1.  A 30 year old patient is having high grade fever with altered sensorium.

           On third day the patient develops seizures and has Nuchal rigidity. The CSF

           examination of the patient shows presence of 300 cells/cu.mm, protein

           70mg%, glucose 50mg% (BLOOD GLUCOSE= 95mg%) with polymorph 65%

           and the rest being lymphocytes. The most probable diagnosis of the patient is:

                  a. Herpetic encephalitis

                  b. Tubercular meningitis

                  c. Pyogenic meningitis

                  d. Cerebral malaria.

Answer is C: pyogenic meningitis

Reference: chapter 381 harrison 18 th edition

• Harrison states for viral encephalitis that “CSF examination should

be performed in all patients with suspected viral encephalitis unless

contraindicated by the presence of severely increased ICP. The

characteristic CSF profile is indistinguishable from that of viral

meningitis and typically consists of a lymphocytic pleocytosis, a

mildly elevated protein concentration, and a normal glucose

concentration.

• Polymorphonuclear pleocytosis occurs in 45% of patients with WNV

encephalitis and is also a common feature in CMV myeloradiculitis

in immunocompromised patients. Large numbers of CSF PMNs

may be present in patients with encephalitis due to EEE virus,

echovirus 9, and, more rarely, other enteroviruses. However,

persisting CSF neutrophilia should prompt consideration of

bacterial infection, leptospirosis, amebic infection, and

noninfectious processes such as acute hemorrhagic

leukoencephalitis.

   2.   A middle aged hypertensive male develops sudden onset unconsciousness,

         with nuchal rigidity. Rest of the neurological examination is within normal

         limits.

                  a. SAH

                  b. Intra-parenchymal bleed

                  c. Extra-dural hemorrhage

                 d. Sub dural haemorrhage.

Answer is A: SAH

Reference: Harrison 18 th edition chapter 275

• At the moment of aneurysmal rupture with major SAH, the ICP

suddenly rises. This may account for the sudden transient loss of

consciousness that occurs in nearly half of patients. Sudden loss of

consciousness may be preceded by a brief moment of excruciating

headache, but most patients first complain of headache upon regaining

consciousness. In 10% of cases, aneurysmal bleeding is severe enough

to cause loss of consciousness for several days. In 45% of cases, severe

headache associated with exertion is the presenting complaint. The

patient often calls the headache "the worst headache of my life";

however, the most important characteristic is sudden onset.Occasionally, these ruptures may present as headache of only moderate

intensity or as a change in the patient's usual headache pattern. The

headache is usually generalized, often with neck stiffness, and

vomiting is common.

• Although sudden headache in the absence of focal neurologic

symptoms is the hallmark of aneurysmal rupture, focal neurologic

deficits may occur. Anterior communicating artery or MCA bifurcation

aneurysms may rupture into the adjacent brain or subdural space and

form a hematoma large enough to produce mass effect. The deficits that

result can include hemiparesis, aphasia, and abulia.

• Occasionally, prodromal symptoms suggest the location of a

progressively enlarging unruptured aneurysm. A third cranial nerve

palsy, particularly when associated with pupillary dilation, loss of

ipsilateral (but retained contralateral) light reflex, and focal pain above

or behind the eye, may occur with an expanding aneurysm at the

junction of the posterior communicating artery and the internal carotid

artery. A sixth nerve palsy may indicate an aneurysm in the cavernous

sinus, and visual field defects can occur with an expanding supraclinoid

carotid or anterior cerebral artery aneurysm. Occipital and posterior

cervical pain may signal a posterior inferior cerebellar artery or

anterior inferior cerebellar artery aneurysm.

• Pain in or behind the eye and in the low temple can occur with an

expanding MCA aneurysm. Thunderclap headache if written in

question again favours diagnosis of SAH.

   3.   Pleural tap pierces all except :

                  a. skin

                  b. intercostal muscle

                  c. Endo-thoracic fascia

                 d. pulmonary pleura

Answer is D: Pulmonary pleura

Reference:

This question is probably testing English of doctors. Well we have common sense and

hence can solve this one. Each lung is invested by an exceedingly delicate serous

membrane, the pleura,which is arranged in the form of a closed invaginated sac. A

portion of the serous membrane covers the surface of the lung and dips into the

fissures between its lobes; it is called the pulmonary pleura (or visceral

pleura).Endothoracic fascia is layer of loose connective tissue that separates the ribs

and muscles from the underlying pleural.

The following layers are pierced during thoracocenteis/pleural tapping:

1. skin- superficial fascia

2. Serratus anterior

3. external intercostal

4. internal intercostal

5. innermost intercoastal

6. parietal pleura

7. pleural cavity is reached and fluid is accessed

1. In HIV infection all are affected except:
      a. Anterior Cingulate cortex
      b. Caudate nucleus
      c. Globus pallidus
      d. cerebral white matter
Answer is A. Anterior cingulate cortex
Reference: Harrison text book chapter 189
· HIV causes subcortical dementia and therefore you can see that
basal ganglia involvement is there. Cerebral white matter
involvement is mentioned in Harrison. Hence by exclusion the
answer is A.
· AIDS related dementia causes psychomotor slowing, apathy,
bradykinesia and altered posture and gait similar to those observed
in advanced Parkinson's disease. The dementia has the hallmarks
attributed to subcortical dementia. The exquisite sensitivity of many
of these patients to dopamine receptor blockade suggested a
profound and, perhaps, selective abnormality of striatal
dopaminergic systems.
· In contrast to "cortical" dementia (such as Alzheimer's disease),
aphasia, apraxia, and agnosia are uncommon, leading some
investigators to classify HIV encephalopathy as a "subcortical
dementia" characterized by defects in short-term memory and
executive function. In addition to dementia, patients with HIV
encephalopathy may also have motor and behavioral abnormalities.
Among the motor problems are unsteady gait, poor balance,
tremor, and difficulty with rapid alternating movements.
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Increased tone and deep tendon reflexes may be found in
patients with spinal cord involvement. Late stages may be
complicated by bowel and/or bladder incontinence. Behavioral
problems include apathy, irritability, and lack of initiative, with
progression to a vegetative state in some instances. Some patients
develop a state of agitation or mild mania. These changes usually
occur without significant changes in level of alertness. This is in
contrast to the finding of somnolence in patients with dementia due
to toxic/metabolic encephalopathies.
· HIV-associated dementia is the initial AIDS-defining illness in 3% of
patients with HIV infection and thus only rarely precedes clinical
evidence of immunodeficiency. Clinically significant encephalopathy
eventually develops in 25% of untreated patients with AIDS.

2. A patient has developed confusion and keeps bumping into objects. He
can speak fluently and on examination patient has inability to differentiate
between fingers, cannot write. On MRI T2 images show cortical and sub cortical
lesions.
      a. Gerstman syndrome
      b. Anton syndrome
     c. Millard Gubler syndrome
     d. Locked in syndrome

Gerstmann syndrome is characterized by four primary
symptoms:
1. Dysgraphia/agraphia: deficiency in the ability to
write.
2. Dyscalculia/acalculia: difficulty in learning or
comprehending mathematics.
3. Finger agnosia: inability to distinguish the fingers
on the hand.
4. Left-right disorientation.

3. Which can differentiate between seizures and syncope
      a. Unconsciousness
      b. Injury due to fall
      c. Urinary incontinence
      d. Tongue bite
Answer D
Reference : Harrrison 18th edition table 399-7.
Harrison mentions clearly that urinary incontinence which is the first thing that
comes to mind is present with both of these conditions. Injury due to fall can
occur in both . Unconsciousness will occur in both though the transition to
unconsciousness varies and so does the recovery.

4. All are true about iron deficiency anaemia?
      a. increased RDW > 14.5%
      b. decreased serum ferritin
      c. decreased Total iron binding capacity( < 480ng/dl)
      d. decreased serum iron( less than 15ng/dl)
Reference: chapter 103 Harrison 18th edition
Red cell distribution width is a measure of dimorphic cell population in patients in
early stages of IRON deficiency anemia as only a part of total cell population would be
microcytic hypochromic and the rest of the cells normal. Thus it is a good screening
test for evaluation of patients of iron deficiency Anemia.
In Iron deficiency obviously iron and ferritin would be lesser and this would send the
Total iron binding systems to work harder to get iron into the system. Thus TIBC is
always increased in iron deficiency Anemia. Remember TIBC value is always inverse of
serum ferritin value.
The following table is a must know for initial MCQ of haematology

5. most common genetic defect in M.O.D.Y
      a. Glucokinase
      b. Hepatocyte nuclear factor 1 alpha
      c. Hepatocyte nuclear factor 4 alpha
      d. Insulin promoter 1
Reference : CMDT page no 1194
Maturity onset dibetes of the young (MODY)
· This subgroup is a relatively rare monogenic disorder characterized by
non – insulin dependent diabetes with autosomal dominant inheritance
and an age at onset of 25 yrs or younger.
· Patients are nonobese, and their hyperglycemia is due to impaired glucose
induced secretion of insulin. Six types of mody have been described.
Except for MODY 2 , in which a glucokinase gene is defective, all other
types involve mutations of a nuclear transcription factor that regulates
islet gene expression.
· The enzyme glucokinase is a rate limiting step in glycolysis and
determines the rate of adenosine triphosphate (ATP) production from
glucose and the insulin secretory response in the beta cell. MODY 2, due to
glucokinase mutations, is usually quite mild, associated with only slight
fasting hyperglycemia and few if any microvascular diabetic
complications. It generally responds well to hygienic measures or low
doses of oral hypoglycemic agents.
· MODY 3, due to mutations is hepatic nuclear factor 1 α is the most
common form, accounting for two birds of all MODY cases. The clinical
course is of progressive beta cell failure and need for insulin therapy.
Mutations in both alleles of glucokinase present with more severe
neonatal diabetes. Mutation in one allele of the pancreatic duodenal
homeobox 1 (PDX1) causes diabetes usually at a later age (~ 35 years)
than other forms of MODY; mutations in both alleles of PDX1 causes
pancreatic agenesis.

1.   A 35 year old man with complaints of ptosis, with difficulty in chewing and
occasionally swallowing. There is no history of diplopia and on examination
there is a symmetrical ptosis, lateral arm abduction time of 60 seconds.
Repetitive nerve stimulation test shows decremental response. EMG shows
myopathic response. Anti –Ach receptor antibodies are negative. Probable
diagnosis is:
       a. Ocular M.Gravis
       b. Generalised M.Gravis
       c. Since Anti-ach receptor antibodies are negative consider other diagnosis
       d. Chronic Progressive external opthalmoplegia
Reference: Harrison 18th edition chapter 386
http://emedicine.medscape.com/article/1215103-overview
This question looks intially as in favour of myaesthenia gravis but the
following points are against the diagnosis of Myasthenia gravis
1. Gender given as MALE at 35 years. While MG is seen in men in 50-60 years
of age.
2. Symetrical Ptosis without Diplopia. In MG we have asymetrical ptosis.
3. No diurnal variation in severity of weakness mentioned
4. For ocular M.G. symptoms must persist for 3 years
5. Anti- ach receptor antibodies are absent in 50% cases of ocular
myaesthenia gravis but they would be absent in CPEO as well as.
6. In CPEO- Ciliary and iris muscles are not involved and hence diplopia
is absent.
I have also compiled harrison and Emedicine data on these two close
answers in a tabular fashion

2.   18 yr old boy is asymptomatic. On ECG he has a short PR interval with delta

waves. Which of the following is not routinely required for these patients?

      a. Holter monitoring

      b. Treadmill test

      c. Reassurance

     d. Beta blockers

Answer is B : Treadmill test

Reference : Chapter 233 harrison 18th edition

o The clinical diagnosis of the patient is WOLF Parkinson SYNDROME.

These patients have a bypass tract that allows conduction of impulses

from atria to ventricles without having to be subjected to the decremental

property of AV node.

o Generally, no activity restrictions are recommended in patients with

ECG findings of pre-excitation in the absence of tachycardia. They

should be restricted from high-risk professions (eg, airline pilot) and

may be restricted from competitive sports.

o Patients presenting with tachycardias and accessory pathways

should avoid participating in competitive sports, because

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catecholamines can decrease the refractoriness of the bypass tract and

facilitate tachyarrhythmias. Patients with hypertrophic cardiomyopathy,

or the Ebstein anomaly should also abstain from competitive sports.

Walking on Treadmill can precipitate due to sympathetic stimulation

an arryhtmia and would not be recommended for patient of W.P.W.

o The Holter monitor records electrical signals from the heart via a series of

electrodes attached to the chest. Electrodes are placed over bones to

minimize artifacts from muscular activity. The number and position of

electrodes varies by model, but most Holter monitors employ between

three and eight. The device is responsible for keeping a log of the heart's

electrical activity throughout the recording period.More modern units

record onto digital flash memory devices. The data are uploaded into a

computer which then automatically analyzes the input, counting ECG

complexes, calculating summary statistics such as average heart rate,

minimum and maximum heart rate, and finding candidate areas in the

recording worthy of further study by the technician. Thus Holter

monitoring in these patients can identify if patient is having a life

threatening event which on recording will help us know that these

patients would or would not require a RADIOFREQUENCY ABLATION

to get rid of the accessory pathway.

