AIIMS Nov 2013 Paper-@mmedicalbooks

1.
Vaginal wall is derived from ?

a) Mesoderm of genital ridge
b) Endoderm of genital ridge
c) Mesoderm of urogenital sinus
d) Endoderm of urogenital sinus
Correct Answer - D
Ans. is 'D' i.e., Endoderm of urogenital sinus
Vagina is derived from two sources :?
1. Upper 2/3" : It is derived from Utero-Vaginal Canal, i.e. the fused
part of paramesonephric duct. Therefore, this part is mesodermal in
origin.
2. Lower 1/3" : It is derived from sinovaginal bulb which inturn is
derived from urogenital sinus. Thus, this part is endodermal in origin.
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Which of the following is not the part of
ethmoid bone?
a) Agger nasi
b) Crista galli
c) Uncinate process
d) Inferior turbinate
Correct Answer - D
Ans. d. Inferior turbinate
Inferior turbinate is not the part of ethmoid bone.
`Lateral nasal wall has 3 bony projections called as turbinates or
conchae. From below upwards, they are inferior, middle and
superior turbinates. The inferior turbinate is a separate bone, while
rest of the turbinates are part of ethmoidal labyrinths.'
The agger nasi air cells, are the most anterior ethmoidal air cells,
lying anterolateral and inferior to the frontoethmoidal recess and
anterior and above the attachment of the middle turbinate. They are
located within the lacrimal bone and therefore have as lateral
relations the orbit, the lacrimal sac and the nasolacrimal duct.'
The crista galli is a median ridge of bone that projects from the
cribriform plate of the ethmoid bone. It is where the falx cerebri
attaches anteriorly to the skull. The olfactory bulbs lie on either side
of the crista galli on top of the cribriform plate.'
In the ethmoid bone, a curved lamina, the uncinate process, projects
downward and backward from this part of the labyrinth; it forms a
small part of the medial wall of the maxillary sinus, and articulates
with the ethmoidal process of the inferior nasal concha.'
3.
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Which part of the fallopian tube acts as a
functional/ anatomical sphincter?
a) Isthmus
b) Intramural
c) Ampulla
d) Infundibulum
Correct Answer - A
Ans. a. Isthmus
Isthmus of the fallopian tube acts as a functional/anatomical
sphincter.
The uterine end of the tube, called the isthmus, acts like sphincter,
and prevents the embryo from being released into the uterus for 2
days, so that it enters the uterus at the just right time for the
implantation.'- How To Have A Baby: Overcoming Infertility By
Aniruddha N Malpani/105
'The lumen of the narrow isthmus is relatively simple, with a few
longitudinal folds. This portion of its tube is 2 or 3 cm long. There are
three layers of musculature: the inner longitudinal, the middle
circular layer, and the outer longitudinal layer. There is some
evidence that the isthmus may act as a sphincter.'- Clinical Anatomy
of the Uterus, Fallopian Tubes, and Ovaries by Eric R Sokol
4. Most important blood supply to stomach:
a) Left gastric artery
b) Short gastric artery
c) Right gastro epiploic artery
d) Left gastro epiploic artery
Correct Answer - A
Answer- A (Left gastric artery)
The left gastric artery is the branch of celiac axis and is the largest
artery supplying the stomach.
Stomach has rich blood supply arising from celiac trunk and its
branches in the form of right and left gastric, right and left
gastroepiploic and short gastric arteries.
Blood Supply of Stomach:
Left gastric artery: Branch of celiac trunk (Largest)
Right gastric artery: Branch of hepatic artery
Right gastroepiploic artery: Branch of gastroduodenal artery
Left gastroepiploic artery: Branch of splenic artery
Short gastric arteries: Branch of splenic artery
5. 'Dynamic stabilizer of shoulder joint' term
is used for:
a) Rotator cuff
b) Glenoid labrum
c) Coracohumeral ligament
d) Glenohumeral ligament
Correct Answer - A
Ans. a. Rotator cuff
`Dynamic stabilizer of shoulder joint' term is used for rotator
cuff or musculotendinous cuff
The rotator cuff is the name given to the tendons of the
subscapularis, supraspinatus, infraspinatus, and teres minor
muscles, which are fused to the underlying capsule of the shoulder
joint. The cuff plays a very important role in stabilizing the shoulder
joinQ. The tone of these muscles assists in holding the head of the
humerus in the glenoid cavity of the scapula during movements at
the shoulder joint. The cuff lies on the anterior, superior, and
posterior aspects of the joint. The cuff is deficient inferiorly, and this
is a site of potential weakness.'- Snells 8/e
Musculotendinous Cuff of the Shoulder or Rotator Cuff
Fibrous sheath formed by four flattened tendons, which blend with
the capsule of the shoulderjoint and strengthen it. The cuff plays a
very important role in stabilizing the shoulder jointQ.
The muscles which form the cuff arise from the scapula and are
inserted into the lesser and greater tubercles of humerus.
Muscles of rotator cuff.
1. SubscapularisQ
2. SupraspinatusQ
3. InfraspinatusQ
4. Teres minorQ
Their tendons while crossing the shoulder joint become flattened
and blend with each other on one hand, and with the capsule of joint
on the other hand, before reaching their points of insertion.
The cuff lies on the anterior, superior, and posterior aspects of
the joint. The cuff is deficient inferiorly, and this is a site of
potential weakness.

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6. Which of the following is not a derivative of
neural ectoderm?
a) Sphincter pupillae
b) Retina
c) Dilator pupillae
d) Ciliary muscles
Correct Answer - D
Ans. d. Ciliary muscles
Ciliary muscles develop from Neural crest, not from neural crest.
Derivative of neural ectoderm:
Ciliary body epitheliumQ
Iris epitheliumQ
Smooth muscles of iris (constrictorQ and dilator pupillaeQ)
Part of vitreous
Ret
Retinal pigment epitheliumQ
RetinaQ (its 9 sensory layers)
Optic vesicle and cup
Optic nerveQ (fibers)
7. Muscle, which is anatomically a back
muscle, but functionally related to thorax
is:
a) Rhomboid
b) Latisimus dorsi
c) Trapezius
d) Levator costae
Correct Answer - B
Ans. b. Lattisimus dorsi
Muscle, which is anatomically a back muscle, but functionally related
to thorax is Latisimus dorsi.
The latissimus dorsi muscle is the widest muscle on the back though
it mostly acts as a shoulder muscle.

8. Which of the followinu artery does not
supply medulla?
a) Anterior spinal artery
b) Vertebral artery
c) Posterior inferior cerebellar artery
d) Superior cerebellar artery
Correct Answer - D
Ans. d. Superior cerebellar artery
Medulla is supplied by anterior spinal artery, branches of vertebral
artery and posterior inferior cerebellar artery (but not the Superior
cerebellar artery).
Blood supply of Medulla Oblongata
1. Anterior spinal arteryQ
The anterior spinal artery supplies the whole medial part of the
medulla oblongata.
A blockage (such as in a stroke) will injure the pyramidal tract,
medial lemniscus, and the hypoglossal nucleus.
This causes a syndrome called medial medullary syndrome.
2. Posterior inferior cerebellar artery (PICA)Q:
The posterior inferior cerebellar artery, a major branch of the
vertebral artery, supplies the posterolateral part of the medulla,
where the main sensory tracts run and synapse.
3. Direct branches of the vertebral arteryQ;
The vertebral artery supplies an area between the other two main
arteries, including the nucleus solitarius and other sensory nuclei
and fibers.
Lateral medullary syndrome can be caused by occlusion of either
the PICA or the vertebral arteries.

9. External anal sphincter is innervated by:
a) S2, S3, S4
b) S2, S3
c) L5, S1
d) L2, L3
Correct Answer - A
Ans. a. S2, S3, S4
External anal sphinaer is innervated by inferior rectal branch of
pudendal nerve (anterior divisions of S2,S3, S4 sacral spinal nerves)
mainly and by perineal branch of S4.

10. Nerve root for dermatome supplying
thumb and index finger:
a) C6 C8
b) C6 C7
c) C7 C8
d) C5 C6
Correct Answer - B
Ans. b. C6 C7
Nerve root Dermatome
C5 Deltoid patch
C6 Lateral forearm
Radial side of hand
Thumb and index finger
C7 Posterior lateral arm and forearm
Middle finger, Index finger
C8 Medial forearm
Ulnar border of hand
Ring and little finger
T1 Medial elbow and arm
11. A patient woke up with difficulty in
extending fingers, can make a grip and
hold a pen. Dorsiflexon was normal.
Sensory and motor examination was
normal. Nerve most commonly involved:
a) C8T1
b) Posterior interosseous nerve
c) Lower brachial plexus
d) Hand area in cortex
Correct Answer - B
Ans. b. Posterior interosseous nerve
A patient woke up with difficulty in extending fingers, can make a
grip and hold a pen. Dorsiflexon was normal. Sensory and motor
examination was normal. Nerve most commonly involved is
Posterior interosseous nerve.
Posterior Interosseous Nerve Palsy:
Nerve supplying extensors: Lesion can lead to difficulty in extending
fingers
Elbow, wrist, interphalangeal joint extension and sensations are
spared (can make a grip and hold a pen. Dorsiflexon was normal.
Sensory and motor examination was normal)
Loss of metacarpophalyngeal joint extension
12. Regular vein, artery and nerve CVAN')
arrangement is not present in which
intercostal space (not the rib):
a) First intercostal space
b) Second intercostal space
c) Third intercostal space
d) Eleventh intercostal space
Correct Answer - A
Ans. a. First intercostal space
Regular vein, artery and nerve (`VAN') arrangement is not present in
first intercostal space.
First Rib
The first rib is supplied by the internal thoracic artery and superior
intercostal artery. Venous drainage is via the intercostal vein.
The rib is innervated by first intercostal nerve.
The first intercostal vessels and nerve pass along the lower surface
between intercostal intimi and costal pleura with arrangements of
nerve, artery and vein from above downwards.

13. Which of the following is not enclosed in
mesorectal fasica?
a) Pararectal nodes
b) Superior rectal vein
c) Inferior rectal vein
d) Inferior mesenteric plexus
Correct Answer - C
Ans. c. Inferior rectal vein
Inferior rectal vein is not enclosed in mesorectal fascia.
`Mesorectum is enclosed by mesorectal fascia which is derived from
the visceral peritoneum, and is also known as visceral fascia of
mesorectum, fascia propria of rectum or presacral wing of
hypogastric sheath. Upper rectum is derived from the embryological
hind gut, it is surrounded by mesorectum and its contents namely
superior rectal artery and its branches, superior rectal vein and
tributaries, lymphatic vessels and nodes along superior rectal artery,
branches from inferior mesenteric plexus to innervate rectum and
loose adipose connective tissue down to the level of levator ani
(pelvic floor).'
Mesorectal Fascia
Mesorectum is enclosed by mesorectal fascia which is derived from
the visceral peritoneumQ, and is also known as visceral fascia of
mesorectum, fascia propria of rectum or presacral wing of
hypogastric sheathQ.
Upper rectum is derived from the embryological hind gut, it is
surrounded by mesorectumQ.
Contents of Mesorectal fascia
Superior rectal artery and its branchesQ
Superior rectal vein and tributariesQ
Lymphatic vessels and nodes along superior rectal arteryQ Branches
from inferior mesenteric plexus to innervate rectumQ
Loose adipose connective tissueQ down to the level of levator ani
(pelvic floor)

14. In spermatogenesis, independent
assortment of paternal and maternal
chromosomes occurs during-
a) Primary to secondary spermatocyte
b) Spermatogonia to primary spermatocyte
c) Secondary spermatocyte to spermatids
d) Spermatids to spermatozoa
Correct Answer - A
Answer- A. Primary to secondary spermatocyte
In spermatogenesis, independent assortment of paternal and
maternal chromosomes occurs during meiosis I, in which primary
spematocyte) to (2n) is converted into two secondary spermatocytes
(In).

15. Sympathetic stimulation increases blood
flow except:
a) Skin
b) Coronary circulation
c) Cerebral
d) Renal
Correct Answer - A
Ans. a. Skin
Sympathetic stimulation decreases blood flow in skin.
Sympathetic Stimulation
Stimulation of sympathetic fibers causes vasoconstriction but it is not
important, as the vasocontricor system is not well developed in
cerebral vascular bed.
Sympathetic stimulation increases myocardial blood flow through an
increased metabolic demand and a predominance of beta-receptor
activation.
16. All of the following are true about
excitation contraction coupling except:
a) Acetylcholine is released at the nerve terminal
b) Calcium is pumped back into the sarcoplasmic reticulum during

relaxation
c) Calcium is released from sarcoplasmic reticulum during

contraction
d) Calcium binds to tropomyosin to initiate muscle contraction
Correct Answer - D
Ans. d. Calcium binds to tropomyosin to initiate muscle
contraction
Calcium binds to Troponin C, not to the tropomyosin, to initiate
muscle contraction.
`The calcium released into the cytosol binds to Troponin C by the
actin filaments, to allow cross-bridge cycling, producing force and, in
some situations, motion.'
17. Transcutaneous electrical nerve
stimulation based on:
a) Central pain
b) Referred pain
c) Gate controlled theory of pain
d) Allodynia
Correct Answer - C
Ans. c. Gate controlled theory of pain
Transcutaneous electrical nerve stimulation is based on gate-
controlled theory of pain.
Gate Control Hypothesis (Metzek and Wall, 1965): Explain the
working of spinal pain suppression system. According to this
hypothesis, the dorsal grey horn acts as gate for transmission of
pain sensation and this gate can be partly or completely closed by
segmental suppression and supraspinal suppression.
18. All of the following are true about Kluver-
Bucy syndrome expect:
a) Hypersexuality
b) Visual agnosia
c) Hypermetamorphosis
d) Intractable seizures
Correct Answer - D
Ans.D. Intractable seizures
Intractable seizures are not seen in Kluver-Bucy syndrome.
Kluver-Bucy syndrome is characterized by visual agnosia,
hypersexuality and hypermetamorphosis.
19. Peripheral resistance is best indicated by:
a) Diastolic blood pressure
b) Pulse pressure
c) Systolic resistance in aorta as it increases in its length
d) Mean arterial pressure, which is responsible for blood flow to an

