde amnesia Explanation:

Midazolam is a short-acting but quickly effective benzodiazepine drug.■

Midazolam has very powerful anxiolytic (anti-anxiety), amnestic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative effects.

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Because it is amnestic, rapidly reaches therapeutic plasma levels, and has a short half-life of only 2-6 hours midazolam is considered optimal for relieving anxiety, sedating patients and causing anterio-grade amnesia in preoperative situations.

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Midazolam is also sometimes used to induce and maintain anesthesia in surgeries, for short term treatment of insomnia, and acute agitation management.

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To sedate patients in the ICU, midazolam is commonly administered via titrated, continuous infusions. Cardio-respiratory effects tend to be minimal; however, hypotension can occur in hypovolemic patients.

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Tolerance and tachyphylaxis (an acute decrease in the response to a drug after its administration) may occur, particularly with longer-term infusions.

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Benzodiazepine withdrawal syndrome has also been associated with high dose/long-term midazolam infusions.

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Compared with propofol infusions, midazolam infusions have been associated with a decreased occurrence of hypotension.

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Lorazepam is a more cost-effective choice for long-term sedation.■

SPM 1. ITP due to vaccine- a) MMR b) Typhoid vaccine c) Influenza vaccine d) HIB

Answer: MMR Explanation:

The MMR vaccine is an immunization vaccine against measles, mumps, and rubella (also called German measles). It is a mixture of live attenuated viruses of the three diseases, administered via injection.

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Rare side effects of the MMR vaccine: Idiopathic thrombocytopenic purpura (ITP) Seizures Allergic reaction

2. Which does not occur after a disaster? a) Leptospirosis b) Leishmania c) ARTI d) Rickettsia

Answer: Leishmania Explanation: Diseases Associated with Natural Disasters:

Acute respiratory infections (ARI) are a significant contributor to death and disability after disasters, and children less than five are affected disproportionately.

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Waterborne diseases include diarrheal pathogens, hepatitis, and leptospirosis.■

Important vector-borne diseases following disasters include malaria, dengue, Japanese encephalitis, and yellow fever, all of which are transmitted by mosquitoes.

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Direct contact diseases: Tetanus and coccidiomycosis■

3. Father of Evidence Based Medicine is a) David Lawrence Sackett b) da Vinci c) Hippocrates, d) Tolstoy

Answer: David Lawrence Sackett Explanation: David Lawrence Sackett is a Canadian medical doctor and a pioneer in evidence-based medicine.

4. All of the following provisions are included in the primary health care according to the Alma Ata declaration except– a) Adequate supply of safe drinking water b) Provision of food supply c) Provision of free medicines d) Basic sanitation

Answer: Provision of free medicines Explanation: Provisions included in the primary health care according to the Alma Ata declaration:- Includes at least:

Education concerning prevailing health problems and the methods of preventing and controlling them;1.

Promotion of food supply and proper nutrition;2.

An adequate supply of safe water and basic sanitation;3.

Maternal and child health care, including family planning; immunization against the major infectious diseases;

4.

Prevention and control of locally endemic diseases;5.

Appropriate treatment of common diseases and injuries; and6.

Provision of essential drugs.7.

5. Universal health coverage of India was recently approved by which committee- a) Medical education health group b) MPW in health and family planning c) High level expert Group d) Health survey and development committee

Answer: High level expert Group Explanation: The recommendations of the High Level Expert Group (HLEG) on Universal Health Coverage encompass the area of health financing, health services norms, human resources for health, community participation and citizen engagement, access to medicines, vaccines and technology and management and institutional reforms.

The main recommendations of the HLEG include: a) Increase public expenditure on health to at least 2.5 percent of GDP by the end of the 12th Plan and to at least 3% of GDP by 2022. b) Ensure availability of free essential medicines by increasing public spending on drug procurement.

OPHTHALMOLOGY 1. Micro-aneurysms in diabetic retinopathy occur in which layer? a) Inner nuclear layer b) Outer plexiform layer c) Retinal pigment epithelium d) Layer of rods and cones

Answer: Inner nuclear layer Explanation:

Micro-aneurysms are the earliest clinical sign of diabetic retinopathy and occur secondary to capillary wall out-pouching due to pericyte loss. They appear as small red dots in the superficial retinal layers, and there is fibrin and red blood cell accumulation in the micro-aneurysm lumen. Micro-aneurysms are located within the inner nuclear layer in capillaries linking the superficial and deep capillary network.

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Hemorrhages – Ruptured micro-aneurysms, capillaries and venules are all sources of intra-retinal hemorrhages, which are mostly located within the outer plexiform and inner nuclear layers.