3.   8 yr old boy is having muscle weakness. On examination he has large muscles in

legs and his CPK levels are reducing. He also has a sub normal IQ. Probable

diagnosis is :

       a. Hereditary sensory and motor neuropathy

       b. Myelin deficiency

       c. Dystrophin deficiency

      d. Congenital myopathy

Answer is C : dystrophin deficiency

Reference: chapter 387 harrison 18th edition

o Duchenne's dystrophy is present at birth, but the disorder usually

becomes apparent between ages 3 and 5 years. The boys fall frequently

and have difficulty keeping up when playing. Running, jumping, and

hopping are invariably abnormal.

o GOWER sign is seen with PSEUDOHYPERTROPHY of the calf muscles.

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o Contractures of the heel cords and iliotibial bands become apparent by

age 6 years, when toe walking is associated with a lordotic posture

o By age 12 years, most patients are wheelchair dependent. Contractures

become fixed, and a progressive scoliosis often develops that may be

associated with pain. The chest deformity with scoliosis impairs

pulmonary function, which is already diminished by muscle weakness. By

age 16–18 years, patients are predisposed to serious, sometimes fatal

pulmonary infections. Other causes of death include aspiration of food and

acute gastric dilation.

o A cardiac cause of death is uncommon despite the presence of a

cardiomyopathy in almost all patients

o Intellectual impairment in Duchenne's dystrophy is common; the

average intelligence quotient (IQ) is 1 SD below the mean. Impairment

of intellectual function appears to be nonprogressive and affects verbal

ability more than performance.

o Serum CK levels are invariably elevated to between 20 and 100 times

normal. The levels are abnormal at birth but decline late in the

disease because of inactivity and loss of muscle mass. EMG

demonstrates features typical of myopathy. The muscle biopsy shows

muscle fibers of varying size as well as small groups of necrotic and

regenerating fibers. Connective tissue and fat replace lost muscle fibers. A

definitive diagnosis of Duchenne's dystrophy can be established on the

basis of dystrophin deficiency in a biopsy of muscle tissue or mutation

analysis on peripheral blood leukocytes, as discussed below.

o A diagnosis of Duchenne's dystrophy can also be made by Western blot

analysis of muscle biopsy specimens, revealing abnormalities on the

quantity and molecular weight of dystrophin protein. In addition,

immunocytochemical staining of muscle with dystrophin antibodies can

be used to demonstrate absence or deficiency of dystrophin localizing to

the sarcolemmal membrane. Carriers of the disease may demonstrate a

mosaic pattern, but dystrophin analysis of muscle biopsy specimens for

carrier detection is not reliable.

4.   3 yr old child is having barking cough with drooling of saliva. His RR is 36/min
and Xray neck lateral view shows “thumb sign”. The probable diagnosis is:
      a. Epiglottis
      b. Croup
      c. Foreign body
     d. Abductor vocal cord palsy.
Answer is A : epiglottitis
Reference: chapter 382.1 nelson textbook
EPIGLOTTITIS: A otherwise healthy child suddenly develops a sore throat
and fever. Within a matter of hours, the patient appears toxic, swallowing is
difficult, and breathing is labored. Drooling is usually present and the neck
is hyperextended in an attempt to maintain the airway. The child may assume
the tripod position, sitting upright and leaning forward with the chin up and
mouth open while bracing on the arms. A brief period of air hunger with
restlessness may be followed by rapidly increasing cyanosis and coma.
Stridor is a late finding and suggests near-complete airway obstruction.
Complete obstruction of the airway and death can ensue unless adequate
treatment is provided. The barking cough typical of croup is rare. Usually, no
other family members are ill with acute respiratory symptoms.The diagnosis
requires visualization of a large, “cherry red” swollen epiglottis by
laryngoscopy. Occasionally, the other supraglottic structures, especially the
aryepiglottic folds, are more involved than the epiglottis itself.. Anxietyprovoking
interventions such as phlebotomy, intravenous line placement,
placing the child supine, or direct inspection of the oral cavity should be
avoided until the airway is secure. If epiglottitis is thought to be possible but
not certain in a patient with acute upper airway obstruction, the patient can
undergo lateral radiographs of the upper airway first. Classic radiographs of
a child who has epiglottitis show the “thumb sign”.
CROUP : Croup is a clinical diagnosis and does not require a radiograph of
the neck. Radiographs of the neck may show the typical subglottic narrowing
or “steeple sign” of croup on the postero-anterior view.

5.   3 year old child is having sore throat with high grade fever. On examination he
has a inflamed phyranx and exudate on tonsils with tender lymphadenopathy.
Which of the following is a non suppurative complication of these patients?
        a. Acute rheumatic fever
        b. Acute glomerulonephritis
        c. Acute rheumatic fever and acute Glomerulonephritis both
       d. Scarlet fever
Answer is C: Acute rheumatic fever and acute Glomerulonephritis both
Reference: CMDT 2013 ,page no x
Group A β – hemolytic streptococci (Streptococcus pyogenes) are the most common
bacterial cause of pharyngitis. Transmission occurs by droplets of infected secretions.
Group A streptococci producing erythrogenic toxin may cause scarlet fever in
susceptible persons.
Clinical Findings
A. Symptoms and Sings
“Strep throat” is characterized by a sudden onset of fever, sore throat, pain
on swallowing, tender cervical adenopathy, malaise, and nausea. The
pharynx, soft palate, and tonsils are red and edematous. There may be a
purulent exudate. The centor clinical criteria for the diagnosis of
streptococcal pharyngitis are temperature > 38oC, tender anterior cervical
adenopathy, lack of a cough, and pharyngotosillar exudates.
The rash of scarlet fever is diffusely erythematous, resembling a sunburn, with
superimposed fine red papules, and is most intense in the groin and axillas. It
blanches on pressure, may become petechial, and fades in 2-5 days, leaving a
fine desquamation. The face is flushed, with circumoral pallor, and the tongue is
coated with enlarged red papillae (strawberry tongue).
B. Laboratory Findings
Leukocytosis with neutrophil predominance is common. Throat culture onto a
single blood agar plate has sensitivity of 80-90%. Rapid diagnostic tests based
on detection of streptococcal antigen are slightly less sensitive than culture.
Clinical criteria such as the centor criteria, are useful for identifying patients in
whom a rapid antigen test or throat culture is indicated. Patients who meet two
or more of these criteria merit further testing. When three of the four are
present, laboratory sensitivity of rapid antigen testing exceeds 90%. When only
one criterion is present, streptococcal pharyngitis is unlikely. In high prevalence
settings or if clinical suspicion for streptococcal pharyngitis or if clinical
suspicion for streptococcal paryngitis is high, a negative antigen test or culture
should be confirmed by a follow up culture.
Complications
Suppurative complications include sinusitis, otitis media, mastoiditis, peritonsillar
abscess and suppuration of cervical lymph nodes.
Nonsuppurative complications are rheumatic fever and glomerulonephritis.
Rheumatic fever may follow recurrent epidoses of pharyngitis beginning 1-4
weeks after the onset of symptoms. Glomerulonephritis follows a single
infections with a nephriotogenic strain of streptococcus group A (eg, types 4, 12,
2, 49 and 60), more commonly on the skin than in the throat, and begins 1 – 3
weeks after the onset of the infection.

6.   28 year old lady with history of recurrent abortions and repeated episodes of
pain the calves is most likely to have deficiency of which of the following
      a. Plasmin
      b. Thrombin
      c. Protein C
     d. Factor 13
Answer is C: protein C
Reference: table 58.3 Harrison 18th Edition and NELSON chapter 478
Factor 13 deficiency and thrombin deficiency causes bleeding manifestations.
Congenital plasminogen deficiency has been mentioned in texts but not
congenital plasmin deficiency. Hence by exclusion the diagnosis is protein C
deficiency.
Thrombohilia should be suspected in patients has a history of recurrent
venous thromboembolism, venous thrombosis in a person younger than
40 years, a familial history of venous thromboembolism, and thrombosis
in unusual sites (eg, mesenteric vein, renal vein, hepatic and cerebral
thrombosis).
Homozygous deficiency of protein C presents with purpura fulminans in the first
few hr of life. Fresh frozen plasma (FFP) is the only immediately available source
of protein C. Amelioration of symptoms usually requires 10–15 mL/kg of FFP
every 8–12 hr. Clinical trials are in progress using a plasma protein C
concentrate, which eliminates the need for large amounts of FFP. A recombinant
activated protein C concentrate (drotrecogin-α) has been approved for the
treatment of adult sepsis, but it has not been approved for treating hereditary
deficiency
Thrombophilic disorders are usually associated with venous thrombosis.
However, protein S, protein C, ATIII deficiencies, and lupus anticoagulants have
been associated with arterial thrombosis.
Patients with protein C and S deficiencies can develop warfarin-induced skin
necrosis when placed on warfarin since protein C and S are vitamin K–
dependent factors and, hence are suppressed.
Remember: Purpura fulminans in infancy could suggest protein C deficiency.
These antibodies occur in about 20% of patients with systemic lupus
erythematosus (SLE), but they are also associated with other autoimmune
diseases. Lupus anticoagulants may occur in patients taking phenothiazines,
phenytoin, phenytoin, hydralazine, quinine, amoxicillin, and oral contraceptives.
Also REMEMBER : Clinical criteria for indicating the presence of lupus
anticoagulants (Sapporo criteria for the antiphospholipid syndrome) are as
follows:
· One or more arterial, venous, or small vessel thrombosis, affecting any organ or
tissue
· Pregnancy morbidity: The risk for maternal and fetal morbidity increases after
the 10th week of pregnancy. Fetal mortality in pregnancy can include
spontaneous abortions, prematurity, and stillbirths.
· Three or more unexplained consecutive spontaneous abortions after the 10th
week of gestation

7.   A lady is pregnant and is a known case of juvenile myoclonic epilepsy and is
receiving sodium valproate. Which of the following drugs is best suited after
valproate for management of this patient
     a. phenytoin
     b. carbamazepine
     c. levetiracetam/lamotrigine
     d. Lacosamide
Answer is C: lamotrigine
Reference: Harrison 18th edition table 368-9 and 369-9
60 year old patient with renal failure. He also has bone pain with X ray limb
showing lytic lesions in the long bones. Serum electrophoresis shows M spike.
Peripheral smear shows 35 % plasma cells. Bone marrow shows presence of
immature plasma cells. Diagnosis is
      a. Plasma cell Leukemia
      b. Multiple myeloma
      c. Smoldering myeloma
      d. Monoclonal Gammopathy of unknown significance.
Answer: A: Plasma cell leukemia
Reference: http://www.medscape.com/viewarticle/731900
The question mentions Peripheral smear showing plasma cells >35% and not in
the bone marrow. Hence the diagnosis goes in favour of plasma cell leukemia.
The diagnostic criteria for Plasma Cell Leukemia include the
Presence of a circulating clonal plasma cell count of more than 2000/μl (if the
total white blood cell count is >10,000/μl) OR
The presence of more than 20% CIRCULATING plasma cells.
Since in this question one of the critieria is satisfied hence diagnosis is
Plasma cell leukemia
· PCL can be secondary PCL (s PCL) if arising from a known a diagnosis of plasma
cell myeloma or primary PCL (p PCL) if no prior history of plasma cell myeloma
can be ascertained. sPCL was felt to arise late in the course of plasma cell
myeloma and those patients have been described to have a worse prognosis
than those with p PCL. However, a recent report indicates that the median time
to transformation to s PCL from plasma cell myeloma is approximately 21
months. The primary form accounts for 60% of all cases of PCL.
· Patients with PCL may present with signs and symptoms commonly found
in patients with plasma cell myeloma, such as bone pain, anemia, renal
dysfunction, Hypercalcemia and lytic bone lesions; or clinical manifestations
normally found in patients with leukemia, including leukocytosis, anemia,
thrombocytopenia, infections and hepato-splenomegaly. In addition, these
patients may also have elevated levels of LDH and β-2-microglobulin. Patients
with PCL are also more likely to present with advanced stage disease (stage III)
and have more significant extramedullary involvement that can include the CNS
· In contrast to most patients with plasma cell myeloma, the malignant cells in
PCL frequently lack CD56, CD9, CD117 and human leukocyte antigen DR
expression. It has been proposed that weak or absent CD56 expression
could explain the propensity of these clonal plasma cells to leukemic
transformation and also account for the lower osteolytic potential and
higher rates of extra-medullary involvement seen in patients with PCL
· The use of traditional combination chemotherapy, such as vincristine,
Adriamycin, dexamethasone (VAD) or high-dose cyclophosphamide-Etoposide is
associated with response rates of up to 59% and median overall survival of 15–
20 months. More aggressive regimens such as fractionated high-dose
cyclophosphamide and dexamethasone with infusional vincristine and
Adriamycin (hyper CVAD) have been used alone or in combination with
thalidomide and have revealed encouraging results including complete response
(CR).

