1. Rhomboids major is inserted on ?

a) Medial border of scapula

b) Lateral border of scapula

c) Inferior angle of scapula

d) Intertubercular groove of humerus

Correct Answer - A
Ans. is 'a' i.e., Medial border of scapula
(Ref: Garg 4Uh/e p. 803, 810-812))
Origin:
Spinous processes of T2 to T5 vertebrae
Insertion
Medial border of the scapula, inferior to the insertion of rhomboid
minor muscle.
2. Insertion of levator scapulae is ?
a) Lateral border of scapula

b) Suprolateral part of scapula

c) Superior part of medial scapula border

d) Inferior angle of scapula

Correct Answer - C
Ans. is'c' i.e., Superior part of medial scapula border
[Ref Rockwood, Charles A.; Matsen, (2009). The shoulder, VoI. 1]
Origin:
Posterior tubercles of transverse processes of C 1 - C4 vertebrae.
Insertion:
Superior part of medial border of scapula
3.
Coracohumeral ligament is the degenerated
part of ?
a) Biceps brachii

b) Coracobrochialis

c) Pectoralis minor

d) Latissimus dorsi

Correct Answer - C
Ans. is'c'i.e., Pectoralis minor
lRef: Clinical anatomy p. 101)
Coracohumeral ligament extends from lateral margin of root of
coracoid process to greater tuberosity of humerus.
Morphologically degenerated part of the pectoralis minor.
4. Which muscle steadies the clavicle during
movement of shoulder ?
a) Pectoralis major

b) Latissimus dorsi

c) Subclavius

d) Serratus anterior

Correct Answer - C
Ans. is'c'i.e., Subclavius
(Ref: Clinical anatomy j'd/e p. 1367)
Subclavius steadies the clavicle during movements of shoulder.
5. Lymphatics from the upper limb drain into
which group of axillary nodes?
a) Anterior group

b) Lateral group

c) Central group

d) Posterior group

Correct Answer - B
Ans. is 'b' i.e., Lateral group
[Ref: BDC 4h/e VoI. I p. 57-58]
Lateral group:
Lie along the upper part of the humerus, medial to the axillary vein.
Receive lymph from upper limb.
6. What is attached to the superior nuchal
line?
a) Trapezius

b) Scalenus anticus

c) Coracobrachialis

d) Biceps Brachii

Correct Answer - A
Ans. is'a'i.e., Trapezius
[Ref: Snell's th/e p. 3a2l
Muscles attached to superior nuchal line
Occipitalis muscle,
The splenius capitis muscle
Trapezius muscle,
Sternocleidomastoid muscle
7. Extensor carpi Radialis longus is crossed
by which of the following two muscles ?
a) Abductor Pollicis Longus and Extensor Pollicis brevis

b) Extensor digitorum and extensor indicis

c) Abductor Pollicis Longus and Extensor Indicis

d) Brachioradialis and Extensor digiti minimi

Correct Answer - A
8. Median nerve supplies which branch to the
brachial arter -
a) Sensory branch

b) Sympathetic branch

c) Motor branch

d) None

Correct Answer - B
Ans. is'b'i.e., Sympathetic branch
Ref: Gray's Anatomy 39,/el
'Median nerve supplies vascular branches to the brachial artery in
the arm.
These fibres are sympathetic fibres.
Median nerve has no sensory or cutaneous branch in the arm.
Only branches it gives off in the arm are sympathetic branches to
the brachial artery.
9. Which of the following structure passes
through the triangular interval of the arm?
a) Radial nerve

b) Axillary nerve

c) Median nerve

d) Ulnar Nerve

Correct Answer - A
Ans. is 'a' i.e., Radial nerve
(Ref:' Gray's anatomy for students. Elsevier/Churchill Livingstone p.
650]
Lower triangular space of arm - Contents:
Boundaries:
Superior: Teres major
Medial: Long head of tricep
Lateral: Shaft of humerus
Contents:
Radial nerve
Profunda brachii vessels.
10. Distal muscles of the hand needed for fine
wrok are controlled by -
a) Radial nerve

b) Median nerve

c) Ulnar nerve

d) Axillary nerve

Correct Answer - C
Ans. is'c'i.e., Ulnar nerve
(Ref: Snell's th/e p. 354)
Ulnar nerve is also known as musicians nerve as it is needed to
carry out fine and precision movements of the hand.
11. Nerve supply of latissimus dorsi -
a) Radial nerve

b) Long thoracic nerve

c) Thoracodorsal nerve

d) Axillary nerve

Correct Answer - C
Ans. is'c'i.e., Thoracodorsal nerve
(Ref. Gray's 3*/e p. S46)
Thoracodorasal nerve (C6-8) is a branch of posterior cord of brachial
plexus that supplies the latissimus dorsi muscle.
Also known as the nerve to latissimus dorsi.
12.
In case of Blockade of 2nd part of axillary
artery blood supply to upper limb is
maintained by which anastomosis -
a) Dorsal scapular anastomosis

b) Ventral scapular anastomosis

c) Circle of Willis

d) Anastomosis around internal thoracic artery

Correct Answer - A
Ans. is'a'i.e., Dorsal scapular anastomosis
(Ref: Clinical anatomy 3d/e p. 756)
Dorsal Scapular Anastomosis:
This anastomosis occurs connects the 1st part of subclavian artery
to the third part of axillary artery providing an alternate route of flow
of blood in case of occlusion anywhere within the subclavian and
axillary artery.
13. Dermatome supplying the middle finger is
-
a) C6

b) C7

c) C8

d) T1

Correct Answer - B
Ans. is'b' i.e., C7
(Ref: BDC Sth/e Vol. 1 p. 68).
Thumb - C6
Ring middle & index finger - C7
Little finger - C8.
14. Sensory supply of the palm is from which
nerves -
a) Median nerve and Radial nerve

b) Radial nerve and ulnar nerve

c) Ulnar nerve and Median nerve

d) Musculocutaneous nerve and Radial nerve

Correct Answer - C
Ans. is'c'i.e., Ulnar nerve and Median nerve
(Rel BDC 5'h/e VoL I p. 108-111)
On Palm side:
Lateral 2/3 of the palm and lateral three and half fibers → Median
nerve.
Medial 1/3 of the palm and medial one and half fingers → Ulnar
nerve.
15. Structures piercing clavipectoral fascia
are all except:
a) Cephalic vein

b) Thoracoacromial artery

c) Lateral pectoral nerve

d) Basilic vein

Correct Answer - D
The clavipectoral fascia is a strong sheet of connective tissue that is
attached above to the clavicle.
Below, it splits to enclose the pectoralis minor muscle and then
continues downward as the suspensory ligament of the axilla and
joins the fascial floor of the armpit.
The coracoclavicular fascia is pierced by the cephalic vein,
thoracoacromial artery and vein, lymphatics pasing from the breast
and pectoral region to the apical group of axillary lymph nodes and
lateral pectoral nerve.
16. Which foot bone does not have any
muscle attachment?
a) Talus

b) Calcaneum

c) Navicular

d) 1" metatarsal

Correct Answer - A
Ans. is 'a' i.e., Talus
[Ref BDC 6'h/e Vol. lI p. 30]
Talus is the only bone in the foot having no muscle attachment. Only
ligamentous attachment.
17. Radial tuberosity provides attachment to -
a) Brachialis

b) Biceps brachii

c) Triceps

d) Coracobrachialis

Correct Answer - B
Ans. is 'b' i.e., Biceps brachii (Ref: Elsevier's integrated anatomy
Vol 2 p 30).
An anterior, rough portion of tubercle - For insertion of tendon of
biceps brachii.
A posterior smooth portions of tubercle - Bursa interposed between
tendon & bone..
18. Which of the following muscle cause hip
extension and knee flexion ?
a) Semitendinosus

b) Gastrosoleus

c) Psoas major

d) Tensor Fascia lata

Correct Answer - A
Ans. is'a' i.e.. Semitendinosus
Semitendinosus is hamstring muscle.
Causes flexion at knee & extension at hip.
19. All of the following are true about the root
of right lung except?
a) Azygous vein crosses anteriorly and superiorly

b) Vagus crosses it anteriorly

c) Phrenic nerve crosses it anteriorly

d) SVC is present anteriorly

Correct Answer - B
Ans 'b'i.e., Vagus crosses it anteriorly
(Ref: Snell's 7th/e p. 94; BDC 4'h/e Vol.l p. 224)
Vagus nerve crosses both hila posteriorly.
Azygous vein arches the hilum of right lung (azygous vein is superior
to hilum)
Phrenic nerve (on both sides) and SVC (on right side) are anterior.
20. Typical intercostal space has -
a) One artery

b) Two arteries

c) Three arteries

d) Four arteries

Correct Answer - C
Ans.is 'c' i.e., Three arteries
(Ref: BDC 6h/e VoI. I p. 219)
Each of upper nine intercostal spaces have one posterior and two
anterior intercostal arteries.
21. Supraventricular crest lies between -
a) Pulmonary orifice and atrioventricular orifice

b) Atrioventricular orifice and fossa ovalis

c) SVC and right atrium

d) Right an dleft coronary artery

Correct Answer - A
Ans. is 'a' i.e., Pulmonary orifice and atrioventricular orifice
(Ref: BDC 8/e Vol, I p. 253-258).
Supraventricular crest (crista supraventriculars) or infundibulo-
ventricular crest separates tricuspid (AV) orifice and pulmonary
orifice, i.e. inlet and outlet parts.
 22. Nerve supply of cervical esophagus ?
a) Vagus

b) Left recurrent larynageal nerve

c) Right recurrent larynageal nerve

d) All of the above

Correct Answer - D
Ans. is d'., All of the above
[Ref Clinical anatomy 3'd/e p. 2891
Nerve supply of esophagus:
Esophagus is supplied by both parasympathetic and sympathetic
fibers.
A) Parasympathetic supply
It provides sensory, motor and secretomotor supply to esophagus.
Complete parasympathetic innervation is provided by vagus
nerve:-
1. Cervical esophagus: Through both (right & left) recurrent laryngeal
nerve.
2. Upper thoracic esophagus: Through left recurrent laryngeal nerve
and by direct branches from vagus nerve.
3. Lower thoracic esophagus: Through esophageal plexus.
B) Sympathetic supply
It provides sensory and vasomotor supply.
It is provided by Ts to Tc spinal segments.
23. True about relations of thoracic
esophagus ?
a) Trachea posteriorly

b) Aortic arch on right side

c) Left bronchus anteriorly

d) Thoracic duct on right side

Correct Answer - C
Ans. is'c'i.e., Ieft bronchus anteriorly
(Ref: Snell's p. 128)
The relations of the thoracic part of the esophagus from above
downward are as follows:
Anteriorly: The trachea and the left recurrent laryngeal nerve: the left
principal bronchus which constricts it; and the pericardium, which
separates the esophagus from the left atrium.
Posteriorly : The bodies of the thoracic vertebrae, the thoracic duct,
the azygos veins, the right posterior intercostal arteries and at its
lower end the descending thoracic aorta.
Right side: The mediastinal pleura and the terminal part of the
azygos vein.
Left side: The left subclavian artery, the aortic arch, the thoracic duct
the mediastinal pleura.
24. Which vein is found at the apex of the
heart ?
a) Great cardiac vein

b) Coronary Sinus

c) Anterior cardiac vein

d) Middle cardiac vein

Correct Answer - A
Ans. is'a'i.e., Great cardiac vein
[Rel BDC 4n/e VoI. I p. 251-252; Keith Moore 4e/e p. 136-137;
Snell's 9/e p. 1211
Great Cardiac Vein:
The great cardiac vein (left coronary vein) begins at the apex of
heart and ascends along the anterior longitudinal sulcus to the base
of ventricle.
25. Xiphisternum is present at what level ?
a) T5

b) T6

c) T9

d) T10

Correct Answer - C
Ans. is'c'i.e., T9
(Ref. Keithl. Moore Clinically Oriented Anatomy Ple p. 84)
Level of xiphisternum - T9
26. Right hepatic vein drains which segment
of the liver?
a) I

b) II

c) IV

d) VII

Correct Answer - D
Ans. is'd' i.e., VII
[Rel Gray's 4fh/e p. 1163-1167; Sabaton 18h/e p. 15841
Segmental anatomy of the liver:
Based on the distribution of portal vein and hepatic vein, Couinaud
divided each physiological (functional) lobe of liver into
4 segments each and hence liver is divided into 8 segments.
The physiological left lobe is composed of 4 segments designated I
to IV and is supplied by left branch of hepatic artery, Ieft branch of
portal vein and drained by left hepatic duct and left hepatic vein.
The physiological right lobe consists of segment V, VI, VII and VIII
and is supplied by right hepatic artery, right branch of portal vein and
drained by right hepatic duct and right hepatic vein.
27. Which of the following is true about upper
1/3' of the rectum?
a) It is covered by peritoneum only anteriorly

b) It is covered by peritoneum on the front, sides and back

c) It has no peritoneal attachments

d) It is covered by peritoneum on the sides and anteriorly

Correct Answer - D
Ans. is'd' i.e., It is covered by peritoneum on the sides and
anteriorly
lRef: Basic Human Anatomy, O'Rahilly, Muller Chapter 36)
Upper 1/3'd of rectum Covered by peritoneum on the front and sides
Middle 1/3"r of rectum Covered by peritoneum on the sides only
Lower 1/3"r of rectum Devoid of peritoneal aitachmerits
 28. Muscles forming floor of pelvis are all
except?
a) Pubococcygeus

b) Iliococcygeus

c) Ischiococcygeus

d) Iliacus

Correct Answer - D
Ans. is'd' i.e.,Iliacus.
(Ref: BDC &/eVol.llp. 425)
The pelvic floor is formed by the levator ani muscle which consists of
three parts:-
1. Pubococcygeus
2. Iliococcygeus
3. Ischiococcygeus
29. Perineal body muscles include all of the
following except?
a) External anal sphincter

b) Levator ani

c) Deep transverse perenei

d) Iliacus

Correct Answer - D
Ans. is 'd' i.e., Iliacus
[Ref: BDC &/e Vol. ll p. 425]
Ten muscles of perineum converge and interlace in the perineal
body -
A) Two unpaired - (i) External anal sphincter, (ii) Fibres of
longitudinal muscle coat of anal canal.
B) Four paired:- (i) Bulbospongiosus, (ii) Superficial transverse
perenei, (iii) Deep transversus perenei, (iv) Levator ani.
In females, sphincter urethrovaginalis is also attached here.
30. Lower 1/3'd of anal canal is derived from?

a) Proctodaeum

b) Cloaca

c) Urogenital Sinus

d) Midgut

Correct Answer - A
Ans. is'a'i.e., Proctodaeum
(Ref: BDC Sh/eVol. Il p. 415)
'The lower third of the anal canal is an ectodermal derivative and is
derived from the proctodaeum.'
Part of anal canal above pectinate line develops from dorsal part of
md.odermal cloaca (primitive rectum) and part of anal canal below
pectinate line develops from ectodermal proctodeum.
31. Anorectal malformations include all of the
following except?
a) Coloanal fistula

b) Rectourethral fistula

c) Imperforate anus

d) Anal Stenosis

Correct Answer - A
Ans. is'a'i.e., Coloanal fistula
Anorectal malformations are conditions occurring due to congenital
anomalies of the rectum and anus
They include :
Anal stenosis
Persistent Cloaca
Imperforate anus
Rectourethral or rectovesical fistula
Rectovaginal fistula
32. Which of the following about the valves of
Houston is true?
a) They disappear after mobilization of the rectum

b) The middle valve folds towards the right side

c) The upper valve corresponds to the anterior peritoneal

reflection

d) The valves contain all layers of the muscle wall

Correct Answer - A
A i.e. They disappear after mobilization of rectum
 33. Hesselback triangle- False is?
a) Indirect inguinal hernia occurs through it

b) It is laterally bounded by inferior epigastric artery

c) it is also known as inguinal triangle

d) Inferior boundary is inguinal ligament

Correct Answer - A
Ans. is 'a' i.e., Indirect inguinal hernia occurs through it
[Ref: BDC 4n/e VoI.2 p. 50, 210]
Inguinal triangle of hesselbach:
It is a peritoneal triangle in the posterior wall of the inguinal canal,
Boundaries
1. Lateral- inferior epigastric artery
2. Medial-lateral border of rectus abdominis
3. Inferior- inguinal ligament
Direct inguinal hernia enters the inguinal canal through this triangle,
which is divided by the obliterated umbilical artery into a medial part
(supravesical fossa) and a lateral part (medial inguinal fossa).
34. At the superficial inguinal canal increased
abdominal pressure leads to closure by
approximation of crura in the opening.
This defect is seen in an aponeurosis
formed by which of the following
muscles?
a) Fascia tranversalis

b) External oblique

c) Internal oblique

d) Erector spinae

Correct Answer - B
Ans. is'b'i.e., External oblique
(Ref: BDC &/e Vol. II p. 212, 213; Ramesh Babu p. 219)
Examinar is asking about superficial inguinal ring which is triangular
defect in external oblique aponeurosis.
Superficial inguinal ring is an anatomical structure in the anterior
abdominal wall. It is a triangular shaped defect in the aponeurosis of
external oblique muscle
35. Normal splanchnic blood supply of the
liver includes?
a) Portal vein

b) Splenic artery

c) Superior mesenteric artery

d) Inferior mesenteric vein

Correct Answer - A
Ans. is'a'i.e., Portal vein
(Ref, Gray's 4F/e p. 1163-1167)
Liver has dual blood supply and receives 20% of its blood supply via
hepatic artery (systemic) and 80% through portal vein (splanchnic).
Portal vein is formed by union of splenic vein and superior
mesenteric veins.
36. Which of the following is present at the
superior border of the pancreas ?
a) Splenic artery

b) Portal vein

c) Left Kidney

d) IVC

Correct Answer - A
Ans. is'a'i.e., Splenic artery
(Ref: BDC &/e Vol.II p. 300)
The body of pancreas has 3 borders-
Anterior border provides attachment to the root of transverse
mesocolon.
Superior border is related to coeliac trunk, hepatic artery and splenic
artery.
Inferior border is related to superior mesenteric vessels.
37. Contraction of Detrusor muscle is
mediated by?
a) S2,S3,S4

b) Vagus

c) Lumbar sympathetic supply

d) Pudendal nerve

Correct Answer - A
Ans. is'a'i.e., S2,S3,S4
[Ref: BDC dh/e VoI. II p. 375; Clinical anatomy p. 9127
Bladder is supplied by both sympathetic and parasympathetic fibers.
A) Parasympathetic:
Preganglionic fibers arise from S2 to S4 cord segments, pass via
pelvic splanchnic nerves.
After relay in ganglion cells in pelvic plexus (inferior hypogastric
plexus) and in bladder wall, postganglionic fibers supply detrusor
muscle.
Contraction of detrusor muscle is mediated by cholinergic
muscarinic receptors (M3).
Preganglionic parasympathetic neurons at S2, S3, and S4 cord
segments innervating bladder form sacral micturition center.
38. Cortex to medulla ratio in adults of the
kidney is?
a) 35-45%

b) 50-60%

c) 60-70%

d) 15-20%

Correct Answer - A
Ans. is 'a' i.e., 35-45%
As the age progresses the amount of cortex in the kidney decreases
more compared to the medulla and hence the ratio decreases.
In children the cortico medullary ratio is high, almost to the extent of
1:1 (around 50%).
In healthy adults it is 35-45%.
39. Which of the following is true about
anatomy of the cerebellum?
a) Globose cells are present in the roof

b) Vermis is present in the midline

c) Flocculonodular lobe is concerned with smoothening and co-

ordination of movements

d) Dentate nucleus is the medial most nucleus

Correct Answer - B
Ans. is 'b' i.e., Vermis is present in the midline.
(Ref: Ganong 23d/e p. 255)
'The vermis is a midline structure that connects the two cerebellar
hemispheres.
'Dentate nucleus is the lateral most nucleus.'
'Spinocerebellum and not flocculonodular lobe is concerned with
smoothing and coordination of movements'
'Globose cells are a part of deep cerebellar nuclei and are present
deep inside the substance of cerebellum.
40. Posterior longitudinal ligament continues
as?
a) Apical ligament

b) Alar ligament

c) Membrana tectoria

d) Transverse ligament

Correct Answer - C
Ans. is'c'i.e., Membrana tectoria
[Ref: Nigel Palastanga; Roger W. Soames (2012). Churchill
Livingstone, ed. Anatomy and Human Movement: Structure and
Function.l
The Posterior longitudinal ligament is situated within the vertebral
canal, and extends along the posterior surface of the bodies of the
vertebrae.
It starts from the body of the axis, where it is continuous with the
membrana tectoria and continues to the sacrum.
41. Artery of Adamkiewicz is related to?
a) Hand

b) Penis

c) Brain

d) Spinal Cord

Correct Answer - D
Ans. is'd'i.e., Spinal Cord
[Ref. Moore, Keith; Anne Agur (2007). Essential Clinical Anatomy,
Third Edition. Lippincott Williams (t Wilkins. p. 29B)
The artery of Adamkiewicz, also known as the great anterior
radiculomedullary artery or arteria radicularis anterior magna, is the
name given to the dominant thoraco-lumbar segmental artery that
supplies the spinal cord.
42. Purkinje cells of cerebellum are
connected to ?
a) Basket cells

b) Stellate cells

c) Deep cerebellar nuclei

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
The two main inputs to the cerebellar cortex are climbing fibers and
mossy fibers, which are excitatory.
The climbing fibers come from a single source, the inferior olivary
nuclei and directly projects to the primary dendrites of a purkinje cell.
43. True about vagal nuclei are all except?
a) There are 4 vagal nuclei

b) They are found in the floor of 4th ventricle

c) Nucleus Ambiguous is a vagal nucleus

d) Spinal trigeminal nucleus is not a vagal nucleus

Correct Answer - D
Ans. is'd'i.e., Spinal trigeminal nucleus is not a vagal nucleus
(Ref: 'Functional and chemical anatomy of the afferent vagal
system". Autonomic Neuroscience. 85 (I-3): I-17.)
The vagus nerve includes axons which emerge from or converge
onto four nuclei of the medulla.
They are present deep in the medulla in the floor of the 4th ventricle.
 44. Association fibers include all of the
following except?
a) Corona Radiata

b) Arcuate fasciculus

c) Cingulum

d) Uncinate fasciculus

Correct Answer - A
Ans. is'a'i.e., Corona Radiata
(Ref Gray's Anatomy p. 411)
White matter of cerebrum hemisphere is divisible into 3 fiber
systems :-
Association fibers:
Connect the one functional area of one cerebral hemisphere to other
in the same cerebral hemisphere.
1. Cingulum
2. Superior longitudinal fasciculus
3. Inferior longitudinal fasciculus
4. Uncinate fasciculus
5. Arcuate fasciculus
6. Fonix
7. Occipitofrontal fasciculus
45. Stellate ganglion is seen in?
a) Cerebellum

b) Mid brain

c) Medulla oblongata

d) Near lower cervical spine

Correct Answer - D
Ans. is 'd' i.e., Near lower cervical spine
[Ry' Gray's 38h/e p. 13031
The stellate ganglion (or cervicothoracic ganglion) is a sympathetic
ganglion formed by the fusion of the inferior cervical ganglion and
the first thoracic ganglion.
Stellate ganglion is located at the level of C7, anterior to the
transverse process of C7 and the neck of the first rib, superior to the
cervical pleura and just below thc subclavian artery.
46. Nerve supply of circumvallate papillae is:

a) Hypoglossal nerve

b) Glossopharyngeal nerve

c) Lingual nerve

d) Chorda tympani

Correct Answer - B
Circumvallate papilla is one of the large papillae near the base on
the dorsal aspect of the tongue arranged in a criteria used at term.
The vast majority of fetuses with V-shape. The taste buds are
located in the epithelium of the trench surrounding the papilla. Motor
nerve supply of tongue: All the intrinsic and extrinsic muscles of the
tongue are supplied by the hypoglossal nerve except the
palatoglossus muscle which is supplied by the cranial part of the
accessory nerve through the pharyngeal plexus.
Glossopharyngeal nerve is both general sensory and special
sensory to the posterior 1/3rd of the tongue. Posterior most part of
the tongue is supplied by the internal laryngeal nerve which is a
branch of vagus nerve.
47. Superior cerebellar peduncle contains
mainly which tract ?
a) Tectocerebellar

b) Olivocerebellar

c) Vestibulo cerebellar

d) Reticulo cerebellar

Correct Answer - A
Ans. is 'a' i.e., Tectocerebellar
Superior cerebellar peduncle
This is the major output of the brain and connects to the
midbrain, via the cerebellothalamic tract (to the thalamus), and
the cerebellorubral tract (to the red nucleus). It receives afferents
from the locus coeruleus, and ventral spinocerebellar tract.
Middle cerebellar peduncle
This is the largest peduncle and connects the cerebellum to the
pons. It connects the contralateral pontine nucleus to the cerebellar
cortex and also carries the input from the contralateral cerebral
cortex. It is composed of three fasciculi including the superior,
inferior and deep.
Inferior cerebellar peduncle
This connects the spinal cord and medulla to the cerebellum.
The posterior spinocerebellar tract receives proprioceptive
information from the body. The cuneocerebellar tract receives
proprioceptive input from the upper limb and neck.
The trigeminocerebellar tract sends proprioceptive input from the
face. The juxtarestiform is an efferent system here.
48. Proprioception is carried by which fibers?
a) Fasciculus cuneatus and fasciculus gracilis

b) Anterior spinothalamic tract

c) Lateral spinothalamic tract

d) Spinocerebellar tract

Correct Answer - A
Ans. is'a'i.e., Fasciculus cuneatus and fasciculus gracilis
(Ref: Guyton 12th/e p. 573)
Posterior column (Dorsal column) (Fasciculus Gracilis and
Fasciculus Cuneatus) carries
Proprioception (Position of body or limb, position of joint)
Vibration
Fine touch (two point discrimination, topognosis, stereognosis).
Kinesthesia
49. Proprioception is lost when?
a) Posterior part of spinal cord is injured

b) Lateral part of spinal cord is injured

c) Anterior part of spinal cord is injured

d) None

Correct Answer - A
Ans. is'a'i.e., Posterior part of spinal cord is injured
[Ref: Guyton 12'h/e p. 573]
Posterior part of spinal cord consists of fasciculus gracilis and
fasciculus cuneatus which carry the sensations of and vibration to
the brain.
They also carry fine touch and kinesthesia.
50. Visual center is present in?
a) Parietal lobe

b) Occipital lobe

c) Frontal lobe

d) Temporal Lobe

Correct Answer - B
Ans. is 'b' i.e., Occipital lobe
(Ref: BDC 6h/e Vol. III p. 421-425)
Occipital lobe has the following areas related to vision
Primary visual cortex (strike area, area 17):
It is present in medial surface of occipital lobe on upper lip and lower
lip of calcarine sulcus.
51. Athepatient presents with a chief complaint of chronic nose bleeds. To control
severity of these nosebleeds, his physician decides to ligate the
sphenopalatine artery. From which of the following arteries does the
sphenopalatine artery arise from?

a) External carotid

b) Facial

c) Maxillary

d) Ophthalmic

Correct Answer - C
The sphenopalatine artery is the terminal branch of the maxillary artery. The maxillary
artery arises from the external carotid artery and then passes through the infratemporal
fossa, giving off branches to structures in this region.
52. All of the following muscles forms the boundary of the suboccipital triangle
found in the suboccipital region of the neck, EXCEPT?

a) Obliquus capitis superior muscle

b) Obliquus capitis inferior muscle

c) Rectus capitis posterior major muscle

d) Rectus capitis posterior minor muscle

Correct Answer - D
The suboccipital triangle is bounded by rectus capitis posterior major and the obliquus
capitis superior and inferior muscles. The floor of this triangle is formed by the posterior
occipitoatlantal membrane and the posterior arch of the C1 vertebrae.
Contents of the triangle are:
Vertebral artery
Suboccipital nerve
Greater occipital nerve
53. Infundibulum develops from ?
a) Floor of lateral ventricle

b) Floor of 4th ventricle

c) Floor of third ventricle

d) Rhombencephalon

Correct Answer - C
Ans. is 'c' i.e., Floor of third ventricle
(Ref: Textbook of Neuroanatomy p. 112)
The infundibulum of the diencephalon is a downward evagination of
the floor of the third ventricle.
As the infundibulum grows down, it meets an ectodermal
diverticulum of the oral cavity, known as Rathke's pouch.
54. Protoplasmic astrocytes are located in ?
a) Gray matter

b) White matter

c) Inside blood vessels

d) Inside neurons

Correct Answer - A
Ans. is'a'i.e., Gray matter
[Ref: Clinical neurology 4h/e p. 7111
There are following types of astrocytes :
Protoplasmic Astrocytes
They are located in gray matter in close association with neurons.
They provide nutrients, assist in metabolism and help in formation of
blood-brain-barrier.
55. Development of the urinary bladder is
from?
a) Urogenital Sinus

b) Paramesonephric Duct

c) Metanephric Blastema

d) Proctodaeum

Correct Answer - A
Ans. is 'a' i.e., Urogenital Sinus
[Ry' Inderbir Singfi Human Embryology Sth/e p. 246]
The urinary bladder (except trigone) is derived from vesicourethral
canal, cranial part of urogenital sinus (endodermal).
Trigone is derived from absorbed part of Wolffian duct/mesonephric
duct (mesodermal).
56. Optic vesicle is derived from ?
a) Neuroectoderm

b) Surface ectoderm

c) Endoderm

d) Mesoderum

Correct Answer - A
Ans. is'a'i.e., Neuroectoderm
(Ref Indo Khurana ernbryology p. 268)
Formation of optic cup
An outgrowth from prosencephalon forms optic vesicle
(neuroectodermal structure).
Proximal part of optic vesicle becomes constricted and elongated to
form optic stalk.
57. Embroyo develops from ?
a) Inner cell mass

b) Troploblasts

c) Outer cell mass

d) None of the above

Correct Answer - A
Ans. is'a'i.e., Inner cell mass
[Ref Textbook of embryology p. 24)
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.
Embryoblast :
A group of centrally located cells of inner cell mass and later give
rise to tissues of the embryo proper.
58. Tragus is supplied by?
a) Lesser occipital nerve

b) Auricular branch of vagus

c) Greater auricular nerve

d) Auriculotemporal nerve

Correct Answer - D
Ans. is'd'i.e., Auriculotemporal nerve
"The auriculotemporal nen)e nerve supplies the majority of lateral
portion of ear including tragus and crux of helix".
59. Which of the following is true about
longus colli?
a) Origin is in the occiput

b) Extensor of the neck

c) Nerve supply is from C2 -C6

d) Inserts on C3-C6

Correct Answer - C
Ans. is 'c'i.e., Nerve supply is from C2 -C6
[Ref: Dalley AF, Agur AM. Clinically Oriented Anatomy, Sixth
Edition. Lippincott Williams).
Loneus Colli:
Situated on the anterior surface of vertebral column, between the
atlas and the 3rd thoracic vertebra.
60. Greater cornua of the hyoid bone fuses
with the body at what age ?
a) 15 years

b) 25 years

c) 10 years

d) 35 years

Correct Answer - B
Ans. is'b'i.e., 25 years
Time of fusion of greater cornua of hyoid - 25 years with the body
Time of fusion of lesser cornua = 35-40 years
61. Suboccipital nerve is?
a) Cl ventral ramus

b) C2 ventral ramus

c) Cl dorsal ramus

d) C2 dorsal ramus

Correct Answer - C
Ans: C. C1 dorsal ramus
(Ref: BDC 5th/e Vol. III p. 871).
The suboccipital nerve is the dorsal primary ramus of the first
cervical nerve (C1).
It exits the spinal cord between the skull and the first cervical
vertebra, the atlas.
It lies within the suboccipital triangle along with the vertebral artery,
where the artery enters the foramen magnum
62. Serotonin is secreted by:
a) Thyroid

b) Adrenal cortex

c) Adrenal medulla

d) Argentaffin cells

Correct Answer - D
Serotonin is a vasoconstricting hormone, produced in the brain and GI tract. In the GI tract
it is produced normally by enterochromaffin cells (argentaffin cells). The principal function is
to regulate smooth muscle contraction and peristalsis.
Serotonin: also called 5-hydroxytryptamine, is a chemical substance that is derived from
the amino acid tryptophan.
Principally found stored in three main cell types;
(a) Serotonergic neurons in the CNS and in the intestinal myenteric plexus,
(b) Enterochromaffin cells in the mucosa of the gastrointestinal tract and
(c) Blood platelets

Synthesis:
Serotonergic neurons and enterochromaffin cells can synthesize serotonin from its
precursor amino acid L-tryptophan, whereas platelets rely upon uptake of serotonin for their
stores. The biochemical pathway for serotonin synthesis initially involves the conversion of
L-tryptophan to 5-hydroxytryptophan by the enzyme L-tryptophan hydroxylase. This
enzyme provides the rate limiting step for serotonin synthesis.

Metabolism of serotonin is carried out primarily by the enzyme monoamine oxidase (MAO),
The action of MAO converts serotonin to 5-hydroxyindole acetaldehyde which in turn is
readily metabolized by aldehyde dehydrogenase to produce 5-hydroxyindole acetic acid as
the major excreted metabolite of serotonin.

Carcinoid syndrome: are neuroendocrine tumours (NETs) of predominantly

enterochromaffin cell origin (Kulchitsky cells).Carcinoid syndrome is made up of a
constellation of symptoms which are caused by the release of a variety of substances
(serotonin, histamine, and substance P, among others) by the carcinoid tumor. It may
cause trytophan deficiency and causes decrease in niacin synthesis leading to pellagra.
Ref: Principles of medical physiology, By Sabyasachi Sicar, Page 641.
63. Secretors are those who?
a) Secrete enzymes in blood

b) Secrete immunoglobulin [IgA] in intestine

c) Secrete blood group antigen in sweat/saliva

d) Secrete hormones in response to stress

Correct Answer - C
Ans. is'c'i.e., Secrete blood group antigen in sweat/saliva
64. a-receptor of estrogens are?
a) Membrane receptors in breast

b) Nuclear receptors in breast

c) Membrane receptors in ovaries

d) Nuclear receptors in ovaries

Correct Answer - B
Ans. is 'b' i.e., Nuclear receptors in breast
(Ref: Principles of medical physiologlt p. 777).
Estrogen binds to nuclear receptors --> Estrogen receptors (ERs)
65. True about calcium and phospharus
metabolism?
a) Parathormone increases phosphate reabsorption in PCT

b) Parathormone increases calcium reabsorption in PCT

c) Calcitriol increases phosphate reabsorption in PCT

d) Calcitriol decreases phosphate absorption in intestine

Correct Answer - C
Ans. is'c'i.e., Calcitriol increases phosphate reabsorption in
PCT
Calcitriol stimulates reabsorption of-
Phosphate in PCT
Ca+ in DCT
PTH has following effects on reabsorption in kidney-
It increases Ca2+ reabsorption in DCT (not in PCT)
It decreases Phosphate reabsorption in PCT
66. Estradiol is a powerful inhibitor of FSH (follicle stimulating hormone). What is
another factor that is a powerful inhibitor of FSH in the female?

a) Testosterone

b) Progesterone

c) LH

d) Inhibin

Correct Answer - D
Inhibin, as its name implies, is an inhibitor. The specific action of inhibin is to inhibit
the release of FSH. Inhibin occurs as a heterodimer It is produced in the male and the
female. Inhibin is produced by the ovarian granulosa cells to prevent more than one follicle
(in general) from becoming a mature follicle. The inhibin produced by the Sertoli cells of the
testes acts to decrease FSH to help in regulation of spermatogenesis.

Ref: Molina P.E. (2013). Chapter 8. Male Reproductive System. In P.E. Molina
(Ed),Endocrine Physiology, 4e.
67. In Autoregulation of hormone?
a) A hormone inhibits its own secretion directly

b) A hormone inhibits its own secretion by inhibiting regulatory

hormone

c) Nervous system inhibits release of hormone

d) All of the above

Correct Answer - B
Ans. is 'b' i.e., A hormone inhibits its own secretion by
inhibiting regulatory hormone.
Feedback control (Autoregulation):
The process of inhibiting or stimulating the first step by the final step
product in a hormonal reaction pathway, is called feedback
regulation.
68. Action of calmodulin is:
a) Ca2+ dependent

b) Through calmodulin dependent kinases

c) Through CAMP dependent kinases

d) A & B

Correct Answer - D
A i.e. Ca2+ dependent; B i.e. Through calmodulin dependent kinase
Calmodulin
It has 148 amino acid residues & 4 Ca++ binding domains. It's 115th
aa. is trimethylated. It is extensively conserved & found in plants &
animals both. Calmodulin is involved in contraction of smooth
muscle .Q It helps in initiation of contraction, not by, uncovering
active site on actin molecule but by activating the myosin cross
bridges.
Is a Ca2+ binding proteinQ present in many cells notably in smooth
muscles and brain cellsQ.
Is a counterpart of Troponin. (Troponin is present in skeletal
muscles)
Calmodulin binds with Cat* & capable of activating 5 different
calmodulin​dependent kinases Q. They are:
(i) Myosine high chain kinaseQ - it phosphorylates myosin head
conferring with the capability of binding with actin filament. This
brings about contraction in smooth muscle.
(ii) Phosphorylase kinaseQ
(iii) Ca2V Calmodulin kinase I & II: concerned with synaptic
function
(iv) Ca2* / Calmodulin kinase III: concerned with protein synthesis
69. Enterohepatic circulation occurs in?
a) Duodenum

b) Jejunum

c) Proximal ileum

d) Distal ileum

Correct Answer - D
Ans. is'd'i.e., Distal ileum
(Ref: Principles of medical physiology p. j89l
About 500 ml of bile is secreted per day (20.8 mVhr) by the liver. In
the gallbladder, bile is stored and concentrated.
After a meal contraction of the gallbladder transfers a large volume
of bile into the duodenum. Most of the bile is reabsorbed into
terminal ileum and undergoes enterohepatic circulation.
70. Basic electrical rhythm is not seen in?
a) Stomach

b) Duodenum

c) Esophagus

d) Cecum

Correct Answer - C
Ans. is 'c' i.e., Esophagus lRef: Ganong 24th/e p. 5041
71. Ion which promotes glucose absorption in
the gut region:
September 2007
a) CI ?

b) K+

c) Na+

d) Ca2+

Correct Answer - C
Ans. C: Na+
Glucose enters cells by facilitated diffusion or, in the intestine and
kidneys, by secondary active transport with Na+. In muscle, fat, and
some other tissues, insulin facilitates glucose entry into cells by
increasing the number of glucose transporters in the cell
membranes.
The glucose transporters that are responsible for facilitated diffusion
of glucose across cell membranes are a family of closely related
proteins that cross the cell membrane 12 times and have their amino
and carboxyl terminals inside the cell. They differ from and have no
homology with the sodium-dependent glucose transporters, SGLT 1
and SGLT 2, responsible for the secondary active transport of
glucose out of the intestine, although the SGLTs also have 12
transmembrane domains. Particularly in transmembrane helical
segments 3, 5, 7, and 11, the amino acids of the facilitative
transporters appear to surround channels that glucose can enter.
Presumably, conformation then changes and glucose is released
inside the cell.
72. Food causes reflex defecation?
a) Enterogastric reflex

b) Defecation reflex

c) Gastrocolic reflex

d) Rectoanal reflex

Correct Answer - C
Ans. is'c'i.e., Gastrocolic reflex
[Rel Guyton llth/e p. 771)
Appearance of mass movements after a rneal is facilitated by
gastrocolic and duodenum reflexes.
These reflexes result from the distension of the stomach and
duodenum.
The best example of gastrocolic reflex is seen in early infancy where
defecation often follows a meal.
73. In free water clearance, free water is
generated in?
a) PCT

b) Descending limb of loop of Henle

c) Ascending limb of loop of Henle

d) All of the above

Correct Answer - C
Ans. is 'c' i.e., Ascending limb of loop of Henle
(Ref: Medical physiology for undergraduate E-book p' 4381
Free water or solute free water is generated in the diluting segments
of the kidney (i.e. thick ascending limb and early distal tubules,
where NaCl is reabsorbed and free water is left in the tubular fluid.
74. Free water clearance is positive when
urine is
a) Dilute

b) Concentrate

c) Isotonic

d) Any of the above

Correct Answer - A
Ans. is 'a' i.e., Dilute
(Ref: Principles of Medical Physiology p' 39Il
Kidney excretes some solutes in the urine daily.
The volume of tater in urine, excreted per unit time in excess of thot
required to excrete the contained solutes is-osmotically with plasma.
Free water clearance is positive in dilute urine, negative where
concentrated urine is passed and zero when isotonic urine is
passed.
75. Which of following formula denotes free
water clearance?
a) Urine flow rate multiplied by osmolal clearance

b) Urine flow rate minus osmolal clearance

c) Urine flow rate divided by osmolol clearance

d) Urine flow,rate plus osmolal clearance

Correct Answer - B
Ans. is'b'i.e., Urine flow rate minus osmolal clearance
Free water clearance (CH2O):
CH2O = V- Cosm
76. Water reabsorption in loop of henle is?
a) Through aquaporin-1 in distending limb

b) Through aquaporin-1 in ascending limb

c) Due to ADH in ascending limb

d) Due to aquaporin-2 in ascending limb

Correct Answer - A
Ans. is 'a' i.e., Through aquaporin-l in descending limb
fRef: Principles of medical physiology p. 3I2l
"Ascending limb of loop of Henle (especially thick ascending limb) is
ako called the diluting segment of nephron because of its ability to
dilute the urine,'
Thin descending segment (limb):
This segment is highly permeable to water and relatively
impermeable to solutes (sodium, chloride and urea).
Therefore, only water is reabsorbed from the thin descending limb of
loop of Henle and the fluid in the descending limb becomes
hypotonic.
This water absorption is also obligatory and occurs through
aquaporin-l water channel.
No active secretion or reabsorption takes place in this segment.
77. In high potassium serum levels, kidney
compensation occurs by?
a) Decreased reabsorption in PCT

b) Increased secretion in PCT

c) Increased secretion in DCT

d) Decreased reabsorption in loop of Henle

Correct Answer - C
Ans. is'c'i.e., Increased secretion in DCT
[Ref: Guyton & hall p. 201
Potassium transport:
Potassium is one of the few substances that are both reabsorbed as
well as secreted by the renal tubules.
The reabsorption of about two-thirds of the filtered K+ occurs in the
proximal tubules
K+ reabsorption as weII as secretion takes place.
Here also, reabsorption of K+ occurs independent of K+ status of the
body.
It is the secretory process that K+ regulated by aldosterone in
response to the K+ and Na+ status of body.
78. Normal urea excretion rate is?
a) 1-2 gm per day

b) 10-20 gm/day

c) 20-40 gm per day

d) 50-100 gm/day

Correct Answer - B
Ans. is 'b' i.e., 10-20 gm/day
(Ref: Medical physiology E Book 2d/e p. 767)
"The physiologically normal individual excrete 12-20 gm of urea
nitrogen in 24 hours"
79. Standard urea clearance in an normal
adult is?
a) 20 ml

b) 50 ml

c) 100 ml

d) 200 ml

Correct Answer - B
Ans. is'b'i.e., 50 ml
[Dr Chatterjee, Shinile Sh/e p. 652]
Standard clearance of urea (Cs) and average normal value is 54
80. In Kidney which of the following is true?
a) Osmolarity of tubular fluid in PCT gradually increases

b) Osmolarity of fluid in DCT is more than in Bowmann's capsule

c) Fluid coming out of descending limb of loop of Henle is

hypotonic

d) Osmolarity of medullary interstitium is more than plasma

Correct Answer - D
Ans. is'd'i.e., Osmolarity of medullary interstitium is more than
plasma
(Ref: Guyton 12/e p. 334)
The renal medulla shows an increasing osmotic pressure with
increasing depth.
Starting, with an osmolarity of 300 mOsm/L in the cortex, the
osmolarity reaches a level of 1200-1400 mosm/L at the pelvic tip of
the medulla, i.e., The inner part of medulla has highest osmotic
gradient.
That means that the renal medullary interstitium has accumulated
solute in greater excess of water.
81. Maximum potassium reabsorption occurs
in?
a) Proximal convoluted tubule

b) Distal convoluted tubule

c) Cortical collecting duct

d) Medullary collecting duct

Correct Answer - A
Ans. is'a'i.e., Proximal convoluted tubule
[Rl Guyton 12n/e p. 334)
Most of the solutes and water are maximally absorbed in
proximal tubule :-
60-70% of Na* is reabsorbed along with 6O-70% of Cl-
60-70% of K+ is reabsorbed
82. Slowest acting buffer system in the body
?
a) PCO, buffer

b) Respiratory buffer

c) Chemical buffer

d) Renal buffer

Correct Answer - D
Ans. is 'd' i.e., Renal buffer
(Re/ Principles of medical physiology p. 712)
Not all buffer systems begin work at the same time.
Chemical buffers respond first, followed by the respiratory system
and finally, the renal system.
83. How to increase reabsorption of iso-
osmolar fluid from glomerular filterate?
a) Increased peritubular capillary pressure

b) Decreased osmotic pressure in peritubular capillaries

c) Increased corticomedullary osmotic gradient

d) Increased filtered load

Correct Answer - D
Ans. is 'd' i.e., Increased filtered load
(Ref: Principles of medical physiology p.786]
Glomerulotubular balance refers to the fact that the total rate of
reabsorption increases as the filtered load increases, even though
the percentage of GFR reabsorbed in the proximal tubules remains
relatively constant about 65%
84. PAH is used to measure?
a) Extracellular fluid

b) Glomerular filtration rate

c) Renal plasma flow

d) Plasma value

Correct Answer - C
Ans. is'c'i.e., Renal plasma flow
[Rel Ganong 248/e p, 678-679)
A substance which closely satisfies this description is para-
aminohippuric acid (PAH), Therefore,
PAH is used to measure renal plasma flow.
The PAH clearance ln a normal adult lc about 625 mV minute. That's
a measure of effective renal plasma flow (ERPF).
PAH is only 90% excreted in the urine in a single passage through
the kidney, i.e., its extraction ratio is 0.9 (90%).
85. True about cubulin receptors?
a) Present in small intestine

b) Prevents proteinuria

c) Prevents steatorrhea

d) All are correct

Correct Answer - B
Ans. is 'b' i.e., Prevents proteinuria
Cubulin is a peripheral membrane protein, and therefore it does not
have an endocytosis signaling sequence.
Megalin is responsible for internalization of cubulin and its ligands in
addition to internalizing its own ligands.
The proteinuria observed in megalin-deficient mice, in dogs lacking
functional cubulin and in patients with distinct mutations of the
cubulin gene illustrates the importance of the receptors.
86. Delayed afterdepolarization implies?
a) Increased intracellular Ca"

b) Excessive catecholamines

c) Digitalis toxicity

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
[Ref Principles of clinical medicine 3'd/e p. 1196]
Delayed afterdepolarizations occur in late phase 3 or early phase 4
when the action potential is nearly of fully repolarized.
The mechanism is poorly understood; however, this type of
arrhythmia is found to be associated with high intracellular Ca++
concentrations as occurs with digitalis toxicity or excessive
catecholamine stimulation.
The triggered impulse can lead to a series of rapid depolarizations
(i.e. a tachyarrhythmia).
87. TRUE regarding action of alpha amylase
a) Breaks glucose from carbohydrate end

b) Cleaves only at a 1-4

c) Cleaves only at a 1-6

d) b & c

Correct Answer - B
B i.e. Cleaves only at (a 1-4)
a Amylase is a carbohydrate digesting enzyme found in saliva,
pancreatic juice and intestinal juice. This enzyme hydrolyses a-1—
>4 glycosidic bonds.
88. Which of the following inhibits gastrin secretion?
a) Intrinsic factor

b) Enterogastrone

c) Histamine

d) Gastrin

Correct Answer - B
Enterogastrone is secreted in the ileum. To a minor extend it inhibits gastric and pancreatic
secretions. It inhibits the secretion of gastrin.

Gastrin:
Gastrin is produced by G cells in the antral portion of the gastric mucosa. Functions of
gastrin: It increases gastric HCl secretion, decreases insulin secretion, stimulates GI
mucosal growth and cause constriction of lower esophageal sphincter.

Stimuli that increase gastrin secretion:

Luminal: distention, peptides and amino acids
Increased vagal discharge via GRP
Calcium
Epinephrine
Stimuli that inhibit gastrin secretion
Luminal: acid, somatostatin
Secretin, GIP, VIP, glucagon, calcitonin
Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 25. Overview of
Gastrointestinal Function & Regulation. In K.E. Barrett, S.M. Barman, S. Boitano, H.L.
Brooks (Eds), Ganong's Review of Medical Physiology, 24e.
89. The organ with maximum blood flow in ml/kg/min during resting is:
a) Kidney

b) Liver

c) Brain

d) Lungs

Correct Answer - A
Resting blood flow of various organs in a normal man:
Region (in kg) mL/min mL/100 g/min

Liver (2.6) 1500 57.7

Kidneys (0.3) 1260 420.0

Brain (1.4) 750 54.0

Skin (3.6) 462 12.8

Skeletal muscle (31.0) 840 2.7

Heart muscle (0.3) 250 84.0

Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 33. Circulation
through Special Regions. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds),
Ganong's Review of Medical Physiology, 24e.
90. Conduction velocity in AV node & SA
node?
a) 0.05 meter/sec

b) 0.5 meter/sec

c) 1 meter/sec

d) 5 meter/sec

Correct Answer - A
Ans .a.0.05 meter/sec [ref Genong2}n/eP' 522)
91. Which vessel regulates blood flow?
a) Artery

b) Arterioles

c) Venules

d) Capillaries

Correct Answer - B
Ans. b' arteriole
Distribution of blood flow is mainly regulated by arteriole, by
alteration in their diameter.Increase or decrease the pertphenl
resistance to blood flow.
92. Muscle hypotension is caused by?
a) Bradykinin

b) Actin

c) Myosin

d) Relaxin

Correct Answer - A
Ans. is'a'i.e., Bradykinin
Only bradykinin cause hypotension → Local hypotension in skeletal
muscle (If pressure BP to fall below 50 mm Hg).
93. Most common cause of Cheyne-Stokes
breathing is?
a) Diabetic ketoacidosis

b) CHF

c) Bulbar polio

d) Pontine hemorrhage

Correct Answer - B
Ans. is'b'i.e., CHF
(Ref Clinicalmedicine p. 713)
Cause of Cheyne-Stokes respiration,
Normally occurs during sleep at high altitude
Congestive cardiac failure
Damage to respiratory centers
94. During normal inspiration diaphragm goes
down by?
a) 1-2 cm

b) 3-5 cm

c) 5-7 cm

d) 7-9 cm

Correct Answer - A
Ans. is 'a' i.e., 1-2 cm
[Ref: Essentials of medical physiology p. 712]
In normal inspiration, the diaphragm descends 1-2 cm into the
abdominal cavity producing a pressure difference of 1-3 mm hg and
the inhalation of about 500 ml of air.
95. Maximum voluntary ventilation is
measured for?
a) 30 sec.

b) 60 sec.

c) 75 sec.

d) 120 sec.99.

Correct Answer - B
Ans. is'b'i.e., 60 sec.
(Ref: Guyton 12h/e p. 470]
Maximum voluntary ventilation (MW) :
It is the maximum amount of air that can be moved into and out of
lungs in 1 minute by voluntary effort.
It is about 125-170 L/min.
96. Main content of bilayer cell membrane is:
March 2009
a) Glycerol

b) Cholesterol

c) Cholesterol ester

d) Triacyl glycerol

Correct Answer - B
Ans. B: Cholesterol
Biological membranes typically include several types of lipids other
than phospholipids. A particularly important example in animal cells
is cholesterol, which helps strengthen the bilayer and decrease its
permeability.
Cholesterol also helps regulate the activity of certain integral
membrane proteins. Integral membrane proteins function when
incorporated into a lipid bilayer.
Because bilayers define the boundaries of the cell and its
compartments, these membrane proteins are involved in many intra-
and inter-cellular signaling processes.
97. In Caveola, the Caveolin molecule is
attached to inner layer of plasma
membrane by -
a) Desmin

b) Dynanin

c) Clathrin

d) Cavin

Correct Answer - D
Ans. is'd'i.e., Cavin
[Rel Principles of medical physiology 4th/e p. 712]
Caveolae are small flask-shaped depressions in the cell membrane.
They are considered to be specialized forms of lipid rafts.
They are formed when Caveolin proteins embed in the phospholipid
bilayer of the membrane and distort it so that forms small flask-like
pits.
Caveolae are produced at the Golgi apparatus when Caveolin joins
together in small groups (oligomers) and binds to cholesterol.
These vesicles move to the cell surface and merge with the cell
membrane.
Here Cavin-l allow caveolir-l to interact with cell membrane to form
Caveolae.
98. Na+-1C+ ATPase is a -

a) Extrinsic protein

b) Peripheral protein

c) Transmembrane protein

d) Intracellular proteins

Correct Answer - C
Ans. is'c'i.e., Transmembrane protein
lRef: Principles of medical physiology p. 5I2) .
Ion pumps (including Na* - K. ATPase) and channels are integral
(Transmembrane) proteins.
99. Shape of RBC is biconcave due to?
a) Ankyrin

b) Spectrin

c) Band protein

d) Glycophorin-C

Correct Answer - B
Ans. is `b' i.e., Spectrin
Membrane proteins of RBC
There are following membrane proteins of RBC:
(A) Integral proteins
These are embedded in membrane via hydrophobic interactions with
lipids
Integral proteins are:
(I) Band-3: It has two functions:
Anionic transport: Exchange bicarbonate for chloride
Structural: Linkage of lipid bilayer to underlying membrane skeleton
and important for prevention of surface loss.
Glycophorins: Imparts a negative charge to the cell, reducing
interaction with endothelium and other cells.
Aquaporin 1: These selective pores for water transport allow RBC to
remian in osmotic equilibrium with ECF
(B) Peripheral membrane proteins
These are located on cytoplasmic surface of lipid bilayer, and
constitute membrane cytoskeleton.
These are anchored via integral proteins
These are reponsible for elastibility and maintenance of RBC shape
& stability.
Important peripheral proteins are:
Spectrin: It is the chief protein component and is responsible for
biconcave shape of RBC.
Actin: Spectrin tail is associated with actin filament.
Protein 4.1: Stabilises actin-spectrin interactions.
Adducin: Stabilises actin-spectrin interactions.
Ankyrin: Interacts with band 3 and spectrin to achieve linkage
between bilayer and skeleton. It is aug​mented by protein 4.2.
100. Release of synaptic transmitter by exocytosis would be blocked most
effectively by preventing the:

a) Propagation of the action potential into the nerve terminal

membrane

b) Depolarization of the nerve terminal membrane

c) Flow of Na+ into the nerve terminal membrane

d) Flow of Ca2+ into the nerve terminal membrane

Correct Answer - D
Preventing the flow of Ca2+ into the cell would prevent the release of transmitter, because
Ca2+ initiates the intracellular events leading to the docking of the vesicle to its binding site
on the active zone. Although Ca2+ normally enters the cell through voltage-operated
channels that are opened by the depolarization of the nerve terminal that occurs as the
action potential propagates along the nerve axon, release of transmitter will not occur if
Ca2+ does not enter the nerve terminal.