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Hard Exudates – Extracellular collections of macrophages within the outer plexiform layer, derived from ingested leaked lipid & proteins from the abnormal vessels.

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Retinal edema – Fluid collects initially between the outer plexiform and inner nuclear layer; secondary edema appear between the inner plexiform and nerve fibre layers.

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2. Soft exudates deposits seen in which layer of retina? a) Outer plexiform layer b) Inner nuclear layer c) Ganglionic layer d) Rods and cones cell layer

Answer: Ganglionic layer Explanation:

Cotton wool spots result from occlusion of retinal pre-capillary arterioles supplying the nerve fibre layer with concomitant swelling of local nerve fibre axons. Also called “soft exudates” or “nerve fibre layer infarctions” they are white, fluffy lesions in the nerve fibre layer.

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The retinal nerve fiber layer (RNFL) is formed by retinal ganglion cell axons and represents the innermost layer of the fundus.

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3. Critical angle of corneal-air interface is a) 46° b) 66° c) 36° d) 56°

Answer: 46° Explanation:

The challenge of visualizing the anterior chamber angle structures lies with the critical angle.■

The critical angle for the cornea-air interface is approximately 46°.■

Corneal lenses or mirrors are needed to overcome the internal reflection of light. In direct gonioscopy, the anterior curve of the contact lens is such that the critical angle is not reached, and the light rays are refracted at the contact lens-air interface.

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In indirect gonioscopy, the light rays are reflected by a mirror in the contact lens and leave the lens at nearly a right angle to the contact lens-air interface.

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4. Ex-press implant of glaucoma is made up of a) Titanium b) Silicon c) Stainless steel d)

Answer: Stainless steel Explanation:

The Ex-Press Mini Glaucoma Shunt is biocompatible device for implantation under the conjunctiva for controlling intraocular pressure (IOP).

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It is a non-valved, MRI compatible, stainless steel device with a 50 micron lumen. It has an external disc at one end and a spur-like extension on the other to prevent extrusion.

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5. Ascorbate and alpha tocopherol levels are maintained in the lens by a) Glucose b) Fatty acids c) Glutathione d) Glycoprotein

Answer: Glutathione Explanation:

Ocular concentrations of glutathione are very high when compared with most other tissues and decreased levels of glutathione are associated with both age related macular degeneration and cataract, and in diabetic patients with similar conditions.

■

Glutathione is critical in maintaining the reduced state of sulfhydryl-containing proteins in the lens.■

Glutathione normally functions to maintain ascorbate, alpha-tocopherol, and other cellular components in reduced states.

■

6. Pt presents with chuna particles fallen into the eye. Which of the following should not be done? a) Repeated irrigation of conjunctival sac with NS b) Frequent instillation of Na citrate drops c) Thorough slit lamp exam d) Double eversion of lids and removal of chuna particles

Answer: Thorough slit lamp exam (?) Explanation:

Kids have lost eyesight due to sudden bursting of packets of chuna or calcium hydroxide, an additive used with chewing tobacco, and children are at the risk of “irreversibly” damaging their eyes in families where this habit is prevalent.

■

Once chuna enters the eye, it sticks into the eye under the eyelid. Even thorough washing doesn’t remove all the particles. Chuna particles leach from under the eyelid and get into cornea, destroying its outer covering called epithelium. The tear secretion system gets completely destroyed and the eye becomes dry. It can lead to complete blindness.

■

The incidence of ulceration and perforation in the cornea of alkali-injured eyes is significantly reduced by treatment with tri-sodium citrate or sodium ascorbate. Topical citrate reduces the inflammatory response in the cornea by inhibiting polymorphonuclear leukocytes.

■

7. Which of the following organism causes corneal perforation in just 2 days? a) Staphylococcus b) Pseudomonas c) Diphtheria d) Aspergillus

Answer: Pseudomonas Explanation:

Eighty percent of bacterial corneal ulcers are caused by Staphylococcus aureus, Streptococcus pneumoniae and Pseudomonas species. Pseudomonas aeruginosa is the most frequent and the most pathogenic ocular pathogen which can cause corneal perforation in just 2-3 days.

■

The most common organisms associated with contact lens related bacterial keratitis are Pseudomonas aeruginosa and Staphylococci.

■

8. Gas used in retinopexy a) Co2 b) SF6

c) Nitrous oxide d)

Answer: SF6 Explanation:

Pneumatic retinopexy (PR) is an alternative to scleral buckling for the surgical repair of selected retinal detachments.

■

A gas bubble is injected into the vitreous cavity, and the patient is positioned so that the bubble closes the retinal break (s), allowing absorption of the sub-retinal fluid.

