JIPMER 2011

JIPMER 2011

1. Clue cell is seen in A.Trichomonas vaginalis B. Bacterial Vaginosis C. Candidiasis D, Herpes

Ans:B. Bacterial Vaginosis(REPEAT)

2.Which of the following joint is a syndesmosis? A.Superior Tibiofibular jt B.Inferior tibiofibular jt C.Talocalcaneal D.Calcaneocuboid

Ans:B.Inferior tibiofibular jt(REPEAT) s type of Fibrous joint3.Spring Ligament refers to: A.Plantar Calcaneo-Navicular Ligament B.Short planatar ligament C.Long Plantar Ligament D.--

Ans:A.Plantar Calcaneo-Navicular Ligament

Reference:Kieth and Moore Clinical anatomy

*****Plantar calcaneonavicular (spring) ligament , which extends across and fills a wedge-shaped gap between the sustentaculum tali and the inferior margin of the posterior articular surface of the navicular. This ligament supports the head of the talus and plays important roles in the transfer of weight from the talus and in maintaining the longitudinal arch of the foot.4.Find the mean median and Mode of the following 1,2,2,2,3,4,4,6,7? Straight answer: Mean:3.4 Median:3 Mode:2

No reference needed

5.EEG is useful in evaluation of: A.Intermittent Explosive disorder B.Panic disorder C. Anxiety disorder D.Bipolar Disorder

Ans:A.Intermittent Explosive disorder

Reference : Kaplan and Saddock Psychiatry

Intermittent Explosive Disorder

Intermittent explosive disorder manifests as discrete episodes of losing control of aggressive impulses; these episodes can result in serious assault or the destruction of property. The aggressiveness expressed is grossly out of proportion to any stressors that may have helped elicit the episodes. The symptoms, which patients may describe as spells or attacks, appear within minutes or hours and, regardless of duration, remit spontaneously and quickly. After each episode, patients usually show genuine regret or self-reproach, and signs of generalized impulsivity or aggressiveness are absent between episodes. The diagnosis of intermittent explosive disorder should not be made if the loss of control can be accounted for by schizophrenia, antisocial or borderline personality disorder, ADHD, conduct disorder, or substance intoxication. ******The term epileptoid personality has been used to convey *****the seizure-like quality of the characteristic outbursts, which are not typical of the patient's usual behavior, and to convey the suspicion of an organic disease process, for example, damage to the central nervous system. Several associated features suggest the possibility of an epileptoid state: the presence of auras; postictal-like changes in the sensorium, including partial or spotty amnesia; and hypersensitivity to photic, aural, or auditory stimuli. 6. Sigmud freud'sPrimary Process of thinking is

A.unconcious and primitive aspect B.absent in dreams C.Illogical and PRIMITIVE D.RationalAns:C.

Reference:Kaplan and Saddok Psychiatry

The mechanisms of condensation, displacement, and symbolic representation are characteristic of a type of thinking that Freud referred to as

****primary process. *****This primitive mode of cognitive activity is characterized by ***illogical, bizarre, and absurd images that seem incoherent. 7.Linezolid belongs to which class of Drugs? A.Macrolide B.Aminoglycoside C.Oxazolidinones D.Streptogamins

Ans:C.Oxazolidinones

Reference: Katzung Pharmacology Linezolid is a member of the *****oxazolidinones, a new class of synthetic antimicrobials. It is active against gram-positive organisms including staphylococci, streptococci, enterococci, gram-positive anaerobic cocci, and gram-positive rods such as corynebacteria and Listeria monocytogenes. It is primarily a bacteriostatic agent except for streptococci, for which it is bactericidal. It is active in vitro against Mycobacterium tuberculosis. 8.Which of the following Antibiotics has a NONSPECIFIC MAO INHIBITOR activity? A.tazobactum B.ampicillin C.spectinomycin D.Linezolid

Ans:D.Linezolid

Reference:Goodman and Gilman Pharmoacology

Linezolid is a weak, ******nonspecific inhibitor of monoamine oxidase. Patients receiving concomitant therapy with an adrenergic or serotonergic agent or consuming more than 100 mg of tyramine a day may experience palpitations, headache, or hypertensive crisis. Peripheral and optic neuropathy, which seem to be reversible upon drug discontinuation, have been reported with prolonged use. 9.Nephrotic syndrome associated with malaria due to infection of A.P.falciparum B.P.malariae C.P.ovale D.P.vivax

Ans:B.P.malariae

Referece:Harrison Principles Of Internal

Medicine

Quartan Malarial Nephropathy

Chronic or repeated infections with ****P. malariae (and possibly with other malarial species) may cause soluble immune-complex injury to the renal glomeruli, resulting in the ****nephrotic syndrome. Other unidentified factors must contribute to this process since only a very small proportion of infected patients develop renal disease. 6. Sigmud freud'sPrimary Process of thinking is

A.unconcious and primitive aspect B.absent in dreams C.Illogical and bizzare ??? this was not in the option insteas it was conscious mind.. D.Rational

.honestly i dint knw the answer so i left it. but abt the options i am sure of it. cos i wasted time to guess some thing instead left it 10. which agent is effective in killing spores? A.Alcohol B.Phenol C.Chlorine D.Aldehyde

Ans:D.Aldehyde(REPEAT)

11.Colour of urine in phenol poisoning? A.Red B.Green C.Yellow D.Blue

Ans:B.Green(REPEAT 2010--answer by PG PYREXIA)12.Hypocalcemia is associated with: A.Metabolic acidosis B.QT prlongation C.-- D.--

Ans:B. QT prolongation(REPEAT)13.OC pills has been shown to be useful in the prevention of which of the following Malignancies: A.ca colon

B.ca endometrium C.ca breast D.ca Ovary

Ans: B

dutta6th edi page ocp non cont. benifits prevention of malignancy endo(50%),ovary(40%),.colon(40%)14. Short head of biceps atttached to : A.coracoid process B.supraglenoid tubercle C.acromion process D.bicipital groove Ans:A. coracoid process(REPEAT)15.vasectomy leads to A/E A.Scrotal hematoma B.Infection C.Decreased libido D.Anti spermin antibody

Ans: C.decreased libido(REPEAT)16. Carbon monoxide poisoning is type of A.Anemic hypoxia B.Histotoxic hypoxia C.Hypoxemic hypoxia D.Stagnant hypoxia

Ans:A.Anemic hypoxia

Reference:Ganong's Physiology

CO is toxic because it reacts with hemoglobin to form carbon monoxyhemoglobin (carboxyhemoglobin, COHb), and COHb cannot take up O2 (Figure 36–15). Carbon monoxide poisoning is often listed as a ****form of** **anemic hypoxia because the amount of hemoglobin that can carry O2 is reduced, but the total hemoglobin content of the blood is unaffected by CO.17. Posterior gastric artery is a branch of A. Splenic art B.Hepatic art C.Left gastric.

D. Right Gastric artery

Ans.A.Splenic artery18.VDRL Is most sensitive in the diagnosis of which stage of syphilis? A.Primary B.Secondary C.Tertiary D.Reactivation

Ans:B.Secondary(REPEAT2009 JIPMER) 19. Carpal tunnel syndrome is due to compression of A.Median nerve B.Ant.interosseus ner C.Radial nerve D.Ulnar nerve

Ans:A.Median nerve(REPEAT)

20.Which has MAXIMUM hypotensive side effect? A.Flufenazine B.Trifluoroperazine C.Thioridazine D.Haloperidol.

Ans:C.Thioridazine(REPEAT 2009)

21. Which of the following Nuclei DOES not lie in the floor of 4th ventricle ?

A. Abducens Nerve B. Facial Nerve C. Hypoglossal Nerve D. Vagus Nerve

Ans:B.Facial nerve(REPEAT JIPMER 1992)22.Mackintosh curved blade laryngoscope is used in ? A.Indirect laryngoscopy B.Direct laryngoscopy C.Video laryngoscopy D.Bronchoscopy

Ans:B.Direct laryngoscopy

23.Grasp reflex deveops at? A.20 weeks B.24Weeks

C.28 weeks D.32 weeks

Ans:C.28 weeks Reference: Nelson pediatrics 24.killed vaccine ? A.polio B.hepatitis b C.yellow fever D.Japanese encephalitis

Ans:D.Japanese encephalitis (REPEAT) 25.Which is Eaton agent ? eaton agent ? A.Mycoplasma B.H.influenza C.Klebsiella D.--

Ans:A.Mycoplasma

26.Hassal corpuscles are seen in? A.Thymus B.Thyroid C.Parathyroid D.-- Ans:A.Thymus27.Cystisarcoma phylloides TOC in a young female? A.Wide excision with a margin B.WE and chemo C.WE and Radio D.--

Ans:A.Wide excision with a margin

Reference:Sabiston surgery

****Local excision of a benign phyllodes tumor is curative, and clearly benign tumors are treated like a fibroadenoma. There is a group of intermediate tumors, so-called borderline phyllodes tumors, in which it is difficult to assign a benign label. These tumors are treated by excision with margins of at least 1 cm. Affected patients are at some risk for local recurrence, most often within the first 2 years after excision, and close follow-up with examination and imaging allows early detection of recurrence.

