File
File
PART – A
SUBJECTS COVERED
PHARMACOLOGY OTOLARYNGOLOGY
02 Dr Ranjan Kumar Patel
05 Dr Rajiv Dhawan
PATHOLOGY OPHTHALMOLOGY
03 Dr Preeti Sharma
06 Dr Utsav Bansal
EDITED BY
Success is not final; failure is not fatal: it is the courage to continue that counts.
—Winston Churchill
We are immensely pleased to write the Preface to this book which is one of its kind. The idea to introduce this student-friendly and exam-oriented book
sprouted after doing intensive market research and interactions with students who encouraged us to bring our nascent idea into a proper shape and today
it is in your hand in the form of this illustrious book.
This book is the result of not one or two rather it is the amalgamation of ten medical scholars’ experience and knowledge and for this, we all are
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form of this charismatic achievement.
Now let us discuss something about this book. As the name suggests, this wonderful and amazingly designed book is meant for NEET/INI-CET/
NExT/FMGE aspirants. This meticulously written and sensible arranged book compiles more than 10,000 questions covering 10 subjects. Conceived
and formulated by ten distinguished and highly reputed medical scholars, this book covers Multiple Choice Questions extracted from all the
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advances in the form of brief theory of respective subjects.
Now, let us understand the structure of the book. The overall Question Bank has been divided into three categories:
1. Last Five Years NEET and INI-CET Recall
2. Frequently-asked Questions
3. Newly-created Clinical-based Questions
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As the motto of this book is: Practice, Practice and Practice, your regular practice and honest efforts will make your dream true and this book is
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With the hope that this book, which is the outcome of Ten distinguished authors’ relentless efforts, will hit the bull’s-eye for you, we are wishing best
of luck to our students for their future endeavors.
Always remember this: “Believe you can and you’re halfway there.”
—Authors
Acknowledgments
We express our sincere thanks to The God Almighty, for giving an idea to accomplish this book. We express our heartiest gratitude to our family
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Special Features of the Book
From the Publisher’s Desk
Dear Students,
Let us begin with a power-packed and inspiring quote:
Arise, awake, and stop not until the goal is achieved.
—Swami Vivekananda
Healthcare is undoubtedly one of the most noble and sacred professions. We are truly fortunate to be a part of this
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At CBS Publishers, we take great pride in supporting the healthcare community by offering resources that empower future professionals. Nine
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This year, we are introducing a new addition to the CBS Exam Book Series: Ten into Ten (Part A and B). According to the market research, there was a
gap, and at present no book is available for practice. Although there are multiple apps from where students can attempt test series, for offline practice, no
single update book is available in the market to fill this gap. The motto of this book is Practice: Practice: Practice as this book offers a decent amount of
MCQs which will meet the evolving needs of students. Ten into Ten is a comprehensive question bank covering 19 medical subjects. It offers over 10,000
meticulously curated questions across 10 key subjects, crafted by 10 renowned medical scholars.
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with the latest and most effective study approaches.
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Mr Bhupesh Aarora
(Sr Vice President – Publishing & Marketing)
[email protected]| +91 95553 53330
Contents
ANATOMY 1–213
Dr Shrikant Verma
Synopsis �������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 1–50
Multiple Choice Questions ��������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 51–213
PHARMACOLOGY 215–325
Dr Ranjan Kumar Patel
Synopsis �������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 215–229
Multiple Choice Questions ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 231–325
PATHOLOGY 327–482
Dr Preeti Sharma
Synopsis �������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 327–353
Multiple Choice Questions ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 355–482
OTOLARYNGOLOGY 647–761
Dr Rajiv Dhawan
Synopsis �������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 647–666
Multiple Choice Questions ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 667–761
OPHTHALMOLOGY 763–932
Dr Utsav Bansal
Synopsis �������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 763–808
Multiple Choice Questions ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 811–932
Detailed Table of Contents
[Subject-wise cum Topic-wise Questions]
Sl. no. Subjects Covered 5 Years Recall Qs Frequently asked Qs New Qs Total Qs
ANATOMY
1. General Anatomy 2 51 18 71
2. Histology 17 31 15 63
3. Embryology 17 96 20 133
6. Thorax 3 66 16 85
PHARMACOLOGY
1. General Pharmacology 22 42 15 79
2. Clinical Pharmacology 0 21 0 21
5. Kidney 4 22 5 31
8. Anticancer Drugs 11 37 15 63
9. Endocrinology 11 54 15 80
13. Blood 10 23 9 42
Sl. no. Subjects Covered 5 Years Recall Qs Frequently asked Qs New Qs Total Qs
PATHOLOGY
Cell Injury 16 19 23 58
Neoplasia 14 16 27 57
Immunity 17 27 33 77
Genetic Disorder 11 18 19 48
Cardiovascular System 10 5 26 41
Respiratory System 7 7 14 28
Gastrointestinal System 6 10 23 39
Renal System 7 11 35 53
Endocrinology 1 10 14 25
Breast 3 5 10 18
Diseases of Muscles 0 2 1 3
Bone 2 2 6 10
Sl. no. Subjects Covered 5 Years Recall Qs Frequently asked Qs New Qs Total Qs
Principles of Epidemiology 22 37 13 72
Biostatistics 27 83 1 111
Preventive Obstetrics 11 15 4 30
Preventive Pediatrics 5 27 12 44
Disaster Management 8 11 3 22
Occupational Health 6 22 8 36
Sl. no. Subjects Covered 5 Years Recall Qs Frequently asked Qs New Qs Total Qs
OTOLARYNGOLOGY
1. Ear 36 258 43 337
OPHTHALMOLOGY
1. Anatomy and Physiology of Eye 1 0 4 5
2. Optics 11 16 13 40
3. Strabismus 9 26 7 42
4. Neuro-Ophthalmology 14 28 14 56
5. Lens 7 42 9 58
6. Glaucoma 14 29 8 51
7. Uvea 5 21 5 31
8. Retina 12 62 27 101
9. Lacrimal Apparatus 4 12 3 19
11. Trauma 5 14 2 21
12. Conjunctiva 8 22 4 34
13. Cornea 10 26 8 44
15. Miscellaneous 1 0 0 1
1. ANATOMY 31
2. PHARMACOLOGY 41
3. PATHOLOGY 55
5. OTOLARYNGOLOGY 19
6. OPHTHALMOLOGY 25
Most Recent Questions
[NEET PG 2024 and INI-CET MAY 2024]
ANATOMY
a. A – Apocrine sweat gland, B – Arrector pilorum, C – Eccrine
NEET PG 2024 sweat gland, D – Sebaceous gland
b. A – Arrector pilorum, B – Apocrine sweat gland, C – Eccrine
1. Fracture at which site affects the longitudinal growth of a bone: sweat gland, D – Sebaceous gland
a. Epiphyseal plate b. Diaphysis c. A – Sebaceous gland, B – Eccrine sweat gland, C – Arrector
c. Epiphysis d. Metaphysis pilorum, D – Apocrine sweat gland
[Ref: Gray’s Anatomy, 42nd ed., p. 97] d. A – Eccrine sweat gland, B – Arrector pilorum, C – Sebaceous
gland, D – Apocrine sweat gland
2. Chronic tobacco consumer went to dental clinic with bleeding [Ref: diFiore’s Atlas of Histology with Functional
lesions on tongue was diagnosed with tongue carcinoma. Which Correlation, 11th ed., p. 219, 223]
of the papillae does not have taste buds?
a. Circumvallate 5. What is the outer covering of abnormal defect shown in the image?
b. Filiform
c. Fungiform
d. Foliate
[Ref: diFiore’s Atlas of Histology with Functional
Correlation, 11th ed., p. 235, 236]
3. Where will you find the epithelium shown in the image?
a. Ureter
b. Gallbladder
c. Duodenum
d. Trachea
a. Endoderm b. Ectoderm
[Ref: diFiore’s Atlas of Histology
c. Chorion d. Amnion
with Functional Correlation,
11th ed., p. 38] [Ref: Larsen’s Human Embryology, 6th ed., p. 82]
ANSWER KEY
ANATOMY
1. a 2. b 3. a 4. d 5. d 6. d
A
Anatomy
natomy
— Dr Shrikant Verma
SYNOPSIS
GENERAL ANATOMY
TYPES OF BONE
Flat bones Thin and flat bones have Mechanical protection to soft • Cranial bones
large surfaces for muscle tissues beneath • Sternum
attachments • Ribs
• Scapulae
Sesamoid Most sesamoid bones are Protect from additional Only one type of sesamoid
bones un-named. friction and use - can form in bone is present in all normal
palms and soles human skeletons so it has a
name; the patella.
TEN into TEN 3
ANATOMY
Anatomy
Dr Shrikant Verma
GENERAL ANATOMY
[Total Questions 71]
1. Which of the following type of joint is present between the bones Explanation: Watershed areas
shown in the photograph? (INI-CET NOV 2023) y Regions of the brain lying at the extreme edges of the major cerebral
arterial territories are called watershed areas and are the first to be
deprived of sufficient blood flow in the event of cerebral hypoperfusion.
Ischemic infarcts of the cortex and adjacent subcortical white matter
in the border zones between these territories are known as watershed,
boundary-zone or border-zone infarcts
y The left colic flexure marks the junction between the transverse and
descending colons and lies in the left hypochondriac region, anterior
to the tail of the pancreas and the left kidney.
Explanation: Examples of Aberrant epiphysis are—epiphysis at the head 11. Largest carpal bone is:
of the 1st metacarpal and at the bases of other metacarpal bones. a. Capitate b. Hamate
c. Scaphoid d. Pisiform
7. Pisiform is which type of bone? [Ref: Gray’s Anatomy, 42nd ed., p. 961,
a. Pneumatic bone BD Chaurasia’s Human Anatomy, 9th ed., vol. 1, p. 26;
b. Sesamoid bone 7th ed., vol. 1, p. 24 & 6th ed., p. 26]
c. Long bone
d. Accessory epiphysis Explanation: The capitate is the central and largest carpal bone.