■

Cryotherapy or laser photocoagulation is applied around the retinal break(s) to form a permanent seal.■

Sulfur hexafluoride (SF6) is the gas most frequently used for PR, followed by per-fluoro-propane (C3F8).■

ENT 1. Size of the laryngeal mask airway (LMA) for normal adults a) 2.5 b) 3 c) 1.5 d) 4

Answer: Size 4 Explanation: The laryngeal mask airway (LMA) is an ingenious supra-glottic airway device that is designed to provide and maintain a seal around the laryngeal inlet for spontaneous ventilation and allow controlled ventilation at modest levels (up to 15 cm H2O) of positive pressure. Ranges of patient laryngeal mask airway sizes: Size 1: Neonates/infants up to 5 kg Size 1.5: Infants 5–10 kg Size 2: Infants/children 10–20 kg Size 2.5: Children 20–30 kg Size 3: Children/small adults over 30 kg Size 4: Normal and large adults Size 5: Large adults

2. Screening test to assess hearing loss in neonate a) Audiometry b) OAE c) BERA d)

Answer: OAE Explanation:

Tests used for screening newborns for hearing loss include Otoacoustic emissions (OAE) and automated Auditory Brainstem Response audiometry (aABR). While OAE is cheap, quick, simple and reliable with a sensitivity of 100% and specificity of 99 %, aABR has the additional advantage of identifying neonates with auditory neuropathy unlike testing for OAE.

■

The most common sequence of tests is a two-step screening process in which OAEs are performed first, followed by ABR in those newborns that do not pass the OAEs.

■

Diagnostic hearing test for infants:

The most common diagnostic hearing test for infants under 6 months of age is the diagnostic auditory brainstem response test. It is similar to the aABR, but it provides more information and must be given by a specialist.

■

Brainstem-evoked response audiometry (BERA) is a special kind of electroencephalogram (EEG) – a test that measures electrical activity in the brain. It is also called the “auditory brainstem response” test (ABR).

■

Tests used to diagnose hearing impairment in older infants and children include: 1.Visual reinforcement audiometry (VRA): This test is used in children between 6 months and 2½ years of age. 2. Conditioned play audiometry (CPA): Children between 2½ and 4 years of age 3. Conventional audiometry: Children ages 4 years and older

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3. Which of the following part of cochlear implant is implanted during surgery? a) Receiver stimulator b) Transmitting coil c) Microphone d) Speech producer

Answer: Receiver stimulator Explanation: Parts of the cochlear implant: The implant is surgically placed under the skin behind the ear. The basic parts of the device include: External:

One or more microphones which picks up sound from the environment1.

A speech processor which selectively filters sound to prioritize audible speech, splits the sound into channels and sends the electrical sound signals through a thin cable to the transmitter,

2.

A transmitter, which is a coil, held in position by a magnet placed behind the external ear, and transmits power and the processed sound signals across the skin to the internal device by electromagnetic induction,

3.

Internal:

A receiver and stimulator secured in bone beneath the skin, which converts the signals into electric impulses and sends them through an internal cable to electrodes

1.

An array of up to 22 electrodes wound through the cochlea, which send the impulses to the nerves in the scala tympani and then directly to the brain through the auditory nerve system.

2.

4. A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. Which of the following would be the best management for the patient? a) FESS with polypectomy b) Medial Maxillectomy c) Caldwell Luc Operation d) Intranasal polypectomy

Answer: FESS (Endoscopic sinus surgery) Explanation:

Antrochoanal polyps are more common in children and young adults than in other age groups, with a higher prevalence in children. They are more common in males than in females.

1.

They nearly always are unilateral, solitary, benign polyps arising from the maxillary antrum.2.

Computed tomography is an important radiological examination of choice for evaluation of antrochoanal polyps.

3.

The treatment of choice is always surgical. Functional endoscopic sinus surgery (FESS) with polypectomy has been the dominating surgical approach. Endoscopic treatment of antrochoanal polyp in children is safe and effective.

4.

Nasal steroids are used in the initial treatment and after the surgical management in order to prevent recurrence.

5.

5. BERA wave V seen in a) Superior olivary nucleus b) Cochlear nerve c) Lateral lemniscus d) Cochlear nucleus

Answer: Lateral lemniscus Explanation:

In auditory brain stem evoked response audiometry (BERA), the impulses are generated by the brain stem. These impulses contain a series of peaks and troughs.

■

The positive peaks (vortex positive) are referred to by the Roman numerals I – VII.■

These peaks are considered to originate from the following anatomical sites:■

Cochlear nerves – waves I and II1.

Cochlear nucleus – wave III2.

Superior olivary complex – wave IV3.

Nulclei of lateral lemniscus – wave V4.

Inferior colliculus – waves VI and VII5.