organ
Correct Answer - A
Ans. a. Diastolic blood pressure
Arterial hypertension is the result of abnormal flow/resistance
relationships. Resistance to outflow consists of different
components: the systolic component is the one generated by
conductance vessels, whereas the diastolic component consists of
peripheral resistance, which regulates peripheral blood supply due
to the run-off of conductance vessels during left ventricular diastole.
Thus, an increase in systemic resistance results in a rise in diastolic
blood pressure. If the elasticity of conductance vessels decreases,
diastolic run-off also decreases and diastolic blood pressure goes
down. When this loss of elasticity occurs, the ejection force cannot
be anymore offset by arterial distension, the pulse wave velocity
increases and reflex waves to the heart arrive earlier, causing the
systolic blood pressure to augment.
Such an augmentation, together with decreasing diastolic blood
pressure results in an enhancement of the pulse pressure. When the
stroke volume is normal, an increase in pulse pressure is, therefore,
a marker of altered conductance. However, if, due to loss of
elasticity of the conductance arteries diastolic blood pressure goes
down, increasing systolic pressure also protects against a decrease
in mean pressure.
Indeed, in conditions of elevated pulse pressure, the mean pressure
Indeed, in conditions of elevated pulse pressure, the mean pressure
can be normal or high, indicating that when evaluating blood
pressure all components should be taken into consideration. A high
systolic blood pressure associated with a normal mean blood
pressure is suggestive of a normal peripheral resistance.'
Diastolic Pressure
Systolic pressure is peak pressure reached during systole, similarly,
diastolic pressure refers to lowest pressure during diastole.
Diastolic blood pressure is an index to peripheral resistance.
Elasticity of aorta and large arteries is mainly responsible for origin
and maintenance of diastolic pressure (by Windkessel elastic recoil
effect).
Because the elasticity is higher in younger subjects, diastolic
pressure is maintained and pulse pressure is narrow.
Because the elasticity is lower in old persons, diastolic pressure is
decreased and pulse pressure is widened.
20. Blood testis barrier is located between:
a) Sertoli and sertoli cells
b) Leydig and myoid cells
c) Sertoli and germ cells
d) Sertoli spermatid
Correct Answer - A
Ans. a. Sertoli and sertoli cells
Blood testis barrier is located between sertoli and sertoli cells.
Sertoli cells are linked by tight junctions, the strongest intercellular
barriers in the body. This arrangement forms the blood testes
barrier. Blood testes barrier protects the developing sperms from
immunologic attack and blood borne noxious agents.'
Sertoli cells are specialized cells within the seminiferous tubules that
are involved in the orchestration and coordination of all the key
events during spermatogenesis and spermiogenesis.'
21. Most common metabolite of progesterone
excreted in urine is _________
a) Pregnanelone
b) Pregnanetriol
c) 17-hydroxy pregnanolone
d) Pregnanediol
Correct Answer - D
Pregnanediol is an inactive metabolic product of progesterone. A
test can be done to measure the amount of pregnanediol in urine,
which offers an indirect way to measure progesterone levels in the
body.
The principal pathway of the metabolism of progesterone is believed
to be progesterone → pregnanedione → pregnanolone →
pregnanediol, although small amounts of the corresponding
allopregnane compounds are formed.
22. Which of the following is known as
suicidal enzyme?
a) Lipoxygenase
b) Cyclooxygenase
c) Thromboxane synthatase
d) 5' nucleotidase
Correct Answer - B
Suicidal enzyme is one, which undergoes self-destruction in order to
terminate its own acitivity, e.g. Cyclooxygenase.
Suicidal Inhibition is conversion of a substrate by the enzyme into a
metabolite, which is a potent inhibitor of the enzyme; example:
Xanthine oxidase converts allopurinol to alloxanthine (oxypurinol),
which is a more potent inhibitor of allopurinol.
Cycloorygenase is known as suicide enzyme because it
catalyzes its own destruction.
23. All of the following are the reasons
responsible for ketosis in a patient of Von
Gierke’s disease?
a) They have hypoglycemia
b) Have low blood sugar levels
c) Oxaloacetate is required for gluconeogenesis
d) Low fat mobilization
Correct Answer - D
Answer- D. Low fat mobilization
Excessive fatty acid mobilization (not the Low fat mobilization) from
adipose tissues leads to ketosis in Von-Gierke's disease.
Type I glycogen storage disorder, inherited as autosomal recessive,
due to the deficiency of glucose-6 phosphatase.
Excessive fatty acid mobilization from adipose tissues leads to
ketosis.
Deficiency of glucose-6 phosphatase leads to low blood sugar and
hypoglycemic attacks.
24. Exact location of a genetic loci is
identified by:
a) Fluorescent in-situ hybridization
b) Polymerase chain reaction
c) Chromosome painting
d) Comparative genomic hybridization
Correct Answer - A
Exact location of a genetic loci is identified by Fluorescent in-situ
hybridization (FISH).
Fluorescent in-situ hybridization:
FISH, which utilizes fluorescent rather than radioactively labeled
probes, is a very sensitive technique for exact location of a genetic
lociQ.
This often places the gene at a location on a given band or region of
the chromosomeQ.
Polymerase chain reaction:
PCR is a cell free, test tube method used for amplifying a target
sequence of DNAQ.
Much faster and more sensitive than cell based cloningQ PCR is
used to amplify specific regions of DNA strandQ (target DNA)
Chromosome painting:
A technique for visualizing CHROMOSOME ABERRATIONS using
fluorescently labeled DNA probes, which are hybridized to
chromosomal DNA.
Multiple fluorochromes may be attached to the probes.
Upon hybridization, this produces a multicolored, or painted, effect
with a unique color at each site of hybridizationQ.
This technique may also be used to identify cross-species homology
by labeling probes from one species for hybridization with
chromosomes from another species.
Comparative genomic hybridization:
Comparative genomic hybridization differentiate the chromosome of
normal and cancer cellsQ.
Comparative genomic hybridization is used to study cryptic
chromosomal imbalances in patients with mental retardation and
multiple congenital anomalies, as well as in prenatal diagnosis and
to detect microdeletions and microduplications in cancer and in
previously unidentified genomic disordersQ.
25. True about RIBOZYME:
a) Peptidyl transferase activity
b) Cut DNA at specific site
c) Participate in DNA synthesis
d) GTPase activity
Correct Answer - A
Ribozymes are RNA molecule with catalytic activity. Ribozymes play
a central role in peptide bond formation (peptidyl transferase
activity).
Ribozyme
Ribozymes are RNA molecule with catalytic activity.
These generally involve transesterification reactions, and most are
concerned with RNA metabolism (splicing and endoribonuclease).
Recently, a ribosomal RNA component was noted to hydrolyze an
aminoacyl ester and thus play a central role in peptide bond
formation (peptidyl transferase).
26. Which enzyme's activity is increased in
low insulin/glucagon level?
a) Hexokinase
b) Glucokinase
c) Glucose-6-phosphatase
d) Pyruvate kinase
Correct Answer - C
Insulin suppresses glucose-6-phosphatase gene.
Glucose-6-phosphatase activity is increased in low insulin/glucagon
level.
Glucocorticoids, glucagon, epinephrine are inducers of glucose-6-
phosphatase whereas insulin is repressor.
Insulin upregulates the transcription of glucokinase,
phosphofructokinase, and pyruvate kinase, while glucagon
downregulates their transcription.
Glucose-6-phosphatase plays an important role in the regulation of
hepatic glucose production, and insulin suppresses glucose-6-
phosphatase gene.
27. Which of the following is false about
NADPH?
a) Produces ATP in RBCs
b) Glucose-6-phosphate dehydrogenase causes decreased

synthesis of NADPH
c) Required for reductive biosynthesis
d) Stabilizes the membrane of RBCs
Correct Answer - A
NADPH does not produce ATP in RBCs.
NADPH
Sources of NADPH:
HMP shunt enzymes:
- Glucose-6-phosphate dehydrogenase
– 6-phospho gluconate dehydrogenase
Cytoplasmic isocitrate dehydrogenases
Malic enzyme (decarboxylating malate dehydrogenase)
NADPH is required for:
Reductive biosynthesis of all lipids including fatty acid synthesis,
cholesterol synthesis, bile acid synthesis as coenzyme.
Regenerating reduced glutathione in RBCs and stabilizing the
membrane or protects the membrane from oxidative stress
28. Which of the following enzyme is not a
component of fatty acid synthase
complex?
a) Acetyl Co-A carboxylase
b) Ketoacyl synthase
c) Enoyl reductase
d) Acetoacetyl
Correct Answer - A
The Fatty Acid Synthase Complex Is a Homodimer of Two
Polypeptide Chains Containing Six Enzyme Activities and the Acyl
Carrier Protein.
The 6 enzymes are-
Ketoacyl synthase
Ketoacyl reductase
Malonyl transacylase
Dehydratase
Enoyl reductase
Thioesterase
Acetyl Co-A carboxylase is the rate-limiting enzyme of fatty acid
synthesis and is an enzyme, which is not a component of fatty acid
synthase complex.
29. Which of the following does not indicate
megaloblastic anemia
a) Increased reticulocyte count
b) Raised Bilirubin
c) Mild splenomegaly
d) Nucleated RBC
Correct Answer - A
Ans. a. Increased reticulocyte count
Megaloblastic anemia is characterized by hypercellular bone marrow
with abnormally large nucleated RBC, raised unconjugated bilirubin
and mild splenomegaly
Characteristic Features of Megaloblastic Anemia
Bone marrow: Hypercellular with a decreased myeloid/erythroid ratio
and abundant stainable iron
RBC precursors: Abnormally large° and have nuclei that appear
much less mature than would
be expected from the development of the cytoplasm (nuclear-
cytoplasmic asynchrony°).
Nuclear chromatin is more dispersed than expected and it
condenses in a peculiar fenestrated pattern°
Raised unconjugated bilirubin°
Mild reversible splenomegaly° (Wintrobes 12/e p1151)
30. Platelet adhesion to collagen occurs via:
a) Factor VIII
b) Factor IX
c) von Willebrand factor
d) Fibronectin
Correct Answer - C
Platelet adhesion to collagen occurs via von-Willebrand factor)
Endothelial injury allows platelets to contact the underlying
extracellular matrix; subsequent adhesion occurs through
interactions with von Willebrand factor (vWF), which is a product of
normal endothelial cells and an essential cofactor for platelet binding
to matrix elements.
31. Markers of acute kidney injury inculde all
of the following except:
a) Micro RNA-122
b) Cystatin C
c) N-gal
d) Kim-1
Correct Answer - A
32. Indoor air pollution does not lead to:
a) Chronic lung disease
b) Impaired neurological development
c) Adverse pregnancy outcome
d) Pneumonia in child
Correct Answer - B
Indoor air pollution can lead to chronic lung disease, adverse
pregnancy outcome and pneumonia in child.
Indoor Air Pollution
The commonest pollutant is tobacco smoke, but additional offenders
are CO, nitrogen dioxide, and asbestos. Volatile substances
containing polycyclic aromatic hydrocarbons generated by cooking
oils and coal burning are important indoor pollutants in some regions
of China.
Wood smoke, containing various oxides of nitrogen and carbon
particulates, may not only be an irritant but also predisposes to lung
infections and may contain the far more dangerous carcinogenic
polycyclic hydrocarbons. Bioaerosols range from microbiologic
agents capable of causing infectious diseases such as Legionnaires'
disease, viral pneumonia, and the common cold, to less threatening
but nonetheless distressing allergens derived from pet dander, dust
mites, and fungi and molds responsible for rhinitis, eye irritation, and
asthma.
Radon, a radioactive gas derived from uranium widely present in soil
and in homes, can cause lung cancer in uranium miners.
Exposure to formaldehyde causes breathing difficulties and a
burning sensation in the eyes and throat, and can trigger asthma
attacks.
33. Chromosomes are visualized through
light microscope with resolution of:
a) 5 kb
b) 50 mb
c) 5 mb
d) 500 kb
Correct Answer - C
Chromosomes are visualized through light microscope with
resolution of 5 mb.
Karyotype analysis:
Organize all chromosomes by homology, size and shape.
Provide an overview of the whole genome.
Detect both numerical and structural chromosomal aberrations
(overall resolution is 5 Mega bases (Mb); breakpoint resolution is 5
to 15 Mb).
34. Tensile strength of wound after
laparoscopic cholecystectomy in a 30
years old woman depends upon:
a) Replacement of type 3 collagen
b) Extensive crosslinking of tropocollagen
c) Macrophage activity/invasion
d) Granulation tissue
Correct Answer - B
The recovery of tensile strength results from the excess of collagen
synthesis over collagen degradation during the first 2 months of
healing, and, at later times, from structural modifications of collagen
fibers (cross-linking, increased fiber size) after collagen synthesis
ceases.
35. In a 70 years old man, who was working in
asbestos factory for 10-15 years, a mass
was seen in right apical region of the lung
on a routine X-ray,. Biopsy was taken from
the mass. Which of the following is seen
on electron microscopic examination?
a) Numerous long, slender microvilli
b) Melanosomes
c) Desmosomes
d) Neurosecretary granules in the cytoplasm
Correct Answer - A
Most likely diagnosis on the basis of description is malignant
mesothelioma. Numerous long, slender microvilli will be seen on
electron microscopy in malignant mesothelioma.
Diagnosis depends on a constellation of findings, including history of
asbestos exposure, clinical signs and symptoms, radiographic
findings, histopathological features, and immunohistochemical and
ultrastructural studies.
On electron microscopy, the presence of long microvilli and
abundant tonofilaments but absent microvillous rootlets and lamella
bodies favors the diagnosis of malignant mesothelioma.
Mesothelioma cells are characterized by a profusion of markedly
elongated surface microvilli in the absence of secretory cytoplasmic
granules. - Robbin's 8/e
36. Which of the following induces apoptosis
in a cell?
a) Oleic acid
b) Glucocorticoids
c) Isoprenoids
d) Myristic acid
Correct Answer - B
Glucocorticoid hormones are therapeutically useful agents for the
treatment of a variety of inflammatory and immune diseases. Their
anti-inflammatory and immunomodulatory actions are explained in
part by the inhibition of NF-κB and its subsequent actions.
3 Mechanisms for the inhibition of NF-κB by glucocorticoids has
been described:
(1) glucocorticoids increase IκB mRNA, which leads to an increase
of IκB protein and more efficient sequestration of NF-κB in the
cytoplasm.
(2) The glucocorticoid receptor competes with NF-κB for binding to
coactivators.
(3) The glucocorticoid receptor directly binds to the p65 subunit of
NF-κB and inhibits its activation.
37. A 45 years old female patient presented
painless supraclavicular
lymphadenopathy. Biopsy revealed
binucleated acidophilic owl eye
appearance with floating lymphocytes in
empty space, which was CD 15, CD 30
positive. What is the most probable
diagnosis?
a) Lymphocytic predominant Hodgkin's lymphoma
b) Nodular sclerosis Hodgkin lymphoma
c) Mixed cellularity Hodgkin lymphoma
d) Lymphocytic depleted lymphoma
Correct Answer - B
In a 45 years old female patient, who presented with painless
supraclavicular lymph node enlargement. Biopsy revealed
binucleated acidophilic owl eye appearance with floating
lymphocytes in empty space, which was CD 15, CD 30 positive. The
most probable diagnosis is Hodgkin's lymphoma. Nodular sclerosis,
mixed cellularity and lymphocyte-depleted variants are positive for
CD 15 and CD30. But Nodular sclerosis variant is most common
type and more common in females. So, in the above-mentioned
clinical situation, most probable diagnosis is nodular sclerosis
variant of Hodgkin's lymphoma.
Reed-Sternberg cells are large and are either multinucleated or have
a bibbed nucleus (thus resembling an 'owl's eye' appearance) with
prominent eosinophilic inclusion-like nucleoli. Reed-Sternberg cells
prominent eosinophilic inclusion-like nucleoli. Reed-Sternberg cells
are CD30 and CDI5 positive, usually negative for CD20 and CD45.
The presence of these cells is necessary in the diagnosis of
Hodgkin's lymphoma - the absence of Reed-Sternberg cells has very
high negative predictive value.
Nodular sclerosis:
Nodular sclerosis is MC type all over the worldQ
Nodular sclerosis is MC in females
It has propensity to involve the cervical, supraclavicular and
mediastinal lymph nodes of adults and adolescents
Lacunar cells of Reed Sternberg cells variant is seen
38. Real time polymerase chain reation is
done for:
a) DNA detection only
b) RNA detection only
c) Both RNA and DNA detection
d) Monitoring amplification of target nucleic acid
Correct Answer - D
Ans. d. Monitoring amplification of target nucleic acid
Real time polymerase chain reaction is done for monitoring
amplification of target nucleic acid.
'A quantitative polymerase chain reaction (qPCR), also called as
real-time polymerase chain reaction, is a laboratory technique of
molecular biology based on the polymerase chain reaction (PCR),
which is used to amplify and simultaneously quantify the targeted
DNA molecule.'
39. Correct match of drug and mechanism of
action is:
a) Brimonidine decreases aqueous production
b) Latanoprost carbonic anhydrase inhibitor
c) Pilocarpine increases uveoscleral outflow
d) Betaxolol increases trabecular outflow
Correct Answer - A
Ans.A. Brimonidine decreases aqueous production
Mechanism of Action:
Brimonidine- Lowers IOT(Intraocular tension) by 20-27% by
reducing aqueous production and by increasing
uveoscleral flow.
Latanoprost- Increase the uveoscleral outflow.
Pilocarpine-Increases trabecular outflow.
Betaxolol- Reduces aqueous secretion by the ciliary body.
40. Which of the following is a Rho kinase
inhibitor?
a) Fasudil
b) Ranolazine
c) Amiloride
d) Nicorandil
Correct Answer - A
Ans. a. Fasudil
41. All of the following are true about user of
iodine except:
a) It inhibits release of thyroid hormones
b) It causes acute inhibition of iodotyrosine and iodothyronine