8.   A patient has Pc02 of 30 mmHg, P02 of 105 mmHg and pH of 7.45.
diagnosis is compensated
     a. respiratory acidosis
     b. respiratory alkalosis
     c. metabolic acidosis
     d. metabolic alkalosis
· Well if you look at values it indicates hyperventilation of the patient
due to C02 washout with increased 02 and normal pH due to the
process of compensation.
· If in same question pH>7.45 we shall call it uncompensated
respiratory alkalosis
Else follow this table:
· If direction of change of pH and pC02 is both in same direction ie
like both reduced or both increased then problem is metabolic
· If direction of change of pH and PC02 is opposite, then the primary
problem is respiratory.
· Else use a pen and mark arrows for increase or decrease in the table
below and u shall see a pattern emerge which will solve all MCQ in
books.

9.   Bilateral Balbinski sign is seen in :
       a. brain- stem stroke
       b. thalamus and basal ganglia damage
       c. cerebellum damage
       d. mid pontine lesions
Reference: Harrison 18th edition figure 370-10 point no M

10.   A 60 year old patient with 60 Packet per year history of smoking is having
 a cancer which shows small cells with high mitotic index. Which of the following
is correct for this patient
      a. aggressive pyscho-social behaviour
      b. repeated blood transfusions
      c. thin limbs with centripetal obesity
      d. increased thirst/ version 2 of this choice was gynaecomastia
Reference: Harrison chapter 100.
Answer is A due to limbic encephalitis causing aggressive behaviour due to
involvement of limbic system. The closest choice increased thirst due to SIADH, is
negated as Harrison writes in the para-neoplastic syndrome (chapter 100) that most
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patient of ectopic ACTH secretion are asymptomatic. Read on the next text for a
comprehensive logic for the question.
The clinical diagnosis of small cell cancer/oat cell cancer of lung which has many
paraneoplastic manifestations:
1. Cushing syndrome is due to ECTOPIC ACTH release by lung cancer. However
these patients due to this aggressive cancer CANNOT HAVE presentation of
centripetal obesity but weight loss and hence choice number C is ruled out.
2. SIADH due to increase secretion of ADH leading to hyponatremia , Most
patients with ectopic vasopressin secretion are asymptomatic and are
identified because of the presence of hyponatremia on routine chemistry
testing. Symptoms may include weakness, lethargy, nausea, confusion,
depressed mental status, and seizures. The severity of symptoms reflects
the rapidity of onset as well as the extent of hyponatremia. Hyponatremia
usually develops slowly but may be exacerbated by the administration of
IV fluids or the institution of new medications.
3. Limbic encephalitis (anti –HU antibodies) due to SCLC can present with
agitation and psycho-social behaviour though the following 4 criteria must be
satisfied.
· Subacute onset (<12 weeks) of seizures, short-term memory loss, confusion, and
psychiatric symptoms
· Neuropathologic or radiologic evidence (MRI, SPECT, PET) of involvement of the
limbic system
· Exclusion of other possible aetiologies of limbic dysfunction
· Demonstration of a cancer within 5 years of the diagnosis of neurologic
symptoms, or the development of classic symptoms of limbic dysfunction in
association with a well-characterized paraneoplastic antibody (Hu, Ma2, CV2,
amphiphysin, Ri)
4. Paraneoplastic syndromes are common in patients with lung cancer, especially
those with SCLC, and may be the presenting finding or the first sign of recurrence.
Ectopic production of parathyroid hormone (PTH), or more commonly, PTHrelated
peptide, is the most common life-threatening metabolic complication of
malignancy, primarily occurring with squamous cell carcinomas of the lung.
Clinical symptoms include nausea, vomiting, abdominal pain, constipation,
polyuria, thirst, and altered mental status.
· Hyponatremia may be caused by the syndrome of inappropriate secretion
of antidiuretic hormone (SIADH) or possibly atrial natriuretic peptide
MEDICINE 2013
(ANP). SIADH resolves within 1–4 weeks of initiating chemotherapy in the
vast majority of cases. During this period, serum sodium can usually be
managed and maintained above 128 meq/L via fluid restriction. Demeclocycline
can be a useful adjunctive measure when fluid restriction alone is insufficient. Of
note, patients with ectopic ANP may have worsening hyponatremia if sodium
intake is not concomitantly increased. Accordingly, if hyponatremia fails to
improve or worsens after 3–4 days of adequate fluid restriction, plasma levels of
ANP should be measured to determine the causative syndrome.
· Ectopic secretion of ACTH by SCLC and pulmonary carcinoids usually
results in additional electrolyte disturbances, especially hypokalemia,
rather than the changes in body habitus that occur in Cushing's syndrome
from a pituitary adenoma. Treatment with standard medications, such as
metyrapone and ketoconazole, is largely ineffective due to extremely high
cortisol levels. The most effective strategy for management of Cushing's
syndrome is effective treatment of the underlying SCLC. Bilateral adrenalectomy
may be considered in extreme cases.
· Skeletal–connective tissue syndromes include clubbing in 30% of cases (usually
NSCLCs) and hypertrophic primary osteoarthropathy in 1–10% of cases (usually
adenocarcinomas). Patients may develop periostitis, causing pain, tenderness,
and swelling over the affected bones and a positive bone scan. Neurologic–
myopathic syndromes are seen in only 1% of patients but are dramatic and
include the myasthenic Eaton-Lambert syndrome and retinal blindness with
SCLC, while peripheral neuropathies, subacute cerebellar degeneration, cortical
degeneration, and polymyositis are seen with all lung cancer types. Many of
these are caused by autoimmune responses such as the development of anti–
voltage-gated calcium channel antibodies in Eaton-Lambert syndrome. Patients
with this disorder present with proximal muscle weakness, usually in the lower
extremities, occasional autonomic dysfunction, and rarely with cranial nerve
symptoms or involvement of the bulbar or respiratory muscles. Depressed deep
tendon reflexes are frequently present. In contrast to patients with myasthenia
gravis, strength improves with serial effort. Some patients who respond to
chemotherapy will have resolution of the neurologic abnormalities. Thus,
chemotherapy is the initial treatment of choice. Paraneoplastic
encephalomyelitis and sensory neuropathies, cerebellar degeneration, limbic
encephalitis, and brainstem encephalitis occur in SCLC in association with a
variety of antineuronal antibodies such as anti-Hu, anti-CRMP5, and ANNA-3.
Paraneoplastic cerebellar degeneration may be associated with anti-Hu, anti-Yo,
or P/Q calcium channel autoantibodies. Coagulation, thrombotic, or other
hematologic manifestations occur in 1–8% of patients and include migratory
venous thrombophlebitis (Trousseau's syndrome), nonbacterial thrombotic
(marantic) endocarditis with arterial emboli, and disseminated intravascular
coagulation with hemorrhage, anemia, granulocytosis, and
MEDICINE 2013
leukoerythroblastosis. Thrombotic disease complicating cancer is usually a poor
prognostic sign. Cutaneous manifestations such as dermatomyositis and
acanthosis nigricans are uncommon (1%), as are the renal manifestations of
nephrotic syndrome and glomerulonephritis
GYNAECOMASTIA is seen with large cell carcinoma of lung.

MEDICINE 2013

1.   LBBB is seen with all except:
           a. Acute MI
           b. Ashmann syndrome
           c. Hypokalemia
           d. Hyperkalemia
Answer: B : Ashman syndrome:

Reference: current diagnosis and management in cardiology, chapter19 :
supraventricular tachycardia
· Normally the septum is activated from left to right, producing small Q waves in
the lateral leads.
· In LBBB, the normal direction of septal depolarisation is reversed (becomes
right to left), as the impulse spreads first to the RV via the right bundle branch
and then to the LV via the septum.
o This sequence of activation extends the QRS duration to > 120 ms and
eliminates the normal septal Q waves in the lateral leads.
o The overall direction of depolarisation (from right to left) produces tall R
waves in the lateral leads (I, V5-6) and deep S waves in the right
precordial leads (V1-3), and usually leads to left axis deviation.
· As the ventricles are activated sequentially (right, then left) rather than
simultaneously, this produces a broad or notched (‘M’-shaped) R wave in the
lateral leads.
Causes of LBBB are:
· Aortic stenosis
· Ischaemic heart disease
· Hypertension
· Dilated cardiomyopathy
· Primary degenerative disease (fibrosis) of the conducting system (Lenegre
disease)
· Hyperkalaemia
· Digoxin toxicity
Ashman phenomenon is seen in atrial fibrillation. U all know atrial
fibrillation has irregularly irregular pulse leading to irregular RR interval in ECG.
MEDICINE 2013
This means there is very fast conduction occurring via bundle of his which is
receiving these impulses from a supraventricular phenomenon. Now the point is
that the two fascicles of bundle of his have different refractory periods. Thus if
an impulse lands on the bundle of his and finds the right bundle refractory then
RBBB will occur. Also remember that the refractory period of right fascicle is
more than that of the left fascicle resulting in RBBB.

AIIMS NOV 2012

ANATOMY

1.      True about testis

a.   Ectodermal origin

b.  Gubernaculum attached to caudal end

c.   Surrounded by peritoneal tunica albuginea

d.  28th weak reach at scrotum

Answer: B (gubernaculum attached to caudal end)

Reference: BDC 4^th vol 2 p 219

2.      Which nerve does not supply gluteal region

a.   Sciatic nerve

b.  Sup gluteal nerve

c.   Inf gluteal nerve

d.  Nerve to obturator internus

Answer: a (sciatic nerve )

Reference: BDC4th vol 2 p 90

3.      Numbness of little and ring finger, atrophy of hypothenar musles nerve dammaged? 

a.   Palmar cut br of ulnar 

b.  Deep br of ulnar  

c.   Ulnar nerve before division into superficial and deep branches

d.  Post cord of brachial plexus

Answer: C (ulnar nerve before division into superficial and deep branches.)
Reference: BDC 4^th vol 1 p123

4.      "Root value of long thoracic nerve

a.   C345

b.  C567

c.   C78 t1

d.  C234

Answer: B (C567)

Refernce: BDC 4^th p53

5.      Loss of extension of little ring finger, hypothenar atrophy

a.   Post interosseous nerve

b.  Radial trunk

c.   Ulnar Nerve

d.  Median nerve

Answer: (c) ulnar nerve.

Reference: BDC 4^th vol 1 p 117

6.      Structures don’t come during surgery for vasectomy

a.   Testicular art

b.  Ilioinguinal nerve

c.   Autonomic nerves

d.  Pampiniform plexus

Answer. (b)  Ilioinguinal nerve
Reference. BDC 4/e Vol.II-201, 208-II; Snell’s Clinical Anatomy 7/e p.175-177; Gray’s 38/e p-822]

7.      Sternocleidomastoid supplied by all except ( AIIMS –Nov 2008)

a.   Occipital Artery

b.  Sup thyroid Artery

c.   Post Auricular  Artery

d.  Thyrocervical trunk

Answer: c.(posterior auricular artery.)

Reference: AKD 4th EDITION Part2 page 118 , BDC 4^th /e Vol3 P. 73

8.      All of the following organs develop in the mesentery of stomach except:

1. Liver
2. Spleen
3. Kidney
4. Pancreas

Answer.(c)' Kidney
[Reference: I.B. Singh embryology 8/e p166-169, 237; Longman's embryology 11/e p215, 219, 222, 236; Moore's embryology 7/e p 259-266, 288]

9.      Abnormal no of vertebra possible with all except

a.       Cervical

b.      Thoracic

c.       Lumbar

d.      Sacral

Answer. (b) Thoracic
Reference: Gray’s Anatomy 40^th Edition Page 713, 728

10.  Ciliary muscle  develops from

a.       Surface ectoderm

b.      Neural crease mesenchyme

c.       Endoderm

d.      Neuroectoderm
Answer: (d) Neural crest mesenchyme
Reference: Langman Embryology 11 Edition Pg. 337

11.  Epiglottics develop from

a.       1^st pharyngeal arch

b.      2^nd pharyngeal arch

c.       3^rd pharyngeal arch

d.      4^th pharyngeal arch
Answer: (d) pharyngeal arch
Reference: Langman Embryology 11 Edition pg. 277

PHYSIOLOGY

12. Which is not second messenger?

a.       cAMP

b.      IP3

c.       Guanylyl cyclase

d.      Diacylglycerol

Answer. (c) Guanylyl cyclase
Reference : Ganong 22^nd edition, pages 37, 42, 43

13. Regarding blood supply increase in exercise muscle all except

a.       Local metabolite

b.      Sympathetic stimulation

c.       Cholinergic

d.      Inhibition of beta receptor

Answer. (B) sympathetic stimulation
Reference : Ganong 22^nd edition, pages 632, 633, 602