6. Part spared in stapedectomy in otosclerosis a) Anterior crus of stapes b) Posterior crus stapes c) Lenticular process of incus d) Stapedius tendon

Answer: Lenticular process of incus Explanation:

Using a hand burr a small fenestra about 0.6mm in diameter is made over the foot plate. The stability of the incus is left intact because the stapedial tendon is not cut at this point. The stapedial tendon is cut after making fenestra and the supra structure of the stapes (Stapedius tendon, Anterior crus of stapes and Posterior crus stapes) is disarticulated and removed.

■

The prosthesis is placed in stapedectomy by inserting the device into the fenestra and leaning it against the posterior surface of the incus, where it will remain standing by capillary attraction.

■

A right-angled pick is then used in one hand to lift the long process of the incus while a second pick slides the bucket forward and under the lenticular process.

■

A few minor maneuvers may be necessary to place the well of the prosthesis beneath the lenticular process of the incus.

■

PEDIATRICS 1. Most common candidal species infecting neonates from caregiver’s hand: a) C. tropicalis b) C. parapsilosis

c) C. glabrata d) C. albicans

Answer: C. parapsilosis Explanation:

In the surgical ICU, C albicans accounts for about 50% of infections, C glabrata for about 25%, and a mixture of other species for the remainder.

■

In the neonatal ICU, C albicans accounts for approximately two thirds of infections and C parapsilosis for the remaining third.

■

Molecular epidemiology shows that the infecting strains of C albicans also colonize the mother’s vaginal mucosa.

■

The strains of C parapsilosis that infect infants are those found on the hands of healthcare workers in the neonatal ICU.

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2. In neonate with Erb’s palsy, Moro reflex is a) Absent b) Symmetrical c) Exaggerated d) Asymmetrical

Answer: Asymmetrical Explanation: Erb’s palsy is caused by damage to the brachial plexus during delivery of the neonate. This is mostly limited to the 5th and 6th cervical nerves. Presentation: Infant is unable to abduct the arm from the shoulder, rotate the arm externally from the shoulder, and supinate the forearm. This results in the classic ‘porter’s tip’ or ‘waiter’s tip’ appearance. Clinical signs:

Characteristic position – adduction and internal rotation of the arm with forearm pronated■

Forearm extension normal■

Biceps reflex absent■

Moro reflex absent on affected side■

Sensory impairment on outer aspect of arm (unusual)■

Power of the forearm is normal (if impaired, suggests injury to lower part of plexus).■

Hand-grasp normal unless lower part of plexus is also damaged.■

3. Not a part of Kangaroo mother care a) Skin to skin contact b) Early discharge c) Free nutritional supplements d) Exclusive breastfeeding (?)

Answer: Free nutritional supplements Explanation: Kangaroo mother care (KMC) includes thermal care through continuous skin-to-skin contact, support for exclusive breastfeeding or other appropriate feeding, early discharge from hospital and early recognition/response to illness. Individual component of kangaroo mother care:

Kangaroo position or skin to skin contact1.

Kangaroo nutrition or exclusive breastfeeding or other appropriate feeding2.

Kangaroo support3.

Kangaroo discharge4.

4. 4 years old girl presents with severe vomiting after viral fever of 6 days. She develops cerebral edema later on. What would be the liver biopsy findings? a) Centri-zonal hemorrhagic necrosis b) Marked micro-vesicular steatosis c) Ring granuloma d) NASH (Nonalcoholic Steato-hepatitis)

Answer: Marked micro-vesicular steatosis Explanation:

Reye syndrome, an extremely rare but serious illness that can affect the brain and liver, occurs most commonly in children recovering from a viral infection.

■

The signs and symptoms of Reye syndrome are almost always preceded by a viral illness, such as an upper respiratory tract infection (a cold, the flu, etc.) and a diarrheal illness.

■

Reye syndrome can occur from 1 day to 2 weeks after a viral infection.■

Symptoms include: frequent vomiting, lethargy or sleepiness, irritability or aggressive behavior■

In the later stages, a child may exhibit irrational behavior, confusion, severe muscle weakness, seizures, and loss of consciousness. There is usually no fever.

■

Liver biopsy: The major histopathological finding is diffuse micro-vesicular steatosis. In the typical case the hepatocytes are swollen and packed with multiple small vacuoles.

5. A 7-year old boy presents with a right-sided hemangioma and left-sided focal seizures. The most likely diagnosis is– a) Neurofibromatosis b) Sturge-Weber disease c) Hemangioma d)

Answer: Sturge-Weber disease Explanation:

Sturge-Weber syndrome is a neuro-cutaneous disorder with angiomas that involve the lepto-meninges and the skin of the face, typically in the ophthalmic (V1) and maxillary (V2) distributions of the trigeminal nerve.