synthesis
c) It can cause iodism
d) Its use is contraindicated in hyperthyroidism
Correct Answer - D
Ans. d. Its use is contraindicated in hyperthyroidism
MC therupeutic indication of 1131 (half life-| days) is
hyperthyroidism due to Grave's disease or toxic nodular goiter.
42. Duration of action of flumazenil :
a) 10 minutes
b) 20 minutes
c) 30 minutes
d) 40 minutes
Correct Answer - D
Ans. d. 40 minutes
`On IV injection, action of flumazenil starts in seconds and lasts for
1-2 hours; elimination t-half is 1 hour, due to rapid metabolism.'
43. Drug having both alpha and beta agonist
property:
a) Fenoldopam
b) Dopamine
c) Epinephrine
d) Phenylephrine
Correct Answer - C
Answer- C. Epinephrine
Epinephrine is having both alpha and beta agonist property.
Adrenaline (Epinephrine) acts on both alpha and beta receptors
44. Which of the following drugs can be
stopped abruptly without any withdrawal
symptoms?
a) Esctilaopram
b) Fluoxetine
c) Fluvoxamine
d) Sertraline
Correct Answer - B
Answer- B. Fluoxetine
Fluoxetine has the lowest incidence of discontinuation syndrome
among several antidepressants including paroxetin and venlafaxine.
The longer half life of fluoxetine will avoid any withdrawal symptoms
because this medication effectively tapers itself from the patient's
system over a few days.
45. Ability of body to eliminate the drug from
body is called as:
a) Volume of distribution
b) Clearance
c) Steady state
d) Rate of elimination
Correct Answer - B
Answer- B. Clearance
Ability of body to eliminate the drug from body is called as
Clearance.
CL = Rate of elimination/C
46. Which of the following is true about
carbamazepine?
a) Not associated with agranulocytosis
b) Has been known to cause Steven-Johnson's syndrome
c) Causes serious nephrogenic toxicity
d) Drug monitoring is not required
Correct Answer - B
Answer- B. Has been known to cause Steven-Johnson's syndrome
Carbamazepine has been known to cause Steven-Johnson's
syndrome.
High risk-
1. Nevirapine
2. Oxicam (NSAlDs)
3. Thiacetazone
4. Allopurinol
5. Carbamazepine
6. Lamotrigine
47. Tricyclic anti-depressants produce side-
effects like dry mouth, urinary retention
due to action on:
a) Muscarinic receptors
b) Nicotinic receptors
c) Adrenergic receptors
d) Serotonergic receptors
Correct Answer - A
Answer- A. Muscarinic receptors
Tricyclic anti-depressants produce side-effects like dry mouth,
urinary retention due to action on Muscarinic receptors.
'Tricyclic atntidepressants have anticholinergic side-effects, acts on
muscarininc receptors, manifested as dry mouth, bad taste'
constipation, epigastric distress, urinary retention (specially in males
with enlarged prostate), blurred vision, palpitation.'
48. Cholinomimetic is not used in which of the following?
a) Bradycardia
b) Glaucoma
c) Myasthenia gravis
d) Post-surgical atony or ileus
Correct Answer - A
Ans. a. Bradycardia
Cholinomimetic is used for open-angle glaucoma, cobra bite, and
myasthenia gravis but not in bradycardia.
Uses of Cholinomimetic
Diseases of eye Glaucoma
and accommodative Atropine overdoses
esotropia
Gastrointestinal and
Alzheimer's disease
urinary tract
Postoperative atony, Cobra bite: Neostigmine and
neurogenic bladder edrophonium
Neuromuscular junction: Myasthenia
Heart: Certain atrial
gravis, Curare induced neuromuscular
arrhythmias
paralysis
49. Which of the following anticholinergic
agent does not cross the blood brain
barrier?
a) Glycopyrrolate
b) Atropine
c) Hyoscine butylbromide
d) Hyoscine hydrobromide
Correct Answer - D
Answer- D. Hyoscine hydrobromide
Glycopyrrolate is a synthetic quaternary anticholinergic, which
doesn't cross the blood brain barrier and completely lacks central
effects.
50. Compared to unfractionated heparin, Low
molecular weight heparin (LMWH) has
reliable anticoagulant action because:
a) It interferes with thrombin and antithrombin III simultaneously
b) It is less protein bound
c) It is given subcutaneously
d) It is cleared by macrophages
Correct Answer - B
Answer- B. It is less protein bound
Compared to unfractionated heparin, Low molecular weight heparin
(LMWH) has reliable anticoagulant action because it is less protein
bound.
Indications of LMW heparins:
Prophylaxis of DVT and pulmonary embolism in high-risk patients
undergoing surgery stroke or other immobilized patients
Treatment of established DVT
Unstable angina
To maintain patency of cannulae and shunts in dialysis patients and
in extracorporeal circulation.
51. All are true for the following about
methanol poisoning EXCEPT:
a) Fomepizole is a competitive inhibitor of aldehyde
dehydrogenase
b) Minimum lethal dose of methanol is 1.25 ml/kg body weight
c) Formic acid is mainly responsible for toxicity
d) Methanol causes snow field vision
Correct Answer - A
Answer- a-Fomepizole is a competitive inhibitor of aldehyde
dehydrogenase
Fomepizole:
Fomepizole (4-methylpyrazole) is a specifc inhibitor of alcohol
dehydrogenase- retards methanol metabolism
Loading dose is 15 mglkg IV followed by l0 mg/kg every 12 hours till
serum methanol falls below 20 g/dl, has been found effective and
safe.
Minimum lethal dose of methanol is 1.25mVkg body weight:
Minimum lethal dose of methanol is 0.3-1.0 gm/kg
Formic acid is malnly rcsponsible for toxicity:
The methyl alcohol poisoning there is CNS depression, cardiac
depression and optic nerve atrophy. These effects are produced due
to Formaldehyde and formic acid.
The specifc toxicity of formic acid is retinal damage.
52.
Doctor or nursing disclosing the identity of
rape, victim is punishable under the following
section of IPC?
a) Section 228A
b) Section 222A
c) Section 224A
d) Section 226A
Correct Answer - A
Answer- A. Section 228A
'Section 228A of the IPC a little known section introduced by an
amendment to the law by the Parliament in 1983, deals with the
disclosure of the identity of a victim of certain offences and prevents
it in rape cases. The section states that anyone who prints or
publishes the name or only matter that may reveal the identity of a
victim of rape shall be punished With fine and up to two years in jail.
The law specifically lays down that under section 376 or 376A, 376
B, 376 C or 376 D, any victim of rape has to have her identity
protected from public.
53. Lateral traction test is done in unnatural
sexual offences in:
a) Habitual active agent
b) Pedophilia active agent
c) Bestiality active agent
d) Habitual passive agent
Correct Answer - D
Answer- D. Habitual passive agent
Lateral traction test is done in unnatural sexual offences in habitual
passive agent.
The useful guide as to the patient’s habituation to anal intercourse is
lateral buttock traction test.
In lateral buttock traction test, the thumb is placed on the cheeks of
the buttock on either side of the anus and gentle lateral traction is
applied.
In patients who are not accustomed to anal penetration (penile or
instrumental or any other) the traction results in reflex constriction of
anal sphincter.
The patients, who are used to anal penetration, react to the lateral
traction test by relaxation of the sphincter.
54. According to 'DELHI ANATOMY ACT
1957', a person died in road traffic
accident, the dead body is said to be
unclaimed after.
a) 24 hours
b) 48 hours
c) 72 hours
d) 96 hours
Correct Answer - C
Answer- C. 72 hours
According to 'DELHI ANATOMY ACT 1957', a person died in road
traffic accident the dead body is said to be unclaimed after 72 hours.
According to Delhi Anatomy Act 1953, the hospital authority can
utilize an unclaimed body (a person who dies in hospital, prison or
public places, which has not been claimed by any of his near
relatives or personal friends within the prescribed timeline of 48
hours) for the purpose of conducting anatomical examination and
dissection or other similar purpose.
55. Embalming without issuing death
certificate is punishable under section:
a) IPC 201
b) IPC 297
c) IPC 299
d) IPC 498
Correct Answer - A
Answer- A. IPC 201
Embalming without issuing death certiJicate is punishable under
section IPC 201.
'ln a medico legal case, condueting embalming before autopsy
invites liabilities, under section 201 IPC (causing disappearance of
evidence of offence, or giving false information to screen offender).
56.
IPC section dealing with illegal abortion with
woman consent?
a) 310
b) 312
c) 313
d) 314
Correct Answer - B
Answer- B. 312
'Indian Penal Code (IPC) Sections 312 (causing miscarriage), 315
(act done with intent to prevent child being born alive or to cause to
die after birth), 316 (causing death of quick unborn child by oct
amount to culpable homicide) and Sections 3 and 4 of the Medical
Termination of Pregnancy (MTP) Act I971 for performing MTP
without license and without taking medical advice.'
57. Rigor mortis not seen in:
AIIMS 13
a) Fetus < 7 months of age
b) Old patients > 80 years
c) Well built female
d) Well built male
Correct Answer - A
Ans. Fetus < 7 months of age
Rigor mortis may not be seen in infant <7 months due to smaller
muscle mass.
58. The role played by Major
Histocompatibility Complex (MHC)-1 and
-2 is to:
a) Transduce the signal to T-cell following antigen recognition
b) Mediate immunogenic class switching
c) Present antigens for recognition by T-cell antigen receptors
d) Enhance secretion of cytokines
Correct Answer - C
Ans. c. Present antigens for recognition by T-cell antigen receptors
The role played by Major Histocompatibility Complex-l and -2 is to
present antigens for recognition by T cell antigen
receptors.
'Main function of MHC molecule is to bind peptide fragments of
foreign protein for presentation to appropriate antigen
specific T cells.'
59. Which of the following is not a common
case of neonatal sepsis in India:
a) Staphylococci
b) Klebsiela
c) E.coli
d) Group B Streptococci
Correct Answer - D
Ans. is d i.e Group B Streptococci Ref. Arch Dis Child Fetal
Neonatal Ed2005;90:F220-FF224
The pathogens most often implicated in neonatal sepsis in
developing countries differ from those seen in developed countries:
Overall, Gram negative organisms are more common and are mainly
represented by Klebsiella, Escherichia coli, Pseudomonas, and
Salmonella.
Of the Gram positive organisms, Staphylococcus aureus, coagulase
negative staphylococci (CONS), Streptococcus pneumoniae, and
Streptococcus pyogenes are most commonly isolated.
Further it is stated that
Group B streptococcus (GBS) is generally rare or not seen at all,
although maternal rectovaginal carriage rates of GBS may be similar
to those recorded in developed countries.
Neonatal Sepsis
Neonatal sepsis specifically refers to the presence of a bacteriamic
infection (such as meningitis, pneumonia, pyelonephritis, or
gastroenteritis) in the setting of fever in a newborn baby.
It is divided into two categories:
Early Onset Sepsis (EOS): EOS refers to sepsis presenting in the
first 7 days of life
Late Onset Sepsis (LOS). with LOS referring to presentation of
sepsis after 7 days
Diagnosis: Culturing for microorganisms from a sample of CSF,
blood or urine, is the gold standard test for definitive diagnosis of
neonatal sepsis.
Note: In western countries, Group Ei streptococci is the most
common etiologic organism responsible for neonatal sepsis.
Rashtriya Swasthya Bima Yojana?
a) Applies to BPL families only
b) Rupees 30,000 per family member
c) Both inpatient and outpatient charges included
d) Patient pays first then it is reimbursed by government
Correct Answer - A
Answer- A. Applies to BPL families only
Rashtriya Swasthya Bima Yojana provide health insurance coverage
for Below Poverty Line (BPL) families.
Beneficiaries under RSBY are entitled to hospitalization coverage up
to 7 30,000 per family per year per hospitalization in public and
private hospitals
Beneficiaries need to pay only Rs.30/- as registration fee while
Central and State Government pays the premium to the insurer
selected by the State Government on the basis of a competitive
bidding.
61. All of the following are true about Roll
back malaria except:
a) Insecticide-treated bed nets
b) Strengthening health system
c) Development of larvivorus fishes for the eradication of larvae.
d) Training health workers
Correct Answer - C
Ans. c. Development of larvivorus fishes for the eradication of
larvae.
The main strategies of Roll Back Malaria initiative are :
Strengthen the health system to ensure better delivery of health
care, especially at the district and community level.
Ensure the proper and expanded use of insecticide-treated mosquito
nets.
Ensure adequate access to basic health care and training of health
care workers.
Encourage the development of simpler and more effective means of
administering medicines, such as training of village health workers
and mothers on early and appropriate treatment of malaria,
especially in children.
Encourage the development of more effective and new anti-malaria
drugs and vaccines.
62. Recommnended daily intake of iodine in
pregnancy-
a) 90 microgram
b) 120 microgram
c) 150 microgram
d) 250 microgram
Correct Answer - D
Answer- D. 250 microgram
Recommended daily intake of iodine in pregnancy is 250 microgram.
63. To evaluate post-operative vision effects
after cataract extraction surgery under
PCB, which of the following is used?
a) Active surveillance
b) Sentinel surveillance
c) Passive surveillance
d) Routine checkup of all operated cases
Correct Answer - D
Answer- D. Routine checkup of all operated cases
Tb evaluates postoperative vision effects after cataract extraction
surgery under NPCB, routine checkup of all operated cases is used.
Strategies under National Programme for Control of Blindness
(NPCB)
Improving follow-up services of cataract operated patients and
treating other causes of epidemics like glaucoma
Shift eye camp approval to a fixed surgical approach and from
conventional surgery to IOL installation for better quality of
postoperative vision to operated patients.
Expand World Bank Project activities like construction of dedicated
eye operation theatres, eye wards at district level, training of other
ophthalmic equipment's to the work community.
To strengthen participants of voluntary organizations in the
programme.
To enhance the coverage of eye care services in the tribal and
underserved areas.
Screening of refractive errors in school going children.
64. Epidemics after disaster are caused by all
except?
a) Leptospirosis
b) Rickettsiosis
c) Leishmaniasis
d) Acute respiratory infection
Correct Answer - C
Ans. is `c' i.e., Leishmaniasis
Disease common in Post-disaster Phase
Gastroenteritis (MC)
Acute respiratory tract infections (Pneumonia)
Leptospirosis
Rickettsiosis
Rabies
Equine encephalitis
65. Percent of Indian GDP spent on health:
a) .012
b) 2
c) 10
d) 15
Correct Answer - A
Health expenditure, public (% of GDP)
Health expenditure, public (% of GDP) in India was 1.37 as of 2009.
Its highest values was 0.93 in 2005.
Ref: Planning Commission of India, GOI; http:/apps.who.int/nha.database ;
Source: World Health Organization National Health Account database (see
http:/apps.who.int/nha/database for the most recent recent updates).
66. What is under-5 mortality' rate in world by
2010?
a) 6 million
b) 8 million
c) 10 million
d) 12 million
Correct Answer - B
Answer- B. 8 million
In 2012, 6.6 million, 2011, 6.9 million children underfive died, down
from 7.6 million in, 8.1 million in 2009 and 12.4 million in 1990.
67. Highly toxic insecticide, according to
WHO classification, are coded as:
a) Red
b) Green
c) Yellow
d) Blue
Correct Answer - C
Answer- C. Yellow
Toxicity labels viz; red label, yellow label, blue label and green label
are mandatory labels employed on pesticide containers in India
identifying the level of toxicity of the contained pesticide.
The schemes follow from the Insecticides Act of 1968 and the
Insecticides Rules of 1971.
Yellow label- Highly toxic- 51-500- Endosulfan, carbaryl, quinalphos,
and others.
68. Extremely axle insecticide according to
WHO classification, are coded as:
a) Red
b) Green
c) Yellow
d) Blue
Correct Answer - A
Answer- A. Red
Extremely toxic insecticide, according to WHO classification, is
coded as Red.
69. Which of the following is not true about
screw feed technology
a) Reduces weight by 30%
b) Reduces volume by 80%
c) Ideal for pathological waste
d) Non-burn heat sterilization technique
Correct Answer - C
Answer- C. Ideal for pathological waste
Screw-Feed Technology:
A non-burn, dry thermal disinfection process
Waste is reduced by 80% in volume
Waste is reduced by 20-35 % in weight
Suitable for treating infectious waste and sharps
Should not be used to process pathological, cytotoxic, or radioactive
waste.
70. According to latest guidelines of
vaccination, which of the following is
applicable at the age of 5 years ?
a) DT booster + Vitamin A
b) DT
c) DPT + OPV
d) DPT + Vitamin A
Correct Answer - D
Ans. is 'd' i.e., DPT + Vitamin A
Recent changes in immunization guidelines in India.
2 doses of measles vaccine
First dose : 9 months
Scond doese : 16-24 months
1 dose of JE live vaccine : 16-24 months
DPT booster : 5-6 years age
Vitamin A : Every 6 months till age of 5 years age (Starting at 9
months age)
71. Measles vaccination compagin between 9-
14 years age for elimination is -
a) Keep up
b) Follow up
c) Mop up
d) Catch up
Correct Answer - D
Ans. is 'd' i.e., Catch up
WHO's measles elimination strategy comprises a three part
vaccination strategy, i.e. :-
i) Catch-up → One-time, nationwide vaccination campaign targeting
usually all children aged 9 months to
14 years regardless of history of measles disease or vaccination
status.
ii) Keep-up → Routine services aimed at vaccinating more than 95%
of each successive birth cohort.
iii) Follow-up → Subsequent nationwide vaccination campaign
conducted every 2-4 years targeting usually all children born after
catch-up campaign.
The priorties of countries persuing measles control include :-
i) Improve routine vaccination coverage level to at least 90%.
Active coverage of more than 90% in catch-up and follow-up
campaigns or active coverage of more than 90% with routine second
dose of measles vaccine.
iii) Establish case - based surveillance with laboratory confirmation
of suspected cases and virus isolation from all chains of
transmission.
iv)Conduct supplementary vaccination campaign together with
administration of vitamin 'A' in high risk areas.
administration of vitamin 'A' in high risk areas.
In India, measles is a major cause of morbidity and a significant
contributor to childhood mortality. Prior to the immunization
programme, cyclical increase in the incidence of measles were
recorded every third year. With the increase in immunization
coverage levels, the intervals between cyclic peaks has increased
and the intensity of the peak minimized.
Epidemic of measles occur if proportion of susceptible children is >
40%
If measles is introduced in a virgin community, it infects > 90% of
children. o Eradication of measles requires vaccine coverage >96%
Following information has been added in 22aVe of Park
At the 2010 World Health Assembly, member states endorsed the
following targets to be met by 2015 as milestones towards eventual
global measles eradication : - (i) Raise routine coverage with the first
dose of measles vaccine to . 90% nationally and 80% in every
district; (2) Reduce and maintain annual measles incidence to < 5
cases per million; and (3) Reduce measles mortality by 95% in
comparison with estimated level in the year 2000.
72. Which of the following is true for ESI act?
a) Funeral benefit is up to Rs 50,000
b) The State Government's share of expenditure on medical care

is 1/8; the ESI Corporation's share of expenditure on medical
care is 7/8 of total cost
c) Person with daily wages of Rs 70 has to contribute Rs 300

towards ESI
d) Employee has to contribute 4.75% and employer contributes

8.75%
Correct Answer - B
Answer- B. The State Government's share of expenditure on
medical care is 1/8; the ESI Corporation's share of expenditure on
medical care is 7/8 of total cost
ESI Act: The State Government's share of expenditure on medical
care is 1/8; the ESI Corporation's share of expenditure on medical
care is 7/8 of total cost.
Employees State lnsurance Act (1948):
Funeral benefit is up to Rs 5000
The State Government's share of expenditure on medical care is 1/8
of total cost of medical care; the ESI Corporation's share of
expenditure on medical care is 7/8 of total cost of medical care.
Person with daily wages of less Rs.70 per day are exempted from
making any payments
The employer contributes 4.75% of total wage bill; the employee
contributes 1.75% of wages.
73. Area under Normal curve with ±1 SD:
a) 0.68
b) 0.17
c) 0.12
d) 0.34
Correct Answer - A
Answer- A. 0.68
Area under Normal curve wilh + I SD is 0.68.

