1.

Anterior interosseous nerve is a branch of?

a) Radial nerve

b) Median nerve

c) Ulnar nerve

d) Axillary nerve

Correct Answer - B
Ans. is 'b' i.e., Median nerve
Anterior interosseous nerve is a branch of median nerve.
Anterior interosseous artery is a branch of ulnar artery.
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2. Olecranon process of ulna helps in
formation of?
a) Radial notch

b) Trochlear notch

c) Olecranon fossa

d) Coronoid fossa.

Correct Answer - B
Ans. is 'b' i.e., Trochlear notch
Inner surface of olecranon process forms trochlear notch for
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articulation of trochlea of humerus.
Radial notch is seen in lateral part of upper end of shaft (not on
olecronon).
Olecranon fossa and coronoid fossa are part of lower end of
humerus.
3. True about clavicle?
a) Endochondral ossification

b) Vertical

c) No medullary cavity

d) Rarely fractures

Correct Answer - C
Ans:C.)No medullary cavity.
Peculiarities of Clavicle:
1.It has no medullary cavity
2. It is the first bone to ossify in the fetus (5th-6th week)
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3. It is the only long bone having 2 primary centers of ossification
(others have only 1)
4. It is the only long bone that ossifies in membrane and not in
cartilage
5. It is the only long bone lying horizontally
6. It is the most common fractured long bone in the body
7. It is subcutaneous throughout
4. Clavipectoral fascia is pierced by all except
?
a) Lateral pectoral nerve

b) Median pectoral nerve

c) Thoracoacromial vessels

d) Cephalic vein

Correct Answer - B
Ans. is 'b' i.e., Median pectoral nerve
Clavipectoral fascia is pierced by -
Thoraco-Acromial vessels. medpox.com
Lateral pectoral nerve.
Lymphatics passing from breast and pectoral region to apical-axillary
1.n.
Cephalic vein.
5. Root value of supinator jerk -
a) C3 C4

b) C4C5

c) C5 C6

d) C8 T1

Correct Answer - C
C5 C6

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6. Small muscles of hand are supplied by:
a) C3

b) C4

c) C6

d) C5-7 , C-8 to T1

Correct Answer - D

All small muscles of hand i.e. thener, hypothenar, interossei &
lumbricals are supplied by median and ulnar nerves which originate
from C5-7 and C8 and T1 nerves.
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7. Bicipital aponeurosis lies over which
structure in cubital fossa?
a) Ulnar nerve

b) Radial nerve

c) Brachial artery

d) Anterior interosseous artery

Correct Answer - C

Bicipital aponeurosis passes superficial to the brachial artery and
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median nerve. It lies deep to superficial veins.
During venipuncture, the bicipital aponeurosis provides limited
protection for brachial artery and median nerve.
8. Structure over bicipital aponeurosis in
cubital fossa?
a) Ulnar nerve

b) Radial nerve

c) Brachial artery

d) Veins

Correct Answer - D
Veins

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 9. Nerve running along with profunda brachii
artery, in spiral groove ?
a) Ulnar

b) Median

c) Radial

d) None

Correct Answer - C
Ans. is 'c' i.e., Radial
Profunda brachii is a branch of brachial artery.
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It accompanies radial nerve in spiral groove.
Branches of profunda brachii artery are :?
1. Deltoid branch (ascending branch) :- It anastomoses with the
descending branch of posterior circumflex humeral artery.
2. Nutrient artery to humerus:
3. Muscular branches
4. Posterior descending (middle collateral) :- It anastomoses with
interosseous recurrent branch of ulnar artery.
5. Anterior descending (radial collateral) :It anastomoses with radial
recurrent branch of radial artery in front of lateral epicondyle.
10. Boundaries of quadrilateral space include
all except?
a) Teres major

b) Long head of triceps

c) Neck of humerus

d) Deltoid

Correct Answer - D
Deltoid

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11. Axillary artery is divided into three parts
by?
a) 1st rib

b) Clavicle

c) Pectoralis minor muscle

d) Teres minor muscle

Correct Answer - C
Axillary artery
It is the main artery of upper limb. It begins at the level of outer
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border of first rib as a continuation of subclavian artery. It ends at the
level of lower border of teres major to continue as brachial artery.
The axillary artery is covered anteriorly by pectoralis minor, which
divides it into three parts:?
1) First part :- This part is proximal to upper border of pectoralis
minor, i.e. extends from outer border of first rib to upper border of
pectoralis minor. The branch of first part is Superior thoracic artery.
2) Second part :- This part is behind pectoral is minor. It gives
following branches.
A) Thoracoacromial artery :- It pierces clavipectoral foscia and
gives following branches :-
(i) Acromial
(ii) Pectoral,
(iii) Clavicular and deltoid.
B) Lateral thoracic artery
3) Third part :- This part is distal to lower border of pectoralis minor,
i.e. extends from pectoralis minor (lower border) to teres major
(lower border). It gives following branches ?
A) Subscapular artery:- It gives off circumflex scapular artery and
then continues us thoracodorsal artery.
B) Anterior circumflex humeral artery.
C) Posterior circumflex humeral artery.
Anterior and posterior circumflex arteries (both are branches of 3rd
part of axillary artery) forms anastomosis around surgical neck of
humerus.

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 12. Posterior wall of axilla is formed by
a) Pectoralis major

b) Pectoralis major

c) Subscapularis

d) Intercostal muscles

Correct Answer - C
Axilla (armpit)
The axilla is apyramidal space situated between the upper part of
the arm and the chest wall. It resembles afour sided pyramid, and
has following : (i) an apex (ii) a base (iii) four walls (anterior,
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posterior, medial and lateral).
1. Anterior (pectoral) wall :- Formed by (i) Pectoralis major, (ii)
Pectoralis minor, and (iii) Subclavius. The latter two muscles
enclosed by clavipectoral fascia.
2. Posterior (subscapular) wall :- Formed by (i) Subcapularis, (ii) Teres
major, and (iii) Latissimus dorsi.
3. Medial (thoracic) wall :- Formed by (i) Upper four ribs (with their
intercostal muscles), and (ii) Upper part of serratus anterior.
4. Lateral (humeral) wall :- Formed by (i) Upper part of humerus with
bicipital groove lodging the tendon of long head of biceps, and (ii)
Corachobrachialis and short head of biceps ?
5. Base :- Formed by Skin, superficial fascia and deep (axillary) fascia.
It is directed downwards.
Apex :- It is directed upwards and medially towards the root of neck.
It communicates with supraclavicular triangle of neck, hence referred
to as Cervicoaxillary canal. It is triangular in shape and is bounded
anteriorly by clavicle, posteriorly by upper part of scapula and
medially by outer border of first rib. The axillary artery and brachial
plaxus enter the axilla through this canal.
plaxus enter the axilla through this canal.

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13. Anterior axillary fold is due to which
muscle ?
a) Pectoralis major

b) Pectoralis minor

c) Subscapularis

d) Teres major

Correct Answer - A
Anterior axillary fold is rounded in shaped and is formed by
pectoralis major (lower border). Posterior axillary fold is formed by
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teres major and latisimus dorsi.
14. Intracapsular but extrasynovial is ?
a) Long head of triceps

b) Long head of biceps

c) Short head of biceps

d) Medial head of biceps

Correct Answer - B
Origin of long head of biceps is intracapsular but extrasynovial,
enclosed by a prolongation of synovial membrane of shoulder joint.

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15. How many lactiferous ducts open in
nipple ?
a) 0 -10

b) 15 -20

c) 25 -50

d) 50 -75

Correct Answer - B
The nipple is pierced by 15-20 lectiferous ducts.

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16. Structure related to deltopectoral groove
?
a) Axillary artery

b) Cephalic vein

c) Baselic vein

d) Radial nerve

Correct Answer - B
Ans. is b' i.e., Cephalic vein
Deltopectoral groove is a groove between deltoid muscle and
pectoralis major muscle. medpox.com
It is traversed by cephalic vein
17. Common interosseous artery is a branch
of -
a) Brachial artery

b) Radial artery

c) Ulnar artery

d) Profunda branchii artery

Correct Answer - C
Branches of ulnar artery
A) In cubital fossa
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1) Anterior ulnar recurrent :- Anastomoses with inferior ulnar
collateral in from of medial epicondyle.
2) Posterior ulnar recurrent :- Anastomoses with superior ulnar
collateral behind medial cpicondyle.
3) Common interosseous :- Divides into
i) Anterior interosseous : It is the deepest artery of front of
forearm. It is accompanied by anterior interosseous nerve (a branch
of median nerve). It pierces interosseous membrane at upper border
of pronator quadratus to enter into extensor (dorsal) compartment.
Its branches are : (a) muscular branches for deep muscles of front of
forearm; (b) nutrient artery to radius and ulna; and (c) median artery.
ii) Posterior interosseous : Near its origin, it gives of interosseous
recurrent artery which ends by anastomosing with middle collateral
artery.
B) In forearm
1) Palmar carpal branch
2) Dorsal carpal branch
C) In palm :- These are terminal branches.
i) Deep branch :- Completes the deep palmar arch on medial side
by joining the terminal part of radial artery.
ii) Superficial branch :- Forms the major part of superficial palmar
arch.

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18. True about blood supply of scaphoid?
a) Mainly through ulnar artery

b) Major supply from ventral surface

c) Major supply from dorsal surface

d) Proximal supply in antegrade fashion

Correct Answer - C
Major blood supply (70-80%) of scaphoid comes through dorsal
surface via dorsal branches of radial artery.
These dorsal vessels enter the scaphoid at or just distal to waist
area and supply the proximal pole in retrograde fashion.
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19. 3rd and 4th lumbrical (lateral two
lumbricals) of foot are supplied by ?
a) Medial plantar nerve

b) Lateral plantar nerve

c) Peroneal nerve

d) None of the above

Correct Answer - B
Behind the medial malleolus, beneath the flexor retinaculum the
tibial nerve divides into its two terminal branches :
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i) Medial plantar nerve :- It corresponds approximately to the median
nerve in the hand as far as skin and muscle supplies are concerned.
It supplies medial part of sole, plantar surface of medial 3rd A digits,
and innervates flexor digitorum brevis, abductor hallucis, flexor
hallucis brevis and the first lumbrical.
ii) Lateral plantar nerve :- It correspods approximately to the ulnar
nerve. It supplies the lateral part of sole, plantar surface of lateral
digits and innervates flexor digitorum accesorius, abductor digiti
minimi, flexor digiti minimi brevis, adductor hallucis, all intcrossei and
2nd,3rd,4th lumbricals.
20. All are true about short saphenous vein
except?
a) Runs behind lateral malleolus

b) Runs on lateral side of leg

c) Accompanied by sural nerve

d) Achillis tendon is medial to vein

Correct Answer - B
Short saphanous vein runs in the back (posteriorly) of leg (not
laterally).
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It enters the back of leg by passing behind the lateral malleolus and
is accompanied by sural nerve.
In leg it ascends lateral to tendocalcaneous (tendoachillis). Thus
tendoachillis is medial to vein.
21. Not true about inferior extensor
retinaculum?
a) Y shaped

b) Superior slip attached to lower end of fibula

c) Inferior slip attached to deep fascia of sole

d) Lateral attached to calcaneum

Correct Answer - B
Ans. is 'b' i.e., Superior slip attached to the lower end of the fibula
Inferior extensor retinaculum
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It is a Y-shaped band lying in front of the ankle joint.
Attachments:-
The stem of the inferior extensor retinaculum is attached to the
upper surface of the calcaneus in front of sulcus calcanei. Passing
medially, the stem divides into two bands. The upper band passes
upwards and medially to be attached to tibial malleolus. The lower
band extends downwards and medially to blend with plantar
aponeurosis.
Structures passing deep to it are :
1) Tibialis anterior tendon.
2) Extensor hallucis longus tendon.
3) Dorsalis pedis vessels.
4) The deep peroneal nerve.
5) Extensor digitorum longus tendons.
6) Peroneus Tertius tendon.
22. True about popliteus are all except?
a) Flexor of knee

b) Intracapsular origin

c) Supplied by tibial nerve

d) Causes locking of knee

Correct Answer - D
Popliteus
Popliteus is a deep muscle of posterior compartment of leg.
Features of popletius are -
Origin medpox.com
Lateral surface of lateral condyle of femur, origin is intracapsular.
Outer margin of lateral meniscus of knee.
Insertion
Posterior surface of shaft of tibia above soleal line.
Nerve supply
Tibial nerve
Action
Ulocks knee joint by lateral rotation of femur on tibia prior flexion.
Accessory flexor of knee.
23. True regarding semitendinosus ?
a) Supplied by common peroneal part of sciatic nerve

b) Proximal flashy distal thin

c) Distal flashy proximal thin

d) Proximal and distal thin middle fleshy

Correct Answer - D
Semitendinosus is a fusiform (spinadle shaped) muscles with main
mass in middle of it. It arises in thin tendon from ischial tuberosity
and ends in a long tendon to insert on medial surface of proximal
part of tibia. o It is supplied by tibial part of sciatic nerve.
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24. Which of the following dorsiflexes the foot
-
a) Tibialis posterior

b) Tibialis anterior

c) Peroneus brevis

d) Extensor digitorum brevis

Correct Answer - B
Tibialis anterior

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25. Artery piercing the oblique popliteal
ligament of knee -
a) Superior genicular

b) Inferior genicular

c) Middle genicular

d) Popliteal

Correct Answer - C
Middle genicular
Oblique popliteal ligament is an expansion from the tendon of
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semimembranosus attachment to intercondylar line of femur.
It is closely related to popliteal artery and is pierced by middle
genicular vessels and nerve and the terminal part of the posterior
division of the obturator nerve.
26. Lateral dislocation of patella is prevented
by ?
a) Rectus femoris

b) Vastus intermedius

c) Vastus lateralis

d) Vastus medialis

Correct Answer - D
Vastus medialis

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27. Hunter's canal is seen in?
a) Cubital fossa

b) Popliteal fossa

c) Thigh

d) Calf

Correct Answer - C
Ans. is 'c' i.e., Thigh

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28. True about iliotibial tract all except?
a) Receives insertion of gluteus maximus

b) Derived from fascia lata

c) Inserted on lateral tibial condyle

d) None

Correct Answer - D
Iliotibial Tract
The fascia lata is thickened laterally where it forms a 5 cm wide
band called the iliotibial tract.
Superiorly the tract splits into two laters.
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The superficial lamina is attached to tubercle of iliac crest, and deep
lamina to the capsule of hip joint.
Inferiorly, the tract is attached to a smooth area on anterior surface
of the lateral condyle of tibia.
The importance of the iliotibial tract is as follows.
a) Two important muscles are inserted into its upper part, between
the superficial and deep laminae. These are the three-fourths part of
the gluteus maximus; and the tensor fasciae latae.
b) The iliotibial tract stabilizes the knee both in extension and in
partial flexion; and is, therefore, used constantly during walking and
running.
29. Ligament supporting the talus is ?
a) Spring ligament

b) Deltoid ligament

c) LCL

d) Cervical ligament

Correct Answer - A
Ans. A) Spring ligament
Spring ligament (Plantar calcaneonavicular ligament) connects
the calcaneum with the navicular bone.
However, its principal job is to provide a sling for the talus,
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to support the head of talus (though it has no attachment to talus).
This aids in supporting the weight of the body.
Weaknes or lengthening along this ligament can cause flat foot
30. False about tibia-fibula is ?
a) Nutrient artery of tibia is from posterior tibial artery

b) Nutrient artery of fibula is from peroneal artery

c) Proximal end of tibia is related to common peroneal nerve

d) Tibia is the most common site of osteomyelitis

Correct Answer - C
Common peroneal nerve is related to neck of fibula (not tibia).
Nutrient artery of tibia is a branch of posterior tibial artery.
Nutrient artery of fibula is a branch of peroneal artery.
Tibia is the commonest site of osteomyelitis.
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31. All are branches of lumbar plexus except?
a) Iliohypogastric nerve

b) Ilioinguinal nerve

c) Obturator nerve

d) Subcostal nerve

Correct Answer - D
Ans. is 'd' i.e., Subcostal nerve

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32. Articular surface of the sarum extends
upto how many vertebrae in males ?
a) 1 to 11/2

b) 2 to 21/2

c) 3 to 31/2

d) 4 to 41/2

Correct Answer - C
Articular surface of sacrum: the rough articular surface on the lateral
aspects of the sacrum that articulates with the ilium on each side.
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33. Lower limit of sacro iliac joint lies upto
which level in females ?
a) 1 to 1 1/2

b) 2 to 2 1/2

c) 3 to 3 1/2

d) 4 to 4 1/2

Correct Answer - B
, 2 to 2 1/2
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34. First rib is not related to ?
a) Sympathetic chain

b) Scalenus anterior

c) Suprapleural membrane

d) T2 Nerve

Correct Answer - D
Ans. is `d' i.e., T2 Nerve
Anteriorly, the neck of the first rib is related to (from medial to
lateral) :- (1) Sympathetic chain, (ii) Ist posterior intercostal vein,
medpox.com st thoracic nerve. These
(iii) Supeior intercostal artery, and (iv) 1
structures are between neck of first rib (posteriorly) and apex of
lung (anteriorly).
Following are attached to first rib :- Scalenus anterior, scalenus
medius, subclavius, serratus anterior ( lst digitation), costo-clavicular
ligament and suprapleural membrane.
35. True about anterior intercostal artery ?
a) Present in 1st to 11th intercostal space

b) Each intercostal space has two anterior intercostal arteries

c) Branch of internal thoracic artery

d) Branch of aorta

Correct Answer - C
Ans. is 'c' i.e., Branch of internal thoracic artery
Each of upper nine intercostal spaces (1 to 9) have one posterior
and two anterior intercostal arteries. The 10"and 11" spaces have
one posterior intercostal artery (no anterior intercostal artery)
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Posterior intercostal artery is the main artery of intercostal space
and runs in the costal groove along the upper border of an
intercostal space, lying between posterior intercostal vein and
intercostal nerve (relationship from above downward VAN). 1" and 2'
posterior intercostal arteries are branches of superior intercostal
artery (a branch of costocervical trunk from 2"d part of subclavian
artery* 05)).Lower nine (3rd to 11`") posterior intercostal arteries are
branches of descending thoracic aorta. Right posterior intercostal
arteries are longer than the left.
Anterior intercostal arteries for upper six spaces (two in each space)
arise from internal thoracic or internal mammary artery. For 7th to 9th
spaces, these are branches of musculophrenic artery (terminal
branch of internal thoracic artery).
36. True about right principal bronchus ?
a) Narrower

b) Horizontal

c) Shorter

d) All are true

Correct Answer - C
Features of right bronchus (in comparison to left bronchus)
1) Shorter
2) Wider
3) Vertical (in the line of trachea).
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37. Thoracic duct is formed by?
a) Union of left subclavian and left internal jugular vein.

b) Union of brachiocephalic vein and internal jugular vein

c) Continuation of upper end of cisterna chyli

d) None of the above

Correct Answer - C
Thoracic duct is also called as Pecquet duct.
It is the largest lymphatic duct in body, about 45 cm (18 inches) long.
It has a beaded appearance because of the presence of many
valves in its lumen. medpox.com
Thoracic duct begins as a continuation of the upper end of the
cisterna chyli near the lower border of T12 vertebra and enters the
thorax through the aortic opening of diaphragm (at T12 ).
It then ascends through the posterior mediastinum and at T5 level
crosses from right side to the left side and ascends along left margin
of oesophagus to enter the neck.
At the level of C7 vertebrae, arches towards left side to open into left
brachiocephalic vein at the angle of union of left subclavian and left
internal jugular veins.
38. Thoracic duct opens into ?
a) Subclavian vein

b) Internal jugular vein

c) Right brachiocephalic vein

d) Left brachiocephalic vein

Correct Answer - D
Left brachiocephalic vein

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39. Posterior relation of hilum of lung ?
a) Azygous vein

b) SVC

c) Vagus nerve

d) Arch of aorta

Correct Answer - C
Vagus nerve

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40. Not related to hilum of right lung?
a) Azygous vein

b) Vagus nerve

c) SVC

d) Arch of aorta

Correct Answer - D
Arch of aorta is related to left lung.

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41. Xiphoid fuses with sternum by what age ?
a) 30 years

b) 35 years

c) 40 years

d) 45 years

Correct Answer - C
Ans. is 'c' i.e., 40 years [Ref Parikh 6th le p. 2.30, 2.31]
Sternum
Pieces of body unite between 14-25 years.
Xiphoid unites with body at 40 years.
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Manubrium unites with body at 60 years.
Other bones
Hyoid : greater cornu unites with body at 40-60 years.
Laryngeal and costal cartilages ossify after 40 years.
Vertebra : Osteophytes outgrowth, lipping of vertebra and disc
atrophy occur.
42. Bronchopulmonary segments in right and
left lungs respectively ?
a) 9, 11

b) 11,9

c) 10,10

d) 8, 10

Correct Answer - C
Each lung has 10 bronchopulmonary segments.

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43. At the level of Arch of aorta, the
relationship of left vagus nerve and left
phrenic nerve?
a) Phrenic nerve anterior, vagus nerve posterior

b) Phrenic nerve posterior, vagus nerve anterior

c) Both in same plane anteroposteriorly

d) Variable in relationship

Correct Answer - A
Phrenic nerve anterior, vagus nerve posterior
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44. Posterior to transverse pericardial sinus?
a) Aorta

b) Pulmonary trunk

c) SVC

d) Left atrium

Correct Answer - C
Ans. is 'c' i.e., SVC
Transverse sinus is a short passage that lies between the reflection
of serous pericardium (epicardium) around arterial (aorta and
pulmonary trunk) and venous ends of the heart tube.
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Transverse sinus is bounded anteriorly by ascending aorta and
pulmonary trunk, posteriorly by SVC, and inferiorly by left atrium.
45. True about cremasteric reflex?
a) Afferent: genital branch of genitofemoral nerve

b) Efferent: genital branch of genitofermoral nerve

c) Efferent: femoral branch of genitofemoral nerve

d) Afferent: pudendal nerve

Correct Answer - B
Ans. is 'b' i.e., Efferent : genital branch of genitofemoral nerve

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46. Urethral crest is an elevation seen in
urethra due to:
a) Prostatic glands

b) Insertion of detrusor muscle

c) Insertion of trigone

d) Preprostatic internal sphincter

Correct Answer - A
Answer- A (Prostatic glands)
The urethral crest is an anatomical feature present in the urinary
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system of both males and females.
The prostatic portion (pars prostatica), the widest and most dilatable
part of the canal, is about 3 cm long.
Upon the posterior wall or floor is a narrow longitudinal ridge, the
urethral crest, formed by an elevation of the mucous membrane and
its subjacent tissue.
On either side of the crest is a slightly depressed fossa, the prostatic
sinus, the floor of which is perforated by numerous apertures, the
orifices of the prostatic ducts from the lateral lobes of the prostate;
the ducts of the middle lobe open behind the crest.
medpox.com
47. Pyramidalis is supplied by ?
a) Subcostal nerve

b) Ilioinguinal nerve

c) Iliohypogastric nerve

d) Genitofemoral nerve

Correct Answer - A
Ans. is 'a' i.e., Subcostal nerve

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48. Appendices epiploicae is a feature of ?
a) Duodenum

b) Stomach

c) Colon

d) Jejunum

Correct Answer - C
Characteristic features of large intestine
i) 3 longitudinal bands, formed by longitudinal muscle coat, called
Taeniae coli.
ii) Sacculation or haustration medpox.com
iii) Fat filled peritoneal pouches called appendices epiploicae. These
are not found in appendix, caecum, and rectum.
iv) Greater part is fixed except for appendix, transverse colon and
sigmoid colon.
v) Pyere's patches (present in small intestine) are not present.
49.

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Appendices epiploicae is seen in all part of
large intestine except -
a) Sigmoid colon

b) Ascending colon

c) Caecum

d) Transverse colon

Correct Answer - C
Ans. is 'c' i.e., Caecum
Small bags of peritoneum filled with fat, called appendices
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epiploicae are present over the surface of large intestine, except for
appendix, caecum and rectum.
50. Inferior rectal artery is a branch of?
a) Inferior mesenteric artery

b) Superior mesenteric artery

c) Coeliac trunk

d) Internal pudendal artery

Correct Answer - D
Ans. is 'd' i.e., Internal pudendal artery

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51. Cremasteric artery is a branch of?
a) Internal pudendal artery

b) External pudendal artery

c) Inferior epigastric artery

d) Superior epigastric artery

Correct Answer - C
Inferior epigastric artery

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52. Superficial epigastric artery is a branch
of?
a) Internal pudendal artery

b) External pudendal artery

c) Internal iliac artery

d) Femoral artery

Correct Answer - D
Ans. is 'd' i.e., Femoral artery
Branches of femoral artery
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1) Superficial :- Superficial external pudendal, superficial
epigastric, superficial circumflex iliac.
2) Deep branches :- Profunda femoris, deep external pudendal,
muscular branches, descending genicular branch (last branch in the
adductor canal).
Note: Superior epigastric artery is a branch of internal thoracic
artery.
53. Inferior epigastric vein drains into?
a) Femoral vein

b) External iliac vein

c) Internal iliac vein

d) Internal pudendal vein

Correct Answer - B
Ans. is 'b' i.e., External iliac vein
Inferior epigastric vein drains into External iliac vein.
Superior epigastic vein drains into Internal thoracic vein.
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54. Superior rectal vein drains into?
a) Inferior mesenteric vein

b) External iliac vein

c) Internal iliac vein

d) Internal pudendal vein

Correct Answer - A
Ans. is 'a' i.e., Inferior mesenteric vein
Superior rectal vein drains into inferior mesenteric vein.
Inferior rectal vein drains into internal pudendal vein.
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55. Most common location of accessory
spleen?
a) Hilum of spleen

b) Greater omentum

c) Lesser omentum

d) None

Correct Answer - A
Accessory spleen may be found at :-
i) Hilum of spleen (most common site).
ii) Tail of pancrease. medpox.com
iii) Derivatives of dorsal mesogastrium :- Greater omentum,
gastrophrenic ligament, gastrosplenic ligament, linorenal ligament.
iv) Broad ligament of uterus (in males) and spermatic cord (in
female); both left side.
56. Length of Posterior vaginal wall is
a) Variable

b) Same as anterior vaginal wall

c) Less than anterior vaginal wall

d) More than anterior vaginal wall

Correct Answer - D
Ans. is 'd' i.e., More than anterior vaginal wall
Vagina
The vagina is a fibromuscular, canal forming the female copulatory
organ. medpox.com
It extends from vulva to uterus.
Mucous membrane is lined by nonkeratinized stratified squamous
epithelium.
The anterior wall is about 8 cm long and the posterior wall is about
10 cm long.
The lumen is circular at the upper end because of the protrusion of
the cervix into it.
Below the cervix, anterior and posterior walls are in contact.
The interior of the upper end of the vagina (or vaginal vault) is in the
form of a circular groove that surrounds the protrudng cervix.
The groove becomes progressively deeper form before backwards
and is arbitrarily divided into four parts called the vaginal fornices :
Anterior fornix lies in front of the cervix and is shallowest.
Posterior fornix lies behind the cervix and is deepest.
Two lateral fornices lie one on each side of the cervix. Lateral fornix
is related to the transverse cervical ligament of pelvic fascia in which
are embedded a network of vaginal vein and the ureter gets crossed
by the uterine artery.
Relations of vagina
Anterior wall
Upper half is related to the base of the bladder.
Lower half to the urethra.
Posterior wall
Upper one-fourth is separated from the rectum by the rectouterine
pouch.
Middle two-fourths are separated from the rectum by loose
connective tissue.
Lower one-fourths is separated from the anal canal by the perineal
body and the muscles attached to it.
Lateral walls
One each side :
Upper one-third is related to the transverse cervical ligament of
pelvic fascia in which are embedded a network of vaginal veins, and
the ureter gets crossed by the uterine artery.
Middle one-third is related the pubococcygeus part of the levator ani.
Lower one-third pierces the perineal membrane, below which it is
related to the bulb of the vestibule, the bulbospongiosus and the
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duct of greater vestibular gland of bartholin.
Arterial supply
Vaginal branch of internal iliac (main supply)
Cervicovaginal branch of uterine artery (in upper part).
Middle rectal and internal pudendal arteries (in lower part).
57. Bare area of liver is related to -
a) Aorta

b) Hepatic vein

c) Portal vein

d) Gall bladder

Correct Answer - B
Hepatic vein
Between two layers of coronary ligaments, there is a large triangular
area in diaphragmatic surface of liver which is not covered by
peritoneum. medpox.com
It is called 'bare area of liver'.
It is related to inferior vena cava (IVC).
The hepatic veins (usually three) leave the liver in bare area.
This area is clinically important as it is a site where infection can
spread from abdominal cavity to thoracic cavity.
58. True about circumcaval ureter ?
a) Developmental anomaly of ureter

b) Ureter passes in front of IVC from lateral to medial

c) Mostly involves right ureter

d) Type 2 is more common

Correct Answer - C
Circumcaval (retrocaval) ureter results from altered vasculature
rather than ureteral development. Thus, preureteral vena-cava is
more appropriate term.
This disorder involves right ureter which passes behind IVC winding
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about and crosses in front of it from medial to lateral direction.
The anomaly is divided into two types :?
1) Type 1 : It is more common and has hydronephrosis with a
typically obstructing pattern demonstrating some degree of fish-hook
shaped deformity of ureter.
2) Type 2 : It has lesser degree of hydronephrosis or not at all.
59. Which of the following is a retroperitoneal
structure?
a) Ileum

b) Jejunum

c) Ureter

d) Appendix

Correct Answer - C
Ureter

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 60. Falciparum ligament contains?
a) Ligamentum venosus

b) Ligamentum teres

c) Linorenal ligament

d) None of the above

Correct Answer - B
Peritoneal ligaments
1. Gastrosplenic ligament :- It extends from hilum of spleen to greater
curvature of stomach. It contains short gastric and left gastroepiploic
vessels. medpox.com
2. Linorenal ligament :- It extends from hilum of spleen to anterior
surface of left kidney. It contains splenic vessels and tail of
pancreas. It develops from dorsal mesogastrium.
3. Gastrophrenic ligament :- It connects the greater curvature of
stomach to diaphragm. It develops from dorsal mesogastrium.
4. Phrenicocolic ligament :- It connects left colic (splenic) flexure to
diaphragm. It supports the anterior border of spleen.
5. Falciform ligament :- It demarcates the right and left lobes of liver. It
contains ligamentum teres (remnant of left umblical vein) and
paraumblical vein. It develops of ventral mesogastrium (ventral part).
6. Coronary ligaments :- It contains superior and inferior layers which
connect liver to diaphragm, and encloses the triangular 'bare area of
liver'.
7. Triangular ligaments (a right and a left) :- These connect right and
left lobes of liver to diaphragm. It develops from ventral
mesogastrium.
61.

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Part of colon with no mesentery?
a) Transverse colon

b) Sigmoid colon

c) Ascending colon

d) Rectum

Correct Answer - C
Mesenteries in intestine
1) Mesentery proper :- Mesentery of small intestine (jejunum and
ileum) is fan shaped double layered peritoneal fold which suspends
the coils of jejunum and ileum. Mesentery has :?
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i) Attached border (root of mesentery) :- It is 15 cm long and
extends from duodenojejunal flexure (on left side of L2) to upper part
of right sacroiliac joint.
Root of mesentery crosses following structures :-
(i) 3rd part (horizontal part) of duodenum,
(ii) abdominal aorta,
(iii) IVC,
(iv) right ureter, and
(v) right psoas major.
ii) Free border (intestinal border) :- It is 6 meters long and is
attached to gut forming its visceral peritoneum (serous coat).
2) Transverse mesocolon :- It connects transverse colon to posterior
abdominal wall and contains middle colic vessels.
3) Mesoappendix :- It connects the appendix to the ileal mesentery
and contains appendicular vessels.
4) Sigmoid mesocolon :- It connects sigmoid colon to posterior pelvic
wall and contains sigmoid vessels.
5) Mesorectum : It contains superior rectal vessels (artery & veins)
with their branches, lymphatic vessels and lymph nodes along
with their branches, lymphatic vessels and lymph nodes along
superior rectal artery, and branches from inferior mesenteric plexus.

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62. False regarding trigone of bladder ?
a) Lined by transitional epithelium

b) Mucosa smooth and firmly adherent.

c) Internal urethral orifice lies at lateral angle of base

d) Developed from mesonephric duct

Correct Answer - C
Trigone of bladder has following features :
1) Lined by transitional epithelium
2) Mucosa is smooth and firmly adherent
3) Ureters open at lateral angles of base and internal urethral
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orifice lies at apex.
4) Has Trigonal muscle of bell (smooth muscle layer just
beneath mucosa).
5) Derived from absorbed part of mesonephric duct (Wolffian
duct).
63. Trigone of urinary bladder develops from:
a) Mesoderm

b) Ectoderm

c) Endoderm of urachus

d) None of the above

Correct Answer - A
With differential growth of the dorsal bladder wall, the ureters come
to open through the lateral angles of the bladder, and the
mesonephric ducts open close together in what will be the urethra.
That part of the dorsal bladder wall marked off by the openings of
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these four ducts forms the trigone of the bladder.
Thus, lining of the bladder over the trigone is mesodermal in origin;
The smooth muscle of the bladder wall is derived from the
splanchnopleuric mesoderm.
The apex of the bladder is continuous with the allantois, which now
becomes obliterated and forms a fibrous core, the urachus.
The urachus persists throughout life as a ligament that runs from the
apex of the bladder to the umbilicus and is called the median
umbilical ligament
o Linining epithelium of bladder mucosa is transitional epithelium.
When empty mucosa is thrown into rugae except in trigone, where
mucosa is smooth and firmly adherent.
o just beneath the mucosa of trigone there is layer of smooth
muscle, Trtgonal muscle of Bell which replaces the submucous coat
in trigone area
 64. Watershed zone of large intestine ?
a) Cecum

b) Ascending colon

c) Rectosigmoid

d) Transverse colon

Correct Answer - C
There are areas of colon with poor blood supply resulting from
incomplete anastomosis of marginal arteries. These are watershed
areas of colon and include :
1. Splenic flexure (Griffith point) : Watershed area between superior
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mesenteric artery and inferior mesenteric artery.
2. Rectosigmoid junction (Sudeck's point) : Watershed zone between
inferior mesenteric artery and internal iliac artery.
65. Ligament extending from cervix and
vagina to lateral pelvic wall ?
a) Broad ligament

b) Pubocervical ligament

c) Round ligament

d) Transverse cervical ligament

Correct Answer - D
Transverse cervical ligaments of Mackenrodt are fan-shaped
condensation of endopelvic fascia on each side of cervix above the
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levator ani and around uterine vessels.
They connect lateral aspect of cervix and upper vaginal wall to
lateral pelvic wall.
They form a 'hammock' that supports the uterus.
66. True about Scarpa's fascia ?
a) Deep fascia of anterior abdominal wall

b) Also called Buck's fascia

c) Attached to Iliotibial tract

d) Forms suspensory ligament of penis

Correct Answer - D
Fascia of anterior abdominal wall
A) Superficial fascia
The superficial fascia of anterior abdominal wall (below the level of
umblicus) is divided into : Superficial fatty layer (fascia of camper or
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camper's fascia), and deep membraneus layer (fascia of scarpa or
scarpa's fascia).
The fatty layer (fascia of camper) is continuous with the superficial
fascia of adjoining part of the body.
However, in the penis it is devoid of fat and in scrotum it is replaced
by dartos muscle, i.e., in scrotum dartos muscle is present instead of
fatty layer of superficial fascia.
B) Deep fascia
It is present in the form of a thin layer covering the muscles and their
aponeuroses and large neurovascular structures. At superficial
inguinal ring it continues over the spermatic cord as external
spermatic fascia into scrotum and continue over the penis as deep
fascia of penis (Buck's fascia).
67. Where is the Cave of Retzius present?
a) Between urinary bladder and rectum

b) Between urinary bladder and cervix

c) In front of the bladder

d) Between the cervix and the rectum

Correct Answer - C
Space of Retzius is a horse-shoe shaped potential space which
intervenes between the antero-lateral pelvic wall and the sides of the
bladder and prostate.
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68. Nerve entering the inguinal canal through
deep inguinal ring ?
a) Ilioinguinal nerve

b) Pudendal nerve

c) Genital branch of genitofemoral

d) Superior rectal nerve

Correct Answer - C
The spermatic cord in males and round ligament of uterus in
females, enter the inguinal canal through the deep inguinal ring and
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pass out through superficial inguinal ring.
Thus consituents of spermatic cord are also components of inguinal
canal; these are ductus deferens (vas deferens), testicular artery,
cremestric artery, artery to ductus deference, pampiniform plexus,
lymphatics, sympathetic plexus, genital branch of genitofemoral
nerve, remains of process vaginalis.
Note: Ili oiguinal nerve enters inguinal canal through interval
between external and internal oblique muscles (not through deep
inguinal ring).
69. Initially, renal arteries are branches of ?
a) Internal pudendal artery

b) External iliac artery

c) Common iliac artery

d) Aorta

Correct Answer - C
Due to ascent of kidneys during development, the blood supply
of kidney changes:?
1) Initially when the kidneys are in pelvis, the renal arteries are
branches of common iliac arteries.
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2) With progressive ascent, the arteries to kidneys are derived
from different levels of aorta.
70. In a neonate, kidney is supplied by?
a) Internal pudendal artery

b) External iliac artery

c) Common iliac artery

d) Aorta

Correct Answer - D

Upto 5th week of intrauterine life, kidney is in lumbar region and renal
arteries are branches of common iliac artery (see above
explanation). medpox.com
After that, differential growth of abdominal wall causes the kidney to
ascent to lumbar region. Adult position (lumbar region of abdomen)
is attained by 9th week. Druing progressive ascent, the arteries to
kidney are derived from different levels of aorta.
After full ascent, definitive renal artery is branch of aorta at 2nd
lumbar segment.
Thus, neonatal kidney is supplied by aorta.
71. External oblique forms all except?
a) Lacunar ligament

b) Pectineal ligament

c) Conjoint tendon

d) Inguinal ligament

Correct Answer - C

Inguinal ligament (Poupart's ligament) is the folded lower border of
external oblique aponeurosis
Lacunar ligament (Gimbernats ligament) is the crescent shaped
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expansion from the medial end of inguinal ligament attached to
pectineal line of pubis.
Pectineal ligament (Cooper's ligament) is strong fibrous band
extending laterally from the lacunar ligament along pectineal line of
pubis. Similar to lacunar ligament, it is made of external oblique
aponeurosis.
Reflected part of inguinal ligament extends from the lateral crus of
superficial inguinal ring formed by inguinal ligament upwards to linea
alba. It forms the posterior wall of inguinal canal.
Conjoint tendon (falx inguinalis) is formed by the aponeuroses of
internal oblique and transversus abdominis muscle and is attached
to pubic crest.
72. Meckel's cave is related to ?
a) Submandibular ganglion

b) Trigeminal ganglion

c) Otic ganglion

d) Pterygopalatine ganglion

Correct Answer - B
Ans. is 'b' i.e., Trigeminal ganglion
Trigeminal ganglion (Gasserion ganglion or semilunar ganglion) lies
in a dural pouch, the cavum trigeminale (Meckel's cave).
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 73. Longest spinous process is seen in ?
a) C2

b) C4

c) C5

d) C7

Correct Answer - D
Ans. is 'd' i.e., C7
Cervical Vertebrae
There are 7 cervical vertebrae of which 3-6 are typical and 1st, 2nd
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and 7th are atypical. Characteristic features of typical cervical
vertebra are : -
i. Foramen transversarium is present in the transverse process.
Foramina transversaria of Cl to C6 vertebrae transmit vertebral
artery, vertebral vein and sympathetic plexus, and that of C7
transmits only vertebral veins.
ii. Body is small and broad transversely (side to side).
iii. Spinous process is small and bifid.
iv. Vertebral foramen is large and triangular.
v. Superior articular facet is directed backwards and upwards, and
inferior facet is directed downwards and forwards. Articular process
are placed horizontally, So that dislocation can occur without
fracture.
vi. The anterior tubercle on transverse process of C6 vertebra is
prominent and is called carotid tubercle or chaissagnac's tubercle. It
is related to common carotid artery which can be palpated against it.
Erb's point is opposite chassaignac's tubercle. Cricoid cartilage is at
same level (C6 vertebra).
 Important features of atypical vertebrae are : ?
1. First cervical vertebra (atlas) is ring like bone having lateral mass on
each side connected by a smaller anterior arch and a larger
posterior arch. Anterior arch has a facet for dens of axis. Each
lateral mass has an upper articular facet for occipital condyle and
lower facet for body of C2 (axis) vertebra. Cl vertebra does not have
body and spinous process.
2. Second cervical vertebra (axis) is characterized by presence of
odontoid process or dens, a peg-like projection from the body.
3. Seventh cervical vertebra is called as vertebra prominens because it
has most promenent spinous process which is not bifid. Foramen
transversarium transmits only vertebral vein, not vertebral artery.

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74. Sweat gland near the lid margins
a) Moll

b) Zeis

c) Meibomian

d) Krause

Correct Answer - A
Ans. is 'a' i.e., Moll
Glands of Moll (Moll's gland) are apocrine sweat glands just next to
the eyelashes.
Zeis glands are sebaceous glands near lid margins.
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Meibomian gland (tarsal glands) are specialized sebaceous gland at
the rim of eyelids inside the tarsal plate.
Krause's glands are accessory lacrimal glands underneath the
eyelid.
75. Anterior lymphatics from the nose drain
into ?
a) Pretracheal nodes

b) Submandibular nodes

c) Sublingual nodes

d) Superficial cervical nodes

Correct Answer - B
Ans. is 'b' i.e., Submandibular nodes
Submandibular nodes
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These nodes lie deep to investing layer of deep cervical fascia in
submandibular triangle, between the deep fascia and submandibular
gland.
These nodes receive afferents from centre of forehead; anterior part
of nasal cavity; frontal, maxillary and ethmoidal air sinuses; inner
canthus (medial angle of eye); whole of upper lip and anterior part of
cheek with underlying gum and teeth; outer part of lower lip with
lower gums and teeth excluding incisors; anterior two third of tongue
excluding the tip; floor of mouth; and angle of mouth.
These nodes also receives efferents of submental nodes.
Submandibular nodes drain into (efferent) upper and lower deep
cervical nodes.
76. Killian's dehisence is seen in ?
a) Oropharynx

b) Nasopharynx

c) Cricopharynx

d) Vocal cords

Correct Answer - C
Ans. is 'c' i.e., Cricopharynx
Inferior constrictor muscle has two parts :-
(i) Thyropharyngeous with oblique fibres, and (ii) Cricopharyngeous
with transverse fibres. medpox.com
Between these two parts of inferior constrictor exists a potential gap
called Killan's dehiscence. It is also called the gateway to tear as
perforation can occur at this site during esophagoscopy. It is also the
site for herniation of pharyngeal mucosa in case of pharyngeal
pouch.
77. Fossa incudis is related to ?
a) Head of malleus

b) Long process of incus

c) Short process of incus

d) Foot process of stapes

Correct Answer - C
Fossa incudis contains short process of Incus.
Head of malleus is attached to epitympanum by ligament of head of
malleus.
Long process of incus is attached to head of stapes.
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Footplate of stapes lies over oval window.
78. Unpaired laryngeal cartilage ?
a) Arytenoid

b) Corniculate

c) Cuneiform

d) Epiglottis

Correct Answer - D
The skeletal supports of larynx is provided by Six cartilages, 3 out of
which are paired (so there are total 9 cartilages).
i) Unpaired :- Thyroid, cricoid, epiglottis.
ii) Paired :- Arytenoid, Corniculate, cuneiform.
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79. Which is the only nerve which exits the
brainstem on dorsal side ?
a) Facial

b) Trigeminal

c) Trochlear

d) Abducent

Correct Answer - C
Unique features of trochlear nerve are :?
i) Most selender cranial nerve.
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ii) Only cranial nerve to emerge on the dorsal aspect of brain.
iii) Only cranial nerve to undergo complete internal decussation
before emerging i.e. right trochlear nerve arises from left trochlear
nucleus and vice versa.
iv) Has'longest intracranial course (Vagus nerve has overall longest
course).
v) Thinnest cranial nerve (smallest nerve in terms of the number of
axons it contains).
80. Blood supply of putamen includes all
except?
a) Medial striate arteries

b) Lateral striate arteries

c) Anterior choroidal artery

d) Posterior communicating artery

Correct Answer - D
Blood supply of basal ganglia
Caudate nucleus and putamen are supplied by lateral and medial
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striate branches of anterior, medial and posterior cerebral arteries.
Putamen receives additional supply from anterior choroidal artery. o
Globus pallidus is supplied by lateral striate and anterior choroidal
arteries.
81. Medulla is supplied by all except?
a) Basilar artery

b) Anterior spinal artery

c) Vertebral artery

d) Posterior cerebral artery

Correct Answer - D
Posterior cerebral artery

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82. Length of Eustachian tube?
a) 12 mm

b) 24mm

c) 36mm

d) 48mm

Correct Answer - C

Length of Eustachian tube is 36 mm. (reached by the age of 7 years)
Lateral third (i.e. 12 mm) is bony.
Medial 2/3 (i.e. 24 mm) is fibrocartilaginous.
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83. Parasympathetic supply to lacrimal
glands are passed through ?
a) Lesser petorsal nerve

b) Chorda tympani

c) Greater petorsal nerve

d) Lingual nerve

Correct Answer - C
Greater petorsal nerve

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84. Onodi cells are seen in?
a) Sphenoid sinus

b) Maxillary sinus

c) Anterior ethmoidal sinus

d) Posterior ethmoidal sinus

Correct Answer - D
Ethmoidal sinuses are divided into two groups :
A) Anterior group
i) Anterior ethmoidal air cells
Anterior ethmoidal air cells drain into- either the ethmoidal
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infundibulum or the frontonasal duct. Some air cells may invade the
orbital floor. These are known as the Haller' cells.
ii) Middle ethmoidal air cells
Also known as bullar sinuses. The middle ethmoidal air cells drain-
into the middle meatus by one or more orifices on or above the
ethmoidal bulla.
B) Posterior group
Posterior ethmoidal air cells usually drain- into the superior meatus.
The posterior group lies very close to the optic canal and optic
nerve. The Onodi cell is usually regarded as the most posterior
ethmoid cell that pneumatizes lateral and superior to the sphenoid
sinus and is intimately associated with the optic nerve.
85. Haller cells are seen in?
a) Roof of nose

b) Orbital floor

c) Lateral nasal wall

d) Maxillary sinus

Correct Answer - B
The Onodi and Haller cells are ethmoidal air cells.
Some air cells may invade the orbital floor. These are known as the
Haller' cells.
The Onodi cell is usually regarded as the most posterior ethmoid cell
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that pneumatizes lateral and superior to the sphenoid sinus and is
intimately associated with the optic nerve.
86. Which valve is present at opening of
nasolacrimal duct?
a) Hasner's valve

b) Heister valve

c) Spiral valve

d) None

Correct Answer - A
Nasolacrimal duct opens into inferior meatus and is closed by a
mucosal flap called Hasner's valve.
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Heister valve (spiral valve) is present in cyctic duct.
87. Cribriform plate forms ?
a) Roof of olfactory region

b) Floor of olfactory region

c) Nasal septum

d) All of the above

Correct Answer - A
Internal nose
Internal nose has following parts
i) Nasal cavity proper :- Internal nose is divided into right and left
nasal cavities by nasal septum. Each nasal cavity communicates
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with the exterior through naris or nostrils and with nasopharynx
through posterior nasal aperture or posterior ?tares or choana.
ii) Vestibule of nose :- Anterior and inferior part of the nasal cavity is
lined by skin and is called vestibule of nose. It contains sebaceous
glands, hair follicles and the hair called vibrissae.
Each nasal cavity has a lateral wall, a medial wall (nasal septum), a
roof, and a floor.
The olfactory mucosa lines upper 1/3 of nasal cavity including the
roof formed by cribriform plate, and medial and lateral wall up to the
level of superior concha.
88. Galen's anastomosis is between ?
a) Recurrent laryngeal nerve and external laryngeal nerve

b) Recurrent laryngeal nerve and internal laryngeal nerve

c) Internal laryngeal nerve and external laryngeal nerve

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., Recurrent laryngeal nerve and internal laryngeal
nerve
There are two types of important anastmosis between laryngeal
branches of vagus :? medpox.com
1. Galen anastomosis (Ramus anastomoticus or Ansa of Galen)
This is an anastomosis between the recurrent laryngeal nerve and
internal laryngeal nerve (internal branch of superior laryngeal nerve).
Generally, posterior branch of recurrent laryngeal nerve contributes
to the anastomosis; however, anterior branch can also contribute.
2. Human communicating nerve
It is an anastomosis between recurrent laryngeal nerve (distal part)
and external laryngeal nerve (external branch of superior laryngeal
nerve).
89. Lamina papyracea is between ?
a) Optic nerve and orbit

b) Maxillary sinus and orbit

c) Ethmoid sinus and orbit

d) Cranial cavity and orbit

Correct Answer - C
The thinnest portion of medial wall of orbit is the lamina papyracea
which separates ethmoid sinuses from orbit. o Infection from
ethmoidal sinus can easily breach this paper thin bone and affect the
orbital contents. medpox.com
 90. False about sternocleidomastoid?
a) Arises from sternum and clavicle

b) Insertes on mastoid process

c) Motor supply by spinal accessory nerve

d) Tilt the head on opposite side

Correct Answer - D
Sternocleidomastoid tsternomastoidl
Origin
1. The, sternal head
2. The clavicular head medpox.com
Insertion
It is inserted :
1. By a thick tendon into the lateral surface of mastoid process, from its
tip to superior border.
2. By a thin apponeurosis into the lateral half of the superior nuchal line
of the occipital bone. Nerve supply
3. The spinal accessory nerve provides the motor supply. It passes
through the muscle.
4. Branches from the ventral rami of C2 are proprioceptive.
Blood supply
Arterial supply-one branch each from superior thyroid artery and
suprascapular artery and, two branches from the occipital artery
supply the big muscle.
Veins follow the arteries.
Actions
1. When one muscle contracts :
a) It turns the chin to the opposite side.
b) It can also tilt the head towards the shoulder of same side.
2. When both muscles contract together :
2. When both muscles contract together :
a) They draw the head forwards, as in eating and in lifting the
head from a pillow.
b) With the longus colli, they flex the neck against resistance.
c) It also helps in forced inspiration.

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91. The key to the root of the neck is the scalenus anterior muscle. Which among
the following is TRUE about scalenus anterior?

a) Not Pierced by phrenic nerve

b) Attached to scalene tubercle on 2nd rib

c) Separates subclavian artery from subclavian vein

d) Pierced by phrenic nerve

Correct Answer - A
Ans. (A) Not pierced by phrenic nerve
The subclavian vein forms an arch across the pleura at a level below
the arch of subclavian artery. The two arches are separated from
each other by scalenus anterior muscle.
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Scalenus anterior arises from the anterior tubercles of C3-C6 and
attaches to the scalene tubercle and adjacent ridge on the inner
border and upper surface of the first rib.
Phrenic nerve passes vertically down across the obliquity of the
muscle, plastered there to by the prevertebral fascia.
Transcervical and suprascapular arteries lie between the scalenus
anterior and the carotid sheath.
92. Tongue muscle which is not developed
from occipital myotome ?
a) Styloglossus

b) Hyoglossus

c) Genioglossus

d) Palatoglossus

Correct Answer - D
DEVELOPMENT OF THE TONGUE :?
I. Epithelium
medpox.com
a) Ant 2/3 -- lingual swellings of 1st arch and tuberculum impar
b) Post 1/3 -- large dorsal part of hypobranchial eminence, Le. 3rd
arch
c) Posterior most part -- small dorsal part of the hypobranchial
eminence, i.e. 4th arch
II. Muscles
From occipital myotomes except palatoglossus which is derived from
the 6th arch.
93. Korner's septum is seen in ?
a) Petrosquamous suture

b) Temporosquamous suture

c) Petromastoid suture

d) Frontozygomatic suture

Correct Answer - A
Mastoid develops from squamous and petrous bone.
Korner's septum is persistence of petrosquamous suture in the form
of a bony plate.
Korner's septum is surgically important as it may cause difficulty in
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locating the antrum and the deeper (ells, and thus lead to incomplete
removal of disease at mastoidectomy. Mastoid antrum cannot be
reached unless the
Korners septum has been removed.
94. What is true about chorda tympani?
a) Postganglionic sympathetic

b) Preganglionic sympathetic

c) Preganglionic parasympathetic

d) Postgalglionic parasympathetic

Correct Answer - C
Chorda tympani arises from intratemporal part (in fallopion canal) of
facial nerve.
* It carries preganglionic secretomotor fibers (not postganglionic) to
submandibular and sublingual glands.
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* It joins lingual nerve in infratemporal fossa.
* It carries taste sensations from anterior 2/3 of tongue.
95. Vidian nerve is formed by union of?
a) Superficial petrosal nerve and deep petrosal nerve

b) Greater petrosal nerve and superficial petrosal nerve

c) Greater petrosal nerve and deep petrosal nerve

d) Greater petrosal nerve and external petrosal nerve

Correct Answer - C
Greater petorsal nerve units with deep petrosal nerve to form nerve
to pterygoid canal (also called vidian nerve).

medpox.com
96. Woodruff's area is located at ?
a) Antero-inferior part of nasal septum

b) Posteroinferior part of nasal septum

c) Superior part of nasal septum

d) Posteroinferior part of lateral nasal wall

Correct Answer - D
Posteriorly on the lateral nasal wall is the area known as Woodruff's
area. It is situated under the posterior end of inferior turbinate.
Sphenopalatine artery anastomoses with posterior pharyngeal
artery, in this area. medpox.com
97. Scutum is present in middle ear ?
a) Roof

b) Lateral wall

c) Medial wall

d) Floor

Correct Answer - B
Lateral wall

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98.

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Not a part of bony labyrinth?
a) Cochlea

b) Vestibule

c) Utricle

d) Semicircular canal

Correct Answer - C
The inner ear within the petrous part of temporal bone consists of a
membranous labyrinth enclosed in a bony (osseous) labyrinth. So,
inner ear has two parts : ?
Bony labyrinth :- Cochlea, Vestibule, Semicircular canals.
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Membranous labyrinth :- Cochlear duct, utricle, Saccules, three
semicircular ducts, and endolymphatic duct & sac.
99. Lymphatic drainage of thyroid gland is
mainly ?
a) Sublingual nodes

b) Submandibular nodes

c) Deep cervical nodes

d) Submental nodes

Correct Answer - C
Lymphatic drainage of thyroid
Lymph from the upper part of the gland reaches the upper deep
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cervical lymph nodes either directly or through the prelaryngeal
nodes.
Lymph from the lower part of the gland drains to the lower deep
cervical nodes directly, and also through the pretracheal and
paratracheal nodes.
100. Organ of corti is situated in ?
a) Basilar membrane

b) Utricle

c) Saccule

d) None of the above

Correct Answer - A
Scala media (cochlear duct or membranous labyrinth) has 3
walls : -
The basilar membrane, which supports the organ of corti.
The Reissner's membrane which separates it from the scala
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vestibuli.
The stria vascularis which contains vascular epithelium and is
concerned with secretion of endolymph.
 101. Floor of 4th ventricle has ?

a) Infundibulum

b) Vagal triangle

c) Mammillary body

d) Tuber cincrium

Correct Answer - B
Floor of 4th ventricle (Rhomboid fossa)
It is diamond or rhomboidal shaped and is formed by posterior
surface of pons (upper triangular part or pontine part) and dorsal
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surface of medulla (lower triangular part or medullary part) junction
of pons and medulla forms intermediate part. Features of 4th
ventricle are :?
i. Median sulcus (a midline groove) divides the floor into two
symmetrical halves.
ii. Medial eminence is present an each side of median sulcus. It
presents facial colliculus formed by genu (recurving fibers) of facial
nerve looping around abducent nucleus. Facial colliculus lies in pons
(i.e. in pontine part of floor).
iii. Hypoglossal triangle overlying hypoglossal nucleus and vagal
triangle overlying dorsal nucleus of vagus. Both of these triangle lie
in the medulla (medullary part of floor).
iv. Vestibular area overlies vestibular nuclei, partly in pons and partly in
medulla.
v. Sulcus coeruleus, a bluish area due to presence of pigmented
neurons containing substantia ferruginea.
vi. Superior and inferior favea.
102. Middle meningeal artery passes through
?
a) Foramen ovale

b) Foramen lacerum

c) Foramen rotundum

d) Foramen spinosum

Correct Answer - D
Foramen spinosum

medpox.com
103. Nerve which loops around
submandibular duct?
a) Mandibular nerve

b) Lingual nerve

c) Hypoglossal nerve

d) Recurrent laryngeal nerve

Correct Answer - B
Submandibular duct
It is 5 cm long duct and runs forwards on hyoglossus, between
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lingual and hypoglossal nerves.
At the anterior border of the hyoglossus muscle it is crossed by
lingual nerve which loops around it.
It opens into the floor of mouth, on the summit of the sublingual
papilla at the side of frenulum of tongue.
104. Medulla oblongata is derived from ?
a) Telencephalon

b) Diencephalon

c) Mesencephalon

d) Myelencephalon

Correct Answer - D
Ans. is d i.e., Myelencephalon
Nervous system develops from ectoderm (neuroectoderm). Nervous
system develops from neural tube which in turn develops by process
of neurulation, i.e. formation of neural plate and its infolding into
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neural tube. Structures formed from neural tube are :?
A) From cranial part (enlarged cephalic part)
Gives rise to brain. Developmental parts are :
i) Forebrain (prosencephalon)
Telencephalon : Cerebral hemisphere and lateral ventricle.
Diencephalon : Optic cup and stalk (gives rise to retina), pituitary,
thalamus, hypothalamus, epithalamus, pineal gland, and third
ventricle.
ii) Midbrain (mesencephalon)
Cerebral aqueduct.
iii) Hindbrain (rhombencephalon)
Metencephalon : Cerebellum, pons
Myelencephalon Medulla oblongata
B) From caudal part
Gives rise to spinal cord.
 105. Morula is how many celled -
a) 4

b) 8

c) 12

d) 16

Correct Answer - D
Ans. is 'd' i.e., 16
At about 16 cells stage the blastomeres tightly align by the process
of compaction to form a compact ball of cells called morula
(mulberry). medpox.com
This process of compaction leads to segregation of cells into two
groups :
1. Inner cells (inner cell mass)
2. Outer cells (outer cell mass)
Morula enters uterine cavity 4 days after fertilization.
106. Dental papilla give rise to ?
a) Enamel

b) Dental cuticle

c) Tooth pulp

d) None

Correct Answer - C
Repeat from previous sessions. See explanation-5 of session-1

medpox.com
107. Malleus and incus are derived from ?
a) 1st Arch

b) 2nd Arch

c) 3rd Arch

d) 4th Arch

Correct Answer - A
Ans. is 'a' i.e., 1st Arch
lst (mandibular arch):-
Muscular Contribution:-Muscles of mastication, Anterior belly of
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the digastric, Mylohyoid, Tensor tympani, Tensor veli palatini.
Skeletal Contributions:- Maxilla, mandible (only as a model for
mandible ), Incus and malleus, Meckel's cartilage, Ant. ligament of
malleus, Sphenomandibular ligament.
Nerve:- Trigeminal nerve (V2 and V3).
Artery:- Maxillary artery, external carotid artery.
108. Optic cup is derived from ?
a) Neural ectoderm

b) Surface ectoderm

c) Mesoderm

d) Neural crest

Correct Answer - A
Ans. is 'a' i.e., Neural ectoderm

medpox.com
109. Optic cup give rise to ?
a) Lens

b) Retina

c) Cornea

d) Sclera

Correct Answer - B
Retina

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110. Excretory system of kidney is derived
from ?
a) Ureteric bud

b) Mesonephros

c) Metanephros

d) None

Correct Answer - C
Ans. is 'c' i.e., Metanephros
Development of kidney
medpox.com
Ureteric bud (mesonephros) arise from mesonephric duct and gives
rise to collecting system of kidney (renal pelvis, major and minor
calyces, collecting tubule) and ureter.
Metanephric mesoderm (blastema or metanephors) arise from
nephrogenic cord which in turn is derived from intermediate
mesoderm. It gives rise to excretory unit (nephron), i.e. glomeruli,
PCT, Loop of henle and DCT.
 111. Ureteric bud arises from ?
a) Paramesonephric Dut

b) Mullerian duct

c) Mesonephric duct

d) Mesonephric tubule

Correct Answer - C
Genital duct system
During 5th and 6th weeks, both male and females have two genital
duct systems, deriverd from mesoderm :
1. Mesonephric duct (wolffian duct) and mesonephric tubules.
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2. Paramesonephric duct (Mullerian duct).
Mesonephric duct is the main genital duct in males as it gives rise to
mainly male genital system :
112. Derivative of vitelline vein?
a) IVC

b) SVC

c) Ligamentum venosum

d) Ligamentum teres

Correct Answer - A
Ans. is 'a' i.e., IVC

medpox.com
113. Not true about development of ovary ?
a) Develops in genital ridge

b) Sex cords are derived from coelomic epithelium

c) Oocytes are mesodermal in origin

d) At birth ovary contains 2 million follicles

Correct Answer - C
Development of ovary
Coelomic epithelium on medial side of the mesonephros becomes
thickened to form genital ridge, the site where ovary develops.
Genital ridge is covered by germinal epithelium (previous coelomic
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epithelium). From these germinal epithelium, cords of cells (sex
cords or medullary cords) proliferate and grow into the underlying
mesoderm.
Primordial germ cells which are developed from endodermal cells of
hindgut (part of yolk sac), migrate to region of developing ovary
(genital ridge area) and give rise to oocytes.
The sex cords become broken up into small masses. The cells of
each mass surround one oocyte to form primordial follicle.
At birth each ovary contains about 2 million primary follicles.
114. Testis lies at deep inguinal ring upto ?
a) 4 months

b) 5 months

c) 7 months

d) 9 months

Correct Answer - C
The testes develop in relation to the lumbar region of the posterior
abdominal wall.
During fetal life, they gradually descend to the scrotum.
They reach the iliac fossa during third month, and lie at the site of
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deep inguinal ring upto 7 month of intrauterine life.
They pass through inguinal canal during seven month, and are
normally in the scrotum by the end of eighth month.
115. Position of testis at 24-28 weeks of
intrauterine life?
a) Inguinal canal

b) Lumbar region

c) Superficial inguinal ring

d) Deep inguinal ring

Correct Answer - D
Deep inguinal ring

medpox.com
 116. True about notochord are all except?
a) Defines axis of embryo

b) Serves as primary inductor

c) Derived from hypoblast

d) Remains as nucleus pulposus

Correct Answer - C
Notochord is a bud like structure formed by epiblast cells extending
from cranial end of primitive streak to caudal end of prochordal plate,
in between the ectoderm and endoderm. Siginificances of notochord
includes following :- medpox.com
i. It defines the axis of embryo.
ii. It functions as the primary inductor, inducing the overlying ectoderm
to develop into neural plate (the primordium of CNS).
iii. It serves as the basis for development of axial skeleton. The
notochord is an intricate structure around which vertebral column is
formed and indicates future site of vertebral bodies. However, the
notochord does not give rise to vertebral column, after development
of vertebral bodies, the notochord degenerates and disappears, but
parts of it persist as the nucleus pulposus of intervertebral disc.
117. Remnant of notochord is ?
a) Annulus fibrosus

b) Nucleus pulposus

c) Ligament flavum

d) Intertransverse ligament

Correct Answer - B
Ans. is 'b' i.e., Nucleus pulposus
Notochord is a bud like structure formed by epihlast cells extending
from cranial end of primitive streak to caudal endof prochordal plate,
in between the ectoderm and endoderm. Siginificances of notochord
medpox.com
includes following :-
It defines the axis of embryo.
It functions as the primary inductor, inducing the overlying ectoderm
to develop into neural plate (the primordium of CNS).
It serves as the basis for development of axial skeleton. The
notochord is an intricate structure around which vertebral column is
formed and indicates future site of vertebral bodies. However, the
notochord does not give rise to vertebral column, after development
of vertebral bodies, the notochord degenerates and disappears, but
parts of it persist as the nucleus pulposus of intervertebral disc.
118.

medpox.com
2ndpart of duodenum is derived from ?
a) Foregut

b) Midgut

c) Both foregut & midgut

d) Hindgut

Correct Answer - C
Both foregut & midgut

medpox.com
119. Stroma of cornea develops from ?
a) Neural ectoderm

b) Surface ectoderm

c) Mesoderm

d) Neural crest

Correct Answer - C
Corneal epithelium develops from Surface ectoderm.
Corneal stroma develops from Mesoderm.

medpox.com
120. Female genital tract develops from ?
a) Mesonephric duct

b) Mesonephric tubules

c) Mullerian duct

d) None

Correct Answer - C
Mesonephric duct (Wolffian duct) is the main genital duct in males
as it gives rise to mainly male genital system.
Paramesonephric duct (Mullerian duct) gives rise to mainly female
genital tract medpox.com
121. Glomus cells are derived from ?
a) Surface ectoderm

b) Neuroectoderm

c) Mesoderm

d) Endoderm

Correct Answer - B

Glomus cells are derived from neural crest which itself is derivative
of neuroectoderm.
Other derivates of neural crest are?
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a) Neural derivatives
Sensory neurons of spinal dorsal root ganglia.
Sympathetic chain ganglia and plexus (celiac/preaortic/renal
ganglia, enteric plexus in GIT, i.e. Auerbachs and Meissner's)
Parasympathetic ganglia and plexus of GIT.
Schwann cells of peripheral nerves, satellite cells of all ganglia.
Adrenal medulla, chromaffin cells, para follicular C-cells of thyroid
gland.
Melanocytes and melanoblasts.
b) Mesenchymal derivatives
Dermal bones of skull : Frontal, parietal, temporal, nasal, vomer,
palatine, mandible, maxillae.
Leptomeninges : arachnoid and pia mater (Durameter is
mesodermal).
Dentine of teeth (odontoblasts).
Eye : choroid, sclera, iris epithelium, pupillary muscles
(sphincter and dilator pupillae, ciliary muscles).
Pharyngeal arch cartilages.
Retinal pigmented epithelium.
Connective tissues of head including dermis, tendon, ligaments.
Bulbar and conal ridges of heart.

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 122. Epithelium of vagina arises from?
a) Ectoderm

b) Wolffian duct

c) Mesoderm

d) Mesonephric duct

Correct Answer - C
Vagina is derived from two sources :-
1. Upper 2/3rd : It is derived from Utero-Vaginal Canal, i.e. the fused
part of paramesonephric duct. Therefore, this part is mesodermal in
origin. medpox.com
rd
2. Lower 1/3 : It is derived from sinovaginal bulb which inturn is
derived from urogenital sinus. Thus, this part is endodermal in origin.
 123. Which of the following is derived from Ist
arch?
a) Frontonasal process

b) Maxillary process

c) Mandibular process

d) Both maxillary & mandibular processes

Correct Answer - D
Face is developed from five facial primordia appear as
prominences of mesenchyme:? medpox.com
1. One frontonasal process : Begins as a proliferation of mesenchyme
on ventral surface of developing brain.
2. Two maxillary processes : Grow out from the upper end of each first
arch.
3. Two mandibular processes : Grow from each first arch.
124. Skeletal derivative of Ist arch ?

a) Stapes

b) Hyoid

c) Maxilla

d) Laryngeal cortilages

Correct Answer - C
Maxilla

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125. Styloid process is derived from ?
a) 1st arch

b) 2nd arch

c) 3rd arch

d) 4th arch

Correct Answer - B
Styloid process is derived from 2nd pharyngeal arch.

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126. Pharyngeal muscles are derived from
which pharyngeal arch ?
a) 1st

b) 2nd

c) 3rd

d) 5th

Correct Answer - C
3rd
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127. Secondary ossification center for lower
end of femur?
a) Present at birth

b) Appears at 6 months of age

c) Appears at 1 year of age

d) Appears at 5 years of age

Correct Answer - A
Secondary center of lower end of femur appears at 9th month of
intrauterine life (present at birth).
Ossification of femur medpox.com
The femur ossifies from one primary and four secondary centres.
The primary centre for the shaft appears in the seventh week of
intrauterine life. The secondary centres appear, one for the lower
end at the end of the ninth month of intrauterine life, one for the
head during the first six months of life, one for the greater trochanter
during the fourth year, and one for the lesser trochanter during the
twelfth year.
There are three epiphyses at the upper end and one epiphysis at the
lower end. The upper epiphyses; lesser trochanter, greater
trochanter and head, in that order, fuse with the shaft at about
eighteen years. The lower epiphysis fuses by the twentieth year.
 128. Sternochondral joint is ?
a) Primary cartilaginous

b) Secondary cartilaginous

c) Fibrous

d) Synovial

Correct Answer - A
Ans. is 'a' i.e., Primary cartilaginous
Costochondral (sternochondral) joints are primary cartilaginous
joints.
Cartilaginous joints medpox.com
1) Primary cartilaginous joints (synchondrosis, or hyaline cartilage
joint) : These are :-
i. Joint between epiphysis and diaphysis of a growing long bone, i.e.
physis.
ii. Spheno-occipital joint
iii. 1st costosternal joint (1st chondrosternal joint)
iv. Costochondral joints
2) Secondary cartilaginous joints (Symphyses or fibrocartilaginous
joints) : These are :-
i. Symphysis pubis
ii. manubriosternal joint
iii. Symphysis menti
iv. Sacroccygeal joint
v. intervertebral disc
129. Innervated structures of joints are all
except ?
a) Synovium

b) Capsule

c) Articular cartilage

d) Ligaments

Correct Answer - C
Ans. is 'c' i.e., Articular cartilage
Characteristic features of articular cartilage
1) Hyaline cartilage medpox.com
2) No innervation (no nerve supply).
3) No blood supply (avascular).
4) No lymphatics
5) Only hyaline cartilage which has no perichondrium.
6) No ability to repair or regenerate itself.
130. Submucosal plexus is ?
a) Myenteric plexus

b) Auerbach's plexus

c) Meissner's plexus

d) Tympanic plexus

Correct Answer - C
Innervation of GIT
The gastrointestinal tract has a nervous system all its own called the
enteric nervous system. It lies entirely in the wall of the gut, begining
in the esophagus and extending all the way to the anus. The enteric
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nervous system is composed mainly of two plexus : -
i) Myenteric plexus orAuerbach's plexus
ii) Meissner's plexus or submucosal plexus
Extrinsic nerves (Parasympathetic and sympathetic) are connected
to both myenteric and submucosal plexuses. Enteric nervous system
can function independently of these extrinsic nerves and these
extrinsic nerves only modify the activity of the enteric nervous
system.
Therefore, peristalsis is present even if the intestine is deprived of
extrinsic innervation.
Parasympathetic stimulation enhances GI motility and secretion
where as sympathetic stimulation inhibits motility and secretions.
131. Hassall's corpuscles are found in?
a) Lymph nodes

b) Spleen

c) Liver

d) Thymus

Correct Answer - D
The dominant feature of medulla of thymus is its epithelial
components, which are onion like structures called Hassall's
Corpuscles, which have an intensely eosinophilic core of dead
material, medpox.com
132. Duct of Bellini are present in:
a) Pancreas

b) Liver

c) Kidney

d) Salivary gland

Correct Answer - C
Answer C. Kidney
Papillary (collecting) ducts are anatomical structures of the kidneys,
previously known as the ducts of Bellini.
Papillary ducts represent the most distal portion of the collecting
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duct.
They receive renal filtrate (precursor to urine) from several medullary
collecting ducts and empty into a minor calyx.
133. Breast is a ?
a) Endocrine gland

b) Modified sweat gland

c) Modified sehaceous gland

d) Holocrine gland

Correct Answer - B
Breast is a modified sweat gland. It is apocrine type of sweat gland.

medpox.com
134. Valve of heister is seen in
a) Cystic duct

b) Common bile duct

c) Common hepatic duct

d) Pancreatic duct

Correct Answer - A
Ans. is 'a' i.e., Cystic duct
The mucous membrane of the cystic duct forms a series of 5-12
crescentic folds, arranged spirally to form the so called spiral valve
of Heister. This is not a true valve.
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Also know
Hartmanns pouch - dilated posteromedial wall of neck of gall
bladder.
Sphincter choledochus - always present - terminal part of bile duct
Sphincter pancreaticus - usually present - terminal part of pancreatic
duct
Sphincter ampullae (of Oddi) - surrounds the hepatopancreatic
ampulla
135. Skin over hypothenar eminence is
supplied by?
a) Radial nerve

b) Median nerve

c) Anterior interosseous nerve

d) Ulnar nerve

Correct Answer - D
Ulnar nerve

medpox.com
136. Which of the following are inactive
during normal respiration ?
a) Pre-Botzinger complex

b) Dorsal group of neurons

c) Ventral VRG group of neurons

d) Pneumotaxic center

Correct Answer - C
Ans. is 'c' i.e., Ventral group of neurons
Medullary respiratory centers
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The principal areas in the medulla oblongata concerned with
regulation of respiration are : ?
1) Dorsal respiratory group (DRG) : - The dorsal respiratory group of
neurons are mainly concerned with inspiration. They descend and
terminate on spinal motor neurons innervating the primary muscles
of inspiration, i.e., the diaphragm and the external intercostal
muscles.
2) Ventral respiratory group (VRG) : - The ventral respiratory group
of neurons is mainly concerned with forceful expiration but also
shows some activity during inspiration. Therefore, these neurons
contribute to both expiration and inspiration. These neurons are
divided into : ?
i) The rostral VRG neurons : - These neurons show activity
primarily synchronous with inspiration and therefore be called
inspiratory (I) neurons. They terminate on spinal motor neurons
supplying the accessory muscles of inspiration, i.e.,
sternocleidomastoid, scalenes and anterior serrati.
ii) The ventral VRG neurons : - These are mostly expiratory (E)
neurons. But since the expiration is generally a passive process, E
neurons are silent most of the time. However, these neurons show
activity when expiration is forceful, as during exercise. These
neurons terminate on spinal motor neurons supply the muscles of
expiration, i.e., internal intercostal and abdominal muscles.
3) Pre-Botzinger complex : - These neurons are responsible for
generation of respiratory rhythm, i.e., the pacemaker cells which
regulate the rate of respiration are located in Pre-Botzinger complex.
Pontine respiratory centers
The important pontine areas concerned with respiration are : ?
1) Pneumotoxic center (nucleus parabrachialis medialis) : - It is
located in upper part of pons and transmits signals to the inspiratory
area. The function of the pneumotaxic center is primarily to limit
inspiration, i.e., the primary effect of this center is to control the
"switch-off" point of the inspiratory ramp thus controlling the depth of
inspiration, i.e., the duration of the filling phase of the lung cycle.
Pneumotaxic center also inhibits apneustic center further inhibiting
inspiration. Therefore strong stimulation of this center results in an
early termination of inspiratory ramp and hence, inspiration is
shortened and the tidal volume decreases. Conversely, in the
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absence of inputs from this center, inspiratory ramp continues much
longer and hence inspiration is prolonged and the tidal volume
increases.
2) Apneustic center : - This center located in the lower (caudal) part
of pons. The apneustic center excites inspiratory center (DRG) and
produce a prolonged inspiratory drive which delays the onset of
expiration. Thus, though the respiratory rhythm is established in the
medulla, this rhythm is spoilt by a strong inspira​tory drive orginating
in the apneustic centers. However, two influences seems to keep the
apneustic center in check : (i) Pneumotaxic center of upper pons
and (ii) Influence from stretch receptors in lung via vagus. Both of
these influence inhibit inspiratory activity.
137. What will occur with increase in alveolar
ventilation rate ?
a) Decreased partial pressure of O2 in alveoli

b) Decreased partial pressure of CO2 in alveoli

c) Decreased CO2 diffusion from blood to alveoli

d) Decreased O2 diffusion from alveoli to blood

Correct Answer - B
Ans. is 'b' i.e., Decreased partial pressure of CO2 in alveoli
Alveolar ventilation is the amount of inspired air entering in gas-
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exchange areas (alveoli) per minute during quite breathing. It
excludes the air which remains in dead space.
138. Pulmonary vasodilatation is caused by ?
a) Hypoxia

b) Thromboxane A2

c) Histamine

d) Angiotensin-II

Correct Answer - C
Ans. is 'c' i.e., Histamine

medpox.com
139. Isocapnic exercise is ?
a) Breathing for short duration against resistance

b) Breathing of decreased volume of ventilation

c) Breathing of increased volume of ventilation for long period

d) Breathing of decreased volume for long period

Correct Answer - C
Ans. is 'c' i.e., Breathing of increased volume of ventilation for long
period

medpox.com
140. Mismatch of ventilation/perfusion ratio is
seen in
a) Apex

b) Base

c) Both

d) None

Correct Answer - C
Ans. is 'C' i.e.,Both
Ventilation perfusion ratio (V/O)
medpox.com
o Considering that cardiac output is 5.0 L/min and alveolar
ventilation is about 4.2 L/min, the overall ventilation: perfusion ratio
is 0-8. Idealy, therefore, each alveolus should have a V/Q ratio of
0.8. However, that is not so even in normal lungs.
o Due to gravity, the apical alveoli are both underventilated and
underperfused while the basal alveoli are both overventilated and
overperfused. However, gravity affects perfusion much more than it
affects ventilation. Hence, apical alveoli are more underperfused
than underventilated while the basal alveoli are more overperfused
than overventilated. Therefore, V/Q is maximun at apex (about 3-0)
and least at base (about 0-6).
o Since ventilation is far in excess of perfusion at apex,
comparatively little oxygen is transferred from the alveoli to the
blood, and CO2 transferred to the alveoli is also less. Hence the gas
tension at the apices are quiet close to those of inspired air, i.e.,
High Pa02 and low PaCO2. On the other hand, at the base of lung
perfusion is better than ventilation; Hence Pa02 and PaCO2 of basal
alveoli are quiet close to those of pulmonary artery, i.e., low PaO,
and high PaCO2. In simple words, ventilation-perfusion mismatch is
responsible for high P02 with low PCO2 at apex and Low PO2 with
high PCO2 at base.

medpox.com
141. Plateau of oxygen-hemoglobin
dissociation curve signifies ?
a) No oxygen is available for binding to Hb

b) No Hb molecule is available to bind with O2

c) All oxygen is released to tissues

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., No Hb molecule is available to bind with O2
Each molecule of hemoglobin can combine with upto four molecules
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of oxygen.
Combination with the first molecule alters the conformation of the
hemoglobin molecule in such a way as to facilitate combination with
the next oxygen molecule.
In light of this, if we look at the curve, as the PO2 starts rising from 0
mm Hg upwards, initially all hemoglobin molecules in blood starts
combining with their first oxygen molecule.
This is the most difficult molecule to combine with.
Hence saturation rises only slowly with initial rise in PO2. As PO2
rises further, hemoglobin molecules combine with their second, third
and fourth molecules, which are progressively easier to combine
with.
Hence saturation rises steeply between PO2 of 15 mm Hg and 40
mm Hg.
When PO2 rises still further, oxygen finds most of the hemoglobin
molecules carrying four molecules of oxygen each.
Since no molecules of hemoglobin can carry more than four
molecules of oxygen, there is not much scope for more O2
combining with hemoglobin.
Hence the curve becomes almost flat again beyond the PO2 of 60
mm Hg.

medpox.com
142. The oxygen dissociation curve of
myoglobin & hemoglobin is different due
to?
a) Hb can bind to 2 oxygen molecules

b) Cooperative binding in Hb

c) Myogloobin has little oxygen affinity

d) Hemoglobin follows a hyperbolic curve

Correct Answer - B
Ans. is `b' i.e., Cooperative binding in Hb
medpox.com
Cooperative binding is responsible for sigmoid shape of the oxygen-
hemoglobin dissociation curve.
As myoglobin is monomeric (consists of one polypeptide chain only),
it can bind only one molecule of oxygen and for the same reason
myoglobin cannot show the phenomenon of cooperative binding.
Hence, the oxygen?myoglobin dissociation curve is hyperbola as
compared to sigmoid shape of Hb-O2 curve.
Hemoglobin - O2 binding
Each molecule of hemoglobin can combine with upto four molecules
of oxygen. Combination with the first molecule alters the
conformation of the hemoglobin molecule in such a way as to
facilitate combination with the next oxygen molecule. In light of this,
if we look at the curve, as the PO2 starts rising from 0 mm Hg
upwards, initially all hemoglobin molecules in blood starts combining
with their first oxygen molecule. This is the most difficult molecule to
combine with. Hence saturation rises only slowly with initial rise in
PO2. As PO2 rises further, hemoglobin molecules combine with their
second, third and fourth molecules, which are progressively easier to
combine with. Hence saturation rises steeply between PO2 of 15
mm Hg and 40 mm Hg. When PO2 rises still further, oxygen finds
most of the hemoglobin molecules carrying four molecules of oxygen
each. Since no molecules of hemoglobin can carry more than four
molecules of oxygen, there is not much scope for more O2
combining with hemoglobin. Hence the curve becomes almost flat
again beyond the PO2 of 60 mm Hg.
Thus, the primary reason for the sigmoid shape of the oxygen-
hemoglobin dissociation curve is that out of the four molecules of
oxygen that can combine with a hemoglobin molecules, the first
combines with the greatest difficulty and binding of an oxygen
molecules increases affinity to next O2 molecule. This phenomenon
is termed as cooperative binding or cooperativity, i.e., a molecule of
O2 binds to a hemoglobin tetramer more readily if other O2
molecules are already bound.
Myoglobin O2 binding
Myoglobin is present in higher concentration in red (slow) muscle
fibers. Myoglobin has greater affinity for oxygen than hemoglobin
medpox.com
and its P50 is only 5 mm Hg (as compared to PO2 of hemoglobin
which is about 26 mm Hg). Therefore, myoglobin-oxygen
dissociation curve is shifted far to the left than Hb-O2 dissociation
curve. It has shape of hyperbola as compared to sigmoid shape of
Hb-O2 curve because it binds 1 molecule of O2 per mole (in
comparison to Hb which binds 4 molecules of O2 per mole). The role
of myoglobin is to bind O2 at very low PO2 and release them at even
lower PO2, for example in exercising muscles where PO2 close to
zero.
143. Compensatory mechanism in acute
hemorrhage?
a) Decreased myocardial contractility

b) Decreased heart rate

c) Increased heart rate

d) Increased respiratory rate

Correct Answer - C
Ans. is 'c' i.e., Increased heart rate
Compensatory mechanisms in acute hemorrhage
medpox.com
In acute hemorrhage there is compensatory sympathetic stimulation
which causes :?
1) Generalized vasoconstriction with increased total peripheral
resistance (TFR).
2) Increased heart rate (tachycardia).
3) Increased cardiac contractility.
4) Increased renin release causing sodium and water retention
through RAA system.
5) Shift of fluid from intracellular and interstitial space into
vascular space.
144. 'v' Wave in JVP is due to ?
a) Right atrial contraction

b) Left atrial contraction

c) Right atrial relaxation

d) Closure of tricuspid valve

Correct Answer - A
Ans. is A
The first elevation (a wave) corresponds to the slight rise in atrial
pressure resulting from atrial contraction.
The first descent (x descent) reflects a fall in atrial pressure that
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starts with atrial relaxation.
The second elevation (v wave) corresponds to ventricular
systole when blood is entering the right atrium from the vena
cavae while the tricuspid valve is closed.
Finally, the second descent (y descent) reflects falling right atrial
pressure as the tricuspid valve opens and blood drains from the
atrium into the ventricle.
145. Blood supply of brain is ?
a) 1500 ml/min

b) 2000 ml/min

c) 750 ml/min

d) 250 ml/min

Correct Answer - C
Ans. is 'c' i.e., 750 ml/min
The cerebral blood flow (CBF) is about 750 ml/min (15% of total
cardiac output), or 54 ml/100 gm brain tissue per minute.
medpox.com
146. Major neurotransmitter in afferents in
nucleus tractus solitarius to regulate
cardiovascular system ?
a) Serotoxin

b) Glutamate

c) Glycine

d) Norepinephrine

Correct Answer - B
Ans. is 'b' i.e., Glutamate medpox.com
Nucleus tractus solitarius (NTS) lies in medulla.
It receives following afferents :?
A) General visceral afferents
i) From tonsil, pharynx, posterior part of tongue, carotid body and
sinus → through glossopharyngeal nerve.
ii) From pharynx, larynx, trachea, esophagus, and other thoracic
and abdominal viscera → through vagus nerve.
B) Special visceral afferents
i) From anterior 2/3 of tongue (except circumvallate papillae) and
palate → through facial nerve
ii) From posterior 1/3 of tongue (including circumvallate
papillae) → through glossopharyngeal nerve.
iii) From posterior most part of tongue and epiglottis → through
vagus nerve.
NTS is involved in regulation of cardiovascular system through
baroreceptors and chemoreceptors.
There is a general consensus that glutamate is the neurotransmitter
released at the therminals of baroreceptor and chemoreceptor
afferents in NTS. — www.springer.com
However, cholinergic, GABAergic, and opioidergic mechanisms are
also present in NTS.

medpox.com
147. Dicrotic notch is caused by
a) Closure of mitral valve

b) Opening of mitral valve

c) Closure of aortic valve

d) Opening of aortic valve

Correct Answer - C
Ans. is 'c' i.e.. Closure of aortic valve
Aortic pressure curve
With the onset of the rapid ejection phase of the ventricular systole,
the aortic pressure rises steeply to reach a maximum of about 120
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mm Hg. The ejection of blood into the aorta causes a stretch on the
aortic walls and makes the blood in the entire arterial system to
move at a faster rate. This sets up a pressure wave that travels
along the arteries. The pressure wave expands the arterial wall as it
travels, and expansion is palpable as the pulse. In the later part of
the ventricular systole, the aortic pressure declines and continues to
decline through​out the diastole, to reach a minimum of about 80 mm
Hg during the isometric contraction of the next cardiac cycle. The
elastic recoil of the aorta and the resistance of arterioles help to
maintain relatively high aortic pressure during diastole.
A notch (incisura or dicrotic notch) is recorded in the early part of the
downstroke of the aortic pressure curve. It corresponds to the
closure of the aortic valve. It is produced by the sudden backward
flow of aortic blood followed by the immediate cessation of backflow
due to closure of the aortic valves.
148. Skin blood flow is decreased by ?
a) Dopamine

b) Isoprenaline

c) Noradrenaline

d) Acetylcholine

Correct Answer - C
Ans. is 'c' i.e., Noradrenaline
Autophagy is the process by which cells sequester and degrade
their own cytoplasmic organelles.
During the process, autophagic vacuole is formed, which is a bilayer
medpox.com
vacule containing unnecessary or dysfunctional organelle.
Autophagic vacule fuses with lysosome to form autophagosome
(autophagolysosome).
Then, hydrolytic enzymes of lysosome degrade the organelle of
autophagic vacuole.
149. S2 is associated with ?
a) Rapid ventricular filling

b) Atrial contraction

c) Closure of semilunar valves

d) Closure of AV valves

Correct Answer - C
Ans. C. Closure of semilunar valves
S2 is due to closure of semilunar valves (aortic and pulmonary
valves).
medpox.com
150. Capacitance vessels have in their wall ?
a) More elastic tissue and less muscle

b) Less elastic tissue and more muscle

c) More elastic tissue and more muscle

d) Less elastic tissue and less muscle

Correct Answer - D
Ans. is 'd' i.e., Less elastic tissue and less muscle
Veins are capacitance vessels. They have less smooth muscle and
less elastic tissue in their wall.
Structure of vessels medpox.com
A) Structure of artery
It is made up three layers -
1.Tunica Intima
The inner most layer (towards lumen) of artery is intima.
It consists of endothelial cells which rest on basment membrane.
There is some subendothelial connective tissue.
Intima is separated from media by internal elastic lamina.
2.Tunica Media
It is mainly contains smooth muscles and laminae of elastic tissue
Media is separated from adventitia by external elastic lamina.
3.Tunica Adventitia
It is the outer most layer.
Contains collegen and elastic fibers.
B) Structure of capillaries
Capillaries are thin walled vessels made up of single layer of
endothelial cells with its basement membrane. o Capillaries are of
three types -
1.Continous capillaries -
These capillaries has continuous lining of endothelial cells with no
These capillaries has continuous lining of endothelial cells with no
fenestration.
Basement membrane is also continuous.
2.Fenesterated capillaries
There are fenestration between the endothelial cells.
Basment membrane is continuous.
3.Sinusoidal capillaries
Both endothelial cells and basement membrane have fenestration.
In resting tissues, most of the capillaries are collapsed and blood
flows through the throughfare vessels from the arterioles to the
venules.
C) Structure of veins
Structure of vein is smiliar to artery except that -
1.Wall is thinner
2.Three tunicae are less well demarcated.
3.Elastic tissue is scanty and not clearly organized into distinct
internal and external elastic lamina.
4.Have valves (except venae cavae and common iliac vein).
medpox.com
 151. In circulatory biomechanics which of the
following is true?
a) Blood viscosity is increased in anemia

b) Blood viscosity is decreased in polycythemia

c) Cardiac output is increased in anemia

d) Cardiac output is decreased in Beri-Beri

Correct Answer - C
Ans. is 'c' i.e., Cardiac output is increased in anemia
Cardiac output is increased in conditions which cause decrease in
medpox.com
peripheral vascular resistance :-
Exercise
1. AV fistula or shunt
2. Severe anemia
3. Thyrotoxicosis
4. Wet beri-beri
5. About other options
Blood viscosity is low in anemia and high in polycythemia.
152. Normal capillar wedge pressure ?
a) 0-2 mm Hg

b) 5-10 mm Hg

c) 15-20 mm Hg

d) 20-30mm Hg

Correct Answer - B
Ans. is 'b' i.e., 5-10 mm Hg
Normal capillary Wedge pressure is 4-12mm Hg. It is a measure of
left atrial pressure.
medpox.com
153. Mannitol infusion causes increase in
a) Blood viscosity

b) Osmolarity

c) Intra-ocular tension

d) Intercranial tension

Correct Answer - B
Ans. is 'b' i.e., Omolarity

medpox.com
154. Correct order of velocity ?
a) Vena cava > Aorta > Vein > Artery > Venule > Arteriole

b) Aorta > Vena cava > Artery > Vein > Arteriole > Venule

c) Aorta > Artery > Vena cava > Vein > Arteriole > Venule

d) Vena cava > Vein > Aorta > Artery > Venule > Arteriole

Correct Answer - B
Ans. is `b' i.e., Aorta > Vena cava > Artery > Vein > Arteriole > Venul

medpox.com
155. Effect of infusion of hypotonic saline?
a) Increased ICF only

b) Increased ECF only

c) Increased in both ICF and ECF

d) Increased ICF and decreased ECF

Correct Answer - C
Ans. is 'c' i.e., Increased in both ICF and ECF
After infusion of hyptonic saline causes a decline in plasma
osmolality and a shift of water into interstial space (as water moves
from higher osmolarity to lower osmolarity), causing decrease in ICF
medpox.com
osmolality.
This results in shift of water from ECF to ICF.
Finally, both ECF and ICF compartments are increased (due to
increases water) and osmolality of both compartment are decreased.
156. Normal QRS axis ?
a) +30 to 110°

b) -30 to +110°

c) +110° to +150°

d) -110° to -150°

Correct Answer - B
Ans. is 'b' i.e., -30 to +110°
In a normal heart, the average direction of the vector during spread
of the depolarization wave through the ventricles, called the mean
QRS vector, is about +59 degrees.
medpox.com
This means that during most of the depolarization wave, the apex of
the heart remains positive with respect to the base of the heart.
The normal electrical axis of the heart (mean electrical axis or mean
QRS vector) lies between -30° and + 100°.
If the axis is more negative than -30° it is called left axis deviation,
whereas if the axis is more positive than + 100°, it is called right axis
deviation.
157. Herring Breuer reflex is an increase in ?
a) Duration of inspiration

b) Duration of expiration

c) Depth of inspiration

d) Depth of expiration

Correct Answer - B
Ans. is 'b' i.e., Duration of expiration
The Hering-Breuer inflation reflex is an increase in the duration of
expiration produced by steady lung inflation, and the Hering-Breuer
deflation reflex is a decrease in the duration of expiration produced
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by marked deflation of the lung.
158. Carotid and aortic bodies are stimulated
when ?
a) Oxygen saturation decreases below 90%

b) Oxygen saturation decreases below 80%

c) Oxygen saturation decreases below 70%

d) Oxygen saturation decreases below 60%

Correct Answer - A
Ans. is 'a' i.e., Oxygen saturation decreases below 90%
Peripheral chemoreceptors (carotid and aortic bodies) are stimulated
medpox.com
if arterial PO is below 60 mmHg.
2
At PO2 of 60 mmHg, O2 saturation is about 90% (89%).
159. Baroreceptor are ?
a) Carotid body

b) Carotid sinus

c) Aortic body

d) None

Correct Answer - B
Ans. is 'b' i.e., Carotid sinus
Baroreceptors are mechanoreceptors that are located in the
adventia of carotid artery and aorta, at specialized locations called
sinuses. medpox.com
1) Carotid sinus is a little bulge at the root of internal carotid artery,
located just above the bifurcation of the common carotid artery. It is
innervated by the sinus nerve, a branch of glossopharyngeal (IX
cranial) nerve.
2) Aortic arch (aortic sinus) also contains mechenoreceptors (stretch
receptors) which are similar to carotid sinus receptors. However,
their afferent nerve fibers travel in the aortic nerve, a branch of
Vagus (X cranial) nerve.
The sinus nerve (from carotid sinus) and aortic nerve/vagal fibers
(from aortic sinus) are together called `Sino​aortic nerves'. They,
together, are also refered to as 'Buffer nerves' because they are the
afferents of cardiovascular reflexes that buffer abrupt changes in
blood pressure.
160. Sleep centre is located in -
a) Basal ganglia

b) Medulla

c) Hypothalamus

d) Cerebellum

Correct Answer - C
Ans. is 'c' i.e., Hypothalamus

medpox.com
161. Umami taste is evoked by ?
a) Glucose

b) Glutamic acid

c) Quinine

d) Sodium chloride

Correct Answer - B
Ans. is 'b' i.e., Glutamic acid
There are four basic tastes namely Sweet, bitter Salty and Sour.
There mechanisms of sensory transduction are :
1) Sweet receptor is a G protein coupled receptor and leads to an
medpox.com
increase in cAMP concentration in the sensory cells which results in
closure of K+ channels and depolarization.
2) Bitter receptors are also G protein coupled receptors and causes
rise in intracellular Ca' by IP3-DAG system. Rise in intracellular Ca+2
triggers neurotransmitter release.
3) Salty-tasting substances depolarize taste cells by activating
amiloride-sensitive Na+ channels.
4) Sour-tasting substances depolarize taste cells by raising the
intracellular H + ion concentration, which causes closure of K+
channels.
The umami taste is the fifth taste which is unique. The proposed
mechanism of umami taste is through glutamate taste sensors
(glutamate receptors) with release of neuronal glutamic acid.
In nature, there are three umami substances :-
i) Monosodium glutamate (MSG)
ii) Disodium 51-guanosine mosphosphate (GMP)
iii) Disodium 51-ionsine monophosphate (IMP)
162. Reward center is located in ?
a) Cerebellum

b) Amygdala

c) Hippocampus

d) Hypothalamus

Correct Answer - D
Ans. is 'd' i.e., Hypothalamus

medpox.com
163. Which is not an extrapyramidal tract ?
a) Reticulospinal tract

b) Rubrospinal tract

c) Corticospinal tract

d) Tectospinal tract

Correct Answer - C
Ans. is 'c' i.e., Corticospinal tract

medpox.com
164. While walking or standing, posture is
maintain by ?
a) Basal ganglia

b) Hypothalamus

c) Cerebellum

d) Amygdala

Correct Answer - C
Ans. is 'c' i.e., Cerebellum
Cerebellum, through its connection with the red nucleus influences
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the activity of brainstem reticular formation and thereby gamma
motor neuron activity.
Through its connections with the vestibular nucleus and
vestibulospinal tract, cerebellum influnences the activity of alpha
motor neurons.
Thus, normal cerebellar function is essential for the maintenance of
normal muscle tone and posture.
The cerebellum seems to play crucial roles in walking as well as
maintaing a standing posture.
Cerebellar vermis plays an important role in maintenance of
standing postuk.
Basal ganglia is also involved in maintaining posture by acting as
relay center for extrapyramidal pathways. But its role is not as
important.
165. Myelination in peripheral nervous system
is done by
a) Astrocytes

b) Oligodendrocytes

c) Ependymal cells

d) Schwann cells

Correct Answer - D
Ans. is d i.e., Schwann cells
Myelination in central nervous system → Oligodendrocytes.
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Myelination in peripheral nervous system → Schwann cell.
166. Sensory perception involves Brodmann's
area ?
a) 3, 1, 2

b) 4, 6

c) 44, 45

d) 41, 42

Correct Answer - A
Ans.A. 3,1,2
Processing of general sensory inputs primarily occurs in primary
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somatosensory area of parietal lobe.
Primary somatosensory area is Brodmann's area 3, 1, 2.
167. Vibrations are felt by ?
a) Meissner's corpuscle

b) Merkel's disc

c) Pacinian corpuscle

d) Ruffini's end organ

Correct Answer - C
Ans. is 'c' i.e., Pacinian corpuscle
Tactile (touch) receptors
These are general exteroreceptors for epicritic senses. These are
divided into superficial and deep receptors.
medpox.com
Superficial receptors are present in the epidermis or papillary layer
of dermis. In glabrous (nonhairy) skin these receptors are Merkel's
disc (slowly adapting) and Meissner 's corpuscle (rapidly adapting).
In hairy skin there are hair follicle receptors.
Deep receptors are present in deeper dermis or in the subcutaneous
tissues. The deep receptors are same in both hair and nonhairy skin
and include Ruffini's end organ (slowly adapting) and Pacinian
corpuscle (Rapidly adapting).
Touch, pressure and vibration are different forms of same sensation.
Pressure is felt when the force applied on the skin is sufficient to
reach the deep receptors, whereas touch is felt when the force is
insufficent to reach the deep receptors, therefore detected by
superficial receptors (Merkel's disc, meissner's corpuscle).
Vibrations are rhythmic variations in pressure (i.e. rhymic variations
of force that reaches the deep receptors). Whether a tactile receptor
senses pressure or vibration depends on whether the receptor is
slowly adapting or slowly adaping :?
i) Slowly adapting (Ruffini's end organ) :- Are meant to detect
sustained pressure; they are useless for vibrations.
ii) Rapidly adapting (Pacinian corpuscle) :- Stop discharge in
response to sustained pressure; they are useful only when the
pressure fluctuates rapidly, i.e. during vibrations. The higher the rate
of adaptation of a receptor, the greater is the vibration frequency it
can detect.
Thus, tactile (touch) sensation can be divided into :?
A) Superficial (generally considered as touch) :- Detected by
Meissner 's corpuscle (detect texture of sur​face, i.e. rough or
smooth) and Merkel's disc (detect two point discrimination).
B) Deep
i) Pressure (Deep touch) :- Detected by Ruffini's end organ.
ii) Vibrations :- Detected by Pacinian corpuscle

medpox.com
168. Sense organ which is having efferent
supply
a) Golgi tendon organ

b) Organ of corti

c) Retina

d) Taste bud

Correct Answer - B
Ans. is 'b i.e., Organ of corti
Afferent (sensory) neurons carry information form sense organs to
CNS (brain & spinal cord). medpox.com
Hair cells (in organ of corti) are the sensory recepors which are also
innervated by efferent neurons.
169. False regarding papillae of tongue ?
a) Fungiform papillae at tip

b) Circumvallate papillae at base

c) Foliate papillae at back edge

d) Filiform papillae have taste buds at tip

Correct Answer - D
Ans. is 'd' i.e., Filiform papillae have taste buds at tip
In tongue, taste buds are grouped in structures called papillae. Taste
buds are located in the walls of papillae. There are three types of
papillae :- medpox.com
i) Fungiform papillae :- Are especially numerous near the tip and the
margins of the tongue.
ii) Circumvallate (Vallate) papillae :- These are the largest papillae
and are distributed to a V-shaped region near the base of tongue.
iii) Foliate papillae :- Confined to the back edge of the tongue.
Besides these three types of papillae, there is also a fourth type, the
filiform papillae but these have no taste buds.
170. Fever is produced by ?
a) PGF2α

b) PGE2

c) PGI2

d) PGD2

Correct Answer - B
Ans. is 'b' i.e., PGE2
Fever is elevated body temperature due to resetting of hypothalamic
thermostat above the normal level.
IL-1 (most potent), TNF-α and IL-6 are pyrogens (fever producing
medpox.com
cytokines).
But they do not act directly.
They stimulate the release of PGE2, which resets the hypothalamic
thermostat at higher level.
Thus, PGE2 is the final effector in production of fever.
171. Endogenous pyrogens act by ?
a) Increasing heat generation

b) Raising thermostat point of hypothalamus

c) Causing vasoconstriction

d) By Non-shivering thermogenesis

Correct Answer - B
Ans. is 'b' i.e., Raising thermostat point of hypothalamus
Bacterial toxins (exogenous pyrogens) stimulate inflammatory cells
to secrete pyrogenic cytokines (endogenous pyrogens), e.g. IL-I,
TNF-a , and IL-6. medpox.com
These endogenous pyrogenes stimulate PGE2 release in
hypothalamus, which raises temperature set point of hypothalamus
to cause fever.
172. Which of the following increases appetite
?
a) CART

b) α - MSH

c) AGPP

d) Insulin

Correct Answer - C
Ans. is 'c' i.e., AGPP

medpox.com
173. Sharp pain is transmitted by which type
of fibres?
a) Aα

b) Aβ

c) Aδ

d) C

Correct Answer - C
Ans. is 'c' i.e., Aδ
Sharp somatic pain (fast pain) is carried by AS fibres.
medpox.com
Pain is carried by two types of fibers : ?
i) Aδ → These are relatively fast. Therefore the pain carries by
these is fast pain (epicritic pain or first pain).
ii) C → These are slow, therefore the pain carries by these is slow
pain (protopathic pain or second pain).
 174. Myosin and actin filaments are kept in
place by
a) Tropomyosin

b) Troponin

c) Actinin

d) Titin

Correct Answer - D
Ans. is 'd' i.e., Titin
The side-by-side relationship between the myosin and actin
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filaments is difficult to maintain.
This is achieved by a large number of filamentous molecules of a
protein called titin.
Titin molecules act as a framework that holds the myosin and actin
filaments in place so that the contractile machinery of the sarcomere
will work.
Important muscle proteins
1. Myosin:- Myosin is the protein that constitutes the thick filaments.
Myosin of skeletal muscle is myosin-IL Myosin participates in the
contractile mechanism and also acts as an ATPase.
2. Actin:- Actin is the major protein of thin filament. It is the actin that
slides over myosin during contraction.
3. Tropomyosin: - It is the other protein of thin .filament. It covers the
active sites (myosin-binding sites) on actin. When Ca+2
concentration of cytoplasm (sarcoplasm) is raised, it uncovers the
active sites of actin and allows the contraction So, the 'cross-bridge
cycling' is switched off or on by the tropomyosin molecule which
slides on the actin molecule to cover or uncover the active sites on
it.

medpox.com
175. True about cerebellar neuronal
connections ?
a) Climbing fibres from inferior olivary nucleus

b) Mossy fibres from inferior olivary nucleus

c) Climbing fibres are inhibitory to Purkinje cells

d) Mossy fibres are inhibitory to Purkinje cells

Correct Answer - A
Ans. is 'a' i.e., Climbing fibres from inferior olivary nucleus
Neuronal circuit in cerebellum
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Afferent for cerebellum comes through two fibers : climbing fibers
and Mossy fibers. Climbing fibers which brings information only from
the inferior olivary nuclei and establish excitatory synapes with
purkinje cells. All other afferent input to the cerebellum is brought by
the other types of fibers, called Mossy fibers which establish
excitatory synapse with granule cells in the granular cell layer. The
axon of granule cells, called parallel fibers, stimulate the purkinje
cells. Thus mossy fibers, like the climbing fibers, also end up in
stimulating the purkinje cells.
Granule cells are the only stimulatory (excitatory) cells in cerebellar
cortex.
The parallel fibers (axons of granule cells) also stimulate three types
of interneurons :- Stellate and basket cells in the molecular layer,
and Golgi cells in the granular layer. Stellate and basket cells inhibit
purkinje cells. Golgi cells, also activated by collateral from mossy
fibers (besides parallel fibers), inhibit transmission from mossy fibers
to granule cells.
Overall, climbing fiber inputs exert a strong excitatory effect on a
single purkinje cell, Whereas mossy fiber inputs exert a weak
excitatory effect on many purkinje cells via the granule cells.
After complex inhibiting and excitatory interactions of various fibers
and cells in the cortex, the output of cerebellar cortex, is projected to
deep cerebellar nuclei by axons of pyramidal cells (only output cells
of cerebellar cortex). The output of the Purkinje cells is inhibitory to
the deep cerebellar nuclei. However, the output of deep cerebellar
nuclei to the brain stem and thalamus is always excitatory because,
beside inhibitory inputs of purkinje cells, deep cerebellar nuclei also
receive excitatory inputs from afferent mossy and climbing fibers
which usually are more prominent.

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176. Post-tetanic potentiation is due to -
a) Hyperpolarization of muscle fibres

b) Rapid K+ efflux

c) Increased availability of Ca++

d) Rapid Na+ influx

Correct Answer - C
Ans. is 'c' i.e., Increased availability of Ca++
"Repetitive stimulation enhances force development due to rise in
intracellular Ca++, a phenomenon called post​tetanic potentiation. It is
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due to increased phosphorylation of myosine light chain with
increased number of cross bridges."
177. Which of the following has small
representation in somatosensory area of
cerebral cortex ?
a) Lips

b) Thumb/fingers

c) Tongue

d) Trunk

Correct Answer - D
Ans. is 'd' i.e., Trunk medpox.com
A distinct topographic represention of the body can be demonstrated
in somatosensory area-I.
Each side of the cortex receives sensory information from the
opposite side of the body only (contralateral representation).
The body is represented upside down (vertical) in the postcentral
gyms, i.e. the face is represented at the foot of the gyrus whereas
the legs and feet are represented at the top extending on the medial
surface.
Some parts of body like face (especially lips, tongue) and fingers
have a proportionately large representation than the other areas like
the trunk. The cortical representation of the part of the body is
proportionate to its innervation density (number of sensory
receptors) rather than its size.
178. Resting membrane potential in cardiac
muscle ?
a) -70 mV

b) +70 mV

c) -90 mV

d) +90 mV

Correct Answer - C
Ans. is 'c' i.e., -90 mV
Normal RMP in myocardial fibers is about -90 mV.
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 179. Noradrenaline is major neurotransmitter
in ?
a) Postganglionic parasympathetic fibres

b) Postganglionic sympathetic fibres except in sweat glands

c) Autonomic ganglia

d) Preganglionic autonomic fibres

Correct Answer - B
Ans. is 'b' i.e., Postganglionic sympathetic fibres except in sweat
glands
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Neurotransmitter in all preganglionic autonomic nerves (both
sympathetic and parasympathetic) is acetylcholine (A CH)
Neurotransmitter in all ganglia (both sympathetic and
parasympathetic) is acetylcholine.
Neurotransmitter in postganglionic parasympathetic fibres is
acetylcholine.
In posganglionic sympathetic fibres, the major neurotransmitter is
noradrenaline (NA) except in renal and mesentric vasculature where
it is dopamine, in sweat glands, some blood vessels where it is
acetylcholine and in adrenal medulla where it is adrenaline.
Most of the visceral organs are supplied by both sympathetic and
parasympathetic system except;
1. Blood vessels, spleen, sweat glands and hair follicles receive only
sympathetic innervation.
2. Ciliary muscle gastric and pancreatic glands receive only
parasympathetic innervation.
In general sympathetic and parasympathetic systems are
antagonistic except :
Refractory period of atrial fibres is decreased by both.
At almost all organs except heart, cholinergic system has excitatory
activity and adrenergic system has relaxing properties Sympathetic
system stimulates (Tachycardia, Positive inotropic) and
parasympathetic system depresses (Bradycardia, Negative
inotropic) the heart.

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180. Receptor for BDNF ?
a) TrK-A

b) TrK-B

c) TrK-C

d) None

Correct Answer - B
Ans. is 'B' i.e., TrK-B

medpox.com
181. Sensations which are appreciated in
thalamus
a) Proprioception

b) Pain & temperature

c) Tactile sensations

d) Pressure

Correct Answer - B
Ans. is 'b' i.e., Pain & temperature
Pain and temperature are primarily appreciated by the thalamus.
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For other forms of sensation, the thalamus is unable to analyze the
details of sensations.
Fibers carrying tactile and proprioceptive information ascend through
the thalamocortical pathway to area 3 of primary somatic sensory
cortex through the thalamic radiation.
Therefore, if the somatosensory cortex is removed, tactile
sensations and proprioceptions are lost, but pain and temperature
sensations persist.
182. 51 S2 is checked by which reflex ?
a) Knee jerk

b) Patellar reflex

c) Calcaneal reflex

d) None

Correct Answer - C
Ans. C. Calcaneal reflex
S1 S2 is checked by ankle jerk (also called Calcaneal reflex or
achilles reflex).
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183. Mitral and periglomerular cells are seen
in ?
a) Medulla

b) Olfactory bulb

c) Primary visual cortex

d) Geniculate body

Correct Answer - B
Ans. is 'b' i.e., Olfactory bulb
The sensory receptors for olfaction (smell) are located in the
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olfactory mucous membrane. In human, the olfactory mucous
membrane (olfactory neuroepithelium) located in the roof of the
nasal cavity near the septum. Because of its location high in the
nasal cavity, the olfactory mucosa is not directly exposed to the flow
of inspired air entering the nose.
The olfactory mucosa contains olfactory receptors. The olfactory
receptors are unique in that the receptor cell itself is a neuron. The
olfactory receptor cell has cilia projecting in the nasal mucosa which
act as receptor for olfaction (These are dendrites of neuron/receptor
cells). The axons of olfactory neuron (olfactory receptor cells) form
olfactory nerve which passes through cribriform plate and terminates
in the olfactory bulb. In olfactory bulb axons of olfactory nerve
synapse with dendrides of mitral cells to form the olfactory glomeruli.
Mitral cells are the principal output neurons of olfactory bulb and
their axons form the olfactory tract.
The olfactory bulb also contains periglomerular cells, which are
inhibitory neurons and granule cells which have no synapse and
make reciprocal synapses with mital and tufted cells.
Like the taste fibers, olfactory tract also projects to the primitive parts
of the brain as well as the neocortex. The projections to the primitive
parts are principally to the pyriform area (olfactory cortex), amygdala
and entorhinal cortex, which in turn projects to the hippocampus.
The pathway to the neocortex involves a relay in the olfactory
tubercle, and then in the thalamus, the output of which projects to
the orbitofrontal cortex.

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184. Weber Fechner law is related to ?
a) Phantom limb

b) Force of contraction in heart

c) Intensity of stimulus and sensation felt

d) Cortical plasticity

Correct Answer - C
Ans. is 'c' i.e., Intensity of stimulus and sensation felt

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185. Prostaglandins are produced by ?
a) Neutrophils

b) Endothelium

c) Macrophages

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above

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186. Prostaglandin was discovered from ?
a) Tear

b) Saliva

c) Seminal fluid

d) Blood

Correct Answer - C
Ans. C. Seminal fluid
The name prostaglandin comes from the prostate gland. When
prostaglandin was first isolated from seminal fluid, it was believed to
have been added from the prostate."
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187. Aromatase produces estrogen from -
a) Progesterone

b) Cortisol

c) Aldosterone

d) Androgen

Correct Answer - D
Ans. is 'd' i.e., Androgen

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188. Action of progesterone ?
a) Increased sensitivity of uterus to oxytocin

b) Inhibits LH secretion

c) Decrease in body temperature

d) Causes proliferative changes in uterus

Correct Answer - B
Ans. is 'b' i.e., Inhibits LH secretion

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189. Corpus leuteum starts regressing after
how many days of ovulation ?
a) 5 days

b) 10 days

c) 24 days

d) None

Correct Answer - B
Ans. is 'b' i.e., 10 days
If ovum is not fertilized, the corpus luteum starts degenerating
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around day 24 of cycle (about 10 days after ovulation) and is
eventually is replaced by fibrous tissue, forming corpus albicans.
Degeneration of corpus luteum is due to decline in level of LH (which
is required for maintenance of corpus luteum) and increase in
secretion of inhibin by luteal cell itself.
190. First polar body is formed after ?
a) Mitosis

b) First meiosis

c) Second meiosis

d) Fertilization

Correct Answer - B
Ans. is 'b' i.e., First meiosis
Oogenesis
Oogenesis refers to the process of formation of ova from the
primitive germ cells. Unlike fetal testis (in which spermatogenesis
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beings at puberty), the fetal ovary begins oogenesis by 10 weeks of
gestation. o The sequence of events in oogenesis are :
i) The primitive germ cells undergo mitotic divisions to form oogonia
(diploid Oogonium is unique in that it is the only female cell in which
both 'X' chromosomes are active.
ii) The oogonia proliferate by mitosis to form primary oocytes (diploid
cells).
iii) Primary oocytes formed from the oogonia enter a prolonged
prophase (diplotene stage) of the first meiotic division and remain in
this stage until ovulation occurs after puberty.
iv) Primary oocytes completes the first meiotic division at puberty
just before ovulation to form secondary oocyte (haploid cell) and 1st
polor body.
v) Secondary oocyte immediately begins second meiotic division but
this division stops at metaphase and is completed only if the mature
ovum (ootid) is fertilized with sperm. At that time second polor body
(polocyte) is extruded and the fertilized ovum proceeds to form a
new individual. Fertilization normally occurs in the ampulla of
fallopian tube.

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191. Fertilization takes place after how much
time of ovulation ?
a) 1-2 days

b) 5-6 days

c) 8-12 days

d) > 12 days

Correct Answer - A
Ans. is 'a' i.e., 1-2 days

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192. Implantation occurs at ?
a) 2-3 days

b) 6-7 days

c) 15-20 days

d) 20-25 days

Correct Answer - B
Ans. is 'b' i.e., 6-7 days

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193. Implantation occurs on which menstrual
cycle day ?
a) 5-7 days

b) 20-22 days

c) 14-18 days

d) 26-28 days

Correct Answer - B
Ans. is 'b' i.e., 20-22 days
Implantation occurs at 6-7 days after fertilization.
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Ovulation occurs at 14th day of menstrual cycle and fertilization
occur within 24 hours after ovulation.
Thus, implantation will correspond to 20-22 days of menstrual cycle.
194. Blastocyte comes out on which day after
fertilization ?
a) 4-7 days

b) 10-12 days

c) 12-15 days

d) 15-20 days

Correct Answer - A
Ans. is 'a' i.e., 4-7 days
Free floating unimplanted blastocyst is seen on 4-5 days.
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195. Growth hormone secretion is stimulated
by ?
a) Increased blood glucose

b) Decreased blood glucose

c) Cortisol

d) Somatostatin

Correct Answer - B
Ans. is 'b' i.e., Decreased blood glucose
Regulation of GH secretion
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GH secretion is regulated by GHRH released from hypothalamus.
GH is secreted in a pulsatile fashion throughout the life, with
elevated rates of secretion immediately after birth and at puberty.
Interestingly, large bursts of secretion occur at night during the onset
of deep sleep.
Stimuli that increase secretion of GH are hypoglycemia, exercise,
fasting, protein meals, aminoacids (like arginine), stress, glucagon,
pyrogen, lysin vasopressin, apomorphins, L-dopa & a-adrenergics,
estrogen, androgens and 2-deoxyglucose.
Stimuli that decrease secretion of GH are REM sleep, glucose,
Somatostatin, cortisol, FFA, GH itself, IGF-1, and
medroxyprogesteron.
196. Hormones required during puberty ?
a) LSH

b) Testesterone

c) Leptin

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
Puberty is triggered by a release of gonadotropins (FSH and LH)
from pituitary gland.
These hormones act as signals to the gonads (testes/ovaries) that
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trigger the production of -
i) Estrogen, progesterone and some testosterone in women.
ii) Testosterone in men.
In both males and females, testosterone is responsible for
development of pubic hair, accelerated bone growth, body odor and
acne during puberty. For boys, testosterone is responsible for the
process of virilization, including the enlargement of the penis,
increased libido and growth of facial and chest hair.
Estrogen is the major hormone responsible for female puberal
development. It causes development of breast and thickening of
endometrium.
Progesterone causes proliferation of acini in mammary glands and
converts watery cervical secretion to viscid and scanty.
Leptin facilitates release of gonadotropin releasing hormone
(GnRH), thereby helping in pubertal onset.
Other hormones which are involved in puberty are thyroxine and
growth hormone.
197. Pubarche is due to ?
a) GH

b) Progesterone

c) Testosterone

d) Estrogen

Correct Answer - C
Ans. is 'c' i.e., Testosterone

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198. Cells which surround the oocyst in
graafian follicle are called ?
a) Discus proligerus

b) Cumulus oophoricus

c) Luteal cells

d) Villus cells

Correct Answer - B
Ans. is 'b' i.e., Cumulus oophoricus
Oocyte lies eccentrically in the graafian (ovarian) follicle.
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It is surrounded by some granulsa cells that are given the name
cumulus oophoriacus (or cumulus ovaricus).
The cells that attach it to the wall of the follicle are given the name
discus proligerus.
199. Following changes are seen during
capacitation of a sperms except ?
a) Increased permeability to calcium

b) Decreased permeability to calcium

c) Removal of cholesterol from acrosome

d) Increased motility

Correct Answer - B
Ans. is 'b' i.e., Decreased permeability to calcium
Capacitation of sperm (spermatozoa)
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Spermatozoa leaving the testis (seminiferous ubules) are not fully
mobile. They continue their maturation and acquire their mobility
during their passage through epididymis. From epididymis they
come to vas deference, distal end of which also receives the
secretions of seminal vesicle, and continues as the ejeculatory duct.
The ejeculatory duct joins the prostatic urethra.
Once ejeculated into the the female, vaginal secretions improve the
motility and fertilizing ability of sperms. Further exposure to
secretions of female genital tract (in uterus and/or fallopian tube)
further improves the mobility and fertilizing ability of the sperms. The
beneficial effects of stay in the female genital tract are collectively
called capacitation, from the isthmus, capacitated sperms move
rapidly to the ampullas, where fertilization takes place.
Following changes occur during capacitation :-
Uterine and fallopian tube fluids wash away the various inhibitory
factors that suppress sperm activity in male genital tract.
Removal of cholesterol vesicle from acrosome so that acrosomal
membrane becomes weak and can release enzyme at the time of
fertilization.
Increase membrane permeability to calcium ion.

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200. Estrogen Beta receptors are found on
a) Uterus

b) Blood vessels

c) Ovary

d) Vagina

Correct Answer - C
Ans. is 'c' i.e., Ovary

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201. Spermatogenesis takes place in ?
a) Epididymis

b) Seminiferous tubule

c) Ductus deferens

d) Prostate

Correct Answer - B
Ans. is 'b' i.e., Seminiferous tubule
Spermatogenesis occurs in seminiferous tubules.
Spermatogenesis refers to the process of formation of spermatozoa
(sperm) from primitive germ cells (spermatogonia).
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Steps in spermatogenesis involve :?
i) Spermatogonia (primitive germ cells) undergo mitosis to form
primary spermatocytes. Both spermatogonia and primary
spermatocytes have diploid chromosomes (46 chromosomes or
diploid of 23 chromosomes).
ii) Primary spermatocytes undergo meiosis to form secondary
spermatocytes. Secondary spermatocytes have haploid (23)
chromosomes.
iii) Secondary spermatocytes undergo mitosis to form spermatids.
iv) Spermatids do not divide further but undergo morphological
changes to form sperms (spermatozoa). This step of formation of
spermatozoa from spermatids is called spermiogenesis. The
spermiogenesis takes place in the deep folds of cytoplasm of sertoli
cells.
202. Conceptus enters uterine cavity in which
cell stage ?
a) 4 cells

b) 8 cells

c) 16 cells

d) 32 cells

Correct Answer - C
Ans. is 'c' i.e., 16 cells
Fertilization and implantation
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Fertilization refers to fusion of male and female gametes (i.e.
spermatozoon and ovum). It takes place in the middle segment
(ampulla) of fallopian tube. Before fertilization, the ovum and sperms
reach the ampulla for fertilization. Fusion of spermatocyte and ovum
leads to formation of zygote. First week of development begins
immediately after fertilization and includes :?
i) Cleavage of zygote : Zygote (fertilized ovum) starts dividing
immediately and large zygote is subdivided into smaller daughter
cells called blastomeres. Blastomeres are still surrounded by zona
pellucida. Cleavage occurs in fallopian tube (uterine tube).
ii) Formation of morula : At about 16 cells stage the blastomeres
tightly align by the process of compaction to form a compact ball of
cells called morula (mulberry). This process of compaction leads to
segregation of cells into two groups (i) inner cells (inner cell mass),
and (ii) outer cells (outer cell mass). Morula enters uterine cavity 4
days after fertilization.
iii) Formation of blastocyst : As the morula enters the uterine
cavity, uterine fluid diffuses through zona pellucida and fills small
intercellular gaps between blastomeres, and morula is converted to
blastocyst. Blastocyst consists of :?
a) Zona pellucida : Outer covering.
b) Embryoblast : A group of centerally located cells of inner cell
mass and later give rise to tissues of embryo proper.
c) Trophoblast : A thin outer layer of cells formed from outer cells
mass and later give rise extraembryonic tissues.
d) Blastocele : Cavity of blastocyst :
The region of blastocyst containing embryoblast is known as
embryonic pole and the opposite pole, the abembryonic pole. The
trophoblasts overlying the embryoblast at embryonic pole is called
polar trophoblast and that occupying the rest of wall called mural
trophoblast. Between 5-6 days after fertilization, blastocyst hatches
from zona pellucida, and this naked blastocyst is ready for
implantation

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 203. Thyroid gland is stimulated by which
hormone during pregnancy ?
a) Prolactin

b) HCG

c) Human placental lactogen

d) ACTH

Correct Answer - B
Ans. is 'b' i.e., HCG
The endocrine system undergoes noteworthy changes during
pregnancy. medpox.com
The pituitary, thyroid and parathyroid glands appear enlarged.
The enlargement of thyroid gland occurs under the influence of
hCGs pituitary thyrotropin (TSH) and human chorionic thyrotropin
from placenta. This results in an increase in thyroxine which
stimulates metabolic activity in mother and fetus.
Increased parathyroid hormone stimulates liberation of calcium ion
from maternal bones for fetal use.
Increased output of ACTH from pituitary stimulates secretion of :-
i. Glucocorticoids : It mobilizes amino acids for protein synthesis in
fetal tissues.
ii. Aldosterone : Promotes fluid retention in pregnancy.
204. FSH and LH both are inhibited by ?
a) Cortisol

b) Aldosterone

c) Estrogen

d) Progesterone

Correct Answer - C
Ans. is 'c' i.e., Estrogen
Consistent with the phenomenon of negative feedback in which the
secretion of the target hormone inhibits its trophic hormone,
pregesterone inhibits LH and inhibin inhibits FSH.
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Estrogen, whose secretion is stimulated by both LH and FSH,
inhibits both LH and FSH.
Progesterone and estrogen act at both hypothalamic and pituitary
levels while inhibin secreted by granulosa cells acts only on the
pituitary.
Under certain conditions, estrogen causes stimulation (positive
feedback) rather than inhibition of LH, e.g., at ovulation.
205. Insulin secretion is normally stimulated
by ?
a) GLP-1

b) GLP-2

c) VIP

d) α-adrenergic receptors

Correct Answer - A
Ans. is 'a' i.e., GLP-1
Recently, attention has been focused on glucagon - like polypeptide
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1 (7-36) (GLP-1 [7-36]) as an additional gut factor for insulin
secretion and GLP-1 (7-36) is more potent insulinotropic hormone.
Regulation of insulin secretion
Factors affecting insulin secretion are : -
i) Simulating insulin secretion :- Glucose; Mannose; Amino acids
(arginine, leucine); Intestinal hormones (GIP. Gastrin, Secretin,
CCK, GLP -1); β-keto acids; Parasympethetic stimulation
(acetylcholine); cAMP; β-adrenergic stimulation; theophylline;
Sulfonylureas; and certain endocrine hormones like growth
hormone, Glucagon and glucocorticoids.
ii) Inhibiting insulin secretion : - Somatostatin; 2-deoxyglucose;
mannoheptulose; a-adrenergic stimulation, P-adrenergic inhibitors;
galanin; Diazoxide; Thiazide diuretics; K+ depletion; Phenytoin;
Alloxan; microtubule inhibitors; and insulin itself.
206. Effect of GLP-1 ?
a) Increased aldosterone secretion by adrenal

b) Increased PTH secretion

c) Increased insulin secretion from beta-cells of pancreas

d) Increased testosterone secretion from Leydig cells

Correct Answer - C
Ans. is 'c' i.e., Increased insulin secretion from beta-cells of
pancreas

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207. Insulin mediated glucose transport is
seen in ?
a) Adipose tissue

b) Brain

c) RBC

d) Kidney

Correct Answer - A
Ans. is 'a' i.e., Adipose tissue
Insulin stimulates the uptake of glucose by myocytes (skeletal
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muscle, cardiac muscles), adipocytes (adipose tissue) and
hepatocytes. Tissues that do not depend on insulin for glucose
uptake include brain, erythrocytes (RBC), the epithelial cells of
kidney & intestine, Liver, and Cornea & lens of eye.
The mechanism through which insulin increases glucose uptake is
different in different tissues. In the muscle and adipose tissues,
insulin increase facilitated diffusion by increasing glucose transporter
(GLUT4) on the cell membrane.
In the liver, insulin stimulates glucose entry into hepatocytes
indirectly by induction of glucokinase so that the glucose entering
the liver cells is promptly converted to glucose - 6 - phosphate
(glucose trapping). This keeps the intracellular glucose
concentration low and favours entry of glucose into the liver. Thus,
though the liver do not depend on insulin for glucose uptake, insulin
stimulates glucose entry into hepatocytes. That means glucose
entery can occur in liver without the action of insulin, but this is
facilitated by insulin. On the other hand, myocytes (skeletal and
cardiac muslces) and adipocytes (adipose tissue) are dependent on
insulin for glucose uptake.
medpox.com
208. Role of growth hormone in
spermatogenesis ?
a) Late division of spermatocytes

b) Early division of spermatogonia

c) Formation of Acrosomes

d) Stimulation of sertoli and Leydig cells

Correct Answer - B
Ans. is `b' i.e., Early division of spermatogonia
Growth hormone specifically promotes early divisions of
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spermatogonia themselves. In the absence of GH, spermatogenesis
is severely deficient or absent.
Growth hormone is also essential for general metabolic process in
testis.
Hormones involved in spermatogenesis
Spermatogenesis is influenced by many hormones. Hormones
required for spermatogenesis are FSH, LH, testosterone, estrogen,
growth hormones inhibin and activin.
FSH is responsible for initiation of spermatogenesis. It binds with
sertoli cells and spermatogonia and induces the proliferation of
spermatogonia. It stimulates certoli cells to secrete endrogen binding
protein, inhibin, mullerian inhibing substance and estrogen.
LH stimulates leydig cells to secrete testosterone.
Testosterone is the principles hormone which directly stimulates
spermatogenesis. It is responsible for the sequence of remaining
stages of spermatogenesis (after initiatin by FSH). It is also
responsible for maintenance of spermatogenesis.
Estrogen is formed from testosterone (by aromatase) in sertoli cells.
It is essential for spermeogenesis (last step of spermatogenesis, i.e.
formation of spermatozoa from spermatids).
formation of spermatozoa from spermatids).
Growth hormone is essentialy promotes early division of
spermatogonia.
Inhibin plays an important role in regulation of spermatogenesis by
feedback inhibition of FSH secretion.
Activin stimulates FSH secretion and stimulates spermatogenesis.

medpox.com
209. Growth hormone has its effect on growth
through?
a) Directly

b) IG1-1

c) Thyroxine

d) Intranuclear receptors

Correct Answer - B
Ans. is 'b' i.e., IGI-1
GH has two major functions :-
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i) Growth of skeletal system :- The growth is mediated by
somatomedins (IGF). Increased deposition of cartilage (including
chondroitin sulfate) and bone with increased proliferation of
chondrocytes and osteocytes.
ii) Metabolic effects :- Most of the metabolic effects are due to direct
action of GH. These include gluconeogenesis, decreased peripheral
utilization of glucose (decreased uptake), lipolysis and anabolic
effect on proteins.
210. Growth hormone does not cause ?
a) Gigantism

b) Acromegaly

c) Diabetes mellitus

d) Hypothyroidism

Correct Answer - D
Ans. is 'd' i.e., Hypothyroidism
Physiological effects of Growth hormone
Growth hormone has two major action, i.e., (1) Stimulation of
skeletal growth, and (2) Regulation of metabolism. 3) Stimulation of
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skeletal growth
The effect of GH on skeletal growth is mediated by somatomedins
(Insulin-like growth factors : IGF). They are synthesized mainly in the
liver. The growth promoting action of somatomedins is helped by
their insulin like actions. GH, through somatomedin (IGF-1),
stimulates proliferation of chondrocytes and osteocytes resulting in
increased deposition of chondroitin sulfate in catilage and increased
ossification of the newly formed cartilage.
GH deficiency in early life causes dwarfism (small height). GH
excess in early life leads to gigantism, whereas growth hormone
excess in adulthood results in acromegaly.
2) Regulation of metabolism
Protein metabolism : - GH has predominantly anabolic effects on
skeletal and cardiac muscle where it promotes amino acid transport
into cells and increase protein synthesis.
Carbohydrate and fat metabolism : - The effects of GH on
carbohydrate and fat metabolism are complicated by the fact that
GH has anti-insulin effects, whereas somatomedins it produces have
insulin like effects:-
i) Anti-insulin effects due to direct effect of GH include decreased
peripheral utilization of glucose, increased gluconeogenesis,
hyperglycemia, and lipolysis. Due to its anti-insulin effects GH
excess can cause insulin resistant diabetes mellitus.
ii) Insulin like effects due to somatomedins (IGF) include
antilipolytic activity, and other insulin like effects.

medpox.com
211. Which of the following is an ionic
channel ?
a) α -1 receptors

b) β - 1 receptors

c) Nicotinic cholinergic receptors

d) Muscarinic cholinergic receptors

Correct Answer - C
Ans. is 'c' i.e., Nicotinic cholinergic receptors

medpox.com
212. Chloride shift is due to ?
a) Generation of HCO-3 in RBCs

b) Metabolism of glucose in RBCs

c) Formation of O2-Hb complex in RBCs

d) None

Correct Answer - A
Ans. is 'a' i.e., Generation of HCO-3 in RBCs
Carbon dioxide is transported in blood as plasma bicarbonate.
Red blood cells (RBCs) play a major role in the mechanism because
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RBCs contain the enzyme carbonic anhydrase that catalyzes the
reaction CO2 + H2O = HCO3 +
Hence when CO2 diffuses into the RBC, it reacts chemically with
water to generate HCO3-.
The ft ions are mopped up by hemoglobin, which is an excellent
buffer.
This enables the reaction to proceed in the forward direction.
The HCO3- ions generated diffuse out into the plasma in exchange
for Cl- ions that diffuse into RBCs simultaneously.
The movement of chloride ions into RBC is called Chloride shift.
The above events results in an increase in total number ions inside
the RBC, which increases its osmolarity.
As a result, water enters the RBC through osmosis.
The RBCs carrying CO2 in bicarbonate form will therefore be
somewhat larger than normal.
Hence the hematocrit of venous blood is normally 3% greater than
that of arterial blood. o In the lungs, Cl- moves out of the RBCs and
they shrink.
medpox.com
213. Insulin resistance down-regulates -
a) GLUT-1

b) GLUT-2

c) GLUT-3

d) GLUT-4

Correct Answer - D
Ans. is 'd' i.e., GLUT-4

medpox.com
214. Maximum amount of K+ ion is seen in
which GI secretion ?
a) Saliva

b) Colonic

c) Gastric

d) Jejunal

Correct Answer - A
Ans. is 'a' i.e., Saliva
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215. Tone of lower esophageal sphincter is
increased by?
a) NO

b) VIP

c) Acetylcholine

d) Epinephrine

Correct Answer - C
Ans. is 'c' i.e., Acetylcholine
Lower esophageal sphincter
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Unlike the rest of the esophagus, the musculature of the
gastroesophageal junction (lower esophageal sphincter; LES) is
tonically active but relaxes on swallowing.
The tonic activity of the LES between meals prevents reflux of
gastirc contents into the esophagus. o The LES is made up of three
components.
The esophageal smooth muscle is more prominent at the junction
with the stomach (intrinsic sphincter).
Fibers of the crural portion of the diaphragm, a skeletal, a skeletal
muscles, surround the esophagus at this point (extrinsic sphincter)
and exert a pinchcock-like action on the esophagus. In addition, the
oblique or sling fibers of the stomach wall create a flap valve that
helps close off the esophagogastric junction and prevent
regurgitation when intragastric pressure rises.
The tone of the LES is under neural control.
Release of acetylcholine from vagal endings causes the intrinsic
sphincter to contact, and release of NO and VIP from interneurons
innervated by other vagal fibers causes it to relax.
Contraction of the crural portion of the diaphragm, which is
innervated by the phrenic nerves, is coordinated with respiration and
contractions of chest and abdominal muscles.
Thus, the intrinsic and extrinsic sphincters operate together to permit
orderly flow of food into the stomach and to prevent reflux of gastric
contents into the esophagus.

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216. Pepsinogen is activated by ?
a) Enterokinase

b) Enteropeptidase

c) H+

d) Trypsin

Correct Answer - C
Ans. is c i.e.,H+
Pepsin is secreted by chief cells of stomach in an inactive
(zymogen) form called pepsinogen.
Acid (IF) in lumen of stomach converts pepsinogen to active pepsin.
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Pepsin once formed also attacks pepsinogen producing more pepsin
molecules by autocatalysis.
217. Bile acid has a detergent action due to ?
a) Formation of soap

b) Formation of zwitter ion

c) Amphipathic nature of bile salts

d) Formation of medium chain triglycerides

Correct Answer - C
Ans. is c i.e., Amphipathic nature of bile acids
Bile-salts help in digestion of fat by emulsification of fat in small
intestine by detergent action of bile salts.
The detergent action of bile salts is due to their amphipathic
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property.
Emulsification increases the surface to volume ratio of the lipid
droplets facilitating the action of lipases.
Bile salts also help in formation of micelles.
Micellar formation solubilizes the digested fats and provides a
mechanism of their absorption into the enterocytes.
218. Digestion of disaccharides occurs at ?
a) Mouth

b) Stomach

c) Small intestine

d) Large intestine

Correct Answer - C
Ans. is 'c' i.e., Small intestine
Digestion of disaccharides (maltose, sucrose and lactose) occurs by
the enzymes present in brush border os small intestinal epithelial
cells. medpox.com
Maltase (a-glucosidase) breaks 1: 4 linkages in maltose and
maltotriose and releases glucose (two molecules of glucose from
maltose and three molecules of glucose from maltotriose).
Isomaltase (a-limit dextrinase) breaks 1 : 6 a linkages of alpha-limit
dextrin and releases glucose. Isomaltase dextrinase) is the only
enzyme that attacks 1 : 6a linkage.
Sucrose is hydrolysed into fructose and glucose by sucrase (an
enzyme present in brush border of intestinal epithelium). Lactose is
hydrolysed into galactose and glucose by lactase ((3-glucosidase).
Trehalase hydrolyzes trehelose (a 1:1 a - linked dimer of glucose)
into two glucose molecules. Trehalose is found in mushrooms.
219. Which of the following is passively
absorbed in gut ?
a) Glucose

b) Lipids

c) Fructose

d) Amino-acids

Correct Answer - B
Ans. is 'b' i.e., Lipids

medpox.com
220. Amount of gastric juice secreted per day
?
a) 500-1000 ml

b) 1000-1500 ml

c) 2000-2500 ml

d) 3000-3500 ml

Correct Answer - C
Ans. is 'c' i.e., 2000-2500 ml

medpox.com
221. Main enzyme involved in digestion of
fatty food?
a) Lingual lipase

b) Gastric lipase

c) Pancreatic lipase

d) Phospholipase

Correct Answer - C
Ans. is 'c' i.e., Pancreatic lipase
Ebner's glands on the dorsum of the tongue secrete lingual lipase
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and the stomach also secretes a lipase (gastric lipase).
However, they are of very little significance in fat digestion.
Fat digestion essentially begins in the duodenum with entry of
pancreatic and biliary secretions. o Pancreatic juice contains lipase
(pancreatic lipase), the most important enzyme for fat digestion.
The pancreatic lipase digests triglycerides (triacylglycerols) into free
fatty acids and 2-monoglycerides (2? m on ocylg lycerols).
Pancreatic lipase hydrolyzes 1-and 3-bonds of triglycerides with
relative sparing of 2-bonds, so the principal products of its action are
free fatty acids and 2-monoglycerides.
222. Effect of cholecystokinin on GIT ?
a) Increases gastric acid secretion

b) Increases small intestinal peristlasis

c) Increases gastric motility

d) Relaxes gall bladder

Correct Answer - B
Ans. is 'b' i.e., Increases small intestinal peristalsis

medpox.com
223. True about iron absorption are all, except
?
a) Major site of absorption is duodenum

b) Stored as Ferritin

c) Absorbed in ferrous form

d) Pancreatic secretions improves the absorption

Correct Answer - D
Ans. is 'd' i.e., Pancreatic secretions improves the absorption
Iron absorption
medpox.com
Iron is absorbed from upper small intestine mainly duodenum.
In diet iron occurs in two forms, haeme iron and inorganic (non-
haeme) iron.
Haem iron is better absorbed than inorganic iron, but the major
fraction of diet is inorganic iron.
Inorganic iron is mostly in ferric form; needs to be reduced to ferrous
form because iron is absorbed in ferrous form.
After absorption ferrous form is once again oxidized to ferric form
inside enterocytes.
A fraction of absorbed iron is rapidly delivered to plasma transferrin.
However, most of the iron is deposited in the enterocytes as ferritin,
some to be transferred more slowly to plasma transferrin, and some
to be lost when senescent mucosal cells (enterocytes) are sloughed
into the intestine.
Iron absorption is regulated according to the demand, e.g., when
there is iron deficiency, absorption increases.
This regulation is mediated by "iron metabolism regulatory
hormone", i.e., hepcidin that inhibit iron absorption.
When there is iron deficiency, concentration of hepacidin falls and
there is increase iron absorption.
Hepacidin also decreases release of iron from storage sites.
Transport and storage of iron
Iron is transported is blood in combination with a glycoprotein
transferrin.
Iron is transported into cells through attachment of transferrin to
specific membrane bound receptors.
Iron is stored as ferritin (major storage form) or haemosiderin.
Ferritin is a complex of iron and apoferritin (iron + apoferritin ferritin).
Iron is mainly stored in reticulo-endothelial cells
monocytes/macrophages of liver, spleen, bonemarrow.
It is also stored in hepatocytes (parenchymal cells of liver) and
myocytes of skeletal muscles. Note :
Iron is stored in ferritin in ferric form.

medpox.com
224. Iron absorption is increased by the following factor in diet:
a) Vitamin-C

b) Phytic acid

c) Fibre diet

d) Phosphates

Correct Answer - A
In a vegetarian diet, nonheme iron is absorbed very poorly because of the inhibitory action
of a variety of dietary components, particularly phosphates, phytates and high fibre content.
Ascorbic acid and meat facilitate the absorption of nonheme iron. Ascorbate forms
complexes with and/or reduces ferric to ferrous iron. Meat facilitates the absorption of iron
by stimulating production of gastric acid; other effects also may be involved. Either of these
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substances can increase availability several fold.

Ref: Kaushansky K., Kipps T.J. (2011). Chapter 37. Hematopoietic Agents: Growth Factors,
Minerals, and Vitamins. In B.C. Knollmann (Ed), Goodman & Gilman's The
Pharmacological Basis of Therapeutics, 12e.

225. Maximum water reabsorption in the
Gastrointestinal tract occurs in ?
a) Stomach

b) Jejunum

c) Ileum

d) Colon

Correct Answer - B
Ans. is 'b' i.e., Jejunum
Water absorption from GIT
medpox.com
Water and electrolytes need no digestion and are absorbed as such.
There is approximately 9 liters of water input : Ingested water : 2.0
litres, Saliva : 1.5 litres, gastric juice : 2.5 litres, bile 0.5 litre,
pancreatic juice : 1.5 litres, and small intestine secretions 1-0 litre.
Out of these 9 litres, 7.7 litres (85%) is absorbed in small intestine
and 1.0 - 1.5 litres (5-10%) is absorbed in large intestine (colon).
Total 8.8 litres of water is absorbed and 0.2 litre is excreted in feces.
In small intestine, most of the water is reabsorbed in the jejunum.
226. Gamma glutamate carboxypeptidase is
linked with absorption of ?
a) Riboflavin

b) Niacin

c) Folic acid

d) Pyridoxinel

Correct Answer - C
Ans. is 'c' i.e., Folic acid
Folic acid or pteroylglutamic acid is a parent compound for a group
of substances called folates.medpox.com
Naturally occurring folic acid typically occurs as
pteroylpolyglutamate, which is simple folic acid that has been
conjugated by gamma peptide linkage with six additional glutamyl
units.
These pteroylpolyglutamates are hydrolysed to
pteroylmonglutamates in the process of intestinal absorption.
The small intestinal mucosa contains gamma glutamate
carboxypeptidase, a hydrolytic enzyme usually known as folate
conjugase, with releases monglutamic folate, which is rapidly
absorbed from the upper small intestine. Thus gamma glutamate
carboxy peptidase is involved in the absorption of folic acid.
227. Migrating motor complex is due to which
GI hormone ?
a) Gastrin

b) Motilin

c) CCK

d) VIP

Correct Answer - B
Ans. is 'b' i.e., Motilin
Migratory motor complex (MMC)
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The gastric antrum shows bursts of propulsive (peristalitic) muscular
activity every 90 minutes. The activity is conducted along the entire
length of the small intestine, from stomach to distal ileum, at a rate
of about 5 cm per minute. As soon as the activity reaches the
terminal ileum, a new wave begins in the stomach. The purpose of
MMC is to clear the stomach and small intestine of luminal contents
in preparation for the next meal. The MMCs are initiated by motilin.
 228. Gastric acid secretion is stimulated by all
except-
a) Gastric distension

b) Gastrin

c) Smell of food

d) Somatostatin

Correct Answer - D
There are following phases of gastric acid secretion : ?
1. The cephalic phase :- Just as salivary secretion may start before
medpox.com
food enters the mouth, gastric secretion is also intitiated before food
enters the stomach. Sight, smell or even thought of food stimulate
gastric acid secretion. It is by parsympathetic system through vagus.
This phase accounts for 20% of acid secretion.
2. The gastric phase :- This phase of acid secretion comes into play
when food makes contact with the gastric mucosa. Acid secretion in
this phase is brought about two factors :- (i) Hormonal stimulation
due to gastrin release and (ii) Stretch of stomach wall due to gastric
distension which activates a vago-vagal reflex as well as a local
intragastric reflex. This phase accounts for 72-80% of acid secretion.
3. The intestinal phase :- Once the food enters upper portion of small
intestine (i.e., duodenum) it causes small amounts of gastric juice
secretion because of gastrin released from dudenal mucosa. While
the intestinal phase play only a minor role in stimulation of gastric
secretion, presence of food in the intestine plays a major role in its
inhibition. With the entry of food into the duodenum, gastric secretion
starts slowing down. The presence of acid, fats, and products of
protein digestion; and increased osmolarity in the duodenum inhibit
gastric secretion by :- (i) Hormonal mechanism : These mentioned
stimuli cause the release of several intestinal hormones like secretin,
cholecystokinin (CCK), vasoactive intestinal peptide (VIP), gastric
inhibitor polypeptide (GIP) and somatostatin. These local hormones
inhibit the gastric secretion as well as gastric motility. (ii) Neural
mechanism (enterogastric reflex) : The above mentioned stimuli
inhibit gastric secretion and motility by intrinsic neural reflex.

medpox.com
229. True about calcium reabsorption in the kidney?
a) Most of the calcium reabsorption occurs in DCT

b) Major regulating factor is Parathormone

c) Parathormone decreases calcium reabsorption

d) Increased plasma phosphate decreases calcium reabsorption

Correct Answer - B
Major regulating factor is parathormone.
The primary controller of renal tubular reabsorption is parathormone.
It increases calcium reabsorption in Loop of Henle (thick ascending
limb) and distal tubules. medpox.com
Most of the calcium (6590) is reabsorbed in PCT.
Increased plasma phosphate increases calcium reabsorption.
230. Correct formula is ?
a) GFR = Kf x 10

b) Kf = GFR x10

c) Kf = GFR x 125

d) GFR =Kf x 125

Correct Answer - A
Ans. A. GFR = Kf x 10
The GFR is determined by (l) the sum of the hydrostatic and colloid
osmotic forces across the glomerular membrane, which gives net
filtration pressure, and (2) the glomerular capillary filtration
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coefficient (Kr).
Mathematically, the GFR equals the product of Kf and the net
filtration pressure.
231. Fibrin is degraded by ?
a) Thrombin

b) Fibrin

c) Plasmin

d) None

Correct Answer - C

Coagulation must be balanced with fibrinolysis to limit the
hemostatic plug to the site of injury.
Injured vascular endothelium secret plasminogen activator that
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converts inactive plasminogen to active plasmin.
Plasmin breaks down fibrin resulting in production of fibrin
degradation products.
Fibrinolytic system is regulated by plasminogen activator inhibitors
(PAIs) that are secreted by endothelium.
232. Gene for Rh antigen is located on
chromosome ?
a) 1

b) 4

c) 9

d) 19

Correct Answer - A
Ans. is 'a' i.e., 1

medpox.com
233. Sirtuins are associated with ?
a) Memory

b) Metabolism

c) Vision

d) Olfaction

Correct Answer - B
Ans. is 'b' i.e., Metabolism
Sirtuins are a family of highly conserved NAD+ dependent
deacetylase 5 that act as cellular sensors to detect energy
availability and modulate metabolic process.
medpox.com
Two mammalian sirtuins are involved in controling metabolic
process : SIRT-1 (in nucleus) and SIRT-2 (in mitochondria).
They are activated by high NAD± levels (low cellular energy status).
They, then, deacetylate a variety of proteins causing induction of
catabolic processes and inhibition of anabolic processes.
SIRT-1 and SIRT-3 coordinately increase cellular energy stores and
ultimately maintain cellular energy homeostasis.
Genetic variant in SIRT-1 gene is associated lower risk of
cardiovascular mortality and with better cognitive functioning.
SIRT-1 variants are associated with decreased basal energy
expenditure and a lower lipid peroxidation rate. Therefore, it has
been proposed that genetic variation in SIRT-1 may determine the
response rates of individuales undergoing caloric restriction and
increased physical activity.
Genetic variants of SIRT-3 may be associated with increased
longevity (increased lifespan), but there is no evidence of such an
association.
234. Sirtuins are associated with ?
a) Antioxidant mechanism in body

b) Logetivity of life span

c) Regeneration of liver after partial resection

d) Carcinogenesis in human

Correct Answer - B
Ans. is 'b' i.e., Logetivity of life span

medpox.com
235. Normal uric acid level is ?
a) 1-2 mg/dl

b) 2-3 mg/dl

c) 3-6 mg/dl

d) 10-15

Correct Answer - C
Ans. is 'c' i.e., 3-6 mg/dl

medpox.com
236. Most diffusible ion across membrane -
a) Na+

b) K+

c) Cl​-

d) None

Correct Answer - C
Ans. is 'c' i.e., Cl?
Among the given options, Cl- has lowest permeability coefficient and
maximum permeability.
Permeability of membranemedpox.com
As the major middle portion of membrane (core of the membrane) is
formed by hydrophobic region of phospholipids, this portion is
impermeable to the usual water-soluble substances, such as ions,
glucose and urea. Conversely, fat-soluble substances, such as
oxygen, carbon dioxide, and alcohol, can penetrate this portion of
the membrane with ease.
The permeability coefficients of small molecules in the lipid bilayer
correlate with their solubilities in nonpolar (hydrophobic) region and
thus their permeability.
237. Dose-response curve in Hormesis ?
a) Straight line

b) Sigmoid

c) Inverted U or J shaped

d) Hyperbola

Correct Answer - C
Ans. is 'c' i.e., Inverted U or J shaped
Hormesis is a dose response phenomenon in which low doses have
stimulatory effect while high doses have inhibitory effect.
The dose response curve may be J-shaped or inverted U shapted,
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the latter being observed, for example, with the effect of chemotactic
peptides on neutrophil adhesion.
238. Beta-2 transferrin is found in ?
a) Blood

b) Urine

c) Tear

d) CSF

Correct Answer - D
Ans. is 'd' i.e., CSF
Beta-2 transferrin is an isoform of transferrin.
It is found in cerebrospinal fluid (CSF).
It is not found in other body fluids (blood, mucus, tear, saliva, urine).
medpox.com
Therefore, it is a specific marker for CSF and is used for diagnostic
of CSF leaks.
239. Which of the following is an example of
active transport?
a) Movement of water across cell membrane

b) Movement of oxygen across cell membrane

c) Co-transport of amino acids with sodium

d) None of the above

Correct Answer - C
Ans. is 'C' i.e., Co-transport of amino acids with Na+
Active transport of Na + and K + is one of the major energy-using
processes in the body. medpox.com
The active transport of Na + is coupled to the transport of other
substances (secondary active transport).
For example, the luminal membranes of mucosal cells in the small
intestine contain a symport that transports glucose into the cell only
if Na + binds to the protein and is transported into the cell at the
same time.
240. Life span of neonatal RBC ?
a) 60-90 days

b) 90-120 days

c) 120-150 days

d) 150-200 days

Correct Answer - A
Ans. is 'a' i.e., 60-90 days

medpox.com
241. Lifespan of fetal RBC is ?
a) Same as adult RBC

b) 1/4 of adult RBC

c) 1/2 of adult RBC

d) 2/3 of adult RBC

Correct Answer - D
Ans. is 'd' i.e., 2/3 of adult RBC
"Life span of fetal RBC is about 2/3' of the adult RBC, i.e. about 80
days."
medpox.com
242. Autophagic vacuoles fuse with ?
a) Golgi complex

b) ER

c) Lysosome

d) Mitocondria

Correct Answer - C
Ans. is 'c' i.e., Lysosome

medpox.com
243. Feed forward inhibition synapse seen in
a) Medulla

b) Cerebellum

c) Basal ganglia

d) Hypothalamus

Correct Answer - B
Ans. is `b' i.e., Cerebellum
Feed forward control system is employed during the regulation of
temperature.
In feed-forward inhibition, a neuron is connected through two
medpox.com
pathways one excitatory and one inhibitory.
For example, in cerebellum the stimulation of Basket cells produces
IPSPs (inhibitory postsynaptic potentials) in Purkinje cells.
However, the basket cells and the Purkinje cells are excited by the
same parallel-fiber excitatory input.
This arrangement is called feed-forward inhibition and helps to
prevent the duration of the excitation produced by any given afferent
impulse.
244. Motor protein in organ of corti ?
a) Kinesin

b) Albumin

c) Dynein

d) Myosin

Correct Answer - D
Ans. is d i.e., Myosin
The inner hair cells of organ of corti have 50-200 ciliated structure
called stereocilia.
The top of each stereocilium is linked to the side of next adjacent
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higher stereocilium by means of a thin filamentous strucuture called
the tip-link.
Mechanically gated ion channels are located at these attachment
points on the sides of stereocilia. Each stereocilium comprises of
several actin filaments encased by a plasma membrane.
The opening and closing of the ion channels is accomplished
through the binding and unbinding of proteins at terminal ends of the
tip links with a group of channel motor proteins (myosin) which move
up and down the actin filaments of stereocilia.
245. Type of collagen present in cornea ?
a) Type I

b) Type II

c) Type III

d) Type IV

Correct Answer - A
Ans. is 'a' i.e., Type I

medpox.com
246. Which of the following is present in
cornea ?
a) Hyaluronic acid

b) Chondroitin sulfate

c) Dermatan sulfate

d) Heparan sulfate

Correct Answer - B
Ans. is 'b' i.e., Chondroitin sulfate

medpox.com
247. True about gap junctions are all, except
?
a) Transmit electric signals

b) Allow ions to pass

c) Intercellular space 1000 nm

d) Seen in cardiac muscle

Correct Answer - C
Ans. is 'c' i.e., Intercellular space 1000 nm
Gap junctions are intercellular connections consist of a pair of
medpox.com
hemichannels (connexons) inserted into the membrane of adjacent
cells.
Each connexone is made of six identical protein subunits called
connexins which enclose a central channel.
When the corresponding connexons of adjacent cell link up end-to-
end, they form a continuous channel that permits substances to
pass through from cell to cell.
At gap junctions, the intercellular space narrows down to 3nm,
thereby helping in binding the cells together. o However, their real
physiological significance lies in allowing ions to flow through them,
i.e. they conduct ionic current.
This enables electrical excitation to spread from cell to cell, as in
smooth and cardiac muscles.
The pore size of gap junctions decreases when intracellular Ca' is
high or pH is low, both of which are commonly associated with cell
damage. Closure of gap junctions in response to these stimuli
isolates damaged cells so that the Ca+2 and 1-1+ do not spread from
the damaged to normal cells.
248. In starvation, earliest to become depleted
-
a) Carbohydrates

b) Proteins

c) Fats

d) None

Correct Answer - A
Ans. is 'a' i.e., Carbohydrates
Metabolic alteration during fasting-starvation
medpox.com
o he metabolic changes observed in fasting are generally opposite
to those described for absorptive (fed) state. In the absence of food,
plasma levels of glucose, amino acids, and TGs fall, triggering a
decline in insulin secretion and an increase in glucagon release.
This results in decreased insulin: glucagon ratio. Which is
responsible for most of the metabolic changes.
249. False about total body water (TBW) ?
a) ICF is 2/3rd of TBW

b) In newborn TBW is 60% of body weight

c) Premature newborns have more TBW

d) In adults, TBW is 60% of body weight

Correct Answer - B
Ans. is 'b' i.e., In newborn TBW is 60% of body weight
In a term newborn, TBW is 70-80% of body weight. It is more in
premature newborn than in term newborn.
Other options are correct. medpox.com
250. Which of the following equation is
correct regarding equilibrium potential
for diffusion ?
a) EMF = 25 CA/CB

b) EMF = 41 CA/CB

c) EMF = 61 CA/CB

d) EMF = 80 CA/CB

Correct Answer - C
Ans. C. EMF = 61 CA/CB medpox.com
When two ionic solution (ions) A and B of different concentration (Ca
and Cb) of an ion separated by a permeable membrane, the ions
tend to diffuse along their concentration gradient.
Since ions are charged particles their diffusion can be stopped by an
appropriate electrical potential (E) applied across the membrane.
The magnitude and polarity of the potential (equilibrium potential)
that must be applied to side A of the membrane for stopping the
diffusion of ions (Ea) is given by nernst equation, i.e., the equilibrium
potential for an ion is calculated by Nernst equation.
251. Which of following is a microfilament ?
a) Tubulin

b) Actin

c) Desmin

d) Vimentin

Correct Answer - B
Ans. is 'b' i.e., Actin

medpox.com
252. Which of the following is not an
intermediate filament?
a) Keratin

b) Desmin

c) Tubulin

d) Lamin

Correct Answer - C
Ans. is `c' i.e., Tubulin

medpox.com
253. All belong to molecular motor family
except ?
a) Kinesin

b) Dynein

c) Myosin

d) Actin

Correct Answer - D
Ans. is 'd' i.e., Actin
Molecular motors
medpox.com
Molecular motors are protein with ATPase or GTPase activity that
move organelles, proteins, and other components of cell to all parts
of the cells. These proteins produce force movement in wide variety
of cellular processes including vesicular transport, cell division,
nuclear migration, muscle contraction, mechanochemical
transduction and others. Molecular motors use energy to generate
this force (molecular motors are ATPase/ GTPase). Important
cytoskeletal molecular motors are :?
i) Kinesin (an ATPase) :- Involved in axoplasmic transport and uses
hydrolysis of ATP to move vesicles down the axon toward the
positive (+) end of microtubule formation.
ii) Dynein (an ATPase) :- It also uses ATP. there are two types of
dynein : ?
a) Cytosolic dynein :- Involved in axoplasmic flow to move vesicle in
opposite direction, i.e., towards the negative end of microtubules.
b) Axonemal dynein :- Power ciliary and flagellar movement.
iii) Dynamin (a GTPase) :- Uses GTP and is involved in endocytosis.
iv) Myosin (an ATPase) Uses ATP and is involved in muscle
contraction by binding with actin.
medpox.com
254. Electric potential of resting membrane
for a given electrolyte is given by which
equation ?
a) Nernst

b) Goldman

c) Donnan-Gibbs

d) None

Correct Answer - A
Ans. is 'a' i.e., Nernst medpox.com
255. Hemoglobin binds/transports all except ?
a) CO

b) O2

c) SO2

d) CO2

Correct Answer - C
Ans. is 'c' i.e., SO2

medpox.com
256. All are true about phosphorus except ?
a) Comprises 1 % of the total body weight

b) 85% remains in the bones

c) Diet is not a common source

d) Parathormone acts on NaPiIIc receptors

Correct Answer - D
Ans. is 'd' i.e., Parathormone acts on NaPilic receptors

medpox.com
257. Extrinsic system of coagulation is
activated by
a) Factor XI

b) Factor X

c) Factor XII

d) Factor III

Correct Answer - D
Ans. is d i.e., Factor III

medpox.com
258. Increased BMR is associated with ?
a) Increased body fat store

b) Increased glycognenesis

c) Increased glycolysis

d) Increased lipogenesis

Correct Answer - C
Ans. is 'c' i.e., Increased glycolysis
Increased BMR is associated with hypermetabolic state which is
characterized by :?
A) Carbohydrate metablism medpox.com
i) ↑ Glycolysis
ii) ↓ Gluconeogenesis
iii) ↓ Glycogenesis
iv) ↑ Glycogenolysis
B) Lipid metablism
i) ↓ Lipogenesis
ii) ↑ Lipolysis
iii) ↓ Cholesterol Synthesis
iv) ↓ Triacylglycerol Synthesis
v) ↓ Lipoprotein degradation
vi) ↑ Ketogenesis
C) Protein metablism
i) Increased protein degradation
ii) Decreased protein biosynthesis
259. Carbohydrate in ABO blood group
antigens is ?
a) Glucose

b) Fructose

c) Inulin

d) Maltose

Correct Answer - B
Ans.'b' Fructose
ABO antigens are glycoproteins, i.e. saccharides (carbohydrates)
linked with polypeptides. medpox.com
There are four main groups :
Blood group A: Containing A antigen
Blood group B : Containing B antigen
Blood group AB : Containing both 'A' and 'EV antigen
Blood group 0 : No ABO antigen
'A' and 'EV antigens are derived from H-antigen. H-antigen is formed
by adding fucose to terminal galactose of backbone strucuture. The
addition of N-acetyl-D-galactosamine or D-galactose to the
galactose residue of H-antigen confers 'A' or 'B' antigen,
respectively.
260. Factor X is ?
a) Hageman factor

b) Stuart-Prower factor

c) Christmas factor

d) Tissue factor

Correct Answer - B
Ans. is 'B' i.e., Stuart-Prower factor

medpox.com
261. Gamma globulin are synthesized in ?
a) Liver

b) Spleen

c) Kidney

d) Plasma cells

Correct Answer - D
Ans. is 'd' i.e., Plasma cells
Liver synthesizes most of the proteins of body except
immunoglobulins (gamma globulins), which are synthesized by
plasma cells. medpox.com
262. NO acts on platelets through ?
a) cAMP

b) Adenosine

c) cGMP

d) TX-A2

Correct Answer - C
Ans. is 'c' i.e., cGMP

medpox.com
263. Isoform of LDH in skeletal muscles ?
a) LDH-1

b) LDH-2

c) LDH-3

d) LDH-4

Correct Answer - D
Ans. is 'd' i.e., LDH-4
Skeletal muscles contain LDH-4 and LDH-5

medpox.com
264. Urease is a/an ?
a) Oxidoreductase

b) Lyase

c) Ligase

d) Hydrolase

Correct Answer - D
functionally, belong to the superfamily of amidohydrolases and
phosphotriesterases
Hydrolases --> All digestive enzymes (Pepsin,trypsin', Lipases,
esterases), lysosomal enzymes'urease'and phosphatase.
medpox.com
265. Transferases are classified as ?
a) EC-1

b) EC-2

c) EC-3

d) EC-4

Correct Answer - B
Ans. B. EC-2

medpox.com
266. True about acid phosphatase is ?
a) Acts at pH 8-9

b) Prostate isoform is tartarate resistant

c) Erythrocyte isoform is inhibited by cupric ions

d) All of the above

Correct Answer - C

Acid phosphatase
Acid phosphatase (ACP) hydrolyzes phosphoric acid esters at pH 5-
6. medpox.com
It is found in different isoforms in prostate, spleen, liver,
erythrocytes, platelets and bones.
Prostatic and erythrocyte isoform can be differentiated by ?
i) Prostatic isoform is inhibited by tartarate (tartarate sensitive),
whereas erythrocyte isoform is not.
ii) Erythrocyte isoform is inhibited by formaldehyde and cupric ions,
whereas prostatic isoform is not.
Acid phosphatase, particularly prostatic enzyme, is unstable at room
temperature above 37°C and at pH above 7.0 and more than 50% of
the acid phosphatase activity may be lost in 1 hour at room
temperature.
267. CO acts by inhibiting which component
of respiratory chain ?
a) Cytochrome b

b) Cytochrome C oxidase

c) NADH CoQ reductase

d) Oxidative phosphorylation

Correct Answer - B
Ans. 'B' Cytochrome C oxidase
Inhibitors of Electron transport chain (Respiratory chain)
medpox.com
Complex I:- Barbiturates (amobarbital), piericidin A, rotenone,
chlorpromazine, guanethidine.
Complex II:- Carboxin, TTFA, malonate.
Complex III:- Dimercaprol, BAL, actinomycin A, Naphthyloquinone.
Complex IV (cytochrome c oxidase) :- Carbon monoxide (CO),
cyanide (CN), H2S, azide (N3-)
268. NADH CoQ reductase is inhibited by ?
a) Rotenone

b) Carbonmonoxide

c) Antimycin

d) Atractyloside

Correct Answer - A

Rotenone inhibits complex I (NADH-CoQ reductase).
Inhibitors of electron transport chain?
Inhibitors of respiratory chain may be divided into three groups : ?
medpox.com
1) Inhibitors of electron transport chain proper
These inhibitors inhibit the flow of electrons through the respiratory
chain. This occurs at following sites.
i) Complex I (NADH to CoQ) is inhibited by : - Barbiturates
(amobarbital), Piericidin A (an antibiotic), rotenone (an insectiside),
chlorpromazine (a tranquilizer), and guanethidine (an
antihypertensive). These inhibitors block the transfer of reducing
equivalents from FeS protein to Coe.
ii) Complex II is inhibited by : - Carboxin and TTFA inhibit transfer of
electon from FADH2 to CoQ, whereas malanate competitively inhibit
from succinate to complex II.
iii) Complex III (Cytochrome b to cytochrome C1) is inhibited by : -
Dimercaprol, antimycin A, BAL (British antilewisite),
Naphthyloquinone. These inhibitors block the transfer of electrons
from cytochrome b to cytochrome CI.
iv) Complex IV (cytochrome C oxidase) is inhibited by : - Carbon
monoxide, CN–, H2S and azide (N3). These inhibitors block the
transfer of electrons from cytochrome aa3 to molecular oxygen and
therefore can totally arrest cellular respiration.
2) Inhibitors of oxidative phosphorylation
These compounds directly inhibit phosphorylation of ADP to ATP.
Oligomycin inhibits Fo component of Fo F1 ATPase. Atractiloside
inhibits translocase, a transport protein that transports ADP into
mitochondria for phosphorylation into ATP.
3) Uncouples
As the name suggests, these componds block the coupeling of
oxidation with phosphorylation. These compounds allow the transfer
of reducing equivalents in respiratory chain but prevent the
phosphorylation of ADP to ATP by uncoupling the linkage between
ETC and phosphorylation. Thus the energy instead of being trapped
by phosphorylation is dissipated as heat. Uncouplers may be :-
i) Natural :- Thermogenin, thyroxine
ii) Synthetic :- 2, 4-dinitrophenol (2, 4-DNP), 2, 4-dinitrocresol (2, 4-
DNC), and CCCP (chlorocarbonylcyanidephenyl hydrazone).

medpox.com
269. In oxidative pathway, NADPH is
produced in ?
a) Cytosol

b) Mitochondria

c) Ribosome

d) Peroxisomes

Correct Answer - A
Ans. is 'a' i.e., Cytosol
NADPH is produced mainly in HMP shunt, which occurs cytosol.
medpox.com
HMP is an alternative route for the oxidation of glucose (beside
glycolysis).
It is also called as "pentose phosphate pathway", "Dickens -
Horecker pathway", "Shunt pathway" or "phosphogluconate
oxidative pathway".
HMP shunt is required for provision of reduced NADPH and fiver-
carbon sugars e.g. ribose (Pentose phosphates) for nucleic acid
synthesis.
Normally, 90% of glucose is oxidized by glycolysis and 10% is
oxidized by HMP shunt.
However, in liver and RBCs HMP shunt accounts for oxidation of
30% glucose.
HMP shunt occurs in the cytosol.
It is highly active in liver, adipose tissue, adrenal cortex, lens,
cornea, lactating (but not the nonlactating) mammary gland. Gonads
(testis, ovary) and erythrocytes.
Activity of this pathway is minimal in muscle and brain, where almost
all of the glucose is degraded by glycolysis.
270. Role of molecular oxygen in ETC ?
a) Transfer of reducing equivalent to CoQ

b) Transfer of reducing equivalent from cytosol to mitochondria

c) To act as last electron acceptor

d) Generation of ATP

Correct Answer - C
Ans. is 'c' i.e., To act as last electron acceptor
Structural organizations of components of ETC
3 Components of respiratory chain do not function as discrete
carriers of reducing equivalent but are organized into four complexes
medpox.com
each of which acts as a specific oxidoreductase. Coenzyme Q and
cytochrome C are not parts of any complex and are not fixed in the
inner mitochondria! membrane. The other components are fixed in
the membrane. These components are arranged in order of
increasing redox potential. Therefore, reducing equivalents
(electrons) flow in one direction, I ---> II --> III --> IV, only because
redox couple with low redox potential is better electron donor where
as the one with high redox potential is electron acceptor. Thus,
reducing equivalents (electrons) flow through the chain from the
components of more negative redox potential to the components of
more positive redox potential.
i) Complex I (NADH - CoQ reductase) catalyzes the transfer of
electron from NADH to coenzyme Q (CoQ).
ii) Complex II (Succinate - CoQ reductase or succinate
dehydrogenase) transfers electrons from succinate to coenzyme Q.
iii) Complex III (CoQ - cytochrome C reductase), transfers electron
from CoQ to cytochrome C.
iv) Complex IV (cytochrome C oxidase) transfers electrons from
cytochrome C to 02.
cytochrome C to 02.

medpox.com
271. Which of the following is not true
regarding ETC?
a) Occurs in mitochondria

b) Generates ATP

c) No role of inorganic phosphate

d) Involves transport of reducing equivalent

Correct Answer - C
Ans. is 'c' i.e., No role of inorganic phosphate
Inorganic phosphate (Pi) is required in ETC to generate ATP.
medpox.com
ADP+pi --> ATP
ETC occurs in mitochondria and involves transfer of reducing
equivalent to generate ATP
272. Maximum energy is liberated by
hydrolysis of ?
a) Creatine phosphate

b) ATP

c) Phosphoenol pyruvate

d) Glucose-6-phosphate

Correct Answer - C
Ans . C. Phosphoenol pyruvate
A compound that liberates 7 Kcal/n:ol or more on hydrolysis is called
medpox.com
high energy compound, or a compound that on hydrolysis
undergoes a large (. 7 kcal/mol) decrease in free energy (AG) under
standard condition is called high energy compound, i.e., AG - 7
Kcal/mol.
273. Which of the following is an aldose
sugar?
a) Ribulose

b) Fructose

c) Glyceraldehyde

d) All of the above

Correct Answer - C
Ans. C. Glyceraldehyde
Number
of medpox.com
Sugar Aldoses Ketoses
carbon
Atoms
Trioses 3 Glyceraldehyde Dihydroxyacetone
Tetroses 4 Erythrose Erythrulose
Pentoses 5 Ribose,Xylose Ribulose,Xylulose
Hexoses 6 Glucose,Galactose,Mannose Fructose
Heptoses7 Glucoheptose Sdoheptulose







274.

medpox.com
Which of the enzyme of glycolysis is a part
ofgluconeogenesis ?
a) Pyruvate kinase

b) PFK

c) Hexokinase

d) Phosphoglycerate kinase

Correct Answer - D
Ans. is 'd' i.e., Phosphoglycerate kinase
Seven of the reactions of glycolysis are reversible and are used in
medpox.com
the synthesis of glucose by gluconeogenesis. Thus, seven enzymes
are common to both glycolysis and gluconeogenesis: (i)
Phosphohexose isomerase; (ii) Aldolase; (iii) Phosphotriose
isomerase, (iv) Glyceraldehyde 3-phosphate dehydrogenase; (v)
Phosphoglycerate kinase; (vi) Phosphoglycerate mutase; (vii)
Enolase.
Three reactions of glycolysis are irreversible which are circumvented
in gluconeogenesis by four reactions. So, enzymes at these steps
are different in glycolysis and gluconeogenesis.
Reactions Enzyme in glycolysis Enzyme
in gluconeogenesis
Glucose – Glucose-6-P Hexokinase/glucokinase
Glucose-6-phosphatase
Fructose-6-P – Fructose- I ,6-BP Phosphofructokinase
Fructose-1-6-bisphosphatase
Phosphoenolpyruvate – Pyruvate Pyruvate kinase
Pyruvate carboxylase PEP carboxykinase
275. Number of ATP produced by RBC when
Glycolysis occurs through Rapoport
Leubering pathway-
a) 2

b) 6

c) 8

d) 0

Correct Answer - D
Ans. 'D' 0 medpox.com
Net number of ATPs produced from 1 mol of Glucose by
Anaerobic Glycolysis- 2 ATPs
Aerobic Glycolysis - 7 ATPs
Aerobic oxidation- 32 ATPs
Rapaport-LeuberingCycle- Zero
276. Number of ATP molecules and NADH
formed in each cycle of glycolysis ?
a) 4 ATP, 2 NADH

b) 2 ATP, 2 NADH

c) 4 ATP, 4 NADH

d) 2 ATP, 4 NADH

Correct Answer - A
Ans. is 'a' i.e., 4 ATP, 2 NADH
Enegetics of glvcolysis
medpox.com
During glycolysis 2 ATP are utilized and 4 ATP are produced at
substrate level. 2 reducing equalents NADH' are produced and
reoxidized by electron transport chain, to generata 5 ATP molecules
(2.5 ATP per NADH' molecule). Thus total 9 ATP molecules are
produced and 2 are utilized, i.e., There is net gain of 7 ATP
molecules in aerobic glycolysis.
In anaerobic conditions, the reoxidation of NADH by electron
transport chain is prevented and NADH gets reoxidized by
conversion of pyruvate to lactate by lactate dehydrogenase. Thus, in
anaerobic glycolysis only 4 ATP are produced at substrate level.
Therefore, there is net gain of 2 ATP molecules in anaerobic
glycolysis.
Note : - Previous calculations were made assuming that NADH
produces 3 ATPs and FADH2 generates 2 ATPs. This will amount to
a net generation of 8ATPs per glucose molecule during glycolysis.
Recent experiments show that these old values are overestimates
and NADH produces 2.5 ATPs and FADH2 produces 1.5 ATPs.
Thus, net generation is only 7ATPs during glycolysis.
277. Which of the following enzyme does not
catalyzes irreversible step in glycolysis ?
a) Hexokinase

b) Phosphoglycerate kinase

c) Pyruvate kinase

d) Phosphofructokinase

Correct Answer - B
Ans. is 'b' i.e., Phosphoglycorate kinase
Glycolysis is regulated at 3 steps which are irreversible.
medpox.com
These reactions are catalyzed by following key enzymes :?
1) Hexokinase and glucokinase
2) Phosphofructokinase - I
3) Pyruvate kinase.
278. UDP glucose is not used in ?
a) Uronic acid pathway

b) Glycogen synthesis

c) Galactose metabolism

d) HMP shunt

Correct Answer - D
Ans. is 'd' i.e., HMP shunt
UDP-glucose is derived from glucose-6-phosphate via glucose-l-
phosphate.
The major fate of UDP-glucose is the synthesis of glycogen.
medpox.com
Other uses of UDP-glucose are -
1. In uronic acid (glucoronic acid) cycle to generate UDP
glucuronate.
2. Galactose metabolism
3. Glycosylation of proteins, lipids and proteoglycans.
279. Source of energy in Kreb's cycle is -
a) NAD

b) NADP

c) NADPH

d) NADH

Correct Answer - D
Ans.'D' NADH
Energetics of TCA cycles (Kreb's cycle)
Alpha-ketoglutarate is oxidatively decarboxylated to form succinyl
CoA by the enzyme alpha-ketoglutarate dehydrogenase.
medpox.com
The NADH thus generated enters into ETC to generate ATPs.
Another molecule of CO2 is removed in this step.
This is the irreversible step in the whole reaction cycle.
280. Number of ATP generated in one TCA
cycle ?
a) 2

b) 8

c) 10

d) 11

Correct Answer - C
Ans. is 'c' i.e., 10
In a single TCA cycle 10 molecules of ATP are produced (12
medpox.com
molecules according to older calculations).
One turn of the TCA cycle, starting with acetyl CoA produces 10
ATPs. When the starting molecule is pyruvate, the oxidative
decarboxylation of pyruvate, the oxidative decarboxylation of
pyruvate yields 2.5 ATPs and therefore, 12.5 ATPs are produced
when starting compound is pyruvate. Since, two molecules of
pyruvate enter the TCA cycle when glucose is metabolized
(glycolysis produces 2 molecules of pyruvate), the number of ATPs
is doubled. Therefore, 25 ATP molecules, per glucose molecule, are
produced when pyruvate enters the TCA cycle.
Note : Previously calculations were made assuming that NADH
produces 3 ATPs and FADH generates 2 ATPs. This will amount a
net generation of 30 ATP molecules in TCA per molecule glucose
and total 38 molecules from starting. Recent experiments show that
these values are overestimates and NADH produces 2.5 ATPs and
FADH produces 1.5 ATPs. Therefore, net generation during TCA is
25 ATPs and complete oxidation of glucose through glycolysis plus
citric acid cycle yield a net 32 ATPs.
Energy yield (number of ATP generated) per molecule of glucose
when it is completely oxidized through glycoly​sis plus citric acid
cycle, under aerobic conditions, is as follows :-

medpox.com
281. Coenzyme used in Kreb's cycle ?
a) NAD

b) NADP

c) NADPH

d) NADH

Correct Answer - A

Niacin is used as coenzyme nicotinamide adenine dinucleotide
(NAD') for transfer of hydrogen.
medpox.com
282. Total number of dehydrogenases Krebs
cycle ?
a) 3

b) 2

c) 4

d) 5

Correct Answer - C
Ans. is 'c' i.e., 4

medpox.com
283. In citric acid cycle, NADH is produced
by-
a) Succinate thiokinase

b) Succinate dehydrogenase

c) Isocitrate dehydrogenase

d) Fumarase

Correct Answer - C
Ans 'C' Fumarase
NADH is produced and CO2 is liberated at 3 steps :
medpox.com
i) Conversion of isocitrate to a-ketoglutarate by isocitrate
dehydrogenase
ii) Conversion of alpha-ketoglutarate to succinyl CoA by alpha-
ketoglutarate dehydrogenase
iii) Conversion of L-malate to oxaloacetate by malate
dehydrogenase.
284. Pyruvate dehydrogenase contains all,
except -
a) NAD

b) FAD

c) Biotin

d) CoA

Correct Answer - C

PDH complex is made up of three enzymes and requires five
coenzymes. medpox.com
The enzymes are :
i) E1 : Pyruvate dehydrogenase or pyruvate decarboxylase
ii) E2 : Dihydrolipoyl transacetylase
iii) E3 : Dihydrolipoyl dehydrogenase.
The coenzyme required are thiamine pyrophosphate (APP), lipoic
acid, FAD, NAD, and CoA.
285. Specific inhibitor of succinate
dehydrogenase?
a) Fluoroacetate

b) Arsenite

c) Malonate

d) Fluoride

Correct Answer - C
Ans. C. Malonate
Inhibition of the enzyme succinate dehydrogenase by malonate
medpox.com
illustrates competitive inhibition by a substrate analog.
Succinate dehydrogenase catalyzes the removal of one hydrogen
atom from each of the two methylene carbons of succinate.
 286. Which is not a common enzyme for
glycolysis and gluconeogenesis?
a) Aldolase

b) Glucose-6-phosphatase

c) Phosphoglycerate mutase

d) Phosphoglycerate kinase

Correct Answer - B
Seven of the reactions of glycolysis are reversible and are used in
the synthesis of glucose by gluconeogenesis.
medpox.com
Thus, seven enzymes are common to both glycolysis and
gluconeogenesis :
1. Phosphohexose isomerase;
2. Aldolase;
3. Phosphotriose isomerase,
4. Glyceraldehyde 3-phosphate dehydrogenase;
5. Phosphoglycerate kinase;
6. Phosphoglycerate mutase;
7. Enolase.
Three reactions of glycolysis are irreversible which are circumvented
in gluconeogenesis by four reactions. So, enzymes at these steps
are different in glycolysis and gluconeogenesis.
287. Which is not a step of gluconeogenesis?
a) Conversion of glucose-6-phosphate to glucose

b) Carboxylation of pyruvate

c) Conversion of oxaloacetate to phosphoenolpyruvate

d) Conversion of phosphoenolpyruvate to pyruvate

Correct Answer - D
Ans.' D' Conversion of phosphoenolpyruvate to pyruvate
Conversion of phosphoenolpyruvate to pyruvate is a step of
glycolysis (not of gluconeogenesis).
Reaction in gluconeogenesis medpox.com
Seven reactions of glycolysis are reversible and therefore are used
with the same enzyme in the synthesis of glucose by
gluconeogenesis. However, three of the reactions of glycolysis are
irreversible and must be circumvented by four special reactions that
are unique to gluconeogenesis and catalyzed by (I) Pyruvate
carboxylase, (ii) Phosphoenolpyruvate carboxykinase, iii) fructose-
I,6-bisphosphatase, (iv) Glucose-6-phosphatase.
All three irreversible steps of glycolysis should be bypassed for
gluconeogenesis to occur. These three bypass steps are
circumvented by four special reactions.
A) First bypass (conversion of pyruvate into phosphoenolpyruvate):-
Conversion of pyruvate into phosphoenolpyruvate takes
place through two reactions:?
i) Carboxylation of pyruvate: - First, pyruvate enters the mitochondria
and is converted into oxaloacetate by pyruvate carboxylase.
Pyruvate carboxylase is a mitochondrial enzyme, therefore this
reaction oc​curs in mitochondria only.
ii) Conversion of oxaloacetate to phosphoenolpyruvate:
- Oxaloacetate produced in the mitochondria cannot cross the
membrane. It is first reduced to malate, which then moves across
the mitochondrial membrane into the cytosol. Malate is, then,
reoxidized to oxaloacetate in the cytosol. Oxaloacetate is converted
to phosphoenolpyruvate by phosphoenolpyruvate (PEP)
carboxykinase.
B) Second bypass: - Conversion of fructose-1,6-bisphosphate into
fructose-6-phosphate is catalyzed by fructose-1,6-bisphosphatase.
Its presence determines whether tissue is capable of synthesizing
glucose (gluconeogenesis) or glycogen (gluconeogenesis) not only
from pyruvate but also from triose phosphate. It is present in the
liver, kidney, and skeletal muscle, but is probably absent from heart
and smooth muscle.
C) Third bypass: - Conversion of glucose-6-phosphate to glucose is
catalyzed by glucose-6-phosphatase.

medpox.com
288. Regulating enzymes in Gluconeogenesis
are all, except
a) Pyruvate carboxylase

b) PEP carboxykinase

c) PFK-1

d) Glucose-6-phosphatase

Correct Answer - C
Ans. is. C. PFK-1

medpox.com
289. Which of the following step is specific
for gluconeogenesis
a) Pyrovate to acetyl CoA

b) Oxaloacetate to citrate

c) Oxaloacetate to PEP

d) Oxaloacetate to PEP

Correct Answer - C
Ans. is 'c' i.e., Oxaloacetate to PEP

medpox.com
290. Tyrosine enters gluconeogenesis by
forming which substrate
a) Succinyl CoA

b) Alpha-ketoglutarate

c) Fumarate

d) Citrate

Correct Answer - C
Ans. 'C' Fumarate
TCA cycle intermediates are the substrate for gluconeogenesis.
medpox.com
Gluconeogenic amino acids enter the TCA cycle after their
transamination into various intermediates of the TCA cycle:?
Histidine, proline, glutamine and arginine are converted to glutamate
which is then transaminated to α-​ketoglutarate.
Isoleucine, methionine and valine enter by conversion into succinyl
CoA. Propionate (a short chain fatty acid) also enter at this level.
Tyrosine, and phenylalanine enter by conversion into fumarate.
Tryptophan is converted to alanine which is then transaminated to
pyruvate.
Hydroxyproline, serine, cysteine, threonine and glycine enter by
conversion into pyruvate.
291. Fumarate of TCA is derived from
transmination of which amino acid
a) Phenylalanine

b) Methionine

c) Valine

d) Glutamine

Correct Answer - A
Ans. is. A. Phenylalanine

medpox.com
292. Which of the following metabolic
pathway in carbohydrate metabolism is
required for synthesis of nucleic acids?
a) Gluconeogenesis

b) Glycolysis

c) HMP shunt

d) Glycogenesis

Correct Answer - C
Ans. 'C' HMP Shunt. medpox.com
HMP is an alternative route for the oxidation of glucose (beside
glycolysis). It is also called a "pentose phosphate pathway",
"Dickens - Horecker pathway", "Shunt
pathway" or "phosphogluconate oxidative pathway"
Metabolic Role of NADPH formed by HMP Shunt Pathway
1. Required for reductive biosyntheses, such as fatty acid,
cholesterol, and steroids.
2. Free radical scavenging
3. RBC membrane integrity
4. Prevention of formation of meth-hemoglobin
5. Detoxification
6. Preserving transparency of the lens of the eye
7. Bactericidal activity of macrophages
8. Production of ribose and deoxyribose for DNA and RNA
synthesis.
293. Type VI glycogen storage disease is due
to the deficiency of –
a) Muscle phosphorylase

b) Glucose-6-phosphatase

c) Liver phosphorylase

d) Branching enzyme

Correct Answer - C
Type VI glycogen is also called Her’s disease and it is caused by
enzyme defect liver phosphorylase.
medpox.com
Clinical features are hepatomegaly, accumulation of glycogen in the
liver and mild hypoglycemia.
294. Pyruvate can be a substrate for
a) Fatty acid synthesis

b) TCA cycle

c) Cholesterol synthesis

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
Pyruvate
a It is a degradation product of glucose (glycolysis) and glycogenic
aminoacids. It can be converted to glucose (gluconeogenesis
medpox.com
through oxaloacetate) and acetyl CoA (therefore all biosynthetic
products which arise from acetyl CoA)
295. Glucose is converted to sorbitol by ?
a) Aldolase B

b) Aldose reductase

c) Sorbitol dehydrogenase

d) All of these

Correct Answer - B
Ans. is 'b' i.e., Aldose reductase

medpox.com
296. Lactose intolerance is due to ?
a) Deficiency of Galactokinase

b) Deficiency of Uridyl transferase

c) Deficiency of Lactase

d) Deficiency of Enteropeptidase

Correct Answer - C
Ans. is 'c' i.e., Deficiency of Lactase
Lactose intolerance
It occurs due to deficiency of lactase, the most important member of
β-galactosidase enzymatic class.
medpox.com
Lactase hydrolyses lactose into glucose and galactose in the small
intestine.
Lactose is present in milk.
Therefore, deficiency of lactase, (β-galactosidase) results in
intolerance to milk and other dairy products.
Clinical features are bloating, diarrhea, failure to thrive, abdominal
distension and abdominal cramp.
297. Glucagon stimulates
a) Gluconeogenesis

b) Glycogenesis

c) Fatty acid synthesis

d) Glycolysis

Correct Answer - A
Ans. 'A' Gluconeogenesis.
Glucagon is a polypeptide hormone that is secreted by the A cells of
the islets of Langerhans of the pancreas. It acts by increasing cAMP.
1) Glucagon stimulates glycogenolysis in the liver but not in muscle.
medpox.com
Breakdown of glycogen yields glucose.
2) Glucagon stimulates the production of glucose from amino acids
(gluconeogenesis). Both glycogenolysis and gluconeogenesis tend
to raise plasma glucose levels.
3) Glucagon stimulates lipolysis. Breakdown of lipids yields free fatty
acids, which may be oxidized completely to carbon dioxide, or
incompletely to form ketone bodies.
298. Immediate energy supply for muscle
contraction ?
a) GTP

b) ATP

c) Creatine phosphate

d) Fatty acid

Correct Answer - C

The immediate source of energy for all muscle contraction is ATP,
medpox.com
followed immediately by creatine phosphate.
The immediate source of energy for all muscle contraction is ATP,
followed immediately by creatine phosphate.
In sternous exercise ATP store is sufficient only for 1-2 seconds and
creatine phosphate for another 5-7 seconds.
Thus, energy rich phosphagen stores (ATP and creatine phosphate)
permit severe muscle contraction for 8-10 seconds only.
After this, energy is obtained from the metabolism of stored
glycogen or from circulating glucose and free fatty acids, depending
upon the availability of oxygen.
Energy source during in exercise can be summarized by :-
i) Short burst of intense activity (e.g., 100 meter sprint or weight
lifting) :- All energy comes from ATP and creatine phosphate.
Breakdown of these compound is an anaerobic processes.
ii) Little longer intense exercise (e.g., 200 meter sprint or 100
meter swim) :- Besides ATP and creatine phosphate, glycogen is
metabolised by anerobic glycolytic pathways to provide a ready
source of energy. So, muscle work is anaerobic.
iii) Longer duration exercise (e.g., jogging, marathan run) : - The
muscle work is aerobic and energy comes from aerobic utilization
of glucose and free fatty acids. More glucose is utilized at the initial
stage, but as the exercise is prolonged, free fatty acids become the
predominant fuel.