[Ref: Gray’s Anatomy, 42nd ed., p. 961; BD Chaurasia’s 12. Thinnest bony part is found in which of the following bone:
General Anatomy, 7th ed., vol. 1, p. 32 & 6th ed., p. 30, 55] a. Frontal b. Ethmoid
Explanation: The pisiform is a sesamoid bone within the tendon of c. Temporal d. Sphenoid
flexor carpi ulnaris that increases the flexion torque applied by the muscle. [Ref: Gray’s Anatomy, 42nd ed., p. 699]
9. Median atlantoaxial joint is: 13. Which of the following is an atavistic epiphysis?
a. Cartilaginous a. Lower end of radius b. Condyles of femur
b. Condylar c. Coracoid process d. Tubercle of humerus
c. Fibrous [Ref: BD Chaurasia’s Handbook 6th ed., p. 42;
d. Synovial joint BD Chaurasia’s Human Anatomy, 9th ed., vol. 1, p. 9]
[Ref: Gray’s Anatomy, 42nd ed., p. 840; BD Chaurasia’s Explanation: The coracoid process of scapula is an atavistic type of
General Anatomy, 6th ed., p. 100 & Textbook of General Anatomy, p. 47]
epiphysis.
Explanation: 14. Which is not a type of epiphysis?
y Pivot (Trochoid) Joints—articular surfaces comprise a central bony a. Traction b. Atavistic
pivot (Peg) surrounded by an osteoligamentous ring. c. Pressure d. Friction
y Movements are permitted in one plane around a vertical axis.
[Ref: BD Chaurasia’s Handbook of General Anatomy,
y For example, Superior and inferior radioulnar joints, median atlanto
6th ed., p. 65]
occipital joints.
Explanation: Types of epiphyses:
10. The metopic suture:
According to number of epiphysis : Simple, compound
a. Separates frontal and parietal bones
According to the function: Pressure, traction, atavistic, aberrant, compound.
b. Separates occipital and parietal
c. Separates two halves of frontal bone 15. Epiphysio-diaphyseal joint is:
d. Separates two halves of the parietal bone a. Synostosis b. Syndesmosis
[Ref: Gray’s Anatomy, 42nd ed., p. 558; BD Chaurasia’s c. Primarily cartilaginous d. Schindylesis
Human Anatomy, 7th ed., vol. 3, p. 5 & 6th ed., p. 5] [Ref: BD Chaurasia’s Handbook, 6th ed., p. 64;
Handbook of General Anatomy, 6th ed., p. 95]
Explanation:
y Superomedial to each orbit is a rounded superciliary arch (more Explanation: Examples of primary cartilaginous joints: Joint between
pronounced in males), between which there may be a median epiphysis and diaphysis of a growing long bone, spheno-occipital joint,
elevation, the glabella. first chondrosternal joint, costochondral joints, xiphisternal joint.
y The glabella may show the remains of the interfrontal (metopic) suture,
which usually closes in the first postnatal year (Weinzweig et al. 2003) 16. Costochondral joint is example of:
but persists in a small percentage of adult skulls in various ethnic groups. a. Synovial joint
y A retained interfrontal suture is usually present in the inferior portion b. Primary cartilaginous joint
of the suture, a feature known as metopism. c. Secondary cartilaginous joint
d. Fibrous joint
ANATOMY
Explanation:
y Cervical vertebra are C1–C7.
y There are 8 carpals in each wrist.
y There are 8 cranial bones.
y There are 5 lumbar vertebrae.
y Different bones and their numbers shown in image:
ANATOMY
ANSWER KEY
60. a
Create a Study Schedule: Allocate specific times for anatomy review to
ensure consistent study habits and prevent cramming.
Pharmacology
P harmacology
— Dr Ranjan Kumar Patel
SYNOPSIS
Lung Cancer
y Small cell lung cancer
Cisplatin + Etoposide + Immunotherapy (Atezolizumab or Durvalumab)
y Non-small cell lung cancer
Refer to following flow chart to understand non-small cell lung cancer in detail.
PHARMACOLOGY
GENERAL PHARMACOLOGY
[Total Questions 79]
1. Which of the following drugs acts via the ATP-binding cassette Explanation: Lesser amount of drug present than expected in a tablet
transporter? (INI-CET NOV 2023) makes it a spurious drug.
1. Verapamil 2. Diltiazem
3. Nifedipine 4. Tacrolimus 4. Which of the following acts by increasing phospholipase C?
a. 1 and 2 b. 1 and 3 (INI-CET MAY 2022)
c. 1, 2 and 4 d. 1, 3 and 4 a. Gs b. Gq
c. Gi d. Go
[Ref: Internet] https://www.ncbi.nlm.nih.gov/.]
[Ref: KD Tripathi, Essential of Medical Pharmacology,
Explanation: Non-DHPs are substrate for ABC Pumps (ATP Binding p. 55-57]
Cassette) or MDR-1/P-glycoprotein pump, but not DHPs.
Explanation: Gs acts via adenylate cyclase, whereas Gq acts via
2. Which of the following options is correct regarding drug receptor phospholipase C.
interaction given in the picture? (INI-CET MAY 2022)
5. The graph given in the picture is an example of:
(INI-CET MAY 2022)
Explanation: Loading dose Explanation: Most common process of drug absorption is passive
diffusion through lipid barrier and hence, it is generalized that a drug is
aVd = D/C
absorbed when it is in lipid soluble form.
or D = aVd × C
34. Ciprofloxacin should not be given to an asthmatic using
The plasma concentration must be specific for a particular clinical effect. theophylline because:
If drug has a high volume of distribution, then to maintain a specific a. Ciprofloxacin inhibits theophylline metabolism
plasma concentration, in the equation above we must increase the dose b. Theophylline inhibits ciprofloxacin metabolism
“D” of the drug. This increased dose of drug for drugs with high aVd to c. Ciprofloxacin decreases effect of theophylline
maintain a specific plasma concentration is known as loading dose. Thus d. Theophylline induces metabolism of ciprofloxacin
loading dose depends on aVd and the formula for calculation is,
[Ref: Goodman and Gilman’s The Pharmacological Basis
Loading dose (LD) = aVd × C
of Therapeutics, 19th ed., p. 130]
31. In metabolism of xenobiotics, all of the following reactions occur
35. False regarding Cytochrome P-450 is:
in phase one; except:
a. They are essential for the production of cholesterols, steroids,
a. Oxidation prostacyclins and thromboxane A2
b. Reduction b. They absorb light with 450 nm wavelength
c. Conjugation c. They occur predominantly in liver
PHARMACOLOGY
ANSWER KEY
28. a 29. b 30. a 31. c 32. a 33. a
34. a 35. d Generic and brand names of drugs are often tested.
324 MCQs
1005. Ciraparantag is a wide spectrum antidote against all of the following drugs; except: New Qs
a. Heparin b. Fondaparinux
c. DOAC d. Warfarin
[Ref: Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 13th ed., p. 720, 726]
Explanation:
1006. A patient was started on warfarin and developed the side- 1007. A patient on anticoagulation therapy developed the side-effect
effect given in the image. All of the following can be used in given in picture. Which of the following might be the reason for
management; except: New Qs the same? New Qs
Pathology
athology
— Dr Preeti Sharma
SYNOPSIS
TYPES OF NECROSIS
GENERAL PATHOLOGY
[Total Questions 293]
CELL INJURY a. 1-D, 2-C, 3-B, 4-A b. 1-C, 2-A, 3-D, 4-B
c. 1-A, 2-B, 3-D, 4-C d. 1-B, 2-A, 3-C, 4-D
1. Which of the following are the features of necrosis? [Ref: Internet]
(INI-CET MAY 2023) 6. Which of the following are true regarding sirtuins?
a. Disrupted cell membrane b. Induces inflammation 1. Increases insulin sensitivity (INI-CET NOV 2022)
c. Cell swelling d. Physiological 2. Promotes genes which increase longevity
a. a and b b. a, b and d 3. They are 7 types
c. a, b and c d. a and c 4. Is a type of histone deacetylase
[Ref: Robbins and Cotran, 10th ed., p. 39] a. 1, 2, 3 b. 1, 2, 3, 4
c. 2, 3 d. 2, 4
Explanation: Necrosis is always pathological. Apoptosis can be both [Ref: Robbins and Cotran, 10th ed., p. 68]
physiological as well as pathological.
7. Cell in cell appearance is seen in: (INI-CET MAY 2022)
2. Which of the following is an antiapoptotic gene? a. Necrosis b. Apoptosis
(INI-CET MAY 2023) c. Necroptosis d. Emperipolesis
a. BAK b. BAX [Ref: Internet]
c. Mcl-1 d. PUMA
[Ref: Internet] Explanation: Emperipolesis is defined as cell in cell appearance without
killing. It is seen in
Explanation: Bcl-2, Mcl-1, Bcl-XL are antiapoptotic. P53, BAK, BAX, y MDS/MPN y Rosai-Dorfman Disease
Bcl-XS are proapoptitic. y Autoimmune hepatitis y CLL
3. Abnormal folding of proteins causes which of the following 8. True statement of telomerase theory of aging is: (NEET PG 2022)
disease? (INI-CET MAY 2023) a. Increasing telomere length is proportional to aging
a. Creutzfelt-Jakob disease b. Cirrhosis b. Telomere mutation is associated with increased aging
c. Nephritic syndrome d. Sickle cell anemia c. Decreased telomere length is associated with aging
[Ref: Harsh Mohan, Textbook of Pathology, d. Increased telomerase activity is associated with aging
8th ed., p. 925] [Ref: Robbins and Cotran, 10th ed., p. 66–69]
Explanation: Abnormal folding of proteins is seen in prion diseases Explanation: Cellular aging is due to telomere shortening. One telomere
(e.g., CJ disease). This causes spongiform changes/vacuolations in CNS, sequence is TTAGGG.
thereby also known as transmissible spongiform encephalopathy (TSE).