■

In the majority of cases the naevus (Port-wine stain- facial cutaneous venous dilation) is unilateral and ipsi-lateral to the intracranial abnormality. The most common clinical manifestation is with childhood seizures that are often refractory to medical therapy.

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MEDICINE 1. A 45 year man is diagnosed with diabetes at his present visit for the first time. When should he visit an ophthalmologist:- a) On his 50th birthday b) When dimness of vision starts c) Before his 50th birthday d) Immediately at time of diagnosis

Answer: Immediately at time of diagnosis Explanation:

The ADA Clinical Practice Guidelines recommend ophthalmologic evaluation for all Type 1 diabetes that have had diabetes for at least 3 years and in all patients with Type 2 diabetes.

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A major difference between type 1 and type 2 diabetes mellitus is that many persons with type 2 diabetes have had the disease for many years prior to diagnosis

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Patients with type 2 diabetes, who generally have had years of undiagnosed diabetes and who have a significant risk of prevalent diabetic retinopathy at time of diabetes diagnosis, should have an initial dilated and comprehensive eye examination soon after diagnosis.

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2. Lung biopsy of a HIV patient showed intra nuclear basophilic inclusion bodies with peri-nuclear halo. The patient’s CD4 was 100 at the time of death. What is the probable cause of death? a) CMV b) MAC c) Pneumocystis d) TB

Answer: CMV Explanation:

CMV infection characteristically is associated with “owl’s-eye” cells, which are large cells with basophilic intra-nuclear inclusions and a surrounding clear Halo.

■

The presence of viral inclusions is diagnostic, although this method has low sensitivity. Therefore, absence of inclusions does not always exclude infection or active disease.

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3. Young male having pain with daily morning stiffness of spine for 30 minutes and reduced chest movements a) Ankylosing Spondylitis b) Rheumatoid Arthritis c) Gouty Arthritis d) Osteoarthritis

Answer: Ankylosing Spondylitis Explanation:

Ankylosing spondylitis (AS) is a chronic disease of unknown cause. It mainly affects the spine and the sacroiliac joints. Sometimes other joints and other parts of the body are affected.

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Tendons and ligaments in various parts of the body (in addition to those attached to the vertebrae of the lower spine) may become inflamed and painful where they attach to bones. Common examples are the Achilles tendon where it attaches to the heel, and where chest muscles attach to the ribs.

■

New criteria to define inflammatory back pain have been proposed; when 2 of the 4 criteria are present, they yield a sensitivity of 70.3% and specificity of 81.2%.These criteria includes the following:

■

Morning stiffness that lasts more than 30 minutes1.

Improvement of back pain with exercise but not rest2.

Nocturnal back pain during second half of the night only3.

Alternating buttock pain4.

4 . Evidence of decreased risk of cardiovascular disease is associated with all of the following except – a) Vitamin E supplementation b) Low to moderate daily alcohol consumption c) Regular physical activity d) Potassium

Answer: Vitamin E supplementation Explanation:

Research has shown that vitamin E does not have any overall benefit in lowering mortality or decreasing the risk of heart death or stroke, and therefore should not be recommended for heart disease prevention.

1.

Drinking moderate amounts of alcohol may have some benefits in terms of reducing the risk for cardiac disease and death related to cardiac disease. While many previous studies have suggested there may be heart benefits from drinking a moderate amount of red wine, the new study shows the findings hold with a moderate intake of any type of alcohol.

2.

K+ is critical to the maintenance of cardiovascular disease health and the normokalemic state is vital to the prevention of potentially serious sequelae, especially in the at-risk cardiovascular disease patient. So a diet that includes potassium-rich fruits and vegetables is good for the heart.

3.

5. True regarding multiple myeloma a/e a) Plasmacytosis b) Increased IgG c) ANA Antibody d) Increased M spikes

Answer: ANA Antibody Explanation:

ANAs are found in patients with a number of different autoimmune diseases, such as systemic lupus erythematosus, Sjögren’s syndrome, rheumatoid arthritis, Polymyositis, scleroderma, Hashimoto’s thyroiditis, juvenile diabetes mellitus, Addison disease, Vitiligo, pernicious anemia, Glomerulo-nephritis, and pulmonary fibrosis.

■

ANAs can also be found in patients with conditions that are not considered classic autoimmune diseases, such as chronic infections and cancer.

■

Diagnostic Tests:

The beta-2 micro-globulin (ß2-M) level is considered to be a standard measure of tumor burden (the extent of disease).

1.

Quantitive immunoglobulin (QIG) testing provides measurements of the levels of the different types of immuno-globulins (antibodies)—that is, IgG, IgA, and IgM—that are elevated and produced by myeloma cells.

2.