The flow of Na+ into the nerve terminal would depolarize the membrane and open Ca2+
channels, leading to Ca2+ entry and exocytosis. However, Na+ entry does not directly
stimulate exocytosis. K+ does not affect the nerve terminal membrane.
101. Which cell in cerebellum produces feed-
forward inhibition -
a) Golgy cell

b) Basket cell

c) Granule cell

d) Stellate cell

Correct Answer - B
Ans. is 'b' i.e., Basket cell
[Rel Principal of medical physiology 3'd/e p. 139).
In feed-forward inhibition, a neuron is connected through two
pathways one excitatory and one inhibitory.
For example, in cerebellum the stimulation of Basket cells produces
IPSPs (inhibitory postsynaptic potentials) in Purkinje cells.
102. The minimum distance for two point
discrimination on fingertips -
a) 2 mm

b) 5 mm

c) 7 mm

d) 10 mm

Correct Answer - A
Ans. is'a'i.e., 2mm
lRef: Ganong 25th/ep. 170 6 24'h/e p. 1621
The magnitude of two point discrimination thresholds varies from
place of place on the body and is smallest where touch receptors
are most abundant.
Stimulation points on the back must be separated by at least 65 mm
before they can be distinguished as separate, whereas on the
fingertips two stimuli are recognized if they are separated by as little
as 2 mm.
103. Rhomboid major is supplied by which
type of neuron?
a) Unipolar

b) Pseudounipolar

c) Bipolar

d) Multipolar

Correct Answer - D
Ans. is 'd' i.e., Multipolar
(Ref: Principles of medical physiology p. 129)
All skeletal muscles are supplied by motor neurons which are
multipolar neurons.
104. Cortical area controlling vestibular
function is located in ?
a) Frontal lobe

b) Parietal lobe

c) Occipital lobe

d) All of the above

Correct Answer - B
Ans. is'b'i.e., Parietal lobe
[Rel Gray's Anatomy'E book p. j20)
Information from the vestibular nuclei also reaches the cerebral
cortex by way of thalamus (probably via posterior parts of the
ventroposterior complex and the medial pulvinar).
The primary vestibular cortical area is located in the parietal lobe
 105. Sympathetic system has adrenergic
nerve endings at all sites except?
a) Heart

b) Blood vessels in skeletal muscles

c) Eye

d) None

Correct Answer - B
Ans. is 'b' i.e., Blood vessels in skeletal muscles
(Ref: Principles of medical physiologY p. 241
Sympathetic adrenergic fibers are those which secrete endogenous
catecholamines (either adrenaline, nor-epinephrine / nor-adrenaline
or dopamine)
Some sympathetic fibers do not secrete catecholamines but
secrete acetylcholine -
1. Sweat glands
2. Blood vessels in skeletal muscles
106. Location of a-1 sympathetic receptors?
a) Blood vessels

b) Bronchi

c) Sweat glands

d) Heart

Correct Answer - A
Ans. is'a' i.e., Blood vessels
(Ref: Ganong 25thie p. 260)
107. Relaxation of Detrusor occurs via which
receptors?
a) β-1 sympathetic

b) β-2 sympathetic

c) a-1 sympathetic

d) a-2 sympathetic

Correct Answer - B
Ans. is 'b' i.e., β-2 sympathetic
Relaxation of detrusor is through beta-2 receptors.
108. Muscles have which efferent nerve fibers
for regulating tone?
a) a-neuron

b) Gamma neuron

c) Beta neuron

d) Delta neuron

Correct Answer - B
Ans. is 'b' i.e., Gamma neuron
(Ref: Ganong 23'd/e p.158-162; Guyton 12n/e p. 657)
Muscle tone is maintained by stretch reflex through muscle spindles
(intrafusal fibers).
109. Find faulty statement regarding muscle
spindle
a) Central zone has no active & myosin

b) Peripheral zone has no actin & myosin

c) Type 1 nuclear bag fibers has low myosin ATP ase activity

d) Type 2 nuclear bag fiber has has high level of myosin ATPase
activity

Correct Answer - B
B i.e. Peripheral zone has no action & myosin
110. Non-specific nuclei of thalamus is
related to which sense / function ?
a) Arousal / alerting

b) Pain & temperature

c) Olfaction

d) Posture

Correct Answer - A
Ans. is 'a' i.e., Arousal / Alerting
(Ref: Principles of medical physiology p. 717)
Non Specific Nuclei:
These nuclei also receive sensory information but project to the
cortex in a diverse manner.
Therefore they seem to be involved in the arousal induced by
sensory stimuli.
These nuclei are intralaminar and reticular nuclei.
111. Rate limiting step in facilitated diffusion?
a) Availability of contransport

b) Conformational change in transporter

c) Synthesis of carrier protein

d) Polarization of solute

Correct Answer - B
Ans. is'b'i.e., Conformational change in transporter
(Ref: Essentials of membrane Biophysics p. 25I).
The relative slowness of the rate constant for conformational change
reorienting the Solute-unoccupied transporter (Step-4) makes it the
rate-limiting step in the process of facilitated diffusion.
112. Following occurs in living cells only?
a) Simple diffusion

b) Facilitated diffusion

c) Osmosis

d) Active transport

Correct Answer - D
Ans. is 'd' i.e., Active transport
[Ref Principles of medical physiology p.12]
"Because the formation and breakdown of ATP require cell activity,
active transport mechanisms occur through living membranes."
Active transport require energy (ATP). Energy is produced in living
cells. Therefore, active transport is possible only in living cells.
113. Concentration of urea on one side (side
A) of permeable membrane is 20 and on
other side (side B) is 40. If concentration
on side A is increased to 40, what will
happen to rate of diffusion?
a) It will become double

b) It will become four times

c) It will be zero

d) It will be reduced four times

Correct Answer - C
Ans. is 'c' i.e., It will be zero
[Ref: Principles of medical physiology p. 71)
This question, the concentration gradient is zero as both sides (A &
B) have same concentration (40) of urea.
Thus there is no diffusion + Rate of diffusion is zero.
114. Demyelination is the major feature of Multiple Sclerosis. Which of the
following cells forms myelin in the central nervous system?

a) Astrocytes

b) Ependymal cells

c) Microglia

d) OIigodendrocytes

Correct Answer - D
The myelin sheath is formed by oligodendrocytes in CNS and by Schwann cells in
the peripheral nervous system (PNS).
The gaps formed between myelin sheath cells along the axons are called nodes of
Ranvier.
Since the lipid structure of myelin serves as a good insulator, the myelin sheaths increase
the rate of propagation and efficacy of transmission of the impulse along the axon.
The electrical impulse jumps from one node to the next at the rate as fast as 120 m/s. This
rapid type of conduction is called saltatory conduction. Demyelination can occur early in
life as consequence of congenital metabolic disorders. Demyelination later in life can be
repaired with glia, which explains the frequent exacerbations and remissions in MS. It is
believed that in MS, multiple mechanisms of immune injury of myelin coexist: cytokine-
mediated injury of oligodendrocytes and myelin, digestion of surface myelin antigens by
macrophages, complement-mediated injury, and direct injury by CD4+ and CD8+ T cells.
This type of injury causes the loss of saltatory conduction in nerve fibers. The exposed
axon is susceptible to further injury, resulting in irreversible axonal damage.
Glial cells do not carry action potentials, but they have many important functions. There are
several types of glial cells: astrocytes, which transport nutrients to neurons, hold neurons
in place, digest parts of dead neurons, and regulate the composition of extracellular space,
and microglia, which possess phagocytic function, clean up debris, and protect the brain
from microorganisms.
Ependymal cells form the epithelial lining of the ventricle.

Ref: Lomen-Hoerth C., Messing R.O. (2010). Chapter 7. Nervous System Disorders. In S.J.
McPhee, G.D. Hammer (Eds), Pathophysiology of Disease, 6e.
115. Blood Brain Barrier is/are formed by:
a) Oligodendrocytes

b) Microglial cell

c) Astrocytes

d) Schwann cell

Correct Answer - C
C i.e. Astrocytes; E i.e. Neuroglia
116. Which of the following are unmyelinated
nerve fibers?
a) Proprioceptive fibers

b) Motor neuron to muscle

c) Postganglionic sympathetic fibers

d) Motor nerve to intrafusal fibers

Correct Answer - C
Ans. is 'c' i.e., Postganglionic sympathetic fibers
[Ref Ganong 24h/e p. 92; Principles of medical physiology p. 5I2l
Type C fibers are unmyelinated fibers which include postganglionic
autonomic fibers,
117. cGMP is involved in which pathway?
a) Taste

b) Phototransduction

c) Smell

d) Olfaction

Correct Answer - B:C:D

Ans. is'b> c & d'i.e., Phototransduction > Smell & Olfaction
"cGMP regulates retinal phototransduction in rod cone
photoreceptors, and cAMP d cGMP regulate olfaction".
118. Sensory receptors with delayed recovery
and least coverage?
a) Pacinion corpuscle

b) Ruffini endings

c) Meissner corpuscle

d) Merkel's disc

Correct Answer - D
Ans. D. Merkel's disk
Receptive field of sensory receptors :
Smallest receptive field (Least coverage) : Merkel's disc, Meissner
corpuscles ii) Wide receptive field : Pacinian corpuscle, Ruffini end
organ (Ruffini corpuscle)
Adaptation of sensory receptors :-
Rapidly adapting (rapid recovery) → Meissner's corpuscles,
Pacinian corpuscles, II) Slowly adapting (delayed recovery) -4
Merkel's disc, Ruffini's end organs
119. Leptin is secreted by?
a) Ovaries

b) Adipose tissue

c) Liver

d) Hypothalamus

Correct Answer - B
Ans, B, Adipose tissue.
(Ref: Principles of medical physiology p.p'704)
Leptin is a protein hormone produced by fat cells of adipose tissue.
It acts on hypothalamus to reduce food intake, decrease lipogenesis
and increase lipolysis, thereby reducing the body fat stores.
120. Which extrapyramidal tract act along
with lateral spinothalamic tract?
a) Reticulospinal tract

b) Rubrospinal tract

c) Tectospinal tract

d) Vestibulospinal tract

Correct Answer - B
Ans. b Rubrospinal tract
[Rpf Genong 2n/e P' 241)
Descending tracts concerned with distal muscles of the limb those
muscles which mediate fine skilled movements) occupy lateral white
column and are called lateral pathways, Lateral pathways include
lateral corticospinal tract and rubrospinal tracts.
121. 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.
122. Position in decorticate rigidity ?
a) Flexion of elbow and extension of knee

b) Extension of elbow and flexion of knee

c) Flexion of elbow and knee

d) Extension of elbow and knee

Correct Answer - A
Ans. is 'a' I,e,, Flexion of elbow and extension of knee
[Ref Principles of medical physiology p, 629]
A decorticate rigidity is made by removing the whole cerebral cortex
but leaving the basal ganglia intact.
Decorticate rigidity is characterized by flexion of upper extremities at
elbow and extension of lower extremities.
The flexion is due to rubrospinal tract excitation of flexors in the
upper extremities and hyperextension of the lower extremity has
same mechanism as in decerebrate rigidity.
123. During Flight or Fight reaction, which of
the following is responsible for increase
in local blood flow :
a) Sympathetic system mediated Cholinergic release

b) Local hormones

c) Para-sympathetic cholinergic

d) Endocrine factors only

Correct Answer - A
A i.e. Sympathetic mediated cholinergic release
The 'flight or fight' reaction is a sympathetic alarm reaction wherein a
large portion of sympathetic nervous system discharged at the same
timeQ, in response to a variety of stress.
124. All are true regarding corticospinal tract
except?
a) Also called pyramidal tract

b) Maximum fibers arise from primary motor cortex

c) Forms pyramids in medulla

d) 80% fibers are crossed

Correct Answer - B
Ans. is 'b' I,e,, Maximum fibers arise from primary motor cortex
[Ref Principles of medical physiology p.238-239
Corticospinal tract is the most important tract through which the
motor cortex controls the activity of the ventral horn cells (alpha-
motor neurons) in the spinal cord.
It is also called pyramidal tract because they form the pyramid of the
medulla.
125. Which hormone is secreted from
stomach that control intake of food:
a) Orexin

b) Insulin like growth hormone

c) Cholecystokinin

d) Ghrelin

Correct Answer - D
Ans. D i.e. Ghrelin
Ghrelin, is released by stomachs, especially during fasting and
stimulates appetites (orexigenic).
CCK, Peptide YY/PYY (secreted from entire gitract but especially
from ileum & colon), glucagon like peptide (secreted by intestines d/t
presence of food) and insulin (produced in response to GLP) are
gastrointestinal hormonal factors, which suppress feeding i.e. cause
satiety (anorexigenic). Whereas, ghrelin another gastrointestinal
hormone produced mainly by stomach is orexigenic (i.e. increase
appetite).
Growth hormone (GH) also k/a somatotropic hormone or
somatotropin exerts much of its effects through intermediate
substances called somatomedins secreted by liver (and to a much
less extent, other tissues). Because many effects of somatomedins
on growth are similar to those of insulin, therefore somatomedins are
also called insulin like growth factors (IGFs). Out of 4 somatomedins
isolated, the most important is somatomedin C (or IGF-1) and
pygmies of Africa & Levi-Lorain dwarf have congenital inability to
synthesize significant amount of IGF-1.
Orexin (hypocretin) producing neurons occur in hypothalamus.
Orexins A and B increase feeding (appetite) whereas, brains from
humans with narcolepsy have fewer orexin producing neurons in
hypothalamus. - Cholecystokinin (CCK) is secreted by I cells of
upper small intestine (jejunum) and decreases feeding
(antiorexigenic / aorexigenic), inhibits gastric emptying, and
stimulates secretion of pancreatic juice rich in enzymes, contraction
of gall bladder, secretion of glucagon & insulin and small intestine &
colonic motality.
It is a gastrointestinal hormone synthesized & released mainly by
oxyntic cells of stomach (Guyton) / P or D1 cells of fundus of
stomach. It is also produced by the intestine & epsilon cells of
pancreas in small amounts. Ghrelin acts to stimulate hunger
(appetite)Q. So blood levels rise during fasting, peak just before
eating and then fall rapidly after a meal (orexigenic). In this way, it is
counter part of hormone leptin, produced by adipose tissue, which
induces satiation (i.e. is anti-orexigenic) when present at higher
levels.
Ghrelin is also produced in arcuate nucleus of hypothalamus and
has marked growth hormone stimulating activity i.e. it stimulates GH
secretion from anterior pituitary gland by acting directly on receptors
in pituitary.
G protein coupled ghrelin receptor formerly k/a growth hormone
secretagogue (GHS) receptor is expressed in arcuate nucleus,
lateral hypothalamus, vagal afferent cell bodies & vagal afferent
endings through out gastrointestinal tract.
It has an important role in neurotrophy, particularly in hippocampus
and is essential for cognitive adaptation to changing environment
and process of learning.
126. Which of the following is most prone to
hypoxic injury ?
a) Thalamus

b) Hippocampus

c) Caudate nucleus

d) Caudate nucleus

Correct Answer - B
B i.e. Hippocampus
127. Amount of coronary flow per minute is?
a) 225 ml

b) 250 ml

c) 50 ml

d) 300 ml

Correct Answer - B
Ans. B i.e. 250 ml
128. What is produced by lung tissue to be
used in lungs?
a) Angiotensin I

b) Renin

c) Surfactant

d) Angiotensin II

Correct Answer - C
Ans. is'c'i.e., Surfactant
Among the given options, two substances are formed in lung-
Surfactant: Used by lungs alveoli to reduce surface tension.
Angiotensin II : ACE in lungs convert angiotensin I to angiotensin II.
But angiotensin II mainly acts on blood vessels, kidney and adrenal
cortex.
129. Non-respiratory function of lungs ?
a) Anion balance

b) Sodium balance

c) Potassium balance

d) Calcium balance

Correct Answer - B
Ans. is 'b' i.e., Sodium balance
(Ref: Lecture notes on human physiology 4th/e p. 400]
One of the most important metabolic (non-respiratory) function
of lungs:
As a part of renin-angiotensin-aldosterone system, lungs indirectly
regulate sodium and water balance (and BP).
However, lungs also directly affect Na+ balance is epithelial Na+
channels (E NaCs).
130. Functional residual volume is?
a) After normal inspiration

b) After normal expiration

c) After forceful expiration

d) After forceful inspiration

Correct Answer - A
Ans:A. After normal inspiration
Functional Residual Capacity (FRC) is the volume of air present in
the lungs at the end of passive expiration.
131. Largest protein in body is ?
a) Titin

b) Myosin

c) Actin

d) Troponin

Correct Answer - A
Ans. is 'a' i.e.,Titin
Titin is a muscle protein
It connects Z lines with M line in a sarcomere
It is responsible for passive elasticity of a muscle
Titin is the third most abundant protein of human body (after myosin
and actin)
Titin is the largest protein in human body. It has 34350 aminoacids.
132. G protein of G protein coupled receptors
are attached to?
a) Aminoterminal end

b) Carboxyterminal end

c) Third transmembrane domain

d) Seventh transmembrane domain

Correct Answer - B
Ans. is 'b' i.e., Carboxyterminal end
G protein coupled receptors are receptors which are coupled to G
protein, G proteins are proteins which get activated on binding to
GTP
There are two types of G proteins, Small G proteins, Heterotrimeric
G proteins
133. When glucose concentration in blood
increases, there is linear increase in?
a) Insulin

b) Glucagon

c) Growth Hormone

d) Cortisol

Correct Answer - A
Ans. is 'a' i.e., Insulin
When blood glucose concentration increases, glucose enters into
pancreatic 13 cells. Glucose goes through glycolysis and citric acid
cycle in 13 cells. ATP is generated. ATP closes K+ channels. This
causes depolarization of pancreatic 13 cells. Depolarisation and the
resultant action potential opens up voltage gated calcium channels.
Entry of calcium ions causes exocytosis of insulin release.
134. Which of the following is action of
insulin ?
a) Gluconeogenesis

b) Increased glucose uptake in muscle

c) Glycogenolysis

d) Increased glucose uptake in endothelium

Correct Answer - B
Ans. is 'b' i.e., Increased glucose uptake in muscle
Insulin is a hypoglycemic and anabolic hormone Immediate effects
of insulin:
Immediate effects of insulin include the effect of insulin on causing
glucose and potassium uptake into cells, Insulin stimulates glucose
uptake into cells by Stimulating GLUT4 transporter up regulation
across the membranes of skeletal muscle, cardiac muscle and
adipose tissue
Stimulating glucokinase in liver. As glucokinase is stimulated in liver,
glucose in liver is converted to glucose 6 phosphate. This reduces
glucose level within hepatocytes. This stimulates further glucose
uptake into hepatocytes
135. Hepatic encephalopathy is caused by an
increase of ?
a) Urea

b) Glutamate

c) Ammonia

d) Fattyacid

Correct Answer - C
Ans. is 'c' i.e., Ammonia
Hepatic encephalopathy is characterized by altered level of
consciousness, caused by liver disorder.
Liver disorder is characterized by elevation of ammonia. As liver is
considered with detoxification of ammonia to form urea, in liver
failure ammonia level is elevated.
Hepatic encephalopathy basically presents with manifestations of
CNS depression
136. Products of Phospholipase C are ?
a) Inositol and diacylglycerol

b) Inositol triphosphate and Diacylglycerol

c) Lysophospholipid and fattyacid

d) Phosphatidate and IP2

Correct Answer - B
Ans. is 'B' i.e., Inositol triphosphate and Diacylglycerol
IP3 or Inositol triphosphate and DAG or Diacyl glycerol are second
messengers formed from Phosphatidyl inositol diphosphate (PIP2)
by the action of Phospholipase C.
Activation of phospholipase (by stimulatory G protein) hydrolyses the
membrane phospholipid phosphatidyl inositol 4, 5 bisphosphate
(PIP2) to generate the second messenger inositol 1, 4, 5 -
triphosphate (IP) and diacylglycerol (DAG).
137. Hepcidin associated with which
molecule?
a) Iron

b) Copper

c) Selenium

d) Flurine

Correct Answer - A
Ans. is 'a' i.e., Iron
Hepcidin is a positive acute phase reactant. Hence during
inflammation, liver releases more hepcidin. This inhibits basolateral
side transport of iron along intestine. This results in a hematological
picture which mimics iron deficiency anemia. This is the basis of
Anemia of Chronic Disease
138. Synthetic Orygen carrier is made up of_
a) Iron

b) Bronze

c) Molybdenum

d) Flurine

Correct Answer - D
Ans. is 'd' i.e., Flurine
Blood doping is a form of fraudulent increase in the oxygen carrying
capacity of a person, widely used to improve the aerobic capacity of
athletes.
139. Hardening of sodalime done by?
a) CaCO

b) CaSO4

c) BaSO4

d) Sodium silicate

Correct Answer - D
Ans. is 'd' i.e.,Sodium silicate
Soda lime is a mixture of chemicals, used in granular form in closed
breathing environments, such as general anaesthesia to remove
carbon dioxide from breathing gases to avoid hypercarbia
140. Unit of turbidity is calculated by ?
a) Measuring the scattered light at 90°

b) Measuring the scattered light at 180°

c) Measuring the scattered light at 270°

d) Measuring scattered light at 135°

Correct Answer - A
Ans: A. Measuring the scattered light at 90°
IT is involved with measuring the amount of transmitted light (and
calculating the absorbed light) by particles in suspension to
determine the concentration of the substance in question.
Amount of absorbed light, and therefore, concentration is dependent
on, Number of particles, Size of particleS, Measurements are made
using light spectrophotometers
Turbidity Unit is the International Standard Unit. Both measure the
light scattered at 90o. NTU uses white light with peak spectral output
at 400 to 680nm as light source. FTU uses Infrared monochromatic
light with peak output at 780 to 900nm as light source.
141. Nephelometry measures the light?
a) Absorbed

b) transmitted

c) Scattered

d) Refracted

Correct Answer - C
Ans. is 'c' i.e., Scattered
When particles are suspended in a solution in a cuvette, they make
the solution unclear (turbid).
Nephelometry is concerned with measurement of scattered light
from a cuvette containing suspended particles in a dilute solution.
The components of a nephelometer are the same as a light
spectrophotometer except that the detector is placed at a specific
angle from the incident light
142. Collagen protein axial periodicity is -
a) 67nm

b) l07nm

c) 207nm

d) 307nm

Correct Answer - A
Ans. is 'a' i.e., 67 nm.
The fibrillogenesis involves the lateral association of collagen triple
helices, the structural unit of collagen, to form long, smooth fibrils
with a characteristic 67-nm axial structural feature known as the D-
periodicity or axial periodicity.
143. Primary bile acid secreted by liver is ?
a) Chenodeoxycholic acid

b) Lithocholic acid

c) Deoxycholic acid

d) Lithodeoxycholate

Correct Answer - A
Ans. is 'a' i.e., Chenodeoxycholic acid [Ref: Ganong 22"/e p. 26]
The primary bile acids are produced from cholesterol in liver. These
are cholic acid and chenodexycholic acid. These are conjugated with
glycine or taurine. So primary bile acids are glycocholic acid,
glycochenodeoxycholic acid, taurocholic
acid, and taurochenodeoxycholic acid. The primary bile acids are
secreted in bile and in the lower parts of small intestine, primary bile
acids are converted to secondary bile acids by bacterial enzymes.
Secondary bile acids are deoxycholic acid and lithocholic acid.
144. Concentration of which of the following
is maximum in a cell next to water ?
a) Protein

b) Fat

c) Sodium

d) Carbohydrates

Correct Answer - A
Ans. is 'a' i.e., Protein
Most of the cytosol is water, which makes up about 70% of the total
volume of a typical cell.
Next higher concentration is of proteins. Protein molecules that do
not bind to cell membranes or the cytoskeleton are dissolved in the
cytosol. The amount of protein in cells is extremely high, and
approaches 200 mg/ml, occupying about 20​30% of the volume of
the cytosol
145. True about chaperone?
a) Also known as HS proteins

b) Have ATPase activity

c) Always bind to specific areas on unfolded proteins

d) They always acts as foldases

Correct Answer - A
Ans. is 'a' i.e., Also known as HS proteins
Chaperones are proteins which help in folding or unfolding of
proteins
Molecular chaperones prevent aggregation and promote refolding
after stress and hence promote cell survival. This so-called stress
response is ubiquitous and conserved across all organisms. Hence
Chaperones are otherwise known as heat shock proteins (HSP)
Chaperones are synthesized in response to heat and other stress
conditions like exposure to heavy metals, UV radiation, oxidative
stress, nutrient deficiencies, dehydration, osmotic pressures and
viral infections. Hence, they are otherwise called as stress proteins
146. Best sample for DNA karyotyping ?
a) Blood

b) Bone marrow

c) Amniotic fluid

d) Chorionic villi

Correct Answer - A
Ans. is 'a' i.e., Blood
Karyotyping is the study of number and appearance of
chromosomes,
Most commonly used sample is blood. Blood is centrifuged. WBCs
are separated. White Blood cells are rapidly dividing cells with DNA.
147. Taq DNA polymerase true is ?
a) Thermolabile

b) High fidelity

c) Optimum temperature for chain elongation is 75°

d) Has 3'S' exonuclease activity

Correct Answer - C
Ans. is 'c' i.e., Optimum temperature for chain elongation is 75° [Ref
Clinical biochemistry p. 888]
As the DNA polymerase that is used in this process should be
capable of withstanding repeated cycles of 94 or 95°C, the enzyme
should be thermostable. Hence the DNA polymerase used in
Polymerase Chain Reaction is extracted from an organism which
lives in hot springs. That organism being Thermus aquaticus and
hence the DNA polymerase is Taq DNA polymerase.
Optimum temperature required for this enzyme for elongation is
75°C. Hence elongation is carried out at 72°C.
148. Epigenetics is ?
a) Alteration in nucleotide sequence

b) Alteration in chromosome number

c) Alteration in gene expression

d) Alteration in chromosome size

Correct Answer - C
Ans. is 'c' i.e., Alteration in gene expression [Ref Essentials of
molecular biochemistry p. 321]
Epigenetics is a heritable change in the level of gene expression, not
caused by changes in DNA sequence. It includes changes like
Histone modification or DNA methylation
149. Which radioisotope labeled molecule is
used to find out rate of DNA synthesis?
a) [H3] Thymidine

b) [H2] Thymidine

c) [H3] Adenine

d) [H2] Adenine

Correct Answer - A
Ans. is 'a' i.e.,[H3] Thymidine [Ref Essentials of molecular
biochemistry p. 321]
One application of isotope labeling would be in measuring DNA
synthesis, that is cell proliferation in vitro. uses [H3]- thymidine
labeling to compare pattern of synthesis (or sequence) in cells.
150. Which of the following is an example of
post translational modification ?
a) Gamma carboxylation of glutamate residues

b) N glycosylation of proteins

c) 7 methyl Guanosine capping

d) Poly A tail addition

Correct Answer - B
Ans. is 'a > b' i..e, Gamma carboxylation of glutamate
residues, N glycosylation of proteins
[Ref Lippin cott's 3'/e p. 429]
Important post-transcriptional modifications are?
7 methyl guanosine capping along 5' end of mRNA
Poly A tail addition along 3' end of mRNA
Removal of introns and linkage of exons - RNA splicing
151. Disease caused by trinucleotide repeats
are all except?
a) Huntington's chorea

b) Myotonic dystrophy [dystrophia myotonica]

c) Friedrich's ataxia

d) Hereditary Nonpolyposis Colon Cancer

Correct Answer - D
Ans. is 'd' i.e., Hereditary Nonpolyposis Colon Cancer [Ref
Essentials of biochemistry p. 676]
Examples of trinucleotide repeat mutation :?
1) Huntignton's disease 2)
Spinocerebella ataxia
3) Friedreich ataxia 4) Fragile - X-
syndrome
5) Dystrophia myotanica 6) Dentorubral
pallidoluysiane atrophy 7) X-chromosome spinobulbar muscular
atrophy
152. Watson and Crick are associated with ?
a) Discovery of helical structure of DNA

b) Association of Helicobacter pylori with chronic gastritis

c) Discovery of HIV virus

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Discovery of helical structure of DNA
153. Pulsed gel electrophoresis is used for?
a) DNA

b) RNA

c) Ribosome

d) Protein

Correct Answer - A
Ans. is 'a' i.e., DNA [Ref Essential of biochemistry p. 912]
Large DNA of size larger than 15 to 20 KB can be separated with
higher resolution by periodically changing the voltage direction. This
is called as pulsed gel Electrophoresis
154. Which of the following can carry larger
genome ?
a) Plasmids

b) BAC

c) YAC

d) Cosmids

Correct Answer - C
Ans. is 'c' i.e., YAC [Ref Harper's 30th/e p. 454 & 29th/e p. 437]
Vector DNA insert size
Plasmid 0.01-10 kb
Phage 10-20 kb
Cosmid 35-50 kb
BAC, PAC 50-250 kb
YAC 500-3000 kb
155. Which micronutrient deficiency causes
anemia?
a) Copper

b) Molybdenum

c) Selenium

d) Flurine

Correct Answer - A
Ans. is 'a' i.e., Copper
Copper containing protein ceruloplasmin is necessary for transport
of iron in the Ferric form across membranes
Copper is an integral component of ALA synthase, which is
necessary for heme synthesis
Copper helps in the uptake of iron across normoblasts
156. Which of the following is a component of
Coenzyme A?
a) 3 Alanine

b) Glycine

c) Pyrrolysine

d) Selenocysteine

Correct Answer - A
Ans. is 'a' i.e., 3 Alanine
Coenzyme A is a carrier of acyl group. Hence it takes part of fatty
acid synthesis and fatty acid oxidation
It is formed from pantothenic acid and mercaptoethanolamine,
Pantothenic acid is formed from pantoic acid and p alanine
157. B12 deficiency causes ?
a) Demyelination

b) Dermatitis

c) Burning foot syndrome

d) Beriberi

Correct Answer - A
Ans. is 'a' i.e., Demyelination
B12 in the form of Adenosyl B12 acts as a coenzyme for Methyl
malonyl CoA mutase. Methyl Malonyl CoA mutase helps in the
conversion of methyl malonyl CoA to Succinyl CoA.
in B12 deficiency, methyl malonyl CoA accumulates. Methyl Malonyl
CoA gets incorporated into fatty acids (instead of malonyl CoA).
This results in abnormal fatty acids getting synthesized. When these
fatty acids get incorporated in myelin, it results in rapid
demyelination
158. Deficiency of zinc causes all except ?
a) Diarrhea

b) Acrodermatitis

c) Vitamin A deficiency

d) Neuropathy

Correct Answer - D
Ans. is 'd' i.e., Neuropathy
·Zinc is found in skeletal muscle and in bones, Sources of Zinc are
grains, beans, cheese, Shell fish
·Zinc is absorbed from duodenum, stored in liver in conjugation with
metallothionein··Zinc is necessary for synthesis of Retinol Binding
Protein.
Hence Zinc deficiency is found to present with Vitamin A deficiency
159. Hemopexin binds ?
a) Heme

b) Hemoglobin

c) Iron

d) Bilirubin

Correct Answer - A
Ans. is 'a' i.e.,Heme·
Hemopexin is a glycoprotein which exhibits the highest affinity for
free heme
Hemopexin's function is to protect the cell and tissues from oxidative
damage cause by heme. Because hemopexin does not only bind to
free heme but also facilitate the uptake of heme into liver by binding
to specific receptors on hepatocytes.
Hence hemopexin helps in recycling iron and the iron stores are
maintained. Hemopexin is also found to cause an upregulation of
heme oxygenasel enzyme, thereby they facilitate the conversion of
heme into bilirubin and biliverdin.
160. Common substrate for purine and
pyrimidine synthesis are all except ?
a) Glutamine

b) Glycine

c) Aspartate

d) Carbon dioxide

Correct Answer - B
Ans. is b i.e., Glycine [Ref Harper 30thIe p. 348]
Glutamine, aspartate (aspartic acid) and CO, are preursors for both
purines & pyrimidines.
In de novo synthesis, purine ring is formed from variety of precursors
is assembled on ribose-5-phosphate.
161. Guanine ring - True are all except ?
a) It has 9 atoms

b) Aspartate acts as the amino group donor for forming guanine

c) Carbonyl group at C6 acts as a hydrogen bond acceptor

d) It forms three hydrogen bonds with cytosine

Correct Answer - B
Ans. is 'b' i.e., Asparate acts as the amino group donor for forming
guanine
Guanine ring is a purine ring. Hence it has nine atoms included in
the ring.
It is formed from IMP (Inosine Mono Phosphate). IMP undergoes
dehydrogenation, in the presence of IMP dehydrogenase (NADP is
the coenzyme) to form Xanthosine Mono Phosphate (XMP). XMP
undergoes amination with glutamine to form GMP.
On the other hand, IMP undergoes amination with Aspartate to form
Adenylosuccinate. Adenylosuccinate in the presence of
Adenylosuccinate lyase to form AMP and fumarate.
162. The protein rich in basic amino acids,
which functions in the packaging of DNA
in chromosomes, is:
a) Histone

b) Collagen

c) Hyaluronic acid binding protein

d) Fibrinogen

Correct Answer - A
A i.e. Histone
163. Which enzyme joins two substrates?
a) Lyase

b) Ligase

c) Isomerase

d) Synthase

Correct Answer - B
Ans. is 'b' i.e., Ligase
[Ref Chatterjea 8thie p. 123-124]
An enzyme which joins two substrates in an energy dependent
process is called ligase.
Ligases ligate or bind two compounds together by creating a new
chemical bond. A source of energy is required, usually ATP,
Example are synthatases, carboxylases.
164. Trypsin, Chymotrypsin & Elastases -
What type of enzymes are they?
a) Hydrolases

b) Lyases

c) Synthases

d) Synthetases

Correct Answer - A
Ans. is 'a' i.e., Hydrolases
All digestive enzymes (trypsin, pepsin, elastase, chymotrypsin) are
hydratases.
165. True about allosteric enzyme?
a) Single unit enzyme

b) Follows saturation kinetics

c) Allosteric activity is more prominent in the active site of the

enzyme

d) Hill's equation is used to study the kinetics of allosteric enzyme

Correct Answer - D
Ans. is 'd' i.e., Hill's equation is used to study the kinetics of allosteric
enzyme
Allosteric enzyme is an enzyme in which activity in one subunit
affects activity in another subunit. Hence allosteric enzymes are
mostly multi subunit enzymes.
Most commonly, in an allosteric enzyme, binding of an allosteric
regulator to an allosteric site, affects activity in the active site of an
enzyme.
166. Allosteric inhibition of an enzyme is ?
a) Binding of inhibitor to catalytic site and inhibition of enzyme

b) Binding of inhibitor to other site and inhibition of enzyme

c) Inhibition of enzyme by inhibitors without binding to enzyme

d) Inactivation by phosphorylation or dephosphorylation

Correct Answer - B
Ans. is 'b' i.e., Binding of inhibitor to other site and inhibition of
enzyme
Some enzymes, called allosteric enzymes, posses a site, in addition
to substrate binding (catalytic) site, known as the allosteric site.
Binding of allosteric modulator at the allosteric site affects the
conformation of catalytic site.
Such enzymes are called allosteric enzymes.
The allosteric modulator (regulator) may facilitate the conformational
change of catalytic site, required for substrate binding.
Such regulators are called allosteric activators (positive allosteric
modifier); for example, fructose-2, 6-bisphosphate is an allosteric
activator of Phosphofructokinase-I.
Some allosteric regulators prevent the conformational change
required for binding of the substrate.
Such regulators are called allosteric inhibitors (negative allosteric
modifier); for example, citrate is an allosteric inhibitor of
phosphoructokinase-I.
167. Which of the following aminoacids is a
component of Thioredoxin reductase?
a) Selenocysteine

b) Cysteine

c) Methionine

d) Homocysteine

Correct Answer - A
Ans. is 'a' i.e., Selenocysteine [Ref Dinesh purl 22"e/e p. 72]
Selenocysteine is present at the active site of some enzymes that
catalyze redox reactions, e.g. thioredoxin reductase, glutathione
peroxidase, and the deiodinase (converts thyroxin to triiothyronine).
168. Co enzyme for dopa decarboxylase?
a) Biotin

b) Vitamin B6

c) Vitamin C

d) B12

Correct Answer - B
Ans. is 'b' i.e., Vitamin B6
All decarboxylases require pyridoxin (vitamin B6)
169. Example of metallo enzyme is ?
a) Lysyl oxidase

b) Lysyl hydroxylase

c) Prolyl hydroxylase

d) Glucosyl transferase

Correct Answer - A
Ans. is 'a' i.e., Lysyl oxidase
[Ref Harper 30th p. 675]
Lysyl oxidase is a metalloenzyme (copper containing
170. True about transfer of electrons in
electron transport chain is ?
a) All the complexes are arranged in an increasing order of redox
potential

b) The direction of transport of electrons in C - Complex III Q -

Complex I -› Complex IV

c) All the complexes are arranged in an increasing order of energy

d) 10 hydrogen ions get translocated when FADH2 electrons get

into electron transport chain

Correct Answer - A
Ans. is 'a' i.e., All the complexes are arranged in an increasing order
of redox potential·
The complexes of electron transport chain are arranged in an
increasing order of redox potential or decreasing order of energy
level.
The direction of transport of electrons from NADH is Complex I -) Q
Complex III -) Complex C -> Complex IV Oxygen.
The direction of transport of electrons from FADH2 is Complexx II Q
Complex III - Complex C -) Complex IV - Oxygen.
171. GLUT 4 is present in ?
a) Endothelium

b) Liver

c) Cardiac muscle

d) Lens

Correct Answer - C
Ans. is 'c' i.e., Cardiac muscle
GLUT4 transporters mediate insulin dependent glucose uptake in
skeletal muscle, cardiac muscle and adipose tissue.
172. Inulin is a homopolymer of ?
a) Fructose

b) Glucose

c) Mannose

d) Galactose

Correct Answer - A
Ans. is 'a' i.e., Fructose
Inulin is a homopolymer made up of fructose.
173. True about carbohydrate absorption?
a) Glucose absorption occurs independent of sodium

b) Fructose absorption occurs dependent on Na

c) Fructose absorption occurs via SGLT 1

d) Fructose absorption is not by secondary active transport

Correct Answer - D
Ans. is 'd' i.e., Fructose absorption is not by secondary active
transport
Glucose absorption
Fructose absorption along the apical side is by GLUT 5 transporter.
GLUT 5 transporter is an example of facilitated passive diffusion
Fructose absorption along the basolateral side is by GLUT 5
transporter or through GLUT 2 transporter
Thus Fructose absorption along both apical side and basolateral
side is by facilitated passive diffusion.
174. In Citric acid cycle, which enzyme is
inhibited by arsenite?
a) Isocitrate Dehydrogenase

b) a ketoglutarate Dehydrogenase

c) Succinate Dehydrogenase

d) Aconitase

Correct Answer - B
Ans. is 'b' i.e., a ketoglutarate Dehydrogenase
Arsenite binds to the sulfhydryl group and hence inhibits the activity
of enzymes which have lipoamide in the active site, Hence Arsenite
inhibits Pyruvate Dehydrogenase and a ketoglutarate
dehydrogenase of citric acid cycle, It is an example for non
competitive inhibition, Succinate dehydrogenase is inhibited by
malonate.
175. Maximum number of enzymes of krebs
cycle are found in ?
a) Mitochondrial matrix

b) Intermembrane space

c) Cytosol

d) Ribosome

Correct Answer - A
Ans. is 'a' i.e., Mitochondrial matrix
Kreb's cycle or citric acid cycle happens in mitochondria. All
enzymes of citric acid cycle are present in mitochondrial matrix.
176. Overingestion of fructose leads to ?
a) Hypertriglycreidemia

b) Hypouricemia

c) Hyperphosphatemia

d) Hypoglycemia

Correct Answer - A
Ans. is 'a' i.e.,Hypertriglycreidemia
As Fructokinase is very active, following fructose ingestion, there is
increased utilization of ATP forming more ADP and AMP. AMP on
catabolism gives rise to uric acid. Hence it results in hyperuricemia.
A person who is on fructose based diet ends up getting
hypertriglyceridemia and hypercholesterolemia.
177. What are the enzymes required for the
formation of Phosphoenolpyruvate from
Pyruvate?
a) Pyruvate dehydrogenase and Pyruvate carboxylase

b) Lactate Dehydrogenase and Pyruvate Dehydrogenase

c) Pyruvate carboxylase and Phosphoenolpyruvate Carboxykinase

d) Phosphoenolpyruvate carboxykinase and Pyruvate

Dehydrogenase

Correct Answer - C
Ans. is 'c' i.e., Pyruvate carboxylase and Phosphoenolpyruvate
Carboxykinase
Pyruvate conversion to Phosphoenol pyruvate is a part of
gluconeogenesis, Pyruvate is converted to Oxaloacetate by
Pyruvate Carboxylase, Pyruvate Carboxylase requires Biotin as
coenzyme. It uses Carbondioxide in the form of Bicarbonate. It uses
ATP as a source of energy.
178. Maximum number of energy rich
phosphate is formed from which of the
following pathways?
a) Glycolysis

b) Gluconeogenesis

c) HMP shunt

d) Citric acid cycle

Correct Answer - D
Ans. is 'd' i.e., Citric acid cycle
Citric acid cycle or Kreb's cycle generates 10 ATPs for every acetyl
CoA that enters into citric acid cycle, Aerobic glycolysis generates 7
ATPS for every molecule of glucose, Anaerobic glycolysis generates
2 ATPs for every molecule of glucose utilised, HMP shunt is a
pathway which neither generates ATP nor utilises ATP.
179. Source of ATP in RBCs is ?
a) Glucose

b) Fatty acid

c) Aminoacid

d) Ketone body

Correct Answer - A
Ans. is 'a' i.e., Glucose
RBCs don't have mitochondria., The only pathway that provides ATP
even in anaerobic conditions is glycolysis.
Oxidation of reducing equivalents in the respiratory chain is coupled
with phosphorylation of ADP to ATP.
This is the most important mechanism for capturing the energy
present in various nutrients.
180. What is the inhibitor of Carnitine
Palmitoyl Transferase-1 [CPT-1]?
a) ATP

b) Acetoacetate

c) Succinyl CoA

d) Acyl CoA

Correct Answer - A
Ans. is 'a' i.e., ATP
[Ref Harper 30th le p. 186]
As CAT-1 is an enzyme catalyzing a catabolic process(produces
ATP), it is stimulated by anything which signals low energy like :
ADP, NAD, FAD, Glucagon (catabolic hormone), Acyl CoA (the
substrate)
181. Omega three fatty acid is?
a) Linoleic acid

b) Arachidonic acid

c) Cervonic acid

d) Oleic acid

Correct Answer - C
Ans. is 'c' i.e., Cervonic acid [Ref Harper 30th le p. 214]
182. Which 2 additional enzymes required in
Beta Oxidation of PUFA?
a) Dienoyl CoA isomerase and Enoyl CoA reductase

b) Dienoyl CoA isomerase and Dienoyl CoA reductase

c) Enoyl CoA racemase and Enoyl CoA reductase

d) Enoyl CoA isomerase and 2,4 Dienoyl CoA reductase

Correct Answer - D
Ans. is 'd' i.e., Enoyl CoA isomerase and 2,4 Dienoyl CoA reductase
Saturated Fatty acid oxidation begins with acyl CoA dehydrogenase
acting on a fatty acid.
Unsaturated fatty acid that is undergoing oxidation has a cis 43
bond, then Enoyl CoA isomerase converts into trans - 42 bond.
For oxidation of saturated fatty acids, the enzymes required are
Carnitine Acyl Palmitoyl Transferase I, Carnitine Acyl Palmitoyl
Transferase II, Acyl CoA dehydrogenase, Hydrap hydroacyl coA
dehydrogenase.
183. Carnitine shuttle is involved in ?
a) Fatty acid synthesis

b) Fatty acid oxidation

c) Cholesterol synthesis

d) Bile acid synthesis

Correct Answer - B
Ans. is 'b' i.e., Fatty acid oxidation
Very short chain, short chain, medium chain and long chain fatty
acids get oxidized in mitochondria,
Very short chain, short chain and medium chain fatty acids can
cross inner mitochondrial membrane by passive diffusion,
Long chain fatty acids cannot cross the inner mitochondrial
membrane. Hence they need a carrier. The carrier is carnitine.
Carnitine is p hydroxy y N trimethylaminobutyric acid. It is
synthesized from lysine.
184. The effect of Lipotropic agents on fat
metabolism is ?
a) Increases the rate of fatty acid synthesis in liver

b) Increases the rate of lipid output from liver

c) Increases the rate of cholesterol synthesis in liver

d) Decreases the rate of cholesterol synthesis in liver

Correct Answer - B
Ans. is 'b' i.e., Increases the rate of lipid output from liver
Lipotropic agents are substances which increase the rate of lipid
output from liver and they also stimulate the rate of lipid utilization in
extrahepatic tissues. This way, lipotropic agents protect liver from
fatty liver changes and liver cirrhosis.
185. Example for a conjugated protein is ?
a) Heme

b) Chylomicron

c) Albumin

d) Histone

Correct Answer - B
Ans. is 'b' i.e., Chylomicron
186. Intake of high protein diet causes?
a) Increased gluconeogenesis

b) Increased beta oxidation

c) Decreased glycogenolysis

d) Metabolic alkalosis

Correct Answer - A
Ans. is 'a' i.e., Increased gluconeogenesis
High protein diet is generally recommended for weight loss.
High protein diet is found to increase the rate of gluconeogenesis.
Glucogenic aminoacids in circulation is found to stimulate glucagon
release.
Glucagon stimulates Phosphoenol pyruvate carboxykinase and
glucose 6 phosphatase. This way blood glucose is increased and
this high blood glucose also has a satiation effect.
High protein diet also stimulates glycogenolysis because of its effect
on glucagon release.
187. Tyrosine deficiency causes ?
a) Depression

b) Hyperthyroidism

c) Hyperpigmentation

d) Phenylketonuria

Correct Answer - A
Ans. is 'a' i.e., Depression [Ref Essential of biochemistry p. 912]
Tyrosine deficiency causes hypothyroidism (lethargy, weight gain)
as tyrosine is required for T3 & T4; depression (due to dopamine
deficiency); albinism & hair hypopigmentation (due to deficiency of
melanin); and stunted growth (as tyrosine is a component of
proteins).
188. Hartnup disease is related to ?
a) Rickets symptoms

b) Pellagra symptoms

c) Burning foot syndrome

d) Angular stomatitis

Correct Answer - B
Ans. B. Pellagra symptoms
Hartnup disease
It is an inherited disorder in the metabolism of tryptophan.
It is due to defective transport of tryptophan and other neutral amino
acids in the intestine and kidney.
This results in deficiency of tryptophan leading to decreased
synthesis of niacin and serotonin.
Thus there are pellagra (niacin deficiency), neurological symptoms
(serotonin deficiency) and amino aciduria due to defective transport
of amino acids in kidney.
189. Oxaloacetate synthesized from which
amino acid -
a) Aspartate

b) Glycine

c) Serine

d) Valine

Correct Answer - A
Ans. is 'a' i.e.,Aspartate [Ref Harper 30th/e p. 298 & 29th/e p. 274]
Two most important transamination reactions are catalyzed by
alamine transminase (ALT) and aspartate transaminase (AST).
190. Oxidative deamination is catalyzed by ?
a) Glutaminase

b) Glutamine synthase

c) Glutamate dehydrogenase

d) None of the above

Correct Answer - C
Ans. is 'c' i.e., Glutamate dehydrogenase
191. Replacing alanine by which amino acid will increase UV absorbance of
protein at 280nm wavelength?

a) Leucine

b) Proline

c) Arginine

d) Tryptophan

Correct Answer - D
Aromatic amino acids (phenylalanine, tryptophan, and tyrosine) absorb UV light at a
maximum of 280 nm because the pi electrons in their aromatic rings can absorb
photons.
That is because benzene, the core of a phenyl group, absorbs UV light as well. Amino acids
do not absorb visible light and thus are colorless.
However, tyrosine, phenylalanine, and especially tryptophan absorb high-wavelength (250–
290 nm) ultraviolet light.
Because it absorbs ultraviolet light about ten times more efficiently than phenylalanine or
tyrosine, tryptophan makes the major contribution to the ability of most proteins to absorb
light in the region of 280 nm.

Ref: Kennelly P.J., Rodwell V.W. (2011). Chapter 3. Amino Acids & Peptides. 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.
192. Which of the following amino acids is
involved in one carbon pool?
a) Glycine

b) Proline

c) Threonine

d) Hydroxyproline

Correct Answer - A
Ans. is 'a' i.e., Glycine
Goups, containing a single carbon atom are called one carbon
groups. One carbon groups are formed from following amino acids
during their metabolism:- Serine, glycine, histidine and
tryptophan. One carbon groups formed during metabolism are:
methyl (CH,), methylene (CH,), methenyl (C H), formyl (CHO) and
formimino (CH=NH).
193. Disulfide bonds are formed by pairs of
which aminoacid?
a) Methionine

b) Homocysteine

c) Serine

d) Cysteine

Correct Answer - D
Ans. is 'd' i.e., Cysteine
There are two sulfur containing amino acids :-
i) Cystein
ii) Methionine
The side chain of cysteine contains sulfhydryl group that has a pKa
of approximately 8.4 for dissociation of its hydrogen sulf​hydryl
groups of two cystein molecules can form covalent disulfide bond to
form cystine.
Methionine although it contains sulfur group, does not containt
sulthydryl group and cannot form disulfide bond.
Disulfide bridges are R-S-S-R', These bridges are formed by
oxidation of Sulfhydryl groups of cysteine residues of proteins.
This is the basis or reducing type of SDS - PAGE. SDS PAGE is
used to find the molecular weight of an unknown protein.
Disulfide bridges are not formed by methionine, as methionine does
not have sulfhydryl group - they have a thioether linkage
194. Which of the following is true about
HPLC and gas chromatography?
a) In Gas Chromatography, the stationary phase is always solid

b) In HPLC, the stationary phase is solid

c) In HPLC, the mobile phase is a liquid or solid

d) In Gas chromatography, the mobile phase is always gas

Correct Answer - D
Ans. is 'd' i.e., In gas chromatography, the mobile phase is always
gas
if a solute has an affinity for the mobile phase, it moves faster. If a
solute has an affinity for stationary phase, it gets retarded.
That way, the solutes get separated based on differential distribution
of them between a mobile phase and a stationary phase.
195. Which vitamin deficiency is seen in
vegetarians especially ?
a) Vitamin B12

b) Vitamin B6

c) Vitamin B3

d) Vitamin B2

Correct Answer - A
Ans. is 'a' i.e.,Vitamin B12
Dietary sources of vitamin B12 are of animal origin only and include
meat, eggs, milk, diary products, fish, poultry etc. Vitamin BI2 is
absent in plant foods. Small amount of vitamin B 12 is synthesized in
the intestine by the action of intestinal flora.
196. Which amino acid required in infants and
not in adults?
a) Histidine

b) Glycine

c) Isoleucine

d) Valine

Correct Answer - A
Ans. is 'a' i.e.,Histidine
Histidine and Arginine are partially or semiessential aminoacids.
They are synthesized by metabolic pathways but the rate of
synthesis is low, that the endogenous synthesis is not sufficient to
meet the requirements during periods of increased demand like
during growth
197. Reperfusion injury is caused by:
a) Vitamin E

b) Superoxide ion

c) Calcium ion

d) Magnesium ion

Correct Answer - B
B i.e. Superoxide ion
- Xanthine oxidase increases oxidative stress by generating
superoxide free radiclesQ
- Ischemic reperfusion injury is caused by reactive oxygen species
(ROS)/free radical or pro oxidant like superoxide ionQ
Antioxidants blocking free radical formation include vitamin A (Beta
carotene), C and E; superoxide dismutase, catalase and selenium
containing glutathione peroxidase enzymes; ceruloplasmin,
transferrin, ferritin, and lactoferrin transport proteins etc.
198. Change seen in mitochondria due to
aging is?
a) Decrease in size & increase in number

b) Decrease in number & increase in size

c) Decrease in size and number both

d) Increase in size and number both

Correct Answer - C
Answer- C. Decrease in size and number both
Celluler changes-
Decrease in cell size and number.
Decreased in size and number of mitochondria Detachment of
ribosomes from ER
Increased number of phagolysosomal vacuoles Defective DNA
repair
Non-enzymatic glycosylation of protien
199. Which of the following is seen in
hyperemia?
a) Decreased arteriolar blood flow to the tissue

b) Increased arteriolar blood flow to the tissue

c) Increased venous blood flow in the tissue

d) Decrease venous blood flow in the tissue

Correct Answer - B
Answer- B. Increased arteriolar blood flow to the tissue
Hypermia and congestion are the terms used for increased volume
of blood within dilated vessels of an organ or tissue.
Hyperemia is an active process resulting from augmmted blood Jlow
to tissue because of arteriolar dilatation, at the site of inflammation
or in skeletal muscle during exercise.
Hyperemia is one of the cardinal sign of inflammation, i.e. redness
(rubor) is due to hyperemia.
200. Hypercalcemia in sarcoidosis all are true
except?
a) Parathormone level is increased

b) PTHrP level is increased

c) Calcitriol level is increased

d) Oral steroids are useful

Correct Answer - A
Answer- A. Parathormone level is increased
Extrarenal synthesis of calcitriol [1,25(OH)2D3] is central to the
pathogenesis of abnormal calcium metabolism in sarcoidosis.
Sarcoidosis causes an increase in l, 25-dihydroxy vitamin D, the
active metabolite of vitamin D, which is usually hydrorylated within
the kidney, but in sarcoidosis patients hydroxylation of vitamin D can
occur outside the kidneys, mainly inside the immune cells found in
the granulomas and produces 1 alpha, 25(OH)2D3, which is the
main cause for hypercalcemia in sarcoidosis.
PTH release is inhibited by hypercalcaemia and high levels of
calcitriol, so PTH level is suppressed in sarcoidosis.
201. Toll like receptors are seen on?
a) Macrophages

b) Natural killer cells

c) Endothelial cells

d) All of the above

Correct Answer - D
Answer-D. All of the above
The Toll-like receptors are rnembrane proteins that recognize
avariety of microbe-derived molecules and stimulate innate immune
responses against the microbes.
The Toll-like receptors are expressed on many different cell types
that participate in innate immune responses including
,macrophages, dendritic cells, neutrophils, NKs cells, mucosal
epithelial cells and endothelial cells.
202. Which of the following are slow reacting
substances of anaphylaxis?
a) LTB4 and C4

b) LT A4 and B4

c) LT A4 and C4

d) LT C4 and D4

Correct Answer - D
Answer- D. LT C4 and D4
Slow-reactine substance of anaohvlaxis (SRS-A)
A mixture of the leukotrienes LTC4, LDD4 and LTE4 are called slow
reacting substances of anaphylaxis (SRS-A).
These are the most potent mediators causing bronchospasm.
They are produced via lipoxygenase pathway (LOX pathway) of
arachidonic acid metabolism during inflammation.
203. Changes in which amyloid structure
makes it insoluble?
a) Primary

b) Secondary

c) Tertiary

d) Quaternary

Correct Answer - B
Answer-B. Secondary
Amyloid is a protein that has an alteration in its secondary structure
which imparts it a particular insoluble form, called the beta-pleated
sheet conformation.
204. Hyperacute rejection occurs most
commonly in which organ:
March 2007
a) Liver

b) Kidney

c) Lung

d) Heart

Correct Answer - B
Ans. B: Kidney
Hyperacute rejection is a complement-mediated response in
recipients with pre-existing antibodies to the donor (for example,
ABO blood type antibodies).
Hyperacute rejection occurs within minutes and the transplant must
be immediately removed to prevent a severe systemic inflammatory
response. Rapid agglutination of the blood occurs.
This is a particular risk in kidney transplants, and so a prospective
cytotoxic crossmatch is performed prior to kidney transplantation to
ensure that antibodies to the donor are not present.
Hyperacute rejection is analogous to a blood transfusion reaction as
it is a humoral-mediated immune response. For other organs,
hyperacute rejection is prevented by transplanting only ABO-
compatible grafts.
Hyperacute rejection is not significant in liver allografts and cellular
transplants because these tissues have remarkable regenerative
abilities.
Hyperacute rejection is the outcome of xenotransplanted organ in
non-immunosuppressed recipients
205. In acute solid organ Graft vs host
disease, which of the following is not
seen?
a) Occurs within 100 days of transplantation

b) Skin is the most common organ involved

c) Preformed antibodies are involved

d) May lead to cholestatic jaundice

Correct Answer - C
Answer- C. Preformed antibodies are involved
Preformed antibodies are involved in hyperacute rejection not in
GVHD.
Acute GVHD occvs within 100 days (usually 10-50 days) of bone
marrow transplantation.
 206. Which of the following organ can cause
antigen reaction when exposed in self
blood?
a) Kidney

b) Liver

c) Eye lens

d) Platelets

Correct Answer - C
Answer- C. Eye lens
Antisen Seauestration
Some self reactive lymphocytes cannot react against the host cells
because these cells or antigens are located in the tissues which do
not communicate with blood & interact with immune system during
development.
These sites are called immune privileged sites, because it is difficult
to induce immune response to antigen in these sites.
These are treated as foreign when introduced into circulation and
they elicit both humoral and cellular response.
Examples of such sites are
1. Eye -lens anduvealttact
2. Testis - sperms
3. Brain
 207. Which of the following is not an extra
articular feature of Rheumatoid arthritis?
a) Weight loss

b) Pleural effusion

c) Conjunctivitis

d) Proteinuria

Correct Answer - D
Answer- D. Proteinuria
Extra-articular manifestations in RA
1. Systemic manifestations: Fever, weight loss, fatigue.
2. Dermatological: Subcutaneous nodule.
3. Cardio-pulmonary: Pericardial & pleural effusion, constrictive
pericariditis, pulmonary fibrosis, lung nodules.
4. Eye : Sjogren syndrome (Keratoconjunctivitis sicca), scleritis.
5. Nervous : Carpal tunnel syndrome, tarsal tunnel syndrome,
mononeuritis multiplex
208. Genetic association of Diabetes?
a) MHC

b) VHL

c) CTLA4

d) PDGF-R

Correct Answer - C
Answer- C. CTLA4
Type I Diabetes
CTLA4 (cytotoxic T lymphocyte-associated 4)- 2q3I -35
209. Acrodermatitis enteropathica is inherited
as?
a) X-linked recessive

b) X-linked dominant

c) Autosomal recessive

d) Autosomal dominant

Correct Answer - C
Answer- C. Autosomal recessive
Acrodermatitis enterooathica is inherited as an autosomal
recessive disorder.
Cystic fibrosis
Phenylketonuria
Galactosemia
Homocystinuria
Lysosomal storage disease.
alpha 1-antitrypsin deficiency
Wilson disease
Hemochromatosis
Glycogen storage disorders
Acrodermatitis enteropathica
210. Which of the following conditions is
associated with decreased E-cadherin?
a) Invasive lobular carcinoma

b) Fibroid

c) Ductal carcinoma

d) Intestinal carcinoma

Correct Answer - A
Answer- A. Invasive lobular carcinoma
Cadherin-E (E-cadherin) is a protein that is encoded by the CDHI
gote (tumor suppressor gene).
Loss of E-cadherin function or expression has been implicated in
cancer progression and metastasis.
E-cadherin down regulation decreases the strength of cellular
adhesion within a tissue, resulting in an increase in cellular motility.
This in turn may allow cancer cells to cross the basement membrane
and invade surrounding tissues. E-cadherin is also involved in
causation of breast cancer.
When compared with invasive ductal carcinoma" E-cadherin
expression is markedly reduced or absent in the great majority of
invasive lobular carcinomas.
 211. Tumor suppressor gene p53 prevents
carcinoma by?
a) DNA repair

b) Cell cycle arrest

c) Apoptosis induction

d) All of the above

Correct Answer - D
Answer- D. All of the above
p53 gene is located on chromosome 17 & acts as molecular
policeman that prevents the propagation of genetically damage cell.
p53 gene product, i.e. p53 protein is a DNA binding protein in the
nucleus, when called into action, it controls the transcription of
several other genes.
p53 causes:-
1. Cell cycle arrest:p-53 induces transcription of p2l,a CDK inhibitor.
p2l inhibit cyclin DCDK- 4complex and there is arrest of cell cycle
late in GI phase. This allow time for DNA repair.
2. DNA repair : p-53 also helps in DNA repair directly by inducing
transcription of GADD 45 (growth arrest and DNA damage).
p53 induces apoptosis by inducing the activation of apoptosis
inducing gene.
212. What is the position of vegetation on
heart valve caused due to non bacterial
thrombotic endocarditis?
a) Pocket of valves

b) Upper surface of cusps

c) Lower surface of cusps

d) Along the line of closure

Correct Answer - D
Answer- D. Along the line of closure
In NBTE, vegetations occur along the line of closure.
213. Normal PCV value is?
a) 30-35%

b) 40-45%

c) 50-55%

d) 60-65%

Correct Answer - B
Answer-B. 40-45%
Normal values are about 45% for men and about 42% for women.
Hematocrit or Packed cell volume (PCV)
It is the proportion of blood volume that is occupied by red blood
cells.
214. Which neoplasm causes pure red cell
aplasia?
a) Thymus

b) Breast

c) Hepatocellular

d) Bronchogenic

Correct Answer - A
Answer-A. Thymus
Pure red cell aplasia (PRCA) is an uncommon disorder in which
maturation arrest occurs in the formation of erythrocytes.
Causes of PRCA include:
Idiopathic
Autoimmune disease such as SLE
Lymphoproliferative. Association of pure red cell aplasia wlth T-cell
large ganular lymphocyte lukemia is well recognized, especially in
China
Thymome
viral infections such as HIV, herpes, parvovirus Bl9 (Fifth disease),
or hepatitis
Drugs such as mycophenolic acid or erythropoietin
Congenital (Diamond-BlacKFan ananemia)
215. Castleman's disease is associated with?
a) Necrotizing vasculitis

b) Benign lymphoid hyperplasia

c) Necrotizing lymphadenitis

d) Coagulation defect

Correct Answer - B
Answer- B. Benign lymphoid hyperplasia
Castleman disease (CD)
It is arare bmignlymphoproliferctive dborder.
Although Castleman disease is not cancerous, it may also be
associated with malignancies such as Kaposi sarcoma, non-Hodgkin
lymphoma, Hodgkin lymphoma and POEMS syndrome
216. According to WHO all are B cell
lymphomas except?
a) Burkitt's lymphoma

b) Follicular lymphoma

c) Mantle cell lymphoma

d) Anaplastic large cell lymphoma

Correct Answer - D
Answer-D. Anaplastic large cell lymphoma
Peripheral T - Cell and NK - Cell Neoplasms
T-cell prolymphocytic leukemia
Large granular lymphocytic leukemia
lylycosis fungoides/Sezary syndrome
Peripheral large cell lymphoma, unspecified
Anaplastic large cell lymphoma
Enteropathy - associated T - cell lymphoma
Hepatosplenic gamma delta T - cell lymphoma
Adult T . cell leukemia / lymphoma
NK I T - cell lymphoma, nasal type
NK cell leukemia
217. Hairy leukoplakia is characterized by?
a) Pain

b) EBV infection

c) No association with HIV

d) Pre-cancerous

Correct Answer - B
Answer-B. EBV infection
It is a condition caused by Epstein-Barr virus (EBV) and occurs
usually in persons who are immunoxompromised, those with
HIV/AIDS.
218. Franklin disease is?
a) heavy chain disease

b) 6-heavy chain disease

c) y-heavy chain disease

d) u-heavy chain disease

Correct Answer - C
Answer- C. y-heavy chain disease
Franklin's disease (gamma heavy chain disease)
It is a very rare B-cell lymphoplasma cell proliferative disorder.
It may be associated with autoimmune diseases and infection is a
common characteristic of the disease.
 219. JAK-2 mutation is strongly associated
with?
a) Burkitt's lymphoma

b) Polycythemia vera

c) Multiple myeloma

d) Mantle cell lymphoma

Correct Answer - B
Answer- B. Polycythemia vera
Janus kinase 2 (JAK- 2), a member of the janus kinase family, is
a non-receptor tyrosine kinase.
JAK2 fusions with the TEL(ETV6) (TEL-JAK2) and PCMI have found
to be associated with leukemia, particularly clonal eosinophilia forms
of the disease.
JAK-2 mutations are associated with
1. Polycythemia vera,
2. Essentialthrombocythemia
3. Myelofibrosis (and other myeloproliferative disorders)
220. Lymphoma is caused by all of the
following viruses except -
a) HIV

b) EBV

c) HSV

d) HHV8

Correct Answer - C
Answer- C. HSV
The number of viruses associated with lymphoma has increased
over the last 20 years, and includes the Epstein-Barr virus (EBV),
human T-cell lymphotropic virus I (HTLVl), human immuno-
deficiency virus (HIV1 and 2) and human herpesvirus 8 (HHVB).
221. Neutrophil count below which infection
is predisposed
a) < 2000

b) < 1500

c) < 1000

d) None

Correct Answer - A
Answer- A. < 2000
"At neutrophil counts of < 1000/L of blood, individuals are at risk
from infection (with the risk of infection inversely proportional to the
neutrophil count.
222. Central bronchiectasis is seen with
a) Cystic Adenomatoid Malformation

b) Cystic fibrosis

c) Broncho carcinoma

d) Tuberculosis

Correct Answer - B
Ans. is'b' i.e., Cystic fibrosis
The distribution ()I. bronchiectasis mar be important diagnostically
A central → Perihilar
allergic bronchopulmonary aspergillosis.
Predominant upper lobe o Middle and lower lobe → Cystic
fibrosis or one of its variants. Distribution is consistent with PCD
Lower lobe involvement is → Middle lobe and lingular segment of
the LUL involvement is characteristic of non tuberculous
mycobacteria (NTM). Idiopathic bronchiectasis
223. Gene NPHP1 encodes?
a) Fibrocystin

b) Nephrocystin

c) Polycystin

d) Podocin

Correct Answer - B
Answer- B. Nephrocystin
Nephrocystin-l is a protein that in humans is encoded by the NPHP1
gene on chromosome 2q. The protein is known to play a role in
functioning of cilia. Mutations in this gene cause familial juvenile
nephronophthisis, a medullary cystic kidney disease. It is a form of
ciliopathy.
224. Most common cause of renal tumor in
adult is?
a) Family history

b) Smoking

c) Obesity

d) Hypertension

Correct Answer - B
Answer- B. Smoking
Important risk factors for RCC are smoking (most significant),
obesity, hypertension, asbestos exposure, estrogen therapy, CRF,
tuberous sclerosis and familial conditions (Von Hippel-Lindau
syndrome).
225. Renal angiomyolipoma is associated with:
a) Tuberous sclerosis

b) Neurofibromatosis 1

c) Neurofibromatosis 2

d) All of the above

Correct Answer - A
Angiomyolipomas are present in 25% to 50% of patients with tuberous sclerosis, a disease
caused by loss-of-function mutations in the TSC1 or TSC2 tumor suppressor genes.
This is a benign tumor consisting of vessels, smooth muscle, and fat.
It is characterized by lesions of the cerebral cortex that produce epilepsy and mental
retardation, a variety of skin abnormalities, and unusual benign tumors at other sites, such
as the heart.