28.Pepsin is activated by: A.HCL B.Enterokinase C.-- D.--

Ans:A.Hcl Refernce:Ganong physiology

The pepsin precursors are called pepsinogens and are activated by ***gastric acid.29.In post natal period the greatest growth in the CNS is of? A.Cell body B.Axon C.Dendrite D.Size of perikaryon

Ans:C.Dendrite(REPEAT--KCET 2001)30.Ongoing hemolysis by whic of the following

A. Target cells

B. Acanthocytes

C. Schistocytes

D. ---

Ans:C Schistocytes31.All muscles are innervated by oculomotor nerve except

a. superior rectus b. inferior rectus c. lateral rectus d. medial rectus

Ans - c LR32.Insulin mediated uptake of glucose into muscle is through? A.GLUT 2 B.GLUT 4

C.-- D.--

Ans:B.GLUT 4 Reference:Lippincott Biochemistry

Membrane effects of insulin: Glucose transport in some tissues, such as skeletal muscle and adipocytes, increases in the presence of insulin (Figure 23.8). Insulin promotes the recruitment of insulin-sensitive glucose transporters ***(GLUT-4, see p. 97) from a pool located in intracellular vesicles. [Note: Some tissues have insulin-independent systems for glucose transport33.Northern Blotting is for: A.RNA B.DNA C.Protein D.--

Ans:A.RNA35.immuno complex reaction A. Type 1 B. Type 2 C. Type 3 D. Type 4

Ans:C. Type 3(REPEAT)36.7-Methyl guanosine cap is present in? A.mRNA B.tRNA C.rRNA D.DNA

Ans:A.mRNA37.lactating mother best contraceptive is a. monophasic pill b. biphasic pill c. triphasic pill d. mini pill Ans: D .minipill(REPEAT)38.Juene syndrome is 1.AR 2.AD 3.X LINKED DOMINANT

4.X LINKED RECESSIVE Ans:1.AR Reference:Emedicine39.Sample of spinal cord preseved in... a.oleander poisoning b.war gases c.Strychnine poisoning d.arsenic poisoning

Ans:c.Strychnine poisoning (REPEAT)40.Candida albicans infection seen in A. chronic granulomatous disease B. lazy leucocyte syndrome C. myeloperoxidase deficiency D. chediak - hegasky syndrome

Ans:C. myeloperoxidase deficiencyReference:Harrison Medicine

Clinically normal except in patients with underlying disease such as diabetes mellitus; then ****candidiasis or other fungal infections41.Kimmesteil wilson lesion is A.Hyaline arteriosclerosis B.Nodular glomerulosclerosis C.-- D.--

Ans: B.Nodular glomerulosclerosis(REPEAT)42.Function of ubiquitin in the Cell is? A.Degradation of intracellular protein B.Endocytosis C.?? No mention of apoptosis in the Q D.Plays an important role in acute inflammation

Ans:A.Degradation of intracellular protein(REPEAT)43.Sudden onset of Delsuions De Novo in a 35yrs old man with no previous symptom should prompt the physician to think of?

1.substance abuse 2.schizophrenia 3.-- 4.--

Ans:1.substance abuse44.bulls eye retinopathy is seen in toxicity of? A.quinine B.tobacco C.ethanol D.Choroquine

Ans:D.Choroquine(REPEAT)45.pterygium causes? A. astigmatism B.Myopia C.Hypermetropia D.--

Ans:A. astigmatism

Reference:Khurana Ophthalmology

Pterygium is an asymptomatic condition in the early stages, except for cosmetic intolerance. Visual disturbances occur when it encroaches the pupillary area or due to corneal ****astigmatism induced due to fibrosis in the regressive stage.46. Coxsackie A virus causes all except A. aseptic meningitis B. herpangina C. Hand Foot and mouth disease D. bornholm ds Ans:D. bornholm ds 47.Drug most useful for Bacteriodes fragilis is? A.cefipime B.ceftazidime C.cefoxitin D.cefotetan

Ans:D.cefotetan

Reference : Goodman and Gilman Pharmacology

Cefotetan is a cephamycin, and like cefoxitin, it has *****good activity against ****B. fragilis. It

also is effective against several other species of Bacteroides, and it is slightly more active than cefoxitin against gram-negative aerobes. After an intramuscular dose of 1 g, peak plasma concentrations of cefotetan average 70 g/ml. It has a half-life of 3.3 hours (Phillips et al., 1983; Wexler and Finegold, 1988). Hypoprothrombinemia and inhibition of vitamin K activation with bleeding have occurred in malnourished patients receiving cefotetan owing to the methyl-tetrazole-thiomethyl (MTT) group at position 3; this is preventable if vitamin K is administered as well.48.Long acting local anaestheic agent a. procaine b. lidocaine c. bupivacaine d.-- Ans:c. bupivacaine

49.which antiepileptic drug is idicated in pregnancy ? a. valproic acid b. carbamazepine c. trimetazadone d. dilatin Ans:B. Carbamazepine50.True about glasgow coma scale ?

a. highest score means bad prognosis b. It includes measuring pupillary size c. -- d. it include verbal response

Ans:d. it include verbal response51.Which of the following arteries is not involved littles area anastomosis? A.Anterior ethmoid B.Sphenopalatine art C.Greater palatine artery D.posterior ethmoid artery

Ans:D.posterior ethmoid artery(REPEAT)52.Protein present in brown adipose tissue? 1)thermogenin

2)dinitroprotein 3)-- 4)--

Ans:1)thermogenin

Reference:Wikipedia *****Thermogenin (called uncoupling protein by its discoverers and now known as uncoupling protein 1, or UCP1)[1] is an uncoupling protein found in the mitochondria of brown adipose tissue (BAT).53.Nitrogen content in 200 gm protein? A.8g B.16g c.32 g d--

Ans:C 32g

Reference:Biocemistry by satyanarayan

Normal Nitrogen content of protein is 16% that is 16g in 100g of protein....

So for 200g it will be 32g...54.13. In which of the following malignancies histological Grade is a good prognositic indicator?

A.Soft tissue sarcoma B.Renal cell ca C.Lung cancer D.Melanoma Ans:A.Soft tissue sarcoma Reference: Sabiston surgery

Sarcoma histiotype is generally important determinants of prognosis and a predictor of distinctive patterns of behavior because none of the existing grading systems is ideal and applicable to all tumor types. Biologic behavior is currently best predicted on the basis of histologic type, histologic grade, tumor size, and depth.

55.A study to evaluate the relationship between smoking and pregnancy was performed with history of smoking exposures taken during PNC visit and the child birthweight after delivery. This type of study is

A. case control B.prospective cohort C. Cross sectional D. Clinical Trial

Ans:B.prospective cohortAns:B.prospective cohort56.Amaurosis fugax caused by lesion/atherosclerosis in ? A.Internal carotid artery B. MCA C.ACA D.Basilar artery

Ans:A.Internal carotid artery Reference :Harrison Principles of Medicine

Transient or Sudden Visual Loss

Amaurosis Fugax

This term refers to a transient ischemic attack of the retina (Chap. 364). Because neural tissue has a high rate of metabolism, interruption of blood flow to the retina for more than a few seconds results in transient monocular blindness, a term used interchangeably with amaurosis fugax. Patients describe a rapid fading of vision like a curtain descending, sometimes affecting only a portion of the visual field. Amaurosis fugax usually occurs from an embolus that becomes stuck within a retinal arteriole (Fig. 29-5). If the embolus breaks up or passes, flow is restored and vision returns quickly to normal without permanent damage. With prolonged interruption of blood flow, the inner retina suffers infarction. Ophthalmoscopy reveals zones of whitened, edematous retina following the distribution of branch retinal arterioles. Complete occlusion of

the central retinal artery produces arrest of blood flow and a milky retina with a cherry-red fovea (Fig. 29-6). Emboli are composed of either cholesterol (Hollenhorst plaque), calcium, or platelet-fibrin debris. The most common source is an atherosclerotic plaque in the***** carotid artery or aorta, although emboli can also arise from the heart, especially in patients with diseased valves, atrial fibrillation, or wall motion abnormalities.57.A patient is in ventricular fibrillation with hypotension,unresponsiveness , peripheral pulses are not felt.What would be the initial management of this patient? A.Lignocaine push B.Amiodarone push C.-- D.200Joule Defibrillation

Ans:D.200Joule Defibrillation

TOC for Unstable VT is DEFIBRILLATION58.Filigree burns seen in A.Radiation B.Electrical burn C.Lightening D.--

Ans:C.Lightening(REPEAT)59.False positive test against treponemal antigen is seen in ? A.HIV B.Infectious mononucleosis C.Lyme's disesase D.--

Ans:B.Infectious mononucleosis

60.Medial boundary of Inguinal Ring is formed By? A.Lacunar ligament B.Pectineal ligament C.Inguinal Ligamnet D.-- Ans:A.Lacunar ligament Reference:Kieth and Moore Anatomy

The boundaries of the femoral ring are as follows:

laterally, a femoral septum between the femoral canal and the femoral vein; posteriorly, the superior ramus of the pubis covered by the pectineus and its fascia; ******medially, the lacunar ligament; and anteriorly, the medial part of the inguinal ligament.61.Toxicity due to ethanol is because of which pathological mechanism? A.Decreased NADH/NAD+ B.Decreased lactate/pyruvate C.Inhbition of gluconeogenesis D.Stimulation of fatty acid oxidation

Ans:C.Inhbition of gluconeogenesis61.Toxicity due to ethanol is because of which pathological mechanism?