9. Which of the following will increase life span/delay the aging
4. Senile atrophy is seen in: (INI-CET NOV 2022) process? (NEET PG 2022)
a. Denervation b. Decreased nutrition a. Regular exercise
c. Decreased workload d. Reduced blood supply b. Decrease stress
[Ref: Robbins and Cotran, 10th ed., p. 60] c. Decrease calorie by 30%
d. Pharmacological intervention by taking PPIs
5. Match the following stains and the tissue. (INI-CET NOV 2022) [Ref: Robbins and Cotran, 10th ed., p. 68]
Column A Column B
1. Prussian blue stain A. Iron ANSWER KEY
2. PAS stain B. Glycogen 1. c. 2. c. 3. a. 4. d. 5. c. 6. b.
3. Congo red stain C. Leprosy 7. d. 8. c. 9. c.
4. Fite–Faraco stain D. Amyloid
TEN into TEN 395
338. An adult male patient presented with shortness of breath, 342. A middle aged immunocompromised man came with fever
hemoptysis and weight loss. On examination, hilar mass and breathlessness. HRCT showed a middle lobe lesion with
was present. Histopathological image is shown as follows. infiltration. Lung biopsy from the lesion is shown as follows.
Immunohistochemistry revealed that the cells were positive for Diagnosis is:
p40. What is the diagnosis? (INI-CET NOV 2022)
345. A middle aged man comes with breathing difficulty. He gives 346. A patient presented with 4-month history of cough with diarrheal
history of working in a factory. Lung fibrosis and pleural thickening episode. Bronchoscopy revealed an intrabronchial polyp. Biopsy
where observed and biopsy was taken. On histopathological from the polyp showed atypical cells with microscopic necrosis
examination, the following picture of lung parenchyma was seen. and 5 mitotic figures per 10 high-power fields shown as follows.
Most likely diagnosis is? Chromogranin staining was positive. What is the diagnosis and
grade of the lesion?
Explanation: Histopathological image shows dumbbell shaped Asbestos Explanation: Typical carcinoids have a mitotic rate of 2 mitoses/2
Bodies/ Ferruginous bodies. These show deposition of iron around the mm2 and no necrosis, while atypical carcinoids have a mitotic rate of
asbestos fibres and stain positive for Perl’s or Prussian blue. 2–10 mitoses/2 mm2 or necrosis.
347. Which type of paraneoplastic syndrome is most commonly associated with small cell lung carcinoma?
a. SIADH b. Gynecomastia
c. Acanthosis nigricans d. Hypocalcemia
[Ref: Robbins and Cotran, 10th ed., p. 1074]
Explanation: SIADH is most commonly associated with small cell lung carcinoma/ oat cell cancer.
Paraneoplastic syndromes associated with lung carcinoma
Features Squamous cell carcinoma Adenocarcinoma Small cell carcinoma Large cell cancer
Paraneoplastic Hypercalcemia Migratory thrombophlebitis SIADH, Lambert-Eaton syn- Gynecomastia
syndrome drome, Cushing’s disease
a. Increased in chronic bronchitis 350. Most common cause of atypical pneumonia is: New Qs
Explanation:
ANSWER KEY Most common cause of atypical pneumonia or walking pneumonia is My-
coplasma pneumoniae.
345. c. 346. b. 347. a. 348. b. 349. a. 350. a.
Mycoplasma is the smallest bacterium and does not have a cell wall.
It shows fried egg colonies on PPLO agar which are visualized by
staining with Diene’s stain.
P
PSM
reventive and Social Medicine (PSM)
— Dr Mukhmohit Singh
SYNOPSIS
PRINCIPLES OF EPIDEMIOLOGY
y JE vaccine—till 15 years Heat sensitive vaccine: OPV > Measles or MR > BCG
y Hep B (birth dose)—till 24 hours of birth Freeze sensitive vaccine: Hep B > Pentavalent > DPT
y OPV (zero dose)—till 15 days of life
Cold chain temperature— +2° to +8°C Cold Chain Equipment
y Vaccine carrier: 16–20 vials, 4 ice packs
Vaccine Vial Monitor
y Cold boxes: 75–300 vials (depending on size—5 liters or 20 liters)
y Qualitative check for effectivity of heat sensitive vaccines with ice packs.
y Discard point—square becomes same color (or darker) than the
outer circle Ice Lined Refrigerator
y Vaccine vials which have VVM on body follow open vial policy. y Needs at least 8-hour electricity in 24 hours to maintain temperature
y Storage:
Diluents always kept in top shelf of ILR
In upper shelves of ILR—Freeze sensitive vaccines
In bottom shelves of ILR—heat sensitive vaccines
y Use dial thermometer for temperature recording (usually done twice
daily).
Discard point is – Image D
MEDICAL RESEARCH
[Total Questions 222]
PRINCIPLES OF EPIDEMIOLOGY 4. A study was conducted to find the association of aniline dye and
bladder cancer. Study was done by comparing two groups of people
1. What kind of study is longitudinal and analytical? working in aniline dye factory and those who are office workers
a. Ecological study [INI-CET NOV 2023] of same factory using records of employment for past 20 years to
b. Cross-sectional study assess the risk. What is the type of study? (NEET PG 2023)
c. Case control study a. Retrospective cohort b. Prospective cohort
d. Randomized clinical trials c. Case control d. Intervention and response
[Ref: Park’s Textbook of Preventive and Social Medicine,
[Ref: Park’s Textbook of Preventive and Social Medicine,
27th ed., p. 84]
27th ed., p. 78]
Explanation: In retrospective Cohort (or historical cohort) study,
Explanation: Case control and Cohort studies are longitudinal studies.
the researcher goes back in time to select people with risk factor using
y Case control is retrospective and Cohort study is prospective study previous employment or medical records.
design.
y Cross-sectional is transverse study. 5. A 10-year-old child in a school should be given which of the
y Ecological is correlational study. following vaccines? (NEET PG 2023)
a. Td vaccine b. Rota virus vaccine
2. About 30,000 women were followed-up for 10 years for c. Measles vaccine d. Hepatitis B vaccine
development of breast cancer. 1200 women developed cancer [Ref: Park’s Textbook of Preventive and Social Medicine,
and were given questionnaire for assessing possible risk factors. 27th ed., p. 136]
Additionally, 2000 women from the same study were used as
control and they were also given questionnaire. What is this type Explanation: National immunization schedule for infants and children
of study called? (INI-CET MAY 2023) 2020 states TT/Td for 10 years and 16 years, dose of 0.5 mL intramuscular
a. Nested case control b. Case Cohort study in upper arm.
c. Retrospective cohort d. Cross control cohort 6. Which of the following options are correct? (INI-CET NOV 2022)
[Ref: Conceptual Review of PSM, CBS Publishers, 1. VVM has a chemical indicator in the circle, which changes color
3rd ed., p. 4] 2. VVM gives an idea for number of days for expiry of vaccine
3. It is the only tool among all time temperature Indicators that is
Explanation: In this MCQ, there is a follow-up for 30,000 females for a available at any time in the process of distribution and at the time
period of 10 years and which makes this as a Cohort study, but also it is a vaccine is administered at health center
mentioned that 2000 females from the same study Cohort were used as 4. It indicates whether the vaccine has been exposed to a
controls to do the study and therefore, this study is a nesting of the case combination of excessive heat over time and whether it is likely
control study within the same Cohort which is technically called a nested to have been damaged
case control study. 5. VVM tells about the efficacy of the vaccine
6. The expiry date of the vaccine can be relaxed if the VVM is intact
3. Which of the following is not correctly matched? a. 1, 2, 4 correct b. 1, 3, 5 are correct
a. Systematic review—PRISMA (INI-CET MAY 2023) c. 3 and 4 are correct d. All are correct
b. Diagnostic studies—CONSORT [Ref: Park’s Textbook of Preventive and Social Medicine,
c. Observational studies—MOOSE 27th ed., p. 122]
d. Case report—CARE
[Ref: Conceptual review of PSM, CBS Publishers, ANSWER KEY
3rd ed., p. 187]
1. c 2. a 3. b 4. a 5. a 6. c
Explanation: CONSORT is done for Randomized control trials and not
for diagnostic studies.
TEN into TEN 505
32. When we are investigating the relationship between steroid 36. What is not true about cross-sectional study?
contraceptive and breast cancer, if the women taking these a. Estimate for prevalence of disease
contraceptives are younger than those in the comparison group, they b. Confirms the etiology of disease
would be at a lower risk of breast cancer since this disease becomes c. Evaluate the disease pattern in the community
common with increasing age. The age factor in this case is called: d. Evaluate the association of risk factors
a. Selection bias b. Berksonian bias [Ref: Park’s Textbook of Preventive and Social Medicine,
c. Confounding factor d. Interviewer bias 27th ed., p. 77]
[Ref: Park’s Textbook of Preventive and Social Medicine,
Explanation: The etiology of the disease cannot be estimated by a
27th ed., p. 80]
cross-sectional study.