Ref: Robbins 8th edition Chapter 20.

226. Pathology in achalasia cardia is in?
a) Excitatory neurons

b) Inhibitory neurons

c) Muscles

d) Neuromuscular junction

Correct Answer - B
Answer-B. Inhibitory neurons
It is due to dysfunction of inhibitory neurons containing nitric oxide
and vasoactive intestinal polypeptide in the distal esophagus. The
cholinergic innervation ofthe LES is intact or affected only in the
advanced stage.
There is neurogenic degeneration either idiopathic or due to
infection.
227. True about familial adenomatous
polyposis is?
a) Also known as Lynch syndrome

b) FAP gene is located on 5p21

c) 100% risk of malignancy in classical variety

d) Males are usual carriers

Correct Answer - C
Answer- C. 100% risk of malignancy in classical variety
Familiar polyposis coli is an autosomal dominant condition affecting
males and females equally
It is also called as familial polyposis coli. It is caused by mutation in
admomatous polyposis coli gene located on long arm of
chromosome 5 (5q21).
228. Multiple ileal strictures and internal
fistulas are features of
a) Intestinal TB

b) Crohn's, disease

c) Ulcerative colitis

d) Diverticulosis

Correct Answer - B
Answer-B. Crohn's, disease
Crohn's disease complicated by multiple strictures and internal
fistulas.
229. Low dietary fiber intake is related to
which carcinoma?
a) Breast

b) Lung

c) Kidney

d) Colon

Correct Answer - D
Answer- D. Colon
Low fibre diet
High
Intake of animal fat
Smoking and alcohol
Streptococcus bovis septicemia/ endocarditis
Ureterosigmoidoscopy
lnflammatory bowel disease (ulcerative colitis)
Acromegaly
Pelvic irradiation
High calorie intake and obesity
230. All of the following are true about
primary biliary cirrhosis except?
a) Portal fibrosis

b) Anti-mitochondrial antibodies

c) Elevated cholesterol level

d) Decreased lipoprotein X level

Correct Answer - D
Answer- D. Decreased lipoprotein X level
Primary biliary cirrhosis is associated with elevated lipoprotein-X
(lipoprotein-X is elevated in conditions causing cholestasis).
231. Most common cancer in liver is
a) Papilloma

b) Hepatic adenoma

c) Metastasis

d) Cavernous Hemangioma

Correct Answer - C
Answer- C. Metastasis
Most commonhqtatic neoplasm is metastasis.
Most common primary benig nlesion of liver is cavernous
hemangioma.
Most common primary malignant lesion of liver is hepatocellular
carcinoma.
Most common primary hepatic tumor of children is hepatoblastoma.
232. Vanishing bile duct syndrome is seen in?
a) Primary sclerosing Cholangitis

b) Primary biliary cirrhosis

c) Cystic fibrosis

d) All of the above

Correct Answer - D
Answer-D. All of the above
vanishing bile duct syndrome refers to a group ofdisorders resulting
in destruction/disappearance ofthe intrahepatic bile ducts and,
ultimately, cholestasis.
Causes
Cystic fibrosis
Intrahepatic bile duct atresia
Caroli's disease
Primary sclerosing Cholangitis
Primary biliary cirrhosis
Hodgkin's lymphoma
233. Her2/neu gene is on which
chromosome?
a) 13

b) 14

c) 15

d) 17

Correct Answer - D
Answer- D. 17
ERBB2, a known proto-oncogene, located at the long arm of human
chromosome 17 (17q12)
HER2 is a member of the human epidermal growth factor receptor
(HER/EGFR/ERBB) which is plasma membrane-bound receptor
tyrosine kinase.
234. Hirano bodies seen in?
a) Rabbies

b) Alzheimer's disease

c) Pick's disease

d) Viral encephalitis

Correct Answer - B
Answer-B. Alzheimer's disease
They are intracellular, paracrystalline, eosinophilic sttwcturesoften
occurring as rod shapes in the neurons ofindividuals with neuro-
degenerative diseases incfuding Alzheimer's and some forms of
Creutzfeldt-Jacob ilisease. They are intracellular aggregates of actin
and actin-associated proteins.
235. Which tumor arises from organ of
Zuckerkandl?
a) Paraganglioma

b) Schwannoma

c) Astrocytoma

d) Medulloblastoma

Correct Answer - A
Answer- A. Paraganglioma
The organ of Zuckerkandl is a chromaffin body derived from neural
crest located at the bifurcation of the aorta or at the origin of the
inferior mesenteric artery.It can be the source of paraganglioma.
236. Which is the nerve sheath tumor
according to WHO?
a) Schwannoma

b) Paraganglioma

c) Medulloblastoma

d) Astrocytoma

Correct Answer - A
Answer- A. Schwannoma
Schannomos are benign tumors of the nerve sheath
Schwannomas can arise from any peripheral nerve containing
Schwann cell, including cranial nerves
The eighth cranial nerve is the most susceptible to schwannomas.
Bilateral schwannomas of the eighth cranial nerve indicate the
presence of type 2 neurofibromatosis.
237. Transfusion associated graft vs host
disease can be prevented by?
a) Irradiation

b) Washing

c) Chemical treatment

d) All of the above

Correct Answer - A
Answer- A. Irradiation
Transfusion-associated graft -versus-host disease (TA-GvHD)
A rare complication of blood transfusion, in which the donor T
lymphocytes mount an immune response against the recipient's
lymphoid tissue.
The only currently efective method to prevent TA-GVHD is gamma
irradiation of blood products prior to transfusion
238. Bronchopulmonary aspergillosis is
associated with?
a) Kertagener syndrome

b) Cystic fibrosis

c) Good Pasture syndrome

d) Silicosis

Correct Answer - B
Answer- B. Cystic fibrosis
Allergic bronchopulmonary aspergillosis (ABPA) is a condition
characterized by a hypersensitivity response) to the
Aspergillus (most commonly Aspergillus fumigatus). It occurs most
often in patients vith asthma or cystic fibrosis
ABPA causes airway inflammation, leading to brochiectasis-a
condition marked by abnormal dilation of the bronchi and
bronchioles.
239. Focal length of high power objective lens
of microscope?
a) 40mm

b) 16mm

c) 20mm

d) 4mm

Correct Answer - D
Answer- D. 4mm
Approximate focal length-4mm
240. Therapeutic drug monitoring is used for
all except?
a) Drugs with low safety margin

b) In case of poisoning

c) To check patient compliance

d) To check the therapeutic effects of drug

Correct Answer - D
Ans. is d i.e., To check the therapeutic effects of drug
Therapeutic drug monitoring is Particularly useful in following
situations:
l. Drugswith lowsafetymargin -
Tricyclic antidePressants
Digoxin
Anticonvulsants
Antiarrythmics
Theophylline
Aminoglycoside antibiotics
Lithium
 241. Which of the following is an example of
idiosyncratic reaction?
a) Captopril - dry cough

b) Isoniazid - hepatitis

c) Haloperidol - extrapyramidal side effects

d) Chloramphenicol - aplastic anemia

Correct Answer - D
Ans. is'd'i.e., Chloramphenicol - aPlastic anemia
(Ref: KDT P/e p. 851)
Idiosyncratic reactions e.g.:
1. Barbiturates cause excitement and mental confusion in some
individuals.
2. Quinine/quinidine cause cramps, diarrhoea, purpura, asthma and
vascular collapse in some patients.
3. Chloramphenicol produces non dose-related serious aplastic
anaemia in rare individuals.
242. Intolerance to a drug occurs at what
dose in an individual ?
a) Subtherapeutic dose

b) Therapeutic dose

c) Toxic dose

d) Not related to the dose of drug

Correct Answer - B
Ans. is'b'i.e., Therapeutic dose
[RelKDT . 851]
Intolerance
It is the appearance of characteristic toxic effects of drug in an
individual at therapeutic doses.
Converse of tolerance and indicates a low threshold of the individual
to the action of a drug.
243. Which of the following acts as
'Gatekeeper' in the GIT ?
a) ATP binding cassette [ABC] transporter

b) P1glycoprotein transporter

c) OAT 1 & OAT2

d) All of the above

Correct Answer - A
Ans. is'a'i.e., ATP binding cassette (ABC) transporter
(Ref www, ncbi.nlm,nih.govl)
MDRI (ABCBI) MRP2 (ABCC2) and BCRP (ABCG2) are members
of the family of ATP binding cassette (ABC) transporters.
These are plasma membrane transporters that are expressed in
various organs.
The role of MDRI and MRP2 in the hepatobiliary system is well
defined
The role of ABCG2, which is also expressed in the canalicular
membrane of hepatocytes
has not yet been fully characterised.
All three proteins are also expressed in the apical membrane of
enterocytes where they probably control oral availability of many
substances.
This important ``gatekeeper" function of ABC transporters has been
recognised recently and is currently under further investigation.
244. Which of the following phenomenon can
be explained with pharmacogenomics ?
a) More chances of irinotecan induced neutropenia and diarrhea in
some patients

b) Acute intermittent porphyria precipitated by barbiturates

c) Increased risk of severe bone marrow toxicity with 6

mercaptopurine

d) Nephrotoxicity by cyclosporine

Correct Answer - A:B:C

Ans. is 'a' i.e., More chances of irinotecan induced neutropenia
and diarrhea in some patients; .b, i.e., Acute Intermittent
porphyria precipitated by barbiturates; & 'c' i.e., increased risk
of severe bone marrow toxicity with 6 mercaptopurine
[Ref: KDT )
Pharmacogenomics
Pharmacogenomics is the use of genetic information to guide the
choice of drug and dose on an individual basis.
It intends to identify individuals who are either more likely or less
likely to respond to a drug, as well as those who require altered dose
of certain drugs.
245. Which of the following drugs belong to
category X risk category for the use in
pregnancy?
a) Penicillin V

b) Thiopentone

c) Aspirin

d) Isotretinoin

Correct Answer - D
Ans. is'd'i.e., Isotretinoin
[Ref KDT //e p. 70)
Category X drugs have proven fetal abnormalities and are
teratogenic.
Eg: Estrogens, isotretinoin, ergometnne thalidomide
246. Renal dose of dopamine is-
a) 2.5 lig/kg/min

b) 5-10 µg/kg/min

c) 10-20 pg/kg/min

d) 1-2 pg/kg/min

Correct Answer - D
Ans. is 'd' i.e., 1-2 gg/kg/min
Dopamine produces dose dependent action:
i) At low dose (1-2 ug/kg/min) causes dilation of renal and
mesentric vessels often referred as renal dose.
ii) At moderately high dose (2-10 ,ug/kg/min) produces a positive
ionotropic effect by stimulating [3, receptor on heart cardiac dose.
iii) At high doses (> 10 pg/kg/min) produces vasoconstriction by
stimulating a, receptors --> vascular dose.
247. Ivabradine is used for management of ?
a) Stable angina

b) Pre renal azotemia

c) Alzheimers disease

d) Anti smoking agent

Correct Answer - A
Ans. is 'a' i.e., Stable angina
(Ref: KDT Vh/e p. 554; Cardiac drug development guide by Micheal
Pugsley p. 381)
Ivabradine
It is an investigational inhibitor ofsino-atrial node.
It is a relatively selective If(funny current) Sodium channel blocker of
early part of slow diastolic depolarization (phase 4) that reduces
heart rate by inhibiting the hyperpolarization-activated sodium
channel in SA node.
Heart rate is a major determinant of angina in coronary disease.
Therefore, lowering the heart rate is an important therapeutic
approach in the treatment of stable angina.
248. 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
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
249. Mechanism of action trimetazidine is ?
a) Fatty acid synthase inhibitor

b) Na channel inhibitor

c) K channel opener

d) Inhibiting mitochondrial LC3-KAT

Correct Answer - D
Ans. is'd'i.e.,Inhibiting mitochondrial LC3-KAT
(Ref: KDTh/e p. 554)
Trimetazidine:
This antianginal drug acts by non hemodynamic mechanisms.
The mechanism of action of trimetazidine is uncertain, but it may
improve cellular tolerance to ischaemia by inhibiting mitochondrial
long chain 3-ketoacyl-CoAthiolase (LC3-KAT) a key enzyme in fatty
acid oxidation- thereby reducing fatty acid metabolism and
increasing glucose metabolism in myocardium.
250. Which antianginal drug can be safely
used with drugs used for treatment of
erectile dysfunction?
a) Nitrates

b) Calcium channel blockers

c) pFOX inhibitor

d) Potassium channel opener

Correct Answer - C
Ans. is'c'i.e., pFOX inhibitor
[Ref: KDT Vh/e p. 5541]
The metabolic modulators (eg, trimetazidine) are known as pFOX
inhibitors because they partially inhibit fatty acid oxidation pathway
in myocardium.
Antianginal action of trimetazidine is independent of any blood
pressure reduction.
It can be effectively used as an antianginal drug in the CAD patients
with erectile dysfunction in the place of nitrates to allow free use of
sildenafil and similar agents.
251. Drug used for euvolemic hyponatremia
in pa​tient with advanced congestive
heart failure is ?
a) Tolvaptan

b) Nesiritide

c) Hydrocortisone

d) Metoprolol

Correct Answer - A
Ans. is'a'i.e., Tolvaptan
[Ref: KDT 7/e p. 5251]
The most common cause of euvolemic hyponatremia in SIADH
(syndrome of inappropriate secretion of antidiuretic hormone).
Thus the question is asking about the drug for SIADH in patients
with cardiac failure.
Tolvaptan
This is an orally active nonpeptide vasopressin V2 receptor
antagonist introduced recently for the correction of water retention
and hyponatremia occurring in syndrome of inappropriate ADH
secretion (SIADH) as well as in advanced CHF.
In clinical trials on CHF patients with hyponatremia, tolvaptan has
afforded short-term improvement by increasing water excretion,
restoring serum Na+ and relieving dyspnoea.
However, no long-term benefits have been noted.
252. Which of the following drugs can be
used for secondary prevention of
coronary artery disease?
a) Gemfibrozil

b) Colestipol

c) Temisartan

d) Vitamin E

Correct Answer - A
Ans. is'a'i.e., Gemfibrozil
[Ref: KDT Vh/e p. 639]
Gemfibrozil
This fibric acid derivative effectively lowers plasma TG level by
enhancing breakdown and suppressing hepatic synthesis of TGs.
Besides high efficacy in type III hyperlipoproteinemia, gemfibrozil
has shown action in subjects with raised blood CH in addition.
In the 'Helsinki Heart Study' men without known CAD treated with
gemfibrozil had a 34% reduction in fatal and nonfatal MI, though
overall mortality was not affected.
That these benefits extend to secondary prevention of coronary
events in men with existing CAD and low HDL CH, has been
demonstrated in another trial.
253. Drug used in treatment of peripheral
vascular disease which acts by
increasing flexibility of RBC membrane
and increasing micro circulation?
a) Cyclandelate

b) Xanhinol nicotinate

c) Pentoxiphylline

d) Cilostazole

Correct Answer - C
Ans. is'c' i.e., Pentoxifylline
(Ref: KDT Vh/e p. 555)
Pentoxifylline (Oxpentifflline)
An analogue of theophylline and a weak phosphodiesterase (PDE)
inhibitor, it has been shown to increase blood flow in ischaemic
areas by reducing whole blood viscosity and by improving flexibility
of RBCs.
Pentoxifylline is mainly used in intermittent claudication (calf pain on
walking) due to occlusive vascular disease (Buerger's disease);
walking distance is increased.
Other conditions claimed to be improved are: trophic leg ulcers,
transient ischaemic attacks (TIAs), non haemorrhagic stroke, and
chronic cerebrovascular insufficiency.
However, overall benefits are modest and restricted to a fraction of
patients
254. Which drug/s is/ are used to control
hypertension intra operatively?
a) Nitroglycerine

b) Nitroprusside

c) Beta blockers

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
[Rel Hypertension primer by joseph L. lzzo, p. 555J
Intraoperative hypertension
Measures commonly used to control intraoperative hypertension
include deepening of anesthesia, use of vasodilators such as
nitroglycerine or nitroprusside, or a combination of the two.
255. Overall action of caffeine on heart rate is
?
a) Increases

b) Decreases

c) No effect

d) First increases then decreases

Correct Answer - B
Ans. is'b' i.e., Decreases (Ref: KDT Vh/e P. 4881)
Caffeine
Caffeine out of the three naturally occurring methylxanthines, only
caffeine is used as a CNS stimulant.
Methylxanthines directly stimulate the heart and increase force of
myocardial contractions.
They tend to increase heart rate by cardiac action, but decrease it by
causing vagal stimulation- net effect is variable.
Tachycardia is more common with theophylline, but caffeine
generally lowers heart rate.
256. Which of the following is a potassium
sparing drug:
September 2005, March 2013
a) Indapamide

b) Frusemide

c) Spironolactone

d) Mannitol

Correct Answer - C
Ans. C: Spironolactone
Potassium-sparing diuretics do not promote the secretion of
potassium into the urine; thus, potassium is spared and not lost as
much as in other diuretics. The term "potassium-sparing" refers to
an effect rather than a mechanism or location; nonetheless, the term
almost always refers to two specific classes that have their effect at
similar locations:
Aldosterone antagonists: Spironolactone, which is a competitive
antagonist of aldosterone. Aldosterone normally adds sodium
channels in the principal cells of the collecting duct and late distal
tubule of the nephron. Spironolactone prevents aldosterone from
entering the principal cells, preventing sodium reabsorption. A
similar agent is potassium canreonate.
Epithelial sodium channel blockers: amiloride and triamterene.
257. Which drug abolishes corticomedullary
osmotic gradient ?
a) Furosemide

b) Thiazide

c) Spironolactone

d) Triamterene

Correct Answer - A
Ans. is'a'i.e., Furosemide
(Ref. KDT p. 579)
Furosemide (Frusemide)
It is a high ceiling (loop) diuretic which inhibits of Na+-K+-2cl-
cotransporter.
The corticomedullary osmotic gradient is abolished and positive as
well as negative free water clearance is blocked.
K+ excretion is increased mainly due to high Na+ load reaching DT.
258. Thiazides and loop diuretics both have
opposite action on which of the following
ions ?
a) Sodium

b) Potassium

c) Calcium

d) Chloride

Correct Answer - C
Ans. is'c'i.e., Calcium
(Ref: KDT 7/e p. 5S2l)
Furosemide action on calcium
Furosemide increases Ca2+ excretion (contrast thiazides which
reduce it)
259. In a 2 months old infant undergoing
surgery for biliary atresia, you would
avoid one of the following anaesthetic
a) Thiopentone

b) Halothane

c) Propofol.

d) Sevoflurane

Correct Answer - B
B i.e. Halothane
Among all these options only halothane is hepatotoxic so it should
be avoided Lets revise some important facts.
All coagulation factors with exception of factor VIII (8) & von wille
brand factor are produced by liverQ
Vit K is necessary for synthesis of prothrombin (factor II) and factor
VII, IX and XQ.
PT is normally 11-14 seconds, mesures the activity of fibrinogen,
prothrombin and factors, V, VII, and XQ
All opioids cause spasm of sphincter of oddi & increase biliary
pressure
Halothane hepatitis is more common in middle age, obese, female
sex, and a repeated exposure (esp with in 28 days)
260. Opioid available as nasal spray
formulation is ?
a) Tramadol

b) Codiene

c) Butorphanol

d) Buprenorphine

Correct Answer - C
Ans. is'c'i.e., Butorphanol
[Ref: KDT 7h/e p. 482)
Butorphanol - Nasal spray (Stadol)
261. Which of the following belongs to NaSSA
group of drugs?
a) Amoxetine

b) Mirtazapine

c) Duloxetine

d) Venalafaxine

Correct Answer - B
Ans. is 'b' i.e., Mirtazapine
(Ref: Depression and Bipolar disorder, Stahl's essential
psychopharmacology 3'd/e p. 1111)
Noradrenergic and specific serotonergic antidepressants ,
(NaSSAs):
They are a class of psychiatric drugs used primarily as
antidepressants'
The NaSSAs include the following agents
Aptazapine
Mirtazapine
Esmirtazapine
Setiptiline/teciptiline
Mianserin
262. Which of the following drugs can be
used as a transcranial patch for
treatment of parkinsonism?
a) Levodepa

b) Rotigotine

c) Apomorphine

d) Aprantine

Correct Answer - B
Ans 'b' i.e. Rotigotine
o Rotigotine is intended to be delivered through transdermal
patches, so as to ensure a slow and constant dosage in a 24-hour
period.
263. Most toxic antiepileptic drug is ?
a) Phenytoin

b) Valproate

c) Carbamazepine

d) Lamotrigine

Correct Answer - C
Ans. is'c' i.e., Carbamazepine
(Ref: www.sciencedirect.com).
Table in a pubmed indexed journal, regarding toxicity of
anticonvulsant drugs shows answer is carbamazepine.
40.0 % toxicity.
264. Ziconotide acts by blocking ?
a) Voltage gated Na channel

b) Voltage gated Ca channel

c) Ligand gated Na channel

d) Ligand gated Ca channel

Correct Answer - B
Ans. is'b'i.e., Voltage gated Ca channel
(Ref: Essential of pain medicine by HonorioBenmn p. 4581)
Ziconotide:
Ziconotide (SNX-111 ; Prialt) is an atypical analgesic agent for the
amelioration of severe and chronic pain.
Acts as a selective N-type voltage-gated calcium channel blocker.
265. Which of the following drug causes
hirsutism?
a) Phenytoin

b) Valproate

c) Carbamazepine

d) Phenobarbitone

Correct Answer - A
Ans. is 'a' i.e., Phenytoin
266. Neuromuscular blockade produced by
rocuronium can be reversed by ?
a) Sugammadex

b) Flumazenil

c) Blood transfusion

d) Plasmapheresis

Correct Answer - A
Ans. is'a'i.e., Sugammadex
(Ref: Miller Eh/e p. 995)
Sugammadex:
Sugammadex is a modified y-cyclodextrin that shows a high affinity
for the steroidal NMBDs rocuronium and vecuronium.
Sugammadex is able to form a tight inclusion complex with either of
these steroidal NMBDs, thereby inactivating the effects of
rocuronium and vecuronium, resulting in rapid reversal of
neuromuscular blockade.
267. Dose of methotrexate for treatment of
rheumatoid arthritis is ?
a) 7.5 - 15 mg/ week

b) 2.5 - 5 mg/ week

c) 7.5 - 15 mg/ month

d) 2.5 - 5 mg/ month

Correct Answer - A
Ans. is'a' i.e., 7.5 - 15 mg/ week
[Ref: KDT Vh/e p. 21 1]
Methotrexate (Mtx) for rheumatoid arthritis:
Induction of oral low-dose (7.5-15 mg) weekly Mk regimen has
improved acceptability of this drug in RA.
268. Pegloticase is used in ?
a) Gout

b) Osteoarthritis

c) Rheumatoid arthritis

d) Reactive arthritis

Correct Answer - A
Ans. is 'a' i.e., Gout
[Rel Gout and other crystal arthropathies by Robert Terkettaud p.
Igj]
Pegloticase:
Pegloticase is a medication for the treatment of severe, treatment of
refractory chronic gout.
It is a third line treatment in those in whom other treatments are not
tolerated.
269. Which drug can exacerbate asthma
secondary to irreversible nonselective
inhibition of cyclooxygenase pathway?
a) Aspirin

b) Ibuprofen

c) Ketorolac

d) Celecoxib

Correct Answer - A
Ans. is'a'i.e., Aspirin
(Ref: KDT Vh/e p. 192, 195).
Aspirin Induced Asthma
The disorder is thought to be caused by an anomaly in the
arachidonic acid metabolizing cascade which leads to increased
production of proinflammatory cysteinyl leukotrienes, a series of
chemicals involved in the body's inflammatory resPonse.
When medications like NSAIDs or aspirin block the COX-I enzyme,
Production of thromboxane and some anti- inflammatory
prostaglandins is decreased, and in patients with aspirin-induced
asthma this results in the overproduction Of pro-inflammatory
leukotrienes to causes severe exacerbations of asthma and allergy
like symptoms.
270. Which of the following is a feature of
nonselective Cox inhibitor but not of
selective Cox 2 inhibitor?
a) Analgesic effect

b) Antiplatelet aggregatory

c) Renal salt/ water retention

d) Prolongation of labour

Correct Answer - B
Ans. is'b'i.e., Antiplatelet aggregatory
(Ref: KDT 7th /e p. 194)
271. Most commonly used NSAIDs in
Rheumatic fever ?
a) Indomethacin

b) Phenylbutazone

c) Aspirin

d) Rofecoxib

Correct Answer - C
Ans. is 'c' i.e., Aspirin
(Ref: Textbook of clinical pediatrics p' 729)
Treatment of Rheumatic fever:
Drug of choice for treatment of RF is penicillin.
Erythromycin is the drug of choice in penicillin allergic patient.
Suppressive therapy:
Corticosteroids or aspirin are given for suppressive therapy.
Corticosteroids are indicated in presence of carilitis with or without
CHF.
Aspirin is preferred in absence of carditis.
Duration of therapy is 12 week.
272. Radioiodine is used in treatment of ?
a) Graves disease

b) Hypothyroidism

c) Medullary carcinoma

d) Anaplastic carcinoma

Correct Answer - A
Ans. is 'a' i.e., Graves disease
(Ref: KDT p.255)
Radioactive iodine is administered as sodium salt of r3rl dissolved in
water and taken orally.
The most common indication is hyperthyroidism due to
Graves'disease or toxic nodular goiter.
The average therapeutic dose is 3-6 m curie-calculated on the basis
of previous tracer studies and thyroid size.
273. Antidiabetic drug with insulin
independent action is ?
a) SGLT2 inhibitor

b) DPP4 inhibitor

c) Meglitinide analogues

d) GLP1 agonist

Correct Answer - A
Ans. is'a'i.e., SGLT 2 inhibitor
(Ref: KDT p.270)
Sodium-glucose cotransport-2 (SGLT-2) inhibitor: Dapagliflozin -
antidiabetic drugs - action independent of insulin
274. Which of the following is true about
Repaglinide?
a) It belongs to sulfonylurea class of drugs

b) It is not well absorbed on oral administration

c) It is used to control sleep time hyperglycemia

d) It should be avoided in patients with liver diseases

Correct Answer - D
Ans. is 'd' i.e., It should be avoided in patients with liver
diseases
Ref: KDT 7/e p. 2731
Repaglinide:
This meglitinide analogue oral hypoglycaemic is designed to
normalise mealtime glucose excursions.
Though not a sulfonylurea, it acts in an analogous manner by
binding to SUR closure of ATP dependent K+ channels
depolarisation insulin release.
Repaglinide is indicated only in selected type 2 diabetics who suffer
pronounced postprandial hyperglycaemia, or to supplement
metformin/long-acting insulin.
It should be avoided in liver disease,
275. Antiinflammatory action of steroid is due
to inhibition of
a) Cyclooygenase

b) Lipooxygenase

c) Phospholipase A2

d) Myeloperoxidase

Correct Answer - C
Ans. is'c' i.e., Phospholipase A2
(Ref: KDT Vh/e p. 286)
Glucocorticoids interfere at several steps in the inflammatory
response but the most important overall mechanism appears to be
limitation of recruitment of inflammatory cells at the local site and
production of proinflammatory mediators like PCs. LTs. PAF through
inhibition of phospholipase A2
276. Systemic adverse effects of long term
inhaled steroids are evident only at
doses more than ?
a) 200 mcg/day

b) 400 mcg/day

c) 600 mcg/day

d) 800 mcg/day

Correct Answer - C
Ans. is 'c' i.e., 600 mcg/day.
lRef: KDT Vhle p. 230)
Systemic effects of long-term inhaled glucocorticoids are clinically
relevant only at doses > 600 mcg/day.
The significant ones are-mood changes, osteoporosis, growth
retardation in children, bruising, petechiae, hyperglycaemia and
pituitary-adrenal suppression; several reports of adrenal crisis have
appeared, especially in children, during stress (of an infection, etc).
277. Which of the following is a selective
progesterone receptor modulator-
a) Onapristone

b) Ulipristal

c) Nomegestrol

d) Toremifene

Correct Answer - B
Ans. is 'b' i.e., Ulipristal
o Ulipristal is a SPRM approved for use as an Emergency
Contraceptive.
o SPRM (selective progesterone receptor modulators) : Asoprisnil, ul
ipristal, onapristone, mifepristone.
278. Which of the folloiwng topical steroid
used in ophthalmology has the maximum
potential to increase intraocular pressure
[I0P] ?
a) Hydrocortisone

b) Prednisolone

c) Dexamethasome

d) Fluoromethalone

Correct Answer - C
Ans. is 'c' i.e., Dexamethasome
[Rel Essential of ophthalmology p.29]
The IOP -elevating potential of steroids is as follows:
dexamethasone > prednisolone > fluoromethalone > hydrocortisone
> tetrahydrotriamcinalone> medrysone (after 6 weeks of
dexamethasone therapy.
42% have IOP > 20 mmHg and 69o have IOP > 31).
The steroids with low IOP - elevating potential are fluorometholone
(FMI). rimexolone (Vexol), and loteprednol (Latemas, Mrex).
279. The major adverse effect of
glucocorticoids especially in children is
?
a) Hyperkalemia

b) Hypoglycemia

c) Muscular weakness

d) Posterior subcapsular cataract

Correct Answer - D
Ans. is'd'i.e., Posterior subcapsular cataract
lRef: KDT p. 293)
Adverse effects glucocorticoids:
Posterior subcapsular cataract may develop after several years of
use, especially in children
280. Pulse steroid therapy can be given in ?
a) Pemphigus vulgaris

b) Acute renal allograft rejection

c) Optic neuritis

d) All the above

Correct Answer - D
Ans. is'd'i.e., All the above
Pulse Steroid therapy
Pulse therapy means the administration of supra pharmacologic
doses of drugs in an intermittent manner to enhance the therapeutic
effect and reduce the side effects.
In context of corticosteroids, pulse therapy refers to discontinuous
i.v. infusion of high doses of the medication, arbitrarily defined as
treatment with more than 250 mg prednisone or its equivalent per
day, for one or more days.
There are no guidelines on the frequenry or timing of administration
of the i.v. pulses; which therefore includes single boluses, daily
boluses given for 3 days in a row, or on alternate days for up to 12
days.
The agent most commonly used for corticosteroid pulse therapy is
methylprednisolone.
281. Cyproterone acetate used in ?
a) Precocious puberty in boys

b) Oral contraceptive

c) Ovulation inducing agent

d) PCOD

Correct Answer - A
Ans. is'a' i.e., Precocious puberty in boys
Ref: KDT Vhle p. 302)
Cyproterone acetate:
Clinical indications are- precocious puberty in boys, inappropriate
sexual behaviour in men, acne and hirsutism in women (usually in
combination with an estrogen),
282. Antithyroid drug contraindicated in
pregnancy ?
a) Propylthiouracil

b) 1131

c) Methimazole

d) Carbimazole

Correct Answer - B
Ans. is'b'i.e., I 131
lRef: KDT 7tu/e p. 25
Antithyroid treatment contraindicated in pregnancy
Thyroidectomy and I 131 are contraindicated during pregnancy.
283. Which of the following is used to control
bleeding associated with fibrinolytic
agents like streptokinase?
a) Epsilon amino-caproic acid

b) Tranexamic acid

c) Factor VIII infusion

d) Blood transfusion

Correct Answer - A:B

Ans. is'b > a'i.e., Tranexamic acid; > Epsilon amino-caproic acid
lRef: KDT 7h/e p. 6281
Antifibrinolytic drugs
These drugs inhibit plasminogen activation and dissolution of clot.
Examples are Epsilon amino-caproic acid (EACA), Aprotinin and
Tranexaemic acid.
284. Warfarin embryopathy manifests
characteristically as ?
a) Chondrodysplasia punctata

b) Dysplastic hips

c) Auditory sensineuronal hearing loss

d) Gastrointestinal atresias

Correct Answer - A
Ans. is 'a' i.e., Chondrodysplasia punctata
Ref: Nelson 2Uh/e P. 2397)
Warfarin embryopathy is characterized by bone and cartilage
abnormalities known as chondrodysplasia punctata.
Affected infants may have nasal hypoplasia and excessive
calcifications in the epiphyses and vertebrae.
285. Doxylamine used in management of
nausea and vomiting is marketed with
which vitamin ?
a) Thiamine

b) Riboflavin

c) Niacin

d) Pyridoxine

Correct Answer - D
Ans. is'd'i.e., Pyridoxine
[Ref: KDT 7e p. 663]
Doxylamine
Sedative H1 antihistamine with prominent anticholinergic activity.
Marketed in combination with pyridoxine, it is specifically promoted
in India for 'morning sickness' (vomiting of early pregnancy),
although such use is not made in the UK and many other countries.
286. Mosapride produces its gastrokinetic
effects by acting as an agonist at which
of the following receptor?
a) 5HT1

b) 5HT2

c) 5HT3

d) 5HT4

Correct Answer - D
Ans. is'd'i.e., 5HT4
[Ref: KDT p. 667)
Mosapride:
It is a congener of cisapride with similar gastrokinetic and LES tonic
action due to 5-HT4 agonistic (major) and 5-HT3 antagonistic
(minor) action in the myenteric plexus.
287. Antibiotic gramicidin S is derived from ?
a) Bacillus brevis

b) Cl difficle

c) S epidermidis

d) Streptococcus bovis

Correct Answer - A
Ans. is'a'i.e., Bacillus brevis
[Rel Peptides: chemistry and biology p.84]
Gramicidin-s is an antibiotic effective against some Gram positive
and Gram negative bacteria as well as some fungi.
It is a derivative of gramicidin, produced by the Gram positive
bacterium Bacillus brevis.
288. Why intravenous quinine, used in the
management of complicated and severe
malaria, given with 5% dextrose?
a) To avert risk of hypoglycemia

b) To avert risk of dehydration

c) To avert risk of electrolyte imbalance

d) To maintain renal blood flow

Correct Answer - A
Ans. is'a'i.e., To avert risk of hypoglycemia
Ref: KDT Vh/e p. 8251
Quinine for the management of complicated and severe malaria
including cerebral malaria :
Intravenous Quinine (i.v.) has been the drug of choice for cerebral
malaria (falciparum malaria with impaired consciousness, and other
forms of complicated malaria.
Hypoglycaemia due to hyperinsulinemia is the most important side
effect due to intravenous administration of quinine, which can be
prevented by infusing quinine in 5% dextrose.
289. Latest drug used for treatment of MDR
TB patients is ?
a) Bedaquiline

b) Amithiozone

c) Capreomycin

d) Linezolid

Correct Answer - A
Ans. is'a'i.e., Bedaquiline
(Ref: Principles and practice of infectious diseases by lohn E.
Bennet, p. 4741
Bedaquiline:
It is a diaryl quinolone.
It acts by inhibiting M. tuberculosis adenosine triphosphate
synthase.
FDA has approved bedaquiline for the management of drug resistant
tuberculosis with a black box warning, relating to possible cardiac
toxicity and sudden death.
290. HIV strains resistant to which of the
following drugs may show cross
resistance to Abacavir?
a) Lamivudine

b) Didanosine

c) Enfuvirtide

d) Raltegravir

Correct Answer - A
Ans. is'a'i.e.Lamivudine
lRef: KDT p.. 8081
Resistance to abacavir develops slowly, and it exhibits little cross
resistance with other NRTIs. Strains of HIV having resistance to
zidovudine and lamivudine show cross resistance with abacavir.
291. Only drug used in pregnancy with
syphilis ?
a) Penicillin

b) Clinadmycin

c) Azithromycin

d) Erythromycin

Correct Answer - A
Ans. is'a'i.e., Penicillin
[Ref: Harrisons 18th/e p. 1j871
Management of Syphilis in Pregnancy:
Penicillin is the only recommended agent for the treatment of
syphilis in pregnancy.
If the patient has a documented penicillin allergy, desensitization
and penicillin therapy should be undertaken according to the CDC's
2010 guidelines.
292. Which of the following is a bactericidal
drug against Mycobacterium leprae?
a) Erythromycin

b) Ofloxacin

c) Cotrimoxazole

d) Amoxicillin

Correct Answer - B
Answer- B. Ofloxacin
Ofloxacin Over 99.9% bacilli were found to be killed by 22 daily
doses of ofloxacin monotherapy
293. WHO recommended regime for the
treatment of Brucella infection is ?
a) Streptomycin with doxycycline

b) Rifampicin with doxycycline

c) Rifampicin with ciprofloxacin

d) Streptomycin with erythromycin

Correct Answer - B
Ans. is 'b' i.e., Rifampin with doxycycline
lRef : Harrison 18n/e p. 1299,1672 & I4/e p. 1268).
The gold standard for the treatment of brucellosis in adults is IM
streptomycin (0.75-1 g daily for 14-21 days) together with
doxycycline (100 mg twice daily for 6 weeks).
In both clinical trials and observational studies, relapse follows such
treatment in 5-10 % of cases.
The usual alternative regimen (and the current World Health
Organization recommendation) k rifampin (600-9{n mg/it) plus
doxycycline (100 mg twice daily) for 6 weeks.
294. Indication for stopping rifampicin ?
a) Hepatitis

b) Visual loss

c) Thrombocytopenia

d) Peripheral neuropathy

Correct Answer - C
Ans. is'c'i.e., Thrombocytopenia
lRef: ATT drug guide p. 7391
Among the given options, hepatitis and thrombocytopenia are
adverse effects of rifampicin.
"If thrombocytopenia purpura or anaemia occurs, rifampin should be
stopped and should never be restarted".
Rifampicin can be restarted under close observation and
supervision, once the liver functional normalize.
295. Which of the following is not true about
silver sulphadiazine used in burns?
a) Local side effects include burning and itch

b) It is used for treating established infection

c) It is good for preventing infection of chronic ulcers

d) Released silver ion is effective for the antibacterial activity

Correct Answer - B
Ans. is'b'i.e., It is used for treating established infection
[Ref: KDT vh/e p. 7061
Silver sulfadiazine:
Used topically as I % cream, it is active against a large number of
bacteria and fungi, even those resistant to other sulfonamides, e.g.
Pseudomonas.
It slowly releases silver ions, which appear to be largely responsible
for the antimicrobial action.
It is considered to be one of the most effective drugs for preventing
infection of burnt surfaces and chronic ulcers and is well tolerated.
However, it is not good for treating established infection.
296. Imipeneme is active against which of the
following organism/s?
a) Gram positive cocci

b) B. fragilis

c) Cl. difficle

d) All the above

Correct Answer - D
Ans. is'd'i.e., All the above
[Ref KDT 7/e p. 731]
Imipenem
A derivative of thienamycin,imipenem is an extremely potent and
broad spectrum bactam antibiotic whose range of activity includes
gram-positive cocci, Enterobacteriaceae, Ps. aeruginosa, Listeria as
well as anaerobes like Bact. fragilis and Cl. difficile.
297. Cizotinib is inhibitor of which receptor ?
a) Tyrosine kinase

b) VEGF receptor

c) TNF alpha receptor

d) PDGF receptor

Correct Answer - A
Ans. is 'a'i.e., Tyrosine kinase
RefCardio - oncology: principles, prevention and management, by
puja Mehta, p. 10)
Crizotinib
It is a small molecule multitargeted tyrosine kinase receptor inhibitor
targeting ALK, MET, ROS1 kinases.
By inhibiting ALK tyrosine kinase activity, crizotinib inhibits cell
proliferation, induces Gl - S phase cell cycle arrest and apoptosis.
It is approved for the first line in the management of metastatic non-
small cell lung cancer with an ALK mutation.
298. Bortezomib drug used in ?
a) Multiple myeloma

b) RCC

c) Liver cell carcinoma

d) Pancreatic carcinoma

Correct Answer - A
Ans. is 'a' i.e., Multiple myeloma
Uses of bortezomib:
The prime indication of bortezomib is multiple myeloma, both for first
line combined therapy as well as for replapsed disease.
It is also used for refractory mantle cell lymphoma.
Note: The most prominent adverse effect of bortezomibis peripheral
neuropathy. Others are diarrhea, fatigue, bone marrow depression
especially thrombocytopenia.
299. Siltuximab is used in treatment of ?
a) Castlemans disease

b) Sezary syndrome

c) Ankylosing spondylitis

d) Non hodgkins lymphoma

Correct Answer - A
Ans. is 'a' i.e., Castleman's disease
lRef: Multiple myeloma, an issue of hematology oncology clinics E
boohKenneth C Anderson p. 9171
Siltuximab (Anti IL-6):
IL-6 is produced by the stromal cells of the bone marrow, and plays
a crucial role in the proliferation and survival of multiple myeloma
cells.
300. Tocilizumab acts as an antagonist at
which reeptor?
a) IL 1

b) IL 2

c) IL 6

d) TNF

Correct Answer - C
Ans. is 'c' i.e., lL 6
(Ref: Harisons 18th/e p. 2750)
Tocilizumab:
Tocilizumab is a humanized monoclonal antibody directed against
the membrane and soluble forms of the IL-6 receptor.
301. What enzyme is inhibited by etoposide ?
a) Topoisomerase I

b) Topoismerase II

c) Dihydrofolate reductase

d) Dihydro orotate oxidase

Correct Answer - B
Ans. is 'b' i.e., Topoisomerase
(Ref: KDT 7h/e p. 8661)
Etoposide
Semisynthetic derivative of podophyllotoxin, a plant glycoside'
Not a mitotic inhibitor, but arrests cells in the G2 phase and causes
DNA breaks by affecting DNA topoisomerase-2 function.
302. Which medication cannot be given in
diarrhea in pregnancy ?
a) Oral rehydration therapy

b) Stimulant purgative

c) Loperamide

d) Diphenoxylate-atropine

Correct Answer - B
Ans. is 'b' i.e., Stimulant purgatives
lRef: KDT 7/e p. 6741
Stimulant purgatives:
They are poweful purgatives: often produce griping. They irritate
intestinal mucosa and thus were thought to primarily stimulate motor
actIVIty.
They can reflexly stimulate gravid uterus, therefore are
contraindicated during pregnancy.
303. Nonoligouric kidney failure occurs with
administration of which of the following
drug/s?
a) Gentamycin

b) Cisplatin

c) Ifosfamide

d) All the above

Correct Answer - D
Ans. is 'd' i.e., All the above
(Ref: Porth pathophysiology: Concepts of altered health states, by
Charlotte Pooler p. 823)
ARF with urine output > 600 ml/day is defined as non-oliguric renal
failure-
Important drugs causing non-oliguric renal failure are -
Aminoglycosides (e.g.gentamicin)
Amphotericin B
Ifosfomide
Radiocontrast agents
Cyclosporine
 304. Potassium channel opener ?
a) Stiripentol

b) Retigabine

c) Lacosamide

d) Modafinil

Correct Answer - B
Ans. is 'b' i.e., Retigabine
[Ref. Epilepsy and brain tumors by Herbert B. Newton, p. 17fl
Potassium channel openers
A potassium channel opener is a type of drug which facilitates ion
transmission through Potassium channels.
Diazoxide vasodilator used for hypertension, smooth muscle
relaxing actIVIty
1. Minoxidil vasodilator used for hypertension, also used to treat hair
loss
2. Nicorandil vasodilator used to treat angina
3. Pinacidil
4. Retigabine, an anticonvulsant
5. Flupirtine, analgesic with muscle relaxant and anticonvulsant
properties
305. Drugs causing painful salivary glands all
except ?
a) Phenybutazone

b) Ambroxol

c) Clozapine

d) Iodides

Correct Answer - B
Ans. is'b'i.e., Ambroxol
[Ref:
httpL/www.ijohmr.com/upload/Adverse%o20Efects%20of/o20Drugso/o20on%o20S
Drugs associated with salivary gland enlargement
Clozapine may cause transient salivary gland swelling as well as
sialorrhea.
306. Oral rehydration therapy takes
advantage of which transporter in GIT ?
a) Na Glucose co transport

b) K glucose co transport

c) Na calcium co transport

d) Na channel

Correct Answer - A
Ans. is'a'i.e., Na Glucose co transport
lRef; KDT 7/ep.679)
Oral rehydration is possible if glucose is added with salt.
It capitalizes on the intactness of glucose coupled Na+ absorption
(Na glucose co transport), even when other mechanisms have failed
or when intestinal secretion is excessive, because the secreted fluid
lacks glucose and cannot be reabsorbed.
307. Which of the following is not true about
hydroquinone?
a) It is a weak hypopigmenting agent

b) It inhibits tyrosinase

c) Response is incomplete and pigmentation may recur

d) It should not be used for melasma or chloasma of pregnancy

Correct Answer - D
Ans. is'd'i.e., It should not be used for melasma or chloasma of
pregnancy .
Ref: KDT Vhle p. 8921
Hydroquinone:
It is a weak hypopigmentation agent.
Inhibits tyrosinase and other melanin forming enzymes, decreases
formation of and increases degradation of melanosomes.
Regular application (as 2-6% lotion or cream) for months is required
in melasma, chloasma of pregnancy, etc.
308. Oral iron chelating agent(s) is/are -
a) Desferrioxamine

b) Deferiprone

c) Deferasirox

d) b and c

Correct Answer - D
Ans. is 'b' i.e., Deferiprone; 'c' i.e., Deferasirox
o Amongst the given options; desferrioxamine, deferiprone and
deferosirox are used for iron poisoning. BAL and succimer are not
used for iron poisoning.
o Desferrioxamine is given parenterally (IM or IV), whereas
deferiprone and deferasirox are used orally.
309. Which of the following drug is used in
SIADH?
a) Tolvapatan

b) Desmopressin

c) Vwb factor

d) Terlipressin

Correct Answer - A
Ans. A. Tolvaptan
Tolvaptan:
Vasopressin antagonists.
Orally active nonpeptide selective V2 receptor antagonist.
Metabolized by CYP3A4 – Not given to patients receiving this
isoenzyme inhibitor.
Given once daily.
t½: 6–8 hours.
Actions:
Increases free water clearance by kidney (aquaretic).
Corrects lower plasma Na+ levels.
Uses:
Useful for hyponatremia treatment.
Hyponatremia caused by CHF, cirrhosis of liver or syndrome of
inappropriate ADH secretion (SIADH).
Side effect:
Thirst & dry mouth (most frequent).
Fever, G.I. upset & hyperglycaemia.
310. Fracture at the angle of mandible most
commonly involves which tooth?
a) Second premolar

b) First molar

c) Incisor

d) Third molars

Correct Answer - D
Ans. is 'd' i.e., Third molars [Ref Fractures of the Facial Skeleton
p. 71]
The most common teeth involved in fracture of angle of mandible
are the third molars.
311. Grey powder (chalk + mercury) is used in
?
a) Poroscopy

b) Cheiloscopy

c) Dactylography

d) Palato prints

Correct Answer - C
Ans. is 'c' i.e., Dactylography [Ref: Reddy 26tVe p. 75]
A latent finger print may be developed by dusting the area with
coloured powders to provide a contrast, and its pattern is recorded
by photography. It can also be examined by oblique lighting. The
commonly used powder is 'grey' powder (chalk and mercury), but
white powders (lead carbonate or French chalk) are used for dusting
dark surfaces.
312. Krogmans table system is used for ?
a) Age determination

b) Sex determination

c) Dental examination

d) Calculating estimated height

Correct Answer - B
Ans. is 'b' i.e., Sex determination [Ref Reddy 30thie p. 59]
Krogman's table is used to determine the percentage of accuracy in
sex determination from isolated skeletal parts.
According to Krogman, the degree of accuracy in sexing adult
skeletal remains is :-
Entire skeleton - 100 %
Pelvis alone 95 %
313. 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]
314. All of the following ossification centers
are present at 7 months of intrauterine
life except ?
a) Talus

b) Calcaneum

c) Clavicle

d) Olecranon

Correct Answer - D
Ans. is 'd' i.e., Olecranon [Ref: Parikh 6th/e p. 5.77]
315. How many superadded teeth appear in
each jaw?
a) 2

b) 4

c) 6

d) 8

Correct Answer - C
An;. is 'c' i.e.,6 [Ref Reddy 30thie p. 61]
Temporary teeth, (milk teeth or deciduous teeth) start appearing at
about 6 months, are 20 in number: being 4 incisors, 2 canines and 4
molars in each jaw. They start shedding at about 6 years, when
permanent teeth start appearing.
316. Primary dentition is complete by:
UPSC 08
a) 1.5 years

b) 2.5 years

c) 3.5 years

d) 4.5 years

Correct Answer - B
Ans. 2.5 years
317. Which X-ray needs to be taken for 16
year old male is ?
a) Wrist

b) Elbow

c) Shoulder

d) Ilium

Correct Answer - B
Ans. is 'b' i.e., Elbow [Ref Parikh 6th/e p. 2.10]
318. Which is the teeth referred to if by
haderup classification it is denoted as (-
4) ?
a) Upper canine

b) Lower first premolar

c) Upper second premolar

d) Lower first molar

Correct Answer - B
Ans. is 'b' i.e., Lower first premolar [Ref: Reddy 26aVe p. 87]
319. Rules followed amongst medical
professionals which are mutual ?
a) Medical etiquettes

b) Medical ethics

c) Privileged communication

d) Vicarious responsibility'

Correct Answer - A
Ans. is 'a' i.e.,Medical etiquettes [Ref Reddy 30thie p. 1]
Medical etiquettes
Medical etiquettes : It refers to existing customs of brotherhood
among members of medical profession, i.e. courtesy followed
between members of medical profession, e.g. it is a custom not to
charge another doctor or his close relatives. Medical ethics
The earliest code of medical ethics was Hippocratic oath. It is
modified by World Medical Association, and was named as
`Declaration of Geneva'; it is followed by MCI as code of medical
ethics.
320. If a patient requests his medical records,
they should be provided to the patient
within what period of time?
a) 7 days

b) 15 days

c) 21 days

d) 30 days

Correct Answer - D
Ans. is 'd' i.e., 30 days [Ref: Personal Injury and the Law of Torts
for Paralegals p. 253]
The patient can request his medical records, which normally should
be provided to the patient within 30 days. This is a national standard.
The medical provider can extend the 30 days to a total of 60 days for
good cause. The patient has to pay for the cost of copies and
postage.
Others who may obtain records are parents of minor children, legal
guardians or an agent (for eg. Someone designated in a Health Care
Power of Attorney).
Police do not have a right to demand medical records except when
there is statutory provision for such requisitions.
321. Dying declaration can be recieved by :
a) Medical officer

b) Lawyer

c) Police officer

d) All

Correct Answer - D
D i.e. All
322.
Which of the following deals with section 377, I.P.C?

a) Unnatural sex offences

b) Rape

c) Incest

d) Adultery

Correct Answer - A
Voluntary sexual intercourse against the order of nature with any man, woman, or animal is
an unnatural sexual offence (Section 377 I.P.C).
Penetration is sufficient to constitute the offence. These offences are punishable with
imprisonment for life or upto ten years and also with fine.