A.Decreased NADH/NAD+ B.Decreased lactate/pyruvate C.Inhbition of gluconeogenesis D.Stimulation of fatty acid oxidation

Ans:C.Inhbition of gluconeogenesis

EXPLANATION:

1.Alcohol increases the NADH levels by its converision to aldehyde metabolites.... 2.Because of Increased NADH/NAD+ ratio the Kreb's Cycle and Fatty acid Oxidation is halted as these are cycles which provide energy....when energy is already in EXCESS why do we need them.OPTION A and D ruled out 3.Pyruvate is converted to lactate as kreb's inhibited 4.Fatty acid synthesis is started 5. Gluconeogenesis is FAULTILY INHIBITED as the body thinks It has lot of energy ...In actual it does not.....this EXPLAINS HYPOGLYCEMIC episodes in Alcoholics----OPTION C62.intranasal calcitonin used for? A.Post menopausal Osteoporosis B.Paget's Ds C.-- D.--

Ans:A.Post menopausal Osteoporosis

Reference:Goodman and Gilman

Salmon calcitonin is approved for clinical use. The latter product also is available as a ****nasal spray, introduced for once-daily treatment of ****postmenopausal osteoporosis63.Which of the following Psychiatric illness is common in a patient with stroke? A.Schizophrenia B.Depression C.Bipolar disorder D.Psychosis

Ans:B.Depression

Reference:Kaplan and sadock Psychiatry

Mood disorder caused by a general medical condition, with depressive features, appears to affect men and women equally, in contrast to major depressive disorder, which predominates in women. As much as 50 percent of all poststroke patients experience depressive illness64.volkman's ischemic contracture seen in? A.supracondylar fracture of humerus B.Tibial plateau fracture C. -- D. -- Ans:A.supracondylar fracture of humerus(REPEAT)65.Efferent neuron for skeletal muscle A.Alfa motor neuron B.Gamma motor neuron C.Ia fibre D.Ib fibre

Ans:A.Alfa motor neuron

Alfa motor neurone is the final common efferent for the skeletal muscle.....Gamma motor neurone is for the Muscle spindle66."aschoff bodies" are seen in? A.rheumatoid arthritis B.rheumatic fever C.bacterial endocarditis D.-- Ans:B.rheumatic fever ---seen in carditis67.Juvenile papillomatosis s caused by A.Hpv B.Ebv C.cmv D.--

Ans:A.Hpv68.Biopsy of parotid gland in sjogren's shows A.Lymphocytes B.Neutrophils C.Eosinophils D.Basophils

Ans.A.Lymphocytes

Reference:Robbin's Pathology 8th ed

. As mentioned earlier, lacrimal and salivary glands are the major targets of the disease, although other exocrine glands, including those lining the respiratory and gastrointestinal tracts and the vagina, may also be involved. The earliest histologic finding in both the major and the minor salivary glands is periductal and perivascular *****lymphocytic infiltration. Eventually the lymphocytic infiltrate becomes extensive ( Fig. 6-35 ), and in the larger salivary glands lymphoid follicles with germinal centers may be seen.69.best sonological marker for diagnosis of downs in 1st trimester A.Nuchal transluscency B.-- C.-- D.--

Ans:A.Nuchal transluscency(REPEAT)70.Primary sclerosing cholangitis, assoc with A.Adenoca pancreas B.adenoca GB C.cholangioca D.HCC

Ans:C.cholangioca Reference:Sabiston surgery

A number of diseases have been linked to cholangiocarcinoma, including ***primary sclerosing cholangitis, choledochal cysts, and hepatolithiasis. Characteristics common to these diseases include bile duct stones, biliary stasis, and infection71.Stretch is detected by?

A.Muscle spindle B. golgi tendon organ C. proprioceptors D.--

Ans :A.Muscle spindle (REPEAT)72.which of the following is not a objective hearing test? A.impedance audiometry B. otoacoustic emmissions C. Bera D. Puretone audiometry

Ans:D. Puretone audiometry

Depends on patients response so subjective73.toxin responsible for staphyloccal toxic shock syndrome? A. superantigenic toxin B. alpha hemolysin C. panton valentine toxin D. coagulase

Ans:A. superantigenic toxin(REPEAT)74.which group of drugs potentiates the action of Neuromuscular blockers A. Aminoglycosides B.-- C.-- D.--

Ans:A. Aminoglycosides(REPEAT)75.Extra mammary pagets MC seen in A.Vulva B.Vagina C.Penis D.--

Ans:A.Vulva

EXTRAMAMMARY PAGET DISEASE

This curious and rare lesion of the ****vulva, and sometimes the perianal region, is similar in its manifestations to Paget disease of the breast ( Chapter 23 ). As a vulvar neoplasm, it presents as a pruritic, red, crusted, sharply demarcated, maplike area, occurring usually on the labia

majora. It may be accompanied by a palpable submucosal thickening or nodule.76.Photopsia are present in which of the following? A.Retinal detachment B.Open angle glaucoma C. Uveitis D. -- Ans: A. Retinal detachment(REPEAT)77.Shoulder dislocation occurs commonly in wch direction A.Anteriorly B.Superiorly C.Postriorly D.Medially

Ans:A.Anteriorly78.Malignant hyperthermia s common with A.Local anesthetics B.Succinyl choline C.Propofol D.--

Ans:B.Succinyl choline(REPEAT)79.Blowout injury refers to what? A.Fracture of orbit B.Fracture of maxillary antrum C.-- D--

Ans:A.Fracture Orbit(REPEAT)80.Urea is formed by the action of the following enzyme? A.Arginase B.Ornithine transcarbamoylase C.Aspartate.. D.---

Ans:A.Arginase81.fetal heart septum is formed at A.5-8 weeks B..8-9 wks C..10-12wks D.-- NEED CORRECTION OF OPTIONS IF ANY

Ans:A.5-8 weeks

Reference:Langman Embryology

Formation of the Cardiac Septa The major septa of the heart are formed between the 27th(4 weeks) and 37th(5 weeks) days of development, when the embryo grows in length from 5 mm to approximately 16 to 17 mm.82.Which of the following is an early sign of Hypermagnesemia? A.Hypotension B.Loss of DTR C.-- D.-- Ans:A.Hypotension

Reference:Harrison Medicine

Clinical and Laboratory Findings

The most prominent clinical manifestations of hypermagnesemia are vasodilation and neuromuscular blockade, which may appear at serum magnesium concentrations >2 mmol/L (>4 meq/L; >4.8 mg/dL). ******Hypotension, refractory to vasopressors or volume expansion, may be an ****early sign. Nausea, lethargy, and weakness may progress to respiratory failure, paralysis, and coma, with hypoactive tendon reflexes, at serum magnesium levels >4 mmol/L. Other findings may include gastrointestinal hypomotility or ileus; facial flushing; pupillary dilation; paradoxical bradycardia; prolongation of PR, QRS, and QT intervals; heart block; and, at serum magnesium levels approaching 10 mmol/L, asystole.83.Progesteron causes stimulation of A.Myometrial activation b.Myometrial quessence c.Increases Oxytocin receptors d.Causes cervical ripening

Ans:b.Myometrial quessence

Reference:Ganong Physiology

The principal target organs of progesterone are the uterus, the breasts, and the brain. Progesterone is responsible for the progestational changes in the endometrium and the cyclic changes in the cervix and vagina described above. It has an antiestrogenic effect on the myometrial cells, ********decreasing their excitability, their sensitivity to oxytocin, and their spontaneous electrical activity while increasing their membrane potential84.Endometrial ca wid poor prognosis A.Adeno grade 2 B.Adenosquamous C.Adenoacanthoma D.Clear cell

Ans:D.Clear cell

Reference:Berek and Novak Gynecology

Clear cell carcinoma characteristically occurs in older women and is a *****very aggressive type of endometrial cancer; the prognosis is similar to or worse than that of papillary serous carcinoma. Overall survival rates of 33% to 64% have been reported. Myometrial invasion and LVSI are important prognostic indicators85.Duct of Bellini are seen in?. A.Kidney B.Lung C.Submandibular salivary gland D.---

Ans:A.Kidney(REPEAT)86.A Female patient with hypertension and obese, normal pituitary function. has chronic headache.Most likely diagnosis is? A.Cushing's Syndrome B.Empty sella syndrome C.Prolactinoma D.--

Ans:A.Cushing's Syndrome87.Clonidine acts on a. sym ner v presynaptic end b. vasomotor center c. symph ganglion d.