Explanation: Confounding factor: The causation of disease (or etiology) may be best measured by
y Is present in both the groups to be assessed (but in unequal Cohort (follow-up) studies.
proportions). Cross-sectional study—salient features:
y It is associated with both disease and the risk factor. y Estimate for the prevalence of the disease
y Evaluation of the risk factors for the disease
33. Best way to avoid known confounders is: y Assess the epidemiological determinants as pattern of disease—host
a. Standardization b. Stratification factors, age groups and other related variables may be assessed.
c. Regression d. Matching
37. For calculation of incidence, denominator is taken as:
[Ref: Internet]
a. Mid-year population b. Population at risk
Explanation: Treatment of known confounders c. Total number of cases d. Total number of deaths
� Matching � Randomization [Ref: Park’s Textbook of Preventive and Social Medicine,
Treatment of unknown confounders 27th ed., p. 68]
� Regression � Randomization
Explanation: Incidence is “Number of new cases of a disease or new spells/
� Standardization � Stratification
episodes of sickness occurring in a defined population during a specified
34. Population at risk is used as denominator in calculation of: period of time”.
a. Mortality rate Number of new cases of
b. Incidence specific disease during a given time period
Incidence rate =
c. Prevalence Population at risk during that period
d. Relative risk
38. True regarding prevalence is:
[Ref: Park’s Textbook of Preventive and Social Medicine, a. Cannot be used to determine the health needs of a community
27th ed., p. 68] b. Independent of incidence
c. Independent of duration
Explanation: Incidence is given by the formula:
d. Measures all cases
Number of new cases of [Ref: Park’s Textbook of Preventive and Social Medicine,
specific disease during a given time period 27th ed., p. 69]
Incidence = × 1000
Population at-risk during that period
The point prevalence is given by the formula: Explanation: Prevalence measures all current cases (old and new) in a
SYNOPSIS
OTOLOGY
Auditory Pathway
Parts of inner ear Functions Sensory end organs Mnemonics
Cochlea Hearing Organ of corti y It mainly lies in the brainstem area.
Utricle and saccule Linear balance Macula E—Eighth nerve (spiral ganglion of 8th nerve in modiolus of
Cochlea).
Semicircular canals Angular balance Crista
C—Cochlear nucleus.
O—Olivary complex (superior)—the site of cross over of
UTRICLE AND SACCULE (OTOLITHIC ORGANS) information and sound localization.
L—Lateral lemniscus.
Utricle Horizontal linear balance.
I—Inferior colliculus.
M—Medial geniculate body.
Saccule Vertical linear balance. A—Auditory cortex.
TEN into TEN 649
EAR
[Total Questions 337]
1. A 30-year-old female patient presents in the OPD with hearing loss 3. A patient presents to the OPD with the complaints of episodic
in both ears since last 1 year. Investigations confirm the diagnosis vertigo which is sudden onset, and right sided sensorineural
of otosclerosis with more hearing loss on right side. Patient was hearing loss (SNHL), and Tinnitus which lasts minutes to hours
advised to have Stapedotomy. Which of the following will be the with accompanied nausea, vomiting and vagal symptoms. What
tuning forks findings? (INI-CET NOV 2023) is the diagnosis of the patient in accordance with the given
a. Right Rinne’s positive and Weber lateralized to left ear audiogram? (INI-CET NOV 2023)
b. Right Rinne’s negative and Weber lateralized to right ear
c. Left Rinne’s positive and Weber lateralized to right ear
d. Left Rinne’s negative and Weber lateralized to left ear
[Ref: Diseases of Ear, Nose and Throat and
Neck Surgery by PL Dhingra, 8th ed., p. 25]
11. A patient presents to ENT OPD with the chief complaint of Explanation: This child is suffering from adenoid hypertrophy with glue
hearing loss. The pure tone audiometry has been done and the ear as per the given Type B Tympanogram. The surgical management
image shows the audiogram of patient. What will be the finding of would need adenoidectomy with myringotomy/grommet insertion.
Rinne and Weber test in this patient: (INI-CET NOV 2022)
13. Arrange in sequence the pathway of production of OAE.
(INI-CET NOV 2022)
1. Outer hair cells 2. Basilar membrane
3. Ossicles 4. Oval window
5. Tympanic membrane 6. Perilymph
a. 1, 2, 3, 4, 5, 6 b. 5, 3, 4, 6, 2, 1
c. 5, 3, 4, 2, 6, 1 d. 5, 3, 4, 6, 1, 2
[Ref: Diseases of Ear, Nose and Throat and
Neck Surgery by PL Dhingra, 8th ed., p. 32]
Explanation:
Grade (Tos) Description
Grade 1 Mild retraction of attic, not touching the neck of malleus
Grade 2 Touching the neck of malleus
OTOLARYNGOLOGY
349. A 27-year-old patient presents to ENT OPD with the complaint of 352. A 50-year-old male patient has presented with left sided unilateral
headache and nasal blockage. The nasal endoscopy shows bilateral nasal mass and epistaxis. The radiological picture is given in the
nasal polypi. The chest examination shows bilateral auscultatory image. What is the most probable diagnosis?(INI-CET NOV 2021)
wheezing. Which drug should this patient avoid? (NEET PG 2022)
a. Gentamicin
b. Aspirin
c. Cetirizine
d. All of these
[Ref: Diseases of Ear, Nose and Throat and
Neck Surgery by PL Dhingra, 8th ed., p. 201-204, 203]
a. Onodi cell
b. Haller’s cell
c. Concha bullosa
d. Agger nasi a. Pneumatized superior turbinate
b. Agger nasi
[Ref: Diseases of Ear, Nose and Throat and c. Concha bullosa
Neck Surgery by PL Dhingra, 8th ed., p. 159] d. Onodi cell
OTOLARYNGOLOGY
Explanation: Onodi cell is in close relation to optic nerve. It is visible in [Ref: Diseases of Ear, Nose and Throat and
roof of sphenoid sinus. Neck Surgery by PL Dhingra, 8th ed., p. 157]
SYNOPSIS
ANATOMY OF EYE
EMBRYOLOGY OF EYE
Various structures in the eye are formed from different germ layers as given:
y Development of eye begins at the end of 3rd week of gestation, y Lens is formed by the lens placode and the lens vesicle
around Day 22 y Mesenchyme derived from neural crest differentiates into a
y Retina develops from the optic cup – Outer layer of cup forms the superficial fibrous layer forming sclera and cornea and deep vascular
outermost layer of retina – Pigment epithelium and inner layer of layer forming the Uveal tract
optic cup forms the Neurosensory retina y Tunica vasculosa lentis – gives nourishment to lens during
y Anterior end of the optic cup differentiates into epithelium of iris development.
and ciliary body and the smooth muscles of iris
766 SYNOPSIS
1° actions of superior and inferior muscles more in 2° actions of superior and inferior muscles more in
OPHTHALMOLOGY
ABduction ADduction
Mnemonic:
ABO SIN
AB : ABduction by S : Superior muscles
O : Obliques IN : INtorters
TEN into TEN 767
Extra Mile
1. Which of the following occurs when retina is exposed to light? 4. A junior researcher is studying the visual pathway and the neurons
(INI-CET NOV 2022) involved in it. Which of the following is the third-order neuron in
a. Depolarization, increase in neurotransmitter release the optic pathway? New Qs
Explanation: The uveal tissue, which includes the iris, ciliary body,
and choroid, has its embryonic origin from the neural crest. The neural
crest is a group of cells that arise from the neural tube during embryonic
development and give rise to various structures in the body, including the ANSWER KEY
uveal tissue of the eye. 1. d 2. b 3. d 4. c 5. b
Ectoderm gives rise to conjunctiva, cornea and lens.
Endoderm does not play a role in the development of eye.
TEN into TEN 813
Explanation: The given image is a Sturm’s conoid. Configuration of Explanation: Applanation tonometer is used to measure IOP. It is based
rays refracted through a toric (regularly astigmatic) surface is known as on Imbert-Fick law, which states that the pressure inside an ideal dry, thin
Sturm’s conoid. walled sphere equals the force necessary to flatten its surface divided by
Astigmatism is a refractive error in which the refraction varies in the area of the flattening.
different meridians of eye, due to which light rays fail to converge in a P = F/A
point focus. Tangent screen used at 1 or 2 meters, it should have a uniform illumination
of 7 foot-candles and it should be large enough to allow testing of the full
8. A 70-year-old patient presents with distant visual acuity of 6/18 30° of central field.
which improved on pin hole testing. He gives history of not
needing glasses for near vision now. On ocular examination 10. A patient has presented for a routine eye evaluation. You have
findings as shown in image were seen. Patient has which of the checked visual acuity on Snellen chart and found it to be 6/6. What
following refractory error. (NEET PG 2023) is the minimum angle of resolution? (INI-CET NOV 2022)
a. 15 minutes of arc b. 5 minutes of arc
c. 10 minutes of arc d. 20 minutes of arc
[Ref: Parsons’ Diseases of Eye, 23rd ed., p. 84-89]
142. A 57-year-old man is brought to the emergency department following a generalized tonic-clonic seizure.
His wife reports that he has no history of seizures. However, she says that he has been complaining of
intermittent headaches, memory loss, and problems with his vision for the past 2 weeks. Brain imaging
shows a solitary mass within the right temporal lobe. Which of the following visual field defects given in
the image is most likely present in this patient? New Qs
a. C b. B
c. A d. D
[Ref: Kanski, 9th ed., p. 786]
Explanation:
Damage to the visual pathway produces distinct types of visual field defects depending on the location of the lesion. Visual perception begins with
light from the nasal visual fields striking the temporal side of each retina and light from the temporal visual fields striking the nasal side of each retina.
Information from the retina is then transmitted by the optic nerves to the optic chiasm. At the optic chiasm, optic nerve fibers from the nasal half of each
retina cross and project into the contralateral optic tract.
In contrast, nerve fibers from the temporal parts pass into the ipsilateral optic tract. The optic tract thus contains nerve fibers from the temporal part
of the ipsilateral retina and the nasal part of the contralateral retina. Optic tract fibers project mainly to the lateral geniculate nucleus (LGN), but also
project to superior colliculus (reflex gaze), pretectal area (light reflex), and the suprachiasmatic nucleus (circadian rhythms).