74. In a study of 2000 population, mean value
of hemoglobin is 13.5 gm, which follows
normal distribution curve. Percentage of
people having higher hemoglobin than
13.5 gm:
a) 5%
b) 25%
c) 50%
d) 75%
Correct Answer - C
Answer- C. 50%
In a population with normal distribation mean, median and mode are
equal So, here median is also 13.5, which divides the population into
two equal halves. So, 50%o will be on either side of 13.5. Hence,
Percentage of people having higher hemoglobin than 13.5 gm is 50.
75. Statistical `Q' test is used for:
a) Comparing the proportion of means of 2 groups
b) To determine outliars
c) To determine normality distribution
d) Comparing the proportion of means of more than 2 groups
Correct Answer - B
Answer- B. To determine outliars
Dixon's Q test, or simply the Q test, is used for identification and
rejection of outliers.
In statistics, an outlier is an observation point that is distant from
other observations.
An outlier may be due to variability in the measurement or it may
indicate experimental error
Outliers can occur by chance in any distribution, but they are often
indicative either of measurement error or that the population has a
heavy-tailed distribution.
This test should be applied sparingly and never more than once to a
single data set.
76. In 2001 census, which one of the following
denominators was used for calculating
the literacy rate -
a) Population 5 years of age and above
b) Population 7 years of age and above
c) Population 10 years of age and above
d) People who can read and write irrespective of age
Correct Answer - B
Ans. is 'b' i.e., Population 7 years of age and above
Literate India): Any person who can read and write, with
understanding, in any one language of India and who
is more than 7 years of age.
Literacy rate: Denominator is population >7 years of age
Crude literacy rate: Denominator is whole population (used earlier)
77. False statement regarding folic acid
supplementation?
a) Fortified in all wheat products in india like as in USA
b) Preconceptionally given for prevention of neural tube defects
c) It is present in leafy vegetables, spinach, paneer
d) Requirement per day in pregnancy is 500 mcg
Correct Answer - A
Ans. is 'a' i.e., Fortified in all wheat products in India like as in USA
o India has not yet adopted recommendation of fortification of all
wheat products in India with folic acid.
o All other options are correct.
78. True about complete eradication of
poliomyelitis from India is -
a) From 2012 onwards, no vaccine associated polio case has
been detected
b) Last polio case in India was reported in 13 January 2011
c) Mostly IPV is used currently
d) India is the only country which is not able to eliminate it

completely
Correct Answer - B
Ans. is 'b' i.e., Last polio case in India was reported in 13 January
2011
Current polio situation 2013 in India :
No wild case of polio in India currently.
Last case was reported on 13 January 2011.
VDPV in India : 5 cases all P2.
OPV is mostly used in India (Routine immunizations, as well as
pulse polio immunization).
79. Topical steroids are not recommended
post-surgery for:
a) Allergic fungal sinusitis
b) Chronic rhinosinusitis
c) Antrochoanal polyp
d) Ethmoidal polyps
Correct Answer - C
Ans. c. Antrochoanal polyp
For antrochoanal polyps, cause is infection and not the allergy.
Antrochoanal polyps are single, unilateral and rarely recur. Topical
steroids are rarely recommended.'
`Corticosteroid nasal sprays have been shown to delay the
recurrence of polyps after surgery however, the benefit for
nonpolypoid chronic rhinosinusitis has been harder to demonstrate
Chronic Rhinosinusitis:
Corticosteroid nasal sprays have been shown to delay the
recurrence of polyps after surgery however, the benefit for
nonpolypoid CRS has been harder to demonstrate.
Multiple ethmoidal polyps:
Antihistaminic, low dose steroids, local steroid sprays, help to
regress the ethmoidal polyps to a certain extent.
However, the above treatment rarely eliminates well-formed polyps
and is often combined with surgery.
Post antrochoanal surgery:
Most patients with antrochoanal polyps have a history of chronic
sinusitis and/or allergy (rarely).
The dominating symptoms are nasal obstruction and chronic
rhinorrhea. Other common symptoms of ACPs in children are
snoring, nocturnal sleep apnea and recurrent upper respiratory tract
infections.
Computed tomography is an important radiological examination of
choice for evaluation of antrochoanal polyps.
The treatment of choice is always surgical.
Functional endoscopic sinus surgery (FESS) with polypectomy has
been the dominating surgical approach.
Antrochoanal polyps are single, unilateral and rarely recur. Topical
steroids are rarely recommended.
Allergic Fungal Sinusitis:
The treatment of choice is generally surgery.
Systemic steroids may be indicated once surgery is performed and
the diagnosis is confirmed.
Topical nasal steroids are helpful postoperatively.
Aggressive nasal salt-water washes are recommended.
Systemic antifungals are not indicated in the absence of invasion.
80. All of the following are true regarding
tonsillectomy in children except:
a) Extracapsular approach is best for cold approach
b) Sleep apnea is an indication
c) Adenoids should also be removed if significantly involved
d) Cricothyroid region is high and anterior in children than adults
Correct Answer - A
Answer- A. Extracapsular approach is best for cold approach
Intracapsular approach is prefened over exlracapsular approach in
tonsillectomyfor cold opproach.
'Intracapsular tonsillectomy with bipolar scissors results in less
postoperative pain than extracapsular tonsillectomy
with bipolar scissors in children age 5 to 19 years.
Obstructive sleep apnea is the most common indicationfor T and A.'
The most common indication for Tonsillectomy and Adenoidectomy
(T and A) was for infectious etiology.
81. What is placed during surgery for
cochlear implant?
a) Microphone
b) Speech processor
c) Transmitting coil
d) Receiver stimulator
Correct Answer - D
Microphone, Speech-processor and Transmitter are the part of
external component of cochlear implant, which remain outside the
body. Receiver/Stimulator (Implanted under the skin) and Electrode
array (implanted in the scala tympani of the cochlea) are the part of
internal component of cochlear implant, which are fitted inside the
body.
82. Patient following peanut consumption
presented with laryngeal edema, stridor,
hoarseness of voice and swelling of
tongue. Most likely diagnosis is
a) Angioneurotic edema
b) Pharyngeal abscess
c) Foreign body larynx
d) Foreign body bronchus
Correct Answer - A
Allergic angloedema: Most common type and usually affects
those with some kind of food allergy.
It can also be caused by insect bites, contact with latex, and some
medications, such as penicillin or aspirin.
In severe cases the throat can swell, making it hard for the patient to
breath.
83. A 36 years old obese man was suffering
from hypertension and snoring. Patient
was a known smoker. In Sleep test, there
were 5 apnea/hyperapneas episodes per
hour. He was given antihypertensives and
advised to quit smoking. Next line of
management:
a) Uvulopalatopharyngeoplasty
b) Weight reduction and diet plan
c) Nasal CPAP
d) Mandibular repositioning sling
Correct Answer - B
The primary treatments of obstructive sleep apnea are: weight loss
in those who are overweight, continuous positive airway pressure,
and mandibular advancement devices. There is little evidence to
support the use of medications or surgery.
Continuous positive airway pressure (CPAP) is effective for both
moderate and severe disease. It is the most common treatment for
obstructive sleep apnea.
Adherence to CPAP is generally better than that to an MRS, and
there is evidence that CPAP improves driving, whereas there are no
such data on MRSs. Thus, CPAP is the current treatment of choice
(for both moderate and severe disease). However, MRSs are
evidence-based second-line therapy in those who fail CPAP.-
Harrison 18/p2189
There is no proven evidence that pharyngel surgery, including
uvulopalatopharyngoplasty (whether by scalpel, laser or thermal
techniques) helps OSAHS patients.
84. A 35 years old pregnant female
complaining of hearing loss, which
aggravated during pregnancy, was sent
for tympanometry. Which of the following
graph will be seen?
a) As
b) Ad
c) B
d) C
Correct Answer - A
A 35 years old pregnant female complained of hearing loss, which
was aggravated during pregnancy. This patient is most probably
suffering from otosclerosis, which is more common in females and
aggravated during pregnancy. Type As tympanogram is seen in
otosclerosis
degenerative myopia?
a) More common in males as compared to females
b) Myopic degeneration can lead to retinal detachment
c) It is seen in less than 6 dioptres of myopia.
d) Retinal tear is less common and it is a late complication
Correct Answer - B
Ans. b. Myopic degeneration can lead to retinal detachment
Degenerative myopia:
* It is seen in more than 6 dioptres of myopia.
* More common in females as compared to males.
- The condition has a racial predilection; it is more common in Jews
and Japanese people, and most cases are of genetic origin.
- Patients with degenerative myopia typically complain of decreased
vision, headaches, and sensitivity to light.
- If retinal degeneration or detachment is present, patients may also
report light flashes and floaters, which are associated with retina
changes.
- Those with degenerative myopia have an increased incidence of
cataract formation (nuclear cataracts are most typical).
Some of the most typical features of degenerative myopia are:
* Vitreous liquefaction and posterior vitreous detachment
* Peripapillary atrophy appearing as temporal choroidal or scleral
crescents or rings around the optic disc
* Lattice degeneration in the peripheral retina
* Tilting or malinsertion of the optic disc, usually associated with
myopic conus
* Thinning of the retinal pigment epithelium with resulting atrophic
appearance of the fundus
* Ectasia of the sclera posteriorly (posterior staphyloma)
Breaks in Bruch’s membrane and choriocapillaris, resulting in lines
across the fundus called “lacquer cracks”
Fuch’s spot in the macular area.
86. Bilateral proptosis in children is the most
common presentation of:
a) Neurofibromatosis
b) PNET
c) Retinoblastoma
d) Neuroblastoma
Correct Answer - D
Ans. d. Neuroblastoma
Leukemic infiltration into the orbit (chloroma) is the most common
cause of bilateral proptosis in children amongst the option provided.
The most common cause of bilateral proptosis in children is not
definitively established, but metastatic neuroblastoma and/or
leukemia (chloroma) should be considered 'The Massachussets Eye
and ear Infirmary review manual for Ophthalmology' 3/e p159, 186
Causes of Bilateral Proptosis
LymphomasQ
LeukemiaQ
Secondaries from:
NeuroblastomaQ
NephroblastomaQ
Ewing's sarcomaQ
MC cause of
unilateral proptosis Orbital cellulitis
in children
MC cause of (non-
inflammatory)
Dermoid cyst°
unilateralproptosis in
children
children
Not definitively
established
MC cause of
. Metastatic
bilateral proptosis in
neuroblastoma°
children
and/or leukemia°
(chloroma)
MC cause of
Thyroid
unilateral proptosis
ophthalmopathy°
in adults
MC cause of
Thyroid
bilateral proptosis in
ophthalmopathy
adults
Bailey and Johnson Head and Neck Surgery 4/1513
MC benign
Cavernous
orbital tumor
Hemangioma
in adults
MC
malignant
Lymphoma°
orbital tumor
in adults
MC benign
orbital tumor Dermoid cyst°
in children
MC
malignant
Rhabdomyosarcomaa
orbital tumor
in children
87. Optic atrophy is not seen in:
a) Retinitis pigmentosa
b) Methanol poisoning
c) Central retinal arterial occlusion (CRAO)
d) Polypoidal choroidal vasculopathy
Correct Answer - D
Answer- D. Polypoidal choroidal vasculopathy
Retinitis pigmentosa, Methanol poisoning and Central retinal arterial
occlusion (CRAO) can lead to optic atrophy.
Occurs secondary to retinal disease (disease of inner retina or its
blood supply)
Its ascending type of optic atrophy.
Causes:
Retinitis pigmentosa
CRAO
Extensive retino choroiditis
88. Band shaped keratopathy is caused by:
a) Amyloid
b) Calcium
c) Monopolysaccharide
d) Lipid
Correct Answer - B
B i.e. Calcium
Band Shaped Keratopathy
It occurs due to deposition of hyaline infiltration of superficial parts of
stroma follwed by deposition of calcareous saltsQ.
A whitish band appears in the inter palpebral area, commencing at
the inner & outer sides, progressing until it forms a continuous band
across the cornea, interspersed with round 'holes' or cleaves within
the band itself. It occurs in
Chronic uveitis especially in blind shrunken eyes, & Still's disease
Aphakic eyesfollowing vitrectomy with silicone oil
Hyperparathyroidism Vitamin D toxicity Sarcoidosis
89. Cells most commonly affected in
glaucomatous optic atrophy?
a) Amacrine cells
b) Bipolar cells
c) Ganglion cells
d) Rods and cones
Correct Answer - C
Answer-C. Ganglion cells
Glaucoma, the second leading cause of blindness, is characterized
by changes in the optic disc and visual field defects'.
The elevated intraocular pressure was considered the prime factor
responsible for the glaucomatous optic neuropathy involving death
of retinal ganglion cells and their axons.
Glaucoma, a leading cause of irreversible visual loss, is
characterized by loss of retinal ganglion cells (RGC) and their axons
over a period of many years.
Mainly the ganglions cells are affected in glaucoma patients, which
may lead to glaucomatus optic atrophy'
indirect opthalmoscopy?
a) Convex lens is used
b) Image is virtual and erect
c) Magnification is 4-5 times
d) It is so bright that regular haziness is penetrated
Correct Answer - B
Answer- B. Image is virtual and erect
Indirect Ophthalmoscopy:
Convex lens is used of +16 to +18 Diopter
Image is real and inverted
Magnification is 4-5 times
It is so bright that regular haziness is penetrated, useful for hazy
media.
91. A 36 years old female on prone dark room
test develops pain in eyes. Which of the
following drugs should be avoided?
a) Acetazolamide
b) Pilocarpine
c) Atropine
d) Timolol
Correct Answer - C
Answer- C. Atropine
'Mydriatic drugs such as atropine, Homatropine, cyclopentolate,
tropicamide and phenylephrine are precipitating factors
for angle closure glaucoma, so contraindicaled in angle closure
glaucoma.'
92. Concentration of tropicamide:
a) 0.01
b) 0.02
c) 0.03
d) 0.04
Correct Answer - A
Answer- A. 0.01
Tropicamide is the shortest acting mydriatic, concentration used is
0.5-l% drops (0.005-0.010).
Tropicamide:
Concentration used: 0.5-l% drops (0.005-0.010)
Duration of action: Though effective for upto 3 hours, maximum
effect appear 30 minutes after the last drop and lasts for only 10-15
minutes
Used in Adults.
93. Which of the following is true regarding
concentration of proteins in senile
cataract?
a) More insoluble protein, less soluble protein
b) More soluble protein, less insoluble protein
c) Equal concentration of soluble and insoluble protein
d) None of the above
Correct Answer - A
Answer- A. More insoluble protein, less soluble protein
In young individuals, most lens proteins are soluble (alpha, beta and
gamma crystallines).
Lenses with cataracts contain more insoluble proteins.
With age, some crystallines become insoluble which is important in
senile cataractogenesis.
94. Changes seen in conjunctiva after vitamti.
A deficiency:
a) Actinic degeneration
b) Hyperplasia of goblet cells
c) Hyperkeratosis of squamous epithelium
d) Stromal infiltration
Correct Answer - C
Answer- C. Hyperkeratosis of squamous epithelium
Change seen in coniunctiva after vitamin A deficiency is
hyperkeratosis of squamous epithelium.
'Vitamin A is necessary for normal differentiation of nonsquamous
epithelium; keratinization is a direct consequence
of its deficieny.
Reduced aqueous tear production, and irregularities of the
keratinized surface may all contribute to stromal melting, which can
occur in the absence of inflammatory infiltration or bacterial invasion.
Squamous metaplasia and keratinization.
95. Which of the following drug should not be
given in a patient of narrow angle
glaucoma?
a) Phenylephrine
b) Timolol
c) Acetazolamide
d) Homatropine
Correct Answer - D
Answer- D. Homatropine
Homatropine is a mydriatic, which can precipitate angle closure
glaucoma and contraindicated in angle closure glaucoma.
Phenylephrine, Timolol and Acetazolamide are used for the
treatment of angle closure glaucoma.
'Mydriatic drugs such as atropine, Homatropine, cyclopentolate,
tropicamide and phenylephrine are precipitating factors
for angle closure glaucoma, so contraindicated in angle closure
glaucoma.
Pterygium?
a) Probe can be passed underneath the pterygium at the limbus
b) Associated with exposure to infrared radiation
c) Bare sclera technique has 30-80% recurrence
d) Elastotic degeneration with distortion of Descemet's membrane
Correct Answer - C
Answer- C. Bare sclera technique has 30-80% recurrence
Simple excision ('bare sclera' technique) is associated with a high
rate of recunence (around 80%) that maybe more
aggressive than the initial lesion.
Pterygium:
Probe cannot be passed underneath the pterygium at the limbus, as
its adherent all around
Associated with exposure to ultra-violet radiation
Bare sclera technique has 30-80% recurrence
Elastotic collagenous degeneration with proliferation ofvascularized
granulation tissue, which invades cornea
Corneal epithelium, Bowman's layer and superficial stroma are
destroyed by invading tissue.
97. In which of the following, long spaced
collagen present?
a) Diaphragm
b) Cornea
c) Basement membrane
d) Tympanic membrane
Correct Answer - B
Answer- B. Cornea
'Long-spacing collagen is a common component of normal human
corneal stroma and its occurrence seems to correlate
with the age-related changes of the tissue.
Corneal transparency is mainly dependent on the arrangement of
these collagen fibers in stroma.
98. A 55- year old diabetic patient presents
with transient obscuration in vision for 2-3
days followed by sudden loss of vision.
Which of the following would be the best
test to evaluate the symptoms?
a) Serum ACE levels
b) Quantiferon-Gold TB test
c) Elevated homocysteine levels
d) Serum creatinine levels
Correct Answer - D
Answer- D. Serum creatinine levels
DM can lead to both retinopathy and nephropathy, Serum creatinine
levels would be the best for kidney function and evaluation of patient
symptoms.
99. A female patient of childbearing age is on
valproate for JME. Which drug should be
used to replace valproate and can be
prescribed as monotherapy?
a) Levetiracetam
b) Lincosamide
c) Carbamazepine
d) Phenytoin
Correct Answer - A
Answer- A. Levetiracetam
Levetiracetam can be prescribed as monotheropy in a female patient
of childbearing age is on valproate JME, because of no known
significant drug interactions.
Drug of choice for the treatment of JME is sodium valproate.
valproate should be avoided in women of childbearing age, because
of significantly increased risk of fetal malformations and
neurodevelopmental delay.
Levetiracetam or lamotrigine are alternative first-line options if
valproate is contraindicated.
Valproate is often used to treat juvenile myoclonic epilepsy.
100. A patient on amphotericin B develops
hypokalemia of 2.3 meq/l. K+
supplementation required?
a) 40 mEq over 24 hours
b) 60 mEq over 24 hours
c) 80 mEq over 24 hours
d) 120-160 mEq over 24 hours
Correct Answer - D
Ans. d. 120-160 mEq over 24 hours
Except in unusual circumstances, the total amount of potassium
administered daily should not exceed 200 mEq.
Potassium Supplementation
A prudent protocol to follow is to add potassium chloride to IV
solutions at a final concentration of 40-60 mEq/L and to administer
no more than 10-20 mEq/L of potassium per hour
Except in unusual circumstances, the total amount of potassium
administered daily should not exceed 200 mEq.
IV potassium replacement is indicated for patients with severe
hypokalemia and for those who can not take oral supplementation.
For severe deficiency, potassium may be given through a peripheral
IV line in a concentration that should exceed 40 mEq/L, at the rates
upto 40 mEq/L/Hour.
Continuous ECG monitoring is indicated and the serum potassium
levels should be checked every 3-6 hours.
For the initial administration, avoid glucose containing fluid to
prevent further shift of potassium intothe
cells. .
Magnesium deficiency also needs to be corrected at the same time,
particularly in refractory hypokalemia
101. A patient with Tubercular meningitis was
taking ATT regularly. At end of 1 month
of regular intake of drugs deterioration in
sensorium is noted in condition of the
patient despite good compliance for
drugs. Which of the following
investigations is not required as
emergency condition?
a) MRI
b) NCCT
c) CSF examination
d) Liver function tests
Correct Answer - C
Answer- C. CSF examination
Altered sensorium might be due to raised intracranial tension and
lumbar punctare can precipitate the ominous herniation of the brain.
So, lumbar puncture (for CSF examination) is not required on
emergency evaluation in the above mentioned patient.
Altered sensorium in a patient of Turbercular meningitis, who was
taking ATT from the last one month maybe due to
Hepatic encephalopathy secondary to hepatotoxicity of ATT. Hence,
LFT should be performed.
Diagnosis:
Lumbar puncture is cornerstone of diagnosis (should not be done in
cases or raised ICT).
CSF examination reveals high leukocyte counto (usually
predominance of lymphocytes but often with a predominance of
neutrophils in the early stage), a protein content of I to 8 g/L (100 to
800 mg/dl) and a low glucose concentration.
Culture of CSF is diagnostic in 80% cases.
CT or MRI may show hydrocephalus and abnormal enhancement of
basal cisterns or ependyma.
102. Recently approved drug by FDA for
treatment of Lennox-Gestaut syndrome:
a) Lacosamide
b) Vigabatrin
c) Zonisamide
d) Rufinamide
Correct Answer - D
Answer- D. Rufinamide
Recently approved drug by FDAfor treatment of Lennox-Gestaul
syndrome is rufinamide.
Rufinamide:
Rufinamide was approved by the US Food and Drug Administration
on November 14, 2008 as adjunctive treatment of seizures
associated with Lennox-Gastaut syndrome in children 4 years and
older and adults.
103. A patient with native aortic valve disease
came with right hemiparesis. What will
you do to prevent further stroke?
a) Antiplatelet only
b) Anticoagulant only
c) Both antiplatelet and anticoagulant
d) One dose of low molecular weight heparin sub-cutaneously