Ref: The Essentials of Forensic Medicine and Toxicology, 27th

edition, Page 363.
323. Awaswoman who gave birth 1 day ago left the child in a railway station. This
witnessed by porter in the station and later the mother apprehended. In
such a scenario, she would be punishable under:

a) IPC 318

b) IPC 317

c) IPC 307

d) IPC 320

Correct Answer - B
If a father or mother of a child below the age of 12 years, or anyone having the care of such
a child, leaves such a child in any place with the intention of abandoning the child shall be
punishable with 7 years imprisonment as per section 317 IPC.

IPC 318 deals with concealment of birth and is punishable with 3 years imprisonment.

IPC 307 deals with attempted murder.

IPC 320 deals with grievous hurt.

Ref: Textbook of Forensic Medicine and Toxicology by Narayan

Reddy, Edition 21
324. Privileged communication is made
between:
a) Patient and Doctor

b) Doctor and court of Law

c) Doctor and Relative

d) Doctor and concerned authority

Correct Answer - D
Privileged communication is a statement made bonafide upon any subject matter by a
doctor to the concerned authority, due to his duty to protect the interest of the community or
the state.
It should be made to the person having interest in it or in reference of which he has a duty.

Ref: Parikh' Textbook of Medical Jurisprudence Forensic Medicine

and Toxicology, 5th Edition, Page 216 and 6th Edition, Page 1.34;
The Essentials of Forensic Medicine and Toxicology By Dr K S
Narayan Reddy, 27th Edition, Pages 28-9
325. Killing of a 6 months old child by parents
is known as ?
a) Genocide

b) Infanticide

c) Neonatal homicide

d) Abortion

Correct Answer - B
Ans. is 'b' i.e., Infanticide [Ref Parikh 6`h/e p. 5.75; SK Parikh 4tVe
p. 268]
Infanticide refers to killing a child after delivery, to till 1 year after
birth. Infanticide in India is considered equivalent to
murder and is tried under section 302 IPC. Law considers every
child as born dead and therefore in a case of infanticide,it has to be
proved that the child was born alive and was then killed. Thus the
first question in the investigation of a case of infanticide is, whether
the child was still born or dead born or whether it was born live.
326. Declaration of Sydney is related to ?
a) Time of death

b) Infliction of torture

c) Therapeutic abortion

d) Humanitarian goals of medicine

Correct Answer - A
Ans. is 'a' i.e., Time of death [Ref APC FMT by Aggrawal p. 20]
Declaration of Sydney
The advent of organ transplantation made this Declaration a guide to
determining the time of death of the comatose donor. "Brain death"
has displaced "cardiac death" as the essential criterion; and the
diagnosis must be made before there is organ death.
The Declaration also states that "If transplantation of an organ is
onvolved, the decision that death exists should be made by one or
more physicians; and the physicians determining the moment of
death should in no way be immediately concerned with the
performance of the transplant."
This makes for objectivity. But it is incorrect to say that "death exists"
or refer to "the moment of death". The patient is not dead until after
life support has been withdrawn.
327. Autopsy is known by all names except ?
a) Obduction

b) Necropsy

c) Biopsy

d) Postmortem examination

Correct Answer - C
Ans. is 'c' i.e., Biopsy [Ref.' Reddy 26"le p. 89]
An autopsy (also known as a post-mortem examination, obduction,
necropsy, or autopsia cadaverum) is a highly specialized surgical
procedure that consists of a thorough examination of a corpse by
dissection to determine the cause and manner of death and to
evaluate any disease or injury that may be present.
328. Cardiac chambers are opened in autopsy
in which order?
i) Left atrium ii) Left ventricle
iii) Right atrium iv) Right ventricle
a) i → ii → iii → iv

b) iii → iv → i → ii

c) i → iii → ii → iv

d) ii → iv → iii → i

Correct Answer - B
Ans. is 'b' i.e., iii → iv → i → ii [Ref Reddy's 261h/e p. 97] Principle
of autopsy of heart
Heart is opened in the direction of the flow of blood with the
enterotome.
The right atrium is cut between the openings of superior and inferior
vena cavae.
A small secondary incision is made to open the auricular appendage
to detect thrombi
In opening the right ventricle, the lateral margin of right ventricle
faces the dissector, the atria being directed towards him.
The left atrium is cut between the openings of the pulmonary veins.
Then, the left atrium is cut along its lateral wall. This incision extends
through the mitral orifice, and passes along lateral margin of the left
ventricle up to the apex.
The next incision extends from the apex along the interventricular
septum into the aorta, opening the aortic valve.
329. In how many flaps is fetal skull opened
during autopsy?
a) 2

b) 3

c) 4

d) 5

Correct Answer - C
Ans. is 'c' i.e., 4 [Ref Autopsy Pathology Manual p. 63]
In infants and fetuses, before skull ossification and suture closure is
complete, the fontanelles can be separated and the skull opened in
4 flaps, in a "butterfly" manner.
In newborn infants in whom sagittal sinus trauma or developmental
abnormalities are suspected, the following alternative cranial
opening preserves the critical anatomy.
To preserve the superior sagittal sinus, dura is incised at lateral
angles of the anterior fontanelle parallel to and approximately 1 cm
lateral on both sides of the midline, preserving the superior sagittal
sinus in between.
Each of these incisions is continued anteriorly and posteriorly (into
frontal and occipital bones) and laterally (into the parietal bones) to
create two large bone flaps, each on a "hinge" of uncut parietal bone
inferiorly.
In adults, the saw line is made in slightly V - shaped direction - to
remove the skull cap.
330. When the cause of death is not clear
even after entire examination on
autopsy, what it is called?
a) Defective autopsy

b) Normal autopsy

c) Obscure autopsy

d) Negative autopsy

Correct Answer - D
Ans. is 'd' i.e., Negative autopsy [Ref APC Forensic Medicine and
Toxicology p. 124]
331. How is cooling curve of the body
postmortem?
a) Parabola

b) Hyperbola

c) Sigmoid

d) Linear

Correct Answer - C
Ans. is 'c' i.e., Sigmoid [Ref Forensic Medicine : Clinical and
Pathological Aspects p. 102]
Body cooling postmortem follows the Newton's law of cooling.
The rates of cooling at the ends of the curve are slower than the
rates in the mid portion - resulting in Sigmoidal shape of the cooling
curve
332. Marbling is noticed by :
a) 18 hours

b) 36 hours

c) 48 hours

d) 24 hours

Correct Answer - B
B i.e. 36 hours
333. Feature of Post mortem clots are ?
a) Can be washed away

b) Laminated

c) Rubbery

d) Variegated

Correct Answer - A
Ans. is 'a' i.e., Can be washed away [Ref Reddy 29m/e p. 164]
 334. Post mortem incision shape in infant
a) I shaped

b) J shaped

c) T shaped

d) L shaped

Correct Answer - A
Ans. is 'a' i.e., I shaped [Ref Reddy 30"le p. 108]
Types of primary skin incisions are :?
1. I-shaped incision : Extending from the chin straight down to
symphysis, passing to the side the umbilicus.
2. Y-shaped incision : Begins close to acromion process and then
extends down below the breast across to xiphoid process from
where it is carried downwards to the symplysis pubis.
3. Modified Y-shaped incision : Incision is made from suprasternal
notch to symphysis pubis. The incision extends from suprasternal
notch over the clavicle to its center on both sides and then passes
upwards over the neck behind the ear.
335. Prolonging a person's life through
technological means is known as :?
a) Dysthanasia

b) Novus actus interveniens

c) Euthanasia

d) Orthotanasia

Correct Answer - A
Ans. is 'a' i.e., Dysthanasia [Ref Internet]
In medicine, dysthanasia means "bad death" and is considered a
common fault of modern medicine: Dysthanasia occurs when a
person who is dying has their biological life extended through
technological means without regard to the person's quality of life.
336. Changes in middle ear after birth are
observed in?
a) Werdin's test

b) Ploucquet's test

c) Fodere's test

d) Breslau's test

Correct Answer - A
Ans. is 'a' i.e., Werdin's test [Ref SK Singhal 4thle p. 271]
Werdin's test: Before birth middle ear contains gelatinous embryonic
tissue which is replaced by air after respiration.
337. Flaying is seen in which wound?
a) Laceration

b) Incised wound

c) Stab wound

d) Contusion

Correct Answer - A
Ans. is 'a' i.e., Laceration [Ref Reddy 31"/e p. 174]
LACERATION (TEAR OR RUPTURE)
Lacerations are tears or splits of skin, mucous membrane and
underlying tissue (e.g., muscle or internal organs). Lacerations are
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.
338. Which one of the following is not a type
of virginal hymen
a) Cruciate

b) Imperforate

c) Cribriform

d) Septate

Correct Answer - A
Ans. is 'a' i.e., Cruciate [Ref Reddy 26thle p. 337]
The different types of hymen are :?
Semilunar or crescentic (commonest type) the opening is placed
anteriorly. Notches or clefts are seen at 10 and 11 clock position,
which may be equal in size or more prominent on one side.
Annular : opening is oval and situated near the centre of the
membrane.
Infantile : a small linear opening in the middle.
Cribriform : several openings.
Vertical the opening is vertical.
Septate: two lateral openings occur side by side, separated partially
or completely by thin strip of tissue.
Imperforate: no opening.
339.
 Section defining the rape ?
a) 304 B IPC

b) 302 IPC

c) 375 IPC

d) 376 IPC

Correct Answer - C
Ans. is 'c' i.e., 375 IPC
Rape
According to Section 375 IPC, a man is said to commit rape, if he
has sexual intercourse with a women :?
1. Against her will
2. Without her consent
3. With her consent if she is
Less than 16 years of age.
With his own wife less than 15 years of age.
Intoxicated or has unsound mind so that she is unable to understand
the conseqences.
Consent is obtained by unlawful means, i.e. fears of death or hurt to
herself or to some one whom she is interested.
Impersonation , i.e. when the man knows he is not her husband and
her consent is given because she believes that he is another man to
whom she is lawfully married.
340. The “Knot” in judicial hanging is placed
at:
a) The back of the neck

b) The side of the neck

c) Below the chin

d) Only left side of neck

Correct Answer - C
Below the chin.
A common and effective method of Judicial hanging is by putting the
knot beneath the chin onto the neck. Though the knot can be placed
on the side of the neck also.
341. Most common substance abused in India
is ?
a) Heroin

b) Alcohol

c) Cocaine

d) Cannabis

Correct Answer - B
Ans. is 'b' i.e., Alcohol
The most commonly abused substance → Alcohol
Second most commonly abused substance → Heroin (Opioid)
Third most commonly abused substance → Cannabis
342. Glass blowers shake seen in which
poisoning?
a) Mercury

b) Lead

c) Phosphorus

d) Arsenic

Correct Answer - A
Ans. is 'a' i.e., Mercury [Ref Parikh 6tVe p. 9.16; Reddy 30tVe p. 495]
Moderately coarse, intentional tremors starting in fingers, hands and
legs are called as Danbury tremors or hatter's shake or glass
blower's shake. They are seen in chronic mercury poisoning. In
severe form, patient becomes unable to dress, write or
walk, i.e. concussio mercuralis (shaking palsy).
343. Minimata disease is due to ?
a) Mercury

b) Copper

c) Arsenic

d) Lead

Correct Answer - A
Ans. is 'a' i.e., Mercury [Ref Clinical medicine 3"1/e p. 712]
Minimata disease is due to organic marcury poisoning due to eating
fish poisoned by mercury.
344. A person has been brought in casualty
with history of road accident. He had lost
consciousness transiently and gained
consciousness but again became
unconscious. Most likely, he is having
brain hemorrhage of
a) Intracerebral

b) Subarachnoid

c) Subdural

d) Extradural

Correct Answer - D
Ans. is 'd' i.e.Extradural
345. Griffith experiment was done on ?
a) Streptococcus

b) Pneumococcus

c) Enterococcus

d) Staphylococcus

Correct Answer - B
Ans. is 'b' i.e., Pneumococcus [Ref Advanced biology p. 396]
In 1928, Frederick Griffith's experiment first demonstrated
transformation in streptococcus pneumoniae.
Frederick Griffith's experiment on pneumococcus (streptococcus
pneumoniae) proved that genetic characters are transmitted from
one generation to the other through transformation.
346. Colony forming unit includes?
a) Viable cells

b) Dead cells

c) Viable plus dead cells

d) None

Correct Answer - A
Ans. is 'a' i.e., Viable cells [Ref Environmental microbiology and
biotechnology p. 41]
Colony-forming unit (CFU or cfu) is a measure of viable bacterial or
fungal cells. In direct microscopic counts (cell counting using
haemocytometer) where all cells, dead and living, are counted,but
CFU measures only viable cells.
For convenience the results are given as CFU/mL (colony-forming
units per milliliter) for liquids, and CFU/g (colony-forming units per
gram) for solids. CFU can be calculated using miles and misra
method, it is useful to determine the microbiological load and
magnitude of infection in blood and other samples.
347. Medium used to isolate M. tuberculosis
contains all except ?
a) Malachite green

b) Hen's egg

c) Bromothymol blue

d) Glycerol

Correct Answer - C
Ans. is 'c' i.e., Bromothymol blue
Lowenstein-Jensen Medium (LT medium)
LJ medium consists of mineral salts, asparagine, glycerol, malachite
green and hen's egg.
The malachite green prevents the growth of other microorganism on
medium.
It is used as a primary isolation medium for mycobacteria.
Mineral salts are monopotassium phosphate, magnesium or sodium
citrate and magnesium sulphate
348. Limulus amoebocyte lysate test is used
to detect ?
a) Endotoxin

b) Verocytotoxin

c) Pyroexotoxin-A

d) Alpha-toxin of Cl. perfringens

Correct Answer - A
Ans. is 'a' i.e., Endotoxin [Ref asn.org]
Limulus amoebocyte lysate (LAL), an aqueous extract of
amoebocytes from the horseshoe crab, Limulus polyphemus, reacts
with endotoxin to form a gel or a clot.
Under standardized conditions, this reaction detects picogram
quantities of endotoxin.
The clotting reaction is triggered when the LAL reagent comes in
contact with the lipopolysaccharide (endotoxin) fraction of the cell
wall of gram-negative bacteria.
The endotoxin activates an enzyme in the LAL reagent which then
reacts with a low-molecular-weight clottable protein to form a gel.
349. Inspissation is ?
a) Heating at 160°C for 15 minutes

b) Heating at 160°C for 30 seconds

c) Heating at 80°C for 30 minutes

d) Heating at 120°C for 15 seconds

Correct Answer - C
Ans. is 'c' i.e., Heating at 80°C for 30 minutes [Ref Handbook of
media for clinical microbiology p. 495]
Inspissation: It is heat exposure method that is employed with high
protein material, like egg containing media, that cannot withstand the
high temperature used in autoclaving.
The medium is exposed to 80°C for 30 minutes for three successive
days in inspissator. It can be used for LI medium and loeffler serum
slop.
350. Spoligotyping is done for ?
a) Staphylococcus

b) Salmonella

c) Mycobacterium tuberculosis

d) Brucella abortus

Correct Answer - C
Ans. is 'c' i.e., Mycobacterium tuberculosis [Ref
www.ncbi.nlm.nih.gov]
Spoligotyping (spacer oligotyping) is a type of polymerase chain
reaction (PCR).
Compared with other PCR-based methods that combine detection
and typing of such DNA, spoligotyping is more sensitive, because it
targets the direct repeats (DRs) present in multiple (sometimes up to
60) copies in the genomic DR locus of M. tuberculosis complex
bacteria.
The well-conserved 36-bp DRs are interspersed with nonrepetitive
spacer sequences of 34 to 41 bp in length (2, 3, 4).
351. Triple sugar iron agar showing gas
production with red slant and yellow
butt. The organism cultured is ?
a) E coli

b) Shigella flexneri

c) Pseudomonas

d) None

Correct Answer - B
Ans. is 'b' i.e., Shigella flexneri [Ref Clinical microbiology p. 1263]
352. Example of heterophile antigen is ?
a) Forssman antigen

b) Cryptococcus polysacchoride

c) Protein A of staphylococcus

d) All of the above

Correct Answer - A
Ans. is 'a' i.e.,Forssman antigen [Ref Essentials of
microbiology p. 89]
Heterogenetic (Heterophile) specificity
Same or closely related antigens occuring in different biological
species, classes and kingdoms are known as heterogenetic or
heterophile antigens.
353.
 MHC restriction is a part of all except ?
a) Antiviral cytotoxic T cell

b) Antibacterial helper T cell/cytotoxic cells

c) Allograft rejection

d) Autoimmune disorder

Correct Answer - D
Ans. is d i.e., Autoimmune disorder
MHC - Class I restriction
1. Graft rejection
2. Cytotoxic cell mediated cytolysis of viral infected or tumor cells.
MHC - Class II restriction
1. Graft versis host response
2. Mixed leukocyte reaction
354. Which of the following cell does not have
cytotoxic activity ?
a) NK cells

b) Cytotoxic T-cells

c) Helper T-cells

d) Antibody dependent cells

Correct Answer - C
Ans. is 'c' i.e.,Helper T-cells [Ref : Essentials of microbiology p.
786]
355. RA antibody causes which type of
hypersensitivity?
a) Type 1

b) Type 2

c) Type 3

d) India ink

Correct Answer - C
Ans. is 'c' i.e., Type 3
Rheumatoid arthritis (caused by RA antibody) is type - 3
hypersensitivity.
356. Which stain is used for Corynebacterium
diphtheriae ?
a) Geimsa

b) Albert

c) PAS

d) India ink

Correct Answer - B
Ans. is b' i.e., Albert
The diphtheria bacillus was first observed and described by Klebs
(1883) but was first cultivated by Loeffler (1884).
Therefore, it is known as Klebs - Loeffler bacillus (KLB).
Corynebacterium diphtheria is gram positive slender rod (bacilli)
which is noncapsulated and non-motile.
The bacilli are arranged in a characteristic fashion in smears, being
at various angles to each other, resembling the letter V or L Chinese
letter or .nneiform arrangement. There is chracteristic 'Clubbed
appearance'.
Characteristic feature is irregular staining due to presence of
granules, called Babes Ernest or volutin granules. These granules
are also called metachromatic granules or polar bodies.
357. A 12 years old child presenting with
painless neck swelling in supraclavicular
region which started discharging after
few days. The most probable diagnosis?
a) Scrofuloderma

b) Actinomycosis

c) Botromycosis

d) Fungal mycetoma

Correct Answer - A
Ans. is 'a' i.e., Scrofuloderma
scrofuloderma is neck swelling with discharge. SCRUfuloderma is
cutaneous tuberculosis due to direct extension of infection from an
underlying tuberculosis present either in a lympnode, bone or a joint.
Starts as bluish painless swelling, which breaks open to form
Sinuses -› Most common presentation is discharging sinuses.
358. There is outbreak of infection with
staphylococcus in a burn ward. Best site
to take a swab ?
a) Skin

b) Oral cavity

c) Nose

d) Conjunctiva

Correct Answer - C
Ans. is 'c' i.e.,Nose [Ref: Harrison 19th/e p. 955-957; Jawetz 24"/e
p. 224-230]
S. aureus is part of normal human flora. The anterior nares is the
most frequent site of human colonization although the skin
(especially when damaged), vagina, axilla, perineum and
oropharynx may also be colonized.
Staphylococci are part of normal human bacterial flora with about
30% of general population being nasal carriers and another 10%
carrying it on the perineal skin.
359. Toxic shock syndrome is due to ?
a) Endotoxin

b) Exotoxin

c) Lipopolysaccharide

d) Staphylococcal protein A

Correct Answer - B
Ans. is 'b' i.e., Exotoxin [Ref Harrison 19th/e p. 959]
TSS is a potentially fatal multisystem disease characterized by
sudden high fever, fainting, watery diarrhea, headache and muscle
ache.
360. Ideal percentage of CO2 required for
growth of Brucella abortus ?
a) 2-5%

b) 5-10%

c) 15-20%

d) 25-30%

Correct Answer - B
Ans. is. b. i.e., 5-10% [Ref : Essentials of microbiology p. 719]
"Addition of 5-10% CO, improves the growth of B abortus and B.
melitensis".
All Brucella spp. are strictly aerobic, but some B. abortus biovars,
some Brucella isolates from marine mammals, and B. ovis only grow
in atmospheres containing 5-10% CO,.
361. Miyagawa corpuscles are characteristic
of ?
a) Psittacosis

b) Malaria

c) Rabies

d) Lymphogranuloma venerum

Correct Answer - D
Ans. is. d. i.e., Lymphogranuloma venerum [Ref : Textbook of
STD p. 124]
Inclusion body of C.trachomatis causing conjuctivitis
→ Halberstaedter prowazek (H.P.) body.
Inclusion body of C. trachomatis causing L.G.V. -s Miyagawa's
granulocorpuscles.
In psittacosis -s Levinthal - toles - lillie bodies.
362. Bacteriophage carries gene for which of
the following ?
a) Cholera toxin

b) Heat labile toxin of E. coli

c) Verocytotoxin of EHEC

d) Anthrax toxin

Correct Answer - C
Ans. is 'c' i.e., Verocytotoxin of EHEC
363. Cat scratch disease is characterized by?
a) Caused by a virus

b) Regional lymphadenopathy is prominent

c) More common in adults

d) All of the above

Correct Answer - B
Ans. is `b' i.e. Regional lymphadenopathy is prominent
Cat-scratch disease (CSD) is a common and usually benign
infectious disease caused by the bacterium Bartonella henselae, a
fastidious, intracellular, gram-negative bacteria.
cases are benign and self-limiting, but lymphadenopathy may
persist for several months after other symptoms disappear. The
disease usually resolves spontaneously, with or without treatment, in
one month.
364. Most common form of Nocardial
respiratory tract infection is ?
a) Laryngitis

b) Pharyngitis

c) Tonsilitis

d) Pneumonia

Correct Answer - D
Ans. is 'd' i.e.,Pneumonia
[Ref: Harrison 19th/e p. 1086]
Nocardia are 'gram positive' `acid fast' filaments.
Nocardia are strict aerobes and partially urease and catalase
positive. Since nocardiae are among the few aerobic microorganism
that use paraffin as a carbon source, paraffin baiting can be used to
isolate the organism from mixed culture.
365. Bisected pearls appearance on culture
medium is seen in ?
a) Brucella

b) Bordetella

c) Haemophilus ducreyi

d) Pseudomonas

Correct Answer - B
Ans. is 'b' i.e., Bordetella [Ref: Ananthanarayan 9th/e p. 333]
Bordetella are gram-negative, capsulated, fimbriated, nonmotile
coccobacillus.
They show bipolar metachromatic granules on staining with toluidine
blue.
366. Haverhill fever is caused by ?
a) Bartonella henselae

b) Streptobacillus moniliformis

c) Eikenella corrodens

d) Coccidioides

Correct Answer - B
Ans. is 'b' i.e., Streptobacillus moniliformis [Ref Textbook of
Microbiology p. 712]
Streptobacillus moniliformis causes rat-bite fever in humans.
It enters the body through the wound caused by the rat bite.
The infection also occurs by the ingestion of water, milk or food
contaminated with rat excreta. In these cases, the infection is known
as 'Haverhill fever'.
Clinical symptoms include fever, rash and arthralgia.
367. The bacteria producing a picture
resembling `pseudohemoptysis' in a
sputum sample due to prodiogisin
production is -
a) Serratia marcesens

b) Erwinia herbicola

c) Ehrlichia sennetsu

d) Legionella pneumophila

Correct Answer - A
Ans. is 'a' i.e., Serratia marcesens
. In genus Serratia only one species is of medical importance - S
marcescens (Bacillus prodigious).
. It may grow in sputum after collection and may suggest hemotysis
because of the pigment formed —> Pseudohemoptysis
. It can cause meningitis, endocarditis, septicemia, peritonitis and
respiratory infection.
368. Best culture for primary isolation of H.
influenzae?
a) Blood agar

b) Fildes agar

c) Nutrient broth

d) Tryptose agar

Correct Answer - B
Ans. is 'b' i.e., Fildes agar
[Ref Ananthanarayan 91Ve p. 328 & Sth/e p. 335]
H. influenzae does not grow on blood agar.
Culture media used for isolation are Fildes agar (best for primary
isolation), Levinthal medium (capsulated strains show iridescence)
and Chocolate agar.
369. True about Corynebacterium diphtheriae
are all except:
a) Iron is required for toxin production

b) Toxin production is responsible for local reaction

c) Nonsporing, noncapsular and nonmotile

d) Toxin production is by lysogenic conversion

Correct Answer - B
Ans. (b) Toxin production is responsible for local reaction
"Mechanical complications of diphtheria are due to the membrane
while the systemic effects are due to the toxin."
Toxin acts mainly systemically though there are partial local effects.
It has affinity for myocardium, adrenals and nerve endings.
Toxin acts by inactivating EF-2 thus inhibiting protein synthesis.
Toxin production is influenced by iron concentration in the medium.
Toxin production is optimal at 0.14 p.g/ ml and is suppressed at 0.5
.tg/ml.
Toxigenicity of diphtheria bacillus depends on symbiotic
bacteriophages, so it shows lysogenic or phage conversion i.e.
nontoxigenic strain toxigenic strain by infecting with beta phage.
370. Corynebacterium diphtheriae can be
grown within 6-8 hour on -
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
 371. On blood agar target appearance of Cl.
perfringens is due to which toxin ?
a) Alpha toxin

b) Theta toxin

c) Beta toxin

d) Mu toxin

Correct Answer - A
Ans. is 'a' i.e., Alpha toxin [Ref Ananthanarayan 9'/e p. 254]
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
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.
372. After 3 days of a road traffic accident, a
wound shows crepitation in the
subcutaneous tissue and muscle with
foul-smelling discharge. Pus culture
shows Cl. perfringens. All of the
following features about Cl. perfringens
are TRUE, EXCEPT:
a) It is the most common cause of gas gangrene

b) Can be detected by Nagler's reaction

c) The most important toxin is hyaluronidase

d) Gas gangrene strains produce heat resistant spores

Correct Answer - C
All types of C perfringens produce the alpha toxin, a necrotizing,
hemolytic exotoxin that is a lecithinase.

Hemolysis and gas production are characteristic.

Lecithinase activity is evaluated by the precipitate formed around

colonies on egg yolk media (Nagler's reaction).

Gas Gangrene producing strains of Cl. Perfringens produce heat

resistant spores.
Also know:
Gases formed in gas gangrene are hydrogen and carbon dioxide
gas.
Ref: Ray C.G., Ryan K.J. (2010). Chapter 29. Clostridium,
Peptostreptococcus, Bacteroides, and Other Anaerobes. In C.G.
Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.
373. Which of the following is false regarding
H pylori ?
a) With chronic infection urease breath test become negative

b) H. pylori infection remains life long if untreated

c) Endoscopy is diagnostic

d) Toxigenic strains usually cause ulcer

Correct Answer - A
Ans. is 'a' i.e., With chronic infection urease breath test become
negative
. Urea breath test is the most consistently accurate test for
diagnosis of H. Pylori infection.
. It is useful for follow-up after treatment, as it becomes negative
after treatment.
. In chronic infection it remains positive.
About other options
. Most H. pylori - colonized person do not develop clinical sequelae.
They may carry infection life long.
. Endoscopic culture is the most specific test.
. Ulcer is caused by strains carrying vacuolating cytotoxin gene.
374. Phagocytosis of mycobacterium
tuberculosis by macro​phages is mainly
mediated by:
a) IL 6

b) IL 3

c) IL 12

d) IFN Gamma

Correct Answer - D
Ans. is. 'd' i. e., IFN Gamma
375. Cefoxitin - cycloserine fructose agar is
used for ?
a) Neisseria

b) Clostridium difficle

c) Bacillus anttacis

d) Reiter's treponema

Correct Answer - B
Ans. is 'b' i.e., Clostridium difficle [Ref Clinical microbiology yd/e
p. 119]
Cefoxitin - cycloserine fructose agar (CCFA) is an enriched
selective and differential medium recommended for the isolation and
cultivation of clostridium difficle from fecal specimens.
376. All of the following statements regarding
melioidosis are true, EXCEPT:
a) It is caused by Burkholderia mallei

b) It is caused by a gram negative aerobic bacteria

c) Etiologic agent shows bipolar staining with methylene blue stain

d) Pulmonary infection is the most common form of melioidosis

Correct Answer - A
Melioidosis is caused by Burkholderia Pseudomallei. It is a free living small motile aerobic
gram negative bacillary saprophyte normally found in soily ponds & rice paddies. Humans
and animals are infected by inoculation, inhalation, or ingestion.

It grows at 42 degree C & oxidize glucose, lactose & is oxidase positive.

It is a facultative intracellular organism which replicates in neutrophils and macrophages

with the help of a polysaccharide capsule.

The organism also possesses elements of a type III secretion system that plays a role in its
intracellular survival.

Gram’s stain of a specimen shows a small gram negative bacilli.

Wright’s stain or methylene blue staining shows a bipolar regularly staining (safety pin
appearance).

Positive culture is diagnostic.

Ref: Harrisson’s Principles of Internal Medicine, 18th Edition, Chapter 152

377. Reverse CAMP test is positive for ?
a) Streptococcus agalactiae

b) Listeria manocytogenes

c) Clostridium perfringens

d) Vibrio parahemolyticus

Correct Answer - C
Ans. is 'c' i.e.,Clostridium perfringens
CAMP positive→ Area of increased hemolysis (arrow head) around
staphylococcus streaks (by streptococcus agalactiae).
CAMP test is also positive in Listeria monocytogenes, Reverse
CAMP test is positive in Clostridium perfringens.
Reverse CAMP test : It is used to differentiate Cl perfringens from
other Clostridia. CAMP positive group 'B' streptococcus is streaked
in Blood agar and Cl perfringens is streaked perpendicular to it.
There is enhanced hemolysis (arrowhead) between the growth of Cl.
378. Disease transmitted from men to
animals:
a) Antropozoonoses

b) Zooanthroponoses

c) Amphixenoses

d) Aptozoonoses

Correct Answer - B
Ans. b. Zooanthroponoses
379. Neutrophil count below which there is
increased risk of nosocomial invasive
pulmonary aspergillosis -
a) < 4000/4

b) < 3000/4

c) < 2000/4

d) < 1000-500/RL

Correct Answer - D
Ans. is 'd' i.e., < 1000-500/RL [Ref Essentials of medical
microbiology p. 712]
Invasive aspergillosis is a severe respiratory infection with a
mortality rate of over 90% in neutropenic patients.
It is most often encountered in patients with absolute neutrophil
counts of <500/4 from leukemia or chemotherapy.
Patients undergoing bone marrow transplantation are susceptible to
a greater extent than patients with heart, kidney, or liver transplants.
380. Nosocomial aspergillosis is spread by ?
a) Aerosols from renovation

b) Aerosols from doctor to patients

c) Contact in OPD

d) Contact with contaminated dressings

Correct Answer - A:D

Ans. is 'a > d' i.e., Aerosols from renovation > Contact with
contaminated dressings
[Ref Clinical mycology E Book p. 72]
Nosocomial transmission of Aspergillus to patients occurs primarily
by airburne route (via aerosols), but contact transmission (e.g. direct
inoculation from occlusive materials) has also been implicated.
Most outbreaks of nosocomial airborne aspergillosis have been
associated with construction or renovation in or adjacent to the
hospital, contaminated air-handling systems, and insulation or
fireproofing material within the walls or ceilings of hospital units.
 381. Foam cells are seen in infection with
which virus ?
a) Measles

b) EBV

c) Molluscum contagiosum

d) RSV

Correct Answer - B
Ans. is 'b' i.e., EBV [Ref Textbook of CNS infection p. 184]
EBV encephalomyelitis shows :
1. Abnormal white matter with perivascular infiltrates of inflammatory
cells and foam cells.
2. Some myelin is replaced by lipid-filled macrophages and
hyperplastic astrocytes.
382. E6 gene product of HPV causes
malignance transformation by acting on
?
a) p53 gene

b) RAS gene

c) C-myc gene

d) N-myc gene

Correct Answer - A
Ans. is 'a' i.e., p-53 gene [Ref : Essentials of microbiology p. 712]
HPV selectively infects the epithelium of skin and mucous
membrane and may immortalize the keratinocytes leading either
asymptomatic infection, or warts or neoplasia.
Products of E-genes (E6, E7) are related to immortalization or
malignant transformation of keratinocytes by interfering with p53 and
Rb genes, respectively.
383. Most common virus causing tumor in
human ?
a) HSV

b) HPV

c) EBV

d) HTLV

Correct Answer - B
Ans. is 'b' i.e., HPV [Ref Essentials of medical microbiology p. 719]
Warts are the most common tumor caused by viruses.
HPV is the cause of warts.
384. Growth of virus in embryonated egg,
eggs are incubated for -
a) 4-8 hours

b) 1-2 days

c) 5-12 days

d) 20-25 days

Correct Answer - C
Ans. is 'c' i.e., 5-12 days [Ref: Principles of microbiology - 213]
"For virus isolation, fertile chicken eggs are incubated for 5-12 days,
and a viral Suspension or suspected virus - containing" tissue is
injected into the fluid of the egg.
 385. Most rapid test for diagnosis of malaria
is ?
a) Thick blood smear

b) HRP-2 antigen

c) Thin blood smear

d) PCR

Correct Answer - B
Ans. is 'b' i.e., HRP-2 antigen [Ref Essentials of Microbiology 3'/e
p. 712]
Rapid diagnostic tests are simple and the procedure can be
performed on the spot in field conditions. These tests use finger-
stick or venous blood, the completed test takes a total of 15-20
minutes, and a laboratory is not needed.
Rapid diagnostic tests are antigen based and directed agains :
1. Histidine rich protein-II (HRP-II)
2. Plasmodium glutamate dehydrogenase (pGIuDH)
3. Plasmodium falciparum lactate dehydrogenase (PfLDH)
4. Plasmodium falciparum aldolase (pAldo) or fructose-bisphosphate
aldolase
 386. Rapid diagnostic test for P. falciparum
ustilizes which enzyme ?
a) HRP-2

b) SGOT

c) LDH

d) Peroxidase

Correct Answer - C
Ans. is 'c' i.e., LDH [Ref : Essentials of medical microbiology p. 712]
Among the given options two are used in rapid diagnostic tests
:
1. HRF-2
2. LDH
Among these LDH is an enzyme while HRP-2 is a simple protein
antigen.
387. 18 years old male developed meningitis 5
days after taking a bath in pond. The
likely causative organism ?
a) Meningococcus

b) Cryptococcus

c) Naegleria fowleri

d) Enterococcus

Correct Answer - C
Ans. is 'c' i.e., Naegleria fowleri
[Ref Lippincott's guide to infectious disease p.118]
Primary amebic meningoencephalitis (PAM) is an acute, fulminant,
and rapidly fatal infection involving the central nervous system. It is
caused by the parasite Naegleria fowleri, a free- living
ameboflagellate found in soil and fresh or brackish water (lakes
rivers, ponds
388. True about trichomonas vaginalis :
a) Flagellated parasite

b) Fungal infection

c) Pruritus

d) A and C both

Correct Answer - D
A and C both
Flagellated parasite; Pruritis; and Sexually transmitted disease
Trichomoniasis is caused by a flagellated parasite – Trichomonas
vaginalis.
It is the most commonly encountered vaginal infection and is
sexually transmitted. It affects female of reproductive age group
more commonly.
Patients complain of profuse frothy thin creamy or greenish coloured
malodorous discharge with pruritis.° For
389. Ring forms of babesia differ from ring
forms of malarial parasite [plasmodium]
?
a) Infected RBCs are not enlarged

b) Lack pigment

c) Multiple infection is seen

d) Tetrad forms are seen

Correct Answer - B:D

Ans. is 'b' i.e., Lack pigment; 'd' i.e., Tetrad forms are seen [Ref
Essentials of microbiology - 1132]
Unlike plasmodium species, rings of babesia lack pigment.
Tetrad forms [maltese cross] are characteristics of babesia.
About option a & c
Infected RBCs are not enlarged both in babesia and P. falciparum
Multiple infection of RBCs is common both in babesia & P falciparum
390. Population - based registries are better
than hospital -based registries because
they ?
a) May be used for etiological studies

b) Help in assesing the effectiveness of control programme

c) Measure the burden of disease in a defined population

d) All of these

Correct Answer - D
Ans. is 'a, b & c' i.e., May be used for etiological studies 'b' i.e.,
Help in assesing the effectiveness of control programme & 'c'
i.e., Measure the burden of disease in a defined population
[Ref Cancer epidemiology : principles & methods - 385]
The cancer registry is an organization for the systematic collection,
storage, analysis, interpretation and reporting of data on subjects
with cancer. There are two main types of cancer registry : hospital -
based and population based cancer registries.
391. WHO definition of health does not
include ?
a) Physical health

b) Mental health

c) Environmental health

d) Social health

Correct Answer - C
Ans. is 'c' i.e., Environmental health [Ref Park 23th/e p. 14]
According to WHO, "Health is a state of complete physical,
mental and social well being and not merely an absence of disease
or infirmity." In recent years, this statement has been amplified to
include "the ability to lead a socially and economically productive
life."
392. Daily physical activity/exercise is which
type of prevention ?
a) Primordial

b) Primary

c) Secondary

d) Tertiary

Correct Answer - B
Ans. is 'b' i.e., Primary [Ref: Park 23rdie p. 44]
Life style & behavioral changes, e.g. doing exercise is health
promotion, a type of primary
 393. True about Pasteurization of milk is all
except
a) Does not kill thermoduric bacteria

b) Does not kill spores

c) Cause > 95% decrease in bacterial count

d) Kills tubercle bacillus

Correct Answer - C
Ans. is 'c' i.e., "Causes > 95% decrease in bacterial count
Pasteurization
Pasteurization is done to destroy the pathogens that may be present
in milk, while causing minimal change in the composition. flovour
and nutritive value.
Pasteurization kills nearly 90% of the bacteria in milk, including the
more heat resistant - Tubercle bacilli - Qfever organisms
It does not kill the thermoduric bacteria.
It does not kill bacteria spores.
There are 3 w idelv used methods for pasteurization :
1. Holder method : Milk kept at 63-66°C fur 30 minutes is rapidly
cooled to 5°C.
2. HTST method : 'High temperature short time' method (Flash
method)
I leated to 72°C for 15 sec. and then rapidly cooled to 4°C
This is now the most widely used method.
method :
Ultra-high temprature method.
Rapidly heated in two stages to 125°C for few seconds.
The second stage is being under pressure.
It is then rapidly cooled.
394. Use of shakirs tape for measuring arm
circumference is -
a) Equitable distributin

b) Community participation

c) Intersectoral coordination

d) Appropriate technology

Correct Answer - D
Ans. is 'd' i.e., Appropriate technology
[Ref Textbook of healthcare in India - 743]
Appropriate technology is defined as 'technology that is scientifically
sound, adaptable to local needs, and acceptable to those who apply
it and those for whom it is used, and that can be maintained by the
people themselves in keeping with the principles of self reliance with
the resources the community and country can afford.
395. Quarantine is related to -
a) Minimum incubation period

b) Maximum incubation period

c) Serial interval

d) Generation time

Correct Answer - B
Ans. is 'b' i.e., Maximum incubation period
Ouarantine
Quarantine is defined as "the limitation offreedom of movement of
such well persons or domestic animals exposed to communicable
disease for a period of time not longer the longest incubation period
of the disease in such manner as to prevent effective contact with
those not exposed".
In simple words "Quarantine separates people who have been
exposed to a specific illness (but are not yet sick and don't have
symptoms)" from those not exposed".
Why would one be quarantined ?
Some infection can be transmitted even before a person knows he
or she is sick or has any symptoms. How long would one be
quarantined ?
The individual and often the entire family will stay at home until the
risk of developing the disease or its symptoms is over that means
maximum incubation period, because following exposure symptoms
develop after incubation period.
So, if after maximum incubation period for a specific disease,
exposed person does not develop disease that means that person
has not acquired infection and the person should be allowed to
move.
What if one is in quarantine and becomes ill ?
A quarantined person who develops symptoms associated with the
disease in question should immediately contact his/her personal
physician and local public health department.
Once ill, the individual will be considered to be in isolation instead of
quarnatine.
 396. Case series report is a type of ?
a) Analytic study

b) Experimental study

c) Observational study

d) Intervention study

Correct Answer - C
Ans. is 'c' i.e., Observational study [Ref Park 24m/e p. 67 & 23'/e
p. 62]
A) Observational studies
1. Descriptive studies : Case reports, case series.
2. Analytic studies : Case-control (case-reference), Cohort (follow-up),
Ecological (correlational), Cross-sectional.
B) Experimental/intervention studies
1. Randomized controlled trials/clinical trials.
2. Community trials.
3. Field trials.
4. Animal studies.
397. True about point source epidemic ?
a) Single exposure

b) Rapid rise

c) Slow fall

d) Secondary wave

Correct Answer - A:B

Ans. is 'a & b' i.e., Single exposure & Rapid rise [Ref Park
24thle p. 69 & 23"/e p. 64]
Single exposure or point source epidemics
The exposure to the disease agent is brief and essentially
simultaneous - single exposure.
Because disease agent enters into all exposed persons at same
time - the resultant cases all develop within one incubation period of
the disease.
The epidemic curve rises and falls rapidly.
Because exposure is single (simultaneous) with no further exposure
No secondary wave (no secondary case).
Epidemic tends to be explosive, there is clustering of cases within a
narrow interval of time.
Point source epidemics are mostly (not always) due to exposure to
an infectious agent.
Examples Food poisoning, Bhopal gas tragedy, Minamata disease in
Japan, Chernobyl tragedy
398. Secular trend is demonstrated by:
a) Line diagram

b) Bar graph

c) Pie chart

d) Stem leaf plot

Correct Answer - A
Line diagram
399. Most important factor which decides the
results of a randomized controlled trial
is:
March 2005
a) Inclusion of all age groups

b) 50% treated with placebo and 50% with drugs

c) 100% follow up

d) Effective randomization

Correct Answer - D
Ans. D: Effective randomization
It is a procedure by which the participants are allocated into groups
usually called 'study' and 'control' groups. Randomization is the
heart of control trials.
It eliminates selection bias
 400. In a randomized controlled trial, the
essential purpose of randomization is -
a) To produce double blinding

b) To decrease the follow- up period

c) To eliminate the selection bias

d) To decrease the sample size

Correct Answer - C
Ans. is 'c' i.e., To eliminate the selection bias
Experimental studies are of two types ?
1. Randomized controlled trials
2. Non - Randomized
Randomized controlled trials (RCT)
Randomization is the heart of RCT.
Randomization is a statistical procedure by which the participants
are allocated into study group (in which intervention is given) and
control group / reference group (in which intervention is not given).
It is worth noting that randomisation is done while dividing the
participants into study group and control (reference) group, and not
while selecting subjects for study, i.e. randomization is done after
the sample of subjects has already been selected.
Therefor, each participant has 'equal and known chance' of falling
into either study group or control group. o Randomization is an
attempt to eliminate bias and allow comparability.
It will give the greatest confidence that the groups are comparable
so that "like" can be compared with "like".
It ensures that the investigator has no control over allocation of
participants to either study or control group, thus eliminating what is
known as selection bias.
That means, by random allocation, every individual gets an equal
chance of being allocated into either group, study (experimental)
group or control (reference) group.
nit of study in RCT: Patient
RCT is of two types:
Concurrent parallel design: Comparisons are made between 2
groups:
Experimental group: Is exposed to specific medication or
intervention
Reference group: Is not exposed to specific medication or
intervention
Crossover design: Comparisons are made between 2 groups:
Experimental group: Is exposed to specific medication or
intervention
Reference group: Is not exposed to specific medication or
intervention Then the groups are crossed-over (exposed group now
becomes non-exposed and vice-versa).
401. All are true of standardised mortality
ratio except ?
a) Expressed as rate per year

b) Can be adjusted for age

c) Can be used for events other than death

d) Ratio of observed deaths to expected deaths

Correct Answer - A
Ans. is 'a' i.e., Expressed as rate per year
o Standardization is most commonly used for age.
Standardization can be used not only for age, but also sex, race,
parity, etc.
SMR is the ratio of observed death to expected death and it is
usually expressed as a percentage. o SMR is commonly used in
occupational studies for comparison of morality in an industry and
general population.
o SMR can be used for occurrence of disease (rather than death).
402. Strain used for BCG vaccine -
a) Edmonston Zagreb strain

b) Oka strain

c) 'Danish' 1331

d) RA 27/3strain

Correct Answer - C
Ans. is 'c' i.e., Danish 1331
403. In a case of meningitis, neiserria
meningitides was grown in culture after
48 hours. Which measure is to be taken
immediately ?
a) Isolation of contacts

b) Antibiotic treatment of contacts

c) Vaccination of contact

d) All of the above

Correct Answer - B
Ans. is 'b' i.e., Antibiotic treatment of contacts [Ref: Park 24"'/e
p. 176]
Close contacts of persons with confirmed meningococcal disease
are at an increased risk of developing meningococcal illness.
Antibiotics are effective in preventing additional cases through
eradicating carriage of the invasive strain.
Most secondary case occur within the first 72 hours after
presentation of the index case; risk of secondary disease decreases
to near baseline by 10-14 days.
Antibiotics effective for this purpose include rifampicin, ciprofloxacin,
ceftriaxone or azithromycin.
404. For post-exposure prophylaxis, dose of
human rabies immunoglobulin is:
September 2007
a) 10 IU/kg

b) 20 IU/kg

c) 30 IU/kg

d) 40 IU/kg

Correct Answer - B
Ans. B: 20 IU/kg
Immunoglobulin should be given in a single dose of 20 IU per kg of
body weight for human anti-rabies immunoglobulin, and 40 IU per kg
of body weight for heterologous (equine) immunoglobulin.
Sensitivity to heterologous immunoglobulin must be determined
before it is administered.
The physician should be prepared to deal with anaphylactic shock
reactions.
Administration of rabies immunoglobulin (RIG) should be infiltrated
into the depth of the wound and around the wound as much as
anatomically feasible. Any remainder should be injected at an
intramuscular site distant from that of vaccine inoculation e.g. into
the anterior thigh/ gluteal region
Treatment should be started as early as possible after exposure, but
in no case should it be denied to exposed persons whatever time
interval has elapsed.
405. Which of the following is defined as
generalized HIV epidemics ?
a) Prevalence in pregnant women > 0.5 %

b) Prevalence in a population > 0.5 %

c) Prevalence in pregnant women > 1%

d) Prevalence in a population > 1%

Correct Answer - C
Ans. is 'c' i.e., Prevalence in pregnant women > 1% [Ref Park
24th/e p. 361, 363]
Low level HIV epidemcs
HIV prevalence has not consistently exceeded 5% in any defined
sub-population.
Concentrated HIV epidemics
HIV prevalence is consistently over 5% in at least one defined sub-
population but is below 1% in pregnant women in urban areas
Generalized HIV epidemics
HIV prevalence consistently over 1% in pregnant women
406. If in a state prevalence of HIV is 5% in
high risk group but in antenatal women it
is <1%. The state belongs to ?
a) High prevalence state

b) Moderate prevalence state

c) Low prevalence state

d) Very low prevalence state

Correct Answer - B
Ans. is 'b' i.e., Moderate prevalence state [Ref. Park 23rd/e p. 432
& 22"d/e p. 317]
Group I (High prevalent states): HIV infection in > 5% high risk group
and 1% antenatal women.
Group II (Moderate prevalent states) : HIV infection in 5% high risk
group and < 1% antenatal women.
Group III (Low prevalent states): HIV infection in < 5% high risk
group and < 1% antenatal women.
407. A population of 100000 is under
surveillance during an year. 100 cases
were positive for malarial thick smear.
What is the annual parasite index ?
a) 1 per 1000

b) 2 per 1000

c) 10 per 1000

d) 20 per 1000

Correct Answer - A
Ans. is 'a' i.e.,1 per 1000 [Ref Park 24th le p. 278]
Annual Parasite Incidence =(confirmed cases during one
year/population under surveillancee) x 1000
Population under surveillance = 100000
Confirmed cases = 100
100
API - x 1000 = 1 100,000
So, API is 1 per 1000 population.
 408. BCG vaccination is given by which route
?
a) Subcutaneous

b) Intradermal

c) Intramuscular

d) Subdermal

Correct Answer - B
Ans. is 'b' i.e., Intradermal [Ref Park 24th/e p. 195 & 23rd /e p. 185]
The routes of important vaccines are :-
1. Subcutaneous : Measles, rubella, killed influenza, killed cholera,
IPV, yellow fever.
2. Intramuscular : Mumps, killed influenza, typhoid Vi-polysaccharide,
DPT (deep intramuscular), rabies, IPV.
3. Intradermal : BCG, rabies.
4. Nasal : Live influenza.
5. Ora/ : OPV, oral cholera, oral typhoid (typhoral).
409. True about leprosy in India ?
a) Annual new case detection rate 9.73 per 100000

b) Total 8 lac cases

c) Prevalence rate 1.2 per 10000

d) All of the above

Correct Answer - A
Ans. is 'a' i.e., Annual new case detection rate 9.73 per
100000 [Ref Park 24th/e p. 333]
A total of 1.25 lac new cases were detected during the year 2014-
15, which gives annual new case detection rate (ANCDR) of 9.73
per lac population.
A total of 0.88 lac cases were on record as on Pt April 2015, giving a
prevalence rate (PR) of 0.69 per 10,000 population.
The detailed information on new leprosy cases detected during
2014-15 indicates the proportion of multibacillary cases was 52.82
per cent, proportion of female cases was 36.81 per cent, child case
proportion was 9.04 per cent (which gives the child case rate of 0.88
per lac population), 4.59 per cent patient were with grade-II
deformity, giving deformity rate of 0.448 per lac population
410. Multidrug Resistance Tuberculosis
(MDR-TB) should be considered in
patients with:
a) Contact with a known case of MDR TB

b) Clinical Deterioration

c) Sputum smear positive at 5 months of treatment

d) All of the above

Correct Answer - D
Answer is D (All of the above):
'Infection Control In The community' by Lawrence & May (2003) All
of the options require consideration for a diagnosis of MDR – TB.
Mult Drug Resistant Tuberculosis (MDR TB)
MDR-TB is defined by the presence of resistance to both Rifampicin
and Isoniazid with or without other resistance
MDR TB should be considered in patients with:
Previous drug treatment for tuberculosis
Contact with a case of known MDR TB
HIV infection
Failure of clinical response on treatment
Prolonged sputum smear or culture positive while on treatment
(smear positivity at 4 months or culture positivity at 5 months)
411. Commonest cause of blindness in India:
a) Vitamin A deficiency

b) Cataract

c) Trauma

d) Trachoma

Correct Answer - A
Ans. Vitamin A deficiency
412. Waist to hip ratio which indicates obesity
in men?
a) > 0.5

b) 0.85

c) > 0.93

d) > 1.0

Correct Answer - D
Ans. is 'd' i.e., > 1.0
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.
413. Mode of prevention in CHD ?
a) High risk strategy

b) Primordial prevention

c) Secondary prevention

d) Tertiary prevention

Correct Answer - B
Ans. is 'b' i.e., Primordial prevention
Best way to prevent mortality from any disease is to prevent the
development of disease.
In case of CHD, primordial prevention is best strategy, which mainly
concerns with life style changes.
 414. Primordial prevention in myocardial
infarction are all except -
a) Maintenance of normal body weight

b) Change in life style

c) Change in Nutritional habits

d) Screening for hypertension

Correct Answer - D
Ans. is 'd' i.e., Screening for hypertension
Primordial prevention is done even before the development of risk
factors.
Risk factors are not allowed to develop.
In CHD :-
1. Maintenance of normal body weight (prevention of development of
obesity).
2. Change in life style.
3. Change in nutritional habits
Similar to previous explanation, there are some tricky
situations :?
A) Exercise in a normal built person → Primordial prevention (as we
are not allowing to develop risk factor, i.e. obesity).
Exercise in an obese → Primary prevention (we are modifying the
risk factor).
B) Similarily, change in life style or in nutritional habits may be either
primordial or primary prevention, depending whether these chages
are being done before or after the development of risk factors.
About option `d'
This is also tricky one.
As you all know, screening (early diagnosis) is type of secondary
prevention.
But screening for hypertension is primary prevention for CHD,
because by diagnosis HT early we can modify it.
So,
Screening for hypertension Secondary prevention for HT.
Screening for hypertension → Primary prevention for CHD (if the
person has not developed CHD yet).
415. For diagnosis of diabetes mellitus,
fasting blood glucose level should be
more than:
a) 126 mg/dl

b) 140 mg/dl

c) 100 mg/dl

d) 200 mg/dl

Correct Answer - A
Answer is A (126mg/dl):
For diagnosis of diabetes mellitus, fasting blood glucose level should
be more than or equal to 126 mg/dl or 7mmol/l
416. Western equine encephalitis virus is
transmitted by ?
a) Anophales mosquito

b) Culex mosquito

c) Sandfly

d) Aedes mosquito

Correct Answer - B
Ans. is 'B' i.e., Culex mosquito
417. Bimodal distribution is seen in ?
a) Thyroid carcinoma

b) Hodgkins lymphoma

c) Renal carcinoma

d) Liver carcinoma

Correct Answer - B
Ans. is 'b' i.e., Hodgkins lymphoma [Ref Modern epidemiology p
716]
One important phenomenon in age distribution is bimodality, i.e.
some disease show two peaks in different age groups. Diseases
showing bimodality are Hodgkin's disease, leukaemia, and female
breast cancer.
418. Rice is deficient in which amino acid ?
a) Serine

b) Threonine

c) Methonine

d) Cystone

Correct Answer - B
Ans. is 'B' i.e., Threonine [Ref Read below]
Cereals (wheat & rice) are deficient in lysine threonine. But in
comparison to other cereals protein (e.g wheat) rice protein contains
more lysine (though in lesser amounts) → thus rice proteins is
considered to be better quality among cereals.
419. Rice protein is deficient in ?
a) Methionine

b) Cysteine

c) Lysine

d) Tryptophon

Correct Answer - C
Ans. is c. i.e., Lysine [Ref Textbook of protein foods - 55]
"A rice diet is deficient in lysine and theronine"
420. Endemic
due to:
ascites cases reported from Madhya Pradesh in 1976 was caused

a) Fusarium

b) Crotalaria

c) Ergot

d) Aflatoxin

Correct Answer - B
Endemic ascites was caused due to contamination of millets with crotalaria (jhunjhunia)
seeds which contain hepato toxins such as pyrrolizidine.

Ref: Park 21st edition, page 608.