Axons from the LGN that project to the striate (primary visual) cortex are known as the optic radiation (or geniculocalcarine tract). The lower fibers of
the optic radiation carry information from the lower retina (upper contralateral visual field) and take a circuitous route anteriorly into the temporal lobe
(Meyer’s loop) before reaching the lingual gyrus of the striate cortex. The upper fibers of the optic radiation carry information from the upper retina (lower
contralateral visual field) and pass more directly from the LGN Reverse Color through the parietal lobe to reach the cuneus gyrus of the striate cortex.
OPHTHALMOLOGY
Lesions in the temporal lobe can disrupt Meyer’s loop and produce a contralateral superior quadrantanopia. Temporal lobe lesions can also produce
other neurologic manifestations, including aphasia (dominant hemisphere lesions), memory deficits, seizures (complex partial and tonic-clonic), and
hallucinations (auditory, olfactory, and visual).
ANSWER KEY
142. a
Creating your own mnemonics for eye muscle functions and nerve
innervations can help you re-member tricky anatomy details more easily.
846 MCQs
Explanation: The given clinical scenario and the given image are 146. Which of the following is not a feature of complicated cataract?
suggestive of an immature senile cataract and the management of this (INI-CET NOV 2022)
condition is phacoemulsification + posterior IOL implantation. a. Polychromatic luster b. Occurs after uveitis
Types of Cataract c. Krukenberg spindle d. Breadcrumb app
[Ref: Kanski’s Clinical Ophthalmology, 9th ed., p. 381]
Explanation:
Capsulorhexis is the step shown in the given image.
Capsulorhexis is a method of anterior capsulotomy, where an opening
is made in the anterior capsule of the lens. It is one of the steps involved
in conventional extracapsular cataract extraction (ECCE).
Anterior capsulotomy can be done by one of three methods—
can-opener technique, linear capsulotomy or envelope technique, or
Glassblowers cataract: Infrared Congenital lamellar (zonular)
continuous curvilinear capsulorhexis.
radiation cataract: Hypoparathyroidism
Continuous curvilinear capsulorhexis (CCC), is considered to be
(Hypocalcemia) and
superior to all the preexisting methods because when done correctly, it
Hypovitaminosis D
does not leave any edges or tears. Trypan blue dye can be used to stain the
lens capsule for better visibility.
Hydrodissection is performed to separate the nucleus and cortex
from the capsule so that the nucleus can be manipulated. A blunt cannula
is inserted just beneath the edge of the capsulorhexis and fluid injected
OPHTHALMOLOGY
ANSWER KEY
146. c 147. a
2 VOLUME SET
PART – B
SUBJECTS COVERED
PEDIATRICS SURGERY
07 Dr Anand Bhatia
09 Dr Rohan Khandelwal
EDITED BY
PEDIATRICS 933–1172
Dr Anand Bhatia
Synopsis �������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 933–954
Multiple Choice Questions ����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 955–1172
MEDICINE 1173–1364
Dr Mohammed Shakeel Sillat
Synopsis ���������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 1173–1207
Multiple Choice Questions ��������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 1209–1364
SURGERY 1365–1576
Dr Rohan Khandelwal
Synopsis ���������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 1365–1433
Multiple Choice Questions ��������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 1435–1576
Sl. no. Subjects Covered 5 Years Recall Qs Frequently asked Qs New Qs Total Qs
PEDIATRICS
1. Growth and Development 6 47 104 157
3. Genetic Disorder 12 8 27 47
4. Neonatology 27 51 96 174
8. Hematology 9 1 10 20
9. Tumors/Oncology 0 0 10 10
10. Cardiology 15 3 53 71
11. Pulmonology 13 7 56 76
12. Gastroenterology 4 3 45 52
13. Hepatology 2 0 5 7
16. Endocrinology 3 3 15 21
17. Vaccine 13 13 19 45
MEDICINE
1. General Medicine 61 18 25 104
Acid-Base Disorders 17 10 7 34
Toxicology 9 0 0 9
Nutrition 3 0 0 3
Miscellaneous 3 0 0 3
xii Detailed Table of Contents
Sl. no. Subjects Covered 5 Years Recall Qs Frequently asked Qs New Qs Total Qs
Tuberculosis 4 6 3 13
COVID-19 10 1 0 11
Pulmonary Infections 6 0 1 7
Viral Hepatitis 10 3 9 22
Miscellaneous 8 5 0 13
3. Neurology 69 33 53 155
Neurological Examination 5 3 2 10
Primary Headache 4 2 1 7
Cerebrovascular Diseases 17 8 17 42
Dementia 5 0 2 7
Parkinson’s Disease 2 3 1 6
Movement Disorders 3 0 3 6
Ataxic Disorders 0 2 1 3
Peripheral Neuropathy 0 0 2 2
Miscellaneous 3 0 3 6
Physical Examination 13 0 11 24
Electrocardiography 7 9 16 32
Bradyarrhythmias 1 0 1 2
Tachyarrhythmias 11 2 7 20
TEN into TEN xiii
Sl. no. Subjects Covered 5 Years Recall Qs Frequently asked Qs New Qs Total Qs
Heart Failure 7 1 0 8
Pericardial Diseases 0 3 1 4
Miscellaneous 1 2 1 4
5. Respiratory System 23 29 43 95
Cystic Fibrosis 2 0 3 5
Pulmonary Hypertension 1 3 0 4
Miscellaneous 0 0 4 4
6. Gastrointestinal System 6 28 38 72
7. Hepatobiliary System 9 22 35 66
Sl. no. Subjects Covered 5 Years Recall Qs Frequently asked Qs New Qs Total Qs
Liver Transplantation 1 0 1 2
Miscellaneous 3 3 6
8. Nephrology 15 30 51 96
Urinary Abnormalities 1 2 2 5
Glomerular Syndromes 7 14 27 48
Tubulointerstitial Diseases 0 2 3 5
Nephrolithiasis 1 3 0 4
Hereditary Nephropathies 2 5 4 11
Miscellaneous 1 0 0 1
Thyroid Gland 6 2 13 21
Parathyroid Gland 1 2 2 5
Adrenal Cortex 3 6 5 14
Diabetes Mellitus 12 4 6 22
Metabolic Disorders 3 6 7 16
Detailed Table of Contents
Miscellaneous 0 0 4 4
Hypoproliferative Anemia 11 0 2 13
Hemoglobinopathies 5 2 5 12
Macrocytic Anemia 3 0 3 6
Hemolytic Anemia 5 3 8 16
Myeloproliferative Neoplasms 0 3 7 10
Sl. no. Subjects Covered 5 Years Recall Qs Frequently asked Qs New Qs Total Qs
Transfusion Medicine 2 0 6 8
Disorders of Hemostasis 6 0 10 16
Miscellaneous 2 0 2 4
11. Rheumatology 31 21 34 86
Inflammatory Myopathies 1 3 0 4
Vasculitis Syndromes 6 1 6 13
Sarcoidosis 3 4 2 9
Miscellaneous 4 1 2 7
SURGERY
1. General Surgery 28 21 87 136
2. Trauma 32 25 58 115
4. Thyroid 18 19 18 55
5. Breast 23 20 43 86
6. Hernia 10 15 21 46
8. Hepatology 43 15 24 82
14. Neurosurgery 7 10 21 38
15. Oncosurgery 6 10 22 38
17. Miscellaneous 0 15 6 21
Sl. no. Subjects Covered 5 Years Recall Qs Frequently asked Qs New Qs Total Qs
Diagnosis of Pregnancy 10 17 8 35
Infection in Pregnancy 8 4 11 23
Miscellaneous Topics 3 4 11 18
Disorders of Menstruation 25 20 44 89
Infections in Gynecology 12 15 33 60
7. PEDIATRICS 40
8. MEDICINE 92
9. SURGERY 60
PEDIATRICS
Explanation:
NEET PG 2024
a. Toxoplasmosis b. CMV
c. Zika virus d. Rubella
[Ref: Nelson, 21st ed., Chapter 316]
2. At what pressure, pop valve is released in bag and mask ventilation?
a. 30-40 cm of H2O b. 40-50 cm of H2O
c. 50-60 cm of H2O d. 60-70 cm of H2O
[Ref: Nelson, 21st ed., Chapter 121]
3. Maximum lymphoid growth is seen at what age?
a. CHPS
b. Intussusception
c. Meckels diverticulum
d. None of the above
[Ref: Nelson, 21st ed., Chapter 355]
ANSWER KEY
PEDIATRICS
a. 2 years b. 6 years
1. a 2. a 3. b 4. a
c. 10 years d. 14 years
[Ref: Nelson, 21st ed., Chapter 20]
P ediatrics
Pediatrics
— Dr Anand Bhatia
SYNOPSIS
SEXUAL MATURITY RATING (1–5) IN GIRLS SEXUAL MATURITY RATING (1–5) IN BOYS
1. HEADSS is used for: (INI-CET NOV 2023) 8. A child came to the emergency with a history of ingestion of button
a. Infants b. 0–5 years battery, on X-ray it was found in the stomach. What is the next step?
c. 5–10 years d. Adolescents a. Endoscopic removal of battery
[Ref: Nelson, 21st ed., p. 820] b. Wait and watch
c. Repeat X-ray after 5 days
2. Handedness is usually determined by the age of: d. Immediate laparotomy
(INI-CET NOV 2022) [Ref: Nelson, 21st ed., p. 2545]
a. 1 year b. 2 years
c. 3 years d. 4 years 9. Which of the following fontanel is the last to close?