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299. Main source of energy in 1 min is ?
a) Glycogen

b) FFA

c) Phosphates

d) Glucose

Correct Answer - A
Source of energy for muscular activity
The immediate source of energy for all muscle contractions is ATP,
followed immediately by creatine phosphate.
In strenuous exercise, the ATP store is sufficient only for 1-2
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seconds and creatine phosphate for another 5-7 seconds.
Thus, energy-rich phosphagen stores (ATP and creatine phosphate)
permit severe muscle contraction for 8-10 seconds only.
After this, energy is obtained from the metabolism of stored
glycogen or from circulating glucose and free fatty acids, depending
upon the availability of oxygen.
Energy source during in exercise can be summarized by : -
i) The short burst of intense activity (e.g., 100-meter sprint or weight
lifting) : - All energy comes from ATP and creatine phosphate. The
breakdown of these compounds is anaerobic processes.
ii) Little longer intense exercise (e.g., 200-meter sprint or 100-meter
swim):- Besides ATP and creatine phosphate, glycogen is
metabolized by anaerobic glycolytic pathways to provide a ready
source of en​ergy. So, muscle work is anaerobic.
iii) Longer duration exercise (e.g., jogging, marathon run): - The
muscle work is aerobic and energy comes from aerobic utilization of
glucose and free fatty acids. More glucose is utilized at the initial
stage, but as the exercise is prolonged, free fatty acids become the
predominant fuel.

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300. Which of the following is increased in
lipoprotein lipase deficiency?
a) VLDL

b) LDL

c) HDL

d) Chylomicrons

Correct Answer - D
Type 1 hyperlipoproteinemias
Lipoprotein fraction elevated- Chylomicrons
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Metabolic defect- Lipoprotein lipase or Apo CII deficiency.
Features- Eruptive xanthoma, hepatomegaly, Pain abdomen.
Management- Restriction of fat intake, supplementation with MCT
301. Major source of energy for brain in
fasting/ starvation ?
a) Glucose

b) Glycogen

c) Fatty acids

d) Ketone bodies

Correct Answer - D
There is no stored fuel in the brain, but it utilized 60% of total energy
under resting conditions.
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Glucose is virtually the sole fuel for the brain, except in prolonged
starving when ketone bodies are the major source.
Fatty acids do not serve as fuel for the brain, because they are
bound to albumin in plasma; hence cannot cross the blood-brain
barrier.
 302. Defect in type II hyperlipidemia
a) Apo-E

b) Lipoprotein lipase

c) LDL receptor

d) None

Correct Answer - C
Also called Familial hypercholesterolemia.
Type II A
(Primary familial hypercholesterolemia)
There is an elevation of LDL. Patients seldom survive in the second
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decade of life due to ischemic heart disease. The cause is the LDL
receptor defect.
Receptor deficiency in the liver and peripheral tissues will result in
the elevation of LDL levels in plasma, leading to
hypercholesterolemia. The LDL receptor defect may be due to the
following reasons:
1. LDL receptor deficiency.
2. Defective binding of B-100 to the receptor.
3. The receptor-LDL complex is not internalized.
Secondary type II hyperlipoproteinemia is seen in hypothyroidism,
diabetes mellitus, nephrotic syndrome, and cholestasis.
303. Rate limiting step in fatty acid synthesis
is ?
a) Production of acetyl CoA

b) Production of oxaloacetate

c) Production of malonyl-CoA

d) Production of citrate

Correct Answer - C
Production of malonyl-CoA is the initial and rate-limiting step in the
fatty acid synthesis.
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Acetyl-CoA needs to be converted to the activated form, which will
serve as the donor of carbon units to the growing fatty acid chain.
Malonyl-CoA, a 3-carbon compound is such an activated form. It is
produced by carboxylation of acetyl-CoA, a reaction catalyzed by
acetyl-CoA carboxylase.
Acetyl-CoA carboxylase requires biotin as a cofactor. The
reaction also requires HCO3- and ATP
The reaction takes place in two steps:
(i) Carboxylation of biotin involving HCO3 and ATP.
(ii) transfer of the carboxyl group to acetyl-CoA to form malonyl-CoA.
304. Which of the following is the rate limiting step in cholesterol synthesis?
a) HMG CoA synthase

b) HMG CoA reductase

c) Thiokinase

d) Mevalonate kinase

Correct Answer - B
Initially in cholesterol synthesis, two molecules of acetyl-CoA condense to form acetoacetyl-
CoA catalyzed by cytosolic thiolase.
Acetoacetyl-CoA condenses with a further molecule of acetyl-CoA catalyzed by HMG-CoA
synthase to form HMG-CoA, which is reduced to mevalonate by NADPH in a reaction
catalyzed by HMG-CoA reductase.
medpox.com
This last step is the principal regulatory step in the pathway of cholesterol synthesis and is
the site of action of the most effective class of cholesterol-lowering drugs, the statins, which
are HMG-CoA reductase inhibitors.

Ref: Botham K.M., Mayes P.A. (2011). Chapter 26. Cholesterol Synthesis, Transport, &
Excretion. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W.
Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.
305. Mineral required for cholesterol
biosynthesis ?
a) Fe

b) Mn

c) Mg

d) Cu

Correct Answer - C
Mg is required in stage 2 of cholesterol synthesis.
Biosynthesis (De Novo Synthesis) of cholesterol
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The liver is the major site for cholesterol biosynthesis. Some
cholesterol is also synthesized in the intestine adrenal cortex,
gonads and skin. The microsomal (smooth endoplasmic reticulum)
and cytosol fraction of cell are responsible for fir cholesterol
synthesis; However, most of the reactions in synthesis occur in the
cytosol.
Cholesterol is a C-27 compound. All 27-carbon atoms of cholesterol
are derived from a single precursor, i.e. acetyl-CoA (activated
acetate).
The first two molecules of acetyl-CoA condense to form acetoacetyl-
CoA. Next, the third molecule of acetyl- CoA condenses with
acetoacetyl-CoA to form 3-hydroxy-3-methylglutaryl-CoA (HMG-
CoA). Then HMG-CoA is converted to mevalonate by HMG-CoA
reductase, the key regulatory enzyme of cholesterol synthesis.
306. Lipoprotein involved in reverse
cholesterol transport?
a) LDL

b) VLDL

c) IDL

d) HDL

Correct Answer - D
The HDL particles are referred to as scavengers because their
primary role is to remove free (unesterified) cholesterol from the
extrahepatic tissues. medpox.com
HDL particles transport cholesterol from extrahepatic tissues to the
liver (i.e. reverse cholesterol transport) which is then excreted
through bile.
Reverse cholesterol transport
All nucleated cells in different tissues synthesize cholesterol, but the
excretion of cholesterol is mainly by the liver in the bile or by
enterocytes in the gut lumen. So, cholesterol must be transported
from peripheral tissue to the liver for excretion. This is facilitated by
HDL and is called reverse cholesterol transport because it transports
the cholesterol in reverse direction to that is transported from the
liver to peripheral tissues through the VLDL → LDL cycle.
Process
HDL is synthesized in the liver and small intestine. Nascent HDL
contains phospholipids and unesterified cholesterol and Apo-A, C, E.
This nascent HDL is secreted into circulation where it acquires
additional unesterified cholesterol from peripheral tissues. Within the
HDL particle, the cholesterol is esterified by lecithin - cholesterol
acetyltransferase (LCAT) to form cholesteryl ester and additional
lipid is transported to HDL from VLDL and chylomicrons. Apo-
A1 activates LCAT.

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307. Lipoprotein associated with carrying
cholesterol from peripheral tissues to
liver is ?
a) HDL

b) LDL

c) VLDL

d) IDL

Correct Answer - A
The total body cholesterol content varies from 130-150 grams.
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LDL (low-density lipoprotein) transports cholesterol from the liver to
the peripheral tissues and HDL (high-density lipoprotein) transports
cholesterol from tissues to the liver.
Cells of extrahepatic tissues take up cholesterol from LDL.
308. Enzyme deficient in gangliosidoses ?
a) β-glucuronidase

b) Iduronidase

c) β-galactosidase

d) Hyaluronidase

Correct Answer - C
Ans. 'C' β-galactosidase
Generalized gangliosidoses is a lipid storage disorder.
Enzyme defect- β-galactosidase
Lipid accumulates- Ganglioside (GM1)
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Clinical features- Mental retardation, hepatomegaly, skeletal
deformities. Foam cells in the bone marrow. Cherry red spot in the
retina.
309. Hunter syndrome is due to deficiency of
a) Beta galactosidase

b) Sphingomyelinase

c) Iduronate Sulfatase

d) Hyaluronidase

Correct Answer - C
Ans. is 'c' i.e., Iduronate Sulfatase

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310. Tay-Sach disease is due to deficiency of
a) Hexosaminidase A

b) Hexosaminidase B

c) Sphingomyelinase

d) α-galactosidase

Correct Answer - A
Ans. is. A. Hexosaminidase A

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311. Alcohol is metabolized by ?
a) Alcohol dehydrogenase

b) MEOS

c) Catalase

d) All of the above

Correct Answer - D

Ethyl alcohol (ethanol) is readily absorbed from GIT and degraded
by oxidation (oxidative process).
Liver is the major site for ethanol oxidation.
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At least three enzyme systems are capable of ethanol oxidation :-
i) Alcohol dehydrogenase (ADH) → Major pathway
ii) Microsomal ethanol oxidising system (MEOS) : It involves
cytochrome P450.
iii) Catalase of peroxisomes.
The product of all three oxidation pathways is acetaldehyde, which is
rapidly oxidized to acetate by aldehyde dehydrogenase (ALDH).
312. Oxidation of very long chain fatty acids
takes place in ?
a) Cytosol

b) Mitochondria

c) Ribosomes

d) Peroxisomes

Correct Answer - D
A modified form of β-oxidation is found in peroxisomes and leads to
the breakdown of very-long-chain fatty acids (eg, C20, C22) with the
formation of acetyl-CoA and H medpox.com
2O2, which is broken down by
catalase.
This system is not linked directly to phosphorylation and the
generation of ATP, and also does not attack shorter-chain fatty
acids.
The peroxisomal enzymes are induced by high-fat diets and in some
species by hypolipidemic drugs such as clofibrate.
Another role of peroxisomal β-oxidation is to shorten the side chain
of cholesterol in bile acid formation
313. which of the following occurs only in
mitochondria
a) ECT

b) Ketogenesis

c) Urea cycle

d) Steroid synthesis

Correct Answer - C
Ans. D. Urea Cycle
Ketogenesis occurs primarily in the mitochondria of liver cells.
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Fatty acids are brought into the mitochondria via carnitine
palmitoyltransferase (CPT-1) and then broken down into acetyl
CoA via beta-oxidation
In eukaryotes, an important electron transport chain is found in
the inner mitochondrial membrane where it serves as the site of
oxidative phosphorylation through the action of ATP synthase.
Mitochondria are essential sites for steroid hormone
biosynthesis. Mitochondria in the steroidogenic cells of the
adrenal, gonad, placenta and brain contain the cholesterol side-
chain cleavage enzyme, P450scc, and its two electron-transfer
partners, ferredoxin reductase and ferredoxin. This enzyme
system converts cholesterol to pregnenolone and determines
net steroidogenic capacity, so that it serves as the chronic
regulator of steroidogenesis.
urea is produced through a series of reactions occurring in
the cytosol and mitochondrial matrix of liver cells both
 314. Which of the following is not a
glycerosphingolipid?
a) Lecithin

b) Cardiolipin

c) Plasmalogens

d) Sphingomyelin

Correct Answer - D
Phospholipids are :
i. Glycerophospholipids (glycerol containing) :- Phosphatidylcholine
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(lecithin), phosphatidylethanolamine (cephaline), phosphatidylserine,
phosphatidylinositol, plasmalogens, lysophospholipids, cardiolipin.
ii. Sphingophospholipids (sphingosine containing) :- Sphingomyelin
315. Highest mobility on electrophoresis
a) HDL

b) VLDL

c) LDL

d) Chylomicrons

Correct Answer - A
As in lipoprotein electrophoresis, HDL shows the highest
mobility followed by VLDL, IDL, and LDL.
Chylomicrons migrate according to their net-charge
between HDL and VLDL because isotachophoresis has negligible
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molecular sieve effects.
316. In argininosuccinase deficiency, what
should be supplemented to continue the
urea cycle ?
a) Aspartate

b) Arginine

c) Citrullin

d) Argininosuccinate

Correct Answer - B
Argininosuccinase (argininosuccinate lyase) catalyzes the cleavage
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of argininosuccinate into arginine and fumarate. Thus, in
argininosuccinase deficiency, arginine cannot be produced.
Supplementation with arginine base helps replenish this amino acid.
317. Immediate precursor of creatine
a) Carbamoyl phosphate

b) Arginosuccinate

c) Guanidoacetate

d) Citrulline

Correct Answer - C
Ans. 'C' Guanidoacetate
Creatine and creatinine are not amino acids, but specialized
products of amino acids.
Creatine is synthesized from glycine, arginine, and methionine.
medpox.com
The synthesis starts with the formation of guanidinoacetate from
glycine and arginine in the kidney.
Further reactions take place in the liver and muscle.
318. Which one of the following can be a homologous substitution for isoleucine
in a protein sequence?

a) Methionine

b) Aspartic acid

c) Valine

d) Arginine

Correct Answer - C
Isoleucine is one of the aminoacid with an aliphatic side chain.
Other aminoacids with an aliphatic side chain is glycine, alanine, valine and leucine.
Among the options provided, valine is the only aminoacid with an aliphatic side chain and
so it can be a homologous substitution for isoleucine in a protein sequence.
Ref: Harper’s Illustrated Biochemistry, 26th Edition, Chapter 3, Page 15; Human Gene
medpox.com
Evolution By David N. Cooper, 1999, Page 299.
319. Bond involved in formation of primary
structure of protein/polypeptide ?
a) Hydrogen

b) Peptide

c) Disulfide

d) a and b both

Correct Answer - D
Ans: D. a and b both
The primary structure is stabilized by a peptide bond, which is a type
of covalent bond medpox.com
Bonds responsible for protein structure
Two types of bonds stabilize protein structure : -
Covalent (strong):- Peptide bonds, Disulfide bond.
Non-covalent (weak):- Hydrogen bond, hydrophobic interactions,
electrostatic (or ionic or salt) bond, Van der Waals interactions.
320. Urea is synthesized in all except
a) Liver

b) Brain

c) Kidney

d) Spleen

Correct Answer - D
Urea is synthesized in liver but small quantities (not significant) may
be formed in brain and kidney also.
Ammonia is ultimately disposed of by formation of urea by "Kreb's
Henseleit urea cycle" in the liver.
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Urea cycle takes place both in mitochondria and cytosol.
First two reactions of urea cycle occur in the mitochondria, and
remaining reactions occurs in cytosol
321. Rate limiting step in urea cycle is
catalyzed by ?
a) Arginase

b) Argininosuccinase

c) Carbamoyl-phosphate synthase

d) Ornithine transcarbamylase

Correct Answer - C
Ans. is 'c' i.e., Carbamoyl-phosphate synthase
Biosynthesis of urea occurs in five steps.
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1) Carbamoyl phosphate synthase-I (CPS-I), a mitochondria!
enzyme, catalyzes the formation of carbamoyl phosphate by
condensation of CO, and ammonia. Two molecules of ATP are
required for the reaction. CPS-I is the rate limiting enzyme of urea
cycle. It is an allosteric enzyme and allosterically activated by N-
acetyl glutamate.
There is one cytosolic carbamyl phosphate synthase-II (CPS-II)
which uses glutamine rather than ammonia as the nitrogen donor
and functions in pyrimidine synthesis.
2) Ornithine transcarbamoylase catalyzes the formation of citrulline
from carbamoyl phosphate and ornithine.
3) Arginosuccinate synthase catalyzes the formation of
arginosuccinate from citrulline and aspartate. This reaction requires I
ATP, but 2 high energy phosphate bonds are consumed as ATP is
converted to AMP + PPi. The amino group of aspartate provides one
of the two nitrogen atoms that appear in urea (The other one is
provided by ammonia NH4).
4) Arginosuccinate lyase (arginosuccinase) catalyses the cleavage
of arginosuccinate into arginine and fumarate. Fumarate enters in
TCA cycle.
TCA cycle.
5) Arginase catalyses the formation of urea from arginine by
hydrolytic cleavage of arginine to yield urea and ornithine. Ornithine
is thus regenerated and can enter mitochondria to initiate another
round of the urea cycle.

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322. Citrullinemia is due to deficiency of ?
a) Argininosuccinate lyase

b) Argininosuccinate synthase

c) Arginase

d) Ornithine transcarbamylase

Correct Answer - B
Ans. is. B. Argininosuccinate synthase

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323. Amino acid carrying ammonia from
muscle to liver?
a) Alanine

b) Glutamine

c) Arginine

d) Lysine

Correct Answer - A
Ans. is 'a' i.e., Alanine.
DISPOSAL/DETOXIFICATION OF AMMONIA
medpox.com
1. First line of Defense (Trapping of ammonia)
Being highly toxic, ammonia should be eliminated or detoxified, as
and when it is formed. Even very minute quantity of ammonia may
produce toxicity in central nervous system.
But, ammonia is always produced by almost all cells, including
neurons.
The intracellular ammonia is immediately trapped by glutamic acid to
form glutamine, especially in brain cells .
The glutamine is then transported to liver, where the reaction is
reversed by the enzyme glutaminase .
The ammonia thus generated is immediately detoxified into urea.
Aspartic acid may also undergo similar reaction to form asparagine .
2. Transportation of Ammonia
Inside the cells of almost all tissues, the transamination of amino
acids produce glutamic acid.
However, glutamate dehydrogenase is available only in the liver.
Therefore, the final deamination and production of ammonia is
taking place in the liver .
Thus, glutamic acid acts as the link between amino groups of amino
acids and ammonia.
The concentration of glutamic acid in blood is 10 times more than
other amino acids.
Glutamine is the transport forms of ammonia from brain and
intestine to liver; while alanine is the transport form from muscle.
3. Final disposal
The ammonia from all over the body thus reaches liver. It is then
detoxified to urea by liver cells, and then excreted through kidneys.
Urea is the end product of protein metabolism.

Transport of alanine from muscle to liver (glucose-alanine

cycle) has two functions :?
i) Providing substrate for gluconeogenesis
ii) Transport of ammonia (NH4-) to liver for urea synthesis.

medpox.com
324. Mousy odor of urine is seen in ?
a) Alkaptunuria

b) Phenylketonuria

c) Hartnup disease

d) Albinism

Correct Answer - B

medpox.com
325. Cabbage-like odour is seen in ?
a) Alkaptonuria

b) Phenylketonuria

c) Hartnup disease

d) Tyrosinemia

Correct Answer - D
Ans. is. D. Tyrosinemia

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326. If urine sample darkens on standing: the
most likely conditions is ?
a) Phenylketonuria

b) Alkaptonuria

c) Maple syrup disease

d) Tyrosinemia

Correct Answer - B
Ans. is 'b' i.e., Alkaptonuria
Alkaptonuria
medpox.com
It is due to deficiency of homogentisate oxidase. As a result
homogentisic acid (homogentisate) is excreted execessively in urine.
There arc three important characteristic features in alkaptonuria?
i) Urine becomes dark after being exposed to air. It is due
spontaneous oxidation of homogentisate into benzoquinone acetate,
which polymerse to form black-brown pigment alkapton which
imparts a characteristic black-brown colour to urine.
ii) Alkapton deposition occurs in sclera, ear, nose, cheeks and
intervertebral disc space. A condition called ochronosis. There may
be calcification of intervertebral discs.
iii) Onchronosis arthritis affecting shoulder, hips, knee.
Benedict's test is strongly positive in urine and so is the ferric
chloride (FeC1 3)test. Benedict's reagent gives a greenish brown
precipitate with brownish black supernatent. Fehling's reagent
(FeC13) gives blue green colour.
327. Derivative of POMC
a) Norepinephrine

b) Dopamine

c) ACTH

d) Acetylcholine

Correct Answer - C

Pro-opiomelanocortin (POMC) comprises 285 amino acid residues
(MW 31000) and serves as a precursor of many
proteins/polypeptide. medpox.com
Derivatives of POMC are:-
i) Pituitary hormones: ACTH, MSH
ii) β-lipotropic hormone (β-LPH)
iii) γ-lipotropic hormone (γ-LPH)
iv) β-endorphin
v) CLIP (corticotropin-like intermediate lobe peptide).
328. Cofactor for dopamine hydroxylase ?
a) Fe

b) Mg

c) Mn

d) Cu

Correct Answer - D
Dopamine 8-hydroxylase is a 'copper' containing monooxygenase
that requires ascorbic acid and molecular oxygen.
It catalyzes the formation of norepinephrine.
medpox.com
329. Not an essential amino acid ?
a) Arginine

b) Histidine

c) Glutamate

d) Lysine

Correct Answer - C
Ans 'C' Glutamate
Essential or Indispensable
The amino acids may further be classified according to their
essentiality for growth. They are
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Isoleucine
Leucine
Threonine
Lysine
Methionine
Phenylalanine
Tryptophan
Valine
330. Nicotinic acid is derived from ?
a) Glutamine

b) Tryptophan

c) Glutathione

d) Phenylalanine

Correct Answer - B
Ans. 'B' Tryptophan.
Nicotinic Acid Pathway of Tryptophan-
About 97% of molecules of tryptophan are metabolized in the major
pathway. About 3% of molecules are diverted at the level of 3-
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hydroxy anthranilic acid, to form NAD+.
The enzyme, QPRT (quinolinate phosphoribosyltransferase) is
the rate-limiting step.
About 60 mg of tryptophan will be equivalent to 1 mg of nicotinic
acid. The development of pellagra like symptoms in the maize eating
population is due to tryptophan deficiency in maize.
Hydroxy anthranilate production is dependent on pyridoxal
phosphate. Hence in vitamin B6 deficiency, nicotinamide deficiency
is also manifested.
331. Amino acids with extra NH (amino 2

group) in structure-
a) Aspartate

b) Glutamate

c) Histidine

d) Alanine

Correct Answer - C
Ans. is. C. Histidine
The amino acids will undergo alpha decarboxylation to form the
corresponding amine. medpox.com
Some important amines are produced from amino acids. For
example,
Histidine → Histamine + CO2
Tyrosine → Tyramine + CO2
Tryptophan → Tryptamine + CO2
Lysine → Cadaverine + CO2
Glutamic acid → Gamma-aminobutyric acid (GABA) + CO2
332. Neutral amino acid is ?
a) Aspartate

b) Arginine

c) Glycine

d) Histidine

Correct Answer - C
Ans. is 'c' i.e., Glycine
Neutral amino acids
Alanine Asparging
Cysteine Glycine Glutamine Isoleucine
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Leucine Methionine
Proline Phenylalanine
Serine
Threonine
Tyrosine Tryptophan
Valine
333. Which of the following amino acids is
purely ketogenic?
a) Phenylalanine

b) Leucine

c) Proline

d) Tyrosine

Correct Answer - B
Ans:B.)Leucine
Amino acids:
Ketogenic : medpox.com
Leucine, Lysine
Glucogenic:
Valine, Cysteine, Serine,Alanine, Histidine,Threonine, Arginine,
Glycine, Glutamate, Proline/Hydroxy proline
Both Glucogenic & Ketogenic :
Isoleucine, Tyrosine ,Tryptophan , Phenylalanine
334. Amino acid which is optically inert ?
a) Valine

b) Alanine

c) Glycine

d) Threonine

Correct Answer - C
Ans. 'C' Glycine
The a-carbon of amino acids has four different groups attached to it
and so is a chiral or asymmetric carbon.
Hence, there are two possible enantiomers, L and D, i.e., mirror
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image with reference to α-carbon.
The chiral carbon is also responsible for optical activity and
stereoisomerism.
The only exception is glycine, which is the simplest amino acid.
Glycine has no chiral carbon (chirality) because a-carbon of glycine
does not have four different groups attached to it.
Therefore glycine does not have optical activity or D and L forms
(enantiomers).
335. Alpha helix and Beta pleated sheet are
examples of?
a) Primary

b) Secondary structure

c) Tertiary

d) Quaternary structure

Correct Answer - B
Ans. 'B' Secondary structure
Structural organization of proteins
medpox.com
Every protein has a unique three -dimensional structure, which is
referred to as its native conformation and made up of only 20
different amino acids. Protein structure can be classified into four
levels of the organization.
1) Primary structures
The linear sequence of amino acid residues and the location of
disulfide bridges, if any, in a polypep​tide chain constitute its
primary structure. In simple words, the primary structure of
proteins refers to the specific sequence of amino acids. The
primary structure is maintained by the covalent 'peptide' bond.
2) Secondary structure
For stability of the primary structure, hydrogen bonding between the
hydrogen of NH and oxygen of C = 0 groups of the polypeptide
chain occurs, which gives rise to twisting, folding or bending of the
primary structure. Thus, regular folding and twisting of the
polypeptide chain brought about by hydrogen bonding is called
secondary structure. Important types of secondary structures
are a-helix, beta-pleated sheet, and beta-bends.
3) Tertiary structure
The peptide chain, with its secondary structure, maybe further folded
and twisted about itself forming three-dimensional arrangement of
the polypeptide chain, i.e., tertiary structure refers to the overall
folding pattern of a polypeptide which forms the three-dimensional
shape. The tertiary structure (three-dimensional shape) is
maintained by weak non-covalent interactions which
include hydrogen bonds, hydrophobic interactions, ionic bond
(electrostatic bonds or salt bridges) and Van-der wall
forces. Covalent linkage (disulfide bond) also plays some (but minor)
role.
4) Quaternary structure
Many proteins are made up of more than one polypeptide chain
(polymers). Each polypeptide chain is known as protomer (or
subunit). The subunit is linked with each other by non-covalent
bonds. The structure formed by the union of subunits is known as
quaternary structure, i.e., the spatial relation of subunits (peptide
chains) with one another is called the quaternary structure. Mainly
three non-covalent bonds stabilize quaternary
structure: Hydrophobic, hydrogen and ionic (electrostatic).
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Dimeric proteins contain two polypeptide chains. Homodimers
contain two copies of the same polypeptide chain, while in a
heterodimer the polypeptides differ.
336. Cystathionine lyase requires which
cofactor ?
a) Thiamine

b) Riboflavin

c) Pyridoxine

d) Niacin

Correct Answer - C
Ans. 'C' Pyridoxine
Hydrolytic cleavage (hydrolysis) of cystathionine forms Homoserine
plus cysteine. medpox.com
This reaction is catalyzed by the enzyme cystathionine lyase
(cystathionase), which requires cofactor pyridoxal phosphate (the
active form of pyridoxine).
337. Taurine is made from ?
a) Glycine

b) Tyrosine

c) Cysteine

d) Phenylalanine

Correct Answer - C
Ans. is 'c' i.e., Cysteine
Taurine is synthesized from cysteine.

medpox.com
338. If tyrosine level in blood is normal
without external supplementation,
deficiency of which of the following is
ruled out ?
a) Tryptophan

b) Phenylalanine

c) Histidine

d) Isoleucine

Correct Answer - B medpox.com

Ans. is 'b' i.e., Phenylalanine
Tyrosine is synthesized from phenylalanine.
In phenylalanine deficiency or in disorders in which phenylalanine
cannot be converted into tyrosine (phenylketonuria), tyrosine
becomes an essential amino acid and should be supplemented from
outside.
339. Nitrogen-9 of purine ring is provided by ?
a) Glycine

b) Aspartate

c) Glutamine

d) CO2

Correct Answer - C

In de novo synthesis, purine ring is formed from variety of precursors
is assembled on ribose-5-phosphate. Precursors for de novo
synthesis are - medpox.com
i) Glycine provides C4, C5 and N7
ii) Aspartate provides N1
iii) Glutamine provides N3 and N9
iv) Tetrahydrofolate derivatives furnish C2 and C8
v) Carbon dioxide provides C6
340. First product of purine metabolism
a) Uric acid

b) Xanthine

c) P-alanine

d) CO2

Correct Answer - B

Humans catabolize purines to uric acid.
But, first purines are catabolized to xanthine, which is further
catabolized to purine. medpox.com
341. Allantoin is the end product of
metabolism of ?
a) Glycogen

b) Purine

c) Pyrimidine

d) Histidine

Correct Answer - B

In non-primate mammals, end product of purine metabolism is
medpox.com
allantoin due to presence of enzyme uricase. Uricase convertes uric
acid to allantoin.
Humans lack the enzyme uricase. Therefore, end product of purine
catabolism in humans is uric acid.
342. First purine nucleotide, which is
synthesized in purine biosynthesis ?
a) AMP

b) GMP

c) IMP

d) UMP

Correct Answer - C

The biosynthesis of purine begins with ribose-5-phosphate, derived
medpox.com
from pentose phosphate pathway (PPP).
First intermediate formed in this pathway, 5-phosphoribosyl-
pyrophosphate (PRPP), is also an intermediate in purine salvage
pathway.
343. Salvage pathway of purine biosynthesis
is important for ?
a) Liver

b) RBCs

c) Kidney

d) Lung

Correct Answer - B

Purine nucleotide synthesis occurs by two pathways :
1.De novo synthesis medpox.com
2.Salvage pathway
Liver is the major site of purine nucleotide biosynthesis (de novo).
Certain tissues cannot synthesize purine nucleotides by de novo
patyway, e g. brain, erythrocytes and polymor​phonuclear leukocytes.
These are dependent on salvage pathway for synthesis of purine
nucleotides by using exogenous purines, which are formed by
degradation of purine nucleotides synthesized in liver.
344. Vitamin involved in decarboxylation ?
a) Biotin

b) Pyridoxine

c) Niacin

d) Thiamine

Correct Answer - B
Ans. is. B. Pyridoxine
Pyridoxal phosphate is a coenzyme for many enzymes involved in
amino 1309 acid metabolism, especially transamination and
decarboxylation. medpox.com
It is also the cofactor of glycogen phosphorylase, where the
phosphate group is catalytically important. In addition, it is important
in steroid hormone action.
Pyridoxal phosphate removes the hormone-receptor complex from
DNA binding, terminating the action of the hormones.
345. Vitamin C is required for ?
a) Posttranslational modification

b) Synthesis of epinephrine

c) Tyrosine metabolism

d) All of the above

Correct Answer - D

Vitamin C (ascorbic acid)
Ascorbic acid (Vitamin C) is also called antiscorbutic factor.
It is very heat labile, especially in basic medium.
medpox.com
Ascorbic acid itself is an active form.
Maximum amount of vitamin C is found in adrenal cortex.
Ascorbic acid functions as a reducing agent and scavanger of free
radicals (antioxidant). Its major functions are :-
i) In collagen synthesis :- Vitamin C is required for post-translational
modification by hydroxylation of proline and lysine residues
converting them into hydroxyproline and hydroxylysine. Thus vitamin
C is essential for the conversion of procollagen to collagen, which is
rich in hydroxyproline and hydroxylysine. Through collagen
synthesis, it plays a role in formation of matrix of bone, cartilage,
dentine and connec​tive tissue.
ii) Synthesis of norepinephrine from dopamine by dopamine-(3-
monoxygenase (dopamine-13-hydroxylase) requires Vitamin C.
iii) Carnitine synthesis
iv) Bile acid synthesis :- 7-a-hydroxylase requires vitamin C.
v) Absorption of iron is stimulated by ascorbic acid by conversion of
ferric to ferrous ions.
vi) During adrenal steroid synthesis, ascorbic acid is required during
hydroxylation reactions.
vii) Tyrosine metabolism - Oxidation of P-hydroxy-phenylpyruvate to
homogentisate.
viii) Folate metabolism - Folic acid is converted to its active form
tetrahydrofolate by help of Vitamin C.

medpox.com
346. Most important vitamin, which promotes
wound healing ?
a) Vitamin C

b) Vitamin D

c) Vitamin A

d) Niacin

Correct Answer - A

Vitamin C is required for collagen synthesis.
medpox.com
Due to its important role in collagen synthesis, vitamin C is required
for adequate wound healing.
347. Deficiency of which vitamin causes
excretion of xantheurenic acid in urine ?
a) Folic acid

b) Pyridoxin

c) Niacin

d) Vitamin B12

Correct Answer - B
Ans. is 'b' i.e., Pyridoxin

medpox.com
348. FIGLU excretion test is used for
assessment of deficiency of ?
a) Vitamin B12

b) Niacin

c) Folic acid

d) Pyridoxin

Correct Answer - C
Ans. is 'c' i.e., Folic acid
Assessment of folate deficiency
medpox.com
Following tests arc used for assessment of folate deficiency.
i) Blood level :- Normal level in serum is about 2-20 nanogram/ml
and about 200 micorgram/ml of packed cells.
ii) Histidine load test or FIGLU excretion test :- Histidine is normally
metabolized to formimino glutamic acid (FIGLU) from which
formimino group is removed by THF. Therefore in folate deficiency,
FIGLU excretion is increased in urine.
349. Not a component of PCR ?
a) Primer

b) Taq polymerase

c) DNA Polymerase

d) Restriction enzyme

Correct Answer - D

Steps in PCR
PCR uses DNA polymerase to repetitively amlify targeted portion of
DNA. Each cycle doubles the amout of DNA in the sample, leading
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to exponential increase with repeated cycles of amplification. Thus
amplification after 'n' number of cycle in (2)". Twenty cycles provide
an amplification of 106 (million) and 30 cycles of 109 (billion).
PCR occurs in following steps -
i) Isolation of target DNA sequence :-
ii) Primers construction:-
iii) Denaturation of DNA :-
iv) Annealing of primers to single stranded DNA :-
v) Chain extension:-
Thus following are required in PCR :- Target double stranded DNA,
two specific primers, a thermostable DNA polymerase (Taq
polymerase), deoxyribonucleotides (dNTP).
350. Which is not a step of PCR ?
a) Annealing

b) Extension

c) Transformation

d) Denaturation

Correct Answer - C
Ans. is 'c' i.e., Transformation [Ref Lippincott' s 5thle p. 479-83;
Harper 28th/e p. 395] Steps in PCR
Isolation of target DNA sequence→ Primer construction →
medpox.com
Denaturation of DNA→ Annealing of primers to single stranded
DNA→ Chain extension.
351. Northern blot is used to detect ?
a) Protein

b) Immunoglobulin

c) RNA

d) DNA

Correct Answer - C
Ans: C. RNA
Visualization of a specific DNA or RNA fragment among the many
thousand of contaminating molecules requires the convergence of
number of techniques collectively termed the blot transfer.
medpox.com
Southern blot → Detects DNA
Northern blot → Detects RNA
Western blot → Detects proteins (proteins are separated by
electrophoresis, renatured and analysed for an interaction by
hybridization with a specific labelled DNA probe).
352. Sex determining region is located on ?
a) Long arm of Y chromosome

b) Short arm of Y chromosome

c) Long arm of X chromosome

d) Short arm of X chromosome

Correct Answer - B
Product of SRY gene is sex-determining region Y protein.
This protein is involved in male sexual development.

medpox.com
353. Which of the following is a nucleoside?
a) Adenine

b) Uridine

c) Thymine

d) Guanine

Correct Answer - B
Ans. is. B. Uridine

medpox.com
354. RNA polymerase has which activity
a) Primase

b) Helicase

c) Ligase

d) Topoisomerase

Correct Answer - A
DNA synthesis cannot commence with deoxyribonucleotides
because DNA polymerase cannot add a mononucleotide to another
mononucleotide.
Thus, DNA polymerase cannot initiate synthesis of complementary
medpox.com
DNA synthesis strand of DNA on a totally single stranded template.
For this, they require RNA primer, which is a short piece of RNA
formed by enzyme primase (RNA polymerase) using DNA as a
template.
RNA primer is then extended by addition of deoxyribonucleotides.
Later on, the ribonucleotides of the primer are replaced by
deoxyribonucleotides.
Primase is actually a DNA primase which has RNA polymerase
activity. This DNA primase is also called DNA polymerase.
355. Number of structural gene in Lac operon
a) 3

b) 4

c) 5

d) 6

Correct Answer - A
Lactose operone or Lac operon
The lac operon is a region of DNA in the genome of E. coli that
contains following genetic elements ?
i) Three structural genes :- These code for 3 proteins that are
medpox.com
involved in catabolism of lactose. These genes are 'Z' gene (codes
for P-galactosidase), 'Y' gene (codes for galactoside permease), and
'A' gene (codes for thiogalactoside transacetylase).
ii) Regulatory gene (lac i) It produces repressor protein.
iii) A promotor site (P) :- It is the binding site for RNA polymerase. It
contains two specific regions ?
a) CAP site (Catabolite activator protein binding site).
b) RNA polymerase binding site
iv) An operator site (0) :- Repressor binds to this site and blocks
transcription.
3 Structural genes are expressed only when '0' site is empty
(repressor is not bound) and the CAP site is bound by a complex of
cAMP and CAP (catabolite gene activator protein).
356. The enzyme involved in initiation of
peptide chain synthesis-
a) Topoisomerase

b) Transformylase

c) RNA polymerase

d) Peptidyl transferase

Correct Answer - B
Ans. 'B' Transformylase
Steps in eukaryotic translation (protein synthesis)
medpox.com
There are three major steps, in protein synthesis (translation):- (i)
Initiation, (ii) Elongation; and (iii) Termination.
In prokaryotes and in mitochondria, the first amino acid methionine
is modified by formylation, i.e. the initiator tRNA carries an N-
formylated methionine. The formyl group is added by the enzyme
transformylase (formyl-transferase).
In Eukaryotes, the initiator tRNA carries a methionine that is not
formylated.
357. Most common physiological form of DNA
a) A-form

b) B-form

c) Z-form

d) C-form

Correct Answer - B
DNA can exist in at least six forms, i.e. A, B, C, D, E and Z.
The B-form of DNA is the most common form of DNA and is right-
handed helix.
It is the strandard DNA structure with 10 base pairs per turn.
medpox.com
Watson and Crick model describes the B-form of DNA.
Other forms of DNA are A-form (contains 11 base pairs per turn and
is right handed helix) and Z-form (contains 12 base pairs per turn
and is left handed helix).
Z-form is favored by alternating G-C sequences in alcohol and high
salt solution; and is inhibited by alternating A-T sequnces (Note-B
form has minimum base pairs per turn, i.e. 10).
358. Quarternary ammonium compound
disinfectants are ?
a) Anionic

b) Cationic

c) Neutral

d) Gases

Correct Answer - B

Quaternary ammonium compounds are cationic detergents.
medpox.com
They have microcidal and viricidal activities.
They can be used for instrument disinfection and skin antisepsis.
359. AST/ALT > 2 occurs in deficiency of
a) Glucose-6-phosphotase

b) Branching enzyme

c) Acid maltase

d) Liver phosphorylase

Correct Answer - C
Ans. is 'c' i.e., Acid maltase [Ref Read below]
In liver diseases, ALT (alanine transaminase) is elevated more than
AST (aspartate transaminase). So, in liver diseases ALT/ AST ratio
is elevated. medpox.com
But, when AST is higher than ALT, a muscle, source of these
enzymes should be considered.
Among the given options, only acid maltase deficiency (Pompe's
disease) is myopathic form of glycogen storage disease (muscular
glycogenosis). Thus, AST/ALT ratio may be more than 2.
Other three options are liver glycogenoses (AST/ALT < 1, as ALT is
raised more than AST).
360. Rate limiting step in heme synthesis is
catalyzed by ?
a) ALA dehydratase

b) ALA synthase

c) UPG decarboxylase

d) Ferrochelatase

Correct Answer - B
Ans. B. ALA synthase
Synthesis of heme
medpox.com
Heme synthesis takes place in all cells, but occurs to greatest extent
in bone marrow and liver.
The first step in the synthesis of heme is the condensation of glycine
and succinyl Co-A to form &-aminolevulinic acid (Delta-ALA), which
occurs in mitochondria.
This reaction is catalyzed by Delta-ALA synthase which requires
pyridoxal phosphate (PLP) as cofactor.
This is the rate limiting step in heme synthesis.
361. Rate limiting step in porphyrine
synthesis -
a) ALA dehydratase

b) ALA synthase

c) UPG decarboxylase

d) Ferrochelatase

Correct Answer - B
Ans. is. B. ALA synthase

medpox.com
362. Heme synthesis requires
a) Ferrous iron

b) Glycine

c) Succhyl CoA

d) All

Correct Answer - D

medpox.com
363. End product of porphyrin metabolism ?
a) Albumin

b) CO2 & NH2

c) Bilirubin

d) None

Correct Answer - C
Ans. is 'c' i.e., Bilirubin
Heme is the most important porphyrin.
It is degraded into bilirubin.
medpox.com
 364. Strongest interactions among the
following
a) Covalent

b) Hydrogen

c) Electrostatic

d) Van der Waals

Correct Answer - A
Ans. A. Covalent
Strongest bond → Covalent
medpox.com
Weakest bond → Van der wals forces
Moleucular interactions
There are two types of interactions between molecules that stabilize
molecular structures :-
1. Covalent bonds, e.g. peptide bonds and disulphide bonds.
2. Non-covalent bonds.
365. Which of the following is a
homopolysaccharide?
a) Heparin

b) Chitin

c) Hyaluronic acid

d) Chondroitin sulfate

Correct Answer - B
Ans. is 'b' i.e., Chitin
Polysaccharides are classified into ?
medpox.com
a) Homopolysaccharides (Homoglycans) :- This type of
polysaccharide is made up of several units of same monosaccharide
unit only. Examples are starch (multiple units of glucose), glycogen
(multiple units of glucose), cellulose (multiple units of glucose), Inulin
(multiple unit of fructose), Dextrin, Dextran (multiple units of
glucose), and chitin.
b) Heteropolysaccharides (Heteroglycans) :- This type of
polysaccharide contains two or more different types of
monosacharide units. Examples are heparin, heparan sulfate,
chondroitin sulfate, dermatan sulfate, hyaluronic acid, keratan
sulfate and blood group polysaccharides.
366. Proteins are separated on the basis of
charge in ?
a) SDS-PAGE

b) Ultracentrifugation

c) Affinity chromatography

d) HPLC

Correct Answer - D
Ans. is 'd' i.e., HPLC

medpox.com
367. Following is true regarding sulhydryl
groups except?
a) They are present in coenzyme A and lipoic acid

b) They are present in Captopril and penicillamine

c) They are not involved in reduction of peroxides

d) They are present in cysteine

Correct Answer - C
Ans. is 'c' i.e., They are not involved in reduction of peroxides
Sulfhydryl Group (or thiol group)
medpox.com
It is an SH group of organic compounds.
Sulfhydryl groups have great and varied reactivity. They oxidize
easily, with the formation of disulfides and
sulfenic, sulfinic, or sulfonic acids, and they readily undergo
alkylation, acylation, and thiol-disulfide exchange.
They form mercaptides upon reacting with the ions of heavy metals,
and they form mercaptals and mercaptols upon reacting with
aldehydes and ketones, respectively.
Sulfhydryl groups play an important role in biochemical processes.
The sulfhydryl groups of coenzyme A, lipoic acid, and 4'-
phosphopantotheine participate in enzymatic reactions for the
formation and transfer of acyl residues that are related to lipid and
carbohydrate metabolism.
The sulfhydryl groups of glutathione play an important role in the
neutralization of foreign organic compounds and the reduction of
peroxides; they are also of major importance in the fulfillment by
glutathione of its function as a coenzyme.
In proteins, residues of the amino acid cysteine have sulfhydryl
groups.
As components of the active centers of a number of enzymes,
sulfhydryl groups participate in the catalytic effect of the enzymes
and in the binding of substrates, coenzymes, and metal ions.
Drugs containing sulfhydryl groups are: captopril, zofenopril and
penicillamine.

medpox.com
368. Replacement of columnar epithelium in
respiratory tract to squamous epithelium
is ?
a) Hyperplasia

b) Hypoplasia

c) Metaplasia

d) None of the above

Correct Answer - C
Ans. is `c' i.e., Metaplasia medpox.com
Metaplasia
Metaplasia is a reversible change in which one differentiated cell
type is replaced by another differentiated cell type.
Metaplasia represents an adaptive substitution of cells that are
sensitive to stress by cell types better able to withstand the adverse
environment.
369. In apoptosis, protein hydrolysis is due to
activation of
a) lipases

b) Transcarboxylase

c) Catalase

d) Caspases

Correct Answer - D
Answer- D. Caspases
The execution phase of apoptosis
medpox.com
In this phase, initiate caspases (Caspase - 8 & 9) activate other
caspases known as execution Caspases (Caspases- 3 & 7). After
being activated the caspases act on many cellular components.
In the nucleus, the target of caspase activation includes proteins
involved in transcription, DNA replication, and DNA repair. Caspases
activate endonucleases (DNAases) that causes double-stranded
breaks in DNA.
370. Execution caspases of apoptosis are
a) Caspase 1 & 3

b) Caspase 3 & 5

c) Caspase 1 & 5

d) Caspase 3 & 7

Correct Answer - D
Answer- D. Caspase 3 & 7
Initiate caspasess → Caspase - 8 & 9.
Execution caspases → Caspase - 3 & 7.
Initiate caspases are activated in initiation phase of apoptosis.
medpox.com
371. Execution caspases of apoptosis are ?
a) Caspase 1 & 3

b) Caspase 3 & 5

c) Caspase 1 & 5

d) Caspase 3 & 7

Correct Answer - D
Ans. is 'd' i.e., Caspase 3 & 7

medpox.com
372. Annexin Visa marker of
a) Apoptosis

b) Necrosis

c) Artherosclerosis

d) Inflammation

Correct Answer - A
Ans. is 'a' i.e., Apoptosis
o Annexin V assays provides simple and effective method to detect
apoptosis at a very early stage.
o This assay makes advantage of the fact that phosphatidylserine
medpox.com
(PS) is translocated from the inner (cytoplasmic)
leaflet of the plasma membrane to the outer (cell surface) leaflet
soon after the induction of apoptosis and that the
annexin V protein has strong specific affinity for phosphatidyl serine.
o Phosphatidyl serine on the outer leaflet is available to bind labelled
annexin V providing the basis for a simple staining assay.
o All of the annexin proteins share the property of binding calcium
and phospholipids.
o Annexin V is a cause of syndrome called antiphospholipid antibody
syndrome.
o Annexin V normally forms a shield around certain phospholipid
molecules that blocks their entry into coagulation (clotting) reactions.
o In the antiphospholipid antibody syndrome; the formation of the
shield is disrupted by the abnormal antibodies. Without the shield,
there is an increased quantity of phospholipid molecules on cell
membranes speeding up coagulation reactions and causing the
abnormal blood clotting characteristic of antiphospholipid antibody
syndrome.
medpox.com
373. Lipid peroxidation of polyunsaturated
lipids of subcellular membranes
produces ?
a) Lipofuscin

b) Hemosiderin

c) Both of above

d) None of above

Correct Answer - A
Ans. is 'a' i.e., Lipofuscin medpox.com
Lipofuscin is an insoluble pigment, also known as lipochrome or
wear-and-tear pigment.
Lipofuscin is composed of polymers of lipids and phospholipids in
complex with protein, suggesting that it is derived through lipid
peroxi- dation of polyunsaturated lipids of subcellular membranes.
374. Hypertrophy is -
a) Increase in cell number

b) Increase in cell size

c) Decrease in cell number

d) Decrease in cell size

Correct Answer - B
Ans. is 'B' i.e., Increase in cell size
Hypertrophy
* Hypertrophy refers to an increase in the size of cells without
increase in the number, resulting in an increase in the size of tissue.
medpox.com
* Hypertrophy involves cell enlargement without cell division.
* So, hypertrophied organ has just larger cells, but no new cells (by
contrast, in hyperplasia there is increase in number of new cells
without increase in size).
* Nuclei in hypertrophied cells have a higher DNA content than in
normal cells because the cells arrest in the cell cycle without
undergoing mitosis.
* Myocardium (heart muscle) and skeletal muscle undergo
hypertrophy.
* The most common stimulus for hypertrophy is increased workload.
Mechanism of hypertrophy
* The increase in cell size is due to synthesis of more structural
proteins.
* The genes that are induced during hypertrophy include those
encoding transcription factors (C-fos, C-jun), growth factors (TGF-(3,
TGF- 1, FGF); and vasoactive agents (a-agonists, endothelin-1,
angiotensin II).
* There may also be a switch of contractile proteins from adult to
fetal or neonatal forms, e.g., during myocardial hypertrophy, the a-
myosin heavy chain is replaced by 13-form of the myosin heavy
chain, which leads to decrease myosine ATPase activity and a
slower, more energetically economical contraction.
* In addition, some genes that are expressed only in embryonic life
are re-expressed in hypertrophied myocardium, e.g., in the
embryonic heart, the gene for Atrial natriuratic peptide (ANP) is
expressed in both atrium and ventricle. After birth, ventricular
regulation of the gene is down regulated. Myocardial hypertrophy is
associated with reinduction of ANF gene expression. ANP induces
salt excretion by kidney L blood volume & pressure, decrease work
load.
Why do these changes occur ?
* As already explained, the most common stimulus for myocardial
hypertrophy is increased workload.
* All the above morphological changes that occur in hypertrophy
either increase muscle activity (to handle the increased workload) or
decrease the workload to heart.
medpox.com
375. Metastatic calcification is characterized
by ?
a) Hypercalcemia

b) Hypocalcemia

c) Eucalcemia

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Hypercalcemia
Pathologic calcifications
medpox.com
Dystrophic calcification: Deposition of calcium at sites of cell injury
and necrosis.
Metastatic calcification: Deposition of calcium in normal tissues,
caused by hypercalcemia (usually a consequence of parathyroid
hormone excess)
376. Calcification of soft tissues without any
distrubance of calcium metabolism is
called -
a) Ionotrophic calcification

b) Monotrophic calcification

c) Dystrophic calcification

d) Calcium induced calcification

Correct Answer - C
Ans. is 'c' i.e., Dystrophic calcification
medpox.com
377. Necrosis with cell bodies retained as
ghost cells is ?
a) Coagulative necrosis

b) Liquefactive

c) Caseous

d) None

Correct Answer - A
Ans. is 'a' i.e., Coagulative necrosis
The microscopic anatomy of coagulative necrosis shows a lighter
medpox.com
staining tissue containing no nuclei with very little structural damage,
giving the appearance often quoted as "Ghost cells" -> outlines of
cells are retained so that the cell type can still be identified but their
cytoplasmic and nuclear details are lost.
378. The Fenton reaction leads to free radical generation when:
a) Radiant energy is absorbed by water

b) Ferrous ions are converted to ferric ions

c) Nitric oxide is converted to peroxynitrite anion

d) Hydrogen peroxide is formed by, myeloperoxidase

Correct Answer - B
Fenton reaction involves the ferrous iron catalyzed conversion of hydrogen peroxide into a
hydroxide ion and a hydroxyl free radical with the concurrent oxidation of ferrous iron to
ferric iron.

Fenton reaction: H.J.H Fenton discovered in 1894 that several metals have a special
medpox.com
oxygen transfer properties which improve the use of hydrogen peroxide.
Actually, some metals have a strong catalytic power to generate highly reactive hydroxyl
radicals (.OH).
Since this discovery, the iron catalyzed hydrogen peroxide has been called Fenton's
reaction.
Hydrogen peroxide is converted to hydroxyl radicals in the Fenton reaction.

The iron can exist in a number of different oxdation states. Therefore the oxidation of fe2+
by h2o2 can proceed through a one electron transfer or a two electron transfer. Fentons
reaction is an inner sphere one electron transfer process. The h2o2 forms a complex
with fe2+ before electron transfer takes place. After addition of the iron and the hydrogen
peroxide, they are going to react together to generate some hydroxyl radicals as it shows in
the following equations:
Fe2+ + H2O2 ----> Fe3+ + .OH + OH-
Fe3+ + H2O2 ----> Fe2+ + .OOH + H+

Importance: Hydroxyl radicals are the most powerful of the reactive oxygen species.It is
capable of destroying any organic molecule.

Uses: Used to treat a large variety of water pollution such as phenols, formaldehyde,
BTEX, pesticides and rubber chemicals.

Ref: Free Radicals in Medicine, By Radu Olinescu, Dr. Terrance L. Smith, Page 28
medpox.com
 379. Which of the following is not a free
radical scavenger -
a) Glutathione peroxidase

b) Superoxide dismutase

c) Catalase

d) Xanthine oxidase

Correct Answer - D
Answer- D. Xanthine oxidase
Free radical scavgers (anti-oxidants) in body
medpox.com
1. Non - enzymatic → Vitamins E, A & C, glutathione, cysteine,
ceruloplasmin, transferrin, lactoforrin, ferritin.
2. Enzymes → Catalase, superoxide dismutase, glutathione
peroxidase
380. Enzyme that protects the brain from free
radical injury is -
a) Myeloperoxidase

b) Superoxide dismutase

c) MAO

d) Hydroxylase

Correct Answer - B
Ans. is 'b' i.e., Superoxide dismutase
Antioxidant mechanisms
medpox.com
Cells have multiple mechanisms to remove free radicals and thereby
minimizing injury.
Several nonenzymatic and enzymatic systems contribute to the
inactivation of free radical reactions.
A. Non-enzymatic system
o Antioxidants (Vit 'E', Vit A, Vit C, glutathione and Cysteine) block
the initiation of free radical formation and inactivate free radicals.
o Tissue proteins (transferrin, ferritin, lactoferrin, and ceruloplasmin).
As already explained, iron and copper can catalyze the formation of
free radicals, these transport and storage proteins decrease the
reactive free iron and copper, thereby minimizing the free radical
formation.
B. Enzymatic system
o A series of enzymes act as free radical-scavenging systems and
breakdown hydrogen peroxide and superoxide anion.
1. Catalase
o Present in peroxisomes and decomposes H202
2 H202__________ 02 + 2 H20
1. 2. Superoxide dismutase (SOD)
o Manganese - superoxide dismutase is present in mitochondria,
while copper-zinc-superoxide dismutase is found in the cytosol.
o It converts superoxide to H202
2 02- + 2 H SOD 2 H202+ 02
3. Glutathione peroxidase
o Present in mitochondria & cytosol. o It catalyzes free radical
breakdown.
H202+2 G S H __ GSSG+2H20
20H+ 2 G SH _ > GSSG+2H20
o The intracellular ratio of oxidized glutathione (G S S G) to
reduced glutathione (G S M) is a reflection of the oxidative state of
the cell.

medpox.com
381. Cellular swelling with blebs and myelin
figures are the changes seen in
a) Reversible cell injury

b) Irreversible cell injury

c) Metaplasia

d) Anaplasia

Correct Answer - A
Answer- A. Reversible cell injury
Pathological features of reversible cell injury are : Cellular swelling
medpox.com
(earliest); loss of microvilli; cytoplasmic membrane blebs; ER
swelling; Myeline figures; detachment of ribosome from ER;
cytoplasmic (lipid) vacuole; clumping of chromatin.
382. First change seen in acute inflammation
is:
September 2009
a) Increased permeability

b) Vasodilation

c) Neutrophil migration

d) Vasoconstriction

Correct Answer - D
Ans. D: Vasoconstriction medpox.com
Cardinal signs:
Rubor (redness) due to dilatation of arterioles
Calor (heat)
Dolor (pain) due to pressure on nerve endings by edema fluid and
chemical mediator bradykinine
Tumor (swelling) due to edema.
Functio laesa (loss of function) due to inhibition of movement by pain
and tissue necrosis.
383. Leukocyte adhesion to endothelium is
mediated by all except ?
a) L selectin

b) E selectin

c) VCAM 1

d) VCAM 4

Correct Answer - D
Ans. is 'd' i.e., VCAM 4
Endothelial molecule P-selectin
medpox.com
E-selectin ICAM- 1 VCAM-1 Glycam-1
CD 31 (PECAM)
 384. Endothelial molecule participating in
rolling is
a) CD 34

b) CD 65

c) CD 56

d) CD 100

Correct Answer - A
Answer- A. CD 34
Adhesion molecules involved in Rolling :
medpox.com
1. Endothelial molecules : P-selectin, E-selectin, GlyCam-1, CD-34.
2. Leucocyte molecules : Sialyl-Lewis X-modified protein, L-selectin.
385. Matrix metalloproteinases is ?
a) Cathepsin

b) Zn metalloproteinases

c) Cu metalloproteinases

d) Cd metalloproteinases

Correct Answer - A
Ans. is b i.e., Zn metalloproteinases
The outcome of the repair process of tissues is influenced by a
balance between synthesis and degradation of ECM proteins.
After its deposition, the connective tissue in the scar continues to be
medpox.com
modified and remodeled.
The degradation of collagens and other ECM components is
accomplished by a family of matrix metalloproteinases (MMPs), so
called because they are dependent on metal ions (e.g., zinc) for their
activity.
MMPs include interstitial collagenases, which cleave fibrillar collagen
(MMP-1, -2 and -3); gelatinases (MMP-2 and 9), which degrade
amorphous collagen and fibronectin; and stromelysins (MMP-3, -10,
and ,11), which degrade a variety of ECM constituents, including
proteo- glycans, laminin, fibronectin, and amorphous collagen.
386. What generates intracellular signals
when cells are subjected to shear
stress
a) Cadherins

b) Selectins

c) Integrins

d) Focal adhesion molecules

Correct Answer - D
Answer- D. Focal adhesion molecules
medpox.com
Focal adhesion complexes are large (>100 proteins)
macromolecular complexes that can be localized at
hemidesmosomes, and include proteins that can generate
intracellular signals when cells are subjected to increased shear
stress, such as endothelium in the bloodstream, or cardiac myocytes
in a failing heart.
387. True about wound healing with primary
intention is
a) By day 5 epidermis recovers its normal thickness

b) Intense inflammatory reaction

c) Wound contraction occurs

d) Abundant granulation tissue grows

Correct Answer - A
Answer- A. By day 5 epidermis recovers its normal thickness
Healing by primary intention
medpox.com
It occurs in wounds with opposed edges, e.g., surgical incision.
The healing process follows a series of sequential steps : -
Immediate after incision
Incisional space filled with blood containing fibrin and blood cells.
Dehydration of the surface clot forms scab that covers the wound.
Within 24 hours
Neutrophils appear at the margins of wound.
In 24-48 hours
Epithelial cells move from the wound edges along the cut margin of
dermis, depositing basement membrane components as they move.
They fuse in the midline beneath the surface scab, producing a
continuous but thin epithelium layer that closes the wound.
By day 3
Neutrophils are largely replaced by macrophages.
Granulation tissue progressively invades the incision space.
Collegen fibers now present in the margin but do not bridge the
incision.
By day 5
Incisional space is largely filled with granulation tissue.
Neovascularization is maximum.
Collegen fibrils become more abundant and begin to bridge the
incision.
The epidermis recovers its normal thickness.
During second week
Leukocytes and edema have disappeared.
There is continued accumulation of collegen and proliferation of
fibroblast.
By the end of first month
Scar is made up of a cellular connective tissue devoid of
inflammatory infiltrate covered now by intact epidermis.

medpox.com
388. The definition of exudate is
a) Extravascular fluid that has a high protein concentration and
contains cellular debris

b) Extravascular fluid that has a low protein concentration

c) Extravascular fluid with high glucose concentration

d) Extravascular fluid with low glucose concentration

Correct Answer - A
Answer- A. Extravascular fluid that has a high protein
concentration and contains cellular debris
Exudate is an inflammatory fluid that contains high protein content,
medpox.com
cellular debris, and specific gravity >1.020. It occurs due to
increased vascular permeability.
389. In tuberculosis the cytokine causing
fever is
a) ILI

b) IL2

c) IL3

d) IL4

Correct Answer - A
Answer- A. ILI
Pyrogenes
medpox.com
Pyrogenes are substances that cause fever.
Pyrogens may be exogenous or endogenous
Exogenous -4 Bacterial toxins
Endogenous → IL-1, TNF-a, IL-6, Interferons, Ciliory's neurotropic
factor
390. Which acute phase reactant induces
rouleaux formation
a) C reactive protein

b) Fibrinogen

c) Serum amyloid A

d) IL 1

Correct Answer - B
Answer- B. Fibrinogen
Fibrinogen binds to red cells and causes them to form stacks
medpox.com
(rouleatix) that sediment more rapidly at unit gravity than do
individual red cells.
391. Activation of naïve B lymphocytes by
protein an​tigens is?
a) T Cell independent

b) NK cell dependent

c) NK cell independent

d) T cell dependent

Correct Answer - D
Ans. is d i.e., T cell dependent
Upon activation, B lymphocytes proliferate and then differentiate into
medpox.com
plasma cells that secrete different classes of antibodies with distinct
functions.
Antibody responses to most protein antigens require T cell help and
are said to be T-dependent.
Many polysaccharide and lipid antigens cannot be recognized by T
cells but have multiple identical antigenic determinants (epitopes)
that are able to engage many antigen receptor molecules on each B
cell and initiate the process of B-cell activation; these responses are
said to be T-independent.
392. Mantoux test is based on which
hypersensitivity?
a) Type 1

b) Type 2

c) Type 3

d) Type 4

Correct Answer - D
Ans. is 'd' i.e., Type 4
Following are the examples of type 4 hypersensitivity reactions
:- medpox.com
Type 1 diabetes mellitus
Hashimoto thyroiditis
Crohn's disease
Multiple sclerosis
Contact dermatitis
Mantoux test
393. Atopy in hypersensitivity is ?
a) Systemic type I hypersensitivity

b) Local type I hypersensitivity

c) Systemic type II hypersensitivity

d) Local type II hypersensitivity

Correct Answer - B
Ans. is `b' i.e., Local type I hypersensitivity
Anaphylaxis -3 Acute, potentially fatal, systemic.
Atopy -›Chronic, Nonfatal, Localized.
medpox.com
394. Macrophage activation syndrome
characterized by all except ?
a) Activation of CD 8 + T cells

b) Presence of cytokine storm

c) It is the other name for hemophagocytic lymphohistiocytosis

d) Low levels of plasma ferretin

Correct Answer - D
Ans. is 'd' i.e., Low levels of plasma ferretin
Hemophagocytic Lymphohistiocytosis
medpox.com
Hemophagocytic lymphohistiocytosis (HLH) is a reactive condition
marked by cytopenias and signs and symp​toms of systemic
inflammation related to macrophage activation. For this reason, it is
also sometimes referred to as macrophage activation syndrome.
Pathogenesis
The common feature of all forms of HLH is systemic activation of
macrophages and CD8+ cytotoxic T cells.
The activated macrophages phagocytose blood cell progenitors in
the marrow and formed elements in the periph​eral tissues, while the
"stew"of mediators released from macrophages and lymphocytes
suppress hematopoiesis and produce symptoms of systemic
inflammation.
These effects lead to cytopenias and a shock-like picture,
sometimes referred to as "cytokine storm" or the systemic
inflammatory response syndrome.
Familial forms of HLH are associated with several different
mutations, all of which impact the ability of cytotoxic T cells and NK
to properly form or deploy cytotoxic granules.
The most common trigger for HLH is infection, particularly with
Epstein-Barr virus (EBV).
Clinical Features
Most patients present with an acute febrile illness associated with
splenomegaly and hepatomegaly.
Hemophagocytosis is usually seen on bone marrow examination,
but is neither sufficient nor required to make the diagnosis.
Laboratory studies typically reveal anemia, thrombocytopenia, and
very high levels of plasma ferritin and soluble IL-2 receptor, both
indicative of severe inflammation, as well as elevated liver function
tests and triglyceride levels, both related to hepatitis.
Coagulation studies may show evidence of disseminated
intravascular coagulation. If untreated, this picture can progress
rapidly to multiorgan failure, shock, and death.
Treatment
Involves the use of immunosuppressive drugs and "mild"
chemotherapy.
Patients with germline mutations that cause HLH or who have
persistent/resistant disease are candidates for hematopoietic stem
cell transplantation. medpox.com
Without treatment, the prognosis is grim, particularly in those with
familial forms of the disease, who typically survive for less than 2
months.
395. HLA associated with rheumatoid arthritis
is ?
a) HLA B27

b) HLA DR 4

c) HLABI9

d) HLA DR2

Correct Answer - B
Ans. is `b' i.e. HLA DR4
Associated with the development of Rheumatoid arthritis
• HLA - DR 4 medpox.com
• HLA - DR 10
• HLA - DR 9

Protects against the development of Rheumatoid arthritis

• HLA - DR 5
• HLA - DR 2
• HLA - DR 3
396. Which of the following interleukin is
secreted by T helper 2 cells?
a) IL 11

b) IL 7

c) IL 1

d) IL 13

Correct Answer - D
Ans. is 'd' i.e., IL 13
A) T helper - 1 (TF,') secretes 4 IL-2 and interferon - y
medpox.com
B) T helper - 2 (T02) secretes -> IL-4, IL-5, IL-6, IL-13
397. Interleukin 2 is produced by
a) T helper cells 1

b) T helper cells 2

c) Natural killer cells

d) Basophils

Correct Answer - A
Ans. is 'a' i.e., T helper cells 1
A) T helper - 1 (TF,') secretes 4 IL-2 and interferon - y
B) T helper - 2 (T02) secretes -> IL-4, IL-5, IL-6, IL-13
medpox.com
398. Non professional antigen presenting cell
is A/E ?
a) Endothelial cell

b) Epidermal cell

c) Fibroblasts

d) Red blood cells

Correct Answer - D
Ans. is 'd' i.e., Red blood cells
Non-professional antigenpresenting cell
medpox.com
A non-professional APC does not constitutively express the Major
Histocompatibility Complex class II (MHC class II) proteins required
for interaction with naive T cells; these are expressed only upon
stimulation of the non? professional APC by certain cytokines such
as IFN-y.
All nucleated cells express the Major Histocompatibility Complex
class I necessary to be considered a non​professional APC.
As erythrocytes do not have a nucleus, they are one of the few cells
in the body that cannot display antigens.
399. Large granular lymphocytes are ?
a) B cells

b) NK cells

c) T cell

d) Plasma cells

Correct Answer - B
Ans. is 'b' NK cells
Null cells (Large granular lymphocytes)
Null cells are called so because they lack features of surface
markers of both B and T lymphocytes.
medpox.com
The account for 5 to 10% of peripheral blood lymphocytes.
They are also called "large granular lymphocytes (LGL)" as they
contain large azurophilic cytoplasmic granules.
Members of this group are:
a) Antibody dependent cytotoxic cells (ADCC)
b) Natural killer cells (NK Cells)
400. NK cell shows presence of ?
a) CD 44

b) CD 16

c) CD 54

d) CD 32

Correct Answer - B
Ans. is 'b' i.e., CD 16
These cells possess cytotoxic activity against virus infected cells,
tumor cells and transplanted foreign cells.
Cytotoxicity of NK cells is neither antibody dependent nor MHC
medpox.com
restricted. Activity is nonimmune as it does not require antigenic
stimulation.
NK-cells are positive for CD16 and CD56.
NK cells are usually negative for CD3, but a subset is positive for
CD3 called NK/T-cells.
401. LE cell is seen in ?
a) Lupus erythmatosus

b) Lupus vulgaris

c) HNPCC

d) Medullary carcinoma of thyroid

Correct Answer - A
Ans. is 'a' i.e., Lupus erythematousus
In SLE, antinuclear antibodies (AN Ps) can not penetrate intact cells.
However, nuclei are exposed, ANA can bind to them.
In tissues, nuclei of damaged cells react with ANAs, lose their
medpox.com
chromatin pattern, and become homogeneous, to produce lupus -
erythematous (LE) bodies or hemotoxylin bodies.
When these LE bodies are engulfed by phagocytic cells (neutrophil
or macrophage/monocyte), the phagocytic cells are called LE cells.
402. Increased permeability in acute
inflammation is due to?
a) Histamine

b) IL-2

c) TGF-(3

d) FGF

Correct Answer - A
Ans. is 'a' i.e., Histamine
Formation of endothelial gaps in venules, i.e. immediate transient
medpox.com
response is the most common mechanism causing increased
vascular permeability in acute inflammation.
Mediators involved in this mechanism are :-
Immediate (more important) : Histamine, bradykinin, leukotrienes,
neuropeptide substance P.
Somewhat delayed: IL-1, TNF, IFN-y
403. Inceased accumulation of fluid in the
interstitial space is described as ?
a) Edema

b) Effusion

c) Transudate

d) Exudate

Correct Answer - A
Ans. is 'a' i.e., Edema
Edema: accumulation of fluid in the interstitial space
medpox.com
Effusion: accumulation of fluid in the body cavities
404. Hyperimmune IgE syndrome is also
called
a) Jobs syndrome

b) Wiscott Aldrich syndrome

c) Chediak-Higashi syndrome

d) Digeorge syndrome

Correct Answer - A
Answer- A. Jobs syndrome
Job's syndrome, also called Hyper-IgE syndrome or
medpox.com
Hyperimmunoglobulin E syndrome, is an autosomal dominant
disorder due to mutations in Signal Transducer and Activator of
Transcription-3 (STAT-3).
There is defect in phagocytosis. IgE levels are elevated. Other
immunoglobulins are normal.
405. Cells responsible for GVHD is ?
a) Immunocompetent T cell donor

b) Immunocompetent T Cell recipient

c) Immunocompetent B cell donor

d) Immunocompetent B cell donor

Correct Answer - A
Ans. is 'a' i.e., Immunocompetent T-cell donor
Graft- versus-host disease (GVHD) :?
GVHD occurs when immunologically competent cells (T cells) or
their precursors are transplanted into immunologically crippled
medpox.com
recipients, and the transferred cells recognize alloantigens in the
host and attack host tissues.
Most commonly involved tissues in Graft versus host disease :-
Liver
Skin
Gut
406. Leukocyte migration through
endothelium is induced by ?
a) Selectin

b) N CAM

c) C CAM

d) PECAM

Correct Answer - D
Ans. is 'd' i.e., PECAM
Migration of the leukocytes through the endothelium is called
medpox.com
transmigration or diapedesis.
Transmigration of leukocytes occurs mainly in postcapillaryvenules.
The molecules involved in transmigration are member of the
immunoglobulin superfamily called CD31 or PECAM-1 (platelet
endothelial cell adhesion molecule).
407. Complement CI synthesized from -
a) Liver

b) Macrophage

c) Intestinal epithelium

d) Endothelium

Correct Answer - C
Answer- C. Intestinal epithelium
CI is synthesized in intestine; C2 and C4 are synthesized by
macrophages; C5 and C8 are synthesized in spleen; and C3, C6
and C9 are synthesized in liver.
medpox.com
[Ref: Short textbook of medical microbiology by Satish Gupte p. 92]
408. RAST test is used in diagnosis of
a) Allergic dermatitis

b) Seborrhoeicdematitis

c) Mycosis fungoides

d) Squamous cell carcinoma

Correct Answer - A
Ans. is 'a' i.e., Allergic dermatitis
RAST : Radioallergosorbent assay
It is the method used to measure total as well as specific IgE against
a particular allergen or a complex.
medpox.com
Diagnostic tests in allergic contact dermatitis
Diagnostic Tests (if indicated)
Patch testing
Photopatch testing
Tests for immediate hypersensitivity
Radioallergosorbent assay test (RAST)
Open and semiopen patch tests (read at 10 and 45 minutes)
Prick test
Scratch-chamber test
Repeat open application "use" test
Potassium hydroxide examination to fungi, glass fibers
Fungal, bacterial, and viral smears and cultures
Skin biopsies
Dimethylglyoxime test for detecting nickel, other tests (detection of
chromates and formaldehyde)
Chemical analysis
409. Perform are produced by
a) NK cell

b) Cytotoxic T cell

c) Plasma cell

d) Monocyte

Correct Answer - A
Answer- A. NK cell
Perforins are hole forming proteins, cause transmembrane pores
through which cytotoxic factors enter the cell and destroy it by
apoptosis. medpox.com
Perforins are produced by:
N.K. Cells
[Ananthanarayan 126]
410. HLA B51 is associated with ?
a) Behcet's disease

b) Chrug strauss syndrome

c) Microscopic polyangitis

d) Polyarteritis nodosa

Correct Answer - A
Ans. is 'a' i.e., Behcet's disease
Behcet's disease :?
Behcet disease is a small- to medium-vessel neutrophilic vasculitis
that classically presents as a clinical triad of recurrent oral aphthous
medpox.com
ulcers, genital ulcers, and uveitis.
There can also be gastrointestinal and pulmonary manifestations,
with disease mortality related to severe neuro​logic involvement or
rupture of vascular aneurysms. There is an association with certain
HLA haplotypes (HLA​B51, in particular)
411. EBV receptor mimics ?
a) CD 20

b) CD 21

c) CD 22

d) CD 23

Correct Answer - B
Ans. is 'b' i.e., CD 21
CD 21 -> EBV receptor : Mature B cells and follicular dendritic cells.

medpox.com
412. Trauma to breast causes which type of
necrosis ?
a) Coagualtive necrosis

b) Liquefactive necrosis

c) Caseous necrosis

d) Fat necrosis

Correct Answer - D
Ans. is 'd' i.e., Fat necrosis
Fat necrosis
medpox.com
Fat necrosis may be of two types : ?
Enzymatic fat necrosis
This is due to action of lipase on adipose tissue.
It occurs most frequently in acute pancreatitis due to leakage of
lipase.
Depending on the severity of acute pancreatitis, fat necrosis may
occur in : - a Adipose tissue contiguous to pancrease,
retroperitoneal fat.
Adipose tissue in anterior mediastinum.
Bone marrow
Omental and abdominal fat
Nonenzymatic or Traumatic fat necrosis
Occurs due to trauma
Is seen in subcutaneous tissue of breast, thigh, and abdomen.
413. Most common cause of death in
amyloidosis is ?
a) Heart failure

b) Renal failure

c) Sepsis

d) None

Correct Answer - A
Ans. is 'a' i.e., Heart Failure
`Most common cause of death is heart failure and/or abnormal
medpox.com
cardiac rhythm' Essentials pathology
414. Fibrosis is due to ?
a) TGF-

b) TNF -

c) IL - 7

d) IL - 10

Correct Answer - A
Ans. is 'a' i.e., TGF- 13
"TFG-b is practically always involved as an important fibrogenic
agent" — Robbins
Mediaters involved in fibrosis :?medpox.com
i) Growth factors :- TGF-(3, PDGF, FGF
ii) Cytokines : IL-1, IL-4, TNF, IL-13
415. Most important growth factors in
angiogenesis ?
a) PDGF

b) TGF alpha

c) TGF beta

d) VEGF

Correct Answer - D
Ans. is 'd i.e., VEGF
Two most important angiogenic factors are :
medpox.com
i) Vascular endothelial growth factor (VEGF) —> most
important.
ii) Basic fibroblast growth factor (FGF-2).
416. Which is the best marker of SLE ?
a) Anti Sm antibodies

b) Anti dsDNA antibodies

c) Anti histone antibodies

d) Anti Ro Antibodies

Correct Answer - B
Ans. is 'b' i.e., Anti dsDNA antibodies
Antibodies to double - stranded DNA and the Smith (Sm) antigen are
virtually diagnostic of SLE".
medpox.com
417. Pendred syndrome due to mutation of ?
a) Bartillin

b) Pendrin

c) Fibrillin

d) Reticulin

Correct Answer - B
Ans. is `b' i.e., Pendrin
Pendred syndrome or Pendred disease :?
Pendred syndrome or Pendred disease is a genetic disorder leading
to congenital bilateral (both sides) senso​
medpox.comrineural hearing loss and
goitre with occasional hypothyroidism.
It has been linked to mutations in the PDSgene, which codes for the
pendrin protein (solute carrier family 26, member 4, SLC26A4). The
gene is located on the long arm of chromosome 7 (7q31). It is an
autosomal recessive disorder.
418. Inheritance pattern of myotonic
dystrophy is ?
a) Autosomal recessive

b) Autosomal dominant

c) X linked dominant

d) X linked recessive

Correct Answer - B
Ans. is `b' i.e., Autosomal dominant
Myotonic dystrophy
medpox.com
Myotonic dystrophy is an autosomal dominant multisys- tem disorder
associated with skeletal muscle weakness, cataracts,
endocrinopathy, and cardiomyopathy
 419. Neurofibromatosis shows which of the
following mode of inheritance ?
a) AD

b) AR

c) X linked dominant

d) X linked recessive

Correct Answer - A
Ans. is 'a' i.e., AD
Neurofibromatosis shows autosomal dominant inheritance
pattern medpox.com
Single gene disorders (Mendelian disorders) typically follow one of
the three patterns of inharitance ?
a. Autosomal dominance
b. Autosomal recessive
c. X-linked
Autosomal dominant disorders
Normally a gene pair has two alleles.
When one allele becomes abnormal due to mutation it is called
heterozygous state.
When both the alleles become abnormal due to mutation it is called
homozygous state.
Autosomal dominant disorders are manifested in heterozygous
state, i.e. only if one allel is abnormal the disease will be manifested.
420. The inheritance pattern of familial
Retinoblastomas is -
a) Autosomal recessive

b) Autosomal dominant

c) X-linked dominant

d) X-linked recessive

Correct Answer - B
Ans. is 'b' i.e., Autosomal dominant
Huntington disease
Neurofibro-matosis medpox.com
Myotonic dys-trohy
Tuberous scle-rosis
Retinoblastoma
421. Gene responsible for Wilson disease is
situated on which chromosome?
a) Chromosome 11

b) Chromosome 12

c) Chromosome 13

d) Chromosome 14

Correct Answer - C
Ans. is 'c' i.e., Chromosome 13
Wilson disease is an autosomal recessive disorder caused by
medpox.com
mutation of the ATP7B gene, resulting in impaired copper excretion
into bile & failure to incorporate copper into ceruloplasmin.
The ATP 7 B gene is located on chromosome 13.
422. Barr body is NOT seen in:
PGI 07; WB 08
a) Turner syndrome

b) Klinefelter syndrome

c) Down's syndrome

d) Marfan's syndrome

Correct Answer - A
Ans. Turner syndrome
Barr body (Sex - chromatin)
medpox.com
It is a densely staining inactivated condensed 'X' chromosome that is
present in each somatic cells of female. o It is found in the nucleus.
It is used as a test of genetic femaleness -4 it is possible to
determine the genetic sex of an individual according as to whether
there is a chromatin mass present on the inner surface of the
nuclear membrane of cells with resting or intermitent nuclei.
Remember following fact and the question will seem very easy.
Chromatid body (Barr body or sex chromatin) is derived from one of
the two X-chromosomes which becomes inactivated.
The numer of Barr bodies is thus one less than the number of X-
chromosomes.
423. Which of the following is not a hereditary
disease?
a) Neurofibromatosis

b) Cretinism

c) Huntingtons disease

d) Hereditary spherocytosis

Correct Answer - B
Ans. is 'b' i.e., Cretinism
Cretinism :?
medpox.com
Cretinism is a condition of severely stunted physical and mental
growth due to untreated congenital deficiency of thyroid hormones
(congenital hypothyroidism) usually due to maternal hypothyroidism.
Thus cretinism is a non hereditary condition.
424. Boys are more likely to be affected by
which genetic disorders ?
a) AD

b) AR

c) X linked dominant

d) X linked recessive

Correct Answer - D
Ans. is 'd' i.e., X linked recessive
X-linked disorders
medpox.com
Except for a few conditions, all X-linked disorders are X-linked
recessive.
As male has only one X-chromosome, the male with affected gene
on X-chromosome will always manifest the disease.
On the other hand, female has 2 X-chromosomes, heterozyogous
female will be carrier because of expression of normal allel on the
other X-chromosome.
So a boy has more probability to manifest X linked recessive as
compared to girls
425. Classic example of missense mutation ?
a) Thalassemia

b) Sickle cell disease

c) Sideroblastic anemia

d) Hemochromatosis

Correct Answer - B
Ans. is 'b' i.e., Sickle cell disease
In sickle cell anemia there is missense type of point mutation.
Mutations
A mutation is apermanant change in the DNA.
medpox.com
Mutations that affect genii cells (sperm or ovum) are transmitted to
progeny and may give rise to inherited disease.
Mutations that affect somatic cells arc not transmitted to progeny but
are important in the genesis of cancers and congenital
malformations.
Mutations may be classified into three categories ?
1. Gene mutations
The vast majority of mutations associated with hereditary disease
are gene mutations.
These may of different types depending whether it involves complete
gene or single base ?
(a) Point mutation
A single nucleotide base is subustituted by a different base.
When a pyrimidine base is subustituted by other pyrimidine base or
a purine base is substituted by other purine
Transition.
When a purine is substituded by a pyrimidine or vice-versa
Transversion.
This may alter the code in a triplet of bases, i.e. in codon and leads
to replacement of one aminoacid by another in the gene product.
Because these mutations alter the meaning of the genetic code, they
are often termed missense mutation.
Example is sickle mutation in which CTC codon in 13-chain of
hemoglobin that codes for glutamic acid is changed to CAC codon
that codes for valine.
Another type of point mutation is nonsense mutation in which a point
mutation may change an amino acid codon to a stop codon.
3 Example is 13-thalassemia in which CAG codon in I3-chain of
hemoglobin that code for glutamin is changed to stop codon UAG
after point mutation.
(b) Deletion and insertions
Deletion or insertion of one or two base lead to alterations in the
reading frame of the DNA strand —> frame shift mutation.
If the number of base pairs invoved is three or a multiple of three
framshift does not occur (because codon is triplet), instead an
abnormal protein missing one or more amino acids is synthesized.
(c) Trinucleotide repeat mutation
medpox.com
Normally a codon is triplet ie trinucleotide.
In this type of mutation a codon, ie trinucleotide sequence
undergoes amplification and the same codon is repeated
continuously so many times in the chain.
For example in fragile X-syndrome, CGG codon is repeated 250-
4000 times, ie. there are 250-4000 tandem repeates of CGG.
2.Chromosome mutation
Result from rearrangement of genetic material that give rise to
visible structural changes in the chromosome. 3.Genome mutation
Involves loss or gain of whole chromosome, e.g. monosomy - Turner
syndrome, trisomy - Down syndrome.
426. Rb gene is located on which
chromosome?
a) 6

b) 9

c) 13

d) 21

Correct Answer - C
Ans. is 'c' i.e.,13 [Ref Robbin's 9tVe p. 290]
Retinoblastoma gene (RB gene) is located on 14 band on the long
medpox.com
arm of chromosome 13 (13q14). RB gene is a tumor supressor
gene.
Retinoblastoma develops when both the normal alleles of the RB
genes are inactive or altered. It is typical example of Knudson's two
hit hypothesis.
427. Most common known causes of
congenital anamolies in humans are
a) Chromosomal aberrations

b) Maternal infections

c) Drugs

d) Irradiation

Correct Answer - A
Answer- A. Chromosomal aberrations
Genetic
medpox.com
Chromosomal aberrations- 10-15
Mendelian inheritance
Environmental
Maternal/placental infections- 2-3
Maternal disease states- 6-8
Drugs and chemicals- 1
Irradiations
Multifactorial 20-25
Unknown- 40-60
428. Which is not a feature of Downs
syndrome
a) Clinodactyly

b) Pigmented birth marks

c) Hypotonia

d) Respiratory tract Infections

Correct Answer - B
Ans. is 'b' i.e., Pigmented birth marks
Other clinical features include :?
medpox.com
1) General :- Mental retardation, short stature
2) Cranio-facial Brachycephaly, epicanthic fold,
protruding tongue, small ears, upward sloping palpebral fissures
(Mongoloid slant), strabismus, nystagmus, Brushfied spots in
iris.
3) Limbs :- Fifth finger clinodactyly, single palmar crease
(simian crease), wide gap between first and second toes (sandle
gap).
4) Congenital heart disease :- Common AV canal, ASD (most
common), VSD, PDA, fallot tetralogy.
5) GIT :- Anal atresia, Duodenal atresia, Hirschsprung
disease, annular pancreas.
6) Increased incidence of leukemia (1%). Leukemias common
are ALL (most common), AML (M7-AML) transient
myeloproliferative disorders, and Juvenil CML.
429. All of the following are true for Turners
syndrome ex​cept:
March 2012
a) Height is more than 145 cm

b) Webbing of neck

c) Increased carrying angle

d) Coarctation of aorta may be seen

Correct Answer - A
Ans: A i.e. Height is more than 145
medpox.com
Turner syndrome
Adult stature in Turner syndrome patients is less than 145 cm
Associated congenital defects are common in heart (coarctation of
aorta)
Lymphedema,
Short stature,
Webbed neck,
Low posterior hairline,
Cubitus valgus (increased carrying angle),
Finger deformities,
Short 4th metacarpal,
45 X0 karyotype
Down syndrome
MC trisomy,
Brachycephalic skull,
Hypotonia,
Palpebral fissure slopes upwards,
Marked epicanthic folds,
Brushfield's spots,
Increased nuchal fold thickness,
Iliac index less than 60,
Simian crease (single palmar crease),
MC associated cardiac lesions: VSD
Duodenal atresia, CML & transient myeloproliferative disorders are
seen
May be associated with Alzheimer's dementia,
MC cause of down syndrome: Maternal non-disjunction
Klinefelter syndrome
47 XXY
MC cause of hypergonadotrophic hypogonadism,
Subnormal intelligence
Fragile X syndrome
Large forehead,
Large head,
Macro-orchidism,
Moderately to severely retarded
medpox.com
430. Diagnose the disorder by looking at the
karyotype shown in the picture below?

a) Down's syndrome.

b) Patau syndrome.

c) Turner syndrome.
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d) Klinefelter's syndrome.

Correct Answer - C
Turner's syndrome
Turner's syndrome is the most common sex chromosomal disorder
in phenotypic females.
Turner's syndrome results from complete or partial loss of one
X chromosome (45, X) and is characterised by hypogonadism
in phenotypic females
Features of Turner syndrome in children :?
The most severely affected patients generally present during infancy
with edema (owing to lymph stasis) of the dorsum of the hand and
foot and sometimes swelling of the nape f the neck.
Swelling of the neck is related to markedly distended lymphatic
channels, producing so called cystic hygroma.
As these infants develop, the swelling subsides but often leave
bilateral neck webbing and persistent looseness of skin on the back
of the neck.
Congenital heart disease is also common, particularly preductal
coarctation of Aorta and bicuspid Aortic valve.
C. VS abnormalities are most important cause of mortality in children
with Turner 's syndrome.
Features of Turner's syndrome in Adolescents and Adult:-
At puberty there is failure to develop normal secondary sex
characteristics.
The genitalia remains infantile, breast development
is inadequate and there is little pubic hair. Nipples are
widely spaced.
Turner syndrome is the single most important cause of primary
amenorrhoea accounting for approximately 1/3 of the cases.
Short stature (height rarely exceeds 150 cm).
The mental status of these patients is usually normal but subtle
defects in nonverbal, visual spatial information processing have
been noted (mental retardation is associated with the presence of
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extra chromosome not with loss of X chromosome).
About 50% of the patients develop autoantibodies directed to
the thyroid gland and upto one half of these patients
develop hypothyroidism.
Other features include low posterior hairline, webbing of neck,
cubitus valgus, streak ovaries. o Glucose intolerance, obesity and
insulin resistance are also seen.
431. Normal upper limit of CA - 125 is ?
a) 25 U/ ml

b) 45 U/ ml

c) 65 U/ ml

d) 85 U/ ml

Correct Answer - A
Ans. is `a' i.e., 25 U/ ml
The normal value is less than 35 U/mL
1) Carcinoembryonic antigen (CEA)
It is a glycoprotein produced by fetal gut, pancreas and liver.
medpox.com
It is used as tumor marker for colorectal cancer (major use), lung
cancer, breast cancer and ovarian cancer. It is also increased in
non-neoplastic conditions like alcoholic cirrhosis, hepatitis, IBD (CD,
UC), smoking and pancreatitis.
In colorectal cancer it is used for screening; response and follow up
after surgery (CEA should diseapper in 6 weeks after resection),
prognosis (higher levels suggests high tumor burden) and to see
recurrence on follow up. CEA antigen has no correlation with hepatic
metastasis.
CEA lacks sensitivity as well as specificity, hence cannot be used to
confirm the diagnosis.
2) Alpha-feto protein (AFP)
It is a glycoprotein synthesized normally early in fetal life by yolk sac,
fetal liver and fetal GIT. It is structurally and genetically related to
albumin.
AFP is raised in liver cancer (hepatocellular carcinoma), lung
carcinoma, pancreatic carcinoma, colon carcinoma, and non-
seminoma germ cell tumor of testis/ovary (yolk sac
 tumor/endodermal sinus tumor, embryonal carcinoma, teratoma).
AFP is also raised in some non-neoplastic conditions like cirrhosis,
hepatitis, and pregnancy.
3) Human chorionic gonadotropin (HCG)
It is a placental hormone synthesized by syncytiotrophoblasts. It is
glycoprotein with two subunits (dimer) : a-subunit and /3-subunit. But
only the P subunit of HCG is typically measured as a tumour marker
because of specificity of the 13 subunit. The i3 subunit of HCG has
unique sequences that are not shared with other human glycoprotein
hormones.
It is detected by radioimmunoassay using antibodies to the 13 chain.
a-HCG is not used as tumour marker because a unit of the FSH, LH
and TSH are identical. So there can be cross reactivity between a
subunits of these hormone. That is why in case of testicular tumours
the patients also undergo simultaneous assay of LH to be certain
that the marker detected is 13 HCG.
HCG (13-HCG) is raised in gestational trophoblastic disease
(hydatidiform moles), gonadal germ cell tumor (embryonal
carcinoma, choriocarcinoma), and pregnancy.
medpox.com
4) CA-125
Most important cancer with elevated CA-125 is epithelial ovarian
cancer. CA-125 is also elevated in cancers of endometrium, cervix,
fallopian tubes, pancreas, breast, lung and colon.
Non-neoplastic conditions causing elevation of CA-125 are
pregnancy, mensturation, endometriosis, PID, abdominal TB,
peritonitis and uterine fibroid.
Tumor markers for testicular/ovarian tumor
1. AFP (alpha-feto protein) : Teratoma, Yolk sac tumor (endodermal
sinus tumor), embryonal carcinoma.
2. HCG (human chorionic gonadotrophin): Choriocarcinoma,
embryonal carcinoma.
3. a,-antitrypsin : Yolk sac tumor (endodermal sinus tumor).
4. Placental alkaline phosphatase : Seminoma.
5. Other : Placental lactogen, LDH.
432. Carcinoembryonic antigen is raised in
which of the following non neoplastic
conditions -
a) Hepatitis

b) Pancreatitis

c) Hemolytic anemia

d) Ulcerative colitis

Correct Answer - B
Ans. is 'b' i.e., Pancreatitis medpox.com
1) Neoplastic conditions with raised CEA —> Colorectal cancer,
lung cancer, breast cancer, ovarian cancer.
2) Non-neoplastic conditions with raised CEA —> Alcoholic
cirrhosis, hepatitis, IBD (UC, CD), smoking, pancreatitis and
hemolytic anemia.
433. Alpha-fetoprotein is a tumor marker for
a) Hepato cellular carcinoma

b) Multiple myeloma

c) Seminoma

d) Breast carcinoma

Correct Answer - A
Answer- A. Hepato cellular carcinoma
Alpha-feto protein (AFP)
AFP is a well estabilished tumor marker
It is a glycoprofein synthesized normaily early in fetal life by the yolk
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sac, fetal liver and fetal GIT.
AFP is raised in -
Carcinomas > Liver Ca, Lung Ca, Colon Ca, Pancreatic Ca, Non-
seminoma germ cell tumor of testis.
Non-neoplastic conditions > Cirrhosis, Hepatitis, Pregnancy
434. Inhibin is tumor marker for ?
a) Granulosa cell tumor

b) Malignant melanoma

c) Prolactinoma

d) Breast carcinoma

Correct Answer - A
Ans. is 'a' i.e., Granulosa cell tumor
Granulosa cell tumor is positive for vimentin, inhibin, CD99.

medpox.com
435. Mesothelioma is positive for which
intermediate filament
a) Vimentin

b) Cytokeratin

c) GFAP

d) Desmin

Correct Answer - B
Answer- B. Cytokeratin
Cytokeratin- Carcinoma, mesothelioma, Non-seminoma GCT
medpox.com
436. Calretinin is used in
a) Mesothelioma

b) Hamartoma

c) Choristoma

d) Chordoma

Correct Answer - A
Answer- A. Mesothelioma
Calretinin and cytokeratin are positive in cases of malignant
mesothelioma.
medpox.com
437. Marker of angiosarcoma is
a) CD 31

b) Cytokeratin

c) Vimentin

d) CD 55

Correct Answer - A
Answer- A. CD 31
The endothelial origin of these tumors can be demonstrated by
immunohistochemical staining for CD31 or von Willebrand factor.
medpox.com
438. Keratinization and pearl formation is
characteristic of
a) Squamous cell carcinoma

b) Basal cell carcinoma

c) Melanoma

d) Lymphoma

Correct Answer - A
Answer- A. Squamous cell carcinoma
Histologically, squamous cell carcinoma is characterized by the
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presence of keratinization and/or intercellular bridges. Keratinization
may take the form of squamous pearls or individual cells with
markedly eosinophilic dense cytoplasm
439. Grade of tumor denotes
a) Degree of differentiation

b) Degree of anaplasia

c) Stage of disease

d) Vascular invasion

Correct Answer - A
Answer- A. Degree of differentiation
Grading is based on the degree of differentiation of tumor cells and
the number of mitosis within the tumor.
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440. Carcinoma due to inherited mutation of
p53 protooncogene
a) Li fraumeni syndrome

b) Familial adenomatous polyposis

c) Retinoblastoma

d) Osteosarcoma

Correct Answer - A
Answer- A. Li fraumeni syndrome
Li-Fraumeni syndrome is due to mutation in p-53 gene.
medpox.com
441. BRCA2 not associated with
a) breast cancer

b) Prostate cancer

c) Ovarian cancer

d) Vulval cancer

Correct Answer - D
Ans. is 'd' i.e., Vulval cancer
BRCA-1 er BRCA-2 are commonly associated with —> Carcinomas
of ovary and breast.
Less commonly BRAC-2 is also associated with —> Carcinomas of
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colon, prostate and pancreas.
[Ref Robbin's Vie p. 1076; Clinical Surgery by Michal M. Henry &
Jeremy N. Thompson 2"a/e p. 453]
442. Modified Bloom Richardson criteria for
Carcinoma Breast includes -
a) Desmoplasia

b) Lymphovenous embolism

c) Mitotic rate

d) All

Correct Answer - C
Ans. is 'c' i.e. mitotic rate
Grading of breast cancer
medpox.com
o Presently, most methods for grading use the previously cited
three-tiered systems for describing tumor structure in terms of tubule
formation, nuclear grade and mitotic count, with the latter usually
expressed as the number of mitosis per 10 high- magnification field.
o Each element is scored on a scale from 1 to 3 according to criteria
of the specific grading system, and the final grade is determined by
the sum of mitosis.
o Totals of 3 to 5 indicate a well-differentiated or low-grade tumor; 6
to 7, a moderately differentiated or intermediate-grade tumor; and 8
to 9 , a poorly differentiated or high-grade tumor.
o This method of scoring is known as the Nottingham combined
histologic grade of Elston-Ellis modification of the Scarff-Bloom-
Richardson grading system, often reported as a modified Scaff-
Bloom-Richardson grade.
Modified Bloom-Richarson histological grading Tubule formation
o Score 1 :- >75% of tumor has tubules
Score 2 :- 10-75% of tumor has tubules
o Score 3 :- < 10% of tumor has tubules
Nuclear size ( nuclear polymorphism)
o Score 1 :- tumor nuclei similar to normal duct nuclei (2-3 x RBC)
o Score 1 :- tumor nuclei similar to normal duct nuclei (2-3 x RBC)
Score 2 :- Intermediate size nuclei
Score 3 :- very large nuclei, usually vesicular with prominent nucleoli
Mitotic count
o Score 1 :- 0-7 mitosis o Score 2 :- 8-14 mitosis o Score 3 :- > 15
mitosis

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443. Excessive fibrosis in tumor in called -
a) Anaplasia

b) Metaplasia

c) Desmoplasia

d) Dysplasia

Correct Answer - C
Ans. is 'c' i.e., Desmoplasia
In some tumors, parenchymal cells stimulate the formation of an
abundant collagenous stroma, referred to as desmoplasia, eg
scirrhous carcinoma of breast.
medpox.com
444. K ras mutation is seen in
a) Pancreatic carcinoma

b) Prostate carcinoma

c) Gastric carcinoma

d) Hepatic carcinoma

Correct Answer - A
Answer- A. Pancreatic carcinoma
K - RAS point mutation : Cancers of colon, lung and Pancreas.
H - RAS point mutation : Cancers of kidney and bladder
N - RAS point mutation : Melanoma and hematological malignancies
medpox.com
[Ref Robbin's 8thie p. 279 & 7h/e p. 295]
445. Sentinel lymph node biopsy is used for ?
a) Melanoma

b) Basal cell carcinoma

c) Squamous cell carcionoma

d) Thyroid carcinoma

Correct Answer - A
Ans. is 'a' i.e., Melanoma
Sentinel lymph node biopsy is used for breast carcinoma and
melanoma.
medpox.com
446. Point mutaton in which protooncogene is
responsible for the development of
gastrointestinal stromal tumor
a) KIT

b) ALK

c) RET

d) FLT3

Correct Answer - A
Ans. is 'a' i.e., KIT medpox.com
Approximately 75% to 80% of all GISTs have oncogenic, gain-of-
function mutations of gene encoding the tyrosine kinase c-KIT.
Approximately 8% of GISTs have mutations that activate a related
tyrosine kinase, platelet derived growth factor receptor a (PDGFRA).
Consitutively active c-KIT or PDGFRA receptor tyrosine kinases
activate RAS and P13K/AKT pathways and thereby promote tumor
cell proliferation.
447. Paraneoplastic syndrome Hypercalcemia
of malignancy, is produced due to
ectopic production of which hormone by
lymphomas ?
a) PTHrP

b) 1,25 dihydroxyvitamin D

c) PGE2

d) Parathormone

Correct Answer - B medpox.com

Ans. is 'b' i.e., 1, 25 dihydroxyvitamin D
Parathyroid hormone-related protein (PTHrP)

1,25 dihydroxyvitamin D
Parathyroid hormone (PTH) (rare) Prostaglandin E2 (PGE2) (rare)
448. DIC is seen in all except
a) Carcinoma pancreas

b) Carcinoma prostate

c) Carcinoma lung

d) Carcinoma kidney

Correct Answer - D
Answer- D. Carcinoma kidney
Cancers associated with DIC
Ca pancreas
Ca lung medpox.com
Acute promyelocytic leukemia
Ca prostate
Ca Stomach
449. The phenomenon by which the cancer
cells are able to sustain and proliferate
under adverse conditions of hypoxia is ?
a) Warburg

b) Wanton

c) Wormian

d) Wolf

Correct Answer - A
Ans. is 'a' i.e., Warburg medpox.com
Otto Warburg described the bioenergetics and metabolic features
that permit cancer cells to survive under adverse conditions such as
hypoxia and enable their proliferation, progression, invasiveness,
and subsequent distant metastasis.
This phenomenon is thus called the growth promoting Warburg
phenomenon.
450. Ladder tears are ?
a) Spiral tears of aortic intima

b) Vertical tears of aortic intima

c) Horizontal tears of aortic intima

d) Oblique tears of aortic intima

Correct Answer - C
Ans. is 'c' i.e., Horizontal tears of aortic intima
Ladder tears are the horizontal tears of intima
It is injury to aorta due to deceleration.
It is so called be cause it resembles the rungs of a ladder.
medpox.com
451. Hepatitis B associated with ?
a) Wegener's granulomatosis

b) Systemic lupus erythmatosus

c) Polyarteritis nodosa

d) Sjogren syndrome

Correct Answer - C
Ans. is 'c' i.e., Polyatrteritis nodosa
The hepatitis B surface antigen is present in 25% of patients with
Polyarteritis Nodosa.
Hepatitis C antibody is present in patients with essential mixed
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cryoglobinuria and rarely in patients with poly arteritis nodosa.
452. pANCA positive vasculitis is
a) Wegener's granulomatosis

b) Churg - Strauss syndrome

c) Polyarteritis nodosa

d) All of the above

Correct Answer - B
Answer- b. Churg - Strauss syndrome
PANCA
Typically found in:
Microscopicpolyangiitis medpox.com
Churg-Strausssyndrome
Idiopathiccrescenticglomerulonephritis
Goodpasteur'ssyndrome.
pANCA's are also associated with certain non-vasculitic entities such
as certain rheumatic and nonrheumatic autoimmune diseases,
Inflammatory bowel diseases, certain drugs. Infections such as
endocarditis and bacterial airway infection in patients with cystic
fibrosis
 453. Patient with chronic hypertension will
show fol​lowing changes on histology of
kidney
a) Hyaline arteriosclerosis

b) Hyperplastic arteriosclerosis

c) Onion skin lesions

d) Vessel lumen dilatation

Correct Answer - A
Ans. is 'a' i.e., Hyaline arteriosclerosis
medpox.com
Hypertension is associated with two forms of small blood vessels
disease ?
1. Hyaline arteriolosclerosis
There is homogenous, pink, hyaline thickening of arteriolar wall. The
lumen becomes narrow. It is characteristic of benign hypertension. It
may also occur in diabetes and aging.
2. Hyperplastic arteriosclerosis
It is characteristic of malignant hypertension. There is concentrentic,
laminated thickening of arteriolar wall → onion skinning. There is
mucinous intimal thickening and fibrous intimal thickening.
There may be accompanied fibrinoid deposits with necrosis of the
vessels wall → fibrinoid necrosis (or necrotizing arteriolitis).
Favoured sites for hyperplastic arteriosclerosis are kidney, small
intestine, gall bladder, peripancreatic fat, and periadrenal fat.
Beside these hypertension also causes :-
1. Atherosclerosis in large arteries.
2. Degenerative changes in the walls of large and medium arteries that
potentiate both aortic dissection and cerebrovascular hemorrhage.
medpox.com
454. Histologic finding in hyperplastic
arteriosclerosis
a) Concentric layer onion skin lesion

b) Mucinous intimal thickening

c) Fibrinoid atherosclerosis

d) All the above

Correct Answer - D
Answer- D. All the above
It is characteristic of malignant hypertension.
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There is concentrentic, laminated thickening of arteriolar wall onion
skinning.
There is mucinous intimal thickening and fibrous intimal thickening.
There may be accompanied fibrinoid deposits with necrosis of the
vessels wall fibrinoid necrosis.
455. Obliterative endarteritis of the vasa
vasorum of aorta is seen in
a) Syphilis

b) Wegener's

c) Chrug strauss

d) Cold hemoglobinuria

Correct Answer - A
Answer- A. Syphilis
Syphilitic aneurysm is due to obliterative endarteritis that involves
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vaso vasorum of aorta in the tertiary stage of syphilis.
456. Antischkow cells are ?
a) Modified macrophages

b) Modified neutrophils

c) Modified B cells

d) Modified RBCs

Correct Answer - A
Ans. is 'a' i.e., Modified macrophages
Pathologic Features of Acute Rheumatic Fever
Aschoff bodies focal inflammatory lesions seen in acute rheumatic
fever consisting of foci of T lymphocytes, occasional plasma cells,
medpox.com
and plump activated macrophages.
These activated macrophages called Anitschkow cells
(pathognomonic for Rheumatic Fever) have abundant cytoplasm
and central round-to- ovoid nuclei (occasionally binucleate) in which
the chromatin condenses into a central, slender, wavy ribbon (hence
also called "caterpillar cells").
Pancarditis - During acute RF, diffuse inflammation and Aschoff
bodies may be found in any of the three layers of the heart, resulting
in pericarditis, myocarditis, or endocarditis
Verrucae are small (1 to 2 mm) vegetations overlying necrotic foci
and along the lines of closure of valves. o MacCallum plaques are
irregularly thickened subendocardial lesions usually in the left
atrium. o Mitral stenosis - Fish Mouth or Button - Hole stenosis.
457. Which isoenzyme of LDH is seen in heart
a) LDH1

b) LDH2

c) LDH3

d) LDH4

Correct Answer - A
Answer- A. LDH1
Most prominent isoenzymed in heart muscle is LDH-1. LDH-2 is 2nd
most prominent form (after LDH 1)
medpox.com
458. Which worm causes myocarditis ?
a) Trichuris

b) Trichinella

c) Enterobius

d) Strogyloides

Correct Answer - B
Ans. is 'b' i.e., Trichinella
Trichinosis is the most common helminthic disease causing
myocarditis.
medpox.com
459. Carcinoid syndrome produces valvular
disease primarily of the
a) Venous valves

b) Tricuspid valve

c) Mitral valve

d) Aortic valve

Correct Answer - B
Answer is B (Tricuspid valve);
The most common site of involvement is the – Ventricular surface of
Tricuspid valve. medpox.com
'Cardiac manifestations in carcinoid syndrome are due to fibrosis
involving the endocardium, primarily on the right side although left
side lesions also occur. Dense fibrous deposits are most commonly
on the ventricular aspect of the tricuspid valve and less commonly
on the pulmonary valve cusps.'
They can result in either constriction of valves (stenosis) or
fixation of valves in open (regurgitation)
- Abnormality produced due to tricuspid valve involvement –
Tricuspid regurgitation Q
- Abnormality produced due to pulmonary valve involvement –
Pulmonary stenosis Q
460. Which of the following is not a large
vessel vasculitiis ?
a) Takayasu arteritis

b) Cogan syndrome

c) Chrug strauss syndrome

d) Giant cell arteritis

Correct Answer - C
Ans. is 'c' i.e., Churg strauss syndrome
Large vessel vasculitis : Giant cell arteritis (temporal arteritis),
medpox.com
Takayasu arteritis, Cogan syndrome.
Medium vessel vasculitis : PAN (classical PAN), kawasaki disease,
Buerger's disease.
Small vessel vasculitis : HSP, Wegner's granulomatosis,
microscopic polyangitis, churg strauss syndrome, Cryoglobulinemia,
SLE, idiopathic crescentic glomerulonephritis, Bechet's syndrome,
renal limited vasculitis.
461. Most common site of glomus tumor is ?
a) Under fingernails

b) Under toenails

c) Neck

d) Axilla

Correct Answer - A
Ans. is 'a' i.e., Under fingernails
Glomus tumor (Glomangioma)
Benign tumor arising from the smooth muscle cells of the glomus
body which is an arteriovenous anastomosis involved in
medpox.com
thermoregulation.
Most commonly present in the distal portion of the digits (under
fingernails).
Histologically, there is presence of branching vascular channels and
stroma containing nests/aggregates of glomus cells arranged around
vessels.
462. Most common type of hodgkins
lymphoma is ?
a) Lymphocyte predominant

b) Lymphocyte depletion

c) Nodular sclerosis

d) Mixed cellularity

Correct Answer - C
Ans. is 'c' i.e., Nodular sclerosis
Best Prognosis
Worst prognosis medpox.com
Most common HL
Most common type HL in India
Least common type HL

Lymphocytic predominance type. —> Lymphocytic depletion type. —
> Nodular sclerosis type.
—> Mixed cellularity type. Lymphocytic depletion type
463. Lacunar type of reed sternberg cell is
seen in ?
a) Nodular sclerosis

b) Lymphocyte predominance

c) Mixed cellularity

d) Lymphocyte depletion

Correct Answer - A
Ans. is 'a' i.e., Nodular sclerosis

medpox.com
464. Popcorn cells are seen in which variety
of hodgkin's disease ?
a) Nodular sclerosis

b) Mixed cellularity

c) Lymphocyte predominant

d) Lymphocyte depletion

Correct Answer - C
Ans. is 'c' i.e., Lymphocyte predominant
Popcorn cells are found in lymphocytic predominant type of
Hodgkin's Lymphoma. medpox.com
465. Birbeck granules in cytoplasm is seen in
?
a) Langerhans cell histiocytosis

b) Hodgkin's lymphoma

c) Non hodgkins lymphoma

d) Gastrointestinal stromal tumor

Correct Answer - A
Ans. is 'a' i.e., Langerhans cell histiocytosis
Birbeck granules are characteristic of langerhans cell histiocytosis
medpox.com
Tumour cells in the langerhan's cell histiocvtosis are derived from
dendritic cells and express :​
S-100
CD1a
HLA-DR
These cells are characterized by the presence of birbeck granules in
their cytoplasm unde rthe electron micro​scope, Birbeck granules
have pentalaminar, rodlike tuular appearance and sometimes a
dilated terminal end (tennis-racket appearance)

466. Shape of birbeck granules is ?
a) Tennis racket

b) Hockey stick

c) Bat

d) Ball

Correct Answer - A
Ans. is 'a' i.e., Tennis racket
Under the electron microscope, Birbeck granules have a
pentalaminar, rodlike, tubular appearance and some​times a dilated
terminal end resembling tennis-racket appearance.
medpox.com
467. Most common site for eosinophilic
granuloma is?
a) Radius

b) Skull

c) Lumbar vertebra

d) Femur

Correct Answer - B
Ans. is 'b' i.e., Skull
The most common sites are skull bones, long bones, spinal
medpox.com
vertebrae, mastoid and mandible.
468. Pelger Huet anamoly shows presence of
?
a) Hyposegmented neutrophil

b) Hypersegmented neutrophil

c) Unsegmented neutrophil

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Hyposegmented neutrophil
Pelger Huet anomaly
medpox.com
It is a genetic disorder with an autosomal dominant inheritance
pattern.
It is a blood laminopathy associated with the lamin B receptor.
It is characterized by a white blood cell type known as a neutrophil
whose nucleus is hyposegmented.
Heterozygotes are clinically normal, although their neutrophils may
be mistaken for immature cells, which may cause mistreatment in a
clinical setting.
Homozygotes tend to have neutrophils with rounded nuclei that do
have some functional problems.
469. MALToma is located in which layer of
gastrointestinal tract
a) Lamina propria

b) Submucosa

c) Muscularispropria

d) Serosa

Correct Answer - A
Answer- A. Lamina propria
Extranodal marginal zone lymphoma or mucosa-associated
medpox.com
lymphoid tissue lymphoma (MALToma).
It is the most common form of marginal zone lymphoma. MALT
lymphoma (MALToma) is divided into gastric (arising in stomach)
and non-gastric (arising in small intestine, salivary gland, thyroid
etc). Gastric MALToma has been associated with H.pylori infection.
Immunophenotype of MALTomas shows positivity for CD 20 and CD
23. They are negative for CD 3, CD 10 and CD 5.
Histologically, MALToma takes form of a dense lymphocytic infiltrate
in the lamina propria layer of GIT.
470. True about gastric lymphoma -
a) Non Hodgkins lymphoma commonest variety

b) Diagnosis is made by biopsy

c) H-Pylori has direct relationship

d) All

Correct Answer - D
Ans. is 'a' i.e., Non Hodgkins lymphoma commonest variety; 'b' i.e.,
Diagnosis is made by biopsy; `c' i.e., H-Pylori has direct relationship
Gastric lymphoma
The stomach is the most common site for extranodal lymphoma.
medpox.com
o Nearly all gastric lymphomas are B-cell lymphomas of mucosa-
associated lymphoid tissue (MALT lymphoma) o Majority of cases
(80%) are associated with chronic gastritis and H. Pylori infection.
o The most striking evidence linking H. Pylori gastritis to MALToma
is that eradication of infection by antibiotics induces durable
remission with low rate of recurrence.
o Gastric lymphoma represents 5% of all gastric malignancies.
It is most prevalent is sixth decade of life.
o Like other tumors of mature B cells, MALTomas express B-cell
markers CD 19 and CD 20. They do not express CD 5, CD 10 and
CD 23.
o Diagnosis is made by endoscopic biopsy.
o Gastric lymphomas are chemosensitive and chemotherapy alone
or along with surgery is used for the treatment of gastric lymphoma.
About option 'a'
o Most common variety of gastric lymphoma is NHL (MALToma).
Very rarely, Hodgkin's lymphoma may also occur in stomach.
471. Which of the following is not true about
idiopathic thrombocytopenic purpura?
a) Antibodies of IgM class

b) Autoantibodies to Gp IIb/ Ilia or IB IX

c) Increased megakaryocytes in bone marrow

d) Spleen is normal in size

Correct Answer - A
Ans. is 'a' i.e., Antibodies of IgM class
I dopathic thrombocytopenic purpura :?
medpox.com
There are two clinical subtypes of primary I.T.P, acute and chronic
both are autoimmune disorders in which platelet destruction results
from formation of antiplatelet antibodies.
Pathogenesis
Chronic ITP is caused by the formation of autoantibodies against
platelet membrane glycoproteins most often Hb-lIla or Ib-IX.
In overwhelming majority of cases the antiplatelet antibodies are of
the .IgL, class.
The mechanism of platelet destruction is similar to that seen in
autoimmune hemolytic anemias. Opsonized platelets are rendered
susceptible to phagocytosis by the cells of the mononuclear
phagocyte system.
The spleen is the major site of the destruction of platelets.
Pathology
The principal morphologic lesions of thrombocytopenic purpura are
found in the spleen and bone marrow but they are not diagnostic.
The point to stress is that despite the increased destruction of
platelets in spleen, the spleen size remains normal.
On histological examination there is congestion of the sinusoids and
hyperactivity and enlargement of the splenic follicles manifested by
the formation of prominent germinal centres. Sometimes scattered
megakaryocytes are found within the sinuses and sinusoidal walls.
This represents a very mild form of extramedullary hematopoiesis.
These splenic findings are not sufficiently distinctive to be
considered diagnostic.
Bone Marrow
Bone marrow reveals a modestly increased number of
megakaryocytes.
These findings are not specific for autoimmune thrombocytopenic
purpura, but merely reflect accelerated thrombopoiesis, being found
in most forms of thrombocytopenia resulting from increased platelet
destruction.
The importance of bone marrow examination is to rule out
thrombocytopenias resulting from bone marrow failure.
A decrease in the number of megakaryocytes goes against the
diagnosis of I.T.P.
medpox.com
472. Defect of glanzmann's thrombosthenia is
?
a) Gp1Ib-IlIa

b) GpIIIa-I lb

c) GpIla-Illb

d) Gpfilb-I la

Correct Answer - A
Ans. is 'a' i.e., GpI1b-IlIa
Defect in Glanzmann's trombsthenia Gp IIb/IIIa
medpox.com
Defect in Bernard soulier syndrome Gp Ib/IX
473. Giant platelets are seen in ?
a) Bernard soulier syndrome

b) vWD

c) Polycythemia rubra vera

d) Leukemia

Correct Answer - A
Ans. is 'a' i.e., Bernard soulier syndrome
Bernad Soulier disease - Defect in the platelet GpIb-IX complex
BT, mild thrombocytopenia, deficient or low levels of platelet GpIb-IX
complex by flowcytometry medpox.com
Ristocetin aggregation test is defective
474. PT is used to test ?
a) Extrinsic and common pathway

b) Intrinsic and common pathway

c) Intrinsic pathway

d) Extrinsic pathwa

Correct Answer - A
Ans. is 'a' i.e., Extrinsic and common pathway
Patients with hemophilia have deficiency of factor VIII that results in
prolonged PTT.
medpox.com
475. Which of the following statements about
coagulation factor VII is not true
a) Deficiency is inherited as an Autosomal Recessive trait

b) Deficiency is associated with prolonged APTT

c) Deficiency can be managed by Fresh Frozen plasma

d) Has a shorter half life in comparison to Hageman factor (XII)

Correct Answer - B
Answer is B (Deficiency is associated with prolonged APTT)
Factor VII deficiency is associated with isolated prolongation of PT,
medpox.com
APTT is normal in Factor VII deficiency
Genetic and laboratory characteristic of inherited coagulation
disorders
Inheritance Laboratory Treatment
Prevalence ' Minimum
Clotting Abnormality
in General Hemostatic
factor aPTI
Population le N els
deficiency PT TT
I in
Fibrinogen AR 100 mg/dL Cryoprecipitate
1.000,000 + + +
I in
ProthrombinAR 20-30% FFP/Pa's
2.000,000 + +
1 in
Factor V AR +/- +1- I 5-10"/a HP
1.000,000
1 in
Factor I II AR - + - 15-20% FFP/PCCs
500,000
FAINT
Factor VIII X-linked I in 5.000 30%
+ - concentrates
Factor IX X-linked I in 30.000 30% FIX concentrates
+ - -
Factor IX X-linked I in 30.000 30% FIX concentrates
+ - -
I in
Factor X AR +1- +/- - 15-20% FFP/PCICs
1.000,000
I in
Factor XI AR 15-20% FFP
1,000,000
Factor XII AR 'SO + - h h
HK AR ND + Ii h
Prckallikrein AR ND _, 6 h
I in
Factor XIII AR +/- 2-5% Cryptoprecipitate
2,000,000








medpox.com


Values within n srmal range (-) or prolonged (±) No risk for bleeding,
treatment is not indicated
HK, high-molecular weight kininogen; AR, autosomal recessive;
aPTT, activated partial thromboplastin time; PT, prothrombin time;
TT, thrombin time; ND, not determined; FFP. fresh frozen plasma;
PCCs, prothrombin complex concentrates.
476. Under Blood safety programme
compulsory tests done are all except ?
a) HIV

b) VDRL

c) Malaria

d) Hepatitis E

Correct Answer - D
Ans. is 'd' i.e., Hepatitis E
Blood safety :?
medpox.com
Under Blood Safety Programme all the blood banks have to ensure
that before transfusion of blood to the patient the mandatory tests for
HIV, VDRL, Hepatitis B, Hepatitis C and Malaria are done.
477. Following statement is true for
hemophilia patients?
a) All Females are carriers and all males are affected

b) All Males are carriers and all females are affected

c) Females are mostly carriers and all males are affected

d) Males are mostly carriers and all females are affected

Correct Answer - C
Ans. is 'c' i.e., Females are mostly carriers and all males are affected
Hemophilia is an X-linked recessive hemorrhagic disease due to
medpox.com
mutations in the F8 gene (hemophilia A or classic hemophilia) or F9
gene (hemophilia B).
The disease affects I in 10,000 males worldwide, in all ethnic
groups; hemophilia A represents 80% of all cases.
Male subjects are clinically affected; women, who carry a single
mutated gene, are generally asymptomatic.
Family history of the disease is absent in 30% of cases and in these
cases, 80% of the mothers are carriers of the de novo mutated
allele.
478. Blood is stored at what temperature in
blood bank?
a) -2 to -4 degrees Celsius

b) -2 to 0 degrees Celsius

c) 1 to 6 degrees Celsius

d) 6 to 12 degrees Celsius

Correct Answer - C
Ans. is 'c' i.e., 1 to 6 degrees Celsius
Storage temperature of blood : 1-6°C
medpox.com
Storage temperature of packed RBCs : 40°C
Storage temperature of FFP : -20°C
Storage temperature of platelets: 20-24°C
479. Normal reticulocyte count in newborn is -
a) 0 - 1%

b) 1 - 1.5%

c) 3 - 6%

d) 6 - 9 %

Correct Answer - C
Ans. is 'c' i.e., 3 - 6%
Normal reticulocyte count in adults is 1 - 1.5% and in newborns is 3 -
6 %
medpox.com

invalid question id
481. Loading dose depends on ?
a) Volume of distribution

b) Elimination rate

c) Half life

d) Plasma volume

Correct Answer - A
Ans. is 'a' i.e., Volume of distribution
Loading dose is governed by volume of distribution and volume of
distribution is affected by lipid solubility.
Maintenance dose is governed by clearance (excretion) of drug and
medpox.com
half life.
482. Maintainence dose is calculated by using
value of?
a) Clearance

b) Volume of distribution

c) Oral bioavailability

d) Daily dosage

Correct Answer - A
Ans. is 'a' i.e., Clearance
Drug dosing
medpox.com
For drugs with longer t1/2 a dose that is sufficient to attain the target
concentration after single administration, if repeated will accumulate
according to plateau principal and produce toxicity later on.
On the other hand, if the dosing is such as to attain target level at
steady state, the therapeutic effect will be delayed by about 5 half
lives and this lapse of time may be undesirable some time.
Such drugs are often administered by initial loading dose and
subsequent maintenance doses.
Loading dose
483. Depot preparations are administered by
?
a) Subcutaneous route

b) Intravenous route

c) Intramuscular route

d) Both subcutaneous and intramuscular route

Correct Answer - D
Ans. D. Both subcutaneous and intramuscular route
A depot injection is an injection, usually subcutaneous or
medpox.com
intramuscular, of a pharmacological agent which releases its active
compound in a consistent way over a long period of time.
Depot injections are usually either solid or oil based.
484. Most variable absorption is seen with
which route?
a) Oral

b) Intramscular

c) Intravenous

d) Per rectal

Correct Answer - A
Ans. is 'a' i.e., Oral
Oral administration of drugs is safe, convenient and economical, but
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has the potential for the most variable absorption
pattern.

Clinical pharmacology
Routes of drug administration
Drugs are administered by various routes.
Different routes have different characteristics, so that the route of
administration may have a profound effect upon the speed and
efficiency with which the drugs act.
The routes of drug administration may be:
i) Local route
ii) Systemic route
Local route - Drug is administered at the site of lesion.
Systemic route - Drug is administered through systemic routes is
intended to be absorbed into the blood stream and distributed all
over, including the site of action, through circulation.
485. About rectal route true is ?
a) Used for irritant and unpleasant drugs

b) Cannot be used in unconscious patient

c) There is predictable absorption of drug

d) Diazepam cannot be given via rectal route of administration

Correct Answer - A
Ans. is 'a' i.e., Used for irritant and unpleasant drugs
Rectal route of administration
It is a route of systemic drug delivery.
Irritant or unpleasant drugs can be put into the rectum as
medpox.com
suppositories or retention enemas.
Can be used in a patient with recurrent vomiting and in unconscious
patient.
Absorption of drug is slower, irregular and unpredictable.
Drug absorbed into the external hemorrhoidal vein (50%) bypasses
the liver but not that absorbed into the internal hemorrhoidal vein.
Diazepam, indomethacin, ergotamine and paracetamol can be used
via rectal route of administration.
486. Transdermal patch is not used for
following drug?
a) GTN

b) Fentanyl

c) Nicotine

d) Naloxone

Correct Answer - D
Ans. is `d' i.e., Naloxone

medpox.com
487. Xenobiotics are metabolized to ?
a) Increase water solubility

b) Increase lipid solubility

c) Make them nonpolar

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Increase water solubility
BIOTRANSFORMATION (METABOLISM)
Most of the drugs are treated by the body as foreign substances
(xenobiotics). medpox.com
Like other foreign substances (xenobiotics), body tries to eliminate
drugs by various mechanisms for ridding itself of chemical intruders.
Biotransformation means chemical alteration of the drug in the body.
Why drug transformation is necessary ?
Kidney plays a pivotal role in terminating the activity of drugs.
For renal excretion the drug tends to be polar (lipid insoluble/water
soluble) so that it can not diffuse back from tubular lumen and can
be excreted.
But pharmacologically active organic molecules (drugs) tend to be
lipophlic (nonpolar) and remains unionized or only partially ionized at
physiological pH.
Biotransformation is needed to render nonpolar (lipid soluble)
compounds polar (water soluble) so that they are not reabsorbed in
the renal tubules and are excreted.
Sites and processes of biotransformation
Primary site of drug metabolism is liver, others are - kidney,
intestine, lung and plasma.
Biotransformation of drugs may lead to :-
Active metabolite from an active drug
Many drugs are partially converted to one or more active
metabolites.
The effects observed are the sumtotal of that due to the parent drug
and its active metabolite.
Activation of inactive drugs
Few drugs are inactive as such and need conversion in the body to
one or more active metabolites.
Such a drug is called prodrug.

medpox.com
488. Branch that deals with medicinal drugs
obtained from plants and other natural
resources -
a) Pharmacognosy

b) Pharmacogenetics

c) Pharmacogenomics

d) Pharmacopia

Correct Answer - A
Ans. is 'a' i.e., Pharmacognosy
medpox.com
Pharmacognosy : It is the branch the deals with the knowledge
pertaining to the medicinal drugs obtained from plants and other
natural sources.
Pharmacogenetics : Study of genetic basis for variability in drug
response
Pharmacogenomics : Use of genetic information to guide the choice
of drug and dose on an individual basis.
489. Pharmacoviglance is used for ?
a) To monitor drug toxicity

b) To monitor unauthorized drug manufacture

c) Monitoring of students

d) Check costs

Correct Answer - A
Ans. is 'a' i.e., To monitor drug toxicity
Pharmacovigilance
Pharmacovigilance is the science and activities relating to detection,
assessment, understanding and prevention of adverse effects or any
medpox.com
other drug related problem.
490. False regarding Cytochrome P 450 is ?
a) They are essential for the production of cholesterols, steroids,
prostacyclins and thromboxane A2

b) They absorb light with 45nm wavelength

c) They occur predominantly in liver

d) They are non heme proteins

Correct Answer - D
Ans. is d i.e., They are non heme proteins
CYTOCHROME P450
They CYP450 are essential for the production of cholesterols,
medpox.com
steroids, prostacyclins and thromboxane A2.
They are also essential for the metabolism of foreign chemicals and
detoxification of drugs.
CYP 450 enzymes are so named because they are bound to
membranes within a cell (cyto) and contain a heme pigment (chrome
and P) that absorbs light at a wavelength of 450 nm when exposed
to carbon monoxide.
There are more than 50 CYP450 enzymes, but the CYP1A2,
CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP3A5 enzymes
metabolize 90 percent of drugs.
491. Glucuronidation takes place in ?
a) Liver

b) RBC

c) Pancreas

d) Thyroid

Correct Answer - A
Ans. is 'a' i.e., Liver
GLUCURONIDATION
This is the most important synthetic reaction carried out by a group
of UDP-glucuronosyl transferases (UGTs).
medpox.com
Glucuronidation occurs mainly in the liver, although the enzyme
responsible for its catalysis, UDP?glucuronyltransferase, has been
found in all major body organs (e.g., intestine, kidneys, brain,
adrenal gland, spleen, and thymus).
Compounds with a hydroxyl or carboxylic acid group are easily
conjugated with glucuronic acid which is derived from glucose.
Examples are- chloramphenicol, aspirin, paracetamol, lorazepam,
morphine, metronidazole.
Not only drugs but endogenous substrates like bilirubin, steroidal
hormones and thyroxine utilize this pathway.
Glucuronidation increases the molecular weight of the drug which
favours its excretion in bile.
Drug glucuronides excreted in bile can be hydrolysed bybacteria in
the gut-the liberated drug is reabsorbed and undergoes the same
fate. This enterohepatic cycling of the drug prolongs its action, e.g.
phenolphthalein, oral contraceptives.
492. Counterfeit drug is ?
a) Fake medicine

b) Contains the wrong ingredient

c) They have active ingredient in wrong dose

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
Counterfeit medicine is fake medicine.
It may be contaminated or contain the wrong or no active ingredient.
They could have the right active ingredient but at the wrong dose.
medpox.com
Counterfeit drugs are illegal and may be harmful to your health.
493. Young child weighing 20 kg was given a
drug in the dose 100mg/kg body weight.
The plasma concentration of the drug is
2mg/ dl and the clearance is 200 ml/hr.
What is the time required to reach steady
state plasma concentration -
a) 10 hrs

b) 20hrs

c) 30hrs

d) 40hrs
medpox.com

Correct Answer - B
Ans. is 'b' i.e., 20 hours
Volume of distribution = total dose/plasma concentration
Total dose= dose/ kg x body weight = 100 x 20 = 2000 mg
Volume of distribution = 2000/2 = 1000
Half life = 0.693 x Volume of distribution/ clearance = 0.693 x
1000/200 = 3.5 hours
Time required to reach steady state plasma concentration is 5.5 half
lives = 5.5 x 3.5 = 19.25 hours
Therefore the most appropriate answer is 20 hours.
494. If Vmax dec to 80% due to an inhibitor
and Km is same as before which is the
type of inhibition?
a) Competitive Equilibrium type

b) Non competitive

c) Competitive Non Equilibrium type

d) None of the above

Correct Answer - B
Ans. B. Non competitive medpox.com
Decrease in Vmax with no change in Km is seen in Non-competitive
inhibition.
 495. Plasma protein bound drug distributed in
which compartment ?
a) Extracellular

b) Intravascular

c) Interstitial

d) Extravascular

Correct Answer - B
Ans. is 'b' i.e., Intravascular
Clinical significance of protein binding:
medpox.com
1. High plasma protein bound drugs are largely restricted to the
vascular compartment and tend to have lower volume of distribution.
2. The bound fraction is not available for action.
3. High degree of protein binding generally makes the drug long acting,
because bound fraction is not available for metabolism or excretion,
unless it is actively excreted by liver or kidney tubules.
4. 1n nephrotic syndrome and other conditions causing
hypoproteinemia, protein binding will be altered. 5.Highly protein
bound drugs are not removed by haemodialysis and need special
techniques for treatment of poisoning.
5. Protein bound drugs can give rise to displacement interactions :
6. In hypoalbuminemia, binding may be reduced and high
concentrations of free drug may be attained, e.g. phenytoin and
furasemide.
496. Following are the advantages of
sustained release preparation over the
conventional preparations except ?
a) Decreased frequency of administration

b) Improved compliance

c) Less incidence of high peak side effects

d) Drugs with half life > 4 hours are suitable

Correct Answer - D
Ans. is 'd' i.e., Drugs with half life > 4 hours are suitable
medpox.com
Acts for a longer period.
Frequency of administration is reduced -more convenient.
Improved patient compliance - a single morning dose is less likely to
be forgotten/omitted than a 6 or 8 hourly regimen; a monthly or
quarterly administered contraceptive over one that has to be taken
daily.
Large fluctuations in plasma concentration are avoided.
Side effects related to high peak plama level just after a dose (e.g.
nifedipine) would be minimized.
Better round-the-clock control of blood sugar, etc.
Drug effect could be maintained overnight without disturbing sleep,
e.g. antiasthmatics, anticonvulsants, etc.
497. Which antiepileptic drug is least secreted
in breast milk ?
a) Ethosuximide

b) Clonazepam

c) Gabapentin

d) Carbamazepine

Correct Answer - B
Ans. is 'b' i.e., Clonazepam

medpox.com
 498. Agonist antagonist combination acting
on the same receptor is ?
a) Isoprenaline and propranolol

b) Adrenaline and histamine

c) Salbutamol and leukotriene

d) Estrogen and tamoxifen

Correct Answer - A
Ans. is 'a' i.e., Isoprenaline and propranolol
Receptor antagonists (Pharmalogical antagonists)
medpox.com
Receptor antagonists are those drugs that blocks the action of
agonist by acting on same receptors. Example:
Isoprenalineis β1 and β2 receptor agonist while propranolol has
antagonistic action on β1 and β2 receptors.
Note :
Physiological antagonists
Physiological antagonists are those that produce opposite action by
acting on different receptors.
Example
1. Histamine causes bronchoconstriction via H1receptors and this
action is antagonized by adrenaline which causes bronchodilodation
through β1 receptors
2. Leukotrienes cause bronchoconstriction via cystinyl leukotriene
receptors and this action is antagonised by salbutamol which causes
bronchodilatation through β2 receptors.
499. Which of the following drug substrate
combinations do not match ?
a) CYP 3A4/5 - simvastatin

b) CYP 2D6 - SSRI

c) CYP 2C8/9 - mifepristone

d) CYP 2C19 - propranolol

Correct Answer - C
Ans. is 'c' i.e., CYP 2C8/9 - mifepristone

medpox.com
 500. Approximate dose of drug in a 5 years
old child ?
a) Same as adult dose

b) 1/2 of adult dose

c) 1/3 of adult dose

d) 'A of adult dose

Correct Answer - C
Ans. C. 1/3 of adult dose
There are three rule's by which drug close in children can
calculated by: medpox.com
1. For children 2 years old and older (Young's rule)
2. For infant and children < 2 years (Fried's rule)
3. Child's dose by weight can be calculated by Clark's rule:
Child's dose = [Weight (1b)/150] * adult dose.
501. A drug having 40% absorption and
hepatic extraction ratio of 0.6. What is
the bioavailability of that drug?
a) 16%

b) 24%

c) 20%

d) 28%

Correct Answer - A
Ans. is 'a' i.e., 16% medpox.com
Absortion of drug is 40% i. e. if 100 mg of drug is taken 40 mg will be
absorbed.
Hepatic extraction ratio is 0.6 i.e. out of the absorbed dose 60% will
be removed by liver; so from the absorbed 40 mg 60% removed i. e.
24 mg removed.
Thus finally the remaining 16 mg of the total dose taken reaches the
systemic circulation. So bioavailability is 16% as 16mg of the total
100 mg finally reached the systemic circulation
502. Essential drugs ?
a) Included in national pharmacopoeia

b) Should always be present at PHC

c) Those that satisfy the primary health care needs of the

population

d) Life saving medications

Correct Answer - C
Ans. is 'c' i.e., Those that satisfy the primary health care needs of
the population
WHO has defined Essential Medications as those that satisy the
medpox.com
priority health care needs of majority of the population.
503. Most common mitochondrial enzyme for
metabolism detoxification reaction is ?
a) CYP 3A4

b) CYP 1A2

c) CYP 2A6

d) CYP 2B6

Correct Answer - A
Ans. is 'a' i.e., CYP 3A4
Subtypes of cytochrome P-450
medpox.com
Depending upon the extent of amino acid sequence homology, the
cytochrome P-450 (CYP) isoenzymes are grouped into families
designated by capital letters (A, B, C ....).
Individual isoenzymes are again alloted numerals (1, 2, 3 ....).
Examples are CYP1A2, 2A6, 2B6, 2C8, 3A4/3A5.
In human beings, only a few members of three isoenzyme families
carry out metabolism of most of the drugs.
Cyp 3 A 4/5 carryout biotransformation of largest number (nearly
50%) of drugs.
Important inducers of CYP 3A4/3A5
Barbiturates
Glucocorticoids
Rifampin
Macrolide antibiotics
Carbamazepine
Phenytoin
Pioglitazone
504. Cholinergic drug which acts on heart by
decrease in levels of cAMP and due to
opening of K+ channels is?
a) Methacholine

b) Oxotremorine

c) Bethanechol

d) DMPP

Correct Answer - A
Ans. 'a' i.e., Methocholine medpox.com
505. Function of M2 receptor in heart ?
a) SA node hyperpolarisation

b) AV node increased velocity of conduction

c) Increased contractility of ventricles

d) Increased Ach release from cholinergic nerve endings

Correct Answer - A
Ans. is 'a' i.e., SA node hyperpolarization

medpox.com
506. Dopamine at 1-2 Microgram/ Kg/ min produces?
a) Renal vasodilatation

b) Positive ionotropic effect

c) Mesenteric vasoconstriction

d) Generalised vasoconstriction

Correct Answer - A
Ans. is 'a' i.e., Renal vasodilatation
Dopamine produces dose-dependent action:
At low dose (1-2 µg/kg/min) causes dilation of renal and mesenteric
vessels → often referred to as renal dose.
medpox.com
At moderately high dose (2-10 µg/kg/min) produces a positive
ionotropic effect by stimulating β1 receptor on heart → cardiac dose.
At high doses (> 10 µg/kg/min) produces vasoconstriction by
stimulating α1 receptors → vascular dose.
507. Most commonly used cholinesterase
regenerator at NM junction is ?
a) Pralidoxime

b) Obidxime

c) Diacetyl monoxime

d) Edrophonium

Correct Answer - A
Ans. is 'a' i.e., Pralidoxime
Pralidoxime is most commonly used cholinesterase reactivater.
OXIMES medpox.com
Oximes Pralidoxime 2-PAM, obidoxime and diacetyl-monoxime
(DAM)] are used in organophosphate poisoning. o Oximes acts by
reactivating cholinesterase enzyme.
Mechanism of action
In organophosphate poisoning esteratic site of cholinesterase is
phosphorylated and anionic site is free.
Phosphorylated cholinesterase reacts very slowly with water.
However, if more reactive OH groups in the form of oximes are
provided, reactivation occurs more than a million time faster.
Oximes attach to anionic site and provide more reactive OH groups.
Oximes are ineffective in Carbamates poisoning.
Pralidoxime is contraindicated in carbamates poisoning, because not
only it does not reactivate carbamylated enzyme, it has weak anti-
chE activity of its own.
Remember
Obidoxime is more potent than pralidoxime.
Pralidoxime and obidoxime are lipid insoluble, while diacetyl-
monoxime (DAM) is lipid soluble so it can cross BBB and regenerate
AChE in brain.
Atropine is used in both organophosphate and carbamate
anticholinesterase poisoning.

medpox.com
508. Selective beta 2 blocker is ?
a) Butoxamine

b) Betoxolol

c) Esmolol

d) Bisoprolol

Correct Answer - A
Ans. is 'a' i.e., Butoxamine

medpox.com
509. Beta blocker with membrane stabilizing
property are all except ?
a) Acebutolol

b) Betaxolol

c) Carvedilol

d) Bevantolol

Correct Answer - D
Ans. is 'd' i.e., Bevantolol

medpox.com
510. Longest acting beta blokeris ?
a) Nodalol

b) Esmolol

c) Carvedilol

d) Acebnolol

Correct Answer - A
Ans. is 'a' i.e., Nodalol
Nodalol is longest acting β-blocker.
Esmolol is shortest acting β-blocker.
Remember medpox.com
Nodalol is longest acting P-blocker.
Esmolol is shortest acting n-blocker
Acebutolol possesses all activities i.e., cardioselectivity, partial
agonist activity, membrane stablizing activity and lipid insolubility.
Beta blockers approved for treatment of CHF : Carvedilol (most
widely used), metaprolol, bisoprolol.
Carvedilol is a 13/ + 132 + al adrenoreceptor blocker with a : i3
blocking property of I : 9. It produces
peripheral vasodilatation due to a-1 blockade as well as calcium
channel blockade (direct effect).
Atenolol, sotalol and nodalol are primarily excreted by kidney →
should not be given in renal failure.
Sotalol, penbutolol and pindolol have almost 100% bioavailibility.
Penbutolol has maximum oral absorption.
Carvedilol has maximum plasma protein binding.
Celiprolol has minimum plasma protein binding.
511. Amphetamine causes which of the
following ?
a) IUGR

b) Cardiac anamoly

c) Cleft lip

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
Following are the fetal or neonatal effects of amphetamines :
IUGR medpox.com
Abruptio placentae
Glassy eyed look
Prematurity
Hypoglycemia
Lethargy
Cardiac anamolies
Sweating
Feeding problems
Cleft palate
Poor visual tracing
512. Neostigmine is used in the following
except ?
a) Myasthenia gravis

b) Cobra bite

c) Atony of bladder

d) Glaucoma

Correct Answer - D
Ans. is 'd' i.e., Glaucoma

medpox.com
513. Beta blocker with d isomer responsible
for beta blocker action is ?
a) Nebivolol

b) Timolol

c) Esmolol

d) Propranolol

Correct Answer - A
Ans. is 'a' i.e., Nebivolol
Nebivolol is a novel betal-blocker with a greater degree of selectivity
medpox.com
for betal-adrenergic receptors than other agents in this class and a
nitric oxide (NO)-potentiating, vasodilatory effect that is unique
among beta-blockers currently available to clinicians. Nebivolol is a
racemic mixture with beta-blocker activity residing in the d-isomer; in
contrast, I-nebivolol is far more potent in facilitating NO release.
Note :
Beta blockers with 1 isomer having beta blocking activity are :?
Propranolol, atenolol, metoprolol, esmolol, timolol
514. Patient on verapamil should not be given
beta blocker as ?
a) Conduction block

b) Bronchospasm

c) Neurogenic shock

d) Anaphylaxis

Correct Answer - A
Ans. is 'a' i.e., Conduction block
Adverse effects of CCBs
medpox.com
Nausea, constipation and bradycardia are more common with
verapamil.
Verapamil can accentuate conduction defect-should be avoided in
2nd & 3rd degree block, in sick sinus syndrome and along with 13-
blocker.
Most common side effects of DHPs are palpitation, flushing,
hypotension, headache, ankle edema, drowsiness and nausea.
Nifedipine can paradoxically increase the frequency of angina in
some patients.
Nifedine can cause voiding difficulty in elderly (relaxant effect on
bladder) and glucose intolerance (decreases insulin release).
515. Nonselective beta adrenergic antagonist
is
a) Nodalol

b) Atenolol

c) Bisoprolol

d) Esmolol

Correct Answer - A
Ans. is 'a' i.e., Nodalol

medpox.com
516. Mechanism of action of timolol is ?
a) Nonselective beta blocker

b) Nonselective alpha blocker

c) Selective beta 1 blocker

d) Selective beta 2 blocker

Correct Answer - A
Ans. is 'a' i.e., Nonselective beta blocker
Timolol is a non selective beta blocker (betal + beta 2).
Thus when it is used in the treatment of glaucoma it can precipitate
an attack of asthma by blocking beta 2 receptors.
medpox.com
517. Beta blockers mask all effects of
hypoglycemia except ?
a) Sweating

b) Palpitations

c) Dizziness

d) Tremors

Correct Answer - C
Ans. is 'c' i.e., Dizziness
Symptoms of hypoglycemia are attributable to :-
medpox.com
i) Sympathetic stimulation : Sweating, tremor, tachycardia
palpitations and anxiety. These are the warning signs.
ii) Cerebral glucose deficiency : Decreased cognitive functions,
dizziness and decreased concentration.
Use of beta-blockers, especially in diabetics who are taking
treatment, may mask typical sympathetic system mediated
symptoms of hypoglycemia such as sweating, tremor, tachycardia,
and palpitations.
Thus, dangerous severe hypoglycemia can occur without any
warning signs.
518. CB 1 antagonist used in smoking
cessation is ?
a) Naloxona

b) Rimonabant

c) Vareniloline

d) Bupripion

Correct Answer - B
Ans. is 'b' i.e., Rimonabant
Rimonabant
medpox.com
A selective cannabinoid receptor-1 (CB-1) antagonist which is being
tried as antismoking and antiobesity drug.
519. IV diazepam has which of the following
effect which is not seen by other routes
?
a) Analgesia

b) Sedation

c) Hypotension

d) Coronary dilatation

Correct Answer - D
Ans. is 'd' i.e., Coronary dilatation
medpox.com
Mechanism of action of benzodiazepines (BZDs)
Benzodiazepines act preferentially on midbrain ascending reticular
formation (which maintains wakefulness) and on limbic system
(thought and mental function).
Muscle relaxation is produced by action on medulla.
Ataxia is due to action on cerebellum.
BZDs acts on GABAA receptors.
GABA,,, receptor has 5 subunits a / p, p, a / y.
GABA binding site is on p. subunit, while BZDs binding site is on a /
y subunit.
BZDs receptor increase the conductance of Cl- channel.
BZDs do not themselves increase Cl- conductance, i.e. they have
only GABA facilitatory but no GABA mimetic action. (Barbiturates
have both GABA facilitatory and GABA mimetic actions).
Effect on CNS
In contrast to barbiturates, BZDs are not general depressant, but
exert relatively selective anxiolytic, hypnotic, muscle relaxant and
anticonvulsant effects.
The antianxiety action of BZDs is not dependent on their sedative
property —› with chronic administration relief of anxiety is
maintained, but drowsiness wanes off due to development of
tolerance.
Stage 2 sleep is increased, while REM, Stage 3 & 4 sleep are
decreased.
Nitrazepam is the only benzodiazepine, which increases REM sleep.
Clonazepan and diazepam have more marked muscle relaxant
property.
Clonazepam, diazepam, nitrazepam and flurazepam have more
prominent anticonvulsant activity than other BZDs.
Diazepam (but not other BZDs) has analgesic action.
Diazepam produces short lasting coronary dilatation on i.v. injection.
Diazepam decreases nocturnal gastric secretion and prevents stress
ulcers.

medpox.com
520. Which of the following SSRI is a
prodrug?
a) Fluoxetine

b) Paroxetine

c) Citalopram

d) Fluvoxamine

Correct Answer - A
Ans. is 'a' i.e., Fluoxetine
Selective serotonin reuptake inhibitors (SSRI)
medpox.com
5-HT (serotonine) is the major player in depressive illness and
serotonergic pathways are closely related to mood disorders
especially depression.
Thus, drugs affecting the 5-HT levels in the neural synapse and
serotonergic pathways are effective in the treatment of depression.
Therefore, the SSRIs have been shown to alleviate depression and
are the most commonly used drugs in the therapy of
depression.
These drugs act by inhibiting reuptake of 5-HT.
These drugs are now 1st choice for depression.
Advantages over TCAs.
1.Little or no sedation, no weight gain.
2.No interference with psychomotor or cognitive function.
3.No anticholinergic side effects.
4.No postural hypotension (no action of a-adrenergic receptors).
5.No propensity to cause seizures or arrythmias.
521. Drug used in treatment of migraine ?
a) 5HT1 agonist

b) 5HT1 antagonist

c) Dl agonist

d) D1 antagonist

Correct Answer - A
Ans. is 'a' i.e., 5HT1 agonist

medpox.com
522. Following are the side effects of
fenfluramine except ?
a) Pulmonary hypertension

b) Valvular defects

c) Sudden deaths

d) Dizziness

Correct Answer - D
Ans. is 'd' i.e., Dizziness
Fenfluramine and Dexfenfluramine
medpox.com
They reduce the food seeking behavior by enhancing the
serotonergic transmission in the hypothalamus.
They were extensively used for slimming
Tolerance develops to the anorectic action of in 2 - 3
monthsEchocardiographic abnormalities, valvular defects,
pulmonary hypertension and sudden deaths are the documented
side effects.
These drugs have been discontinued by USFDA.
523. Following is false about aripiprazole
except ?
a) Only antipsychotic with D1 agonistic activity

b) It has 5HT1A antagonistic action

c) It has maximum sedating potential

d) It is the drug of choice in treatment of acute mania

Correct Answer - D
Ans. is `d' i.e., It is the drug of choice in treatment of acute mania
Atypical antipsychotics —> Olanzapine, risperidone, aripiprazole or
medpox.com
quetiapine with or without benzodiazepine is the treatment of choice
for acute mania.
Aripiprazole
Only antipsychotic with D2 agonistic activity. (all others are D2
antagonists).
Longest acting
It also has 5HT,A agonistic and 5HT2 antagonistic activity - Also
known as dopamine-serotinine stabilizer.
It is least sedating antipsychotic → can cause insomnia.
524. Which is the antidepressant with no
anticholinergic effects?
a) Imipramine

b) Mianserine

c) Fluoxamine

d) Amitryptiline

Correct Answer - C
Ans. is 'c' i.e., Fluoxamine
Antidepressants with no anticholinergic (antimuscarinic)
action. medpox.com
Bupropion
Escitalopram
Fluvoxamine
Paroxetine
Trazodone
Citalopram
Duloxetine
Venlafaxine
Sertaline
Mirtazapine Fluoxetine is the only SSRI which has some
anticholinergic action.
Remember
Antidepressants with no sedative action
Bupropion
Citalopram
Fluvoxamine
Protriptyline
Duloxetine
Escitalopram
Venlafaxine
(Note : First 6 drugs are same in both groups)

medpox.com
525. Inverse agonist of benzodiazepine
receptor is -
a) Phenobarbitone

b) Flumazenil

c) Beta carboline

d) Gabapentin

Correct Answer - C
Ans. is `c' i.e., Beta carboline

medpox.com
 526. Dantrolene acts on ?
a) Raynodine receptor

b) Cannabinoid receptor

c) Both of the above

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Raynodine receptor
Dantrolene
Dantrolene is a directly acting skeletal muscle relaxant.
Mechanism of action medpox.com
Normally excitation (depolarization of end plate) is coupled with
contraction by Ca" Excitation contraction coupling.
Dantrolone acts on Ryanodine receptors (RyR) Calcium channels in
sarcoplasmic reticulum of skeletal muscles and prevents their
depolarization triggered opening → no release of intracellular
Ca+2 → No excitation contraction coupling → No contraction.
That means muscle contraction is uncoupled from depolarization of
the membrane.
Dantrolene is DOC for malignant hyperthermia.
It can also be used in
1. Neuroleptic malignant syndrome.
2. To reduce spasticity in UMN disorders, hemiplegia, paraplegia,
cerebral palsy and multiple sclerosis.
Muscular weakness is the dose limiting side effect.
Other side effects are sedation, malaise, light headedness,
troublesome diarrhoea and liver toxicity. Remember
Quinine also acts as directly acting muscle relaxant.
It increases refractory period and decreases excitability of motor end
plates.
It can be used in nocturnal leg cramp.

medpox.com
527. All release histamine except ?
a) Pancuronium

b) D- TC

c) Succinylcholine

d) Mivacurium

Correct Answer - A
Ans. is 'a' i.e., Pancuronium
Properties of NM Blockers
Longest acting Neuromuscular blocker → Pancuronium (duration of
action 120-180 minutes). (Goodman & Gilman 11 th/e p. 222) (Note:
medpox.com
In some books pipecuronium or Doxacurium have given as the
longer activity).
Shortest and fastest acting neuromuscular blocker →
Succinylcholine (suxamethonium) - duration of action 5-8 minutes.
Shortest acting competitive (nondepolarizing) neuromuscular blocker
→ Mivacurium (duration of action 12-18 minutes).
Fastest acting nondepolarizing blocker Rocuronium (can be used for
endotracheal intubation as an alternative to Sch).
Non-depolarizing neuro-muscular blockers can cause ganglion
block, vagal block and Histamine release (different agents has
different propensity).
Histamine release is caused by → D-TC (maximum tendency),
succinylcholine, mivacurium, doxacurium, atracurium, tubocurarine
→ can cause bronchoconstriction.
Virtually no histamine release → Pancuronium
Vagal block is caused by Pancuronium, recuronium, Gallamine.
Maximal vagal block and tachycardia is caused by → Pancuronium
(Previously it was gallamine, but it is not used now).
Vagal stimulation is caused by → succinylcholine (can cause
bradycardia).
Ganglion block is caused by → d-Tc, Metocurine, Alcuronium.
Maximum ganglion blockade is caused by → d-TC.
Ganglion stimulation is caused by → Succinylcholine.

medpox.com
528. Atomoxetine is used for ?
a) Nocturnal enuresis

b) ADHD

c) Temper tantrums

d) Patent ductusarteriosus

Correct Answer - B
Ans. is 'b' i.e., ADHD
Atomoxetine it is selective norepinephrine reuptake inhibitor and is
approved for use in ADHD.
It is indicated in children > 6 years and in adults with concentration
medpox.com
and attention problems.
Atomoxetine absorbed orally, hydroxylated by CYP2D6 and
excreted in urine, mainly as glucuronide.
While majority of individuals are extensive metabolizers (EM), few
are poor metabolizers (PM) due to polymorphism of CYP2D6.
Inhibitors of CYP2D6 like fluoxetine, paroxetine, quinidine increase
concentration and toxicity of atomoxetine.
It should not be given with MAO inhibitors and is contraindicated in
glaucoma.
529. Fomepizole acts as antidote for ?
a) Methanol poisoning

b) Cannabis poisoning

c) Lead poisoning

d) Cadmium Poisoning

Correct Answer - A
Ans. is 'a' i.e., Methanol poisoning

Methanol is highly toxic alcohol. It is metabolized to formaldehyde
(by alcohol dehydrogenas) and formic acid (by acetaldehyde
medpox.com
dehydrogenase).
It is the accumulation of formic acid which causes toxic effects in
methanol poisoning. Accumulation of formic acid results in lactic
acidosis/high anion gap metabolic acidosis with low plasma
bicarbonates, blindness due to retinal damage, papilledema.
Methanol poisoning can be treated by supportive measures, gastric
lavage and sodium bicarbonate (to treat acidosis). Ethanol is useful
because it competitively inhibits the conversion of methanol to formic
acid. Fomepizole can also be used as it is a specific inhibitor of
alcohol dehydrogenase. Folic acid or folinic acid. Enhance the
metabolism formic acid to CO2. Hemodialysis may also be used.
530. Weight gain is seen with all of the
following antipsychiatric medications
except ?
a) Quitiapine

b) Resperidone

c) Clozapine

d) Molindone

Correct Answer - D
Ans. is `d' i.e., Molindone medpox.com
Antipsychotics usually cause weight gain. Quitiapine, olanzapine,
clozapine and resperidone, all have been implicated in weight gain.
Molindone has often been reported to cause weight loss rather than
weight gain.
531. Which drug is used in amytrophic lateral
sclerosis?
a) Riluzole

b) Glatirame

c) Tacrine

d) Olanzapine

Correct Answer - A
Ans. is 'a' i.e., Riluzole
Drugs used in neurodegenerative disorders
Multiple sclerosis medpox.com
Beta-interferon or glatirame decrease the frequency of relapses in
relapsing remitting MS. Recently, natalizumab (a monoclonal
antibody) has been tried.
Amyotropic lateral sclerosis
Riluzole (NMDA antagonist) is useful in ALS. To relieve spasticity
Baclofen may be used.
532. Rotigotine is ?
a) Dopamine agonist

b) Dopamine antagonist

c) GABA agonist

d) GABA antagonist

Correct Answer - A
Ans. is 'a' i.e., Dopamine agonist
Rotigotine
Rotigotine is a dopamine agonist drug and is indicated in the
treatment of parkinosonism.medpox.com
Rotigotine is intended to be delivered through transdermal patches,
so as to ensure a slow and constant dosage in a 24-hour period.
Side effects are--skin reaction at the patch site, nausea, vomiting,
diziness, drowsiness, insomnia.
533. Natalizumab is used in treatment of ?
a) Muliple sclerosis

b) Breast carcinoma

c) Psoriasis

d) B cell lymphoma

Correct Answer - A
Ans. is 'a' i.e., Multiple sclerosis
Treatment of multiple sclerosis
1. Treatment of acute attack
Corticosteroids (Methylprednisolone, prednisolone) are used
medpox.com
2. Treatment with disease-modifing agents that reduce the biological
activity of MS
Disease modifying agents for multiple sclerosis are (i) IFN-13 la; (ii)
IFN-13 lb, (iii) Glatiramer; (iv) Natalizumab; (v) Finoglimod: (vi)
Mitoxantrone; (vii) Cladaribine.
3. Other treatment options
Other off-label treatment options are (i) methotrexate; (ii)
cyclophosphamide; (iii) IV immunoglobulins; (iv) azathioprine.
4. Symptomatic Treatment
It includes healthy diet, regualr exercise.
Treatment of rigidity (baclofen, diazepam, tizanidine, dantroline)
Treatment of weakness (Potassium channel blockers like 4-
aminopyridine)
Treatment of pain by anticonvulsants (carbamezapine, phenytoin,
gabapentin, pregabalin), or antidiepressants (mexiletin).
Treatment of UTI, bladder dysfunction, constipation, depression,
fatigue and cognitive problems.
534. Most common receptor for typical
antipsychotics is ?
a) D1

b) D2

c) D3

d) D4

Correct Answer - B
Ans. is 'b' i.e., D2
ANTIPSYCHOTICS
medpox.com
Antipsychotic (neuroleptic) drugs can be divided into typical and
atypical.
Typical
Block D2 receptors
Have significant extrapyramidal symptoms (except for thioridazine) -
Parkinsonism, Acute muscular dystonia, Akathisia, Malignant
neuroleptic syndrome, Tardive dyskinesia.
Atypical
These are newer generation (second generation) antipsychotics that
have weak D2 blocking but potent 5-HT2 antagonistic activity.
Called atypical because they have no D2 blocking property (except
resperidone).
Extrapyramidal side effects are minimal (Resperidone can cause
some extrapyramidal effects).
Have no antiemetic effect.
Examples are → Clozapine, Risperidone, Olanzapine, Quetiapine,
Aripiprazole, Ziprasidone.
535. Patient on treatment on carbidopa +
levodopa for 10 yrs now has weaning off
effect. What should be added to restore
action ?
a) Tolcapone

b) Amantadine

c) Rasagiline

d) Benzhexol

Correct Answer - A medpox.com

Ans. is A i.e., Tolcapone
Both Entacapone and tolcapone enhance and prolong the
therapeutic effect of levodopa-carbidopa in advanced and fluctuating
parkinsons disease. They may be used to smoothen off the 'wearing
off', increase 'on' time and decrease 'off' time, improve activities of
daily living and allow levodopa dose to be reduced.
Tolcapone
It is a drug used to treat Parkinson's disease (PD).
It is a selective, potent and reversible nitrocatechol-type inhibitor of
the enzyme catechol-O-methyltransferase (COMT).
In comparison with entacapone, another nitrocatechol COMT
inhibitor, tolcapone has a longer half life (2.9 hours vs. 0.8 hours)
and can better penetrate the blood–brain barrier, acting both in the
central nervous system and in the periphery. However, entacapone
is less toxic for the liver.
Tolcapone improves the bioavailability and reduces the clearance of
levodopa and subsequently dopamine from the CNS.
Without administration of tolcapone, the beneficial effects of
levodopa tend to wear off more quickly, resulting in motor
fluctuations.

medpox.com
536. Patient of juvenile myoclonic epilepsy on
valproate comes to you at 5 months of
pregnancy with level H scan normal what
will you advise?
a) Change the drug

b) Continue the drug in same dose

c) Decrease the dose of drug

d) Increase the dose of drug

Correct Answer - B medpox.com

Ans. is 'b' i.e., Continue the drug in same dose
Valproic acid has the risk of fetal malformations during the first
trimester of pregnancy.
This patient has normal level II scan at 5 months of pregnancy so
the risk period of valproate is already over and valproate is the drug
of choice in juvenile myoclonic epilepsy.
Thus the drug shoud be continued in the same doses.
537. Varenicline acts by ?
a) Partial nicotine receptor agonist

b) Nicotine receptor antagonist

c) Both agonist and antagonist at nicotine receptor

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Partial nicotine receptor agonist
Varenicline
It is partial agonist at the nicotine receptor.
It is used in nicotine addicts.medpox.com
538. Drugs which potentiate effect of NMDA at
NMDA receptors are all except ?
a) Ketamine

b) Aspartic acid

c) D alanine

d) Homocysteic acid

Correct Answer - A
Ans. is 'a' i.e., Ketamine
Ketamine is NMDA receptor blocker so it does not potentiate the
NMDA action. medpox.com
 539. Which does not act by blocking NMDA
receptors?
a) Methoxetamine

b) Methadone

c) Ketamine

d) Diltiazem

Correct Answer - D
Ans. is 'd' i.e., Diltiazem
Drugs acting by blocking NMDA receptors are:
i. Methoxetamine medpox.com
ii. Phencyclidine
iii. Methadone
iv. Dizocilpine
v. Felbamate
vi. Dextropropoxyphene
vii. Acamprost
viii. Tramadol
ix. Ketamine
x. Pethidine
xi. Atomoxetine
xii. Nitrous oxide
540. Most common renal sequel of lithium
toxicity is ?
a) Nephrogenic DM

b) Renal tubular acidosis

c) Glycosuria

d) MPGN

Correct Answer - A
Ans. is 'a' i.e., Nephrogenic DM
Lithium associated renal toxicity
medpox.com
The use of lithium salts for the treatment of manic-depressive illness
may have several renal sequelae, the most common of which is
nephrogenic diabetes insipidus manifesting as polyuria and
polydipsia.
Lithium accumulates in principal cells of the collecting duct by
entering through the epithelial sodium channel (ENaC), where it
inhibits glycogen synthase kinase 3 and down- regulates
vasopressin-regulated aquaporin water channels.
Less frequently, chronic tubulointerstitial nephritis develops after
prolonged (greater than 10-20 years) lithium use and is most likely to
occur in patients that have experienced repeated episodes of toxic
lithium levels.
541. Magnan's phenomenon occurs in
addiction of:
a) Alcohol

b) Cocaine

c) LSD

d) Opiates

Correct Answer - B
Cocaine

medpox.com
 542. Most serious side effect of valproate is
a) Fulminant hepatits

b) Spina bifida

c) Weight gain

d) Thrombocytopenia

Correct Answer - A
Ans. is 'a' i.e., Fulminant hepatits
Valproate
Valproate acts by multiple mechanism :
1. Prolongation of inactivated Na* channel.
medpox.com
2. Inhibition of T type Ca' current.
3. Inhibition of degradation of GABA by GABA transminase →
facilitation of GABA mediated Cl- channel opening.
Its most serious adverse effect is fulminant hepatitis especially in
children below 3 years.
Used during pregnancy, it has produced spina bifida and other
neural tube defects.
Uses (other than epilepsy) --> mania & bipolar illness, prophylaxis of
migraine, trigeminal neuralgia, tardive dyskinesia.
Adverse effect of Valproate
Neurological - Ataxia, sedation,tremor
Systemic- Hepatotoxicity, thromobocytopenia,GI irritation, weight
gain, transient alopecia, hyperammonemia, pancreatitis,coagulation
disorder.
543. Oxcarbazepine true is all except ?
a) Metabolises itself

b) Less chances of hyponatremia than carbazepine

c) It is less enzyme inducer than carbamazepine

d) Less chances of hepatotoxicity than carbamazepine

Correct Answer - B
Ans. is 'b' i.e., Less chances of hyponatremia
Oxcarbazepine
It is rapidly converted into active metabolite.
Drug interactions and autoinduction of its own metabolism are less
medpox.com
marked, because it is a weak enzyme inducer.
Risk of hepatotoxicity is lower than with carbamazepine.
Chances of hyponatremia are more with oxcarbazepine compared to
carbamazepine.
It 1.5 times less potent than carbamazepine.
544. Treatment of choice for cheese reaction
?
a) Prazocin

b) Pentazocin

c) Phentolamine

d) Phenoxybenzamine

Correct Answer - C
Ans. is 'c' i.e., Phentolamine
Cheese reaction
medpox.com
Certain varieties of cheese, beer, wines, picked meat and fish, yeast
extract contain large quantities of tyramine, dopa.
In MAO inhibited patients these indirectly acting sympathomimetic
amines escape degradation in the intestinal wall and liver →
reaching into systemic circulation they displace large amount of NA
from adrenergic nerve endings Hypertensive crisis, cerebrovascular
accidents.
This can be treated by i.v. injection of a rapidly acting phentolamine.
Prazosin and chlorpromazine are alternative.
545. Following are the side effects of
thiazides except?
a) Hypokalemia

b) Hypocalcemia

c) Hepatic coma

d) Impotence

Correct Answer - B
Ans. is 'b' i.e., Hypocalcemia
Following are the side effects of thiazides:
Hypokalemia medpox.com
Acute saline depletion, hemoconcentration and increased risk of
peripheral venous thrombosis
Dilutionsalhyponatremia
Nausea omitting diarrhea
Rarely headache, giddiness, weakness, parethesias, impotence
Hearing loss
Rashes, photosensitivity
Hyperuricemia
Hyperglycemia hyperlipidemia o Hypercalcemia
Magnesium depletion
Aggravated renal insufficiency
Brisk diuresis leading to mental disturbance and hepatic coma
546. A = ACE inhibitor, B = beta blocker, C =
calcium channel blocker, D= diuretics.
For elderly with hypertension
antihypertensive drug of choice is ?
a) A or D

b) A or B

c) A or C

d) C or D

Correct Answer - D medpox.com

Ans. is 'd' i.e., C or D
Pharmacological treatment of hypertension
Indications of drug therapy (the British hypertension society
guidelines).
When sustained BP exceeds 160/100 mmHg or.
When BP is in the range of 140-159 / 90-99 mmHg and there is
target organ damage or cardiovascular disease.
For diabetics when BP exceeds 140/90 mmHg.
The optimal target is to lower BP to or below 140/85 mmHg in
nondiabetics and 140/80 mmHg in diabetics (WHO target is 130/85
mmHg).
Drug therapy
A simple stepped AB/CD regimen is used.
547. Digitalis produces which of the following
changes in ECG ?
a) Tall T waves

b) ST segment elevation

c) Prolonged QT interval

d) Prolonged PR interval

Correct Answer - D
Ans. is 'd' i.e., Prolonged PR interval
There are some characteristic ECG changes by digitalis use, some
medpox.com
of which occur at therapeutic concentration and some occurs at toxic
level :
At therapeutic level
Prolongation of PR interval
Scooping of ST segment → Also known as digitalis wave or dig sag
there is down sloping ST depression (initially)
Shortening of QT interval
Decreased T wave amplitude/or T wave inversion
At toxic level: Above changes are amplified
Prolongation of PR interval → conduction block may occur
T wave inversion
ST depression
QT interval shortens further
Increased automaticity → Arrhythmias
548. Anti-inflammatory dose of aspirin ?
a) 500 mg/d

b) 1 - 2 g/d

c) 3 - 6 g/d

d) 6 - 12 g/d

Correct Answer - C
Ans. is 'c' i.e., 3 - 6 g/d
The anti-inflammatory action of aspirin is exerted at high doses of 3 -
6 g/ day or 100 mg/ Kg/ day.
The anti-inflammatory action is mainly due to inhibition of COX,
medpox.com
causing inhibition of PGs synthesis.
In addition to COX inhibition, quenching of free radicals may
contribute to its anti-inflammatory action.
549. Mechanism of action of levosimenden is
?
a) Inoconstrictor

b) Potassium channel opener

c) Sodium channel opener

d) Beta blocker

Correct Answer - B
Ans. is b i.e., Potassium channel opener
Levosimendon
medpox.com
A new ionodilator is Levosimendon
It has inodilator effect by:
i) Inotropic effect : Levosimendon is calcium sensitiser, i.e. it
increases the sensitivity of the heart to calcium that results in
increased cardiac contractility without a rise in intracellular calcium.
ii) Vasodilatory effect : by opening ATP-sensitive potassium
channels in vascular smooth muscles it causes smooth muscle
relaxation.
550. Antihypertensive which can not be given
in pregnancy ?
a) Labetolol

b) Propranolol

c) Esmolol

d) Hydralazine

Correct Answer - B
Ans. is 'b' i.e., Propranolol

medpox.com
551. Fluoroquinolone with minimum
bioavailability ?
a) Levofloxacin

b) Moxifloxacin

c) Norfloxacin

d) Ciprofloxacin

Correct Answer - C
Ans. is 'c' i.e., Nortloxacin

medpox.com
 552. Maximum sterilising action is shown by
which anti TB drug ?
a) Rifampicin

b) INH

c) Pyrazinamide

d) Streptomycin

Correct Answer - A
Ans. is 'a' i.e., Rifampicin
There are three main properties of antitubercular drugs :-
medpox.com
i. Bactericidal activity (tuberculocidal activity).
ii. Sterilizing activity.
iii. Ability to prevent resistance
Bactericidal activity
Isoniazid and rifampicin are the most powerful bactericidal drugs,
active against all populations of TB bacilli. Pyrazinamide and
streptomycin are also bactericidal against certain populations of TB
bacilli.
Sterilizing activity
Sterilizing acitivity is the ability to kill all the bacilli in lesions as
rapidly as possible.
Rifampicin is the most potent sterilizing antitubercular drug.
Pyrazinamide is also having sterilizing action.
To prevent resistance
Ethambutol and thioacetazone are used in association with more
powerful drugs to prevent emergence of resistance.
553. Neuropsychiatry symptoms are seen
with which anti TB drug ?
a) INH

b) Rifampicin

c) Pyrazinamide

d) Streptomycin

Correct Answer - A
Ans. is 'a' i.e., INH
Adverse effects of INH
medpox.com
Peripheral neuritis (most common), hepatitis, optic neuritis &
atrophy, seizure, ataxia, muscle twitching, toxic encephalopathy,
psychoses, rashes, fever, arthralgia, acne, lupus like syndrome,
hemolytic anemia in G6PD deficiency.
Note: Most common antitubercular drug which is implicated in
causing peripheral neuropathy is INH.
554. Which anti TB drug is avoided in HIV
patient ?
a) INH

b) Rifampicin

c) Pyrazinamide

d) Streptomycin

Correct Answer - B
Ans. is 'b i.e., Rifampicin
All HIV-infected TB patients are candidates for ART, and the optimal
medpox.com
timing for its initiation is as soon as possible and within the first 8
weeks of anti-TB therapy.
Rifampin, a potent inducer of enzymes of the cytochrome P450
system, lowers serum levels of many HIV protease inhibitors and
some non- nucleoside reverse transcriptase inhibitors-essential
drugs used in ART.
In such cases, rifabutin, which has much less enzyme- inducing
activity, has been recommended in place of rifampin. However,
dosage adjustment for rifabutin and/or the antiret- roviral drugs may
be necessary.
555. Cyclic peptide chain is present in ?
a) Gramicidin A

b) Gramicidin B

c) Gramicidin D

d) Gramicidin S

Correct Answer - D
Ans. is d i.e., Gramicidin S
Gramicidin
Gramicidin is a heterogeneous mixture of three antibiotic
compounds, gramicidins A, B and C, making up 80%, 6%, and 14%,
medpox.com
respectively,all of which are obtained from the soil bacterial species
Bacillus brevis and called collectively gramicidin D.
Gramicidin D contains linear pentadecapeptides, that is chains made
up of 15 amino acid.
This is in contrast to gramicidin S, which is a cyclic peptide chain.
Gramicidin is active against Gram-positive bacteria, except for the
Gram-positive bacilli, and against select Gram-negative organisms,
such as Neisseriabacteria. Its therapeutic use is limited to topical
application, as it induces hemolysis in lower concentrations than
bacteria cell death, so it cannot be administered internally.
556. Drug of choice for MRSA infection ?
a) Ciprofloxacin

b) Oxacillin

c) Vancomycin

d) Clindamycin

Correct Answer - C
Ans. is 'c' i.e., Vancomycin
Methicillin resistance staphylococcus aureus (MRSA)
MRSA is a bacterium responsible for several difficult-to-treat
infections in humans. medpox.com
It may also be referred to as multi-drug resistant staphylococcus
aureus or oxacillin resistant staphylococcus aureus (ORSA).
MRSA is by definition any strain of staphylococcus aureus that is
resistant to a 13-lactams including penicillin, methicillin, cloxacillin,
nafcillin, oxacillin and cephalosporins.
Resistance develops due to alteration in transpeptidase (penicillin
binding protein) on which all 13-lactam antibiotic act : so, MRSA is
resistant to all 0-lactam antibiotics.
MRSA (especially community acquired MRSA; CA-MRSA) display
enhanced virulence, spreading more rapidly and causing disease
much more severe than traditional staphylococcus aureus.
557. Colistin is obtained from ?
a) Bacteria

b) Fungi

c) Actinmycetes

d) Herbs

Correct Answer - A
Ans. is 'a' i.e., Bacteria
Amongst the given options no drugs is obtained from fungus.
Antibiotics are obtained from -
1. Fungi - Penicilllin, Cephalosporin, Griseofulvin.
medpox.com
2.Bacteria - Polymyxin B, Colistin, Bacitracin, Tyrothricin,
aztreonam.
3. Actinomycetes - Aminoglycosides, Tetracyclines,
Chloramphenicol, macrolides, Polyenes.
558. HIV integrase inhibitor is ?
a) Elvitegravir

b) Abacavir

c) Maraviroc

d) Tenofovir

Correct Answer - A
Ans. is 'a' i.e., Elvitegravir
Integrase inhibitors
Raltegravir and Elvitegravir act by inhibiting enzyme integrase.
medpox.com
559. Treatment agent for scarlet fever is
a) Penicillin

b) Ciprofloxacin

c) Erythromycin

d) Chloramphenicol

Correct Answer - A
Ans. is 'a' i.e., Penicillin
Treatment :
Immediate hospitalization and isolation of the patient is indicated.
Penicillin is the treatment of choice.
medpox.com
560. Treatment for impetigo ?
a) Dicloxacillin

b) Ciprofloxacin

c) Gentamycin

d) Amoxicillin and clavulanic acid

Correct Answer - A
Ans. is 'a' i.e., Dicloxacillin
Treatment of impetigo is either dicloxacillin or cephalexin can be
given at a dose of 250 mg four times daily for 10 days.
Topical mupirocin ointment is also effective.
medpox.com
561. Which of the following can prolong QT
interval?
a) Nalidixic acid

b) Ofloxacin

c) Gatifloxacin

d) Pefloxacin

Correct Answer - C
Ans. is 'c' i.e, Gatifloxacin

medpox.com
562. Which of the following drugs has both
antihelminth and antiprotozoal activity ?
a) Nitazoxanide

b) Emetine

c) Chloroquine

d) Diloxanidefuroate

Correct Answer - A
Ans. is 'a' i.e., Nitazoxanide
Nitazoxanide
medpox.com
This is the salicylamidecogener of the antihelminthniclosamide,
introduced for the treatment of giardiasis and cryptosporidiosis and
is also active against other protozoa and helminthes including E.
histolytica, T. vaginalis, Ascaris and H. nana.
It is a prodrug which onn absorption is converted into active for
tizoxanide.
Tizoxanide is an inhibitor of PFOR enzyme that is the essential
pathway of electron transport energy metabolism in anaerobic
organisms.
563. Which of these is not used for the
treatment of typhoid ?
a) Chloramphenicol

b) Ciprofloxacin

c) Ceftriaxone

d) Cefixime

Correct Answer - D
Ans. is 'd' i.e., Cefixime

medpox.com
564. Antifungal which can be used orally but
not iv is?
a) Voriconazole

b) Amphoterecin B

c) Terbinafine

d) None of the above

Correct Answer - C
Ans. is 'c' i.e., Terbinafine

medpox.com
565. Bacteria not affected by streptogramins
is ?
a) E. coli

b) Staphylococcuaureus

c) Legionella

d) M. pneumoniae

Correct Answer - A
Ans. is 'a' i.e., E. coli
Streptogramins are active against gram-positive cocci and
medpox.com
organisms responsible for atypical pneumonia (e.g., M. pneumoniae,
Legionella spp., and Chlamydia pneumoniae), but largely inactive
against gram-negative organisms.
They are bactericidal against streptococci and many strains of
staphylococci, but bacteriostatic against E. faecium.
566. Not a drug recommended for P.
falciparum is ?
a) Quinine

b) Ciprofloxacin

c) Artemether

d) Doxycycline

Correct Answer - B
Ans. is 'b' i.e., Ciprofloxacin

medpox.com
567. Cephalosporin causing
thrombocytopenia is ?
a) Cefixime

b) Ceftazidime

c) Cefoperazone

d) Cefdinir

Correct Answer - B
Ans. is 'b' i.e., Ceftazidime
Adverse effects of cephalosporins
medpox.com
Hypersensitivity reaction - It is the most usual side effect. There is
cross allergy between penicillins and cephalosporine in 5-10% of
cases.
Diarrhea - due to alteration of gut flora, maximum with oral
cephradine and parentral cefperazone (cefperazone is significantly
excreted in bile) → May cause pseudomembranous colitis caused
by Cl. difficle.
Superinfection - Most common organisms are candida and
pseudomonas, less common are staphylococci, proteus.
Ceftriaxone achieves high concentration in bile and, as the calcium
salt, may precipitate to cause symptoms resembling cholelithiasis
(Biliary pseudolithiasis).
Nephrotoxicity - highest with cephaloridine.
Bleeding - ceftriaxone, cefoperazone, moxalactam & cefamandole
can cause hypoprothrmbinemia and bleeding.
Disulfiram like reaction - cefamandole, cefoperazone, moxalactam
and cefotetan can cause disulfiram like reaction with alcohol.
Neutropenia and thrombocytopenia can be caused by ceftazidim.
568. XDR TB is resistance to ?
a) Isoniazid

b) Isoniazid + Rifampicin

c) Isoniazid + Rifampicin + Ethambutol

d) Isoniazid + Rifampicin + Kanamycin

Correct Answer - D
Ans.is d i.e., Isoniazid + Rifampicin + Kanamycin
Treatment of extensive drug resistance (XDR) TB
XDR-TB is defined as resistance to any fluoroquinolone and at least
one of the following three second-line drugs (capreomycin,
medpox.com
kanamycin, amikacin), in addition to multidrug resistance.
The Regimen for XDR-TB would be of 24-30 months duration, with
6-12 months Intensive Phase (IP) and 18 months Continuation
Phase (CP).
Regimen is :-
i) Intensive phase (6-12 months) : Seven drugs : Capreomycin, PAS,
moxifloxacin, high dose INH, clofazimine, Linezolid, amoxyclay.
ii) Continuation phase (18 months) : Six drugs : PAS, moxifloxacin,
high dose INH, clofazimine, linezolid, amoxyclay.
569. Maximum liver toxicity is seen with
which anti -TB drug?
a) Isoniazid

b) Rifampicin

c) Pyrazinamide

d) Streptomycin

Correct Answer - C
Ans. is 'c' i.e., Pyrazinamide
Three first line antitubercular drugs are associated with
hepatotoxicity :? medpox.com
i) Rifampicin
ii) INH
iii) Pyrazinamide
Of the three, rifampicin is least likely to cause hepatocellular
damage, although it is associated with cholestatic jaundice.
Pyrazinamide is the most hepatotoxic of the first line drugs.
Among the second-line drugs, ethionamide, PAS and protionamide
can also be hepatotoxic, although less so than any of the first line
drugs.
570. Why quinine is unsafe in pregnancy?
a) It causes hemolysis

b) It causes hypokalemia

c) It causes hyponatremia

d) It causes smooth muscle contraction

Correct Answer - A
Ans. is 'a' i.e., It causes hemolysis
Quinine occasionally causes hemolysis, especially in pregnant
women and in patients with falciparum malaria resulting in
hemogloginuria and kidney damage. Also if used in pregnancy
medpox.com
special care should be taken to prevent hypoglycemia.
Ouinine
It is levo rotatory alkaloid obtained from cinchona bark. Its d-isomer
quinidine is used as an antiarrhythmic.
Quinine is an erythrocytic schizontocide for all species of
plasmodium.
Quinine has no effect on pre and exoerythrocytic stage.
Mechanism of action is similar to chloroquine.
571. Anti HIV drug used for prevention of
vertical transmission ?
a) Nevirapine

b) Lamivudine

c) Efavirez

d) Tenofovir

Correct Answer - A
Ans. is 'a' i.e., Nevirapine
Treatment during pregnancy
medpox.com
HIV infected mother can transmit the virus to fetus/infant during
pregnancy, during delivery or by breast feeding.
Early diagnosis and antiretroviral therapy to mother and infant
significantly decrease the rate of intrapartum and perinatal
transmission (vertical transmission) of HIV infection.
Zidovudine treatment of HIV infected pregnant women from the
beginning of second trimester through delivery and of infant for 6
weeks following birth decreases the rate of transmission from 22.6%
to < 5%.
Single dose of nevirapine given to the mother at the onset of labor
followed by a single dose to the newborn within 72 hours of birth
decreased transmission by 50%. This is the prefered regimen now in
developing countries.
572. A melanocytic naevus surrounded by a depigmented halo is called:
a) Sutton's nevus

b) Meyerson’s naevus

c) Cockade naevus

d) Nevus anaemicus

Correct Answer - A
Sutton's nevus/halo's nevus : a halo of depigmentation appears around a
preexisting melanocytic naevus.
Meyerson’s naevus is used to describe a melanocytic naevus that has developed an
associated inflammatory reaction, which looks like eczema.
medpox.com
Ref: Rook's textbook of dermatology, 8th edition Pg 54.20.
573. Most effective agent to prevent motion
sickness is?
a) Ephedrine

b) Nedocromil

c) Cyproheptidine

d) Hyoscine

Correct Answer - D
Ans. is `d' i.e., Hyoscine
Motion sickness is more easily prevented than cured.
medpox.com
Transdermal hyoscine (scopolamine) is the best agent for the
prevention of /notion sickness.
Antihistamines can also be used for prevention.
 574. Agent used for treatment of heparin
induced thrombocytopenia ?
a) Lepirudin

b) Abciximab

c) Warfarin

d) Alteplase

Correct Answer - A
Ans. is 'a' i.e., Lepirudin
Heparin induced thrombocytopenia (HIT)
medpox.com
Heparin induced thrombocytopenia is an important adverse effect of
heparin administration, usually caused by unfractionated heparin,
but may also be seen with the use of low molecular weight heparin
(LMWH).
HIT may be of two types :
1. Type 1 (Non-immune mediated) :- It is mild and heparin may be
continued.
2. Type 2 (Immune mediated) :- It is due to formation of antibodies
against platelets. Paradoxical thrombosis can occur. Heparin must
be discontinued immediately. Warfarin and LMW are
contraindicated. Lepirudin (a direct thrombin inhibitor) is
anticoagulant of choice. Alternatives are danaparoid, hirudin and
Argatroban.
 575. Anticancer drug with disulfuram like
action -
a) Procarbazine

b) Nitrosurea

c) 5 FU

d) Methotrexate

Correct Answer - A
Ans. is 'a' i.e., Procarbazine
Disulfiram like reaction
medpox.com
Certain drugs when taken concurrently with alcohol produce
disulfiram like actions.
That means these drugs produce similar distressing symptoms as
disulfiram, when taken with alcohol → flushing, burning sensation,
throbbing headache, prespiration, unesasiness, tightness in chest,
vomiting, dizziness, visual disturbances, mental confusion, postural
fainting and circulatory collapse.
The drugs causing Disulfiram like actions
i. Chlorpropramide
ii. Animal charcol
iii. Cephalosporins (Cefoperazone, moxalactam, cefamandole)
iv. Griseofulvin
v. Metronidazole
vi. Procarbazine
vii. Citrated calcium carbamide
viii. Tinidazine
ix. Cynamide
 576. TADALAFIL false is ?
a) It is longest acting phosphodiesterase inhibitor

b) It cannot be used for the treatment of PAH

c) It is used in erectile dysfunction

d) Its half life is 17-5 hours

Correct Answer - B
Ans. is 'b' i.e., It cannot be used for the treatment of PAH
1. Tadalafil is the longest acting phosphodiesterase inhibitor used for
erectile dysfunction.
2. Its half life is 17.5 hours. medpox.com
3. It can be used as once-daily phosphodiesterase type 5 (PDE5)
inhibitor for the treatment of pulmonary arterial hypertension (PAH).
577. Which of the following drugs is
contraindicated in liver dysfunction?
a) Pefloxacin

b) Vancomycin

c) Amikacin

d) Hydralazine

Correct Answer - A
Ans. is 'a' i.e., Pefloxacin

medpox.com
578. Irreversible hearing loss caused by ?
a) Gentamycin

b) Clarithromycin

c) Both of the above

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Gentamycin
Gentamycin is the most commonly used of the aminoglycosides. It
produces vestibular toxicity and irreversible hearing loss.
Clarithromycin is known to produce reversible hearing loss.
medpox.com
579. Mechanism of action of colchicine is ?
a) Inhibits gouty inflammation

b) Inhbits the release of chemotactic factors

c) Inhibits granulocyte migration

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
Colchicine
It is neither analgesic nor anti inflammatory.
It specifically inhibits gouty inflammation.
medpox.com
It is inhibits release of chemoattractant molecules.
It inhibits granulocyte migration into the joint.
It is antimitotic causes metaphase arrest by binding to microtubules.
It increases gut motility.
 580. Hypolipidemic drugs act on all except ?
a) HMG Co A reductase

b) Lipoprotein lipase

c) Acyl CoA, cholesterol acyl transferase 1

d) Peripheral decarboxylase

Correct Answer - D
Ans. is 'd' i.e., Peripheral decarboxylase
Hypolipidemic drugs
1. HMG-CoA reductase inhibitors (statins) - Lovastatin, Simvastatin,
Pravastatin, Atorvastatin, Rosuvastatin.
medpox.com
2. Bile acid sequestrants (Resins) - cholestyramine, colestipol.
3. Activate lipoprotein lipase (fibric acid derivatives) - clofibrate,
gemfibrozil, bezafibrate, fenofibrate.
4. Inhibit lipolysis and triglyceride synthesis - Nicotinic acid.
5. Other - Probucol, Gugulipid, Ezetimibe, Avasimibe, Torcetrapib.
Ezetimibe inhibits intestinal cholesterole absorption.
Avasimibe inhibits enzyme acyl Coenzyme A : cholesterol acyl
transferase-1 (ACAT-1) which causes esterification of cholesterol.
Torcetrapib inhibits cholesterol ester triglyceride transport protein →
T HDL cholesterol.
 581. Mannitol is not useful for ?
a) Glaucoma

b) Raised ICT

c) Impending renal failure

d) Pulmonary edema

Correct Answer - D
Ans. is 'd' i.e., Pulmonary edema
Mannitol
It is a nonelectrolyte of low molecular weight that is
pharmacologically inert. medpox.com
It raises osmolarity of plasma and tubular fluid.
Mannitol decreases tubular water and electrolyte reabsorption by ?
1. Due to osmotic effect, fluid is retained in the lumen of PT.
2. Inhibits transport processes in thick AscL+1 - most important cause
of diuresis.
3. Expands ECF (r intravascular volume) - draws water from the
intracellular compartment → increases GFR and inhibits renin
release.
4. Increases renal blood flow, especially to medulla -3 medullary
hypertonicity is reduced → corticomedullary osmotic gradient is
dissipated → passive salt reabsortion is reduced.
Uses - Raised IOT (glaucoma), raised ICT, to maintain. GFR and
urine flow in impending renal failure, and to counteract low
osmolality of plasma/ECF due to rapid hemodialysis.
Contraindications → Acute tubular necrosis (ARF), anuria,
pulmonary edema, Acute LVF, cerebral hemorrhage.
582. Vit K is available as all except ?
a) Menoquinone

b) Menadione

c) Phytonadione

d) Phytoquinone

Correct Answer - D
Ans. is 'd' i.e., Phytoquinone
Vitamin-K
It is a fat soluble vitamin.
It is the major coagulant of human body (coagulants are substances
medpox.com
which promote coagulation).
It is of three types ?
a) K1 (from plants) - Phytonadione
b) K2 (Produced by bacteria) - Menaquinones
C) K3 (Synthetic) - Menadione
Half life of vit K is 72 hours - Mahenderbhan Singh 5th/e - 348
lit K acts as a cofactor at a late stage in the synthasis of coagulation
factors by liver - Prothrombin (factor II), Factor VII, IX and X (also
protein 'C' & Protein '8").
It catalyzes the final step in activation of these factors i.e. gamma
carboxylation of glutamate residues which confers on them the
capacity to bind Ca+2 and to get bound to phospholipids surfaces -
properties essential for participation in the coagulation cascade.
583.