421. Reagent used to detect the microrganism
in milk before pasteurization ?
a) Crystal violet

b) Methylene blue

c) Phosphatase

d) Nitric acid

Correct Answer - B
Ans. is 'b' i.e.,Methylene blue [Ref Park 24th/e p. 692 & 23rd/e p. 655]
Methylene blue Reduction test' is an indirect test for detection of
microorganism in milk. It is carried out on milk prior to the process of
pasterurization and is not used to check the efficiency of
pasteruization.
Test to check the adequecy (efficiency) of pasteurization are :
Posphatase test (m.c. used), standard plate count, and coliform
count.
422. Acceptable noise level in industries ?
a) 25-30 dB

b) 30-40 dB

c) 40-50 dB

d) 60-80 dB

Correct Answer - C
Ans. is 'c' i.e.,40 50 dB
423. Replacement & periodic examination in
radiation industary is recommended ?
a) Every month

b) Every 2 months

c) Every 6 months

d) Every year

Correct Answer - B
Ans. is 'b' i.e., Every 2 months [Ref Park 24th/e p. 846]
Preventive measures in radiation industeries
Inhalation, swallowing or direct contact with the skin should be
avoided.
In case of X-rays, shielding should be used of such thickness and of
such material as to reduce the exposure below allowable exposures.
The employees should be monitored at intervals not exceeding 6
months by use of the filf badge of pocket electrometer devices.
Suitable protective clothing to prevent contact with harmful material
should be used.
Adequate ventilation of work-place is necessayr to prevent inhalation
of harmful gases and dusts.
Replacement and periodic examination of workers should be done
every 2 months. If harmful effects are found, the employees should
be transferred to work not involving exposure to radiation.
Pregnant women should not be allowed to work in places where
there is continuous exposure.
424. True about mosquito preventive nets are
all except?
a) Hole size < 0.0475

b) 150 holes per square inch

c) Best pattern in circular

d) There should be no rent

Correct Answer - C
Ans. is 'c' i.e.,Best pattern is circular [Ref Park 24th/e p. 810 & 23rdie
p. 773]
The best pattern of mosquito net is the rectangular net.
There should not be a single rent in the net.
The Size of openings in the net is of utmost importance, the size
should not exceed 0.0475 inch in any diameter.
The number of holes in one square inch in usually 150..
425. Process of mixing waste with cement
before disposal is known as ?
a) Inertization

b) Controlled tipping

c) Sanitary landfill

d) Burial

Correct Answer - A
Ans. is 'a' i.e., Inertization [Ref Safe management of wastes from
health-care activities - 126]
The process of inertization involves mixing waste with cement and
water substances before disposal to minimize the risk of toxic
substances contained in the waste migrating into surface water or
groundwater. It is especially suitable for pharmaceuticals and for
incineration ashes with a high metal content (in this case, the
process is also called "stabilization").
426. If 25 persons are working on a project for
30 years. There is how many person-
years of employement.
a) 75

b) 750

c) 120

d) 1200

Correct Answer - B
Ans. is 'b' i.e.,750 [Ref Textbook of gross development in
employement - 121]
"10000 people working for 1 year would lead to 1000 person years
of employment"
Thus, 25 persons working for 30 years will lead to 750 person-years
of employment.
427. Community development block covers a
population of?
a) 3000-5000

b) 20000-30000

c) 30000-50000

d) 80000-120000

Correct Answer - D
Ans. is 'd' i.e., 80000-120000 [Ref: Textbook of preventive &
community dentistry - 175]
At present a community development block covers an area of about
620 sq km with around 100 villages and a population of about
100000 (80000 - 120000).
428. Which of the following conditions must
be fulfilled for a PHC to become a first
referral unit ?
a) 4-6 beds

b) 15 workers

c) Emergency obsteric care

d) Basic laboratory services

Correct Answer - C
Ans. is 'c' i.e., Emergency obsteric care [Ref Textbook of Indian
Health care - 728]
Critical determinants of a first feferral unit
24-hour delivery services including normal and assisted deliveries
Emergency obstetric care including surgical interventions like
caesarean sections and other medical interventions, New-born care,
Emergency care of sick children, Full range of family planning
services including laproscopic services, Safe abortion services,
Treatment of STI / RTI, Blood storage facility, Essential laboratory
services, Referral (transport) services.
429. Number of beds in a CHC is:
March 2010
a) 20

b) 30

c) 40

d) 50

Correct Answer - B
Ans. B: 30
430. Community health centers provide ?
a) Primary health care

b) Secondary health care

c) Tertiary health care

d) Any of the above

Correct Answer - B
Ans. is 'b' i.e., Secondary health care [Ref Park 23'/e p. 904]
431. Training period for anganwadi worker ?
a) 3 months

b) 4 months

c) 6 months

d) 1 year

Correct Answer - B
Ans. is 'b' i.e., 4 months
Anganwadi workers are under ICDS scheme.
There is an anganwadi worker for a population of 400-800 in plains
and 300-800 in hilly/tribal areas.
She undergoes training in various aspects of health, nutrition and
development for 4 months.
She is a part-time worker.
She is paid an honorarium of Rs. 1500 per month.
432. World diabetes day is celebrated on ?
a) 8th may

b) 8th march

c) 14th November

d) 1" december

Correct Answer - C
Ans. is 'c' i.e., 14th November
8 May → World Red Cross Day
8th March → International Women's Day
14th November -÷ World Diabetes Day
l' December → World AIDS Day
433. Used urine bags are disposed in which
color bag ?
a) Red

b) Yellow

c) White

d) Black

Correct Answer - A
Ans. is 'a' i.e., Red [Ref: Imanh. org]
Contaminated recylable wastes are disposed in which red color bag.
These are tubing, bottles, IV tubes, IV sets, catheters, urine bags,
syringes (without needles) and vaccutainers (with their needles cut)
and gloves.
434. Ergonomics?
a) Adjusting the Worker to his job

b) Study of human behavior

c) Study of social mobility

d) None

Correct Answer - A
Ans. is 'a' i.e., Adjusting the Worker to his job
Ergonomics Simply means "fitting the job to the worker".
The object of ergonomics is "to achieve the best mutual adjustment
of man and his work, for the improvement of human efficiency and
well being".
435. Which of the following is not a
fundamental aspect of Disaster
management ?
a) Disaster response

b) Disaster mitigation

c) Disaster awakening

d) Disaster preparedness

Correct Answer - C
Ans. is `c' i.e. Disaster awakening
436. 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.
437. Failure rate of contraceptive method is
determined by-
a) Pearl index

b) Half 1 ife

c) Number of accidental pregnancies

d) Period of contraceptive practice continued

Correct Answer - A
Ans. is 'a' i.e., Pearl index
Pearl index
o Contraceptive methods are evaluated by Pearl index
Pearl index is "failure rate per hundred women years of exposure
(HWY)"
Total accidental
pregnancies
Failure rate Total months of x
per HWY — exposure 1200

o In applying the above formula, the total accidental pregnancies

shown in the numerator, must include every known conception,
whatever its outcome. The factor 1200 is the number of months in
100 yrs.
o A failure rate of 10 per HWY would mean that in the lifetime of an
average women about one fourth or 2.5 accidental pregnancies
would result, since the average fertile period of a women is about 25
yrs.
438. Denominator for maternal mortality rate
is:
September 2005, 2010, March 2013 (d, e,
h)
a) 100,000 pregnancies

b) 100,000 live births

c) 100,000 births

d) 100,000 population

Correct Answer - B
Ans. B: 100,000 live births
The maternal mortality rate is the number of maternal deaths due to
childbearing per 100,000 live births. The crude death rate is the total
number of deaths per year per 1000 people.
The perinatal mortality rate is the sum of neonatal deaths and fetal
deaths (stillbirths) per 1000 births. The infant mortality rate is the
number of deaths of children less than 1 year old per 1000 live
births.
The child mortality rate is the number of deaths of children less than
5 years old per 1000 live births.
The standardised mortality rate (SMR)- This represents a
proportional comparison to the numbers of deaths that would have
been expected if the population had been of a standard composition
in terms of age, gender, etc.. The age-specific mortality rate (ASMR)
- This refers to the total number of deaths per year per 1000 people
of a given age (e.g. age 62 last birthday).
439. Birth & death in India should be
registered within?
a) 7 days

b) 14 days

c) 21 days

d) 30 days

Correct Answer - C
Ans. is 'c' i.e., 21 days [Ref Park 24thie p. 877 & 23rd/e p. 840; IRS-
2009]
Birth 21 days
Death 21 days
Marriage 30 days
Pregnancy NO LEGISLATION YET
440. ESI act does not cover which of the
following:
September 2010
a) Hotel employee

b) Transpoters

c) Railway employees

d) Factory employees

Correct Answer - C
Ans. C: Railway employees
This act covers all employees including engaged through the
contracts but whose remuneration does not exceed Rs. 10, 000 p.m.
including staff in the class of administrative, canteen, loading-
unloading, security, etc.
Apprentices who are appointed for learning the work with no right of
being absorbed in service, do not come with the ambit of this act.
441. Goal is defined as ?
a) Planned end-point of all activities

b) Planned discrete activity for the programme

c) Ultimate desired state

d) All of the above

Correct Answer - C
Ans. is 'c' i.e., Ultimate desired state [Ref Park 23ra/e p. 868]
A goal is defined as the ultimate desired state towards which
objectives are directed. Goals are not necessarily attainable. Unlike
objectives and targets, goals are not constrained by time or existing
resources.
442.
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 : ?
1) Bony labyrinth :- Cochlea, Vestibule, Semicircular canals.
2) Membranous labyrinth :- Cochlear duct, utricle, Saccules, three
semicircular ducts, and endolymphatic duct & sac.
443. Cells of the Organ of Corti which are
vulnerable to noise induced damage are
?
a) Inner hair cells

b) Outer hair cells

c) Deiter's cells

d) Cells of Hensen

Correct Answer - B
Ans. is 'b' i.e., Outer hair cells
444. Reissner membrane seperates:
a) Scala Vestibuli from Scala media

b) Scala tympani from scale Vestibuli

c) Scala tympani from Scala media

d) None of the above

Correct Answer - A
Reissner membrane separates scala vestibule from scala media.
445. Bleeding ear discharge is mostly due ?
a) Glomus tumour

b) Otosclerosis

c) Otitis media with effusion

d) Acoustic neuroma

Correct Answer - A
Ans. is'a'i.e., Glomus tumour
(Ref: Dhingra 6h/e p. 109)
446. Progressive loss of hearing, tinnitus and
ataxia are com​monly seen in a case of:
a) Otitis media

b) Cerebral glioma

c) Acoustic neuroma

d) Ependymoma

Correct Answer - C
Ans. C. Acoustic neuroma
447. A 15 year old male has nominal aphasia.
There is also history of scanty, foul
smelling discharge in the past. The
patient reports of some bleeding when
cleaning the ear. Which of the following
is the most likely diagnosis?
a) Extradural abscess

b) Temporal lobe abscess

c) Cavernous thrombosis

d) Lateral sinus thrombophlebitis

Correct Answer - B
Ans. is'b'i.e., Temporal lobe abscess
lRef: Dhingra Sh/e p. 85
Otogenic brain abscess
Ear infections are the most common cause of brain abscess.
Most common site of cerebral abscess is temporal lobe.
Due to increased ICT.
Headache
Nausea/vomiting
Lethargy progressing to drowsiness, confusion, stupor and coma.
 448. In serous otitis media, which one of the
following state​ments is true?
a) Sensorineural deafness occurs as a complication in 80% of the
cases

b) Intracranial spread of the infection complicates the clini​cal

courses

c) Tympanostomy tubes are usually required for treatment

d) Gram-positive organisms are grown routinely in culture in the

aspirate

Correct Answer - C
Ans. C tympanostomy tubes are usually required for treatment
Lets see at the options one by one:
Serous otitis media:
Option a
Sensori neural deafness occurs as a complication in 80% of cases
This is not correct because serous otitis media leads to conductive
type of hearing loss.
Option b
Intracranial spread of the infection complicates the clinical
course
1. This is not true as complications of serous otitis media are:
2. Adhesive otitis media
3. Atrophy of tympanic membrane
4. Tympanosclerosis (chalky white deposits seen on. membrane)
5. Atelectasis of middle ear
6. Ossicular necrosis
7. Cholesteatoma due to retraction pockets
8. Cholesterol granuloma due to stasis of secretions
 Option c
1. Tympanostomy tubes are usually required for treatment:
2. This is quite correct as myringotomy and aspiration of middle ear
effusion without ventilation tube/Tyrnpanostomy tube/ grommet
insertion has a short lived benefit and is not-recommended
3. Hence if otitis media with effusion I serous OM is notresolved
spontaneously, tympanostomy tube is inserted.

Option d
1. Gram positive organism are grown routinely in culture in the aspirate
2. Absolutely incorrect because fluid collection in serous otitis media ls
sterile
449. Most common cause of congenital
sensineuronal hearing loss ?
a) Parvovirus

b) CMV

c) Rubella

d) Toxoplasmosis

Correct Answer - B
Ans. is'b'i.e., CMV
[Rel paediatric Otolaryngology p. 78]
Cytomegalovirus -+ Most common viral cause of congenital viral
deafness
Mumps -+ Most common cause viral of acquired sensorineural
hearing loss.
450. In cavernous sinus thrombosis, first
nerve to be af​fected is:
September 2012
a) 6th

b) 5th

c) 4th

d) 3rd

Correct Answer - A
Ans. A i.e. 6th
451. Prolonged blockade of Eustachian tube
leads to ?
a) Atelectatic ear

b) Cholesteatoma

c) Perforation

d) All of the above

Correct Answer - D
Ans. is'd'i.e., All of the above
[Rf Dhingra 6h/e p. 60)
Acute tubal blockage → AbsorPtion of ME gases → Negative
Pressure in ME → Retraction of TM → Transudate in
ME/haemorrhage (acute OME) → Prolonged tubal
blockage/dysfunction → OME (thin watery or mucoid discharge) →
Atelectatic ear/Perforation → Retraction pocket/cholesteatoma
452. Cottle test is positive in case of ?
a) Deviated Nasal septum

b) Rhinosporidiosis

c) Hypertrophied inferior nasal turbinate

d) Atrophic rhinitis

Correct Answer - A

Cottle test : It is used to test nasal obstruction due to abnormality of

nasal valve as in case of deviated nasal septum.
In this test, cheek is drawn laterally while the patient breathes
quietly. If the nasal airway improves on the test side, the test is
positive, and indicates abnormality of the vestibular component of
nasal valve.
453. Most common cause of nasal polyp in
children is?
a) Human papilloma virus

b) Allergic rhinitis

c) Inverted papilloma

d) Rhinosporidiosis

Correct Answer - B
Ans. is'b'i.e., Allergic rhinitis
Re/ BRS Gross Anatomy p' 405)
The most common cause of nasal polyp is allergic rhinitis'
Nasal polyps are not particularly common in children.
Occasionally so-called "allergic PolyPs" are encountered' and
occasionally recurrent bouts of allergy and infection lead to chronic
hypertrophic polypoid rhinosinusitis.
However' most commonly when nasal polyps are encountered in
children, the underlying problem is cystic fibrosis'
454. Le Forte II facial fracture implies -
a) Fracture running through alveolar ridge

b) Fracture running through midline of the palate and zygomatico

maxillary suture

c) Fracture running through zygomatic process of the maxilla, floor

of orbit, root of nose on one side only

d) Similar to C but on both sides

Correct Answer - D
Ans. is 'd' i.e., Similar to C but on both sides
Le Fort Classification of Mid-face #s
Le Fort I (transverse fracture)
the # line runs above & parallel to the palate and effectively
separates the alveolus and palate from the facial skeleton above.
it crosses the lower part of the nasal septum, maxillary antra and the
pterygoid plates.
Le Fort II fracture
it is pyramidal in shape and passes through the root of nose,
lacrimal bone, floor of orbit, upper part of maxillary sinus and
pterygoid plates. the orbital floor is always involved
Le Fort III fracture (craniofacial dysjunction) there is complete
separation of facial bones from the cranial bones.
the # line runs high through the nasal bridge, septum and ethmoids,
and through the bones of orbit to the frontozygomatic suture. The
zygomatic
arch fractures and the facial skeleton is separated from the bones
above at a high level through the lateral wall of maxillary sinus and
the pterygoid plates.
455. Juvenile nasopharyngeal angiofibroma
spreading to pterygomaxillary fossa is
which stage?
a) Stage I

b) Stage II

c) Stage III

d) Stage IV

Correct Answer - B
Ans. is .b, i.e., Stage II
lRef: Neuroradiologlt by Zimmerman p. 455; CT and MRI of the
Whole Boily Shle p' 6101
IA -+ Tumor limited to posterior nares or nasopharyngeal vault
IB + Extension into one or more Paranasal sinuses
IIA -+ Minimal lateral extension through sphenopalatine foramen into
medial pterygomaxillary fossa.
IIB + Full occupation of pterygomaxillary fossa, di-splacing posterior
wall of antrum forward; superior extension eroding orbital bones.
IIC + Extension tt roogi ptetygomoilary fossa into cheek and
temporal fossa
III -+ Intracranial extension
456. Regarding Juvenile 1,7ngeal
papillomatosis, false is ?
a) Recurrent

b) Interferon is used in treatment

c) Premalignant

d) HPV 18 is the causative agent

Correct Answer - D
Ans. is 'd' i.e., HPV 18 is the causative agent [
(Ref Nelson l8n/e p' 1772; Dhingra 6h/e p' 449)
Juvenile papilloma (Recurrent laryngeal papillomatosis/Recurrent
respiratory papillomatosis)
Recurrent Respiratory Laryngeal Papillomatosis is a disease of viral
origin characterized by the presence of multiple recurrent papillomas
in the larynx.
The disease is common in anterior part of glottis, especially anterior
commissure.
Etiology:
Associated with Human Papilloma Virus infection (HpV).
HPV6 and HPV 11 are most commonly associated with laryngeal
disease.
HPV 11 is associated with a more aggressive disease and makes
the patient more prone to malignant change.
457. Most common presentation in
nasopharyngeal carcinoma:
a) Epistaxis

b) Hoarseness of voice

c) Nasal stuffiness

d) Cervical lymphadenopathy

Correct Answer - D

Cervical lymphadenopathy is the M/C presentation of

nasopharyngeal carcinoma. It may be the only manifestation in
some cases.
458. Which of the following is not a feature of
chronic tonsillitis?
a) Fever

b) Halitosis

c) Recurrent attacks of sore throat

d) Choking spells at night

Correct Answer - A
Ans. is 'a' i.e., Fever
(ref Dhingra 6h/e p. 258]
Fever is a symptom in case of acute tonsillitis, not chronic tonsillitis.
Chronic tonsillitis is characterized by:-
Recurrent attacks of sore throat or acute tonsillitis.
459. Treatment of early cases of vocal
nodules is ?
a) Excision

b) Laser Ablation

c) Voice therapy

d) Tissue sampling followed by definitive therapy

Correct Answer - C
Ans. is'c'i.e., Voice therapy
[Ref: Dhingra &/e p. 3031]
Early cases of vocal nodules can be treated conservatively by
educating the patient in proper use of voice.
Many nodules especially in children, disappear with this treatment'
Surgery is required for large nodules or long standing nodules in
adults.
Microscopic (microlaryngoscopic) erosion is the treatment of choice,
 460. Structures removed in vertical partial
laryngectomy are all except ?
a) True cord

b) Epiglottis

c) Arytenoid

d) Thyroid cartilage

Correct Answer - B
Ans. is'b'i.e., Epiglottis
(Ref' ENT by Michaels p' 307
Partial Vertical larYngectomY :
Used to remove carcinoma confined to or with little spread from the
true vocal cord.
Structures removed are:
1. Whole vocal cord on the affected side, including the carcinoma
2. Ipsilateral arytenoid cartilage
3. Adjacent part of ipsilateral thyroid cartilage
4. Part of the adjacent cricoid cartilage, if there is some subglottic
spread.
461. All the following can cause mouth ulcers
except ?
a) Sickle cell anemia

b) Lichen planus

c) Mouth washes

d) Psoriasis

Correct Answer - D
Ans. is 'd' i.e., Psoriasis
(lRef Dhingra &/e p. 217)
462. True statement about oral cancer is/are:
a) Most common in buccal mucosa

b) Systemic metastasis uncommon

c) Responds to radiotherapy

d) b and c

Correct Answer - D
Ans. D. b and c
463. Which of the following is the feature of
aphthous ulcer?
a) Recurrent

b) Genital ulcer

c) Malignant

d) Old age

Correct Answer - A
Ans. is 'a' i.e., Recurrent
(Ref: Dhingra eh/e p. 218)
Aphthous ulcers are small ulcer craters in the lining of the mouth that
are frequently painfuL and sensitive.
Characterized by recurrent, small, round or oval ulcers with
circumscribed margins, erythematous haloes, and yellow or gray
floor.
464. Schatzki's Ring is present at ?
a) Upper end of trachea

b) Lower end of trachea

c) Upper end of esophagus

d) Lower end of esophagus

Correct Answer - D
Ans. is 'd' i.e., Lower end of esophagus
Schatzki's ring
It occurs at the junction of squamous and columnar epithelium at the
lower end of oesophagus and has also been called lower
oesophageal ring.
Usually seen in patients above 50 years of age.
Cause is unknown.
Symptomatic patients complain of intermittent dysphagia and some
may even present with bolus obstruction.
It may be associated with hiatus hernia.
Treatment is oesophageal dilatation.
465. In which one of the following conditions
the sialography is contraindicated
a) Ductal calculus

b) Chronic parotitis

c) Acute parotitis

d) Recurrent sialodenitis

Correct Answer - C
Ans. is 'c' i.e. Acute parotitis
"Sialography is contraindicated in acute sialadenitis (includes
parotitis) for fear of exacerbating the condition." -Sutton
466. Incision used in endomeatal approach to
the ear ?
a) Lempert I incision

b) Lempert II incision

c) Rosen's incision

d) Wilde's incision

Correct Answer - C
Ans. is 'C i.e., Rosen's incision
(Ref Dhingra @/e p. 400)
Endomeatal or transcanal approach.
It is used to raise a tympanomeatal flap in order to expose the
middle ear.
Rosen's incision is the most commonly used lot stapedectomy.
467. FESS means:
a) Factual endoscopic sinus surgey

b) Functionl endonasal sinus surgery

c) Factual endonasal sinus surgery

d) Functionl endoscopic sinus surgery

Correct Answer - D
Indications ofFESS
i) Chronic bacterial sinusitis unresponsive to adequate medical
treatment.
ii) Recurrentacutebacteridsinusitis.
iii) Polypoid rhinosinusitis (diftrse nasal polyposis)'
w) Fungal sinusitis with fungal ball or nasal polypi'
v) Antrochoanal polyp and Ethmoid polyp
vi) Mucocele of frontoethmoid or sphenoid sinus.
vii) Control of epistaxis by endoscopic cautery.
viii) Removal of foreign body from the nose or sinus'
ix) EndoscoPicsePtoPlastY.
x) Removal of benign tumours, e.g. invertedpapillomas or
an$ofibromas.
xi) Orbital abscess ot cellulltls nonageme,tt.
xii) DacryocYstorhinostomY.
:lolii) RepaltofCSFleak,
xiv) Pituitarysurgery
xv) Optic nerve decomPression.
xvi) Orbitd decompression for Graves disease-
xvii) Control ofposterior epistaxis(endoscopic
clipping ofsphenopalatine artery).
xviii) Choanal atresia.
468. The structure damaged in High
Tracheostomy ?
a) Thyroid isthmus

b) Aortic knuckle

c) First tracheal ring

d) Recurrent laryngeal nerve

Correct Answer - C
Ans. is'c' i.e., First tracheal ring
(Ref: Dhingra dle p' 317)
High tracheostomy: Performed above the level of thyroid isthmus
which lies against II, III and IV tracheal rings:
Indicated in carcinoma larynx when laryngectomy is anticipated.
Drawback : tracheostomy at this point violates the 1st ring of trachea
and causes perichondritis of the cricoid cartilage and subglottic
stenosis, so it is better avoided.
469. Optic nerve glioma is associated with
a) Sturge Weber Syndrome

b) Neurofibromatosis I

c) VKH Syndrome

d) Von Hippel Lindau Syndrome

Correct Answer - B
Answer- B. Neurofibromatosis I
Opttic nervee glioma (astrocytoma) is the most common intrinsic
tumor of the optic nerve. Most common type of optic nerve glioma is
juvenile pilocytic astrocytoma.
Optic nerve gliomas are associated with Neurofibromatosis-l (Von
Recklinghausen's disease)
470. With accommodation at rest, total
refractory power of crystalline lens is
a) 14D

b) 16D

c) 18D

d) 20D

Correct Answer - B
Answer- B. 16D
The diopteric power of reduced eye is + 6OD, of which + 44D is
contributed by cornea and + 16D by the crystalline lens.
471. Volume of orbit is
a) 19 ml

b) 29 ml

c) 39 ml

d) 49 ml

Correct Answer - B
Answer- B. 29 ml
Volume of each orbit is 29 ml.
Orbit is made up of 7 bones: frontal, ethmoid, lacrimal, palatine,
maxilla, zygomatic and sphenoid
472. Anterior focal point is at distance of in
front of cornea in recuded eye
a) 22.6 mm

b) 17.2 mm

c) 15.7 mm

d) 24.13 mm

Correct Answer - C
Answer- C. 15.7 mm
Anterior Focal Point- 15.7 mm
473. Distance between nodal point and
cornea in Listing's Reduced eye is
a) 7.2mm

b) 9mm

c) 12mm

d) 15.3mm

Correct Answer - A
Answer- A. 7.2mm
Nodal Point- 7.2 mm behind the anterior corneal surface
474. Which intraocular muscle inserts closest
to limbus
a) Lateral Rectus

b) Medial Rectus

c) Superior Rectus

d) Inferior Rectus

Correct Answer - B
Answer- B. Medial Rectus
Medial rectus -Distance of insertion from limbus- 5.5 mm
475. Hyphaema i.e. blood in the anterior
chamber is suggestive of
a) Intraocular trauma

b) Posterior uveitis

c) Capillary hemangioma of the lid

d) High grade myopia

Correct Answer - A
Answer- A. Intraocular trauma
Etiologyof hnhaema
The most common causes of hyphema are intraocular surgery, blunt
trauma, and lacerating trauma.
Hyphemas may also occur spontaneously, without any inciting
trauma
476. A 30 year old female wears contact lens
for 2 months continuously. The
symptoms she experiences therafter
could be due to all except
a) Giant Papillary conjunctivitis

b) Microbial keratits

c) Increased sensitivity

d) Open angle glaucoma

Correct Answer - D
Answer- D. Open angle glaucoma
Corneal complications : - Corneal abrasion, Corneal edema, Corneal
vascularization, Microbial keratitis (pseudomonas, acanthamoeba),
Sterile corneal infiltrate
Giant papillary conjunctivitis
Hypoxia : - Cornea b deprived of oxygen from the tear film by the
presence of the contact lens. The cornea becomes edematous and
new vessels may develop in the limbal area.
477. Swimmer after coming out from
swimming pool presents with redness
and mucopurulent discharge. There is no
history of contact lens wear. On
examination, no corneal involvement
seen. Probable diagnosis is
a) Acanthamoeba keratitis

b) Adult inclusion conjunctivitis

c) Vernal keratoconjunctivitis

d) Angular conjunctivitis

Correct Answer - B
Answer- B. Adult inclusion conjunctivitis
is a type of follicular conjunctivitis caused by serotypes D to K of
chlamydia trachomatis in sexually active young adults.
Transmission may occur either through contaminated fingers or
through contaminated water of swimming pools (Swimming pool
granuloma).
 478. KISA% is associated with
a) Keratoconus

b) Keratoglobus

c) Hypermetropia with astigmatism

d) Terrien's marginal degeneration

Correct Answer - A
Answer- A. Keratoconus
The KISA index is used in cases ofkeratoconus and is derived
using 4 indices:
1. Central keratometry K
2. Inferior- Superior keratometry (I-S)
3. Astigmatism Index (AST)
479. What is deposited in band keratopathy
a) CaSO4

b) CaPO4

c) MgSO4

d) MgPO4

Correct Answer - B
Answer- B. CaPO4
Band keratopathy is characterized by the deposition ofcalcium and
phosphorus salts (especially hydroxyapatite) in a bandlike pattern in
the anterior layers of the cornea. The keratopathy is usually limited
to the interpalpebral area. Symptoms include irritation, injection, and
blurring of vision.
Chronic eye diseases (most common cause)
480. Ciliary staphyloma affects ciliary zone
upto mm behind the limbus
a) 4

b) 6

c) 8

d) 10

Correct Answer - C
Answer- C. 8
Staphyloma is an abnormal protrusion of uveal tissue through a
weak and thin portion of cornea or sclera. So, a staphyloma is lined
internally by weal tissue and ertnnally by weak cornea or sclera.
Ciliary staphyloma : - This afects the ciliary zone that includes the
region upto I mm behind the limbls. The ciliary body is incarcerated
in the region of scleral ectasia. Causes are Developmental
glaucoma, Primary or secondary glaucoma end stage, scleritis,
trauma to ciliary region.
481. In complicated cataract opacity develops
in
a) Anterior capsule

b) Nucleus

c) Posterior subcapsular

d) Cortical

Correct Answer - C
Answer-C. Posterior subcapsular
Complicated cataract refers to the lens opacification secondary to
some other intraocular disease, Anterior uveitis is the most common
cause.
Posterior cortical complicated cataract : - This type of cataract is due
to affections of posterior segment. This cataract is located in a
posterior subcapsular cataract and typically opacification starts in
the posterior part of the cortex in the axial region.
482. Most common method of anterior
capsulotomy in phacoemulsification
a) Can-opener capsulotomy

b) Intercapsular capsulotomy

c) Capsulorhexis

d) Envelop capsulotomy

Correct Answer - C
Answer- C. Capsulorhexis
The most commonly used technique for anterior capsulotomy during
phacoemulsification is continuous curvilinear capsulorhexis (CCC).
483. SRK formula is used to calculate
a) Power of intraocular lens

b) Corneal curvature

c) Corneal endothelial cell count

d) Extent of retinal detachment

Correct Answer - A
Answer- A. Power of intraocular lens
Intraocular lens power calculation :- Which requires Keratometry (K),
Axial length of eyeball or Biometry (L) and a
constant (A). It is calculated by SRK formula:
Power of IOL= A- 2.5L -0.9K
484. Trabeculectomy for glaucoma leads to
formation of a channel between
a) Subconjuntival space and anterior chamber

b) Anterior chamber and Posterior chamber

c) Subconjunctival space and posterior chamber

d) None of the above

Correct Answer - A
Answer- A. Subconjuntival space and anterior chamber
Trabeculectomy is a surgical procedure used in the treatment of
glaucoma to relieve intraocular pressure by removing part of the
eye's trabecular meshwork and adjacent structures.
It is the most common glaucoma surgery performed and allows
drainage of aqueous humor from the anterior chamber to
underneath the conjunctiva where it is absorbed.
485. Sudden acute loss of vision with shallow
anterior chamber is suggestive of
a) Acute angle closure glaucoma

b) Acute iridocyclitis

c) Open angle glaucoma

d) Viral keratitis

Correct Answer - A
Answer- A. Acute angle closure glaucoma
Lid edema
Conjunctiva is chemosed and congested (both conjunctival &
ciliaryvessels are congested) o Cornea is oedematous and
insensitive Anterior chamber is very shallow & with aqueous flare
Angle of anterior chamber is closed (on gonioscopy) Iris is
discoloured.
Optic disc is oedematous & hyperemic Fellow eye shows shallow
anterior chamber and a narrow angle.
486. Tertiary vitreous is represented by
a) Zonular system

b) Ciliary body

c) Anterior uvea

d) Lens

Correct Answer - A
Answer- A. Zonular system
"Tertiary vitteous indicates the mnular system. The pimary and
secondary vitreous are stages in developmmt of vitreous,
However the tertiary vitreous i.e. the zonules are named so only
because of their proximity to the vitreous.
487. Mittendorf dot is found on
a) Anterior capsule of lens

b) Posterior capsule of lens

c) Vitreous

d) Retina

Correct Answer - B
Answer- B. Posterior capsule of lens
During the development of eye there is a blood vessel which runs
between the optic nerve and the back of the lens, called hyaloid
vessel. This vessel carries nutrients and orygen to the developing
parts ofthe anterior section ofeye. This hyaloid vessel along with
surrounding embryonic material is called primary vitreous. Hyaloid
vessels and primary vitreous begin to involute in the second month
of gestation giving way to the secondary vitreous (the vitreous
humor). Small remnants of the system are common findings in
healthy adults, e.g. Bergmeister papilla (tuft of tissue at the optic
disc) and miftendorf dot (tag of tissue on the posterior capsule of
lens). However extensive remnants of this "hyaloid vessel - primary
vitreous" system are called persistent hyperplastic primary vitreous.
488. Smoke stake pattern is characteristic of?
a) Sickle cell retinopathy

b) Sarcoidosis

c) Acute retinal necrosis

d) Central serous retinopathy

Correct Answer - D
Answer- D. Central serous retinopathy
Smoke stack pattern (small hyper ftuorescent spot which ascends
vertically like a smoke-stack), which gradually spreads
laterally to take a mushroom or umbrella configuration, is a Fundus
Fluorescein Angiography (FFA) finding of Central
Serous Retinopathy.
489. Condition where subhyloid hemorrhage
is associated with subarachnoid
hemorrhage is
a) Posner-Schlossman syndrome

b) Axenfeld-Rieger syndrome

c) Pseudoexfoliation syndrome

d) Terson's syndrome

Correct Answer - D
Answer- D. Terson's syndrome
Terson syndrome is intraocular hemorrhage associated with
subarachnoid hemorrhage, intracerebral hemorrhage or traumatic
brain injury. Hemorrhage may be present in the vitreous, sub-hyloid,
or intraretina/ sub-internal limiting membrane.
Subarachnoid hemorrhage may be directly transmitted forward
through the optic nerve sheath.
490. A 30 year old male came with complains
of unilateral blurred vision with floaters
since 15 days. On examination, AC flare
and cells were seen with 'headlight in
fog' appearance on indirect
ophthalmoscopy. Also, a single
inflammatory focus of fluffy
retinochoroiditis lesion is seen. What is
the diagnosis ?
a) Cytomegalovirus retinitis

b) Toxoplasmosis chorioretinitis

c) Toxocariasis

d) Sarcoidosis

Correct Answer - B
Answer- B. Toxoplasmosis chorioretinitis
Toxoplasmosis is caused by Toxoplasma gondii, an obligate
intracellular protozoan.
Symptoms: Unilateral acute or subacute onset of floaters, blurring
and photophobia.
'Spill-over' anterior uveitis is common. It may be granulomatous or
resemble Fuchs uveitis syndrome; elevated IOP may develop.
Vitritis may be severe and impair fundus visualization. 'Headlight in
the fog' is the classic description of a white retinal inflammatory
nidus viewed through vitritis.
491. Circinate retinopathy is seen in
a) Diabetic Retinopathy

b) Hypertensive Retinopathy

c) Best Disease

d) Stargardt's Disease

Correct Answer - A
Answer- A. Diabetic Retinopathy
Circinate retinopathy is a feature of Diabetic Retinopathy. It is a
feature of diabetic macular edema.
Circinate retinoiathy a condition markedby a circle ofwhite
spotsenclosing the macular area,leading to complete foveal
blindness.
492. Asteroid Hyalosis bodies are composed
of
a) Iron

b) Calcium and phosphates

c) Cadmium and chloride

d) None

Correct Answer - B
Answer- B. Calcium and phosphates
Asteroid hyalosis is a degenerative condition of the eye involving
small white opacities in the vitreous humor.
The asteroid bodies are made up of hydroxyapatite, which in turn
consists of calcium and phosphates.
493. What is the length of optic nerve
a) 20 mm

b) 30 mm

c) 40 mm

d) 50 mm

Correct Answer - D
Answer- D. 50 mm
optic nerve is about 47-50 mm in length and can be divided into
4 parts : -
Intraocular part (1 mm)
Intraorbital part (30 mm)
Intracanalicular part (5-9 mm)
Intracranial part (10 mm)
494. Optic radiations arise from
a) Lateral Geniculate body

b) Medial Geniculate Body

c) Superior colliculus

d) Inferior colliculus

Correct Answer - A
Answer- A. Lateral Geniculate body
The optic radiations (geniculocalcarine pathway) extend from the
lateral geniculate body to the visual cortex. Inferior fibres of optic
radiations ,subserve upper visual fields and superior fibres subserve
inferior visual fields.
The visual pathway starting from retina consists of optic nerve, optic
chiasma, optic tracts, lateral geniculate bodies, optic radiations,
visual cortex.
495. Foster kennedy syndrome seen with
a) AION

b) Retinal detachment

c) Frontal lobe tumor

d) Macular edema

Correct Answer - C
Answer- C. Frontal lobe tumor
Foster - kennedy syndrome :- The frontal lobe, pituitary and middle
ear tumor such as meningiomata of the oflactor groove are
sometimes associated with Ipsilateral pressure atrophy of the optic
nerve and contralateral papilloedema.
496. What will be the consequence if the left
optic nerve is cut
a) Left eye complete blindness with loss of contralateral direct and
ipsilateral consensual light reflex

b) Left eye complete blindness with loss of ipsilateral direct and

contralateral consensual light reflex

c) Left eye complete blindness with no effect on light reflex

d) Bitemporal hemianopia

Correct Answer - B
Answer- B. Left eye complete blindness with loss of ipsilateral direct
and contralateral consensual light reflex
Lesion of optic nerve causes-
Complete visual field loss of the ipsilateral eye (blindness);
Abolition of ipsilateral direct and contralateral consensual light reflex;
497. A child has esotropia. What corrective
surgery is to be performed
a) Medial rectus resection

b) Lateral rectus recession

c) Medial rectus recession

d) All of the above

Correct Answer - C
Answer- C. Medial rectus recession
Correction of refractive error is the initial treatment.
Surgery should be considered only if spectacles do not fully correct
the deviation and after every attempt has been made to treat
amblyopia.
Bilateral medial rectus recessions OR unilateral medial rectus
recession combined with lateral rectus resection may be done
498. Duane Retraction Syndrome is most
commonly characterised by
a) Deficiency in action of 6th nerve characterized by difficult
abduction

b) Weakness of superior oblique

c) Presence of corneal pigmentation

d) Presence of acute increase in intraocular pressure

Correct Answer - A
Answer- A. Deficiency in action of 6th nerve characterized by
difficult abduction
Duane retraction syndrome represents the most frequent and most
prominent congenital (CCDD). cranial dysinnervation d.isorder
Duane retraction syndrome is a congenital strabismus that is usually
caused by failure of normal development of the abducens nerve (the
sixth cranial nerve). There is absence ofthe abducens nerve and
fascicle with anomalous innervation of the lateral rectus muscle by
the oculomotor nerve.
499. Which of the following antivirals cannot
be used topically in the eye ?
a) Acyclovir

b) Ganciclovir

c) Idoxuridine

d) Famciclovir

Correct Answer - D
Answer- D. Famciclovir
Topical antivirals used are - Acyclovir, Ganciclovir, triflurothymidine,
Vidarabine, Idoxuridine.
500. Most common site of bony metastases in
retinoblastoma
a) Skull bones

b) Hip bones

c) Ribs

d) Vertebrae

Correct Answer - A
Answer-A. Skull bones
The most frequently identified sites of metaststic involvement in
children with retinoblastoma include skull bones, distal bones, brain,
spinal cord, lymph nodes and abdominal viscera.
501. Fusion of two eyelids by thin tags is
called
a) Ankyloblepharon filiforme adnatum

b) Euryblepharon

c) Ablepharon

d) Epiblepharon

Correct Answer - A
Answer- A. Ankyloblepharon filiforme adnatum
In ankyloblepharon filiforme adnatum the upper and lower eyelids
are joined by thrn tags; most cases are sporadic. Treatment involves
transection with scissors.
502. Nasolacrimal duct runs in the
nasolacrimal canal. It is made up of all
the following bones except
a) Maxillary bone

b) Inferior nasal conchae

c) Lacrimal bone

d) Ethmoid

Correct Answer - D
Answer- D. Ethmoid
Nasolacrimal Canal
The canal containing the nasolacrimal duct is called the
nasolacrirnal canal.
It is formed by indentations in the inferior nasal conchae, maxilla and
lacrimal bone.
It drains to-into the nasal cavity through the anterior portion of the
inferior meatus which is between the inferior concha and the floor
ofthe nasal cavity.
503. Muscle not paralysed in retrobulbar
block
a) Superior oblique

b) Lateral rectus

c) Superior rectus

d) Medial rectus

Correct Answer - A
Answer- A. Superior oblique
A retrobulbar block is a regional anaesthesic nerve block in the
retrobulbar space, the area located behind the globe ofthe eye.
Injection oflocal anaesthesic into this space constitutes the
retrobulbar block.
Cranial nerve IV lies outside the muscle cone,but is blocked by
diffusion of the local anaesthetic.
Superior oblique is supplied by cranial nerve IV.
 504. Anisocoria in homers syndrome is due
to
a) Oculo sympathetic palsy

b) Oculo parasympathetic palsy

c) Oculomotor nerve palsy

d) Abducens nerve palsy

Correct Answer - A
Answer- A. Oculo sympathetic palsy
Horner's syndrome is oculo sympathetic palsy.
Horner's syndrome consists of classical triad of ipsilateral:-
1. Ptosis,
2. Miosis,
3. Anhydrosis (loss of sweating)
Other features are :- Loss of cilio-spinal reflex, Enophthatnos,
Heterochromia (ipsilateral iris is of light colour), the pupil is slow to
dilate, slight elevation of inferior eyelid, normal pupillary reflex.
505. Gorlins formula is used to calculate
a) Area of stenotic aortic valve

b) Amount of daily calorie intake

c) Body mass index

d) Basal metabolic rate

Correct Answer - A
Answer-A. Area of stenotic aortic valve
The stenotic valve orifice are is derived fromthe pressure gradient
and cardiac output with the formula developed by Gorlin and Gorlin,
which involves the fundamental hydraulic relationships, linking the
a.ea of an orifice to the flow and pressure drop across the orifice.
506. Which of the following is a feature of first
degree AV block?
a) PR interval > 200 ms

b) Inversion of T wave

c) Progressive shortenting of PR interval

d) Presence of U wave

Correct Answer - A
Answer- A. PR interval > 200 ms
First-degree AV block (PR interval >200 ms) is a slowing of
conduction through the AV junction.
The site of delay is typically in the AV node but maybe in the atria,
bundle of His, or His-Purkinje system.
In second degree AV block there is an intermittent failure of
electrical impulse conduction from atrium to ventricle.
Second-degree AV block is subclassified as Mobitz type I
(Wenckebach) or Mobitz type II.
507. Which of the following is an
electrocardiographic feature of
pulmonary hypertention?
a) T wave inversion

b) Presence of U wave

c) SI, Q3, T3 pattern

d) PR prolongation

Correct Answer - A
Answer- A. T wave inversion
The electrocardiogram (ECG) of a patient with PH may
demonstrate.
Signs of right ventricular hypertrophy or strain including : -
Right axis deviation,an R wave/S wave ratio greater than one in lead
Vl (dominant R wave)
508. Which of the following is true about
rheumatic fever
a) Characteristic manifestation of carditis in previously unaffected
individuals is mitral stenosis

b) Chorea occurs in the absence of other manifestations after

prolonged latent period

c) Isolated aortic valve involvement is most common

d) 90% of the patients with acute rheumatic fever proceed to

rheumatic eart disease

Correct Answer - B
Answer- B. Chorea occurs in the absence of other
manifestations after prolonged latent period
Acute rheumatic fever (ARF) is a multisystem disease resulting from
an autoimmune reaction to infection with group A streptococcus.
The endocardium, pericardium, or myocardium may be affected.
Valvular damage is the hallmark of rheumatic carditis
The mitral valve is almost always affected, sometimes together with
the aortic valve; isolated aortic valve involvement is rare.
Early valvular damage leads to regurgitation.
usually as a result of recurrent episodes, leaflet thickening, scarring,
calcification, and valvular stenosis may develop.
Therefore the characteristic manifestation of carditis in previously
unaffected individuals is mitral regurgitation, sometimes
accompanied by aortic regurgitation.
509. Orthodeoxia is a feature of
a) Hepatorenal syndrome

b) Hepatopulmonary syndrome

c) Hepatic encephalopathy

d) Hepatic failure

Correct Answer - B
Answer- B. Hepatopulmonary syndrome
Orthodeoxia refeis to arterial desaturation noted when sitting uP as
opposed to lying down.
Conditions associated:
A) Cardiac (intracardiac shunt)
Atrial septal defect (ASD)
Patent foramen ovale (PFO)
Pneumonectomy
Usually associated with pulmonary hypertension or raised right atrial
(RA) pressure (e.g. constrictive pericarditis, cardiac tamponade).
B) Pulmonary (intrapulmonary right-to-left shunts)
Hepatopulmonarysyndrome
Pulmonary disease
COPD
Pulmonary embolism
C) Upper airway tumour
Acute respiratory distress syndrome
D) Miscellaneouscauses
Autonomic neuropathy
Acute respiratory distress syndrome (ARDS)
510. Levine sign is seen in
a) Stable angina pectoris

b) Acute bronchial asthma

c) Hemolytic anemia

d) Gastroesophageal reflux disease

Correct Answer - A
Answer- A. Stable angina pectoris
Stable Angina Pectoris:
This episodic clinical syndrome is due to transient myocardial
ischemia
When the patient is asked to localize the sensation, he or she
typically places a hand over the sternum, sometimes with a clenched
fist, to indicate a squeezing, central, substernal discomfort (Levine's
sign).
511. Which of the following is not an absolute
contraindication for thrombolytic therapy
in acute ST segment elevation
myocardial infarction?
a) Significant closed head injury

b) Symptoms suggestive of aortic dissection

c) Presence of metastatic intracranial malignancy

d) Pregnancy

Correct Answer - D
Answer- D. Pregnancy
Pregnancy is a relative contraindication for thrombolytic therapy in
acute ST segment elevation myocardial infarction and not an
absolute contraindication.
Historv of any intracranial hemorrhagic
History of ischemicl stroke within the preceriing thrse months, with
the important exception of acute ischemic storke seen within three
hours, which may be treated with thrombolytic therapy.
Presence of a cerebral vascular malformation or a primary or
metastatic intracranial malignancy.
Symptoms or signs suggestive of an aortic dessection-
A bleeding diathesis or active bleeding, with the exception of
menses. thrombolytic therapy may increase the risk of moderate
bleeding, which is offset by the benefits of thrombolysis.
512. Which of the following complications is
not seen in mitral valve prolapse?
a) Stroke

b) Infective endocarditis

c) Mitral stenosis

d) Ventricular arrhythmia

Correct Answer - C
Answer- C. Mitral stenosis
Infective endocarditis
Mitral insuficiency (mitral regurgitation)
Stroke or other systemic infarct resulting from embolism of leaflet
thrombi
Arrhythmias
513. Not included in modified Jones criteria?
a) Polyarthalgia

b) Carditis

c) Chorea

d) Erythema marginatum

Correct Answer - A
Ans. is 'a' i.e., Polyarthalgia
514. Intra arterial thrombolysis is indicated in
a) Suspected occlusion of larger artery

b) History of subarachnoid hemorrhage

c) History of dementia

d) Stroke of > 6 hours duration

Correct Answer - A
Answer- A. Suspected occlusion of larger artery
Acute ischemic stroke < 6 hours in duration
Stroke is significant, (i.e., disabling or life threatening)
Suspected occlusion of a large artery (i.e., non-lacunar stroke
syndrome)
No hemorrhage on screening computed tomography scan
515. Which of the following murmurs increase
with Valsalva maneuver?
a) MR

b) VSD

c) AS

d) HOCM

Correct Answer - D
Answer is D (HOCM)
Murmurs of HOCM are increased on Valsalva maneuver
Murmurs of VSD, MR and AS all decrease in intensity on Valsalva
maneuver
Differentiation of systolic murmurs base don changes in their
intensity from physiologic maneuvers
Maneuver HOCM AS MR/VSD MVP TR Flow
Valsalva's
•1, .1, 1‘ .1, .1,
maneuver
Stand 1‘ - - is - .1,
Squat ,I, - - .1, 1'
Handgrip/TAO J. - 1' 1' -
Inspiration - - - 1' - ori‘
Post-PVC T T - T
AS= aortic stenosis; Flow = benign flow murmur; HOCM =
hypertrophic obstructive cardiomyopathy; MR = mitral regurgitation;
MVP = mitral valve prolapse; PVC = pressure ventricular
contraction; TAO = transient arterial occlusion; TR = tricuspid
regurgitation; VSD = ventriocular septal defect; 1'= increased in
murmur intensity; .1, = decreased in murmur intensity; - = no
predictable change
predictable change
516. Features of superior vena cava
syndrome are all except which of the
following?
a) Facial swelling

b) Hoarseness

c) Aggravation of symptoms in sitting position

d) Syncope

Correct Answer - C
Answer- C. Aggravation of symptoms in sitting position
Superior vena cava syndrome (SVCS) is the clinical manifestation of
superior vena cava (SVC) obstruction, with severe reduction in
venous return from the head, neck and upper extremities.
Aggravating factors:
Bending forward or lying down may aggravate the symptoms.
517. Which of the following is a characteristic
feature of Moyamoya disease?
a) Involvement of proximal internal carotid artery

b) Absence of vascular inflammation

c) Patients can be given anticoagulants without any additional risk

d) Surgical bypass from internal carotid artery to middle meningeal

artery can be a treatment.

Correct Answer - B
Answer- B. Absence of vascular inflammation
Occlusive disease involving large intracranial arteries, especially the
distal internal carotid artery and the stem of the middle cerebral and
anterior cerebral artery.
The lenticulostriate arteries develop a rich collateral circulation
around the occlusive lesion, which gives the impression of a 'puff of
smoke" ( moyamoya in ]apanese) on conventional x-ray angiography
Occurs mainly in Asian children or young adults.
Surgical bypass of extracranial carotid arteries to the dura or MCAs
may prevent stroke and hemorrhage.
518. Modified wells criteria is used for initial
assessment of patients with suspected
a) Pulmonary embolism

b) Pleural Effusion

c) Cardiac tamponade

d) Myocardial infarction

Correct Answer - A
Answer- A. Pulmonary embolism
519. Value of Pa02/ Fi02 chracteristic of ARDS
is
a) < 200 mmHg

b) 200 - 400 mmHg

c) 400 - 600 mmHg

d) 600 - 800 mmHg

Correct Answer - A
Answer- A. < 200 mmHg
Acute respiratory distress syndrome (ARDS) is a clinical symdrome
of severe dyspnea of rapid onset, hypoxemia, and diffirse pulmonary
infiltrates leading to respiratory failure.
The arterial PaO, (in mmHg)/FiO, (inspiratory O, fraction) <200
mmHg is characteristic of ARDS, while a PaO, /FiO, between 200
and 300 identifies patients with ALI who are likely to benefit from
aggressive therapy.
520. Which of the following is not an
evidenced based recommended therapy
for the management of acute respiratory
distress syndrome
a) Low tidal volume mechanical ventilation

b) Inhaled nitric oxide

c) Minimize left atrial filling pressures

d) Prone positioning

Correct Answer - B
Answer- B. Inhaled nitric oxide
Mechanical ventilation
Lorv tidal volumc
Mininrize left atrial filling pressures
High-PEEP or "open lung"
Prone position
Glucocorticoids
High frequency ventilation
521. Massive hemoptysis seen in
a) Mitral stenosis

b) Aortic stenosis

c) Pulmonary stenosis

d) Aortic regurgitation

Correct Answer - A
Answer- A. Mitral stenosis
Large volume hemoprysis, referred to as massive hemoptysis , is
variably defined as hemoptysis of greater than 200-600 cc in 24 h.
Massive hemoptysis should be considered a medicai emersency.
Hemoptysis does not occur from heart failure itself. Most commonly
it is due to mitral valve diseases like or mitral mitral stenosis
regurgitation.
522. Investigation of choice to establish the
diagnosis in case of nephrotic syndrome
in adult is
a) Renal biopsy

b) DMSA

c) CT Scan

d) MRI

Correct Answer - A
Answer- A. Renal biopsy
In adults since steroid responsive disease is less likely (<30%), and
a wide differential diagnosis ofnephrotic syndrome exists, renal
biopsy is recommended to establish the diagnosis.
523. What is the cause of hyperkalemia in
chronic kidney failure
a) Release from cells

b) Hyperinsulinemia

c) Decreased excretion

d) Hyperaldosteronism

Correct Answer - C
Answer- C. Decreased excretion
524. Routine use of recombinant
erythropoietin in patients of chronic
kidney disease obviates the chances of
a) Regular blood transfusions

b) Iron supplementation

c) Dialysis

d) Hyperkalemia

Correct Answer - A
Answer- A. Regular blood transfusions
Recombinant human EPO and modified EPO products, such as
darbepoetin- alpha, has been one of the most significant advances
in the care of renal patients since the introduction of dialysis and
renal transplantation.
The routine use of these products has obviated the need for regular
blood transfusions in severely anemic CKD patients.
Frequent blood transfusions in dialysis patients also leads to the
development of allo-antibodies that could sensitize the patient to
donor kidney antigens and make renal transplantation difficult.
Adequate bone marrow iron stores should be available before
treatment with EPO is initiated.
For patients on hemodialysis, IV iron can be administered during
dialysis.
 525. MDRD (Modification of Diet in Renal
Disease) formula for estimation of GFR
does not include which of following?
a) Age

b) Sex

c) Race

d) Body weight

Correct Answer - D
Answer- D. Body weight
MDRD Formula includes:
1. Age
2. Sex (Multiply by 0.742 for women)
3. Race (Multiply by l.2l for African Americans)
526. Arterial blood gas analysis of a patient
reveals - pH 7.2, HCO3 36 mmol/L pCO2
70 mmHg. The abnormality is
a) Respiratory acidosis with metabolic alkalosis

b) Respiratory acidosis

c) Respiratory alkalosis with metabolic acidosis

d) Respiratory acidosis with metabolic acidosis

Correct Answer - A
Answer- A. Respiratory acidosis with metabolic alkalosis
In this patient
pH → Decreased
HCO3 → Increased
PCO2 → Increased
PCO2 is increased which indicates respiratory acidosis
HCO3- is increased which indicates metabolic alkalosis
Thus this is a case of mixed disorder, where respiratory acidosis and
metabolic alkalosis exist together.
527. pH 7.49, pCO2 38 mmHg, p02 92 mmHg,
HCO3 35, Sa02 97%. Which of the
following should not be used in the
management of this patient?
a) Hyperventilation

b) Correction of serum potassium levels

c) Correction of extracellular fluid volume contraction

d) Use of dilute hydrochloric acid

Correct Answer - A
Answer- A. Hyperventilation
Suggestive of metabolic alkalosis.
H+ loss by the stomach or kidneys can be mitigated by the use of
proton pump inhibitors.
The second aspect of treatment is to remove increase in HCO3-
reabsorption, such as ECFV contraction or K+ deficiency.
Isotonic saline is usually sufficient to reverse the alkalosis if ECFV
contraction is present.
Dilute hydrochloric acid (0.1 N HCl) is also effective but can cause
hemolysis, and must be delivered centrally and slowly.
Hemodialysis against a dialysate low in (HCO3-) and high in (Cl-)
can be effective when renal function is impaired.
528. Peritoneal dialysis uses which of the
following process/ es?
a) Osmosis

b) Diffusion

c) Ultrafiltration

d) All the above

Correct Answer - D
Answer- D. All the above
The repetitive installation and drainage of dialysis solution into and
from peritoneal cavity - uses process of osmosis, ultrafiltration and
diftrsion to remove wastes, toxins and fluid from the blood.
529. The most common cause of euvolemic hyponatremia is which of the following?
a) Hypothyroidism

b) Hypoadrenalism

c) Hyperthyroidism

d) SIADH

Correct Answer - D
The syndrome of inappropriate antidiuresis is the most common cause of euvolemic hyponatremia.
Reference:
Harrisons Principles of Internal Medicine, 18th Edition, Page 345
530. Hypo-osmotic dehydration is seen in
a) Adrenocortical insufficiency

b) Decreased water intake

c) Chronic renal failure

d) SIADH

Correct Answer - A
Answer- A. Adrenocortical insufficiency
Loss of salt in excess of water causes hypo-osmotic volume
contraction.
This usually results from adrenocortical insufficiency associated with
renal loss of NaCl.
Aspiration ofgastric secretions can cause hypertonic fluid loss from
body.
531. Hyperkalemia is a feature of
a) Conns syndrome

b) Gitelman's syndrome

c) Pseudohypoaldosteronism type 2

d) Liddle syndrome

Correct Answer - C
Answer- C. Pseudohypoaldosteronism type 2
Pseudohypoaldosteronism tnre 2 is associated with
hyperkalemia.
Conns syndrome, Gitelman's syndrome and Liddle syndrome are
associated with hypokalemia.
532. Adverse effects of excess potassium
intake can be seen in which of the
following individuals?
a) Patients with adrenal insufficiency

b) Patients with diabetes mellitus

c) Patients taking angiotensin receptor blockers

d) All the above

Correct Answer - D
Answer- D. All the above
supplemental potassium can lead to acute toxicity in healthy
individuals.
Indviduals whose urinary potassium is impaired, a potassium intake
less than 4.7 g/d appropriate because of adverse cardiac effects
(arrhythmias) from hyperkalemia.
Drugs that commonly impair potassium excretion are, angiotensin
converting enzyme inhibitors, angiotensin receptor blockers, and
potassium sparing diuretics.
Conditions associated impaired potassium excretion, are diabetes,
chronic renal insufficiency, end stage renal disease, severe heart
failure, and adrenal insufficiency.
Elderly individuals are at increased risk of hyperkalemia.
533. 28 years old male presents with fever,
anorexia, nausea, vomiting, headache,
photophobia and arthralgias. Liver is
enlarged and tender and associated with
right upper quadrant discomfort. Which
of the following is the most probable
diagnosis?
a) Acute viral hepatitis

b) Sickle cell disease

c) Thalasemia

d) Acute lymphocytic lymphoma

Correct Answer - A
Answer- A. Acute viral hepatitis
Symptoms are anorexia, nausea and vomiting, fatigue, malaise,
arthralgias, myalgias, headache, photophobia, pharyngitis, cough.
Dark urine and clay-colored stools may be noticed by the patient
from 1 -5 days before the onset of clinical jaundice.
The liver becomes enlarged and tender and may be associated with
right upper quadrant pain and discomfort.
Splenomegaly and cervical adenopathy are present.
534. Hepatic secretory function is evaluated
using
a) Alkaline phosphatase

b) 5' nucleotidase

c) Gamma glutamyl transpeptidase

d) Prothrombin time (PT)