[Ref: Nelson, 21st ed., p. 1157] a. Posterior fontanel normally
b. Anterior fontanel
3. Alternate way to measure height in a 4-year-old child is: c. Mastoid fontanel
(INI-CET NOV 2022) d. Sphenoidal fontanel
a. Head circumference b. Knee height [Ref: Nelson, 21st ed., p. 3766]
c. Crown-rump length d. Arm span
[Ref: Nelson, 21st ed., p. 1183] 10. The milestones of a 3-year-old child are considered delayed if he
is unable to:
4. Method of measurement of height in 4 years: (INI-CET NOV 2022) a. Hop on one foot b. Use spoon effectively
a. Infantometer b. Stadiometer c. Copy a square d. Reliably catch a ball
c. Harpenden caliper d. None of these [Ref: Nelson, 21st ed., p. 1124]
[Ref: Nelson, 21st ed., p. 1182]
11. What is the drug of choice for precocious puberty in girls?
5. Match the following according to the developmental milestones of a. GnRH analogs
different age group of infants:(INI-CET NOV 2021) b. Cyproterone acetate
1. Social smile A. 1–2 months c. Danazol
d. Medroxyprogesterone acetate
2. Pincer grasp B. 5–6 months
[Ref: Nelson, 21st ed., p. 11359]
3. Walks 1–2 steps C. 9–1 months
12. A 6-year-old male child comes with complaints of bedwetting.
4. Transfer objects D. 12–13 months
The child is continent during the day and the problem is only at
a. 1A 2C 3D 4B b. 1C 2A 3D 4B night. Growth and development of the child were normal. Urine
c. 1A 2C 3B 4D d. 1B 2A 3C 4D microscopy is normal and urine specific gravity is 1.020. How will
[Ref: Nelson, 21st ed., p. 22] you manage?
a. Reassure the parents and follow-up after 6 months
6. Bidextrous grip is seen at what age? (NEET PG 2019) b. Refer to psychiatrist
a. 4 months b. 5 months c. Complete blood counts
c. 6 months d. 7 months d. Ultrasound–KUB
[Ref: Nelson, 21st ed., p. 1105] [Ref: Nelson, 21st ed., p. 11044]
7. Which of the following is considered developmental delay in a
3-year-old child?
a. Unable to copy square
b. Unable to use spoon ANSWER KEY
c. Unable to hop on one foot 1. d 2. c 3. d 4. b 5. a 6. a
d. Unable to catch ball properly 7. b 8. a 9. b 10. b 11. a 12. a
[Ref: Nelson, 21st ed., p. 1150]
958 MCQs
54. A 6-month-old infant is brought to the clinic for a routine 59. During a routine developmental assessment, a 3-year-old child’s
check-up. On examination, the head circumference is found to Gesell Developmental Schedule yields a developmental quotient
be significantly smaller than the 3rd percentile, while the height (DQ) of 100. What is the most appropriate interpretation of this
and weight are at the 50th percentile. The infant demonstrates finding? New Qs
irritability and increased muscle tone. Which of the following a. Normal development b. Mild developmental delay
conditions is most likely associated with these clinical findings? c. Borderline development d. Advanced development
a. Microcephaly b. Hydrocephalus New Qs
[Ref: Nelson, 21st ed., p. 1869]
c. Down syndrome d. Prader-Willi syndrome
[Ref: Nelson, 21st ed., p. 1695] 60. A 4-year-old boy is brought to the pediatrician for a routine check-up.
On examination, his height is noted to have doubled since birth.
Explanation: Option a: The combination of a significantly small head What is the most likely interpretation of this finding? New Qs
circumference, normal height and weight, along with irritability and a. Accelerated growth requiring further investigation
increased muscle tone, is indicative of microcephaly b. Normal growth trajectory for a 4-year-old
c. Constitutional growth delay
55. A 2-month-old infant is brought to the pediatrician for a routine
d. Early onset of puberty
examination. On palpation, the physician identifies a soft spot
on the infant’s skull located at the intersection of the frontal and [Ref: Nelson, 21st ed., p. 1870]
parietal bones. Which of the following terms best describes the 61. A 2-week-old newborn is brought for a well-baby check-up. On
precise location of this soft spot in the infant’s skull? New Qs
examination, the pediatrician notes a small, diamond-shaped
a. Bregma b. Lambda anterior fontanel. What is the most likely cause of the fontanel’s
c. Asterion d. Pterion appearance in this healthy newborn? New Qs
[Ref: Nelson, 21st ed., p. 2551] a. Craniosynostosis b. Normal variation
c. Hydrocephalus d. Vitamin D deficiency
56. A 3-year-old boy is brought to the clinic due to concerns about
his growth and development. Physical examination reveals [Ref: Nelson, 21st ed., p. 3766]
macrocephaly, a prominent jaw, and a pointed chin. His height
62. A 2-month-old infant is brought to the pediatrician, and the
and weight are both above the 97th percentile for his age, and he
parents express concern about the soft spot on the baby’s head. In
has advanced bone age. The child’s developmental milestones are
a newborn, how many fontanels are typically present? New Qs
appropriate for his age. Which of the following is the most likely
a. One b. Two
diagnosis? New Qs
c. Three d. Six
a. Sotos syndrome
b. Marfan syndrome [Ref: Nelson, 21st ed., p. 3767]
c. Beckwith-Wiedemann syndrome 63. A 7-month-old infant is brought to the pediatrician, and the
d. Fragile X syndrome parents inquire about the appearance of the baby’s first teeth.
[Ref: Nelson, 21st ed., p. 11319] Which of the following sets of temporary teeth is most likely to
have erupted or be in the process of erupting in this infant?
57. A 1-month-old infant is brought to the clinic with downward
a. Lower central incisors New Qs
slanting eyes, absence of lower eyelashes, and bilateral external
b. Upper lateral incisors
ear anomalies characterized by hypoplastic, malformed, or absent
c. Upper central incisors
pinnae. The child also has a small mandible and cleft palate.
d. Canines
Which of the following conditions is the most likely diagnosis in
this case? New Qs [Ref: Nelson, 21st ed., p. 7593]
a. Treacher Collins syndrome 64. A 15-month-old toddler is brought to the pediatrician for a
b. Down syndrome developmental check-up. The parents express concerns about
c. Pierre Robin sequence the child’s brain development. The pediatrician explains that by
d. Turner syndrome the age of 2, approximately what percentage of the child’s brain
[Ref: Nelson, 21st ed., p. 4222] growth is expected to be completed? New Qs
58. A pregnant woman in her first trimester with a history of neural a. 50% b. 70%
tube defects (NTDs) in a previous pregnancy is seeking guidance c. 85–90% d. 100%
on folic acid supplementation. What is the recommended daily [Ref: Nelson, 21st ed., p. 1742]
dose of folic acid supplementation for this high-risk population?
Explanation: The correct answer is (c) 85%–90%. By the age of 2 years
a. 400 mg
b. 600 mg New Qs 65. A 9-year-old girl is referred for evaluation of short stature. Physical
c. 800 mg examination reveals normal growth parameters, and bone age
d. 4000 mg assessment indicates delayed skeletal maturation. Laboratory
[Ref: Nelson, 21st ed., p. 1926] tests rule out endocrine abnormalities. What is the most likely
PEDIATRICS
426. You are evaluating a term newborn for respiratory distress, and you want to calculate the Silverman-Anderson score. Upon examination, the
baby exhibits the following clinical signs: just visible lower chest retractions, minimal nasal flaring, grunting with naked ear, and see saw
respiration with no xiphoid retractions. What would be the calculated Silverman-Anderson score for this newborn? New Qs
a. 0 b. 3
c. 6 d. 9
[Ref: Nelson, 21st ed., p. 3997]
Explanation: The Silverman-Anderson score is a clinical assessment tool used to evaluate the severity of respiratory distress in newborns. It assesses
five criteria, each scored from 0 to 2: chest retractions, nasal flaring, expiratory grunting, audible wheezing, and oxygen requirement.
In this case, the baby exhibits the following clinical signs:
y Lower chest retractions: just visible (score 1)
y Minimal nasal flaring: Present (score 1)
y Grunting with naked ear: Present (score 2)
y See saw respiration: Present (score 2)
y No Xiphoid retractions: (score 0)
To calculate the Silverman-Anderson score, sum the scores for each criterion: 1 + 1 + 2 + 2 + 0 = 6.
So, the calculated Silverman-Anderson score for this newborn is: c) 6
A higher score indicates a greater severity of respiratory distress. In this case, the baby’s score of 6 suggests moderate respiratory distress.
427. In a neonatal intensive care unit, a nurse observes a newborn as 429. A term newborn is being assessed for gestational age using the
part of routine assessments and notices certain characteristics Ballard score. On examination, the baby has abundant lanugo,
related to the eyes. To better understand the normal features of smooth pink visible veins, and breast tissue barely perceptible. The
a newborn’s pupils and their implications, the nurse initiates a plantar creases are present at the entire sole, eyelids fused tightly,
discussion with colleagues. What are the distinctive characteristics testes in upper canal, rare rugae. What would be the calculated
of a newborn’s pupils? New Qs Ballard score in the physical maturity for this newborn? New Qs
a. Dilated b. Constricted a. 5 b. 7
c. Mid dilated d. Mid constricted c. 9 d. 11
[Ref: Nelson, 21st ed., p. 10,153] [Ref: Nelson, 21st ed., p. 3883]
Explanation: The Ballard score is a clinical assessment tool used to estimate the gestational age of a newborn based on physical and neuromuscular
criteria. It includes two main categories: physical and neuromuscular signs.
In this case, the baby exhibits the following physical signs:
� Abundant lanugo: 1 score � Smooth pink visible veins : 1 score
� Breast tissue barely perceptible: 0 score
The neuromuscular signs are described as:
� Plantar creases at the entire sole: 4 score � Eyelids fused tightly: –2 score
� Testes in upper canal, rare rugae: 1 score
So, the calculated Ballard score for this newborn is: a 5
The Ballard score ranges from –10 to +50, with lower scores indicating a more premature infant and higher scores indicating a more mature infant.