medpox.com
Drugs for paralytic ileus for bowel resection
surgery are all except ?
a) Alvinopam

b) Dihydroergotamine

c) Naloxone

d) Methylnaltrexone

Correct Answer - C
Ans. is 'c' i.e., Naloxone
Pharmacologic Management of Post op paralytic ileus (P01):
medpox.com
Minimizing the sympathetic inhibition of gastrointestinal motility,
decreasing inflammation and stimulation of gastrointestinal 11-opioid
receptors are the ultimate goals of pharmacologic management.
A) Minimizing sympathetic inhibition
Both propranolol, a nonspecific 13-receptor antagonist, and
dihydroergotamine, an a-receptor antagonist, have been
investigated for treatment of POI.
Neostigmine is an acetylcholinsterase inhibitor that causes an
increase in cholinergic (parasympathetic) activity in the gut wall,
which is believed to thereby stimulate colonic motility.
Use of edrophonium chloride and bethanechol chloride, which
competitively inhibit acetylcholine on the binding site of
acetylcholinesterase, has been reported to show improvement of
POI.
Cisapride is a serotonin (5-HT)4 receptor antagonist that promotes
acetylcholine release from postganglionic nerve endings in the
myenteric plexus and is thought to indirectly improve gastrointestinal
motility.
Metocloprimide is suspected to enhance gastrointestinal motility
without stimulating gastric secretion, but its use has not been
substantiated for POI.
B) Decreasing inflammation
Decreasing inflammation may be indicated in patients who are about
to undergo major intestinal surgery, as this is thought to be an
important contributing factor to POI.
Nonsteroidal anti-inflammatory (NSAIDs) agents can be used in
conjunction with opioid analgesics for their dual effects on pain
control and inflammatory inhibition.
C) Stimulation of gastrointestinal iii-opioid receptors
Stimulation of gastrointestinal .1-opioid receptors can theoretically
influence gastrointestinal motility directly; therefore, blocking the
peripheral gastrointestinal effects of centrally acting opioids used for
analgesia may help prevent POI.
Two novel drugs are being investigated for this reason: alvimopan
and methylnaltrexone.
Both drugs are If-opioid receptor antagonists, and both appear to
offer promising results for preventing prolonged POI.
Opioid therapy for postoperative or chronic pain is frequently
medpox.com
associated with adverse effects, the most common being dose-
limiting and debilitating bowel dysfunction, so alvimopan and
methylnaltrexone may also be useful in the treatment of chronic
opioid bowel dysfunction.
The currently available opioid antagonists such as naloxone are of
limited use because they also act at central opioid receptors to
reverse analgesia and elicit opioid withdrawal.
Alvimopan and methylnaltrexone are peripherally acting if-opioid
receptor antagonists that have been studied in patients undergoing
abdominal and pelvic surgery and have been shown in several
studies to significantly accelerate gastrointestinal recovery.
Alvimopan received FDA approval for the treatment of POI on May
20, 2008.
D) Alternative medications
Bisacodyl administration versus placebo twice daily starting on
postoperative day 1, patients who received bisacodyl had
significantly earlier bowel movements than those who received
placebo (25 h v. 56 h), but further studies are needed to assess the
effect of laxatives on POI.

medpox.com
584. Drugs causing peptic ulcer are all except
?
a) Clopidogrel

b) NSAID

c) Mycophenolate mofetil

d) Propylthiouracil

Correct Answer - D
Ans. is 'd' i.e., Propylthiouracil
Drug/Toxin causing peptic ulcer disease:
Bisphosphonates medpox.com
Chemotherapy
Clopidogrel
Crack cocaine
Glucocorticoids (when combined with NSAIDs)
Mycophenolate mofetil
Potassium chloride
585. The commonest side-effect of Cisapride
is -
a) Abdominal cramps

b) Diarrhea

c) Headache

d) Convulsions

Correct Answer - B
Ans. is 'b' i.e., Diarrhea
Cisapride is a prokinetic agent and often produces loose stools
medpox.com
(diarrhea is thus the commonest side effect)
586. Drug not acting on P2y12 receptor is ?
a) Ticlopidine

b) Clopidrogel

c) Dipyridamole

d) Prasugrel

Correct Answer - C
Ans. is 'c' i.e., Dipyridamole
Dipyridamole: inhibits phosphodiesterase as well as blocks uptake of
adenosine to increase platelet cAMP which in turn potentiates PGI2
and interferes with aggregation.
medpox.com
Ticlopidine, Clopidogrel and prasugrel act on the P2y12 receptor
and inhibits ADP as well as fibrinogen induced platelet aggregation.
Note: Prasugrelis the latest most potent and fastest acting P2Y12
purinergic receptor blocker. It is used in acute coronary sydromes
and when strong antiplatelet action is required).
587. Active substance in Dakins skin dressing
agent used in burns is ?
a) Mafenide acetate

b) Silver sulfadiazine

c) Sodium hypochlorite

d) Nystatin

Correct Answer - C
Ans.C. Sodium hypochlorite
Dakin's skin dressing agent contains sodium hypochlorite'
medpox.com
It is used for superficial and deep burns.
588. Omalizumab is ?
a) Anti IgM antibody

b) AntilgG antibody

c) Anti IgE antibody

d) Anti IgD antibody

Correct Answer - C
Ans. is 'c' i.e., Anti IgE antibody

medpox.com
 589. Nicotinic acid ?
a) Increases HDL

b) Increased triglyceride synthesis

c) Type II hyperlipoproteinemia

d) Decreased hydrolysis of VLDL

Correct Answer - A
Ans. is 'a' i.e., Increases HDL
Nicotinic acid (Niacin)
There arc three main type of lipases related to metabolism of
lipoproteins ? medpox.com
1. Lipoprotein lipase → Present in blood vessels and causes hydrolysis
of tryglyceride content of VLDL and chylomicrones.
2. Hepatic lipase → Converts IDL to LDL by hydrolysing the triglyceride
content of IDL.
3. Hormone sensitive lipase → Present intracellularly in peripheral
tissue and causes intracellular lipolysis by hydrolysing triglycerides.
Niacin (Nicotinic acid) inhibits intracellular lipolysis by inhibiting
hormone sensitive lipase → intracellular FFA to liver - 4 .1,
triglyceride synthesis.
Niacin also increases the activity of lipoprotein lipase → T hydrolysis
of VLDL triglyceride.
Nicotinic acid also reduces the production of VLDL in liver by
inhibiting TG-synthesis → indirectly the VLDL degradation products
IDL and LDL are also reduced.
Nicotinic acid is the most effective drug to raise HDL-CH.
Increased HDL is due to interference of direct pathway of HDL
cholesterol to liver which involves apo-Ai → Niacin decreases apo-
A, mediated hepatic clearance.
Nicotinic acid is used in type I, III, IV & V hyperlipoproteinemias.

medpox.com
590. Drug that decreases LpA in blood ?
a) Statin

b) Nicotinic acid

c) Ezetimibe

d) CETP inhibitors

Correct Answer - B
Ans. is 'b' i.e., Nicotinic acid
Nicotinic acid reduces Lp(a) while statins do not have any effect on
Lp(a).
medpox.com
591. Platelet adhesion is inhibited by ?
a) Nitric oxide

b) Substance P

c) Thrombin

d) IL 2

Correct Answer - A
Ans. is 'a' i.e., Nitric Oxide

medpox.com
592. Which of the following is the longest
acting oral anticoagulant ?
a) Bishydroxycoumarin

b) Warfarin

c) Acenocoumarol

d) Phenindione

Correct Answer - A
Ans. is 'a' i.e., Bishydroxycoumarin
Bishydroxycoumarin (Dicumarol) is the longest acting oral
anticoagulant. medpox.com
Ethylbiscoumacetate is the shortest acting anticoagulant.
593. Methysergide is banned as it causes ?
a) Pulmonary fibrosis

b) Pleural effusion

c) Syncope

d) Myocarditis

Correct Answer - A
Ans. is 'a' i.e., Pulmonary fibrosis
Methysergide
It is chemically related to ergot alkaloids and antagonizes the action
of serotonin on smooth muscles including that of blood vessels,
medpox.com
withot producing ergot like effects.
It is a potent 5HT2A/2C antagonist.
It has been used for migraine prophylaxis, carcinoid and
postgastrectomy dumping syndrome.
Prolonged use has caused abdominal, pulmonary and endocardial
fibrosis, because of which it has gone into disrepute.
594. Which of the following is a univalent
direct thrombin inhibitor?
a) Argatroban

b) Hirudin

c) Bivalirudin

d) Lepirudin

Correct Answer - A
Ans. is 'a' i.e., Argatroban
Direct thrombin inhibitors (DTIs)
medpox.com
This is a class of medications that act as anticoagulants by directly
inhibiting the thrombin (unlike heparin which inhibits thrombin
indirectly through antithrombin → so, heparin is an indirect thrombin
inhibitor).
595. Streptokinase causes increase in ?
a) Plasmin

b) Thrombin

c) Kallikrein

d) Angiotensin II

Correct Answer - A
Ans. is 'a' i.e., Plasmin
Streptokinase
Fibrinolytic drug
Obtained from group C streptococci
medpox.com
Streptokinase is inactive as such. It combines with' circulating
plasminogen molecules to form an activator complex, which then
causes limited proteolysis of other plasminogen molecules to
generate active enzyme plasmin.
596. LT antagonists are used in asthma for ?
a) Along with beta agonists to reduce steroids

b) In place of beta blockers as sole therapy

c) Prophylactic therapy for mild to moderate asthma

d) Definitive therapy in acute attack of asthma

Correct Answer - C
Ans. is 'c' i.e., Prophylactic therapy for mild to moderate asthma
Monteleukast and zafirleucast are cystenyl LT1 (cys LT1) receptor
antagonists.
They are indicated for prophylactic therapy of mild to moderate
medpox.com
asthma as alternatives to inhaled glucocorticoids.
597. Following is true about iron dextran
except ?
a) It is parenteral iron preparation

b) It can be given either iv or im

c) It binds to transferrin

d) It is not excreted

Correct Answer - C
Ans. is 'c' i.e., It binds to trnasferrin

medpox.com
598. Compared to high molecular weight
heparin following is true about low
molecular weight heparin ?
a) Monitoring is not needed for low molecular weight heparin

b) Daily two subcutaneous doses are essential

c) They are easily filtered at the glomerulus

d) They do not interact with plasma proteins

Correct Answer - B
Ans. is 'b' i.e., Daily two subcutaneous doses are essential
medpox.com
Advantages of LMWH
Longer, more consistent and predictable response —> Single daily
dose is sufficient by subcutaneous route. o Lower risk of
osteoporosis and HIT syndrome.
Bleeding chances are less : LMW heparins have a different
anticoagulant profile.
They selectively inhibit factor Xa with little effect on antithrombin and
coagulation in general.
They act only by inducing conformational change in AT III.
They appear to have lesser antiplatelet action.
As a result they have a small effect on a PTT and whole blood
clotting time.
Since a PTT/clotting times are not prolonged (much) laboratory
monitoring is not needed, and the incidence of haemorrhagic
complication is less.
They are easily filtered from glomerular capillaries because of there
smaller molecular weight.
LMW heparins do not interact with plasma proteins.


medpox.com
599. Prophylactic dose of vitamin K given to
new born infants at delivery is ?
a) 1mg

b) 5mg

c) 10mg

d) 15mg

Correct Answer - A
Ans. is 'a' i.e., 1 mg
Vitamin K Deficiency in Newborns
medpox.com
The symptoms of vitamin K deficiency are due to hemorrhage
Newborns are particularly susceptible to vitamin K deficiency
because of low fat stores, low breast milk levels of vitamin K, sterility
of the infantile intestinal tract, liver immaturity, and poor placental
transport.
Intracranial bleeding, as well as gastrointestinal and skin bleeding,
can occur in vitamin K-deficient infants 1​7 days after birth.
Thus, vitamin K (1 mg IM) is given prophylactically at the time of
delivery.
600. Which of the following is not an anti
histaminic drug of the ethanolamine
group?
a) Clemastine

b) Diphenhydramine

c) Dimenhydrinate

d) Chlorpheniramine

Correct Answer - D
Ans. is d i.e., Chlorpheniramine
medpox.com
Ethanolamine derivative group of antihistaminics are:
Carbinoxamine maleate
Clemastinefumarate
Diphenhydrmine HC1
Dimenhydrinate
601. All of the following can precipitate
porphyria except ?
a) Steroids

b) Griesiofulvin

c) Penicillin

d) Estrogen

Correct Answer - C
Ans. is 'c' i.e., Penicillin
Penicillin is a safe drug in acute intermittent porphyria
medpox.com
Drugs precipitating acute intermittent porphyria
Barbiturates
Griseofulvin
Chlorpropramide
Rifampicin
Oral contraceptives
Estrogen
Phenytoin
Sulfonamides
602. Heparin activates following factors
except ?
a) IIa

b) VIIa

c) IXa

d) Xa

Correct Answer - B
Ans. is `b' i.e., Villa
Chemical nature and preparation of Heparin
medpox.com
Heparin is a sulfated mucopolysaccharide which occurs in the
secretory granules of mast cells.
It is the strongest organic acid in the body and in the solution it
carries an electronegative charge.
It is prepared commercially from a variety of animal tissues
(generally porcine intestinal mucosa or bovine lung).
Mechanism of Action of Heparin
Heparin acts by activating antithrombin which is a naturally occuring
inhibitor of activated coagulation factors of intrinsic and common
pathway.
 603. Bromocriptine is used in following
clinical situations except ?
a) Type II DM

b) Hepatic Coma

c) Cyclical mastalgia

d) Hypoprolactinemia

Correct Answer - D
Ans. is `d' i.e., Hypoprolactinemia
Uses of Bromocriptive
medpox.com
Bromocriptine is a powerful dopamine agonist. It suppresses
prolactin secretion while promoting secretion of gonadotropins.
Its therapeutic uses are:
i. Suppression of lactation in galactorrhea
ii. Cyclical mastalgia
iii. Induction of ovulation in anovulatory infertility caused by
hyperprolactinemia
iv. Parkinsonism
v. Acromegaly due to small pitutary tumours
vi. Hepatic coma
vii. Recently, it has been approved for treatment of type 2 DM.
604. Following is true about GnRH agonists
except ?
a) Used in cases of precocious puberty

b) They have action similar to gonadotropin releasing hormone

c) Long acting preparations can be used as nasal spray

d) Ganirelix is the most potent agent

Correct Answer - D
Ans. is 'd' i.e., Ganirelix is the most potent agent
GnRH agonists
medpox.com
Long acting GnRH (LHRH) agonists causes reversible
pharmacological orchiectomy (medical castration) and are used for
precocious puberty, prostatic carcinoma, endometriosis,
premenopausal breast cancer, uterine leiomyoma, polycystic ovarian
disease and to assist induced ovulation.
GnRH agonists have action similar to Gonadotropin releasing
hormone, i.e., they increase the secretion of gonadotropins (FSH,
LH).
Then how do they suppress gonadol function ? Lets see.
GnRH agonists increases Gn secretion.
But after 1-2 weeks they cause desensitization and down-regulation
of FSH/LH receptors. (continous exposure to agonist may cause
down regulation of receptors) —> suppression of gonadal function.
Spermatogenesis/ovulation cease and testosterone/estrogen levels
fall to castration level because the action of Gonadotropins (FSH &
LH) is not there (these hormones promote gametogenesis and
secretion of gonadal hormones).
Preparation of superactive GnRH analogues are —> Busereline,
Goserelin, Leuprolide, Nafarelin, Triptorelin.
Superactive/Long acting GnRH are used as nasal spray or SC
injection.
Cetrorelix, ganirelix and abarelix are GnRh antagonists. These are
used subcutanously for the treatment of uterine fibroid &
endoinetriosis and for controlled ovarian stimulation in in-vitro
fertilization.
GnRh agonists as well as GnRh antagonists can cause hot flushes,
loss of libido and osteoporosis as adverse effects.

medpox.com
605. Female on carbimazole therapy presents
with sudden fever, rigors and sore
throat. Which is the investigation of
choice for this patient?
a) Check blood counts

b) Check C reactive protein

c) Take throat Swab

d) Treat for malaria

Correct Answer - A medpox.com

Ans. is 'a' i.e., Check blood counts
The most common side effect of carbimazole is maculopapular
pruritic rash, while most serious adverse effect is agranulocytosis
which is reversible.
Patient in the given question presents with sudden onset fever,
rigors and sore throat. Infection of any site which is sudden onset
and rapidly progressive in a patient on carbimazole therapy the
suspicion should be development of agranulocytosis, so it is
essential to do blood counts.
606. HbA1C is decreased most by?
a) Biguanides

b) Sulfonylureas

c) Thiazolidinediones

d) Acarbosc

Correct Answer - B
Ans. is 'b' i.e., Sulfonylureas
Effect of oral hypoglycemic in lowering blood glucose can be
measured by reduction in HbAlC level
i) Oral hypoglycemic with maximum decrease in HbAlc
medpox.com
sulfonylureas.
ii)Oral hypoglycemic with minimum decrease in HbAIC Glucosidase
inhibitors (Acrarbose, Migital)
607. Cabergoline is used in -
a) Acromegaly

b) Hyperprolactinoma

c) Both a and b

d) None of the above

Correct Answer - C
Ans. is 'c' i.e., Both a and b
Prolactin is physiologically involved in lactation. In a breast which
has been primed by female hormones (estrogen and progesteron),
prolactin induces and maintains lactation by stimulating synthesis of
medpox.com
milk. Prolactin is the only pituitary hormone which is primarily
under the inhibitory control of hypothalamus. Its secretion is
inhibited by dopamine (prolactin inhibiting substance) through
D2 receptors. Therefore, dopamine agonists inhibit prolactin
release, and D, antagonists (antipsychotics, metoclopromide) cause
hyperprolactinemia.
o Bromocripitine, a synthetic ergot, is a potent dopamine agonist
with greater action on D2 receptors. On Di receptors it acts as
partial agonist or antagonist. It also has a weak a-adrenergic
blocking action. Bromocriptine decreases (i) Prolactin secretion,
(ii) GI motility, and (iii) GH secretion in acromegaly. It stimulates
CTZ to cause nausea and vomiting. It is used in
hyperprolactinemia, suppression of lactation in galactorrhea,
cyclic mastalgia, parkinsonism, acromegaly, hepatic coma, and
type 2 DM (recently approved).
Cabergoline is another D2 agonist, which is more potent and longer
acting than bromocriptine. It is preferred for acromegaly and
hyperprolactinemia. Quinagolide, other D, agonist, its effective for
hyperprolactinemia.

medpox.com
608. Tamoxifene ?
a) SSRI

b) SERM

c) SNRI

d) DNRI

Correct Answer - B
Ans. is `b' i.e., SERM
Tamoxifen is a selective estrogen receptor modulator (SERM).

medpox.com
609. Letrozole belongs to which group?
a) SERM

b) SERD

c) LHRH analogues

d) Aromatse inhibitors

Correct Answer - D
Ans. is 'd' i.e., Aromatase inhibitors
Aromatase inhibitors
Aromatase inhibitors are drugs which inhibit the enzyme Aromatase.
Aromatase is an enzyme responsible for the conversion of
medpox.com
testosterone (androgens) to estrogens.
This conversion of androgens to estrogens occur in several tissues
including ovary, adrenal cortex, peripheral tissues.
Inhibition of Aromatase leads to decrease in estrogen level.
Aromatase inhibitors prevent the conversion of androgens to
estrogens only in postmenopausal women, not in premenopausal
women.
In premenopausal women, as the level of estrogens decrease it
activates the pituitary hypothalamic axis. Activation of pituitary
hypothalamic axis leads to increased secretion of pituitary
gonadotropins. The pituitary gonadotropins inturn increase the
secretion of estrogens. Thus the estrogen level returns back to their
normal level.
On the other hand aromatase inhibitors effectively decrease the
secretion of estrogen in postmenopausal women.
In postmenopausal women, the production of estrogen from
androgens occurs, only in extraovarian sites such as peripheral
tissues where the conversion of androgens to estrogens is blocked
 by aromatase inhibitors.
Use of aromatase inhibitors
Aromatase inhibitors are used in the t/t of Hormone receptor positive
breast carcinomas in postmenopausal women. They are not
effective in premenopausal women.
How are Aromatase inhibitors useful in Breast carcinomas ?
In breast carcinomas, estrogen delivers growth signals to the
hormone receptors. The hormone receptors upon receiving the
growth signals, cause the proliferation of tumor cells.
After the inhibition by aromatase inhibitors, estrogen level
decreases, this leads to lesser delivery of growth signals and in turn
lesser proliferation of tumor cells.
Aromatase inhibitors are of two types :
Type I (steroidal) aromatase inhibitor - They cause irreversible
inhibition of aromatase, e.g. Exmestane, formestane.
Type II (non-steroidal) aromatase inhibitor - They cause reversible
inhibition of aromatase e.g. Anastrazole, Letrozole, vorozale.
Above classification is based on chemical structure (steroidal or non-
steroidal) and type of inhibition (reversible or irreversible). Based on
medpox.com
the evolution the aromatase inibitors arc:
i. First generation → Aminoglotethimide
ii. Second generation → Steroidal type I (Example, formestane), non-
steroidal type II (Anastrazole, Letrozole, Vorozole, fadrozole)
Side effects - Hot flushes, nausea, diarrhoea, dyspepsia, thinning of
hair and Joint Pain (Arthralgia) and increased risk of fracture.
There is no endometrial proliferation (no risk of endometrial
carcinoma), no risk of venous thromboembolism and no
deterioration of lipid profile.
Remember
Anastrozole and letrozole are nonsteroidol compound, while
exemestane is steroidol. o Exemestane also has weak androgenic
activity.
Anastrozole is more potent than letrozole.
First generation aromatase inhibitors → Aminoglutethimide.
Second generation aromatase inhibitors → Letrozole, anastrozole,
fadrozole and exemestone.
610. DMPA is given once in -
a) 3 months

b) 6 months

c) 9 months

d) 45 days

Correct Answer - A
Ans. is 'a' i.e., 3 months
HORMONAL CONTRACEPTIVES
These are hormonal preparations used for reversible suppression of
fertility. medpox.com
Types of methods
A. Oral
Combined pill (monophasic pills)
It contains an estrogen and a progestin.
This is the most effective and popular method.
Efficacy is 98-99%
Preparation are -
Ethinyl estradiol 30 pg (•03 mg) + Norgestrel 0.3 mg
Ethinyl estradiol 50 .tg (•05 mg) + Levonorgestrel 0.25 mg
Ethinyl estradiol 30 pig (•03 mg) + Desogestreol 0.15 mg
One tablet (containing estrogen and progesterone) is taken daily for
21 days starting on 51"day of mensturation.
Phased regimens
The estrogen dose is kept constant (or varied slightly between 30-40
mg), while the amount of pregestin is low in first phase and
progressiely higher in the second and third phases.
Preparations are
Biphasic pills
Day 1-10 → Ethinyl estradiol 35 mg + Norethindrone 0.5 mg
Day 11-21 → Ethinyl estradiol 35 mg + Norethindrone 1 mg.
Triphasic pills
Day 1-7 → Ethinyl estradiol 35 mg + Norethindrone 0.5 mg
Day 8-14 →Ethinyl estradiol 35 mg + Norethindrone 0.75 mg
Day 15-21 → Ehinyl estradiol 35 mg + Norethindrone 1 mg
Minipill (progestin only pill)
A low dose progestin pill is taken daily without any gap.
Preparations → Norethindrone (0.35 mg) or Norgestrel 75 mg.
Postcoital (emergency) pills.
a) Levonorgestrel 0.5 mg + ethinyl estradiol 0.1 mg —> within 72
hours of unprotected intercourse and repeated after 12 hours -
Yuzpe method.
b) Levonorgestrel alone 0.75 mg taken twice with 12 hour gap within
72 hours of unprotected intercourse → method of choice for
emergency contraception.
c) Mifepristone 600 mg single dose within 72 hours of unprotected
intercourse.
B. Injectable medpox.com
They are given i.m. as oily solution
1.Long acting progestin alone
a) Depot medroxy progesterone acetate (DMPA) 150 mg at 3 month
intervals. or
b) Norethindrone (norethisterone) enanthate (NEE) 200 mg at 2
months intervals.
c) The most important undesirable property is complete disruption of
menstural bleeding pattern and total amenorrhoea (more common
with DMPA).
2.Long acting progestin + long acting estrogen - once a month.
611. Pramlintide is ?
a) Synthetic amylin analogue

b) Inhibitor of DPP 4

c) GLP 1 analogue

d) PPAR gamma

Correct Answer - A
Ans. is 'a' i.e., Synthetic amylin analogue
NEWER ANTIDIABETIC DRUGS
Exenatide
Exenatide is a synthetic glucagon-like peptide - 1 (GLP-1) analogue.
medpox.com
GLP-1 is an important incretin that is released from gut in response
to oral glucose.
But GLP-1 can not be used clinically as it is degraded rapidly by
enzyme dipeptidly peptidase → (DPP-4).
Exenatide is resistant to DPP-4.
It acts similar to GLP-1 → Enhancement of postprandial insulin
release, suppression of glucagon release and appetite as well as
slowing of gastric emptying.
It is given by subcutaneous route & used in type 2 DM
Nausea is most important side effect.
Sitagliptin
This is orally active inhibitor of DPP-4.
It prevents degradation of endogenous GLP-1 and other incretins,
potentiating their action, resulting in limitation of postprandial
hyperglycemia.
It is used in type 2 DM.
Other DPP-4 inhibitor is vildagliptin
Pramlintide
This is a synthetic amylin analogue (Amylin is a polypeptide
produced by pancreatic (3-cells which reduces glucagon secretion
from a-cells and delays gastric emptying).
Pramlintide attenuates postprandial hyperglycemia and exerts a
centrally mediate anorectic action. o It is given by subcutaneous
route and is used in both Type 1 and Type 2 DM.
Glucomannan
This is powdered extract from tuber of konjar.
It is promoted as a dietary adjunct for diabetes.
It swells in stomach by absorbing water and is claimed to reduce
appetite, blood sugar, serum lipids and relieve constipation.
Bromocriptine
Recently bromocriptine has been approved by FDA, as an adjunct to
diet and exercise to improve glycemic control in type 2 DM. It has
been found that dopamine alter insulin resistance by acting on
hypothalmus and bromocriptine blocks O2 receptors.

medpox.com
612. Which drug prevent peripheral
conversion of T4 to T3 -
a) Propylthiouracil

b) Propranolol

c) Iodides

d) a and b both

Correct Answer - D
Ans. is 'a' i.e., Propylthiouracil & 'b' i.e., Propranolol
medpox.com
613. 1, 25 dihydrocholecalciferol acts on ?
a) Surface receptors

b) Cytosolic receptors

c) Intranuclear receptors

d) None of the above

Correct Answer - C
Ans. is 'c' i.e., Intranuclear receptors

medpox.com
614. Dose of centchroman is ?
a) 30 mg

b) 60 mg

c) 120 mg

d) 240 mg

Correct Answer - A
Ans. is 'a' i.e., 30 mg
Cetchroman (Saheli)
Ormeloxifene, research product of Central Drug Research Institute,
Lucknow, India. medpox.com
It is a potent non - steroidal compound with potent anti - estrogenic
and weak estrogenic properties. It is taken orally (30 mg) twice a
week for first three months then once a week.
It works primarily by preventing implantation of fertilized ovum. It
does not inhibit ovulation.
It is avoided in PCOD, with liver and kidney diseases and in
tuberculosis. There may be a tendency of oligomenorrhoea.
The failure rate is 1 - 4/100 woman years of use. Failure rate is less
with increased doses. It is devoid of any significant adverse
metabolic effect.
This may also be used as a emergency contraceptive.
615. Reason for hepatic involvement in oral
contraceptives is ?
a) Estrogen

b) Progesterone

c) Estrogen +Progesterone

d) Mixed trace elements

Correct Answer - A
Ans. is 'a' i.e., Estrogen
Hepatotoxicity with oral contraceptive pills
medpox.com
While early formulations of OCPs were associated with frequent
serum enzyme elevations, current formulations and hormonal
replacement therapy have not been linked to ALT or alkaline
phosphatase elevations at rates any higher than occur with placebo.
Estrogens in OCPs can cause mild inhibition of bilirubin excretion
leading to jaundice in patients with inherited forms of bilirubin
metabolism such as the Dubin Johnson syndrome.
It can induce a clinically apparent cholestatic liver injury which
typically arises during the first few cycles of therapy, and rarely after
the six months.
It has also been linked to hepatic tumors, both benign and
malignant.
616. Incretin like function is seen in ?
a) Exenatide

b) Miglital

c) Poiglitazone

d) Repaglinide

Correct Answer - A
Ans. is 'a' i.e., Exenatide
Exenatide is a synthetic glucagon-like peptide - 1 (GLP-1) analogue.
GLP-1 is an important incretin that is released from gut in response
to oral glucose. medpox.com
But GLP-1 can not be used clinically as it is degraded rapidly by
enzyme dipeptidly peptidase → (DPP-4).
Exenatide is resistant to DPP-4.
It acts similar to GLP-1 → Enhancement of postprandial insulin
release, suppression of glucagon release and appetite as well as
slowing of gastric emptying.
It is given by subcutaneous route & used in type 2 DM
Nausea is most important side effect.
617. Which is a long acting insulin?
a) Lispro

b) Aspart

c) Glargine

d) Glulicine

Correct Answer - C
Ans. is 'c' i.e., Glargine

medpox.com
618. Special feature of glargine insulin is ?
a) It produces a smooth peakless effect

b) It is not suitable for once daily administration

c) It remains souble at pH 7

d) It can control meal time hyperglycemia

Correct Answer - A
Ans. is 'a' i.e., It produces a smooth peakless effect
InsuinGlargine
It is long acting biosynthetic insulin.
It remains soluble at pH 4 of the formulation and precipitates at
medpox.com
neutral pH on subcutaneous administration.
Onset of action is delayed.
It produces a smooth peakless effect.
It is suitable for once daily administration.
Low incidence of night time hypoglycemia.
It does not control meal time yperglycemia.
619. Long acting corticosteroid is ?
a) Triamcinolone

b) Betamethasone

c) Hydrocortisone

d) Prednisolone

Correct Answer - B
Ans. is 'b' i.e., Betamethasone
Short acting glucocorticoids (t1/2 : 8-12 hrs.) : Cortisol,
hydrocortisone.
Intermediate acting glucocorticoids (t1/2 : 12-36 hrs.) : Prednisolone,
medpox.com
methylprednisolone, triamcinolone.
Long acting glucocorticoids (t1/2 : 36-54 hrs.) : Dexamethasone,
betamethasone.
620. Adrenocortical suppression causing
drugs are all except ?
a) Prednisone

b) Ketoconazole

c) Mitotane

d) Spironolactone

Correct Answer - D
Ans. is 'd' i.e., Spironolactone
Drugs causing adrenocortical suppression are:
medpox.com
Steroids (prednisone, hydrocortisone, and dexamethasone)
Aminoglutethimide
Fludrocortisone
Ketoconazole
Megestrol
Metyrapone
Mitotane
621. Drug which decreases efficacy of
testosterone
a) Isoniazid

b) Ketoconazole

c) Rifampicin

d) None

Correct Answer - B
Ans. is 'b' i.e., Ketoconazole

medpox.com
 622. Danazol has which of the following
actions ?
a) Weak androgenic

b) Progestational

c) Anabolic

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
Danazole
medpox.com
It has weak androgenic, anabolic and progestational activity.
The most prominent action is suppression of gonadotropin (FSH/LH)
from pitutary in both men and women → inhibition of
testicular/ovarian function.
Uses are :
1. Endometriosis (major use)
2. Fibrocystic breast disease
3. Infertility
4. Menorrhagia
5. Hereditary angioneuretic edema
Side effects are complete amenorrhoea, androgenic effects (acne,
hirusitism, decreased breast size, deepening of voice, edema,
weight gain), loss of libido in men, hot flushes in women, night
sweats and muscle cramp.
Liver enzyme may be raised.
623. Fastest acting antithyroid drugs ?
a) Iodides of Na/ K

b) Propylthiuracil

c) Methimazole

d) Nitrates

Correct Answer - A
Ans. is 'a' i.e., Iodides of Na
Iodine and Iodides
Iodine is the fastest acting thyroid inhibitor
Most important action is inhibition of hormone release (thyroid
medpox.com
constipation); but all facets of thyroid synthesis may be affected.
Excess iodide inhibits its own transport in thyroid cells and may alter
the redox potential of cells, thus interfering iodination → reduced
T4/T3 synthesis (Wolff-chaikoff effect).
624. Mechanism of action Trilostane ?
a) 11 beta hydroxylase inhibitor

b) 1 alpha hydroxylase inhibitor

c) 3 betahydroxysteroiddehydrgenase inhibitor

d) 7 alpha hydrolase inhibitor

Correct Answer - C
Ans. is 'c' i.e., 3 beta hydroxyl steroid dehydrogenase inhibitor

medpox.com
625. Insulin secretion increasing drug by
acting on beta cells of pancreas is -
a) Rapaglinide

b) Metformin

c) Poiglitazone

d) Acarbose

Correct Answer - A
Ans. is 'a' i.e., Rapaglinide
Oral hypoglycemic drugs may be divided into two groups.
1. Group 1 medpox.com
These drugs reduce plasma glucose by stimulating insulin
production, therefore called insulin secretogogues.
Hypoglycemia is a well known side effect.
Examples are:
i) Sulfonylureas: first generation (chlorpropamide, tobutamide);
second generation (Glimipiride, glyburide, glipizide, gliclazide).
ii) Megalitinnide/D-phenylalanine analogues: Nateglinide,
Rapaglinide.
2. Group 2
These drugs reduce blood glucose without stimulating insulin
production, therefore are insulin non​secretogogues.
These durgs do not cuase hypoglycemia when used alone and can
cause hypoglycemia, only when used with other oral hypoglycemics.
Examples are:
i) Biguanides: Metformin, Phenformin
ii) Thiazolidinediones: Rosiglitazone, Pioglitazone, Troglitazone.
iii) a - glucosidase inhibitors: Acarbose, miglital.
626. Bevacizumab is used in ?
a) Carcinoma colon

b) Liver carcinoma

c) Renal cell carcinoma

d) Pancreatic carcinoma

Correct Answer - A
Ans. is 'a' i.e., Carcinoma colon

medpox.com
627. Bevacizumab is ?
a) Anti VEGF antibody

b) Histone decyclase inhibitor

c) Proteosome inhibitor

d) Her2 neu inhibitor

Correct Answer - A
Ans. is 'a' i.e., Anti VEGF antibody

medpox.com
628. Which of the following anticancer drugs
are competitive inhibitors of tyrosine
kinase ?
a) Imatinib and sunitinib

b) Letrozole

c) Bicalutamide

d) Fulvestrant

Correct Answer - A
Ans. is 'a' i.e., Imatinib and sunitinib
medpox.com
Molecular targeted agents
Tyrosine kinase inhibitors
Competitive inhibitors → Imatinib, Nilotinib, Sunitinib, Dasatinib,
Erlotinib, Gefitinib, Lapatinib, Sorafenib (Remember all end with '
nib').
Monoclonal antibodies → Cetuximab, panitumumab.
HER2/neu (ERB B2) inhibitors Monoclonal antibody - Trastuzumab.
Targeted antibody → Gemtuzumab (anti CD-33), Rituximab (anti -
CD20), Alemtuzumab (anti CD-52).
Vascular endothelial growth factor (VEGF) inhibitor → Monoclonal
antibody - Bevacizumab.
Proteosome inhibitors → Bortezomib.
Histone deacetylase inhibitor → Vorinostat
DNA - methyltransferase inhibitor → 5-azacytidine, 2-deoxy-5
azacytidine.
All - trans-retinoic acid.
Biological response modifier - Recombinant IL-2 (aldesleukin,
denileukin).
medpox.com
629. Thalidomide is used in ?
a) Mutilple myeloma

b) Squamous cell carcinoma

c) Basal cell carcinoma

d) Masopharyngeal carcinoma

Correct Answer - A
Ans. is 'a' i.e., Multiple myeloma
Clinical uses of thalidomide
AIDS related aphthous ulcers
AIDS related wasting syndromemedpox.com
Multiple myeloma and other solid tumours
Prevention of graft versus host disease after transplantation
Rheumatoid arthritis
Ankylosing spondylitis
Crohn's disease and Bechet's syndrome
Erythema Nodusum Leprosum
630. Daclizumab acts through ?
a) cGMP activation

b) Adenylcyclase inhibition

c) IL 2 receptor blocker

d) IL10 receptor blocker

Correct Answer - C
Ans. is 'c' i.e., IL 2 receptor blocker
Monoclonal antibodies (daclizumab and basiliximab) that block the
interleukin 2 receptor and are used in prevention of graft rejection as
immunosuppresant. medpox.com
631. Mechanism of action of actinomycin D is
?
a) Inhibits DNA dependent RNA synthesis

b) Activates DNA dependent RNA synthesis

c) Inhibits RNA dependent DNA synthesis

d) Activates RNA dependent DNA synthesis

Correct Answer - A
Ans. is 'a' i.e., Inhibits DNA dependent RNA synthesis
The anticancer antibiotics are
medpox.com
Actinomycin - D (Dactinomycin)
Daunorubicin (Rubidomycin)
Mitomycin C
Doxorubicin
Mitoxantrone
Mithramycin (plicamycin)
Bleomycins
These anticancer, antibiotics obtained from micro-organisms and
have prominent antitumour activity.
Mechanism of action : They are intercalated between DNA strands
and interfere with its template function.
Actinomycin `D' inhibits DNA dependent RNA synthesis.
Bleomycin cause DNA breakage and free radical formation .
Doxo-and daunorubicin inhibit Topoisomerase I & II.
Mitomycin acts like alkylating agents.
Mitoxantrane binds to DNA to produce strand breakage and inhibits
both DNA & RNA synthesis.
Remember
All antitumor antibiotics are cell cycle nonspecific except for
bleomycin which acts in G2 phase.

medpox.com
 632. Tocilizumab is antibody against ?
a) IL 2

b) IL 4

c) IL 6

d) IL 8

Correct Answer - C
Ans. is 'c' i.e., IL 6
Tocilizumab
It is the antibody directed against IL 6 receptor
It is approved for use in : medpox.com
i. Rheumatoid arthritis
ii. Neuromyelitisoptica
iii. Castleman's disease
iv. Systemic juvenile idiopathic arthritis
633. Mechanism of action tacrolimus is ?
a) Inhibition of calcineurin

b) Antimetabolite

c) mTOR inhibitor

d) Inhibition of DNA synthesis

Correct Answer - A
Ans. is 'a' i.e., Inhibition of calcineurin
Tacrolimus
It is a macrolide immunosuppressant agent.
Its mechanism of action is similar to cyclosporine, i.e. inhibition of
medpox.com
transcription of IL-2 and T-cell proliferation, but it binds to other
immunophilin called FKBP (in contrast to cyclosporine which binds
to cyclophilin). Subsequent steps are some, i.e. inhibition of
calcineurin, which inhibits T cell activation.
Tocrolimus is 10-100 times more potent than cyclosporine.
It is also more toxic than cyclosporin.
Adverse effects are nephrotoxicity (most common), neurotoxicity,
hyperglycemia (DM).
Mechanism of nephrotoxicity → Periglomerular afferent arteriolar
vasoconstrication and reduced GFR.
634. Hydroxyurea mechanism of action in
cancer is by inhibiting the enzyme ?
a) Ribonucleotide diphosphate reductase

b) Ribonucleotide oxidase

c) DNA lyase

d) DNA synthetase

Correct Answer - A
Ans. is 'a' i.e., Ribonucleoside diphosphate reductase
Hydroxyurea
medpox.com
It blocks the conversion of ribonucleotides to deoxyribonucleotides
by inhibiting the enzyme ribonucleoside diphosphate reductase; thus
inhibits the DNA synthesis; S phase specific.
Myelosuppression is the major toxicity. GI disturbances and
cutaneous reactions (pigmentation) also occur.
It is used in CML, psoriasis, polycythemia vera and some solid
tumors.
It is also used as radiosensitizer before radiotherapy and is a first
line drug for sickle cell disease in adults.
635. Nitrosoureas used in the treatment of
cancer are?
a) Carmustine

b) 5FU

c) Methotrexate

d) Cisplatin

Correct Answer - A
Ans. is 'a' i.e., Carmustine
Nitrosoureas
medpox.com
Nitrosoureas (Lomustine and carmustine) are highly lipid soluble
alkylating agents - cross blood - brain barrier → Effective in
meningeal leukaemias and brain tumours.
Nitrosoureas are highly lipid soluble and can cross blood brain
barrier used in brain tumors like gliomas.
Because they cross BBB, most common adverse effects are
nausea, vomiting and other CNS effects.
Bone marrow depression is peculiarly delayed, taking nearly 6
weeks to develop. → delayed neutropenia
Nitrosoureas can cause visceral fibrosis and renal damage.

invalid question id
637. Nullity of marriage is considered when ?
a) Adultery in first 7 years

b) Infertility of husband

c) Assault in first 7yrs

d) Age > 55years

Correct Answer - B
Ans. is 'b' i.e., Infertility of husband
Under section 12 of Hindu Marriage Act 1955 or section 24 of
Special Marriage Act 1954, a wife may seek divorce on the ground
that her husband was impotent at the time of marriage and
medpox.com
continues to be impotent therefore he is incapable of fulfilling the
rights of consummation of marriage by an act of sexual intercourse.
Conditions for nullity of marriage
Any marriage can be declared null and void under following
conditions:?
1) Bigamy, i.e. one spouse has made one more marriage
2) Impotence
3) If either party is underage
4) If one spouse is having unsound mind at the time of marriage,
virulent form of leprosy or veneral disease in a communicable form.
5) If one spouse has not been heard of as being alive for a period of
7 years or undergoing a sentence of imprisonment for 7 years.
6) If the consent has been obtained by coercion or fraud.
7) If the woman already pregnant with some one else's child at the
time of marriage.
638. WHO definition of abdominal obesity is ?
a) Waist - hip ratio > 0.80 in females

b) Waist - hip ratio > 0.85 in females

c) Waist - hip ratio > 0.90 in females

d) Waist - hip ratio > 0.95 in females

Correct Answer - B
Ans. is 'b' i.e., Waist - hip ratio > 0.85 in females
Assessment of obesity
Following parameters are used to assess obesity :?
1) Skin fold thickness (SFT) medpox.com
Since it is most accessible, SFT is the most common method used
to assess obesity.
Measurements are taken at 4 sites : mid triceps (best site), biceps,
subscapular and suprailiac regions.
The sum of measurements _ 50 mm in girls and 240 mm in boys
indicate obesity.
At single mid triceps level (best site to measure SFT), thickness 18
mm in boys and 32 mm in girls indicate obesity.
The instrument used to estimate SFT is Harpenden skin callipers.
2) Waist circumference (WC) and Waist / Hip ratio (WHR)
These are good predictors for metabolic complications and risk of
cardiovascular disease.
The cut-off for waist circumference is 102 cms in boys (for India
90 cms) and 88 cms in girls (for India . 80 cms). WHR > 1.0 in
men and > 0.85 in women indicates obesity and abdominal fat
accumulation.
3) Waist-Height ratio (WHtR)
It is the best indicator of cardiovascular risk. It is independent of
age and sex. Cut-off value is 0.5.
4) Indices based on weight and/or height
These are :?
i) Body mass index (Qetelet's index)
It is used internationally as reference standard for assessing the
prevalence of obesity.
It is dependent both on height and weight (has been explained
earlier).
ii) Ponderal index
It is dependent both on height and weight.
It is defined as height (cm) divided by cube root of weight (kg).

medpox.com
639. Constitution by which we can force
people on hunger strike to eat is ?
a) Article 21

b) Article 35

c) Article 48

d) Article 52

Correct Answer - A
Ans. is 'a' i.e., Article 21
Indian constitution (Article 21) ensures right to life; there is no
medpox.com
equivalent right to die. Since Indian constitution is supreme, force
feeding in hunger strikers is lawful in India.
640. How much is punishment for sex
determination ?
a) 3 years

b) 5 years

c) 7 years

d) 9 years

Correct Answer - A
Ans. is 'A' i.e., 3 years
Since the question is about punishment for sex determination not
medpox.com
repeat offence of sex determination answer will be 3 years
The families of a pregnant woman who ask for sex determination are
also liable to be punished.
Not adhering to the provisions of this act could warrant punishment
in the form of up to 3 years imprisonment and up to Rs 10,000 fine,
and on repeat offence up to 5 years imprisonment and up to Rs
50,000 fine.
The name of the registered practitioner would be removed from the
state council for 5 years if guilty and permanently if repeat offence is
committed under section 23 of the act.
641. A person is declared dead if not seen by
relatives for how many years ?
a) 3 years

b) 7 years

c) 10 years

d) 12 years

Correct Answer - B
Ans. is 'b' i.e., 7 years
A person is legally declared dead if not seen for 7 years from the
date of declared missing. medpox.com
The Indian Evidence Act, under section 108 provides 7 years from
the date whence a person is declared to be missing and his
whereabouts are not known for presuming a person to be dead
(Death in absentia).
642.

medpox.com
Punishment for perjury is covered under
section -
a) 191 IPC

b) 193 IPC

c) 195 IPC

d) 1971PC

Correct Answer - B
Ans. is 'b' i.e., 193 IPC

medpox.com
643. Grevious hurt comes under section:
a) 319

b) 320

c) 324

d) 326

Correct Answer - B
320

medpox.com
644. IPC 319 deals with ?
a) Definition of hurt

b) Voluntarily causing hurt

c) Definition of grievous hurt

d) Voluntarily causing grievous hurt

Correct Answer - A
Ans. is 'a' i.e., Definition of hurt

medpox.com
645. Which IPC includes vitriolage ?
a) 318

b) 319

c) 320

d) 321

Correct Answer - C
Ans. is 'c' i.e., 320
Vitriolage is a potential cause of permanent disfigurement of face
and thus is covered under grevious hurt and so comes under IPC
320. medpox.com
Vitriolage' is throwing of any corrosive on another person. Eyes are
affected most commonly. It comes under sector 320 IPS.
646.

medpox.com
Doctor who did surgery on wrong side of the
pateient is punishable under section ?
a) S. 304 A IPC

b) S. WC

c) S. 305 AIPC

d) S. 305 IPC

Correct Answer - A
Ans. is 'a' i.e., S. 304 A IPC
Section 304 A IPC
medpox.com
Causing death by negligence: Whosoever causes the death of any
person, by doing any rash or negligent act not amounting to culpable
homicide shall be punished with imprisonment for a term which may
extend to 2 years or with fine, or with both.
Doctor doing surgery on the wrong side of the patient is an example
of gross inattention and recklessness shown by the doctor and is
thus an example of criminal negligence.
Criminal negligence is punishable under S. 304 A IPC.
647. In case of death in lock up, the inquest is
held by
a) A police officer

b) Magistrate

c) Panchayat officer

d) District Attorney

Correct Answer - B
B i.e. Magistrate

medpox.com
648. Cephalic index is used for
a) Race

b) Age

c) Sex

d) Stature

Correct Answer - A
Ans. is 'a' i.e., Race
Cephalic index, height index & nasal index are used for
determination of race.
Cephalic index = maximum breadth of skull/ maximum length of skull
medpox.com
x 100
Cephalic
Type of skull Race
index
Dolichocephalic (long Pure Aryan,
70 - 75
headed) Aborigines, Negroes
Mesaticephalic Europeans and
75 - 80
(medium headed) Chinese
Brachycephalic (short
80- 85 Mongolian
headed)
649. Majority is obtained by a person under
court guardianship by age of ?
a) 19 years

b) 20 years

c) 21 years

d) 22 years

Correct Answer - C
Ans. is 'c' i.e., 21 years
A person attains majority on completion of 18 years. However if a
medpox.com
person is under the guardianship of court, he attains majority after
21 years (Indian Majority Act 1875).
 650. According to juvenile justice act, age of
juvenile is ?
a) < 14 years

c) < 18 years

d) < 20 years

Correct Answer - C
Ans. is 'c' i.e., < 18 years
Juvenile Justice Act 2000
Juvenile justice (care and protection of children Act, 2000 (now
Amendment Act 2006) covers :-
i. Juveniles in conflict → child who is alleged to have committed an
medpox.com
offence.
ii. Children in need of care and protection → children who are
neglected, abused, or abandoned.
This act defines a juvenile / child as a person who has not
completed the age of 18 years.
 651. Which line of death certificate represent
major antecedent cause of death -
a) Ia

b) Ib

c) Ic

d) II

Correct Answer - C
Ans. is 'c' i.e., Ic
International death certificate
medpox.com
The basis of mortality data is death certificate.
For ensuring national and international comparability, it is necessary
to have a uniform and standardized system of recording and
classifying deaths.
For this purpose WHO has recommended international death
certificate.
Consist of four lines:
1. Line Ia: Disease or condition directly leading to death
2. Line Ib: Antecedent/ underlying cause
3. Line Ic: Main antecedent / underlying cause
4. Line II: Other significant conditions contributing to death but not
related to disease/ condition causing it
Example of a death certificate:
1. Line Ia: Renal failure
2. Line Ib: Diabetic nephropathy
3. Line Ic: Diabetes mellitus
4. Line II: Hypertension
Concept of underlying cause, Line Ic is the most important line in
death certificate, thus also known as `Essence of Death Certificate'.
medpox.com
652. Exception to the rule of professional
secrecy is allowed under following
circumstances except ?
a) Court of law

b) Cases of suspected crime

c) In negligent suits

d) In interest of relatives

Correct Answer - D
Ans. is 'd' i.e., In interest of relatives
medpox.com
Professional secrecy is an implied ethical and legal obligation (or
contract), that the doctor will not divulge any thing he comes to know
concerning patient during the course of his professional work. Doctor
is liable to damages for its breech.
However, it is justified in certain circumstances, to disclose
information to proper authority, and this is known as privileged
communication. It is defined as a communication made by doctor to
a proper authority that has corresponding legal, social, and moral
duties to protect the public. Privileged communication is made in
certain circumstances where the doctor is justified in disclosing
information about his patient. Such communication is regarded as
privileged and is an exception to the general rule of professional
secrecy between doctor and patient. Example are :?
1) In court of law : When asked by judge.
2) As compulsor duty : Every doctor has to give details of birth,
death and communicable disease.
3) As a social duty : If health of a patient can cause danger to
society, e.g. :-
i) Railway engine driver being colour blind.
ii) Bus driver being epileptic, drug addict or hypertensive.
iii) Pilot having refractive errors.
iv) Hotel waitor suffering from TB or being typhoid carrier.
v) Swimming pool user suffering from STD (e.g. syphilis) or
infectious disease.
vi) Person suffering from STD or HIV infection likely to marry.
vii) Cases of food poisoining.
viii) Water pollution.
4) In cases of suspected crime.
5) In self interest, both in civil and criminal suits by patient.
6) When a servant is sent by master.
7) In negligent suits when doctor is employed by opposite party to
cross-examine patient who filed the suit.
8) In insurance reports, he can report any disease found. But he
should not answer queries of insurance company or solicitor without
the patient consent.
9) In the interest of patient : If patient is not taking proper care,
details can be communicated to the relatives.
medpox.com
 653. Judge can ask clarifying questions when
?
a) After cross exam

b) Before cross exam

c) Before re cross exam

d) At any time he wishes

Correct Answer - D
Ans. is 'd' i.e., At any time he wishes
The judge may ask any question, in any form, about any fact,
medpox.com
relevant or irrelevant, at any stage of the examination to clear up
doubts.
Recording of evidence
After oath administration, the evidence is recorded under
following steps :-
i. Examination in chief (direct examination) : It is the examination of
the witness by lawyer of the party calling the witness. In government
prosecutions, it is done by public prosecutor (PP)/district
government pleader(DGP). The objective is to elicit all relevant, and
convincing facts. No leading questions are permitted. Leading
question means the question, which leads the witness to desired
answer. However, if the witness is declared hostile, leading
questions can be asked.
ii. Cross-examination : Examination of the witness is conducted by the
lawyer ofthe opposite party. In government prosecutions it is done
by defence lawyer. The objective is to elicit, remove or modify facts
and to test the accuracy of statement or witness. Leading questions
are allowed.
iii. Re-examination (Redirect examination) : It is conducted like
 examination in chief and so by the lawyer of same party. The
objective is to clear out any discrepancies/doubt, that have arisen
during cross-examination. Leading questions are not allowed. The
witness should not tell any new thing at this stage, otherwise
opposing lawyer is permitted for re-cross examination.
iv. Court questions : At any stage, during the recording of evidence, the
judge may ask questions to clear his doubts.

medpox.com
 654. Which of the gustafson's parameter is
the most accurate ?
a) Attrition

b) Periodontosis

c) Root resorption

d) Transperency of the tooth

Correct Answer - D
Ans. is 'd' i.e., Trnasperency of the tooth
Age from teeth after 20 years
medpox.com
Teeth eruption is useful for age estimation upto about 18 years,
beyond which it is just a guess work. The methods used are :?
A) Gustafson's method : Useful only in persons older than 21 years
of age, depending on the physiological changes in each of the dental
tissues.
1. Attrition - due to wear and tear from mastication, upper surface of
teeth destroyed gradually, first involving the enamel - dentine - pulp
(depending on the functional use of teeth and hardness of enamel).
2. Paradentosis - recession of gums and periodontal tissue
surrounding the teeth, exposing the neck and adjacent part of root -
teeth fall off (poor hygiene increases paradentosis).
3. Secondary dentine formation - develop within the pulp cavity and
decrease size of the cavity, start from base - apex, obliterate the
cavity, increase with age, caries and paradentosis.
4. Cementum apposition - near the end of root, increase cementum,
increase thickness, deposited throughout life, and form incremental
lines (devised by Boyde).
5. Root resorption - because of cementum and dentine, absorption of
root start at apex and extend upward (may be pathological).
6. Transparency of the root - seen after 30 years of age, canal in the
dentine at first widen, increase with age because of deposition of
minerals. They become invisible and dentine becomes transparent
(Most reliable of all the criteria).
B) Mile's method : Age can be known by changes of root
transparency.
Q Boyde' method : On enamel of the tooth, there is a line at birth
(neonatal line). With increase in age, more lines are added, study of
which helps in age determination.
D) Stack's method : Age of infant can be known from height and
weight of erupting teeth.

medpox.com
655. Which of the following teeth erupt earlier
in the upper jaw ?
a) Central incisor

b) Lateral incisor

c) Canine

d) First molar

Correct Answer - B
Ans. is b' i.e., Lateral incisor

medpox.com
 656. Commonly used long bone for
identification ?
a) Femur

b) Radius

c) Ulna

d) Humerus

Correct Answer - A
Ans. is 'a' i.e., Femur
Stature can be calculated from the length of long bones and used for
identification. medpox.com
Femur and tibia give more accurate values compared to humerus
and radius
Stature is determined in the dismembered body (skeletal remains)
by :
1. Length from the tip of the middle finger to the tip of the opposite
middle finger when arms are fully extended.
2. Twice the length of one arm + 30 cm (of two clavicles) + 4 cm (for
the sternum).
3. Humerus length is 1/5th of height.
4. The length from the vertex to the symphysis pubis is half of the total
length.
5. The length from the sternal notch to Symphysis pubis x 3.3.
6. The length of the forearm measured from the tip of the middle finger
is =5/19 of total length.
7. The height of head measured by the vertical distance from the top of
the head (vertex) to the tip of chin = 1/8 of the total length.
8. The length of the vertebral column = 34/100 of total length. To the
length of the entire skeleton, add 2.5 to 4 cm for the thickness of the
 soft parts.
9. As a general rule humerus is 20%, the tibia is 22%, the femur is 27%
and the spine is 35% of the individual height.

medpox.com
657. According to federation dental lower left
canine is designated as ?
a) 32

b) 33

c) 42

d) 43

Correct Answer - B
Ans. is 'b' i.e., 33

medpox.com
658. Most common finger print type is ?
a) Loops

b) Whorls

c) Composite

d) Arches

Correct Answer - A
Ans. is 'a' i.e., Loops
Dactylography / DermatogIvphics / Calton system / Finger
prints
Finger prints are present from birth both on epidermis and dermis,
medpox.com
remain constant through out life and can't be altered without
destroying true skin.
Finger print pattern is absolutely individual i.e. no two hands are
entirely alike, not even identical twins. That's why, it is best (most
sensitive and most specific) and most reliable method of
identification (Quetelet's rule of biological variation). DNA finger
printing may be same in monozygotic twins.
The pattern is neither inherited nor identical in any two persons. So
the paternity cannot be proved through finger print patterns.
However, paternity can be proved by DNA finger printing.
Loops (67% most common) > whorls (25%) > arches (7%) >
composite (2% least common) are four main types of pattern.
It is accepted that chances of 2 finger prints matching 16 ridge
characteristic are infinitely small (Parikh's). In practice 8 - 16 (Reddy)
/ 16 - 20 (Seth, Simpson) points of fine comparision are accepted as
proof of identity.
Locard's poroscopy method is study of microscopic pores, formed by
mouths of ducts of subepidermal sweat gland present on ridges of
fingers. These pores are permanent, remain un changed during life
and are very useful when only fragments offingerprints are available.
Each milimeter contains 9 - 18 pores.
Criminals may attempt to multilate finger prints by applying CO2
snow, corrosive agents, burns or eroding against hard surface. But
these manners do not destroy finger prints permanently unless true
skin is completely de​stroyed.

medpox.com
659. Tattooing in old decomposed body can
be visualized by use of all except ?
a) H2O2 3%

b) Gamma rays

c) Infrared photography

d) Examination with magnifying glass

Correct Answer - B
Ans. is 'b' i.e., Gamma rays
Latent tattoo marks are faded marks and they can be visualized by
Use of ultraviolet light medpox.com
Infrared photograpy
Rubbing the part and examining under magnifying glass
If tattoo marks are obscured by decomposition they can be
visualized by treating with 3 % H2O2.
Tatto marks can be developed by treating the skin by 0.5% caustic
potash.
Histopathology of local lymph nodes for pigment.
660. Age of eruption of Permanent 1st molor
?
a) 6 years

b) 8 years

c) 10 years

d) 12 years

Correct Answer - A
Ans. is 'a' i.e., 6 years
medpox.com
661. How many cusps are present in chewing
surface of premolars ?
a) 2

b) 3

c) 4

d) 5

Correct Answer - A
Ans. is 'a' i.e., 2
Premolars or bicuspids
medpox.com
They have two cusps on the chewing surface of teeth. The root is
usually single but may be double.
662. Age under which child is considered
incapable of committing an offence is ?
a) 3 years

b) 7 years

c) 14 years

d) 18 years

Correct Answer - B
Ans. is 'b' i.e., 7 years

medpox.com
663. In India exhumation is ordered by ?
a) Magistrate

b) Health Secretory

c) Health Minister

d) Any local MLA

Correct Answer - A
Ans. is 'a' i.e., Magistrate
Exhumation
Exhumation is lawful digging out of a burried body from the grave for
the purpose of identification or determination of cause of death.
medpox.com
Only a magistrate (executive magistrate) can order for exhumation.
In india, there is no time limit for exhumation, i.e. can be done at any
time after death.
It is done under supervision of medical officer and Magistrate in
presence of a police officer who provides witnesses to identify grave,
coffin and dead body, whenever possible, Magistrate should inform
the relatives and allow them not to remain present at the time of
enquiry.
The whole procedure should be conducted and completed in natural
day light.
Therefore, it is usually started early in morning.
664.

medpox.com
Pre auricular sulcus is a part of ?
a) Humerus

b) Femur

c) Pelvis

d) Skull

Correct Answer - C
Ans. is `c' i.e., Pelvis
Preauricular sulcus is used for determination of sex.
It is more frequent, broad and deep in female pelvis.
There is attachment of anterior sacroiliac ligament.
medpox.com
665. Soft friable extradural hematoma with
honeycomb appearance seen in autopsy
in cases of death due to?
a) Coagulopathy

b) Thermal injury

c) Post mortem trauma

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., Thermal injury
medpox.com
When the head is exposed to intense heat, sufficient to cause
charring of the skull, heat hematomas occur.
They have the appearance like extradural hemorrhage, but signs of
injury blunt force do not accompany it.
It consists of soft friable clot of light chocklate colour and may be
pink, if blood contains CO.
The clot has honeycombed appearance due to bubbles of steam
produced by heat.
Thickness - 11/2 to 15 mm and volume 120 ml.
Thus the findings described in the question have typical appearance
secondary to excess heat as seen in thermal injuries due to burns.
666. Fencing attiude of the dead bodies is
caused by ?
a) Ciagulation of proteins

b) Emulsification of fact

c) Exposure to excess cold

d) Electric shock

Correct Answer - A
Ans. is 'a' i.e., Coagulation of proteins
Pugilistic attitude(boxing/fencing/defence attitude)
medpox.com
It is heat stiffening caused by denaturation and coagulation of
proteins.
It is indicative of exposure to intense heat.
There is flexion at all joints and ?clawing of fingers.
This phenomenon occurs both in antemortem and postmortem
burns.
667. Rule of 9 in burns is used to denote ?
a) Depth of bums

b) % of total body surfacearea

c) Severity of bums

d) Type of bums

Correct Answer - B
Ans. is 'b' i.e., % of total body surface area

medpox.com
668. Back of 10 - 14 years old contributes how
much percentage to total body surface
area ?
a) 13%

b) 15%

c) 16%

d) 19%

Correct Answer - C
Ans. is 'c' i.e., 16% medpox.com
 669. Bone pearl appearance is seen in ?
a) Electrical burns

b) Hydrocution

c) Strangulation

d) Throttling

Correct Answer - A
Ans. is 'a' i.e., Electrical burns
Electric burns
Electric burns are at times, also referred to as joule burns.
Technically, joule burn is an endogenous burn, i.e. burns produced
medpox.com
due to release of heat from the body, on application of electric
current. Electric burns may be of following types :?
1) Contact burns : Due to contact with live wire.
2) Spark burns : Due to sparking of current, e.g. in loose electrical
fitting.
3) Flash burns : Caused on being near the main power line, without
actual contact. Burns result due to arcing of current from these lines.
Characteristic features of electric burns are :?
1) There may be holes in clothes or shoes.
2) There is a wound of entry and wound of exit of electric current :-
i. Entry wound : It is non-bleeding, thick, leathery, greyish white,
depressed, hard and cauliflower like, known as crater formation.
High voltage current may cause burns over large areas of skin, i.e.
crocodile skin lesions. The skin may get coloured due to metallic
pigment : green (in brass electrode), black (in iron electrode), blue
(in copper electrode) and grey (in aluminium electrode).
ii. Exit wound : It is like a laceration and is bleeding.
3) Metals from electrode may melt and as small balls (current pearls)
may be carried to tissue. Calcium phosphate of bones may also melt
may be carried to tissue. Calcium phosphate of bones may also melt
and is radiologically seen as bone pearls (wax dripping).
4) Muscles show Zenker's degeneration.
Causes of death
Commonest cause of death is ventricular fibrillation. Other causes
include shock, cardiopulmonary arrest, cerebral anoxia, paralysis of
respiratory muscles, and mechanical injuries due to fall.

medpox.com
670. Filigree burn occur in:
FMGE 09; NJI 10; JIPMER 11
a) Lightning

b) Electrocution

c) Vitriolage

d) Infanticide

Correct Answer - A
Ans. Lightning

medpox.com
671. Following is false regarding the bullet
entry wound in skull ?
a) Punched in hole in outer table

b) Inner table shows bevelling surface

c) No pieces of bone are present in the bullet track

d) Wound is funnel shaped with the funnel opening in the direction

in which the bullet is travelling

Correct Answer - C
Ans. is 'c' i.e., No pieces of bone are present in the bullet track
medpox.com
Firearm/bullet wounds in the skull
Wound of entrance shows a punched in (clean) hole in the outer
table. Cone shaped bone is detached from the inner table forming a
crater that is larger than the hole of the outer table and shows
beveling (sloping surface).
Fissured fractures are seen radiating from the defect.
Irregular lacerations may be seen involving the leptomeninges.
Pieces of bone from the wound of entry are often driven into the
cranial cavity and may establish the bullet track.
At the point of exit a punched out opening is produced in the inner
table and beveled opening in the outer table.
The wound is funnel shaped with the funnel opening in the direction
in which the bullet is travelling both in entrance and exit wound.
The exit wound is larger due to deformity and tumbling of the bullet
after entering the skull.
672. Bullet entry wound, for bullet entering at
acute angle is identified by what shape
of abrasion collar ?
a) Circular

b) Rectangular

c) Oval

d) None of the above

Correct Answer - C
Ans. is `c' i.e., Oval medpox.com
If bullet enters at acute angle to the skin then the abrasion collar is
oval and if the bullet enters at right angle to the skin the abrasion
collar is circular.
673. Black gun powder composition ?
a) Charcoal 60% + Potassium nitrate 20% + sulphur 20%

b) Charcoal 25% + Potassium nitrate 70% + sulphur 05%

c) Charcoal 15%+ Potassium nitrate 75% + sulphur 10%

d) Charcoal 65% + Potassium nitrate 20% + sulphur 15%

Correct Answer - C
Ans. is 'c' i.e., Charcoal 15% + Potassium nitrate 75% + sulphur
10%
The classical gun powder is known as black powder, consists of
charcol (15%), Sulphur (10%), and potassium nitrate (75%).
medpox.com
Depending on fineness, the black gun powder is designated as FG,
FFG, FFFG. etc. (F = fineness). Pyrodex is another gun powder with
same components, but with different ratios.
Black gun powder produces smoke, i.e. It is smoke producing
powder. Smokeless powder, in addition to black powder, has
nitrocellulose (single base), or nitrocellulose plus nitroglycerine
(double base), or nitrocellulose plus nitroglycerine plus
nitroguanidine (triple base). Semi smokeless powder has 80% black
powder and 20% smokeless powder (nitrocellulose).
 674. Presence of spiral grooves in the barrel
of weapon is referred to as ?
a) Rifling

b) Incendiary

c) Cocking

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Rifling
Type of firearm weapons
medpox.com
Bore (caliber) is the inner diameter of barrel. Based on inside of
barrel (i.e., bore), the firearm weapons are divided into:?
1. Smooth bore weapons : Barrel or bore is smooth inside, e.g., shot
gun, muskets, and muzzle loaders.
2. Rifled weapons : Barrel or bore is rifled from inside, i.e., has
longitudinally twised grooves. Example are : Pistals, rifles and
revolvers.
Pistals and revolvers are small, so referred to as hand guns.
675. Maximum soft tissue bruising in neck is
seen in -
a) Strangulation

b) Hanging

c) Burking

d) Smothering

Correct Answer - A
Ans. is 'a' i.e., Strangulation
As manual strangulation (throttling) is among the most violent form
medpox.com
of asphyxia, hyoid fracture and other injury to neck structures is
more common.
676. Hyoid bone fracture most common
occurs in ?
a) Manual strangulation

b) Hanging

c) Smothering

d) Traumatic asphyxia

Correct Answer - A
Ans. is 'a' i.e., Manual strangulation
As manual strangulation (throttling) is among the most violent form
medpox.com
of asphyxia, hyoid fracture and other injury to neck structures is
more common.
677. What is the situation of the knot of
ligature in cases of typical hanging?
a) In front of chin

b) Angle of mandible

c) Occiput

d) Mastoid

Correct Answer - C
Ans. is 'c' i.e., Occiput
Typical hanging : The ligature runs from the midline above the
medpox.com
thyroid cartilage, symmetrically upward on both side of neck to the
occipital region, the point of suspension (knot of ligature) being on
occiput (at nape of neck).
Atypical hanging : Any variation from typical knot site (i.e. other than
occiput/nape of neck) is called atypical hanging. Most common site
of knot is near one side of mastoid process or angle of mandible.
 678. Torture in which legs or thighs are tied
with bamboo and the torturer presses on
the two sides of the clamp to cause pain
is called ?
a) Falanga

b) Telefono

c) Mercelago

d) Chepuwa

Correct Answer - D medpox.com

Ans. is 'd' i.e., Chepuwa
Physical torture
Torture is defined as deliberate, systemic or wanton infliction of
physical or mental suffering by one or more persons acting alone or
on the orders of any authority, to force a person to yield information,
to make a confession or for any other reason.
Torture may be physical or psychological. Important methods of
physical torture are :?
1. Beating : Beating may be of following types ?
i. Falanga (Falolka/Baatinada) : Beating of soles of feet with blunt
object.
ii. Telefono : Simultaneous beating of both ears with palms.
iii. Quirofana : Beating on abdomen while upper half of body lying
unsupported on table.
2. Electric : Electric torture may be -
i. Piacana : Placing electric wires in vagina, mouth, anus or over
nipples and testis.
ii. Black slave : Heated metal skewer inserted into anus.
 3. Near suffocation : These are -
i. Dry submarine : Plastic bag covering head and face.
ii. Wet submarine (Labaneva/Latina/Pileta): Forced immersion of
victim's head in water, often contaminated with urine or vomit or
blood.
4. Suspension : Suspension may be -
i. La-Bandera : By wrist.
ii. Mercelago : By ankles.
5. Forced posture : It may be ?
i. Planton : Prolonged standing.
ii. Cabellete (Saw horse) : Forced struddling of a bar.
iii. Parrot's perch (Jack/paude Grava) : Head down by a horizontal pole
placed under knees, with the wrists bound to the ankles.
iv. Chepuwa : Tight clamping of thighs or legs with bamboo, and the
torturer may press two sides of clamps with his legs or may stand on
two sides of clamps (practiced on Bhutanese refugees in Nepal).

medpox.com
 679. Most common organ affected in
underwater blast ?
a) Intestine

b) Liver

c) Spleen

d) Heart

Correct Answer - A
Ans. is 'a' i.e., Intestine
The most common organ affected in underwater blast injury is
intestine. medpox.com
Explosion injury
An explosion is a phenomenon resulting from sudden release of
energy which is then dissipated by a blast wave, by translocation of
objects, or by the generation of heat. Injuries in explosion occur due
to four factors :?
1) Blast or shock wave
When an explosion occurs, the explosive material produces a large
volume of gas and releases a large amount of energy. It produces a
'shock wave' which spread concentrically from the site of explosion.
The injuries depend on the enviornment in which blast occurs :-
i. Air blast (most common) : Explosion occurs in air. There is
barotrauma to air filled hollow organs. Tympanic membrane (ear
drum) is most sensitive and most commonly injured. Lung is the
second organ to be injured and is the most commonly injured hollow
organ and most common cause of life threatening injury. Other parts
injured are middle ear, cochlea, eyes, bowels, mesentery, omentum
and brain. Homogenous solid organs like liver and muscles are
usually not affected.
 ii. Under water blast (explosion under water): Gastrointestinal tract is
injured most commonly. Lungs are also injured.
iii. Solid blast : Explosive is detonated near a rigid/solid structure and
wave of energy spreads through it. If people are in contact with that
rigid structure, injuries take place. The injuries are mostly skeletal;
fracture of legs and vertebral column are more common. GIT
damage is more common than lung.
2) Flame or hot gases
Burns or burning of body may occur.
3) Flying missiles (debris)
Flying pieces of explosive debris may be driven through air against
the skin causing bruises, abrasions, lacerations, and ragged
perforations.
4) Anoxia
Various gases liberated during explosion may cause anoxia, e.g.
carbon monoxide, nitrous oxide, nitric oxide, HCN and SO,.

medpox.com
 680. Bullet which is left inside the body for
long is referred to as ?
a) Souvenir bullet

b) Tracer bullet

c) Tumbling bullet

d) Tandem bullet

Correct Answer - A
Ans. is 'a' i.e., Souvenir bullet
Projectile is an object propelled by force of rapidly burning gases. In
medpox.com
shotgun these are lead shots and pellets (recently steel is also used
instead of lead) and in rifled weapons (pistal, rifle, revolver), these
are bullets.
Tip of the bullet is knwon as nose. Varieties of bullets are :-
i. Incendiary (igniting) bullet : The tip of bullet contains self igniting
material e.g. barium nitrate and powdered aluminium and
magnesium (in the past, phosphorus was used), so that it catches
fire on hitting the target. It is used to cause fire in usually
inflammable targets like fuel tanks (of air crafts etc).
ii. Explosive bullet : The tip contains a detonator or lead azide, so that
the bullet explodes on hitting the target.
iii. Dum-dum bullet (expanding bullet): It is a jacketed bullet with is nose
tip chiseled or cut off. It is designed to increase in diameter and
expand upon striking the target, thus producing larger diameter
wounds of limited penetration.
iv. Tandem bullet (Piggey tail bullet) : It is called one-behind-other bullet
because two bullets are ejected one after the other, when first bullet
failed to leave the burrel and is ejected by subsequently fired bullet.
Therefore, both enter body through same enterance wound (some
 times, they may enter through different entries), but the wounds of
exit are always two.
v. Tandem (Duplex) cartridge is one in which two bullets are present in
same cartridge. It is used in military rifles.
vi. Tracer bullet: It leaves a trace in atmosphere along the path so that
a person (gunner) can observe the strike. Burning of barium nitrate
produces flame and powdered magnesium along with strontium
nitrate are added to give red color to the flame.
vii. Tumbling bullet : One that rotates in end on end during its motion.
viii. Yawning bullet : One which travels in an irregular fashion and
causes a key hole entery wound. Yaw means deviation between
long axis of bullet and the axis of path of bullet.
ix. Souvenir bullet : A bullet left in body for long time and is surrounded
by fibrous tissue.
x. Frangile bullet : Designed to fragment upon impact.
xi. Mushrooming of bullet : A soft nose bullet, an hitting the target may
get deformed to assume the shape of a mushroom.

medpox.com
681. Feature which differentiates true from
artificial bruise is ?
a) Round shape with irregular margins

b) Irregular shape with regular margins

c) Swelling of surrounding area

d) Erythema of surrounding area

Correct Answer - A
Ans. is 'a' i.e., Round shape with irregular margins
Such "injury" is an artificial/false bruise that may be produced by
medpox.com
applying the juices of various irritant vegetable poisons.
Other agents that can produce artificial bruise may include madar
juice or Plumbago root. The juice, like vitriol, has been thrown on the
face with evil intention. Homicidal poisoning by internal
administration of the juice is very rare.

682. Incised wound which is not a feature ?
a) Length is the greatest dimention

b) Width is more than the thickness of the blade

c) Margins are inverted

d) Hesitation cuts are seen in suicidal attempt

Correct Answer - C
Ans. is 'c' i.e., Margins are inverted
Margins are everted, clear, and clean cut.

medpox.com
683. Incised looking laceration is seen at ?
a) Forehead

b) Hand

c) Thorax

d) Abdomen

Correct Answer - A
Ans. is 'a' i.e., Forehead
LACERATIONS (Tear or Rupture)
Lacerations are tears or splits of skin, mucous membrane and
underlying tissue (e.g., muscle or internal organs). Lacerations are
medpox.com
produced by application of blunt force to broad area of the body,
which crush or stretch tissues beyond the limits of their elasticity.
Localized portions of tissue are displaced by the impact of the blunt
force, which sets up traction forces and causes tearing of tissues.
Features of lacerations are :?
i) Hair and hair bulb, nerves and blood vessels are crushed → There
may be paralysis (nerve crushed) and hemorrhage is not
pronounced (blood vessels crushed).
ii) Site of injury is the site of impact.
iii) Shape of injury is irregular, margins are irregular and
contused/abraded and show tags of tissue.
iv) Size of injury does not corresponds to impacting surface.
There are following types of laceration : ?
1) Split laceration : Splitting occurs by crushing of skin between
two hard objects. Blunt force on areas where the skin is close to rigid
structures like bone with scanty subcutaneous tissue, may produce
a wound that by linear splitting of tissue may look like incised wound,
i.e., incised like or incised looking wound. Examples of such area
are scalp, eye brows, cheek bones (zygomatic), lower jaw, iliac
crest, perineum and skin. A wound produced by a fall on knee or
elbow with limb flexed and by a sharp stone also simulates incised
wound.
2) Strech lacerations : Overstretching of the skin, if it is fixed, will
cause laceration, for example, by kicking, sudden deformity of bone
occurs after fracture, making it compound.
3) Avulsion (shearing laceration) : An avulsion is a laceration
produced by sufficient force (shearing force) delivered at an acute
angle to detach (tear off) a portion of a traumatized surface or viscus
from its attachment, the shearing and grinding force by a weight.
Flaying is type of avulsion in which shearing and grinding force by
weight (such as of lorry wheel passing over a limb) may produce
avulsion (separation of skin from underlying tissue/degloving of a
large area).
4) ears : Tears of the skin and tissues can occur from imact by a
against irregular or semi-sharp objects, such as door handle of a
car. This is another form of overstretching.
5) Cut laceration : Cut lacerations may be produced by a heavy
medpox.com
sharp edged instrument.
684. Counter coup injury seen in when ?
a) Moving head is suddenly decelerated

b) Stationery head is suddenly accelerated

c) Fall of heavy object on head

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Moving head is suddenly decelerated
Countrecoup injury is caused when moving head is suddenly
decelerated by hitting a firm surface.
It can either be a subdural or subarachnoid hemorrhage.
medpox.com
Brain injuries
Coup injury is defined as the injury of skull and/or brain at the site of
impact, e.g. a blow on forehead, resulting in fracture of frontal bone
and injury or haemorrhage in frontal lobe.
Contre coup injury is defined as an injury to the skull or brain, on
opposite (contralateral) side of the area of impact.
Cerebral concussion (stunning) occurs due to head trauma and is
characterized by gross physiological disturbance of brain without
any anatomical damage. There is sudden loss of consciousness with
a tendency to spontaneous recovery. The condition is more severe
when damage is caused to the moving head (decceleration injury)
than when it results from blows to skull. Recovery from concussion
is often followed by retrograde amnesia.
685. Puppe's rule deals with?
a) Chemical injuries

b) Multiple impact injuries

c) Sexual assault

d) Percentage of burns

Correct Answer - B
Ans. is `b' i.e., Multiple impact injuries

medpox.com
686. Lucid interval may be seen in ?
a) Intracerebral hemorrhage

b) Alcohol intake

c) Insanity

d) Subdural hemorrhage

Correct Answer - C
Ans. is `e' i.e., Insanity
Lucid interval is seen in insanity and epidural haemorrhage.
Lucid interval is a state of consciousness between two episodes of
unconsciousness in subacute/chronic epidural haemorrhage. It is
medpox.com
significant that during this period (lucid interval), the person can :
(i) Make a valid will, (ii) Can give valid evidence, and (iii) Is legally
responsible for act done (civil/criminal).
Lucid interval is also seen in insanity, i.e. the period of sanity
between two phases of insanity.
687. Frigidity is ?
a) Inability to initiate sexual arousal in males

b) Inability to initiate sexual arousal in females

c) Inability to initiate and maintain sexual arousal in males

d) Inability to initiate and maintain sexual arousal in females.

Correct Answer - D
Ans. is 'd' i.e., Inability to initiate and maintain sexual arousal in
females
Frigidity : Inability to initiate and maintain sexual arousal in females.
medpox.com
688. "Last" to putrefy in male is:
a) Uterus

b) Prostate

c) Testes

d) Liver

Correct Answer - B
Prostate

medpox.com
689. Anal coitus with opposite sex is -
a) Bestiality

b) Sodomy

c) Sin of Gomorrah

d) Fellatio

Correct Answer - B
Ans. is 'b' i.e., Sodomy
Anal intercourse between two males or between a male and female
is called sodomy. It is called sodomy as it used to be practiced in a
town called sodomy. medpox.com
690. Impotence is not a feature of -
a) Double penis

b) Bilateral castration

c) Hypospadias

d) Penile amputation

Correct Answer - C
Ans. is 'c' i.e., Hypospadias
"Congenital problems such as hypospadias are not usually
associated with erectile dysfunction" — Michael C Foster
medpox.com
691. Which of the following is not a sexual
offence in India -
a) Incest

b) Sodomy

c) Indecent assault

d) Bestiality

Correct Answer - A
Ans. is 'a' i.e., Incest
Incest
medpox.com
It means sexual intercourse by a man with a woman who is closely
related to him by blood (prohibited degrees of relationship), e.g. a
daughter, grand daughter, sister, step sister, aunt, or mother.
These cases usually have psychological features.
In India, incest as such is not an offence.
692. Taking off ones clothes and running
naked in a public race is called ?
a) Mooning

b) Exhibitionism

c) Voyeurism

d) Undinism

Correct Answer - B
Ans. is 'b' i.e., Exhibitionism
Exhibitionism (Sec 294 IPC): It is a willful and intentional exposure
medpox.com
of the genitalia in a public place while in the presence of others to
obtain sexual pleasure. May or may not be associated with
masturbation (punishment = 3 months + fine).
Voyeurism = Scoptophilia = Peeping tom: Sexual gratification is
obtained by looking at the sexual organs of other persons, watching
the act of sexual intercourse, or witnessing undressing by a woman.
Frotteurism: Sexual satisfaction is obtained by rubbing against
persons in a crowd. If they attempt intercourse, they have premature
ejaculation or they are impotent. It is an uncommon perversion and
rarely occurs alone.
Undinism: In this, sexual pleasure is often obtained by witnessing
the act of urination by someone of the same or opposite sex.
 693. Evidence not used in rape?
a) Semen in vagina

b) Semen on clothes

c) Presence of smega bacilli in vagina

d) Presence of smegma under prepuce

Correct Answer - D
Ans. is 'd' i.e., Presence of smegma under prepuce
Examination in a case of rape
A. Examination of victim
Victim cannot be examined without written informed consent.
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Informed written consent should be obtained if the age of victim is
above 12 years. If she is less than 12 years of age or if she is
mentally unsound, the written consent of parent/guardian should be
taken (Sec. 90 IPC). Victim (female) should be examined by or
under supervision of a female RMP (Sec. 53(2) CrPC).
Finding which are suggestive of rape are :-
1. Signs of struggle on clothes (tear, blood, semen, mud etc), body and
genitals (abrasion, contusion, bites or nail marks etc).
2. Presence of the semen in the vagina (proof of sexual intercourse).
3. Presence of spermatozoa in the vagina.
4. Locards principal of exchange states that whenever two bodies
come in contact with each other, there is exchange of material
between the two and so a criminal can be linked to crime. In case of
rape, piece of cloth, button, hair, blood, saliva, semen or smegma
from the accused may be found on the body of victim and conversly
materials of victim may be found on the body of accused.
5. Presence of smegma bacilli in vagina is suggestive of coitus.
B.Examination of accused
1. An accused can be examined even without his consent (Sec 53(A)
CrPC). Findings may be Presence of torn frenulum is consistent with
a recent intercourse.
2. The presence of smegma under prepuce is inconsistent with recent
intercoures as it gets rubbed off during sexual intercourse and may
be deposited in vagina. It takes about 24 hours to accumulate. Thus,
absence of smegma may indicate sexual intercourse, provided no
bath is taken.
3. Presence of vaginal epithelial cells on penis can be detected by
lugol's iodine.

medpox.com
 694. Immersion syndrome occurs due to ?
a) Vagal inhibition

b) Vagal Stimulation

c) Sympathetic stimulation

d) Sympathetic inhibition

Correct Answer - A
Ans. is 'a' i.e., Vagal inhibition
Types of drowning
Drowning is classified as (1) typical and (2) atypical.
1. Typical drowning (wet drowning)
medpox.com
Typical drowning refers to obstruction of air passages and lungs by
inhalation of water or other fluid. Therefore it is also called wet
drowning and findings offluid and froth are present in PM
examination. Typical drowning may be :-
i. Fresh water drowning : In fresh water drowning large quantities of
water cross the alveolar membrane into circulation causing
hypervolaemia and hemodilution. RBCs imbibe water and burst
(hemolysis) with liberation of potossium. Therefore, heart is exposed
to volume overload, potassium excess, sodium deficit
(hyponatremia), and anoxia. Anoxia and hyperkalemia cause
ventricular fibrillation and death in 4-5 minutes.
ii. Salt water drowning : Hypertonicity of inhaled water causes loss of
fluid from circulation into the lungs giving rise fulminating pulmonary
edema with progressive hypovolaemia, circulatary shock, and
eventually cardiac standstill (asystole) with death in 8-12 minutes.
2. Atypical drowning
It refers to drowning in which even after submersion of body in
water, little or no water anters respiratory passages and lungs.
 Hence typical findings of wet drowning in the form of froth and
oedema aquosum of lungs are not found. Atypical drowning may be
:-
i. Dry drowning : On contact with water, especially cold water, there
results intense laryngospasm, so that water does not enter the
lungs. Death is due to asphyxia because of laryngospasm.
ii. Immersion syndrome (hydrocution/submersion inhibition/vagal
inhibition) : Sudden death occurs due to vagal inhibition as a result
of (a) sudden impact with cold water, (b) duck diving (falling in water
with feet first), and (c) horizontal entry in water with impact on
epigastrium.
iii. Submersion of unconscious : If person is unconscious since before
submersion in water, little or no water enters respiratory passages. It
may occur in MI, cerebrovascular accident, hypertension, epilepsy,
cerebral aneurysm and in drunk state.
iv. Near drowning (secondary drowning syndrome/post immersion
syndrome) : In this drowning is survived and death occurs at a later
stage after removal from water. Either the person himself comes out
of water or he is recovered alive, but due to complications of
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submersion, he dies at a later stage. It is due to hypoxic
encephalopathy and fibrosing alveolitis. The death occurs due to
combined effect of cerebral hypoxia, pulmonary edema, aspiration
pneumonitis, electrolyte disturbances and metabolic acidosis.
695. What of the following is seen in fresh
water drowning ?
a) Hypovolemia

b) Hemoconcentration

c) Hyperkalemia

d) Hypernatremia

Correct Answer - C
Ans. is 'c' i.e. Hyperkalemia

medpox.com
696. Legal age by which fetus is capable of
independent existence is ?
a) 240 days

b) 230 days

c) 220 days

d) 210 days

Correct Answer - D
Ans. is 'd' i.e., 210 days
Viability means the physical ability of a foetus to lead a separate
medpox.com
existence after birth apart from its mother, by virtue of a certain
degree of development. A child is viable after 210 days (7 months)
of intrauterine life, and in some cases after 180 days (6 months) but
in most of these cases fetus is immature.
Full term mature infant show :-
Length (crown-heel length) 48-52 cm, head circumference 30-35 cm.
Ossification center at lower end of femur (appears at the end of 9
months or just before birth) and Ossification center of cuboid and
upper tibia may also present (Note : some ossification centers are
also present, but they appear before the attainment of viability so
their presence does not have importance. These are (i) Clavicle,
mandible, ribs vertebra → at the end of 2nd month, (ii) Calcaneum(os
calcis) and manubrium sterni → at the end of 5th month and (iii)
Sternum → at the end of 6 month). Other center which appears at
attainment of viability is primary ossificaion center of talus which
appears at the end of 7th month.
697. Rule of Haase is used to calculate ?
a) Age of fetus

b) Length of femur

c) Diameter of skull

d) Percentage of burns

Correct Answer - A
Ans. is 'a' i.e., Age of fetus
Rule of Haase
Hess's rule (Haase's rule) : It is a rough method for calculating the
age of fetus by measuring the length from crown to heel.
medpox.com
Upto 5th month of gestation, length of foetus in cm is square of the
month of gestation and beyound 5 months, length in cm is 5 times
the month of gestation.
698. What is the proof of eyes being open for
few hours after death ?
a) Kevokian sign

b) Tache noir

c) Both of the above

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., Tache noir
If the eye lids are open for a few hours after death, a film of cell
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debris and mucous forms two yellow triangles on the sclera on either
side of the iris , which become brown and then black called tache
noir withing 3 - 4 hours.
699. Which method is not used for autopsy ?
a) Virchow

b) Rokitansky

c) Lettulle

d) Thomas

Correct Answer - D
Ans. is 'd' i.e., Thomas
Methods of removal of organs
Virchow's technique - organs are removed one by one. Cranial
cavity is exposed first, followed by thoracic, cervical & abdominal
medpox.com
organs.
Rokitansky's technique - It involves in situ dissection in part,
combined with en block removal.
Lettulle's technique - Cervical, thoracic, abdominal & pelvic organs
are removed en masse & dissected as organ block.
700. Spalding sign is seen in ?
a) Drowning

b) Mummification

c) Maceration

d) Starvation

Correct Answer - C
Ans. is 'c' i.e., Maceration
Dead born : A deadborn child is one which has died in utero and
shows one of the following signs after it is completely born :?
1) Rigor mortis : Rigor mortis may occur in dead fetus before birth or
medpox.com
at birth.
2) Maceration : Maceration is a process of aseptic autolysis. It
occurs when a dead fetus remains in the uterus for 3-4 days
surrounded by liquor amnii but with exclusion of air. Skin slippage is
the earliest sign (occurs within 12 hours). There is gas in the great
vessels and chambers of heart (Robert's sign). Except for lung and
uterus, which remain unchanged for a long time, all other organs
become soft, oedematous and loose there morphology. The one
important radiological sign suggestive of maceration is 'Spaulding's
sign' i.e. skull bones override each other. The smell is somewhat
rancid.
3) Putrefaction (decomposition) : If the membranes are ruptured
after death of fetus and air gains entry into liquor amnii, fetus
undergoes putrefaction instead of maceration. Body is greenish, foul
smelling and bloated.
4) Mummification : It results when there is deficient blood supply,
scanty liquor and no air enters uterus. Body is thin, shrivelled dark
brown and emitting smell like rotten cheese.
medpox.com
701. Rigor mortis in fetus at birth can be seen
in ?
a) Dead born

b) Still born

c) Superfoetation

d) Superfecundation

Correct Answer - A
Ans. is 'a' i.e., Dead born
Signs of dead born (intrauterine death : IUD) are (i) Rigor mortis at
medpox.com
birth, (ii) Maceration, (iii)Putrefaction, and (iv) Mummification.
702. Following is not true about adipocere
formation ?
a) It is a modification of putrefaction

b) It is developed in presence of air

c) It occurs in dead bodies lying in water

d) Body has an offensive sweet smell

Correct Answer - B
Ans. is 'b' i.e., It is developed in presence of air
Adipocere formation (saponification).
medpox.com
Adipocere is a modification of putrefaction, which occurs in the
absence of air. That is when there is excessive moisture (humidity)
and warnth (warm temperature), but absence of air i.e. warm humid
climate, normal putrefaction does not occur, rather saponification
occurs.
Thus adipocese formation occurs in dead bodies which are lying in
water (immered in water) or burned in damp lay soil.
Saponification (adipocer formation) is the conversion of dead body
into soft, fatty waxy substance due to conversion of unsaturated
liquid fats to saturated solid fats under the influence of intrinsic
lipase and lecithinase produced by Cl. perfringens. The process
involves gradual hydrolysis and hydrogenation of body fats into
higher fatty acids which combine with calcium and ammonium ions
to form insoluble soaps. Ultimately, palmitic, oleic, stearic and
hydroxystearic acids are formed, mixture of these is known as
adipocere.
Adipocere formation starts in subcutaneous fat and is marked in
areas having excessive fat, eg. cheeks, female breast, buttocks and
abdomen. Slowly the whole body including muscles and internal
viscera change into adipocere. Adipocere has offensive or sweetish
smell, however in early stages, smell is ammonical.
Body is converted into soft, waxy and brittle substance, it floats on
water, it can be cut easily, it dissolves in alcohol and ethers, and it
melts on heating. Facial features and injuries on body are well
preserved, thus identfication of body and determination cause of
death (in case of injury) are possible.
Normally adipocere formation requires 3 weeks to upto 3 to 6
months. However shortest recorded period in india is 3 days 22
hours. In india, it has been observed to begin within 4-5 days.
Adipocere may persist for years or decades. Adipocere does not
occur in foetus less than 7 month's.
Medicolegal importance : (i) Identification of body (facial features are
preserved), (ii) cause of death (injury marks are preserved), (iii) time
since death can be estimated.

medpox.com
703. Mummification is enhanced by ?
a) Moist and hot air

b) Moist and cool air

c) Dry and hot air

d) Dry and cool air

Correct Answer - C
Ans. is 'c' i.e., Dry and hot air
Mummification
It is a modification of putrefaction, which occurs in the absence of
moisture. That is when there is excess air and warmth but no
medpox.com
moisture (humidity), i.e. hot dry and windy climate, mummification
takes place in place of normal putrefaction. Thus mummification
occurs in deserts, especially in summer and also in bodies buried in
shallow grave in sandy soil.
Mummification is characterized by dessication or drying of the dead
body. There is drying, dehydration and shriveling of dead body. It
proceeds from exterior to interior. Therefore first to be involved is
skin, especially of exposed body parts like lips, nose tip, hands
(fingers) and feet (toes). The skin is shrunken, contracted, dry,
brittle, leathery, streched across bony prominences and rusty brown
to black in color. Internal viscera also dry up, darken in color and
blend with each other to form a single mass. Body emits smell like
rotten cheese. Facial features and injuries are well preserved, thus
identification of body and cause of death can be determined (like
adipocere formation).
Time required for mummification varies between 3 months - 2 years.
If properly preserved, a mummified body can remain for years.
Chronic arsenic or antimony poisoning favor mummification.
Medicolegal importance : (i) Identification of body (facial features are
preserved), (ii) cause of death (injury marks are preserved), (iii) time
since death can be estimated.

medpox.com
704. Suspended animation is seen in
following except?
a) Sun stroke

b) Cerebral concussion

c) Cholera

d) Delerium tremens

Correct Answer - D
Ans. is 'd' i.e., Delirium tremens
Suspended animation may be seen in electrocution, drowning,
medpox.com
cholera, after anesthesia, shock, sunstroke, cerebral concussion,
narcotic poisoning, new born infants and yogis/voluntary.
705. When group of muscles of dead body
were in state of strong contration
immediately prior to death and remain so
even after death, this is termed as ?
a) Gas stiffening

b) Rigor mortis

c) Cadaveric spasm

d) Cold stiffening

Correct Answer - C medpox.com

Ans. is 'c' i.e., Cadaveric spasm
Cadaveric spasm (instantaneous rigor) is defined as the condition
wherein a group of muscles, which were in contraction or spasm at
the time of death, continue to be in spasm even after death, without
the stage of primary relaxation.
It is a condition in which the muscles of the body which were in a
state of contraction immediately before death, continue to be so after
death without passing through the stage of primary relaxation.
Cadaveric spasm, being an antemortem phenomenon, reflects the
last act of the subject performed before and at the time of his death.
The cause and manner of death may be judged.
It may be due to exhausted ATP in the affected muscles with the
persistence of contraction even after death and the resulting failure
of the chemical processes required for active muscular relaxation to
occur during molecular death. Adrenocortical exhaustion, which
impairs resynthesis of ATP may be the possible cause
706. Atria mortis other name for?
a) Gateways of death

b) Gateways of life

c) Gateways of air

d) Gateways of water

Correct Answer - A
Ans. is 'a' i.e., Gateways of death

medpox.com
707. Postmortem blood is collected from
which vessel ?
a) Femoral artery

b) Femoral vein

c) Cephalic vein

d) Brachial artery

Correct Answer - B
Ans. is 'b' i.e., Femoral vein
Before autopsy 10 - 20 ml of blood is collected from the femoral vein
medpox.com
in groin. Jugular/ subclavian vein can also be used.
708. Barberio's test uses which of the
following?
a) Picric acid

b) Acetic acid

c) Hydrochloric acid

d) Sulfuric acid

Correct Answer - A
Ans. is 'a' i.e., Picric acid

medpox.com
709. Which of following tests in used to
detect semen?
a) Phenolphthalein test

b) Reine's test

c) Barberio's test

d) Paraffin test

Correct Answer - C
C i.e. Barberio's test :
Barberio's test is used for identification of seminal stains
medpox.com
Few drops of barberio's reagent (containing pieric acid) are added to
the seminal stain.
Positive test is indicated by formation of Yellow and needle shaped
crystals of spermine picrate.
(Spermine in seminal stain reacts with picric acid to form these
crystals)
Phenolphthalein test (Kastle-Meyer test) is used for identification of
haemoglobin in blood stains - Parikh 6th/7.16
Paraffin test (or Dermal nitrate test) is used to detect gun powder on
skin i.e. to determine if suspect had discharged a firearm- Parikh
6"/7.39
Reine's test has not been mentioned in forensic literature
Forensic tests to detect
Seminal
Blood Stains
Stain
- Barberio's
- Benzidine testQ
testO
- Fluorence - Phenophthalein
testQ (Kastle?
testQ (Kastle?
- Acid
Meyer) testQ
phosphatase
testQ - Takayama's
- Creatine Haemochromogen
phosphatase crystal
test testQ
- Elisa test - Teichmann's
Haemin crystal
testQ
- Spectroscopic

test

medpox.com
710. Sodium flouride may be use for
preservation of
a) Cyanide

b) Arsenic

c) Alcohol

d) Urine

Correct Answer - C
Ans. is 'c' i.e., Alcohol [Ref Parikh 6th/e p. 2.62; Essentials of
forensic medicine & toxicology 23rd/e p. 101]
medpox.com
Sodium fluride should be added to urine or vitreous humor, if alcohol
estimation is required; and also to samples for analysis for cocaine,
cyanides and CO.
711. Alkaline diuresis is treatment of choice
in poisoning with ?
a) Benzodiazepine

b) Barbiturates

c) Dhatura

d) Morphine

Correct Answer - B
Ans. is 'b' i.e., Barbiturate poisoning
Elimination of poison from circulation can be by following methods :?
medpox.com
A) Forced diuresis with or without alteration of urinary pH
Diuresis and ion trapping via alteration of urinary pH may prevent
the renal reabsorption of poisons that under go excretion by
glomerular filteration and active tubular secretion. Forced diuresis
may be of following types :?
1) Alkaline diuresis : Poisons which are trapped and excreted in
alkaline urine are barbiturates (phenobarbitone), chlorpropamide,
diffunisol, sulfonamides and salicylates.
2) Acid diuresis : It is done for amphetamines, cocaine, strychnine,
phencyclidine, quinidine, quinine, chloroquine, TCA and tocainide.
3) Saline diuresis : It is useful for alcohol, thallium, bromide, lithium,
fluoride, chromium, potassium and isoniazide.
B) Extracorporal removal therapies
These are peritoneal dialysis, hemodialysis, hemoperfusion (resin or
charcol), hemofiltration, plasmapheresis and exchange transfusion.
Commonly used procedures are :?
1) Haemodialysis : It is useful in poisoning with alcohol (ethanol and
methanol), aspirin (salicylates), acetone, atenolol, acetaminophen,
barbiturates (phenobarbitone), bromide, boric acid, chloral hydrate,
ethylene glycol, fluoride, lithium, trivalent arsenic, procainamide,
ethylene glycol, fluoride, lithium, trivalent arsenic, procainamide,
theophylline, thiocyanate, sodium chlorate and sotalol. Hemodialysis
is not useful in copper sulphate, benzodiazepines,
organophosphates, kerosine and digitalis poisonings.
In all poisonings, where hemodialysis is indicated peritoneal dialysis
is also used with one more indication of mercury poisoning.
2) Hemoperfusion (chorcol or resin) : It is used in acetaminophen,
barbiturates carbamazepine, chloral hydrate, caffeine, CC14,
chloramphenical, phenytoin, procainamide, salicylates, theophylline,
valproate, dapsone and methotrexate.

medpox.com
712. Amyl Nitrate is used as an antidote
in...poisoning :
a) CO2

b) CO

c) Cyanide

d) Nitric acid

Correct Answer - C
C i.e. Cyanide

medpox.com
713. Phossy jaw is caused by ?
a) White phosphorus

b) Red Phosphorus

c) Arsenic

d) Antimony

Correct Answer - A
Ans. is 'a' i.e., White Phosphorus
Phossy jaw is caused by phosphorus poisoning. All phosphorus
poisoning are caused by white (yellow) phosphorus (Red
phosphorus is nontoxic). medpox.com
Phosphorus poisoning
Phosphorus is a protoplasmic poison affecting cellular oxidation and
causing anoxic necorbiosis, classically affecting liver. It increases fat
deposition and inhibits glycogen deposition in liver. It is used in fire
works (Diwali poisoning) and as rat poison. Lethal dose is 60-120
mg.
Phosphorus occurs in two forms :?
1) White/yellow phosphorus : It is white, and becomes yellow on
exposure to air. It is translucent, waxy, luminous and crystalline
cylinders. It has garlic like odor. It is insoluble in water and luminous
in dark. Its fumes show phosphorescence.
2) Red phosphorus : It is reddish brown, inert, odourless and
tasteless. It is nontoxic (thus poisoning occurs only due to white
phosphorus). It is put on the sides (striking surface) of match box
(along with powdered galss).
Acute poisoning
It has following stages :
i) 1st Stage (GI irritation) : There is nausea, vomiting, diarrhea and
garlic odor. This stage lasts for 8 hours to 3 days.
garlic odor. This stage lasts for 8 hours to 3 days.
ii) 2nd Stage (Asymptomatic) : This stage lasts for 3 days.
iii) 3rd Stage : There is liver and kidney damage due to absorbed
phosphorus. Initially liver is enlarged due to acute fatty infiltration.
Later liver shruks due to necrosis, i.e. acute yellow atrophy.
Chronic poisoning
Toothache is the first symptom which is associated with loosening of
teeth, necrosis of gums and osteomyelitis of jaw. Therefore chronic
phosphorus poisoning is also know as phossy jaw (or glass jaw).
Postmortem appearance
There is garlic odor. Viscera and stool glow in dark (due to
luminosity).
To preserve luminosity, viscera are preserved in saturated saline
solution. Rectified spirit is not used as it causes loss of luminosity.

medpox.com
714. Which type of neuropathy is seen in
arsenic poisoning ?
a) Symmetric peripheral motor neuropathy

b) Asymmetrical peripheral motor neuropathy

c) Symmetrical peripheral sensory neuropathy

d) Asymmetrical peripheral sensory neuropathy

Correct Answer - D
Ans. is 'd' i.e., Asymmetrical peripheral sensory neuropathy
Neurological manifestations of arsenic poisoning
medpox.com
Headache, vertigo, hyperthermia, tremors, convulsions, coma,
general paralysis.
Peripheral neuropathy that is more sensory than motor occurs in
asymmetric distal stocking glove distribution after one to two weeks
of acute or chronic exposure.
715. What is the upper permissible limit of
alcohol allowed while driving in India -
a) 20 mg%

b) 30 mg%

c) 40 mg%

d) 50 mg%

Correct Answer - B
Ans. is 'b' i.e., 30 mg%
The statutory limit of alcohol level in blood in India while driving
medpox.com
beyond which driving is considered as crime is 30 mg%.
It is covered under S. 185 Motor Vehicle Act 1988.
The punishment for first offence is fine upto Rs. 2000/- or 6 months
of imprisonment or both and for second or subsequent offence fine
upto Rs. 3000/- or imprisonment upto 2 years or both.
716. What is the level of alcohol in blood
beyond which person is condidered
intoxicated ?
a) 40 mg%

b) 80 mg%

c) 120 mg%

d) 140 mg%

Correct Answer - D
Ans. is 'd' i.e., 140 mg% medpox.com
All individuals with a blood alcohol level of 140 mg% are considered
intoxicated to the point where they cannot deal with unusual,
emergency or non - customary problems.
717. The pathways followed by corrosive
acids in stomach is called ?
a) Curling ulcer

b) Cushing ulcer

c) Magenstrasse

d) None

Correct Answer - C
Ans. is 'c' i.e., Magenstrasse
Magenstrasse is the term applied to the pathway acidic agents
follow in stomach. medpox.com
The pathway of acids and alkalis in food filled stomach starts along
the lesser curvature of the stomach and leads to the pylorus, which
explains the location of greatest damage in food filled stomach.
Stomach without food have significant injury in the lower half of two
thirds and may have sparing of fundus.

718. Chocolate Brown postmortem staining is
seen in ?
a) KCl poisoning

b) Opium poisoning

c) H2S poisoning

d) Cyanide poisoning

Correct Answer - A
Ans. is 'a' i.e., KCl Poisoning
medpox.com
719. Bitter almond odour is percieved in
poisoning with?
a) Cobalt

b) Arsenic

c) Cyanide

d) Lead

Correct Answer - C
Ans. is 'c' i.e., Cyanide

medpox.com
720. Trousseau sign positive in which
poisoning ?
a) Citric acid

b) Oxalic acid

c) Acetic acid

d) Carbolic acid

Correct Answer - B
Ans. is 'b' i.e., Oxalic acid
Trousseou's sign and chovstek's sign are seen in hypocalcemia.
medpox.com
Oxalic acid poisoning can cause hypoclacemia.
Oxalic acid
It is also known as salt of sorrel or acid of sugar. It is used to erase
writing, as bleaching agent and in calico printing. It occurs in leaves
of rhubarb.
Local effects : Oxalic acid rarely damages the skin but readily
corrode the mucus membrane of digestive tract.
Systemic : (i) Shock : Large doses can cause death from shock; (ii)
Hypocalcemia : Oxalic acid readily combines with calcium to cause
hypocalcemia, which may present as tingling, numbness, twitching,
tetany, and convulsions, (iii) Renal damage : It is due to oxaluria
which may cause tubular necrosis.
Antidote : Any calcium preparation (e.g. calcium gluconate/chloride,
lime water, suspension of chalk) which converts poison into
insoluble calcium oxalate is an antidote for oxalate poisoning.
721. Tactile hallucination seen in abuse with ?
a) Heroine

b) Cocaine

c) Cannabis

d) Alcohol

Correct Answer - B
Ans. is 'b' i.e., Cocaine
Magnan's symptoms is tactile hallucination (formication) i.e. feeling
of bugs crawling under the skin is seen with cocaine abuse/
poisoning. medpox.com
Cocaine
Cocaine is an alkaloid derived from the Coca bush, Erythrexylum
CoCa. It was the first local anaesthetic which was used clinically.
Toxicity of cocaine may be : ?
A) Acute toxicity : - Acute cocaine intoxication is characterized by : ?
1) Sympathetic hyperactivity : - Tachycardia, hypertension,
mydriasis, sweating, nausea & vomiting.
2) Hypomanic state : - Increased psychomotor activity, grandiosity,
elation, hypervigilance, Increased speech output.
B) Chronic overuse : - Chronic overuse can cause : ?
1) Psychotic episodes (Cocaine psychosis) : - Persecutory delusions
with tactile hallucinations (formination). Tactile hallucinations are
manifested as bugs crawling under the skin → Cocaine bugs or
magnan's symptoms.
2) Other : - Anxiety reaction, compulsive behavior, delirium and
delusional disorders.
3) Black pigmentation of tongue and teeth
A combination of cocaine and heroin taken by injection is called
speed ball.
speed ball.

medpox.com
722. Pupil dilatation is seen in poisoning with
-
a) Dhatura

b) Ethyl alcohol

c) Brium carbonate

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
Poisoning of the following is associated with dilated pupils
Atropine medpox.com
Tricyclic antidepressants
Phenothiazines
Dhatura
Ethyl alcohol
Barium carbonate
723. Fatal dose of KCN is ?
a) 50 - 60 mg

b) 120 -130 mg

c) 180 -190 mg

d) 280 - 300 mg

Correct Answer - D
Ans. is 'd' i.e., 280 - 300 mg
Fatal dose of hydrocyanic acid in the pure form is 50 - 60 mg while
as sodium or potassium cyanide is 200 - 300 mg.
medpox.com
724. Pin point pupils are seen in all except ?
a) Pontine hemorrhage

b) Organophosphorus poisoning

c) Opium poisoning

d) Barbiturate poisoning

Correct Answer - D
Ans. is 'd' i.e., Barbiturate poisoning
Pin point pupil can be caused by : Opioids (morphine),
organophosphates, phenothiazines, clonidine, mushroom poisoning,
chloral hydrate, carbolic acid and pontine hemorrhage.
medpox.com
725. Nysten's rule pertains to ?
a) Rigor mortis

b) Identification

c) Bullet injuries

d) Putrefaction

Correct Answer - A
Ans. is 'a' i.e., Rigor mortis
Rigor mortis
It is defined as contraction, stiffening, shortenig and opacity of
muscles after death. medpox.com
It occurs after molecular (cellular) death. In tropical countries (e.g.
india), it begins 1-2 hours after death, takes further 2 hours to
develop, and lasts for 18-36 hours in summer and 24-48 hours in
winter.
In temperate countries, it begins in 3-6 hours, takes further 2-3 hours
to develop and lasts for 2-3 days.
All muscles of body are involved, i.e. voluntary or involuntary.
However, it does not start in all muscles simultaneously (nysten's
rule).
Involuntary muscles (heart) are involved first than voluntary muscles.
Sequence of muscles involvement is as follows : Heart > upper
eyelid > neck > jaw > face > chest > upper limb > abdomen > lower
limb > finger and toes.
It passes off in the same order in which it has appeared.
726. Hunger pangs are seen how long after
starvation ?
a) 6 hours

b) 12 hours

c) 24 hours

d) 48 hours

Correct Answer - C
Ans. is 'c' i.e., 24 hours
When hunger contractions start to occur in the stomach, they are
medpox.com
informally referred to as hunger pangs. Hunger pangs usually do not
begin until 12 to 24 hours after the last ingestion of food.
 727. Extreme hunger in starvation lasts upto -
a) 6 - 12 hours

b) 12 - 24 hours

c) 24 - 36 hours

d) 36 - 48 hours

Correct Answer - D
Ans. is 'd' i.e., 36 - 48 hours
Starvation is the result of actual deprivation of food or administration
of unsuitable food. Starvation may be :?
1. Acute (complete) : Sudden and complete stopage of food.
medpox.com
2. Chronic (partial) : Gradual deficient supply of food.
3. An acute starvation, the reserve carbohydrates, then fat and last the
proteins are used up.
4. Feeling of hunger with hunger pain lasts for 30-48 hours.
5. After 4-5 days, there is emaciation, absorption fat and loss of weight
(7-8 kg in 10 days).
728. For phage typing, how many phages of
staphylococcus aureus are used ?
a) 12

b) 15

c) 20

d) 23

Correct Answer - D
Ans. is' D i.e., 23
Bacteriophage typing of staphylococcus is based on the
medpox.com
susceptibility of cocci to bacteriophages.
This is carried out by pattern method where a set of 23 standard
typing phages of S. aureus is used to type staphylococcal isolates
and distinguish them from one another by their patterns of
susceptibility to lysis.
The phage-type of a strain is known by the designation of the
phages that lyse it.
For example, if a strain is lysed by phages 83A, 84 and 85, it is
called type 83A/84/85.
729. Most common biotype of S. aureus
causing human infection ?
a) A

b) B

c) C

d) D

Correct Answer - A
Ans. is 'a' i.e., A
Staphylococcus aureus has been classified into six biotypes : A, B,
C, D, E and F. medpox.com
Most human pathogenic strains belong to biotype A.
730. In pontaic fever, which antigen is seen in
urine?
a) Lipopolysaccharide-1

b) Lipopolysaccharide-2

c) Lipopolysaccharide-4

d) Lipopolysaccharide-6

Correct Answer - A
Ans. is 'a' i.e., Lipopolysaccharide-1
Legionella are classified into serogroup on the basis ofgroup specific
medpox.com
lipopolysaccharide (somatic antigen or 'O' antigen).
Legionella pneumophila sero-group-1 (LP-1) is the most common
infecting organism.
Urine test detect LP-1.
 731. Spores of clostridium perfringens are
located ?
a) In the middle of cells

b) At the poles of cells

c) Between middle and pole of cells

d) None of the above

Correct Answer - C
Ans. is 'c' i.e., Between middle and pole of cells
Clostridium perfringens (C. perfringens) is a spore-forming gram-
medpox.com
positive bacterium that is found in many environmental sources as
well as in the intestines of humans and animals. C. perfringens is
commonly found on raw meat and poultry
Spores of clostridium may be:?
1. Terminal: Located at poles.
2. Central: Located in the middle of the cells.
3. Subterminal: Between the middle of the cell and pole of the cells.
732. Subterminal spores are seen in ?
a) Cl perfringens

b) Cl tetani

c) Cl tertium

d) None

Correct Answer - A
Ans. is 'a' i.e., Cl perfringens

medpox.com
 733. Double zone of hemolysis is seen in ?
a) Staphylococcus areus

b) Streptococcus pyogenes

c) Clostridium perfringens

d) Corynebacterium diphtheriae

Correct Answer - C
Ans. is 'c' i.e., Clostridium perfringens
Two important characteristic feature of Cl. perfringens are :?
1. Target hemolysis (double zone hemolysis) on blood agar. It is a
narrow zone of complete hemolysis by theta toxin which is
medpox.com
surrounded by a wider incomplete hemolysis by alpha-toxin.
2. Naegler's reaction detects alpha toxin (phospholipase or lecithinase
C). When CL. perfringens is grown on a medium with the antitoxin
spread on one half of the plate, colonies on the other half without the
antitoxin will be surrounded by a zone of opacity. There will be no
opacity around the colonies on the half of the plate with the antitoxin,
due to the specific neutralisation of the alpha-toxin.
734. Virulence factor for clostridium tetani ?
a) Endotoxin

b) Tetanolysin

c) Tetanospasmin

d) Bacteremia

Correct Answer - C
Ans. is 'c' i.e., Tetanospasmin
Pathogenicity of CI tetani
Cl. tetani has little invasive property and is confined to the primary
site of lodgment. Tetanus results from the action of the potent
medpox.com
exotoxin it produces.
Toxins of CI tetani
1) Tetanolysin (Hemolysin)
Not relevant in the pathogenesis of tetanus.
2) Tetanospasmin (neurotoxin)
Responsible for tetanus
It is plasmid coded
In the brainstem and spinal cord it blocks release of the inhibitory
neurotransmitter glycine and 'y​aminobutyric acid (GABA).
It resembles strychnine in its effects, but it acts presynaptically, while
strychnine acts postsynaptically. o Tetanus toxin and botulinum toxin
resemble each other in their aminoacid sequences.
3) Nonspasmogenic, peripherally active neurotoxin
Its role is not known
735. Mechanism of action in pathogenesis of
Pseudomembranous colitis by CI difficle
?
a) Due to invasiveness

b) Due to endotoxin

c) Due to exotoxin

d) Due to NM blockade

Correct Answer - C
Ans. is 'c' i.e., Due to exotoxin
medpox.com
Pathogenesis of pseudomembranous colitis is due to
production of two large toxins by C. difficile :
i) Toxin A (an enterotoxin)
Is a potent neutrophil chemoattractant
Causes disruption of cell cytoskeleton by glycosylation of GTP -
binding proteins that regulate the actin cell cytoskeleton.
ii) Toxin B (a cytotoxin)
Causes disruption of cell cytoskeleton by similar mechanism.
736. Gram positive, catalase negative cocci ?
a) Staph aureus

b) Staph epidermidis

c) Staph saprophyticus

d) Pneumococcus

Correct Answer - D
Ans. is 'd' i.e., Pneumococcus

medpox.com
 737. Bullous impetigo is caused by ?
a) Streptococcus

b) Staphylococcus

c) Staphylococcus

d) Y. Pestis

Correct Answer - B
Ans. is 'b' i.e., Staphylococcus
Impetigo
Impetigo is a highly contagious, Gram-positive bacterial infection of
superficial layer of epidermis. Impetigo occurs in Two forms : ?
medpox.com
1. Non - bullous impetigo (Impetigo contagiosa)
It is the most common bacterial infection of children (occurs mainly
in children in contrast to Bullous impetigo which occurs in infants). It
is caused by both staphylococcus aureus and hemolytic group A
streptococcus (Str. pyogens), though it is mostly caused by staph
aureus. Most commonly occurs on face, i.e., around nose & mouth;
and exposed parts, i.e., arms, legs. Presents erythematous
macule/papule which changes into vesicle which soon ruptures with
formation of crusting. Crust has characteristic features : -
1. Honey-yellow colour in streptococcal impetigo.
2. Waxy in staphylococcal impetigo.
Lesion heal without scarring. Mucous membrane involvement is
rare. Lymphadenopathy is common
2. Bullous impetigo
It is caused by staphylococcus aureus most often phage type 71. It
usually occurs in infants and manifests as vesicle that develop into
bulla and later a pustule without any surrounding erythema. It mainly
occurs on face. Mucous membrane may be involved (in contrast to
impetigo contigiosa). Lymphadenopathy is rare.

medpox.com
738. Scarlet fever is caused by
a) Streptococcus agalactie

b) Streptococcus pyogenes

c) Streptococcus pneumoniae

d) Streptococcus equisimilus

Correct Answer - B
Ans. is 'b' i.e., Streptococcus pyogenes
Infections caused by streptococcus pyogenes
Scarlet fever consists of streptococcal pharyngitis, accompanied by
a characteristic rash which has a tiny red pinpoint appearance with
medpox.com
sand-paper like texture.
It occurs due to production of erythrogenic toxin
Respiratory infections
Sore throat is the most common of streptococcal disease. It may be
localised as tonsillitis as in older children and adults or it may involve
the pharynx more diffusely (pharyngitis) as in younger children. Otitis
media.
 739. Infective endocarditis after tooth
extraction is probably due to ?
a) Streptococcus viridans

b) Streptococcus pneumoniae

c) Streptococcus pyogenes

d) Staphylococcus aureus

Correct Answer - A
Ans. is 'a' i.e., Streptococcus viridans
Viridans streptococci are normally resident in the mouth and upper
medpox.com
respiratory tract. They cause transient bacteremia following tooth
extraction or other dental procedures; and get implanted on
damaged or prosthetic valves or in a congenitally diseased heart,
and grow to form vegetations.
They are ordinarily nonpathogenic but can on occasion cause
disease. In persons with preexisting cardiac lesions, they may cause
bacterial endocarditis, Str. sanguis being most often responsible.
Str. mutans is important in causation of dental caries.
The transient viridans streptococcal bacteremia induced by eating,
tooth-brushing, flossing and other source of minor trauma, together
with adherence to biological surfaces, is thought to account for the
predilection of these organisms to cause endocarditis.
Viridans streptococci are also isolated, often as a part of a mixed
flora, from sites of sinusitis, brain abscess and liver abscess.
Viridans streptococcal bacteremia occurs relatively frequently in
neutropenic patients, particularly after bone marrow transplantation
or high dose chemotherapy for cancer.
Treatment of varidans streptococcal infections include :-
1. Bacteremia in neutropenic patients → Vancomycin.
2. Other infection → Penicillin.

medpox.com
740. Shigella are be divided into subgroup on
the basis of ability to ferment -
a) Lactose

b) Maltose

c) Fructose

d) Mannitol

Correct Answer - D
Ans. is 'd' i.e., Mannitol
Fermentation of mannitol is of importance in classification
Shigella medpox.com
Mannitol fermenting Mannitol nonfermenting
Sh. flexneri (sub group B) Sh. dysenteriae (sub
group A)
Sh boydii (sub group C)
Sh. Sonnei (sub group D)
741. Shiga toxin acts by ?
a) Activating adenylyl cyclase to increase cAMP

b) Activating guanylyl cyclase to increase cGMP

c) Inhibiting protein synthesis

d) Inhibiting DNA replication

Correct Answer - C
Ans. is 'c' i.e., Inhibiting protein synthesis

medpox.com
742. Selective medium for shigella ?
a) Chocolate agar

b) BYCE medium

c) Hektoen agar

d) EMJH medium

Correct Answer - C
Ans. is 'c' i.e., Hektoen agar

medpox.com
743. Phenylalanine deaminase test is positive
in ?
a) Salmonella

b) Proteus

c) Vibrio cholerae

d) Helicobacter

Correct Answer - B
Ans. is 'b' i.e., Proteus
The distinctive character of proteus genus is deamination of phenyl
medpox.com
alanine to phenyl pyruvic acid (PPA + ye)
744. Enteric fever is caused by:
September 2005
a) Salmonella typhi

b) Salmonella paratyphi A

c) Salmonella paratyphi B

d) All of the above

Correct Answer - D
Ans. D: All of the above
Typhoid fever is caused by Salmonella typhi.
medpox.com
Paratyphoid fever is caused by Salmonella paratyphi A, B and C.
The term enteric fever encompasses both typhoid and paratyphoid
fevers.
 745. Salmonellae other than S typhi and S
paratyphi cause ?
a) Typhoid fever

b) Enteric fever

c) Gastroenteritis

d) All of the above

Correct Answer - C
Ans. is 'c' i.e., Gastroenteritis
SALMONELLOSIS
medpox.com
Salmonellosis is referred to the infection caused by bacteria of
genus salmonella.
Salmonellosis is of two types?
1. Typhoidal Salmonellosis caused by S.typhi and paratyphi 'A','B' and
'C' (has been explained, see previous explanations)
2. Non-typhoidal Salmonellosis
Non-tvphoidal Salmonellosis (NTS)
It is the most common type of salmonellosis ( more common than
typhoidal salmonellosis)
Common NTS species are?
i. S. enteritidis
ii. S. heidelburg
iii. S. hadar
iv. S. typhimurium
v. S. newport
Unlike typhoid salmonella (S. typhi and S. paratyphi), where only
reservoir is humans; non-typhoidal salmonella can be acquired from
multiple animal reservoirs.
Transmission is most commonly associated with?
 i. Animal food products especially eggs, poultry, undercooked meat
ii. Dairy products
iii. Fresh produce contaminated with animal waste

medpox.com
746. Chronic carrier of typhoid shed bacilli for
?
a) 1-3 weeks after cure

b) 3 weeks to 3 months after cure

c) 3 months - 1 year after cure

d) More than 1 year after cure

Correct Answer - D
Ans. is 'd' i.e., More than 1 year after cure
Carriers
medpox.com
Bacilli presist in the gall bladder or kidney and are eliminated in the
feces (fecal carriers) or urine (urinary carrier), respectively.
The development of the carrier state is more common in women and
in older age groups ( over 40 yrs)
Carriers are the more frequent source of infection than cases.
Urinary carriage is less frequent but more dangerous than intestinal
carrier - Park PSM
Urinary carrier is generally associated with some urinary lesions
such as calculi or schistosomiasis.
Presence of Vi antibody indicates the carrier state.
747. Enrichment media for cholera ?
a) VR medium

b) TCBS medium

c) Cary-Blair medium

d) Alkaline peptone water

Correct Answer - D
Ans. is 'd' i.e., Alkaline peptone water

medpox.com
748. Optimal percentage of NaCI for V
cholerae ?
a) 1%

b) 2%

c) 3%

d) 4%

Correct Answer - A
Ans. is 'a' i.e., 1%

medpox.com
749. Transmission of cholera is through ?
a) Fecally contaminated food

b) Fecally contaminated water

c) Contaminated food by vomits of a case

d) All of the above

Correct Answer - D
Man is the only reservoir. The immediate source of infection are the
stools and vomits of cases and carrier. Infection is acquired through
fecally contaminated water or food. Chlorination of water is effective
against V cholerae. medpox.com
There are following tyes of carrier in cholera.
i) Incubatory : Shed vibrios only in the brief incubation period of
1-5 days.
ii) Convalescent : Shed vibrios for 2-3 weeks.
iii) Healthy or contact carrier : Has had subclinical infection and
shed vibrios for less than 10 days.
iv) Chronic carriers : Can shed vibrios for months or years and
may have persistent infection in gall bladder.
750. Most halophilic vibrio ?
a) V cholerae

b) V vulnificus

c) V alginolyticus

d) V parahemolyticus

Correct Answer - C
Ans. is 'c' i.e., V alginolyticus
V alginolyticus is most salt tolerant (most halophilic) species of
vibrio.
medpox.com
751. True about vibrio parahemolyticus ?
a) Polar flagella

b) Non halophilic vibrio

c) Non-capsulated

d) Requires NaCI

Correct Answer - D
Ans. is 'd' i.e., Requires NaCI
It is halophilic vibrio.
* Inhabits the coastal sea, where it isfound inftshes arthopods such
as shrimps and ctabs and molluscs such as oyster.
medpox.com
* It resembles the cholera vibrio except that:
--> It is capsulated.
--> Shows bipolar staining
* Produces peritrichous flagella when grown on solid mediun (V.
cholerae has polar flagella), in liquid medium polar flagella are
formed.
* It grows, only in media containing NaCl, optimum conc.is 2-4
%, lts enteropathogenic is closely linked to
its ability to cause hemolysis on Wagatsuma agar t the Kanagawa
phenomenon.
752. Kanagawa's phenomenon is seen in ?
a) Pseudomonea aeuroginosa

b) Vibrio parahemolyticus

c) Shigella sonie

d) Proteus mirabilis

Correct Answer - B
Ans. is 'b' i.e., Vibrio parahemolyticus
Strains of vibrio parahemolyticus isolated from patients are always
hymolytic on Wagatsuma agar, while strains from environmental
sources are always non-hemolytic.
medpox.com
This linkage of enteropathogenicity to ability of hemolysis on
Wagatsuma agar is called Kanagawa's phenomenon.
753. True about vibrio vulnificus ?
a) Causes diarrhea commonly

b) Halophilic

c) Drug of choice is penicillin

d) Produces shiga toxin

Correct Answer - B
Ans. is 'b i.e., Halophilic
V. Vulnificus
V. vulnificus is a halophilic vibrio. It has been linked to two distinct
syndrome. medpox.com
754. True about Campylobacter jejuni ?
a) Obligate aerobe

b) Oxidase negative

c) Grows at 42°C

d) Non-motile

Correct Answer - C
Ans. is 'C' i.e., Grows at 42°C
Campylobacter jejuni
Morphology
Gram negative medpox.com
Comma shaped
Motile with a single polar flagellum → Darting or tumbling motility
Non capsulated
Non Sporing
Culture
Growth occurs under microaerophilic conditions (5% O2, 10%
CO2 and 85% N2).
Thermophilic, growing at 42°C (Can grow at 37°C, but incubation at
higher temperatures suppresses normal fecal flora.)
Biochemical reactions
Do not ferment carbohydrate
Catalase and oxidase-positive
Nitrate reduction positive
755. Culture medium for campylobactor jejuni
?
a) BYCE medium

b) Skirrow's medium

c) Thayer-Martin medium

d) TCBS medium

Correct Answer - B
Ans. is 'b' i.e., Skirrow's medium

medpox.com
756. Culture media used for 0157 : H7 Entero​‐
hemorrhagic E coli ?
a) Sorbitol containing agar

b) Mannitol containing agar

c) Sucrose containing agar

d) Dextrose containing agar

Correct Answer - A
Ans. is 'a' i.e., Sorbitol containing agar
Culture of 0157: H7 E.coli
medpox.com
E.coli 0157:H7 is not identified on routine stool cultures.
E.coli 0157:H7 can be specifically detected by the use of modified
Mac Conkey media which containssorbitol in place of lactose
(SMAC).
Sorbitol Mac Conkey media is specifically useful for the detection of
E.coli 0157:H7 as unlike most strains of E. coli, the 0157: H7 strain
does not ferment sorbitol.
Non fermenting colonies on a Sorbitol Mac Conkey plate (SMAC)
therefore suggest the diagnosis of E.coli 0157:H7.
Sorbitol Mac Conkey media is the screening method of choice for
E.coli 0157:H7.
757. E coli causing hemolytic uremic
syndrome ?
a) Enteropathogenic

b) Enterotoxigenic

c) Enteroinvasive

d) Enterohemorrhagic

Correct Answer - D
Ans. is 'd' i.e., Enterohemorrhagic
SCHERICHIA COLI
medpox.com
At least six distinct "pathotypes" of intestinal pathogenic E. coli exist
:
Enteropathogenic E. coli lEnteroadherent E. colil
It causes diarrhoea in infants and children usually occuring as
institutional out breaks.
It does not produce enterotoxin, nor are they invasive. They adhere
to the mucosa of small intestine and cause disruption of the brush
border microvilli.
These strains can be identified by their adhesion to HEP - 2 cells.
Enterotoxigenic E. coli
It causes traveller's diarrhoea [ETEC is the most common cause of
traveller's diarrhea!.
It produces enterotoxins. They can produce heat labile toxin (LT) or
heat stable toxin or both.
Toxin production alone may not lead to illness. The strain should first
be able to adhere to intestinal mucosa. This adhesiveness is
medicated by fimbrial or colonisation factor antigen (CFA).
Enteroinvasive E. coli
They themselves resemble shigella and their infection resembles
shigellosis (remember : shiga like toxin is elaborated by
enterohemorrhagic E. coli).
They produce mild diarrhoea to frank dysentry and occur in adult as
well as in children.
They have been termed enteroinvasive because they have the
capacity to invade intestinal epithelial cells in vivo and penetrate
HeLa or HEP - 2 cells in tissue culture.
This ability of penetration is plasmid determined which codes for
outer membrane antigens called the 'virulence marker antigen'
(VMA). The detection of plasmid can be diagnostic.
For laboratory diagnosis of EIEC, the sereny test used to be
employed.
These strains are non motile, do not ferment lactose or ferment it
late with acid without producing any gas.
Enterohemorrhagic E. coli or verotoxigenic E. coli
These strains produce verocytotoxin (VT) or shiga like toxin (SLT)
They can cause mild diarrhoea to fatal hemorrhagic colitis.
Shiga like toxin belongs to class ribosome inactivating proteins
(RIPs). It inhibits protein synthesis by inhibiting ribosomal function.
medpox.com
This toxin also acts on vascular endothelium to promote the
synthesis of coagulation factor VIII, vWF -* Platelet aggregation.
They can cause hemolytic uremic syndrome particularly in young
children and the elderly.
0 157 : H 7 is the most prominent serotype of EHEC, associated with
HUS, but 06, 026, 055, 091, 0103, 0111, 0113 and OX3 have also
been associated with this syndrome.
The primary target for VT is vascular endothelium.
The typical EHEC is serotype 0157: H7 which does not ferement
sorbital unlike majority of E. coli (but Harrison writes that few species
of this serotype can ferment sorbital).
Some other serotype like 026 : H1 also belongs to this group.
Laboratory diagnosis of VIEC diarrhea is established by
demonstration of the bacilli or VT in feces directly or in culture.
758. Satellitism is seen in cultures of?
a) Hemophilus

b) Streptococcus

c) Klebsiella

d) Proteus

Correct Answer - A
Ans. is 'a' i.e., Haemophilus
Satellitism
The growth of Haemophilus influenzae is scanty on blood agar, as
the factor V is not freely available, being imprisoned inside the red
medpox.com
blood cells. Growth is, therefore, better if the source of the V factor is
also provided.
When Staph aureus is streaked across a plate of blood agar on
which a specimen containing H. influenzae has been inoculated,
after overnight incubation, the colonies of H. influenzae will be large
and well developed alongside the streak of staphylococcus, and
smaller further away. This phenomenon is called satellitism.
Satellitism is due to a high concentration of factor 'V' in staph aureus
which is released into medium and is used by H. influenzae.
759. Mycobacterium tuberculosis grows in LJ
media in?
a) 1 0- 14 days

b) 2-3 weeks

c) 4-8 weeks

d) > 10 weeks

Correct Answer - C
Ans. is 'c' i.e., 4-8 weeks
M tuberculosis produces visible colonies on solid media (L.J. media)
in 4-8 weeks medpox.com
Use of liquid media with radiomimetic growth detection (BACTEC-
460) and the identification of isolates by nucleic acid probes give
result in 2-3 weeks.
760. Liquid medium for tuberculosis ?
a) LJ medium

b) Dorset medium

c) Loeffler's medium

d) MGIT

Correct Answer - D
Ans. is 'd' i.e., MGIT
Mycobacterial growth indicator tube (MGIT) is an automated liquid
culture method. It contains 7 ml of modified Middle brook 7 H9 Broth
base. medpox.com
761. Fastest method for diagnosis of TB -
a) Gene expert

b) LJ medium

c) TB MGIT

d) BAC, IEC

Correct Answer - A
Ans. is 'a' i.e., Gene expert
GeneXpert MTB/RIF
The Xpert MTB/RIF detects DNA sequences specific for
Mycobacterium tuberculosis and rifampicin resistance by
medpox.com
polymerase chain reaction.
It is based on the Cepheid GeneXpert system, a platform for rapid
and simple-to-use nucleic acid amplification tests (NAAT).
The Xpert MTB/RIF purifies and concentrates Mycobacterium
tuberculosis bacilli from sputum samples, isolates genomic material
form the captured bacteria by sonication and subsequently amplifies
the genomic DNA by PCR.
The process identifies all the clinically relevant rifampicin resistance
inducing mutations in the RNA polymerase beta (rpoB) gene in the
mycobacterium tuberculosis genome in a real time format using
fluorescent probes called molecular beacons.
Results are obtained from unprocessed sputum samples in 90
minutes, with minimal biohazard and very little technical training
required to operate.
762. Which type of pulmonary TB is most
likely to give sputum positive ?
a) Fibronodular

b) Pleural effusion

c) Cavitary

d) None

Correct Answer - C
Ans. is 'c' i.e., Cavitary
Sputum smears are usually positive in patients with laryngeal TB,
medpox.com
endobronchial TB and cavitary pulmonary TB" — Kelley 's
"Patients with cavitary pulmonary TB have high bacterial load in their
sputum" — Internet
 763. True about diphtheria toxin ?
a) Heat stable

b) Acts through cGMP

c) Consists of three fragments

d) Special affinity for brain

Correct Answer - A
Ans. is 'a' i.e., Heat stable
"Diphtheria toxin is a heat-stable polypeptide, composed of two
fragments" - Medical microbiology
Diphtheria toxin medpox.com
The diphtheria toxin acts by inhibiting protein synthesis. It inhibits
polypeptide chain elongation in the presence of nicotinamide adinine
dinucleotide (NAD) by inactivating elongation factor, EF - 2.
The diphtheria toxin is a protein which consists of two fragments, A
and B.
Both fragments are necessary for the toxic effect :
1. Fragment A - has enzymatic activity and inhibits protein synthesis by
inhibiting the chain elongation by inactivating the elongation factor -
2 (Ef - 2)
2. Fragment B - responsible for binding the toxin to the cells.
Toxin has special affinity for certain tissues such as myocardium,
adrenals and nerve endings.
The strain almost universally used for toxin production is the "Park
williams 8 strain".
764. How does chlamydia differ from other
usual bacteria?
a) Lack cell wall

b) Cannot grow in cell free culture media

c) Contains inclusion body

d) None of the above

Correct Answer - C
Ans. is 'c' i.e., Contains inclusion body
Chlamydia produces basophilic (intracytoplasmic) inclusion bodies in
medpox.com
infected cells in contrast to eosinophilic inclusion bodies produced
by most viruses and hence they are sometimes referred to as
Basophilic viruses.
Unique properties of chlamydiae are
Chlamydia is an obligate intracellular parasite. This means they can
survive only by establishig residence inside animal cells
They need their host's ATP as an energy source for their own
cellular activity. They are energy parasites using a cell membrane
transport system that uses ATP from the host system and gives out
ADP.
This obligate intracellular existence makes it impossible to culture
these organisms on nonliving artificial media. Due to their small size
and failure to grow in cell - free media they were considered to be
viruses.
Chlamydiae grows in cultures of a variety of eukaryotic cell lines Mc
Coy or HeLa cells. It may be necessary to treat cells with polyanionic
compounds such as DEAD-dextran to reduce the electrostatic
barrier to infection. Antimetabolite such as cycloheximide is added to
favour competition for host cell amino acid pools. All types of
 chlamydiae proliferate in embryonated eggs particulary in the yolk
sac.
The special features in structure and chemical composition of
chlamydiae are:
1. The outer cell wall resembles the cell wall of gram negative bacteria
2. It has a relatively high lipid content
3. It is rigid but it does not contain typical bacterial peptidoglycan;
perhaps it contain a tetrapeptide linked matrix.
4. N Acetylmuramic acid also appears to be absent from chlamydiae
cell wall.

medpox.com
765. A patient is suffering from pneumonia.
Laboratory study shows acid-fast
filamentous bacterium. The causative
organism is ?
a) M. tuberculosis

b) Actinomyces

c) Nocardia

d) Mycobacterium Avium intracellulare

Correct Answer - C medpox.com

Ans. is 'c' i.e., Nocardia
Symptoms of pneumonia by a filamentous acid fast bacterium
suggest the diagnosis of Nocardia.
766. Frie's test is useful for diagnosis of ?
a) Mycoplasma

b) Rickettsia

c) Sarcoidosis

d) Chlamydia

Correct Answer - D
Ans. is 'd' i.e., Chlamydia
Fries test (skin hypersensitivity test) was used for LGV (caused by
chlamydia trachomatis).
But it is not used now because of high false positive results.
medpox.com
 767. Safety pin appearance is seen in ?
a) Vibrio vulnificus

b) Vibrio parahemolyticus

c) Pseudomonas aeuroginosa

d) H. influenzae

Correct Answer - B
Ans. is `b' i.e., Vibrio parahemolyticus
Bipolar staining (safety pin appearance)
Some bacteria display a safety pin appearance due to the
accumulation of dye at the poles of the cells.
medpox.com
This characteristic is called bipolar staining.
Bacteria showing bipolar staining are?
1. Calymmatobacter granulomatis (Donovani granulomatis)
2. Vibrio parahemolyticus
3. Pseudomonas mallei
4. Yersinia pestis
5. Pseudomonas pseudomallei
6. H. ducreyi
768. Pseudomonas exotoxin inhibits protein
synthesis by inhibiting ?
a) RNA polymerase

b) EF-2

c) Transpeptidase

d) Reverse transcriptase

Correct Answer - B
Ans. is 'b' i.e., EF-2
Exotoxin 'A' of P. aeruginosa inhibits protein synthesis through
medpox.com
interference with adenosine diphosphate ribosylation of elongation
factor - 2.
Remember
Bacterial toxins inhibiting protein synthesis :
Exotoxin A of P aeruginosa
Shiga toxin (Shigella)
Diphtheria toxin
Shiga like toxin or verocytotoxin of EHEC.
769. New York agar is used for ?
a) Salmonella

b) Clostridia

c) Neisseria

d) Bacillus Anthracis

Correct Answer - C
Ans. is 'c' i.e., Neisseria
New York City (NYC) medium is primarily designed for isolation of
pathogenic Neisseria.
It also supports the growth of genital mycoplasma (Mycoplasma
medpox.com
hominis and Ureoplasma Urealyticum).
It is useful in the diagnosis of gonorrhea and mycoplasma infection.
It consists of primarily a peptone-corn starch agar-base buffered with
phosphates and supplemented with horse plasma, horse
hemoglobin, dextrose, yeast autolysate and antibiotics.
770. Milk ring test is done to detect which
organism present in milk?
a) Bordetella

b) Brucellosis

c) Bartonella

d) Salmonella

Correct Answer - B
correct answer- B--> Brucellosis
For the detection of Brucella in infected animals, pooled milk
medpox.com
samples may be tested for bacilli by culture and for antibodies by
several techniques.
In the milk ring test, a sample of whole milk is mixed well with a drop
of stained brucella antigen and incubated in a water bath at 70
degrees for 40-50 min.
If antibodies are present in the milk, the bacilli are agglutinated and
rise with the cream to form a blue ring at the top, leaving the milk
unstained.
If antibodies are absent, no colour ring is formed and the milk
remains uniformly blue.
Also Know:
Bordetella is detected using the cough plate method, post nasal
swab, and the pernasal swab method.
Bartonella bacilliformis causes Oroya fever.
Bartonella quintana causes trench fever.
Bartonella henselae causes cat scratch disease.
Salmonella is detected using a widal reaction.
771. Indian tick typhus is caused by:
a) R typhi

b) R conorii

c) R akari

d) C burnetii

Correct Answer - B
Ans. is. 'b' i. e., R conorii

medpox.com
772. LGV (lymphogranuloma venerum) is
caused by ?
a) Treponema pallidum

b) Chlamydia trachomatis

c) Calymmatobacter granulomatosis

d) H Ducreyi

Correct Answer - B
Ans. is 'b' i.e., Chlamydia trachomatis
Lymphogranuloma venereum (LGV) is a long-term (chronic)
medpox.com
infection of the lymphatic system.
It is caused by any of 3 different types (serovars) of the
bacteria Chlamydia trachomatis.
The bacteria are spread by sexual contact. The infection is not
caused by the same bacteria that cause genital chlamydia.
Chlamydia trachomatis causes eye (conjunctivitis, trachoma),
respiratory (pneumonia), and genital tract (urethritis,
lymphogranuloma venereum) infections.
Diagnosis made with nucleic acid test for C trachomatis, LGV
serovars diagnosed serologically.
773. PLET medium is used in ?
a) Plague

b) Anthrax

c) Typhoid

d) Cholera

Correct Answer - B
Ans. is `b' i.e., Anthrax
Selective media for B. antracis is PLET medium, consisting of
polymyxin, lysozyme, ethylene diamine tetraacetic acid (EDTA) and
thallous acetate added to heart infusion agar.
medpox.com
774. Waterhouse-Friderichsen syndrome is
seen in ?
a) Pneumococci

b) N. meningitidis

c) Pseudomonas

d) Yersinia

Correct Answer - B
Ans. is 'b' i.e., N. meningitidis
Waterhouse–Friderichsen syndrome (WFS) is defined as adrenal
medpox.com
gland failure due to bleeding into the adrenal glands, commonly
caused by a severe bacterial infection. Typically, it is caused
by Neisseria meningitides. The bacterial infection leads to
massive bleeding into one or (usually) both adrenal glands.
Fulminant meningococcemia (purpura fulminans or Waterhouse -
Friderichsen syndrome) is the most rapidly lethal form of septic
shock experienced by humans.
It differs from most other forms of septic shock by the prominence of
hemorrhagic skin lesions (petechiae, purpura) and the consistent
development of DIC.
775. Weil felix reaction is heterophile
antibodies reaction due sharing of
Rickettsial antigen with
a) Shigella

b) Proteus

c) Chlamydia

d) Mycoplasma

Correct Answer - B
Ans. is 'b' i.e., Proteus medpox.com
Weil felix reaction
This reaction is an agglutination test in which sera are tested for
agglutinins to 0 antigens of certain nonmotile proteus strains OX -19,
OX - 2 and OX - K.
The basis of the test is the sharing of an alkali - stable carbohydrate
antigen by some rickettsiae and by certain strains of proteus, P.
vulgaris OX - 19 and OX - 2 and P. mirabilis OX - K.
The test is usually done as a tube agglutination, though rapid slide
agglutination methods have been employed for screening
776. Mode of transmission of Listeria
a) Ingestion

b) Inhalation

c) Skin inoculation

d) None

Correct Answer - A
Ans. is 'a' i.e., Ingestion
LISTERIOSIS
Mode of transmission;
Foodborne → Most common (most cases are due to serotype 4b)
medpox.com
Nosocomial → In late-onset neonatal infection.
L monocytogenes enters the body through the gastrointestinal tract
after ingestion of contaminated foods such as cheese, fruit, or
vegetables.
The organism has several adhesion proteins (Ami (an autolysin
amidase), Fbp A (fibronectin binding protein), and flagellin proteins)
that facilitate bacterial binding to the host cells and that contribute to
virulence.
Iron is an important virulence factor. Listeria produces siderophores
and is able to obtain iron from transferrin.
777. Frisch bacillus affects most commonly
a) Mouth

b) Nose

c) Eye

d) Ear

Correct Answer - B
Ans. is 'b' i.e., Nose
Frisch bacillus is Klebsiella rhinoscleromatis, which causes
rhinoscleroma, a granulomatous disease of the nose.
K pneumoniae subspecies rhinoscleromatis form rhinoscleroma, a
medpox.com
destructive granuloma of the nose and pharynx.
Klebsiella granulomatis (formerly Calymmatobacterium
granulomatis) causes a chronic genital ulcerative disease,
granuloma
inguinale, an uncommon sexually transmitted disease
 778. Bile esculin agar is used for ?
a) Group A streptococcus

b) Group B streptococcus

c) Group C streptococcus

d) Enterococcus

Correct Answer - D
Ans. is 'd' i.e., Enterococcus
Enterococcus
Majority of the infections are caused by E. faecalis and E. faecium.
Less frequently isolated species are E. gallinarum, E. durans, E.
medpox.com
hirae and E. avium.
Enterococci are normal inhabitants of the large bowel of human
adults, although they usually make up < 1% of the culturable
intestinal microflora.
They are catalase negative (as all streptococci).
Their characteristic feature is that they can grow in presence of
:?
1. 40% bile
2. 6.5% Sodium chloride
3. At pH 9.6
4. At 45°C (relative heat resistant surving 60°C for 30 minutes)
5. In 0-1% methylene blue milk
They hydrolyze esculin. They grow in presence of 40% bile and
hydrolyze esculin → Bile esculin positive.
They are PYR (Pyrrolidonyl Arylamidase) positive.
They are usually non-hemolytic (gamma-hemolytic), but some-times
may show alpha or beta hemolysis.
779. Rash is not caused by ?
a) Salmonella

b) Shigella

c) Meningococci

d) Staphylococcus

Correct Answer - B
Ans. is 'b' i.e., Shigella
Salmonella (typhoid) and meningococci cause morbiliform rash.
Staphylococcus causes scarlentiform rash in TS S and SSSS.
Infections causing Exanthems (acute generalized rash)
medpox.com
Morbilliform
Viral : Measles (rubeola), rubella, erythema infectiosum, EBV, CMV,
adenovirus, echovirus, early HIV, coxasackie virus.
Bacterial : Typhoid, Early secondary syphiis, Early rickettsia, Early
meningoccemia.
Scarlentiform
Scarlet fever (streptococcus).
Toxic shock syndrome.
Staphylococcal scalded skin syndrome.
780. Most common cause of infection due to
catheter in urinary tract ?
a) E coli

b) Coagulase negative staphylococci

c) Staph aureus

d) Pseudomonas

Correct Answer - A
Ans. is 'a' i.e., E coli
"E coli cause 80% of acute UTI in patients without
medpox.com
catheterization".
"E. coil is the most common cause of catheter associated UTI too".
 781. Man had uncooked meat at dinner 3 days
back, Now presenting with diarrhea.
Stool examination shows coma shaped
organism with RBC and WBC. Causative
organism is ?
a) Vibrio cholerae

b) Shigella

c) Campylobacter jejuni

d) Yersinia enterocolitia

medpox.com
Correct Answer - C
Ans. is 'c' i.e., Campylobacter jejuni
This is a case of dysentery (RBC in stools along with WBC).
Among the given options, 'b', 'c' and 'd' can cause dysentery. But,
coma shaped organism is campylobactor jejuni.
Based on the depth of intestinal invasion, there are different clinical
manifestations of infection with organisms causing diarrhea:-
No cell invesion (noninflammatory)
The bacteria bind to intestinal epithelial cells but do not enter the
cell.
Diarrhea is caused by the release of enterotoxins.
Watery diarrhea with no fecal leukocytes and no systemic symptoms
(e.g. fever) occurs.
Organisms are :
1. V cholerae
2. Clostridium perfringens
3. Cryptosporidia
 4. Adenovirus
5. ETEC
6. B. cereus
7. Microsporidia
8. Staph. aureus
9. Giardia
10. Rotavirus
Invasion of the intestinal epithelial cells (Inflammatory)
The organisms have virulence factors that allow binding and
invasion into cells.
Toxins may be then released that destroy the cell.
The cell penetration results in a systemic immune response with
fecal leukocytes as well as fever.
The cell death results in RBC leakage into the stool (dysentery).

medpox.com
782. Reservoir of plague is ?
a) Domestic rat

b) Wild rat

c) Rat flea

d) Man

Correct Answer - B
Ans. is 'b' i.e., Wild rat

medpox.com
783. Sterols are found in ?
a) Cell wall of Ricketssia

b) Cell membrane of Ricketssia

c) Cell wall of Mycoplasma

d) Cell membrane of Mycoplasma

Correct Answer - D
Ans. is 'd' i.e., Cell membrane of Mycoplasma
Mycoplasma lack cell wall. They are bounded by triple layered unit
membrane that contains sterol. o Thus they require cholesterole and
related sterols. medpox.com
784. Mechanism action of botulinum toxin ?
a) Increased cAMP

b) Increased cGMP

c) Inhibition of acetylcholine release

d) Inhibition of noradrenaline release

Correct Answer - C
Ans. is 'c' i.e., Inhibition of acetylcholine release
Botulinum Toxin
Cl. botulinum produces a powerful exotoxin that is responsible for its
pathogenicity. medpox.com
The toxin differs from other exotoxins in that it is not released during
the life of organism. It is produced intracellularly and appears in the
medium only on the death and autolysis of the cell.
It is the most toxic substance known.
Toxin is heat labile, but spores are highly heat resistant.
It acts by blocking the release of acetylcholine at synapses and
neuromuscular junction. It acts presynaptically.
Toxin of all types (A, B, C, D, E, F, G) are neurotoxin except C2
which is a cytotoxin (enterotoxin).
785. All selective media are correctly matched
except ?
a) V cholerae - TCBS medium

b) Pseudomonas - Cetrimide agar

c) M tuberculosis - LJ medium

d) Campylobacter - BCYE medium

Correct Answer - D
Ans. is 'd' i.e., Campylobacter - BCYE medium

medpox.com
786. Agar media used for Haemophilus
influenza ?
a) Blood agar

b) Chocolate agar

c) Tryptose agar

d) BYCE agar

Correct Answer - B
Ans. is 'b' i.e., Chocolate agar

medpox.com
787. Earliest growth of diphtheria is detect on
which media ?
a) Potassium tellurite media with iron

b) McConkey's agar

c) Dorset egg medium

d) Loeffler's serum slope

Correct Answer - D
Ans. is 'd' i.e., Loeffler's serum slope
Diphtheria bacilli grow on Loeffler's serum slope very rapidly and
medpox.com
colonies can be seen in 6-8 hours, long before other bacteria grow.
788. Tunica reaction is positive in ?
a) R prowazekii

b) R typhi

c) R tsutsugamushi

d) R akari

Correct Answer - B
Ans. is 'b' i.e., R typhi
Neill - Mooser (Tunica) reaction
When male guinea pigs are inoculated intraperitoneally with blood
from a case of endemic typhus or with a culture of R. typhi (R.
medpox.com
mooseri) they develop fever and a characteristic scrotal
inflammation.
This reaction is used to differentiate R. typhi and R. prowazekii.
789. Most common species of pseudomonas
causingintravascular catheter related
infections is ?
a) P. cepacia

b) P. aeruginosa

c) P. maltiphila

d) P. mallei

Correct Answer - B
P. aeruginosa [Ref- Harrison 17 th/e p. 838, 839; The Internet
medpox.com
journal of Anaesthesiology]
Most common species of pseudomonas associated with
intravascular catheter is Pseudomonas Aeruginosa.
Intravascular catheter related infections
Indwelling vascular catheters are a leading source of bloodstream
infections.
Amongst indwelling vascular catheters, central venous catheters are
the most common culprits.
Pathogenesis
There are four potential sources for catheter related infections ?
1) The skin insertion site
2) The catheter hub
3) Hematogenous seeding from a distant infection
4) Contaminated infusate
The skin insertion site and the catheter hub are by for the two most
important sources.
Approximately 65% of catheter related infections originate from the
skin flora, 30% from the contaminated hub and 5% from other
pathways.
For short term catheters, skin contamination is the most likely
mechanism of pathogenesis.
On the other hand, for long term catheters, hub contamination is
more .frequent because such catheters often have to be intercepted
and manipulated.
Skin organisms migrate from the skin insertion site along the
external surface of catheter, colonizing the distal intravascular tip of
the catheter, and ultimately causing blood-stream infection. On the
other hand, in hub related infections, organisms are usually
introduced into the hub from the hands of medical personnel and the
organisms migrate along the internal surface of the catheter, where
they can cause a bloodstream infection.
Microbiology
Most of the micro-organisms implicated in CRIs arise from the skin
flora.
Staphylococci are the most frequently isolated pathogens,
paricularly coagulase-negative staphylococci.
Etiology of catheter related infection
medpox.com
Microorganism Percentage
• Coagulase negative
30 - 40
staphylococci
• Staph aureus 5 - 10
• Enterococci 4 - 6
• Candida spp. 3 - 6
• Pseudomonas
2 - 5
aeruginosa
• Enterobacter spp 1 - 4
• Acinetobacter spp. 1 - 2
• Serratia spp. <1
• Others < 1 - 5
790. Which of the following is incubated at
temperature 40-44 degrees ?
a) Vibrio cholerae

b) Pseudomonas aeruginosa

c) Vibrio parahemolyticus

d) E coli

Correct Answer - B
Ans. is 'b' i.e., Pseudomonas aeruginosa
"The optimum temperature for growth of pseudomonas aeruginosa
medpox.com
is 37 degree and is able to grow at temperature as high as 42° C" -
Essentials of Microbiology
Pseudomonas aeruginosa
Morphology
Gram negative bacilli
Motile by polar flagellum
Non capsulated but many strains have mucoid slim layer
especially the organisms which are isolated from cystic fibrosis
patient.
Culture
Obligate aerobe
Colonies emit a distinctive, musty, mawkish, earthy or sweet grape-
like odour or corn tocolike odour.
Cetrimide agar is a selective media.
Pseudomonas aeruginosa produces a numbers of pigments. The
production of these pigments accounts for the colour of colonies.
Pyocyanin is produced only by P.aeruginosa and it inhibits the
growth of many other bacteria.
Pyoverdin may be produced by many other species.
medpox.com
791. Varicella zoster virus belongs to which
family of DNA viruses ?
a) Poxviridae

b) Herpesviridae

c) Adenoviridae

d) Papovaviridae

Correct Answer - B
Ans. is `b' i.e., Herpesviridae
DNA viruses
medpox.com
Poxviridae :- Variola, vaccinia, cowpox, monkeypox, tanapox,
molluscum contagiosum Herpesviridae :- HSV-1, HSV-2, varicella-
zoster, EBV, CMV, HTLV- 1, RK-virus Adenoviride Adenovirus
Parvoviridae Parvovirus, Adenosatellovirus, Densovirus
Papovaviridae Papilloma virus (HPV), Polyomavirus
Hepadnaviridae Hepatitis-B virus
792. Molluscum contagiosum virus belongs
to ?
a) Poxviruses

b) Herpesviruses

c) Picornaviruses

d) Adenovirus

Correct Answer - A
Ans. is 'a' i.e., Poxviruses

medpox.com
793. Which of the following is not a pox
virus?
a) Cow pox

b) Molluscum contagiosum

c) Small pox

d) Chicken pox

Correct Answer - D
Ans. is 'd' i.e., Chicken pox
Poxviruses causing disease in humans
Variola (small pox) medpox.com
Buffalopox
Cowpox
Molluscum contagiosum
Vaccinia
Monkeypox
Orf
Tanapox
Chicken pox is caused by varicella - zoster virus, which is a herpes
virus.
794. Double stranded RNA virus with
segmented genome?
a) Influenza

b) Rotavirus

c) Arenavirus

d) Bunyavirus

Correct Answer - B
Ans. is 'b' i.e., Rotavirus

medpox.com
795. Double stranded RNA virus ?
a) Rotavirus

b) Measles virus

c) Mumps virus

d) Influenza virus

Correct Answer - A
Ans. is 'a' i.e., Rotavirus

medpox.com
796. Smallest Virus is ?
a) Herpes virus

b) Adenovirus

c) Parvovirus

d) Poxvirus

Correct Answer - C
Ans. is `c' i.e. Parvovirus

medpox.com
797. Most common pox virus infection in
human is ?
a) Smallpox

b) Monkeypox

c) Cowpox

d) Mulluscum contagiosum

Correct Answer - D
Ans. is 'd' i.e., Mulluscum contagiosum
Among the given options, smallpox (variola) virus and molluscum
medpox.com
contagiosum affect human as their primary host.
Small pox has been eradicated.
Molluscum contagiosum is a common skin infection.
798. Cause of Herpes Zoster ?
a) Primary infection with VZV

b) Recurrent infection with VZV

c) Reactivation of latent infection of VZV

d) Multiple infection with VZV

Correct Answer - C
Ans. is 'c' i.e., Reactivation of latent infection of VZV
Varicella zoster virus infection
Varicella (Chicken pox) and Herpes zoster are different
manifestations of the same virus infection. The virus is therefore
medpox.com
called varicella zoster virus (VZA)
Primary infection with VZV causes chicken pox.
Reactivation of latent VZV, when immunity has fallen to ineffective
levels causes-Herpes zoster
The virus remains dormant in sensory ganglion of trigeminal nerve
and reaches the eye along one or more branches of the opthalmic
division of the 5th nerve
Herpes Zoster (Shingles)
Occurs in old age 60 years or above
As a consequence of reactivation of latent infection from the dorsal
root ganglion. o Unilateral vesicular eruptions within a dermatomal
distribution
Dermatomes from T3 to L3 and trigeminal nerve (especially
ophthalmic branch) are involved. o Zoster ophthalmicus - due to
reactivation in ophthalmic branch of trigeminal (gasserian) ganglia o
Ramsay Hunt Syndrome - due to reactivation in geniculate ganglion
of facial nerve. o Complications Post herpetic neuralgia - most
debilitating complication
1. Meningeal irritation
2. Transverse myelitis
3. Cutaneous dissemination
4. Patient's with hodgkin's disease and non hodgkin's lymphoma are at
greatest risk for progressive hespes zoster.
5. Bacterial superinfection

medpox.com
799. Wrong statement about chicken pox/
herpes zoster?
a) Caused by VZV

b) Chicken-pox primary infection

c) Herpes-zoster recurrent infection

d) Latent infection in trigeminal ganglion

Correct Answer - C
Ans. is 'c' i.e., Herpes-Zoster recurrent infection
Herpes-Zoster is due to reactivation of latent infection (not due to
medpox.com
recurrent infection). Other options are correct.
800. Most common complication of chicken-
pox -
a) Bacterial infection

b) Meningitis

c) Pneumonia

d) Nephritis

Correct Answer - A
Ans. is 'a' i.e., Bacterial infection
Complications of chicken pox
medpox.com
The most common infectious complication of varicella is secondary
bacterial superinfection of the skin, which is usually caused by
streptococcus pyogenes or Staphylococcus aureus.
The most common extracutaneous site of involvement in children is
CNS.
Varicella pneumonia is the most serious complication following
chickenpox in adults.
801. Which myxovirus does not have
hemagglutinin and neuraminidase but
have membrane fusion protein -
a) Measles

b) Parainfluenza

c) RSV

d) Influenza

Correct Answer - C
Ans. is 'c' i.e., RSV medpox.com
RSV does not posses hemagglutinin or neuraminidase.
The viral envelope has two glycoproteins?
i) G protein → By which virus attaches to cell surface
ii) F- protein ( Fusion protein ) → which bring about fusion between
viral and host cell membranes. It is also responsible for cell to cell
fusion, which leads to characteristic syncytial formation.
802. Virus most sensitive to inactivation by
biocides ?
a) Adenovirus

b) Herpes virus

c) Parvovirus

d) Poliovirus

Correct Answer - B
Ans. is 'b' i.e., Herpes virus
Enveloped viruses are most sensitive to inactivation by biocides.
medpox.com
Among the given options only Herpesvirus is enveloped virus.
Adenovirus, parvovirus and poliovirus (picornavirus) are non-
enveloped viruses.
803. Exanthema subitum is caused by ?
a) HHV-6

b) HHV-8

c) Parvovirus

d) Coxsackievirus

Correct Answer - A
Ans. is 'a' i.e., HHV-6
HHV-6 causes roseola infantum (also called exanthema subitum or
sixth disease).
medpox.com
804. HHV-6 causes ?
a) Erythema infectiosum

b) Kaposi sarcoma

c) Roseola infantum

d) Herpangina

Correct Answer - C
Ans. is 'c' i.e., Roseola infantum

medpox.com
805. All cause viral hepatitis except -
a) Measles

b) EBV

c) Rhinovirus

d) Reovirus

Correct Answer - C
Ans. is 'c' i.e., Rhinovirus
Important viruses causing hepatitis:?
1) Hepatotropic viruses : HAV, HBV, HCV, HD V, HEV.
2) Herpes viruses : CMV, EBV, HSV-1, VZV.
medpox.com
3) Flaviviruses : Yellow fever, dengue fever.
4) Filoviruses : Marburg virus, Ebola virus.
5) Occasinal causes Measles virus, adenovirus, Echoviruses,
Coxsackieviruses, influenza virus, parvoviruses, reoviruses, mumps
virus.
806. Which flavivirus causes hepatitis in
human ?
a) Hepatitis A

b) Hepatitis B

c) Hepatitis C

d) Hepatitis D

Correct Answer - C
Ans. is 'c' i.e., Hepatitis C

medpox.com
807. Which of the following hepatitis viruses
is a DNA virus ?
a) Hepatitis C virus

b) Hepatitis B virus

c) Delta agent

d) Hepatitis E virus

Correct Answer - B
Ans. is 'b' i.e., Hepatitis B virus
Hepatitis B virus (HBV)
medpox.com
Hepatitis B virus is the most widespread virus and the most
important cause of viral hepatitis. o HBV belongs to Hepadna viridae
HBV is hepadnavirus type -1
Hepatitis B is the only hepatitis virus which has DNA. All others are
RNA viruses.
HBV contains two linear strands of DNA. One of the strands (the
plus strand) is incomplete and other is complete (the minus
strand) → Partially double stranded DNA.
HBV contains both DNA-dependent DNA polymerase and RNA
dependent reverse transcriptase.
Instead of DNA replication directly from a DNA template, HBV relys
on reverse transcription of minus strand DNA from a pregenomic
RNA intermediate (like retrovirus).
808. Which is not parenterally transmitted
a) HAV

b) HBV

c) HCV

d) HDV

Correct Answer - A
Ans. is 'a' i.e., HAV

medpox.com
809. Defective hepatitis virus is ?
a) HAV

b) HBV

c) HCV

d) HDV

Correct Answer - D
Ans. is 'd' i.e., HDV
Hepatitis D (HDV) or Delta virus
It is defective RNA virus dependent on the helper function of HBV for
its replication and expression.
medpox.com
It contains single stranded RNA (ssRNA) - Defective RNA.
It has no independent existence and can survive and replicate only
as long as HBV infection persists in the host.
It resembles some plant viruses, such as viroids or satellite viruses.
It has been classified in genus Deltavirus.
Delta core of HDV is encapsidated by an outer envelope of HBs Ag,
so it require cooperative function of HBV.
Intracellular replication of HDV RNA can occur without HBV but liver
injury requires the presence of HBV.
HDV can cause two types of infection.
810. Maternal mortality is more in ?
a) HAV

b) HBV

c) HCV

d) HEV

Correct Answer - D
Ans. is 'd' i.e., HEV
Hepatitis E virus
Also known as enterically transmitted non-A non - B (NANB) virus or
epidemic NANB. medpox.com
It is classified in the genus Herpesvirus under the family caliciviridae.
It is a RNA virus with single - stranded positive sense RNA
It is transmitted by fecal-oral route.
In India, HEV is responsible for the majority of epidemic and
sporadic hepatitis in adults.
An epidemiological feature that distinguishes HEV from other enteric
agents is the rarity of secondary person to person transmission
(Secondary attack rate is very low 2-3% as against 10-20 % in HAV
infection)
A unique feature is the clinical severity and high case fatality rate of
20-40 % in pregnant women, especially in the last trimester of
pregnancy.
It is characteristically associated with cholestasis
811. E antigen (HBeAg) of hepatitis B virus is
a product of which gene
a) S

b) C

c) p

d) x

Correct Answer - B
Ans. is 'b' i.e., C
Genes & gene products
medpox.com
The genome of HBV is made of circular DNA, but it is unusual
because the DNA is not fully double stranded --> one of the strands
is incomplete and other is complete → partially double stranded
DNA.
There are four known genes encoded by genome —› 'C' , X', `P' ,'S'.
812. DNA polymerase of HBV is encoded by
which of the following ?
a) S gene

b) C gene

c) P gene

d) X gene

Correct Answer - C
Ans. is `c' i.e., P gene
DNA polymerase of HBV is encoded by P gene
medpox.com
813. Infectivity of HBV is indicated by ?
a) HBeAg

b) HbsAg

c) HBV DNA

d) Anti HBs Ag

Correct Answer - A
Ans. is 'a' i.e., H BeAg

medpox.com
814. Serum marker after Hepatitis B
vaccination ?
a) Anti-HBsAg

b) Anti-HBeAg

c) Anti-HBcAg

d) HBsAg

Correct Answer - A
Ans. is 'a' i.e., Anti-HBsAg

medpox.com
815. Super carrier of HBV shows following
serum markers ?
a) HBsAg

b) HbsAg + HBV DNA

c) HbsAg + HBeAg + HBV DNA

d) Anti-HBsAg + HBV DNA

Correct Answer - C
Ans. is 'c' i.e., HbsAg + HBeAg + HBV DNA
In HBV infection, there are two types of carriers :
Super Carriers medpox.com
High titre of HBs Ag, HBe Ag, DNA polymerase and HBV in the
circulation
Highly infective
Simple carriers
Low titre of HBsAg with negative HBe Ag, DNA polymerase and
HBV
Have low infectivity
816. A 17 years old female presents with sore
throat, lymphadenopathy and positive
heterophile antibodies test. Diagnosis is
?
a) Tuberculosis

b) Streptococcal pharyngitis

c) Infectious mononucleosis

d) Cytomegalic inclusion disease

Correct Answer - C medpox.com

Ans. is 'c' i.e., Infectious mononucleosis
Laboratory diagnosis
In IMN, there is predominantly lymphocytosis with presence of 20%
or more atypical lymphocytes. These atypical lymphocytes are
activated T-lymphocytes which have round or irregularly shaped
nuclei, with abundant flowing cytoplasm that characteristically has a
dark-staining peripheri.
817. Suckling mice is used for isolation of ?
a) Coxsachie virus

b) Pox

c) Herpes

d) Adenovirus

Correct Answer - A
Ans. is 'a' i.e., Coxsackie virus
It is necessary to employ suckling mice for the isolation of coxsackie
viruses.
Inoculation is usually made by intracerebral, subcutaneous and
medpox.com
intraperitoneal route.
Adult mice are not susceptible.
818. Syncytium formation is a property of ?
a) Herpes virus

b) Adenovirus

c) Measles virus

d) Rabies virus

Correct Answer - C
Ans. is 'c' i.e., Measles virus

medpox.com
819. True about Nipah virus are all except ?
a) Is a paramyxovirus

b) Causes hemorrhagic fever

c) Emerging infection

d) Present in India

Correct Answer - B
Ans. is 'b' i.e., Causes hemorrhagic fever
Nipah virus is an emerging infectious agent belongs to
paramyxoviridae.
It was first isolated in Malaysia in 1998, causing encephalitis in
medpox.com
domestic pigs, with direct transmission from pigs to human.
There have been Nipah virus infection outbreaks in pigs in Malaysia
and Singapore and human disease in Malaysia, Singapore, India
and Bangladesh.
Typically the human infection presents as an encephalitis syndrome
marked by fever headache, drowsiness, disorientation, mental
confusion, coma and death.
820. Causative organism of SARS
a) HiN,

b) Corona virus

c) Rotavirus

d) RSV

Correct Answer - B
Ans. is 'b' i.e., Corona virus

Severe acute respiratory syndrome
medpox.com
In November 2002, China experienced an outbreak of an unusual
respiratory infection with many deaths
Severe acute respiratory syndrome (SARS). o It is caused by
Corona virus type – 4.
SARS spreads by inhalation of the virus present in droplets or
aerosols of respiratory secretions of patients.
Fecal aerosols may also be infectious. o Incubation period is less
than 10 days.