followed by dual antiplatelet therapy
Correct Answer - A
Answer- A. Antiplatelet only
* Aspirin is the only antiplatelet agent that has been proven
elfectivefor the acute treatment of ischemic stroke; use of aspirin
within 48 hoars of stroke onset reduced both stroke recurrence risk
and mortality minimally.
* Asprin is the only antiplatelet agent that has been proven effecfive
for the acute treatment of ischemic stroke; there are several
antiplatelet agents proven for the secondary prevention of stroke.
* Two layer trials, the International Stroke Trial (IST) and the
Chinese Acute Stroke Trial (CAST),found that the use ofaspirin
within 48 hours ofstroke onset reduced both stroke recurrence risk
and mortality minimally.
104. Which of the following is true about CML
in children?
a) Translocation between long arm of chromosome 9 and short
arm of chromosome 22
b) Protein tyrosine kinase inhibitors are used in treatment
c) Commonly presents as blast crisis
d) 2nd most common leukemia in children
Correct Answer - B
Answer- B. Protein tyrosine kinase inhibitors are used in treatment
Protein tyrosine kinase inhibitors (lmatinib mesylate) are used in
treatment of CML.
Imatinib (Gleevec) gets rapidly become the treatment of choice for
patients with chronic-phase CML.
Treatment for CML-
Imatinib therapy controls blood counts and substantially decreases
the risk of transformation to the accelerated phase and blast crisis,
which is the greatest threat to the patient..
For relatively young patients, allogenic bone marrow transplantation
performed in the stable phase is curative in about 75% of cases and
remains the treatment of choice.
Imatinib (Gleevec) has rapidly become the treatment of choice for
patients with chronic-phase CML.
105. Coarse tremors of tongue is seen in all
except:
a) Parkinsonism
b) Alcohol
c) Thyrotoxicosis
d) General paresis
Correct Answer - C
Answer- C. Thyrotoxicosis
Typically the tremor of Parkinson's disease is asymmetrical, at least
initially, and affects an upper limb involving the ipsilateral leg after a
latency of approximately two years. The disease may also produce
tremor of the lips, tongue or jaw but it rarely causes significant head
or vocal tremor.
Fine tremors- Thyrotoxicosis
106. A lady developed breathlessness,
pruritus, urticaria 1 hour after eating
NSAIDS for headache. Chest
examination was remarkable for rales
with BP-80/50 mm Hg. All of following
can be used for initial management
except:
a) Crystalloids infusion
b) Steroids
c) Early respiratory support and oxygenation
d) Adrenaline
Correct Answer - B
Answer- B. Steroids
Mild symptoms such as pruritus and urticaria can be controlled by
administration of 0.3 to 0.5 mL of l: 1000 (l mg/mL) epinephrine SC
or IM.
An IV infusion should be initiated to provide a route for
administration of 2.5 mL epinephrine, diluted l: 10,000, at 5- to l0-
min intervals, volume expanders such as normal saline, and
vasopressor agents such as dopamine if intractable hypotension
occurs.
Oxygen alone via a nasal catheter or with nebulized albuterol may
be helpful, but either endotracheal intubation or a tracheostomy is
mandatory for oxygen delivery if progressive hypoxia develops.
107. Which among the following is not a risk
factor for contrast-induced
nephropathy?
a) Diabetic nephropathy
b) High osmolar agent
c) Obesity
d) Dehydration
Correct Answer - C
Ans. C
Side effects of iodinated contrast material are:
Idiosyncratic – Anaphylactoid reaction. They are complement-
mediated reactions and not IgE. The patient develops
bronchospasm and hypotension.
Dose-dependent side effect – Contrast-induced nephropathy and
seen especially with high osmolar agents.
Contrast-induced nephropathy:
The patient has non-oliguric transient nephropathy and occurs due
to tubular damage. It is defined as the impairment of renal function
and is measured as either a 25% increase in serum creatinine from
baseline or 0.5 mg/dl increase in absolute value, within 48-72hrs of
intravenous contrast administration.
Risk Factors for Contrast Medium-Induced Nephropathy:
Patient-related:
eGFR < 60 mL/min/1.73 m2 before intra-arterial administration
eGFR < 45 mL/min/1.73 m2 before intravenous administration
In particular in combination with:
Diabetic nephropathy
Dehydration
Congestive heart failure (NYHA grade 3–4) and low LVEF
Recent myocardial infarction (
Intra-aortic balloon pump
Peri-procedural hypotension
Low hematocrit level
Age over 70
Concurrent administration of nephrotoxic drugs
Known or suspected acute renal failure
Procedure-related:
Intra-arterial administration of contrast medium
High-osmolality agents
Large doses of contrast medium
Multiple contrast medium administrations within a few days
If the patient is on Metformin and is having de-arranged RFT, then
before giving contrast agent metformin should be stopped since it
can precipitate lactic acidosis
108. A 50 years old patient presented with
progressive jaundice. Liver function test
was done in which conju¬gated serum
bilirubin-4.8% and total bilirubin-6.7%,
alkaline phosphatase- 550 IU, SGOT-50,
SGPT-65. Most probable diagnosis is;
a) Jaundice due to choledocholithiasis
b) Dubin-Johnson syndrome
c) Viral hepatitis
d) Malignant obstructive jaundice
Correct Answer - A
Answer- A. Jaundice due to choledocholithiasis
The maximum bilirubin level is seldom >256.5 micromol/L (15.0
mg/dl) in patients wilh choledocholithiasis unless concomitant
hepatic disease or anotherfactor leading to marked
hyperbilirubinemia exists.'-Harrison I8/e p2625.
'Serum bilirubin levels >342.0 micromol/L (20 mg/dL) should suggest
the possibility of neoplastic obstruction.'-Harrisonl8/e p2625
Choledocholithiasis
CBD stones should be suspected in any patient with cholecystitis
whose serum bilirubin level is >85.5 micromol/L (5 mg/dL).
The maximum bilirubin level is seldom >256.5 micromol/L (15.0
mg/dl) in patients with choledocholithiasis.
109. A 60 years old male with alcoholic liver
disease presented to emergency with a
history of hematemesis. Which of the
following is false regarding his
management'
a) Somatostatin infusion is indicated
b) Negative nasogastric aspirate does not exclude variceal bleed
c) Nasogastric tube insertion can provoke variceal bleeding
d) Upper GI endoscopy is done initially
Correct Answer - C
Answer- C. Nasogastric tube insertion can provoke variceal bleeding
Octreotide is the preferred pharmacologic agent for initial
management of acute variceal bleeding.
Management of Acute Variceal Bleeding:
Patients should be admitted to an ICU for resuscitation and
managementa.
Blood resuscitation should be performed to a hemoglobin level of 8
g/dL.
Over-replacement of packed red blood cells and the overzealous
administration of saline can lead to both rebleeding and increased
mortality.
Administration of FFP and platelets in patients with severe
coagulopathy.
Shunt therapy (surgical shunts or TIPS) has been shown to control
refractory variceal bleeding.
Combination of pharmacologic and EVL therapy improve initial
control of bleeding and increase the 5-day hemostasis rate.
110. A 50 years old male patient came to
emergency with right hemiparesis and
loss of speech for 2.5 hours. BP is
180/100. What is the next best step in the
management of this patient?
a) Give antihypertensive to control BP
b) Aspirin 300 mg and anticoagulants
c) Administer t-Plasminogen activator
d) Go for NCCT
Correct Answer - D
Answer- D. Go for NCCT
CT imaging of the brain is the standard imaging modality to detect
the presence or absence of intracranial hemorrhage. If the stroke is
ischemic, administration of recombinant tissue plasminogen
activator (rtPA) or endovascular mechanical thrombectomy may be
beneficial in restoring cerebral perfusion. Medical management to
reduce the risk of complications becomes the next priority, followed
by plans for secondary prevention.'- Harrison 18e/p3273.
111. A 32 years old Bengali women had fever
since 48 hours with history of irrelevant
talk and 2 episodes of tonic clonic
seizures on succession on the way to
hospital. She was previously alright.
Which of the following drug can be given
while rest of the investigations were
being carried out?
a) IV mannitol
b) IV amphotericin B
c) IV penicillin
d) IV acyclovir
Correct Answer - D
Answer- D. IV acyclovir
Acyclovir is of benefit in the treatment of HSV and should be started
empirically in patients with suspected viral encephalitis, especially if
focal features arc present, while awaiting viral diagnostic studies.'-
Harrison l8/e
112. A 14 years old male child presented with
abnormal body movements with MRI
showing signal changes in corpus
striatum, thalami, pons, medulla,
centrum semiovale and asymmetric
diffuse white matter involvement. Most
likely diagnosis is:
a) Parkinsonism
b) Nigrostriatal degeneration
c) Wilson's disease
d) Hallervorden-Spatz disease
Correct Answer - C
Answer- C. Wilson's disease
Wilson disease:
Wilson disease usually presents with tremors, rigidity, dementia, and
pseudobulbar features and has an autosomal recessive mode of
inheritance.
Slit-lamp examination of the eyes may reveal a Kayser-Fleischer
ring.
MRI in Wilson disease exhibits the characteristic changes consisting
of high-intensity lesions in the basal ganglia, thalami, and mid brain
on T2-weighted images. The normal low intensity of red nuclei and
SN surrounded by abnormal high-signal intensity in the tegmentum
of the mid brain gives rise to the typical 'face-of-the-giant-panda'
sign.
Best diagnostic clue is symmetrical T2 hyperintensity.
113. In which of the following glucocorticoid
is used?
a) E.coli septicemia
b) Severe typhoid
c) Cerebral Malaria
d) Leishmaniasis
Correct Answer - B
Answer- B. Severe typhoid
In critically ill patients with enteric fever, the administration of
dexamethasone with chloramphenicol was asssociated with a
sabstantially lower mortality rate than was treatment with
chloramphenicol alone.
114. True about critical illness
myoneuropathy?
a) Neurological recovery is completed
b) Sequential nerve demyelination followed by inflammatory

myopathy during course of disease
c) Cranial nerves are involved more commonly than peripheral

nerve
d) Diaphragmatic atony due to prolonged intubation may cause it
Correct Answer - D
Answer- D. Diaphragmatic atony due to prolonged intubation may
cause it
Diaphragmatic atony due to prolonged intubation may cause critical
illness myoneuropathy.
Critical Illness Myoneuropathy (CIM):
The most common causes of acute generalized weakness leading to
admission to a medical intensive care unit (ICU) are GBS and
myasthenia gravis. However, weakness developing in critically ill
patients while in the ICU is usually caused by critical illness
polyneuropathy (CIP) or critical illness myopathy (CIM).
CIM is more common. Both CIM and CIP develop as a complication
of sepsis and multiple organ failure. They usually present as an
inability to wear a patient from a ventilator.
115. True about critical illness
myoneuropathy?
a) Neurological recovery is completed
b) Sequential nerve demyelination followed by inflammatory

myopathy during course of disease
c) Cranial nerves are involved more commonly than peripheral

nerve
d) Diaphragmatic atony due to prolonged intubation may cause it
Correct Answer - D
Answer- D. Diaphragmatic atony due to prolonged intubation may
cause it
Diaphragmatic atony due to prolonged intubation may cause critical
illness myoneuropathy.
Critical Illness Myoneuropathy (CIM):
The most common causes of acute generalized weakness leading to
admission to a medical intensive care unit (ICU) are GBS and
myasthenia gravis. However, weakness developing in critically ill
patients while in the ICU is usually caused by critical illness
polyneuropathy (CIP) or critical illness myopathy (CIM).
CIM is more common. Both CIM and CIP develop as a complication
of sepsis and multiple organ failure. They usually present as an
inability to wear a patient from a ventilator.
116. A patient developed sudden severe
headache two hours ago and become
unconscious. Upon regaining conscious,
patient developed photophobia and neck
rigidity, What is the next line of
management?
a) Non-contrast CT scan
b) IV antibiotics
c) Lumbar puncture
d) IV mannitol
Correct Answer - A
Answer- A. Non-contrast CT scan
Diagnosis:
Noncontrast CT scan: Investigation of choice (Lumbar puncture is
not indicated prior to an imaging procedure)
CSF picture: Hallmark of aneurysmal rupture is blood in CSF
(Xanthochromic spinal fluid)
Lumbar puncture should be performed if the CT scan fails to
establish the diagnosis of SAH and no mass lesion or obstructive
hydrocephalus is found to establish the presence of subarachnoid
blood.
117. All of the following are true about
aspiration pneumonia except:
a) Aspiration of 20-30 mL of contents with pH < 2.5 is required
b) Fungal infection is the common cause of pneumonia
c) Posterior segment of the right upper lobe is most commonly

affected in the recumbent position
d) Aspiration responsible for 5-15% of community acquired