Serum protein electrophoresis (SPEP) detects the presence and level of various proteins in the blood, including M protein. Higher levels of M protein indicate more extensive disease.

3.

A bone marrow aspirate or biopsy shows that at least 10 percent of the cells are plasma cells (plasmacytosis).

4.

Criteria for diagnosis: The diagnosis of multiple myeloma requires the following:

A bone marrow aspirate or biopsy showing that at least 10 percent of the cells are plasma cells or the presence of a plasma cell tumor (called a plasmacytoma), plus

1.

M protein in the blood or urine, plus2.

Evidence of damage to the body as a result of the plasma cell growth, such as destructive bone lesions, kidney failure, anemia, or high calcium in the blood

3.

6. False about blackout a) Confused state b) Antero-grade amnesia c) Alcohol intake is reason d) Remote memory intact

Answer: Confused state Explanation:

Blackouts are caused by breakdown in the transfer of short-term memory into long-term storage and subsequent retrieval primarily through dose-dependent disruption of hippocampal CA1 pyramidal cell activity.

■

The exact mechanism is believed to involve potentiation of gamma-aminobutyric acid-alpha mediated inhibition and interference with excitatory hippocampal N-methyl-d-aspartate [NMDA] receptor activation, resulting in decreased long-term potentiation.

■

Alcohol primarily interferes with the ability to form new long–term memories, leaving intact previously established long–term memories and the ability to keep new information active in memory for brief periods.

■

Blackouts represent episodes of amnesia, during which subjects are capable of participating even in salient, emotionally charged events—as well as more mundane events—that they later cannot remember.

■

Periods of amnesia are primarily “antero-grade,” meaning that alcohol impairs the ability to form new memories while the person is intoxicated, but does not typically erase memories formed before intoxication.

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7. Right atria chronic overload or acute overload is indicated by P wave of more than a) 2.5 b) 3.5 c) 4.5 d) 5.5

Answer: 2.5 Explanation:

Right atrial enlargement is diagnosed by the presence of a P wave 2.5 millimeters or greater in height. This increased voltage is caused by hypertrophy or acute strain of right atrial tissue.

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Dilation or hypertrophy of the left atrium may increase the duration of the P wave. The P wave is normally less than 0.11 msec.

■

The long or abnormally shaped P wave occurs because of delay in electrical activation of the enlarged left atrium.

■

A P wave longer than 0.11 milliseconds is diagnostic of left atrial enlargement■

8. The ‘v’ wave is larger than ‘a’ wave in left atrium because – a) Left atrium has high pressure area b) Left atrium is more compliant c) Pressure from right atria left atria transferred to lungs d)

Answer: ? Explanation: The reasons for tall left atrial v waves are

V waves are passive atrial filling waves and a-wave is produced from the increased pressure during the atrial contraction.

■

Left atrium is relatively thick, stiff, less compliant chamber.■

Apart from relative thinness, right atrial volume is more; hence it can accommodate more volume without raising its pressure.

■

The left atrium is decompressed by relatively stiff pulmonary veins cannot adequately dampen the refluxing tides of v waves, while the low pressure vena cava of RA dampen the right atrial v waves with ease.

■

Further, the adjoining systemic left ventricle, adds up to the stiffness of left atrial filling.■

SURGERY 1. Serious complication of sitting position technique a) Dys-arrhythmia b) Hypotension, c) Nerve paralysis, d) Venous Air embolism

Answer: Venous Air embolism Explanation:

Venous Air embolism is most serious complication in sitting position technique in neurosurgery.■

Intra-operative trans-esophageal echocardiography (TEE) is found to be the monitoring technique with the highest sensitivity. The sitting position is a safe positioning technique if TEE monitoring is used.

■

2. Not related with CA colon? a) EGFR b) C.myc c) KRAS d) Micro satellite instability

Answer: EGFR mutation Explanation: Molecular genetics of sporadic colon cancer: APC K-ras Oncogene P53 Mismatch repair genes DCC (deleted in colon cancer) gene C-myc Oncogene

Microsatellite instability (MSI) is the condition of genetic hyper-mutability that results from impaired DNA Mismatch Repair.

■

Micro satellite instability (MSI) may result in colon cancer, gastric cancer, endometrium cancer, ovarian cancer, hepato-biliary tract cancer, urinary tract cancer, brain cancer and skin cancers. MSI is most prevalent in the cause of colon cancers.

■

EGFR over-expression (known as up-regulation) has been associated with a number of cancers, including lung cancer, anal cancers and glioblastoma multiforme.

■

3. About neurogenic shock, true is: a) Hypotension with bradycardia b) Hypertension and bradycardia c) Hypotension and tachycardia d) Hypertension and tachycardia

Answer: Hypotension with bradycardia Explanation:

In brain or spinal injury, the sympathetic trunk stops working and blood vessels dilate and result in blood pooling away from the heart.