821. Influenza pandemic is
a) Seasonal trend

b) Cyclical trend

c) Secular tred

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., Cyclical trend
Diseases occurring in cycles spread over a short period show
cyclical trends of time distribution.
- It is a type of periodic fluctuation.
medpox.com
- Examples:
-Influenza pandemic: every 7–10 years due to antigenic variations.
- Measles: every 2-3 years in the prevaccination era.
- Rubella: 6-9 years in the prevaccination era.
-Non-infectious conditions can also show cyclical trends.
822. Oncogenic DNA virus is ?
a) Retrovirus

b) HBV

c) HIV

d) HTLV

Correct Answer - B
Ans. is 'b' i.e., HBV

medpox.com
823. Window period in HIV infection ?
a) 1-2 weeks

b) 4-8 weeks

c) 8-12 weeks

d) > 12 weeks

Correct Answer - B
Ans. is 'b ' i.e., 4-8 weeks
Window period
It takes 2-8 weeks to months for antibodies to appear after infection.
This period, from infection to appearance of antibodies, is called as
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window period.
During this period patients is seronegative i.e. serological tests
(ELISA and Western blot) are negative. o The individual may be
highly infectious during this period.
824. The chance that a health worker gets HIV
from an accidental needle prick is -
a) 1%

b) 10%

c) 95%

d) 100%

Correct Answer - A
Ans. is 'a' i.e., 1%
Common modes of transmission of HIV and their relative risk
medpox.com
Approximate
Types of chance of
exposure infection per
exposure
Sexual intercourse : 0.1-1.0% anal, vaginal, oral
II Blood and blood
products, Factor VII > 90% etc. Blood
transfusion
III Tissue and organ 50-90% donation,
semen, cornea,
bone marrow, kidney etc.
IV Injections and 0.5-1.0% injuries;
shared needles
by drug addicts
Injections with unsterile
Needle-stick and other
injuries in health staff?
Surgical wounds
Surgical wounds
V Mother to baby : 30% Transplacental
At birth
After birth
Breast milk

medpox.com
 825. Paralysis in polio is characterized by ?
a) Spasticity

b) Symmetrical

c) LMN type

d) Progressive

Correct Answer - C
Ans. is 'c' i.e., LMN type
Clinical manifestations of polio
Incubation period ranges from 3-35 days (usually 7-14 days).
The clinical spectrum includes :-
medpox.com
1. Subclinical (inapparent) infections (95%) : Most common and play
predominant role in spread of infection.
2. Minor (abortive) illness (4.8%) : Present with fever, sore throat,
headache and malaise.
3. Aseptic meningitis/ non paralytic polio (1%) : There are signs and
symptoms of meningitis.
4. Paralytic polio (There is flaccid paralysis with absent reflexes.
Respiratory paralysis is the most common cause of death.
826. Virus causing oropharyngeal carcinoma
?
a) EBV

b) HPV

c) HHV-8

d) HTLV

Correct Answer - B
Ans. is 'b' i.e., HPV

medpox.com
 827. Break bone fever is caused by ?
a) Yellow fever

b) Japanese encephlitis

c) Dengue fever

d) KFD

Correct Answer - C
Ans. is 'c' i.e., Dengue fever
Break bone fever (Saddle back fever) is caused by dengue virus.
Dengue fever
Dengue fever is caused by arboviruses (at least 4 serotypes have
medpox.com
been recognized)
It is transmitted by Aedes (Aedes aegypti is the main vector).
The reservoir of infection is both man and mosquito.
The transmission cycle is Man-mosquito-man
Dengue fever occurs both epidemically and endemically. Epidemics
starts in rainy season and are usually explosive.
Aedes mosquito becomes infective by feeding on a patient from the
day before onset to the 5th day of illness.
Various manifestations of Dengue infection
A) Classical dengue fever –
i. Also known as break bone fever
ii. Incubation period 2-7 days (3-10 days -4 Park)
iii. Onset is sudden with chills and fever. Fever is usually between 39°c
and 40°c temperature returns to normal after 5-6 days or subside on
about the 3rd day and rise again after 5-8 days after onset (saddle
back fever).
iv. Rashes appear in 80% of cases during remission or during second
febrile phase. The rash lasts for 2 hours to several days and may be
followed by desquamation.
B) Dengue Hemorrhagic fever (DHF)-
It is a severe form of dengue fever caused by infection with more
than one dengue virus.
The severe illness is thought to be due to double infection with more
than one dengue virus.
Dengue hemorrhagic fever is believed to result from reinfection with
a virus of different serotype ( due to enhancing antibodies)
DHF usally occurs after sequential infection with any two of the four
serotypes of dengue virus.
Sequence of infection may be important; serotype 1 followed by
serotype2 is more dangerous than serotype 4 followed by serotype
2.

medpox.com
828. Virus causing Latent infection (or Latent
period is shown by which virus) -
a) Rubella

b) HBV

c) Pertussis

d) Rota virus

Correct Answer - B
Ans. is 'b' i.e., HBV

medpox.com
829. True regarding arbovirus is all except ?
a) KFD is transmitted by Tick

b) Dengue virus has one Serotype

c) Yellow fever is not seen in India

d) Dengue fever is transmitted by Aedes

Correct Answer - B
Ans. is 'b' i.e., Dengue virus has one Serotype
KFD is mainly transmitted by Hard tick, but soft tick can also transmit
the disease.
Dengue virus has four serotypes.
medpox.com
Yellow fever is not endemic in India, it is distributed in Africa and
South America.
Dengue fever is transmitted by Aedes mosquito.
830. Which prion disease affect human ?
a) Scrapie

b) Madcow disease

c) Kuru

d) Bovine spongiform encephalopathy

Correct Answer - C
Kuru prion Infection through ritualistic cannibalism

medpox.com
831. Owl eye intranuclear inclusion body is
seen in ?
a) Herpes zoster

b) Herpes simplex

c) CMV

d) EBV

Correct Answer - C
Ans. is 'c' i.e., CMV
CYTOMEGALOVIRUS (CMV)
medpox.com
Also known as salivary gland virus
CMV is the largest virus amongst herpes viruses
They are characterized by enlargment of infected cells (cytomegalic
cells) and intranuclear inclusions.
Intranuclear inclusion is eccentrically placed and is surrounded by a
halo - owl's eye appearance
Once infected an individual carries CMV for life
CMV is the most common organism causing intrauterine infection.
CMV is the most common pathogen complicating organ
transplantation.
 832. True about hydatid cyst are all, except ?
a) Most common site is liver

b) Calcification is common in lung

c) May involve kidney

d) Liver cysts are more common in right lobe

Correct Answer - B
Ans. is 'b' i.e., Calcification is common in lung
Hydatid disease
Liver cysts
The majority of hydatid cysts occur in the liver, causing symptoms :
medpox.com
Chronic abdominal discomfort
Palpable abdominal mass
Allergic reactions due to cyst rupture - skin rash, anaphylactic shock,
or death.
Abscess formation due to secondry bacterial infection
Liver cysts occur more frequently in the right lobe.
Lung cyst
Second most common organ (after liver)
Usually asymptomatic
Occasionally may cause symptoms.
Least common site of calcified hydatid cyst.
Radiographic signs
1. Meniscus sign
2. Water - lily sign, camalote sign
3. Rising sun sign, serpent sign
4. Empty cyst sign
833. Parasites for which modified ZN stain is
used ?
a) Isospora

b) Microsporidia

c) Plasmodium

d) Echinococcus

Correct Answer - A
Ans. is 'a' i.e., Isospora

medpox.com
834. A patient presents with fever. Peripheral
smears shows band across the
erythrocytes. Diagnosis is ?
a) P Falciparum

b) P vivax

c) P ovate

d) P malariae

Correct Answer - D
Ans. is 'd' i.e., P malariae medpox.com
Band across erythrocytes (band-form trophozoites) is characteristic
of P malariae.
835. Band form of P malariae is ?
a) Schizoint stage

b) Trophozoite stage

c) Merozoite stage

d) Gametocyte stage

Correct Answer - B
Ans. is 'b' i.e., Trophozoite stage

medpox.com
836. Schizoint are not seen in peripheral
blood of which malarial parasites ?
a) P vivax

b) P falciparum

c) P ovale

d) P malariae

Correct Answer - B
Ans. is 'b' i.e., P falciparum
In peripheral smear offalciparum malaria following forms are seen
Early ring form medpox.com
Gametocytes
Mature trophozoites and schizoint are not found in peripheral blood
because schizogony occurs inside the capillary of internal organs
(spleen, liver and bone marrow).
 837. Babesiosis is transmitted by ?
a) Tick

b) Mites

c) Flea

d) Mosquito

Correct Answer - A
Ans. is 'a' i.e., Tick
Babesia
Babesiosis is a protozoan disease caused by two species of
Babesia : Babesia microti and Babesia divergens.
medpox.com
It is transmitted by Ioxdid tick.
Babesia infects the RBCs and resides inside the RBCs (
intraerythrocytic). Intraerythrocytic infection of Babe​siosis is
characterised by maltese cross. Maltese cross is a characteristic
arrangement of parasites within the erythrocytes → Parasites within
erythrocytes are arranged such that pointed ends of four parasites
come in contact thereby giving a tetrad configuration resembling a
maltese cross. Tetrad forms or 'Maltese cross' appearance is
considered pathognomic of Babesiosis.
Clinically Babesiosis presents with chills, fever, mild
hepatosplenomegaly, and mild hemolytic anemia. o Treatment
includes Atovaquone plus azithromycin or quinine plus clindamycin.
Babesiosis can easily be confused with P. falciparum malaria.
Following two features distinguish Babesiosis from malaria :?
1. Presence of maltese cross in Babesiosis (absent in malaria)
2. Absence of pigment Hemozoin in Babesiosis (present in malaria)
Note - Maltese cross is also seen in cryptococcus and aspergillus.
 838. Sabin feldman Dye test is used to
demonstrate infection with ?
a) Filaria

b) Toxoplasma

c) Histoplasma

d) Ascaris

Correct Answer - B
Ans. is •b' i.e., Toxoplasma
The polyclonal IgG antibodies evoked by infection are parasiticidal in
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vitro in the presence of serum complement and are the basis for the
Sabin - Feldman dye test.
Laboratory diagnosis of toxoplasmosis
Laboratory diagnosis can be made by
1. Microscopic demonstration of the parasite
2. Isolation of the parasite by animal inoculation or tissue culture.
3. Polymerase chain reaction
4. Serology
The most common method of laboratory diagnosis
Persons should initially be tested for the presence of Toxoplasma
specific IgG antibodies to determine their
immune status. A positive IgG titre indicates infection with the
organism at sometime ( recent or past).
Then an IgG positive person should have an IgM test. A negative
test essentially excludes recent infection. However, a positive IgM
test does not always mean a recent infection because toxoplasma
specific IgM antibodies may persist for months to year following
primary infection. Therefore :?
Negative IgM with positive IgG always means a past infection.
Positive IgM with positive IgG indicates possibility of recent infection,
but not with 100% surety. It may or may not be recent infection. To
differentiate between recent and past infection, IgG avidity test is
used.
It is worth noting here that a third situation is also possible when IgM
test is positive but IgG test is negative. In this situation a second
sample should be taken after 2-4 weeks and should be tested :?
If the second sample is positive for IgG and IgM, it indicates that the
first sample was taken early in the disease when IgG was not yet
developed.
If the second sample is still negative for IgG with positive IgM, it
indicates false positive IgM test.
Tests for IgG antibodies Tests for IgM antibodies
IgG ELISA/EIA IgM indirect flourscent antibody
Sabin- Fieldman dye test test (IgM IFA)
IgG indirect flourscent Double sandwich ELISA
antibody test(IgG IFA) IgM capture EIA
Diffemtial agglutination ( Immunosorbant agglutination
AC/HS) assay ( ISAGA)
medpox.com
Avidity test
839. Ovoviviparous parasite which is
associated with autoinfection ?
a) Ancylostoma duodenale

b) Strongyloides stercoralis

c) Enterobius vermicularis

d) Ascaris

Correct Answer - B
Ans. is 'b' i.e., Strongyloides stercoralis
Among the given options, strongyloides and enterobius can cause
autoinfection. medpox.com
Strongyloides is ovoviviparous, whereas enterobius is oviparous.
840. A patient presents with headache, high
fever and meningismus. Within 3 days he
becomes unconscious. Most probable
causative agent ?
a) Naegleria fowleri

b) Acanthamoeba castellani

c) Entamoeba histolytica

d) Trypanosoma cruzi

Correct Answer - A medpox.com

Ans. is 'a' i.e., Naegleria fowleri
Amongst the given options Naeglaria and Acanthamoeba cause
amoebic encephalitis.
"The prognosis of Naeglaria encephalitis is uniformaly poor, most
patients die within a week".
"Acanthamoeba encephalitis follows a more indolent course".
841. Tachyzoites are seen in ?
a) Toxoplasma

b) Toxocara

c) Pulmonary eosinophilia

d) Ascaris

Correct Answer - A
Ans. is 'a' i.e., Toxoplasma
Toxoplasmosis is the disease caused by infection with the obligate
intracellular parasite Toxoplasma gondii.
There are two distinct stages in the life cycle of T gondii :?
medpox.com
Nonfeline stage
In this stage tissue cysts (containg bradyzoites) or sporulated
oocysts are ingested by intermediate hosts (Human, mouse, sheep
or pig).
The cyst is rapidly digested by the acidic-pH gastric secretion
releasing bradyzoites or sporozoites.
These bradyzoites or sporozoites enter the small - intestinal
epithelium and tranform into rapidly dividing tachyzoites
(endozoites).
The tachyzoites can infect and replicate in all mammalian cells
except red blood cells.
Tissue cysts containing many bradyzoite develop 7-10 days after
systemic tachyzoite infection.
These tissue cysts occur in a variety of host organs but persist
principally within the CNS and muscle.
Feline stage (sexual stage)
This stage takes place in the definitive host (cat)
This cycle is associated with formation of oocysts, which are
excreted in cat feces.
Mature oocysts contain 2 sporocysts, each with 4 sporozoites.
The formation of tissue cysts in cats constitutes the other part of
feline cycle.

medpox.com
842. Mucocutaneous leishmaniasis is caused
by -
a) L-braziliensis

b) L. tropica

c) L. donovani

d) L-orientalis

Correct Answer - A
Ans. is 'a' i.e., L. braziliensis
Leishmaniasis
medpox.com
o Visceral leishmaniasis (Kala azar) -L. donovani
Cutaneous Leishmaniasis
a) Oriental sore - L. tropica
b) Mucocutaneous leishmaniasis (Espundia) -L. brasiliensis
843. The cystic form of all are seen in man
except ?
a) E.histolytica

b) Giardia

c) Trichomonas

d) Toxoplasma

Correct Answer - C
Ans. is 'c' i.e., Trichomonas
Protozoal parasites have two phases.
Cystic phase medpox.com
Trophozoite Cystic phase is not seen in :
Trichomonas
Entamoeba gingivalis
Dientamoeba fragilis
844. Which of the following is a sexual spore
?
a) Chlamydospore

b) Sporangiospore

c) Ascospore

d) Phialoconidia

Correct Answer - C
Ans. is 'c' i.e., Ascospore

medpox.com
845. True about cryptococcus are all except
a) Primarily infects lung

b) Urease negative

c) India-ink is used

d) All are true

Correct Answer - B
Ans. is `b i.e., Urease negative
CRYPTOCOCCUS NEOFORMANS
The only pathogenic yeast
Four capsular serotypes - A, B, C and D
medpox.com
It has polysaccharide capsule
Most infections in immunocompromized patients are caused by
serotype A.
Pigeon droppings commonly contains serotype A and D.
Eucalyptus tree contain serotype B.
It is urease positive.
Mode of transmission
By inhalation of the fungus into the lung (most common)
Through skin or mucosa (some times).
 846. Which of the following fungi is/are
difficult to isolate culture ?
a) Candida

b) Dermatophytes

c) Cryptococcus

d) Malassezia furfur

Correct Answer - D
Ans. is 'D' i.e., Malassezia furfur
Malassezia furfur does not grow on regular sabouraud's medium.
medpox.com
It requires complex media to grow
M. furfur is a lipid dependent fungus and 1% emulsified olive oil is
added to sabouraud medium for its cultivation
Two media are now widely employed for all malassezia species.
1. Dixon medium
2. Modified dixon medium
847. KOH wet mount is prepared for ?
a) Herpes Zoster

b) Candida

c) Gonorrhea

d) Trichomonas vaginalis

Correct Answer - B
Ans. is 'b' i.e., Candida

medpox.com
848. All are true about candida except ?
a) Pseudohyphae seen

b) Produce chlamydospore

c) It is a mould

d) It is a dimorphic fungus

Correct Answer - C
Ans. is 'c' i.e., It is a mould
Candida
Candida is a yeast like fungus (not mould).
Candida albicans is the most common cause of mucosal
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candidiasis.
All candida species pathogenic for humans are also encountered as
commensals of humans, particularly in the mouth, stool and vagina.
They grow rapidly on simple media as oval budding cells at 25° to
37°C.
In tissue, both yeasts and pseudohyphae are present.
Candida albicans is differentiated by other candida :
It forms true hyphae (mycelia) or germ tubes when grown in serum.
It forms thick walled large spores called chlamydospores when
grown in corn meal agar.
It is dimorphic.
Remember → Candida albicans can produce yeast, true hyphae
and pseudohyphae.
A rapid method of identifying C. albicans is based on its ability to
form germ tubes within two hours when incubated in human serum
at 37°C Reynolds - Braude phenomenon ( Also known as germ tube
test)
849. Not true about Histoplasma capsulatum
?
a) Dimorphic fungus

b) May mimic TB

c) Capsulated

d) Mostly asymptomic

Correct Answer - C
Ans. is 'c' i.e., Capsulated
Histoplasma capsulatum
A dimorphic fungus medpox.com
Non encapsulated → The only medically important capsulated
fungus is cryptococcus.
Infection is acquired by inhalation of microconidia (small spores) in
dust contaminated with bird or bat dropping.
It causes intracellular infection of reticuloendothelial system.
Clinical manifestations → Majority of patients are asymptomatic
850. Intermediate host for guinea worm ?
a) Fish

b) Man

c) Cyclops

d) Crab

Correct Answer - C
Ans. is 'c' i.e., Cyclops

medpox.com
851. R-factor in bacteria is transfered by ?
a) Transduction

b) Transformation

c) Conjugation

d) Vertical transmission

Correct Answer - C
Ans. is 'c' i.e., Conjugation
Conjugation
Bacterial conjugation is the transfer of genetic material between
bacteria through direct cell to cell contact or through a bridge- like
medpox.com
connection between two cells.
Conjugation is process where by a donor (male) bacterium makes
physical contact with a recipient (female) bacterium.
Donor status is determined by the presence of plasmid.
This plasmid codes for specialized fimbria (sex pilus) and for self
transfer.
Sex pilus (conjugation tube) helps in transfer of genetic material
from male bacterium to female bacterium.
The plasmid is known as transfer factor (sex factor or fertility factor).
Plasmid may be R factor, which codes for transferrable multiple drug
resistance.
The DNA of the plasmid replicates during transfer so that each
bacterium receives a copy Recipient becomes donor and the donor
retains its donor status.
852. HEPA filter is used to disinfect ?
a) Water

b) Air

c) Culture

d) Blood

Correct Answer - B
Ans. is 'b' i.e., Air
HEPA (High-efficiency particulate air) filter is used to remove
microorganisms from air.
HEPA filter traps airborne particles and microbes.
medpox.com
It can remove > 95% of all particles including microorganisms with a
diameter > 0.3 p.m.
853. Feces are disinfected best by ?
a) 1% formaldehyde

b) 5% cresol

c) 5% phenol

d) Isopropyl alcohol

Correct Answer - B
Ans. is 'b' i.e., 5% cresol
"The most effective disinfectant for general use is a coal-tar
disinfectant with a Rideal-Walker (RW) coefficient of 10 or more
such as cresol". medpox.com
854. Endoscope tube is sterilized by?
a) Glutaraldehyde

b) Formalin

c) Autoclaving

d) Boiling

Correct Answer - A
Ans. is 'a' i.e., Glutaraldehyde
2% Glutaraldehyde (cidex) is most often used for equipment such as
endoscope that cannot be sterilized or disinfected by heat.
medpox.com
855. Laproscope is sterilized by ?
a) 2% formalin

b) 2% glutaraldehyde

c) Autoclaving

d) Boiling

Correct Answer - B
Ans. is 'b' i.e., 2% glutaraldehyde
All endoscopes (e.g. laproscope) are sterilized by 2% glutaraldehyde
(cidex).
medpox.com
856. Heat labile liquids are sterilized by ?
a) Hot air oven

b) Autoclaving

c) Membrane filter

d) Moist heat

Correct Answer - C
Ans. is 'c' i.e., Membrane filter
Filters are used to sterilize heat-labile solutions.
Membrane filters are used to sterilize pharmaceutical substances,
ophthalmic solutions, liquid culture media, oils, antibiotics and other
medpox.com
heat sensitive solutions.
857. Cold sterilization is ?
a) Sterilization by negative temperature

b) Sterilization by ionizing radiation

c) Sterilization by liquid CO2

d) Sterilization by non-ionizing radiation

Correct Answer - B
Ans. is 'b' i.e., Sterilization by ionizing radiation

medpox.com
858. Lethal effect of dry heat is due to ?
a) Denaturation of proteins

b) Oxidative damage

c) Toxicity due to metabolites

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
HEAT STERILIZATION
Heat is the most reliable method of sterilisation and should be the
method of choice unless contraindicated. o Sterilization by heat is of
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two types.
Dry heat
Killing effect is due to protein denaturation, oxidative damage and
the toxic effect of elevated metabolites.
859. Temperature required for holding period
of 20 minutes in Hot air oven -
a) 160° C

b) 170° C

c) 120° C

d) 130° C

Correct Answer - B
Ans. is 'b' i.e., 170° C

medpox.com
860. Rideal-Walker coefficient is related with
?
a) Disinfecting power

b) Parasitic clearance

c) Dietary requirement

d) Statistical correlation

Correct Answer - A
Ans. is 'a' i.e., Disinfecting power
Traditional testing of disinfectants
medpox.com
Two traditional tests for determining the efficiency of disinfectants
are :?
1) Rideal-Walker test : Phenol is taken as the standard with unit
as phenol coefficient (pheno1=1)
2) Chick-Martin test : The disinfectant acts in the presence of
organic matter (dried yeast or feces).
861. Best indicator for sterilization by
autoclaving ?
a) Bacillus subtilis

b) Geobacillus

c) Bacillus pumilis

d) Clostridium

Correct Answer - B
Ans. is 'b' i.e., Geobacillus
Biological indicators
medpox.com
Biological indicators are standardised preparations of
microorganisms used to assess the effectiveness of a sterilization
process.
They usually consist of a population of bacterial spores placed on an
inert carrier, for example a strip of filter paper, a glass slide or a
plastic tube.
Most commonly, spores of Bacillus stereothermophilus (Geobacillus
stearothermophilus) are used. Spores of Bacillus subtilis and
Bacillus pumilis are alse used.
862. Sterilization is defined as ?
a) Disinfection of skin

b) Complete destruction of all microorganisms

c) Destruction of pathogenic organisms

d) Decrease bacterial count from objects

Correct Answer - B
Ans. is 'b' i.e., Complete destruction of all microorganisms
Sterilization
The process by which an article surface or medium is freed of all
living microorganisms either in the vegetative or spore state
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Complete absence of microorganism.
Disinfection
Destruction or removal of all pathogenic organisms capable of giving
rise to infection reduction in the microorganisms to such a level
which is deemed no longer harmful to health.
Unlike sterilization, disinfection is not sporicidal (does not kill
spores).
Decontamination
The process of rendering of an article or area free of danger from
contaminants, including microbial, chemical, radioactive and other
hazards.
Antisepsis
It is defined as" Prevention of infection, usually by inhibiting the
growth of bacteria in wound or tissues".
Antiseptics
Chemical disinfectants which can be safely applied to skin or
mucous membrane are called antiseptics or skin disinfactant.
Best and most commonly used antiseptic is povidone iodine
(betadine). Commonly used skin disinfactants for hand washing are
povidone iodine (betadine), chlorhexidine and isopropyl alcohol.
Disinfectants
Antimicrobials applied only to inanimate object. They are not used
for surface disinfection(A"9) (skin or mucous membrane).
Germicides
These include both antiseptics and disinfectant.

medpox.com
 863. Stool specimen is transported in ?
a) Cary blair medium

b) Blood agar

c) Selenite F broth

d) Compy BAP medium

Correct Answer - A
Ans. is 'a' i.e., Cary blair medium
Transport media for stool specimen are :?
a. Cary-Blair medium
b. Buffered glycerol saline medpox.com
c. Stuart medium
Inoculate media for routine stool culture are :-
a. Blood agar
b. MacConkey agar
c. Hektoen enteric HE ( agar)
d. Selective media for campylobactor : Campy BAP, skirrow
e. Selenite F broth or GN Broth
f. Xylose-lysine deoxycholate agar (XLD agar)
For specific situations, selective media are used :-
i. Vibrio : TCBS agar or Alkaline peptone broth.
ii. Yersinia : Cefsulodin-Irgasan-Novobiosin (CIN) agar or Phosphate
Buffered Saline (PBS) broth.
iii. E.coli 0157:H7: Sarbitol-MacConkey agar.
864. Which anticoagulant is used when blood
is sent for blood culture ?
a) Sodium citrate

b) EDTA

c) Oxalate

d) SPS

Correct Answer - D
Ans. is 'd' i.e., SPS
Many different types of bacteria and fungi have been identified as
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causative agents of septicemia.
For this reason, many diverse culture media formulations are
available in prepared blood culture bottles.
Majority of these media contain 0.03% SPS (Sodium polyanethal
sulfonate), a polyanionic anticoagulant, which additionally inhibits
complement and lysozyme activity, interferes with phagocytosis and
inactivates aminoglycosides.
Following important blood culture bottles are there :-
i) Brain heart infusion (BHI) with PABA (para-aminobenzoic acid)
ii) Brucella broth with 6% sorbitol
iii) Brucella broth with 10% sucrose
iv) Columbia broth
v) Thioglycolate medium
vi) Tryptic soy broth
 865. Triple iron sugar medium contains all,
except ?
a) Lactose

b) Sucrose

c) Glucose

d) Maltose

Correct Answer - D
Ans. is d i.e., Maltose
Triple sugar iron agar is used for the differentiation of
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microorganisms on the basis of :?
i. Fermentation of dextrose (glucose), lactose and sucrose.
ii. Production of H2S.
It is recommended for differentiation of enteric gram negative bacilli
from clinical specimens, dairy samples and food products.
Contents of the medium are :?
i. Enzymatic digest of casein and animal tissue.
ii. Yeast enriched peptone.
iii. Three sugars : Dextrose (glucose), lactose and sucrose.
iv. Ferric ammonium citrate.
v. Sodium chloride.
vi. Sodium thiosulfate.
vii. Phenol red.
viii. Agar.
When carbohydrates are fermented, acid production is detected by
the phenol red indicator, which is yellow in acid and red in alkaline
conditions.
Sodium thiosulfate is reduced to hydrogen sulfide (H2S) and H2S
reacts with an iron salt yielding typical black iron sulfide. Ferric
ammonium citrate is hydrogen sulfide indicator.
Results
Two areas of tube are examined : (i) Butt of the tube, and (ii) Slant of
the tube.
An alkaline slant (red)- acid butt (yellow) indicates fermentation of
dextrose (glucose) only → red /yellow. Examples are Proteus
mirabilis, salmonella thyphimurium and shigella flexneri.
An acid slant (yellow) - acid butt (yellow) indicates fermentations of
dextrose (glucose), lactose and/or sucrose → yellow/yellow.
Example is E coli.
An alkaline slant (red) - alkaline butt (red) indicates no fermentation
(non-fermenter) → red/red. Example is Pseudomonas aeruginosa.
An alkaline precipitate in butt indicates H2S production. It is
produced by Proteus mirabilis and Salmonella typhimurium.

medpox.com
866. Indicator used in MaConkey Agar ?
a) Methylene blue

b) Methyl red

c) Neutral red

d) Bromothymol blue

Correct Answer - C
Ans. is 'c' i.e., Neutral red
MacConkey agar is a selective medium for enteric gram negative
bacilli.
It is used to differentiate lactose fermenting enteric bacilli from
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lactose non-fermenters.
Composition of MacConkey agar ?
1) Enzymatic digest of gelatin, casein and animal tissue : To provide
nutrition.
2) Lactose : Fermentable carbohydrate.
3) Bile salts : Selective agent and inhibits gram positive organisms.
4) Crystal violet : Inhibits gram positive bacteria.
5) Sodium chloride : Supplies essential electrolytes and osmotic
balance.
6) Neutral red : pH indicator (when lactose is fermented, the pH of
medium decreases, changing color of neutral red to pink).
7) Agar : Solidifying agent.
867. Blood agar is an example of ?
a) Enriched media

b) Indicator media

c) Enrichment media

d) Selective media

Correct Answer - A
Ans. is 'a' i.e., Enriched media

medpox.com
 868. Best specimen for anaerobic culture ?
a) Exudates from wound

b) Pus aspirated in vial

c) Swab from wound

d) Mid-stream urine

Correct Answer - B
Ans. is 'b' i.e., PUS aspirated in vial
Ideal specimens for anaerobic cultures are samples of needle
aspirates and proper tissue specimens. Anaerobic swabs are usually
discouraged. medpox.com
Important specimens are :-
i. Local abscess : Needle aspirates.
ii. Pulmonary : Transtracheal aspirates, lung aspirates, pleural fluid,
protected bronchial wash.
iii. Abdominal : Abdominal abscess aspirate.
iv. Urinary tract : Suprapubic bladder aspirate.
v. Genital tract : Culdocentesis specimen, endometrial swabs.
vi. CNS : CSF, Aspirate of abscess.
Aspirated material then injected into one of the following :?
a. Anaerobic swab
b. Thioglycollate enrichment broth
c. Oxygen free vials
Exudates, swabs from burns, wound and skin abscesses are
generally unacceptable for anaerobic culture. Cysts and abscess are
contaminated with normal anaerobic flora.
Voided and catheterized urine are contaminated with distal urethral
anaerobes and are therefore unacceptable for anaerobic culture.
869. Aerobic blood culture should be
incubated for how many days, before
discarding ?
a) 2 days

b) 5 days

c) 10 days

d) 14 days

Correct Answer - D
Ans. is 'd' i.e., 14 days medpox.com
Blood specimens of 5 or 10 ml generally are added to bottles
containing, 50 or 100 ml of reagent (medium) to achieve a 1:10
blood medium ratio.
All bottles should be transported to the laboratory as soon as
possible and immediately incubeted at 35 ± 2°C in an upright
position (Note - Lower incubation temperature may be preferred for
isolation of some specific bacteria, e.g. Listeria grows well at 20-
25°C).
A total incubation period of 7 days is generally sufficient for routine
isolation procedure, which can be extended up to 14 days before
discarding those that do not show evidence of growth.
870. Drug resistance in Tuberculosis is due to
?
a) Transformation

b) Transduction

c) Conjugation

d) Mutation

Correct Answer - D
Ans. is 'd' i.e., Mutation

medpox.com
871. Method used for acid fast staining ?
a) Robertson's method

b) Ziehl Neelsen

c) Silver imprignation method

d) Dark ground illumination

Correct Answer - B
Ans. is 'b' i.e., Ziehl Neelsen
Acid fast staining
After staining with aniline dye, acid fast organisms resist
decolourisation with acids. medpox.com
Method most commonly used is modified Ziehl Neelsen.
872. Metachromatic granules are seen in ?
a) Gardenella vaginali

b) Corynebacteria

c) Argobacterim

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
Polvpmetahosphate / volutin granules
Some bacteria contain granules composed of polymetaphosphate.
They were first described in spirillum volutans, so they were called
medpox.com
as Volutin granules.
These granules are also known as Babes Ernst granules or polar
bodies or metachromatic granules.
These granules stain reddish violet with methylene blue or toluidine
blue.
These granules are strongly basophilic.
In the granules, there is stored phosphate in the form of linear
chains of inorganic phosphate. These granules represent
intracellular phosphate reserve when nucleic acid syntheis does not
occur.
The phosphate is incorporated into nucleic acid during the synthesis
of the latter.
When nucleic acid synthesis is prevented by starvation , the
granules accumulate in the cytoplasm. So, volutin metachromatic
granules are most frequent in cells grown under conditions of
nutritional deficiency (starvation) and tend to disappear when the
deficient nutrients are supplied.
Volutin metachromatic granules are common in -
 i. Corynebacteria diptheriae
ii. Gardenella vaginalis
iii. Agrobacterim tumefaciens
iv. Mycobacteria
v. Spirillum voluants

medpox.com
873. Bifringence polarization microscopy is
used for ?
a) Flagella

b) Intracellular structures

c) Capsule

d) Spores

Correct Answer - B
Ans. is `b' i.e., Intracellular structures
Polarization microscope enables the study of intracellular structure
medpox.com
using differences in bifringence.
 874. Thermophile bacteria grow at ?
a) 20°C

b) 20-40° C

c) 40-60°C

d) 60-80°C

Correct Answer - D
Ans. is 'd' i.e., 60-80° C
Temperature requirement of bacteria
Bacteria vary in their requirements of temprature for growth.
1. Psychrophilic bacteria grow best at temperature below 20°C
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2. Thermophilic bacteria grow best between 55-80°C
3. Mesophilic bacteria grow best between 25-40°C
875. Cell wall deficient organisms are
a) Chlamydia

b) Mycoplasma

c) Streptococcus

d) Anaerobes

Correct Answer - B
Ans. is 'b' i.e., Mycoplasma
Mycoplasma
Smallest free living organism, are prokaryotes
Lack cell wall, are bounded by a triple layered unit membrane that
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contains sterol (therefore mycoplasmas require sterol for growth).
Their lack of cell wall is associated with cellular pleomorphism and
resistance to cell wall - active antimicrobial agents, such as
penicillins and cephalosporins (13 - lactam drugs).
Multiplication is by binary fission.
Unique among prokaryotes is the requirment of most mycoplasmas
for cholesterol and related sterols.
876. Darting motility which occur in
V.cholerae, also found in -
a) Shigella

b) Campylobacter jejuni

c) Pneumococcus

d) Bacillus anthrax

Correct Answer - B
Ans. is 'b' i.e., Campylobacter jejuni
Darting (shooting star) motility is seen in
V. Cholerae medpox.com
Gardnerella vaginalis
Campylobactor
877. Peritrichous flagellae are seen in ?
a) Vibrio cholerae

b) Proteus

c) Campylobacter

d) Legionella

Correct Answer - B
Ans. is 'b' i.e., Proteus

medpox.com
878. True about endotoxin ?
a) Protein

b) Highly antigenic

c) No enzymatic activity

d) Produced by gram positive bacteria

Correct Answer - C
Ans. is 'c' i.e., No enzymatic activity

medpox.com
879. Which of the following is an example of
heterophile antibody test ?
a) Widal test

b) Weil-Felix reaction

c) Rose-waler test

d) Blood grouping & cross matching

Correct Answer - B
Ans. is 'b' i.e., Weil-Felix reaction
Heterophilic agglutination reaction
medpox.com
Some organisms of different class or species share closely related
antigens.
When serum containing agglutinin (antibody) of one organism gives
agglutination reaction with antigen of other organism, it is called
heterophilic agglutination test.
Examples are
Streptococcus M.G. agglutination test for primary atypical
pneumonia.
Weil - Felix reaction for typhus fever.
Paul Bunnell test for IM1V.
880. Complement components are:
a) Lipids

b) Proteins

c) Lipoproteins

d) Polysaccharide

Correct Answer - B
Ans. b. Proteins

medpox.com
881. Complement components are ?
a) Lipoproteins

b) Glycoproteins

c) Polysaccharides

d) Lipid

Correct Answer - B
Ans. is 'b' i.e., Glycoproteins
The proteins and glycoprotiens that constitute the complement
system are synthesized by hepatocytes" — Internet
"Most of the complement glycoproteins are synthesized
medpox.com
predominantly by the liver, but macrophages and many other cell
types are also sources of various complement components" -
Medical immunology
"Complement components are glycoproteins" — Textbook of
Human Blood Plasma Protiens
882. C1 esterase inhibitor deficiency causes ?
a) Neisseria infection

b) Hereditary angioneurotic edema

c) Hemolytic disease

d) Hemolytic uremic syndrome

Correct Answer - B
Ans. is 'b' i.e., Hereditary angioneurotic edema
Hereditary angioneurotic edema is due to C1 inhibitor (CI esterase
inhibitor) deficiency.
medpox.com
883. Membrane attack complex (MAC) in
complement system is:
a) C3b

b) C13

c) C5_9

d) C24

Correct Answer - C
Ans. c. C5_9

medpox.com
884. Runt disease is ?
a) Graft rejection

b) Graft vs host disease

c) Host vs graft disease

d) Type III hypersensitivity

Correct Answer - B
Ans. is 'b' i.e., Graft vs host disease

medpox.com
885. Acquire IgA deficiency may occur in ?
a) Severe Congenital toxoplasmosis

b) Severe Measles infection

c) Severe Brucellosis

d) Severe Leptospirosis

Correct Answer - A
Severe Congenital toxoplasmosis
Block in B cell differentiation due to defective interaction between T
and B cells. Naive B cells are not able to differentiate into IgA -
producing cells. medpox.com
886. Neutrilization test is
a) Widal test

b) Weil-Felix test

c) Paul Bunnel test

d) Nagler reaction

Correct Answer - D
Ans. is `d' i.e., Nagler reaction
Neutralization reaction
When antibody reacts with a toxin or other biologically active
antigen, it may neutralize the effect of toxin or antigen.
medpox.com
This ability to used in neutralization test.
Neutralization tests are of two types
887. IgE binds to which cell ?
a) T cells

b) B cells

c) Mast cells

d) NK cells

Correct Answer - C
IgE binds to Mast cells and basophils, and mediate Type I
hypersensitivity.

medpox.com
888. Which of the following Staphylococcal
infection is not toxin mediated:
a) Toxic shock syndrome

b) Scalded skin syndrome

c) Food poisoning

d) Septic shock

Correct Answer - D
Ans. is (d) Septic shock
Toxin mediated illness of S.
Disease medpox.com Toxin involved
- Toxic shock syndrome Toxic shock syndrome toxin
- Food poisoning Enterotoxin
- Staphylococcal scalded skin Exfoliative/epidermolytic
syndrome toxin
Note: Septic shock is due to bacteremia.
889. Which of the following is Amphixenoses
?
a) Anthrax

b) Rabies

c) Trypanosoma cruzi

d) Salmonella

Correct Answer - C
Ans. is 'C' i.e., Trypanosoma cruzi
Zoonoses
medpox.com
Zoonoses are diseases and infections which are naturally
transmitted between vertebrate animal and man.
The zoonoses may be classified according to the direction of
transmission of disease :
1. Anthropozoonoses
Infection is transmitted to man from lower vertebrate animals.
Examples → Rabies, plague, hydatid disease, anthrax, trichinosis.
2. Zoonthroponoses
Infection is transmitted from man to lower vertebrate animals
Examples → Human tuberculosis in cattle
3. Amphixenoses
Infection is maintained in both man and lower vertebrate animals
that may be transmitted in either direction.
Examples → T cruzi, S. japonicum.
890. Which vaccine can cause adverse effects
in persons with allergy to egg ?
a) Measles

b) Rubella

c) Rabies

d) Mumps

Correct Answer - C
Ans. is 'c' i.e., Rabies
Duck embryo Vaccine has less neuroparalytic complications, but can
medpox.com
cause allergic reactions. Persons allergic to eggs, should not be
given this vaccine.
Rabies Vaccine
Rabies vaccines are fluid or dried prepration of fixed virus grown in
the neural tissues of rabbits, sheep, goats, mice or rats or in
embryonated ducks egg or in cell cultures.
Inactivation of virus is commonly done by treatment with formalin or
13. Propiolactone (B.P.L.) o Antirabies vaccine fall into two main
categries.
891. Most common Nosocomial infection ?
a) Pneumonia

b) UTI

c) Surgical wound infection

d) Nephritis

Correct Answer - B
Ans. is 'b' i.e., UTI
Most common nosocomial infection → Urinary tract infection.
Most of the nosocomial UTIs occur after urinary catheterization.
Second most common nosocomial infection → Pneumonia.
medpox.com
Most of the nosocomial pneumonias are acquire through respiratory
intubation, mechanical ventilation and suction of the material from
mouth.
892. Which of the following is not related to
epidemiology ?
a) Promotion of health

b) Identification of etiology of disease

c) To collect data of magnitude of health problem

d) To teach a medical student how to conduct safe delivery

Correct Answer - D
Ans. is 'd' i.e., To teach a medical student how to conduct safe
delivery
medpox.com
According to the International Epidemiological Association (IEA),
epidemiology has three main aims :
a) To describe the distribution and magnitude of health and disease
problems in human populations.
b) To identify aetiological factors (risk factors) in the pathogenesis of
disease; and
c) To provide the data essential to the planning, implementation and
evaluation of services for the prevention, control and treatment of
disease and to the setting up of priorities among those services.
In order to fulfil these aims, three rather different classes of
epidemiological studies may be mentioned : descriptive studies,
analytical studies, and experimental or intervention studies.
The ultimate aim of epidemiology is to lead to effective action :
a) To eliminate or reduce the health problem or its consequences;
and
b) To promote the health and well-being of society as a whole.
893. India causing maximum death ?
a) Drowning

b) Road traffic accident

c) Burns

d) Poisoning

Correct Answer - B
Ans. is 'b' i.e., Road traffic accident
Among the accidental deaths, maximum deaths are caused by traffic
accidents, followed by drowning (2nd m.c. cause) and poisoning (3rd
m.c. cause). medpox.com
 894. Durkheim work was related to ?
a) Recommendation of multipurpose worker

b) Management in Health manpower

c) Division of labor

d) Integratation of medical and health services

Correct Answer - C
Ans. is 'c' i.e., Division of labor
Four major works of Durkheim are :?
1. Division of Labor in society.
2. Rules of sociological methods. medpox.com
3. Suicide
4. Elementary forms of religious life.
895. Medical audit is done ?
a) To improve patients care

b) For doctor's benefit

c) For hospital staff management

d) For decreasing cost of treatment

Correct Answer - A
Ans. is 'a' i.e., To improve patients care
Medical audit
An objective and systematic way of evaluating the physicians
performance is known "MEDICAL AUDIT"
medpox.com
The Evaluation of the "PROCESS" of medical care is carried out by
comparing with a pre-determined standard.
Medical audit is the professional review of services provided by the
hospital against given standard.
It is defined as the retrospective evaluation of quality of medical care
through the scientific analysis of medical records.
Medical audit is an important component of quality assurance, which
in turn is an essential part of any management process.
896. Clinical audit means ?
a) Measuring hospital records

b) Measuring current patients care against explicit criteria

c) Measuring input-output analysis

d) Measuring shortest time needed to complete task

Correct Answer - B
Ans. is 'b' i.e., Measuring current patients care against explicit
criteria
Clinical audit is a quality improving process, in which patients care is
improved. medpox.com
In this, current patients outcome and outcomes are measured
against explicit audit criteria (against reference standards).
897. Disability adjusted life year (DALY) is a
measure of ?
a) Life expectancy

b) Effectiveness of treatment

c) Quality of life

d) Human development

Correct Answer - B
Ans. is 'b' i.e., Effectiveness of treatment
Disability - adjusted life year (DALY)
medpox.com
DALY is a measure of :-

The burden of disease in a defined population

The effectiveness of interventions

It expresses years lost to premature death and years lived with

disability adjusted for the severity of the disability.
That means, DALY measures both mortality and disability
together (in contrast to sullivan's index which is related to disability
only).
One DALY is one lost year of healthy life.
DALY combines following : -

Years of lost life (YLL).

Years lost to disability (YLD)
DALY = YLL + YLD

Japanese life expectancy statistics are used as a standard for

measuring premature death, as Japanese have the longest life
expectancy.

Health - adjusted life expectancy (HALE)

HALE is the indicator used to measure healthy life expectancy.

HALE is based on the life expectancy at birth but includes an
adjustment for time spent in poor health.
It is the equivalent number of years in full health that a newborn
can expect to live based on current rates of ill health and mortality.

medpox.com
 898. Human development index includes all
except ?
a) Longevity

b) Knowledge

c) Income

d) Literacy rate

Correct Answer - D
Ans. is 'd' i.e., Literacy rate
Human development index
medpox.com
HDI is a composite index combining indicators representing three
dimensions.
i. Longevity : Life expectancy at birth.
ii. Knowledge : Mean years of schooling (gross enrolment ratio) and
expected year of schooling. (In older editions of Park, i.e., 21st/e and
older than that, it was adult literacy rate instead of expected year
schooling).
iii. Income : GNI Per Capita (In older editions of Park, it was GDP per
capita instead of GNI per capita).
 899. Primordial prevention is done to prevent
development of ?
a) Disease

b) Risk factors

c) Impairment

d) Disability

Correct Answer - B
Ans. is 'b' i.e., Risk factors
LEVELS OF PREVENTION
medpox.com
There are four levels of prevention :?
1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention
Primordial Level of Prevention: Is primary prevention (see below) in
purest sense
It is the prevention of the emergence or development of risk factors
in countries or population groups in which they have not yet
appeared
Modes of Intervention:
1. Individual Education
2. Mass Education
Primordial Level is Best level of prevention for Non-communicable
diseases
900. Screening is a type of ?
a) Primordial prevention

b) Secondary prevention

c) Primary prevention

d) Tertiary prevention

Correct Answer - B
Ans. is 'b i.e., Secondary prevention
In secondary prevention, action halts the progress of a disease at its
incipient stage and prevents complication.
Screening tests (e.g. - Pap smear), helps in diagnosis at early stage
medpox.com
so that adequate treatment can halt disease progression and
prevent complication.
901.

medpox.com
Lack of ability of a part to do normal function
is called as ?
a) Impairment

b) Disease

c) Disability

d) Handicap

Correct Answer - C
Ans. is 'c' i.e., Disability
According to WHO definitions,
medpox.com
Disease: Any abnormal condition of an individual that impairs
function
Impairment: Any loss or abnormality of psychological, physiological
or anatomical structure or function
Disability: (Because of impairment,) any restriction or inability to
perform an activity in a range considered normal for a human being
902. Quarantine period of cholera ?
a) 1 day

b) 2 days

c) 5 days

d) 10 days

Correct Answer - C
Ans. is 'c' i.e., 5 days

medpox.com
903. Not true about Alma-Ata declaration ?
a) Was held in 1978

b) Community participation

c) Health for all

d) Best approach for health for all is basic health care

Correct Answer - D
Ans. is 'd' i.e., Best approach for health for al is basic health care
The Declaration of Alma-Ata (1978) by emphasizing the need for
"individual and community participation" gave a new meaning and
direction to the practice of health education.
medpox.com
In 1978, the Alma-Ata International conference on Primary Health
Care reaffirmed Health for All as the major social goal fo
governments, and stated that the best approach to achieve the goal
of HFA is by providing primary health care, especially to the vast
majority of underserved rural people and urban poor.
It was envisaged that by the year 2000, at least essential health care
should be accessible to all individuals and families in an acceptable
and affordable way, with their full participation.
The Alma-Ata Conference called on all governments to formulate
national policies, strategies and plans of action to launch and sustain
primary health care as part of a national health system.
It is left to each country to develop its norms and indicators for
providing primary health care according to its own circumstances.
904. In a child who is allergic to egg, which
vaccine should be avoided ?
a) Measles

b) MMR

c) Influenza

d) DPT

Correct Answer - C
Ans. is 'c' i.e., Influenza

medpox.com
905. Active and passive immunity should be
given together in all except -
a) Tetanus

b) Rabies

c) Measles

d) Hepatitis B

Correct Answer - C
Ans. is `c' i.e., Measles
First see the difference between active and passive immunity.
Active immunity medpox.com
o Active immunity develops because of active participation of
immuniological system of the host.
o That means, after antigenic stimulation, the host develops
antibodies or cellular immune response against that antigen due to
activation of self B and/or cells.
o Antigenic stimulation may be : ?
i) Clinical infection
ii) Subclinical infection
iii) Vaccination (live attenuated vaccine or killed vaccine or toxoid).
Passive immunity
o The host's immune system does not take active participation but
depends on ready-made antibodies or T cells to be transferred to it.
o Examples :
i) Administeration of immunoglobulin or antiserum
ii) Transplancental transfer of antibodies from mother to fetus.
iii) Administration of lymphocytes.
Coming back to question
o In some diseases passive immunization is often undertaken in
conjunction with inactivated vaccine products, to provide both : ?
conjunction with inactivated vaccine products, to provide both : ?
i) Immediate (but temporary) passive immunity.
ii) Slowly developing long lasting active immunity.
o The disease in which simultaneous active and passive
immunization are used : ?
i) Tetanus iii) Diphtheria
ii) Rabies iv) Hepatitis B
o In measles also, both active and passive immunization are used,
but not simultaneously. Because the antibody response to live
attenuated measles vaccine is diminished in persons who receive
immunoglobulin can currently. o So, the person passively immunized
should be given live measles vaccine 8-12 weeks later.
So, both active and passive immunity are used : ?
i) Simultaneously —> Tetanus, rabies, Diphtheria, Hepatitis B.
At different time —> Measles.

medpox.com
 906. Post exposure prophylaxis is given in all
except ?
a) Rabies

b) Chickenpox

c) Measles

d) Typhoid

Correct Answer - D
Ans. is 'd' i.e., Typhoid
Post-exposure immunization
medpox.com
Post exposure immunization is prophylactic immunization
immediately after exposure to a pathogen, in order to prevent
infection by the pathogen and the development of disease.
Post exposure immunization is given for -
i. Varicella (chicken pox)
ii. Measles
iii. Rabies
iv. Tetanus
v. Hepatitis
vi. Meningococcal meningitis
907. Isolation is not done in ?
a) Cholera

b) Diphtheria

c) Mumps

d) Hepatitis

Correct Answer - C:D

Ans. is (D) Hepatitis (C) Mumps
Isolation has a distinctive value in the control of some infectious
diseases, e.g., diphtheria, cholera, streptococcal respiratory disease,
pneumonic plague. medpox.com
In some diseaes where there is a large component of subclinical
infection and carrier state, even the most rigid isolation will not
prevent the spread of disease, e.g., polio, hepatitis and typhoid
fever.
Mumps is highly infectious before it is diagnosed hence isolation for
most cases of mumps has proved futile - Park.
Measles is also highly infectious during prodromal period, isolation is
most useful if diagnosis can be established in the
prodromal/catarrhal stage. But most cases of measles are
diagnosed with the appearance of rash when communicability
begins to decline. Isolation in measles is therefore not likely to be
very effective.
908. Notifiable diseases to WHO are all except
?
a) Cholera

b) Plague

c) Yellow fever

d) Tuberculosis

Correct Answer - D
Ans. is 'd' i.e., Tuberculosis

medpox.com
909. Vaccine which should not be frozen -
a) OPV

b) Measles

c) HBV

d) Yellow fever

Correct Answer - C
Ans. is 'c' i.e., HBV
OPV and measles vaccines are stored in deep freezers. (Note :
Yellow fever vaccine is also freez dried, but is not used in India).
Vaccine which must be stored in the cold part but never allowed to
medpox.com
freez.
Typhoid
DPT
TT
Hepatitis B
DT
BCG
Diluents
910. Not true about vaccines ?
a) Two live vaccines can be given at same time at different sites

b) Two live vaccines at same site should be given at least 3 weeks

apart

c) In vaccine vial monitor if the color of inner square is same as

outer background, vaccine is good for use

d) Live and killed vaccines can be given together

Correct Answer - C
Ans. is 'c' i.e., In vaccine vial monitor if the color of inner
square is same as outer background, vaccine is good for use
medpox.com
Vaccine Vial monitor
An important improvement in PPI during 1998 has been the use of
vaccine vial monitor.
Colour monitors or labels are put on vaccine bottles.
Each label has a circle of deep blue colour.
Inside it is a white square which changes colour and gradually
becomes blue, if vaccine bottle is exposed to higher temprature.
When the colour of the white square becomes blue like that of
surrounding circle, the vaccine should be consid​ered ineffective.
Thereby, the health worker can easily ascertain that the vaccine
being given is effective or not.
911. Which of the following is not a killed
vaccine ?
a) Polio

b) HBV

c) HAV

d) Yellow fever vaccine

Correct Answer - D
Ans. is 'd' i.e., Yellow fever vaccine
Yellow fever vaccine is a killed vaccine.
medpox.com
 912. Hepatitis A vaccine available ?
a) Live attenuated

b) Killed (Inactivated)

c) Both live and inactivated

d) Subunit vaccine

Correct Answer - C
Ans. is 'c' i.e., Both live and inactivated
Two types of hepatitis A vaccines are used :-
1. Formaldehyde inactivated vaccine
2. Live attenuated vaccine medpox.com
913. True about carriers ?
a) Infection with clinical symptoms

b) Serves as source of infection

c) More infectious than cases

d) Less dangerous than cases

Correct Answer - B
Ans. is 'b' i.e., Serves as source of infection
A carrier is defined as "an infected person or animal that harbours a
specific infectious agent in the absence of clinical disease and
serves as a potential source of infection".
medpox.com
As a rule carriers are less infectious than cases, but
epidemiologically they are more dangerous than cases because they
escape recognition, and continuing as they do to live a normal life
among the population or comunity, they readily infect the susceptible
individuals over a wider area and longer period of time.
914. Healthy carrier are not seen in
a) Salmonella

b) Diphtheria

c) Measles

d) Cholera

Correct Answer - C
Ans. is 'c' i.e., Measles
The infectious agent is shed by the infected host as it multiplies in
them but the host does not manifest signs of the disease.
Subclinical infection does not occur in measles
medpox.com
915. Interval between primary and secondary
cases ?
a) Latent period

b) Communicable period

c) Serial interval

d) Generation time

Correct Answer - C
Ans. is 'c' i.e., Serial interval
Latent period, serial interval and generation time, all are
medpox.com
approximate measure of incubation period, i.e., these period can
give some idea about incubation period.
Latent period
The period from disease initiation to disease detection.
It is used in non-infectious disease as the equivalent of incubation
period in infectious disease.
Serial interval
The gap time between onset of primary case and secondary case.
By collecting information about a whole series of such onset, we get
a distribution of secondary cases from which we can guess the
incubation period.
Generation time
Interval between receipt of infecton by host and maximal infectivity
of the host.
Generation time is roughly equal to the incubation period.
About option 'b'
Communicable period
The time during which an infectious agent may be transferred
directly or indirectly from an infected person to another person.
The period of communicability has no relation with incubation period,
it merely reflects the duration when the infectious agent may be
transferred. This may occur during incubation period, during actual
illness or during convalsescence.
Generally communicable diseaes are not communicable in
incubation period except - measles, Chicken pox, Pertussis hepatitis
A, i.e., these diseases are communicable during their late incubation
period.

medpox.com
916. Transmission of microfilaria in mosquito
is ?
a) Cyclo-developmental

b) Cyclo-propagative

c) Propagative

d) Cyclical

Correct Answer - A
Ans. is 'a' i.e., Cyclodevelopmental
In vector born diseases, an arthropod or any living carrier (e.g.,
medpox.com
snail) acts as a vector and transports an infectious agent to a
susceptible individual.
Transmission by a vector may be of following types : ?
A. Mechanical transmission
The infectious agent is mechanically transported by vector, e.g.,
through souling of feet of flying arthropod.
There is no development or multiplication of infectious agent within
the vector.
B. Biological transmission
The infectious agent undergoes replication (change in number) or
development (change in form) or both in vector.
So, inectious agent requires an incubation period (extrinsic
incubation period) before vector can transmit it to host.
This type of transmission is of three types : -
i) Propagative
Agent undergoes multiplication (change in number) in the vector.
There is no development → No change in form.
Example → Plague bacilli in rate fleas.
ii) Cyclo-developmental
Agent undergoes only development → Change in form.
No multiplication → No change in number.
Example → Micorfilaria in mosquito.
iii) Cyclo-propagative
Agent undergoes both development and multiplication → Change in
form and number.
Example → Malaria parasite (plasmodium sp.) in mosquito.

medpox.com
917. Multifactorial causation of disease theory
was proposed by
a) Louis Pasteur

b) Pettenkofer

c) Robert koch

d) Aristotle

Correct Answer - B
Ans. is 'b' i.e., Pettenkofer
Multifactorial causation of disease theory was proposed by
Pettenkofer. medpox.com
918. Continuous scrutiny of health related
factors is called ?
a) Isolation

b) Surveillancec

c) Monitoring

d) Quarntine

Correct Answer - B
Ans. is 'b' i.e., Surveillance
Monitoring
medpox.com
Monitoring is the performance and analysis of routine measurements
aimed at detecting changes in the environment or health status of
population, e.g. monitoring of air pollution, water quality, and growth
& nutritional status. Surveillance
Surveillance is the continuous scrutiny of the factors that determine
the occurrence and distribution of disease and other conditions of ill
health.
In simple words "surveillance is systemic ongoing collection,
collation and analysis of data and the timely dissemination of
information to those who need to know so that action can be taken".
According to above definition, monitoring becomes one specific and
essential part of the broader concept embraced by surveillance.
Following example will help to differentiate these two ?
In tobacco control -
Surveillance includes collection of data about prevalence of tobacco
use, its health and enconomic consequences, its socio-cultural
determinats and tobacco control policy responses and tobacco
industry activities. By collecting all these information effective
tobacco control interventions can be taken.
 Monitoring will continously oversight the activities of this tobacco
control interventions, to ensure that they are proceeding according
to plan. It keeps track of achievement, resources supply and
utilization, staff movement, etc, so that if anything goes wrong,
immediate corrective measure can be taken.
So,
1. In surveillance, data is collected & collated, and this information is
used to know what action to be taken - making a plan of action.
2. Monitoring than keep a watch that this plan of action is working
properly It is a part of continued surveillance.
"Surveillance is a systemic method for continuous monitoring of
disease in a population, in order to be able to detect changes in
disease patterns and then to control them". Epidemiology glossary

medpox.com
919. Association of Two variables explained
by 3rd variable is ?
a) Spurious association

b) Indirect association

c) Direct association

d) Causal association

Correct Answer - B
Ans. is 'b' i.e., Indirect association
Association medpox.com
Descriptive studies help to suggest an aetiological hypothesis.
Analytic and experimental studies test the hypothesis, derived from
descriptive studies and confirm or refute the observed association
between suspected causes and disease.
Association may be defined as the concurrence of two variables
more often than would be expected by chance.
In other words, events are said to be associated when they occur
more frequently togeher than one would expect by chance.
Association can be of following types : -
1 .Spurious association
Observed association between a disease and suspected factor is
spurious, i.e., not real.
In other words there is an observed association when none actually
exists.
2.Indirect association
The indirect association is a statistical association between a
variable of interest and a disease due to the presence of another
factor, known or unknown, that is common to both the variable and
the disease.
This third factor (i.e., the common factor) is also known as the
confounding variable.
For example, endemic goitre (disease) is found at high altitudes
(variable), showing thereby an association between altitude and
endemic goitre. But it is due to iodine deficiency which is common at
high altitude. So, iodine deficiency acts as a confounding factor as it
is associated with both high altitude and endemic goitre.
3.Direct (causal) association
a) One to one causal relationship
Two variables are stated to be causally related if change in one is
followed by change in other.
If It does not, then their relationship cannot be causal.
b) Multifactorial causation
The causal thinking is different in non-communicable disease (e.g.,
CHD) where the etiology is multifactorial, i.e., more than one factors
are associated with disease causation.

medpox.com
 920. Missing cases are detected by ?
a) Active surveillance

b) Passive surveillance

c) Sentinel surveillance

d) Prevalence rate

Correct Answer - C
Ans. is 'c' i.e., Sentinel surveillance
Surveillance
Surveillance is defined as "the continous scrutiny of the factors that
determine the occurrence and distribution of disease and other
medpox.com
conditions of ill health".
Surveillance may be of following types :?
1) Passive surveillance
Data is reported itself to health system, e.g. a patient (clinical case)
is coming to a doctor.
Most of the national health programmes in India rely on passive
surveillance for data collection.
2) Active surveillance
Data is collected actively by health system, e.g. collection of blood
slides every fortnight from house to house to control malaria.
Active surveillance in India is done in :-
1. National leprosy elimination programme (modified leprosy
elimination campaigns).
2. National vector Borne disease control programme (VVBDCP) e.g.
malaria.
3) Sentinel surveillance
1. Sentinel surveillance helps in identifying missing cases and
supplementing notified cases.
2. Sentinel surveillance in India is done in national AIDS control
programme.

medpox.com
921. First step in epidemic done by an
epidemiologist?
a) Identity the cases

b) Confirm the diagnosis

c) Identify the prone people

d) Identify the causative factors

Correct Answer - B
Ans. is 'b' i.e., Confirmation of diagnosis
Steps for Investigation of Epidemic :
Verification of diagnosis : medpox.com
Is the first step in investigation of an epidemic'
Confirmation of existence of an epidemic:
Compare with disease frequencies during same period in previous
years
Epidemic threshold: An arbitrary limit of '2 standard errors from the
endemic occurrence'
Defining the population at risk:
Obtaining the map of the area
Calculation of 'appropriate denominator of population at risk'
Rapid search for all cases and their characteristics:
Medical survey
Epidemiological case sheet
Searching for more cases: Search for new cases is carried out
everyday, till the area is declared free of epidemic; this period is
usually taken as 'twice the incubation period of the disease since the
occurrence of last case'
Data analysis:
Formulation of hypothesis
Testing of hypothesis
Evaluation of ecological factors
Further investigation of population at risk
Writing the report

medpox.com
922. Proportional mortality rate is ?
a) Number of death due to a particular cause

b) Number of death during that year

c) Number of death in one month

d) None

Correct Answer - A
Ans. is 'a' i.e., Number of death due to a particular cause
Proportional mortality rate (ratio)
Proportional mortality rate measures the proportion of total death
due to specific cause or proportion of deaths in a particular age
medpox.com
group.
It is defined as "number of deaths due to a particular cause (or in
specific age group) per 100 total deaths".
It is the 'simplest measure of estimating the burden of disears' in the
community.
It is a useful 'health Status indicator'; indicates magnitude of
preventable mortality.
It is used when population data is not available.
It does not indicate the risk of members of population contracting or
dying from the disease.
923. Best indicator for burden of disease ?
a) Incidence

b) Crude death rate

c) Cause specific death rate

d) Proportional mortality rate

Correct Answer - D
Ans. is 'd' i.e., Proportional mortality rate

medpox.com
924. Case fatality rate is a ?
a) Rate

b) Ratio

c) Proportion

d) None

Correct Answer - C
Ans. is 'c' i.e., Proportion

medpox.com
 925. Natural history of disease is studied with
?
a) Longitudinal studies

b) Cross-sectional studies

c) Both

d) None

Correct Answer - A
Ans. is 'a' i.e., Longitudinal studies
Longitudinal studies
medpox.com
In this type of study, observations are repeated in the same
population over a prolonged period using follow up examinations.
They are useful to
1. Study the natural history of the disease
2. For identifying risk factors of disease
3. For finding out the incidence rate or rate of recurrence of new cases
of the disease.
Note: Longitudinal studies are difficult to organize and more time
consuming than cross-sectional studies.
926. Incidence is calculated by ?
a) Cross sectional study

b) Cohort study

c) Case control study

d) None

Correct Answer - B
Ans. is 'b' i.e., Cohort study

medpox.com
927. Case control study is an example of ?
a) Prospective study

b) Retrospective study

c) Combined retrospective and prospective study

d) Study at one point of time

Correct Answer - B
Ans. is 'b' i.e., Retrospective study

medpox.com
 928. Example of case control study (risk
factor and disease/outcome) ?
a) Maternal smoking and congenital malformation

b) Vaginal adenocarcinoma and intrauterine exposure to DES

c) Thalidomide exposure and teratogenicity

d) All of the above

Correct Answer - D
Ans. is `d' i.e., All of the above
Important risk factors and their outcomes/diseases which have
medpox.com
been studied by case-control study are :-
i. Cigarette smoking and lung cancer.
ii. Maternal smoking and congenital malformation.
iii. Radiation and leukemia.
iv. OCP used and hepatocellular carcinoma.
v. Herpes-simplex and Bells palsy.
vi. Artificial sweeteners and bladder cancer.
vii. DES exposure in fetal life and vaginal adenocarcinoma.
viii. OCP use and thromboembolic disease.
ix. Thalidomide use in pregnancy and teratogenicity.
929. Study suitable for rare diseases ?
a) Cohort study

b) Case-control study

c) Both of the above

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., Case-control study

medpox.com
 930. Best epidemiological study is -
a) RCT

b) Meta-analysis

c) Cohort study

d) Case-control study

Correct Answer - B
Ans. is 'b' i.e., Meta-analysis
Here are the different epidemiological studies with decreasing order
of accuracy to test the association between risk factor and disease
:? medpox.com
1. Systematic review and meta-analysis → Overall most reliable
2. Randomized controlled trials (controlled clinical trails) → Most
reliable individual study.
3. Retrospective (Non-concurrent/historic) Cohort study.
4. Prospective (concurrent) Cohort study.
5. Case control study
6. Cross-sectional study
7. Ecological study
931. Matching is not required in which
epidemiological study?
a) Case control study

b) Cohort study

c) Case report

d) Randomized control trial

Correct Answer - C
Ans. is `c' i.e., Case report
Case report:
medpox.com
In medicine, a case report is a detailed report of the symptoms,
signs, diagnosis, treatment, and follow-up of an individual patient.
Case reports may contain a demographic profile of the patient, but
usually describe an unusual or novel occurrence. Since it involves
information on single case it does not require matching.
Others i. e. case control study, cohort study and randomized control
trials are based on the comparative study of two groups.
To decrease the bias in the observations in the two groups under
consideration it is essential that the groups be matched for all the
characteristics except for the one under study. Thus matching is
essential in these epidemiological studies.
932. Randomized study is done in people who
are volunteer for the study. Which type
of bias may occur ?
a) Hawthorne bias

b) Berkesonian bias

c) Selection bias

d) Attention bias

Correct Answer - C
Ans. is 'c' i.e., Selection biasmedpox.com
933. Not true about propagated epidemics ?
a) Gradual rise

b) Gradual fall

c) Person to person transmission

d) No secondary wave

Correct Answer - D
Ans. is 'd' i.e., No secondary wave

medpox.com
934. Total number of TB cases in a
community of 6000 population 150.
Number death due to TB are 30. What is
the TB specific death rate (per 1000
population) ?
a) 20

b) 10

c) 5

d) 0-5

medpox.com
Correct Answer - D
Ans. is 'd' i.e., 0-5
Specific death rates
When analysis is planned to throw light on etiology, it is essential to
use specific death rates.
The specified death rate helps identify particular 'at risk' group (s) for
prevention.
It also permits comparison between different causes within same
population.
The specific death rates may be ?
a) Cause or disease specific, e.g. TB, cancer, accident.
b) Related to specific groups - e.g. age specific, sex specific.
935. An infectious disease shows iceberg
phenomenon. That means it has ?
a) More case fatality rate

b) More SAR

c) More subclinical cases

d) More complications

Correct Answer - C
Ans. is 'C' i.e., More subclinical cases
Iceberg of disease
medpox.com
Disease in a community may be compared with an iceberg.
The floating tip of the iceberg represents what the physician sees in
the community, i.e. clinical cases (Diagnosed case, symptomatic
case of the clinically apparent case).
The vast submerged portion of the iceberg represents the hidden
mass of disease, i.e. latent, inapparent, presymptomatic and
undiagnosed cases and carriers in the community.
The "waterline" represents the demarcation between apparent and
inapparent disease.
An epidemiologist is concerned with the hidden portion of the
iceberg whereas the clinician is concerned with the tip of the
iceberg.
Screening is done for a Hidden portion of the iceberg whereas
diagnosis is done for the tip of the iceberg.
The iceberg phenomenon of disease is not shown by Rabies,
Tetanus, Rubella, and Measles.
The clinician concerned only with the tip of iceberg, i.e symptomatic
cases that are seen in clinical treatment, this can result in inaccurate
view of the nature and causes of a disease results because the
 minority of the cases are studied (hidden cases:- submerged portion
of iceberg is not studied) → Clinician's Fallacy
Diseases with a great deal of subclinical infection (therefore
have iceberg phenomenon) are :
1. Polio
2. Japanese encephalitis
3. Influenza
4. Mumps
5. Hepatitis A and B
6. Diphtheria

medpox.com
936. Relationship between positive predictive
value and prevalence ?
a) PPV α Prevalence

b) PPV α 1/Prevalence

c) PPV x Prevalence = 1

d) PPV = 1/Prevalence

Correct Answer - A
Ans. is 'a' i.e., PPV α Prevalence
Prevalence affects the PPV the most. PPV is directly
medpox.com
proportional to the prevalence of the disease in the population.
However, both sensitivity and specificity can change the
predictive value.

The prevalence of a disease in a population is high, the more

accurate will be the positive predictive value of a screening
test. If the prevalence declines, the PPV will be low.
NPV varies inversely with the prevalence
 937. Screening is not recommended if ?
a) Prevalence of disease is high

b) Life expectancy can be prolonged by early diagnosis

c) Diagnostic test should be available

d) Diseases with no latent period

Correct Answer - D
Ans. is 'd' i.e., Disease with no latent period
The disease to be screened should fulfil the following criteria
before it is considered suitable for screening:?
1. The condition sougth should be an important health problem (in
medpox.com
general, prevalence should be high).
2. There should be a recognizable latent or early asymptomatic stage.
3. The natural history of the contition, including development from
latent to declared disease, should be adequately understood (so that
we can know at what stage the process ceases to be reversible).
4. There is a test that can detect the disease prior to the onset of signs
and symptoms.
5. Facilities should be available for confirmation of the diagnosis.
6. There is an effective treatment.
7. There should be an agreed-on policy concerning whom to treat as
patients (e.g., lower ranges of blood pressure; border-line diabetes).
8. There is good evidence that early detection and treatment reduces
morbidity and mortality.
9. The expected benefits (e.g., the number of lives saved) of early
detection exceed the risks and costs.
938. The validity of a test denotes ?
a) Precision

b) Accuracy

c) Reproducibility

d) Reliability

Correct Answer - B
Ans. is 'b' i.e., Accuracy
Screening test to be applied
The screening test to be applied should fulfill the following important
criteria before it is considered suitable for screening : -
medpox.com
1.Acceptability
The test should be acceptable to the people at whom it is aimed.
In general painful or embarrassing tests e.g., per rectal or vaginal
examination are not likely to be acceptable.
2.Repeatability (reliability)
Repeatability means the test must give consistent results when it is
repeated more than once on the same individual under the same
conditions.
That means the results of the test are precise (exact), So
repeatability is sometimes called precision, reliability or
reproducibility.
3. Validity (accuracy)
Validity refers to what extent the test accurately measures which is
purports to measures.
That means a valid test distinguish the people who have the disease
from those who do not.
Validity has components --> Sensitivity and specificity.
939. Positive predictive value is a function of
sensitivity,specificity and
a) Absolute risk

b) Relative risk

c) Incidence

d) Prevalence

Correct Answer - D
Ans. d. Prevalence
The predictive value of a positive result falls as the disease
prevalence declines. medpox.com
Positive Predictive Value
In addition to sensitivity and specificity, the performance of a
screening test is measured by its 'predictive value', which reflects
the diagnostic power of the test.
The predictive accuracy depends upon sensitivity, specificity and
disease prevalence.
The predictive value of a positive test indicates the probability that a
patient with a positive test result, has, in fact, the disease in
questions.
The more prevalent a disease in the given population, the more
accurate will be the predictive value of a positive screening test.
The predictive value of a positive result falls as the disease
prevalence declines
940. Numerator in negative predictive value ?
a) True positive

b) False positive

c) True negative

d) False negative

Correct Answer - C
Ans. is 'c' i.e., True negative
specificity = True negatives/True negatives+False positives
Sensitivity=True Positives/True positives+False negatives
Positive predictive value = True positives/(true+false) positives
medpox.com
Negative predictive value = True negatives/(true+false) negatives
941. Formula to calculate sensitivity of a
screening test ?
a) True positive/true positive + false negative

b) True negative/true positive + false negative

c) True positive/true negative + false positive

d) True negative/true negative + false positive

Correct Answer - A
Ans. is 'a' i.e., True positive/true positive + false negative
The formula for the positive likelihood ratio ("LR+") considers
medpox.com
both sensitivity and specificity: it's sensitivity divided by (1-
specificity), or the true positive rate divided by the false positives.
This shows how much more likely is a person with the disease to
score positive than a person without the disease.

 942. Positive mortality indicator is ?
a) IMR

b) Child mortality rate

c) MMR

d) Life expectancy

Correct Answer - D
Ans. is 'd' i.e., Life expectancy
Mortality indicators
These are :?
i. Crude death rate medpox.com
ii. Maternal mortality rate
iii. Expectation of life (life expectancy)
iv. Disease specific mortality rate
v. Infant mortality rate
vi. Age specific death rate
vii. Child mortality rate
viii. Adult mortality rate
ix. Under-5 proportional mortality rate
x. Years of potential life lost
Among these only life expectancy is a positive mortality indicator, i.e.
increase life expectancy means improvement in health.
All other are 'negative' health indicators, i.e. increase value of these
indicators implies poor health of community.
943. What is the route of administration of
avian influenza vaccine?
a) Intranasal

b) Intramuscular

c) Subcutaneous

d) Intradermal

Correct Answer - B
Ans. is 'b' i.e., Intramuscular
Vaccine Avian Influenza:
medpox.com
On April 17, 2007, FDA licensed the first vaccine in the United
States for the prevention of H5N1 influenza, commonly referred to
as avian influenza or "bird flu".
This inactivated influenza virus vaccine is for use in people 18
through 64 years of age who are at increased risk of exposure to the
H5N 1 influenza virus subtype contained in the vaccine.
This vaccine is derived from the A/Vietnam/1203/2004 influenza
virus.
It is administered as a two-dose regimen. One 90 microgram dose is
given intramuscularly, in the upper arm, and a second 90 microgram
dose is given in the same manner, 28 days later.
944. Mortality rate in measles encephalitis is -
a) 1-2%

b) 10-20%

c) 20-30%

d) 30-40%

Correct Answer - B
Ans. is 'b i.e., 10-20%
"The mortality rate in encephalitis associated with measles is about
10-20 %" — Park
"Case fatality rate in acute measles encephalitis is 15%"
medpox.com
wwwcdc.gov.
945. Mortality rate of measles in developing
countries?
a) 10%

b) 20%

c) 30%

d) 40%

Correct Answer - A
Ans. is 'a' i.e., 10%
Measles-associated mortality is usually higher among the very
young and very old. medpox.com
Mortality in developing countries may be as high as 10 to 15% due
to one or several factors, including the early age of infection,
malnutrition, diarrhea, concomitant/secondary bacterial infections,
and lack of access to good medical care.
Most common cause of death is pneumonia in children and
encephalitis in adults.
946. Measles elimination criteria are all except
?
a) Absence of endemic measles

b) For more than 12 months

c) Incidence < 1 per 1 lac population

d) Transmission at low level

Correct Answer - D
Ans. is 'd' i.e., Transmission at low level
WHO defines elimination of measles as the absence of endemic
medpox.com
measles for a period of 12 months in the presence of adequate
surveillance.
One indicater of measles elimination is a sustained measles
incidence < 1/100, 000 population.
In 2005, the World Health Assembly set a goal of achieving a 90%
reduction in global measles mortality by 2010 as compared with
level in 2000.
947. True about measles are all except ?
a) Koplik's spots is pathognomonic

b) Source is a case

c) Infectivity is low

d) Affect age group 1 to 3 years

Correct Answer - C
Ans. is 'c' i.e., Infectivity is low
Measles has high infectivity with secondary attack rate of 80%.
Other options are correct.
medpox.com
948. Koplik spot is pathognomic of which
infection ?
a) Rubella

b) Influenza

c) Mumps

d) Measles

Correct Answer - D
Ans. is 'd' i.e., Measles

medpox.com
949. Most rapid diagnosis of pulmonary TB
can be done by ?
a) Sputum culture

b) Sputum microscopy

c) Radiometric BACTEC method

d) Genexpert

Correct Answer - B
Ans. is 'b' i.e., Sputum microscopy
Sputum smear microscopy is the quickest and easiest procedure.
medpox.com
But it lacks both sensitivity and specificity.
Sputum culture is sensitive and most specific. But it takes 2-8 weeks
for culture on routine L.J. media (solid medium).
M tuberculosis produces visible colonies on solid media (L.J. media)
in 4-8 weeks.
Studies have shown that the rate of Isolation of positive cultures was
significantly faster with the Bactec method with 87% of the positives
being obtained at 7 days and 96% by 14 days.
Gene XPert should be used as the initial diagnostic test in
individuals suspected of having MDR-TB or HIV-associated TB
(strong recommendation)," and "Xpert may be used as a follow-on
test to microscopy where MDR and/or HIV are of lesser concern,
especially in smear-negative specimens (conditional
recommendation).
The GeneXpert MTB/RIF assay is a novel integrated diagnostic
device for the diagnosis of tuberculosis and rapid detection of RIF
resistance in clinical specimens.
 950. All are true about DOTS, except ?
a) Short course of chemotherapy

b) Drugs are given free of cost

c) Supervised drugs intake in intensive phase

d) Daily treatment is recommended

Correct Answer - D
Ans. is 'd' i.e., Daily treatment is recommended
Directly observed treatment short course (DOTS)
In the Revised National Tuberculosis Control Programme (RNTCP),
patients are provided short course chemotherapy as DOTS.
medpox.com
All patients are provided short-course chemotherapy free of charge.
During the intensive phase of treatment a health worker watches as
the patient swallows the drug in his presence. o During continuation
phase, the patient is issued medicine for one week in a multiblister
combipack of which the first dose is swallowed by the patient in the
presence of health worker.
The consumption of medicine in the continuation phase is also
checked by return of empty multiblister combipack when the patient
comes to collect medicine for the next week.
In this programme, alternate day treatment is given.
Under RNTCP, active case finding is no longer pursued. Case
finding is passive. Patients presenting themselves with symptoms
suspicious of tuberculosis are treated with DOTS therapy.
The colour of boxes (containing the drugs for full course of
treatment) is according to the category of regimen?
i. Category I patients → Red
ii. Category II patients → Blue
iii. Category III patients → Green
medpox.com
951. As per RNTCP guidelines first do in TB
suspect case ?
a) Chest X-ray

b) Sputum culture

c) Sputum microscopy

d) Start short-course chemotherapy

Correct Answer - C
Ans. is 'c' i.e., Sputum microscopy
Treatment stratgics in RNTCP
medpox.com
Under the RNTCP active case finding is not prusued.
Case finding is passive.
Patients presenting thremselves with symptoms suspicious of
tuberculosis are screened through 2 sputum smear examination.
Sputum microscopic examination is done in designated RNTCP
microscopy centres.
It is essential to examine 2 sputum specimens of each patient before
a conclusive diagnosis can be made.
If only 1 sputum smear is positive, chest x-ray helps in diagnosis.
Once the diagnosis is confirmed, treatment is started according to
DOTS (Directly observed therapy short term).
Patient are expected to collect drugs once a month (not daily) on
fixed dates from the nearest treatment centre.
 952. STOP TB Strategy was lauched in ?
a) 2002

b) 2006

c) 2010

d) 2013

Correct Answer - B
Ans. is 'b' i.e., 2006
STOP TB Strategy
In 2006, WHO launched the new Stop TB Strategy.
The core of this strategy is DOTS.
medpox.com
The strategy is to be implemented over the next 10 years as
described in the Global Plan to Stop TB 2006-2015.
The targets and indicators for TB control are as defined within the
framework of MDGs.
These will be used to measure the progress made under the stop TB
strategy.
It focuses onthe five principal indicators that are used to measure
the implementation and impact of TB control.
They are : case detection, treatment success, incidence, prevalence
and deaths.
The global targets for case detection and treatment success have
been set by WHO's World Health Assembly.
i. By 2015: The global burden of TB (prevalence and death rates) will
be reduced by 50% relative to 1990 levels. This means reducing
prevalence to 150 per 100,000 or lower and deaths to 15 per
100,000 per year or lower by 2015 (including TB cases coinfected
with HIV). The number of people dying from TB in 2015 should be
less than approximately 1 million, including those coinfected with
 HIV.
ii. By 2050 : The global incidence of TB disease will be less than or
equal to 1 case per million population per year.

medpox.com
 953. According to DOTS-PLUS guidelines
2013 treatment of multidrug resistance
TB includes all except ?
a) Total duration 24-27 months

b) Intensive phase - 6 drugs

c) Continutation phase - 2 drugs

d) Intensive phase 6-9 months

Correct Answer - C
Ans. is 'c' i.e., Continutation phase-2 drgus
medpox.com
Treatment of multidrug resistance (MDR) TB
MDR-TB is defined as resistance to at least both INH and rifampicin.
Previously it was classified as Category IV under DOTS (DOTS-
PLUS).
The treatment is given in two phases, the intestive phase (IP) and
the continuation phase (CP). The total duration of treatment for
regimen for MDR-TB is 24-27 months, depending on the IP duration.
o Treatment regimen comprises :-
i. Intensive phase (6-9 months) : Six drugs : Kanamycin (Km),
levofloxacin (Lvx), ethionamide (Eto), pyrazinamide (Z), ethambutol
(E), and cycloserine (Cs).
ii. Continuation phase (18 months) : Four drugs : Levofloxaxcin,
ethionamide, ethambutol and cycloserine.
iii. Total duration of treatment is 24-27 months.
Treatment of extensive drug resistance (XDR) TB
XDR-TB is defined as resistance to any fluoroquinolone and at least
one of the following three second-line drugs (capreomycin,
kanamycin, amikacin), in addition to multidrug resistance.
 The Regimen for XDR-TB would be of 24-30 months duration, with
6-12 months Intensive Phase (IP) and 18 months Continuation
Phase (CP).
Regimen is :-
i. Intensive phase (6-12 months) : Seven drugs : Capreomycin, PAS,
moxifloxacin, high dose INH, clofazimine, Linezolid, amoxyclay.
ii. Continuation phase (18 months) : Six drugs : PAS, moxifloxacin,
high dose INH, clofazimine, linezolid, amoxyclay.

medpox.com
954. Which drug is not included in RNTCP
regime for MDR TB ?
a) Cycloserine

b) Ethionamide

c) Levofloxacin

d) PAS

Correct Answer - D
Ans. is `d' i.e., PAS

medpox.com
955. One TB unit is recommended for how
much population in Hilly areas ?
a) 50,000

b) 100,000

c) 150,000

d) 250,000

Correct Answer - D
Ans. is 'd' i.e., 250,000

medpox.com
956. Definition of relapse in TB ?
a) A patient who returns sputum positive after leaving treatment
for at least 2 months.

b) A pateint who returns sputum positive which was cured by

previous treatment

c) A patient who remains sputum positive after 5 months of

treatment

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., A pateint who returns sputum postive which was
medpox.com
curved by previous treatment
Some definitions of tuberculosis cases and treatment
Case of tuberculosis : A patient in whom tuberculosis has been
confirmed by bacteriology or diagnosed by a clinician.
Sputum smear examination - Laboratory technique to screen sputum
for tuberculosis, where acid fast bacilli (AFB) are stained red by the
Ziehl Neelsen method, and then identified and counted.
using microscopy.
Smear positive tuberculosis - At least one initial sputum smears
positive for AFB or one AFB positive.
Smear negative tuberculosis - At least two negative smears, but
tuberculosis suggestive symptoms and X-ray abnormalities or
positive culture.
Adherence - Person takes appropriate drug regimen for required
time (also known as compliance).
New case - A patient with sputum positive pulmonary tuberculosis
who has never had treatment for tuberculosis or has taken anti -
tuberculosis drugs for less than 4 weeks.
Relapse - A patient who returns smear positive having previously
been treated for tuberculosis and declared cured after the
completion of his treatment.
Failure case - A patient who was initially smear positive, who began
treatment and who remained or became mear positive again at five
months or later during the course of treatment.
Return after default - A patient who returns sputum smear positive,
after having left treatment for at least two months.
Transfer in - A patient recorded in another administrative area
register and transferred into another area to continue treatment
(treatment results should be reported to the district where the patient
was initially registered). Transfer out - A patient who has been
transferred to another area register and treatment results are not
known. Cured - Initially smear positive patient who completed
treatment and had negative smear result on at least two occasions
(one at treatment completion).
Treatment completed - Initially smear negative patient who received
full course of treatment, or smear positive who completed treatment,
with negative smear at the end of initial phase, but no or only one
medpox.com
negative smear during continuation and none at treatment end.
Cohort - A group of patients in whom TB has been diagnosed, and
who were registered for treatment during a specified time period
(e.g. the cohort of new smear-positive cases registered in the
calender year 2003). This group forms the denominator for
calculating treatment outcomes. The sum of the treatment
outcomes, plus any case for which no outcome is recorded (eg. still
on treatment) should equal the number of cases registered.
Case detection rate : - The case detection rate is calculated as the
number of notification of new and relapse cases in a year divided by
the estimated incidence of such cases in the same year.
957. Daily dose of INH for TB ?
a) 600 mg

b) 300 mg

c) 150 mg

d) 1500 mg

Correct Answer - B
Ans. is 'b' i.e., 300 mg

medpox.com
 958. In Revised National Tuberculosis Control
programme the silent features are to
achieve ?
a) Cure rate 85% & diagnosis 85%

b) Cure rate 85% & diagnosis rate 70%

c) Cure rate 80% & diagnosis 85%

d) Cure rate 80% & diagnosis rate 80%

Correct Answer - B
Ans. is 'b' i.e., Cure rate 85% & diagnosis rate 70%
medpox.com
Revised National Tuberculosis Control Programme
The Government of India, WHO and World Bank together reviewed
the NTP in the year 1992. Based on the findings a revised strategy
for NTP was evolved.
The salient features of this strategy are : -
Achievement of at least 85 percent cure rate of infectious cases
through supervised Short Course Chemotherapy involving peripheral
health functionaries.
Augmentation of case finding activities through quality sputum
microscopy to detect at least 70 percent estimated cases; and
Involvement of NG0s; Information, Education and communication
and improved operational research.
For a "TB - free India" following objectives have been proposed :
i. To achieve 90% notification rate
ii. To achieve 90% success rate for all new cases and 85% for
retreatment cases
iii. To significantly improve the successful outcomes of treatment of
drug resistant TB cases
iv. To decrease morbidity and mortality of HIV associated TB
v. To improve outcomes of TB care in the private sector

medpox.com
959. Which of the following anti-leprotic drug
is not given under supervision ?
a) Rifampicin

b) Clofazimine

c) Dapsone

d) All are given supervised

Correct Answer - C
Ans. is 'c' i.e., Dapsone

medpox.com
960. Secondary attack rate of chickenpox ?
a) 70%

b) 90%

c) 65%

d) 80%

Correct Answer - B
Ans. is `b' i.e., 9%

medpox.com
961. True about rash of chicken pox ?
a) Deep seated

b) Centripetal

c) Affects palm & sole

d) Slow evolution

Correct Answer - B
Ans. is 'b' i.e., Centripetal

medpox.com
962. Spread of chicken pox is maximum ?
a) After formation of scab

b) Just before and after onset of rash

c) One week before onset of rash

d) During convelescence

Correct Answer - B
Ans. is 'b' i.e., Just before and after onset of rash
Communicable period (period of maximum infectivity) in chicken pox
is 2 days before to 5 days after onset of rash.
medpox.com
963. Incubation period of measles is:
a) 18-72 hours

b) 10-14 days

c) 3-4 days

d) 20-25 days

Correct Answer - B
Ans. b. 10-14 days

medpox.com
964. Incubation period of influenza -
a) 18 - 72 hrs

b) 1 - 6 hrs

c) 5 - 10 days

d) < 1 hrs

Correct Answer - A
Ans. is 'a' i.e., 18 - 72 hrs

medpox.com
965. Prevalence of Influenza in India ?
a) 10 per 10000 population

b) 10 per 100000 population

c) 10 per 1000 population

d) Data regarding prevalence of influenza is not adequate

Correct Answer - D
Ans. is 'd' i.e., Data regarding prevalence of influenza is not
adequate

medpox.com
966. In epidemics measles vaccine is to be
given within how many days of exposure
?
a) 3 days

b) 7 days

c) 10 days

d) 15 days

Correct Answer - A
Ans. is 'a' i.e., 3 days medpox.com
Incubation period of measles virus is 10 days.
Incubation period of live attenuated measles virus of live vaccine is 7
days.
Thus, if the vaccine is given within 2-3 days of exposure, the
replication of vaccine virus takes preference over replication of wild
virus.
"Susceptible contacts over the age of 9-12 months may be protected
against measles with measles vaccine, provided that this is given
within 3 days of exposure. This is because, the incubation period of
measles induced by vaccine is about 7 days, compaired with 10
days for the naturally acquird measles." — Park
967. Most common presentation of mumps ?
a) Pain and lacrimation of eye

b) Pain and swelling of parotid glands

c) Pain and swelling of submandibular and sublingual glands

d) Aseptic meningitis

Correct Answer - B
Ans. is 'b' i.e., Pain and swelling of parotid glands

medpox.com
968. Most common manifestation of mumps
in adult males -
a) Aseptic meningitis

b) Encephalitis

c) Orchitis

d) Sinusitis

Correct Answer - C
Ans. is 'c' i.e., Orchitis
Orchitis is the most common manifestation of mumps among
postpubertal males. medpox.com
969. Most common type of polio is ?
a) Non-paralytic polio

b) Paralytic polio

c) Abortive illness

d) Inapparent infection

Correct Answer - D
Ans. is `d' i.e., Inapparent infection

medpox.com
970. Mortality of rabies is ?
a) 25%

b) 50%

c) 75%

d) 100%

Correct Answer - D
Ans. is 'd' i.e., 100%
Rabies
Rabies is primarily a zoonotic disease of warm-blooded animals,
particularly carnivorous such as dogs, Cats, Jackals and wolves.
medpox.com
971. HIV screening for blood transfusion is
done by -
a) NACO

b) ASHA

c) Ministry of education

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., NACO [Ref Park 23rd/e p. 437]
Access to safe blood for the needy is the primary responsibility of
medpox.com
NACO (National AIDS control organization).
Guidelines for blood bank, blood donors and dialysis unit have been
formulated.
The strategy is to ensure safe collection, processing, storage and
distribution of blood and blood products.
Testing of every unit of blood is mandatory for HIV, HBV, HCV,
malaria, syphilis.
972. Cluster testing technique is useful in
which of the following conditions?
a) Sexually Transmitted Diseases

b) Poliomyelitis

c) Measles

d) Smallpox

Correct Answer - A
Explanation: Following methods are used for case detection of
STD:
medpox.com
• CONTACT TRACING: Contact tracing is the term used for the
technique by which the sexual partners of diagnosed patients are
identified, located, investigated, and treated.
• CLUSTER TESTING: Here the patients are asked name other
persons of either sex who move in the same socio-sexual
environment. These persons are then screened.

Ref: Park’s textbook of Preventive and Social Medicine, 21stedition,

Page 313
973. Prevalence of HIV infection in antenatal
women is less than 1% and in high risk
population is less than 5%. The state
belongs to ?
a) Group I

b) Group II

c) Group III

d) Group IV

Correct Answer - C medpox.com

Ans. is `c' i.e., Group III
Based on sentinel surveillance data HIV prevalence in adult
population can be broadly classified in three groups of state / UT sin
the country.
974. In AIDs control programme, For
treatment of STDs, blue colored pack is
used for treatment of-
a) Urethral discharge

b) Scrotal swelling

c) Genital ulcers

d) Ano-rectal discharge

Correct Answer - C
Ans. is 'c' i.e., Genital ulcer
medpox.com
NACO centers providing ART (as of sept 2006)
The National AIDS control organization (NACO) has increased the
numbers of centres providing ART from 54 to 91 centres with
another 9 more centres also getting operational soon.
All the 9lcentres have specially appointed and trained doctors,
counsellors and laboratory technicians to help initiate patients on
ART and follow them regularly.
At these 91 centres medicines for treating 85000 patients have been
made available.
The ART is a combination of three potent drugs, which is being
given to the persons with advanced stage of AIDS.
Apart from providing free treatment, all the ART centres are
providing counselling to the infected persons so that they maintain
regularly of their medication.
ACO has branded the STI/RTI services as "Suraksha clinic" and has
developed a communication strategy for generating demand for
these services.
975. Cholera vaccination is indicated ?
a) To control epidemics

b) For travellers

c) In endemic areas

d) In Neonates

Correct Answer - C
Ans. is 'c' i.e., In endemic areas
Cholera vaccination should be considered in areas where cholera is
endemic.
However, it should always be done in conjunction with
medpox.com
implementation of safe water, sanitation and hygiene promotion
programme.
In resource poor areas, vaccination should be targeted at children
aged 2 years.
Cholera vaccine has not been recommended in outbreak/epidemic
settings or complex humanitarian emergencies because of the
logistical challanges of administering 2-dose vaccine, and concern
that long-scale vaccination would divert limited resources from
higher priority measures.
As it does not prevent epidemic cholera transmission, it is not
recommended for general population.
Cholera transmission is not recommended for travelers, as
counseling about risk avoidance is more cost effective than
vaccination.
976. All are true about epidemiological
features of cholera except ?
a) Epidemic is self limiting

b) Poor sanitation is a cause of epidemic

c) El Tor biotype has decreased endemicity

d) Onset of epidemic is abrupt

Correct Answer - C
The El Tor biotypes have greater endemic tendency than its
classical counterpart in that it causes a higher infection-to-case ratio
medpox.com
(i.e. more inapparent infections and mild cases).
About other options
Cholera epidemic has an abrupt onset. It starts as common source
epidemic and often treat an acute health problem. Then it continues
as a propagated epidemics as cases become the source for the
other persons.
Cholera epidemic in a community is self-limiting. This is attributed to
the acquisition of temporary immunity, as well as due to the
occurrence of a large number of subclinical cases.
Poor environmental sanitation is the most important predisposing
factor for epidemic
977. To determine the endemicity of hepatitis
B, what should be measured ?
a) HBsAg

b) HBcAg

c) HBeAg

d) Anti-HBeAg

Correct Answer - A
Ans. is 'a' i.e., HBsAg
HBsAg testing is widely used as a marker of HBV infection in
epidemiological surveys. medpox.com
Serological markers for HBV
Serological markers for HBV infection are :?
HBs Ag (surface antigen or Australia antigen) : It is the first marker
which appears in the serum. It is the epidemiological marker for HBV
infection.
HBc Ag (core antigen) : It is not demonstrable in serum because it is
enclosed by HBsAg coat.
HBe Ag (envelope antigen) : It is marker of active replication and
high infectivity. It is qualitative marker of replication. HBs Ag carrier
mothers who are HBe Ag positive almost invariably (> 90%) transmit
hepatitis B infection to their offspring, where as HBs Ag carrier
mothers with anti HBe rarely (10 to 15%) infect their offspring.
Anti-HBc Ag : It is the first antibody appears in serum. IgM anti-HBc
Ag is a marker of acute or recent infection. IgG anti-HBc Ag
indicates remote infection.
Anti-HBs Ag : It is protective antibody. It is the only serological
marker present after vaccination. After an infection, its presence
indicates recovery and end of period of communicability.
Anti-HBe Ag : Its presence indicate stopage of replication and low
infectivity.
HBV DNA : It is quantitative marker of HBV replication.

medpox.com
978. An epidemiologist visits a village and
wants to collect data for recent parasitic
activity. What should be measure ?
a) Spleen rate

b) Infant parasite rate

c) Slide positivity rate

d) Slide falciparum rate

Correct Answer - B
Ans. is 'b' i.e., Infant parasite rate
medpox.com
MEASUREMENT OF MALARIA
In the pre-eradication era, the magnitude of the malaria problem in a
country used to be determined mostly from the reports of the
clinically diagnosed malaria cases and the classical malariometric
measures, e.g., spleen rate, parasite rate etc.
On the other hand, during eradication era, the microscopic diagnosis
of malaria cases became the main method of diagnosis and the
parameters used are mostly parasitological in nature e.g., API,
ABER, SPR and SFR.
Measurements of malaria in the pre eradication era
a) Spleen rate:
Defined as the percentage of children between 2 & 10 years of age
showing enlargement of spleen. Spleen rate is widely used for
measuring the endemicity of malaria in a community.
b) Av. enlarged spleen :
A refinement of spleen rate , denoting the average size of spleen.
c) Parasite rate :
Defined as on the percentage of children between the ages of 2 &
10 yrs showing malarial parsites in their blood films.
d) Parasite density index :
Average degree of parasitimia
e) Infant parasite rate
Percentage of infants showing malarial parasites in their blood films.
It is the most sensitive index of recent transmission of malaria in a
locality. If the infant parasite rate is zero for three consecutive years
in a locality, it is regarded as absence of malaria transmission even
though, the Anopheline vectors responsible for previous
transmissions may remain.
Eradication Era
a) Annual Parasite Incidence (API)*
= (Confirmed cases during one year / population under surveillance)
x 1000
b) Annual Blood Examination Rate = (No. of slides
examined/population) x 100
ABER is an index of operational efficiency.
In the modified plan of operation, the minimum prescribed is 10
percent of the population in a year
medpox.com
c) Annual falciparum index
d) Slide positivity rate
Slide positivity rate is the percentage of slides found positive for
malarial parasite, irrespective of the type of species.
Slide falciparum rate
It is the percentage of slides positive for P. falciparum.
979. Index of operational efficiency of Malaria
?
a) API

b) ABER

c) Infant parasite rate

d) Spleen rate

Correct Answer - B
Ans. is 'b' i.e., ABER
Annual blood examination rate (ABER) is an index of operational
efficiency. medpox.com
980. False about transmission of Rubella ?
a) Droplet infection

b) Vertical transmission

c) Infection in early pregnancy causes milder disease

d) Fetus affected in late pregnancy may have only deafness

Correct Answer - C
Ans. is 'c' i.e., Infection in early pregnancy causes milder disease

medpox.com
981. Risk period for maximum fetal damage
by congenital rubella ?
a) First trimester of pregnancy

b) Second trimester of pregnancy

c) Third trimester of pregnancy

d) Risk is same throughout the pregnancy

Correct Answer - A
Ans. is 'a' i.e., First trimester of pregnancy
In general, the earlier in pregnancy infection occurs, the greater the
medpox.com
damage to the fetus. Maximum damage to the fetus occurs when
infection is acquired in the first trimester of pregnancy.
982. AFP surveillance registry indicator is ?
a) Number of AFP cases reported

b) Number of wild polio-virus positive cases

c) Number of non-polio AFP < 5 years

d) Number of non-polio AFP < 15 years

Correct Answer - A
Ans. is 'a' i.e., Number of AFP cases reported
The number of AFP cases reported each year is used as an
indicator of a country's ability to detect polio, even in countries where
the disease no longer occurs. medpox.com
Polio surveillance
It is the most important part of whole polio eradication intiative. It has
two components:?
Acute flaccid paralysis (AFP) surveillance
Acute flaccid paralysis is defined as acute onset (< 4 weeks) of
flaccid paralysis (reduced tone) without other obvious cause in
children WHO recommends the immediate reporting and
investigation of every case of AFP in children less than 15 years.
983. Polio is said to be eradicated if no case
of polio by wild poliovirus occurs in an
area for ?
a) 1 year

b) 2 years

c) 3 years

d) 4 years

Correct Answer - C
Ans. is 'c' i.e., 3 years medpox.com
Certification of polio eradication is conducted an regional bases.
Each region can consider certification only when all countries in the
area demonstrate the absence of wild poliovirus transmission for at
least three consecutive years.
984. Dose of rabies immunoglobulin for post-
exposure prophylaxis ?
a) 10 IU/kg

b) 20 IU/kg

c) 30 IU/kg

d) 40 1U/kg

Correct Answer - B
Ans. is 'b' i.e., 20 IU/kg
Dose of rabies immunoglobulin (equine immunoglobulin) → 20 IU/kg
body weight. medpox.com
Dose of F (ab)2 products → 40 IU/kg body weight.
 985. An american wants prophylaxis for
Hepatitis-A before coming to India for 10
days. What should be given ?
a) Two dose of HAV vaccine

b) immunoglobulin

c) Antiviral drug prophylaxis

d) Nothing is required

Correct Answer - B
Ans. is 'b' i.e., Immunoglobulin
medpox.com
Advice for travellers
Some of the recommendation pertain to the following :?
1. Avoid bathing with polluted water as this may result in ear, eye and
skin infections. Excessive heat and humidity or over-exertion in
these conditions may lead to exhaustion from loss of water and salt.
2. The measures for prevention of insect bites.
3. Diarrhoeal Diseases : "Be careful what you eat" is common advice to
travellers, but very few truely understand its implications. Diarrhoea
affects an estimated 20-50 per cent of all travellers. Contaminated
food drinks are the most common source of these infections. Careful
selection and preparation of food and drink offer the best protection.
Unfortunately appearance of food is no guide as to its safety. The
main personal proection is to consider unpasteurized milk, non-
bottled drinks, uncooked food (apart from the fruits and vegetables
that can be peeled or shelled), as likely to be contaminated and
therefore unsafe. The food should be throughly and freshly cooked.
Use boiled water or bottled mineral water (now available
everywhere). Travellers should be aware of the importance of oral
 rehydration fluids containing salt and glucose for countering
dehydration.
4. Malaria : There is a high risk of acquiring malaria in endemic areas.
Travellers are advised to protect themselves by chemoprophylaxis.
Drug prophylaxis should begin at the latest on the day of arrival in
the malarious areas and continued for 4-6 weeks after leaving the
malarious areas.
5. Hepatitis A : Normal human immunoglobulin in a dose of 0.02-0.05
mg/kg of body weight has been recommended every 4 months.
Ideally immunoglobulin should not be given within 3 weeks before,
or untill 2 weeks after administration of a live vaccine. A highly safe,
inactivated HAV vaccine is available in several European countries.
6. Hepatitis E : There is no vaccine against hepatitis E and
immunoglobulin prepared in Europe and USA does not give much of
protection. Avoidence of contaminated food and water is the only
effective protective measure.
7. Hepatitis B : Hepatitis B vaccines are available and are safe. Three
doses of vaccine constitute the complete course. The first two doses
are given one month apart and the third dose about 6 months later.
medpox.com
8. STD and HIV : Measures for preventing STD are the same whether
the individual is travelling abroad or not, i.e. avoidance of sex
altogether or limit it to a single faithful, uninfected partner. Use of
condom is an important preventive measure. To reduce the risk of
acquiring HIV and hepatitis B from syringes and needles, travellers
should avoid injectable drugs and if an injection is essential they
should make sure that the needle and syringe come from sterile
pack.
9. Yellow fever : Vaccination certificate for yellow fever is the only
certificate required for international travel. Yellow fever vaccine is
recommended for travellers to countires designated as yellow fever
endemic zone.
10. Tetanus : It is a wise precaution for the traveller to have a booster
dose of tetanus toxoid if 10 years or more have elapsed since the
last injection of a complete course or booster.
986. Amplifier for Japanese encephalitis ?
a) Horse

b) Pigs

c) Dogs

d) Monkey

Correct Answer - B
Ans. is 'b' i.e., Pigs

medpox.com
987. A patient comes with CLW on knee 10x2
cm, 12 hours old. He had taken TT 6
months back for another injury. What
should be done ?
a) Nothing should be done

b) One dose of TT with immunoglobulin

c) Full course of TT

d) Full course of TT with immunoglobulin

Correct Answer - B medpox.com

Ans. is 'b' i.e., One dose of TT with immunoglobulin
Prevention of tetanus after injury
All wounds must be thoroughly cleaned soon after injury - removal of
foreign bodies, soil dust, necrotic tissue. This procedure will abolish
anaerobic conditions which favour germination of tetanus spore.
988. Major sign for AIDS surveillance in WHO
case definition ?
a) > 10% weight loss

b) Cough > 1 month

c) Generalized lymphadenopathy

d) Disseminated Herpes

Correct Answer - A
Ans. is 'a' i.e., > 10% weight loss
WHO case definition for AIDS surveillance
medpox.com
For the purpose of AIDS surveillance an adult or adolescent (six
years of age) is considered to have AIDS if at least 2 of the following
major signs are present in combination with one minor sign.
Major Signs
Weight loss > 10 % of body weight
Chronic diarrhoea for more than 1 month
Prolonged fever for more than 1 month
Minor signs
Persistent cough for more than one month
Generalized pruritic dermatitis
History of herpes zoster
Chronic progressive or disseminated herpes simplex infection
Generalized lymphadenopathy
Oropharyngeal Candidiasis.
Expanded WHO case definition for AIDS surveillance
For the purpose of surveillance on adult or adolescent (>12 years of
age) is considered to have AIDS if a test for
HIV antibody gives a positive result and one or more of the following
conditions are present :
>10% body weight loss or cachexia, with diarrhoea or fever or both,
for at least 1 month, not known to be due to a condition unrelated to
HIV infection.

medpox.com
 989. Typhoid oral vaccine is given ?
a) 1, 3, 5 days

b) 1, 2, 3 days

c) 1, 2, 4 days

d) 1, 7, 14 days

Correct Answer - A
Ans. is 'a' i.e., 1, 3, 5 days
ANTI-TYPHOID VACCINES
The old parenteral killed whole-cell vaccine was effective but
produced strong side-effects. medpox.com
So, they are not used now.
Two safe and effective vaccines are now licensed and available : -
1.The Vi polysachharide vaccine
1. It is composed of purified Vi capsular polysaccharide from the Ty2
strain of S.Typhi.
2. It is administered subcutaneously or intramuscularly.
3. Only one dose is required.
4. The vaccine confers protection 7 days after injection.
5. To maintain protection, re-vaccination is recommended every 3
years.
6. The vaccine is licensed for individuals aged 2 years. → It does not
elicit immune response in children < 2 years.
7. The vaccine is stable for 6 months at 37° C and for 2 years at 20°C.
The recommended storage temprature is 2-8°C.
8. The Vi polysaccharide vaccine can be co-administered with other
vaccines relevant for international travellers-such as yellow fever
and hepatitis A
9. Acyclovir is given to prevent the development of systemic disease in
 varicella infected immunosuppresed patients & can halt the
progression of zoster in adults.
Varicella zoster immunoglobulin given within 72 hrs of exposure can
prevent chicken pox and is recommended in exposed
immunocompromised persons.
A live attenuated varicella vaccine is recommended for children
between 12-18 months. It is effective even if given within 3-5 days
after exposure.
2.The Ty 21a oral vaccine
It is an orally administered, live attenuated Ty2 strain of S.Typhi in
which multiple genes (including for Vi Capsular polysaccharide)
have been mutated chemically.
This lyophilized vaccine is available in 2 preparations : ?
1. Enteric coated capsules → Used for travellers to developing
countries. It is used in individuals 5 years of age.
2.Liquid suspension → Used by public health programmes for young
children in developing countries. It can be administered from the age
of 2 years.
1. Vaccine is administered on 1, 3 and 5the day, i.e., a 3-dose regimen
medpox.com
is recommended.
2. Vaccine confers protection 7 days after the last dose.
3. The recommendation is to repeat this series (3 doses) every 3 years
for people living in endemic areas, and every year for individuals
travelling from non-endemic to endemic countries.
4. Ty 21 a requires storage at 2-8°C, it retains potency for
approximately 14 days at 25°C.
5. Proguanil and antibacterial drugs should be stopped from 3 days
before until 3 days after giving Ty 21 a, as these drugs may harm
live bacteria.
6. The vaccine is not efficacious if administered at the time of ongoing
diarrhea.
7. Avoided during diarrhoea as efficacy will reduce.
8. Can be given to HIV +ve, asymptomatic persons with CD4 cell count
of > 200/mm3
9. Well tolerated and has low rates of adverse events.
10. Not recommended in congenital or acquired immunodeficiency,
acute febrile illness, acute intestinal infection and in patients on
 antimitotic drugs
11. May be given simultaneously with live vaccines of polio, cholera,
yellow fever and MMR.

medpox.com
990. True about typhoid vaccines are all
except ?
a) Vi polysaccharide vaccine is given in single dose

b) Storage temperature is +2 to +8°C

c) Typhoral vaccine is given in 3 doses

d) Typhoral vaccine cannot be given with other live vaccines

Correct Answer - D
Ans. is 'd' i.e., Typhoral vaccine cannot be given with other live
vaccines
medpox.com
991. Rabies vaccine was first developed by ?
a) Robert Koch

b) Louis Pasteur

c) Edward Jenner

d) Loeffler

Correct Answer - B
Ans. is 'b' i.e., Louis pasteur
Louis pasteur is associated with :
Development of live vaccine (first was anthrax)
Development of vaccine for rabies (hydrophobia)
medpox.com
Introduction of technique of sterilization
Disprove the theory of spontaneous generation (abiogenesis)
Established the different growth need of different bacteria (helped in
complex media)
Coined the term vaccine
992. True about influenza ?
a) Incubation period 2-3 weeks

b) Most infections are subclinical

c) Type-A virus causes Reye's syndrome

d) Pandemic is caused by Type-B virus

Correct Answer - B
Ans. is 'b' i.e., Most infections are subclinical
Influenza
Influenza virus a RNA virus, belongs to orthomyxovirus.
There are three viral subtypes : i) Type A (causes all pandemics and
medpox.com
most epidemics); type B; and type C (not circulating currently).
Currently the influenza viruses circulating in the world are : 111 N, of
type A (causes swine flu); H2 N2 of type A; H3 N2 of type A ; H5 NI of
type A (causes birdflu or avian influenza); H7 N9 of type A (caused
epidemic of avian influenza in China in 2013); and type B.
Influenza shows cyclic trend with epidemic occuring every 2-3 years
in case of influenza - A and every 4-7 years in case of influenza-B.
Pandemics are caused by only influenza - A every 10-15 years.
Influenza affects all ages and both sexes.
Source of infection of influenza is a clinical case or subclinical case.
Major reservoir of influenza virus exists in animal and birds.
Incubation period is 18-72 hours. Most of the infections are
subclinical. Clinical cases present with cough, fever, myalgia and
headache.
993. Aedes aegypti index near ports should
be less than -
a) 1%

b) 5%

c) 8%

d) 10%

Correct Answer - A
Ans. is 'a' i.e., 1%
For the surveillance of Aedes mosquitoes, the WHO uses an index
known as Aedes aegypti index. medpox.com
This is a house index and is defined as "The percentage of houses
and their premises, in a limited well-defined area, showing actual
breeding of Aedes aegypti larvae".
This index should not be more than 1% in towns and seaports in
endeic areas to ensure freedom from yellow fever.
International health regulation for yellow fever
Measures designed to restrict the spread of yellow fever are
specified in the "International health regulation" of WHO.
These are implemented by the Govt of India through stringent aerial
and maritime traffic regulations.
Broadly these comprise : -
i) Travellers
All travellers (including infants) exposed to yellow fever or passing
through endemic zones of yellow fever must posses a valid
international certificate fo vaccination against yellow fever before
they are allowed to enter yellow fever receptive areas like India.
The validity of the certificate begins 10 days after the date of
vaccination and extends up to 10 years.
 Revaccination performed before the end of the validity of certicicate
renders the certificate valid for a further period of 10 years starting
on the day of revaccination.
If no such certificate fo vaccination is available, the travellar is
placed on quarantine for 6 days from the date of leaving an infected
area.
ii) Mosquitoes
The aircraft and ships arriving from endemic areas are subjected to
aerosol spraying with prescribed insecticides.
Airports and Seaports are kept free from the breeding of insect
vectors over an area extending at least 400 metres around their
perimeters.
The "aedes aegypti index" is kept below 1.

medpox.com
994. All are true regarding Japanese
encephalitis except ?
a) Caused by flavivirus

b) Humans are dead-end hosts

c) Transmitted by culex

d) Cattles are amplifier hosts

Correct Answer - D
Ans. is 'd' i.e., Cattles are amplifier hosts
Japanese encephalitis
medpox.com
Caused by a group B arbovirus (flavivirus)
It is a Zoonotic disease ie infecting mainly animals and incidentally
man.
In south, epidemics have occured in Karnataka, Andhra predesh,
TamilNadu, and Kerala.
Human, cattle, and horses are dead-end hosts as the disease
manifests as fatal encephalitis.
Pigs act as an amplifying host and have a very important role in the
epidemiology of the disease.
Infection in swine is asymptomatic, except in pregnant sows, when
abortion and fetal abnormalities are common sequelae.
The most important vector is Culex tritaeniorhynchus, which feeds
on cattle in preference to humans.
The natural hosts of the Japanese encephalitis virus are birds, not
humans.
In November 2011, the Japanese encephalitis virus was reported
in Culex bitaeniorhynchus in South Korea
995. Endemic typhus is transmitted by ?
a) Louse

b) Fleac

c) Tick

d) Mite

Correct Answer - B
Ans. is 'b' i.e., Flea

medpox.com
996. In calendar method of contraception,
first day of fertile period is?
a) 10th day of shortest menstural cycle

b) 18th day of shortest menstural cycle

c) 10th day of longest menstural cycle

d) 18th day of longest menstural cycle

Correct Answer - A
Ans. is 'a' i.e. 10th day of shortest menstural cycle
Safe Period (rhythm method)
medpox.com
This is also known as the calendar method first described by Ogino.
The method is based upon the fact that ovulation occurs from 12 to
16 days before the onset of mensturation.
Calculation is as follows :
The shortest cycle minus 18 days gives the first day of the fertile
period.
The longest cycle minus 10 days gives the last day of fertile period.
For example, if a woman's menstural cycle varies from 28-31 days,
the fertile period during which she should not have intercourse would
be from the 10th day to 21st day of the menstural cycle, counting
day one as the first day of the menstural period. Thus, the 1st day of
fertile period is 10th day of shortest cycle.
997. Billings method of contraception is
based on ?
a) Change in temperature

b) Change in cervical mucus

c) Safe period (calendar method)

d) Coitus interruptus

Correct Answer - B
Ans. is 'b' i.e., Change in cervical mucus

medpox.com
Miscellaneous methods of contraceptions
These are (i) Abstinence, (ii) Coitus interruptus, (iii) Safe period
(rhythm method), and (iv) Natural family planning methods.
Abstinence
There is complete abstinence from sexual intercourse. It is not used
and can hardly be considered as a method of contraception to be
advocated for the masses.
Coitus interruptus
It is the oldest method of voluntary fertility control. The male
withdraws before ejaculation and thereby tries to prevent the
deposition of semen into the vagina. The failure rate is very high at
25%.
Natural family planning methods
These are :?
Basal body temperature (BBT) method: It is based on the principle
that there is a rise BBT at or just before ovulation.
Cervical mucus method (Billings method or ovulation method) : It is
based on the observation that at the time of ovulation cervical mucus
becomes watery clear resembling raw egg white, smooth, slippery
and profuse.
and profuse.
Symptothermic method: This method combines temperature,
cervical mucus, and safe period (calendar method) methods.

medpox.com
998. Not a copper containing IUD ?
a) CuT-200

b) Nova -T

c) Multiload-250

d) LNG-20

Correct Answer - D
Ans. is `d i.e., LNG-20
LNG-20 is third generation IUD which does not contain cooper.
Other three options are 2"d generation (copper containing) IUDs.
medpox.com
 999. Absolute contraindication for insertion of
IUD
a) History of PID

b) Congenital uterine malformation

c) Undiagnosed vaginal bleeding

d) Purulent cervical discharge

Correct Answer - C
Ans. is 'c' i.e., Undiagnosed vaginal bleeding
Contraindications
ABSOLUTE: medpox.com
a. Suspected pregnancy
b. Pelvic inflammatory disease
c. Vaginal bleeding of undiagnosed etiology
d. Cancer of the cervix, uterus or adnexa and other pelvic tumours
e. Previous ectopic pregnancy
RELATIVE :
a. Anaemia
b. Menorrhagia
c. History of PID since last pregnancy
d. Purulent cervical discharge
e. Distortions of the uterine cavity due to congenital malformations,
fibroid
f. Unmotivated person
1000. Contraception with increased risk of
actinomycosis ?
a) OCPs

b) Condom

c) IUCD

d) Vaginal

Correct Answer - C
Ans. is `c' i.e., IUCD

medpox.com
1001. Pearls index?
a) Per 100 woman years

b) Per 10 woman years

c) Per 1000 woman years

d) Per 50 woman years

Correct Answer - A
Ans. is 'a' i.e., Per 100 woman years

medpox.com
1002. Iron content of MALA-D ?
a) 10 mg

b) 19-5 mg

c) 29.5 mg

d) 40 mg

Correct Answer - B
Ans. is 'b' i.e., 19-5 mg
MALA-D contains -
i) 30 ug (0.03 mg) of ethinyl estradiol.
ii) 0.15 mg of desogestrel (D-norgestrel).
medpox.com
Each brown coloured film coated tablet contains 60 mg ferrous
fumarate equivalent to ferrous iron 19.5 mg.
1003. Minimum number of ANC visits required
as per 2010 MOHFW (Ministry of Health
and Family Welfare) guidelines ?
a) 1

b) 2

c) 3

d) 4

Correct Answer - D
Ans. is 'd' i.e., 4 medpox.com
Now, at least 4 antenatal visits, during pregnancy, are
recommended.
1004. India belongs to which stage of the
demographic cycle ?
a) Slow stationary

b) High stationary

c) Early stationary

d) Late expanding

Correct Answer - D
Ans. is 'd' i.e., Late expanding
Demographic process
Fertility medpox.com
Mortality
Marriage
Migration
Social Mobility
Demographic cycle
Stage 1 : High stationary
High birth rate and high death rate render the population stationary.
Narrow demographic gap.
Stage 2 : Early expanding
Death rate declines and birth rate remains unchanged
The demographic gap starts increasing and then becomes maximum
Stage 3 : Late expanding
Death rate decline further and birth rate falls
India is in this stage, currently
The demographic gap starts declining
Stage 4 : Low stationary
Low birth rate and low death rate renders the population stationary
Narrow demographic gap
Stage 5 : Declining
Stage 5 : Declining
Population begins to decline as birth rate is lower than death rate
The demographic gap is negative

medpox.com
1005. Percentage of women 15-24 years age
group in India ?
a) 10%

b) 20%

c) 30%

d) 40%

Correct Answer - B
Ans. is 'b' i.e., 20%
In India percentage of women in 15-24 years age group.
medpox.com
1006. Least Neonatal mortality rate is seen in
-
a) Delhi

b) Tamil Nadu

c) Karnataka

d) Maharashtra

Correct Answer - B
Ans. is 'b' i.e., Tamil Nadu
Overall, least neonatal mortality is recorded in Kerala. However,
medpox.com
among the given options Tamilnadu has minimum neonatal
mortaltiy.
1007. Denominator in perinatal mortality rate
?
a) Total births

b) Total live births

c) Live births + Still birth

d) Total number of newborns

Correct Answer - B
Ans. is 'b' i.e., Total live births

medpox.com
1008. Current MMR in India is (per 1 lac live
births) ?
a) 400

b) 280

c) 180

d) 110

Correct Answer - C
Ans. is 'c' i.e., 180

medpox.com
 1009. In MCH programme, best indicator for
mother and child health ?
a) MMR

b) IMR

c) Still birth rate

d) Neonatal mortality rate

Correct Answer - B
Ans. is 'b' i.e., IMR
IMR is best indicator for:-
medpox.com
1. Health status of a community.
2. Level of living.
3. Effectiveness of MCH services.
IMR is second best indicator of socioeconomic status of country
(under 5 mortality rate is more refined indicator for socioeconomic
status).
 1010. Not a baby friendly hospital
recommendation ?
a) Breast feeding with half-hour of birth

b) Breast feeding on demand

c) Use of artificial teats when required

d) No oral feed other than breast milk

Correct Answer - C
Ans. is 'c' i.e., Use of artificial teats when required
Baby friendly hospital initiatives
medpox.com
Baby friendly hospital initiative (BFHI) was launched for promotion,
protection and support of breastfeeding.
It was launched by WHO and UNICEF.
BFHI has listed following ten steps, which the hospital must fulfill.
1. Have a written breastfeeding policy that is routinely communicated
to all health care staff
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of
breastfeeding.
4. Help mothers initiate berastfeeding within a half-hour of birth.
5. Show mothers how to breastfeed, and how to maintain lactation
even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breastmilk, unless
medically indicated.
7. Practice rooming-in-allow mothers and infants to remain together -
24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers)
to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer
mothers to them on discharge from the hospital or clinic.

medpox.com
1011. Average daily breast milk output during
first 6 months ?
a) 100-200 ml

b) 200-300 ml

c) 300-400 ml

d) 500-600 ml

Correct Answer - D
Ans. is 'd' i.e., 500-600 ml
Under normal conditions, Indian mothers secrete 450 - 600 ml of
milk daily medpox.com
Maximum output of milk is at 5 - 6 months (730 ml/ day) after which
the output constantly declines.
At 12 months the output is 525 ml/day -Park p. 455
1012. Protein content in F-75 milk formula ?
a) 0.5 gm per 100 ml

b) 0-9 gm per 100 ml

c) 1-5 gm per 100 ml

d) 2.0 gm per 100 ml

Correct Answer - B
Ans. is `b' i.e., 0.9 gm per 100 ml

medpox.com
1013. WHO defines adolescent age between ?
a) 10-19 years of age

b) 10-14 years of age

c) 10-25 years of age

d) 9-14 years of age

Correct Answer - A
Ans. is 'a' i.e., 10 - 19 Years of age

medpox.com
1014. Stage of contraction of family starts at ?
a) Marriage

b) Birth of first child

c) Birth of last child

d) Leaving home of first child

Correct Answer - D
Ans. is `d' i.e., Leaving home of first child

medpox.com
1015. Fluoride helps in ?
a) Vision

b) Dentition

c) Myelination

d) Joint stability

Correct Answer - B
Ans. is 'b' i.e., Dentition

medpox.com
1016. Recommended level of fluoride in
drinking water?
a) 0.2-0.5 mg/L

b) 0-5-0.8 mg/L

c) 0.8-1.2 mg/L

d) 1.2-2.0 mg/L

Correct Answer - B
Ans. is 'b' i.e., 0.5 - 0.8 mg/L
The recommended level of fluoride in drinking water in the country is
medpox.com
accepted as 0.5 to 0.8 mg/ Liter. -Park
Maximum permissible limit is 1.5 mg/Lit.
1017. Dental fluorosis occurs if fluoride level
is more than
a) 0 5 mg/dl
.

b) 1-5 mg/dl

c) 3 mg/dl

d) 6 mg/dl

Correct Answer - B
Ans. is 'b' i.e., 1-5 mg/dl
Dental fluorosis → > 1.5 mg/L (PPM)
medpox.com
Skeletal fluorosis → 3-6 mg/L (PPM)
Crippling fluorosis → > 10 mg/L (PPM)

1018. Neurolathyrism is due to ?
a) Argemone oil

b) Jhunjhunia

c) Khesari dal

d) None

Correct Answer - C
Ans. is 'c' i.e., Khesari dal

medpox.com
 1019. Recommended daily dietary requirment
of folate (folic acid) in children ?
a) 80-120 μg

b) 200 μg

c) 400 μg

d) 600 μg

Correct Answer - A
Ans. is 'a' i.e., 80-120 μg
Recommended daily allowances of folic acid are:-
medpox.com
a. Healthy adults → 200 micro gm.(mcg)
b. Pregnancy → 500 mcg
c. Lactation → 300 mcg
d. Children → 80-120 mcg
1020. Extra energy, needed per day during
pregnancy?
a) 150 Kcal

b) 200 Kcal

c) 300 Kcal

d) 350 Kcal

Correct Answer - D
Ans. is 'd' i.e., 350 Kcal

medpox.com
1021. Recommended content of Iodine in salt
at production level ?
a) 10 ppm

b) 15 ppm

c) 20 ppm

d) 30 ppm

Correct Answer - D
Ans. is 'd' i.e., 30 ppm
Goitre control
medpox.com
There are following essential components of national goitre control
programme.
1. Iodized salt
The iodization of salt is now the most widely used prophylactic public
health measure against endemic goitre.
In India the level of iodization is fixed under the Prevention of food
adulteration (PFA) act and is not less than 30 ppm at the production
point and not less than 15 ppm of iodine at the consumer level.
Iodized salt is most economical, convenient and effective means of
mass prophylaxis in endemic areas.
Recently the National institure of Nutrition at Hyderabad has come
out with a new product, common salt fortified with iron and iodine —
> two in one salt (twin fortified salt or double fortified salt).
Iodized oil --> It is another effective method for controlling goitre. IM
injection of iodized oil (mostly poppy seed oil) is given. An average
dose of 1 ml will provide protection for 4 years.
2. Iodine monitoring
Neonatal hypothyroidism is a sensitive pointer to environmental
iodine deficiency and can thus be an effective indicator for
monitoring the impact of a programme.
3. Manpower training
4. Mass communication
"The WHO regional strategy for the control of IDD has its principal
objective the reduction of prevalence of goitre in areas of endemicity
to 10% or below by the year 2000".

medpox.com
1022. Pulses contain all except ?
a) Lysine

b) Cystein

c) Arginin

d) Protein

Correct Answer - B
Ans. is `b' i.e., Cystein
Pulses
Pulses comprise a variety of grams, also known as dhal.
Pulses contain 20 to 25% of protein, which is double that found in
medpox.com
wheat and three times that found in Rice.
In fact, pulses contain more protein than eggs, fish or flesh food. But
in regard to quality, pulse proteins are inferior to animal proteins.
Pulse proteins are poor in methionine and to a lesser extent of
cystein.
On the other hand pulse proteins are rich in lysine.
Soyabeam is exceptionally rich in protein.
Pulses are rich in minerals and B-group vitamins such as riboflavin
and thiamin.
In dry state pulses do not contain vitamin 'C'. However, Germinating
pulses contain higher concentration of vitamin 'C' and 'B' vitamins.
Fermentation also modifies the nutritive value of pulses in that
vitamin content of riboflavin, thiamine and niacin is enhanced.
Pulse are called "poor man's meat".
1023. Amino acid deficient in both Wheat and
Maize ?
a) Lysine

b) Threonine

c) Tryptophan

d) Methionine

Correct Answer - A
Ans. is 'a' i.e., Lysine
Wheat
medpox.com
Next to rice, wheat is the most important cereal.
The limiting amino acids in wheat proteins are lysine and threonine.
1024. Good sources of vitamin 'C' are all
except ?
a) Amala

b) Lime

c) Guava

d) Egg

Correct Answer - D
Ans. is 'd' i.e., Egg
Vitamin C
Also known as ascorbic acid. medpox.com
It is the most sensitive of all vitamins to heat.
Man, monkey and guinea pigs are the perhaps the only species
known to require vitamin 'C' in their diet.
The richest source of vitamin C is Indian goosebery (Amla).
Important sources of vitamin C in decreasing order : ?
Amla > Guava > Cabbage > Amaranth > Lime > Cauliflower >
Orange > Spinach > Tomato > Potato
1025. Maximum protein is found in ?
a) Egg

b) Soyabean

c) Rice

d) Wheat

Correct Answer - B
Ans. is 'b' i.e., Soyabean

medpox.com
1026. Protein content in 100 grams of cow
milk
a) 4.3

b) 3.2

c) 2.2

d) 1.2

Correct Answer - B
Ans. is 'b' i.e., 3.2

medpox.com
1027. True about Indian reference female
a) Height 161 cm

b) Weight 60 kg.

c) BMI 22

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Height 161 cm
Reference man and woman
Energy intake recommendations are formulated for a "reference
man" and a "reference woman" whose profiles are described, and
medpox.com
then necessary adjustment are made for subjects deviate from he
standard reference.
1.Indian reference man
He is between 18-29 years of age.
He weights 60 kg.
His height is 1.73 meter and BMI is 20.3
He is free from disease and physically fit for active work.
On each working day he is employed for 8 hours in occupation that
usually involves moderate activity.
Spends 8 hours in bed, 4 to 6 hours sitting and moving around and 2
hours in walking and in active recreation or household duties.
2.An Indian reference woman
She is between 18-29 years of age
She weights 55 kg.
Her height is 1.61 meter and BMI is 21.2
She is engaged for 8 hours in houshold work, in light industry or in
other moderate activity.
Spends 8 hours in bed, 4 to 6 hours sitting and moving around and 2
hours in walking and in active recreation or household duties.

medpox.com
1028. Weight of an indian reference woman is
?
a) 45 kg

b) 50 kg

c) 55 kg

d) 60 kg

Correct Answer - C
Ans. is 'c' i.e., 55 kg

medpox.com
1029. RDA of vitamin A in an adolescent
female ?
a) 400 mcg

b) 350 mcg

c) 600 mcg

d) 800 mcg

Correct Answer - C
Ans. is 'c' i.e., 600 mcg

medpox.com
1030. First ocular sign of Vitamin A deficiency
?
a) Bitot's spot

b) Conjunctival xerosis

c) Night blindness

d) Keratomalacia

Correct Answer - B
Ans. is 'b' i.e., Conjunctival xerosis

medpox.com
1031. Iodized salt is given to prevent goitre to
?
a) All population

b) Population of Himalayan belt

c) Population of Hilly areas

d) Population of village area

Correct Answer - A
Ans. is 'a' i.e., All population
In India, the entire population is prone to IDD due to deficiency of
medpox.com
iodine in the soil of the subcontinent consequently the food derived
from it.
The iodization of salt is now the most widely used prophylactic public
health measure against endemic goitre.
In India the level of iodization is fixed under the Prevention of food
adulteration (PFA) act and is not less than 30 ppm at the production
point and not less than 15 ppm of iodine at the consumer level.
1032. Protein requirement in adult male ?
a) 0.5 gm/kg/day

b) 1 gm/kg/day

c) 1.5 gm/kg/day

d) 2 gm/kg/day

Correct Answer - B
Ans. is 'b' i.e., 1 gm/kg/day

medpox.com
1033. Nutrient which is lost maximum in
polished rice?
a) Proteins

b) Thiamine

c) Ascorbic acid

d) Calcitriol

Correct Answer - B
Ans. is 'b' i.e., Thiamine
Effect of milling on rice
medpox.com
The milling process deprives the rice grain of its valuable nutritive
elements
1034. Zinc supplement given in 12 month
baby -
a) lgm/day

b) 10 mg/day

c) 5 mg/day

d) 15 mg/day

Correct Answer - C
Ans. is 'c' i.e., 5 mg/day
The requirements for infants range between 3.5 - 5.0 mg/day.
medpox.com
1035. RDA of zinc in a child ?
a) 10 mg

b) 20 mg

c) 6-8 mg

d) 4-5 mg

Correct Answer - C
Ans. is 'c' i.e., 6-8 mg
RDA of Zinc in children
1 - 3 years —> 3mg
4 - 8 years -5 5 mg
medpox.com
9 years and above (male) —> 8 - 11 mg
9 years and above (female) --> 8 mg
1036. Biological value of protein is
a) Increase in weight per unit protein consumed

b) Percentage of ingested protein retained inside the body

c) Percentage of absorbed nitrogen retained

d) Percentage of energy provided by a protein of food

Correct Answer - C
Ans. is 'c' i.e., Percentage of absorbed nitrogen retained
Assessment of proteins
Protein can be assessed qualitatively or quantitatively:?
1) Protein quantity medpox.com
It is assessed by the protein-energy ratio.
2) Protein quality
It is assessed by amino-acid score, biological value, net protein
utilization, protein efficiency ratio, and protein digestibility corrected
amino acid score.
Protein energy Ratio (Protein-energy percentage)
It is a quantitative measure for assessment of protein.
It measures the percentage of energy that is provided by the protein
in the food.
 1037. Breast milk is deficient in which vitamin
a) Vitamin A

b) Vitamin B1

c) Vitamin K

d) Vitamin C

Correct Answer - C
Ans. is 'c' i.e., Vitamin K
Exclusive breasfed infants may have following deficiencies -
1. Vit B12 (if mother is strict vegetarian)
2. Fluoride medpox.com
3. Vit D
4. Vit K
"Breastfed infants are protected as the breastmilk contains adequate
amounts of vitamin C, except when the mother is deficient in Vitamin
C".
1038. Disease associated with excessive
maize diet ?
a) Wernicke's encephalopathy

b) Pellagra

c) Beri-Beri

d) Scurvy

Correct Answer - B
Ans. is 'b' i.e., Pellagra
Excess of Leucine interferes in conversion of Tryptophan into Niacin,
medpox.com
and aggravates the pallagrogenic action of maize.
Similar to maize, Jowar also contains excess of leucine.
Leucine interferes with conversion of tryptophan to niacin.
Pellagra has been reported in India in Telangana area of Andhra
Pradesh because of Jower (Sorghum vulgare) consumption.
 1039. ICDS meals for pregnant women
provides ?
a) 300 calories & 10 grams protein

b) 500 calories & 15 grams protein

c) 600 calories & 10 grams protein

d) 600 calories & 20 grams protein

Correct Answer - D
Ans. is d i.e., 600 calories & 20 grams protein
Under ICDS Scheme supplementary nutrition is given to:
Children below 6 yrs medpox.com
Nursing mothers
Expectant mothers
The aim is to supplement nutritional intake for
1. Each child 6-72 months of age 500 calories and 12-15 grams of
protein (financial norm of Rs 6.00 per child per day).
2. Severely malnourished child 6-72 months of age → 800 calories and
20-25 grams protein (financial norm of Rs 6.00 per child per day).
3. Each pregnant and nursing woman → 600 calories and 18-20 grams
of protein (financial norm of Rs 5.00 per beneficiary per day).
Under the revised nutritional and feeding norms for supplementary
nutrition, State goverments/UTs have been mandated to provide
more than one meal to the children who come to AWCs, which
include providing a morning snack in the form of
milk/banana/egg/seasonal fruit/micronutrient fortified food followed
by a hot cooked meal. For children below 3 years of age and
pregnant & lactating mothers, "take home ration" is to be provided.
Supplementary nutrition is given for 300 days a year.
1040. Mid-day meals provided in schools
provide ?
a) 1/2 of total calories & 1/2 of protein

b) 1/3 of total calories & 1/2 of protein

c) 1/2 of total calories & 1/3 of protein

d) 1/3 of total calories & 1/4 of protein

Correct Answer - B
Ans. is `b' i.e., 1/3rd of total calories & 1/2 of daily protein
requirement
medpox.com
 1041. Vitamin deficient in Famines ?
a) A

b) D

c) B12

d) B6

Correct Answer - A
Ans. is 'a' i.e.,A [Ref Food scarcity and Famine p. 100]
In times of food scarcity and famine, the most important deficiency
disease is xerophthalmia (vitamin A deficiency), which can cause
medpox.com
permanent blindness and may also contribute to increased
incidence, severity and duration of infectious diseases like measles,
diarrhea and respiratory tract infection.
Where people are totally dependent on food aid rations, other
deficiency diseases may also develop :-
1. Scurvy (Vitamin C deficiency)
2. Pellagra (Niacin deficiency)
3. Nutritional anemia (Iron or folic acid deficiency)
1042. Under MCH programme, adult IFA tablet
contains ?
a) 100 mg elemental iron and 0.1 mg FA

b) 100 mg elemental iron and 0.5 mg FA

c) 20 mg elemental iron and 0.1 mg FA

d) 20 mg elemental iron and 0-5 mg FA

Correct Answer - B
Ans. is 'b' i.e., 100 mg elemental iron and 0.5 mg FA
Iron and Folic Acid content per IFA tablet:
medpox.com
Adult tablet: 100 mg elemental iron and 500 mcg folic acid
Pediatric tablet: 20 mg elemental iron and 100 mcg folic acid
For preterm infants, recommended Iron and Folic Acid content per
IFA tablet:
Pediatric tablet: 10 — 15 mg elemental iron and 100 mcg folic acid.
1043. Kala-azar is transmitted by ?
a) Reduvid bug

b) Sandfly

c) Tsetse fly

d) Mosquito

Correct Answer - B
Ans. is 'b' i.e., Sandfly

medpox.com
1044. Vector for transmission of sleeping
sickness ?
a) Sandfly

b) Black fly

c) Tse-tse fly

d) Hard tick

Correct Answer - C
Ans. is 'c' i.e., Tse-tse fly

medpox.com
1045. Vagabond disease is transmitted by ?
a) Louse

b) Mite

c) Tick

d) Black Fly

Correct Answer - A
Ans. is 'a' i.e., Louse
Vagabond's disease is pediculosis corporis, caused by body louse.

medpox.com
1046. Which stage of larva of housefly is
voracious feeder -
a) 1

b) 2

c) 3

d) 4

Correct Answer - A
Ans. is 'a' i.e., 1
The larva of housefly (maggot) moults twice, i.e. there are three
instar stages. medpox.com
The first instar larva is a varacious feeder, feeding mainly on
decomposing liquid organic matter.
1047. False regarding larvae of anopheles ?
a) Long siphon tube

b) Parallel to water

c) Palmate hairs

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Long siphon tube

medpox.com
1048. Virus not sensitive to disinfection by
chlorination
a) Rotavirus

b) Norwalk virus

c) Poliovirus

d) None

Correct Answer - C
Ans. is 'c' i.e., Poliovirus
Chlorination
medpox.com
Chlorination is one of the greatest advances in water purification.
Chlorine kills pathogenic bacteria, but has no effect on spores,
certain viruses (e.g., polio, viral hepatitis) and cyst of E.histolytica, in
usual doses.
Mechanism of action
When chlorine is added to water, there is the formation of
hypochloric and hypochlorous acid
The hypochloric acid is neutralized by the alkalinity of the water.
The hypochlorous acid ionizes to form hydrogen ions and
hypochlorite ions.
The disinfecting action of chlorine is mainly due to the hypochlorous
acid and to a small extent due to the hypochlorite ions.
The hypochlorous acid is the most effective form of chlorine for
water disinfection, it is 70-80 times more effective than hypochlorite
ion.
1049. Human anatomical wastes are
treated/disposed by ?
a) Autoclaving

b) Chemical disinfection

c) Incineration

d) Microwaving

Correct Answer - C
Ans. is 'c' i.e., Incineration
Human anatomical wastes such as human tissues, organs, and
medpox.com
body parts are classified as Waste Category No. I They are
disposed in 'plastic bags' with a 'yellow color code' and treated by
'Incineration or deep burial'.
1050. Level of Hardness if the value is 50-150
mg/L ?
a) Soft water

b) Moderately hard water

c) Hard water

d) Very hard water

Correct Answer - B
Ans. is 'b' i.e., Moterately hard water

medpox.com
1051. Cytotoxic drugs are treated/disposed by
?
a) Autoclaving

b) Chemical disinfection

c) Incineration

d) Microwaving

Correct Answer - C
Ans. is 'c' i.e., Incineration
Cytotoxic drugs are category No. 5 wastes which are destroyed by
medpox.com
incineration and disposed by secured landfills.
1052. Yellow bag is used for -
a) Waste sharp

b) Cytotoxic drugs

c) Animal waste

d) Chemical waste

Correct Answer - C
Ans. is 'c' i.e., Animal waste

medpox.com
1053. Incineration is done for waste category
?
a) Category 7

b) Category 9

c) Category 6

d) Category 5

Correct Answer - C
Ans. is 'c' i.e., Category 6

medpox.com
 1054. Best way to dispose e-waste is?
a) Burning

b) Incineration

c) In a landfill

d) Recycling

Correct Answer - D
Ans. is 'd' i.e., Recycling
E-Waste
E-waste is a popular, informal name for electronic products nearing
the end of their "useful life. medpox.com
"E-wastes are considered dangerous, as certain components of
some electronics products contain materials that are hazardous,
depending on their condition and density.
The hazardous content of these materials pose a threat to human
health and environment.
Discarded computers, television, VCRs, stereos, copiers, fax
machines, electric lamps, cell phones, audio equiopment and
batteries if improperly disposed can leach lead and other substances
into soil and groundwater.
Many of these products can be reused, refurbished, or recycled, or
recyled in an environmentally sound manner so that they are less
harmful to the ecosystem.
Managment of E-Waste
In industries management of e-waste should begin at the point of
generation. This can be done by waste minimization techniques and
by sustainable product design. Waste minimization in industries
involves adopting:
1. inventory management,
2. production-process modification,
3. volume reduction,
4. recovery and reuse
Inventory management
Proper control over the materials used in the manufacturing process
is an important way to reduce waste generation.
By reducing both the quantity of hazardous materials used in the
process and the amount of excess raw materials in stock, the
quantity of waste generated can be reduced.
Developing review procedures for all material purchased is the first
stop in establishing an inventory management program.
Another inventory management procedure for waste reduction is to
ensure that only the needed quantity of a material is ordered.
Production-process modification
Changes cna be made in the production process, which will reduce
waste generation.
This reduction can be accomplished by changing the materials used
to make the product or by the more efficient use of input materials in
the production process or both.
medpox.com
Volume reduction
Volume reduction includes those techniques that remove the
hazardous portion of a waste from a non-hazardous portion.
These techniques are usually to reduce the volume, and thus the
cost of disposing of a waste material.
Recovery and reuse
This technique could eliminate waste disposal costs, reduce raw
material costs and provide income from a salable waste.
Waste can be recovered on-site, or at an off-site recovery facility, or
through inter industry exchange.
1055. Most common cancer in males in India
?
a) Ca rectum

b) Ca oral cavity

c) Ca testis

d) Ca bladder

Correct Answer - B
Ans. is 'b' i.e., Ca oral cavity
Most common cancer in males in India : Lip/oral cavity
medpox.com
1056. Blindness criteria in India ?
a) Vision < 3/60

b) Vision < 6/60

c) Vision < 12/60

d) Vision < 18/60

Correct Answer - B
Ans. is 'b' i.e., Vision < 6/60
National programme for control of blindness (NPCB), India defines
blindness as visual acuity of < 6/60 in better eve with best possible
correction In contrast to WHO, which defines blindness as visual
medpox.com
acuity of < 3/60).
1057. Goal of NPCB was to reduce prevalence
of blindness to ?
a) < 0.3% by 2000

b) < 0.3% by 2005

c) < 0.5% by 2010

d) < 0.5% by 2015

Correct Answer - A
Ans. is 'a' i.e., < 0.3% by 2000
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS
medpox.com
(NPCB)
The national program for Control of Blindness (NPCB) has
been re-designated recently as the National Programme for
Control of Blindness and Visual Impairment
Launched in 1976
Its objective is to reduce the prevalence of eye diseases in general,
and the prevalence of blindness from 1.40% to 0.3% by 2000 AD.
Apex Centre (National Eye Institute) is
Dr. Rajendra Prasad Centre for Ophthalmic Sciences (New Delhi,
AIIMS).
Revised strategies of NPCB
a) To make NPCB more comprehensive by strengthening services
for other causes of blindness like corneal blindness(requiring
transplantation of donated eyes), refractive errors in school-going
children, improving follow-up services of cataract operated persons
and treating other causes of blindness like glaucoma; To shift from
the eye camp approach to a fixed facility surgical approach and from
conventional surgery to IOL implantation for better quality of post-
operative vision in operated patients.
b) To expand the World Bank project activities like construction of
dedicated eye operation theatres, eye wards at the district level,
training of eye surgeons in modern cataract surgery and other eye
surgeries and supply of ophthalmic equipment, etc. to the whole
country.
c) To strengthen the participation of Voluntary Organizations in the
program and to earmark geographic areas to NGOs and
Government Hospitals to avoid duplication of effort and improve the
performance of Government Units like Medical Colleges, District
Hospitals, Sub Divisional Hospitals, Community Health Centres,
Primary Health Centres.
d) To enhance the coverage of eye care services in tribal and other
under-served areas through the identification of bilateral blind
patients, preparation of village-wise blind register and giving
preference to bilateral blind patients for cataract surgery.

medpox.com
1058. Revised strategy for NPCB includes all
except ?
a) Fixed facility surgery

b) IOL implantation for cataract

c) Mobile surgical camps

d) Uniform distribution

Correct Answer - C
Ans. is 'c' i.e. Mobile surgical camps
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS
(NPCB) medpox.com
The national program for Control of Blindness (NPCB) has been re-
designated recently as the National Programme for Control of
Blindness and Visual Impairment
Launched in 1976,
It is a 100% centrally sponsored scheme.
Its objective is to reduce the prevalence of eye diseases in general,
and the prevalence of blindness from 1.40% to 0.3% by 2000 AD.
Apex Centre (National Eye Institute) is
Dr. Rajendra Prasad Centre for Ophthalmic Sciences (New Delhi,
AIIMS).
Revised strategies of NPCB
a) To make NPCB more comprehensive by strengthening services
for other causes of blindness like corneal blindness(requiring
transplantation of donated eyes), refractive errors in school-going
children, improving follow-up services of cataract operated persons
and treating other causes of blindness like glaucoma; To shift from
the eye camp approach to a fixed facility surgical approach and from
conventional surgery to IOL implantation for better quality of post-
operative vision in operated patients.
operative vision in operated patients.
b) To expand the World Bank project activities like construction of
dedicated eye operation theatres, eye wards at the district level,
training of eye surgeons in modern cataract surgery and other eye
surgeries and supply of ophthalmic equipment, etc. to the whole
country.
c) To strengthen the participation of Voluntary Organizations in the
program and to earmark geographic areas to NGOs and
Government Hospitals to avoid duplication of effort and improve the
performance of Government Units like Medical Colleges, District
Hospitals, Sub Divisional Hospitals, Community Health Centres,
Primary Health Centres.
d) To enhance the coverage of eye care services in tribal and other
under-served areas (uniform distribution) through the identification of
bilateral blind patients, preparation of village-wise blind register and
giving preference to bilateral blind patients for cataract surgery.

medpox.com
1059. The most common cause of blindness
in India is ?
a) Cataract

b) Trachoma

c) Refractive errors

d) Vitamin A deficiency

Correct Answer - A
Ans. is 'a' i.e., Cataract

medpox.com
1060. Under National Cancer control
Programme, oncology wings were
sanctioned to -
a) Regional Cancer institutes

b) District Hospitals

c) Medical college Hospitals

d) Voluntary Agenecies treating cancer patients

Correct Answer - C
Ans. is 'c' i.e., Medical college Hospital
medpox.com
o Government hospital and government medical colleges are
provided with a grant of Rs 3.00 crores for the development of
oncology wing.
 1061. RCH-II major strategies are all except ?
a) Essential obstetric care

b) Emergency obstetric care

c) Family planning

d) Strengthening referral system

Correct Answer - C
Ans. is 'c' i.e., Family planning
4 components of RCH programme are (i) Family planning; (ii) Child
survival and safe motherhood; (iii) Client approach to health care,
and (iv) Prevention of RTI/STD/AIDS.
medpox.com
Reproductive and Child health Programme
RCH programme was launched in October 1997.
Reproductive and child health approach has been defined as : -
1. People have the ability to reproduce and regulate their fertility.
2. Women are able to go through pregnancy and child birth safety.
3. The Outcome of pregnancies is successful in terms of maternal and
infant survival and well being.
Couples are able to have sexual relations free of fear of pregnancy
and of contracting disease.
RCH phase I programme incorporated the following components.
1062. A problem village is one where ?
a) Source of water > 1.6 km away

b) Water available > 15 meters depth

c) Excess of fluoride in water

d) All of the above

Correct Answer - D
Ans. is `d' i.e., All of the above
A problem village has been defined as one
Where no source of safe water is available within a distance of 1.6
km, or medpox.com
Where water is available at a depth of more than 15 meters, or
Where water source has excess salinity, iron, fluorides and other
toxic elements, or
Where water is exposed to the risk of cholera.
1063. Mental health programme was started
in?
a) 1982

b) 1987

c) 1990

d) 1995

Correct Answer - A
Ans. is 'a' i.e., 1982
The Government of India has launched the National Mental Health
Programme (NMHP) in 1982. medpox.com
Also know
Mental health act was started in 1987.
1064. Most common type of mental
retardation ?
a) Mild

b) Moderate

c) Severe

d) Profound

Correct Answer - A
Ans. is 'a' i.e., Mild

medpox.com
 1065. Basic laboratory service is not available
at PHC for which disease ?
a) TB

b) Malaria

c) Syphilis

d) Leprosy

Correct Answer - D
Ans. is 'd' i.e., Leprosy
Basic laboratory services at PHC
medpox.com
i. Routine urine, stool and blood tests.
ii. Bleeding time, clotting time.
iii. Diagnosis of RT1/STDs with wet mounting, Grama stain, etc.
iv. Sputum testing for tuberculosis (if designated as a microscopy
center under RNTCP).
v. Blood smear examination for malarial parasite.
vi. Rapid tests for pregnancy.
vii. RPR test for Syphilis/YAWS surveillance.
viii. Rapid diagnostic tests for typhoid (Typhi Dot) and malaria.
ix. Raid test kit for faecal contamination of water.
x. Estimation of chlorine level of water using orthotoludine reagent.
 1066. Most important measure to prevent
hospital infection ?
a) Use of antibiotics

b) Use of antiseptics

c) Proper hand washing

d) Formalin fumigation

Correct Answer - C
Ans. is 'c' i.e., Proper hand washing
There are following types of modes of transmission of hospital-
acquired infections : medpox.com
1) Contact transmission
i. It is the most common and most preventable means of transmission.
It is divided into two types -
ii. Direct contact : It involves contact of body surface to body surface
with a physical transfer of microorganisms. Hand contact is most
common mode of transmission.
iii. Indirect contact : It involves body surface contact with a
contaminated intermediate object.
As hand contact is the most common mode of transmission, the best
preventive measure of nosocomial infection is proper hand hygiene.
2) Droplet transmission
It occurs when droplet containing microorganisms from an infected
person are propelled through the air (e.g. coughing, sneezing) and
land on the mouth, eyes or nose of another person.
3) Airborne transmission
It results when a droplet containing microorganisms evaporates and
remains suspended in air for a long time (this should not be
confused with droplet infection, in which transmission is immediate
and droplets do not remains suspended in the air).
Airborne transmission also occurs by dust particles containing
microorganism.
4) Vehicle transmission
It refers to transmission of infection by contaminated items such as
food, water, medications, devices and equipment.

medpox.com
1067. True about critical path method are all
except
a) Network analysis

b) Longest path

c) Cannot be delayed

d) Shortest path

Correct Answer - D
Ans. is 'd' i.e., Shortest path
Network analysis
medpox.com
A network analysis is a graphic of all events and activities to be
completed in order to reach an end objective. It brings greater
discipline in planning. The two common types of network technique
are :
a) Programme Evaluation and Review technique (PERT)
b) Critical Path method (CPM)
Programme Evaluation and Review technique (PERT)
PERT is a management technique which makes possible more
detailed planing and more comprehensive supervision.
PERT is method to analyze the involved tasks in completing a given
project, especially the time needed to complete each task, and
identifying the minimum time needed to complete the total project.
The essence of PERT is to construct an arrow diagram, which
represents the logical sequence in which events must take place. It
is possible with such a diagram to calculate the time by which each
activity must be completed, and to identify those activities that are
critical.
Critical path method (CPM)
The longest path of the network is called the critical path. Critical
path method determines the activities of a project which are critical
and are given longest path. Other activities are total float, i.e. they
can be delayed without making the project longer. Any delay in
activity on the critical path results in delay of the project. o In the
above figure, the longest path is from equipment ordered to
equipment installed.
That means, this is the critical path and installating of equiment is
the most critical step (taking 10 months). o Other activities are total
float, i.e. they can be delayed for sometimes without delaying the
project.

medpox.com
 1068. NFHS-3 was conducted in ?
a) 1992-93

b) 1998-99

c) 2005-06

d) 2009-10

Correct Answer - C
Ans. is 'c' i.e., 2005-06
National family health survey (NFHS)
Is a large-scale, multi-round survey conducted in a representative
sample of households throughout India.
medpox.com
3 rounds of the survey have been conducted till date.
1. NFHS-1: 1992-93
2. NFHS-2: 1998-99
3. NFHS-3: 2005-06
Goals of NFHS survey:
1. To provide essential data needed by Ministry of Health & Family
Welfare and other agencies for policy and programme purposes
2. To provide information on important emerging health and family
welfare issues
Few key findings of NFHS-3, India (2005-06)
1. Literacy rate : Male - 83%, Female - 59%.
2. IMR : 57 per 1000 live births.
3. TFR : 2.6
4. Contraceptive prevalence : 56% (Sterilization 37%)
5. 3 AN check ups : 51%.
6. Took IFA : 65% (Took IFA for 90 days) or more : 23%.
7. Received > 2 TT injections : 76%
8. Institutional deliveries : 41%
 9. Delivery assisted by health professionals : 48%.
10. Delivery conducted by a skilled provider : 47%.
11. Anemia - children : 79%
12. Anemia - pregnancy : 58%
13. Women experienced domestic violence : 37%

medpox.com
 1069. All are components of 'Health for all'
except ?
a) Adequacy

b) Acceptibility

c) Equity

d) Resource allocation

Correct Answer - D
Ans. is 'd' i.e., Resource allocation
Health for All
medpox.com
Health for all' is defined as "attainment of a level of health that will
enable every individual to lead a socially and economically
productive life".
The fundamental principle of HFA strategy is equity, that is, an
equal, health status for people and countries, ensured by an
equitable distribution of health resources.
The best approach to achieve the goal for HFA is by providing
primary health care.
At least essential health care should be accessible to all individuals
in an acceptable and affordable way.
The seven principles of health for all outline by WHO
i. The right to health
ii. Health promotion
iii. Equity in health ( equitable distribution)
iv. Primary health care
v. Community participation
vi. Intersectoral cooporation
vii. Intersectoral collaboration
Primary health care (PHC) is one of the most important component.
The basic requirments for PHC are (8A's and 3C's) -
The basic requirments for PHC are (8A's and 3C's) -
Appropriateness
Availability
Adequacy
Accessibility
Acceptibility
Affordability
Assessability
Accountability
Completeness
Comprehensiveness
Continuity

medpox.com
 1070. "3 by 5" initiative in AIDS control
programme is ?
a) Providing 3 million people treatment by end of 2005

b) Providing treatment to 3 out of 5 patients

c) Reducing incidence of AIDS by 3% by 2005

d) All of the above

Correct Answer - A
Ans. is 'a' i.e., Providing 3 million people treatment by end of
2005
3 by 5 target medpox.com
On 1st December 2003, WHO and UNAIDS announced a detailed
plan to reach the "3 by 5 target" of providing antiretroviral treatment
(ART) to three million people living with HIV/AIDS in the developing
countries by the end of 2005.
Ultimate goal of this strategy is to provide universal access to ART
to anyone who needs it.
It has five Pillars (focus areas of concerns) :?
1. Simplified standard tools to deliver ART
2. A new service to ensure effective, reliable supply of medicines and
diagnostics
3. Dissemination and application of new knowledge and successful
strategy
4. Urgent, sustained support to countries
5. Global leadership, backed by strong partnership
1071. Impact indicator for ASHA ?
a) Number of ASHA trained

b) Infant mortality rate

c) % of institutional deliveries

d) % of JSY claims made to ASHA

Correct Answer - B
Ans. is 'b' i.e., Infant mortality rate
Monitoring and Evaluation of ASHA's work
Government of India has set up following indicators for monitoring
ASHA (41). medpox.com
1.Process Indicators
a) Number of ASHAs selected by due process
b) Number of ASHAs trained; and
c) % of ASHAs attending review meeting after one year
2.Outcome Indicators
a) % of newborn who were weighed and families counseled.
b) % of children with diarrhoea who received ORS.
c) % of deliveries with skilled assistance.
d) % of institutional deliveries.
e) % of JSY claims made to ASHA
f) % of completely immunized in 12 to 23 months age group.
g) % of unmet need for spacing contraception among BPL.
h) % of fever cases who received chloroquine with in first week in a
malaria endemic area.
3.Impact Indicators
a) IMR
b) Child malnutrition rates
c) Number of cases of TB/leprosy detected as compared to previous
year.
year.

medpox.com
1072. Ujjwala scheme does not include ?
a) Rescue

b) Rehabilitation

c) Reintegration

d) Reward

Correct Answer - D
Ans. is `d' i.e., Reward

medpox.com
1073. Byssinosis is due to exposure of ?
a) Coal dust

b) Cotton dust

c) Sugarcane dust

d) Silica

Correct Answer - B
Ans. is 'b' i.e., Cotton dust
Byssinosis is due to exposure to cotton dust in textile industries.

medpox.com
1074. Which of the following is used to
represent continuous (quantitative) data
?
a) Bar diagram

b) Pie chart

c) Histogram

d) Map diagram

Correct Answer - C
Ans. is `c' i.e., Histogram medpox.com
1075. Which is best to represent the data of
following table -
Year 1991 199219931994
Number 75 125 50 25
of LBW
bodies

a) Bar chart

b) Histogram

c) Frequency polygone

d) Scatter diagram

medpox.com
Correct Answer - A
Ans. is 'a' i.e.,Bar chart
We can plot the low birth statistics of a hospital on Bar chart,
histogram or frequency polygon depending on what type of data we
want.
To know the total number of LBW neonates in different years and
compare the frequencies Bar chart.
To know the number of LBW neonates in different range of weights
at a given time -) Histogram or frequency polygone.
1076. Test used to assess quantitative
observations before and after an
intervention ?
a) Unpaired T-test

b) Paired T-test

c) Chi-square test

d) Fisher-T-test

Correct Answer - B
Ans. is 'b' i.e., Paired T-test
medpox.com
A paired t-test is used to compare two population means where
you have two samples in which observations in one sample can
be paired with observations in the other sample
this might occur in:
• Before-and-after observations on the same subjects (e.g.
students’ diagnostic test results before and after a particular
module or course).
• A comparison of two different methods of measurement or
two different treat
ments where the measurements/treatments are applied to the
same subjects (e.g. blood pressure measurements using a
stethoscope and a dynamap).
Paired test : Is applied to paired data, when each individual gives a
pair of observations such as : when observations are made before
and after the play of a factor e.g. pulse rate before and after a drug.
Further, it proceeds similar to the unpaired test.
1077. People are arranged alphabetically by
their names and then every 3rd person
is chosen for study. The type of
sampling is ?
a) Stratified random

b) Systematic random

c) Simple random

d) None of the above

Correct Answer - B medpox.com

Ans. is 'b' i.e., Systematic random
Simple random sampling
Simple random sampling, also, known as 'unrestricted random
sampling'; is applicable for small, homogenous, readily available
population and is used in clinical trials.
In simple random sampling each individual is chosen randomly and
entirely by chance.
So, each individual has the same probability of being chosen at any
stage during the sampling process. For example
Let us assume you had a school with 1000 students, divided equally
into boys and girls, and you wanted to select 100 of them for further
study.
You might put all their names in a bucket and then pull 100 names
out.
Not only does each person have an equal chance of being selected,
we can also easily calculate the probaility of
1078. Positive head impulse test is
suggestive of ?
a) Injury to vestibular nuclei

b) Injury to peripheral vestibular nerve

c) Lesion in the brain stem

d) Injury to Occulomotor nerve

Correct Answer - B
Ans. is `b' i.e., Injury to peripheral vestibular nerve
Head Impulse Test
medpox.com
It is also called head thrust test.
It is test for the diagnosis of injury to vestibular nerve which forms
the peripheral vestibular pathway.
Clinician asks the patient to fix his gaze on a target and then perform
passive horizontal and vertical head impulses and observes the
patient's eyes.
Observation of a refixation saccade after the head impulse indicates
decreased decreasedvestibulo ocular reflex secondary to peripheral
vestibular lesions (vestibular nerve involvement).
1079. Mini tracheostomy is performed
through ?
a) Cricothyroid membrane

b) 2nd and 3rd tracheal rings

c) Any of the above

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Cricothyroid membrane
Cricothyrotomy or Laryngtomy or Minitracheostomy
medpox.com
It is the procedure to open the airway through the cricothyroid
membrane.
Patient's head and neck are extended, lower border of throid
cartilage and cricoid ring is identified. Skin in this area is incised
vertically and then cricothyroid membrane is opened with a
transverse incision.
It is an emergency procedure to buy time for the patient to be shifted
to the operation theatre.
1080. Sago grain appearance is seen in ?
a) Healed myringitis bullosa

b) Otomycosis

c) Malignant otitis externa

d) Keratosis obturans

Correct Answer - A
Ans. is 'a' i.e., Healed myringitis bullosa
Otitis externa haemorrhagica
This condition is also known as Bullous myringitis or myringitis
bullosa. medpox.com
This condition is extremely painful and has sudden onset.
It is thought to be due to mycoplasma pneumoniae or viral infection,
usually influenza'.
There may be a mild conductive deafness and a mildly discharging
car.
The appearance of haemorrhagic bullae on the tympanic membrane
and in the deep meatus is characteristic. The bullae are filled with
serosanguinous fluid and blood.
On healing, bullae look like Sago-grain.
Therefore "Sago-grain" appearance of tympanic membrane is seen
in healed myringitis bullosa.
1081. Most common cause of trigeminal
neuralgia ?
a) Infection

b) Trauma

c) Vascular compression

d) Iatrogenic

Correct Answer - C
Ans. is 'c' i.e., Vascular compression
Trigeminal neuralgia (tic douloureux) is characterized by intermittent,
shooting pain in the face. medpox.com
It is due to involvement of trigeminal nerve.
95% of causes of trigeminal neuralgia are due to pressure on
trigeminal nerve close to where it enters the brain stem, past the
Gasserian ganglion. In most cases, this pressure seems to be
caused by an artery or vein compressing trigeminal nerve.
Other causes are tumor, cysts, AV malformation and multiple
sclerosis.
Most commonly used drugs for treatment of trigeminal neuralgia are
carbamazepine, gabapentin and valproate.
1082. When a patient says Ah the right uvula
presses the palate which of the
following nerve is damaged ?
a) Rght X CN

b) Right XII CN

c) Left X CN

d) Right XII CN

Correct Answer - C
Ans. is 'c' i.e., Left X CN medpox.com
Assessment of the movement of soft palate - Both IX and X CNs are
tested:
The glossopharyngeal nerve (IX CN) is a mixed nerve with motor,
sensory and some parasympathetic activity. It carries sensory input
from the palate and pharynx and the taste from the posterior third of
the tongue. It provides afferent limb of the gag reflex.
The vagus (X CN) is also a mixed nerve with motor, sensory and
parasympathetic activity. It provides the motor supply to the pharynx,
soft palate and larynx and provides the efferent limb to the gag
reflex.
Normally on oral examination thesoft palate is symmetrical with the
uvula dangling in the centre and dividing the soft palate.
When the patient is asked to say AAAh! The soft palate should
elevate symmetrically and the uvula should remain centric. If there is
unilateral weakness of the soft palate the uvula is pulled away from
the weakened side.
Now in the question given when the patient says aaah the right
uvula presses the palate i. e. the right side soft palate pulls the uvula
away from the weak left side. The weakness of the left soft palate
away from the weak left side. The weakness of the left soft palate
can be because of the weakness of the left IX or X cranial nerves.

medpox.com
1083. Lumpy feeling in throat relieved on
taking food is attributed to ?
a) Globus pharyngeus

b) Pharyngeal pouch

c) Diverticular disease

d) Esophageal atresia

Correct Answer - A
Ans. is 'a' i.e., Globus Pharyngeus
Globus Pharyngeus
medpox.com
Symptom where in a patient describes something stuck in throat or a
sensation of lump or tightness in throat which is relieved by taking
food or talking.
1084. Strawberry tongue is seen in ?
a) Streptococcal scarlet fever

b) Kawasaki disease

c) Both of the above

d) None of the above

Correct Answer - C
Ans. is 'c' i.e., Both of the above
Strawberry tongue
It is also called raspberry tongue
It basically refers to glossitis, which manifests with hyperplastic
medpox.com
(enlarged) fungiform papillae, giving the appearance of a strawberry.
White strawberry tongue is where there is a white coating on the
tongue through which the hyperplastic fungiform papillae protrude.
Red strawberry tongue is where the white coating is lost and a dark
red, erythematous surface is revealed, interspaced with the
hyperplastic fungiform papillae.
White strawberry tongue is seen in early scarlet fever (a systemic
infection of group A hemolytic streptococci).
Red strawberry tongue occurs later, after 4-5 days.
Other conditions in which strawberry tongue is seen are: Kawasaki
disease, toxic shock syndrome, and vitamin B 12 deficiency.
1085. Treatment of middle ear papilloma is ?
a) Myringotomy and simple excision

b) Myringectomy and simple excision

c) Tympanomastoidectomy

d) Local infiltration with podophyllin

Correct Answer - C
Ans. is 'c' i.e., Tympanomastoidectomy
Middle ear pappilomas
The middle ear papillomas are rare presentations and medical
literature is mainly limited to case reports or case series.
medpox.com
These include aggressive pappilary tumors, schneiderian type of
pappilomas and inverted pappilomas.
They are associated with hearing difficulty and vertigo and may be
associated with Von Hippel Lindau syndrome.
They tend to be slowly growing, locally aggressive non
metastasizing neoplasms
The approach for treatment of such pathology is usually radical and
tympanomastoidectomy is considered the treatment of choice. This
gives the best chance of cure.
1086. Best time for hearing assessment in an
infant ?
a) 1st month of life

b) 3-6 months

c) 6-9 months

d) 9-12 months

Correct Answer - A
Ans. is 'a' i.e., 1st month of life
The American Academy of Pediatrics (AAP), Joint Committee on
medpox.com
Infant hearing (2007), has recommended that all newborn infants be
screened for hearing impairment either as neonate or before 1
month of age and that those infants who fail newborn screening
have an audiologic examination to varify hearing loss before age of
3 months.
1087. Following protein is not found in organ
of corti ?
a) Myosin

b) Microtubule associated protein 2

c) Microtubule associated protein 4

d) Fodrin

Correct Answer - C
Ans. is 'c' i.e., Microtubule associated protein 4
Proteins present in cochlea
medpox.com
Actin-binding and microtubule-associated proteins regulate
microfilament and microtubule number, length, organization and
location in cells.
In freeze-dried preparations of the guinea pig cochlea, both actin
and tubulin are found in the sensory and supporting cells of the
organ of Corti.
Fodrin (brain spectrin) co-localized with actin in the cuticular plates
of both inner and outer hair cells and along the lateral wall of the
outer hair cells.
Alpha-actinin co-localized with actin in the cuticular plates of the hair
cells and in the head and foot plates of the supporting cells. It was
also found in the junctional regions between hair cells and
supporting cells. o Profilin co-localized with actin in the cuticular
plates of the sensory hair cells.
Myosin was detected only in the cuticular plates of the outer hair
cells and in the supporting cells in the region facing endolymph.
Gelsolin was found in the region of the nerve fibers.
Tubulin is found in microtubules in all cells of the organ of Corti.
In supporting cells, microtubules are bundled together with actin
microfilaments and tropomyosin, as well as being present as
individual microtubules arranged in networks.
An intensely stained network of microtubules is found in both outer
and inner sensory hair cells.
The microtubules in the outer hair cells appear to course throughout
the entire length of the cells, and based on their staining with
antibodies to the tyrosinated form of tubulin they appear to be more
dynamic structures than the microtubules in the supporting cells.
The microtubule-associated protein MAP-2 is present only in outer
hair cells within the organ of Corti and co-localizes with tubulin in
these cells. No other MAPs (1,3,4,5) are present.
Tau is found in the nerve fibers below both inner and outer hair cells
and in the osseous spiral lamina.

medpox.com
1088. Darwin tubercle is seen in ?
a) Tragus

b) Helix

c) Antihelix

d) Lobule

Correct Answer - B
Ans. is 'b' i.e., Helix
Darwin's tubercle (or auricular tubercle) is a congenital earcondition
which often presents as a thickening on the helix at the junction of
the upper and middle thirds.medpox.com
The feature is present in approximately 10.4% of the population.This
acuminate nodule represents the point of the mammalian ear.
1089. Incisura terminalis is between ?
a) Tragus and crux of helix

b) Ear lobule and antihelix

c) Antihelix and external auditory meatus

d) Tragus and ear lobule

Correct Answer - A
Ans. is 'a' i.e., Tragus and crux of helix
Incisura ternzinalis is the area between the tragus and crus of helix

medpox.com
1090. Callaural fistula is an abnormality of ?
a) 1" branchial arch

b) Pt branchial cleft

c) 2nd branchial arch

d) 2nd branchial cleft

Correct Answer - B
Ans. is 'b' i.e., Pt branchial cleft
Collaural fistula is a 1" branchial cleft anomaly which arises from
failure of fusion of the ventral part of the Pt cleft.
medpox.com
Its upper part opens into floor of external auditary canal.
Its lower part opens in the neck between angle of mandible and
sternocleidomastoid muscle.
1091. Potato tumor due to ?
a) Hypotrophy of sebaceous glands of nose

b) Hypertrophy of sebaceous glands of nose

c) Hypotrophy of sweat glands of nose

d) Hpertrophy of sweat glands of nose

Correct Answer - B
Ans. is 'b' i.e., Hypertrophy of sebaceous glands of nose
Rhinophyma (Potato tumor)
Rhinophyma is large, bulb-shaped, red-colored (ruddy) nose. It is a
slow growing benign tumor due to hypertrophy of the sebaceous
medpox.com
glands. The cause of rhinophyma is unknown, though it is thought to
be a severe form of acne roscea. Rhinophyma was once thought to
be caused by heavy alcohol consumption, but this is not the case.
Rhinophyma occurs equally in those who do not drink at all and
those who drink large quantities of alcohol. It mostly affects men
past middle age. Red/pink colour of the tumor is due to engorgment
of superficial vessels.
Treatment
Surgery to reshape the nose is the best known treatment for
rhinophyma. Surgery may be done with a laser (carbon dioxide
laser), scalpel (sharp knife) or a rotating brush (dermabrasion) and
the area is allowed to re-epithelialize. Sometimes, tumour is
completely excised and the raw area is skin-grafted.
 1092. Surgical markings for finding the facial
nerve is are?
a) Tympano - mastoid suture

b) Tragal pointer

c) Posterior belly of digastric

d) All the above

Correct Answer - A
Ans. is 'a' i.e., Tympano-mastoid suture
Surgical landmarks to identify main trunk of the facial nerve are
as follows: medpox.com
i. Tympanomastoid suture line - it is located between the mastoid and
the tympanic bones. The main facial trunk lies 6 -8 mm distal to the
end of the suture.
ii. Tragal pointer - the main nerve trunk lies 1.0 to 1.5 cm deep and
slightly anterior and inferior to the tip of the external ear canal
cartilage.
iii. Posterior belly of digastric -the main nerve trunk lies 1 cm deep to
the medial attachment of the posterior belly of digastric muscle to
the digastric groove (mastoid notch) of the mastoid bone.
iv. Mastoid bone - main nerve trunk is identified inside the mastoid
bone by mastoidectomy.
 1093. Which of the following is not a cause of
oropharyngeal carcinoma?
a) Occupational exposue to hydrochloric acid

b) Smoking

c) Human Papilloma Virus infection

d) Occupational exposure to isopropyl oil

Correct Answer - A
Ans. is 'a' i.e., Occupational exposure to hydrochloric acid
Etiology of oropharyngeal carcinoma
medpox.com
i. Tobacco in any form - cigarette smoking or chewing
ii. Heavy alcohol abuse
iii. Beetle nut chewing
iv. Plummer vinson syndrome, cirrhosis
v. Syphilis
vi. Trauma
vii. Dental irritation
viii. Poor oral hygiene
ix. Occupational exposure to isopropyl alcohol, sulphuric acid and
nickel
x. HPV infection
1094. False regarding the foreign body of
oropharynx is ?
a) Impacted foreign bodies most often lodge in the soft tissue at
the base of tongue

b) Food particles are the most common oropharyngeal foreign

bodies in children

c) Clinical hypopharyngeal foreign bodies are amenable to clinical

examination

d) Endoscopy and MDCT are used in the diagnosis

Correct Answer - B medpox.com

Ans. is 'b' i.e., Food particles are the most common
oropharyngeal foreign bodies in children
Oropharyngeal foreign bodies
Most ingested foreign bodies do not impact in the oropharynx
Sharp foreign bodies like fish and chicken bones most commonly
impact in the soft tissues at the base of the tongue.
Hypopharyngeal foreign bodies can be detected by good physical
examination.
Endoscopy and MDCT are used in the diagnosis of foreign bodies of
cervical esophagus.
Coins are the most common impacted oropharyngeal foreign bodies
encountered in children followed by food particles.
1095. Ostmann fat pad is related to ?
a) Ear lobule

b) Buccal mucosa

c) Eustachian tube

d) Tip of nose

Correct Answer - C
Ans. is 'c' i.e., Eustachian tube
There are small fat bodies located infermedial to Eustachian tube.
These are called Ostmann fat pads.
They are important in normal closure of eustachian tube and
medpox.com
preventing transmission of nasopharyngeal pressure to middle ear.
These fat pads are absent in Patulous tube syndrome.
1096. Fowl smelling nasal discharge is seen
in all except?
a) Nasal Myiasis

b) Choanal atresia

c) Foreign body in nose

d) Rhinolith

Correct Answer - B
Ans. is `b' i.e., Choanal atresia
Diseases with fowl smelling nasal discharge are:
Nasal myiasis medpox.com
Foreign body in nose
Rhinolith
In choanal atresia there is presence of nasal discharge without air
bubbles.
1097. Cauliflower ear is due to ?
a) Hematoma

b) Carcinoma

c) Fungal infection

d) Herpes

Correct Answer - A
Ans. is 'a' i.e., Hematoma
Hematoma of the auricle
It is the collection of blood between the auricular cartilage and its
perichondrium. medpox.com
It usually occurs due to blunt trauma and often seen in boxers,
wrestlers and rugby players, therefore it is also called Boxer's ear.
Extravasated blood may clot and then organise, resulting in typical
deformity called, Cauliflower ear. If hae​matoma gets infected, severe
perichondritis may set in.
1098. Fowl smelling ear discharge with
presence of pale granulation tissue in
ear in an adolescent boy is suggestive
of ?
a) Cholesteatoma

b) Exostosis

c) Otomycosis

d) Malignant otitis externa

Correct Answer - A medpox.com

Ans. is 'a' i.e., Cholesteatoma
Fowl smelling ear discharge with presence of granulation tissue in
earin adolescent boy is suggestive chronic suppurativeotits media of
the unsafe type (atticoantral disease). Such patients have underlying
cholesteatoma along with evidence of bone destruction.
Clinical features of cholesteatoma/atticoantral CSOM
Otorrhoea :- Scanty, foul smelling discharge due to bone
destruction.
Hearing loss :- Initially conductive due to destruction of ossicles.
Later sensorineural element may be added, which results in mixed
hearing loss.
Bleeding :- May occur from granulation or the polyp when cleaning
the ear.
Tympanic membrane show posterior marginal or attic perforation.
Also granulation tissue and polyps may be present in ear.
1099.

medpox.com
Central part of cholesteatoma contains ?
a) Keratin debris

b) Keratinized squamous epithelium

c) Coulmnar epithelium

d) Fibroblasts

Correct Answer - A
Ans. is 'a' i.e., Keratin debris
Cholesteatoma
Destructive or expanding growth in the middle ear or mastoid
process medpox.com
The term cholesteatoma is a misnomer, because it neither contains
cholesterol crystals nor is it a tumor to merit the suffix `oma'.
Cholesteatoma has the property to destroy bone. It may cause
destruction of ear ossicles, erosion of bony labyrinth, canal of facial
nerve, sinus plate or tegmen tympani and thus cause several
complications. Bone destruction by cholesteatoma has been
attributed to various proteolytic enzymes liberated by osteoclasts
and mononuclear inflammatory cells, seen in association with
cholesteatoma.
Cholesteatoma consists of two parts : ?
i) Matrix : - Made up of keratinizing squamous epithelium.
ii) Keratin debris (central white mass) : - Produced by the matrix.
Therefore, cholesteatoma also referred to as epidermosisor
keratoma.
 1100. Which of the following is included in the
Levenson criteria for congenital
cholesteatoma ?
a) White mass medial to normal tympanic membrane

b) Atticoantral perforation of the tympanic membrane

c) Definite history of otorrhoea

d) History of prior otologic procedures

Correct Answer - A
Ans. is 'a' i.e., White mass medial to normal tympanic
medpox.com
membrane
Levenson criteria for congenital cholesteatoma
1. White mass medial to normal TM.
2. Normal pars flaccida and tensa.
3. No history of otorrhea or perforations.
4. No prior otologic procedures.
5. Prior bouts of otitis media no ground for exclusions.
 1101. Which of the following structures is not
at immediate risk of erosion by
cholesteatoma ?
a) Long process of incus

b) Fallopian canal containing facial nerve

c) Horizontal/ lateral semicircular canal

d) Base plate of stapes

Correct Answer - D
Ans. is 'd' i.e., Base plate of stapes
medpox.com
Cholesteatoma has the property to destroy the bone by virtue of the
enzymes released by it.
Structures immediately at the risk of erosion are : -
i. Long process of incus.
ii. Fallopian canal containing facial nerve.
iii. Horizontal / lateral semicircular canal
1102. Acute suppurative otits media in
children is most commonly caused by ?
a) St. pneumoniae

b) S. epidermidis

c) S. aureus

d) Pseudomonas

Correct Answer - A
Ans. is 'a' i.e., St. pneumonia [Ref Dhingra 5thle p. 54]
ASOM is especially common in infants and children. Most of the time
medpox.com
ASOM usually follows respiratory tract infections (i.e., acute
tonsillitis, common cold or influenza) and the infection travel up by
the eustachian tube to the middle ear.
The most common causative organism is streptococcus pneumoniae
1103. Most common organism cultured in
CSOM is ?
a) Staphylococcus aureus

b) Staphylococcus epidermidis

c) Streptococcus pneumonia

d) Pseudomonas aeruginosa

Correct Answer - D
Ans. is 'd' i.e., Pseudomonas aeruginosa
Microbiology of CSOM
medpox.com
Pus culture in both types of aerobic and anaerobic CSOM may show
multiple organisms.
Most commonly isolated organisms are gram negative bacilli, i.e.,
Pseudomonas, proteus, E.coli.
These organisms are not commonly found in the respiratory tract,
while commonly found in the skin of external ear.
1104. Most common nerve to be damaged in
CSOM is
a) III

b) VII

c) IV

d) VI

Correct Answer - B

Facial nerve is the M/C nerve to be damaged in CSOM.
medpox.com
1105. Attico antral disease is treated by ?
a) Modified radical mastoidectomy

b) Antibiotics

c) Grommet insertion

d) Synringing

Correct Answer - A
Ans. is 'a' i.e., Modified radical mastoidectomy
Treatment of atticoantral disease
Since cholesteatoma is going to expand and destroy bone and
mucous membrane, it has to be removed. Therefore, surgery is the
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mainstay of treatment. Primary aim is removal of disease by
mastoidectomy to make ear safe followed by reconstruction of
hearing at a later stage. Modified radical mastoidectomy is the
surgery of choice.
Two types of surgical procedures (mastoidectomy) are done to deal
with cholesteatoma.
1) Canal wall down procedures
These leave the mastoid cavity open into the external auditory canal
so that the diseased area is fully exteriorized.
The commonly used procedures for atticoantral disease are
atticotomy, modified radical mastoidectomy and rarely radical
mastoidectomy.
Modified radical mastoidectomy is the procedure of choice.
2) Canal wall up procedures (cortical mastoidectomy)
Here disease is removed by combined approach through the meatus
and mastoid but retaining the posterior bony meatus wall, thereby
avoiding an open mastoid cavity.
For reconstruction of hearing mechanism myringoplasty or
tympanoplasty can be done at the time of primary surgery or as a
second stage procedure.