pneumonia
Correct Answer - B
Answer- B.Fungal infection is the common cause of pneumonia
Mixed polymicrobial infection involving both aerobes and anaerobes
are the common cause of aspiration pneumonia, not the fungal
infection.
Incidence: It is common and may account for up to 15% of patients
with community-acquired pneumonia.
Gastric pH of 2.5 or less with a gastric contents volume greater than
25 ml are critical values for causing aspiration pneumonia.
The posterior segments of the upper lobe and apical segments of
lower lobes are most commonly involved when aspiration occurs in a
supine position.
The basal segments of the lower lobes are usually affected in
patients who aspirate in an upright or semirecumbent position.
118. The most common subtype of Non-
Hodgkin's lymphoma in India is:
a) Diffuse small cell lymphocytic lymphoma
b) Diffuse large B cell lymphoma
c) Follicular lymphoma
d) Burkitt's lymphoma
Correct Answer - B
Answer- B. Diffuse large B cell lymphoma
The most common subtype of Non-Hodgkin's lymphomt in India is
dilfuse large B cell lymphoma.
Diffuse large B-cell lymphoma: MC subtype (34%)
Follicular centre-cell lymphomas: 12.6% .
B-celf small lymphocytic lymphoma:.5.7%
Mantle-cell lymphoma: 3.4%
Marginal zone B-cell lymphomas (including MALT lymphomas):
8.2%
hemoptysis?
a) Massive hemoptysis is bleeding > 600 ml in 24 hours
b) In 90% cases, bleeding from bronchial arteries
c) CT chest is the first investigation done
d) In an unstable patient, rigid bronchoscopy is done to identify the

lesion
Correct Answer - C
Answer- C. CT chest is the first investigation done
'For most patients, the next step in evaluation of hemop4tsis should
be a standard chest radiograph. If a source of bleeding is not
identified on plain film, a CT of the chest should be obtained. '-
Harrison I 8/e p285
120. Acquired cause of pure red cell aplasia
are all except:
a) ABO incompatibility in bone marrow transplantation
b) Lymphoma
c) Drug induced-NSAIDs
d) Chromosome 5q deletion syndrome (5q monosomy)
Correct Answer - C
Answer- C. Drug induced-NSAIDs
NSAIDs are not the cause of Acquired pure red cell aplasia.
Acquired pure red cell aplasia:
Cancer: Thymoma, Lymphoid malignancies, Paraneoplastic to solid
tumors.
Drugs: Phenytoin, azathioprine, Chloramphenicol, Procainamide,
isoniazid
121. All of the following are criteria for
admission in upper GI bleed except:
a) Shock index >1.5
b) Hematocrit > 40%
c) Frank blood in nasogastric aspirate
d) BP <100 mm Hg
Correct Answer - B
Answer- B. Hematocrit > 40%
Hematocrit > 40% is not a criteria for admission in upper GI bleed.
Shock index >1.5, Frank blood in nasogastric aspirate and BP <100
mm Hg are the indications of hospital admission and resuscitation in
upper GI bleed.
122. All of the following are true about iron
deficiency anemia except:
a) Transferrin saturation <16%
b) Detected by serum ferritin levels even in earlier states
c) Mostly presents without any symptoms with abnormal

laboratory findings
d) Latent anemia is most prevalent in India
Correct Answer - C
Answer- C. Mostly presents without any symptoms with abnormal
laboratory findings
Iron deficiency anemia is widely prevalent in India.
IDA is preceded by a stage of latent iron deficiency, where serum
ferritin is reduced but hemoglobin is normal.
Iron Deficiency Anemia:
Decreased MCV and MCH
Elevated red cell distribution width
Increased TIBC
Decreased serum iron
Decreased serum ferritin
Transferrin saturation <10.
123. Which of the following drug can be given
in patients of primary pulmonary
hypertension?
a) Icatibant
b) Bosentan
c) Labetolol
d) Sodium nitroprusside
Correct Answer - B
Answer- B. Bosentan
Treatment for Primary pulmonary hypertension:
CALCIUM CHANNEL BLOCKERS:
Patients who respond to short-acting vasodilators at the time of
cardiac catheterization should be treated with calcium channel
blockers.
The endothelin receptor antagonists bosentan and ambrisentan are
approved treatments of PAH
Bosentan is contraindicated in patients who are on cyclosporine or
glyburide concurrently.
124. A 50 years old female on junk food diet
presented with point hemorrhages in
scalp, bleeding in joints and
erythemataous lesions in the skin. X-ray
of knee joint was suggestive of
hemarthrosis. Problem lies with:
a) Hydroxylation of proline and lysine
b) Carboxylation of glutamic acid
c) Carboxylation of coagulation factors
d) Platelet aggregation defect
Correct Answer - A
Answer- A. Hydroxylation of proline and lysine
Vitamin C is required for post-translational modification of lysine and
proline in collagen synthesis
Hydroxyproline is formed by post-translational hydroxylation
catalyzed by prolyl hydroxylase, whose cofactors are ascorbic acid
and Keto- alpha glutarate.
125. All of the following are true about severe
malaria except:
a) Hypoglycemia, blood sugar level less than 40 mg
b) Creatinine more than 3 mg/dL
c) LDH > 750 U/L
d) Hematocrit more than 15
Correct Answer - D
Answer- D. Hematocrit more than 15
Hematocrit <15 (not more than 15) is suggestive of severe malaria.
Manifestations of Severe Falciparum Malaria:
Hematocrit of <15% or hemoglobin level of <50 g/L (<5 g/dl) with
parasitemia level of > 100,000/microL
Serum creatinine level of >265 micromol,{L (>3 mg/dl)
Plasma glucose level of <2.2 mmol/L (<40 mg/dL)
126. An adult hypertensive male presented
with sudden onset severe headache and
vomiting. On examination, there is
marked neck rigidity and no focal
neurological deficit was found. The
symptoms are most likely due to:
a) Intracerebral parenchymal hemorrhage
b) Ischemic stroke
c) Meningitis
d) Subarachnoid hemorrhage
Correct Answer - D
Ans. d. Subarachnoid hemorrhage
The most likely diagnosis here is a subarachnoid bleed (SAH).
The most common cause is trauma and is managed conservatively.
The second most common cause is a rupture of a berry aneurysm.
The typical presentation of a subarachnoid hemorrhage includes a
‘thunderclap’ headache.
Meningitic features of neck stiffness and photophobia often
develop over hours.
Computed tomography (CT) is the investigation of choice.
Lumbar puncture should be performed if the CT scan fails to
establish the diagnosis of SAH; it shows a xanthochromic blood
picture.
Delayed ischemic neurological deficit (DIND) is attributed to
vasospasm of the cerebral vasculature typically developing 3–10
days following ictus. It is the main cause of a poor outcome.
Endovascular treatment ("coiling") is generally preferred over
craniotomy and clipping for aneurysms amenable to this approach.
127. Mortality associated with emergency
abdominal aortic surgery is-
a) 0.1%
b) 0.2 %
c) 0.4 %
d) >50%
Correct Answer - D
Answer- D. >50%
With careful preoperative cardiac evaluation and postoperative care,
the operative mortality rate approximates l-2%.
After acute rupture, the mortality rate of emergent operation is 45-
50%. Endovascular repair with stent placement is an emerging
approach but at the current time is associated with a mortality rate of
approximately 40%'- Harrison I 8/e p2063.
128. A 35 years old lactating mother
presented with a painful breast lump.
Most appropriate initial investigation
should be-
a) Mammography
b) USG
c) MRI
d) X-ray
Correct Answer - B
Answer- B. USG
USG and needle biopsy are used for diagnosis
Mammography is rarely indicated due to its decreased sensitivity
during pregnancy and lactation
129. Lactating women with painful breast, 1st
investigation to be done should be:
a) USG
b) Mammography
c) CT
d) MR1
Correct Answer - A
Ans. USG
130. Anorchia best diagnosed by:
a) USG
b) SPECT
c) CT
d) Laparoscopy
Correct Answer - D
Ans. Laparoscopy
131. In a couple for treatment of infertility
from the last four years, female partner is
normal. Male partner has 0.8 ml semen
volume per ejaculate on two repeated
samples and absent fructose, with no
sperms on examination under
microscope. What is the next line of
management?
a) Per-rectal examination to check ejaculatory duct obstruction
b) Give antioxidants
c) Testicular biopsy
d) Transrectal ultrasound to detect duct obstruction
Correct Answer - D
Answer- D. Transrectal ultrasound to detect duct obstruction
Absent fructose with no sperms in ejaculate is suggestive of
obstruction of vas deferens with seminal vesicle agenesis or
obstruction. Next line of management in this patient would be
transrectal ultrasound to detect duct obstruction.
Transrectal Ultrasound-
High-frequency (5-7) mHz transrectal ultrasound (TRUS) offers
superb imaging of the prostate, seminal vesicles, and ejaculatory
ducts.
Due to both accuracy and convenience, TRUS has replaced surgical
vasography in the diagnosis of obstructive lesions that cause
infertility.
132. A patient with spine, chest and
abdominal injury in road traffic accident
developed hypotension and bradycardia.
Most likely reason is:
a) Hypovolemic shock
b) Hypovolemic + neurogenic shock
c) Hypovolemic + septicemic shock
d) Neurogenic shock
Correct Answer - D
Answer- D. Neurogenic shock
Neurogenic shock- In addition to arteriolar dilation, venodilation
causes pooling in the venous system, which decreases venous
return and cardiac output.'- Harrison I8/e
Interruption of sympathetic vasomotor input after a high cervical
spinal cord injury, inadvertent cephalad migration of spinal
anesthesia, or devastating head injury may result in neurogenic
shock.
133. Full form of FAST?
a) Focused abdominal sonography for trauma
b) Focused assessment by sonography for trauma
c) Focussed assessment by sonography and tomography
d) Fast assessment by sonography and trauma
Correct Answer - B
Ans. Focused assessment by sonography for trauma
FAST stands for Focused assessment with Sonography for
trauma. It is a rapid diagnostic examination to assess patients
with potential thoracoabdominal injuries.
Performed within 2-4 minutes.
Sequentially surveys for the presence or absence of blood in
the pericardial sac, the Right Upper Quadrant (RUQ), Left Upper
Quadrant (LUQ), and pelvis.
4 ‘Ps’ are evaluated in sequence: Pericardial sac → Perihepatic
region → Perisplenic region → Pelvis.
FAST also stands for Focussed abdominal sonography for
trauma. However, since FAST is not only used to assess abdominal
injuries but also to assess haemopericardium in cases of pericardial
injuries, the expansion "Focussed assessment with sonography
for trauma" is preferred.
134. A patient after road traffic accident
presented with tension pneumothorax.
What is the first line of management?
a) Insert wide bore needle in 2nd intercostal space
b) Immediate chest X-ray
c) CT scanEmergency thoracotomy
d) Emergency thoracotomy
Correct Answer - A
Answer- A. Insert wide bore needle in 2nd intercostal space
First line of management in tension pneumothorax: Insert wide bore
needle in 2nd intercostal space.
135. A 60 years old male presented with fever,
chills and dysuria. Patient was
hospitalized in emergency for 5 days.
PSA level was 7.4. Next best step in this
patient:
a) Repeat PSA
b) TURP
c) TRUS guided biopsy
d) Antibiotics and admit
Correct Answer - D
Answer- D. Antibiotics and admit
Treatment for acute bacterial prostatitis:
MC used antibiotics are: TMP-SMX and Ciprofloxacin (Both are
having better concentration in prostatic tissue)
Around 4-6 weeks of antibiotic therapy is used to avert chronic
bacterial prostatitis.
136. Best management of contaminated
wound with necrotic material:
a) Debridement
b) Tetanus toxoid
c) Gas gangrene serum
d) Broad spectrum antibiotics
Correct Answer - A
Answer. A. Debridement
Management for necrotizing fascilitis:
This is a surgical emergency and surgical debridement is mandatory
Treatment: Urgent surgical debridement + IV fluids + Broad
spectrum IV antibiotics + Supportive treatment
137. High priority in triage is for -
a) Red color
b) Yellow color
c) Green color
d) Black color
Correct Answer - A
Ans. is 'a' i.e., Red colour
138. Which of the following is false regarding
endemic bladder stones?
a) Always associated with recurrence
b) High incidence in cereal based diet
c) Peak incidence in 3 years old children in India
d) Most common type is ammonium urate or calcium oxalate
Correct Answer - A
Answer- A. Always associated with recurrence
Primary bladder calculi are most common in children younger than
the age of 10, with a peak incidence at 2 to 4 years of age. The
disease is much more common in boys than in girls.
'Stones are usually solitary and once removed, rarely recurr'-
Campbell 10/e p2522
Ammonium acid urate, calcium oxalate, uric acid, and calcium
phosphate are the most common components of primary bladder
calculi.- Campbell 10/e p2522
139. In Glasgow coma scale, withdrawal to
pain stimulus comes under:
a) M4
b) M3
c) M2
d) M5
Correct Answer - A
Answer- A. M4
Maximum score-15, minimum score-3.
Best predictor of outcome: Motor response
Patients scoring 3 or 4 have an 85% chance of dying or remaining
vegetative, while scores above indicate only a 5-l0% likelihood of
death.
140. Tumor marker for seminoma:
a) PLAP
b) LDH
c) AFP
d) HCG
Correct Answer - A
Answer- A. PLAP
PLAP (Placental alkaline phosphatase):
Elevated levels present in as many as 40% patients with advanced
disease.
Most useful as a marker for bulk disease.
Elevated in seminomaa
141. A 60 years old man presents to the
emergency department with history of
RTA, in unconscious state and gains
consciousness in between but again
becomes unconscious. The time when
he becomes conscious is called as:
a) Lucid Interval
b) Extradural hematoma
c) Subdural hematoma
d) None
Correct Answer - A
Answer-A. Lucid interval
This is a period occurring in insanity, during which all the symptoms
of insanity disappear completely
The individual is able to judge his acts soundly, and he becomes
legally liable for his acts
Lucid interval is seen in mania, melanocholia and Extradural
hemorrhage.
142.
A young healthy male patient presented with
abdominal pain and history of altered bowel
habits from the last 6 months. On CT
examination, there was dilated distal part of
ileum, thickened ileocecal junction with
thickened cecum with presence of
sacculations on the antimesenteric border.
The vascularity of adjoining mesentery is
also increased and there is surrounding
mesentery fat. Which of the following is not a
differential diagnosis?
a) Ulcerative colitis
b) Crohn's disease
c) Tuberculosis
d) Ischemic bowel disease
Correct Answer - D
Answer- D. Ischemic bowel disease
CT scans associated with bowel ischemia include dilation of the
bowel lumen, bowel wall thickening abnormal bowel wall
enhancement, arterial occlusion, venous thrombosis, and intramural
or portal venous gas
Dilation of an ischemic bowel segment suggests interruption of
normal peristaltic activity.
Symmetrical bowel wall thickening greater than 3 mm in a distended
segment.
143. In which of the following, neo-adjuvant
chemotherapy is not used?
a) Osteosarcoma
b) Chest wall PNET
c) Breast cancer stage 2
d) Ovarian cancer stage 3
Correct Answer - C
Answer- C. Breast cancer stage 2
A. Early Invasive Breast Cancer (Stage I, IIA, IIB):
Mastectomy + Axillary LN status assessmenta or BCT + Axillary LN
status assessment + RT
If sentinel LN can not be identified or found to harbor metastatic
disease, axillary LN dissection (Level I+Il) should be done.
144. An 8 year old boy complaints of
increasing muscle weakness. On
examination, his calves are bulky and
show muscle tightening. His serum
creatine kinase levels are increasing with
age. Which of the following is the most
likely diagnosis?
a) Hereditary sensorimotor neuropathy
b) Myelin deficiency
c) Dystrophin deficiency
d) Congenital myopathy
Correct Answer - C
Answer- C. Dystrophin deficiency
Most likely diagnosis is duchenne Muscular Dystrophy due to
Dystrophin deficiency.
145. A 2 year old premature neonate develops
GTCS. What is the best investigation
done to diagnose the pathology?
a) Transcranial ultrasound
b) CT Head
c) MRI brain
d) X-ray
Correct Answer - A
Answer- A. Transcranial ultrasound
Diagnostic Procedures:
Polygraphic video-EEG recording ofsuspected events is probably
mandatory for an incontrovertible seizure diagnosis.
It is performed at the bedside and provides effective assessment of
ventricular size and other fluid-containing lesions as well as effective
viewing of haemorrhagic and ischaemic lesions and their evolution.
CT brain scan is often of secondary or adjunctive importance to
ultrasound. Last-generation CT brain scan images
are of high resolution, can be generated within seconds and can
accurately detect haemorrhage, infarction, gross
malformations and ventricular and other pathological conditions.
MRI is much superior for abnormalities of cortical development used
for the detection of structural abnormalities
such as malformations of cortical development, intracranial
haemorrhage, hydrocephalus and cerebral infarction.
146. A pediatrician in a district hospital with
specialization neonatal care unit calls an
ophthalmologist for consultation for
which of the following?
a) A newborn with respiratory distress
b) A baby born at 28 weeks of gestation
c) Newborn with jaundice
d) A newborn with birth weight 2300 grams
Correct Answer - B
Answer- B. A baby born at 28 weeks of gestation
Premature baby needs to be screenedfor Retinopathy of
prematurity.
All babies weighing <1500 gm or having a gestational period <32
weeks should be screened with indirect ophthalmoscopy
between 32-36 weeks postconception.
147. An Afroamerican boy DI car ui age
presented with abdominal pain, chronic
hemolysis and abnormal RBC shape on
peripheral smear. Most likely disorder
responsible for this condition:
a) Point mutation
b) Trinucleotide repeat
c) Antibody against RBC membrane
d) Genomic imprinting
Correct Answer - A
Ans. a. Point mutation
This patient is suffering from sickle cell anemia.
'Sickle cell anemia is an autosomal recessive disease that results
from the substitution of valine from glutamic acid at
position 6 of the beta-globin gene (Point mutation)- Ghai
Sickle cell disease is a common hereditary hemoglobinopathy that
occurs primarily in individuals of African descent.
In certain populations in Africa the prevalence of heterozygosity is as
high as 30%. This high frequency probably stems from protection
afforded by HbS against falciparum malaria.
Morphology:
* Peripheral blood demonstrates variable numbers of irreversibly
sickled cells, reticulocytosis, and target cells,
* Howell-Jolly bodies (small nuclear remnants).
* The bone marrow is hyperplastic as a result of a compensatory
erythroid hyperplasia.
* Expansion of the malrow leads to bone resorption and secondary
new bone formation, resulting in prominent cheekbones and
changes in the skull that resemble a crew-cut in X-rays.
* Increased breakdown of hemoglobin can cause pigment gallstones
and hyperbilirubinemia.
* Splenic infarction, fibrosis, and progressive shrinkage
(autosplenectomy)
148. 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.
149. All of the following syndromes are
associated with uniparental disomy
except-
a) Prader-Willi syndrome
b) Russell-Silver syndrome
c) Bloom syndrome
d) Angelman syndrome
Correct Answer - C
Answer- C. Bloom syndrome
Bloom syndrome is not associated wilh uniparental disomy.
Uniparental disomy is the term used when both chromosome of a
pair of chromosome in a person with normal number of
chromosome, have been inherited from only one parent.
150. A new born who has frothing of mouth.
Cyanosis is present on day one. The
most probable diagnosis is:
a) Lung hypoplasia
b) Lung cyst
c) Diaphragmatic hernia
d) Esophageal atresia
Correct Answer - D
Answer- D. Esophageal atresia
Esophageal atresia:
The diagnosis of esophageal atresia is entertained in an infant with
excessive salivation along with coughing or choking during the first
oral feeding.
151. A 6 weeks old baby presents with cough
and cold for the last three days.
Respiratory rate is 48/min. Patient is
febrile, there are no chest retractions but
wheezing is present. Which of the
following statement is not true?
a) Antibiotics are not required
b) Child is suffering from pneumonia
c) Treat only wheezing
d) Treat only fever
Correct Answer - B
Answer- B. Child is suffering from pneumonia
Pneumonia:
The World Health Organization has defined pneumonia in children
clinically based on either a cough or difficulty breathing and a rapid
respiratory rate, chest indrawing, or a decreased level of
consciousness.
A rapid respiratory rate is defined as >60 breaths/minute in children
<2 months old, 50 breaths/minute in children 2 months to 1 year old,
or >40 breaths/minute in children 1 to 5 years old.
152. Efficacy of phototherapy is not affected
by-
a) Skin pigmentation
b) Type of light used
c) Spectral irradiation by incident light
d) Initial concentration of bilirubin
Correct Answer - A
Answer- A. Skin pigmentation
'Efficacy ofphototherapy depends upon irradiance, surface area
exposed, distance from phototherapy unit, initial serum total bilirubin
and adequacy of breastfeeding.'- Ghai 7/e pl50
153. To establish the diagnosis of H-type
trachea-esophageal fistula, which if the
following is required?
a) Chest X-ray
b) Tracheo-bronchoscopy
c) CT scan
d) Esophagoscopy
Correct Answer - B
Answer- B. Tracheo-bronchoscopy
Isolated tracheoesophageal fistula (TEF) (H-type fistula):
Congenital isolated TEF (H-type) is a rare disorder posing diagnostic
and management problems.
H-type TEF is more frequent than H-type, owing to the oblique angle
of the fistula from the trachea (carina or main bronchi) to the
oesophagus, anatomically at the level of the neck root (c7-T1).
Pressure changes between both structures can cause entry of air
into the oesophagus, or entry of oesophageal content into the
trachea.
154. A 3 days old baby is admitted with
intraventricular hemorrhage. Baby
develops abdominal distention. The X-
ray abdomen showed pneumatosis
portalis. Stage the necrotizing
enterocolitis:
a) lb
b) 2a
c) 2b
d) 3a
Correct Answer - C
Answer- C. 2b
The severity, radiology and management of Necrotizing enterocolitis
is best exemplified by the 'Modified Bell's staging
crileria'- According to 'Modified Bell's staging criteria'pneumatosis
portalis (Presinie of gas in pofiai vein) is suggestive
of stage 2b.
155. Children with germline retinoblastoma
are more likely to develop other primary
malignancies in their later lifetime
course. Which of the following
malignancy can occur in such patients?
a) Osteosarcoma of lower limbs
b) Thyroid carcinoma
c) Seminoma
d) Renal cell carcinoma
Correct Answer - A
Answer- A. Osteosarcoma of lower limbs
Children with germline retinoblastoma are more likely to develop
other primary malignancies in their later lifetime course.
Osteosarcoma of lower limbs can occur in such patients.
Retinoblastoma Syndrome (Primary site malignancy)- Familial
Retinoblastoma
156. Children with germline retinoblastoma
are more likely to develop other primary
malignancies in their later lifetime
course. Which of the following
malignancy can occur in such patients?
a) Osteosarcoma
b) Renal cell carcinoma
c) Pinealoblastoma
d) Chondrosarcoma
Correct Answer - A
Answer- A. Osteosarcoma
Children with germline retinoblastoma are more likely to develop
other primary malignancies in their later lifetime course,
Osteosarcoma can occur in such patients.
157. A 4 years old girl presented with
abdominal lump. Bone scan is needed in:
a) Wilm's tumor
b) Neuroblastoma
c) Rhabdomyosarcoma
d) PNET
Correct Answer - B
Answer- B. Neuroblastoma
Bone scan is needed in Neuroblastoma as metaslasis is present in
60-70% of patients at the time of diagnosiso and MC site of
metastasis in older children are bones.
MC presentation: Fixed, lobular mass extending from the flank
toward the midlinea of the abdomen.
Most (80%) cases present before 4 years and peak incidence is 2
years of age.
Metastasis is present in 60-700/o of patients at the time of diagnosis
MC site of metastasis in older children are bones (long bones >facial
bones, skull particularly sphenoid), bone marrow and LN.
158. A 24 year old college student while
playing hockey injured his right knee.
The patient presents after 3 months with
instability of knee joint in full extension
without instability at 90 degree of flexion.
The structure most commonly damaged
is-
a) Posterolateral bundle of anterior cruciate ligament
b) Anteromedial bundle of anterior cruciate ligament
c) Posterior cruciate ligament
d) Anterior horn of medial meniscus
Correct Answer - A
Answer- A. Posterolateral bundle of anterior cruciate ligament
When knee is extended, resistance to anterior drawer test is by
posterolateral bundle.
It limits anterior translation, hyperextension and rotation.
Hyper extension and internal rotation place posterolateral bundle at
greater risk of injury.
Rupture cause increase in hyperextension and anterior translation
(extended knee).
supracondvlar fracture of humerus?
a) Distal segment is dislocated anteriorly more than posterior
b) Cubitus valgus more common than cubitus varus during