■

Patients are generally hypotensive with warm, dry skin. The loss of sympathetic tone may impair the ability to redirect blood flow from the periphery to the core circulation leading to excessive heat loss and hypothermia.

■

Bradycardia is a characteristic finding of neurogenic shock; however, it is not universally present.■

4. Most common viral cause of kidney transplant rejection a) Polymyoma virus b) HCV c) HBV high risk d) Herpes simplex type

Answer: Polymyoma virus Explanation:

The polyomaviruses cause clinical disease among immuno-compromised patients.■

BK virus and JC virus are the two most common polyomaviruses associated with human disease and the only two associated with nephropathy.

■

The major diseases caused by BK virus are tubule-interstitial nephritis and ureteral stenosis in renal transplant recipients, and hemorrhagic cystitis in bone marrow transplant recipients.

■

BK virus causes clinical disease of the genitourinary tract, due in part to its tropism for genitourinary epithelium.

■

The JC virus causes a similar disease among kidney transplant recipients, but is far less common.■

BK-induced nephropathy reportedly occurs in up to 10 percent of kidney allograft recipients. Overall, the reported incidence of allograft failure ranges from 15 to 50 percent of affected individuals.

■

5. Not a cause of pancreatitis a) Hyperlipidemia b) Islet cell hyperplasia c) Abdominal trauma d) Trypsinogen

Answer: Islet cell hyperplasia Explanation:

Inflammation of the pancreas has various causes. Once the gland becomes inflamed, the condition can progress to swelling of the gland and surrounding blood vessels, bleeding, infection, and damage to the gland. There, digestive juices become trapped and start “digesting” the pancreas itself.

■

A number of causes have been identified for acute pancreatitis and chronic pancreatitis, including: Alcoholism, Gallstones, Abdominal surgery and during, ERCP procedure, certain medications, Cigarette smoking, Cystic fibrosis, Family history of pancreatitis, Hyper-calcemia, Hyper-triglyceridemia, Infection, Injury to the abdomen and Pancreatic cancer

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GYNAECOLOGY AND OBSTETRICS 1. Which drug is not given in pregnancy induced hypertension? a) Alpha methyl dopa b) Enalapril c) Nifedipine d) Labetalol

Answer: Enalapril Explanation: Commonly used antihypertensive medications in pregnancy: Severe hypertension Hydralazine Labetalol Short-acting Nifedipine Mild to moderate hypertension Methyldopa Labetalol Hydralazine Long-acting Nifedipine

Congenital malformations have been reported with the use of ACE inhibitors during the first trimester of pregnancy, while fetal and neonatal toxicity, death, and congenital anomalies have been reported with the use of ACE inhibitors during the second and third trimesters of pregnancy.

■

If the patient becomes pregnant, Enalapril should be discontinued as soon as possible. Enalapril is considered contraindicated during pregnancy.

■

2. Diagnostic criteria for HELLP syndrome are A/E: 1) Hemolysis 2) Elevated liver enzyme 3) Low platelets < 25000 4) Retro-peritoneal hemorrhages

Answer: Retro-peritoneal hemorrhages Explanation: The HELLP syndrome is a serious complication in pregnancy characterized by hemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia. Diagnostic criteria for HELLP syndrome Hemolysis Elevated Liver Enzymes and Thrombocytopenia

3. All are advantage of Hysteroscopic over open Myomectomy except a) Less Pain b) Early Ambulation c) Less Blood loss d) Recurrence

Answer: Recurrence Explanation: For women who are candidates for Hysteroscopic Myomectomy, this procedure is preferred over an abdominal approach, particularly laparotomy, for the following reasons:

Outpatient procedure1.

Minimal recovery time2.

Decreased peri-operative morbidity3.

Minimal or no scarring of myometrium4.

Reduced the risk of postoperative adhesion formation5.

Reduced postoperative pain6.

Blood loss7.

4. Not a criteria for diagnosis of superimposed preeclampsia in a pregnant lady with pre existing hypertension: a) Increase in systolic BP by 30mm Hg and diastolic BP by 15mm Hg b) Platelets less than 75000 c) New onset proteinuria d) Nevo-vascular changes in retinal vessels

Answer: Nevo-vascular changes in retinal vessels Explanation:

Preeclampsia is defined by the new onset of elevated blood pressure and proteinuria after 20 weeks of gestation.

■

Hypertension is defined as blood pressure equal to or greater than 140/90 mm Hg or an increase in mean arterial pressure of 20 mm Hg. The use of an increase in blood pressure of 30/15 mm Hg over first-trimester values is controversial.