PEDIATRICS
ANSWER KEY
Other benign, transient neonatal changes seen are: Etiology: Pathologically, any factors which interfere with the circulation
y Transient neonatal pustular melanosis between maternal and fetal blood exchange.
y Erythema toxicum Pathophysiology of Asphyxia
y Breast enlargement Redistribution of blood flow to vital organs (brain, heart and adrenal) to
y Vaginal discharge prevent from hypoxic damage. ‘Diving Reflex’
y Vernix caseosa
y Caput succedaneum Features Stage I Stage II Stage III
y Epstein pearls Severity Mild degree Moderate Severe degree
y Subconjunctival hemorrhages degree
Options a, b and c are true statements regarding the Mongolian spots.
Consciousness Hyper alert and Lethargic and Comatosed
440. A mother brings her 5-day-old neonate with the appearance of irritable obtunded
the following rash on day 3 of life. On examination the child was
alert and active. There were no other significant clinical sign or Pupils Dilated Constricted Dilated
symptom noted in the child. Based on the clinical history and
Tone Normal tone Marked Flaccidity
findings given, identify the condition diagnosis? New Qs
hypotonia
SYNOPSIS
GENERAL MEDICINE
APPROACH TO HYPONATREMIA
1174 SYNOPSIS
* Syndrome of Inappropriate ADH Release | ** Cerebral Salt Wasting Syndrome | *** Diabetes insipidus
• Due to group A β hemolytic entrapped in mesangium of lungs and glomerulus d/t mutation of the α5 chain of syndrome
streptococci (M type). • Seen in < 1 week of URTI (GBM) Type IV collagen • MC cause of chronic renal
• Usually affects children • MC cause of GN worldwide • Antibody formed is • α5-chain gene is located on ‘X’ failure
Facts
against noncollagenous chromosome
domain of α3 chain of • MC pattern of inheritance
Type IV collagen → X linked (classical Alport
syndrome)
• Can be inherited as X-linked, AR
or AD
• Development of hematuria • Synpharyngitic hematuria – • Pulmonary manifestations • Presents with a triad of → • Similar to nephrotic syndrome
1–4 weeks after an episode of Development of hematuria within are hemoptysis 1. Hereditary Nephritis: • Passage of foamy urine
URTI or skin infection (delayed 2–4 days of pharyngitis/URTI • Pulmonary hemorrhage Recurrent gross hematuria • May present with
hematuria). • Recurrent Gross Hematuria → MC (diffuse alveolar Proteinuria complications like diabetic
• Oliguria, edema, HTN clinical feature hemorrhage) Progressive renal failure by retinopathy, CAD, neuropathy,
• Complete recovery in >95% • Persistent asymptomatic microscopic • Renal manifestations 30 years etc.
patients hematuria may be present are features of RPGN like 2. Sensorineural hearing loss:
• One attack confers lifelong • Usual age—2nd–3rd decade hematuria, proteinuria, MC extrarenal manifestation
immunity rapidly progressive renal 3. Ocular abnormalities:
Clinical features
failure, etc. Anterior lenticonus is
characteristic
Cataract
Keratoconus
• Transient • Normal C3 level • Normal complement level. • Kidney or skin biopsy • Microalbuminuria → 1st
hypocomplementemia • ASO titer → Normal • Circulating IgG anti, GBM • High frequency audiometry for clinically detectable sign/
• C3 levels ↓ and then return to Antibody SNHL Earliest clinical feature
normal • Dysmorphic RBC and RBC • Genetic analysis • Spot urine sample is preferred
• ASO titer↑↑ cast and is best
• Subnephrotic proteinuria • CXR → Diffuse B/L • Macroalbuminuria→ Indicates
(1–2 g/d) pulmonary infiltrates established disease
Investigations
• RBC and WBC casts in urine • ANCA may be +ve in upto
30% patient
• Crescents • Mesangioproliferative GN • Diffuse crescenteric GN • EM → Irregular thinning and • Diffuse glomerulosclerosis:
• Hypercellularity of mesangial • IF → Mesangial deposits of IgA • IF → Diffuse linear IgG splitting of GBM giving a basket • MC pattern
and endothelial cells (subclass IgA1) often with C3 and staining along BM weave appearance or split • Thickening of GBM
• Subendothelial deposits and Properidin basement membrane • Capsular hyaline drops or fibrin
subepithelial humps • IgG deposits may also be seen caps may be present
• EM → Electron dense deposits in • Nodular glomerulosclerosis
Microscopy
mesangium • Also known as Kimmelstiel
Wilson lesion
• Pathognomonic of DM.
• Early systemic antibiotic • Rx: ACEI for proteinuria • T/T → Plasmapheresis • Lenticonus + Hematuria is • Armani - Ebstein cells →
therapy for throat or skin considered pathognomonic for Tubular cells with glycogen
infection will not eliminate the classical Alport. deposit
risk of GN • Kidney size may increase in
Extra edge
• Recurrence → Rare • Recurrence → Common • Recurrence of disorder in renal initial stage of disease
• Prognosis – excellent transplant → rare
TEN into TEN 1205
RHEUMATOLOGY
MEDICINE
Medicine
Dr Mohammed Shakeel Sillat
GENERAL MEDICINE
[Total Questions 104]
2. What is the diagnosis in a sick COPD patient with pH = 7.3, 3. Calculate the anion gap from the following values: Na+145 mEq/L,
pCO2 = 80 mm Hg, and HCO3 = 28 mEq/L? (INI-CET NOV 2023)
K+ 4 mEq/L, CI– 90 mEq/L, HCO3– 20 mEq/L. (INI-CET MAY 2023)
a. Respiratory acidosis due to hyperventilation and adequate
a. 35 b. 68
compensation
c. 25 d. 43
b. Respiratory acidosis due to hyperventilation and partial
compensation [Ref: Harrison’s Principles of Internal Medicine, 21st ed.,
c. Respiratory alkalosis due to hyperventilation and adequate p. 360]
compensation
Explanation: Anion gap = [Na+]–([Cl–] + [HCO3–])
d. Respiratory alkalosis due to hyperventilation and partial
compensation 4. A patient presents with severe vomiting and diarrhea and has
[Harrison’s Principles of Internal Medicine, 21st ed., orthostatic hypotension. What metabolic abnormalities would
p. 361] you expect in this patient? (INI-CET MAY 2023)
Explanation: In acute respiratory acidosis, there is 1 mEq/L increase in a. Hypokalemia b. Hypochloremia
c. Metabolic alkalosis d. Respiratory alkalosis
HCO3 per 10 mm Hg rise in PaCO2. In chronic respiratory acidosis (after
24 h), there is 4 mEq/L increase in HCO3 for every 10 mm Hg increase [Harrison’s Principles of Internal Medicine, 21st ed.,
in PaCO2. In this COPD patient with chronic respiratory acidosis, PaCO2 p. 366]
increased by 40 mm Hg, hence, expected HCO3 would be approx 40
5. Which of the following can be used to determine the acid-base
mEq/L.
imbalance? (INI-CET MAY 2023)
Prediction of compensatory responses to simple acid-base 1. Arterial pH 2. Venous pH
disturbance and pattern of changes 3. Venous pO2 4. Venous pCO2
Disorder Prediction of Range of value Select the correct answer from the given code.
compensation pH HCO–3 PaCO2 a. 1 b. 1, 4
Metabolic PaCO2 = (1.5 × HCO ) + 8 + 2
– Low Low Low c. 1, 3, 4 d. 1, 2, 3, 4
3
acidosis [Ref: Harrison’s Principles of Internal Medicine, 21st ed.,
Metabolic PaCO2 will ↑ 6 mm Hg per High High High p. 359]
alkalosis 10 mmol/L ↑ in [HCO–3]
ANSWER KEY
Respiratory High Low Low
1. b 2. b 3. a 4. d 5. a
alkalosis
Acute [HCO–3] will ↓ 0.2 mmol/L
per mm Hg ↓ in PaCO2
TEN into TEN 1211
17. Identify the regions marked A and B in the following image: 18. Metabolic acidosis with a normal anion gap is seen in a patient with:
(INI-CET NOV 2020) a. Alcohol intoxication b. Small bowel fistula
c. Shock d. Aspirin ingestion
[Ref: Harrison’s Principles of Internal Medicine, 21st ed.,
p. 364]
19. Urinary anion gap is increased in:
a. Diarrhea b. Water intoxication
c. Ureterosigmoidostomy d. Renal tubular acidosis
[Ref: Harrison’s Principles of Internal Medicine, 21st ed.,
p. 364]
20. All of the following are causes of metabolic acidosis with normal
anion gap; except:
a. Proximal renal tubular acidosis
b. Salicylate poisoning
c. Diarrhea
d. Pancreatitis
[Ref: Harrison’s Principles of Internal Medicine, 21st ed.,
p. 361]
21. A 60-year-old man, case of COPD is admitted with labored
breathing at rest and marked use of accessory muscles. Arterial
blood gas analysis reveals the following values:
pH 7.33, PaCO2 64 mm Hg, PaO2 50 mm Hg, HCO3 34 mEq/L
What is the possible diagnosis?
a. Metabolic acidosis with respiratory alkalosis
b. Chronic respiratory acidosis with compensated metabolic alkalosis
a. Chronic respiratory acidosis and metabolic acidosis c. Acute respiratory acidosis with compensated metabolic alkalosis
b. Metabolic alkalosis and metabolic acidosis d. Respiratory and metabolic acidosis
c. Acute respiratory acidosis and chronic respiratory alkalosis
[Ref: Harrison’s Principles of Internal Medicine, 21st ed.,
d. Acute respiratory acidosis and metabolic acidosis
p. 359]
[Ref: Harrison’s Principles of Internal Medicine, 21st ed.,
p. 359] 22. Best management option for respiratory alkalosis is:
a. Acetazolamide b. IPPV
Explanation: c. Normal saline d. Rebreathing from a paper bag
[Ref: Harrison’s Principles of Internal Medicine, 21st ed.,
p. 368]
23. A 70-year-old man with history of CHF presents with shortness of
breath and leg swelling. ABG shows pH 7.24, PCO2 60 mm Hg, PO2
52 mm Hg, HCO3 27 mEq/L. What is the primary acid-base disorder?
a. Respiratory alkalosis b. Metabolic alkalosis
c. Metabolic acidosis d. Respiratory acidosis
[Ref: Harrison’s Principles of Internal Medicine, 21st ed.,
p. 359]
24. Type B lactic acidosis occurs due to:
a. Cyanide poisoning b. Diabetes mellitus
c. CHF d. Severe anemia
[Ref: Harrison’s Principles of Internal Medicine, 21st ed.,
p. 361]
ANSWER KEY
17. a 18. b 19. d 20. b 21. b 22. d
23. d 24. b
S
Surgery
urgery
— Dr Rohan Khandelwal
SYNOPSIS
GENERAL SURGERY
Enhanced recovery after surgery (ERAS) protocol: Monopolar cautery Bipolar cautery
Drains
OT POSITIONS
y Corrugated rubber drain: Open
Supine position: drain for abscesses. Rarely used.
y M/c position for abdominal and
breast surgeries.