Ans:b. vasomotor center

88.Ability to form a concept and generalise it A.Concrete thinking B.Abstract thinking C.Intellectualisation D.--

Ans:B.Abstract thinking

Reference:Kaplan and Sadok Psychiatry

Abstract Thought

Abstract thinking is the ****ability to deal with *****concepts. Patients can have disturbances in the manner in which they ****conceptualize or handle ideas. Can the patient explain similarities, such as those between an apple and a pear or between truth and beauty? Are the meanings of simple proverbs, such as â€œA rolling stone gathers no moss,â€ understood? Answers can be �concrete (giving specific examples to illustrate the

meaning) or overly abstract (giving too generalized an explanation).89.umblical cord contains ? A. 1 umblical a, 2 veins B. 1 veins, 1 a C. 2 a, 1 vein D.--

Ans:C. 2 a, 1 vein(REPEAT)90.lower end of spinal cord in adults? A. lower end of L1 B. lower end of L3 C. lower end of L2 D. upper end of L3

Ans:A. lower end of L1(REPEAT)91.Multi drug resistance through plasmids is transferred by A.Transduction B.Transfection C.Conjugation D.Recombination

Ans:C.Conjugation(REPEAT)92.Metastatic prostate ca,trtmt A.RT B.estrogen therapy C.GnRH analogs D.RT wit chemotherapy

Ans:C.GnRH analogs


The management of patients with castrate metastatic disease requires first that the castrate status be documented. Patients receiving an antiandrogen alone, whose serum testosterone levels are elevated, should be treated first with a *****GnRH analogue or orchiectomy and observed for response 93.Poor prognostic factor in a pt with pancreatitis

A.Leucocytosis >20,000 B.Elev ser. amylase

C.Elev ser lipase D.Diastolic BP>90mm Hg

Ans:A.Leucocytosis >20,000---its a RANSON criteria94.A man presents with weakness , pain in upper abd.,hyperpigmentation, arthritis, hyperglycemia and an enlarged palpable liver.Most probable diagnosis is A.Haemochromatosis B. Addisson's disease C.Insulin Dependent DM D.--

Ans:A Hemochromatosis95.A man presents with weakness, tachycardia,sweating, palpitations, giddiness on fasting and relieved by takin food.Diagnosis? A.Insulinoma B. Pancreatic ca C. Carcinoid D.--Ans:A ..Insulinoma96.which alpha 2 agonist is used to relieve spasticity in amyotrophic lateral sclerosis? A.clonidine B.Brimonidine C.Apraclonidine D.Tizanidine

Ans:D.Tizanidine

Reference:Katzung Pharmacology

Tizanidine

As noted in Chapter 11, agonists such as clonidine and other imidazoline compounds have a variety of effects on the central nervous system that are not fully understood. Among these effects is the ability to reduce muscle spasm. Tizanidine is a congener of clonidine that has been studied for its ***spasmolytic actions. ***Tizanidine has *****significant 2-adrenoceptor agonist effects,

but it reduces spasticity in experimental models at doses that cause fewer cardiovascular effects than clonidine. Neurophysiologic studies in animals and humans suggest that tizanidine reinforces both presynaptic and postsynaptic inhibition in the cord. It also inhibits nociceptive transmission in the spinal dorsal horn.97.von gierke"s disease false? A.Metabolic acidosis B.Hyperuricemia C. Muscle atrophy D.Hypertriglyceridemia

Ans:C. Muscle atrophy98. .Obstruction at the bifurcation of aorta leads to A.Claudication of buttocks and thigh B.Retrograde ejaculation C.Gangrene D.Pallor of lower limb

Ans:A.Claudication of buttocks and thigh

Classically, it is described in male patients as a triad of symptoms consisting of: ****claudication of the buttocks and pages atrophy of the musculature of the legs impotence (due to paralysis of the L1 nerve)NOT RETROGRADE EJACULATION

Reference:Sabiston surgery99.retroperitoneal fibrosis MC presents as A.b/l pedal edema B.ascites C.ureteral obstruction D.--

Ans:C.ureteral obstruction(REPEAT)

Reference:Sabiston

The fibrosis is usually confined to the central and paravertebral spaces between the renal arteries and sacrum and tends to encase the aorta,

inferior vena cava, and ureters. The process usually begins at the level of the aortic bifurcation and spreads cephalad. In 15% of instances, the fibrotic process extends outside of the retroperitoneum to also involve the peripancreatic and periduodenal spaces, the pelvis, and the mediastinum.

Patients present with a vague constellation of symptoms, including abdominal or flank pain, weight loss, malaise, and hypertension. Scrotal or leg edema caused by lymphatic obstruction may also be present. Laboratory tests often provide evidence of renal insufficiency and anemia. Other laboratory abnormalities include an elevated erythrocyte sedimentation rate and an elevated C-reactive protein level.100.Incidence Of H.Pylori in Gastric ulcer is A.5% B.20% C.60% D.80%

Ans: C.60%

Refernce : Harrison Medicine

H. pylori infection is virtually always associated with a chronic active gastritis, but only 10–15% of infected individuals develop frank peptic ulceration. The basis for this difference is unknown. Initial studies suggested that >90% of all DUs were associated with H. pylori, but H. pylori is present in only *****30–60% of individuals with ****GUs and 50–70% of patients with DUs.101.lobular ca breast histology?

A.Single file pattern B.Pleomorphic cells in sheets C.-- D.--

Ans:A.Single file pattern

Reference: Sabiston Surgery

However, invasive lobular cancer tends to permeate the breast in a single-file nature, which explains why it remains clinically occult and escapes detection on mammography or physical examination until the total extent of the disease is large.102.A woman comes to er few hrs back with long bone fracture now complaints of breathlessness ,ther r petechial rashes over chest, auscultation findings r normal , abg p02 50, pc02-20mmhg...., diagnosis? A. air embolism B. fat embolism C. pulmonary embolism D.-- Ans:B. fat embolism103.treatment of uveitis consists of: a.antibiotic and steroid b.steroid and cyclopegic c.antibiotic and cyclopegic d.steroid and mydriatic

Ans:b.steroid and cyclopegic104.True regarding direct hernia ? A.mc type in women B. medial to inferior epigastric a C. most of the times descends upto the bottom of scrotum D.we need to open the sac while reducing at surgery

Ans :B. medial to inf epigastric a105.paranoid schizophrenia is caused by intake of ? A.Amphetamine B.Heroin C.Cannabis D. Ans:A.mphetamine

Reference:Kaplan and Saddock Psychiatry A person who abuses amphetamines requires increasingly high doses of amphetamine to obtain

the usual high, and physical signs of amphetamine abuse (e.g., decreased weight and ****paranoid ideas) almost always develop with continued abuse106.Treatment of Stage A( Superficial and Submucosal )Bladder carcinoma is? A.Local excision B.Intravesical Chemotherapy C.Radiotherapy D.Chemotherapy

Ans:B>A107.which is not considered for screening? A.Disease burden B.Physician's Knowledge of the the disease C.Cost of the test D.Treatment efficacy

Ans:B.Physician's Knowledge of the the disease(BEST ANS)pt with rhabdomyolysis with arf what should be done 1st? A.mannitol B. alkali diuresis C.-- D.--

Ans:B. alkali diuresis


108.pt with rhabdomyolysis with arf what should be done 1st? A.mannitol

B. alkali diuresis C.-- D.--

Ans:B. alkali dieresis109.A pt presents with hypotension in confused state & METABOLIC ALKALOSIS which of the following tests will best suggest the diagnosis? 1) urine ph 2) urine Na+ 3) urine Cl- 4) urine k+

Ans:1) urine ph

Urine pH tells if the Kidney is compensating for the metabolic problem or not and what is the main cause..... Serum Cl is useful in classifying Metabolic acidosis....110.treatment of leukoplakia consist of--- a.topical chemotherapy b.excision biopsy of ALL lesions c.ill fitted dencture reposition d.Local Radiotherapy