14. End diastolic volume increases in

a.       Decrease in total blood volume

b.      Increase in intrapericardial pressure

c.       Increase in negative intrathoracic pressure

d.      Decrease in ventricular compliance

Answer.  (C) increase in negative intrathoracic pressure

Reference : Ganong 22^nd edition, page 573

15. Right axis deviation seen in

a.       Lying down position

b.      Thin and tall

c.       Obese person

d.      Exercise

Answer. (B)  thin and tall

Reference : Guyton, 11^th edition, page 138

16. Internal carotid artery ligation below the carotid sinus

a.       Increase in vasomotor centre activity

b.      Increase in discharge of carotid sinus afferent nerves

c.       Increase in vagal parasympathetic activity

Answer. (A) increase in vasomotor centre activity

Reference : Ganong 22^nd edition, pages 605, 606, 607

17.  Self stimulation

a.       Medial forebrain bundle

b.      Area around aqueduct of sylvius

c.       PV region of hypothalamus

d.      Radical radiotherapy

Answer. (A) Medical forebrain bundle

Reference: Reference : Ganong 22^nd edition, pages  260

18.  Kinemyograhy is used for:

a.       Monitoring of neuromuscular function

b.      Monitoring of muscle spindle activity

c.       Monitoring of Exercize capacity

d.      Not Recalled

Answer: A

Reference:http://faculty.washington.edu/ramaiahr/Review%20Articles/Neuromuscular%20Monitoring-Update-1.pdf

19.  A politician is shot in the back during a rally at level of T8 vertebral immediately after the shot he losses all the sensation below level of lesion. As the examining doctor you realize there is no chance of improvement in neurological function this can be due to all except

a.       Lack of endoneural tubes

b.      Lack of growth factors

c.       Presence of glial scar

d.      Lack of myelin inhibiting substance

Answer. (d) lack of myelin inhibiting substance
Reference: Surgery of the Spinal Cord: Potential for Regeneration and Recovery: Robert N. N. Holtzman, Bennett M. Stein

20.  Which is True about dobutamine?

a.       Dobutamine decreases peripheral resistance

b.      Acts on D1 & D2 receptors

c.       Decrease kidney circulation

d.      Has no effect on coronary circulation

Answer. (a) Dobutamine decreases peripheral resistance

Reference: Harrison 18th edition/chapter 234/ heart failure and cor-pulmonal

BIOCHEMISTRY

21.  Liver enzyme dephosphorylation to phosphorylation true is- 

a.       Always activates the enzyme

b.      Catecholamines stimulate it

c.       More commonly seen in fasting state than in fed state

d.      Always activated by cAMP  dependent Protein kinase

Answer is (d) : Always activated by cAMP  dependent Protein kinase.

Reference: vasudevan 6 edi page chap 523

22.  Nanotechnology true except

a.       Narrow emission spectra

b.      Narrow gap between absorbance and re-emission      

c.       Not recalled

d.      Not recalled

For nanotechnology visit our website pgdiams.com

23.  No loss of genetic material occurs in

a.       Deletion

b.      Insertion

c.       Substitution

d.      Inversion

Answer (d) Inversion

24.  Patient present with skin bullae on sun exposure. The defect is of?

a.       Thymidine dimmers

b.      Trinucleotide repeats

c.       Sugar changes 

d.      DNA methylation

Answer.: (d)  DNA methylation or DNA damage can be the answer.

Reference: harpr’s Illustrated biochemistry 27/ep-345 -46

25.  True about RIBOZYME

a.       Pepitdyl transfuse activity

b.      Cut DNA at specific site

c.       Portiapate in DNA synthesis

d.      GTPase

Answer: A, Pepitdyl transfuse activity

Reference; John Baynes 3/e pg-441; Lippincott 4^th /ed pg-435-39; Harper 28^th /ed pg-363]

26.  Test to differentiate in the chromosome of normal & cancer cells

a.       PCR

b.      Comparative genomic hybridization 

c.       Western  Blotting

d.      Southern Blotting

Answer. (B) : Comparative genomic hybridization 

Reference: Harrison 18th edition/chapter 62 

27.  Enzymes fond in CSF

a.       GGT+ALP

b.      ALP+CK-MB

c.       CK+LDH

d.      Deaminase and Peroxidase

Answer (c)  CK and LDH

(Reference: Cerebrospinal Fluid in Clinical Practice  By David N. Irani; Chapter 10.)

28.  Which of the following is seen in association with membrane raft

a.       Mannose binding protein

b.      GTP associated receptor

c.       GPI anchored protein

Answer (C)   GPI anchored protein

References’

I.        Hartlova, A., Cerveny, L., Hubalek, M., Krocova, Z. and Stulik, J. Membrane rafts: a potential gateway for bacterial entry into host cells. Microbiol. Immunol., 54, 237-245 (2010)

II.     Merrill, A.H. Sphingolipids. In: Biochemistry of Lipids, Lipoproteins and Membranes (5th Edition). pp. 363-397 (Vance, D.E. and Vance, J. (editors), Elsevier, Amsterdam) (2008).

PATHOLOGY

29.  Flow cytometry is  done in:    

a.       Polycythemia

b.      Thrombocytosis

c.       Neutrophilia

d.      Lymphocytosis

Answer: (d) Lymphocytosis

Reference: Robbins 8th ed. Page 603 – 604

30.  Which of these does not indicate megaloblastic anemia  

a.       Increased reticulocyte count

b.      Raised Bilirubin

c.       Mild splenomegaly

d.      Nucleated RBC

                        Answer:- A. Increased Reticulocyte Count

Reference: Robbins edition 8^th edition, page no 655. / Harrison table 105-1 /18th edition/chapter 105 

31.  Myelo-fibrosis leading to a dry tap on bone marrow aspiration is seen with which of the following  condition

a.       Burkitt’s lymphoma

b.      Acute erythroblastic leukemia

c.       Acute megakaryocytic leukemia

d.      Acute undifferentiated leukemia

Answer: (c)   Acute megakaryocytic leukemia.

Reference:  Robbins Page 6e22

32.  Receptor on neuronal membrane that induces development of Glioma

a.       CD44

b.      CD133

c.       CD33

d.      CD24

Answer : (b) CD133

Reference: http://cdn.intechopen.com/pdfs/14462/InTech-Glioma_stem_cells_cell_culture_markers_and_targets_for_new_combinationtherapies.pdf

33.  CD 95 is a marker of       

a.       Intrinsic pathway of apoptosis

b.      Extrinsic pathway of apoptosis

c.       Necrosis of cell           

d.      Not recalled

Answer. (b) Extrinsic pathway of apoptosis

Reference: Robbins 8^thedpg 29 - 30

34.  Marker of myeloid cancers

a.       S100

b.      HMB45

c.       Common leukocyte antigen

d.      Cyto-keratin

Answer. (C) Common leukocyte antigen

35.  Adult Patient presents with Generalized lymphadenopathy and blood film shows 70% immature looking lymphocytes

a.       Genotyping/karyotyping

b.      Immunophenotyping

c.       Bone marrow

d.      Peripheral smear study

Answer. B, Immuno-phenotyping

Reference: Robbins 8^th ed.Page 604

36.  Most common  fixative used in electron microscopy

a.       Glutaraldehyde

b.      Formalin

c.       Picric acid

d.      Absolute Alcohol

Answer. (A) Glutaraldehyde

Reference: Reference: (http://www.abdn.ac.uk/emunit/emunit/fixatives.htm)

37.  In a specimen of kidney, fibrinoid necrosis is seen and onion peel appearance is also present. Most probable pathology is

a.       Hyaline degeneration

b.      Hyperplastic arteriosclerosis

c.       Glomerulosclerosis

d.      Fibrillary glomerulonephritis

Answer: B, Hyperplastic arteriosclerosis

Reference: Robins Page 950-951

38.  Staining done for sebaceous cell carcinoma  ?

a.       Oil Red O

b.      PAS

c.       Methamine silver

d.      Not Recalled

Answer:(a) , Oil Red O

Reference: Robbins Page 1177

39.  Mutation in CoL4A5 chain the diagnosis

a.       Alports syndrome

b.      Good pasture’s syndrome  

c.       Thin membrane disease

d.      Nodular glomerulosclerosis

Answer: Alport’s syndrome

Reference: Robbins 7^th Edition p 988, 989, /Robbins 8^th Edition p. 931, 932

40.  Person having heterozygous sickle cell trait are protected from infection of

a.       P. falciparum

b.      P. viavax

c.       Pneumococcous

d.      Solmonella

Answer: (a) P. Falciparum

Ref. Robbin 8^th  Edition pg. 645

41.  Hyperacute rejection is due to

a.       Preformed antibodies

b.      Cytotoxic T-lymphocyte medicated injury

c.       Circulating macrophage mediated  injury

d.      Endothelitis caused by donor antibodies

Answer: (a) Preformed antibodies

Reference: Robbins 8^th Edition /Pg. 228

42.  True all except

a.       Omega-3 fatty acid (abundant in fish oil) decrease LDL

b.      Atherosclerosis in less important in age more than 45 years age

c.       Cigarette smoking is independent  risk  factor for M.I

d.      Not recalled

Answer: (b) Atherosclerosis in less important in age more than 45 year’s age

Reference: Robbin 8^th Edition pg. 497

PHARMACOLOGY

43.  Mechanism of gentamicin toxicity

a.       Direct hair cell toxicity

b.      Binds to hair cell Na+ K+ ATPAase

c.       Non-cummulative toxicity

d.      Bind to Ca⁺² channel

Answer (a) Direct hair cell toxicity

(Reference: Dhikav V, Drugs of Choice’ 2013, 5^th Ed, AITBS Publishers, Current Medical Diagnosis & Treatment’ 2012, pp-87-88)

44.  -rho kinase inhibitor

a.       Fasudil

b.      Ranolazine

c.       Amiloride

d.      Nicorandil

Answer: (a) Fasudil

(Reference: Dhikav V, Drugs of Choice’ 2013, list of new drugs, 5^th Ed, Dhikav V, Newer Drugs’ 2012, 2^nd Ed, Elsevier’s sciences, India, www.wikepedia.com)

45.  Best agent for premenstrual syndrome management?      

a.       Progesterone

b.      ANXIOLYTIC

c.       SSRI

d.      vitamin E

Answer (c) SSRI
Reference: Dikav V, Drugs of Choice, 5^th Ed, 2013, AITBS Publishers, India

46.  Which is not a 2nd generation  antihistamine?

a.       Cetrizine

b.      Cyclizine

c.       Loratidine

d.      Fexofenadine

Answer (b) Cyclizine

(Reference: Dhikav V, Drugs of Choice’ 2013, 5^th Ed, AITBS Publishers, Current Medical Diagnosis & Treatment’ 2012, pp-288-89)

47.  Expanded spectrum betalactam resistance drug used

a.       Amoxicillin –clavulinic acid

b.      Cefepime

c.       Piperacillin-Tazobactam

d.      Ceftriaxone

            Answer (B)Cefepime

(Reference: Dhikav V, Drugs of Choice’ 2013, 5^th Ed, AITBS Publishers, BG Katzung’s Basic & Clinical Pharmacology, 11^th Ed, pp-599)

48.  Lidocaine all are true except

a.       It acts on sodium channels in both active and inactive state

b.      It is most cardiotoxic local anesthetic

c.       It is given iv in cardiac arrhythmias

Answer (b)It is most cardiotoxic local anesthetic

(Reference: Dhikav V, Drugs of Choice’ 2013, 5^th Ed, AITBS Publishers, Lee’s Synopsis of anesthesia, pp 59)

49.  Unfavourable are all except

a.       Omeprazole-reducing acid secretion

b.      Methotrexate inhibiting folate

c.       Barbiturates-dec B12 absorption

d.      Antihistaminic overdose is safe

Answer d: Antihistaminic overdose is save

Reference: (BG Katzung’s Basic & Clinical Pharmacology 6^th Ed 2009, pp-678)

50.  Drug not given to glaucoma patient who is on beta blockers

a.       Brimonidine

b.      Dorzolamide

c.       Levobunolol

d.      Acetazolamide

Answer (c): Levobunolol
(Reference: Dhikav V, Drugs of Choice’ 2013, 5^th Ed, AITBS Publishers, Lipincott’s Pharmacology, pp-78, BG Katzung’s Basic & Clinical Pharmacology, pp-789)

MICRO

51.   Aerosol spread leading to epidemics

a.        Legionella

b.       Hemophilus

c.       Influenza

d.       Mycoplasma

Answer. is (c) Influenza.