medpox.com
1106. In a patient with CSOM, labrynthine
fistula most commnonly involves ?
a) Superior SCC

b) Lateral SCC

c) Posterior SCC

d) Utricle

Correct Answer - B
Ans. is 'b' i.e., Lateral SCC
Labrynthine fistula is almost exclusively reported in association with
medpox.com
chronic otitis media and cholesteatoma.
The most commonly affected canal is lateral (horizontal) semicircular
canal, but involvement of the posterior and superior canals as well
as other regions of labyrinth have been reported.
The incidence of labrynthine fistula in chronic otitis media is
approximately 10%.
1107. Gradenigo syndrome is characterized
by all except ?
a) Diplopia

b) Retro-orbital pain

c) Persistent ear discharge

d) Vertigo

Correct Answer - D
Ans. is d i.e., Vertigo
Infection of mastoid and middle ear may be complicated by the
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spread of infection within the temporal bone into petrous apex.
Petrositis is an extension of infection from middle ear and mastoid to
the petrous part of the temporal bone.
Gradenigo's syndrome is the classical presentation and
consists of a triad of : -
External rectus palsy (VIth nerve/abducent nerve palsy) causing
diplopia.
Deep seated orbital or retroorbital pain (Vth nerve involvement).
Persistent ear discharge due to ipsilateral acute or chronic otitis
media.
Associated symptoms of otitis media are also present e.g.,
conductive deafness. Other symptoms are fever, head​ache,
vomiting, and sometimes neck rigidity. Some patient may get facial
paralysis and recurrent vertigo due to involvement of facial and
statoacoustic nerves.
1108. All are true for gradenigo's syndrome
except ?
a) Associated with intermittent ear discharge

b) Associated with conductive hearing loss

c) Causes diplopia

d) Leads to retro orbital pain

Correct Answer - A
Ans. is 'a' i.e., Associated with intermittent ear discharge
Gradenigo's syndrome, also called Gradenigo-Lannois
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syndrome, is a complication of otitis media and mastoiditis involving
the apex of the petrous temporal bone.
Symptoms
Components of the syndrome include:
retroorbital pain due to pain in the area supplied by the ophthalmic
branch of the trigeminal nerve (fifth cranial nerve),
abducens nerve palsy (sixth cranial nerve)
otitis media
Other symptoms can include photophobia,
excessive lacrimation, fever, and reduced corneal sensitivity. The
syndrome is classically caused by the spread of an infection into the
petrous apex of the temporal bone.

medpox.com
 1109. Following is the preferred treatment of
Serous Otitis Media -
a) Grommet surgery

b) Oral Amoxicillin for 5 - 10 days

c) Modified radical mastoidectomy

d) Bed rest, antipyretics and adequate fluid intake

Correct Answer - A
Ans. is 'a' i.e., Grommet surgery
Treatment of otitis media
medpox.com
Following two treatments have been described : ?
1) Watchful waiting
Watchful waiting is the active monitoring of the condition and hearing
in anticipation of spontaneous resolution. Guidlines aimed at both
primary care and specialist otolaryngologist broadly agree that a
watch​ful waiting period for about three months is the initial
management of children with serous otitis media. Therefore, unless
there are also signs of an infection, most health care providers will
not treat SOM at first Instead, they will recheck the problem in 2-3
months. This should be coupled with reassurance that doing nothing
is as likely as doing something to result in resolution of the SOM and
the associated symptoms.
2) Surgery
Surgical intervention is recommended when watchful waiting and
monitoring of hearing has confirmed failure of resolution of SOM.
Following surgical intervention are used commonly : -
i. Myringotomy and aspiration offluid : -An incision is made in tympanic
membrane and fluid aspirated with suction.
ii. Grommet (ventilation tube) surgery : - If myringotomy and aspiration
 combined with medical measures has not helped and fluid recurs, a
grommet is inserted to provide continued aeration of middle ear.
This is the most common surgical intervention for SOM. Most
prefered site of grommet insertion is antero-inferior through
circumferential or radial incision.
iii. Surgical treatment of causative factor : - Adenoidectomy,
tonsillectomy etc.
Medical measures are controversial and involve : ?
1. Decongestants
2. Antiallergic measures
3. Antibiotics
4. Middle ear aeration :- Valsalva maneuver, Politzerisation or
eustachian tube catheterization, Chewing gum.

medpox.com
1110. Multiple perforation of tympanic
membrane characteristic of ?
a) Tubercular Otitis Media

b) Syphilitic Otitis Media

c) Pseudomonas infection

d) Fungal Otitis Media

Correct Answer - A
Ans. is 'a' i.e., Tubercular otitis media
Tubercular otitis media
medpox.com
Tuberculosis of middle ear is a comparatively rare entity usually
seen in association with or secondary to pulmonarytuberculosis,
infection reaches the middle ear through eustachian tube.
The rare modes of infection are through hematogenous spread from
tubercular focus in lung, tonsils, cervical lymph nodes; or due to
ingestion of infected cow's milk.
It usually affects children and young adults.
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. There may be
multiple perforations in the early stages, but they coalesce into a
large tympanic membrane perforation accompanied by a pale
granulation tissue.
Periauricular fistulae, lymphadenopathy and facial palsy are
infrequent findings.
Late complications include facial paralysis, labyrinthitis, postauricular
fistulae, subperiosteal abscess, petrous apicitis and intracranial
extension of infection.

medpox.com
1111. Patient with thin painless otorrhoea,
multiple perforations of the tympanic
membrane and failure to respond to
antimicrobial treatment. What is the
most probable causative organism ?
a) Mycobacterium tuberculosis

b) Staphylococcus aureus

c) Candida albicans

d) Aspegillusfumigatus

medpox.com
Correct Answer - A
Ans. is 'a' i.e., Mycobacterium tuberculosis
Thin painless otorrhoea, multiple perforations of the tympanic
membrane and failure to respond to antimicrobial treatment are the
features of tubercular otitis media and it is caused by Mycobacterium
tuberculosis.
1112. Conducting hearing loss with intact
tympanic membrane ?
a) Presbycausis

b) Meniere's disease

c) Glue ear

d) Acoustic neuroma

Correct Answer - C
Ans. is 'c' i.e., Glue ear
Among the given options, only glue ear (serous otitis media) is a
medpox.com
cause of conductive deafness.
1113. Length of external auditory meatus is ?
a) 12mm

b) 16mm

c) 20mm

d) 24mm

Correct Answer - D
Ans. is 'd' i.e., 24 mm
External auditory canal (External acoustic meatus)
External auditory canal is a 'S' shaped canal with length of 24-
25 mm and it is divided into two parts :?
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1) Cartilagenous part
It forms outer/lateral 1/3 (8mm) of the external auditory canal. It has
two fissures / deficiencies in the anterior part called fissure of
santorini through which parotid or superficial mastoid infection can
appear in the canal and vice versa. Skin covering it is thick and has
ceruminous glands (modified apocrine sweat glands), pilosebaceous
glands and hair. Since hair is confined to cartilaginous part,
furuncles are seen only in the outer third of the canal.
2) Bony part
It forms inner/medial 2/3 (16 mm) of external auditory canal. Skin
lining the bony part is thin and is devoid of hair and ceruminous
glands. Isthmus is the narrowest portion of bony canal and is 5 mm
lateral to tympanic membrane. Foreign bodies get lodged in isthmus
are difficult to remove as it is the narrowest part. `Foramen of
Huschke' is a deficiency present in antero-inferior part of bony canal
in children upto 4 years of age, permitting infection to and from
parotid.
1114. Not a cause of objective tinnitus ?
a) Palatal myoclonus

b) Glomus tumor

c) Carotid artery aneurysm

d) Presbyacusis

Correct Answer - D
Ans. is 'd' i.e., Presbyacusis
Tinnitus
Tinnitus is ringing sound or noise in the ear.
The characteristic feature is that the origin of this sound is within the
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patient.
1115. Which of the following is false
regarding Frey's syndrome?
a) It is also called gustatory sweating

b) It is caused by injury to auriculotemporal nerve

c) It occurs immediately after the parotid surgery

d) It is caused by aberrant regeneration of post

Correct Answer - C
Ans. is 'c' i.e., It occurs immediately after the parotid surgery
Frey's syndrome (gustatory sweating)
medpox.com
Gustatory sweating or Frey's syndrome involves post-parotidectomy
facial sweating and skin flushing while eating.
The symptoms usually occur several months or even years after
parotid surgery.
The likely pathophysiology is aberrant regeneration of postganglionic
secretomotor parasympathetic nerve fibres (originating from the otic
ganglion) misdirected through several axonal sheaths of post-
ganglionic sympathetic fibres feeding the sweat glands. These
sympathetic fibres are to the sweat glands of the skin in the
dissected field.
The frey's syndrome is likely due to injury to auriculotemporal nerve
with faulty regeneration, therefore Frey's syndrome is also known as
Auriculotemporal syndrome.
A variant of Frey's syndrome in which there is gustatory facial
flushing but not sweating, occurs following facial paralysis due to
faulty regeneration following injury to the facial nerve. So, Frey's
syndrome is not limited to parotid surgery with injury to
auriculotemporal nerve.
1116. Synkinesis is a sequel of ?
a) Facial nerve paralysis

b) Trigeminal nerve paralysis

c) Superficial temporal nerve paralysis

d) Greater Petrosal nerve paralysis

Correct Answer - A
Ans. is 'a' i.e., Facial nerve paralysis
Clinical features of Bell's palsy
Acute onset, ipsilateral facial paralysis.
Facial paralysis is usually preceded by pain behind the ear.
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Patient is unable to close his eyes.
Bells phenomenon, i.e. on attempting to close the eye, eyeball turns
up and out.
Face becomes asymmetrical and saliva dribbles from angle of
mouth.
Ipsilateral loss of taste sensation, salivation and lacrimation.
Intolerance to high pitched or loud sound (hyperacusis).
Most patients (80%) recover within few weeks to months.
Synkinesis and crocodile tear are sequelae of Bell's palsy :-
Synkinesis or facial synkinesis is a common sequelae to Bell's palsy.
This is due to cross innervation of nerve fibres during recovery.
When the patient wishes to close the eye, corner of mouth also
twiches and vice versa.
Crocodile tear (gustatory lacrimation) is due to faulty regeneration of
parasympathetic fibres which now supply lacrimal gland instead of
the salivary glands.
1117. Glomus jugulare commonly arises from
?
a) Hypotympanum

b) Mesotympanum

c) Epitympanum

d) Prussaks space

Correct Answer - A
Ans. is 'a' i.e., Hypotympanum
There are two types of glomus tumors:-
i) Glomus jugulare medpox.com
These glomus tumors arise from the dome of the internal jugular
vein in the hypotympanum and jugular foramen. In jugular foramen
they can invade IX to XII cranial nerves.
ii) Glomus tympanicum
They arise from the promontory of the middle ear along the course
of the tympanic branch of the IXth cranial nerve.
1118. Following are the laboratory tests for
the diagnosis of vestibular dysfunction
except ?
a) Electronystagmography

b) Optokinetic test

c) Galvanic test

d) Gelle's test

Correct Answer - D
Ans. is 'd' i.e., Gelle's testmedpox.com
Vestibular system
The vestibular system contributes to balance and to the sense of
spatial orientation.
It is a sensory system that provides the leading contribution about
movement and sense of balance.
It includes the labyrinth (semicircular canals and otolith : utricle &
sacules) of the inner ear and is situated in the vestibulum in the
inner ear.
The symptoms of vestibular dysfunction are vertigo, dizziness and
Unbalance.
1119. Not a test for Eustachian tube patency ?
a) Tympanometry

b) Toynbee

c) Valsalva

d) Frenzel maneuver

Correct Answer - A
Ans. is 'a' i.e., Tympanometry
Tests for Eustachian tubepatency
Valsalva test
Methylene blue test medpox.com
Sonotubometry
Politzer test
Toynbee test
Frenzel maneuver
Catheterization
Inflation - Deflation test
1120. Horizontal acceleration with forward
movement in the sagittal plane is
detected by ?
a) Macula of Utricle

b) Macula of Saccule

c) Lateral semicircular canal

d) Posterior semicircular canal

Correct Answer - A
Ans. is 'a' i.e., Macula of utricle
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1121.

medpox.com
Exostosis due to repetitive exposure to cold
water is common in which part of the
temporal bone?
a) Squamous part

b) Tympanic part

c) Ptreous part

d) Mastoid part

Correct Answer - B
Ans. is 'b' i.e., Tympanic part
medpox.com
Surfer's ear
It is the common name for an exostosis or abnormal bone growth
within the external auditory canal.
Surfer's ear is not the same as swimmer's ear, although infection
can result as a side effect.
Irritation from cold wind and water exposure causes the bone
surrounding the ear canal to develop lumps of new bony growth
which constrict the ear canal. The condition is so named due to its
prevalence among cold water surfers. Cold water surfers experience
surfer's ear at about six times the rate of warm water surfers.
Common site for surfer's ear is external auditory canal. Tympanic
part of the temporal bone is a U shaped curved bony plate that
forms most of the part of the external auditory canal. Thus exostosis
is common in the tympanic part of the temporal bone.
Note: Parts of temporal bone are: squamous, tympanic, styloid,
petrous, and mastoid.
 1122. Which of the following is not a
derivative of the middle ear cleft ?
a) Semicircular canal

b) Mastoid air cell

c) Tympanic cavity

d) Eustachian tube

Correct Answer - A
Ans. is 'a' i.e., Semicircular canal
The middle - ear cleft in the temporal bone includes :?
i. Eustachian tube medpox.com
ii. The middle ear (tympanic cavity)
iii. Aditus which leads posteriorly to the mastoid antrum and air cells.
1123. When the patient fails to understand
normal speech, but can understand
shouted or amplified speech the
hearing loss, is termed ?
a) Mild hearing loss

b) Moderate hearing loss

c) Severe hearing loss

d) Profound hearing loss

Correct Answer - C medpox.com

Ans. is 'c' i.e., Severe hearing loss
Severe hearing loss
What is severe hearing loss? On average, the most quiet sounds
heard by people with their better ear are between 70 and 95 dB.
People who suffer from severe hearing loss will benefit from
powerful hearing aids, but often they rely heavily on lip-reading even
when they are using hearing aids. Some also use sign language.
 1124. Presence of delta sign on contrast
enhanced CT SCAN suggests presence
of ?
a) Lateral Sinus thrombophlebitis

b) Cholesteatoma

c) Cerebellar abscess

d) Mastoiditis

Correct Answer - A
Ans. is 'a' i.e., Lateral Sinus thrombophlebitis
medpox.com
LATERAL SINUS THROMBOPHLEBITIS (SIGMOID SINUS
THROMBOSIS)
Lateral or sigmoid sinus thrombophlebitis arises from inflammation in
the adjacent mastoid. It may occur as a complication of : ?
i. Acute coalescent mastoiditis
ii. CSOM and cholesteatoma
Clinical features
Hectic Picket-Fence type of fever with rigor.
Headache, Progressive anemia and emaciation.
Griesinger's sign : - odema over the posterior part of mastoid due to
thrombosis of mastoid emissary veins.
Papilloedema
Tobey-Ayer test :- Compression of vein on the thrombosed side
produces no effect while compression of vein on healthy side
produces rapid rise in CSF pressure which will be equal to bilateral
compression of jugular veins.
Crowe-Beck test :- Pressure on jugular vein of healthy side produces
engorgement of retinal veins. Pressure on affected side does not
produce such change.
Tenderness along jugular vein
Imaging studies
Contrast-enhanced CT scan can show sinus thrombosis by typical
delta-sign. It is a triangular area with rim enhancement, and central
low density area is seen in posterior cranial fossa on axial cuts.
Delta-sign may also be seen on contrast enhanced MRI.

medpox.com
1125. Ohgren's line passes from ?
a) Medial canthus to angle of mandible

b) Lateral canthus to angle of mandible

c) Medial canthus to mastoid process

d) Lateral canthus to mastoid process

Correct Answer - A
Ans. is 'a' i.e., Medial canthus to angle of mandible

medpox.com
1126. Which of the following is not true about
inverted papilloma ?
a) It is always unilateral

b) It is more common in males

c) 10-15 % of the cases may be associated with squamous cell

carcinoma

d) It is also called Ringertz tumor

Correct Answer - D
Ans. is 'd' i.e., It is also called Ringertz tumor
medpox.com
Inverted Papilloma (Transitional cell papilloma / Schneiderion
papilloma)
Inverted papilloma is a benign neoplasm occurs mostly between 40-
70 years with male preponderance (5 : 1). o It arises from the lateral
wall of nose and is always unilateral. Rarely, it may arise from nasal
septum. o Features of inverted papilloma are :-
It shows finger like epithelial invasions into the underlying stroma of
the epithelium rather than on surface so called inverted papilloma.
It is usually unilateral and is a locally aggressive tumour.
Patients complain of nasal obstruction, rhinorrhea & unilateral
epistaxis.
In 10-15% cases there may be associated squamous cell
carcinoma.
Treatment is adequate local excision. If it arises in maxillary sinus,
then a radical antrostomy is carried out.If it arises in the ethmoidal
sinus, an external ethmoidectomy is done. If it arises from nose,
treatment is wide surgical excision by lateral rhinotomy.
Has a tendency to recur even after removal.
1127.
Inverted papilloma of nose arise from ?

a) Nasal septum

b) Roof of the nose

c) Tip of the nose

d) Lateral wall of the nose

medpox.com
Correct Answer - D
Ans. is 'd' i.e., Lateral wall of the nose
Inverted Papilloma (Transitional cell papilloma/Schneiderion
papilloma)
Inverted papilloma is a benign neoplasm occurs mostly between 40-
70 years with male preponderance (5 : 1).
It arises from the lateral wall of nose and is always unilateral.
Rarely, it may arise from nasal septum.
Features of inverted papilloma are : -
It shows finger like epithelial invasions into the underlying stroma of
the epithelium rather than on surface so called inverted papilloma.
It is usually unilateral and is a locally aggressive tumour.
Patients complain of nasal obstruction, rhinorrhea & unilateral
epistaxis.
In 10-15% cases there may be associated squamous cell
carcinoma.
Treatment is adequate local excision. If it arises in maxillary sinus,
then a radical antrostomy is carried out. If it arises in the ethmoidal
sinus, an external ethmoidectomy is done. If it arises from nose,
treatment is wide surgical excision by lateral rhinotomy.
Has a tendency to recur even after removal.

medpox.com
1128. Which of the following is false
regarding frontal sinusitis ?
a) Pain shows periodicity

b) Most common sinus involved in infants and children

c) Pain is referred to as office headache

d) Tenderness is present just above the medial canthus of eye

Correct Answer - B
Ans. is 'b' i.e., Most common sinus involved in infants and children
Most common sinus involved in infant and children is Ethmoid sinus.
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Clinical features of acute sinusitis
Most common presenting patient's compliant is persistent nasal
discharge which can be of any quality (thin, thick, clear, or purulent).
Nasal discharge from a sinus infection can be blood - tinged from
excessive nose blowing and irritation. The clinical symptoms of
acute sinusitis have been classified into major and minor.
1129. Samters triad is seen in patients with ?
a) Asthma

b) Chronic pancreatitis

c) Crohn's disease

d) Liver cell carcinoma

Correct Answer - A
Ans. is 'a' i.e., Asthma
Samter's triad
Samter's triad is a medical condition consisting of asthma, aspirin
sensitivity, and nasal/ethmoidal polyposis. It occurs in middle age
medpox.com
(twenties and thirties are the most common onset times) and may
not include any allergies.
Most commonly, the first symptom is rhinitis.
The disorder typically progeses to asthma, then polyposis, with
aspirin sensitivity coming last.
The aspirin reaction can be severe, including an asthma attack,
anaphylaxis, and urticaria in some cases. Patients typically react to
other NSAIDS such as ibuprofen, although paracetamol is generally
considered safe.
Anosmia (lack of smell) is also typical, as the inflammation reaches
the olfactory receptors in the nose.
1130. Nasopharyngeal carcinoma seen in
which occupation?
a) Asbestos industry

b) Cement industry

c) Wood workers

d) Chimney workers

Correct Answer - C
Ans. is 'c' i.e., Wood workers
Ref Dhingra 4h/e p. 235; Nasopharyngeal carcinoma By Andrew
Van Hasselt, medpox.com
Alan G. Gibb 2d/e p. 4
Wood dusts exposure is a risk factor of nasopharyngeal carcinoma
and
Adenocarcinoma of PNS.
Formaldehyde exposure is a risk factor of Nasopharyngeal
carcinoma.
1131. Trotter triad not included is ?
a) Conductive deafness

b) Temporoparietal neuralgia

c) Palatal paralysis

d) Seizures

Correct Answer - D
Ans. is 'd' i.e., Seizures
Trotter's triad
Trotter's triad occurs in nasopharyngeal carcinoma
It includes :- medpox.com
i) Conductive deafness (due to Eustachian tube blockage)
ii) Temporo - parietal neuralgia (due to involvement of ipsilateral Vth
cranial nerve)
iii) Palatal paralysis (due to involvement of Xth cranial nerve)
1132. Following is true about laryngomalacia
except ?
a) Omega shaped epiglottis

b) Reassuarance of the patient is the treatment of choice

c) Condition is first noticed in the first few weeks of life

d) Expiratory stridor

Correct Answer - D
Ans. is 'd' i.e., Expiratory stridor
Laryngomalacia
medpox.com
It is the most common congenital abnormality of the larynx.
Laryngomalacia is the most frequent cause of stridor or noisy
breathing in infants. It occurs as a result of a floppy portion of the
larynx (in supraglottic larynx) that has not yet developed the strength
to provide rigid support to the airway. During inspiration negative
pressure is created through larynx, which results in a collapse of
these structures into the airway and a narrower breathing passage.
Partial obstruction is the source of the noise with breathing (stridor),
and sometimes cyanosis.
The hallmark sign includes intermittent stridor mostly in inspiration. It
is usually more prominent when the infant is lying on his/her back
(supine position, crying, feeding, excited or has a cold. Stridor gets
relieved on placing the patient in prone position. This is usually first
noticed in the first few weeks of life.
It may worsen over the first few months and become louder. This is
because as the baby grows, inspiratory force is greater, which
causes greater collapse of the laryngeal structures into the airway.
This is usually worst at 3-6 months and then gradually improves as
the rigidity of the cartilage improves.
Most children are symptom free by 1 to 2 years.
Sometimes, cyanosis may occur.
Direct laryngoscopy shows :-
Omega shaped epiglottis, i.e. elongated and curled on itself.
Floopy, tall, foreshortened and thin aryepiglottic folds.
Prominent arytenoids.
In most patients laryngomalacia is a self limiting condition.
Treatment of laryngomalacia is reassurance to the parents and early
antibiotic therapy for upper respiratory tract infections.

medpox.com
1133. Patient presents with mouth breathing,
recurrent serous otitis media and
adenoid facies. What is the best line of
management ?
a) Adenoidectomy

b) Tonsillectomy

c) Antibiotics

d) Supportive therapy

Correct Answer - A medpox.com

Ans. is 'a' i.e., Adenoidectomy
The triad of nasal and aural symptoms with adenoid facies points to
the diagnosis of enlarged adenoids.
For the treatment of enlarged adenoids when symptoms are not
marked breathing excercise, decongenstant nasal drops and
antihistaminics are used and when symptoms are marked,
adenoidectomy is done.
We have a patient with marked and recurrent symptoms thus
adenoidectomy is the treatment of choice.
1134. Rhinitis most common bacterial cause
?
a) Haemophilus influenza

b) Streptococcus haemolyticus

c) Pasturellamultocida

d) Cornybacterium diphtheria

Correct Answer - A
Ans. is 'a' i.e., Haemophilus influenza
Acute bacterial rhinitis is most commonly seen among children, but
medpox.com
adult may develop the condition after nasal trauma, viral upper
respiratory tract infection, or surgery.
The clinical presentation of acute bacterial rhinitis may be identical
to that of common cold.
Most common causative organisms include S. pneumoniae, H.
influenzae and Moraxella Catarrhalis.
Note: Overall, most common cause of infective rhinitis is viral
infection (viral rhinitis).
1135. Which of the following organisms is
known to cause Atrophic rhinitis ?
a) Klebsiella ozaena

b) Klebsiella pneumonia

c) Streptococcus pneumonia

d) Streptococcus foetidis

Correct Answer - A
Ans. is 'a' i.e., Klebsiella ozaena
Atrophic rhinitis (Ozaena)
medpox.com
Atrophic rhinitis is a chronic inflammation of nose characterized by
atrophy of nasal mucosa, including the glands, turbinate bones and
the nerve elements. Atrophic rhinitis may be primary or secondary :
?
1) Primary atrophic rhinitis
The primary pathology is inflammation and atrophy of the nose.
Generally, atrophic rhinitis refers to primary atrophic rhinitis.
Causes are : -
i) Hereditary
ii) Endocrinal pathology - Starts at puberty. Stops after menopause
iii) Racial factors - Seen more in Whites and Yellow races
iv) Nutritional deficiency - Deficiency of vitamin A, D, E and iron may
be responsible for it.
v) Infective - Klebsiella ozanae, Diphtheriods, P. vulgaris, E.coli,
Staphylococci, Streptococci.
vi) Autoimmune process - Causing destruction of nasal,
neurovascular and glandular elements may be the cause.
2) Secondary atrophic rhinitis
Specific infections, such as syphilis, lupus, leprosy, and
rhinoscleroma, may cause destruction of the nasal structures
leading to atrophic changes. Can also results from long standing
purulent sinusitis , radiotherapy of nose, excessive surgical removal
of the turbinate and as complication of DNS on the root side of nose.

medpox.com
1136. Vidian neurectomy is done for ?
a) Allergic rhinitis

b) Atrophic rhinitis

c) Vasomotor rhinitis

d) Chronic hypertrophic rhinitis

Correct Answer - C
Ans. is 'c' i.e., Vasomotor rhinitis
Vasomotor rhinitis
Vasomotor is a nonallergic condition that involves a constant runny
nose, sneezing and nasal congestion, i.e., the nose is stuffy or runny
medpox.com
for reasons other than allergies and infections. The exact etiology is
unknown, but triggers include emotions, odors, poor air quality, spicy
foods, and medication side effects. Pathogenesis include:-
Parasympathetic overactivity
Hyperactive nasal mucosa to several non-specific stimuli especially
in women of 20-40 years.
Symptoms of vasomotor rhinitis include excessive clear rhinorrhoea,
nasal obstruction/congestion, irritation, paroxysmal sneezing and
post-nasal drip. Nasal mucosa is hypertrophied & congested; and
mucosa of turbinates may give mulberry like appearance and is pale
to dusky red in colour.
Complications of vasomotor rhinitis include hypertrophic rhinitis &
sinusitis, and nasal polyp.
Treatment
Treatment of vasomotor rhinitis includes : -
1. Conservative treatment
Avoidance of physical factors which provoke symptoms.
Antihistaminics and oral or nasal decongestants.
Topical or systemic steroids
2. Surgical treatment
Nasal obstruction can be relieved by measures which reduce the
size of hypertrophied nasal turbinate : -Cryosurgery, submucosal
diathermy, Linear cauterization, partial or total turbinectomy,
submucosal
resection of turbinate.
Excessive rhinorrhoea in vasomotor Rhinitis not corrected by
medical therapy and bothersome to the patient, is relieved by
sectioning the parasympathetic secretomotor fibres to nose i.e.,
vidian neurectomy.

medpox.com
 1137. Young's operation is done for
a) Allergic rhinitis

b) Atropic rhinitis

c) Vasomotor rhinitis

d) Idiopathic rhinitis

Correct Answer - B
Ans. is 'b' i.e., Atrophic rhinitis [Ref Dhingra 5th/e p. 171;
Essential otolaryngology 2"d/e p. 523]
Surgical treatment of Atrophic rhinitis
1. Young's operation medpox.com
2. Modified Young's operation
3. Narrowing of the nasal cavity by (Lautenslagers operation)
4. Lautenslagers operation
1138. Which of the following is the most common form of malignant melanoma?
a) Nodular

b) Superficial spreading

c) Acral lentiginous

d) Mucosal

Correct Answer - B
The commonest type of melanoma is the superficial spreading melanoma (SSM). The
melanoma progress through 3 phases: in situ, radial growth, vertical growth.
NB: A primary melanoma with no recognizable adjacent in situ or radial growth phase is
nodular melanoma.
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Melanoma with similar prevalence in all ethnic groups- acral lentiginous

Ref: Rook's textbook of dermatology, Edition-8, Page-54.45.
1139. Rhinoscleroma occurs due to ?
a) Autoimmune cause

b) Inflammatory cause

c) Klebsiella rhinoscleromatis infection

d) Mycotic infection

Correct Answer - C
Ans. is 'c' i.e., Klebsiellarhinoscleromatis infection
Rhinoscleroma
The causative organism is Klebsiellarhinosclerontatisor Frisch
bacillus, which can be cultured from the biopsy material.
medpox.com
The disease is endemic in several parts of world.
In India, it is seen more often in northern than in the southern parts.
Biopsy shows infiltration of submucosa with plasma cells,
lymphocytes, eosinophils, Mikulicz cells & Russell bodies.
The latter two are diagnostic features of the disease.
The disease starts in the nose & extends to nasopharynx,
oropharynx, larynx, trachea & bronchi.
Mode of infection is unknown.
Both sexes of any age may be affected.
1140. Complication of trauma to danger area
of face ?
a) Cavernous sinus infection

b) Meningitis

c) Visual loss

d) Loss of memory

Correct Answer - A
Ans. is 'a' i,e., Cavernous sinus infection
The area of upper lip and the lower part of nose is the danger area
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of face. It is due to that this area is the common site of infection.
This area is drained by facial vein which communicates with the
cavernous sinus through the superior ophthalmic vein and pterygoid
venous plexus through the emissary vein.
In case of any infection of this area it may spread to the cavernous
sinus causing infection and/or thrombosis.
1141. Tympanoplasty deals with
reconstruction of -
a) Tympanic membrane

b) Ossicular chain

c) Both a and b

d) None of the above

Correct Answer - C
Ans. is 'c' i.e., Both a and b
Tympanoplasty is the surgical operation performed for
medpox.com
reconstruction of tympanic membrane and/or middle ear ossicles.
Myringoplasty is the reconstruction of tympanic membrane.
Ossiculoplasty is the reconstruction of ossicular chain.
Tympanoplasty = Myringoplasty ± ossiculoplasty
 1142. Graft for myringoplasty
a) Temporalis fascia

b) Iliacus fascia

c) Coles fascia

d) I hotibial band

Correct Answer - A
Ans. is 'a' i.e., Temporalis fascia
Graft material used for myringoplasty are :
i. Temporalis fascia (most common)
ii. Tragal cartilage medpox.com
iii. Perichondrium from the tragus
iv. Vein
1143. Pyriform fossa is situated in ?
a) Oropharynx

b) Hypopharynx

c) Nasopharynx

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., Hypopharynx
Pyriform fossa is a part of laryngopharynx (hypopharynx)

medpox.com
1144. Most common site for carcinoma
pharynx in females suffering from
plummer vinson syndrome is
a) Post cricoid region

b) Posterior wall

c) Lateral wall

d) Pyriformis fossa

Correct Answer - A
Ans. is 'a' i.e., Post cricoidmedpox.com
Plummer-Vinson syndrome
Plummer-Vinson syndrome, also known as Brown-Kelly-Paterson
syndrome or sederopenic dysphagia, seen in middle aged
edentulous women.
The plummer Vinsion Paterson Brown Kelly Syndrome is
characterized by : -
Dysphagia
Chronic iron deficiency anemia
Atrophic oral mucosa and glossitis
Brittle, spoon-shaped fingernails (Koilonychia)
The cause of dysphagia is usually a cervical esophageal web, but
abnormal pharyngeal and esophageal motility may play a role.
The syndrome characterstically occurs in middle aged edentulous
(without teeth) women.
It is a premalignant lesion. Approximately 10% of patient develop
squamous cell Ca of esophagus, oral cavity or the hypopharynx.
As iron-deficiency anemia is a common finding, it is also known as
sideropenic dysphagia.
Carcinoma develops in post-cricoid region.

medpox.com
1145. Turban epiglottis is seen in ?
a) TB

b) Leprosy

c) Laryngeal papilloma

d) Epiglottitis

Correct Answer - A
Ans. is 'a' i.e., TB
Tubercular larvn_gitis
Tubercular laryngitis is almost always secondary to pulmonary
lesions, mostly affecting males in middle age (20-40 years). Disease
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affects the posterior third of larynx more commonly than anterior
part.The parts affected in descending order of frequency are :- i)
Interarytenoid fold, ii) Ventricular band, iii) Vocal cords, iv) Epiglottis
Clinical features
Weakness of voice with periods of aphonia earliest symptoms. o
Hoarsness, cough, dysphagia (odynophagia)
Referred otalgia
Laryngeal examination in TB laryngitis
Hyperaemia of the vocal cord in its whole extent or confined to
posterior part with impairment of adduction is the first sign.
Swelling in the interarytenoid region giving a mammilated
appearance.
Ulceration of vocal cord giving mouse-nibbled appearance.
Superficial ragged ulceration on the arytenoids and interarytenoid
region.
Granulation tissue in interarytenoid region or vocal process of
arytenoid.
Pseudoedema of the epiglottis "turban epiglottis".
Swelling of ventricular bands and aryepiglottic folds.
Marked pallor of surrounding mucosa.

medpox.com
1146. Another name for oral thrush is ?
a) Candidiasis

b) Herpangina

c) Vincent's infection

d) Hand foot and mouth disease

Correct Answer - A
Ans. is 'a' i.e., Candidiasis
Oral thrush
Also called: oral candidiasis
It is the fungal infection of the oral cavity. It is caused by candida
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albicans.
It manifests as greyish white patches on the oral mucosa and
tongue.\When wiped off it leaves an erythematous mucosa.
This is more common in infants and children. Adults suffering fro
diabetes, malignancy, taking broad spectrum oral antibiotics,
radiation, cytotoxic drugs or steroids can also be affected.
It is treated by topical application of nystatin or clotrimazole.
Chronic Hypertrophic Candidiasis (Candidial Leukoplakia)
Appears as a white patch in the oral cavity which cannot be wiped
off.
It mostly affects the anterior buccal mucosa just behind the angle of
mouth.
It is treated by excision of the lesion.
1147. BSGT stands for ?
a) Bagolini striated glasses test

b) Bagolini smooth glasses test

c) Bagolini shiny glasses test

d) Bagolini second glue test

Correct Answer - A
Ans. is 'a' i.e., Bagolini striated glasses test
Bagolini striated glasses test, or BSGT, is a subjective clinical test to
detect the presence or extent of binocular functions and is generally
performed by an orthoptist. It is mainly used in strabismus clinics.
medpox.com
1148. Melanocytes in conjunctiva are derived
from ?
a) Neural ectoderm

b) Surface ectoderm

c) Mesoderm

d) Neural crest

Correct Answer - D
Ans. is 'd' i.e., Neural crest

medpox.com
1149. Density of cells in adult corneal
endothelium ?
a) 2000 cells/mm2

b) 3000 cells/mm2

c) 4000 cells/mm2

d) 5000 cells/mm2

Correct Answer - B
Ans. is 'b' i.e., 3000 cells/mm2
The cell density of corneal endothelium is around 3000 cells/mm2 in
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young adults, which decreases with the advancing age.
1150. No movement of Red reflex in
retinoscopy -
a) No refractive error

b) Myopia of 3D

c) Myopia of ID

d) Hypermetropia

Correct Answer - C
Ans. is 'c' i.e., Myopia of ID
Retinoscopy
medpox.com
Retinoscopy, also called skiascopy or shadow test, is an objective
method of finding out the error of refraction by the method of
neutralization.
Retinoscopy is based on the fact that when a light is reflected from a
mirror into the eye, the direction in which the light will travel across
the pupil will depend upon the refractive state of the eye.
With the help of a retinoscope, light is thrown onto the patient's eye
and through a hole in the retinoscope's mirror the examiner
observes of red reflex in the pupillary area of the patient.
Then the retinoscope is moved in horizontal the vertical meridia
keeping a watch on red reflex, which also moves when the
retinoscope is moved.
 1151. Maximum refractive index ?
a) Cornea

b) Air

c) Lens

d) Vitreous

Correct Answer - C
Ans. is 'c' i.e., Lens
1. Refractive index of various eye parts
1. Cornea-1.376
2. Aqueous humor-1.336 medpox.com
3. Lens(from cortex to core)-1.386-1.406
4. Vitreous humor-1.336
2. How to memorise!
a. The refractive index depends upon the optical density
1. Aqueous and vitreous being fluids have low density-
have low refractive index.
2. Cornea is less optically dense than lens.(cornea is thinner than
lens!)
b. So remember 4 values
1. i. 1.336-aqueous/vitreous
2. ii. 1.376-cornea
3. iii. 1.386-cortex of lens
4. iv. 1.406-core or centroid of lens
c. Also remember,the refractive index of the anterior surface of lens
is greater than the posterior surface.
1152. Imbert-Fick law is associate with ?
a) Schiotz tonometry

b) Applanation tonometry

c) Pachymetry

d) Keratometry

Correct Answer - B
Ans. is 'b' i.e., Applanation tonometry
Applanation tonometry
The concept of applanation tonometry was introduced by Goldmann
is 1954. It is based on Imbert- Fick lawwhich states that the pressure
medpox.com
inside a sphere (P) is equal to the force (W) required to flatten its
surface divided by the area of flattening (A); i.e., P = W/A.
1153. Corneal endothelial cell count is
measured by ?
a) Specular microscope

b) Ophthalmoscope

c) Synoptophore

d) Amsler's grid

Correct Answer - A
Ans. is 'a' i.e., Specular microscope
Corneal endothelium is examined with specular microscope, which
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allows a clear morphological study of endothelial cells including
photographic documentation.
The cell density of endothelium is around 3000 cells/mm2 in young
adults, which decreases with advancing age.
1154. Quantification of corneal sensation is
done by ?
a) Pachymeter

b) Keratometer

c) Aesthesiometer

d) Tonometer

Correct Answer - C
Ans. is 'c' i.e., Aesthesiometer
Measurement of Corneal Sensitivity
medpox.com
Corneal sensitivity may be tested by touching it in various places
with a wisp of cotton-wool twisted to a fine point and comparing the
effect with that on the other, normal cornea. There is in general a
brisk reflex closure of the lids.
Corneal sensations are often diminished after any gross disorder,
but the change is of diagnostic significance in certain cases,
particularly herpes keratitis where minimal corneal changes are
accompanied by a gross diminution of sensation.
Quantification of the corneal sensation is possible to some degree
by the use of a corneal aesthesiometer in which a single horse hair
of varying length is used instead of a wisp of cotton-wool. The
longest length which induces blinking is a measure of the threshold
of corneal sensitivity.
1155. Amsler's grid is used to evaluate ?
a) Central 10 degress of vision

b) Central 20 degrees of vision

c) Peripheral vision

d) Lens opacity

Correct Answer - A
Ans. is 'a' i.e., Central 10 degress of vision
Metamorphopsia is a phenomenon wherein the patient perceives
objects to have an altered, irregular contour or shape. For example,
graph paper lines may be bent or obscured in areas.
medpox.com
This can be reviewed for any changes over time using an Amsler
grid, which tests the central 10° of vision.
It is associated with diseases affecting the macula such as central
serous choroidopathy, age- related macular degeneration, diabetic
macular oedema and macular hole.
1156. Objective methods for checking the
refractive error are all except
a) Ophthalmoscopy

b) Retinoscopy

c) Refractometry

d) Keratometry

Correct Answer - A
Ans. is 'a' i.e., Ophthalmoscopy
The procedure of determining and correcting refractive errors is
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termed as refraction. The refraction comprises two complementary
methods : ?
A) Objective methods : Objective methods of refraction include :- (i)
Retinoscopy, (ii) Refractometry, (iii) Keratometry.
B) Subjective methods : These are :- (i) Subjective verification of
refraction, (ii) Subjective refining of refraction, (iii) Subjective
binocular balancing.
 1157. Floaters are seen in following except ?
a) Vitreous hemorrhage

b) Retinal detachment

c) Uveitis

d) Acute congestive glaucoma

Correct Answer - D
Ans. is `d' i.e., Acute congestive glaucoma
Floaters
A floater is something in the fluids of the eye that casts a shadow on
the retina and looks like a dark spot or spots floating around in the
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field of vision. Floaters are usually described by patients, as small,
semitranslucent particles of varying shapes moving across the visual
field with the movement of the eye. Floater can only be seen with the
eyes open and in a lighted environment. Floaters are usually grey or
black, since they are actually shadow on the retina.
Causes of floaters are :-
i. Posterior vitreous detachment (PVD)
ii. Bleeding (vitreous hemorrhage)
iii. Retinal detachment
iv. Inflammation of eye (uveitis)
v. High myopia
1158. Newborn eye is ?
a) Myopic

b) Hypermetropic

c) Presbyopic

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., Hypermetropic
Eye at birth
Anteroposterior diameter of eye ball is about 16.5 mm (70% of adult
size). Adult size is attained by 7-8 years.
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Corneal diameter is about 10 mm. Adult size (11.7 mm) is attained
by 2 years of age.
Anterior chamber is shallow and angle is narrow.
Lens is spherical at birth.
Retina :- Apart from macular area, the retina is fully differentiated.
Macula differentiates 4-6 months after birth.
Myelination of optic nerve fibres has reached the lamina cribrosa.
New born is usually hypermetropic by +2 to +3D.
Orbit is more divergent (50°) as compared to adult (45°).
Lacrimal gland is still underdeveloped and tears are not secreted.
1159. Gaze fixation takes place at which age ?
a) 3 months

b) 6 months

c) 1 year

d) 2 years

Correct Answer - B
Ans. is 'b' i.e., 6 months
Gaze Fixation starts developing in the first month and is completed
in 6 months.
Macula is fully developed by 4 - 6 months.
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Fusional reflexes, stereopsis and accommodation is well developed
by 4 - 6 months.
Cornea attains normal adult diameter by 2 years of age.
Lens grows throughout life.
1160. Subconjunctival cyst is seen in?
a) Toxoplasmosis

b) Cysticercosis

c) Leishmaniasis

d) Chaga's disease

Correct Answer - B
Ans. is b i.e., Cysticercosis
Parasitic cysts occurs in subconjunctival cysticercus, hydatid cyst
and filarial cyst.
medpox.com
1161. Cause of blindness in pterygium ?
a) Astigmatism

b) Loss of visual axis

c) Cataract

d) Limitation of ocular movements

Correct Answer - A
Ans. is 'a' i.e., Astigmatism
Ptervgium
Pterygium is a non-cancerous (non-neoplastic) growth of
conjunctiva, characterized by a wing-shaped fold of conjunctiva
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encroaching upon the cornea from either side within the
interpalpebral fissure. Pterygium is always situated in the palpebral
aperture.
Pathologically Pterygium is a degenerative and hyperplastic
condition of conjunctiva. The subconjunctival tissue undergoes
elastotic degeneration and proliferates as vascularized granulation
tissue under the epithelium, which ultimately encroaches the cornea.
The corneal epithelium, Bowman's layer and stroma are destroyed.
Etiology & Clinical features
Pterygium is more common in people with excess outdoor exposure
to sunlight (UV rays), dry heat, high wind and abundance of dust.
Therefore it is more common in those who work outdoors.
Clinically it presents as a triangular fold of conjunctiva encroaching
the cornea in the area of palpebral aperture, usually on the nasal
side. Other findings are stocker's line (deposition of iron)
Ptergyium is an asymptomatic condition in the early stages, except
for cosmetic intolerance. Visual disturbance or corneal astigmatism
may occur. Visual disturbances are due to encroachment of
pterygium on pupillary area or corneal astigmatism.
Occasionally diplopia may occur due to limitation of ocular
movements.
Treatment
Asymptomatic pterygium which is not progressive is best left alone.
Surgical excision is the only satisfactory treatment and is
indicated for : - (1) Cosmetic reasons, (2) Continued progression
threatening to encroach onto the pupillary area (once the pterygium
has encroached pupillary area, wait till it crosses on the other side),
(3) Diplopia due to interference in ocular movement.

medpox.com
 1162. What is the most common problem
following surgical treatment of
pterygium?
a) Recurrence

b) Corneal ulceration

c) Astigmatism

d) Scleral scarring

Correct Answer - A
Ans. is 'a' i.e., Recurrencemedpox.com
Surgical excision of pterygium is its only satisfactory treatment
and is indicated for ?
1. Cosmetic reasons
2. Continued progression threatening to encroach onto the pupillary
area (once the pterygium has encroached pupillary area, wait till it
crosses on the other side)
3. Diplopia due to interference in ocular movements.
Recurrence of the pterygium after surgical excision is the most
common problem after pterigium excision and is seen in 30 - 50 % of
the cases.
The post operative complications of pterigium surgery are:
1. Recurrence (most common)
2. Others : Bleeding, corneal thinning, scarring, fornix loss,
symblepharon formation, rectus muscle injury, wound dehiscence,
dellen formation, graft chemosis, conjunctival granuloma, epithelial
inclusion cysts, astigmatism etc.
1163. Cause of blindness in trachoma ?
a) Scarring

b) Pannus

c) Chronic dacrocystitis

d) Entropion

Correct Answer - A
Ans. is 'a' i.e., Scarring
The later structural changes of trachoma are referred to as
"cicatricial trachoma".
These include scarring in the eyelid (tarsal conjunctiva) that leads to
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distortion of the eyelid with buckling of the lid (tarsus) so that eye
lashes rub on the eye (trichiasis).
Rubbing of eye lashes of scarred eye lids against the cornea
leads to corneal opacities and scarring and then to blindness.
Thus actual cause of blindness is corneal opacity and scarring,
which may be secondary to eyelid scarring.
1164. Angular conjunctivitis is caused mainly
by
a) Moraxella axenfeld

b) Staphylococcus aureus

c) Streptococcus pneumonae

d) Pseudomonas aeruginosa

Correct Answer - A
Ans. is 'a' i.e., Moraxella axenfeld
Angular conjunctivitis (diplobacillary conjunctivitis)
medpox.com
It is a type of chronic conjunctivitis characterized by mild grade
inflammation confined to conjunctiva and lid margins near the angles
associated with maceration of the surrounding skin.
Moraxella axenfeld (Moraxella lacunata), a diplobacillus, is the
commonest causative organism.
Less commonly, staphylococcus aureus can also cause angular
conjunctivitis.
Source of infection: Nasal tract of healthy people and the nasal
discharge of patients with angular conjunctivitis.
It spreads from the nasal cavity to the eye by contaminated hands
and handkerchief.
Angular conjunctivitis responds to tetracycline
ointment, Oxytetracycline for 10 to 14 days.
Eye drops containing zinc inhibit the proteolytic ferment and are of
great value although less rapidly effective, and may be used in
addition to tetracycline.
 1165. Keratitis is caused by ?
a) Bacteria

b) Atopy

c) Protozoa

d) All

Correct Answer - D
Ans. is 'd' i.e., All
Causes of keratitis
1. Infective keratitis
a. Bacterial medpox.com
b. Viral
c. Fungal
d. Chlamydial
e. Protozoal
f. Spirochaetal
2. Allergic keratitis
a. Phlyctenular keratitis
b. Vernal keratitis
c. Atopic keratitis
3. Trophic keratitis
a. Exposure keratitis
b. Neuroparalytic keratitis
c. Keratomalacia
d. Atheromatous ulcer
4. Keratitis associated with diseases of skin and mucous membrane.
5. Keratitis associated with systemic collagen vascular disorders.
6. Traumatic keratitis, which may be due to mechanical trauma,
chemical trauma, thermal burns, radiations.
 7. Idiopathic keratitis e.g.,
a. Mooren's corneal ulcer
b. Superior limbic keratoconjunctivitis
c. Superficial punctate keratitis of Thygeson

medpox.com
1166. Munson's sign is a feature of ?
a) Keratoconus

b) Corneal ulcer

c) Pterygium

d) Posterior staphyloma

Correct Answer - A
Ans. is 'a' i.e., Keratoconus
Kerotoconus
Keratoconus is a progressive, noninflammatory, bilateral ectatic
corneal disease, characterizedparaxia/stromal thinning and
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weakening that leads to corneal surface distortion.
Essential pathological changes are thinning and ectasia which occur
as a result of defective synthesis of mucopolysaccharide and
collagen tissue.
It usually starts at puberty and progresses slowly.
Symptoms usually begins as blurred vision with shadowing around
images.
Vision becomes progressively more blurred and distorted with
associated glare, halos around lights, light sensitivity and ocular
irritation.
Visual loss occurs primarily from irregular astigmatism and myopia,
and secondarily from corneal scarring. o The hallmark of
keratoconus is central or paracentral stromal thinning, apical
protrusion of anterior corneaand irregular astigmatism.
The cornea thins near the centre and progressively bulges forwards,
with the apex of cone always being slightly below the centre of the
cornea.
Important findings an examination are -
i) Distarted window reflex (Corneal reflex)e.
ii) Fleisher's rine.
iii) Yawning reflex (Scissor reflex).
iv) Oil drop reflex.
v) Munson's signs
Treatment includes :?
1) Spectacles for regular or mild irregular astigmatism.
2) Rigid gas permeable contact lens for higher astigmatism.
3) Epikeratoplasty in patients intolerant to lens and without
significant corneal scarring.
4) Keratoplasty penetrating or deep lamellar if there is significant
corneal scarring.

medpox.com
1167. Safe size of corneal graft with less
chances of failure is ?
a) 7.5 mm

b) 6.5 mm

c) 5.5 mm

d) 4.5 mm

Correct Answer - A
Ans. is 'a' i.e., 7.5 mm
Correlation of corneal graft diameter and chances of graft failure
medpox.com
Increased corneal graft size has been reported in some studies to be
a significant risk factore for graft rejection.
Other studies refute this and point to smaller graft size as more likely
to be rejected.
There is increased risk of rejection and endothelial failure in small
grafts with recipient size < 7mm and also increased risk of rejection
in large grafts with graft size > 8.5 mm.
Thus the corneal graft with graft diameter between 7 and 8.5 mm
has more chances of survival.
 1168. Koeppe's nodules are type of ?
a) Granulomatous uveitis

b) Non granulomatous uveitis

c) Coroiditis

d) Pars planitis

Correct Answer - A
Ans. is 'a' i.e., Granulomatous uveitis
Nodules on the iris surface. These are observed in
granulomatous uveitis (Koeppe’s and Busacca’s nodules),
melanoma, tuberculoma and gumma of the iris
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Iris nodules
There are many types of nodules that develop on iris in
granulomatous uveitis :-
i. Keoppe nodule :- Seen at pupillary margin.
ii. Busacca's nodule :- Seen on the peripheral part of anterior surface
of iris.
iii. Tubercular nodules :- Scattered throughout the iris and ciliary body,
mostly in stroma. They are more common at pupillary margin.
iv. Syphilitic nodules :- At pupillary margin.
v. Sarcoid nodules :- At pupillary margin or in the stroma of the iris.
1169. Pars planitis is ?
a) Anterior uveitis

b) Intermediate uveitis

c) Posterior uveitis

d) Pan uveitis

Correct Answer - B
Ans. is b i.e., intermediate uveitis
Uveitis
Uveitis refers to the inflammation of uveal tissue.
However, practically there is always some associated inflammation
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of the adjacent structures such as retina, vitreous, sclera and
cornea.
Due to close relationship between the anatomically distinct part of
the uveal tract, the inflammatory process usually involve the uvea as
a whole and are generally not limited to a single part.
However, the uveitis is classified according to the part of uvea which
is clinically more affected. For example, the term iritis is used when
iris appears to be more affected.
Anatomical classification of uveitis
1. Anterior uveitis. It is inflammation of the uveal tissue from iris up
to pars plicata of ciliary body. It may be subdivided into -
Iritis, in which inflammation predominantly affects the iris.
Iridocyctitis in which iris and pars plicata part of ciliary body are
equally involved, and
Cyclitis, in which pars plicata part of ciliary body is predominatly
affected.
2. Intermediate uveitis. It includes inflammation of the pars plana
and peripheral part of the retina and underlying `choroid'. It is also
called 'pars planitis'.
3. Posterior uveitis. It refers to inflammation of the choroid
(choroiditis). Always there is associated inflamation of retina and
hence the term `chorioretinitis' is used.
4. Panuveitis. It is inflammation of the whole uvea.

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 1170. Anterior uveitis earliest lesion ?
a) Aqueous flare

b) Keratic precipitates

c) Circumcorneal congestion

d) Blurring of vision

Correct Answer - A
Ans. is 'a' i.e., Aqueous flare
Aqueous flare is the earliest sign of acute anterior uveitis.
Keratic precipitates is the pathognomic sign of acute anterior uveitis
Clinical features of acute anterior uveitis
medpox.com
Acute anterior uveitis is the most common form of uveits, accounting
for 60-70% of cases. It is characterized by sudden onset and
duration less than 3 months. Presentation is typical with sudden
onset of unilateral pain, photophobia, redness, lacrimation and
blepherospasm. Vision may be normal initially. However, later there
may be distrubance in vision due to ciliary spasm (induced myopia),
corneal haze (due to edema & 1(13s) and aqueous turbidity.
External examination shows following signs :-
i. Circumcorneal (ciliary) congestion Which has a violaceous hue.
ii. Corneal edema, posterior corneal opacities.
iii. Keratic precipitates (KPs):- are proteinaceous cellular deposits at the
back of cornea on endothelium.
iv. Anterior chamber signs :- Aqueous cells, Aqueous flare, hypopyon,
hyphaemia (in hemorrhagic uveitis), deep anterior chamber (If
posterior synachiae occurs).
v. Iris signs :- Blurred & indistinct iris, i.e. muddy iris, instead of being
clear and sharply defined.
vi. Papillary signs :- Narrow (miotic) pupil, irregular pupil due to
segmental posterior synechiae which gives festooned appearance
(festooned pupil) when dilated with atropine, sluggish pupillary
reaction, ectropion pupillae (evertion of pupillary margins), occlusio
pupillae (due to complete occlusion of pupil by organised exudate).

medpox.com
1171. Which of the following indicates activity
of anterior uveitis?
a) Cells in anterior chamber

b) Circumcorneal congestion

c) Keratic precipitate

d) Corneal edema

Correct Answer - A
Ans. is 'a' i.e., Cells in anterior chamber
Activity of acute anterior uveitis is indicated by presence of cells
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(aquous cells) and flare in anterior chamber→Grading is done on
these two.
Grade Aquous cells Grade Aquous flare
0 cells 0no flare
+_ 1-5 cells +1Just detectable
+1 6-10 cells +2Moderate flare
+2 11-20 cells +3Marked flare
+3 21-50 cells +4Intense flare
+4 > 50 cells
1172. Which of the following condition is associated with the development of
posterior staphyloma?

a) Pathological myopia

b) Retinoblastoma

c) Acid injury

d) Sympathetic ophthalmia

Correct Answer - A
Posterior staphyloma, the posterior outpouching of the wall of the
eye, is an important component of the diagnosis of pathologic
myopia; indeed, it is one of the hallmarks of pathologic myopia.
With the exception of inferior staphyloma related to tilted disc
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syndrome, it does not occur in pathologies other than pathologic
myopia.
Thus, the presence of staphyloma is specific to pathologic myopia
and critically important in differentiating simple school myopia with
good best corrected visual acuity (BCVA) and pathologic myopia
that could cause the loss of BCVA.
1173. Following is feature of Fusch's hetero
chromic iridocyclitis ?
a) Heterochromia of iris

b) Keratic precipitates

c) Posterior subcapsular cataract

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
Fuch's heterochromic iridocyclitis (Fuch's uveitis syndrome)
medpox.com
It is a form of anterior and intermediate uveitis.
The condition is usually unilateral and chronic in nature and is
characterized by a chronic non-granulomatous uveitis and eventually
results in iris heterochromia (a change in the colour of iris).
The disease has following characteristic features :
i) Heterochromia of iris
ii) Diffuse stromal iris atrophy
iii) Fine KPs at back of cornea
iv) Faint aqueous flare
v) Absence of posterior synechiae
vi) A fairly common rubeosis iridis, sometimes associated with
neovascularisation of the angle of anterior chamber.
vii) Comparatively early development of complicated cataract and
secondary glaucoma (usually open angle type). Glaucoma has been
reported in 10-59% of cases.
Treatment
Fuch's heterchromic uveitis responds variable to steroids and
cycloplegics. The complications of long term use of these drugs may
at times outweigh their potential benefits. Therefore, treatment with
topical steroids is given to iritis which is sufficiently active to require
the treatment, otherwise the patient is routinely followed without
giving any treatment.
Cataract responds well to most forms of intraocular surgeries,
including the standard IOL implantation. Hyphemia may occur
because of rubeosis iridis (neovascularization of iris).
Glaucoma control may be somewhat more problematic, with surgical
options indicated for later forms of disease

medpox.com
1174. Recurrent non-granulomatous uveitis is
seen in?
a) Vogt koyanagi-Harada syndrome

b) Posner-Schlossman syndrome

c) Tuberculosis

d) Sarcoidosis

Correct Answer - B
Ans. is `b' i.e., Posner-Schlossman syndrome
Glaumatocyclic crisis
medpox.com
Glamatocyclitic crisis (Posner - Schlossman syndrome) is a
unilateral recurrent non- granulomatous iritis that is associated with
an elevated ocular pressure during the attacks. This self- limiting
condition tends to occur in persons during the third to sixth decade
and the visual fields, the optic nerve head, and anterior chamber
angle are normal. A mild inflammatory reaction is very rarely present
as evidenced by a few keratic precipitates on the posterior surface of
the cornea. The cause of the glaucoma remains unknown, but a
trabeculitis is suspected. Many patients (55%) subsequently develop
open angle glaucoma.
1175.

medpox.com
Optic canal is a part of ?
a) Lesser wing of sphenoid

b) Greater wing of sphenoid

c) Ethmoid

d) Pterygoid

Correct Answer - A
Ans. is 'a' i.e., Lesser wing of sphenoid
The optic nerve leaves the orbit is the optic canal to enter the cranial
vault.
The optic canal is the most posterior landmark of the orbit. It
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measures 10 mm in length.
The thin piece of bone separating the optic canal from the superior
orbital fissure is the optic strut.
The optic strut and optic canal are a part of the lesser wing of
sphenoid bone.
1176. Treatment of presbyopia is by use of
which lens?
a) Convex

b) Concave

c) Biconcave

d) Concavoconvex

Correct Answer - A
Ans. is 'a' i.e., Convex
Presbvopia
medpox.com
Presbyopia is a vision condition in which the crystalline lens of eye
loses its flexibility, which make it difficult to focus on the objects
closer to the eye. Presbyopia is not an error of refraction but a
condition of physiological insufficiency of accommodation leading to
a progressive fall in near vision. Presbyopia is an age related
problem, therefore also called eye sight of old age.
Symptoms are usually seen after 40 years of age.
Presbyopia is not a disease, rather a natural part of the aging
process of the eye.
The treatment of presbyopia is the prescription of appropriate
convex glasses for near work.
 1177. Gland of Moll opens in/on the ?
a) Skin

b) Hair follicle

c) Tarsal plate

d) Ducts of Meibomian glands

Correct Answer - B
Ans. is 'b' i.e., Hair follicle
GLANDS OF EYELIDS :
i. Meibomian glands : These are also known as tarsal glands and are
present in the stroma of tarsal plate arranged vertically. They are
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modified sebaceous glands. Their ducts open at the lid margin. Their
secretion constitutes the oily layer of the tear film.
ii. Glands of Zeis : These are also sebaceous glands, which open into
the follicles of eyelashes.
iii. Glands of Moll : These are modified sweat glands situated near the
hair follicle. They open into the hair follicles or into the ducts of Zeis
glands. They do not open directly onto the skin surface or
elsewhere.
iv. Accessory lacrimal glands of Wolfring : These are present near the
upper border of the tarsal plate.
1178. All are true about Bullous keratopathy
except ?
a) Seen in Macular dystrophy

b) Treatment is lamellar kertoplasty

c) Lenses can be prescribed for such patients

d) Seen in Fuch's dystrophy

Correct Answer - A
Ans. is 'a' i.e., Seen in Macular dystrophy
Fuch's epithelial - endothelial dystrophy
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Fuch's dystrophy-slowly progressive bilateral condition affecting
females more than males. Primary open angle glaucoma is
associated with this condition.
Stages and clinical features
i) Stage of cornea guttata
Hassal - Henle type of excrescences in the central part of cornea.
A gradual increase of central guttae with peripheral spread and
confluence gives rise to the so called 'beaten - metal' appearance.
This stage is asyptomatic.
ii) Oedematous stage or Stage of endothelial decompensation
Early stromal edema and epithelial dystrophy
Patients complain of blurring of vision.
iii) Stage of Bullous keratopathy
Follows long standing stromal edema
Marked epithelial edema with formation of bullae, which when
rupture cause pain, discomfort and irritation with associated
decreased visual acuity.
iv) Stage of scarring
Cornea becomes opaque and vascularized.
 May be complicated by secondary infection or glaucoma.
Treatment
i. Edematous stage : 5% Sodium chloride (Hypertonic saline)
ii. Bullous keratopathy: Bandage soft contact lenses.
iii. Penetrating kertaoplasty : treatment of choice.

medpox.com
1179. All of the following has HLAB27
associated with uveitis except ?
a) Ankylosing spondylitis

b) Reiters syndrome

c) Behcets syndrome

d) None of the above

Correct Answer - C
Ans. is 'c' i.e., Behcets syndrome
A few examples of HLA-associated diseases with uveitis are as
follows : medpox.com
i) HLA-B27 : Acute anterior uveitis associated with ankylosing
spondylitis and also in Reiter's syndrome.
ii) HLA-B5 : Uveitis in Behcet's disease.
iii) HLA-DR4 and DW15 : Vogt Koyanagi Harada's disease.
 1180. Fundus in retinitis Pigmentosa is ?
a) White spots with red disc

b) Jet- black spots with pale-waxy disc

c) No pigmentation

d) Dilatation of arterioles

Correct Answer - B
Ans. is 'b' i.e., Jet- black spots with pale-waxy disc
Examination findings in retinitis pigmentosa
Ophthalmoscopic findings are characteristic and include :-
i. Retinal pigmentary changes (Bone spicule intraneural retinal
medpox.com
pigmentation) : - Retina studded with small, jet-black spots
resembling bone corpuscles with a spidery outline. These
pigmentary changes are typically perivascular and retinal veins
(never arteries) have a sheath of pigment for part of their course.
These changes affect equatorial region initially sparing the posterior
pole and periphery. Later in the course of disease whole retina is
involved.
ii. Attenuated and thread like retinal arterioles and veins.
iii. Pale and waxy optic disc (consecutive optic atrophy).
iv. Thinning and atrophy of retinal pigment epithelium (RPE) in mid and
far peripheral retina with relative sparing of RPE at macula.
Electroretinogram (ERG) and particularly the electro-oculogram
(EOG) are markedly subnormal.
1181. Vitreous hemorrhage produces ?
a) Sudden painless loss of vision

b) Sudden painful loss of vision

c) Gradual painless loss of vision

d) Gradual painful loss of vision

Correct Answer - A
Ans. is 'a' i.e., Sudden painless loss of vision

medpox.com
 1182. What is the immediate management of
vitreous hemorrhage in eye ?
a) No treatment

b) Steroids

c) Antibiotics

d) Vitrectomy

Correct Answer - A
Ans. is 'a' i.e., No treatment
Treatment of vitreous haemorrhage :
medpox.com
1. Conervative treatment : Bed rest, elevation of patient's head and
bilateral eye patches. This will allow the blood to settle down.
2. Treatment of the cause : Once the blood settles down, indirect
ophthalmoscopy should be performed to locate and further manage
the causative lesion such as a retinal break, phlebitis, prolifrative
retinopathy, etc.
3. Vitrectomy by pars plana route should be considered to clear the
vitreous, if the haemorrhage is not absorbed after 3 months.
1183. Cherry red spot is seen in ?
a) Niemann - Pick's disease

b) Tay Sach's disease

c) Central retinal artery occlusion

d) All of the above

Correct Answer - D
Ans. is 'd i.e., All of the above
Causes of cherry red spot
GM2 gangliosidoses (Tay sachs & sandhoff)
Hurler's syndrome medpox.com
GM1 gangliosidoses
Cryoglobulinemia
Niemann - Pick's disease
Laber's congenital amaurosis
Gaucher's disease
Sialidosis (galactosialidosis)
Metachromatic leukodystrophy
Mucopolysacharidosis VII
Central retinal artery occlusion (CRAO)
Multiple sulfatase deficiency
Trauma (Berlin's edema / commotio retinae)
Poisoning :- Carbon mono-oxide, methanol
Quinine and Dapsone
Shprintzen-Goldberg syndrome
Farber's disease
Hallervorden Spatz disease
Goldberg's disease
Rarely in krabbe's disease
medpox.com
1184. Retinal detachment occurs between
a) Layers of neurosensory retina

b) Neurosensory retina and pigment epithelium

c) Pigment epithelium and choroid

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., Neurosensory retina and pigment epithelium
Retina has total ten layers from with out inward :- (i) Pigmented
epithelium, (ii) Layers ofRods & cones, (iii) External limiting
membrane, (iv) Outer nuclear layer, (v) Outer plexiform layers, (vi)
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Inner nuclear layer, (vii) Inner plexiform layer, (viii) Ganglionic cell
layer, (ix) Nerve fibre layer, (x) Internal limiting membrane
Broadly these layers are subdivided into two layers based on the
function :?
Neurosensory layer or sensory layer (containing layers ii to x of
above 10 layers) :- for vision.
Pigmented epithelium (layer i) :- Provide metabolic support to
neurosensory layer and acts as an antireflective layer.
So, inner layers are included in neurosensory layer and outer most
layer is retinal pigmented epithelium(RPE).
Retinal detachment is a disorder of eye in which retina peels away
from its underlying layer of support tissue. Usually

there is separation between the neuroepithelium (neurosensory

epithelium or sensory epithelium) and the pigmented
layer, because there is a potential space between these two layers
where fluid can accumulates and can cause separation.
 1185. Retinal tears seen most commonly seen
in ?
a) Primary retinal detachment

b) Secondary retinal detachment

c) Tractional retinal detachment

d) Exudative retinal detachment

Correct Answer - A
Ans. is 'a' i.e., Primary retinal detachment
Retinal detachment is a disorder of eye in which retina peels away
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from its underlying layer of support tissue. Usually there is
separation between the neuroepithelium (neurosensory epithelium)
and the pigmented layer.
The retinal separation is divided into:
1. Primary :- Rheugmatogenous retinal detachment.
2. Secondary :- Tractional retinal detachment and exudative retinal
detachment.
Rhegmatogeneous retinal detachment
This is the commonest type of retinal detachment. This is due to a
retinal break/tear/hole which allows the liquid vitreous to seeps into
the subretinal space and separates the sensory retina from the
pigmentary epithelium.
Predisposing factors include : (i) Myopia, (ii) Previous intraocular
surgery : cataract extraction, (aphakia) or pseudoaphakia); (iii)
Trauma; (iv) Retinal degeneration (Lattice degeneration; Snail track
degeneration, Senile or degenerative retinoschisis.
Tractional retinal detachment
It is due to pulling on the retina usually from fibro-vascular band in
the vitreous cavity, i.e., vitroretinal band.
Exudative retinal detachment (solid retinal detachment)
It occurs due to the retina being pushed away by accumulation of
fluid or a neoplasm beneath the retina. This type of detachment is
caused by inflammatory disorders or by tumors.

medpox.com
1186. Methanol attacks ?
a) Cones

b) Rods

c) Ganglion cells of retina

d) Germinal cell layer

Correct Answer - C
Ans. is 'c' i.e., Ganglion cells of retina
Methyl alcohol is metabolised very slowly and thus stays for a longer
period in the body.
It is oxidised into formic acid and formaldehyde in the tissues. These
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toxic agents cause oedema followed by degeneration of the ganglion
cells of the retina, resulting in complete blindness due to optic
atrophy.
1187. Diabetic ischemic maculopathy is
characterized by all except ?
a) It occurs due to microvascular blockage

b) Mild visual loss

c) Areas of non perfusion are evident on fluorescein angiography

d) Microaneurysms and hemorrhages are seen

Correct Answer - B
Ans. is `b' i.e., Mild visual loss
Ischaemic diabetic maculopathy
medpox.com
It occurs due to microvascular blockage.
Clinically it is characterised by marked visual loss with
microaneurysms, haemorrhages, mild or no macular oedema and a
few hard exudates.
Fluorescein angiography shows areas of non-perfusion which in
early cases are in the form of enlargement of foveal avascular zone
(FAZ), later on areas of capillary dropouts are seen and in advanced
cases precapillary arterioles are blocked.
1188. Refsum's syndrome is associated with
?
a) Retinitis pigmentosa

b) Xerophthalmia

c) Chalcosis

d) Diabetes retinopathy

Correct Answer - A
Ans. is 'a' i.e., Retinitis pigmentosa
Associations of retinitis pigmentosa
medpox.com
Ocular associations : These include myopia, primary open angle
glaucoma, microphthalmos, conical cornea and posterior
subcapsular cataract.
Systemic associations : These are in the form of following
syndromes :-
i) Laurence-Moon-Biedl syndrome : It is characterised by retinitis
pigmentosa, obesity, hypogenitalism, polydactyly and mental
deficiency.
ii) Cockayne's syndrome : It comprises retinitis pigmentosa,
progressive infantile deafness, dwarfism, mental retardation,
nystagmus and ataxia.
iii) Refsum's syndrome : It is characterized by retinitis pigmentosa,
peripheral neuropathy and cerebellar ataxia.
iv) Usher's syndrome : It includes retinitis pigmentosa and
labyrinthine deafness.
v) Hallgren's syndrome : It comprises retinitis pigmentosa, vestibulo-
cerebellar ataxia, congenital deafness and mental deficiency.
1189. Which gas is most commonly used with
pneumatic retinopathy ?
a) SF6

b) C3F8

c) CO2

d) N3

Correct Answer - A
Ans. is 'a' i.e., SF6
Sulfur hexafluoride gas (SF6) is most commonly used with
pneumatic retinopexy. medpox.com
1190. Which antiglaucoma drug decreases
aqueous formation ?
a) Prostaglandins

b) Beta - blockers

c) Mannitol

d) Pilocarpine

Correct Answer - B
Ans. is 'b' i.e., Beta - blockers

medpox.com
1191. Selective alpha 2 agoinst used in
glaucoma ?
a) Tirriolol

b) Epinephrine

c) Dipivefrine

d) Brimonidine

Correct Answer - D
Ans. is 'd' i.e., Brimonidine

medpox.com
1192. Main MOA brimonidine in glaucoma ?
a) Decreased aqueous secretion

b) Increased trabecular outflow

c) Increased uveoscleral outflow

d) Reduce vitreous volume

Correct Answer - A
Ans. is 'a' i.e., Decreased aqueous secretion

medpox.com
1193. Following are the side effects of
apraclonidine except ?
a) Lid dermatitis

b) Follicular conjunctivitis

c) Eye lid retraction

d) Watering of mouth

Correct Answer - D
Ans. is 'd' i.e., Watering of mouth
Apraclonidine
medpox.com
Topical application lowers the intra ocular pressure by 25 %.
It decreases aqueous production by primary alphal and subsidiary
alpha 2 action in ciliary body.
Itching, lid dermatitis, follicular conjunctivitis, mydriasis, eyelid
retraction, dryness of mouth and nose are common side effects.
Its use is restricted to short term control of spikes of intraocular
tension after laser trabeculolasty or iridotomy.
1194. Drug kept as a last resort in the
management of primary open angle
glaucoma is ?
a) Latanoprost

b) Topical beta blocker

c) Brimonidine

d) Oral acetazolamide

Correct Answer - D
Ans. is 'd' i.e., Oral acetazolamide
medpox.com
Treatment of POAG (Primary open angle glaucoma)
Following treatment options are available for POAG :
Medical therapy :- Total medical therapy is the treatment of choice
for POAG. Topical 13-blockers (Timolol, Betoxalol, Levobunolol,
carteolol) are the drugs of choice. Topical prostaglandin analogues
(Latanoprost, bimatoprost, travoprost) are the second choice drugs.
Other topical drugs for POAG are:- LI Alpha agonists (non - selective
: epinephrine, dipivefrine; and Selective - a2: apraclonidine,
brimonidine)
Carbonic anhydrase inhibitors (Dorzalamide, brinzolamide)
Cholinomimetic drugs (Pilocarpine, physostigmine, echothiophate,
carbachol) Pilocarpire has several drawbacks, therefore, is being
considered as an adjunctive therapy only as a last resort.
Approach to treatment of POAG
Start monotherapy with topical P-blocker or latanoprost.
If target IOT is not attained either change over to the alternative drug
or use both the above concurrently.
Brimonidine/dorazolamide/dipivefrine are used only when there are
contraindications to PG analogues or 13-blockers.
Topical miotics and oral acetazolamide are added only as the last
resort.
Systemic therapy is considered only as a last resort. Drugs used for
systemic therapy are :- (i) Carbonic anhydrase inhibitors
(Acetazolamide, Dichlorphenamide, methazolamide), (ii)
Hyperosmotic agents (mannitol, glycerol).

medpox.com
1195. Following is a cause of secondary angle
closure glaucoma ?
a) Pseudophakia

b) Corticosteroid induced

c) Angle recession glaucoma

d) Congenital glaucoma

Correct Answer - A
Ans. is 'a' i.e., Pseudophakia
Causes of secondary angle closure glaucoma
medpox.com
Pupillary block: uveitis, psudophakia
Angle fibrosis: neovascular glaucoma
1196. Laser used to manage after cataract:
March 2005, September 2009
a) Excimer laser

b) Argon green laser

c) Diode laser

d) Nd:YAG laser

Correct Answer - D
Ans. D: Nd:YAG laser
The Nd:YAG laser is a solid state laser that uses a neodymium-
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doped yttrium-aluminum-garnet crystal as the lasing medium. It is
optically pumped with a lamp or diode and most commonly emits
infrared light at 1064nm. It can be used in either a pulsed or
continuous mode. Pulsed YAG lasers are typically Q-switched to
achieve high-intensity pulses, which can be frequency doubled to
emit light at 532nm.
There are numerous ophthalmic applications for Nd:YAG
lasers.
They are most commonly used to treat posterior capsular
opacification after cataract surgery
To create a peripheral iridotomy in patients with narrow angles or
angle-closure glaucoma.
YAG lasers can also be used to cut the anterior capsule for capsular
block syndrome and capsular phimosis
To cut vitreous strands in the anterior chamber.
In malignant glaucoma, disruption of the anterior hyaloid face is
performed with the YAG laser
In refractory glaucomas, these lasers can be used for
cyclophotoablation of the ciliary body.
They have also been helpful for draining premacular subhyaloid
hemorrhages in patients with Valsalva retinopathy.
Panretinal photocoagulation can be performed with frequency-
doubled Nd:YAG lasers.
Other applications include the treatment of recurrent corneal
erosions and vitreous floaters.
Excimer (Argon fluoride) laser is used in photorefractive keratectomy
(PRK), phototherapeutic keratectomy (PTK), LASIK, LASEK
Argon green laser is used in trabeculoplasty, iridoplasty,
pupillomydriasis and retinal photocoagulation Diode laser is used in
retinal photocoagulation

medpox.com
1197. Phacoemulsification incision is at ?
a) Sclero-corneal junction

b) Cornea

c) Sclera

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Sclero-corneal junction
In phacoemulsification very small 3 cmm incision is taken at the
sclerocorneal junction.
Phacoemulsification medpox.com
It is nothing else but an advancement in the method of doing ECCE.
Here the nucleus is converted into pulp or emulsified using high
frequency sound waves, and then sucked out of the eye through a
small (3.2 mm) incision. A special foldable IOL is then inserted into
the posterior chamber through the same incision. ECCE by
phacoemulsification with foldable posterior chamber IOL is the
procedure of choice for cataract.
The steps in phacoemulsification include :(i) Corneoscleral incision,
(ii) Continuous curvilinear capsulorrhexis, (iii) Hydrodissection and
hydrodelineation (iv) Emulsification and aspiration of nucleus and
then cortex, and (v) Foldable IOL implantation in posterior chamber.
Recovery with phacoemulsification is fastest as incision is very small
and no sutures are taken.
1198. Bilateral inferior dislocation of lens is
seen in ?
a) Marfans syndrome

b) Homocystinuria

c) Weil Marchesani syndrome

d) Trauma

Correct Answer - B
Ans. is `b' i.e., Homocystinuria
Ectopia lentis
medpox.com
Ectopia lentis is defined as displacement or malposition of the
crystalline lens of the eye. The lens is considered dislocated
(luxated) when it lies completely outside the lens patellar fossa. The
lens is described as subluxated when it is partially displaced but
contained within the lens space.
1199. Lens dislocation in marfans syndrome
is -
a) Superotemporal

b) Inferonasal

c) Forward

d) Backward

Correct Answer - A
Ans. is 'a' i.e., Superotemporal

medpox.com
1200. Diabetic cataract is due to accumulation
of:
March 2009
a) Fructose

b) Galactose

c) Glucose

d) Sorbitol

Correct Answer - D
Ans. D) Sorbitol medpox.com
The enzyme aldose reductase (AR) catalyzes the reduction of
glucose to sorbitol through the polyol pathway, a process linked to
the development of diabetic cataract.
1201. Cataract is cases of diabetes mellitus is
due to accumulation of ?
a) Glycated crytallins

b) Calcified crystallins

c) Glycated fibrillins

d) Calcified fibrillins

Correct Answer - A
Ans. is 'a' i.e., Glycated crytallins
Diabetic cataract
medpox.com
Senile cataract tends to develop at an earlier age and more rapidly
than usual in diabetic subjects. The lenses of an adult diabetic are
said to be in the same condition as a non-diabetic who is 15 years
older. In diabetic adults, coin- pared to non-diabetics, cataracts are
more prevalent, are dependent on the duration of diabetes and
progress more rapidly. The mechanisms are believed to be
glycation, carbamylation of crystallins and increased oxidative
damage.
True diabetic cataract is a rare condition occurring typi- cally in
young people in whom the diabetes is so acute as to disturb grossly
the water balance of the body. A large number of fluid vacuoles
appear under the anterior -td posterior parts of the capsule, initially
manifesting as myopia and then producing a diffuse opacity which at
this stage is reversible.
The lens then rapidly becomes cataractous, with dense, white
subcapsular opacities in the anterior and posterior cortex resembling
a snowstorm- 'snowflake' cataract. Fine, needle-shaped
polychromatic cortical opacities may also form. With appropriate
treatment to control hyperglycaemia, the rapid progression to mature
cataract may be arrested at this stage.

medpox.com
1202. Soft contact lenses are made of:
a) Polymethyl methacrylate

b) Hydroxymethyl methacrylate

c) Glass

d) Silicone

Correct Answer - B
Ans. Hydroxymethyl methacrylate

medpox.com
1203. Ganglionic cells are, neurons ?
a) First order

b) Second order

c) Third order

d) None

Correct Answer - B
Ans. is 'b' i.e., Second order

medpox.com
1204. Primary action of inferior oblique ?
a) Abduction

b) Adduction

c) Extorsion

d) Elevation

Correct Answer - C
Ans. is 'c' i.e., Extorsion

medpox.com
1205. Right esotropia is evident with ?
a) Left lateral rectus paralysis

b) Right lateral rectus paralysis

c) Left medial rectus paralysis

d) Right medial rectus paralysis

Correct Answer - A
Ans. is 'a' i.e., Left lateral rectus paralysis

medpox.com
1206. Disscociated vertical deviation seen in
?
a) AV dissociation

b) Infantile esotropia

c) Congenital esotropia

d) Superior oblique palsy

Correct Answer - C
Ans. is 'c' i.e., Congenital esotropia
The usual age of presentation of congenital (infantile) esotropia is
medpox.com
between 2-4 months of age. Presentation at birth is very rare.
Infantile esotropia has been classically described as large angle
constant esotropia (not variable).
The classicle triad of associated motor abnormalies in congenital
esotropia is inferior oblique overaction, dissociated vertical deviation
(DVD) and latent nystagmus.
"It seems, from a review of literature, that infants with esotropia
have, on average, refractive errors similar to the normal age
matched population". — Handbook
1207. Following is a feature of concomitant
squint ?
a) Constant amount of deviation in all directions of gaze

b) Associated limitation of ocular movements

c) Different amount of deviation in different directions of gaze

d) Develops in the patients at 15 - 20 years of age.

Correct Answer - A
Ans. is 'a' i.e., Constant amount of deviation in all directions of
gaze
MANFEST SQUINT (HETEROTROPIA) medpox.com
In manifest squint the deviation of eye is present as such and cannot
be compensated by fusion. Two main types of manifest squint are
concomitant squint and paralytic squint.
A) Concomitant squint
In concomitant squint the eyes are not in alignment and the degree
of malalignment remains constant in all the directions of gaze and
there is no limitation of ocular movements. Concomitant squint may
be of following types:
1) Esotropia (Convergent squint) :- It denotes inward deviation of
eye. It can be unilateral or uniocular (the same eye always deviates
inwards) or alternating (either of the eyes deviates inwards and the
other eye takes up fixation, alternately). Concomitant esotropia is the
most common type of squint in children. Following types of esotropia
are there :-
i) Congenital esotropia (infantile esotropia)
True congenital (infantile) esotropia usually appears between the
age of 2 and 4 months. However, rarely it may be present from birth.
The inward turn of the eye is constant of large amount, i.e., deviation
 is > 35 prism diopters (17-5').
Binocular vision (both eyes fixing simultaneously) does not develop.
There is alternate fixation in primary gaze, i.e, when the infant looks
straight, he fixes the gaze with one eye at a time alternately. On
lateral gaze there is cross fixation, i.e, use right eye to fix across the
nose to view the objects to the left and vice versa. Amblyopia
develops in 25- 40% of cases.
Latent horizontal nystagmus (common) and many rotatory
nystagmus may occur. Inferior oblique overaction may be present
initially or develop later and dissociated vertical deviation develop in
80% by age of 3 years.
It is more difficult to help this type of strabismus with nonsurgical
methods, thus, surgery is the treatment of choice. Surgical
procedure to make both medial recti weak by recession. Surgery
should be done as early as possible to avoid development of
amblyopia and for the development of proper binocular vision. The
usually recommended time is between 6 month - 2 years of age (and
preferably before 1 year of age).It is important to treat the amblyopia
before performing surgery by patching of normal eye.
medpox.com
ii) Accommodative esotropia
Accommodative esotropia occurs due to overaction of convergence
associated with accommodation reflex. Accommodative esotropia is
the most common type of squint in children (Previously it was
believed that congenital esotropia is the most common type squint in
children. However now it is very much clear that accommodative
esotropia is the most common one). It esotropia is noted around 2-3
years of age, it is most likely accommodative esotropia. On the
bases of AC/A (accommodative convergence/accomodation) ratio,
accommodative esotropia is divided into two types : (a) Refractive
(Normal AC/A ratio); (b) Non - refractive (abnormal AC/A ratio).
AC/A ratio gives the relationship between the amount of
convergence that is goverened by a given amount of
accommodation.
a. Normal AC/A ratio accommodative esotropia :- This occurs in
children with hypermetropia. Esotropia is a physiological response to
excessive hypermetropia. Patients with high hypermetropia generate
large amount of accommodation to see clearly at near fixation. This
 excessive accommodation may cause esotropia as accommodation
is associated with convergence. AC/A ratio is normal.
b. Large AC/A ratio accommodative esotropia :- Children have large
amounts of focusing power and sometimes the increase of
accommodation is accompanied by a disproportionately large
increase of convergence. This occurs in patient with hypermetropia
but may occur in myopia and without any refractive error. AC/A ratio
is high.
Usually, there are no symptoms except for cosmetic embarrassment
to the patient. There is no diplopia as the image in the squinting eye
is automatically suppressed, i.e., amblyopia develops in squinting
eye. The main feature is the failure of binocular vision.
2) Exotropia (divergent squint) :- It is characterized by outward
deviation of eye. This is very less common than esotropia.
3) Hypertropia (Vertical squint) :- It is characterized by vertical
deviation of eye. It is also rare.
B) Incomitant squint
Incomitant squint is a squint in which the angle of deviation differs
depending upon the direction of gaze i.e, amount of deviation varies
medpox.com
in different directions of gaze. There are many type of incomitant
squints (paralytic, restrictive, 'A' & 'V' pattern), however the most
common type is Paralytic squint and the word incomitant squint is
usually used for paralytic squint. Therefore, I will explain paralytic
squint here Paralytic squint is the most common type of squint in
adults. Paralytic squint is the strabismus resulting from complete or
incomplete paralysis of one or more extraocular muscles. There are
many causes like neurogenic (e.g. meningitis, cranial nerve palsy
etc.), myogenic (myopathies), or neuromuscular junction lesions. o
Symptoms of paralytic squint are :-
i) Diplopia : It is the main symptom. It is most marked in the direction
of action of paralysed muscle. For example in left rectus palsy, the
maximum diplopia occurs when patient tries to see horizontally on
left side and in left superior oblique palsy (causes Dextrodepression)
diplopia is maximum when patient tries to look downward and right.
It is worth noting here that in diplopia, if the images are separated
horizontally it is probable that either a lateral or a medial recuts is
affected; when the images are separated vertically or the image is
tilted (torsion) it is likely that one or more of the vertical recti or the
tilted (torsion) it is likely that one or more of the vertical recti or the
obliques are affected.
ii) Other symptoms : Confusion, nausea & vertigo, ocular deviation,
loss of stereopsis.
Signs of paralytic squint are :-
i) Secondary deviation is more than primary deviation:- Primary
deviation is the deviation in the affected eye and is away from the
action of paralysed muscle. Secondary deviation is the deviation of
normal eye seen under cover, when the patient is made to fix with
the squinting eye.
ii) Restriction of ocular movements
iii) Compensatory head posture :- Patients with a paralytic squint
move their head such that the eyes occupy a position in the orbit
where the angle of squint is minimal and this can avoid confusion
and diplopia. Head is turned towards the action of paralysed muscle.
When the horizontal recti (medial or lateral) are affected, the
characteristic posture is a turn of the face to right or left, e.g. in left
lateral rectus palsy the head is turned to the left and in left medial
recuts palsy the head is turned to the right. When a vertical rectus
medpox.com
(superior or inferior) or an oblique muscle is affected, a tilt of the
head to the right or left with depression or elevation of the chin is
adopted to reduce both the vertical deviation and rotation, e.g in
superior oblique palsy (dextrodepression of left eye is affected) the
head is tilted to left so that the left eye can see down and medially.
iv) There is false projection or orientation
v) There is no amblyopia and visual acuity is normal as paralytic
squint develops in adults when visual acuity has already developed.
1208. Diplopia is usually seen in ?
a) Paralytic squint

b) Non-paralytic squint

c) Both of the above

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Paralytic squint

medpox.com
1209. Following are the clinical features of
Leber optic neuropathy except
a) Seen in the 2nd or 3rd decade of life

b) It is a example of gradual painless visual loss

c) Males can transmit the disease

d) No leak of dye is observed in fluorescein angiography

Correct Answer - C
Ans. is 'c' i.e., Males can transmit the disease
Leber's Hereditary optic neuropathv
medpox.com
Leber's hereditary optic neuropathy is characterized by sequential
subacute optic neuropathy in males aged 11-30 years. The
underlying genetic abnormality is a point mutation in mitochondria!
DNA. Since mitochondrial DNA is exclusively derived from mother,
males do not transmit the disease and the disease is transmitted by
carrier females.
It is characterizeed by bilateral, painless, subacute visual failure that
develops during young adult life. Males are four to five times more
likely than females to be affected. Affected individuals are usually
entirely asymptomatic until they develop blurring affecting the central
visual field of one eye; Similar symptoms appear in the other eye an
average of two to three months late. In about 25% of cases, visual
loss is bilateral at onset.
On examination, patients generally have bilateral impairments of
visual acuity. There is centrocecal scotoma that begins nasal to the
blind spot and extends to involve fixation of both sides of the vertical
meridian. Pupillary reactions are often normal. Ophthalmoscopic
examination shows fundus abnormalities in acute phase like swelling
of the disc, peripapillary retinal telangiectasia, but characteristically
there is no leak from the optic disc during fluorescein angiography.
Later in atrophic phase, disc becomes atrophic and pale.

medpox.com
1210. Homonymous hemianopia type of
visual field defect is seen in all except ?
a) Lateral geniculate body

b) Total optic radiation

c) Optic tract

d) Optic chaisma

Correct Answer - D
Ans. is 'd' i.e., Optic chaisma

medpox.com
1211. Bitemporal hemianopia is characteristic
of ?
a) Glaucoma

b) Optic neuritis

c) Pituitary tumor

d) Retinal detachment

Correct Answer - C
Ans. is 'c' i.e., Pituitary tumor
Characteristic visual field defect of central chiasmatic lesion is
medpox.com
bitemporal hemianopia. Pituitary tumor causes central chiasmatic
lesion.
Bitemporal hemianopia results due to central (sagittal) lesion of the
optic chiasma, common causes of which are tumors of the pituitary
gland (most common), craniopharyngioma, suprasellar meningioma,
glioma of third ventricle, chiasmal arachnoiditis, and third ventricular
dilatation.
1212. Wernicke's hemianopic pupillary
reponse is seen in lesions at ?
a) Optic tract

b) Optic chiasma

c) Optic radiation

d) Lateral geniculate body

Correct Answer - A
Ans. is 'a' i.e., Optic tract

medpox.com
1213. Marcus gunn jaw winking phenomenon
due to relation between which cranial
nerves
a) VII + VIII

b) III + V

c) V + VII

d) III + VI

Correct Answer - B
Ans. is 'b' i.e., III + V medpox.com
Marcus Gunn phenomenon (a.k.a. Marcus Gunn Jaw-Winkingor
Trigemino-oculomotor Synkineses)
IT is an autosomal-dominant condition with incomplete penetrance,
in which nursing infants will have rhythmic upward jerking of their
upper eyelid.
This condition is characterized as a synkinesis: when two or more
muscles that are independently innervated have either simultaneous
or coordinated movements.
1214. A person with defective blue color
appreciation is called ?
a) Deuteranomalous

b) Deuteranopia

c) Tritanopia

d) Tritanomalous

Correct Answer - D
Ans. is `d' i.e., Tritanomalous

medpox.com
1215. Brushfield spot in iris is seen in -
a) Neurofibromatosis

b) Down syndrome

c) Tuberous sclerosis

d) Toxoplasmosis

Correct Answer - B
Ans. is 'b' i.e., Down syndrome
Brushfield spots are white spots in the iris in patients with Down
syndrome.
medpox.com
1216. Most common orbital cyst in children-
a) Neuroenteric cyst

b) Dermoid cyst

c) Lymphoma

d) Clobomatous cyst

Correct Answer - B
Ans. is 'b' i.e., Dermoid cyst
Epidermal dermoid cyst (dermoid) is by for the most common orbital
cystic lesion in children, accounting for over 40% of all orbital lesions
of childhood and for 89% of all orbital cystic lesions of childhood that
medpox.com
come to biopsy or surgical removal.
Most important secondary cyst is a mucocele that can occur in
children with cystic fibrosis.
1217. Most common malignant intraorbital
tumor in adult is ?
a) Lymphoma

b) Rhabdomyosarcoma

c) Dermoid cyst

d) Sarcoma

Correct Answer - A
Ans. is 'a' i.e., Lymphoma
An orbital tumor is any tumor that occurs within the orbit of the eye.
medpox.com
The orbit is a bony housing in the skull that provides protection to
the entire eyeball except the frontal surface. It is lined by the orbital
bones and contains the eyeball, its muscles, blood vessels, nerves
and fat.
An intraocular tumor is the tumor which occurs within the eyeball.
Most common intraocular tumor in adults is metastasis. Metastasis
is particularly common from carcinoma of breast and lung.
Most common primary intraocular tumor in adults is uveal
melanoma. Most of the uveal malignant melanoma arise in choroid.
Most common primary intraocular tumor is children is
retinoblastoma.
Most common orbital tumors in adults are benign vascular tumors →
Cavernous hamangioma.
Most common malignant orbital tumor in adult → lymphoma
Most common orbital tumors in children are benign tumors →
Dermoid cyst > capillary hemangioma
Most common malignant orbital tumor in children →
rhabdomyosarcoma.
Overall most common primary malignant tumor of eye is malignant
melanoma followed by retinoblastoma
Most common malignant eyelid tumor → Basal cell carcinoma.
Most common epithelial tumor of lacrimal gland Pleomorphic
adenoma (benign mixed tumor)
Overall most common tumor of lacrimal gland → Lymphoid tumour
and inflammatory pseudo - tumors
Most common malignant tumor of conjunctiva & cornea →
Squamous cell carcinoma.

medpox.com
1218. Most common primary intraocular
neoplasm in a child is ?
a) Metastasis

b) Retinoblastoma

c) Basal cell carcinoma

d) Squamous cell carcinoma

Correct Answer - B
Ans. is 'b' i.e., Retinoblastoma

medpox.com
1219. Retinoblastoma can occur bilaterally in
how many percentage of the cases?
a) 10 - 15%

b) 15 - 20%

c) 20 - 25%

d) 25 - 30%

Correct Answer - D
Ans. is 'd' i.e., 25- 30%
RETINOBLASTOMA
medpox.com
Retinoblastoma is the most common intraocular tumor in children.
The tumor is confined to infancy and very young children (1-2
years). There is no sex predisposition. Retinoblastoma is unilateral
in 70-75% of cases and bilateral in 25-30% of cases.
Etiology
Retinoblastoma gene (RB gene) is located on 14 band on the long
arm of chromosome 13 (13q14). RB gene is a tumor supressor
gene. Retinoblastoma develops when both the normal alleles of the
RB genes are inactived or altered.lt is typical example of Knudson's
two hit hypothesis. In Hereditary retinoblastoma first genetic change
(first hit) in RB gene is inherited from an affected parent, where as
second mutation (second hit) occurs in postnatal life and both alleles
are lost. In non- hereditary retinoblastoma, both mutations (first and
second hits) occur postnataly.
1220. Axial proptosis is produced by tumors
lying in ?
a) Retrobulbar space

b) Subperiosteal space

c) Tenon space

d) Peripheral space

Correct Answer - A
Ans. is 'a' i.e., Retrobulbar space
SURGICAL SPACES IN THE ORBIT
medpox.com
These are of importance as most orbital pathologies tend to remain
in the space in which they are formed.
Therefore, their knowledge helps the surgeon in choosing the most
direct surgical approach. Each orbit is divisible into four surgical
spaces.
1. The subperiosteal space
This is a potential space between the bone and the periorbita
(periosteum).
2. The peripheral space
It is bounded peripherally by the periorbita and internally by the four
recti with thin intermuscular septa. Tumours present here produce
eccentric proptosis and can usually be palpated. For peribulbar
anaesthesia, injection is made in this space.
3. The central space
It is also called muscular cone or retrobulbar space. It is bounded
anteriorly by the Tenon's capsule lining back of the eyeball and
peripherally by the four recti muscles and their intermuscular septa
in the anterior part. In the posterior part, it becomes continuous with
the peripheral space. Tumours lying here usually produce axial
proptosis. Retrobulbar injections are made in this space.
4. Tenon's space
It is a potential space around the eyeball between the sclera and the
tenons capsule.

medpox.com
1221. Pulsatile proptosis is a feature of ?
a) Orbital varix

b) Retinoblastoma

c) Cortico-cavernous fistula

d) Covernous sinus thrombosis

Correct Answer - C
Ans. is 'c' i.e., Cortico-cavernous fistula
Proptosis
Proptosis is bulging of the eyeball (forward bulging) beyond the
orbital margins. Though the word exophthalmos is synonymous with
medpox.com
proptosis; some source define xophthalmos as a protrusion of globe
greater than 18mm and proptosis as a protrusion equal to or less
than 18 mm. Proptosis may be classified as follows : ?
Unilateral Proptosis Proptosis of one eye.
Inflammatory lesions :- Orbital cellulitis, abscess, cavernous sinus
thrombosis, etc.
Vascular disturbances :- Haemorrhage, varicose orbital veins,
haemangioma, etc.
Cysts and tumour :- Dermoid cyst, osteoma, lymphoma,
lymphosarcoma, glioma, meningioma of optic nerve, retinoblastoma
and metastatic deposits in orbit Neuroblastoma, breast, prostate,
lung, GIT, Kidney, Ewing's tumor, melanoma, wilms tumor
(Nephroblastoma)].
Systemic diseases - Leukemias and endocrine disturbances such
as Graves' disease and thyrotropic exophthalmos in initial stages.
Paralysis of extraocular muscles as in complete ophthalmoplegia.
Mucocele of PNS' - Frontal (most common), ethmoid, maxillary.
Bilateral Proptosis Proptosis of both eyes.
evelopmental anomalies of the skull- Oxycephaly (tower skull).
Endocrine exophthalmos, both thyrotoxic and thyrotropic.
Inflammatory lesions - Cavernous sinus thrombosis.
Tumours - lymphosarcoma, lymphoma, pseudotumour,
nephroblastoma, Ewing's sarcoma.
Systemic disease - Histocytosis (Hand - schuller christon disease),
amyloidosis, wegner's granulomatosis.
Intermittent proptosis
Proptosis developing intermittently and rapidly in one eye when
venous stasis is induced by forward bending or lowering the head,
turning the head forcibly, hyperextension of the neck, coughing,
forced expiration with or without compression of the nostrils, or
pressure on jugular veins. The most important casue is orbital varix
(varicocele).
Pulsatile proptosis : - Pulsatile proptosis is seen in
caroticocovernous fistula; saccular aneurysm of ophthalmic artery;
and due to transmitted cerebral pulsation as seen in meningocele,
neurofibromatosis and traumatic or operative hiatus.
medpox.com
1222. Stye is suppurative inflammation of
glands of ?
a) Zeis

b) Meibonian

c) Wolfring

d) All the above

Correct Answer - A
Ans. is 'a' i.e., Zeis

medpox.com
 1223. Meibomian glands secrete which
component of sweat?
a) Water (aqueous)

b) Mucin

c) Protein

d) Lipid

Correct Answer - D
Ans. is 'd' i.e., Lipid
The major function of lacrimal apparatus is to secrete and drain the
tear. medpox.com
Tear film consists of 3 layers :-
i. Mucous or mucin layer (innermost):- Secreted by conjunctival goblet
cells, crypts of Henle, glands of Manz.
ii. Aqueous layer (intermediate) :- This forms the bulk of the tear. It is
secreted by main lacrimal and accessory lacrimal glands.
iii. Lipid layer (outermost) :- Secreted by the Meibomion Zeis, and Moll
glands.
1224. Treatment of dacryocystitis in three
months old child ?
a) Daily probing

b) Weekly probing

c) Massaging

d) Syringing

Correct Answer - C
Ans. is 'c' i.e., Massaging
Spontaneous recanalization of obstructed nosolacrimal duct occurs
medpox.com
during first 6-8 weeks and sometimes after 6-12 months in 90% of
infants. Therefore upto 9-12 months only massage and antibiotic
drops are indicated. After the age of 12 months high pressure
syringing is indicated.
1225. Treatment of acute dacrocystitis in
stage of cellulitis is ?
a) Antibiotics

b) Abscess drainage

c) DCT

d) DCR

Correct Answer - A
Ans. A. Antibiotics
Treatment of acute dacyrocystitis
During cellulitis stage medpox.com
It consists of systemic and topical antibiotics to control infection; and
systemic anti-inflammatory analgesic drugs and hot fomentation to
relieve pain and swelling.
1226. For congenital obstruction of
nasolacrimal duct, probing is done at
what age ?
a) 2 months

b) 6 months

c) 10 months

d) 14 months

Correct Answer - B
Ans. is 'b' i.e., 6 months medpox.com
Probing of congenital nasolacrimal duct blockade with Bowman's
probe
It should be performed, in case the condition is not cured by the age
of 3-4 months.
Some surgeons prefer to wait till the age of 6 months.
It is usually performed under general anaesthesia.
While performing probing, care must be taken not to injure the
canaliculus.
1227. Treatment for mild ptosis is ?
a) Fasanella servat operation

b) Levator resection

c) Frontalis sling operation

d) Everbusch's operation

Correct Answer - A
Ans. is 'a' i.e., Fasanella servat operation
Fasanella-Servat operation. It is performed in cases having mild
ptosis (1-5-2mm) and good levator function. In it, upper lid is everted
and the upper tarsal border along with its attached Muller's muscle
medpox.com
and conjunctiva are resected.
 1228. Kayser flescher ring is seen in ?
a) Siderosis

b) Chalcosis

c) Open angle glaucoma

d) Chemical injuries

Correct Answer - B
Ans. is 'b' i.e., Chalcosis
Chalcosis
It refers to the specific changes produced by the alloy of copper in
the eye. medpox.com
Mechanism. Copper ions from the alloy are dissociated
electrolytically and deposited under the membranous structures of
the eye. Unlike iron ions these do not enter into a chemical
combination with the proteins of the cells and thus produce no
degenerative changes.
Clinical manifestations
i. Kayser-Fleischer ring : It is a golden brown ring which occurs due to
deposition of copper under peripheral parts of the Descemet's
membrane of the cornea.
ii. Sunflower cataract : It is produced by deposition of copper under the
posterior capsule of the lens. It is brilliant golden green in colour and
arranged like the petals of a sun flower.
iii. Retina : It may show deposition of golden plaques at the posterior
pole which reflect the light with a metallic sheen.
1229. `Ischemic necrosis' in alkali burn is ?
a) Stage I

b) Stage II

c) Stage III

d) Stage IV

Correct Answer - A
Ans. is 'a' i.e., Stage I
Alkali burns are among the most severe chemical injuries to eye.
Common alkalies responsible for burns are liquid ammonia (most
harmful), lime, caustic potash or caustic soda. o Clinical features are
medpox.com
divided into three stages.
1) Acute ischemic necrosis (Stage I) :- In this stage there are signs
in conjunctiva (edema, congestion, necrosis, copious discharge),
cornea (sloughing, edema and opacity) and iris (iridocyclitis).
2) Reparation (Stage II) :- Conjunctival and corneal epithelium
regenerate, and there is corneal neovascularization.
3) Complications (Stage III) :- Symblepharon, recurrent corneal
ulceration, complicated cataract, secondary glaucoma.
1230. Bett's classification deals with ?
a) Ocular trauma

b) Ocular foreign body

c) Squint

d) Maculopathy

Correct Answer - A
Ans. is 'a' i.e., Ocular trauma
BETTS (Birmingham Eye Trauma Classification System)
Ocular trauma classification group has organized eye injuries using
standard technology to describe various forms of ocular injury. This
medpox.com
is called BETTS - Birmingham Eye Trauma Classification System.
 1231. Steroid is contraindicated in ?
a) Herpetic keratitis

b) Atopic dermatitis

c) Fungal corneal ulcer

d) Exposure keratitis

Correct Answer - C
Ans. is 'c' i.e., Fungal corneal ulcer
Topical corticosteroids enhance fungal replication and corneal
invasion and therefore, contraindicated in a fungal corneal ulcer.
Now, option 'a' requires specific mention here :-
medpox.com
Topical corticosteroids are contraindicated in herpetic keratitis. But
not in all forms of herpetic keratitis :-
i. Epithelial herpetic keratitis (Dendritic ulcer, geographic ulcer) Topicla
corticosteroids are contraindicated.
ii. Stromal keratitis (Disciform & Diffuse necrotic) Topical
corticosteroids along with topical antiviral drugs are used as the first
line of treatment.
So, my opinion for this type of question is that :-
i. If herpetic keratitis has given as the option, then look at other
options. If any of the other options is a clear cut contraindication for
corticosteroid (e.g. fungal corneal ulcer in this question), consider
that option as your answer. If no ther option is a contraindication for
topical corticosteroid, considere herpetic keratitis as the answer.
ii. If examiner has specifically mentioned dendritic ulcer as an option,
consider it as the answer.
1232. Tubular vision seen in -
a) Myopia

b) Hypermetropia

c) Presbyopia

d) Optic neuritis

Correct Answer - A
Ans. is 'a' i.e., Myopia
Causes of Tubular vision
Retinitis pigmentosa
High Myopia medpox.com
Primary open angle glaucoma
CRAO with sparing of cilioretinal artery
 1233. In xerophthalmia classification X 2
stage is ?
a) Bitots spots

b) Corneal xerosis

c) Corneal ulceration

d) Corneal scar

Correct Answer - B
Ans. is b i.e., Corneal xerosis
WHO classification (1982)
medpox.com
The new xerophthalmia classification (modification of original 1976
classification) is as follows :
1. XN Night blindness
2. X1A Conjunctival xerosis
3. X1B Bitot's spots
4. X2 Corneal xerosis
5. X3A Corneal ulceration/keratomalacia affecting less than one-third
corneal surface.
6. X3B Corneal ulceration/keratomalacia affecting more than one-third
corneal surface.
7. XS Corneal scar due to xerophthalmia
8. XF Xerophthalmic fundus.
1234. What is the correct sequence of
xerophthalmia
a) Nightblindness 4 Conjunctival xerosis → corneal xerosis -
corneal ulcer

b) Conjunctival xerosis → corneal xerosis → corneal

ulcer → Nightblindness

c) Corneal xerosis → corneal ulcer 4 Nightblindness →

Conjunctival xerosis

d) Corneal ulcer → Nightblindness → Conjunctival xerosis -3

corneal xerosis

medpox.com
Correct Answer - A
Ans. A. Nightblindness 4 Conjunctival xerosis → corneal
xerosis - corneal ulcer
1235. Increased intraocular tension can be
diagnosed by ?
a) Tonometer

b) Pachymeter

c) Placido's disc

d) Keratometer

Correct Answer - A
Ans. is 'a' i.e., Tonometer
The exact measurement of intraocular pressure is done by an
medpox.com
instrument called tonometer. Indentation (Schiotz tonometer) and
applanation (e.g., Goldmann's tonometer) tonometers are frequently
used.
1236. Following is true about behcet's
disease except ?
a) It shows presence of aphthous ulceration, genital ulceration and
uveitis

b) Uveitis is bilateral, acute recurrent iridocyclitis with hypopyon

c) It has good visual prognosis

d) Chlorambucil can be used to control the disease

Correct Answer - C
Ans. is 'c' i.e., It has good visual prognosis
BEHCET'S DISEASE medpox.com
It is an idiopathic multisystem disease characterised by recurrent,
non-granulomatous uveitis, aphthous ulceration, genital ulcerations
and erythema multiforme.
Etiology
It is still unknown; the basic lesion is an obliterative vasculitis
probably caused by circulating immune complexes. The disease
typically affects the young men who are positive for HLA-B5 1.
Clinical features
Uveitis seen in Behcet's disease is typically bilateral, acute recurrent
iridocyclitis associated with hypopyon. It may also be associated
with posterior uveitis, vitritis, periphlebitis retinae and retinitis in the
form of white necrotic infiltrates.
Treatment
No satisfactory treatment is available, and thus the disease has got
comparatively poor visual prognosis. Corticosteroids may by helpful
initially but ultimate response is poor. In some cases the disease
may be controlled by chlorambucil.
 1237. How many incisions are used in the
divided system approach of pars
planavitrectomy?
a) 1

b) 2

c) 3

d) 4

Correct Answer - C
Ans. is 'c' i.e., 3 medpox.com
Techniques of performing vitrectomy
A) Open-sky vitrectomy
This technique is employed to perform only anterior vitrectomy.
Open sky vitrectomy is performed through the primary wound to
manage the disturbed vitreous during cataract surgery or
aphakickeratoplasty.
B) Closed vitrectomy (Pars planavitrectomy)
Pars plana approach is employed to perform core vitrectomy,
subtotal and total vitrectomy.Pars planavitrectomy is a highly
sophisticated microsurgery which can be performed by using two
type of systems:
1. Full function system vitrectomy is now-a-days sparingly used. It
employs a multifunction system that comprises vitreous infusion,
suction, cutter and illumination (VISC), all in one.
2. Divided system approach is the most commonly employed technique
in modern vitrectomy. In this technique three separate incisions are
given in pars plana region. That is why the procedure is also called
three-port pars plana vitrectomy. The cutting and aspiration
functions are contained in one probe, illumination is provided by a
separate fiberoptic probe and infusion is provided by a carmula
introduced through the third pars plana incision.

medpox.com
1238. Following is true about oculocardiac
reflex except ?
a) It is also called aschner phenomenon

b) It is mediated by occulomotor and vagus nerve

c) It is characterized by bradycardia following traction on extra-

ocular muscles

d) Reflex is more sensitive in neonates

Correct Answer - B
Ans. is 'b' i.e., It is mediated by occulomotor and vagus nerve
Oculocardiac reflex medpox.com
Oculocardiac reflex, is also known as Aschner phenomenon,
Aschner reflex, or Aschner-Dagnini reflex, o It is characterized by
decrease in pulse rate (bradycardia) associated with traction applied
to extraocular muscles and/or compression of the eyeball.
The reflex is mediated by nerve connections between the ophthalmic
branch of the trigeminal cranial nerve via the ciliary ganglion, and
the vagus nerve of the parasympathetic nervous system.
This reflex is especially sensitive in neonates and children,
particularly during strabismus correction surgery. However, this
reflex may also occur with adults.
Bradycardia, junctional rhythm and asystole, all of which may be life-
threatening,can be induced through this reflex.
1239. Pleomorphic adenoma of the lacrimal
gland moves the eyeball ?
a) Downwards and outwards

b) Downwards and inwards

c) Upwards and outwards

d) Upwards and inwards

Correct Answer - A
Ans. is 'a' i.e., Downwards and outwards
Benign mixed tumour of lacrimal gland IPleomorphic adenoma'
medpox.com
It is also known as pleomorphic adenoma and occurs predominantly
in young adult males.
Clinically it presents as a slowly progressive painless swelling in the
upper-outer quadrant of the orbit displacing the eyeball downwards
and outwards.
It is locally invasive and may infiltrate its own pseudocapsule to
involve the adjacent periosteum.
Histologically, it is characterised by presence of pleomorphic
myxomatous tissue, just like benign mixed tumour of salivary gland.
Treatment consists of complete surgical removal with the capsule.
Recurrences are very common following incomplete removal.
1240. Illuminated frenzel glasses are used in
detecting?
a) Nystagmus

b) Heterophoria

c) Esotropia

d) Astigmatism

Correct Answer - A
Ans. is 'a' i.e., Nystagmus
Illuminated frenzel galsses (+20 lenses) are useful for abolishing
medpox.com
fixation and thus revealing peripheral vestibular nystagmus.
1241. Which metabolic derangement is seen
in pregnancy?
a) Metabolic acidosis

b) Metabolic alkalosis

c) Respiratory acidosis

d) Respiratory alkalosis

Correct Answer - D
Answer- D. Respiratory alkalosis
Hyperventilation in pregnancy will lead to respiratory alkalosis.
medpox.com
The hyperventilation that occur during pregnancy is probably due in
part to progesterone stimulating the centre.
Lung volume changes and altered compliance may also contribute.
The effect is a chronic respiratory alkalosis which is compensated by
renal excretion of bicarbonate.
1242. Turner syndrome is maximally
associated with ?
a) Horseshoe kidney

b) Coarctation of aorta

c) VSD

d) ASD

Correct Answer - B
Ans. is 'b' i.e., Coarctation of aorta
Among the given options Aortic coarctation is most common.
medpox.com
Turner's syndrome is commonly associated with congenital heart
diseases.
The most common anomaly associated is bicuspid Aortic valves in
one third to one half of the patients (50%).
Other congential anomalies associated with Turner's syndrome —>
Aortic coarctation (30%), Aortic stenosis, Mitral valve prolapse,
Anomalous pulmonary venous drainage.
1243. All of the following are true about treatment of migraine, EXCEPT:
a) Naratriptan acts longer than sumatryptan

b) Sumatryptan is used in acute attack of migraine

c) Sumatryptan acts on 5HT 1B/1D receptors in great vessels

d) Sumatryptan is used for chronic migraine

Correct Answer - D
Sumatriptan is an agonist at 5-HT serotonin receptors, in particular 5HT 1B/1Dreceptors. It is used in
the treatment of acute migraine attacks but is not recommended for migraine prophylaxis. The drug
provides rapid relief of migraine headache as well as relief of the associated manifestations of
migraine including nausea, vomiting, photophobia and phonophobia.
Short-acting, rapidly effective triptans include almotriptan, sumatriptan, rizatriptan, zolmitriptan,
medpox.com
and eletriptan, whereas naratriptan and frovatriptan have the longest half-lives.

5HT 1B/1Dreceptor agonists are sumatriptan, naratriptan, rizatriptan, and zolmitriptan.

Ref: Instant Pharmacology By Kourosh Saeb-Parsy, Ravi G. Assomull, Fakhar Z. Khan,

Kasra Saeb-Parsy, Eamonn Kelly, 1999, Page 300 ; Harrison's 17th ed chapter 15
 1244. Which of the following is not used for
investigation of fat malabsorption
a) 13C Trioctanoin

b) 13C Triolein

c) 13C Tripalmitin

d) 13C Triclosan

Correct Answer - D
Answer- D. 13C Triclosan
Tests used for fat malabsorption
1. "C Triolene breath test medpox.com
2. '3C Tripalmitin breath test
3. '3C Mixed-Triglyceride breath test
4. "C-Trioctanoin breath test
1245. Typhoid is treated by all except
a) Erythromycin

b) Ceftriaxone

c) Amikacin

d) Ciprofloxacin

Correct Answer - A
Ans. is 'a' i.e., Erythromycin
The older agents used for the treatment of typhoid were :
Chloramphenicol
Ampicilin medpox.com
Trimethoprim Sulfamethoxazole
Beta lactam
Parenteral → Ceftriaxone
Orall → Cefixime
These drugs are not used nowdays because of widespread
resistance. o Nowdays the drug of choice for Typhoid all over the
world is a "Fluroquinolone" (Ciprofloxacin, ofloxacin).
An important point to remember
High level of fluoroquinolone resistance (ciprofloxacin) have been
reported from India and other parts of South East Asia in S.
paratyphi and S.typhi infection.
Nalidixic acid resistant S.typhi (NARST) have decreased
ciprofloxacin sensitivity and are less effectively treated with
fluoroquinolones.
The fluroquinolones should not be used as first line treatment for
typhoid fevers in patients from India and other parts of South Asia
with high rates of fluroquinolone resistance unless antibiotic
susceptibility data demonstrates fluoroquinolone or nalidixic acid
sensitivity.

medpox.com
1246. Drug treatment is given for how many
days in pneumococcal meningitis
a) 5 days

b) 7 days

c) 14 days

d) 21 days

Correct Answer - C
Ans. is 'c' i.e., 14 days
Recommendations for duration of treatment
medpox.com
Pneumococcal meningitis —> 10-14 days
Meningococcal meningitis 5-7 days
Hib meningitis —> 7-14 days
Listeria meningitis —> 21 days
1247. The treatment of choice in acute
hyperkalemia of life threatening to
cardiac myocytes is
a) Infusion of calcium gluconate

b) Oral resins

c) Intravenous infusion of insulin

d) β blocker

Correct Answer - A
Ans. is `a' i.e. Infusion of calcium gluconate
medpox.com
Emergent t/t of hyperkalemia is needed in conditions with
severe hyperkalemia (IC >7 meq/L). In these cases cardiac
toxicity or muscular paralysis is present.
Calcium gluconate is the fastest acting agent among the agents
used in the t/t of hyperkalemia°.
It acts within minutes but an important point to note is that it
does not cause transcellular movement of potassium, instead,
it acts on cardiac cell membrane
1248. Vitamin E deficiency causes
a) Hemorrhagic stroke

b) Cardiac failure

c) Ataxia

d) Megalablastic anemia

Correct Answer - C
Answer- C. Ataxia
Clinical Manifestations
Axonal degeneration
Hemolytic anaemia medpox.com
Peripheral neuropathy
Spinocerebellar ataxia
Dry skin
Thrombocytosis
Ataxia
1249. Which of the following circulating
antibodies has the best sensitivity and
sepcificity for the diagnosis of celiac
disease ?
a) Anti Saccharomyces antibody

b) Anti-tissue transglutaminase antibody

c) Anti-gliadin antibody

d) Anti-gliadin antibody antibody

Correct Answer - A medpox.com

Ans. is 'a' i.e. Anti saccharomyces antibody
Serologic evaluation in celiac disease
Immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody
is the single preferred test for detection of celiac disease in
individuals over the age of two years.
Serum antibody assays
A variety of serologic studies have been described to aid in the
diagnosis of celiac disease, including:
IgA endomysial antibody (IgA EMA)
IgA tissue transglutaminase antibody (IgA tTG)
IgG tissue transglutaminase antibody (IgG tTG)
IgA deamidated gliadin peptide (IgA DGP)
IgG deamidated gliadin peptide (IgG DGP)
Serum IgA endomysial and tissue transglutaminase antibody testing
have the highest diagnostic accuracy.
The IgA and IgG antigliadin antibody tests have lower diagnostic
accuracy with frequent false positive results as compared with IgA
tTG and IgA DGP assays and are therefore no longer recommended
for initial diagnostic evaluation or screening
However, the newer anti-deamidated gliadin peptide (DGP) assays
described above show high diagnostic accuracy.
IgA EMA, IgA tTG,IgA DGP and IgG DGP levels fall with treatment;
as a result, these assays can be used as a noninvasive means of
monitoring the response to a gluten-free diet.

Assay sensitivity and specificity
IgA endomysial antibodies- → Sensitivity 85 to 98
percent; specificity 97 to 100 percent
IgA tissue transglutaminase antibodies → Sensitivity 90 to 98
percent; specificity 95 to 97 percent --
IgA deamidated gliadin peptide → Sen sitivity 94
percent; specificity 99 percent
IgG deamidated gliadin peptide → Sensitivity 92
percent; specificity 100 percent

medpox.com
1250. Aseptic meningitis caused by
a) Indomethacin

b) Ibuprofen

c) Aspirin

d) Icatibant

Correct Answer - B
Ans. is 'b' i.e., Ibuprofen
Medications known to cause aseptic meningitis Medications
Medication Common Uncommon
medpox.com Sulindac Naproxen
NSAIDs Ibuprofen Diclofenac
Rofecoxib
Antimicrobials Trimethoprim/sulfamethoxazoleSulfonamides
Immunomodulating Monoclonalantibody
Azathioprine
agents OKT3Intravenous IgG
Metrizamide
Cytarabine
Intrahecal agents
Methylprednisolone
acetate
Other Carbamazepine
Causes of acute aseptic meningitis
Infectious

cases
Lyne disease
Leptospirosis
Mycobacterium tuberculosis
infection
Bacterial Subacute bacterial endocarditis
 Subacute bacterial endocarditis
Parameningeal infection
(epidural subdural abcess, sinus
or ear infection) Partially treated
bacterial meningitis
Echovirus infection
Coxaackie virus infection
Mumps
St. Louis encephalitis
Eastern equine encephalitis
Viral Western equine encephalitis
Calcifornia encerphalitis
Herpes simplex virus type 2
infection HIV infection
Lymphocytic choriomeningitis
Poliovirus infection

medpox.com
1251. High Steppage Gait is seen in
a) Foot drop

b) Frontal lobe stroke

c) Tabes dorsalis

d) Leprosy

Correct Answer - C
Ans. is 'c' i.e., Tabes dorsalis
High stepping gait or steppage gait or foot drop gait is due to foot
drop -+ leg is lifted more in order to get clearance and first to touch
the ground is fore foot (not the heel as occur in normal gait).
medpox.com
It may occur in all motor peripheral neuropathies involving common
peroneal nerve —> Tabes dorsalis, leprosy etc.
[Ref Harrison 18th/e chapter 377]
1252. Feature of Acute severe Asthma include
all of the following, Except:
a) Tachycardia > 120/min

b) Pulsus paradoxus

c) Respiratory acidosis

d) Drowsy

Correct Answer - A
Answer is A. Tachycardia > 120/min
Diaphoresis
Bradycardia medpox.com
Paradoxical throcobadominal movements
PEER < 33%
Hypotension
Pulsus paradoxus
Hypercapnea
Silent chest
1253. In a patient with bronchial asthma silent
chest signifies
a) Good Prognosis

b) Bad Prognosis

c) Grave Prognosis

d) Not a Prognostic sign

Correct Answer - C
Ans. is 'c' i.e., Grave Prognosis
Silent chest (Little/no air movement without wheezes in Bronchial
medpox.com
Asthma suggests a grave prognosis/impending respiratory failure
(Life threatening Asthma).
Signs of impending respiratory failure include :
Drowsiness or confusion
Diaphoresis
Bradycardia
Paradoxical thoraco abdominal
Signs of impending respiratory failure in Asthma
Drowsiness or confusion
Diaphoresis
Bradycardia
Paradoxical thracoabdominal movements
PEFR < 33%
Hypotension
Pulsus paradoxus
Hypercapnea
Silent chest
1254. Which is correct about pneumonia
a) Bronchophonia

b) Decreased vocal fremitus

c) Shifting of trachea

d) Amphoric breathing

Correct Answer - A
Ans. is 'a' i.e., Bronchophonia
Physical examination findings of Common pulmonary
conditions

medpox.com Endobronchial
Pleural effusion Pneumonia
tumor Pneumothorax
Tracheal Shifted or Shifted or
Midline Shifted or midline
position midline midline
Reduced or Reduced or Reduced or
Chest wall Reduced
normal normal normal
Normal or
Fremitus Decreased Increased None
decreased
PercussionDull Dull Normal or Dull Hyperresonant
Breath Normal or
Decreased Increased Decreased/absent
sounds Decreased
Crackles None None None None
Wheeze None None Possible None
Band above
Egophony Present None None
effusion(skodiac)

Tracheal
position
Deviated
Away from
Pneumo
thorax
Effusion
Deviated
towards
Collapse
Consolidation
Tactile vocal fremitus
Tactile vocal fremitus is vibration felt on the patients chest during low
frequency vocalisation.
Commonly the patient is asked to repeat a phrase while the
examiner feels for vibtations by placing a hand over the patient chest
or back.
Tactile fremitus is normally more intense in the right second
intercostal space as well as in the interscapular region as these :
Tactile fremitus
medpox.com
Increased → Consolidation
Decreased or absent → Pleural effusion or Pneumothorax
Reason for increased fremitus in a consolidated lung is the fact that
the sound waves are transmitted with less decay in solid or fluid
medium (consolidation) than in a gaseous medium (consolidation)
than in a gaseous medium (aerated lung). Conversely the reason for
decreased fremitus in a pleural effusion or pneumothorax (or any
pathology separating the lung tissue itself from the body wall) is that
this increased space diminishes or prevents entirely sound
transmission
Egophony is a change in timbre (E0 to A) but not pitch or volume.
It is due to decrease in the amplitude and an increase in the
frequency of the second formant produced by solid (including
compressed lung) interposed between the resonator and the
stethoscope head.
The sound of a spoken "E" change to "A" over an area of
consolidation. The spoken "E" is heared as "A" when listening over
the consolidation because the frequencies of the vibrations are
altered by the consolidation. Egophony or "E" to "A" changes may
also occur in small band like area just above a pleural effusion
because of compression of lung tissue that occurs just above the
effusion.

medpox.com
1255. Systemic Millary TB spreads via
a) Artery

b) Vein

c) Bronchus

d) Lymphatic

Correct Answer - A
. Ans. is 'a' i.e., Artery
Systemic miliary ensues when infective foci in the lungs seed the
pulmonary venous return to the heart; the organisms subsequently
disseminate through the systemic arterial system.
medpox.com
1256. DOC for acute attack of Hereditary
angioneurotic edema
a) Danazol

b) Cl, inhibitor concentrate

c) Icatibant

d) Methylprednisolone

Correct Answer - B
Ans. is 'b' i.e., Cl inhibitor concentrate
Medication
medpox.com
C inhibitor concentrate (Plasma-derived) (Berinert, Berinert P,
1
Cinryze.
Recombinant C1 inhibitor Conestat alfa (Ruconest, Rhucin).
Bradykinin Bzreceptor antagonist Icatibant (Firazyr).
Kallikrein inhibitor Ecallantide (Kalbitor)
Plasma
1257. Type 5 Hypersensitivity mimics
a) Type 1

b) Type 2

c) Type 3

d) Type 4

Correct Answer - B
Ans. is 'b' i.e., Type 2
Type V hypersensitivity reactions were additionally added to the
scheme originally described by Coombs and Gell. Contrary to type
IV and in agreement with types I, 11 and III respectively, they are
medpox.com
mediated by antibodies too.
The type V reactions are sometimes considered as a subtype of
the type II hypersensitivity.
As its mechanisms do not destroy target cells, they are responsible
for induction of organ/tissue dysfunctions only most of authors prefer
it to be and independent, the 5' type of hypersensitivity reactions
1258. Broca's aphasia is?
a) Fluent aphasia

b) Non fluent aphasia

c) Sensory aphasia

d) Conduction aphasia

Correct Answer - B
Answer is B (Non-fluent Aphasia):
Broca's Aphasia is a Non-Fluent Expressive (Motor) Aphasia with
preserved comprehension and impaired repetition
medpox.com
1259. All of the following are Fluent Aphasia's
Except:
a) Anomie Aphasia

b) Wernicke's Aphasia

c) Conduction Aphasia

d) Broca's Aphasia

Correct Answer - D
Answer is D (Broca's Aphasia):
Neurologic Differential Diagnosis: A Case-Based Approach
medpox.com
(Cambridge University Press, 2014)/ 36
Broca's Aphasia is a Non-Fluent Expressive (Motor) Aphasia with
preserved comprehension and impaired repetition.
Non-Fluent Aphasias
Global
Broca's
Mixed Transcortical
Transcortical Motor
Fluent Aphasias
Anomie
Wernicke's
Conduction
Transcortical Sensory
1260. Comprehension in intact with aphasia
in
a) Wernicke's

b) Broca's

c) Global aphasia

d) Transcortical sensory

Correct Answer - B
Ans. is 'b' i.e., Broca's

medpox.com
1261. Fluent Aphasia with preserved
comprehension and impaired repetition
is:
a) Broca's

b) Wernicke's

c) Anomie

d) Conduction

Correct Answer - D
Answer is D (conduction): medpox.com
Conduction Aphasia is a 'Fluent' Aphasia with preserved
comprehension and impaired Repetition.
Clinical
Non-Fluent Aphasias Fluent Aphas'as
Syndrome
Features Wernicke'sTranscortical

TranscorticalMotor Sensory
Fluent NoNo No NoYesYesYes Yes
ComprehensionNoNo Yes YesYesYesNo No
Repeat NoYes Yes NoYes NoNo Yes
1262. Aphasia which affects the arcuate fibres
is called
a) Global aphasia

b) Anomie aphasia

c) Conduction aphasia

d) Broca's aphasia

Correct Answer - C
Ans. is 'c' i.e., Conduction aphasia
Arcuate fibers are bundle of nerve fibres that connect Brocas area to
the Wernicke 's area. medpox.com
Damage to the arcuate fasciculus causes a disorder called
conduction aphasia
1263. Erb's Point in cardiology refers to:
a) Right 2nd intercostal space

b) Left 2nd intercostal space

c) Right 3rd intercostal space

d) Left 2nd intercostal space

Correct Answer - C
Answer is C (Right 3rd intercostal space)
In cardiology, Erb's point refers to the third intercostal space on the
left sternal border where both components of S2 (A2 and P2) can be
well appreciated. medpox.com
Both components of S2 (A2 and P2) are usually well transmitted to
the Erb's point. The physiological splitting of S2 into A2 and P2 is
believed to be appreciated best at the Erb's point or in the pulmonic
area.
A2 is best heard over the aortic area in the right second intercostal
space
P2 is best heard over the pulmonic area in the left second intercostal
space
Second heart sound (S2) is best heard over the pulmonic area
(Since both A2 and P2 can be heard at the pulmonic area) and at
the Erb's Point. Note that even at the pulmonic area A2 is louder
than P2
Second intercostal space to the right of the
1. Aortic area
sternum (along right upper sternal border)
Pulmonic Second intercostal space to the left of the sternum
2.
area (along left upper sternal border)
Third intercostal to the left of the sternum(along left
3. Erb's point
sternal border)
 sternal border)
Tricuspid Fourth or Fifth intercostal space to the left of the
4.
area sternum (along left lower sternal border)
Mitral area
5. Fifth intercostal space on the left midclavicular line.
(Apex)

medpox.com
1264. Drug for management of hypertension
in Phaeochromocytoma
a) Phenoxybenzamine

b) Phentolamine

c) Labetalol

d) Esmolol

Correct Answer - A
Ans. is 'a' i.e., Phenoxybenzamine
Once a pheochromocytoma is diagnosed, all patients should
medpox.com
undergo a resection of the pheochromocytoma following appropriate
medical preparation.
Resetting a pheochromocytoma is a high-risk surgical procedure
and an experienced surgeon/anesthesiologist team is required.
Some form of preoperative pharmacologic preparation is indicated
for all patients with catecholamine-secreting neoplasms.
Preoperative medical therapy is aimed at:
Controlling hypertension (including preventing a hypertensive crisis
during surgery) o Volume expansion
In patients with undiagnosed pheochromocytomas who undergo
surgery for other reasons (and who therefore have not undergone
preoperative medical therapy), surgical mortality rates are high due
to lethal hypertensive crises, malignant arrhythmias, and multiorgan
failure.
Combined alpha- and beta-adrenergic blockade
Combined alpha- and beta-adrenergic blockade is the most common
approach to control blood pressure and prevent intraoperative
hypertensive crises.
Alpha-adrenergic blockade
An alpha-adrenergic blocker is given 10 to 14 days preoperatively to
normalize blood pressure and expand the contracted blood volume.
Phenoxybenzamine is the preferred drug for preoperative
preparation to control blood pressure and arrhythmia in most centers
in the United States. It is an irreversible, long-acting, nonspecific
alpha-adrenergic blocking agent.
The initial dose is 10 mg once or twice daily, and the dose is
increased by 10 to 20 mg in divided doses every two to three days
as needed to control blood pressure and spells.
The final dose of phenoxybenzamine is typically between 20 and
100 mg daily.
Beta-adrenergic blockade
After adequate alpha-adrenergic blockade has been achieved, beta-
adrenergic blockade is initiated, which typically occurs two to three
days preoperatively.
The beta-adrenergic blocker should never be started first because
blockade of vasodilatory peripheral beta​adrenergic receptors with
unopposed alpha-adrenergic receptor stimulation can lead to a
further elevation in blood pressure.
medpox.com
The alternatives to a and 13 adrenergic agents are calcium
channel blockers and metyrosine.
Calcium channel blockers
Although perioperative alpha-adrenergic blockade is widely
recommended, a second regimen that has been utilized involves the
administration of a calcium channel blocker.
Nicardipine is the most commonly used calcium channel blocker in
this setting; the starting dose is 30 mg twice daily of the sustained
release preparation.
Metyrosine
Another approach involves the administration of metyrosine (alpha-
methyl Para-tyrosine), which inhibits catecholamine synthesis.
1265. Causes of hyperparathyroidism are all
except
a) Solitary adenoma

b) Malignant

c) Thyroid malignancy

d) Parathyroid hyperplasia

Correct Answer - C
Ans.:C.)Thyroid malignancy
Hyperparathyroidism
Pathology medpox.com
Increased levels of the PTH lead to increased osteoclastic activity.
The resultant bone resorption produces cortical thinning
(subperiosteal resorption) and osteopaenia.
Subtypes
primary hyperparathyroidism
parathyroid adenoma (~80%)
multiple parathyroid adenomas (4%)
parathyroid hyperplasia (10-15%)
parathyroid carcinoma (1-5%)
secondary hyperparathyroidism
caused by chronic hypocalcaemia with renal osteodystrophy being
the most common cause (others include malnutrition, vitamin D
deficiency)
results in parathyroid hyperplasia
tertiary hyperparathyroidism
autonomous parathyroid adenoma caused by the chronic
overstimulation of hyperplastic glands in renal insufficiency
 1266. 1 year old male child is having a Heart
Rate 40/min, BP 90/60. His serum
Potassium = 6.5 what is the next best
management?
a) Ipratropium

b) Adrenaline

c) Sodium bicarbonate

d) Calcium chloride

Correct Answer - C medpox.com

Answer- C. Sodium bicarbonate
For severe elevation 7 meq/L
You need to shift potassium into the cells together with
elimination of potassium from the body
1. Stabilize the heart
2. Shift potassium into cells
3. Promotes potassium excretion
Shift potassium into the cells
Calcium Chloride : reduce the effect of potassium at the myocardial
cell membrane
Sodium bicarbonate
Glucose plus insulin
Nebulized albuterol
Promotes potassium excretion
Diuretics (Furosemide)
Kayexalate
Dialysis
[Ref Harrison's 18`51e chapter 45]
medpox.com
1267. Persistent priapism is due to
a) Sickle cell anaemia

b) Hairy cell leukaemia

c) Paraphimosis

d) Urethral stenosis

Correct Answer - A
Ans. is 'a' i.e., Sickle cell anemia
Priapism is defined as erection lasting for > 4 hours.
Low-flow priapism may be due to any of the following:
An excessive release of neurotransmitters
medpox.com
Blockage of draining venules (eg, mechanical interference in sickle
cell crisis, leukemia, or excessive use of intravenous parenteral
lipids)
Paralysis of the intrinsic detumescence mechanism
Prolonged relaxation of the intracavernous smooth muscles (most
often caused by the use of exogenous smooth-muscle relaxants
such as injectable intra-cavernosal prostaglandin E I)
Prolonged low-flow priapism leads to a painful ischemic state, which
can cause fibrosis of the corporeal smooth muscle and cavernosal
artery thrombosis. The degree of ischemia is a function of the
number of emissary veins involved and the duration of occlusion
1268. The type of arteritis which may lead to
myocardial infarction in children is
a) Kawasaki disease

b) Takayasu arteritis

c) Polyarteritis nodosa

d) Microscopic polyangitis

Correct Answer - A
Ans. is 'a' i.e., Kawasaki disease
o Kawasaki disease is an acute, self limited vasculitis of unknown
medpox.com
etiology that occurs predominantly in infants and young children of
all races.
Coronary artery aneyrysms or ectasia develops in 15-25% of
untreated children with the disease and may lead to ischemic heart
disease, myocardial infarction, or even sudden death. In the USA,
Kawasaki disease has surpassed acture rheumatic fever as teh
leading cause of acquited heart disease in children
1269. Onion skin spleen is seen in
a) ITP

b) Thalassemia

c) SLE

d) Scleroderma

Correct Answer - C
Ans. is 'c' i.e., SLE
The characterisitc histopathologic picture of the spleen in SLE
is periaterial fibrosis or anion skin lesion.
First described by Libman and Sacks, this lesion is defined as the
medpox.com
presene of 3 to as many as 20 seperated layers of the normally
densely packed periarterial collagen of the penicillary or follicular
arteries producing the appearance of concentric rings (onion peel).
1270. Most common pulmonary manifestation
in AIDS
a) TB

b) Pneumonia

c) Bronchiectasis

d) Mycobacterial avium intracellular

Correct Answer - B
Ans. is 'b' i.e., Pneumonia
Respiratory complications in AIDS
medpox.com
Respiratory diseases in AIDS include
A) Acute bronchitis and sinusitis
They are caused by S. pneumoniae and H influenzae and are very
common.
B) Pulmonary diseases
Pulmonary diseases are :-
1. Pneumonia
Most common pulmonary manifestation is pneumonia :
Bacterial pneumonia : It is caused most commonly by S pneumoniae
and pneumococcal infection is the earliest serious infection in AIDS.
H influenzae is also a common cause.
P canna pneumonia : It is the most common cause of pneumonia in
AIDS. Risk is greater when CD4 count less than 200/ml.
2. Tuberculosis
In developing countries like India, most important pathogen is M
tuberculosis. Other common pathogen causing TB is MAC (atypical
mycobacteria).
3. Other pulmonary diseases
These are fungal infections (cryptococcus, histoplasma, aspergillus),
neopasms (Kaposi sarcoma, lymphoma) and idiopathic interstitial
pneumonia.

medpox.com
1271. Most common presentation of extra-
pulmonary TB
a) Tubercular lymphadenitis

b) Peritoneal TB

c) Pericardial TB

d) Tubercular meningitis

Correct Answer - A
Answer- A. Tubercular lymphadenitis
The most common presentation of extra-pulmonary TB in both HIV
medpox.com
sero-negative and HIV-infected patients to about 35% in general,
lymph node disease is particularly frequent among HIV infected
patients and in children.
1272. Chronic hemodialysis in ESRD patient
is done
a) Once per week

b) Twice per week

c) Thrice per week

d) Daily

Correct Answer - C
Ans. is 'c' i.e., Thrice per week
For the majority of patients with ESRD, between 9 and 12 h of
medpox.com
dialysis are required each week, usually divided into three equal
sessions.
Current targets of hemodialvsis
Urea reduction ratio (the fractional reduction in blood urea nitrogen
per hemodialysis session) of > 65-70%.
Body water-indexed clearance x time product (KT/V) above 1.2 or
1.05.
1273. Interstitial nephritis is common with
a) NSAID

b) Black water fever

c) Rhabdomyolysis

d) Tumor lysis syndrome

Correct Answer - A
Ans. is 'a' i.e., NSAID
DRUGS CAUSING INTERSTITIAL NEPHRITIS
Antibiotics Diuretics AnticonvulsantsMiscellaneous
β Lactams Thiazide Phenytoin
medpox.com Captopril
H2 receptor
Sulfonamides Furosemide Phenobarbitone
blockers
Quinolones TriamtereneCarbamazepine Omeprazole
Vancomycin NSAIDS Valproic acid Mesalazine
Erythromycin Indinavir
Minocycline Allopurinol
Rifampicin
Ethambutol
Acyclovir
1274. MELD score includes
a) Serum creatinine

b) Transaminase

c) Albumin

d) Alkaline phosphatase

Correct Answer - A
Answer. A. Serum creatinine
The Model for End-stage Liver Disease (MELD) is a prospectively
developed and validated chronic liver disease severity scoring
system that uses a patient’s laboratory values for –
medpox.com
Li Serum bilirubin
Serum creatinine
The international normalized ratio (INR) for prothrombin time to
predict three month survival.
Patients with cirrhosis, and increasing MELD score is associated
with increasing severity of hepatic dysfunction and increased three-
month mortality risk.
Given its accuracy in predicting short-term survival among patients
with cirrhosis, MELD was adopted by the United network for organ
sharing (UNOS) in 2002 for prioritization or patients awaiting liver
transplantation in the United states.
1275. Best test for lung fibrosis
a) Chest x-ray

b) MRI

c) HRCT

d) Biopsy

Correct Answer - C
Ans. is 'c' i.e., HRCT
Lung fibrosis is a diffuse parenchymal lung disease.
Idiopathic pulmonary fibrosis is the most common form of idiopathic
interstitial pneumonia. medpox.com
We have already discussed that best investigation for interstitial lung
disease is HRCT
Estimated relative frequency of the interstitial lung disease
Relative frequency,
Diagnosis
%
Idiopathic interstitial
40
pneumonias
Idiopathic pulmonary fibrosis 55
Nonspecific interstitial
25
pneumonia
Respiratory bronchiolitis-ILD
15
and

Cryptogenic organizing
3
pneumonia
Acute interstitial pneumonia <1
Occupational and environmental 26
Sarcoidosis 10
Sarcoidosis 10
Connective tissue diseases 9
Drug and radiation 1
Pulmonary hemorrhage
<1
syndromes
Other 13

medpox.com
1276. Drug of choice for the treatment of
acute gout in patients in whom NSAIDs
are contraindicated is?
a) Colchicine

b) Allopurinol

c) Xyloric acid

d) Paracetamol

Correct Answer - A
Ans. is 'a' i.e., Colchicine medpox.com
Treatment of Gout
1) Acute gout
NSAIDs are the drugs of choice
Colchicine is the fastest acting drug. However it is reserved for the
patients in which NSAIDs are contraindicated, because colchicine
can cause gastrointestinal disturbances.
If neither NSAIDs nor colchicin are tolerated, oral prednisolone is
used.
Allopurinol and uricosuric drugs (sulfinpyrazone, probenacid) are not
effective in acute gout because they will not relieve symptoms as
they don't have anti-inflammatory property.
2) Chronic gout
Allopurinal is the drug of choice.
Other drugs are sulfinpyrazone and probenacid.
1277. All drugs used in treatment of acute
gout except
a) Allopurinol

b) Aspirin

c) Colchicine

d) Naproxen

Correct Answer - A
Ans. is 'a' i.e., Allopurinol
Management of gout
Treatment of acute gout medpox.com
To provide rapid and safe pain relief
Drugs used are :
i) NSAIDs:
These are the most frequently used drugs to treat gout because they
are so well tolerated.
Indomethacin is the agent of choice but other NSAIDs may be just
as effective. Aspirin is usually avoided because low doses of aspirin
aggravate hyperuricemia.
ii) Colchicinee:
Colchicine is effective but less well tolerated than NSAIDs
iii) GlucocorticoidsQ:
Usually reserved for patients in whom colchicines or NSAIDs are
contraindicated or ineffective.
Treatment of chronic gout (maintain serum urate levels at 5.0
mg/dl or less) AllopurinolQ:
Xanthine oxidase inhibitor
Agent of choice for most patients with gouty'
Uricosuric agents
Probenecid2
SulfinpyrazoneQ
Treatment of gout according to the stage
No treatment indicated, the
causes should be
Asymptomatic
determined and any
hyperuricemia
associated problem should
be addressed rigorously)
Acute gouty NSAIDs or colchicines or
arthritis glucocorticoid
Intercritical Prophylactic colchicines (to
period reduce further attacks)
Acute Urate lowering
tophoaecous drug
gout (allopurinol or probenecid,
sulfinpyrinazole)

medpox.com
1278. Which of the following endocrine tumors is most commonly seen in MEN
I?

a) Insulinoma

b) Gastrinoma

c) Glucagonoma

d) Somatostatmoma

Correct Answer - B
Amongst the options provided, gastrinomas are the most common enteropancreatic tumors
associated with MEN I with insulinomas being the second most common.
Ref: Harrison’s Principles of Internal Medicine, 17th Edition, Page 2358 & 2359; 16th/
2232; Davidson’s principles and practice of Medicine, 20th Edition, Chapter 20, Page 803
medpox.com
1279. Good syndrome is
a) Thymoma with immunodeficiency

b) Thymoma with M. Gravis

c) Thymoma with serum sickness

d) Thymoma with pure red cell aplasia

Correct Answer - A
Ans. is 'a' i.e., Thymoma with immunodeficiency
Good's syndrome (thymoma with immunodeficiency) is a rare cause
of combined B and T cell immunodeficiency in adults.
Clinical features of Good's syndrome are :-
medpox.com
Increased susceptibility to bacterial infections with encapsulated
organisms and opportunistic viral and fungal infection.
The most consistent immunological abnormalities are :-
Hypogammaglobulinaemia and
Reduced or absent B cells
Treatment
Resection of the thymoma and immunoglobulin replacement to
maintain adequate through IgG values
1280. An Adult with asthma presents with
asthma symptoms every day and wakes
up in the night approximately 2 to 3
days in a week.
He can be classified as having :
a) Intermittent Asthma

b) Mild Persistent Asthma

c) Moderate Persistent Asthma

d) Severe Persistent Asthma

medpox.com
Correct Answer - C
Answer is C (Moderate Persistent Asthma):
'Giudelines for the diagnosis and management of Asthma' Summary
Report 2007 (N1H Publication Number 08-5846); Koda-Kimble and
Young's Applied Therapeutics: The Clinical Use of Drugs
10TH/568,569,570
Moderate Persistent Asthma in an adult (>12 years) is defined as
Day-Time Symptoms that occur daily and Night-Time Symptoms
occurring more than 1 night per week but not every night.
1281. In a Patient with clinical signs of
Asthma which of the following tests will
confirm the diagnosis:
a) Increase in FEV1/FVC

b) > 200 ml increase in FEVI after Methacholine

c) Diurnal variation in PEF > 20 Percent

d) Reduction of FEV I > 20 % after bronchodilators

Correct Answer - C
Answer is C (Diurnal variation in PEF > 20 Percent):
medpox.com
Demonstrate Outflow Obstruction
Decreased FEV1
Decreased PEF
Decreased FEV1 /FVC
While respiratory symptoms suggest asthma, the sine qua non for
the diagnosis of asthma is the presence of Reversible Airflow
Obstruction and/or Airway Hyper-responsiveness or Increased Peak
Expiratory Flow (PEF) Variability in subjects without airways
obstruction.
Reversible Airflow Obstruction
Reversibility is demonstrated by repeating spirometry results 15
minutes after administering a short acting bronchodilator
> 12% reversibility in FEV1
>200 ml increase in Baseline FEV1
Positive Reversibility Results Strongly (Considered Diagnostic)
Increased Peak Expiratory Flow Rate (PEF) Variability
Demonstration of Diurnal Variation in the Peak Expiratory Flow Rate
A diurnal variation in PEF of more than 20 percent Strongly suggests
a diagnosis of Asthma (Considered Diagnostic)
Airway Hyper-responsiveness
Measured by Methacholine orHistamine challenge.
Increasing Concentrations of Methacholine are administered and if
the FEV1 drops to >20 percent of baseline with any standard dose
the test is consideredpositive.
Positive test strongly suggests a diagnosis of Asthma

medpox.com
1282. A Patient with history of shortness of
breath has Decreased FEV1/FVC Ratio,
Normal DLCO. A 200 ml increase in
baseline FEVI is observed 15 minutes
after administration of bronchodilators.
The likely diagnosis is
a) Asthma

b) Chronic Bronchitis

c) Emphysema

d) Interstitial Lung Disease

medpox.com

Correct Answer - A
Ans. is 'a' i.e., Asthma

Diagnosis of Asthma require

Demonstration of Airways obstruction
Decrease in the ratio of FEVI/FVC
Demonstration of acute reversibility of airflow Administer 2-4 puffs of
quick acting bronchodilator e.g., albuterol and repreat spirometry 10-
15 min An increase in FEV1 of 12% or more accompanied by an
absolute increase in FEV lof at least 20 ml
A bronchoprovocator (Methacholine) is administered
hyperresponsiveness of the airway is demonstrated by reduction of
FEV1 to 20%
1283. Patient diagnosed with HIV and
Tuberculosis. How to start ATT and c-
A.R.T
a) Start ATT first

b) Start cART first

c) Start both simultaneously

d) Start cART only

Correct Answer - A
Ans. is 'a' i.e., Start ATT firstmedpox.com
In a case when HIV and TB are diagnosed together ATT should be
started first.
ATT started first, because of IRIS (Immune Reconstitution
Inflammatory syndrome).
If ART started first, it may improve CD4 cells at first, but later a
previously acquired infection (TB, Herpes), responds with an
overshelming inflammatory response that paradoxically makes the
symptom of infection worse.
Therefore, starting of ATT-2 weeks before ART, have shown to
decrease the incidence of IRIS.
1284. Most common cause of lung abscess
a) Staph aureus

b) Oral anaerobes

c) Klebsiella

d) Tuberculosis

Correct Answer - B
Ans. is 'b' i.e., Oral Anaerobes
Most nonspecific lung abscesses are presumed to be due to
anaerobic bacteria.
medpox.com
1285. Normal CRP with elevated ESR seen in
a) RA

b) SLE

c) Scleroderma

d) Polymyalgia rheumatica

Correct Answer - B
Ans. is 'b' i.e., SLE
Both ESR and CRP are markers of inflammation
Erythrocyte sedimentation rate or ESR is used to separate
inflammation from non-inflammation.
medpox.com
Another sign of inflammation is the rise in blood level of number of
proteins called as acute phase proteins.
One of the proteins is C-reactive protein (CRP).
Like ESR and other acute phase proteins, CRP also goes up in
inflammation.
In systemic lupus however the level does not rise unless there is
infection associated.
The normal response to active inflammatory disease is an increase
in plasma CRP concentration. o For reasons that remain unclear tht
response is either significantly lower in magnitude or entirely absent
in a few inflammatory conditions.
This has proven diagnostically useful because there are very few
inflammatory conditions in which ESR is significantly raised
(reflecting an inflammatory process) but plasma CRP is only slightly
raised or even normal.
One ofthese conditions is systemic lupus erythematosus (SLE or
lupus), a relatively common chronic autoimmune disease that
predominantly affects women of child-bearing age.
When this inflammation occurs in the lupus patient it is accompanied
as expected by a marked increase in ESR. However in contrst to
most other inflammatory condition, the plasma CRP remains
resolutely normal. The combination of raised ESR and normal CRP
is a useful diagnostic feature of SLE.
Other disorders where CRP is not increased
Osteoarthritis, leukemia, anemia
Polycythemia, viral infection
Ulcerative colitis, pregnancy, estrogen

medpox.com
1286. Incorrect about takayasu arteritis
a) Spares pulmonary artery

b) Renovascular hypertension

c) Blood pressure difference between left and right limbs

d) Strongly positive mantoux

Correct Answer - A
Answer- A. Spares pulmonary artery
Takayasu arteritis is granulomatous vasculitis of large and medium
arteries. It is characterized principally by ocular disturbance and
marked weakening of pulses in the upper extremities -> Pulseless
medpox.com
disease.
It is also characterized by a strong predilection for aortic arch and its
branches - Aortic arch syndrome.
Subclavian artery is involved most commonly
Other vessels involved are common carotid, abdominal aorta,
coeliac, superior mesenteric, renal, vertebral, iliac, pulmonary and
coronary arteries.
1287. Restrictive and constrictive pericarditis
occurs together in
a) Radiation

b) Adriamycin

c) Amyloidosis

d) Post cardiotomy syndrome

Correct Answer - A
Ans. is 'a' i.e., Radiation
Progressive fibrosis can cause restrictive myocardial disease without
medpox.com
dilation. Thoracic radiation, common for breast and lung cancer or
mediastinal lymphoma, can produce early or late restrictive
cardiomyopathy. Patients with radiation cardiomyopathy may
present with a possible diagnosis of contrictive pericarditis, as the
two conditions often coexist.
 1288. Vitamin not deficient in celiac disease
is?
a) Vitamin D

b) Vitamin B 12

c) Folic acid

d) Vitamin A

Correct Answer - C
Folk acid REF: Sheila Crowe - 2010 page 384, Harrison 17th ed
chapter 288
medpox.com
Vitamins deficient in celiac disease are:
1. Vitamin A
2. Vitamin D
3. Vitamin K
4. Vitamin B12
1289. Skip granulomatous lesions are seen in
?
a) Ulcerative colitis

b) Crohn's disease

c) Whipple's disease

d) Reiter's disease

Correct Answer - B
Ans. is 'b' i.e., Crohn's Disease
Features of CD
medpox.com
In the affected segment, mesentric fat wraps around the bowel
surface —> creeping fat
o The intestinal wall is rubbery and thick, as a consequence of
edema, inflammation, fibrosis, and hypertrophy of the muscularis
propria —> lumen is almost always narrowed --> string sign on
barium meal.
o A classic feature of CD is the sharp demarcation of diseased
bowel segments from adjucent uninvolved bowel. o When multiple
bowel segments are involved, the intervening bowel is normal —>
skip lesions. o There are serpentine linear ulcer along the axis of
bowel.
As the intervening mucosa tends to be relatively spared, the mucosa
acquires a coarsely textured Cobblestone appearance.
o Narrow fissures develop between the folds of the mucosa.
Fissures can penetrate deeply through the bowel wall and leading to
bowel adhesions and serositis. o Further extension of fissures leads
to fistula or sinus tract formation.
o There is transmural inflammation affecting all layers of bowel wall.
Sarcoid like noncaseating granulomas may be present in all tissue
layers.
layers.
o Neutrophilic infiltration into the crypts results in formation of crypt
abscess.
o Fibrosis of the submucosa, muscularis propria, and mucosa
eventually leads to stricture formation.
There is an increased incidence of cancer of GIT in patients with
long-standing CD, but the risk of cancer in CD is considerably less
than in patients with chronic UC.

medpox.com
1290. Which of the following is associated
with highest risk of Anaphylaxis
a) Iron dextran

b) Iron sucrose

c) Ferumoxytol

d) Iron Gluconate

Correct Answer - A
Answer- A. Iron dextran
The risk of anaphylaxis is maximally associated with high molecular
medpox.com
weight dextran (not so with low molecular weight dextran).
1291. Rarest type of Von Willebrand disease :
a) vWD type 1

b) vWD type 2A

c) vWD type 2N

d) vWD type 3

Correct Answer - D
Ans. is 'd' i.e., vWD type 3
ConditionDefect
Mild to moderate quantitative
vWD
deficiency of vWF (ie, about 20-
medpox.com
type 1
25% of normal levels).
The most common qualitative
vWD abnormality of vWF, is associated
type 2A withselective loss of large and
medium-sized multimers
Loss of only large multimers as
vWD mutant vWF spontaneously binds
type 2B to Gplb in the absence of
subendothelial contact
Characterized by a defect residing
vWD within the patient 's plasma vWF
type 2N that interferes with its ability to
bind FVIII
Involves qualitative variants with
decreased platelet-dependent
vWD
function not resulting from
type 2M
absence of highmolecular weight
multimers
 multimers
A severe, quantitative deficiency
associated with very little or no
vWD
detectable plasma or platelet
type 3
vWF, have a profound bleeding
disorder

medpox.com
1292. A patient has ecchymosis and
petechiae all over the body with no
hepato-splenomegaly. All are true
except
a) Increased megakaryocytes in bone narrow

b) Bleeding into the joints

c) Decreased platelet in blood

d) Disease resolves itself in 80% of Patients in 2-6

Correct Answer - B medpox.com

Ans. is 'b' i.e., Bleeding into the joints
Features of Acute and Chronic Idiopathic Thrombocytopenic
Purpura
Feature Acute ITP Chronic ITP
Peak age of Children 2-6 Adults, 20-40
incidence year year
3:1 female to
Sex predilection None
male
Antecedent Common 1-2
Unusual
infection week
Onset of
Before Abrupt Insidious
bleeding
Hemorrhagic Present in
Usually absent
bullae in mouth severe cases
Platelet count < 20000/4 3000-80000/8L
Eosinophilia and
Common Rare
yphocytosis
Spontaneous Occurs in Months or years
Spontaneous Occurs in Months or years
remission 80% cases Uncommon

medpox.com
1293. Development of Lymphoma in Sjogren's
syndrome is suggested by all of the
following except
a) Persistent parotid gland enlargement

b) Cyoglobilinemia

c) Leukopenia

d) High C4 compement levels

Correct Answer - D
Ans. is 'd' i.e., High C4 complement levels
medpox.com
Lymphoa is a well-known complication of Sjogren's syndrome Most
lymphomas are extra-nodal, low grade marginal B cell lymphomas.
Development of Lymphoma in Sjogren's syndrome is suggested by
low C4 complement levels.
Lymphoma in Sjogren's syndrome
The development ofLymphomas in patients with Sjogren
syndrome is suggested by : -
Persistent parotid gland enlargement
Purpura
Leukopenia
Cryoglobulinemia
Low C4 complement levels
1294. All of the following are true about
Rheumatoid arthritis, except
a) PIP and DIP joints involved equally

b) Pathology limited to articular cartilage

c) Women are affected 3 times more commonly than men

d) 20% of patients have extra articular manifestations

Correct Answer - D
Ans. is 'd' i.e., 20% of patients have extra articular manifestations
Association of Rheumatoid Arthritis with HLA DR-4
medpox.com
The class II major histocompatibility complex allele HLA-DR4 and
related alleles are known to be a major genetic risk factor for
Rheumatoid arthritis.
Rheumatoid Arthritis is strongly associated with HLA DR4
The genetic risk for Rheumatoid arthritis is associated with allelic
variation in the HLA-DRBI "gene i.e. DRB1 0401, 04, 05".
Some of the HLA DRB1 alleles bestow a high risk of disease

Clinical features:
It occurs between the age of 20 to 50 years.
Women are affected about 3 times more commonly than men.
Following presentations are common:
a) An acute, symmetrical polyarthritis:
Pain and stiffness in multiple joints (at least four)
Symptoms of articular inflammation.
Common in-
MP joints of hand
PIP joints of fingers
Wrists, knees, elbows, ankles
medpox.com
1295. The pathognomonic finding in miliary TB is which of the following?
a) Bone marrow infiltrations

b) Choroid tubercles

c) Miliary mottling in chest X-Ray

d) Histological finding in liver biopsy

Correct Answer - B
Eye examination may reveal choroidal tubercles, which are pathognomonic of miliary TB, seen in up
to 30% of cases.