malunion
c) Nerve injury related manifestations are transitory
d) Injury causes weakness of elbow flexion
Correct Answer - C
Answer- C. Nerve injury related manifestations are transitory
Supracondylar Fracture Humerus:
Distal segment is dislocated posteriorly more than anterior
cubitus varus more common than cubitus varus during malunion
cubitus valgus more common than cubitus varus during nonunion
Nerve injury related manifestations are transitory due to neuropraxia
Weakness of elbow flexion is not seen in supracondylar fracture
160. In 2 years old child gallows traction is
applied. Child is suffering from fracture
OHMS 'Vov 201? if
a) Neck of femur
b) Greater trochanter of femur
c) Fracture shaft of femur
d) Shaft of tibia
Correct Answer - C
Ans. c. Fracture shaft of femur
Russel's traction or Thomas splint is used for fracture shaft femur in
older children.
Gallow's Traction
Gallow's traction is used for treatment of fracture shaft of femur, in
infants and children <2 years of ageQ.
Weight must not be >12 kgs
Both the fractured and the normal femur are placed in skin traction
and infant is suspended by these from a special frame. The buttocks
should be lifted just off the bed so that the weight of the body
provides counter traction and the fracture is reduced.
161. A 7 years old child comes with fever and
tibial swelling exhibits on X- ray exhibits
periosteal reaction. Laboratory results
show raised ESR and TLC. What is the
next step in diagnosis of the patient?
a) MRI
b) Pus culture
c) Bone biopsy
d) Blood culture
Correct Answer - A
Answer- A. MRI
Ewingts sarcoma:
MRI is essential to elucidate soft-tissue involvement in Ewing's
sarcoma, because the tumor has low signal intensity on Tl-weighted
images compared with the normal high signal intensity of the bone
marow.
Osteomyelitis:
MRI allows early detection of osteomyelitis and assessment of the
extent of involvement and the activity of the disease in cases of
chronic bone infection.
It is considered the most useful imaging technique to evaluate
suspected osteomyelitis because of its ability to demonstrate
changes in the water content ofbone marrow with an excellent
structural definition and spatial resolution.
162. Which of the following is not a cause of
clubfoot in newborns?
a) CTEV
b) Arthogryposis multiplex cngenita
c) Polio
d) Spina bifida
Correct Answer - C
Answer- C. Polio
Etiology of club foot
Idiopathic (MC) or CTEV
Secondary club foot:
Neurological disorders and neural tube defects (myelomeningocele,
spinal dysraphism)
Paralytic disorders as spina bifida, myelodysplasia and Freidreich's
ataxia
Arthrogryposis multiplex congenita
Larsen syndrome
Freeman-Sheldon (Mobius) syndrome
Diastrophic dwarfism
Sacral agenesis, tibial deficiency, constriction rings and amniotic
bands
Fetal alcohol syndrome
Down's syndrome
Larsen syndrome
163. A 40-year old man presented with acute
onset pain and swelling of left great toe.
On X-ray, punched out lytic lesion seen
on phalanx with sclerotic margins and
overhanging bony edges. Diagnosis is:
a) Gout
b) Rheumatoid arthritis
c) Psoriatic arthritis
d) Reiter's syndrome
Correct Answer - A
Ans. a. Gout
'Gout is a metabolic disease that most oJten afibct.s middle- aged to
elderly men andpostmenopausal women. It results from
an increased body pool of urate with hyperuricemia. It typically is
characterized by episodic acute and chronic arthritis
caused by deposition of MSU crystals in joints and conneclive tissue
tophi and the risk for deposition in kidney interstitium
or uric acid nephrolirhiasis. Usually, only one joint is affected initially
and the metatarsophalangeal joint of the first toe is the most
commonly involved joint- Harrison
164. Both bone and disc spaces are
destroyed in-
a) Tuberculosis
b) Metastasis
c) Lymphoma
d) Multiple myeloma
Correct Answer - A
Answer- A. Tuberculosis
The spine is the MC site of skeletal tuberculosis, accounting for
5OVo cases followed by hip and knees.
MC infective pathology of spine is tuberculosis.
165. All of the following are regarding
osteoporosis except.
a) Calcitonin decreases pain
b) Bisphophonates are work horse for treatment
c) T-score <1.5 in osteoporosis
d) PTH is used in severe osteoporosis
Correct Answer - C
Answer- C. T-score <1.5 in osteoporosis
TLscore -2.5 or less is seen in osteoporosis.
T-score Interpretation
-1 or more- Normal
Between -l and -2.5 Osteopenia
-2.5 or less- Osteoporosis
Severe osteoporosis
-2.5 or less with fragility fracture -
166. Which of the following findings can be seen during clinical examination of a
pregnant female with heart disease compared with normal pregnancy?
a) Pedal edema
b) Engorged neck veins
c) Dyspnea
d) Exercise intolerance
Correct Answer - B
In normal pregnancy, functional systolic heart murmurs are common;
respiratory effort is accentuated and at times suggests dyspnea;
edema in the lower extremities after mid pregnancy is common; and
fatigue and exercise intolerance develop in most women. Some
systolic flow murmurs may be loud.
Clinical indicators of heart disease during pregnancy:
Symptoms:
Progressive dyspnea or orthopnea
Nocturnal cough
Hemoptysis
Syncope
Chest pain
Clinical Findings
Cyanosis
Clubbing of fingers
Persistent neck vein distension
Systolic murmur grade 3/6 or greater
Diastolic murmur
Cardiomegaly
Persistent arrhythmia
Persistent split second sound
Criteria for pulmonary hypertension
Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse
D.J., Spong C.Y. (2010). Chapter 44. Cardiovascular Disease. In
F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse,
C.Y. Spong (Eds), Williams Obstetrics, 23e.
167. All of the following complications are
more common in ventouse assisted
delivery than forceps except:
a) Subgaleal hemorrhage
b) Cephalhematoma
c) Intracranial hemorrhage
d) Transient lateral rectus palsy
Correct Answer - D
Answer- D. Transient lateral rectus palsy
Transient lateral rectus palsy is more common inforceps assisted
delivery.
Subgaleal hemonhage, cephalhematoma and intracranial
hemonhage are more common in ventouse assisted delivery.
168. All of the following are risk factors of
cervical cancer except?
a) Low parity
b) Multiple partners
c) Early sexual intercourse
d) Smoking
Correct Answer - A
Answer- A. Low parity
Multiparity (not the low parity), Maltiple partners, Early sexual
intercourse and Smoking are the risk factors for carcinoma cervix.
169. A fertilized ovum reaches uterine cavity
in?
a) 3-4 days
b) 5-6 days
c) 7-8 days
d) 10 days
Correct Answer - A
Ans. A. 3-4 days
REF: William's obstetrics 22nd ed, Langman's Medical Embryology 9'
edition page 45
24 hours before

LH Surge ovulation
Ovulation 0 hours
24 hours after
Fertilization
ovulation (Day 1)
Reaches uterine 3-4 days post
4-5 post ovulation)
cavity fertilization (Day
7-9 day post
Implantation
fertilization
170. A 16 years old girl came for evaluation of
primary amenorrhea. She was having
hirsutism, irregular bleeding and
infertility, diagnosed as PCOS. Which of
the following drugs should not be given?
a) Spironolactone
b) Tamoxifen
c) OCPs
d) Clomiphene citrate
Correct Answer - B
Answer- B. Tamoxifen
Medical Treatment of PCOS
Estrogen best given with progesterone (combined OCPs) with no
androgenic properties
Hirsutism is treated with cyproterone acetate or spironolactone.
Infertility is treated with Clomiphene, 80% ovulate and 40%
conceive.
In Clomiphene failed group, ovulation can be induced with FSH or
GnRH analogues.
Metformin treats the root cause of PCOS, rectifies endocrine and
metabolic functions and improves fertility and is
drug of choice.
171. Maximal level of cardiac output is seen
at:
September 2009
a) 22-26 weeks of pregnancy
b) 26-30 weeks of pregnancy
c) 30-34 weeks of pregnancy
d) 34-38 weeks of pregnancy
Correct Answer - C
Ans. C: 30-34 Weeks of Pregnancy
The cardiac output starts to increase from 5th week of pregnancy
and reaches its peak 40-50% at about 30-34 weeks. Cardiac output
increase further during labour (+50%) and immediately following
delivery (+70%) It returns to pre-pregnancy level by 4 weeks time
after labour.
172. A woman with 20 weeks pregnancy
presents with bleeding per vaginum. On
speculum examination, the os is open
but no products have comes t. The most
likely diagnosis is:
a) Incomplete abortion
b) Complete abortion
c) Inevitable abortion
d) Missed abortion
Correct Answer - C
Answer- C. Inevitable abortion
Inevitatrle Abortion:
Clinical picture: Bleeding, pain and shock
Size of uterus: Equal or less
Internal os: Open with products felt
Ultrasound: Dead fetus
173. A 26 years old healthy female got
pregnant for 1st time and LSCS was
done for fetal distress. Mild hypertension
was present during pregnancy. Two days
after delivery she had headache and
seizures but proteinuria was not seen.
CT scan shows 2 x 3 cm parasagittal
hematoma. Diagnosis is:
a) Eclampsia
b) Hypertensive intracranial hemorrhage
c) Sagittal sinus thrombosis
d) Pituitary apoplexy
Correct Answer - C
Answer- C. Sagittal sinus thrombosis
Venous sinus thrombosis of the lateral or sagittal sinus or of small
cortical veins (cortical vein thrombosis) occurs as a complication of
oral contraceptive use, pregnancy and the postpartum period,
inflammatory bowel disease, intracranial infections (meningitis), and
dehydration.
Patients present with headache and may also have focal neurologic
signs (especially paraparesis) and seizures.
174. If untreated, percentage of mother to
child transmission of HIV during delivery
without intervention in a non-breast fed
child is:
a) 40-50%
b) 10-15%
c) 15-30%
d) 5%
Correct Answer - C
Answer- C. 15-30%
'In the absence of any intervention, an estimated 15-30% of mothers
with HIY infection will transmit the infection during
prcgnsncy and delivery. and 10-20% will transmit the infection,
through breast feeding. Vertical transmission of IIIV-L
occurs mostly during the intrapartum period (50-70%).'- COGDT l0/e
p692
175. Dose of radiation for early and locally
advanced cancer cervix at point A during
brachytherapy?
a) 70-75 Gray and 75- 80 Gray
b) 75-80 Gray and 80-85 Gray
c) 80-85 Gray and 85-90 Gray
d) 85-90 Gray and 90-95 Gray
Correct Answer - C
Answer- C. 80-85 Gray and 85-90 Gray
Early stage disease (nonbulky Stage I-II): 80-85 Gy
Advanced stage disease (bulky or Stage IIIB): 85-90 Gy
176. Which of the following is not true about
latent phase of labour?
a) According to ACOG it starts after 3-4 cm cervical dilatation but
they are planning to increase it to 5 cm
b) Begins at the end of active phase and is a part of 1st stage of