52.  Which of the following features is not shared between ‘T cells’ and B cells’

a.       Positive selection during development

b.      Class I MHC Expression

c.       Antigen Specific Receptors

d.      All of the above

Answer is (a) Positive selection during development

Reference: 'Lippincott 'v Immunology' (IllustratedReviews)2007/1 13; The Immune Response: Basic and clinical principles by Sounders (2005)/346; 'Elements of Immunology' by Fahim Halim Khan (Pearson Education)2009/206

53.  With reference to Bacteroides fragilis the following statements are true except

a.       B. fragilis is the most frequent anaerobe isolated from clinical samples

b.      B. fragilis is not uniformly sensitive to Metronidazole

c.       The lipoolysaccharide formed by B. fragilis is structurally and functionally different from the conventional Endotoxin

d.      Shock and DIC  are common in Bacteroides bacteremia

Answer. D Shock and DIC  are common in Bacteroides bacteremia

Reference: Jawetz 25/e p 273-278; Harrison 18/e p 1079}

54.  A former from the sub-Himalayan region presents with multiple leg ulcers.  The most likely causative agent is:

a.       Trichophyton Rubrum

b.      Cladosporium species

c.       Sporothrix Schenkii

d.      Aspergillus

Answer (c)  (Sporothrix Shenkii): Ananthanarayanan 8^th 609;

Reference: Harrison 's 18^th /1664; Journal of Neglected Tropical Diseases ; vol 6.6; June 2012; 'Sporotrichosis in sub-

Himalayan India (PLOS Negl. Trop Dis. 2012 Junne 6 (6): e 1673

55.  Farmer presents with the features of high fever painful inguinal lymphodenopathy, vomiting and diarrhea and hypotension.  Which stain will help in the diagnosis

a.       Neisser stain

b.      Wayson’s stain

c.       Alberts stain

d.      McFadyean’s stain

Answer.B, Wayson’s stain

Ref. Harrison 17^th /e.p. 983

56.  Endotoxin of which gram negative bacteria have no part in pathogensis of disease

a.       E. coli

b.      Klebsiella

c.       Vibrio  cholera

d.      Pseudomonas

Answer (C)  Vibrio cholera-: Ananthnarayanan 8^th /307;

Reference; Lippincort's Microbiology 2^nd/'18; MI MS pathogenesis of Infectious Diseases

57.  Which of the following agent is not used in erectile dysfunction

a.       PGE2

b.      Vardalafil

c.       Phenylephrine

d.      Alprostadil
Answer: (c)Phenylephrine
Reference: Harrison /17^th Edition Pg.299, KDT/6^th  Edition Pg. 295-296

58.  True about Penicillin G           

a.       It can be given orally

b.      It is has broad spectrum activity

c.       Used for treatment rate bite fever

d.      Probenecid given along with PnG decrease its direction of action
Answer: (c) Used for treatment of Rate Bile fever
Reference:  Katzung 10^th Edi. Pg. 726-731: KDT 6^th Ed. Pg 694-697

59.  Cholinomimetic NOT used for

a.       Open angle Glaucoma

b.      Bradycardia

c.       Cobra bite

d.      Myasthenia gravis

Answer: (b) Bradycardia

Reference: Katzung 11 Edition, KDT 6 Edition pg. 104

60.  Side effect HAART therapy all are except

a.       Steatosis

b.      Lipodytrophy

c.       Optic neuritis

d.      Increased cholesterol

Answer: (c) Optic neuritis
Reference: Gobind Garg Pharmacology 4^th Edition  pg. 468

FSM

61.  Fracture of teeth and some injury around mouth

a.       Simple injury

b.      Grievous injury

c.       Dangerous injury        

d.      Assult

Answer (B):  Grievous Injury:

Reference:  Reddy 29^th  Edition Page 261

62.  Person had a fight with a neighbor where he assaulted him, he can be booked under ipc

a.       IPC 44

b.      IPC351

c.       IPC319

d.      IPC320

Answer.  (B)351

Reference:  Reddy 29^th Edition Page 351

44 IPC- injury definitions

319- Hurt

        320- Grievous Hurt

        351- Assault

63.  Double base smokeless gun powder contains

a.       Nitrocellulose n nitroglycerine

b.      Pot nitranate n nitro

c.       Pot nitrate n lead

d.      Nitro cellulose

Answer (a) nitrocellulose n nitroglycerine

Reference. : forensic reddy 29^th Edition 192 page

64.  Blue white colour in UV rays is seen in

a.       Semen

b.      Blood

c.       Pus

d.      Leucorrhoea

Answer: (a) Semen

Reference: Forensic Sci. Int.  Vol. 51, p.289 (1991)

Reference :  Stoilivic, M. “Detection of Semen and Blood Stains Using Polilight as a Light Source”

65.  A conceptus material (Fetus) by police has been brought of 2cm length and 10 gm weight. What is the age?      

a.       2 weeks

b.      4 weeks

c.       5 weeks

d.      6 weeks

Answer. (d) 6 weeks

Reference: Forensic Reddy Page No: 76

66.  Choking is seen in

a.       Revolver

b.      Pistol

c.       Shotgun

d.      Rifle

Answer: (c) Shotgun

Reference: Parikh Forensic 6/ep 4.33,  Reddy 29/epi 89.

ENT

67.  Laser uvulopalatoplasty done for

a.       Snoring

b.      Pharyngotonsillitis

c.       Cleft palate

d.      Stammering

Answerwer- A. Snoring

References  1. Elsevier’s ENT SECRETS page no 176 and

68.  Cochlear implant is to be done if following is intact?

a.       Outer hair cell

b.      Inner hair cell

c.       Spiral ganglion cell

d.      Auditory nerve

Answer- (d). Auditory nerve

References :

Dr Agarwal’s ENT, page no 48 . Quote from the book “for the cochlear implant to function the neural pathway has to be intact”.

69.  Third window effect  is seen in which of these

a.       Perforated tympanum

b.      Dehiscent superior semicircular canal

c.       Round window

d.      Oval window

Answer- (b) Dehiscent superior semicircular canal

Reference 1.  Glasscock-Shambaugh surgery of the ear. Page no 62.

70.  Pseudosulcus in larynx

a.       Vocal abuse

b.      Tuberculosis

c.       Larangapharangeal reflux

d.      Chronic steroid use

Answer-C. laryngopharyngeal reflex.

Reference -1. (Laryngopharyngeal Reflux): Ballenger’s Otorhinolaryngology 17^th / 886, ‘ Head and Neck Surgery Otolaryngology’ by Bailey 4^th / 833, 834.

71.  High frequency audiometry used in ?

a.       Otosclerosis

b.      Ototoxicity

c.       Otosclerosis

d.      Meniers's disease  

Answer:  (b) Ototoxicity

Reference: Audiology By Ross J. Roeser, Michael Valente, Holly Hosford-Dunn 2/ep242; Ototoxicity By Peter S. Roland, John A. Rutka p 154]

OPTHA

72.  Most common complication after lens extraction in persistent hyperplastic primary vitreous is

a.       Orbital cellulite

b.      Retinal detachment

c.       Vitreous hemorrhage

d.      Keratitis

Answer (b) Retinal detachment
Reference: nelson 18th edition/chapter 629

73.  In corneal ulcer, what is not to be given

a.       Chlorophenicol

b.      Methylcellulose

c.       Flumetasone

d.      Not recalled
Answer: (c)  Flumetasone
Reference: Corneal Ulceration and Ulcerative Keratitis in Emergency Medicine Medication/http://emedicine.medscape.com/article/798100-medication

74.  Disability certificate for poor vision if 4/60

a.       100

b.      75

c.       40

d.      30

Answer: (b 75
Ref. Guidelines for Assessment of Visual Disability, NIOH, GOI

75.  Patient was 20 year old male present with photophobia & Subnormal electrophysiological response?

a.       Stargardt disease

b.      Batten disease

c.       Cone dystrophy

d.      Chloroquine toxicity

Answer; (c) Cone dystrophy
Reference: Chapter 620 and  629 /nelson textbook of pediatrics

76.  Protozoa can affect eye

a.       E. histolytica

b.      Toxoplasmosis

c.       G. lamblia

d.      E. coli

Answer (b) Toxoplasmosis
Reference: Harrison 18th edition/chapter 214

77.  Secondary Glaucoma,Iris atrophy, Fixed dilated pupil

a.       Benedict syndrome

b.      Posner shlosman synd

c.       Fuchs Heterochromic Iridocyclitis

d.      Uveitic glaucoma

Answer (b)  Posner schlossman syndrome
Reference: Posner-Schlossman Syndrome – http//emedicine.medscape.com/article/1205949

78.  Tonometer with variation in application surface

a.       Mackey Mar tonometer

b.      Rebound tonometer

c.       Dreger’s tonometer

d.      Maklakov  tonometer

Answer (d)  Maklakov  tonometer

Reference: Page no 80 Pearls of Glaucoma Management Edited by JoAnn A. Giaconi, Simon K. Law, Anne L. Coleman, Joseph Caprioli

P.S.M

79.  Sampling schools then sections then students

a.       Stratified sampling

b.       Simple random sampling

c.       Cluster sampling

d.      Multistage sampling

Answer: (D) Multistage sampling

Reference: The Basics of Social Research by Babbie, 5^th Ed., Pg 234

80.  Transition from increased prevalence of infectious pandemic diseases to manmade disease

a.       Paradoxic transition

b.      Reversal of transition

c.       Epidemiological transition

d.      Demographic transition

Answer. (C) Epidemiological transition

Reference: Epidemiology for Public Health Practice by Friis & Sellers, 1^st Ed., Pg 58

81.  Mass chemoprophylaxis is not given for one of the following

a.       Lymphatic filariasis

b.      Plague

c.       Vit A deficiency

d.      Scabies

Answer. (D)Scabies
[Reference: Park 21/e p248, 271, 592, 722 Wikipedia. org,    www. wellsphere. com/general-medicine-article/mass-drug-prophylaxis-against-filariasis/877981]

82.  District population 10lac,with under-16 are 30%,prevalence of blindness is 0.8/1000 of under-16 population. Calculate no. of blind under-16?

a.       240

b.      2400               

c.       24000

d.      240000

Answer. (a) 240

Reference. Textbook of Preventive & Social Medicine by K Park, 21^st Ed., Pg 58

83.  True regarding tetanus except

a.       Tetanus  no use if previous unimmunized

b.      Herd immunity present           

c.       Can’t be eradicated     

d.      Elimination is less than 1 case per 1000 births

Answer. (B) herd immunity present
Reference. Textbook of Preventive & Social Medicine by K Park, 21^st Ed., Pg 284-288

84.  Current percent of Indian GDP spent on health?

a.       1.2

b.      2

c.       10

d.      15

Answer. (B) 2
Reference. Planning Commission of India, GOI

85.  BIRADS  

a.       Breast Imaging Reporting and Data System

b.      Best Imaging Reporting and Data System

c.       Brain Imaging Reporting and data system

d.      best imaging reporting and data system

Answer. (a) Breast Imaging Reporting and Data System

Reference: Primary Care for Women by Leppert & Piepert, 2^nd Ed., Pg 203

86.  Which of the following is the least likely cause of neonatal mortality in India:

a.       Prematurity

b.      Infection

c.       Birth asphyxia

d.      Congenital anomalies

Answer. (D)  Congenital anomalies
[Reference: Park SPM 21/e p521, 524 (20/e p485, 489)]

{References: http://www.censusindia.gov.inA>ital_statistics/SRS_Bulletins/MMR_release_

070711.pdf http://www. censusindia.gov. in/http://www. who. int/healthinfo/statistics/mortality_neonatal/en/index. html]

87.  Population of 5000. 500 are already myopic on January 1, 2011. no. of new myopic cases till December 31,2011 is 90.Calculate incidence

a.       0.018

b.      0.02

c.       0.05

Answer. (B) 0.02
Reference. Textbook of Preventive & Social Medicine by K Park, 21^st Ed., Pg 57

88.  Current cancer patient in India reported annually

a.       0.5 million

b.      1 million

c.       5 million

d.      10 million

Answer. (B) 1 million
Reference. Textbook of Preventive & Social Medicine by K Park, 21^st Ed., Pg 354

89.  In a certain population, there were 4050 births in the last one year. There were 50 still births. 50 infants died within 7 days whereas 150 died within the first 28 days. What is the Neontatal mortality rate?

a.       50

b.      62.5

c.       12.5

d.      49.4

Answer: (A) 50
Reference: Park SPM 20/e p486]

90.  Which is a MDG

a.       Reduce by 2/3rd,the under five mortality by year 1990-2015

b.      Half the prevalence of HIV-AIDS by 2015

c.       Reduce maternal mortality by 50%

d.      Combat PEM & Diarrhoea

Answer: (a) Reduce by 2/3rd,the under five mortality by year 1990-2015

Reference. Textbook of Preventive & Social Medicine by K Park, 21^st Ed., Pg 27, 830

91.  Trachoma screening age

a.       0- 5 years

b.      5 – 15

c.       5 -10

d.      1 to9 years                  

Answer. (d) 1 to 9 years
Reference. Trachoma Surveillance Annual Report 2008.