Ans:c.ill fitted dencture reposition(OPEN FOR ARGUMENTS)

References: WIKIPEDIA---better references welcome The treatment of leukoplakia mainly involves ****avoidance of predisposing factors — tobacco cessation, smoking, quitting betel chewing, abstinence from alcohol — and ***avoidance of chronic irritants, e.g., the sharp edges of teeth. A biopsy should be done, and the lesion surgically excised ****if pre-cancerous changes or cancer is detected.111.Absence of which of foll makes dia of pul. embolism most unlikely: A.Pleuritic chest pain B.Hemoptysis C.Tachypnoea D.Wheezing

Ans:C.Tachypnoea Reference:CMDT 2011 LINE TO LINE PICK

Indeed, no single symptom or sign or combination of clinical findings is specific to PE. Some findings are fairly sensitive: ***dyspnea and pain on inspiration occur in ***75–85% and 65–75% of patients, respectively.***** Tachypnea is the only sign reliably found in more than half of patients.112.distinct feature of bronchial asthma when compared to other obstructive lung diseases? a)hyperinflation on CXR b)reversible obstrucction c)acute exacerbation with URI d)decreased fvc1/fvc

Ans:b)reversible obstruction113.RPGN is chaecterised by------- a.crescent formation b.splliting of bm c.neutrophil infiltration of iterstitium d.---

Ans:a.crescent formation(REPEAT)114.In which condition is there a pain before the onset of mensturation which relieves after the begining of menses? A.Spasmodic Dysmenorrhea B.Congestive Dysmenorrhea C.Membranous Dysmenorrhea D.Menorrhagia

Ans:B.Congestive Dysmenorrhea

Reference:Shaw Gynecology Page:265 LINE TO LINE ICK115.M/C site of ectopic pregncy? A.ampullary portion of fallopian tube B.Isthmus C.Interstitium D.Abdomen

Ans:A.ampullary portion of fallopian tube(REEAT)

116.hypotension is caused by all except ? A.Halothane B.Propofol C.Ketamine D.?

Ans: C.Ketamine(REPEAT)117.Fixed performance device: A.venturi mask B.nasal cannula C.simple mask D.non rebreathing mask

Ans :A.venturi mask118.which of the following is not present in dhatura? A.hyoscine B.hyocyamine C.Muscarine D.stramonium

Ans : C.Muscarine

Reference:Forensic Medicine By Narayan Reddy Pg:514

The main alkaloids are Atropine,Hyosine and Hyocynamine

Strmonium is the other name of Datura Stramonium

So better answer is Muscarine>Stramonium119.administration of which of the following can prevent neural defects in newborn? A.Folic acid B.vit b 12 C.-- D.-- Ans :A. Folic acid120.Receptor for vit b 12-IF compelex is located in? A.ileum B.colon C.jejunum

D.Duodenum

Ans:A.ileum

Reference:Harrison Principles of Medicine

The IF-cobalamin complex passes to the ****ileum, where IF attaches to a specific receptor (cubilin) on the microvillus membrane of the enterocytes.121.Which of the following is best in studying the decline in percentage of alcohol usage in men and women over several years? A.Pie Chart B.Histogram C.Frequency polygon D.Line diagram

Ans:D.Line diagram

Reference:Park Page644

Line diagram is used to show the ****trend of events with the ***passage of Time

Remember the Runs scored chart of CRICKET....just like that.comparing male and female alcohol consumption decrease over several years122.Urinary stone formed in patients with regional bowel enteritis is A.ca oxalate B.Urate C.Phosphate D.cysteine

Ans:A.ca oxalate


The most frequent genitourinary complications are calculi, ureteral obstruction, and fistulas. The highest frequency of nephrolithiasis (10–20%) occurs in patients with CD following small-bowel resection. *******Calcium oxalate stones

develop secondary to hyperoxaluria, which results from increased absorption of dietary oxalate.123.Antepartum bleed of fetal origin is? A.vasa praevia B.Circumvallate placenta C.Abruptio placenta D.Placenta praevia

Ans:A.vasa praevia(REPEAT)124.Which of the following drugs is NOT having active metabolite ? A.Propanolol B.Procainamide C.Diazepam D.Fexofenadine

Ans:D.Fexofenadine

Reference:Goodman and Gilman

Fexofenadine is derived from TERFENADINE

Propranolol is metabolised to form several metabolites of which 4Hydroxypropranolol is one ..It has Beta adrenergic activity..125.Prolactin is secreted by a) chromophobe cells b) acidophilic cells c) basophilic cells d) Chromophill cells

Ans:b) acidophilic cells Reference:Ganong Physiology [img]http://www.rxpgonline.com/modules/Shack/uploads/anand_parsns/lacto.bmp[/img]

126.vasopressin inhibited by ? a) alcohol b) carbamazepine c) clofibrate d) Pain

ans. A(REPEAT)

127.most radio resistant in cell cycle a) G1 b) early S phase c) late s phase d) G2

Ans:c) late s phaseMost common cause of End stage renal disease is? A.DM B.Hypertension C.-- D.--

Ans:A.DM

Reference:CMDT 2011

129.Post Kidney transplantation complication caused by CMV is? 1) parotitis 2) cholecystitis 3) pyelonephritis 4) GI Necrosis and stricture

Ans:4) GI Necrosis and stricture

Reference:Harrison Principles OF Medicine

CMV ulcerations occur in both the lower and the upper gastrointestinal tract, and it may be difficult to distinguish diarrhea due to GVHD from that due to CMV infection.

Post transplant CMV infections:

Associated graft rejection

Fever

Bone marrow failure

Pneumonitis

Gastrointestinal disease130.Which of the following is least protein bound? A.Morphine B.Sufentanyl C.-- D.--

Ans:A.Morphine

Morphine--30% protein bound131.Cortex of ovary consist of all the following EXCEPT a)graffian follicle b)hilus c)primordial follicle d)corpus luteum

Ans:b)hilus(REPEAT)132.Q: A 25 yr old male complains of paroxysm of unilateral head ache, associated with nasal discharge and tearing of eyes on the side of head ache, precipitated by bouts of alcohol, most likely diagnosis is

A. Cluster head ache B. Migraine C. Sinusitis D. ??

Ans:A. Cluster head ache Reference:Harrison Medicine Cluster headache is a rare form of primary headache with a population frequency of 0.1%. The pain is *****deep, usually retroorbital, often excruciating in intensity, nonfluctuating, and explosive in quality. A core feature of cluster

headache is periodicity. At least one of the daily attacks of pain recurs at about the same hour each day for the duration of a cluster bout. The typical cluster headache patient has daily bouts of one to two attacks of relatively short-duration unilateral pain for 8–10 weeks a year; this is usually followed by a pain-free interval that averages 1 year. Cluster headache is characterized as chronic when there is no period of sustained remission.

Cluster headache is associated with *****ipsilateral symptoms of cranial parasympathetic autonomic activation: conjunctival injection or lacrimation, rhinorrhea or nasal congestion, or cranial sympathetic dysfunction such as ptosis.133. Which of the following is affected in MEGALOBLASTIC anemia?

A. DNA B. RNA C. Globin D. ??

Ans:A. DNA


LINE TO LINE PICK

Biochemical Basis of Megaloblastic Anemia

The common feature of all megaloblastic anemias is a *********defect in DNA synthesis that affects rapidly dividing cells in the bone marrow. All conditions that give rise to megaloblastic changes share in common a disparity in the rate of synthesis or availability of the four immediate precursors of DNA: the deoxyribonucleoside triphosphates (dNTPs): dA(adenine)TP and dG(guanine)TP (purines), dT(thymine)TP and dC(cytosine)TP (pyrimidines). In deficiencies of either folate or cobalamin, there is failure to convert deoxyuridine monophosphate (dUMP) to

deoxythymidine monophosphate (dTMP), the precursor of dTTP (Fig. 100-1). This is because folate is needed as the coenzyme 5,10-methylene-THF polyglutamate for conversion of dUMP to dTMP; the availability of 5,10-methylene-THF is reduced in either cobalamin or folate deficiency. An alternative theory for megaloblastic anemia in cobalamin or folate deficiency is misincorporation of uracil into DNA because of a build-up of deoxyuridine triphosphate (dUTP) at the DNA replication fork as a consequence of the block in conversion of dUMP to dTMP.