Correct Answer - D
Answer- D. Prothrombin time (PT)
The most widely used tests are those measuring the blood
concentration of aspartate aminotransferase (AST) and alanine
aminotransferase (ALT).
Congulation proteins: The easiest way to estimate the
concentration of the coagulation factors is by measuring the
prothrombin time (PT), which is normally l0 to 13 seconds.
Prolonged PT is a sensitive index of liver function loss.
535. Which antibodies are associated with
autoimmune hepatitis type IIa
a) ANA antibody

b) p ANCA

c) Anti histone antibody

d) Anti LKM antibody

Correct Answer - D
Answer- D. Anti LKM antibody
Type II autoimmune hepatitis
Associated with anti LKM
IIa-
Young women
High titre anti LKM
Responds to glucocorticoid.
536. A patient undergoes a lipid profile
screening. On withdrawing the blood, it
appears white in colour, Which of the
following is the most probable elevated
lipoprotein?
a) Chylomicrons

b) HDL

c) LPL

d) Cholesterol

Correct Answer - A
Answer- A. Chylomicrons
White (Lactescent) appearance is caused by chylomicrons.
537. Typical symptom of gastroesophageal
reflux disease is
a) Regurgitation

b) Dysphasia

c) Chest pain

d) Cough

Correct Answer - A
Answer- A. Regurgitation
Heartburn and regurgitation are the typical symptoms of GERD.
Dysphagia and chest pain.
Extraesophageal syndrome, with an established association to
GERD include chronic cough, laryngitis, asthma, and dental
erosions.
538. Bristol chart is used fore
a) Stool consistency

b) Nocturnal enuresis

c) Mental retardation

d) Cognitive development

Correct Answer - A
Answer- A. Stool consistency
The Bristol stool scale(Bristol stool chart (BsC)) is a diagnostic
medical tool designed to classifr the form of human feces into seven
categories.
The seven types ofstcol are
Type 1 Separate hard lumps, like nuts (hard to pass); also known as
goat faeces
Type 2: Sausage-shaped but lumpy
Type 3: Like a sausage but with cracks on its surface
Type 4: Like a sausage or snake, smooth and soft
Type 5: Soft blobs with clear cut edges (passed easily)
Type 6: Fluft pieces with ragged edges, a mushy stool
Type 7: Watery, no solid pieces, entirely liquid
539. Pitying testing for lower motor neuron
lesion involving nucleus ambiguous;
uvula
a) Is deviated to the affected side

b) Is deviated to the normal side

c) Remains in midline

d) Is not used in testing

Correct Answer - B
Answer- B. Is deviated to the normal side
It is the column of cells running almost the entire length of medulla.
Motor neurons in the nucleus ambiguous innervate the constrictor
muscles of the pharynx, muscles of the velopharynx (such as
constrictor veli palatine), intrinsic muscle of the larynx, and single
muscle of the tongue.
In case of unilateral lower motor neuron lesion, when the patient
phonates the soft palate will raise asymmetrically, with higher
elevation on the healthy side and the uvula pulled of the midline in
the same direction i.e. it is deviated to the normal unaffected side.
540. Pseudobulbar palsy is seen with
a) Unilateral gortigandbar lesions

b) Bilateral corticobulbar lesions

c) Cranial nerve IX involvement

d) Cranial nerve N involvement

Correct Answer - B
Answer- B. Bilateral corticobulbar lesions
This pattern of weakness results from disorders that affect the upper
motor neurons or their axons in the cerebral cortex, subcortical white
matter, internal capsule, brainstem, or spinal cord.
With corticobulbar involvement, weakness usually is observed only
in the lower face and tongue; extraocular, upper facial, pharyngeal,
and jaw muscles almost always are spared.
With bilateral corticobulbar lesions, pseudobulbar palsy often
develops: dysarthria, dysphagia, dysphonia, andemotional lability
accompany bilateral facial weakness and a brisk jaw jerk.
541. Conduction aphasia is classically seen
due to lesion in -
a) Arcuate fascicultis

b) Cingulate gyms

c) Bruges area

d) Werniekes area

Correct Answer - A
Answer- A. Arcuate fascicultis
542. Intetion tremor, druken gait and
scanning speech together point towards
involvement of
a) Cerebellum

b) Cortex

c) Medulla

d) Micihreio

Correct Answer - A
Answer- A. Cerebellum
Clinical features of Cerebellar lesions:
Incordination of rapid alternating movements - dysdiadokokinesia
Inaccuracy of purposeful movements - dysmetria
Irregular variations in the volume and rhythm ofspeech - scanning
speech
Broad based reeling gait - like a drunken sailor
Quasirhythmical rocking of the head and trunk - titubation
Hypotonia
Nystagmus
543. Most common cause of death in
amyotropic lateral sclerosis is
a) Cardiac failure

b) Respiratory failure

c) Renal failure

d) Liver failure

Correct Answer - B
Answer-B. Respiratory failure
Amyotrophic lateral sclerosis (ALS) is the most cornmon form of
progressive motor neuron disease. It is a prime example of a
neurodegenerative disease and is arguably the most devastating
ofthe neurodegenerative disorders.
Respiratory failure is the leading cause of death in amyotrophic
lateral sclerosis, and terminal dysnoea is a major fear in patients
with amyotrophic lateral sclerosis.
544. Working memory con be affected due to
lesion in -
a) Hypothalamus

b) Thalamus

c) Mammillary body

d) Dorsolateral frontal lobe

Correct Answer - A
Answer- A. Hypothalamus
Working memory stores items only as long as the information is in
consciousness and is either being rehearsed (subvocally) or
manipulated in some other fashion (i.e. rotated or integrated with
existing information in semantic memory).
Working memory is highly vulnerable to distraction and sometimes is
even called working attention to emphasize the conscious and
effortful processes that it entails.
Lesions that disrupt the structure or function of the dorsolateral
frontal or posterior parietal regions decimate working memory.
545.
Anomia is seen in lesions of which part of
temporal lobe
a) Posterior part

b) Unctis

c) Inferior temporal lobe

d) Meyers loop

Correct Answer - A
Answer- A. Posterior part
Uncus part of pyriform lobe
Posterior part of temporal lobe
546. Which of the following is true about
typical absence seizures?
a) Long term lapse in conciousness

b) Profound post ictal confusion

c) Hyperventilation provokes absence seizures

d) Absence seizures originate after 40 yrs of age

Correct Answer - C
Answer- C. Hyperventilation provokes absence seizures
Typical absence seizures are characterized by sudden, brief lapses
of consciousness without loss of postural control.
The seizure typically lasts for only seconds, consciousness returns
as suddenly as it was lost, and there is no post ictal confusion.
Typical absence seizures are associated with a group of genetically
determined epilepsies with onset usually in childhood (ages 4-8
years) or early adolescence.
Hyperventilation tends to provoke these electrographic discharges
and even the seizures themselves and is routinely used when
recording the EEG.
547. Cerebellar shape in fetus with spina
bifida before 24 weeks of gestation
mimics which of the following?
a) Banana

b) Orange

c) Swiss cheese

d) Pea

Correct Answer - A
Answer- A. Banana
In majority ofcases ofspina bifida, the cerebellum is either not
detectable sonographically or has a banana shaped appearance.
548. Most common cause of lobar
hemorrhage in the elderly
a) Coagulopathy

b) Aneurysm

c) Amyloid angiopathy

d) Trauma

Correct Answer - C
Answer- C. Amyloid angiopathy
Lobar intracerebral hemorrhage is bleeding in the largest part of the
brain called the cerebrum.
Intracerebral hemorrhage are attributed to hypertensive
vasculopathy in small penetrating brain arteries and subcortical
vessels in patients with amyloid angiopathy.
Amyloid angiopathn a chronic deposition of congophilic rnaterial in
brain vessels, is the most common cause of lobar hemorrhage in
older patients.
549. Intravenous rtPA is indicated in ischemic
stroke within how many hours of onset
of disease process
a) 1 hour

b) 3 hours

c) 6 hours

d) 12 hours

Correct Answer - B
Answer- B. 3 hours
The National Institute of Neurological Disorders and Stroke (NINDS)
recombinant tPA (rtPA) Stroke Study showed a clear benefit for IV
rtPA in selected patients with acute stroke.
The NINDS study used IV rtPA (0.9 mg/kg to a 90-mg max; l0% as a
bolus, then the remainder over 60 minutes) versus placebo in
patients with ischemic stroke within 3 hours of onset.
550. Drug of Choice for absence seizure in
children < 3 years of age is
a) Ethosuximide

b) Carbamazepine

c) Lamtrigine

d) Phenytain

Correct Answer - A
Answer- A. Ethosuximide
Ethosuximide is the DOC for absence seizures in children below 3
years of age as Na valproate may cause fulminant hepatitis in
children below 3 years of age. Broadly. Na valproate is the DOC for
absence seizures.
551. Which of the following is true about
Wernicke's encephalopathy
a) Extrapyramidal symptoms

b) Auditory hallucinations

c) Vagus nerve palsy

d) Presence of horizontal nystagmus

Correct Answer - D
Answer- D. Presence of horizontal nystagmus
Wernicke's disease is a common and preventable disorder due to
deficiency of thiamine.
It is commonly seen in alcoholic patients with chronic thiamine
deficiency.
Wernicke's encephalopathy is characterized by clinical triad of
Global confusion
Ophthalmoplegra
Ataria
It includes horizontal nystatmus on lateral gaze lateral rectus palsy.
Gait Ataxia
It results from combination of polyneuropathy, cerebellar
involvement and vestibular paresis.
552. Parinaud syndrome is caused by damage
to
a) Anterior commisure

b) Posterior commisure

c) Medial commisure

d) Lateral commisure

Correct Answer - B
Answer- B. Posterior commisure
Also known as dorsal midbrain syndrome, this is a distinct
supranuclear vertical gaze disorder caused by damage to the
posterior commissure.
Pineal region tumors, cysticercosis, and stroke also cause
Parinaud's syndrome.
553. Which of the following is true about
Hyperglycemic hyperosmolar state -
a) it is more common in young patients with type 1 diabetes
melitus

b) Mental status is not altered in any case

c) There is associated hypertension and tachycardia

d) Kussumaul respirations are characteristic

Correct Answer - D
Answer- D. Kussumaul respirations are characteristic
Hyperglycemic hyperosmolar nonketotic coma
Notably absent are symptoms of nausea, vomiting, and abdominal
pain and the Kussmaul respirations characteristic of DKA.
This is a life threatening complication of diabetes mellitus
characterized by marked hyperglycemia, dehydration, and
hyperosmolarity with or without mental obtundation in the absence of
significant ketoacidosis.
The prototypical patient with HHS is an elderly individual with type 2
DM.
Sepsis, pneumonia, and other serious infections are frequent
precipitants.
554. Hypercalcemia related to malignancy is
seen in which of the following cancers?
a) Multiple myeloma

b) Lung carcinoma

c) Carcinoma breast

d) All the above

Correct Answer - D
Answer- D. All the above
Malignancy related-
Solid tumor with metastasis/ paraneoplastic syndrome
Carcinoma breast/ Lung/ Kidney etc
Hematological: Multiple myeloma/
Lymphoma/Leukemia
Aluminum intoxication
Milk Alkali syndrome
555. All are seen in MEN IIA syndrome
except
a) Medullary carcinoma of thyroid is seen in 100% of the patients

b) 40 - 30% patients have phaeochromocytoms

c) Caused by loss of function mutation in IIRT protooncogene

d) Primary hyperparathyroidism is the most variable feature of

MEN II A syndrome

Correct Answer - C
Answer- C. Caused by loss of function mutation in IIRT
protooncogene
MEN-2A or Sipple syndrome, is characterized by
pheochromocytoma, medullary carcinoma of the thyroid, and
parathyroid hyperplasia.
Parathyroid hyperplasia and evidence of hypercalcemia or renal
stones.
MEN-2A is clinically and genetically distinct from MEN-I and is
caused by germline gain-of-function mutations in the
RET proto-oncogene on chromosome l0qll.2.
40% to 50% have pheochromocytomas.
Primary hyperparathyroidism is the most variable feature of MEN 2A
syndrome.
556. which of the following can be used to
differentiate between diabetes mellitus
type 1 and 2?
a) Association with All 3/4

b) Presence or absence of insulitis

c) Insulin levels

d) All the above

Correct Answer - D
Answer- D. All the above
Age- <20 years
Autoimmune destruction of Beta cells mediated by T cells and
humoral mediators. Anti islet cell antibodies.
Islet cells- Early Insulitis, marked atrophy and fibrosis, Beta cell
depletion.
Marked decrease blood insulin.
557. A female presents with swelling in neck,
palpitations and exopthalmos, Which of
the following is the most likely
diagnosis?
a) Oranulomatous thyroiditis

b) Hashimoto thyroiditis

c) Graves disease

d) Mutinodular goitre

Correct Answer - C
Answer- C. Graves disease
The clinical findings in Graves disease include some changes
associated with thyrotoxicosis.
The ophthalmopathy of Graves disease results in abnormal
protrusion of the eyeball (exophthalmos).
The infiltrative dermopathy, or pretibial myxedema, is most common
in the skin overlying the shins.
Graves disease, such as diffuse hyperplasia of the thyroid.
558. HbA1c control for how much time
a) 2 -3 weeks

b) 3 - 6 weeks

c) 6 - 8 weeks

d) 14 - 18 weeks

Correct Answer - C
Answer- C. 6 - 8 weeks
The half-life of an erythrocyte is typically 60 days, the level of
glycated hemoglobin (HbA1c) reflects the mean blood glucose
concentration over the preceding 6-8 weeks.
559. Samogyi effect is -
a) Morning hyperglycemia due to insulin resistance

b) Morning hyperglycemia due to large dose of exogenous insulin

c) Morning hypoglycemia due to large dose of exogenous insulin

d) Evening hypoglycemia due to insulin resistance

Correct Answer - B
Answer- B. Morning hyperglycemia due to large dose of
exogenous insulin
Rebound hyperglycemia, results from excess xogenous insulin,
which causes hypoglycemia overnight and stimulates the release to
counter regulatory hormones that in turn increase blood glucose
levels.
560. Normocytic normochromic anemia is
seen in which of the following?
a) Sideroblastic anemia

b) Pernicious anemia

c) Aplastic anemia

d) Sickle cell disease

Correct Answer - C
Answer- C. Aplastic anemia
Marrow damage
Infiltration/fibrosis
Aplasia
Iron deficiency
Decrease Stimulation
Inflammation
Metabolic defect
Renal disease
561. 24 years old female patient presents with
acute blood loss secondary to bilateral
fracture femur. Reticulocytosis is evident
on peripheral smear examination.
Patient's anemia can be categorized into
which of the following types?
a) Normocytic normochromic

b) Normocytic Hypochromic

c) Microcytic hypochromic

d) Microcytic normochromic

Correct Answer - A
Answer- A. Normocytic normochromic
Anemia Due to Acute Blood loss (Acute posthemorrhagic anemia):
It is a variety of normocytic normochromic anemia.
Posthemorrhagic anemia can be external (as after trauma, or
obstetric hemorrhage) or internal (e.g., from bleeding in the
gastrointestinal tract, rupture of the spleen, rupture of an ectopic
pregnancy, subarachnoid hemorrhage).
Such type of anemia is accompanied by reticulocytosis.
562. Venous thrombosis In patients with
paroxysmal nocturnal hemoglobinuria is
observed in
a) Cerebral veins

b) Leg veins

c) Intrabdominal veins

d) Axillary vein

Correct Answer - C
Answer- C. Intrabdominal veins
Venous thrombosis is an inconstant but severe clinical manifestation
of P.N.H.
Thrombosis occcurs due to absence of CD59 which k a membrane
attached protein
Thrombosis usually occurs in abdominal veins. Intra-abdominal
yeins are the most common site of thromosis in P.N.H.
563. Anemia seen in patients with orotic
aciduria is corrected with
a) Folic acid supplementation

b) Vitamin B12 supplementation

c) Replacement of uridine

d) Iron supplementation

Correct Answer - C
Answer- C. Replacement of uridine
Hereditary orotic aciduria is caused by mutations in a bifunctional
enzyme, uridine-5 -monophosphate (UMP) synthase, which converts
orotic acid to UMP in the de novo synthesis pathway.
Replacement of uridine (100-200 mg/kg per day) corrects the
anemia, reduces orotic acid excretion, and improves the other
sequelae of the disorder.
564. Neoplastic cells in Franklin disease
express
a) CD5

b) CD10

c) CD55

d) CD79a

Correct Answer - D
Answer- D. CD79a
In classic Franklin disease, neoplastic lymphocytes, plasmacytoid
lymphocytes and plasma cells can be found in lymph nodes,
Waldeyer ring, gastrointestinal tract and other extranodal sites,
spleen, liver, bone marrow.
Systemic symptoms- fever, weight loss, weakness, anorexia,
recurrent bacterial infections.
Neoplastic cells in Franklin disease, are believed to represent post
germinal center B cells. The neoplastic cells contain gamma heavy
chains in the cytoplasm ofcells (without light chains) and express CD
79a.
Neoplastic lpnphocytes in this disorder express CD20, neoplastic
plasma cells in this disorder express CD 138.
565. Which of the following inherited
neutropenias show a self limited course?
a) Shwachman-Diamond syndrome

b) Dyskeratosis congenita

c) Chiediak higashi syndrome

d) Autoimmune neutropenia of infancy

Correct Answer - D
Answer- D. Autoimmune neutropenia of infancy
It is recognized as a fairly specific syndrome of early childhood.
Low neutrophil numbers are often discovered during the course
ofroutine investigation for benign febrile illness.
The illness abates but the neutropenia persists, sometimes for
months and occasionally for years.
The prognosis is good and neutropenia is self-limited albeit
protracted, and patients seldom develop serious bacterial infections.
566. Cigarette smoking increases the risk of
all the following diseases except
a) Pancreatic carcinoma

b) Cerebrovascular accident

c) Sudden infant death syndrome

d) Primary pulmonary hypertention

Correct Answer - D
Answer- D. Primary pulmonary hypertention
Coronayheart disease
Cerbrovascularlesions
Aortic aneurysm
Chronic airway obstruction
Sudden infant death syndrome
Infant respiratory distress syndrome
Cancer of Pancreas, Lung, Kidney.
567. Category of patients with juvenile
idiopathic arthritis, with HLA B27
positive in most of the cases, who
present with entheisits, lower limb
arthritis involving knees and ankle and
presence of inflammatory low back pain,
is most likely to be
a) Enthesitis related arthritis

b) Rheumatoid arthritis

c) Reactive arthritis

d) Cryoglobulinemia

Correct Answer - A
Answer- A. Enthesitis related arthritis
Arthritis most commonly affects the lower extremities, knees and
ankles, but the hip can also be affected.
Enthesitis occurs frequently and is commonly seen as plantar
fasciitis, achiles tendinitis and patellar tendon enthesitis.
Inflammatory back pain is often seen, defined as lumbosacral spinal
pain at rest, with morning stiftress that improves on movement.
There is a strong association with HLA B27,with most of the patients
of enthesitis associated arthritis positive for HLA B27.
Iritis, usually acute, severe hip disease.
568. A patient presents with symptoms of
chronic diarrhea and cough and sputum
production. On investigations he is
diagnosed to be suffering from both HIV
infection and pulmonary tuberculosis.
What medical management is to be
started first in this patient?
a) Antitubercular therapy

b) Antiretroviral therapy

c) Antitubercular therapy or antiretroviral therapy

d) Sequence of beginning treatment is not important

Correct Answer - A
Answer- A. Antitubercular therapy
In the question give, it is essential to begin antituberculous therapy
before beginning antiretroviral therapy
Infections most commonly associated with IRIS include
Mycobacterium tuberculosis and cryptococcal meningitis.
Immune reconstitution inflammatory syndrome (IRIS) (also known as
immune recovery syndrome) can develop if antiretroviral therapy is
begun before treating the opportunistic infection.
569. Which immunoglobulin combination is
predominantly in pathogenesis of
cryglobulinemic vasculitis
a) IgA + IgG

b) IgM + IgG

c) IgA + IgE

d) IgE + IgM

Correct Answer - B
Answer- B. IgM + IgG
cryoglobulinemic vasculitis occurs when an aberrant immune
response to hepatitis C infection leads to the formation of immune
complexes consisting of hepatitis C antigens,polyclonal hepatitis C-
specific IgG, and monoclonal IgM rheumatoid factor.
570. Bannwarth's syndrome develops
secondary to infection with
a) B. burgdorferi

b) T. pallidum

c) B.cereus

d) afragilis

Correct Answer - B
Answer- B. T. pallidum
It is also called neuroborrelisosis.
It is secondary to infection with B. burgdorferi.
Meningeal irritation may develop early in Lyme disease when
erphema migrans is present.
untreated patients develop frank neurologic abnormalities, including
meningitis,
subtle encephalitic signs, cranial neuritis (including bilateral facial
palsy), motor or sensory radiculoneuropathy, peripheral neuropathy,
mononeuritis multiplex, cerebellar ataxia, or myelitis.
In Europe and Asia, the first neurologic sign is characteristically
radicular pain, which is followed by the development of CSF
pleocytosis (called meningopolyneuritis, or Bannwarth's syndrome );
meningeal or encephalitic signs are frequently absent.
571. Hormonal abnormalities in men and post
menopausal women suffering from
rheumatoid arthritis include the following
except
a) Decreased testosterone

b) Decreased luteinizing hormone

c) Decreased dehydroepiandrosterone

d) Decreased thyroid autoantibodies

Correct Answer - D
Answer- D. Decreased thyroid autoantibodies
Men and postmenopausal women with RA have lower mean serum
testosterone, luteinizing hormone (LH) and dehydroepiandrosterone
(DHEA) levels than control populations.
572. Which of the following toxin is
responsible for manifestations of puffer
fish poisoning?
a) BOAA

b) Tetrodotoxin

c) Strychnine

d) Ciguatoxin

Correct Answer - B
Answer- B. Tetrodotoxin
The toxin involved is tetrodotorin.
Syrnptoms of pufferfish poisoning include initial tingling, numbness
of lips, tongue and fingers. trading to the paralysis of the extremities,
ataxia, difficulty in speaking, and finally death by asphpiation sue to
respiratory paralysis.
573. Increased urinary excretion of calcium is
seen in which of the following
condition/s?
a) Sarcoidosis

b) Glucocorticoid excess

c) Wilsons disease

d) All the above

Correct Answer - D
Answer- D. All the above
Parathyroid hyperfunction
Sarcoidosis
Primary cancers ofthe breast and bladder
Metastatic malignancies
Wilson's disease
Renal tubular acidosis
Glucocorticoid excess
Respiratory disease
574. Lassa fever virus belongs to family
a) Arenaviridae

b) Bunyaviridae

c) Flaviviridae

d) Reoviridae

Correct Answer - A
Answer- A. Arenaviridae
There are two main phylogenetic branches of Arenaviridae: the Old
World viruses, such as lassa fever and lymphocytic choriomeningitis
(LCM) viruses.
575. Drug of choice for intractable hiccups -
a) Promethazine

b) Chlorpromazine

c) Scopolamine

d) Clozapine

Correct Answer - B
Answer- B. Chlorpromazine
Hiccups are repeated spasmodic involuntary contractions ofthe
diaphragm that occur when you inhale.
Persistent or Intractable Hiccups:-
i) Chlorpromazine → Drug of choice ii) Baclofen iii)
Diphenylhydantoin
iv) Valproic acid v) Amitriptyline vi) Metoclopromide
576. Recommended drug for patients with
intrahepatic Wilson's disease i.e.
patients with hepatitis, is
a) Zinc

b) Triamterene

c) Trientine

d) Penicillamine

Correct Answer - A
Answer- A. Zinc
Hepatitis or cirrhosis without decompensation Zinc (first choice) &
Trientine (2nd choice).
577. Which of the following is/ are the cause/s
of unilateral elevation of
hemidiaphragm?
a) Pulmonary hypoplasia

b) Subphrenic infection

c) Phrenic nerve palsy

d) All the above

Correct Answer - D
Answer- D. All the above
Posture - Lateral decubitus position (dependent side)
Gaseous distension of stomach or colon
Dorsal scoliosis
Pulmonary hypoplasia
Pulmonary collapse
Phrenic nerve palsy
Eventration
Pneumonia or pleurisy
Pulmonary thromboembolism
Rib fracture and other painful conditions
Subphrenic infection
Subphrenic mass
578. Most common cause of death in
Rheumatoid Arthritis?
a) Ischemic heart disease

b) ARDS

c) Pulmonary fibrosis

d) Hepatic failure

Correct Answer - A
Answer- A. Ischemic heart disease
The overall mortality rate in RA is two times greater than the general
population, with ischemic heart disease being the most common
cause of death followed by infection.
579. Incidence of Pneumocystis jiroveci
pneumonia has declined in recent times
due to which of the following?
a) Better living conditions

b) Decrease in the incidence of HIV infection

c) Use of combination ART

d) Stronger immunity of the cohort

Correct Answer - C
Answer- C. Use of combination ART
Pneumocystis pneumonia (PCP), once the hallmark of AIDS, has
dramatically declined in incidence following the development of
effective prophylactic regimens and the widespread use of cART.
580. A 34 years old male patient presents with
symptoms of headache nausea and
vomiting and intermittent focal seizures.
On investigation patient is diagnosed to
be suffering from neurocysticercosis.
Antiparasitic drug used in the
management of these patients are given
for a duration of
a) 15 - 30 days

b) 60 - 90 days

c) 3 - 4 months

d) 6 months

Correct Answer - A
Answer- A. 15 - 30 days
For the treatment of patients with brain parenchl.mal cysticerci. most
authorities favor antiparasitic drugs, including albendazole (15
mdkgper dayforS-28 days) orpraziquantel (50-100 mdkgdailyinthree
divideddoses for 15-30 days).
581. Which of the following is the most
serious late side effect of treatment of
Hodgkins disease?
a) Cardiac injury

b) Infertility

c) Hair loss

d) Osteoporosis

Correct Answer - A
Answer- A. Cardiac injury
The most serious late side effects include second malignancies and
cardiac injury. Patients are at risk for the development of acute
leukemia in the first 10 years after treatment with combination
chemotherapy regimens that contain alkylating agents plus radiation
therapy.
582. Which of the following is not true about
the risk factors of systemic sclerosis?
a) Human CMV infection

b) Human parvovirus B 19 infection

c) Miners exposed to lead

d) Drugs like bleomycin

Correct Answer - C
Answer- C. Miners exposed to lead
Patients with Systemic sclerosis (SSc) have increased serum
antibodies to human cytomegalovirus (hCMV), and
antitopoisomerase-I (Scl-70) autoantibodies recognize antigenic
epitopes present on the hCMV-derived proteins.
Drugs implicated in SSc-like illnesses include bleomycin,
pentazocine and cocaine, and appetite suppressants linked with
pulmonary hypertension.
583. Not classified as untidy wound is
a) Burn wound

b) Incised wound

c) Crush wound

d) Lacerated wound

Correct Answer - B
Answer- B. Incised wound
Usually involves crushing and tearing and contain devitalized
tissues.
Needs conversion to tidy wound before closure is considered.
These wounds result from crushing, avulsion or burns. Fractures are
common and may be multifragmentary.
Treatment - Once the untidy wound is convereted to a didy one by
wound excision, it can be saiely closed or allowed to heal by second
intention.
584. Which of the following is not a hard sign
of arterial injury?
a) Expanding or pulsatile hematoma

b) Arterial bleeding

c) Shock

d) Bruit

Correct Answer - C
Answer- C. Shock
Hard signs
Distal circulatory deficit
Ischaemia
Absent or diminished pulses
Bruit
Expanding or pulsatile hematoma
Arterial bleeding
585. Most reliable sign of injury to
intrathoracic aorta is
a) Presence of apical cap of pleural fluid

b) Depression of left main stem bronchous

c) Obliteration of aortic knob contour

d) Funny looking mediastenum

Correct Answer - C
Answer- C. Obliteration of aortic knob contour
The most reliable of these signs for the blunt aortic iniury is loss
ofthe aortic knob contour.
586. Most common site of injury to aorta in
patients who manage to reach the
hospital for medical care is
a) Ascending aorta

b) Aortic isthmus

c) Descending thoracic aorta

d) Abdominal aorta

Correct Answer - B
Answer- B. Aortic isthmus
Trauma can result in aortic transaction or disruption.
Traumatc injuries to the aorta are rapidly fatal ith most victims dying
at the scene of injury.
Post traumatic aneurysms to the aorta are distinctive by their
location.
The two most common sites are proximal ascending aorta and aortic
isthmus, the site of insertion of ligamentum arteriosum.
Among patients who survive traumatic aortic injury and reach
medical care, about 95% have injury to aortic isthmus.
587. 80 kg male with bilateral upper limb, right
lower limb with perineum burns 3rd
degree, amount of fluid required in first 8
hours is
a) 3920 ml

b) 4920 ml

c) 5920 ml

d) 6560 ml

Correct Answer - D
Answer- D. 6560 ml
The amount of fluid required fot the above patient = 4ml x 80 x 41 =
13120 ml.
Half of the calculated fluid is gtum in first 8 hrs and half in next 76
hrs.
So the amount of fluid to be given in the first hrs = total fluid
required/ 2 = 1312O/ 2 = 6560ml
588. Best fluid for resuscitation of burns
patient
a) Hartmann solution

b) Colloid

c) Normal saline

d) 5% Dextrose

Correct Answer - A
Answer- A. Hartmann solution
Fluid resuscitation begins with an isotonic crystalloid solution -
Ringer's lactate solution (RL)(Hartman's solution) k the
prefered solution (Normal saline shouldbe avoided as the volumes
required for resuscitation may lead to hyperchloremic metabolic
acidosis).
589. Longitudinal incision with Z plasty
closure is used in which of the
following
a) Hand surgery

b) Breast surgery

c) Thyroid sugery

d) Hernia surgery

Correct Answer - A
Answer- A. Hand surgery
Z-plasty is a versatile plastic surgery technique that is used to
improve the functional and cosmetic appearance of scars. It can
elongate a contracted scar or rotate the scar tension line.
Longitudinal incision with Z plasty closure is used in the
management of duputryens contracture of hand.
590. Stewart-Treves syndrome is used to
described development of
a) Lymphangiosarcoma

b) Rhabdomyoma

c) Angiosarcoma

d) Mesothelioma

Correct Answer - A
Answer- A. Lymphangiosarcoma
Stewart-Treves' syndrome:
Ulceration, non-healing bruises and raised purple-red nodules in
patients with lymphatic disorders, should lead to suspicion of
malignancy.
Lymphangiosarcoma was originally described in postmastectomy
oedema (Stewart-Treves'syndrome)
591. Child presents after trauma to head with
hyponatremia, volume depletion and
increased excretion of urinary Na [>150
mmol/L]. What is the probable
diagnosis?
a) Cerebral salt wasting syndrome

b) SIADH

c) Adrenal hemorrhage

d) Autonomic failure

Correct Answer - A
Answer- A. Cerebral salt wasting syndrome
Electrolyte imbalance is common in traumatic brain injury (TBI), and
contributes to brain swelling and to causing seizures.
Cerebral salt wasting, a poorly understood form of excretory
dysregulation in association with brain insult, leads to volume
depletion and hlponatraemia.
592. Pyuria found in all except
a) Appendicular abscess

b) CA bladder

c) Renal tuberculosis

d) Vaginosis

Correct Answer - A
Answer- A. Appendicular abscess
Causes of Pyuria
Urinary tract infections
STDs like chlamydiae or gonorrhea or vagintis
Genitourinarytuberculosis (Sterile Pyuria)
Stones in Bladder and ureter
Pregnancy
Cystitis or bladder infections
Viral infections
Benign and malignant tumours of the urinary system
Mechanical Trauma
Parasites like Trichomonas Vaginalis, Giardia Lamblia etc
593. Prehn sign is positive in
a) Acute epidydimoorchitis

b) Chronic orchitis

c) Testicular torsion

d) None

Correct Answer - A
Answer- A. Acute epidydimoorchitis
On elevation of testis the-
Pain is not relieved in torsion (test is negative)
Pain relieved in epidydimoorchitis (test is positive)
594. Laparoscopy - pressure in the abdomen
of children
a) 2 - 6 mm Hg

b) 8 - 12 mm Hg

c) 14 - 18 mm Hg

d) 20 - 24 mm Hg

Correct Answer - B
Answer- B. 8 - 12 mm Hg
The optimal intrabdominal pressure for laproscopy in children has
been established to be between 8 - 12 mm Hg, with neonates
tolerating lower pressures than elders.
595.
 Definitive surgery is a part of which stage of
damage control surgery?
a) I

b) II

c) III

d) IV

Correct Answer - D
Answer- D. IV
Following major injury, protracted surgery in the physiologically
unstable patient with the 'deadly triad' - the combination of
hypothermia, acidosis and coagulopathy
'Damage control' or 'damage limitation surgery' is a concept that
originated from naval architecture, whereby a ship was designed to
have areas sealed off in the case of damage, to limit flooding.
Stages-
1. Patient selection
2. Control of haemorrhage and control of contamination
3. Resuscitation continued in the intensive care unit
4. Definitive surgery
5. Abdominal closure
 596. Everted edge seen in ulcer due to which
of the following?
a) Tuberculosis

b) Epithelioma

c) Syphilis

d) Basal cell carcinoma

Correct Answer - B
Answer- B. Epithelioma
characteristic shapes ofthe edges of ulcers.
1. None-specific ulcer: note the shelving edge.
2. Tubercubus ulcer: note the undermined edge
3. Basal cell carcinoma (rodent ulcer): note the rolled edge, which may
exhibit small blood vessels.
4. Epithelioma: note the heaped-up everted edge and irregular
thickened base.
5. Syphilis
597. Management of stage 2 pressure sore,
clean ulcer without cellulitis is
a) Protective dressing

b) Moist dressing

c) Absorbent dressing

d) Topical antibiotics

Correct Answer - B
Answer- B. Moist dressing
598. For vascular anastomosis sutures of
choice
a) Polypropylene

b) Chromic catgut

c) Silk

d) Nylon

Correct Answer - A
Answer- A. Polypropylene
Vascular anastomoses require an extremely accurate closure as
they must be immediately watertight at the end of the operation
when the vascular clamps are removed.
In many cases, some form of prosthetic material or graft may be
used which will never be integrated into the body tissues and so the
integrity of the suture line needs to be permanent.
For this reason, polypropylene is one of the best sutures as it is not
biodegradable. It is used in its monofilament form,mounted on an
atraumatic, curved, round bodied needle.
 599. Which of the following is true about
venous thrombosis?
a) It affects only the deep venous system

b) Most important factor for development of deep venous

thrombosis is hospital admission

c) Coralline thrombus is platelet aggregate surrounded by white

blood cells

d) Lung infarction is a common complication of deep venous

thrombosis

Correct Answer - B
Answer- B. Most important factor for development of deep
venous thrombosis is hospital admission
Venous thrombosis is the formation of a semi-solid coagulum within
the venous system and may occur in the superficial system.
Patients are at risk of dweloping a post-thrombotic limb and venous
ulceration
Virchow triad-
1. Changes in the wssel wall (endothelial damage)
2. Stasis, which is diminished blood flow through the veins
3. Coagulability of blood (thrombophilia)
The most important factor is a hospital admission for the treatment
of a medical or surgcal condition.
The coralline thrombus then progresses as a propagated loose red
fibrin clot, containing many red cells.
600. Which of the following conditions shows
susceptibility to squamous cell
carcinoma in skin?
a) Epidermodysplasia verruciformis

b) Actinic keratosis

c) Xeroderma pigmentosum

d) All the above

Correct Answer - D
Answer- D. All the above
Squamous cell carcinoma is the second most common tumor arising
on sunexposed sites in oltler people, exceeded olly by basal cell
carcinoma.
The most important ceuse of cutaneous squamous cell carcinoma is
DNA damage induced by exposure to UV light.
Immunosuppression may contribute to carcinogenesis by reducing
host surveillance and increasing the susceptibility of keratinocytes to
infection and transformation by oncogenic viruses, particularly
human papilloma virus (HPV) subtypes.
Other risk factors for squamous cell carcinoma include industrial
carcinogens (tars and oils), chronic ulcers and draining
osteomyelitis, old burn scars, ingestion of arsenicals, ionizing
radiation, and (in the oral cavity) tobacco and betel nut chewing.
 601. Lehriche syndrome is characterized by
presence of arterial insufficiency in
a) Aorto- iliac artery

b) Superficial femoral artery

c) Temporal artery

d) Brachial artery

Correct Answer - A
Answer- A. Aorto- iliac artery
1. Brought on by walking
2. Not present on taking the first step (unlike osteoarthritis)
3. Relieved by standing still
The pain of claudication is usually felt in the calf because the
superficial femoral artery is the most commonly affected.
Aortoiliac disease (30 per cent of cases) may cause thigh or buttock
claudication.
Buttock claudication in association with sexual impotence resulting
from arterial insufficiency is eponymously called Leriche's syndrome.
It is very rare.
602. Most common cause of bleeding for
massive hemothorax in blunt trauma to
chest is from
a) Intercostal vessels

b) Bronchial vessels

c) Pulmonary vessels

d) Internal mammary artery

Correct Answer - A
Answer- A. Intercostal vessels
The most common cause of massive haemothorax in blunt injury to
chest is continuing bleeding from torn intercostal vexels or
occasionallyfrom the internal mammary artety.
603. A patient developed wound infection
post laparotomy for pyoperitoneam, was
treated conservatively. Now, granulation
tissue is seen in the wound. Next step in
management is
a) Daily dressing

b) Mesh repair

c) Incision and drainage

d) Resuturing with interrupted stitches

Correct Answer - D
Answer- D. Resuturing with interrupted stitches
Presence ofgranulation tissue indicates that the wound is healthy
and angiogenesis is occurring at the edges and base of the wound.
This is an indication that the wound can now be safely closed with
interrupted sutures without any risk of complications.
604. Hunt Hess scale is used to grade
manifestations of
a) Subarachnoid hemorrhage

b) Meningioma

c) Hydrocephalus

d) Tuberculous meningitis

Correct Answer - A
Answer-A. Subarachnoid hemorrhage
The initial clinical manifestations of SAH are graded using the Hunt-
Hess or World Federation of Neurosurgical Societies classification
schemes.
A grading system has therefore been developed to document the
severity of patient's disease in order to guide therapy and
prognostication.
605. Ligament of Cooper, used in the surgery
for femoral hernia repair, is formed by
which of the extentions of inguinal
ligament?
a) Lacunar ligament

b) Pectineal ligament

c) Ilioinguinal ligament

d) Reflected part of inguinal ligament

Correct Answer - A
Answer-A. Lacunar ligament
It is also called Gimbernat's ligament.
From the medial end, deep fibres curve horizontally backward to the
medial side of pectin pubis forming lacunar ligament.
This ligament is trainagular in shape, with the apex attached to the
pubic tubercle.
Its sharp lateral edge forms the medial boundary of the femoral
canal, which is the site of production of femoral hernia.
606. Maximum score of APACHE
a) 41

b) 51

c) 61

d) 71

Correct Answer - D
Answer- D. 71
APACHE II ('Acute Physiology and Chronic Health Evaluation II") is
a severity-of-disease classification system.
The APACHE II system is the most commonly used SOI scoring
system in North America.
APACHE IV uses a modified statistical model of logistic regression;
it is the most recently released version of this scoring system.
It is applied within 24 hours of admission of a patient to an intensive
care unit (ICU): an integer score from 0 (minimum) to 7l (maximum)
is computed based on several measurements; higher scores
correspond to more severe disease and a igher risk of death.
607. 26 yr old female came for the first time in
OPD with lump in breast first
investigation
a) USG

b) Mammogram

c) MRI

d) PET scan

Correct Answer - B
Answer- B. Mammogram
Radiological investigations for the initial assessment for breast lump
are either USG or Mammography.
Since the patient given in the question is a young female.
Ultrasonography is a preferred first investigation for evaluation of
breast lump.
ultrasound is particularly useful in young women with dense breasts
in whom mammograms are difficult to interpret, and in distinguishing
cysts from solid lesions.
608. Fixity of the breast tissue in carcinoma
of breast indicates infiltration of
a) Suspensory ligaments

b) Lymphatics

c) Pectoralis muscle and fascia

d) Internal mammary artery

Correct Answer - C
Answer- C. Pectoralis muscle and fascia
Fixity of the breast tissue is tested by asking the patient to press the
hand against the hip forcibly to contract Pectoralis major muscle &
moves the breast over the pectoralis fascia in the direction of muscle
frbres of the pectorals major muscle.
Loss of normal mobility or fixity of the breast tissue indicates spread
of cancer cells to underlying pectoralis muscle and fascia.
609. Nipple retraction in Ca breast due to
infiltration of
a) Suspensory ligaments

b) Lactiferous ducts

c) Lymphatics

d) Pectoralis fascia

Correct Answer - B
Answer- B. Lactiferous ducts
It is seen in breast carcinoma due to infltration of the lactiferous
ducts by carcinoma.
It is due to extention of the growth along the lactiferous ducts and
subsequent fibrosis.
Nipple retraction is circumferential in carcinoma and slit like in
periductal mastitis.
610. Surgery for ductal ectasia
a) Microdochectomy

b) Radical duct excision

c) Radiation

d) Chemotherapy

Correct Answer - B
Answer- B. Radical duct excision
Duct ectasia of the breast or m:rmmary duct ectasia or plasma cell
mastitis is a condition in which the lactiferous
duct becomes blocked or clogged.This is the most common cause of
greenish discharge.
Clinical features
Nipple discharge of any colour, abscess, mammary duct fistula,
subareolar mass and nipple retraction.
Treatment
Antibiotic therapy may be tried but surgery is mostly required to cure
this notoriously difficult condition. Surgery consists of excision of all
the maior ducts (Hadfield's operation)
611. Surgery for periductal mastitis -
a) Hadfield's operation

b) Patey's mastectomy

c) Modified radical mastectomy

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Hadfield's operation
612. Lady with recent delivery engorged shiny
mass on breast under nipple fever
a) Breast abscess

b) Fibroadenosis

c) Sebaceous cyst

d) Fibroadenoma

Correct Answer - A
Answer- A. Breast abscess
Featuresfavouringbreastabscess :
Lactating woman
Tender swelling
Pyreia
Tense shiny overlying skin
613. Hilton method is best used in
a) Breast abscess

b) Axillary abscess

c) Paronychia

d) Pulp abscess

Correct Answer - B
Answer- B. Axillary abscess
Hilton's method of abscess drainage is chosen when there are
plenty of important structures like nerves and yessels around the
abscess caity, like axilla. In this method incision is made only
through the skin and subcutaneous tissue. The deep fascia is not
incised.
 614. Reduction of size and vascularity prior to
thyroidectomy is done by
a) Iodides

b) Propylthiouracil

c) Radioiodine

d) Propranolol

Correct Answer - A
Answer- A. Iodides
Effects of iodide/ Lugol's iodine on thyroid:
1. Decrease rate of blood flow to the thyroid
2. Decreased vascularity of the thyroid
3. Decreased intraoperative blood loss during surgery
615. Alvarado score is used for
a) Acute cholecystitis

b) Acute appendicitis

c) Acute apncreatitis

d) Acute epidydimitis

Correct Answer - B
Answer- B. Acute appendicitis
Scoring system for Acute Appendicitis: Alvarado Score:
The diagnosis of appendicitis is based primarily on clinical history
and physical examination assisted by blood counts. A number of
clinical and laboratory based scoring systems have been devised to
assist diagnosis.The most widely used scoring system is Alvarado
score.
616. Which appendix pain is referred to
suprapubic region with pain on internal
rotation of hip
a) Pre ileal

b) Pelvic

c) Post ileal

d) Paracolic

Correct Answer - B
Answer- B. Pelvic
Pelvic appendicitis can present with
Absence of abdominal wall rigidity and tenderness
Tenderness in retrovescial pouch
Hypogastric or suprapubic pain
Obturator sign: pain on internal rotation of the hip
617. Which muscle is irritated by inflamed
retrocaecal appendix
a) Psoas major

b) Gluteus maximus

c) Quadratus femoris

d) Obturator internus

Correct Answer - A
Answer- A. Psoas major
In children with abdominal pain, who hold their right hip in a flexed
position to obtain relief from the pain, one should suspect
retrocaecal appendicitis causing irritation ofthe psoas muscle.
618. What permanent deleterious effects are
seen, if 25% of the small intestine is
resected?
a) Nothing Diarrhea

b) Fat malabsorption syndrome

c) Intestinal failure

d) None

Correct Answer - A
Answer- A. Nothing Diarrhea
Up to 50 per cent of the small intestine can be surgically removed or
bypassed without permanent deleterious effects.
619. Which of the following is not true about
Boerhaave syndrome?
a) Perforation of the esophagus due to barotrauma

b) Most common site is left posteromedial aspect 3 - 5 cms above

the gastroesophageal junction

c) Pain is the principal early manifestation

d) Most cases follow a bout of heavy eating or drinking

Correct Answer - B
Answer- B. Most common site is left posteromedial aspect 3 - 5
cms above the gastroesophageal junction
Boerhaave's syndrome is spontaneous perforation of the
esophagus, occuring usually due tosevere barotrauma when a
person vomits against a closed glottis.
Most common location of perforation is in the left posterolateral
aspect 3-5 cm above the gastroesophageal junction. Second most
common site of perforation is at the midthoracic esophagus on the
right side.
The principal early manifestation is pain felt in the chest and upper
abdomen.
620. The commonest cause of intestinal
obstruction in a 30 yr. old Indian female
a) TB stricture

b) Crohn's ds.

c) Post op. adhesions

d) Adenocarcioma

Correct Answer - C
Ans. is 'c' i.e. Post op. adhesions
621. Which of the following is associated with
destruction of myenteric plexus?
a) Hirschsprung disease

b) Secondary Achalasia

c) HPSS

d) GIST

Correct Answer - B
Answer- B. Secondary Achalasia
Secondary achalasia may arise in Chagas disease, in which
Trypanosoma cruzi infection causes destruction of the myenteric
plexus, failure of peristalsis, and esophageal dilatation.
622. Which of the following is true about
gastrointestinal carcinoid tumor?
a) Alcohol has no effect on the flushing attacks

b) Occur most commonly in jejunum

c) Tumors most commonly produce histamine

d) Preoperative octreotide scanning can detect extent of the

disease

Correct Answer - D
Answer- D. Preoperative octreotide scanning can detect extent
of the disease
These neuroendocrine tumours occur throughout the gastrointestinal
tract, most commonly in the appendix, ileum and rectum in
decreasing order of frequency. Appendicular carcinoid tumours are
most commonly noted as an incidental finding at appendicectomy.
Carcinoid tumours arise from Kulchitsky cells at the base of
intestinal crypts (of Lieberkuhn)
The tumours can produce a number of vasoactive peptides, most
commonly S-hydroxytryptamine (serotonin), but also histamine,
prostaglandins and kallikrein.
Classically, the flushing attack are induced by alcohol.
The extent of disease can be assessed preoperatively using
octreotide scanning, which may detect othertise clinically apparent
primary and secondary tumour.
623. Esophageal carcinoma what is the most
important prognostic indicator?
a) Length of involvement

b) Depth of invasion

c) Histological grading

d) Immunohistochemistry

Correct Answer - B
Answer- B. Depth of invasion
The depth of invasion of the tumor through the wall of esophagus, is
the most important prognostic indicator, with considerable
independent prognostic significance.
624. Hinchey classification is used for
perforations of colon secondary to
a) Trauma

b) Carcinoma

c) Diverticulitis

d) Inflammatory enteropathy

Correct Answer - C
Answer-C. Diverticulitis
Hinchey Classification is used to describe perforations of the
colon due to diverticulitis.
Hinchey I - localised abscess (para-colonic)
Hinchey II - pelvic abscess
Hinchey III - purulent peritonitis (the presence of pus in the
abdominal cavity)
Hinchey IV - feculent peritonitis. (Intestinal perforation allowing feces
into abdominal cavity)
625. A 50 years labourer, smoker presented
with repeated episodes of epigastric
pain, associated with ocassional
vomiting and weight loss. What is the
diagnosis
a) Hiatus hernia

b) Gastric ulcer

c) Gastric volvulus

d) Barret's esophagus

Correct Answer - B
Answer- B. Gastric ulcer
Smoking with epigastric pain and vomiting with weight loss is
strongly suggestive of gastric ulcer.
626. Pain in left hypochondrium vomiting,
diarrhea, malena, weight loss diagnosis
a) Cholangitis

b) Enterocolitis

c) Zollinger Ellison syndrome

d) Amebiasis

Correct Answer - C
Answer- C. Zollinger Ellison syndrome
Peptic ulceration is the most common manifestation of Zollinger
Ellison syndrome leading to left hypochondriac pain, vomlting and
weight loss and ulcers refractory to medical therapy.
A bleeding ulcer gives rise to malena.
627. Patient is on autocoids for 1 year
complains of severe pain epigasrium
relieved iv antacids now complains of
pain in right iliac fossa and epigastrium
with fever and loss of liver dullness
diagnosis
a) Duodenal perforation

b) Diverticulitis

c) Gastroenteritis

d) Enteric perforation

Correct Answer - A
Answer- A. Duodenal perforation
Long term therapy with autocoids led to an ulcer that eventually
perforated and now the patient has presented early signs of
peritonitis.
Clinical features of perfontion of duodenal ulcer
Perforated duodenal ulcer is characterized by sever constant onset
epogastric pain
Patient looks ill and lies unusually still
Tachycardia
Shallow respiration
Tender with intense guarding and rigidity
If the air has escaped into peritoneal cavity then liver dullness may
be absent
Peptic ulcer perforation leads to chemical peritonitis initially.
628. 5 year old Boy with something coming
out of the anus with pedicle attached to
rectal/ anal wall and bright red bleeding-
most common diagnosis
a) Juvenile rectal Polyp

b) Pedicle pile

c) Fissure

d) CA Colon

Correct Answer - A
Answer- A. Juvenile rectal Polyp
Juvenile polyps are the most common type of childhood polyp,
occurring in up to l% of preschool children. They are usually solitary
polyps found in the rectum which most commonly present with rectal
bleeding.
These are hamartomatous pollps, which are usually pedunculated
but can be sessile.
629. Duhamel procedure is done for
a) Hirschsprung's disease

b) HPSS

c) Meckels diverticulum

d) Volvulus

Correct Answer - A
Answer- A. Hirschsprung's disease
Surgery in Hirschsprung's discase aims to remove the aganglionic
segment and'pull-through'ganglionic bowel to the anus (e.9.
Swenson, Duhamel, Soave and transanal procedures) and can be
done in a single stage or in several stages after first establishing a
proximal stoma in normally innervated bowel.
630. Treatment surgery for fissure in ano
a) Lateral sphinterotomy

b) Fissurectrny

c) Seton

d) None

Correct Answer - A
Answer- A. Lateral sphinterotomy
Conservative t/t
Stool bulking agents and stool softners
Nitric oxide or Glyceryl tinitrate
Dilatation of the sphincter under GA
laterd anal sphincterotomy - the intetnal sphincter is divided away
from the rtssure itself - usually either in the rigltt or the left lateral
position
Anal advancement flap
631. Position of internal hemorrhoid in anus
is especially common in
a) 4 0' clock position

b) 11 0' clock position

c) 8 0' clock position

d) 9 0' clock position

Correct Answer - B
Answer- B. 11 0' clock position
Internal hemorrhoids characteristically lie in 3, 7 and 11 o'clock
positions.
632. Splenectomy is not indicated in which of
the following pathologies?
a) Sarcoidosis

b) Trauma

c) ITP

d) Hereditary spherocytosis

Correct Answer - A
Answer- A. Sarcoidosis
General indications for splenectomy include symptomatic
splenomegaly, hypersplenism, hemolytic anemia, thrombocytopenia
and other cytopenias.
633. During splenectomy, splenic vessels are
ligated at which level
a) Near splenic hilum

b) Superior border of pancreas

c) Inferior border of pancreas

d) Midway between the splenic hilum and superior border of

pancreas

Correct Answer - B
Answer- B. Superior border of pancreas
Most surgeons use a midline or transverse left subcostal incision for
open splenectomy.
In elective splenectomy, the gastrosplenic ligament is opened up,
and the short gastric vessels are divided.
The splenic vessels at the superior border ofthe pancreas are suture
ligated
634. Most common variety of mesenteric cyst
is?
a) Enterogenous

b) Chylolymphatic

c) Dermoid

d) Urogenital remnant

Correct Answer - B
Answer- B. Chylolymphatic
Chylolymphatic is the most common variety , probably arising in the
congenitally misplaced lymphatic tissue that has no eferent
communication with the lymphatic system (most frequently in
mesentery of ileum)."
635. Preferred shunt procedure in patient with
portal hypertension having acceptable
operative risk and adequate liver
function is
a) End to side portocaval shunt

b) End to end portocaval shunt

c) Mesocaval shunt

d) Distal splenorenal shunt

Correct Answer - D
Answer- D. Distal splenorenal shunt
Portosystemic shunt procedures such as splenorenal shunt and
mesocaval shunt, may be indicated in patients with complication of
portal hypertension.
Given the early occlusion rate and the need for constant
surveillance, it is generally advised that TIPS should be reserved for
Child C classification of cirrhosis, whereas a distal splenorenal shunt
is safe, durable, preferred and effective treatment in patients with
acceptable operative risk and still good liver function.
636. Not true about choledochal cyst is:
a) Associated with anomalous junction of the pancreatic and
biliary duct

b) Type 2 is most common

c) Surgical removal is the treatment of choice

d) If ruptures can cause biliary peritonitis

Correct Answer - B
Ans is b i.e. Type 2 is most common
637. A patient presents with severe pain in
right upper quadrant associated with
nausea and vomiting, exacerbation
during inspiration and tenderness on
palpation. Which of the following is the
imaging modality of choice for the above
patient?
a) Ultrasonography

b) CT Scan

c) MRI

d) X ray

Correct Answer - A
Answer- A. Ultrasonography
Patient with severe pain in right upper quadrant associated with
nausea and vomiting, exacerbation during inspiration and
tenderness on palpation is suggestive of probable case of acute
cholecystitis with positive murphys sign. Ultrasonography is the
modality of choice for the diagnosis of this condition.
 638. Courvoiser's law exception
a) Double impaction

b) Portal lymphademopathy

c) Periampullary CA

d) None

Correct Answer - A
Answer- A. Double impaction
Courvoisier's law states that in the presence of an enlarged gall
bladder which is nontender and accompanied with jaundice the
cause is unlikely to be gallstones. This is because gall stones
areformed over alonger period oftime, and this result in a shrunken,
fibrotic gall bladder which does not distend easily.
Exception to Courvoiser's law:
1. Double impaction
2. Pancreatic calculus obstruction ampulla
3. Oiental cholangio hepatic
4. Mitizzisyndrome
639.
The possibility of liver lobe resection is
considered in patients with carcinoma of gall
bladder from/ beyond which stage of gall
bladder carcinoma?
a) IA

b) IIA

c) III

d) IV

Correct Answer - B
Answer- B. IIA
Radical en-bloc resections which may include segmental or
extended hepatectomy, bile duct resection and regional
lymphadenectomy should be considered in selected patients. The
aim is to remove the tumour entirely and achieve negative
histopathological margins. This option can be considered in the
operable patients with carcinoma of gall bladder, who come under
stage IIA ofgall bladder carcinoma and beyond.
640. Maylard incision involves a trasverse cut
through which of the following muscles?
a) Rectus abdominis

b) Serratus anterior

c) Pectoralis major

d) Psoas major

Correct Answer - A
Answer- A. Rectus abdominis
Mayland Incision is a surgical incision in which a transverse cut is
made on rectus abdominis muscle to allow wider access to the
pelvic cavity. It is also called Mackenrodt incision.
641. Which of the following predisposes to
testicular germ cell tumors?
a) Kleinfelter syndrome

b) Testicular carcinoma in sibling

c) Cryptorchidism

d) All the above

Correct Answer - D
Answer- D. All the above
Cryptorchidism
Testicularfeminization syndrome
GCT of one testis is a risk factor for the other testis
Testicular Ca in a sibling
Klienfelter syndrome - is associated with mediastinal GCT
642. Pain in region of penis in acute urethritis
is typically experienced
a) Before micturition

b) After micturition

c) During micturition

d) Irrespective micturition

Correct Answer - C
Answer- C. During micturition
Causes of pain in the penis experienced during micturition
Disease of the urethra
Acute inflammation, gonorrhoeal/non-specific urethritis (NSU)'
chemical or other
The passage or impaction of a calculus
Stricture ofthe urethra
Injury to the urethra
Foreign body in the urethra
Disease of the prostate
Acute prostatitis
Prostatic abscess
Prostatic carcinoma
Diseases of the bladder
Acute rystitis
Bladder calculus
Pedunculated bladder carcinoma
643. Yoyo reflux
a) Duplication of ureter

b) Polycystic Kidney

c) Mellutary sponge Kidney

d) Pseudo kidney

Correct Answer - A
Answer- A. Duplication of ureter
Reflux of the urine from one limb of the collecting system to the
other limb, rather than down towards the bladder is called yo-yo
reflux (saddle reflux)
Cause : Duplication of ureters, partial duplication ofureters, duplicate
renal pelvis
644. 16 F foleys is used in
a) Acute urinary retention

b) CA penis

c) Pyonephrosis

d) None

Correct Answer - A
Answer- A. Acute urinary retention
l6F and l8F foleys are mainly used for adults
8F and 10F are mainly used for children
cute urinary retention is an indication for catheterization
645. Which of the following is extended
criteria donor [ECD] for kidney
transplantation?
a) Donors with extremes of age

b) Donors with excess alcohol intake

c) Donors having cerebrovascular accident

d) All the above

Correct Answer - D
Answer- D. All the above
With the limited number of organs available for transplantation,
donors who would previously been declined are now being
accepted.
Criteria include extremes of age, iteath for intracranial hemorrhage,
organ specifc diseases such as excess alcohol intake or hepatitis,
general co morbidities such as diabetes, cerebrcvascular accident or
cardiovascular instability.
The long-term outcomes of the transplants performed from ECD are
poorer than standard criteria donors, and the potential risks to the
recepients must be weighed against the benefits. There is an
increased risk ofdelayed graft function.
646. 35 years male presents with a swelling in
scrotum that is non tender and seperate
from testes and on transillumination,
chinese lantern pattern is seen
diagnosis
a) Vaginal hydrocele

b) Inguinal harnia

c) Epididymal cyst

d) Varicocele

Correct Answer - C
Answer- C. Epididymal cyst
Cysts of the epididymis (multiloculated epididymal cyst,
spermatocele) are not swrounded by fluid and for this reason are felt
as swellings above, behind the testis, which is also easily palpable in
this situation.
Because of the septation, multiloculated epididlmal cysts have a
characteristic 'Chinese lantern' aPPearance on transillumination.
647. Most Common congenital GI Tract
anamoly is
a) Meckels diverticulum

b) Patent rachus

c) Ileal atresia

d) Jejunal aplasia

Correct Answer - A
Answer- A. Meckels diverticulum
Meckel's diverticulum is a true diverticulum as it has all the 3layers
of the intestine.
It's the most common congenital anomaly of the gastrointestinal tract
648. Treatment of stage I bladder cancer is
a) Radical cystectomy