■

Superimposed pre-eclampsia (on chronic hypertension)

New onset proteinuria in a woman with hypertension but no proteinuria before 20 weeks gestation■

A sudden increase in proteinuria or blood pressure, or platelet count less than 100,000 in women with hypertension and proteinuria before 20 weeks gestation

■

ANESTHESIA 1. Which anesthetic doesn’t interfere with CSF secretion? a) N2O b) Thiopentone c) Halothane d) Ketamine

Answer: N2O (Nitrous oxide) Explanation: Anesthetic agents Halothane, ketamine – increase CSF production Thiopental – decreases CSF production Active transport inhibitors Acetazolamide, Frusemide – reduce CSF production Hormones Angiotensin, vasopressin – reduce CSF production

2. Most appropriate mode of ventilation for head injury patient? a) CPAP b) SIMV c) AMV d) CMV

Answer: CMV Explanation:

Controlled mechanical ventilation (CMV): The ventilator delivers a preset number of breadths and tidal volume, and makes no allowance for any effort by the patient.

■

This is used in heavily sedated and paralyzed or deeply unconscious patients.■

Any respiratory attempt by the patient may lead to fighting the ventilator, resulting in hemodynamic instability, coughing, restlessness, and raised ICP due to cerebral venous congestion.

■

3. Stage of surgical anesthesia during ether administration is a) Loss of consciousness b) Failure of circulation c) Regular respiration to cessation of breathing d) Loss of consciousness to beginning of regular respiration

Answer: Regular respiration to cessation of breathing Explanation: Stages of Anesthesia Stage I (stage of analgesia or disorientation): from beginning of induction of general anesthesia to loss of consciousness. Stage II (stage of excitement or delirium): from loss of consciousness to onset of automatic breathing. Stage III (stage of surgical anesthesia): from onset of automatic respiration to respiratory paralysis. It is divided into four planes:

Plane I – from onset of automatic respiration to cessation of eyeball movements.■

Plane II – from cessation of eyeball movements to beginning of paralysis of inter-costal muscles.■

Plane III – from beginning to completion of inter-costal muscle paralysis. Diaphragmatic respiration persists but there is progressive inter-costal paralysis, pupils dilated and light reflex is abolished.

■

Plane IV – from complete inter-costal paralysis to diaphragmatic paralysis (apnea).■

Stage IV: from stoppage of respiration till death. Anesthetic overdose cause medullary paralysis with respiratory arrest and vasomotor collapse. Pupils are widely dilated and muscles are relaxed.

SKIN 1. Multiple, shiny, pinhead size papules on dorsal surface of hand forearm & penis in young boy a) Scabies b) Lichen planus c) Lichen nitidus d) Molluscum contagiosum

Ans: Lichen nitidus Explanation:

Lichen nitidus is a relatively rare, chronic skin eruption that is flat-topped, skin-colored micro-papules. Lichen nitidus mainly affects children and young adults.

■

The most common sites of involvement are the trunk, flexor aspects of upper extremities, dorsal aspects of hands, and genitalia.

■

Lichen nitidus is usually an asymptomatic eruption; however, patients occasionally complain of pruritus.■

2. 37 year female with itchy linear wheal, with itching for 30 minutes at site, diagnosis is a) Dermatographic urticaria b) Pressure urticaria c) Acute urticaria d) Chronic urticaria

Ans: Dermatographic urticaria Explanation:

Pressure urticaria is an uncommon form of physical urticaria. Patients who have had urticaria for more than 6 weeks are given the diagnosis of chronic urticaria. A proportion of patients with chronic urticaria have physical urticaria, which is urticaria incited by a physical stimulus, such as cold, vibration, or pressure.

■

The term dermographism (or dermatographism) literally means writing on the skin. It is the commonest form of physical urticaria. Firm stroking of the skin produces a linear wheal. Whealing usually develops within 5-10 minutes of stroking the skin and persists for 15-30 minutes.

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3. Treatment of choice of comedone lesions on face trunk a) Retinoids b) Clindamycin c) Retinoids plus oral doxycycline d)

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Answer: Retinoids plus oral doxycycline Explanation:

Comedonal acne: It forms because a component of skin oil called sebum along with old skin cells block the pores of the skin. Comedonal acne appears most often on the forehead, nose, and chin.

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The most common treatment is retinoids with an oral antibiotic, such as doxycycline, tetracycline, minocycline or erythromycin, which kills the bacteria that cause inflammation around the blocked pores.

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Topical retinoids are comedolytic and anti-inflammatory. They normalize follicular hyper-proliferation and hyper-keratinization. Topical retinoids reduce the numbers of micro-comedones, comedones, and inflammatory lesions.

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