Reference:
medpox.com
Harrisons Principles of Internal Medicine, 18th Edition, Page 1349
1296. In AIDS patient presenting with fever,
cough a diagnosis of pneumocystin
pneumonia is best established by
a) CT scan chest

b) Bronchoalveolar lavage

c) Staining of intra-nuclear inclusion with silver staining

d) Aspiration and culture

Correct Answer - B
Ans. is 'b' i.e., Bronchoalveolar lavage
medpox.com
Diagnosis of PCP requires
Demonstration of the organism in samples obtained from induced
sputum.
Bronchoalveolar lavage, transbronchial biopsy, or open-lung biopsy.
If the histological examination fails :?
u PCR is required to make the diagnosis
1297. Hemodialysis can be performed for long
periods from the same site due to
a) Arteriovenous fistula reduces bacterial contamination of site

b) Arteriovenous fistula results in arterialization of vein

c) Arteriovenous fistula reduces chances of graft failure

d) Aretiovenous fistula facilitates small bore needles for high flow

rates

Correct Answer - B
Ans. is 'b' i.e., Arteriovenous fistula results in arterialization of vein
medpox.com
The tstu/a graft, or catheter hemodialvsis is often referred to as
a dialysis access.
A native fistula created by the anastomosis of an artery to a vein
(e.g. the Bresica-Cimino fistula, in which the cephalic vein is
anastomosed end-to-side to the radial artery) results in
arterialization of the vein.
This facilitates its subsequent use in the placement of large needles
(typically 15 Gauge) to access the circulation.
Fistulas have the highest long-term patency rate of all dialysis
access options.
The most important complication of arteriovenous grafts is
thrombosis of the graft and graft failure, due principally to intimal
hyperplasia at the anastomosis between the graft and recipient vein.
Many patients undergo placement of an arteriovenous graft (i.e., the
interposition of prosthetic material, usually polytetrafluoroethylene,
between an artery and a vein) or a tunneled dialysis catheter.
1298. The most common neurological
disorder seen in CRF patients
a) Dementia

b) Peripheral neuropathy

c) Bakes intestinal dilator.

d) Restless leg syndrome

Correct Answer - B
Ans. is 'b' i.e., Peripheral neuropathy
Peripheral neuropathy is the most common neurological problem in
CRF, which may be? medpox.com
i) Uremic peripheral neuropathy (due to uremia).
ii) More often a presenting feature of the cause of CRF Diabetic
neuropathy (DM is the most common cause of CRF).
1299. ECG image,U wave seen, patient is on
furosemide & beta blocker. Diagnosis
a) Hypocalcemia

b) Hypokalemia

c) Hyperkalemia

d) Hypercalcemia

Correct Answer - B
Ans. is 'b' i.e., Hypokalemia
E.C.G. manifestations of electrolyte disorders
Hvperkalemia medpox.com
A tall peaked and symmetrical T-waves is the first change seen on
ECG in patients with hyperkalemia. o RR interval lengthens and
QRS duration increases.
Flattening or disappearance of P wave.
ST elevation.
Widening of the QRS complexes due to a severe conduction delay
and may become 'sine wave'.
The progresion and the severity of the E. C. G change do not
correlate well with the serum potassiam concentration.
Hvpokalemia
Similar to hyperkalemia, hypokalemia produce changes on the E. C.
G which are not necessary related to serum potassiam level.
Depression of the ST segment
Decrease in amplitude of T waves
Increase in amplitude of U waves
U and T wave merge in some cases to form a T-U wave which may
be misdiagnosed as prolonged QT interval.
P wave can become larger and wider and PR interval prolong
slightly.
QRS duration may increase when hypokalemia becomes more
severe.
Hvpocalcemia
Prolongation of the QT interval
Due to prolongation of the phase 2 of the ventricular action potential
and lengthening of the ST segment while the T wave (which
correlate with time for repolarisation remains unaltered).
Hvpercalcemia
Shortening of the QT interval
(Primarily due to a decrease in phase 2 of the ventricular action
potential and resultant decrease in ST segment duration).
Iltpothermia
Causes slow impulse conduction through all cardial tissues resulting
in :?
Prolongation of all the ECG intervals
RR
PR
QRS' medpox.com
QT
There is also "elevation of the J point" (Only if the ST segment is
unaltered producing characteristics T or osborne wave.)
1300. In Zollinger Ellison syndrome what is
raised?
a) Insulin

b) VIP

c) Gastrin

d) Glucagon

Correct Answer - C
Ans. is 'c' i.e., Gastrin
Zollinger Ellison syndrome ?
medpox.com
Severe peptic ulcer disease secondary to gastric acid
hypersecretion due to unregulated gastrin release from a non 13 cell
endocrine tumour (gastrinoma), defines the components of Zollinger
Ellison syndrome.
Pathophysiology of Zollinger Ellison syndrome
The driving force responsible for clinical manifestations of Zollinger
Ellison syndrome is hypergastrinemia originating from Gastrinoma
(autonomus neoplasm, non [3 cell neoplasm)
Gastrinoma
Hyper gastrinemia
Hyper acidemia
Peptic ulcer, erosive esophagitis and diarrhoea
Other important characteristic of Gastrinoma
o Over 80% of these tumours are seen in Gastrinoma triangle°
(triangle formed between duodenum and pancreas) most of them
are seen in the head of pancreas.
o About 2/3'of these tumours are malignant°.
o About one half of these tumours are multiple°.
o About one fourth of the patients have multiple endocrine neoplasia
(MEN I) syndrome with tumours of parathyroid, pituitary and
pancreatic islets being present.
Remember :
Most common site of gastrinoma's is →
Duodenum (50-70%), (Pancreas 20-40%)
Most common hormone to be secreted → ACTH
besides gastrin is
Most common site of peptic ulcers produced is → ls' part of
Duodenum.
Most valuable provocative test in → The Secretin
injection tests. identifying patients with ZES is
Basal acid output is greater than 60% of out pu → BAO> MAO
induced by maximal stimulation
The term pancreatic endocrine tumour is misnomer because these
tumours can occur either almost exclusively in the pancreas or at
both pancreatic and extrapancreatic sites

medpox.com
1301. Menke's disease" is a disease of
a) Impaired zinc transport

b) Impaired copper transport

c) Impaired magnesium transport

d) Impaired molybdenum transport

Correct Answer - B
Ans. is 'b' i.e., Impaired copper transport
Menke's disease is caused due to defect in the copper
transport.
There is defect in the transport of copper present in the intestinal
medpox.com
mucosa to the blood stream.
The mucosal lining of intestine contains high level of copper bound
to metallothionein protein.
Rather than being transporated to bloodstream, the copper
remained in the mucosa and was lost when intestinal cells were
naturally soughed off.
Menkes disease is caused due to defect in the "MNK" gene.
The protein normally function by moving copper from the intestinal
mucosal cells into the blood stream, where it is hound by proteins
such as albumin and transported to organs and tissues.
Serum copper is critical for the functioning of several enzymes
Lysyl oxidase → It is important for the cross linking of collagen and
elastin such that deficiencies lead to problems in connective tissues
such as bones
Cytochrome oxidase → Involved in temperature maintenance
Tyrosinase → Necessary for pigmentation
Clinical features of menkes disease
Growth retardation
Coarse hair, brittle and ivory white (result of depigmentations). The
hair fibres are twiisted and broken helically (kinky hair).
Seizures
Cerebral and cerebellar degeneration (postmortem analysis)
Hypothermia
Thrombosis
Poor bone development
Increased tendency towards aneurysms

medpox.com
1302. Anosmia is early clinical feature of
a) Alzheimer

b) Parkinson's disease

c) Huntington's chorea

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
Main causes of anosmia
Main causes of anosmia
Nasal. medpox.com
Smoking.
Chronic rhinitis (allergic, atrophic, cocaine, infectious-Herpes,
influenza).
Overuse of nasal vasoconstrictors.
Olfactory epithelium.
Head injury with tearing of olfactory, filaments
Cranial surgery.
Subarachnoid hemorrhage, meningitis.
Toxic (organic solvents, certain antibiotics-am inoglycosides,
tetracyclines, corticosteroids, methotrexate,
opiates, 1-dopa).
Metabolic (thiamine deficiency, adrenal and thyroid deficiency,
cirrhosis, renal failure, menses).
Wegener granulomatosis.
Compressive and infiltrative lesions (craniopharyngioma,
meningioma, aneurysm, meningoencephalocele).
Degenerative disease (Parkinson, Alzheimer, Huntington
Temporal lobe epilepsy.
Malingering and hysteria

medpox.com
1303. Which of the following is the least
common bacteria responsible for Acute
Exacerbation of Chronic Bronchitis
a) Streptococcus pneumoniae

b) Moraxella catarrhalis

c) Haemophilus influenza

d) Staphylocccus aureus

Correct Answer - D
Answer is D (Staphylocccus aureus):
medpox.com
The Global Initiative for Chronic Obstructive Lung Disease (GOLD);
Report produced by the National Heart, Lung, and Blood Institute
(NHLBI) and the World Health Organization (WHO)
Staphylococcus Aureus is not a common bacterial pathogen
responsible for Acute Exacerbation of Chronic Bronchitis.
Common Bacterial Pathogens (30%-50%) Responsible for Acute
Exacerbations of COPD
Haemophilus influenza
Streptococcus pneumonia
Moraxella catarrhalis
Pseudomonas aeruginosa and Enterobacteriaceae are also
commonly isolated, particularly from patients with severe COPD.
Acute Exacerbation of COPD: Bacterial Infections
The GOLD, the NHLBI and the WHO, defines exacerbation of COPD
as acute increase in symptoms beyond normal day-to-day variation.
This generally includes one or more of the following cardinal
symptoms.
Cough increases in frequency and severity
Sputum production increases in volume and/or changes character
Dyspnea increases
Constitutional symptoms, decrease in pulmonary function, and
tachypnea are variably present during an exacerbation, but the CXR
is usually unchanged.
In the presence of severe underlying airflow obstruction,
exacerbation can cause respiratory failure and death.
It is estimated that 70 to 80% of exacerbations of COPD are due to
respiratory infections.
The remaining 20 to 30% are due to environmental pollution or have
an unknown etiology. Viral and bacterial infections cause most
exacerbations
Bacterial infections appear to trigger 33% to 50% of COPD
exacerbations.
Non-typeable H. influenzae, M. catarrhalis, and S. pneumoniae are
the bacteria most frequently isolated bronchoscopically from patients
having an exacerbation of COPD
Pseudomonas aeruginosa and other members of family
Enterobacteriaceae are also commonly isolated, particularly from
medpox.com
patients with severe COPD.
Exacerbations of COPD are strongly associated with acquisition of
new strain of H. influenzae, M. catarrhalis, S. pneumoniae, or P.
aeruginosa.
As a result, it has been proposed that acquisition of new bacterial
strain plays central role in the pathogenesis of an exacerbation.
The idea that exacerbations of COPD are due to acquisition of new
strain of bacteria has largely replaced older hypothesis that
increases in concentration of colonizing bacteria are the primary
cause of exacerbations.
1304. Pseudo-hemoptysis is seen mostly with
a) Streptococcus

b) E. coli

c) Serratia marcescens

d) R.S.V

Correct Answer - C
Ans. is 'C' i.e., Serratia marcesens
Pseudo-hemoptysis is expectoration of blood other than the
respiratory tract i.e. GIT or blood draining from the larynx.
Serratia marcescens is a cause of pseudohemoptysis.
medpox.com
1305. Finger is glove sign is seen in
a) Pulmonary alveolar Proteinosis

b) Pneumocystis Carinii

c) Tuberculosis

d) Bronchocele

Correct Answer - D
Ans. is 'd' i.e., Bronchocele
Rabbit ear appearance
Mickey mouse appearance
Toothpaste shaped opacities medpox.com
Y-shaped opacities
V-shaped opacities
Aetiology
Obstructive
In bronchial obstruction, the portion of the bronchus distal to the
obstruction is dilated with the presence of mucous secretions
(mucus plugging). Causes of bronchial obstruction include :
Bronchial hamartoma
Bronchial lipoma
Bronchial carcinoid
Bronchogenic carcinoma
Congenital bronchial atresia (rarely)
Non obstructive
Causes include .-
Asthma
Allergic bronchopulmonary aspergillosis (ABPA)
Cystic fibrosis
1306. Which of the following disorders is
least likely associated with progression
to lymphoma
a) Sjogren's syndrome

b) Araxia telangiectasia

c) Severe combined immunodeficiency

d) Lynch II syndrome

Correct Answer - C
Ans. is 'c' i.e., Severe combined immunodeficiency
medpox.com
Choice Cancers associated
NHL mainly MALT-oma
Sjogren
involving salivary
syndrome
glands>stomach
Elevated incidence of
cancers, approximately
100-fold in comparison
to the general
population. In children,
more than 85% of
Ataxia
neoplasm cases are
telengectasia
acute lymphocytic
leukemia or lymphoma.
In adults with ataxia-
telangiectaisa, solid
tumors are more
frequent
Gastrointestinal cancer
associated with
 associated with
endometrial/ovarian
Lynch-II
carcinoma. Early onset
syndrome
brain tumor and
lymphoma also seen in
children

medpox.com
1307. Woman of 30-years with Raynaud's
phenomenon, polyarthritis, dysphagia
of 5-years and mild Sclerodactyl, blood
showing Anti-centromere antibody
positive, the likely cause is
a) CREST

b) Mixed connective tissue disorder

c) SLE

d) Rheumatoid arthritis

medpox.com
Correct Answer - A
Ans. is 'a' i.e., CREST
The disease is divided into two categories :?
1) Diffuse scleroderma
. There is wide-spread involvement of skin at onset. There is
rapid progression with early visceral involvement. It is associated
with Anti-DNA topoisomerase (anti-Scl 70) antibodies.
2) Limited (localized) scleroderma (morphea)
. Skin involvement is confined to finges, forearm and face. It
is associated with slow progression and late visceral involvement.
Some patients develop CREST syndrome (Cacinosis, Raynaud's
phenomenon, esophageal dysmotility,
sclerodactyly, and telangiactasia). It is associated with
anticentromere antibodies.
1308. All of the following are features of
Scleroderma are following except
a) Diffuse periosteal reaction

b) Esophageal dysmotility

c) Erosion of tip of phalanges

d) Lung Nodular infiltrates

Correct Answer - A
Ans. is 'a' i.e., Diffuse periosteal reaction
Skin involvement in systemic sclerosis
medpox.com
Skin involvement is a nearly universal feature of systemic sclerosis
(SSc).
It is characterized by variable extent and severity of skin. Thickening
and hardening.
The fingers, hands, and face are generally the earliest areas of the
body involved.
Edematous swelling and erythema may preceede skin induration.
Other prominent skin manifestations include :
Pruritus in the early stages
Edema in the early stages
Sclerodactyly
Digital ulcers
Pitting at the fingertips
Telangiectasia
Calcinosis cutis
Radiographs of the hands may reveal
Soft tissue calcifications (calcinosis cutis).
Resorption of the distal phalangeal tufts (acro-osteolysis).
Less common radiographic findings are :
Articular erosions
Joint space narrowing
Demineralization
The symptoms of the female and presence of antinuclear antibody
points towards the diagnosis of systemic sclerosis. It is a case of
systemic sclerosis or scleroderma.
The clues to the diagnosis of scleroderma are :
Sclerodactyly
Raynaud's phenomenon
Dysphagia
Presence of antinuclear antibody
Though systemic sclerosis is a multisystem disease, the two most
distinguishing features of systemic sclerosis are:
o Striking cutaneous changes
Notable skin thickening. This is the most easily recognized
manifestation of scleroderma.
Raynaud's phenomenon
This is the first manifestation of disease in almost every patients.
Dysphagia medpox.com
Attributable to esophageal fibrosis and its resultant hypomotlity is
present in more than 50% of patients.
Remember,
Whenever skin thickening is present along with Raynaud's
phenomenon, it is almost always a case of scleroderma".
These two features are not present in any other multisystem disease
whose clinical features overlap with that of systemic sclerosis e.g.
SLE, rheumatoid arthritis, inflammatory myopathy, Sjogren
syndrome".
Although skin changes and Raynaud's phenomenon are the major
diagnostic clues, scleroderma is a multisystem disease that most
commonly targets peripheral circulation, muscles, joints,
gastrointestinal tract, lung, heart and kidney.
So, the symptoms encountered in early presentation of scleroderma
include musculoskeletal discomfort, fatigue, weight loss, and heart
burn and dysphagia associated with gastroesophageal reflex
disease (GERD).
When these symptoms are accompanied by the skin thickness and
Raynaud c phenomenon, diagnosis ofscleroderma
should be considered.
Role of autoantibodies in the diagnosis of scleroderma
Autoantibodies are found in nearly every patient with scleroderma
(sensitivity >95%), but they are not specific for scleroderma0.
Scleroderma is associated with wide array of autoantibodies.
Two ANA'S which are more or less unique to scleroderma are:
Seen in patients with
Antitopoisomerase
diffuse systemic
antibody (20-40%)
sclerosis
Patients with this
autoantibody are more
likely to havepulmonary

.fibrosis and peripheral
vascular disease

Patients with these

autoantibodies have
medpox.com
poor prognosis
These autoantibodies
Anticentromere are seen in patients with
antibody (20-40%) limited systemic
sclerosis
1309. Which of the following is not a sign of
upper motor neuron paralysis
a) Babinski sign

b) Spastic paralysis

c) Denervation potential in EMG

d) Exaggeration of tendon reflexes

Correct Answer - C
Ans. is 'c' i.e., Denervation potential in EMG
Difference between upper and lower motor neuron paralysis
medpox.com
Upper motor
Lower motor neuron
neuron
paralysis
paralysis
Muscles
affected in
Individual muscles may
groups never
be affected
individual
muscles
o Atrophy
Atrophy pronounced up
slight and due
to 70% of the total bulk
to disuse
Spasticity with
Flaccidity and hypotoniaQ
hyperactivity of
of affected muscles with
the tendon
loss of tendon reflexes
reflexes and
Extensor
Plantar reflex if present is
plantar reflex
of normal flexor type
(Babinski sign)
(Babinski sign)
Fascicular
Fasciculation may be
twitches
present
absent
Normal nerve Abnormal nerve
conduction conduction studies;
studies; no denervation potential
denervation (fibrillations,
potentials in fasciculations positive
E.M.G. sharp waves) in EMG

medpox.com
1310. Involvement of pyramidal tract leads to
all of the following except
a) Spasticity

b) Fasciculation

c) Hyper-reflexia

d) Positive Babinski sign

Correct Answer - B
Answer is B (Fasciculation):
Fasciculations are a feature of Lower Motor Neuron Lesions.
medpox.com
Involvement of Pyramidal tract indicates an Upper Motor Neuron
Lesion. Hypertonia with Spasticity, Hyper-reflexia and a Positive
Babinski Sign with an Extensor Planter response are all features of
an upper motor neuron lesion (Pyramidal Tract Lesion).
1311. Most common oral infection in diabetes
mellitus
a) Candida

b) Aspergillus

c) Streptococcus

d) Stphylococcus

Correct Answer - A
Ans. is 'a' i.e., Candida
Individuals with DM have a greater frequency and severity of the
medpox.com
infection. The reasons for this include incompletely defined
abnormalities in cell-mediated immunity and phagocyte function
associated with hyperglycemia, as well as diminished
vascularization. Hyperglycemia aids the colonization and growth of a
variety of organisms (candida and other fungal species).
1312. Doughy skin and woody induration of
tongue is seen in
a) Hypernatremia

b) Hyponatremia

c) Hypokalemia

d) Hyperkalemia

Correct Answer - A
Ans. is 'a' i.e., Hypernatremia
Because of intracellular water loss (hypernatremic dehydration), the
medpox.com
pinched abdominal skin of a hypernatremic dehydrated patient has a
"doughy" feel and there is dry woody tongue.
1313. All are features of hypernatremia except
a) Convulsions

b) Elevated intracranial tension

c) Periodic paralysis

d) Doughy skin

Correct Answer - C
Ans. is 'c' i.e., Periodic paralysis
Periodic paralysis, is seen in hyponatermia
Clinical features of Hypernatremia :?
Most patients with hypernatremia are dehydrated and have the
medpox.com
typical signs and symptoms of dehydration.
Hypernatremia even without dehydration causes central nervous
system symptoms that tend to parallel the degree of sodium
elevation and the acuity of the increase.
Patients are irritable, restless weak and lethargic
Some have high pitched cry and hyperpnea.
Alert patient are very thirsty.
Hypernatremia causes fever although many patients have
underlying process that contributes to the fever
Except for dehydration, there is no clear direct effect of
hypernatremia on other organs or tissues except the brain.
Complication of hypernatremia :?
Brain hemorrhage is the most devastating consequence of
hypernatremia. As the extracellular osmolarity increases water
moves out of brain cells, resulting in decrease in brain volume. This
can result in tearing of intra cerebral veins and bridging vessels as
the brain moves away from the skull and the meninges. Patient may
have subarachnoid, subdural and parenchymal hemorrhage.
Seizure and coma are possible sequale of the hemorrhage even
though seizures are more common during t/t.
Thrombotic complications are common in severe hypernatremic
dehydration and include stroke, dural sinus thrombosis, peripheral
thrombosis and renal vein thrombosis.
The intracranial tension can be increased due to hemorrhage

medpox.com
1314. Which of the following is MOST
commonly affected by Crohn's Disease
a) Cecum

b) Rectum

c) Sigmoid colon

d) Terminal Ileum

Correct Answer - D
Ans. is 'd' i.e., Terminal ileum
Inflammatory Bowel disease site of involvement
medpox.com
Ulcerative
Crohn's
cocitis
Any part of the
Limited to the
Gout from mouth
colon
to anus
Involves the
Most commonly entire colon
affected is small starting from the
intestine rectum
particularly ileum (retrograde
manner)
Rectum is most
Terminal ileitis or commonly
affected
Ileum not
involved may get
Granulomatous involvedmay get
colitis involved in some
cases
 cases
(backwash ileitis).
Rectum spared
Full thickness of
the intestine
involved but in
patchy manner
skip lesions

medpox.com
1315. Vitamin B level in chronic myeloid
leukemia is
a) Elevated'

b) Decreased

c) Normal

d) Markedly

Correct Answer - A
Ans. is 'a' i.e., Elevated
CML there will be rise in
B1, level medpox.com
LDH level
And decreased levels of ALP.
1316. Which is the most common organ
involved in sarcoidosis
a) Lung

b) Liver

c) CNS

d) Eye

Correct Answer - A
Ans. is 'a' i.e., Lung

medpox.com
Following organs are commonly affected :?
1) Lung and lymph nodes (95%)
2) Skin (24%-43%)
3) Eye (12-29%
1317. Following statements about sarcoidosis
is false
a) Elevated level of angiotensin converting enzyme (ACE)

b) Bilateral parotid enlargement is the rule

c) Pleural effusion is common

d) Facial nerve palsy may be seen

Correct Answer - C
Ans. is 'c' i.e., Pleural effusion is common
Diffuse Effusion is an uncommon atypical manifestation in
medpox.com
Sarcoidosis reported in up to 5% of patients.
Parotid enlargement is a classic feature of sarcoidosis and bilateral
involvement is the rule
Neurological disease is reported in 5-10% of patients with
sarcoidosis
Facial nerve palsy is the single most common neurological
manifestation of sarcoidosis seen in up to 50% of patients with
Neurosarcoidosis.
Angiotensin converting enzyme (ACE) levels are raised in
sarcoidosis
Lung involvement in sarcoidosis
Most common involved organ (90%).
Characterized by B/L hilar adenopathy.
Cavitations are rare
Pleural effusion are rare (1-2%)
1318. Following statements about sarcoidosis
is false
a) The first manifestation of the disease is an accumulation of
mononuclear inflammatory cells, mostly CD8 + THI
lymphocytes in affected organs

b) The Heerfordt-Waldenstrom syndrome describes individuals

with fever, parotid enlargement, anterior uveitis, and facial
nerve palsy

c) Elevated level of angiotensin converting enzyme (ACE) are a

feature

d) Bilateral parotid involment is the rule

medpox.com

Correct Answer - A
Ans. is 'a' i.e., The first manifestation of the disease is an
accumulation of mononuclear inflammatory cells, mostly CD8 + THI
lymphocytes in affected organs
1319. The most common cause of seizures in
a patient of AIDS is
a) Toxoplasmosis

b) Cryptococcal meningitis

c) Progressive multifocal leucoencephalopathy

d) CNS lymphoma

Correct Answer - A
Ans. is 'a' i.e., Toxoplasmosis
Neurological manifestations of H.I.V.
medpox.com
AIDS dementia complex (HIV encephalopathy) is a result of direct
effects of HIV on CNS (not an opportunistic disease). It is subcortical
dementia.
Most common cause of seizures —> Toxoplasma
Most common cause of meningitis —> Cryptococcus
M.C. cause of focal neurological deficit —> Toxoplasma
Toxoplasmosis is the most common CNS infection in AIDS.
CNS lymphoma and prograssive multifocal leukoencephalopathy
may occur.
1320. Gene responsible for resistance to
rifampicin
a) Rpo B gene

b) Kat G gene

c) Rpm B gene

d) Emb B gene

Correct Answer - A
Ans. is 'a' i.e., Rpo B gene
Gene
ATT Drug medpox.com
responsible for
drug resistance
inhA and Kat G
INH
gene
Ethambutol emb B gene
Rifampicin rpoB gene
PyrazinamidepncA gene
1321. Bechterews disease also known as
a) Rheumatoid arthritis

b) Ankylosing spondylitis

c) Osteoarthritis

d) Syphilitic arthritis

Correct Answer - B
Ans. is 'b' i.e., Ankylosing spondylitis
ANKYLOSING SPONDYLITIS (MARIE - STRUMPELL DISEASE)
Ankylosing spondylitis is a chronic progressive inflammatory disease
of the sacroiliac joints and the axial skeleton.
medpox.com
Prototype 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. o Male to female ratio is 2-3 : 1
Strong correlation with HLA-B27
90-95% of cases are positive for HLA B27.
Joints involved in ankvlosing 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. o Rarely knee
(Ebenzar 4thie 593) and ankle (Apley's 9th/e 67) are also involved.
Clinical features
Low back pain of insidious onset
Duration usually less than 3 months
Significant morning stiffness and improvement with exercise o
Limited chest expansion
Diffuse tenderness over the spine and sacroiliac joints
Loss of lumbar lordosis, increased thoracic kyphosis
Decreased spinal movements (especially extension) in all directions.
Radiological features of ankvlosing spondvlitis
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.
o 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
medpox.com
longitudinal ligament.
Loss of the lumbar lordosis
Bridging `osteophytes' (syndesmophytes)
Bamboo spine appearance
1322. The treatment options for patients with
RRMS (relapsing-remitting multiple
sclerosis) are all except
a) IFN - 1 b

b) IFN - 1 a

c) Glatiramer acetate

d) TNF - a

Correct Answer - D
Ans. is 'd' i.e., TNF - a medpox.com
Treatment of RRMS is divided into:-
i) In acute attack: Corticosteroids are given
ii) Prophylaxis of acute attack (relapse) during remission: Disease
modifying agents for MS are used to reduce the biological activity.
Treatment is started by IFN-P la or IFN-[31b or Glatiramer or
fingalimod. If there is poor response or intolerance to these drugs,
Natalizumab is started.
1323. DOC for Tourette syndrome
a) Haloperidol

b) Valproate

c) B complex

d) Clonidine

Correct Answer - D
Ans. is 'd' i.e., Clonidine
Earlier Haloperidol was considered as DOC for Tourette syndrome.
Clonidine is considered as DOC for Tourette syndrome
medpox.com
Treatment
There's no cure for Tourette syndrome. Treatment is aimed at
controlling tics that interfere with everyday activities and functioning.
When tics aren't severe, treatment might not be necessary.
Medication
Medications that block or lessen dopamine. Fluphenazine,
haloperidol (Haldol), risperidone (Risperdal) and pimozide (Orap)
can help control tics.
Botulinum (Botox) injections
Central adrenergic inhibitors. Medications such as clonidine
(Catapres, Kapvay) and guanfacine (Intuniv) — typically prescribed
for high blood pressure — might help control behavioral symptoms
such as impulse control problems and rage attacks.
Antidepressants. Fluoxetine (Prozac, Sarafem, others)
Antiseizure medications.
Therapy
Behavior therapy. Cognitive Behavioral Interventions for Tics,
medpox.com
including habit-reversal training, can help you monitor tics, identify
premonitory urges and learn to voluntarily move in a way that's
incompatible with the tic.
Psychotherapy. In addition to helping you cope with Tourette
syndrome, psychotherapy can help with accompanying problems,
such as ADHD, obsessions, depression or anxiety.
Deep brain stimulation (DBS). For severe tics that don't respond to
other treatment, DBS might help. DBS involves implanting a battery-
operated medical device in the brain to deliver electrical stimulation
to targeted areas that control movement.
1324. SSPE is not diagnosed by
a) EEG

b) Antibodies to measles in CSF

c) Antibodies to measles in blood

d) Antigen in brain biopsy

Correct Answer - C
Ans. is 'c' i.e., Antibodies to measles in blood [Ref. Nelson l8n/e
chapter 2431]
The diagnosis of SSPE can be establisheil througlt documentation of
a compatible clinical course and at least I of the following
medpox.com
supportingfindings.
Measles antibody detected in CSF.
Characteristic electroencephalographic findings.
Typical histologic fndings and/or isolation of viurs or viral antigen in
brain tissue obtained by biopsy or post-mortem examination.
CSF analysis reveals normal cells but elevated IgG and IgM
antibody titers in dilutions of >1.8. Electroencephaloraphic patterns
are normal in stagel, but in the myclonic phase suppression-burst
episodes are seen that are characteristic ofbut not
pathognomic for,SSPE. Brain biopsy is no longer routinely indicated
for diagnosis o/SSPE.
1325. Bronchiectasis Sicca is seen with
a) Tuberculosis

b) Pertussis

c) Cystic fibrosis

d) Kartagener syndrome

Correct Answer - A
Ans. is 'a' i.e., Tuberculosis
Bronchiectasis Sicca or Dry Bronchiectasis is typically
associated with Tuberculosis.
Tuberculosis is associted with a type of dry bronchiectasis called
medpox.com
Bronchiectasis Sicca, which is predominantly seen in upper lobes.
Dry Bronchiectasis (Bronchiectasis Sicca) is typically characterized
by absence of copious amount of sputum which is usually a hall
mark of bronchiectasis.
Dry cough associated with hemoptysis is the typical presentation
Endobronchial tuberculosis commonly leads to bronchiectasis, either
from bronchial stenosis or secondary traction from fibrosis. Traction
bronchiectasis characteristically affects peripheral bronchi (which
lack cartilage support) in areas of end-stage fibrosis
1326. Brock's Syndrome is
a) Bronchiectasis Sicca

b) Middle Labe Bronchiectasis

c) Kartagener's Syndrome

d) Sarcoidosis

Correct Answer - B
Ans. is 'b' i.e., Middle Lobe Bronchiectasis
Brock's Syndrome
Right middle lobe bronchiectasis occurring as a late sequel ofprimaiy
tuberculosis is known as Brock's syndrome or middle lobe
medpox.com
syndrome.
Brock's syndrome is believed to be caused by pressure of lymph
nodes in primary tuberculosis on the middle lobe bronchus.
It has been described as a typical outcome of hilar node involvement
by tuberculosis in childhood.
This term is also applied to recurrent atelectasis of the right middle
lobe in the absence of endobronchial obstruction.
Bronchiectasis develops after recurrent episodes of atelectasis and
fibrosis
1327. Upper lobe bronchiectasis is seen in
which disease?
a) Cystic fibrosis

b) Aspergilloma

c) HIV

d) Bronchogenic carcinoma

Correct Answer - A
Answer- A. Cystic fibrosis
Upper lobe bronchiectasis-
Cystic fibrosis medpox.com
Tuberculosis
Non tuberculous mycobacterial infections
1328. Bilateral Painless parotid enlargement
is seen in all except
a) Mumps

b) Alcoholics

c) Sarcoidosis

d) Diabetes mellitus

Correct Answer - A
Ans. is 'a' i.e., Mumps
Bilateral parotid enlargement is seen in
Viral medpox.com
Metabolic causes Endocrinal Sarcoidosis
infectionQ
Mumps Diabetes mcuitus Gonadal Amyloidosis
Sjogren's
Influenza Hyperlipoproteinemiahypofunction
syndrome
Epstein
Chronic pancreatitis Acromegaly
barr virus
Coxackie
Hepatic cirrhosis
virus A
CMV
HIV
1329. Therapeutic hypothermia is of benefit in
preventing neurological complications
in
a) Sepsis

b) Poly-trauma

c) Cardiac arrest

d) lschemic stroke

Correct Answer - C
Ans. is 'c' i.e., Cardiac arrest
medpox.com
Inducing mild therapeutic hypothermia in selected patients surviving
out-of-hospital sudden cardiac arrest can
significantly improve rates of long-term neurologically intact survival
and may prove to be one of the important
clinical advancements in the science of resuscitation.
The types of medical events that hypothermic therapies may
effectively treat fall into four primary categories:
Cardiac arrest
Ischemic stroke
Trumatic brain or spinal cord injury without fever.
Neurogenic fever following brain trauma
1330. Distribution of weakness in Pyrimidal
tract lesions?
a) Extensors more than flexors in lower limb

b) Flexors more than extensors in upper limb

c) Antigravity muscles are affected

d) Antigravity muscles are spared

Correct Answer - D
Ans. is 'd' i.e., Antigravity muscles are spared
The following clinical features characterize a UMN lesion:
Increased tone (spasticitv) medpox.com
Initially, UMN weakness may be flaccid, with absent or diminished
deep tendon reflexes. There is little understanding of the reasons
behind this initial flaccidity and it is often referred to as 'shock'.
Increased tone of a UMN type is called spasticity. It may develop
several hours, days or even weeks after the initial lesion has
occurred. Spasticity is manifested by :
Spastic catch' :
Mild spasticity may be detected as a resistance to passive
movement or 'catch' in the pronators on passive supination of the
forearm and in the flexors of the hand/forearm on extension of the
wrist/elbow.
The 'clasp-knife' phenomenon:
In more severe lesions, following strong resistance to passive flexion
of the knee or extension of the elbow, there is a sudden relaxation of
the extensor muscles of the leg and flexor muscles in the arm.
Clonus:
Rhythmic involuntary muscular contractions follow an abruptly
applied and sustained stretch stimulus, e.g. at the ankle following
sudden passive dorsiflexion of the foot.
`Pyramidal-pattern' weakness
The antigravity muscles are preferentially spared and stronger
The flexors of the upper limbs and the extensors of the lower limbs.
The patient can develop a characteristic posture of flexed and
pronated arms with clenched fingers, and extended and adducted
legs with plantar flexion of the feet.
In upper extremiteis
Relative sparing of the flexors
More involvement of the extensor
In lower extremities
Predominant invovlement of the flexors with
Relative sparing of the extensor or
Absence of muscle wasting and fasciculations
Focal muscle wasting andjasciculations are features of an LMN
lesion. With chronic disuse, some loss of muscle bulk can occur
after a UMN lesion, but this is rarely severe or focal.
Brisk tendon reflexes and extensor plantar responses
The tendon reflexes are brisk. The cremasteric and abdominal or
medpox.com
'cutaneous' reflexes are depressed or absent. The plantar responses
are extensor (upgoing toes' or 'positive' babinski sign).
Anti-gravity muscles are typically spared in pyramidal tract lesions.
Weakness, in pyramidal tract lesions is often termed as 'pyramidal'
in distribution affecting extensors more than flexors in the upper
limb, and flexors more than extensors in the lower limb (Anti-gravity
muscles are spared).
Pyramidal weakness → Loss of power most marked in the
extensors muscles in the arms and flexors in the legs
Proximal weakness → Shoulders, hips, trunks, neck and
sometimes face. Associated with myopathy.
Distal weakness → Affects hands and feets. Associated
with peripheral motor neuropathy.
Global weakness → Generalized weakness in limbs
which may result from severe pathologies.
1331. Aldose reductase inhibitor drugs are
useful in
a) Cataract

b) Diabetes mellitus

c) Hereditary fructose intolerance

d) Essential fructosuria

Correct Answer - B
Ans. is 'b' i.e., Diabetes mellitus
Aldose reductase catalyzes the NADPH-dependent conversion of
medpox.com
glucose to sorbitol, the first step in polyol pathway of glucose
metabolism.
Aldose reductase inhibitors are a class of drugs being studied as a
way to prevent eye and nerve damage in people with diabetes
mellitus.
Examples of aldose reductase inhibitors include:
Tolrestat (withdrawn from market)
Apalrestat
Ranirestat
Fidarestat
1332. Most common cause of hypernatremia
a) Adipsic diabetes insipidus

b) Carcinoid syndrome

c) Renal losses

d) Sweating

Correct Answer - C
Ans. is `c' i.e., Renal losses
Major causes of hypernatremia
Unreplaced water loss (which requires an impairment in either
thirst or access to water) medpox.com
Insensible and sweat losses
Gastrointestinal losses
Central or nephrogenic diabetes insipidus o Osmotic diuresis
Glucose in uncontrolled diabetes mellitus
Urea in high-protein tube feedings
Mannitol
Hypothalamic lesions impairing thirst or osmoreceptor function
Primary hypodipsia
Reset osmostat in mineralocorticoid excess
Water loss into cells
Severe exercise or seizures
Sodioutn overload
Intake or administration of hypertonic sodium solutions
1333. Not a cause of hypernatremia
a) Adipsic diabetes insipidus

b) Decreased insensible losses

c) Nephrogenic diabetes insipidus

d) Carcinoid syndrome

Correct Answer - B
Ans. is 'b' i.e., Decreased insensible losses
Major causes of hypernatremia
Unreplaced water loss (which requires an impairment in either thirst
or access to water) medpox.com
Insensible and sweat losses
Gastrointestinal losses
Central or nephrogenic diabetes insipidus
Osmotic diuresis
Glucose in uncontrolled diabetes mellitus
Urea in high-protein tube feedings
Mannitol
Hypothalamic lesions impairing thirst or osmoreceptor function
Primary hypodipsia
Reset osmostat in mineralocorticoid excess
Water loss into cells
Severe exercise or seizures
Sodioum overload
Intake or administration of hypertonic sodium solutions
1334. Hyponatremia is seen in
a) Hyperthyroidism

b) Hypothyroidism

c) Diabetes insipidus

d) Increased insensible losses

Correct Answer - B
Ans. is 'b' i.e., Hypothyroidism [RefHarrison's 18th
Hypothyroidism is characterised by low cardiac output leading to
increased AVP production and resultant hyponatremia.
Addison disease must be ruled out in chronic cases of hyponatremia
medpox.com
Major causes of hyponatremia
Disorders in which ADH levels are elevated
Effective circulating volume depletion
True volume depletion
Heart failure
Cirrhosis
Thiazide diuretics
Syndrome of inappropriate ADH secretion, including reset osmostat
pattern
Hormonal changes
Adrenal insufficiency
Hypothyroidism
Pregnancy
Disorders in which ADH levels may be appropriately
suppressed
Advanced renal failure
Primary polydipsia
Beer drinker's potomama
Hyponatremia with normal or elevated plasma osmolality
High plasma osmolality (effective osmols)
Hyperglycemia
Mannitol
High plasma osmolality (ineffective osmols)
Renal failure
Alcohol intoxication with an elevated serum alcohlo concentration
Normal plasma osmolality
Psedohyponatremia (laboratory artifact)
High triglycerides
Chloestatic and obstructive jaundice (lipoprotein x)
Multiple myeloma
Absorption of irrigant solutions
Glycine Sorbitol Mannitol

medpox.com
1335. Backwash ileitis is seen in
a) Ulcerative colitis

b) Crohn's disease

c) Colonic carcinoma

d) heal polyp

Correct Answer - A
Ans. is 'a' i.e., Ulcerative colitis
Ulcerative colitis always involves the rectum and extends proximally
in continuous fashion to involve part or all part of the colon.
Involvement of terminal ileum in ulcerative colitis is called backwash
medpox.com
ileitis
1336. What is true about ulcerative colitis ?
a) Involves rectum and then whole colon backwards

b) Involves only colon

c) Skip lesions seen

d) Ileum not involved

Correct Answer - A
Ans. is- A. Involves rectum and then whole colon backwards
Ulcerative colitis (UC) is a long-term condition that results
in inflammation and ulcers of the colon and rectum.
medpox.com
1337. Which of the following is given to treat
thrombocytopenia secondary to anti-
cancer therapy and is known to
stimulate progenitor megakaryocytes
a) Filgrastim

b) Oprelvekin

c) Erythropoietin

d) Anagrelide

Correct Answer - B medpox.com

Ans. is 'b' i.e., Oprelvekin
Oprelvekin ( IL-11) is used to prevent and treat thrombocytopenia.
[Ref Harrison's 18th chapter 85 and Katzung 11th 580-581]
1338. Lambda - Panda sign is typically seen
in
a) Sarcoidosis

b) Tuberculosis

c) Histoplasmosis

d) Leishmaniasis

Correct Answer - A
Ans. is 'a' i.e., Sarcoidosis
Lambda sign and Panda sign on Gallium scan are typically
described for sarcoidosis.medpox.com
Active pulmonary and/or mediastinal sarcoidosis is gallium avid and
a positive gallium scan can support the diagnosis of sarcoidosis.
Typical patterns of uptake have been described as 'panda' and
'lambda' signs.
Lambda sign → Formed from increased uptake in bilateral hilar
and right paratracheal nodes
Panda sign → Formed from increased uptake in the parotids
and lacrimal glands
A Lambda sign in combination with a so-called Panda sign (Lambda-
Panda Sign) is a highly specific pattern for sarcoidosis.
The degree of uptake typically depends on the activity of disease
and gallium scan is positive only in the setting of active parenchymal
disease and negative in remission
1339. All are indications for stopping
effending ATT drug permanently except
a) Gout

b) Autoimmune thrombocytopenia

c) Optic neuritis

d) Hepatitis

Correct Answer - D
Ans. is 'd' i.e., Hepatitis
For patients with symptomatic hepatitis and those with marked (five
medpox.com
to six fold) elevations in serum levels of aspartate aminotransferase,
treatment should be immediately stopped and drugs reintroduced
one at a time after liver function has returned to normal.
Indications for stopping the A.T.T. permanently
Hyperuricemia and arthralgia
Optic neuritis
Autoimmune thrombocytopenia
1340. Interferon gamma release assay
measures IFN release against which M.
TB antigen
a) ESAT-6

b) E SAT-7

c) CF-11

d) CF-12

Correct Answer - A
Ans. is 'a' i.e., ESAT-6 medpox.com
3 Interferon-gamma release assays (IGRAs) are diagnostic tools
for latent tuberculosis infection (LTBI).
They are surrogate markers of Mycobacterium tuberculosis infection
and indicate a cellular immune response to M. tuberculosis.
a IGRAs cannot distinguish between latent infection and active
tuberculosis (TB) disease and should not be used for diagnosis of
active TB, which is a microbiological diagnosis. A positive IGRA
result may not necessarily indicate active TB, and a negative IGRA
result may not rule out active TB .
3 Because IGRAs are not affected by Bacille Calmette-Guerin
(BCG) vaccination status, IGRAs are useful for evaluation of LTBI in
BCG-vaccinated individuals, particularly in settings where BCG
vaccination is administered after infancy or multiple (booster) BCG
vaccinations are given.
Assay antigens
M. tuberculosis-specific antigens include :-
Early secreted antigenic target 6 (ESAT-6) and
Culture filtrate protein 10 (CFP-10).
These are encoded by genes located within the region of difference
1 (RD1) segment of the M. tuberculosis genome.
They are more specific for M. tuberculosis than purified protein
derivative (PPD) because they are not shared with any BCG vaccine
strains or most species of NTM other than M marinum, M. kansasii,
M szulgai, and M. flavescens.
Types of assays
Two IGRAs are available in many countries :-
The QuantiFERON-TB Gold In-Tube (QFT-GIT) assay, which has
replaced the second-generation Quantiferon​TB Gold (QFT-G)
assay, and the T-SPOTTB assay.
The QFT-GIT assay is an enzyme-linked immunosorbent assay
(ELISA)-based, whole-blood test that uses peptides from three TB
antigens i.e.,
CFP-10, and
TB7.7) in an in-tube format
The result is reported as quantification of interferon (IFN)-gamma in
international units (IU) per mL.
A newer assay, the QuantiFERON-TB Gold Plus (QFT-Plus),
medpox.com
became available in 2015.
This test is available in Europe but not in North America. The QFT-
Plus assay has two TB antigen tubes, unlike the QFT assay (which
has a single TB antigen tube).
Sensitivity and specificity
IGRAs have specificity >95 percent for diagnosis of latent TB
infection. The sensitivity for T-SPOTTB appears to be higher than for
QFT-GIT or TST (approximately 90, 80, and 80 percent,
respectively) [2]. The higher sensitivity of T-SPOTTB may be useful
for evaluating individuals with immunosuppressive conditions.
TST specificity is high in populations not vaccinated with BCG (97
percent). Among populations where BCG is administered, it is much
lower although variable (approximately 60 percent).
1341. Muehrcke lines in nails are seen in
a) Nephrotic syndrome

b) Barrter syndrome

c) Nail patella syndrome

d) Acute tubular necrosis

Correct Answer - A
Ans. is 'a' i.e., Nephrotic syndrome
Muehrcke's lines are characteristic of hypoalbuminemia. Nephrotic
syndrome causes hypoalbunemia.
medpox.com
1342. Herpes simplex infection can lead to?
a) Frontal lobe infarction

b) Parietal lobe infarction

c) Temporal lobe infarction

d) Occipital neuralgia

Correct Answer - C
Answer- C. Temporal lobe infarction
Herpes simplex infection has a predilection for the involvement of
Temporal lobe.
The lesions in HSV encephalitis are intense hemorrhagic necrosis of
medpox.com
the inferior and medial temporal lobe and the mediorbital part of
frontal lobes.
1343. Brain death is said to occur if there
is:
March 2008
a) Absent spinal reflexes

b) Cortical death following widespread brain injury

c) Absence of brainstem reflexes

d) Core temperature of the body is below 35 degree C

Correct Answer - C
Ans. C: Absence of brainstem reflexes
medpox.com
Brainstem is responsible for the respiratory drive and mostly for the
maintenance of BP. All motor outputs from the brain travel through
the brainstem. Apart from smell and vision. All sensory traffic coming
into the brain comes through the brainstem. The brainstem also
mediates the cranial nerve reflexes. Hence a properly functioning
brain stem is a precondition for full consciousness.
Irreversible brain damage and loss of brain function, is evidenced by
cessation of breathing and other vital reflexes (mediated by brain
stem), unresponsiveness to stimuli, absence of muscle activity, and
a flat electroencephalogram for a specific length of time.
1344. Occupational Lung Disease commonly
seen in Textile Industry Workers is:
a) Byssinosis

b) Bagassosis

c) Farmer's Lung

d) Asbestosis

Correct Answer - A
Answer is A (Byssinosis)
Occupational Lung Disease in Textile Industry Workers (Cotton
industry) medpox.com
Byssinosis is an asthma-like condition caused by inhalation of cotton
fiber dust over prolonged period of time.
Workers occupationally exposed to cotton dust (but also to flax,
hemp or jute dust) in the production of yarns for textile and rope
making are at risk of Byssinosis.
Exposure occurs throughout the manufacturing process but is most
pronounced in the portions of the factory involved with the treatment
of cotton before spinning (blowing, mixing, carding or straightening)
Byssinosis is more common during milling and processing of cotton
than during spinning.
1345. Duration of apnea in obstructive sleep
apnea is
a) <10 sec

b) <20 sec

c) <30 sec

d) <60 sec

Correct Answer - A
Ans. is 'a' i.e., <10 sec
Sleep apnea ?
medpox.com
o Sleep apnea is defined as intermittent cessation of airflow at the
nose and mouth during sleep.
o By convention apneas of at least 10 seconds duration have been
considered important but in most patients the apneas are 20s to 30
seconds in duration and may be as long as 2-3 minutes.
o Sleep apnea is of two types -
Sleep apnea
Obstructive sleep apnea Central sleep apnea
Occurs due to
Occurs due to occlusion of transient abolition
upperairway at the level of ofthe central neural
oropharynx drive to the respiratory
muscles
Primary and
secondary central
alveolarhypoventilation
Conditions associated are syndrome, hypoxia
adenotonsillarhypertrophy, (high altitude)
retrognathia, cardiovascular
macroglossiaalcohol, disease, pulmonary
obesity congestion, central
nervous system
disease, prolonged
circulation time.
Clinical features of sleep apnea -
Excessive daytime sleepiness
Cardiorespiratory disturbances which include

Recurrent respiratory failure

Pulmonary hypertension

Heart failure
Systemic hypertension 7 Chronic hypoventilation

Polycythemia
o Arterial blood gas analysis reveals hypoxemia and hypercapnia.
medpox.com
1346. Obstructive sleep apnoea may result in
all of thefollowing except
a) Systemic hypertension

b) Pulmonary hypertension

c) Cardiac arrhythmia

d) Impotence

Correct Answer - C
Ans. is 'c' i.e., Cardiac arrhythmia
Daytime function and cognition
medpox.com
OSA is associated with excessive daytime sleepiness, inattention,
and fatigue, which may impair daily function, induce or exacerbate
cognitive deficits, and increase the likelihood of errors and
accidents.
Cardiovascular morbidity
Patients with OSA, are at increased risk for a broad range of
cardiovascular morbidities, including systemic hypertension,
pulmonary arterial hypertension, coronary artery disease, cardiac
arrhythmias, heart failure, and stroke.
Metabolic syndrome and type 2 diabetes
Patients with OSA have an increased prevalence of insulin
resistance and type 2 diabetes.
Nonalcoholic fatty liver disease
Intermittent nocturnal hypoxia due to OSA may contribute to the
development and severity of nonalcoholic fatty liver disease
(NAFLD), independent of shared risk factors such as obesity.
Perioperative complications
Patients with OSA may be at greater risk for perioperative
complications such as postoperative oxygen desaturation, acute
respiratory failure, postoperative cardiac events, and intensive care
unit transfers.
Mortality
Patients with untreated severe OSA (ie, AHI 30 events per hour)
have a two- to three fold increased risk of all-cause mortality
compared with individuals without OSA, independent of other risk
factors such as obesity and cardiovascular disease.

medpox.com
1347. Not true obstructive sleep appoea
a) Nocturnal asphyxia

b) Alcoholism is a cofactor

c) Prone to hypertension

d) Overnight oximetry is diagnostic to replace polysomnography

Correct Answer - D
Ans. is 'd' i.e., Overnight oximetry is diagnostic to replace
polysomnography
Cardinal features in adults include:
Obstructive apneas, hypopneas, or respiratory effort related
medpox.com
arousals
Daytime symptoms attributable to disrupted sleep, such as
sleepiness, fatigue, or poor concentration
Signs of disturbed sleep, such as snoring, restlessness, or
resuscitative snorts
Clinical presentation
Most patients with OSA first come to the attention of a clinician
because the patient complains of daytime sleepiness, or the bed
partner reports loud snoring, gasping, snorting, or interruptions in
breathing while sleeping.
Daytime sleepiness, distinct from fatigue, is a common feature of
OSA
Sleepiness is the inability to remain fully awake or alert during the
wakefulness portion of the sleep-wake cycle.
Snoring is the other common feature of OSA. While snoring is
associated with a sensitivity of 80 to 90 percent for the diagnosis of
OSA, its specificity is below 50 percent.
Clinical features of obstructive sleep apnea (OSA)
Daytime sleepiness Obesity
Daytime sleepiness Obesity
Large neck
Nonrestorative sleep
circumference
Systemic
Loud snoring
hypertension
Witnessed apneas by
Hypercapnia
bed partner
Awakening with Cardiovascular
choking disease
Nocturnal Cerebrovascular
restlessness disease
Insomnia with Cardiac
frequent awakenings dysrhythmias
Narrow or
Lack of concentration "crowded"
airway
Pulmonary
Cognitive deficits
hypertension
Changes in mood medpox.com
Cor pulmonale
Morning headaches Polycythemia
Vivid, strange, or Floppy eyelid
threatening dreams syndrome
Gastroesophageal
Nocturia
reflux
Polysomnography
Full-night, attended, in-laboratory polysomnography is considered
the "gold-standard diagnostic" test for OSA.
It involves monitoring the patient during a full night's sleep.
Unattended, out of centre sleep "(OCST) may be used as an
alternative to polysomnography for the diagnosis of OSA in patients
with a high pre-test probability of moderate to severe OSA, provided
there are no medical comorbidities such as heart failure that
predispose to alternative or additional sleep related breathing
disorders.
The diagnosis of OSA is based upon the presence or absence of
related symptoms, as well as the frequency of respiratory events
during sleep (ie, apneas, hypopneas, and respiratory effort related
arousals IRERAsJ as measured by polysomnography or out-of-
center sleep testing (OCST).
In adults, the diagnosis of OSA is confirmed if either of the two
conditions exists:
There are "fil_y" or more predominantly obstructive respiratory
events (obstructive and mixed apneas, hypopneas, or RERAs) per
hour of sleep (for polysomnography) or recording time (for OCST) in
a patient with one or more of the following:
Sleepiness, nonrestorative sleep, fatigue, or insomnia symptoms.
Waking up with breath holding, gasping, or choking.
Habitual snoring, breathing interruptions, or both noted by a bed
partner or other observer
Hypertension, mood disorder, cognitive dysfunction, coronary artery
disease, stroke, congestive heart failure, atrial fibrillation, or type 2
diabetes mellitus
There are 15 or more predominantly obstructive respiratory events
(apneas, hypopneas, or RERAs) per hour of sleep (for
polysomnography) or recording time (for OCST), regardless of the
medpox.com
presence of associated symptoms or comorbidities
1348. Tophi in gout found in all regions
except
a) Prepatellar bursae

b) Muscle

c) Helix of ear

d) Synovial membrane

Correct Answer - B
Ans. is 'b' i.e., Muscle
Location of Tophi
medpox.com
They are classically located along the helix of the ear.
Can also be seen in :-
Fingers
Toes
Prepattelar bursa
Olecranon
Although gout typically cuases joint inflammation, it can also cause
inflammation in other synovial-based structures, such as bursae and
tendons.
Tophi are collections of urate crystals in the soft tissues. They tend
to develop after about a decade in untreated patients who develop
chronic gouty arthritis.
Tophi may develop earlier in older women, particularly those
receiving diuretics.
1349. Early loss of bladder control is seen in
a) Conus Medullaris

b) Cauda Equina

c) Gullain Barre Syndrome

d) Amyotrophic Lateral Sclerosis

Correct Answer - A
Answer is A (Conus Medullaris):
Harrison's 18th Loss of bladder control is an early and marked
feature of conus medullaris.
Cauda
medpox.com
Conus
Feature Equina GBS AMLS
Medullaris
syndrome
Early and Late and less Absent
Bladder Uncommon
Marked marked /uncommon
'Bladder 'Bladder
'If bladder 'Even in late
Involvement dysfunction involvement is
dysfunction a stages of
is a
late prominent
a prominent the illness
presentation feature and
feature and bowel and
in cauda- comes
early in the bladder
comes early equina
course, functions
in the syndrome
diagnostic are
course of possibilities preserved'
disease' other than
GBS

should be
 considered

medpox.com
1350. Subacture combined degeneration of
cord is caused due to deficiency of
a) Vitamin B1

b) Vitamin B5

c) Vitamin B6

d) Vitamin B12

Correct Answer - D
Ans. is 'd' i.e., Vitamin B12
Subacate combined degeneration of the spinal cord is the term used
medpox.com
for the degeneration of the spinal cord due to vitamin B 12 deficiency.
The spinal cord, brain, optic nerves, peripheral nerves may all be
affected in vitamin B12 deficiency but the spinal cord is usually
affected first and exclusively.
The tracts mainly involved in the spinal cord are: o Posterior
column
Corticospinal tract
Later on peripheral nerves are involved
Clinical features of vitamin B deficiency or subacute combined
degeneration of the cord :
Patient first notices mild general weakenss and paresthesia
consisting of tingling 'pins and needle'.
As the illness progresses the gait becomes unsteady and stiffness
and weakenss of the limbs and legs develop. If the disease remains
untreated ataxic paraplegia evolve.
Sometimes there may be loss of superficial sensations, such as
tactile, pain and thermal sensations, but these signs are rare.
Loss of "vibration sense" is the most consistent sign and is usually
accompanied by loss of position sensee.
Motor signs seen are:-
Loss of strength in proximal limb muscles
Spasticity, changes in tendon reflexes
Clonus and extensor plantar responses
Sometimes tendon reflexes may be absente (due to involvement of
peripheral nerve) o Gait is ataxic
Now,
The Clinicopathological Correlation
Clinical Tracts
features involved
Paresthesia,
inpairment of Due to lesion
deep in posterior
sensation and column
ataxia
Weakness,
Due to
spasticity and
corticospinalmedpox.com
increased
tract
tendon
involvement
reflexes
Due to
Occasional
spinothalamic
findings of
tract
loss of pain
involvement
and
(rarely
temperature
involved)
Distal and Involvement of
symmetrical peripheral
impairmeat of nerve
superficial (occassionally)
1351. Foot ulcers in diabetes are due to all
except
a) Decreased immunity

b) Neuropathy

c) Microangiopathy

d) Macroangiopathy

Correct Answer - A
Ans. is 'a' i.e., Decreased immunity
The reasons for the increased incidence of foot ulcers in DM involve
medpox.com
the interaction of several pathogenic factors
Neuropathy (Microvascular complication)
Motor and sensory neuropathy lead to abnormal foot muscle
mechanics and structural changes in the foot (hammertoe, claw toe
deformity, prominent metatarsal heads, Charcot joint).
Autonomic neuropathy
Results in anhidrosis and altered superficial blood flow in the foot,
which promote drying of the skin and fissure formation. PAD and
poor wound healing impede the resolution of minor breaks in the
skin, allowing them to enlarge and to become infected.
Abnormal foot biomechanics.
P.A.D. (Macrovascular complication)
This leads to occlusive arterial disease that results in ischemia in the
lower extremity and an increased risk of ulceration in diabetic
patients.
Poor wound healing.
Grades of diabetic foot ulcers
Grade 0 skin intact but bony deformities produce a "foot at risk".
Grade 1 localized, superficial ulcer.
Grade 2 deep ulcer to tendon, bone, ligament, or joint.
Grade 3 deep abscess, osteomyelitis
Grade 4 gangrene of toes or forefoot
Grade 5 gangrene of the entire foot

medpox.com
1352. Not a cause of Gynaecomastia
a) Hypothyroidism

b) Kallman

c) obesity

d) Klinefelter syndrome

Correct Answer - A
. Ans. is 'a' i.e., Hypothyroidism
Causes of Gynaecomastia
Puberty
During puberty, the serum oestradiol rises to adult levels before
medpox.com
testosterone, causing transient gynaecomastia. This normally
resolves within six months to two years.
Cirrhosis
Gynaecomastia occurs due to altered sex hormone metabolism, and
an increase in the oestradiol; free testosterone ratio.
Hypogonadism
Primary hypogonadism causes a compensatory rise in LH, in turn
causing increased peripheral aromatization of testosterone to
oestradiol.
Secondary hypogonadism, due to pituitary or hypothalamic disease
(e.g. prolactin excess, Kallman's syndrome haemachromatosis),
may also cause gynaecomastia despite LH deficiency, since the
adrenal cortex continues to produce oestrogen precursors, which
are converted to oestrogens in peripheral tissues.
Tumours
Testicular tumours:
Germ cell tumours account for over 95% testicular tumours.
Gynaecomatia occurs in 5% of patients, due to hCG secretion
stimulating oestradol production by the testes.
Leydig cell tumours cause gynaecomastia in 20 – 30% of cases.
These tumours present with precocious puberty in boys, or poot
libido and gynaecomastia in young males. Approximately 10% of
these tumours are malignant.
Sertoli cell turnours cause gynaecomastia through excess
aromatization of androgents to oestrogens. These turnours may
occur in Peutz- Jeger 's syndrome.
Adrenocortical turnours may cause gynaecomastia through
overproduction of androgens such as androstenedione, which are
converted to oestrogens in peripheral tissues.
Ectopic hCG-secreting tumours include lung, gastric, renal, and
hepatocellular carcinomas.
Hypogonadism from chemotherapy or radiotherapy may also cause
gynaecomastia in patients with testicular tumours.
Graves disease
Gynaecomastia may occur due to increased sex hormone-binding
globulin (SHBG), and decreased free testosterone levels.
Chronic renal failure: medpox.com
Half of patients receiving haemodialysis develop gynaecomastia due
to decreased leydig cell function. Gynaecomastia may also occur
following kidney transplantation due to ciclosporin use.
Androgen insensitivity syndrome :
Complete androgen insensitivity, .formerly termed 'testicular
feminization syndrome', causes a femalephynotype in patients who
are genotype males. These patients are regarded as female, and
therefore present with infertility and amenorrhoea rather
gynaecomastia. Partial androgen receptor defects maycause
gynaecomastia in phenotypic males.
Drugs cause gvnaecomastia
Anti-androgens
Cyproterone acetate
Finasteride/dutasteride
Gastrointestinal drugs
Cimetidine / ranitidine
Cancer chemotherapy
Alkylating agents/vinca alkaloids (due to testicular damage and
hypogonadism)
Imatinib (tyrosine kinase inhibitor used for chronic myeloid leukemia
(CML) and gastrointestinal stromal tumour (GIST).
Cardiovascular drugs
Spironolactone (displaces oestrogen from SHBG, increasing free
oestrogen: testosterone ratio)
Digoxin
Amiodarone
Methyl-dopa
Antimicrobial drugs
Isoniazid
Ketoconazole
Metronodazole
Anti-viral drugs
Highly active anti-retroviral (HAART) therapy (especially protease
inhibitors)
Neurological drugs
Phenothiazines
Metoclopramide medpox.com
Tricyclic anti-depressants
Opiates
1353. Brain tumor causing hypernatremia in
children
a) Medulloblastoma

b) Cerebellar astrocytoma

c) Craniophyrangioma

d) Brain stem glioma

Correct Answer - C
Ans. is 'c' i.e., Craniophyrangioma
Craniophyrangioma leads to central diabetes mellitus and resultant
medpox.com
loss of water leads to hypernatremia.
1354. Poorly controlled diabetes with blood
sugar of 450 mg% is associated with:
a) Hyponatremia

b) Hypernatremia

c) Hypokalemia

d) Hypomagnesemia

Correct Answer - A
Ans. is 'a' i.e., Hyponatremia
Poorly controlled diabetes draws water out of cells resulting in
hyponatremia. medpox.com
n Plasma concentration falls by 1.4 mmol/L for every 100mg/d1 rise
in plasma glucose concentration of sodium.
1355. All of the following drugs may be used
in the treatment of ulcerative colitis
Except
a) Corticosteroids

b) Azathioprine

c) Sulfasalazine

d) Methotrexate

Correct Answer - D
Ans. is 'd' i.e., Methotrexatemedpox.com
Methotrexate in crohn's disease
Methotrexate has been shown to be effective for inducing remission
in patients with steroid dependent and steroid refractory crohn's
disease.
Agents that may be used for treatment of ulcerative colitis
5-ASA
Glucocorticoids
Azathioprine and 6 mercaptopurine
Cyclosporine or TNF alpha therapy (Infliximab).
Tacrolimus is a macrolide antibody that has shown to be effective in
adults with steroid dependent or refractory ulcerative colitis.
Drugs used in crohn's disease
Cyclosporine or infliximab
6-Mercaptopurine or azathioprine
Glucocorticoid IV
Glucocorticoid oral
Glucocorticoid rectal
5-ASA rectal or oral
medpox.com
1356. Treatment of choice in acute
sarcoidosis is
a) Prednisolone

b) Cyclosporin

c) Infliximab

d) IV immunoglobulins

Correct Answer - A
Ans. is 'a' i.e., Prednisolone
Prednisolone (corticosteroid) is the treatment of choice for both
medpox.com
acute and chronic phase of sarcoidosis that requires treatment.
1357. The following are the complication of
haemodialysis except -
a) Hypotension

b) Peritonitis

c) Hypertension

d) bleeding tendency

Correct Answer - B
Ans. is 'b' i.e., Peritonitis
Patients with endstage renal disease (ESRD) on long term dialysis
medpox.com
therapy have very high mortality due to predominantly
cardiovascular causes.
'Sudden cardiac death is the single most common form of death in
hemodialysis, accounting for 20% to 30 all deaths in this cohort.'
Dialysis patients have extraordinarity high mortailty rates with cardic
disease accounting for 43 percent deaths
in this population. Data indicates that approximately 27% of the
mortailties are due to sudden cardic death.
More on cardiovascular complications in dialysis
Cardiovasucular disease is the major cause of death in ESRD
patients and atheroscleroses is present in all long term dialysis
patients.
Premature cardiac death has reached epidemic levels in world
dialysis population occurring five to ten times as commonly as in age
matched general population and accounting for at least half of all
patients death. o Hypertension is a major risk factor
Other risk factor are :-
Hyperphosphetemia and elevated calcium phosphorus with calcium
deposition in coronary arteries.
Anemia
Hypertriglyceridemia
Low HDL cholesterol
Increased lipoprotein (a)
Insulin deficiency or resistance
Hyperhomocysteinem
Also know
Complications of dialysis
Acute
Long term
complications of
complications
hemodialysis
o Hypotension o Cardiovascular
o Cramps o Anemia
Secondary
Nausea and
hyperparathyrodism
vomiting
and
Headache o Malnutrition
o Hepatitis (A, B, C,
Chest pain o medpox.com
D, E
Back pain Depression
o Dialysis
Itching
encephalopathy
Fever and chills Malignant tumours
Carpal tunnel

syndrome
Uremic neurophty
1358. Most common acute complication of
dialysis is
a) Hypotension

b) Bleeding

c) Dementia

d) Muscle cramps

Correct Answer - A
Ans. is 'a' i.e., Hypotension
Hypotension is the most common acute complication of
medpox.com
hemodialysis particularly among patients with diabetes mellitus.
Factors involved are :-
Excessive ultrafiltration, with inadequate compensatory vascular
filling, impaired vasoactive or autonomic response, osmolar shifts,
overzealous use of antihypertensives
1359. The most likely diagnosis in the case of
a patient with multiple pulmonary
cavities, hematuria and red cell casts is
a) Anti-GBM disease

b) Churg-Strauss

c) Systemic lupus erythematousus

d) Wegner's granulomatosis

Correct Answer - D
Ans. is 'd' i.e., Wegner's granulomatosis
medpox.com
Multi lung cavities and hematuria are characteristic of Wegner's
granulomatosis.
Anti-GBM disease (Goodpasture's syndrome) usually does not
cause lung cavities.
Churg-strauss syndrome usually does not cause hematuria.
SLE is not a usual cause of lung cavities.
1360. Hung-up reflexes are seen in
a) Chorea

b) Atheotosis

c) Cerebral palsy

d) Cerebellar palsy

Correct Answer - A
Ans. is 'a' i.e., Chorea
Hung up knee jerk
When patellor tendon is tapped while the foot is hanging free, the leg
may be held in extension for few seconds before relaxing owing to
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prolonged contraction of quadriceps.
This is seen in "chorea".
Other neurological signs associated with chorea
Milkmaids grip
Piano sign
Handwriting
Milkmaid's grip
Inability to maintain sustained voluntary contraction of muscle group
at a constant level.
Inability to apply steady pressure during handshake leading to a
characteristic squeeze and release of grip.
Patient's have difficulty maintaining sustained eyelid closure and
sustained tongue protrusion
1361. Arsenic poisoning causes
a) Polyneuritis

b) Mononeuritis multiplex

c) Radiculopathy

d) Myelopathy

Correct Answer - A
Ans. is 'a' i.e., Polyneuritis
There is sensory and motor (i.e. mixed) polyneuropathy, with painful
paresthesia of hands and feet and muscle tenderness.
medpox.com
1362. Tropical pulmonary eosinophilia is
caused because of
a) Occult filariasis

b) Cerebral melaria

c) Penumonic plague

d) Asthmatic bronchitis

Correct Answer - A
Ans. is 'a' i.e., Occult filariasis
Occult filariasis is a rare condition which is caused by
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hypersensitivity reaction to filarial antigen.
Micro filatia are absent in the blood.
Lymphatic filariasis is absent.
Indirect evidence of filarial infection is obtained by demonstrating
antifilarial antibodies
1363. All the following are features of Tropical
pulmonary Eosinophilia except-
a) Eosinophilia > 3000/mm3

b) Microfilaria in blood

c) Paroxysmal cough and wheeze

d) Bilateral chest mottling and increased bronchovascular

markings

Correct Answer - B
Answer is B (Microfilaria in blood) :
medpox.com
In TPE, Microfilaria are rapidly cleared from the blood stream by the
lungs.
Thus, microfilariae are sequestrated in the lungs and are not found
in the blood.
Tropical Pulmonary Eosinophilia
Tropical Pulmonary Eosinophilia (TPE) is a distinct syndrome that
develops in individuals infected with Lymphatic filarial species.
Clinical symptoms result from allergic and inflammatory reaction
elicited by the cleared parasites.
Features of Tropical Pulmonary eosinophilia (TPE) :
Male more commonly affected than females (4: 1)
History of resistance in filarial endemic region
Paroxysmal cough and wheezing that are usually nocturnal
Weight loss, low grade fever, adenopathy
Eosinophilia > 3000 eosinophilia / ,uLe
Chest X-Ray : increased bronchovascular markings , diffuse miliary
lesions , or mottled opacities.
Restrictive changes on Pulmonary function test 2
Elevated levels of IgE e & Antifilarial antibody titers.
In TPE, Microfilaria are rapidly cleared from the blood stream by the
lungs.
Thus, microfilariae are sequestrated in the lungs and are not found
in the blood.

medpox.com
1364. In anklyosing spondylitis joint
involvement is least in?
a) Wrist and hand

b) Sacroiliac joint

c) Acromio-clavicular joint

d) Costochondral junction

Correct Answer - A
Ans. is 'a' i.e., Wrist and hand
Ankylosing spondylitis (marie - strumpell disease)
medpox.com
Ankylosing spondylitis is a chronic progressive inflammatory disease
of the sacroiliac joints and the axial skeleton.
Prototype 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-B27
90-95% of cases are positive for HLA - B27.
Joints involved in 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. o Hip joint
is the most commonly affected peripheral joint. o Rarely knee and
ankle 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.
Inflammatory bowel disease (CD, UC) may also be seen.
Clinicalfeatures (symptoms)
Low back pain of insidious onset
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Duration usually less than 3 months
Significant morning stiffness and improvement with exercise
Limited chest expansion
Diffuse tenderness over the spine and sacroiliac joints
Loss of lumbar lordosis, increased thoracic kyphosis
Decreased spinal movements (especially extension) in all directions.
Radiological features of an kvlasing spondylitis
Radiographic evidence of sacroiliac joint is the most consistent
finding in ankylosing spondylitis and is crucial for diagnosis.
The findings are :-
D 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 :-
Li Squaring of vertebrae : The normal anterior concavity of the
vertebral body is lost because of calcification of the anterior
longitudinal ligament.
Loss of the lumbar lordosis.
Bridging 'osteophytes' (syndesmophytes)
Bamboo spine appearance
In the early disease process, plain x-rays may be read as normal.
More accurate and early diagnosis can be done by using MR1
and/or CT scan.
Dynamic MRI with fat saturation, either short tau inversion recovery
(STIR) sequnece or TI weighted images with contrast enhancement
is highly sensitive and specific for identifying early intra-articular
inflammation, cartilage changes, and underlying bone marrow
edema in sacroilitis.
Magnetic resonance imaging allows for visualization of acute
sacroilitis, spondylitis, and spondylodiscitis, and can also detect
acute inflammation of the entheses, bone and synovium. The ability
to detect early inflammatiion and acurately visualize cartilaginous
and enthesal lesions makes magnetic resonance imaging a useful
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assessment tool in the spondyloarthropathies.
1365. Least common site involved in
osteoarthritis is
a) Hip joint

b) Knee joint

c) Carpometacarpal joint of thumb

d) Distal carpophalangeal joint

Correct Answer - C
Ans. is 'C'
In the hand the joints specifically involved are ?
medpox.com
Distal interphalangeal join& (of particular importance is the point that
this joint is not involved in rheumatoid arthritis).
Proximal interphalangeal join&
First carpometacarpal jointsQ
Remember these two important features of joint involvement in
osteoarthritis
It does not involve the metacarpophalangeal jointso
It does not involve the wrist joINTEGER(2. It also does not involve
the carpometacarpalQ joint (except at the base of thumb).
Osteoarthritis involves the carpometacarpal joint at the base of
thumb, infact it is the second most common area of involvement in
osteoarthritis.
Other joints which are commonly involved in osteoarthritis are
Hips,
Knees,
Lower lumbar
Cervical.
Joints which are usually spared in osteoarthritis are
WristsQ, carpometacarpale
ElbowsQ
Shoulder joint

medpox.com
1366. 65-year-old man presents with anemia,
posterior columan dysfunction, and
planter extensor. Which of the following
is the likely cause
a) Tabes dorsalis

b) Frederich's ataxia

c) Vitamin B1 deficiency

d) Vitamin B 12 deficiency

Correct Answer - D medpox.com

Ans. is 'd' i.e., Vitamin B12 deficiency
Anemia along with involvement of posterior column is characteristic
of subacute combined degeneration of spinal cord caused by vitamin
B12 deficiency.
1367. Which is not true of Tabes dorsalis?
a) Seen in neuro syphilis

b) Paresthesia is seen

c) Deep tendon reflexes are retained

d) Abdominal pain and visceral symptoms occur

Correct Answer - C
Deep tendon reflexes are retained REF: Harrison's Principles of
Internal Medicine 17th ed chapter 372
TABES DORSALIS:
The classic syndromes of tabes dorsalis and meningovascular
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syphilis of the spinal cord are now less frequent than in the past but
must be considered in the differential diagnosis of spinal cord
disorders.
The characteristic symptoms of tabes are fleeting and repetitive
lancinating pains, primarily in the legs or less often in the back,
thorax, abdomen, arms, and face. Ataxia of the legs and gait due to
loss of position sense occurs in half of patients.
Paresthesias, bladder disturbances, and acute abdominal pain with
vomiting (visceral crisis) occur in 15-30% of patients.
The cardinal signs of tabes are loss of reflexes in the legs; impaired
position and vibratory sense; Romberg's sign; and, in almost all
cases, bilateral Argyll Robertson pupils, which fail to constrict to light
but accommodate. Diabetic polyradiculopathy may simulate tabes.
1368. Maximum loss of sodium in a child
occurs in
a) Gastric juice

b) Ileal fluid

c) Non cholera Diarrhoea

d) Cholera

Correct Answer - B
Ans. is 'b' i.e., heal fluid
Cations and anions in biological fluids in meq/dl
Fluid Sodium Potassium medpox.com
Chloride
Gastric
60 10 85
juice
heal
130 10 115
fluid
Diarrhea
10-90 10-80 10-110
stool
1369. All of the following statements about
genetics of G6PD deficiency are true,
except
a) X-linked inheritance

b) More severe in Men

c) Contradicts Lyon Hypothesis

d) May affect Heterozygous females

Correct Answer - C
Ans. is 'c' i.e., Contradicts Lyon Hypothesis
medpox.com
Genetics of G6PD
The gene for G6PD is located on the X chromosome (band X q28)
[8] and has been cloned and sequenced. o Even though females
have two X chromosomes per cell, normal males and females have
the same enzyme activity
in their red cells because one of the X chromosomes in each cell of
the female embryo is inactivated and remains
inactive throughout subsequent cell divisions (Lyon hypothesis).
G6PD deficiency is expressed in males carrying a variant gene,
while heterozygous females are usually clinically normal.
However, the mean red blood cell enzyme activity in heterozygous
females may be normal, moderately reduced, or grossly deficient
depending upon the degree of lyonization and the degree to which
the abnormal G6PD variant is expressed.
G6PD supports Lyon's hypothesis :-
According to lyon's hypothesis one of the two chromosome in each
cell of the female embryo is inactivated and remains inactive
throughout subsequent cell division.
G6PD is inherited as an X-linked (recessive) disorder, it is more
common in males.
Heterozygous Female may also be affected depend on the extent of
lyonisation (inactivation of one X-chromosome) but the overall
average degrees of hemolysis in heterozygous female is less.
A heterozygous female with 50 percent normal G6PD activity has 50
percent normal red cells and 50 percent G6PD-deficient red cells.
The deficient cells are as vulnerable to hemolysis as the enzyme-
deficient red blood cells in males.
Male
Males, who have only one copy of the X chromosome, are either
normal or hemizygous for the variant glucose 6-phosphate
dehydrogenase (G6PD) gene.
Thus, G6PD deficiency is expressed in males carrying a variant
gene on their X chromosome that produces sufficient enzyme
deficiency to lead to symptoms. All of the red cells in affected males
are vulnerable to hemolysis.
Female
Females, who have two copies of the X chromosome, are either
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normal, heterozygous, or homozygous for the variant gene.
Heterozygous females are usually clinically normal.
However, their mean red blood cell enzyme activity may be normal,
moderately reduced, or grossly deficient depending upon the degree
of X chromosome inactivation (lyonization) and the degree to which
the abnormal G6PD variant is expressed.
A female with 50 percent normal G6PD activity, due to inactivation of
one X chromosome in each cell via lyonization, has 50 percent
normal red cells and 50 percent G6PD-deficient red cells.
The deficient cells are as vulnerable to hemolysis as the enzyme-
deficient red blood cells in males.
Homozygous females are as severely affected clinically as
hemizygous males. All of their red cells are vulner​able to hemolysis
1370. With regards to G6PD deficiency, which
of the following in false
a) Affects the pentose phosphate pathway

b) Associated with neonatal jaundice

c) Acute haemolysis can be precipitated by broad beans

d) X-linked recessive disorder that does not affect heterozygous

famales

Correct Answer - D
Ans. is 'd' i.e., X-linked recessive disorder that does not affect
heterozygous famales medpox.com
Glucose 6-phosphate dehydrogenase (G6PD) deficiency, an X-
linked disorder, is the most common enzymatic disorder of red blood
cells in humans, affecting 400 million people worldwide.
Clinical spectrum
The clinical expression of G6PD variants encompasses a spectrum
of hemolytic syndromes
The four forms of symptomatic G6PD deficiency :
Acute hemolytic anemia
Favism
Congenital nonspherocytic hemolytic anemia
Neonatal hyperbilirubinemia
G6PD deficiency is expressed in males carrying a variant gene that
results in sufficient enzyme deficiency to lead to symptoms.
Acute hemolytic anemia
Almost all individuals with the most prevalent G6PD variants, G6PD
A- and G6PD Mediterranean, are asymptomatic in the steady state.
They have neither anemia, evidence of increased red cell
destruction, nor an alteration in blood morphology,. o However
sudden destruction of enzyme deficient erythrocytes can be
triggered by certain drugs or chemicals, by selected infections, and
rarely by metabolic abnormalities (eg, diabetic ketoacidosis).
Clinical course
At two to four days after drug ingestion, there is the sudden onset of
jaundice, pallor, and dark urine, with or without abdominal and back
pain.
This is associated with an abrupt fall in the hemoglobin
concentration of 3 to 4 g/dL, during which time the
peripheral blood smear reveals red cell fragments,
microspherocytes, and eccentrocytes or "bite" cells.
The anemia induces an appropriate stimulation of erythropoiesis,
characterized by an increase in reticulocytes that is apparent within
five days and is maximal at 7 to 10 days after the onset of
hemolysis.
Even with continued drug exposure, the acute hemolytic process
ends after about one week, with ultimate reversal of the anemia.
Inciting events
Patients with class II or III variants develop intermittent hemolysis
medpox.com
only after one or more of the following inciting events.
Infection
Oxidant drugs
Chemical agents (eg, moth balls, aniline dyes, henna compounds)
Diabetic ketoacidosis
Ingestion of fava beans
Drugs and chemicals
Primaquine, dapsone, and a number of other drugs can precipitate
hemolysis in G6PD deficient subjects.
Foods: fava beans and bitter melon
G6PD deficiency can also be precipitated by the the ingestion of
fresh fava beans (favism).
Manifestation offavism begins 5-24 hrs after fava bean ingestion and
include headache, nausea, back pain.
Congenital nonspherocytic hemolytic anemia
Patients with class I G6PD variants have such severe G6PD
deficiency that lifelong hemolysis occurs in the absence of infection
or drug exposure.
Such patients fall under the category of having congenital
nonspherocytic hemolytic anemia.
These G6PD variants have low in vitro activity and/or marked
instability of the molecule, and most have DNA mutations at the
glucose-6-phosphate or NADP binding sites.
These sites are central to the function of G6PD, which oxidizes
glucose-6-phosphate and reduces NADP to NADPH. It is presumed
that the functional defect is so severe that the red cells cannot
withstand even the normal oxidative stresses encountered in the
circulation.
Anemia and jaundice are often first noted in the newborn period, and
the degree of hyperbilirubinemia is frequently of sufficient severity to
require exchange transfusion.
After infancy, hemolytic manifestations are subtle and inconstant.
Most individuals have mild to moderate anemia (hemoglobin 8 to 10
g/dL) with a reticulocyte count of 10 to 15 percent. Pallor is
uncommon, scleral icterus is intermittent, splenomegaly is rare, and
splenectomy generally is of little benefit.
Hemolysis can be exaggerated by exposure to drugs or chemicals
medpox.com
with oxidant potential or exposure to fava beans.
Some drugs with relatively mild oxidant potential that are safe in
patients with class II or class III G6PD variants may increase
hemolysis in patients with class I variants.
Neonatal hyperbilirubineinia
The clinical picture of neonatal jaundice due to G6PD deficiency
differs from neonatal jaundice seen in hemolytic disease of the fetus
and newborn (HDFN) associated with Rh(D) incompatibility in two
main respects.
G6PD deficiency-related neonatal jaundice is rarely present at birth;
the peak incidence of clinical onset is between days two and three.
a There is more jaundice than anemia, and the anemia is rarely
severe. The severity ofjaundice varies widely, from being subclinical
to imposing the threat of kernicterus if not treated
1371. Platelets in stored blood do not live
after
a) 24 hours

b) 48 hours

c) 72 hours

d) 96 hours

Correct Answer - C
Ans. is 'c' i.e., 72 hours
Platelets are provided as a pooled preparation from one or several
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donors, usually as a 6-unit bag, which is the
usual amount given to an average-sized adult.
Each unit contains approximately 8 x 101° platelets and should
increase the platelet count by about 7000-10,000/ pL in a 75kg adult.
Platelets stored at room temperature can be used for up to 5 days
and have a life span of 8 days.
Those stored at 4°C are useful for only 24 hours (only 50-70% of
total platelet activity is present at 6 hours) and have a life span of
only 2-3 days.
ABO compatibility should be observed for platelets, but is not
essential. For each donor used, there is a similar risk of transmitting
hepatitis and HIV as for one unit of blood.
Platelet should be administered through a 170pm filter.
1372. Schober's sign is for :
a) Flexion of lumbar spine

b) Chest expansion

c) Pain with motion of hip

d) Neck pain and stiffness

Correct Answer - A
A i.e. Flexion of lumber spine
Schober's test is measure of flexion on lumber spineQ. This test is
done in ankylosing spondylitisQ
medpox.com
1373. Earliest and often the only presentation
of TB kidney is
a) Increased frequency

b) Colicky pain

c) Hematuria

d) Renal calculi

Correct Answer - A
Ans. is 'a' i.e., Increased frequency
Urinary frequency, dysuria, nocturia, hematuria, and flank or
medpox.com
abdominal pain is common presentations.
However, patients may be asymptomatic and the disease is
discovered only after severe destructive lesions of the kidneys have
developed.
Urinalysis gives abnormal results in 90% of cases, revealing pyuria
and hematuria.
The documentation of culture-negative pyuria in acidic urine raises
the suspicion of TB.
IV pyelography, abdominal CT, or MRI may show deformities and
obstruction, and calcifications and ureteral strictures are suggestive
findings.
Culture of three morning urine specimens yields a definitive
diagnosis in nearly 90% of cases.
1374. Most common cause of diarrhea in
AIDS patients?
a) Salmonella typhimurium

b) Cryptosporidium

c) Candida

d) isophora

Correct Answer - B
Ans. is 'b' i.e., Cryptosporidium
Most common cause of diarrhea in HIV → Cryptosporidium.
medpox.com
Diseases of Oropharvnx and GI system in H.I.V.
These are :?
Oral lesions : Thrush (oral candidiasis), oral Hairy leukoplakia
(caused by EBV), and aphthous ulcer. Esophageal : Esophagitis by
CMV, HSV or candida.
Diarrhea : Diarrhea is caused by :-
Bacteria : Salmonella, Shigella, Campylobacter, and mycobacteria
avium intracellulare.
Fungal : Histoplasma, Coccidioides, penicillium.
Other : CMV, microsporidia, isospora helli, and cryptosporidia.
AIDS enteropathy (HIV enteropathy)
1375. Not seen with uremic lung
a) alveolar injury

b) Pulmonary edema

c) Interstitial fibrosis

d) Fibrinous exudate in alveoli

Correct Answer - C
Ans. is 'c' i.e., Interstitial fibrosis
Uremic lung is referred to abnormalities expressed chest x-ray
abnormalities seen in patients with CKD.
The pathogenesis was believed to be related to blood urea nitrogen
medpox.com
and creatinine retention.
There is :
Its pathophysiology is based on uremia-induced increased
permeability of pulmonary alveolo-capillary interfaces, leading to
Interstitial and intra-alveolar edema
Atelectasis
Alveolar hemorrhage
Pulmonary hyaline membrane formation.
These changes are compounded by bleeding diathesis secondary to
platelet dysfunction in advanced renal disease.
The pulmonary symptoms and radiographic findings are reversible
with hemodialysis.
1376. Oliguric phase of ARF is characterized
by A/E
a) Chest pain

b) Acidosis

c) Hypertension

d) Hypokalemia

Correct Answer - D
Ans. is 'd' i.e., Hypokalemia

medpox.com
Maintenance phase (Oliguric phase) (Lasts for 1-2 weeks) Uremic
complications and electrolyte abnormalities arise during this phase-
• GFR reaches its lowest point, urine output is lowest (typically 5-10
ml/min)
• Due to fluid overload and decreased electrolyte excretion, following
electrolyte abnormalities are seen
• Hyperkalemia - (d/t reduced excretion)
. Hyponatremia -s (d/t volume overload)
. Hyperphosphatemia 4 (d/t reduced excretion)
. Hypermagnesemia - (d/t reduced excretion)
. Hyperuricemia -> (d/t reduced excretion)
. Hypocalcemia -> (d/t deposition of calcium phosphate)
. Elevation of B. U.N. 4 (d/t reduced excretion)
. Hyposmolality -> (d/t volume overload)
. Anemia 4 (d/t Impaired erythropoiesis Hemolysis, bleeding Dilution)
1377. In EEG type of wave seen in metabolic
encephalophathy
a) Alpha

b) Beta

c) Gamma

d) Delta

Correct Answer - D
Ans. is 'cl' i.e., Delta
E.E.G. changes in metabolic encephalopathy
medpox.com
In metabolic encephalopathy changes are typically nonfocal
E.E.G. has been widely used to evaluate metabolic encephalopathy.
The E.E.G .findings are abnormal in acute encephalopathic stages.
It is difficult to establish a diagnosis of metabolic encephalopathy
with certainity through E.E.G.
There is generalized slowing of the E.E.G with an excess of the
delta and theta waves with suppression of normal alpha and beta
wave activity and occasionally bilateral spikes and waves complexes
occurring in absence of seizure activity".
In metabolic encephalopathies, the E.E.G evolution correlates well
with the severity of encephalopathy. o However EEG has little
specificity in differentiating etiologies in metabolic encephalopathy.
For example, though triphasic waves are most frequently mentioned
in hepatic encephalopathy, they can also be seen in uremic
encephalopathy or even in aged psychiatric patients treated with
lithium. o Spikes and waves may appear in hypo or hyperglycemia
uremic encephalopathy or vitamin deficiencies.
Common principles of EEG changes in metabolic
encephalopathy are : -
Varied degrees of slowing
Associated mixtures of epileptic discharge
High incidence of triphasic waves
Reversibility after treatment of underlying causes
Metabolic
EEG rythm
encephalopathy
Dominant activity is
Grade I (almost
alpha rhythm with
normal)
minimal teta activity
Dominant teta
Grade II (mildly background with
abnormal) some alpha and
delta activities.
Continuous delta
Grade II activity
(moderately predominates, little
abnormal) activity of faster
frequencies medpox.com
Low-amplitude delta
Grade IV
activity or
(severely
suppression-burst
abnormal)
pattern
Grade V Nearly"flat" tracing
(extremely or electrocerebral
abnormal) inactivity.
1378. Alveolar hypoventilation is present in
A/E:
a) Bulber poliomyelitis

b) COPD

c) Kyphoscoliosis

d) Lobar pneumonia

Correct Answer - D
D i.e Lobar Pneumonia
The important causes of hypoventilation :-
medpox.com
i) Obstruction in airways :- Foreign body, COPD (chronic
bronchitis, emphysema).
ii) Decrease in respiratory drive :- It is due to decrease in
stimulation of respiration from CNS e.g. brain injury, meningitis,
bulbar poliomyelitis, Drugs (morphine, sedative, anesthetics),
hypothyroidism.
iii) Decrease in functioning of respiratory muscles :- Mysthenia
gravis, poliomyelitis, kyphoscoliosis, myopathy, polymyositis, GB
syndrome, interstitial lung disorders, AML.
iv) Increased load on respiratory system :- It may be due to :?
a) Reduced chest wall compliance :- Pleural effusion,
pneumothorax, ascitis, rib cage disorder (kyphoscoliosis), ankylosing
spondylitis.
b) Reduced lung compliance :- Atelectasis, lung resection, alveolar
edema, PEEP.
1379. Asbestosis causes all except
a) Shaggy heart borders

b) Honeycombing

c) Hilar lymphadenopathy

d) Basal peribronchial fibrosis

Correct Answer - C
Ans. is 'c' i.e., Hilar lymphadenopathy
Asbestosis causes fibrosis in the lower lobes of the lung.
Pleural plaque formed by asbestosis most commonly affects
anterolateral and posterolateral aspects of parietal pleura and over
medpox.com
the dome of diaphragm
1380. The most common cause of sudden
death in sarcoidosis is
a) Pneumonia

b) Cor pulmonale

c) Arrythmias

d) Liver failure

Correct Answer - C
Ans. is 'c' i.e., Arrhythmias
Cardiac involvement occurs initially with inflammation and
medpox.com
granuloma formation followed by scarring. The initial inflammation
can lead to triggered ventricular arrhythmias with subsequent
scarring resulting in the substrate for reentrant monomorphic
ventricular tachycardia.
1381. Most common cause of unilateral Hilar
lymphadenopathy
a) Histoplasmosis

b) Sarcoidosis

c) Aspergillosis

d) Tuberculosis

Correct Answer - D
Ans. is 'd' i.e., Tuberculosis
Primary TB most commonly presents with focal alveolar pneumonia
medpox.com
and associated unilateral hilar or mediastinal adenopathy.
1382. Most common cause of embolic stroke
is?
a) Intra-Cardiac Thrombi

b) Particulate Matter From IV Drug Injections

c) Protein C deficiency

d) Antiphospholipid syndrome

Correct Answer - A
Answer is A (Intracardiac Thrombi):
The most common cause of embolic strokes are Intro-cardiac
Thrombi. medpox.com
The most common sources of systemic embolism and embolic
stroke are Intra-cardiac thrombi formed as a result of atrial
fibrillation, ST- elevation MI, left ventricular dysfunction or heart
failure.
Atrial Fibrillation is the single most important predisposing factor
(Atrial Thrombus) followed by Myocardial Infarction (Left Ventricular
Thrombus).
1383. Most common site for berry aneurysm
rupture
a) Anterior circulation of brai

b) Posterior circulation of brain

c) Ascending aorta

d) Descending aorta

Correct Answer - A
Ans. is 'a' i.e., Anterior circulation of brain
The most common sites in descending order of frequency are -
medpox.com
Li Proximal portion of anterior communicating artery (at the junction
of anterior communicating artery with cerebral artery)
At the origin of the posterior communicating artery from the stem of
the internal carotid artery.
At the first major bifurcation of middle cerebral artery.
At the bifurcation of internal carotid into middle and anterior cerebral
arteries.
Vertibrobasilar bifurcation (3%)
1384. Obesity is seen in all except
a) Cushing syndrome

b) Pickwinian syndrome

c) Prader willi syndrome

d) Sipple syndrome

Correct Answer - D
Ans. is `d' i.e., Sipple syndrome
Important syndromes associated with obesity
Albright hereditary osteodystrophy (pseudohypoparathyroidism type
la) medpox.com
Alstrom syndrome
Bardet-Biedl syndrome
Beckwith-Wiedemann syndrome
Carpenter syndrome
Cohen syndrome • Prader-willi syndrome
1385. Cause of death in diabetic ketoacidosis
in children
a) Cerebral edema

b) Hypokalemia

c) Infection

d) Acidosis

Correct Answer - A
Ans. is 'a' i.e., Cerebral edema
High blood sugar will cross the blood-brain barrier and
medpox.com
simultaneously will draw water inside leading to cerebral edema.
Cerebral edema accounts for 60-90% of all DKA related deaths in
children.
Infection is a precipitator for the development of DKA.
Other precipitating factors can be tissue ischemia, inadequate
insulin administration, drugs (cocaine) and pregnancy.
1386. Acute hyponatremia becomes
symptomatic at
a) < 135 mEq

b) < 125 mEq

c) < 120 mEq

d) < 110 mEq

Correct Answer - B
Ans. is 'b' i.e., < 125 mEq
Serum level of sodium at which symptoms develop
Acute < 125 meq/L medpox.com
Chronic < 120 meq/L
Hyponatremia is commonly defined as a serum sodium < 135
mmol/L (< 135 mEq/L). Neurological symptoms
occur at different levels of low sodium, depending not only on the
absolute value but also on the rate of fall.
In patients with hyponatremia that develops over hours, life-
threatening seizures and cerebral edema may occur
at values as high as 125 mmol/L.
In contrast, some patients with more chronic hyponatremia that has
slowly developed over months to years may be asymptomatic even
with serum levels < 110 mmol.
Acute or hvperacute hvponatremia
The hyponatremia developed within the previous 24 hours, it is
called "acute."
If the hyponatremia developed over just a few hours due to a
marked increase in water intake (self-induced water intoxication, as
may be seen in marathon runners, psychotic patients, and users of
ecstasy), it is called "hyperacute."
Chronic hyponatremia
If it is known that the hyponatremia has been presentfbr more than
48 hours, or if the duration is unknown (such as in patients who
develop hyponatremia at home), it is called "chronic."
Mild to moderate hyponatremia
Mild hyponatremia is usually defined as a serum sodium
concentration between 130 and 135 meq/L.
Moderate hyponatremia is often defined as a serum sodium
concentration between 121 and 129 meq/L.
Severe hvponatremia
Severe hyponatremia can be defined as a serum sodium of 120
meq/L or less.
Symptoms of hvponatremia
Absent symptoms
Patients with hyponatremia are frequently asymptomatic, particularly
if the hyponatremia is chronic and of mild or moderate severity (ie,
serum sodium >120 meq/L).
However, such patients may have subclinical impairments in
mentation and gait. medpox.com
Mild to moderate symptoms
Mild to moderate symptoms of hyponatremia are relatively
nonspecific and include headache, nausea, vomiting, fatigue, gait
disturbances, and confusion.
In patients with chronic hyponatremia (ie, >48 hours duration), these
findings are not associated with impending herniation; however, in
patients with more acute hyponatremia, such symptoms should be
considered ominous and may evolve without warning to seizures,
respiratory arrest, and herniation.
Severe symptoms
Severe symptoms of hyponatremia include
u Seizures
Obtundation
Coma
Respiratory arrest.
1387. What is the Neutrophil count for
moderate neutropenia
a) < 500/mm'

b) 500-1000/mm'

c) > 1000/mm3

d) 100/mm3

Correct Answer - B
Ans. is 'b' i.e., 500-1000mm'
Mild neutropenia → Is present when the ANC is 1000-
15000 cells/µL medpox.com
Moderate neutropenia → Is present with an ANC of 500-1000/4
Severe neutropenia ANC lower than 500 cells/pL.
The risk of bacterial infection is related to both the severity and
duration of the neutropenia.
1388. Keratoderma Blenorrhagica is typically
seen in
a) Rheumatoid Arthritis

b) Psoriatic Arthritis

c) Reactive Arthritis

d) Ankylosing spondylitis

Correct Answer - C
Answer is C (Reactive Arthritis):
Keratoderma Blenorrhagica is the charachteristic skin lesion seen in
medpox.com
patients with Reactive Arthritis.
'The charachteristic skin lesions in Reactive Arthritis, Keratoderma
Blenorrha2ica, consist of vesicles that become hyperkeratotic,
ultimately forming a crust before disappearing. In patients with HIV
infection, these lesions are often extremely severe and extensive
sometimes dominating the clinical picture '-
1389. Keratoderma-Blenorrhagicum is
pathogno-monic of
a) Behcet's disease

b) Reiter's disease

c) Lyme's disease

d) Glucagonoma

Correct Answer - B
Ans. is 'b' i.e., Reiter's disease
Keratoderma Blenorrhagica is the characteristic skin lesion
medpox.com
seen in patients with Reactive Arthritis.
"The Characteristic skin lesions in Reactive Arthritis, Keratoderma
Blenorrhagica, consist of vesicles that become hyperkeratotic,
ultimately forming a crust before disappearing. These are seen in
palms and soles.
1390. Gout can be precipitated by all of the
following
a) Thiazides

b) Furosemide

c) Cyclosporine

d) High dose salicylates

Correct Answer - D
Ans. is 'd' i.e., High dose salicylates
High dose Salicylates are uricosuric and do not cause
Hyperuricemia. medpox.com
Diuretics including Thiazides and Furosemide are known to cause
Hyperuricemia. Cyclosporine and Tacrolimus are also associated
with Hyperuricemia.
High Doses of Salicylates > 3.0 g/day are uricosuric, while Low
doses (0.3 to 3.0 g/day) are associated with uric acid retention and
Hyperuricemia.
Also know
Causes of drug or diet induced hvperuricemia.
Diuretics (thiazides and loop diuretics)
Cyclosporine and tacrolimus.
Low dose salicylates.
Ethambutol.
Pyrazinamide.
Ethanol.
Levodopa.
Methoxyflurane.
Laxative abuse (alkalosis).
Salt restriction.
medpox.com
1391. Relative risk of developing TB in
patients already infected with TB
bacilus is highest in
a) Diabetes

b) Recent infection

c) Post transplantation

d) Malnutrition

Correct Answer - C
Ans. is 'c' i.e., Post transplantation
medpox.com
Relative risk of developing T.B.
Post 20-
transplantation 70
HIV 30
Silicosis 30
Recent infection 12
Diabetes 3-4
Malnutrition 2-3
1392. I.R.I.S. is
a) Immune reconstitution idiopathic syndrome

b) Immune reconstitution immunological syndrome

c) Immune reconstitution inflammatory syndrome

d) Inflammatory reconstitution immune syndrome

Correct Answer - C
Ans. is 'c' i.e., Immune reconstitution inflammatory syndrome
Causes of bone marrow suppression in patients with HIV
infection
HIV infection Medications medpox.com
Mycobacterial
Zidovudine
infections
Fungal
Dapsone
infections
B 19
parvovirus Trimethoprim/Sulfamethoxazole
infection
Pyrimethamine
5-Flucytosine
Lymphoma Ganciclovir Interferon a
Trimetrexate
Foscarnet
1393. In renal failure, metabolic acidosis is
due to
a) Increased fr production

b) Loss of HCO,

c) Decreased ammonia synthesis

d) Use of diuretics

Correct Answer - C
Ans. is 'c' i.e., Decreased ammonia synthesis
The predominant reason for metabolic acidosis in C.R.E is
decreased ammonia production.medpox.com
Metabolic acidosis is a common disturbance in advanced chronic
kidney disease
The majority of patients can still acidly the urine but they produce
less ammonia and, therefore, cannot excrete the normal quantity of
protons in combination with this urinary buffer.
1394. Diagnostic feature of CRF is
a) Broad casts in urine

b) Elevated blood urea

c) Proteinuria

d) Bleeding diathesis

Correct Answer - A
Ans. is 'a' i.e., Broad casts in urine
Casts ?
Urinary casts are formed only in the distal convoluted tubulee (DCT)
or the collecting dude (distal nephron).
medpox.com
The proximal convoluted tubule and loop of henle are not the
locations for cast formation.
Casts are
formed through the solidification of materials in the tubules of
nephrons
Later the material is flushed out of the kidney upon the production of
more urine leaving a small solidified microscopic cylinder that can
also contain what ever other materials that might be within the
tubules of the kidneys at the time of cast formation.
The microscopic detection of various types of casts can often be
helpful diagnostic tool in the study of various types of renal diseases
1395. Eosinophilic meningitis is seen with all
except?
a) Coccidiomycosis

b) Cryptococcal meningitis

c) Lepto meningeal metastasis

d) Helminthic infections

Correct Answer - B
Ans. is 'b' i.e., Cryptococcal meningitis
Causes of eosinophilic meningitis
Infectious, parasitic causes medpox.com
Roundworm (nematode) infections - commonly present as
eosinophilic meningitis
Angiotronglylus cantonensis - migrating larvae inherently neurotropic
Gnathostoma spinigerum - migrating larvae in visceral and/or neural
tissues
Baylisascaris procyonis - migrating larvae inherently neurotropic
Tapeworm (cestode) infections - may present as eosinophilic
meningitis
Cysticercosis -Cysts develop in CNS and/or visceral tissues
Fluke (trematode) infections - occasionally cause eosinophilic
meningitis
Paragonimus westermani - ectopic spinal or cerebral localization.
Schistosomiasis - ectopic spinal or cerebral localization.
Fascioliasis - ectopic CNS localization.
Other roundworm infections which occasionally cause
eosinophilic meningitis
Toxocariasis - migrating larvae
Nonparasitic, infectious causes
Coccidioidomycosis
Cryptococcosis - CSF eosinophilia rare
Myiasis - with CNS penetration
Virus and bacteria - are of uncertain causality
Noninfectious causes
Idiopathic hypereosinophilic syndromes
Ventriculoperitoneal shunts
Leukemia or lymphoma with CNS involvement (Hodgkin's)
Nonsteroidal antiinflammatory drugs
Antibiotics - ciprofloxacin, trimethoprim - sulfamethoxazole,
intraventricular gentamicin or vancomycin
Myelography contrast agents

medpox.com
1396. Christmas tree appearance of urinary
bladder is seen in
a) Neurogenic bladder

b) Stress incontinence

c) Autonomous bladder

d) Enuresis

Correct Answer - A
Ans. is 'a' i.e., Neurogenic bladder
Christmas tree appearance of the bladder is seen in neurogenic
medpox.com
bladder caused by detrusor hyperreflexia.
Detrusor hyperreflexia is caused by lesions of the spinal cord above
the sacral segments but below the pons. Such patients have
noperception of bladder filling or emptying and voluntary voiding is
not possible.
Voiding when it does occur is involuntary with simultaneous
contractions of the detrusor and external sphincter muscles.
Common neurological condition resulting in detrusor hyperreflexia
include
Multiple sclerosis
Myelodysplasia,
Spinal cord trauma
Spinal cord tumours,
A-V malformatio not the spinal cord
Radiologically, patients with long terms untreated detrusor
hyperreflaxia have characteristic changes of the urinary tact.
Bladder is vertically oriented, with an irregular contours, consistent
with trabeculation. There are frequently multipel diverticula, Such a
bladder is referred to as a christmas tree.
 Automatic Autonomous

bladder bladder
Cauda equina
Above T5 or damage /
Lesion site
higher lower motero
neuron
Small spastic damage Large
Manifestation
bladder flaccid bladder
Has no urge
sensation and
urge comes continuous
again and DRIBBLING
again due to occurs, So it is
repeated like the
Why this contractions bladder is
name and hence working all the
empties time but Brain
repeatedly has no control
after some medpox.com
over it and
time hence called
autonomous
bladder
No VUR but
Christmas still bladder is
Radiological
tree large and
data
appearance holds lots of
residual urine
1397. All of the following are more commonly
seen in Klebsiella Pneumonia than in
Pneumococcal Pneumonia, Except:
a) Lower lobe involvement

b) Abscess Formation

c) Pleural Effusion

d) Cavitation

Correct Answer - A
The answer is A (Lower Lobe Involvement):
medpox.com
Pneumococcal pneumonia has a predilection to involve the right
lower lobe, whereas Klebsiella usually affects one of the upper
lobes.
Features Pneumococcal Klebsiella Pneumonia
Pneumonia
Consolidation • Lobar Consolidation • Lobar Consolidation with
Pattern with positive air positive air
bronchogram sign bronchogram sign
Lobe • The predilection to • The predilection to
Predilection involve Lower Lobe involve Upper Lobe
(Any lobe may be (Any lobe may be
involved) involved)
• Usually Unilobar • Often Multilobar
(Usually do not (Tendency to expand
expand involved lobe) involved lobe)
• Abscess formation • Abscess Formation
Abscess
uncommon common
Pleural • Pleural Effusion • Pleural Effusion
Effusion uncommon common
Cavitation • Cavitation is rare • Cavitation is common

medpox.com
1398. Most common pattern of Pneumonia
seen in Klebsiella infection is:
a) Lobar Pneumonia

b) Bronchopneumonia

c) Interstitial Pneumonia

d) Miliary Pneumonia

Correct Answer - A
Answer is A (Lobar Pneumonia):
The most common pattern of Pneumonia seen in Klebsiella infection
is Lobar Pneumonia medpox.com
Streptococcus Pneumoniae (Pneumococcus) and Klebsiella are
two common organisms that produce a lobar pattern of
Pneumonia.
The radiographic pattern of pneumonia.
Lobar
Lobular (bronchopneumonia)
Interstitial
1399. Friedlander Pneumonia refers to
Pneumonia caused by:
a) Klebsiella

b) Pneumococcus

c) H. lnfluenzae

d) Staphylococcus

Correct Answer - A
Answer is A (Klebsiella):
Klebsiella Pneumonia is also known as Friedlander Pneumonia.
medpox.com
Klebsiella initially described in 1882 by Friedlander was also known
as Friedlander's bacillus. Community acquired Pneumonia caused
by Friedlander's bacillus (Klebsiella) was termed as Friedlander
Pneumonia.
1400. the diffusion capacity of lung (DL) is
decreased in all of the following
conditions except
a) Inerstitial lung diseas

b) Goodpasture's syndrome

c) Pneumocystis Jiroveci

d) Primary pulmonary hypertension

Correct Answer - B
Ans. is 'b' i.e., Goodpasture's syndrome
medpox.com
Gas diffusion tests :
Gas diffusion tests measure the amount of oxygen and other gases
that cross the alveoli into the blood.
These tests evaluate how well gases are being absorbed into the
blood from lungs. Gas diffusion tests include.
Carbon monoxide diffusing capacity (transfer factor DLcy)
Arterial blood gases
Carbon monoxide diffusing capacity (DL):
This measures how well the lung transfers a small amount of carbon
monoxide into the blood0.
Normally, in the lung, a gas has to cross the alveolar membrane,
capillary membrane to reach the blood where it combines with
hemoglobin.
So quiet obviously the diffusion capacity of gas depends upon
Driving pressure of the gas
Surface area of alveolar capillary membrane
Thickness of alveolar capillary membrane
Diffusion coefficient of the gas
Red blood cell volume.
Reaction rate with hemoglobin and hemoglobin level of patient.
Degree of V/Q mismatching.

medpox.com
1401. Rupture of berry aneurysm most
commonly results in
a) Subarachnoid hemorrhage

b) Subdural hemorrhage

c) Extradural hemorrhage

d) Intra-parenchymal hemorrhage

Correct Answer - A
Ans. is 'a' i.e., Subarachnoid hemorrhage
Most common cause of
Trauma
subarachnoid hemorrhage medpox.com
Rupture of
Berry
Most common cause of
aneurysm
spontaneoussubarachnoid
(or
hemorrhage
Saccular
aneurysm)
Also know
Mycotic aneurysm ?
Mycotic aneurysm is caused by a septic embolus that weakens the
wall of the vessel in which it lodges.
1402. Target BP before thrombolysis in
ischemic stroke is below
a) 185/110 mmHg

b) 165/100 mm Hg

c) 145/100 Hg

d) 120/80 mm Hg

Correct Answer - A
Ans. is 'a' i.e., 185/110 mm Hg
Recommended target blood pressure before thrombolysis in patients
medpox.com
with ischemic stroke is less than 185/110mm Hg.
1403. The most common cause of malignant
adrenal mass is
a) Adrenocortical carcinoma

b) Malignant phaeochromocytoma

c) Lymphoma

d) Metastasis from another solid tissue tumor

Correct Answer - D
Ans. is 'd' i.e., Metastasis from another solid tissue tumor
The most common cause of adrenal tumors is metastasis from
medpox.com
another solid tumor like breast cancer and lung cancer.
Malignant Percentage
Adrenocortical carcinoma 2-5%
Malignant
<I%
pheochromocytoma
Adrenal neuroblastoma <0- 1%
Lymphomas (incl. primary
<1%
adrena lymphoma)
Metastases (most frequent :
15%
Breast, lung)
1404. The drug used in the management of
medullary carcinoma thyroid is
a) Cabozantinib

b) Rituximab

c) Tenofovir

d) Anakinra

Correct Answer - A
Ans.is 'a' i.e., Cabozantinib
Medullary thyroid cancers (MTCs) are neuroendocrine tumors
medpox.com
of thyroid paraf011icular cells that do not concentrate iodine.
The primary treatment for MTC is extensive and meticulous surgical
resection.
There is a limited role for external-beam radiotherapy.
For patients with asymptomatic metastatic tumors generally
less than 1 to 2 cm in diameter, growing in diameter less than
20 percent per year
Systemic therapy is not required
Such patients should be monitored for disease progression. Known
sites of metastatic disease should be imaged by CT or MRI every 6
to 12 months, and potential new sites of disease should be imaged
every 12 to 24 months.
For patients with metastatic tumors at least 1 to 2 cm in diameter,
growing by at least 20 percent per year, or Or patients with
symptoms related to multiple metastatic foci that cannot be
alleviated with surgery or external beam radiotherapy
Administer systemic treatment as part of a clinical trial.

Forpatients with metastatic tumors at least I to 2 cm in diameter,
growing by at least 20 percent per year, or
for patients with .symptoms related to multiple metastatic foci
who cannot participate in a clinical trial

An oral tyrosine kinase inhibitor (TKI) is suggested, rather than
traditional cytotoxic chemotherapy.
For initial TKI therapy
Cabozantinib or vandetanib rather than sorafenib or sunitinib.
Cytotoxic chemotherapy, of which dacarbazine-based regimens
such as cyclophosphamide-vincristine​dacarbazine are preferable, is
an alternative option for patients who cannot tolerate or who fail
multiple TKIs
Drugs used in medullary carcinoma thyroid
Tyrosine
Cvtotoxic
kinase
chemotherapy
inhibitors
CabozanitibCyclophosphamide
Vandetanib Vincristine
Sorafenib Dacarbazine medpox.com
Sunitinib
1405. Incorrect about cerebral salt wasting
syndrome
a) Urine sodium > 20mEq/d1

b) Hyponatremia

c) Fludrocortisone is used

d) Expansion of plasma volume

Correct Answer - D
Ans. is 'd' i.e., Expansion of plasma volume
Cerebral salt wasting syndrome (renal salt wasting)
medpox.com
Cerebral salt wasting (CSW) is characterized by hyponatremia and
extracellular fluid depletion due to inappropriate sodium wasting in
the urine in the setting of acute disease in central nervous system
(CNS), usually subarachnoid hemorrhage.
CSW is a much less common cause of hyponatremia in patients with
cerebral injury than the syndrome of inappropriate ADH secretion
(SIADH).
The pathophysiology of CSW is related to impaired sodium
reabsorption, possibly due to the release of brain natriuretic
peptide and/or diminished central sympathetic activity.
Regardless of the mechanism, sodium wasting can lead sequentially
to volume depletion, increased ADH release, hyponatremia due to
the associated water retention, and possibly increased neurologic
injury.
Laboratory findings
Hyponatremia with a low plasma osmolality
An inappropriately elevated urine osmolality (above 100
mosmol/kgand usually above 300mosmol/kg)
A urine sodium concentration above 40meq/L, and
A low serum uric acid concentration due to urate wasting in the
urine.
CSW mimics all of the laboratory findings in the SIADH
The only clue to the presence of CSW rather than SIADH is clinical
evident of extracellular volume depletion, such as hypotension and
decreased skin turgor, and/or increased hematocrit, in a patient with
a urine sodium concentration above 40meq/L
Unlike SIADH, volume repletion in CSW leads to a dilute urine, due
to removal of the hypovolemic stimulus to ADH release, and
subsequent correction of the hyponatremia.
Treatment
IV hypertonic saline solutions are employed to correct intravascular
vloume depletion and hyponatremia and to replace ongoing urinary
sodium loss
Flurocortisone promotes sodium re-absorption

medpox.com
1406. A 70 kg adult male presents with serum
sodium of 110 meq/dl. Calculate
correction required in 24 hours
a) 100 mEq

b) 200 mEq

c) 300 mEq

d) 400 mEq

Correct Answer - D
Ans. is `d' i.e., 400 mEq medpox.com
Goals of therapy in hyponatremia
In patients who are treated to increase the serum sodium, the goal
of initial therapy is to raise the serum sodium concentration by 4 to 6
meq/L in a 24-hour period.
In patients who require emergency therapy, this goal should be
achieved quickly, over six hours or less; thereafter, the serum
sodium can be maintained at a constant level for the remainder of
the 24-hour period to avoid overly rapid correction.
Every effort should be made to keep the rise in serum sodium
less than 9 meq/L in anv 24-hour period.
In general, the same rate of rise can be continued on subsequent
days until the sodium is normal or near normal. The rationale for
these recommendations is as follows:
Sodium deficit = Total body water x desired SNa - Actual SNa = .6 x
70 x 120 - 110 =420 mEq
Treatment of hvponatrentia
Aprviatitleaet_uIsupon risk stratification
The following general approach for treating patients with
hyponatremia is based upon the duration and severity of the
hyponatremia and upon the presence and severity of symptoms:
Disposition
Patients with acute or hyperacute hyponatremia, most patients with
severe hyponatremia, and many symptomatic patients with
moderate hyponatremia should be treated in the hospital.
In contrast, patients with mild hyponatremia and asymptomatic
patients with moderate hyponatremia usually do not require
hospitalization.
Emergency therapy
Aggressive therapy to raise the serum sodium as soon as possible
(typically with hypertonic saline) is indicated in the following settings.
Patients with severe symptoms due to hyponatremia, such as
seizures or obtundation.
Patients with acute hyponatremia who have symptoms due to
hyponatremia, even if such symptoms are mild. Because of
osmotically driven water flow across the blood-brain barrier, an
acute onset of hyponatremia can result in life-threatening cerebral
edema. Thus, even mild symptoms in acute hyponatremia present a
medpox.com
medical emergency that requires prompt and aggressive treatment
with hypertonic saline to prevent brain herniation.
Patients with hyperacute hyponatremia due to self-induced water
intoxication, even if there are no symptoms at the time of initial
evaluation. Brain herniation has been reported in such patients, and
the serum sodium may worsen spontaneously due to delayed
absorption of ingested water
Symptomatic patients who have either acute postoperative
hyponatremia or hyponatremia associated with intracranial
pathology. As with hyperacute hyponatremia, herniation may occur;
and the serum sodium may decrease further because of absorption
of ingested water or the excretion of high concentrations of sodium
in the urine (desalination).
1407. Uricase used in the treatment of chronic
gout is
a) Allopurinol

b) Benzbromarone

c) Pegloticase

d) Methotrexate

Correct Answer - C
Ans. is 'c' i.e., Pegloticase
Pegloticase is a recombinant mammalian Uricase linked to
medpox.com
polyethylene glycol (PEG) approved for the treatment
of Hyperuricemia in patients with treatment refractory gout.
Pegloticase facilitates the conversion of Uric acid into allantoin,
which is far more soluble. Pegloticase is approved for intravenous
administration and its use is associated with rapid and marked
decline in serum uric acid levels.
Agents inhibiting IL-1 action are used for the treatment of
refractory Gout
Anakinra
Canakinumab
1408. A 14 year old boy presents wit recurrent
episodes of hepatitis Opthalmoscopic
evalution reveals KF rings and serum
ceruloplasmin levels are < 20 mg/dl.
The treatment of choice for initial
therapy is
a) Zinc

b) Penicillamine

c) Tetrathromolybdate

d) Hepatic transplantation
medpox.com

Correct Answer - A
Answer is A (Zinc)
Presence of KF rings and decreased ceruloplasmin levels suggest
the diagnosis of Wilson 's disease.
The patient in question is presenting with intial hepatic disease
without any evidence of hepatic decompensation.
Zinc is the therapy of choice for patients with hepatitis or cirrhosis
without evidence of hepatic decompensation or neuropsychiatric
symptoms.
1409. All are seen in acute HiV syndrome
except
a) Diarrhoea

b) Pneumonia

c) Wight loss

d) Myelopathy

Correct Answer - B
Ans. is 'b' i.e., Pneumonia
Clinical findings in the acute HIV syndrome
medpox.com
General Neurologic Dermatology rash
Fever Meningitis Erythematous ulceration
Pharyngitis Encephalitis maculo-papular
Lymphadenopathy Peripheral Mucocutaneous
Headache/retroorbital neuropathy
pain Myelopathy
Arthralgias/myalgias
Lethargy/malaise
Anorexia/weight loss
Nausea/vomiting/diarrhea
[Ref Harrison 19th/e p. 1249]
1410. Nephrocalcinosis is seen in all except
a) Polycystic kidney

b) Hyperparathyroidism

c) Medullary sponge kidney

d) Renal tubular acidosis

Correct Answer - A
Ans. is 'a' i.e., Polycystic kidney
Causes of Nephrocalcinosis
Medullary sponge kidney
Hyperparathyroidism medpox.com
Hypoparathyroidism
Renal tubular acidosis (specifically distal RTA)
Renal tuberculosis
Renal papillary necrosis
Hyperoxaluria
Immobilization
Milk-alkali syndrome
Hypervitaminosis D
Sarcoidosis
1411. Round pneumonia is seen with
a) Streptococcal pneumonia

b) Kerosene oil aspiration

c) Lung cancer

d) Mendelson syndrome

Correct Answer - A
Ans. is 'a' i.e., Streptococcal pneumonia
Streptococcus Pneumoniae (pneumococcus) is the most common
organism responsible for round pneumonia.
Round Pneumonia is spherical pneumonia that is usually seen in
medpox.com
children due to the lack of collateral air drift.
Streptococcus Pneumoniae (pneumococcus) is the most common
organism responsible for round pneumonia.
Round pneumonia is important as they may simulate a tumor mass
from which they must be differentiated
1412. An elderly male admitted for Pneumonia
presents with diarrhea and gripping
abdominal pain five days after
discharge from the hospital. Drug which
is likely to benefit is
a) Imodium

b) Metranidozole

c) Diphenoxylate

d) Levofloxacin

medpox.com
Correct Answer - D
Ans. is 'd' i.e., Levofloxacin
Development of pneumonia and gastrointestinal symptoms (diarrhea
& gripping abdominal pain) within 10 days after discharge from
hospital hints to a possible diagnosis of Legionnaire's disease. The
drugs of choice for legionnairs's disease include Azithromycin and
Respiratory Fluoroquinolones such as levofloxacin, gatifloxacin,
Gemifloxacin and Moxifloxacin
It is a case of legionnaire's disease.
Legionnaires disease usually presents as atypical pneumoniae.
The unique feature of legionnaires disease is that the clinical
manifestation of this disease are usually more severe than those of
most atypical pneumonias and the course and prognosis of
legionella pneumonia more closely resemble those of bacteremic
pneumococcal pneumonia than those ofpneumonia due to other
organisms
Think about the diagnosis as legionaire's disease whenever the
question talks about a pneumonia like picture along with any of
the following -
Gastrointestinal disturbances such as diarrhoea.
Neurological abnormalities such as confusion and headache altered
sensorium.
High fever (> 40°C or > 104°F)
Numerous neutrophils, but no organisms revealed by gram's staining
of respiratory secretions.
Failure to respond to $ lactam drugs (penicillins and cephalosporins)
and aminoglycoside antibiotics. Hyponatremia (S.Na- < 131 meq/1)
Elevation in liver function tests.
Occurrence of illness in an environment in which the potable water
supply is known to be contaminated with legionella.
Onset of symptoms within 10 days of discharge from hospital.
Occurence of illness in immunocompromised individual

medpox.com
1413. Causes of haemorrhagic pleural
effusion are all except
a) Pulmonary infarction

b) Mesothelioma

c) Bronchial adenoma

d) Tuberculosis

Correct Answer - C
Ans. is 'c' i.e., Bronchial adenoma
Causes of hemorrhagic pleural effusion
Trauma medpox.com
Malignancy
Postpericardiotomy syndrome
Asbestos related effusion
Tuberculosis
1414. Following is characteristic neurologic
finding in primary amyloidosis
a) Peripheral motor and sensory neuropathy

b) Peripheral neuropathy associated with cerebral manifestation

c) Guillain - Barre type of syndrome

d) Spinal cord compression in thoracic region

Correct Answer - A
Ans. is 'a' i.e., Peripheral motor and sensory neuropathy
ATTR usually presents as a syndrome of familial amyloidotic
medpox.com
polyneuropathy or familial amyloidotic cardiomyopathy.
Peripheral neuropathy usually begins as a lower-extremity sensor
and motor neuropathy and progresses to the upper extremities.
Autonomic neuropathy is manifest by gastrointestinal symptoms of
diarrhea with weight loss and orthostatic hypotension.
1415. Reactive arthritis is usually caused by
a) Shigella flexneri

b) Shigella boydii

c) Shigela shiga

d) Shigela dysentriae

Correct Answer - A
Ans. is 'a' i.e., Shigella Flexneri
Organisms that have been associated with ReiterArthritis
include the following:
C trachomatis (L2b serotype) medpox.com
Ureaplasma urealyticum
Neisseria gonorrhoeae
Shigella flexneri
Salmonella enterica serovars Typhimurium
Mycoplasma pneumoniae
Mycobacterium tuberculosis
Yersinia enterocolitica and pseudotuberculosis
Campylobacter jejuni
Clostridium difficile
Beta-hemolytic (example, group A) and viridans streptococci
1416. Dose of rTPA in ischaemic stroke is
a) 60 mg

b) 90 mg

c) 100 mg

d) 120 mg

Correct Answer - B
Ans. is 'b' i.e., 90 mg
Recommended dose for thrombolysis with IV TPA is 0.9 mg/kg with
the maximum dose being 90 mg. 10% should be given as a bolus
over one minute, followed by remaining 90% as a continuous
medpox.com
infusion over 60 minutes.
1417. Cerebral angiography was performed
by
a) Sir Walter Dandy

b) George Moore

c) Seldinger

d) Egas Moniz

Correct Answer - D
Ans. is 'd' i.e., Egas Moniz
Egas Moniz first performed cerebral Angiography in 1927. n He
medpox.com
received the Nobel Prize for developing for developing frontal
leucotomy as a treatment for psychiatric diseases.
1418. Mauriac's syndrome is characterized by
all except
a) Diabetes

b) Obesity

c) Dwarfism

d) Cardiomegaly

Correct Answer - D
Ans. is D i.e., Cardiomegaly
Mauriac Syndrome
medpox.com
Children with poorly controlled type I diabetes may develop Mauriac
syndrome. It is characterized by : -
Growth attenuation
Delayed puberty
Hepatomegaly
Abnormal glycogen storage and steatosis
Cushingoid features
Rare in the modern era of insulin therapy but is occasionally
reported.
1419. Which of the following is associated
with hyponatremia and low osmolality
a) Hyperlipidemia

b) SIADH

c) CHF

d) CKD

Correct Answer - C
Ans. is 'c' i.e., CHF
CHF is characterised by low perfusion of kidneys stimulating
medpox.com
R.A.A.S and resultant absorption of salt and disproportionate amout
of water would lead to hyponatremia with decreased osmolality.
Isotonic hyponatremia is seen with hyperlipidemia and
hvperproteinemia like in paraproteinemia.
Intravenous immunoglobulin therapy also interferes with
measurement of serum sodium.
Major causes of hyponatremia
Disorders in which ADH levels are elevated
Effective circulating volume depletion
True volume depletion
Heart failure
Cirrhosis
Thiazide diuretics
Syndrome of inappropriate ADH secretion, including reset osmostat
pattern
Hormonal changes
Adrenal insufficiency
Hypothyroidism
Pregnancy
Disorders in which ADH levels may be appropriately
suppressed
Advanced renal failure
Primary polydipsia
Beer drinker's potomania
Hyponatremia with normal or elevated plasma osmolality
High plasma osmolality (effective osmols)
Hyperglycemia
Mannitol
High plasma osmolality (ineffective osmols)
Renal failure
Alcohol intoxication with an elevated serum alcohlo concentration
Normal plasma osmolality
Psedohyponatremia (laboratory artifact)
High triglycerides
Chloestatic and obstructive jaundice (lipoprotein x)
Multiple myeloma
Absorption of irrigant solutions
Glycine Sorbitol Mannitol medpox.com
1420. Bence jones proteinuria is best
detected by
a) Dipstick method

b) Sulfosalicylic acid

c) Heat test

d) Electrophoresis

Correct Answer - D
Ans. is `d' i.e., Electrophoresis
Bence Jones proteins are seen in multiple myeloma.
medpox.com
Urinary protein electrophoresis will exhibit a discrete protein peak.
In myeloma plasma cells produce immuno-globulin of a single heavy
and light chain, a monoclonal protein commonly referred to as a
paraprotein.
Heat test is false negative in 50% of patients with light chain
myeloma.
Dipstick detects albumin and not paraproteins.
1421. Which of the following statements
about Hematochromatosis is not true
a) Hypogonadism may be seen

b) Arthropathy may occur

c) Diabetes Mellitus may develop

d) Desferrioxamine is treatment of choice

Correct Answer - D
Answer is D (Desferrioromine is treatment of choice):
The therapy of hematochromatosis involves removal of excess body
iron. medpox.com
Iron removal is best achieved by periodic phlebotomies which is the
treatment of choice for Hematochromosis.
Chelating agents like desferoxamine are less effective and indicated
when anemia or hypoproteinemia is severe enough to preclude
phlebotomy.
Chelating agents are not the treatment of choice for
Hematochromatosis.
1422. HIV RNA by PCR can detect as low as
a) 30 copies viral RNA/ml of blood

b) 40 copies viral RNA/ml of blood

c) 50 copies of viral RNA/ml of blood

d) 60 copies of viral RNA/ml of blood

Correct Answer - B
Ans. is 'b' i.e., 40 copies viral RNA/ml of blood
This assay generates data in the form of number of copies of HIV
RNA per milli litre of serum or plasma and can reliably detect as few
as 40 copies of HIV RNA per mili litre of plasma.
medpox.com
Research based assay can detect down to one copy/ml.
1423. Biomarker not involved in acute kidney
injury is
a) NGAL

b) KIM 1

c) Micro RNA 122

d) Cystatin C

Correct Answer - C
Ans. is 'c' i.e., Micro RNA 122
Biomarkers of acute kidney injury
Alanine aminopeptidase (AAP) medpox.com
Alkaline phosphatase (AP)
a-glutathione-S-transferase (a-GST)
y-glutamyl transpeptidase (yGT)
N-acetyl-13-glucosaminidase (NAG)
pfmicroglobulin
a imicroglobulin
Retinol-binding protein (RBP)
Cystatin C
Microalbumin
Kidney injury molecule-1 (KIM-1)
Clusterin
Neutrophil gelatinase associated lipocalin (NGAL)
Interleukin-18 (IL-18)
Cysteine-rich protein (CYR-61)
Osteopontin (OPN)
Fatty acid binding protein (FABP)
Sodium/hydrogen exchanger isoform (NHE3)
Exosomal fetuin-A
medpox.com
1424. Most common site of cerebral infarction
is in the territory of
a) Anterior cerebral artery

b) Middle cerebral artery

c) Posterior cerebral artery

d) Posterior inferior cerebellar artery

Correct Answer - B
Ans. is 'b' i.e., Middle cerebral artery
Hemiplegia most commonly occurs due to lesion of middle cerebral
artery medpox.com
1425. Hemiplegia is most often caused by
thrombosis of ?
a) Anteiror cerebral artery

b) Middle cerebral artery

c) Posterior cerebral artery

d) Basiliar artery

Correct Answer - B
Ans. is 'b' i.e., Middle cerebral artery
Middle Cerebral Artery
medpox.com
Deep branches of the middle cerebral artery on the lenticulostriate
branches supply the internal capsule (posterior limb).
Motor tracts are densely packed in this region and hence occlusion
of deep branches or lenticulostrials branches leads to Densse
Hemiplegia/Pure motor Hemiplegia.
Anterior choroidal artery supplies the posterior limb of internal
capsule (and not anterior limb of internal capsule).
Anterior chorodial artery arises from the internal carotid artery and
supplies the posterior limb of internal capsule. The complete
syndrome of anterior choroidal artery occlusion consists of
contralateral hemiplegia hemianesthesia (hypoesthesia) and
homonymous hemianopia
Posterior Cerebral Artery
The posterior cerebral artery supplies the midbrain, thalamus lateral
geniculate bodies, posterior of chroid plexus, occipital lobes, inferior
and medial aspect of the temporal lobe and posterior inferior areas
of the parietal lobe
Occlusion of the Posterior Cerebral Artery usually results in
two common clinical syndrome depending on the areas
involved
P1 Syndrome P2 Syndrome
Occlusion of
the
Occlusion of the distalsegment
proximal segment of PCA
ofPCA from its origin to distal to the
its union withthe junction of
posterior PCA with
communicating artery theposterior
communicating
artery
P2 syndrome
P1 syndrome present presents
primarily withthe primarily
following signs withthe
following signs
Temporal lobe
Midbrain signs medpox.com
signs
Thalamic signs Occipital lobe
Subthalamic signs signs
1426. True statement about Pneumocystic
Jiroveci is:
a) Often associated with CMV infection

b) Usually diagnosed by sputum examination

c) Infection occurs only in immunocompromised patients

d) Always associated with Pneumatocele

Correct Answer - B
Pneumocystis Jiroveci is usually diagnosed by sputum examination.

medpox.com
Ref: Medical Microbiology By Jawetz, 24th Edition, Pages 648-49;
Washington Manual of Pulmonary Medicine, 2006, Page 104;
Pneumocystis Pneumonia By Walzer, Cushion, 3rd Edition, Page
418; Harrison’s Principles of Internal Medicine, 16th Edition, Pages
1194-95
1427. Indication for prophylaxis in
pneumocystis carini pneumonia include
a) CD4 count < 200

b) Tuberculosis

c) Viral load > 25,000 copies/ml

d) Oral candidiasis

Correct Answer - A
Ans. is 'A' i.e., CD4 count < 200
PROPHYLAXIS OF PNEUMOCYSTIC CARINI PNEUMONIA
medpox.com
Primary prophylaxis is indicated for
Patients with CD4- cell counts of< 200/4
History of oropharyngeal candidiasis
Secondary prophylaxis is indicated for
Both HIV infected and non-HIV infected patients.
Who has recovered from pneumocystosis
Primary and secondary prophylaxis may be discontinued in HIV
infected persons once.
CD4+ counts have risen to > 200/p1 and remained at that level for 3
months.
Also know
First choice agent for prophylaxis
Trimethoprim, sulphamethoxazole.
Other agents used in prophylaxis.
Dapsone, pentamidine.
 1428. C V junction abnormalities are seen in
all of the following except
a) Rheumatoid arthritis

b) Ankylosing spondylitis

c) Odontoid dysgenesis

d) Basilar invagination

Correct Answer - B
Answer- B. Ankylosing spondylitis
Developmental and acquired abnormalities
Atlanto axial instability medpox.com
1. Errors of metabolism (e.g. Morquio's syndrome)
2. Infections (e.g. Grisel's syndrome)
3. Inflammatory (e.g. rheumatioid arthritis, Psoriasis, Ankylosing
Spondylitis)
4. Traumatic atlanto-axial dislocation, Atlantal-dislocation, Down
syndrome
5. Malignancy (e.g. Chordoma, Plasmacytoma, Osteoblastoma,
Neurofibromatosis)
6. Degenerative (e.g. fetal warfarin syndrome, Conradi's Syndrome,
Goldenhar syndrome
1429. Most common cause of unilateral pedal
edema
a) Pregnancy

b) Lymphedema

c) Venous insufficiency

d) Milroy disease

Correct Answer - C
Ans. is 'c' i.e., Venous insufficiency
The most likely cause of leg edema in patients over age 50 is
venous insufficiency. medpox.com
Venous insufficiency affects up to 30% of the population, whereas
heart failure affects only approximately 1%.
The most important cause of unilateral pedal edema is venous
insufficiency.
Milroys disease :
The defect in Milroy's disease is present from birth and symptoms
are usually first experienced in childhood.
The most common problem is one-sided leg swelling, unilateral
edema, which is progressive and can affect both legs.
Impaired intestinal lymphatics can cause steatorrhea due to
impaired transport of chylomicrons
1430. All of the following statements about
Pulsus Bigeminus are true, except:
a) Must be distinguished from Pulsus Alternans

b) Is a sign of digitalis toxicity

c) Compensatory pause is absent

d) Rhythm is Irregular

Correct Answer - C
Answer is C (Compensatory pause is absent):
Pulsus Bigeminus is associated with a compensatory Pause.
medpox.com
Compensatory pause is absent in Pulsus Alternans
Pulsus Bigeminus is a disorder of rhythm (Irregular rhythm) caused
by a normal heat alternating with a premature contraction and a
compensatory pause resulting in alternation of the strength of pulse.
The stroke volume of the premature beat is diminished in relation to
that of the normal beats, and the pulse varies in amplitude
accordingly. Pulsus Bigeminus most closely mimics Pulsus
Alternans from which it must be distinguished. In Pulsus Alternans
the rhythm is regular and the compensatory pause is absent.
1431. Pulsus Bigeminus is seen in therapy
with:
a) Digitalis

b) Beta Blockers

c) ACE Inhibitors

d) Calcium Channel Blockers

Correct Answer - A
Answer is A (Digitalis)
Pulsus Bigeminus is recognized as a cause of digitalis toxicity.
medpox.com
Pulsus Bigeminus is a disorder of rhythm (Irregular rhythm;
arrhythmia) most commonly caused by Premature Ventricular
Contractions that results in a pulse with irregular rhythm that
alternates in amplitude (pressure) from beat to beat. The most
common cause of Pulsus Bigeminus is Digitalis and Pulsus
Bigeminus is recognized as a cause of digitalis toxicity.
1432. Which is best for plaque morphology
a) CCTA

b) MRI

c) CMR

d) IVUS

Correct Answer - A
Ans. is 'a' i.e., CCTA
Coronary lesions prone to rupture have a distinct morphology
compared with stable plaques, and provide a unique opportunity for
noninvasive imaging to identify vulnerable plques before they lead to
medpox.com
clinical events. This can be achieved using a non-invasive cardiac
imaging using coronary CT angiography.
o Large plaque volume, low CT attenuation, napkin-ring sign,
positive re-moedlling, and spotty calcification are all associated with
a high risk of acute cardiovascular events in patients. Intravascular
USG can give comparable results but is an invasive test
1433. Most common cause of heart block in
infants is
a) SLE

b) Surgery for congentital heart disease

c) Viral myocarditis

d) Rheumatic fever

Correct Answer - B
Ans. is 'b' i.e., Surgery for congentital heart disease
In children, the most common cause of permanent acquired
medpox.com
complete AV block is surgery for congenital heart disease.
Postsurgical completer atrioventricular block (A VB) is the most
common cause for acquired AV block in children, resulting from
trauma to the AV node at time of surgery (i.e., hemorrhage,
ischemia, necrosis, inflammation, traumatic disruption).
The second most common cause is congenital herat disease
associated with complete AV block.
Other etiologies of acquired AV block are often reversible and
include :
Digitalis and other drug intoxications.
Viral myocarditis.
Acute rheumatic fever, Lyme disease, and infectious mononucleosis.
1434. S2 is best appreciated in:
a) 3rd left intercostal space

b) 2nd right intercostal space

c) 4th left intercostal space

d) 5 left intercostal space

Correct Answer - A
Answer is A (3rd left intercostal space)
Best areas to auscultate for both components of the second heart
sound (A2 and P2) are either the left sternal border at the level of
second intercostal space (Pulmonic area) or the left sternal border at
medpox.com
the level of third intercostal space (Erb's point).
The second heart sound has two components A2 (from Aortic
closure) and P2 (from pulmonary closure). P2 is a soft sound that is
poorly transmitted. It is best heard at the pulmonic area and is
transmitted only as far as the Erb's point. A2 is a loud sound best
heard over the aortic area but since it is widely transmitted it may be
heard across all areas of the chest even as far as the apex. Second
heart sound (S2) is best heard over the pulmonic area (Since both
A2 and P2 can be heard at the pulmonic area). Note that even at the
pulmonic area A2 is louder than P2. The other area to auscultate for
both components of the second heart sound is at the left sternal
border of the third intercostal space (Erb 's point)
1435. Rytand's murmur is seen in
a) A-V Block

b) Mitral stenosis

c) Aortic stenosis

d) Aortic regurgitation

Correct Answer - A
Ans. is 'a' i. e.,A-V Block
Rytand Murmur
Rytan 's murmur is mid-diastolic (or late-diastolic) murmur that is
heard in patients with complete artioventricular heart block.
medpox.com
Rytand's murmur is best heard at the apex and may be
confused with mitral stenosis.
The slow heart rate, variable duration of the murmur changing
intensity of the S I and lack of opening snap are helpful
Also know
Carey Coombs murmur → Rheumatic fever
Austin Flint murmur → Aortic regurgitation
Graham-Steel murmur → Pulmonary regurgitation
Rytands murmur → Complete heart block
Docks murmur → Left Anterior Descending
(LAD) artery stenosis
Mill wheel murmur → Due to air emboli (air in PV
cavity)
1436. Most common mechanism of
arrhythmia ?
a) Re-entry

b) Early after depolarization

c) Late after depolarization

d) Automaticity

Correct Answer - A
Answer- A. Re-entry
Re-entry appears to be basis for most abnormal sustained Supra
medpox.com
Ventricular Tachycardias (SVTs) and VTs.
Examples of re-entry are :-
VF due to acute myocardial ischemia and
1437. -30 to -90 degree axis deviation
indicates
a) Left Axis Deviation

b) Right Axis Deviation

c) Extrene Right Axis Deviation

d) Normal Cardiac Axis

Correct Answer - A
Ans. is 'a' i.e., Left Axis Deviation
Cardiac axis
medpox.com
The electrical signal recorded on the electrocardiogram (ECG)
contains information relative to direction and magnitude of the
various complexes.
The average direction of any of the complexes can be determined.
Normal Cardiac Axis
The normal QRS electrical axis, as established in the frontal plane,
is between -30 and 90° (directed downward or inferior and to the left)
in adults.
Left Axis Deviation
An axis between -30° and -90° (directed superior and to the left) is
termed left axis deviation. Right Axis Deviation
If the axis is between 90° and 180° (directed inferior and to the
right), then right axis deviation is present. Extreme Right Axis
Deviation
An axis between -90' and -180° (directed superior and to the right) is
referred to as extreme right or left axis. Indeterminate
If the QRS is equiphasic in all leads with no dominant QRS
deflection, it is indeterminate axis.
Causes of axis deviation include
 Right axis
Left axis deviation
deviation
Normal variation
Normal variation (physiologic,
(vertical heart with
often with age)
an axis of 90°)
Mechanical shifts, Mechanical shifts, such as
such as expiration, high diaphragm
inspiration and (pregnancy, ascites, abdominal
emphysema tumor)
Right ventricular
Left ventricular hypertrophy
hypertrophy
Left posterior
Left bundle branch block
fascicular block
Dextrocardia Left anterior fascicular block
Congenital heart disease (prim
Ventricular ectopic
um atrial septal Hefect,
rhythms
endocardial cushion defect)
Ventricular ectopic
Emphysemamedpox.com
rhythms
Pre-excitation
syndrome (Wolff- Hyperkalemia
Parkinson-White
Lateral wall
myocardial Ventricular ectopic rhythms
infarction
Secundum atrial Pre-excitation syndromes
septal defect (Wolff-Parkinson-White
Inferior wall myocardial

infarction
1438. Left Axis Deviation is seen as
a) Positive in Lead I and Positive in Lead II

b) Positive in Lead I and Negative in Lead II

c) Negative in Lead I and Negative in Lead II

d) Negative in Lead I and positive in Lead II

Correct Answer - B
Answer is B (Positive in Lead I and Negative in Lead II)
Left axis deviation is seen as positive deflexion in Lead I and a
Negative deflection in Lead II.
Calculating the cardiac axis:medpox.com
Right axis Left axis
Normal Axis
deviation deviation
Lead I Positive Negative Positive
Positive or
Lead II Positive Negative
negative
Positive or
Lead III Positive Negative
negative
Note:
Lead I : POSITIVE BETWEEN -90 TO +90 (CLOCKWISE) Lead II :
POSITIVE BETWEEN -30 TO +150 (CLOCKWISE) Lead III :
POSITIVE BETWEEN +30 TO -150 (CLOCKWISE)
1439. LBBB is seen with all except
a) Acute MI

b) Ashmann syndrome

c) Hypokalemia

d) Hyperkalemia

Correct Answer - C
Ans. is 'c' i.e., Hypokalemia
Causes of LBBB are :-
Aortic stenosis
Ischaemic heart disease medpox.com
Hypertension
Dilated cardiomyopathy
Anterior MI
Primary degenerative disease (fibrosis) of the conducting system
(Lenergre disease)
Hyperkalaemia
Digoxin toxicity
Ashmann phenomenon (has both LBBB and RBBB)
Atrial fibrillation has a narrow complex qRS but Ashmann
phenomenon seen in atrialfibrillation is characterized by broad
complex qRS with usually a RBBB morphology. Thus if an impulse
lands on the bundle of HIS and finds the right bundle refractory then
RBBB will occur. Also remember that the refractory period of right
fascicle ix more than that of the left fascicle resulting in RBBB mostly
in these patients.
ECG findings of LBBB
Normally the septum is activated from left to right, producing small Q
waves in the lateral leads. In LBBB, the normal direction of septal
depolarisation is reversed (becomes right to left), as the impulse
spreads first to the RV via the right bundle branch and them to the
LV via the septum.
This sequence of activation extends the qRS duration to > 120 ms
and eliminates the normal septal Q waves in the lateral leads.
The overall direction of depolarisation (from right to left) produces
tall R waves in the lateral leads (IaVLV5V6) deep S waves in the
right precordial leads (V4 R) and usually leads to left axis deviation.
As the ventricles are activated sequentially (right, then left) rather
than simultaneously, this produces a broad or notched (`W-shaped)
R wave in the lateral leads.
Non-concordance in ST segment and T wave changes.
The point is that the two fasciles of bundle of his have different
refractory periods with the right fascicle having higher refractory
period than the left.
This means that if an impulse lands on the bundle of HIS and finds
the right bundle refractory then RBBB will occur.
In atrial fibrillation because of faster conduction, normally we see
narrow complex qRS but sometimes we may see broad complex
medpox.com
qRS also which is technically called Ashmann phenomenon.
Mostly in Ashmann phenomenon RBBB is seen based on the
physiological principle of refractory period of right fascicle more than
the left one. However, rarely LBBB can also be seen if the impulse
lands to find the left fascicle refractory. Irrespective of RBBB or
LBBB, broad complex qRS will occur in case of atrial fibrillation and
Ashmann phenomenon is occurrence of broad complex qRS in atrial
fibrillation and not the occurrence of RBBB as is the popular
perception.
Hyperkalemia can cause defective repolarization and hence cause
Bundle branch block that culminates in sine wave pattern.
In acute MI, ischemia can damage the left bundle leading to LBBB.
1440. A patient in regular rhythm presents
with absent P waves on ECG. Leads II,
III and AVF reveal a Saw-Tooth Pattern.
Which of the following is the most likely
diagnosis:
a) Atrial Fibrillation

b) Atrial Flutter with Variable Block

c) Atrial Flutter with Fixed Block

d) Multifocal Atrial Tachcardia

medpox.com
Correct Answer - C
Answer is C (Atrial Flutter with Fixed Block)
The absence of any discernible P waves on ECG, together with the
presence of Saw Tooth Flutter waves in inferior leads (Leads II, III
and AVF) strongly suggests a diagnosis of Atrial Flutter. The
presence of a regular rhyti,,o suggests a Fixed Block .
Findings/Features Diagnosis
Irregular Rhythm with no discernible P wave Atrial Fibrillation
(Chaotic base line with fibrillary f waves)
Irregular rhythm with no discernible P wave Atrial Flutter with
(Saw tooth ,Ilutter waves especially in inferior variable block
leads and VI)
Regular rhythm with no discernible P waves Atrial Flutter with
(Saw tooth flutter waves especially in inferior fixed block
leads and V1)
Irregular Rhythm with multiple P wave Multifocal Atrial
morphologies (P waves Discernible) Tachycardia
and Varying PR intervals
and Varying PR intervals

medpox.com
1441. A wide and notched P wave is typically
seen in:
a) Mitral Stenosis

b) Cor-Pulmonale

c) COPD

d) Pulmonary embolism

Correct Answer - A
Answer is A (Mitral Stenosis)
Mitral Stenosis is typically associated with a Wide and Notched P
medpox.com
wave from Left Atrial Enlargement (LAE) Cor-Pulmonale, COPD and
Pulmonary embolism are all associated with Right Atrial
Enlargement resulting in a Tall P wave (not a wide p wave)
1442. Wrong abour continuous murmur
a) Seen with coarctation of aorta

b) Peaks at S2

c) Heard both in systole and diastole

d) Increase on squatting

Correct Answer - D
Ans. is 'd' i.e., Increase on squatting
A continuous murmur is defined as one that begins in systole and
extends through S2 into part or all of diastole.
It need not occupy the entire cardiac cycle.
medpox.com
Continuous murmurs are not affected by dynamic auscultation
maneuvers like squatting etc.
They can oftern be difficult to distinguish from individual systolic and
diastolic murmurs in patients with mixed valvular heart disease.
The classic example of a continuous murmur is that associated with
a patent ductus arteriosus, which usually is heard in the second or
third interspace at a slight distance from the sternal border.
1443. Banana shaped left ventricle is seen in
a) HOCM

b) DCM

c) RCM

d) Takotsubo cardiomyopathy

Correct Answer - A
Ans. is 'a' i.e., HOCM
Spherical Dilated
ventricle cardiomyopathy
Stress medpox.com
Apical
cardiomyopathy /
ballooning
Tako-Tsubo
Spade-
Apical hypertrophic
shaped
cardiomyopathy
ventricle
Myocardial
Distortion infarctions /
of ventricle aneurysms /
remodeling
Banana -
Hypertrophic
shaped
cardiomyopathy
ventricle
1444. A QRS duration between 100 and 120
milliseconds suggests all of the
following, Except:
a) Normal

b) Left anterior Fascicular Block

c) Left posterior Fascicular Block

d) Left Bundle Branch Block

Correct Answer - D
Answer is D (Left Bundle Branch Block)
medpox.com
Left Bundle Branch block is typically associated with a QRS duration
greater than 120 milli seconds.
Partial Blocks (Fascicular or hemiblocks) in the left bundle system
(left anterior or posterior fascicular blocks) generally do not prolong
the QRS duration substantially and QRS duration typically remains
less than 120 milliseconds.
1445. Wide QRS complex 0.12 seconds may
be seen in all of the following, except
a) Hyperkalemia

b) Wolf Parkinson White Syndrome

c) Ventricular Tachycaridia

d) Left Anterior Fascicular Block

Correct Answer - D
Ans. is 'd' i.e., Left Anterior Fascicular Block
Left Anterior Fascicular Block is a partial block in the left bundle
medpox.com
system and does not prolong the QRS duration
significantly. Typically the QRS duration is slightly prolonged and
remains between 0.10 to 0.12 seconds.
Major causes of a wide ORS complex
Intrinsic intraventricular conduction delay o Left bundle branch block
and variants
Right bundle branch block and variants o Other nonspecific IVCD
patterns
Extrinsic intraventricular conduction delay
Hyperkalemia
Drug-induced - type 1 antiarrhythmic drugs and related sodium
channel blocking agents (eg, tricyclic antidepressants and
phenothiazines)
Ventricular beat o Premature o Escape
Paced
Ventricular preexcitation
Wolff:Parkinson-White (WPW) pattern and variants
Factitious
ECG unintentionally recorded at fast paper speeds (50 or 100 mm/s)
Wide QRS complex tachyarrhythmias
Ventricular tachycardia
Supraventricular tachycardia or atrial fibrillation or flutter with
aberrant intraventricular conduc​tion due to:
Bundle branch block
Atrioventricular bypass tract (preexcitation syndromes with
orthodromic conduction

medpox.com
1446. Wide QRS complex is typically seen in
a) Bundle Branch block

b) Sick sinus syndrome

c) Mobitz type I block

d) Mobithz type II block

Correct Answer - A
Ans. is 'a' i.e., Bundle Branch block
Repeat from previous session.
Intrinsic intraventricular conduction delays such as left bundle block
and right bundle branch block are associated with wide QRS
medpox.com
complex.
1447. ST elevation is seen in all of the
following conditions except :
a) Myocardial infarction

b) Coronary artery spasm

c) Constrictive pericarditis

d) Ventricular aneurysm

Correct Answer - C
Answer is C (Constrictive pericarditis)
ST segment is measured from the end of QRS complex to the
medpox.com
beginning of the T wave, and represents the time interval between
ventricular depolarization and repolarization.
1448. Inverted T waves are seen in
a) Hyperkalemia

b) Hyperthermia

c) Wellen syndrome

d) Coronary syndrome

Correct Answer - C
Ans. is 'c' i.e., Wellen syndrome
Severe anterior wall Ischemia (with or without infarction) may cause
prominent T-wave inversions in the precordial leads. This pattern
(sometimes referred to as Wellens T-waves) is usually associated
medpox.com
with a high-grade stenosis of the left anterior descending coronary
artery.
Hyperkalemia has tall Tented T-waves.
Coronary syndrome Xis characterised by blockage of perforators
while the epicardial coronary artery is normal. In these patients
stenting of coronaries is not useful. Nitrates are mainstay of therapy.
1449. Low QRS voltage on ECG indicates ?
a) Pulmonary embolism

b) Pericardial effusion

c) Cor pulmonale

d) Infective endocarditis

Correct Answer - B
Ans. is 'b' i.e., Pericardial effusion
Causes of low voltage QRS complexes
Adrenal insufficiency
Anasarca medpox.com
Artifactual or spurious, eg, unrecognized standardization of ECG at
one-half the usual gain (i.e., 5 mm/mv)
Cardiac infiltration or replacement (e.g., amyloidosis, tumor)
Cardiac transplantation, especially with acute or chronic rejection
Cardiomyopathy, idiopathic or secondary
Chronic obstructive pulmonary disease
Constrictive pericarditis
Hypothyroidism, usually with sinus bradycardia
Left pneumothorax (mid-left chest leads)
Myocardial infarction, extensive
Myocarditis, acute or chronic
Normal varian
Obesity
Pericardial effusion
Pericardial tamponade, usually with sinus tachycardia
Pleural effusions
1450. Which of the following is cause of
RBBB
a) It can occur in a normal person

b) Pulmonary embolism

c) Corpulmonale

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
Causes of RBBB
Normal physiological medpox.com
Pulmonary embolism/corpulmonale
Pulmonary artery hypertension
ASD
Rheumatic heart disease
1451. Alternating RBBB with Left anterior
hemiblock is seen in
a) 1' degree heart block

b) Complete heart block

c) Mobitz type II block

d) Bi-fascicular block

Correct Answer - D
Ans. is 'd' i.e., Bi-fascicular block
Bifascicular block → combination of RBBB with
medpox.com
either left anterior hemiblock or left posterior hemiblock.
Tri fascicular block → RBBB plus either
LAHB/LPHB+ first degree AV block.
Complete heart block destruction of → AV node leading to AV
dissociation
1452. Low QRS voltage on ECG with left
ventricular hypertrophy on
Echocardiography suggests a
diagnosis of:
a) Pericardial effusion

b) Cardiac Amyloidosis

c) Corpulmonale

d) Infective endocarditis

Correct Answer - B medpox.com

Answer is B (Cardiac Amyloidosis)
Low QRS voltage on ECG with left ventricular hypertrophy on
Echocardiography suggests a diagnosis of infiltrative
cardiomyopathy like amyloidosis.
The combination of low QRS voltage plus a thick left ventricle on
echocardiogram strongly suggests the diagnosis of infiltrative
cardiomyopathy like cardiac amyloidosis. The increased thickness is
the amyloid. It is not muscle (not true hypertrophy), does not
depolarize and therefore adds nothing to QRS voltage
1453. In LVH, SV1 +RV6 is more than mm
a) 25

b) 30

c) 35

d) 45

Correct Answer - C
Ans. is 'c' i.e., 35
Arrhythmias by Kathryn Lewis p. 219] o In LVH, SV-1 plus RV-6
is more than 15 mm.
To diagnose the left ventricular hypertrophy on ECG one of the
medpox.com
following criteria should be met :?
The sokolow-lyon criteria is most often used -
R in V, or V6 + 5 in V > 35 mm in men

The cornell-criteria has different values
R in aVL and S in V3 > 28 mm in men
R in aVL and S in V3 > 20 mm in women
As the left ventricular wall becomes thicker QRS complexes are
larger in leads V1-V6
S wave is deep in V,
R wave is high in V4
ST depression in V„-V, (strain pattern)
1454. Which is not a high pitched heart sound
a) Mid systolic click

b) Pericardial shudder

c) Opening snap

d) Tumor plop sound

Correct Answer - D
Ans. is 'd' i.e., Tumor plop sound
Low pitch heart sounds are :
S3
S4 medpox.com
Tumor plop sound
Mid systolic clicks are
Heard in mitral valve prolapse during systole and are high pitch
sounds.
The pericardial knock (PK) is
Also high-pitched and occurs slightly later than the opening snap,
corresponding in timing to the abrupt cessation of ventricular
expansion after tricuspid valve opening and to an exaggerated y
descent seen in the jugular venous waveform in patients with
constrictive pericarditis.
A tumor plop is
A lower-pitched sound that can be heard in patients with atrial
myxoma.
It may be appreciated only in certain positions and arises from the
diastolic prolapse of the tumor across the mitral valve
1455. Broad complex tachycardia, due to
ventricular tachycardia is suggested by
all except
a) Fusion beats

b) AV dissociation

c) Capture beats

d) Termination of tachycardia by carotid sinus massage

Correct Answer - D
Ans. is `d' i.e., Termination of tachycardia by carotid sinus massage
medpox.com
1456. Which of the following arrhythmia is
most commonly associated with
alcohol binge in the alcoholics
a) Ventricular fibrillations

b) Ventricular premature contractions

c) Atrial flutter

d) Atrial fibrilation

Correct Answer - D
Ans. is 'd' i.e., Atrial fibrilation
medpox.com
When ever the pulse is irregularly irregular atrial fibrillation is
almost always the diagnosis.
Arrythmia occuring after a drinking binge is k/a Holiday heart
syndrome.
Arrythmias known to follow drinking Binge in order of
frequency
Atrial fibrillation (MC)
Atrial flutter
Ventricular premature Contractions
Also know
The most common cardiac effect of chronic drinking is Dilated
Cardiomyopathy
1457. Treatment of asymptomatic bradycardia
is
a) No treatment is required

b) Give atropine

c) Isoprenaline

d) Cardiac pacing

Correct Answer - A
Ans. is 'a' i.e., No treatment is required
The normal heart rate has been considered historically to range from
medpox.com
60 to 100 beats per minute, with sinus bradycardia being defined as
a sinus rhythm with a rate below 60 beats per minute.
Treatment is not indicated in asymptomatic patients with sinus
bradycardia.
n Pharmacologic therapy may be important in an acute
myocardial infarction when the SA node is depressed by excessive
parasympathomimetic activity or possibly ischemia. Treatment is
indicated when Sinus bradycardia results in hemodynamic
compromise.
1458. WPW syndrome is caused by
a) Bundle Branch Block

b) Right sided accessory pathway

c) Ectopic pacemaker in atrium

d) Left budle Branch block

Correct Answer - B
Ans. is 'b' i.e., Right sided accessory pathway
Anatomy (Location ofAccessory pathway) in W.R W syndrome
Electrophysiological studies and mapping have shown that
accessory. Atrioventricular pathways may be located anywhere
medpox.com
along the A-V rign or groove in the septum.
The most frequent locations are : -
Left lateral (50%), posteroseptal (30%) right anteroseptal (10%).
Right lateral (10%).
Preexcitation resulting from left sided accessory is called type A
preexcitation.
Preexcitation resulting from right sided accessory pathway is called
type B preexcitation.
1459. Canon 'a' wave is seen in
a) Junctional rhythm

b) Atrial fibrillation

c) Atrial flutter

d) Ventricular fibrillation

Correct Answer - A
Ans. is 'a' i.e., Junctional rhythm
Regularly –> During junctional rhythm
• Irregularly A- V dissociation with ventricular
tachycardia complete heart block.
medpox.com
1460. Which of the following is not seen in
Secondary Adrenal insufficiency
a) Pigmentation

b) Postural hypotension

c) Hypoglycemia

d) Lassitude

Correct Answer - A
Secondary adrenal insufficiency is adrenal hypofunction due to a
lack of adrenocorticotropic hormone (ACTH).
medpox.com
Secondary adrenal insufficiency may occur in
Panhypopituitarism
Isolated failure of adrenocorticotropic hormone (ACTH) production
Patients receiving corticosteroids (by any route, including high doses
of inhaled, intra-articular, or topical corticosteroids)
Patients who have stopped taking corticosteroids
Symptoms are the same as for Addison disease and include fatigue,
weakness, weight loss, nausea, vomiting, and diarrhea, but there is
usually less hypovolemia.
1461. Which of the following is not expected
in a case of Microcytic Hypochromic
Anemia:
a) Reduced serum Iron

b) Reduced Total RBC distribution Width

c) Normal Ferritin levels

d) Increased TIBC

Correct Answer - B
Answer is B (Reduced Total RBC distribution width
medpox.com
Microcytic Hypochromic Anemias are typically associated with a
Normal or High Red Cell Distribution Width
Condition Iron Thalassemia Sideroblastic Anemia of chronic
Test deficiency anemia disease
(normal
values)
Microcytic Microcytic Microcytic Normocytic
hypochromic hypochromic hypochromic normochromic
Smear
>
Microcytic
Micro/hypochromic
(MCV<80)
(but Micro/Hypo
may be present)
Serum iron Low (<30) Normal Normal .1. (<50)
(50-
150n/d1)
TIBC High (>360) Normal Normal ,i, (<300)
(300-360 (Chandrasoma
µg/dl) Taylor)
% < 10 (J')
% < 10 (J')
N or Ted N or "I' 4,
Saturation
(30-80) (30-80) (10-20)
(30-50%)
Ferritin < 15 (fed) T (50-300) T (50-300)
(R/1) Normal or T
(50-200 (30-200)
µg/L)
Hemoglobin
Normal Abnormal Normal Normal
pattern
Free Ted Normal Ted Ted
Erythrocyte
Protporphrin
RDW Ted Normal Normal Normal

medpox.com
 1462. On medical check up of a Punjabi
student following findings were seen
Hb of 9.9gm/d1, RBC count of 5.1
million, MCV of 62.5 fl and RDW of
13.51%. What is the most probable
diagnosis ?
a) HbD

b) Thalassemia trait

c) Iron deficiency anemia

d) Anemia of chronic disease

medpox.com

Correct Answer - B
Answer- B. Thalassemia trait
Normal RDW with low MCV is seen in--
1. Anemia of chronic disease
2. Heterozygous thalassemia (Thalassemia trait)
3. Hemoglobin E trait.
1463. Megaloblastic anemia should be treated
with both folic acid vitamin B12
because :
a) Folic acid alone causes improvement of hematologic symptoms
but worsening of neurological symptoms

b) It is a Co factor

c) It is enzyme

d) None of the above

Correct Answer - A medpox.com

Answer is A (Folic acid alone causes improvement in hematologic in
symptoms but worsening of neurological symptoms)
Megaloblastic anemia may be caused by a deficiency of vitamin B12
(cobalamine) or deficiency of folate. Unless it is clearly established,
which of the two deficienceis / folate or cobalamine) is the cause
anemia treatment should include administration of both .folk acid
and. vitamin Bp. If only folic acid is administered in a patient with
mezaloblastic anemia due to vitamin BI2 deficiency, worseninz of
neurological symptoms (cobalamine neuropathy) is seen despite an
improvement in the hematological .symptoms (anemia)
'Although prompt hematologic response heralded by reticulocytosis
follows the administration of folic acid, it should he cautioned that the
hematologic symptoms of a vitamin B,2 deficiency anemia also
respond to folate therapy. However Mate does not prevent and may
even exacerbate the progression of neurological deficits typical of
vitamin B12 deficiency states'
Before large doses of folic acid are given, cobalamine deficiency
must be excluded and if present corrected, otherwise cobalamine
neuropathy may develop despite a response of the anemia of
cobalamine deficiency to Palate therapy.

medpox.com
1464. Which of the following statements
regarding the schilling test for vitamin
B12 malabsorption is most accurate?
a) The schilling test results are abnormal in patients with dietary
vitamin B12 deficiency.

b) In patients with pernicious anemia, the results of the schilling

test normalize after oral administration of intrinsic factor,

c) In patients with ileal disease, the results of the schilling test

normalize after oral administration of intrinsic factor

d) Pancreatic exocrine insufficiency does not cause schilling test

results to be abnormal.
medpox.com

Correct Answer - B
Answer is B (In patients with pernicious anemia, the results of the
Schilling test normalize after oral administration of intrinsic factor):
An abnormal Schilling's test that corrects or normalizes after
administration of intrinsic factor suggests a diagnosis of Pernicious
Anemia (Intrinsic Factor Deficiency).
Shilling's test is done to determine the cause of cyanocobalamine
deficiency (Vitamin B12).Schilling test is
abnormal in conditions that affect cobalamine absorption including
Pernicious anemia, Chronic Pancreatitis, Bacterial overgrowth
syndrome and Ileal dysfunction.
An Abnormal Schilling's test that corrects after administration of
Intrinsic Factor indicates Pernicious Anemia
An Abnormal Schilling's test that corrects after administration of
Pancreatic Enzymes suggests Exocrine Pancreatic Insufficiency
(from Chronic Pancreatitis)
An Abnormal Schilling's test that corrects after administration of five
days of antibiotics suggests Bacterial Overgrowth Syndrome
An Abnormal Schilling's test that does not correct after
administration of intrinsic factor, pancreatic enzymes and/or
antibiotics suggests Ileal mucosal dysfunction

medpox.com
1465. Mentzer index more than 13 suggests a
diagnosis of
a) Iron deficiency anemia

b) Thalassemia

c) Hereditary Spherocytosis

d) Autoimmune Hemolytic Anemia

Correct Answer - A
Ans. is 'a' i.e., Iron deficiency Anemia
Mentzer index more than 13 suggests a diagnosis of Iron-deficiency
anemia. medpox.com
Mentzer index
The Mentzer index is used to help in differentiating iron deficiency
anemia from beta thalassemia.
The index is calculated as the quotient of the mean corpuscular
volume (MCV, in fL) divided by the red blood cell count (RBC, in
millions per microleter).
If the Mentzer index is less than 13, thallassemia is said to be more
likely.
If the Mentzer Index is greater than 13, Then iron-deficiency anemia
is said to be more likely.
Principle
In iron deficiency, the marrow cannot produce as many RBCs and
they are small (imcrocytic), so the RBC count and the MCV will both
be low, and as a result, the index will be greater than 13.
Conversely, in thalassemia, which is a disorder of globin synthesis,
the number of RBCs produced is normal, but the cells are smaller
and more fragile. Therefore, the RBC count is normal, but the MCV
is low, so the index will be less than 13.
In practice, the Mentzer index is not a reliable indicator and should
not, by itself be used to differentiate the two conditions.
Value for
Value for
iron
Index Formula iron
deficiency
thalassemia
anemia
Mentzer MC V/RBC
> 13 < 13
index count
Shine and MCV2 x
> 1530 < 1530
Lal index MCH x 0.01
MCV – RBC
England and
- (5 x Hb) > 0 < 0
Fraser index
5.19
Srivastava
MCH/RBC > 3.8 < 3.8
index
MCV2 x
Green and
RDW x > 65 < 65
king index
Hb/100
Red cell medpox.com
MCV x
distribution > 220 < 220
RDW/RBC
width index
1466. Which of the following statements
about iron deficiency anemia is correct
a) Decreased TIBC

b) Increased ferritin levels

c) Bone marrow iron is decreased after serum iron is decreased

d) Bone marrow iron is decreased earlier than serum iron

Correct Answer - D
Ans. is 'D' i.e., Bone marrow iron is decreased earlier than serum
iron
medpox.com
"In iron deficiency anemia the first change is decrease in iron stores
"
The decrease in iron stores is demonstrated by decreased serum
ferritin level.
Remember,
Serum ferritin reflects the amount of storage iron in the body.
As the total body iron level begins to fall a characteristic,
sequence of events ensue :
First Stage or Prelatent Stage of Iron Depletion
When iron loss exceeds absorption, a negative iron balance exists.
Stored iron begins to be, mobilized from stores. The iron present in
the macrophages of liver, spleen and bone marrow are depleted
Decrease in stored iron is reflected by decrease in serum ferritin.
At this stage all other parameters of iron status are normal.
Second Stage or Stage of Latent Iron Deficiency :
Iron stores are exhausted but the blood hemoglobin level remains
higher than the lower limit of normal. o After the exhaustion of iron
stores :
The plasma iron concentration fallsQ.
Plasma iron binding capacity increases2.
Percentage saturation falls below 15%Q.
The percentage of sideroblast decreases in the bone marrowQ.
Third Stage or Stage of Apparent Iron Deficiency Anemia
Supply of iron to marrow becomes inadequate for normal
hemoglobin production,
So the blood hemoglobin concentration fallsQ below the lower limit of
normal and iron deficiency anemia is apparent.

medpox.com
1467. Direct Coomb's test detects:
a) Antibodies attached to RBC Surface

b) Antibodies in the serum

c) Antigens attached to RBC Surface

d) Antigens in the serum

Correct Answer - A
Answer is A (Antibodies attached to RBC Surface)
Direct Coomb's test detects IgG Antibodies (or complements)
attached to the surface of RBCs. Indirect Coomb's test detects IgG
antibodies in the serum (e.g. Anti-D Antibodies).
medpox.com
1468. All of following cause intravascular
hemolysis, except
a) Mismatched blood transfusion

b) Paroxysmal cold hemoglobinuria

c) Thermal burns

d) Hereditary spherocytosis

Correct Answer - D
Ans. is 'd' i.e., Hereditary spherocytosis
Blood transfusion
ABO mismatched transfusion medpox.com
Infected blood
Thermal burns
Snake bites
Sepsis
Bacterial/parasitic infections
Clostridial sepsis
Malaria
Bartonellosis
Mycoplasma pneumoniae
Mechanical heart valves
Paroxysmal hemoglobinuria
PNH
PCH
1469. Which of the following is not seen in
Hereditary Spherocytosis
a) Direct Coomb's Positive

b) Increased Osmotic Fragility

c) Splenomegaly

d) Gall stones

Correct Answer - A
Ans. is 'a' i.e., Direct Coomb's positive
Hereditary Spherocytosis
medpox.com
Membrane cytoskeleton that lies closely opposed to the internal
surface of the plasma membrane, is responsible for elasticity and
maintenance of RBC shape.
Membrane skeleton consists :?
Spectrin → The chief protein component
responsible for biconcave shape.
Ankyrin and band 4-2 → Binds spectrin to band 3
Band 3 → A transmembrane ion transport
protein.
Band 4.1 → Binds spectrin to glycophorin A,
atransmembrane protein.
Hereditary spherocytosis is an autosomal dominant disorder
characterized by intrinsic defects in red cell membrane. This results
in production of red cells that are sphere (spherocytes) rather than
biconcave.
The mutation most commonly involves the gene coding for ankyrin,
followed by Band-3 (anionic transport channel), spectrin, and Band
4.2 (also called palladin).
Also know
Most common, defect in hereditary elliptocytosis is in spectrin
Pathogensis of Hereditary spherocytosis
Loss of membrane cytoskeleton proteins (ankyrin, spectrin, Band 3,
4.2) results in reduced membrane stability. Reduced membrane
stability leads to spontaneous loss of membrane fragments during
exposure to shear stresses in the circulation. The loss of membrane
relative to cytoplasm forces the cells to assume the smallest
possible diameter for a given volume cells become
microspherocytes.
Because of their spheroidal shape and reduced membrane plasticity,
red cells become less deformable and are trapped in to spleen as
they are unable to pass through the interendothelial fenestrations of
the venous sinusoids. In the splenic sinusoides, red cells are
phagocytosed by RE cells Extravascular hemolysis.
Clinical features of Hereditory spherocytosis
The clinical features are those of extravascular hemolysis :
Anemia → Mild to moderate
Jaundice (Mainly indirect bilirubin) → Splenomegaly
medpox.com
Gall stones → Elevated excretion of
bilirubin promotes formation of pigment stone.
Leg ulcer → Rare clinical
manifestation.
Aplastic crisis → Triggered by parvo-
virus infection.
Laboratory findings
Spherocytosis --> Peripheral smear shows microspherocytes which
are small RBCs without central pallor (Normally central 1/3 pallor is
present in red cells).
MCV4
MCHC r
Increased unconjugate bilirubin
Urine urobilinogen 1'
Stool stercobilinogen
Reticulocytosis -4 As seen with any type of hemolytic anemia.
Hemoglobin 1
Serum Heptoglobin --> Nonnal to decreased.
Increased osmotic fragility on pink test.
Coomb's test is used to distinguish hereditary spherocytosis from
autoimmune hemolytic anemias.
Autoimmune hemolytic anemias are coomb's positive_ whereas
hereditary spherocytosis is coomb's negative.

medpox.com
1470. Usually associated with parvovirus B19
infection in those with hereditary
spherocytosis
a) Mild to moderate splenomegaly

b) Aplastic crisis

c) Gallstones

d) Hemolytic crisis

Correct Answer - B
Ans. is 'b' i.e., Aplastic crisismedpox.com
Parvovirus B19 selectively infects erythroid precursors and is the
most common aetiological agent that induces
aplastic crisis in patients with hereditary spherocytosis (and other
Hemolytic disorders).
Transient aplastic crisis
Persons with decreased erythrocytes caused by conditions such as
iron deficiency anemia, human immunodeficiency virus sickle cell
disease, spherocytosis or thalassemia are at risk of transient
aplastic crisis if infected with parvovirus B19.
The virus causes a cessation of erythrocyte production.
Parvovirus infection may be the first manifestation in HS.
It begins with reticulocytosis and thrombocytosis
1471. With regards to hereditary
spherocytosis, which of the following is
false
a) Usually has autosomal dominant inheritance

b) Caused by mutations in genes for proteins such as spectrin,

ankrin or band 3

c) Red blood cells are destroyed in the spleen

d) Aplastic crises are common

Correct Answer - D medpox.com

Ans. is 'd' i.e., Aplastic Crisis are common
Aplastic crisis are a rare/uncommon complication of Hereditary
Spherocytosis typically caused by virally induced
bone marrow suppression.
The most common aetiological agent that induces Aplastic Crisis in
patients with Hereditary Spherocytosis is Parvovirus B19
Hereditary spherocvtosis usually has autosomal dominant
inheritance caused by mutation in genes for proteins such as
spectrin. ankrin or band 3.
The genes responsible for HS include akyrin, b spectrin, band-3-
protein, a-spectrin, and protein 4.2. In approximately two-thirds to
three-quarter of HS patients, inheritance is autosomal dominant. In
the remaining patients, inheritance is non-dominant due to
autosomal recessive inheritance of a de novo mutation.
In patients with hereditary spherocvtosis Red blood cells are
destroyed in the spleen
The spleen plays a critical role in the pathobiology of HS, as
destruction of spherocytes in the spleen is the primary cause of
hemolysis in HS patients.
Aplastic Crisis is an Uncommon Complication
Aplastic crisis following virally induced bone marrow suppression are
uncommon, but may result in severe anaemia with serious
complications including congestive heart failure or even death.
The most common aetiological agent in these cases is parvovirus
B19.
Parvovirus selectively infects erythropoietic progenitor cells and
inhibits their growth

medpox.com
1472. All of the following are true regarding
splenectomy in patients with hereditary
spherocytosis, except ?
a) Avoid in mild cases

b) Delay splenectomy until at least 4 years old age

c) Anti-pneumococcal vaccination must be given before

splenectomy

d) Prolonged anti-pneumococcal antibiotic prophylaxis must be

given after splenectomy

medpox.com
Correct Answer - D
Ans. is 'd' i.e., Prolonged Anti-pneumococcal Antibiotic Prophylaxis
must be given after splenectomy
Splencectomv in patients with Hereditary spherocytosis
Avoid splenectomy in mild cases.
Delay splenectomy until at least 4 years of age after the risk of
severe sepsis has peaked.
Anti-pneumococcal vaccination befoe splenectomy is imperative
while anti-pneumococcal prophylaxis post-splenectomy is
controversial.
1473. Most common heavy chain disease is
a) Franklin disease

b) Seligmann disease

c) Mu heavy chain disease

d) Waldenstrom cryoglobulinemia

Correct Answer - B
Ans. is 'b' i.e., Seligmann Disease (Alpha heavy chain disease)
There are four forms:
* Alpha chain disease (Seligmann's disease)- most common type
* Gamma chain disease (Franklin's disease)
medpox.com
* Mu chain disease
* Delta chain disease
1474. Leukoerythroblastic picture may be seen in all of the following conditions,
except:

a) Myelofibrosis

b) Metastatic carcinoma

c) Gaucher's disease

d) Thalassemia

Correct Answer - D
Leukoerythroblastosis refers to the presence of immature nucleated RBCs, immature white
blood cells, and megakaryocyte fragments on the peripheral blood smear. It occur due to
bone marrow infiltration.

When marrow infiltration causes anemia or pancytopenia, it is referred to as

medpox.com
myelophthisic anemia. The most common cause of myelophthisis includes metastatic
carcinoma of the lung, breast, or prostate. Other causes include hematologic malignancies
(leukemia, lymphoma), infections (tuberculosis, fungi), and metabolic diseases (Gaucher
disease, Niemann-Pick disease). Thalassemia is not associated with leukoerythroblastosis.

Ref: CURRENT Diagnosis & Treatment in Family Medicine, 3rd Edition, Chapter 31
1475. Chronic Non-Spherocytic hemolytic
anemia is seen in which class of G6PD
deficiency
a) Class I

b) Class II

c) Class III

d) Class IV

Correct Answer - A
Ans. is 'a' i.e., Class I medpox.com
The four forms of symptomatic G6PD deficiency :
Acute hemolytic anemia
Favism
Congenital nonspherocytic hemolytic anemia
Neonatal hyperbilirubinemia
Congenital nonspherocvtic hemolytic anemia
Patients with class I G6PD variants have such severe G6PD
deficiency that lifelong hemolysis occurs in the absence of infection
or drug exposure.
Such patients fall under the category of having congenital
nonspherocvtic hemolytic anemia.
These G6PD variants have low in vitro activity and/or marked
instability of the molecule, and most have DNA mutations at the
glucose-6-phosphate or NADP binding sites.
These sites are central to the function of G6PD, which oxidizes
glucose-6-phosphate and reduces NADP to NADPH. It is presumed
that the functional defect is so severe that the red cells cannot
withstand even the normal oxidative stresses encountered in the
circulation.
Anemia and jaundice are often first noted in the newborn period, and
the degree of hyperbilirubinemia is frequently of sufficient severity to
require exchange transfusion.
After infancy, hemolytic manifestations are subtle and inconstant.
Most individuals have mild to moderate anemia (hemoglobin 8 to 10
g/dL) with a reticulocyte count of 10 to 15 percent. Pallor is
uncommon, scleral icterus is intermittent, splenomegaly is rare, and
splenectomy generally is of little benefit.
Hemolysis can be exaggerated by exposure to drugs or chemicals
with oxidant potential or exposure to fava beans.
Some drugs with relatively mild oxidant potential that are safe in
patients with class II or class III G6PD variants may increase
hemolysis in patients with class I variants.
Disease variants of Glucose 6 phosphate dehvdrogenase
deficiency
The World Health Organization has classified the different G6PD
variants according to the magnitude of the enzyme deficiency and
the severity of hemolysis. Classes IV and V are of no clinical
medpox.com
significance.
TypesFeatures
Variants have severe enzyme
deficiency (less than 10 percent
Class
of normal) and have chronic
I
(nonspherocytic) hemolytic
anemia.
Variants, such as G6PD
Mediterranean, also have
severe enzyme deficiency, but
Class
there are, usually only
II
intermittent episodes of acute
hemolysis associated with
infection, drugs, or chemicals.
Variants, such as G6PD A-,
have moderate enzyme
Class deficiency (10 to 60 percent of
normal) with intermittent
III episodes of acute hemolysis
usually associated with
infection, drugs, or chemicals
Class Variants have no
IV enzyme.deficiency or hemolysis.
Class Variants have increased
V enzyme activity

medpox.com
1476. Sickle cell anemia leads to resistance towards?
a) P. falciparum

b) P. ovale

c) P. malariae

d) P. vivax

Correct Answer - A

Individuals with sickle cell trait (hemoglobin genotype AS) are resistant to the lethal effects
of Plasmodium falciparum infection.
This is because the sickle cell traits prevents the development of high parasitemia, probably
partly as a result of parasitized red cells sickling in the circulation and being removed by the
medpox.com
spleen before they can develop into schizonts.
Absence of RBC Duffy antigen confers resistance to P. Vivax.

Ref: Harrison's 17th ed chapter 213 ; Essentials of clinical immunology by Helen Chapel,
Man;e. Haeney, Siraj Misbah, 5th edition, Page 48 ; Lecture Notes: Tropical
Medicine edited by G. V. Gill, Nick Beeching, 2011, Page 62.
1477. Which of the following is a quantitative
defect in globin synthesis
a) Thalassemia

b) Sickle cell hemoglobinopathy

c) G6PD deficiency

d) Diamond-Black fan syndrome

Correct Answer - A
Ans. is 'a' i.e., Thalassemia
The thalassemia syndromes are a heterogeneous group of disorders
medpox.com
caused by inherited mutations that decrease the synthesis of either
the c-globin or p-globin chains that compose adult hemoglobin, HbA
(c2p2), leading to anemia, tissue hypoxia, and red cell hemolysis
related to the imbalance in globin chain synthesis.
1478. The most important diagnositic feature
for beta thalassemia trait
a) Raised HbF

b) Reduced MCH

c) Reduced MCV

d) Raised HbA2

Correct Answer - D
Ans. is 'd' i.e., Raised HbA2
An abnormal increase in the level of HbA2 is the most significant
medpox.com
parameter in the diagnosis of beta-thalassemia carriers. HbA-2 is
constanly elevated in heterozygous carriers of [3-thalassemia in all
the ethnic groups studied. The values range from 3.5 to 7%.
Investigations in thalassemia
Hemoglobin electrophoresis should always be the first investigation
to include/exclude the diagnosis of thalasemia. The level of normal
adult hemoglobin HbA is markedly decreased with proportionate
increase in HbA2 and HbF.
X-ray skull shows :?
i) Crew-cut appearance
ii) Hair on end appearance
1479. Deletion of one alpha globin gene on
one chromosome is best defined as
a) Hb Barts hydrops fetails

b) Alpha thalassemia major

c) Alpha thalassemia trait

d) Alpha thalassemia silent carrier

Correct Answer - D
Ans. is 'd' i.e., Alpha thalassemia silent carrier
Clinical
Condition Defect
medpox.comGenotype
syndrome
Deletion of 1
Silent Thalassemia -a/aa Normal
alpha genes
Deletion of 2 -a/-a Microscopic
Thalessemia trait
alpha genes (homogygous) hypochromic
Blood picture
(heterogenous)
but
No/Minimal
Anemia
Deletion of 3 Hemolytic
HbH disease --/-a
alpha genes anemia
Hydrops fetalis (Hb Deletion of 4 --/-- Fatal in utero or
Barts) alpha genes at birth
1480. Which of the following is caused by
deletion of all four alpha globin genes
a) Beta thalassemia major

b) Hb Barts

c) HbH

d) a° thalassemia trait

Correct Answer - B
Ans. is 'b' i.e., Hb Barts
Clinical
Condition Defect
medpox.comGenotype
syndrome
Deletion of 1
Silent Thalassemia -a/aa Normal
alpha genes
Deletion of 2 -a/-a Microscopic
Thalessemia trait
alpha genes (homogygous) hypochromic
Blood picture
(heterogenous)
but
No/Minimal
Anemia
Deletion of 3 Hemolytic
HbH disease --/-a
alpha genes anemia
Hydrops fetalis (Hb Deletion of 4 --/-- Fatal in utero or
Barts) alpha genes at birth
1481. In Beta thalassemia, the most common
gene mutation is
a) Intron 1 inversion

b) Intron 22

c) 619 bp deletion

d) 3.7 bp deletion

Correct Answer - A
Ans. is 'a' i.e., Intron 1 inversion
Thalassemias are autosomal recessive disorder
medpox.com
The most common mutation causing 13 thalassemias is
intron/inversion
Also know:
Synthesis of alpha chain is controlled by 2 gene clusters on →
Chromosome 16
Synthesis of beta chain is controlled by 2 gene clusters on →
Chromosome 11
Thalassemia mutations in India
Multations Frequency
IVS1-5 (G —>C) 48%
619 bp defection 18%
IVS-1 (G T) 9%
FR41/42(TCTT) 9%
FR8/9 (+G) 5%
Codonl5 (G --> A) 6%
Others 100%
1482. Which is the most common cytogenetic
abnormality in adult myelodysplastic
syndrome (MDS) -
a) Trisomy 8

b) 20q?

c) 5q?

d) Monosmy 7

Correct Answer - C
Answer is C (5q-) medpox.com
`Monosomy 7 is by far the most common cytogenetic abnormality in
children (pediatric MDS) whereas 5q- is observed most frequent!,' in
adults' – Myelodysplastic Syndromes by John Bennett (2002)/300
Cytogenetic Abnormalities in MDS: Facts to Remember
Monosomy 7 is the most frequent cytogenetic abnormality in
children.Q Deletion 5q (5q) is the most frequent cytogenetic
abnormality in adults Q. Trisomy 8 is the most frequent tri.somyQ.
Differences between Myelodysplastic Syndromes in children
and Adults (`Myelodysplastic Syndromes' 2002/300; 'Childhood
Leukemias' 2'"/549)
Feature Children
Adults
• Frequency Less common More common
• Presence of Uncommon More common (,-
sideroblasts (<2%) -25%)
• Cytogenetic

Abervations
Most common Less common
-7/7q-
(r,30%) (,=-40%)
-7/7q-
(r,30%) (,=-40%)
Uncommon (--L- Most common
-5/5q-
1-2%) (z20%)

medpox.com
1483. Reversed Coarctation is seen in:
a) Giant cell Arteritis

b) Polyarteritis Nodosa

c) Takayasu Arteritis

d) Kawasaki Disease

Correct Answer - C
Answer is C (Takayasu Arteritis):
Takayasu arteritis is also known as 'Reversed Coarctation'.
Takayasu Arteritis
Condition Coarctation of Aorta
medpox.com (Reversed Coarctation)
Obstruction is most
Obstruction is most
commonly seen in proximal
commonly found just
Pathology aspect of branches of the
distal to the origin of the
(Site of aortic arch including the
left Subclavian artery
Obstruction) Subclavian and Common
thereby sparing the
Carotid thereby affecting the
upper limb vessels
upper limb vessels
Absence or diminished Absence or diminished pulse
Pulses
pulse in the lower limbs in the upper limbs
Blood Increased blood pressure Decreased blood pressure in
Pressure in the upper limbs the upper limbs
1484. Most common variant of Takayasu
Disease in India is:
a) Type-1

b) Type-2

c) Type-3

d) Type-4

Correct Answer - C
Answer is C (Type -3):
The most common type of Takayasu arteritis reported in India is
Type III. medpox.com
Most studies from India have reported Type III as the most common
form of Takayasu arteritis in India accounting for 53 to 76 percent of
cases.
Classification /
Predominant Site Involved
Type
Type-I (Shimizu-
Arch of aorta and its branches
Savo)
Thoraco-abdominal aorta and its branches without
Type-II (Kimoto)
involvement of the aortic arch
Type-III (Inada) Combined features of both Type-I & Type-II
Pulmonary involvement (in addition to features of
Type-I, II or III)
Type-IV (Oata)
Involvement of coronary arteries (in addition to
features of Type-1, II or III)

1485. In Takayasu's arteritis there is
a) Intimal fibrosis

b) Renal hypertension

c) Coronary aneurysm

d) All of the above

Correct Answer - B
Ans. is `b' i.e., Renal hypertension
Potential
Artery clinical
manifestation
medpox.com
Arm
claudication,
Subclavian
Raynaud's
phenomenon
Visual
changes,
syncope
Commoncarotid
transient,
ischaemic
attacks stroke
Abdominal
AbdominalAorta pain, nausea
vomiting
Hypertension,
renal failure,
aortic
Renal
insufficiency,
congestive
heart failure
 heart failure
Visual
Vertebral changes,
dizziness
Abdominal
Coeliac axis pain, nausea
vomiting
Iliac Leg

claudication
Atypical chest
Pulmonary
pain dyspnea
Chest pain
Coronary myocardial
infarction

medpox.com
1486. Marker of acute kidney injury all except
a) Clusterin

b) Osteopontin

c) Alanine aminopeptidase

d) Acid phosphatase

Correct Answer - D
Ans. is 'd' i.e., Acid phosphatase
Alanine aminopeptidase (AAP) Kidney injury
molecule-1 (KIM-1)
Alkaline phosphatase (AP) Clusterin
medpox.com
utathione-S-transferase (a-GST) Neutrophil
gelatinase associated lipocalin (NGAL)
yglutamyl transpeptidase (TGT) Interleukin-18 (IL-
18)
N-acetyl-0-glucosaminidase (NAG) Cysteine-rich
protein (CYR-61)
2-microglobulin Osteopontin (OPN)
microglobulin o Retinol-binding protein (RBP) Fatty acid binding
protein (FABP
Cystatin C Sodium/hydrogen
exchanger isoform (NHE3) o
Microalbumin Exosomal fetuin-A
1487. Lepsroy causes ?
a) Membranous GN

b) Focal glomerulosclerosis

c) Membranoproliferative GN

d) Mesangioproliferative GN

Correct Answer - A
Ans. is 'a' i.e., Membranous GN
Infectious diseases causing membranous GN
• Hepatitis B
• Hydatid disease •Leprosy
and C medpox.com
• Filariasis • Syphilis •Enterococcal
• Malaria • Endocarditis •Schistosomiasis
1488. Nephrotic syndrome is the hall mark of
the following primary kidney diseases
except
a) Membranous Glomerulopathy

b) IgA nephropathy

c) Minimal change disease

d) Focal segmental Glomerulosclerosis

Correct Answer - B
Ans. is 'b' i.e., IgA nephropathy
medpox.com
Most common presentation of IgA nephropathy is grass hematuria.
It is the most common form of glomerulonephritis worldwide
Causes of Nephrotic syndrome
Minimal change disease
Focal segmental glomerulosclerosis o Membranous
glomerulonephritis o Diabetes nephropathy
AL and AA amyloidosis
Light chain deposition disease
Fibrillary immunotactoid disease
1489. The term end-stage renal disease
(ESRD) is considered appropriate when
GFR falls to
a) 50% of normal

b) 25% of normal

c) 10-25% of normal

d) 5-10% of normal

Correct Answer - D
Ans. is 'd' i.e., 5-10% of normal
medpox.com

1490. Characteristic ECG finding of
pulmonary embolism
a) Sinus tachycardia

b) S Q3T3

c) T wave inversion

d) Epsilon waves

Correct Answer - B
Ans. is `b' i.e., SJQ3T3
E.C.G. changes of pulmonary embolism ?
medpox.com
Sinus tachycardia is the most frequent and nonspecific finding on
electrocardiography in acute pulmonary embolism.
Features suggesting acute right heart strain on the ECG occur
relatively infrequently, these include.
Acute right axis deviation
P pulmonale
Right bundle branch block
Inverted T waves
ST segment changes in right sided leads.
Earlier the following E.C.G. changes were considered highly
predictive of acute pulmonary embolism, but these observations
were found in less than 12% of patients with pulmonary emboli in
recent studies. These E.C.G. features are -
S wave in lead I
Q wave in lead III
Inverted Tin lead III ("S1Q31.3")
S waves in lead I, II and III ("Si,S2 S3")
Also know
Areterial blood gas analysis in pulmonary embolism :
Arterial blood gas analysis shows
Mid to moderate hypoxemia
Increased P (A - a) 0,
Mildly reduced PaCO2
Almost all patients with pulmonary embolism have PaO, < 80 mm Hg
but no absolute level of Pa02 can be used to exclude the diagnosis.

medpox.com
1491. Pleural effusion in rheumatoid arthritis
is typically associated with the
following features except
a) Glucose > 60 mg/dl

b) Protein > 3 gm/di

c) Pleural fluid protien to serum protein ratio of >0 .5

d) Pleural fluid LDH to serum LDH ratio of >0.6

Correct Answer - A
Ans. is 'a' i.e., Glucose > 60 mg/dl
medpox.com
Causes of low glucose pleural fluid
Malignancy
Rheumatoid arthritis
Empyema
Hemothorax
Paragonimiasis
Churg strauss syndrome
Lupus pleuritis (occasionally)
1492. Bowel punctured during laproscopy
a) Trocar kept

b) trocar removal

c) trocar repositioned

d) None

Correct Answer - A
Answer- A. Trocar kept
To assist in identifying the precise site of injuty.

medpox.com
1493. What is not done in case of puncture
wound of left colon
a) Primary suture

b) Hemicolectomy

c) Externalization

d) Resection and anastomosis

Correct Answer - B
Answer- B. Hemicolectomy
Small wound are repaired primarily by simple suturing.
medpox.com
More extensive wound are treated by resection and anastomosis.
Some may require colostomy (externalization)
[Ref Bailey er Love 25th/e p. 1184]
 1494. What is the percentage body surface
area involved in head + face in burns
a) 13

b) 15

c) 17

d) 09

Correct Answer - D
Answer- D. 09
According to rule of 9 (Wallace's formula), burn surface area is
calculated as : medpox.com
1. 9% for the head and neck.
2. 9% for each upper limb.
3. 9% for the front of each lower limb.
4. 9% for the back of each lower limb.
5. 9% for the front of the chest.
6. 9% for the back of the chest.
7. 9% for the front of the abdomen.
8. 9% for the back of the abdomen.
9. 1% for the genitalia.
[Ref Bailey & Love 25th le p. 381]
1495. Burst abdomen most commonly occurs
on the
a) 2nd day

b) 3rd day

c) 7th day

d) 9th day

Correct Answer - C
Ans. is 'c' i.e., 7"' day
Burst abdomen occurs mostly between the 7" and 10th day after
medpox.com
operation (but may occur anytime after surgery from 1 to more than
20 days)(ref Sabiston 18/e )
1496. Plunging Ranula is
a) Cystic growth of sublingual gland

b) Lymph node

c) A tumor in floor of mouth

d) None

Correct Answer - A
Answer- A. Cystic growth of the sublingual gland
Plunging ranula is a rare form of mucous retention cyst that arises
from the sublingual salivary glands.
Mucus collects below the gland and perforates through the
medpox.com
mylohyoid muscle diaphragm to enter the neck.
1497. Sialolithiasis is most commonly seen in
which gland
a) Parotid

b) Sublingual

c) Submandibular

d) Minor salivary gland

Correct Answer - C
Answer- C. Submandibular
Most common site for salivary gland stone (Sialolithiasis) is
medpox.com
submandibular gland, especially duct of submandibular gland
(Wharton's duct).
1498. Which structure is not preserved in
modified radical mastectomy
a) Cephalic vein

b) Pectoralis minor

c) Pectoralis major

d) Branches of lntercostobrachial N.