b) Endoscopic removal with intravesical chemotherapy

c) Chemotherapy

d) Radiotherapy

Correct Answer - B
Answer- B. Endoscopic removal with intravesical
chemotherapy
649. Which of the following is used to
differentiate between hypercalcemia of
malignancy from primary
hyperparathyroidism?
a) Hydrocortisone suppression test

b) Glucose challenge test

c) 24 hour urine calcium measurement

d) Percentage of ionized calcium

Correct Answer - A
Answer- A. Hydrocortisone suppression test
lf doubt exists, hyilrocortkone suppression test is of value.
If the test is performed as originally described, (120 mg
hydrocortisone per day for 10 days, correcting the serum calcium for
haemodilution), it provides an excellent discrimination, since
significant suppression ofserum calcium does not occur in primary
hyperparathyroidism, where as malignant hypercalcemia is usually
completely alleviated.
650. What is proband in pedigree?
a) Male child of disease

b) Female child of diseased

c) Diseased individual

d) Pregnancy

Correct Answer - C
Ans. is 'c' i.e., Diseased individual
Pedigree analysis is the analysis of human gene transmission.
Pedigree chart is a diagrammatic method of illustrating the
inheritance of genes within a family.
The starting point is often the identification of an affected individual,
called the `propositus' or `proband', i.e. propositus or proband is the
individual which is studied in a pedigree, such as the individual with
a certain disease or other inherited interest.
651. All of following may be causes of
precocious puberty in girls except -
a) Hypothalamic hamartoma

b) Mc Cuone Albright syndrome

c) Granulosa cell tumor of human ovary

d) Congential 21-a hydroxylase deficiency

Correct Answer - D
Ans. is 'd' i.e., Congenital 21-hydroxylase
o Congenital 21 hydroxylase deficiency causes precocious puberty
in male due to excess of androgens.
o In female, it results in virilization.
652. 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
653. Not seen in kwashiorkor -
a) Apathy

b) Flaky paint dermatosis

c) Poor appetite

d) Increased albumin

Correct Answer - D
Ans. is 'd' i.e., Increased albumin
o Albumin level is low in kwashiorkor, which results in generalized
edema.
o Other options are true regarding kwashiorkor.
654. 1st symptom of vitamin A
deficiency:
March 2009
a) Conjunctival xerosis

b) Bitot's spots

c) Night blindness

d) Corneal ulcer

Correct Answer - C
Ans. C: Night blindness
Vitamin A deficiency is common in developing countries but rarely
seen in developed countries. Night blindness is one of the first signs
of vitamin A deficiency.
Xerophthalmia and complete blindness can also occur since Vitamin
A has a major role in phototransduction.
Vitamin A deficiency also diminishes the ability to fight infections. In
countries where children are not immunized, infectious disease like
measles, have higher fatality rates.
Even mild, subclinical deficiency can also be a problem, as it may
increase children's risk of developing respiratory and diarrheal
infections, decrease growth rate, slow bone development and
decrease likelihood of survival from serious illness.
655. Index of duration of malnutrition is -
a) Weight for height

b) Height for age

c) Weight for age

d) None

Correct Answer - B
Ans. is 'b' i.e., Height for age
o Stunting (deficit in height for age) generally points towards a
chronic course of malnutrition. - O.P. Ghai -
Height is a stable measurement of growth as opposed to body
weight. Whereas weight reflects only the present health status of the
child, height indicates the events in the past also".
656. Casal's paint necklace is caused by:
a) Lichen planus

b) Pellagra

c) Pernicious anemia

d) SLE

Correct Answer - B
B i.e. Pellagra
657. Which of the following type of cell is involved in myelination of the CNS?
a) Microglia

b) Astrocytes

c) Macrophages

d) Oligodendrocytes

Correct Answer - D
Oligodendroglial cells are a type of neuroglial cells, they myelinate
the nerve fibre of the central nervous system.
The formation of a myelin sheath is the result of a process from an
oligodendrocyte spiralling around an axon so that the cytoplasm is
extruded until the opposite membranes meet, thus forming a multi-
layered lipoprotein coat with a node of Ranvier at each end.
It has multiple cytoplasmmic processes and myelinate several axons
at the same time.
Myelination of the cortex begins at 7-8 mo gestation and continues
into adolescence and young adulthood. It proceeds in a posterior to
anterior fashion, allowing progressive maturation of sensory, motor,
and finally associative pathways.
Must know:
Peripheral nerves are myelinated from the schwann cells. Loss
of myelin, known as demyelination, results in disturbance of the
ability to transmit a nerve impulse through the demyelinated
segment and this has serious consequences for function.
Damage to one oligodendrocyte, therefore, can result in loss of
myelin from many axons, whereas damage to a Schwann cell only
results in loss of myelin from a single axon.
Good to know:
Tracts in the nervous system get myelinated at about the time they
start to function.
 658. Which of the following is the most likely
diagnosis in case of a child with
increased cough at night?
a) Pneumonia

b) Asthma

c) Bronchiolitis

d) Laryngomalacia

Correct Answer - B
Ans. is 'b' i.e., Asthma
Variation in intensity of cough
1. Worse in night and early morning → Asthma, Persistent moist
2. Seasonal variation → Asthma, Bronchitis
3. Postural variation → Bronchiectasis, Lung abscess
659. A child is brought to the paediatric OPD
with fever of 24 hours duration. History
reveals 3 episodes of chest infection and
passage of foul smelling stools. The
most probable diagnosis is-
a) Cystic Fibrosis

b) Maple Syrup urine Disease

c) Bilirubin Congugation Defect

d) Criggler Najar Syndrome

Correct Answer - A
Ans. is 'a' i.e., Cystic Fibrosis
o Recurrent chest infection in a child with evidence of exocrine
pancreatic insufficiency (bulky, foul smelling stool) suggest a
diagnosis of cystic fibrosis.
660. Which is the baseline investigation in the
case of an acute abdomen in this high -
tech era -
a) Abdomen CT

b) Abdomen X - Ray

c) USG

d) Colonoscopy

Correct Answer - B
Ans. is 'b' i.e., Abdomen X-Ray
661. Which of the following is not elevated in
a child presenting with jaundice, icterus,
pruritus and clay-colored stools?
a) 5' nucleotidase

b) Alkaline phosphatase

c) Glutamate dehydrogenase

d) Gamma glutamyl transpeptidase

Correct Answer - C
Ans. C. Glutamate dehydrogenase
(Ref: HARRISON 19/E PG-1997, 18/E, P2530)
Glutamate dehydrogenase is not elevated in obstructive jaundice.
Liver diseases in which necrosis of hepatocytes is the predominant
event, such as toxic liver damage or hypoxic liver disease, are
characterized by high serum GLDH levels. GLDH is important for
distinguishing between acute viral hepatitis and acute toxic liver
necrosis or acute hypoxic liver disease, particularly.
Gamma glutamyl transpeptidase is important to differentiate
between neonatal hepatitis and biliary atresia in infant with jaundice
662. Hutchinson's triad of congenital syphilis
includes all of the following except
a) Eighth nerve deafness

b) Interstitial keratitis

c) Hutchinson's teeth

d) Saddle nose

Correct Answer - D
Ans. D. Saddle nose
663. All of the following are features of
systemic Juvenile Rheumatoid Arthritis
except-
a) Uveitis

b) Rash

c) Fever

d) Hepatosplenomegaly

Correct Answer - A
Ans. is 'a' i.e., Uveitis
o The eye manifestation are seen in Pauciarticular and Polyarticular
JRA but not in systemic JRA.
664. A baby is born with meconium stained
liquor which of the following is taken
account of in terming a baby vigorous
except -
a) Tone

b) Colour

c) Respiration

d) All

Correct Answer - B
Ans. is 'b' i.e., Colour
Resuscitation of neonate born through meconium-stained
liquer (MSL)
o When baby passes meconium in utero, there is a chance that the
mecomium will be aspirated into infant's mouth and potentially into
the trachea and lungs.
o Appropriate steps must be taken immediately after delivery to
reduce the risk of serious consequences resulting from aspiration of
meconium.
o Intrapartum nasopharyngeal suctioning just after the delivery of
head is no longer recommended as it does not reduce the risk of
meconium aspiration syndrome and, on rare occasions, may cause
nasopharyngeal trauma or a cardiac arrhythmia.
The first step after delivery is to identify whether the newborn is
vigrous or non-vigrous : ?
A) Vigrous newborn
A newborn is classified as vigrous, if he has all the three
signs are present : ?
1) Strong respiratory effort
2) Good muscle tone
3) Heart rate greater than 100
LI The vigrous child does not require any tracheal suctioning and the
usual initial steps of resuscitation are provided, i.e., provide warmith,
positioning, suctioning of mouth and nose (not tracheal suctioning),
Dry, stimulate and 02 if necessary.
B) Non-vigrous newborn
If any of the above three signs is present, the newborn is
classified as non-vigrous.
For non-vigrous child, the initial steps are modified :
Place the baby under radiant warmer and postpone suctioning to
prevent stimulation of posterior pharyngeal wall that can cause
bradycardia.
ii) Residual meconium in the mouth and posterior pharynx
should be removed by suctioning under direct vision using a
laryngoscope.
iii) The trachea should then be intubated and mechonium
suctioned from the lower airway. Tracheal suctioning is best done by
applying suction directly to the endotracheal tube.
After providing initial steps, the further management is
same as with resucitation for other conditions (See previous
explanation).
665. Which of the following is not a
component of Kangaroo mother care
(KMC)?
a) Skin to skin contact

b) Supplementary nutrition

c) Exclusive breast feeding

d) Early discharge and follow-up

Correct Answer - B
Ans. b. Supplementary nutrition
Kangaroo position
The kangaroo position consists of skin-to-skin contact (SSC)
between the mother and the infant in a strictly vertical position,
between the mother's breasts and under her clothes.
SSC should be started as early as possible after birth and can be of
two types depending upon the duration: continuous or intermittent.
Kangaroo nutrition
This can be exclusive breastfeeding/fortification.
. Kangaroo nutrition is the delivery of nutrition to "kangarooed"
infants as soon as oral feeding is possible.
. lt is based on exclusive breastfeeding by direct sucking, whenever
possible.
. Goal is to provide exclusive or nearly exclusive breastfeeding with
fortification, if needed.
. Breastfeeding is an integral component of KMC and it might
contribute to significant gains in neurological development and lQ
 666. Which of the following does not describe
an infant "at risk" ?
a) Third child

b) Birth weight less than 2.5 kg

c) On artificial feed

d) Twins

Correct Answer - A
Ans. is 'a' i.e., Third child
Identification of 'At Risk' Infants
1. Birth weight < 2.5 Kg
2. Twins
3. Birth order 5 or more
4. Artificial feeding
5. Weight below 70% of expected weight (i.e. grade II & III malnutrition)
6. Failure to gain weight during 3 successive months
7. Children with PEM, Diarrhea.
8. Working mother, one parent.
9. Spacing of less than 1 year.
 667. All are seen in treacher collin syndrome
except
a) Conductive deafness

b) Cleft palate

c) Mandibular hypoplasia

d) Choanal atresia

Correct Answer - D
Ans. is 'd' i.e., Choanal atresia
Treacher collins syndrome
It is rare condition that presents several craniofacial deformities of
different levels.
This is a congenital malformation involving the first and second
branchial arches.
The disorder is characterized by abnormalities of the auricular pinna,
hypoplasia of facial bones, antimongoloid slanting palpebral fissures
with coloboma of the lower eyelids and cleft palate.
Important clinical findings are :-
1. Antimongoloid palpebral fissures
2. Malformed malleus and incus (normal stapes)
3. Coloboma of lower lid
4. Conductive deafness
5. Hypoplasia of mandible (micrognathia) and molar bones
6. Cleft palate
7. Malformed pinna and meatal atresia
It is the most common benign neoplasm of nasopharynx.
It is a highly vascular tumor and blood supply of the tumor most
commonly arises from the internal maxillary artery.
Juvenile nasopharyngeal angiofibroma (JNA) occurs almost
exclusively in males.
Female with Juvenile nasopharyngeal angiofibroma (JNA) should
undergo genetic testing.
Onset is most commonly in the second decades, the range is 7-19
years.
The exact cause is unknown. As the tumour is predominantly seen
in adolescent males in the second decade of life, it is thought to be
testosterone dependent.
The most common site is posterior part of nasal cavity close to the
margin of sphenopalatine foramen.
The tumor starts adjacent to the sphenopalatine foramen.
Large tumors are frequently bilobed or dumbbel shaped, with one
portion of tumor filling the nasopharynx and the other portion
extending to the pterygopalatine fossa.
Clinical features
Symptoms depend on spread of tumour to nasal cavity, paranasal
sinuses, pterygomaxillary fossa, infratemporal fossa, cheek, orbits
(through inferior orbital fissure), cranial cavity (most common site is
middle cranial fossa).
Nasal obstruction (80-90%) is the most common symptom,
especially in the initial stages. This results in denasal speech,
hyposmia, broadening of nasal bridge.
pontaneous profuse & recurrent epistaxis is the second most
common symptom
Otalgia, conductive hearing loss, serous otitis media, due to
eustachian tube obstruction.
Pink or purplish mass obstructing one or both chonae in
nasopharynx.
Tumour in the orbit causes : proptosis; and frog-face deformity;
diplopia and diminshed vision.
Tumour in infratemporal fossa can cause trismus and bulge of
parotid.
II, III, IV, V, VI cranial nerve can be involved.
Splaying of nasal bones.
Swelling of cheek and fullness of face.
Diagnosis and treatment
Contrast CT is the investigation of choice.
Biopsy should be avoided as it can cause severe bleeding.
Surgical excision is the treatment of choice.
668. The following is not a feature of pierre –
Robin syndrome -
a) Hearing defect

b) Coloboma Iris

c) Respiratory distress

d) Mandibular hypoplasia

Correct Answer - B
Ans. is 'b' i.e., Cloboma iris
Pierre Robin syndrome consists of -
Micrognatnia
Fore shortened floor of mouth
CHDs
Cleft palate or high arched palate
Mandibular hypoplasia (Micrognathia)
Respiratory obstruction
Normal size tongue
669. Gilbert syndrome, true all except ?
a) Causes cirrhosis

b) Autosomal dominant

c) Normal liver function test

d) Normal histology

Correct Answer - A
Ans. is 'a' i.e., Causes cirrhosis
Gilbert's Syndrome: ?
o It is an autosomal dominant condition.
o It is characterized by unconjugated hyperbilirubinemia (normally
the bilirubin is transported into liver cells by intracellular proteins. In
the liver bilirubin is conjugated. This conjugation is brought about by
certain enzymes. In Gilbert's syndrome these enzymes are absent
which cause unconjugated hyperbilirubinemia).
The hyperbilirubinemia is usually precipitated by following conditions
– Stress, Fatigue, Alcohol use, reduced calorie intake, intercurrent
illness.
The hepatic biochemical tests are normal except for elevated
bilirubin level (serum bilirubin concentration are usually < 3mg/dl)
Embryonal carcinomaThe hepatic histology is normal
There is no association with cirrhosis.
670. A6 month old child with Tetralogy of
Fallot develops cyanotic spell initiated
by crying. Which one of the following
drugs you would like to avoid-
a) Sodium bicarbonate

b) Propranolol

c) Phenylephrine

d) Isoprenaline

Correct Answer - D
Ans. is 'd' i.e., Isoprenaline
In Tetralogy of Fallot there is right outflow obstruction due to
pulmonary stenosis with supravalvular pulmonary artery obstruction.
In case of severe obstruction, the right ventricular pressure becomes
greater than the left ventricular presence and the deoxygenated
blood starts moving to the left ventricle resulting in severe cyanosis
and erythrocytosis.
671. For TOF management in antenatal period
includes ?
a) Balloon valvotomy

b) Open heart surgery

c) Karyotyping

d) Aspirin

Correct Answer - C
Ans. is 'c' i.e., Karyotyping
TOF has been associated with untreated maternal diabetes,
phenylketonuria, and intake of retinoic acid.
Associated chromosomal anomalies occur in 30% cases and include
trisomies 21, 18, 13 and 22q11 microdeletion, especially in
pulmonary atresia and absent pulmonary valve syndrome (APVS).
There is also a high association with extra - cardiac anomalies in
particular, abdominal and thoracic abnormalities.
When a TOF is diagnosed during fetal life, karyotyping and targeted
morphologic ultrasound examination should be offered.
Isolated TOF → Good prognosis in TOF with pulmonary stenosis
(>90% survival after surgery).
However, other forms of TOF such as pulmonary atresia and absent
pulmonary valve syndrome do not have a good prognosis (moderate
prognosis for pulmonary atresia and bad prognosis for APVS).
672. Ductus dependent blood flow is required
for all of these congenital heart diseases
except
a) Persistent truncus arteriosus

b) Hypoplastic left heart syndrome

c) Pulmonary stenosis

d) TGA with intact ventricular septum

Correct Answer - A
Persistent truncus arteriosus [ReP V. Mohan Reddy. Cardiac
Surgery for Premature and Low Birth Weight Neonates, Pediatric
Cardiac Surgery Annual of the Seminars in Thoracic and
Cardiovascular Surgery 2003; 4; 271-76]
Congenital heart disease in the newborn can be broadly categorized
by the relationship between the patient's cardiac defect and the
patent ductus arteriosus and this categorization yields four distinct
groups.
First are newborns dependent on a patent ductus arteriosus (PDA)
for pulmonary blood flow.
Second are newborns dependent on the PDA for systemic blood
flow.
Third are those dependent on the patent ductus for proper mixing of
oxygenated blood
Fourthly are neonates with a non- ductal dependent circulation.
For the ductal dependent group, "intravenous prostaglandin" (E-1) is
used as necessary to maintain ductal patency and is the single most
important step in supporting these patients to diagnosis and
definitive therapy.
Nevertheless, all newborns ductal dependent for systemic or
pulmonary blood flow require an intervention, surgical or cardiologic
to eliminate ductal dependence prior to discharge.
1. Pulmonary flow ductal dependence
- Newborns with congenital heart disease who are dependent on
the patency of their ductus for pubnonary blood .flow present with
varying degrees of cyanosis.
- Critical Pulmonary Valve Stenosis with Intact Ventricular Septum
- Tricuspid AtresiaQ
- Tetralogy of Fallote
2. Systemic flow ductal dependence
- These newborns are dependent on their ducats arteriosus for
systemic blood flow and unlike the babies who are pulmonary flow
dependent, these newborns present with severely decreased
cardiac output.
- This decreased systemic .flow is characterized by pallor,
diminished peripheral pulses, low urine output, cool extremities and
varying degrees of metabolic acidosis.
Included are newborns born with left ventricular outflow tract
obstruction at various levels.
Congenital Valvular Aortic Stenosis
Coarctation of the Aorta
- Interruptued Aortic Arch
Hypoplastic Left Heart Syndrome (HLHS)
3. Oxygenation ductal dependence
- These are babies who are born with congenital heart disease that
requires a patent ductus ,for adequate mixing of saturated and
desaturated blood.
- Transposition of great arteries
4. Ductal independence
-These are neonates who are not dependent on a patent ductus but
still require urgent operation
- Total anomalous pulmonary venous return (TAPVR)
- Truncus Arteriosus
- Anomalous origin of the left main coronary artery from the
pulmonary artery.
673. Tuft of hair over the lumbosacral region
in a new born is suggestive of ?
a) Spina bifida occulta

b) Sinus tract

c) Tumor

d) Any of the above

Correct Answer - D
Ans. d. Any of the above
Tufts of hair over the lumbosacral spine suggest an underlying
abnormality, such as occult spina bifida, a sinus tract, or a tumor.
674. The following type of fetal ultrasound is
seen in which condition?

a) Arnold Chiari Malformation

b) Hydrocephalus

c) Down Syndrome

d) Lymphoma

Correct Answer - A
Ans:A.)Arnold Chiari Malformation.
Image shows:Typical frontal 'pinching' of calvarium gives a 'lemon'
appearance of the skull, and a 'banana' shaped cerebellum is seen
due to a shallow posterior fossa. These are tell tale signs of a
shallow posterior fossa anomalies or Chiari malformation.
Arnold Chiari Malformation
Chiari I malformation describes low-lying cerebellar tonsils without
other congenital brain malformations.
Chiari II malformation is a complex anomaly with skull, dura, brain,
spine and spinal cord manifestations, which usually presents in early
childhood or in infancy. This disorder is usually associated with the
spinal defect myelomeningocele.
675. Content of meningocele?
a) Dura mater

b) Spinal cord

c) Brain mater

d) Cauda equina

Correct Answer - A
Ans. is 'a' i.e.,Dura mater
Meningocele
There is protrusion of meninges (dura mater, arachnoid mater)
through a defect in neural arch. This contains only CSF. There may
be associated genital tract abnormalities, e.g. vaginal septa and
rectovaginal fistula.
676. Nephrotic syndrome is characterised by
a) Proteinuria

b) Hyperlipidemia

c) Oedema

d) All

Correct Answer - D
Ans. is 'a' i.e., Proteinuria; 'b' i.e., Hyperlpidemia; 'c' i.e., Oedema
Pathophvsiologv of nephrotic syndrome
Proteinuria
o The most important feature of nephrotic syndrome is massive
proteinuria (>3.5 gm/day)
o Proteinuria results from altered permeability of glomerular filtration
barrier for protein.
o The largest proportion of protein lost in the urine is albumin but
globulins are also excreted in some diseases. The ratio of low to
high molecular weight proteins in urine in various cases of syndrome
is a manifestation of the selectivity of proteinuria. A highly selective
proteinuria consists mostly of low molecular weight proteins, i.e.
albumin & transferrin, where as apoorly selective proteinuria
consists of higher molecular weight globulin in addition to albumin.
Edema
o Proteinuria leads to hypoalbuminemia that results in decreased
colloid osmotic pressure edema. Hyperlipidemia
o Increased synthesis of lipoproteins by liver.
o Decreased catabolism of lipids.
o There is increased cholesterol, triglycerides VLDL, and LDL.
Lipiduria
o Hyperlipidemia results in lipiduria due to excessive leakiness of
glomerular filtration barrier.
glomerular filtration barrier.
677. A child with nephrotic syndrome
following an episode of diarrhea
presented with acute kidney injury with a
creatinine of 4.5. All of the following are
possible reasons except?
a) Excess furosemide

b) Diarrhea water depletion

c) Renal vein thrombosis

d) Steroid induced diabetes

Correct Answer - D
Ans. d. Steroid induced diabetes
Massive proteinuria, with the daily loss of 3.5 gm or more of protein
Hypoalbuminemia, with piasma albumin levels < 3 gm/dl
Generalized edema
Hyperlipidemia and lipiduria
Steroid induced diabetes is not the csuse of acute kidney injury in
patients of nephrotic syndrome who present with episode
of diamhea and raised creatinine.
678. 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
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.
679. Acute mesenteric lymphadenitis is
caused by -
a) E. coli

b) a-hemolytic streptococci

c) Hemophilus

d) Yersinia

Correct Answer - D
Ans. is 'd' i.e., Yersinia
Acute mesenteric lymphadenitis is the diagnosis usually given when
enlarged, slightly reddened lymphnodes are encountered at the root
of mesentery along with normal appendix, when a pt. suspected of
appendicitis is opened. "Whether this is a single, discrete entity is
unclear, since the causative factor is not known. Some of these
patients have infection with Y. pseudotuberculosis or Y.
enterocolytica, in which case the diagnosis can be established by
culture of the mesenteric nodes or by serologic titres. Children seem
to be affected more frequently than men."
680. Osteogenesis imperfecta is a group of diseases characterized by genetic
mutations which lead to?

a) Shortened a1(I) collagen chains

b) Increased processing of procollagen chains

c) Decreased formation of hydroxylysine residues in collagen

d) Decreased synthesis of a2(I) collagen chains

Correct Answer - A
Collagen is a fibrous protein composed of 3 chains which form the collagen triple helix.
Several different types of collagen exist which vary in the types and combinations of the 3
chains forming the collagen helix.
Each collagen chain is the product of separate genes.
For example, the type of collagen found in skin, arteries, bone, and tendons, Type I
Collagen, is composed of 2 a1(I) chains and 1 a2(I) chain. Every third amino acid residue of
all of the collagen chains is glycine.
This allows the chains to intertwine with glycine at the center. Osteogenesis imperfecta is a
disease consisting of at least 4 clinically, genetically, and biochemically distinguishable
disorders.

All are characterized by multiple bone fractures which result in bone deformities. Mutations
leading to shortened a1(I) chains cause many of these variants. The short a1(I) chain
associates with normal a1(I) chains and a2(I) chains which prevents normal helix
formation. Defective molecules are degraded leading to weakened collagen
structures.

Other forms of osteogenesis imperfecta are due to mutations in which glycine residues are
changed to other amino acids. This leads to destabilization of the collagen helix because of
the larger amino acid forced to the center of the helix structure. A decrease in
hydroxyproline occurs in scurvy. This occurs because ascorbic acid (vitamin C) is
necessary to form the hydroxyproline.

With decreased amounts of hydroxyproline in the collagen molecule, the helix is less stable.
The result is deficient growth and poor wound healing in the individual with scurvy. The
disease Ehlers-Danlos VI is characterized by a decrease in the enzyme lysyl hydroxylase,
the enzyme responsible for the formation of hydroxylysine. The decrease in hydroxylysine
in collagen results in less stable cross-linking of the collagen molecules.
Ref: Prockop D.J., Bateman J.F. (2012). Chapter 363. Heritable Disorders of Connective
Tissue. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo
(Eds), Harrison's Principles of Internal Medicine, 18e.
681. In congenital adrenal hyperplasia,
deficient enzyme is - most womon
a) 11(3 hydroxylase deficiency

b) 21 a hydroxylase deficiency

c) 3a hydroxylase deficiency

d) 17a hydroxylase deficiency

Correct Answer - B
Ans. is 'b' i.e., 21-a Hydroxylase
Congenital adrenal hyperplasia (CAH)
Group of AR disorder
MC adrenal disorder in childhood
Most common 21-hydroxylase deficiency
In 21a-hyroxylese deficiency
There is deficiency of mineralocorticoids & glucocorticoid.
This leads to hypoglycemia, hyponatremia
 682. Maffucci syndrome is associated with
which bone tumor?
a) Enchondroma

b) Osteochondroma

c) Multiple myeloma

d) Chondrosarcoma

Correct Answer - A
Answer- A. Enchondroma
Enchondroma is a benign tumor characterized by the formation of
mature hyaline cartilage.
The most common site is short tubular bones of hand, i.e.,
Phalanges (most common) and metatarsals. When tumor is located
centrally in the bone, it is called enchondroma. When it islocated on
the surface (juxtacortical) it is called chondroma.
Mostly enchondtomas are solitary,however following
syndromes may have multiple enchondroma:-
1. Ollier's ilisease
2. Maffuccis syldrome
 683. What is the age of tendon transfer in
post polio residual paralysis
a) <6 months

b) 1 year

c) 2 years

d) >5 years

Correct Answer - D
Answer- D. >5 years
The available musclepower is redistributed either to equalize an
unbalanced paralysis, or to use the motorpower for a more useful
function.
1. Transfer of extensor hallucis longus (EHL) from the distal phalanx of
great toe to the neck of the first metatarsal (modified Jone's
operation). This is done to correct first metatarsal drop in case of
tibialis anterior muscle weakness
2. Transfer of peronius tertious and brevis muscles (evertors oi the
foot) to the dorsum of the foot. The transfer is required in a foot with
dorsiflexor weakness. Evertors can be spared for more useful
function of dorsiflexion of the foot
3. Hamstring (knee flexors) transfer to the quadriceps muscle to
support a weak knee extensor
684. Which of the following is seen in
popliteal entrapment syndrome
a) Evidence of atheroscelrosis

b) Exercise induced calf claudications

c) Abnormal relation between popliteal artery and lateral head of

gastrocnemius

d) Decreased ankle pulses with ankle extention

Correct Answer - B
Answer- B. Exercise induced calf claudications
PoPliteal Artery Entrapment Syndrome
It is caused by the congenital abnormality in the relation ship
between popliteal artery anil meilial head of gastrocnemius and
associated muscle.
Clinical Presentation:
Young male or female without atherosclerosis
Exercise induced calf claudication
685. Ideal age for PMSTR is
a) < 1 year

b) 1 - 3 years

c) 3 - 6 years

d) 6 - 9 years

Correct Answer - B
Answer- B. 1 - 3 years
PMSTR: Posteromedial Soft tissue release:
It is the soft tissue surgical treatment for
congenitaltalipesEquinovarus.
The results of early operation for treatment of
congentialtalipesequino varus, in particular neonatal surgery have
not been shown to be better than those of late surgery
Delaying surgery until the child is near walking age has the
advantage of operating of larger foot (making surgery easier)
Posteromedial soft tissue release (PMSTR), (Turcos) is best done at
young age (l-3 years)
686. Ponsetti technique failure in children
should be managed with
a) Posteromedial soft tissue release

b) Anterolateral soft tissue release

c) Triple arthrodesis

d) Lateral closing wedge osteotomy of calcaneum

Correct Answer - A
Answer- A. Posteromedial soft tissue release
If treatment by manipulation and retention fails, operation should
usually be undertaken before 9 months of age, mostly at 4- 6
months.
The idea behind early operation is to set the tarsal bones in normal
relationship to one another and to remove deforming forces, thus
allowing the bones to develop in their normal shape from an early
age.
The procedure used is soft tissue release, i.e. postero-medial
release (PMR).
 687. Which of the following is/are X ray
feature/s of perthes disease?
a) Increased medial joint space

b) Metaphyseal cysts and rarefaction

c) Lateral extrusion of femur head

d) All the above

Correct Answer - D
Answer- D. All the above
Radiological findings in perthe's disease are :-
1. Increased meilial joint space
2. Widening offemoral neck
3. Lateral extrusion (lateral subluxation)
4. Metaphyseal cysts and rarefaction of metaphysis
5. Horizontal physis with speckled calcification lateral to it
6. Fragmentation of femoral head with increased density (irregular
densities in the epiphysis)
688. Bakers cyst is a type of
a) Pulsion diverticulum of knee joint

b) Retention cyst

c) Bursistis

d) Benign tumor

Correct Answer - A
Answer- A. Pulsion diverticulum of knee joint
It is the pulsion diverticulum of the knee joint, caused by chronic
disease in the joint.
Bulging of the posterior capsule and synovial herniation may
produce a swelling in the popliteal fossa.
689. Tenderness in anatomical snuff box is
characteristic of which carpal bone
fracture?
a) Scaphoid

b) Capitate

c) Lunate

d) Triquetrum

Correct Answer - A
Answer- A. Scaphoid
Clinical features of scaphoid fracture
History of fall on outstretched hand
Pain andfullness in the wrist, especially on radial side in the region
of anatomical snuffbox.
Movements at wrist are painful.
Tenderness in the anatomical snuffbox
A force transmitted along the axis of second metacarpal or pressure
along the thumb produces pain in the region of scaphoid.
690. Which of the following is not true about
osteoid osteoma
a) Most common true benign tumor of bone

b) Occurs between 10 - 30 years of age

c) Lesion appears ill defined on x-ray with permeative margins

d) Bone scan shows increased uptake in the lesion

Correct Answer - C
Answer-C. Lesion appears ill defined on x-ray with permeative
margins
Osteoid osteoma is the most common true benign tumor of the bone
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
On X-ray, there is a small radiolucent area (nidus) surrounded by
dense 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.
691. Fasciotomy- all of the following are cut
except
a) Skin

b) Superficial fascia

c) Deep fascia

d) Muscles

Correct Answer - D
Answer- D. Muscles
Fasciotomy or fasciectomy is a surgical procedure where the fascia
is cut to relieve tension or pressure commonly to treat the resulting
loss of circulation to an area of tissue or muscle.
Fasciotomy is a limb-saving procedure when used to treat acute
compartment syndrome
692. No man's land in palm corresponds to -
a) Zone I

b) Zone II

c) Zone III

d) Zone IV

Correct Answer - B
Ans. is 'b' i.e., Zone II
693. In hand injury first structure to be
repaired should be?
a) Skin

b) Nerve

c) Muscle

d) Bone

Correct Answer - D
Ans is 'd' i.e. Bone
CSDT 13/e p1149 writes -"Bone must first be stabilized with K wires
or metal plates before vascular repairs are performed. Arterial and
venous repairs are done with microscopic magnification, and the
ischemic tissue is reperfused."
Sabiston 18/e p1995 writes-"Although control of active hemorrhage
is always a top priority, reconstruction of injured vessels must be
carefully orchestrated with the management of bone and soft tissue
injuries. It is preferable to achieve bone alignment before vascular
reconstruction because orthopedic manipulation and reconstruction
takes time and may disrupt the vascular repair. Thus, if the limb is
not grossly ischemic, reduction and fixation of fractures is performed
first. If the limb is ischemic, a temporary intraluminal shunt is
inserted to maintain distal perfusion during the orthopedic
procedure."
694. Deformity with decreased carrying angle
is-
a) Cubitus varus

b) Mannus varus

c) Cubitus valgus

d) Mannus valgus

Correct Answer - A
Answer- A. Cubitus varus
Carrying angle:
Angle between long axis of arm and forearm is called carrying angle.
It is measured with the elbow in frilI extention.
Cubitus Varus develops with is reduced carrying angle and cubitus
valgus is increased carrying angle.
Varus - distal part towards midline and valgus is distal part away
from midline.
695. What suggests segmental demyelination
on NCV
a) Decreased CAMP amplitudes

b) Uniform slowing of nerve conduction

c) Decreased area under CAMP curve

d) No evidence of distal conduction

Correct Answer - A
Answer- A. Decreased CAMP amplitudes
Segmental Demyelination : Because there is variable slowing or
different nerve fibers withing the nerve, conduction velocity will be
slowed and distal latencies will be prolonged in segmentally
demyelinatiing injuries.
CMAP amplitudes may be decreased because of temporal
dispersion, not because of axonal damage. Therefore, the CMAP
may be longer in duration. However, the area under the CAMP will
be normal.
696. Crutch palsy is injury to which nerve?
a) Radial nerve

b) Ulnar nerve

c) Median nerve

d) Musculocutaneous nerve

Correct Answer - A
Answer-A. Radial nerve
Very high lesions of radial nerve may be caused by trauma or
operations around the shoulder.
This is seen in drink and drug addicts who fall into a stupor with the
arm dangling over the back of a chair ('saturday night pals/) or in thin
elderly patients using crutches ('crutch palsy').
697. Autonomous zone of sensory supply by
radial nerve is
a) P dorsal web space

b) Tip of index finger

c) Tip of thumb

d) Tip of little finger

Correct Answer - A
Answer- A. P dorsal web space
Autonomous Zone of peripheral nerves:
Radial nerve:lst dorsal web space of hand (Anatomical snuff box)
Median nerve:Distal phalanx (tip) of index finger (2nd finger)
Unar nerve: Distal phalanx (tip) of little finger (5th finger).
698. Compartment syndrome is commonly
seen in
a) Fracture of proximal tibia

b) Fracture shaft humerus

c) Fracture of femur shaft

d) Fracture distal end radius

Correct Answer - A
Answer-A. Fracture of proximal tibia
High-risk injuries for development of compartment syndrome are
fractures of the elbow, forearm bones, proximal third of the tibia, and
also multiple fractures of the hand or foot, crush iniuries and
circumferentialburns.
699. Most specific antibody seen in RA
a) Anti CCP

b) Rheumatoid factor

c) ANA

d) Anti dsDNA

Correct Answer - A
Answer- A. Anti CCP
The presence of serum anti-CCP antibodies has about the same
sensitivity as serum RF for the diagnosis of RA.
However, its diagnostic specificity approaches 95% (most specific
for RA), so a positive test for anti-CCP antibodies in the setting of an
early inflammatory arthritis is usefrrlfor distinguishing RA from other
forms of arthritis.
700. Unna boot is used for treatment of
a) Diabetic foot ulcer

b) Varicose ulcers

c) Ankle instability

d) Calcaneum fracture

Correct Answer - B
Answer- B. Varicose ulcers
It is named for the dermatologist Paul Gerson Unna.
This boot can be used to treat uninfected nonnecrotic leg and foot
ulcers that result from such conditions as venous insuftciency
(varicose ulcers) and stasis dermatitis.
701. A patient presents with normal babinsky
reflex with anlde areflexia with presence
of saddle anesthesia and difficulty in
micturition. What is the most probable
diagnosis?
a) Cauda equine syndrome

b) Brown Sequard syndrome

c) Lehriche syndrome

d) Williams syndrome

Correct Answer - A
Answer- A. Cauda equine syndrome
Caudaequina syndrome (CES) signffies an injury of multiple
lumbosacral nerve roots within the spinal canal distal to the
termination of the spinal cord at Ll-2.
Low back pain, weakness and areflexia ofankle, saddle anesthesia,
or loss of bladder function may occur.
It is a lower motor neuron ty?e of lesion, so sign of signs of upper
motor neuron involvement like positive babinsky spasticity etc. are
absent.
702. Paprika sign during debridement is
crucial in management which of the
following condition?
a) Chronic osteomyelitis

b) Osteosarcoma

c) Osteoid osteoma

d) Brodies abscess

Correct Answer - A
Answer- A. Chronic osteomyelitis
Sequestrectomy and curettage require more time toperform and
result in considerably more blood loss than an inexperienced
surgeon would anticipate.
Exposed infected area of bone, incision given and drill is used to
remove all sequestra, purulent material, and scarred and necrotic
tissue. If sclerotic bone seals off a cavity within the medullary canal,
open it into the canal in both directions to allow blood vessels to
grow into the cavity. Use a high-speed burr to debride necrotic or
ischemic bone until the "paprika sign" (active punctate bleeding
bone) is achieved, indicating healthy tissue.
703. High crural index is seen in
a) Jumping athletes

b) Gymnasts

c) Weight lifters

d) Long - distance runners

Correct Answer - A
Answer- A. Jumping athletes
Crural index the ratio of lower leg length to thigh length. A high crural
index allows application of force against the ground for a greater
period of time than a lower crural index. fumping athletes (such as in
basketball) and sprint swimmers tend to have above-average crural
indices.
704. A 32-year-old primigravida at 39 weeks of
gestational age has a blood pressure
reading of 150/100 mm Hg obtained
during a routine visit. Her baseline blood
pressure during the pregnancy was
120/70 mmHg. The patient denies any
headache, visual changes, nausea,
vomiting, or abdominal pain. Her repeat
BP is 160/90 mmHg, and urinalysis is
negative for protein. Which of the
following is the most likely diagnosis?
a) Preeclampsia

b) Chronic hypertension with superimposed preeclampsia

c) Eclampsia

d) Gestational hypertension

Correct Answer - D
Ans. is 'd' i.e.,Gestational hypertension
Hypertension in pregnancy is defined as blood pressure of 140/90
mmHg or greater on at least two separate occasions that are 6 h or
more apart.
The presence of edema is no longer used as a diagnostic criterion
because it is so prevalent in normal pregnant women.
A rise in systolic blood pressure of 30 mmHg and a rise in diastolic
blood pressure of 15 mmHg are also no longer used.
In gestational hypertension, maternal blood pressure reaches
140/90 or greater for the first time during pregnancy, and proteinuria
is not present.
In preeclampsia, blood pressure increases to 140/90 after 20 weeks
of gestation and proteinuria is present (300 mg in 24 h or 1+ protein
or greater on dipstick). Eclampsia is present when women with
preeclampsia develop seizures.
705. By which day after fertilization, is
placental circulation established :
a) 11th day

b) 13th day

c) 15th day

d) 17th day

Correct Answer - D
17th day
Development of the placental villi:
While the embryo is nourished in the first weeks through simple
diffusion, later, due to its rapid growth, it needs a more powerful gas
and nutrient exchange system.
This is made possible by the development of the utero-placental
circulation system in which the circulation systems of the mother and
of the embryo get closer together, thus allowing an exchange of
gases and metabolites via diffusion.
Through the lytic activity of the syncytiotrophoblast the maternal
capillaries are eroded and anastomose with the trophoblast lacunae,
forming the sinusoids.
At the end of the pregnancy the lacunae communicate with each
other and form a single, connected system that is delimited by the
syncytiotrophoblast and is termed the intervillous space.
1.Cytotrophoblast
2.Syncytiotrophoblast
3.Spaces between syncytiotrophoblast (Lacunae)
4.Maternal vessel
Maternal vessel, eroded by the ST,which form the maternal
sinusoids through communication with the lacunae.
Between the 11th and 13th day cytotrophoblast cells penetrate into
the cords of the syncytiotrophoblast creating the primary trophoblast
villi

1.Cytotrophoblast
2.Syncytiotrophoblast

After the 16th day the extra-embryonic mesoblast also grows into
this primary trophoblast villus, which is now called a secondary
villus and expands into the lacunae that are filled with maternal
blood. As was already mentioned, the ST forms the outermost layer
of every villus.
1.Extra-embryonic mesoblast
2 Cytotrophoblast
3 Syncytiotrophoblast
At the end of the 3rd week the villus mesoblast differentiates into
connective tissue and blood vessels. They connect up with the
embryonic blood vessels. Villi that contain differentiated blood
vessels are called tertiary villi

1 Extra-embryonic mesoblast
2 Cytotrophoblast
3 Syncytiotrophoblast
4 Fetal capillaries
706. Adevelopment.
mother brought her 7 year old daughter complaining of breast
Thelarche occurs normally at?

a) 7-11 years

b) 8-13 years

c) 11-13 years

d) 12-14 years

Correct Answer - B
Breast development, termed thelarche, begins in most girls between the ages of 8 and 13
years. Thelarche prior to age 8 or lack of breast development by age 13 is considered
abnormal and should be investigated.
Pubertal changes before the age of 8 years in girls and 9 years in
boys are considered as precocious.
Although the most common cause of precocious puberty in girls is
idiopathic, it is essential to ensure close long-term follow-up of these
patients to ascertain that there is no serious underlying pathology,
such as tumors of the ovary or CNS.
Only 1-2% patients with precocious puberty have an estrogen-
producing ovarian tumor as the causative factor.
Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D.,
Cunningham F.G., Calver L.E. (2012). Chapter 14. Pediatric Gynecology. In B.L. Hoffman,
J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver
(Eds), Williams Gynecology, 2e.
707. Blighted ovum is :
a) Synaptic knobs

b) Avascular villi

c) Intervillous hemorrhage

d) None

Correct Answer - B
Ans. is b i.e. Avascular villi
According to the clinical and echographic findings, it is
possible to separate early pregnancy losses into two groups :
alighted ova : Those early pregnancy losses in which foetal
development is not observed with ultrasound (so that only a
gestational sac is present with or without a yolk sac) and fetal tissue
is absent on histologic examination of the products of conception.
• Early Fetal demise Those early pregnancy losses in which fetal
development is clearly observed by ultrasound and feta! tissue is
found on the histologic examination.
The difference between these two types of abortion is of
fundamental importance. The lack of development of fetal structures
defines a subset of abortions of genetic origin.
In contrast, the early interruption of fetal life is a complex
phenomenon with multiple etiologies. Therefore, the patients
with blighted ova do not require extensive work up, whereas
patients who have aborted cytogenetically normal fetuses need
an extensive search for non genetic factors responsible for the
pregnancy loss.
708. A girl with normal stature and minimal or
absent pubertal development is seen in
a) Kallman syndrome

b) Turner syndrome

c) Testicular feminization syndrome

d) Pure gonadal dysgenesis

Correct Answer - A
Ans. a. Kallman syndrome
'Kallmann syndrome is a genetic condition where the primary
symptom is a failure to start puberty or a failure to fully
complete it. It occurs in both males and females and has the
additional symptoms o.f hypogonadism and almost invariably
infertility. Kallmann syndrome al.so features the additional symptom
of an altered sense of smell; either totally absent
(anosmia) or highly reduced (hyposmia)- Nelson
709. End point of D/C is ?
a) After 2 strokes

b) Presence of fresh bleeding

c) Uterine cry

d) All of the above

Correct Answer - C
Ans. is 'c' i.e., Uterine cry
The curette should be inserted gently to the uterine fundus and
withdrawn slightly. To decrease the risk of perforation, do not force
the curette.
The end point of this scrubbing should be the detection of a
scratching/grating sensation or sound (the "uterine cry"), which
represents a sharp curette running over myometrium. Too vigorous
a pursuit of this end point may lead to formation of synechiae
(Asherman's syndrome).
710. Cause of unilateral dysmenorrhea :
a) One horn of malformed uterus

b) Endometriosis with unilateral distribution

c) Small fibroid at the utero tubal junction

d) All of the above

Correct Answer - D
All of the above
711. A 20 year old woman gives a history of
sharp pain in the lower abdomen tor 2 - 3
days every month approximately 2 weeks
before the menses. The most probable
etiology for her pain is :
a) Endometriosis

b) Dysmenorrhea

c) Pelvic tuberculosis

d) Mittelschmerz

Correct Answer - D
Mittelschmerz
Afemale giving history of sharp pain in lower abdomen, every month,
2 weeks before the menstruation suggests mittelschmerz as the
diagnosis.
Mittelschmez is synonymous to painful ovulation. Pain is associated
with rupture of ovarian follicle at the time of ovulation
Characteristics of : Mittelschmerz or Ovular pain
It appears in the mid-menstrual period.o
Pain is usually situated in the hypogastrium or to one iliac fossa.o
Pain is usually located on one side and does not change side
according to which ovary is ovulating.o
Nausea and vomitinois consDicuouslv absent.o
It rarelv lasts for more than 12 hours.o
It may be associated with slight vaginal bleeding or mucoid
discharge.o
The probable factors - Increased tension of graffian follicle just prior
are : to rupture.o
- Peritoneal irritation by follicular fluid following
ovulation.o
- Contraction of tubes and uterus.o
Management :
Assurance and analgesics
In refractory cases cycles are made anovular by giving OCPs
Also Know : The phenomenon of ovulation bleeding or mucus tinged
with blood at the time of ovulation is called as mittel bluto . This may
be associated with ovulation pain, although each may occur
independently.
712. According to the 2010 WHO criteria what
are the characteristics of normal semen
analysis?
a) Volume 2.0 mL, count 20 million, morphology 4% progressive
motility 32%

b) Volume 1.5 mL, count 15 million, morphology 4% progressive

motility 32%

c) Volume 2.0 mL, count 15 million, morphology 40% progressive

motility 32%

d) Volume 1.5 mL. count 20 million, morphology 4% progressive

motility 32%

Correct Answer - B
Ans: B. Volume 1.5 mL, count 15 million, morphology 4%
progressive motility 32%
(Ref Dutta 6/e p222)
According to 2010 WHO criteria:
Characteristics of normal semen analysis:
Semen
WHO 1999 WHO 2010
Characteristics
Greater or equal to 1.5
Volume (ml) Greater or equal to 2 ml
ml
Greater or equal to 15
Sperm count Greater or equal to 20
million/ml
Total sperm Greater or equal to 40 Greater or equal to 39
count million per ejaculate million per ejaculate
Total motility Greater or equal to 50% Greater or equal to 40%
Progressive
motility Greater or equal to 25% Greater or equal to 32%
Vitality Greater or equal to 75% Greater or equal to 58%
Morphology
14% Greater or equal to 4%
(Normal form)
Leukocyte count
<1 <1
(104/m1)
713. The fetus (which is partly foreign to the
mother) is not rejected by mother due to
:
a) Immunosuppressive effect of placental hormones

b) Absence of HLA molecules in villous trophoblast

c) Production of blocking Antibody

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
The fetus and the placenta contain paternally determined
antigens which can lead to immunological rejection. The
placenta has some role in preventing such a rejection:
Placental hormones (EPF,PAPP-A,STERIODS & HCG) have got
some immunosuppressive effect.
There is production of blocking antibodies by mother in response to
TLX (trophoblast lymphocyte cross reactive antigen) which protect
the fetus from rejection.
Absence of HLA molecules in villous trophoblast.
714. The amniotic fluid is in balance by :
a) Excretion by fetal kidneys

b) Maternal hemostasis

c) Fetal intestinal absorption

d) All

Correct Answer - D
Ans. is a, b, c
Amniotic fluid originates from
In early pregnancy - As an ultrafiltrate of maternal plasma (i.e.,
option "b" correct).
By beginning of the second trimester - It consists of extracellular
fluid which diffuses through the fetal skin (i.e., option "e").
After 20 weeks - Cornification of skin prevents this diffusion and
amniotic fluid is composed of fetal urine (option "a" correct).
Also know : The water in the amniotic fluid is completely changed
and replaced in every 3 hours.
Other minor contributors : • Pulmonary fluid
Fluid filtering through the placenta
The fetus swallows 200 - 500 ml liquor every day at term.
(Option "c" correct) i.e. Excretion by fetal kidneys; Maternal
hemostasis; Fetal intestinal absorption
715. Which is not a test for ovulation?
a) Fern test

b) Basal body temperature

c) Hysteroscopy

d) LH surge

Correct Answer - C
Hysteroscopy REF: 12th edition of Novak's Gynecology p. 408
METHODS TO DOCUMENT OVULATION:
Luteinizing Hormone Monitoring Documentation of the LH surge
represents a remarkably reproducible method of predicting
ovulation. Ovulation occurs 34 to 36 hours after the onset of the LH
surge and about 10 to 12 hours after the LH peak
Basal Body Temperature The least expensive method of confirming
ovulation is for the
patient to record her temperature each morning on a basal body
temperature (BBT) chart.
Midluteal Serum Progesterone
Ultrasound Monitoring Ovulation can also be documented by
monitoring the development of a dominant follicle by ultrasound until
ovulation takes place
A ferning pattern is seen when periovulatory cervical mucus is
spread and dried on a microscope slide.
716. Hypergonadotropic hypogonadism ?
a) Decrease FSH and LH

b) Decrease FSH and increase LH

c) Increase FSH increase LH

d) Increase FSH decrease LH

Correct Answer - C
Ans. is ‘-c' i.e., Increase FSH increase LH
Hypergonadotropic hypogonadism
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(FSH and LH).
Causes : Chromosomal abnormalitis
Turner's syndrome
Klinefelter syndrome
Swyer's syndrome
Enzyme defect
17 , hydroxylase
17, 20 lyase deficiency
 717. All are indications of intra uterine
insemination EXCEPT:
a) Vicid cervical mucus

b) Oligozoospermia

c) Tubal blockade

d) Immune factor of sperms

Correct Answer - C
Tubal blockade REF: A handbook of intrauterine insemination by
Godwin Ikechukwu Meniru, Peter R. Brinsden, Ian Logan Craft Page
4
Indications of intrauterine insemination:
1. Ejaculatory failure (neurogenic, psychogenic, hypospadias,
retrograde ejaculation)
2. Cervical factor (poor cervical mucus, cervical mucus hostility)
3. Male subfertility (oligozoospermia, asthenozoospermia,
teratozoospermia)
4. Immunological (male/female antisperm antibodies)
5. Endometriosis
6. Idiopathic
7. Combined factors
718. Aabortion.
lady presented with secondary amenorrhea 6 months after having an
Her FSH levels were measured as 6 mlU/ml what is the most
probable diagnosis:

a) Pituitary failure

b) Ovarian failure

c) Fresh pregnancy

d) Uterine synechiae

Correct Answer - D
Since the lady in the question is having secondary amenorrhea
following an abortion, uterine synechiae is the most likely cause.
Low normal FSH level is consistent with uterine abnormality.
(Normal serum FSH value in adult is woman is 5-20 mlU).