134.Best advice to be given to a patient of newly diagnosed type 2 DM

A. Limit intake of carbohydrates B. Follow consistent calorie diet intake. C.stop sucrose D.less than 10% of saturated fat

Ans:A. Limit intake of carbohydrates

Reference:CMDT 2011 and Harrison Medicine

Diet

A well-balanced, nutritious diet remains a fundamental element of therapy. The American Diabetes Association (ADA) recommends about 45–65% of total daily calories in the form of carbohydrates; 25–35% in the form of fat (of which *******< 7% are from saturated fat), and 10–35% in the form of protein. In patients with type 2 diabetes, *******limiting the carbohydrate intake and substituting some of the calories with monounsaturated fats, such as olive oil, rapeseed (canola) oil, or the oils in nuts and avocados, can lower triglycerides and increase HDL cholesterol. Patients with type 1 diabetes or type 2 diabetes who take insulin should be taught "carbohydrate counting," so they can administer their insulin bolus for each meal based on its carbohydrate content. In obese individuals with diabetes, an additional goal is weight reduction by caloric restriction (see Chapter 29: Nutritional Disorders).

135. In a screening test for Ca Breast The sensitivity is 90(ninety)% specificity is [snip](ninety eight)%,what is the chance of a patient with Ca breast to be detected negative in screening conducted in two consecutive years.. A.1/10 B.2/10 C.1/100 D.2/100 Ans: C.1/100 Explanation: Sensitivity=True positivity rate is 90%=0.9 False negative rate=100-sensitivity=10%=0.1 So for 2 yrs of consequitive false negative in a patient with carcinoma breast.we need to apply multiplication rule of probability That is:0.1 X 0.1=1/100136.Which of the following is false regarding Peritonsilar abcess? A.Usually presents with trismus B.The accumulation of pus is lateral to the superior constrictor muscle C.It does not involve the floor of mouth D.It causes bulge of the uvula/soft palate Ans:B.The accumulation of pus is lateral to the superior constrictor muscle

“”Peritonsillar space is located ***Mediall to the superior constrictor muscle”” “””Progressive inflammation and suppuration may extend to directly involve the ****soft palate, the lateral wall of the pharynx, and, occasionally, the base of the tongue.”””

“””Many patients present with ipsilateral referred otalgia with swallowing. ****Trismus (ie, a limitation in the ability to open the oral cavity) of varying severity is present in ***all cases, reflecting*** lateral pharyngeal wall and pterygoid musculature inflammation.””” “”As the degree of inflammation and infection proceeds, symptoms include progression in the ****floor of the mouth, the parapharyngeal space, and the prevertebral space.”” 137. Most common serious complication of end colostomy is? A.Parastomal hernia B.prolapse

C.obstruction D.bleeding Ans: A.Parastomal hernia Reference:Shwartz surgery and Emergency medicine a comprehensive study guide Most common late complication of End colostomy is Parastomal hernia. More serious complications of end colostomy include necrosis, retraction, stenosis, and parastomal hernias.

138. aromatic enzyme complex is involved in the biosynthesis of A.Cholesterol B.Adrenal hormones C.vitamin D3 D.Estradiol/estrogens Ans: D.Estradiol/estrogens Reference:Katzung Pharmacology In many target tissues, testosterone is converted to dihydrotestosterone by 5 -reductase. In these tissues, dihydrotestosterone is the major active androgen. The conversion of testosterone to ***estradiol by P450 aromatase also occurs in some tissues, including adipose tissue, liver, and the hypothalamus, where it may be of importance in regulating gonadal function.139. Blunt injury to which region causes max vascular injury a.Inferior dislocation of clavicular region(option

unclear) b.Knee dislocation c.Elbow dislocation d.Tibial plateau fracture Ans: b.Knee dislocation (Most probably—shall review more references) High yield Orthopedics A knee dislocation is a difficult injury for the junior surgeon to diagnose. It represents a disabling and limb-threatening injury.Where doubt exists, the patient must be admitted for vascular observation and treatment, in that popliteal artery injury occurs in 35% to 45% of all knee dislocations.

140. which shouldnt be refrigrated before primary innoculation ? a) CSF b) urine c) sputum d) pus Ans: a) CSF(REPEAT) Reference:Anatanarayan csf should not be refrigerated bcoz h.influezae s killed.141. Most common organ injured in blunt injury ?? a. liver b. spleen c. intestine d. Kidney

Ans: b. Spleen142. which of the following occur in ischemic cardiac tissue A.increased ATP B.increased anaerobic glycolysis C.increased PH D.Increased release of Ca Ans: B.increased anaerobic glycolysis Reference:Harper Biochemistry If the thrombus in a coronary artery occludes approximately 90% of the vessel wall, blood flow through the

affected vessel may cease (total ischemia) and the oxygen supply of the affected area of mycocardium will be rapidly compromised. The normal metabolism of the myocardium is aerobic, with most of its ATP being derived from oxidative phosphorylation. The anoxia secondary to total ischemia results in a ****switch to anaerobicglycolysis, which generates only about one-tenth of the ATP produced by oxidative phosphorylation. Not only does this switch in metabolism occur, but the flow of substrates into the myocardium via the blood and the removal of metabolic products from it are also greatly reduced. This accumulation of intracellular metabolites increases the intracellular oncotic pressure, resulting in cell swelling, affecting the permeability of the plasma membrane. Thus, the affected myocardium exhibits depletion of ATP, ******accumulation of lactic acid, development of severe acidosis, and marked reduction of contractile force. The precise metabolic changes that commit a cell to dying are being investigated in many laboratories; this is a very important area of research. Changes under study include depletion of ATP, activation of intracellular phospholipases (resulting in damage to cellular membranes), activation of proteases, and *****accumulation of intracellular Ca2+ .143.Biconcave shape of RBC is useful for all except? A.Helps in passing through capilaries B.Helps in cellular metabolism C.Increased surface area diffusion of gases D.Prevent osmotic lysis Ans: B.Helps in cellular metabolism Reference:Harper Biochemistry Options A and D are clearly the functions. ATP is synthesized from glycolysis and is

important in processes that help the red blood cell maintain its biconcave shape and also in the regulation of the transport of ions (eg, by the Na+ -K+ ATPase and the anion exchange protein [see below]) and of water in and out of the cell. The biconcave shape ***increases the surface-to-volume ratio of the red blood cell, thus ****facilitating gas exchange. The red cell contains cytoskeletal components (see below) that play an important role in determining its shape.144.Swarming motility is shown by? A.Proteus B.Cholera C.— D.— Ans: A.Proteus

Reference:Harrison Medicine Proteus is readily isolated and identified in the laboratory. Most strains are lactose negative, produce H2S, and demonstrate characteristic swarming motility on agar plates. P. mirabilis is indole negative, whereas P. vulgaris and P. penneri are indole positive.144.Regarding appendicitis in CHILDREN, all are true except? A.localised pain is single most imp reliable sign B.vomiting precedes abd pain C.80 % cases perforation occurs in children less than 5 yrs D.60%perf in 48hrs

Reference: Nelson Textbook of Pediatrics: LINE TO LINE PICK LINE TO LINE PICK LINE TO LINE PICK LINE TO LINE PICK For option A:CORRECT Physical examination remains primary in accurate diagnosis of acute appendicitis and begins with inspection of the child's demeanor as well as the appearance of the abdomen. Children with early appendicitis typically appear mildly ill and move tentatively, hunched forward and often with a

slight limp favoring the right side. Supine, they are frequently lying quietly, on their right side with their knees pulled up to relax the abdominal muscles, and when asked to lie flat or sit up, they move cautiously and may use a hand to protect the right lower quadrant. Early in appendicitis, the abdomen is typically flat; abdominal distention suggests more advanced disease characteristic of perforation or developing small bowel obstruction. Auscultation may reveal normal or hyperactive bowel sounds in early appendicitis, to be replaced by hypoactive bowel sounds as the disease progresses to perforation. ******Localized abdominal tenderness is the single most reliable finding in the diagnosis of acute appendicitis.

For option B:INCORRECT Classically, acute appendicitis begins as an insidious illness with generalized malaise and anorexia. Abdominal pain is ****consistently the primary symptom and begins shortly (hours) after the onset of illness. The pain is initially vague, unrelated to activity or position, often colicky, and periumbilical in location as a result of visceral inflammation from a distended appendix. Progression of the inflammatory process in the next 12–24 hr leads to involvement of the adjacent parietal surfaces, resulting in somatic pain localized to the right lower quadrant. The pain becomes steady and more severe and is exacerbated by movement. The child often describes marked discomfort with the “bumpy” car ride to the hospital, moves cautiously, and has difficulty getting on to the examining room stretcher. Nausea and *****vomiting occur in more than half the patients and *****almost always follow the onset of abdominal pain by several hours. OPTION C:CORRECT Morbidity rates for appendicitis vary widely in large series from 10% to 45%. The principal determinant of complications is the severity of the appendicitis. In simple acute appendicitis, an

overall complication rate of 5–10% is expected. With gangrenous or perforated appendicitis, the complication rate rises to 15–30%. The most common complications are wound infections and intra-abdominal abscesses; both are more common after perforation. *****Perforation rates are consistently >80% in children <5 yr of age. OPTION D:CORRECT No direct line mentioning it in Nelson.........but logically appears correct............and anyway OPTION B is clearly WRONG145.Regarding appendicitis in CHILDREN, all are true except? A.localised pain is single most imp reliable sign B.vomiting precedes abd pain C.80 % cases perforation occurs in children less than 5 yrs D.60%perf in 48hrs

Reference: Nelson Textbook of Pediatrics: LINE TO LINE PICK LINE TO LINE PICK LINE TO LINE PICK LINE TO LINE PICK For option A:CORRECT Physical examination remains primary in accurate diagnosis of acute appendicitis and begins with inspection of the child's demeanor as well as the appearance of the abdomen. Children with early appendicitis typically appear mildly ill and move tentatively, hunched forward and often with a slight limp favoring the right side. Supine, they are frequently lying quietly, on their right side with their knees pulled up to relax the abdominal muscles, and when asked to lie flat or sit up, they move cautiously and may use a hand to protect the right lower quadrant. Early in appendicitis, the abdomen is typically flat; abdominal distention suggests more advanced disease characteristic of perforation or developing small bowel obstruction. Auscultation may reveal normal or hyperactive bowel sounds in early appendicitis, to be replaced by hypoactive bowel sounds as the disease progresses to perforation.