92.  NPCDCS

a.       Seperate centre for stroke, DM,

b.      Implementation in some 5 states over 10 district

c.       CHC has facilities for diagnosis and treatment of CVD, Diabetes

Answer. (C) CHC has facilities for diagnosis and treatment of CVD, Diabetes
Reference. NPCDCS Operational Guidelines, DGHS, GOI, Pg 6

93.  Rashtriya Suraksa Bima Yojna

a.       Applies to BPL only

b.      30000 per family member

c.       75% premium borne by family

d.      Implemented all over India

Answer. (A) Applies to BPL only

Reference . RSBY website, GOI

94.  HIV sentinel surveillance used to calculate

a.       High risk

b.      Prevalence

c.       Trend finding

d.      All of the above

Answer. (d) All of the above
Ref. Textbook of Preventive & Social Medicine by K Park, 21^st Ed., Pg 38, 398

95.  Disease with low prevalence, high incidence, true is :

a.       Highly curable / fatal

b.      Not curable/ not fatal

c.       Incidence and prevalence unrelated to each other

d.      Calculation of incidence or prevalence is incorrect

Answer. A. highly curable / fatal

[Ref. K Park, 21^st Ed., pg 58]

96.  200 population, (range 70-90) at 1 SD how many people would be included

a.       134

b.      140

c.       150

d.      190

Answer. A. 134

[Reference. K Park, 21^st Ed., pg 788]

97.  Roll back malaria all except

a.       Insecticide nets

b.      Strengthening health system

c.       Develop new insecticide

d.      Training health workers          

Answer. NONE

[Reference. WHO Roll Back Malaria Document]

98.  Highest mean lowest mode

a.       Positive skewing

b.      Negative skewing

c.       Normal           

d.      Symmetrical

Answer. a. positive skewing

[Reference. Statistics: Essentials for Research by Klugh, Pg 36]

99.  True about OPV all except

a.       We get quick immune response

b.      It is a live vaccine

c.       It is used in epidemic

d.      Maternal antibody interfere with immune response

Answer: (d) Maternal antibody interfere with immune response

Reference: Park 21th Edition Page No. 188

100.                      If the prevalence is very low as compared to the incidence for a disease. It implies

a.       Disease is very fatal and /or easily curable

b.      Disease is non fatal

c.       Calculation of prevalence and incidence is wrong

d.      Nothing can be said as they are independent
Answer: (a) disease in very fatal and /or easily curable
Reference: K Park 21 Edition pg 58

ORTHOPEDIC

101.                      Forced abduction from the lateral aspect of the knee causes a fracture. The fracture line is passing through the intercondylar eminence. Which of the following structures will most likely be injured?

a.       Medial collateral ligament

b.      Lateral collateral ligament

c.       Anterior cruciate ligament

d.      Medial meniscus

Answer – (c) Anterior curciate ligament

Reference: Campbell's Operative Orthopaedics, 11th Edition

102.       The ligaments connecting the menisci to the tibia are known as –

a.       Coronary

b.      Arcuate

c.       Transverse

d.      Oblique

Answer – (a) Coronary

Reference: Turek's Orthopaedics: Principles And Their Application , 6th edition

103.       Ankle sprain due to forced inversion of a plantar flexed foot is due to injury to –

a.       Anterior talofibular ligament

b.      Posterior talofibular ligament

c.       Calcaneofibular ligament

d.      Posterior fibres of deltoid

Answer – (a) Anterior talfibular ligament

Reference:  www.orthopaedicsplus.in

104.       Dennis stability concept is based on which of the following?

a.       2 column

b.      3 column

c.       4 column

d.      5 column

Answer – (b) 3 column

Reference:  www.jbjs.org

105.                      A young male after sudden unconsciousness, on awakening, finds that both of his arms were adducted and internally rotated. The most probable diagnosis is

a.       Anterior dislocation

b.      Posterior dislocation

c.       Greater tuberosity fracture

d.      Rotator cuff injury

Answer – (b) Posterior dislocation

Reference: Orthopaedics Clinics of North America

106.                      After a brawl, a young male presented with inability to extend his distal interphalangeal joint. An X-ray was taken and was shown to be normal. What should be the next step in managing the patient?

a.       Splint

b.      Surgery

c.       Wax bath

d.      Ignore

Answer – (a) Splint

Reference: Mallet Finger

107.       A 12-year old boy presents with a symmetric, expansile cystic lesion in the proximal humerus. All of the following can be done for his treatment except –

a.       Curettage

b.      Intralesional steroids

c.       Intralesional sclerosing agents

d.      Radiotherapy

Answer. : (d) Radiotherapy

SKIN

108.       A young man with asymptomatic macules and papule over trunk and reddish patch over palate with a flat, moist lesion on glans penis.patient has generalised lymphadenopathy. What is line of management?

a.       Ceftriax

b.      Benzathine penicillin

c.       Acyclovir

d.      Fluconazole

Answer. (b) : Benzathine penicillin
      Reference: Harrison 17e P-1038-45; CMDT-2004-1386: Fitzpatrick’s Dermatology in General Medicine 6/e p-2164-2212; Rooks Textbook of Dermatology 7/e p.30.1, 35 25.20-39]

109.       50yr old male present with bulla on body and oral mucosa. Lesion present in

a.       Intradermal

b.      Suprabasal

c.       Epidermal

d.      Sub corneal

Answer. (b) Suprabasal
Reference: Harrison’s 17/e p-336; Thomas Habif Clinical Dermatology 4/e p. 549; Fitzpatrick 7/e p. 45-47, 349, 459-84, 1714, 1878, 1892; Rooks textbook of Dermatology 8/e p. 40.3-40.64]

110.          Patient  with urticaria on sun exposure.

a.       Cholinergic urticaria

a.       Atopic reaction

b.      Photo dermatitis

c.       SolarUrticari

Answer. (A) Cholinergic Urticaria
Reference: Roxburgh’s –common Skin disease 17/ep. 71-75; pasricha-Treatment  of skin disease 4/e p. 144-150; Harrison 16/e p. 305-306; Fitzpatrick’s Dermatology in General Medicine 6/e p=1181-1203; Rooks Textbook of Dermatology 7/e p. 47.1-47.29]

ANESTHESIA

111.                      EEG monitoring done in

a.       General anesthesia

b.      Regional anaesthesia

c.       Neuro anesthesia

d.      Analgesia

Answer. (c)Neuroanaesthesia

Reference:Clinical Anaesthesiology, Morgan, 4th Ed. , Pg 144-146
Lee's Synopsis of Anaesthesia,  12th Ed. , Pg. 443-447

112.          ASA grade in hypertensive pt which is controlled

a.       2

b.      3

c.       4

d.      1

Answer. (a) : 2

Reference: Clinical Anaesthesiology, Morgan, 4th Ed. , Pg 10,  table 1-5

Lee' Synopsis. of anaesthesia, 12th. Ed. , Pg 7-8

113.          Modified allen test at

a.       Wrist

b.      Arm

c.       Elbow

d.      Forearm

Answer. (a). wrist
Reference : Clinical Anaesthesiology, Morgan, 4th Ed. , Pg 123-124

114.       MOST POTENT analgesic agent among following

a.       Nitrous oxide

b.      Nitric oxide

c.       Co2

d.      Oxygen

Answer. (a) Nitrous oxide

Reference : Clinical anaesthesia , Barash, 5th Ed. , Pg 396-397

115.       Dose of which neuromuscular blocking agent  in a obese female requires calculation of actual body wt is required instead of average body weight

a.       atracuronium

b.      vecuronium

c.       pancuronium

d.      rocurium

Answer: None…… The correct answer should be succinyl choline, the only neuromuscular blocking agent which is dosed by the total body weight rather than the ideal body weight
Reference: Clinical Anaesthesiology, Morgan,  4th Ed. , Pg 814-815

116.       A Child is intubated for craniotomy. During surgery after 2 min, bellows of anaesthetic machine collapses. Next step?

a.       ventilate manually

b.      continue the operation

c.       use bigger size tube

d.      Increase flow

Answer. (a) Ventilate manually
Reference: Anaesthesia Faculty / Senior Resident Trauma Unit AIIMS

117.                      A infant present with respiratory distress, was intubated. The fastest and accurate method to confirm intubation

a.       Capnography

b.      Clinically by auscultation

c.       Chest readiography

d.      Airway pressure measurement

Answer: Capnography
Reference: Morgan 4^th Edition pg. 590-93

RADIO

118.                      True about MRCP all are except

a.       Entire biliary tree and pancreatic duct are seen in single MRCP

b.      T₂ weighted images are used for bile & pancreatic secretions in biliary tree

c.       MRCP has less spatial resolution than ERCP

d.      Gadolinium based contrast is not used

Answer (a) Entire biliary tree and pancreatic duct are seen in single MRCP

Reference: Cancer Imaging volume 2 by M.A. Hayat

119.                      Ionizing radiation affects which stage of cell cycle

e.       G2 S

f.       G1 G2

g.       G2 M

h.      G0 G1

Answer: C, G2M

Reference: Harrison 17^th Page 516.

PSYCHIATRY

120.                      14 year old boy is not able to get good grades on 9th standard exam. But he is very sharp and intelligent. Best test to diagnose his problem?

a.       Child behaviour checklist

b.      Bhatia's battery

c.       Specific learning disability test

d.      Child behaviour battery

Answer. (c) Specific learning disability test

Reference: Kaplan & Sadock’s Comprehensive Textbook of Psychiatry 09^th Edition page 3495-3499

121.                      In insomnia patient sleep most acurately recorded by

a.       Barogragph

b.      Kymograph

c.       Actigraphy

d.      Plethysmography

            Answer: (C) Actigraphy

                Reference: Taber’s Cyclopedic Medical Dictionary 21 Edition page 36

122.                      Male started alcohol at 20 years, presently taking 3 quarters daily over 30 years, now complains that he gets the kick in 1 quarter, diagnosis

a.       Withdrawl

b.      Mallenby phenomenon

c.       Reverse tolerance

d.      Cross tolerance

  Answer. (c) reverse tolerance
Reference: Kaplan & Sadock’s Comprehensive Textbook of Psychiatry 09^th Edition page 1271

123.                      Knowledge of own disease/illness in Mental status examination

a.       Insight

b.      Orientation

c.       Judgement

d.      Rapport

Answer. (a) Insight
Reference: Kaplan & Sadock’s Comprehensive Textbook of Psychiatry 09^th Edition page 897

124.                      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

            Answer. (a) operant conditioning

  Reference: Kaplan & Sadock’s Comprehensive Textbook of Psychiatry 09^th Edition page 2791-92

125.                      All are true regarding Fronto temporal dementia except

a.       Stereotypic movement

b.      Loss of insight

c.       Less than 65 years

d.      Changes in mood

Answer. (a) Stereotypic movement
Reference: Kaplan & Sadock’s Comprehensive Textbook of Psychiatry 09^th Edition page 1194-98

126.                      Cognitive decline in old age due to

a.       Homocysteine

b.      Methionine

c.       Cysteine

d.      Taurine

Answer. (A)  Homocysteine
[Reference: Harrison 16/e P. 1430, 1432]

127.                      A Young man is with known heroin addiction is brought in the emergency in unconscious state. On examination his pupil are pin point. What will be the treatment of choice?

a.       Oral natrexone

b.      IV naloxone

c.       Oral diazepam

d.      Oral Buprenorphine                                                                                                        

Answer. (b)IV naloxone
Reference: Kaplan & Sadock’s Comprehensive Textbook of Psychiatry 09^th Edition page 1375-76 & 1384

OBS/GYNAE

128.                      Treatment of Ca Cervix IIIB include

a.       Wertheims hysterectomy

b.      Schuata’s hysterectomy

c.       Chemotherapy

d.      Concurrent Chemoradiation

Answer. (d) Concurrent Chemoradiation

Reference: William’s Gynae p. 657, 658, 659

129.                      A female present with 8 week amenorrohea with pain left lower adbomen. On USG thick endometrium  with mass in lateral adenexea diagnosis?

a.       Ectopic pregnancy

b.      T orsion of dermoid cyst        

c.       Tubo ovarian mass

d.      Hydrosalpinx

Answer. (A) ectopic pregnancy

Reference. Shaw 13/e, p 267

130.                      In a study it is observed that the right ovary ovulates more than the left, all are possible explanation for the cause except

a.       Anatomical asymmetry

b.      Difference in blood supply to both sides

c.       Right handedness is more common in population

d.      Some embryological basis

Answer. (C) Right handedness is more common in population

         Reference:  humrep.oxofordjournal.org/content/12/8/1730.full.pdf]

131.                      Patient came with vaginal discharge on exam no cervical discharge empirical protocol treament package is

a.       Metro + fluconazole

b.      Metro+doxycycline

c.       Metro + tetracycline

d.      Metro+azithromycin

Answer. (a) metro + fluconazole

Reference.  Shaw 13/e, p 125,127, 129

132.                      Leiomyoma of uterus, least likely change to occur

a.       Red degeneration

b.      Sarcomatous change

c.       Fatty generation

d.      Hyaline generation

Answer. (B) Sarcomatous change

Reference. Shaw 13/e , p 341

133.                      Which of the following is seen during heart disease in pregnancy and not during normal pregnancy

a.       Pedal edema

b.      Engorged neck veins

c.       Dyspnea

d.      Hypotension

Answer. (b) Engorged neck veins
Reference. Williams Obs. 22/e, p 1019

134.                      36 week a female present with amenorhea with blurred vision and headache admission,mx of bp with antihypertensives and delivery at term

a.       Admit & give antiHTN ,mgso4 and terminate

b.      Admit & give antiHTN ,mgso4 and Observation

c.       Only admit & watch pt.