Correct Answer - A
Answer- A
In the modified radical mastectomy, the procedure involves removal
medpox.com
of the breast but preservation of the pectoralis major muscle. The
extent of preservation of the pectoralis minor and axillary nodes
varies.
Preserve thoracodorsal nerve/vessels.
1499. Duputyrens and peyonies are both type
of
a) Fibromatosis

b) Fibroblastic hyperplesia

c) Burn contracture

d) Myalgias

Correct Answer - B
Answer- B. Fibroblastic hyperplesia
Dupuytren contracture and Peyranie's diseases are fibroblastic
hyperplasia. medpox.com
Dupuytren's contracture is characterized in the established phase by
flexion contracture of one or more fingers from thickening and
shortening of palmar oponeurosis.
1500. Mid gut Volvulus symptoms appear at
a) 1" week

b) 3rd weeks

c) 2" weeks

d) 4th weeks

Correct Answer - A
Answer- A. 1" week
Midgut volvulus can happen at any age, but most commonly occurs
during the first few weeks of life. Bilious emesis is usually the first
sign of volvulus. medpox.com
1501. Orchidopexy for incompletely
descended testis is done after the age
of:
September 2011
a) At birth

b) 1 year

c) 2 years

d) 5 years

Correct Answer - B medpox.com

Ans. B: 1 year
Orchidopexy is usually performed after the age of 1 year to avoid the
risk of operating on a tiny patient Remember:
Incomplete descent of testes may increased liability to malignant
change
All types of malignant testicular tumours are more common in
incompletely descended testes even if they have been brought down
surgically
1502. Which of the following statement about
Renal Cell Carcinoma (Hypemephroma)
is false:
a) Originate in the cortex

b) Histologically are usually Adenocarcinomas

c) May present with varicocele

d) Radiosensitive

Correct Answer - D
Answer is D (Radiosensitive): medpox.com
Renal cell carcinoma is a relatively radioresistant tumor.
Renal cell carcinoma originates in the Renal cortex
`Renal cell carcinoma originates in the Renal cortex and tends to
grow out into perinephric tissue causing the typical bulge or mass
effect that aids in their detection by diagnostic imaging studies' –
Smith's Urology
Renal Cell carcinoma are adenocarcinomas
Histologically Renal cell carcinoma is most often a mixed
adenocarcinoma — Smith's Urology
Renal cell carcinomas may present with varicocele
'Renal cell carcinomas may present with Rapidly developing
varicocele. Varicocele is usually observed on the left side. This
occurs because left gonadal vein is obstructed where it joins the left
renal vein.
Renal cell carcinomas are Relatively Radioresistant tumors
Renal cell carcinomas are generally considered radioresistant
tumors
Role of Radiotherapy in renal Cell carcinoma
Preoperative Radiation has shown no impact on survival
Postoperative Radiation has also shown no evidence of improved
survival but may be used as it shows improvement in local control.
Palliative Radiotherapy has been shown to be effective in metastatic
disease to brain, bone and lungs.

medpox.com
 1503. Most common nerve damaged during
hernia repair
a) ilioinguinal nerve

b) Iliohypogastric

c) Genitofumoral

d) None

Correct Answer - A
Answer- A. ilioinguinal nerve
There nerves are exposed to injury during inguinal hernia repair.
1. Ilioinguinal nerve medpox.com
2. Genitofemoral nerve
3. Iliohypogastric nerve
The most commonly injured nerve is ilioinguinal nerve.
 1504. Progressive dysphagia is seen in all
except
a) CA esophagus

b) Diffuse esophageal spasm

c) Stricture

d) Achalasia cardia

Correct Answer - B
Answer- B. Diffuse esophageal spasm
Propgressive dysphagis is seen in
CA esophagus medpox.com
Stricture
Achalasia cardia
Dysphagia equal for both solids and liquids from onset:
1. Achalasia
2. Diffuse esophageal spasm
1505. In carcinoma of anus distal margin of
clearance of anal canal of at least
a) 2 cm

b) 5 cm

c) 4 cm

d) 7 cm

Correct Answer - A
Ans. is 'a' i.e., 2 cm

medpox.com

[Ref Bailey & Love 25th/e p. 1233]
1506. Kher sign is seen in
a) Splenic trauma

b) Hepatic trauma

c) Renal trauma

d) Pacreatic trauma

Correct Answer - A
Answer- A. Splenic trauma
In splenic rupture the pain may be referred to the tip of the left
shoulder.
This is known as Kehr's sign. medpox.com
It occurs due to irritation of the undersurface of the diaphragm with
blood and the pain is referred to the shoulder through the affected
fibres of phrenic nerve (C4 and C5).
1507. ABPI of imminent necrosis
a) < 0.3

b) 0.3

c) < 0.6

d) > 0-6

Correct Answer - A
Answer- A. < 0.3
Lower ABPI is an indication of peripheral vascular disease of lower
limb.
Critical ischemia (restpain or tissue necrosis) most commonly is
medpox.com
associated with an ABI < 0.4.
1508. Ankle brachial pressure index is
a) 1.0

b) 10

c) 01

d) None

Correct Answer - A
Answer- A. 1.0
Ankle - brachial pressure index (ABPI) is the ratio of BP in ankle to
BP in arm (upper limb).
Normal ABPI is around 1 (0.9 - 1.2).
medpox.com
1509. In Ainhum, constriction develops
usually at the level of interphalangeal
joint of
a) Great toe

b) 2nd toe

c) Little toe

d) None

Correct Answer - C
Answer- C. Little toe medpox.com
Ainhum is bilateral painful constriction at the base of 5th toe (little
toe).
This leads to bilateral autoamputation of little toes.
1510. Breast conservation surgery not
indicated ?
a) Large pendular breast

b) SLE

c) Diffuse microcalcification

d) All

Correct Answer - D
Answer (a) Large pendular breast; (b) SLE ; (c) Diffuse
microcalcification
medpox.com
1511. True about carcinoma of male breast is
a) Invasive lobular Ca is most common

b) Estrogen receptor negative

c) Seen in young males

d) BRCA2 mutation is associated with increased risk

Correct Answer - D
Answer- D. BRCA2 mutation is associated with increased risk
The average age of men diagnosed with breast cancer is 68 years
(old age).
Breast cancers in male have estrogen receptors and high estorgen
medpox.com
level is a risk factor for breast carcinoma in males.
Men who inherit abnormal BRCA-1 and BRCA-2 genes have an
increased risk for male breast cancer.
Most breast cancers in men are ductal carcinomas.
1512. Most common carcinoma breast in male
s
a) Lobular carcinoma in situ

b) Ductal carcinoma in situ

c) Infiltrating ductal Ca

d) None

Correct Answer - C
Answer- C. Infiltrating ductal Ca
Most breast cancers in men are ductal carcinomas.
medpox.com
1513. Pressure in laproscopy is
a) 10-12 mmHg

b) 12-14 mmHg

c) 14-16 mmHg

d) 16-18 mmHg

Correct Answer - B
Answer- B. 12-14 mmHg
In laproscopy with standard pressure pneumoperitoneum, the gas
pressure is 12-14 mmHg.
medpox.com
1514. Most common site of direct hernia
a) Hesselbach's triangle

b) Femoral gland

c) No site predilection

d) None

Correct Answer - A
Answer- A. Hesselbach's triangle
It enters the canal through inguinal triangle of Hesselbach.
Common in elderly
Always acquired medpox.com
Herniation through posterior wall of the inguinal canal
Globular/round in shape; descends directly forward bulge.
Truss cannot prevent progression of Sliding type of inguinal hernia
 1515. Lymph drainage is increased from
lower limbs by
a) Massasaging

b) Running

c) Cycling

d) Sleeping

Correct Answer - A
Answer- A. Massasaging
In the healthy limb, lymph flow is largely due to intrinsic lymphatic
medpox.com
contractility, although this is augmented by exercise, limb movement
and external compresion (massaging).
Lymphatic pump/suction pump :
1. Skeletal muscle contraction (skeletal muscle pump);
2. Squeezing action of smooth muscle lining the larger lymphatics;
3. Positive intra-abdominal and negative intrathoracic pressure.
4. Therefore, compression of tissues by objects outside the body (e.g.,
massage of foot) increases lymph flow.
1516. Nodule on thyroid with
lymphadenopathy
a) Radiation

b) Chemotherapy

c) Excision of nodule

d) Total thyroidectomy + MRND

Correct Answer - D
Answer- D. Total thyroidectomy + MRND
Total Thyroidectomy is the treatment of choice for patients with MTC
medpox.com
because of high incidence of multicentricity.
In patients with palpable cervical nodes or involved central neck
nodes, ipsilateral or bilateral modified radical neck dissection is
recommended.
 1517. Treatment of contaminated wound of
leg
a) Debridement and antibiotics

b) Hyperbaric oxygen

c) Amputation

d) None

Correct Answer - A
Answer- A. Debridement and antibiotics
After debridement, wound is reassessed and further management
depends on the type of wound. medpox.com
1. If it is small and clean Primary closure can be done
2. If it is large and clean Coverage procedure (skin graft/muscle pedicle
graft) should be done.
3. If it is still contaminated - Daily dressing and debridement is done till
the wound is clean.
1518. Indications of Liver transplantation are
All/Except
a) Biliary atresia

b) Sclerosing cholangitis

c) Hepatitis A

d) Cirrhosis

Correct Answer - C
Ans. is 'c' i.e. Hepatitis A
Liver transplantation is indicated for those children and adults, who
medpox.com
in the absence of contraindications suffer from severe, irreversible
liver disease for which alternative medical or surgical treatments
have been exhausted or are unavailable.
Most common indication
in children ________ Biliary atresia
in adults --> Cirrhosis
Harrison 17/e writes- "Currently, chronic hepatitis C and alcoholic
liver disease are the most common indications for liver
transplantation, accounting for over 40% of all adult candidates who
undergo the procedure."
Indications for
ver Transplantation
Children Adults
Biliary atresia Primary biliary cirrhosis
Secondary biliary
Neonatal hepatitis
cirrhosis
Congenital hepatic Primary sclerosing
fibrosis cholangitis
Alagille's disease Autoimmune hepatitis
Alagille's disease Autoimmune hepatitis
Byler's disease Caroli's disease
al- antitrypsin
Cryptogenic cirrhosis
deficiency
Inherited disorders of Chronic hepatitis with
metabolism cirrhosis
Wilson's disease Hepatic vein thrombosis
Tyrosinemia Fulminant hepatitis
Glycogen storage
Alcoholic cirrhosis
diseases
Lysosomal storage
Chronic viral hepatitis
diseases
Primary hepatocellular
Protoporphyria
malignancies
Crigler-Najjar disease
Hepatic adenomas
type I
Familial Nonalcoholic
hypercholesterolemia steatohepatitis
medpox.com
Primary hyperoxaluria Familial amyloid
type I polyneuropathy
Hemophilia

Contraindications to Liver Transplantation
Absolute Relative
Uncontrolled extrahepatobiliary
Age >70
infection
Prior extensive hepatobiliary
Active, untreated sepsis
surgery
Uncorrectable, life-limiting
Portal vein thrombosis
congenital anomalies
Active substance or alcohol
Renal failure
abuse
Advanced cardiopulmonary Previous extrahepatic
disease malignancy (not
including nonmelanoma skin
cancer)
Extrahepatobiliary malignancy Severe obesity
Extrahepatobiliary malignancy Severe obesity
(not including
nonmelanoma skin cancer)
Metastatic malignancy to the
Severe malnutrition/wasting
liver
Cholangiocarcinoma Medical noncompliance
AIDS HIV seropositivity
Life-threatening systemic Intrahepatic sepsis
diseases Severe hypoxemia
secondary to right-to-left
intrapulmonary shunts (P02 <
50 mmHg)
Severe pulmonary
hypertension (mean PA
pressure >35 mmHg)
Uncontrolled psychiatric
disorder

medpox.com
1519. Cock's peculiar tumor is
a) Basal cell CA

b) Squamous cell CA

c) Ulcerated sebaceous cyst

d) Cylindroma

Correct Answer - C
Ulcerated sebaceous cyst [Ref. Love & Bailey 23/e page 173, 595;
Das text book of Surgery3/e p81] Repeat from May 04
Cock's peculiar tumour is a sebaceous cyst linked growth that can
resemble a squamous cell carcinoma.
medpox.com
The proliferating cyst is usually solitary, but it often arises from a
simple trichilemmal cysts in the hair follicle epithelium.
1520. Most important diagnostic feature of
congenital hypertrophic pyloric
stenosis
a) Metabolic alkalosis

b) Non bilious vomiting

c) Jaundice

d) Fever

Correct Answer - B
Answer- B. Non bilious vomiting
medpox.com
metabolik alkalosis also occurs, non-bilious vomiting is the most
important feature of CHPS.
1521. Criteria for viability of muscle are all
except
a) Colour

b) Intact fascia

c) Contractability

d) Bleeding when cut

Correct Answer - B
Answer- B. Intact fascia
Non viable muscle can be identified by 4cs -
Color ? Consistency medpox.com
Contraction, and ? Circulation (bleeding on cut)
1522. Gall stone impacted causing intestinal
obstruction
a) Raynods pentad

b) Hepatitis

c) Gallstone ileus

d) Obstructive jaundice

Correct Answer - C
Answer- C. Gallstone ileus
Gallstone ileus refers to mechanical intestinal obstruction resulting
medpox.com
from the passage of a large gallstone into the bowel lumen.
The stone enters the duodenum through a cholecystoenteric fistula.
The site of obstruction by the impacted Gall stones is usually the
terminal end of the ileum provided that the more proximal small
bowel is of normal caliber.
1523. A middle aged male complains of ache
and mumbness and sensated of fatigus
over his calf muscles that develops on
exercise and is relieved on rest; this
condition is not associated with
a) Smoking

b) Hypocalcemia

c) Peripheral arterial disease

d) Hypertension and diabetes

medpox.com
Correct Answer - B
Answer- B. Hypocalcemia
Hyperlipidemia
Diabetes
Hypertension
Cigarette smoking
Alcohol, lipoprotein (a)
Chlamydia pneumonae
Physcial inactivity
Herpes virus
CMV infection
1524. Seton used in fistula in ano is
a) Draining seton

b) Cutting seton

c) Dissolving seton

d) None

Correct Answer - B
Answer- B. Cutting seton
seton (Tight seton) : Made up of silk/prolene/monofilament nylon and
used in fistula in ano
It promotes slow transection of external sphincter muscle as a result
medpox.com
of pressure necrosis with minimum separation of ds. cut a fistula.
1525. Multiple air fluid levels in X-ray of
abdomen is seen in
a) Hollow viscera perforation

b) Pyoperitoneum

c) Intestinal obstruction

d) None

Correct Answer - C
Answer- C. Intestinal obstruction
The obstruction may be due to adhesion, hernia, neoplasm, foreign
body etc. medpox.com
A normal person has on average 4 air fluid levels. Most of them are
seen in the colon.
For the diagnosis of small intestinal obstruction, we should see more
than 2 air fluid levels among the dilated loops of small bowel.
1526. Mondor's disease is ?
a) Thrombophlebitis of the Superficial veins of Breast

b) Carcinoma of the breast

c) Premalignant condition of the breast

d) Filariasis of the breast

Correct Answer - A
Ans is 'a' i.e., Thrombophlebitis of Superficial veins of Breast
Mondor's disease
is thrombophlebitis of the superficial veins of anterior chest wall and
breast although it has also been seen in the arm.
medpox.com
frequently involved veins are lateral thoracic vein, thoracoepigastric
vein and superficial epigastric veins.
aetiology is unknown
also known as 'string phlebitis', it presents as a tender cord-like
structure.
The women may present with acute pain in the lateral asepct of
breast or the anterior chest wall. A tender cord-like superficial
thrombosed vein is formed and when the skin over the breast is
stretched by raising the arm, a narrow shallow subcutaneous groove
alongside the cord becomes apparent.
rarely it may be bilateral.
Management
it's a benign self-limited disorder
The differential diagnosis is lymphatic permeation from an occult
carcinoma of breast
When the diagnosis is uncertain or a mass is present near the cord,
a biopsy may be done. Treatment
antiinflammatory drugs and warm compresses
restricted arm movements as well as brassiere support of breast
it usually resolves within 4 to 6 weeks. When symptoms persists or
are refractory to treatment, the involved vein segment may be
excised.

medpox.com
1527. Treatment of rib fracture ?
a) Immediate thoracotomy

b) IPPV

c) Analgesics

d) b and c

Correct Answer - C
Answer is 'c' i.e. Analgeic
Rib fractures are the most common injuries after blunt chest trauma.
Ribs 4 to 10 are usually fractured.
Management of # rib medpox.com
- Pain control with oral or i.v. analgesics or intercostal nerve blocks
or epidural analgesia.(Poor pain control significantly contributes to
complications such as atelectasis and pneumonia)
- Chest strapping is no longer advised.
Management of flail chest, as mentioned in previous question, may
need IPPV.
1528. Triangle of Doom is bounded by all of
the following except:
a) Cooper's ligament

b) Vas deferens

c) Gonadal vessels

d) Peritoneal reflection

Correct Answer - A
Ans is a i.e. Cooper's ligament
The triangle of doom is bounded
Medially by the vas deferens medpox.com
Laterally by the vessels of the spermatic cord (gonadal vessels)
Inferiorly by peritoneal reflection
Apex oriented superiorly at internal ring.
The contents of the space include
External iliac vessels
Deep circumflex iliac vein
Femoral nerve
Genital branch of the genitofemoral nerve
medpox.com
1529. Commonest type of anal canal carcinoma is?
a) Squamous cell carcinoma

b) Adenocarcinoma

c) Adenoacanthoma

d) Papillary type

Correct Answer - A
Squamous cell carcinoma is the most common type of anal cancer. This cancer
begins in the outer lining of the anal canal.
Mainly three types of malignant neoplasm are seen in anal canal
Squamous cell carcinoma (most common)
medpox.com
Basal cell carcinoma (2nd most common)
Melanoma
Also remember:
Most common type of rectal and colon cancer Adenocarcinoma

Ref: S. Das textbook of surgery 3/e, Page 1078.
1530. Blunt trauma chest, first step in
management after initial resuscitation is
a) CT scan

b) Angiography

c) X-ray chest

d) USG

Correct Answer - C
Answer- C. X-ray chest
First investigation of choice in any type of chest injury is chest X-ray.
medpox.com
1531. All are true about amoebic liver abscess
except:
a) More common in females

b) More common in left lobe of liver

c) Metronidazole is mainstay of treatment

d) a and b

Correct Answer - D
Ans is D
a i.e. More common in females & b i.e. More common in left lobe of
liver medpox.com
“Male preponderance of greater than 10:1 has been reported in all
studies”
The right lobe of the liver is more commonly affected than the left
lobe.
amebic liver abscess is 7-12 times more common in men than in
women, with a predominance among men aged 18-50 years.
Metronidazole 800 mg TDS for 5–10 days
Aspiration
Repeated imaging of liver
1532. False about hydatid cyst of liver:
a) Mostly asymptomatic

b) Most commonly located in right lobe of liver

c) Most common causative organism is echinococcus granulosus

d) Hepatic resection is never done

Correct Answer - D
Ans is 'd' i.e. Hepatic resection is never done
Laparoscopic aspiration, unroofing and evacuation of the hepatic
hydatid cysts can be done.
medpox.com
1533. Hemorrhage after thyroidectomy is due
to
a) External carotid artery

b) Internal carotid artey

c) Superior thyroid artery

d) Inferior thyroid artery

Correct Answer - C
Answer C. Superior thyroid artery
Is usually due to slipping of ligature on the superior thyroid artery.
medpox.com
Hematomas may cause airway compromise and must be evacuated
immediately.
1534. Foreign body aspiration in supine
position causes which of the following
parts of the lung commonly to be
affected -
a) Apical left lobe

b) Apical lobe of right lung

c) Apical part of the lower lobe

d) Posterobasal segment of left lung

Correct Answer - C medpox.com

Ans. is 'c' i.e. Apical part of right lower lobe
Right upper lobe - posterior segment
Right lower lobe - superior segment
Left lower lobe - superior segment
Right basilar segments (of lower lobe)
1535. Intralobar sequestration of lung takes
its blood supply from -
a) Internal mammary artery

b) Descending abdominal aorta

c) Pulmonary artery

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., Descending abdominal aorta
A sequestration consists of normally developed bronchioles and
medpox.com
alveoli supplied by systemic rather than pulmonary arteries.
This blood supply is from the Aorta either above or below the
diaphragm.
Mostly (approx 95%) this is from the descending thoracic aorta.
Other characteristic features of sequestration -
They occur most commonly in the lower lobes, L > R
. Lung sequestrations are of two types
1536. Dumping syndrome is due to:
a) Diarrhoea

b) Presence of hypertonic content in small intestine

c) Vagotomy

d) Reduced gastric capacity

Correct Answer - B
Answer is B (Presence of Hypertonic Contents in small intestine)
DUMPING SYNDROME refers to a syndrome of abdominal and
vasomator symptoms which results from dumping of food stuffs with
a high osmotic load, front the stomach, into the small bowel.
medpox.com
Loss of storage capacity of stomach and ablation, by pass or
destruction of pylorus, results in rapid emptying of hyperostnolar
chyme into duodenummm and small intestine. Extracellular fluid
then shifts into the intestinal lumen to restore isotonicity resulting in
decreased intravascular volume, which gives rise to the vasomotor
symptoms. Note that while reduced gastric capacity contributes,
option (b) is a more accurate answer.
Dumping Syndrome is actually of two types:
Early dumping syndrome (as described above)
Late dumping syndrome: This is Reactive hypoglvcemiae. The
carbohydrate load in thesmall intestine later causes a rise in plasma
glucose, which in turn causes insulin levels to rise causing a
secondary hypoglycemia.
1537. In case of benign mixed parotid
tumours T/t of choice is -
a) Superficial Parotidectomy

b) Total parotidectomy

c) Leave facial nerve and remove all gland

d) Radical Parotidectomy

Correct Answer - A
Ans is 'a' ie Superficial parotidectomy
Schwartz writes - "Treatment of benign neoplasms is surgical
medpox.com
excision of the affected gland or, in the case of the parotid, excision
of the superficial lobe with facial nerve dissection and preservation.
The minimal surgical procedure for neoplasms of the parotid is
superficial parotidectomy with preservation of the facial nerve.
'Shelling out' of the tumor mass is not recommended because of the
risk of incomplete excision and tumor spillage."
Superficial parotidectomy is the treatment of choice for
most benign tumors in the superficial lobe.
1538. Linitis plastica is a type of :
a) Gastric ulcer

b) Ca stomach

c) Duodenal ulcer

d) None of the above

Correct Answer - B
Linitis plastica is a type of adenocarcinoma. Adenocarcinoma is the most common
form of stomach cancer. Linitis plastica spreads to the muscles of the stomach wall
and makes it thicker and more rigid.
Linitis plastica is a subtype of gastric cancer that is characterized by diffuse infiltrating
adenocarcinoma without obvious carters and ulcers.
medpox.com
It is thought to originate from parietal cell portion of gastric mucosa.

Because of its diffuse nature ,this form of gastric cancer ususally involves the whole
stomach.

Ref : Clinical Scenarios in Surgical Oncology edited by Vijay P. Khatri
 1539. True about blind loop syndrome, all
except
a) Syndrome of bacterial overgrowth

b) Steatorrhea, mayeloblastic anemia & deficiency of fat soluble

vitamins

c) Surgery is not indicated

d) 14C-xylose or 14C-cholyglycine breath tests are indirect tests

for bacterial overgrowth

Correct Answer - C
medpox.com
Answer- C. Surgery is not indicated
Features
Diarrhea
Steatorrhea
Megaloblastic anemia (vit. B12 deficiency)
Weight loss
Abdominal pain
Fat soluble vitamin deficiency
Treatment
Parentral vit. B1, therapy
Broad spectrum antibiotics :
1. Tetracycline or co-amoxyclav
2. Cephalexin + metronidazole
3. Chloremphenical
1540. Liver transplantation was first done by
?
a) Starzl

b) Huggins

c) Carrel

d) Christian Benard

Correct Answer - A
Ans. is 'a' i.e., Starzl
The first human liver transplant was performed in 1963 by Dr.
Thomas Starzl. medpox.com
1541. % of malignancy in duct ectasia is
a) No risk

b) 1.5:1

c) 7:1

d) 10:1

Correct Answer - A
Answer- A. No risk
Duct ectasia
Cysts
Apocrine metaplasia medpox.com
Apocrine metaplasia
Mild hyperplasia
A denosis
Fibroadenoma (without atypia)
No increased risk for cancer
1542. Tissue suturing glue contains:
a) Cyanoacrylate

b) Ethanolamine oleate

c) Methacrylate

d) Polychloroprene

Correct Answer - A
Ans is 'a' i.e. Cyanoacrylate
Most tissue adhesives or glue are cyanoacrylate polymers, such as
n-butyl-2-cyanoacrylate (eg, Histoacryl®, PeriAcryl®) or 2-octyl
cyanoacrylate (eg, Dermabond®, Surgiseal).
medpox.com
Cyanoacrylate tissue adhesives are liquid monomers that undergo
an exothermic reaction on exposure to moisture (eg, on the skin
surface), changing to polymers that form a strong tissue bond. When
applied to a laceration, the polymer binds the wound edges together
to allow normal healing of the underlying tissue.
Compared with wounds closed with sutures, the tensile strength of
wounds closed by tissue adhesives is less at the time of initial
application, but equalizes by one week post-repair.
Advantages:
Less painful application, and sometimes no need for local anesthetic
injection
More rapid application and repair time
Cosmetically similar results at 12 months post-repair
Waterproof barrier
Antimicrobial properties
Better acceptance by patients
No need for suture removal or follow-up
Indications and contraindications:
For use of tissue adhesives the wound needs to be clean, dry with
near perfect hemostasis and under no tension.
Complex stellate lesions or crush injuries should not be closed with
tissue adhesives since good wound approximation is difficult to
achieve.
Tissue adhesives are not recommended for lacerations of the hands,
feet, or joints, since repetitive movements could cause the adhesive
bond to break before sufficient tensile strength is achieved.
Tissue adhesives are not recommended for the oral mucosa or other
mucosal surfaces or areas of high moisture such as the axillae and
perineum.
Lacerations involving the hairline or vermilion border require more
precision, and should be repaired with traditional sutures.

medpox.com
1543. Dysphagia lusoria is due to?
a) Esophageal diverticulum

b) Aneurysm of aorta

c) Esophageal web

d) Compression by aberrant blood vessel

Correct Answer - D
Dysphagia lusoria is a disorder of swallowing caused due to vascular anomalies and
includes:
A right aortic arch
A double aortic arch
medpox.com
A vascular constricting ring formed by a PDA or a ligamentum arteriosum and pulmonary
artery or aortic arch
An abnormal right subclavian artery
An abnormal innominate artery
Diagnosis is made by lipoidal swallow or arteriography.

Ref: Bailey and Love 24/e, Page 995

1544. Recurrent anal fistula, most appropriate
investigation is
a) Endorectal US

b) Colonoscopy

c) MRI

d) Proctoscopy

Correct Answer - C
Answer- C. MRI
MRI is most accurate investigation for determining presence and
medpox.com
course of recurrent anal fistulae.
1545. Anal fissure diagnosed by
a) TRUS

b) Colonoscopy

c) Clinical examination

d) Ba enema

Correct Answer - C
Answer- C. Colonoscopy
Anal fissure is a linear ulcer of the lower half of the anal canal, thus
can be diagnosed by visually inspecting the anal verge with gentle
separation of the gluteal cleft.
medpox.com
The history is typical of pain and bleeding with defecation
1546. 70 yr old female with bleeding from
proximal colon
a) Colitis

b) Polyp

c) Diverticulitis

d) Ca colon

Correct Answer - D
Answer- D. Ca colon
Bleeding per rectum in old age suggests the diagnosis of colorectal
carcinoma. medpox.com
Symptoms of colorectal carcinoma are non-specific and generally
develop when the cancer is locally advanced.
Symptoms vary with the anatomic location of the tumor.
Abd. pain
Anemia (microcytic hypochronic anemia indicative of iron def.)
Fatigue, palpitation and even angina pectoris
Mass in right iliac fossa
A cecal carcinoma can act as lead point in intussusception
1547. A 25 year old man presents with 3 days
history of pain in the right lower
abdomen and vomitings. patient's
general condition is satisfactory and
clinical examination reveals a tender
lump in right iliac fossa. The most
appropriate management in this case
would be
a) Immediate appendicectomy

b) Exploratory laprotomy

c) Oschner Sherren regimen

medpox.com
d) External drainage

Correct Answer - C
Ans. is 'c' i.e., Oschner Sherren regimen
The patient is presenting with typical clinical features of appendical
mass.
If an appendix mass is present and the condition of the patient is
satisfactory, the standard treatment is the conservative Ochs​ner-
Sherren regimen.
This strategy is used as the inflammatory process is already
localised and that inadvertent surgery is dificult and may be dan​‐
gerous.
It may be impossible to find the appendix and, occasionally, a faecal
fistula may form.
For these reasons, it is wise to observe a non-operative programme
but to be prepared to operate should clinical deterioration

medpox.com
1548. A 27 year old patient presented with left
sided abdominal pain 6 hours after
RTA. He was hemodynamically stable
and FAST positive. CT scan showed
grade III splenic injury. What will be
appropriate treatment
a) Splenectomy

b) Splenorrhaphy

c) Splenic artery embolization

d) Conservative management
medpox.com

Correct Answer - D
Answer- D. Conservative management
"In early reports, most investigators expressed extreme caution
regarding nonoperative management of grades III and IV, even with
hemodynamic stability. As experience has accumulated, most feel
comfortable with observing stable grade III injuries, and many have
begun observing grade IV and V injuries". --Sabiston
1549. Retraction ball seen in
a) Burns

b) Acute pancreatitis

c) Diffuse axonal injury

d) Tracheobronchial injury

Correct Answer - C
Answer- C. Diffuse axonal injury
At the distal tip of the amputated axon there is often and enlarged
ball shaped collection of cytoplasm termed a 'retraction ball'.
Axonal retraction balls- The Hallmark of Diffuse Axonal Injury.
medpox.com
1550. Prophylactic thyroidectomy is indicated
in
a) Hashimoto thyroiditis

b) MEN type 2

c) Riedel thyroiditis

d) De-Quervain's thyroiditis

Correct Answer - B
Answer- B. MEN type 2
MEN type 2 syndrome consists of medullary carcinoma thyroid, for
medpox.com
patients in low to high-risk groups, prophylactic thyroidectomy is
recommended by age 5.
Prophylactic thyroidectomy is indicated in MEN 2B syndrome.
Medullary thyroid carcinoma (MTC) can be inherited as familial
MTC, MEN 2A or MEN 2B syndromes.
These conditions are autosomal dominant and occur due to RET
proto-oncogene mutation.
Individuals with RET mutation are very likely to develop MTC at a
younger age. Once the mutation is confirmed, it is advised to
undergo prophylactic thyroidectomy.
1551. Prophylactic Thyroidectomy for MEN 2
is recommended at age of
a) 5 years

b) Before 1 year

c) When detected

d) Any time

Correct Answer - A
Answer- A. 5 years
MEN type 2 syndrome consists of medullary carcinoma thyroid, for
medpox.com
patients in low to high risk groups, prophylactic thyroidectomy is
recommended by age 5.
1552. The following is the commonest site for
venous ulcer:
March 2013 (a, e)
a) Lower third of leg and ankle

b) Instep of foot

c) Lower 2/ 3rd of leg

d) Middle 1/3rd of leg

Correct Answer - A
Ans. A i.e. Lower third of leg and ankle
medpox.com
Venous ulcers usually lie just proximal to the medial or lateral
malleolus.
Venous ulcers are accompanied by lipodermatosclerosis and
hemosiderosis (if these are not present then the ulcer is probably not
of venous origin).
1553. Cleft palate is ideally repaired at
a) 5 month of age

b) 1 year of age

c) Before going to school

d) 6-8 years of age

Correct Answer - B
Answer- B. 1 year of age
Timing of Repair of Cleft Palate
According to Sabiston - before 12 months
According to Schwartz - at 9 to 12 months of age
medpox.com
According to Bailey & Love - between 6 and 18 months
1554. Heller's myotomy is done for:
September 2007, 2009, 2010
a) Esophageal carcinoma

b) Pyloric hypertrophy

c) Achalasia cardia

d) Inguinal hernia

Correct Answer - C
Ans. C: Achalasia cardia
Achalasia is associated with loss of ganglion cells in the esophageal
myenteric plexus. medpox.com
These important inhibitory neurons induce LES relaxation and
coordinate proximal-to-distal peristaltic contraction of the esophagus
Achalasia is an esophageal motor disorder characterized by
increased lower esophageal sphincter (LES) pressure, diminished-
to-absent peristalsis in the distal portion of the esophagus composed
of smooth muscle, and lack of a coordinated LES relaxation in
response to swallowing.
Barium radiology may show 'bird's beak' appearance.
Esophageal (Heller) myotomy is a surgical procedure that is
performed with minimally invasive techniques. The laparoscopic
approach appears to be most appropriate.
1555. Radiofrequency ablation is
a) Derived from AC current

b) Used to separate fascial planes during surgery

c) Uses microwave

d) Used for hemostasis

Correct Answer - A
Answer- A. Derived from AC current
Radiofrequency ablation is a medical procedure in which part of the
electrical conduction system of the heart, tumor or other
dysfunctional tissue is ablated using the heat generation from high
medpox.com
frequency alternating current (in the range of 350-500 KHz).
 1556. Malignant melanoma false is
a) Radiosensitive

b) Surgery is the treatment of choice

c) Acral lentiginous has worst prognosis

d) Treatment is mide local excision

Correct Answer - A
Answer- A. Radiosensitive
Melanoma are among the most radioresistant tumors.
There are 4 common type of melanoma (these are in order of
decreasing frequency) medpox.com
1. Superficial spreading type (most common)
2. Nodular
3. Lentigo maligna
4. Acral lentiginous (least common)
Wide local excision of the primary tumor is the management of
choice.
[Ref Sabiston IV/Ye p. 742; Schwartz 10th/e p. 488, 490; Harrison
17thle p. 541; Chandrasoma Taylor 3rd/e p. 895]
 1557. DVT not common causes
a) Prolonged immobilizationa

b) Extensive pelvic sx of > 30 minutes

c) Obesity

d) Age less than 40

Correct Answer - D
Answer- D. Age less than 40
A) Venous Thrombosis
1. Inherited : Factor V Leiden (Leiden factor), antithrombin III
deficiency, Protein S deficiency, Protein C deficiency.
medpox.com
2. Acquired : Old age, immobilization, prolonged bed rest, major
surgery (e.g orthopaedics hip surgery), major trauma, pregnancy
and pureperium, obesity, infection.
B) Both arterial and venous thrombosis
1. Inherited : Homocystinuria/homomtinemia, dysfibrinogenemia.
2. Acquired : Malignancy, antiphospholipid syndrome (lupus
anticoagulant), hormonal therapy (estrogen component of DCPs),
polycythemia, PNH, DIG.
1558. Fogarty's catheter is used for
a) Embolization

b) Embolectomy

c) Radiofrequency ablation

d) Angiography

Correct Answer - B
Answer- B. Embolectomy
Fogarty's catheter is an embolectomy catheter indicated for the
removal of fresh, soft emboli and thrombi from vessels in the arterial
system. medpox.com
The Fogarty embolectomy catheter has been found useful in
minimizing blood loss in large surgical procedures about the hip and
pelvis. Its utility lies in the ability to achieve temporary intraluminal
occlusion of the common iliac artery while the proposed surgical
procedure is being carried out.
1559.

medpox.com
Aganglionic segment is encountered in which
part of colon in case of Hirschsprung disease
?
a) Distal to dilated segment

b) In Whole colon

c) Proximal to dilated segment

d) In the dilated segment

Correct Answer - A
Ans. is 'a' i.e., Distal to dilated segment
medpox.com
Congenital aganglionic megcolon (Hirschsprung disease)
o Hirshsprung disease a congenital disorder characterized by
aganglionosis of a portion of the intestinal tract.
o An intestinal segment lacks both Meissner submucosal and
Auerbach myenteric plexuses. This leads to func​tional obstruction
and intestinal dilation Proximal to the affected segment.
o Histological findings are :-
(i) Absence of ganglion cells and ganglia in the muscle wall and
submucosa of the affected segment.
(ii) Thickening and hypertrophy of nerve trunk.
o Rectum is always affected with involvement of more proximal
colon to variable extent --> most cases involve the rectum and
sigmoid only.
o Proximal to the aganglionic segment, the colon undergoes
progressive dilation and hypertrophy. o With time, the proximal
innervated colon may become massively distended --> megacolon.
1560. "Cork screw appearance" is
characteristic of?
a) Carcinoma esophagus

b) Hypertrophic pyloric stenosis

c) Diffuse esophageal spasm

d) Sigmoid volvulous

Correct Answer - C
Diffuse esophageal spasm REF: Wofganag 5th e p. 846/748
Sign Disease
Rat tail appearance medpox.com
Carcinoma esophagus
Bird beak appearance Achalasia
Beak sign/ double track/ tram track Hypertrophic pyloric stenosis
Medusa head colonies on CT Round worm
Pincer/claw/coiled spring/target/
Intussception
meniscus sign
Coffee bean sign Sigmoid volvulous
Lead pipe appearance Ulcerative colitis
String of kantor/bull's eye Chron's disease
Thumb printing sign Ischemic colitis
Saw tooth appeance on barium
Diverticulosis
enema
Apple core sign Carcinoma colon
Cork screw appearance Diffuse esophageal spasm
String sign Hypertrophic pyloric stenosis
1561. Choledochal cyst is dilatation of
a) Gall bladder

b) CBD

c) Hepatic duct

d) Bile duct

Correct Answer - D
Answer- D. Bile duct
A choledochal cyst is an isolated or combined congenital dilatation
of the extrahepatic or intrahepatic biliary tree.
medpox.com
 1562. False about retroperitoneal fibrosis is
a) Ureter is most commonly involved

b) More common in females

c) Primary idiopathic form is called ormond's disease

d) Corticosteroids are mainstay of treatment

Correct Answer - B
Answer- B. More common in females
RETROPERITONEAL FIBROSIS (ORMOND’S DISEASE)
RPF is an uncommon inflammatory condition characteristed by
proliferation of fibrous tissue in the retroperitoneum.
medpox.com
The major structure involved are-
1. Ureter - Most commonly involved
2. Aorta
3. Inferior venacava
Corticosteroids, with or without surgery, are the mainstay of medical
therapy.
 1563. Most commonly affected in ormond's
disease
a) Aorta

b) IVC

c) Ureter

d) Gonadal vessels

Correct Answer - C
Answer- C. Ureter
The major structure involved are-
medpox.com
1. Ureter - Most commonly involved
2. orta
3. Inferior venacava
1564. Mucocele of gall bladder, false
statement is
a) Complication of gall stones

b) Treatment is early cholecystectomy

c) Obstruction at neck of gall bladder

d) Gall bladder is never palpable

Correct Answer - D
Answer- D. Gall bladder is never palpable
It is one of the complications of Gall stones.
medpox.com
Caused due to obstruction of the stone at the neck of the bladder.
The t/t is early cholycystectomy.
1565. Which of the following is not a sign
seen in acute apendicitis
a) Rovsing's

b) Rosenstein's sign

c) Boa's sign

d) Hamburger sign

Correct Answer - C
Ans. is 'C'
Accessory signs of appendicitis
medpox.com
Aure-Rozanova's sign: Increased pain on palpation with finger in
right Petit triangle (can be a positive Shchetkin-Bloomberg's).
Bartomier-Michelson's sign: Increased pain on palpation at the
right iliac region as the person being examined lies on his or her left
side compared to when he/she lies on the back.
Dunphy's sign: Increased pain in the right lower quadrant with
coughing.
Hamburger sign: The patient refuses to eat (anorexia is 80%
specific for appendicitis)
Kocher's (Kosher's) sign: From the person's medical history, the
start of pain in the umbilical region with a subsequent shift to the
right iliac region.
Massouh sign: Developed in and popular in southwest England, the
examiner performs a firm swish with his or her index and middle
finger across the abdomen from the xiphoid process to the left and
the right iliac fossa. A positive Massouh sign is a grimace of the
person being examined upon a right sided (and not left) sweep.
Obturator sign: The person being evaluated lies on her or his back
with the hip and knee both flexed at ninety degrees. The examiner
holds the person's ankle with one hand and knee with the other
hand. The examiner rotates the hip by moving the person's ankle
away from his or her body while allowing the knee to move only
inward. A positive test is pain with internal rotation of the hip.
Psoas sign, also known as "Obraztsova's sign", is right lower-
quadrant pain that is produced with either the passive extension of
the right hip or by the active flexion of the person's right hip while
supine. The pain that is elicited is due to inflammation of the
peritoneum overlying the iliopsoas muscles and inflammation of the
psoas muscles themselves. Straightening out the leg causes pain
because it stretches these muscles, while flexing the hip activates
the iliopsoas and causes pain.
Rovsing's sign: Pain in the lower right abdominal quadrant with
continuous deep palpation starting from the left iliac fossa upwards
(counterclockwise along the colon). The thought is there will be
increased pressure around the appendix by pushing bowel contents
and air toward the ileocaecal valve provoking right-sided abdominal
pain.
Sitkovskiy (Rosenstein)'s sign: Increased pain in the right iliac
medpox.com
region as the person is being examined lies on his/her left side
1566. Investigation of choice for 74 yr old
male patient scanty bleeding per rectum
irregular bowel habits
a) Sigmoidoscopy

b) Barium enema

c) Colonoscopy

d) Barium meal follow through

Correct Answer - B
Answer- B. Barium enemamedpox.com
The clinical features suggest diagnosis of diverticulosis.
They are mainly found in the colon (mainly the left side of colon) with
sigmoid colon being the most common site.
Colonic diverticulosis is best diagnosed by Barium enema.
1567. Obstruction and dilatation of large
intestine in absence of any mechanical
obstruction
a) Ogilve syndrome

b) Hirschsprung disease

c) Chagas disease

d) None

Correct Answer - A
Answer- A. Ogilve syndrome medpox.com
Ogilvie syndrome, or acute colonic pseudo-obstruction (ACPO), is a
clinical disorder with the signs, symptoms, and radiographic
appearance of an acute large bowel obstruction with no evidence of
actual physical cause of the obstruction.
1568. Thyroid nodule increased radioisotope
uptake IOC is
a) Biopsy

b) Thyroid scan

c) FNAC

d) None

Correct Answer - C
Answer- C. FNAC
isotope scanning a thyroid nodule can be 'hot, 'warm' or 'cold'.
medpox.com
FNAC is the investigation of choice for solitary thyroid nodule.
1569. The tendency of colonic carcinoma to
metastasize is best assessed by -
a) Size of tumor

b) Carcinoembryonic antigen (CEA) levels

c) Depth of penetration of bowel wall

d) Proportion of bowel circumference involved.

Correct Answer - C
Ans. is c) i.e. depth of penetration of bowel walls
Schwartz writes
medpox.com
"Regional lymph node involvement is the most common form of
spread of colorectal carcinoma and usually preceeds distant
metastasis or the development of carcinomatosis. the T stage (depth
of invasion) is the single most significant predictor of lymph node
spread."
From the above given lines 'depth of penetration of bowel wall'
appears to be predictor of distant metastases as well.
CEA level is a marker for recurrance of colorectal ca after surgical
resection.
Though its preoperative levels has some prognostic significance, it is
not a predictor for distant metastasis.
CEA level is used to follow up post operative cases of colorectal
cancer, for early detection of recurrance.
1570. What is intussuscepiens
a) The entire complex of intussusception

b) The entering layer

c) The outer layer

d) The process of reducing the intussusception

Correct Answer - C
Answer- C. The outer layer
An intussusception is composed of three parts :
The entering or inner tube - intussusceptum
The returning or middle tubemedpox.com
The sheath or outer tube - intussuscipiens
1571. Gum tumor with 5 cm in dimension and
contralateral lymph node enlargement
of 2 cm. There is no distant metasis.
The stage of tumor :
a) T3N2M0

b) T2N2M0

c) T1N2Mo

d) T3N3M0

Correct Answer - A medpox.com

Answer- A. T3N2M0
TNM STAGING OF ORAL CARCINOMA
Primary tumor, as follows:
T0 - No primary tumor
Tis - Carcinoma in situ
T1 - Tumor 2 cm or smaller
T2 - Tumor 4 cm or smaller
T3 - Tumor larger than 4 cm
T4 - Tumor larger than 4 cm and deep invasion to muscle, bone, or
deep structures (eg, antrum)
Lymphatic node involvement, as follows:
N0: No regional lymph node metastasis
N1: Metastasis in a single ipsilateral lymph node
N2a: Metastasis in a single ipsilateral lymph node >3 cm but not > 6
cm
N2b: Metastasis in multiple ipsilateral lymph nodes, none >6 cm in
greatest dimension
N2c: Metastasis in bilateral or contralateral lymph nodes, none >6
cm in greatest dimension
N3: Metastasis in any lymph node >6 cm
Tumor metastasis(M), as follows:
M0 - No metastasis
M1 - Metastasis noted
Staging
Stage I : T1, N0, M0.
Stage II : T2, N0, M0.
Stage III :
T3, N0, M0
T1, T2, T3, N1, M0
Stage IV :
T4, N0, M0
Any T, N2 or N3, M0
Any T, any N, any M

medpox.com
1572. Which is M.C. site for iatrogenic
oesophageal perforation -
a) Abdominal portion

b) Cervical portion

c) Above arch of aorta

d) Below arch of aorta

Correct Answer - B
Ans is 'b' ie Cervical portion
Oesophageal perforation is of two types
Iatrogenic (MC) : medpox.com
- Common site is cervical esophagus Just above the upper
sphinctcr.
Spontaneous rupture : as seen in Boerhaaves syndrome (Rupture of
esophagus after vomitting)
- common in the lower 1/3 of esophagus.
1573. The most common type of Tracheo-
Oesophageal Fistula is -
a) Esophageal atresia without tracheoesophageal fistula

b) Esophageal atresia with proximal tracheoesophageal fistula

c) Esophageal atresia with distal tracheoesophageal fistula

d) Esophageal atresia with proximal and distal fistula

Correct Answer - C
Ans. is 'c' i.e., Esophageal atresia with distal
tracheoesophageal fistula
medpox.com
TEF is classified into five types based on presence of esophageal
atresia and location of fistula:?
1) Type A : There is esophageal atresia without TEF. There is no
gas in abdomen. It is 2'd most common type.
2) Type B : There is proximal TEF. There is no gas in abdomen.
3) Type C : There is proximal esophageal atresia with distal TEF.
Gas in abdomen is present. It is most common.
4) Type D : Both proximal and distal fistula are present. Gas in
abdomen is present. It is least common.
5) Type E : Isolated TEF (H or N type) is there.
1574. Flap commonly used in breast
reconstruction is?
a) Serratus anterior

b) TRAM

c) Flap from arm

d) Delto pectoral flap

Correct Answer - B
Ans. is 'b' i.e. TRAM
(Most common) Single Pedicle Double Pedicle Free flap
medpox.com
Deep inferior epigastric perforator flap
1575. Most common cause of duodenal
obstruction in adults
a) Lymphoma

b) Ca pancreas

c) Ca liver

d) Ca gall bladder

Correct Answer - B
Answer- B. Ca pancreas
Most common cause of duodenal obstruction (gastric outlet
medpox.com
obstruction) in adults → Peptic ulcer disease.
Most common cause of gastric outlet obstruction → Pyloric stenosis
Most common cancer causing duodenal obstruction → Pancreatic
cancer.
1576. Most common cause of small intestine
obstruction is?
a) Intussception

b) Idiopathic adhesions Tumors

c) Tumors

d) Postoperative adhesions

Correct Answer - D
Postoperative adhesions REF: Bailey & Love 25th edition page
1188, http://emedicine.medscape.com/article/774140​overview
medpox.com
"The most common cause of small-bowel obstruction (SBO) is
postsurgical adhesions"
The most common causes of intestinal obstruction in adults are:
Intestinal adhesions — bands of fibrous tissue in the abdominal
cavity that can form after abdominal or pelvic surgery
In children, the most common cause of intestinal obstruction is
telescoping of the intestine (intussusception).
1577. M.C. site of CA oesophagus is -
a) Middle 1/3rd

b) Upper 1/3rd

c) Lower 1/3rd

d) Lower end of esophagus

Correct Answer - A
Ans is (a) ie Middle 1/3rd
Well, I am not quite sure of the answer.
Esophageal Carcinoma is of two common histological types
i) Squamous cell Ca - the MC type in world (-95% according to
medpox.com
Sabiston)
ii) Adenocarcinoma - where incidence is increasing at a rapid
rate and is now the MC type in USA (Ref. Harrison, Schwartz)
Distribution of Squamous Cell Ca.
Upper 1/3 10%
Middle 113 60%
Lower 1/3 30%
Adenocarcinoma is mainly located in lower 1/3.
Nowhere, I could get the MC site of esophageal carcinoma overall
(including both squamous and adeno variety). [Harrison writes the
MC site to be lower 1/3, but it gives incidence for US population
only, not for the whole world]
But one thing is sure - squamous cell Ca is the MC type of
esophageal cancer in world [(Ref: Bailey & Love, 25/e p1026 (24/e
p1009); Robbins 8/e p772 (7/e p806); Sabiston I8/e p1090 (I7/e
p1118)]
So I presume that the overall MC site would be the MC site involved
by the MC type of esophageal cancer i.e. -* Middle 1/3
So remember
MC type of esophageal Ca in world -> Squamous Cell Ca (--95%)
MC site -> Middle 1/3

medpox.com
1578. Case of diagnosed cholecystitis
presentation acute pain sharp going to
the back diagnosis
a) Acute pancreatitis

b) Cholecystitis

c) Appendicitis

d) Aortic aneurysm

Correct Answer - A
Answer- A. Acute pancreatitis
medpox.com
Clinical features-
Acute severe, refractory, upper abdominal pain radiating to back
Some patients may gain relief by sitting or leaning forwards
Icterus can be caused by biliary obstruction in gallstone pancreatitis
Grey turner's sign – bluish discolouration of the flanks
Cullen's sign – bluish discoloration around umbilicus
Fox sign – discoloration below inguinal ligament
Shock, acute renal failure, ARDS, MODS
Left sided pleural effusion
1579. Man presented with acute abdomen,
when man was put in knee chest
position helped to relieve the pain what
might be the cause.
a) Acute pancreatitis

b) Cholecystitis

c) Superior mesenteric artery ischemia

d) Renal

Correct Answer - A medpox.com

Answer- A. Acute pancreatitis
Acute severe, refractory, upper abdominal pain radiating to back
Some patients may gain relief by sitting or leaning forwards
Icterus can be caused by biliary obstruction in gallstone pancreatitis
Grey turner's sign – bluish discolouration of the flanks
Cullen's sign – bluish discoloration around umbilicus
Fox sign – discoloration below inguinal ligament
Shock, acute renal failure, ARDS, MODS
Left sided pleural effusion
1580. Man gunshot wound in thorax chest
tube 1900 ml blood, 200 ml of blood lost
per hr. next step
a) Blood transfusion

b) Thoracotomy

c) PPV

d) FFP

Correct Answer - B
Answer- B. Thoracotomy medpox.com
Initial drainage of more than 1500 ml blood or on going hemorrhage
of more than 200 ml/hr over 3-4 hours is generally con¬sidered an
indication for thoracotomy.
1581. Most common cause of acute abdomen
in young girl
a) Acute appendicitis

b) ovarian torsion

c) Mitzschmerz

d) Renal colic

Correct Answer - A
Answer- A. Acute appendicitis
Most common cause of acute abdomen in yound women is acute
appendicitis. medpox.com
Other causes are intestinal obstruction, diverticulitis, adnexal torsion,
ovarian cyst rupture/hemorrhage, PID, endometriosis and
dysmenorrhea.
1582. Lateral border of tongue carcinoma
after resection
a) Chemotherapy

b) Radiotherapy

c) Observation

d) Neck dissection

Correct Answer - D
Answer- D. Neck dissection
If regional lymphnodes are involved- Modified radical neck
medpox.com
dissection or selective neck dissection is done.
Indications for postoperative radiation therapy include evidence of
perineural or angiolymphatic spread or positive nodal disease.
1583. Commonest cause of pyogenic liver
abscess ?
a) Stricture of CBD

b) Biliary Colic

c) Appendicitis

d) Sigmoid Diverticulitis

Correct Answer - A
Ans is 'a' ie Stricture of CBD
Most common route of infection to liver is along the bile duct. It may
be due to : - medpox.com
i) Stone impacted in CBD.
ii) Benign or malignant stricture of CBD.
Most common infecting organisms are E.coli and Klebsiella
pneumonia
1584. Following is least common about
angiodyplasia of colon -
a) Involvement of cecum

b) Involvement of rectum in 50% of cases

c) Affecting age group > 40 yrs.

d) Cause of troublesome lower G.I. hemorrhage

Correct Answer - B
Ans. is 'b' i.e., Involvement of rectum in 50% cases
Site: Occur most commonly in the ascending colon and caecum;
medpox.com
however they can also occure in rest of colon and small bowel.
Clinical features
Anemia - most common presentation
Hemoatochezia
Malena
There is an association with aortic stenosis (heyd's syndrome).
1585. Curlings ulcer is seen in -
a) Burn patients

b) Patients with head injuries

c) Zollinger Ellison syndrome

d) Analgesic drug abuse

Correct Answer - A
Ans. is 'a' i.e., Burn patients
Curling ulcers: are stress ulcers associated with burns and most
commonly found in the first part of duodenum.
medpox.com
1586. Decubitus ulcer is
a) Venous ulcer

b) Wet gangrene

c) Trophic ulcer

d) Post thrombotic ulcer

Correct Answer - C
Aswer- C. Trophic ulcer
Trophic ulcers are neurogenic ulcers which are caused by various
factors such as impairment of nutrition of the tissues, inadequate
blood supply and neurological deficit.
medpox.com
 1587. Maximum weight reduction is by which
surgery
a) BPD

b) Roux en Y gastric bypass

c) Sleeve gastrectomy

d) Gastric banding

Correct Answer - A
Answer- A. BPD
Mixed procedures
medpox.com
1. Gastric bypass (Roux en Y gastric bypass)
2. Sleeve gastrectrney with duodenal snitch
3. Implantable gastric stimulation
In general malabsorptive procedures lead to more weight loss than
restrictive procedures however morbidity risks are greater.
Studies have shown that it is maximum with Biliopancreatic diversion
(BPD).
1588. Most common organism associated
with breast abscess
a) Streptococcus

b) Staphylococcus aureus

c) Klebsiella

d) None

Correct Answer - B
Answer- B. Staphylococcus aureus
Staphylococcus aureus is the most common cause of breast
abscess. medpox.com
Most are caused by S. aureus and, if hospital-acquired, are likely to
be penicillin-resistant.
Staphylococcus aureus causes the clotting of milk in the
blocked duct and multiply. Duct initially gets blocked by
epithelial debris or by the retracted nipple.
 1589. All is true about skull fracture except
a) Puppes rule gives the sequence of fracture

b) Pond fracture is a mild depressed fracture

c) Fissured fracture is most common

d) Skull fractures are due to traction

Correct Answer - B
Answer- B. Pond fracture is a mild depressed fracture
Types of Skull fracture-
1. Linear or fissured fracture: are the most common skull fractures.
2. Depressed Fracture medpox.com
3. Comminuted fracture
4. Pond or indented fracture- This is a simple dent of the skull,
occurring only in skull of infants, for eg. in oblique bullet wounds.
5. Gutter fractures
6. Ring or foramen fractures
Puppe's rule
It help to assess the chronological order in which fracture were
formed, since later fractures will typically stop at previously formed
ones.
1590. Hunterian perforators are seen in ?
a) Upper thigh

b) Lower thigh

c) Calf

d) Mid thigh

Correct Answer - D
Ans. is 'd' i.e., Mid thigh
Mid-thigh (Mid-hunter) - Adductor canal- Great saphenous with
femoral
Hunter perforator (Hunterian perforator or adductor canal perforator)
medpox.com
is seen in mid thigh.
1591. A patient with external hemorrhoids develops pain while passing stools.
Which of the following nerve mediating this pain?

a) Pudendal nerve

b) Hypogastric nerve

c) Sympathetic plexus

d) Splanchnic visceral nerve

Correct Answer - A
External hemorrhoids are covered by the mucous membrane of the lower half of the anal
canal or the skin, and they are innervated by the inferior rectal nerves. Inferior rectal nerve
is a branch of pudendal nerve. Lower half of anal canal is sensitive to pain, temperature,
touch, and pressure.
medpox.com
The pectinate line indicates the level where the upper half of the anal canal joins the lower
half.
The mucous membrane of the upper half is sensitive to stretch and is innervated by
sensory fibers that ascend through the hypogastric plexuses.
The involuntary internal sphincter is supplied by sympathetic fibers from the inferior
hypogastric plexuses.
The voluntary external sphincter is supplied by the inferior rectal nerve, a branch of the
pudendal nerve and the perineal branch of the fourth sacral nerve.
1592. Cecum forms the posterior wall of
which hernia
a) Sliding hernia

b) Rolling hernia

c) Incisional hernia

d) Hiatus hernia

Correct Answer - A
Answer- A. Sliding hernia
Sliding hernia is defined as any hernia in which part of the sac
medpox.com
(usually the posterior) is formed by the wall of a viscus.
Cecum is involved on the right side and sigmoid colon is involved on
left side.
It should be clearly understood that the caecum, appendix or part of
colon wholly within a hernial sac does not constitute a sliding hernia
(The viscera must form a wall of the sac to be termed as sliding
hernia).
[Ref: Bailey & Love 26th/e p. 956]
1593. In last decade, duodenal ulcer and its
morbidity is reduced due to
a) Life style modification

b) Eradication of H pylori

c) Proton pump inhibitors

d) None

Correct Answer - C
Answer- C. Proton pump inhibitors
In last decades, with the introduction of proton pump inhibitors and
medpox.com
increased knowledge of perforated pectic ulcer (PPU) etiology the
incidence of PPU has reportedly decreased in western countries.
1594. Posterior duodenal ulcer is related to
a) Gartoduodenal artery

b) Spleenic artery

c) Left gastric Artery

d) Sup mesentric artery

Correct Answer - A
Answer- A. Gartoduodenal artery
Gastroduodenal artery is the most common artery involved in
duodenal ulcer haemorrhage.
Also remember medpox.com
Peptic ulcer is the most common cause of massive upper
gastrointestinal bleed (Duodenal ulcers > Gastric ulcer)
1595. Postion in surgery for pilonidal sinus
a) Sim's

b) Tredelenberg

c) Lithotomy

d) Jack knife

Correct Answer - D
Answer- D. Jack knife
For most procedures, patient is placed in prone jack knife position
with slight trendelenburg.
Jack knife position medpox.com
An anatomical position in which the patient is placed on the stomach
with the hips flexed and the knees bent at a 90° angle and the arm
outstretached in front of the patient.
1596. Length of flexible sigmoidoscope
a) 30 cm

b) 40 cm

c) 60 cm

d) 70 cm

Correct Answer - C
Answer- C. 60 cm
The length of rigid sigmoidoscope is 25 cm, where as flexible
sigmoidoscope are 60 cm long.
[Ref Bailey & Love 25th/e p.1221; www.medicinenet.com]
medpox.com
1597. True about reactionary hemorrhage
following surgery:
UP 10
a) Hemorrhage occurring within 48 h

b) Hemorrhage occurring within 36 h

c) Hemorrhage occurring within 24 h

d) Hemorrhage occurring during surgery

Correct Answer - C
Ans. Hemorrhage occurring within 24 h
medpox.com
Hemorrhage according to the Time of appearance can be classified
as belows
Primary hemorrhage
Is one which occur at the time of injury or operation.
Reactionary hemorrhage
In majority of cases reactionary occur within 4 to 6 hours. Such
bleeding may also occur due to:
Restlessness
Coughing
Vomiting with raises the venous pressure
Secondary hemorrhage
This occurs usually after 7 to 14 days of injury or operation.
This is usually due to infection and sloughing of a part of the arterial
wall.
1598. In breast carcinoma metastasis,
prognosis depends best upon -
a) Estrogen receptor status

b) Axillary lymphnode status

c) Size of tumour

d) Site of tumour

Correct Answer - A
Ans is 'a' i.e., Estrogen receptor status
In case of metastasis, the prognosis no more depends upon the
lymph node status. medpox.com
The lymph node status is the most important prognostic indicator for
tumor localized to breast, as the presence of nodal metastasis
implies systemic dissemination of cancer and hence a bad
prognosis. But once a metastasis is discovered, the lymph node
status is of little significance. Metastatic disease confers the breast
tumor TNM stage IV status, with worst prognosis. Currently stage IV
diseases are not curative.
Schwartz 9/e writes - "Treatment for stage IV breast cancer is not
curative, but may prolong survival and enhance a women's quality of
life. Hormonal therapies that are associated with minimal toxicity are
preferred to cytotoxic chemotherapy. Appropriate candidates for
initial hormonal therapy include women with hormone receptor-
positive cancers; women with bone or soft tissue metastasis only;
and women with limited and asymptomatic visceral metastasis.
About hormone receptors, CSDT 11/e, p 329 writes - "the presence
or absence of estrogen and progesterone receptors in the cytoplasm
of tumor cells is of paramount importance in managing all patients
with breast cancer, especially those with recurrent or metastatic
disease. They are of proved value in determining adjuvant therapy
and therapy for patients with advanced disease. Upto 60% of
patients with metastatic breast cancer will respond to hormonal
manipulation if their tumors contain estrogen receptors. However
fewer than 5% of patients with metastatic ER-negative tumors can
be successfully treated with hormonal manipulation."

medpox.com
1599. Charcot's triad is defined by all of the
following except:
September 2007, March 2009
a) Fever

b) Gall stones

c) Jaundice

d) Pain

Correct Answer - B
Ans. B: Gall stones medpox.com
Cholangitis is due to partial or complete obstruction of the biliary tree
with resulting bile stasis and secondary bacterial or microbial
infection of the biliary tree
Causes ?
Common bile duct stones
Benign biliary stricture (primary sclerosing cholangitis)
Malignancy (head of pancreas adenocarcinoma, ampulla of Vater,
bile duct tumors)
Chronic pancreatitis
Prosthesis or stents in the common bile duct
Features:
Charcot's triad - right upper quadrant pain, fever, jaundice
Reynolds' pentad - right upper quadrant pain, fever, jaundice,
hypotension, and mental status changes (delirium, anxiety, and
coma)
Nausea and/or vomiting
Right upper quadrant tenderness (mild to moderate)
1600. Hernia common in children
a) Umbilical

b) Bockdelac

c) Morgagni

d) Inguinal

Correct Answer - A
Answer- A. Umbilical
"Congenital umbilical hernias represent the most common
abdominal wall defect in infant and children".
The incidence of umblical hernias is 5-10% in white children and
medpox.com
may be as high as 25-50% in black children.
1601. Gangrene not caused by
a) Frost bite

b) Burger's disease

c) Varicose veins

d) Atherosclerosis

Correct Answer - C
Answer- C. Varicose veins
Important causes of gangrene
Diabetes
PVD (Buerger's disease) medpox.com
Trauma
Obesity
Atherosclerosis
Raynaud's disease
Frostibite
1602. Bilateral breast carcinoma
a) Invasive lobular

b) Infiltractive ductal

c) Ductal ca in situ

d) None

Correct Answer - A
Answer- A. Invasive lobular
Lobular carcinoma (invasive) is frequently bilateral.
Histologic hallmark : pattern of single infiltrating tumor cells often
only one cell in width or in loose clusters or sheets.
medpox.com
Signet ring cells common. Lobular carcinoma have a different
pattern of metastasis compared to other breast cancers.
1603. Most common conotruncal anomaly
a) TGA

b) Tetralogy of fallot

c) Truncus arteriosus

d) Double oulet right ventricle

Correct Answer - A
Answer- A. TGA
Conotruncal defects are abnormalities of outflow tract septation or
ectomesenchymal tissue migration abnormalities.
Most common conotructal defect is transposition of great arteries
medpox.com
(TGA).
 1604. Fallot physiology includes all except
a) TOF

b) Eisenmenger complex

c) TGA

d) Tricuspid atresia

Correct Answer - B
Answer- B. Eisenmenger complex
These includes
1. TOF
2. Single ventricle with PS medpox.com
3. TGA with VSD & PS
4. Corrected TGA with VSD & PS
5. TA
6. Double outlet right ventricle with PS
 1605. True about Ebstein anomaly is?
a) Right ventricular dilatation

b) Right atrial dilatation

c) Left ventricular dilatation

d) Left atrial dilatation

Correct Answer - B
Ans. is 'b' i.e., Right atrial dilatation
Ebstein's anomaly
Ebstein anomaly consists of downward displacement of an abnormal
tricuspid valve into the right ventricle. o Normally tricuspid valve has
medpox.com
three leaflets Anterior, posterior and septal.
Fixed end of these leaflets is attached to valve ring in tricuspid area.
In Ebstein anomaly, anterior leaflet is attached to valve ring as
normal, but the other two leaflets (posterior and septal) are
displaced downward and are attached to the wall of left ventricle.
The portion of right ventricle above he tricuspid valve becomes a
part of right atrium —÷ atrialized right ventricle. Hemodynamics
The tricuspid valve anomaly results in obstruction of blood flow as
well as regurgitation of blood from the right ventricle into the right
atrium → Dilatation and hypertrophy of right atrium due to volume
overload.
Blood flows right atrium to left atrium through patent foramen ovale
or ASD → Right to left shunt and cyanosis. Clinical manifestations
1. Cyanosis → Fatigue
2. Dyspnea on exertion → Paroxysmal attacks of tachycardia Signs
3. Cyanosis and clubbing → S., wider split but variable
4. Dominant V wave on JVP. → Right ventricular S3
5. Systolic thrill at the left sternal border → Right atrial S4.
Si normal
Systolic murmur due to regurgitation at tricuspid valve.
Delayed diastolic murmur due to obstruction at tricuspid valve like
tricuspid stenosis.
Both systolic and diastolic murmur produced at the tricuspid valve
have scratchy character like pericardial friction rib.

medpox.com
1606. Most common ASD is ?
a) Ostium primum

b) Patent foramen ovale

c) Ostium secondum

d) Sinus venosus

Correct Answer - C
Ans. is 'c' i.e., Osteum secondum
ASD can occur in any portion of atrial septum -
Secundum
Primum medpox.com
Sinus venosus
Absent atrial septum (leads to single atrium)
Ostium secondum defect
Defect in region of fossa ovalis
Most common form of ASD
 1607. Most common cardio vascular
abnormality in down syndrome is ?
a) VSD

b) Endocardial cushion defect

c) TOF

d) COA

Correct Answer - B
Ans. is 'b' i.e., Endocardial cushion defect
About 40% of down syndrome have CHD.
medpox.com
Endocardial cushion Atrio ventricular septal defect account for 40-
60% of cases.
Other feature in down syndrome.
Hypotonia, flat face, upward and slanted palpebral fissures and
epicanthic folds, speckled irises (Brushfield spot);varying degrees of
mental and growth retardation;dysplasia of the pelvis, cardiac
malformations, and simian crease;short, broad hands, hypoplasia of
middle phalanx of 5th finger, duodenal atresia, and high arched
palate;5% of patients with Down syndrome are the result of a
translocation-t(14q21q), t(15q21q), and t(13q21q)-in which the
phenotype is the same as trisomy 21.
Other feature ?
1. Duodenal atresia
2. Annular pancreas
3. Tracheoesophageal fistula
4. Hirschsprung disease
5. Short stature
6. Short sternum
7. Brachycephaly
 8. Delayed fontanel closure
9. Three fontanels
10. Frontal sinus hypoplasia
11. Peripheral joint laxity
12. Atlantoaxial instability (C1-C2 subluxation)
13. Exaggerated space between
14. Mottled skin in infancy
15. Dry coarse skin in adolescence 1st and 2nd toes
Increased Risk for Development of -
Leukemia:AML, ALL
Myelodysplasia
Transient lymphoproliferative syndrome
Celiac disease
Hypothyroidism
Diabetes mellitus
Obesity
Refractive errors
Strabismus
Mitral valve prolapse medpox.com
Conductive and/or
Obstructive sleep apnea
Epilepsy sensorineural hearing loss
ADHD
Alzheimer disease
Conduct oppositional disorders
1608. Figure of 8 in chest X-ray ?
a) Supracardiac TAPVC

b) Tetralogy of fallot

c) TGA

d) None of above

Correct Answer - A
Ans. is 'a' Supracardiac TAPVC
Tertralogy of fallot—* boot shaped heart
Transposition of great vessel-* egg on side
TPVC (supracardioe) --> snownan or figure of 8 configuration
medpox.com
1609. Large PDA leads to ?
a) Endocardial valvulitis

b) Eisenmenger syndrome

c) CHF

d) All of above

Correct Answer - D
Ans. is 'd' i.e., All of above
Patent ductus arteriosus (PDA)
Small PDA may not cause any complication but large defect if
untread may leads to : medpox.com
Pulmonary hypertension Left to Right shunt leads to too much
circulation of blood in lung which leads to pulmonary hypertension.
Eisenmenger's syndrome - Large standing pulmonary hypertension
leads to permanent lung damage and causes Right to Left shunt.
Endocarditis.
Arrhythmia Enlargement of heart due to PDA increase risk of
arrhythmias
1610. Drug used in congenital heart disease
to keep PDA patent
a) PGEi

b) PGE2

c) PGI2

d) Indomethacin

Correct Answer - A
Ans. is 'a' i.e., PGE,
Prostaglandin El (PGE1) infusion usually effective in keeping the
medpox.com
ductus arteriosus open before surgical intervention to reduce
hypoxemia and acidemia before surgery in ductus dependent lesion
like.
Pulmonary atresia
TOF with severe PS
TOF with pulmonary atresia
Transposition of great arteries with VSD and PS
Indomethacin is used for ductal closure
1611. PDA true is all except ?
a) More common in preterm baby

b) Left to right shunt

c) Acyanotic congenital heart disease

d) More common in term baby

Correct Answer - D
Ans. is 'd i.e., More common in term baby
During fetal life, most of the pulmonary arterial blood is shunted
through the ductus arteriosus into the aorta .
Functional closure of the ductus normally occurs soon after birth, but
medpox.com
if the ductus remains patent when pulmonary vascular resistance
falls, aortic blood is shunted into the pulmonary artery.
The aortic end of the ductus is just distal to the origin of the left
subclavian artery, and the ductus enters the pulmonary artery at its
bifurcation
Female patients with PDA outnumber males 2 : 1.
PDA is also associated with maternal rubella infection during early
pregnancy.
It is a common problem in premature infants, where it can cause
severe hemodynamic derangements and several major sequelae
1612. Pulmonary plethora is seen with - all
except
a) TGA

b) Hypoplastic left heart syndrome

c) Ebstein anomalis

d) Double outlet right ventricle

Correct Answer - C
Answer- C. Ebstein anomalis
Pulmonary oligamia
TOF medpox.com
TA
Ebstein's anomaly
Pulmonary atresia
1613. Major criteria for rheumatic fever - AJE
a) Carditis

b) Arthralgia

c) Erythema marginatum

d) Subcutaneous nodule

Correct Answer - B
Ans. is 'b' i.e., Arthralgia
Jone's criteria
Major criteria are : Carditis, arthritis, subcutaneous natule, chorea,
and erythema marginatum medpox.com
1614. Not included in modified Jones criteria?
a) Polyarthalgia

b) Carditis

c) Chorea

d) Erythema marginatum

Correct Answer - A
Ans. is 'a' i.e., Polyarthalgia
All the given options are included in modified Jones criteria. Carditis,
chorea and erythema marginatum are major criteria. Only
polyarthralgia (arthralgia) is minor criterian.
medpox.com
1615. Most common cardiac defect in Turner
syndrome
a) Coartaction of aorta

b) VSD

c) ASD

d) TOF

Correct Answer - A
Ans. is 'a' i.e., Coartaction of aorta
Disorders Associated with Turner Syndrome
Short stature medpox.com
Congenital lymphedema
Horseshoe kidney
Patella dislocation
Increased carrying angle of elbow
Madelung deformity (chondrodysplasia of distal radial epiphysis)
Congenital hip dislocation
Scoliosis
Widespread nipples
Shield chest
Redundant nuchal skin (in utero cystic hygroma)
Low posterior hairline
Coarctation of aorta
Bicuspid aortic valve
Cardiac conduction abnormalities
Hypoplastic left heart syndrome
Gonadal dysgenesis (infertility, primary amenorrhea)
Gonadoblastoma (if Y chromosome material present)
Learning disabilities (nonverbal perceptual motor and visuospatial
skills) [in 70%]
Developmental delay (in 10%)
Social awkwardness
Hypothyroidism (acquired in 15-30%)
Type 2 diabetes mellitus (insulin resistance)
Strabismus
Cataract
Red-green colorblindness (as in males)
Recurrent otitis media
Sensorineural hearing loss
Inflammatory bowel disease
Celiac disease

medpox.com
1616. Most common cause of acquired heart
disease in children
a) Acute rheuamatic fever

b) Kawasaki

c) Takayasu

d) Diabetes

Correct Answer - A
Ans. is 'a' i.e., Acute Rheumatic fever
Acute rheumatic fever
medpox.com
Most common cause of acquired heart disease in children.
Caused by group A f3 hemolytic streptococci
Usually seen in school going children
Jones criteria = very impotrant
Mitral valve most common followed by aortic valve
In acute phase - MR seen
In RI-ID MS seen
1617. Single umblical artery is associated
with?
a) NTD

b) Hydrops fetalis

c) Congenital heart disease

d) In utero death

Correct Answer - C
Ans. is `c'i.e., Congenital heart disease
Approximately 30% of infants with a single umbilical artery have
congenital abnormalities. medpox.com
Trisomy 18 is one of the more frequent abnormalities.
The most common congenital anomalies in chromosomally normal
fetuses and neonates were.
Genitourinary (6.48%)
Cardiovascular (6.25%)
Musculoskeletal (5.44%).
1618. Not a finding in potter syndrome?
a) Bilateral renal agenesis

b) Polyhydromnios

c) Pulmonary Hyperplasia

d) Flat chain

Correct Answer - B
Ans. is 'b' i.e., Poly hydromnios
Potter syndrome
Bilateral renal agenesis is incompatible with extrauterine life and is
termed Potter syndrome. medpox.com
Death occurs shortly after birth from pulmonary hypoplasia.
The newborn has a characteristic facial appearance, termed Potter
facies. The eyes are widely separated withepicanthic folds, the ears
are low set, the nose is broad and compressed flat, the chin is
receding, and there arelimb anomalies.
Bilateral renal agenesis should be suspected when maternal
ultrasonography demonstrates oligohydramnios,nonvisualization of
the bladder, and absent kidneys.
1619. Sitting without support is appear at
which month
a) 5 month

b) 6 month

c) 7 month

d) 8 month

Correct Answer - B
Ans. is 'b' i.e., 6 month
3 month Neck holding
5 month Roll over medpox.com
6 month Sits in tripod position
8 month Sitting without support
9 month Stand with support
1620. Child knows his/her sex by age of?
a) 2 year

b) 3 year

c) 4 year

d) 5 year

Correct Answer - B
Ans. is 'b' i.e., 3 year
Rides tricycle
Stands momentarily on one
foot. medpox.com
Draws a circle
Can dress or undress
himself completely
Builds tower of 10 cubes
Knows his age and sex.
Repeat a sentence of 6
syllables
Has a vocabulary of 250
words.
Counts 3 objects correctly.
Can withhold and
postpone bowel
movement.
1621. Handedness develops by age of?
a) 2 years

b) 3 years

c) 4 years

d) 5 years

Correct Answer - B
Ans. is 'b' i.e., 3 year
Handedness is usually established by the 3rd yr. Frustration may
result from attempts to change children's hand preference.
Variations in fine motor development reflect both individual
medpox.com
proclivities and different opportunities for learning. Children who are
seldom allowed to use crayons, for example, develop a mature
pencil grasp later
1622. 10 month old child can not perform?
a) Standing with support

b) Pincer group

c) Walking with suppor

d) Two words with meaning

Correct Answer - D
Ans. is 'd' i.e., Two words with meaning
o A child can transfer the objects from one hand to another by 5-7
months.
o A child can build a tower of 6 cubes by 21 months
medpox.com
o A child can pull himself up by the age of 10 months.
o A child makes a simple sentence first time by the age of 2 years.
o Pincer grasp develops by 9 months.
1623. mental retardation can be proved if
delayed milestones and slow or
retarded growth seen upto which age
(in year)?
a) 12

b) 16

c) 18

d) 20

Correct Answer - C medpox.com

Ans. is 'c' i.e., 18 year
a) Significantly sub-average intellectual functioning:an IQ score
of 70 or below on an individually administered IQ test (for infants, a
clinical judgment of significantly sub-average intellectual
functioning).
1624. Height of child acquire 100 cm in?
a) 2.5 year

b) 3.5 year

c) 4.5 year

d) 5.5 year

Correct Answer - C
Ans. is 'c' i.e., 4.5 year
1 Year- 75 cm
2 Year- 90 cm
4 1/2 Year- 100 cm medpox.com
1625. Swallowing breathing reflex - not seen
in fetus for ?
a) 14 weeks

b) 12 weeks

c) 16 weeks

d) Appear in all above period

Correct Answer - B
Ans. is 'b' i.e., 12 weeks
Behavioural deveopment in intrauterine life
medpox.com
Muscle contractions first appear around 8 wk, soon followed by
lateral flexion movements.
By 13-14 wk, breathing and swallowing motions appear and tactile
stimulation elicits graceful movements. o The grasp reflex appears
at 17 wk and is well developed by 27 wk.
Eye opening occurs around 26 wk.
During the 3rd trimester, fetuses respond to external stimuli with
heart rate elevation and body movements
1626. Characteristics of SMR-2 in boys ?
a) Appearance of pubic hair

b) Appearance of axillary hair

c) Enlargement of scrotum

d) All of above

Correct Answer - C
Ans. is 'c' i.e., Enlargement of scrotum
Scanty & long pubic hair appear at SMR-2. Enlargement of scrotum
is there at SMR-2.
medpox.com
1627. First sign of puberty in female ?
a) Tanner stage I

b) Tanner stage II

c) Pubic hair

d) Axillary hair

Correct Answer - B
Ans. is `b' i.e., Tanner stage 11
Thelarche- first sign of puberty in Girl around age of 10 year in
Girl
Definition :- Begining of secondary (Post natal) breast development
medpox.com
at onset of puberty in girls.
Tanner stage 2 breast development.
Because of rising level of estradiol
Breast development during puberty in male termed as gynecomastia
not thelarche.
1628. In marasmus wasting is due to ?
a) Prolonge dietery deficiency of calori

b) Prolonge dietery deficiency of protein

c) Excess catabolism of fat & muscle mass to provide energy

d) All of above

Correct Answer - D
Ans. is 'd' i.e., All of above
Marasmus
Prolonge deficiency of calory & protein due to starvation.
Monkey facies- loss of buccal fat.
medpox.com
Baggy pants appearance- loose skin of the buttocks hanging down.
Loss of axillary fat.
Appetite is preserved.
No edema.
1629. Kwashiorkor not true is?
a) Apathy

b) Flaky paint dermatosis

c) Increased transaminase

d) Voracious appetit

Correct Answer - D
Ans. is 'd' i.e., Voracious appetite
There is decreased appetite in kwasiorkor (not varacious appetite).
Kwashiorkar
Kwashiorkar represents the uncompensated phase of PEM.
medpox.com
It is characterized by classical 'triad' of edema (Due to
hypoalbuminemia), markedly retarded growth, and psychomotor
(mental) changes
1630. Acute malnutrition in a child is clinically
assessed by:
September 2005
a) Body mass index

b) Weight for age

c) Height for age

d) Weight for height

Correct Answer - D
Ans. D: Weight for height medpox.com
An indicator known as weight-for-height is used to determine
whether a child is acutely malnourished or not. The child's weight is
compared to the 'normal' weight for that height.
Based on this information, the World Health Organisation (WHO)
has developed charts known as international standards for expected
growth.
If a child's weight falls within the range considered normal for his/her
height, the child is found to be well-nourished. If the weight is less
than the international standards, the child is considered acutely
malnourished or wasted. WHO has created cut-off points to indicate
the severity of the malnutrition.
If a child's weight-for-height is less than -2 z-scores (or standard
deviations) of normal children, s/he is considered to suffer from
moderate acute malnutrition or wasting.
If the child's weight-for-height is less than -3 z-scores (standard
deviations) of normal children s/he suffers from severe acute
malnutrition and is considered to be severely wasted.
Another measurement used to determine a child's nutritional status
is the mid-upper arm circumference (MUAC) measurement.
is the mid-upper arm circumference (MUAC) measurement.
Because MUAC measurements require a simple, colour-coded
measuring band rather than weighing scales and height boards, they
are often used during crisis situations.
Useful for children between six months and five years of age, a
MUAC measurement of less than 12.5 cm indicates that a child is
suffering from moderate acute malnutrition.
If the MUAC measurement is under 11.0 cm, however, the under-
five child's life may be in danger as he or she is suffering from
severe acute malnutrition.
Although no anthropometric measure is a perfect marker of acute
malnutrition, in the past, there has been a tendency to view W/H
measures as the gold-standard anthropometric measure to diagnose
acute malnutrition in emergencies. Discrepancies between MUAC
and W/H have therefore been explained by MUAC being a poor
indicator of nutritional status.
A third way of diagnosing acute malnutrition is by testing for the
presence of oedema.
Oedema affects a child's appearance, giving him or her a puffy,
medpox.com
swollen look in either lower limbs and feet or face.
It can be detected by small pits or indentations remaining in the
child's lower ankles or feet, after pressing lightly with the thumbs.
The presence of oedema in both feet and lower legs is always
considered a sign of severe acute malnutrition.
1631. 3 year old child with normal height for
age, abnormal weight for age and
abnormal weight for height, what It is
not be?
a) Acute malnutrition

b) Chronic Malnutrition

c) Acute on chronic

d) None of above

Correct Answer - B medpox.com

Ans. is 'b' i.e., Chronic malnutrition
For this purpose wasting and stunting are measured :-
i) Wasting (deficit in weight for height) 4 Acute malnutrition.
ii) Stunting (deficit in height for age) - Chronic malnutrition.
iii) Wasting and stunting - Acute on chronic malnutrition.
1632. Pigmentation and growth retardation is
seen in?
a) Zinc deficiency

b) Riboflavin deficiency

c) Niacin deficiency

d) Vit A deficiency

Correct Answer - A
Ans. is 'a' i.e., Zinc dificiency

medpox.com
Dwarfism (growth retardation)
Diarrhea
Dermatitis
Hepatosplenomegaly
Iron deficiency anemia
Acrodermatitis enteropathica
Hyperpigmentation
1633. Keshan disease in due to deficiency of
a) Selenium

b) Copper

c) Zinc

d) Iron

Correct Answer - A
Ans. 'a' Selenium
Selenium is required for the synthesis of the amino acid
selenocysteine. Selenocysteine is present at the active site of
several human enzymes that catalyze redox reactions. Impairments
medpox.com
in human selenoproteins have been implicated in tumorigenesis and
atherosclerosis, and are associated with selenium deficiency
cardiomyopathy (Keshan disease)
1634. Weight of child is 70% of normal
according to IAP classification,
categorised in ?
a) Mild

b) Moderate

c) Severe

d) Normal

Correct Answer - B
Ans. is `b' i.e., Moderate medpox.com
1635. Most common cause of lower
respiratory tract infection in 3 year old
child is
a) Klebsella

b) H-influenza

c) Streptococcal pneumonia

d) Staphe aureus

Correct Answer - C
Ans. is 'c' i.e., Streptococcal pneumonia
medpox.com
Most common cause of paediatric pneumonia is respiratory syncytial
virus (RSV). Other viruses causing pneumonia are influenza virus
(2^d most common virus), adenovirus, rhinovirus, and parainfluenza
virus.
Most common bacterial cause of pediatric pneumonia is
streptococus pneumoniae (pneumococcus). Bacteria causing
atypical pneumonia commonly are mycoplasma and chlamydia.
1636. False regarding croup is ?
a) Disease include epiglottis, laryngitis, laryngotrachictis

b) Brassy cough is main presenting feature

c) Causes upper airway obstruction

d) All of above

Correct Answer - C
Ans. is 'c' i.e., Causes upper airway obstruction
Croup is variety of condition which include acute epiglottis, laryngitis,
trachiobronchitis.
Infection of lower respiratory tract.
medpox.com
Brassy cough main presenting feature.
Treatment
Humidified
I.V. fluid
Antibiotics
Nebulisation
Steroid.
1637. Koplik spot true is ?
a) Pathognomic of measls

b) Present on buccal mucosa opposite P' molar

c) Always present

d) All of above

Correct Answer - A
Ans. is 'a' i.e., Pathognomic of measls
Measle
Caused by RNA virus.
Highly contagious droplet spread from secretion of nose and throat 4
medpox.com
day before and 5 days after rash.
Secondary attack rate >90% in contact.
Prodromal phase - characterized by fever, rhinorrhea, conjuctival
congestion and dry hackig cough.
Koplik spots-bluish-gray specks or "grains of sand" on a red base-
develop on the buccal mucosa opposite the second molars
Generally appear 1-2 days before the rash and last 3-5 days
Pathognomonic for measles, but not always present
Rash appears on D4 first behind pinna on neck the spread of face,
thrunk and abdomen.
SSPE is long term complication seen in measls.
1638. Post term baby with tachypnea -
commonest cause?
a) Transient tachypnea of newborn

b) Meconium aspiration syndrome

c) Hyaline membrane disease

d) Infection

Correct Answer - B
Ans. is 'b' i.e., meconium aspiration syndrome
Transient Tachypnea of the Newborn
medpox.com
Transient tachypnea of the newborn is the most common cause of
neonatal respiratory distress, constituting more than 40 percent of
cases.1
A benign condition, it occurs when residual pulmonary fluid remains
in fetal lung tissue after delivery o Respiratory Distress Syndrome
Respiratory distress syndrome of the newborn, also called hyaline
membrane disease, is the most common cause of respiratory
distress in premature infants
Immature type II alveolar cells produce less surfactant, causing an
increase in alveolar surface tension and a decrease in compliant
Meconium Aspiration Syndrome
Meconium-stained amniotic fluid occurs in approximately 15 percent
of deliveries, causing meconium aspiration syndrome in the infant in
10 to 15 percent of those cases, typically in term and post-term
infants
Infection
Bacterial infection is another possible cause of neonatal respiratory
distress.
Common pathogens include group B streptococci (GBS),
Staphylococcus aureus, Streptococcus pneumoniae, and gram-
negative enteric rods.
Pneumonia and sepsis have various manifestations, including the
typical signs of distress as well as temperature instability

medpox.com
1639. Influenza vaccine cause ?
a) Local swelling

b) Fever

c) Itching

d) All of above

Correct Answer - D
Ans. is 'd' i.e., All of above
Mild problems following inactivated flu vaccine:
Soreness, redness, or swelling where the shot was given
Hoarseness medpox.com
Sore, red or itchy eyes
Cough
Fever
Aches
Headache
Itching
Fatigue
If these problems occur, they usually begin soon after the shot and
last 1 or 2 days.
Moderate problems following inactivated flu vaccine:
Young children who get inactivated flu vaccine and pneumococcal
vaccine (PCV13) at the same time may be at increased risk for
seizures caused by fever. Ask your doctor for more information. Tell
your doctor if a child who is getting flu vaccine has ever had a
seizure.
Problems that could happen after any vaccine:
Brief fainting spells can happen after any medical procedure,
including vaccination. Sitting or lying down for about 15 minutes can
help prevent fainting, and injuries caused by a fall. Tell your doctor if
you feel dizzy, or have vision changes or ringing in the ears.
Severe shoulder pain and reduced range of motion in the arm where
a shot was given can happen, very rarely, after a vaccination.
Severe allergic reactions from a vaccine are very rare, estimated at
less than 1 in a million doses. If one were to occur, it would usually
be within a few minutes to a few hours after the vaccination.

medpox.com
1640. Child with rash- wrong is
a) Typhus - day 5

b) Varicella - day 1

c) Typhoid - day 5

d) Measles - day 4

Correct Answer - C
Answer- C. Typhoid - day 5
Very Sick Person Must Take Double Tablets
Very Varicella (day 1)
Sick Scarlet fever (day 2) medpox.com
Person Pox-small pox (day 3)
Must Measles (day 4)
Take Typhus (day 5)
Double Dengue (day 6)
Tablets Typhoid (day 7)
1641. Infant has fever, one episode of febrile
convulsions admitted for observation,
fever than subsided and followed by
rash on abdomen & chest, maculo​‐
papular erythematous-what is the
cause?
a) Chickenpox

b) Measles

c) Typhoid

d) Dengue
medpox.com

Correct Answer - A
Ans. is 'a' i.e., Chickenpox
In this question, infant had develop rash on first day offever &
distribution of rash is in favour of chickenpox, or varicella.
Mnemonic for Day of appearance of rash in a febrile patient is
Very Sick Person Must Take Double Tablets
Very - Varicella (day 1)
Sick - Scarlet fever (day 2)
Person - Pox-small pox (day 3)
Must - Measles (day 4)
Take - Typhus (day 5)
Double - Dengue (day 6)
Tablets - Typhoid (day 7)
Chicken pox (Varicella ):
Caused by virus
Child develop fever with rash
 Rash are macular, maculo-papular, vesicular (pleomorphic)
Distribution is usually centripetal
Complication include - more seen in immunocompromised child.
a. Mild thrombocytopenia
b. Hematurea
c. GI Bledding
d. Encephalitis
e. Pneumonia

medpox.com
1642. True about foremilk & hind milk?
a) Foremilk has fat

b) Hind milk relieve hunger

c) Fore milk relieve hunger

d) Hind milk is rich in protein

Correct Answer - B
Ans. is 'b' i.e., Hind milk relive hunger
The foremilk (the milk "in front"); is produced at the beginning of
each feeding. It contains water, vitamins, and protein and relieve
thurst. medpox.com
The hindmilk ; is pushed out latter, it is heavier, richer in lipid and
satisfy hunger.
1643. Most common GI malignancy of
childhood
a) Adenocarcinoma

b) Lymphoma

c) Sarcoma

d) carcinoid

Correct Answer - B
Ans. is 'b' i.e., Lymphoma
Over all hemangioma is most common Tumor in infant.
medpox.com
Hemangioma is usually benign in Nature.
Leukemia is most common malignancy in pediatric age gyp.
2"' most common is CNS Tumor = Lymphoma is the most common
malignancy of the gastrointestinal tract in children. About 30% of
children with non-Hodgkin lymphoma present with abdominal
tumors.
1644. Most common intra abdominal solid
organ tumor in child is ?
a) Neuroblastoma

b) Rhabdomyoblastoma

c) Wilm's tumor

d) Hypernephroma

Correct Answer - A
Ans. is 'a' i.e., Neuro blastoma
Most common abdominal cancer of childhood.
Most common cancer of infancy.medpox.com
Most common extracranial solid tumor of childhood (most common
solid tumor of childhood is brain tumor).
1645. Most common malignancy in children is
?
a) ALL

b) AML

c) Neuroblastoma

d) Wilm's tumor

Correct Answer - A
Ans. is 'a' i.e., ALL
Leukemia is most common malignancy in pediatric age group. o
medpox.com
Leukemia / lymphoma = 40% (ALL is more common than AML)
CNS Tumor= 30%
Embryonal & Sarcoma =10%
2nd most common is CNS Tumor (30%)
1646. Pedigree analysis chart?
a) Used for growth monitoring

b) To assess side effect during chemotherapy

c) Used to see gentic transmission

d) To assess developmental delay in infant

Correct Answer - C
Ans. is 'c' i.e., Used to see genetic transmission
Pedigree
Provide graphic depiction of a family structure medical history.
Person providing information is formed as proband.
medpox.com
Special symbol is used for each designation.
Three generation pedigree should be made.
Closer the relationship of proband to the person, greater is change
of shared genetic component.
1647. Prader willi syndrome, chromosomal
defect?
a) Chromosome 15

b) Chromosome 5

c) Chromosome 10

d) Chromosome 21

Correct Answer - A
Ans. is 'a' i.e., Chromosome 15
Prader-Willi syndrome is a complex genetic condition that affects
many parts of the body. medpox.com
In infancy, this condition is characterized by weak muscle tone
(hypotonia), feeding difficulties, poor growth, and delayed
development. Beginning in childhood, affected individuals develop
an insatiable appetite, which leads to chronic overeating
(hyperphagia) and obesity.
Some people with Prader-Willi syndrome, particularly those with
obesity, also develop type 2 diabetes mellitus (the most common
form of diabetes).
People with Prader-Willi syndrome typically have mild to moderate
intellectual impairment and learning disabilities. o Behavioral
problems are common, including temper outbursts, stubbornness,
and compulsive behavior such as picking at the skin. Sleep
abnormalities can also occur.
Additional features of this condition include distinctive facial features
such as a narrow forehead, almond-shaped eyes, and a triangular
mouth; short stature; and small hands and feet. Some people with
Prader-Willi syndrome have unusually fair skin and light-colored hair.
Both affected males and affected females have underdeveloped
genitals. Puberty is delayed or incomplete, and most affected
individuals are unable to have children (infertile).

medpox.com
1648. Hemophilia X-linked?
a) Hemophilia A

b) Hemophilia B

c) Hemophilia C

d) Both A & B

Correct Answer - D
Ans. is 'D' i.e., Both a & b
Hemophilia A (also known as classic hemophilia or factor VIII
deficiency) and hemophilia B (also known as Christmas disease or
factor IX deficiency) are inherited in an X-linked recessive pattern.
medpox.com
Haemophilia C is caused by a deficiency of coagulation factor XI and
is distinguished from haemophilia A and B by the fact it does not
lead to bleeding into the joints. Furthermore, it has autosomal
recessive inheritance
1649. Turner syndrome - karyotyping is?
a) 45, X0

b) 46 X0

c) 47 XXX

d) Trisomy 21

Correct Answer - A
Ans. is 'a' i.e., 45 XO
45X0
Lymphadema of dorsum of hand & fat
Loose skin fold at nape of neck
medpox.com
Short stature
Short Neck (with webbing of neck)
Anomalies ear
Broad shield like chest with widely spaced small nipple
Renal anomalies (Horse-shoe, souble or cleft renal pelvis)
Coart of aorta
1650. 21-Hydroxylase deficiency - false is ?
a) Most common cause of congenital adrenal hyperlasia

b) Autosomal recessive

c) Femal pseudo hermaphroditism

d) Male pseudo hermephroditism

Correct Answer - D
Ans. is 'd' i.e., Male pseudo hermephroditism
Congenital adrenal hvperplasia (CAH)
Group of AR disorder
MC adrenal disorder in childhood
medpox.com
Most common 21-hydroxylase deficiency =There is elevated level of
pregenolone, 17 -OH pergenelone DHEA and decreas level of
progesterone, deoxycortisol,and estradiol so 21 hydroxylase
deficiency causes female pseudoher​maphroditism.
1651. In congenital adrenal hyperplasia
precocious puberty in male is due to ?
a) 21 alpha hydroxylase deficiency

b) 11(3 hydroxylase deficiency)

c) Both

d) None

Correct Answer - C
Ans. is 'c' i.e., Both
21 hydroxylase and 3-13-HSD
• Salt losing medpox.com
• Virilization of female (Female pseudohermaphroditism)
• Precocious puberty in male
1652. Precocious puberty is seen in -
a) Hypothyroidism

b) CNS irridation

c) Mc cune-Albright syndrome

d) All

Correct Answer - D
Ans. is 'a' i.e., Hypothyroidism; 'b' i.e., CNS irradiation; 'c' i.e., Mc
Cune Albright syndrome
Precocious puberty
o Puberty before the age of 8 years in girls or 9 years in boys is
medpox.com
considered precocious puberty. o Menarche before the age of 10
years in girls is also considered as precocious.
o Precocious puberty is of two types
1. Central or true precocious puberty
Results from excessive GnRH, gonadotropins and target sex
hormone elaborated by premature activation of hypothlamic
pituitary-gonadal (HPG) axis.
2. Peripheral or pseudo-precocious puberty
Due to increased sex steroid secretion from either the
adrenal gland or the gonads.
It is independent of HPG axis activation
Causes of Precocious puberty
A. Central precocious puberty
1. Idiopathic : Sporadic or familial.
2. Central nervous system abnormalities
i) Congenital anomalies of CNS: Hypothalamic hamartoma,
hydrocephalus, porencephaly, arachnoid cysts.
ii) Acquired lesions of CNS : Inflammation, granuloma, trauma,
surgery, radiation, chemotherapy.
iii) Tumors of CNS : Pineal tumors, optic glioma, ependymoma,
camiopharyngioma.
iv) Hypothyroidism
B. Peripheral precocious puberty : Isosexual
Girls
1. Ovarian causes : McCune-Albright syndrome, benign follicular
cysts, granulosa-theca cell tumors; Gonadoblastoma
2. Adrenal causes : Feminizing adrenal neoplasia
3. Exogenous estrogen administration
Boys
1. Testis : Leydig cell tumor, adrenal rest tumor, testotoxicosis.
2. Adrenal: CAH (21 or 11-(3 hydroxylase deficiency), virilizing
tumors.
3. hCG secreting tumors : Hepatoma, hepatoblastoma,
choriocarcinoma, chorionepithelioma, teratoma, dysgerminoma.
Exogenous testosterone
C. Heterosexual precocity
1. Girls : Virilization in girls due to virilizing CAH, ovarian or adrenal
medpox.com
neoplasia, polycystic ovarian disease.
2. Boys : Feminization due to estogen producing adrenal tumors,
exogenous estrogen, marijuana smoking.
Note - Hypothyroidism usually causes delayed puberty, but juvenile
hypothyroidism some times can cause precocious puberty.
1653. Delayed puberty in female?
a) No breast budding in 10 years

b) Menarche > 16 year

c) menarche > 1 year of brean budding

d) FSH

Correct Answer - B
Ans. is 'b' i.e., Menarche > 16 year
Delayed Puberty
More common in boy than girl
Most common cause in constitutional delay
medpox.com
Girls-Delayed puberty is defined as
Lack of secondary sexual character by age of 17 years
Absence of menarche by age of 16 year
5 year after pubertal onset.
Boys-Lack of pubertal changes by the age of 14 years.
1654. Hypergonadotropic hypogonadism is
sean in all except?
a) Turner syndrome

b) Down syndrome

c) Klinefelter syndrome

d) Swyer's syndrome

Correct Answer - B
Ans. is 'b' i.e., Down syndrome
Hypergonadotropic hypogonadism
medpox.com
Also K/a primary or peripheral hypogonadism.
Characterised by hypogonadism due to an impaired response of the
gonads to the gonadotropin, FSH and LH.
In turn a lack of sex steroid production and elevated gonadotropin
level.
Causes :
Chromosomal abnormalitis
Turner's syndrome
Klinefelter syndrome
Swyer's syndrome
Enzyme defect
17 , hydroxylase
17, 20 lyase deficiency
1655. Female hermaphrodite is?
a) Female sexual characterstic with testes

b) Male sexual charaterstic with ovary

c) XY

d) Female sexual characteristic with both testes & ovary

Correct Answer - B
Ans. is 'b' i.e., Male sexual characteristc with ovary
Female pseudo hermaphroditism
Have internal genitalia female type
Katy() type XX medpox.com
Masculinisation of external genitalia
Most common - CAN
Congenital adrenal hyperplasia
M-C. 21 hydroxylase deficiency
Other cause excess maternal androgen due to - o Maternal ovarian
tumor.
Maternal drug intake
Treatment
Hormonal therapy
1656. Fanconi's anemia - false is ?
a) Autosomal recessive

b) Pancytopenia

c) Type I RTA

d) All are true

Correct Answer - C
Ans. is 'c' i.e., Type I RTA
Fanconi anemia
Autosomal recessive
Pancytopenia medpox.com
Hyper pigmentation of trunk, neck, and inlertriginous area.
Growth failure
Fanconi facies (small head, small eyes)
Renal abormality
Proximal RTA (type II RTA)
Renal tubular acidosis 3 types
Distal RTA (type I)
Proximal RTA (type II)
Hyperkalemic RTA (type IV)
1657. Exchange blood transfusion what is
used ?
a) Whole blood

b) EPP

c) Serum

d) Pack cell

Correct Answer - A
Ans. is 'a' i.e., Whole blood
Exchange transfusion is the process of slowly removing patient
medpox.com
blood and replacing with fresh donor whole blood.
1658. ITP false is ?
a) Plattet transfusion should be avoided

b) Anticedent history of febrile illness

c) Overactive immune system

d) Steroid should be avoided

Correct Answer - D
Ans. is 'd' i.e., Steroid should be avoided
Idiopathic thrombocytopenic purpura (ITP)
Commonest bleeding disorder presenting in children between 1-7
year of age. medpox.com
ITP is proposed to be occur due to over active immune response.
Antecedent H/o febrile illness present.
Treatment
Platlet transfusion should be avoided
IVIG or steroid.
1659. In infant, bone marrow biopsy is done
from ?
a) Sternum

b) Iliac crest

c) Tibia

d) All of above

Correct Answer - C
Ans. is 'c' i.e., Tibia
Sternum : —>
Hematopoitically active medpox.com
Site in cooperative patient like adult
Ilium :
Apprehesive patient
Useful in older children & adult
Tibia :
Useful in newborn & infant and children below 2 year of age.
1660. Case of hemorrhagic disease of
newborn bleed on 2nd day?
a) 2, 7, 9, 10

b) 3, 7, 9, 10

c) 2, 8, 9, 10

d) 2, 5, 9, 10

Correct Answer - A
Ans. is 'a' i.e., 2, 7, 9, 10
Hemorrhagic disease of newborn is due to deficiency of Vitamin K
medpox.com
dependent factors —> II, VII, IX and X.
1661. Child having long history of
hemoglobin 5 gm% next step?
a) Blood transfusion

b) CBC,reti count with periphesal smear.

c) Start Iron

d) Hb elechophoresis

Correct Answer - B
Ans. is 'b' i.e., CBC,reti count with peripheral smear
In above question, if child is stable, then no need to give blood
transfusion. medpox.com
Before starting Iron, we have to rule out types of anemia as Iron is
indicated only in nutritioral anemia.
Hb ele ctrophoresis is indicated if there is featuer of hemolytic
anemia (thalassemia) so over all our next step is complete
hemogram with manual peripheral smear examination. (obtion b).
1662. Mildly elevated bilirubin, normal liver
enzymes are seen in?
a) Malaria

b) Thalassemia

c) G-6 PD deficie

d) All of above

Correct Answer - D
Ans. is 'd' i.e., All of above
Mildly elevated bilirubin especially indirect and normal liver enzyme
seen in hemolytic anemia. medpox.com
In above question all causes hemolytic anemia.
1663. Baby '0* positive, blood group, mother
Rh negative, cord bilirubin 7 mg%,
conjugated I now treatment is?
a) Nothing

b) Stop breast feeding for 48 hours

c) Continue breast feeding and phototherapy

d) Stop breast feed and prepare for exchange blood transfusion

Correct Answer - D
Ans. is 'd' i.e., Stop breast tad and prepare for exchange blood medpox.com
transfusion
· In hemolytic disease, immediate exchange
transfusion indication :
a) Cord bilirubin is > 4.5 mg/dl and Hb < 11 gm%
b) Bilirubin rising > 1 mg/dl/hour despite phototherapy
c) Hb level 11-13 gm/dl and bilirubin rising more than 0.5 mg/dl/hour
d) Bilirubin is rising inspite of phototherapy
1664. In neonate, intra muscular injection
given at -
a) Deltoid

b) Gluteal

c) Thigh

d) Abdomen

Correct Answer - C
Answer- C. Thigh
Anterolateral aspect of thigh because of lack of important blood
medpox.com
vessel & nerve is preferred site upto 12 month of age.
1665. Cat bites in child treatment - false is
a) Cleaning the wound thoroughly

b) Puncture wound most common

c) May require rabies vaccination

d) All of above

Correct Answer - D
Ans. is `d' i.e., All of above
The most common type of injury from cat and rat bites is a puncture
wound. Cat bites often penetrate to deep tissue
Infection is the most common complication of any type of bite
medpox.com
injuries.
Treatment includes cleansing of wound, debridement, wound
culture, tetanus and antirabies immunization, and initiation of
antibiotics.
A moxicillin-clavulanate is an excellent choice for empirical oral
therapy for human and animal bite wounds because of its activity
against most of the strains of bacteria that have been isolated from
infected bite injuries.
1666. Most common site of extra - pulmonary
TB in children is ?
a) Abdominal

b) Genitourinary

c) Lymphnode

d) Congenital

Correct Answer - C
Ans. is 'c' i.e., Lymphnode
Most common site of extra pulmonary TB is lymphnode
medpox.com
Most children who develop tuberculosis disease experience
pulmonary manifestations 25 to 35 percent of children have an
extrapulmonary presentation.
The most common extrapulmonary form of tuberculosis is lymphatic
disease accounting for about two thirds of cases of extrapulmonary
tuberculosis. the second most common form is meningeal disease
occurring in 13% of patients
1667. Most common organ involved in
congenital Tb is?
a) Liver

b) Pancreas

c) Kidney

d) Lung

Correct Answer - A
Ans. is 'a' i.e., Liver
Congenital tuberculosis
medpox.com
Although it is rare as mother having tuberculosis primarily present
with infertility.
Tuberculous bacilli sometimes pass throgh umblical vein and may
develop focus in liver (hepatic complex).
When neonate aspirate amniotic fluid containing bacilli then develop
GI tuberculosis or lung infection.
Neonate usually present as respiratory distress,
hepatosplenomegaly lymphadenopathy.
Overall liver is most commonly involved in congenital tuberculosis
 1668. Ideal time to start Iron therapy in a
marasamic child with fever and
hemoglobin 7 gm% is
a) Immedietly

b) At discharge

c) When fever goes down

d) At any time

Correct Answer - C
Ans. is 'c' i.e., When fever goes down
medpox.com
Iron at 3 mg/kg 1 day should started when child gaining weight once
stabilisation phase is over. o The core of the accepted WHO
management protocol is 10 steps in two phases ?
1. Stabilization
2. Rehabilitation.
These 10 essential steps are listed below:
1. Treat/prevent hypoglycemia;
2. Treat/prevent hypothermia;
3. Treat/prevent dehydration;
4. Correct electrolyte imbalance;
5. Treat/prevent infection;
6. Correct micronutrient deficiencies;
7. Start cautious feeding with F-75;
8. Achieve catch-up growth by feeding F-100 after appetite returns;
9. Provide sensory stimulation and emotional support; and
10. Prepare for follow-up after recovery
F-75 is the "starter" formula used during initial management of
malnutrition, beginning as soon as possible and continuing for 2-7
days until the child is stabilized. Severely malnourished children
cannot tolerate normal amounts ofprotein and sodium or high
amounts offat. They may die i f given too much protein or sodium.
They also need glucose, so they must be given a diet that is low in
protein and sodium and high in carbohydrate. F-75 has is specially
mixed to meet the child's needs without overwhelming the body 's
systems in the initial stage of treatment. Use of F-75 prevents
deaths. F-75 contains 75 kcal and 0.9 g protein per 100 ml.
As soon as the child is stabilized on F-75, F-100 is used as a "catch-
up" formula to rebuild wasted tissues. F​100 contains more calories
and protein: 100 kcal and 2.9g protein per 100 ml.

medpox.com
1669. Non-obstructive hydrocephalus - true is
?
a) Also kin communicating hydrocephalus

b) Due to obliteration of subarachrod cistemae or malfunction of

arachnoid villi

c) Dilatation of all 4 ventricle

d) All of above

Correct Answer - D
Ans. is 'd' i.e., All of above
medpox.com
H hy_LQggPllalus is not a specific disease; rather, it represents a
diverse group of conditions that result from impaired circulation and
absorption of CSF or, in the rare circumstance, from increased
production by a choroid plexus papilloma
flyLk.QCSPLlalus resulting from obstruction within the ventricular
system is called obstructive or noncommunicating hydrocephalus
The CSF circulates from the basal cisterns posteriorly through the
cistern system and over the convexities of the cerebral hemispheres.
CSF is absorbed primarily by the arachnoid villi through tight
junctions of their endothelium by the pressure forces that were noted
earlier.
CSF is absorbed to a much lesser extent by the lymphatic channels
directed to the paranasal sinuses, along nerve root sleeves, and by
the choroid plexus itself.
Hydrocephalus resulting from obliteration of the subarachnoid
cisterns or malfunction of the arachnoid villi is called nonobstructive
or communicating hydrocephalus
1670. Febrile seizure most common - age
groups?
a) 1 month to 1 year

b) 6 month to 5 year

c) 6 month to 2 year

d) 2 month to 5 year

Correct Answer - B
Ans. is 'b' i.e., 6 month to 5 year
Febrile convulsion :-
Commonest provoked seizure medpox.com
Between 6 months to 5 year
Neurologically normal child
Occurs when temp rise abruptly
Simple benign febrile convulsion
Fits occur within 24 hour of onset of fever.
Duration less than 10 min.
Usually single per febrile episode
Generalised type of convulsion
Atypical febrile seizures
Presence of family history of epilepsy
Neurodevelopmental retardation
Focal neurological deficit.
1671. What is recurrence of febrile seizure -
a) 10-20%

b) 20-30%

c) 30-50%

d) 50-70%

Correct Answer - C
Answer- C. 30-50%
Recurrent febrile seizures occur in 30-50% of cases.
More than 90% of febrile seizures are generalized.
Acute respiratory illness are most commonly associated with febrile
medpox.com
seizures.
1672. Drug used for absence seizure?
a) Lamotrigine

b) Carbamazepine

c) Phenytoin

d) Vigabatrine

Correct Answer - A
Ans. is 'a' i.e., Lamotrigine
Drug of choice for absence seizures is Valproate (Previously it was
ethosuxamide). Other drugs used are lamotrigine and clonazepam.
medpox.com
1673. Child comes with blood sugar 32 mg/dl
with convulsions Treatment is?
a) 5% dextrose 2 ml/kg

b) 10% dextrose 2 ml/kg bolus

c) 10% dextrose 4 ml/kg

d) 5% Dextrose 4 ml/kg

Correct Answer - C
Ans. is 'c' i.e., 10% Dextrose 4 ml/kg
Symtomatic Hypoglycemia (<40mg/d1) should be managed with
10% IV Dextrose. medpox.com
In seizures, dose of 10% dextrose is 4 ml/kg.
1674. Minimum interval between 2 live
vaccine immunization ?
a) 2 weeks

b) 4 weeks

c) 6 week

d) 8 weeks

Correct Answer - B
Ans. is 'b' i.e., 4 weeks
Basic principle of immunization
medpox.com
Minimum 4 week interval recommended between 2 live
vaccine administration except OPV and oral typhoid.
Two or more killed vaccine may be administrated simultaneously or
at any given interval
A live and killed vaccine given simultaneously but at different site.
If immunisation status unknown, give age appropriate vaccine
Mixing of vaccine in same syringe not recommended
Live vaccine should be avoided in AIDS,
1675. A child having H/0 profuse watery
diarrhoea not taking oraly and not
passed urine since 2 days, what to be
given
a) Milk

b) ORS

c) I.V. fluid

d) I.V. antibiotic

Correct Answer - C medpox.com

Ans. is 'c' i.e., I.V. fluid
Child having history of profuse watery diarrhoea with poor oral intake
and not passed urine since 2 days is suffering from diarrhoea with
dehydration and probably acute renal failure of pre renal types.
Here best choice is intravenous I.V. fluid
If I.V. access not possible, then you can give feed through Ryle's
tube or intra osseous fluid.
 1676. Fluid of choice in child with burn < 24
hour is
a) Fresh frozen plasma

b) Isolye-P

c) Ringer lactate

d) Platlet tranfusion

Correct Answer - C
Ans. is 'c' i.e., Ringer lactate
Fluid resuscitation in burn injury
Parkland formulaa medpox.com
a. Initial 24 hours: Ringer's lactated (RL) solution 4 ml/kg/% burn
for adults and 3 ml/kg/% burn for children. RL solution is added for
maintenance for children:
a. 4 ml/kg/hour for children weighing 0-10 kg
b. 40 ml/hour +2 ml/hour for children weighing 10-20 kg
c. 60 ml/hour + 1 ml/kg/hour for children weighing 20 kg or higher
This formula recommends no colloid in the initial 24 hours.
b Next 24 hours: Colloids given as 20-60% of calculated plasma
volume. No crystalloids. Glucose in water is added in amounts
required to maintain a urinary output of 0.5-1 ml/hour in adults
and 1 ml/hour in children.
 1677. Erythroposis starts in fetal liver during
?
a) 2-4 weeks

b) 4-6 weeks

c) 6-8 weeks

d) 8-10 weeks

Correct Answer - C
Ans. is 'c' i.e., 6-8 weeks
Developmental hematopoiesis occurs in three anatomic stages:?
1. Mesoblastic medpox.com
2. Hepatic
3. Myeloid
Mesoblastic hematopoiesis occurs in extraembryonic structures,
principally in the yolk sac, and begins between the 10th and 14th
days of gestation.
By 6-8 wk of gestation the liver replaces the yolk sac as the primary
site of blood cell production, and by 10-12 wk extraembryonic
hematopoiesis has essentially ceased.
Hepatic hematopoiesis occurs in the liver throughout the remainder
of gestation, although production begins to diminish during the
second trimester as bone marrow (myeloid) hematopoiesis
increases.
The liver remains the predominant hematopoietic organ through wk
20-24 of gestation
1678. Antiendomysial antibody is used in
screening of ?
a) Myasthenia gravis

b) Auto immune hepatitis

c) Coeliac diseases

d) Graves disease

Correct Answer - A
Ans. is 'a' i.e., Coeliac diseases
Coeliac disea.se (CD) is a permanent intolerance of the small
medpox.com
intestine to gluten, characterized by gluten-dependent changes in
villous morphology and/or signs of immunological activation
detectable in the lamina propria of intestinal mucosa.
The presence of serum anti-endomysial antibodies (EMA) is
generally considered to be highly suggestive for CD because of their
high values of sensitivity and specificity.
Other antibodies used for diagnosis
Tissue transglutaminase,
Antigliadin antibodies
Treatment is Gluten-free diet
1679. True about bartter's syndrome are all
except ?
a) Hyperkalemic alkalosis

b) Presents in neonate with ototoxicity have bartin gene mutation

c) Decreased K+ assorption from thick descending loop

d) Autosomal recessive

Correct Answer - A
Ans. is 'a' i.e., Hyperkalemic alkalosis
Antibodies in coeliac disease are anti-endomysian, antigliadin and
anti-transglutaminase. medpox.com
1680. Posterior urethral valve - true A/E ?
a) Palpable bladder

b) Hydronephrosis

c) Painful stress incontinence

d) Recurrent UTI

Correct Answer - C
Ans. is `c' i.e., Painful stress incontinence
Posterior urethral valve
Most common cause of severe obstructive uropathy in children.
30% of children experienced end stage renal disease/CRF
medpox.com
Dilated prostatic urethra.
Hypertrophy of bladder muscle
Vesicouretic reflux seen in 50% of cases.
Back pressure change:
Hydronephrosis
Distended bladder
Thin urinary stream
Recurent UTI because of urinary stasis
1681. 2 year old boy of weight 12 kg with
vitamin A deficiency what is oral dose
of vitamin A
a) 50, 000 I.U

b) 1 lakh I.U.

c) 1.5 lakh I.U

d) 2 lakh I.U

Correct Answer - D
Ans.D. 2 lakh I.U medpox.com
Treatment:
Oral therapy: The oral regimen of vitamin A is 200,000 IU on day of
presentation, next day, and 2-4 weeks later.
Children less than 1 year of age or less than 8 kg should receive half
the dose of the above dose. Repeat 200,000 IU every 6 months up
to 6 years of age to prevent recurrence.
Parenteral therapy: If the patient has severe disease, is unable to
take oral feeds, or has malabsorption, the preferable dose is
100,000 IU of vitamin A given intramuscularly.
Children with severe measles should also receive vitamin A as they
are very likely to be benefited from such therapy both in terms of
saving sight and reducing case fatality.
Prevention
Prophylaxis consists of periodic administration of Vitamin A
supplements. WHO recommended schedule, which is
universally recommended is as follows:
Infants 6–12 months old and any older children weighing less than 8
kg – 100,000 IU orally every 3–6 months
Children over 1 year and under 6 years of age – 200,000 IU orally
every 6 months
Infants less than 6 months old, who are not being breastfed – 50,000
IU orally should be given before they attain the age of 6 months

medpox.com
1682. Alopecia thin brittle nail, sparse hair
with thin enamel diagnosis is ?
a) Ectodermal dysplasia

b) Alopecia aerata

c) Alopica congenita

d) None of above

Correct Answer - A
Ans. is 'a' i.e., Ectodermal dysplasia
Ectodermal dysplasia
Group of syndrome medpox.com
All derived from ectodemal structure
Abnormalities of two or more ectodermal structure such as
Hair
Teeth
Nail
Sweat gland
Cranio facial structure
Digit
1683. Hair an syndrome is consists of ?
a) Hyperandrogenism

b) Acanthosis nigricans

c) Insulin resistance

d) All of above

Correct Answer - D
Ans. is 'd' i.e., All of above
HAIR-AN syndrome consists of hyperandrogenism (HA), insulin
resistance (IR), and acanthosis nigricans (AN).
It is a subset of polycystic ovary syndrome
medpox.com
1684. Renal tubuler acidosis with ABG value
pH = 7.24 P02=80; PaCO2= 36 Na = 131;
HCO3 = 14 C1= 90; BE = -13 Glucose =
135 above ABG picture suggest ?
a) Metabolic acidosis

b) Respiratory acidosis

c) Respiratory alkalosis

d) Metabolic alkalosis

Correct Answer - A medpox.com

Ans. is 'a' i.e., Metabolic acidosis
The given values have low pH, and low HCo2- Indicate metabolic
acidosis
PCO2 in lower normal range (normal value 35-45 mm/hg)
1685. Grimace with APGAR score -
a) 0

b) 1

c) 2

d) 3

Correct Answer - B
Ans. is `b i.e., 1

medpox.com

1686. 0.9% NaCI contains True as?
a) 0.9 gm of Nacl in 1000 ml of fluid

b) 77 meg of sodium is 1000 ml of fluid

c) 154 meg of chloride in 1000 ml of fluid

d) 30 meg of sodium in 1000 ml of fluid.

Correct Answer - C
Ans. is 'c' i.e., 154 meq of chloride in 1000 ml of fluid
Nomal saline (Isotonic saline)
Contains - 9 gms of Nacl in 1000 ml of fluid
154 meq/sodium in 1000 ml of fluid
medpox.com
154 meq Chloride in 1000 ml of fluid
1687. Confirmation of male intersex by?
a) USG abdomen

b) Genetic testing

c) Hormonal study

d) All of above

Correct Answer - B
Ans. is 'b' i.e., Genetic testing
Intersex :(DSD)
Discrepancy between morphology of gonads and that of extemal
genitalia medpox.com
Now Disorder of Sex development (DSD) is preferred instead of
intersex
Distinctly not defined as male or female
Intersex trait not always manitest at both
Some as not aware of intersex and it is confirned by Genetic testing
Most common is virilisation of female 46 XX DSD.
46 XX DSD -
Phenotype is xx & gonads are ovary but external genitalia is virilised.
(due to lack of antimullerian hormone (AMH))
Most common is congenital adrenal hyper plasia (CAH)
Most commonly 21 a hydroxylase & 11[3 - Hydroxylase deficiency.
1688. Drug used in neonatal resuscitation
a) Adrenaline

b) Soda bi carbonate

c) Naloxone

d) All of above

Correct Answer - D
Ans. is 'd' i.e., All of above
Drug used during neonatal resuscitation
Epinephrine./Adrenalin
NS or RL medpox.com
Naloxone
Sodium-by-carbonate
1689. Reye syndrome false is?
a) Associated with salicylate ingestion

b) Hepatomegaly

c) Jaundice

d) Hypoglycemia

Correct Answer - C
Ans. is 'c' i.e., Jaundice
Reve syndrome
Detrimental effects to many organs, especially the brain and liver, as
well as causing low blood sugar and increase ammonia level.
medpox.com
Secondary Mitochondria hepatopathy
H/o viral injection (Influenza, varicella) & salicylate interactions.
Higher mortality rate.
The disease causes fatty liver with minimal inflammation and
cerebral edema (swelling of the brain).
Jaundice is not usually present. With raised enzyme with normal
bilirubin.
Children of ages 4 to 12 are most commonly afflicted.
Early diagnosis is vital; although most children recover with
supportive therapy, it may lead to severe brain injury and death
1690. 3 year old child come in ER with H/o
vomiting, loose watey motion for 3
days. on examination, child was
drowsy, sunken eye. Hypothermia and
skin pinch take time to revert back,
diagnosis?
a) No dehydration

b) Mild dehydration

c) Some dehydration

d) Severe dehydration
medpox.com

Correct Answer - D
Ans. is 'd' i.e., Severe dehydration
A child with severe dehydration will have at least two of the following
four signs : sensorium is abnormally sleepy or lethargic, sunken
eyes, drinking poorly or not at all, and a very slow skin pinch.
A child with some signs of dehydration will have two of the following
: restlessness or irritability, sunken eyes, drinking eagerly or slow
skin pinch.
A child with either one or none of these signs is classified as having
no signs of dehydration.
1691. In duschene the knee jerk ?
a) Exaggerrated

b) Decrease

c) May be normal initially lateron increase

d) May be normal initially lateron decrease

Correct Answer - D
Ans. is 'd' i.e., May be normal initially lateron decrease
Duchenne and Becker's muscular dystrophy.
X-like recessive So expression of gene is essentially confirmed
in males. medpox.com
Females are affected only if X-chromosome carrying the normal
allele is lost or inactivated
Becker is milder form with late onset and slow progression.
In duchenni, onset is early with deloyed misection.
Pseudohypertrophy of calf muscle, glutei, deltiod,
Gower sign may positive at age of 3 year.
Cardiac involvement started at 10 year of age.
Deep tendon reflexes remain normal or are decreased in
patients with DMD.
Ankle jerks are relatively preserved until the terminal stages,
while the knee jerk reflex is less brisk than the ankles by age
six, but is eventually lost.
Histopathology shows diffuse degeneration & regeneration of
muscle fibre.
Serum CPX are markedly high.
1692. Intra uterine hydronephrosis of 32-34
weeks-management?
a) Intrauterine drainage

b) Wait until 3 weeks

c) Immediate delivery

d) Require serial USG and other associated anomalies

Correct Answer - D
Ans. is `d' i.e., Require serial USG and other associated anomalies
Antenatal hydronephrosis (ANH) is transient and resolves by the
medpox.com
third trimester in almost one-half cases.
The presence of oligohydramnios and additional renal or extrarenal
anomalies suggests significant pathology. o All patients with ANH
should undergo postnatal ultrasonography
The intensity of subsequent evaluation depends on anteroposterior
diameter (APD) of the renal pelvis and/or Society for Fetal Urology
(SFU) grading.
Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-
4 should be screened for upper or lower urinary tract obstruction and
vesicoureteric reflux.
Surgery is considered in patients with increasing renal pelvic APD
and/or an obstructed renogram with differential renal function <35-
40% or its subsequent decline.
1693. 10-year-old boy with an ulcerated lesion
with undermined edges over the upper
chest with satellite lesion in anterior
axillary fold for two months. Axillary
lymph nodes present. Histopathology
showed dermal abscess with ill defined
histiocytes. AFB staining of the tissue
was positive. Chest X ray showed
infiltrations and cavities. Mantoux test
was positive.

medpox.com

a) Scrofuloderma

b) Skin abscess

c) Furuncle

d) Cellulitis
 d) Cellulitis

Correct Answer - A
Answer- A. Scrofuloderma
Scrofuloderma occurs as a result of spread of infection to the skin
from an underlying tuberculosis focus, usually a lymph node but also
infected bones or joints. The lesions start as firm, painless and
subcutaneous nodules that gradually enlarge and suppurate and
then, form ulcers and sinus tracts in the overlying skin. Typical
ulcers have undermined edges and a floor of granulation tissue.

medpox.com
1694. Goldenhar syndrome is associated with
which prominent ocular manifestation:
a) Microcornea

b) Megalocornea

c) Sclerocornea

d) Epibulbar dermoids

Correct Answer - D
Ans. Epibulbar dermoids
Goldenhar syndrome (oculoauriculovertebral dysplasia with
medpox.com
hemifacial microsomia) is a rare congenital developmental anomaly
involving the first and second branchial arches.
The classic features of this syndrome include ocular changes such
as microphthalmia, epibulbar dermoids, lipodermoids and coloboma;
aural features such as preauricular tragi, hearing loss and microtia;
and vertebral anomalies such as scoliosis, hemivertebrae and
cervical fusion.
Other ocular anomalies are rare but include microphthalmos,
microcornea, anophthalmos, eyelid colobomas, iris and choroid
colobomas, motility disorders, strabismus, blepharoptosis, palpebral
fissure, iris atrophy, polar cataract, anomalous lacrimal drainage
system, and retinal and optic nerve anomalies
1695. True about SLE is?
a) Autoimmune disease

b) Childhood SLE had poor prognosis than adult SLE

c) Presence of ANA

d) All are true

Correct Answer - D
Ans. is 'd' i.e., All are true
SLE (sytemic lupus Erythematosus)
Autoimmune disorder
Inflammation of blood vessel medpox.com
Childhood SLE had poor pnognosis than adult SLE
Hall mark of SLE is presence of antinuclean antibody (ANA)
More common in female.
Malar rash in pathognomic of SLE
Non - erosive arthritis
Nephritis
Encephalopathy
Pleuritis / Pericarditis
Cytopenia
1696. 8 year old child with hematuria in 5
days after throat infection?
a) Post streptococcal nephropathy

b) Ig A nephropathy

c) Nephrotic syndrome

d) can be a or b

Correct Answer - B
Ans. is 'b'i.e., Ig A Nephnopathy
IgA nephropathy
medpox.com
Predominant deposition of IgA in glomeruli.
RECURRENT episode of gross rematuria that also precipitation by
URTI in last 2-5 days.
PSGN
Acute GN following infection by group A - -hemolytic streptococci.
Common in school age children. o Streptococcal infection usually of
throat (4 or 12 strain) or skin (strain 49) by 1-4 week prior to AGN.
Edema, oliguria, hypertension, ARF, hematurea of abrupt onset.
1697. Meconium can passed upto → days in
healthy bady -
a) 1

b) 3

c) 5

d) 7

Correct Answer - B
Answer- B. 3
Meconium is passed within → 24 hours of birth.
medpox.com
Meconium stools are passed → upto 3 days.
Transition stools are passed → zith & 5th days.
Regular milk stools are passed → After 5 days.
1698. In HSP gross hematurea is seen in what
% of children?
a) 5 - 10%

b) 10 - 20%

c) 20 - 30%

d) 30 - 40%

Correct Answer - C
Ans. is 'c' i.e., 20 - 30%
Henoch-schonlein_purpura (HSP)
Small vessel vasculitis medpox.com
Purpuric rash
Arthritis
Abdominal pain
Glomerulonephritis
Gross hematuria is seen in 20-30% of cases
1699. Child has lesion on buttocks since 2
year spreading peripherally with central
scarring non symptomatic diagnosis?
a) Erythema annular cetrifugam

b) Erythema migrains

c) Erythema marginatum

d) Erythema Gyratum

Correct Answer - A
Ans. is 'a' i.e., Erythema annulase cetrifugam
medpox.com
Erythema annulare centrifugum : an asymptomatic or pruritic
eruption of variable duration. The eruption may be associated with
an underlying disease (eg, infection, malignancy, sarcoidosis, other
systemic illness)
The eruption begins as erythematous papules that spread
peripherally while clearing centrally. These lesions enlarge at a rate
of approximately 2-5 mm/d to produce annular, arcuate, figurate,
circinate, or polycyclic plaques
Lesions demonstrate a predilection for the thighs and the legs, but
they may occur on the upper extremities, the trunk, or the face. The
palms and the soles are spared.
Erythema migrans: These lesions are typically less numerous, less
circinate in configuration, and often accompanied by a history of a
tick bite.
Erythema gyratum repens: EAC can be distinguished from this
condition by its slower rate of spread and by its less bizarre
configuration. Also, erythema gyratum repens is almost always
associated with an underlying malignancy.
Erythema marginatum rheumaticum: This is a nonscaling gyrate
erythema that by definition is found in association with rheumatic
fever (10-18% of patients with rheumatic fever).

medpox.com
1700. 7 year old boy is ill and has fever. what
is the caloric requirement?
a) 1200 kcal/d

b) 1500 kcal/d

c) 1900 kcal/d

d) 2200 kcal/d

Correct Answer - C
Ans. is 'c' i.e., 1900 kcal/day
Children
6 year 7 -> 1690 medpox.com
9 year -> 1950
1701. Boy power school preference no
spoken at school, normal speech at
other place, IQ assessment normal
diagnosis is?
a) Selective mutism

b) ADHD

c) Autism

d) Dyslexia

Correct Answer - A medpox.com

Ans. is 'a' i.e., Selective mutism
Autism typically diagnosed before 36 month of age.
Autism is a neurodevelopmental disorder of unknown etiology, but
with a strong genetic basis.
It develops and is typically diagnosed before 36 mo of age.
It is characterized by a behavioral phenotype that includes
qualitative impairment in the areas of language development or
communication skills, social interactions and reciprocity, and
imagination and play.
Selective mutism is defined as a failure to speak in specific social
situations, despite speaking in other situations; it is typically a
symptom of an underlying anxiety disorder. Children with selective
mutism can speak normally in certain settings, such as within their
home or when they are alone with their parents, but do not speak in
other social settings, such as at school or at other places outside
their home.
Attention-deficit/hyperactivity disorder (ADHD) is the most common
neurobehavioral disorder of childhood, 1 of the most prevalent
chronic health conditions affecting school-aged children.
ADHD is characterized by:
Inattention, including increased distractibility and difficulty sustaining
attention.
Poor impulse control and decreased self-inhibitory capacity
Motor overactivity and motor restlessness.
Dyslexia is characterized by an unexpected difficulty in reading in
children and adults who otherwise possess the intelligence,
motivation, and opportunities to learn considered necessary for
accurate and fluent reading. Dyslexia is the most common and most
comprehensively studied of the learning disabilities

medpox.com
1702. Kangaroo mother care - False is?
a) Can also be given by father

b) Especially for low birth weight body

c) Effective thermal control

d) All of above

Correct Answer - A
Ans.:A.)Can also be given by father
KANGAROO MOTHER CARE
• KMC is care of preterm or LBW infants by placing skin-to-skin
contact with the mother medpox.com
• Position: vertical position between the mother's breasts and under
her clothes
• The position is maintained until the infant no longer tolerates it
(indicated by sweating or baby refuses to stay in KMC position)
• Kangaroo nutrition: exclusive breast feeding
• Continuous KMC is an alternative to minimal care in an incubator
for infants who have already overcome major problems while
adapting to extra-uterine life
Able to suck and swallow properly
Thriving in neutral thermal environment
• Intermittent KMC (atleast 1-2 hour) when continuous KMC is not
possible
• All mothers can provide KMC irrespective of age, parity, education,
culture or religion
• Initiated in a facility and continued at home
Clinical benefits
• Significantly increases milk production in mothers
• Increases exclusive breast feeding rates
• Reduces incidence of respiratory tract and nosocomial infection
• Better cardiorespiratory stability
• Fewer apneic episodes
• Improved weight gain
• Improves thermal protection in infants and there is a reduced
chance of hypothermia
• Improves emotional bonding between the infant and mothers
• Reduces the duration of hospital stay
• Improved survival in low resource setting
Criteria for eligibility for KMC
• Indicated in all stable LBW babies
• Very sick babies needing special care should be cared for under
radiant warmer initially. KMC should be started after the baby is
hemodynamically stable
• Short KMC sessions can be initiated during recovery with ongoing
medical treatment
• KMC can be provided while the baby is being fed via orogastric
tube or on oxygen therapy
• BW > 1800g: generally stable at birth and KMC initiated soon after
medpox.com
birth
• BW 1200 — 1799 g: many babies have significant neonatal
problems. It might take a few days to start KMC
• BW < 1200g: it might take days to weeks before initiating KMC
When to stop KMC
• When the baby attains a weight of 2500g and a gestation of 37
weeks
• A baby who upon being put in kangaroo position, tends to wriggle
out, pull limbs out or cries, is not in need of KMC any more
1703. Hypocalcemia in a child may be
associated with
a) Digeorge syndrome

b) Hypo parathyroidism

c) Magnesium deficiency

d) All of above

Correct Answer - D
Ans. is 'd' i.e., All of above
Causes of hypocakemia
Hypo parathyroidism medpox.com
Digeorge syndrome
PTH receptor defect (pseudo hypoparathyroidism)
Magnesium dificiency
Exogenous organic phosphate excess
Vit D difeciency
1704. 3 days old newborn with unknown
inborn error of
metabolism, hyperammonemia in
blood.
a) Maple syrup urine disease

b) Urea cycle enzyme dificiency

c) Organic acidurea

d) Phenyl ketonuria

Correct Answer - B medpox.com

Ans. is 'b' i.e., Urea cycle enzyme deficiency
Urea cycle enzyme defect
Catabolism of amino acid leads to free ammonia which is highly
toxic
Free ammonia is converted into urea by group of 5 enzyme
Newborn is usually asymphomatic but leter on become symptomatic
after giving protein
Treatment is dietery protein restriction
MSUD (maple syrup urine disease)
Defective decorboxglation of branch chain amino acid (leucine,
Isoleuvine, valine)
Autosomal recessine
Smell of maple syrup in urine.
Phenyl ketonuria
Autosomal recessive
Deficiency of phenylalanine hydroxylase.
Defect in conversion of phenylalanine to tyrosine.
This leads to increase level of phenylalanine.
This increase phenlylalanine converted into phenylpyruvate and
phenyl acetate.
This phenyl acetate gives mousy or musty odour in urine/body.
Other point to remember?
Sweaty feat odour -Isovaleric academia
In Alkaptanuria - Urine become darkish brown when exposed to air
while purplish brown in porphyria.
Smoky sweat - MSUD
Mousy or Musty - Phenylketonuria
Boiled cabbage - Tyrosinemia

medpox.com
1705. 13 year old female having sudden onset
high grade fever with delirium. CT.
finding s/o involvement of limbic
system & medial temporal lobe - Dx is
a) Subarachnoid hemorrhage

b) Herpes simplex encephalitis

c) Pyomeningitis

d) Cerebral malaria

Correct Answer - B medpox.com

Ans. is 'b' i.e., Herpes simplex encephalitis
Herpes simplex encephalitis
Acute necrotising infection involving frontal, temporal lobe & limbic
system.
Feature Non specific - fever, headache, nuchal rigidity. convulsion,
altered sensorium.
Confirmed by CSF examin & radio imaging.
Treatment supportive and Acyclovir
1706. Jaipur foot was invented by ?
a) P. K. Sethi

b) S. K. Verma

c) B. L. Sehgal

d) H. R. Gupta

Correct Answer - A
Ans. is 'a' i.e., P. K. Sethi
P. K. Sethi. Pramod Karan Sethi (28 November 1927 - 6 January
2008) was an Indian orthopaedic surgeon. With Ram Chandra
Sharma, he co-invented the "Jaipur foot", an inexpensive and
medpox.com
flexible artificial limb, in 1969.
1707. Metaphyseal fracture touching physis
but not crossing it, comes under which
type of Salter Harris physeal injury?
a) I

b) II

c) III

d) IV

Correct Answer - B
Ans. is 'b' i.e., II medpox.com
Salter and Harris have classified epiphyseal injuries into five
types -
Type I : Complete separation of epiphysis from the metaphysis
without fracture. Common in rickets, scurvy and osteomyelitis.
Type II : The fracture involves the physis and a triangle of
metaphyseal bone (Thurston Holland sign) i.e. metaphyseal fracture
touching the physis but not crossing it. This is the commonest type
of epiphyseal injury accounting for 73 percent of cases over 10
years of age.
Type III :The fracture is intra- articular and extends along the physis
and then along the growth plate. This injury is relatively uncommon.
Type IV : The fracture is intra- articular and extends through the
epiphysis, physis and metaphysis. Perfect reduction is necessary
and open reduction is more often necessary to prevent growth
arrest.
Type V : Crushing of epiphysis. Growth arrest usually follows.
Type VI (Rang's type) : There is a peripheral physis (perichondrial
ring) injury.
medpox.com
1708. Which of the following is true about
hallux valgus?
a) Great toe points laterally

b) Great toe points medially

c) Lateral angulation of the 1 stmetatarsophalyngeal joint

d) Dorsal angulation of the lstmetatarsophalyngeal joint

Correct Answer - A
Ans. is 'a' i.e., Great toe points laterally
Hallux valgus
medpox.com
Hallux valgus is lateral (outward) deviation of great toe at the
metatarsophalangeal joint.
It is the commonest foot deformity.
It is common in women past middle age, and is not infrequent even
in young women.
Common causes are :
Rheumatoid arthritis
Wearing pointed shoes with high heels
Hereditary factors
Idiopathic
Pathology
Outward deviation of the great toe.
After several years two secondary changes occur :-
i) Formation of a thick walled bursa (bunion) over the medial
prominence of 1" metatarsal head.
ii) Osteoarthritis of metatarsophalangeal joint.
It is worth noting that medial prominence over metatarsal head looks
like an exostosis, but there is no true exostosis.
Lateral deviation of great toe causes overcrowding of lateral toes
and sometimes overriding of adjacent toes.

medpox.com
1709. Callus formation is seen between what
duration of fracture healing ?
a) 0 - 2 weeks

b) 2 - 4 weeks

c) 4 - 12 weeks

d) 12 - 16 weeks

Correct Answer - C
Ans. is 'c' i.e., 4 - 12 weeks
Healing of a fracture
medpox.com
The process of fracture healing varies according to the type of bone
involved and the amount of movement at the fracture site. Following
healing processes are there :?
Indirect fracture healing (healing by callus)
This is the 'natural' form of healing in tubular bones and in the
absence of rigid fixation when there is micromovement at fracture
site. There is formation of internal and external callus. This stage is
divided in three phases which are further subdivided into five stages
:
1710. Most common cause of amputation in
India is ?
a) Diabetic gangrene

b) Gas gangrene

c) Road traffic accident

d) Tumors

Correct Answer - C
Ans. is 'c' i.e., Road traffic accident
Amputation
medpox.com
Amputation is a procedure where a part of the limb is removed
through one or more bones.
Disarticulation is a procedure where the limb is removed through a
joint.
Indications of amputation
Indications of amputations may be absolute or relative :?
A) Absolute indications
Gas gangrene
Diabetic gangrene
Irreparable loss of blood supply due to trauma or disease
Peripheral vascular disease (Burger's gangrene)
B) Relative indications
Trauma
Tumors
Severe loss of function of limb
Nerve injuries
Congenital anomalies
Overall most common cause of amputation is trauma (injury) to a
limb.
Most common cause of trauma is road traffic accident.

medpox.com
1711. Which of the following structure are not
normally visualized during the
arthroscopy of the knee?
a) Meniscus

b) Cruciate ligaments

c) Collateral ligaments

d) Patella articular surface

Correct Answer - C
Ans. is 'c' i.e., Collateral ligaments
medpox.com
The following structures are visualized during the knee
arthroscopy :-
i) Medial and lateral meniscus
ii) Anterior and posterior cruciate ligaments
iii) Knee articular cartilage
iv) Patello - femoral joint
v) Loose bodies in joint
 1712. Cock up splint is used in treatment of ?
a) Radial nerve palsy

b) Ulnar nerve palsy

c) Median nerve palsy

d) Posterior interosseous nerve palsy

Correct Answer - A
Ans. is 'a' i.e., Radial nerve palsy
Splints
Any material which is used to support a fracture is called splint.
Splints are used for immobilizing fractures; either temporarily during
medpox.com
transportation or for definitive treatment.
The most commonly employed splints is plaster of paris (POP)
splint. Various POP splints are.
1. Casts : - Here the POP roll completely encircles the limb.
2. Slab : - It is not completely encircles the limb, but only one half or
one third circumference.
3. Spica : - This encircles a part of the body; e.g., hip spica for
fractures around hip.
1713. Thomas splint is used for immobilizing
fractures of ?
a) Femur

b) Tibia

c) Radius

d) Ulna

Correct Answer - A
Ans. is 'a' i.e., Femur
Splints
medpox.com
Any material which is used to support a fracture is called splint.
Splints are used for immobilizing fractures; either temporarily during
transportation or for definitive treatment.
The most commonly employed splints is plaster of paris (POP)
splint. Various POP splints are:-
1) Casts : - Here the POP roll completely encircles the limb.
2) Slab : - It is not completely encircles the limb, but only one half or
one third circumference.
3) Spica : - This encircles a part of the body; e.g., hip spica for
fractures around hip.
 1714. Functional cast bracing not used in
fracture of ?
a) Humerus

b) Tibia

c) Ulna

d) Thoracolumbar spine

Correct Answer - D
Ans. is 'd' i.e., Thoracolumbar spine
Functional cast bracing is used for the fracture of :-
i. Humerus medpox.com
ii. Femur
iii. Ulna
iv. Tibia
1715. Gallows traction is used for fracture:
a) Shaft femur

b) Neck femur

c) Shaft tibia

d) Tibial tuberosity

Correct Answer - A
Ans. a. Shaft femur
Gallow's traction is used for treatment of fracture shaft of femur, in
infants and children
Gallow's Traction medpox.com
Gallow's traction is used for treatment of fracture shaft of femur, in
infants and children
Weight must not be >12 kgs
Both the fractured and the normal femur are placed in skin traction
and infant is suspended by these from a special frame. The buttocks
should be lifted just off the bed so that the weight of the body
provides counter traction and the fracture is reduced
Uses of Tractions
Name Use
Bryant's Fracture shaft of femur in
Traction Q children
Gallow's Fracture shaft of femur in
TractionQ children
Russel's Fracture shaft of femur in
Traction Q older children
Perkin's Fracture shaft of femur in
Traction Q adults
Fracture shaft of femur in
90°-90° Fracture shaft of femur in
TractionQ children
Agnes-Hunt
Correction of Hip deformit
TractionQ
Well-Leg Correction of adduction or
TractionQ abduction deformity of hip
Dunlop Supracondylar fracture of
TractionQ humerus
Smith's Supracondylar fracture of
TractionQ humerus
Uses of Tractions
Name Use
Calcaneal Open fractures of
Traction ankle or leg
Metacarpal Open forearm
Traction fractures
Head-Halter Cervical spine
Traction injuries medpox.com
Crutchfield Cervical spine
TractionQ injuries
Halo-Pelvic
Scoliosis
Traction
1716. What about durham pin is true ?
a) It is used to give skeletal traction

b) It has threads in the center of pin

c) It is used to give skeletal traction through calcaneum

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
Denham pin
It is a type of pin used to give skeletal traction.
Threaded portion of the pin engages the bony cortices and reduces
medpox.com
the chances of pin sliding.
This type of pin is used commonly to give skeletal traction through
the cancellous bone i.e. calcaneum. It can also be used to give
traction through osteoporotic bones.
1717. Patient comes with crush injury to
upper limb, doctor is concerned about
gangrene and sepsis what can help
decide between amputation and limb
salvage?
a) MESS

b) Guliton score

c) Gustilo Anderson classification

d) ASIA guidelines

medpox.com
Correct Answer - A
Ans. is 'a' i.e., MESS
MESS (Mangled Extremity Severity Score) :
Estimates viability of an extremity after trauma, to determine need
for salvage vs empiric amputation.
Following parameters are looked for :-
i) Limb ischemia
ii) Patient age range
iii) Shock
iv) Injury mechanism
1718. The most common bone fractured
during birth
a) Clavicle

b) Scapula

c) Radius

d) Humerus

Correct Answer - A
A i.e. Clavicle
Clavicle is the most common bone to be fractured in children and
during birth. medpox.com
 1719. All are true about colles fracture except
?
a) In old age

b) Dorsal shift

c) At cortico-cancellous junction

d) Garden spade deformity

Correct Answer - D
Ans. is 'd' i.e., Garden spade deformity
COLLES FRACTURE
medpox.com
Colle's fracture is an extra-articular fracture at the distal end of
radius, at its cortico-cancellous junction. It is the most common
fracture in person over 40 years of age and especially in women
after menopause (Postmenopausal females). The association of the
fracture with osteoporosis is now well established and it is one of the
fragility fracture, seen in osteoporosis. The fracture nearly always
caused by fall on outstretched hand.
Displacement in colle's fracture
The fracture line runs transversely at the cortico-cancellous junction.
In the majority of the cases, one or more displacements of the distal
fragment occur :-
i. Dorsal displacement (Dorsal shift)
ii. Lateral tilt (lateral angulation)
iii. Dorsal tilt (Dorsal angulation)
iv. Supination (external rotation)
v. Lateral displacement (lateral shift)
vi. Impaction (proximal migration)
vii. Clinical features of colles fracture
Pain and swelling at the wrist.
Typical deformity : There is a dorsal hollow or depression just
proximal to the fracture and immediately distal to this there is a
marked prominence caused by lower fragment being displaced
backwards, carrying with it the whole of the carpus and hand. This
gives appearance of a fork, So named dinner fork/ silver fork / spoon
shaped deformity.

medpox.com
1720. Most common type of supra condylar
fracture in children ?
a) Posteromedial extension

b) Posterolateral extension

c) Anteromedial flexion

d) Anterolateral flexion

Correct Answer - A
Ans. is 'a' i.e., Posteromedial extension
Supracondylar fracture of humerus
medpox.com
Supracondylar humeral fractures are the most common elbow
fractures in children. Most common age group affected is 5-8 years.
Boys are affected more than girls. Left side is more common than
right.
Mechanism of injury
Mostly it occurs due to hyperextension injury.
Fracture is caused by a fall onto the outstretched hand with
hyperextension at elbow.
Types of supracondylar fracture
Supracondylar fracture is broadly classified into extension type and
flexion type.
1) Extension type
It is the most common type (97 - 99%).
Distal fragment is extended (tilted backward/posteriorly) in relation to
proximal fragment.
Occurs due to hyperextension injury after fall on outstretched hands.
Generally, displacement of distal fragment may be : -
i) Posteromedial (70-80%)
ii) Posterolateral (20-30%)
2) Flexion type
It is less common type (1-3 %)
Distal fragment is flexed (tilted forward/anteriorly) in relation to
proximal fragments.
The mechanism of injury generally is believed to be a fall directly
onto the elbow rather than a fall on outstretched hand.
As the extension type fracture is more common (97 - 99%), the most
common elbow injury in children is extension type of supracondylar
fracture.
Clinical features of supracondylar fracture
Following a fall, the child is in pain and elbow is swollen.
In extension type of injury, `S' shaped deformity of the elbow is
obvious.
There is loss of both active and passive movements of elbow.
Symptoms relating to vascular and nerve injury may be seen.
Unusual posterior prominence of the point of elbow (tip of olecrenon)
because of backward tilt of the distal fragment.
Three point bony relationship is maintained as the fracture is above
the level of condyles. medpox.com
Dimple sign due to one of the spikes of proximal fragment
penetrating the muscle and tethring the skin.
1721. Not a complication of fracture neck of
femur ?
a) Non-union

b) Malunion

c) AVN

d) Osteoarthritis

Correct Answer - B
Ans. is 'b' i.e., Malunion
Complications of femoral neck fracture
medpox.com
Fractures of the neck of the femur are more prone to serious
complications than in any other fracture. All the complications affect
fractures with displacement rather than impacted abducted (valgus
impacted) fractures.
The important complications are :
1) Avascular necrosis of femoral head
AVN is the most common complication of femoral neck fracture.
It occurs in 15-35% of cases of displaced fractures and
2) Non-union
Non-union is the second most common complication of femoral neck
fracture.
It occurs in 10-30% of cases of displaced fractures and
3) Secondary osteoarthritis
It occurs a few years following fracture neck femur.
Avascular necrosis or collapse of femoral head leads to secondary
osteoarthritis of the hip joint.
1722. Garden's classification used for which
fracture?
a) Surgical neck humerus

b) Shaft humerus

c) Neck of femur

d) Shaft femur

Correct Answer - C
Ans. is 'c' i.e., Neck of femur
Garden's classification
medpox.com
Garden's classification is the most useful and most accepted
classification of the neck of femur. This is based on the degree of
displacement of the fracture. Following 4 stages of fracture are there
:?
1) Stage 1 : The fracture is incomplete, with head tilted in postero-
lateral direction, i.e. into valgus, therefore is known as valgus
(abduction) impacted fracture.
2) Stage 2 : Complete fracture but undisplaced.
3) Stage 3 : Complete fracture with partial displacement.
4) Stage 4 : Complete fracture with total displacement.
The degree of displacement, in Garden's classification, is judged
from change in the direction of medial trabecular stream of the neck,
in relation to the bony trabeculae in the weight bearing part of the
head and in the corre​sponding part of the acetabulum.
i) Stage 1 :- There is an obtuse angle laterally at the trabecular
stream.
ii) Stage 2 :- Trebeculae between head and neck are broken but
they are in alignment with each other and with trabeculae in the
acetabulum.
iii) Stage 3 :- All three trabeulae are out of alignment.
iv) Stage 4 :- Acetabular and head trabeculae are in alignment but
head and neck trabeculae are not aligned.

medpox.com
1723. Radiological factors indicating an
unstable pelvis are all except ?
a) Posterior sacroiliac complex displacement by > 1 cm

b) Avulsion fracture of sacral or ischial end of the sacrospinous

ligament

c) Avulsion fractures of the L5 transverse process

d) Isolated disruption of pubic symphysis with pubic diastasis of 2

cm.

Correct Answer - D
medpox.com
Ans. is 'd' i.e., Isolated disruption of pubic symphysis with
pubic diastasis of 2 cm
Radiographic factors indicating unstable pelvis are :-
Posterior sacroiliac complex displacement by > lcm
Avulsion fracture of sacral or ischial end of the sacrospinous
ligament
Avulsion fractures of the L5 transverse process
Disruption of pubic symphysis with pubic diastasis of 2 cm with
posterior pelvic injury or injury to anterior/ posterior sacroiliac
ligament or sacrospinous ligaments.
Presence of gap rather than impaction in the posterior pelvic ring.
1724. Pipkin's classification system is used
for ?
a) Fracture femur head

b) Fracture femur shaft

c) Fracture proximal tibia

d) Fracture calcaneum

Correct Answer - A
Ans. is 'a' i.e., Fracture femur head
Pipikin's classification of femoral head fracture
medpox.com
Type I : Femoral head fracture inferior (caudal) to fovea.
Type II : Femoral head fracture superior (cephalad) to fovea.
Type III : Femoral head fracture with associated femoral neck
fracture.
Type IV : Type I, II or III with associated acetabular fracture.
1725. One of the common fractures that occur
during boxing by hitting with a closed
fist is ?
a) Monteggia fracture dislocation

b) Galeazzi fracture dislocation

c) Bennett's fracture dislocation

d) Smith's fracture

Correct Answer - C
Ans. is 'c' i.e., Bennett's fracture dislocation
medpox.com
The common mechanism of injury for Benett's fracture is an axial
blow directed against the partially flexed metacarpal, in most cases
during 'fist fights'.
Benett's fracture
Benett's fracture is an intra-articular fracture dislocation of the
palmar base of first metacarpal bone of the thumb with either
subluxation or dislocation of first carpometacarpal joint, i.e.
trapezometacarpal joint. The common mechanism of injury is an
axial blow directed against the partially flexed metacarpal, in most
cases during "Fist fights ". Patient complains of pain, swelling and
tenderness over the base of the thumb. Movements of thumb are
restricted.
Displacing force in Bennett's fractures
Following are the deforming forces in Bennett's fracture :-
i) At the distal fragment, it is the adductor pollicis.
ii) At the proximal fragment, it is the abductor pollicis longus.
Base of the thumb metacarpal is pulled dorsally and medially by the
abductor pollicis longus, while the distal attachment of adductor
pollicis further levers the base into abduction.

medpox.com
 1726. Most common complication of mid
shaft humerus fracture is ?
a) Radial nerve palsy

b) Median nerve palsy

c) Nonunion

d) Malunion

Correct Answer - A
Ans. is 'a' i.e., Radial nerve palsy
Complications of humerus shaft fracture
medpox.com
1. Nerve injury : - Radial nerve is the most commonly injured nerve in
fracture shaft humerus. It is particularly common in oblique fractures
at the junction of middle and distal third of the bone (Holstein- Lews
fracture).
2. Vascular injury : - Brachial artery damage.
3. Delayed union or non-union : - Delayed union or non-union may
occur, especially in transverse fracture of the midshaft. The cause of
non-union is distraction at fracture site due to gravity and weight of
plaster.
4. Joint stiffness : - Shoulder & elbow stiffness.
1727. Motorcyclist's fracture is ?
a) Stellate fracture across base of skull

b) Transverse fracture across base of skull

c) Lamina fracture of CI vertebra

d) Spinous process fracture of C7 vertebra

Correct Answer - B
Ans. is `b' i.e., Transverse fracture across base of skull
Motorcyclist's fracture
Because of the inherent instability of two wheeled vehicles, the rider
and passanger inevitably fall to the ground in a crash. Injuries can
medpox.com
occur to any part of the body, but the limbs and head are particularly
susceptible to serious injury.
Impact with the road surface or another vehicle at speed often
causes skull fracture, even in the presence of a helmet.
A transverse fracture across the floor of the skull, usually called a
"hinge fracture", is sometimes referred to as motorcyclist fracture. At
autopsy, the base of the skull may be appriciated to have divided
into two halves, each moving independently of each other like a
hinge, the so-called motorcyclist fracture.
1728. March fracture is fracture of:
September 2007
a) Calcaneus

b) 2nd metatarsal

c) Distal fibula

d) Proximal tibia

Correct Answer - B
Ans. B: 2nd metatarsal
A stress fracture of the 2nd or 3rd metatarsal bone is sometimes
medpox.com
called a 'march fracture' because soldiers running in boots often get
it.
The fracture heals spontaneously, so treatment is purely
symptomatic.
1729. What is not true about pulled elbow?
a) Occurs due to sudden axial pull on extended elbow

b) Forearm is held in pronation and extention

c) Most commonly occurs between 2-5 years of age

d) Treatment is quick pronation and flexion of elbow

Correct Answer - D
Ans. is 'd' i.e., Treatment is quick pronation and flexion of
elbow
Pulled elbow
If a young child is lifted by the wrist, the head of the radius may be
medpox.com
pulled partly out of the annular ligament, i.e., subluxation of the head
of the radius.
It occurs when forearm is pronated, elbow is extended and
longitudinal traction is applied to the hand or wrist, e.g., lifting,
spinning or swinging a child with wrist or hand. Pulled elbow most
commonly occurs between the age of 2-5 years.
Clinical features of pulled elbow
History of sudden axial pull on extended elbow.
Immediately child starts crying and is unable to move the affected
elbow.
The forearm is held in pronation and extension and any attempt to
supinate is resisted.
Child does not allow to touch the affected limb.
X-ray seems to be normal.
Treatment of pulled elbow
Treatment is simple. The child's attention is diverted, the elbow is
quickly supinated and then slightly flexed.
This reduces the subluxation or dislocation and the radial head is
relocated with a snap.

medpox.com
1730. Hangman's fracture is the fracture
involving which cervical vertebra?
a) C1

b) C2

c) C3

d) C4

Correct Answer - B
Ans. is 'b' i.e., C2
Hangman's fracture is a bilateral fracture of the pars interarticularis
medpox.com
of the axis (C2) with a traumatic spondylolisthesis of axis (C2) over
the C3 vertebrae. Thus Hangman's fracture is not simply a fracture,
but fracture-dislocation of the axis (C2).
The mechanism of injury is an extension with distraction (in true,
judicial hangman's fracture) and hyper-extension, axial compression
& flexion (in civilian injuries, which are now more common).
It is the second most common type of Axis (C2) fracture, second only
to odontoid fractures.
Fatalities are common, However, neurological deficit is unusual as
the fracture of the posterior arch decompresses the spinal cord.
Most of the fatalities occur at the scene of injury, acute post-
admission mortality is low.
Successful healing of C2 traumatic spondylolisthesis is reported to
approach 95%. This is most commonly achieved with non-operative
measures, even in the presence of displacement of pars inter-
articularis.
1731. Most common site for the osteoporotic
vertebral fracture is ?
a) Dorsolumbar spine

b) Cervical spine

c) Lumbosacral spine

d) Dorsal spine

Correct Answer - A
Ans. is 'a' i.e., Dorsolumbar spine
Osteoporosis is an asymptomatic disorder unless complications
medpox.com
(predominantly fractures) occur.
Most common symptom of osteoporosis is back pain secondary to
vertebral compression fracture.
Dorso-lumbar spine is the most frequent site.
Other common sites of fracture are lower end radius (Colle's
fracture) and fracture neck femur.
Osteoporotic fracture (fragile fractures) are : (i) Fracture vertebrae
(most common), (ii) Colle's fracture, (iii) Fracture neck femur.
Serum calcium, phosphate and alkaline phosphatase are normal in
osteoporosis.
1732. When do you operate for prolapsed disc
?
a) Busy executive needs quick surgery

b) Only with weakness no pain

c) Severe pain interfering with activity and not relieved by rest and
treatment of 8 weeks

d) Patient of PID with difficulty in ambulation

Correct Answer - C
Ans. is 'c' i.e., Severe pain interfering with activity and not relieved
medpox.com
by rest and treatment of 8 weeks
Indications for surgery in cases of Prolapsed intervertebral disc are
:-
i) Failure of conservative treatment (even after 8 weeks of
treatment).
ii) Progressive neurological deficit.
iii) Cauda - equina syndrome.
iv) Severe sciatic tilt.
1733. Vertebral rotation in scoliosis is
checked in
a) Forward bending

b) Backward bending

c) Sideways

d) Without bending

Correct Answer - A
Ans. is 'a' i.e., Forward bending
The forward bending test is very sensitive in demonstrating the
medpox.com
vertebral rotation that takes place in a structural scoliotic curve.
Quantification of the rotation is done by measuring the rib hump by
use of inclinometer or scoliometer.
Severity of the curve in scoliosis is measured by cobb's angle, i.e. an
angle between line passing through the margins of vertebra at ends
of curve. To use the cobb method, one must first decide which
vertebrae are the end-vertebrae of the curve. These end vertebrae
are the vertebrae at the upper and lower limits of curve which tilt
most severely toward the conavity of the curve. Other method used
to measure scoliosis angle is Ferguson's method.
1734. Test used for prolapsed lumbar
intervertebral disc is -
a) Active straight leg raising test

b) Lasegue test

c) Thomas test

d) Apley's grinding test

Correct Answer - B
Ans. is 'b' i.e., Lasegue test
Clinical examination in PID
medpox.com
Forward stooping (bending), twisting or coughing aggravate the
pain.
The trunk is tilted to one side (sciatic scoliosis or sciatic tilt).
Movements of lumbar spine are restricted especially flexion.
Straight leg raising (SLR) test is positive, i.e. straight leg raising is
possible 40° or less (AIIMSO4).
Lasegue test (a modification of SLR test) is positive.
1735. Lumbar canal stenosis presents as ?
a) Claudication

b) Scoliotic deformity

c) Kyphotic deformity

d) Radiculopathy

Correct Answer - A
Ans. is 'a' i.e., Claudication
The patient of lumbar canal stenosis is usually a man aged over 50,
complains of aching, heaviness, numbness and paraesthesia in the
thighs and legs; it comes on after standing upright or walking for 5-
medpox.com
10 minutes, and is consistently relieved by sitting, squatting or
leaning against a wall to flex the spine (hence the term 'spinal
claudication').
 1736. Posterior gliding of tibia on femur is
prevented by ?
a) Anterior cruciate ligament

b) Posterior cruciate ligament

c) Medial collateral ligament

d) Lateral collateral ligament

Correct Answer - B
Ans. is 'b' i.e., Posterior cruciate ligament
Posterior cruciate ligament
medpox.com
PCL begins from posterior part of intercondylar area of tibia and runs
upwards, forwards and medially to attach the anterior part of the
lateral surface of medial condyle of femur.
PCL is extrasynovial but intracapsular, i.e., lies between synovium
and capsule of the knee joint.
It provides antero-posterior stability and prevents posterior gliding of
tibia on femur.
It is taut in flexion.
Blood supply of cruciate (anterior & posterior) ligaments is from : -
1. Middle genicular artery (major supply)
2. Inferior genicular (medial & lateral) artery (less important).
Nerve supply of cruciate ligaments (ACL & PCL) is from posterior
articular branch of tibial nerve.
 1737. Lachmann's test is used for ?
a) ACL injury

b) PCL injury

c) MCL injury

d) LCL injury

Correct Answer - A
Ans. is 'a' i.e., ACL injury
ACL injury
ACL is the most commonly injured ligament of knee.
Most common mechanism of injury is twisting (medial rotation) with
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valgus injury on semiflexed knee.
Often with this mechanism MCL and medial meniscus are also
injured. This triple injury of ACL , MCL and medial meniscus is called
O'Donghue triad.
Isolated ACL can also be injured by hyperextension injury.
Tests for ACL injury
Following tests are used for ACL injury : ?
i. Lachman's test
ii. Pivot shift test
iii. Flexion-rotation drawer test
iv. Anterior drawer test
v. Jerk test
vi. Loose's test
Lachman's test is the most sensitive test for anterior cruciate
ligament tears. It is done with the knee flexed at 20 degrees. So it
can be done in acute as well as chronic injuries. (because in acute
cases with hemarthrosis more flexion is usually not possible so
performing anterior drawer test is difficult).
medpox.com
1738. Which among the following is not a
feature of Unhappy triad of 0'
Donoghue?
a) ACL injury

b) Medial meniscus injury

c) Medial collateral ligament injury

d) Fibular collateral ligament injury

Correct Answer - D
Ans. is 'd' i.e., Fibular collateral ligament injury
medpox.com
The most common mechanism of ligament disruption of knee is
adduction (valgus), flexion and internal rotation offemur on tibia
which usually occur in sports in which the foot is planted solidly on
the ground and leg is twisted by rotating body (i.e., foot ball, soccer,
basket ball, skiing).
The medial structures medial (tibial) collateral ligament (MCL) and
medial capsular ligament are first to fail, followed by ACL tears, if the
force is of sufficient magnitude. The medial meniscus may be
trapped between condyles and have a peripheral tear, thus
producing unhappy triad of 0' Donoghue.
1739. Commonest ligament injured in ankle
injury ?
a) Anterior talofibular ligament

b) Calcaneofibular ligament

c) Posterior talofibular ligament

d) Spring ligament

Correct Answer - A
Ans. is 'a' i.e., Anterior talofibular ligament
The ankle is one of the most common sites for acute
medpox.com
musculoskeletal injuries. Sprains constitute 85% of all ankle injuries,
and 85% of those involve a lateral inversion mechanism.
Inversion Sprain - Inversion ankle sprains occur when the foot turns
in or out to an abnormal degree relative to the ankle. The most
common mechanism of an ankle sprain is a combination of
plantarflexion and inversion where the foot is pointing downward and
inward.
The lateral ligaments are involved in an inversion ankle sprain and
hence most commonly damaged. These ligaments are on the
outside of the ankle, which includes the anterior talofibular (ATFL),
calcaneofibular (CFL) and posterior talofibular ligaments (PTFL).
Injury to the ATFL is the most common. When both the ATFL and
CFL are injured together, ankle instability will be more noticeable.
The PTFL is the strongest of the three ligaments and is rarely injured
in an inversion sprain.
1740. Puttiplat operation is done for ?
a) Elbow instability

b) Shoulder instability

c) Rotator cuff tear

d) Biceps Tendinitis

Correct Answer - B
Ans. is 'b' i.e., Shoulder instability
Important surgeries for recurrent anterior dislocation of shoulder are:
i) Barkart's operation iii) Bristow's
operation v) Eden Hybinette operation
medpox.com
ii) Putti-Platt's operation iv) McLaughin's
operation vi) Magnum & Stack operation
 1741. Investigation of choice for entrapment
neuropathy is ?
a) CT SCAN

b) Clinical examination

c) Ulrasonography

d) EMG NCV

Correct Answer - D
Ans. is 'd' i.e., EMG NCV
The diagnosis of mononeuropathy in entrapment neuropathy is
medpox.com
based on electrodiagnostic studies (EMG/ NCV) and Magnetic
resonance imaging (MRI).
Entrapment neuropathy is a medical condition caused by
entrapment and compression of a peripheral nerve wherever it
traverses fibro-osseous tunnels.
Sites of entrapment neuropathy are : -
i. Carpal tunnel :- Median nerve (carpal tunnel syndrome)
ii. Cubital tunnel :- Ulnar nerve (cubital tunnel syndrome)
iii. Guyan's canal :- Ulnar nerve (Guyan's canal syndrome)
iv. Tarsal tunnel :- Posterior tibial nerve (Tarsal tunnel syndrome)
v. Inguinal ligament :- Lateral cutaneous nerve of thigh (meralgia
paraesthetica).
vi. Suprascapular notch :- Suprascapular nerve
vii. Neck of fibula :- Common peroneal nerve
viii. Fascial tunnel of superficial peroneal nerve :- Superficial peroneal
nerve
ix. Arcase of Frohse :- Posterior interosseous syndrome
x. Thoracic outlet :- Lower trunk of brachial plexus
xi. Compression in the foot :- Digital nerve (Morten's metatarsalgia)
medpox.com
1742. Froment's sign is positive in cases of
weakness of ?
a) Thumb adduction

b) Thumb abduction

c) Thumb flexion

d) Thumb extension

Correct Answer - A
Ans. is 'a' i.e., Thumb adduction
Normally when a person is asked to grasp a book between the
medpox.com
thumb and index finger, he will grasp the book
firmly with thumb extended, taking full advantage of the adductor
pollicis and the first dorsal interosseous muscles.
If the ulnar nerve is injured the adductor pollicis will be paralysed
and the patient will hold the book by using the flexor pollicislongus
(supplied by median nerve) producing flexion at the interphalangeal
joint.
This becomes more pronounced if the examiner tries to pull the book
out while the patient tries to hold it.
This sign is known as `Froment's sign' or the 'book test'.
 1743. Inability to pronate forearm is due to
injury to which nerve ?
a) Ulnar

b) Radial

c) Median nerve

d) Musculocutaneous

Correct Answer - C
Ans. is 'c' i.e., Median nerve
Pronation of the forearm is by two muscles pronator teres and
medpox.com
pronator quadratus. These two muscles are supplied by median
nerve. Thus injury to median nerve produces inability to pronate
forearm.
The median nerve is also called labourer's nerve. The median nerve
arises by two roots, one from the lateral cord (C5,6,7) and the other
from the medial cord (C8, T1). The various muscles supplied by
median nerve are : ?
1) In the forearm
All the flexor muscles of the forearm, except the flexor carpi ulnaris
and the medial half of flexor digitorum profundus to the ulnar two
fingers. These muscles are : -
i. Pronater teres
ii. Flexor digitorum superficialis
iii. Flexor pollicis longus
iv. Flexor carpi radialis
v. Flexor digitorum profundus (lateral half)
vi. Pronator quadratus
vii. Pulmaris longus
2) In hand
 Median nerve supplies : -
i. Thenar muscles (except adductor pollicis) - Flexor pollicis brevis,
opponens pollicis and abductor pollicis brevis. Adductor pollicis is
supplied by ulnar nerve.
ii. First two lumbricals

medpox.com
1744. Which of the following deformity is
evident in case of erbs palsy?
a) Policeman tip deformity

b) Winging of scapula

c) Claw hand

d) Wrist drop

Correct Answer - A
Ans. is 'a' i.e., Policeman tip deformity
Deformity (position of the limb) in Erb's palsy
medpox.com
i) Arm : Hanges by the side; it is adducted and medially rotated
ii) Forearm : Extended and pronated
n The deformity is known as 'policeman's tip hand' or 'porter's tip
hand'.
1745. High stepping gait is seen in ?
a) CTEV

b) Common peroneal nerve palsy

c) Polio

d) Cerebral palsy

Correct Answer - B
Ans. is 'b' i.e., Common peroneal nerve palsy
First to touch the ground is the forefoot, and not the heel.

medpox.com
1746. Sunderland classification is used for ?
a) Nerve injury

b) Muscle injury

c) Tendon injury

d) Ligament injury

Correct Answer - A
Ans. is 'a' i.e., Nerve injury
Sunderland is an extension of the seddon classification and includes
5 types of nerve injuries.
medpox.com
1747. Arthritis involving DIP, PIP, 1st
carpometacarpal with sparing of MCP
and wrist joints is typical of ?
a) Osteoarthritis

b) Rheumatoid arthritis

c) Ankylosing spondylitis

d) Psoriatic arthritis

Correct Answer - A
Ans. is 'a' i.e., Osteoarthritismedpox.com
1st Carpometacarpal joint Wrist- Osteoarthritis
1748. Heberden node denotes involvement of
?
a) Distal inetrphalangeal joint

b) Proximal interphalangel joint

c) Metacarpophalangeal joint

d) Metatarsophalangeal joint

Correct Answer - A
Ans. is 'a' i.e., Distal inetrphalangeal joint
In osteoarthritis of hand :
medpox.com
i) Distal interphalangeal joint :- Heberden's node
ii) Proximal interphalangeal joint :- Bouchard's node
1749. Which of the following is not the extra -
articular manifestations of ankylosing
spondylitis?
a) Acute anterior uveitis

b) Aortic valve disease

c) Pulmonary fibrosis

d) Dilated cardiomyopathy

Correct Answer - D
Ans. is 'd' i.e., Dilated cardiomyopathy
medpox.com
Extra articular manifestations of ankylosing spondylitis are acute
anterior uveitis (in 5%); rarely aortic valve disease, carditis and
pulmonary fibrosis also occur.
Ankylosing spondylitis (marie-strumpell disease)
Ankylosing spondylitis is a chronic progressive inflammatory disease
of the sacroiliac joints and the axial skeleton.
Prototype 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-B27
90-95% of cases 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 9th/e 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) o 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?
1. Inflammation with granulation tissue formation and erosion of
adjacent bone.
2. Fibrosis of granulation tissuemedpox.com
3. Ossification of the fibrous tissue, leading to ankylosis of the joint.
1750. True about ankylosing spondylitis are
all except ?
a) Affects males

b) 3 0-40yrs

c) 90% HLA-B5

d) Bamboo spine

Correct Answer - C
Ans. is 'c' i.e., 90% HLA-B5
Ankylosing spondylitis (marie-strumpell disease)
medpox.com
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
medpox.com
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
1751. Which of the following is not a feature
of rheumatoid arthritis?
a) Heberden nodes

b) Swan neck deformity

c) Ulnar deviation of fingers at metacarpopalyngeal joint

d) Symmetric reduction of joint space

Correct Answer - A
Ans. is 'a' i.e., Heberden nodes
Heberden nodes is a feature of osteoarthritis and not rheumatoid
arthritis. medpox.com
Important hand deformities of hand in RA
Boutonniere deformity : Flexion contracture of PIP joint and
extension of DIP joint.
Swan neck deformity : Hyperextension of PIP joint and flexion at DIP
joint.
Z-deformity : Radial deviation of wrist with ulnar deviation of
fingers.
Hyperextension of 1st interphalangeal joint and flexion of MP joint.
1752. Swan neck deformity is seen in:
March 2013 (a, c, e)
a) Ankylosing spondylitis

b) Rheumatoid arthritis

c) Osteoarthritis

d) Reiter's syndrome

Correct Answer - B
Ans. B i.e. Rheumatoid arthritis
Rheumatoid arthritis
medpox.com
RA is a disease of: Synovium/ synovial membrane
RA starts in: Synovium
Body tissue mostly affected in RA: Synovium
Characteristic feature:
- Persistent inflammatory synovitis,
- Peripheral joint,
- Symmetrical distribution
Causes:
- Immunological,
- Familial,
– Infective (implicated)
Mostly affects: Females (three times)
Earliest lesion in rheumatoid synovitis:
– Microvascular injury,
– Increase in number of synovial lining cells
Joints characteristically involved in RA:
– MCP,
– PIP (symmetric arthritis)
Boutonniere deformity:
– Flexion contracture of the PIP
– Extension of DIP
Criteria for diagnosis: Any 4 criteria must be present
Pathognomic feature: Rheumatoid nodule
Extra-articular manifestations are seen in: Individuals with high titres
of RF (autoantibodies to the Fc component of IgG)

medpox.com
 1753. CASPAR criteria is used in diagnosis of
?
a) Psoriatic arthritis

b) Rheumatoid arthritis

c) Ankyosing spondylitis

d) Reactive synnovitis

Correct Answer - A
Ans. is 'a' i.e., Psoriatic arthritis
Classification criteria for psoriatic arthritis (CASPAR) is used for the
medpox.com
diagnosis of psoriatic arthropathy.
The CASPAR (classification Criteria for Psoriatic Arthritis) Criteria
To meet the CASPAR criteria a patient must have inflammatory
articular disease (joint, spine, or entheseal) with 3 points from any of
the following five categories :
1. Evidence of current psoriasis, a personal history of psoriasis, or fa
family history of psoriasis.
2. Typical psoriatic nail dystrophy observed on current physical
examination.
3. A negative test result for rheumatoid factor.
4. Either current dactylitis or a history of dactylitis recorded by a
rheumatologist.
5. Radiographic evidence of juxtaarticular new bone formation in the
hand or foot.
1754. Most common joint involved in gout is ?
a) Knee

b) Hip

c) MP joint of great toe

d) MP joint of thumb

Correct Answer - C
Ans. is 'c' i.e., MP joint of great toe
Gout is the common end point of a group of disorders that produce
hyperuricemia.
It is marked by transient attacks of acute arthritis intitiated by
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crystallization of monosodium urate into the joints, leading
eventually to chronic gouty arthritis and deposition of masses of
urates in joints and other sites, creating tophi.
Most common joint involved in gout is big toe, i.e.
metatarsophalangeal joint of great toe.
Tophi are pathognomic of gout. They are formed by large
aggregations of urate crystals. The urate crystals are surrounded
by -
1755. Which joint is most commonly affected
in pseudogout -
a) Knee

b) Hip

c) MP joint great toe

d) MP joint thumb

Correct Answer - A
Ans. is 'a' i.e., Knee
Pseudogout
medpox.com
It is one of the forms of "Calcium pyrophosphate dihydrate" (CPPD)
arthropathy.
Pseudogout commonly involves the larger joints. Knee joint is most
commonly involved; other sites are wrist, elbow, shoulder, ankle.
Involvement of small joints is uncommon.
Age group is > 60 yrs.
In CPPD arthropathy, CPPD deposition occurs in articular tissues. It
can present in any of the following three forms :?
1) Asympatomatic chondrocalcinosis
2) Acute synovitis - Pseudogout
3) Chronic pyrophosphate arthropathy
The radiologic hallmark of CPPD is "chondrocalcinosis.
Chondrocalcinosis is seen as punctate and/or linear radiodense
deposits in fibrocartilaginous joint menisci or articular hyaline
cartilage.
Definitive diagnosis is made by synovial fluid polarised light
microscopy which shows weakly positive, birefringent, rhomboid
crystals of CPPD. [In gout polarized light shows - strongly negative
birefringent, needle shaped crystals of monosodium urate]
medpox.com
1756. Needle shaped crystals negatively
birefringent on polarized microscopy is
characteristic of which crystal
associated arthropathy?
a) Gout

b) CPPD

c) Neuropathic arthropathy

d) Hemophilic arthropathy

Correct Answer - A medpox.com

Ans. is 'a' i.e., Gout
Crystal of Pseudogout
Made up of calcium pyrophosphate
Weakly positive birefringent, rhomboid
Crystal of gout :-
Made up of uric acid (monosodium urate)
Strongly negative birefringent, needle shaped
1757. Loose body in joint most common site
is -
a) Knee

b) Hip

c) Elbow

d) Ankle

Correct Answer - A
Ans. is 'a' i.e., Knee
Loose body in joint
medpox.com
A loose body is a free-floating piece of bone, cartilage or foreign
object in a joint.
The knee is the most common joint where one would find a loose
body.
Causes of loose bodies include :-
i) Osteoarthritis
ii) Osteochondritisdessicans
iii) Osteochondral fracture(injury)
iv) Charcot's disease
v) Synovial chondromatosis
1758. Charcot's joint in diabetes affects
commonly -
a) Shoulder joint

b) Knee joint

c) Hip joint

d) Tarsal joint

Correct Answer - D
Answer- D. Tarsal joint
Tabes dorsalis → Knees, hip & ankles
Loose body in joint medpox.com
A loose body is a free-floating piece of bone, cartilage or foreign
object in a joint.
The knee is the most common joint where one would find a loose
body.
Causes of loose bodies include :-
i) Osteoarthritis iii) Osteochondral
fracture(injury) v) Synovial chondromatosis
ii) Osteochondritisdessicans iv) Charcot's disease
1759. Most common site of metastasis in
skeleton ?
a) Femur

b) Tibia

c) Vertebrae

d) Skull

Correct Answer - C
Ans. is 'c' i.e., Vertebrae
Metastasis
medpox.com
Metastatic bone disease is the commonest malignancy of bones and
is much more common than primary bone tumors.
The commonest sites for bone metastases are vertebrae (most
common), pelvis, the proximal half of the femur and the humerus.
Extremities distal to elbow and knee are least commonly involved
sites.
Spread is usually via the blood stream; occasionally, visceral tumors
spread directly into adjacent bones e.g., the pelvis and ribs.
Certain tumors are known to be common sources of bone
metastasis.
The following primary tumors are the most common to metastasize
in the bone; breast, prostate, lung, thyroid, kidney, and
gastrointestinal tract.
The commonest source of metastatic bone disease is carcinoma of
the breast.
In males most common source is prostate carcinoma.
Bladder and uterine carcinomas are less common sources. In
children, skeletal metastases originate from neuroblastoma, Ewing's
sarcoma, and osteosarcoma.
medpox.com
1760. Calcification in osteosarcoma is due to
presence of
a) Osteoid matrix

b) Osteoblasts

c) High calcium levels in serum

d) High calcitonin

Correct Answer - A
Answer- A. Osteoid matrix
The pattern of mineralization (calcification) on radiograph may be
medpox.com
helpful in identifying tumor matrix.
Dense, homogenous mineralization (calcification) is typical of
osteoid matrix, formed by benign and malignant bone-forming
lesions
Calcified rings and arcs, dense punctate calcification, and flocculent
calcification (small, loosely aggregated masses) are pattern of
mineralization of chondroid matrix, formed by benign and malignant
cartilage forming tumors.
1761. Sunray appearance on X - ray is seen in
?
a) Osteosarcoma

b) Osteochondroma

c) Osteoclastoma

d) Chondroblastoma

Correct Answer - A
Ans. is 'a' i.e., Osteosarcoma
Codman's triangle and sunray appearance are typical of
osteosarcoma. medpox.com
However, you should keep in your mind following very important
facts : -
Sunray (sunburst) appearance and codman's triangle indicates
periosteal reaction (periosteal new bone formation).
Both these are typical of osteosarcoma but may also occur in other
rapidly growing bone tumors (Ewing's sarcoma), and infection
(osteomyelitis).
Similarly, onion peel appearance indicates periosteal new bone-
formation and is typical for Ewing's sarcoma. But this can also occur
in oseosarcoma and osteomyelitis.
The crux is that, aggresively growing tumors and infection stimulate
the periosteum which then react by forming new bone, (therefore it is
called periosteal reaction) which may take any of the above form.
1762. In osteogenic sarcoma predominant
histological finding is ?
a) Giant cells

b) Osteoid forming tumor cells

c) Fibroblastic proliferation

d) Chondroblasts

Correct Answer - B
Ans. is 'b' i.e., Osteoid forming tumor cells
Histologic appearance of osteosarcoma
medpox.com
It appears pale and extending through the cortex on gross cut
section examination.
On histological sections it consists of malignant stromal tissue
showing osteoid formation.
Osteoid bone formation by tumor cells is diagnostic of OGS.
1763. Development of Chondrosarcomas is
related with?
a) Maffucci syndrome

b) Felty syndrome

c) a and b both

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Maffucci syndrome
Chondrosarcomasdeveloping in patients with ollier's and maffucci
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syndrome is called secondary chondrosarcoma.
Secondary chondrosarcoma
It is the chondrosarcoma arising in benign precursor either
osteochondroma and enchondroma.
There are no reliable figures about the risk of developing secondary
chondrosarcoma in benign precursors.
The risk of chondrosarcoma in solitary osteochondroma is 2% and
that for osteochondromatosis is 5 - 25%.
Patients with ollier's disease and maffucci syndrome have a 25 -
30% risk of developing chondrosarcoma.
1764. Osteoid osteoma consists of -
a) Osteoblasts

b) Osteoclasts

c) Both of above

d) None of the above

Correct Answer - C
Ans. is 'c' i.e., Both of above
Osteoid Osteoma
Osteoid osteoma is the most common true benign tumor of the
bone. This is a benign circumscribed lesion that may arise in the
medpox.com
cortex of long bones or occasionally in the cancellous bone of spine.
The characteristic feature is the formation of a small nidus of osteoid
tissue, surrounded by a reactive zone of dense sclerosis (Sclerotic
new bone formation).
Microscopically, the tumor is composed of thin, irregular, trabeculae
within a cellular granulation tissue containing osteoblasts and
osteoclasts.Trabeculae are more mature in the center, which is often
partially calcified. Reactive, sclerotic bone surrounds the nidus.
Clinical features of osteoid osteoma
The tumor occurs between 10-30 years of age and is more common
in males.
The diaphysis of long bones is involved, most common bone
involved is the tibia followed by femur. Posterior elements of the
vertebrae may also be involved.
The presenting complaint is a nagging pain, worst at night, and is
relieved by salicylates or other NSAIDs, a diagnostic feature.
On X-ray, there is a small radiolucent area (nidus) surrounded by
dens sclerosis.
X-ray, in some cases, show local sclerotic thickening of the shaft
that may obscure the small central nidus within the area of
rarefaction.
Bone scan shows increased uptake in the nidus.
The only treatment is wide en block excision along with internal
fixation with or without bone grafting.

medpox.com
1765. Which is the commonest true benign
bone tumor?
a) Osteoid osteoma

b) Hemangioma

c) Osteochondroma

d) Enchondroma

Correct Answer - A
Ans. is 'a' i.e., Osteoid osteoma
Osteoid osteoma is the most common true benign tumor of the
medpox.com
bone. This is a benign circumscribed lesion that may arise in
the cortex of long bones or occasionally in the cancellous bone of
spine. The characteristic feature is the formation of a small
nidus of osteoid tissue, surrounded by a reactive zone of dense
sclerosis (Sclerotic new bone formation).
1766. Deformity of hip in stage of tubercular
synovitis stage is ?
a) Flexion, abduction external rotation

b) Flexion, adduction internal rotation

c) Flexion adduction external rotation

d) Flexion abduction internal rotation

Correct Answer - A
Ans. is 'a' i.e., Flexion, abduction external rotation
Synovitis- Flexion abduction external rotation apparent lengthening
medpox.com
1767. Perkin's line on X-ray is used for
diagnosis of -
a) Perthe's disease

b) CDH

c) CTEV

d) AVN Hip

Correct Answer - B
Ans. is 'b' i.e., CDH
Radiological features of DDH/CDH
medpox.com
In Von Rosen's view following parameters should be noted
Perkin's line : Vertical line drawn at the outer border of acetabulum
Hilgenreiner's line : Horizontal line drawn at the level of tri-radiate
cartilage
Shenton's line : Smooth curve formed by inferior border of neck of
femur with superior margin of obturator foramen.
Acetabular index : Normally is S 30°
CE angle of Wiberg : Normal value is 15-30"
Normally the head lies in the lower and inner quadrant formed by
two lines (Perkin's & Hilgenreiner's). In DDH the head lies in outer &
upper quadrant
Shenton "s line is broken
Delayed appearance & retarded development of ossification of head
of femur
Sloping acetabulum
Superior & lateral displacement of femoral head
Von-Rosen's line
This is a line, which helps in the diagnosis of DDH in infants less
than 6 months.
For this AP view of pelvis is taken with both lower limb in 450
abduction and full internal rotation.
Upward prolongation of long axis of shaft of the femur points
towards the lateral margin of the acetabulum and crosses the pelvis
in the region of sacroiliac joint.
In CDH, upward prolongation of this line points towards anterior
superior iliac spine and crosses the midline in the lower lumber
region → Positive Von-Rosen's sign.

medpox.com
 1768. Ortolani test is positive when the
examiner hears the ?
a) Clunk of entry on abduction and flexion of hip

b) Clunk of entry on extension and adduction of hip

c) Click of exit on abduction and flexion of hip

d) Click of exit on extension and adduction of hip

Correct Answer - A
Ans. is 'a' i.e., Clunk of entry on abduction and flexion of hip
Clinical tests for CDH/DDH
In infancy two tests are used.medpox.com
Barlow's test
This test is done within 2-3 days of birth.
The test has two parts :?
1. Part 1 :- Infant is in supine position with hip and knee in 90° of
flexion, The hip is slowly adducted & pushed to dislocate the hip and
one can hear a clunck of exit of femoral head out of the acetabulum.
2. Part 2 :- Now the hip is gentely abducted and pulled to reduce the
hip. This will cause 'clunk' indicating reduction of hip.
It is quite obvious that part 1 can be done only dislocatable hip; but
not in already dislocated hip as the head is already out of the
acetabulum.
Ortolani's test
This test is similar to 2nd part of Barlow's test, i.e. slow abduction of
hip in flexed position of hip & knee to reduce the hip.
1769. The typical deformity in CTEV is ?
a) Ankle equinus

b) Subtalar inversion

c) Forefoot adduction

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
CTEV is the commonest and most important congenital deformity of
the foot.
CTEV is more common males in than in females (males to female
medpox.com
.
ratio 2 5 : 1).
In half of the cases CTEV is bilateral.
Right and left foot are affected equally.
The deformity consists of following elements :?
i) Equinus, i.e. Plantar flexion at ankle joint (tibiotalar joint).
ii) Inversion of foot at subtalar joint (talocalcaneal joint).
iii) Forefoot adduction, at mid-tarsal joints, especially at talo-
navicular joint.
iv) Sometimes forefoot cavus, i.e. excessive arching of the foot at
mid-tarsal joints.
1770. Cozen's test is used for the diagnosis of
?
a) Tennis elbow

b) Golfer's elbow

c) Base baller's pitcher elbow

d) Carpal tunnel syndrome

Correct Answer - A
Ans. is 'a' i.e., Tennis elbow
Signs and Tests
medpox.com
Adson's test : for thoracic outlet syndrome
Allen's test : for testing patency of radial and ulnar arteries
Alli's test : for CDH
Anvil test : for testing tenderness of the spine
Ape thumb : for median nerve injury
Apley's grinding test :for meniscus injury
Apprehension test : for recurrent dislocation of the shoulder
Barlow's test : for CDH
Blue sclera : Osteogenesis imperfecta
Bryant's test : for anterior dislocation of the shoulder
Callways' test : for anterior dislocation of the shoulder
Chovstek's sign : for tetany
Claw hand : for ulnar nerve injury
Coin test : for dorso lumbar tuberculosis of spine
Cozen's test : for tennis elbow
Drawer test : for ACL and PCL injutries
Anterior : for ACL injury
Posterior : for ACL injury
Finkelstein's test : for de Quervain's tenovaginitis
Foot drop : for common peroneal nerve injury
Froment's sign : for ulnar nerve injury
Gaenslen's test: for SI joint involvement
Galleazzi sign : for CDH
Gower's sign : for musular dystrophy
Hamilton ruler test : for anterior dislocation of the shoulder
Kanavel's sign : for infection in ulnar bursa
Lasegue's test: for disc prolapse
Lachmann test : for ACL injury
Ludloffs sign: for avulsion of lesser trochanter
McMurray's test : for meniscus injury
Nagffziger test : for disc prolapse
Ober's test : for tight ilio- tibial band (e.g., in polio)
O' Donoghue triad: traid of MCL, ACL & medial meniscus injuries
occurring together
Ortolani's test : for CDH
Pivot shift test : for ACL injury
Policeman tip : for Erb's palsy
Runner's knee : Patellar tendinitis
medpox.com
Sulcus sign: for inferior dislocation of the shoulder
Thomas' test : for hip flexion deformity
Trendelenburg's test: for unstable hip due to any reaseon (e.g.,
CDH)
Tinel's sign: for detecting improving nerve injury
Volkmann's sign : for ischaemic contracture of forearm muscles
Wrist drop : for radial nerve injury
1771. Infection of ulnar bursa is diagnosed by
-
a) Kanavel's sign

b) Chowstek's sign

c) Gower's sign

d) Ludloff's sign

Correct Answer - A
Ans. is 'a' i.e., Kanavel's sign
Kanavel's sign is for infection of ulnar bursa.
medpox.com
1772. De - quervian's tenovaginitis involves ?
a) Abductor pollicislongus

b) Extensor pollicisbrevis

c) Both of the above

d) None of the above

Correct Answer - C
Ans. is 'c' i.e., Both of the above
De-Quervian's tenovaginitis is characterized by pain over the styloid
process of the radius and palpable thickening in the course of the
abductor pollicis longus and extensor pollicis brevis tendons.
medpox.com
The fibrous sheaths of the abductor pollicis longus and extensor
pollicis brevis tendons are thickened where they cross the tip of the
radial syloid process.
The tendons themselves appear normal as does the synovial lining
of sheath.
Exact cause is unknow. Excessive friction from overuse may be a
factor, because the condition seems prone to follow repetitive
actions such as wringing clothes, or in more recent times excessive
typing or manipulations.
The condition is five times commoner in women than men,
predominantly in middle age.
The main symptom is pain on using the hand, especially when
movement tenses the abductor pollicis longus and extensors pollicis
brevis tendons (as in lifting a saucepan or a teapot).
On examination, there is local tenderness at the point where the
tendons cross the radial styloid process.
The thickened fibrous sheath are usually palpable as firm nodule.
Passive adduction of the wrist or thumb causes the patient to wince
with pain.
Finkelstein's test is used to diagnose De-Quervain's tenovaginitis.
To perform the test, the patients ask to flex their thumb and clench
their fist over the thumb followed by ulnar deviation. This produces
sharp pain along the distal radius.

medpox.com
1773. Causes of Carpal tunnel syndrome are
all except?
a) DM

b) RA

c) Leprosy

d) Gout

Correct Answer - C
Ans. is 'c' i.e., Leprosy
Carpal tunnel syndrome
medpox.com
Carpal tunnel syndrome is the most common and widely known
entrapment neuropathy in which the body's peripheral nerve is
compressed or traumatized. Carpal tunnel syndrome occurs when
the median nerve is compressed in the carpal tunnel below flexor
retinaculum. The carpal tunnel is a narrow rigid passage way of
ligament and bones at the base of hand, in front of distal part of
wrist. Carpal tunnel houses the median nerve and 9 tendons (4 FDS,
4 FDP & FPL).
Causes of carpal tunnel syndrome
There are many causes of carpal tunnel syndrome :
1) Idiopathic : - This is the most common cause.
2) Pregnancy and menopause
3) Metabolic : - Gout, Diabetes mellitus
4) Endocrine : - Hypothyroidism, Myxedema, Acromegaly,
Hyperparathyroidism.
5) Deposition disorder Amyloidosis, Sarcoidosis, Rheumatid
arthritis, Leukemia, CRF, Mucopoly saccharoidosis.
6) Alcoholism
7) Local causes : - Malunited colle's fracture, osteo-arthritis of the
carpal bones, synovitits of flexor tendon sheath, hematoma.
Clinical features of carpal tunnel syndrome
Carpal tunnel syndrome is more common in women and occurs
between 35-50 years.
Symptoms usually start gradually, with frequent burning, tingling,
paresthesia and numbness in the distribution of median nerve, i.e.,
lateral three & half of fingers and lateral 2/3rd of palm.
The symptoms often first appear during night, since many people
sleep with flexed wrists. (Flexion decreases the space in carpal
tunnel which results in increased pressure over median nerve).
Sensory symptoms can often be reproduced by percussing over
median nerve (Tinel's sign) or by holding the wrist fully flexed for a
minute (Phalen's test).
As the disease progresses, clumsiness of hand and impairment of
digital function develop.
Later in the disease, there is sensory loss in median nerve
distribution and obvious wasting of thenar eminence. Clinical Tests
for Carpal tunnel syndrome
There are some provocative tests which act as important screening
medpox.com
methods : ?
1) Wrist flexion (Phalen's test) : - The patient is asked to actively
place the wrist in complete flexion. If tingling and numbness develop
in the distribution of median nerve, the test is positive. This is the
most sensitive provocative test.
2) Tourniquet test : - A pneumatic BP cuff is applied proximal to the
elbow and inflated higher than the patient's systolic BP. The test is
positive if there is paresthesia or numbness in the region of median
nerve distribution in hand.
3) Median nerve percussion test (Tinel's sign) : - The median nerve
is gently tapped at the wrist. The test is positive if there is tingling
sensation.
4) Median nerve compression test : - Direct pressure is exerted
equally over both wrists by the examiner. If symptoms of carpal
tunnel syndrome appear, the test is positive.