******Localized abdominal tenderness is the single most reliable finding in the diagnosis of acute appendicitis.

For option B:INCORRECT Classically, acute appendicitis begins as an insidious illness with generalized malaise and anorexia. Abdominal pain is ****consistently the primary symptom and begins shortly (hours) after the onset of illness. The pain is initially vague, unrelated to activity or position, often colicky, and periumbilical in location as a result of visceral inflammation from a distended appendix. Progression of the inflammatory process in the next 12–24 hr leads to involvement of the adjacent parietal surfaces, resulting in somatic pain localized to the right lower quadrant. The pain becomes steady and more severe and is exacerbated by movement. The child often describes marked discomfort with the “bumpy” car ride to the hospital, moves cautiously, and has difficulty getting on to the examining room stretcher. Nausea and *****vomiting occur in more than half the patients and *****almost always follow the onset of abdominal pain by several hours. OPTION C:CORRECT Morbidity rates for appendicitis vary widely in large series from 10% to 45%. The principal determinant of complications is the severity of the appendicitis. In simple acute appendicitis, an overall complication rate of 5–10% is expected. With gangrenous or perforated appendicitis, the complication rate rises to 15–30%. The most common complications are wound infections and intra-abdominal abscesses; both are more common after perforation. *****Perforation rates are consistently >80% in children <5 yr of age. OPTION D:CORRECT No direct line mentioning it in Nelson.........but logically appears correct............and anyway OPTION B is clearly WRONG

146. Neovascularisation of iris is seen in? A.diabetic maculopathy B.hypertensive retinopathy C.primary open angle glaucoma D.CRVO

Ans: D CRVO > A.diabetic maculopathy Reference:Khurana Ophthalmology Neovascularization develops following retinal ischaemia, which is a common feature of : _ Diabetic retinopathy, _ Central retinal vein occlusion, _ Sickle-cell retinopathy and _ Eales’ disease. _ Other rare causes are chronic intraocular inflammations, intraocular tumours, long-standing retinal detachment and central retinal artery occlusion. The pathognomic features for differentiating ischaemic CRVO from non-ischaemic CRVO are presence of relative afferent pupillary defect (RAPD),visual field defects and reduced amplitude of b-wave of electroretinogram (ERG). Complications. Rubeosis iridis and neovascularglaucoma (NVG) occur in more than 50 percent caseswithin 3 months (so also called as 90 days glaucoma),A few cases develop vitreous haemorrhage and proliferative retinopathy.147. Modified biophysical profile includes? A.Fetal tone and breathing B.Fetal movements and tone C.NST and AFI D.—

Ans:C.NST &AMNIOTIC FLUID INDEX

Reference:William’s Obstetrics MODIFIED BIOPHYSICAL PROFILE. Because the biophysical profile is labor intensive and requires a person trained in ultrasonic visualization of the fetus, Clark and co-workers (1989) used an abbreviated biophysical profile as

their first-line antepartum screening test in 2628 singleton pregnancies. Specifically, a vibroacoustic ****nonstress test was performed twice weekly along with *****determination of the amnionic fluid index (see Chap. 16, p. 392). An amnionic fluid index of less than 5 cm was considered abnormal. This abbreviated biophysical profile required about 10 minutes to perform, and they concluded that it was a superb method of antepartum surveillance because there were no unexpected fetal deaths.148. all from wolfian duct except

a. eoophoron

b. paraoooporon

c. gartner duct

d . bartholin duct

Ans: d . bartholin duct149. Antibiotic prophylaxis is indicated in all the following for prevention of endocarditis EXCEPT: (contributed by dragonliver4ever) a)cardiac catheterisation b)prostectomt c)cystescopy d)Dental procedures

Ans: a)cardiac catheterisation(REPEAT)150. rubor in inflammation due to A.Decreased tissue oncotic pressure B.Decreased oncotic pressure in arterioles C.Constriction of the capillaries D.Dilatation of the arterioles

Ans: Dilatation of arterioles

Reference:Robbins Pathology The clinical and pathologic manifestations of the inflammatory response are caused by several

reactions. The vascular phenomena of acute inflammation are characterized by increased blood flow to the injured area, resulting mainly from ******arteriolar dilation and opening of capillary beds induced by mediators such as histamine. Increased vascular permeability results in the accumulation of protein-rich extravascular fluid, which forms the exudate. Plasma proteins leave the vessels, most commonly through widened interendothelial cell junctions of the venules. The ****redness (rubor), warmth (calor), and swelling (tumor) of acute inflammation are caused by the *****increased blood flow and edema.151.The best initial management of a tumor of Anal CANAL of 2cm is A.Wide excision B.Chemoradiation C.— D.— Ans: B.Chemoradiation(REPEAT)152. Antiprogestin used for emergency contraception is? A.Mifepristone B.Misoprostal C.Methotrexate D.— Ans: A.Mifepristone(REPEAT) 153.Stability of ALPHA helix is affected by which amino acid? A.Tryptophan B.Proline C.Gulamate D.— Ans:B.Proline Reference:Harper Biochemistry The stability of an helix arises primarily from hydrogen bonds formed between the oxygen of the peptide bond carbonyl and the hydrogen atom of the peptide bond nitrogen of the fourth residue down the polypeptide chain (Figure 5–4). The ability to form the maximum number of hydrogen bonds, supplemented

by van der Waals interactions in the core of this tightly packed structure, provides the thermodynamic driving force for the formation of an helix. Since the peptide bond nitrogen of proline lacks a hydrogen atom to contribute to a hydrogen bond, proline can only be stably accommodated within the first turn of an helix. When present elsewhere, ****proline disrupts the conformation of the helix, producing a bend. Because of its small size, glycine also often induces bends in helices154. which gas accumulated in cavities post ga? 1) nitrous oxide 2) halothane 3 )-- 4 )-- Ans :1) nitrous oxide (REPEAT)155.Renal blood flow contributes what % of the cardiac output A.15% B.25% C.45% D.50%

Ans:B. 25% Reference:Ganong Physiology In a resting adult, the kidneys receive 1.2 to 1.3 L of blood per minute, or just ****under 25% of the cardiac output.156.Most common type of Finger print is? A.Whorl B.Loop C.Arch D.Composite

Ans:B.Loop(REPEAT)157. Point prevalence overestimates diseases with A.high incidence B.low incidence C.long duration D.high mortality

Ans: C.long duration Explanation: Now We Know that Prevalence=Incidence X Duration So both HIGH INCIDENCE And PROLOGED DURATION can INCREASE the PREVALENCE of a Disease.

BUT IN THE CASE OF HIGH INCIDENCE---it is NOT an OVERESTIMATION...as the NUMBER OF CASES IS HIGH IN CASE OF diseases WITH LONG DURATION—though the number of cases is LOW we GET AN IMPRESSION OF HIGH PREVALENCE due TO EXISTING OLD CASES

158.A Patient presents with hemolytic transfusion rxn, wat shd b done next? a.fluid restriction b.0.1M HCl c.iv fuids with mannitol d.steroids.

Ans:c.iv fuids with mannitol Reference:CMDT 2011

LINE TO LINE PICK LINE TO LINE PICK LINE TO LINE PICK Treatment If an acute hemolytic transfusion reaction is suspected, the transfusion should be stopped at once. The patient should be**** vigorously hydrated to prevent acute tubular necrosis. Forced diuresis with ****mannitol may help prevent kidney damage.159.Regarding portal vein false statement is: a.cbd is ant and right b.gastroduodenal art ant and left c.formed behind neck of pancreas d.behind 2nd part of duodenum

Ans . behind second part of duodenum

Reference: gray's anatomy ........................The portal vein (vena portæ) is about 8 cm. in length, and is formed at the level of the second lumbar vertebra by the junction of the superior mesenteric and lienal veins, the union of these veins taking place in front of the inferior vena cava and behind the neck of the pancreas. It passes upward behind the superior part of the duodenum and then ascends in the right border of the lesser omentum to the right extremity of the porta hepatis, where it divides into a right and a left branch, which accompany the corresponding branches of the hepatic artery into the substance of the liver. In the lesser omentum it is placed **********behind and between the common bile duct and the hepatic artery, the former lying to the**** right of the latter.