d.      Give antihtn and send home

Answer. (A ) Admitt, give MgSO4, antihypertentensive, and  terminate the pregnancy

135.                      Test not useful in case of tubal pregnancy

a.       Pelvic examination

b.      Usg

c.       Hcg levels

d.      Hysterosalpingography

Answer. (D) Hysterosalpingography

Reference. Dutta Obs. 6/e, p 186

136.                      A 19 year old patient came to the out patient department with complaints of Primary Amenorrhea.  She had well develope3d breast and pubic hair. However there was abse3nce of vagina and uterus.  Likely diagnosis is

a.       XYY

b.      Mullerian agenesis

c.       Gonadal dysgenesis

d.      Kleinfelter’s syndrome

Answer. Is ‘b’ i.e., Mullerian agenesis

[Reference; Shaws text book of Gynaecology 14/e p. 252; Novak’s Gynaecology 14/e p. 1004]

137.                      At 34 weeks multigravida with previous 2 normal delivery now have unstable lie due to

a.       Oligohydramnios

b.      Placenta previa

c.       Pelvic tumor

d.      Uterine anomalies

Answer.(b) Placenta previa

Oligohydraminos does’nt present with unstable lie

Reference.  Dutta Obs 6/e, p 244

138.                      Trial of normal labour is contraindicated

a.       History of previous classical CS

b.      History of previous CS due to CPD

c.       No history of prior vaginal delivery

d.      History of previous CS due to malpresentation

Answer. (b) History of previous classical caesarean section

Reference. Williams Obs. 21/e, p 542- 543

139.                      Female with infertility dysparenuia cyclic pain, investigations?

a.       TVS

b.      Diagnostic laproscopy

c.       HSG

d.      CT/ MRI

Answer. (b) diagnostic laparoscopy

Reference. Berek and Novak’

140.                      Beyond which critical value Shock Index [Heart rate/BP] in pregnancy is considered abnormal?

a.       0.9-1.1

b.      0.5 0-.7

c.       0.3-0.5

d.      0.7-0.9

Answer.(A) 0.9-1.1

Reference: http://emedicine.medscape.com/article/168402-differential:

141.                      All are true except

a.       Retinal hemorrhage intra cranial hemorrhage and subgaleal hemorrhage are more common in venthouse  delivery than forceps

b.      Vaccum needs more skill than forceps delivery

c.       Cephal-hematoma is more common with vaccum extraction 

d.      Less maternal trauma by vaccum as compared with forceps
Answer: (b) Vaccum needs more skill than forceps delivery
Reference: William 22^nd Edition Pg. 549

GENERAL MEDICINE

142.                      A patient on amphotericin B develops hypokalemia of 2.3meq/l. K+ supplementation requires is?

a.       40meq over 24 hrs

b.      60meq over 24 he's

c.       80 meq over 24 hrs

d.      120-160meq over 24 hrs

Answer (A) 40meq over 24 hrs

Reference: Harrison 18^th edition, chapter 46

143.                      A patient with 12cm abscess in liver which was drained under sonographic monitoring 3 times and On follow up a residual cavity of 4cm was found to be present .An oral lumicidal drug was given for 14 days. Next plan of action shall be:           

a.       Stool examination serially

b.      USG weekly for 1 month followed by monthly USG till 1 year.

c.       USG weekly for 1 month followed by CT scan at 3 months.

d.      Monthly CT scan

Answer (b) USG weekly for 1 month followed by monthly USG till 1 year.

Reference: Harrison 18 th edition chapter 202

144.                      Which of the following is Not true aboutpolymyositis ?

a.       Limb girdle weakness

b.      Ophthalmoplegia

c.       Para-neoplastic syndrome

d.      Spontaneous discharge in EMG.

Answer (B) Ophthalmoplegia

Reference: Harrison 18^th chapter 383

145.                      35 year old female with recurrent renal stone. not advised is:

a.       Increase water 

b.      Restrict protein

c.       Restrict salt

d.      Ophthalmoplegia

Answer (D) Ophthalmoplegia

Reference: Harrison 18^th edition/ chapter 281/page 1817/ Reference: www. Uptodate.com/contents/prevention of recurrent calcium stones in adults, Campbell’s urology chapter 43

146.                      A 28 yr old man has lenticonus and ESRD now. His maternal uncle also died of similar illness. Diagnosis is

a.       ARPKD          

b.      ADPKD

c.       Oxalosis

d.      Alport's syndrome

Answer: (D) Alport’s syndrome

Reference: Harrison 18^th Chapter 357

147.                      Pinna calcification Except

a.       Gout

b.      Onchrnosis

c.       Frost bite

d.      Addisons disease

Answer (a) Gout
Reference :Chapter 54. Skin Manifestations of Internal Disease, Harrison 18^th (www.nejm.org/doi/full/10.1056/NEJMicm1000193)

148.                      Which of the following doesnot need treatment?

a.       Neuroblastoma

b.      Burkitts

c.       t cell lymphoblastic leukemia

d.      Not Recalled

Answer is A

Reference: Nelson 18^th text book of pediatrics/chapter 498

149.                      With ageing, a slight decrease in cognitive impairment is seen due to increase in level of

a.       Homocysteine

b.      Taurine

c.       Methionine

d.      Cysteine

Answer (a) Homocysteine

Reference: CMDT 2012 / page 1620

150.                      A Patient presents with pain in Meta-Tarso-Phalangeal jointsM.T.P.andis a known case of Chronic Renal Failure. This is due to accumulation of-

a.       Rh factor

b.      Uric acid

c.       Serum urea

d.      HLA B27 typing

Answer (b) Uric Acid

Reference: Harrison 18^th edition/table 280.4/ chapter280 and http://www.ncbi.nlm.nih.gov/pubmed/21321568

151.                      SARS causative agent

a.       Corona-virus

b.      Picorna-virus

c.       Myxovirus

d.      Recalled

Answer: (a) Corona-virus

Reference  :Harrison 18^th edition-chapter 179

152.                      Blink reflex is used for?

a.       Mid pontine lesions

b.      Neuromuscular transmission

c.       Axonal neuropathy

d.      Motor neuron disease

Answer (a) Mid pontine lesions
Reference: http://www.ncbi.nlm.nih.gov/pubmed/17727783/ Clinical value of blink reflex

153.                      Grisel syndrome all are true except:

a.       Post-adeniodectomy

b.      Conservation treatment

c.       Inflammation of cervical spine ligaments

d.      No need for neurosurgeon

Answer (d) No need for neurosurgeon

Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2639892/

154.                      Cervical syringomyelia all are seen except

a.       Burning sensation in hands

b.      Hypertrophy of abductor pollicisbrevis

c.       Plantar extensor

d.      Absent biceps reflex.

Answer: (b) Hypertrophy of abductor pollicisbrevis
Reference: Harrison textbook of medicine 18 th edition chapter 377/ above figure 377-7http://emedicine.medscape.com/article/1151685-clinical

155.                      70year female is on treatment with Alendronate for severe osteoporosis.Now she complains of pain in right thigh. What is the next investigation to be performed?

a.       DEXA scan

b.      x ray

c.       Serum vitamin D levels

d.      Serum alkaline phosphate levels

Answer (b) X-ray

Reference: CMDT 2012/page 1118

156.                      A 70 year old retired Military person with good previous medical record complains of bi-temporal headache which is decreased in lying down position. He states that he gets relief by giving pressure over bilateral temples. The patient also complains of loss of appetite with feeling feverish.

a.       Chronic tension headache

b.      Temporal arteritis

c.       Migraine

d.      Fibromyalgia

Answer (b) Temporal arteritis

Reference: CMDT 2011 page 819 and http://emedicine.medscape.com/article/809492-clinical#a0216

157.                      A patient of rheumatoid arthritis develops sudden onset Quadriparesis, , increased muscle tone of limbs with exaggerated tendon jerks and worseningof  gait. The investigation to be done:

a.       Flexion and extension Cervical area X ray of neck

b.      MRI brain

c.       EMG and NCV

d.      Carotid angiography

Answer( a) Flexion and extension Cervical area X ray of neck

Reference:Harrison chapter 15/18 th edition

158.                      Patient with ICD collapses, ICD imaging modality

a.       Chest x ray

b.      MRI

c.       CT

d.      USG

Answer (a) Chest X ray

Reference: Harrison: 18 th edition/ just above table 233-9/ chapter 233./Emedicine:http://emedicine.medscape.com/article/162245-overview#aw2aab6c12

159.                      Type 1 renal tubular acidosis all are trueExcept?

a.       Renal stones

b.      Hypokalemia

c.       > 4mg/ day Sodium bicarbonate         

d.      Urine pH > 5.

Answer (c) > 4mg/ day Sodium bicarbonate

Reference: Harrison 18^th edition 284/ CMDT 2011 page 862

160.                      A diabetes mellitus patient with fungal infection of sinuses and peri-orbital region with significant visual impairment:

a.       Amphotericin B

b.      Itraconazole

c.       Ketoconazole

d.      Broad spectrum antibiotics

Answer: Amphotericin B

Reference: Harrison 18^th  Edition/ Chapter 205

161.                      Gait apraxia?

a.       ACA

b.      MCA

c.       PCA

d.      Posterior choroidal artery

Answer: (a) Amphotericin B

Reference: chapter 24 Harrison18th : Gait and balance disorders

162.                      Prions, which of following is correct

a.       Long incubation period

b.      Destroyed by autoclaving at 121C

c.       Nucleic acid present

d.      Immunogenic

Answer (a) Long incubation period

Reference: The following lines are excerpt from Harrison 18^th chapter 383:

163.                      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. Which of the following investigations is not required on emergency evaluation?

a.       MRI

b.      NCCT 

c.       CSF examination

d.      Liver function tests

Answer (c) CSF examination

References: included in the text

Therefore the following logical conclusion can be:

ALTERED SENSORIUM due to Hepatic encephalopathy secondary to hepatotoxicity of ATT.  Hence LFT should be performed.

ALTEREDED SENSORIUM due to Obstructive hydrocephalus could lead to raised ICT leading to pressure on midbrain and resultant status.  Therefore a MRI scan can identify the process and necessitate a neurosurgical consult.

(Page 540 of OP GHAI 7th edition) ALTERED SENSORIUM due to end-arteritis resulting in brain infarction and hypo-dense lesions.  Tubercular encephalopathy results in diffuse edema of brain simulating post-infective allergic encephalopathy,   Necrotizing or hemorrhagic leuko-encephalopathy may occur in TB meningitis.. In choice NCCT is given and it can identify infarction as well cerebral Edema.

The que3stion mentions altered sensorium in the patient and if we see the table in (Fig 376-1 harry boy 17^th edition Harrison) on altered sensorium, imaging should be performed.  Lumbar puncture now can precipitate the ominous herniation of the brain.

164.                      What is feature of temporal arteritis

a.       Giant cell arteritis

b.      Granulomatous vasculitis

c.       Necrotizing vasculitis

d.      Leucocytoclasticvasculitis

Answer (a) Giant cell arteritis
Reference: Harrison: 18^th edition/ chapter 326

165.                      A patient withHepatits C, exhibits hypo-complimentemia, 2g/day proteinuria andhematuria is present. The most probable diagnosis is: REPEAT

a.       M.P.G.N.        

b.      Cryo-globulinemia

c.       Membranous Glomerulopathy

d.      Post-infectious Glomerulonephritis

Answer (a) M.P.G.N.

Reference: Chapter 326/ Harrison 18^th edition/http://emedicine.medscape.com/article/329255-clinical/CMDT 2012 pg 899.