Ref: Novak's, 14th Edition, Chapter 27; Speroff, 7th Edition, Chapter 11; Shaw's, 14th
Edition, Pages 263, 264; The Subfertility Handbook : A Clinician's Guide By Gab Kovacs,
2nd Edition, Page 117
719. The production rate of the following
hormone near term, is the greatest of any
known hormone in humans
(approximately lgm/day)-
a) Relaxin

b) Progesterone

c) hCG

d) hPL

Correct Answer - D
Ans. is 'd' i.e., hPL
Human placenta lactogen (hPL) was named so , because of its
potent lactogenic & growth hormone like bioactivity, as well as
immunochemical resemblance to human growth hormone.
It is detected as early as 2nd or 3rd week after fertilization.
Maternal plasma concentrations are linked to placental mass & they
rise steadily till 34-36 weeks of gestation.
The hPLproduction rate near term is by far the greatest of any
known hormone in humans- approximately 1gm/day.
720. Labour is termed as precipitate if it
occurs under:
a) 1 hour

b) 2 hours

c) 1/2 hours

d) 4 hours

Correct Answer - B
2 hours
721. Treatment of carcinoma Cervix stage IIIB
include:
a) Wertheim's hysterectomy

b) Schuata's hysterectomy

c) Chemotherapy

d) Concurrent chemoradiation

Correct Answer - D
Ans. d. Concurrent chemoradiation
Treatment Options by Stage
Carcinoma in Situ (Stage 0)
Conization, such as cold-knife conization, loop electrosurgical
excision procedure(LEEP), or laser surgery.
Hysterectomy for women who cannot or no longer want to have
children. This is done only if the tumor cannot be completely
removed by conization.
Internal radiation therapy for women who cannot have surgery.
Stage IA Cervical Cancer
Treatment for stage IA1 may include the following:
Conization.
Total hysterectomy with or without bilateral salpingo-oophorectomy.
Treatment for stage IA2 may include the following:
Modified radical hysterectomy and removal of lymph nodes.
Radical trachelectomy.
Internal radiation therapy for women who cannot have surgery.
Stages IB and IIA Cervical Cancer
Radiation therapy with chemotherapy given at the same time.
Radical hysterectomy and removal of pelvic lymph nodes with or
without radiation therapy to the pelvis, plus chemotherapy.
Radical trachelectomy.
Chemotherapy followed by surgery.
Radiation therapy alone.
Stages IIB, III, and IVA Cervical Cancer
Radiation therapy with chemotherapy given at the same time.
Surgery to remove pelvic lymph nodes followed by radiation therapy
with or without chemotherapy.
Internal radiation therapy.
A clinical trial of chemotherapy to shrink the tumor followed by
surgery.
A clinical trial of chemotherapy and radiation therapy given at the
same time, followed by chemotherapy.
Stage IVB Cervical Cancer
Radiation therapy as palliative therapy to relieve symptoms caused
by the cancer and improve quality of life.
Chemotherapy and targeted therapy.
Chemotherapy as palliative therapy to relieve symptoms caused by
the cancer and improve quality of life.
Clinical trials of new anticancer drugs or drug combinations.
Treatment Options for Recurrent Cervical
Cancer
Immunotherapy.
Radiation therapy and chemotherapy.
Chemotherapy and targeted therapy.
Chemotherapy as palliative therapy to relieve symptoms caused by
the cancer and improve quality of life.
Pelvic exenteration.
Clinical trials of new anticancer drugs or drug combinations.
Cervical Cancer During Pregnancy
Carcinoma in Situ (Stage 0) During Pregnancy
Usually, no treatment is needed for carcinoma in situ (stage
0) during pregnancy. A colposcopy may be done to check
for invasive cancer.
Stage I Cervical Cancer During Pregnancy
Pregnant women with slow-growing stage I cervical cancer may be
able to delay treatment until the second trimester of pregnancy or
after delivery.
Pregnant women with fast-growing stage I cervical cancer may need
immediate treatment. Treatment may include:
Conization.
Radical trachelectomy.
Women should be tested to find out if the cancer has spread to
the lymph nodes. If cancer has spread to the lymph nodes,
immediate treatment may be needed.
Stage II, III, and IV Cervical Cancer During Pregnancy
Chemotherapy to shrink the tumor in the second or third trimester of
pregnancy. Surgery or radiation therapy may be done after delivery.
Radiation therapy plus chemotherapy. Talk with your doctor about
the effects of radiation on the fetus. It may be necessary to end the
pregnancy before treatment begins.
722. In Fothergill's operation the following are
undertaken EXCEPT :
a) Amputation of cervix

b) Anterior colporrhaphy

c) Colpoperineorrhaphy

d) Plication of round ligament

Correct Answer - D
Plication of round ligament
723. What are the findings in U/S, which
suggests incompetent os :
a) Cervical length

b) Funneling of amniotic sac

c) Internal os

d) All

Correct Answer - D
Ans. is a, b and c i.e. Cervical length; Internal os; and Funneling of
amniotic sac
Closed cervix (competent os) on USG appears like the letter T.
Cervical incompetence :
Cervical incompetence is characterised by painless°
cervical dilatation in the second° or early third trimester° with
ballooning of the amniotic sac into the vagina°, followed by rupture
of membranes and expulsion of a usually live fetus.
It usually occurs in 16 - 24 weeks.
Diagnosis :
History : The typical history of painless rupture of membranes°
followed by the quick delivery of a live fetus in midtrimester is very
suggestive.°
Non pregnant state : Internal os allows the passage of a No. 8
Heger's cervical dilator or Foley's catheter filled with 1 ml water
without resistance.°
Premenstrual Hysterocervicography will show the typical funneling of
the internal os°.
In Pregnancy :
Transvaginal ultrasound is the ideal method to detect early
incompetence.
Incompetent os on USG shows the following features: Before
opening, the cervix shortens and then funneling can take place,
which on USG looks like the letter Y (indicating incompetent os) that
can progress to look like the letter V (cervix is just about to open).
The normal cervical length at 14 weeks is 35 - 40 mm and the
internal os diameter is less than 20 mm. A cervical length less than
30 mm and an internal os diameter more than 20 mm is suggestive
of cervical incompetence.
Other findings on ultrasound are funneling of the os.° Serial scans
may be necessary.
724. A lady with abdominal mass was
investigated. On surgery, she was found
to have bilateral ovarian masses with
smooth surface. On microscopy they
revealed mucin-secreting cells with
signet ring shapes. Most probable
diagnosis is:
a) Krukenberg tumor

b) Dysgerminoma

c) Mucinous adenocarcinoma of the ovaries

d) Dermoid cyst

Correct Answer - A
Ans: A. Krukenberg tumor
(Ref Robbins 9/e p1034: 8/e p1050)
Krukenberg tumor:
Classic metastatic gastrointestinal carcinoma involving ovaries.
Features:
Characterized by bilateral metastases composed of mucin-
producing, signet-ring cancer cells, most often of gastric origin.
725. Treatment of choice in a
postmenopausal lady with atypical
endometrial hyperplasia is ;
a) Estrogens

b) Hysterectomy

c) Progestogens

d) Radiotherapy

Correct Answer - B
Ans: B. Hysterectomy
Type I:
Variable Endometrioid Type II: Serous
75% of 25% of
endometrial endometrial
Epidemiology cancers cancers
Etiology Unopposed Unrelated to
estrogen estrogen; the
stimulation (e.g. p53 mutation is
tamoxifen present in
use, exogenous 90% of cases.
estrogen-
only therapy).
Hyperplasia and None
Precursor atypical
lesion hyperplasia.
Mean age at 55 years 67 years
diagnosis
Prognosis Favorable Poor
726. Air in the urine bag after laparoscopic
hysterectomy is due to:
a) Expected & a normal finding

b) Bowel perforation

c) Bladder injury

d) Blocked Foley catheter

Correct Answer - C
Ans. is 'c' i.e., Bladder injury
When injured, the bladder is usually penetrated by, the Veress
needle or trocar .
Trocar injuries are typically to the bladder dome and have an entry
and exit wound.
The position of the bladder should be assessed on initial
examination with the laparoscope. All secondary trocars should be
placed under direct visualization.
During the operation, the diagnosis of bladder injury is suggested by
the presence of gas filling up the Foley bag or visibly bloody urine in
the Foley bag.
Other signs of injury are urinary/fluid drainage from a secondary
trocar site incision, or fluid pooling in the abdomen/pelvis.
If a bladder injury is suspected, the bladder should be filled with
methylene blue-colored saline. The forcing out of fluid/dye indicates
a bladder injury.
727. All of the following are advantages of
laparoscope assisted vaginal
hysterectomy (LAVH) over abdominal
hysterectomy except:
March 2011
a) Less peritoneal adhesions postoperatively

b) Short hospital stay

c) Less postoperative pain

d) Scope of wide exploration of the abdominal and pelvic orga

Correct Answer - D
Ans. D: Scope of wide exploration of the abdominal and pelvic
organs
Advantages of laparoscopy over laparotomy includes 1) reduced
pain and quick recovery, 2) short hospital stay and 3) less peritoneal
adhesions postoperatively
Vaginal hysterectomy
First clamp includes uteroscaral & Macenrodt's ligament
Second clamp includes uterine artery
Third clamp includes cornual structures
In abdominal hysterectomy it will be in the reverse order of the
above & hence round ligament & cornual structures are clamped
first.
728. The incision in which rectus abdominis
muscle is cut transversely is :
a) Pfannenstiel

b) Maylard

c) Kerr

d) All of the above

Correct Answer - B
Ans. is 'b' i.e, Maylard
Maylard Incision is a surgical incision in which a transverse cut is
made on rectus abdominis muscle to allow wider access to the
pelvic cavity. It is also called Mackenrodt incision.
For gynaecological surgery, the skin incision is made 5-8 cm above
the pubic symphysis.
The rectus fascia and rectus muscles are transected. Care must be
exercised at the lateral margin of the rectus muscle to ensure the
integrity of the inferior epigastric artery and vein. The muscle is
totally transected.
729. 22 years old female unable to conceive
since 12 months, known case of pelvic
inflammatory disease, normal menses,
normal vaginal and cervical examination,
next line investigation :
a) HSG

b) AMH

c) Hysteroscopy

d) CA 125

Correct Answer - A
Ans. is 'a' i.e., HSG
Pelvic Inflammatory Disease
It is the infection and inflammation of the upper genital tracts,
typically involving fallopian tubes, ovaries, and surrounding
structures.
It can cause tubal damage & can lead to infertility (tubal factor).
Hence , in this patient, tubes need to evaluated.
Hysterosalpingography (HSG) : cavity of the uterus and fallopian
tube patency can be checked: As it does not require anesthesia, it is
the first-line investigation for checking tubal patency.
730. Incidence of infertility isin reproductive
age couples ?
a) 0-5 %

b) 5-10%

c) 10-20 %

d) 25-30%

Correct Answer - C
Ans: C. 10-20 %
Infertility is defined as the failure to conceive after one year of
regular unprotected intercourse.
Incidence
10-20% of reproductive ages couples.
 731. Which
floor?
of the following is the largest and most important muscle in the pelvic

a) Coccygeus

b) External anal sphincter

c) Levator ani

d) Obturator internus

Correct Answer - C
Ans. C. Levator ani
The pelvic floor is formed by the large levator ani (with parts
including the pubococcygeus, puborectalis, and iliococcygeus) and
the much smaller coccygeus.
Internal rotation of fetal head occurs when the fetal head touches the
pelvic floor (levator ani muscle).
The movement involves the gradual turning of the occiput from its
original position anteriorly toward the symphysis pubis.
The main purpose of internal rotation is to place the occiput behind
the pubic symphysis.
Theories which explain the anterior rotation of the occiput:
1. Hart's rule: The part of the fetal skull which presses on the levator
ani muscle is pushed anteriorly with each recoil.
2. Pelvic shape: Pelvic outlet is greater in AP diameter. Hence, the
head tries to accommodate in the maximum available diameter.
Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M.,
Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 38.
Anatomy. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M.
Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds),
Williams Gynecology, 2e.
732. Prophylactic forceps in a cardiac
diseased patient is used, when head is at
station :
a) 0

b) +1

c) +2

d) -1

Correct Answer - C
+2
733. At what level of b-HCG is it that normal
pregnancy can be earliest detected by
TVS:
a) 500 IU/m1

b) 1000 IU/m1

c) 1500 IU/m1

d) 2000 IU/m1

Correct Answer - B
Ans. is b i.e. 1000 IU/m1
PhCG level Structure
TVS/TAS
(MiU/mi) visible
• 1000 - Gestational
1200 sac TVS
Gestational
• 6000 TAS
Sac
• 7000 Yolk sac TAS
• 11000 Embryo TAS
734. The most important risk factor for
development of post partum uterine
infection/sepsis is:
a) Anemia

b) Route of delivery

c) Diabetes

d) Obesity

Correct Answer - B
Ans. is 'b' i.e., Route of delivery
The route of delivery is the single most significant risk factor for the
development of uterine infection.
Compared with cesarean delivery, metritis following vaginal delivery
is relatively uncommon.
Most female pelvic infections are caused by bacteria indigenous to
the female genital tract.
735. Which of these is diagnostic of
menopause?
a) Serum FSH > 40

b) Serum LH > 20

c) Serum FSH < 40

d) Serum estradiol < 30

Correct Answer - A
Ans: A. Serum FSH > 40
(Ref. Shaw’s. 16/e p66. 15/e p62).
Serum FSH > 40 1U/L is diagnostic of menopause.
Criteria for Menopause
Estrogen (E2): 10-20 pg/ml° E2/E1 < 1°
Estrone (El): 30-70 pg/ml° Urine FSH > 40 IU/L°
Laboratory diagnosis:
FSH & estrogen level - Assess ovarian failure.
Especially in premature ovarian failure case or women seeking
treatment for infertility.
FSH levels:
Greater FSH level (>40 m IU/ml).
Documents ovarian failure associated with menopause.
Estrogen level:
Normal/elevated - Depending on stage of menopausal transition.
After menopause extremely low estrogen level.
Evaluated to assess women's response to hormone replacement
therapy.
736. Maturation index in mid-secretory phase
of menstrual cycle is ?
a) 0/95/5

b) 80/20/0

c) 0/70/30

d) 0/95/5

Correct Answer - C
Ans. is 'c' i.e., 0/70/30
Maturation index (MI) is the relative percentage of parabasal,
intermediate and superficial cells per 100 cells counted.
MI is expressed in 3 numbers—the left one parabasal percentage,
intermediate in the center and on the right, the percentage of
superficial cells.
At birth 0/95/5
Childhood 80/20/0
Preovulatory 0/40/60
Mid-secretory 0/70/30
Pregnancy 0/95/5
Postpartum 100/0/0
Postmenopause0/100/0 or 100/0/0
737. MC cause of anovulation is?
a) PCOS

b) Hyperprolactinemia

c) Premature ovarian failure

d) Low ovarian reserves

Correct Answer - A
Ans. is 'a' i.e.,PCOS
Anovulation and ovulatory dysfunction can be caused by a number
of factors.
The most common cause of ovulatory dysfunction is polycystic
ovarian syndrome, or PCOS.
Other potential causes of irregular or absent ovulation:
Obesity
Underweight
Extreme exercise
Hyperprolactinemia
Premature ovarian failure
Perimenopause, or low ovarian reserves
Thyroid dysfunction
Extremely high levels of stress
738. A 20-year old average weight female
complains of oligomenorrhea along with
facial hair. Preliminary investigations
reveal raised free testosterone levels.
USG Pelvis: ovary shows normal
morphology. Which of the following
could be likely etiology
a) Idiopathic hirsutism

b) PCOD

c) Adrenal hyperplasia

d) Testosterone secreting tumor

Correct Answer - B
Ans. b. PCOD (Ref Jeffcott 6/e p205; Shaw's 14/331-332, 13/e
p353-354; Novak's 14/1077, 1082)
739. Suction evacuation can be done up to:
a) 6 weeks

b) 10 weeks

c) 16 weeks

d) 18 weeks

Correct Answer - B
Ans. is b i.e. 10 weeks
740. Recurrent abortion seen in all except:
a) Syphilis

b) TORCH

c) Rh incompatibility

d) Chromosomal abnormality

Correct Answer - B
TORCH
Recurrent miscarriage, habitual abortion, or recurrent pregnancy
loss (RPL) is three or more consecutive pregnancy losses at less
than (or equal to) 20 weeks of gestation or with a fetal weight of
<500 grams.
It affects approximately 1% to 2% of women
741. The commonest chromosomal
abnormality in early spontaneous
abortions is :
a) Monosomy

b) Autosomal trisomy

c) Triploidy

d) Tetraploidy

Correct Answer - B
Autosomal trisomy
742. A 25-year-old female presented with
history of recurrent abortions. The most
relevant investigation to identify the
cause is:
a) Bleeding time

b) Rothrombin time

c) Dilute russel viper venom test

d) Clot solubility test

Correct Answer - C
Ans. c. Dilute russet viper venom test
Recurrent abortions is one of the manifestations of antiphospholipid
antibody syndrome. The most relevant investigation to identify
antiphospholipid antibody syndrome is Dilute russet viper venom
test.
Lupus Anticoagulant
Lupus anticoagulants are acquired inhibitors directed against
phospholipid binding proteins and are a common cause of APTT
prolongation.Q
Dilute Russel viper venom test is one of the tests to detect lupus
anticoagulant.Q
In-vivo
Lupus anticoagulant don't interfere with coagulation factor complex
formation on the platelet surfaceQ
Not usually associated with bleeding tendencyQ
Frequently associated with thrombosisQ
In-vitro
This prolongation results in paradoxical prolongation of phospholipid
based clotting assays such as PTT, kaolin, clotting time and Dilute
Russel viper venom antibody (dRWT testing)Q
743. True regarding PPH
a) Type B lynch suture used

b) With new advances both atonic and traumatic PPH can be

reduced

c) More common in multipara and Associated with polyhydramnios

both

d) All or the above

Correct Answer - D
Ans. is a, b and c i.e. Type B lynch suture used; With new advances
both atonic and traumatic PPH can be reduced; More common in
multipara; and Associated with polyhydramnios
PPH is more common in multipara due to laxed abdomen and
associated factors like adherent placenta and anemia .
Overdistension of uterus as in multiple pregnancy, hydraminos and
large baby also lead to PPH .
Incidence of atonic and traumatic PPH can be reduced with new
advances or rather by intelligent anticipation, skilled supervision,
prompt detection and effective institution of therapy.
B lynch suture are used for management of PPH .
Mifepristone is not used in the management of PPH .
744. In a patient with heart disease, which of
the following should not be used to
control PPH :
a) Methyergometrine

b) Oxytocin

c) Misoprostol

d) Hysterectomy

Correct Answer - A
Ans. is a i.e. Methylergometrine
Antepartum Management
NYHA Class I and II :
Pregnancy and delivery are usually uneventful.
Patient can be managed on ambulatory treatment and need not be
hospitalized early.
Time of hospitalisation in Class I patients is 36 weeks° and Class II
patients is 28 weeks°.
Physical activity is limited to well within the patient's cardiac reserve.
Adequate rest is prescribed.
If any surgical procedure like tooth extraction is required, bacterial
endocarditis prophylaxis is indicated. NYHA Class III and IV :
They are at very high risk and ideally should become pregnant only
after surgical correction.
If seen in the first trimester, such patients are candidates for MTP.
If pregnancy is continued, then the women are hospitalized for the
remainder of the pregnancy.
Intrapartum Management :
This is the period of maximum risk as the cardiac output increases.
Patients should be allowed to go into spontaneous labour, if required
Patients should be allowed to go into spontaneous labour, if required
induction with vaginal PGE2 may be done (Induction is safe in case
of heart disease)
There is no place for trial of labour° in a patient with heart disease
and in such cases, elective cesarean section should be done.
Vaginal delivery is preferred unless there are obstetric indications for
cesarean section.
Only heart disease where vaginal delivery is contraindicated :
Coarctation of aorta.
Patient is laid in semi recumbent position/propped up position and if
required oxygen inhalation is given to the patient.
Pain should be adequately relieved (best done by epidural
anaesthesia)
Meticulous fluid balance (not more than 75m1/hour).
Cut short the second stage with outlet forceps.
40 mg of intravenous frusemide can be given immediately after the
baby is born°. This will divert some of the excess blood volume that
is added to the circulation by the contraction of uterus.
Management of Third stage :
Ergometrine and methergin are contraindicated.°
Oxytocin should be used in the third stage by IV infusion to reduce
the amount of bleeding. If PPH occurs in a cardiac patient—
Oxytocin, and prostaglandins can be used.
As per WHO & AGOG guidelines OXYTOCIN is the first line DOC
for atonic PPH
Rapid, continuous infusion of dilute IV oxytocin (40-80 U) in 1L NS to
be started.
Antibiotics are given as a prophylactic measure against infective
endocarditis.
Management of Puerperium
Early ambulation (to pervent thrombosis) and lactation are
encouraged.
745. Contraindications for medical method
(mifepristone misoprostol) of first
trimester MTP?
a) Patient with hemoglobin of 7 gm%

b) Suspected ectopic pregnancy

c) Glaucoma

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
Contraindications (due to medical reasons) for medical method
of abortion:
Smoking > 35 years
Hemoglobin < 8 g%
Ectopic pregnancy/ adnexal mass
Coagulopathy
Chronic adrenal failure
Uncontrolled hypertension ( BP>160/100mmHg)
CVD
Severe renal, hepatic or respiratory diseases
Glaucoma
Uncontrolled seizure
Allergy or intolerance to mifepristone /misoprostol or other
prostaglandins
Lack of access to 24 hours emergency services
746. Hemoconcentration is seen In?
a) Normal pregnancy

b) Preeclampsia

c) Ectopic pregnancy

d) All of the above

Correct Answer - B
Ans. is 'b' i.e., Preeclampsia
Preeclampsia is a pregnancy specific syndrome of reduced organ
perfusion secondary to vasospasm and endothelial activation
characterized by BP 140/90 mm Hg after 20 weeks of gestation and
proteinuria 300 mg per 24 h after 20th week in a previously
normotensive and nonproteinuric patient.
747. Correct statement about establishing the
chorionicity in twin pregnancy is:
a) Same sex rule out dichorionicity

b) Twin peak in dichorionicity

c) Thick membrane is present in monochorionic

d) Best detected after 16 weeks

Correct Answer - B
Ans. is b i.e. Twin peak in dichorionicity
Chorionicity is the most important factor that affects the
outcome in Twin gestation.
Diagnosed by ultrasound at 6 to 9 weeks of gestation. In
dichoronic twins there is a thick septum between the chorionic sacs.
It is best identified at the base of the membrane, where a triangular
projection is seen. This is known as lambda or twin peak sign.
Presence of lambda or twin peak sign indicates dichorionic placenta"
So it is clear that lambda / Twin peak sign clearly indicates
dichorionic placenta & is hence the correct option 'b'.
As far as other options are concerned.
Option a - Same sex rules out dichorionicity, this is incorrect
because
Twins of opposite sex are almost always dizygotic dichorionic but
same sex does not rule out dichorionicity. Option c - Thick
membrane is present in monochrionic twins
This is also incorrect because monochorionic means there is a
single chorion whereas dichorionic means there are 2 chorions so
obviously dichorionic membrane will be thick.
"Monochorionic pregnancies have a dividing membrane that is
so thin, it may not be seen until the second trimester. The
membrane is generally less than 2mm thick & magnification
reveals only 2 layers (of
amnion)"
Option d – Chorionicity is best detected after 16 weeks –
Again this statement is incorrect because the best time to detect
chrorionicity by USG is between 6 to 9 weeks.
748. Most common site of ectopic pregnancy
in fallopian tube:
March 2005
a) Infundibulum

b) Ampulla

c) Isthmus

d) Interstitium

Correct Answer - B
Ans. B: Ampulla
The vast majority of ectopic pregnancies implant in the Fallopian
tube.
Pregnancies can grow in the infundibulum (18% of all ectopics), the
ampullary section (55%), the isthmus (25%), and the interstitial part
of the tube (20%).
Ampullary pregnancy ruptures generally at 8 weeks
Mortality of a tubal pregnancy at the isthmus or within the uterus
(interstitial pregnancy) is higher as there is increased vascularity that
may result more likely in sudden major internal hemorrhage.
749. Hormone responsible for decidual
reaction and Arias stella reaction in
ectopic pregnancy is :
a) Oestrogen

b) Progesterone

c) HCG

d) HPL

Correct Answer - B
Ans. is b i.e. Progesterone
A single progesterone measurement can be used to establish that
there is a normally developing pregnancy with high reliability.
A value exceeding 25 ng/mL excludes ectopic pregnancy with 92.5%
sensitivity.
Arias stella reaction
Arias stella reaction is characterized by adenomatous change of the
endometrial glands.
Cells loose their polarity, have hyperchromatic nucleus, vacuolated
cytoplasm and occasional mitosis.
The reaction is seen in ectopic pregnancy (in 10-15% cases) and
indicates blightening of conceptus be it intrauterine or extrauterine.
(therfore it is not specific for ectopic pregnancy)
It occurs under the influence of progesterone.°
Decidual reaction
Under the hormonal effect of ectopic pregnancy (i.e. oestrogen,
progesterone and chorionic gonadotrophin) the endometrium
hypertrophies and is converted to decidua similar to normal uterine
pregnancy.
The decidua has all the characteristics of intrauterine
pregnancy except it does not have chorionic villi.°
The decidual reaction occurs under the influence of estrogen,
progesterone and HCG.°
So, hormone which is common to both Arias stella reaction and
decidual reaction is progesterone which is our answer of choice.
750.
A 55 year old lady presenting to out
patient department with postmenopausal
bleeding for 3 months has a 1 x 1 cm
nodule on the anterior lip of cervix.
Which of the following is the most
appropriate investigation to be done
subsequently in this care?
a) Pap smear

b) Punch biopsy

c) Colposcopy

d) Endocervical curettage

Correct Answer - B
Most appropriate investigation which can be done in the OPD in this
patient who has a visible 1 x 1 cm nodule on the anterior lip of cervix
is puch biopsy.

For non-visible lesions coloposcopy allows accurate delineation of

suspicious areas for tissue biopsy.

Ref: Shaw’s Textbook of Gynaecology, 13th Edition, Page 384

751. In colposcopy, following are visualized
except :
a) Upper 2/3rd endocervix

b) Lower 1/3rd endocervix

c) Vault of vagina

d) Lateral fornix

Correct Answer - A
Upper 2/3rd endocervix
Colposcopy is a method to evaluate the changes in the terminal
vascular network of the cervix, the transformation zone, Vagina and
Fornix.
In the cervix, upper 2/3"i of endocervix is not visualized by
colposcopy (the maximum limit being 5 mm above the canal).
A colposcope is a binocular microscope producing magnification of 5
– 15 times.°
Colposcopy is done after application of 3 – 5% acetic acid, to the
abnormal area.°
It can detect cervical dysplasias, metaplasia and carcinoma in situ.°
Indications (very important)
:
In case of abnormal pap smear cytology°.
To locate abnormal areas.°
To obtain directed biopsies.°
Conservative therapy under colposcopic guidance.°
For follow up of patients treated conservatively.°
Some other Indications
:
In case of unexplained intermenstrual or post coital bleeding.
History of Inutero Diethylstilbestrol exposure.
Vulva' or vaginal neoplasia.
For more details on Colposcopy, see Chapter 12 B – CIN and Ca
Cervix.
752. Indications for instituting single-agent
chemotherapy following evacuation of a
hydatidiform mole usually include
a) A rise in hCG titers

b) A plateau of hCG titers for 1 week

c) Return of hCG titer to normal at 6 weeks after evacuation

d) Appearance of liver metastasis

Correct Answer - A
(Mishell, 3/e, pp 455–456.) Single-agent chemotherapy is usually
instituted if levels of hCG remain elevated 8 weeks after evacuation
of a hydatidiform mole. Approximately 50% of the patients who
have persistently high hCG titers will develop malignant sequelae.
If hCG titers rise or reach a plateau for 2 to 3 successive weeks
following molar evacuation, a single-agent chemotherapy should be
instituted, provided that the trophoblastic disease has not
metastasized to the liver or brain. The presence of such metastases
usually requires initiation of combination chemotherapy.
753. Incidence of choriocarcinoma is seen
more after:
a) Ectopic pregnancy

b) Spontaneous abortion

c) Normal delivery

d) Cesarean section

Correct Answer - B
Ans. is 'b' i.e., Spontaneous abortion
Among all the cases of choriocarcinoma:
50% develop following a hydatidiform mole
25% develop following an abortion
20% develop following a full-term pregnancy and 5% develop
following an ectopic pregnancy
754. Choriocarcinoma with lung metastasis is
stage ?
a) 1

b) 3

c) 2

d) 4

Correct Answer - B
Ans. is 'b i.e., 3 Stage I
Disease confined to uterus
Stage
Disease confined to uterus with no risk factors
IA:
Stage
Disease confined to uterus with one risk factor
IB:
Stage
Disease confined to uterus with two risk factors
IC:
Gestational trophoblastic tumor extending outside uterus
Stage II: but limited to genital structures(adnexa, vagina, and broad
ligament)
Stage Gestational trophoblastic tumor extending outside uterus
IIA: but limited to genital structures without risk factors
Stage Gestational trophoblastic tumor extending outside uterus
IIB: but limited to genital structures with one risk factor
Stage Gestational trophoblastic tumor extending outside uterus
IIC: but limited to genital structures with two risk factors
Stage Gestationaltrophoblastic disease extending to lungs with
III: orwithout known genital tract involvement
Stage Gestational trophoblastic tumor extending to lungs with or
IIIA
IIIA without genital:tract involvement and with no risk factors
Stage Gestational trophoblastic tumor extending to lungs with or
IIIB without genital tract involvement and with one risk factor
Stage Gestational trophoblastic tumors extending to lungs with or
IIIC without genital tract involvement and with two risk factors
Stage
All other metastatic sites (liver/brain)
IV:
Stage
All other metastatic sites without risk factors
IVA:
Stage
All other metastatic sites with one risk factor
IVB:
Stage
All other metastatic sites with two risk factors
IVC:
755. 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.
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.
756. Appropriate exposure time for topical
phototherapy after TMP application
a) 10-20 min

b) 30- 40 min

c) 50-60 min

d) 1-2 hours

Correct Answer - A
Ans. is'a'i.e., 10-20 min
lRef: IADW textbook of dermatology 3'd/e p. 17191
Topical PUVA:
A lotion containing 0.1-l7o 8-MOP is applied on affected area and is
exposed to UVA either immediately or after 1-2 hours.
Alternatively a vanishing cream containing 0.01% TMP is applied 10-
20 minutes before exposure.
757. A 25-year-old girl presented with
erythematous papules on the face as
seen in the figure. The lesions were
exacerbated on excessive sweating, sun
exposure and emotional disturbance.
What is the diagnosis?

a) SLE

b) Acne rosacea

c) Acne vulgaris

d) Photodermatitis

Correct Answer - B
Ans: B. Acne rosacea
(Ref Rooks 8/e p43.1-43.10; Fitzpatrick 7/e p704-708; Roxburgh
18/e pl 72-1 78; Harrison 19/e 18/e p404, 444)
Most likely diagnosis = Acne rosacea.
Acne rosacea:
Characterized by erythema of central face persisting for months or
more.
Convex areas of nose, cheeks, chin & forehead - Characteristically
involved.
Spares perioral & periorbital areas.
Vascular abnormalities:
Abnormal vascular reactivity - Exaggerated flushing response to
heat, spicy food, alcohol and stress).
No pharmacological defect found.
758. Which of the following is
characteristically associated with
dermatitis?
a) Spongiosis

b) Orthokeratosis

c) Hypergranulosis

d) Acanthosis

Correct Answer - A
Ans. is'a'i.e., Spongiosis
lRef: Venkataram 1"'/e p. 36-381
Intercellular edema in stratum spinosum is known as spongiosis. It is
considered to be the most characteristic histopathological finding of
eczema ( dermatitis)
759. Kogoj's pustules are seen in?
a) Lichen planus

b) Pemphigus vulgaris

c) Mycosis fungoides

d) Psoriasis vulgaris

Correct Answer - D
Ans. is'd'i.e., Psoriasis vulgaris
[Rel Venkataram |i/e p. 49]
On histopathological examination of psoriasis lesion there is
accumulation of polymorphs in stratum malpighi layer. These
clusters are known as Kogoj pustules.
760. Pemphigus vulgaris is caused due to
which type of hypersensitivity reaction?
a) I

b) II

c) III

d) IV

Correct Answer - B
Ans. is 'b' i.e., ll
lRef: IADVL textbook of dermatology 3'd/e p. 10991
Pemphigus is a type 2 hypersensitivity reaction (antibody mediated),
with formation of antibodies to pemphigus antigen present rn
intercellular substance.
761. A 35 years old male patient presented
with extremely itchy eczematous lesions
over forehead, 'V' area of neck, ear pinna
and dorsum of forehead. Severity od
itching increases on going out in the
sun. which of the following medicine will
help in the treatment?
a) Retinoid

b) Doxycycline

c) Dapsone

d) Hydrochloroquine

Correct Answer - D
Ans. is'd'i.e., Hydroxychloroquine
[Ref: IADW 3'd/e p. 6261
Presence of eczematous lesions on sun exposed areas & worsening
of symptoms on sun exposure indicates towards the diagnosis of
photodermatitis.
Hydroxychloroquine is a useful systemic drug in the treatment of
photodermatitis .
762. Painful vaginal ulcer with inguinal
lymphadenopathy and school of fish
appearance of microorganism or
microscopy are characteristic of:
a) Syphilis

b) LGV

c) Granuloma inguinale

d) Chancroid

Correct Answer - D
Ans. is. 'd' i. e., Chancroid
Chancroid is a bacterial sexually transmitted disease (STD) caused
by infection with Haemophilus ducreyi.
It is characterized by painful necrotizing genital ulcers that may be
accompanied by inguinal lymphadenopathy. It is a highly contagious
but curable disease.
H ducreyi, a small, gram-negative, facultative anaerobic bacillus that
is highly infective.
It is pathogenic only in humans, with no intermediary environmental
or animal host.
H ducreyi enters the skin through disrupted mucosa and causes a
local inflammatory reaction
H ducreyi is transmitted sexually by direct contact with purulent
lesions and by autoinoculation to nonsexual sites, such as the eye
and skin.
The organism has an incubation period of 1 day to 2 weeks, with a
median time of 5-7 days.
763. Painful lymphadenopathy is seen in:
a) Donovanosis

b) Syphilis

c) Chancroid

d) All

Correct Answer - C
C i.e. Chancroid
764. Lesion characteristic of secondary
syphilis is?
a) Genital Ulcer

b) Condyloma acuminata

c) Dermal tenderness

d) Hutchinson's teeth

Correct Answer - C
Ans. is'c'i.e., Dermal tenderness
lRef: Hanison 18th/e p. 1382, p. 1040)
Deep dermal tenderness on pressure (Buschke ollendraff sign) is a
characteristic feature of secondary syphilis.
765. True about Lucio's phenomenon is?
a) Associated with tuberculoid leprosy

b) Occurs as side effect of treatment of leprosy

c) Ischemic necrosis

d) Also known as type 2 Lepra reaction

Correct Answer - C
Ans. is 'c' i.e., ischemic necrosis
(Ref: IADVL 3'd/e p. 2023,24)
Lucio's phenomenon is seen in untreated cases of lepromatous
leprosy.
Lucio's phenomenon is seen in lepromatous leprosy (LL).
It occurs in patients who are untreated.
Patients develop recurrent crops of large sharply marginated,
ulcerative lesions, particularly on lower extremities.
It is due to heavy parasitism of endothelial cell, endothelial
proliferation and thrombus formation which lead to ischemic
necrosis.
766. A 36 years old factory worker developed
itchy annular scaly plaques in both
groins. Application of a carticosteroid
ointment led to temporary relief but the
plaques continued to extend at the
periphery. The most likely diagnosis is:
a) Erythema annulare centrifugam

b) Granuloma annulare

c) Annular lichen planus

d) Tenia cruris

Correct Answer - D
D ie Tinea cruris
767. True about cutaneous carcinoma is?
a) Squamous cell carcinoma occurs in early age

b) SCC & BCC comprise majority of non melanoma

c) Punch biopsy is IOC in SCC

d) Melanoma is the most common skin cancer

Correct Answer - B
Ans. is'b'i.e., SCC & BCC comprise majority of non melanoma
There are three main types of skin cancer: basal-cell skin cancer
(BCC), squamous-cell skin cancer (SCC) and melanoma
The first two, along with a number of less common skin cancers, are
known as nonmelanoma skin cancer (NMSC).
Basal cell carcinoma most common skin cancer.
most SCCs appear in people over 50.
768. Enzyme deficient in occulocutaneous
albinism type 1 is ?
a) Tyrosinase

b) Pink protein

c) Tyrosinase related protein 1

d) Membrane associated transport protein (MATP)

Correct Answer - A
Ans. is 'a' i.e., Tyrosinase
769. Which antibody is least commonly seen
in keloid
a) IgG

b) IgM

c) IgE

d) None

Correct Answer - C
Ans. is'c'i.e. IgE
(Ref: Aesth. plast" Sarg. 6:149_152, 19g2]
770. Hypomelanosis of Ito is associated with?
a) Mental retardation

b) Seizures

c) Visual abnormalities

d) All of the above

Correct Answer - D
Ans' is 'd' i'e', All of the above
Hypomelanosis of Ito (Incontinentia pigmmti achromians) is part of a
rare genetic neurocutaneous syndrome.
Associated Seizures
Mental retardation
Hearing Abnormalities
Tooth or mouth problems
Visual problems
Orthopedic problems
771. A 65-year old male presented with tense
blisters associated with itching on
normal looking skin with urticarial
plaques as seen in the figure. What is the
most likely diagnosis?
a) Bullous pemphigoid

b) Pemphigus vulgaris

c) Dermatitis herpetiformis

d) IgA pemphigus

Correct Answer - A
Ans. a. Bullous pemphigoid
Tlte nrcst likely diagnosis in this 65-year old male with tense blisters
on normal lookinl4 skin associated with itching und
urticarial plaques as seen in thefigure are hullous pemphigoitl.
772. MC late complication of central venous
line:
March 2013 (f)
a) Air embolism

b) Thromboembolism

c) Cardiac arrhythmias

d) Sepsis

Correct Answer - D
Ans. D i.e. Sepsis
Central venous lines (CVLs)
They are routinely used for monitoring and the administration of total
parenteral nutrition (TPN) and medications in almost all critical /
intensive care units (CCUs).
Central venous access is normally obtained by cannulation of the
internal jugular, the subclavian, or the femoral veins.
Central venous access may also be obtained from more distal sites,
typically the basilic and brachial veins, using a peripherally inserted
central catheter (PICC).
However, intravascular catheters are often associated with serious
complications, such as catheter-related bloodstream infection.
773. Which of the following prevents
aspiration?
a) LMA

b) Oropharyngeal airway

c) Nasopharyngeal airway

d) Proseal LMA

Correct Answer - D
Ans. is 'd' i.e., Proseal LMA [Ref: Understanding Paediatric
Anaesthesia Td/e p. 141
A type of definite airway
Definite airway is an airway that is adequately secured in trachea
and it adequately protect the airway from aspiration.
ProSeal (PLMA), a modification of Classic LMA, has a gastric
drainage tube placed lateral to main airway tube which allows the
regurgitated gastric contents to bypass the glottis and prevents the
pulmonary aspiration.
774. Shifting patient from assisted ventilation
to voluntary ventilation which of the
following shows failure?
a) 0, saturation <80%

b) PEEP <5cms

c) RR <35 mins

d) Tidal volume >5 ml/kg

Correct Answer - A
Ans. is 'a' i.e., O2 saturation < 80%
O2 saturation of >90% is one of the criteria for successful weaning
from mechanical ventilation.
775. Which of the following inhalational agents, is the induction agent of choice in
children?

a) Isoflurane

b) Desflurane

c) Sevoflurane

d) Methoxyflurane

Correct Answer - C
Sevoflurane is considered to be the inhalational induction agent of choice in children,
since it has a pleasant, faster, and smooth induction with no significant systemic toxicity.
Other drugs which can be used in children are are a mixture of oxygen and nitrous oxide or
halothane.

Ref: Synopsis of Pediatric Emergency Medicine By Gary Robert Fleisher, 4th Edition, Page
34; Textbook of Anesthesia for Postgraduates By T. K. Agasti, Page 799.
776. Brain dead patient comes under which
category in ASA classification?
a) ASA I

b) ASA 3

c) ASA 4

d) ASA 6

Correct Answer - D
Ans. is'd'i.e., ASA 6
(Ref: Millers anesthesia 8th/e p. 1144)
Brain dead patient is ASA grade-6.
777. ASA grading is anesthesia is done for?
a) Mental status

b) Physical status

c) Respiratory status

d) Socio-economic status

Correct Answer - B
Ans. is'b'i.e., Physical status
[ref: Millers anesthesia p. 1144]
ASA is the simplest and most widely used system for describing
patient's physical status to assess the risk factors before
anaesthesia.
778. Which of the following is not a sign of successful stellate ganglion block?
a) Nasal stuffiness

b) Guttmansign

c) Horner's syndrome

d) Bradycardia

Correct Answer - D
Bradycardia is not an established sign of successful stellate ganglion block.

Ref: Short Textbook of Anesthesia By Ajay Yadav, 2nd Edition, Page 113; Image-Guided
Intervention By Matthew A. Mauro, Kieran Murphy, Kenneth Thomson, Christoph L.
Zollikofer, 2008, Page 1741; Atlas of Image-Guided Intervention in Regional Anesthesia
and Pain Medicine By James P. Rathmell, 2005, Page 115
779. What is not true about preoperative
modification of drugs?
a) Lithium should be stopped 2-3 days before

b) Low dose aspirin should be stopped 7 days before

c) TCAs can be continued till the date of operation

d) Oral anticoagulants are stopped 4 days before

Correct Answer - B
Ans. is 'b' i.e., Low dose aspirin should be stopped 7 days
before
[Ref Ajay Yadav 3'd/e p. 461]
Antiplatelet drugs like clopidogrel and conventions dose of aspirin
should be stopped 7 days prior to surgery.
But low dose aspirin can be continued till the day of surgery.
780. Capnography is used for?
a) Oxygen saturation of blood

b) Amount of CO2 transported in blood

c) Diagnosing malignant hyperthermia

d) Myocardial perfusion

Correct Answer - C
Ans. is 'c' i.e., Diagnosing malignant hyperthermia
[Ref: Dorsch & Dorsch 4h/e p. 8901]
Uses of CapnoGRaphy
It is the surest confirmatory sigr of correct intubation in trachea.
Incorrect position of tube in the esophagus instead of trachea
(esophageal intubation) will yield ETCO2 = 0.
Diagnosing malignant hyperthermia → ETCO2 increases
significantly (more than 100 mg Hg).
781. Following is true about halothane
except?
a) Volatile liquid with sweet odour

b) Sensitises heart to adrenaline

c) Constricts bronchii

d) Causes malignant hyperthermia

Correct Answer - C
Ans. is 'c' i.e., Constricts bronchii
Halothane
It is a volatile liquid with sweet odour, nonirritating and
noninflammable.
It is a potent anaesthetic with poor analgesic and muscle relaxant
properties.
Halothane causes direct depression of myocardial contractility by
reducing intracellular Ca.
It causes fall in BP and CO.
Heart rate decreases due to vagal stimulation.
It tends to sensitize the heart to arrhythmogenic action of
adrenaline → contraindicated in pheochromocytoma.
It causes greater depression of respiration and ventilation perfusion
mismatch.
It dilates the bronchi → inhalation agent of choice in asthmatics
(intravaneous anaesthetic of choice in asthmatics is ketamine).
It is a hepatotoxic drug and can also cause malignant hyperthermia
(Succinylcholine accentuate it).
Recovery is smooth and reasonably quick.
It causes postanaesthetic shivering and chills.
It inhibits intestinal and uterine contractions → agent of choice for
assisting external or internal version during late pregnancy.
Because its uterine relaxant action it is contraindicated during
labour.
It is particularly suitable for induction and maintenance in children
and as maintenance anaesthetic in adults.
782. Regarding propofol, which one of the
following is false?
a) It is used as an intravenous induction agent

b) It causes severe vomiting

c) It is painful on injecting intravenously

d) It has no muscle relaxant property

Correct Answer - B
Ans. is 'b' i.e., It causes severe vomiting
Propofol
Propofol is a milky white powder that is preservative free; therefore,
it must be used within 6 hours. It is an oil based preparation,
therefore injection is painful.
Propofol is the most frequently used intravenous anaesthetic today.
—Miller 6thie - 318
It can be used for both induction as well as maintenace.
It does not possess anticonvulsive action (unlike thiopentone).
It causes fall in BP and bradycardia.
Like thiopental it does not possess muscle relaxant action.
Propofol possess significant antiemetic and antipruritic
action.→Miller 6th/e - 324
Propofol decreases polymorphonuclear leukocyte chemotoxis but
not aherence, phagocytosis and killing (Thiopentone blocks all
these) —) increased life threatning infections.
Propofol is particularly suitable for outpatient surgery.
Intermittent injection or continuous infusion of propofol is frequently
used for total Lv. anaesthesia (TINA) when supplemented by
fentanyl.
 It is anaesthetics of choice for intubation in ICU and for patients with
malignant hyperthermia.
Side effects - pain on injection, myoclonus, apnea, L BP and rarely
thrombophlebitis.
Propofol infusion syndrome
1. A lethal syndrome, associated with infusion of propofol for 48 hours
or longer.
2. Occurs in children and critically ill.
3. It occurs as a result of failure of free fatty acid metabolism and
failure of the mitochondrial respiratory chain.
4. Features are - cardiomyopathy with acute cardiac failure, metabolic
acidosis, skeletal myopathy, hyperkalemia, hepatomegaly and
lipemia
783. Positive end-expiratory pressure causes
increase in which respiratory parameter
?
a) Lung compliance

b) FRC

c) Tidal volume

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
[Ref Fundamental of anaesthesia - 7961]
Positive airway pressure therapy means providing positive pressure
during breathing.
It may be :-
1. Positive end-expiratory pressure (PEEP)
PEEP is the positive pressure is applied at the end of respiration
during mechanical ventilation.
2. Pulmonary effects of PEEP and CPAP
Positive pressure in PEEP & CPAP results in : -
Re-expansion (recruitment) and stabilization of partially
collapsed lung which causes : -
Increased FRC, tidal volume & lung compliance.
Connection of ventilation/pe{usioa abnormalities → Improved
oxygenation.
784. Reason of difficult intubation in an obese
patient is?
a) Difficult visualization

b) Decreased safe apnea time

c) Lower tidal volume

d) All of the above

Correct Answer - D
Ans. is'd'i.e., All of the above
Reasons for difrcult intubation in obese patients
Increased soft tissue mass
Increased pressure on diaphragm
Reduced 'Safe Apnoea Time"
785. USG of a patient shows solitary hypoechoic lesion of liver with septa and
debris which are characteristic of?

a) Caroli's disease

b) Simple cyst

c) Hydatid cyst

d) Liver abscess

Correct Answer - C
The sonographic appearance of hydatid disease includes a unilocular cyst; a complex cyst
with multiple internal daughter cysts; a complex cyst with septations, echogenic debris, or
floating membranes.

Daughter cysts appear as numerous small fluid-filled areas surrounded by thick walls inside
a parent cyst.
The demonstration of daughter cysts is considered pathognomonic of hydatid
disease.
Calcifications may be seen in the walls of the cysts or in the septations.

Ref: Pediatric Sonography By Marilyn J. Siegel, 2010, Page 242; Sleisenger 6th edition,
Page 1381; Schiff 8th edition, Page 1085; Rumack's Diagnostic ultrasound 3rd edition,
Page 86-94; Kuntz/Kuntz Hepatology Textbook and Atlas 3rd edition, Page 143-144.
786. Threshold radiation dose for
hematological syndrome is?
a) 2 Gy

b) 6 Gy

c) 15 Gy

d) 50 Gy

Correct Answer - A
Ans. is'a'i.e., 2 Gy
[Ref: Harrison 15h/e p. 25901]
Bone marrow or hematological syndrome:- Full syndrome occurs
with a dose between 0.7 and 3 Gy (70-300 rads).
The destruction of bone marrow cells results in pancytopenia.
787. 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]
Hummingbird sign on brain MRI is a radiological sign of progressive
supranuclear palsy.
788. Nuchal translucency at 14 wks is
suggestive of :
a) Down's syndrome

b) Oesophageal atresia

c) Trisomy 18

d) Foregut duplication cyst

Correct Answer - A
Ans. is a i.e. Down syndrome
Friends, before I go into the details of nuchal translucency I want to
first explain why I have opted for Down syndrome as the answer and
not Turner syndrome, though increased nuchal translucency is seen
in both the conditions.
My answer is based on the following lines from USG in Obs. &
Gynae. by Callen
"Johnson et al showed that simple nuchal translucency
between 10 and 14 weeks were associated with a 60% incidence
of abnormal karyotypes–mostly trisomy 21. Unlike the second
trimester experience, in which large cystic hygromas were most
often associated with turner syndrome, the 45X karyotype
represented a minority of the karyotypic abnormalities in the
group of fetuses with first trimester nuchal translucency
thickening."
Nuchal translucency and its Significance :
Nuchal translucency is a thickening of the nuchal soft tissues.
Embryos with aneuploidy have an increased amount of fluid in the
neck region resulting in increased NT measurement.
The maximum thickness of the subcutaneous translucent area
between the skin and soft tissue that overlies the fetus spine in the
sagittal plane is measured.
A cut off of 3mm is used as threshold for an abnormal nuchal
translucency in first trimester and 6mm for second trimester (16 - 20
weeks).
Best time to assess nuchal translucency in first trimester 10 - 13
weeks.
Best approach – Transvaginal (but trans abdominal is also
reasonably good).
It is best seen in the mid sagittal plane as a sonolucency at the back
of fetal neck.
Note: Increased nuchal translucency itself is not a fetal abnormality,
but rather a marker or soft sign that confers increased risk of fetal
abnormality.
Causes of Increased nuchal translucency :
Down syndrome (Trisomy 21)
Trisomy 18 Trisomy 13
Turner syndrome
Klinefelter syndrome Triploidy.
Nuchal translucency with large cystic hygroma is seen in Turners
syndrome.
Nuchal translucency with septations carries bad prognosis.
Chromosomally normal fetus with increased nuchal translucency is
associated with increased risk of :
– Cardiac abnormalities°
– Diaphragmatic hernia°
– Anterior abdominal wall defect°
– Fetal akinesia/dyskinesia syndrome°
Therefore, ACOG recommends that when nuchal translucency
measurement is 3.5 mm or more with a normal karyotype, then
targeted sonographic examination or fetal echocardiography or both
should be done.
Nuchal translucency of > 3mm in 1st trimester identifies 67% of fetus
with trisomy 21.
Increased nuchal fold thickness (> 6mm) is the most sensitive and
specific single ultrasound marker for the mid trimester detection of
down syndrome.
Extra Edge :
 Nuchal translucency is the most important sonographic marker of
aneuploidy in the first trimester whereas, Nuchal fold thickness
(NFT) is the most important sonographic marker of aneuploidy in
second trimester.
NT is measured from external surface of the skull to the internal
surface of the skin.
NFT is measured from the external surface of occipital bone to the
external surface of skin.
NFT is useful for screening between 14-23 weeks.
Cut off value for NFT is 5mm (above which it is considered
abnormal).
Note: In the first trimester 2 most reliable ultrasonographic markers
for detecting Down syndrome?
1. Increased muscal translucency
2. Absent nasal bone.
789. A lady presented with 7 weeks
amenorrhea presented with slight
vaginal spotting. CRL was 5mm with
well-formed gestational sac with
calculated GA of 5.6 weeks on TVS. Next
line of management?
a) Wait for another I week and repeat TVS

b) Surgical or medical evacuation

c) Wait for another 4 weeks

d) Serum hCG levels

Correct Answer - A
Ans: A. Wait for another I week and repeat TVS
Ref: Williams ohstetrics, 24'h ed.
An intrauterine gestational sac is reliably visualized with transvaginal
sonography by 5 weeks, and an embryo with cardiac activity by 6
weeks.
The embryo should be visible transvaginally once the mean sac
diameter has reached 20 mm, otherwise the gestation is
anembryonic.
Cardiac motion is usually visible with transvaginal imaging when the
embryo length has reached 5 mm. If an embryo less than 7 mm is
not identified to have cardiac activity, a subsequent examination is
recommended in 1 week.
790. Double decidual sac sign is indicative
of?
a) Ectopic pregnancy

b) Intrauterine pregnancy

c) H. mole

d) Twin pregnancy

Correct Answer - B
Ans. is'b'i.e., Intrauterine pregnancy
[Ref: sutton 7/e p. 1041 & callen 4th/e p . 114)
If a double decidual sac sign is present, then it is highly suggestive
that the intrauterine fluid collection is an intrauterine pregnancy.
791. Soft markers on ultrasonography are
helpful in diagnosing?
a) Fetal age

b) Chromosomal anomalies

c) Fetal size

d) Site of pregnancy

Correct Answer - B
Ans. is'b'i.e., Chromosomal anomalies
Antenatal soft ultrasound markers are fetal sonographic findings that
are generally not abnormalities as such but are indicative of an
increased age adjusted risk of an underlying fetal aneuploidic or
some non chromosomal abnormalities.
 792. Ring of fire on USG signifies?
a) H. mole

b) Ectopic pregnancy

c) PCOD

d) Aneuploidy

Correct Answer - B
Ans. is'b'i.e., Ectopic pregnancy
[Ref: Diagnostic Ultrasound: Abdomen and Pelvis E-Book p. 8011]
The ring of fire sign also known as ring of vascularity signifies a
hypervascular lesion with peripheral vascularity on colour or pulsed
doppler examination of the adnexa due to low impedance high
diastolic flow.
This sign can be seen in
1. Corpusluteum cyst (more commonly)
2. Ectopic pregnancy
793. Most important mechanism of action of
microwave irradiation is?
a) Thermal effect

b) Ionizing effect

c) Stereotactic effect

d) All of the above

Correct Answer - A
Ans. is'a'i.e., Thermal effect .
Ref: cdn.intechopen.com/.../InTech- Prospective -apPlication -of-
microwaves-in-medicine
The most important mechanism in medical applications of
microwaves is the thermal effects of EM field.
794. Electron beam therapy is used for which
tumor ?
a) Renal carcinoma

b) Kaposi sarcoma

c) Hepatic carcinoma

d) AML

Correct Answer - B
Ans. is'b'i.e., Kaposi sarcoma
[Ref: Textbook of radiotherapy - 1031]
Electron-beam radiation therapy is the most common modality
employed for the treatment of localized KS.
795. Patient presents with mass in
paraphaygeal region pushing carotid
artery backwards, the likely cause is ?
a) Carotid body tumor

b) Lymph node enlargement

c) Sternocleidomastoid tumor

d) None of the above

Correct Answer - A

Paragangliomas are clusters of neuroendocrine cells associated with

the sympathetic and parasympathetic nervous system.
Paraganglioma is the tumor of neuroendocrine cells of these
paraganglia that occurs at various body sites including head, neck,
thorax and abdomen.
Most common location of paragangliomas is adrenal medulla, where
they are referred to as pheochromocytomas.
Other locations are :
1) Paravertebral ganglion (organs of zuckerkandl) and rarely
bladder.
2) Paraganglia related to the great vessels of head and neck, so
called aorticopulmonary chain, including carotid bodies (most
common); ganglion nodosum of vagus nerve; and clusters located
about the oral cavity, nose nasopharynx, larynx, and orbit.
Note: Paragangliomas arising from the carotid body typically pushes
the great vessels of the aorticopulmonary chain, thus the most likely
diagnosis in this patient is a carotid body tumor.
796. On barium swallow Leiomyoma shows
following characteristic appearance?
a) Rat tail appearance

b) Cork screw appearance

c) Oval mass lined by barium

d) String sign

Correct Answer - C
Ans. is 'c' i.e., Oval mass lined by barium
[Rel Atlas of Esophageal Surgery p. 1761]
On barium swallow, leiomyoma may be seen as a discrete round or
ovoid submucosal mass that is well outlined by barium.
Its borders form slightly obtuse angles with the esophageal wall.
Esophageal leiomyoma is a benign smooth-muscle neoplasm of the
oesophagus.
It is the most common benign tumor of the oesophagus.
They typically involve the mid-to-distal oesophagus.
797. Aversion therapy is used in treatment of
?
a) Paraphilias

b) Tribaldism

c) Cunnilingus

d) Nymphomania

Correct Answer - A
Ans. is'a'i.e., Paraphilias
(Ref: Nirai Ahuia 6h/e p. 2281
Aversion therapy is used for the treatment of conditions which are
pleasant but undesirable (e.g., alcoholism, trichotillomania, drug
abuse and smoking).
The underlying principle is the pairing of the pleasant stimulus (e.g.,
alcohol) with an unpleasant response (e.g., brief electric stimulus).
Although aversion therapy can potentially eliminate almost any
unwanted behavior, two of the most cofirnofl opplicotions of this
treatment approach over the years ire rehabilitation programs fot sex
offenders and drug and alcohol addiction treatment.
798. The following are the psychiatric
sequalae after stroke in elderly
a) Depression

b) Post traumatic stress disorder

c) Both

d) None

Correct Answer - A
A i.e. Depression
799. When a person I asked about his blood
sugar level, he answers like "Diabetics
have sweet urine... urine and feces are
excreta".... Before finally telling his blood
sugar. It is an example of?
a) Tangentiality

b) Circumstantiality

c) Flight of ideas

d) Loosening of association

Correct Answer - B
Ans. is 'b' i.e., Circumstantiality
(Reli Fish's clinical psychopathology 3'd/el
In the given example, patient's goal is to tell the blood sugar level.
But the patient does -not reach his goal directly; rather he gives
irrelevant details and digressions.
lt is an example of circumstantiality.
800. A girl falls in love with a film star &
believes that he also loves her. It is best
exemplified by?
a) Persecutory delusion

b) Grandiose delusion

c) Erotomania

d) Nymphomania

Correct Answer - C
Ans. is'c'i.e., Erotomania
Erotomania (Delusions of love): - False belief that another person is
in love with one (commoner in woman).
801. Oedipus complex is related to which
phase of psychosexual development ?
a) Oral

b) Anal

c) Genital

d) Phallic

Correct Answer - D
Ans. is `d' i.e., Phallic
802. A person thinks that others are
implanting a machine on his head. It is
an example of?
a) Bizarre delusions

b) Non bizarre delusions

c) Hallucinations

d) Illusion

Correct Answer - A
Ans. is'a'i.e., Bizarre delusion
Ref: Niraj Ahuja 6h/e p. 59)
A bizarre delusion is a delusion that is very strange and completely
implausible (impractical for the person's culture); for example a
bizarre delusion would be that aliens have removed the affected
person's brain.
Bizarre delusions are characteristic of schizophrenia.
 803. A person is very impatient, competitive
and works like a perfectionist. He/she
can be best described as ?
a) Type A personality

b) Type B personality

c) Type C personality

d) Type D personality

Correct Answer - A
Ans. is 'a' i.e., Type A personality
[Ref: Essential of clinical psychiatry 4h/e p. 889]
Type A personality:
Impatient, time-conscious, highly competitive, ambitious, hostile, and
aggressive.
They have difficulty in relaxing and are concerned about their status.
Type A individuals are often highly achieving workaholics,who do
multitask, drive themselves with deadlines and are unhappy about
the smallest of delay.
Expressed in three major symptoms : -
1. Time urgency and impatience (Time pressure)
2. Free floating hostility
3. Competitiveness
804. Most common perceptual disturbance in
delirium is?
a) Illusion

b) Decreased perceptions per unit of time

c) Visual Hallucination

d) Auditory hallucination

Correct Answer - B
Ans. is'b'i.e., Decreased perceptions per unit of time
lRef: Neurology in Clinical Practice: Principles of diagnosis and
management 4h/e p. 301
The most common perceptual disturbance is decreased perceptions
per unit of time."
805. Which is true about age and sex
distribution of Schizophrenia?
a) Most common age is >50 years

b) Early onset is a good prognostic factor

c) Male sex is a poor prognostic factor

d) Males are prone for the disease

Correct Answer - C
Ans. is 'c' i.e., Male sex is a poor prognostic factor
(Ref: Kaplan Sadock Synopsis lfr/e p.480)
The schizophrenia starts in late adolescent and early adult (15-25
years).
Men and women have an equal lifetime risk for schizophrenia.
However' schizophrenia tends to strike women 3-4 years later than
men.
Most men develop schizophrenia between 75 and 25 years of age.
For women the period of maximum onset is between 15 and 30 with
a smaller peak between 45 and 50 (after menopause).
806. Cataplexy is characterized by?
a) Hypnopompic hallucinations

b) Nocturnal penile tumescence

c) Decreased muscle tone

d) Somnambulism

Correct Answer - C
Ans. is'c'i.e., Decreased muscle tone
[Ref Namboodiri 3'd/e p. 3601
Cataplery is the most common accessory symptom of Narcolepsy
and is characterized by sudden decrease in muscle tone, either local
or generalized.
807. Tic Douloureux is facial pain traveling
through which of the following nerves?
a) Facial

b) Hypoglossal

c) Trigeminal

d) Vestibulocochlear

Correct Answer - C
Answer is C (Trigeminal nerve):
Tic Douloureux refers to the association of Hemifacial spasm with
Trigeminal Neuralgia (Trigeminal nerve) Trigeminal neuralgia (TN, or
TGN), also known as Prosopalgia, Fothergill's disease or formerly
'Suicide disease' is a neuropathic disorder characterized by
episodes of intense pain in the face, originating from the trigeminal
nerve. Pain is typically limited to the distribution of one or more
divisions of the trigeminal nerve The pain often evokes spasm of the
muscle of the face on the affected side. The clinical association
between Trigeminal Neuralgia and hemifacial spasm is called Tic
Douloureux.
808. All are used in nicotine de-addiction,
except:
NIMHANS 10, 11
a) Bupropion

b) Clonidine

c) Nicotine gum

d) Buspirone

Correct Answer - D
Ans. Buspirone
809. True about psychoactive drugs is?
a) Can cause sexual dysfunction

b) Used in OCD

c) Used in psychotic disorders and Used in drug withdrawal

d) All of these

Correct Answer - D
Ans: D. All of these
All the above mentioned options are true about Psychotropic drugs
A psychoactive drug or psychotropic substance is a chemical
substance that acts primarily upon the central nervous system where
it alters brain function, resulting in temporary changes in perception,
mood, consciousness and behaviour.
In addition , several psychoactive substances are currently
employed to treat various addictions. These include acamprosate or
naltrexone in the treatment of alcoholism, or methadone or
buprenorphine maintenance therapy in the case of opioid addiction.
810. All are recognised features of Tourette’s syndrome, EXCEPT:
a) Motor Tics

b) Ataxia

c) Coprolalia

d) Predominantly affects males

Correct Answer - B
Tourette’s syndrome is a neurobehavioral disorder named after the French neurologist
Georges Gilles de la Tourette. It predominantly affects males. TS is characterized by
multiple motor tics often accompanied by vocalizations. Associated behavioral disturbances
include anxiety, depression, attention deficit hyperactivity disorder, and obsessive-
compulsive disorder.

Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 3332

811. Thiamine deficiency in a chronic alcoholic can reduce energy production as
a result of which of the following reasons?

a) It is required for the process of transamination

b) It is a co-factor for oxidative reduction

c) It is a co-enzyme for transketolase in pentose phosphate

pathway

d) It is a co-enzyme for pyruvate dehydrogenase and α-

ketoglutarate dehydrogenase in TCA pathway

Correct Answer - D
Thiamine is a co-enzyme for pyruvate dehydrogenase and α-ketoglutarate
dehydrogenase in the TCA pathway. Both the steps of the TCA cycle have thiamine
requiring enzymes are required for the aerobic generation of ATP through krebs cycle. So
thiamine deficiency can result in decreased energy production.

Ref: Textbook of biochemistry by DM Vasudevan, 3rd Edition, Page 268

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