1774. Index finger infection spreads to ?
a) Thenar space

b) Mid palmar space

c) Hypothenar space

d) Flexion space

Correct Answer - A
Ans. is 'a' i.e., Thenar space
Thenar space communicates with the index finger while the mid
palmar space communicates with the middle, ring and little fingers.
Thus infection of index finger leads to thenar space infection while
medpox.com
the infection of middle, ring or little finger leads to mid palmar space
infection.
 1775. Causes of painful arc syndrome is/ are
?
a) Supraspinatus tendinitis

b) Subacromial bursitis

c) Fracture of greater tuberosity

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
Painful Arc syndrome
medpox.com
This is a clinical syndrome in which there is pain in the shoulder and
upper arm during the mid range of glenohumeral abduction.
Following are the common causes :
i. Minor tears of the supraspinatus tendon
ii. Supraspinatus tendinitis
iii. Calcification of supraspinatus tendon
iv. Subacromial bursitis
v. Fracture of the greater tuberosity
In all these conditions, the space between the upper - end of the
humerus and the acrominon gets compromised, so that during mid -
abduction the tendon of the rotator - cuff gets nipped between the
greater tuberosity and acrominon.
X- ray of the shoulder may show calcific deposit, or a fracture of the
greater tuberosity or acromion. o Treatment consists of ultrasonics
to the tender point and anti- inflammatory drugs.
Some cases need an injection of hydrocortisone in the subacromial
space or excision of the anterior, often prominent part of the
acromion.
1776. Ring shaped epiphyses is seen in ?
a) Osteogenesis imperfecta

b) Morquios syndrome

c) Zellweger syndrome

d) Multiple epiphyseal dysplasia

Correct Answer - A
Ans. is 'a' i.e., Osteogenesis imperfecta
Ring shaped epiphysis
i) Hypothyroidism (healing phase) iv)
Osteoporosis medpox.com
ii) Osteogenesis imperfecta v) Rickets
(healing phase)
iii) Osteopetrosis vi) Scurvy
 1777. Fat embolism syndrome is most
commonly seen after ?
a) Femur fracture

b) Acetabular fracture

c) Pelvis fracture

d) Calcaneal fracture

Correct Answer - A
Ans. is 'a' i.e., Femur fracture
Fat embolism means circulation of fat globule away from its site of
origin. medpox.com
When fat embolism causes symptoms it is called fat embolism
syndrome.
Causes of fat embolism
1. Fracture of long bone (most common) - Blunt trauma
2. Recent Corticosteroid administration
3. Soft tissue trauma
4. Acute pancreatitis
5. Burns
6. D.M.
7. Parenteral lipid infusion
8. Liposuction
9. Sickle cell crisis
10. Decompression sickness
 1778. Most common cause of acute
compartment syndrome in children is ?
a) Fracture supracondylar humerus

b) Transphysealhumerus fracture

c) Fracture radius /ulna

d) Fracture shaft humerus

Correct Answer - A
Ans. is 'a' i.e., Fracture supracondylar humerus
Compartment syndrome is most commonly caused by
extremity fractures :- medpox.com
i. Supracondylar fracture of humerus is the most common cause is
children.
ii. Crush injuries to forearm are the most common cause in adults.
iii. Other injuries are fracture both bones forearm, elbow dislocation.
1779. Z score measures the bone mineral
density compred to ?
a) Age, Race and sex matched individuals

b) Race and sex matched individuals

c) Sex matched individuals

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Age, Race and sex matched individuals
T Score and Z score are the measures of bone mineral density.
medpox.com
Z score : Measures the bone mineral density in terms standard
deviation from the mean bone mineral density of age, race and sex
matched individuals.
T score : Measures the bone mineral density in terms standard
deviation from the mean bone mineral density of race and sex
matched individuals of normal younger age group.
1780. Sectoral sign is positive in ?
a) Avascular necrosis of femur head

b) Osteoarthritis of hip

c) Protrusio acetabuli

d) Slipped capital femoral epiphyses

Correct Answer - A
Ans. is 'a' i.e., Avascular necrosis of femur head
Clinical features of AVN
In the earlier stages of AVN, the patient is asymptomatic, and by the
time patient presents, the lesion is well advanced.
medpox.com
Common histories patient gives (Any of the following) : -
i) Dislocation of Hip
ii) Alcoholism
iii) Steroid intake for any disorder
iv) Nephrotic syndrome
Pain is a common complaint. Pain is felt in the grain and may radiate
to knee.
Decreased range of motion especially internal rotation followed by
abduction.
Sectoral sign or Differential rotation : - Internal rotation is possible in
extended position of hip, but as seen as the hip is flexed to 90° no
internal rotation is possible. This is the characteristic sign of AVN. o
Limp with antalgic gait.
Trendelenberg's test positive.
1781. Keinbock's disease is osteochondritis
of ?
a) Scaphoid

b) Lunate

c) Calcaneum

d) Tibial tuberosity

Correct Answer - B
Ans. is 'b' i.e., Lunate
Perthes's disease- Femoral head
Panner's disease- Capitulummedpox.com
Kienbock's disease- Lunate bone
Osgood Shlatter's disease- Tibial tubercle
Sever's disease- Calcaneal tuberosity
Kohler's disease- Navicular bone
1782. Osteoporosis is characterized by all the
following except ?
a) Decreased bone mineral density

b) Decreased Serum Calcium, phosphorus and alkaline

phosphatase is seen

c) Glucocorticoids can cause osteoposis

d) Dorsolumbar spine is the most coomon site of osteoporotic

fracture

Correct Answer - B
medpox.com
Ans. is 'b' i.e., Decreased Serum Calcium, phosphorus and alkaline
phosphatase is seen
Osteoporosis is a state of decreased mass per unit volume of a
normally mineralized bone. Osteoporosis is the commonest
metabolic bone disease. Osteoporosis is characterized by an
abnormally low bone mass (low bone density) and defects in bone
structure, a combination of which renders the bone unusually fragile
and at greater than normal risk of fracture. Bone depletion may be
brought about by predominant bone resorption, decreased bone
formation or a combination of the two.
1783. Polyspermy is inhibited by which ion ?
a) Ca

b) Na

c) K

d) Cl

Correct Answer - A
Ans, A. Ca
The calcium wave amplifies the local signal at the site of sperm-
oocyte interaction and distributes it throughout the oocyte cytoplasm.
The increase in calcium concentration is the signal that causes the
medpox.com
oocyte to resume cell division, initiating the completion of meiosis II
and setting of the developmental programme that leads to
embryogenesis.
1784. Which of the following is present in
normal vagina?
a) Trichomonas buccalis

b) Trichomonas hominis

c) Trichomonas vaginalis

d) Trichomonas bovis

Correct Answer - C
Ans. C. Trichomonas vaginalis

medpox.com
1785. Maximum amniotic fluid at ?
a) 32 weeks

b) 34 weeks

c) 36 weeks

d) 40 weeks

Correct Answer - C
Ans, C. 36 weeks

medpox.com
1786. At 20 weeks of gestation amniotic fluid
volume is ?
a) 200 ml

b) 400 ml

c) 600 ml

d) 800 ml

Correct Answer - B
Ans, B. 400 ml

medpox.com
1787. Fertilized ovum reaches the uterus at
what day of menstrual cycle?
a) 6th

b) 14th

c) 20th

d) 25th

Correct Answer - C
Ans, C. 20th
Implantation of the fertilized ovum occurs in the endometrium of the
medpox.com
anterior or posterior wall of the body near the fundus on the & ilay of
fertilization which corresponds to the 20th day of the regular
menstrual cycle.
1788.

medpox.com
 Fertilization usually occurs in which part of
fallopian tube?
a) Fimbrial end

b) Ampulla

c) Interstitium

d) Isthmus

Correct Answer - B
Ans. B. Ampulla
Fertilization is the process of fusion of the spermatozoon with the
mature ovum. medpox.com
It begins with sperm egg collision and ends with production of a
mononucleated single cell called the zygote.
Its objectives are:
1. To initiate the embryonic development of the egg and
2. To restore the chromosome number of the species.
Almost always, fertilization occurs in the ampullary part of the uterine
tube.
1789. Physiologic change in leukocyte
numbers in pregnancy is
a) Neutrophilic leukocytosis

b) Lymphocytic leukocytosis

c) Neutropenia

d) Basophilic leukocytosis

Correct Answer - A
Ans. A. Neutrophilic leukocytosis
Physiological change observed in leukocyte numbers in pregnancy
is neutrophilic leukocytosis.medpox.com
It occurs to the tune of 8000/mm3 and may upto 20,000/ mm3 in
labour.
The increase maybe due to the rise in levels of estrogen and
cortisol.
1790. Weight of uterus at term is ?
a) 400-500 gm

b) 600-700gm

c) 800-900 gm

d) 900-1000 gm

Correct Answer - D
Ans. D. 900-1000 gm
The uterus in the non-pregnant state weight is about 60 gm, with a
cavity of 5 - 70 ml and measures about 7.5 cm in length.
At term it weighs about 900 - 1000 gm and measures 35 cm in
medpox.com
length.
1791. During pregnancy estrogen causes
which of the following?
a) Growth of ducts of breasts

b) Growth of alveoli of breasts

c) Both a and b

d) None of the above

Correct Answer - C
Ans. C. Both a and b
The increased size of the breasts is evident in the early weeks of
pregnancy. medpox.com
The increase in size is due to hypertrophy and proliferation of the
ducts and the alveoli.
Estrogen is responsible for the hypertrophy and proliferation of the
ducts and alveoli while progesterone is only responsible for the
hypertrophy and proliferation of the alveoli.
1792. Maternal side layer of the placenta is
called ?
a) Decidua basalis layer

b) Decidua capsularis layer

c) Decidua parietalis

d) Decidua spongiosa

Correct Answer - A
Ans., A. Decidua basalis layer
Decidua basalis (Decidual plate) is the part of endometrium related
medpox.com
to embryonic pole of conceptus and forms the maternal p art of
placenta.
1793. Which of the following is not a
physiological change of pregnancy in
urinary bladder?
a) Edematous mucosa

b) Increased frequency at 14 weeks

c) Stress incontinence

d) Pressure on bladder in late pregnancy

Correct Answer - B
Ans.B. Increased frequency at 14 weeks
medpox.com
Physiological changes in bladder in pregnancy
Marked congestion and hypertrophy of the muscles and elastic
tissues of the bladder wall.
Edematous bhdder mucosa in late pregnancy especially in
primigravida.
Increased frequency of micturition at 6 - 8 weeks which subsides by
12 weeks and reappears in late pregnancy due to pressure of the
gravid uterus on bladder.
Stress urinary incontinence in late pregnancy.
1794. Urinary retention earliest in pregnancy
is seen at ?
a) 10 weeks

b) 18 weeks

c) 22 weeks

d) 34 weeks

Correct Answer - A
Ans, A. 10 weeks
Urinary retention in pregnancy is rare
medpox.com
It is classically described in some women with retroverted uterus,
which becomes impacted in the pelvis, usually seen earliest
between 8 - 12 weeks of pregnancy and causes outflow obstruction.
1795. Beta HCG is detected earliest by which
day of conception?
a) 8 days

b) 15 days

c) 21 days

d) 30 days

Correct Answer - A
Ans, A. 8 days
hCG is a glycoprotein produced by the syncytiotrophoblast.
medpox.com
hCG-c is identical to the c subunit of LH, FSH, and TSH.
Its presence in the urine in early pregnancy is the basis of the
various laboratory tests for pregnancy, and it can sometimes be
detected in the urine as early as 14 d after conception and in serum
as early as 8-9 days,
1796. Doubling time of beta HCG in early
pregnancy is ?
a) 24 hrs

b) 48 hrs

c) 72 hrs

d) 96 hrs

Correct Answer - B
Ans, B. 48 hrs
Beta hCG usually double about every 2 days (48 hours) during first
four weak of pregnancy. medpox.com
As pregnancy progresses, doubling time becomes longer. By 6-7
weeks beta hCG levels may take as long as 3.5 days to double.
1797. Tubal patency test in which phase of
the menstrual cycle?
a) Menstrual

b) Preovulatory

c) Leuteal

d) Premenstrual

Correct Answer - B
Ans, B. Preovulatory
The testing of tubal patency and detecting tubal pathology are done
medpox.com
in pre-ovulatory phase of the menstrual cycle.
If performed in the post-ovulatory period, insufflation might disturb
an implanted or fertilized ovum and may also cause pelvic
endometriosis.
1798. Following physiological changes are
seen in vagina in pregnancy except ?
a) Jacquimiers sign

b) Increased length of anterior vaginal wall

c) pH acidic

d) Decreased number of navicular cells

Correct Answer - D
Ans, D. Decreased number of navicular cells
The vaginal walls become hypertrophied, edematous and more
vascular. medpox.com
Increased blood supply to venous plexus surrounding the walls gives
bluish coloration of the mucosa (Jacquemier's sign).
The length of the anterior vaginal wall is increased.
The secretion of vagina becomes copious, thin and curdy white, due
to marked exfoliated cells and bacteria.
The pH becomes acidic (3.5 - 6) due to more conversion of glycogen
into lactic acid by lactobacillus acidophilus consequent on high
estrogen level.
The acidic pH prevents multiplication of pathogenic organisms.
There is predominance of navicular cells in cluster and plenty of
lactobacilli.
1799. FHS can be usually heard by
stethoscope at ?
a) 14 weeks

b) 18 weeks

c) 22 weeks

d) 26 weeks

Correct Answer - B
Ans, B. 18 weeks
Fetal heart sound (FHS) is most conclusive clinical sign of
medpox.com
pregnancy. With an ordinary stethoscope it can be detected between
18 - 20 weeks of PregnancY.
1800. What is the fetoplacental relationship at
24 weeks of gestation?
a) 3

b) 4

c) 5

d) 6

Correct Answer - A
Ans, A. 3
The relationship between the fetal and placental weights can be
medpox.com
studied by the so called fetoplacental relationship (fetal weight/
placental weight ratio).
The fetoplacental relationship increases as the pregnancy advances.
1801. Down syndrome is earliest diagnosed at
?
a) 8 - 10 weeks

b) 10 - 12 weeks

c) 12 - 14 weeks

d) 14 - 16 weeks

Correct Answer - B
Ans. B. 10 - 12 weeks
Earliest diagnosis of genetic defects can be done by use of chorionic
villous sampling. medpox.com
Chorionic villous sampling is carried out transcervically at 10 - 12
weeks and transabdominally from 10 weeks to term.
1802. Chorionic villus biopsy is done earliest
in which week of gestation ?
a) 9 weeks

b) 11 weeks

c) 13 weeks

d) 15 weeks

Correct Answer - B
Ans, B. 11 weeks
It is carried out transcervically between 7O - 12 weeks and
medpox.com
transabdominally from 10 weeks to term.
1803. When is folic acid started in pregnancy
?
a) 4 weeks prior to conception

b) 8 weeks prior toconception

c) 4 weeks after conception

d) 8 weeks after conception

Correct Answer - A
Ans. A. 4 weeks prior to conception
Folic acid supplementation (4mg/day) is stated 4 weeks prior to
medpox.com
conception and continued upto 12 weeks of pregnancy.
This can reduce the incidence of neural tube defects.
1804. Term placenta weight to Baby weight
ratio is ?
a) 1 : 3

b) 1 : 4

c) 1 : 5

d) 1 : 6

Correct Answer - D
Ans, D. 1 : 6
The term Placenta
medpox.com
Placenta at term is a circular disc with a diameter of 15 - 20 cm.
It has thickness of 3 cm at center and thins of towards the edges.
It feels spongy and weighs about 500 gm.
The ratio of placemat weight at term and the baby weight is 1:6.
It occupies about 30% of the uterine wall.
1805. First trimester diagnosis for
anencephaly is by increased?
a) Alpha feto protein in maternal serum

b) Alpha feto protein in amniotic fluid

c) Beta HCG in maternal serum

d) Beta HCG in amniotic fluid

Correct Answer - B
Ans, B. Alpha feto protein in amniotic fluid
In the first half of the pregnancy the diagnosis of anencephaly is
medpox.com
made by elevated alpha feto protein in amniotic fluid and confirmed
by sonography.
1806. Which of the following is true about
EDD ?
a) Less than 10% of deliveries occur on EDD

b) Less than 20% of deliveries occur on EDD

c) 80% of the deliveries occur on EDD

d) 90% of the deliveries occur on EDD

Correct Answer - A
Ans, A. Less than 10% of deliveries occur on EDD
Fewer than 5% of all the pregnancies end on the expected date of
delitery (EDD). medpox.com
13% of the births occur preterm.
5 - 7% of the pregnancies are delivered post term.
Majority of the deliveries occur within 7 days of EDD.
1807. a) Most common position of
engagement in vertex presentation?
a) LOA

b) ROA

c) LOP

d) ROP

Correct Answer - A
Ans, A. LOA
Vertex occupying the left anterior quadrant of the pelvis is the
medpox.com
commonest and is called left occipito -anterior position.
1808. Which is the engaging diameter in
occipitoposterior nresentation?
a) Suboccipito frontal

b) Mento vertical

c) Submentovertical

d) Bitrochanteric

Correct Answer - A
Ans, A. Suboccipito frontal

medpox.com
1809. Which is the most common
presentation in twin pregnancy?
a) Vertex - vertex

b) Vertex - breech

c) Breech - Breech

d) Vertex - Footling

Correct Answer - A
Ans. A. Vertex - vertex

medpox.com
1810. Direct Occipitoposterior position is a
favourable position in which type of
pelvis ?
a) Anthropoid

b) Android pelvis

c) Gynaecoid

d) Mongoloid

Correct Answer - A
Ans, A. Anthropoid medpox.com
Direct Occipitoposterior position is a favourable position in
anthropoid type of pelvis.
1811. Persistent OP position is most common
in which pelvis?
a) Android

b) Gynaecoid

c) Anthrpoid

d) Mixed

Correct Answer - A
Ans, A. Android
With android type of pelvis the occipitoPosterior position is common
medpox.com
due to funnel shape of the pelvis.
1812. Contraindication for induction of labour
is all except?
a) Hypertensive disease of pregnancy

b) Heart disease of pregnancy

c) Pelvic tumor

d) Vasa previa

Correct Answer - A
Ans. A. Hypertensive disease of pregnancy
Hypertensive disease of pregnancy is an indication for induction of
medpox.com
labour. Other three are contraindications.
1813. Medical management of ectopic
pregnancy has decreased success if ?
a) Gestational sac < 3cm

b) Duration of gestation < 5 weeks

c) Cardiac activity present

d) Beta HCG < 8000 IU/L

Correct Answer - C
Ans. C. Cardiac activity present
Medical management of an ectoPic Pregnancy is done when :
medpox.com
Patient is hemodynamically stable
No evidence of acute intra abdominal bleeding
Ready to comply with follow up care
Serum beta HCG < 10,000 IU/L
Absent embryonic heart activity
Diameter of ectopic gestational mass less than 4 cm.
1814. All are the prognostic factors of Boer-
meisel system except -
a) Extent of adhesions

b) Thickness of tubal wall

c) Size of hydrosalpinx

d) Infecting organism

Correct Answer - D
Ans, D. Infecting organism
Boer-meisel system of prognostic classification for chronic
medpox.com
pelvic inflammatory disease includes:
Extent of adhesions
Nature of adhesions flimsy or dense
Size of hydrosalpinx
Macroscopic condition of hydrosalpinx
Thickness of tubal wall
1815. Pregnant uterus will compress ureters
at ?
a) Pelvic brim

b) Uterovesical junction

c) Trigone

d) Ureterovesical junction

Correct Answer - A
Ans, A. Pelvic brim
Ureters become atonic due to high progesterone level in pregnancy,
medpox.com
Dilatation of the ureter above the pelvic brim with stasis is marked
on the right side especially in the primigravidae.
It is due to deoxtrorotation of the uterus pressing the right ureter
against the pelvic brim and abo due to pressure by right ovarian
vein, which crosses the right ureter at right angle.
1816. Following is given to a patient with pre
term labour exept -
a) Glucocorticoids

b) Tocolytic drugs

c) Antibiotics

d) Beta blocker

Correct Answer - D
Ans. D. Beta blocker
Tocolytic drugs [Note: betamimetic and not beta blocker is a
tocolytic] medpox.com
1817. Most common cause of tenth day post
partum bleeding?
a) Retained bits of membrane

b) Infection

c) Endometritis

d) Blood coagulopathy

Correct Answer - A
Ans. A. Retained bits of membrane
Postpartum hemorrhage (PPH) is defined as blood loss of more than
medpox.com
500 ml following birth of baby.
1818. A multgravida 4 kg fetus is in labour
since 15 hours and has 5cm dilation of
cervix for last 8 hours. What is the
further management of this patient ?
a) Wait and watch

b) Amniotomy

c) Injection Oxytocin

d) Caesarian section

Correct Answer - D medpox.com

Ans. D. Caesarian section
1819. The treatment of choice for bartholin
cyst is ?
a) Marsupilisation

b) Aspiration

c) Observe

d) Curettage and closure

Correct Answer - A
Ans. A. Marsupilisation
Bartholin's cyst
medpox.com
Bartholin's cyst is formed when duct of bartholins gland is blocked
either by inflammation or by inspissated secretion.
It appears as a swelling on the inner side of the junction of the
anterior two-thirds with the posterior one-third of the labium majus.
A small cyst remains asymptomatic, but a larger one bulges across
the vaginal introitus and causes dyspareunia, discomfort and may
get infected when it needs excision or marsupialization
1820. Gartner's cyst are seen at ?
a) Antero lateral vaginal wall

b) Antero - lateral cervix

c) Posterolateral vaginal wall

d) Posterolateral cervix

Correct Answer - A
Ans, A,’. Antero lateral vaginal wall
Gartners duct cyst arises from the remnants of the mesotephric duct
and lies in the anterolateral aspect of vaginal wall.
medpox.com
1821. Most common cause of death of baby in
vasa previa is?
a) Infection

b) Maternal exanguination

c) Fetal exanguination

d) Both b and c

Correct Answer - C
Ans, C. Fetal exanguination
Vasa previa
medpox.com
In it a leash of blood vessels happen to traverse through the
membranes overlying the internal os, in front of presenting part.
Rupture of membranes involving the overlying vessels leads to
vaginal bleeding.
As it is entirely fetal blood, this may result in fetal exanguination and
even death.
1822. Sheehan syndrome is ?
a) Pitutary adenoma

b) Pitutary necrosis

c) Adrenal necrosis

d) Adrenal adenoma

Correct Answer - B
Ans., B. Pitutary necrosis
Sheehan's syndrome is anterior pituitory necrosis following severe
PPH, shock or severe infection.
medpox.com
1823. Most common cause of menorrhagia in
adolescents?
a) Thyroid disorder

b) Coagulation disorders

c) Leiomyomas

d) Polyps

Correct Answer - B
Ans, B. Coagulation disorders
In adolescent age group, abnormal uterine bleeding results from
medpox.com
anovulation and coagulation defects at disproportionately higher
rates compared with older reproductive-aged women
Coagulation disorders account for 20% of cases of menorrhagia in
adolescents.
1824. Not associated with endometrial
hyperplasia ?
a) PCOD

b) Glucose intolerance

c) HRT

d) Unopposed exposure to progesterone

Correct Answer - D
Ans. D. Unopposed exposure to progesterone
Following are the causes of endometrial hyperplasia
Follicular cysts of ovary medpox.com
PCOD
Granulosa and theca cell tumors of ovary
HRT
Glucose in tolerance
Unopposed exposure to estrogen (endogenous or exogenous)
1825. Following are the causes of maternal
deaths in patients with hypertensive
disorder of pregnanacy except ?
a) Cardiac failure

b) ARDS

c) Chronic renal failure

d) Cerebral hemorrhage

Correct Answer - C
Ans. C. Chronic renal failure
medpox.com
Causes of maternal deaths in cases of hypertensive disorders
of pregnancy are
Cardiac failure
Cerebral hemorrhage
ARDS
Puerperal sepsis
Pulmonary edema
Acute renal failure
Pulmonary embolism
Aspiration and/or septic pneumonia
Cardio-pulmonary arrest
Post-partum shock
1826. Classical name of mid cycle abdominal
pain with vaginal bleeding is called ?
a) Endometriosis

b) Mittelschmez

c) Meteropathiahemorrhagica

d) Menometrorrhagia

Correct Answer - B
Ans. B. Mittelschmez
Mittelschmerz is a mid-cycle pain, not lasting more than 12-24
medpox.com
hours, around ovulation. Pain is located in one of the iliac fossa and
may be accompanied with vaginal bleeding.
1827. Following is true about leuteoma of
pregnancy ?
a) Usually bilateral

b) It is a benign self limiting condition

c) It consists of leutenized cells

d) All the above

Correct Answer - D
Ans. D. All the above
Leuteoma of Pregnancy
medpox.com
It usually appears as bilateral, multinodular, solid masses in ovaries.
It is characterized by replacement of normal ovarian parenchyma by
solid proliferation of leutenized stromal cells under influence of
human chorionic gonadotroPin.
It is benign self-limiting condition and requires no treatment.
1828. Clinical alarming sign of MgSO4 toxicity
is ?
a) Loss of knee jerk

b) Loss of superficial abdominal reflexes

c) Loss of pin prick sensation

d) Loss of proprioception

Correct Answer - A
Ans. A. Loss of knee jerk
medpox.com
1829. False about MgSo4 is ?
a) Not used as antihypertensive

b) Its dose is different for eclampsia and preeclampsia

c) Deep tendon reflexes is monitored for toxicity

d) It acts as a membrane stabilizer and neuroprotector

Correct Answer - B
Ans. B. Its dose is different for eclampsia and preeclampsia
Dose of magnesium sulphate for management of pre-eclampsia and
eclampsia is the same.
medpox.com
1830. 18 weeks pregnancy of a lady, last two
times history of midtrimester abortion,
which was painless. What is the
diagnosis ?
a) Incompetent os

b) Chromosomal abnormality

c) Bivalve uterus

d) Progesterone deficiency

Correct Answer - A medpox.com

Ans. A. Incompetent os
Most common cause of second trimester pregnancy loss is cervical
incompetence, in which patient presents with recurrent painless
abortion.
1831. Following are the features of true labour
pain ?
a) Uterine contractions at regular intervals

b) Progressive effacement and dilation of cervix

c) Formation of bag of membranes

d) All the above

Correct Answer - D
Ans. D. All the above
Features of true labour Pains
medpox.com
Uterine contractions at regular intervals
Frequency of contractions increase gradually
Intensity and duration of contractions increase progressively
Associated with show
Progressive effacement and dilation of cervix
Descent of the presenting part
Formation of bag of forewaters
Not relieved by enema and sedatives
1832. HRT improves ?
a) Bone density

b) Demetia

c) Coronary artery disease

d) Endometrial cancer

Correct Answer - A
Ans, A. Bone density
Hormone replacement therapy improves bone density,

medpox.com
1833. Most common risk factor for rupture of
scarred uterus is
a) Use of oxytocin in labour

b) Grand multiparity

c) Forceps application

d) Obstructed labour

Correct Answer - A
Ans, A. Use of oxytocin in labour
The most common cause of rupture of scarred uterus k use of high
medpox.com
doses of oxytocin for the augmuntation of labour.
1834. Invalueable tool in the diagnosis of
chronic pelvic pain is ?
a) Endometrial biopsy

b) Ultrasound

c) Laparoscopy

d) Colposcopy

Correct Answer - C
Ans, C. Laparoscopy
Laproscopy is an invalueable diagnostic tool in the investigation of
chronic pelvic pain. medpox.com
1835. Most common site of ectopic pregnancy
is ?
a) Ovary

b) Fallopian tube

c) Peritoneum

d) Cervix

Correct Answer - B
Ans. B. Fallopian tube

medpox.com
1836. Least common site of ectopic
pregnancy in fallopian tubes is ?
a) Interstitium

b) Ampulla

c) Infundibulum

d) Isthumus

Correct Answer - A
Ans, A. Interstitium
Most common site for ectopic pregnancy fallopian tubes,
medpox.com
1837. Criteria for Puerperal pyrexia is
temperature ?
a) 100.4 degrees F on two separate occasions

b) 101 degrees F on two separate occasions

c) 100.4 degrees F on three separate occasions

d) 101 degrees F on three separate occasions

Correct Answer - A
Ans, A. 100.4 degrees F on two separate occasions
Puerperal pyrexia
medpox.com
A rise of temperature reaching 100.4 degrees F (38 degrees C) or
more (measured orally) on two separate occasions at 24 hours apart
(excluding first 24 hours) within first 10 days following delivery is
called puerperal pyrexia.
1838. Investigation of choice for diagnosis of
PID is ?
a) Laparoscopy

b) Colposcopy

c) Hysteroscopy

d) Ultrasonography

Correct Answer - A
Ans, A. Laparoscopy
Laparoscopy is considered the investigation of choice for the
medpox.com
diagnosis of pelvic inflammatory disease.
1839. Which drug is preferred for the
treatement of 21 hydroxylase deficient
female fetus to prevent genital
virilization?
a) Materal cortisol

b) Maternal dexamethasone

c) Maternal hydrocortisone

d) Maternal methylprednisolone

Correct Answer - B medpox.com

Ans, b. Maternal dexamethasone
Fetus is at risk of CAH maternal dexamethasone therapy can
suppress the fetal HPA axis and prevent
genital virilization in affected female fetus.
1840. Speilberg criteria is used for ?
a) Ovarian pregnancy

b) Ovarian malignancy

c) Cervical pregnancy

d) Cervical malignancy

Correct Answer - A
Ans, A. Ovarian pregnancy

medpox.com
1841. Main factor responsible for increased
perinatal mortality in twin pregnancy is
?
a) Prematurity

b) IUGR

c) Polyhydramnios

d) Uterine rupture

Correct Answer - A
Ans, A. Prematurity medpox.com
1842. Cryptomenorrhoea is a feature of ?
a) Vaginal atresia

b) Turner syndrome

c) Empty sella syndrome

d) Gonadal agenesis

Correct Answer - A
Ans, A. Vaginal atresia

medpox.com
1843. . Which of the following antiepileptic
drug is associated with causing
congenital heart disease in fetus?
a) Barbiturates

b) Valproate

c) Carbamazepine

d) Phenytoin

Correct Answer - A
Ans. A. Barbiturates medpox.com
1844. Engagement of head in labour means ?
a) Smallest horizontal plane of the presenting part has crossed the
pelvic brim

b) Greatest horizontal plane of the presenting part has crossed the

pelvic brim

c) Smallest horizontal plane of the presenting part has crossed the

pelvic outlet

d) Greatest horizontal plane of the presenting part has crossed the

pelvic outlet

Correct Answer - B medpox.com

Ans. B. Greatest horizontal plane of the presenting part has
crossed the pelvic brim
When the greatest horizontal plane of the presenting part has
passed the plane of pelvic brim the presenting part is said to be
engaged.
1845. Which of the following has maximum
diabetogenic potency in pregnancy ?
a) Estrogen

b) Progesterone

c) Cortisol

d) Prolactin

Correct Answer - C
Ans, C, Cortisol

medpox.com
1846. Old complete perineal tear is repaired at
?
a) Immediately

b) 3 - 6 months

c) 6 - 9 months

d) 9 - 12 months

Correct Answer - B
Ans, B. 3 - 6 months
The definitive surgery for complete perineal tear k repair of the anal
medpox.com
sphincter complex (sphinaeroptasty) with restoration of the perineal
body (perineoraphy).
For the fresh injuries the best time of repair is within 24 hours afire
injury,
For old perineal tears this should preferable be done 3 - 6 months
following injury.
1847. Amenorrhoea following
hyperprolactinoma is caused by ?
a) Inhibition of GnRH pulse secretion

b) Inhibition of adrenal steoridogenesis

c) It causes hypergonadotropic hypogonadism

d) It leads to formation of ovarian cysts

Correct Answer - A
Ans, A. Inhibition of GnRH pulse secretion
Prolactin inhibits GnRH pulse secretion and suppresses
ganadotropin levels. medpox.com
Hyperprolactinemiacauses amenorrhea, anovulation and
Hypogonadism.
1848. Sequence of lochia ?
a) Rubra - Serosa - Alba

b) Serosa - Alba - Rubra

c) Alba - Rubra - Serosa

d) Alba - Serosa - Rubra

Correct Answer - A
Ans, A, Rubra - Serosa - Alba
Lochia
It is the vaginal discharge for the first fortnight during peurperium.
The discharge originates from the uterine body, cervix and vagina.
medpox.com
1849. Following is true regarding the
management of intrauterine fetal death
except ?
a) In 50% of cases spontaneous expulsion occurs in 2 weeks

b) Fibrinogen levels should be checked weekly

c) Delivery by medical induction is preferred if spontaneous

expulsion does not occur

d) Caesarian section has limited place in management of

intrauterine fetal death

medpox.com
Correct Answer - A
Ans, A, In 50% of cases spontaneous expulsion occurs in 2
weeks
1850. Following is true about tamoxifene
except ?
a) It is a selective estrogen receptor modulator

b) It is a competitive inhibitor of estrogen at receptor site

c) It decreases risk of venous thromboembolism

d) It can be used for induction of ovulation

Correct Answer - C
Ans, C, It decreases risk of venous thromboembolism

medpox.com
1851. What is the risk of recurrence of
anencephaly in subsequent pregnancy?
a) 1%

b) 2%

c) 3%

d) 4%

Correct Answer - B
Ans, B. 2%
The risk of recurrence of anencephaly in subsequent pregnancy is
2%. medpox.com
1852. Another name for mancehster operation
for uterine prolapse is ?
a) Fothergill

b) Mercy

c) McDonald

d) Purandare

Correct Answer - A
Ans, A, Fothergill
Manchester operation also called Fothergill's operation.
medpox.com
1853. Definitive treatment for a case of severe
pre eclampsia is -
a) MgS0,

b) Delivery of baby

c) Antihypertensive drugs

d) Rest

Correct Answer - B
Ans, B. Delivery of baby
For all types of PIH, irrespective of severity, definitive management
is termination of pregnancy"medpox.com
1854. LEEP stands for ?
a) Loop electrosurgical excision procedure

b) Loop electromagnetic excision procedure

c) Loop electrodiagnostic excision procedure

d) Loop electrochemical excision procedure

Correct Answer - A
Ans, A, Loop electrosurgical excision procedure
LEEP
Stands for Loop Electrosurgical diagnostic procedure.
It is also known as large loop excision of the transformation zone
medpox.com
(LLETZ).
1855. Simultaneous administration of
estrogen and progesterone in hormone
replacement therapy increases risk of ?
a) Ovarian cancer

b) Breast cancer

c) Cervical cancer

d) Both a and b

Correct Answer - D
Ans D. Both a and b medpox.com
Risk due to both estrogen and progesterone in HRT:-
Breast cancer
Ovarian cancer
Risk due to only estrogen in HRT:-
Endometrial carcinoma
1856. Duration of second stage of labor
depends upon -
a) Size of fetus

b) Mother's build

c) Parity

d) Lie of fetus

Correct Answer - C
Ans, C, Parity
The duration of the normal second stage is usually very much
medpox.com
shorter than the normalfirst stage of labour.
As with the first stage the duration of the second stage
willmainlydepends on whether it is the first labour or the woman
haspreviously given birth to a viable infant i. e. it depends on the
parity status ofthe mother,
1857. Vasa previa is seen in which type of
placenta ?
a) Central

b) Vilamentous

c) Peripheral

d) None of the above

Correct Answer - B
Ans. B. Vilamentous
Vasa previa
medpox.com
If a leash of blood vessels happen to traverse through the
membranes overlying the internal os, in front of presenting part, the
condition is called vasa previa.
These are the unsupported umbilical vessels in vilamentous
placenta.
1858.

medpox.com
Which is not a part of basic essential
obstetric care?
a) Blood transfusion

b) Parenteral antibiotics

c) Parenteral oxytocic drugs

d) Parenteral sedatives for eclampsia

Correct Answer - A
Ans. A. Blood transfusion
Basic essential obstetric care services at the health center level
medpox.com
should include at least the following:
Parenteral antibiotics
Parenteral oxytocic drugs
Parenteral sedativesfor eclampsia
Manual removal of placenta
Manual removal of retained products
1859. Mediolateral episiotomy is preferred
because ?
a) Reduces damage to anal sphincter and anal canal

b) Less blood loss

c) Easy to suture

d) Easy technique

Correct Answer - A
Ans, A. Reduces damage to anal sphincter and anal canal
Mediolateral episiotomy reduces the risk of damage to anal
medpox.com
sphincter and anal canal thought it may slightly increase the
bleeding.
1860. Monzygotic twin with one healthy baby
born at term and one dead mummified
fetusis suggestive of ?
a) Fetus acardiacus

b) Fetus papyraceous

c) Hydatidiform mole

d) Vanishing twin

Correct Answer - B
Ans. B. Fetus papyraceous medpox.com
Fetus Paoyraceous or compressus-
Is a state which occurs in case of twins when one of the fetuses dies
early.
The dead fetus is flattened mummifed and compressed between the
membranes of livingfetus and uterine waII.
It may occur in both varieties of twins but is more common in
monozygotic twins and is discovered at delivery or earlier by
sonography.
1861. Sarcoma botryoides all are true except
?
a) Also called embryonalrhabdomyosarcoma

b) Commonly arises from vagina

c) It presents with blood stained watery vaginal discharge

d) It can be treated with VAC regime

Correct Answer - B
Ans B. Commonly arises from vagina
Sarcoma botyroides ( Embrvonalrhabdomyosarcoma)
medpox.com
Special type of mixed mesodermal tumour commonly arising from
cervix, rarely from vagina &uterus.
1862. Following are the indicatons of
hysterosalpingography except
a) Fallopian tube patency in infertility

b) Study uterine anamoly

c) Detect uterine synechiae

d) Detect endometriosis

Correct Answer - D
Ans, D. Detect endometriosis
Indications of HysterosaIpingography
medpox.com
To study the patency offallopian tubes in infertility and postoperative
tuboplasty
To assess the feasibility of tuboplasty by studying the extent of tubal
pathologist.
To study the uterine anomaly such as septate and cornuate uterus
To detect uterine synechiae
To detect uterine polyp
To study the incompetence of internal OS
1863. Most common cause of early abortion -
a) Genetic

b) Maternal

c) Immunologic

d) Anatomic abnormalities

Correct Answer - A
Ans. A. Genetic

medpox.com
1864. Following are the ultrasound doppler
parameters used in the diagnosis of
intrauterine growth restriction except?
a) Abdominal circumference

b) Doppler velocimetry

c) Increased diastolic velocity in middle cerebral artery

d) Ponderal index

Correct Answer - A
Ans, A. Abdominal circumference
medpox.com
1865. What is used to aid identification of
areas of dysplasia in colposcopy?
a) 3 - 5% acetic acid

b) Acetocarmine red

c) 1 % formic acid

d) 1 % alcohol

Correct Answer - A
Ans. A. 3 - 5% acetic acid
Colposcopy is the mainstay in the diagnosis of cervical dysplasia
and precancerous lesions. medpox.com
1866. Which of the following is an absolute
indication for caesarian section?
a) Central placenta previa

b) Breech presentation

c) Bad obstetric history

d) Previous caesarian delivery

Correct Answer - A
Ans, A. Central placenta previa
Absolute indications for caesarian section-
Central placenta previa medpox.com
Contracted pelvis or cephalopelvic disproportion (absolute)
Pelvic mass causing obstruction (cervical or broad ligament fibroid)
1867. 34 weeks pregnancy with low lying
placenta previa, floating head, Hb - 11
gm%. What should be the further line of
management?
a) Expectant management

b) Induction of labour

c) Caesarian section

d) Blood transfusion

Correct Answer - A medpox.com

Ans. A. Expectant management
1868. Risk factors for the ectopic pregnancy
are ?
a) IUCD

b) History of infertility

c) Tubal endometriosis

d) All the above

Correct Answer - D
Ans, D, All the above

medpox.com
1869. Not a risk for ectopic pregnancy ?
a) Use of condom

b) OCP

c) PID

d) Previous ectopic pregnancy

Correct Answer - A
Ans. A. Use of condom

medpox.com
1870. Following are the causes of
oligohydramnios except?
a) IUGR

b) Postmaturity

c) Maternal dehydration

d) Labetolol

Correct Answer - D
Ans, D. Labetolol

medpox.com
1871. Red cell volume is increased by what
percentage in pregnancy?
a) 10 - 20%

b) 20 - 30%

c) 30 - 40%

d) 40 - 50%

Correct Answer - B
Ans. B. 20 - 30%

medpox.com
1872. How much time after reduced
movement fetal heart stops?
a) 1 hr

b) 2 hrs

c) 6 hrs

d) 12 hrs

Correct Answer - D
Ans, D, 12 hrs
On an averagefetalheart stops after 12 - 48 hours of diseased fetal
medpox.com
movements in intrauterinefetal death.
1873. Lileys zone 3 at 35 weeks gestation
management is?
a) Follow up

b) Intrauterine infusion

c) Preterm termination of pregnancy

d) Cordocentesis

Correct Answer - C
Ans, C. Preterm termination of pregnancy
A chart that uses the spectrographic measurement of amniotic fluid
medpox.com
bilirubin levels plotted against gestational age to estimate the
severity of fetal hemolysis resultingfrom Rh isoimmunizntion.
1874. Upper age limit to diagnose a patient as
having primary amenorrhoea is ?
a) 13 years

b) 14 years

c) 15 years

d) 16 years

Correct Answer - D
Ans. D. 16 years
A young girl who has not yet menstruated by her 16 years of age
medpox.com
has pimary amenonhoea rather than delayed metarche.
Delayed puberty is defined as failure of development of signs of
sexual development by the age of 14 years in boy.
In girls delayed puberty is defined as failure of breast budding by I 3
years or absence of menarche by I 5 year or lack of secondary
sexual characters by l7 years.
1875. Swiss cheese pattern is seen in ?
a) Metropathica hemorrhagica

b) Serous cystadenoma

c) Mucinous cystadenoma

d) Dermoid

Correct Answer - A
Ans. A. Metropathica hemorrhagica
Microscopicappearance of endometrium shows: Glandular
hyperplasiawith cystic dilation of few glands of variable sizes givingit
a swiss cheese appearance. medpox.com
1876. Couvelaire uterus is seen in ?
a) Placenta previa

b) Abruptio placentae

c) Plencenta accrete

d) Velamentous placenta

Correct Answer - B
Ans. B. Abruptio placentae
Couvelaire uterus
Also called uteroplacental apoplexy.
It is seen in association with severe forms of "concealed abruptio
medpox.com
placen "
1877. Condition where there is ingrowth of
the endometrium, both glandular and
stromal component in myometrium is ?
a) Adenomyosis

b) Courvelaire uterus

c) Placenta accreta

d) Uterine fibroid

Correct Answer - A
Ans, A. Adenomyosis medpox.com
Adenomyosis is a condition where there is ingrowth of the
endometrium, both the glandular and stromal components, directly
into the myometrium.
1878. In PID due to neiserriea gonorrhea,
tubal damage is?
a) Peritubal

b) Endotubal

c) Extratubal

d) Juxtatubal

Correct Answer - B
Ans. B. Endotubal
Gonococcal infection involves the mucosa and mainly remains an
medpox.com
endoluminal pathology while the other bacterial PID tend to involve
deeper tissues and can also involve extratubal tissues. So the most
probable answer is endotubal.
1879. 20 year old female with primary
amenorrhoea with normal presentation
of everything except no axillary or
pubic hair. What is the diagnosis?
a) Testicular feminization syndrome

b) Kallman syndrome

c) Turners syndrome

d) Klienfelters syndrome

Correct Answer - A medpox.com

Ans, A. Testicular feminization syndrome
Phenotypically normal females with absence of axillary and
pubic hair with primary amenorrhoea have two differential
diagnosis:
Testicular feminizing syndrome and
Mullerian agenesis.
1880. Transverse lie is caused by all except ?
a) Multiparity

b) Prematurity

c) Anencephaly

d) Placenta previa

Correct Answer - C
Ans, C. Anencephaly
Etiology transverse lie:
Multiparity
Twins medpox.com
Contracted pelvis
Pelvic tumors
Intrauterine death
Prematurity
Hydramnios
Placentaprevia
Congenital malformation of uterus - arcuate, subseptate
1881. Most common breech presentation in
primigravida is ?
a) Flexed breech

b) Frank breech

c) Footling presentation

d) Incomplete

Correct Answer - B
Ans, B. Frank breech
Breech with extended legs/Frank breech
medpox.com
1882. Estimation of fetal hemoglobin is done
by ?
a) Gerhard test

b) Kleihauser-Betke Acid Elution Test

c) Grinders test

d) Simpsons test

Correct Answer - B
Ans. B. Kleihauser-Betke Acid Elution Test
Modified Keihauser-Betke Acid Elution test: it k used to note the
medpox.com
number fetal red cells per 0 low power fields.
If there are 80 fetal erythrocyte in 50 low power fields in maternal
peripheralblood films, it presents the transplacental hemorrhage of 4
ml of fetal blood.
1883. Most common mode of spread for
genital tuberculosis is?
a) Hematogenous

b) Lymphatic

c) Direct

d) Ascending

Correct Answer - A
Ans. A. Hematogenous
From any of the primary sites, the pelvic organs involved by
medpox.com
hematogenous spread in about 90% of the cases.
1884. What is the next step in investigating a
45 yrs old female with post coital
bleeding and visible cervical mass on
speculum examination ?
a) Dilatation and curettage

b) Conisation

c) Colposcopy

d) Hysteroscopy

Correct Answer - C medpox.com

Ans. C. Colposcopy
1885. Treatment of IBI ca cervix ?
a) Wertheim's hysterectomy

b) Radiotherapy

c) Chemotherapy

d) Chemoradiotherapy

Correct Answer - A
Ans. A. Wertheim's hysterectomy

medpox.com
1886. Management of Stage IIA carcinoma
cervix in third trimester of pregnancy is
?
a) Radical hysterectomy, pelvic lymphadenetomy after classic
caesarian delivery

b) Periodic cytology and evaluation

c) Cone biopsy

d) Chemotherapy and brachytherapy

Correct Answer - A medpox.com

Ans. A. Radical hysterectomy, pelvic lymphadenetomy after
classic caesarian delivery
1887. Inhibin is a tumor marker for ?
a) Granulosa cell tumor

b) Dysgerminoma

c) Serous cystadenoma

d) Krukenberg tumor

Correct Answer - A
Ans. A. Granulosa cell tumor

medpox.com
1888. Call Exner bodies seen in ?
a) Granulosa cell tumors

b) Serous cystadenomas

c) Dysgerminoma

d) Krukenberg tumor

Correct Answer - A
Ans. A. Granulosa cell tumors
The formation of Call - Exner bodies is a distinct feature of granulosa
cells and can be readilyrecognized in certain types of granulosa cell
tumours. medpox.com
1889. Most common germ cell tumor of ovary
is ?
a) Dysgerminoma

b) Serous cystadenoma

c) Yolk sac tumor

d) Dermoid cyst

Correct Answer - D
Ans. D. Dermoid cyst

medpox.com
1890. Which of the following is the most
common malignant germ cell tumor of
ovary?
a) Yolk sac tumor

b) Dysgerminoma

c) Polyembryoma

d) Choriocarcinoma

Correct Answer - B
Ans, B. Dysgerminoma medpox.com
1891. Most common malignant ovarian tumor
is ?
a) Serous cystadenocarcinoma

b) Mucinous cysadenocarcinoma

c) Malignant teratoma

d) Sarcoma

Correct Answer - A
Ans, A. Serous cystadenocarcinoma

medpox.com
1892. Most common ovarian cyst to undergo
torsion is ?
a) Dysgerminoma

b) Benign cystic teratoma

c) Ovarian fibroma

d) Brenner's tumor

Correct Answer - B
Ans, B. Benign cystic teratoma
Benign cystic teratoma is the most common ovarian neoplasm to
undergo torsion. medpox.com
1893. Following the criteria for conservative
surgery in patients with ovarian
carcinoma except ?
a) FIGO stage II disease

b) Young patient with no or few children

c) Well differentiated serous tumor

d) No infiltration of capsule, lymphatics or mesoovarium

Correct Answer - A
Ans. A. FIGO stage II disease
medpox.com
Requirements for conservative surgery in patients with
ovarianCancer are:
FIGO stage IA disease
Well differentiated serous, mucinous, endometroid or clear cell
tumor
Young patient with no or few children
No other pelvic pathology precluding pregnancy
1894. Most common cause of vulval
carcinoma is ?
a) HPV infection

b) EBV infection

c) Herpes genitalis infection

d) Syphilis infection

Correct Answer - A
Ans. A. HPV infection
HPV infection is a common risk factor for the development of
invasive vulval carcinoma. medpox.com
1895. Most common cancer in pregnancy ?
a) Melanoma

b) Breast carcinoma

c) Gastric carcinoma

d) Thyroid carcinoma

Correct Answer - B
Ans. B. Breast carcinoma
Breast carcinoma is the most common cancer in pregnancy
constituting 46% (1:3000 to 10,000) of the cases followed by
hematological malignancies constituting 18 - 25%o of the cases,
medpox.com
1896. Most common type of fibroid is ?
a) Intramural

b) Subserosal

c) Cervical

d) Submucosal

Correct Answer - A
Ans. A. Intramural

medpox.com
1897. Sentinel lymph node biopsy is used to
map the lymph node status of which
cancers?
a) Breast

b) Melanoma

c) Vulva

d) All the above

Correct Answer - D
Ans, D. All the above medpox.com
Lymphatic mapping and sentinel lymph node biopsy
Technique use to know the local lymph node status in cancers of
breast, vulva and melanoma
1898. Meigs syndrome is associated with
which tumor ?
a) Fibroma

b) Cystadenoma

c) Dysgerminoma

d) Teratoma

Correct Answer - A
Ans. A. Fibroma
Meigs syndrome combination offibroma with ascites andhydrothorax,
usuaily rightsided. medpox.com
Seen in 1- 5% patients.
1899. Carcinoma endometrium with
involvement of the vaginal wall is
included in which stage ?
a) IIIA

b) IIIB

c) IIIC

d) IVA

Correct Answer - B
Ans. B. IIIB medpox.com
1900. Investigation of choice in endometriosis
?
a) Laproscopy

b) Hysteoscopy

c) CT scan

d) MRI

Correct Answer - A
Ans. A. Laproscopy
Laproscopy is considered as gold standard investigation for
diagnosis of endometriosis.medpox.com
It is diagnostic as well as therapeutic,
1901. Drug commonly used in treatment of
endometriosis is?
a) LH

b) GnRH

c) MPA

d) FSH

Correct Answer - B
Ans. B. GnRH

medpox.com
1902. First line treatment of infertility in PCOS
is ?
a) Clomiphene

b) FSH

c) GnRH

d) Assisted reproductive techniques

Correct Answer - A
Ans. A. Clomiphene
Clomiphene citrate is the first line of treatment of infertility in a PCOS
woman. medpox.com
1903. Clomiphene citrate is used for ?
a) Anovulation

b) Endometriosis

c) Puberty menorrhagia

d) Hormone replacement therapy

Correct Answer - A
Ans A. Anovulation

medpox.com
1904. Copper IUCD as a contraceptive
measure can be used maximum till what
time after contact ?
a) 2 days

b) 3 days

c) 4 days

d) 5 days

Correct Answer - D
Ans. D. 5 days medpox.com
IntroductionofCopperlUDwithinamaximumperiodof5dayscan
preventconceptionfollowingaccidentalunprotectedexposure.
1905. Absolute contraindication of OC pills
are all except?
a) Suspicious vaginal bleeding

b) Cervical cancer

c) Uterine anamoly

d) Old STD

Correct Answer - D
Ans. D. Old STD
Current STD is an absolute contraindication (not past STDs).
medpox.com
1906. Most common infection in long term
IUCD use -
a) Actinomyosis

b) Mucormycosis

c) Aspergillosis

d) Candidiasis

Correct Answer - A
Ans. A. Actinomyosis
Actinomycosis is an infection common in patients sing inert IUCDs.
medpox.com
1907. Mechanism of action of IUCD is all
except ?
a) Inhibit ovulation

b) Induce biochemical changes in endometrium

c) Increase tubal motility

d) Inflammatory respone in endometrium

Correct Answer - A
Ans, A. Inhibit ovulation
Act predominantly in the uterine cavity and do not inhibit ovulation.
medpox.com
1908. Components of Mala D are all except ?
a) 0.03 mg Ethinyl estradiol

b) 0.15mg desogestrel

c) 0.15 mg levenogestrel

d) Iron tablets

Correct Answer - B
Ans, B. 0.15mg desogestrel

medpox.com
1909. Not true in complete hydatidiform mole
?
a) Triploid

b) Absence of fetal parts

c) Diffuse trophoblastic hyperplasia

d) Beta HCG > 50,000

Correct Answer - A
Ans, A. Triploid
Triploidy and diploidy are seen in partial mole. Complete mole has
46 XX karyotype. medpox.com
1910. Risk of scar rupture in lower segment of
previous scar present is ?
a) 05 - 1.5 %

b) 15 - 25 %

c) 2.5 - 3.5 %

d) 3.5 - 4.5 %

Correct Answer - A
Ans. A. 05 - 1.5 %

medpox.com
 1911. Heliotopre sign is seen in ?
a) Dermatomyositis

b) Scleroderma

c) Photodermatitis

d) Vitiligo

Correct Answer - A
Ans. is 'a' i.e., Dermatomyositis
Cutaneous signs of dermatomyosits
Gottron's papules :- lilac or violaceous papules on knuckle, dorsa of
hands. medpox.com
Gottron's sign :- Violaceous erythema with edema over shoulder,
arms, forearms.
Heliotrope sign :- Violaceous erythema with edema over eyelids,
periorbital region.
Poikiloderma :- Atrophy of skin, hypopigmentaion, dilated blood
vessels over trunk.
Mechanic hand :- Symmetric hyperkeratosis along ulnar aspect of
thumb and radial aspect of fingers.
Shawl Sign :- Violaceous erythema extending from dorsolateral
aspect of hands, forearms, and arms to shoulder & neck.
Calcinosis cutis :- Calcium deposits in skin (in Juvenile variant).
Miscellaneous signs :- Photosensitivity, vasculitis, panniculitis, Nail-
fold telangiectasia.
Extracutaneous involvement
1. Proximal myositis
2. Cardiomyopathy
3. Raynaud's phenomenon
4. Arthralgia
medpox.com
1912. Gottron signs is sign in?

a) dermatomyositis
medpox.com
b) herpes infection

c) Bacterial infection

d) All of the above.

Correct Answer - A
Dermatomyositis (DM) is a connective-tissue disease related
to polymyositis (PM) that is characterized by inflammation of the
muscles and the skin. While DM most frequently affects the skin and
muscles, it is a systemic disorder that may also affect the joints, the
esophagus, the lungs, and the heart.
1913. Patient presents with discharge per
urethrum and microscopy shows
presence of intracytoplasmic gram
negative cocci; what is the most
probable diagnosis ?
a) Gonorrhea

b) Donovanosis

c) Bacterial vaginosis

d) Syphilis

medpox.com
Correct Answer - A
Ans. is 'a' i.e., Gonorrhea
Presence of pus discharge per urethrum in males with presence of
intracytoplasmic gram negative cocci are pointers to the presence of
N. gonorrhea infection.
GONOCOCCAL INFECTION
N.Gonorrhoeae is an intracytoplasmic gram negative coccus.
N. gonorrhoeae is exclusively a human pathogen although
chimpanzees have been infected artificially.
It is never found as a normal commensal although a proportion of
those infected, particularly women, may remain asymptomatic.
Acute urethritis is most common manifestation. Purulent discharge
per urethra is the most common manifestation.
The process may extend, along the urethra, to prostate, seminal
vesicle, epididymis.
1914. Christmas tree appearance in skin is
seen in ?
a) Pityriasis rosea

b) Pityriasisrubrapilaris

c) Psoriasis

d) Vitiligo

Correct Answer - A
Ans. is 'a' i.e., Pityriasis rosea
Pityriasis rosacea
medpox.com
P. rosea is a common scaly disorder, occuring usually in children
and young adults (10-35 years).
Characterized by round/oval pink brown patches with a superficial,
centrifugal scale, distributed over trunk in a Christmas tree pattern.
The disease is thought to be viral disease, is self limiting, and
subsides in 6-12 weeks.
The exact etiology is not known, but it is considered to be a viral
disease; Human Herpes virus 6 (HHV 6) and Human Herpes virus 7
(HHV 7) may play a role.
Clinical manifestations of P. rosea
The disease starts with an upper respiratory prodrome or a mild flu.
After 1-2 weeks, Annular erythmatous plaque appears on trunk that
is referred to as mother patch or herald patch.
Over the next 1-2 weeks, fresh patch appear all over the trunk, in a
Christmas tree configuration or Fir tree Configration.
The lesions are pinkish in white skin, hence the name rosea.
However, on the dark Indian skin the lesions are skin coloured or
brown.
The most characteristic clue for the diagnosis is the presence of a
fine scale at the edge of the lesion referrred to as centrifugal scale or
collarette scales or cigarette paper scales.
Lesions subside with hyperpigmentation.
Trunk is involved predominantly, Sometimes (in 20% of patients)
lesions occur predominantly on extremities and neck (inverse
pattern).

medpox.com
1915. Pomphylox affects ?
a) Palms & soles

b) Groin

c) Scalp

d) Trunk

Correct Answer - A
Ans is 'a' i.e., Palms & soles
POMPHOLYX
An attack of pompholyx is characterized by the sudden onset of
crops of clear vesicles, which appear 'sago-like'.
medpox.com
Itching may be severe, preceding the eruption of vesicles.
The attack subsides spontaneously in 2-3 weeks .
In mild cases, only the sides of the fingers may be affected, but in a
typical case the vesicles develop symmetrically on the palms and/or
soles
1916. Pseudobubo seen in:
a) Chancroid

b) Syphilis

c) Lymphogranuloma inguinale

d) Lymphogranuloma venerum

Correct Answer - C
Ans. is. 'c' i. e., Lymphogranuloma inguinale

medpox.com
1917. Erythrasma is caused by ?
a) Comybacterium

b) Staphylococcus

c) Streptococcus

d) Herpes Virus

Correct Answer - A
Ans. is 'a' i.e., Cornybacterium
Erythrasma is a skin disease that causes brown, scaly skin patches.
It is caused by the Gram-positivebacterium
Corynebacteriumminutissimum. It is prevalent among diabetics and
medpox.com
the obese, and in warm climates; it is worsened by wearing
occlusive clothing.
1918. HPV causes ?
a) Condylomalata

b) Condyloma acuminata

c) Bubo

d) Chancre

Correct Answer - B
Ans. is 'b' i.e., Condyloma acuminata

medpox.com
1919. Drug of choice for genital warts is ?
a) Acyclovir

b) Podophyllin

c) Minocyclin

d) Interferon alpha

Correct Answer - B
Ans. is 'b' i.e., Podophyllin

medpox.com
1920. Depigmenting agent of choice in in
treatment of dermatological disorders
is
a) Hydroquinone

b) Zinc

c) Kojic acid

d) Azelaic acid

Correct Answer - A
Ans. is 'a' i.e., Hydroquinone
medpox.com
Skin depigmenting agents in clinical use are
Hydroquinone - most effective and widely used
Kojic acid
Kojicdipalmitate
Azelaic acid
1921. Nail pitting is seen with ?
a) Paronychia

b) Ectodermal dysplasia

c) Alopecia areate

d) All the above

Correct Answer - D
Ans. is'd' i.e., All the above

medpox.com
1922. Vitiligo is associated with the following
except
a) Addison's disease

b) Men syndrome

c) Pernicious anemia

d) Crohns disease

Correct Answer - D
Ans. is 'd' i.e., Crohns disease
Vitiligo is associated with the following autoimmune diseases :-
Alopecia areata medpox.com
Diabetes mellitus
Hyperthyroidism
Hypothyroidism
Pernicious anemia
Addison disease
Multiple endocrinopathy syndrome
1923. Treatment of nodulocystic acne is
a) Erythromycin

b) Tertacycline

c) Isoretinonine (Retinoic acid)

d) Steroids

Correct Answer - C
C i.e. Isoretinonine

medpox.com
1924. True about erythema
toxicumneonatorum is ?
a) It is present in 3 - 5 % of the newborns

b) It is mostly present at birth

c) It is called the flea bitten rash of newborn

d) Topical antibiotics is the treatment of choice

Correct Answer - C
Ans. is 'c' i.e., It is called the flea bitten rash of newborn
Erythema ToxicumNeonatorum
medpox.com
It is the harmless, erythematous, short lived eruptions of the
newborn.
It is present in 30 - 50% of the newborns
It is considered a part of normal transition from the watery womb to
the dry external environment.
It appears most often in the first 2 days of life and is rarely present at
birth
It consists of widespread erythematous macules most present in the
trunk and the proximal parts of the extremities.
Hurwitz called it the flea bitten rash of new born.
No active therapy is needed for the treatment.
1925. What is the the most probable
diagnosis of a child who presents with
white umbilicated lesions on face?
a) Molluscumcontagiosum

b) Herpes simplex infection

c) Erythema toxicumneonatorum

d) Human pappiloma virus infection

Correct Answer - A
Ans. is 'a' i.e., Molluscumcontagiosum
medpox.com
Pearly white umblicated papule on face in children is most
commonly seen in Molluscumcontagiosum.
Molluscum contagiosum
It is a common viral infection in children. It is caused by pox virus,
i.e., Molluscum contagiosum virus. It is characterized by multiple
pearly white, dome-shaped papules which are umbilicated centrally.
On using a hand lens, many of the papules has a mosaic
appearance. Epidermal cells contain eosinophilic intracytoplasmic
inclusion bodies (Molluscum or Henderso-Paterson bodies).
Autoinoculation can give rise to lesions arranged linearly along line
of trauma ----> pseudoismorphic (pseudokoebner's) phenomenon.
M.C. may involve any part of the body In children face is involved
most commonly. Anogenital molluscum contagiosum is a STD.
Treatement
Curretage, electrocautery, cryotherapy are simple and effective
methods. Imiquimed, a recently introduced immunostimulant, is
helpful in patients with multiple lesions and in small children.
1926. Haascheiben cells in epidermis are
responsible for?
a) Touch

b) Temperature

c) Pressure

d) Proprioception

Correct Answer - A
Ans. is 'a' i.e., Touch

medpox.com
 1927. Apple jelly noddule is seen in ?
a) Lupus vulgaris

b) Cutaneous anaphylaxus

c) Erythroderma

d) Erysepals

Correct Answer - A
Ans. is 'a' i.e., Lupus vulgaris
Lupus vulgaris
Lupus vulgaris is a chronic and progressive form of cutaneous
tuberculosis that occurs in tuberculin sensitive patients. It is the most
medpox.com
common type of cutaneous tuberculosis and has most variable
presentation. Seen in children and young adults, though no age is
exempted. Occurs on exposed area like face (nose, eyelid, pinna);
and sometimes on buttock, trunk.
Lesions are usually solitary and characterized by : -
1. Reddish brown (erythematous).
2. Annular in shape.
3. Indurated.
4. Slowly increases in size (gradually progressive).
5. Healing with tissue paper like scarring at centre (most common) or
edge.
6. Peripheral crusting.
7. Blanching with glass slide (diascopy) will reveal grey green foci —>
Apple jelly nodules.
8. Match-stick test positive —> Apple jelly nodule has no resistance to
pressure by a sharp match-stick.
Reappearance of new nodules within previously atrophic or scarred
lesions is characteristic. Cartilage (Ear, nose) in the affected area is
progressively destroyed (Lupus vorax); bone is usually spared.
Buccal, nasal and conjuctival mucosa may be involved primarily or
by extension. Treatment is antitubercular drugs (ATT).

medpox.com
 1928. Flaccid bullae with mucosal
involvement and intraepidermal
acantholysis are characteristic of?
a) Pemphygus vulgaris

b) Pemphigus foliaceous

c) Psoriasis

d) Vitiligo

Correct Answer - A
Ans. is 'a' i.e., Pemphygus vulgaris
medpox.com
Among the given options, two are vesicullabullous disorders :-
1. Pemphigus vulgaris
2. Pemphigus foliaceous
Both of these cause flaccid bullae with intraepidermal blisters.
but, mucosal involvement is common in pemphigus vulgaris (not in P
foliaceous).
1929. Ig A deposition in dermoepidermal
junction skin seen in ?
a) Dermatitis herpetiformis

b) Bullous pemphigoid

c) Linear IgA disease

d) Epidermolysis bullosa

Correct Answer - C
Ans. is 'c' i.e., Linear IgA disease

medpox.com
1930. Not a feature of scabies is ?
a) Serpentine burrow

b) Severe itching

c) Web space affection

d) Genitalia are not affected

Correct Answer - D
Ans. is 'd' i.e., Genitalia are not affected

medpox.com
1931. True about the lesions of lichen planus
?
a) Polygonal violaceous paple

b) Affect skin and mucous membranes

c) Are pruritic

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above

medpox.com
1932. Antigen defect in Pemphigus Vulgaris -
a) Desmoglein-1

b) Desmoglein-3

c) Desmocollin-3

d) Desmocollin-2

Correct Answer - B
Ans. is 'b' i.e., Desmoglein-3

medpox.com
1933. Color of tuberous sclerosis lesions on
wood lamp examination ?
a) Bright green

b) Milky white

c) Golden yellow

d) Blue white

Correct Answer - D
Ans. is 'd' i.e., Blue white
Wood lamp
medpox.com
This is a source of ultraviolet light (320-400nm) from which virtually
all visible rays have been excluded by a Wood's (nickel oxide) filter.
Primarily emits 360nm.
UV light, when absorbed by certain substances, fluorescences in
dark and color produced, is useful in diagnosis of the certain
conditions
Condition Fluorescence colour
Tinea capitis Bright yellow green
Erythrasma Coral red or pink
Vitiligo Milky white
Albinism Blue white
Leprosy Blue white
Tuberous sclerosis Blue white
Pseudomonas infectionGreenish white
Porphyria Pink/orange
Tinea vesicolor Golden yellow
1934. Alopecia areata is a/ an ?
a) Autoimmune disorder

b) Allergic disorder

c) Anaphylactic disorder

d) Bacterial infection

Correct Answer - A
Ans. is 'a' i.e., Autoimmune disorder

medpox.com
1935. Whitfield's ointment consists of ?
a) 3% salicylic acid + 6% benzoic acid

b) 3% benzoic acid + 6% salicylic acid

c) 2% salicylic acid + 4% benzoic acid

d) 2% benzoic acid + 4% salicylic acid

Correct Answer - A
Ans. is 'a' i.e., 3% salicylic acid + 6% benzoic acid
Whitfield's Ointment
Whitfield's ointment is salicylic acid and benzoic acid in a suitable
base, such as lanolin or vaseline.
medpox.com
The original ointment contains 3% salicylic acid and 6% benzoic
acid, but other ratios are also used.
It is used for the treatment of fungal infections, such as athlete's foot.
Its effectiveness is unclear.
It can have a slight burning effect that goes away after a few
minutes.
It is named for Arthur Whitfield (1868-1947), a British dermatologist
 1936. Sphagetti and meat ball appearance is
seen in ?
a) Pityriasis rosacae

b) Tinea capitis

c) Tinea carporis

d) Tinea versicolor

Correct Answer - D
Ans. is 'd' i.e., Tinea versicolo
Pitvriasis versicolor (tinea versicolor)
medpox.com
Tinea versicolor is a misnomer as it is not caused by a
dermatophyte; it is caused by a nondermatophytic fungus called
Pityrosporum ovale (malasezia furfur). Usually affects young adults.
Clinical features
There are multiple scaly hypopigmented (more common) or
hyperpigmented macules. Scaling is fufuraciousor rice powder like.
Macules start around the hair follicles and they merge with each
other to form large areas. Affects trunk and shoulders (mainly chest
and back). There may be loosening of scales with finger nails-
coupled onle or stroke of nail. Lesions are recurrent in nature.
Diagnosis
1. Examination of scales in 10% KOH shows short hyphae and round
spores (sphagetti and meat ball appearance). Wood's lamp shows
apple green fluorescence(blue-green fluorescnce).
2. Skin surface biopsy - a cyanoacrylate adhesive is used to separate
the layer of stratum corneum on glass slide and then stained with
PAS reagent.
Treatment
1. Systemic agents :- systemic azoles provide convenient therapeutic
 option. Drugs used are ketokonazole, fluconazole or iatroconazole
2. Topical antifungals used are ?
Azoles clotrimazole, econazole, miconazole, ketoconazole
Others :- selenium sulphide, sodium thiosulphate, whitefield's
ointment (3% salicylic acid + 6% benzoic acid).

medpox.com
1937. Which of the following can cause both
cicatricial as well as noncicatrical
alopecia ?
a) Alopecia areata

b) Telogen effluvium

c) SLE

d) Hypothyroidism

Correct Answer - C
Ans. is 'c' i.e., SLE medpox.com
1938. Fox Fordyce Disease effects:
a) Sebaceous glands

b) Eccrine Glands

c) Apocrine glands

d) Any gland

Correct Answer - C
Apocrine glands

medpox.com
 1939. Miliaria arises from obstruction of ?
a) Eccrine sweat glands

b) Apocrine sweat glands

c) Sebaceous glands

d) Ectopic sebaceous glands

Correct Answer - A
Ans. is 'a' i.e., Eccrine sweat glands
Milliria
Occur as a result of either obliteration or disruption of the eccrine
sweat duct. medpox.com
Three forms :-
1. Miliaria crystallina- Clear, thin-walled vesicles, 1-2 mm in diameter,
without an inflammatory areola, are usually symptomless and
develop in crops, mainly on the trunk.
2. Miliaria rubra- erythematous papules especially in areas of friction
with clothing, and in flexures, produce intense pricking sensation.
3. Miliaria profunda- This nearly always follows repeated attacks of
miliaria rubra, o Complications :- Secondary infection and
disturbance of heat regulation
1940. Infectious cause of erythema
multiforme in given image is -

a) Staphylococcus

b) TB

c) HSV

medpox.com
d) EBV

Correct Answer - C
Answer-C-Herpes simplex virus
Herpes simplex is the primary cause of erythema multiforme, and
the virus is present in 70 percent of recurrent erythema multiforme
cases. Both types of herpes simplex virus (HSV) can cause the
condition, but HSV-1, which also causes cold sores, is responsible
for most cases.
Causes of Erythema multiforme
Idiopathic → Most common cause
Viral → HSV (most important) HBV, Mumps, Adenovirus
Bacteria → Streptococci, tuberculosis
Fungal → Coccidioidomycosis, Histoplasmosis.
Drugs →Antibiotics (Sulphonamide), Phenytoin, NSAIDS.
Autoimmune disease → SLE, thyroiditis, RA
Others → Sarcoidosis, Pregnancy, Malignancy.

medpox.com
1941. Patchy hair loss with velvety skin
points to the diagnosis of
a) Alopecia aereata

b) Trichotelomania

c) Hyperthyroidism

d) Adenoma sebacicum

Correct Answer - C
Ans. is 'c' i.e., Hyperthyroidism
Hair loss in combination with velvety skin is seen in patients with
medpox.com
excess of thyroid hormone production; thus the most probable
answer is hyperthyroidism
1942. Black piedra is caused by ?
a) Piedraia hortae

b) Trichosporon asahi

c) Trichosporon ovoides

d) Trichosporon inkin

Correct Answer - A
Ans. is 'a' i.e., Piedraia hortae
Piedra is an asymptomatic superficial fungal infection of the hair
shaft also known as trichomycosis nodu- laris. Black piedra is
caused by Piedraia hortae, whereas white piedra is caused by
medpox.com
pathogenic species of the Trichosporon genus, namely Trichosporon
asahii, Trichosporon ovoides, Trichosporon inkin, Trichosporon
mucoides, Trichosporon asteroides, and Trichosporon cutaneum.
 1943. Keratodermic sandles is a feature of ?
a) Pityriasis rosacea

b) Lichen planus

c) Psoriasis

d) Pityriasis rubra pilaris

Correct Answer - D
Ans. is `d' i.e., Pityriasis rubra pilaris
Pityriasis rubra pilaris
It is a chronic papulosquamous disorder of unknown etiology
characterized by : ? medpox.com
1. Scaling (Pityriasis means scaling Skin disorder)
2. Erythmatous plaque (Rubra)
3. Follicular papules (Pilaris)
Hence the name pityriasis rubra pilaris.
Two peaks of age are seen : ?
1. 5-10 years in juvenile type
2. 40 - 60 years in adult type
Clinical presentation
Characteristic lesions are erythmatous (orange to pink), follicular,
scaly plaques. A characteristic feature of plaques is the presence of
distinct islands of normal skin.
Sites of predilection
Trunk —> Lesions on the trunk evolve in craniocaudal (Cephalo
caudal) direction. Typically, follicular lesions are seen on the dorsum
of hands on knuckles --> Nutmeg papules. Associated features
1. Diffuse erythema and scaling of face.
2. Orangish thickening of palms and soles (Keratodermic sandals).
3. Nails —> Distal yellow brown discoloration and nail plate thickening.
Complications Erythroderma
Treatment
Localized lesions —> Topical corticosteroids + Keratolytics (Salicylic
acid, urea)
Erythroderma -4 Vitamin A, Acitretin (Retinoids), oral methotrexate

medpox.com
1944. In scabies which skin layer is affected?
a) Stratum corneum

b) Stratum basale

c) Stratum lucidum

d) Stratum germinatum

Correct Answer - A
Ans. is 'a' i.e., Stratum corneum
After copulation, the male mite dies and the female mite burrows into
the superficial skin layer (stratum cornuem) at the rate of 2 mm/day.
Female mite lays eggs which hatch into larva, which moulds and
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mature into adult mites.
The mite then burrows into stratum corneum.
These burrow is visible clinically as an irregular gray-brown line.
Burrow is a pathognomic sign for scabies.
1945. Groove sign of greenbalt is seen in ?
a) LGV

b) Donovanosis

c) Chancroid

d) Genital Herpes

Correct Answer - A
Ans. is 'a' i.e., LGV
Groove sign of Greenblatt' is pathognomonic of LGV when inguinal
lymph nodes are enlarged, they are separated by Poupart's ligment,
producing a groove. medpox.com
 1946. Mutation in which collagen is present in
epidermolysis bullosa ?
a) II

b) IV

c) V

d) VII

Correct Answer - D
Ans. is 'd' i.e., VII
Molecular pathology of EB
medpox.com
Normal basement membrane is between epidermal basal layer and
dermis. This basement membrane (basal lamina) is attached to
basal cells hemidesmosomes with the help of keratin containing
intermediate filaments and is attached to dermis (dermal papillary
layer) with the help of type VII collegen containing fibrils. Any defect
in this anchoring complex leads to separation of skin; the site of
separation depends on the type of defect
1. EB simplex —> Mutation in gene coding for keratin 5 & 14 (major
keratin of BMZ) and separation will be epidermal.
2. EB junctional —> Mutation in Lantinin a-3 (LAM a-3), LAM [I-3, LAM
7-2 genes. As laminin is part of basement membrane the separation
will be at dermo-epidermal junction (DEJ).
3. EB dystrophicans —> Mutation in collagen VII-Al gene. As collagen
VII containing fibrils join BM to dermal papilla, separation will be in
the dermis.
Any of the above defect results in defective cohesiveness which
leads to vulnerability to trauma and blisters formation. As the
disease is inherited, Family history may be positive.
 1947. Dermatophyes affect ?
a) Keratin

b) Dermis of skin

c) Stratum basal

d) Stratum basal

Correct Answer - A
Ans. is 'a' i.e., Keratin
Dermatophytes are keratinophillic fungi, living only on the superficial
dead keratin. That is why they infect skin, hair and nail. In skin they
infect most superficial layer of the epidermis i.e. stratum corneum.
medpox.com
They do not penetrate living tissues. Dermatophytes cause a variety
of clinical conditions, collectively known as dermatophytosis, tinea or
ringworm. Dermatophytes have been classified into 3 genera :-
trichophyton, microsporum, epidermophyton.
1. Trichophyton affects;- skin, hair, nails
2. Microsporum affects ;- skin, hair (nails are not affected)
3. Epidermophyton affects:- skin, nails (hair are not affected)
Deep fungal infections (eg:- maycetoma, chromoblastomycosis,
pheohyphomycosis, sporotrichosis, lobomycosis, rhinosporidiosis)
involve subcutaneous tissue.
Dermatophytosis is itchy and scaly
 1948. Onychomycosis is most commonly
caused by ?
a) a) Trichophyton rubrum

b) Trichophyton mentagrophytes

c) Epidermatophyton floccosum

d) a) Candida

Correct Answer - A
Ans. is 'a' i.e., Trichophyton rubrum
Tinea Unguium (Onychomycosis)
medpox.com
Tinea unguium is dermatophytic infection of fingers and toe nails.
Most common causative species is T-rubrum. Toe nails are more
commonly involved. T. Unguium may be of two types : ?
1. Distal subungal onychomycosis : - This is most common type of
fungal infection of nail (90%). It starts at the distal edge of the nail
plate and slowly grows inwards to involve entire nail plate.
2. Proximal Subungal onychomycosis : - Starts at the base of nail and
slowly involves the entire nail plate.
1949. Gas used in rapid airbag inflation
a) Sodium azide

b) Nitrocellulose

c) Mercuric nitrate

d) Potassium nitrate

Correct Answer - A
Ans. is 'a' i.e., Sodium azide
Chemistry of air bags
The inclusion of air bags in the modern automobiles has led to
decrease in the automobile injures.
medpox.com
The term air bag is a misnomer as air is not involved in the inflation
process.
Rather an air bag inflates rapidly (in about 30ms) due to explosive
production of N2 gas. Sodium azide is used which is rapidly
decomposed to Nitrogen gas.
1950. What is the next step in management in
managing a child with difficult
intubation with 4 failed attempts at
intubation?
a) Use LMA

b) Abandon the procedure

c) Try ET tube intibation again

d) Cricothyrotomy

Correct Answer - A medpox.com

Ans. is 'a' i.e., Use LMA
1951. Current mode of analgesia best for
intrapartum pain relief?
a) Epidural analgesia

b) Spinal anaesthesia

c) Inhalational

d) Local analgesia

Correct Answer - A
Ans. is 'a' i.e., Epidural Analgesia
Continuous lumbar epidural analgesia is the procedure of choice for
medpox.com
pain relief during normal labour and vaginal delivery (Intrapartum
pain).
1952. Elderly patient with fracture right hip
anesthetic of choice
a) Spinal/ epidural

b) General

c) Local infiltration

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Spinal/epidural

medpox.com
1953. Which of the following inhalational
agent sensitizes myocardium to
catecholamine
a) Sevoflurane

b) Isoflurane

c) Ether

d) Halothane

Correct Answer - D
Ans. is 'd' i.e., Halothane medpox.com
Some inhalational agent sensitize the heart to adrenaline —>
Arrhythmias can occur —> Therefore these agents are
contraindicated in Pheochromocytoma and along with adrenaline.
Halothane has maximum propensity .
Other agents sensitizing the heart to adrenaline are Trilene,
Cyclopropane, Chloroform, Enflurane
1954. Which of the following is not primarily
used to anesthetize mucosa ?
a) Benzocaine

b) Lidocaine

c) Bupivacain

d) Tetracaine

Correct Answer - C
Ans. is 'c' i.e., Bupivacaine

medpox.com
1955. Post spinal headache lasts for ?
a) 10 min

b) I hrs

c) 10 days

d) 1 week

Correct Answer - C
Ans. is 'c' i.e., 10 days
Post dural puncture headache is due to CSF leak. Typical location is
bifrontal or occipital.
Headache gets worsen on sitting or upright posture and is relieved
medpox.com
by lying down position and abdominal pressure —> The hallmark of
postdural puncture headache i.e., association with body position.
The onset of headache is usually 12-72 hours following the
procedure, however, it may be seen almost immediately. In most
cases it lasts for 7-10 days.
PDPH is believed to result from leakage of CSF from a dural defect
and decreased ICT. Loss of CSF at a rate faster that it can be
produced causes traction on structure supporting the brain,
particularly dura and tentorium. Traction on cranial nerve
(particularly 6th nerve) produces diplopia.
Factors that increase the incidence of PDPH are young age, female
sex, Pregnancy, large bore needle and multiple punctures.
Use of small bore needle can prevent PDPH .
Intially conservative treatment is given which includes analgesics
(NSAIDs), oral or i.v., fluids, Sumatriptan, cosyntropin, caffeine and
recumbent position.
If conservative treatment fails, epidural blood patch can be used. It
involves injecting 15-20 ml of autologus blood into the epidural
space which stop leakage of CSF by coagulation and mass effect

medpox.com
1956. Onset of post spinal headache is
usually at hours after spinal anesthesia
a) 0 - 6

b) 6-12

c) 12 - 72

d) 72 - 96

Correct Answer - C
Ans. is 'c' i.e., 12 - 72

medpox.com
1957. True about post dural headache is all
except:?
a) Orienting beveled edge needle parallel to long axis prevents it

b) Thin bore needle prevents it

c) It is more common in males

d) Timing of ambulation has no effect over its incidence

Correct Answer - C
Ans. is `c' i.e., It is more common in males
FACTORS THAT INCREASE THE INCIDENCE OF HEADACHE
AFTER SPINAL PUNCTURE medpox.com
Age : Younger, more frequent.
Sex : Females > males
Needle size : Larger > smaller
Needle bevel : Less when the needle bevel is placed in the long axis
of the neuraxis
Pregnancy : More when pregnant
Dural punctures : More with multiple punctures
FACTORS THAT DO NOT INCREASE THE INCIDENCE OF
HEADACHE AFTER SPINAL PUNCTURE
Insertion and use of catheters for continuous spinal anaesthesia
Timing of ambulation
About option a
Orienting a needle bevel parallel with the axis of the spine, such that
the longitudinal fibres of the dura would more likely be separated
than cut, results in a lower incidence of postspinal puncture
headache.
1958. Local anaesthetic causing
methemoglobinuria is?
a) Dibucaine

b) Chlorprocaine

c) Procaine

d) Benzocaine

Correct Answer - D
Ans. is 'd' i.e., Benzocaine
Important facts about LAs
medpox.com
Chlorprocaine is the shortest acting LA.
Dibucaine is the longest acting, most potent and most toxic LA.
Procaine & chlorprocaine are least potent LAs.
Bupivacaine is the most cardiotoxic LA (Ropivacaine is a newer
bupivacaine congener with less cardiotoxicity).
Levobupivacaine (The S (-) enantiomer of bupivacaine) is less
cardiotoxic and less prone to cause seizure.
Prilocaine and Benzocaine can cause Methaemoglobinemia
Lignocaine is the most commonly used LA.
Bupivacaine has the highest local tissue irritancy.
Chlorprocaine is contraindicated in spinal anaesthesia as it can
cause paraplegia due to presence of neurotoxic preservative sodium
metabisulphite.
Procaine is the LA of choice in malignant hyperthermia
1959. Percentage of lidocaine in Eutectic
mixture -
a) 1%

b) 2.5%

c) 5%

d) 10%

Correct Answer - B
Ans. is 'b' i.e., 2-5%
Eutectic mixture of local Anaesthetics
medpox.com
This is unique topical preparation which can anaesthetise intact skin.
It is a mixture of 2.5% lidocaine and 2.5 prilocaine.
It acts slowly and the cream must held in contact with skin for at
least 1 hour.
EMLA is used : to make venepuncture painless especially in
children, and for procedure like skin grafting & circumcision.
As systemic absorption of prilocaine can cause methemoglobinemia,
EMLA should not be used on mucocutaneous membrane or in very
small child.
1960. Percentage of tetracaine used in eye
surgery?
a) 0.5%

b) 1%

c) 2%

d) 4%

Correct Answer - A
Ans. is 'a' i.e., 0.5%
Cataract surgery can be performed using topical anaesthesia alone.
medpox.com
Tetracaine 0.5% and Lidocaine 4% can be used.
Advantages of this method is that it avoids the potential
complications with retorbulbar and peribulbar injections.
Dsadvantages include the potential for eye movement during
surgery, increased patient anxiety, and discomfort from the
microscope light
1961. In epidural anaesthesia drug is injected
?
a) Outside the dura

b) Inside the duramater

c) Inside arachnoidmater

d) Inside piamater

Correct Answer - A
Ans. is 'a' i.e., Outside the dura

medpox.com
1962. Local anaesthetic with prolonged action
?
a) Procaine

b) Cocaine

c) Lidocaine

d) Dibucaine

Correct Answer - D
Ans. is 'd' i.e., Dibuca
Dibucaine is the longest acting local anaesthetic
medpox.com
Chlorprocaine is the shortest acting local anaesthetic
Decreasing order of duration : - Dibucaine > Bupivacine =
Tetracaine = Ropivacaine = Etidocaine > Prilocaine = Lignocaine =
Mepivacaine = Cocaine > Procaine > Chlorprocaine .
1963. Drug used to prolong action of LA in
Hypertensive pts?
a) Clonidine

b) Felypressin

c) Dexmeditomidate

d) Noradrenalin

Correct Answer - B
Ans. is 'b'.e., Felypressin

medpox.com
1964. Supraclavicular block is used for
surgery of ?
a) Shoulder

b) Forearm

c) Arm

d) All

Correct Answer - D
Ans. is D.`(A) Shoulder (B) Forearm (C) Arm

medpox.com
1965. Most common complication of coeliac
plexus block ?
a) Hypotension

b) Parasthesias

c) Diarrhea

d) Pneumothorax

Correct Answer - A
Ans. is 'a' i.e., Hypotension
Celiac plexus block
medpox.com
The celiac plexus is situated retroperitoneally in the upper abdomen.
It is at the level of T12 and L, vertebrae anterior to the crura of the
diaphragm. It contains visceral afferent and efferent fibers divided
from T5 to T1, by means of greater, lesser and least splanchnic
nerves. Celiac plexus innervates most of the abdominal viscera,
therefore this procedure blocks the nerves which come from the
pancreas, liver, gall bladder, stomach, intestine, spleen, kidney and
adrenal glands.
A celiac plexus block can be combined with an intercostal block to
provide anesthesia for intra-abdominal surgery.
Because celiac plexus block results in blockade of the autonomic
nervous system, this block may help to reduce stress and endocrine
responses to surgery. For the same reason, the most common
complication of celiac plexus block is postural hypotenstion because
of blockade of lumbar sympathetic chain leading to upper abdominal
vessel dilation and venous pooling.
Celiac plexus block can be done by following three approaches : -
Retrocrural (classic) approach, anterocrural approach and
splanchnic nerve block.
Celiac plexus block is given to treat intractable pain in chronic
pancreatitis, gastric & pancreatic malignancies.
It can be combined with an intercostal block to provide anesthesia
for intra-abdomival surgery.
Postural hypotension is the Most common complication of classic
retrocrural and splanchnic nerve block,
Where as most common complication of Anterocrural approach is
transient diarrhoea

medpox.com
1966. False about local anesthetics
a) Prilocaine is less toxic than lignocaine

b) Lignocaine is used as an antiarrhythmic

c) Mixture of ligno + prilocaine is known as eutectic

d) Lidocaine is shorter acting than bupivacaine

Correct Answer - A
Ans. is 'a' i.e., Prilocaine is less toxic than lignocaine

medpox.com
1967. Risk factors associated with health care
associated pneumonia (HCAP)-
a) Acute care hospitalization for at least 2 days in the preceding
90 days

b) Home infusion therapy

c) Immunosuppressive disease or immunosuppressive therapy

d) Antibiotic therapy in the preceding 90 days

e) Hospitalization for > 48 h

medpox.com
Correct Answer - A:B:C:D:E
Answer- (A) Acute care hospitalization for at least 2 days in the
preceding 90 days (B) Home infusion therapy
(C) Immunosuppressive disease or immunosuppressive
therapy (D) Antibiotic therapy in the preceding 90 days
(E) Hospitalization for > 48 h
Acute care hospitalization for at least 2 days in the preceding 90
days
Residence in a nursing home or extended care facility
Home infusion therapy, including chemotherapy, within the past 30
days
Long-term dialysis within the past 30 days
Home wound care
Family member with an infection involving a multiple drug resistant
pathogen
Immunosuppressive disease or immunosuppressive therapy
1968. Pudendal Nerve Block Involve
a) LiL2L3

b) L2L3L4

c) SiS2S3

d) S2S3S4

Correct Answer - D
D i.e. S2 S3 S4

medpox.com
1969. In Bier's block aesthetic agent given by
which route?
a) Intravenous

b) Peribulbar region

c) Retrobulbar area

d) Dermal

Correct Answer - A
Ans. is 'a' i.e., Intravenous
Intravenous regional anaesthesia (IVRA) is used most often for
medpox.com
surgery of the forearm and hand, but can also be used for distal leg
and foot.
First IV cannula is inserted usually in the dorsum of hand.
Then tourniquet cuff is applied to proximal arm.
Limb is elevated and exsanguinated with the help of an elastic
bandage (Esmarch).
Now tourniquet cuff is inflated above systolic pressure (so that no
blood can enter in that limb and the limb remains exsanguinated).
Now the local anaesthetic solution is slowly injected into cannula.
The veins are filled with only local anaesthetic as there is no blood
—> local anaesthetic can not be drained out form upper limb and
can not enter in systemic circulation because of inflated cuff in
proximal arm.
The arm is anaesthetized in 6-8 minutes.
Lidocaine without adrenaline is the DOC for this technique.-
Goodman & Gilman Ilth/e p. 381
A few clinician prefers prilocaine over lidocaine because of its higher
therapeutic index - least toxic LA.
Tornique cuff deflation, premature release or failure of torniquet can
cause release of LA into circulation and toxicity
may occur —> So, cardiotoxic LAs like bupivacaine and etidocaine
are contraindicated for Bier's block.

medpox.com
1970. Which of the following is
contraindicated in head injury?
a) Ketamine

b) Halothane

c) N,0

d) Propofol

Correct Answer - A
Ans. is 'a' i.e., Ketamine

medpox.com
1971. Ketamine contraindicated in all except?
a) Head injury

b) Hypertension

c) Asthma

d) Glaucoma

Correct Answer - C
Ans. is `c' i.e., Asthma
Ketamine increases cerebral blood flow, metabolism, oxygen
consumption and intracranial tension, unlike thiopentone,
propofol&etomidate, which have cerebroprotectiveeffect, therefore
medpox.com
ketamine is contraindicated in head injury, intracranial space
occupying lesions and for neuroanaesthesia.
Cerebrovascular responsiveness to CO2 is preserved, and reducing
the arterial CO2 tension by hyperventilation attenuates the ketamine
induced rise in ICT.
Ketamine has direct myocardial depressant (negative ionotropic) &
vasodilator effect. However, ketamine also has
indirect sympathomimetic effect. Indirect sympathomimetic effect
predominates over direct myocardial depressant &vasodilator effect;
usual response is increased BP, cardiac output and heart rate-
Cardiac 02 demand is increased.
Ketamine is contraindicated in aortic aneurysm, hypertensive and
ischemic heart disease. Ketamine also sensitizes
the heart to adrenaline - arrhythmias may occur.
As ketamine cause sympathetic stimulation, it is the intravenous
anaesthetic of choice in patients with shock and hypovolemia.
Ketamine increases intra-ocular tension - Contraindicated in
glaucoma & open eye surgery.
It is a potent bronchodilator and relieves bronchospasm -
Intravenous anesthetic agent of choice in asthmatic (inhalational
anaesthetic agent of choice in asthmatics is halothane)
It increases uterine tone and intensity of uterine contraction - agent
of choice in patients with obstetric haemorrhage and flaccid uterus.
Injection of ketamine is not painful (all other i.v. inducing agents
cause pain on injection).

medpox.com
1972. Which of the following is fastest acting
inhalational anaesthetic agent?
a) Halothane

b) Desflurane

c) Sevoflurane

d) Isoflurane

Correct Answer - B
Ans. is 'b' i.e., Desflurane
Blood : Gas partition coefficient (B:G cofflcient)
medpox.com
It is the measure of solubility of the agent in the blood. Agent with
low blood solubility (low B : G coefficient) will have high
concentration in alveolar air as it will diffuse less through the alveolar
capillary membrane because of low blood solubility. Since alveolar
concentration determines the induction and recovery, induction &
recovery will be fast with agent with less B : G partition coefficient;
and induction & recovery will be slower with agents with high B : G
partition coefficient.
Desflurane has minimum B : G partition coefficient (least blood
solubility) Has Fastest onset and recovery. o Methoxyflurane has
maximum B : G partition coefficient (Maximum blood solubility) -4
Has slowest onset & recovery.
Speed of onset & recovery in decreasing order (Increasing order of
B: G partition coefficient and blood solubility):?
Desflurane (0.42) > Cyclopropane (0.44) > N2O (0.47) > Sevoflurane
(0.69)> Isoflurane (1.38) > Enflurane (1.8) > Halothane (2.4) >
Chloroform (8) > Trilene (9) > Ether (12) > Methoxyflurane (15)
1973. Characteristic EEC pattern seen in
surgical tolerance stage of anesthesia
is?
a) Alpha

b) Beta

c) Delta

d) Theta

Correct Answer - C
Ans. is 'c' i.e., Delta medpox.com
1974. Thiopentone is not used in?
a) Induction of anesthesia

b) Medically induced coma

c) As truth serum

d) As antidepressant

Correct Answer - D
Ans. is 'd' i.e., As antidepressant

medpox.com
1975. All of the following about thiopentone
are true except?
a) It decreases ICT

b) It has anticonvulsant action

c) IV injection is painless

d) It can cause reflex tachycardia

Correct Answer - C
Ans. is 'c' i.e., IV injection is painless

medpox.com
1976. Propofol infusion syndrome all except?
a) Occurs with infusion of propofol for 48 hours or longer

b) Occurs in critically ill patients

c) Features are nausea and vomiting

d) Features are cardiomyopathy, hepatomegaly

Correct Answer - C
Ans. is 'c' i.e., Features are nausea and vomiting
Propofol infusion syndrome
A lethal syndrome, associated with infusion of propofol for 48 hours
or longer. medpox.com
Occurs in children and critically ill.
Occurs as a result of failure of free fatty acid metabolism and failure
of the mitochondrial respiratory chain.
Features are-cardiomyopathy with acute cardiac failure, metabolic
acidosis, skeletal myopathy, hyperkalemia, hepatomegaly and
lipemia.
1977. Anesthetic agent/s which have tocolytic
effect are?
a) Halothane

b) Enflurane

c) Isoflurane

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
Halothane, enflurane and isoflurane produce a dose dependent
medpox.com
decrease in uterine tone (tocolysis).
Studies of isoflurane demonstrate that halogenated compounds
reduce both the frequency of uterinecontractions and the interval
between them.
1978. Action of which anesthetic agent is
through NMDA receptors?
a) Xenon

b) NO

c) Succinylcholine

d) Etomidate

Correct Answer - A
Ans. is 'a' i.e., Xenon
Xenon
medpox.com
It exerts anaesthetic action by non competitive blockade of NMDA
receptors.
Xenon has been used as a general anesthetic.
Xenon interacts with many different receptors and ion channels and
like many theoretically
1979. Following are hepatotoxic anesthetic
agents except?
a) Halothane

b) Chloroform

c) Ether

d) Propofol

Correct Answer - D
Ans. is `d' i.e., Propofol
Zimmermann p. 458]
medpox.com
Following are the groups of hepatotoxic anesthetic agents:
Group I : Drugs with well known hepatotoxic potential and containing
Chlorine or bromine. Eg: chloroform.
Group II : Drugs which contain fluorine Eg: halothane,
methoxyflurane.
Desflurane, enflurane, sevoflurane, isoflurane, nitrous oxide and
carbon tetrachloride are also linked with hepatotoxicity.
1980. Drugs used for day care surgery are all
except?
a) Propofol

b) Sevoflurane

c) Doxacurium

d) Desflurane

Correct Answer - C
Ans. is 'c' i.e., Doxacurium

medpox.com
1981. Anaesthetic of choice for day care
srgery is?
a) Thiopentone

b) Nitrous oxide

c) Propofol

d) Halothane

Correct Answer - C
Ans. is 'c' i.e., Propofol

medpox.com
1982. All of the following are Nondepolarising
muscular blockers except
a) Pancuranium

b) Dexacurium

c) D-Tubocurarine

d) Succinylcholine

Correct Answer - D
Ans. is 'd' i.e., Succinylcholine

medpox.com
1983. Which among the following is a
depolarising muscle relaxant?
a) Decamethonium

b) D tubocurarine

c) Doxacurium

d) Atracurium

Correct Answer - A
Ans. is 'a' i.e., Decamethonium
Morgan 4th/e p. 214]
medpox.com
See explanation-4 of session-3.
1984. Longest acting among muscle relaxant
is?
a) Doxacurium

b) Rocuronium

c) Vecuronium

d) Atracurium

Correct Answer - A
Ans. is 'a' i.e., Doxacurium
Among the given options, only doxacurium is long acting.
medpox.com
See explanation- 4 of session- 3.
1985. Atracurium is excreted by
a) Renal excretion

b) Hepatic elimination

c) Nonenzymatic degradation

d) All of the above

Correct Answer - C
Ans. is 'c' i.e., Nonenzymatic degradation
The unique feature of atracurium is inactivation in plasma by
spontaneous nonenzymatic degradation (Hofmann elimination) in
addition to that by alkaline ester hydrolysis.
medpox.com
Consequently its duration of action is not altered in patients with
hepatic / renal insufficiency or hypodynamic circulation Preferred
muscle relaxant for such patients as well as for neonates and the
elderly.o Atracurium is metabolised to laudanosine that is
responsible for seizures.
It can cause histamine release Hypotension & bronchoconstriction.
1986. Which is a safe muscle relaxant in renal
failure ?
a) Cisatracurium

b) Rocuronum

c) Vecuronium

d) Succinylcholine

Correct Answer - A
Ans. is 'a' i.e., Cisatracurium
The unique feature of atracurium and cisatracurium is inactivation in
medpox.com
plasma by spontaneous nonenzymatic degradation (Hofman
elimination) in addition to that by alkaline ester hydrolysis.
Therefore both of these do not require hepatic or renal routes for
elimination therefore can be used safely in hepatic and renal failure.
Moreover, cisatracurium does not provoke histamine release,
therefore it is preferred over atracurium.
1987. Shortest acting non depolarizing
muscle relaxant is?
a) Mivacurium

b) Doxacuronium

c) Pipecurium

d) Vecuronium

Correct Answer - A
Ans. is 'a' i.e., Mivacurium
Suxamethonium (succinylcholine) is the shortest acting skeletal
medpox.com
muscle relaxant. o Mivacurium is the shortest acting nondepolarizing
skeletal muscle relaxant.
1988. True about malignant hyperthermia is
all except
a) Most common cause is Sch

b) Dantrolene is the drug of choice

c) End tidal CO, is increased

d) Bradycardia occurs

Correct Answer - D
Ans. is 'd' i.e., Bradycardia

medpox.com
1989. DISS is used for ?
a) Correct application of cylinder to anaesthesia machine

b) To provide analgesia

c) To monitor BP

d) To monitor CVP

Correct Answer - A
Ans. is `a' i.e., Correct application of cylinder to anaesthesia
machine

medpox.com
 1990. Laryngeal mask airway not used in ?
a) Baby weighing < 1500gms

b) Pregnant Patients

c) Ocular Surgeries

d) Difficult airway

Correct Answer - B
Ans. is `b' i.e., Pregnant Patients
Indications of LMA
1. As an alternative to intubation where difficult intubation is anticipated
(difficult airway). medpox.com
2. To facilitate endo-tracheal intubation in a patient with difficult
airways.
3. Situations involving a difficult mask fit.
4. Securing airway (as cardiopulmonary resuscitation) in emergency
where intubation and mask ventilation is not possible.
5. For minor surgeries (short surgeries), where anaesthetist wants to
avoid intubation.
6. As a conduit for bronchoscopes, small size tubes, gum elastic
bougies.
7. For extra and intra-ocular surgeries including retinopathy surgery in
premature infants —) LMA is particularly useful in ophthalmic
surgery as problems created by other two airways are eliminated : -
8. Face mask creates problem in surgical field access due to its size
(LMA provides a better access).
9. Endotracheal intubation may cause raised IOT (LMA has no effect).
Contraindications of LMA
1. Conditions with high risk of aspiration i.e., full stomach patients,
hiatus hernia, pregnancy.
2. Oropharyngeal abscess or mass (tumor).
3. Massive thoracic injury
4. Massive maxillofacial trauma

medpox.com
1991. The laryngeal mask airway used for securing the airway of a patient in all
of the following conditions, EXCEPT:

a) In a difficult intubation

b) In cardiopulmonary resuscitation

c) In a child undergoing an elective/routine eye surgery

d) In a patient with a large tumour in the oral cavity

Correct Answer - D
Oropharyngeal abscess or mass is a contraindication to the use of laryngeal mask airway.

Ref: Short Textbook of Anaesthesia By Ajay Yadav, 2nd Edition, Page 36

medpox.com
1992. Which of the following systems can be
used to produce PEEP?
a) Spring system

b) Ball valve system

c) Pneumatic system

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
anesthesia by Hartigan p. 179] PEEP Valve
medpox.com
A PEEP Valve is a device which maintains the airway at end
exhalation.
Spring valve system is the simplest PEEP valve system. Other valve
systems for PEEP are electronic, magnetic, pneumatic and ball vale.
PEEP devices may be integrated into ventilator or may be separate
devices that are attached directly into anesthesia circuit, CPAP
device or manual resuscitation bag.
1993. What is the pressure at which oxygen is
stored?
a) 75 psi

b) 1600 psi

c) 760 psi

d) 2200 psi

Correct Answer - D
Ans. is 'd' i.e., 2200 psi

medpox.com
1994. The most appropriate circuit for
ventilating a spontaneously breathing
infant during anaesthesia is?
a) jackson Rees modification of Ayre's T piece

b) Mapleson A or Magill's circuit

c) Mapleson C or Waters to and fro canister

d) Bains circuit

Correct Answer - A
Ans. is 'a' i.e., Jackson Rees modification
medpox.com
1995. Standard method to differentiate
between endotracheal and esophageal
intubation is?
a) End tidal CO2

b) Chest X-rays

c) Auscultation

d) Partial pressure of 02

Correct Answer - A
Ans. is 'a' i.e., End tidal CO2
medpox.com
1996. Treatment in post operative shivering?
a) Pethidine

b) Piritramide

c) Methadone

d) Pentazocine

Correct Answer - A
Ans. is 'a' i.e., Pethidine
Post-anaesthesia shivering (PAS)
Post anaesthesia (post operative) shivering occurs in 40% of
patients recovering from general anaesthesia.
medpox.com
Some time it is preceded by central hypothermia and peripheral
vasoconstriction, indicating that it is a thermoregulatory mechanism
Pethidine is most effective drug for treatment of PAS.
Other drugs used are --clonidine, doxapram, ketanserin, alfentonil,
butorphanol, chlorpromazine.
1997. Hyperbaric oxygen is not useful in?
a) Anemia

b) Vertigo

c) Gas gangrene

d) Compartment Syndrome

Correct Answer - B
Ans. is 'b' i.e., Vertigo

medpox.com
1998. Henrys law states that?
a) At a constant temperature gas dissolves in solution in
proportion to its partial pressure

b) At a constant Pressure gas dissolves in solution in proportion to

its temperature

c) At a constant temperature gas dissolves in solution in

proportion to its fat solubility

d) At a constant pressure gas dissolves in solution in proportion to

its fat solubility

Correct Answer - A medpox.com

Ans. is 'a' i.e., At a constant temperature gas dissolves in so lution in
proportion to its partial pressure
1999. Warfarin to be stopped____________
days before surgery?
a) 2 to 3 days

b) 4 to 5 days

c) 6 to 7 days

d) 8 to 9 days

Correct Answer - B
Ans. is 'b' i.e., 4 to 5 days
Warfarin may increase peri- operative bleeding, except for minor
medpox.com
procedures such as cataract surgery without bulbar blocks. No
consensus exists on the optimal perioperative management of
patients receiving warfarin.
The usual recommendation is to withhold warfarin starting 4 to 5
days preoperatively (if the INR is between 2.0 and 3.0) to allow the
INR to decrease to less than 1.5, which is a level considered safe for
surgical procedures and neuraxial blockade.
If the INR is greater than 3.0, it is usually necessary to withhold
warfarin longer than 4 to 5 days.
If the INR is measured the day before the surgical procedure and
remains higher than 1.8, a small dose of vitamin K (1 to 5 mg
administrated orally or subcutaneously) can reverse anticoagulation.
Vitamin K has an effect within 6 to 10 hours after oral or
subcutaneous administration (more predictable with oral
administration), and it peaks within 24 hours to 48 hours.
Administration of higher doses may lead to warfarin resistance when
therapy is initiated again.
2000. IV dose of 1: 10000 concentration of
epinephrine in pre term baby is?
a) 0.1m1

b) 0.2 ml

c) 0.3 ml

d) 0.4 ml

Correct Answer - B
Ans. is 'b' i.e., 0-2 ml
Epinephrine
medpox.com
The IV dose of 1: 10,000 concentration is 0.1m1/Kg. Thus it is about
0.5ml for term baby and 0.2 ml for pre term baby.
Endotracheal tube dosing is 1m1/ Kg. thus it is about 3m1 for term
baby and 1 ml for preterm.
2001. Macintosh indicator is used for ?
a) To assess degree of NM blockade

b) Localization of extradural space

c) To assess level of GA

d) To monitor respiratory depression

Correct Answer - B
Ans. is 'b' i.e., Localization of extradural space
Various methods have been used to locate the epidural (extra dural
space), most of which rely on subatmospheric pressure.
These are :- medpox.com
Loss of resistance to air or saline (most common technique).
Gutierrez's method : A hanging drop of saline on the hub of needle is
drawn in as the epidural space is entered (more reliable in thorocic
than lumbar region).
Odom 's indicator : A fine-bore glass tube filled with saline and a
bubble that moves in response to a drop in pressure.
Macintosh's indicator : A small rubber balloon filled with air
connected to an adaptor causing it to deflate on entering the
epidural space.
Macintosh's spring-loaded needle.
Ultrasonic localization.
Oxford epidular space detector.
2002. Following group of drugs is not the first
line in the management of chronic
pain?
a) Opioids

b) Antiepileptics

c) Serotonergic drugs

d) Dopamine antagonist

Correct Answer - D
Ans. is 'd' i.e., Dopamine antagonist
medpox.com
 2003. Which of the following are features of
pulmonary oxygen toxicity?
a) Increased capillary endothelial permeability

b) Decreased mucociliary transport in airways

c) Inhibition of phagocytosis function of alveolar macrophages

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
1. Prolonged inhalation of high concentration of 0, is known to damage
the lungs. medpox.com
2. Pulmonary toxicity of 0, is related to the oxygen tension in alveoli.
The pulmonary oxygen toxicity has the following features
Increased capillary endothelial permeability causing accumulation of
fluid in the interstitial space.
Depression of mucociliary transport function of airway
Inhibition of phagocytosis of alveolar macrophages
Changes in the surfactant activity and its production.
2004. USG is done to visualize all except -
a) Fluid

b) Bile

c) Blood flow

d) Bone

Correct Answer - D
Answer- D. Bone
USG is done to visualize soft tissues and fluids. But not for bone.

medpox.com
 2005. Regarding HRCT, all are true except -
a) Means high reconstruction CT imaging

b) Has narrow beam collimation

c) Investigation of choice for interstitial lung disease

d) Has small field of vision

Correct Answer - A
Answer- A. Means high reconstruction CT imaging
Principles of HRCT (High resolution CT) are :
1. Narrow beam collimation (Thin collimation)
2. High frequency reconstruction algorythm, e.g., bone algorithm
medpox.com
3. Small field of vision
2006. A PET scan uses which of the following tracer materials?
a) FDG

b) CDF

c) ADP

d) MIBG

Correct Answer - A
Positron emission tomography (PET) uses positron-emitting
radioisotope (tracer) - 18F-FDG
A PET scan uses a small amount of a radioactive drug, or tracer, to
show differences between healthy tissue and diseased tissue.
medpox.com
The most commonly used tracer is called FDG (fluorodeoxyglucose),
so the test is sometimes called an FDG-PET scan.
Very expensive.
Better contrast and spatial resolution
2007. All of the following about MRI are
correct except:
a) MRI is contraindicated in patients with pacemakers

b) MRI is useful for evaluating bone marrow

c) MRI is better for calcified lesions

d) MRI is useful for localizing small lesione in the brain

Correct Answer - C
C i.e. MRI is better for calcified lesions
* MRI is very poor in detection of calcification. It is inferior to CT
medpox.com
scan, mammography and x-ray in detecting calcification. That is why
it lags behind mammography in early detection of noninvasive ductal
carcinoma in situ (DCIS)Q, which most commonly
has microcalcification as its only presenting feature. And similarly it
has a very limited role in detection of renal stones and gall
stonesQ. However, it is important to note that only upto 60% of gall
stones have enough calcium density (more than that of bile) to get
visualized on CT. Becaus of its superior calcification detection
abilities, MDCT is used in Agatston scoring (Coronary calcium
scoring) of calcified plaques of coronary artery using coronary
calcium as a surrogate marker to detect the presence and measure
the amount of coronary atherosclerosis. Because with exception of
patients with renal failure calcification of arteries occurs exclusively
in context of atherosclerosis.
Similarly nonenhanced helical CT is superior to all other imaging
modalities in diagnosis of urinary tract calculiQ but at the cost of
higher radiation exposure.
Now there is no need to say that MRI is better that CT for evaluation
of bone marrow, small brain lesions, meniscus/ ligament injuries,
soft tissue tumors and meningeal pathology. But MRI is very poor in
soft tissue tumors and meningeal pathology. But MRI is very poor in
detection of calcification.

medpox.com
2008. An absolute contraindication of MRI is:
a) Pacemaker

b) Prosthetic cardiac valves

c) Insulin pump

d) Choclear implants

Correct Answer - A
Pacemaker [Ref: Harrison 17/e p2494; Grainger Diagnostic
Radiology 4/e p122;
various websites-http://www.mr-tip.com/servl.php?ope=dbl
&dbs=Prosthetic%20Heart%20Valves
medpox.com
http://www. imrser.org/PDF/Shellock.HeartValves.JMRLpdf; http
://www. mr​tip. com/se ry 1.php ?type = dh 1 &dbs= Prosthetic
%20Heart %20Valves
;and journal- _RadioGraphic s 2004 ;24 : 1257- 1267
MR is considered among the safest imaging modalities for patients,
even at very high field strengths, more than 3-4 tesla.
But Ferromagnetic objects under magnetic field can be vulnerable to
4 adverse effects:
Movement (causing structural injury),
Current conduction (potentially causing electrical shock),
Heating (possibly causing burn injury), and
Artifact generation
Serious injuries can be caused by attraction of ferromagnetic objects
into the magnet, which would act as missiles if brought too close to
the magnet.
Ferromagnetic implants, such as aneurysm clips, may torque (turn
or twist) due to the magnetic field, causing damage to vessels and
even death.
Metallic foreign bodies in the eye have moved and caused
intraocular hemorrhage.
Pacemakers and pacemaker leads are a contraindication, as the
pacemaker can malfunction and cause arrhythmia or even death.
However with growing expansion of MR, increasing number of
implant medical devices are being MR safe. So newer pacemaker
and aneurysm clips are being made which are MR safe.
Absolute Contraindications for the MRI scan:
Electronically, magnetically, and mechanically activated implants
Ferromagnetic or electronically operated active devices like
automatic cardioverter defibrillators
Cardiac pacemakers
Metallic splinters in the eye
Ferromagnetic haemostatic clips in the central nervous system
(CNS)
Patients with an implanted cardiac pacemaker have been scanned
on rare occasions, but pacemakers are generally considered an
absolute contraindication.
Relative Contraindications for the MRI scan:
medpox.com
Cochlear implants
Other pacemakers, e.g. for the carotid sinus
Insulin pumps and nerve stimulators
Lend wires or similar wires (MRI Safety risk)
Prosthetic heart valves (in high .fields, if dehiscence is suspected)
Haemostatic clips (body)
Nonierromagnetic stapedial implants
Women with a.first-trimester pregnancy
Tattoos (only a problem in higher-strength magnetic .field i.e. more
than 3 tesla)
1Reflittp://www.mr-tip.com/se ry 1 .php?type=dbl &dbs= Prosthetic
%20Heart%20Valvesi
2009. Radiocontrast is contraindicated in all of the following conditions except?
a) Renal failure

b) Patient on metformin

c) Dehydration

d) Obesity

Correct Answer - D
Obesity is not a contra-indication for the administration of radio-contrast agent.

Ref: Radiologic Technology at a Glance By Theresa S. Reid-Paul; pages 66.

medpox.com
2010. All of the following are true about
neutron contrast study except -
a) Provides spatial resolution

b) Hydrogen and boron have high neutron cross section

c) Allows visualization of light elements inside heavy metallic

objects

d) Is an example of destructive testing

Correct Answer - D
Answer- D. Is an example of destructive testing
medpox.com
Neutrons interact with matter in a way that is quite complementary to
X-rays, and so neutron imaging and neutron radiography are
important techniques for non-destructive testing, most suited for
visualization of light elements in the interior of (heavy) metallic
objects.
Examples of high absorption cross- section materials include
hydrogen and boron while iron has lower neutron cross-section.
2011. In normal X-ray of shoulder which is
superior most structure -
a) Greater tubercle

b) Surgical neck of humerus

c) Coracoid process

d) Head of humerus

Correct Answer - C
Answer- C. Coracoid process
From superior to inferior (important structure on X-ray sholder) :-
medpox.com
Clavicle : Acromian : Coracoid : Superior margin of humeral head :
greater tubercle : anatomical neck : surgical neck.
2012. Maximal valve of HU Unit -
a) Water

b) Fat

c) Soft tissue

d) Bone

Correct Answer - D
Answer- D. Bone
Bone has maximum HU → +1000

medpox.com
2013. Piezoelectric crystal most widely used
in ultrasonography probes is -
a) Quartz

b) Molybdenum

c) Titanium

d) Lead zircona tetitanate

Correct Answer - D
Answer- D. Lead zircona tetitanate
Lead zirconate titanate (PZT) is the most widely used material in the
medpox.com
ultrasound transducers / probes replacing the firstly discovered
barium titanate.
2014. The principle used in radiotherapy is:
a) Cytoplasmic coagulation

b) Ionising the molecules

c) DNA damage

d) Low dose causes tissue necrosis

Correct Answer - C
Ans. DNA damage
Radiotherapy is the treatment of cancer with ionizing radiation.
It works by damaging the DNA within the tumor cells, making them
unable to divide and grow. medpox.com
The goal of radiation therapy is to maximize the dose to tumor cells
while minimizing exposure to normal, healthy cells.

Ref: Emami B et al. 1991

2015. Adder head appearance is seen in:
March 2011
a) Posterior urethral valve

b) Uretrocoele

c) Bladder tumour

d) Horse shoe kidney

Correct Answer - B
Ans. B: Ureterocoele
The 'adder head' on excretory urography is typical of ureterocoele
medpox.com
Ureterocele is a cystic dilatation of the distal ureter.
Cobra head or Adder head appearance is diagnostic of ureterocele.
Spider leg appearance in polycystic kidney.
Ref: Bailey & Love, 25th Edition, Page 1290
2016. Most sensitive investigation for
minimum gas in abdomen is -
a) Chest X-ray AP View

b) CT Scan

c) X-ray abdomen in supine position

d) X-ray abdomen in erect position

Correct Answer - B
Answer- B. CT Scan
CT Scan is superior to plain radiographs in detection of minute
quatities of pneumoperitoneum medpox.com
Thus CT Scan is regarded as the most sensitive investigation for
detection of minute quantities of intraperitoneal gas.
Best radiographic view for pneumoperitoneum is Chest x-ray. It is
usually the first investigation of choice.
2017. Cotton wool skull is a radiological
feature of -
a) Pagets disease

b) Eosinophilic granuloma

c) Fibrous dysplasia

d) Fibrous dysplasia

Correct Answer - A
Answer- A. Pagets disease
Cotton wool skull-Paget's disease
medpox.com
Groundglass skull- Fibrous dysplasia
Punched out/Raindrop lesion of skull- Multiple myeloma
Geographic skull- Eosinophilic granuloma
2018. The most sensitive imaging modality for
diagnosis of ureteric stone in patient
with acute renal colic is -
a) X ray KUB

b) USG

c) Non contrast CT abdomen

d) Contrast enhanced CT abdomen

Correct Answer - C
Answer- C. Non contrast CT abdomen
medpox.com
Non-contrast spiral CT has now become the investigation of choice
to diagnose renal and ureteric stones.
Investigation of choice for renal and ureteric stones non - contrast
spiral CT
2019. Radiological features of coarctation of
aorta is/ are -
a) Reverse figure of 3 sign

b) Dock sign

c) Double aortic knuckle

d) All of the above

Correct Answer - D
Answer- D. All of the above
Radiological signs of COA are : i) Reverse figure of 3 sign (double
medpox.com
bulge sign or E sign), ii) Dock's sign; iii) Double aortic knuckle.
Globular heart with oligemic lung fields
Reverse figure of '3' sign
Double aortic knuckle
 2020. Eye of tiger appearance is seen in -
a) Halle vorden Spatza

b) Suparanuclear palsy

c) Levodopa-responsive

d) All

Correct Answer - D
Answer- D. All
This appearance can be seen in:
1. Hallervorden-Spatz syndrome: classical but not 100%
pathognomonic medpox.com
2. Progressive supranuclear palsy
3. Early-onset levodopa-responsive parkinsonism
4. Cortical-basal ganglionic degeneration
 2021. Tufting of distal phalanx is
characteristically seen in
a) Gout

b) Hyperkalemia

c) Hypoparathyroidism

d) Hyperparathyroidism

Correct Answer - D
Ans. is. D. Hyperparathyroidism
Acro-osteolysis is the term used to describe resorption of the distal
medpox.com
phalangeal tufts. Causes are : -
1. Scleroderma
2. Trauma & thermal injury
3. Hyperparathyroidism
4. Epidermalysis bullosa
5. Arthropathy (RA, Psoriasis)
6. Neuropathy (diabetes, syringomyelia
2022. Soap Bubble appearance in X-ray is
seen in
a) Multiple cystic Kidney

b) Neuroblastoma

c) Cystic lymphagiectasis

d) Meconium ileus

Correct Answer - D
D i.e. Meconium ileus
Soap bubble appearance in X ray is seen in meconium ileus due to
medpox.com
admixture of gas with meconium.
2023. Mercedes Benz sign is seen in:
a) Gall stone

b) Bladder stone

c) Renal stones

d) Foreign body bronchus

Correct Answer - A
Gall stone REF: Sutton's textbook of radiology, Th edition, volume 1
page 713
Mercedes Benz sign/Seagull sign/Crow feet sign:
Gall bladder stone if radiopaque has a stellate faceted appearance
medpox.com
with gas containing fissures on the plain radiograph and is called as
Mercedes Benz sign/Seagull sign or Crow feet sign
2024. Coffee bean sign is seen in?
a) Gastric volvulus

b) Sigmoid volvulus

c) Hypertrophic pyloric stenosis

d) Midgut volvulus

Correct Answer - B
Sigmoid volvulus REF: Wofganag 5th e p. 846/748
Sign Disease
Rat tail appearance Carcinoma esophagus
Bird beak appearance medpox.com
Achalasia
Beak sign/double track/ tram track Hypertrophic pyloric stenosis
Medusa head colonies on CT Round worm
Pincer/claw/coiled
Intussception
spring/target/meniscus sign
Coffee bean sign Sigmoid volvulous
Lead pipe appearance Ulcerative colitis
String of kantor/bull's eye Chron's disease
Thumb printing sign Ischemic colitis
Saw tooth appeance on barium
Diverticulosis
enema
Apple core sign Carcinoma colon
Cork screw appearance Diffuse esophageal spasm
String sign Hypertrophic pyloric stenosis
 2025. Following are suggestive of benign
lesion on mammogram -
a) Macrocalcification

b) Floating calcification

c) Tramline calcification

d) All the above

Correct Answer - D
Answer- D. All the above
Calcification patterns in benign lesions of breast on
mammography: medpox.com
1. Macrocalcification
2. Popcorn (in fibroadenoma)
3. Rod like wide-spread
4. Egg shell curvilinear
5. Tramline / tortous
2026. Anamoly scan done at how many weeks
of gestation -
a) 14

b) 16

c) 18

d) 20

Correct Answer - D
Answer- D. 20
Anamoly Scan is done between 18-21 weeks of pregnancy. It is also
medpox.com
called as mid pregnancy or 20-week scan.
2027. Flowing wax appearance on anterior
and posterior borders of vertebrae is
seen in -
a) Ankylosing spondylitis

b) DISH

c) Psoriatic arthropathy

d) Rheumatoid arthritis

Correct Answer - B
Answer- B. DISH medpox.com
Diffuse idiopathic skeletal hyperostosis : DISH (hyperostotic
spondylosis, Forestier's disease) is a multifocal entity of older people
characterized by 'flowing ossifications of the spine" involving four or
more contiguous vertebrae and hyperostosis of some ligamentous
attachments.
2028. Caldwell view is done for
a) Sphenoid sinus

b) Maxillary sinus

c) Ethmoid sinus

d) Frontal sinus

Correct Answer - D

Caldwell view is the occipito frontal view. The frontal sinuses are
seen clearly in this view.
medpox.com
2029. Radiological view which best shows
maxillary sinus and orbit is -
a) Water's view

b) Caldwell view

c) Lateral view

d) Towne view

Correct Answer - A
Answer- A. Water's view
Best view for maxillary sinus → Water's view (occipito-mental view)
medpox.com
Best view for frontal sinus → Caldwell view (occipito-frontal view)
Best view for sphenoid sinus → Basal view (submentovertical view)
2030. Best view for sphenoid sinus is -
a) Water's view

b) Caldwell view

c) Basal view

d) Towne's view

Correct Answer - C
Answer- C. Basal view
Best view for maxillary sinus → Water's view (occipito-mental view)
Best view for frontal sinus → Caldwell view (occipito-frontal view)
Best view for sphenoid sinus → Basal view (submentovertical view)
medpox.com
2031. Following are the indications of barium
meal X-ray except -
a) Duodenal ulcer

b) Carcinoma stomach

c) Carcinoma head of pancreas

d) Ischemic Colitis

Correct Answer - D
Answer- D. Ischemic Colitis
Indications for Barium meal X-ray
Duodenal ulcer medpox.com
Periampulary carcinoma
Psendocyst of pancreas
Carcinoma stomach
Chronic duodenal ileus
Carcinoma head of pancreas
Duodenal diverticula
 2032. In a children ectopic kidneys can be
diagnosed by -
a) DTPA

b) DMSA

c) MAG 3

d) None of the above

Correct Answer - B
Answer- B. DMSA
Indications for static renal scintigraphy (Tc - 99m - DMSA) :
medpox.com
1. Assessment of reflux nephropathy (scars)
2. Space occupying lesions (cortical mass)
3. Investigation of horse shoe, solitary or ectopic kidney
2033. Gestational sac can be seen using
ultrasonography at the earliest by:
Gujarat 07
a) 3rd week

b) 4th week

c) 5th week

d) 8th week

Correct Answer - C
Ans. 5th week medpox.com
The gestational sac can be visualized as early as 41/2 weeks by
transvaginal USG and 5 weeks by transabdominal USG.
2034. First line investigation for deep venous
thrombosis is -
a) Ultrasonography

b) Venography

c) MRI

d) Nuclear imaging

Correct Answer - A
Answer- A. Ultrasonography
Ultrasonography is the current first-line imaging examination for DVT
medpox.com
because of its relative ease of use.
2035. Which of the following is not a chest
radiographic feature of left atrial
enlargement?
a) Double left heart border

b) Elevated left main bronchous

c) Splaying of carina

d) Enlargement of left atrila appendage

Correct Answer - A
Answer- A. Double left heart border
medpox.com
Sings of left atrial enlargement
Straightening of left heart border (due to enlargement of left atrial
appendage).
Elevation of left main bronchus with widening (Splaying) of carina.
Double density (atrial) sign.
Posterior displacement of esophagus on barium swallow.
2036. Floating water lily sign is seen in
a) Aspergillosis

b) Hamartoma

c) Hydatid cyst

d) Cavitating metastasis

Correct Answer - C
Hydatid cyst [Ref Radiology Review Manual by Dahnert 5/e, p 699;
vviviv.emedicine.00In/Ined/TOPIC629.htn]
Separated membranes floating with the cyst give the appearance of
water lily. medpox.com
It is pathognomonic of hydatid cyst.
 2037. HRCT features of interstitial pneumonia
are all except -
a) Reticular opacities

b) Honeycombing

c) Ground glass opacities

d) No bronchieactatic features

Correct Answer - D
Answer- D. No bronchieactatic features
Classical HRCT features of interstitial pneumonia are:
medpox.com
1. Reticular opacities in basal and peripheral distribution.
2. Traction bronchiestasis.
3. Honeycombing (clustered airspaces 3-10mm diameter/in subpleural
location.
 2038. Following are the causes of cavity in
lungs except -
a) Staphylococcus

b) Wegeners

c) Hydatid

d) Sarcoidosis

Correct Answer - D
Answer- D. Sarcoidosis
Causes of lung cavities are :
1) Necrotizing infections medpox.com
2) Vascular : Pulmonary infarction.
3) Neoplastic :
1. Carcinoma bronchus :- Especially squamous cell carcinoma.
2. Metastases
3. Lymphoma
4) Granulomas :- Wegener's granulomatosis, Rheumatoid arthritis
(also Kaplan's syndrome)
5) Abnormal lung :- Infected emphysematos bulla, sequestrated
segment, bronchogenic cyst.
6) Traumatic :- Haematoma
2039. Beaded lumen with fimbrial fluid is seen
in -
a) TB of fallopian tube

b) TB of endometrium

c) TB of Ovary

d) None

Correct Answer - A
Answer- A. TB of fallopian tube
Fallopian tube is the most common site of female genital tract which
is affected in tuberculosis. medpox.com
On hysterosalpingography, the fallopian tube often show ragged
outlines with multiple strictures, giving a beaded appearance; in
some patients the entire tube appears rigid and may exhibit small
terminal sacculation of the ampullary end.
2040. Following are radiological findings in
rheumatoid arthritis except -
a) Symmetrical involvement

b) Juxta-articiular osteopenia

c) Marginal erosion

d) Subchondral sclerosis

Correct Answer - D
Answer- D. Subchondral sclerosis
Rheumatoid arthritis
medpox.com
Bilateral symmetrical involvement
Marginal erosion
Ankylosis
Periarticular soft tissue swelling
Subchondral cysts
Subluxation or dislocation
Juxta - articular osteopenia
Narrowing of joint space (Later)
Arthritis multilans (late)
2041. Which of the following is/are
radiological features of fluorosis?
a) Osteosclerosis

b) Cortical thickening

c) Enthesopathy

d) All the above

Correct Answer - D
Answer- D. All the above
Radiological features of fluorosis are :
medpox.com
Osteosclerosis - particularly affecting the axial skeleton.
Cortical thickening with encroachment on medullary cavity.
Enthesopathy with ligamentous ossification.
Large spinal osteophytes.
2042. Depth of gastric carcinomas is
assessed by -
a) Abdominal ultrasound

b) Barium meal

c) Endoluminal ultrasound

d) Laproscopy

Correct Answer - C
Answer- C. Endoluminal ultrasound
Five layers of the gastric wall can be identified by endoluminal
medpox.com
ultrasound and the depth of invasion of tumor can be assessed by
exquisite accuracy.
 2043. Radiological signs of acute pancreatitis
on plain radiography are -
a) Sentinel loop sign

b) Colon cut off sign

c) Renal halo sign

d) All the above

Correct Answer - D
Answer- D. All the above
Radiological features of acute pancreatitis :-
1. Air in duodenal C-loop medpox.com
2. Colon cut off sign
3. Gasless abdomen
4. Sentinal loop sign
5. Renal Halo sign
2044. Gold standard investigation for chronic
pancreatitis?
a) MRI

b) ERCP

c) Pancreatic function tests

d) Fecal fat estimation

Correct Answer - B
Answer- B. ERCP
ERCP has been considered the most sensitive radiologic test for the
medpox.com
diagnosis of chronic pancreatitis, with specific ERCP findings that
are highly correlative with the degree or stage of chronic disease.
2045. Most sensitive investigation for Diffuse
axonal injury is -
a) MRI

b) CT

c) X ray

d) PET scan

Correct Answer - A
Answer- A. MRI
MRI is the most sensitive investigation for diffuse axonal injuries.
medpox.com
It shows multiple small faces of increased intensity on T,IAT and
decreased intensity on Ty.
 2046. Most common view used for X-ray chest
-
a) PA view

b) AP view

c) Lateral view

d) Oblique view

Correct Answer - A
Answer- A. PA view
Important views for chest x-ray are :
medpox.com
1. Posterior - anterior view (PA view)
2. Anterior - posterior view (AP view)
3. Lateral view
4. Lateral decubitus view
2047. Best investigation for bone metastases
is -
a) MRI

b) CT

c) Bone Scan

d) X Ray

Correct Answer - C
Answer- C. Bone Scan
Bone scan (scintigraphy) is the investigation of choice for bone
metastasis. medpox.com
2048. Double track sign is seen in -
a) Duodenal atresia

b) CHPS

c) Gastric ulcer

d) Achalasia

Correct Answer - B
Answer- B. CHPS
Double/triple track sign is seen in congenital hypertrophic pyloric
stenosis.
medpox.com
2049. Half life of Ra-226 -
a) 8 days

b) 28 years

c) 16-22 years

d) 38 years

Correct Answer - C
Answer- C. 16-22 years
Half life of Ra-226 is 16-22 years.

medpox.com
2050. Which view is taken for aortic window -
a) AP

b) LAO

c) RAO

d) LPO

Correct Answer - B
Answer- B. LAO
`A left anterior oblique (LAO) view is useful to assess thoracic aorta,
aortic window and the chamber of heart".
Clinicalradiology medpox.com
Aortic window is the space between ascending and descending
thoracic aorta.
2051. Best imaging modality in patients with
breast implants is:
a) MRI scan

b) CT scan

c) Mammography

d) Radionuclide scan

Correct Answer - A
Ans. MRI scan
It is the best imaging modality for the breasts of women with
implants. medpox.com
MRI can be usefirl to distinguish scar from recurrence in women who
have had previous breast conservation therapy for cancer
2052. The primary diagnostic evaluation for
developmental dyslasia of hip is -
a) Clinical examination

b) X-ray

c) USG

d) CT Scan

Correct Answer - C
Answer- C. USG
Ultrasonography is now the primary imaging technique in the
medpox.com
diagnosis and follow up of DDH and has been shown to be more
accurate than clinical and radiological assessment with a sensitivity
of 100% and specificity of 98%.
2053. Hummingbird sign in brain MRI is seen
in ?
a) Multiple sclerosis

b) Progressive supranuclear palsy

c) Parkinson's disease

d) Alzheimer disease

Correct Answer - B
Ans. is 'b' i.e., Progressive supranuclear palsy
[Ref Clinical neurology - 113]
medpox.com
Hummingbird sign on brain MRI is a radiological sign of progressive
supranuclear palsy.
2054. Investigation of choice for pancoast
tumor is -
a) MRI

b) HRCT

c) CECT

d) Bronchography

Correct Answer - A
Answer- A. MRI
Radiological investigation of choice for pubnonary malignencies is
medpox.com
CT scan excep in superior sulcus (pancoast tumor) where MRI is
preferred.
2055. Well defined rounded opacity is the
lung with cause irregular calcification is
a feature of:
a) Hamartoma

b) Hydatid cyst

c) Amoebic abscess

d) Ca lung

Correct Answer - A
Ans. Hamartoma medpox.com
Irregular central calcification (Popcorn calcification) is characteristic
of hamartoma.
2056. Emile Durkheim is linked with work on
which condition in psychiatry?
a) Suicide

b) Obsessive compulsive disorder

c) Anxiety disorder

d) Schizophrenia

Correct Answer - A
Ans. A. Suicide
Suicide (French: Le Suicide)
medpox.com
It was a groundbreaking book in the field of sociology.
It was written by French sociologistEmile Durliiheim and pubtshed in
1897.
It was ostensibly a case study of suicide, a publication unique for its
time that provided an example of what the sociological monograph
should look like.
2057. Highest insight is ?
a) Intellectual

b) Emotional

c) Psychological

d) Affective

Correct Answer - B
Ans. b. Emotional
Neziroglu and Stevens proposed four different levels of
insights:
True emotional insight medpox.com
Intellectual insight
Partial internally and externally based insight
Denial of illness
True emotional insight is representative of the highest level of insight
possible. In it the patients' awareness and understanding of their
own thoughts, feelings and motives can be used to change behavior.
2058. Extracampine hallucinations term was
given by ?
a) Eugene Bleuler

b) William Harvey

c) Robert Macinoff

d) Eden Speroff

Correct Answer - A
Ans. A. Eugene Bleuler
Extracampine hallucinations
medpox.com
The term extracampine is indebted to Latin words extra - outside
and campaneus - field.
It was introduced in or shortly before 1903 by Swiss Psychiatrist
Eugene Bleuler to denote a hallucination that is experienced by
affected individual as being outside the range of normal perception.
2059. Hypomimia is ?
a) Decreased ability to copy

b) Decreased execution

c) Deficit of expression by gesture

d) Deficit of fluent speech

Correct Answer - C
Ans. C. Deficit of expression by gesture
Hypomimia
Hypomimia or amimia is a deficit or absence of expression by
gesture or mimicry. medpox.com
This is usually most obvious as a lack of facial expressive mobility
(mask - like facies).
This is a feature of frontal subcortical disease.
2060. Serial 7 substraction is used to test ?
a) Working memory

b) Long term memory

c) Mathematical ability

d) Recall power

Correct Answer - A
Ans. A. Working memory
Serial sevens substraction test
Serial sevens, counting down from one hundred by sevens, is a
clinical test used to test mental function; for example, to help assess
medpox.com
mental status after possible head injury or in suspected cases of
dementia.
This well-known test, in active documented use since at least
l944,was adopted as part of the mini-mental state examination.
The test is also used in determining when a patient is becoming
unconscious under anaesthetic, for example prior to major dental
surgery.
2061. Which of the following are sections of
mental state examination?
a) Mood and affect

b) Speech and language

c) Cognition

d) All the above

Correct Answer - D
Ans. D. All the above

medpox.com
2062. Obsessive attention by an individual
towards another person is called ?
a) Stalking

b) Percieving

c) Following

d) Pressurizing

Correct Answer - A
Ans. A. Stalking
Stalking
medpox.com
Stalking is unwanted or obsessive attention by an individual or group
toward another Person.
Stalking behaviors are related to harassment and intimidation and
may include following the victim in person or monitoring them.
The word stalking is used, with some differing meanings, in
psychology and psychiatry and also in some legal jurisdictions as a
term for a criminal offense.
2063. Most common of all psychiatric
disorders are -
a) Anxiety disorder

b) Schizophrenia

c) Depression

d) Mania

Correct Answer - A
Ans. A. Anxiety disorder
Most common psychiatric disorder > Anxiety disorders.
medpox.com
2d most common psychiatric disorder > Depression.
2064. Patient wants to scratch for itching in
his amputated limb is an example of ?
a) Illusion

b) Pseudohallucination

c) Phantom limb hallucination

d) Autoscopy hallucination

Correct Answer - C
Ans. C. Phantom limb hallucination
Phantom limb hallucination - The person feels his body parts intact
medpox.com
in their respective places even after they are lost through amputation
or injury.
In the question given patient feels itching in the amputated limb and
tries to scratch the limb. Thus it is an example of phantom limb
hallucination.
2065. Myxedema madness includes ?
a) Auditory hallucinations and paranoia

b) Visual hallucinations and depression

c) Auditory hallucinations and depression

d) Paranoia and depression

Correct Answer - A
Ans. A. Auditory hallucinations and paranoia
Psychiatric disorders in hypothyroidism
These include depressed mood, apathy, impaired memory and other
cognitive defects. medpox.com
Hypothyroidism can contribute to the development of treatment
refractory depression.
Myxedema madness consisting of auditory hallucinations and
paranoia is seen in some Patients.
2066. APACHE II does not include ?
a) Acute physiology score

b) Age

c) Sex

d) Chronic health evaluation

Correct Answer - C
Ans. C. Sex
Acute physiology and chronic health evaluation
Knaus et al (1981) introduced the first the Acute Physiology and
Chronic Health Evaluation (APACHE) model in 1981 and revised it
medpox.com
to APACHE II in 1985. APACHE III was presented in 1991 but as the
regression analysis modelling is not in the public domain its uptake
has been slow.
APACHE II is made up of four basic comPonents:
1) Acute physiology score;
2) Chronic health evaluation;
3) Age;
4) Urgency of admission to critical care
2067. SSRIs should be carefully used in the
young for the management of
depression due to increase in?
a) Nihilism ideation

b) Guilt ideation

c) Suicidal ideation

d) Envious ideation

Correct Answer - C
Ans. C. Suicidal ideation medpox.com
In 2003, th UK Medicine and Health Care products regulatory
agency concluded that all SSNs, with the exception of fluoxetine,
were contraindicated in the treatment of depression in young people
due to increase in suicidal ideation and dubious efficacy.
2068. If a person is asked, "what will he do if
he sees a house on fire"?, Then what is
being tested in that person ?
a) Social judgement

b) Test judgement

c) Response judgement

d) None of the above

Correct Answer - B
AnS. B. Test judgement medpox.com
Judgement
It is the ability to assess a situation correctly and act appropriately
within that situation'
Social judgement: is observed during the hospital stay and during
the interview session. It includes evaluation of personal judgement.
Test Judgement: is assessed by asking the patient what he would
do in certain test situations like - house on fire, man lying on road.
It is rated as good/ intact normal or poor/ impaired/abnormal'
2069. What is produced by the
supersensitivity of Dopamine receptors
?
a) Dyskinesia

b) Hyperphagia

c) Hyperpathia

d) Hypomania

Correct Answer - A
Ans. is 'a' i.e., Dyskinesia medpox.com
(Ref: Pathophysiology, pharmacology and biochemistry of
dyskinesia p. 195)
Increased neostriatal dopamine receptor density and dopaminergic
supersensitivity in the neuroendocrine system are associated with
the development of tardive dyskinesia.
2070. The most common substance of abuse in India:
a) Cannabis

b) Tobacco

c) Alcohol

d) Opium

Correct Answer - A
By most estimates, cannabis (Indian hemp plant) remains the world's most commonly used
illicit drug.
Cannabis is perhaps the most widely used drug in India too, due to it's easy availability.
Cannabis, a substance that has been traditionally used in India as an intoxicant.
It is produced from the plant cannabis saliva or Indian Hemp plant. It grows in the wild over
most parts of the country.
medpox.com

Ref: Kaplan & Sadock's Synopsis of Psychiatry 9th Edition, Page 444, 424-27; Park’s
Social and Preventive Medicine 18th Edition, Page 635; Shorter Oxford Textbook of
Psychiatry 5th Edition, Page 332-342
 2071. Illusion is a disorder of ?
a) Thought

b) Perception

c) Affect

d) Emotion

Correct Answer - B
Ans, B. Perception
Disorders of perception
1. Altered perception - Sensory distortion (micropsia, hyeracusis),
Illusion. medpox.com
2. False perception - Hallucination.
 2072. Rope seen as snake is an example of -
a) Illusion

b) Hallucination

c) Delusion

d) Pseudohallucination

Correct Answer - A
Ans. A. Illusion
llusions are altered perception in which a real eternal object is
combined with imagery to produce false internal percept.
In simple words, illusion is misinterpretation of an actual sensory
medpox.com
input.
For example: -
1. Hearing once name in a train whistle:- Train whistle is a real eternal
stimulus, which is perceived as once name (false internal percept).
2. Mistaking a stick or rope for snake in dark room:- Stick is a real
external object, which is perceived falsely as snake.
2073. Woman firmly and persistently feels her
husband is cheating on her and she
disapproves to accePt any proof given
in the husbands support' The other
family members do not
supportherbelief. This is anexample of-
a) Illusion

b) Delusion

c) Hallucination

d) Perversion
medpox.com

Correct Answer - B
Ans. B. Delusion
In the question given the woman has a false unshakable belief that
her husband is cheating on her and she disapproves all her relatives
and proofs in support of her husband.
Thus this is an example of delusion.
2074. All of the following are formal thought
disorder EXCEPT:
March 2013 (b, c, h)
a) Schizophrenia

b) Delusion

c) Loosening of association

d) Mania

Correct Answer - B
Ans. B i.e. Delusion medpox.com
Delusion is a disorder of thought content (NOT a formal thought
disorder/disorder of thought process)
Delusion
Disorder of thought;
False unshaken belief not amenable to reasoning
Hallucination
Disorder of perception;
Perception in the absence of external stimuli;
Not dependent of will of observer
Illusion
Misinterpretation of external stimuli
2075. Withdrawal of which of the following
causes piloerecton?
a) Morphine

b) Cannabis

c) Smoking

d) Alcohol

Correct Answer - A
Ans. A. Morphine
Manifestations of morphine withdrawal
Lacrimation medpox.com
Anxiety & fear
Sweating
Restlessness r
Yawning
Gooseflash (Piloerection).
2076. Schizotypal personality belongs to
which cluster of personality disorders?
a) A

b) B

c) C

d) D

Correct Answer - A
Ans. A. A
Cluster A: Paranoid, Schizoid, Schizotypal.
medpox.com
Cluster B: Antisocial (Dissocial), Histrionic, Narcissistic, Borderline.
Cluster C: Anxious (avoidant), Dependent, obsessive - compulsive
(anankastic).
2077. Cardinal feature of antisocial
personality -
a) Violation of rules of society

b) Attention - seeking behavior

c) Unstable interpersonal relationship

d) Grandiose behaviour

Correct Answer - A
Ans. A. Violation of rules of society
The essential features of antisocial personality disorder are a
medpox.com
disregard for and violation of the rights of the other and the rules of
the society.
2078. Markedly inappropriate sensitivity, self
importance and suspiciousness are
clinical features of
a) Aantisocial

b) Historic

c) Schizoid

d) Paranoid

Correct Answer - D
D i.e. Paranoid P medpox.com
2079.

medpox.com
Which personality disorder/s can be a part of
autistic sPectrum of disorders?
a) Schizoid

b) Schizotypical

c) Borderline

d) All the above

Correct Answer - D
Ans. D. All the above
Following personality disorders can be diagnosed later in life in
medpox.com
patients with childhood autistic spectrum of disorders: Borderline,
Obsessive compulsive, narcissitic, paranoid, schizotypical and,
avoidant, personality.
2080. Patients who are grandiose and require
admiration from others has which type
of personality?
a) Narcissistic

b) Histrionic

c) Borderline

d) Antisocial

Correct Answer - A
Ans. A. Narcissistic medpox.com
Grandiosity and admiration from others are feature of Narcissistic
personality disorder.
2081. Max duration of time spent is in NREM
stage?
a) I

b) II

c) III

d) IV

Correct Answer - B
Ans, B. II
REM sleep occupies 20-30% of total sleep and NREM sleep ocupies
medpox.com
60-70% (state I: 5-70%, stage II : 40-50%, stage III & IV : 15_20%)
2082. All are true about narcolepsy except:
a) Day dreaming

b) Hypnagogic hallucinations

c) Cataplexy

d) Sudden sleep

e) Decreased REM latency

Correct Answer - A
Ans. (A) Day dreaming
medpox.com
[Ref Neeraj Ahuja 7th/ I j8-39; Kaplan & Sailockls Textbook of
psychiatry 11th/547-50; Harrison 19th/189, t7th/172- ZB; CMDT
2016/1072]
Narcolepsy:
Disorder characterized by excessive daytime sleepiness often
distributed night time sleep and disturbances in REM sleep.
Hallmark of this disorder is decreased REM latency, I.e. decreased
latent period before the first REM period occurs.
Normal REM latency is 90- 100 minutes, in narcolepsy, REM sleep
occurs within 10 minutes of the onset of sleep.
Classical tetrad of symptoms:
Sleep attacks (MC)
Cataplexy
Hallucinations at sleep onset (Hypnagogic) and upon waking
(Hypnopompic)
Sleep paralysis.
2083. All the following are true regarding pseudocyesis, EXCEPT:
a) The patients usually have an intense desire to have children

b) Change in the breast may be present

c) There may be considerable increase in the size of the abdomen

d) The labour pain invariably continue to persist even if she is told

that she is not pregnant

Correct Answer - D
Pseudocyesis or phantom pregnancy is usually seen in patients nearing menopause or in
young women who intensely desire children.
Most of them suffer from some forms of psychic or hormonal disorder.
The abdomen may distend due to deposition of fat.
medpox.com
The pregnancy may progress to full term and the labour pain may stop abruptly when
informed that she is not pregnant.

Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page -
333
2084. Post traumatic stress disorder (PTSD)
is differentiated from all other disorders
by:
a) Nightmares about events

b) Autonomic arrousal and anxiety

c) Recall of events and avoidance of similar experiences in PTSD

d) Depression

Correct Answer - C
C i.e. Recall of events and avoidance of similar experiences in
medpox.com
PTSD
- PTSD arises as response to traumatic event (criteria A) that is
characterized by persistent re-experience (criteria B), persistent
avoidance and numbness (C), hyperarousal (D), of > 1 month
duration (criteria E) causing significant distress & impaired
functioning (criteria F)Q. The onset may be delayed (6 months to
years after event).
- PTSD arises as a delayed/protracted response to an exceptionally
stressful or catastrophic life event or situation which is likely to cause
pervasive distress in almost any person (eg. disaster, war, rape,
torture, serious accident). It may develop even after 6 months to
years after stressorQ.
- PTSD is characterized by peristent/recurrent intrusive distressing
recollections of stressful event either in flashbacks (images,
thoughts or perceptions), dreams, reliving experiences, illusions,
hallucinations or distress/ physiological reactivity on exposure to
reminders of traumatic events. There is marked (persistent)
avoidance of stimuli/events or situations that arouse recollection of
stressful events and increased arousal (hyperarousal) and numbing
of general responsivenessQ.
Partial amnesia for some aspects of stressful events, anhedonia
(inability to experience pleasure) and alexithymia (characterized by
inability to identify & articulate feelings) may be present.

medpox.com
2085. Catatonia is a type of:
September 2007
a) Schizophrenia

b) Phobia

c) Depression

d) OCD

Correct Answer - A
Ans. A: Schizophrenia
Schizophrenia is a severe, persistent, debilitating, and poorly
medpox.com
understood psychiatric disorder that probably consists of several
separate illnesses.
Symptoms include disturbances in thoughts (or cognitions), mood
(or affects), perceptions, and relationships with others. The hallmark
symptoms of schizophrenia are auditory hallucinations and
delusions, which are fixed false beliefs. The symptoms of
schizophrenia may be divided into the following 4 domains:
Positive symptoms: These include psychotic symptoms, such as
hallucinations, which are usually auditory; delusions; and
disorganized speech and behavior.
Negative symptoms: These include a decrease in emotional range,
poverty of speech, loss of interests, and loss of drive.
Cognitive symptoms: These include neurocognitive deficits, such as
deficits in working memory and attention and executive functions
such as the ability to organize and abstract.
Mood symptoms: Schizophrenia patients often seem cheerful or sad
in a way that does not make sense to others. They often are
depressed.
Catatonia Schizophrenia
This syndrome occurs in children, adolescents, and adults; is
This syndrome occurs in children, adolescents, and adults; is
associated with a heterogeneous group of comorbid conditions; and
is characterized by a variety of symptoms and signs of impairment of
the expression of voluntary thoughts and movements.
Typically, the syndrome of catatonia is episodic, with periods of
remission.
It can presents in three clinical forms:
Excited catatonia
Stuporous catatonia
Catatonia alternating between excitement and stupor.

medpox.com
2086. Spouse jealousy is a feature of ?
a) Othello syndrome

b) Chronic alcoholism

c) Stockholm syndrome

d) Clerambault's syndrome

Correct Answer - A
Ans. A. Othello syndrome
Othello Syndrome:
When the content of delusions is predominantly jealousy (infidelity)
involving the spouse, person feels an unreasonable fear that a
medpox.com
partner has been unfaithful, is presently unfaithful, or plans to be
unfaithful, it is called as Othello Syndrome or conjugal paranoia.
Elaborate steps are taken to prevent the spouse to go outside
(Locks the spouse, not allowing her to go outside).
2087. All of the following are true about
pseudohalluci​nations except ?
a) Arises in inner subjective self

b) Patient describes the sensations being perceived by mind eye

c) Are under voluntary control

d) Distressing flashback of PTSD is a n example

Correct Answer - C
Ans.C. Are under voluntary control
Pseudohallucination
medpox.com
Pseudohallucination is a perceptual experience, which differs from a
hallucination in that it appears to arise in the inner subjective space,
not through one of the external sensory organs.
Patients tend to describe these sensations as being perceived with
the 'inner eye' or 'mind eye' (or ear).
However, like true hallucinations pseudohallucinations are not under
voluntary control.
Example include: Distressing flashbacks in post-traumatic stress
disorder or the recently bereaved widow waking up to briefly 'see'
her husband sitting at the foot of the bed,
2088. Delirium is defined as ?
a) Acute onset of disturbed consciousness

b) Chronic onset of disturbed consciousness

c) Progressive generalized impairment of intellectual functions and

memory without impairment of consciousness

d) Disorientation without clouding of consciousness

Correct Answer - A
Ans. A. Acute onset of disturbed consciousness
Delirium is defined by the acute onset of fluctuating cognitive
impairment and a disturbance of consciousness.
medpox.com
It is also referred to as acute confusional state or acute organic brain
syndrome.
 2089. All the following drugs are used to
prevent relapse and maintain
abstinence in cases of alcohol
withdrawal except ?
a) Disulfiram

b) Acamprosate

c) Naltrexone

d) Propranolol

Correct Answer - D medpox.com

Ans. D. Propranolol
Detoxification (treatment of withdrawal):- BZDs are the drugs of
choice, e.g. chlordiazepoxiile (Id choice), Diazepam (2nd choice).
Maintenance after detoxification (to prevent relapse and
maintenance of abstinence):-
1. Aversive agent (ileferent agents):- Disulfiram, CCC, metronidazole,
Natrafezole.
2. Anticraving agent: - Naltrexone, Acamprosate, fluoxetine,
Topiramate, Nalmefene.
2090. Treatment of acute alcohol
withdrawal:
Punjab 09
a) Diazepam

b) Bupropion

c) Disulfiram

d) Acamprosate

Correct Answer - A
Ans. Diazepam medpox.com
2091. True about RETT Syndrome –
a) Macrocephaly

b) Cardiac arrhythmia

c) Seizures

d) Mental retardation

e) Autistic behaviour

Correct Answer - B:C:D:E

Ans. is'b'i.e., Cardiac arrhythmia,'c'i.e., Seizures,'d'i.e., Mental
medpox.com
retardation &'e'i.e., Autistic behaviour
Rett's Syndrome
This is the characteristic features, that they begin to loose their
acquired skills, e.g., cognitive and head growth is normal during
early period after which there is an arrest of growth.
Acquired microcephaly
Most children develop peculiar sighing respirations with intermittent
periods of apnea that may be associated with cyanosis → Breath
holding spells.
Autistic behaviour → Impaired social interaction, language and
communication.
Generalized tonic-clonic convulsions occur in the majority.
Feeding disorder and poor weight gain
2092. Which of the following could be a component of conversion disorder?
a) Pseudoseizures

b) Derealisation

c) Depersonalisation

d) Amnesia

Correct Answer - A
Pseudoseizure can occur in conversion disorder.
Paralysis, blindness and mutism are the most common conversion disorder symptoms.
Anaesthesia and paresthesia especially of the extremities are the most common sensory
symptoms.
Other sensory symptoms includes deafness, blindness and tunnel vision.
medpox.com

Motor symptoms associated with it are: abnormal movements, gait disturbance, weakness
and paralysis.
One gait disturbance seen in this is ataxia abasia, which is a wildly ataxic, staggering gait
accompanied by gross, irregular, jerky truncal movements and thrashing and waving arm
movements.

Ref: Kaplan and Sadock's Concise Textbook of Clinical Psychiatry, 3rd Edition By
Benjamin J. Sadock, Page 279
2093. La belle indifference is seen in
a) Conversion Reaction

b) Schizophrenia

c) Mania

d) Depression

Correct Answer - A
A i.e. Conversion reaction
La belle indifferenceQ is in-appropiate attitude of calm or lack of
concern about one's disability. It is seen in conversion (dissociative)
disorderQ (but not specific), physical illness etc.
medpox.com
2094. Which is the most common type of
persistent delusional disorder ?
a) Delusion of persecution

b) Somatic delusion

c) Delusion of jealousy

d) Delusion of grandeur

Correct Answer - A
Ans. A. Delusion of persecution
Delusion of persecution is the most common type of persistent
delusional disorder. medpox.com
2095. Dysthymia is ?
a) Chronic depression

b) Chronic mania

c) Bipolar disorder

d) Personality disorder

Correct Answer - A
Ans. A. Chronic depression
Persistent depressive disorder (Dysthymia)
Depression may run a chronic course over years with fluctuation of
mood interposed with symptom free intervals (less than 2 months).
medpox.com
If symptoms persist for more than 2 years, they are referred to as
persistent depressive disorder or dysthymia.
2096. Bipolar II disorder includes ?
a) Cyclothymic disorder

b) Dysthymia

c) Single maniac episode

d) Major depression and hypomania

Correct Answer - D
Ans. D. Major depression and hypomania
Bipolar II: One or more major depressive episodes together with at
least 1 hypomanic episode.
medpox.com
2097. Paraphilias are all except :
a) Bisexuality

b) Homosexuality

c) Bestiality

d) Frottuerism

Correct Answer - A
A i.e. Bisexuality
- Abnormal & unorthodox sex play by using unusal objects or parts
of body are known as paraphillia eg. Sadomasochism,
Transvestism, Uranism, Beastality, Fortteurism, Urolangia,
medpox.com
Homosexuality etc.
- Bisexuality means hermaphrodite i.e. an individual with both ovary
& testis & external genitals of both sexes.
2098. Drugs used in ADHD are -
a) Atomoxetine

b) Methylphenidate

c) Dextro-amphetamine

d) All

Correct Answer - D
Ans. is 'a' i.e., Atomoxetine; 'b' i.e., Methylphenidate; 'c' i.e., Dextro-
amphetamine
Some common stimulants used to treat ADHD include:
Adderall (amphetamine) medpox.com
Ritalin (methylphenidate)
Concerta (methylphenidate)
Focalin (dexmethylphenidate)
Daytrana (methylphenidate patch)
Metadate or Methylin (methylphenidate)
Dexedrine or Dextrostat (dextroamphetamine)
Vyvanse (lisdexamfetamine dimesylate)
 2099. Psychotic patient on antipsychotic
drugs develops torticollis within 4 days
of therapy. what is the treatment?
a) Central anticholinergic

b) Peripheral anticholinergic

c) Beta blocker

d) Dantrolene

Correct Answer - A
Ans. A. Central anticholinergic
medpox.com
This is a case of drug induced muscular dystonia, which is treated
by central anticholinergic.
Drug of choice for antipsychotic induced extrapyramidal side effects
1. Acute muscular dystonia -+ Central anticholinergic
2. Akathisia - Beta blocker
3. Parkinsonism - Central anticholinergic.
4. Neuroleptic malignant syndrome - Dantrolene
5. Tardive dyskinesia → Terabenazine (TBZ)
2100. ECT is contraindicated in -
a) Very ill patients

b) Raised ICT

c) Heart disease

d) Pregnancy

Correct Answer - B
Ans. is 'b' i.e., Raised ICT

medpox.com
2101. Visual analogue scale (VAS) most
widely used to measure
a) Sleep

b) Sedation

c) Pain intensity

d) Depth of Anaesthesia

Correct Answer - C
C i.e. Pain intensity

medpox.com
2102. True about anorexia nervosa is all
except ?
a) Binge eating is common

b) Unknown in male

c) Ammenorrhoea starts before severe loss of weight

d) Self-induced vomiting

Correct Answer - B
Ans. is 'b' i.e., Unknown in male
Anorexia nervosa is less common in male, but can be seen.
medpox.com
There is binge eating and self induced vomiting.
"Amenorrhea often precedes severe weight loss" – Essentials of
psychiatry
ANOREXIA NERVOSA
The term '`anorexia nervosa" is a misnomer as loss of appetite is a
rare symptom. This disorder is characterized by self imposed dietary
restrictions leading to malnutrition and severe weight loss.
Clinical features
Females are far more commonly affected than males. Onset usually
occurs between the age of 10-30 years, usually in mid adolescence.
A deliberate and persistent restriction of food is usually the earliest
presenting symptom. There is intense fear of becoming of obese,
even if body becomes very thin and underweight.
There is a body-image disturbance. The person is unable to
perceive the body size accurately.
Some patients cannot continuously control their voluntary restriction
of food intake and So have eating binges. These binges usually
occur secretly and often at night and are frequently followed by self-
induced vomiting. Patients abuse laxatives and even diuretics to
lose weight, and ritualistic exercising, extensive cycling, walking,
jogging and running are common activities.
Patients with anorexia nervosa exhibit peculiar behavior about food.
They hide food all over the house, frequently carry large quantities of
candies in their pockets and purses. They try to dispose of food in
their napkins or hide in their pockets, while eating meals. They cut
their meat into very small pieces and spend a great deal of time
rearranging the pieces on their plates.
There is significant weight loss and patient is underweight.
Amenorrhea is seen in almost all women and loss of libido may
occur in male patients. There may be poor sexual adjustment.
Obsessive compulsive neurosis, depression and anxiety like
psychiatric illness may coexist.
Complications of malnutrition may occur, e.g., hypoglycemia,
hypothermia, low BP, bradycardia, leucopenia, endocrine changes
(raised GH and Cortisol, reduced gonadotrophin), and appearance
of lanugo hair.

medpox.com
2103. Main difference between anorexia
nervosa and bulimia nervosa lies
in:
March 2013
a) Symptomatology

b) Weight

c) Gender

d) Age

Correct Answer - B medpox.com

Ans. B i.e. Weight
Anorexia nervosa and bulimia
Both anorexia nervosa and bulimia are characterized by an
overvalued drive for thinness and a disturbance in eating behavior.
The main difference between diagnoses is that anorexia nervosa is
a syndrome of self-starvation involving significant weight loss of 15
percent or more of ideal body weight, whereas patients with bulimia
nervosa are, by definition, at normal weight or above.
Bulimia is characterized by a cycle of dieting, binge-eating and
compensatory purging behavior to prevent weight gain.
Purging behavior includes vomiting, diuretic or laxative abuse.
Excessive exercise aimed at weight loss or at preventing weight gain
is common in both anorexia nervosa and in bulimia.
2104. Most common cause dementia in adult:
a) Alzheimer's

b) Multiinfrct

c) Pick' disease

d) Metabolic cause

Correct Answer - A
A i.e. Alzheimer's

medpox.com
2105. Following are the major symptoms of
obsessive compulsive disorders ?
a) Contamination

b) Pathological doubts

c) Intrusive thoughts

d) All the above

Correct Answer - D
Ans. is'd'i.e., AII the above
[Rl Kaplan & Saddock's |tr/e p. 605)
medpox.com
OCD has four major symptom patterns :-
Contamination : -
Contamination is the most common pattern of an obsession followed
by washing (washer)
Pathological doubts : -
Doubts is the second most common pattern of an obsession,
followed by a compulsive checking (checkers).
Intrusive thoughts (Pure obsessions) : -
In this third most common pattern, there are intrusive obsessional
thoughts without a compulsion.
Such obsessions are usually r4re titious thoughts of a sexual or
aggressive act that is reprehensible to the patient.
Symmetry: -
This is the fourth most common pattern in which there is an
obsession for symmetry or precision, which can lead to compulsion
of slowness.
Patients can literally take hours to shave their faces or to eat a meal.
2106. Which of the following drug is not given
in acute
mania:
September 2009
a) Lithium

b) Lamotrigine

c) Valproate

d) Olanzapine

Correct Answer - B medpox.com

Ans. B: Lamotrigine
Lamotrigine is not recommended for acute mania.
It is especially useful in rapidly cycling bipolar depression.
2107. A 3 year old boy with normal
developmental milestones with delayed
speech and difficulty in communication
and concentration. He is not making
friends. Most probable diagnosis is ?
a) Autism

b) ADHD

c) Mental retardation

d) Specific learning disability

medpox.com
Correct Answer - A
Ans. is 'A' i.e., Autism
Delayed speech, difficulty in communication and concentration in a 3
year old child suggests the diagnosis of autism.
Autism is characterized by impaired social interaction and
communication, and by restricted and repetitive behavior. These
signs all begin before a child is three years old.
Autism affects information processing in the brain by altering how
nerve cells and their synapses connect and organize
It is one of three recognized disorders in the autism spectrum, the
other two being Asperger syndrome, which lacks delays in cognitive
development and language, and pervasive developmental Disorder-
not otherwise specified (commonly abbreviated as PDD-NOS)
2108. Eugene Blueler's 4As include following
except ?
a) Autism

b) Affect

c) Anhedonia

d) Association

Correct Answer - C
Ans. C. Anhedonia
Bleuler's 4 'As' are: (l) Ambivalence (2) Autism; (3) Affect
medpox.com
disturbances (inappropriate affect); and (4) Association disturbances
(loosening of association, thought disorder).
2109. Key symptom in alcohol withdrawal
syndrome is:
a) Sleep disturbance

b) Visual hallucinations

c) Tremors

d) Delirium

Correct Answer - C
Ans: C. Tremors
Key symptom - Tremor.
medpox.com
Withdrawal Syndromes
SubstanceFeatures
Yawning°, Insomnia, Dysphoric mood
Water loss from different orifices° (Lacrimation°,
Opioid sweating°, diarrhea°, vomiting,
Increased vitals° (BP, Pulse, RR, Temperature)°
Pupillary dilation, piloerection°
Hang over (MC)°
Hallucinations° (usually auditory) and illusions°
Insomnia°
Tremors/Seizures (Alcoholic seizures/Rum fits): Classic
sign
Delirium tremens:
Alcohol Occurs within 5 days° of complete or significant
abstinence° from heavy alcohol
Recovery occurs within 7 days
Characteristic features are clouding of consciousness°,
disorientation°, hallucinations (mostly visual and
 auditory)°, illusion°, autonomic disturbances°, agitation°
and insomnia°.
Increased or decreased Sleep (hypersomnia° or
insomnia) Psychomotor activity
Cocaine
Vivid unpleasant dreams°
Increased apetite and fatigue

medpox.com
2110. Lithium is treatment of choice for
a) Unipolar MDP prophylaxis

b) Bipolar MDP prophylaxis

c) Schizophrenia

d) Acute mania

Correct Answer - B
B i.e. Bipolar MDP prophylaxis
Lithium: Indications:
Established indications:
Treatment of acute mania medpox.com
Prophylaxis of bipolar mood disorder.
Possible clinical indications:
Treatment of the schizo-affective disorder
Prophylaxis of unipolar mood ilisorder
treatment of cyclothymia
Treatment if acute depression(as an adjuvant for refractory
depression)
Treatment of chronic akoholism(in presence of significant depressive
symptoms) 6 psychoactive use disorders(e'g cocaine dePendence)
Treatment of impulsive aggression.
Treatment of Keine-Levin syndrome

2111. Appetite for nonnutritive substances is
called ?
a) Pica

b) Apprepritant

c) Bulimia

d) Bolean

Correct Answer - A
Ans. A. Pica
Pica is characterized by an appetite for substances that are largely
medpox.com
non-nutritive, such as paper, clay, metal, chalk, soil, glass, or sand.
2112. Not involved in Wernicke - Korsakoff
syndrome:
a) Mammilary body

b) Thalamus

c) Periventricular grey matter

d) Hippocampus

Correct Answer - C
C i.e. Periventricular grey matter
Korsakoff's Psychosis (K P)
medpox.com
It is the commonest cause of organic amnestic syndrome. It is also
k/ a Wernicke - Korsakov syndrome, because it often follows an
acute neurological syndrome called Wernicke's encephalopathy
comprising delirium, ataxia, opthalmoplegia, nystagmus & peripheral
neuropathy.
It is a potentially reversible conditionQ caused by thiamine
deficiency most commonly associated with chronic alcohol abuse
malnutrition. But other causes of malnutrition eg. starvation,
hyperemesis gravidarum, dialysis, cancer, AIDS, gastric plication or
prolonged IV hyperalimentation, alone can also result in thiamine
deficiency & KP.
Neuropathological lesion caused by thiamine deficiency is usually
widespread but most consistent changes are seen in bilateral
dorsomedial (& anterior) nucleus of thalamus, mammillary bodies,
and hippocampus, in form of small vessels hyperplasia; petechial
hemorrhages, astrocytic hypertrophy & degenerationQ. It disrupts a
critical circuit between hippocampus & frontal lobes. The changes
are also seen in periventricular (around 3rd ventricle), periaqueductal
grey matter, cerebellum, and brain stem (midbrain, pons, medulla
fornix) as symmetrical lesions.
The cardinal feature is a profound deficit of episodic memory,
confabulation and lack of insight into the amnesiaQ. It presents as :

Change in personality (frontal lobe like) such that they display lack of
initiative, interest or concern & diminished spontaneity.
- Executive function deficits involving attention, planning, set shifting,
& inferential reasoning.
- Apathy, passivity & confabulationQ are often prominent. There is
disorientation for time, emotional blunting, & inertia.
- There is little impairment in implicit memory and their ability to
perform (complete) complex motor procedures remain intactQ.
Typically general intelligence, perceptual skills & language remain
relatively normalQ.
Memory disorder
- Profound deficit of episodic type explicit (declarative) memory 1/t
loss of autobiographic information (often extending back for many
years).
Severe anterograde amnesia (learning defect) for verbal & visual
medpox.com
material with a lack of insight into the amnesia. Events are recalled
immediately after they occur, but forgotten a few minutes later. Thus
digit span, testing the short term memory store, is normal. Storage is
mildly impaired but retrieval & learning are severely impairedQ.
When patients learn new material they will forget it at a normal rate,
but learning the new material is extremely difficult, and in severe
cases new learning is impossible. So these patients have difficult
encoding & consolidating explicit memory.
- Retrograde amnesia back to the onset of illness, is as severe as
anterograde loss; but the overall retrograde memory impairment (i.e.
before the onset of illness) is not as severe as that of anterograde
memory.
New learning & recent memory is grossly defective but retrograde
(remote) memory is relatively (variably) preserved, and show a
temporal gradient, with older memories better preserved. As a result
these patients retain more distant memories dramatically more
proficiently than they learn new material.
- Although remote memory is surprisingly intact, patients are unable
to organize them in a temporal context. So they distort the
relationship between facts and fill the remote memory gaps by
confabulationQ (a vivid & wholly fictitious account of recent activities
which the patient believes to be true).

medpox.com
 2113. All are features of Korsakoff syndrome
except
a) Antegrade amnesia

b) Retrograde amnesia

c) Ataxia

d) Confabulation

Correct Answer - C
Ans. 'C' i.e., Ataxia
Korsakoff syndrome
medpox.com
Korsakoff's syndrome is the chronic amnestic syndrome that follows
Wernicke's encephalopathy, and the two syndromes are believed to
be pathophysiologically related. Korsakoff's syndrome is
characterized by severe and irreversible memory impairments and
confabulation behaviour in the absence of intellectual decline or
attention deficit. Important clinical features are:?
1. Memory:- The Korsakoff syndrome is characterized by both
antegrade (i.e., learning) and retrograde (i.e., a memory of past
events) amnesia. Antegrade amnesia is severe with a lack of insight.
Retrograde amnesia is not as severe. New learning and recent
memory are impaired but remote memory is relatively preserved.
Although remote memory is relatively preserved, the patient is
unable to organize them in a temporal context and distort the
relationship between facts and fill the remote memory gaps by
confabulation. There is a profound deficit of explicit (conscious or
declarative) type of long term memory, with little impairment of
implicit (unconscious or non-declarative) type of long term memory.
2. Personality:- Passive and malleable such that they display a lack of
initiatives, interest, or concern and diminished spontaneity.
3. Other:- Perseveration, lack of motivation (amotivational syndrome),
apathy, passivity.
4. General intelligence, language, and motor & perceptual skills are not
impaired.

medpox.com
2114. Bad trip is seen with ?
a) Cocaine

b) Cannabis

c) LSD

d) Heroin

Correct Answer - C
Ans. C. LSD
Acute panic reaction with loss of control on onself, called Bad trip, is
characteristic of LSD or otJrer hallocinogens.
medpox.com
2115. Mania is characterized by:
a) Paranoid delusion

b) Loss of orientation

c) High self esteem

d) All

Correct Answer - C
C i.e. High self esteem

medpox.com
2116. Antipsychotic drug causing retinal
pigment disorder is?
a) Thiaoridazine

b) Clozapine

c) Chlorpromazine

d) None of the above

Correct Answer - A
Ans. A. Thiaoridazine
Blue pigmentation of skin, corneal and lenticular opacities, retinal
medpox.com
degenration can occur with thioridazine.
2117. Antipsychotic drug with least extra
pyramidal symptoms?
a) Pimozide

b) Thioridazone

c) Clozapine

d) Flupromazine

Correct Answer - C
Ans. C. Clozapine
Antipsychotics with no extrapyramidal side effects clozapine,
aripiprazole, quetiapine. medpox.com
Amongst typical antipsychotics, thioridazone has least extrapyramial
side effects.
2118. Following is true about alcoholic
dependence syndrome except -
a) No tolerance

b) Withdrawal symptoms

c) CAGE questionnaire

d) Physical dependence

Correct Answer - A
Ans. A. No tolerance
Alcohol dependence has following criteria:- (i) Tolerance; (ii)
medpox.com
Withdrawal symptoms; (iii) Taken in larger amount or longer
duration; (iv) Persistent craving (desire) to take alcohol; (v) A great
deal of time spent to obtain alcohol or to use it; (vi) Neglect of other
activities (social, occupational); and (vii) Continued use despite clear
evidence of overtly harmful consequences.
The CAGE questionnaire is a tool used to assess individuals for
potential alcohol problems, including dependence.
Alcohol produces both physical as well as psychological
dependence.
2119. DSM IV criterion for depression is?
a) 1 week

b) 2 weeks

c) 3 weeks

d) 4 weeks

Correct Answer - B
Ans. B. 2 weeks
For the diagnosis of minor depression 2-4 and for major depression
> 5 DSM IV symptoms are required for at least for a two week
period. medpox.com
2120. The clinical effects of the
antidepressant drugs is mainly based
on ?
a) Change in neurotransmitter receptor sensitivity

b) Decreased level of neurotransmitters

c) Change in efficacy of neurotransmitters

d) None of the above

Correct Answer - A
Ans. A. Change in neurotransmitter receptor sensitivity
medpox.com
Temporal correlation of clinical effects with changes in receptor
sensitivity has given rise to hypothesis that changes in
neurotransmitter receptor sensitivity may actually mediate the
clinical effects of antidepressant drugs.
These clinical effects include not only antidepressant and anxiolytic
actions but also the development of tolerance to the acute side
effects of antidepressant drugs.
2121. Identify the instrument depicted in the
image

a) Osteometric board

b) Shakir's board

c) Radiometric board
medpox.com

d) Thermometric bord

Correct Answer - A
Ans. is 'a' i.e.,Osteometric board [Ref Narayan Reddy 30thie p.
116]
It is Hepburn osteometric Board for measurement of length of long
bones.
Used For measurement of Bone length of large bones like TIBIA &
FEMUR.
2122. A child with pneumonia has following
chest X-ray. Most likely causative
organism is -

a) Str. pneumoniae

b) Staph aureus

c) Str. pyogenes

d) Listeria medpox.com

Correct Answer - B
Answer- B. Staph aureus
The given chest X-ray is showing large pneumatocele in right lung
—> characteristic of staph aureus pneumonia.
2123. Chest x-ray of a child presenting with
acute breathlessness. Diagnosis

medpox.com

a) Pneumothorax

b) Penuma ocele

c) Normal

d) None of above

Correct Answer - A
Answer- A. Pneumothorax
The above film shows a right sided tension pneumothorax with right
sided lucency and leftward mediastinal shift. This is a medical
emergency. And require immediate intercostals drainage.
2124. 1 day old male baby delivered by LSCS
had swelling over back in midline.

a) Iron

b) Folic acid

c) Thiamine

d) Vit A

medpox.com

Correct Answer - B
Answer- B. Folic acid
The figure is showing meningocele (a neural tube defect). Neural
tube defect can be prevented by folic acid supplementation.
2125. Following figure denotes -

a) Standard distribution

b) Negatively skewed

c) Positively skewed

d) Right handed

medpox.com
Correct Answer - C
Ans. is 'c' i.e., 5%
Shaded area represents the region beyond 2 standard deviations of
the normal distribution curve; thus represents an area of
approximately 5%.
2126. What percentage of the normal
distribution curve is represented by the
shaded area?

a) 1%

b) 3%

c) 5% medpox.com

d) 7%

Correct Answer - C
Ans. is 'c' i.e., 5% [Rep High yield biostatistics p. 11, 12]
Normal Positively skewed (rt. Handed)Negatively
distribution skewed (left handed) distribution
deviation
invalid question id

medpox.com