166.                      All are indicated in a patient increased s. cysteine and multiple renal stones except:

a.       Cysteamine or

b.      Increase fluid intake

c.       Alkalinisation of urine

d.      Pencillamine

Answer: (a) Cysteamine or

Reference: CMDT 2012/ page 923/chapter 287 harrison 18^th edition

SURGERY

167.                      Not a Causes of acute anal pain:

a.       Thrombosed hemorrhoids

b.      Acute anal fissure

c.       Fistula in ano

d.      Perianal abccess

Answer : (c) Fistula in ano

Reference: Harrison 18^th edition/chapter 297, Bailey and love 26^th edition,page 1263

168.                      70 yr old man with prostate cancer was given radiotherapy. The recurrence of the cancer is monitored biochemically by

a.       Androgens only

b.      Prostate specific antigen and carcino-embryonic antigen

c.       Prostate specific antigen only

d.      ALP and CEA

Answer: (b) Prostate specific antigen and carcino-embryonic antigen

Reference: NICE clinical guideline 58 – Prostate cancer (http://www.nice.org.uk/nicemedia/pdf/CG58NICEGuideline.pdf) and http://emedicine.medscape.com/article/1967731-treatment#a1156

169.                      A   patient has a surgical cause of obstructive jaundice. USG can tell all of the following except

a.        Level of obstruction

b.      Peritioneal deposits

c.       Gall bladder stones

d.      Ascites

ANSWER (b) Peritioneal deposits

Reference:

A.     Sutton Textbook of Radiology Volume 1 page 716 & 717

B.     Biliary Obstruction Workup Imaging :guidelines/http://emedicine.medscape.com/article/187001-workup#a0720

C.     Harrison 18^th edition chapter 311/ table 311.3

Sutton says - In presence of biliary obstruction ultrasound is reported to define level in 95% and cause upto 88% of patients

170.                      Organism associated with fish consumption and also cause carcinoma gallbladder

a.       Clonorchis sinensis

b.      Gnathisomia               

c.       Anglostronglyoidosis cantonensis

d.      H. dimunata

Answer. (a) Clonorchis sinensis
[Reference: Harrison 17/e p1330; http//www.ncbi.nlm.nih.gov/pubmed/12483392
http://www.ncbi.nlm.nih.gov/pubmed/3993073]

171.                      Rupture of urethra above the deep perineal pouch causes urine retention in which region?

a.       Medial aspect of thigh

b.      Scrotum

c.       True pelvis only

d.      Anterior abdominal wall

Answer: (c) True pelvis only

Reference: Smith Urology page 910

172.                      Ileal resection for intusussception in adults would be done in?

a.       Carcinoid Tumor

b.      Lymphoma

c.       Villous adenoma

d.      Soft tissue

Answer: C, Villous adenoma

Reference: Chapter 91 Harrison 18^th Edition

Intussusception of the bowel in adults: A review World J Gastroenterol. 2009 January 28; 15(4): 407–411

Pediatric Intussusception Surgery/http://emedicine.medscape.com/article/937730-overview#a0102

173.                      All are true about intestinal obstruction radio-graphically except

a.       On lying supine fluid air gap absence does not signify obstruction

b.      Volvulus shows a characteristic appearance on radiograph

c.       Small intestine dilation> 3 cm

d.      Distal  large intestine >9 cm  and proximal  intestine>3 cm

Answer (d) Distal  large intestine >9 cm  and proximal  intestine>3 cm

Reference: Oxford textbook of surgery Reference: Swartz’s 9e

174.                      Buerger disease  all except are true

a.       Ulnar artery and peroneal arteries involved

b.      Neural involvement present

c.       small acral vessels of limb involved

d.      Phlebitis migrans

Answer (c) Small Acral vessels of limb small acral vessels of involvement causes hypohidrosis

Reference:  CMDT 2012 page 458

Vascular Disease: Diagnostic and Therapeutic Approaches By Michael R. Jaff

Robbins textbook page 517 8^th Edition

175.                      Next Investigation to be done for painful breast lump in a lactating woman

a.       Mammography

b.      USG

c.       MRI

d.      X

Answer (b) USG

Reference: Breast Ultrasonography/http://emedicine.medscape.com/article/1948269-overview

176.                      Which of the following is not associated with elevation Right hemi-diaphragam:

a.       Amebic abscess

b.      Pyogenic abscess

c.       Cholecystitis

d.      Subdiaphragmatic  abscess

 Answer. (c) Cholecystis

Reference: Green filed surgery page No: 910& 911 

177.                      Not true of hernia is :

a.       Conservative managment        

b.      In Child hernia treatment with herniotomy

c.       Aborshable mesh not used

d.      Long standing hernia increases changes of incarceration

Answer: D long standing hernia increases chances of incarceration

Reference: chapter 343 ,Nelson textbook of Pediatrics 18^th edition

178.                      Stereotactic radiotherapy is used for treatment of   ?

a.       Brain tumor

b.      Lungs carcinoma

c.       Cervix cancer

a.       Renal carcinoma

Answer. (a>b)
Reference: Neurology tumors of the brain and spine – M.D. Anderson cancer care series Page 136 Radiation Oncology for Tumors of the Central Nervous System

Reference:

http://www.cancerresearchuk.org/cancer-help/type/brain-tumour/treatment/radiotherapy/stereotactic-radiotherapy-for-brain-tumours

Reference:http://www.rtanswers.com/treatmentinformation/treatmenttypes/stereotacticradiation.aspx

Stereotactic Radiation Therapy

Reference:

http://www.radiologyinfo.org/en/info.cfm?pg=stereotactic

179.                      Patient presents with varicose vein with sapheno-femoral incompetence and normal perforator  management :

a.       endovascular striping

b.      Sclero-theraphy

c.       Sapheno-femoral flush ligation

d.       saphenofemoral flush ligation with striping

Answer: (d) saphenofemoral flush ligation with striping
Reference: Bailey& Love, Short practice of Surgery, 25^th Edition ,page No: 930,

Sabiston textbook of surgery 18^th Edition Chapter Primary Venus        Insufficiency /below figure 68.6

PEDIATRICS

180.                      A neurosurgeon in parent teacher meeting saw a child with precocious puberty and  uncontrollable laughing. He suggested the parent of child to get a MRI done to evaluate for the possibility of

a.       Hypothalamic Hamartoma

b.      Pineo-germinoma

c.       Pituitary adenoa

d.      Craniophangioma

                        Answer: A  HYPOTHALAMIC HAMARTOMA

Reference: 563. 2 Precocious Puberty Resulting from Organic Brain Lesions

181.                      A child presented to the casualty with seizures. On examination an oval hypo-pigmented macules were noted  on the trunk, along with sub-normal IQ. Probable diagnosis of the child is:

a.       Neurofibromatosis

b.      Sturge Weber

c.       Tuberous sclerosis

d.      IncontinentiaPigmenti

                        Answer (c) : TUBEROUS SCLEROSIS

PAGE NO. 564 OPG

182.                      At what age child can eat food without spilling, identify her gender, say her full name, can dress self with supervision

a.       2 yrs

b.      3 yrs

c.       4 yrs

d.      5 yrs

Answer (b) : AGE 3 YEARS

PAGE NO. 31/ OPG 7^th edition

183.                      A Pre-termer 32 weeks baby after birth had a respiratory rate of 86/min with presence of grunting. On examination there was no nasal flaring, mild chest in-drawing, noxiphisternal recession and abdomen lags behind the chest .Thesilverman scoring for the neonate shall be

a.       3

b.      4

c.       5

d.      6

Answer (b) : 4

Reference: Maternity and Pediatric Nursing By Susan Scott Ricci, Terri Kyle, P. 729-30;Silverman WC, Anderson DH. Controlled clinical trial on effects of water mist on obsrtructive respiratory signs, death rate and necropsy findings among premature infants. Pediatrics 1956; 17:1-4; OP Ghai. 7/e, p 143]

184.                      In a child with rickets with deformity, when should a decision to undertake corrective surgery be undertaken :

a.       When vitamin D levels turn to normal

b.      When growth plate healing is seen radio-graphically

c.       When bone specific alkaline phosphatise is normal

d.      When serum calcium becomes normal

Answer  (b) When growth plate healing is seen radio-graphically
Reference: Kliegman: Nelson Textbook of PEDIATRICS//Chapter 48 – Rickets and Hypervitaminosis D /Larry A. Greenbaum/ http://emedicine.medscape.com/article/985510-treatment

185.                      Reversal of shunt not possible in natural history?

a.       ASD

b.      VSD

c.       TOF

d.      PDA

Answer( c) TOF

Reference: TOF:  PAGE NO 408. OP ghai :

186.                      A preterm infant with poor respiration at birth starts throwing seizures at 10 hours after birth. Anti- epileptic of choice shall be:

a.       Levetiracetam

b.      Phenytoin

c.       Phenobarbitone

d.      Lorazepam

Answer : (c)Phenobarbitone

Reference: PAGE NO. 527. OPG/593.7 NELSON Neonatal seizures

187.                      Correct about respiratory distress syndrome is:

a.       Seen after 6 hours of birth

b.      Ante natal steroid

c.       Term pregnancy

d.      Air bronchograms seen on x-ray chest

Answer (d) Air bronchograms seen on x-ray chest

Reference: PAGE NO. 143/OP GHAI

188.                      7 year old girl is  easily distracted in class and exhibits poor scholastic performance. Seizures are precipitated by hyperventilation.

a.       Myoclonic seizures

b.      Absence seizures

c.       Atonic seizures

d.      Myoclonia

Answer: (b) Absence seizures

Reference: NELSON 593.4

189.                      Best screening test to evaluate hearing in a neonate

a.       Pure Tone Audiometry

b.      Stapedial  Reflex

c.       Oto –acoustic Emissions

d.      Brain stem evoked auditory response

Answer: (c) Oto –acoustic Emissions
Reference: Nelson chapter 636 /HEARING  SCREENING.

190.                      One of the parents has a balanced translocation between chromosome 15 and 21. What advice will u provide to the couple to prevent a child being born with Down syndrome?

a.       Prenatal diagnosis &  advice abortion

b.      Artificial insemination with donor's sperm

c.       Adoption

d.      Does not matter

Answer (c) Adoption

References included in text

·         Nelson says - Translocation (21;21) carriers have a 100% recurrence risk for a chromosomally abnormal child.

·         Carriers of Robertsonian translocations involving chromosome 21 have a higher chance of having a child with Down syndrome. This is known as a 'translocation Downs'. This is due to a mis-segregation (Non-disjunction) during gametogenesis. The mother has a higher (10%) risk of transmission than the father (1%). Robertsonian translocations involving chromosome 14 also carry a slight risk of uniparental disomy 14 due to trisomy rescue

·         If the mother is a 'balanced translocation' carrier to another chromosome (usually 13, 14, 15, 22), then the recurrence risk is about 1 in 8.

191.                      Trisomy 13 , all of the following are true statement except:

a.       Bilateral mircopthalmia

b.      Neurofibroma

c.       Capillary hemangioma

d.      Dermoid cyst

Answer: (a) Bilateral mircopthalmia

Reference:PAGE NO 615 , OP GHAI

192.                      Which of the following is true for Wilson disease?

a.       High ceruloplasmin

b.      Low serum and high urinary copper

c.       Low serum copper

d.      Low urinary copper

Answer is : B>C

Reference: Harrison 18^th edition: chapter 360/OPG PAGE NO. 641 /354.2 Nelson

193.                      A child with low blood glucose is not able to do glycogenolysis or gluconeogenesis. Which of the following enzyme is missing in the child?

a.       Fructokinase

b.      Glucokinase

c.       Glucose 6 phosphastase

d.      Transketolase

Answer (c) Glucose 6 phosphastase

Reference: OP GHAI Page no 636. /7^th edition

194.                      Which of the following does not require a lumbar puncture in children?

a.       ALL

b.      HL

c.       NHL

d.      AML

Answer (b) :Hodgkins lymphoma

Reference : 495.2   NELSON Acute leukemia/496.2 NELSON- NHL

195.                      Bilateral proptosis is seen in

a.       Neurofibromatosis

b.      Leukemia

c.       Cavernous hemangioma

d.      Malignant fibrous Histiocytoma

Answer: (b), Leukemia

Reference:NELSON CHAPTER 632/TUMORS OF THE ORBIT.

196.                      A child with fever and tibial swelling exhibits on X-ray periosteal reaction and raised ESR .What is the next step in diagnosis of the patient?

a.       MRI

b.      Pus culture

c.       Bone biopsy

d.      Blood culture

Answer: (a) MRI

Reference: CMDT 2012 page no 839/nelson chapter 683/Harrison chapter 126

197.                      A child presents with seborrheic dermatitis, sinusitis and chronically draining ears. On examination child has failure to thrive with hepato-splenomegaly and exophthalmos. Probable diagnosis is

a.       Histiocytosis-X

b.      Wegenersgranulomatosis

c.       x

d.      Chediakhigashi syndrome

Answer (a) Histiocytosis-X

Reference: Page no. 595/ OP GHAI

198.                      Most common cause of sepsis in neonates in developing countries:

a.       E.coli

b.      Staph. Albus

c.       Pseudomonas

d.      Group B streptococcus

Answer: (a) E.coli

Reference no1: Report of the National Neonatal Perinatal Database (National Neonatology Forum), 2002-2003

Reference2: journal of clinical neonatology.http://www.jcnonweb.com/article.asp?issn=22494847/yr2012

Reference no 3http://www.ncbi.nlm.nih.gov/pubmed/22455256/2010 Oct-Dec; 22(4):33-6.

199.                      A preterm baby with Patent ductus arteriosus all are true Except:

a.       Narrow pulse pressure

b.      Necrotizing enterocolitis

c.       Continuous murmur

d.      Congestive heart failure

Answer (a) : Narrow pulse pressure

Reference:  Nelson textbook of pediaatrics 18^th edition/chapter 426 and 102.2

200.                      A 6yrs old child belonging to Punjabi family with past history of blood transfusions presented with Hemoglobin – 3.5 g/dl, MCV – 30 fl,MCHC – x (not recalled/controversy)

Peripheral Smear findings of  Microcytic Hypochromic anemia with target cell and reduced osmotic fragility. The probable diagnosis of patient:

a.       Alpha thalassemia

b.      Beta thalassemia

c.       Sickle cell anemia

d.      G6PD deficiency

Answer. (b)  – Beta Thalassemia

Reference: nelson 18^th chapter 462

Reference: Mutational spectrum of thalassemias in India/Inusha Panigrahi, RK Marwaha//Division of Genetics, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India