Prone position:
y Used for spinal surgery and
pilonidal sinus surgery.
TEN into TEN 1419
M/c site: Face (above line joining angle of mouth to ear lobule).
Malignant Melanoma
Risk factors:
y UV radiation
y White population.
y Familial atypical mole melanoma syndrome.
Types:
y Superficial spreading:
M/c type.
Seen in young.
Sun exposed areas.
M/c melanoma in a pre-existing mole.
y Lentigo maligna: Rx:
In situ melanoma. Wide local excision
Elderly patient. If LN not enlarged → SLNB is done.
Best prognosis. Most important prognostic factor: LN status.
y Acral:
Marjolin’s ulcer:
M/c in dark skinned patients.
Long standing burns/venous ulcers → SCC.
Seen in palm, sole.
y Nodular:
Most aggressive.
Worst prognosis.
Rapid vertical phase of growth.
Variant: Amelanotic melanoma.
y For detection of melanoma:
A → Asymmetry
B → Borders which are uneven
C → Change in color
D → Increase in diameter >6 mm
IHC markers:
y S–100.
y HMB 45.
y Melan A.
SURGERY
Surgery
Dr Rohan Khandelwal
GENERAL SURGERY
[Total Questions 136]
1. Open cardiac massage is what kind of wound? 4. Identify the surgical instrument shown in the image.
(INI-CET NOV 2023) (INI-CET MAY 2023)
a. Clean b. Contaminated
c. Dirty d. Clean contaminated
[Ref: Bailey & Love’s Short Practice of Surgery, 28th ed.,
p. 973]
2. Feeding is done through the method shown in image. Which of
the following is not a complication? (INI-CET MAY 2023)
a. Mixter b. Adson’s
c. Kocher’s d. Rampley
[Ref: Bailey & Love’s Short Practice of Surgery, 27th ed.,
ch. 11, p. 123]
782. A patient is undergoing a surgery during which the nurse passes 784. A patient presented with severe pain in his abdomen.
this over to the surgeon. What is this patient most likely being Imaging findings are shown here. What is the most likely
treated for? New Qs diagnosis? New Qs
790. A patient is undergoing a surgery during which this photo is taken. 792. A male patient presented with pain in his penis. Clinical finding is
What is the most likely diagnosis based on this image shown shown here. Which of the following cannot be done in this patient
here? New Qs to manage his condition? New Qs
ANSWER KEY
790. b 791. a 792. a 793. b
Many students remember complex surgical procedures better when they use
mnemonics, which simplify steps into easy-to-remember phrases.
O bstetrics and Gynecology
OBG
— Dr Sakshi Arora Hans
SYNOPSIS
OBSTETRICS
ANEUPLOIDY SCREENING
TEN into TEN 1579
ECTOPIC PREGNANCY
OBSTETRICS AND GYNECOLOGY
Relevant Embryology
1. Major part of female genital tract is derived from Müllerian duct.
2. Müllerian duct: Invagination of coelomic epithelium (at 6 weeks).
3. Each MD gives rise to that side FT, half of uterus, half of cervix
and upper half of vagina.
4. At 10 weeks: Right and left MD approach in midline and fuse
with each to form a septa.
Gynae Complications with Müllerian Malformation 5. Fusion begins in below upward direction.
y Infertility
y Outflow tract obstruction → hematometra 6. At 20 weeks: The septa dissolves (from below upward). A single
y Endometriosis uterine cavity is now formed.
y Dysmenorrhea 7. Last step: Fundus of uterus becomes dome shaped.
Müllerian Malformations
CLASS HSG Image Comment
Class I: Müllerian agenesis – • Both MD Absent
• Ovary presents as it arises from
genital ridge
Unicornuate uterus
Class III: Uterus didelphys • Both MD are present but fail to fuse.
Hence 2 vagina seen
• It is the only condition where
2 vagina are present
• Hence on HSG 2 Leech Wilkinson
Cannula used
Uterus didelphys
Contd…
TEN into TEN 1613
Class IV: Bicornuate Uterus (Grossly: Fundus of • MD Start fusing but fusion is
uterus is divided into incomplete.
2 parts) • There are two uterine horns and
single vagina.
• Cervix could be one or two
1. If there is single cervix: Unicollis
2. If 2 cervix: Bicollis
Arcuate uterus
Class VII: In utero exposure to Diethylstilbestrol • M/C malignancy a/w DES: Clear cell
(DES) cancer of cervix and vagina
• M/C uterine malformation a/w DES:
Hypoplastic uterus
• Most specific uterine malformation
a/w DES: T shaped uterus
• DES exposure does not lead to renal
anomalies in female fetuses.
OBG
Dr Sakshi Arora Hans
OBSTETRICS
[Total Questions 526]
ANATOMY AND PHYSIOLOGY OF Explanation: Pure gonadal dysgenesis results from a point mutation
REPRODUCTIVE ORGANS in SRY/SRY deletion or point mutations in another gene with testis-
determining effects (DAX-1, SF-1, CBX2). This leads to underdeveloped
1. Which of the following vessels will serve as an alternate source dysgenetic gonads that fail to produce androgens or AMH. This is
of blood supply to prevent uterine ischemia, in case the primary characterized by a normal prepubertal female phenotype and a normal
artery is ligated in the event of PPH? (INI-CET NOV 2023) müllerian system due to absent AMH.
a. Ovarian artery b. Uterine artery Amongst the given options, a point mutation in the SRY gene is most
c. Arcuate artery d. Round ligament artery likely to result in complete gonadal dysgenesis but this answer remains
[Ref: DC Dutta’s Textbook of Obstetrics, controversial as some other sources mention SRY deletion is more
10th ed., p. 389–392] commonly associated. The most common cause attributable to about
85% of cases is still idiopathic.
2. SRY region is located in: (INI-CET MAY 2023)
a. Short arm of Y chromosome 4. Which of the following is incorrect regarding innervation of the
b. Short arm of X chromosome uterus? (INI-CET MAY 2022)
c. Long arm of Y chromosome a. Sensory level is from T10 to L1.
d. Long arm of X chromosome b. Uterine contractility is mediated by innervations from level
[Ref: William’s Gynecology, 4th ed.; p. 408] T7-T8.
c. In the 1st stage of labor, pain is due to the fibers at level of
Explanation: Y-chromosome determines testes formation as testis- T10 to L1.
determining factor (TDF) is located on short arm of chromosome Y. TDF d. In early labor, pain is usually because of the uterine contraction.
is controlled by SRY gene (sex-determining region of Y chromosome).
The TDF differentiates Sertoli cells that start producing anti- [Ref: DC Dutta’s Textbook of Obstetrics, 10th ed., p. 6]
Müllerian substance (AMS) or hormone. Anti-Müllerian substance
Explanation: The hormonal mechanisms mainly responsible for uterine
inhibits development of the Müllerian ducts.
Thus, absence of Y-chromosome (SRY gene) or TDF results in the contraction. The hormones which cause contractions are estrogen,
formation of ovary. prostaglandin and oxytocin, while relaxation caused by progesterone.
TDF also helps in differentiation of Leydig cells from mesoderm Uterine sensory supply is by ascending afferent fibers which is pass
of gonadal ridge. Leydig cells start secreting testosterone and through the inferior hypogastric plexus and enters the spinal cord
dihydrotestosterone 8 weeks onward next testosterone stimulates through T10-T12 and L1 roots.
growth of mesonephric duct that forms male genital duct system. Labor pain is due to stimulation of nocicepetors in the genital tract
Dihydrotestosterone helps in formation of penis, penile urethra, prostate caused by ischemia.
and scrotum. y First stage labor: Pain is mediated by T10 to L1 spinal segments. It is
caused by distension of the cervix and low uterine segment along with
3. In a 46XY female, on doing amniocentesis complete gonadal isometric uterine contraction.
dysgenesis was noted. Complete gonadal dysgenesis is caused by y Second stage labor: Pain is carried by T12 to L1 and S2 to S4 spinal
which of the following in the SRY gene? (INI-CET MAY 2023) segments. It is caused by tissue damage in the pelvis and perineum.
a. Point mutation b. Deletion of gene
c. Translation d. Inversion
[Ref: William’s Gynecology, 4th ed., p. 413]
ANSWER KEY
1. a 2. a 3. a 4. b
Chunking information helps in making learning less overwhelming and
improves recall during exams.
TEN into TEN 1697
ANSWER KEY
408. c 409. c 410. a 411. a 412. c 413. b
414. c 415. a
TEN into TEN 1709
b. Recurrent abortion
c. Consumptive coagulopathy
d. Future infertility
e. Ectopic pregnancies
[Ref: Dutta’s Obstetrics, 10th ed., p. 310–312]
a. Jolls retractor
ANSWER KEY
b. Czerny retractor
c. Morris retractor 520. a 521. a 522. c 523. a 524. c
d. Deaver retractor
Ref: Internet