labour
c) Patient may present with false labour due to mild cramps
d) Starts with contractions of the uterus
Correct Answer - C
Answer- C. Patient may present with false labour due to mild
cramps
It starts at the point at which mother perceives true labour pains and
ends when cervix is 3cm dilated and 1.5 cm/hour for parous cervix.
Duration in nulliparous is 6-8 hours and 5.3 hours in multiparous
(average 4-6 hours).
Mainly concerned with cervical effacement
177. A 16-year old female presents with
primary amenorrhea and raised FSH
level. On examination, her height was 58
inches. What would be the
histopathological finding in the ovary?
a) Absence of oocytes in the ovaries (streak ovaries)
b) Mucinous cystadenoma
c) Psamomma bodies
d) Hemorrhagic corpus leuteum
Correct Answer - A
Answer- A. Absence of oocytes in the ovaries (streak ovaries)
Inereased serum FSH and absent breasl indicates primary
ovarianfailure. This is mostly caused by 'Gondal Dysgenesis'
(Turner's syndrome). Elevated FSH is due to absence of ovarian
oocytes and follicles leading to reduction in negative
feedback on FSH from estradiol and inhibins A and B.
178. Most accurate and safe method to
diagnose viable pregnancy at 6weeks-
a) Doppler assessment of fetal cardiac activity
b) USG for fetal cardiac activity
c) Urinary Beta-hCG determination
d) Per vaginal examination of uterine size corresponding to 6

weeks gestation
Correct Answer - B
Answer- B. USG for fetal cardiac activity
USG for fetal cardiac activity:
At 6 weeks it is routine to detect fetal cardiac activity by ultrasound
5 1/2 Yz to 6 weeks is usually a very good time to detect either a
fetal pole or even a fetal heart beat by vaginal
ultrasound.
179. Most common site of primary for
intraocular metastasis is from-
a) Breast
b) Ovary
c) Cervix
d) Endometrium
Correct Answer - A
Answer- A. Breast
Most common site of primary for intraocular metastasis is from
breast.
'Breast cancer is the most common tumor to metastasize to the eye
followed by lung cancer.
180. Order in lochia:
AIIMS 13
a) Serosa, rubra, alba
b) Rubra, serosa, alba
c) Alba, rubra, serosa
d) Rubra, alba, serosa
Correct Answer - B
Ans. Rubra, serosa, alba
181. All of the following are used for
screening cancers in females except
a) CA-125: Ovarian cancer
b) Office endometrial aspirate: Endometrial carcinoma
c) Pap smear: Cervical cancer
d) Mammography: Breast cancer
Correct Answer - B
Ans. b. Office endometrial aspirate: Endometrial carcinoma
Office endometrial aspirate is not used for screening of Endometrial
carcinoma.
Transvaginal ultrasound and endometrial sampling have been
advocated as screening tests for endometrial cancer but benefit from
routine screening have not been shown.
`Screening for endometrial cancer should currently not be
undertaken because of a lack of an appropriate, cost-effective and
acceptable test that reduces mortality. Routine PAP testing is an
inadequate test that reduces mortality. Routine PAP testing is
inadequate and endometrial cytology assessment is too insensitive
and non-specific to be useful in screening for endometrial cancer
even in a high-risk population.'

Disease
Screening Test
Screened
Papanicolaou Cervical
(Pap's) smear cancer
Breast
Mammography
cancer
Ovarian
CA-125
Ovarian
CA-125
cancer
Screening Test
The screening test is used to search for an unrecognized disease or
defect, in apparently healthy individuals, using rapidly applied tests,
examination or other procedures
Screening Test Disease Screened
Papanicolaou
Cervical cancerQ
(Pap's) smear
Mammography Breast cancerQ
Bimanual oral
Oral cancerQ
examination
ELISA HIVQ
Urine for sugar,
Diabetes mellitusQ
Random blood sugar
Developmental
AFP
anomalies in fetusQ
DRE + PSA Prostate cancerQ
Fecal occult blood
Colorectal cancerQ
test
CA-125 Ovarian cancerQ
182. Which type of abnormality in sexual
development has best prognosis?
a) Congenital adrenal hyperplasia
b) Mixed gonadal dysgenesis
c) Androgen insensitivity syndrome
d) True hermaphroditism
Correct Answer - A
Answer- A. Congenital adrenal hyperplasia
'Congenital adrenal hyperplasia can be managed by supplying
enough glucocorticoids to suppress excess androgen production.
The deformity in genitalia (enlarged clitoris, fuslon of labia minora)
can be coirected surgically. Newborn screening methods to detect
CAH and eforrts to treat CAH in utero have improved the prognosis.
Women with CAH can get pregnant and have healthy lnfants.
183. Tubocurare affects which muscle first?
a) Head and neck
b) Limbs
c) Respiratory muscles
d) Abdominal muscles
Correct Answer - A
Answer- A. Head and neck
Sequence of Muscle Paralysis after giving Tlrbocurare:
Jaw muscles + eyelid muscles and other muscles of head and
nech → limbs → intercostals + diaphragm)
abdomen → trunk.
Facial and diaphragm muscles are first to recover, followed in order
by legs, arms, shoulder girdle, trunk, larynx,
hands and feet, and pharynx.
184. According to `AHA 2010 Guidelines'
which of the following drug is not used
in CPCR?
a) Adrenalin
b) Vasopressin
c) Atropine
d) Amiodarone
Correct Answer - C
Answer- C. Atropine
'According to AHA 2020 Guidelines, Atropine is no longer
recommended for routine use in the management of pulseless
electrical activity (PEA)asystole.'
ACLS- medications for pulses arrest
Atropine: deleted from pulseless arrest algorithm
Epinephrine: dose, interval unchanged
Vasopressin: dose, use unchanged
Amiodarone: dose, indications unchanged
Lidocaine: dose, indications unchanged
Sodium Bicarbonate: routine use not recommended
Calcium: for treatment of cardiac arrest not recommended
185. On doing laparoscopic cholecystectomy
patient developed wheezing. Which of
the following is used in the treatment?
a) N ketamine
b) IV lignocaine
c) Administration of beta agonist
d) Deepen the plane of anesthesia
Correct Answer - D
Answer- D. Deepen the plane of anesthesia
The most common cause of asthmatic attack during surgery is
inadequate depth of anesthesia. First, deepen the level of
anesthesia and increase FIO2. Remember that the patient is under
anesthesia and undergoing surgery. Therefore, medical intervention,
such as B-agonist administration, is not the first choice of treatment-
Yao and Artusiois Anesthesiology.
186.
Sensory block for lower segment caesarian
section is given at the level of?
a) T4
b) T6
c) T8
d) T10
Correct Answer - A
Answer- A. T4
'Caesarean sections require sensory blockade up to the T4
dermatome level, as this not only blocks the somatic sensations
of the Caesarean sections but also eliminates the visceral pain from
peritoneal manipulation.
Cesarean sections require sensory blockade up to the T4
dermatome level, as this not only blocks the somatic sensations of
the Caesarean sections but also eliminates the visceral pain from
peritoneal manipulation.
187. Centrineuraxial (spinal and epidural)
anaesthesia is not contraindicated in -
a) Platelets < 80,000
b) Patient on aspirin
c) Patient on oral anticoagulants
d) Patient on LMH (heparin)
Correct Answer - B
B i.e. Patient on aspirin
- Centrineuraxial anesthesia is not associated with increased risk
with most antiplatelet agents (eg. aspirinQ & NSAIDs).
Neuroxial block is combined name given to Spinal, Epidural and
Caudal Blocks. Principal site of action for neuroaxial blok is Nerve
root Q.
188. Effective strategies to decrease the risk
of post puncture dural headache are all
except:
a) Use of small bore needle
b) Use of atraumatic needle
c) Supplementation of fluids
d) Replacement of stylet prior to removal of needle
Correct Answer - D
Answer- D. Replacement of stylet prior to removal of needle
Patient on antihypertensive medication is not a contraindication for
neuraxial block.
Neuraxial Block:
Patients with platelet <80,000/ml: Relative contraindicatlon
Marked coagulopathy, blood dyscrasias or full anticoagulant therapy:
Absolute contraindication
Marked skin sepsis and marked spinal deformity: Absolute
contraindication
189. Induction of inhalational agent is faster.
a) Agent with high blood gas solubility
b) Combined with nitrous oxide
c) Person with increased residual volume
d) Right to left shunt
Correct Answer - B
Answer- B. Combined with nitrous oxide
Induction of inhalational agent is faster, if it is combined with nitrous
oxide.
'The blood:gas partition coelficient is the mainfactor that determines
the rate of induction and recovery of an inhalation
anaesthesic, and the lower the blood: gas partition coefficient, the
faster is induction and recovery.
The second gos effect usually refers to nitrous oxide combined with
an inhalation agent. Because nitrous oxide is not
soluble in blood, its rapid absorption from alveoli causes an abrupt
rise in the alveolar concentration of the other
inhalation anesthetic leading to faster induction.
190. Which of the following intravenous
anesthetic agent is contraindicated in
epileptic patients posted for general
anesthesia?
a) Propofo
b) Thiopentone
c) Ketamine
d) Midazolam
Correct Answer - C
Ans. c. Ketamine
Ketamine should be avoided in patients with history of seizures as it
further increases ICP and also causes delirium and hallucinations.
Midazolam is a benzodiazepine, which has anti-seizure potential and
thus used in treating seizueres.
Both thiopentone and propofol decreases ICP and are
neuroprotective.
191. Cause of malignant hyperthermia is?
a) Halothane
b) Isoflurane
c) Thiopentone
d) Suxamethonium
Correct Answer - D
Ans. is 'd > b' i.e., Suxamethonium > Isoflurane
Drugs causing Malignant hvperthermia (MH)
* Succinylcholine
* Enflurane
* Methoxyflurane
* Phenothiazines
* Halothane
* Sevoflurane
* MAO inhibitors
* Lignocaine
* Isoflurane
* Desflurane
* TCA
- Succinylcholine is the most common cause of MH.
- Amongst anaesthetics, halothane is most common cause.
- Combination of Sch and Halothane has a much higher incidence.
192. A 70 years old female is on treatment
withAlendronate for 7 years for
osteoporosis. Now she complains of
pain in right thigh'at is the next
investigation to be performed?
a) DEXA scan
b) X-ray
c) Serum vitamin D levels
d) Serum alkaline phosphate levels
Correct Answer - B
Ans. b. X-ray
The pain in right thigh in a 70 years old female, who is on treatment
with alendronate for 7 years for osteoporosis might be due to
femoral shaft fracture.
Plain X-rays showed a characteristic picture consisting of a
transverse or short oblique fracture line, lateral cortical thickening,
and medial spiking.
Spontaneous femoral shaft fracture after long-term
alendronate:
Alendronate is used as first-line treatment for osteoporosis in
postmenopausal women worldwide.
The evidence supporting its benefit in reducing the risk of fragility
fracture among this high-risk group is well established.
Due to its mechanism of action, there were concerns about potential
reduction in bone turnover, repair of microdamage and hence
reduced bone toughness and increased risk of fractures with long-
term use.
Plain X-rays:
Plain X-rays showed a characteristic picture consisting of a
transverse or short oblique fracture line, lateral cortical thickening,
and medial spiking.
193. Symptomatic spinal injury without any
radiological evidence most commonly
found in:
a) Children
b) Elderly
c) Teenagers
d) Young adults
Correct Answer - A
Ans. Children
194. Radiologically, increased pulmonary
blood flow is indicated by the following
except:
a) Descending pulmonary artery diameter> 16 mm
b) Kerley b lines
c) Diameter of peripheral arteries > 2 accompanying bronchiole
d) > 6 blood vessel in outer 1/3''
Correct Answer - B
Ans. Kerley b lines
195.
A patient of RTA with injury over chest and
limbs has low sp 02. M mode US of right
upper part of chest shows stratosphere sign.
What is the diagnosis?
a) Haemothotax
b) Pneumothorax
c) Cardiac tamponade
d) Pulmonary embolism
Correct Answer - B
Ans. Pneumothorax
196. A 14 year old obese child is referred from
an endocrinologist for painful limping of
hip.Which of the following investigation
is least useful in this clinical setting?
a) CT
b) USG
c) MRI
d) X-ray PBH
Correct Answer - B
Ans. USG
Slipped Capital Femoral Epiphysis (SCFE):
Age: Adolescence, during period of rapid growth (l 1-16 years)
Patients are either overweight (fat) and sexually immature
Presents with tendemess at Scarpa's triangle with slight limitation of
flexion
USG can detect early slip by demonstrating joint effusion and step.
CT is useful in demonstrating closure of the proximal femoral physis
assessment of severity of residual deformity, and
penetration ofhipjoint by fixation device.
Tc-99 scan show increased uptake in capital femoral physis in
SCFE, decreased uptake within epiphysis is highly specific
for AVN.
197. A known alcoholic is brought to the
emergency department by his wife. The
person has not consumed alcohol for the
past two days due to religious reasons.
The person complained of nausea,
vomiting and dizziness. On the second
day, he developed seizures, that
progressed to generalized tonic clonic
seizures (GTCs). Which of the following
would be the best medication to manage
the seizures of the patients?
a) Sodium valproate
b) Phenytoin
c) Diazepam
d) Clonidine
Correct Answer - C
Ans. c. Diazepam
The seizures in this patient, is due to alcohol withdrawal. Diazepam
would be best medication to manage the seizure of
the patient.
'Long acting benzodiazepines such as chlordiazepoxide and
diazepam or short acting such as lorazepam can be used to
treat mild-moderate uncomplicated alcohol withdrawal.
'Chlordiazepoxide is preferred over diazepamfor treatment of alcohol
withdrawal syndrome.
withdrawal syndrome.

198. Child not eating vegetables. His mother
starts giving a chocolate each time he
finishes vegetables in the diet. The
condition is
a) Operant conditioning
b) Classical conditioning
c) Social training
d) Negative reinforcement
Correct Answer - A
Ans. a. Operant conditioning
199. 20-year-old female had abdominal pain
previous week, USG and clinically
normal. Again she presented with loss of
vision, examination is normal. Diagnosis
is:
AIIMS 13
a) Malingering
b) Masochist
c) Hypochondriac
d) Anxiety disorder
Correct Answer - A
Ans. Malingering
Malingering is fabricating or exaggerating the symptoms of mental or
physical disorders for a variety of 'secondary
gain' motives, which may include financial compensation (often tied
to fraud); avoiding school, work or military service;
obtaining drugs; getting lighter criminal sentences; or simply to
attract attention or sympathy.
200. Cognitive remediation is used for:
a) Cognitive restructuring
b) Memory improvement
c) Correcting cognitive distortion
d) Improving study habits
Correct Answer - A
Answer- A. Cognitive restructuring
cognitive remediation therapy (CRT), also called Cognitive
enhancement therapy, is a cognitive rehabilitation
therapy developed at King's College in London designed to improve
neurocognitive abilities such as attention, working
memory, cognitive flexibility and planning, and executive functioning
which leads to improved social functioning'

201. Given EEG is suggestive of:
a) Bifrontal spike and wave
b) Movement artifact
c) Polyspike and wave
d) Generalized slow spike and wave
Correct Answer - C
Answer- C. Polyspike and wave
Given EEG is suggestive of polyspike and wave, seen in myoclonic
epilepsy.


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Vaginal wall is derived from ?

b) Endoderm of genital ridge

c) Mesoderm of urogenital sinus

d) Endoderm of urogenital sinus

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b) Short gastric artery

c) Right gastro epiploic artery

d) Left gastro epiploic artery

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c) Posterior inferior cerebellar artery

d) Superior cerebellar artery

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b) Posterior interosseous nerve

c) Lower brachial plexus

d) Hand area in cortex

b) Second intercostal space

c) Third intercostal space

d) Eleventh intercostal space

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b) Superior rectal vein

c) Inferior rectal vein

d) Inferior mesenteric plexus

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b) Spermatogonia to primary spermatocyte

c) Secondary spermatocyte to spermatids

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b) Calcium is pumped back into the sarcoplasmic reticulum during

c) Calcium is released from sarcoplasmic reticulum during

d) Calcium binds to tropomyosin to initiate muscle contraction

c) Gate controlled theory of pain

c) Systolic resistance in aorta as it increases in its length

d) Mean arterial pressure, which is responsible for blood flow to an

b) Leydig and myoid cells

c) Sertoli and germ cells

b) Have low blood sugar levels

c) Oxaloacetate is required for gluconeogenesis

d) Low fat mobilization

b) Polymerase chain reaction

d) Comparative genomic hybridization

b) Cut DNA at specific site

c) Participate in DNA synthesis

b) Glucose-6-phosphate dehydrogenase causes de​creased

c) Required for reductive biosynthesis

d) Stabilizes the membrane of RBCs

c) von Willebrand factor

b) Impaired neurological development

c) Adverse pregnancy outcome

b) Extensive crosslinking of tropocollagen

d) Neurosecretary granules in the cytoplasm

b) Nodular sclerosis Hodgkin lymphoma

b) Glucose-6-phosphate dehydrogenase causes decreased