********Portal vein is a posterior relation to the 1st part of duodenum---Kieth and Moore Anatomy160. Endodermal sinus tumor best tumor marker A.HCG B.AFP C. CEA D.LDH Ans: B.AFP161. X ray diagnosis of scurvy is established by ? a] Ring epiphysis b] white line in metaphysis c] thinning of the cortex d)ground glass appearance

Ans. d)ground glass appearance

Reference: "SCURVY =BARLOW DISEASE = vitamin C deficiency with defective osteogenesis from abnormal osteoblast functionAge:6-9 months (maternal vitamin C protects for first 6 months) irritability tenderness + weakness of lower limbs scorbutic rosary of ribs bleeding of gums (teething) legs drawn up +

widely spread = pseudoparalysisLocation:distal femur (esp. medial side), proximal and distal tibia + fibula, distal radius + ulna, proximal humerus, sternal end of ribs Wimberger ring = sclerotic ring around epiphysis indicating loss of epiphyseal density white line of Fränkel = metaphyseal zone of preparatory calcification (DDx: lead / phosphorus poisoning, bismuth treatment, healing rickets) Trümmerfeld zone = radiolucent zone on shaft side of Fränkels white line (site of subepiphyseal infraction) Parke corner sign = subepiphyseal infraction / comminution resulting in mushrooming / cupping of epiphysis (DDx: syphilis, rickets) Pelkan spurs = metaphyseal spurs projecting at right angles to shaft axis "ground-glass" osteoporosis (CHARACTERISTIC) cortical thinning subperiosteal hematoma with calcification of elevated periosteum (sure radiographic sign of healing) soft-tissue edema (rare)"162.Mechanism of Meniscal injury is? A.Compression B.— C.— D.Flexion and rotation Ans: D.Flexion and rotation

Reference:eMedicine Mechanism of injury Meniscal injuries, particularly sports-related injuries, usually involve damage due to rotational force. A common mechanism of injury is a varus or valgus force directed to a flexed knee. When the foot is planted and the femur is internally rotated, a valgus force applied to a flexed knee may cause a tear of the medial meniscus. A varus force on a flexed knee with the femur externally rotated may lead to a lateral meniscus lesion. According to Ricklin, the medial meniscus is attached more firmly than the relatively mobile lateral meniscus, and this may result in a greater incidence of medial meniscus injury.

163. cardiac output decreases in all the following conditions except? A.sleep B.Heart disease C.sitting from supine D.Arrythmias((((Pregnancy was not there in the options)))) Ans: A.sleep Reference:Ganong Physiology LINE TO LINE PICK LINE TO LINE PICK LINE TO LINE PICK

164. salmon patch is seen with. which keratitis a)interstitial b)phylectenular c)acne rosace d)disciform

Ans:A. interstitial Ref . comprehensive opthalmology – Khurana

The clinical picture of interstitial keratitis can be divided into three stages:

1. Initial progressive stage. The disease begins with oedema of the endothelium and deeper stroma, secondary to anterior uveitis, as evidenced by the

presence of keratic precipitates (KPs). There is

associated pain, lacrimation, photophobia, blepharospasm and circumcorneal injection followedby a diffuse corneal haze giving it a ground glass appearance. This stage lasts for about 2 weeks.

2. Florid stage. In this stage eye remains acutely inflamed. Deep vascularization of cornea, consisting of radial bundle of brush-like vessels develops. Since these vessels are covered by hazy cornea, they look dull reddish pink which is called **********'Salmon patch appearance'**********. There is often a moderate degree of superficial vascularization. These vessels arising from the terminal arches of conjunctival vessels, run a short distance over the cornea. These vessels and conjunctiva heap at the limbus in the form of epulit. This stage lasts for about 2 months.

3. Stage of regression. The acute inflammation resolves with the progressive appearance of vascular invasion. Clearing of cornea is slow and begins from periphery and advances centrally. Resolution of the lesion leaves behind some opacities and ghost vessels. This stage may last for about 1 to 2 years165.Antigen presenting cells present in skin are : A.Langerhan cells B.Follicular Dendritic cells C.Microglia D.—

Ans: A.Langerhan cells Reference:Robbin’s Pathology 8th edition

There are two types of cells with dendritic

morphology that are functionally quite different. Both have numerous fine cytoplasmic processes that resemble dendrites, from which they derive their name. One type is called interdigitating dendritic cells, or just dendritic cells ( Fig. 6-4 ).[8] These cells are the most important antigen-presenting cells (APCs) for initiating primary T-cell responses against protein antigens (described later). Several features of dendritic cells account for their key role in antigen presentation. First, these cells are located at the right place to capture antigens—under epithelia, the common site of entry of microbes and foreign antigens, and in the interstitia of all tissues, where antigens may be produced. Immature dendritic cells within the epidermis are called Langerhans cells. Second, dendritic cells express many receptors for capturing and responding to microbes (and other antigens), including TLRs and mannose receptors. Third, in response to microbes, dendritic cells are recruited to the T-cell zones of lymphoid organs, where they are ideally located to present antigens to T cells. Fourth, dendritic cells express high levels of the molecules needed for presenting antigens to and activating CD4+ T cells.167.All of the following changes occur in pregnancy except? A.Increase in Cardiac output B.Increase in heart rate C.Increase in Viscosity D.— Ans: C.Increase in Viscosity Reference:Williams Obstetrics Hemoglobin Concentration and Hematocrit. In spite of augmented erythropoiesis, hemoglobin concentration and the hematocrit decrease slightly during normal pregnancy. As a result, ******whole blood viscosity decreases (Huisman and colleagues, 1987). Hemoglobin concentration at term averages 12.5 g/dL and in 6 percent of women it is below 11.0 g/dL (see Fig. 51-1 and Table 51-1). Thus, in most women, a hemoglobin concentration below 11.0 g/dL,

especially late in pregnancy, should be considered abnormal and usually due to iron deficiency rather than to hypervolemia of pregnancy.168. BLOOM SYNDROME A/E 1.Decreased levels of IgG 2.D.l.o. IgM 3.D.l.o Ig A 4.Raised IgE levels

Ans: 4.Raised IgE levels>1.Decreased levels of IgG

Reference:eMEDICINE

Immunoglobulin levels should be checked; decreased immunoglobulin A and immunoglobulin M, with or without immunoglobulin G changes, are expected.169. which is most commonly injured in transverse fracture of low humerus 1)median 2)ulnar 3)circumflex brachial nerve 4)radial

Ans: 2)ulnar nerve(if it is distal shaft of humerus then we can go with median nerve as for supracondylar fracture)170.Which of the following visual defects is seen in a patient with a pituitary tumor compressing the central optic chiasma? A.Homonymous hemianopia B.Superior quadrantic field defect C.Inerior quadratic field defect D.Bitemporal hemianopia

Ans: D.Bitemporal hemianopia171.Autoimmune thyroiditis is confirmed by? A.Biopsy B.Antibodies C.— D.—

Ans: A.Biopsy


Once clinical or subclinical hypothyroidism is confirmed, the etiology is ****usually easily established by demonstrating the presence of TPO antibodies, which are present in >90% of patients with autoimmune hypothyroidism. TBII can be found in 10–20% of patients, but these determinations are not needed routinely. If there is any doubt about the cause of a goiter associated with hypothyroidism, FNA biopsy can be used to *****confirm the presence of autoimmune thyroiditis.

172.The ratio of the length of the uterin body to the cervix in a neonate is: A.1:1 B.1:2 C.2:1 D.1:3 Ans:B.1:2

173. Automatisms and abnormal Olfactory sensations are seen in: A.non dominant parietal lobe lesion B.temporal lobe lesion C.-- D.— Ans: B.temporal lobe lesion

174.What is the percentage of CD4 T Lymphocytes in a child? A.35% B.45% C.65% D.— Ans: C.65%

Reference:Anatanarayan and Paniker Microbiology

175.Which of the following vitamin defeciencies is noted in a patient who has undergone partial gastrectomy?

A.Vit B12 defeciency B.Folic acid defeciecy C.Iron deficiency D.—

Ans: A.Vit B12 defeciency Reference:Harrison Table on causes of Megaloblastic anemia due to B12 defeciency

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JIPMER 2011